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Volume XIX, Number I, 2012


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CONTENTS Volume XIX , Number I, 2012 EDITORIAL TEAM Alfred Naaman, Nada Naaman, Jihad Fakhoury, Dona Raad, Antoine Saadé, Lina Chamseddine, Tarek Kotob, Mohammed Rifai, Bilal Koleilat, Leila Roumani, Mohammad H. Al-Jammaz COORDINATOR Vanessa Abdelahad ART DEPARTMENT Krystel Kouyoumdjis SUBSCRIPTION Micheline Assaf, Nariman Nehmeh ADVERTISING Josiane Younes PHOTOGRAPHY Albert Saykali TRANSLATION Gisèle Wakim, Marielle Khoury DIRECTOR Tony Dib ISSN 1026-261X

13 18

Marketing the Dental Practice on Facebook Dr. Edward Zuckerberg Tooth Surface Loss due to Dental Erosion A clinical Approach Dr Hadeel Al-Ateeqi

DENTAL NEWS – Sami Solh Ave., G. Younis Bldg. POB: 116-5515 Beirut, Lebanon. Tel: 961-3-30 30 48 Fax: 961-1-38 46 57 Email: Website:


Pr. M.A. Bassiouny BDS, DMD, MSc, Ph.D. Director International Program, Temple University, Philadelphia, USA. Pr. N.F. Bissada D.D.S., M.S.D Professor and Chairman, Department of Periodontics, Case Western Reserve University, USA. Pr. Jean-Louis Brouillet D.C.D, D.S.O. Chairman, Department of Restorative Dentistry, Aix-Marseille II, France. Pierre Colon D.C.D., D.S.O. Maître de conférence des universités, Paris, France. <j&B]Yf%;dYm\]>jYfimaf$<aj][l]mj\]dMfal­\]J][`]j[`]=J)).$EYjk]add]$>jYf[]& Pr. Gilles Koubi D.C.D., D.S.O. Department of Restorative Dentistry, Aix-Marseille II, France. Hj&?ma\g?gjY[[a&Mfan]jkalqD9K9HA=FR9$K[`ggdg^E]\a[af]<]flakljq$JgeY$AlYdaY& :jaYfB&EaddYj:<K$H`&<&?mqk$Caf_k$Yf\Kl&L`geYk;gdd]_]K[`ggdg^E]\][af]<]flakljq$Dgf\gf$ UK. Pr. Dr. Klaus Ott, Director of the Clinics of Westfälischen Wilhelms-University, Münster, Germany. Oad`]de%Bgk]h`H]jlgl<=9$EY³lj]\][gf^­j]f[]$9ap%EYjk]add]AA$>jYf[]& Pr. Dr. Alfred Renk, Bayerische Julius-Maximilians-University, Würzburg, Germany. <j&H`adahh]Jg[`]%Hg__a<=9&EY³lj]\][gf^­j]f[]\]kmfan]jkal­k$9ap%EYjk]add]AA$>jYf[]& Ea[`]dKapgm<&;&<&$<&=&9&<]hYjle]flg^Hjag\gflgdg_q$Lgmdgmk]$>jYf[]& Pr. M. Sharawy B.D.S., Ph.D. Professor and Director, Department of Oral biology, Medical College of Georgia, Augusta, Georgia, USA.

25 30 34 40 44

Using the 3D Shade System in Color Matching Comparison Dr. Wael Abdulla, Dr. Waleed AlYaseen Diode Lasers: The Soft Tissue Handpiece Dr. Fay Goldstep, Dr. George Freedman ICD mission and achievements Dr. Cedric Haddad AEEDC 2012 CONTENTS


Treatment of “White Spot Lesions” after Removal of Fixed Orthodontic Appliances Dr. Derek Mahony


DENTAL NEWS IS A QUARTERLY MAGAZINE DISTRIBUTED MAINLY IN THE MIDDLE EAST & NORTH AFRICA IN COLLABORATION WITH THE COUNCIL OF DENTAL SOCIETIES FOR THE GCC. Statements and opinions expressed in the articles and communications herein are those of the author(s) and not necessarily those of the Editor(s) or publisher. No part of this magazine may be reproduced in any form, either electronic or mechanical, without the express written permission of the publisher.

An Unusual large Submandibular Gland Calculus Dr. Moutaz Al Khen, Dr. Bader Abdeen

58 66 twitter: @dentalnews


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INTERNATIONAL CALENDAR May 3 - 4, 2012 6th CAD/CAM & Computerized Dentistry International Conference at The Address Hotel Dubai Marina, Dubai, UAE Email: Website:

October 6 - 7, 2012 7th CAD/CAM & Computerized Dentistry International Conference at The Marina Bay Sands Hotel, Singapore Email: Website:

May 9 - 11, 2012 STARS MEETING 2012 Organized by Alexandria Oral Implantology Association (AOIA) Email: Website:

October 11 - 13, 2012 The European Association for Osseointegration will meet in Copenhagen, Denmark - 11 to 13 October 2012 . 20 years, what have we learned? Email: Website:

May 31- June 2, 2012 10èmes Journées Odontologiques 31 Mai, 1-2 Juin 2012. Saint Joseph University, Dental School scientific meeting to be held at the medical sciences campus, Damascus road, Beirut, Lebanon. Registration: 00961 1 421282 - 421000 ext 2183 Email:

November 7-11, 2012 Alexandria International Dental Congress, Alexandria University, Egypt. Email:

August 29 - September 1, 2012 The 100th FDI 2012 Annual World Dental Congress will be held in Hong Kong from 29 August to 1 September. Email: Website: September 19 - 22, 2012 Lebanese Dental Association, Beirut International Dental Meeting 2012 at the Palais des Congrès Dbayeh, Lebanon Email: Website:

November 9 - 10, 2012 4th Dental - Facial Cosmetic International Conference, Jumeirah Beach Hotel, Dubai, UAE - Tel: +971 4 3616174 Email: Website: December 7-8, 2012 ITI Congress Middle East, Abu Dhabi, United Arab Emirates Organized by the “ITI International Team for Implantology” Email: Website:


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PRACTICE MANAGEMENT Dr. Edward Zuckerberg, ’78,



Talks About Marketing His Dental Practice on

FACEBOOK dentistry is combined with a love of deep-sea diving, of photographing seas and oceans, and of all things aquatic, which dominate his office décor. Also contributing to the sense of flow is the fact that his office is located in an annex to his home, allowing easy access between family and practice life. Recently, Global Health Nexus spoke with Dr. Zuckerberg about his commitment to social media as the chief means of marketing and managing his practice.

An early technology adopter, Dr. Zuckerberg’s vision and commitment to technology provided the perfect environment in which to nurture his children, Randi, Mark, Donna, and Arielle, all of whom are high-technology adepts. Dr. Zuckerberg computerized his dental practice in 1984, introduced digital radiography in 1997, and went paperless in 2005, which, among other things, enables patients to fill out medical histories online, receive appointment confirmations and reminders electronically, and access secure patient portals to view their records and request appointments.

Global Health Nexus (GHN): When did you start using social media in your practice? Dr. Zuckerberg: Because I’m related to the Facebook founder, I was an early user of Facebook. But I didn’t begin to utilize its full potential until about two years ago, when I got a message from Dave Kerpen, whose company, Likeable Media (Likeable. com) specializes in helping businesses develop and grow their Facebook presence. He facilitated setting up my Facebook page and uses it to show prospective clients that Facebook can provide what he calls “word-of-mouth marketing on steroids.”

Dr. Zuckerberg’s practice slogan is “We cater to cowards.” He has been aided in this approach by his wife, Karen, who formerly managed his office and used her psychiatric training to counsel dentally phobic patients. Meeting Ed Zuckerberg, it’s impossible not to be struck by the thought that “flow” is an apt metaphor for both his personal and professional life. An openness to all the possibilities of technology and of using technology to improve the way he practices

GHN: How does Facebook help you to market your practice? Dr. Zuckerberg: The best way to build a practice is by referrals from satisfied patients. With Facebook, you have the opportunity to build referrals by first getting people to like your practice and then letting their Facebook friends know that they like it. My practice is proof positive that, with Facebook, one person with 100 friends can have as much influence as an entire institution. Dental News, Volume XIX, Number I, 2012


Dr. Edward Zuckerberg graduated from the NYU College of Dentistry in 1978 and became a fellow of the Academy of General Dentistry in 1984. He has been in private practice for 31 years, the last 29 years in Dobbs Ferry, New York. He and his wife, Karen, a psychiatrist, have four children, including son Mark, the founder and CEO of Facebook, Inc. Dr. Zuckerberg can be contacted at or on his Facebook page at

Marketing the Dental Practice on Facebook

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GHN: How do patients react to your emphasis on technology? Dr. Zuckerberg: My patients are used to me being state-ofthe-art; they’re used to technology. We’ve been collecting e-mail addresses in the practice since e-mail was in its infancy. We use e-mail to send appointment reminders, recall reminders, statements, quarterly newsletters. I’m Inspector Gadget – my patients always expect to see something new in my office. And this includes providing patients with Internet access and iPods to make their time in my office even more efficient and rewarding for them. GHN: Given the prevalence and the power of social media in today’s world, can you envision the inclusion of social media in continuing education courses for practicing dentists and in practice management courses for dental students? Dr. Zuckerberg: Absolutely. But every type of business, not only dentistry, can benefit from marketing on Facebook. More than 600 million people are using Facebook worldwide. With more than 150 million in the US alone, chances are good that nearly 50 percent of a dentist’s current patient base is not only using Facebook, but is logging on several times a week, if not daily. This is a tremendous opportunity to project your message and reinforce relationships with current patients, as well as tap into a market of new patients. GHN: Have you ever taught or been interested in teaching? Dr. Zuckerberg: I actually teach a lot – but not dentistry. I teach bridge; bridge is one of my passions. I’ve been playing bridge actively for over 20 years and I’m on the board of the organization that oversees bridge activities in Westchester County. I run their Web site and their Facebook page, and I became a certified bridge teacher about 15 years ago. In fact, I’ve been teaching one course a semester for the past five years in the adult continuing education program at Westchester Community College. My life is full of bridges – the Brooklyn Bridge, which was the link from my childhood home to study at NYUCD; playing bridge; bridges in a dental sense. And of course, the ultimate bridge: technology as the bridge to the future. GHN: Your son Mark recently announced the formation of a $100 million foundation to improve education among underserved students in Newark, New Jersey’s, struggling school system. What are your thoughts about his decision? Dr. Zuckerberg: I’m extremely proud of him for starting the philanthropic part of his career so early in life.

