Dental News March 2020 Issue

LOCATOR R-Tx An Improved Attachment System Correcting Excessive Overbites with V-Bend Activations of Super Elastic Wires

SIDC 2020 AEEDC 2020

MARCH 2020

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ARTICLES

CONGRESSES

LOCATOR R-Tx – An Improved and Advanced Removable Attachment System

54. SIDC 2020

30th Saudi Dental Society International Conference

Joseph J. Massad, Swati Ahuja, Russell Wicks, David R. Cagna

January 23 – 25, 2020 Ritz-Carlton - Riyadh, Saudi Arabia

60. AEEDC 2020 20.

17th Global Scientific Dental Alliance

Surgical Removal of Maxillary first and second molars

February 4 - 6, 2020 Dubai, United Arab Emirates

Parmanand Dhanrajani

70. ICD

International College of Dentistry Middle East section

28.

February 27th, 2020 Lebanese Dental Association HQ Beirut, Lebanon

Correcting Excessive overbites with V-Bend Activations of Super Elastic Wires Suhail A. Khouri, Derek Mahony

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FDI World Dental Congress

September 1 - 4, 2020 Shanghai, CHINA www.fdiworlddental.org

Expodental 2020

September 17 - 19, 2020 Rimini, ITALY www.expodental.it

IOC 2020 - 9th International Orthodontic Congress

October 4 - 7, 2020 Yokohama, JAPAN www.wfo2020yokohama.org

Moroccan Dental Meeting

October 29 - 31, 2020 Marrakech, MOROCCO www.moroccandentalmeeting.com

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March 2020

Dental News

11

Prosthodontics

LOCATOR R-Tx – An Improved and Advanced Removable Attachment System Abstract

Joseph J. Massad, DDS, Associate Professor, Department of Prosthodontics, University of Tennessee Health Center School of Dentistry, Memphis, Tennessee, USA

Swati Ahuja, BDS, MDS, Adjunct Assistant Professor Department of Prosthodontics University of Tennessee Health Science Center, College of Dentistry, Memphis, Tennessee, USA sahuja@uthsc.edu Russell Wicks, DDS, MS, Professor and Chair Department of Prosthodontics University of Tennessee Health Science Center, College of Dentistry, Memphis, Tennessee, USA

David R. Cagna, DMD, MS, Professor, Department of Prosthodontics, University of Tennessee Health Science Center, College of Dentistry

Republished with permission from Dentistry Today

12

Dental News

Zest Dental Solutions has introduced the next-generation LOCATOR attachment system (LOCATOR R-Tx Removable Attachment System) to improve the angle correction capability of the conventional LOCATOR attachment along with several new features incorporated in the design to improve its clinical performance. LOCATOR R-Tx abutments are restored using the same technique as conventional LOCATOR attachment systems.

The purpose of this article is to report a case utilizing LOCATOR R-Tx attachment systems to facilitate fabrication of an esthetic and functional implant-retained, removable, complete denture prosthesis.

Implant overdentures may be supported and retained using bar and clip attachment systems or through individual, free standing abutment-based attachments. Free standing abutment attachments include balls, magnets, resilient stud attachments, such as the LOCATOR system (Zest Dental Solutions) and ERA (Sterngold), and non-resilient stud attachments such as Ankylos Syncone (Dentsply International).1-4 Attachment system selection depends on a variety of factors that must be identified early in the treatment sequence. These factors include implant position, desire for cross-arch stabilization, size of the prosthesis, economics, oral hygiene compliance, sore spots tendency, restorative space availability, condition of the prosthesis in the opposing arch, and/or ease of fabrication or repair of the prosthesis.4 Bars have been primarily indicated to accommodate non-parallel implant trajectories.

However, most bar systems require substantial planning and the fabrication of a bar supported prosthesis is technique sensitive.5 They require more vertical restorative space compared to individual stud attachments.5 Patients with bar-supported prostheses may be prone to develop mucosal hyperplasia beneath the bar and mucositis around the implants.6-8 Reduced tissue coverage of individual stud attachments, such as LOCATOR or ERA attachments make them a preferred treatment choice for patients with poor oral hygiene.4 LOCATOR attachments were introduced in 2001 and have been used successfully since their inception. They have several advantages including resiliency; self-alignment9-11 (making it easy for the patient to align and seat the prosthesis as well as decreasing the wear of nylon retentive inserts due to improper prosthesis placement), dual retention (internal and external)9-11; ease of replacement of the nylon retentive inserts12, 13, maintenance of oral March 2020

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Prosthodontics

LOCATOR R-Tx – An Improved and Advanced Removable Attachment System

hygiene8; and low-profile11 (3.17 mm for external hexagon implant, 2.5 mm for internal connection). The LOCATOR attachment system has become a popular choice when there is reduced vertical restorative space.5 The reduced height of the attachment also decreases the forces to the implant by reducing the lever arm length.14 LOCATOR attachments make it possible to transform an existing denture to an implant-retained overdenture.11, 15 They can be used to support and retain both complete11 and partial removable prostheses.16 They are compatible with the majority of available implant systems.17 Implant overdentures using LOCATOR attachment systems demonstrate a high success rate (over 94.5%)18 and have demonstrated superior clinical results compared to ball and bar attachments, with regard to rate of prosthodontic complications and the maintenance of the oral function.11 However, all stud attachments, including LOCATOR attachments, display a significant reduction in retention when used in conjunction with non-parallel implants.19-21 The manufacturer recommends using the Extended Range (Gray, red, orange or green) LOCATOR inserts to correct up to 20° angulation per implant (40 degrees between two implants). However, the Extended Range Inserts provide only external retention and also wear faster than the Standard Range.17, 22 The success of a removable implant restoration primarily depends on the retentive capacity of its attachment to sustain its longterm functionality.

Recently, Zest Dental Solutions has introduced the nextgeneration LOCATOR attachment system (LOCATOR R-Tx Removable Attachment System) (Fig. 1) to improve the limitations associated with conventional LOCATOR attachment. In addition to its angle correction capability, several new features have been incorporated to improve its clinical performance.17 The new features include: a DuraTec® titanium carbon nitride coating, which is aesthetic, harder, and more wear resistant compared to the titanium nitride coating used on conventional LOCATOR abutment; an industry-standard .050-in / 1.25-mm hex drive mechanism, precluding the need of special drivers; a smaller central cavity which decreases food and plaque accumulation; dual-retentive features on the external surface of the abutment; and absence of internal engagement, preventing debris and plaque accumulation within the drive mechanism from impacting proper seating; and a reduction in the coronal abutment dimension, making it easier for the patient to align and seat the prosthesis.17

14

Dental News

Fig. 1

Figure 1: LOCATOR R-Tx abutment (left) and Denture Attachment Housing (DAH[right]) with black processing insert

The redesigned Denture Attachment Housings (DAH) (Fig. 2) is anodized pink for aesthetics and designed with flats and grooves to resist vertical and rotational movement.17 It permits 50% increase in pivoting capability and up to 30-degree angle correction per implant as opposed to maximum of 20-degree angle correction per implant with conventional LOCATOR.17 Fig. 2

Figure 2: Interior of DAH

A conventional locator DAH is not anodized and only designed with horizontal grooves to resist vertical movement.17 Opposed to the conventional LOCATOR, LOCATOR R-Tx offers only one set of inserts (Zero retention -Gray, Low retention -Blue, Medium retention -Pink and High retention -white) (Fig. 3) In addition, the LOCATOR R-Tx all-in-one packaging (Fig. 4) provides all the necessary components needed with only a single part number: Abutment, DAH with Processing Insert, Retention Inserts, and Block Out Spacer.

March 2020

Fig. 3

Fig. 4

The oral hygiene of the patient was good. The patient’s medical history was noncontributory. The patient was very esthetic conscious and desired a simple, easy to clean and retentive maxillary restoration.

Fig. 5

Figure 5: Dual-sided LOCATOR R-Tx tool

Fig. 6 Figure 3: Single set of Retention Inserts. Note: Gray- Zero retention, Blue- Low retention, Pink-Medium retention and WhiteHigh retention. Figure 4: All-in-1 package assembly of LOCATOR R-Tx Attachment System

The dual-sided LOCATOR R-Tx tool (Fig.5) permits easy insertion and removal of the retention insert.17 Metal slot feature on the back of the tool allows the clinician to disengage a retentive insert with minimal risk of tearing gloves.17 A recent CR report stated that 100% of CR Project Directors would incorporate the LOCATOR R-Tx into their practice and all of them (100%) rated it excellent or good and worthy of trial by colleagues.23 LOCATOR R-Tx abutments are restored with the same restorative technique used for conventional LOCATOR attachment systems.17 The purpose of this article is to report a case utilizing LOCATOR R-Tx attachment systems to facilitate fabrication of an esthetic and functional implant-retained removable prosthesis.

Figure 6: Panoramic radiograph depicting 4 maxillary and two mandibular implants

The mandibular implants were restored with porcelain fused to metal screw-retained crowns which helped establish the mandibular occlusal plane (Fig. 7). An implant-supported overdenture was planned for the maxillary arch. The maxillary implants had a 30-35 degrees divergence, making it challenging to use conventional stud attachments (Fig. 8).

Fig. 7

Case Report A 46-year-old Caucasian female patient presented to the author’s clinic for restoration of 4 maxillary and two mandibular implants (teeth #6, #9, #11 #13, #19 and #20 locations) (Fig. 6). The implants were planned by the restorative dentist and placed by the oral surgeon.

5 implants were initially planned and placed in the maxillary arch (teeth #4, #6, #9, #11 #13 locations), but implant in location of tooth #4 failed and it had to be removed.

Fig. 7 Porcelain fused to metal screw-retained crowns fabricated to restore the mandibular implants

Prosthodontics

LOCATOR R-Tx – An Improved and Advanced Removable Attachment System

into the prosthesis via a chairside pick-up procedure.

The finished maxillary implant-supported removable dental prostheses incorporating a metal framework was returned from the laboratory (Fig. 12) and evaluated in the patient’s mouth. The fit, form and occlusion was evaluated, and the prosthesis was adjusted, finished and polished as needed.

Fig. 8

Fig. 11

Figure 8: Right and left lateral radiographic views demonstrating divergence between the maxillary implants

The newly introduced LOCATOR abutments (LOCATOR R-Tx, Zest Dental Solutions), were chosen to help manage the divergence between the implants. The following procedures were accomplished to fabricate and deliver the definitive prosthesis:

Figure 11: Maxillary wax trial denture

Fig. 12

The healing abutments were removed and a maxillary open tray impression was made using direct transfer copings (Fig. 9), yielding an implant level tissue cast (Fig. 10).

