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Introduction To Laser Applications in Dental Treatments

ISSN 1026 261X

Mouth Breathing, Malocclusion & the restoration of nasal breathing

JUNE 2019

IDS 2019 CAD/CAM 2019 Lebanese University 16 International Convention th

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Introduction To Laser Applications in Dental Treatments

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Mouth Breathing, Malocclusion & the restoration of nasal breathing

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June 2019



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February 4 - 6, 2020 Dubai, UAE


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June 2019

Dental News


Laser Dentistry

Introduction To Laser Applications in Dental Treatments Laser History

Dr. Hoda El Hallal Dental Surgeon Private Practice in Beirut-Lebanon Diploma in Oral Biology DOB Fellowship & Master of Science MSc in Laser Dentistry Professor a.c. at Genoa University Reviewer at LIMS

In 1960, the American physicist Theodore Maiman created the first Laser1 at Hughes Research laboratory, Malibu - California. He was able to take a rod of ruby, a synthetic crystal, to energize it with a flashlamp & to produce red laser light in the visible spectrum at 694 nm, that he could see. In 1965, Ralph H. Stern and Reidar Sognnaes2, from the University of California - Los Ange-

les, used the ruby laser to vaporize enamel and dentin. Hard tissue ablation with ruby laser reported an increase in pulpal temperature with detrimental effects. Technology should wait until 1989, when the American dentist Terry Myers designed the first Nd:YAG laser specifically for dentistry. Since then, clinical applications continue to increase making laser use one of dentistry’s most exciting advances.

Different dental laser wavelengths (visible & infrared invisible range) & the electromagnetic spectrum (fig.1) Nowadays, available commercial dental lasers are in the range of 377nm to 10600nm and are all nonionizing electromagnetic radiation i.e. they do not cause any mutations in the cellular DNA3 components like gamma-rays and X-rays. Some are in the visible spectrum of light (about 380nm – 750nm) such as Alexandrite laser 377nm violet light that has a very high absorption in calculus and not so high absorption in dentin. Another laser in the visible spectrum is, the new blue diode laser 445nm, that is very highly absorbed in hemoglobin, almost 500 times as well as 810nm diode lasers permitting very easy soft tissue ablation. Argon laser, no longer available for dentistry, that has 2 wavelengths one 488nm is blue light for composite curing and the other is 514nm in the intense green light, helpful for soft tissue ablation. The frequency doubled Nd:YAG 532nm green color laser also called KTP (Potassium Titanyl Phosphate) laser very useful for photochemical bleaching. He-Ne (Helium Neon) laser has 632nm red light or Diagnodent caries diagnostic laser uses a visible red wavelength of 655nm etc. All the rest of the dental lasers emit invisible light in the near, mid and far infrared portion of the electromagnetic spectrum: The diode laser (805, 808, 810, 830, 940, 980 and 1064nm), the Nd:YAG laser (1064nm), the Erbium family lasers with the Er,Cr:YSGG laser (2780nm) and Er:YAG laser (2940nm), the CO2 laser (9300, 9600 & 10600nm)4.


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June 2019

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Laser Dentistry

Fig. 1

Figure 1: Electromagnetic spectrum is the range of all electromagnetic radiations.

Invisible infrared dental lasers Currently, all available dental lasers are soft tissue lasers. The dentist can choose from the variety of wavelengths, because they are all absorbed by at least one of the soft tissue components. Infrared dental wavelengths can be divided in 2 major categories: • Short laser wavelengths in the near-infrared spectrum (800–1100 nm) such as diodes and Nd:YAG lasers are essentially transmitted through water, showing a low absorption coefficient in water5. This explains their deep scattering into healthy soft tissue (0.8-6mm). However, they are selectively absorbed in areas of inflammation by blood components and tissue pigment which make them soft tissue lasers by excellence6. There is also minimal to no interaction of diodes and Nd:YAG lasers with healthy dental hard tissue, which makes them suitable for soft tissue procedures only7. All surgical applications for lasers rely on the conversion of electromagnetic energy into thermal energy8. These lasers are quite effective for intraoral soft tissue procedures such as gingivectomy, operculectomy, oral biopsy, gingival troughing, second stage implant uncovering, frenectomy and fribroma removal etc. However, they can also be used for periodontal procedures where periodontal pocket sulcular debridement predominates. They also may be applied for laser-assisted tooth bleaching, dentin desensitization, direct laser irradiation in conventional laser endodontic.


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Introduction To Laser Applications in Dental Treatments

Moreover, these short laser wavelengths have excellent photobiomodulation properties as well. • Longer laser wavelengths, mid-IR and far IR such as Erbium family and CO2 lasers, present a very high absorption coefficient in water, and due to the high water content of oral mucosa (>70 - 90%), they are very selective for soft tissue procedures. Ablation of tissue is achieved through the nearinstantaneous vaporization of interstitial water, leading to an explosive fragmentation of tissue structure, making them soft and hard tissue lasers at the same time9. These lasers (Er,Cr:YSGG, Er:YAG and CO2 lasers) may also be applied in periodontal therapy such as direct removal of calculus through scaling & root planning (SRP) the periodontal pocket, indirect laser irradiation and photoacoustic effet in endodontic procedure, treatment of mucositis & periimplantitis, all clinical situations of bone cutting and restorative procedures etc.

Case report of soft tissue crown lengthening The case report that will be presented below was realized with a 980 nm diode laser. Diode laser is one of the most popular lasers because of its compact size, light weight, portable unit (fig.2) and relatively reduced cost while remaining efficient with beneficial effects.

Fig. 2

Figure 2: 980nm Diode laser Wiser from dr Smile company.

Its active medium is a solid state, composed from semi-conductor crystal combining Indium, Gallium and Arsenide (InGaAs) that transform the electric current into light energy. It is a modern device with the foundation of modern electronics. Depending on the clinical situation, the diode laser can be used in contact mode (incision, excision, surgery fig.3) or non-contact mode (PBM, bleaching, desensitizing fig.4 etc.).

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Laser Dentistry

Fig. 3

Figure 3: Diode laser in contact mode for gingivectomy

Introduction To Laser Applications in Dental Treatments

amount of heat generated is translated directly into the amount of collateral damage)10. B) With gated continuous mode, when using gated mode, there is still a rise in temperature, but the tissue has time to cool down during the thermal relaxation time, which leads to controlled collateral damage & lower thermal rise. This explains the general recommendation for laser use at low power and in gated mode for soft tissue procedures10. Before surgery with the diode laser, the ultra-thin lasing fiber could be initiated (fig.5). This process allows capturing most of the energy (60% of the energy or more) at the end of the laser fiber and the incision is faster. Fig. 5

Fig. 4

Figure 5: 300Âľm diode fiber initiation on articulating paper.

Figure 4 : Diode laser in non-contact mode for tooth desensitizing

Cutting tissue by diode lasers occurs through photothermolysis: Chromophores in the target tissue absorb the light energy rapidly, immediate rise in temperature with subsequent denaturation of tissue protein, as well as fragmentation and vaporization of the melanin, followed by vaporization of water content. So, it is temperature rise that causes soft tissue disruption. Depending on the temperature level reached at the surgical site, soft tissue are subjected to warming, welding, coagulation, protein denaturation, drying, ablation then vaporization or carbonization10.

This is done by tapping the laser fiber on articulating paper while the laser is energized. Usually a 300Âľm tip is selected for surgical gingival cutting rather than a 200Âľm tip, because this latter is more fragile and breakable11. Before cutting gingival tissue, the depth of the sulcus should be measured with a periodontal probe (fig.7). The bone level should be sounded and a biological width of 2-3mm should be respected in order to avoid any further periodontal damage12. Fig. 6

Power settings of the diode laser device are adjustable, and the laser beam may be delivered in a constant continuous mode or in gated mode: A) With continuous mode, there is a gradual increase in the temperature then heat generation gets much faster; there is tremendous risk to get uncontrolled damage (the


Dental News

Figure 6: Pre-operative photograph. Patient complaining form gummy smile on teeth # 12-11-21-22. June 2019

Laser Dentistry Introduction To Laser Applications in Dental Treatments

Fig. 7

Figure 7: Periodontal probing before soft tissue cutting.

During surgery, the 300Âľm fiber tip is placed in contact with the tissue. This gives the clinician the essential tactile feedback which is absent with some other lasers such as CO2 lasers12. Excision is performed with gentle sweeping brush motions (fig.8). It is important to emphasize that the laser tip does not cut like a blade, but it vaporizes tissue layer by layer at the fiber end and not on the sides, since these latter areas are protected by the collimation cladding so the energy cannot be transmitted through the sides10. The correct technique is to avoid pressing on the fiber, but to simply guide it along the precise route desired, using light brush stroke to “paint away“ the amount of tissue to cut11, and to let the highly directed laser energy do the work. Water irrigation with a syringe is helpful to reduce the charred layers and to cool down the tissue; high aspiration removes the dangerous laser plume. Fig. 8

Fig. 9

Figure 8: 300um laser tip in action. Figure 9: Immediately post-operative view. No bleeding at all. Little carbonized tissue that will be removed with a damp gauze.