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PRACTICE MANAGEMENT GHN: What makes Facebook so attractive for advertising a dental practice? Dr. Zuckerberg: The heart of Facebook’s social network is the free page each person or business can set up, which can include photos, interests, personal information, and anything else they wish to include in their online persona. They link to other friends and acquaintances by inviting each other and accepting invitations to be linked online as friends, thus developing their own network. In addition to personal pages, Facebook allows creation of business pages, which are open to the public, any of whom can subscribe to your business page by “liking” it, thus becoming a “fan” of your page. Your page may include everything a regular Web page has – articles, biographies of staff members, listing of hours, maps and directions, photos and videos. More important, the page is interactive. There is a “wall” on each page where fans can post comments, ask questions, review your practice, and start discussions. With a little computer know-how, you can easily set up the page yourself, or for a more professional look, you can use an outside company, such as Likeable Media. Facebook lets you target your advertising in ways that no other form of advertising can, and delivers the power of your fans’ social networking connections to create the online version of word-of-mouth referrals. In Facebook’s ad setup page, you can select from a variety of demographics to target your market, including but not limited to age groups, geographic locations, gender, academic levels achieved and any interest or job title listed on an individual’s profile. Of course, the more specific you are in selecting demographics, the more the target market will decrease, but you will get more bang for your advertising dollar as you assure that your message is only getting out to those you want to receive it. GHN: What challenges does Facebook pose in marketing a dental practice? Dr. Zuckerberg: The hardest part about developing your Facebook presence is getting existing patients and their acquaintances to “like” your page. According to Dave Kerpen, getting fans for your page starts by listing your Facebook Web address on your business cards, stationery, invoices, Web page, newsletter, office signage, and just about everywhere you have office information listed. Also, offer incentives for your patients and other contacts to “like” your page. The incentive may be in the form of free merchandise, discounts on services, or special offers. For example, people who check in three times at my office are eligible to receive a free tooth bleaching. GHN: Once you have developed a nucleus of fans of your page, how do you attract new patients to your practice? Dr. Zuckerberg: What happens on Facebook is that people have “friends,” and you can target your marketing to people who are “friends” of those who already “like” your page. As a result, Facebook – the ultimate social network marketing tool – allows Dental News, Volume XIX, Number I, 2012

“I pride myself on my ability to evaluate technology. It improves my ability to help my patients understand my treatment recommendations and also allows me to raise the level of care I provide. In short, technology allows me to reinforce my practice vision, which is priceless.“ you to do many of the things you are already doing to market your practice, but much more effectively and at significantly lower cost. An important key to the success of a Facebook marketing program is utilizing a selectable category in the ad selection process on Facebook, called “friends of fans.” For example, John Smith is a fan of your practice. Most people on Facebook have at least 100 friends, some upward of several hundred. Using demographic limitations, assume that 25 of John’s friends fit into your parameters. When your ad appears before John’s friends on their Facebook page, there will also be a thumbs-up graphic along with “John Smith likes your practice!” This is the online equivalent of a word-of mouth referral. Can you imagine if your direct mail could include references to the recipient’s friends liking your practice? If that person is looking for a new dentist and they value John’s recommendation, you have successfully harnessed a referral without having to ask John to be a missionary for you. This is what is known as the concept of “social search,” which is a type of Web search method that determines the relevance of search results by considering the interactions or contributions of users. GHN: Was the adoption of Facebook a natural fit for you, or was there a learning curve? Dr. Zuckerberg: It was a natural fit because I’ve always been a technology enthusiast. For example, I recognized early that digital X-rays reduce radiation exposure for my patients by up to 80 percent. The instantaneous nature of digital won me over very quickly. I pride myself on my ability to evaluate technology. It improves my ability to help my patients understand my treatment recommendations and also allows me to raise the level of care I provide. In short, technology allows me to reinforce my practice vision, which is priceless. This vision is what led me to adopt CAD/CAM, which allows me to dramatically improve restoration quality and efficiency.


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Tooth Surface Loss due to dental erosion Dr. Hadeel Al-Ateeqi BDS

Abstract Tooth Surface Loss is an increasing problem, it may results from erosion, attrition, abrasion and abfraction. It can present due to one condition or in combination, each has its own clinical management. This paper is about tooth Surface Loss due to acid erosion. Acid erosion can be from extrinsic or intrinsic sources. The management of patients with acid erosion will be discussed. Clinical Relevance: Initial management of patients with dental erosion is important to control further tooth surface loss that might complicate the treatment


Tooth Surface Loss due to dental erosion

Key Words: Acid erosion, prevention, Dahl concept

Introduction Dental erosion is one form of tooth substance loss. It is by definition: The progressive loss of tooth substance by chemical process that do not involve bacterial action producing defects that are sharply defined, wedged shaped depressions often in facial and cervical areas. It is increasingly common condition affecting children and adults.1 A study of random sample in Switzerland from two age adult groups reported frequent to severe erosion. The adult dental health survey in 1998 stated that 65% of adults in the up had some form of toothwear.2 A study of random sample of 14 years Item Lemon Juice Coke Vinegar Grapes Apple Orange Apricots Red wine Salad dressing Tomatoes Milk Table 1: Dietary items pH Dental News, Volume XIX, Number I, 2012

old children in the UK reported 48% of children had low erosion, 51% had moderate erosion and 1% had severe erosion.3 The management of patients with acid erosion is based on identifying the risk factors, prevention, restorative management when indicated and monitoring its progress

Role of acid in Dental Erosion Tooth enamel can dissolve at a pH 5.5 or below and Dentine can dissolve at a pH of 6.5 or below.4 Table 1 showed different food and drinks and their associated pH.5 Acid weaken the outer 3-5 microns of mineralized tissue and increase the susceptibility of the enamel and dentine to abrasion from tooth brushing with or without tooth paste

Risk Factors There are many Factors involved that can be extrinsic and intrinsic Extrinsic factors s¬Diet: The erosive activity of citric, malic and phosphoric present in some food and drinks causes dental erosion. The Potential for these acids to be erosive depends on its pH, its titrable acid content and buffering capacity. The greater the buffering capacity of the drink, the longer it will take for saliva to neutralize the acid

Approximate pH 2.00-2.60 2.60 3.20 2.90-4.50 3.30-3.90 3.30-4.05 3.30-4.80 3.40 3.60 4.30-4.90 6.70 Figure 1: Palatal erosion in cases with gastric acid reflux


Treatment Treatment is indicated when the oral environment is stable, tooth wear and disease have been controlled, the presence of symptoms, deteriorating appearance and encroachment of interarch space. Treatment of early erosive tooth wear if the spaces for restorations are available is simply by adhesive restorations. Majority of patients with acid erosion have lost the clinical crown height of their anterior teeth which allowed for dento - alveolar compensation to take place (Figure 4). The Dahl concept which was developed by Dahl in 1975 allows for creation of the space in the anterior region by allowing posterior teeth to over erupt in certain clinical situation as indicated in table 4. The original Dahl appliance was based on Metal Cobalt Chromium appliance cemented on palatal surfaces of upper anterior teeth.15, 16, 17, 18 More recently, Composite restorations are used to create the space.19 The placement of Composite restorations to treat localized anterior tooth wear has good short to medium term survival.20 A survival analysis

Figure 4: Dento - alveolar compensation in a case with severe acid erosion

study of composite restorations to manage localized anterior tooth wear demonstrates itâ&#x20AC;&#x2122;s a viable treatment option over a ten year period.21 Treatment of advanced erosive tooth wear is by indirect restorations.22, 23

Conclusion Prevention is the key to success in the management of erosive tooth surface loss just as it is in the treatment of other pathological processes such as caries and periodontal disease. Intervention in terms of preventive advice and monitoring is required in all cases where erosion is diagnosed. Adopting this approach can reduce the need for extensive treatment and contribute to improving the prognosis for any restorative treatment that is provided.

12. Johansson A, Johansson AK, Omar R, Carlsson GE. Rehabilitation of the worn dentition. Journal of Oral Rehabilitation 2008; 35: 548-566. 13. Chander S, Rees J. Strategies for the Prevention of Erosive Tooth Surface Loss. Dental Update .2010; 37:12-18 14. Mehta SB, Banerji S, Miller BJ, Suarez-Feilto. Current concept on the management of tooth wear: part 1.British Dental Journal 2012;212:17-27 15. Shava S, Summerwill AJ. Reviewing the Concept of Dahl. Dental Update 2004; 31: 442-447 16. Pyster NJ, Porter RWJ, Briggs PFA, Chana HS, KELLEHER M. The Dahl Concept: past, present and future. British Dental Journal 2005; 198: 669-676. 17. Bloom DR, Padayachy JN. Increasing occlusal vertical dimension-why, when and how. British Dental Journal 2006;200:251-256. 18. Dahl BL, Krogstad O, Karlsen K. An alternative treatment in cases with advanced localized attrition. J Oral Rehabil 1975;2:209-14. 19. Robinson S, Nixon P, Gahan MJ, Chan FW. Techniques for Restoring Worn Anterior Teeth with Direct Composite Resin. Dental Update 2008; 35: 551-558. 20. Redman CDJ, Hammings KW, Good JA. The survival and clinical performance of resin-based composite restorations used to treat localized anterior tooth wear. British Dental Journal 2003; 194: 566-572. 21. Gulamali AB, Hemmings CJ, Tredwin , Petrie A. Survival analysis of composite Dahl restorations provided to manage localized anterior tooth wear ( ten year follow up).British dental Journal 2011;211:1-7. 22. Chadwick RG. Dental erosion. Quintessence publishing, 2006. 23. Khan F, Young WG. The ABC of the Worn Dentition. Willey- Blackwell , 2011.

Dental News, Volume XIX, Number I, 2012


1. Lucci A, Schaffner M, Shutter P. Dental erosion in population of Swiss adults. Community Dental Oral Epidemiology 1991; 19: 286-290. 2. Kelly M, Steel JG, Nuttall N. Adult dental health survey. Oral Health in the united Kingdom, London: ONS.1998. 3. Al-Dlaigan YH, Shaw L, Smith A. Dental erosion in a group of British 14-yearold school children. Part I: Prevalence and influence of different socioeconomic backgrounds. British Dental Journal 2001; 190: 145-149. 4. Bartlett DA. The role of erosion in tooth wear: etiology, prevention and management. International Dental Journal 2005; 55: 277-284. 5. Rees JS. The Role of Drinks in Tooth Surface Loss. Dental Update 2004; 31: 318-326. 6. Osullivan E, Milosevic A. UK national clinical guidelines in Peadiatric Dentistry: diagnosis, prevention and management of dental erosion. International Journal of Paediatric Dentistry 2008; 18:29-38. 7. Milosevic A. Gastro-oesophageal reflux and dental erosion .Evidence based Dentistry 2008; 9: 54. 8. Zero DT, Lussi A. Erosion-chemical and biological factors of importance to the dental practitioner. International Dental Journal 2005; 55: 285-290. 9. Milosevic A. Tooth Wear: Etiology and Presentation. Dental Update 1998; 25: 6-11. 10. Watson ML, Burke T. Investigation and Treatment of Patients with Teeth Affected by Tooth Surface Loss: A review. Dental Update 2000; 7: 175-183. 11. Osullivan E , Milosivik A. Clinical Guideline on Dental Erosion. Faculty of Dentistry Royal College of Surgeons England.

