Dental News March 2021

Rehabilitation by single complete removable denture NYU Dentistry Study Describes Cellular Mechanisms Leading to Enamel Deficiency SARS-CoV-2 Vaccines: Reality and Expectations

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Vaccination of dentists and dental teams is important to contribute to continued access to oral healthcare.

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MARCH 2021

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Comparing the COVID-19 Vaccines: How Are They Different?

62. SARS-CoV-2 Vaccines:

Reality and Expectations

Kathy Katella

February 11th, 2021 Speaker: Prof. Jon Suzuki

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Panelists: Dr Joseph Massad, Dr Hady Ghanem

Rehabilitation by single complete removable denture: a follow-up in a Tunisian clinical study Alaeddine Mahfoudhi, Oumaima Tayari, Amani Mizouri, Jamila Jaouadi

28.

An Overview of Pedagogical Approaches to Caries-Control Medications in Canadian Dental and Dental Hygiene Programs Mario A. Brondani, Michael Siarkowski, Cecilia C.C. Ribeiro, Claudia M.C. Alves, Leeann Donnelly, Kavita Mathu-Muju

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SARS-CoV-2 (COVID) Virus Infection Pandemic is a worldwide health problem and has caused havoc in all aspects of human life. Pursuit of Vaccines, Therapies, and Diagnostics remains one of the primary objectives of the FDA, CDC, and NIH Health arms of the US Federal Government. FDA (USA) has approved three vaccines; Pfizer, Moderna, and J & J. Current COVID viral pathogenesis and systemic manifestations were presented. Also, the Immunologic mechanisms of antibody response from COVID vaccinations were discussed.

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NYU Dentistry Study Describes Cellular Mechanisms Leading to Enamel Deficiency

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7

Comparing the COVID-19 Vaccines: Community Dentistry

How Are They Different?

Abstract

Kathy Katella kathy.katella-cofrancesco@yale.edu

Even if you’re still waiting for a vaccine, watching the first people get their COVID-19 vaccinations may have felt like a huge relief.

As the weeks pass, countless reports are coming out about the effectiveness of new vaccines that may be approved.

It’s important to keep up, but it’s also a daunting task, given the flood of information (and misinformation) coming at us from so many directions.

So, how do they differ? Here’s what we know so far.

Vaccines from Pfizer-BioNTech and Moderna are being administered in the U.S. right now, Johnson & Johnson just received emergency use authorization (EUA) from the Food and Drug Administration (FDA) for its COVID-19 vaccine, and others are on track to do the same. Even though you will likely not be able to choose which vaccine you will get, it’s still helpful to know how each one is different.

With that in mind, we mapped out a comparison of the most prominent vaccines so far.

The three vaccines authorized by the FDA

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Vaccination of dentists and dental teams is important to contribute to continued access to

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oral healthcare.

” March 2021

Community Dentistry

Comparing the COVID-19 Vaccines: How Are They Different?

Pfizer-BioNTech On December 11, 2020, this became the first COVID-19 vaccine to receive an FDA EUA, after the company reported positive clinical trial data, which included news that the vaccine was up to 95% more effective than a placebo at preventing symptomatic disease. But the Pfizer-BioNTech vaccine has had strict requirements involving how the vaccine is stored. For instance, it has required shipping in ultra-cold temperature-controlled units (-94 degrees Fahrenheit).

In mid-February, the company submitted new data to the FDA demonstrating the stability of the vaccine at temperatures more commonly found in pharmaceutical refrigerators and freezers. Approval would make the vaccine easier to distribute.

For that reason, the Centers for Disease Control and Prevention (CDC) requires vaccination sites to monitor everyone for 15 minutes after their COVID-19 shot, and for 30 minutes if they have a history of severe allergies or are taking a blood thinner.

How it works: This is a messenger RNA (mRNA) vaccine, which uses a relatively new technology. Unlike vaccines that put a weakened or inactivated disease germ into the body, the Pfizer-BioNTech mRNA vaccine delivers a tiny piece of genetic code from the SARS CoV-2 virus to host cells in the body, essentially giving those cells instructions, or blueprints, for making copies of spike proteins (the spikes you see sticking out of the coronavirus in pictures online and on TV). The spikes do the work of penetrating and infecting host cells. These proteins stimulate an immune response, producing antibodies and developing memory cells that will recognize and respond if the body is infected with the actual virus.

How well it works: 95% efficacy in preventing COVID-19 in those without prior infection. The researchers report that the vaccine was equally effective across a variety of different types of people and variables, including age, gender, race, ethnicity, and body mass index (BMI)—or presence of other medical conditions. In clinical trials, the vaccine was 100% effective at preventing severe disease.