Fig. 10

Fig. 11

Figure 10: 2 weeks post-operative view. Mild inflammation on teeth # 11 & 21 due to patient use of H2O2 during at home bleaching. Figure 11: One month post-operative view


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June 2019

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Laser Dentistry

Fig. 12

Introduction To Laser Applications in Dental Treatments

3. Musale PK, Soni AS, Mujawar S and al., Use of Nd:YAG laser in the treatment of ankyloglossia for pediatric patient. Journal of Dental Lasers 2012;1(6):33-7 4. Dang M, Ram S. Integrating Laser Dentistry into Esthetic dentistry. IJOLD 10022-1021 5. Kotlow L. Lasers and Soft Tissue Treatments for the Pediatric Dental Patient. Alpha Omegan 2008;101(3):140-51

Figure 12: 6 months post-operative view. 6. Gupta A, Jain N and Makhija P.G. Clinical Applications of 980 nm

Advantages of diode laser surgical applications in comparison with conventional techniques

Diode Laser for Soft Tissue Procedures in Prosthetic Restorative Dentistry. J Lasers Med Sci. 2012; 3(4):185-8 7. Kravitz ND, Kusnoto B. Soft-tissue lasers in orthodontics: an overview. Am J Orthod Dentofacial Orthop. 2008;133(4):S110-4.

The inherent properties of laser light make diode surgical lasers the treatment of choice in cutting oral soft tissue because of their ability: • Achieve excellent hemostatic effect with bloodless surgical site due to the nature of photo-thermal ablation that causes denaturation of proteins in tissue leading to small vessels sealing and also stimulation of production of clotting Factor VII 13-14 • No sutures, no dressings – healing by secondary intention. Another advantage is the production of surface coagulum when laser is used thus, preventing the need for sutures. • Less scarring –associated with lack of fibroblast alignment on incisional line. • Less anesthetic required • Reduce the amount of bacteria & other pathogens on the surgical site • Reduce chair side time & reduce per-operative pain • Can be used for medically compromised patients15 • Long healing course in the initial phases16 • Photobiomodulation effect: Minimal postoperative pain, minimal edema with infection & discomfort. Thus reducing the need of analgesics.


8. Gracco A, Tracey S, Lombardo L and al. Soft tissue laser in orthodontics. Prog Orthod. 2011;12(1):66-72 9. Convissar RA. Book of “Principles and Practice of Laser Dentistry”. C Mosby-Elsevier. 10. Sarver DM, Yanosky M. Principles of cosmetic dentistry in orthodontics: part 2. Soft tissue laser technology and cosmetic gingival contouring. Am J Orthod Dentofacial Orthop. 2005; 127(1):85-90. 11. Hilgers JJ. and Tracey SG. Clinical uses of diode lasers in orthodontics. J Clin Orthod. 2004; 38(5):266-73 12. Gracco A, Tracey S, Lombardo L and al. Soft tissue laser in orthodontics. Prog Orthod. 2011; 12(1):66-72 13. Parker S. Laser-tissue interaction. British Dental Journal 2007;202(2):73-81. 14. Parker S. Verifiable CPD paper: laser-tissue interaction. Br Dent J. 2007; 202(2):73-81 15. Kalakonda B, Pradeep K, Mishra A and al. Periodontal Management of Sturge-Weber Syndrome. Case Rep Dent. 2013;2013: 517145

1. Maiman T., Stimulated Optical Radiation in Ruby. Nature

16. Fisher S. et al. A comparative histological study of wand healing


following CO2 laser and conventional surgical excision of canine buccal mucosa. Arch Oral Biol 1983;28:287-29

2. Stern RH, Sognnaes RF. Laser beam effect on dental hard tissues. J Dent Res. 1964;43:873


Dental News

June 2019


Mouth Breathing, Malocclusion and the restoration of nasal breathing Introduction

Derek Mahony

Roger Price

Most dentists and orthodontists are aware of the impact that mouth breathing has on the development of the maxilla. Most are also aware of the fact that even after successful realignment of teeth, unless a retainer is used, relapse usually occurs. The tongue is nature’s retainer and at the lateral force exertion of 500 Gm provides the balance required against the inward force pull of the cheek muscles, at also around 500 Gm. In an ideal world, these two forces would balance each other and normal maxillary development would take place. The primary teeth would erupt smoothly and

evenly and even in the mixed dentition stage there should not be overcrowding or malalignment of teeth. So what causes mouth breathing to occur and what can be done about it? The answer to this lies in the basic physiology that we all studied during the early part of our careers. At the time we learned it we were not able to see its overall importance as we had yet to study the full gamut of anatomy and physiology to see how it all inter-related. By the time this happened we had forgotten most of it. So it should not come as any surprise that the information that follows will certainly strike a chord and probably elicit the usual comment “But I knew that!�

Discussion Before attempting to discuss what constitutes Functional as opposed to Dysfunctional Breathing it is necessary to understand the mechanism of breathing in all its complexity. Functional breathing is initiated when the CO2 level in the arteries (pACO2) reaches 40 mm Hg and stimulates the medullary response at the base of the brain. This in turn sends a signal to the diaphragm causing it to contract and relax and so the breathing cycle is maintained. So what goes wrong? (Fig. 1) There is a norm for blood pressure, pulse, temperature, chemical content of the blood etc., but there is no such thing as Normal Breathing. Breathing has to be appropriate for the activity at the time, and what might be okay when running around the football field is certainly not okay when sitting on a couch watching a football game, beer in hand and loads of high fatty, salt-laden snackfood at hand. So in the absence of Normal Breathing the best we can hope for is the determination of Functional Breathing at Rest. (Fig 2)


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June 2019

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Mouth Breathing, Malocclusion and the restoration of nasal breathing

In the 64 years since starting my studies as a pharmacist, and moving on to many other -ology and –opathy modalities, I have seldom come across a doctor or dentist who has looked at a patient, counted the number of breaths they take per minute and commented that they are breathing for two or three people. They surely enough comment about over-eating or drinking, but the breathing is never even noticed. Figure 1: What makes us breathe Anything that happens to the human body that the system wants to resist or reject sets up a stress response. This stress response, or mini-flight or fight, causes the release of adrenalin from the adrenal glands and our breathing rate rises. This applies to what we ingest, what stressors we encounter factually, as well as emotionally or perceived, and also what physical stresses are placed on the body through poor posture and other anatomical abnormalities.

Figure 2: Functional breathing at rest

The constant messages of increased breathing rate or hyperventilation cause the chemoreceptors in the brainstem to re-set themselves at what is now regarded as the “new normal” and the standard breathing rate rises from 8–10 breaths per minute to anything from 18– 30 bpm. (Fig. 3) Because the nose is not designed to cope with this volume of air, we become mouth breathers, and the constant lowering of CO2 through breathing through the mouth perpetuates the problem. (Fig. 4) The air contains very little CO2 as will be seen from the chart below (Fig. 5). We have to produce our own, within the body, to make up the required amounts. This is done primarily as the by-product of the chemical reactions which take place during exercise and digestion. Numerous health problems arise as a result of this, mainly due to the uncontrolled spasm of smooth muscle systems throughout the body which are dependent on the presence of 40 mm Hg PaCO2 and approximately 6.5% pulmonary content of CO2 to maintain integrity.


Dental News

June 2019


Mouth Breathing, Malocclusion and the restoration of nasal breathing

So, apart from the dental and orthodontic problems caused, myriad other problems arise due to this dysfunctional breathing. The two with most impact on the dental and orthodontic professions are:

• Snoring Snoring is essentially the movement of too much air over the loose tissue at the back of the throat, causing it to rattle. Usually accompanied by open mouth breathing it perpetuates the loss of CO2 and maintains the dysfunctional breathing pattern. In many cases, teaching the patient to reduce the breathing rate and to sleep with closed mouth virtually eliminates the problem.

Figure 3: Why breathing changes

• Sleep Apnea (Fig. 6) Sleep apnea is a little different in that it is in many cases caused by a disruption of the pH of the blood due to the decrease in CO2. This causes the blood to become too alkaline leading the brain to think that the body cells are in danger of dying (which they are). The brain’s response to this is to suppress breathing for sufficient time for the CO2 level to rise, for more carbonic acid to be produced to buffer the blood and remove the


Dental News

Figure 4: The problem with mouth breathing danger to the cells. Once this has been achieved the signal to breathe is again given. However, in the case of sleep apnea the ensuing breath is a large gasp and this lowers the CO2 levels again to danger point. This is why sleep apnea is characterised by a pause-gasp cycle which can occur up to 20–50 times an hour. In most cases this can be controlled by restoring CO2 levels to normal, ensuring that the pH integrity is maintained and the need to stop breathing is then removed. June 2019

Orthodontics Mouth Breathing, Malocclusion and the restoration of nasal breathing


So much flexibility is unbelievable!

