Dental Tribune Asia Pacific No. 5, 217 by Dental Tribune International

DENTALTRIBUNE The World’s Dental Newspaper · Asia Pacific Edition

Published in Hong Kong

www.dental-tribune.asia

BLUE LASER SCANNER

Read about the new intra-oral scanning technology soon to be introduced by Taiwan’s Metal Industries Research and Development Centre. ” Page 3

Vol. 15, No. 5

INTERVIEW

INLAY RESTORATION

Staying ahead of the curve: iData Strategic Analyst Manager Jeff Wong about market potential and how current trends are shaping the global dental industry.

In this case report, Dr Gerhard Werling introduces the use of the VITA ENAMIC hybrid ceramic for aesthetically pleasing inlay restorations.

” Page 4

” Page 13

Cancer risk: Ill-fitting dentures © TunedIn by Westend61/Shutterstock.com

By DTI MUMBAI, India: Chronic mucosal irritation resulting from ill-fitting dentures may be a risk factor for the development of oral cancer, researchers from the Department of Head and Neck Oncology at Tata Memorial Centre in Mumbai concluded after reviewing existing literature on the relationship. In addition to a variety of factors that are known to increase the risk of oral cancer, including tobacco and alcohol use, poor diet and neglected oral hygiene, chronic mucosal trauma has been associated with the disease in the past. However, the connection between such trauma, which can be caused by sharp teeth, dentures or implants, among others, and the occurrence of oral cancer has not been scientifically established thus far. In the current study, the researchers systematically reviewed 22 articles that described the role of chronic irritation in causing oral cancer. The results suggest

Chronic irritation caused by ill-fitting dentures may increase the risk of developing trauma-related cancer, a literature review in India has found.

that chronic mucosal irritation resulting from ill-fitting dentures may be considered a risk factor for carcinogenesis in the mouth. According to the researchers, trauma-related cancers might be seen more often at the lateral border of the tongue and at the alveolus. However, no association was found for the duration of denture use and cancer formation.

Referring to mechanisms behind the relationship, research has suggested different scenarios, the researchers wrote. It has been proposed that persistent mechanical irritation causes DNA damage and may eventually result in cancer formation. Another possible mechanism is that chronic mucosal trauma results in inflammation, thereby releasing chemical

mediators such as cytokines, prostaglandins and tumour necrosis factor, which may result in carcinogenesis. The study, titled “The role of chronic mucosal trauma in oral cancer: A review of literature”, was published online on 30 March in the Indian Journal of Medical and Paediatric Oncology.

P. gingivalis in focus MELBOURNE, Australia: The latest findings on the bacterium Porphyromonas gingivalis will be in focus at PgMelbourne2017 from 14 to 16 May. The conference, hosted by the Oral Health CRC (Cooperative Research Centre) at the University of Melbourne, is the third in a series of international conferences on P. gingivalis and related species in oral and systemic diseases. P. gingivalis is recognised as being a key factor in the development and progression of periodontitis. It can also influence the host response and the behaviour of other oral bacteria. A definite point of discussion at PgMelbourne2017 will be the recent development of a vaccine for chronic periodontitis by researchers at the Oral Health CRC. This vaccine aims to reduce or even eliminate the need for antibiotics and surgery for the condition and clinical trials are to commence in 2018. More information about the conference is available at www.pgmelbourne2017.com.

IV_Image_Anz_102x128_Layout 1 01.12.11 17:10 Seite 1 AD

Early-life stress Yan Gao is the first Chinese master’s student to visit Plymouth University in the UK as part of an agreement with Capital Medical University in Beijing. During her six-month stay, she will be working on a research project focusing on the role of stem cells in craniofacial tissue and bone regeneration.

Two new Digital face MALO CLINICs reconstruction The MALO CLINIC group has signed a partnership agreement with Data Pacific Medical Group that will result in the establishment of two new dental clinics in Macao. According to Dr Paulo Malo, founder and president of the group, the first will open this year at Centro Médico Pedder and a larger one will follow in 2018 in the islands.

In creating a digital reconstruction of the face of a woman who lived 13,640 years ago in what is today Thailand, researchers used measurements of skulls, muscle, skin and soft facial tissue derived from contemporary populations worldwide. While the approximated face shows characteristics of Late Pleistocene skulls, it is surprisingly modernlooking, the researchers said.

While low birth weight, for example, has been established as a primary marker of early-life stress, the fi ndings of a new study have suggested that lower-face asymmetries, assessed according to the asymmetry of occlusion, are a marker of environmental stress and cerebral lateralisation during early development too. In the study, researchers at the University of Washington assessed data on 6,654 US adolescents collected between 1966 and 1970. Retrognathic asymmetries (17 per cent), the most common lower-face asymmetry in the US population, were found to fluctuate randomly between the left and right sides of the face. Such randomness indicates early-life stress, said lead author Prof. Philippe Hujoel, from the university’s School of Dentistry.

Distinguished by innovation Healthy teeth produce a radiant smile. We strive to achieve this goal on a daily basis. It inspires us to search for innovative, economic and esthetic solutions for direct filling procedures and the fabrication of indirect, fixed or removable restorations, so that you have quality products at your disposal to help people regain a beautiful smile.

www.ivoclarvivadent.com Ivoclar Vivadent AG Bendererstr. 2 | FL-9494 Schaan | Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 5/2017

Drug-related oral health problems investigated

IMPRINT GROUP EDITOR: Daniel ZIMMERMANN newsroom@dental-tribune.com Tel.: +44 161 223 1830

MANAGING EDITOR AP: Kristin HÜBNER

EDITOR: Yvonne BACHMANN

with substance use disorders. These include high-sugar diets, malnutrition, poor oral hygiene and lack of regular professional dental care. In order to lift the burden of oral health-related problems, a cautious dental approach is needed when treating these patients. However, according to lead researcher Dr Hooman Baghaie from the University of Queensland, there are simple measures that both dentists and doctors can take to improve these patients’ oral health.

Lead researcher Dr Hooman Baghaie from the University of Queensland.

By DTI BRISBANE, Australia: People with substance use disorders are more prone to dental caries and periodontal disease than the general population, as well as less likely to receive regular dental care. Hence, the oral health of these patients is a particular challenge for dentists. A new review study has now aimed to examine drugassociated oral health problems

and ways for dental professionals to improve these patients’ oral health. Drug use is associated with problems such as xerostomia, an increased urge to snack, clenching and grinding of teeth, and chemical erosion due to applying cocaine to teeth and gingivae, research has shown. In addition, lifestyle-associated factors can worsen the oral health in patients

“Dentists should screen their patients for substance use, notice any advanced dental or periodontal disease inconsistent with a patient’s age and consider referral to medical doctors for management,” Baghaie said. In addition, dentists should be aware of issues concerning treatment and consent when the patient is intoxicated and be alert to the possibility of resistance to painkillers, he emphasised. Generally, doctors and clinicians who care for people with

substance use disorders should screen for oral disease and warn patients of the oral health risks associated with xerostomia and cravings for sweet foods, Baghaie added.

ONLINE EDITOR/SOCIAL MEDIA MANAGER:

The review combined the results of 28 studies from around the world, which collectively provided data on 4,086 patients with substance use disorders. The fi ndings indicated that one in 20 people between the ages of 15 and 64 use drugs each year, with approximately 10 per cent of this number having drug dependence or substance use disorders.

COPY EDITORS:

The findings mirror those of increased dental caries and periodontal disease in people with severe mental illness, eating disorders and alcohol use disorders, compared with the general population. The study, titled “A systematic review and meta-analysis of the association between poor oral health and substance abuse”, was published in the May 2017 issue of the Addiction journal.

Hong Kong: Access to dental subsidy scheme to be widened By DTI

Last year, the age requirement for the scheme was already lowered from 80 to 75, giving an additional 24,600 senior citizens access to funding. However, even with this and the recently announced expansion of those eligible for aid, the sheer lack of public dental services in Hong Kong is still a limiting factor for adequate treatment for the elderly, according to experts. Although the lower age limit will enable more

HONG KONG: The age limit for the Community Care Fund scheme, which subsidises dental care for Hong Kong’s elderly population, among other assistance programmes, is set to be lowered from 75 to 70, fund task force chairman Dr Law Chi-kwong has announced. However, a general lack of services for this vulnerable group remains a problem in the city.

people to obtain public dental care, the general capacity to provide services will remain the same. As reported by the South China Morning Post, out of the 39 government dental clinics across the city, only 11 offer emergency services to the public. This imbalance is worsened by the fact that most of the government clinics provide only very basic services

free, such as pain relief and tooth extraction, and are open to the public only for limited sessions per week, the paper wrote. As a result, elderly patients are often forced to queue in the early morning hours to beat the crowds to see a dentist. “Dental care servicing in Hong Kong has never been subject to

any serious review or any longterm planning,” Law said in this regard. “This is something that needs to be thought about.” However, the problem will probably not be solved in a few years, he stressed. Just as in other Asian cities, Hong Kong’s population is ageing rapidly. However, while countries such as Japan and South Korea have three and four dentists per 1,000 elderly residents, respectively, Hong Kong’s dentist–population ratio is only two to 1,000. In the population eligible for funding, problems such as tooth loss, untreated dental caries and periodontal disease are more prevalent than in the general public.

While more people have been granted access to dental care, the continued shortage of dental service providers for the elderly in the public sector remains a challenge in Hong Kong.

Figures from a 2011 oral health survey by the Department of Health indicate that about 40 per cent of those aged 65–74 have fewer than 20 teeth remaining and about 5.5 per cent have none.

