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Prosthetic management and Diode Laser surgery for the treatment of Epulis Fissuratum on edentulous patients

52. SOS 2019

Oumaima Tayari, Safa Jemli, Jamila Jaouadi, Adel Bouguezzi, Mohamed Ali Bouzidi

Saudi Orthodontic Society February 22 - 24, 2019 Jeddah, Saudi Arabia

56. AIO 2019

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June 13 - 15, 2019 Sardinia, Italy

The Effect Of Diameter and Length On The Success Rate Of Dental Implant Liqaa S. Farhan

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September 2019



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INTERNATIONAL CALENDAR Vo l u m e X X V I , N u m b e r I I I , 2 0 1 9 EDITORIAL TEAM Alfred Naaman, Nada Naaman,


Khalil Aleisa, Jihad Fakhoury, Dona Raad, Antoine Saadé, Lina Chamseddine, Tarek Kotob, Mohammed Rifai, Bilal Koleilat, Mohammad H. Al-Jammaz Suha Nader Marc Salloum Micheline Assaf, Nariman Nehmeh Josiane Younes Albert Saykali Gisèle Wakim Tony Dib 1026-261X


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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.

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Laser Dentistry

Prosthetic management and Diode Laser surgery for the treatment of Epulis Fissuratum on edentulous patients Abstract

Oumaima Tayari Resident, Complete Removable Prosthodontic department

Epulis fissuratum caused by chronic irritation due to poorly adapted denture may considerably hinder oral functions and produce pain and discomfort to the patient.

Additionally to the appropriate prosthetic management, treatment of this lesion can be of two types: conservative or surgical.

Safa Jemli Resident, Complete Removable Prosthodontic department

Jamila Jaouadi Professor, Complete Removable Prosthodontic department

Adel Bouguezzi Assistant Professor, Oral surgery and implantology department

Mohamed Ali Bouzidi Professor, Complete Removable Prosthodontic department

Research laboratory LR12ES11 Faculty of Dental Medicine University of Monastir Monastir - Tunisia


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For the latter option, there have been numerous surgical techniques for removing the Epulis fissuratum in order to improve alveolar ridge contour and adaptation of complete dentures.

In fact, since about twenty years and thanks to a plethora of benefits, Laser can be used by dentists, as an effective surgical technique, for the treatment of oral soft tissue pathologies including Epulis fissuratum. The purpose of this report is to expose a case showing the prosthetic management and the mini-invasive surgical removal of an Epulis fissuratum caused by an ill fitting denture, in a geriatric patient. Key words: Epulis fissuratum, Diode laser, ill-fitting prosthesis, oral surgery, prosthetic rehabilitation.

Introduction Epulis fissuratum is a pseudotumor growth located over the soft tissues of the vestibular sulcus with variable degrees of hypertrophy and hyperplasia. This lesion is also known as “fibrous reactive hyperplasia”, “fibrous hyperplastic lesion” or “denture-induced fibrous hyperplasia”. 1, 3 It is frequently due to excessive mechanical pressure on the mucosa induced by the repeated trauma or chronic irritation of broken or ill-fitting denture flange. It occurs in vestibule, mostly in the anterior region of the upper or lower jaw.3, 5 The size of the lesion is directly related to the extent of surface involved by the trauma, and may reach several centimeters. Depending on the intensity of the trauma, the surface may become ulcerated or not. 6 In fact, in this case, prostheses were generally unstable due to its inadequate adaptation to the remaining ridge after resorption and tissue modifications. The subsequent changes led to occlusal discrepancies, aesthetic and functional deficiencies and aggravate the lesion status. September 2019

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Laser Dentistry

Prosthetic management and Diode Laser surgery for the treatment of Epulis Fissuratum on edentulous patients

That’s why Epulis fissuratum must be treated at the earliest time to improve the patient’s quality of life and the treatment can be conservative and/or surgical. 5, 6 In fact, in early stages, when fibrosis is recent and/or minimal, nonsurgical treatment consisting on prosthesis adjustment (occlusion, denture flange..) and tissue conditioning in order to eliminate the trauma and reduce the inflammation, should be the prime option as it is non invasive. It is frequently sufficient for reduction or elimination of a limited lesion. 4 But in most cases, elimination of trauma/irritation and inflammation can simply lead to modest decrease in lesion size. In fact, when the causal factor persists, the tissue becomes more fibrous over time, and because this does not respond to nonsurgical treatment, excision is frequently required as definitive treatment. 4, 7 Geriatric patients often pose with systemic disorders that

are tough to deal with. This mandates the maintenance of a strict protocol during their management, especially in complicated situations. The advent of various new surgical modalities, such as laser, has made their management much easier. 5 Diode laser with wavelengths ranging from 810 to 980nm in a continuous or pulsed mode was used as a possible instrument for oral soft tissue surgery. Since its introduction in dentistry, it has become an important alternative for the treatment of those lesions due to the numerous advantages it offers. 3, 8 The aim of this work is to present a case showing the treatment of Epulis fissuratum caused by an ill fitting denture, in a debilitated geriatric 71-year-old male patient, with the surgical removal of the oral hyperplasia using diode laser radiation and the prosthetic rehabilitation with a complete denture.

Case report 71-year-old male, with arterial hypertention and type II diabetis, reported to the prosthodontic department of the faculty of dental medicine of Monastir, with a chief complaint of discomfort while using his maxillary denture. He has described a lesion in the anterior maxilla that produced pain and negatively affected the mastication, speech, aesthetics and his overall well-being. Fig. 1

Fig. 2A

Fig. 2B

He has been wearing the current set of dentures from the last 10 years. The patient gave a history of using broken upper denture for last 6 months. Extraoral examination revealed decrease of the occlusal vertical dimension which led to angular cheilitis apparition. (fig 1, 2a, 2b) Intraoral examination showed, on visual inspection, a fibrous hyperplastic mass in relation to the anterior maxillary vestibule which gradually grew in size in the past 6 months, about 2 cm away from the midline. It extended to the crest of the residual ridge involving the frenulum and to the palatal region. The color and surface texture of the mass was the same as normal tissue. No associated ulcerations were present at the time of examination. (fig 3a) On palpation, all the inspectory findings were confirmed and the lesion was soft in consistency and smooth in texture. (fig 3b)

Figure 1: Extra oral appearance, Figure 2: commissural cheilitis. a: right side ; b: left side.


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September 2019


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Laser Dentistry

Prosthetic management and Diode Laser surgery for the treatment of Epulis Fissuratum on edentulous patients

Fig. 3A

Fig. 3B

Figure 3: Appearance of the lesion along the maxillary ridge. a: on inspection, b: on palpation

Fig. 4

The surgical procedure was planned with laser therapy considering the advantages that it would bring. Opinion and Consent was obtained from the patient’s diabetologist and haematologist for the treatment of the Epulis fissuratum, and the patient was informed in detail about the procedure. At the first appointment, an adjustment of the prostheses was performed to relieve the entire area that is in contact with the lesion: The ill-fitting maxillary denture was relined according to the present residual ridge using delayedcuring resin (Fitt KerrŽ). (fig 6a) Modified mandibular denture, using chemopolymerized resin over the artificial teeth, served to restore the vertical dimension and centric relation provisionally until fabricating new dentures. (fig 6b)

Figure 4: badly fitted prosthesis

While wearing the denture, the hyperplastic tissue was under and surrounding the anterior borders of the illfitting maxillary denture. Occlusion was misadjusted and caused trauma to the area during swallowing and mastication. (fig 4)

Withdrawal of the denture during mastication and topical application of antifungal agents and paste containing local analgesic over the affected site was beneficial before removal of epulis fissuratum. The lesion is evaluated after 21 days and there is Fig. 6A

Fig. 6B

On examining the denture, we found teeth abrasion and previous denture reparations. (fig 5a-5c) Fig. 5

Figure 6: dentures modifications. a: tissue conditioning , b: occlusal reconstruction Figure 5: Dentures examination

According to the data obtained, a presumptive diagnosis of an Epulis fissuratum, due to the excessive and continuous mechanical pressure imparted by the faulty maxillary denture was performed. The patient was planned for a new complete denture followed by a complete removal of the lesion, which included a cut-off of the upper labial frenulum, and vestibuloplasty in order to avoid the recurrence of the lesion.


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no variation on its size, aside the regression of the inflammation and the healing of the cheilitis. During the next appointments, clinical procedures for new complete denture were initiated. Fabrication of new denture should be carried out following the conventional technique until the stage of teeth setting try-in, the time to have a final impression under functional pressure to obtain the final cast. (fig 7a-7c)

September 2019

Laser Dentistry Prosthetic management and Diode Laser surgery for the treatment of Epulis Fissuratum on edentulous patients

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Fig. 7















CA ®


Figure 7: maxillary final impression. a: perforations on the corresponding to the hyperplastic area, b: impression under occlusal pressure, c: maxillary final impression



Before manufacturing the final dentures, surgical procedures must be simulated on this final cast by scraping the amount of plaster corresponding to the ulterior removed tissue (fig 8). After manufacturing, the final maxillary denture must be duplicated with transparent resin which served as a surgical guide (fig 9a,9b). For the surgical procedures, a routine blood check up was done which revealed the patient’s glycemic levels. Fig. 8

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Figure 8: surgery simulation, Figure 9: denture duplication. a: maxillary denture, b: surgical guide

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Infiltrative local anesthesia technique (2% lidocaine) was necessary before performing the excision of the lesion using laser with a wavelength of 810 nm.

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It concerned respectively: the mucosa (fig 10a), including the superior labial frenulum(fig10b), the muscles and then the periosteum (fig 10c).

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September 2019

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Laser Dentistry

Prosthetic management and Diode Laser surgery for the treatment of Epulis Fissuratum on edentulous patients

Additionally, a partial vestibuloplasty was performed creating a clean supraperiostal bed over the area of the alveolar ridge. (fig 11) Fig. 11

Immediately after surgery, minor occlusal adjustments were performed and patient’s own maxillary denture was relined with a tissue conditioner adapted to the bearing area and reinserted over the surgical bed, and should be kept in place continuously during the first 2–3 days. (fig 14a) Fig. 14

Figure 11: vestibuloplasty Surgery was controlled by the surgical guide until obtaining the wanted width of the vestibule. (fig 12) The surgery was very soft with minimal pain, excellent hemorrhage control and on-chair time management. Fig. 12

Figure 14: soft tissue conditioner for adequate tissue repair

The delayed-cure resin may reduce inflammation and continuous trauma over the lesion and consequently, ameliorate its healing. The soft flange must achieve the vestibule width to maintain vestibuloplasty result. (fig 14b) As postoperative instructions, chlorhexidine gel was indicated to avoid wound overinfection and salt water rinses to aid healing.