Figure 5: The carbon dioxide confusion

Restoring nasal breathing as the norm


The good news is that it is possible to reverse this situation and re-create functional breathing. This requires several steps which begin with identifying the cause of the original problem. Unless this is done, and the habit modified, relapse is a real fact of life. It is also necessary to address the breathing mechanics and dynamics so that the optimal levels of retained CO2 can be restored. The moment this happens the medullary response recognizes that retained CO2 levels have risen and starts to re-set the response to the appropriate level. (Fig. 7)


Dental News

June 2019


Figure 6: Central sleep apnea

Dr Derek Mahony is a Sydneybased specialist orthodontist who has spoken to thousands of practitioners about the benefits of interceptive orthodontic treatment. Early in his career, he learnt from leading clinicians the dramatic effect functional appliance therapy can afford patients in orthodontic treatment, and he has been combining the fixed and functional appliance approach ever since. His lectures are based on the positive impact such a combined treatment approach has had on his orthodontic results and the benefits this philosophy provides from a practice management viewpoint. Roger Price is an internationally recognised Integrative Health Educator with more than 60 years of experience in various aspects of human health, growth and development. For the past 20 years he has been working with Dentists and Orthodontists correcting the erroneous belief that the raft of chronic disease – caused by fractionated sleep and disturbed sleep cycles – are ‘Sleep Disorders”. This is, in the vast majority of cases, untrue. People do not wake because they can’t ‘sleep’, it is

Figure 7: Restoring functional breathing

because they can’t ‘breathe’. He can be contacted at The Graduate School for Behavioral Health Sciences where he is the Director of Professional Services.

FDW Concept Esthetic Dentistry Miladinov Milos dental technician Arnold Forray dental technician

Implementation in everyday practice From the desire to find a 100% predictable workflow in morpho-functional rehabilitation of patients through 100% digital procedures that require shorter prosthetic time, we put together a digital puzzle about which we will speak in the next few lines. First of all we need the right equipment, tested

and approved, to meet these high demands and here we speak of speed, precision and predictability in the work process. After about 3 years of research and work to get these results we can confirm that we can easily achieve these cases with the help of advanced technology.

List of necessary equipment

1. Facial Scanner Why facial scanner? The documentary protocol will no longer have the photo included, because now the 3D face capture technology is advanced enough to be used in planning our cases. Some scanners are quite inaccessible due to their higher price or difficult use, although we can identify some apps that are sold on the market that can turn the mobile phone into a facial scanner. Be aware that when choosing your facial scanner you have to

Fig. 1

Figure 1: AFT face scanner


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make sure it has a integrated workflow in order to be able to use it in everyday practice. For example, phone apps for 3D face capture have distortions and are not accurate due to algorithms that are meant to smooth the face skin, which can distort the final results. You need a dedicated facial scanner with integrated workflow and especially the ability to do multiple body scanning in order to transfer vital information into the 3D design of the future smile.

Fig. 2

Figure 2: forehead scan body and mouth scan body June 2019

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Esthetic Dentistry

So far it’s simple, but what are body scans and how can they help us? For the AFT scanner we have two such accessories: -a leading body scan -a body scan for your mouth They are positioned according to the training that you benefit from when purchasing the product, namely the leading one is positioned on the front of the patient and is fixed well because it’s being used throughout the scanning period. The mouth accessory is fixed intra orally with the fingerprint material in the intra oral component of this accessory, and the extra oral accessory remains out to be scanned. After that we save the data into the EXOCAD CAD design software, where we can see the exact position of the jaw in the patient’s head, the same position as the patient’s jaw position. Thus, we no longer need a jaw guidance, which makes it easier to simplify the workflow by acquiring highly accurate data. The design software allows us to place the patient’s head and intra oral stl file with great precision in the virtual articulator, and then we can begin designing the new smile with respect to the patient’s face. Until now, this was completely lacking and all protocols relied heavily on a 2D picture which was not enough. With the help of the virtual articulator, once we finish the new design, we can create a prosthetic piece, both aesthetic and functional. The most important thing is that we can now communicate more easily and precisely with your physician allowing us to connect computers or apps in real time, thus actively participating in the design and confirmation of the final design.

FDW Concept Implementation in everyday practice

2. Intra oral Scanner The multitude of intra oral scanners and prices can give you headaches in choosing them. Before purchasing, you should know how accurate the data acquisition is, how reliable it is and how much it is appreciated in the work protocol. Our choice was the MEDIT i500 new Korean scanner of high precision and speed. WHY MEDIT? Simple: • Accuracy and speed • Color scanning • Easy to use interface • Free updates • Very good purchase price • Exports STL and PLY files • Zero annual fee These reasons are almost enough, but it’s always a good idea to read the reviews of other experts and real feedback of real users who already have this scanner. We use it successfully in courses already and in patient cases, of course in combination with the facial scanner for higher predictability. One of the best advantages of this scanner is the reduced weight and the smaller head than the next one on the market, so the acquisition of the data, ie the intra oral impression in hard-to-reach areas, is much easier. Imprint time is much lower than the classic version, which of course implies lower costs. The impression does not suffer from contractions and the printed model is 100% faithful, which helps us eliminate the two major causes of errors in the prosthetic parts. As with analog impression we still need to use the retraction cord as it’s not possible for any scanner to access the sub gingival area.

Fig. 3

Figure 3: Face scan cu scan body/ Face scan in rest position/ Face scan in full smile


Dental News

June 2019

Esthetic Dentistry

FDW Concept Implementation in everyday practice

Intra oral scanners can also be of use in cases where no photos are needed. You can store .stl files on your computer before and after the end of the case. This way you can have the patient’s three-dimensional real situation at any time.

Fig. 4

Figure 4: MEDIT i500 intra oral scanner

Fig. 5

Figure 5: digital color impression in .ply format for exocad

3. CAD design - EXOCAD Once you’ve acquired the .stl files from the facial and intra oral scanners, you can integrate them into Exocad and you can accurately plan the new design for the prosthetic piece. The project will be part of the facial and intra oral scanner file superimposed by the two types of scan bodies, the result being one of great precision when compared to cheap scanners without working protocols. Both the front of the patient and the intra oral situation will be visible on the screen, so we will be able to use the virtual articulator and we can function the prosthetic piece.

When finished, we can show in real-time to the physician the new design for confirmation and/ or on request, we can make small adjustments of shape or size. Now there are dozens of teeth libraries, from which we can choose a morphology/ shape that best suits the situation, especially as planning is being done on a simulator, identical to the patient. The new smile will be made taking into account the interaction between the teeth, lip and face of the patient. We can also add the CBCT of the patient if we need the hard and soft tissues for a more accurate planning if implants, bone remodelling for coronary elongation, etc. are required.

Fig. 6

Figure 6: integration of facial and intra oral scanners into Exocad


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June 2019

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Esthetic Dentistry

Fig. 7

FDW Concept Implementation in everyday practice

If we are to implement the latest method, namely the direct printing of veneers, you need to know that it is the fastest and most accurate. The greatest advantage is that it can be “customised” by the physician directly into the patient’s mouth and can be rescanned to serve as the ultimate design. The patient can thus benefit from a real “testdrive” of the new smile. After final acceptance, this design can overlap on the final digital impression with preparations and can replicate 1 on 1, so the patient and the doctor will not have unpleasant surprises to receive restorations that do not resemble the initial stage teeth.

Figure 7: full project in exocad

4. 3DPrinter, SHERA print30

Fig. 8

Once the design has been completed and we have the physician’s/ patient’s consent, we can go to the last stage of planning, namely the printing of the new design. Here are three possibilities: • Printing a block model and making a silicone key - the classic method • Printing a silicone key and making a mock-up after this key • Printing the initial situation without preparation and printing the mock-up veneers, the full-digital, fastest and most accurate method.

Fig. 7 Figure 8: Printed veneers project

As a variety of materials we can mention: • hard resins for creating working patterns or surgical guides • resilient resins for making the gum or silicone-type keys for mock-up • aesthetic hard resins for veneers used for mock-up • total burning resins for pressing technique This printer uses DLP technology and is very fast, being able to print two Geller arcades in less than an hour, or 30 crown veneers in less than 45 minutes being net superior to the quality and speed of any milling machines. Figure 7: printing done with SHERA print30


Dental News

June 2019

We can be highly predictable from the planning phase, with the new design, and we can accurately measure the length or width and even the thickness of the future prosthetic piece. Moreover, we can measure the distance between the lip and the teeth and we can influence the thickness of future veneers to create an ideal support for the lips.

Fig. 9

Figure 9: elastic gum model

Following the design we are ready to print the veneers, as you can see the result in the following pictures. The patient has confirmed and accepted the treatment plan and we will proceed to the next stage, namely the completion of the case with minimally invasive veneers with Dr. Dan Patroi.