How well it works on virus mutations: So far, the PfizerBioNTech vaccine has been found to protect against the variant that was first detected in Great Britain (B.1.1.7), but it may be less effective against the variant first detected in South Africa (B.1.351).

Status: Emergency use in the U.S. and other countries Recommended for: Anyone 16 and older. PfizerBioNTech is still testing the vaccine in kids ages 12-15.

Dosage: Two shots, 21 days apart Common side effects: Chills, headache, pain, tiredness, and/or redness and swelling at the injection site, all of which generally resolve within a day or two of rest, hydration, and medications like acetaminophen. (If symptoms don’t resolve within 72 hours or if you have respiratory symptoms, such as cough or shortness of breath, call your doctor.) On rare occasions (as in, 11 cases in 18 million vaccinations), mRNA vaccines have appeared to trigger anaphylaxis, a severe reaction that is treatable with epinephrine (the drug in Epipens®).

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Dental News

Moderna Moderna’s vaccine was the second one authorized for emergency use in the U.S.—it received FDA EUA on December 18, 2020, about a week after the Pfizer vaccine. Moderna is also an mRNA vaccine, using the same technology as the Pfizer-BioNTech one and with a similarly high efficacy at preventing symptomatic disease.

There are two key differences: The Moderna vaccine can be shipped and kept in long-term storage in standard freezer temperatures, and stored for up to 30 days using normal refrigeration, making it easier to distribute and store. Also, the Moderna vaccine was slightly less effective in clinical trials—about 86%—in people who are 65 and older.

March 2021

Community Dentistry

Comparing the COVID-19 Vaccines: How Are They Different?

Status: Emergency use in the U.S. and other countries Recommended for: Adults 18 and older.

Moderna is still testing the vaccine in children ages 12-17.

Dosage: Two shots, 28 days apart Common side effects: Similar to the Pfizer vaccine, side effects can include chills, headache, pain, tiredness, and/or redness and swelling at the injection site, all of which generally resolve within a day or two.

On rare occasions, mRNA vaccines have appeared to trigger anaphylaxis, a severe reaction that is treatable with epinephrine (the drug in Epipens®).

For that reason, the CDC requires vaccination sites to monitor everyone for 15 minutes after their COVID-19 shot, and for 30 minutes if they have a history of severe allergies.

How it works: Similar to the Pfizer vaccine, this is an mRNA vaccine that sends the body’s cells instructions for making a spike protein that will train the immune system to recognize it. The immune system will then attack the spike protein the next time it sees one (attached to a real SARS CoV-2 virus).

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How well it works: 94.1% effective at preventing symptomatic infection in people with no evidence of previous COVID-19 infection. The vaccine appeared to have high efficacy in clinical trials among people of diverse age, sex, race, and ethnicity categories and among persons with underlying medical conditions (although as mentioned above, the efficacy rate drops to 86.4% for people ages 65 and older).

How well it works on virus mutations: Some research has suggested that Moderna’s vaccine may provide protection against the B.1.1.7 and B.1.351 variants. Researchers are still studying this.

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Dental News

March 2021

Johnson & Johnson On February 27, 2021, the FDA granted emergency use approval for a different type of vaccine, called a carrier, or virus vector, vaccine. In comparison to the Pfizer and Moderna vaccines, this one is easier to store (in refrigerator temperature), and requires only a single shot, both of which could make it easier to distribute and administer.

An analysis released by the FDA in late February showed that the vaccine may reduce the spread of the virus by vaccinated people.

Status: Emergency use in the U.S. and other countries Recommended for: Adults 18 and older. The company also expects to start testing the vaccine on children.

Dosage: Single shot. In November, Johnson & Johnson announced it would launch a second Phase 3 clinical trial to study using two doses, two months apart, to see if that regimen will provide better protection.

Common side effects: Fatigue, fever headache, injection site pain, or myalgia (pain in a muscle or group of muscles), all of which generally resolve within a day or two. It has had noticeably milder side effects than the Pfizer and Moderna vaccines, according to the FDA report released in late February.

No one suffered an allergic reaction in clinical trials for the vaccine, according to the company.

How it works: This is a carrier vaccine, which uses a different approach than the mRNA vaccines to instruct human cells to make the SARS CoV-2 spike protein.

Scientists engineer a harmless adenovirus (a common virus that, when not inactivated, can cause colds, bronchitis, and other illnesses) as a shell to carry genetic code on the spike proteins to the cells (similar to a Trojan Horse).

