Dental News March 2019

SIDC 2019 AEEDC 2019 IPG-DET Technique March 2019

Management of Dental Fluorosis Stains

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IPG-DET Technique: Innovative Approach of Implant Placement and Grafting in the Sinus A Reliable Alternative to Sinus Floor Elevation (SFE)

56. Greater New York

Panagiotis I. Georgakopoulos, Francesco Inchingolo, Gianna Dipalma, Giuseppina Malcangi, Tiziano Batani, Ioannis P. Georgakopoulos

58. Lebanese Society

Dental Meeting

November 29 - December 4, 2018 New York, United States

of Prosthodontics January 11 - 12, 2019 Hilton Metropolitan Palace Beirut, Lebanon

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Causes of Complete Dentures Renewal

60. SIDC 2019 January 12 - 14, 2019 Ritz Carlton, Saudi Arabia

Héla Haloui, Oumaima Tayari, Jaouadi Jamila, Ali Ben Rahma

68. AEEDC 2019 February 5 - 7, 2019 Dubai, United Arab Emirates

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Biological & esthetic management of enamel white discoloration: Erosion infiltration technique

76. Lebanese Society

of Endodontology February 8 - 9, 2019 Hilton Metropolitan Palace Beirut, Lebanon

Hana Sarraj, Emna Hidoussi, Neila Zokkar

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

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

Antonine University Dental Meeting

March 29, 2019 Palais des Congrès Dbayeh, LEBANON www.ua.edu.lb

IDEX Istanbul 2019

April 11 - 14, 2019 Istanbul, TURKEY www.cnridex.com

14th CAD/CAM & Digital Dentistry Conference

April 12 - 13, 2019 Jumeirah Dubai, UAE www.cappmea.com/digital-dentistry

Lebanese University 16th International Convention

May 2 - 4, 2019 Lebanese University Hadath, LEBANON www.fdmcongress.ul.edu.lb

Expodental 2019

May 12 - 16, 2019 Rimini, ITALY www.expodental.it

AIO 2019 International Congress

June 13 - 15, 2019 Chia, Sardinia, ITALY www.congressaio.it

Beirut International Dental Meeting

October 3 - 5, 2019 Forum de Beyrouth, LEBANON www.bidm-lda.com

Digital Dentistry Society Global Conference

October 3 - 6, 2019 Baden Baden, GERMANY www.digital-dentistry.org

CADEX Central Asia Dental Expo

October 17 - 19, 2019 Almaty, KAZAKHSTAN www.cadex.kz

Moroccan Dental Meeting

October 31 - November 2, 2019 Marrakesh, MOROCCO www.moroccandentalmeeting.com

Greater New York Dental Meeting

December 1 - 4, 2019 New York, USA www.gnydm.com

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IPG-DET Technique: Innovative Approach of Implant Placement and Grafting in the Sinus Oral Surgery Panagiotis I. Georgakopoulos 2,4

Francesco Inchingolo 1,4

Gianna Dipalma 1,4

Giuseppina Malcangi 3,4

Tiziano Batani 4

Ioannis P. Georgakopoulos 3,4 dentisteduipg@gmail.com

1. Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Italy 2. University Alfonso X El Sabio, Dental School, Madrid - Spain 3. Medicine school, University of Bari “Aldo Moro”, Italy 4. World Academy of Growth Factors & Stem Cells in Dentistry (WAGRO)

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A Reliable Alternative to Sinus Floor Elevation (SFE) Minimally invasive sinus grafting and implant placement without sinus floor elevation (SFE) by using autologous CGF (Concentrated Growth Factors) and Stem Cells CD34+ but with intentional perforation of the sinus membrane.

Abstract This article describes the placement of 84 implants in the posterior maxillary areas of 37 patients utilizing minimal invasive surgery. Following a certain protocol, the implants were introduced in to the sinus with intentional perforation of the Schneiderian membrane. Concentrated Growth Factors (CGF) and Novocor-Plus bone graft material (B&B, Italy), were used in these cases.

At various stages during osseointegration, radiological examination was performed to assess the increase and maturation of bone structure formed around the implants and over the sinus floor. This unexpected event allowed the sinus membrane to reconstruct over the newly formed bone, proving how well an individual is capable of adapting under new conditions.

Introduction Partially or completely edentulous patients typically prefer an implant supported fixed denture. During treatment planning, it is often observed that SFE may be required in order to acquire the desired alveolar

ridge dimensions necessary to achieve in the implant initial stability and long term success. Previous investigations have reported maxillary sinusitis up to 20 percent of patients following SFE procedures. The complications of SFE predominantly consist of disturbed wound healing, haematoma, sequestration of bone and transient maxillary sinusitis.

Postoperative acute maxillary sinusitis even cause implant and graft failure.

The task for the dental practitioner placing the dental implants can be much simplified by using IPG-DET Technique providing great relief for patients if another expensive surgical procedure like SFE can be avoided.

At first glance, an uneventful and unexpectedly fast placement of implants in the sinus cavity with intentional perforation of the sinus membrane would appear to have uncertain success and many other post-operative complications.

The authors present the innovative IPG-DET Technique, which will demonstrate that SFE is no longer considered necessary.

The combined employment of CGF (and Stem Cells CD34+) and bone grafting material within the osteotomy site by means of implant immersion was made in such a manner that the sinus can adapt to new conditions, which is, to form new bone around implants without the need to perform SFE. Implant placement has been done by utilizing minimal invasive surgery.

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Oral Surgery

The IPG-DET Technique: Innovative Approach of Implant Placement and Grafting in the Sinus

New bone was seen to have formed around all 84 implants placed in the sinuses. This was radiographically evaluated with panoramic x-ray and cone beam CT scans.

Aim Quick placement of implants in the sinus cavity by means of intentional perforation of the sinus membrane following a certain clinical protocol without performing SFE.

Materials and Methods Thirty-seven patients (fifteen female, twenty-two male) between ages 35 and 73 needed upper jaw rehabilitation with non-removable prosthesis. The option of placing a total of 84 implants was offered to them. All of them have been informed about the clinical procedure and a written consent was signed. According to the proposed clinical protocol, all implants should be placed in a minimal invasive approach and entered each sinus with intentional perforation of the Schneiderian membrane.

Osteotomy was extended through the full bone height available. Drilling was done with the initial drill and with a 2,1 drill. Therefore the procedure are continued by using Duravit bone compactor-expanders diameter dimensions of 3 and 3,5 (B&B, Italy) until the sinus membrane was perforated.

A CGF matrix was inserted through the osteotomy site into the sinus through the membrane perforation using a fibrin injector (Silfradent, Italy). Another CGF matrix was cut into small pieces and mixed with 0,5 ml of Novocor-Plus bone material (B&B, Italy).

Novocor-Plus is a medical bone graft material made of granules of natural coral with a low surface-to-volume ratio included between 200 and 500 mm.

Fig. 3

Fig. 5

Pre-surgical procedure Prior to surgery, blood was collected from the patient using six 9ml sterile tubes, using the cell separation device Medifuge (Silfradent. Italy), according to the CGF protocol.

Surgical procedure Povidine iodine (Betadine) was used for extra oral disinfection to reduce the possibilities of microbial contamination of the surgical site. Immediately thereafter, 2 per cent lidocaine with 1:100,000 epinephrine was administered.

Fig. 1

Figure 3: CGF-CD34+Matrix autologous bio-material for using during IPG-DET procedures Figure 4: A B&B dental implant before be impregnated to the LPCGF to create a CGF bio-energetic membrane around its surface Figure 5: A B&B dental implant after be impregnated to the LPCGF with a CGF bio-energetic membrane around its surface

Madreporic coral, also known as coral hydroxyapatite, consists of 98% calcium carbonate in the form of aragonite (CaCO3), (B&B, Italy).

Fig. 2 Fig. 6

Figure 1: Medifuge device for centrifugation and blood cell separation Figure 2: Silfradent instrument for CGF membranes and LPCGF (Liquid phase CGF preparation

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Dental News

Fig. 4

Fig. 7

Figure 6: A B&B implant with CGF bio-material during the procedures of IPG-DET technique and before its placement in the Sinus. Figure 7: A CGF-CD34-Matrix bio-material during its insertion trough the site preparation with IPG-DET technique March 2019

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Oral Surgery

The IPG-DET Technique: Innovative Approach of Implant Placement and Grafting in the Sinus

Before placing each implant in the osteotomy site, it was first carefully and completely immersed into the LPCGF (Liquid Phase Concentrated Growth Factors) in order to create a bio-energetic membrane around the implant.

The LPCGF was prepared by squeezing one CGF matrix using the CGF forceps (Silfradent, Italy) and collected in a sanitized container for immersion of all implants.

The implants were then placed using a hand wrench and the insertion torque was measured to be between 20Ncm2 and 25Ncm2. Low insertion torques were expected since the bone heights at all implant sites were very low.

Fig. 8

Fig. 9

Figure 8: B&B Duravit bone compactor-expanders during IPG-DET procedures Figure 9: Pre-op panoramic x-ray detail before the immediate implant placement with IPG-DET technique

Discussion The aesthetics and functional integrity of the periodontal tissues, as well as the vertical and horizontal dimensions of the alveolar processes, are usually compromised following tooth loss. In such cases, various bone regenerative techniques are used in order to restore the alveolar processes back to their original shape, allowing for a more predictable, long-term aesthetic and functional success of the implant placed. For the maxillary posterior segments, a regenerative technique called “sinus elevation procedure” has spread widely and is taught extensively. Whether a “sinus elevation” is carried out in the same or separated day as implant placement, it makes treatment planing more complex with more treatments steps necessary. The predictability of the treatment outcome would also depend upon the operator’s experience in performing this technically demanding surgical procedure. Sinus elevation also increases both cost and treatment time required for completion of each case.

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Dental News

This procedure is generally accepted by patients when they are informed that this is the only way to restore function in the posterior maxillary area if implants are to be used. Without a doubt, patients would choose a flapless or minimal invasive and painless procedure if it was offered to them. The IPG-DET involves the use of autologous bio-material CGF-CD3+Matrix (Concentrated Growth Factors, Stem Cells 34 positive found in CGF at the top 3mm to 4 mm of the blood aggregate of the tube and CGF matrix) together with bone grafting material into the intentionally perforated sinus membrane in order to allow implant placement in the sinuses atraumatically or minimal invasive and with no sinus elevation procedures.

Fig. 10

Figure 10: Pre-op panoramic x-ray detail after the immediate implant placement with IPG-DET technique in the same patient

The authors consider the IPG-DET as an absolutely safe procedure without any postoperative complications involving the sinuses. It has been found out that platelets found in growth factors (CGF matrix), as well as in the blood circulation, possess pseudo-legs, which are projections from the platelets’ body, allowing anchorage on the surface in which they are placed or at the area where there is trauma.

Fig. 11

Figure 11: Pre-op panoramic x-ray before the immediate implant placement with IPG-DET technique in right maxilla March 2019

Oral Surgery

The IPG-DET Technique: Innovative Approach of Implant Placement and Grafting in the Sinus

Anchorage of the CGF matrix in the sinuses is also provided by platelets released after the penetration and when there is slight hemorrhage of the sinus membrane.

For this reason, once the CGF matrix is placed in the sinus, it will not be displaced away from where it is originally placed and that is why bone is regenerated locally and around the implants. As new bone is formed in the sinus, it will slowly be covered by a new sinus membrane, while the existing sinus membrane under the new bone is believed to disintegrate slowly. A positive finding of the IPG-DET was the complete absence of any post-operative complication (e.g., pain, inflammation) usually expected following placement of implants, or the multiple perforation of the sinuses.

Results Panoramic x-ray and CBCT scans showed new bone formation around the implants by means of textural image analysis. None of patients’ sinuses presented any signs of infection.