Fig. 10

Figure 10: geller printed model

Fig. 10

Figure 10: Full smile Digital Wax Up

4. MATERIAL used for milling After everything is properly planned and we have already approved the final shape of the veneers/ crowns, we can use a wide range of materials for an optimal aesthetic result: • IPS e.max CAD in colors A1 - D3 • IPS empress CAD multi in colors A1 - D3 • IPS e.max zirCAD LT & MULTI • Telio CAD


The Relationship Between Periodontal Disease and Vitamin D Introduction

Colin Bonnet DMD, MDent

Rasheda Rabbani PhD

Anastasia Kelekis-Cholakis DMD, MDent

Vitamin D is a fat-soluble vitamin obtained from exposure to sunlight, diet and nutritional supplements.8 Vitamin D is metabolized in the liver to 25-hydroxyvitamin D (25(OH) D) and then metabolized in the kidneys to its active form, 1,25-dihydroxyvitamin D (1,25-(OH)2D).8 As the major circulating metabolite in the blood, 25(OH)D is used to determine a patient’s vitamin D status.8 Although there is no consensus on optimal levels of 25(OH)D, most experts define < 50 nmol/L (20 ng/mL) as vitamin D insufficiency.8 Recent evidence suggests that 25(OH)D levels may need to be as high as 75 nmol/L (30 ng/mL) to achieve optimal vitamin D status.8

Robert J. Schroth DMD, MSc, PhD

Vitamin D is involved in regulating calcium absorption from the intestines, maintaining plasma calcium concentration and bone mineralization.9 Studies have found significant positive associations between 25(OH)D levels and bone mineral density10 as well as between vitamin D supplementation and a lower risk of fractures.11

Michael E.K. Moffatt MD, MSc

Republished with permission from the Journal of the Canadian Dental Association Issue number 2019;85:j4


Chronic periodontitis is an inflammatory condition of the periodontium initiated by microbial biofilms that form on the teeth.1 Bacterial products, as well as the host’s immune response to these products, result in destruction of the tissues that support the teeth, including alveolar bone. Because of this tissue destruction, chronic periodontitis is a major cause of tooth loss in adults.2,3 Prevention of this disease is important because tooth loss can affect one’s nutritional status4 and quality of life.5 Chronic periodontitis has also been associated with systemic conditions, such as cardiovascular disease6 and type II diabetes mellitus.7

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More recent evidence indicates that vitamin D also has a regulatory effect on the immune response, stimulating immune response at times, while inhibiting it at others. One study12 demonstrated that increased production of the antibacterial proteins cathelicidin and beta-defensins followed exposure to antigens. The authors concluded that the ability to produce active vitamin D improved bactericidal activity. There are many examples of vitamin D’s ability to inhibit the immune response. In vitro studies have shown that 1,25-(OH)2D inhibits the proliferation, maturation and differentiation of dendritic cells from monocytes.13 The active form of vitamin D also inhibits the production of inflammatory cytokines in monocytes.13 Some studies have also reported that 1,25-(OH)2D has the ability to suppress the proliferation and cytokine production of T-lymphocytes.13 References available in the digital copy. Read it on June 2019

Because chronic periodontitis is characterized by bone loss triggered by a host immune response reaction to bacterial plaque, vitamin D deficiency may have an effect on the development and progression of periodontal disease.14-19 Two large cross-sectional studies14,15,17 have found an association between low vitamin D levels and markers of periodontal disease. However, the largest prospective study to date,19 as well as the most recent cross-sectional study,20 found no relation between these two entities. It is clear that further research is needed to determine what impact vitamin D status has on the progression of periodontal disease. The aim of this study was to explore the relation between 25(OH) D concentration and periodontal disease measured by gingival index (GI) and loss of attachment (LOA) using data derived from the Canadian Health Measures Survey (CHMS).

Materials and Methods Study Sample Data were obtained from people 6–79 years of age participating in cycle 1 of the CHMS. Cycle 1, which was undertaken from 2007 to 2009, was a national, crosssectional survey, conducted by Statistics Canada, of a representative sample of 97% of the Canadian population in all provinces and territories.21 Data collection involved physical measurements and interviews (household questionnaire) completed by 5604 participants.21 All participants provided informed consent. The CHMS excluded full-time members of the Canadian Forces and residents of First Nations reserves, Crown land, certain remote regions of Canada and institutions. Statistics Canada used a probability sampling approach, incorporating aspects of stratification and cluster sampling. From a possible 257 identified sites, 15 were selected and stratified by region. For the purposes of this investigation, we restricted the analysis to those 13–79 years of age for GI and 20–79 years of age for LOA.

Clinical Oral Examination Dental examinations were completed by 14 Canadian Forces dentists calibrated to World Health Organization (WHO) standards (Cohen’s Kappa ≥ 0.6). GI on the buccal, lingual, mesial and distal surfaces of each of 6 indicator teeth (16, 12, 24, 36, 32 and 44) was recorded. GI was scored using Löe’s gingival index, the highest GI score for each participant was used and the data were

dichotomized into “no or mild inflammation” (groups 0 and 1 combined) and “moderate to severe inflammation” (groups 2 and 3 combined). The Williams probe was used to measure LOA, which was defined as the distance from the cemento-enamel junction to the bottom of the periodontal pocket, at 6 sites on each of the WHO’s indicator teeth that were present (17, 16, 11, 26, 27, 37, 36, 31, 46 and 47). Examiners recorded the highest LOA measurement for each sextant. The highest score for LOA for each participant was used and then LOA was grouped into 3 categories: slight (≤ 3 mm), moderate (4–5 mm) and severe (> 5 mm). Using Green and Vermillion’s simplified oral hygiene index, examiners recorded plaque on the labial surfaces of maxillary teeth and mandibular incisors and the lingual surfaces of mandibular molars on the same indicator teeth used for LOA, recording the highest score for each sextant; a mean plaque score was calculated for each participant.

Assessment of Plasma 25(OH)D Plasma vitamin D levels were measured by a chemiluminescence assay, the LIAISON 25-hydroxyvitamin D TOTAL assay (DiaSorin, Ltd., Stillwater, MN, USA).21 Two vitamin D cutoff levels were examined in this investigation: 50 nmol/L (based on the Institute of Medicine’s threshold for vitamin D sufficiency) as well as 75 nmol/L (based on emerging evidence for optimal vitamin D). Mean 25(OH)D levels were also examined.

Data on Other Covariates To account for other confounding factors affecting GI and LOA, additional independent variables were considered. Smoking was included using the household questionnaire. Respondents were classified as “never smokers” (smoked < 100 cigarettes during lifetime), “former smokers” (smoked ≥ 100 cigarettes during lifetime, but not currently smoking) and “current smokers” (smoked ≥ 100 cigarettes in lifetime and currently smoking). For the analysis, current smokers and former smokers were combined and compared with never smokers. Smoking was also analyzed using pack-years. This statistic was calculated by taking the number of cigarettes smoked each day times the number of years smoked divided by 20; this statistic has been found to correlate with LOA.22 Diabetic status was determined based on the self-


reported household questionnaire. Diabetes status has been shown to correlate with gingival inflammation23 as well as with extent and severity of periodontal disease.24-26 An analysis of percentage of glycosylated hemoglobin (HbA1c) was also performed. HbA1c is a measure of long-term diabetic control and values indicative of poor diabetic control have been previously correlated with prevalence, severity and extent of periodontitis.26,27 Values ≤ 7.0% were considered to be good control, whereas values > 7.0% were considered to be moderate to poor control. Body mass index (BMI) may have an influence on GI and LOA.28,29 Mean and classes of BMI were compared with markers of gingival and periodontal infection. BMI was calculated using kg/m2 and participants were classified as underweight (BMI < 18.5), normal (BMI 18.5–24.9), overweight (BMI 25–29.9) or obese (BMI ≥ 30). Annual household income was explored and categorized as < $20 000, $20 000–60 000 or > $60 000. Other covariates considered included daily vitamin D and multivitamin supplement use, annual dental professional visit (yearly or not), tooth-brushing frequency (twice a day or not), flossing frequency, age and sex.

Statistical Methods Data were accessed and analyzed at the Research Data Centre (RDC) at the University of Manitoba using SPSS 20 (IBM, Armonk, NY), SAS 9.2 (SAS, Cary, NC), and Stata 13 MP (StataCorp LP, College Station, Tex.). As per RDC restrictions, original sample sizes were suppressed. Bootstrap weights for variance estimation and weighted results are presented with degrees of freedom fixed to 11. Descriptive statistics include means and frequencies with 95% confidence intervals (CI). X2 tests were used to determine the unadjusted correlation of each categorical independent variable with GI and LOA. Student t tests were used to determine the unadjusted correlation of each continuous independent variable with GI and LOA. Three multiple logistic regression models for GI and for LOA were developed to determine the adjusted association between 25(OH)D levels and GI and LOA, controlling for potential confounders. Model A used 25(OH)D concentration of < 50 nmol/L, model B used 25(OH)D concentration < 75 nmol/L, and model C used mean 25(OH)D concentration. Variables with a p value of ≤ 0.075 were included in the multiple logistic regression


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The Relationship Between Periodontal Disease and Vitamin D

analysis for GI and LOA, with the exception of plasma vitamin D concentration and known risk factors for periodontal disease, such as smoking. A p value ≤ 0.05 was significant.

Results The mean 25(OH)D concentrations (95% CI) in the GI and LOA samples were 90.8 (77.5–104.2) and 85.6 (74.6–97.2) nmol/L, respectively. Although mean 25(OH)D levels were above the thresholds for vitamin D sufficiency, 63% of each sample had concentrations below the 75 nmol/L threshold and 25% of each population had 25(OH)D levels < 50 nmol/L. Bivariate analysis of GI (Table 1) [Ed. Note: All Tables in this article are available in the PDF version]. showed that several variables were significantly associated with 25(OH)D concentrations below the thresholds for vitamin D sufficiency. Participants with 25(OH)D concentrations < 50 nmol/L and < 75 nmol/L had significantly increased odds of having more GI (odds ratio (OR) 1.63 and 1.44, respectively). Those taking vitamin D supplements had significantly lower odds for GI (OR 0.56), while those with diabetes had increased odds of having moderate to severe GI (OR 1.33). Mean BMI was significantly higher among those with the worst GI. Meanwhile, those who reported frequenting a dental professional ≥ 1 time a year, brushing their teeth twice daily and flossing daily had significantly lower odds for GI. Increased scores for plaque were associated with increased odds for moderate to severe GI. Males had increased odds for GI compared with females, while those in higher-income categories had lower odds for GI than those in lowerincome categories. However, when confounding variables were controlled for, multiple logistic regression analysis of GI (Table 2) showed that only plaque and sex were significantly associated with GI. Females had lower odds of moderate to severe GI, while high values for the plaque index increased the odds of moderate to severe GI. No significant relation between 25(OH)D and GI was observed in models A, B or C in the multiple logistic regression analysis of GI. Several variables were significant in the bivariate analysis of LOA (Table 3). Surprisingly, taking a multivitamin or a vitamin D supplement was associated with increased odds of more severe LOA. Higher mean HbA1c values were associated with increased odds of more severe LOA as was HbA1c > 7%. June 2019

Older age was associated with increased odds of more severe LOA, while an income of > $60 000 was associated with lower odds of more severe LOA. No significant association was found between 25(OH)D levels and LOA in the bivariate analysis. After multiple logistic regression analysis, few variables were found to be significantly and independently associated with more severe LOA (Table 4). However, 25(OH)D concentrations < 75 nmol/L were found to be statistically significant (p = 0.05); levels below this threshold were associated with an increased relative risk ratio (RRR 2.09) of severe versus slight LOA. Age and smoking were also found to be significant, with increased age and former or current smoking status increasing the relative risk of moderate versus slight LOA.