The shell and the code can’t make you sick, but once the code is inside the cells, the cells produce a spike protein to train the body’s immune system, which creates antibodies and memory cells to protect against an actual SARS-CoV-2 infection.

How well it works: 72% overall efficacy and 86% efficacy against severe disease in the U.S. How well it works on virus mutations: This vaccine’s effectiveness has been shown to offer protection against the B.1.1.7 variant. According to the analyses the FDA released in late February, there was 64% overall efficacy and 82% efficacy against severe disease in South Africa, where the B.1.351 variant was first detected.

Community Dentistry

Comparing the COVID-19 Vaccines: How Are They Different?

Four vaccines not (yet) available in the U.S.

Oxford-AstraZeneca This vaccine, which is currently being distributed in the United Kingdom, is distinguished from some of its competitors by its lower cost—it’s cheaper to make per dose, and it can be stored, transported, and handled in normal refrigeration for at least six months.

Some countries temporarily suspended use of this vaccine in March after a small number of recipients developed blood clots, although the European Medicines Agency (EMA), which monitors the safety of medicines, among other things, stated that there is “no indication that vaccination has caused these conditions.” The WHO and EMA continue to endorse the vaccine.

Status: Not available in the U.S., but approved for emergency use in other countries Recommended for: Adults 18 and older Dosage: Two doses, four to 12 weeks apart Common side effects: Tenderness, pain, warmth, redness, itching, swelling or bruising at the injection site, all of which generally resolve within a day or two.

How it works: Similar to the Johnson & Johnson’s vaccine, this is a carrier vaccine, made from a modified version of a harmless adenovirus. The final product contains the

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Dental News

spike protein found in SARS-CoV-2. When that protein reaches the body’s cells, the immune system mounts a defense, creating antibodies and memory cells to protect against an actual SARS-Cov2 infection.

How well it works: An early review of Phase 3 trials showed 70% efficacy starting after the first dose, and 100% protection against severe disease, hospitalization, and death after the second dose. The analysis also showed the potential for the vaccine to reduce asymptomatic transmission of the virus by as much as 67%.

In late March, AstraZeneca reported on new Phase 3 trial data that showed the vaccine to be even more promising than earlier reported, but the National Institute for Allergy and Infectious Diseases expressed concern about the data, saying it may have included outdated information, which would make its efficacy data incomplete. A spokesperson from AstraZeneca told the Associated Press it was «looking into it».

How well it works on virus mutations: So far it seems to work better against the mutation that emerged in Great Britain than the one that emerged in South Africa.

A paper in early February (not yet peer-reviewed) cited 74.6% efficacy against the B.1.1.7 variant.

However, the vaccine did not protect as well against mild and moderate cases in people infected with the B.1.351 variant. Therefore, South Africa halted its rollout while scientists continue to study whether the vaccine can prevent severe illness and death in people infected with this variant.

March 2021

Novavax

Sputnik V

This vaccine has been shown to be effective not only against COVID-19, but also against the mutations that have emerged in Great Britain and, to some extent, South Africa (although in late January, efficacy against the latter was found to be less than 50% against severe illness).

The European Medicines Agency decided to start the rolling review based on results from laboratory studies and clinical studies in adults. These studies indicate that Sputnik V triggers the production of antibodies and immune cells that target the SARS-CoV-2 coronavirus and may help protect against COVID-19.

While the other breakthrough vaccines have been either mRNA or vector platforms, the Novavax vaccine is yet another type, called a protein adjuvant. It is also simpler to make and can be stored in a refrigerator.

How is the vaccine expected to work?

Sputnik V is expected to work by preparing the body to defend itself against infection with the SARS-CoV-2 virus.

This virus uses proteins on its outer surface, called spike proteins, to enter the body’s cells and cause COVID-19.

Sputnik V is made up of two different viruses belonging to the adenovirus family, Ad26 and Ad5. These adenoviruses have been modified to contain the gene for making the SARS-CoV-2 spike protein; they cannot reproduce in the body and do not cause disease. The two adenoviruses are given separately: Ad26 is used in the first dose and Ad5 is used in the second to boost the vaccine’s effect.

Status: Still completing clinical trials Recommended for: The vaccine is being studied in adults ages 18-84 Dosage: 2 doses, three weeks apart Common side effects: While the Novavax vaccine is still being studied, early trials have shown no adverse events.

How it works: Unlike the mRNA and vector vaccines, this is a protein adjuvant (an adjuvant is an ingredient used to strengthen the immune response).