Tooth Surface Loss due to dental erosion



Figure 2: Cupping of lower posterior teeth

Figure 3: Severe acid erosion affecting upper anterior teeth

sÂŹMedication: Such as Chewable Asprin tablets, Chewable Vitamin C sÂŹEnvironmental: contact with acid as part of work e.g. industrial process. Swimming in swimming pool

remineralization. Salivary pellicle acts as a type of diffusion barrier that limits acid penetration and mineral ingress. Management of patients with dental Erosion sÂŹ%XTRAORALEXAMINATION'ENERALEXTRAORALEXAMINATION0RESENCE of Russells signs which is a callous formation on the back of the hand used to induce vomiting is indication of Bulimia sÂŹ)NTRAORALEXAMINATION#LINICALSIGNSOFDENTALEROSIONCANPRESent as listed in table 2 (Figures 1,2,3) sÂŹ-EDICAL CONSULTATION #OMMUNICATION WITH THE PATIENTS PHYSIcians if there were symptoms of GERD sÂŹ2ADIOGRAPHICANALYSIS sÂŹ)NTRAORALPHOTOGRAPHSFORCASESTUDYANDMONITORING sÂŹ$IETANALYSISFOURDAYSDIETSHEETINCLUDINGTHEDAYSWEEKEND must be completed by the patient to investigate the presence of acidic food sÂŹ3TUDY-ODELSFORMONITORINGTHERATEOFDENTALEROSION SHOULD be repeated every 6-12 months. 9,10,11,12


Tooth Surface Loss due to dental erosion

Intrinsic Factors sÂŹ6OMITINGREPEATEDINDUCEDVOMITINGEG!NOREXIANERVOSAAND Bulimia. Repeated not controlled vomiting such as in pregnancy sÂŹ2UMINATION 5NCOMMON ITS THE ABILITY TO RELAX THE LOWER esophageal sphincter, reďŹ&#x201A;ux gastric contents into the mouth and reswallow sÂŹ'ASTRICACID2EmUX2EmUXOFHYDROCHLORICACIDFROMTHESTOMach into the oral cavity. It can be due to incompetence of lower esophageal sphincter such as in Hiatus hernia, oesophagitis and the use of some drugs and Increased gastric volume and pressure. Gastro-esophageal reďŹ&#x201A;ux disease (GERD) is the passive effortless movement of regurgitated acid into the mouth. Signs and symptoms are: restrosternal discomfort, heartburn, Epigastric pain. Some patients are asymptomatic.6 There is strong association between GERD and dental erosion, the severity of dental erosion correlated with the presence of GERD symptoms.7

The role of Saliva in dental Erosion Saliva ďŹ&#x201A;ow rate and buffering capacity are the most important biological modifying factors. Salivary bicarbonate is the principal buffer in saliva, it provides some protection through acid clearance and neutralization. The buffering by saliva of dietary acids is much quicker in the erosive than in the carious process.8 Saliva provides calcium, phosphate and possibly ďŹ&#x201A;uoride necessary for Clinical signs of Dental erosion s Smooth Polished appearance of Teeth s Absence of Developmental ridges s Rounded teeth s Increased translucency due to thinning of enamel s Cupping s Amalgam and composite restorations stand Proud s Base of lesion not in contact with Opposing tooth s Absence of staining s Discoloration, Teeth have yellow appearance Table 2: Intra Oral Clinical Signs of Erosion Dental News, Volume XIX, Number I, 2012

Prevention of Dental Erosion 1. Prevention is based on early recognition of signs and acid erosion 2. Risk assessment: Assessing the presence of any risk factors associated with dental erosions 3. Patient Education: Preventive advice should be given to patients as listed in table 313,14 4. Control of further tooth loss by mechanical protection of teeth such as with composite resin Patient education s Personalized s Active patient engagement s Avoid swishing and holding drink in the mouth and drink with straw s Reduce frequency of acid intake s Confine acid to meal time s Where possible recommend safer alternatives food drinks s Follow acid intake with water s Consider use of salivary stimulant e.g. cheese, sugar free gum s Brush teeth with fluoride tooth paste e.g. Pronamel tooth paste s Avoid brushing for one hour following acid intake s Advice use of (CPP-ACP) products such as GC MI paste plus s Consider use of Fluoride mouth wash Table 3: Patient Education





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An Unusual large

Submandibular Gland Calculus


Dr. Moutaz Al Khen, DDS, MSc - Dr. Bader E. Abdeen, DDS

Salivary gland stones (Sialothiasis) most commonly occur in the Submandibular duct. This report describes the case of a patient who had an unusual large submandibular gland sialolith (calculus) that was completely obstructing the submandibular gland duct.

Introduction The great majority of salivary calculi (80%) occur in the submandibular gland and in the duct. Ten percent occur in the parotid and the remaining 10% in the sublingual gland and the minor salivar glands.1 Bilateral or multiple-gland sialolithiasis is occurring in fewer than 3% of cases.2 In patients with multiple stones, calculi may be located in different positions along the salivary duct and gland. Submandibular stones close to the hilum of the gland tend to become large before they become symptomatic. Sialolithiasis occurs equally on the right and left sides.

Figure 2: OPG showing large radiopaque mass.

Figure 3a

Figure 1: Left Sublingual Mass.

Figure 3b

Figure 3c

Figure 4 Figure 5 Figures 3a,b,c, 4, and 5: CT scan showing the size and location of the calculus. Dental News, Volume XIX, Number I, 2012

An Unusual large Submandibular Gland Calculus


Commonly, Sialoliths measure from 1mm to less than 1 cm. Giant salivary gland stones (GSGS) are those stones measuring over 1.5 cm and have been rarely reported in the medical literature.3,4 GSGS measuring over 3 cm are extremely rare, with only scanty reported cases.5


Key Words: Calculi, Giant salivary gland stones.

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An Unusual large Submandibular Gland Calculus

Figure 6 and 7: The incision in the floor of the mouth and the calculus removal.

Figure 8: The calculus was yellow, oval and had a rough, irregular surface.

Figure 9: The short Polyethylene tube.

Case Report

exact etiology and pathogenesis are still unknown. There is a slight predilection for occurrence in men, usually above the age of 40 years.7 Patients present with pain, discomfort, and swelling before or during meals. Recurrent submandibular swelling is often mentioned. Bimanual massage of the affected gland and the excretory duct should be carried out, observing the flow and the clearness of the saliva. The calculus can often be located in the excretory duct, often quite anterior. This characteristically causes pain. Submandibular gland calculi have been reported to be radiopaque in 80% to 94.7% of cases.8, 9, 10 In the anterior floor of the mouth, an occlusal radiograph may reveal the calculus. Ultrasonography is widely reported as being very helpful in detecting salivary stones. As many as 90% of all stones larger than 2 mm can be detected as echodense spots on Ultrasonography.11 However, detection of small calculi may be difficult with ultrasonography Computed tomography (CT) is also highly diagnostic.12 When located in the submandibular gland itself a panoramic radiograph may be helpful. In small and radiolucent calculi radiographic findings may be negative and sialography can be the examination of choice, although displacement of the calculus

In 2010, a 53-year-old white male was referred to the Oral and Maxillofacial Surgery Department at Damascus General Hospital. He complained of a large, firm mass in the left side of the floor of his mouth in the submandibular gland area. He had a history of having episodes of left submandibular swelling occurring with meals. The past medical history was unremarkable. Upon examination, bimanual palpation of the swollen area corresponding to the anatomic location of the left submandibular salivary gland duct further indicated that the mass was mobile, firm and non-tender (Figure 1). The floor of the mouth was swollen. OPG revealed a large calcified mass at that area (Figure 2). A CT (Computerized tomography) scan showed a 3.32*1.14 cm calculus blocking the submandibular gland duct (Figures 3,4 and 5). Findings on blood and serum biochemistry were within normal limits. Under local Anesthesia, the Calculus was excised via incision in the floor of the mouth and directly over the palpable mass. (Figure 6 and 7). The yellowish calculus was oval and had a rough, irregular surface (Figure 8). A short polyethylene tube was inserted at the site of incision. The flab was sutured around the tube (Figure 9). The sutures and the tube were removed after 2 weeks.

Discussion The great majority of salivary calculi (80%) occur in the submandibular gland and in the duct. Ten percent occur in the parotid and the remaining 10% in the sublingual gland and the minor salivar glands.1 Flow of saliva against gravity, its more alkaline pH, and the high mucine and Ca+ content could explain the preferential stone formation in the submandibular gland.6 The Dental News, Volume XIX, Number I, 2012

Figure 10: The excised Calculus.

ORAL SURGERY toward the gland cannot always be avoided. Although large sialoliths have been reported both in salivary glands and in salivary ducts, stones larger than 3 cm are rare.8,13,14 The giant siaolith in this patient was completely encased in the duct of the submandibular gland. A review of the literature by Ledesma-Montes et al. found only 16 reported cases of stones having a size or 3.5 cm or greater.5 Sialoliths are ovoid or round, smooth or rough with a yellowish color. They consist of calcium phosphate with small accounts of hydroxyapatite, magnesium, potassium and ammonia.10 Submandibular stones are typically removed surgically via either an intraoral or an external approach.15, 16 surgical removals of the calculi is performed when located in the excretory duct near the opening. If the calculi are located in the gland itself, fragmentation can be performed by extracorporeal or endoscopic laser lithotripsy.17, 19 this treatment has to be performed several times. After operative removal or lithotripsy of calculi, scintigraphic

examination shows functional recovery of the gland. In a nonfunctioning gland surgical removal would be indicated to avoid recurrent disease. In many units removal of the gland may be the first choice of treatment. The future holds great promise due to the developments of nonsurgical, non-invasive techniques such as shock wave lithotripsy, basket retrieval, and endoscopic laser lithotripsy.20, 21 In a review of over 4,691 patients, Iro, et al.21 reported that retrieval of stones by baskets or microforceps is usually done for stones less than 5 mm and extracorporeal lithotripsy was mainly used for fixed parotid stones that were less than 7 mm in diameter.21

Conclusion This case highlights a rare case of large Calculus which can be avoided by early diagnosis and proper treatment. Once the diagnosis of a salivary gland stone is established attempts at removal by minimally invasive techniques should be considered.