Discussion In this first study on the association between 25(OH)D levels and markers of periodontal disease in a Canadian population, observations supporting the hypothesis that lower 25(OH)D levels would be associated with higher measures for GI and LOA were mixed. Although we found significant associations between low 25(OH)D thresholds and increased odds of GI, these relations were not observed after multiple regression analysis. Conversely, although no significant associations were found between 25(OH)D levels and LOA using bivariate analysis, we did observe a significant association between the 25(OH)D threshold of < 75 nmol/L and increased relative risk of LOA after multiple regression analysis. One must exercise caution in interpreting this latter finding, as it may or may not represent a true association. Because 25(OH)D levels were a key independent variable of interest, they were included in the various logistic regression models for LOA even though they were not associated with LOA at the bivariate level. Furthermore, it was not possible to perform backward elimination in the multiple regression analysis using the available software while using a bootstrapping command. The fact that stronger associations between 25(OH) D levels and GI or LOA were not observed may seem counter-intuitive based on vitamin D’s roles in bone homeostasis and immune system regulation. However, currently there is conflicting evidence in the literature regarding the relation between vitamin D and periodontal disease.

One of the first studies to support an association between 25(OH)D levels and periodontal disease used crosssectional data from 11 202 participants in the National Health and Nutritional Examination Survey III (NHANES III).14 It reported an inverse relation between 25(OH) D levels and attachment loss in participants ≼ 50 years that was independent of confounding variables. This same group performed a separate analysis on a sample of 6700 participants from NHANES III and found that sites in participants in the lowest 25(OH)D quintile were 20% less likely to bleed on gingival probing than sites in participants in the highest 25(OH)D quintile.15 Millen et al.17 also reported an association between 25(OH) D levels and periodontal disease in a sample of 920 postmenopausal women by measuring alveolar crestal height, tooth loss, clinical attachment level, probing depth and percentage bleeding on gingival probing. They categorized participants as vitamin D adequate (≼ 50 nmol/L) and inadequate (< 50 nmol/L) and also found that vitamin D status was inversely associated with periodontal disease as measured by bleeding on probing and clinical categories that incorporated probing depth as a parameter. Millen et al.19 also published the largest and longest longitudinal study to date analyzing the relation between vitamin D and periodontal disease. Their 5-year cohort study of 655 postmenopausal women measured 25(OH)D concentrations at baseline and follow up as well as multiple periodontal parameters. This study found no significant associations between baseline 25(OH)D concentrations and change in periodontal disease measures after 5 years. Antonoglou et al.20 also reported no significant association between 25(OH)D and selected indicators of periodontal disease among 1262 Finnish participants in their cross-sectional study. The results of our study contain mixed evidence supporting an association between low 25(OH)D levels and periodontal disease. Our observation of associations between low 25(OH)D thresholds and increased odds of GI at the bivariate level are consistent with other studies supporting a relation between 25(OH)D levels and periodontal disease.14,15,17 Likewise, our observation of a significant association between the 25(OH)D threshold of < 75 nmol/L and increased relative risk of LOA in the multiple logistic regression analysis is also consistent with these other


The Relationship Between Periodontal Disease and Vitamin D

studies.14,15,17 Conversely, our observation of no association between low 25(OH)D thresholds and LOA at the bivariate level and low 25(OH) D thresholds and GI in the multiple regression analysis is more in line with results from published longitudinal studies.19,20 Limitations of the present study include the cross-sectional design as well as how the markers of periodontal disease were defined in the CHMS. The cross-sectional design does not permit the determination of causality or the determination of 25(OH)D levels at the time when attachment loss occurred. Measurements for GI and LOA were performed on 6 and 10 indicator teeth. Furthermore, the worst score for each participant was then used to categorize participants into 1 of the categories for GI or LOA resulting in greater potential to overestimate or underestimate the severity and extent of periodontal disease than if full-mouth probing had been used. The use of GI may increase the

subjectivity in this assessment compared with an assessment of bleeding on probing. However, data on bleeding on probing were not available. This subjectivity could lead to the overestimation or underestimation of periodontal disease. An additional limitation is that fact that our samples included participants spanning considerable age ranges: 13–79 years for GI and 20–79 years for LOA. Youth and younger adults are likely to have better oral health than older adults, which may have affected our analysis of selected periodontal outcome measures. The possibility that unaccounted residual confounding variables is another limitation of this study. Strengths of this study include the large size and representative nature of the sample under investigation and the examiner calibration. Another advantage is the availability of actual 25(OH)D levels, which is the recognized gold standard in determining a person’s overall vitamin D status, instead of relying on dietary intake estimates.

Conclusions Although cross-sectional studies14,15,17 have provided strong evidence supporting a relation between vitamin D status and periodontal disease, the largest and longest longitudinal study19 as well as a recent crosssectional study20 failed to find an association between these two entities. The results of our study, performed on a representative sample of Canadian adults, provide modest evidence supporting a relation between low 25(OH)D concentrations and periodontal disease as measured by GI and LOA. Prospective studies with longer follow up are likely required to fully elucidate what effect, if any, vitamin D levels have on the progression of periodontal disease.

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June 2019


Super Coarse Business Administration for the Dental Profession By Ehab Heikal

The theme of this book is intentionally made Black & White….. The two extremes….Being in the dark….. Or under the light… The light of knowledge…. And between both extremes, lies numberless degrees of gray scales. So you select your area. We –as dentists- are very concerned about the oral cavity, but I always say that the mouth is small and the world is vast. So why constrain ourselves in that small cavity? What we are doing in our clinics is not just dentistry. We are in a business, and we run our small organization, thus we need to learn how to effectively and efficiently run our small business in a manner that meets today’s business standards. This book sheds some light on your daily business activity and guides you through the modern techniques of Business Administration. So go ahead, and open the door and, WORK SMARTER, NOT HARDER

IDS 2019 38th International Dental Show

March 12 - 16, 2019 Koelnmesse, Cologne - Germany

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Ribbon cutting with Britta Heidemann (fencing Olympic champion) IDS 2019: Leading global trade fair of the dental industry underlines its outstanding position IDS 2019, which came to an end in Cologne on 16 March 2019 after five days, more than fulfilled the high expectations of the international industry. As such, the undisputed leading global trade fair of the dental industry once again underlined its exceptional position. The event was able to replicate the very good results of the previous event and at the same time realise the ambitious goals for more internationality and higher quality in the offer and demand. The outcome of the trade fair consequently led to satisfied exhibitors and trade visitors. With 2,327 companies from 64 countries, the number of exhibitors rose once again by good twenty suppliers. They came together with over 160,000 trade visitors from 166 countries. Hence, the overall number of visitors rose by 3.2 percent, the number of foreign trade visitors by 6 percent indeed. At the same time, the exhibition space expanded by over four percent up to 170,000 m².

Mr. Poulsen in the BISCO Booth

Almost 80 percent of the visitors were satisfied or very satisfied with the range of exhibition offerings. Good 93 percent said that they would recommend a good business acquaintance to visit IDS. And 70 percent of the respondents are already planning to visit the next IDS in 2021.

South Entrance Drs; Bastawisi with Mr. Malata on W&H Booth


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A-DEC Booth June 2019


ORAL-B Booth SDI Booth

MANI Booth 46

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June 2019


Cologne, Germany March 12 - 16


VOCO Booth

Exhibition Floor

GC Booth




FKG Booth

IDS 2019

SCE ’19 Antonine University Scientific Congress & Exhibition 2019 March 29 - 30, 2019 Palais des congrès Dbayeh, Lebanon

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Inauguration of the SCE in the presence of P. Michel Jalakh the rector and HE Ghassan Atallah Distinguished Guests, The past challenges and the huge technological advancement will be analyzed as a path to reshape our future at the SCE 2019. The birth of the Antonine Institute in dental laboratory in 1986, embraced the spirit of a country with an open horizon. A country thriving for economical, social and scientific success. As impatient optimists, we did not fear globalization nor its adverse challenges. We rather nurtured excellence and sought new means of cooperation. We also understood, that the longing for a dignified profession is not strictly Lebanese, Arab, European, or American. It is universal. It echoes the ambition of each of us to leave a footprint in the academic curricula and the dental laboratories, thus rendering the university a better place. One should simply admit that cooperation is flourishing with universities, big companies in dental technology, and with leaders in the dental field. They remain our best hope for the transfer of knowledge, and their generosity is reciprocated by creating long life learners and consumers. How the knowledge developed by universities can be better transferred towards having a greater impact on the communities? Firstly, always thrive to make legislations better. Legislations are the empowerment of every profession. Secondly, the curricula in dental laboratory must provide adequate business education, leadership, training and practice management modules, they have become basic needs. Thirdly, we should bear in mind that the fine tuning of each individual piece of restoration remains a must. Whatever the technological devices may offer, the uniqueness of the patient makes each restorative piece exclusive and unique too. Fourthly, keep in mind that the body of work has nothing to do with wealth and status, we should always choose lasting achievements over short term gains, in order to make the future viable both economically and psychologically. Above all the cooperation among all members of the dental health team should be established on ethics, values and common beliefs.