Claudia DUSCHEK

MANAGING EDITOR & HEAD OF DTI COMMUNICATION SERVICES: Marc CHALUPSKY

JUNIOR PR EDITORS: Brendan DAY Julia MACIEJEK Sabrina RAAFF Ann-Katrin PAULICK

CLINICAL EDITORS: Magda WOJTKIEWICZ Nathalie SCHÜLLER

PUBLISHER/PRESIDENT/CEO: Torsten R. OEMUS

CHIEF FINANCIAL OFFICER: Dan WUNDERLICH

BUSINESS DEVELOPMENT MANAGER: Claudia SALWICZEK-MAJONEK

PROJECT MANAGER ONLINE: Tom CARVALHO

JUNIOR PROJECT MANAGER ONLINE: Hannes KUSCHICK

E-LEARNING MANAGER: Lars HOFFMANN

MARKETING SERVICES: Nadine DEHMEL

SALES SERVICES: Nicole ANDRÄ

ACCOUNTING SERVICES: Anja MAYWALD Karen HAMATSCHEK Manuela HUNGER

MEDIA SALES MANAGER: Antje KAHNT (International) Barbora SOLAROVA (Eastern Europe) Hélène CARPENTIER (Western Europe) Maria KAISER (North America) Matthias DIESSNER (Key Accounts) Melissa BROWN (International) Peter WITTECZEK (Asia Pacific) Weridiana MAGESWKI (Latin America)

EXECUTIVE PRODUCER: Gernot MEYER

ADVERTISING DISPOSITION: Marius MEZGER

DESIGNER: Nora SOMMER

Published by DT Asia Pacific Ltd. DENTAL TRIBUNE INTERNATIONAL Holbeinstr. 29, 04229, Leipzig, Germany Tel.: +49 341 48474-302 Fax: +49 341 48474-173 info@dental-tribune.com www.dental-tribune.com

Regional Offices: DT ASIA PACIFIC LTD. c/o Yonto Risio Communications Ltd, Room 1406, Rightful Centre, 12 Tak Hing Street, Jordan, Kowloon, Hong Kong Tel.: +852 3113 6177 Fax: +852 3113 6199

UNITED KINGDOM 535, Stillwater Drive 5 Manchester M11 4TF Tel.: +44 161 223 1830 www.dental-tribune.co.uk

All rights reserved. Dental Tribune makes every effort to report clinical information and manufacturer’s product news accurately, but cannot assume responsibility for the validity of product claims, or for typographical errors. The publishers also do not assume responsibility for product names or claims, or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune International. Scan this code to subscribe our weekly Dental Tribune AP e-newsletter.

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 5/2017

New cost-effective blue laser intra-oral scanning technology

Screenshot Youtube/solberg hu

By DTI AD

TAIPEI, Taiwan: Taiwan’s Metal Industries Research and Development Centre (MIRDC) has introduced a new blue laser line intra-oral scanning technology. According to the developers, the device is built with mostly Taiwanese electronic components and will be significantly cheaper than similar scanning devices from international competitors.

Tetric N-Ceram Bulk Fill ®

The efficient posterior composite

Through software, the device uses a triangular measuring method to focus a high-coherence laser light on to the object to be scanned. In this manner, it is able to accurately construct a dental model, taking precise measurements within an area of 22 × 18 mm, which reduces the margin of error, the developers said.

Save

55% on time

The blue laser line was introduced at a press conference held at the Ministry of Economic Affairs in the capital city of Taipei in April. According to the ministry, the technology has attracted nearly NT$70.61 million (US$2.4 million) in investments and generated nearly NT$200 million (US$6.6 million) in market value so far.

and achieve amazing results

Data available on request.

Screenshot Youtube/solberg hu

NTED

rin

Ivoce

H T I NITI

E AT

A NOW FLOW! TO

The scanner, which is currently being tested in clinical trials, is to be introduced to the market later this year. According to the MIRDC, similar oral scanning devices made in Germany, Denmark and the US, for example, cost about NT$1.2 million–1.6 million (US$39,900–53,200). The MIRDC’s partners, however, hope that the commercialised product will sell for US$30,000 to hospitals and dental clinics.

* Compared with Tetric® N-Flow and Tetric® N-Ceram

Developed by the MIRDC, a non-profit organisation established in October 1963 to research and develop leading technologies for use in the metal and related industries in Taiwan, the blue laser line was transferred to several Taiwanese companies, including EPED, ARIX CNC Machines, Gillion Technology and Ain Tec Industrial, Taiwan News reported online.

Tetric® N-Ceram Bulk Fill

Tetric® N-Flow Bulk Fill

sculptable

flowable

www.ivoclarvivadent.com Ivoclar Vivadent AG

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

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 5/2017

Many Asian countries are experiencing a great deal of growth An interview with Jeff Wong, Strategic Analyst Manager at medical market research firm iData dict that the trend will continue. Of course, there will always be a couple of smaller companies that will end up becoming fairly large themselves and remain independent. However, we expect that many of the successful emerging companies will be acquired at some point. One advantage that the larger competitors have is the amount of resources they have. They can always stay ahead of the curve. If they see somebody come to the market with something unique, they have

Jeff Wong in talks with Dental Tribune.

By DTI The ever-progressing digitalisation, changing regulations and a tendency towards mergers are currently shaping the dental industry. At the International Dental Show in Cologne, Dental Tribune met with Jeff Wong, Strategic Analyst Manager at international medical market research and consulting firm iData, to talk about how— major and emerging—competitors have reacted to these trends. Digitalisation is one of the main trends that is changing the industry. Other than that, what developments are dominating the dental market? Yes, digitalisation is still the up-and-coming trend and everybody is trying to get into that market now. On the product side, I would say it is 3-D printing and intra-oral scanning. Three or four years ago, there was only a handful of competitors in both of those areas. This year at IDS, almost

every year, but many are also either acquired or close down. There are definitely certain regions that are experiencing a great deal of growth, for example many Asian countries. At the same time, traditional markets such as Italy, Brazil and the US are doing very well. These markets are well penetrated at this point, so in terms of market growth it will definitely slow down. However, there is still substantial growth opportunity for the lower-priced competitors, while the traditional pre-

So, you are saying that larger companies are looking for smaller businesses to acquire in order to bring new technology to market? Not only on the technology side, but also to compete on the pricing level as well. In the current political climate, the Chairman of the Association of the German Dental Industry has issued a warning about protectionism and trade barriers. What are companies doing in this regard?

“Digitalisation is still the up-and-coming trend.” everybody is presenting some new product in these fields—knowing how fast these markets develop, everybody wants to participate. What consequences will this have for the market in general? Especially in these two areas, where the level of imitation is high, with so many competitors, it will definitely start diluting the market shares among the existing companies. However, if these participants start focusing on specific regions or niche audiences, I think there will still be a great deal of benefit. What about the recent merger trend—is that something we will see more of in the future? From what we have seen in other industries, we definitely pre-

the resources to quickly develop a product of their own.

mium brands will see considerable competition from other markets.

What role do the emerging markets play? What regions will become more significant in the future? Regarding digital dentistry, I would say much of the development is linked to implantology and prosthodontics. The key countries where those areas are big as well are Brazil and Italy. Even though the penetration of digital dentistry might be relatively higher in those areas compared with others, I would say they have the greatest opportunities for growth.

Do you think this will lead to those companies buying local competitors? Or what will their strategy to succeed be? I think the strategy of most of the larger key competitors will be continuing acquisition. However, the strategy of some of the larger regional companies, for example in Brazil, is to continue going and to expand their global presence instead of being acquired. In addition, many of the current key participants—with the regional regulations changing from country to country—are being forced to acquire new companies in order to be able to operate in the region.

What are the main trends in implantology? In terms of implants, dozens of new companies are popping up

At this stage, I think, companies are mainly waiting to see what will happen. Nevertheless, in light of what is happening in other industries regarding the whole Brexit issue—for example, European Union chiefs have warned airlines, including easyJet and Ryanair, to relocate their headquarters to the EU if they wish to continue their routes within continental Europe after the Brexit—if that can happen in the airline industry, who is to say it cannot happen in the dental industry. Again, for example in Mexico, which has a major dental tourism industry, if that is going to be affected in terms of procedural volumes, it is definitely going to affect the dental manufacturers as well. Thank you very much for the interview.

Sino Dental 09.06 - 12.06.2017

Beijing / China

Light-curing micro-hybrid composite • applicable for various indications and all cavity classes • high translucency and a perfect colour adaption • Polishable to a high gloss • excellent physical properties for durable fillings • high filler content • packable consistency (also available as Composan LCM flow)

Temporary crown & bridge material • less than 5 min. processing time • strong functional load • perfect long-term aesthetics • excellent biocompatibility

Visit www.promedica.de to see all our products

Dental Material GmbH

24537 Neumünster / Germany Tel. +49 43 21 / 5 41 73 Fax +49 43 21 / 5 19 08 eMail info@promedica.de Internet www.promedica.de

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 5/2017

Osteoporosis: Resolvable magnesium implants may promote bone formation By DTI MALMÖ, Sweden: According to new research from Sweden, a groundbreaking method for stimulating bone formation around implants could soon be available. In testing the cellular and molecular effects of magnesium-based implants in the early healing stages of implant integration, the researchers found that the release of magnesium promoted rapid bone formation and the activation of osteogenic signals near implants placed in osteoporotic bone.

Thus far, the method has only been tested in animal models and will need more research before proceeding with clinical tests on

human patients, Prof. Lars Magnus Bjursten from Lund University emphasised in the radio interview. However, he said that it is

important to always look for alternatives, particularly in orthopaedics, and magnesium seems to be a useful material.

Whether the method could potentially assist osseointegration around dental implants was not addressed in the current research project. AD

I AM DEMANDING

“We observed that the implant material disappeared, having formed calcium and phosphate, which are similar to bone structure,” lead researcher and doctoral student Silvia Galli from Malmö University’s Faculty of Odontology told public broadcaster Sveriges Radio. By using magnesium-based implants that dissolve completely over time instead of titanium ones, osseointegration in osteoporotic patients thus might be enhanced. The use of magnesium-based implants could be a potential method for restoring skulls after facial fractures through promoting new bone tissue formation as the implant dissolves over time. According to Galli, the amount of metal used in the implants is so insignificant that it leaves the body without a trace of the traumatic event having taken place and without any side-effects for the kidneys, or the need for a second surgical procedure to remove the implant, for example.

3D technology that facilitates implant planning with instant volume measurement and bone density assessment Exceptional image quality and 75 μm resolution Wide range of field of view (110x80; 80x80 60x60; 40x40) focused perfectly on the region of interest Powerful and adjustable artefact reduction filter Simplified implant planning and a substantial and scalable implant library Considerable accuracy in endodontic analyses

Reduced doses for improved patient and medical staff safety

Magnesium implants that dissolve over time may enhance bone formation in patients with impaired bone healing, such as people suffering from osteoporosis, a Swedish study has found.