1- Seifert G, Mann W, Kastenbauer E 1992 Sialolithiasis. In :Naumann HH, Helms J, Herberhold C, Kastenbauer E (eds) Oto-Rhino-Laryngologie in Klinik und Praxis, Bd 2. Thieme, Stuttgart, pp 729-732 2- McKenna JP, Bostock DJ, McMenamin PG. Sialolithiasis. Am Fam Physician 1987 Nov;36: 119-25. 3- Bodner L. Giant salivary gland calculi: diagnostic imaging and surgical management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Sep;94(3):320-3 4- Soares EC, Costa FW, Pessoa RM, Bezerra Giant salivary calculus of the submandibular gland. Otolaryngol Head Neck Surg. 2009 Jan;140(1):1289. 5- Ledesma-Montes C, Garcés-Ortíz M, Salcido-García J, Hernández-Flores F, Hernández-Guerrero H. Giant Sialolith, Case report and review of literature. J Oral Maxillofac Surg 2007; 65:128-30. 6- Peel RL, Gnepp DR 1985 Diseases of the Salivary Glands. In: Barnes L (ed) Surgical pathology of the head and neck, vol 1. Dekker, New York 533—645. 7- Lustmann J, Rege V, Mlelamed Y 1990 Sialolithiasis. A survey on 245 patients and a review of the literature. International Journal of Oral and MaxilloCcial Surgery 19:135—138. 8- Zakaria MA. Giant calculi of the submandibular salivary gland. Br J Oral Surg 1981 Sep;19: 230-2. 9- Marchal F, Kurt AM, Dulgerov P, Lehmann W. Retrograde theory in sialolithiasis formation. Arch Otolaryngol Head Neck Surg 2001 Jan;127: 66- 8. 10- Williams MF. Sialolithisis. Otolaryngol Clin North Am 1999 Oct;32: 819-34. 11- Van den Akker HP. Diagnostic imaging in salivary gland disease. Oral Surg Oral Med Oral Pathol 1988 Nov;66: 625-37. 12- Weissman JL. Imaging of the salivary glands. Semin Ultrasound CT MR 1995


An Unusual large Submandibular Gland Calculus


Dental News, Volume XIX, Number I, 2012

Dec;16: 546-68. 13- Akin I, Esmer N. A submandibular sialolith of unusual size: A case report. J Otolaryngol 1991 Aor;20: 123-5. 14- Siddiqui SJ. Sialolithiasis: An unusually large submandibular salivary stone. Br Dent J 2002 Jul;193: 89-91. 15- Zenk J, Constantinidis J, Al-Kadah B, Iro H. Transoral removal of submandibular stones. Arch Otolaryngol Head Neck Surg. 2001 Apr;127: 432-6. 16- Marchal F, Dulguerov P. Sialolithiasis management, The state of the art. Arch Otolaryngol Head Neck Surg. 2003 Sep;129: 951-6. 17- Iro H, Benzel W, Zenk J et al 1993 Minimal-invasive Behandlung der Sialolithiasis mittels extrakorporaler StoBwellen. HNO 41:311—3 16. 18- Kater W, Rahn R, Meyer WW et al 1990 Ambulante extrakorporale StoBlwellenlithotripsie von Speichelsteinen als neues nichtinvasives Behandlungskonzept. Deutsche Zeitschrift für Mund-, Kiefer und Gesichtschirurgie 14:216— 220. 19- Nahlieli 0, Neder A, Baruchin AM 1994 Salivary gland endoscopy: a new technique for diagnosis and treatment of sialolithiasis. Journal of Oral and Maxillofacial Surgery 52:1240—1242. 20- Ottaviani F, Capacio P, Campi M, Ottaviani A. Extracorporeal electromagnetic shock-wave lithotripsy for salivary gland stones. Laryngoscope 1996 Jun;106: 761-4. 21- Iro H, Zenk J, Escudier MP, Nahliell O, Capaccio P, Katz P, Brown J & McGurk M. Outcome of minimally invasive management of salivary calculi in 4,691 patients. The Laryngoscope 2009 Feb;119(2):263-8.


Treatment of WHITE SPOT LESIONS after removal of ďŹ xed orthodontic appliances Dr. Derek Mahony

Demineralised white spot lesions occur frequently, after orthodontic treatment. Some teeth are more prone to demineralization, typically the maxillary lateral incisors and the mandibular canine teeth. The disto-gingival area of the labial enamel surface is the area most commonly affected. (Fig. 1) In the first few weeks after removal of the fixed appliances, there is a reduction in white spot lesion size, and appearance, possibly due to the action of saliva. (Fig. 2)

Fig 1 White Spots - typical: C-shaped or irregular.

Fig 3 Clinical image of an incipient caries lesion.

Fig 4 Cariogenic acids demineralise the enamel

Various treatments have been proposed to assist remineralization. It is important to note that fluoride should not be used, in high concentration, as it tends to prevent demineralization and can lead to further unsightly staining. Low concentrations of fluoride may asFig 5 Icon blocks the diffusion sist remineralisation, such as those paths. amounts found in casein calcium phosphate materials. Stimulation of salivary flow, by chewing sugarfree gum, is also helpful. This article will describe a revolutionary new approach to the cosmetic treatment of white spot lesions (Fig.3 & 4). Icon represents a rapid approach to the treatment of these lesions. The


Treatment of white lesions after removal of fixed orthodontic appliances

BDS, MScOrth, DOrth RCS

Fig 2 Smooth surface caries lesion. Dental News, Volume XIX, Number I, 2012

Fig 6 The first treatment to bridge the gap between prevention and restoration.

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Fig 7 Smooth surface procedure.

breakthrough, micro invasive technology, fills and reinforces demineralised enamel, without drilling or anesthesia. (Fig. 5 & 6) The reason previous approaches, in the treatment of white spot lesions, have fallen short, is because fluoride therapy is not always effective in the advanced stages, and the use of restorative fillings almost always sacrifices significant amounts of healthy tooth structure. Instead of adopting a â&#x20AC;&#x153;wait and seeâ&#x20AC;? approach, Icon can arrest the progress of early enamel lesions, up to the first third of dentine. This is done in one simple procedure, without the unnecessary loss of healthy tooth structure. The procedure, in using Icon, is as follows: the surface area of the white spot lesion is eroded with a 15% HCl gel. This opens the pore system of the lesion. The pore system is then dried with ethanol. Icon is then applied onto the lesion, with the application aid. The extremely high penetration coefficient, of the Icon resin, enables it to penetrate into the lesion pores. Excess material is


Treatment of white lesions after removal of fixed orthodontic appliances

Fig 8a Lesions before Icon treatment.

Dental News, Volume XIX, Number I, 2012

Fig 8b After icon treatment.

then removed, and the material is light cured. The total treatment time is about 15 minutes. (Fig.7) The cosmetic treatment of cariogenic white spots, in one patient visit, is very appealing to patients, and their parents (Fig.8a, b). There is no drilling or anesthesia is required, so there is greater patient comfort. Furthermore, patients that have already demonstrated poor compliance with their brushing, can be treated earlier. This is not just minimally invasive dentistry; it is microinvasive dentistry. I would recommend that all clinicians try the Icon product when attempting to remineralize white spot lesions, post orthodontic treatment.


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Using the 3D Shade System in Color Matching Comparison;

Easy Shade system Vs. Visual Methods Wael Abdulla DMD, MS, Waleed AlYaseen DDS, MS, Abdulaziz Sadeq DDS, MS


Easy Shade system Vs. Visual Methods

Background Today patients are very aware and esthetically conscious of color and can be very demanding when it comes to the esthetics of restoring a tooth. They might not know the technicality of the procedure but they can definitely judge the look of the restoration and how close it matches the adjacent tooth. The esthetic makeup of a restoration includes both shape and matching color of the adjacent tooth. Shade matching is one of the most important and critical factor in a successful and esthetically superior restoration. The ability to correctly match shades of teeth to the shade guide is a major factor in the treatment process. As we move anteriorly the esthetic demands become greater. Patient demand is also higher for an exact replication of their restoration to their natural dentition especially if it is a single unit restoration. According to a 2002 survey in Dental Product Report, nearly half of the general practitioners changed their typical shade taking procedures for single unit anterior cases.1 Practitioners are now seeking computer technology to contribute to their every day procedures to eliminate the human errors. A new alternative form of shade selecting is the VITA Easyshade system. A hand held device using electronic optical measurements. The manufacturer claims that their device is superior in reading and analyzing color thus giving a color match reading that will be more accurate than the human eye. This technology is assumed to be repeatable and accurate eliminating the human errors with Dental News, Volume XIX, Number I, 2012

visual matching. Clinical shade matching has always been conducted by the operator or the dental auxiliary personnel. Patient’s feedback also play a major contributor in the color matching decision. This study will evaluate the electronic color matching in comparison to the trained the human eye. The reading from each subject is compared and to the shade selected by the trained operator using the VITA 3D shade guide system and the data collected will be analyzed and compared to the VITA classic shade guide results. Currently available electronic shade-matching devices are spectrophotometers, colorimeters, digital color analyzers, or combinations of these. Spectrophotometers are useful in the measurement of surface color. A prism disperses white light from a tungstenfilament bulb in the spectrophotometer into a spectrum of wavelength bands between 10 and 20 nm.2 The amount of light reflected from a specimen is measured for each wavelength in the visible spectrum. Of all devices, a spectrophotometer is the most accurate for absolute color measurement. These instruments have a longer working life than colorimeters and are unaffected by object metamerism.2-4 Colorimeters are useful in quantifying color differences between specimens. These devices measure tristimulus

OPERATIVE DENTISTRY values according to CIE illuminant and observer conditions.3,5 Colorimeters use photodiode filters to control light reaching the specimen. The light reflected from the specimen is then measured by a detector. Colorimeters are easier to use and are less expensive than spectrophotometers. However, repeatability may be poor due to aging of filters, and object metamerism can be a challenge to their accuracy.4,5 The Vita 3D-Master shade guide6,7 features a systematic colorimetric distribution of 26 shade tabs within the tooth color space. The manufacturer purports that this shade guide demonstrates an equidistant distribution in the color space. The shade guide is organized into 5 primary value levels, with a secondary distribution based on chroma and hue. These value groups are arranged from lightest (value level 1) to darkest (value level 5), left to right. Intermediate shades can be achieved based on mixing formulas. The manufacturer advocates a 3-step process: value is determined first in making a shade determination, then the proper chroma and hue are determined. The selection process is simplified because the number of choices decreases throughout the 3-step procedure.6


Easy Shade system Vs. Visual Methods

The CIE L*a*b* (CIELAB) color space is a uniform color space derived from the tristimulus values of X, Y, Z, with L*, a*, and b* coordinates.13 It is one of the color spaces within the international standard color specification system by the CIE (Commission Internationale de l’Eclairage, or the International Commission on Illumination), and is useful for colorimetric assessments of natural teeth and dental restorative materials.