Figure 12: surgery control using surgical guide

Fig. 15

After the excision, the lesion was irrigated abundantly with physiological saline solution. For the right side interrupted sutures were used at the height of the vestibular periosteum. On the other side, the wounds were left bloody to repair by second intention. (fig 13) Excised tissues were submitted for routine histological examination. Fig. 13 Figure 15: healing process of the treated area

Antibiotics, an anti-inflammatory drug and an analgesic were prescribed. The patient was recalled at 3 days, 1, 2 and 3 weeks for observation. Postoperative pain and oedema are reported to be minimal. (fig 15a-15e) Figure 13: immediate post-operative view


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September 2019

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Laser Dentistry

Prosthetic management and Diode Laser surgery for the treatment of Epulis Fissuratum on edentulous patients

After a month, the healing of the tissues was observed to be satisfactory without scars or signs of recurrence and with anatomic sulcus integrity. (fig 15f) The patient was satisfied with the prosthesis fit, comfort mastication and phonetics. In these circumstances, to stabilize results, it was planned to reline the denture, improving the fit and, therefore, the quality of life of the patient, as well as avoiding the recurrence of the lesion. The delayed-cure resin was replaced with chemopolymerized resin and final occlusal adjustments were performed. (fig 16a, 16b)

Fig. 16

Pogrel has reported a decrease in vestibular depth with conventional Epulis fissuratum surgery when the wound is closed with sutures. 11 The advent of the various other new surgical modalities has made their management much easier and had helped to improve alveolar ridge contour and improving adaptation of full prostheses. 6, 10 With the advent of lasers, the former technique has taken a back seat. Some of the lasers used in dentistry for this purpose is CO2 laser, Er:YAG laser, Nd:YAG laser, diode laser, argon laser and KTP laser. Nowadays, the diode laser, successfully used in our reported case, is being one of the most used in soft tissue surgery since it gives numerous advantages compared to the conventional scalpel or other types of lasers. 3, 10 It is used because of its effectiveness, ease of use and obvious advantage such as the lower intraoperative bleeding and therefore a better visibility and a reduction of surgical time. It offers high precision in tissue destruction, less inflammation of the area and better scarring and postoperative healing. 5, 12, 13, 14

Figure 16: stabilization. a: chemopolymerized resin molding, b: occlusal adjustments

Discussion The management of the Epulis fissuratum can be especially challenging in edentulous geriatric patients. 5 Its treatment can be of two types: conservative or/and surgical. The conservative approach should be the first option as it is non invasive. It includes removal of the acrylic flange and occlusal adjustments followed by denture relining and rebasing until the complete healing of the lesion. However it is quite time consuming. 9, 10 With appropriate prosthetic reconstruction, surgical excision is always the definitive treatment of Epulis fissuratum. It includes using any of the following: the conventional scalpel, electro cauterisation, soft tissue lasers and liquid nitrogen cryosurgery. 1 The surgical scalpel has been used in the past to treat this soft tissue lesion. This technique, however, is associated with significant loss of sulcus depth, sometimes with full elimination of the vestibule. 1, 10


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Diode laser has the advantage of excellent hemostasis. For this reason there is no need for suture and the wound is allowed to repair by second intention which can explain the excellent postoperative vestibular depth in the present case. This could reduce performing an ordinary vestibuloplasty with vestibular deepening with union of surgical borders, allows the maintenance of an adequate sulcus depth and the achieving of a correct peripheral seal for dental prosthesis retention and stability preventing further recurrences. 1, 15 As the literature shows, the diode laser can be considered a safer alternative. It is used in conjunction with application fibers that direct the laser beam into the tissue that needs to be treated, causing a minimal impact on the surrounding tissue and reducing wounds or pain. 3 The potential benefit of each treatment and overall prognosis are important factors that we need to assess and reconcile in shaping treatment strategies. The most common risk seen in the treatment of epulis fissuratum is the lesion re-growth. Recurrences are rare as long as the sources of trauma and/or the patient’s habits are eliminated and the appropriate prosthetic reconstruction is provided. 7 However, mere excision of the lesion without eliminating the causative factor would definitely result its recurrence. As a component of the surgical treatment, the denture must appropriately be re-made or substantially adjusted.4 Additionally, the denture September 2019

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Laser Dentistry Prosthetic management and Diode Laser surgery for the treatment of Epulis Fissuratum on edentulous patients

should be covered with tissue conditioner, adapted and reinserted over the surgical bed, permitting the maintenance of vestibular sulcus depth and the safe use of denture during the healing process.

Conclusion As described in the case report and according to the current literature, the appropriate prosthetic rehabilitation additionally to the use of the diode laser can provide a truly effective predictable treatment procedure in the management of the Epulis fissuratum, without any postoperative complications, very mild discomfort and an excellent healing as observed in the re-evaluation.

References 1. Luís Silva M, João M, Ana A, Marco I C, Marco André M, José M LF. Treatment of Epulis Fissuratum with Carbon Dioxide Laser in a Patient with Antithrombotic Medication. Braz Dent J (2012) 23(1): 77-81 2. Canger EM, Celenk P, Kayipmaz S. Denture-related hyperplasia: A clinical study of a Turkish population group. Braz Dent J 2009;20:243-8. 3. Jorge A. CD, Daniel OC, Juan Francisco PC, Luis Miguel SA, Víctor M. PR, Juan LQ. Employment of Diode Laser in the Treatment of Epulis Fissuratum. Case Report. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) ; Volume 16, Issue 5 Ver. I (May. 2017), PP 112-115 4. Amit.A A, Mahendra M, Aarti M, Swagat D. Application of diode laser for excision of non-inflammatory vascular epulis fissuratum. IJCRI – International Journal of Case Reports and Images, Vol. 3 No. 9, September 201 2. ISSN – [0976-31 98] 5. Prasad V, Madhumietha A, Pratheeth G. Management of Geriatric Patient with Epulis Fissuratum Using Liquid Nitrogen Cryosurgery: A Case Report. J Indian Prosthodont Soc (Jan-Mar 2014) 14(1):115–119 6. Niccoli-Filho W, Neves A.C.C, Penna L.A.P, Seraidarian P.I, Riva R. Removal of Epulis Fissuratum Associated to Vestibuloplasty with Carbon Dioxide Laser. Lasers Med Sci 1999, 14:203–206 7. Cerveira Netto H. Prohtese Total Imediata, 1th edn. Sao Paulo: Pancast Editorial, 1987:107–134 8. Ehsan A, Nassimeh S. Diode Laser Application in Soft Tissue Oral Surgery. J Lasers Med Sci 2013; 4(4):206-11 9. American Prosthodontic Society (2005) The glossary of prosthodontic terms. J Prosthet Dent 94(1):10–92 10. Kafas P, Upile T, Stavrianos C, Angouridakis N, Jerjes W. Mucogingival overgrowth in a geriatric patient. Dermatol Online J (2010) 16(8):7 11. Pogrel MA. The carbon dioxide laser in soft tissue preprosthetic surgery. J Prosthetic Dent 1989; 61:203-8. 12. Asnaashari M, Zadsirjan S. Application of laser in oral surgery. J Lasers Med Sci. 2014; 5: 97-107. 13. Deppe H, Horch HH. Laser applications in oral surgery and implant dentistry. Lasers Med Sci. 2007; 22: 217 -21. 14. Rezvan B, Mahumoudhashemi H. Comparative survey on cardon dioxide laser and surgical scalpel removal of epulis fissuratum. J Oral Laser Applications 2007; 7:187-90. 15. Luís Silva M, João M, Ana A, Marco IC, Marco AM, José FL. Treatment of epulis fissuratum with carbon dioxide laser. rev port estomatol med dent cir maxilofac. 2011; 52(3):165–169.


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September 2019



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The Effect Of Diameter and Length On The Success Rate Of Dental Implant Abstract

Liqaa S. Farhan MSc. B.D.S Teacher instructor, Department of Oral And Maxillofacial Surgery, College Of Dentistry, University Of Anbar, Iraq

The problem of missing teeth and edentulism is a worldwide issue. Replacing such teeth by Dental implants instead of bridges or dentures is more successful. Focus on the factors that enhance the overall success rate of implants is becoming an important subject. The variation in dental implant geometry and dimensions provided by the manufacturing companies are important controlling factors on the success rate of the dental implant. Aims: To estimate the success rate of dental implants using various diameters and lengths. Materials and Method: A study involved (680) patients at the department of dental implantology in Al-Ramadi city health center between (May 2007-May 2018). 870 Easy implant® by a French dental implants manufacturer, conical with internal hexagon are used to replace teeth in variety of length and diameter: Maxillary Central incisor 5×11.5,

Max. lateral incisors 5×8.5, Max. canine 5×8.5, Max. 1st premolar 4.3×11, Max. 2nd premolar 4.3-8, Max. molars 5×7, Mandibular central incisors 3.5×10, Mand. lateral incisor 3.5×10.5, Mand. canine 3.5×11.5, Mand. 1st premolar 3.5×8, Mand. 2nd premolar 3.4×8, Mand. molars 4.5×7. The success rate is estimated. Results: The statistical results in Table (2) & figure (2,3) indicate that the higher survival rate was (75%) in the Anterior incisors area due standard diameter and length of dental implant. The mean difference is significant at 0.05 level (P<0.05). Conclusion: Use of standardized diameter/ length of dental implant is one factor used to enhance the success rate of this treatment. Key Words: Dental implant, Diameter, Length, Occlusal load, Marginal Bone loss, Success rate.

Introduction The problem of losing teeth due to extensive caries and periodontal disease is worldwide. Replacement of missing teeth by dental implants is an alternative used by many dentists instead of fixed bridges and removable dentures.1,2 Dental implant is a metal component inserted surgically in the jaw bone to hold fixed bridges and crowns and over dentures.3 The success rate of dental implants is very high nowadays due to the development of new designs, protocols and load characteristics.4,5 The distribution of dental implants in the jaw is another factor that affects the stress transmitted over osseointegrated implant. The use of short dental implants in molar areas due mechanical and anatomical limitations.6


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September 2019


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The Effect Of Diameter and Length On The Success Rate Of Dental Implant

The high occlusal force over the molar teeth in comparison to anterior teeth make the size of the dental implant an important factor. High occlusal forces also affect the success of osseointegration. 7,8 Large size of dental implants in molar areas affect the thickness of surrounding bone and the success of placement of dental implant placed in such high stress area and other problems related to operative skill.9,10 Bone quality and height and location of vital anatomical structure in the jaw bones is also other factors to be considered.11 For such reasons conical shaped threaded implants of various diameters and length have been developed to enhance the survival rate of dental implants.12

Materials and Method A study involved (680) patients treated at Al-Ramadi health center in the department of dental implantology between (May 2007-May 2108). 820 Easy implant® by a French dental implants manufacturer, conical with internal hexagon are used in variety of length and diameter: Maxillary Central incisor 5×11.5, Max. lateral incisors 5×8.5, Max. canine 5×8.5, Max. 1st premolar 4.3×11, Max. 2nd premolar 4.3-8, Max. molars 5×7, Mandibular central incisors 3.5×10, Mand. lateral incisor 3.5×10.5, Mand. canine 3.5×11.5, Mand. 1st premolar 3.5×8, Mand. 2nd premolar 3.4×8, Mand. molars 4.5×7. The patients were followed up and success rate were recorded and compared.