Fig. 9

Fig. 10

Figure 12: Maxillary implant supported removable dental prostheses incorporating a metal framework with recesses for DAHs Figure 9: Definitive maxillary open tray impression made using direct transfer copings. Figure 10: Implant level cast.

Following this impression, the healing abutments were re-attached to the maxillary implants. An additional impression was made to generate a mandibular cast.

Maxillo-mandibular jaw relationship records (Face bow record, Protrusive record and Centric relation record) were registered and the casts were mounted on a semi-adjustable articulator (Whip Mix 2240, Whipmix, Louisville, KY, USA). A wax trial denture procedure was accomplished to evaluate fit, form, occlusion and esthetics (Fig. 11).

LOCATOR R-Tx abutments (heights chosen based on mucosal thickness) and the DAHs were attached to the implant analogs on the maxillary cast. The mounted casts, and wax trial denture were sent to the laboratory along with detailed instructions for fabrication of the removable dental prostheses incorporating a metal framework. The framework was designed to accommodate the DAHs which were to be integrated

16

Dental News

The healing abutments were removed from the mouth and the LOCATOR R-Tx abutments (retrieved from the laboratory) carefully attached to the implants and torqued as per the manufacturer specifications (Fig. 13).

A radiograph was taken to confirm the complete seating of the abutments (Fig. 14). The DAHs (also retrieved from the laboratory) were seated over the abutments (Fig. 15).

Fig. 13

Figure 13: LOCATOR R-Tx abutments attached to the implants March 2020

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Prosthodontics

LOCATOR R-Tx – An Improved and Advanced Removable Attachment System

Fig. 14

The black processing inserts were removed and replaced with pink retention inserts with the LOCATOR R-Tx tool (Fig. 16). The prosthesis was seated in the mouth. The patient was very pleased with her prosthesis (Fig. 17). The patient was given home care instructions regarding the hygiene and maintenance of the prostheses and placed on a biannual recall schedule.

Fig. 17

Figure 14: Radiograph taken to confirm complete seating of LOCATOR R-Tx attachments

Fig. 15

Figure 17: Patient’s smile with her new prosthesis

Summary

Figure 15: DAHs seated over the abutments

The prosthesis was tried in the patient’s mouth to reverify the fit, occlusion and to ensure that there was no contact of the DAHs within the recesses created in the prosthesis.

The recesses were roughened and sandblasted and the denture attachment housings were cleaned and dried.

A metal bonding acrylic agent (UBAR Metal Bonding Cold Cure, Protech) was applied to the recesses and the denture attachment housings were picked up directly utilizing an auto-polymerizing resin material (CHAIRSIDE Attachment Processing Material, Zest Dental Solutions) as per the manufacturer recommendations. The prosthesis was adjusted, finished and polished as needed.

Ongoing research and development has led to the innovation of the LOCATOR R-Tx attachment system.

Additional patients have been successfully treated using the new attachments (Fig. 18, Fig.19). This article compares the features of the LOCATOR R-Tx with the conventional LOCATOR attachment system.

Fig. 18

Fig. 16

Figure 18: Patient #2 LOCATOR R-Tx attachments used to retain and support a mandibular implant overdenture (Left). Mandibu-

Figure 16: DAHs picked up in the maxillary prosthesis, black processing inserts removed and replaced with pink retention inserts

18

Dental News

lar denture with LOCATOR R-Tx DAH and various inserts (Right) Note: This patient had a fixed implant supported restoration.

Lack of oral hygiene resulted in mucosal inflammation and soreness (top left) leading to treatment failure. The fixed restoration was removed and replaced with a removable implant supported restoration (top right). Improvement in mucosal health observed at two weeks follow up appointment (Bottom).

March 2020

It also includes angulated implant case presentation including clinical and laboratory steps for the fabrication of a metal reinforced overdenture prosthesis incorporating LOCATOR R-Tx attachments.

clinical report. Int J Oral Maxillofac Implants 2001;16:98-104 7. Widbom C, Söderfeldt B, Kronström M. A retrospective evaluation of treatments with implant-supported maxillary overdentures.

Clin Implant Dent Relat Res 2005;7:166-72 8. Ahuja SA, Wicks R, Selecman A. Fabrication of new restorations

Fig. 19

with a consideration of oral hygiene. J Indian Prosthodont Soc 2016;16:307-10 9. Evtimovska E, Masri R, Driscoll CF, Romberg E. The change in retentive values of locator attachments and hader clips over time. J Prosthodont 2009;18:479-83 10. Büttel AE, Bühler NM, Marinello CP. Locator or ball attachment: a guide for clinical decision making. Schweiz Monatsschr Zahnmed 2009;119:901-18 11. Cakarer S, Can T, Yaltirik M, Keskin C. Complications associated with the ball, bar and Locator attachments for implant-supported overdentures. Med Oral Patol Oral Cir Bucal 2011 ;16:e953-9 12. Chikunov I, Doan P, Vahidi F. Implant-retained partial overdenture with resilient attachments. J Prosthodont 2008;17:141-8 13. Kleis WK, Kämmerer PW, Hartmann S, Al-Nawas B, Wagner W. A comparison of three different attachment systems for mandibular two-implant overdentures: one-year report. Clin Implant Dent Relat Res 2010;12:209-18 14. Ibrahim AM, Radi I AW. The effect of two types of attachments on the bone height changes around divergent implants retaining mandibular overdentures. Cairo Dent J 2009;25:181-9 15. Yoo JS, Kwon K-R, Noh K, Lee H, Paek J. Stress analysis of mandibular implant overdenture with locator and bar/clip attachment: Comparative study with differences in the denture base length. The Journal of Advanced Prosthodontics 2017;9:143-51

Figure 19: Patient #3 LOCATOR R-Tx attachments used to retain and support mandibular implant overdenture with divergent implants (top). Mandibular denture with LOCATOR R-Tx DAH and blue inserts (bottom)

16. Mahrous AI, Aldawash HA, Soliman TA, Banasr FH, Abdelwahed A. Implant supported distal extension over denture retained by two types of attachments. A comparative radiographic study by cone beam computed tomography. Journal of International Oral Health : JIOH. 2015;7:5-10 17. http://www.zestdent.com, accessed 3.15.18

References

18. Seo YH, Bae EB, Kim JW, Lee SH, Yun MJ, Jeong CM, Jeon YC, Huh JB. Clinical evaluation of mandibular implant overdentures via Locator implant attachment and Locator bar attachment. J Adv Prosthodont 2016; 8: 313-20

1. Trakas T, Michalakis K, Kang K, Hirayama H. Attachment systems

19. Elsyad MA, Abid KS, Elkhalek EA. Effect of buccal implant in-

for implant retained overdentures: a literature review. Implant Dent

clination on stresses around two-implant-retained overdentures

2006;15:24-34

with resilient stud attachments. Int J Oral Maxillofac Implants

2. Gotfredsen K, Holm B. Implant-supported mandibular overden-

2017;32:e135–e142

tures retained with ball or bar attachments: a randomized prospec-

20. Aroso C, Silva AS, Ustrell R, Mendes JM, Braga AC, Berastegui E,

tive 5-year study. Int J Prosthodont 2000;13:125-30

Escuin T . Effect of abutment angulation in the retention and dura-

3. Alsabeeha NH, Payne AG, Swain MV. Attachment systems for

bility of three overdenture attachment systems: An in vitro study. J

mandibular two-implant overdentures: a review of in vitro in-

Adv Prosthodont 2016;8: 21–29

vestigations on retention and wear features. Int J Prosthodont

21. Uludag B, Polat S, Sahin V, Çomut AA. Effects of implant an-

2009;22:429-40

gulations and attachment configurations on the retentive forces of

4. Massad JJ, Ahuja S, Cagna D. Implant overdentures: selections for

locator attachment-retained overdentures.

attachment systems. Dent Today. 2013;32:128, 130-2

Int J OralMaxillofac Implants 2014;29:1053-7

5. Ahuja SA, Cagna D. Classification and management of restorative

22. Evtimovska E, Masri R, Driscoll CF, Romberg E. The change in

space in edentulous implant overdenture patients. Journal of Pros-

retentive values of locator attachments and hader clips over time. J

thet Dent 2011;105:332-37

Prosthodont 2009;18:479-83.

6. Krennmair G, Ulm C. The symphyseal single-tooth implant for an-

23. Christensen, G. Products Rated Highly by Evaluators in CR Clini-

chorage of a mandibular complete denture in geriatric patients: a

cal Trials. Clinicians report,2018;11:8

Laser Dentistry

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

Oral Surgery

Surgical Removal of Maxillary first and second molars Abstract

Dr. Parmanand Dhanrajani Oral surgeon Bds, mds, msc, msc, fracds, fdsrcs, ffdrcsi Hcf dental centre, Sydney, Australia dan.dhanrajani@gmail.com

This paper presents technical notes on removal of maxillary upper first and second molars. Maxillary first and second molars are difficult and challenging to remove in best experienced hands. The technique described is easy to learn and implement.

It preserves bone and imply minimal trauma as well as avoids complication such as perforation of maxillary sinus floor.

Keywords: Exodontia, Surgical Removal

Maxillary

molar,

Introduction The extraction of maxillary first and second molars is often difficult and challenging especially if they are heavily restored. Teeth with large restorations and/or which are root canal treated are prone to fracture during a forceps removal and a planned surgical technique must be used to start with. These extractions are further complicated by the close proximity of these teeth to the maxillary antrum. Surgical technique requires good planning, meticulous tissue handling and proper use of instruments, especially luxators, so that mishaps such as fracture roots or displacing roots into the sinus are avoided. In the era of implant replacement of the tooth it becomes imperative to maintain as much bone as possible and preserve soft tissue around the extraction site for future replacement 1.

This paper describes a systematic approach for removal of maxillary first and second molars which avoids the most common complications such as fractured root tips, sinus perforations and displacing roots into the sinus while simultaneously maintaining bone and soft tissue2.

Technical Notes for removal of maxillary first and second molars 2.1. Pre-operative assessment of the patient’s medical and social history, ensuring that there are no contraindications for surgical procedures. Informed consent is mandatory before the start of the procedure. This must include the warning that prophylactic closure of maxillary sinus may be required.

2.2. Proper clinical and radiographic examination is essential. During examination assess the status of the tooth in regard to decay, restorations and the amount of tooth loss at the gingival and alveolar margins. Assess the soft tissue available if a buccal advancement flap is required.