WINDOWS® COMPATIBLE

3D reconstruction time in 29 seconds Comprehensive and intuitive software A complete and illustrated implant report in less than a minute

ACTEON Australia/New Zealand Suite 119/30-40 Harcourt Parade, Rosebery l NSW l 2018 l AUSTRALIA l Toll Free. 1300 ACTEON (22 83 66) l E-mail: info@acteongroup.com l www.acteongroup.com

ADVERTORIAL

Dental Tribune Asia Pacific Edition | 5/2017

“The Asian market is one of the most important growth markets for Adentatec” Introducing German dental manufacturer Adentatec given priority to patient health. Its products thus undergo biocompatibility and corrosion resistance tests, among others, and

optimally cover traditional casting technology and the new CAD/CAM technologies, such as milling and selective laser melting.”

tomers. “At this year’s Sino-Dental, we would like to introduce the further developed cobalt– chromium milling system SOFT-

“We are very well positioned with our products and can optimally cover traditional casting technology and the new CAD/CAM technologies.” By DTI Based in Cologne in Germany, Adentatec is a global dental company specialised in the manufacture and distribution of non-precious dental alloys. Its medical devices are exclusively produced in Germany and certified to the highest standards (CE marking, US Food and Drug Administration, and China Food and Drug Administration). Adentatec is committed to the strict implementation of the quality and process requirements AD

of DIN EN ISO 13485 and DIN EN ISO 9001 in relation to the entire manufacturing chain.

are manufactured from highquality raw materials to ensure consistent quality.

The company was established in 1997 and initially manufactured and distributed sandblasting material, dental plaster and consumables to dental laboratories. In 2003, Adentatec began production of dental alloys, for which it implemented a quality management system. As a manufacturer of medical products, the company has always

Over the last decade, the company’s export business has increased steadily. Consequently, Adentatec now has more than 20 agents worldwide who represent its product range. “The Asian market is one of the most important growth markets for Adentatec in the future,” Sales Director Julia Grabensee said. “We are very well positioned with our products and can

CAD/CAM discs on cobalt–chromium and titanium bases The company’s brand-name casting alloys, such as SYSTEM KN, SYSTEM MG and SYSTEM NE, have long been in use and been proven over many years. In 2009, Adentatec expanded the range to CAD/CAM discs on a cobalt–chromium base (SYSTEM NE-BLANK and SYSTEM SOFTBLANK). The high-quality discs are available in many sizes and compatible with all open milling systems. Among the noteworthy features of SYSTEM SOFT-BLANK are its high corrosion resistance and biocompatibility in accordance with DIN EN ISO 10271 and 10993-1. Owing to a special heat treatment, it is especially soft and homogeneous and has a high strength. The system is available in many diameters and heights, for almost every type of machine.

BLANK. Based on our experiences at the recent International Dental Show in Cologne in March, we expect a great deal of interest, particularly because of the significant improvements regarding new milling properties and more improved compatibility with veneering ceramics,” she said.

In addition, the CAD/CAM product portfolio was extended in 2012 with titanium milling discs (SYSTEM TI 5-BLANK) especially for the production of implant-supported restorations.

Just last year, the company expanded its product range with a metal-free alternative, the new ceramic-filled CAD/ CAM high-performance polymer SYSTEM PEEK-BLANK. Owing to the material’s good physical properties and low weight, the patient will enjoy wearing comfort and be assured of a strong material, the company said. SYSTEM PEEK-BLANK meets all of the biocompatibility requirements of DIN EN ISO 10993 and is an ideal option for removable dentures, particularly for allergic or sensitive patients. According to the company, it has been particularly optimised for implant-supported restorations, secondary structures on telescopic crowns, two-piece abutments, gingiva formers, denture bases and many other indications.

With the company’s planned exhibitions at Asian dental shows this year, Grabensee is confident it will win over cus-

More information about Adentatec and its product range can be found at www.adentatec. com.

Dental Tribune Asia Pacific Edition | 5/2017

BUSINESS

Change requires motivation The iTOP approach to oral prophylaxis

By DTI Despite advances in oral health care, patients and dental professionals remain uncertain about good oral hygiene, particularly regarding interdental cleaning. Prof. Denis Bourgeois, Dean of the University of Lyon’s dental faculty in France, has presented scientific evidence that interdental brushes are efficient tools for interrupting the biofilm between teeth. In order to use these correctly, dental professionals need to offer a certain level of individual instruction to their patients. How can this be achieved easily? According to Bourgeois, the majority of his studies have found a positive significant difference in the plaque index when using an interdental brush compared with floss. In general, interdental brushes were found to be more effective in removing plaque compared with brushing alone or the combined use of toothbrushing and dental floss. Establishing the accessibility and widths of the interdental spaces should therefore be part of the routine examination of all patients. An interdental brush that is sized correctly for each space is easy to handle and atraumatic, yet effective. However, this routine examination needs to be taught. In fact, one major problem with interdental cleaning has always been patient ability and motivation. “Interdental cleaning does not readily become an established part of daily oral hygiene,” according to Bourgeois. Damage to the interdental papillae and abrasive trauma to the dental surface result from a lack of motivation and instruction. From a clinical perspective, it is therefore necessary to emphasise individual instruction and selection of high-quality oral hygiene products. The ultimate goal should be a high level of cleanliness with little or no harm to

The iTOP trainers use the principle of “Touch to Teach” in their seminars. “Only someone who has experienced it in his or her mouth knows the exact pressure of an interdental brush and understands the importance of oral hygiene and can thus teach this to others,” said Dr Jiri Sedelmayer, founder of iTOP. Through the iTOP approach, which combines efficient tools with a thorough knowledge of cleaning techniques, dental professionals and patients can achieve optimum and sustainable oral health. In 2016, 200 seminars were held in 44 countries.

After the iTOP seminar, you will simply rediscover the meaning of oral health,” said Dr Ana Stevanovi, Head of Education at

iTOP. Introductory and advanced iTOP seminars in Ho Chi Minh City are being offered on 30 and 31 May as well as 1 June.

Dental professionals interested in attending can obtain more information at info@itopdental.com. AD

VITA ENAMIC redefines load capacity.* ®

The first hybrid ceramic with dual network structure for unsurpassed absorption of masticatory forces

IC AMor N A E ol VITmultiC

! NEW

Four-day Englishspeaking course in Vietnam The next iTOP teacher will take place in Ho Chi Minh City in Vietnam from 24 May 2017. The four-day course offers theoretical and practical training. The intense theoretical part includes presentations by several international iTOP lecturers covering the main topics of this prophylaxis approach in more detail. In the practical part, certified instructors will demonstrate the requisite instruments and techniques using the “Touch to Teach” principle. Around 22 participants from seven countries are expected to attend. “Our iTOP seminars will allow you to experience motivation and education from the patient’s perspective and transmit this knowledge to your patients in an individual and tailored way.

3522E/1

Prof. Denis Bourgeois

Change through motivation: The iTOP programme The iTOP (individually trained oral prophylaxis) programme covers the necessary techniques, knowledge and instructions for dental professionals. This established educational system provides simple and practical training for dental staff, who can then apply this approach to their dental hygiene delivery and teach an effective prevention technique to their patients. All iTOP seminars are led by independent dentists and dental hygienists who have completed the courses themselves. Only iTOP facilitates individual training with regular check-ups and corrections to the prophylaxis techniques learnt.

either soft- or hard-tissue. Oral prophylaxis should therefore be taught individually to dental professionals and not in lectures. By correcting and repeating the right cleaning technique, prevention of oral and systemic disease can be achieved.

VITA ENAMIC

• enormous load capacity since masticatory forces are absorbed • reduction of wall thickness possible to achieve restorations that require minimal preparation • highly precise and particularly accurate results • tooth-like material properties • fast and easy to process with no furnace required *) In addition to a high degree of elasticity, this innovative hybrid ceramic guarantees outstanding load capacity after adhesive bonding.

www.vita-enamic.com

3522E_1_162x227.indd 1

facebook.com/vita.zahnfabrik

VITA shade, VITA made.

03.04.17 16:06

BUSINESS

Dental Tribune Asia Pacific Edition | 5/2017

Stronger together An interview with Jean-François Tivoly, CEO of the TIVOLY group, and Christian Fontaine, CEO of FFDM Pneumat

Fig. 1: The Tivoly family: Jean-François Tivoly, Jamy Tivoly, Edouard Tivoly and Marc Tivoly (from left).

By DT France In October 2016, the TIVOLY group acquired the FFDM group. The two companies specialise in the design and production of cutting tools. Both trace their origins to the same familial and industrial culture dating back to the early twentieth century. The acquisition is part of TIVOLY’s development strategy, aimed at strengthening its industrial base and consolidating its position in aeronautics and its investments in expanding markets like medical devices. FFDM will benefit by having a stronger base for its investments, especially in research and development. The aim is to renew and strengthen their respective offerings and to put the THOMAS brand at the forefront of the dental market, in the context of tightening regulation and increased competition from Asian products. Dental Tribune France met with TIVOLY CEO JeanFrançois Tivoly and FFDM Pneumat CEO Christian Fontaine.

What are the secret ingredients that make a partnership successful? Christian Fontaine: The founding of both of these family companies was based on a commitment to the service of society. Lucien Tivoly, for example, built his first factory to manufacture the cutting tools essential to the arms industry during the First World War, and FFDM was established during the Second World War. One war may have separated us, but we share common values. Throughout our history, we have always striven for progress and concentrated our efforts on becoming a centre of excellence regarding our core business. Our teams have the ability to listen and share a spirit of open-mindedness that fuels intuition. We are, in fact, creating added value, by using an approach that focuses on adapting our products and services to the needs of today’s consumers. Our aim is not simply to anticipate their expectations, but to surpass them.