Statistical Results The statistical analysis in below tables indicate the following:

Table 1: Descriptive statistical table.

Table 2: Anova test.

Figure 1: Relation between mean diameter of dental implant and position


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The Effect Of Diameter and Length On The Success Rate Of Dental Implant

Table 3: Multiple comparison table.

Table 4: Descriptive statistical table

Table 5: Anova testplant and position.

Figure 2: Relation between mean Length of dental implant and Position


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September 2019

Table 6: Multiple comparison table.

Table 9: Anova test Table 7: Correlation test between Diameter and Length of dental implant

Table 8: Descriptive statistical table


The Effect Of Diameter and Length On The Success Rate Of Dental Implant

Table 10: Multiple comparison table

Table 12: Anova test

Figure 3: Relation between Success Rate and Position of dental implant

Table 11: Descriptive statistical table


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September 2019

Table 13: Multiple comparison table

Table 14: Descriptive statistical table

Table 15: Anova test

Figure 4: Relation between Failure Rate and Position of dental implant


The Effect Of Diameter and Length On The Success Rate Of Dental Implant

Table 10: Multiple comparison table

Discussion Our study was done to estimate the success rate of dental implants using different diameter and length of dental implants placed in different locations. The statistical results of the study in table 8,9 & figure 3 show survival rate of dental implant in different treated locations. The high survival rate of dental implants was in the Maxillary Incisor area (75%) due to the use of standard size with wide and long dental implants and low stress applied over the dental implant that enhanced the success of osteointegration in this area. 13,14 This is also due because the large size of dental implant increase the surface of the contact area between bone and the dental implant and minimize the stress distributed to this area and thus increases the success rate of osteointegration. While the lowest survival rate of dental implants was in the mandibular molar area (55%) in comparison with other sites, this is due to the use of wide size and short dental implants to overcome the anatomical and occlusal stress in the area. The mean difference is significant at 0.05 level (P<0.05). Statistical results in table 1,2 & Figure 1 indicate that the higher mean value of diameter of dental implant was in Maxillary Anterior area (5.000±0.0000). While the lowest mean value was (3.5000±0.000) in Anterior Mandible. The mean difference is significant at 0.05 level (P<0.05). While the statistical results in table 4,5 & Figure 2 indicate that the highest mean value of length of dental implant was (10.6667±0.76376) in the Anterior Mandible. While the lowest mean value of length of dental implant was in the posterior mandible was (7.6667±0.57735).


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Figure 5: Relation between Marginal Bone Loss and Position of dental implant

The mean difference is non-significant at 0.05 level (P<0.05). Table 14, 15 & figure 5 indicate that the highest mean value of mesial and distal marginal loss was (3.6000± 0.10000) in the mandibular molar area in comparison with other sites (0.1233±0.00577). The mean difference is significant at 0.05 level (P<0.05). 15,16 Short and large diameter dental implant were used instead of bone grafting to avoid the danger of damaging the inferior alveolar nerve and canal and the result of high occlusal load over scars bone and hinder successful osteointegration.17,18 September 2019

The difficulty in placing such size is also another factor to be considered in the failure rate of dental implants in these areas. 19,20 This is consistent with the study conducted by Renouard who indicated that the failure rate of dental implants increase with short and large diameter, this leads to low thickness of surrounding bone and also poor skills of the dentist. 21 The failure rate of dental implants is increased also due to other factor such as smoking, systemic disease, periodontal condition, surface texture, dental appliance and distribution of dental implant through the jaw. 22 Studies by Misch indicate that placement of short dental implants <10 mm in the posterior molar area associated with high failure rate about 85% after placement of dental appliance. 23 But their use have added advantages, as it minimizes the time required for grafting procedures, cost and avoid the postoperative surgical complications and morbidity. 24 Short dental implants in (molars) has complications related to the initial stability due to less surface contact with bone and in term of stress distribution which hinder successful osseointgration. 25



So much flexibility is unbelievable!

Variation in Dental implant geometry provided by many companies to overcome the limitation in use of dental implants in certain areas. Large size dental implants increase the area of contact with bone and better distribution of occlusal load which is required for osseointergation. This make considerable increases in the overall success rate.

Acknowledgement Great thank and respect to my family who helped me to finish my study.

References 1. Sonal Raikar, Pratim Talukdar, Sarala Kumari, Sangram Kumar, Vinni Mary, Arivnd Prasad. Survival rate of dental implant. J In Sco Prev


Community Dent.2017;12(3):65-87. 2. Tonetti MS, Schmid Pathology of failed dental implant. Periodontol. 2000;15(5):77-99. 3. Han DH, Kim SJ, Lee KW. Local factors affecting the success of dental implant. J Academic Prosthodont. 2010;11(32):55-87. 4. Esponsito M, Grusovin MG, Coulthard P, Thomsen P. Retrospective Study On Osteointergated dental implant. In Oral Maxill Facia Implant. 2005;12(6):98-112.


The Effect Of Diameter and Length On The Success Rate Of Dental Implant

5. Misch CE. Size of dental implant. Dent Today. 2005;14(8):100-123.

12. Antiua E, Tapia R, Luzuriaga F, Orive G. The effect

6. Renourad F, Nisand D. The effect of diameter in the success rate of dental im-

of dental implant dimension on the distributed stress.

plant. Clin Oral Implant Resa. 2006;10(11):54-76.

Int J Period Res.2010;22(6):88-100.

7. Arsalanloo Z, Telchi R, Osgouie KG. Choice of suitable implant size. In J Biosci

13. Yesiladl R, Karabudak F, Bayindir F, Sagsoz NP.

Biochem Bioinfo. 2014;13(8):120-145.

The effect of diameter and Length on the distribution

8. Topkaya T, Solmaz MY, Eltas A. The effect of geometry of dental implant on the

of stress around dental implant. Open access Library

load distribution. Cumhuriyet Dent J. 201511(8):77-90.


9. Borie E, Orsi IA, de Araujo CP. The effect of dental implant diameter and length

14. Thakur MD, Quazi TZ, Dhatrak PN. The effect of

on the bone. Act Odonto Scand. 2015;13(7):88-99.

dental implant length and shape on the stress distrib-

10. R.Eazhil, Siva Vadivel, Madhan Gunaseelan, G.Vijay Kannan. Effect of diameter

uted at bone dental implant interface. In J Engg Sci

and length on the ossteointegration. J In Sco Prev Community

Res Technol. 2016;15(7):123-156.

Dent. 2016;23(8):22-56.

15. Terzioglu H, Kursunoglu S. The effect of diameter

11. Petrie CS, Willium JL. The effect of various implant designs on the stress over the

and length of dental implant on marginal bone loss.

bone. Clin Oral Implant Res .2015;16(8):99-108.

Clin Oral Implant Rese. 2014;13(7):109-120. 16. Toa Li, Kaijin Hu, Libo Cheng ,Ying Ding, Yuxiang Ding. Choice of suitable dental implant size in mandibular molar area. Applied Mathematical Modelling. 2011;14(5):99-118. 17. Miriam Ting, Mattew Palermo, David Donatelli,John P. Gaughan. The effect of implant surface characteristics on survival rate. International journal of Implant dentistry. 2015;8(6):77-110. 18. Malo P, de Araujo Nobre M. Use of wide diameter dental implant in mandibular molar area. Clin Dental Implant Res. 2011.14(8):68-99. 19. Olate S, Lyrio MC, de Moraes M, Moreira RW. The effect of dental implant

geometry on the

success rate of dental implant. J Oral Maxillofac Surg.2010;11(5):76-87. 20. Bataineh AB, Al -Dakes AM. The effect of length on the dental implant

stability. J Clin Exp Dent.

2017;9(10):47-99. 21. Termeie D, Klokkevold PR, Caputo AA. The effect of diameter of dental implant on the distribution of occlual load. J Oral Implant. 2015;14(4):55-78. 22. Misch CE, Perel ML, Wang HL, Galindo –Moreno P. The failure rate of dental implant. Impl Den. 2008;33(5):54-87. 23. Misch CE, Steignga J, Barboza E, Cianciola LJ. Use of short dental implant in molar area. J Periodontol. 2009 ;14(8):100-120

Glass ionomer filling material • Variable mixing time for adjustment of consistency • Modulation is possible right after insertion • Perfect marginal adaption • High compressive strength • High abrasion resistance • Easy activation without the need of an activator • Perfect for smaller cavities • Excellent for difficult to reach areas

24. Garnt BT, Pancko FX, Kraut RA. Results of Plac-

Medifil IX forte Glasionomer Füllungsmaterial Glas Ionomer restorative material Matériau verre ionomère pour restaurations Material de obturación de ionómero de vidrio 50 Capsules

ing short dental implant in mandibular molar region. J Oral maxillofacial surg.2006;12(6):65-88. 25. Bozakaya D, Muftu A. Assessment of load transmitted over six various dental implant. J Prosthetic Den. 2014;17(3):45-87.

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Bond Strength of Universal Self-Etch 1-Step Adhesive Systems for Orthodontic Brackets Abstract

Melissa Cerone, DDS, MSc

Objective The objective of this study was to assess the shear bond strength (SBS) of orthodontic brackets bonded to uncut enamel with universal self- etch 1-step adhesive systems.

Methods Wafa El-Badrawy, DDS, MSc

Siew-Ging Gong, BDS, Ortho (Cert), PhD

Extracted uncut premolars (n = 160) were randomly divided into 4 groups for treatment with Scotchbond Universal Adhesive (SU), All-Bond Universal (BU), Clearfil Universal Bond (CU) or the control, Adper Scotchbond Multi-Purpose Adhesive. Following bonding of brackets on tooth surfaces, teeth were stored in distilled water for 24 h and 6 months, and brackets were tested for SBS. The adhesive remnant index (ARI) and quantitative percent- age of remaining resin (%RR) were recorded. Scanning electron microscopy was used to analyze debonded surfaces qualitatively. SBS and %RR data were analyzed by 2-way ANOVA followed by the Tukey test (α = 0.05).

Results Anuradha Prakki, PhD

At neither time did these universal adhesives achieve satisfactory SBS for orthodontic treatment. The control group had the highest SBS, ARI score and mean %RR (and these differences were significant), while the BU group had the lowest SBS. SBS mean values and ARI scores decreased over time for SU and BU, but remained stable for CU. There was no difference in %RR among the universal adhesives tested.