Conclusions In conclusion, our data supports the concept of onestep atraumatic or minimal invasive implant placement procedure through the sinus membrane when there is ridge deficiency and when the patient allows the procedure. IPG-DET‘s promising results demonstrate that it can be considered as a reliable alternative to the SFE procedure.

Fig. 12 It must be emphasized that when the correct protocol (IPG-DET) is used and the correct training for performing this technique has been completed, only then should this technique be attempted.

Figure 12: Post-op panoramic x-ray of the same patient 4 months after the immediate implant placement with IPG-DET technique in right maxilla

Fig. 13

Figure 13: CPCT details of the same patient Pre-op, 2 months Post-op and 4 months Post-op implant placement with IG-DET technique. On the right full osseointegration is observed.

References Future case studies and research will provide us with more information on the minimum time required to wait until uncovering implants.

Future studies are also required to determine whether the observed enhancement of bone height will be maintained over the long-term or if there will be bone loss due to remodeling.

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Dental News

1.

Georgakopoulos I. P. et all. A case-Study of Seven Implants

Placed in the Maxillary Sinus With Intentional Schneiderian’s Membrane Perforation. Journal of Implant and Advanced Clinical Dentistry, 2014; 6(1) 9-19.

2. Georgakopoulos IG, Makris N, Almasri M, Tsantis S, Georgakopoulos IP (2016) “IPG” DET Minimal Invasive Sinus Implant Placement

March 2019

and Grafting without Sinus Floor Elevation – The Evolution of New Age Concepts. Dentistry 6: 375. 2016 doi:10.4172/2161-1122.1000375 3. Aghaloo TL, Moy PK. Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement? Int J Oral Maxillofac Implants. 2007;22(suppl):49–70.

4. Buser D, Janner SF, Wittneben JG, Brägger U, Ramseier CA, Salvi GE. 10-year survival and success rates of 511 titanium implants

IT‘S MY CHOICE.

with a sandblasted and acid-etched surface: A retrospective study in 303 partially edentulous patients. Clin Implant Dent Relat Res 2012;14:839 – 851.

5. Timmenga NM, Raghoebar GM, Boering G, van Weissenbruch R. Maxillary sinus function after sinus lifts for the insertion of dental implants. J Oral Maxillofac. Surg. 1997;55:936–939.

6. Timmenga NM, Raghoebar GM, van Weissenbruch R, Vissink A. Maxillary sinusitis after augmentation of the maxillary sinus floor: a report of 2 cases. J Oral Maxillofac Surg. 2001;59:200–204.

7. Rodella LF, Favero G, Boninsegna R, Buffoli B, Labanca M, Scarì G, Sacco L, Batani T, Rezzani R. Growth Factors, CD34 positive cells

So much flexibility is unbelievable!

and fibrin network analysis in concentrate growth factors fraction.

Microsc Res Tech. 2011 Aug;74(8):772-7 8. Sohn DS, Heo JU, Kwak DH, Kim DE, Kim JM, Moon JW, Lee JH, Park IS. Bone regeneration in the maxillary sinus using an autologous fibrin-rich block with concentrated growth factors alone. Implant Dent. 2011 Oct;20(5):389-95.

9. Kim, J. W., Kim, S. J. & Kim, M. R. Leucocyte-rich and platelet-rich fibrin for the treatment of bisphosphonate-related osteonecrosis of the jaw: A prospective feasibility study. Br. J. Oral Maxillofac. Surg.

(2014). doi:10.1016/j.bjoms.2014.07.256 10. Oliveira, M. R. et al. Influence of the association between platelet-rich fibrin and bovine bone on bone regeneration. A histomorphometric study in the calvaria of rats. Int. J. Oral Maxillofac. Surg.

(2015). doi:10.1016/j.ijom.2014.12.005 11. Francesco Inchingolo, Panagiotis G. Georgakopoulos, Gianna Dipalma, Stavros Tsantis, and Ioannis P. Georgakopoulos, ‘ Immediate Implant Placement By using Bone-Albumin allograft and Concen-

ONE IMPLANT – TWO ABUTMENTS.

trated Growth factors: preliminary results of a pilot study’ Oral & Implantology, Anno XI - N. 1/2018, 47:56 12. Barbara Zitová, Jan Flusser: Image registration methods: a survey. Image Vision Comput. 21(11): 977-1000 (2003 13. Rodella LF, Favero G, Labanca M. Biomaterials in maxillofacial surgery: membranes and grafts. Int J Biomed Sci. 2011;7(2):81-8.

www.dentaurum-implants.com

Prosthodontics

Causes of Complete Dentures Renewal Abstract

Dr. HĂŠla Haloui Resident, departement of complete denture

Dr. Oumaima Tayari Resident, departement of complete denture

Prof. Jaouadi Jamila Director, department of prosthodontics j.jaouadi@yahoo.fr

During the replacement of the missing teeth, it is imperative that consideration should also be given to the amount of soft tissue which needs to be restored. A restoration can be termed functional only when it provides sufficient support to the extraoral and intraoral tissues while assisting proper speech, esthetics, and mastication.

The nursing and the medical staff in particular should be informed via appropriately designed educational materials

and other resources specific to the oral health needs of older adults.

Prosthodontic replacement aims to reach high absolute patient satisfaction with the new prosthesis as well as improvement of satisfaction when comparing new and old dentures.

Key words: Complaints, complete dentures, denture replacement, oral and general health status, Compression-molded

Introduction Conventional removable dentures still play an important role in the treatment of lost teeth. A thorough understanding of the parameters that influence patient satisfaction is useful for deciding whether denture replacement is meaningful. From a clinical perspective, factors that can be measured before starting treatment are relevant 14.

Prof. Ali Ben Rahma Head of Service, departement of complete denture

Replacement of missing teeth and the associated structures are done with the help of artificial prosthesis. Acrylic resin, by virtue of its excellent properties is widely used as a material of choice for fabrication of denture base. In spite of its higher esthetic quality, tissue compatibility and ease of manipulation, it has an inherent deficiency that it is prone to fracture. Acrylic resin, which came into market in 1950s, was widely accepted as denture base material, because of its excellent properties like good esthetic value, ease of manipulation, ease of repair and also for economical factors 12. The expectations of patients can profoundly influence treatment outcome.

Clinic of dentistry of Monastir, Department of Prosthetic Dentistry, University of Monastir, Laboratory of oro-facial rehabilitation and oral health (LR12ES11)

Many prosthetic failures may result not from technical problems but from a lack of communication between the dentist and the patient with regard to the treatment outcome. Patient education should help to create a positive attitude by informing the patient about the limitations associated with complete dentures like being placed on a resilient base and masticatory inefficiency. The patient should be motivated on ways to overcome or compensate for these problems as well as proper oral and denture hygiene9.

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A thorough understanding of the parameters that influence patient satisfaction might help to predict treatment outcome and could hence be useful in deciding whether denture replacement is helpful 13.

This paper aims to review the factors associated with an increased risk of failure in complete denture patients since identifying potential problems will help to improve outcomes for edentulous patients treated with conventional complete dentures.

Causes of renewal The clinical management of some edentulous patients can be a source of frustration for both patient and clinician as, despite the best efforts, patients remain unable to adapt to wearing the dentures that have been provided. Often the patients who fall into this category have had poor previous experience of denture-wearing and may arguably have unrealistic expectations.

Nonetheless, repeated adjustments, or even remakes, can significantly add to the cost of denture construction and this can result in a negative experience for both the clinician and the patient 11.

1. Related to health Presently, one of the major problems in dentistry is the dental care for elderly patients. In order to solve this problem, most of the developed countries have investigated the dental and general health status of their elderly. Although the health care and dental needs of the elderly are known in developing countries, there are no studies or a worldwide system to organize social services according to the needs and demands of the patients.

On the other hand, while oral disorders are rarely life-threatening, they can have a significant impact on the social and psychological well-being of elderly people. It is often assumed that improved oral health will improve the quality of life.

In older adults, this becomes more significant because many of these persons have substantial disabilities and handicaps that could impair oral care. This situation may consequently lead to poor oral health or development of oral diseases in the elderly that could become an important public health issue 15.

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Dental News

Causes of complete dentures renewal

Studies assessing both the medical and oral health of older adults are not common; clearly dental treatments are not within their priorities; In some studies it has been demonstrated that edentulous subjects have inadequate dentures ranging between 31% and 80%. It is very difficult to identify whether this was due to biological and physiological changes in the mouth or was a consequence of malpractice during denture construction 7.

2. Bases’ defaults The most common causes of denture fracture may be either extra-oral cause like fall from patient’s hand to the hard surfaces or intra-oral during function. One has to depend mostly upon the users’ version for the cause of the denture fracture. (Fig. 1, Fig. 2) Inside the mouth, fracture can happen for various reasons like improper occlusion, placement of artificial teeth in the buccal slope of the ridge or against the palate, pressure from opposing natural teeth, poor retention and stability, prolonged use causing wear of artificial teeth and resorption of residual ridge, presence of high frenal attachments, prominent mid palatine suture, palatal or lingual torus, hard or soft tissue undercut, etc.

Fig. 1

Figure 1: Bases’ fracture

Fig. 2

Figure 2: Bases instability

Fig. 2

Figure 2: lack of retention

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Prosthodontics Causes of complete dentures renewal

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Defects in the denture may also be created during laboratory procedure. This may include thin denture base, placing the artificial teeth in the buccal slope of the ridge, incorporation of metal strengtheners, inclusions like plaster or air bubbles within the material, porosity, deep scratches which act as a stress raiser and predispose the denture to fracture 12.

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Dentures have to function in a dynamic environment.

The tongue being the most versatile muscle in the body, it can be used to control the denture. Post-placement denture problems have been classified by various authors. Heartwell and Rahn classified post-placement problems as incompatibility with the surrounding oral environment, problems with mastication, disharmony with functions like speech, respiration and deglutition, dissatisfaction with aesthetics and deterioration of soft tissues or bony support 11.

Failure to recognize the cardinal importance of tooth position and flange form and contour often results in dentures which are unstable and unsatisfactory, even though they were skillfully designed and expertly constructed.

Incorrect tooth placement and arbitrary shaping of the polished surfaces may have an adverse effect on the success of the prosthesis.

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March 2019

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Prosthodontics

Causes of complete dentures renewal

One of the methods used to solve this problem is the neutral zone technique.

to abrasion of the artificial teeth and residual ridge resorption, causing esthetic complications.

The artificial teeth can then be set up in the correct positions. (Fig. 3) The basal area of the denture foundation greatly influenced the masticatory efficiency, suggesting that the masticatory efficiency in complete denture wearers was limited by their own residual ridges and patients should be informed about the limitation of the recovery of masticatory ability before the beginning of denture treatment 1.

Most patients with old dentures and incorrect OVD accept reestablishment of the OVD with new complete dentures, even if they were used to their old dentures.

For this reason, it is usually believed that changes in the OVD should be conservative and for a trial period, with an interim prosthesis if necessary. It is a gradual process that allows assessing the patient’s tolerance, esthetics, and phonetics at the proposed restored OVD 2 .

4. Occlusal defaults

Occlusal checking should be performed via a remount procedure because denture base materials and fabrication procedures cannot provide dimensionally accurate complete dentures.

A period of 6-8 weeks is necessary to establish new memory patterns for the masticatory muscles. In a study by Goiato et al. patients experienced improved masticatory efficiency after one year with their new dentures 3. Correction of the vertical and sagittal occlusal relationship by fitting new dentures has also been found to alter head and cervical spine postures significantly, to relieve signs and symptoms of CMD (cranio-mandibular disorders) and to have a positive effect on the masticatory muscles 6.

It has also been suggested that incorrect vertical dimension and centric relation were the most frequent causes of TMD (temporo-mandibular disorder).

Deflective occlusal contacts of denture teeth in centric occlusion can be eliminated by selective grinding and by tooth-guided excursive movements 15.