Dental Application The prevalence of color defective vision in male dentists was found by Barna et al. to be 14%8, by Moser et al. to be 9.9%,9 and by McMaugh to be 8.2%.10 The prevalence of color defective vision in male dentists, being as much as 14%, supports the conclusions of different studies that every dentist as well as dental students along with dental auxiliaries should be tested for color deficient vision as well as their shade matching abilities be evaluated for accuracy.8,11,12 The ability to consistently match shades accurately can help reduce the number of unsatisfactory results which could lead to costly remakes. Previous authors have recommended that dental students, dentists and auxiliaries be tested for color discrimination.9,11-13 The Farnsworth 100-Hue test has been used in dental research studies as a screening test to rule out defective color vision subjects.14 The 100-Hue test is a sensitive and accurate test that is used widely and is considered the standard by which most other color discrimination tests are measured.15-17 The Easyshade is a relatively new system. The standard for clinical shade matching has always been the human eye. The machine will be analyzed for effectiveness as well as compared to specific operator’s abilities whose Dental News, Volume XIX, Number I, 2012

effectiveness in color analysis has been determined by using a simple color screening test. Hamad et al.18 stated that the use of the Vitapan 3D-Master shade guide significantly improved intrarater repeatability among general practitioners when compared with the Vita Lumin Vacuum shade guide (P_.0001). This improvement could be attributable to the color science information gained by the general practitioners after they used the organized and scientific approach associated with the Vitapan 3D-Master shade guide. This study will compare the results using the 3D Vita shade guide with the results using the Vita classic shade guide when using the Easyshade system.

Materials and Methods The Vita-Vita test17 was used to identify two visual shade evaluators with a predetermined superior shade matching ability. The individuals were the evaluators to whom the Vita Easy Shade’s accuracy was compared. Expert observers were chosen to participate in the vita easy shade matching study. The Vita Easy Shade machine was used on 40 subjects to measure the central region of each subject’s left maxillary central incisor. Protocol consisted of mandating virgin non restored teeth without any gross signs of developmental intrinsic staining. The two visual evaluators selected a shade from the same area of the left maxillary central incisor for all subjects. The visual evaluators were instructed to focus only on the central portion of the tooth. The evaluators analyzed the tooth first, and then the tooth was scanned by the machine. If the evaluators disagreed amongst the shade chosen, they were asked to retake the shade and come to a consensus of one shade. The machine tip was placed on the middle third of the tooth for shade analysis. The Vita Easyshade (Vita Zahnfabrik) is an intraoral dental spectrophotometer that provides CIE L*a*b* values in specific modes. This shade-taking device (Vita Easyshade) comprises a base unit, a handpiece, and a fiberoptic cable assembly. There are 3 measuring modes: tooth, shade tab, and restoration. The appropriate mode must be selected prior to measuring, and data reported are modespecific. The accuracy of the Vita Easy Shade was based on the comparison of the results obtained compared to the shade chosen using the visual evaluation method. All readings on the Vita easy shade instrument were made by the same operator for consistency. Statistical analysis included comparison of the correct matches of the Vita Easy Shade to the standard matching technique the visual observers using a standard t-test. A 95% confidence interval was used in comparative analysis.

Discussion Shade matching to adjacent teeth is one of the most difficult and important aspects of an esthetically successful restoration.

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OPERATIVE DENTISTRY The Vita Easy Shade system is a relatively new handheld device that uses electronic optical measurements of teeth. While the standard method for clinical shade matching is the human eye, different visual evaluators are able to match shades more or less effectively depending on multiple variables. This is why the VitaVita test was used to choose the best visual evaluators available. Also, shade matching was performed under similar conditions as well as during the same time of day. It was considered a “match” if the visual evaluator’s choice matched the machines’ reading.

Results The results showed that the machine was accurate 97.5% of the time. However, at a 95% confidence interval one can be certain that 95% of the time the machine will not perform below 92.7% matches the visual method. One can only infer that this machine is not absolutely reliable, but considerably accurate and should be used as an adjunctive shade matching method.

Conclusion As more dentists realize the importance of a scientific approach to color matching in dentistry, manufacturers will continue to research and develop better digital equipment. Currently, the Vita Easy Shade instrument in combination with the 3D vita shade guide shows superiority in color matching and determination when compared to the Vita classic shade. Nevertheless, this machine is not a replacement for traditional methods. However, it is a definite adjunct to visual shade matching. The final question, regardless of which system used, visual or electronic, is “Does it match?” The final evaluation system for success or failure will be the patients’ and their peers’ visual methods. The art of dentistry will always rely on individual observation and interpretation, and adjunctive electronic instruments can only enhance this process and attempt make it more reliable.

1. Kanawati A, Richards MW, Becker JJ. “Repeatability of a dental shade-matching instrument when compared to traditional visual methods of Shade Evaluation”. General Dentistry, Accepted for publication: March/April 2009 2. Berns RS. Billmeyer and Saltzman’s principles of color technology. 3rd ed. New York: John Wiley & Sons Inc; 2000. p.88-92. 3. Seungee Kim-Pusateri, Jane D.Brewer, Robert G. Dunford, Alvin G.Wee. In Vitro Model To Evaluate Reliability and Accuracy of a Dental Shade-Matching Instrument. J. of Prosthetic Dent. 2007; 98: 353-358 4. Paravina RD, Powers JM. Esthetic color training in dentistry. St. Louis: Mosby; 2004. p. 17-28, 169-170 5. CIE (Commission Internationale de l’Eclairage). Colorimetry, official recommendations of the International Commission on Illumination, Publication CIE No.15:2004: Colorimetry, 3rd ed 6. Judy Chia-Chun Yuan, Jane D. Brewer, Edward A. Monaco, Elaine Davis. Defining a Natural Tooth Color Space Based on a 3-Dimentional Shade System. J Prosthet Dent 2007;98 :110-119 7. Baltzer A, Kaufmann-Jinoian V. The determination of the tooth colors. Special reprint. Quintessenz Zahntechnik 2004;30:726-40. 8. Barna GJ, Taylor JW, King GE, Pelleu GB. The influence of selected light intensities on color perception within the color range of natural teeth. J Prosthet Dent 1981 ;46:450-453. 9. Moser JB, Wozniak WT, Naleway CA, et al. Color vision in dentistry: A survey. JADA 1985;110:509-510.


Easy Shade system Vs. Visual Methods


Dental News, Volume XIX, Number I, 2012

10. McMaugh DR. A comparative analysis of the colour matching ability of dentists, dental students, and ceramic technicians. Aust Dent J 1977;22: 165-167. 11. Shillingburg HT. Fundamentals of fixed prosthodontics, ed. 3. Chicago: Quintessence Publishing Co., Inc.; 1997:425-430. 12. Sproull RC: Color matching in dentistry. Part 111: Color control. J Prosthet Dent 1974;31:146-154. 13. Rawlinson A. A simple eyesight screening programme for dental undergraduates: Results after 7 years. Aust Dent J 1993;38:394-399. 14. Farnsworth, D. The Farnsworth-Munsell 100-Hue test manual. New York: Macbeth Division, Kollmorgen Instruments Corp.;1957:1-7. 15. Han DP, Thompson HS. Nomograms for the assessment of Farnsworth-Munsell 100-Hue test scores. Am J Opthalmol 1983;95:622-625. 16. Lugo M, Tiedeman JS. Computerized scoring and graphing of the FarnsworthMunsell 100-Hue vision test. AmJ Opthalmol 1986; 101:469-474. 17. Lua MJR, Goodkind RJ, Schwabacher WB. Clinical evaluation of an experimental body shade guide based on in vivo tooth color measurements. J Prosthod 1992;1:74-83. 18. Ihab A Hammad. Intrarater Repeatability of Shade Selection with Two Shade Guides. J prosthet Dent 2003; 89: 50-53. 19. Yorty JS, Richards MW, Kanawati A, Davis S, House RC, Okubo, SR. A simple screening test for color matching in dentistry. General Dentistry 2000; 48-3:272276.

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The Soft Tissue


Fay Goldstep DDS, FACD, FADFE, George Freedman DDS, FAACD, FACD

Fig 1

While dental lasers have been commercially available for several decades, and their popularity among patients is unparalleled, the dental profession has taken to this treatment modality rather slowly. Lasers have been thoroughly documented in the dental literature. They are an exciting technology, widely used in medicine, kind to tissues, and excellent for healing. So why have they not been more widely embraced by the practicing dentist? There is a wide perception in the profession that somehow the dental laser is not useful, too complicated, and too expensive. These parameters have change forever with the arrival of the diode laser onto the dental scene. There is now a convergence of documented scientific evidence, ease of use and greater affordability that makes the diode laser a “must have” for every dental practice.

L A S E R is an acronym for Light Amplification by Stimulated Emission of Radiation. Lasers are commonly named for the substance which is stimulated to produce the coherent light beam. In the diode laser, this substance is a semiconductor (a class of materials which are the foundation of modern electronics including computers, telephones and radios). This innovative technology has produced a laser that is compact, and far lower in cost than earlier versions. Much of the research has focused on the 810nm diode laser. This wavelength is ideally suited for soft tissue procedures since it is highly absorbed by haemoglobin and melanin. This gives the diode laser the ability to precisely cut, coagulate,


Diode Lasers: The Soft Tissue Handpiece

Diode Lasers: The Science in Brief

Fig 2

Fig 5

Fig 3

Fig 6

Dental News, Volume XIX, Number I, 2012

Fig 4

Fig 2-6 courtesy of Dr. Phil Hudson

ablate or vaporize the target soft tissue.1 Treatment with the 810nm diode laser Fig 1(Picasso Diode Laser, AMD Lasers) has been shown to have a significant long- term bactericidal effect in periodontal pockets. A. actinomycetemcomitans, an invasive pathogen associated with the development of periodontal disease and generally quite difficult to eliminate, responds well to laser treatment.2, 3 Scaling and root planing outcomes are enhanced when diode laser therapy is added to the dental armamentarium. The patient is typically more comfortable during and after treatment, and gingival healing is faster and more stable.4, 5

Diode Laser: Ease of Use Early adopter dentists thrive on new technologies. They enjoy the challenges that come with being the first to use a product. Most dentists, however, are not early adopters. Over the past two decades lasers have intimidated mainstream dentists with their large footprint, lack of portability, their high maintenance profile, confusion of operating tips, and complex procedural settings. Common questions: When do I use which tip? What setting works for which procedure? Why do I need a laser when I have been managing well without one? Enter the diode laser. It is compact. It can easily be moved from one treatment room to another. It is self-contained, and does not have to be hooked up to water or air lines. It has one simple fiberoptic cable which is can be utilized as a reusable operating tip. The units come with several presets, although after a very short time, the operator becomes so comfortable that they are rarely needed. The power and pulse settings are quickly adjusted to suit the particular patient and procedure. One of the authors is a dentist who does not thrive on the challenge of brand new high-tech, high-stress technology. In fact, having tried many lasers in the past that promised to be user-friendly, they were found to be anything but. The 810nm diode laser was a totally different experience; after a brief in-office demonstration, the laser handpiece felt comfortable enough to perform some simple clinical procedures. Further online training and lecture courses enhanced both clinical comfort level and competency.

recent data suggesting that it may be related to coronary heart disease.10 The diode laser is effective in decreasing A. actinomycetemcomitans2, 4 and thereby indirectly improving the patients’ heart health.