While other vaccines trick the body’s cells into creating parts of the virus that can trigger the immune system, the Novavax vaccine takes a different approach. It contains the spike protein of the coronavirus itself, but formulated as a nanoparticle, which cannot cause disease. When the vaccine is injected, this stimulates the immune system to produce antibodies and T-cell immune responses.

How well it works: 89.3% efficacy How well it works on virus mutations: Novavax’s report of 89.3% efficacy in January covered both the original coronavirus and the B.1.1.7 variant. But results showed only 49% efficacy against the B.1.351 variant. Novavax has said it plans to begin clinical development of a vaccine specifically targeted to B.1.351.

Once it has been given, the vaccine delivers the SARSCoV-2 gene into cells in the body. The cells will use the gene to produce the spike protein. The person’s immune system will treat this spike protein as foreign and produce natural defenses − antibodies and T cells − against this protein.

If, later on, the vaccinated person comes into contact with SARS-CoV-2, the immune system will recognize the spike protein on the virus and be prepared to attack it: antibodies and T cells can work together to kill the virus, prevent its entry into the body’s cells and destroy infected cells, thus helping to protect against COVID-19.

Dosage: 2 shots (regular fridge temperature) How well it works: 92% efficacy in clinical trials (the Lancet)

Community Dentistry

Comparing the COVID-19 Vaccines: How Are They Different?

Sinopharm In early 2020, the Beijing Institute of Biological Products created an inactivated coronavirus vaccine called BBIBPCorV. Clinical trials run by the state-owned company Sinopharm showed that it had an efficacy rate of 79 percent. China approved the vaccine and soon began exporting it to other countries.

To create BBIBP-CorV, the Beijing Institute researchers obtained three variants of the coronavirus from patients in Chinese hospitals. They picked one of the variants because it was able to multiply quickly in monkey kidney cells grown in bioreactor tanks.

Once the researchers produced large stocks of the coronaviruses, they soaked them with a chemical called beta-propiolactone. The compound disabled the coronaviruses by bonding to their genes. The inactivated coronaviruses could no longer replicate. But their proteins, including spike, remained intact.

Prompting an coronaviruses in injected into the inside the body,

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Dental News

Immune Response; Because the BBIBP-CorV are dead, they can be arm without causing Covid-19. Once some of the inactivated viruses are

swallowed up by a type of immune cell called an antigenpresenting cell that tears the coronavirus apart and displays some of its fragments on its surface. The helper T cell may detect the fragment. If the fragment fits into one of its surface proteins, the T cell becomes activated and can help recruit other immune cells to respond to the vaccine.

The B cell, may also encounter the inactivated coronavirus.

B cells have surface proteins in a huge variety of shapes, and a few might have the right shape to latch onto the coronavirus.

When a B cell locks on, it can pull part or all of the virus inside and present coronavirus fragments on its surface.

B cells get activated, they proliferate and pour out antibodies that have the same shape as their surface proteins.

Status: approved in China, U.A.E., Hungary, Egypt, Bahrain, Morocco, Peru and many other Asian countries.

Dosage: 2 shots (regular fridge temperature) How well it works: 79% efficacy in Chinese clinical trials.

March 2021

Prosthodontics

Rehabilitation by single complete removable denture: a follow-up in a Tunisian clinical study Abstract

alaaeddinemahfoudhi@yahoo.com

Introduction: the Single Complete Removable Denture (SCRD) is a frequent therapeutic solution offered to edentulous patients.

Results: The studied population comprises 34 patients. The majority of complaints were about prosthetic instability followed by pain and discomfort.

Oumaima Tayari assistant professor in prosthodontics

Due to the diversity and complexity of the clinical situations, it is a challenge to the dentist and to the patient who comes with many complaints.

Conclusion: a thorough pre-prosthetic analysis and diagnostics is essential to avoid the many pitfalls of the complete unimaxillary denture and ensure the stability of the prosthetic appliance on the edentulous arch.

Alaeddine Mahfoudhi Resident in prosthodontics

Amani Mizouri Resident in prosthodontics

Jamila Jaouadi Professor in prosthodontics, head of removable complete denture department in dental clinic of Monastir

Faculty of Dental Medicine of Monastir, Oral health and Oral-Facial Rehabilitation Laboratory Research (LR12ES11), University of Monastir, Monastir, Tunisia Dental Clinic of Monastir, Department of removable complete Denture, Monastir, Tunisia

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Dental News

Materials and methods: The complaints of patients with a SCRD were analyzed through a clinical and statistical study carried out in the removable denture department at the Dental clinic of Monastir, Tunisia.

Key Words: Single complete removable denture, Complaints,Prosthetic Instability, Pain, Occlusion.

Introduction The prosthetic rehabilitation of an unimaxillary arch is considered as a complex reconstruction that must be perfectly controlled by the practitioner to ensure the prosthetic durability and the occlusal comfort of the patient. The success in SCRD is dependent on the initial analysis and preparation of the opposing arch in order to obtain a successful denture.

However, many patients express complaints about their prostheses. Therefore, we propose to study these complaints through a clinical study carried out in the department of complete removable denture at the Dental clinic of Monastir, Tunisia among the edentulous patients rehabilitated by SCRD either maxillary or mandibular.

The objective of this work was to analyze the complaints of the wearers of the complete unimaxillary prosthesis in order to determine their natures and to uncover the possible etiologies.

March 2021

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Prosthodontics

Rehabilitation by single complete removable denture: a follow-up in a Tunisian clinical study

Materials and methods This study was carried out at the dental clinic of Monastir for two months (July-August, 2020). 34 edentulous patients who received the treatment in the removable denture department by full maxillary denture and came back to consult with complaints. This study included all patients of all ages who have benefited from a SCRD and who consult for complaints.

Patients with bi-maxillary complete removable denture and implant stabilized prostheses were excluded. The data collection was conducted by a resident under the supervision of a removable prosthetics teacher through a questionnaire designed for the purpose of the study and divided into two parts: • The first part was about the patient’s socio-

demographic data, his chief prosthetic characteristics

complaints and some

• The second part of the questionnaire was reserved for clinical observations made by the dentist in order to analyze the edentulous arch, the condition of the osteomucosal surface, and to evaluate the quality of the prostheses in terms of stability, retention, aesthetics, occlusion and phonation.

The data were entered as a multiparametric database using the 2007 Excel table. The descriptive and analytical statistical study was conducted using the IBM-SPSS software version 23.0.

The significance threshold was set for a value of p 0.05.

Results The socio-demographic characteristics of the sample were grouped in Table

Table III: Distribution of patients by sangiuolo classification

Table I: Sociodemographic characteristics of the sample

Table II: Distribution of Complete Prostheses by Arch

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Dental News

Table IV: Distribution of the different complaints according to the concerned arch March 2021

Prosthodontics

Rehabilitation by single complete removable denture: a follow-up in a Tunisian clinical study

For the analytical results, a significant correlation was found between the Sangiuolo classification at the maxillary arch and the static instability expressed by the patient with a p = 0.012.

Also a dependency relationship was found between the patient’s age and the denture base fracture with a p=0.03.

Discussion In our study, the percentage of men who consult for complaints is the same as that of women, which seems very similar to other studies: for the study of Modhi Al Deeb (2020) in which women represent 46.5% of the population while men represent 53,5%). However, other studies show a higher percentage of men, such as those of Bekri (2019) and Gueye M (2016), whereas Cayrel (2011) and Mboj EB (2010) women are more mentioned in their studies. [1] [2] [3] [4] [5] The average age in our study sample is 63.3 which is similar to the studies of Bilhan coll and Gueye M with an average age of 64.1 years. [6] [3] 44.1% of the study population had general diseases, the most declared of which is diabetes. According to Frank (1998) dissatisfaction with removable prostheses increases in patients with poorer health. [7] This sample consists of 20 maxillary prostheses and 14 complete mandibular prostheses. The high number of maxillary dentures is explained by the notion of delayed loss of mandibular teeth compared to the maxillary ones.

Moreover, practitioners are often aware of the difficulty of ensuring the balance of a complete mandibular prosthesis due to the reduced bearing area. So they are more conservative on the mandibular.

The majority of patients express their complaints after a period of wearing the prosthesis for more than a year which is correlated with the results of Gueye M including 68 prostheses that date back more than a year.

Stability presents the resistance to displacement under horizontal and rotational stress. It depends on the quality of adaptation of the denture to the prosthetic support structures in the horizontal and vertical planes. [8] [9] More than 57% of complaints in our study call for problems

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Dental News

of prosthetic instability (static or/and dynamic). As well Bekri (2019) in his study shows that instability is the major complaint with 49% of the cases. [2] In fact, some anatomo-clinical situations such as the fibromucosal state and bone resorption were the cause of poor retention and consequently prosthetic instability. A relationship has already been found between the maxillary Sangiuolo class and static instability. More instability is found with class II and III. Instability can be also caused during function, for this is essential to control occlusal relations during propulsion and lateral movement according to balanced occlusal concept with a stable prosthesis on these supports [10] Balanced occlusion in excursive movements will lead to prosthesis instability, loss of retention and disinsertion of the prosthesis. [11] [12] Pain is the second complaint represented in this survey at the maxillary and mandibular arch with a respective percentage of 55% and 43%. These values are similar to some studies [6] [14].

An inadequate prosthesis causes pain complaints or functional disturbances capable of causing denture rejection [14] Oral dryness is one of the risk factors of soft tissue pain and especially at the mandibular arch. According to Inamochi Y (2019) 15% of patients claim discomfort with maxillary prosthesis and 21% with mandibular prostheses.

[15] These sensitivities are expressed as result of a functional discomfort related to the prosthetic volume, «full mouth» sensation and prosthetic lip distension. This discomfort is due to either a real over extension of the prosthetic limits or from a significant modification of the prosthetic limits compared to the original prostheses after a long service. [16] Patients in our study consult after denture-base fractures or for detachment of prosthetic teeth. 5.4% of fractured teeth accrues after 2 to 5 years of service of the prosthesis. [14] These alterations can be explained by different etiologies such as improper handling during the prosthetic manufacturing procedures and their impact on the quality of the prosthesis.

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Prosthodontics Rehabilitation by single complete removable denture: a follow-up in a Tunisian clinical study

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those made with VALPLAST. The PMMA present a high rate of artificial teeth loss.[17] Koper believes that occlusal problems and fractures of the prosthesis observed in the single complete prosthesis result of one or all of the following: occlusal stress on the maxillary prosthesis, underlying edentulous tissue, and accustomed muscles to opposing natural teeth, the position of mandibular teeth which may not be properly aligned for the occlusal bilateral balance concept needed for prosthetic stability.

[18] A relationship was found between the age and fracture of the prosthesis that may be due to the cleaning techniques with unsuitable products such as abrasive substances or even the fall of the device during its handling.

[19] [20] [21]

Study limit It is desirable that this clinical study should be multicentric given that the psychological state of patients differ from one region to another. Especially when those complaints are subjective claims that are difficult to assess.

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The SCRD is a delicate treatment for the practitioners who is facing anatomic and physiological different obstacles. This causes many problems and bring back the patient to consult for complaints.

In our study, instability is the most common complaint expressed by the patients followed by pain.

Our role is to find the solution for complaints and motivate the patient for rigorous hygiene of the osteo-mucous surface and the prosthesis. Also control sessions must be programmed after the delivery of the denture.

In complete unimaxillary denture, the problem comes from the fact that the occlusal pattern already exists at the level of the toothed arch and is seldom adapted to the stabilization requirements of the combined removable prosthesis.

24

Dental News

March 2021

@ a-dec.com/500EXPERIENCE

Prosthodontics

Rehabilitation by single complete removable denture: a follow-up in a Tunisian clinical study

References 1. Al Debb M, Abduljabbar T, Vohra F, Zafar M et Hussain M. As-

11. Ortman HR. Complete denture occlusion.

sessment of factors influencing oral health-related quality of life

Dent Clin North Am 1977;21(2):299–320.

(OHRQoL) of patients with removable dental prosthesis.

Pak J Med Sci. 2020 Jan-Feb; 36(2): 213–218

12. Stephens AP. The single complete denture Sharry JJ, editor. Complete denture prosthodontics. 3rd edition.

2. Bekri S, Labidi A, Mabrouk Y, Triki H, Mansour L, B Salem k

New York: McGraw-Hill Book Co; 1974. p. 241–65.

Evaluation of the Treatment Complexity with Single Complete Removable Denture: A Cross-sectional Study in Tunisia. The Jour-

13. Sheppard IM, Schwartz LR, et al. Oral status of edentulous and

nal of Contemporary

complete denture-wearing patients. J Am Dent Assoc 1971;83(3):

Dental Practice (2019): 10.5005/jp-jour-

nals-10024-2621

614–620. DOI: 10.14219/jada.archive.1971.0376.

3. GUEYE M, MBODJ EB, PESSON DM, DIENG L, NDIAYE A,

14. POUYSSEGUR V, DURELLE S, HEBERT D.

DJEREDOU KB. SUCCES DES PROTHESES AMOVIBLES COM-

Objectiver et prévenir les doléances en prothèse amovible com-

PLETES : ENQUETE EVALUATIVE AU SERVICE DE PROTHÈSE

plète: l’échelle d’adaptation. Strat Proth 2008 ; 8 (4) : 295- 300.

DU DÉPARTEMENT D’ODONTOLOGIE DE L’UNIVERSITE CHEIKH ANTA DIOP DE DAKAR. Rev Col Odonto-Stomatol Afr Chir Maxil-

15. Inamochi Y, Fueki K, Matsuyama Y, Yoshida-Kohno E, Fujiwara T,

lo-fac, 2016 Vol 23, n°1, pp. 48-51

Wakabayashi N Does oral dryness influence pressure pain sensitivity in the oral mucosa of removable denture wearers?

4. CAYREL C, BRAUD A, HUE O.

Clin Oral Investig. 2019 Nov 8.

Etude de l’évolution à court terme de la satisfaction après l’insertion de prothèses amovibles partielles. Strat Proth 2011; 11(1): 63-9.

16. Braud A, Erdogan O, Ergin S, et al.

Complication rates and patient satisfaction with removable den-

5. MBODJ EB, NDIAYE C, SECK MT et Al.Impact du port de prothèse

tures. J Adv Prosthodont 2012 ; 4:109-15.

sur la qualité de vie. Dakar Med 2010; 55(1) :13-6.

17. Licia Manzon , Giovanni Fratto, Ottavia Poli , Emilia Infusino Pa6. Bilhan H, Erdogan O, et al.

tient and Clinical Evaluation of Traditional Metal and Polyamide Re-

Complication rates and patient satisfaction with removable

movable Partial Dentures in an Elderly Cohort

dentures. J Adv

Journal of Prosthodontics 28(1) · August 2019

Prosthodont 2012;4(2):109–115. DOI: 10.4047/

jap.2012.4.2.109.

18. Koper A. 7. Frank RP, Milgrom P, Leroux BG, Hawkins NR.

The maxillary complete denture opposing natural teeth: problems

Treatment outcomes with mandibular removable partial dentures: A

and some solutions.

population based study of patient satisfaction.

J Prosthet Dent 1987;57(6):704–7.

J Prosthet Dent. 1998 Jul; 80(1):36-45 19. Vallittu PK, Lassila VP, Lappalainen R. 8. Hill EE, Rubel B. Regarnissage dur direct(en cabinet) d’une

Evaluation of damage to removable dentures in two cities in Finland.

prothèse partielle amovible neuve à extension distale: facteurs à

Acta Odontol Scand. déc 1993;51(6):363- 9.

considerer et techniques. J Can Dent Assoc 2011 ;77 :b84 20. Darbar UR, Huggett R, Harrison A. Denture fracture--a survey.

9. Hofmann E, Behr M, Handel G.

Br Dent J. 7 mai 1994;176(9):342- 5

Frequency and costs of technical failures of clasp- and double crown-retained removable partial dentures. Clin Oral Investig. juin

21. Takamiya AS, Monteiro DR, Marra J, Compagnoni MA, Barbosa

2002;6(2):104- 8

DB. Complete denture wearing and fractures among edentulous patients treated in university clinics.

10. Begin M, Mollet PH

Gerodontology juin 2012;29(2):e728-734.

Douleurs et blessures en prothèses amovible. Actual Odontostolmatol (Paris) 1995 ; 192 :581-91

26

Dental News

March 2021

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Community Dentistry Mario A. Brondani, DDS, MPH, PhD

An Overview of Pedagogical Approaches to Caries-Control Medications in Canadian Dental and Dental Hygiene Programs Abstract

associate professor, department of oral health sciences, division of dental public health 1 brondani@dentistry.ubc.ca

Objective: To investigate pedagogical approaches and perceived barriers to teaching about caries-control medications, particularly silver diamine fluoride (SDF), in Canadian undergraduate dental and dental hygiene programs.

Michael Siarkowski, BSc undergraduate dental student 1 Ibrahim Alibrahim, undergraduate dental student, Umm Al-Qura University, Makkah, Saudi Arabia Cecilia C.C. Ribeiro, DDS, MSc, PhD

Methods: In summer 2018, a 9-item questionnaire was distributed to all 10 dental schools and 32 dental hygiene programs in Canada. It enquired about the types of caries-control medications used, teaching methods and perceived barriers to instruction on managing active caries with SDF.

associate professor 2 Claudia M.C. Alves, DDS, MSc, PhD associate professor 2

Results: The response rate was 80% (n = 8) from dental schools and 72% (n = 23) from dental hygiene programs. All curricula included information about conventional caries-control medica-

tions: fluoride, silver nitrate and povidone iodine.