However, if it is found that there is a large change in the vertical dimension of occlusion, producing an open bite Fig. 5

Also, a decrease in vertical dimension contributes to cheek biting since the cheeks tend to collapse into the occlusal area.

Fig. 4

26

Figure 4: New jaw relation was taken

Figure 5: new occlusal relation after registering new and correct OVDs

Patients should be educated that the chewing efficiency of the denture wearer is less than one-sixth that of the subject with a natural dentition. The assessment and reestablishment of the occlusal vertical dimension (OVD) are considered important factors in the treatment of complete denture wearers. The long-term use of a complete denture can result in jaw displacement due

of more than 3 mm, then any adjustments to the teeth to correct this, are going to result in a complete re-shaping of the occlusal surfaces and almost certainly a complete loss of the cuspal anatomy of the teeth. The only recourse is to remove the posterior teeth, re-take the jaw registration, remount on the articulator, and set and process new posterior teeth to the correct occlusal vertical dimension.

Dental News

March 2019

Prosthodontics

Causes of complete dentures renewal

When there is a discrepancy between centric relation and maximum intercuspation the clinician must first consider the size of the error: if it is the result of an incorrect recording of the centric relation position, and if the discrepancy is no more than the width of a cusp, the dentures must be remounted on the articulator using a new jaw relationship record (a “check bite�) and the occlusion corrected on the articulator.

If the discrepancy is too large to be adjusted in this way (i.e. more than the width of a cusp), then the posterior teeth must be removed, a new jaw registration record made, the dentures must be remounted, and new teeth processed onto the base.

Finally; these new parameters can be adopted for a new complete denture 4. (Fig. 4, Fig. 5, Fig. 6)

5. Technical procedures Most dentists will have examined a patient who is perfectly happy with his/her ill-fitting, mobile and maloccluded dentures. Indeed, patient ratings for satisfaction with their dentures have been shown to change significantly over time.

This illustrates the influence of adaptive capacity on patient satisfaction with dentures, however, this should not be used as an excuse for poor prosthodontic work, as the need to rely on adaptive capacity will be minimized by producing technically correct dentures.

Fig. 6

Defaults due to technical procedures

Not all patients display such adaptive capacity.

Additionally, there is a small number of studies that demonstrate that technically correct dentures will better satisfy patients than poor quality ones 5.

The dental laboratory generally does not have detailed diagnostic and examination findings about the patient. Even if dental laboratory technicians have access to the information, they do not have the training to properly evaluate it and determine the appropriate treatment. Without a thorough understanding of biologic and physiologic principles, laboratory personnel could unknowingly place harmful forces on the patient’s dentition.

Common errors are about failing to use accurate burn out temperatures and times. If the burn out temperature is too low and the burn out time is too short, the investment will not experience enough thermal expansion. As a result, the casting may fit the definitive cast too tightly. If the burn out temperature is too high, the investment will decompose and cause the casting to be pitted and rough 10.

However if, the flask is closed too rapidly to permit the resin to flow into all spaces, unequal pressure will be exerted and tooth displacement might occur.

A classical study reported that processing dentures by long cycle in a water bath is recommended, as it causes least dimensional changes and Slow cooling inside the water bath is recommended before deflasking to avoid high residual stresses generated by thermal expansion differences between the plaster mold and denture base 8.

Figure 6

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March 2019

Conclusion Successful prosthodontic therapy is multi-factorial.

Factors which have been shown to carry a high risk of failure include: • Dentist-related factors; • Inaccurate jaw relations; • Not involving patients in aesthetic choices; • Poor impression-taking; • Patient-related factors; • Neurotic patients; • A severely resorbed ridge.

6. M. R a u s t i a , m. P e l t o l a & m . A . M . S a l o n e n Influence of complete denture renewal on craniomandibular disorders: a 1-year follow-up study Journal of Ora! Rehabilitation 1997 24; 30-36 7. Müller F, Nitschke I. Oral health, dental state and nutrition in older adults. Z Gerontol Geriatr 2005; 38: 334–341 8. Phoenix RD (1996) Denture base resins: Technical considerations and processing techniques.In Anusavice KJ, Phillips’ Science of Dental Materials.(10thedn) Philadelphia, PA, Saunders WB. pp: 237-271

It is suggested that, if these patient-related factors are present, the patient should be considered high risk for non-adaptation to new complete dentures. This should be discussed with the patient prior to commencing treatment so that expectations can be appropriately managed 12.

9. Priyanka Makhija ; dr kamal Shigli ; M C Suresh Sajjan ; Chandrasekharan Nair. Problem solving in complete dentures-An overview. C l i n i c a l D e n t i s t r y , M u m b a i • S e p t e m b e r 2 0 1 4 ;p26-32 10. Robert W. Rudd, and Kenneth D. Rudd. A review of 243 errors

Mouth preparation should be given primary importance; to minimize the possibility of fracture, E-glass fiber reinforced PMMA, visible light polymerized resin, metal reinforced resin may be used. Last, but not the least, proper instruction should be given to the patients about the careful handling of the denture, as many of them broke due to sudden fall. Patients should clean the denture within a bowl filled with water 13.

possible during the fabrication of a removable partial denture: Part II The journal of prosthetic dentistry ;p262-276 ;volume 86 number 3 11. Rahn AO, Heartwell CM. Treating Problems Associated with Denture Use. Syllabus of Complete Dentures. 5th ed. New Delhi: Harcourt Private Limited; 2003. p. 403-14.

12. Simon B Critchlow ;Janice S Ellis ; James Field. Reducing the Risk of Failure in Complete Denture Patients. Dental update · August

References

2012,427-436 13. Sampa Ray (Bhattacharya), Pradip Kumar Ray, Manabendra Makhal, Saibal Kumar Sen. Incidence and causes of fracture of

1. CHANDRA SHEKAR S. Management of a severely resorbed man-

acrylic resin complete denture. J of Evolution of Med and Dent Sci/

dibular ridge with the neutral zone technique Contemporary Clinical

eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 69/Dec 11, 2014

Dentistry | Jan-Mar 2010 | Vol 1| Issue 1 14. Stefanie Krausch-Hofmann, Line Cuypers, Anna Ivanova & Joke 2. Danny Omar Mendoza Marin and al. Reestablishment of Occlu-

Duyck, Predictors of Patient Satisfaction with Removable Denture

sal Vertical Dimension in Complete Denture Wearing in Two Stages.

Renewal: A Pilot Study. Journal of Prosthodontics (2016) 1–8 C _

Case Reports in Dentistry, vol. 2015, Article ID 762914, 5 pages, 2015.

2016 by the American College of Prosthodontists

3. Goiato MC, Garcia AR, Dos Santos DM, Zuim PR. Analysis of mas-

15. Tomislav Badel,Josip Panduric´,Sonja Kraljevic´,Niks˘ a Dulc˘ic´

ticatory cycle efficiency in complete denture wearers. J Prostho-

Checking the occlusal relationships of complete dentures via a re-

dont. 2010; 19:10-13

mount procedure

4. J. F. Mc Cord and A. A. Grant, Identification of complete den-

16. Y. Ozkan et al. General health, dental status and perceived dental

ture problems: a summary. British dental journal, volume 189, no. 3,

treatment needs of an elderly population in Istanbul. The Gerodon-

p128-134;august 12 2000

tology Society and John Wiley & Sons A/S, Gerodontology 2011; 28: 28–36 .

5. Ladha K, Tiwari B. Processing-induced Tooth Displacement and Occlusal Changes in Complete Dentures – An Overview. Periodon Prosthodon. 2015, 1:1

Restorative Dentistry

Biological & esthetic management of enamel white discoloration:

Erosion infiltration technique Abstract

Hana Sarraj* Post graduate Student sarrajhana2311@gmail.com

Emna Hidoussi* Assistant Professor minoumd@gmail.com

Neila Zokkar Professor

*Both authors contributed equally to this work

Early stage caries (White spots), fluorosis, traumatic hypomineralizations and molar incisor hypomineralization (MIH) all present to differing degree, clinical symptoms involving white marks on the enamel.

It can impact patients’ quality of life. The most conservative treatment in such cases is erosion-infiltration. This treatment using Icon® (DMG, Hamburg, Germany) is one of the most conservative and efficient protocols.

The Icon® treatment was initially proposed as a simple and minimally invasive alternative for caries treatment of initial proximal lesions, but surprisingly the technique proved a high ability to mask the white spots by modifying the refractive index of the lesion.

The proposed strategy is not based on the elimination of dysplastic enamel, but on masking the lesion by infiltrating the porous subsurface enamel with a hydrophobic resin that has a refraction index closer to that of sound enamel, after permeating the non-porous surface enamel through hydrophobic acid erosion.

This article provides an overview of different indications suitable for treatment with the technique of resin infiltration (Icon®, DMG), such as white-spot lesions (WSL), enamel fluorosis, and molar-incisor hypomineralisation (MIH) in different patients.

Key words: Infiltration, White spot lesion, Fluorosis, MIH

Introduction Clinically, early carious lesions in enamel is initially seen as a white opaque spot and is characterized by being softer than the adjacent sound enamel. It becomes even whiter when dried with air. These lesions may present a serious aesthetic problem along with the progression of demineralization 1. These white spots can be the result of different factors: early stage caries (due to plaque accumulation and bad oral hygiene) near the gingival line or around orthodontic brackets, fluorosis, medicine intake, molar incisal hypomineralization (MIH) and traumatic hypomineralization 2.

Department of Restorative Dentistr y- Endodontics , Faculty of Dental Medicine, Monastir, Tunisia

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Management of this type of white spot lesion is generally by means of topical application of Fluoride therapy, Casein-Phospho Peptide-Amorphous Calcium Phosphate pastes, Novamin (calcium sodium phosphosilicate) 3. All these treatment modalities end up in surface remineralization, but the subsurface is still porous.

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Restorative Dentistry

Erosion infiltration technique

To overcome the drawback of retaining a porous subsurface caries, resin infiltration seems to be a promising and less invasive treatment modality. In this method, the subsurface porosities are occluded by a clear hydrophobic resin applied on the surface of the conditioned lesion 5.

A reduced visibility of infiltrated WS-lesions is an additional positive side-effect, which is due to the similar refractive index of the infiltrated and sound enamel areas. This technique has been reported to remove the whitish opaque color therapy changing the color and translucency of the white lesion 7.

The resin infiltration technique prevents further progression of the lesion using a low-viscosity resin with a high penetration coefficient, filling the enamel intercrystalline spaces 6.

The purpose of this clinical report was to describe and illustrate a minimally invasive technique that improves the esthetic aspect of the white spot lesion.

Clinical Cases report This article presents a series of three cases of patients aged between 20 and 26 years who exhibited enamel white discolorations in esthetically compromised tooth areas. Anamnesis and clinical assessment were performed to determine the etiology of discolorations.

All patients signed an informed consent authorizing the treatments and use of images. The treatment decision was based on minimal intervention dentistry, using the resin infiltration technique with low-viscosity resin (Icon®, DMG, Hamburg, Germany) as an attempt to mask these lesions.

Case 1 (Figure 1) were diagnosed as postorthodontic white spot lesion. Case 2 very mild fluorosis (Figure 2) Case 3 (Figure 3) was classified as hypomineralized spots resulting from molar incisor hypomineralization.

When lesions were close to the gingival margin, a conventional rubber dam with ligatures was used to protect the oral soft tissues, deflect the gingival tissue, expose the cervical portion of the tooth, and provide a clean and dry working field. On the other hand, when no deflection of the gingival tissue was necessary, a resinous gingival barrier (liquid rubber dam) was used.

After cleaning with prophylaxis pumice, the affected areas were etched with 15% hydrochloric acid (Icon-etch) for two minutes and then washed with water spray for at least 30 seconds.