Laser Education Most diode laser manufacturers provide some education to get the new user started quickly and effectively. The most comprehensive online diode laser introductory course with certification (which includes the science, safety and clinical procedures) can be found at the International Center for Laser Education, tel: +1 877 522 6863. This course provides everything necessary to get started with soft tissue diode laser therapy. Advanced courses are available for more complex procedures. The soft tissue diode laser has become a “must have” mainstream technology for every general practice. The science, ease of use, and affordability make it simple to incorporate. The laser is now the essential “soft tissue handpiece” for the practice. In fact, there is a case for having a diode laser in each restorative and each hygiene treatment room. Restorative dentistry becomes easier, more predictable and less stressful. Laser therapy expands the clinical scope of practice to include new soft tissue procedures

that keep patients in the office. The patient’s gingival health is improved in a minimally invasive, gentler manner. Every time the dentist picks up the diode laser the question is: where have you been all my life?


1. Pirnat S, Versatility of an 810 nm Diode Laser in Dentistry: An Overview, Journal of Laser and Health Academy Vol. 2007 No. 4 1 -8 2. Moritz A, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J, Sperr W, Treatment of periodontal pockets with a diode laser, Lasers Surg Med, 1998; 22(5): 302-11 3. Moritz A, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J, Sperr W, bacterial reduction in periodontal pockets through irradiation with a diode laser: a pilot study, J Clin Laser Med Surg. 1997 Feb; 15(1): 33-7 4. Ciancio SG, Kazimerczak M, Zambon JJ, Baumbartner S, Bessinger MA, Ho A, clinical Effects of diode laser treatment of wound healing, AADR, 2006, abs 2183 5. Haraszthy VI, Zambon MM, Ciancio SG, Zambon JJ, Microbiological Effects of 810 nm Diode Laser Treatment of Periodontal Pockets, AADR 2006, abs 1163 6. Goharkhay K, Mortiz A, Wilder-Smith P, Schoop U, Kluger W, Jakolitsch S, Sperr W, Effects on oral soft tissue produced by a diode laser in vitro, Lasers Surg Med, 1999; 25(5): 401-6 7. Walinski CJ, Irritation Fibroma Removal: A Comparison of Two Laser Wavelengths, Gen Dent 2004, May – June; 52(3): 236-8 8. Adams TC, Pang PK, Lasers in Aesthetic Dentistry, Dent Clin North Am, 2004 Oct; 48(4): 833-60, vi 9. Haraszthy VI, Zambon JJ, Trevisan M, et al, Identification of Periodontal Pathogens in Atheromatous Plaques, J Periodontol 2000, 71:1554-1560 10. Spahr A, Klein E, Khuseyinova N, et al, Periodontal Infections and Coronary Heart Disease: Role of periodontal bacteria and importance of total pathogen burden in the Coronary Event and Periodontal Disease (CORODONT) study, Arch Intern Med, 2006 166:554-559

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Fig 7 & Fig 8 - Courtesy of Biolase

Fig 9, 10, 11 - Courtesy of Ivoclar Vivadent

Diode laser: Affordability Laser technology has always come with a high price tag. Manufacturing costs are high and cutting edge technology commands steep pricing. Diode lasers are less expensive to produce. Breakthrough pricing for this technology has now reached under $5,000. At this level the diode laser becomes eminently affordable for the average practicing dentist.


Diode Lasers: The Soft Tissue Handpiece

Diode laser: Why do I need this technology? The 810nm diode laser is specifically a soft tissue laser. This wavelength is ideally suited for soft tissue procedures since haemoglobin and melanin, both prevalent in dental soft tissues, are excellent absorbers. This provides the diode laser with broad clinical utility: it cuts precisely, coagulates, ablates or vaporizes the target tissue with less trauma, improved post-operative healing, and faster recovery times.6, 7, 8 Given the incredible ease of use and its versatility in treating soft tissue, the diode laser becomes the “soft tissue handpiece” in the dentist’s armamentarium. The dentist can use the diode laser soft tissue handpiece to remove, refine and adjust soft tissues in the same way that the traditional dental handpiece is used on enamel and dentin. This extends the scope of practice of the general dentist to include many soft tissue procedures. The following procedures are easy entry points for the new laser user: 1. Gingivectomy Haemostasis Gingival troughing for impressions The diode laser makes restorative dentistry a breeze (Picasso, AMD Lasers Inc.). Any gingival tissue that covers a tooth during preparation can be easily removed as haemostasis is simultaneously achieved. Figs 2-6 The restoration is no longer compromised due to poor gingival conditions. There is no more battling with unruly soft tissue and blood. Excess gingival tissue can be readily managed (Fig 7-8) for improved restorative access to Class V preparation (ezlase, Biolase Technology Inc.) Dental News, Volume XIX, Number I, 2012

Fig 12 - Courtesy of Biolase

Gingival toughing prior to taking impression Fig 6-7 (Picasso, AMD Lasers Inc.) ensures an accurate impression (particularly at the all-important margins) and an improved restorative outcome. Packing cord is no longer necessary. Diode lasers make restorative dentistry less stressful, more predictable and more enjoyable for the dental team and the patient. 2. Operculectomy Excision and/or recontouring of gingival hyperplasia Frenectomy These procedures are not commonly offered or performed by the general dentist. They are examples of the expanded range of services readily added to the general practice. The dentist becomes more proactive in dealing with hyperplasic tissues that can increase risk of caries and periodontal disease. Figs 9-11 A frenectomy is now a simple and straightforward procedure (ezlase). Fig 12 3. Laser Assisted Periodontal Treatment The use of the diode laser in conjunction with routine scaling and root planing is more effective than scaling and root planning alone. It enhances the speed and extent of the patient’s gingival healing and post-operative comfort. (Ref 4,5). This is accomplished through laser bacterial reduction (Picasso, AMD Lasers Inc), debridement and biostimulation. Fig 13-14 A. actinomycetemcomitans which has been implicated in aggressive periodontal may also be implicated in systemic disease. It has been found in atherosclerotic plaque (Ref 9) and there has been

Fig 13 & Fig 14 - Courtesy of Dr. William Chen

SOCIAL RESPONSIBILITY DN: What are the advantages of becoming an ICD Fellow? Dr. Haddad: Fellowship in the ICD is an honor: fellows are recognized; it is not a post that offers advantages or rewards. The important thing is for fellows to be actively involved in the worldwide professional cordiality that is one of the basic objectives of fellowship DN: From your experience what have been the most substantial accomplishments of the ICD Sector 10? Dr. Haddad: The Middle East Section was chartered as an autonomous section in 1967. At that time, and for many years, the main activity was the diffusion of knowledge through the organization of several dental meetings at a time where such meetings were very much needed. The early meetings were in association with the Middle East Medical Assembly at the American University of Beirut. Continuing education meetings were resumed at the end of the civil strife in Lebanon, and still are one of the main activities of the section. Other activities have been the participation in the establishment of the dental library of the Lebanese Dental Association, and recently in the translation to Arabic, the dubbing and distribution of “Oral Longevity” a public awareness DVD. The Section has

also been involved in the creation of a cooperation agreement between the dental schools of the Lebanese University and Tufts University. DN: The ICD originated in the 1920s when there were large barriers restricting international collaboration. Has the extensive use of the internet and social media affected ICD’s role? Dr. Haddad: The International College has evolved in such a way as to adapt to change. It has added to its mission of disseminating knowledge the involvement, throughout the world in humanitarian projects which range from assistance to International exchange programs, outreach programs to underprivileged areas in many places in the world, to the help in areas of natural disaster, and the list is long. ICD Immediate Past President Charles Siroky, completed a full listing of these projects in what is known as “Project 55” and which can be viewed on the College’s website

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Dr. Cedric P. Haddad, DDS talks about the

ICD mission and achievements Interviewed by: Leila Roumani DMD


ICD mission and achievements

Dental News (DN): As former President of the International College of Dentists (ICD) Sector 10, can you tell us a little about what ICD stands for and about its vision for dentistry? Dr. Haddad: The motto of the International College of Dentists summarizes what it stands for, “Recognizing service and the Opportunity to serve”. It is therefore a leading honorary dental organization which recognizes outstanding accomplished professionals who have served the profession and their community. It is a global association which has among its many objectives encouraging cordial relations between members of the profession, promoting postgraduate study and research, and the establishment of projects of humanitarian nature.

Dr. Cedric Haddad graduated with a DDS degree cum laude from George Washington University in June 1967 then he pursued Rotating Internship at the Eastman Dental Center in Rochester New York 1967-1968. He maintains a Private Practice in Beirut, Lebanon from 1968 till today. His professional achievements: Dental Diploma and certification in Italy in 1989. Vice President of the American Dental Society of Europe 2005. ICD Posts: Registrar Middle East Section 1988-1999 President Middle East Section 1999-2003 Represented the Section at International Council meetings in 2000, 2004, 2008 *Presently: Councilor Middle East Section ICD, Editor of Middle East Section ICD Dental News, Volume XIX, Number I, 2012

DN: I understand that to become an ICD Fellow distinguished dentists must be invited; what are the criteria for invitation to become an ICD Fellow? Dr. Haddad: Professionals who are invited to receive the honor of fellowship in the ICD are, as I have mentioned, outstanding professionals. There are, of course some requirements such as being in active practice, teaching or research, belonging to his/ her country’s professional association, having been in practice for of five years and be at least 30 years of age. I would like, at this stage, to quote Manfred Seideman, Past International President of the College, in his appraisal of fellowship: The International College of Dentists amalgamates its members through the Practice of Cordiality, Respect, Service and Fellowship. Also, through the tacit commitment by all the Fellows to “do the right thing, not for the applause or a reward, but because it is the right thing to do.” This integration assures that the Fellows are “One College, One ICD-Team.”




Trophy Distribution

Dr. Azem Kaddoumi from Jordan

Dr. Ammar Ekry from Bahrain

Dr. Mohamed Jishi from Bahrain


AEEDC 2012

Dr. Wassim Moubadder from Lebanon

Dr. Ahmed Osman Rizig from Sudan

Representatives of dental societies and ministries of health

Dental News, Volume XIX, Number I, 2012






AEEDC 2012

The 17th edition of the AEEDC Dubai 2013 will take place at the Dubai International Convention & Exhibition Centre (DICEC) from 5 to 7 February 2013.

H.H. Sheikh Hamdan Bin Rashid Al Maktoum, inaugurates the AEEDC 2012

Awards GC

Dental News, Volume XIX, Number I, 2012



For extra protection from the effects of Acid Wear... Modern eating and drinking habits increase the exposure of tooth enamel to dietary acid that can lead to Acid Wear (erosive tooth wear), the biggest contributor to tooth wear.1–5 Acid Wear is a widespread and growing condition, affecting both adults and children,6 but in its early stages can be difficult to identify.

...Recommend the Pronamel combination regime Individually Pronamel Daily Toothpaste and Pronamel Daily Mouthwash are proven to reharden acid-softened enamel compared to standard options7,8


Mean percentage surface microhardness recovery



45 30 15 0 Pronamel (1450ppm NaF)

A leading toothpaste (1450ppm NaF)

Placebo (oppm F)

Adapted from Hara AT et al. Bovine enamel specimens were subjected to an erosive challenge. This was followed by fixation to palatal appliances and a 4-hour intra-oralphase in 58 human subjects.

