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CONTENTS Volume XIX , Number II, 2012
DENTAL NEWS – Sami Solh Ave., G. Younis Bldg. POB: 116-5515 Beirut, Lebanon. Tel: 961-3-30 30 48 Fax: 961-1-38 46 57 Email: info@dentalnews.com Website: www.dentalnews.com www.facebook.com/dentalnews1
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INTERNATIONAL REVIEW BOARD
Pr. M.A. Bassiouny BDS, DMD, MSc, Ph.D. Director International Program, Temple University, Philadelphia, USA. Pr. N.F. Bissada D.D.S., M.S.D Professor and Chairman, Department of Periodontics, Case Western Reserve University, USA. Pr. Jean-Louis Brouillet D.C.D, D.S.O. Chairman, Department of Restorative Dentistry, Aix-Marseille II, France. Pierre Colon D.C.D., D.S.O. Maître de conférence des universités, Paris, France. <j& B]Yf%;dYm\] >jYfimaf$ <aj][l]mj \] d Mfal \] J][`]j[`] =J)).$ EYjk]add]$ >jYf[]& Pr. Gilles Koubi D.C.D., D.S.O. Department of Restorative Dentistry, Aix-Marseille II, France. Hj& ?ma\g ?gjY[[a& Mfan]jkalq D9 K9HA=FR9$ K[`ggd g^ E]\a[af] <]flakljq$ JgeY$ AlYdaY& :jaYf B& EaddYj :<K$ H`&<& ?mq k$ Caf_ k$ Yf\ Kl& L`geYk ;gdd]_] K[`ggd g^ E]\][af] <]flakljq$ Dgf\gf$ UK. Pr. Dr. Klaus Ott, Director of the Clinics of Westfälischen Wilhelms-University, Münster, Germany. Oad`]de%Bgk]h` H]jlgl <=9$ EY³lj] \] [gf^j]f[]$ 9ap%EYjk]add] AA$ >jYf[]& Pr. Dr. Alfred Renk, Bayerische Julius-Maximilians-University, Würzburg, Germany. <j& H`adahh] Jg[`]%Hg__a <=9& EY³lj] \] [gf^j]f[] \]k mfan]jkalk$ 9ap%EYjk]add] AA$ >jYf[]& Ea[`]d Kapgm <&;&<&$ <&=&9& <]hYjle]fl g^ Hjag\gflgdg_q$ Lgmdgmk]$ >jYf[]& Pr. M. Sharawy B.D.S., Ph.D. Professor and Director, Department of Oral biology, Medical College of Georgia, Augusta, Georgia, USA.V
DENTAL NEWS IS A QUARTERLY MAGAZINE DISTRIBUTED MAINLY IN THE MIDDLE EAST & NORTH AFRICA IN COLLABORATION WITH THE COUNCIL OF DENTAL SOCIETIES FOR THE GCC. Statements and opinions expressed in the articles and communications herein are those of the author(s) and not necessarily those of the Editor(s) or publisher. No part of this magazine may be reproduced in any form, either electronic or mechanical, without the express written permission of the publisher.
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Refining Occlusion with Muscle Balance to Enhance Long Term Orthodontic Stability Dr. Derek Mahony A Standardized Protocol For Successful Mandibular Implant Overdentures Dr. Marwan Daas, Dr. André Assaf, Dr. Karim Dada
Introducing Oral Health Education to the Schools of the State of Kuwait Dr. Mohammed Al-Awwad, Dr. Alaa Al-Awwad, Dr. Mohammad Abdulwahab Repairing, Relining, Rebasing in a Complete Denture Dr. Jaouadi Jamila Kuwait Dental Association 16th Scientific Congress, Kuwait.
Lebanese Society of Pediatric Dentistry, Le Bristol Hotel, Lebanon. April 3, 2012 6th CAD/CAM & Computerized Dentistry. The Ritz-Carlton Hotel Dubai, UAE. 3
EDITORIAL TEAM Alfred Naaman, Nada Naaman, Jihad Fakhoury, Dona Raad, Antoine Saadé, Lina Chamseddine, Tarek Kotob, Mohammed Rifai, Bilal Koleilat, Mohammad H. Al-Jammaz COORDINATOR Vanessa Abdelahad ART DEPARTMENT Ibrahim Mantoufeh SUBSCRIPTION Micheline Assaf, Nariman Nehmeh ADVERTISING Josiane Younes PHOTOGRAPHY Albert Saykali TRANSLATION Gisèle Wakim, Marielle Khoury DIRECTOR Tony Dib ISSN 1026-261X
Lebanese Dental Laboratory Show, UNESCO palace, Beirut. May 18 - 20, 2012 Antonine University Dental Laboratories Congress, Lebanon, April 20 - 21, 2012 Direct Restoration of Lower Anteriors with COMPONEER Dr. Georg Rüscher
Dental News, Volume XIX, Number II, 2012
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INTERNATIONAL CALENDAR August 29 - September 1_FDI 2012 Annual World Dental Congress The 100th FDI 2012 Annual World Dental Congress will be held in Hong Kong from 29 August to 1 September. Email: info@fdiworldental.org Website: www.fdiworldental.org September 19 - 22, 2012_Lebanese Dental Association Beirut International Dental Meeting 2012 at the Palais des Congrès Dbayeh, Lebanon Email: bidm@lda.org.lb Website: www.lda.org.lb October 6 - 7, 2012_7th CAD/CAM 7th CAD/CAM & Computerized Dentistry International Conference at The Marina Bay Sands Hotel, Singapore Email: info@cappmea.com Website: www.capp-asia.com October 9 - 12, 2012 The Jordanian International Dental Conference under the title: Dentistry, much is Possible. Organized by the Jordan Dental Association at the Land Mark Hotel Amman, Jordan. Email: conference@jda.org.jo Website: www.conf.jda.org.jo October 11 - 13, 2012_EAO The European Association for Osseointegration will meet in Copenhagen, Denmark - 11 to 13 October 2012 . 20 years, what have we learned? Email: eao@congrex.com Website: www.eao.org
November 7 - 11, 2012_AIDC Alexandria International Dental Congress Email: azaher@idsc.net.eg November 9 - 10, 2012_DFCIC 2012 4th Dental - Facial Cosmetic International Conference, Jumeirah Beach Hotel, Dubai, UAE - Tel: +971 4 3616174 Email: info@cappmea.com Website: www.cappmea.com November 27 - 30, 2012_ADF Le congrès 2012 se tiendra du 27 Novembre au 1er Décembre 2012 au Palais des Congrès de Paris, Email: adf@adf.asso.fr Website: www.adfcongres.com December 7 - 8, 2012 ITI Congress Middle East, Abu Dhabi, United Arab Emirates Organized by the “ITI International Team for Implantology” Email: events@iticenter.ch Website: www.iti.org November 21 - 23, 2012 Arab Dental Federation Conference Sanaa, Yemen. Email: adf.yemen@gmail.com
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Thinking ahead. Focused on life.
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ORTHODONTICS
Refining Occlusion with Muscle Balance to Enhance Long Term Orthodontic Stability Dr. Derek Mahony
understand the functions of the muscles of mastication.1 In the intervening years since, surface EMG has revealed several key facts about the relationship between the muscles and a patient’s occlusion. Today we can routinely record up to 8 channels of EMG data, right in the clinic. And, data interpretation can lead us to a better understanding of our patient’s specific condition Figure 1. An 8 channel Electromyograph (EMG)
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The primary objective of orthodontic treatment is the movement of teeth into a more ideal relationship, not only for aesthetic, but also for functional considerations. Another very important objective, often not given enough consideration, is the need to finish the case with the muscles of mastication in equilibrium. If muscle balance is not achieved, an endless procession of retainers, is required for retention. In simple terms, if the occlusal forces in maximum intercuspation are unevenly distributed around the arch, tooth movement will most likely occur. However, today it is possible to precisely measure the relative force of each occlusal contact, the timing of the occlusal contacts and specific muscle contraction levels, all simultaneously. This technological breakthrough represents a new opportunity for orthodontists everywhere.
Refining Occlusion with Muscle Balance
info@derekmahony.com
Muscle Balance and Occlusion Many well respected orthodontists agree that there is more to occlusion than just “teeth.” Temporomandibular joint function and the maxillo-mandibular relation are as much a part of occlusion as are the teeth. Consequently, when a malfunction occurs within the TM joints or a maxillo-mandibular mal-relation exists, a compensatory response is elicited from the stomatognathic musculature. Most often that response can be measured through electromyography (EMG). Over 50 years ago one orthodontist began to record muscle activity through surface electromyography in an effort to better Dental News, Volume XIX, Number II, 2012
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Refining Occlusion with Muscle Balance
ORTHODONTICS
Figure 2.
a) relaxed, quite muscles
Figure 3.
a) balanced clench
b) hyperactive muscles
b) unbalanced clench
In figure 2. we see muscles that are; a) relaxed at rest (the normal condition) b) hyperactive at rest (indicating a maxillo-mandibular malrelation) or c) exhibiting a neurological abnormality (large motor-unit firing). While these factors routinely go unmeasured, their contribution to a precise diagnosis can be highly significant, even to the long-term outcome of a particular case.2-5
Determining muscle balance in function is an easy task for EMG.6Typically, the patient is asked to clench in maximum intercuspation and then swallow. The clench will appear balanced (fig. 3a.) or unbalanced (fig. 3b.). The swallow will either be with the teeth together (fig. 3c.) or with a tongue-thrust (fig. 3d.) Then, if an appliance is utilized, muscle activity can be recorded before, during and after adjustment of the appliance. This will immediately demonstrate the effectiveness of the appliance.14-20
c) normal swallow
c) large motor-unit firing
d) aberrant swallow
T-Scan II: The simplest solution to the problem of evaluating the timing and force of occlusal contacts is the T-Scan II.21-23 It provides a very sensitive measure of contact force and a moving picture of the order in which the contacts occur.24-32 It is the only technology available to the clinician that can show precisely the order in which contacts occur and simultaneously, the relative force of each distinct contact. The new high density sensors are flexible, more precise and very durable (usable for up to 30 registrations).
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If we see that the muscles are balanced, we know we have a result that will remain stable. But, if the muscles are not in balance, we canâ&#x20AC;&#x2122;t tell from the EMG recordings along exactly what to do about it. While much has been learned about muscle hyperactivity and the various conditions of imbalance that can exist within the masticatory musculature, EMG is not, nor will it likely ever be, adequate to the task of directing case treatment by itself. While surface EMG is a fast, easy and reliable way to record the relative contraction levels of the muscles at rest or in function, it has a low sensitivity to occlusal force locations and the timing of tooth contacts.
Dental News, Volume XIX, Number II, 2012
A bite-force recording is taken by having the patient bite down several times on the T-Scan wafer to condition it. This allows it to conform to the shape of the arch. Then a recording is taken with the patient closing from rest position into the intercuspal position, followed by a clench. Other recordings can also be taken in centric relation, lateral excursions and protrusion.
Figure 4. The T-Scan II
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CEREC – PRECISION AND SIMPLICITY REDEFINED
ORTHODONTICS A Map of the Sequence from Initial Anterior Contact to Bilateral Contact
Figure 5.
a) 1st contact
b) 1st Posterior Contact
c) 1st Left Posterior Contact
16
Refining Occlusion with Muscle Balance
Figure 6. Force movie frames
In the recording in Figure 5. the initial contact points occur only on the incisors. As the patient continues to close a contact appears on the right area of the second molar. Eventually a contact appears on the left second molar creating a tripod effect. When the recording is replayed as a “force movie” a three dimensional graph is displayed showing the relative force at each point of contact. Again we see that the initial contacts are on the incisors, then the right posterior and finally the left second molars. What is also evident is that in full closure, the highest contact force is actually on the left second molar, (indicated by the tallest spike) despite the lateness of the contact. Further inspection clearly suggests that the reason the excessive force is being born by the left second molar is due to a lack of solid contacts on the left first molar and bicuspids. In spite of the large number of contact points around the arch, this is an occlusion badly in need of adjustment. However, as we analyze the tracing above, as clear as the picture of occlusion of this case is, we realize that we do not and cannot from this information understand what the musculature is doing to accommodate. But there is a way to do both.
T-SCAN II – BioEMG II Previous studies have attempted to correlate T-Scan data with EMG data.33,34 Recently the two companies who separately manufacture the T-Scan II and the BioEMG II have created a milestone by making their programs talk to each other.35 This is not something that happens often in dentistry, but the synergy created now offers a unique opportunity for dentists to more clearly understand their patients’ occlusal conditions comprehensively. The reason that the programs needed to talk to each other was to synchronize their respective data streams. This is Dental News, Volume XIX, Number II, 2012
Why the T-Scan wafer at 85 microns is not too thick! According to the latest research on mandibular function (Gallo et al) we now know that the sagittal path of closure is more complicated than a simple hinge movement. In fact, the “helical axis of rotation” moves from the vicinity of the angle of the mandible (early in opening) to about mid-ramus (late in opening). In close proximity to where the inferior alveolar nerve enters the mandibular foramen. For a voluntary closure between rest and occlusion (2 - 3 mm) the average amount of rotation has been measured at 0.7 degrees (Lewin A. and Moss C.). For an 85 micron change that’s about 0.02 degrees of rotation (about 1.5 minutes of arc). If the A/P distance between the incisors and the 2nd molars is 40 mm, 1.5 minutes of arc translates to an 18 micron difference in vertical change (more in the anterior, less posterior) between “Wafer in” and “Wafer out.” This is a very small difference in comparison to the size of an occlusal adjustment being made and well within the adaptive capacity of the system. Another benefit of placing the T-Scan wafer between the arches ... it that it reduces the acuity of proprioception, which reduces, but doesn’t eliminate, the ability of the central nervous system to avoid any existing prematurities.
accomplished by having either program act as a “master” while the other program acts as a slave to it. That is, a dentist can ‘Run” the T-Scan program and the BioEMG II program will dutifully “follow” it. Or, he/she can “Run” the BioEMG II program and the T-Scan II program will follow it. This is true in recording as well as in playback analysis.
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Dental News, Volume XIX, Number II, 2012
ORTHODONTICS Balanced Forces do not Guarantee Balanced Muscles
Figure 7. The Simultaneous Recording of Occlusal Force, Timing and Muscle activity One high force point on the left bicuspids, right anterior temporalis hyperactivity
When we see that the highest force of contact is on the left can we assume that the greatest muscle activity will be the same? Not at all. Figure 7. shows an example of a patient with a higher force level on the left side (63% of total), focused in the bicuspid area. At the same time we clearly see that the right anterior temporalis is firing at nearly twice the level of the left one. It is also apparent that the combined activities of the right masseter and temporalis are far greater than the same muscles on the left. How is this possible? Not one of the muscles of mastication that elevates the mandible is positioned such that there is a straight vertical relationship between the origin and the insertion. Each elevator muscle has a horizontal component to its direction of applied force. Due to the ginglymo-arthroidial structure of the temporomandibular joints, the mandible is able to move freely forward and back, left and right. The same “elevator muscles” that apply vertical forces can and do apply horizontal forces to the mandible as needed for function. In figure 7. then, we can see that while the left side muscles are applying more force in the vertical direction, the right side temporalis must be applying a significant amount of its force in a non-vertical (horizontal) direction. However, with some extra effort, it is possible to achieve a muscle and force balanced occlusion. See Figure 8.