For example, in the era of smartphones, no tool is available to dismantle, clean and repair these devices, so we created a toolkit to address the problem. It is difficult for dental surgeons to remove posts of any kind from root canals, so FFDM, along with Prof. Pierre Machtou, improved an existing kit, the Gonon kit, which is now used in innumerable dental practices around the world. Whatever the problem, our expertise and knowledge of precision tools for the machining of materials can always provide a concrete, tailor-made solution. The exchanges that will inevitably be created between the teams in charge of research and development will definitely enable us to serve new markets linked to our craftsman origins. Mr Tivoly, could you briefly introduce us to your company? Jean-François Tivoly: TIVOLY is a family business that was established in 1917 and has its headquarters in Savoy. It is a highly

Fig. 2: Grinding and sharpening of an FFDM implant drill.—Fig. 3: Production of implant drills.

international industrial company that designs and manufactures cutting tools (drills, milling cutters, taps, etc.) and the related accessories. TIVOLY is a publicly traded company (Euronext) and its annual turnover is € 85 million (one full year with FFDM). TIVOLY is structured around two business units. The first, the consumer unit, supplies tools for the construction, DIY and industrial maintenance markets. The second, the industrial unit, offers machining solutions for industry, for example the aeronautic and automobile industries. At present, FFDM’s dental offering is part of the industrial unit at group level, but with a view to these activities being expanded, it seems logical to create a medical unit at group level, encompassing dental products at first, but eventually including all of the other areas we have planned for the future. TIVOLY is aiming for strong growth, strengthened over the

next few years by its products and international positioning. To speed this growth up further, TIVOLY making other acquisitions is a possibility, on condition that these are part of its strategy. Which indicators make you believe medicine is the field of the future? Tivoly: Dentistry, which is an FFDM specialty, is part of the broader field of medicine. Globally, it is widely believed that this area will continue growing. Indeed, populations always continue to increase in number and age. In many areas, such as India, Africa and China—where we have a factory—living standards are improving, and as the proportion of income spent on necessities decreases, more income is left over to invest in health. However, there is strong competition in the medical equipment field, with many companies of various sizes—some quite modest—in France. The market and technolo-

BUSINESS

Dental Tribune Asia Pacific Edition | 5/2017

Fig. 4: The TIVOLY factory in China.—Fig. 5: TIVOLY’s ‘surgical’ smartphone kit.

gies are developing simultaneously. Thus, it is evident that there are many factors that may influence the future. All of these can be viewed as opportunities and that is why medicine is the field of the future. Mr Fontaine, could you tell us about FFDM? Fontaine: FFDM, with its THOMAS brand, is a French company that has been active in the dental field for over 70 years, along with the companies NICHROMINOX, Anthogyr and MICRO-MEGA. This seniority explains our strong international presence. We are present in over 65 countries with our own brands and/or under the trademarks of our distributors, and more than 80 per cent of our annual turnover comes from exports. The first dental products produced by FFDM were milling cutters in 1946, sold under our THOMAS brand or private labels (under our clients’ brands). Our THOMAS range was then expanded through the manufacture and sale of con-

ventional endodontic files, marketing Gonon extraction kits, etc. Parallel to developing in the dental industry, FFDM has expanded its knowledge base into the industrial area through the design, production and sale of cutting tools and assembly solutions, also under the THOMAS trademark, and the design, manufacture and sale of machinery and assembly solutions under the Pneumat trademark. Today, we are recognised as a major and essential partner. Getting back to the dental field, we have designed dental implant drills for about 20 years. This activity has been a strong lever for our company’s growth. We currently work with some 50 implant companies across the world, many of which are very well known, demonstrating our expertise and quality products in this domain. We have more than doubled our turnover in the past decade, owing to a highly sustainable investment and devel-

opment policy. More recently, we have invested over 10 per cent of our annual turnover. We now have an assemblage of modern, highperformance machines at our disposal. We will continue following this approach in the future, so we can provide our clients with an even better service. Now, we have a stakeholder that is a family-managed manufacturer just like FFDM has been since it was founded. It was surprising to discover the similarity of the industrial paths that the TIVOLY group and FFDM have taken. We are now part of a group that employs over 500 members of staff, with commercial and manufacturing plants in many countries, spanning three continents. Jamy Tivoly, the grandson of the founder, was recently honoured with a distinguished national award in recognition of his remarkable industrial career. How do you see the future, and what are your plans?

Fontaine: Currently, our implant drills are sold exclusively to implantology companies. The drills are made according to specifications from these companies (we are subcontractors; our brand name never appears on the instruments). We intend to offer a range of standard drills to be sold under our THOMAS trademark with our own CE marking. The aim is to sell these directly to distributors and practitioners to boost the THOMAS brand and give it greater visibility. With standard drills, another advantage for interested implantology companies would be that they would not have to take care of the CE marking themselves, as this would be an additional service we would offer them. We plan to strengthen our technical and regulatory services to help our clients with their new products throughout all the stages of registration. We also intend extending our product ranges (mainly the endodontic range) so we can provide complete solutions to our clients.

Fig. 6: Plastic moulding of root canal instruments.—Fig. 7: Implant drills being cleaned.—Fig. 8: Drilling into metal with a TIVOLY drill.

We also have our sights set on other markets, like cutting tools for the ancillary orthopaedic segment. We have strengthened our collaboration with well-known dentists to gain greater visibility on the market. We have achieved this in the past with Prof. Machtou with immense success. Online sales is also an area we are looking into. Through integration into TIVOLY, which guarantees committed and transparent management, we now have the financial capacity to implement all of our development projects, both industrial and commercial. TIVOLY’s commercial and industrial sites in Europe, Asia and North America will give us access to facilities that are closer to our clients and to our markets. Thank you very much for the interview. Combining your respective expertise should enable you to achieve even greater things. We hope you enjoy many successes together.

FREE – weekly e-news delivered to your inbox – latest industry developments – event specials – exclusive interviews with key opinion leaders – product information – clinical cases – job adverts

Dental Tribune Asia Pacific Edition | 5/2017

SCIENCE & PRACTICE

Acupuncture: Probing its way into dentistry—Part II Dental applications of acupuncture in managing xerostomia, dental anxiety and gag reflex By Dr Wong Li Beng, Singapore After a general introduction to acupuncture and its practical applications in contemporary dental practice, this second part of the article will discuss the use of the method in managing oral conditions such as xerostomia and its effect in reducing dental phobia and the gag reflex before illustrating the recent uptake of acupuncture in the mainstream health care sector in Singapore. Management of xerostomia Xerostomia may be medication-induced and other common causes are autoimmune conditions like Sjögren’s syndrome and irradiation of the head or neck region. Conventional management of xerostomia includes palliative treatment, such as a saliva substitute or chewing gum, and systemic medication, like pilocarpine. The use of acupuncture as an alternative treatment modality for xerostomia has been documented in Western medicine since the 1980s. Observational studies have demonstrated that acupuncture treatment may increase salivary flow in healthy volunteers, patients with Sjögren’s syndrome and patients who have undergone radiotherapy of the head or neck region. In a long-term retrospective study involving 70 patients with xerostomia due to primary and secondary Sjögren’s syndrome, irradiation and other causes,1 the patients received a course of 24 acupuncture treatment sessions over the first six months. The salivary flow rate (SFR) for stimulated and unstimulated saliva was measured six months after the baseline acupuncture treatment and according to subjective changes observed by the patients. Data for up to three years was also analysed, comparing those who chose to receive additional acupuncture treatment with those who did not. The results showed that the SFR in both stimulated and unstimulated saliva was significantly higher after six months compared with the baseline and this was consistent with the subjective improvement described by the patients. In addition, patients who received additional acupuncture treatment after six months had a consistently higher median SFR in both stimulated and unstimulated saliva compared with those who did not, suggesting that supportive acupuncture treatment given over a long period may help to maintain its therapeutic effect. This finding is in accordance with the traditional Chinese medicine (TCM) concept that the treatment effect of acupuncture may be accumulative after repeated sessions.

Acupuncture treatment may provide relief for pilocarpine-resistant xerostomic patients after radiotherapy for head or neck malignancies.2 However, the treatment outcome for the study cited was only based on the Xerostomia Inventory score, which is a self-report questionnaire. Acupuncture

seems to be able to increase the SFR, provided that the salivary glands are still functional. For those patients whose salivary glands have been structurally affected by radiotherapy and become resistant even to pilocarpine, acupuncture may provide subjective relief to a limited ex-

tent, although the patients should be advised on realistic expectations of acupuncture therapy. The mechanism behind how acupuncture can increase the SFR is still not fully understood. It can be a placebo effect as shown in Pavlovian conditioning, in which ex-

“...scientific evidence for [acupuncture's] role in pain management is strong.”

pectation alone of those receiving treatment can induce saliva production. Local acupoints in the head and neck region may also directly stimulate the nerves innervating the salivary glands. Some authors have suggested that acupuncture treatment triggers the release of neuropeptides and this can affect blood flow, have anti-inflammatory properties and exert a trophic effect on the salivary glands.3 Another possibility may be related to neuronal activation. In a descriptive study, cortical regions were evaluated using functional magnetic resonance imaging of volunteers undergoing acupuncture treatment. 4 It was observed that acupuncture treatment activated the parietal, Rolandic and frontal opercula, as well as the insula, overlapping with the regions involved in gestation and salivation. The authors proposed that acupuncture treatment may tap into the neuronal circuit that activates the salivary nuclei in the pons and subsequently the salivary glands via the cranial nerves. More studies are needed to investigate how acupuncture therapy may increase salivary flow. Management of dental anxiety and gag reflex A recent Cochrane review showed that 31 per cent of adults are fearful of dental treatment.5 A phobic patient may develop reluctance towards or avoidance of dental treatment and thus not seek dental care. During dental

12 procedures, an anxious patient may hinder the operator from executing procedures properly. Traditionally, medications like benzodiazepines and midazolam have been used to manage dental anxiety. The use of acupuncture may provide an alternative treatment modality without possible adverse drug reactions. Several reports on the use of auricular acupuncture for treating chronic and acute anxiety have shown promis-

SCIENCE & PRACTICE

ing results. A randomised controlled trial comparing auricular acupuncture with intranasal midazolam for managing dental anxiety suggested that both treatment methods were similarly effective.6 More large-scale studies are needed to verify this finding. The gag reflex is a normal protective, physiological mechanism that occurs to prevent foreign objects or noxious material from entering the pharynx, larynx or tra-

chea. Its causes may be somatic, that is brought about by stimulating certain trigger areas in the oral cavity, or psychogenic, that is induced by thought stimulus modulated by the higher brain centres. A hyperactive gag reflex can be a hindrance to dental procedures, such as during taking of alginate impressions for denture fabrication. The use of certain acupoints like PC6 (neiguan) and CV24 (chengjiang) have been reported to reduce

Dental Tribune Asia Pacific Edition | 5/2017

the gag reflex significantly.7 Auricular acupuncture too has been suggested for treating a severe gag reflex.8 According to the TCM theory, the acupoint PC6 (neiguan), located on the palmar side of the forearm 2 in. (50.8 mm) above the transverse crease of the wrist, falls on the pericardium meridian, which has the effect of “calming the heart which houses the spirit”. It is often used to treat heart palpitation, nausea and vomiting. In providing an explanation in the context of Western med-

icine, it has been proposed that acupuncture may trigger an increase in circulating endorphin, which binds to the opioid receptor, exerting an antiemetic effect.9 The anti-gagging point located on the ear corresponds with the area of the skin innervated by the auricular branch of the vagus nerve and adjacent to the area innervated by the auriculotemporal branch of the mandibular division of the trigeminal nerve, both are responsible for the sensory and motor function of the larynx, pharynx and palatal region. It can be postulated that stimulation of the auricular acupoint may inhibit the muscular function in the gag reflex. More studies to verify the effectiveness of acupuncture in controlling the gag reflex should be carried out.