Figure 2: In vitro laboratory rehardening (mean) microindentation study following treatment with fluoride mouthwashes8 Enamel microhardness relative to initial etched / %

Figure 1: In situ rehardening microindentation study following treatment with dentifrices7




100 Pronamel Daily Mouthwash


Listerine coolmint



Adapted from Young M and Willson R. 6 human enamel specimens were subjected to an erosive challenge in vitro. This was followed by a mean rehardening microindentation study after treatment with fluoride mouthwashes.

But used in combination, provide 80% more protection from the effects of Acid Wear than brushing with Pronamel Daily Toothpaste alone 9* Figure 3: In situ erosive resistance after treatment with a dentifrice and mouthwash regime9


Mean % net erosion resistance

0 -5

Pronamel Daily Toothpaste (1450ppm NaF) and Pronamel Daily Mouthwash (450ppm NaF)

Fluoride-free Toothpaste and Pronamel Competitor Pronamel Daily Daily Toothpaste toothpaste Mouthwash (1450ppm NaF) (1450ppm NaF) (450ppm NaF) and water and water



-10 -15


-20 -25 -30 -35

The smaller the negative value the better the products have performed.


Adapted from Maggio B et al. 2010. Original study design contained 5 test cells; the one not included here is a fluoride-free dentrifice plus water.

Extra protection from the effects of Acid Erosion

Give your patients 80% more protection from the effects of Acid Wear, compared to Pronamel Daily Toothpaste alone by recommending the Pronamel combination regime *based on clinical data with 450ppm Pronamel Daily Mouthwash and 1450ppm Pronamel Daily Toothpaste References: 1. Lussi A. Erosive Tooth Wear – a Multifactorial Condition. In: Lussi A, editor. Dental Erosion – from Diagnosis to Therapy. Karger, Basel, 2006. 2. Lussi A. EurJ Oral Sci 1996;104:191–198. 3. Bartlett DWet al. Int Dent J 2005;55:277–284. 4. Zero DT.Int Dent J 2005;55:285–290. 5. Zero DTet al.J Clin Dent 2006;17 (Spec Iss):112–116. 6. Deery Cet al. Pediatr Dent 2000;22(6):505–510. 7. Hara ATet al. Caries Research 2009;43:57-63. 8. Young Mand Willson R. GSK data on file. 2008. 9. Maggio Bet al. J Dent 2010;38(53);537–544. Prepared October 2011, Z-11-404.

Consumer Healthcare

Sensoydne Pronamel is a registered trademark of GlaxoSmithKline Group of companies. Further information is available upon request from GlaxoSmithKline Health care, P.O. Box 23816, Dubai, UAE. For adverse event reporting, please send us an email on




Dr. Sabbarini, Dr. Debaybo discussed Space Maintenance as Interceptive Trend

Dr. Moneim presented how to combine Invisalign with implants

Dr. Robert Edwab lectured on Oral and Maxillofacial Surgery

Dr. Ounsi talked about Endodontic High-tec devices

Dr. Ziad Salameh offering John Philipp a trophy Dr. Riad Bacho lectured Management of traumatic injuries to primary teeth

Dr. Koleilat, Dr. Ayoub explained Bone graft in implant

Dr. Rhayel explained the treatment of Perio Pockets with Lasers

Dr. Carine Tabarani talked on Biphosphonates



Pr. Gutknecht shed light on Modern Laser applications

Dr. Wilhelm Pertot defined Endodontic success

Revo-S , getting to the root of the problem! ™

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University of Sharjah, College of Dentistry winner of the “AEEDC Knowledge Champion 2012”

Dental News, Volume XIX, Number I, 2012



Thinking ahead. Focused on life.

Soaric Soaric has been awarded the renowned iF Design Gold Award for 2012. With an impressive history spanning over 50 years, the German iF Design Award is one of the most prestigious awards globally, adjudicated by leading design experts from all over the world. On an international scale, more than 4,300 products competed for awards this year, with Soaric receiving the highest accolade, the Gold Award for Product Design. Soaric also received two Communication Design Awards for its user interface and for the Soaric catalogue, advertising and printed media design.

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J. MORITA EUROPE GMBH Justus-von-Liebig-Strasse 27A, D-63128 Dietzenbach, Germany Tel: +49-6074-836-0, Fax: +49-6074-836-299 SIAMDENT CO., LTD. 444 Olympia Thai Tower, 3rd Floor, Ratchadapisek Road, Samsennok, Huay Kwang, Bangkok 10310, Thailand Tel: +66-2-512-6049, Fax: +66-2-512-6099, J.MORITA CORPORATION AUSTRALIA & NEW ZEALAND Suite 2.05, 247 Coward Street, Mascot, NSW 2020, Australia Tel: +61-2-9667-3555, Fax: +61-2-9667-3577 J.MORITA MIDDLE EAST 4 Tag Al Aoasaa, Saba Pacha 21311, Alexandria, Egypt Tel: +203-58-222-94, Fax: +203-58-222-96





Dental News, Volume XIX, Number I, 2012





Dental News, Volume XIX, Number I, 2012

It’s what’s inside that counts Sensodyne potassium formulations work inside the tooth to target the source of pain1–4

15 ** Mean dentin loss (μm)

Your patients can suffer from dentine hypersensitivity at any time. With an advanced formulation and a new fresh flavour, Sensodyne potassium formulations deliver clinically proven relief and 24/7 protection from the pain of dentine hypersensitivity.*1–7 Sensodyne continues to strive to deliver the best solutions for you and your patients with dentine hypersensitivity.

Mean dentine loss shown in situ after 15 days of treatment10


New improved Sensodyne’s formulation is low abrasion§9




0 Water

Low abrasion toothpaste

Moderate abrasion toothpaste

High abrasion toothpaste

No significant difference observed between brushing with water alone when compared to brushing with a low abrasion toothpaste. **Significant differences observed between brushing with water alone when compared to brushing with a moderate abrasion toothpaste (p=0.0071) and a high abrasion toothpaste (p<0.0001).


Adapted from GSK data on file 2010.10 Randomised, analyst-blind, in situ model involving 29 subjects to evaluate the effect on dentine of low abrasion toothpaste (RDA 60), moderate abrasion toothpaste (RDA 80) and high abrasion toothpaste (RDA 150) compared to water after 15 days of use by contact profilometry.

Proven 24/7 protection*1–7

Sensodyne potassium formulations deliver clinically proven relief and 24/7 protection from the pain of dentine hypersensitivity1–7

Sensodyne potassium formulations work within the tooth to withstand daily physical and dietary challenges and provide around the clock protection from dentine hypersensitivity.*1–7

Low abrasion

A gentle formulation for exposed dentine 8-10

SLS-free New fresh flavour

Because exposed dentine is up to 10 times softer than tooth enamel,8 Sensodyne potassium formulations are low abrasion†9 and SLS-free.‡ This can protect vulnerable dentine from further damage and helps preserve the protective smear layer.

Think sensitivity, think *Based on twice daily brushing

Sensodyne Gentle Whitening formula is moderate abrasion


Sodium Lauryl Sulphate

References: 1. Jeandot J et al. Clinc (French) 2007; 28: 379−384. 2. Leight RS et al. J Clin Dent 2008; 19: 147−153. 3. Nagata T et al. J Clin Periodontol 1994; 21(3): 217–221. 4. Salvato AR et al. Am J Dent 1992; 5(6): 303−306. 5. Silverman G. Compend Contin Educ Dent 1985; 6(2): 131-136, 136. 6. Silverman G et al. Am J Dent 1994; 7(1): 9–12. 7. Troullos ES et al. 1992. GSK data on file. 8. Pickles MJ. In: Duckworth R M, editor. The Teeth and Their Environment. Monogr Oral Sci. Basel, Karger, 2006; 19: 86−104. 9. RDA: GSK data on file. 2010. 10. Bannon L et al. 2010. GSK data on file. Prepared June 2011 Z-11-202






Dental News, Volume XVIV, Number I, 2012



KSU and SDS Intl conference 2012

to Dr. Antoine Saadeh from Lebanon


to Dr. Samer El Hout from Lebanon


to Dr. Abdullah Aldrees from the KSU


Dr. Ahmed Al Kahtani President of the Saudi Dental Society presenting to Dr. Adel Al Hadlaq from the KSU

Poster presentation

Dr. Stanley Malamed from USC California, lecturing on the management of fearful patient

Pr. Charles Goodacre from Loma Linda California, talking on complications of fixed prosthodontics


Dr. Joe Hobeiche from St. Joseph University, Lebanon talking on TMJ treatments

Dental News, Volume XIX, Number I, 2012



…ô≤æ©dG óªfi øH ódÉN QƒàcódG PÉà°SC’G ‹É©dG º«∏©àdG ôjRh ‹É©ŸG ÖMÉ°U ¿Éªã©dG øªMôdG óÑY øH ¬∏dGóÑY QƒàcódG PÉà°SC’G Oƒ©°S ∂∏ŸG á©eÉL ôjóe ‹É©e »eÓ°SE’Gh »Hô©dG ⁄É©dÉH ¿Éæ°SC’G ÖW äÉ«©ªLh äÉHÉ≤f AÉ°SDhQ IOÉ©°ùdG ÜÉë°UG äÉ«∏μdG AGóªYh äÉ©eÉ÷G AÓch IOÉ©°ùdG ÜÉë°UCG


KSU and SDS Intl conference 2012

Dr. Ahmed Al Kahtani President of the Saudi Dental Society

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Dr. Khalid Al Wazzan Dean KSU College of Dentistry Lebanese delegation with the Egyptian Dental Assosiation Board Dental News, Volume XIX, Number I, 2012

Minister of Higher education, Dr. Khalid Al Anqari cutting the ribbon of the exhibition






Visit to the old town was one of the social committee activities

Dental News, Volume XIX, Number I, 2012

BLACKLINE ENTER A NEW ERA Light, efficient and ultra-strong: BLACKLINE vacuum-moulded carbon fibre turbines set a new technological standard. Three times lighter than titanium, carbon fibre makes the turbines extremely robust. BLACKLINE turbines resist 10,000 wear cycles and repeated sterilisations without leaving any trace. They are also provided with the fantastic DUALOOK adjustable-intensity LED lighting system, and the ACCU-SPRAY system ensuring ultra-precise nebulisation and optimal cooling. Bien-Air BLACKLINE turbines. Increase your requirements.