A Force and Muscle Activity Balanced Occlusion
18
Refining Occlusion with Muscle Balance
Analyzing the Combined Traces
Sometimes we can record a relatively even balance of forces between the right and left sides, but the patient is still not comfortable. Even with adequate stable contacts on both sides some patients still complain. The patient in Figure 9. had regular temporal headaches. The left-right force balance was rather good at 56% right to 44% left. It is evident that the initial contact is on the left side (see the center of force vector), that during the closure the force passes to the right side before reaching its balanced force condition at maximum intercuspation. However, notice that the temporalis muscles are contracting 2 ½ times greater levels than the masseter muscles. Soon after a repositioning appliance was placed that balanced both the muscle and the forces, the headaches were relieved.
Figure 9. By the time the total force has reached 93.5% of maximum, the center of force has returned to the midline and the vertical muscle forces are even between left and right sides. However, it is clear that the temporalis muscles are “overloaded” compared to the masseters.
With the technology that is available today an ordinary practicing dentist has the ability to more thoroughly evaluate the masticatory system than ever before. It is now possible to routinely adjust an occlusion, not only to equalize the occlusal forces, but also to create an environment where the muscles can function in harmony with each other.
References
Figure 8. Both the forces and the activities of the muscles are balanced in this patient Dental News, Volume XIX, Number II, 2012
1. THOMPSON JR: CONCEPTS REGARDING THE FUNCTION OF THE STOMATOGNATHIC SYSTEM. JADA 1954 JUN; 48:626-637 2. GERVAIS RO, FITZSIMMONS GW, THOMAS NR. MASSETER AND TEMPORALIS ELECTROMYOGRAPHIC ACTIVITY IN ASYMPTOMATIC, SUBCLINICAL, AND TEMPOROMANDIBULAR JOINT DYSFUNCTION PATIENTS. CRANIO. 1989 JAN;7(1):52-7. 3. GLAROS AG, MCGLYNN FD, KAPEL L. SENSITIVITY, SPECIFICITY, AND THE PREDICTIVE VALUE OF FACIAL ELECTROMYOGRAPHIC DATA IN DIAGNOSING MYOFASCIAL PAIN-DYSFUNCTION. CRANIO. 1989 JUL;7(3):189-93. 4. GLAROS AG, GLASS EG, BROCKMAN D. ELECTROMYOGRAPHIC DATA FROM TMD PATIENTS WITH MYOFASCIAL PAIN AND FROM MATCHED CONTROL SUBJECTS: EVIDENCE FOR STATISTICAL, NOT CLINICAL, SIGNIFICANCE. J OROFAC PAIN. 1997 SPRING;11(2):125-9. 5. KAMYSZEK G, KETCHAM R, GARCIA R JR, RADKE J. ELECTROMYOGRAPHIC EVIDENCE OF REDUCED MUSCLE ACTIVITY WHEN ULF-TENS IS APPLIED TO THE VTH AND VIITH CRANIAL NERVES. CRANIO. 2001 JUL;19(3):162-8. 6. BELSER UC, HANNAM AG. THE INFLUENCE OF ALTERED WORKING-SIDE OCCLUSAL GUIDANCE ON MASTICATORY
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ORTHODONTICS MUSCLES AND RELATED JAW MOVEMENT.
J PROSTHET DENT. 1985 MAR;53(3):406-13 7. MCCARROLL RS, NAEIJE M, HANSSON TL. BALANCE IN MASTICATORY MUSCLE ACTIVITY DURING NATURAL CHEWING AND SUBMAXIMAL CLENCHING. J ORAL REHABIL. 1989 SEP;16(5):441-6. 8. VISSER A, MCCARROLL RS, OOSTING J, NAEIJE M. MASTICATORY ELECTROMYOGRAPHIC ACTIVITY IN HEALTHY YOUNG ADULTS AND MYOGENOUS CRANIOMANDIBULAR DISORDER PATIENTS. J ORAL REHABIL. 1994 JAN;21(1):67-76. 9. CHRISTENSEN LV, RASSOULI NM. EXPERIMENTAL OCCLUSAL INTERFERENCES. PART I. A REVIEW. J ORAL REHABIL. 1995 JUL;22(7):515-20. 10. CHRISTENSEN LV, RASSOULI NM. EXPERIMENTAL OCCLUSAL INTERFERENCES. PART II. MASSETERIC EMG RESPONSES TO AN INTERCUSPAL INTERFERENCE. J ORAL REHABIL. 1995 JUL;22(7):521-31. 11. BORROMEO GL, SUVINEN TI, READE PC. A COMPARISON OF THE EFFECTS OF GROUP FUNCTION AND CANINE GUIDANCE INTEROCCLUSAL DEVICE ON MASSETER MUSCLE ELECTROMYOGRAPHIC ACTIVITY IN NORMAL SUBJECTS. J PROSTHET DENT. 1995 AUG;74(2):174-80. 12. CHRISTENSEN LV, MOHAMED SE. BILATERAL MASSETERIC CONTRACTILE ACTIVITY IN UNILATERAL GUM CHEWING: DIFFERENTIAL CALCULUS. J ORAL REHABIL. 1996 SEP;23(9):638-47. 13. SAIFUDDIN M, MIYAMOTO K, UEDA HM, SHIKATA N, TANNE K. AN ELECTROMYOGRAPHIC EVALUATION OF THE
Medesy is glad to introduce GAMMAFIX ™, a new range of sterilization trays. The quality and functionality of these trays facilitate the cleaning and sterilization process. Their special shape allows an extremely safe handling of the surgical instruments during the washing and sterilization phases. We selected the finest stainless steel to withstand the thermal shock caused by the constant sterilization cycles.
BILATERAL SYMMETRY AND NATURE OF MASTICATORY MUSCLE ACTIVITY IN JAW DEFORMITY PATIENTS DURING NORMAL DAILY
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Refining Occlusion with Muscle Balance
ACTIVITIES.
J ORAL REHABIL. 2003 JUN;30(6):578-86. 14. MCCARROLL RS, NAEIJE M, KIM YK, HANSSON TL. SHORT-TERM EFFECT OF A STABILIZATION SPLINT ON THE ASYMMETRY OF SUBMAXIMAL MASTICATORY MUSCLE ACTIVITY. J ORAL REHABIL. 1989 MAR;16(2):171-6. 15. NAEIJE M, HANSSON TL. SHORT-TERM EFFECT OF THE STABILIZATION APPLIANCE ON MASTICATORY MUSCLE ACTIVITY IN MYOGENOUS CRANIOMANDIBULAR DISORDER PATIENTS. J CRANIOMANDIB DISORD. 1991 FALL;5(4):245-50. 16. LOBBEZOO F, VAN DER GLAS HW, VAN KAMPEN FM, BOSMAN F. THE EFFECT OF AN OCCLUSAL STABILIZATION SPLINT AND THE MODE OF VISUAL FEEDBACK ON THE ACTIVITY BALANCE BETWEEN JAW-ELEVATOR MUSCLES DURING ISOMETRIC CONTRACTION. J DENT RES. 1993 MAY;72(5):876-82. ERRATUM IN: J DENT RES 1993 AUG;72(8):1264. 17. VISSER A, NAEIJE M, HANSSON TL. THE TEMPORAL/MASSETER CO-CONTRACTION: AN ELECTROMYOGRAPHIC AND CLINICAL EVALUATION OF SHORT-TERM STABILIZATION SPLINT THERAPY IN MYOGENOUS CMD PATIENTS. J ORAL REHABIL. 1995 MAY;22(5):387-9. 18. AL-QURAN FA, LYONS MF.THE IMMEDIATE EFFECT OF HARD AND SOFT SPLINTS ON THE EMG ACTIVITY OF THE MASSETER AND TEMPORALIS MUSCLES. J ORAL REHABIL. 1999 JUL;26(7):559-63. 19. FERRARIO VF, SFORZA C, TARTAGLIA GM, DELLAVIA C. IMMEDIATE EFFECT OF A STABILIZATION SPLINT ON MASTICATORY MUSCLE ACTIVITY IN TEMPOROMANDIBULAR DISORDER PATIENTS. J ORAL REHABIL. 2002 SEP;29(9):810-5. 20. ROARK AL, GLAROS AG, O’MAHONY AM. EFFECTS OF INTEROCCLUSAL APPLIANCES ON EMG ACTIVITY DURING PARAFUNCTIONAL TOOTH CONTACT. J ORAL REHABIL. 2003 JUN;30(6):573-7. 21. MANESS WL, PODOLOFF R. DISTRIBUTION OF OCCLUSAL CONTACTS IN MAXIMUM INTERCUSPATION. J PROSTHET DENT. 1989 AUG;62(2):238-42. 22. MANESS WL. LABORATORY COMPARISON OF THREE OCCLUSAL REGISTRATION METHODS FOR IDENTIFICATION OF INDUCED INTERCEPTIVE CONTACTS. J PROSTHET DENT. 1991 APR;65(4):483-7. 23. REZA MOINI M, NEFF PA. REPRODUCIBILITY OF OCCLUSAL CONTACTS UTILIZING A COMPUTERIZED INSTRUMENT. QUINTESSENCE INT. 1991 MAY;22(5):357-60. 24. MIZUI M, NABESHIMA F, TOSA J, TANAKA M, KAWAZOE T. QUANTITATIVE ANALYSIS OF OCCLUSAL BALANCE IN INTERCUSPAL POSITION USING THE T-SCAN SYSTEM. INT J PROSTHODONT. 1994 JAN-FEB;7(1):62-71. 25. GONZALEZ SEQUEROS O, GARRIDO GARCIA VC, GARCIA CARTAGENA A. STUDY OF OCCLUSAL CONTACT VARIABILITY WITHIN INDIVIDUALS IN A POSITION OF MAXIMUM INTERCUSPATION USING THE T-SCAN SYSTEM. J ORAL REHABIL. 1997 APR;24(4):287-90. 26. GARCIA CARTAGENA A, GONZALEZ SEQUEROS O, GARRIDO GARCIA VC. ANALYSIS OF TWO METHODS FOR OCCLUSAL CONTACT REGISTRATION WITH THE T-SCAN SYSTEM. J ORAL REHABIL. 1997 JUN;24(6):426-32. 27. SUDA S, MATSUGISHI K, SEKI Y, SAKURAI K, SUZUKI T, MORITA S, HANADA K, HARA K. A MULTIPARAMETRIC ANALYSIS OF OCCLUSAL AND PERIODONTAL JAW REFLEX CHARACTERISTICS IN YOUNG ADULTS WITH NORMAL OCCLUSION. J ORAL REHABIL. 1997 AUG;24(8):610-3. 28. GARRIDO GARCIA VC, GARCIA CARTAGENA A, GONZALEZ SEQUEROS O. EVALUATION OF OCCLUSAL CONTACTS IN MAXIMUM INTERCUSPATION USING THE T-SCAN SYSTEM. J ORAL REHABIL. 1997 DEC;24(12):899-903. 29. KIRVESKARI P. ASSESSMENT OF OCCLUSAL STABILITY BY MEASURING CONTACT TIME AND CENTRIC SLIDE. J ORAL REHABIL. 1999 OCT;26(10):763-6. 30. KERSTEIN RB. IMPROVING THE DELIVERY OF A FIXED BRIDGE. DENT TODAY. 1999 MAY;18(5):82-4, 86-7. 31. SUDA S, MACHIDA N, MOMOSE M, YAMAKI M, SEKI Y, YOSHIE H, HANADA K, HARA K. A MULTIPARAMETRIC ANALYSIS OF OCCLUSAL AND PERIODONTAL JAW REFLEX CHARACTERISTICS IN ADULT SKELETAL MANDIBULAR PROTRUSION BEFORE AND AFTER ORTHOGNATHIC SURGERY.
J ORAL REHABIL. 1999 AUG;26(8):686-90. 32. SARACOGLU A, OZPINAR B. IN VIVO AND IN VITRO EVALUATION OF OCCLUSAL INDICATOR SENSITIVITY. J PROSTHET DENT. 2002 NOV;88(5):522-6. COMMENT IN: J PROSTHET DENT. 2003 SEP;90(3):310; AUTHOR REPLY 310-1. 33. KERSTEIN RB, WRIGHT NR. ELECTROMYOGRAPHIC AND COMPUTER ANALYSES OF PATIENTS SUFFERING FROM CHRONIC MYOFASCIAL PAIN-DYSFUNCTION SYNDROME: BEFORE AND AFTER TREATMENT WITH IMMEDIATE COMPLETE ANTERIOR GUIDANCE DEVELOPMENT. J PROSTHET DENT. 1991 NOV;66(5):677-86. COMMENT IN: J PROSTHET DENT. 1993 JUL;70(1):99-100. 34. HIDAKA O, IWASAKI M, SAITO M, MORIMOTO T. INFLUENCE OF CLENCHING INTENSITY ON BITE FORCE BALANCE, OCCLUSAL CONTACT AREA, AND AVERAGE BITE PRESSURE. J DENT RES. 1999 JUL;78(7):1336-44. 35. KERSTEIN RB. COMBINING TECHNOLOGIES: A COMPUTERIZED OCCLUSAL SYSTEM SYNCHRONIZED WITH A COMPUTERIZED ELECTROMYOGRAHIC SYSTEM. CRANIO. 2004 APR;22(2):96-109.
by
NEW GENERATION TRAYS 1670/1 DIAGNOSTIC SET
Dental News, Volume XIX, Number II, 2012
www.medesy.it
Stronger... ... because patients do funny things.
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PROSTHETIC DENTISTRY
A STANDADIZED PROTOCOL FOR SUCCESSFUL MANDIBULAR IMPLANT OVERDENTURES
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Mandibular Implant Overdentures Protocol
Dr. Marwan Daas, Dr. André Assaf, Dr. Karim Dada draa_lb@yahoo.fr
In a recent meeting at McGill University (Canada)1, a consensus was reached concerning the mandibular overdenture retained by two symphyseal implants. It must now be considered the minimal prosthetic treatment that most edentulous patients should expect from their dentist. However, the implant procedure must follow a well-controlled protocol since its success is neither the goal in and of itself nor is it a solution to the prosthetic handicap. Placing the implants is only the means to foster a higher success rate for the denture.2 Beyond the psychological problem related to its removability, the mandibular implant overdenture (MIO) is considered by many patients to be satisfactory on the aesthetic and functional levels, together with the comfort and ease of maintenance that it provides.3-4 If this treatment modality meets a certain number of criteria, it will be able to respond to the demand of a large number of totally edentulous patients and, this, in a simple, rapid and reliable way, what is more for a reasonable cost. The MIO, as will be described in this paper,4-5-6-7-8 aims at increasing the stability and more importantly the retention of the denture via the use of one ball attachment on each of the two implants, or a round bar joining the two implants together, both designs containing a stress-breaking mechanism. A standardized sequence of treatment is needed, beginning with the decision making to the execution per se of the prosthesis, the only way to enable the practitioner to anticipate and thus avoid the many possible pitfalls during the different steps of treatment.