Growing interest among medical and dental professionals A recent press report in Singapore indicated that there are an increasing number of medical and dental professionals also trained in providing acupuncture treatment.10 Based on the official figure at the end of 2015, there were 249 registered acupuncturists in Singapore, of which 134 were medical doctors and dentists, constituting 54 per cent of the group. In addition, acupuncture treatment for pain management is currently being offered in four major public hospitals in the country, a major step towards its recognition as a treatment modality in the mainstream health care sector.

Conclusion The use of acupuncture has a long history and has been proven to be an effective treatment modality in TCM. The scientific evidence for its role in pain management is strong, although more large-scale studies with better experimental designs should be carried out to verify its application in other areas. The use of acupuncture in dentistry may provide an added dimension to the patientorientated holistic treatment approach that all health care providers should strive to achieve. Editorial note: A list of references is available from the publisher.

Dr Wong Li Beng is a consultant periodontist at Ng Teng Fong General Hospital and Jurong Medical Centre in Singapore and Director of Preventive Dentistry at the centre. In 2011, he obtained a graduate diploma in acupuncture from the Singapore College of Traditional Chinese Medicine and is now a registered acupuncturist with the Traditional Chinese Medicine Practitioners Board. He can be contacted at Li_Beng_Wong@ juronghealth.com.sg.

Hingis_DailyRitual_A4.indd 1

23.03.17 09:23

Dental Tribune Asia Pacific Edition | 5/2017

TRENDS & APPLICATIONS

Minimally invasive inlay restoration using the VITA ENAMIC hybrid ceramic

By Dr Gerhard Werling, Germany Inlay restorations using CEREC procedures (Dentsply Sirona) have been an established process in digital dentistry for decades. However, owing to the required minimum wall thickness, a great deal of tooth substance frequently had to be removed in reconstructions using conventional ceramics. Owing to reduced minimum wall thickness, VITA ENAMIC (VITA Zahnfabrik) allows for minimally invasive restorations and can be precisely ground to thinly tapering edges. In this case report, I explain the clinical procedures for an inlay restoration using this hybrid ceramic on teeth #24–26.

Initial situation Figures 1 and 2 show the initial situation of the 38-year-old male patient. On the basis of his history and in accordance with his request, he was not treated with alternative methods (infi ltration technique, fluoridation, regular controls, etc.). Instead, a cavity was carefully prepared on the teeth in which caries was radiographically shown to have already penetrated the approximal enamel. Surprisingly, it was found clinically that the caries had penetrated deep into the dentine, such that after extensive excavation, a considerable defect in the tooth substance was present.

Material selection As the patient wanted a permanent enamel-like and toothlike restoration, composite could not be used as a restorative material. It was decided to proceed according to the extension for prevention rule, but as minimally invasively as possible. VITA ENAMIC is very advantageous in such a case. The unique network structure in which ceramic and acrylate polymers interpenetrate provides for enormous resilience and offers more freedom than conventional restorative materials do.

CAD/CAM workflow Three VITA ENAMIC inlays were fabricated using the CEREC

system (Sirona Dental Systems, now Dentsply Sirona). The intraoral scan was performed using the CEREC Omnicam. With the biogeneric software, the reconstruction was done corresponding to the missing occlusal surfaces. In the grinding preview, the inlays were placed in the material blanks. The EM-10 (8 × 10 × 15 mm) geometry was chosen according to the shade determination with VITA Easyshade (VITA Zahnfabrik) in Shade 1M2-HT. The hybrid ceramic can be processed very simply and quickly by machine and manually. Owing to the high load-bearing capacity and edge stability, constructions with comparatively thin wall thicknesses and thin edges are also feasible. Edge chipping, which can occur with conventional ceramics, is rare with this material.

“Virtually no transition between the tooth and the restoration remains visible.”

Processing and integration It is advantageous that there is no firing process, and shade characterisation is possible if desired. The available shade selection (0M1–4M2) in two translucency levels and the good light transmission of the material allow for aesthetically pleasing results. The inlays were polished to a high gloss with the VITA ENAMIC Polishing Set in the clinic. The hybrid ceramic can also be easily polished intra-orally. With VITA polishing instruments, the restoration edges can be finely polished so that virtually no transition between the tooth and the restoration remains visible. Bonding is performed adhesively.

Dr Gerhard Werling is a specialist in aesthetic dentistry and implantology and runs a private practice in Bellheim in Germany. He can be contacted at dr.werling@t-online.de.

Fig. 1: Initial situation.—Fig. 2: Radiographic situation: does the apparent caries have to be treated or can it be addressed with alternative methods?—Fig. 3: Care was taken with the careful preparation of a cavity, but in the course of the excavation, there were clinically extensive undermining defects.—Fig. 4: Extension for prevention—but as minimally invasively as possible.—Fig. 5: The digital impression was taken with an intraoral scanner.—Fig. 6: The occlusal surfaces were reconstructed using the software.—Fig. 7: By overlaying the opposing occlusal surfaces, the contact points could be checked.— Fig. 8: In the grinding preview, the designs were placed optimally in the blank (the inlay for tooth #26 is shown).—Fig. 9: For the adhesive bonding, absolute isolation was ensured with a rubber dam. Fig. 10: A defect-oriented restoration with composite fillings was planned. The result was a minimally invasive restoration with VITA ENAMIC inlays.

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 5/2017

Shade analysis: See, determine, realise

By Bastian Wagner, Germany The wide variety of ceramic materials available today allows the dental technician to reproduce the natural, dynamic light qualities of natural dentition. Determining and realising these visual characteristics, however, are challenges that can only be mastered with a great deal of patience and knowledge. Each patient case requires the full attention of all involved— patient, dentist, dental technician—to the fi ner details in this complex piece of work. It is the dental technician’s job to produce a durable prosthetic restoration that, with its functional, biological and aesthetic characteristics, is adapted to the individual requirements and specifications of the patient. The advancement in technologies and materials within the last several years has dramatically changed the work of dental technicians. We are, however, still often faced

with a significant challenge: to recreate nature’s perfection in harmony with the surrounding dentition. In particular, consistency and discipline are needed to fabricate anterior teeth. In order to produce an aesthetic restoration, the dental technician must determine the correlation between the tooth shape, surface structure and function, and the effects of phonetics and colour. These factors form the foundation. With a passion for the work involved and the necessary sensitivity and specialist knowledge, a lifelike appearance can be successfully imitated. At times, this can be a laborious task and require a great deal of patience; sometimes, it takes quite a few attempts to achieve the desired results. In order to realise a harmonious and aesthetic smile in the end, good communication between the patient and dental technician is essential. The patient’s expectations must be clearly understood by all parties and his or her

1 2

The visual properties of natural teeth Three shade characteristics must be taken into account when determining the shade: the colour (hue), the brightness (value) and the colour intensity (chroma). The colour itself is the most obvious part of a shade. The brightness refers to how light or dark a colour is. The colour intensity describes the purity of a colour. The greatest attention should be paid to the brightness. If the value of a restoration is not ideally matched to the rest of the dentition, even the slightest deviation can be detected within normal speaking distance by the person standing opposite.1

wishes transposed as a team. This article concentrates on shade selection and reproduction using the veneering ceramic IPS e.max Ceram (Ivoclar Vivadent). The fabrication of an anterior tooth is demonstrated based on a patient case.

The principles of shade selection For shade selection, a shade guide is used and it presents the following colour tones: A = orange B = yellow/orange C = grey/orange D = brown/orange. The shade should be selected at the start of the restorative treatment so that it is not affected by a dehydrated natural tooth structure. In order to select the hue, value and chroma, individually fabricated shade samples in the relevant ceramic assortment are useful (Fig. 1). The ceramic materials are designed in such a way that the complex shades and characteristics of natural teeth can be better distinguished. The colour of the gingiva or other surrounding influences can affect the shade selection. For example, the background colour during shade selection can change the perception of the colour inten-

sity and the colour tone. In order to avoid any misinterpretation, it is advisable to cover the dark oral cavity with a grey card. Another method is to use a gingivacoloured holder (Gumy, SHOFU) for each individual shade sample in order to provide simultaneous and successive contrast effects. The samples are surrounded by a colour that imitates their natural environment. The Gumy gingival mask is available in four different colours. When a shade is selected, the sample is then placed into the Gumy so that it can be checked against the gingiva. For basic shade determination, it is advisable to take a photograph of three different shade samples on one photograph. This provides a comparison. One sample should represent the brightness of the tooth to be prepared, the second should have a lower value and the third a slightly higher value. Furthermore, during the pre-operative shade determination, important information on the selection of a suitable material should be considered.

Fig. 1: Individual shade samples for the IPS e.max Ceram ceramic range.—Fig. 2: Reconstruction of tooth #11. Shade determination at the beginning.— Fig. 3: Shade determination with a gingiva-coloured holder for the shade samples.—Fig. 4: Shade determination of the internal structures.—Fig 5: Selection of the individual Opal Effect materials using self-fabricated shade samples.—Fig. 6: The crown framework IPS e.max Press (MO 1 ingot) before the wash bake.—Fig. 7: The wash bake and characterisation with MM light before firing.—Fig 8: The crown framework was built up with Dentin B1 and MM light, and Deep Dentin and MM light were built up towards the edges.

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 5/2017

Fig. 9: Completion of the internal structure with Dentin BL3.—Fig. 10: Creation of the mamelon structure with a mixture of MM light and Essence materials.—Fig. 11: Completion of the incisal plate with Opal Effect materials.—Fig. 12: The results after the first bake.—Fig. 13: Checking the 15 surface structure.—Fig. 14: The finished piece of work after the glaze firing.—Fig. 15: The finished restoration of tooth #11 in situ.