Bien-Air Dental SA L채nggasse 60 P.O. Box 2500 Bienne 6, Switzerland Phone +41 (0)32 344 64 64 Fax +41 (0)32 344 64 91



Prince Mishal Bin Majed during the congress inauguration

Dean KAU Faculty of Dentistry, Dr. Abdulghani Mira


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Left to right: Pr. Z. Murshid, Pr. Y. Talic and Dean Khaled Al Wazzan Dental News, Volume XIX, Number I, 2012

Members of the social committee with their guests in the lobby of the Hilton





Dr. Hessam Nowzari from USC discussed Periodontics

Dr. Maurice Salama discussed augmentation techniques

Dr. Cliff Ruddle lectured on new instrumentation in endodontics


Dr. Ed Mclaren from UCLA lectured on Esthetic dentistry

Picture of the audience Dental News, Volume XIX, Number I, 2012

Supported by:

Council of Cooperative Health Insurance

In association with:





Dental News, Volume XIX, Number I, 2012

VOCO GmbH · Anton-Flettner-Straße 1-3 · 27472 Cuxhaven · Germany · Tel. +49 (0) 4721 719-0 ·

The Power. The Silence. The new Tornado Super Silent


Tornado – the new generation of compressors from Dürr Dental Dürr Dental, the inventor of oil-free dental compressors, presents an unbelievably quiet and powerful compressor for dentistry in the form of the new “Made in Germany“ Tornado. ▪ Oil-free, dry, and hygienic ▪ One of the quietest of its kind ▪ Dust- and Sandresistant ▪ Antibacterial inner tank coating ▪ Low-maintenance thanks to membrane-drying unit Duerr Dental Middle East, P.O.Box: 87355, Al Ain - U.A.E., Mobile: +971 (0) 50 - 550 84 12, Fax: +971 (0) 3 767 - 5615, email:


New A-dec LED Light unveils brilliant simplicity Unveiled to the Middle East and Africa market at the AEEDC exhibition in Dubai, the new A-dec LED dental operatory light is now available to dentists around the world. “Designed for optimal visual acuity and treatment-room ergonomics, the A-dec LED is an outstanding solution that outperforms all other industry options,” says A-dec Product Manager Tom McCleskey. “By evolving LED technology, we’ve established a new benchmark for operatory lighting.” A-dec’s advanced light emitting diode (LED) technology has been optically engineered specifically for dentists and the dental operatory. The A-dec LED stands alone in the market because of how well it reduces eye strain and provides optimal ergonomics while ensuring ample illumination, clarity and depth during treatment. The new offering features multiple intensity levels, cure-safe mode, low cost of ownership, and intuitive ergonomics. Adjustable intensity levels of 15,000 lux, 25,000 lux, and 30,000 lux at 5,000K are able to flood the oral cavity with a consistently

neutral white light for true-to-life tones, which help practitioners, diagnose clearly. The light’s cure-safe mode emits a brilliant yellow light at 25,000 lux, enabling the dental team to work effectively without curing photo-initiated resins. www.



Mectron Piezosurgery® touch Mectron launched the very first generation of PIEZOSURGERY® in 2001, in a time where talking about piezoelectric bone surgery was revolutionary and pioneering at the same time! At IDS 2011, Mectron presented the last generation of PIEZOSURGERY® ,with the main aim to consolidate his philosophy of “clinician orientated” unit. Highest attention has been paid to the user interface, in order to make the controls even more intuitive: an exclusive black glass touch screen allows to select in no time the correct bone quality and the irrigation flow rate – and here you go! The new Mectron PIEZOSURGERY® touch is characterized by a new handpiece with a 360 degrees rotating LED which enables the user to switch the light on or off directly from the keyboard, or to select the “auto” mode to activate automatically the LED when the foot pedal is pressed. Dental News, Volume XIX, Number I, 2012

New inserts will be available for Mectron PIEZOSURGERY®: from tips dedicated to mini dental implants to new applications in prosthesis related to the finishing of the cervical margin in crown preparations.



pola office+

The World’s Fastest Bleach

Pola Office+ is the world’s fastest in-office tooth whitening system. Absolutely minimal chair time is required: the total treatment time will take less than 30 minutes. Less chair time means increased patient comfort and satisfaction. Pola Office+ can be used with or without a bleaching light as it does not require light activation. Any heat emitting curing light can be used thus eliminating the need for special and expensive lights. With Pola Office+, there is no need for trays to be made and no mixing is required. Pola Office+ uses a dual barrel syringe system, which mixes as you apply ensuring a consistent blend of freshly activated gel for every treatment. The fine applicator tip syringe allows easy application even in tight spots. Achieving a whiter smile produces happy patients and satisfied dental offices. Using the world’s fastest bleach means you spend just 30 minutes.


high viscosity, light cured, resin reinforced glass ionomer restorative material

UÊ >ÃÞÊ̜ÊÅ>«iÊ>˜`ÊVœ˜ÌœÕÀÊqʘœ˜ÊÃ̈VŽÞ UÊ -ÌÀœ˜}Ê`i˜Ìˆ˜ÊÀi«>Vi“i˜Ì UÊ *ÊEÊ ÊvÀii UÊ œÊÅÀˆ˜Ž>}i UÊ Ài>Ìʓ>À}ˆ˜>Ê>`>«Ì>̈œ˜ UÊ ÝVii˜ÌÊvœÀʓˆ˜ˆ“>Þʈ˜Û>ÈÛi Ê `i˜ÌˆÃÌÀÞÊ­ ® UÊ ˆ}…Ê>Vˆ`ÊÀiÈÃÌ>˜Vi

UÊ >ÃÞÊ̜ʓ>˜ˆ«Õ>ÌiÊ>˜`ÊÃVՏ«Ì UÊ *ÊvÀii UÊ "À>˜}iʏˆ}…ÌÊÃ>viÊ̈«Ê«ÀiÛi˜ÌÃ Ê «Ài“>ÌÕÀiÊÃiÌ̈˜} UÊ ˆ}…iÃÌÊVœœÕÀÊÃÌ>LˆˆÌÞÊ̜ÊÌi>ÊEÊVœvvii UÊ œ˜}ÊÌiÀ“ÊÜi>ÀÊÀiÈÃÌ>˜ViÊ`ÕiÊ Ê ÌœÊ…ˆ}…ÊÃÕÀv>Viʅ>À`˜iÃà UÊ i݈LiÊܜÀŽˆ˜}Ê̈“iÊ

non-stick GIC Your Smile. Our Vision.

,ˆÛ>ʈ}…ÌÊ ÕÀi\Ê/ Ê /Ê 6-",Ê 6œÊÓn]Ê œ°Ê™]Ê œÛÊÓ䣣


Chiropro L Increase your expectations Implantology is a demanding discipline. That is why Chiropro L leaves nothing to chance. Created with practitioners for practitioners, it is an ultra-efficient, extremely versatile implantology system, designed for numerous clinical applications. THE UNIT The Chiropro L incorporates 7 of the leading implant systems on the market with their complete sequences. Chiropro L can also be customised according to your needs and adapt to multiple users. From preparation of the implant site to implant insertion, the pre-programmed clinical sequence is displayed on screen. Only a few seconds are needed to define, save or modify your program. Designed to simplify your daily practice, the Chiropro L unit is infinitely versatile, allowing numerous clinical applications such as implantology, endodentistry and dental surgery. MX-LED CHIROPRO The MX-LED Chiropro micromotor is a model of stability. At both high and low speeds, the MX-LED Chiropro offers you ideal working comfort. With itâ&#x20AC;&#x2122;s high level of output torque, the MX-LED Chiropro is just simply the most powerful micromotor

on the market. Depending on the torque needed, the power is automatically regulated and stabilised electronically. Accordingly, the speed is kept constant throughout the operation. Another major advantage is that the micromotor allows LED lighting on the contra-angle with the same luminous intensity at both high and low speeds.



Carestream Dental Cares Dentists may have noticed a gradual change to the brand Kodak Dental Systems as it moves over to Carestream dental and so we decided that perhaps a brief summary might be appropriate. In 2004 the Health Division of the Eastman Kodak Corporation acquired Practice Works who in turn had recently acquired Trophy Radiology and created Kodak Dental Systems. Immediately you had the combination of three great companies that have served the trade with milestone innovations. Kodak invented x-ray film; Trophy produced the first ever digitals sensor and Practice Works pioneered practice management software However in 2007 Eastman Kodak sold all of the assets and patents of their medical and dental business to Canadian company Onex and the name Carestream Health and Carestream Dental were introduced. Dental News, Volume XIX, Number I, 2012

Carestream Dental are unique in that they provide manufacture the complete solution in dental imaging. The factory in Paris turns out up over 400 generators per week as well as coordinates their research and development of new technologies. Many of the products are manufactured from basic components ensuring total control of the quality of our products. Carestream Dental Imaging Systems are installed throughout the world taking in excess of 800,000,000 images per year, When you choose a Carestream Dental product, be it film or digital, you are joining millions of other Dentists throughout the world who have also made that choice to ensure that they are benefiting their patients with the highest quality images at the minimum dose to provide accurate diagnostics.




The best things in life are simple.

1909 – 2009

The new KaVo ESTETICA® E50. Simply top of its class. DEPURDENT® cleaning and polishing paste for a brilliant smile Experience the feel of perfection and allow % Free from chemical bleaching substances, visionary details and an intuitive operating preservatives and system to make yourenzymes everyday work easier. % Eliminates plaque and • Simpleeasily to use: user-friendly dentiststains of tea, element thanks to ideal combination of nicotine, coffee and fruits direct buttons and menu control. % Contains the naturalstate-of-the-art active ingredient • Simple to upgrade: upgrade possibilities and visionary pumice system solutions. % For professional and home use • Simply reliable: 100 years experience with highest quality, made in Germany. Simply made to perfection. The new KaVo ESTETICA E50.









DEPURDENT® Mouthrinse - The perfect supplement to DEPURDENT® cleaning and polishing paste! % Its special formula prevents the formation of plaque and stains and helps to retain the natural white color of the teeth. % Fluoride protects against caries. % Refreshing taste for long-lasting fresh breath.

Dr. Wild & Co. AG

New Swiss professional oral care

Dr. Wild’s Mideast Regional Office: Actco, P.O. Box 40746, Larnaca 6306, Cyprus, Tel.: (24) 623515 / 654252, Fax: (24) 623844. E-Mail:

Bahrain: Awal Pharmacy, East Riffa, Bahrain. Egypt: Sesic, Alexandria. Kuwait: Al-Maseela Pharmaceutical Co., Safat. Lebanon: A.M.G. Medical.JdeidehKaVo Khalil Dental GmbH · D-88400 · TelefonSaudi +49 7351Arabia: 56-0 · Fax +49 7351 1103 · du Moyen OriAzur Center Oman: Ibn Sina Pharmacy L.L.C., Muscat. Qatar: Ahmed Al Baker &Biberach/Riß Sons, Doha. Depot Pharmaceutique ent, Jeddah. Sudan: Pharma Care Co, Khartoum. United Arab Emirates: Al Hayat Pharmaceuticals, Sharjah. Yemen: Al Rawdha Trading Group, Sana’a.



The ESTHETIC dual-/light-curing luting composite system


The UNIVERSAL self-curing luting composite with light-curing option


The FAST self-adhesive, self-curing resin cement with light-curing option Ivoclar Vivadent AG

Bendererstr. 2 | FL-9494 Schaan | Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60

Dental News March 2012