Decision making The MIO procedure’s aim is to reconcile the patient’s desire with the treatment options available, those being related to the practitioner’s skills on one hand and the patient’s local anatomic and general health conditions on the other hand. Many steps are involved:6-8-9 Patient’s profile It seeks to identify the patient’s complaints, whether objective and/ or subjective, and assists in determining the reality of his problems Dental News, Volume XIX, Number II, 2012
so as to address them precisely.
Clinical observation: The clinical examination must take into consideration a certain number of criteria: 1. The maximum range of opening, particularly when opposed to natural dentition. 2. The value of the supporting tissues, to compare with the radiographic exam; 3. The muscular coordination, especially the muscles of the tongue. 4. The neuromuscular coordination, needed for a precise and reproducible inter-maxillary relation. The contra-indications of implant surgery are those of every oral surgery in general. The MIO being mostly prescribed for old patients, the chances of encountering a counter-indicative pathology are elevated. In case of a doubtful assessment of the general heath, it is always advised to discuss the decision to operate or not and the needed precautions with the treating physician.
Patient’s information. Before making any decision, the patient should be informed of the: 1. Different possible implant modalities. 2. Different prosthetic modalities. 3. Different possible surgical protocols. 4. Total cost of the treatment. 5. Consequences of any foreseeable failure. 6. Main steps of the treatment plan.
Preparatory stage 1st criteria: The conventional complete denture (CCD) 10-11-12 The practitioner begins the treatment with the fabrication of a CCD. A precise mounting of teeth and waxing of the record base is essential in order to provide him with complete information, an inadequate mounting being useless for subsequent stages. The success of the MIO and therefore of the feasibility of the implant therapy cannot be guaranteed unless it is based on a well-designed CD. It is therefore imperative to validate the CD at the waxing-up before processing the prosthesis.
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PROSTHETIC DENTISTRY Radiologic stent with barium sulfate The fabrication of the CD falls therefore within the scope of the implant treatment. It must meet the criteria of quality described by SATO et al10 which allow to: 1. validate the occluso-prosthetic concept chosen for the rehabilitation and to treat the maxillary occlusal plan. 2. visualize the final aesthetic result. 3. determine the prosthetic volume available for the different surgical and prosthetic components. 4. guarantee continuity and ease of transition between the surgical and prosthetic treatments. 5. provide for temporization that is safe for the implant since a stable prosthesis induces less micro-movements. The use of a conventional prosthesis as a template for all future stages of treatment allows a better management of the transition between the prosthetic and surgical therapies and thus guarantees an optimal placement of the implant.
Figure 1. The radiological guide is obtained by the adjunction of barium sulphate to the resin.
Figure 2. The desired position of each implant is determined.
24
Mandibular Implant Overdentures Protocol
2nd criteria: The radiologic stent The objective of the radiologic stent is to determine the optimal implant positioning on the oblique reconstructions of the scanner. The study is based on the CD that has already been validated aesthetically as well as functionally, and the implant sites are determined with precision and fall within the prosthetic envelope defined by the denture. The actual trend is rather to use entirely radio-opaque stents. They are obtained by the addition of barium sulfate (20% maximum) to the resin of the denture duplicate.8 The implant sites are materialized in negative by drilling through the radio-opaque material. The technique greatly simplifies the pre-operative stage since the different information concerning the prosthetic volume and the soft tissue thicknesses are easily and directly read on the radiography without any further alterations of the stent. It is important to note that whatever the selected treatment option is, the preparation of the radiological stent remains the same. The stent must be worn before proceeding with the scanning. The patient must have been trained to find his occlusion. Eventually, a resin bite block can be used to insure a proper occlusal stabilization.
Figure 3. Perforation of the stent with a round bur, until half of the supporting surfaces.
Figure 4. It’s possible to widen the perforations by using the first surgical drill….
Figure 5. …and even the 2d surgical drill.
3rd criteria: Radiologic Analysis The radiographic reconstructions offer the following readings: Residual ridge volume and density, Matching between remaining bone volume and the desired prosthetic orientation, Relation of the denture to the anatomical structures, Possible presence of neighboring bone lesions. Using the classification of Lekholm and Zarb13, the residual bone is analyzed quantitatively as well as qualitatively at the level of the selected implant sites. This initial study is essential since the collected information will allow indicating which surgical technique applies, namely choosing between a one- or two-stage technique. Based on the implant possibilities suggested by the radiographic stent, the CT scan examination also allows the determination of the most appropriate implant positioning, based on both the anatomic as well as the prosthetic stand point, the latest requiring that the implant angulation fits that of the connecting components within the denture.
Dental News, Volume XIX, Number II, 2012
Figure 6&7. The perforations are Figure 8. Later, it is delivered to the patient to wear and keep into occlusion when the scanning is being made. Two bite blocks in Duralay™ resin enable proper positioning of the stent.
thus situated within the prosthetic envelop in accordance with the mounting.
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PROSTHETIC DENTISTRY CT Scan Interpretation
26
Mandibular Implant Overdentures Protocol
fig. 10
fig. 11
fig. 12
Figure 9: CT Scan of mandible with the radio-opaque radiographic stent. Axial view of reference: the prospective implant emerging points are clearly visualized.
Figure 10: Coronal oblique cut of reconstruction passing along the lateral incisor. Figure 11: Coronal oblique cut of reconstruction passing along the canine. Figure 12: Coronal oblique cut of reconstruction passing along the first premolar.
Implant orientation and choice of attachment system
the Implant sites and angulations, Implant dimensions, Attachment system (bar or ball attachments), Method of fabrication for the MOI. Three solutions are possible for fabricating the MOI: 1. Transforming the existing CD into an implant overdenture by a chair-side direct connection with self-cure acrylic resin. The technique is delicate, particularly with bars, and the used resins have lower performance and quality than the heat-cure densified denture resins. However, the technique is less costly to the patient. 2. Readapting the existing CD by a complete rebasing procedure, the impression being made with the denture. However the patient must accept to remain without his appliance for the few days that are needed for the lab-side transformation. 3. Fabrication of a new CD by using the duplicate of the existing CD as a functional special tray.8-11-12 This option answers the previous disadvantages and also provides the patient with a breakdown service denture; however it is the most expensive of all.
Three implant situations can be envisaged: - In the lateral incisor position. If a bar is chosen, the inter-implant distance should allow at least one rider to be used. - In the canine position. It is the most often employed option. It is also the most distalized position that still offers a choice between a ball and a bar attachment system. - In the first premolar position. It allows only ball attachment systems and necessitates a larger prosthetic height due to the presence of the denture tooth over the attachment. The final choice is made prior to the surgery and according to the: - CT Scan analysis, i.e. the anatomy of the symphyseal region. - Available prosthetic space, the required height being variable among attachment systems, with a 7mm distance considered average. Regarding the selection between different types of attachments, it is often determined in relation to the: - practitioner preferences, - implants’ position on the arch: a straight bar can only be used for implants separated by a moderate distance and on square shaped or large ovoid ridges so as to avoid any cantilevering. - implants’ long axis: if the implants are divergent by more than 10°, the chances of using a ball attachment system are reduced or at least confined to some brands that specifically allow for such divergence. - bulkiness: while it is true that a bar system might need a lower vertical room directly over the implants than the ball attachment system, its bulkiness still affects the anterior part of the ridge. - splinting the implants or not: if the implants are connected together though a bar, stress distribution is improved. Still, distal extensions are contraindicated since they might create a risky cantilevering effect that endangers the longevity of the implants. Retention, on the other hand, will not be improved. At the end of this study, the practitioner must be able to determine Dental News, Volume XIX, Number II, 2012
Surgical Phase The surgical phase begins right after the final decision is made.
4th criteria: the surgical stent One important difficulty in implant treatment for the mandibular edentulous patients resides in the accuracy of the data transfer between the prosthetic planning phase to the surgical phase. It is related to the loss of landmarks following the loss of the teeth. The use of a surgical stent can overcome this problem. The tissue surface of the stent is cut back at the area concerned by the flap reflection in order not to hinder its seating. Moreover the teeth at the implant sites are cut down so not to hold back the cutting action of the surgical drills down to the full needed depth of drilling. In order to optimize the precision in implant positioning, metallic drilling channels (tubes of internal diameter of 2,1mm) can be included in the surgical stent. This takes into consideration the modifications of the implant orientations decided in the course of the radiographic study.
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PROSTHETIC DENTISTRY Prosthetic Phase 5th criteria : The Impression The success of a MOI depends on the accuracy of recording with the same functional impression the characteristics of two different structures: the denture supporting tissues and the implant positions. These multiple objectives are best attained via a single functional impression that allows one working model on which the different parts of the prosthesis are constructed. Moreover, the impression technique must be able to appreciate the gradient of compressibility existing between the mucosal tissue and the implants. Whether the fabrication of a MOI is based on an existing CD or on a duplicate to be used as a special tray in occlusion, it must account for this tissue duality. However, the impression technique is not exactly the same with ball attachments and bar systems.
28
Mandibular Implant Overdentures Protocol
Impression in a ball-attachment case The ball abutments are connected to the implants and tightened up to 20 Ncm. The existing CD (in case of rebasing) or the denture duplicate (in case of a new denture fabrication) is perforated at the attachment sites. These perforations are closed with silicone material to allow for an impression of the whole ridge in conditions similar to a CCD. For that purpose, a bite registration (wax wafer) is made using either an impression compound material (Kerr™) or self-curing acrylic resin (Duralay). Then, a circumferential peripheral seal can eventually be obtained using the high viscosity polyether material (Permadyne orange). It is followed by an adhesive coating specific to the wash material (Permlastic light from Kerr™ or Impregum from 3M-ESPE™). It is applied to the mucosal side of the tray, whether the CD or the duplicate, except where facing the implant abutments. As for the impression per se, the mucosal supporting tissues are first recorded through a wash of material made in occlusion, followed by functional muscle trimming of the borders with the mouth opened wide and tongue protracted. When full setting is attained, the tray is retrieved, the excesses of material are cut away and the silicone placed at implant sites is removed. The impression tray is then replaced on the ridge in order to record the exact implant positions in a closed mouth technique. A low or medium viscosity polyether material is injected in the perforations and the patient is instructed to bite in maximum intercuspation until the full setting. The impression material of choice is the medium (Impregum) or low viscosity (Permadyne blue) polyether due to its rigidity after setting, a property required for a correct and precise connection of the abutment analogs. The impression together with the analogs is treated in a conventional way and the obtained cast is mounted on the articulator using the bite record already made.
Dental News, Volume XIX, Number II, 2012
Surgical Stent with Drilling Channels
fig. 13
fig. 14
fig. 15
fig. 16
fig. 17
fig. 18
Figure 13: The surgery zone is cleared on the buccal side … Figure 14: … and lingually. Figure 15: The incisal edge of the anterior teeth is cut down. Figure 16: Removable drilling channels are placed at the reference points at incisor areas Figure 17: The removable drilling channels are placed at the reference points at canine areas. Figure 18: The surgical stent is ready for use.
Impression of rebasing for ball attachments
fig. 19
fig. 20
fig. 21
fig. 22
fig. 23
fig. 24
fig. 25
fig. 26
fig. 27
Fig 19: A bite record in Duralay acrylic resin is first realized. Fig 20: Perforations are made facing the attachments. Fig 21: Silicone plugs to seal the perforations. Fig 22: A through recording of the peripheral seal with Permadyne orange is made in occlusion first, and then the tray is maintained manually. Fig 23: The material present within the tray is removed. Fig 24: The wash with Permlastic light material. Fig 25: Removing the plugs opens the access to the ball attachments. Fig 26: Injection of a medium viscosity polyether (Impregum) on the ball attachments. Fig 27: Finished impression. Fig 28: Fitting surface of the finished MOI showing the female parts of the attachments.
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How the best perform
PROSTHETIC DENTISTRY Impression for the ball attachments using an adapted special tray and in occlusion
fig. 29
fig. 30
fig. 31
fig. 32
Figure 29: The impression copings must not interfere with the special tray. Figure 30:Same as previously, Impregum material is injected around the impression copings. Figure 31: The finished impression with the abutment analog in place.. Figure 32: .. and the workingmodel.
30
Mandibular Implant Overdentures Protocol
Impression in a bar-attachment case The use of impression copings, either for the implant or for the abutment, is needed. These must be connected and tightened up to 20 Ncm. Then the special tray (duplicate of the existing CD) is hollowed at the copings site and any interference is removed. The tray is loaded with a medium viscosity polyether (Impregum) and the impression is made under occlusal pressure first and then with finger pressure. After complete setting of the material, the transfer screws are loosened, the tray retrieved and the impression checked and validated. Lab analogs are then connected and a working cast is obtained and mounted on the articulator. After setting the denture teeth, two indices are made in heavy silicone, one buccal and one lingual. They allow the bar to be designed according to the polished surface profile and to the setting of teeth. No matter how the impression is made, the lab technician must use a spacer during the positioning of the female counterpart, whether for independent axial attachments or the rider of a bar.
6 th criteria: The maintenance Like any implant prosthesis, the MOI needs follow-up on a regular basis. The eventual repairs 8-19-20-21, mainly in the first year following implant placement, are: 1. Activation or replacement of the female matrix attached to the denture. 2. Replacement of the ball abutment for its wear, a situation that is less frequent than the previous one. 3. Activation or replacement of the clips or riders in case of bars. However, any loss or fracture of prosthetic components or rapid atrophy of the edentulous ridge necessitating frequent rebasing or repair are, rather, the result of an inappropriate prosthetic design.
Conclusion The scientific data currently available show that there is enough evidence that MOIs on two implants can be considered as the treatDental News, Volume XIX, Number II, 2012
Impression for a bar
fig. 33
fig. 34
figs. 35
figs. 36
fig. 37
fig. 38
fig. 39
fig. 40
Figure 33: The impression copings should not interfere with. Figure 34: Finished impression. Figure 35: Before separation, the model is mounted on the articulator using the special tray. Figure 36: The bar is fabricated according to the lingual and buccal that materialize the prosthetic space. Figure 37: The finished bar must be totally passive at its try-in. Figure 38: The fitting surface of the denture showing the riders in place. Figure 39: View showing the setting of teeth and the stabilizing profile of the polished surface ... Figure 40: ... and of the lingual pouch.
ment of reference for the edentulous mandible.This paper describes a systematic clinical approach in 4 points and according to 6 criteria leading to a long term success of the MIO: 1. Fabrication of a conventional complete denture meeting quality criteria. 2. Fabrication of a radiologic stent, based on the finisheddenture, with the goal of exploring the implant scopes related to each patient. 3. Transformation into a surgical stent for a precise placement of the implants. 4. Ultimate modification of this stent into a special tray that will pickup the implant positions.This protocol guaranties predictability and durability of the implant prosthetic therapy.