Conclusion None of the universal adhesives used in self-etch mode achieved SBS values (at 24 h and 6 months) that were satisfactory for orthodontic treatment.

Introduction Republished with permission from the Journal of the Canadian Dental Association Issue number 2019;85:j6


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Successful orthodontic treatment depends on the orthodontist’s ability to control tooth movement and relies on a stable interface between wire and bracket.1 The adhesive system that bonds the bracket to enamel must be strong enough to resist all masticatory and orthodontic forces and remain adhered to the tooth and bracket throughout the course of treatment. In 1975, a shear bond strength (SBS) of 5.9–7.8 MPa for orthodontic brackets was first shown to be sufficient to withstand such forces.2 September 2019





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Bond Strength of Universal Self-Etch 1-Step Adhesive Systems for Orthodontic Brackets

Although empirically established, this is still the clinically accepted SBS range for orthodontic brackets.3-5 Although it is critical that the adhesive withstand such forces during treatment, on completion of treatment, debonding of brackets must occur with minimal patient discomfort and enamel damage.6

USE1SASs have been tested extensively on dentin and enamel surfaces. Although the SBSs reported in many of these studies are within the recommended 5.9–7.8 MPa2 for orthodontics, most were measured on cut enamel.5,12 Only limited studies exist on the performance of self-etch adhesives on uncut enamel13 or in an orthodontic setting.8

Currently in orthodontics, total-etch, multi-step adhesive systems (TEMSAS) are most commonly used to bond brackets to enamel. These systems provide adequate bond strength3 to withstand masticatory forces. However, bonding as well as debonding appointments are time consuming for both the orthodontist and the patient, and debonding can cause enamel damage. The demand by dental professionals for adhesives with reduced technique sensitivity, shorter clinical application time7,8 and lower incidence of post-operative sensitivity has led to the development of self-etching adhesive systems.9,10 Among these are universal self-etch 1-step adhesive systems (USE1SASs) that combine the 3 steps required for adhesion into a 1-step application. These systems can be used in self-etch mode, selective enameletch mode or total-etch mode for restorative procedures. When used in a self-etch mode, USE1SASs may significantly simplify the bonding process by reducing the number of bonding steps and eliminating the need for total acid etching.11 In turn, this would decrease the risk of contamination, reduce the bonding procedure time11 and, potentially, reduce the risks of damaging enamel during debonding.

The objectives of this study were to investigate the SBS and debonded enamel surface characteristics of 3 USE1SASs, compared with a TEMSAS, used in bonding orthodontic brackets to uncut enamel at 2 time points. The tested null hypotheses were: there are no significant differences in SBSs among tested bonding agents; there are no significant differences in SBSs after a 6-month aging period; there are no significant differences among tested bonding agents in the amount of remaining resin on teeth after bracket debonding.

Materials and Methods Experimental Design We studied 4 bonding agents at baseline and 6 months, using 8 groups of 20 teeth. The quantitative response variables were enamel SBS, adhesive remnant index (ARI) score and evaluation of remaining resin (%RR). Scanning electron microscopy (SEM) was used for qualitative analysis of debonded surfaces.

Note: bis-GMA = bisphenol A-glycidyl methacrylate, HEMA = hydroxy ethyl methacrylate, MDP = 10-methacryloyloxydecyl dihydrogen phosphate.

Table 1: Composition of the tested adhesives.


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Bond Strength of Universal Self-Etch 1-Step Adhesive Systems for Orthodontic Brackets

Materials Used

Shear Bond Strength

The composition of the materials used in this study is shown in Table 1.

Before testing SBS, each tooth was placed in a circular mounting jig (made of SR Ivolen’s polymethyl methacrylate base; Ivoclar Vivadent, Schaan, Liechtenstein) for consistent tooth alignment such that an occluso-gingival load could be applied by a chisel to produce a shear force at the bracket–tooth interface.

Definition of Groups and Sample Preparation A total of 160 extracted, caries-free human premolars were used in the study. Tooth inclusion criteria included absence of endodontic treatment, carious lesions, restorations and enamel defects, such as enamel hypoplasia, enamel hypomineralization or visible cracks. The selected teeth were disinfected in 0.5% chloramine-T solution for 1 week, stored in distilled water at 37°C and used within 6 months of extraction. Teeth were randomly divided into 4 groups, based on the adhesive to be used: Scotchbond Universal (SU; 3M ESPE, St. Paul, MN, USA ); All-Bond Universal (BU; Bisco Dental Products, Schaumburg, IL, USA); Clearfil Universal Bond (CU; Kuraray Dental, New York, NY, USA); and the control (C), which was Adper Scotchbond Multi-Purpose (3M ESPE, St. Paul, MN, USA). All teeth were initially cleaned and pumiced using a rubber cup with fluoride-free paste for 10 s, thoroughly washed with water and air dried. Bonding procedures were performed according to the manufacturers’ recommendations. Light-polymerization was performed using an Ortholux Luminous Curing Light (3M Unitek, Monrovia, CA, USA) at 1600 mW/cm2 irradiance intensity. Stainless steel premolar brackets (Mini Master Series, 0.56 mm slot, surface area 10.29 mm2; American Orthodontics, Sheboygan, WI, USA) with the best surface contact and fit on the buccal surface of the teeth were chosen. Retention pads provided dual mechanical retention by layering 80-gauge mesh over an etched foil base. To bond the brackets, Transbond XT Light Cure Adhesive (3M Unitek) was compressed with a plastic instrument into the mesh of the brackets, which were then placed on the buccal surface of the tooth, with their slots parallel to the incisal edge. After pressing the brackets onto the buccal surfaces of the teeth with a carver instrument and gentle removal of any excess adhesive, the curing light was held stationary at a distance of 1–2 mm from the bracket for 12 s, with the light beam directed for 6 s each at the mesial and distal aspects of the bracket.14 The 40 teeth from each adhesive group were then divided into 2 groups (n = 20) and stored for 24 h (baseline) or 6 months in 37°C distilled water.


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To ensure that the chisel blade attached to the Universal Testing Machine (model 4301; Instron, Norwood, Mass., USA) contacted each bracket from the incisal aspect as close to the bonding interface as possible, the facial surface of the tooth was mounted parallel to the chisel. Each bracket was then debonded at a crosshead speed of 1 mm/minute. The maximum force required to debond a bracket was recorded and mean SBS (in MPa) was calculated for each group.

Adhesive Remnant Index and Quantitative Evaluation of Remaining Resin After bracket debonding, the enamel surface of each tooth was examined under a stereomicroscope at 10× magnification. Tested surfaces were classified according to the ARI scores described by Artun and Bergland.15

Figure 1: Stereomicroscopic images (10×) of enamel surfaces. A: All-Bond Universal (BU) group at 6 months, adhesive remnant index (ARI) score = 0. B: Clearfil Universal Bond (CU) group at baseline, ARI score = 1. C: control (Adper Scotchbond Multi-Purpose Adhesive) group at 6 months, ARI score = 2. D: control group at 6 months, ARI score = 3. September 2019

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Bond Strength of Universal Self-Etch 1-Step Adhesive Systems for Orthodontic Brackets

The ARI is a scaled score based on the amount of adhesive left on the enamel surface: 0 = none, 1 and 2 = less than half and greater than half, respectively, and 3 = all (Fig. 1). The frequency of each score was recorded and results were expressed as the percentage of each score for each adhesive and time. In addition, the amount of adhesive remaining on teeth was analyzed by quantitative measurements from enlarged images of the tooth surfaces. Individual photographs of debonded surfaces (alongside a ruler) were taken with a Spot Insight Color 3.2.0 Camera (Diagnostic Instruments Inc., Sterling Heights, MI, USA) and the surface area of the bracket and remaining resin for each tooth was measured using ImageJ Software (National Institutes of Health, Bethesda, Md., USA). The residual resin for each tooth was expressed as a percentage of the remaining resin within the bracket perimeter (%RR).

Scanning Electron Microscopy Samples representing each ARI score were qualitatively analyzed with SEM (Leica EM ACE200, Leica Microsystems, Wetzlar, Germany) at 500× and 1000× magnification.

Statistical Analysis Two-way analysis of variance (ANOVA) and the Tukey post hoc test were used to compare mean SBS and %RR among the groups (α = 0.05).

Ethics approval Ethics approval for this study was obtained from the Universi- ty of Toronto research ethics board (protocol #31823).


Results Bond Strength For all tests, the assumption of normal distribution of errors was checked and satisfied by the Shapiro-Wilk test. The evaluated factors — group (p = 0.000), time (p = 0.001) and group × time (p = 0.009) — had a significant effect on SBS. The BU and C groups had the lowest and highest SBS values, respectively (p < 0.05), at both baseline and 6 months (Table 2). At both times, SU and CU had similar results and did not differ significantly from each other (p > 0.05). Significantly lower mean SBS was observed at 6 months compared with baseline for C, but there was no significant difference over time for the USE1SASs. SBS of USE1SASs ranged from 1.9 to 4.1 MPa at baseline and 0.55 to 4.6 MPa at 6 months; these SBS values are not considered appropri- ate for orthodontic treatment.

Remaining Resin and Surface Characteristics of Enamel after Debonding All 3 USE1SASs showed ARI scores of 0 or 1 at both times, indicating that there was no resin or less than half of the resin left on the enamel. A larger number of teeth in the control group showed remaining resin, especially at 6 months. At baseline, the ARI scores for the 3 USE1SASs were similar. However, for group C, 84% of teeth had a score of 1 and 16% had a score of 2 (Table 3). Although the most predominant mode of failure for all the adhesive groups at baseline and 6 months (Table 4) was a combination of adhesive and cohesive failures, there was a trend toward less resin remaining on the tooth surface in the USE1SAS groups compared with the control at 6 months.


= Scotchbond Universal Adhesive, BU = All-Bond Universal, CU = Clearfil Universal Bond, C = control (AdperTM Scotchbond Multi-Purpose Adhesive). Note: Different uppercase letters within a row indicate significant differences among means. Different lowercase letters within a column indicate significant differences among means.

*SU = Scotchbond Universal Adhesive, BU = All-Bond Universal, CU = Clearfil Universal Bond, C = control (AdperTM Scotchbond Multi-Purpose Adhesive). Note: Different uppercase letters within a row indicate significant differences among means. Different lowercase letters within a column indicate significant differences among means.

Table 2: Mean shear bond strength of various adhesive systems* at baseline and after 6 months.

Table 3: Distribution of adhesive system groups by adhesive remnant index (ARI) scores at baseline.

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Bond Strength of Universal Self-Etch 1-Step Adhesive Systems for Orthodontic Brackets

*SU = Scotchbond Universal Adhesive, BU = All-Bond Universal, CU = Clearfil Universal Bond, C = control (Adper Scotchbond Multi-Purpose Adhesive). †Amount of adhesive left on tooth: 0 = none, 1 = less than half, 2 = more than half, 3 = all.