At this time, the lesions were assessed for color alteration, and if no visual color change was obtained with water, the etchant was applied again for an additional two minutes, until some color alteration could be observed at the wet eroded surface. The surface was then air dried,

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and ethanol (Icon-dry) was applied for 30 seconds to maximize the water removal inside the lesions. The lesions were air dried again, and the surfaces exhibited a chalky white appearance. The resin infiltrant (Icon®) was then applied on the lesion surface, and it was allowed to penetrate for three minutes. Excess resin was removed using a blow of air, and light curing was performed for 40 seconds.

The resin infiltrant application was repeated for one minute, followed by light curing for 40 seconds. The surfaces were polished using fine-grained abrasive flexible discs, rubber points, and finishing strips, depending on the treated area. An immediate esthetic improvement, with partial or total color masking, could be observed after treatment. The final pictures were obtained one week after the end of the treatment, allowing rehydration of the teeth and gingival tissue repair.

Case Report 1 A 24-year-old female patient reported to our department of restorative dentistry and endodontics with a chief complaint of white patches in the lower tooth.

After oral examination, she presented with mild to moderate postorthodontic WSLs at the right lower canine and premolar (Figure 1a) following treatment with a fixed orthodontic appliance for two years at the Department of Orthodontics.

Informed consent was obtained from the patient and treatment plan was established as Caries Infiltration with ICON® (DMG, Germany) (Figure 1b, c, d) March 2019

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Restorative Dentistry

Fig. 1

Erosion infiltration technique

A

B

C

D

E

F

G

Figure 1: Postorthodontic white spot eradicated with resin infiltration A: Clinical preoperative view B: Isolation with Rubber dam C: microabrasion D: Etching with 15% hydrochloric acid E: Application with Icon Dry F: immediate post-operative view G: Final post operative view

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March 2019

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Restorative Dentistry

Erosion infiltration technique

Case Report 2 A 26-year-old female patient who did not have any problems in her medical history was referred to the department of conservative dentistry and endodontics, with a chief complain of white lines on her maxillary incisors and brown and yellow discolorations on the other maxillary teeth.

Informed consent was obtained from the patient and treatment plan was established as Caries Infiltration with IconÂŽ (DMG, Germany) and dental whitening with 16% carbamide peroxide. (Figure 2)

Fig. 2

Figure 2 A: Preoperative view

B

Figure 2 B: Transillumination test

C

Figure 2 C: Rubber dam is applied to protect soft tissue and healthy enamel

D

Figure 2 D: Immediate post-operative after application of icon Dry

F

Figure 2 F: Immediate post-operative after application of icon infiltrant

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Dental News

A

E

Figure 2 E: polishing

G

Figure 2 G: Post-operative view after external bleaching with 16% peroxide carbamide March 2019

Case Report 3 A 23-year-old female patient presented with white spot lesions on her upper teeth. The spots are easily visible in the frontal view of the anterior teeth: a big white spot on tooth number 21 and 11. This patient was looking for an esthetic solution for these defects in her smile (Fig. 3).

After the clinical and radiographic examination, the occurrence of hypomineralization of the upper and all the first permanent molars characterizing MIH was diagnosed.

In our first case describing superficial infiltration we limited application of the erosion/infiltration technique to cases which required no dental preparation, such as early stage caries, most types of mild fluorosis and hypomineralization resulting from superficial traumatic lesions. But the technique as presented resulted in failures in many cases such as where lesions originate at the dentino-enamel junction and extend into the enamel, as in MIH. This is why treatments of MIH lesions by erosion/infiltration were never, or almost never, successful.

In view of the high level of prevalence of such cases, it was essential to find solutions to overcome these failures. The concept of deep infiltration involves paying a price in the form of mild mutilation of the enamel through preparation by sandblasting or milling so as to ensure that the infiltration can indeed reach the “ceiling� of the lesion in the case of MIH or spread through almost the whole of the lesion if the latter is deep (fluorosis or deep traumatic hypomineralization.

Fig. 3

A

Figure 3 A: Clinical preoperative view B

Figure 3 B: Transillumination test

Restorative Dentistry

Erosion infiltration technique

C

Figure 3 C: Rubber dam isolation

D

Figure 3 D: Microabrasion E

Figure 3 E: Application of Icon Etch

F

Figure 3 F: the lesion is dried by applying ethanol G

Figure 3 G: Application of infiltrant

H

Figure 3 H: immediately post-operative view

Discussion White marks and white lesions on anterior teeth can be unsightly. Patients often seek treatment to have these marks eradicated. Whilst there is a wide array of treatments available, which includes whitening as a first choice7 and bonding over the mark as a last option, a new technique using resin infiltration has been introduced 8.

Tooth-whitening techniques have been employed, with the aim of bleaching regular enamel, camouflaging the white-involved areas, and making the tooth color more uniform. Nevertheless, the results are not always satisfactory, and in many cases, microabrasion with pumice and hydrochloric acid needs to be performed.

Enamel microabrasion can produce acceptable esthetic improvement in shallow lesions, 11 and although the amount of enamel loss is related to the acid type and concentration, abrasive particles, duration and number of applications.

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Dental News

Minimal invasive dentistry by resin infiltration technique seems to provide a good solution in treating early enamel lesions. The ultimate goal of treating discoloration of teeth is to get an acceptable aesthetic result in the most conservative way possible. Initially resin infiltration was used as a method of treating incipient caries 9 either interproximally or on the smooth surfaces of teeth 10.

The technique using IconÂŽ DMG advocates the etching procedure to remove mineral of the surface layer, less than 40 Âľm demineralized enamel 5. The purpose of the etching procedure is to expose the lesion porosities there for low-viscosity light-curing resin can infiltrate, filling microporosities of the white spot lesion and replacing the initial appearance of the enamel.

In this case, we found yellow and brown discolorations, so microabrasion and bleaching using 16 % de carbamide peroxide to improve the esthetic appearance of the March 2019

the discolored teeth. Infiltration of the enamel by resin allows to obstruct the diffusion pathways for acids, external colorations and dissolved minerals 15.

It seems necessary to evaluate the accurate depth of the lesion, so we use trans-illumination test with polarized light. Then Two cases may occur: • Blurring opaque aspect means that the lesion is deep • Limited opaque aspect means that the lesion is superficial We might have also an heterogeneous aspect that means a variable depth and thickness of the lesion.

An indicator is required to show whether the ceiling of the lesion has been reached. The alcohol can play this role.

After etching the enamel surface, it is placed onto the surface as a drying agents and left for 2 minutes. Since it has a relatively high refractive index it offers a preview, in a less effective way, of what will be achieved by the resin.

When the application of alcohol seems to mask the lesion to some degree, this is a sign that ceiling of the lesion has been reached or, in the case of a deep lesion, that the infiltration will be sufficient. If alcohol does not produce this effect, either chemical erosion should be repeated or further microabrasion should be performed 12.

At the final step, the resin (Icon-infiltrate) can be applied for 2 -5min. It is a very low viscosity, TEGDMA-based resin. It uses capillary action to infiltrate and goes very deep into the lesion. We noted that this resin appears slightly since it contains camphorquinone. After the Photopolymerization which was done for 40s, the yellow tinge will disappear because the camphorquinone has been consumed.

A positive side effect of resin infiltration is that enamel lesions lose their whitish appearance when their microporosities are filled with the resin and look similar to sound enamel. Since the refractive index of the infiltrant material (RIIcon = 1.52) is close to enamel (RIhydroxyapatite = 1.62-1.65), when the lesion is filled, the optical properties of affected enamel are modified and lesions are masked12.

The infiltrant (Icon®, DMG) can be used for both the vestibular and interproximal noncavitated lesions. A limitation of this technique is the need to follow accurate diagnosis criteria to distinguish between the developmental and non-developmental opacities, because the resin infiltration shows limited effects in cases of developmental defects; furthermore it is a radiolucent material, which

may be a concern to some dentists. These factors determine the success of treatment 13.

It is also important to consider that the depth of resin infiltration is 60 µm, therefore the best treatment must be assessed for the elimination of white spots given deeper lesions could be detected even after treatment with resin infiltration 14. Since the fluorotic and hypomineralized enamel exhibits a subsurface reduced mineral content, similar to an initial caries lesion, the indication of the low-viscosity infiltration resin technique was recently broadened to mask the undesirable esthetic appearance in these cases. 19, 24 Nevertheless, because of the high variety of traumatic hypomineralization topographic characteristics, the results of treatment using infiltration are difficult to predict. In fact, this case series presents an improvement of the esthetic appearance of the white discolorations, with patient satisfaction.

However, the masking effect was not always complete, mainly in the cases of traumatic hypomineralized discolorations. This may be related to the histology of these defects, since their depth and morphology are highly variable. In some cases, the defect presents a circular shape, forming an acute angle with the enamel surface which hampers the infiltration of the resin on the margins and results in a visual contouring of the lesion known as the ‘‘edge effect.’

This deep infiltration technique has been proposed for the treatment of deep spots originating at the surface (fluorosis traumatic hypomineralization) or for those, like MIH, that originate at the dentino-enamel junction and for which, until now, no mini-invasive treatment was available. The method described can be applied to all spots, whatever their etiology. In fact, treatment of all white spots can begin without sandblasting or milling; then, if this is not sufficient, additional chemical and mechanical treatments can be undertaken until alcohol produces an optical change 12.

Conclusion The infiltration technique is a minimally invasive, and esthetic treatment of white spots. It has many advantages such as preservation of hard tissue, stopping the demineralization process by increasing the resistance of the enamel to demineralization, sealing of the micropores and cavities and minimizing the risk of developing secondary caries. This procedure is also well accepted by

Restorative Dentistry

Erosion infiltration technique

the patient and practitioner. The only disadvantage is the high staining 4. Michael K, Roberto V, Paulo S. potential of the infiltrating resin over time. This can be resolved by cov- Infiltration of White-Spot-Lesions and developmenering the resin with a thin layer of composite. tal enamel defects. Rev. Clin. Periodoncia Implantol.

Rehabil. Oral vol 2017 ;10(2) : 1 5. Meyer-Lueckel H, Paris S, Kielbassa AM.

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Caries Res. 2007;41:223–30.

1. Roopa KB, Pathak S, Poornima P, Neena IE.

6. Meyer-Lueckel H, Paris S.

White spot lesions: A literature review. J Pediatr Dent 2015; 3: 1

Improved resin infiltration of natural caries lesions.

2. Richter AE, Arruda AO, Peters MC, Sohn W.

J Dent Res 2008;87:1112-6

Incidence of caries lesions among patients treated with comprehensive orthodon-

7. Greenwall L.H.

tics. Am J Orthod Dentofacial Orthop 2011;139 (5):657–64.

White lesions and bleaching treatments.

3. Praveen M, Aarthi G, Mohan KS, Vanita D.

Aesthetic Dentistry Today 2009 ; 3(2) :15-18

Erosion Infiltration Technique’: A Novel Alternative for Masking Enamel White Spot

8. Munoz MA, Arana-Gordillo LA, Gomes GM, Gomes

Lesion. Journal of Pharmacy & Bioallied Sciences 2017 ;9(5) :289-291.

OM, Bombarda NH, Reis A, Loquercio AD. Alternative Esthetic Management of Fluorosis and Hypoplasia Stains: Blending Effect Obtained with Resin Infiltration Techniques. J Esthet Restor Dent 2013 ; 25 (1) :32-39 9. Meyer – Lueckel H, Paris S. Improved resin infiltration of natural caries lesions.

J Dent Res 2008 87:1112-1126.

10. Greenwall L. White lesion eradication using resin infiltration.

International dentistry 2013 ; 3(4) : 54-62.

11. Nahsan FP, da Silva LM, Baseggio W, Franco EB, Francisconi PA, Mondelli RF, & Wang L. Conservative approach for a clinical resolution of enamel white spot lesions Quintessence International 2011 ; 42(5) 423-426.

12. Jean-Pierre ATTAL, Anthony ATLAN, Maud DENIS, Elsa VENNAT, Gilles TIRLET. White spots on enamel: Treatment protocol by superficial or deep infiltration International Orthodontics 2014 ; 12 : 1-31.