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PROSTHETIC DENTISTRY References 1- FEINE JS ET AL. THE MC GILL CONSENSUS STATEMENT ON OVERDENTURES. MANDIBULAR 2-IMPLANT OVERDENTURES EUR J PROSTHODONT REST DENT 2002;10:95-6. 2- ZARB GA, ALBREKTSSON T. CONSENSUS REPORT: TOWARDS OPTIMIZED TREATMENT OUTCOMES FOR DENTAL IMPLANTS. J PROSTHET DENT. 1998; 80: 641. 3- DE GRANDMONT P., FEINE J.S., TACHE R., BOUDRIAS P., DONOHUE W.B., TANGUAY R., LUND J.P. WITHIN SUBJECT COMPARISONS OF IMPLANT-SUPPORTED MANDIBULAR PROSTHESES: PSYCHOMETRIC EVALUATION. J DENT RES 1994;73:1096-1104. 4- THOMASON JM. THE USE OF MANDIBULAR IMPLANT-RETAINED OVERDENTURES IMPROVE PATIENT SATISFACTION AND QUALITY OF LIFE. J EVID BASED DENT PRACT. 2010 MAR;10(1):61-3. 5- FEINE JS, CARLSSON GE IMPLANT OVERDENTURES: THE STANDARD OF CARE FOR EDENTULOUS PATIENTS QUINTESSENCE INTERNATIONAL 2003,172 PP. 6- SETHI A., KAUS T. PRACTICAL IMPLANT DENTISTRY: DIAGNOSTIC, SURGICAL, RESTORATIVE AND TECHNICAL ASPECTS OF AESTHETIC AND FUNCTIONAL HARMONY QUINTESSENCE INTERNATIONAL 2007,288P. 7- BALAGUER J., GARCÍA B., PEÑARROCHA MA., PEÑARROCHA M. SATISFACTION OF PATIENTS FITTED WITH IMPLANTRETAINED OVERDENTURES. MED ORAL PATHOL ORAL CIR BUCAL. 2010 AUG 15. 8- POSTAIRE M., DAAS M., DADA K. RÉUSSIR PROTHÈSES ET IMPLANTS POUR L’ÉDENTÉ COMPLET MANDIBULAIRE. PARIS: EDITIONS QUINTESSENCE INTERNATIONAL 2006,115P. 9- DAVARPANAH M., SZMUKLER-MONCLER S. IMMEDIATE LOADING OF DENTAL IMPLANTS: THEORY AND CLINICAL PRACTICE. QUINTESSENCE INTERNATIONAL 2007, 368P. 10- SATO Y., TSUGA K., AKAGAWA Y., TENMA H. A METHOD FOR QUANTIFYING COMPLETE DENTURE QUALITY. J PROSTHET DENT. 1998;80:52-7. 11- HAYAKAWA I. PRINCIPLES AND PRACTICES OF COMPLETE DENTURES. QUINTESSENCE INTERNATIONAL 1999,255P. 12- MACENTEE MICHAEL. THE COMPLETE DENTURE: A CLINICAL PATHWAY. QUINTESSENCE INTERNATIONAL 1999,136P.
AS FIRST CHOICE STANDARD OF CARE FOR EDENTULOUS PATIENTS.
13- LEKHOLM U, ZARB GA. PATIENT SELECTION AND PREPARATION. IN : BRÅNEMARK P-I, ZARB G A, ALBREKTSSON T. TISSUE-INTEGRATED PROSTHESES CHICAGO : QUINTESSENCE PUBLISHING CO INC 1985:199–209. 14- CUNE M., BURGERS M., VAN KAMPEN F., DE PUTTER C., VAN DER BILT A. MANDIBULAR OVERDENTURES RETAINED BY TWO IMPLANTS: 10-YEAR RESULTS FROM A CROSSOVER CLINICAL TRIAL COMPARING BALL-SOCKET AND BAR-CLIP ATTACHMENTS. INT J PROSTHODONT. 2010 JUL-AUG;23(4):310-7. 15- WEINLÄNDER M., PIEHSLINGER E., KRENNMAIR G.REMOVABLE IMPLANT-PROSTHODONTIC REHABILITATION OF THE EDENTULOUS MANDIBLE: FIVE-YEAR RESULTS OF DIFFERENT PROSTHETIC ANCHORAGE CONCEPTS. INT J ORAL MAXILLOFAC IMPLANTS. 2010 MAY-JUN;25(3):589-97. 16- DAAS M., DUBOIS G., BONNET A-S., LIPINSKI P., RIGNON-BRET C.A COMPLETE FINITE ELEMENT MODEL OF A MANDIBULAR IMPLANT-RETAINED OVERDENTURE WITH TWO IMPLANTS: COMPARISON BETWEEN RIGID AND RESILIENT ATTACHMENT CONFIGURATIONS. MEDICAL ENGINEERING & PHYSICS 2008, 30: 218-225. 17- KLEIS WK., KÄMMERER PW., HARTMANN S., AL-NAWAS B., WAGNER W.A COMPARISON OF THREE DIFFERENT ATTACHMENT SYSTEMS FOR MANDIBULAR TWO-IMPLANT OVERDENTURES: ONE-YEAR REPORT. CLIN IMPLANT DENT RELAT RES. 2010 SEP;12(3):209-18. EPUB 2009 MAR 31. 18- MACENTEE MI., WALTON JN., GLICK N. A CLINICAL TRIAL OF PATIENT SATISFACTION AND PROSTHODONTIC NEEDS WITH BALL AND BAR ATTACHMENTS FOR IMPLANT-RETAINED COMPLETE OVERDENTURES: THREE-YEAR RESULTS. J PROSTHET DENT 2005; 93:28-37. 19- PAYNE AG., SOLOMONS YF. THE PROSTHODONTIC MAINTENANCE REQUIREMENTS OF MANDIBULAR MUCOSA- AND IMPLANT- SUPPORTED OVERDENTURES: A REVUE OF THE LITERATURE. INT J PROSTHODONT 2000;13:238-43. 20- ANDREIOTELLI M, ATT W, STRUB JR. PROSTHODONTIC COMPLICATIONS WITH IMPLANT OVERDENTURES: A SYSTEMATIC LITERATURE REVIEW. INT J PROSTHODONT. 2010 MAY-JUN;23(3):195-203. 21- CEHRELI MC., KARASOY D., KOKAT AM., AKCA K., ECKERT SE. SYSTEMATIC REVIEW OF PROSTHETIC MAINTENANCE REQUIREMENTS FOR IMPLANT-SUPPORTED OVERDENTURES. INT J ORAL MAXILLOFAC IMPLANTS. 2010 JAN-FEB;25(1):163-80.
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ORAL HEALTH
INTRODUCING ORAL HEALTH EDUCATION TO THE SCHOOLS OF THE STATE OF
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Oral Health Education in Kuwait
Mohammed Al-Awwad, DMD, MPH - Alaa Al-Awwad, DDS, Msc. Mohammad Abdulwahab, DMD, MPH drmohdalawwad@hotmail.com
Introduction
Background
Oral health includes within its meaning the health of teeth, gingiva, palate, tongue, lips and masticatory muscles however it exceeds this meaning by affecting the general health and social well-being of an individual thus having an overall impact on their quality of life. Importance of oral health starts early in life and many states have realized the importance of oral health education as a goal to improve the well-being of their residents. Kuwait is a state that has given importance to oral health and has taken different measures to expand and improve the dental services provided to its population. It has developed the Kuwait School Oral health Program which was implemented in 1992 and was developed by the Forsyth Institute with the aim of improving the oral health status of children in Kuwait. This program has contributed to an overall improvement of oral health throughout the state of Kuwait. Although the program has been successful in many measures it lacks a focused oral health education program. The main objective of this project is to create an Oral Health Education Program for the State of Kuwait that aims to improve awareness and educates participants so as to prevent oral disease. The primary target will be school children through which almost every family will be reached thus a diffusion of information on oral health will be reached throughout the population. The proposal involves expansion and improvement of the existing Oral Health Program Of the State of Kuwait with support from all involved parties including Ministry of Education, Ministry of Health, Ministry of information, University of Kuwait Medical and Dental College and Kuwait Dental Association. The specific aims of the project after funding is in place is to develop and pilot test a school-based oral health education program for the state. Once finalized and edited to then go ahead and implement it nationally in all public schools. The project will be evaluated after one year of complete operation. On the long-term an evaluation system will be designed to measure the impact of the program on the overall health status of the State of Kuwait.
Poor oral health amongst children includes dental caries, dental trauma, periodontal disease, dental erosion and oral cancer. According to the US General Accounting Office of Oral Health, poor oral health has a definite effect on a child’s performance in school and also his/her future life success.2 Children with tooth pain/dental abscesses will be distracted and not focused when learning.3 Oral disease is considered a risk factor for several general health conditions and is associated with a variety of problems such as diabetes and cardiovascular disease.3 The Kuwait School Oral Program was proposed in 1983 by the Ministry of Health . This program was developed by The Forsyth Institute and was implemented in 1992 starting in the governate of Jahra and later expanded to all five governates.1 This program showed improvement in children’s oral health but failed to reach the set goals by the government of Kuwait. This can be supported by L.E. Asfour statement “restorative treatment preventive measures are highly needed in both age groups (age groups are 6-9 and 10-12 years old) of kuwaiti children with mixed dentition. Jawad M. Behebahani et al states in a review paper of Oral Health of Kuwait “the prevalence of dental caries in Kuwait and there is no indication of a decrease...”, “ Oral health promotion needs to be strengthened and a defined strategy should be developed”, “Pregnant women and mothers of small children should be targeted by oral health education”.5 Prevention of oral disease is essential for the State of Kuwait where almost free dental services are provided for the entire population in order to decrease overall health service costs in the long run. Dasanayake AP et al concluded in their study of “Restorative cost savings related to dental sealants in Alabama Medicaid children” that children who do not receive sealants are more likely to obtain subsequent restorative care and cost more money to the health care system.8 This is further supported by Matthew F Savage et al where they found that the age of the first preventive dental visit had a
Dental News, Volume XIX, Number II, 2012
ORAL HEALTH significant positive effect on dentally related expenditures. The American Dental Association reports by Stacie Crozier the conduction of Kuwait Eyes Fluoridation. The symposium targeted the need for caries prevention and an apparent concern was the increase in caries prevalence and the discontinuation of water fluoridation in Kuwait. The World Health Organization is stressing the importance of promoting educational investment thus providing documentation on how to promote oral health through schools. It has placed recommendations for the State of Kuwait to consider the introduction of school-based oral health education this is after finding an alarming status of caries for the state. This is documented in annex 2.3 Why should schools be targeted and why is oral health promotion in schools effective? Schools are an excellent place to promote oral health because they represent a micro view of a larger community and thus by targeting schools you can efficiently increase oral health knowledge throughout the community. Children are good candidates for reception of guidance. By targeting the children in a learning environment at an early age this empowers their personalities and thus creates a positive attitude towards more responsibility for their own health and thus prevention of oral health problems. Schools provide a safe environment where policies can easily be set and awareness can be raised about oral health. As it is an educated environment it is easy to involve and train personnel to be able to become participants and support the program.26
Kindergarten The content of the lectures will focus on introduction of the importance of teeth. What is tooth decay? how to prevent tooth decay and the importance of a healthy diet. Lectures should be animated and include a fairy-tale. Grades 1 - 5: The content of the lectures will focus on introduction of the importance of teeth. What are the parts of a tooth. What is tooth decay and gingivitis? How to brush/floss. Importance of healthy diet, prevention of injury and regular visits to the dentist. Grades 6 - 8: The content of the lectures will focus on introduction of the importance of oral health. Causes of tooth decay and gingivitis. How to brush/floss. Importance of healthy diet, and prevention of injury (especially during contact sports). Importance of keeping away from bad habits like smoking and the detrimental effects and risks of oral piercing. Importance of regular dental visits and consultation with an Orthodontist. Grades 8 -12: Similar to Grades 6-8 while stressing more about keeping away from bad habits and introducing the detrimental effects of alcohol and meth and smoking.
36
Oral Health Education in Kuwait
Program Description The Oral Health Education Program for the State of Kuwait will concentrate on developing and implementing an improved oral health education program and incorporate it into the existing Kuwait School Oral Health Program. It will target mainly the school curriculum. Thus it will be based mainly on lectures tailored and designed for different levels of age groups. The objectives of all levels of lectures is to define oral health and stress the importance of maintaining good oral health and how it contributes to the overall health.The lectures will increase the awareness of the effects of bad habits on oral health allowing children to be involved in their oral health and introducing them to the different strategies of prevention that include regular dental visits, correct brushing/flossing, diet, fluoride, sealants etc. Those lectures will be designed using as a base the lectures provided by the Department of Health and Senior Services of the state of Missouri on their internet link http://www.dhss.mo.gov/oralhealth/ OralHealthEducation.html. These free of charge powerpoint based lectures are an excellent example and can cover the overall material that needs to be presented in the Oral Health Education Program of the State of Kuwait. With review, translation to Arabic language and a little tailoring and adaptation to fit intellectual levels of each school grade a lecture system for four different school levels can be created. Dental News, Volume XIX, Number II, 2012
A one-day training module will be designed for the personnel involved in this program including teachers, nurses and dentists. On completion of the curriculum those personnel will be qualified in promoting oral health education and contributing to the program. This training module will focus on management of oral health of children. It will review oral conditions and how to prevent oral disease. It will focus on how to provide oral health instructions and how to teach brushing / flossing as well as how to manage oral injuries and bad habits. The capabilities of the personnel will be broadened by teaching them how to manage oral health lectures, work with techniques to capture the interest of children and how to get them involved in their oral health. It will allow them to be role models and will introduce them to resources that can be of help. They will also have a complete review of the lectures that will be presented and how to handle any questions/issues while conducting the lectures. The Oral Health Education Program of the State of Kuwait will be approached according to three agendas thus allowing a planned expansion of the program scheduled according to the conclusions drawn after evaluation of each applied part of the program. The first agenda: this will focus primarily on training of health professionals that will be part of the program and training of teachers of model schools. Publicization of the program aiming to draw attention for funding and national support. Introduction of the lec
37
ORAL HEALTH tures to the curriculum of model schools in one governate as well as performing oral screenings, providing educational brochures and letters to parents. Evaluation of the applied program as well as level of publicity and support received.
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Oral Health Education in Kuwait
the second agenda: this will focus on further training of personnel including teachers as well as reviewing of lectures applied. Any negative feedback about the program will be addressed. The program will be applied to all schools within the the same governate and applied to model schools in all the other governates of the state. Further involvement will be allowed especially medical/dental students and thus opening the door to public health research. Efforts will also be directed to attract further contributions and more media involvement and publicity. Evaluation of the overall program will also be conducted. The third agenda: this agenda will be focused primarily on advertising the program on a full fledged scale with the aim of having a recognized Oral Health Week. All schools of the State will be involved as it is a recognized Oral Health Week. The attention and excitement raised in the community will help encourage all dental clinics to be involved in the Oral Health Week with expectations of discounted screenings/treatment for school children, marathon organization, brochures and samples etc. Part of the agenda will be to evaluate the wide scope approach of the program. A time frame has been set where the expectation is ~ 12 months for each agenda26. The planning and proceedings of the program will be decided by the Board representing the program. The members of the Board will be chosen according to qualifications and experience. Their positive influence and focal decisions should target designing and developing strategies for the program and attraction of funding thus allowing long-term sustainability of the program. One of the main focuses of the Board is evaluating the program and addressing any negative feedback with sound planning and adaptation.