Table 4: Distribution of adhesive system groups by adhesive remnant index (ARI) scores at 6 months.

The trend in ARI scoring was confirmed by the more precise quantification of remaining adhesive on enamel surfaces after debonding (Table 5). All evaluated factors — group, time and group × time (p = 0.000) — had a significant effect on %RR. The C group had a significantly higher mean percentage of remaining resin on the tooth surfaces compared with the 3 USE1SASs at both times (p < 0.05), with no significant differences among the selfetching adhesives. Comparing differences at baseline and 6 months, C and BU groups showed a significant difference (p < 0.001).

*SU = Scotchbond Universal Adhesive, BU = All-Bond Universal, CU = Clearfil Universal Bond, C = control (Adper Scotchbond Multi-Purpose Adhesive). Note: Different uppercase letters within a row indicate significant differences among means. Different lowercase letters within a column indicate significant differences among means.

Table 5: Percentage of adhesive remaining at baseline and after 6 months for different systems.*

SEM analyses of the debonded enamel surfaces showed that, in general, the enamel surface of teeth in the USE1SAS groups appeared smooth and less porous with minimal remaining resin on the enamel surfaces (Figs. 2 and 3). In contrast, for the C group, superficial microporosities are clearly visible on total-etched debonded surfaces. Based on our results, all 3 null hypotheses were rejected.


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Figure 2: Scanning electron microscope images (1000×) of debonded surfaces at baseline. Note: E = enamel, R = resin. A: Scotchbond Universal Adhesive (SU) group. B: All-Bond Universal (BU) group. C: Clearfil Universal Bond (CU) group. D: control (Adper Scotchbond Multi-Purpose Adhesive) group.

Figure 3: Scanning electron microscope images (500×) of debonded surfaces at 6 months. Note: AD = adhesive, E = enamel, R = resin. A: Scotchbond Universal Adhesive (SU) group. B: All-Bond Universal (BU) group. C: Clearfil Universal Bond (CU) group. D: control (Adper Scotchbond Multi-Purpose Adhesive) group.

Discussion Mild or ultra-mild USE1SASs (pH 2.3–3.2), such as the ones used in this study, rely on a 2-fold bonding mechanism: a micromechanical bond and a chemical bond.7 Their monomers usually contain a carboxylic or phosphoric acid group, which etches the tooth, creating surface porosity to produce mechanical retention.7 The chemical bond is September 2019

related to the presence of a specific functional monomer, 10-methacryloyloxydecyl dihydrogen phosphate (10MDP), which combines enamel demineralization with the ability to bond ionically with the calcium ions of hydroxyapa- tite.16,17 Uncut enamel is a hypermineralized and aprismatic substrate by nature.13 On such a substrate, this study showed that the more aggressive demineralizing effect created by the TEMSAS (H3PO4, pH < 1) superseded the dual bonding mechanism of the 3 USE1SASs, leading to significantly higher SBS. The other factor that influences SBS is the presence of functional monomer impurities that can affect the durability of the enamel bond.18,19 Yoshihara and colleagues18 confirmed that both the purity and presence of 10-MDP dimers in adhesives influence the etching efficacy of hydroxyapatite and bond strength. Therefore, it is possible that the lower SBS of BU compared with SU and CU may be a result of impurities in the 10-MDP functional monomer. These impurities and dimers may undergo hydrolytic degradation more rapidly, thus accounting for the decrease in SBS with time. Although no significant individual decrease in SBS in the USE1SAS groups occurred after 6 months, our results indicate that the factor time did significantly reduce overall SBS (p = 0.001). These results, especially in the CU group, are in agreement with McLean et al.12 and Atash Biz Yeganeh et al.20 Studies have reported a relation between bond strength and failure mode, as greater bond strengths correlate with more mixed fractures.21 This relation was apparent when we looked at bond strength and the amount of resin remaining after debonding in the C group compared with the USE1SAS groups at both times. These results are in agreement with Sharma et al.,5 who showed that a total-etch system had a greater ARI score than selfetch systems. In addition, Schnebel et al.22 showed that total-etch adhesives fail mainly at the bracket–adhesive interface, thus leaving more residual resin on the enamel surface. On the other hand, self-etch adhesives result in more failures at the enamel– adhesive interface, leaving less resin on the tooth surface. As bracket failure occurs at the weakest interface, this also indicated a weaker bond to the enamel surface, resulting in lower SBS.22 Our study shows a clear relation between SBS, ARI and %RR. Over time, the overall ARI score, %RR and SBS decreased for BU. A lower ARI score after 6 months signified less resin remaining on the tooth and a weaker

bond between the resin and the enamel, which correlated with its decrease in SBS. Although the overall ARI score and SBS also decreased for the SU group, there was no difference in %RR. An ARI score of 1 remained constant for CU and there was no difference in %RR, which reflected a greater stability of SBS. However, for the C group, although the overall ARI score and mean %RR increased over the 6-month period, there was a decrease in SBS. A study by Burrow et al.,23 which assessed the 7-year dentin bond strength of a total-etch and a self-etch system, demonstrated similar results. In that study, although the SBS of both systems decreased over time, the mode of failure for the self-etch system did not change with time, whereas the total-etch system had an increase in cohesive failures in dentin.23 This signifies that, in the present study, the bond between the resin and tooth, for some samples, may have increased over time and the weakest point was between the bracket and Bond Strength of Universal Self-Etch 1-Step Adhesive Systems for Orthodontic Brackets adhesive system. In general, the %RR results of this study are in agreement with the ARI scores, thus validating the ARI scoring index. In a comparative study of qualitative and quantitative methods for the assessment of adhesive remnant after bracket debonding, Cehreli et al.24 also concluded that qualitative visual scoring using the ARI is capable of generating results that are consistent with those assessed by quantitative image analysis techniques. Under SEM, the amount of residual resin on selected enamel surfaces was greater than the calculated percentage of remaining resin; however, there was no change in ARI score for the selected teeth. As previously mentioned, enamel surface conditioning by the USE1SASs was less effective than TEMSAS conditioning, possibly resulting in decreased micromechanical retention. Figures 1 and 2 show that enamel surfaces in the USE1SAS groups were smooth after debonding and less porous than surfaces in the TEMSAS group. Although of relevance to orthodontics, not many studies have evaluated the strength of bonding agents to uncut enamel. In 2003, Perdigao and Geraldeli25 evaluated immediate bond strength of 1-step and 2-step self-etch adhesives, compared with a 2-step total-etch adhesive, on uncut enamel. Microtensile bond strength for 1-step and 2-step self-etch adhesives was 0.08–11.8 MPa and 11.3–16.7 MPa, respectively, whereas the 2-step total-etch adhesive had the highest bond strength at 31.5 MPa. The very low mean bond strength value obtained for the One-Up Bond F system (Tokuyama Dental Corp.,


Bond Strength of Universal Self-Etch 1-Step Adhesive Systems for Orthodontic Brackets

Taitou-ku Tokyo, Japan), i.e., 0.08 MPa, was justified by its “relatively high pH of 2.57.” These results were supported by field emission SEM analyses, which showed virtually no interprismatic penetration of the adhesive as well as formation of gaps across the entire interface. In another study, Patil et al.13 found that the immediate bond strength of 2-step total-etch was 4.94 MPa compared with 3.62 MPa for 1-step self-etch bonding agent to uncut enamel.

9. Christensen GJ. Self-etching primers are here. J Am Dent Assoc. 2001;132(7):1041-3. 10. Stape THS, Tjäderhane L, Abuna G, Sinhoreti MAC, Martins LRM, Tezvergil-Mutluay A. Optimization of the etch-and-rinse technique: new perspectives to improve resin–dentin bonding and hybrid layer integrity by reducing residual water using dimethyl sulfoxide pretreatments. Dent Mater. 2018;34(7):967-77. 11. Nair M, Paul J, Kumar S, Chakravarthy Y, Krishna V, Shivaprasad. Comparative evaluation of the bonding efficacy of sixth and seventh generation

The range for SBS for USE1SASs in the present study (immediate 1.9–4.1 MPa, aged 0.55–4.6 MPa) falls within and is consistent with previous literature. Differences in absolute mean values may be attributed to variations in the chemistry of bonding systems, testing methods and bonding substrate, such as age of teeth and fluoridation. This study showed that USE1SASs not only had significantly lower SBS to uncut enamel than the TEMSAS, but also that SBS values were below minimal strength appropriate for orthodontic applications in selfetch mode.

bonding agents: an in-vitro study. J Conserv Dent. 2014;17(1):27-30. 12. McLean DE, Meyers EJ, Guillory VL, Vandewalle KS. Enamel bond strength of new universal adhesive bonding agents. Oper Dent. 2015;40(4):410-7. 13. Patil D, Singbal KP, Kamat S. Comparative evaluation of the enamel bond strength of ‘etch-and-rinse’ and ‘all-in- one’ bonding agents on cut and uncut enamel surfaces. J Conserv Dent. 2011;14(2):147-50. 14. Swanson T, Dunn WJ, Childers DE, Taloumis LJ. Shear bond strength of orthodontic brackets bonded with light-emitting diode curing units at various polymerization times. Am. J Orthod Dentofacial Orthop. 2004;125(3):337-41. 15. Artun J, Bergland S. Clinical trials with crystal growth conditioning as an alternative to acid-etch enamel pretreatment. Am J Orthod. 1984;85(4):33340. 16. Cardoso MV, de Almeida Neves A, Mine A, Coutinho E, Van Landuyt K, De Munck J, et al. Current aspects on bonding effectiveness and stability


in adhesive dentistry. Aust Dent J. 2011;56(Suppl 1):31-44. 17. Van Meerbeek B, De Munck J, Yoshida Y, Inoue S, Vargas M, Vijay P, et al. Buonocore memorial lecture. Adhesion to enamel and dentin: current status and future challenges. Oper Dent. 2003;28(3):215-35.


1. Costa AR, Vedovello-Filho M, Correr AB, Vedovello SA, Puppin-Rontani

18. Yoshihara K, Nagaoka N, Okihara T, Kuroboshi M, Hayakawa S, Maruo

RM Ogliari FA, et al. Bonding orthodontics brackets to enamel using exper-

Y, et al. Functional monomer impurity affects adhesive performance. Dent

imental composites with an iodonium salt. Eur J Orthod. 2014;36(3):297-

Mater. 2015;31(12):1493-501.


19. Tsuchiya K, Takamizawa T, Barkmeier WW, Tsubota K, Tsujimoto A, Ber-

2. Reynolds I. A review of direct orthodontic bonding. Br J Orthod.

ry TP, et al. Effect of a functional monomer (MDP) on the enamel bond du-


rability of single-step self-etch adhesives. Eur J Oral Sci. 2016;124(1):96-102.

3. Bakhadher W, Halawany H, Talic N, Abraham N, Jacob V. Factors affect-

20. Atash Biz Yeganeh L, Seyed Tabai E, Mohammadi Basir M. Bonding du-

ing the shear bond strength of orthodontic brackets - a review of in vitro

rability of four adhesive systems. J Dent (Tehran). 2015;12(8):563-70.

studies. Acta Medica (Hradec Kralove) 2015;58(2):43-8.

21. al-Salehi SK, Burke FJ. Methods used in dentin bonding tests: an analysis

4. Finnema KJ, Ozcan M, Post WJ, Ren Y, Dijkstra PU. In-vitro orthodontic

of 50 investigations on bond strength. Quintessence Int. 1997;28(11):717-23.

bond strength testing: a systematic review and meta-analysis. Am J Orthod

22. Schnebel B, Mateer S, Maganzini AL, Freeman K. Clinical acceptability

Dentofacial Orthop. 2010;137(5):615-22.e3.

of two self-etch adhesive resins for the bonding of orthodontic brackets to

5. Sharma S, Tandon P, Nagar A, Singh GP, Singh A, Chugh VK. A com-

enamel. J Orthod. 2012;39(4):256-61.

parison of shear bond strength of orthodontic brackets bonded with four

23. Burrow MF, Harada N, Kitasako Y, Nikaido T, Tagami J. Seven-year

different orthodontic adhesives. J Orthod Sci. 2014;3(2):29-33.

dentin bond strengths of a total- and self-etch system. Eur J Oral Sci.

6. Patil P, Kaur S, Kaur M, Kaur M, Vinuta S, Kaur RK. Orthodontic cements


and adhesives: a review. J Adv Med Dent Sci Res. 2014;2(3):35-8.

24. Cehreli SB, Polat-Ozsoy O, Sar C, Cubukcu HE, Cehreli ZC. A compara-

7. Giannini M, Makishi P, Ayres AP, Vermelho P, Fronza B, Nikaido T, et al.

tive study of qualitative and quantitative methods for the assessment of ad-

Self-etch adhesive systems: a literature review. Braz Dent J. 2015;26(1):3-10.

hesive remnant after bracket debonding. Eur J Orthod. 2012;34(2):188-92.

8. Shaik JA, Reddy RK, Bhagyalakshmi K, Shah MJ, Madhavi O, Ramesh SV.

25. Perdigão J, Geraldeli S. Bonding characteristics of self-etching adhe-

In vitro evaluation of shear bond strength of orthodontic brackets bonded

sives to intact versus prepared enamel. J Esthet Restor Dent. 2003;15(1):32-

with different adhesives. Contemp Clin Dent. 2018;9(2):289-92.


Dental News

September 2019

Dental Marketing

Dr. Edward Martin Motivational speaker and public speaking & marketing consultant.

How To Use Public Speaking To Attract New Dental Patients Are your marketing methods failing to get you known in your city ? Do you feel that your marketing doesn’t really get the public to know you personally and as a dental expert. Well, you are not the only dentist with these kinds of feelings. Many dentists tell me that they feel “invisible” to the public. These practitioners have great skills, but their marketing doesn’t convince people to trust them.

Let me give you examples of “invisible” and “visible” marketing. First, invisible marketing leaves you feeling that nobody knows and trusts your dental skills. Here, a good example is to try to imagine that people see your business sign that states your name and that you are a dentist. Now, what does the public learn about you from this type of marketing ? Were they able to get to know you as an expert in your field? Or, are you still an unknown professional, who is basically invisible to them ? Let’s try to analyze this topic a little deeper. There are many types of marketing and advertising methods that fail to introduce you personally and professionally to the public. People still don’t know who you are and they don’t even know if they like and trust you. This type of impersonal marketing doesn’t tell people enough about you and it will keep you invisible to potential patients. It also will not motivate them to find out more about you and your practice. So, we have to change our goal or “marketing mindset”. We will need a more personal and visible approach to our marketing plan. Here, we have to show the public who we are and let them get to know us as trustworthy professionals. In addition, it is important to offer question / answer sessions, so that people can understand how you plan to solve their dental problems.

At this point, let me introduce you to a second type of marketing which is stronger, more personal and it allows you to be very visible in your city. This type of marketing is known as “public speaking”. Here, we find that giving speeches is very effective for attracting new patients, because of the following reasons : 1. You are able to give speeches to different groups of people several times per week. Your staff can also be trained to give speeches in your city.


Dental News

September 2019

Dental Martketing

2. Each audience will see you as a dental expert in your field and you will be able to answer their questions after your speech. Many groups will give you 15 to 30 minutes to answer their questions after you give your speech. In addition, you will be able to meet and shake hands with many of the audience members after your speech is over. 3. Successful dentists try to give at least two speeches each week. This will result in you giving around 100 speeches in a twelve month period. Some dentists, with large goals, try to speak 150 to 200 times per year. In addition, many successful dentists also have their staff members trained to go out and give speeches in their city. This would include other dentists that work in your office, dental hygienists, dental assistants, office managers and secretaries. - You don’t have to be a dentist in order to give a speech. 4. Speakers have the choice of speaking to small groups and large groups of people. Dentists and their staff members have speaking engagements at groups ranging in size from 20 to 500 people. So, start with smaller groups and gradually try larger groups of people, as you become a confident speaker. It is also important to expand your speaking engagements to the following kinds of groups: Corporations, associations, conferences, conventions, organizations, schools, colleges & universities and associations for other kinds of health professionals that have the ability to make referrals to you. - This will take some effort and rehearsing of different “pitches”, in order to acquire speaking engagements at good “targeted” groups. ( Don’t try to speak to every kind of group ). It does take a lot of effort and work, but it will be worth it. In addition, your employees can help with a lot of the work. 5. If you have a fear of public speaking, you can conquer your fear by practicing in small groups or seminars.

How To Use Public Speaking To Attract New Dental Patients

You can also practice your pitches for getting speaking engagements. In addition, you can start analyzing which kinds of groups are your best target markets for what you are trying to promote. 6. Start setting a goal of being a well known and visible dentist in your city. Public speaking can help you become a well known professional to thousands of people in your city and surrounding areas. Giving speeches can also help you make many strong contacts with medical, dental and other health professionals, who have the ability to send referrals to you. 7. Here are a few more bonuses that you have a good chance of attaining, as a result of giving speeches on a regular basis : Being hired for paid Keynote speeches, receiving high fees for freelance consulting and training jobs, receiving many referrals for more speaking engagements and being asked to give many seminars and workshops. All in all, you will be able to choose if you want to speak locally, nationally or both. 8. Let’s conclude with one final point that demonstrates the power of public speaking. We will start with a small goal of speaking to 100 groups in a year. This would require that you give two speeches each week. Now, if you speak to 100 small groups that have around fifty people in the audience, you would have spoken to 5,000 people in a year.

Can you imagine the number of potential new dental patients that you might acquire by speaking to 5,000 people in a year ? Furthermore, when you are speaking to each group, your audience will get to know you and you will be seen as an expert in your field. They will also have a chance to ask you questions about their dental conditions. Now, this is just the beginning, as you can always decide to get speaking engagements more often at much larger groups. You can also increase the number of speeches you give to the public and to professional organizations that have the potential to send you referrals. Finally, many of your office workers and staff members can be trained to give speeches when you are busy. So, stop being invisible and choose to be a successful well known dentist by using public speaking.


Dental News

September 2019

‫‪SOS 2019‬‬ ‫‪Saudi Orthodontic Society‬‬ ‫‪13th Annual Conference‬‬

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‫‪February 22 - 24, 2019‬‬ ‫‪Jeddah, Saudi Arabia‬‬

‫‪Prof. Ali Habib and Prof. Khalil ElEisa Offering the trophy‬‬ ‫‪to Dr. Hani Jokhadar representing the Minister of Health‬‬

‫سعادة وكيل وزارة الصحة للصحة العامة‪ :‬الدكتور هاين جخدار‪ ،‬األخوة واألخوات‬ ‫‏تترشف الجمعية السعودية لتقويم األسنان بعقد مؤمترها الثالث عرش وإستضافة مؤمتر الجمعية العربية لتقويم‬ ‫األسنان الرابع عرش ورئاستها لهذه الدورة ‪ ،‬وذلك برعاية كرمية من معايل وزير الصحة الدكتور توفيق الربيعة‪.‬‬ ‫لقد أصبحت الجمعية السعودية لتقويم االسنان ولله الحمد من الجمعيات الرائدة عامليا رغم حداثة سنها‪.‬‬ ‫فلديها االن مايقارب ال‪ ٢٠٠٠‬عضوا‪ .‬ولديها مجلة عاملية محكمة‪ .‬وباإلضافة ملؤمترها السنوي والنصف سنوي‬ ‫وف معظم مناطق مملكتنا‬ ‫والتي تعقد دوريا‪ ،‬توسعت نشاطاتها لتشمل برامج تعليم مستمر عىل مدار السنة ِ‬ ‫الحبيبة وحمالت توعوية للعامة عن مشاكل االطباق وكيفية عالجها والوقاية من بعضها ومسابقات بحثية‬ ‫ورسيرية ‪ .‬كام انها حرصت كل الحرص عىل تبني العمل التطوعي وجعله سمة وعالمة فارقة يف نشاطاتها العلمية‪.‬‬ ‫‏وهكذا الجمعية العربية لتقويم االسنان حظيت بأهتامم قوي من أعضاءها الجمعيات العربية وتطورت تطورا‬ ‫ملحوظا يف نشاطاتها واستمرار انعقاد مؤمترها دوريا‪ ،‬وأصيح لها دورا مهام يف منظمة التقويم العاملية (‪.)WFO‬‬ ‫ان مؤمترنا يتميز ولله الحمد بكفاءة التنظيم وبعدد وكفاءة متحدثيه العاملني والعرب والسعوديني وجامل معرضه‬ ‫املصاحب ‪ ،‬والحضور املتميز الغري عادي من حميع أنحاء اململكة والعامل العريب ‪ .‬وجوائزه يف التميز يف العالج‬ ‫الرسيري والبحثي‪.‬‬

‫الربفسور عيل حبيب‬ ‫رئيس الجمعية السعودية لتقويم األسنان‬

‫‪Prof. Ali Habib,‬‬ ‫‪president Saudi‬‬ ‫‪Orthodontic Society‬‬

‫‪Presidents of the Arab Orthodontic societies with WFO officers; Left to right: Eiman Abdel Kader‬‬ ‫‪(Libya), Zakaria Bentahar (Morocco), Khaled Abolazm (Secretary General Arab Ortho Soc.), Mona Ghossoub‬‬ ‫‪(Lebanon), Abbas Zaher (Egypt), Ahmed al Tarawneh (Jordan), Joseph AbouSerhal (Lebanon), Nikhilesh Vaid‬‬ ‫‪(India, WFO board member) and Ali Habib (KSA, president Saudi Ortho Society), Takashi Ono (Japan,‬‬ ‫‪WFO board member), Akram al Huwaizy (Iraq), Al Nasry (Sudan), Saad Nafaa (Palestine).‬‬ ‫‪September 2019‬‬

‫‪Dental News‬‬


Prof. Ali Habib offering the trophy to Prof. Joseph Bouserhal

Dr. Wael Elias Dr. Gihad AlBaroudi

Dr. Tim Tremont Dr. Lisa Alvetro

Dr. Tarek AlBaily 56

Dental News

September 2019

Dr. Mohammed Harbi and Prof. Ali Habib offering the trophy to Dr. Kengi Ojima

Jeddah, Saudi Arabia February 22 - 24

SOS 2019

Dr. Nikilesh Vaid

Trophy Distribution

Dr. Eustaquio Araujo

Dr. Khaled Aboulazm

Dr. Junji Sugawara

Dr. Fahad AlSulimani

Dr. Mubarak al Saeed

Drs; Naif Felemban, Tony Dib, Joseph Bouserhal, Nikilesh Vaid, Khalil Al Ali, Meshari Alotaibi, Takashi Ono

AIO 2019 10th International Congress

June 13 - 15, 2019 Chia (Calgliari), Sardinia, Italy

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Opening speech by Dr. Enrico Lai and a group of speakers

During the 10th International Congress held by the Italian Dental Association, AIO in Chia. Hands on courses in esthetics, endodontics, implantology and tongue reeducation in TMJ therapy were held by top international dentists, each one an expert their field with an eye pointed towards the future. Giovanni Zucchelli from the University of Bologna presented: Treatment of Soft Tissues Surrounding the Natural Dentition. The course provided step by step surgical procedures for root coverage, the harvesting of connective tissue grafts as well as suturing techniques. Alessandro Rampello from the University of Rome held a course in the treatment of TMJ disorders also Alfonso Coscaella from Grosseto in Tuscany held a course in the prevention and treatment of biologic complications in implantology. The theoretical part of the course covered magnifying systems, microsurgical instruments, the Air Flow and the Er YAG laser that perfectly decontaminates the implant surface allowing for more effective preventive and regenerative procedures to be performed. During the hands-on portion the use of a new generation Air Flow was demonstrated as well as the use of the Er YAG laser in treating early stage perimplantitis.

Dr. Kathryn Kell, Dr. Gerhard Seeberger, Dr. Enrico Lai 58

Dental News

Dr. Paulo Kano, Dr. Enrico Lai

Drs. Luigi Paglia, Claudia Caprioglio, Maria ElKhoury Abboud September 2019

Chia, Italy June 13 - 15

AIO 2019

Dimitar Fitlchev with Rumiana Terzieva, Kamen, Georgi, Cveti, Maria Khoury Abboud, Andre Saadoun & Elitsa Rutseva



LOS 2019 Lebanese Orthodontic Society 17th Annual Meeting June 21 - 22, 2019 Movenpick Hotel, Beirut, Lebanon

Prof. Roger Rebeiz, President of the Lebanese Dental association

Prof. Mona Ghossoub, President of the Lebanese Orthodontic Society

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Prof. Joseph Ghoubril, Chairman of the scientific committee

Dear Speakers, Dear Members of the Lebanese Orthodontic Society, Dear academic colleagues and administrative authorities I would like to express my deep satisfaction in sharing this important moment contributing in the development of the dentistry’s first specialty with you. On behalf of the Lebanese Orthodontic Society Board and committees, it gives me great pleasure to welcome you all today for the 17TH annual meeting of the LOS. The Lebanese Orthodontic Society (LOS) was founded in 1965 in Beirut, Lebanon, and is one of the oldest dental scientific societies in the Middle East. Today, the LOS is a member of the Arab Orthodontic Society, a corresponding member of the European Federation of Orthodontics and an affiliate organization of the World Federation of Orthodontists. It has currently 250 affiliated members who are orthodontic specialists and practice orthodontics exclusively. Working closely with the Lebanese universities, the LOS supports the development of the specialty in Lebanon by furthering the continuing education of its members and by encouraging the development of scientific research in orthodontics. Motivation and teamwork were the main reasons for the success and continuity of the LOS over the years. A few experienced orthodontists instigated the Society at the start with the ambition of better structuring the profession and keeping the orthodontists informed on the latest advancements and techniques in the field. The goal of the successive LOS presidents was to build momentum and establish more regional and international connections with other dental and orthodontic societies. The LOS participation in lots of international events all over the World as well as organizing many conventions in Lebanon helped in establishing good relationships with other orthodontists and dental professionals on a scientific and human level. Motivating orthodontists to join the LOS keeps them interacting within the educational path. Interdisciplinary seminars with eminent speakers are organized on regular basis conferring different topics in relation with orthodontics. Lately working hand in hand with other orthodontic Societies such as the Tunisian, the ATREO “Association Tunisienne de recherche et d’études en orthodontie”, in two joint Meetings was a real success.


Dental News

September 2019







The first one took place in June, 2018 in Beirut and the second in December 2018 in Tunis where colleagues shared their knowledge and consolidated friendships. It is important to emphasize that all previous and upcoming LOS achievements are owed to the teamwork and efforts made by the preceding Presidents and Committees. In the LOS, many fundamental goals are of major importance. The main one is hopefully placing the LOS in a leading position internationally by enhancing and supporting scientific research and publications. LOS can contribute actively to connect Lebanese orthodontists with other orthodontic organizations and institutions to attain this aim. Thus, it is a real privilege to launch this congress which theme is “Overcoming challenges in Orthodontics�. The main goal of this meeting is to enable practitioners to interact together and with other experienced and renowned international and local speakers. I would like to acknowledge the efforts implemented by the former Lebanese Orthodontic Society Presidents and committees for their precious contributions to establish a lasting base on which we will continue to add in order to attain all the predetermined goals. I also want to thank the current scientific committee and its chairperson Prof. Joseph Ghoubril for his involvement and constant efforts; the organizing committee represented by Doctors Fadi Dahboul and Fadi Gaith for their hard work, as well as the continuous support of the Executive Board and all members of the Lebanese Orthodontic Society for their absolute support and their willingness to learn and evolve. And last but not least, I would like to thank all the companies who are always backing and sponsoring our events, giving us valuable support with their presence year after year. And now I declare opened the 17th Annual Meeting of the Lebanese Orthodontic Society.

Dr. Mona Sayegh Ghoussoub President of the Lebanese Orthodontic Society

Drs; Ali Fahs, Ramzi Haddad, Samer AlRifai, Roger Rebeiz, Mona Ghossoub, Fadi Ghaith, Adib Kassis

Drs; Fadi Ghaith, Mona Ghossoub, Fares AbouObeid, Joseph Ghoubril, Roula Akl, Zouhair Skaff

Drs; Lina Medawar, Giorgio Fiorelli, Mona Ghossoub, Rola Akl

Drs; Fadi Ghaith, Ibrahim Nasseh, Mona Ghossoub, Roula Akl Drs; Fadi Ghaith, Nunzio Cirulli, Mona Ghossoub, Roula Akl, Joseph Ghoubril, Adib Kassis

Drs; Nassib Ballout, Mona Ghossoub, Joseph Ghoubril, Roula Akl, Adib Kassis 62

Dental News

September 2019

Drs; Fadi Ghaith, Khaled Abou Al azm, March 2019 Mona Ghossoub, Roula Akl, Joseph Ghoubril

Beirut, Lebanon June 21 - 22

LOS 2019

Trophy Distribution

First prize winner: Sarah Khamis Second prize winner: Christophe Zoughaib

Nathalie Abou Salha Michelle Chekie

Exhibition Floor

EDSIC 2019 Egyptian Dental Syndicate International Congress September 4 - 6, 2019 Intercontinental City Stars, Cairo, Egypt

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The EDSIC organizing committee: Drs; Khaled ElSherif, Ashraf Zalouk, Mohamad Badaoui, Islam Moussa, Hisham Abdelnasser, Ehab Haikal, Nashwa It is a privilege and great honor to be here as an EDSIC member. This event is the culmination of an enormous collective effort which began in 2015 . It is a great pleasure to welcome you to this year’s EDSIC. I am delighted that so many esteemed guests and speakers from around the world are taking part in this conference. A warm welcome from Egypt to you all. Dentistry is a constantly evolving profession and dentists need to constantly renew their knowledge and information to take into account the latest developments, being ahead of the game is what our customers expect from us. To EDSIC board I am also greatly impressed by the program you have put together. See you in the next EDSIC 2020 in September.

Dr. Khaled Elsherif Dear Colleagues, Welcome to the Egyptian Dental Syndicate International Congress in its 5th Edition. Hoping that the current Edition will be the beginning of a New ERA. We have been keen in this Edition to add new events and to have a greater role for young Dentists in all aspects of the conference with their ideas developed. We hope that every doctor in this edition of the conference will find everything he wants and aspires to.

Dr. Youssef Hamza

Dr. Khaled Nour


Dental News

Pr. Mohsen Abi El Hassan

September 2019

Cairo, Egypt September 4 - 6

Prof. Essam Zaatar Dr. Atef Ismail

Exhibition Floor

EDSIC 2019

On our website to receive 30% off CT reports. The Ultimate Second Opinion from a US Board Certified Radiologist

Arab Society of Periodontists 1st Meeting

On the 24th of July with the representatives of Perio societies and clubs from five Arab countries (Egypt, Lebanon, KSA , UAE and Jordan the hosting country). The first meeting was held in Amman, the participants stated the importance of having a Pan Arab society for Arab periodontists in the Arabic countries. Where ASP (Arab Society of Periodontists) will be the Scientific and social tribune of all Periodontists & dentists who have the Perio passion. ASP will partner with all international Perio societies, at the same time the attendees stressed on the importance of expanding this society to all local societies in the Arabic countries. The attendees drafted the internal bylaws of the society and agreed to hold the first regional Arab Perio in Amman on April 6th, 2020 and the 2nd one will be held in Beirut in 2022. September 2019

The attendees elected: Dr. Alaa Ersheidat (President), Prof Nada Naaman (Vice-president), Dr. Abdallah Al Amri (Treasury). Dental News



MS cial of of

Dr. Hassem Geha Oral and MaxillofaRadiology University Connecticut, School Dental Medicine, Farmington , CT

A 62-year-old female presented complaining of periodic symptoms from right mandibular molar area Symptoms haven’t been severe in recent times. She was previously seen by a dentist approximately 12-18 months ago due to swelling and infection in that area. At that time, she was treated with antibiotics and was told that the mandibular right wisdom tooth needs removal by a surgeon. The patient reported that she has had anesthesia of her lower right lip during flare up episodes, but this has resolved completely with no further paresthesia or anesthesia after antibiotherapy. Current clinical examination showed moderate gingival inflammation surrounding 48, and 48 was slightly tender to percussion. Caries were noted on teeth 48 and 18.

Radiographic findings A panoramic radiograph and a Cone beam

CT of the right mandible showing 48 and 47 and part of the mandibular ramus were available for radiographic interpretation. The viewed images show that Tooth 48 is impacted with an enlarged follicular sac. There is a well-defined, non-corticated low density extending from the level of the buccal CEJ of this tooth and extends inferiorly to the level of the apex of this tooth and loops around the apex into the lingual aspect of the tooth. This low density extends to the lingual cortical plate causing thinning and mild expansion and likely a perforation. Additional Findings • Endodontically treated 36 with widened PDL space were noted suggestive a periapical pathosis. • Missing teeth 28.

Area of tooth 48 Panoramic Radiograph


Dental News

September 2019

11TH Dental Facial Cosmetic Conference Joint Meeting with

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


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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.

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A 62-year-old female presented complaining of periodic symptoms from right mandibular molar area

Radiographic differential diagnosis Findings in the area of 48 are suggestive of an enlarged pericoronal sac that got infected and invaded the buccal PDL space of 48 and spread into the lingual area of this tooth. This is highly supported by the history of inflammation and infection as reported by the patient and the current clinical observation of tender swelling and moderate inflammation. In addition, there appears to be some occlusal trauma on 48 by 18 causing an additional stress on the PDL space of the tooth leading to a wider PDL space. Although an infected cyst can cause resorption, it is unlikely that it loops around the roots and causes resorption lingually and thinning and perforation of the lingual cortical plate with no expansion or subperiostal new bone formation. Usually, such cysts expand in a balloon-like fashion beyond the CEJ. This feature is not present in the current lesion. We clearly see a different path of expansion on the distal aspect of 48 that is not in continuity with the follicular sac. Also, while an infected cyst can cause erosion of the

cortical outline of the mandibular canal, there is likelihood that the origin of the lesion is neurogenic tumour that extends from the mandibular canal and causes the resorption on the lingual aspect of 48. Such a lesion can cause thinning and perforation of the lingual cortical plate with no expansion. Also the patient has had episodes of anesthesia that can fit a neurogenic tumour. However, as these symptoms resolved, such tumour becomes an unlikely candidate. Another unlikely lesion can be a low grade mucoepidermoid carcinoma. Usually such malignant tumours tend to cause anesthesia or paresthesia that does not subside with treatment. Our differential included the following in a preferential order: 1. High likelihood for infected follicular cyst. 2. Low likelihood of Neurogenic tumour with or without superimposed infection. 3. Least likelihood of a low grade malignant tumour.

Tracing the mandibular canal

Cross-sectional views showing the path of the mandibular canal Area of 48 with tracing of the mandibular canal


Dental News

September 2019

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A 62-year-old female presented complaining of periodic symptoms from right mandibular molar area

Sagittal View

Coronal View

Axial View

Course of action Since the patient was asymptomatic, she was referred to an Oral and Maxillofacial surgeon for tooth extraction and biopsy. Surgical planning of extraction of 48 and associated requested biopsy should take into consideration the position of the mandibular canal within the lesion and the fact that the cortical outline is lost. Also, the surgical treatment should take into consideration the possible lingual perforation and the risk of injury of the lingual nerve in this area. Lingual view of a 3D rendering of the area of 48

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Dental News

September 2019

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3s PowerCure The art of efficiency with posterior restorations Esthetic, high-quality and efficient: New composites make it possible The incremental layering technique is very timeconsuming, especially when dealing with large cavities. Dentists can now reduce their treatment time by more than half whilst achieving the same esthetics and function. The 3s PowerCure product system is key to this improvement in efficiency. Many dentists would welcome an efficient alternative to the complex multi-layer technique. They want a composite that streamlines their treatment times and offers higher processing safety. This applies in particular when dealing with larger restorations in the posterior region of permanent dentition, in Classes I and II. 3s PowerCure provides the solution: Products that are optimally coordinated for direct restorative procedures enable esthetic, high-quality posterior restorations to be produced extremely efficiently. Streamlined application protocol Adhese Universal, the intelligent, high-performance curing light Bluephase PowerCure, the sculptable Tetric PowerFill and the flowable Tetric PowerFlow 4-mm composites – the latest innovations from Ivoclar Vivadent – form part of this product system. The extended layer thickness of up to 4 mm significantly reduces the number of treatment steps required.

Same esthetic results as with conventional composites Conventional composites designed for the placement of large increments are often very translucent. The highly reactive light initiator Ivocerin has paved the way for the development of Tetric PowerFill and Tetric PowerFlow for esthetic posterior restorations. These 4-mm composites offer enamel- and dentin-like translucency levels. This allows you to achieve the same esthetic results in the posterior region as with conventional composites. In addition, these materials can be light-cured from the occlusal aspect in only 3 seconds with the new Bluephase PowerCure curing light. The intelligent curing light Bluephase PowerCure incorporates the new generation of curing lights. It is the smartest Bluephase that ever existed. Thanks to the automatic assistance system, the device automatically detects unintentional movement of the handpiece during the light-curing procedure. It alerts the user of improper operation by vibrating and automatically extends the exposure time. If the accidental movement prevents the material from curing properly, the light will automatically interrupt the exposure cycle. It can then be repeated correctly. Experience the difference In a nutshell: Fewer layers. Extremely short exposure times. The 3s PowerCure product system for esthetic posterior restorations reduces the risk of application errors and insufficient curing. Dentists will notice the difference right away.


Dental News

September 2019






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A truly transparent vinyl polysiloxane EXACLEAR is an innovative, clear silicone material that is useful in a myriad of indications, for dentists as well as dental technicians. Due to its absolute transparency, light-curing through the silicone is optimal whilst having a great visual control of the entire procedure. The material is particularly suitable for those indications where light-curing through the matrix is necessary or can be a benefit. For example, injection moulding is an efficient technique to create direct veneers or to restore the worn dentition, thereby adjusting the occlusal vertical dimension.


But it is just as suitable to create indirect composite restorations in the lab. It is very easy to drill holes in the material and it does not tear when it is removed and placed again on the teeth. In the mouth, the material only needs two minutes of setting before it can be removed. • Injection moulding technique: easy control of injection & perfect light-curing. In this technique, the use of G-aenial Universal Injectable gives a perfect combination. • Temporary crown and bridge work: efficient light-curing of dual-cure materials like TEMPSMART™ DC • Composite layering: light-curing also possible from palatal side • Placement of fibres or brackets: easy transfer from the model to the mouth

New Lara Sterilizers: Ready for the future

Incredible outside You don’t need to be a lover of design to appreciate the new Lara sterilizers. Their smooth surfaces are comfortable to the touch, the instruments are easy to load and the flat colour screen displays allow you to navigate through the intelligent menu structure quickly and with ease. Incredible inside Discover the new W&H Lara sterilizers down to the smallest detail. So many components, perfectly arranged to offer you complete satisfaction by simplifying the sterilization process while providing you with comprehensive documentation.

Incredible because • Fastest B cycle in its segment • Unique upgradeability thanks to Activation Codes • Colour touch display for easy navigation • Automatic cycle record via high capacity USB stick • Optional high end label and cycle report printer • Ergonomics and functional design Fastest in its segement: Even with the basic equipment, the new Lara sterilizers offer you the fastest B cycle in their performance segment. Upgradeable: Customize your sterilizer simply by using the new Activation Code system for even higher speed and comprehensive documentation. Easy to use: Explore new ergonomic thanks to the large colour display and intelligent menu structure.



Dental News

September 2019

Connect Case Center:

Send and manage scan data quickly and reliably A seamless transition into digital impressions and CAD/CAM dentistry: With the new Primescan from Dentsply Sirona, the new Connect software and the Connect Case Center, it’s a breeze. The portal for cooperation with the lab, which has been known as Sirona Connect until now, has been completely overhauled and is now even more convenient and flexible. Validated interfaces enable secure transmission of data to many important partners. Easy, quick, and above all, accurate – intraoral scanning with the new Primescan from Dentsply Sirona meets the clinical requirements for impressions, making it a first-class method. The Connect Case Center is a portal for further processing of the scan with versatile options and full flexibility. The Connect Case Center replaces the Sirona Connect Portal which, until now, has enabled practices to link to laboratories that use the inLab software. The basic function of the new platform is the secure transmission of scan data and case information. Photos can also be transmitted to the lab as attachments. If you want to communicate directly with the dental technician, you can make use of the chat function. The seamless connection to Simplant enables users to use the Dentsply Sirona implant planning service quickly and easily. The connection to SureSmile enables the user to order full service aligners, a model print, and Smile Design in the lab. Labs that work with the inLab software are also seamlessly integrated and can offer CEREC users an attractive design service. website:

VITA VM LC flow:

Layering composite like ceramic The viscous and light-curing VITA VM LC flow is the complete system of the future for composite veneering from dentin core to incisal edge. The comprehensive VM LC BASE DENTINE-shade spectrum in VITA classical A1 – D4 and in the VITA SYSTEM 3D-MASTER shade standard is also available as a low-viscosity version. This not only means that all framework materials can be veneered using shades and effects comparable to the ceramic VITA VM concept, but the handling is also designed from the dentin core, as dental technicians are used to with ceramic layering. Thanks to their consistency, the materials can either be applied directly from the syringe or layered from a mixing plate using a brush. The thixotropic property provides stability, reducing the number of intermediate hardening steps. Combining the moldable paste with the viscous VITA VM LC flow variants is also possible, depending on the required handling. The vestibular anatomy can be individually reproduced on every removable denture with the five gingival shades available. For implant and combination work of any kind, the veneering composite system unites the framework, base and artificial teeth with accurate, richly nuanced shade matching.


CAD/CAM titanium adhesive bases for the tioLogic® TWINFIT implant system Located in the Northern Black Forest, one of Germany’s centers for precision engineering, Dentaurum Implants develops and manufactures its products true to the motto «Quality – made in Germany». The CAD/CAM titanium adhesive bases are one of the latest developments for the implant system tioLogic® TWINFIT which was launched in January 2019. The new CAD/CAM titanium adhesive bases are especially suited for the bonding of multi-unit bridge restorations or full-arch restorations on tioLogic® TWINFIT implants in the edentulous mandible or maxilla. They have a platform connector geometry which ensures the prosthesis sits optimally. There is no rotational security to enable maximum freedom when positioning the base on the implant. The cone is 3.2 mm high and has retention grooves which enhance the effect of the adhesive on the cone. The titanium adhesive bases are constructed in such a way that implant divergencies of up to 30° can be compensated. By using the bonding technique, the ceramic bridges, manufactured using CAD/CAM, can be fitted passively. website:

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Dental News

September 2019

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