Maya Nohra, MPH - Director of Dental Laboratory Technology Department

Maya Nohra and Stephan Provencher president of the Canadian Dental Lab order 48

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Antonine University organization team June 2019

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Bassam Haddad talking

Von Grow explaining the DTG philosophy

about the moon concept

Paolo Battistella life demonstration

Edris Esta Receiving his Certificate from Rodney Abdallah for his lecture about the choice of restorative materials

Elie Mina Dental Left to Right: Dr Brigitte Douaihy, Mr Nasser Shademan, Mr Ahmad Al Samman

Paty Dental Booth 50

Dental News

June 2019

Dentalica Booth

Dbayeh, Lebanon March 29 - 30

Exhibition Floor

Zirconnet team winner of the international charity auction at the Amann Girrbach booth

SCE ‘19

LSPD 2019 Lebanese Society of Pediatric Dentistry 27th Annual Scientific Meeting An FDI continuing Education Day

April 2, 2019 Hilton Metropolitan Palace Hotel Sin El Fil - Lebanon

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Photo from the Opening Ceremony Dear all, During this 27th scientific meeting of the LSPD we tried to get along with a new challenging subject: “Pediatric Oral Pathology and Oral Medicine.� Over the years, Oral Pathology in children and adolescents was always a delicate issue to diagnose and treat. We tried to address this subject with specialists in dentistry and dermatologists. We had the privilege to make it an FDI continuing education day and the honor to be under the Patronage of the Lebanese Minister of Public Health Dr Jamil Jabak. The LSPD is hosting for the second time in Lebanon the International Congress of both Arab and Mediterranean Societies of Pediatric Dentistry during October 29-31, 2020. We will keep on increasing the level of science to be more scientifically connected worldwide.

Dr Bechara Al Asmar President Lebanese Society Of Pediatric Dentistry

Dr. Bechara Asmar, President Lebanese Society of Pediatric Dentistry 52

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Prof. Roger Rbeiz, president Lebanese Dental Association June 2019

Dr. Joseph ElHelou representing the Minister of Public Health

Prof. Ziad Noujeim in his lecture “young mouths in disease”

Trophy Distribution

Prof. Mounir Doumit, representative of the FDI in the Middle East and Northern Africa

Prof. Hani Abdel Salam

shedding light on the oral mucosa

Dr Agop Lazoyan, Prof Mona Ghossoub, Prof Tony Zeinoun, Prof Fouad Ayoub, Dr Tony Dib

Profs; Sherine Badr, Maha Daou

Left to Right: Drs; George Abi Hatem, Guitta Abi Nasr, Shaza Kouchaji, Sandra Dagher, Nathalie Abi Samra, Bechara Al Asmar

Sin El Fil, Lebanon April 2

LSPD 2019

Exhibition Floor

Dr. Micheline Katramiz, Prof. Mona Nahas, Dr. Hasan Bacho, Prof. Roula Dib

Profs; Edgard Nehme, Amine Zoghby

Left to Right: Drs; Jean Claude AbouChedid, Marlene Freiha, Guitta Abi Nasr, Sandra Dagher, Joseph Makzoumeh, Tony Dib


The expected success of a growing event MORE THAN 21,000 VISITORS AT EXPODENTAL MEETING 2019 With another successful edition, the Rimini event confirms itself as the reference event for the sector in Italy. The recently completed edition of Expodental Meeting, the dental sector fair organized by UNIDI, confirms the positive trend of a growing sector: the influx of professionals and operators who crowded the Rimini Fiera pavilions from May 16th to 18th exceeded 8% last year, recording 21,600 total attendees.

The companies on display The approximately 350 exhibitors present have made the utmost effort to involve the public, skillfully mixing recreational and convivial moments with the presentation of their latest innovations, practical demonstrations and scientific events.

As in previous years, Expodental Meeting 2019 stood out in the international trade fair scene due to the extreme care taken in preparation and organizational details. The companies’ interest in the internationalization project of the fair is reconfirmed: thanks to the collaboration of ITA / ICE and the support of the MISE (Ministry of Economic Development), around 1,400 B2B meetings were organized among the over 80 foreign buyers from 24 Italian Countries and Companies. An encouraging + 10% of Italian companies involved in B2B meetings, with + 10% of meetings held compared to the previous edition, shows that the interest of Italian companies abroad is increasingly alive, and that Expodental Meeting is a fundamental platform to expose oneself to the world panorama.


Dental News

June 2019

The scientific update The scientific program deserves a separate discussion: this year too, UNIDI has arranged a set of clinical and extra-clinical events able to offer the best of training to all professionals in the sector, with prominent and great speakers variety of topics covered: this would not be possible without the precious collaboration of the Associations, scientific Societies and universities of the sector.

Compared to previous years, the moments of updating dedicated to dental technology have increased.The crowded rooms, the involvement and the satisfaction demonstrated by the professionals who attended the courses in Rimini, show that we win together.

Not just business In addition to the many extra-business initiatives proposed by the Companies - sweepstakes, aperitifs, parties, etc. - UNIDI celebrated its fiftieth anniversary and thanked exhibitors and visitors for offering Friday closing evening an aperitif to the over 1,500 visitors who were flowing from the pavilions, accompanied from an acrobatic show inspired by Fellini’s circus; despite the unexpected bad weather he has prevented the complete development, it was an opportunity for UNIDI to celebrate with Exhibitors and Visitors of Expodental a unique recurrence.

As in previous years, special attention has been paid to digital news: EXPO3D, UNIDI has added a series of clinical tables and practical demonstrations carried out in collaboration with companies and a pool of young speakers who have received great interest among the participants.

“Our fair is a typical made in Italy product,” says Gianna Pamich, President of UNIDI “Beyond being essential for business and updating, as well as offering innovative and consistent content, it focuses on aesthetics and style”.

The next edition of Expodental Meeting, in Rimini from 14 to 16 May 2020.

‫‪LSOMS 2019‬‬ ‫‪Lebanese Society of Oral‬‬ ‫‪& Maxillofacial Surgeons‬‬ ‫‪View More Pictures On‬‬ ‫‪‬‬

‫‪April 6, 2019‬‬ ‫‪Coral Beach, Beirut - Lebanon‬‬

‫‪Opening Ceremony‬‬

‫أيها الزمالء والحضور الكريم‪،‬‬ ‫تم اإلعرتاف بإختصاص جراحة الفم والوجه والفكني يف لبنان سنة ‪ ،١٩٩٥‬وقد أعطي إذن مزاولة املهنة لألطباء املتدربني ملدة أربع سنوات‪ .‬حالياً‪ ،‬وبعد‬ ‫مرور ‪ ٢٤‬عاماً أصبح عدد السنوات املعرتف به عاملياً خمس سنوات‪ ،‬نرجو من النقيب ومن أعضاء مجلس النقابة وممثيل وزارة الصحة‪ ،‬املساعدة عىل‬ ‫تغيري هذا القانون‪.‬‬ ‫يف سنة ‪ ١٩٩٥‬اعرتفت وزارة الصحة ومؤسسات الجيش‪ ،‬األمن العام‪ ،‬األمن الداخيل وتعاونية املوظفني بهاذا اإلختصاص من طب األسنان‪.‬‬ ‫يف سنة ‪ ٢٠٠٠‬قرر الضامن اإلجتامعي اإلستفادة من خدماتنا وضمنا إىل مؤسسته‪.‬‬ ‫خالل ‪ ٢٤‬عاماً‪ ،‬عمل حاميل هذا اإلختصاص يف املستشفيات الخاصة والحكومية وقد انجزوا عمليات مهمة يف مجال الكسور والرضوض‪ ،‬األمراض‬ ‫الرسطانية‪ ،‬األورام الحميدة‪ ،‬التشوهات الخلقية واملكتسبة يف منطقة الفم والوجه والفكني والعنق‪.‬‬ ‫اكتسبنا ثقة األطباء العاملني معنا يف املستشفيات من اختصاصات مختلفة‪ ،‬وتوصلنا إىل مرحلة التعاون الرسيري ولكن مل نستطيع إنجاز نجاحات مامثلة‬ ‫يف مجتمع أطباء األسنان وسبب ذلك أوالً‪ :‬فصل طب األسنان عن الطب اإلستشفايئ وعن مؤسسات الدولة الضامنة‪.‬‬ ‫هذا اإلختصاص بحاجة إىل تضافر الجهود بني وزارة الصحة والجامعة اللبنانية ونقابتنا‪.‬‬