Photographic documentation of the shade selection In an addition to the shade selection, photographic documentation is essential. A photographic shade comparison of the natural tooth colour and the corresponding shade tabs provides further details. In general, digital photography is a unique communication tool for the entire treatment team, and it should be firmly established within the treatment process.2 When taking photographs, the following procedure must be observed. The shade sample and the natural tooth must both be parallel to the sensor level on the camera and receive the same amount of light exposure from the camera flash. The shade information in the photograph and the anatomical and morphological characterisation can then be analysed on the screen. In order to avoid falsified information on the screen, it should be calibrated perfectly. If a grey card is used while photographing, differing camera values can be corrected using white balance with an image-editing programme (e.g. Adobe Photoshop

Lightroom, Adobe Systems) so that information is not lost or distorted. When the photographs are converted in the image-editing programme into black and white images, the surface texture and difference in brightness are clearly visible. In order to better identify internal characterisation, the contrast control can be adjusted to “maximum” and the highlight function to “minimum”. This will show all of the details clearly. The collected information is converted into a shade diagram, which is synchronised with the ceramic material to be used, and a layering concept is created. The following case demonstrates one possible procedure for realising the determined tooth shade.

Patient case This patient case with the reconstruction of tooth #11 illustrates clearly how the determined shade can be reproduced. The pre-operative shade analysis showed that the adjacent tooth #21 had a very high degree of brightness in the cervical area and in the body (Figs. 2 & 3). The natural tooth exhibited opalescent/transparent areas on the ridges and in the incisal region. The mamelon structure had a

high value and a slightly yellowish chroma (Figs. 4 & 5). The basic shade selected was BL3. Various methods can be used to increase the brightness of the IPS e.max Ceram ceramic. In this case, owing to the high degree of value, the brightness of the Dentin B1 ceramic material was increased with the highly fluorescent MM light ceramic material from the IPS e.max range. The framework material used was an MO 1 Press ingot (Fig. 6). The structure was lightly covered in a wash bake with MM light and then fired (Fig. 7). During the fi rst dentine bake, the framework was evenly covered with Dentin B1 and MM light. The area towards the ridge that had a high degree of value was imitated using Deep Dentin B1 and MM light in a ratio of 4:1 (Fig. 8). The tooth shape was then completed using Dentin BL3 (Fig. 9). Cutting back the incisal area and the edges made space for the Effect materials. Before the actual build-up, in order to create the mamelon structure, the material MM light was mixed with Essence lemon and white until the ideal mixing ratio had been found and then a fi ring sample

was fabricated. The exactly mixed ratio was then applied to the incisal plate (Fig. 10) and the edges were built up with OE1. The incisal plateau was completed by alternately layering OE2 and OE3 (Fig. 11). Finally, the halo effect was imitated from the incisal edge to the proximal area and the crown was then fi red (Fig. 12). The second bake included slight shape corrections. In order to achieve a natural appearance, the ceramic surface was given structure and then fi xed with a glaze bake (Figs. 13–15).

In autumn 2015, Ivoclar Vivadent introduced the IPS e. max Ceram Power Dentin and Incisal layering ceramics, which feature a high brightness value. These materials are ideal for use on less-reflective translucent substructures. In cases such as the one presented in this article, in which a high degree of brightness is required, the Power materials can also be used on opaque frameworks to realise the desired results with little effort. Editorial note: A list of references is available from the publisher.

Conclusion The diverse spectrum of a modern ceramic range gives the technician the ability to reproduce a variety of dynamic light properties. Determining and realising the tooth shade pose significant challenges. This is why the intensive study of chromatics and of one’s own ceramic assortment is essential. Even though the material prerequisites for reproducing lifelike restorations are available, each dental technician is responsible for developing his or her own skills and capabilities. The challenge of recreating a shade will always be unique for each patient case.

Bastian Wagner Master dental technician Bastian Wagner is an expert in the use of Ivoclar Vivadent materials for dental restorations. He works in a dental laboratory in Munich in Germany and can be contacted at wagner.zahntechnik@ gmail.com. AD

• Non-precious dental alloys on nickel-chrome base System KN and System NH •

Non-precious dental alloys on cobalt-chrome base System NE and System Duro

•

Partial alloy System MG

•

CAD/CAM discs on cobalt-chrome base System NE-Blank and System Soft-Blank

•

CAD/CAM disc on titanium base System Ti5-Blank

Adentatec GmbH

•

Investment for crowns and bridges ADENTA-VEST CB

Konrad-Adenauer-Str. 13 50996 Koeln-GERMANY

• Investment for partial denture ADENTA-VEST PA

Phone + 49 2 21 - 35 96 - 100 Fax + 49 2 21 - 35 96 - 170 info@adentatec.com www.adentatec.com

37th Australian Dental Congress • Melbourne, 17–21 May 2017 Interview

Networking

Practice Diary

ADC speaker Prof. Philip Marsh from the University of Leeds on the link between lifestyle, the oral microbiome, health and well-being.

There is much to do and see at this year’s ADC. Find an overview of the event’s social programme in the “what’s on” section.

In this article, dentist Dr Diyari Abdah shares a week of clinical cases utilising ACTEON’s X-Mind trium CBCT imaging unit.

» page 2

» page 4

» page 6

ADC 2017: All about education Melbourne welcomes dental community to biggest event to date n From 17 to 21 May, the 37th Australian Dental Congress (ADC) 2017 is bringing together over 4,000 dental practitioners at the Melbourne Convention and Exhibition Centre. Established in 1907 and organised by the Australian Dental Association (ADA), the event is set to be the biggest ever this year. Held under the theme “Educating for dental excellence”, ADC 2017 has attracted an impressive line-up of four keynote speakers: acclaimed UK prosthodontist Dr John Besford, UK periodontics and prosthodontics specialist Dr Andrew Dawood, endodontist Prof. Anil Kishen from the University of Toronto in Canada and prosthodontist Dr Ken Malament from the US. With an additional 100 speakers from all over the world and a range of topics in all fields of dentistry, including oral cancer screening, root canal irrigation, ergonomics and infection control, ADC 2017 is the largest continuing professional development (CPD) event for dental practitioners

in Australia and an ideal way to fulfil CPD requirements. According to the ADA, the main scientific programme and associated workshops, forums and “lunch and learn” sessions offer over 32 hours of CPD for dentists, 12 hours for dental hygienists, oral health therapists and dental therapists, and 11.5 hours for dental prosthetists. Another key part of the congress programme is the ADA/PFA National Emerging Young Lecturer Competi-

tion. Sponsored by the ADA and Pierre Fauchard Academy (PFA), the competition gives ADA branch-nominated young clinicians the opportunity to present their clinical, research and lecture skills, providing insight into the latest work being undertaken in dental schools across Australia. Candidates hold 15-minute presentations with a short Q & A session and are judged by a panel of four experts from both sponsoring organisations.

The presentations will be held on Friday from 10:30 to 14:30. The winners will be announced at 15:00. The National Emerging Young Lecturer is granted a sponsorship from the PFA of A$ 5,000. A second prize, the Encouragement Award, is worth A$ 1,000.

Free industry exhibition For the first time, the accompanying industry exhibition—the largest of its kind in Australia—is free, not just

for congress attendees, but also for all those in dental practice. Hosting over 100 major companies, the exhibition is showcasing a wide selection of products and services available to the dental profession. It runs from 18 to 20 May in a building adjacent to the venues where the main congress programme will be presented. The exhibition is also the location of the morning and afternoon teas. Graduate dentists should check out the extensive range of work opportunities at the Employment Fair, which has been brought back after its successful premiere at the 2015 event. The fair features organisations from across the dental industry, including private practices, public sector employers and companies, with whom graduates will be able to book appointments to discuss the opportunities available. 7 Read about the ADC’s numerous networking opportunities on pages 4 and 5.

“This year’s congress is not limited by a theme” An interview with Dr Gordon Burt, Chairman of the Scientific Programme Division for the 37th Australian Dental Congress (ADC) n Providing three and a half days of presentations and over 100 speakers, this year’s edition of the ADC will be the largest continuing professional development (CPD) event for dental practitioners in Australia in 2017. today international spoke with Dr Gordon Burt about highlights and new additions to the Australian Dental Association’s (ADA) flagship event, such as the “whole of practice” sessions and the new congress app— and coffee, which he believes is one of the best things Melbourne has to offer. The congress has a very diverse schedule of sessions. What did you aim at when composing the scientific programme? This year’s congress is not limited by a theme. We have tried to organise the concurrent sessions of the main scientific programme into “procedural” (practical), “wholistic” (patient-centred) and “blue sky” (visionary and creative) streams. For example, attendees have the opportu-

Canada, as well as other international and local presenters. Including the “lunch and learn” sessions, there are more than 100 speakers. The congress also features programmes for dental hygienists, oral health therapists and dental therapists.

nity to attend lectures that inform them of techniques they could apply in their practices on Monday morning, or confirm their contribution to the health of a patient, or learn about the future directions of the profession. We have invited four keynote speakers from the UK, the US and

What is the proportion of attendees in these professions and have you noticed an increase in participation by these groups in recent years? The ADA has selectively included allied dental health professions as part of the biennial congress since 2013. Two-day programmes are now offered to dental hygienists and therapists, dental assistants, practice managers and dental prosthetists. While these attendees make up a fraction of the total, they are none the less important. Generally, the participation figures are continuing to increase. You have introduced a new congress app for recording of participants’ CPD hours. How does this work?

As well as providing general information about sessions and speakers, the congress app allows those attending the main scientific, dental hygienist and therapist, or dental assistant programmes to accrue CPD hours, by entering a unique code specific to the session they are attending into the app. The code is only displayed in the session venue. For ADA members, the recorded CPD hours will flow back to the members’ CPD portal. For other participants, this information will form the basis of a CPD certificate of attendance of the congress. The app is available for smartphones and tablets. Could you introduce the concept of the “whole of practice” sessions? The “whole of practice” sessions are a first for the congress. The dental profession has always relied on various clinicians and support from others to provide the best care for an individual. To include those providers who work closely with the dentist is logical.