13. Gugnani N, Pandit IK, Goyal V, Gugani S, Sharma J, Dogra S.

IDS 2019 Hall : 10.2 Booth: V15

12.- 16. 03. 2019 Cologne/ Germany

Improvement of white sopt lesions and non-pitted fluorosis using resin infiltration techniques : Series of four clinicla cases.

Glass ionomer luting cement

• High level of adhesion • Highly biocompatible, low acidity • Continuous fluoride release • Precision due to micro- fine film thickness • Translucency for an aesthetic result

I Indian Soc Pedod Prev Dent 2014 ; 32 : 178-180.

14. Davila JM, Buonocore MG, Greeley CB, Provenza DV. Adhesive Penetration in human artificial and natural white spots.

J Dent Res 1975 ; 54 : 999-100.

15. Pini NIP et al.

Enamel microabrasion: An overview of clinical and scientific considerations. World J Vlin Cases 2015 ; 3 (1) : 34-41.

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March 2019

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Restorative Dentistry

Effectiveness of Microabrasion Procedure for Aesthetic Management of Dental Fluorosis Stains Abstract

Dr Mayada Jemâa 1 dr.jemaamayada@gmail.com Dr S. Lakhal 2 Dr H. Brahem 1 Pr N. Zokkar 3 Pr L. Bhouri 3 Pr S. Marouen 4 Pr MB. Khattech 4

1

Assistant Professor, Department of

Dental Medicine, Military Principal

The excessive systemic absorption of fluoride during the tooth development will cause dental fluorosis which is the most common type of enamel demineralization. 1 This kind of pathology leads to the whitish, opaque and unpleasant appearance of enamel that is often visible. 2

the esthetic aspect of teeth with fluorosis.

Added to that, surface enamel modifications (roughness and microhardness) resulting from microabrasion, are easily restored by saliva. 4

Dental fluorosis may induce psychosocial effects on patients and affect their quality of life. 3 In the literature, different treatment modalities to manage dental fluorosis were described. The treatment depends on the severity of the fluorosis ranging from ceramic veneers to composite restorations and chemo-mechanical procedure. 2

- To define the dental fluorosis - To describe the microabrasion method: Step by step - To discuss the effects of microabrasion technique on the enamel surface.

- To report three clinical cases suffering from moderate dental fluorosis treated in our service of Dental Medicine with enamel microabrasion procedure.

Recently, enamel microabrasion has been proposed as a safe, effective, economic, conservative, minimally invasive, non-restorative and less time-consuming method that improves

Hence, the objectives of this article are:

Key Words: Enamel microabrasion, fluorosis, tooth discoloration, remineralization, esthetics, minimally invasive treatment.

Hospital of Instruction, Tunis, Tunisia 2

Resident, Department of Dental

Medicine, Military Principal Hospital of

Introduction

Instruction, Tunis, Tunisia 3

Professor, Department of Restor-

ative

Dentistry

and

Endodontics,

Dental Clinic, Monastir, Tunisia 4

Professor, Department of Dental

Medicine, Military Principal Hospital of Instruction, Tunis, Tunisia

42

Dental News

During tooth development, the excessive systemic absorption of fluoride can result in dental fluorosis. 5, 1, 3 Dean et al. in 1940 have demonstrated that there is a relation between the concentration of fluoride in drinking water and the prevalence and the gravity of dental fluorosis. 6 Referring to Danielson Guedes Pontes et al. 2012, the dental fluorosis is the result of chronic fluoride intoxication caused by excess ingestion going beyond tolerable limits for a prolonged period. 7 Bilateral, diffuse, thin and horizontal white striations and stained plaque areas are present. Then, depending on the severity of the dental fluorosis, the affected enamel may become discolored and/or pitted. 3, 4 March 2019

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Restorative Dentistry

Effectiveness of microabrasion procedure for aesthetic management of dental fluorosis stains

The severity of dental fluorosis depends on three factors: quantity of ingested fluoride, exposure duration and the stage of tooth development during fluoride ingestion. 7 Dentists have to diagnose fluorosis correctly and choose the appropriate treatment plan because of its important incidence. 1 Opaque white areas or discolorations ranging from yellow to dark brown, together with porosities on the enamel surface, characterize dental fluorosis. 4, 8 This pathology is one of the most common types of enamel demineralization. 1, 9 Dental fluorosis has a psychological impact on patients because of the unaesthetic affected anterior teeth. 8 Referring to literature, teeth discolored by fluorosis may be managed by porcelain laminate veneers, crowns or resin composite restorations. However, all these techniques are considered invasive. 7 Generally, most patients demanding treatments for fluorosis are young adults and the invasive prosthetic treatment options (veneers, crowns) are not recommended because of the excessive sacrifice of tooth structure, the high cost and the more time consuming. 6,10 Referring to the International Symposium on NonRestorative Treatment of Discolored Teeth, the microabrasion technique is described as a safe, conserva-

tive and effective atraumatic procedure to eliminate the superficial enamel stains caused for example by fluorosis. 5 Different publications reported patient satisfaction after using microabrasion procedure alone and considering it as a safe, effective and simple technique to manage fluorosis stains mainly located in esthetic areas. 8

Indices to measure dental fluorosis 1, 23 Different indices have been proposed to measure dental fluorosis like Dean‘s index, The Community Fluorosis Index (1946), Thylstrup-Fejerskov index, Total Surface Index of Fluorosis, Fluorosis Risk Index, Developmental defects of enamel Index.

Nowadays, new concepts in measurement of Dental Fluorosis exist such as visual analogue scale (VAS) by Vieira et al. 2005, Quantitative Light Fluorescence by Pretty et al. 2006 and Quantitative Light Fluorescence and Polarised white light Images by Pretty et al. 2012.

In our clinical cases we used Dean‘s index: (Table 1) First, this index was proposed in 1934 and in 1942, it was modified. It classifies dental fluorosis on a 6-point ordinal scale.

Severe

Table 1: Dean‘s index. 1, 23

44

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March 2019

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Restorative Dentistry

Effectiveness of microabrasion procedure for aesthetic management of dental fluorosis stains

Microabrasion technique Referring to Pini et al. 2015, enamel microabrasion should be the first option to manage teeth with intrinsic stains because it eliminates opaque, brown colorations and surface irregularities by offering a more regular and lustrous surface. 4 After microabrasion, the surface can be considered more caries resistant compared with the initial surface. 1 First, Dr. Walter Kane (Colorado Springs, 1916) proposed this procedure. It consists of the use of mild acid combined with rotary application of an abrasive medium.1 McCloskey in 1984 proposed the use of acid combined with pumice to manage dental fluorosis. After two years, Croll called this technique “microabrasion”. 1 The microabrasion procedure requires the use of hydrochloric acid mixed with an abrasive powder (combination of erosion and abrasion). After this procedure, the surface has a glass-like lustre aspect because of the presence of dense prismless layer that was formed on the abraded enamel surface. 11 Croll and Cavanaugh removed white enamel opacities by means of a wooden stick and firm finger pressure for 5 seconds of application of hydrochloric acid (18%) and pumice. Not surpassing 15 applications. After each application, the treated enamel was washed and dried. 5, 12 Actually, this technique is no longer relevant because the use of an important concentration of hydrochloric acid in the mouth is dangerous (caustic potential of 18 % HCl). 5, 3 Recently, other secure highly safe and efficient microabrasion products were developed and were commercially available such as Prema compound (Premier Dental Products), Opalustre (Ultradent), Whiteness RM (FGM).

Prema Compound, Opalustre and Whiteness RM contain a mild concentration of hydrochloric acid (10%, 6% and 6% respectively) and a fine-grit silicon carbide abrasive in a water-soluble gel. The microabrasion product is applied in a little quantity on the fluorosis stains or on the surface irregularities.

For Prema Compound product, it is recommended to use synthetic rubber tips, a rotary mandrel and 10: 1 gear reduction angle at 30-second intervals. For the Opalustre product, dentists should use a rubber cup

46

Dental News

with a 10:1 gear reduction angle at 1-minute intervals.

Regular rinse by means of water spray is necessary between the different applications of the microabrasion product. The last step is to rinse, dry and polish the surface. We can also use a gel containing 2% of neutral sodium fluoride to apply on the enamel surface for 4 minutes. 12 Referring to Sundfeld et al. 2007, the quantity of eliminated enamel by microabrasion procedure is not pertinent. 12 Referring to Celik et al. 2013, the microabrasive technique just removes the outer enamel surface (10–200 μm); Although different publications recommend the use of microabrasion procedure alone to treat dental fluorosis, other studies advocate the combination of enamel microabrasion with vital bleaching and composite restorations to manage tooth discoloration.

The aim of this combination is that microabrasion technique used alone cannot offer excellent results. 8 The success of enamel microabrasion is related to the depth of enamel alteration. 13 When the severity of dental fluorosis increases, it is hard to eliminate deep intrinsic stains and porosities by only microabrasion method. 8 Better esthetic results with microabrasion technique are achieved for surface stains than deeper ones. 14 After enamel microabrasion, the color of treated teeth may become darker or more yellow because of the thinner enamel and the color of dentin will be more evident like the color observed in the cervical third of crown or like teeth ageing. 13, 15

Indications of Enamel Microabrasion

4

- Stains or defects limited only to enamel surface, - Dental fluorosis, - Reparation of surface irregularities (imperfect enamel formation, surface irregularities caused by removal of residual resin composite from orthodontic brackets with diamond burs…), - Mineralized white stains, - Localized or idiopathic enamel hypoplasia limited to the outer enamel layer, - Polishing of enamel and helping to remove composite resin residues after orthodontic treatment.

March 2019

Limits of Enamel Microabrasion

2, 4, 12

The age of the patient is not pertinent for such procedure. Some limitations of this technique are mentioned such as the difficult use of rubber dam when teeth are not completely erupted, deficient lip sealing (risk of development of a moisturizing pellicle on enamel in absence of upper and lower lips protection) and also dentin located stains.

In case of deficient lip sealing, following orthodontic treatment and/or speech therapy is the first recommended option before enamel microabrasion.

Referring to Benbachir et al. 2007, enamel microabrasion is not recommended for amelogenesis imperfecta that presents deep lesions. 16 Referring to Ardu et al. 2009, although enamel microabrasion is cheaper than prosthetic treatment it is considered costly because of the important chair time when dental fluorosis is medium or severe and the procedure must be repeated frequently to acquire the acceptable result.

Examples of microabrasion products that are commercially available (Table 2) 4, 5, 14

Table 2: Examples of Microabrasive agents (manufacturer, composition).