‫الربوفسور جورج ايب خليل‬ ‫رئيس جمعية جراحي الفم والوجه والفكني يف لبنان‬

‫‪Dr. Georges Abi Khalil president LSMOS‬‬ ‫‪June 2019‬‬

‫‪Prof. Roger Rbeiz President of the‬‬ ‫‪Lebanese Dental Association‬‬ ‫‪Dental News‬‬


Prof. Anwar Al Batayneh from Jordan talking about preprosthetic surgery

Prof. Ibrahim Zeitoun from Egypt talking about the temporal region

Dr. Naji Abboud receiving the certificate for his lecture on ridge augmentation


Dr. Mohamad Abou Khalil offering the certificate to Dr. Mohamad Chahrour

Dr. Wahid Terro offering the certificate to Dr. Saad Al Fayoumi from Egypt Dr. Ibrahim el Husseini offering the certificate to Dr Moutaz Al Khenn

Dr. Ibrahim El Housseini offering the certificate to Dr. Saad El Fayoumi 60

Dental News

June 2019

Dr. Said El Halabi offering the certificate to Prof Akman el Mehdi from Iraq

Tried and tested aspects of the BEGO Semados® S-Implants remain unchanged in the SC/SCX implants Lebanese Fullcare company launched the BEGO Semados implant systems at the Bristol hotel in Beirut with a conference by Dr Andreas Barbetseas and Dr Marcio dos Santos. BEGO Medical is offering the following implant system: • BEGO Semados® SC/SCX implants can be implanted in all jaw regions and all bone qualities. They are recommended for the following applications in particular: in the upper and lower jaw, for D1 and D2 bone qualities, with sufficient bone volume, for sinus augmentation to protect against inadvertent perforation of the Schneiderian membrane. • The SC/SCX implants are available in the standard diameters (3.25/ 3.75/ 4.1/ 4.5/ 5.5 mm) and lengths (7/ 8.5/ 10/ 11.5/ 13/ 15 mm) of the S-implants.

• The trusted surgical process / the surgical preparation with the BEGO Semados® S-Line TrayPlus remains. The existing processing instruments can still be used.

• The BEGO Semados® SC-implants feature the established machined shoulder with a micro-roughness comparable to natural dental enamel (Ra ≈ 0.4).

• Individual treatments, made of a range of materials, can be obtained as usual via the CAD/CAM supported production of BEGO Medical. June 2019

Dental News


CAD/CAM 2019 14th CAD/CAM & Digital Dentistry Conference & Exhibition

April 12 - 13, 2019 Madinat Jumeirah Conference & Events Center Dubai, United Arab Emirates

View More Pictures On

Photo from the audience on the first day of the conference The 14th edition of the CAD/CAM & Digital Dentistry Conference & Exhibition organized by CAPP covered all current trends in digital dentistry, further educating dental professionals with additional insights into the latest CAD/CAM systems and Digital Dentistry. Advances in digital dentistry bring substantial changes in today’s dental practices. The traditional partnership between dental laboratories and dental offices are built on a foundation of computer-assisted designs and the growing movement towards digital impressions. Moreover, CAD/CAM systems in dental clinics and dental labs are becoming standard equipment. The dental conference programme is designed by dentists for dentists, sharing the dental knowledge and perceptions that dental professionals require and need. The gathering provided the latest thinking in dentistry due to continuous research and development in close collaboration with dentists and input from across the dental profession. This year’s main purpose of the dental event was to examine the concept of digital dentistry, its advantages, limitations while generating statements and observations on specific areas of digital dentistry based on scientific research, direct personal experience and communication with dental manufacturers as well as clinicians worldwide.


Dental News

June 2019

David Claridge explaining

the economics of intraoral scanning

Prof Goran Urde lecturing on treatment planning in implantology

Dr Nawaf AlDousary lecturing about custom made artistic smile

Germen Versteeg explaining digital dentures

Dr Eduardo Mahn lecturing about choosing the appropriate material for CAD/CAM

Dr Isablle Savoye explaining digital orthodontics and 3D Applications

Jan Paulics lecture “Mastering the art of Digital Impressions� 66

Dental News

June 2019

Drs: Randa Labban, Saadalla Dana, Tony Abdelnour

Dubai, UAE April 12 - 13

CAM/CAM 2019

Drs: Aisha Sultan, Samer Rifai, representing the Lebanese Dental Association, Dobrina Mollova, Pr Mona Ghossoub, president Lebanese Orthodontic Society

L-R; Dr. Thamer AlSherif, Dr. Basem Abozenada, Prof. Abdulghani Mira, Dr. Tony Dib



Dr Maryam Sayed AlSharaf, Dr Mona Ghossoub

Photos from the Exhibition Floor

11TH Dental Facial Cosmetic Conference Joint Meeting with

Dental Hygienist Seminar Hands-On Courses Exhibition Date: Venue:


CME available

08-09 November 2019 InterContinental Hotel, Dubai Festival City, Dubai, UAE Lecture 1: How to Improve the Prosthetic Rehabilitation from the Aesthetic and Tissue Health Point of View Lecture 2: Sinus Lift from Crestal Approach

Innovative Periodontal Laser Treatment Concept with Additional Attention to Gingival Recontouring and Depigmentation

Prof Domenico Bald, Italy

Prof. Dr. med. dent. Norbert Gutknecht, Germany

Managing Aesthetics and Tooth Wear the MI Way

Non-invasive Teeth Discoloration Treatment. Modern Aspects of Enamel Remineralising Therapy

Prof Brian Millar, UK

GBR and GTR. The Magic Bullets for Implant and Perio? Asst Prof Attila Horvath, Hungary

Prof Andrey Akulovich, Russia

How to Achieve Long-term Aesthetic Success in Implant Rehabilitation Dr Maurizio Martini, Italy

True Bone Regeneration: Working with Host Healing Prof Peter JM Fairbairn, South Africa

Oral Rehabilitation Inuencing Smile Design and Facial Aesthetics Prof Jean-Marie Megarbane, Lebanon

Coming Soon Dr Costa Nicolopoulos, Greece

Top Up Your Dental Plan with Facial Aesthetics Dr Rami Haidar, UK

Coming Soon Dr Simone Moretto, Brazil

What Should we Assess Before Approaching with any Device or Debridement Instrument to Maintain our Restored and Healthy Patient? Consolata Pejrone, Italy

Interdisciplinary v/s Multidisciplinary Treatment of Maxillofacial Trauma in the Aesthetic Zone Dr Nadim Aboujaoude, Lebanon

Coming Soon Ihssan Hamadeh, Syria

Centre for Advanced Professional Practices (CAPP) is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

CAPP designates this activity for 14 CE Credits

REGISTER NOW +97143476747 | +971502793711

‫‪Lebanese University‬‬ ‫‪16th International Convention‬‬

‫‪View More Pictures On‬‬ ‫‪‬‬

‫‪May 2 - 4, 2019‬‬ ‫‪Lebanese University - Rafic Hariri Campus‬‬ ‫‪Hadath, Lebanon‬‬

‫‪Picture from the opening ceremony under the auspices of the president of the republic‬‬

‫أيها الحفل الكريم ‪،‬‬ ‫أرحب بكم جميعاً يف هذا الرصح العظيم‪ ,‬هذا الرصح الوطني التعليمي الذي جمع كبار أسامء العلم و التعليم و السياسة و الريادة‪ ,‬مام يجعلني فخورا ً‬ ‫بهذه املؤسسة املستقبلية الجامعة اللبنانية‪ ,‬التي فرضت نفسها كحجر الزاوية يف وطن العلم و املعرفة‪ .‬استطاعت كليتنا ان تقفز عالياً يف سلم النجاح‬ ‫بفضل اساتذتها و موظفيها وبفضل رئيس الجامعة اللبنانية‪ ,‬الربوفسور فؤاد أيوب الذي سعى اىل كتابة و تنقيح و متابعة و اصدار املرسوم رقم ‪3261‬‬ ‫الذي تضمن احكاماً خاصة بكلية طب األسنان يف الجامعة اللبنانية و قد لحظ رشوط تعيني و ترفيع األساتذة املتعاقدين بالساعة بالقابهم األكادمي َية و‬ ‫الرسيرية و مشددا ً‪ ,‬عىل أهمية إجراء األبحاث العلمية و الحصول عىل دكتوراه اإلختصاص يف علوم األسنان‪.‬‬ ‫مل تتقدم كليتنا مصادف ًة فقد شددنا مؤخرا ً عىل أهمية البحث و نرش البحوث العلمية‪ ,‬ايضاً اكدنا‪ ,‬عىل أهمية تحضري و تقديم اطروحات الدكتوراه يف‬ ‫علوم األسنان فكان لنا ما طلبنا ملصلحة األساتذة و الكلية‪ ,‬و بكل فخ ٍر اعلمكم أنه يف السنتني األخريتني حتى االن تم الدفاع عن اثني عرش اطروحة‬ ‫دكتوراه داخل الكلية و هناك خمس اطروحات قيد التنفيذ‪ ،‬إضافة اىل ذلك‪ ،‬تم إنشاء وحدة ‪ Digital Impression‬ليك نواكب العرص الحديث يف العلم‬ ‫تأسس منربنا وبدأ بالنمو والتط ّور ليصبح‪ ،‬يف عام‬ ‫واملعرفة‪ .‬وقد وافق مجلس الكلية عىل برنامج التعليم املستمر مع ‪ .Fradeani Institute‬عام ‪ّ 1987‬‬ ‫‪ ،2019‬املؤمتر الدويل السادس عرش الذي ميثّل صوت طبيب األسنان العريب والرشق أوسطي‪ .‬مؤمترنا هو التج ّمع العلمي املتع ّدد الوجوه العلميّة واملهنيّة‬ ‫حضت لنا برنامجاً علميّاً متن ّوعاً وغنيّاً‪،‬‬ ‫ولهذا السبب تح ّول منربا ً اقليمياً ودولياً ذاع صيته وراء حدود لبنان والعامل العريب‪ .‬اللجنة العلميّة للمؤمتر ّ‬ ‫برنامجاً يتطلّب مجهودا ً فك ّرياً نظرا ً لتعدديّة املحاور العلميّة السنيّة والفمويّة والفكيّة التي يتض ّمنها‪.‬‬ ‫كل التقن ّيات الحديثة والعرصيّة من خالل محارضات وبرامج عالج امراض الفم بالليزر بالتعاون مع الجمعية الدولية لعالج أمراض‬ ‫ستشهدون وتشاركون ّ‬ ‫الفم بالليزر التي حرضت خصيصاً اىل لبنان للمشاركة يف أعامل املؤمتر‪.‬‬