The opportunity for the whole team to attend lectures together is valuable in reinforcing the bond between us all and building mutual respect. Melbourne is your home town. Could you give attendees some tips on making the most of their time in the host city after hours? Walk the streets and be spontaneous. Melbourne is one of those cities that really need to be explored. Within a few metres from the congress site, there are arts venues, live music, clubs, bars, restaurants, laneways and graffiti—and coffee. In my opinion, it is the best in the world. One of Melbourne’s most successful international exports seems to be the barista. There are plenty of online publications that will tell attendees what is on (apart from the ADA events). Do not worry about the weather; there will be some—a coat and umbrella may be necessary. Thank you very much for the interview. 7

news

The link between lifestyle, the oral microbiome, health and well-being An interview with ADC speaker Prof. Philip Marsh, UK n Philip Marsh is Professor of Oral Microbiology at the University of Leeds in the UK. He has received national and international awards for his research in the field and is a regular conference speaker. In Melbourne, he will be addressing the topics of dental biofilms and oral microbial ecology in three lectures. Ahead of the event, today international had the opportunity to speak with him about the relationship between lifestyle factors and the microbial composition and how to best maintain a healthy bacterial balance in the mouth. The microbial balance of the oral cavity is essential for dental (and overall) health. Could you briefly explain this relationship? Humans and microorganisms have evolved to have a close and important symbiotic relationship, to the extent that we are 50 per cent microbial! These microorganisms [the

human microbiome] are natural and deliver essential health benefits. In the mouth, the normal oral microbiome prevents colonisation by external microbes—some of which would be potentially pathogenic—and contributes to the development of our host defences and cardiovascular system. The natural oral microbiome is closely linked to oral health and is not associated with oral disease.

Prof. Philip Marsh

The 65th Annual Meeting of Japanese Association for Dental Research JADR 2017 [ Dates ]

11/18 (Sat.) - 19 (Sun.) , 2017

[ Venue ]

SHOWA UNIVERSITY, Tokyo, Japan

[ Theme e]

Forefront of Dental Science

[U R L]

h ttp ://ja d r 6 5 .u min .j p

- Toward the Global Standard in Medical Science

[ Congress President ]

Ryutaro Kamijo

Department of Biochemistry, School of Dentistry, Showa University

TOKYO

[ Congress Secretariat ]

Department of Biochemistry, School of Dentistry, Showa University 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan TEL: +81-3-3784-8163 FAX: +81-3-3784-5555

[ Management Secretariat ]

Japanese Association for Dental Research Academic Square Co., LTD. 2-348-302, Ryogae-machi, Fushimi-ku, Kyoto 612-8082, Japan TEL: +81-75-468-8772 FAX: +81-75-468-8773 E-MAIL: jadr65@ac-square.co.jp

Australian Dental Congress 2017

The oral microbiota is vulnerable to disruption by lifestyle and environmental changes. What exactly can cause a shift and what are potential consequences? The symbiotic relationship between the oral microbiota and the host is dynamic and can alter if the oral environment undergoes a substantial change, often as a consequence of an altered lifestyle. A clear example is when salivary flow is reduced or when an individual more regularly consumes sugar-containing foods and beverages. In this situation, the dental biofilm spends more time at an acidic pH. This leads to an enrichment of acid-producing and -tolerating bacteria at the expense of beneficial organisms and increases the risk of dental caries. Similarly, the host mounts an inflammatory response if biofilm accumulates around the gingival margin. If this fails to reduce the microbial load, then the protein-rich gingival exudate that delivers the host defences inadvertently acts as a novel supply of nutrients for the proteolytic and obligately anaerobic bacteria in subgingival biofilms. These bacteria subvert the host response and continue to drive inflammation; this exaggerated response is responsible for host tissue damage. Is the composition of the oral microbiota mainly based on heredity or can it be managed through external factors? Some elements of the make-up of the oral microbiota are linked to heredity, but the general composition and activity of these microbes can be managed by effective oral hygiene and an appropriate lifestyle, for example reducing the amount and frequency of intake of fermentable sugars in the diet, avoidance of tobacco-smoking, etc. An unintended side-effect of some medications can be a reduction of salivary flow; this would disturb the natural balance of the oral microbiota and increase the risk of dental caries. Dental care products aim to reduce harmful bacteria while maintaining the good ones. Is there a danger of using too much product and thereby destroying the oral flora? The oral microbiota is natural and beneficial and therefore needs to be managed and maintained at levels compatible with oral health. Oral care products are designed and evaluated to support the patient in maintaining an appropriate level of oral microorganisms, so if they are used as intended, there is little danger of negatively disrupting the oral

At ADC 2017, Marsh will be holding the following lectures: · Friday, 19 May: “Are dental diseases examples of ecological catastrophes?” (14:35–15:20) and “Oral biofilms in sickness and in health” (16:00–16:45) Saturday, 20 May: “The oral · microbiome: The good, the bad and the ugly” (10:30–11:15).

microbiota. In contrast, the longterm use of broad-spectrum antibiotics can lead to the suppression of significant numbers and types of beneficial oral bacteria, and this can result in overgrowth by yeasts or environmental microbes. Bacteria play an important role in the development of diseases such as periodontitis or caries. Are there ways to manage harmful colonisation other than with dental hygiene measures, for example with vaccines, or will there be in the future? New strategies to promote beneficial oral bacteria and/or to suppress the likelihood of disease are being developed. These strategies include the development of oral probiotic bacteria to prevent dental disease and the use of prebiotics, which are supplements designed to boost the growth of beneficial bacteria. Novel anti-inflammatory agents are being evaluated that would promote wound healing and reduce the tissue damage caused by a subverted host response to subgingival dental biofilms. Molecules that reduce biofilm formation or inhibit species implicated in dental disease are under active investigation. Some snack foods and drinks contain sweeteners that cannot be metabolised into acid by oral bacteria. Is dentistry experiencing greater challenges with regard to biofilms and bacterial shifts today than in the past, and if so, why? The main differences today compared with the past probably surround the increased amounts of sugar in snack foods and drinks. Also, people are living longer and are retaining their teeth into later life, so the dentition is vulnerable to dental disease for longer, and this is coupled with the fact that a side-effect of many medications taken by the elderly is a reduction in salivary flow. What strategies for keeping a healthy balance in the mouth can dentists teach patients? The main strategies are for patients to practise effective oral hygiene and thereby reduce biofilm accumulation and to appreciate the impact of sugar in their diet on their risk of dental caries. It may be helpful if patients realise the relationship and direct link between their lifestyle, their oral microbiome, and their oral and general health and well-being. Thank you very much for the interview. 7

FREE

– education everywhere and anytime – live and interactive webinars – more than 1,000 archived courses – a focused discussion forum – free membership – no travel costs – no time away from the practice – interaction with colleagues and experts across the globe – a growing database of scientific articles and case reports – ADA CERP-recognized credit administration

www.DTStudyClub.com

Join the largest educational network in dentistry! ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof 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.

what’s on

From welcome reception to Dia de los M

In addition to the vast number of educational and scientific opportunities on offer at the 37th Australian Dental Congress (ADC), attendees will be able to network with colleagu

Welcome reception

Madrid, Spain 29 August - 1 September 2017

Giving the opportunity to reconnect with close friends ipation of the event to come, the welcome reception kicks 20:30. The reception event is included in the registration For those still looking to party after the official event h enade offers many opportunities, including wonderful wat most beautiful waterside views in Melbourne. A ride along the Yarra River will add to the holiday pick-up and drop-off service for passengers at the Melbourn ing point. The water taxis operate day and night all week. melbournewatertaxis.com.au.

Accompanying persons programme

Not to be forgotten at ADC 2017 are the partners of den This year’s programme for accompanying persons has und even more memorable. Instead of the traditional lunch, he

meet-and-greet event will give accompanying persons the one another in a relaxed and convivial setting. Another addition is a tourism desk operated by Best o ration of the event, allowing visitors to plan their own exp bourne. One thing that remains unchanged is the Accompanyin able to help themselves to a range of hot and cold beverage leagues from Australia and around the world.

Congress Late Night

Bringing the World together to improve oral health THE BIGGEST INTERNATIONAL DENTAL CONGRESS

What could be better than wrapping up a stimulating tal minds with Congress Late Night on Saturday? Under th Dead), attendees will witness calacas and calaveras—skele point, and brightly decorated altars covered in candles, fru to welcome the dead back into the land of the living with Providing musical entertainment will be Los Romántico embodies the essence of Mexico and who play a vibrant m tendees can while away the evening strolling through the ican dancers and food and drink stands serving tequila a faces painted in the vividly coloured sugar skull tradition ican festival.

More information on the social events is made available aft

Abstract submission deadline: 3 April 2017 Early-bird registration deadline: 31 May 2017

Editorial/Administrative Office Dental Tribune International GmbH Holbeinstraße 29, 04229 Leipzig, Germany Phone: +49 341 48474-302 Fax: +49 341 48474-173 Internet: www.dti-publishing.com www.dental-tribune.com Publisher Torsten Oemus Director of Finance and Controlling Dan Wunderlich Managing Editor Kristin Hübner

www.world-dental-congress.org

Business Development Claudia Salwiczek-Majonek Product Manager Antje Kahnt

2017_WDC-ad-A4.indd 1

Australian Dental Congress 2017

28/09/16 18:22

Productio

today will a 2017.

The magaz right. Any u admissible information nies and co conditions

what’s on

e los Muertos: Social events at ADC 2017

k with colleagues and friends at a series of social events, commencing with a welcome reception on opening night and ending with Congress Late Night on the final evening.

with close friends and colleagues in celebration and antice reception kicks off at 18:30 on Wednesday and runs until the registration fee regardless of the category you fall in. he official event has ended, the nearby South Wharf Promng wonderful waterside dining options—likely boasting the urne. dd to the holiday feeling. Melbourne Water Taxis offer a s at the Melbourne Convention and Exhibition Centre landnd night all week. More information can be found at www.

he partners of dental professionals attending the congress. g persons has undergone some changes to make the event ditional lunch, held on the Friday in the past, a Thursday

2017

HKIDEAS Hong Kong International Dental Expo And Symposium

4 – 6 AUGUST Hong Kong Convention and Exhibition Centre

www. h k i d ea s . o rg

kochenko/Shutterstock.com

nying persons the opportunity to become acquainted with etting. perated by Best of Victoria, which will be open for the dulan their own experience of the beautiful host city of Mel-

the Accompanying Persons’ Lounge, where visitors will be and cold beverages while catching up with friends and colworld.