20

Dental News

March 2020

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Oral pathology

Oral Surgery Surgical Removal of Maxillary first and second molars

4.– 6. February 2020 Stand: 7D17

2.3. The orthopantomograph (OPG), periapical X-ray and Cone beam CT, if available, should be examined in detail to confirm clinical findings such as the state of tooth crown remaining, shape and length of roots, and if root canal treated or not (Fig 1). Assessment of the proximity of the roots to the maxillary antrum floor and adjacent teeth, and the presence of any pathology such as cyst or granuloma is required.

Figure 1: Orthopantomograph showing heavily filled left maxillary second molar.

2.4. Local anaesthetic should be administered to the buccal and palatal aspect of the tooth; infiltration does work satisfactorily.

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Figure 2: Photograph showing buccal flap with sectioning of crown and roots in the form of T at CEJ.

22

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March 2020

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Oral Surgery

2.6. Removal of buccal bone using a Tungsten Carbide round bur (Dentsply HP Rd 8) until the cementoenamel junction (CEJ) is visible. Start by sectioning the mesiodistal roots buccally at the CEJ so that the palatal root remains intact. This is performed by using a Tungsten Carbide fissure bur (Dentsply Taper 702). Mesial and distal roots are also separated by removing interradicular bone at trifurcation as a figure of T. Luxator number 3 (Hu-Friedy) can be used gently with finger movement to separate the mesial and distal roots from the remaining portion of the crown (Fig 3).

Surgical Removal of Maxillary first and second molars

2.10. Toileting of wound is completed, and closure is carried out with either 3/0 catgut or vicryl sutures (Ethicon, Somerville, New Jersey, USA) (Fig 5).

Figure 5: Photograph post inspection and toileting of the socket.

2.11. Appropriate post-operative analgesics, antibiotics and mouth wash should be prescribed. The patient may be provided with post-operative instructions, monojet syringe for home care and follow-up.

Figure 3: Photograph after removal of mesiobuccal and distobuccal roots.

2.12. If required or indicated a post-surgical OPG or Periapical x-ray can be done to confirm complete removal (Fig 6).

2.7. Gentle luxation separates the mesiobuccal and distobuccal root which then can be elevated leaving the palatal root and the portion of crown intact.

2.8. Full crown or upper premolar forceps can then be used to loosen the remaining palatal root with rotational movement.

2.9. The socket is examined to see if there is any perforation of maxillary sinus floor before closure (Fig 4).

Figure 6: Orthopantomograph showing post extraction of tooth.

Discussion Maxillary first and second molars are difficult and challenging to remove. Morphology of tooth, divergent roots, thin buccal plate and approximation of sinus floor makes surgical removal challenging. The technique described here is easy to learn and implement.

Figure 4: Photograph showing roots and crown.

24

Dental News

March 2020

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Oral Surgery

Surgical Removal of Maxillary first and second molars

It preserves bone and minimizes trauma as well as avoiding complications such as perforation of maxillary sinus floor. Handling of luxators is most important to avoid undue forces during the separation of roots and/or disjunction from the crown.

This avoids displacing the roots into the maxillary sinus. It is important to check the socket for oro-antral communication before closure. It is advisable to take a post-surgical radiograph if in doubt for any missing root before discharging the patient. Most important not to use air rotor to section the tooth , this may lead to surgical emphysema.

4. Preserves alveolar bone for a future replacement procedure 5. Chances of breaking roots are minimized 6. Less chances of a communication into the maxillary sinus or displacing roots into the sinus cavity.

Conclusion Good pre-operative assessment clinically as well as radiographically is of prime importance before attempting removal of upper molar teeth. The success of the procedure depends on efficient planning, meticulous tissue handling and post-op care.

Advantages of this technique are: 1. Easy to learn and implement 2. Patient’s comfort 3. Does not require special instruments

References 1. Fatfat K, Mundra V. Extraction of a maxillary molar tooth -simplified (A case report). IOSRJDMS 2017; 16:8: III, 61-65.

2. Bhargava V, Renton T. Routine Exodontia: Preventing failed extractions. Dent Update 2019; 46:866-879.

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March 2020

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Orthodontics

Correcting Excessive overbites with V-Bend Activations of Super Elastic Wires Introduction

Suhail A. Khouri, D.D.S., ABO

Derek Mahony, BDS, MDS, IBO

Traditional techniques correcting overbite features in all malocclusions have been known to be quite complicated, and challenging to orthodontists. Strong mechanical background, sophisticated appliance designs, diligent patient’s cooperation and multiple adjustment visits over a long treatment time are crucial elements for successful treatment prognosis of this dento-alveolar deformity. Despite the overwhelming advances that already modernized many orthodontic concepts, techniques, and practice, nonetheless modalities correcting overbites did not witness significant advances.

To date super elastic wires have been principally used only in their straight prefabricated form for the sole purpose of initial teeth leveling, until the Bendistal Pliers demonstrated their unique ability to cinch-back and bend NiTi wires, for the first time1. The possibility of placing permanent V-bends on super elastic archwires intraorally armed orthodontists with full control of super elastic wires and resurrected their advanced mechanical properties that were overlooked after performing initial teeth alignment. These bends provided instant techniques to employ their favorable light and consistent force delivery to effectively move groups of teeth in both transverse and vertical planes of space.

Clinical application of this concept has resulted in evolution of new techniques that showed efficiency in correcting a multitude of major orthodontic dentoalveolar deformities with unprecedented simplicity, convenience and time saving2. This article elaborates on one new technique that corrects dental and skeletal deep overbite mostly featured in Class I and Class II malocclusions using simple routine wire adjustments during patient’s regular visits.

Literature Review Orthodontic literature had described myriad approaches for overbite correction. Some approaches used fabricated loops, helices and springs made of stainless steel wires to create the bite-opening force system3, 10-14. Other ones used functional appliances with and without headgears4, 5; while severe skeletal cases were managed with surgical approaches6-9.

Ever since the inception of their use in orthodontic practice, impossibility of bending

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Dental News

March 2020

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Orthodontics

Correcting Excessive overbites with V-Bend Activations of Super Elastic Wires

super elastic archwires has restricted orthodontists to use them only in their prefabricated straight arch forms in initial teeth leveling. Subsequently they couldn’t use the superior elasticity of those wires in other orthodontic tooth movements. They could not even bend distal ends of such wires without annealing that ruins the entire wire’s resiliency and defeats the only purpose of their use. Many researchers demonstrated the validity of using intrusion appliances, helices and springs made of super elastic wires in their prefabricated forms15-17. Despite this success, however, the inability to bend these wires made it impossible to customize the costly intrusion appliances, and resulted in limiting the use of prefabricated elastic appliances and even wires.

Bending titanium wires without annealing or breakage requires specially designed pliers. Khouri developed one such set of pliers – Bendistal Pliers and subsequently showed how clinicians could use them for many intraoral sundry super elastic wire activations that moved segments of teeth and corrected overbites, crossbites, expanded and constricted dental arches, tip backs and rotate molars.2 The mechanical principles underlying bite opening techniques have been well-established and appreciated. in literature3, 16, 19, 20. Dake and Sinclair13 reported that intrusions and extrusions achieved by both Ricketts and modified Tweed techniques remained stable. Hans et al.18 compared the efficiency of the headgear and bionator with fixed appliances in bite opening and found that both approaches produced incisor intrusion combined with skeletal mandibular changes that contributed to the correction of deep overbites.

Burstone3 has advocated that not all patients with overbites require incisor intrusion exclusively, rather some require posterior teeth extrusion to open their bite. He presented upright intrusion springs that intrude anterior teeth with minimal effect on posterior teeth.

He recommended spring appliances with low load/ deflection rates to produce the optimal intrusive forces.

Sander et al.16 described intrusion mechanics completed with NiTi uprighting springs with low load / deflection rates that could intrude incisors a magnitude of 7mm.

Shroff et al.11 found it difficult to correct deep overbites when accompanied with flared incisors by conventional orthodontic therapies. They subsequently recommended the Burstone segmented arch approach for achieving

30

Dental News

precise vertical and horizontal simultaneous movements of teeth. Davidovitch and Rebella12 described an intrusion archwire that uses only tip back bends close to molars, to achieve bite opening. Nanda has also described appliance systems and biomechanical techniques for incisor intrusion. Melsen et al.15 compared force systems generated by stainless steel and beta titanium cantilevers with helices and have demonstrated that quality of the wire influences the relative stiffness. They showed how various laboratory wire configurations could deliver predetermined horizontal and vertical forces.

Using the V- bends in bite opening mechanics and other mass tooth movements’ is not new and was successfully used on manufacturer-bent super elastic wires by researchers13, 15, 21, 22.

What makes this technique more clinically applicable however is the orthodontist’s ability to customize the exact orientation, locations and easy placement of permanent V-bends intraorally on tied super elastic wires with the proper tool during their patient’s routine adjustment visits.

Material and Method The pliers used to place the intraoral V-bends on NiTi wires in this technique are new pliers called Bendistal Pliers (Figure 1 A,B). They are designed longer and thinner than conventional ones, for easier accessibility in the patient buccal sulcus.

They are made in a set of two pliers – one for the archwire adjustments in maxillary right and mandibular left quadrants, while the other pair makes adjustments in maxillary left and mandibular right quadrants.

Fig. 1A

Fig. 1B

Figure 1, A: Front View of Bendistal Pliers showing engraved letter abbreviations of the two quadrants each pair of pliers serves.

B: Enlarged view of the pliers jaws that serve maxillary right and mandibular left quadrants.

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Orthodontics Correcting Excessive overbites with V-Bend Activations of Super Elastic Wires

IT‘S MY CHOICE.

So much flexibility is unbelievable!

A full squeeze of the pliers jaws around the archwire creates a permanent sharp bend on most types and sizes of super elastic wires extraorally and intraorally without annealing or fracture (Figure 2. a & b). The resulting bend angle is slightly obtuse and ranges between 100-110 degrees. The stability of the obtuse bend angle protects the titanium archwire against fatigue or fracture after tying, and maintains an efficient and consistent level of light force delivery.

Placing such V-bends has expanded the scope of clinical usefulness of super elastic wires far beyond the preliminary alignment and rotational control of teeth they primarily do. They activate such wires to move single or whole segments of teeth in vertical and horizontal planes to correct many dento-alveolar deformities with unsurpassed simplicity and dispatch. This article is focused on the vertically oriented V-bends that help open severe overbites.

Making the V-Bends To place the bite opening V-bends on maxillary archwire, position the apex of gingival jaw of Bendistal Pliers above the archwire, with the occlusal jaw underneath it as shown in figure 2, a. For bite opening V-bends on mandibular archwire, position the apex of the gingival jaw below the archwire and the occlusal jaw above the archwire as illustrated in figures 2, b. Then make a firm squeeze in the recommended locations on the archwire.

Fig. 2A

GINGIVAL JAW

Fig. 2B

OCCLUSAL JAW

ONE IMPLANT – TWO ABUTMENTS.

Figure 2, A: Permanent 110 degree intrusive bends on a maxillary NiTi wire 0.016”x 0.22” placed extraorally distal to canine’s areas.

B: placing Intrusive bend on mandibular archwire is done by reversing plier’s jaws.

Before using the pliers, clinicians must be familiar with the most effective orientation, location, and direction of each V-bend on archwire that activate it to create the prescribed force system prescribed to elicit the planned teeth movement. Also the proper positioning of the pliers jaws in relation to the archwire, is equally critical to place the proper bends and to master the technique. www.dentaurum-implants.com

32

Dental News

March 2020

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Orthodontics

Correcting Excessive overbites with V-Bend Activations of Super Elastic Wires

Precision in orienting the apex of the V- bend on an archwires determines whether the teeth will intrude or extrude. To intrude maxillary incisors, place pliers jaws as shown in (figure 2A), and to intrude lower incisors place pliers jaws as shown in (figure 2B) and vise versa.

moments to the couple of forces causing them, we see intrusion of the furthest teeth on both sides of the V-bend; and extrusion of teeth closest to that bend (Figure 4.B).

Actually the intrusion effect and the extrusion side effect resulting from this V-bend technique both work favorably to open the deep overbite.

Fig. 3 Fig. 4A

Figure 3: illustrates the long range of wire activation after placing the V bends on 0.016�X0.022� NiTi archwire.

Those bends can be easily placed either extraorally or intraorally in the midway point between canine and first premolar brackets. Upon tying the active wire will deliver a consistent intrusive force and moment on anterior teeth segment - from canine to canine. The curvy shape of activated wire delineates the ultimate prospective incisors positions the wire will intrude them to.

Fig. 4B

Rationale of the New Technique This technique was actually inspired by Bendistal Pliers ability to place lasting bends and activate tied super elastic archwires intraorally. Resiliency of super elastic wires provided light force delivery and allowed bending tied archwires without breaking adjacent brackets.

Also the stability of bends ensures consistency of force delivery over the long range of activation those wires are famous for. The key to success of this technique is its simple clinical applicability, its convenience and time saving, besides enabling orthodontists to customize number and locations the intrusive V-bends on tied archwires.

Mechanical Considerations of the V- Bends 1. It is well known that V-bend on any orthodontic wire create two moments equal in magnitude and opposite in directions acting on teeth in both sides of that bend (Figure 4A). The labially directed moment acting on teeth segment anterior to the V-bend is counter acted by an equal and posteriorly directed moment (side effect), on teeth segment posterior to that bend. Analyzing those

34

Dental News

Figure 4, A: Diagram showing analysis of the force system created by V-bends located between canine and first premolar. To bring the system into equilibrium, anterior moment M1 must be equal to posterior moment M2. B: Shows the intrusion and extrusion effects of both moments acting on tooth segments located on both sides of the bend.

2. The apically directed forces applied through facial brackets of anterior teeth, intrude them and cause them to flare because the force line passes facial to their center of resistance creating a labially directed moment. Such flaring can be controlled with elastomeric power chain extending from one upper molar to the other.

3. In maxillary 1st premolar extraction patients, posterior segment consisting of 1st molars and 2nd premolars provides an anchorage of 8 roots, to intrude the six roots of the anterior teeth segment. Posterior teeth anchorage March 2020

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Orthodontics

Correcting Excessive overbites with V-Bend Activations of Super Elastic Wires

can be further strengthened by adding both maxillary 2nd molars that increases number of anchor roots to 14, if minimizing the side effect is indicated. The anterior teeth intrusion is elicited by the vertical component of force of the anterior clockwise moment causing the bite to open. Clinician can decide whether to prevent or take advantage of the extrusive side effect on teeth close to both sides of the V-bend that help opening the deep overbite as well, figure 4.

4. Although intrusion of the furthest molars of posterior segments may be an unwelcome side effect23 however, it is very advantageous since the apically-directed force acting buccally to molar’s center of resistance, intrudes their buccal cusps and extrudes their lingual cusps. This very side effect becomes a favorable indispensable step to disengage upper and lower molar cusps that simplifies cross-bite correction by routine bend adjustments. It actually constitutes the core of the rationale for another technique to correct cross bites. This technique will be addressed in a future article.

A

B

C

Figure 5 A: Intraoral frontal view of a skeletal overbite overjet of Class 11 Div.1. B: Lateral intraoral view of the same patient half way through bite-opening process, and the intrusive V-bends on 0.016”X0.022” NiTi distal to canines (arrows) on both archwires. Note how once maxillary incisors are intruded enough to bond mandibular teeth how mandibular archwire with reversed V-bends on it helped opening the bite. C: Frontal intraoral view showing the bite opening effects of V- bends on maxillary and mandibular arches in an advanced stage of treatment.

36

Dental News

Clinical Technique and Wire Sequence Traditional intrusive appliance designs and springs made of stainless steel wires required long prefabrication time, frequent adjustments, and high patient cooperation over long treatment time. Although V-bends on stainless steel wires were already known to intrude teeth, however their relative stiffness and short range of activation limited their efficiency and clinical application.

On the other hand, using Bendistal Pliers makes it clinically simple and possible to place V-bends on titanium archwires ensuring light and consistent intrusive force delivery. To master this technique, orthodontists must have good background in creating the bite opening force system through placing V-bends that incidentally conform to segmental formats.

This technique can be started as early as the initial smallsized 0.016” NiTi wire finish its sole role in preliminary teeth alignment. Instead of discarding this wire, placing V- bends on it distal to both canines rejuvenate this wire and take its performance to a much higher level as shown in figure 4. Once the bite opens enough to allow mandibular incisor bonding, a similar small sized NiTi wire is tied in to align mandibular teeth and possibly start early intrusive bends on mandibular archwire. Then the light magnitude of the intrusive force on anterior teeth can be increased according to case severity, by upgrading wire size, to a thicker rectangular one. (Figure 5) A

B

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Orthodontics Correcting Excessive overbites with V-Bend Activations of Super Elastic Wires

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C

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Figure 6. A: Frontal intraoral photograph of a Class II division 2 patient with more than 100%severe overbite that prevented mandibular incisors bonding. B: Same patient with a blue bite-raising plate in place (arrow), allowing mandibular teeth bonding and simultaneous placement of mandibular initial aligning archwires. C: Right intraoral view during treatment showing the bite-opening effect of the upper and lower V-bends (arrows) on 0.016� X 0.022�

NiTi archwires that allowed safe removal of the acrylic bite plate and continuation of treatment.

If overbites extend more that 100%, greater force is required to intrude anterior teeth. V-bends on larger size rectangular NiTi wires (.016 x .022), deliver relatively greater and consistent force that is still tolerable by patients and not so stiff to break the neighboring teeth brackets.

As the mandibular teeth align and the mandibular curve of Spee starts to flatten, replace the initial wire with a .016 x .022 NiTi archwire to get a greater force magnitude by placing similar V-bends in the same locations on it.

Monitor the case for few months until the overbite opens.

In cooperative patients overbite is corrected in about six months.

In later stages of treatment, if greater force is required, stainless steel rectangular wire may be used with similar V bends to over correct or/and maintain results. A very gentle or incomplete squeeze of the plier’s jaws is adequate to activate stainless steel wires to deliver a greater intrusive force without breaking adjacent brackets.

Patients who display severe skeletal overbites (150% or more), will benefit from acrylic bite plates that will allow early and simultaneous mandibular incisor bonding and commencement of intrusion mechanics on both dental arches (figure 6). Simultaneous bonding both arches shortens bite opening time. The same wire sequence and activation is followed in mandibular arch as that in maxillary one.

38

Dental News

March 2020

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Orthodontics

Correcting Excessive overbites with V-Bend Activations of Super Elastic Wires

Once overbite opens enough to allow mandibular incisors bonding, remove the bite plate and leave the active wires for few more months until the normal 1-2 mm overbite relation is restored. Intrusive wires should not be left in mouth unsupervised for long months to avoid unnecessary over treatment. At this stage clinician can reposition mandibular incisor brackets more incisally where needed, (especially in cases where the brackets were placed gingivally to avoid occlusal interference).

This step flattens mandibular curve of Spee and facilitates restoring and maintaining the normal overbite relation with just tying a straight wire. Rectangular finishing NiTi or stainless steel archwires without bends are recommended for this purpose. Should the need A

A

B

B

C

C

Figure 7, A: Pretreatment lateral intraoral photograph of a severe over bite, complicated by excessive overjet in a Class II Division 1 patient. B: The excessive overjet allowed easier mandibular teeth bonding that helped tying an initial and later on intrusive mandibular archwire. C: Shows mandibular teeth leveling and bite opening effects of the V-bends in on both archwires. Note flattening of mandibular curve of Spee and location of V- bends on both archwires that brought about this progressive result with and after anterior teeth retraction.

40

for additional bite opening develop during the finishing stage, half-squeeze bends on stainless steel wires or full squeezes on finishing NiTi wires ensures over correction.

Dealing with severe skeletal overbite that is complicated by excessive skeletal overjet in Class II division 1 patients, there is usually an adequate space allowing mandibular incisors bonding with or sometimes, without bite plate. Despite the severity of such cases, simultaneous commencement of bite-opening mechanics on maxillary and mandibular arches along with maxillary anterior teeth retraction that should have been planned and executed concurrently; bring about a fast treatment result (Figure 7).

Dental News

Figure 8. A: Pretreatment photograph showing excessive overbite in a Class II, division 2 patient. B: shows the orthodontic effect of V-bend’s bite–opening mechanics in both arches. Note locations of additional V-bends distal to lateral incisors on maxillary and mandibular 0.016”X0.22” NiTi archwires (arrows), that brought about this effect. C: Shows post-treatment frontal intraoral photograph of the same patient.

March 2020

Patient Case 1ATreatments

Case 1B

Following are cases with severe overbites treated by this V-bend technique.

Case 1 A: Frontal view of pretreatment of a patient with severe over bite. B: Post treatment result with bite opened to normal limit.

Case 2A

Case 2B

Case 2 A: Frontal view of pretreatment of a patient with severe over bite. B: Lateral view of the same patient showing that the V-bends not only corrected the overbite, but over treated it when the intrusive archwire remained in place long enough.

Discussion Orthodontic researchers and authors have not yet offered orthodontists an easy and clinically applicable method for correcting deep overbites using super elastic wires. This professional deficit has occurred primarily due to lack of instrumentation to activate the highly flexible, brittle NiTi archwires.

The new Bendistal Pliers provide the proper armamentarium needed to control such wires and offer the following advantages: 1. The tiny jaw tips of the pliers easily fit between brackets and allow making the bends without wire or bracket breakage.

2. The light and consistent forces produced by these intraoral bends provided efficiency in tooth movement and convenience to clinicians and patients.

3. The long range of activation of super elastic wires resulting from single bends increases magnitude of intrusion and minimizes the number of adjustments.

4. The mass tooth-moving effect of these V-bends

creates the optimal intrusive forces system created by traditional appliances and in a segmental format.

Patients presented in this article illustrate the simplicity, efficiency, convenience and time conservation V-bends can offer in the solution of such a difficult orthodontic problem. Clinicians can customize placement of intrusive or extrusive V-bends without the need for using costly prefabricated traditional bite opening appliance designs, lab work or rely on patient cooperation.

Conclusion This presentation describes a simple, effective and clinically applicable alternative bite opening technique using V-bends on super elastic wires that are created by new orthodontic pliers. Cases treated in this article showed that this instant treatment modality is clinically accessible to orthodontists and can efficiently correct a wide variety of excessive overbites in class I and II

Orthodontics

Correcting Excessive overbites with V-Bend Activations of Super Elastic Wires

malocclusions. This new technique can be performed during the regular orthodontic adjustment visits, without the need for costly and time-consuming prefabricated appliances or laboratory works.

11. Shroff, B., Lindauer, S.J., Burstone, C.J., Leiss, J.B., Segmented

Future research is needed to quantify the amount of dental and skeletal changes elicited by this technique and compare its efficiency with other conventional bite opening modalities.

12. Davidovitch, M., Rebellato, J., Two-couple orthodontic appliance

approach to simultaneous intrusion and space closure: biomechanics of the three-piece base arch appliance. Am J. Orthodon Dentofacial Orthop, 1995. 107(2): p. 136-143.

systems utility arches: a two-couple intrusion arch. Semin Orthod, 1995. 1(1): p. 25-30.

13. Dake, M.L., A comparison of Ricketts and Tweed-type arch leveling techniques. Am J. Orthodon Dentofacial Orthop, 1989. 95(1):

References

p. 72-78.

14. Nanda, R., Correction of deep bite in adults. Dent Clin North Am, 1997. 41(1): p. 67-87.

1. Khouri, S.A., A solution for distal end bending of super elastic wires. Am J. Orthodon Dentofacial Orthop, 1998. 114: p. 675-676.

15. Melsen, B., Konstantellos, V., Lagoudakis, M., Planet, J., Combined intrusion and retraction generated by cantilevers and helical coil. J

2. Khouri, S.A., Using the bendistal pliers for the correction of com-

Orofac Orthop., 1997. 58(4): p. 232-241.

mon orthodontic problems. World J. Orthod, 2002. 3(2): p. 172-174.

16. Sander, F.G., Wichelhaus, A. Scheimann, C., Intrusion mechanics 3. Burstone, C.R., Deep overbite correction by intrusion. Am J. Or-

according to Burstone with the NiTi-SE-steel uprighting spring. J

thodon Dentofacial Orthop, 1977. 72(1): p. 1-22.

Orofac Orthop., 1996. 57(4): p. 210-223.

4. Mahoney, D.R., Witzeg, J.A., A modification of the twin block

17. Nanda, R., Marzban, R., Kulberg, A., The Connecticut Intrusion

technique for patients with a deep bite. Functional Orthodon, 1999.

Arch. J Clin Orthod, 1998. 32(12): p. 708-715.

10(April-June): p. 4-8.

18. Molligan T F, Molar Control Part 1. J Clin. Orthod. 2002 Jan; 36 5. Demisch, A., Ingervall, B, Thur, U., Mandibular displacement in An-

(1): 11-23

gle Class II division 2 malocclusions. Am J. Orthodon Dentofacial Orthop, 1992. 102(6): p. 509-518.

19. Hans, G.M., Kishiyama, C., Parker, S.H., Wolf, G.R., Noachtar, R., Cephalometric evaluation of two treatment strategies for deep bite

6. Delair, J., Sagittal splitting of the body of the mandible (Mehmet›s

correction. Angle Orthod, 1994. 64(4): p. 265-276.

technique) for correction of open bite and deep over bite. J. Maxillofac Surg, 1977. 5(2): p. 142-145.

20. Parker, C.D., Nanda, R.S., Currier, C.F., Skeletal and dental changes associated with the treatment of deep bite malocclusion. Am J.

7. Hinkle, F.G., Surgical treatment of adult Class II division 2 maloc-

Orthodon Dentofacial Orthop, 1995. 107(4): p. 382-393.

clusion. Am J. Orthodon Dentofacial Orthop, 1989. 95(3): p. 185-191.

21. Burstone, C.J., and Koenig, H.A. Creative wire-The force system 8. Piecuch, J.F., Tideman, Hl, Correction of deep bite by total man-

from step and V-bends. Am J Orthod 1988; 93:59-67.

dibular osteotomy; report of a case. J Oral Surg., 1981. 39(8): p. 601606.

22. Lopez, I Goldberg, J., and Burstone, C..J. Bending characteristics of Nitinol wire. Am J Orthod 1979; 75: 569-575.

9. Bell, W.H., Jacobs, J.D., Legan, H.L., Am J. Orthodon Dentofacial Orthop, 1984. 85(1): p. 1-20.

23. Tran, P.H., The three-tooth problem: a facial plane force system delivered by a gabled archwire segment. Master degree theses

10. Cooke, M.S., Wreakes, G., Upper torque/intrusion mechanics in

2004

deep bite cases using the upper utility wire and directional headgear. Br. J. Orthod., 1979. 6(3): p. 157-161.

42

Dental News

March 2020

G-CEM™ Veneer from GC: The perfect flow G-CEM™ Veneer: a light-cure resin cement for high aesthetic demand with easy placement featuring an innovative technology.

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 aesthetic 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.

recommended temperature and do not naturally spread over the surface. Special care must be taken to prevent veneer fracture during placement when a high viscosity material is used.

G-CEM Veneer is made using the latest innovation in filler technology: Full-coverage Silane Coating (FSC). This new technology enables to disperse a higher amount of fillers in a very efficient way and leads to a thixotropic consistency. It stays in place when untouched but gets fluid under pressure.

As a result, a better adaptation can be obtained, the low film thickness ensures an excellent fit and excesses are removed very easily. The optimal surface wetting and homogeneous spread ensures high bond strengths and with a filler rate of 69%, flexural strength and wear resistance are exceptionally high.

Combined with G-Multi PRIMER, a universal primer for all types of substrates, and with G-Premio BOND, a universal bonding for all types of preparations, G-CEM Veneer ensures high bond strength for durable aesthetic restorations. Hence, the same simple procedure as G-CEM LinkForce remains while having the additional benefits of the FSC technology and light-curing, such as extended working time.

Viscosity is a very important property when cementing thin restorations. With a cement that is too liquid, the veneer can shift during the seating and clean-up of excess cement and marginal areas can be tedious and time-consuming. Additionally, mechanical properties tend to be lower when the filler content is low. For these reasons, many dentists have started using pre-heated composites. However, they must be warmed up to the

G-CEM Veneer adapts to all demanding aesthetic cases, by providing a natural result with incorporated fluorescence. It comes in four aesthetic shades (translucent, A2, opaque and bleach) that all remain stable over time. Accompanying water-soluble try-in pastes are available for an easy and predictable shade selection.

For more info, please check our website www.gceurope.com

Restorative Dentistry Jürgen Freitag Master Dental Technician Bad Homburg, Germany

Pressing and Veneering on a Whole New Level: “A True Model of the Future for All-Ceramic Restorations” Despite the long-term success of CAD/CAM, many dental laboratories still use wax for modeling, investment, firing and pressing in the manufacture of all-ceramic dentures.

That is the reality of the situation.

Jürgen Freitag MDT (Bad Homburg, Germany) has already used the new VITA AMBRIA press ceramic for more than 50 restorations on 20 different patients. In this interview, he shares his experiences using the new material and describes his all-ceramic protocol in conjunction with the VITA LUMEX AC universal veneering ceramic.

Mr. Freitag, you have switched to the VITA AMBRIA lithium disilicate for your press ceramic. Have your work methods changed as a result?

Jürgen Freitag MDT: My general work methods have not changed at all with VITA AMBRIA. I simply used the corresponding system components such as the investment ring, investment materials, liquid and plunger according to the working instructions. There was also no difference in the processing time. Positive changes include the precision, vivid esthetics and absolute shade accuracy matching the VITA shade standard that I am able to achieve with this glass ceramic.

with other press ceramics. During the testing phase, I used strong sandblasting at 2.5 to 3 bar with a particle size of 110 μm without experiencing any negative effects.

According to the usage instructions, the particle size should only be 50 μm and the pressure 4 bar. Even when working with abrasive rubber polishers, the material proved to be extremely stable.

What were the press results like directly after devesting and what did you notice during the finishing process?

The reaction layer is minimal. During devesting and sandblasting, the material proved highly robust. I really didn’t have to pay as much attention as I usually would

44

Dental News

Mr. Jürgen Freitag March 2020

Restorative dentistry

Pressing and Veneering on a Whole New Level: “A True Model of the Future for All-Ceramic Restorations”

What possibilities do you see with the interplay between VITA AMBRIA press ceramic and the new VITA LUMEX AC veneering ceramic?

I have never truly experienced this kind of modeling quality. Due to the particle size, the veneering materials can be modeled with a very gentle touch. In combination with the outstanding stability, I am able to achieve the shape faster with fewer adjustments.

Figure 1: Veneers and full crowns made with VITA AMBRIA and VITA LUMEX AC display an optimal fit and a versatile interplay of shade and light. © Jürgen Freitag, MDT

The cut-back with VITA AMBRIA and the individualization possible with VITA LUMEX AC makes it a true model of the future for me, helping me to achieve high esthetics quickly and reliably.

What was your experience with the fit and marginal fit in the laboratory and on the patient?

Because the reaction layer is minimal, the restoration margins are clearly defined. The interaction of the investment material and the glass ceramic leads to results that are dimensionally stable. After the finishing, I put the restorations on the model and they fit.

I received the same feedback from the dental practice.

There were no problems with the fit during the integration process, even with total reconstructions that were more complex.

Figure 2: VITA LUMEX AC enables highly precise modeling, thanks to outstanding stability, and based on optimal interlocking of the ceramic particles through ideal particle size distribution.

Figure 3: The partial crowns cemented in the mouth at 11 and 21 have been integrated naturally and harmoniously with the natural tooth substance. © Jürgen Freitag, MDT

46

Dental News

March 2020

Studies have shown that EdgeEndo has better cyclic fatigue Resistance than other file systems • Similar File Systems • Performance. Price. Technology • Save Thousands

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For more information, please visit www.edgeendo.com/. As based on resistance cyclic testing as shown on the FireWire NiTi Strength Graph: http://edgeendo.com/comparative-study-of-cyclic-fatigue-resistance/. ProTaper®, ProTaper Gold®, ProTaper® Next, Vortex®, and Vortex Blue® are registered trademarks of Dentsply Tulsa Dental Specialties. EndoSequence® is a registered trademark of Brasseler USA.

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Press release

New intraoral scanner “Primescan” from Dentsply Sirona impresses users With its completely new, patent pending digital impressioning technology the new intraoral scanner Primescan enables high-precision digital impressions to be taken of the entire jaw.

These scans present numerous possibilities for users. Primescan was designed for various digital workflows – with the laboratory, directly in the practice, with CEREC or in cooperation with external partners. Validated interfaces noticeably simplify the process, offering dentists the flexibility they desire.

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 new technology, which enables high-precision scans. This has been substantiated by a new study at the University of Zurich. «Dentists rightly expect products and solutions from Dentsply Sirona that make their work at the dental practice easier, safer and better,» says Dr. Alexander Völcker, Group Vice President, CAD/CAM and Orthodontics at Dentsply Sirona.

«Primescan is the solution to an important issue in practices – the option of faster, precise impressioning – which is easy to manage in the usual practice environment, which is reliable, which delivers clinically flawless results, and which is simply fun to use.»

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Dental News

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 and shortwave light, capturing up to one million 3-D data points per second. With optical highfrequency contrast analysis, they can now be calculated very accurately. Dentsply Sirona has submitted a patent application for this process. 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

March 2020

the dental surfaces immediately, in the required resolution and with a high sharpness even at great depths, thereby ensuring a highly detailed 3-D model.

To monitor the scanning process simply and easily and to be able to assess the model immediately, the accompanying Primescan AC acquisition center has a modern touchscreen that pivots and swivels as needed to ensure it is always set to the right ergonomic position.

Dentists acknowledge the intuitive operation and high level of comfort during first-time use, which is also greatly appreciated by patients.

Primescan also scores in terms of hygienic safety. Thanks to the smooth surfaces of Primescan and the acquisition center, the hygienically critical areas, which are often difficult to clean, can be reprocessed safely, quickly and easily.

Comprehensive range of applications The precise scanning technology enables Primescan to be implemented universally. Not only does it produce high-precision images of natural teeth and preparations, it also provides extremely accurate images of other materials commonly used in dentistry.

For example, implant specialists appreciate the simple impressions of edentulous arches or sites with implants, and orthodontists highly rate the detailed scan results for soft tissues (gums, frenulum). With this new scanning technology, impressions can be completed very quickly.

A full jaw impression, including model calculation, is complete in just two to three minutes.

High flexibility for further processing of the scanned images With Primescan, users can leverage the full potential of digital processes for better treatment. The modular concept offers a suitable solution for every need within the practice. The digital 3-D model can be transmitted to a laboratory via the new Connect software (formerly Sirona Connect), and can also be further processed with different software, e.g., for orthodontic or implant treatment planning. The newly developed Connect Case Center Inbox enables laboratories around the world to connect to the Connect Case Center.

In the process, validated scan data from both Primescan and Omnicam can be received easily for further processing in the desired programs and workflows. Alternatively, the restoration can be planned and manufactured in the practice using the new CEREC software 5, with its pleasing fresh, new design, intuitive touch functionality and noticeably improved screen resolution.

Dr. Alexander VĂślcker expresses his confidence. ÂŤDigital impressions with Primescan are the starting point for other exciting digital processes without limiting the future decisions of dental practices. With our seamless solutions and validated workflows with external partners, we are offering our customers a wide range of options which, thanks to digital technologies, enable even better dentistry.Âť

Press release

Fundamental principles in designing reprocessing areas It is recognized all too often that very little consideration is given to sterilization or reprocessing areas in either existing or newly designed dental practices. And yet reprocessing instruments between patients is crucial to meet today’s hygiene rules in dental offices.

Not to mention the dental practitioner’s moral and legal ‘duty of care’ calling for effective, well-defined and implemented infection control measures to prevent the transmission of infectious diseases to patients and staff.

It is particularly noticeable that since the emergence of SARS, the avian influenza outbreaks and the current Ebola pandemic, patients have become more sensitive to hygiene, not hesitating to question dental professionals about asepsis rules and standard precautions.

This is also the case with tattoo, piercing and podiatry salons, corroborated by the numerous press articles dedicated to this topic.

Beyond the purely regulatory and safety aspects, many dentists have made the sterilization area a key asset for their activity. Located in a prime and visible location lets patients understand up front that their health and safety is important to them.

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Dental News

The staff don’t hesitate to share this passion for hygiene with patients, happy to answer any questions they may have. Flattered by this attention, it makes the patient feel confident and secure.

To create new reprocessing areas or enhance existing ones is not an «insurmountable» challenge. It simply requires some basic principles this article will outline.

The amount of space of the reprocessing area The amount of space dedicated to the reprocessing area is essential. In most of the cases it is undersized. The room must

March 2020

be functional, well lit and in correlation with the size of the dental practice and number of instruments to be reprocessed. The integration of cleaning and sterilization devices with their respective accessories and ensuring enough bench space for storage of instruments between the steps of the protocol i.e. before/after cleaning; before/ after packaging and sterilization.

The first fundamental principal is to foresee two (virtual) areas in the room; a dirty and a clean zone. Rationally, instruments will travel in one direction from the dirty zone towards the clean zone. As a consequence of this oneway flow, processed (clean) instruments shall not enter the dirty zone; hence the reprocessing area should ideally be rectangular, a kind of pass-through corridor, featuring two doors (IN & OUT). Both areas require ventilation and the air flow must stream from the clean zone to the dirty zone to prevent potentially contaminated air from the dirty zone being circulated in the clean zone. This can be achieved by pressurizing the clean area or exhausting the dirty area.

At the entrance, there should be a hand washing basin equipped with an eye washing station, vital in case of accidental splashing of disinfectant or any harmful fluid.

Soap and hydro-alcoholic gel dispensers should have an automated dispensation which avoids contaminating taps or bottles with soiled hands. It is recommended to pat dry hands with paper tissues.

Reprocessing area The configuration of each workspace and device will follow the reprocessing steps i.e. pre-disinfection, rinsing, cleaning, rinsing, drying, packaging and sterilization. This room shall not be used for any other purpose. Floors and working surfaces shall be smooth, avoiding sharp corners and edges and be easy to clean and disinfect.

Waste Waste should be disposed of into bags or containers through openings in the bench. Sharps and cutting items must be safely disposed of in specific plastic containers to protect staff, be collected and processed by specialized companies in treating contaminated waste. It is imperative to follow your local national guidelines as they may vary from country to country.

Pre-disinfection – Soaking In order to prevent blood, saliva and debris from drying, all used and non-used instruments shall be soaked as soon as possible after the procedure, using one or more disinfecting containers depending on the number, type and size of the instruments i.e. a small one for burs and files, bigger one(s) for bulk of items, kits or cassettes, etc. Note the manufacturer’s guidelines NOT to immerse or soak transmission instruments in solutions! The manufacturer’s guideline on the concentration and contact time of the chemicals must be strictly observed.

The temperature of the solution shall not exceed 4045°C, thus preventing coagulation of blood proteins which increase the challenge of cleaning. Another benefit of this crucial first step is the reduction of the microbial population, decreasing the risk of infection during handling and cleaning. A basin will permit rinsing of the instruments with tap water aiming to removal any residual chemicals particularly in hollow and hinged items.

Chemical residues could lead to irreversible staining and damage to instruments should a thorough rinsing step be missed.

Cleaning The cleaning step is of utmost importance. Mechanical cleaning by means of an ultrasonic cleaner offers a good level of performance.

Note: Manual cleaning is the least efficient method of cleaning particularly for complex or hollow instruments and rough surfaces.

Press Release

The degree of cleanliness relies on the operator›s experience and appreciation and also raises the risk of staff injuries and infections.

Fundamental principles in designing reprocessing areas

Sterilization «validated process used to render a product free from viable microorganisms».

In order to remove chemicals, all instruments must be rinsed with tap water in a second basin. This would ideally be followed by a second rinse with demineralized water to eliminate residues and salts present in tap water which could lead to whitish stains on sterilized instruments.

«…the presence of a viable microorganism on any individual item can be expressed in terms of probability.

This probability may be reduced to a very low number; it can never be reduced to zero.» (ISO/TS 11139:2006).

Conclusion

In other words; the better each step is accomplished, the closer to «zero».

I would like all readers reflect on these two definitions:

Reprocessing

Always bear in mind that each step of the reprocessing cycle is important. None shall be rushed or skipped which would compromise sterility and the safety of patients and staff.

«All activities required to ensure that a used medical device is safe for reuse» (ADA Guidelines for Infection Control - 2012).»

About the author Christian Stempf has worked extensively within the European dental industry. He has been involved in infection prevention for over 20 years, with focus on reprocessing reusable medical devices, in particular sterilization and organization of sterilization areas.

He has gathered valuable practical knowledge and experience through his daily activities and contacts with healthcare professionals and experts in the field of infection prevention throughout the world.

He is a member of the European (CEN-TC102) normalization committee participating to two working groups i.e. bench top sterilizers (EN13060) and washer disinfectors (EN15883).

Christian shares this experience offering lectures in all objectivity on the topic of sterilization and infection prevention for healthcare professionals as well as comprehensive courses for dental assistants worldwide.

52

Dental News

March 2020

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SIDC 2020 30th Saudi Dental Society International Conference January 23 – 25, 2020 Ritz-Carlton - Riyadh, Saudi Arabia

View More Pictures On facebook.com/dentalnews1

Inauguration of the Exhibition Hall by Badran A. O. AlOmar, Rector of KSU It is a great pleasure to welcome you in the Saudi International Dental Conference 2020 at the Ritz-Carlton, Riyadh. We are organizing an exciting event with rich scientific content that will leave you with a remarkable educational and professional experience. We will be enriched by the participation of many renowned Saudi and International speakers, who excel in their field of specialties to share with you the recent advances in dentistry. This conference gathers many dental specialties like digital dentistry, implant dentistry, orthodontics, cleft lip and palate, endodontics, restorative and esthetic dentistry, pediatric dentistry, periodontics, prosthodontics, and oral surgery that all are centered in providing an excellent dental care to our patients. In addition, we have interesting poster presentations and several research awards. SIDC 2020 provides a wide range of opportunity for all dental professionals, dental assistants, dental hygienists, and technicians to gain knowledge about new advances in different dental specialties. Moreover, you can also witness the state-of-the-art exhibition from the leading medical and dental companies showcasing their wide array of equipment and products.

I would like to thank all attendees for their continuous participation and contribution in making SIDC 2020 a grand success.

I wish everyone a great experience at SIDC 2020 and look forward to seeing you again in Riyadh very soon.

Prof. Mohammed Al Rifai Dean, College of Dentistry, King Saud University / President, SIDC 2020 On behalf of the organizing committee, I welcome you to the 31st edition of Saudi International Dental Conference (SIDC), a premier scientific dental conference in the Kingdom of Saudi Arabia, providing world-class dental education and expertise to dentistry professionals across the region. This year, SIDC conference features the participation of 83 expert speakers coming from across the region and the world. Additionally, on the sidelines of the conference, we have 33 hands-on workshops for the benefit of industry professionals, who aim to improve their understanding and clinical expertise in their respective departments of dentistry. Moreover, the conference will also include 250 E-posters to specially focus on the latest research in various departments of dentistry. Considering the rich legacy of SIDC in the Kingdom of Saudi Arabia, the conference is expected to attract over 7000 visitors and participants from 35 countries during the 3-day event. SIDC will also include Research Awards, where we aim to celebrate the unique scientific achievements and success of our dentistry professionals in the region. We hope that SIDC awards will play a key role in inspiring a new generation of dentists and doctors from across the region and abroad.

Prof. Khalil Aleisa President, Saudi Dental Society / Chairman, SIDC 2020 Organizing Committee

Badran A. O. AlOmar, Rector of KSU 54

Dental News

Prof. Mohamed Al Rifaiy, President, SIDC 2020

Prof. Khalil Aleisa, President, Saudi Dental Society March 2020

Prof. Thakib AlShalaan, Dean Al Farabi colleges Badran A. O. AlOmar, Rector of KSU

Dr. Samer Al Refai, Lebanese Dental Association

Trophy Distribution

Dr. Aisha Sultan, President Emirate Dental Society

Prof. Tarek Abbas, Egyptian Dental Association

Dr. Rola Dib Khalaf, President Lebanese Dental Association, Tripoli

Prof. Maguid Amin, Egyptian Dental Association

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Dental News

March 2020

Dr. Bsais AlAjmi, Kuwait Dental Association

Riyadh, Saudi Arabia January 23 - 25

SIDC 2020

Dr. Yaser AlJundi, President of the Egyptian Dental Society Dr. Adel Alenazi, from Saudi Arabia lecture about Maxillary Sinus Lift

Dr. Azem Qaddomi, President of the Jordan Dental Association

Jeff Ward from Australia talking about Advances to Improve Endodontic Excellence

Dr. Mohammed Alkindi, from Saudi Arabia, lecture about Surgery in Dento-Facial Deformities

Antonis Chaniotis from Greece lecturing about Regenerative Endodontic Procedures

L to R, Drs: Nazih Saleh, Najib Khalaf, Maya Zakaria, Samira Oseilan, Profs; Thakib AlShalan, Rola Khalaf president LDA Tripoli, Gerhard Seeberger president FDI

GC Booth Exhibition Floor

BELMONT Booth

NSK Booth

SDI Booth

IVOCLAR VIVADENT Booth DURR Booth

DENMAT Booth 58

Dental News

March 2020

DENTSPLY SIRONA Booth

December 2019

L to R, Prof. Abdulghani Mira, Prof. Esam Tashkandi, Dr. Gerhard Seeberger, Prof. Ihsane Ben Yahya, Dr. Tony Dib, Dr. Ismail Melhem

L to R, Drs; Radwan, Othman Othman, Prof. Thakib AlShalaan, Samir Radwan, Firas Alem

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February 4 - 6, 2020 Dubai, United Arab Emirates

View More Pictures On facebook.com/dentalnews1

Inauguration of the Exhibition Hall by his Highness Sheikh Hamdan bin Rashid Al Maktoum AEEDC Dubai 2020 continued its legacy to exceed expectations. It was held at the Dubai World Trade Center, UAE. The inauguration was under the auspices of his Highness Sheikh Hamdan bin Rashid Al Maktoum, Deputy Ruler of Dubai, Minister of Finance and President of Dubai Health Authority (DHA).

Since its inception, AEEDC Dubai has been bringing the very best minds and brands to the stage and floor. Every year, AEEDC Dubai united tens of thousands of stakeholders from across the dental spectrum to advance their knowledge and network with like-minded colleagues.

AEEDC Dubai is where all Dentists, Nurses, Assistants, Hygienists, Technicians, Radiologists, Students, Faculty, members of Dental Associations, Ministry Representatives, Manufacturers, Traders meet to learn more, network, and do business.

AEEDC Dubai sets aside ample time for networking with peers and colleagues, during the coffee breaks, luncheons, and the AEEDC Dubai Night activities where participants enjoyed live entertainment and oriental cuisine with new and old friends. With over 4800 exhibiting companies representing more than 4000 brands, 12 exhibition halls, 15 national pavilions in the 2020 edition, AEEDC Dubai 2020 Exhibition is by far the perfect platform to meet peers, demonstrate products, drive brand-awareness, conduct face-to-face business.

AEEDC Dubai 2021 is set to continue its legacy to exceed expectations on February 9-11, 2021, slated to be held at the Dubai International Convention & Exhibition Centre, Dubai, UAE.

Prof. Tony Zeinoun offering a souvenir to Dr Abdulsalam Al Madani 60

Dental News

Dr Abdulsalam Al Madani and Dr. Gerhard Seeberger President of the FDI March 2020

Dr. Amro Adel, GM DentsplySirona MENA Region introducing Prof. Marco Martignoni

Prof. Giuseppe Luongo lecture about Digital Implantology

Dr. Henriette Lerner chairing the Digital Dentistry Society forum Speakers

Dr. Alexandros Manolakis lecturing about Predictable Dental Implant Restorations

Dr. Prasanna Neelakantan lecturing on Bioactive Root Canal Fillings

Prof. Ziad Salameh lecture on CAD-CAM for Endodontically-Treated Teeth

Group Photo of the 17th Global Scientific Dental Alliance Annual Meeting (GSDA)

Dubai, UAE February 4 – 6

AEEDC 2020

Prof. Mohamed Sherine El-Attar lecture on How to Become A Unique Implantologist Dr. Hoda Abdellatif talk about Community-Based Learning in Dental Education

Prof. Dr. Stanley Malamed on Making Anesthesia More Comfortable and More Effective

Dr. Mahmood Ghazi in Digital Occlusion Made Easy

Dr. Maryam Sayed Jaffar Glimpse on Dental Prevention Care in Ras Al Khaimah

Prof. Hezekiah Mozadomi in Optimizing The Role of Dental Scholars in Preventive Dentistry

Prof. Hani Ounsi lecture about Everyday Endodontic Success

Prof. Abbas Zaher in Orthodontic Practices to Enhance Gingival Esthetics

Dr. Paul Nahas Reasons for the Success of Bonding to Laser Irradiated Teeth

Dr. Jaafar Mouhyi Invasive Surgery

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Shreya Rajkumar, Dilip Kumar, Gerhard Seeberger, Tony Dib

Azem el Qaddoumi, Tarek Abbas, Moushira Salah, Josiane Dib, Tony Dib

MORITA Booth Exhibition Floor

BISCO Booth

ZHERMACK Booth ULTRADENT Booth

IVOCLAR VIVADENT Booth 66

Dental News

March 2020

Piro Trading International Booth

W&H Booth A-DEC Booth

EMS Booth Exhibition Floor

VOCO Booth

PROMEDICA Booth FKG Booth

BELMONT Booth 68

Dental News

March 2020

DENMAT Booth

Dubai, UAE February 4 – 6

SDI Booth DURR DENTAL Booth

MANI Booth HENRY SCHEIN Booth

IVOCLAR VIVADENT Booth

GC Booth

SEPTODONT Booth

COLTENE Booth

AEEDC 2020

ICD - Middle East section The International College of Dentists, Middle East Section held its handover ceremony on February 4th 2020 at the Novotel World Trade Center, Dubai, UAE. The ceremony was attended by Fellow Dr. Aisha Sultan, President of health authority in UAE, ICD fellows, general dentists, friends and other related family members.

Councilor Cedric Haddad welcomed the audience with a brief speech. A word from Past ICD President Youssef Talic, represented by his son Doctor Fouad Talic, was stated.

President Talic thanked all fellows for their support during his term, and congratulated the new elected President, Dr. Nadim Aboujaoude, wishing him all the success during his presidency.

Afterwards, Fellow Nabil Barakat presented the ICD golden medal to President Aboujaoude who showed his gratitude to ICD fellows for their trust,

and promised to put all his efforts to promote social, scientific and humanitarian activities under the ICD umbrella. The meeting was ended by taking memorial pictures with the elected president.

On another hand, the ICD-Middle East Section (Section X) convened for its Annual Assembly Meeting for the election of a new board of Officers on February 27th, 2020 at the Lebanese Dental Association Headquarter, Beirut, Lebanon.

The nominated officers were unanimously approved and elected by the attending Fellows for the term 2020-2022.

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Dental News

March 2020

The new board was as follows: President Nadim Aboujaoude President Elect Nasir AlHamlan Vice President Philip Souhaid Immediate Past President Youssef Talic Registrar Joseph Sabbagh Treasurer

Fadl Khaled Editor Ramzi Haddad Councilor Cedric Haddad Regent District 1

Edmond Koyess Scientific Committee Chair Nicole Geha Regent District 2 Eman AlNamnakani

Left to Right: Dr. Fouad Talic, Prof. Nabil Barakat, Dr. Nadim Abou Jaoudeh, Dr. Cedric Haddad

The new elected ICD-ME board for the term 2020-2022; From left to right: Fadl Khaled, Ramzi Haddad Joseph Sabbagh, Nadim Aboujaoude, Cedric Haddad, Nicole Geha, Philip Souhaid, Edmond Koyess

Left to Right: Prof. Riad Bacho, Dr. Rima Abdallah, Dr. Aisha Sultan, Dr. Nadim AbouJaoude, Dr. Maria Haddad

Left to Right: Prof. Nabil Barakat, Dr. Nadim AbouJaoude, Prof. Abbas Zaher

Press release

#dentalsunited From right now back to business It is times of crisis that show how important it is to stick together. For this reason we want to share our know-how and send “professionals� back to a normal business life all over the world. We want to face the challenges of the Covid-19 pandemic together, provide the best support possible and break new ground. For this purpose we have launched the campaign #dentalsunited.

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The whole world is holding its breath because of the coronavirus. There is a lot of uncertainty even in dental practices. More than ever, it is about mastering the challenges posed by lockdown in an imaginative and responsible manner and to gradually return to a regulated and safe daily routine.

Via #dentalsunited we provide valuable tips for a professional hygiene management and how to deal with aerosols. We answer questions about service and provide special offers. In every action, we use interactive dialogue as well as quick, individual solutions – strengths that distinguish W&H even in times of crisis.

As experts within the dental community, we want to actively support our customers and partners during this challenging time.

With #dentalsunited we want to provide dentists around the world with guidance and a positive perspective on the way back to normality.

March 2020

ZirCAD

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More and more dentists and dental lab technicians rely on IPS e.max, the clinically proven all-ceramic system that offers high esthetics and dependable strength. 100 million restorations placed attest to this. From crowns, inlays, onlays, thin veneers and abutments to bridges – make the choice more dental professionals make... MAKE IT e.max!

www.ivoclarvivadent.com Ivoclar Vivadent AG

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

Boston Dental Clinic Deploys Autonomous Robots to Eradicate Covid-19 Virus Boston Dental Clinic, an award-winning dental practice in Boston, USA and Dubai, United Arab Emirates, announces the deployment of UV Disinfection Robots to sterilize the premises and eradicate the spread of Covid-19 (coronavirus). The first dental clinic in the world to utilize this autonomous technology, the UVD Robots eliminate harmful pathogens and superbugs on surfaces and in the air within the room through a highly effective process of sterilization.

A field hospital opened in Wuhan, the epicenter of the virus, was recently staffed with the UVD Robots to ease the burden on pressured healthcare workers and cleaning staff while eliminating the possibility of human error during sanitization.

Within a span of 10 minutes, the autonomous technology and self-navigating robots eliminate the need for additional cleaning staff within a confined space.

Dr. Maged El-Malecki, Dental Director of Boston Dental said, “As the first dental clinic in the world to utilize these autonomous UVD robots, we are providing a protected state-of-the-art experience for all of our patients while ensuring peace of mind during the Covid-19 pandemic.

Our goal has always been to exceed expectations, and our staff and patients are our top priority. We’ve invested heavily in optimizing our safety and sterilization processes, March 2020

including additional hospital-grade air filtrations and personal protective equipment (PPE) for all of our staff.

As the pandemic continues globally, we’re striving daily to ensure a well-protected atmosphere for our patients and staff members.”

The robots use eight UV-C ultraviolet lights to disinfect, and move in a 360-degree fashion to offer complete coverage of the room while destroying 99.99% of all viruses and bacteria. They are more effective than manual cleaning procedures that involve spraying disinfectants. This helps slow the spread of coronavirus and helps protect the frontline healthcare workers that frequent these spaces.

To ensure the safety of those around it, the robots are equipped with an emergency button and sensor-based safety features that shut down the UV lights in case a person is present within the space they’re disinfecting.

In addition to deploying the robots, Boston Dental has implemented additional sterilization methods, enhanced their disinfection tools and air-duct purification methods and provided person protective equipment (PPE) to their entire team.

Dental News

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Voco Solflex Printers SolFlex 650 – 350 - 170

The SolFlex series of industrial grade 3D printers offer innovative features for easier, more efficient workflows and higher process reliability for the dental laboratory and dental practice.

SolFlex 3D Printers have proven themselves capable of handling individual mass production in the hearing aid industry. They are ready for the dental industry with VOCO’s individually matched materials. Different from most other printer manufacturers, VOCO is not only

manufacturing the printer but we also make all of our 3D print materials and therefore can guarantee the perfect compatibility of printer and material.

The know-how of more than 3 decades in the dental industry combined with our own research and development of leading resin technologies ensures superior print materials. Three important innovations make your dental workflow fast, precise and economical.

• Use of STL format • High vat volume allows production over night • DLP-Technology with a long-lasting UV-LED light source • Maximized building speed with high process reliability due to SMP technology • Patented Flex-Vat technology – increasing printing speed while minimizing support structures, saving time and material website: www.voco.dental

HyFlex™ EDM NiTi Files Root Canal Shaping

• Up to 700% higher fracture resistance • Specially hardened surface • Less filing required for treatment success The new HyFlex EDM files constitute the 5th generation root canal files. HyFlex EDM NiTi files have completely new properties due to their innovative manufacturing process using electric discharge machining.

Workpieces are machined in the EDM manufacturing process by generating a potential between the workpiece and the tool. The sparks generated in this process cause the surface of the material to melt and evaporate. This creates the unique surface of the new NiTi files and makes the HyFlex EDM files stronger and more fracture resistant.

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This entirely unique combination of flexibility and fracture resistance makes it possible to reduce the number of files required for cleaning and shaping during root canal treatments without having to compromise preservation of the root canal anatomy.

Just like HyFlex CM files, HyFlex EDM files have the already familiar controlled memory effect (CM). This results in very similar properties in terms of material flexibility and regeneration. website: www.coltene.com

March 2020

XP-endo®

3D Solutions for Root Canal Treatment Since launching its first revolutionary 3D instrument – the XP-endo® Finisher – four years ago, Swiss manufacturer of innovative, high quality endodontic solutions, FKG Dentaire SA, introduces the latest application expansions to its total therapy system : XP-endo® Solutions.

XP-endo® Solutions comprises 2 different files : XP-endo® Shaper and XP-endo® Finisher, that expand at body temperature to achieve safe and easy management of root canal therapy while preserving dentine.

Together with the introduction at IDS 2019 of XP-endo® Retreatment, a new clinical sequence focused on more efficient retreatment solutions, XP-endo® Solutions delivers a more complete system to both practitioners and patients in initial treatment and retreatment management, requiring fewer files.

A Complete System XP-endo® Shaper, with its snake-like shape, is primarily dedicated to canal shaping. Thanks to its adaptive core and a 1% taper associated to a guiding tip, XP-endo® Shaper is able to shape all types of canals with greater safeguarding of the original shape of the root – from regular structures to the most complex. The XP-endo® Retreatment clinical sequence utilizes XP-endo® Shaper that acts like a corkscrew to remove filling material from the canal with extreme precision and efficiency.

XP-endo® Finisher is designed to provide optimal expansion properties through a minimalistic design that ensures smooth and extraordinary, efficient cleaning capabilities of root canal walls. website: www.fkg.ch

VITA VIONIC VIGO®

3D Solutions for Root Canal Treatment VITA VIONIC VIGO is a completely new generation of teeth made of SE polymer with a design perfected for the digital fabrication of dentures.

This new generation can be fixed precisely and reliably in the denture base without any reworking, enabling an efficient completion.

The VITA VIONIC SOLUTIONS portfolio includes: Eight upper anterior tooth moulds, four lower anterior tooth moulds, four upper and lower posterior tooth moulds each, one bonding system, and material blanks for wax try-ins and plastic bases.

Increase productivity • Economical fabrication without any manual/CAM reworking, thanks to a tooth design perfected for a digital workflow Completion in a time-saving manner • Time-saving finalization of the denture via adhesive bonding of the cervically sandblasted teeth in the base, without further auxiliary steps

Natural appearance at the push of a button • Efficient reproduction of nature by means of prefabricated teeth with a vivid play of shape and color, as well as directly accessible digital denture setups Process-reliable fabrication • Reliable, digital fabrication using a coordinated material system, including a unique bonding solution for precise fixation of teeth website: www.vita-zahnfabrik.com

A Bone Level

REG & PX designs for biological integration With more than 30 years of experience in implantology, Anthogyr launched the AxiomÂŽ implant system 10 years ago to improve access to implantology by offering innovative and accessible solutions, a greater comfort for practitionners and performance in their everyday practice.

www.anthogyr.com

Free sample print at www.voco.dental

Sensor Monitored Production

FAST. PRECISE. COST-EFFICIENT. • DLP technology with a long-lasting 385 nm UV-LED light source

DLP 3D printerSolFlex 350 /650

• Maximized building speed of print objects due to SMP technology • Patented Flex-Vat – material-saving, since less and thinner support material is necessary • Large build area for parallel printing of up to 24 splints; allows overnight printing • Compatible with all conventional lab-CAD-programs (STL.-file) • Wide range of suitable materials for printing models, splints, surgical guides etc.

05.-07.02.2019 Stand: 7F06

Please visit us in Cologne 12.-16.03.2019 Stand R8/S9 + P10, Hall 10.2 Stand C40, Hall 5.2

VOCO GmbH · Anton-Flettner-Straße 1-3 · 27472 Cuxhaven · Germany · Tel. +49 4721 719-0 · www.voco.dental

How to Handwash?

WASH HANDS WHEN VISIBLY SOILED! OTHERWISE, USE HANDRUB Duration of the entire procedure: 40-60 seconds

0

1

Wet hands with water;

3

2

Apply enough soap to cover all hand surfaces;

4

Right palm over left dorsum with interlaced fingers and vice versa;

6

5

Palm to palm with fingers interlaced;

7

Rotational rubbing of left thumb clasped in right palm and vice versa;

9

Dry hands thoroughly with a single use towel;

Rub hands palm to palm;

Backs of fingers to opposing palms with fingers interlocked;

8

Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa;

Rinse hands with water;

10

11

Use towel to turn off faucet;

Your hands are now safe.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.

May 2009