Evaluation Methods The evaluation of the Oral Health Education Program of The State of Kuwait will include an Oral Health Screening Survey as well as an Oral Health Quiz. It will also include a Feedback Evaluation of the Oral Health Education Program. The screening survey will be designed according to the guidelines mentioned by the Association of State and Territorial Dental Disorders (ASTDD) in the Basic Screening Survey (BSS) project. This survey will be considered cross-sectional as it will be viewing the population at a point in time, it will also be descriptive as it will be estimating the oral health status of the children of Kuwait. it will include both a questionnaire and an oral screening with specific information to be collected.26 The Oral Health Quiz will give direct results of the amount of knowledge attained by the Oral Health Educational School Program and thus can measure its success. In order to create a baseline for evaluation of the knowledge the students have Dental News, Volume XIX, Number II, 2012
before the presentations and lectures of the Oral Health Education Program the quiz will be given prior to any lectures and will then be offered again at the end of the curriculum. This will allow direct assessment of the success of communication of knowledge about oral health.26 The feedback evaluation will be distributed at the end of the curriculum to all participants in the program as well as a randomly selected group of senior students and parents of participating students. This for will encourage them to share their thoughts of the strengths and weaknesses of the program and how they think it can be improved.
Funding and Long - term sustainability When introducing a new program a key factor for the success of the program is long term sustainability. It is imperative that this program be adopted by the Ministry of Health and Ministry of Education. Both ministries have budgets that are directed towards similar activities and thus, gaining support from both ministries, is essential. However this will depend on the credibility of the program and the influence of its board members as well as the collaboration of influential personalities in the state. Once official support is established the efficacy of the program in controlling the expansion of the dramatically increasing oral disease treatment cost in the state will directly affect its maintenance and sustainability. As the program gains its credibility the attraction of the private sector will expand the support and contributions and thus will allow the program to present itself as an unweighty burden as it expands its activities.26 The goal of this program is to be a strategic success that sets an example of the efficacy of public health education program by distributing essential knowledge and reducing the burdens of treatment cost on the state on the long run. It aims to gain long term financial support from both the Ministry of Health and Ministry of Education and to merge their efforts towards the success of the Oral Health Education Program of the State of Kuwait. Finally, creating a recognized oral health week that attracts yearly excitement throughout the state to further support the success of the program.
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ORAL HEALTH
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Oral Health Education in Kuwait
References 1. FORSYTH/KUWAIT PROGRAM- KUWAIT SCHOOL ORAL HEALTH PROGRAM. WEBSITE: HTTP://FORSYTH.ORG/GLOBAL/ KUWAIT.HTML. ACCESSED ON JUNE 17, 2008. 2. GENERAL ACCOUNTING OFFICES. ORAL HEALTH: DENTAL DISEASE IS A CHRONIC PROBLEM AMONG LOW-INCOME POPULATIONS. REPORT TO CONGRESSIONAL REQUESTERS. WASHINGTON, 2000. 3. WORLD HEALTH ORGANIZATION. ORAL HEALTH PROMOTION: AN ESSENTIAL ELEMENT OF A HEALTH-PROMOTING SCHOOL. GENEVA: WHO, 2003. 4. ORAL HEALTH OF KUWAITI CHILDREN WITH MIXED DENTITION L.E. ASFOUR1, N.O. SALAKO1, V. ROTIMI1, P.N. SHARMA2, AND E.I. KONONEN3, 1KUWAIT UNIVERSITY, SAFAT, KUWAIT, 2KUWAIT UNIVERSITY, KUWAIT CITY, KUWAIT, 3KUWAIT UNIVERSITY, NATIONAL PUBLIC HEALTH INSTITUTE (KTL), HELSINKI, FINLAND 5. BEHBEHANI JM, SCHEUTZ F. ORAL HEALTH IN KUWAIT. INTERNATIONAL DENTAL JOURNAL 2004; 54: 401-408. 6. BEHBEHANI JM, SHAH NM. ORAL HEALTH IN KUWAIT BEFORE THE GULF WAR. MED PRINC PRACT 2002; 11 SUPPL 1: 36-43. 7. NADYA A. AL-GHANNAM,* BDS, MSC, SBARD, NAZEER B. KHAN,** MSC, PHD ABDULLAH R. AL-SHAMMERY,*** BDS, MDS, AMJAD H. WYNE,** BDS, BSC, MDS, TRENDS IN DENTAL CARIES AND MISSING TEETH IN ADULT PATIENTS IN AL-AHSA, SAUDI ARABIA, FASDCSAUDI DENTAL JOURNAL VOLUME17-NUMBER-2/2005. 8. DASANAYAKE AP, LI Y, KIRK K, BRONSTEIN J, CHILDERS NK. RESTORATIVE COST SAVINGS RELATED TO DENTAL SEALANTS IN ALABAMA MEDICAID CHILDREN. PEDIATR DENT. 2003 NOV-DEC; 25(6): 572-6. 9. MATTHEW F SAVAGE, JESSICA Y LEE, JONATHAN B KOTCH, WILLIAM F VANN JR. EARLY PREVENTIVE DENTAL VISITS: EFFECTS ON SUBSEQUENT UTILIZATION AND COSTS. PEDIATR DENTAL. 2004 OCT; 114(4): 418-23. 10. MORGAN MV, CROWLEY SJ, WRIGHT C. ECONOMIC EVALUATION OF A PIT AND FISSURE DENTAL SEALANT AND FLUORIDE MOUTH RINSING PROGRAM IN TWO NONFLUORIDATED REGIONS OF VICTORIA, AUSTRALIA. J PUBLIC HEALTH DENT. 1998 WINTER;58(1):19-27. 11. AMERICAN DENTAL ASSOCIATION. KUWAIT EYES FLUORIDATION. WEBSITE: HTTP://WWW.ADA.ORG/PROF/RESOURCES/ PUBS/ADANEWS/ADANEWSARTICLE.ASP ARTICLEID = 2387. ACCESSED ON JUNE 17, 2008. 12. FDI WORLD DENTAL FEDERATION. WEBSITE: HTTP://WWW.FDIWORLDENTAL.ORG/RESOURCES/ASSETS/FACTS_AND_FIGURES/2000/KUWAIT.PDF. ACCESSED ON JUNE 17, 2008. 13. PETERSON PE, TORRES AM. PREVENTIVE ORAL HEALTH CARE AND HEALTH PROMOTION PROVIDED FOR CHILDREN AND ADOLESCENTS BY THE MUNICIPAL DENTAL HEALTH SERVICE IN DENMARK. INT J PAEDIATR DENT 1999; 9: 81-91. 14. WORLD HEALTH ORGANIZATION. RESEARCH TO IMPROVE IMPLEMENTATION AND EFFECTIVENESS OF SCHOOL HEALTH PROGRAMMES. REPORT OF THE SCHOOL WORKING GROUP AND THE WHO EXPERT COMMITTEE ON COMPREHENSIVE SCHOOL HEALTH EDUCATION AND PROMOTION. GENEVA: WHO, 1996. 15. MOYSES ST, MOYSES SJ, WATT RG, SHEIHAM A. ASSOCIATIONS BETWEEN HEALTH PROMOTING SCHOOLS’ POLICIES AND INDICATORS OF ORAL HEALTH IN BRAZIL. HEALTH PROMOT INT 2003; 18: 209-218. 16. DEPARTMENT OF HEALTH AND SENIOR SERVICES OF THE STATE OF MISSOURI. WEBSITE: HTTP://WWW.DHSS.MO.GOV/ ORALHEALTH/ORALHEALTHEDUCATION.HTML. ACCESSED ON JUNE 17, 2008. 17. MARCHAND, R. 1985. ADVERTISING THE AMERICAN DREAM: MAKING WAY FOR MODERNITY, 1920-1940 BERKELEY: UNIVERSITY OF CALIFORNIA PRESS. 18. PRESCOTT, H. 2001. FROM ORAL HEALTH TO PERFECT SMILE: ADVERTISING AND CHILDREN’S ORAL HEALTH. CAMBRIDGE MA: HARVARD UNIVERSITY PRESS. 19. MARKETING WITH BROCHURES. WEBSITE: HTTP://EZINEARTICLES.COM/?MARKETING-WITH-BROCHURES&ID=34514. ACCESSED JUNE 17, 2008. 20. DEPARTMENT OF HEALTH AND HUMAN SERVICES U.S (2000). ORAL HEALTH IN AMERICA: REPORT OF THE SURGEON GENERAL- EXECUTIVE SUMMARY. ROCKVILLE, MD; NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH, NATIONAL INSTITUTE OF HEALTH. 21. KHALAF F. AL-SHAMMARI, JASSEM M. AL-ANSARI, AREEJ K. AL-KHABBAZ, SISKO HONKALA. BARRIERS TO SEEKING PREVENTIVE DENTAL CARE BY KUWAITI ADULTS. MED PRINC PRACT 2007;16:413-419. 22. W.K. KELLOGG FOUNDATION. COMPONENTS OF COMMUNITY-BASED ORAL HEALTH PROGRAM EVALUATION. WEBSITE: HTTP://WWW.WKKF.ORG/ORALHEALTHEVALUATION/INTERIORPAGE.ASPX?PAGEID=81&LANGUAGEID=0. ACCESSED JUNE 17, 2008. 23. ASSOCIATION OF STATE AND TERRITORIAL DENTAL DIRECTORS. BASIC SCREENING SURVEY: AN APPROACH TO MONITORING COMMUNITY ORAL HEALTH. WEBSITE: HTTP://WWW.ASTDD.ORG/DOCS/BSS_MANUAL_9-25-03.PDF. ACCESSED ON JUNE 17, 2008. 24. SUMMATIVE VS FORMATIVE EVALUATION. WEBSITE: HTTP://JAN.UCC.NAU.EDU/EDTECH/ETC667/PROPOSAL/EVALUATION/SUMMATIVE_VS._FORMATIVE.HTM. ACCESSED JUNE 17, 2008. 25. GILMORE, GARY D., AND M. DONALD CAMPBELL. 2005. NEEDS AND CAPACITY ASSESSMENT STRATEGIES FOR HEALTH EDUCATION AND HEALTH PROMOTION, 3RD EDITION. BOSTON: JONES AND BARTLETT PUBLISHERS. 26. AL-AWWAD, MOHAMMED. 2008. INTRODUCING ORAL HEALTH EDUCATION TO THE SCHOOLS OF THE STATE OF KUWAIT. GRADUATE SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF PITTSBURGH.
Dental News, Volume XIX, Number II, 2012
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PROSTHETIC DENTISTRY
Repairing, Relining, Rebasing IN A
COMPLETE DENTURE Dr. Jaouadi Jamila j.Jaouadi@yahoo.fr
Introduction: An ill-fitting complete denture may cause various lesions on mucosa and inflammatory overgrowth could appear, so, reparing, relining or rebasing the denture will certainly resolve the problem.
REPAIRING:
Complete Denture Repair
Denture may fracture during the function, or may drop on a hard surface. So the key of repairing is the accurate reassembling and alignment of the broken parts in their original position.
the polished surface. - Assembled parts may be strengthened with burs or plastic sticks. - Any undercut on the fitting surface is blocked out with wax or clay. - Stone plaster is poured into the fitting surface. After stone setting the denture is removed from the cast and cleaned from any traces of sticky wax. - Fractured edges are reduced, widened (8-10mm) along the fracture line and beveled towards the polished surface to increase bonding surface area. - Dove tail cuts may be made to strengthen the repair joint. - The cast is painted with separating medium and the denture is secured to the cast with rubber bands. - Self cure is applied to the modified fracture area until the area is overfilled. Relief of the median palate raphea. - Reline if needed. - Remake in some cases.
ANY PART FRACTURE Main causes
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Falling on the ground or the sink during cleaning.
Types MIDLINE FRACTURE Causes - No or insufficient relief in the midline.2 - Ridge resorption wit loss of relief effect.
Procedure Broken parts are assembled and fixed together with sticky wax on
Dental News, Volume XIX, Number II, 2012
- Fracture with no missing part (repaired as mentioned) - Fracture with missing or lost part.
Procedure - An impression is made with the denture placed in patient mouth. - After pouring the cast; either self cure is applied to replace the missing part, or wax is added and carved to resemble the broken denture part followed by flashing, packing, curing, finishing and polishing.
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PROSTHETIC DENTISTRY General consideration: - Optimal tissue health. - Reasonable R.C/C.O. - Adequate peripheral extensions.
Procedures Patient is instructed to leave his denture out of his mouth at least 48 hours to allow for recovery of tissues and reduce irritation caused by ill-fitted denture.
Fracture with broken or missing teeth Procedure - Fractured teeth are cut away with burs. - On the lingual side; enough acrylic is removed and dove tailed. - Teeth of same shape; size and shade are positioned in proper alignment and waxed with base plate wax. - A plaster index (key) is made to record and secure the position of waxed teeth. - Tooth to be repaired are removed together with all wax around them. - Teeth are then put back exactly in their original position aided by a plaster key. - Self cure acrylic resin is added from the lingual side until repair area is over buit. It is then covered with tin foil. - After curing; the index is removed and the denture is finished and polished.
Denture preparation: - Any undercuts are removed from the denture base. - Peripheral extensions are checked and adjusted. - Borders are reduced and squared to provide a definite edge for addition of new resin material. - A hole is made in the palatal surface to allow escape of excess impression material. - Border tracing and new impressions are made under centric occlusion to maintain occlusal relationship. - The denture with impression material is boxed and poured into stone. - The denture is flasked and the old resin material is thoroughly cleaned and roughened. - New resin acrylic material is packed and the denture is cured in pressure curing unit containing water at 45°C for 20 min. To prevent porosity of new resin material and wrapage of new resin material (release of internal stresses). - Finishing and polishing is done in the usual manner.
Rebasing
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Complete Denture Repair
Definition Relining of complete denture: Definition Resurfacing or correction of denture adaptation to underlying tissues by the addition of a new resin material to its fitting surface without changing its occlusal relation. Addition of material to the tissue side of a denture to improve its adaptation to the supporting mucosa.
Indication Whenever the denture loses or has poor adaptation to the underlying tissues, while all other factors as occlusion; esthetics; centric relation; v.d.o and denture base material are satisfactory: - Loss of retention. - Instability. - Food under denture. - Abused mucosa.
Dental News, Volume XIX, Number II, 2012
It’s a process of readaptation of a denture to the underlining tissues by replacing the denture base material with a new one without changing its occlusal relation.
Indications When the existing denture base is unsatisfactory; crazed or porous.
Procedure - An impression is made with the denture and a cast is obtained. - An occlusal and incisal index of the teeth is made in plaster using HOOPER DUPLICATOR, the posts of the lower part of the duplicator are seated in the upper part to maintain the relationship of the casts to the plaster index. - The denture with the impression material are removed from the cast. - Artificial plastic teeth are sectioned from the denture and all base material around the teeth is removed (porcelain teeth are removed by flaming). - Teeth are placed and held in position in the index using sticky wax on the labial and buccal surface.
PROSTHETIC DENTISTRY
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- A layer of base plate wax is placed over the ridge of the cast. - The upper part of the duplicator is closed and denture teeth are waxed to the proper thickness and counter to the cast. - The cast is removed; flasked and processed in the usual manner. - After deflasking, the cast is reattached to the upper part of the duplicator to adjust any occlusal errors. - Occlusion of rebased denture is further perfected by clinical remount.