CALL FOR ABSTRACT

up a stimulating three days of learning from the best denaturday? Under the theme “Dia de los Muertos” (Day of the d calaveras—skeletons and skulls—adorning every vantage ed in candles, fruit and toys, all of which are part of rituals of the living with celebration and song. be Los Románticos, a 22-piece Mariachi band whose music play a vibrant mix of traditional folk and modern pop. Atling through the festively decorated space filled with Mexserving tequila and churros. Visitors can even have their ar skull tradition that is the literal face of this iconic Mex-

P R E L I M I N A R Y F A C U LT Y

Deadline: 15 April 2017

Professor Patrick Allen (Singapore) – Geriatric Dentistry Dr. Yu-chih Chiang (Taiwan) – Restorative Dentistry Dr. Jeanette Chua (Malaysia) – Periodontics

E A R LY - B I R D R E G I S T R A T I O N Deadline: 15 May 2017

Dr. Peter Pospiech (Germany) – Prosthodontics Professor Iain Pretty (United Kingdom) – Preventive Dentistry Dr. Alan Reid (Australia) – Medical Emergency

made available after registration.

about the publisher

Production Executive Gernot Meyer Production Matthias Abicht today will appear at Australian Dental Congress in Melbourne, 17–21 May, 2017. The magazine and all articles and illustrations therein are protected by copyright. Any utilisation without prior consent from the editor or publisher is inadmissible and liable to prosecution. No responsibility shall be assumed for information published about associations, companies and commercial markets. General terms and conditions apply, legal venue is Leipzig, Germany.

NEW HORIZON IN DENTISTRY Organizer

Australian Dental Congress 2017

trends & applications

One-week diary of the use of the X-Mind trium CBCT unit in practice By Dr Diyari Abdah, UK pared with a 2-D image that generally does not make sense to the untrained eye. In order to show how a CBCT unit can affect day-to-day dentistry in a small family practice, it would be beneficial to share a week’s diary of its use. This article provides a small selection from a week’s diary regarding the use of the X-Mind trium CBCT unit in the clinic. More CBCT scans were often obtained on any one day depending on the cases on that day; however, owing to space limitations in this article, only one to two cases per day are described. It must be borne in mind that each practice’s needs are different, but one thing should be common above all and that is to assess every case individually and never take 3-D scans routinely, despite their clear diagnostic benefits. n There is mounting evidence in the literature of the diagnostic superiority of 3-D imaging versus 2-D. As a result, many clinicians today are using 3-D imaging either by referring their patients to a CBCT scanning centre or having mobile units visit them—the only benefit of this is that there is no initial capital outlay to buy the machine. In contrast, the benefits of an in-house CBCT device are many, including the convenience of an on-demand service at any time (pre-, peri- or postoperatively if needed), learning one software programme and utilising it fully, rather than having to learn different ones for different machines from various manufacturers and thus not employing it to its full potential. Addi-

Fig. 1

Fig. 6

tionally, patients appreciate the convenience of not having to travel to another location. Our X-Mind trium CBCT unit from ACTEON is rather new to our

ing acceptable diagnostic value, and sometimes, a 2-D image does not provide satisfactory diagnostic value. A great deal of guesswork is often involved with 2-D imaging and

trium and other settings that reduce the radiation significantly, individual assessment of every case is still very important to obtain the most from the 3-D image without

Day 1 The patient had had all of his mandibular teeth extracted many months before, owing to mobility

“Assess every case individually and never take 3-D scans routinely, despite their clear diagnostic benefits.” practice, and we have yet to fully utilise it. Every day we find new uses and ways to benefit our patients by using 3-D imaging where applicable. Following the latest evidence from experts in the utilisation of 3-D imaging can help a great deal in deciding where and when to use it, consequently minimising radiation dosage and improving diagnostics and planning. We owe our patients the lowest possible dose with the correspond-

Fig. 2

that could affect our decision-making and treatment planning. Judging every case individually is important in order for the benefits of using a CBCT scan to outweigh the potential risks involved with the use of any type of radiographic unit. A modern CBCT machine should allow for different fields of view (FOV) to be utilised in order to minimise the dose to the patient. Despite the choice of four different FOV settings with the X-Mind

Fig. 3

Fig. 7

Australian Dental Congress 2017

exposing the patient to extra radiation. In many cases, a small FOV that is enough for one to several teeth could be equal to the radiation dose of several periapical radiographs, but with a much higher diagnostic value. When a 3-D image is necessary, patients appreciate the information and education they obtain by the case being discussed with them while pointing out vital structures and proposed solutions in 3-D com-

Fig. 4

and infections, and preferred to have a fixed solution through implant therapy. At that point, the patient was wearing a well-fitted temporary mandibular denture. Initially, the idea was to take a scan of the existing denture with radiopaque markers (gutta-percha in six to eight holes made in the denture) to plan for the placement stage. However, a decision was made to duplicate the existing denture using a duplication flask (Lang

Fig. 5

Fig. 8

trends & applications

Fig. 9

Dental) in order to fabricate a clear acrylic radiographic guide (Figs. 1 & 2). A 3-D scan was obtained using the X-Mind trium CBCT scanner to be utilised in the treatment planning of the case, and we found it to be an invaluable resource. Through the scan, the type and position of the implants in relation to the density of the surrounding bone were checked. The ACTEON Imaging Suite software that comes with the device includes a library of the most current implants on the market, allowing placement of the right implant with the right angulation, plus abutments and crowns, in order to maximise the predictability of positioning the implants, thus improving the treatment success. For clinicians who use more than one implant system, in order to change the implant model that was inserted from the library, one simply clicks in the middle of the implant and the implant library is opened again, allowing the selection of another implant model. The software will retain the same insertion point and direction of the previous one. In addition, the software evaluates the bone density around the implant. The aim is to show, both through colour maps and numerically (Figs. 3 & 4), the values before commencing surgery (green if the

Fig. 10

Fig. 11

with an implant-supported crown. In planning the case, a CBCT scan was obtained to serve many purposes in assessing the positions, including the anatomy and bone surrounding these teeth. After this image was taken, both teeth were extracted and the socket was grafted fully to prepare the site for a later implant placement (Figs. 7 & 8).

Day 4 Case 1 A mandibular molar case was in the planning stage, and the position of the mandibular canal was located. At this stage, different implant sizes were tested to check for best fit and the prognosis for maximum integration in the future. The ACTEON Imaging Suite indicated that the first implant considered was too long and there was a risk of nerve damage (Fig. 9); thus, another implant size was chosen to allow sufficient clearance above the nerve, and the density of the bone was checked at the same time, indicating good values in green, which the patient too could understand (Fig. 10). These tools, as mentioned above, can be quite a revelation for patients, and their use can affect the outcome positively. Case 2 A broken and loose bridge was planned to be removed. The man-

ning, and it clearly showed that this may have proved difficult. In addition, on the 3-D image, we noted that the tip of the implant on the left side may have been colliding with the root of the adjacent tooth, with long-term uncertainty as a result (Fig. 15). In a scanning slice (Fig. 16), we also noted the challenge ahead for grafting this implant successfully, indicating that a great deal of consideration would have to be given and careful planning employed in order to obtain a successful outcome for this case. However, and despite the outcome at that point with these two implants, the patient appreciated the high quality of the 3-D technology and being able to see the problem clearly and from different perspectives, eliminating any guesswork that might have affected the final outcome and guiding the treatment in the right direction.

Conclusion These cases and many more every week pass through any dental clinic, with patients hoping for the best available treatment under the circumstances (clinical, timescale, financial, etc.). We know that 3-D imaging is here to stay, and in order to make treatments safer and more predictable for our patients, we have to engage these technologies and involve patients more in show-

“We know that 3-D imaging is here to stay.” Fig. 12

Fig. 13

values are acceptable or high and red if the values are low; Fig. 5), allowing the clinician to make the right decision. This can also be a very good educational tool to show the patient the bone density around any potential implant. In our experience, patients like this feature once shown what it means.

Day 2 Fig. 14

Fig. 15

Fig. 16

An implant was planned to replace a missing mandibular molar, and the position of the mandibular canal was not very clear on a 2-D image; even on the 3-D image, the position was still a little confusing. For this case, we decided to use the ACTEON Imaging Suite’s FlyMode option, which is like a virtual endoscope that follows the mandibular canal tract from within and clarifies the path to confirm that our nerve tracking is correct (Fig. 6). This is one of the unique features of the software.

Day 3 Obtaining the correct position and trajectory of a retained maxillary canine has conventionally been dealt with by taking 2-D images (periapical radiographs) at different angles and possibly an occlusal film to determine the correct position in the buccopalatal aspect, together with some guesswork. 3-D imaging can be an invaluable tool for this indication. The patient refused orthodontic extrusion of the maxillary left canine and wanted both the primary and permanent canines extracted and replaced

dibular left second molar, which served as the most posterior bridge abutment tooth, was beyond saving (visual inspection and probing). 3-D imaging helped with planning the case, including tracking the position of the mandibular canal in relation to the proposed positioning of the implants (Figs. 11 & 12). In addition, the density of the bone was checked (Fig. 13), and the results indicated that a wider implant would possibly be a better choice to improve integration, rather than the one chosen from the implant library. This would also allow us to decide on perhaps performing an under-preparation of the osteotomy site in order for the implant to engage the bone better. This obviously depends on the type of implant used and other factors with which the expert clinician will be familiar.

Day 5 This case was performed by another clinician, who was hoping to achieve good integration after placing two anterior implants with grafting material. According to the clinician, primary stability was good at the time of placement and the implants were placed in bone with some buccal fenestrations, hence the grafting. It thus appeared that success was indicated. After the patient complained about some threads showing through the soft tissue, the clinician suggested further grafting to secure the implants. A CBCT scan was obtained (Fig. 14) as part of the case plan-

ing them their clinical conditions and perhaps the limitations (anatomical, structural, etc.), together with other factors that may affect treatment planning and outcome, hopefully for the better. We hope to be able to use our CBCT scanner for more indications, especially in endodontics, as we have seen amazingly positive results from using a CBCT scan in some difficult endodontic cases since we acquired this 3-D technology. It is the way forward, and we wish we had had the X-Mind trium sooner. 7 Editorial note: A list of references is available from the publisher.

Dr Diyari Abdah is a cosmetic and implant expert and runs a private dental practice in Cambridge in the UK. Passionate about research and innovations, especially in the fields of implantology and 3-D imaging, he deals with all aspects of implantology and grafting techniques and has been actively promoting and teaching implantology to general dental practitioners worldwide for over 15 years through lectures, workshops, articles and mentoring programmes. He can be reached at drabdah@hotmail.com.

Australian Dental Congress 2017

Dental Tribune International

ESSENTIAL DENTAL MEDIA www.dental-tribune.com