‫الربوفسور طوين زينون ‪ -‬عميد كلية طب االسنان يف الجامعة اللبنانية‬

‫‪Prof Tony Zeinoun,‬‬ ‫‪Dean College of Dentistry‬‬ ‫‪June 2019‬‬

‫‪His excellency Pierre Raffoul‬‬ ‫‪representing the president of the‬‬ ‫‪republic, General Michel Aoun‬‬

‫‪Prof Fouad Ayoub, president‬‬ ‫‪of the Lebanese University‬‬ ‫‪Dental News‬‬


Professors: Mohamed Rifai, Maria Saadeh, Nina Zeidan, Fouad Ayoub, Tony Zeinoun

Prof Tony Zeinoun, HE Pierre Raffoul, Prof Fouad Ayoub Professors; Rima Abdalla, Sami Moakdieh, Maria Saadeh Haddad, Mayssa AboulHesn

Drs; Georgina El Goul, Sami Moakdieh, Cynthia Abillama, Mirna Hobeika

Drs; Antoine Choufani, Tony Dib, Wadih Nassif, Tony Zeinoun, Joe Hobeish

Prof Mohamed Rifai, Mr Jamal Hage, HE Kasem Hashem, Prof Tony Zeinoun, Prof Joseph Makzoumeh

Professors; Essam Osman, Stefen Koubi, Tony Zeinoun, Edgard Jabbour

Jan Paulics developing intraoral scanning

Stefano Gracis from Italy

lecturing on impressions for implant and teeth

Umberto Romeo talking about jaw osteonecrosis

Wilhelm Pertot receiving the certificate for his lecture on reciprocation

Prof Antoine Saadeh lecturing on skeletal age assessment


Dental News

June 2019

Prof. Mounir Doumit Presenting March 2019 the trophy to Prof. Hien Ngo

Hadath, Lebanon May 2 - 4

Prof Fidele Nabbout handing the certificate to Prof Mona Ghossoub

Profs Khaldoun Rifai, Jose Chidiac, Joe Hobeish

Prof Georges Terhini

Profs Wahid Terro, George Khalil

LU 2019

Bassel Doughan, Patrizio Bortolus, Mounir Doumit


Profs Joe Sabbagh, Francesco Mangani, Edgard Jabbour

Rola Khalaf, Samir Nammour, Tony Zeinoun

Profs Yared, De Franco, Gracis, Ghafari

The Egyptian Delegation attending the congress

Left to Right: Krikor Sahakian, Tony Dib, Wilhelm Pertot

Left to Right: Wilhelm Pertot, Walid Nehme, Tony Dib

Exhibition Floor

Left to Right: Levon Naltchayan, Najoie Waked, Sami Moakdieh 74

Dental News

June 2019

Left to Right: Prof. Issam Khalil, March 2019 Dr. Mohamed Basma, Dr. Ghada B assil




, from Peru– an accountant, volleyball player, and hiker – smiles most when admiring a gorgeous view after a good hike



WHERE? WHEN? WHAT KIND & WHY? Are you spending too much on bone substitute materials and not getting the desired results in bone augmentation? Did you try several fixation membranes & techniques and still not feeling secure in containing enough by time the graft? Are you tired waiting too much time (6 to 9 months) for implant insertion after bone graft and loading the implants? Bone graft with simultaneous implant insertion or bone graft at first? Not convinced about what kind of biomaterial and fixation membranes for what kind of bone graft and where? Feeling that you don’t have enough information about soft tissue management techniques to cover the bone graft site & surrounding implants? All answers for these questions and much more you can find in a 4 days course of 3 levels : LEVEL 1



Minimal invasive Autogenous Bone Graft and simultaneous implants insert (one day)

Sinus Floor Elevation using the “Layered technique” upon the biologic concept of Prof. F. Khoury (one day)

Advance Vertical and Lateral bone graft : the Prof. F. Khoury Biologic concept of Autogenous Bone grafting (2 Days)

For registration or more information please contact: +9611290412, +9613234681 or


Dental News

June 2019

everX Flow from GC:

the strength of fibres in a flowable consistency everX Flow is the new fibre-reinforced flowable composite of GC. It is especially designed to replace dentine and reinforce restorations. Most composites offer the perfect features for enamel replacement, such as high wear resistance and aesthetics. However, they are not able to equal dentine when it comes to resistance to fracture. This issue is overcome by the new everX Flow, which possess superior flexural strength and fracture toughness and efficiently reinforce restorations thanks to a high fibre content. It should be fully covered with a light-cured composite, such as G-ænial or Essentia to achieve a smooth and wear-resistant surface. everX Flow will easily adapt to every preparation thanks to its optimal thixotropy, with less porosities as a result. Its controlled flow also enables placement in upper molars without slumping. everX Flow is available in two shades. The ‘Bulk’ shade has a depth of cure no less than 5.5 mm and is well suited for the fast restoration of deep posterior cavities. The ‘Dentin’ shade has a conventional depth of cure of 2 mm and offers an aesthetic solution with the same reinforcing properties. website:

Unlimited Flexibility

HyFlex EDM NiTi System with additional files sizes allowing more flexible application Due to limited access endo experts often want more flexibility from their instruments. Pre-bendable tools can extend the horizon into new dimensions. Particularly in a limited working space, modular nickel-titanium systems display their full strength. From now on dentists can choose from a series of additional file sizes for a fast and safe instrumentation to the remotest parts of the root canal system. 21 mm Agility With a total of seven highly flexible file variants, the Swiss dental specialist COLTENE is now expanding its wide-ranging HyFlex NiTi program. In addition to the usual lengths of 25 mm, all preparation files of the popular EDM series are now also available in 21 mm working length. The application of the more agile, shorter models is particularly recommended in the treatment of the posterior molars and in patients with cranio-mandibular problems. Being just about the size of a five cent coin, the


Dental News

new HyFlex EDM files enable comfortable work in insufficient interocclusal space. The secured working with the pre-bendable NiTi files becomes now a straight forward matter. After creating a glide path with the Glidepathfile 10/.05, the new file with the same taper allows minimally invasive, fast preparation of the canal. Subsequently the actual shaping can be done in the usual manner with the universal file HyFlex EDM OneFile, size 25. The good cutting performance and fracture resistance of the flexible NiTi files, is due to a special manufacturing process referred to as “Electrical Discharge Machining“(EDM in short). Based on their robust high performance they are ideal for both, Endo specialists and general practitioners who want to produce reliable results with a reduced number of files. website: June 2019

Surefil® one: Big steps forward in the dental workflow Being able to provide nearly every patient with treatment that is fast, simple, aesthetic, and stable in the long term – Dentsply Sirona keeps this important issue for dentists in mind when further developing its range of consumable products. At the IDS 2019, the world’s largest manufacturer of dental products and technologies presented the restoration material Surefil one, which allow cavities to be treated with an aesthetic, durable tooth coloured filling faster and more easily.

Surefil one is an innovative filling concept for posterior teeth. Posterior restorations are the most frequently performed restoration, making up more than half of all fillings. So it is all the more important to have a solution at hand for every clinical need. Surefil one is a self-adhesive restoration material that is forgiving and combines the simplicity of a glass ionomer with the stability of a conventional composite, all without sacrificing the aesthetic outcome. Dentists can treat a cavity without an adhesive and without retentive preparation in just one layer, making the filling procedure more efficient and safer. This technology is indicated especially for cases where clinical, time, or financial aspects have to be considered when restoring a tooth. website:

VITA YZ SOLUTIONS zirconia for any situation

Dental laboratories need to be able to work efficiently and economically, as well as to respond to the needs and preferences of their patients at all times. The four different translucency levels of the VITA YZ SOLUTIONS zirconia can now cover all of the fixed indication ranges based on the individual situation – from single crowns to long-span bridges – all with one single material system. Each translucency level is available as an uncolored variant (white) and can be individually infiltrated before sintering using VITA YZ SHADE LIQUIDS for the super, extra-high translucent variants, or the VITA YZ T COLORING LIQUIDS for the translucent variants. website: