ISSUE 5 / 2012
How to build up tHe perfect tootH
MiniMally invasive sinus lift using Hydrostatic pressure and a novel iMplant design
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Contents ISSUE 5/2012 (No.32)
features 14 20 25 36 40
Minimally Invasive Sinus Lift Using Hydrostatic Pressure and a Novel Implant Design How to build up the perfect tooth Modern concepts in endodontic diagnostics and therapies International Expert Symposium: All-Ceramics meets Implant Esthetics Survey shows high prevalence of gum disease
Product finder/launchPad 8-13 • • • • •
Tetric N-Ceram Bulk Fill EasyMode for TENEO NobelActive implant system Hygiene solutions for dental surgery CEREC Omnicam: Powder-free 3D scanning in full color
uPdate 28-35 • • • • • • • • • •
World Dental Congress in Istanbul German dental technology at Sino Dental Nobel Biocare Global Symposium CEREC anniversary celebration Computerized Dentistry conference Guide to effective infection control Grants for dental student service Computer security threats in focus Possible link between pancreatic cancer and gum disease OsseoCare Pro launch at EAO
dePartMents 6 38 42 44
EDITORIAL DPN NETWORK LIFESTYLE DENTAL EVENTS
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Cover photo: photo courtesy of ids
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EDITORIAL
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As part of our efforts to reach out to a wider audience of dental professionals in the region, we are happy to announce the launch of Dental Network Asia (DNA) website. Dental Network Asia is an online regional network for dental professionals developed by Dental Practice News magazine. Since its inception in June 2012, Dental Network Asia has grown to an extensive network with over 25,000 online users from around the region. Our online network includes Singapore, Malaysia, Thailand, Indonesia, Philippines, Vietnam, Cambodia, Hong Kong, Taiwan and India. Asia is one of the fastest growing regions in global dental industry now. And many dental professionals in the region use the online media for their communication and social needs. Our online and digital media platform is extensively and easily accessible by our readers and users even in the remote places of the region. The key digital media platform under Dental Network Asia includes: 1. Dental Practice News e-edition 2. DNA e-newsletter 3. The Leading Dentist page These products are all available online free-of-charge for dental professionals. Readers may join our dental network now with free membership in order to receive the free dental publications. To join Dental Network Asia as members or request for free e-editions of our dental publications, please e-mail to: dentalnetworkasia@gmail.com Dental Network Asia is owned and managed by DPN Communications Pte Ltd, publisher of Dental Practice News magazine. For more info about the DNA digital media platform, please visit the web page: http://dentalnetwork.sharepoint.com
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TeTrIC N-Ceram Bulk FIll Tetric N-Ceram Bulk Fill from Ivoclar Vivadent offers dental professionals an efficient solution for restoring posterior teeth. The mouldable composite resin can be placed in increments of up to fourmillimetres using the bulk filling technique. Dentists no longer have to place fillings in several two-millimetre increments that need to be cured individually. Tetric N-Ceram Bulk Fill enables posterior teeth to be restored with only one layer measuring up to four-millimetres in thickness, which considerably heightens efficiency. The patented light activator Ivocerin is responsible for ensuring the complete cure of the filling. Compared with conventional light initiators, the Ivocerin polymerization booster is much more reactive. Therefore, polymerization is initiated even in very deep cavities and the material is fully cured.
even though Tetric N-Ceram Bulk Fill cures quickly in only ten seconds (> 1,000 mW/cm2), it can be shaped for as long as 3 minutes and 20 seconds. The light sensitivity inhibitor shields the material from ambient light and allows it to be contoured without the pressure of time. Due to its smooth consistency, Tetric N-Ceram Bulk Fill readily adapts to cavity walls. a specially conditioned composite filler, also called a shrinkage stress reliever, keeps shrinkage and shrinkage stress during polymerization to a minimum. It acts like a spring to dampen the forces generated during shrinkage. Tetric N-Ceram Bulk Fill is available in three universal shades: IVa, IVB and IVW. Tetric N-Ceram Bulk Fill forms a part of the Tetric N-Collection, a comprehensive restorative system for the fabrication of high-quality standard restorations. all the products of this system are coordinated to ensure clinical success. apart from the universal composite Tetric N-Ceram, the Tetric N-Collection comprises the flowable composite Tetric N-Flow and the total-etch adhesive Tetric N-Bond, which is best used in conjunction with N-etch, a 37-per cent phosphoric acid etching gel. alternatively, the self-etching adhesive Tetric N-Bond is available. www.ivoclarvivadent.com
easymoDe For TENEO sirona has launched the new easymode for TeNeo at the recent Fachdental leipzig trade show. The latest version of the award-winning premium treatment center offers the same TeNeo functionality, now with an additional operating mode. an important step forward in the practitioner’s customized control of the treatment center. Today’s advanced treatment centers offer the latest technologies for the dental practice and with numerous benefits to the practitioner. But their operation needs to be as simple as possible. sirona masters this balancing act with innovative control concepts that have already received prestigious awards. In the TeNeo easymode, the company now offers its treatment centers with greater operating comfort and full functionality. For this purpose, an additional control option has been developed, which takes the user directly to the desired setting without going through multiple menu layers. “We received the iF communication design award in 2010 for our proven control concept easyTouch,” says susanne schmidinger, head of Treatment Center marketing at sirona. “For us this was not only a confirmation but also an inducement to develop solutions for even greater operating comfort. “With the TeNeo easymode we give the practitioner the option to use a premium unit with the tactile comfort of a touchscreen so he can concentrate fully on the treatment. It is operated like speed-dial on a telephone. When you don’t want to have to remember a long number and know just where you want to go you use speed dial.” The TeNeo treatment center is one of the most innovative dental equipment on the global market, according to sirona. The concept was developed after a careful analysis
of work processes during treatment and based on decades of experience at sirona. Innovations such as the easyTouch user interface that makes it easy for the practitioner to concentrate on his work. easymode is the new control option that makes it easy to operate TeNeo with the press of a button and without the menus. Individual settings can be set in advance and then called up directly in easymode. This not only increases the practitioner’s comfort, it also raises the safety level during treatment. With the new control concept, sirona takes the classic control concept and makes it easier to use the new treatment center, especially for TeNeo beginners. Not only current users of sirona treatment centers will like the familiar controls in an advanced unit, but practitioners who are used to working with technology from other manufacturers will appreciate the new operating comfort of the TeNeo easymode.
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proDuCTFINDer
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Nobelactive imPlaNt system The Nobelactive implant system remains one of the most successful implant initiatives in the history of implant dentistry, according to Nobel Biocare. each year since its introduction in 2008 this innovative implant system has continued to attract more dental clinicians and surgeons around the world. several new third-party evaluation awards, including “Best product 2012,” reaffirm that Nobelactive truly is an implant like no other. Nobelactive 3.0 was named “Best product 2012” in the september issue of Dental product shopper, a renowned publication in the united states, which focuses on in depth reviews of dental products. This is the highest accolade given by Dental product shopper and is reserved only for products that achieve very high scores in the clinician evaluation process. This award follows two recent awards, also from a well-known us publication, where the innovative Nobelactive implant system was named to Dentistry Today magazine’s “Top 100 products 2012” in the July edition and “Top 25 Implant products 2012” in the may edition. Nobelactive has previously received honors as “Top 25 Implant products 2011” in Dentistry Today, “Best Implant 2011” in saúde oral, a portuguese dental magazine, and “Best product 2009” in Dental product shopper. The award-winning Nobelactive implant system satisfies both the surgical and
restorative clinicians’ needs by providing high initial stability in all indications and esthetic excellence, says Nobel Biocare. Clinicians receive maximum flexibility, both in placement and restorability, and its unique design expands treatment options. The latest edition to the successful Nobelactive implant family is the new 3mm diameter implant, Nobelactive 3.0, which offers safe implant placement in areas with limited space and is an excellent solution for restorations in the esthetic zone.
Hygiene solutions for DeNtal surgery In modern dentistry, treatment processes can be modelled efficiently. at the same time, requirements for comprehensive surgery hygiene are becoming ever more complex and challenging. The range of instruments, devices, and materials used is also growing, and consequently there are more disinfection tasks to master. Complete reliability and economic efficiency for hygiene tasks are thus more important than ever. Dürr Dental is a pioneer in the field of hygiene for dental surgeries. The holistic hygiene concept offered by Dürr Dental includes a wide range of tailored system solutions from a single source. The concentrates and ready-to-use solutions in the Dürr Dental system Hygiene range cover all usage areas. The colour coding on its products simplifies their usage: blue for instruments, green for surfaces, pink for skin/hands, and yellow for special applications such as suction systems, spittoon bowls, casts and so on. The main development goals for powerful classics such as orotol plus (for suction system disinfection) and innovations such as the Hygowipe plus sensor dispenser (for the contact-free dispensing of damp disinfection cloths), are to ensure that they are reliable, easy to use, and cost-effective, according to Dürr Dental. In addition to supplying products that combat germs, Dürr Dental focuses on doing every-thing possible to make sure that microbial contamination chains do not even occur in the first place. The use of contact-free sensor technology when dispensing and metering products demonstrates this. The Hygocare plus sensor dispenser for the
disinfection and cleaning of hands and the Hygowipe plus for dispensing surface disinfection cloths have proven their worth in many dental surgeries. Hygiene has been a central aspect of product for many years. For example, orotol disinfectant concentrate was developed back in 1966. This product ensures top hygiene standards and safeguards the life of Dürr Dental suction systems. Thanks to its unique, valuepreserving properties, orotol plus is now a market leader in many countries, says Dürr Dental. With the right tools and a fully attuned team, disinfection can become less of a chore. Having a sterile surgery is paramount to safe practice, not only for the patient, but also the dental professionals.
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CEREC OmNiCAm:
POwDER-fREE 3D SCANNiNg iN fULL COLOR
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Sirona launched its new CEREC Omnicam camera last August at a special event in Las Vegas, USA. This exciting new product has now been unveiled to dental professionals in Europe. To this end Sirona invited distributors and journalists to an informative product presentation at the company’s new headquarters in Salzburg. The attendees saw with their own eyes how dentists can now generate precise whole-arch scans in the shortest possible time. Three features of the CEREC Omnicam stand out in particular: it supports video streaming; it digitizes the structures of the jaw in their natural color; and it does not require a powder coating of the tooth surfaces. The CEREC Omnicam is extremely
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resistant to camera shake. it is not necessary to apply a powder coating to the teeth. instead the user moves the camera head over the intraoral surfaces in a smooth, flowing movement. A virtual 3D model is displayed in natural color on the monitor of the CEREC AC. High-precision images Thanks to this lifelike visualization, it is easy to distinguish between different materials (enamel, dentine, metal or composite) and identify the palatinal and gingival contours. As a result it is easy to navigate around the oral cavity and determine the preparation margin – even in subgingival or epigingival areas. The extensive depth of field of CEREC Omnicam delivers high-precision images, even in cases where the camera has been placed directly on the tooth. The ergonomic, lightweight camera feels comfortable in the hand. Thanks to the slimline design and the compact camera head, it is easy to scan inaccessible areas such as the distal surfaces of the posterior molars. in addition, the CEREC Omnicam boasts a patient counseling mode. The dentist can record short video clips
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and present these to the patient via the CEREC AC monitor. This promotes effective communication and enables the patient to take important decisions on the basis of reliable information. in future the CEREC AC acquisition center will be available in combination with either the tried-and-tested CEREC Bluecam or the new CEREC Omnicam. Both cameras are easy to use and generate high-precision scans. The Bluecam and Omnicam differ in terms of technology and field of application. whereas the CEREC Omnicam is particularly well-suited to multiple restorations, the strengths of the CEREC Bluecam lie in its proven precision and extensive field of view, which makes it ideal for single-tooth restorations. The Bluecam generates a series of 3D images, which are subsequently combined in order to create a “tooth panorama”. in the interests of optimum precision the Bluecam requires a powder coating. in the case of chairside restorations this coating is simply sprayed onto the teeth before the scanning process starts. The benefits of the CEREC Omnicam at a glance:
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Unrivalled Handling • Slim, lightweight casing and compact camera head • Natural flowing movement of the camera over the tooth surfaces • Anti-shake function and extensive depth of field
Powder free • Fewer processing steps • Faster learning curve • The digital impression-taking process can be delegated to an assistant
Color visUalization • Improved patient counseling • The natural colors of the virtual 3D model enable the dentist to clearly identify the various tooth surfaces and determine the preparation margins.
Due to on-going marketing authorization procedures, the CEREC Omnicam is not yet available in China, Japan, South Korea, individual countries in the CiS and South America.
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Dental InnovatIon
AuThor: Dr AnDy ChAn (privAte prACtiCe, hong Kong)
MInIMAlly InvAsIve sInus lIfT usIng hydrosTATIc Pressure And A novel IMPlAnT desIgn clInIcAl exPerIence wITh A new IMPlAnT ThAT enABles hydrAulIc elevATIon of The schneIderIAn MeMBrAne
Keywords: sinus lift, Schneiderian membrane, hydraulic sinus lift, bone grafting Atrophy of the posterior maxillary alveolar ridge is a common consequence of pneumatization of the maxillary sinus, and often precludes the placement of dental implants in the region unless a bone augmentation procedure is performed [1]. In 50 per cent or more of cases, a sinus lift procedure is required prior to placing dental implants to replace missing maxillary molars [1]. The open sinus lift, first presented by Boyne and James [3] and subsequently 1 by Tatum [4], is now a widely accepted and predictable method to restore the necessary alveolar ridge volume prior to placing implants. This procedure, however, involves complications [5-9] such as the perforation of the schneiderian membrane [2, 8, 9, 10]. The patient experiences significant trauma and a consequent long recovery time involving pain, swelling and bleeding in the facial area. Patients often lose several work days [11]. In recent years, several clinicians have presented a new alternative for safely elevating the schneiderian membrane: hydraulic sinus elevation, or hydraulic sinus condensing [12, 13]. using this method, the clinician creates hydrostatic pressure beneath the schneiderian membrane, causing it to detach from the sinus floor. subsequently, a bone substitute is placed underneath the membrane in the space created by the fluid pressure. The physical properties of hydrostatic pressure (Pascal’s law) ensure that the pressure is evenly distributed over the exposed surface of the membrane, reducing the risk of perforation [14].
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The forces that are required to separate the membrane from the floor of the maxillary sinus are significantly less than those that could rupture the membrane [15]. This manuscript presents a case performed with a novel dental implant (iraise by Maxillent, Israel) (figure 1) that employs the hydrostatic principle to enable a simultaneous, hydraulic sinus elevation and dental implantation. The sinus lift implant comprises an internal channel that allows the injection of fluids in order to first separate the membrane using saline solution, and then insert fluid bone graft to complete the elevation procedure. The internal channel is based on a special l-shaped design that allows the injection of fluids intra-operatively but blocks the channel from the oral cavity post-operatively in order to prevent an ascending bacterial migration into the alveolar bone and the sinus cavity.
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Case presentation The patient was a 50 year old female who was generally healthy. The patient presented with a missing upper right second molar (position 17). A dental implant had previously been place in the first molar position (16). The residual bone height at the intended implantation site was 5.6mm as measured on a pre-operative cT scan, therefore requiring a sinus elevation for prosthetic restoration using dental implants (fig. 10, 12). The sinus appeared normal in the cT. Before the treatment, the patient received prophylactic antibiotics (amoxicillin and clavulanic acid, 875mg) and a mouth wash (chlorhexidine gluconate 0.12%). A mucoperiosteal flap was created by crestal incision, with small vertical extensions for release. next, an osteotomy was prepared with a series of dedicated drills. The sinus floor was identified manually using a flat bur that provides a tactile sensation of the hard cortical bone of the sinus floor, thereby preventing entry of the drill into the sinus and avoiding the risk of membrane rupture. The osteotomy was widened with subsequent drills, and finally a specialized diamond bur was used to weaken the sinus floor (fig. 2). This drill is designed with a
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Dental InnovatIon
diamond tip that abrades the bone while reducing the risk of damage if it contacts the membrane, together with a non-active shoulder that helps prevent entrance into the sinus. The implant was inserted into the osteotomy. At this point, blood was observed to emerge from the lateral opening in the implant, providing a clinical indication that the implant apex came into contact with the schneiderian membrane, detaching the blood vessels at its bottom (fig. 3). A tube connector was then attached to the implant to enable the injection of fluids (fig. 4). Two cc of normal saline solution were injected through the implant in order to elevate the membrane by hydrostatic pressure (fig. 5). The saline was drawn from the sinus and was observed to be mixed with blood (fig. 6), which provided a further clinical indicator for the fact that the saline came in contact with the schneiderian membrane. next, two cc of synthetic bone substitute was inserted (MBcP gel, Biomatlante, france) (fig. 7). This bone substitute was selected because it can be easily injected through the implant and is fairly radiopaque, allowing it to be identified by postoperative x-ray images. The connector was removed and the implant fully inserted into the bone (fig. 8, 9). figures 10-13 show cT images before and immediately after the treatment. The cT shows the schneiderian membrane to be elevated and filled with bone graft 6 7
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in a symmetrical balloon shape that has the potential to provide ample volume of new generated bone supporting the implant. The volume contains a small radiolucent area just beneath the elevated schneiderian membrane, which may represent bleeding due to the separation of the membrane as described above, and should not affect the success of the bone regeneration. After the procedure, the patient immediately resumed full activity and did not report experiencing pain, swelling or bleeding.
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referenCeS 1.
Ten Bruggenkate cM, van den Bergh JP. Maxillary sinus floor elevation: a valuable pre-prosthetic procedure. Periodontology 2000 1998; 17:176–182.
2.
seong wJ, Barczak M, Jung J, Basu s, olin Ps, conrad hJ. Prevalence of sinus augmentation associated with maxillary posterior implants. J oral Implantol. 2011 Jun 8.
3.
Boyne PJ, James rA. grafting of the maxillary sinus floor with autogenous marrow and bone. J oral surg 1980; 38:613–616.
4.
Tatum h Jr. Maxillary and sinus implant reconstructions. dent clin north Am. 1986;30:207-29.
5.
Katranji A, fotek P, wang hl. sinus augmentation complications: etiology and treatment. Implant dent. 2008;17:339-49.
6.
raghoebar gM, Batenburg rh, Timmenga nM, vissink A, reintsema h. Morbidity and complications of bone grafting of the floor of the maxillary sinus for the placement of endosseous implants. Mund Kiefer gesichtschir. 1999;3suppl 1:s65-9.
7.
regev e, smith rA, Perrott dh, Pogrel MA. Maxillary sinus complications related to endosseous implants. Int J oral Maxillofac Implants. 1995;10:451-61.
8.
schwartz-Arad d, herzberg r, dolev e. The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival. J Periodontol. 2004;75:511-6.
9.
Ardekian l, oved-Peleg e, Mactei ee, Peled M. The clinical significance of sinus membrane perforation during augmen-tation of the maxillary sinus. J oral Maxillofac surg 2006; 64:277–282. 10. Aimetti M, romagnoli r, ricci g, Massei g. Maxillary sinus elevation: the effect of macrolacerations and microlacerations of the sinus membrane as determined by endoscopy. Int J Periodontics restorative dent. 2001 dec;21(6):581-9. 11. Mardinger o, Poliakov h, Biteltum I, nissan J, chaushu g. Patient’s perception of recovery after sinus floor augmentation - A prospective study. J Periodontol. 2009;80:572-6. 12. chen l, cha J. An 8-year retrospective study: 1,100 patients receiving 1,557 implants using the minimally invasive hydraulic sinus condensing technique. J Periodontol. 2005;76:482-91. 13. sotirakis eg, gonshor A. elevation of the maxillary sinus floor with hydraulic pressure. J oral Implantol. 2005;31(4):197-204. 14. watzek g. The Percrestal sinuslift—from Illusion to reality. Quintessence Publishing 2012. IsBn 978-1-85097-222-8. 15. Pommer B, unger e, sütö d, hack n, watzek g. Mechanical properties of the schneiderian membrane in vitro. clin oral Implants res. 2009 Jun;20(6):633-7. epub 2009 Mar 4.
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The sinus lift implant
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cortex drill. note diamond tip and non-active shoulder
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Insertion of the implant into the osteotomy. Blood is observed in the lateral opening, confirming that the implant touches the membrane.
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Assembling the tube connector on the implant
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&
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Inserting saline into the implant (left) and retrieving the saline (right) (blood is observed in the saline) Inserting bone graft through the implant
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Discussion This case demonstrated a novel dental implant that allows a simultaneous sinus floor elevation procedure using hydrostatic pressure. The author found the technique to be easy to perform. The patient reported minimal impact on her comfort or on her subsequent daily routine. As compared to the open sinus lift, the new technique may potentially provide a simpler surgical technique and reduced trauma and recovery time for the patient. In order to fully assess the potential of the technique and device, further cases need to be performed. In addition, the patient must be followed up to confirm that bone is regenerated in the intended volume.
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&
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final insertion of the sinus lift implant
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&
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cT images, sagittal sections: pre-op (top) and immediately post-op (bottom).
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cT images, coronal sections. Pre-op (top) and immediately post-op (bottom).
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how To bUIlD UP
ThE PERfECT TooTh
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A ComPoSITE RESIn wITh IDEAl mATERIAl PRoPERTIES CAn bE USED To CREATE AnATomICAlly CoRRECT TooTh ConToURS AnD ThEREfoRE lIfElIKE DEnTAl RESToRATIonS by USInG A SUITAblE lAyERInG PRoToCol.
Author: Ulf Krueger-Janson (Germany)
The natural appearance of a tooth can be successfully reconstructed with a composite resin that is based on an integrated shade and layering system. Restorations of this kind blend in seamlessly with the natural dentition in accordance with biomimetic principles. Choosing the most suitable material for the task at hand is decisive for the successful outcome. The shade range of IPS Empress Direct composite resin comprises five dentin materials in A shades (high opacity) and five matching enamel shades (high translucency). In addition, stronger as well as more translucent shades are available, some of which are opalescent, for designing the lateral enamel areas and incisal edges. This well-rounded range of shades and layering materials facilitates the creation of naturallooking restorations with composite resin.
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The following article describes the fabrication of a composite resin restoration in an anterior tooth using IPS Empress Direct. The procedure is described chronologically, starting with shade selection and ending with the final design adjustments. Assessment of the preoperative situation The appearance of the upper anterior teeth in the preoperative situation was unsatisfactory. Tooth 11 looked particularly unattractive. neither its shape nor its shade satisfied the standards of a high-quality dental restoration. In order to obtain a clearer picture of the preoperative situation, a greyscale image was produced (fig. 1). This image illustrates the insufficient brilliancy as well as lack of translucent areas. furthermore, surface structures and their various transitions as well as wavelike white striations are visible. from the incisal aspect the vestibular contour looks distinctly uneven (fig. 2). As a result, the right incisor leans towards the labial aspect. The “wing effect” of the teeth in this particular case could not be reconstructed. Consequently, tooth 11 looks out of place.
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The shade system of IPS Empress Direct comprises various dentin shades, which exhibit a high opacity. They are suitable for achieving bright effects (bleach l/Xl) or providing complete coverage (IVA5/A6). The system also includes matching enamel materials with more translucent bleach and Incisal shades as well as shade components called Trans opal (opalescent). A straightforward method is available for gaining a general impression of the shade layers of the natural neighboring tooth. Various shade samples of IPS Empress Direct are applied on the untreated enamel surface of the adjacent tooth – in this case tooth 21 – and polymerized (fig. 3). Shade variations should be eliminated due to the polymerization process. The prepared tooth is then illuminated from various angles with the operatory light. As a result, the viewer gains a good idea of what the individual shades will look like in the mouth of the patient. The shade impressions obtained in this way provide the operator with valuable information 5 regarding the shade behavior of the composite resin system in use and the shades required for building up the restoration. In the present case, for example, the opalescent material Trans opal was applied to the sides of the restoration in order to imitate the bluishwhite areas of the natural adjacent tooth. Build-up and layering of the basic shape After the old restoration had been removed from tooth 11, the first increments were placed (fig. 4). In order to imitate the saturated and intensive shade (opacity) of the neighboring tooth, dentin shade A3 was placed at the base of the restoration. In addition, dentin and enamel shades
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A2 were applied in the incisal area. A lighter shade was required in the cervical region and therefore Dentin A2 layers were applied. Enamel A2 was placed on the sides (distal, mesial) of the restoration in order to impart more brightness to the tooth. figure 5 clearly shows the different layers: The shade designations have been projected onto the image. Due to the dehydration of tooth 21, the shade had already changed compared with the samples shown in figure 3. This serves as an important reminder that shade selection must be done very quickly, since the neighboring tooth no longer provides a reliable shade reference once it is dehydrated. The built-up materials were covered with a coating of flow A2 and the vestibular surfaces were created. Tooth 11 was built up according to the described layering protocol. The aim of this step was to copy the shading of the neighboring tooth and create the basic shape of the restoration (fig. 6). The incisal area of this roundish tooth shape was difficult to recreate. The mesial edge was quite angular and only transitioned into the rounded body of the tooth towards the distal aspect. In this case, it was necessary to exaggerate the contours of this area when the composite was placed. This created ample scope for finishing the restoration. In all cases, the convex and concave areas have to be carefully finished. This task is often difficult to accomplish in the first attempt. The functional parameters are also taken into consideration in this process. This approach has shown to be very effective in routine practice work. If time is tight, for example, patients can be discharged with this type of “preliminary solution”. The final layering procedure takes place at a later stage. before the patient leaves the practice, however, the surface of the build-up should be coated with a flowable product in order to give the patient a comfortable feeling in the mouth. Customized shading The restoration build-up was completed with different shades from the range of composite resin materials. mamelon-like depressions were cut into the surface of the preliminarily shaped and shaded restoration with a finisher (red code, fine grit) using the cut-back technique (figs 7 and 8). The individual shade effects were inserted into these grooves at a later stage (inlay technique). The neighboring tooth provided a mirror-image example. Various depths and widths imparted vibrancy to the structure. The ground composite resin surface was coated with an unfilled bonding agent. Subsequently, the bonding agent was dispersed with air (fig. 9) to prevent the
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accumulation of a thick layer of material in the marginal regions, which could cause an undesirable greyish transitional zone. The prepared vestibular tooth surface was filled with the selected flowable shades. The shades of Tetric Evoflow exhibit various whitish opacity levels. Different shade values ranging from yellowish (bleach I) to bluish (bleach l) are available. bleach Xl contains titanium oxide fillers and is therefore the most densely filled product (fig. 10). The wide spectrum of shades enables fine shade nuances to be created. In the present case, the surfaces between the mamelons were filled, beginning with the deepest point. for this purpose, the flowable material was placed and then “pulled” into the areas needing to be filled with a probe tip. This procedure prevented the formation of bubbles. Various levels of opalescence were created (T, bleach l, I, m, Xl). If a highly translucent shade such as bleach I is used, the grey value is increased to achieve a greyish “intermamelon area”. In order to illustrate the shade design more clearly, a shade map was projected onto the image in figure 11. finally, the restoration was coated with a flowable layer. In this case, Transpa (T) material was chosen. In situations where various shades are required to merge into each other, the flowable materials can be mixed with each other on the tooth surface. nevertheless, close attention must be paid to preventing the inclusion of air bubbles! Re-examination is important one week after the completion of the restoration, the tooth was clinically evaluated and checked with regard to the adaptation of the shade to that of the surrounding natural dentition (fig. 12). on closer inspection, very discerning operators may miss a bluish tinge in the incisal edge. If desired, however, this area can be optimized by cutting it back slightly and inserting Trans opal to adjust the appearance.
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1
Preoperative situation: The unattractive composite build-up on tooth 11 needs to be replaced. The image is shown in greyscale to emphasize the shade nuances and the surface quality.
2
Incisal view: Uneven vestibular contour. The neighboring tooth 21 shows that in order for the tooth to appear lifelike, it needs to be positioned like a “butterfly wing”.
3
Individual shade samples from the composite range in use are applied to the neighboring tooth 21 as a shade reference.
4
After the removal of the old restoration, the layering process begins.
5
The image illustrates the layering process; the shade designations have been projected onto the image.
6
The basic shape and color of tooth 11 have been recreated. The overall appearance corresponds to that of the adjacent tooth.
7 & 8
The cut-back technique involves grinding out mamelon-like grooves. Various depths and widths impart vibrancy to the structure of the restoration.
9
The prepared surfaces are coated with a bonding agent.
10
The different shade values of the Tetric Evoflow range from yellowish (bleach I) to bluish (bleach l). bleach Xl contains titanium oxide fillers and is therefore the most densely filled product.
11
In order to provide a clear indication of the shading process, the shade areas have been projected onto the image.
12
one week after completion: Critical evaluation – a perfectionist may miss a bluish tinge in the incisal region. nevertheless, the patient and the operator are completely satisfied.
13
The morphological integration has succeeded. The incisal view shows the natural-looking “wing effect” and a vestibular contour that is identical to that of the neighboring tooth.
14
final evaluation of the composite build-up.
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The morphological integration of the restoration was successful. The view from the incisal aspect clearly shows the “wing effect” of the “butterfly teeth” and an even vestibular contour (fig. 13), resulting in a natural appearance. The incisal-to-cervical curvature was adjusted with a file from the Eva System (KaVo). The final evaluation of the composite build-up was carried out by looking at the tooth from different angles (fig. 14). The light reflecting bands at the sides are a reliable indicator of the proper anatomic shape of the restoration. These bands are responsible for the threedimensional effect of the tooth. These side areas are created by a ridge that results from the transition between the vestibular surface and the interdental area. As shown in figure 12, it is particularly important to round the distal side of “butterfly teeth”. Conclusion The success of a composite resin restoration primarily depends on the appropriate reconstruction of the tooth morphology. furthermore, the recreation of natural shade effects should be given equal attention. The resulting restoration will blend in smoothly with the surrounding dentition also in terms of biomimetics. In the case of complicated shapes, the contours of the neighboring tooth should be copied as faithfully as possible. A three-dimensional design is a prerequisite for ensuring the overall integrity of the restoration. The incisal edge contours as well as the mesial and distal contacts are decisive to establishing the appropriate tooth shape. modern materials allow discerning professionals to restore even very complex shade cases with composite resin layers. for this purpose, a composite that is available in true-tonature shade components is requisite. The cut-back method simplifies the layering process, providing ample design freedom. note: Ulf Krueger-Janson is the author of “3D Composites – natural Shading & Shaping”. The publication is available from www.teamworkmedia.de or www. teamwork-bookshop.de.
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MoDErn concEpTs
In EnDoDonTIc DIagnosTIcs anD ThErapIEs The success story of endodontics continues as dentists now have a large arsenal of instruments at their disposal to treat bacterial infections of the root canal. The standard equipment for dentists practicing endodontics includes magnifying spectacles with optimized LED lighting or, in more demanding situations, dental microscopes to assist them in visualizing the working area, which in most cases is very small. In addition, modern imaging methods make it possible to know the exact state of the root canal anatomy and to establish the conditions necessary for a targeted and comprehensive therapy.
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That’s why the long-term and sustainable preservation of teeth through endodontics is benefiting our aging society more and more. This makes possible the preservation of potential abutment teeth even in advanced old age. over time, modern endodontics has been integrated into the spectrum of therapy offered by many general dentists. This includes manual or mechanical root canal preparation, efficient flushing methods for disinfection and modern instruments and materials for threedimensional obturation. Even crown-to-root fractures of incisors are endodontically treatable thanks to advanced root canal post systems. The use of highly developed diagnostic and treatment regimens allows today’s practitioner to prepare and disinfect all accessible root canals all the way to the apex. In particular, mechanically rotating systems of files have contributed to this advance. These complete systems, which consist of only a few files, offer dentists a reliable instrument. Mechanical root canal preparation using rotating – sometimes reciprocally rotating – instruments is increasingly regarded as an alternative to preparing root canals by hand. Modern nickeltitanium alloys provide an extremely high level of fracture resistance.
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niTi file systems which use disposable files are becoming increasingly popular, and in 90 per cent of cases, only one file is needed for patient preparation. highperformance, electronically controlled drive units with optional reciprocating motion and torque control help to almost completely eliminate fractures when using the mechanized files. at the same time, modern methods provide for the chemical-mechanical disinfection of the root canal using ultrasonic principles or hydrodynamics. They ensure a guaranteed reduction of the number of germs present even in lateral canals. composite-based sealer adhesives and cements as well as modern thermoplastic gutta-percha systems – for vertical condensation – are also available for a subsequent bacteria-tight three-dimensional obturation. These free-flowing and fully sealing materials permit the reliable filling of even complex canal structures. all of the latest innovations in endodontics will be on display for visitors at International Dental show (IDs) in cologne, germany, from 12-16 March 2013. Scientific and technological progress revision of root canals and apicoectomy are among the more challenging areas of endodontics. specialists in endodontics have at their disposal everything from minimally invasive microsurgical concepts to treatments for complex endo-periodontal lesions. The material of choice for the files they use is a nickel-titanium alloy. It goes without saying that procedures are performed, at the very least, with the aid of lighted magnifying spectacles. For the specialist, a surgical microscope provides such crucial assistance that no one wants to do without it. after all, these aids make a substantial contribution to a high level of reliability in the results. “The impressive scientific and technological progress in the field of endodontics can now ensure long-term preservation of teeth to an advanced age and meets the
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WITh ThEsE procEDurEs, LEsIons oF ThE rooT canaL can BE IDEnTIFIED MorE prEcIsELy anD suBsEquEnTLy TrEaTED MorE EFFEcTIVELy.
demand for a prophylactic and conservationist approach to dentistry,” says Dr Martin rickert, chairman of the Board of Directors of the association of german Dental Manufacturers (VDDI). Thanks to the intensive cooperation between a large number of endodontic specialists and companies in the dental industry, fully developed diagnostic methods have come into being. With these procedures, lesions of the root canal can be identified more precisely and subsequently treated more effectively. For example, modern imaging techniques can deliver an exact visualization of complex multiple-root canals all the way down to the finest or obliterated places. Likewise, they not only make possible endodontic measurement of the root canal all the way to the apex, but also provide exact control of the file position during canal preparation. Digital X-rays, digital volume tomography (DVT) and computer tomography (cT) are all essential tools in the highly specialized world of endodontics. Diagnoses made using these devices can also be saved and used for time-saving online documentation of the course of treatment. Technological advances have also become apparent in other areas of endodontics. Traditionally, X-rays were generally used to determine the working length of a root canal. Today, modern electronic measuring methods which don’t involve additional exposure to radiation can be used. For anyone wanting to get acquainted with the entire spectrum of new developments in endodontics, the IDs will be a particularly valuable source of comprehensive information. at IDs, endodontic specialists representing well-known companies from the dental sector will present the latest treatment strategies and procedures to an audience of trade visitors. In talks and discussions with experts, dentists and dental assistants will get a unique overview of the current state of endodontics.
The world’s largest trade fair for dentistry offers a multitude of stimulating topics on subjects ranging from endodontic procedures in private practice to the integration of complex treatment systems at the expert level. successful endodontic treatment increases the long-term chances of tooth retention and makes for satisfied patients, even in times of tighter financial resources in the healthcare system. “In our population, the desire to keep one’s own teeth into old age is growing. This trend is taken into account at the IDs in cologne. The world’s largest trade fair for dental medicine and dental technology will offer dentists and their assistants who are interested in endodontics the best opportunity to talk with specialists from exhibiting companies and experienced users in discussions about the whole spectrum of modern endodontic concepts and the current trends in treatments and diagnostics,” says Dr Markus heibach, executive director of the VDDI.
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World dental Congress in Istanbul Preparations are already under way for next year’s FDI Annual World Dental Congress to be held in Istanbul, Turkey, from August 28-31, 2013, according to the FDI World Dental Federation. The congress website is already up and running, with online registration and abstract submission set to open on 5 November and 3 December respectively. Based on the outline preview, the FDI 2013 Istanbul scientific program will feature “Early Morning” and “Meet the Expert” Sessions, two highly successful formats first piloted at the 2012 Annual World Dental Congress in Hong Kong. Also announced are “Interactive sessions”: details of this new format will be available shortly. FDI 2013 Istanbul is organized jointly by FDI and the Turkish Dental Association (TDA). FDI President Dr Orlando Monteiro da Silva, says: “FDI and TDA share a common perception as to what constitutes a truly international event with strong local flavor and the kind of program to satisfy the high demands of delegates from far overseas, from neighboring countries and from Turkey itself. “The scientific program is worthy of the high ambition of FDI 2013 Istanbul to be the ‘must-attend’ dental event of the year, a reflection of the enthusiasm that has grown exponentially since its official launch in April 2012.” Focusing on the unique attractiveness of Istanbul as a congress venue, Prof Dr Taner Yücel, TDA president and Chair of the Local Organizing Committee says: “I believe that Istanbul deserves your interest as a city which has something to offer to everyone and you will be surprised to discover your ‘own’ Istanbul.” Noting that the city bridges religions, cultures and ideas from east to west and west to east, FDI 2013 Istanbul, he adds, “unites global oral health in August 2013”. FDI 2013 Istanbul follows on from FDI 2102 Hong Kong, the celebratory 100th anniversary congress, which saw record international and regional attendance.
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german dental teChnology at sIno dental The Federal Ministry of Economics and Technology (BMWi) will present a German pavilion at Sino Dental 2013 in Beijing, China, from 9 to 12 June 2013. The pavilion will feature around 50 exhibitors occupying some 1,500 square-meters of floor space. For the first time, the supplier presentations will be accompanied by a German dental industry showcase entitled, ”Dental Technology from Germany”. Koelnmesse has taken over responsibility for the complete preparation and realization of this national participation, working in cooperation with the BMWi and the Association of the German Trade Fair Industry (AUMA). These responsibilities include working out the concept and design of the pavilion in preparation for the event and managing the project in Beijing. The Association of German Dental Manufacturers (VDDI) will not only have a presence at the German pavilion through its member companies but will also provide strong assistance for the organization of the special showcase. A high-level official of the Federal Ministry of Economics and Technology will be on hand to open the “Dental Technology from Germany” showcase at the China National Convention Center in Beijing. The goal of the industry showcase is to spotlight the leading role played by the German dental industry in research and innovation. In particular, this presentation will focus on the unique cooperation of science and research with the German dental industry, and will include an overview of groundbreaking products and technologies. The “German Dental Day” traditionally takes place on the second day of Sino Dental, which is 10 June in 2013. This event includes a specialist symposium that is part of the overall German participation.
Nobel Biocare has announced that it will host the Nobel Biocare Global Symposium 2013 in New York City, USA. The event will take place from 20-22 June 2013 at the Waldorf=Astoria in New York. The Symposium’s program will build on Nobel Biocare’s mission of “Designing for Life: Today and in the future.” “Designing for Life” is Nobel Biocare’s commitment to helping dentists treat more patients with better solutions. It is a commitment to improving the quality of life of every patient through solutions that are designed to deliver fully functional, natural-looking results with the aspiration to last a lifetime, according to Nobel Biocare. The Nobel Biocare Global Symposium 2013 builds on Nobel Biocare’s series of scientific symposia started in 2012. The exclusive three-day event, chaired by Professor George Zarb, will bring together over 70 of the world’s most renowned experts and speakers in restorative dentistry to discuss key current and emerging trends as well as techniques and technologies shaping the industry’s future. The symposium will feature a new program format that outlines treatment workflow from patient presentation to treatment follow-up. Nobel Biocare says it has pioneered innovation in the industry and continues its commitment to creative synergy between scholarship and industry to ensure the best possible dental treatment for patients.
In contrast to the special showcase, which will present existing solutions, the main focus of the specialist symposium will be on possible approaches to solutions for the future. These will be presented by two top-class scientists and practicing doctors from Germany. The German Dental Day is an established event that is highly regarded by the Chinese Stomatological Association. This group recognizes the symposium as a supplementary educational measure in the field of dentistry and grants supplemental education points to the participants. The German participation at Sino Dental 2013 will be rounded off by an evening reception at the German embassy for several hundred invited guests from China and Germany.
nobel bIoCare
global symposIum
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CereC annIversary CelebratIon A record number of dental professionals – over 4,000 – gathered in Las Vegas, USA at the Venetian Resort Hotel Casino for Sirona’s CEREC 27 and a half year Anniversary Celebration last August. The event also marked the launch of two products: the new CEREC Omnicam 3D intraoral camera and Schick 33 intraoral sensor. Sirona chairman and CEO Jost Fischer launched the CEREC Omnicam and Schick 33 sensor by unveiling the products centerstage in front of thousands of dental professionals. Attendees were then treated to detailed clinical presentations of the products from Sirona advocates, Dr Sameer Puri and Dr Andreas Bindl and dozens of other notable speakers and educators. “The CEREC 27 and a half Anniversary Celebration is another milestone event for Sirona,” said Mr Fischer. “With the launch of two key new products, Sirona has once again demonstrated its commitment to investing in research and development in an effort to improve patient care and our customers’ practice lifestyle.” In addition, more than 600 dental professionals arrived a day early for Sirona’s CEREC Discovery and 3D Summit sales events. These events provide a first-class educational experience, giving dentists the information they need to make an informed decision about incorporating in-office CAD/CAM and 3D cone-beam technology into their own practices.
Computerized dentistry conference The 1st Asia-Pacific CAD/CAM & Computerized Dentistry International Conference attracted over 500 dental professionals and industry players from 44 countries, according to organizers CAPP Asia. The event was held at Marina Bay Sands, Singapore from 6-7 October 2012 with the support of Singapore Dental Association. The conference was a platform for exchange of knowledge and experience on the latest development in the field of digital dentistry. Technology is changing the world of dentistry in an increasingly inter-linked global environment. Associate Professor Patrick Tseng, Chief Dental Officer at the Ministry of Health Singapore, opened the event in Singapore with an inspiring speech at the Marina Bay Sands. In total 14 speakers shared their insights on a variety of topics at the main scientific session. The event also witnessed the introduction of the first ever Dental Technicians Parallel Session – an event focused entirely for dental technicians with a total of 7 speakers.
The digital dental industry in Asia is growing at a tremendous pace. The increasing demand for high-quality service has boosted the purchase of CAD/CAM solutions and paved the way forward for dentistry with greater accuracy and efficiency, says CAPP Asia.
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The Leading denTisT
Asia’s biggest dental community page thanks to the growing support of dental professionals, the leading dentist is now Asia’s biggest dental community page on online social media. the leading dentist is the leading community page for dental professionals in Asia with over 15,000 users who follow the page on Facebook. the online page provides updates on trends and developments in global dentistry, as well as networking and lifestyle services for the community. the online users come mainly from the Asia-Pacific region including key markets such as Singapore, thailand, indonesia, Malaysia, the Philippines and india. the page has been developed by dental Practice News (dPN) magazine since November 2010 as part of its efforts to create an online community of dental professionals with a strong focus on the fast-growing Asian markets. the leading dentist mission: to build a leading online network for dental professionals in Asia. the leading dentist page is also part of a regional alliance called dental Network Asia – an online network for dental healthcare in Asia. the network currently has over 22,000 online users in the region and is poised for further growth in the future. Many dentists and other dental professionals in Asia are now active on online social media such as Facebook. the leading dentist page is proud to be an early mover and now a leader in this media platform.
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University of Washington iMPlANt deNtiStry CoUrSe • Participants will get to learn from the same multi-disciplinary team of specialists involved in implant dentistry. A prosthodontist, a periodontist and an oral surgeon make up the team. The benefit of training under a team of specialists will enable the participants to learn the unique strength of each specialty. For example, a prosthodontist can teach many aspect of restoring an implant prosthesis, a periodontist can impart the skills in management of soft tissue around implants while an oral surgeon can discuss techniques of bone grafting in great detail. • The course aims to train participants in the basic surgical and prosthodontic skills of implant dentistry. in addition, the course will also have strong emphasis on the advanced surgical and prosthodontic skills required for aesthetic implant restorations. • The specialist trainers are committed to run the course on a long-term basis. It is important to have the same specialists in the teaching team so that there will be consistency in the treatment philosophy. this will avoid confusion amongst the participants who may hear too many differing opinions from different specialists.
the University of Washington implant dentistry Course is a four-module program that offers comprehensive implant training for regional dentists. The first three modules are conducted • at t32 dental Academy in Singapore, while the fourth and final module is conducted at the University of Washington in Seattle, USA. Specialists and trainers from • Singapore and Hong Kong provide a holistic approach to implant training in this course. the team includes Prosthodontist dr Wong Keng Mun, Periodontist dr Ang Chee Wan and oral • Surgeon dr James Chow. the University of Washington implant dentistry Course offers many unique • features:
Besides the team of specialists from Singapore and Hong Kong, participants can also expect to spend a full day with an alumnus from the University of Washington graduate school of prosthodontics. this is a unique opportunity to learn from the group of highly sought after speakers. Hence, participants will get to learn from more specialists in a single course. The implant course has many hands-on workshops that complement the lecture content. the aim of such program design is to ensure the participants can apply their freshly acquired knowledge during the hands-on workshops using realistic models. Progressive nature of the training program will enable participants to build upon the knowledge and skills acquired in previous modules. Participants will get the opportunity to attend a specially designed 4-day training program in University of Washington. this highly regarded university has produced many esteemed practitioners in implant dentistry. during the program, participants will get to experience the vibrant learning environment in the university and learn from the teachers of many well-respected specialists.
• Upon completion of the course, participants will receive a certificate issued by the University of Washington. The participants will receive the certificate in a graduation ceremony to be conducted on the university campus. • Participants who have graduated can also enroll in the alumni group. This group provides a platform for past graduates to interact with each other and the trainers. Such access will be useful when a participant wants to seek consultation on a case. this training & education program is organized by t32 dental Academy in association with dental Practice News (dPN) Magazine. For more details and registration, email to: dpnmag@gmail.com For updates on dental Training & Education programs, visit our Page: www.facebook.com/TheLeadingDentist
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guIde to effeCtIve InfeCtIon Control A newly revised edition of The ADA Practical Guide to Effective Infection Control is available to help dentists prevent and control the spread of infectious diseases in their practices. The guide includes a 40-minute DVD that illustrates correct, safe and efficient infection control using actual clinical procedures. A corresponding workbook provides more in-depth coverage of the various topics covered in the program. The guide’s key features include: • Work practice controls for needles, hand hygiene and care, disinfection of dental prostheses and impressions, chairside infection control and more • World Health Organization hand rub and hand wash instructional guidelines • Updated lists of recommended resources and Web resources for current information regarding infection control • Self-assessment checklist of current infection control practices • Eight hours of continuing education credit. The ADA Practical Guide to Effective Infection Control (P692-Book with CD-ROM) is available US$135 for members and US$202.50 for non-members. For more info, visit www.adacatalog.org
grants for dental student servICe The ADA Foundation is accepting applications for two grants that support dental student outreach to underserved populations domestically and internationally. Dental student groups are invited to submit applications for either the Bud Tarrson Dental School Community Leadership Award or the Dr Thomas J. Zwemer Award. Applications must be completed and submitted to the ADA Foundation by 26 November 2012. The Tarrson Award is named in memory of the late Mr Bud Tarrson, longtime owner of the former Butler Toothbrush Company and an oral health philanthropist. Its goal is to highlight significant dental student outreach to vulnerable communities within the United States. One award is made each year to a dental school in honor of the winning student outreach program. The Zwemer Award is created in 2012 by Dr Richard Simms, a member of the ADAF Board of Directors, in honor of his mentor and longtime friend, Dr Thomas J. Zwemer. The goal is to recognize and encourage student programs that provide services to underserved populations in international communities outside of the United States. For applications and award guidelines, visit adafoundation.org.
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Computer security threats In foCus Regardless of the security and protection a dental office has on its computer system, it can still be vulnerable to threats and attacks. Thus, dentists need to be prepared. The National Institute of Standards and Technology, US, has published the final version of Computer Security Incident Handling Guide for managing computer security incidents. “This revised version encourages incident teams to think of the attack in three ways,” said Tim Grance, co-author. “One is by method – what’s happening and what needs to be fixed. Another is to consider an attack’s impact by measuring how long the system was down, what type of information was stolen and what resources are required to recover from the incident. Finally, share information and coordination methods to help your team and others handle major incidents.” The guide includes a handful of scenarios that detail various breaches and ways to prepare for or handle them. While geared toward large government agencies or corporations, a number of recommendations can be helpful to small business owners, including dentists. Much of the information can be applied to what dentists need to do to comply with the Health Insurance Portability and Accountability Act Privacy, Security and Breach Notification Rules. HIPAA does not require medical providers to comply with each one of the recommendations of this guide but the document may be helpful with ongoing security planning. Complete and up-to-date information about these topics can be obtained from The ADA Practical Guide to HIPAA Compliance by visiting www. adacatalog.org.
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possIble lInk betWeen panCreatIC CanCer and gum dIsease A new scientific research is a further indication of a possible link between pancreatic cancer and gum disease, according to the British Dental Health Foundation. The latest research, presented in the journal Gut, found one of the bacterium key in the development of gum disease was associated with a two-fold increase in risk for pancreatic cancer. The study also discovered those with non-harmful oral bacteria had a 45 per cent lower risk of pancreatic cancer. Although researchers cannot confirm whether gum disease contributes towards a higher risk of developing pancreatic cancer, the research is a further indication of a potential link between the two diseases. Previous research has also drawn an association between bacteria responsible for gum disease and pancreatic cancer, although in both cases it remains unclear whether the presence of particular types of bacteria are a cause or effect of pancreatic cancer. The paper’s corresponding author Dominique Michaud, epidemiologist at Brown University, commented: “This is not an established risk factor. But I feel more confident that something is going on. It’s something we need to understand better.” Co-lead author Jacques Izard, of the Forsyth Institute and Harvard University concurred. He said: “We need to further investigate the importance of bacteria in pancreatic cancer beyond the associated risk.” Pancreatic cancer accounted for 7,901 deaths in 2010, while only four per cent of people in England survived the disease for more than five years. Given these statistics, chief executive of the British Dental Health Foundation, Dr Nigel Carter, believes any link between the two diseases should provide a timely reminder about the importance of good oral health.
Dr Carter said: “This research provides further ammunition to the growing belief these two diseases could be related. “There is no escaping the fact poor oral health has some role to play, as a number of studies are now starting to show. What we must remember is oral health is relatively simple to maintain. The Foundation’s three key messages – brushing your teeth for two minutes twice a day using a fluoride toothpaste, cutting down on how often you have sugary foods and drinks and visiting the dentist regularly, as often as they recommend – are a great starting point for maintaining good oral health. “If you have swollen gums that bleed regularly when brushing, bad breath, loose teeth or regular mouth infections appear, it is likely you have gum disease. If any of these symptoms persist, your dentist may be able to help you.”
osseoCare pro launch at eao Nobel Biocare launched its new product, OsseoCare Pro, at the 21st Annual Scientific Congress of the European Association of Osseointegration (EAO) in Copenhagen, Denmark. Besides OsseoCare Pro, the company’s other highlights were 11-year TiUnite implant surface data and a corporate forum led by leading experts in the field of implant dentistry and centered on the company’s mission, “Designing for Life.” Participants of the congress who visited the Nobel Biocare booth were not only introduced to the OsseoCare Pro but also the recent product innovations of NobelReplace Conical Connection, NobelReplace Platform Shift, NobelActive 3.0 and the next generation diagnostics and treatment planning NobelClinician Software available on both Mac and PC. For each step of the patient treatment flow – from diagnosis and treatment planning to surgery and finally prosthetic restoration – Nobel Biocare provides products and solutions to ensure maximum treatment safety, patient comfort and long-term success.