References Clinic Manual 2003-2004; The Ohio State University Department of Primary Care Boucher’s Prosthodontic Treatment for Edentulous Patients, 11th Edition; Zarb et al., 2004 Contemporary Fixed Prosthodontics, Rosenstiel et al., 2001 Complex Denture Fabrication, M. van Putten, 2000 RG Craig, Review of Impression Materials, Advance in Dental Research, Aug 1988, 2,51-64.
FUTURE OF DENTISTRY 16th scientific congress
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Dr. Youssef Doueiry
ﻣﻦ ﻛﻠﻤﺔ اﻟﺪﻛﺘﻮر إﺑﺮاﻫﻴﻢ إﺳامﻋﻴﻞ :ﻳﺄيت ﻣﺆمتﺮﻧﺎ اﻟﻴﻮم ﻋﺎﻛﺴﺎ أﻫﻤﻴﺔ ﺗﻀﺎﻓﺮ اﻟﺠﻬﻮد ﺑني اﻟﻘﻄﺎﻋني اﻟﺤﻜﻮﻣﻲ واﻷﻫﲇ ﰲ اﻻرﺗﻘﺎء ﺑﺎﻷداء ﰲ اﻟﻘﻄﺎع اﻟﺼﺤﻲ واﻟﺬي ميﺜﻞ رﻓﻊ اﳌﺴﺘﻮى اﻟﻌﻠﻤﻲ ﻟﻸﻃﺒﺎء ﻋﻤﻮﻣﺎً وﻷﻃﺒﺎء اﻷﺳﻨﺎن ﻋﲆ ﻧﺤﻮ ﺧﺎص رﻛﻴﺰة ﻣﻦ رﻛﺎﺋﺰ اﻻرﺗﻘﺎء واﳌﻮاﻛﺒﺔ ﻟﻠﻤﺴﺘﺠﺪات وﻣﻦ أﺟﻞ ﺗﻘﺪﻳﻢ اﻟﺨﺪﻣﺔ و اﻟﺮﻋﺎﻳﺔ اﻷﻓﻀﻞ ﻟﻠﻤﺮﴇ ﰲ اﳌﺴﺘﺸﻔﻴﺎت واﳌﺮاﻛﺰ اﻟﺼﺤﻴﺔ ﻋﲆ اﻣﺘﺪاد دوﻟﺔ اﻟﻜﻮﻳﺖ .ﺗﻨﻘﺴﻢ ﻓﻌﺎﻟﻴﺎت اﳌﺆمتﺮ إﱃ ﺷﻘني رﺋﻴﺴني ﻳﻀﻢ أوﻟﻬام ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﳌﺤﺎﴐات وﻋﺮض ﻷوراق ﻋﻠﻤﻴﺔ ﻗﻴﻤﺔ ﻷﻛﺎدميﻴني وﻣامرﺳني ﻣﺮﻣﻮﻗني ﻟﻄﺐ
Dr. Ibrahim Esmail president of the organizing committee
اﻷﺳﻨﺎن ﺣﻮل اﻟﻌﺎمل ـ ﺑﻴﻨﻬﺎ ﻣﺤﺎﴐات وﺑﺤﻮث ﻣﻦ اﻟﻮﻻﻳﺎت اﳌﺘﺤﺪة اﻷﻣﺮﻳﻜﻴﺔ ودوﻟﺔ اﻟﻜﻮﻳﺖ وﺟﻤﻬﻮرﻳﺔ ﻣﴫ اﻟﻌﺮﺑﻴﺔ وﺳﻠﻄﻨﺔ ﻋامن واﳌﻤﻠﻜﺔ اﳌﺘﺤﺪة ﺑﻴﻨام ﻳﺘﻀﻤﻦ اﻟﺸﻖ اﻟﺜﺎين ﻣﻦ ﻓﻌﺎﻟﻴﺎت اﳌﺆمتﺮ ﻣﺠﻤﻮﻋﺔ ﻣﻦ ورش اﻟﻌﻤﻞ اﻟﺤﻴﻮﻳﺔ ...وﺗﻐﻄﻰ اﳌﺤﺎﴐات وورش اﻟﻌﻤﻞ ﻣﺠﺎﻻت ﺑﺎﻟﻐﺔ اﻟﺤﻴﻮﻳﺔ ﳌﻨﺘﺴﺒﻲ ﻋﻠﻢ ﻃﺐ اﻷﺳﻨﺎن وﻣامرس ﻃﺐ اﻷﺳﻨﺎن ﻣﻨﻬﺎ ﻋﻼج اﻟﻌﺼﺐ ،اﻟﺤﺸﻮات اﻟﺘﺠﻤﻴﻠﻴﺔ وزراﻋﺔ اﻷﺳﻨﺎن – آﻻم اﻟﻮﺟﻪ واﻟﻔﻜني ،ﺗﻜﻨﻮﻟﻮﺟﻴﺎ ﺗﻠﺒﻴﺲ اﻷﺳﻨﺎن ﺑﺎﻟﺴرياﻣﻴﻚ ، أﺣﺪث اﳌﺴﺘﺠﺪات ﰲ ﺗﺠﻤﻴﻞ اﻷﺳﻨﺎن ،اﻟﺘﺨﺪﻳﺮ ﺑﺎﻟﻐﺎز ،ﻋﻼج اﻷﻧﺴﺠﺔ .
Left to Right: Dr. Ibrahim Esmail, Dr. Youssef Doueiry, Dr. Ahmad Asaad Chairman,KDA
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Picture from the opening ceremony
Dental News, Volume XIX, Number II, 2012
TROPHY DISTRIBUTION
pictures from the
Trophy distrubution to the Lebanese delegation
exhibition ďŹ&#x201A;oor
Dr. Clifford Ruddle in the endodontic workshop
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Trophy distrubution to the Egyptian delegation
Dental News, Volume XIX, Number II, 2012
FUTURE OF DENTISTRY 16th scientiямБc congress
MOVENPICK Hotel, Kuwait, March, 17 - 19, 2012
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PICTURES FROM THE EXHIBITION
Dental News, Volume XIX, Number II, 2012
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FUTURE OF DENTISTRY 16th scientiямБc congress
MOVENPICK Hotel, Kuwait, March, 17 - 19, 2012
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PICTURES FROM THE EXHIBITION
Dental News, Volume XIX, Number II, 2012
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The Lebanese Society of Pediatric Dentistry Organized its scientific meeting under the collaboration of the L.D.A. The main interest was focused on endodontic treatment in the early childhood with the recent materials and the latest actual treatment.
Executive Committee of the Lebanese Society left to right, Dr. Rima Osta, Dr. George Abi Hatem (treasurer), Dr. Sandra Dagher, Dr. Mohammad Ezzeddine (President), Dr. Marlene Khoury (vice President), Dr. Bechara Al-Asmar (Secretary General)
Dr. Mouhammad Ezzeddine President of the LSPD
Dental News, Volume XIX, Number II, 2012
Ass. Prof. Samia Abou Jaoude Farha
Dr. Rima Osta
Dr. Marc Kaloustian (Speaker)
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6th CAD/CAM & Computerized Dentistry y International Conference The Ritz-Carlton Hotel Dubai, UAE 3rd - 4th May 2012
The CAD/CAM & Computerized Dentistry International Conference, held on 02 - 05 May 2012 at The Ritz-Carlton Hotel in Dubai, UAE, brought together 845 attendees from 24 countries for the sixth time continuing the reputation as the industryâ&#x20AC;&#x2122;s leading international conference. The conference was organized by Emirates Dental Society and Center for Advanced Professional Practices (CAPP), and co-organized by the Saudi
Conference Chairman Dr. Munir J. Silwadi
Dental Volumeroom XIX, Number II, 2012 picture from theNews, conference
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Dental Society. The scientific program was accredited by the Health Authority - Abu Dhabi, Ministry of Health UAE and Saudi Commission for Health Specialties. The fast growth in CAD/CAM Dentistry alongside new technology, materials and equipment has seen an increasingly rapid integration into both dental offices and dental laboratories.
Certificate distribution in the exhibition floor
PICTURES FROM THE EXHIBITION
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Mr. Abdo Salem, from Amann Girrbach, demonstrating the latest technologies in CAD/CAM
Prof. Dr. Atef Shaker during the live demonsration at SIRONA booth
Dental News, Volume XIX, Number II, 2012
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Lebanese Dental Laboratory Show MORE PICTURES AVAILABLE ON
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7th scientific congress
UNESCO palace, Beirut, May 18 - 20, 2012
ﻛﻠﻤﺔ اﻟﺮﺋﻴﺲ ﺟامل اﻟﺤﺎج :ﻓﺨﺎﻣﺔ اﻟﺮﺋﻴﺲ ،أﻳﻬﺎ اﻷﺣﺒﺎء ،إﻧﻨﻲ أﺗﻨﺒﻪ إﱃ ﻣﺎ ﻳﺠﺮي ﺣﻮﻟﻨﺎ ﻣﻦ ﺣﺮاك ﺷﻌﺒﻲ وﺳﻴﺎﳼ ﻣﺪﻋﻮﻣﺎً ﻣﻦ ﻛﻞ اﻟﺨﺎرج ﻋﲆ اﺧﺘﻼف ﻣﻴﻮﻟﻪ وﺗﺨﻠﻒ ﺑﻌﺾ ﻣﺤﺮﻛﻴﻪ ،ﻓﺈﻧﻨﻲ أرى أن اﻟﺜﻐﺮات اﳌﻮﺟﻮدة ﰲ ﺟﺪران اﻟﺪول ﻫﻲ اﻻرﺗﺠﺎل واﻻﺗﻜﺎل ،اﻻرﺗﺠﺎل ﰲ ﺗﺴﻴري اﻷﻣﻮر، واﻻﺗﻜﺎل ﻋﲆ اﳌﺴﺎﻋﺪة ﻣﻦ أﻳﻨام ﻛﺎﻧﺖ .وﻷن ﻫﺬه اﻷﺳﺎﻟﻴﺐ ﺗﺪﻣﺮ وﻻ ﺗﻌﻤﺮ ﻓﺈﻧﻨﺎ ﻧﺸﺪد ﻋﲆ ﻋﻤﻠﻨﺎ ﰲ ﻣﺠﺎل اﻟﻨﻘﺎﺑﺎت واﻟﺘﻲ ﺗﻌﻤﻞ ﻋﲆ أﺳﺲ ﻋﻠﻤﻴﺔ ﺑﻨﺎءة وﺧﻼﻗﺔ وﺿﺎﺑﻄﺔ ﻟﻠﻌﻼﻗﺎت ﺑني اﳌﺠﺘﻤﻊ واﻟﺪوﻟﺔ واﻟﺤﺎﻣﻴﺔ ﻣﻦ أي اﻧﺰﻻﻗﺎت واﺳﺘﻐﻼل ﻣﻦ ﻫﻨﺎ أو ﻫﻨﺎك ،وﺑﺬﻟﻚ ﻧﺴﺎﻫﻢ ﰲ ﺑﻨﺎء اﻟﺪوﻟﺔ اﻟﺤﺪﻳﺜﺔ وﻧﺤﻤﻲ اﳌﺠﺘﻤﻊ وﻧﺸﻜﻞ اﻷمنﻮذج اﻟﻌﴫي ﰲ ﺗﺤﻘﻴﻖ اﻟﻌﺪاﻟﺔ اﻻﺟﺘامﻋﻴﺔ .ﻟﺬا
ﻧﻄﻠﺐ ﻣﻦ دوﻟﺘﻨﺎ اﻻﻟﺘﻔﺎت ﻧﺤﻮ ﺗﺸﺠﻴﻊ اﻟﻨﻘﺎﺑﺎت وإﻋﻄﺎﺋﻬﺎ ﺣﻘﻬﺎ ﰲ ﺗﴩﻳﻊ اﻟﻘﻮاﻧني اﻟﺪاﻋﻤﺔ واﻟﺤﺎﻣﻴﺔ ﻟﻬﺎ واﻻﻋﺘامد ﻋﻠﻴﻬﺎ ﰲ ﺗﻨﻈﻴﻢ اﻟﺤﻴﺎة اﳌﺪﻧﻴﺔ ﻛﺮاﻓﺪ وﻃﻨﻲ ﻳﺴﻬﻞ اﻟﻠﻘﺎء ﺑني اﻟﺪوﻟﺔ واﳌﻮاﻃﻦ .وﻧﻘﺎﺑﺘﻨﺎ اﻟﺘﻲ ﻧﻨﺘﻤﻲ إﻟﻴﻬﺎ ﻫﻲ واﺣﺪة ﻣﻦ اﻟﺠﺴﻮر اﻟﺘﻲ ﻳﻌﱪ ﺑﻬﺎ اﻟﻮﻃﻦ إﱃ اﻟﺤﺪاﺛﺔ وﻣﻮاﻛﺒﺔ اﻟﻌﺎمل ﰲ ﻣﺴرية اﻟﻌﻠﻢ واﻟﻌﻤﻞ واﻟﺘﻘﺪم وﻣﺎ أوﺻﻠﻨﺎ إﱃ ﻫﺬه اﻟﺪوﺧﺔ اﻟﻌﻈﻴﻤﺔ واﻟﺮﻋﺐ اﳌﺘﺰاﻳﺪ اﳌﺴﺒﺐ ﳌﻮﺟﺔ اﻟﺠﻨﻮن اﻟﺘﻲ ﺗﺠﺘﺎح اﻟﻜﻮن إﻻ اﻟﺒﻌﺪ ﻋﻦ اﻟﺤﻖ واﻋﺘامد اﻷﺳﺎﻟﻴﻴﺐ اﳌﻠﺘﻮﻳﺔ وﻟﻐﺔ اﳌﺤﺎﺻﺼﺔ واﳌﺤﺴﻮﺑﻴﺎت وﴐب اﻟﻄﺮق اﳌﺆدﻳﺔ إﱃ ﺗﻨﻈﻴﻢ اﻟﻌﻼﻗﺔ ﺑني اﻟﻨﺎس ﻣﻦ ﺧﻼل ﺗﻬﻤﻴﺶ اﻟﻨﻘﺎﺑﺎت وﻋﺪم ﺗﻈﻬريﻫﺎ ﻛﺤﺮﻛﺔ راﻗﻴﺔ وﻣﺴﺘﻮﻋﺒﺔ ﻟﻠﻜﻞ مبﻔﺎﻫﻴﻤﻬﺎ اﻟﺠﺎﻣﻌﺔ وﻋﻤﻠﻬﺎ اﻟﺠﺎﻣﻌﻲ وﺑﻨﻈﺮة اﳌﺘﺒﴫ ﻟﻠﺸﻌﻮب اﻟﺮاﻗﻴﺔ.
Mr. Jamal El Hajj president of the Lebanese Dental Labaratories Association offering a trophy to Dr. Hashem Kassem MP.
Mr. Elias Sabbagh president of the congress
Handing the trophy to Col. Bahjat Manasir from Jordan
Mr. Max Basshart MDT from Switzerland
58 58 Dental News, Volume XIX, Number II, 2012 pictures from the opening ceremony
PICTURES FROM THE EXHIBITION
Willi Geller paid a one-day visit to the headquarters of Ivoclar Vivadent AG in the Principality of Liechtenstein. The discussions conducted on the occasion served the purpose of exchanging ideas and experiences. Current market trends and new technologies were at the centre of the discussions. Particular attention was given to the pros and cons of traditional and state-of-the-art techniques, which were weighed
up against each other. Mr Geller emphasized the great responsibility of the dental industry within the context of introducing new products, as the high esthetic and functional requirements placed on dental restorations today need to be met. He also used his visit to obtain information about the products of the IPS e.max system from Ivoclar Vivadent, in particular about the esthetic possibilities opened up by these materials. The discussions, which took place in an informal setting, were characterized by a cooperative spirit and mutual appreciation. www.ivoclarvivadent.com 59
Willi Geller visits Ivoclar Vivadent
Lebanese Dental Laboratory Show 7th scientiďŹ c congress
UNESCO palace, Beirut, May 18 - 20, 2012
MORE PICTURES AVAILABLE ON
www.facebook.com/dentalnews1
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AEEDC 60 2012
Ribbon Cutting of the Technical exhibition
esentatives of dental societies and ministries of health
Dental News, Volume XIX, Number II, 2012
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ﻃﺐ اﻷﺳﻨﺎن : ﻣﻦ ﻛﻠﻤﺔ اﻷﺳﺘﺎذ ﻧﺒﻴﻞ أﺳﻤﺮ ﻣﺪﻳﺮ ﻣﻌﻬﺪ ﻣﺨﺘﱪات ّ
إﺳﻤﺤﻮا ﱄ ﺑﺪاﻳ ًﺔ أن أُ َﻋ ﱢ َﱪ ﻋﻦ ِ ﺧﺎﻟﺺ ﺷُ ﻜﺮي واﻣﺘﻨﺎين ﻟﺤﻀﻮ ِرﻛُﻢ اﻟْ َﻤ ْﻴﻤﻮن ﺑﻴﻨﻨﺎ ﰲ ﺣﻔﻞ اﻓﺘﺘﺎ ِح اﳌﺆمت ِﺮ اﻟ ِﻌﻠ ِﻤ ﱢﻲ ﰲ َﴏ ِح اﻟﺠﺎﻣﻌ ِﺔ اﻷﻧﻄﻮﻧ ّﻴﺔ. ﻛﻞ أﻋامﻟِﻨﺎ وﻣﺒﺎدراﺗِﻨﺎ وﻟﻘﺎءاﺗِﻨﺎ اﻷﻛﺎدميِﻴّ ِﺔ ﻓﻬﺬا ﺟﺰ ٌء ِﻣ ْﻦ ﻣﻌﻨﻰ ﻋﲆ ﱢ ُﻀﻔﻲ ً أَ ْن ﻧ َ ﻓﻠﺴﻔ ِﺘﻨﺎ اﻷﻛﺎدميﻴّﺔ .ﻫﺬه اﻟﻔﻠﺴﻔ ُﺔ ﺗﻮﺿَ ُﻊ ﰲ ﺧﺪﻣ ِﺔ أﺟﻴﺎﻟِﻨﺎ ِ اﻟﻨﺎﺷﺌَ ِﺔ وﰲ ﺑﻨﺎ ِء ﻣﺠﺘﻤﻊٍ ﴫ ﻫﻤﻮ ُﻣ ُﻪ واﻫ ِﺘامﻣﺎﺗ ُ ُﻪ ﺑِﺎﻟﺘﱠ ْﻘ ِﻨ ّﻴ ِ ﺎت اﻟﺤﺪﻳﺜ ِﺔ ﻓَ َﺤ ْﺴﺐ ،ﺑﻞ ﺑﺎﻷﺧﻼﻗ ّﻴﺎت ﻣﺘﻘﺪﱢمٍ ﻻ ﺗﻨ َﺤ ِ ُ اﻟﺼﺎﻟِ َﺤﺔ .ﻧﺤﻦ ﻻ ﻧ ِ واﳌ ِ ُﻔﺎﺧ ُﺮ مبﻌﺮﻓ ِﺘﻨﺎ اﻟ ِﻌﻠ ِﻤ ّﻴ ِﺔ ،وﻻ ﻧَ ْﻨﺘَ ِﻘ ُﺺ ﻣﻦ ﺗﻘﺪﱡمِ اﻵﺧَﺮﻳ َﻦ ُﻮاﻃﻨ ّﻴ ِﺔ ّ ِ ِ ﰲ اﳌﺠﺎﻻت ِ ﻳﺘﻜﺎﺗﻒ أﺑﻨﺎؤ ُه وﻳَﺘﺂﻟَﻔﻮ َن ﻟام ﻓﻴﻪ ﺜﺎﱄ ُ ﻧﻔﺴﻬﺎ ..إ ّن اﳌﺠﺘﻤ َﻊ اﻟﺠﻴﱢ َﺪ واﳌ ِ ﱠ ﻣﺼﻠﺤ ُﺔ اﻟﻮﻃﻦِ واﻟﺨ ُري اﻟﻌﺎ ّم .وإ ّن اﳌﺠﺘﻤ َﻊ اﻟﺠ ﱢﻴ َﺪ أﻳﻀﺎً ،ﻳﻀَ ُﻊ أﺑﻨﺎؤ ُه اﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ِﺐ أَ ْن ﺗﺴﻌﻰ واﻟﻌﻠ َﻢ ﰲ ﺧﺪﻣ ِﺔ اﳌﺤﺮوﻣ َني واﳌﺤﺘﺎﺟني .واﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﻋﲆ ﺗﻨ ﱡﻮ ِﻋﻬﺎ ﻳَﺠ ُ اﻟرث ِ ِ دامئﺎً ﻣﻦ أﺟﻞِ ﺗﺤﺴ ِني ﻧﻮﻋﻴّ ِﺔ اﻟﺼ ّﺤ ِﺔ واﻟﺘﻌﻠﻴﻢ ،ﻻ ﻣﻦ أﺟﻞِ ﺗﻜﺪﻳﺲ ﱠ وات اﻟﺘﻲ ﻻ ﻧﻔ َﻊ ﻣﻨﻬﺎ إ ْن مل ِ ﺗﺼ ْﻞ إﱃ اﻟﻔﺮ ِد ،أو إ ْن مل ﺗ ُﻔ ﱢﺮ ْج ﻋ ْﻦ ُﻣﺤﺘﺎج .وﻫﻞ ﻳﺎ ﺗُﺮى أﺧﺬَتِ اﻻﻛﺘﺸﺎﻓﺎت واﻹﺑﺮ ِ ِ اﻣﺎت اﻟﻌﻠﻤﻴﺔ؟ وﻫﻞ أﻧﺒﻞ ﰲ ِﺧﻀَ ﱢﻢ وﻣﻌﻨﻰ َ أﻓﻀﻞ اﻟﺤﻴﺎ ُة ﺳري ًة َ ً اﻟﺤﺮوب واﻧﺘﻬﺖ اﻟﻨﺰاﻋﺎت؟ ﺗﻀﺎ َءﻟ َْﺖ ُ ﻛﻞ زﻣﻼيئ ﰲ ﻣﻬﻨﺔ »ﻣﺨﺘﱪات اﻟﺼ َﺪ ِد أ ْن أو ﱢﺟ َﻪ ﺗﺤﻴّ َﺔ ﺷﻜ ٍﺮ وإﻛﺒﺎ ِر إﱃ ﱢ ﻻ ﺑ ّﺪ ﱄ ﰲ ﻫﺬا ﱠ اﻷﺳﻨﺎن« ،ﻫﺆﻻ ِء اﻟﺬﻳﻦ ﻳﻌﻤﻠﻮ َن ﰲ اﻟْﺨﻔﺎ ِء ﺑ َني آﻻﺗِ ِﻬ ْﻢ وأدواﺗِ ِﻬ ْﻢ ٍ ﺑﺠﻬﺪ وﻛَ ﱟﺪُ ،ﻣﻘ ﱠﻴﺪﻳ َﻦ ٍ ﻇﺮوف ﺿﺎﻏﻄ ٍﺔ وﺑﻼ ﻣﺒﺎﻻ ٍة ﰲ أﻛرثِ اﻷَﺣﻴﺎنِ ،وذﻟﻚ ﻣﻦ أﺟﻞ إرﺿﺎ ِء وﻣﻨﻌﺰﻟ َني ﰲ ِﻇ ﱢﻞ ﺗﻄ ﱡﻮ ِر اﳌِﻬﻨ ِﺔ وﺗﻘ ﱡﺪ ِﻣﻬﺎ ،وﻣﻦ أﺟﻞِ إرﺿﺎ ِء اﻷﻃﺒّﺎ ِء واﳌ َﺮﴇ. أﺻﺤﺎب اﳌﻌﺎﱄ واﻟﺴﻴﺎدة واﻟﻨﻴﺎﻓﺔ ،أﻳّﻬﺎ اﻷﺳﺎﺗﺬ ُة اﻟ ﱡﺰﻣﻼء ،واﻟﻀﱡ ُ ﻴﻮف اﻟﻜﺮام اﻟﺼﻠﺒ ِﺔ وأﻣﺎﻟِﻜُﻢ اﻟﻜﺒري ِة وﺟﻬﻮ ِدﻛُﻢ اﻟﺤﺜﻴﺜ ِﺔ ﻣﻦ أﺟﻞِ إﻛام ِل ﻧﺤﻦ ﻣﻘﺘ ِﻨﻌﻮ َن ﺑﺈرادﺗِﻜُﻢ ﱠ اﻟﱪاﻣ ِﺞ اﻟﻮﻃﻨ ّﻴ ِﺔ ﰲ ﻣﺠﺎﻻت اﻟﺼ ّﺤ ِﺔ واﻟﱰﺑﻴ ِﺔ ،وﻧﺘﻄﻠّﻊ إﻟﻴﻬﺎ ﺑﺎﻋ ِﺘﺰاز ،وﻧﺆا ِز ُرﻛُﻢ ﰲ َ وﺳﻮف ﺗﻨﺒَ ِﺜ ُﻖ ﻣﻦ واﻟﺨﺎص. ﺗﺤﻘﻴﻘﻬﺎ .ﻓﻨﺤﻦ ﻧُﺆ ِﻣ ُﻦ ﺑﺎﻟﴩاﻛ ِﺔ ﺑ َني اﻟﻘﻄﺎ ِع اﻟﻌﺎ ﱢم ّ ِﺣﻮاراﺗِﻨﺎ وﺗﻌﺎﺿﺪﻧﺎ وﻟﻘﺎءاﺗِﻨﺎ اﻟﻌﺪﻳﺪة ،ﺑﺈذن اﻟﻠﻪ ،ﺳﻴﺎﺳﺎتٌ وﻃﻨﻴّﺔٌ ،وﺣﻜﻮﻣﻴّﺔٌ، وﺟﺎﻣﻌ ّﻴ ٌﺔ ِ ﻣﻨﺼﻔ ٌﺔ وﺧﻼّﻗﺔ .ﻣﻨﺼﻔ ٌﺔ ﰲ ﻋﻤﻠِ ﱠﻴ ِﺔ ﺗﻮزﻳﻊ اﳌﻮار ِد اﻟﻮﻃﻨ ّﻴ ِﺔ اﳌ ُﺘﺎ َﺣﺔ .وﺧﻼّﻗ ٌﺔ ﻋﲆ ﻣﺴﺘﻮى اﻟﻔﺮ ِد واﻟﺠامﻋﺎت.
Mr. Nabil Asmar Director of the Dental Technician Institute
Mr. Jamal El Hajj President of the Lebanese Dental Laboratories Association
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Picture from the opening ceremony
Dental News, Volume XIX, Number II, 2012
Beauty. Versatility.
Performance.
INTRODUCING Sultan Healthcare introduces VersaCOMPâ&#x201E;˘, a complete line of restorative materials that offers easy handling, versatility and clinical performanceâ&#x20AC;Śall at a great price. The result is the ideal combination of performance and value.
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AFTER
VersaCOMPâ&#x201E;˘ Universal Hybrid Composite
VersaCOMPâ&#x201E;˘ Flowable Composite
VersaCOMPâ&#x201E;˘ Universal Total Etch Adhesive
(ACKENSACK !VENUE TH &LOOR s (ACKENSACK .* 53! s 0HONE s &AX s SULTANHEALTHCARE COM
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The Minister of health Mr. Hasan Khalil and the president of the university P. Germanos Germanos Inaugurating of the technical exhibit
P. Germanos offering the trophy to Pr. Mounir Doumit
Dental News, Volume XIX, Number 2012 to Pr. Khaldoun Al Rifai P. Germanos offering theII, trophy
P. Germanos offering the trophy to Mr. Jamal El Hajj
PRESSRELEASE ZOOM Advanced Power System Fast, Effective Results
In our “I want it yesterday” society, patients are requesting faster results. This has been a challenge with whitening because of often time-consuming and inadequate isolation methods, as well as weak chairside bleaching lights. A “Whiter” Paradigm Discus Dental introduced a chairside system that combines the Zoom Advanced Power Lamp with Zoom 25% hydrogen peroxide in-office bleaching gel to provide easier chairside whitening. The gel works in combination with the Zoom lamp technology. The gel is dispensed from a patented, dual-barrel syringe that auto-mixes a 32% hydrogen peroxide gel with a high pH booster gel, producing a 25% hydrogen peroxide gel. To Light or Not to Light? Light activation of bleaching gels has long been debated. Some studies with other chairside whitening units have demonstrated minimal, if any, noticeable differences in whitening when comparing teeth treated with the same bleaching gel without a chairside light. One drawback to chairside whitening has been redarkening after treatment. Recent studies have shown that Zoom gel used with the Zoom lamp works better than gel alone. Researchers at Loma Linda University have found that immediately after treatment teeth whitened with the Zoom System (lamp and gel) are 48% whiter than teeth whitened with gel alone. This conclusion was supported by Ontiveros and colleagues at the University of Texas Dental Branch Houston. Even 1 week after treatment, teeth whitened with the Zoom System remain 35% whiter than those whitened with gel alone. Solving the Sensitivity Issue Another drawback to chairside whitening is sensitivity as teeth rehydrate. Some patients demonstrate increased sensitivity after chairside whitening, especially those who have sensitivity before the procedure or have root exposure and enamel wear. The Zoom System uses a sensitivity protocol to maximize patient comfort. This includes the application of Relief ACP Oral Care Gel, which acts as a desensitizing agent that can be applied in trays or with a toothbrush. CLINICAL TIPS Successful Chairside Whitening with Zoom Advanced Power System 1. Isolation is critical because chairside whitening solutions typically use hydrogen peroxide bleaching gel, which is stronger than carbamide peroxide and can cause soft-tissue damage if it comes in contact with the gingiva or lips. Lip and tongue retractors, such as Discus Dental’s IsoPrep Retractor and Liquidam light-curable dam, can completely isolate the soft tissue
from contact with the bleaching gel and exposure to the chairside whitening lights. 2. The whitening gel should be applied in a 1-mm to 2-mm thick layer over all tooth surfaces that will be whitened to ensure that adequate bleaching gel is present to whiten teeth when the light is applied. To avoid spreading the bleaching gel onto the soft tissue or under the isolation, remove the gel from the teeth using a surgical suction tip (now included in the new redesigned Zoom kit) after each 15-minute session. Avoid using the air/water syringe because this can dislodge the isolation and push bleaching gel onto the soft tissue. Any remaining gel can be removed with moist gauze. 3. Tooth sensitivity can be addressed by having the patient use a desensitizing agent. The Zoom System includes a unique Patient Post Care & Maintenance Kit that includes a syringe Relief ACP (Discus Dental). Relief ACP can be administered in either a take-home tray or applied with a toothbrush daily for 10 to 30 minutes. 4. Application of vitamin E oil to the lips before beginning whitening will minimize irritation. 5. Patients also should be advised that consuming coffee, tea, or red wine or smoking during the first 2 hours after chairside whitening can lead to staining and darkening of the teeth. It will take about 2 hours for a pellicle to reform on the enamel surface. 6. To maintain and further enhance the chairside whitening results, it is advisable to fabricate take-home trays to be worn by the patient for 30 minutes weekly. The Zoom System provides whitening maintenance with either NiteWhite ACP or DayWhite ACP take-home whitening gels, also conveniently found in the Patient Post Care & Maintenance kit. Author information: Dr. Kurtzman is in private general practice in Silver Spring, MD, USA and is a former Assistant Clinical Professor at the University of Maryland, Department of Endodontics, Prosthetics and Operative Dentistry. He has lectured nationally and internationally on a variety of dental topics and has published over 230 articles. He is on the editorial board of numerous dental publications and has been recognized annually since 2006 as one of the “TOP CLINICIANS IN CE” by Dentistry Today. Dental News, Volume XIX, Number II, 2012
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Gregori M. Kurtzman, DDS, MAGD, FPFA, FACD, FADI, DICOI, DADIA
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PICTURES FROM THE EXHIBITION
Dental News, Volume XIX, Number II, 2012
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HIGH QUALITY 36 MONTHS GUARANTEE BEST PRICE
SOLE BA B CLASS steam sterilizing system
tr dent
TRIDENT S.r.l. via Verdi, 20 - 20090 ASSAGO - ITALY t.+39 02 87072380 - fax.+39 02 87072381 www.trident-dental.com info@trident-dental.com
Dedicated to dental imaging
WHO CARES?