Some studies suggest replacing hydrochloric acid with 37% phosphoric acid in microabrasion method. The phosphoric acid is useful in such procedure for two reasons: it is frequently used in clinical practice for other procedures (bonding‌) and it generates less enamel surface damages (less enamel loss) compared with HCL. 3, 4, 15 Referring to Sundfeld et al. 2014, the 37% phosphoric acid was combined with extra fine grain pumice in equal volume proportions in microabrasion method. 17 A study of Bassir et al. 2013 comparing clinical efficiency of phosphoric acid- pumice compound with

conventional hydrochloric acid- pumice compound in treating different severities of dental fluorosis with the microabrasion technique concluded that the phosphoric acid- pumice compound improved aesthetic indices in fluorotic teeth similar to the HCl-pumice compound. 9 Referring to Fragoso et al. 2011, the combination of 30-40% of phosphoric acid and pumice is indicated to eliminate the white spots resulting from inactive surface decalcifications because of the ineffective teeth cleaning during orthodontic therapy. 14

Restorative Dentistry

Effectiveness of microabrasion procedure for aesthetic management of dental fluorosis stains

A study of Sheoran et al. 2014 evaluating the effectiveness of two microabrasion products (37% phosphoric acid and 18% hydrochloric acid) for the removal of developmental enamel opacities in young permanent maxillary incisors showed that both microabrasion procedures revealed comparative highly significant successful outcome in esthetic clinical treatment of enamel opacities and in terms of subject’s satisfaction. 18

was that despite enamel microabrasion was described as a conservative treatment regardless of the type of the microabrasive agent used, the products used in the study revealed minor roughness alterations and minimal wear. Added to that, the use of phosphoric acid and pumice stone presented similar results to commercial microabrasive products concerning the surface roughness and wear. 21

Effects of microabrasion procedure on Tooth bleaching associated to enamel enamel surface Microabrasion An in-vitro study of Bertoldo et al. 2014 evaluated the enamel roughness after microabrasion (37% phosphoric acid and pumice, Opalustre) followed by different polishing methods. The conclusion was that all enamel microabrasion products increased enamel roughness and the efficiency of the polishing systems was dependent upon the abrasive employed. 19 A study of Fragoso et al. 2011 evaluated the effect of microabrasion (37% phosphoric acid and pumice, Opalustre, Whiteness RM) and polishing on the microhardness and roughness of bovine enamel, and the effect of artificial saliva on the hardness of enamel. The conclusion was that enamel microabrasion followed by polishing generated higher hardness and better enamel surface smoothness. Although, enamel hardness was not increased by its immersion in artificial saliva. 14 Referring to Pini et al. 2015, enamel surface roughness is increased by microabrasion procedure nevertheless (6.6 %) hydrochloric acid or (18% or 35%) phosphoric acid with abrasive was employed. Added to that, enamel roughness and hardness can be inverted by polishing technique or the exposure to saliva. 4 A study of Pini et al. 2016 evaluating the effect of saliva on enamel after microabrasion procedure (35% phosphoric acid and pumice, 6.6% hydrochloric acid (HCl) and silica) with different microabrasive compounds under in situ conditions concluded that saliva was effective in promoting the rehardening of enamel after microabrasion procedure, essentially for the surfaces treated with HCl and silica. 20 An in vitro study of Rodrigues et al. 2013 evaluated the in vitro changes on the enamel surface after a microabrasion procedure realized by different products (silicon polisher, 37% phosphoric acid and pumice stone, Micropol, Opalustre, Whiteness RM). The conclusion

48

Dental News

After microabrasion procedure, dentists can accomplish bleaching to mask remnants of white spot lesions and to enhance the results of the enamel microabrasion (uniform tooth shade). 2, 3, 7, 10 The combination of microabrasion and dental bleaching offers excellent esthetic results and patient acceptance. Both methods are conservative, painless, fast and easy to perform. 7, 16 At- home bleaching contributes to the assimilation of the color of the fluorotic stains with the color of the remaining enamel surface. Moreover, in-office bleaching did not affect the color and the luminosity of the fluorotic teeth. 3 Referring to Sundfeld et al. 2007, teeth treated with microabrasion procedure can obtain a yellowish or darker coloration after this treatment. To resolve this esthetic problem, it is recommended to achieve dental bleaching (hydrogen peroxide gel in a polyethylene strip system or bleaching topical application with carbamide peroxide gel in custom-formed soft vinyl mouth trays). The concentrations of carbamide peroxide can be 10%, 15% or 16%. 12 A study of Franco et al. 2016 evaluating the effects of the association of microabrasion and dental bleaching on the physical properties of enamel concluded that dental bleaching does not cause important damage to microabraided enamel, and that just human saliva recovered the initial enamel microhardness. Therefore, the immediate or late association of dental bleaching with enamel microabrasion will not lead to a negative influence on the surface roughness or hardness of enamel. 22 A study of Perete-de-Freitas et al. 2017 evaluating the effect of prior microabrasion procedure on the teeth color modification and teeth bleaching efficiency concluded that although microabrasion procedure have changed tooth color, it did not affect the final results obtained with tooth bleaching using an important concentration of hydrogen peroxide. 13 March 2019

Clinical cases Case report N°1 A 22- year old girl looked for dental therapy to remove and/or minimize the noticeable brown/yellow staining on the buccal surfaces (incisal third) of her teeth (11 and 21).

Fig. 1

Diagnosis: Mild fluorosis staining determined by using Dean’s Fluorosis Index (Table 1). A treatment plan (minimally invasive) was presented to the patient: Microabrasion of the superficial enamel with Opalustre (Ultradent).

Figure 1: initial view of the patient’s teeth. Presence of white stains in anterior teeth and brown stains in the buccal surfaces (incisal third) of her upper central incisors.

Fig. 2

Figure 2: Enamel surface appearance after two visits. In each visit, five applications were required. In every application, the gel was scrubbed on the stained enamel by means of a rubber cup for 15-20 seconds. After that, the surface was rinsed off and examined. After microabrasion procedure, enamel surface was polished and a desensibilizing gel was applied on the buccal enamel surface for 5 minutes.

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Restorative Dentistry

Effectiveness of microabrasion procedure for aesthetic management of dental fluorosis stains

Case report N°2 A 25- year old girl looked for cosmetic treatment for her teeth that presented white and brown stains.

Fig. 3

Diagnosis: Mild fluorosis staining referring to Dean’s Fluorosis Index (Table 1). Treatment proposed: Enamel Microabrasion technique with Whiteness RM (FGM).

Fig. 4

Fig 3: Initial image of the patient with white and brown stains of fluorosis affecting especially the upper anterior teeth.

Fig. 5

Fig 4: Close view of the anterior teeth.

Fig 5: Enamel appearance after 5 applications of Whiteness RM microabrasion paste (first appointment).

Fig. 6

Fig. 7

Figures 6 and 7: Final result (enamel appearance after other 5 applications of Whiteness RM paste in the second appointment). After microabrasion method, the surface was polished and a desensitizing fluoride paste was applied for 5 minutes.

The patient was greatly satisfied.

Case report N°3 A 30- year old girl consulted with a chief complaint about the appearance of her front teeth that present white and brown stains.

Diagnosis: Mild fluorosis staining referring to Dean’s Fluorosis Index (Table 1). The treatment plan presented to the patient included enamel Microabrasion by means of Whiteness RM (FGM).

Fig. 8

Figure 8: Preoperative view.

Fig. 9 Figure 9: The microabrasion paste was applied on the enamel surface of the upper anterior teeth. Then, it was scrubbed on the stained enamel with a rubber cup for 15-20 seconds. After that, the enamel surface was rinsed off and air-dried for examination.

Enamel microabrasion procedure was performed in 2 visits (5 applications of microabrasion paste/visit).

50

Dental News

March 2019

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Restorative Dentistry

Effectiveness of microabrasion procedure for aesthetic management of dental fluorosis stains

Fig. 10

Fig. 11

Figures 10 and 11: Postoperative view and patient’s smile after the microabrasion procedure.

Conclusion

The results of our clinical cases suffering from mild dental fluorosis treated with only microabrasion procedure showed improvement in appearance of discolored teeth and patient‘s satisfaction.

In case of moderate-severe fluorosis, the association of enamel microabrasion and dental bleaching is advisable to optimize the esthetic result.

After microabrasion method, it is recommended to polish the enamel surface and eventually to apply a desensitizing paste based on fluoride and/or CPP-ACP for 5 to 15 minutes. This minimal invasive atraumatic and safe approach forthe elimination of superficial enamel stains and defects offers favourable aesthetic permanent results and re-establish patient’s self-esteem.

References

52

1. Balan B, Madanda Uthaiah C, Narayanan S, Mookalamada Monnappa P. Microabra-

Faria ESAL. Impact of Microabrasion on the Effectiveness of Tooth Bleaching. Bra-

sion: an effective method for improvement of esthetics in dentistry. Case reports in

zilian dental journal. 2017;28(5):612-7. 14. Fragoso LS, Lima DA, de Alexandre RS,

dentistry. 2013;2013:951589. 2. Ardu S, Benbachir N, Stavridakis M, Dietschi D, Krejci

Bertoldo CE, Aguiar FH, Lovadino JR. Evaluation of physical properties of enamel

I, Feilzer A. A combined chemo-mechanical approach for aesthetic management of

after microabrasion, polishing, and storage in artificial saliva. Biomedical materials

superficial enamel defects. British dental journal. 2009;206(4):205-8. 3. Castro KS,

(Bristol, England). 2011;6(3):035001. 15. Sundfeld D, Pavani CC, Schott TC, Macha-

Ferreira AC, Duarte RM, Sampaio FC, Meireles SS. Acceptability, efficacy and safety

do LS, Pini NIP, Bertoz APM, et al. Dental bleaching on teeth submitted to enamel

of two treatment protocols for dental fluorosis: a randomized clinical trial. Journal of

microabrasion 30 years ago-a case report of patients’ compliance during bleaching

dentistry. 2014;42(8):938-44. 4. Pini NI, Sundfeld-Neto D, Aguiar FH, Sundfeld RH,

treatment. Clinical oral investigations. 2018. 16. Benbachir N, Ardu S, Krejci I. Indica-

Martins LR, Lovadino JR, et al. Enamel microabrasion: An overview of clinical and

tions and limits of the microabrasion technique. Quintessence international (Berlin,

scientific considerations. World journal of clinical cases. 2015;3(1):34-41. 5. Loguer-

Germany : 1985). 2007;38(10):811-5. 17. Sundfeld RH, Sundfeld-Neto D, Machado LS,

cio AD, Correia LD, Zago C, Tagliari D, Neumann E, Gomes OM, et al. Clinical effec-

Franco LM, Fagundes TC, Briso AL. Microabrasion in tooth enamel discoloration de-

tiveness of two microabrasion materials for the removal of enamel fluorosis stains.

fects: three cases with long-term follow-ups. Journal of applied oral science : revista

Operative dentistry. 2007;32(6):531-8. 6. Ardu S, Stavridakis M, Krejci I. A minimally

FOB. 2014;22(4):347-54. 18. Sheoran N, Garg S, Damle SG, Dhindsa A, Opal S, Gupta

invasive treatment of severe dental fluorosis. Quintessence international (Berlin,

S. Esthetic management of developmental enamel opacities in young permanent

Germany : 1985). 2007;38(6):455-8. 7. Pontes DG, Correa KM, Cohen-Carneiro F.

maxillary incisors with two microabrasion techniques--a split mouth study. Journal

Re-establishing esthetics of fluorosis-stained teeth using enamel microabrasion

of esthetic and restorative dentistry : official publication of the American Academy

and dental bleaching techniques. The European journal of esthetic dentistry : offi-

of Esthetic Dentistry [et al]. 2014;26(5):345-52. 19. Bertoldo C, Lima D, Fragoso L,

cial journal of the European Academy of Esthetic Dentistry. 2012;7(2):130-7. 8. Celik

Ambrosano G, Aguiar F, Lovadino J. Evaluation of the effect of different methods

EU, Yildiz G, Yazkan B. clinical evaluation of enamel microabrasion for the aesthetic

of microabrasion and polishing on surface roughness of dental enamel. Indian jour-

management of mild-to-severe dental fluorosis. Journal of esthetic and restorative

nal of dental research : official publication of Indian Society for Dental Research.

dentistry : official publication of the American Academy of Esthetic Dentistry [et al].

2014;25(3):290-3. 20. Pini NIP, Lima D, Sundfeld RH, Ambrosano GMB, Aguiar FHB,

2013;25(6):422-30. 9. Bassir MM, Bagheri G. Comparison between phosphoric acid

Lovadino JR. Tooth enamel properties and morphology after microabrasion: an in

and hydrochloric acid in microabrasion technique for the treatment of dental fluo-

situ study. Journal of investigative and clinical dentistry. 2016;8(2). 21. Rodrigues

rosis. Journal of conservative dentistry : JCD. 2013;16(1):41-4. 10. Romero MF, Babb

MC, Mondelli RF, Oliveira GU, Franco EB, Baseggio W, Wang L. Minimal alterations

CS, Delash J, Brackett WW. Minimally invasive esthetic improvement in a patient

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Sciences 2014; 13(7): 55-60.