Nobel Biocare presented its latest product innovations at EAO including OsseoCare Pro, the first drill motor to be operated by an iPad. The intuitive user interface of the OsseoCare Pro offers unique handling features providing clinicians and their patients with high treatment efficiency and security.
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InternatIonal expert SyMpoSIuM:
all-CeraMICS MeetS
Ivoclar Vivadent hosted a prestigious professional education event, International expert Symposium, in Berlin, Germany on 15 September 2012. Fourteen renowned specialists from around the world discussed the theme of “allCeramics meets Implant estheticsâ€? at the event. around 750 participants from 37 countries attended the symposium. they were keen to hear what leading dental professionals had to say about the latest materials and their clinical applications. For example, lithium disilicate (lS2) has become the material of choice for esthetic rehabilitations. used in conjunction with the press and CaD/CaM techniques, this glass-ceramic for the fabrication of monolithic restorations (lS2) minimizes the risk of chipping, which is often associated with veneered Zro2. In addition, lS2 restorations are characterized by their high bending strength (360 to 400 Mpa) and highly esthetic appearance, including translucent properties. Esthetics around the globe professor Dr nitzan Bichacho from hebrew university in Jerusalem, Israel, and Dr arndt happe from MĂźnster, Germany, presented the treatment protocols that they have developed to produce highly esthetic restorations. In the process, the participants obtained useful tips to take back to their dental offices. the specialists emphasized the importance of fluorescence in the gingival part of anterior teeth in implant-supported prosthetics. In contrast to Zro2, lithium disilicate has fluorescent properties. andreas Kunz, an acclaimed master dental technician from Berlin, demonstrated his system for achieving customized esthetic results in edentulous patients. Mr Kunz uses the prefabricated phonates II teeth from Ivoclar Vivadent. these teeth 1 2
3
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IMplant eSthetICS take into account the high chewing forces to which implants are exposed and they have a vital appearance. Dr andreas Kurbad from Viersen, Germany, showed a series of highly esthetic case pictures. he said that changing the appearance of a patient’s teeth with minimallyinvasive procedures and ultra-thin lithium disilicate veneers is often a life-changing experience for the patient. Certain individual details considerably contribute to the overall esthetic picture. In this context, Dr yukio Kusama from tokyo, Japan, explained the advantages and disadvantages of different abutment types. the latest designs have biomimetic features: cusps in posterior teeth and mamelons in anterior teeth. august Bruguera, a recognized dental technician from Barcelona, Spain, shared the following tip: the best results with pressed lS2 abutments on titanium implants are achieved with the medium-opacity blocks. Dr Kenneth a. Malament from tufts university in Boston, uSa, also praised the lithium disilicate material due to its esthetics and durability. he has been using the IpS e.max-System since 2008 and has not seen a single failure. Long-term statistics on all-ceramics almost all of the experts at the symposium commented on the excellent clinical performance of all-ceramics. professor Dr Matthias Kern from the university of Kiel, Germany, presented clinical studies on lS2 bridges with survival rates of 89 per cent after 10 years. this corresponds to the requirement of Dr Jan hajtó based in Munich, Germany: a failure rate of only one per cent per year. Furthermore, the fatigue tests of professor Van p. thompson from new york university, uSa, showed that lithium disilicate is a very reliable material. Dr urs Brodbeck from the Dental Clinic north-Zurich, Switzerland presented patient cases from his 23-year experience with dental ceramics. the pictures offered visual testimony to the long-term success of dental ceramics: lasting esthetics and high marginal integrity over time with rare incident of discolouration or chipping. Dr Christian Coachman from São paulo, Brazil, and Dr eric van Dooren from antwerp, Belgium, together with Dr Galip Gürel from Istanbul, turkey, provided an additional highlight. they showed how they join forces to treat patients by taking advantage of modern means of communication, such as online meetings, video conferencing and desktop sharing, without ever having to leave their individual workplaces. the Digital Smile Design concept developed by Dr Coachman has gained
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worldwide recognition. on the day preceding the symposium, six specialists discussed their work and provided insightful perspectives at a round-table discussion. together with armin ospelt, head of Global Marketing at Ivoclar Vivadent, they answered the questions from the audience in a lively panel discussion. Josef richter, member of the Ivoclar Vivadent Corporate Management and chief sales officer noted that the dialogue with leading international experts would continue. the international symposium will be held every two years in the future in a different european venue each time. 1. Dr Galip Gürel from turkey 2. Josef richter, member of the Ivoclar Vivadent Corporate Management and chief sales officer (left) and robert Ganley, Ceo of Ivoclar Vivadent were pleased to welcome leading experts to the symposium. 3. over 750 participants from 37 countries attended the International expert Symposium 4. Dr Kenneth a. Malament from uSa
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7th CAD/CAM & Computerized Dentistry International Conference, Marina Bay Sands, Singapore October 6-7, 2012
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NUS Graduates Party Amara Hotel, Singapore September 3, 2012
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Patient Education
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roughly half of american adults aged 30 or older have some form of periodontal or gum disease, according to centers for disease control and Prevention survey data reported last august. “Periodontal disease is an important public health problem in the united States,” said the study published in the Journal of dental research, official publication of the international and american associations for dental research. “this is the most accurate picture of periodontal disease in the u.S. adult population we have ever had,” said dr Pamela Mcclain, president of the american academy of Periodontology (aaP) and a practicing periodontist in aurora, colorado. “we now have a precise measure of the prevalence of periodontal disease and can better understand the true severity and extent of periodontal disease in our country.” an estimated 47.2 per cent, or 64.7 million american, have mild, moderate or severe periodontitis, or gum disease, according to an analysis of data collected as part of cdc’s 2009-2010 national health and nutrition Survey. Prevalence rates increase to 70.1 per cent for adults 65 and older. the data also indicate certain prevalence disparities. Periodontal disease is higher in men than women, 56.4 and 38.4 per cent respectively, and highest in Mexicanamericans, 66.7 per cent, compared to other races. the prevalence rate is 64.2 per cent for current smokers, 65.4 per cent for adults living below the federal poverty level and 66.9 per cent for adults with less than a high school education. the survey included for the first time a full-mouth periodontal examination, “making it the most comprehensive survey of oral health ever conducted in the united States,” said aaP. the academy has been working with the cdc since 2003 to determine the extent, severity and prevalence of periodontal disease. this is the first national probability sample that employed a full-mouth periodontal examination protocol versus partial mouth examinations, the associations for dental research said. the data support the need for comprehensive periodontal evaluations performed annually by a member of the dental team including a dentist, dental hygienist or periodontist, the aaP said. this includes examining every tooth and measuring both attachment loss and probing depth to get the most accurate assessment of periodontal disease, said dr Mcclain. “Many of our patients have periodontal disease and do not know it. as dental professionals, it is more important than ever that we provide patients with a
SurvEy ShowS high PrEvalEncE
of guM diSEaSE
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comprehensive periodontal evaluation annually to determine their disease status.” “we have demonstrated a high burden of periodontal disease in the adult u.S. population, especially among adults 65 and older,” said Paul Eke, Ph.d., the study’s lead author and a cdc epidemiologist. “Periodontal disease is associated with age, and as americans live longer and retain more of their natural teeth, periodontal disease may take on more prominence in the oral health of the u.S. adult population. Maintaining good periodontal health is important to the overall health and well-being of our aging population. our findings support a need for public health programs to improve the oral health of adults.” “we now know that periodontal disease is one of the most prevalent noncommunicable chronic diseases in our population similar to cardiovascular disease and diabetes,” said co-author dr robert genco, distinguished Professor at the State university of new york at Buffalo and iadr/aadr past president.
Patient Education
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nhanES studies are designed to assess the health and nutritional status of adults and children in the united States. the study “Prevalence of Periodontitis in adults in the united States: 2009 and 2010” estimated the prevalence, severity and extent of periodontitis in the adult u.S. population. Estimates were derived from a sample of 3,742 civilian, non-institutionalized adults 30 years and older with one or more natural teeth. Source: American Dental Association
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Lifestyle
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outside in:
A MAgnuM Photos showcAse For the first time in Asia, photography fans will get a chance to see works by three distinguished photographers – Stuart Franklin, Mark Power and Jacob Aue Sobol – from 10 October to 6 January 2013 at the ArtScience Museum, Singapore. The works are part of an exhibition called Outside In: A Magnum Photos Showcase, which marks the 65th anniversary of the Magnum Photos agency. It is the largest collection of Magnum photographs in Singapore, with a total of 143 pieces on display. Best known for his iconic photograph of a student challenging army tanks in Tiananmen Square in 1989, legendary British photographer Stuart Franklin will be displaying his long-term work, Footprint: Our Landscape in Flux, which tracks Europe’s altering landscape through the effects of pollution, flooding and the diminishing of glaciers. His work also documents the positive side of environmental changes that includes the presence of sanitary water, regenerating
forests in Scotland and Poland, and cleaner cities. Franklin received critical acclaim for his work on the coverage of the Sahel Famine in the early 1980s. He contributed to the likes of National Geographic, where he completed over twenty assignments for the publication. His passion for documentary photography has taken him to exotic destinations such as Central and South America, China, Southeast Asia and Europe. Since 2004, he has focused on long-term projects concerned primarily with man and the environment. British photographer Mark Powers’ Sound of Two Songs is a more intimate account of a foreigner’s impression of Poland. Initially a Magnum-instigated project, the five-year project saw Power making more than 20 trips back to Poland as he discovered the poetic side of the country’s fascinating transition and state. Power’s work is best known for his large-scale format and conceptual
techniques. He has published five books and is currently a Professor of Photography at the University of Brighton in the United Kingdom. The third featured exhibition is by Danish photographer Jacob Aue Sobol, Magnum’s newest member. I, Tokyo is a personal pictorial journal of Sobol, which captures his experience living in Tokyo with his Japanese girlfriend. The clash of cultures saw Sobol feeling out of place with the lack of eye contact, silence among big crowds and the fast pace of life in Japan. Pictures were taken with a pocket camera and served as a reminder for Sobol to document his experiences and mood at that time. The snap-shot style of I, Tokyo gives visitors an intimate sense of unpredictability and playfulness, inviting them into Sobol’s self-discovery in Japan. For more info, visit www.marinabaysands.com/ ArtScienceMuseum
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Lifestyle
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TRIPADVISOR APP FOR SIngAPORe cITy guIDe
The Singapore Tourism Board (STB) has teamed up with TripAdvisor to provide traveler content on YourSingapore.com website. The destination web portal will now display TripAdvisor ratings, reviews and opinions on Singapore’s restaurants, attractions and shopping. Currently, visitors planning a trip to Singapore can access event listings and information on places of interest from YourSingapore.com. With the addition of ratings, reviews and opinions from TripAdvisor, visitors will now be able to gain insights from fellow travelers who may share similar needs and preferences. This will help visitors make better informed decisions while planning their trips. Beyond the destination website, the partnership with TripAdvisor extends to TripAdvisor’s Singapore City Guides mobile application. STB collaborated with TripAdvisor to provide destination content for the application’s Free Guided Tours, which enables travelers to select their own cultural, dining, entertainment, shopping and sightseeing experience through seven user-friendly walking tours starting with the Orchard Road: the Home to Style & Glamour; Kampong Glam: Hip Heritage; and Chinatown: Indulge in the Unexpected. Four more walking tours will be added before October
2012, Little India: Enjoy the quirkier side of Singapore; Marina Bay: Indulge in the High Life; Sentosa: Fun for all ages; and Singapore River: A Stroll through Heritage. The TripAdvisor Singapore City Guides mobile application can be downloaded and conveniently accessed offline. Visitors in Singapore will be able to use the fuss-free mobile tool to explore the attractions and experiences with ease. The collaboration is in response to shifts in travel behavior and the way travelers plan their trips. In line with Singapore’s destination brand, YourSingapore, which empowers visitors to personalize their Singapore experience according to their needs and wants, the partnership with TripAdvisor recognizes that international travelers are becoming more reliant on digital content in their travel planning processes. According to a TripAdvisor Custom Online Survey conducted by Forrester Consulting, 81 per cent of travelers find user reviews important when determining which hotel to stay at during their trip, and nearly half will not book a property if it does not have reviews on sites like TripAdvisor. Consumers are also increasingly leveraging the mobile space for travel information. This trend has been amplified by the growth of the smart phone market and the popularity of tablets, with 72 per cent of respondents accessing mobile content, including phones and tablets, even while travelling.
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Dental Events
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MEETINGS EXHIBITIONS
PHoTo Ivoclar vIvadent
WORKSHOPS
8th FDI/IDA Joint Meeting & Medan Dental International Exhibition 2012
FDI Continuing Education Program
D at e:
SpeakerS :
Ven u e:
S p ea ker S:
WebS it e:
November 16-18, 2012 Santika Hotel, Medan, Indonesia Dr How Kim Chuan, Prof M Wainwright, Dr Thomas Li, Dr Stephen Cohen www.pdgi-medan.org
FDI Continuing Education Program D at e: Ven u e:
S p ea ker S:
WebS it e:
November 24-25, 2012 Bandar Seri Begawan, Brunei Prof Niklaus Lang, Dr Robert Ng, Dr Li-Wu Zheng www.fdiworldental.org
Greater New York Dental Meeting D at e: Ven u e:
ema il : WebS it e:
November 23–28, 2012 Jacob K. Javits Convention Center, Ney York, USA info@gnydm.com www.gnydm.com
Multidisciplinary Implant Dentistry D at e: Ven u e: Org a n izer :
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November 28–30, 2012 Bangkok, Thailand Thai Association of Dental Implantology www.bisthailand.net
Date: Venue:
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December 1-2, 2012 Hyderabad, India Dr Derek Mahony, Prof Lakshman Samaranayake, Dr Piyanee Panitvisai, Dr Prathip Phantumvanit, Prof Stephen Wei www.fdiworldental.org
9th FDI/Cambodia Dental Association Scientific Convention Date: Venue:
WebSite:
35th Asia-Pacific Dental Congress Date:
KPPIKG 2013
Venue:
Date:
Organizer:
Venue:
Organizer:
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February 27 – March 2, 2013 Jakarta Convention Center, Jakarta, Indonesia Faculty of Dentistry, University of Indonesia www.kppikg.com
WebSite:
Date: Venue: email: WebS ite:
February 27- March 2, 2013 Guangzhou, China dentalvisit@ste.cn www.dentalsouthchina. com/en
Date: Venue: Organizer: WebSite:
Date:
Date:
WebSite:
Venue: Organizer:
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Achieving Esthetic Success in Implant Dentistry May 16-17, 2013 Bangkok, Thailand ITI www.iti.org
FDI World Dental Congress
35th International Dental Show
March 12-16, 2013 Cologne, Germany Koelnmesse/Association of German Dental Manufacturers www.ids-cologne.de
May 7-12, 2013 Kuala Lumpur Convention Centre, Malaysia Asia Pacific Dental Federation www.mda.org.my
ITI Congress Southeast Asia theme:
Dental South China 2013
March 15-16, 2013 Naga World Hotel, Phnom Penh, Cambodia www.fdiworldental.org
Venue: Organizer:
August 28-31, 2013 Istanbul, Turkey FDI World Dental Federation www.fdiworldental.org
nOte:
The dates and programs of these dental events may be subject to change. Please contact the event organizers for more information.
Synergizing Practice Excellence with Modern Technological Advances
LOG ON
www.35thAPDC2013.com for updates
Date : 7-12 May 2013 Venue : Kuala Lumpur Convention Centre, Kuala Lumpur, Malaysia Bringing together international dental experts and leaders at a world-class venue... Discover Malaysian hospitality, endless opportunities to enjoy nature-based adventures, enriching cultural experiences and fabulous shopping sprees...
Come join us for an unforgettable experience! Main / Platinum Sponsor:
Speaker sponsors:
Supported by:
From left: G. Ubassy, Dental Technician, France | M. Roberts, Dental Technician, USA | M. Temperani, Dental Technician, Italy | D. Hornbrook, Dentist, USA | O. Brix, Dental Technician, Germany | U. Brodbeck, Dentist, Switzerland | G. Gürel, Dentist, Turkey | C. Coachman, Dentist, Ceramist, Brazil | A. Shepperson, Dentist, New Zealand | A. Bruguera, Dental Technician, Spain | S. Kataoka, Dental Technician, Japan | S. Kina, Dentist, Brazil
THE WORLD SPEAKS e.max.
SO DOES THE SCIENCE.
*
UP TO 10 YEARS OF CLINICAL EVIDENCE. 1
98.2 % CROWN SURVIVAL RATE. 40 MILLION RESTORATIONS. 1 PROVEN SYSTEM: IPS e.max 2
3
* The IPS e.max Scientific Report Vol. 01 (2001 – 2011) is now available at: www.ivoclarvivadent.com/science_e
amic all cer need u all yo
M. Kern et al. “Ten-year results of three-unit bridges made of monolithic lithium disilicate ceramic“; Journal of the American Dental Association; March 2012; 143(3):234-240. Mean observation period 4 years IPS e.max Press, 2.5 years IPS e.max CAD. See the IPS e.max Scientific Report Vol. 01 (2001 – 2011). 3 Based on sales. 1
2
www.ivoclarvivadent.com Ivoclar Vivadent AG
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