Mectron Sinus Physiolift Mectron has recently brought out on worldwide market a new surgical kit for indirect maxillary sinus lifts. The Sinus Physiolift® is used with the crestal technique elevating the Scheneiderian membrane with an innovative screw-lift and hydrodynamic pressure. This new technique, developed in scientific collaboration with Dr. Rosario Sentineri, allows the Schneiderian membrane to be detached in a safe and intuitive manner. The technique involves the introduction of a pressurized physiological solution into the implant site, through a dedicated instrument (Physiolifter) which allows a micrometric control of the hydraulic pressure. Moreover, once the implant site has been prepared with the piezoelectric technique, an appropriate sinus elevator (CS1) is introduced up to the basal cortex, which helps keep the system watertight during the membrane elevation.
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The new Sinus Physiolift technique is not traumatic for the patient since it does not involve osteotomes and a hammer. A flapless approach may be used if a primary stability higher than 40Ncm is expected.
Under the heading “All-Ceramics meets Implant Esthetics”, Ivoclar Vivadent will hold an International Expert Symposium in Berlin on Saturday, 15 September 2012. The symposium is aimed at dentists and dental technicians. For more information please contact: Jutta Nagler Ivoclar Vivadent GmbH Professional Services Dr. Adolf-Schneider-Str. 2 73479 Ellwangen Germany Phone +49 (0) 79 61 889 205 Fax +49 (0) 79 61 6326 E-mail: Jutta.nagler@ivoclarvivadent.com
Multiple implant placements can be performed too: the sinus Physiolift technique does not require a vestibular access thanks to the introduction of a second sinus elevator. A dedicated sealed tube closes the first sinus elevator, to avoid pressure loss during the second membrane elevation. Sinus Physiolift: safe, simple and fast!
www.mectron.com
CARESTREAM DENTAL CARES We consider it vital that we have remained focused on dental imaging. By drawing on a century of experience, leadership and continued learning, we can provide oral health professionals the world over with the very best imaging and diagnostic solutions, which enhance their workflow and optimize patient care. We used to be known as Kodak Dental Systems, now we’re Carestream Dental – the global leader in dental imaging. visit carestreamdental.com
Pola day and Pola Night Pola Day and Pola Night will make them feel wonderful from the moment they purchase their kit! Pola Day and Pola Night are available in sophisticated cosmetic style packaging. Your patients will feel like they are treating themselves! Pola Day is available in 3%, 6%, 7.5% and 9.5% hydrogen peroxide and Pola Night is available in 10%, 16%, 18% and 22% carbamide peroxide. Pola Day’s and Pola Night’s neutral pHs ensure the full power of the peroxide is released without jeopardizing patient comfort. The unique blend of soothers and conditioners inhibits plaque formation, and aids in calcium absorption to further reduce sensitivity and
ion loss from the enamel. The high water content reduces dehydration of the enamel and decreases patient sensitivity. The addition of fluoride enables remineralization of the tooth surface to further prevent sensitivity during and after bleaching. The high viscosity gel ensures it can be easily and securely placed into the tray and will remain in the tray for the entire procedure. The pleasantly flavored spearmint gel is both fresh and long lasting. Pola Day and Pola Night are available in single syringe refills, 4 syringe kits, 10 syringe kits and 50 syringe kits. For further information, please contact SDI Limited: www.sdi.com.au
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Having whiter teeth can increase a patient’s self-confidence and body image. From the first purchase onwards, your patient wants to feel good. They want to feel like they have been to a cosmetic counter or a beautician, not a pharmacy or a dentist.
RESTORATIVE DENTISTRY
Direct Restoration of Lower Anteriors with COMPONEER
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Direct Restoration
Dr. Georg Rüscher Alois.Ruescher@coltene.com
After the patient’s upper jaw has been fitted with a model cast prosthesis, it is desirable to make corresponding aesthetic corrections to the lower anteriors. For the patient, the costbenefit relationship is of primary concern here. COMPONEER, a product newly launched by Coltène/Whaledent, makes costoptimised treatment possible. The following case involves the use of prefabricated Composite Veneers to do direct restoration work on lower anteriors with significant abrasion and fillings in need of repair (Fig. 1 + 2). In order to match the colouring of the COMPONEER treatment as closely as possible to that of the restored area, colour selections are made at the very beginning, using the intact, discolouration-free ceramic restoration work as a guide. As the dentine is darker in colour than the dentine colours included in the kit, the corresponding SYNERGY D6 composite line’s comprehensive colour key is a useful aid. Dentine colour selection is followed by determining the appropriate enamel colour – here, Dentine A3.5 and a Universal Enamel have been chosen. By laying the enamel shell on top of the dentine core, the selected colours can be checked and it is easier to imagine the end results (Fig. 3). A rubber dam can now be placed over the lower anteriors. Discolouration is removed using an air abrasion tool (Fig. 4), after which an appropriate COMPONEER is selected (here, Size M) using the Contour Guide (Fig. 5). In order to achieve an optimal end result, the insufficient, discoloured fillings are replaced with a suitable composite (SYNERGY D6 Dentine) (Fig. 6). Dental News, Volume XIX, Number II, 2012
fig. 1
fig. 2
fig. 3
fig. 4
fig. 5
fig. 6
Figure. 1: Initial condition of the lower anteriors to be restored. Figure. 2: Detail view of lower anteriors prior to treatment. Figure. 3: Colour selection using the SYNERGY D6 colour key. Figure. 4: Removal of discolouration with air abrasion tool. Figure. 5: Size selection using the COMPONEER Contour Guide. Figure. 6: Replacement of unsatisfactory filling.
RESTORATIVE DENTISTRY
fig. 7
fig. 8
fig. 9
fig. 10
fig. 11
fig. 12
surfaces of the COMPONEER shells are conditioned. The microretentive interior surfaces make mechanical pre-treatment of the veneers unnecessary. Etchant Gel S is first applied and spread evenly, then sprayed off and dried after the prescribed application time has elapsed. After this, enamel and dentine areas as well as interior COMPONEER surfaces are pre-treated with «One Coat Bond» which displays exceptional wettability on the surfaces being treated (Figs. 10 + 11). The thin layer of Bond on the interior COMPONEER surfaces is not light-cured. Highly viscous composite is then applied to the conditioned interior COMPONEER surfaces and distributed evenly (Fig. 12). The MB5 modelling instrument is highly suitable for this purpose, as it has an exceptionally straight working end as well as a very thin, precise spatula end. The COMPONEER is held in place with a pincette and rested against a base during the application process. The composite can be applied to the tooth as well (Fig. 13). The COMPONEER is now placed onto the appropriate tooth using light pressure, and a gentle lateral motion if necessary, and is finally positioned with the help of the Placer – a particularly innovative instrument (Fig. 14). In order to ensure proper axial alignment of the front teeth, it helps to place the two incisors simultaneously.
fig. 13
fig. 14
fig.15
fig. 16
Figure: 13. Application of SYNERGY D6 to the tooth. Figure: 14. Positioning the COMPONEER using the Placer. Figure. 15: Light-curing of lingual side. Figure. 16: Finishing the edges (ProxoShape file).
Dental News, Volume XIX, Number II, 2012
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As with traditional veneer preparations, dental substance reduction is usually necessary in order to create enough space for COMPONEER (Fig. 7). However, preparations can be designed so as to taper supragingivially. To create a homogeneous surface effect, it is best to create sufficient space to ensure that the inner COMPONEER surfaces are covered with an even layer of the solid composite material. Before the selected COMPONEER is removed from the blister pack, the label on the back can be removed and archived in the patient’s file for documentation purposes (Fig. 8). If necessary (as here), a rough disc can be used to make form corrections to COMPONEER (Fig. 9). To ensure a precise fit, the individualised COMPONEER shells are placed onto the prepared tooth surfaces before being permanently fixed. At this point, it is still possible to make minor shape corrections by sanding. For improved adhesion, tooth surfaces can be roughened using a sand blaster (50-micron aluminium oxide grains) before etching. The teeth are then separated using plastic matrices. Interproximal contact points keep the matrix bands in place without trouble; for gapped teeth, the matrices can be affixed to lingual surfaces using composite (Flow) and held in the desired position. After separation, the tooth surfaces and the interior
Direct Restoration
Figure. 7: Minimal dental substance reduction. Figure. 8: Removable label for patient file. Figure. 9: COMPONEER individualisation. Figure. 10: Application of One Coat Bond to the interior surface of componeer. Figure. 11: Application of One Coat Bond to dentine and enamel areas. Figure. 12: Distribution of SYNERGY D6 out to the edges.
RESTORATIVE DENTISTRY
fig. 17
fig. 18
fig. 19
fig. 20
Figure. 17: Polishing (SwissFlex polishing disc). Figure. 18: Finishing in approximal area (SwissFlex polishing strips). Figure. 19: Burnishing surfaces(Composhine Plus Polisher). Figure. 20: End results with COMPONEER. Figure. 21: Detail view of lower anteriors after treatment. fig. 2 Before
Only then is the excess composite trimmed away using the MB5 modelling instrument. After checking the final position once more, the composite is lightcured (Fig. 15). SYNERGY D6 Composite Material allows sufficient time to position the COMPONEER. This makes it especially advantageous when treating lower teeth: immediately after the individual enamel shells have been fitted, occlusion can be checked and any necessary sanding can be done. Once all COMPONEER have been applied, excesses are removed (wherever applicable), and the edges are finished using appropriate rotating instruments and ProxoShape files (Fig. 16) as well as flexible discs (Fig. 17). Finishing and polishing strips with progressively finer grain sizes are available for approximal spaces (Fig. 18). Finishing and polishing are done with composite polishers and brushes using the established methods. Using COMPONEER in anterior restoration work makes it possible to achieve aesthetically attractive results in a reasonable amount of time (Figs. 20 + 21). In COMPONEER, Coltène/Whaledent has provided dentists with a well-designed, easy-to-use direct veneering system which supplements and enriches our spectrum of treatment options in a practical way. fig. 21 After
88 Years of Innovation in Dentistry
ULTRADENT Anniversary
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The future of dental manufacturing is in the best of hands. ULTRADENT was founded in Munich 88 years ago. Still located in Munich, the dental manufacturing company has set new standards through its many ideas and original concepts, and is a leader in the field of dental-medical equipment. Praxisoriented design and the introduction of innovative technologies are still essential requirements for product development. Programmed with an eye to the future. In Brunnthal instruments for dental medicine are developed through craftsmanship and with a great depth of production; not only are they remarkable because of excellent quality, carefully selected materials, and practice-oriented design, but they also assure ergonomy and efficiency for the individual practice. In addition to compact treatment units for general dentistry, the product line also includes special units for orthodontics, implantology, endodontics, surgery and paediatric dentistry. Ergonomic dentistâ&#x20AC;&#x2122;s chairs, OP-lights, integrated small instruDental News, Volume XIX, Number II, 2012
ments, a multimedia system, and a concept for modernizing the practice round out the range of products.
COMPONEER
™
Surprise your patients with a new smile – in only one session! Innovative. Time-saving. Surprisingly easy. COMPONEER is the Direct Composite Veneering System used for quick, easy and save restorations of single or multiple teeth. This offers new perspectives for you and your patients. So both of you have a reason to smile. www.componeer.info
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THE SMILE TO GO.
COMPONEER™ benefits: No laboratory required | One session | Naturally aesthetic corrections using freehand technique | Easy application with prefabricated composite veneers | Brillant result | Attractive added value
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www.coltene.com/contact
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DEPURDENT® cleaning and polishing paste for a brilliant smile % Free from chemical bleaching substances, preservatives and enzymes % Eliminates easily plaque and stains of tea, nicotine, coffee and fruits % Contains the natural active ingredient pumice % For professional and home use
DEPURDENT® Mouthrinse - The perfect 80
supplement to DEPURDENT® cleaning and polishing paste! % Its special formula prevents the formation of plaque and stains and helps to retain the natural white color of the teeth. % Fluoride protects against caries. % Refreshing taste for long-lasting fresh breath.
Dr. Wild & Co. AG
www.wild-pharma.com
New Swiss professional oral care
Dr. Wild’s Mideast Regional Office: Actco, P.O. Box 40746, Larnaca 6306, Cyprus, Tel.: (24) 623515 / 654252, Fax: (24) 623844. E-Mail: joeissa@yahoo.com
Bahrain: Awal Pharmacy, East Riffa, Bahrain. Egypt: Sesic, Alexandria. Kuwait: Al-Maseela Pharmaceutical Co., Safat. Lebanon: A.M.G. Medical.JdeidehNews, VolumeIbn XIX, Sina Number II, 2012 L.L.C., Muscat. Qatar: Ahmed Khalil Al Baker & Sons, Doha. Saudi Arabia: Depot Pharmaceutique du Moyen OriAzur Dental Center Oman: Pharmacy ent, Jeddah. Sudan: Pharma Care Co, Khartoum. United Arab Emirates: Al Hayat Pharmaceuticals, Sharjah. Yemen: Al Rawdha Trading Group, Sana’a.