Dental News

March 2019

Section X is expanding and organized 2 Section Meetings in Both Districts In this first year of my presidency of the Middle East Section of the International College of Dentists, I have had the opportunity to attend two Section Meetings one in each of our two Districts.

In February, in Riyadh, where I received the President’s chain and the responsibility that it symbolizes, and the second, on December 7 and 8 in Beirut. I mention this, to point out that our Section has grown and developed through the efforts of an active team of officers under the leadership of visionary Presidents.

Our Section has also had some noteworthy activities in the educational as well as the humanitarian fields, and, at our Regents’ meeting in Beirut, we agreed to work toward producing a book that would include the history of the Section as well as highlight the services it has given to the profession and to the society, so that all of us can be proud of being part of this Section X and of the College.

the Lebanon mountains. I hope that this book will be ready for the upcoming Centennial Celebration and that we will have a good representative group in Nagoya in November 2020 so that, as we join other Sections, we can proudly show of our achievements.

The Riyadh Section Meeting had four aspects: Regents’ Meeting, half day educational program and an Induction Ceremony as well as a presidency handing over from President Georges Tawil to President Youssef Talic. Three officers from Lebanon, President Tawil, Vice President Nadim AbouJaoude and Councilor Cedric Haddad joined President Elect Talic, Regent Nassir Al Hamlan and Past President Ali Alehaideb to host the meeting at the King AbdulAziz University for Medical Sciences. During the officers meeting, plans for future activities and for the improvement of the section’s organization and efficiency were discussed.

To name a few of our achievements, I can start with the early meetings organized in conjunction with the Middle East Medical Assembly at the American University of Beirut, to being part of building the Medical Reference library of the Lebanese Dental Association, the outreach meetings in several parts of Lebanon and the Emirates, the translation and dubbing of the ADA produced Oral Longevity DVD and neither last nor least, the humanitarian project in Chahtoul in

54

Dental News

March 2019

Two Deputy Regents for District 2 were named; Dima Debaybo (UAE) and Sahar Al Bokhari (Jeddah, KSA) Three Speakers took part in the half day Continuing Education Program, Georges Tawil (Lebanon), Mounir Silwadi (UAE) and Samar Hayek (KSA) and covered Long Term outcome of Reconstructive Implant Dentistry, Digital Implantology and The Esthetic Challenge in Cleft Lip Patients. The lectures were followed by a lunch and the induction of 5 new fellows: Sahar Al Bokhari, Adel Al Hadlak, Eman Al Namnakani, Saud Orfali and Mansour Al Rajaie. The meeting ended with a handing over of the Presidency between Presidents Tawil and Talic and an address by the new Section President.

The 52nd Meeting and Celebration was held at the Hilton Habtour Hotel in Beirut, and consisted of four different activities: Continuing Education Program, the Zahi Khalaf Merit Awards, and Induction Ceremony and a banquet. The day long Continuing Education Program was under the heading “Smile Mission 2020, Celebrating 100 Years”. Regent Philip Souhaid gave a word of welcome followed by Section President Youssef Talic who greeted the audience and expressed his pleasure to be among us in Beirut.

Fellow Nicole Geha Chair of the CE day, went briefly over the day’s program then left the floor to 8 different fellow speakers as well as our guest speaker Dr Imad Ghandour.

Lectures covered the ways in which each dental specialty dealt with preserving or succeeding in rebuilding a perfect smile through endodontics (Fadl Khaled) implant surgery, (Nadim Mokbel), periodontics (Alain Romanos) prosthodontics (Nadim AbouJaoude), pedodontics (Mohamad Ezzedin) and laser technology.

Our guest speakers shared his expertise in using Cad Cam technology (digital tools and artificial intelligence, in the quest for a perfect smile.)

The Zahi Khalaf Merit Awards ceremony was at midday.

The day ended with the induction of 9 few fellows into the College 8 from District 1 and one from District 2.

Dr Cedric Haddad

Profs: Edmond Koyes, Nadim Abou Jaoudeh, Edgard Jabbour, Youssef Talic, Philip Souaid, Joe Sabbagh

Greater New York Dental Meeting November 29 - December 4, 2018 New York, United States

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Dr. Lauro Medrano-Saldaña giving a personal award to Dr. Chad Gehani, President Elect ADA during the celebrity luncheon Education at the Greater New York Dental Meeting has always been the primary concern of the Meeting› s founders and remains so today. They offer almost every dental subject and many are available for a minimal cost on a daily basis. The Greater New York Dental Meeting is an ADA CERP recognized provider.

The Scientific Sessions are divided into Seminars, Hands-on Workshops, Essays, and Scientific Poster Sessions. The Educational Scientific Program offered over 350 programs, featuring hundreds of the world most respected dental educators, are presented as full and half-day courses. With over 6 hours of free CE daily the education program at the Greater New York Dental Meeting is an experience not to be missed!

Dr Tony Dib, Prof. Jon Suzuki

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Greater New York Dental Meeting Highlights Total Registration – 52,320 Dentists – 20,187 Dental Assistants – 5,206 Dental Hygienists – 3,949 Dental Technicians – 569 Total Internationals Attendees – 10,661 Countries - 146

March 2019

Professor Khalil ElEissa new member of the International Academy of Dental Facial Esthetics receiving the certificate from Dr George Freedman

Exhibition Floor

Lebanese Society of Prosthodontics 10th International Convention January 11 - 12, 2019 Hilton Metropolitan Palace Beirut, Lebanon

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Mr. President, Ladies and Gentlemen, Dear Colleagues, Please allow me to thank each one of you for the effort made to be here with us today. On behalf of the Lebanese Society of Prosthodontics, I am pleased to welcome the new President of the Lebanese Dental Association, Prof. Roger Rbeiz.

Dr. Carole Yared, President, Lebanese Society of Prosthodontics

Pr. Roger Rbeiz, President of the Lebanese Dental Association

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I would like to thank him deeply for the help and facilities that he provided for the success of our event. My appreciation goes to the Deans of the faculties of Dentistry, Pr. Ossman, Pr. Makzoume and Pr. Zeinoun for the commitment, keen interest and support they extended to our scientific and professional event as well as to their active presence during the coming days. I would also like to welcome the presidents of the different scientific and specialized committees for their collaboration.

The success of the “10th Scientific Convention” is the fruit of a multitude of efforts brought together by the current board members, in addition to those of the previous boards’ achievements. Moreover, we owe the breadth of this year’s convention to previous ones, namely the “8th scientific convention” in collaboration with Nobel and the “9th scientific convention” with GC during the Dental Meeting 2018 held at Saint Joseph University.

This year, we are deeply grateful for the golden sponsors Straumann And Prodent and for all the other sponsors. Owing to the presence of our speaker and friend, Dr. Hani Tohme, and of our special guest, Pr. Urs Belser, our “10th International convention” during which knowledge and skill sharing are of prime importance, will be of the greatest interest to all the participants. “La Main d’Or”, our annual award launched in 2017, shall be offered this year to a special and eminent person, renowned for his knowledge, competence and expertise at the professional level, and for his kindness, his commitment and loyalty at the personal level; Prof. Nouhad Rizk.

Dr. Carole Yared President, Lebanese Society of Prosthodontics March 2019

The recipient of the “La Main d’Or” 2019 reward, Prof. Nouhad Rizk, with the members of the LSP and the Deans and the president of the LDA

Prof. Dr. Urs Belser talking about esthetic implant restorations

Dr. Hani Tohme with Dr. Carole Yared, president of the LSP

Prof. Nouhad Rizk receiving “La Main d’Or” trophy from the LDA President and Dean Osman

LSP Members: Najib Abou Hamra, Pierre Khoury, Urs Belser, Carole Yared, Marwan Daou, Pascale Habre, Loubna Chamseddine

Picture from the Audience

SIDC 2019 Saudi Dental Society Dental Conference January 12 - 14, 2019 Ritz Carlton, Riyadh - Saudi Arabia

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Dr Fahad AlShehri, President of the Congress During the Opening Ceremony The Saudi International Dental Conference 2019 aims to provide international forum addressing the key challenges faced by practitioners, to share new research and information on best expertise to make the parallel scientific sessions an avenue for contemporary dental practice in Saudi Arabia. It was held on the 12th to 14th January 2019 at The Ritz-Carlton Riyadh that welcomed 6,600 dental professionals, delegates, and participants from around the world. During the conference, there were 96 lectures and 23 workshops delivered by 69 international & local speakers representing 18 countries from Europe, America, and GCC areas. Organized by Saudi Dental Society under the patronage of Prince Faisal bin Bandar bin Abdulaziz Al Saud, His Royal Highness Prince of Riyadh.

On its 3 decades’ tenure, the annual dental conference features new scientific activities which includes Dental Hygiene Symposium, Dental Technology Symposium, Dental Assistants Symposium, Computer Guided Maxillofacial Radiology & Surgery Symposium, Dental Students Research Meeting, and Dental Industry Exhibition. These featured highly prominent international and national speakers who shared, discussed, and deliberated significant new developments and scientific advancements that will influence the future of related fields in dental hygiene, dental lab technology, and dentistry. Not to mention, there were 300 research papers in the field of dentistry that qualified and were accomplished for Graduate & Young Dentists Research Competition, Clinical Case and E-Poster Presentation by scientific researcher finalists in which, the best 18 candidates were deliberately selected in winning the excellence awards for this year.

The number of scientific activities were very significant in attracting huge number of dentists, dental specialists, paradental staff, dental students, dental interns, dental hygienists, dental technicians, dental radiologists, industry leaders and professionals over the three days of the event. The Saudi Dental International Conference 2019 closed with a total of 6,600 attendees from GCC & Middle East, America, Europe, and Asia. In addition, the conference program received CME accreditation from various accreditation bodies.

Badran Al-Omar, the president of King Saud University in Riyadh 60

Dental News

Dr Khalil AlEissa president elect of the Saudi Dental Society March 2019

Dr Edward Lynch from the State University, Nevada

Dr Frank Lippert from Indiana University

Drs; Mohamed Al Shehri, Mostafa Ghezzaoui, Fahed Al Shehri, Abdullah Al Amri

Drs: Najib Khalaf, Rola Dib, Roy Sabri, Riyad Bacho from Lebanon

Dr Hassan AbdelWassie, Mohamed Al Harbi, Ali Habib, Osama Basri at the SOS booth

Drs Rose Khairallah, Rafi Chirvanian, Eli Bouchedid, Tony Dib

Drs; Khalid AlSeif, Tony Dib, Suleiman Omran, Dr Faisal, Dr Saleh Al Shemrani

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Dental News

March 2019

Drs Ismail Melhem (Palestine), Faez Al Khalaileh (Jordan), Yasser AlKhiary (KSA)

Saudi Arabia January 12 - 14

Saudi Society of Periodontology booth

SIDC 2019

SIDC 2019 Exhibition Floor

Dentsply Sirona Booth

Durr Booth

Drs Walid Sadek, Prof. Yousef Talic, Prof. Hassan Halawani

Drs; Omar Bahgat, Hassan Abdul Wassie, Khaled Balto

Denmat Booth

The Finnish Ambassador at the Planmeca booth

Pr Ali Habib president of the Saudi Orthodontic Society and Dr Roy Sabri

Dr Fahed AlKahtani, Pr Magid Amine, Dr Tony Dib

SDI Booth FKG Booth

Bien Air Booth

Dentaurum Booth 64

Dental News

March 2019

NSK showing their new Electric Micromotor upgrading system

Profs Thakeb AlShalaan, Saoud Al Orfali, Magid Amine, Dr Tony Dib, Dr Salem Sakr AlSulami at AlFarabi Colleges Booth

Drs; Tony Dib, Yasser ElGendy, Ahmad Rizk

Ivoclar Vivadent Booth

IDS, Hall 4.2 - Booth J29-G28 Endo Training every hour www.fkg.ch/xpendo

sit down with

Dr. Henriette Lerner President, Digital Dentistry Society Can you introduce me to DDS, what does is stand for?

The Digital Dentistry Society International is a non-profit society, which mission is to get out there, gather and know the newest technology in dentistry, validate those technologies through studies and research, implement them in a core and workflow and teach them through a structured education. We are represented in approximately forty countries, through ambassadors, embassies and partner societies.

Our targets for the next time is to implement continuing education in all these countries in a structured way and at the end of the day also delivering masterships in digital dentistry. We have a journal which is the BMC journal where we can publish all the articles that our members are providing on the topics of digital. I am here in Saudi Arabia invited as representative of the DDS, looking forward for cooperation with different platforms, societies and universities in Saudi Arabia. Our target is to get as much possible free members to profit ofrom our information and our continuing education in the future.

Where is your society registered and how old is it?

DDS is a society that started 5 years ago and registered in Switzerland, I have the honor to be the current president until the end of 2019, and the first president was Giuseppe Luongo who was also the past president of the academy of osseointegration in Italy. We have an international board of members from all over the world.

Our website is digital-dentistry.org

Where will your next meeting be held?

Our global meeting takes place every 2 years. This year it will be held on 3-6 Oct, 2019 in Baden-Baden Germany. We expect a couple of hundreds of people from our extended DDS family from forty countries.

The meeting will take place for 3 days; it will focus on clinical, scientific and brand new technologies. In Baden-Baden, Germany, in a very classic environment we will provide a high tech meeting in many terms. Digital dentistry applies to all disciplines of dentistry including prosthodontics, implantology, radiology and digital orthodontics.

Looking forward to seeing you in Germany.

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March 2019

February 5 - 7, 2019 International Convention & Exhibition Center Dubai, United Arab Emirates

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GSDA group photo following their meeting in Dubai during the AEEDC 2019 AEEDC Dubai witnessed the launch of the 16th Global Scientific Dental Alliance Meeting (GSDA), with the participation of 157-member representatives coming from all corners of the globe. The meeting was chaired by Dr. Abdul Salam Al Madani, Executive Chairman of GSDA and AEEDC Dubai and, Dr. Nasser Al Malik, Chairman, Scientific Committee of AEEDC Dubai, Dr. Mohammad Abedin, Scientific Vice-Chairman of AEEDC Dubai, Eng. Anas Al Madani, Vice Chairman and Group CEO of INDEX Holding, and a number of leading dignitaries, heads of dental associations, world renowned dentists and deans of dental colleges and universities from the UAE and abroad. AEEDC Dubai featured a Signing Ceremony ‘Memorandum of Understanding’ between AEEDC Dubai and Saudi Orthodontics Society in the presence of Eng. Anas Al Madani, and Prof. Ali Habib, President of Saudi Orthodontic Society. This MOU is part of the efforts of the two parties to participate in various plans that aim at developing the field of orthodontics and contribute to raise awareness among members of the community of the importance of dental care in general and orthodontics in particular. The meeting witnessed the announcement of the launch of the 1st edition of AEEDC Cairo Conference and Exhibition which is set to be held from 12 – 14 December 2019 at Royal Maxim Palace Kempinski Cairo.

Announcement of the 1st edition of AEEDC Cairo Conference and Exhibition 68

Dental News

“MOU” Signing between AEEDC and Saudi Orthodontic Society by Eng. Anas Al Madani, and Prof. Ali Habib

Photo from the opening ceremony March 2019

EXHIBITION

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DIGITAL WORKFLOW

Josiane Younes, Aicha Sultan, Azhar Nasib, Tony Dib Maya Nohra, Roger Rbeiz, Rodny Abdallah

Khaled Tanazefti Ghada Bassil, Hani Ounsi

Tony Dib, Khalil Eissa Abdul Rahman AlAzri

Mariko Kosaka, Hiroaki Yoshida 70

Dental News

March 2019

Tobyn Bower, Stephen Lawry

Dubai, UAE February 5 - 7

AEEDC 2019

Abbas Zaher, Abdulrahman Tawfik, Tony Dib Abeer Al Matooq, Josiane Younes, Tony Dib, Christian Makari, Mohammed Shahda

Abdallah El Gendy, Yasser El Gendy

DENTAL NEWS PHOTO BOOTH

Sanjiv Gimmini, Dietmar Goldmann

Tony Dib, Josiane Younes, Zakia and Mohammed Al Jishi

Denis Cuendet, Nicolas Bernard Masson

Tony Dib, Josiane Younes, Nada Farhat, Joseph Makzoume, Fadi Hage, Christian Jaber, Paul Boulos

Tony Dib, Josiane Younes, Maria Saadeh, Fouad Ayoub (President LU), Tony Zeinoun, Ibrahim Nasseh, Ahmed Rizk, Ziad Salameh

Michael Buzanich, Josiane Younes, Zahi Janho

Nour Habib, Josiane Younes, Moushira Salah, Samira Oseilan, Tarek Abbas

Josiane Younes, Barbara Maddalena, Sophia Yadi

Tony Dib, Josiane Younes, Joseph Makzoume, Maneli Teymouri, Diego Gabathuler, Tarek Abbas, Ali Habib

Dubai, UAE February 5 - 7

AEEDC 2019

KAU booth with Deans Makzoume and Mira

Septodont Booth

Morita Booth

GC Booth

Ivoclar Vivadent Booth

Exhibition Floor

Henry Schein Booth

Dr Hany Ounsi at the FKG Booth

MK Dent Booth

NSK Booth W&H Booth

Planmeca Booth A-Dec Booth

Dr. Wild Booth

Dentsply Sirona Booth 74

Dental News

March 2019

3shape Booth

Dubai, UAE February 5 - 7

Belmont Booth Bisco Booth

FKG Booth

Micro Mega Booth

Denmat Booth

Exhibition Floor

Bien Air Booth

Piro Trading Booth

Ultradent Booth

AEEDC 2019

Lebanese Society of Endodontology 14th International Scientific Meeting February 8 - 9, 2019 Hilton Metropolitan Palace Beirut, Lebanon

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Left to Right; Marc Kaloustian, Fadl Khaled, Roula Dib, Elias Maalouf, Roger Rebeiz, Carla Z. Moubarak, Walid Nehmeh, Edward Rizk, Edmond Koyess, Marc Habib

Prof. Carla Zgheib Moubarak, President LSE

Prof. Roger Rebeiz, President LDA 76

Dental News

It is a great pleasure to welcome you to this 14’ th Lebanese Society of Endodontology International Congress. I am delighted that so many esteemed guests and speakers from around the world are taking part in this congress. A warm welcome to all of you.

I would like to take this opportunity to acknowledge the presence of our special guests: LDA’s new President Pr Roger Rebeiz, a master in clinical endodontics, who is honoring us by attending this ceremony and our congress.

My gratitude goes to the deans of the faculties of Dentistry, Pr Osman, Pr Zeinoun represented

by Pr Koyess, Pr Makzoume represented by Pr Khalil who are leaders in science and professional knowledge and who have constantly been supporting our society and it s activities.

Ladies and gentlemen, the theme of this year’s congress is Mastering Clinical Endodontics. We are honored by the distinguished presence of top reputed world wide clinicians, researchers and speakers: Prs Elio Berutti from Italy, Gilberto Debelian from Norway, Gustavo De-Deus from Brasil, Rui Da Costa from Portugal, Antonis Chaniotis from Greece and last but not least Dr Simone Staffoli from Italy. I must thank you personnaly Elio, Gustavo, Gilberto, Antonis, Simone and Rui for giving us the honor of accepting our invitation and sharing with us your experience and Knowledge and for your precious friendship.

The Lebanese Society of Endodontology was founded in 1991 by Pr Elie Maalouf, Prof. Pierre Souaid, Prof. Joseph Sader, Dr Faysal Alameddine and Dr Ghassan Al Oueini. LSE is a member of international endodontic organisations: IFEA, ESE, APEC and the PanArab Endodontic Association. Our society and its members are experts and leaders in our field of specialty.

Dear colleagues, our profession as endodontists has reached the ultimate level today taking mechanical developments to a new era with the introduction of state-of-the-art newer instruments and equipment in conjunction with biology and medical care. We are counting on all of you members and friends of the LSE to help fulfilling our dreams in raising our specialty to the highest level and for a bright and exalted future for our Endodontic Society.

As President of LSE, I will always work dedicatedly towards “excellence in endodontics”. We all know that none of us can enter into a commitment like this without support of colleagues, friends, and family. I would like to congratulate and encourage all the new board members in their new mission.

Prof. Carla Zgheib Moubarak - President, Lebanese Society of Endodontology March 2019

Prof. Roger Rebeiz, Prof. Carla Z Moubarak, Prof. Elio Berutti, Dr. Fadl Khaled, Dr. Edward Rizk, Dr. Gilberto Debelian

Dr. Edward Rizk, Pr. Gustavo De-Deus, Pr. Carla Z Moubarak

Pr. Carla Z Moubarak, Pr. Elio Berutti, Dr. Edward Rizk

Pr. Carla Z Moubarak, Dr. Simone Staffoli, Dr. Marc Kaloustian

Dr. Jihad AlHusseini, Dr. Gilberto Debelian, Dr. Diana Abla

Microscopy hands-on by Dr. Gilberto Debelian

Dr. Alaa ElMais, Dr. Antonis Chaniotis, Dr. Hassan Husseini

G-CEM™ Veneer from GC: The perfect flow

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Aesthetic dentistry is evolving towards less invasive preparations with high aesthetic restorations which deserve dedicated luting solutions. Featuring a perfect viscosity and high physical performance, G-CEM Veneer has been designed to offer standardized luting procedure for indirect restorations less than 2 mm thick. Thanks to the Full Silane Coverage (FSC) technology, it possesses unique thixotropic properties that make it easy to dispense, apply and clean up, while maintaining an exceptional strength. website: www.gceurope.com

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March 2019

PRIMESCAN: The New intraoral scanner from Dentsply Sirona Easier than ever, faster than before, more accurate than previously possible – all describe Primescan, the new intraoral scanner from Dentsply Sirona What was considered an absolute sensation more than 30 years ago is almost taken for granted today. In terms of quality, digital intraoral impressions are in no way inferior to conventional methods, and therefore, are becoming a reliable alternative for taking impressions of both individual teeth and the entire jaw for more and more dentists.

Dentsply Sirona introduced the digital impression to dentistry with CEREC. Now, with Primescan, the Company is introducing an intraoral scanner with outstanding technology, which enables scans that are more precise than anything we have known before. This has been substantiated by a new study at the University of Zurich.

Scans up to 20 millimeters in depth Primescan’s optical impression system has been decisively developed. The scan of the surfaces of the teeth is done with high-resolution sensors, capturing up to one million 3-D data points per second. With optical high-frequency contrast analysis, they can now be calculated more accurately than ever before. With Primescan, it also is possible to scan deeper areas (up to 20 mm). This enables digital impressions even for subgingival or particularly deep preparations. Virtually all the tooth surfaces are captured, even when scanning from very shallow angles. Primescan captures the dental surfaces immediately, in the required resolution and with a high sharpness even at great depths, thereby ensuring a much more detailed 3-D model. website: www.dentsplysirona.com

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The fixation system is housed in a clearly structured metal box and contains primers for metal and ceramic, as well as hydrofluoric acid gel and accessories, in addition to the highly opaque composite cements. The secret: An intelligent mixer provides a fixation rate that is approximately 30 % higher on average than standard automix systems. The outstanding adhesive properties can be significantly increased by sterilizing the abutment crowns fixed in the lab. VITA ADIVA IA-CEM Ultra opaque masks titanium completely and creates a strong adhesive bonding between the metal surface and the restoration. website: www.vita-zahnfabrik.com

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