In all programs, instruction regarding SDF was predominantly didactic: 93% of programs presented lectures on SDF and 30% of programs included clinical teaching and use of SDF in primary dentition only. The lack of consensus on clinical protocols outlining the number and frequency of SDF applications to arrest caries was cited by 43% of the programs as a barrier to clinical teaching.

Conclusions: There is some variation across Canada in pedagogical approaches to caries-control medications and the inclusion of SDF in curricula. Poorly defined clinical protocols were reported as the main barrier to didactic and clinical use of SDF in undergraduate dental education programs.

Leeann Donnelly, RDH, MSc, PhD associate professor, dpt of oral and biomedical sciences 1 Kavita Mathu-Muju, DDS, MPH, MSc associate professor, dpt of oral health sciences, division of pediatric dentistry 1 1: faculty of dentistry, University of British Columbia, Vancouver, British Columbia

Oral health has long been recognized as a basic human right.1 However, in Canada, oral health is excluded from the federally funded health care system and access is challenging for those who are economically disadvantaged.2-5 Complex surgical and restorative dental treatment of teeth affected by caries may be too costly for many. Instead, active carious lesions may be managed by promoting remineralization of affected enamel and dentin via non-surgical methods, including topical application of fluoride, silver nitrate and povidone iodine. In February 2017, silver diamine fluoride (SDF) was approved for use by Health Canada.4

2: department of dentistry II, Federal University of Maranhão, São Luis-Maranhão, Brazil

Republished with permission Journal of the Canadian Dental Association

28

Dental News

SDF is a colourless solution of silver (25%), ammonia (8%), fluoride (5.5%) and water (62%) that has been demonstrated to arrest dental caries effectively. To date, most literature discusses its use in the primary dentition,4,6-12 with very few studies including adults and older adults with root caries.13,14

Appendix available in digital at www.dentalnews.com March 2021

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Community Dentistry

An Overview of Pedagogical Approaches to Caries-Control Medications in Canadian Dental and Dental Hygiene Programs

The current extent to which SDF has been integrated into routine clinical care in Canada is unknown. Recent reports have focused on its incorporation into the caries management curricula of United States dental schools.15,16 These studies suggest considerable variation, both in terms of the extent to which SDF is taught in undergraduate15 and graduate dental programs16 and of acceptable clinical protocols for its use.17,18 The amount of clinical and didactic instruction focused on SDF and other caries-control medications in Canadian dental programs is largely unknown.19 Educational institutions have traditionally been resistant to change when shifting from restorative and prosthetic procedures to more conservative, non-surgical and minimally invasive caries management methods.20,21 The objectives of this study were to investigate the teaching practices and perceived barriers to instruction on caries-control medications, particularly SDF, in Canadian dental and dental hygiene educational programs.

Methods A non-systematic, yet comprehensive, literature search was initiated using the keywords “caries control” AND “silver diamine fluoride”, AND “education” on PubMED/ Medline. The search was limited to full-text studies on humans published in English, Portuguese or Spanish (languages that the authors could understand) between 1970 and August 2018. A supplementary search for conference proceedings and graduate theses was undertaken using ProQuest and the same keywords.

MS identified publications, screened them and excluded those failing to meet the search criteria based on the study objectives. Two pairs of independent researchers (MAB and CMCA; MS and IA) scrutinized the title, abstract and text of the selected publications and included those of relevance to the study. The researchers then met to discuss discrepancies until consensus was reached on which studies to include. Although the literature was searched comprehensively, this manuscript does not present a regular systematic review and meta-analysis for quality assessment given that there was no patient, intervention, comparison and outcome (PICO) question.

In all, 26 full-text articles were included based on their relevance to the study objectives, i.e., describing teaching pedagogies or methods pertaining to caries-control medications and instructions on SDF use. Of these,

30

Dental News

12 reported on both didactic and clinical pedagogical approaches to the use of caries-control medications, including SDF. Some studies reviewed SDF instruction at the undergraduate level,22 while others focused on the graduate level.16 Two studies presented the clinical protocols used to apply SDF.17,22 Most studies mentioning SDF (22) were from the United States, 2 were from Canada,19,20 1 was from Australia and New Zealand23 and 1 was from Brazil.24 Based on these 26 studies, the use of caries-control medications is taught primarily via didactic methods, as a stand-alone subject or within a more robust course, usually restorative or operative dentistry or cariology.

These methods include varying combinations of lectures, case presentations, problem-based learning, case studies, videos and undergraduate/graduate curricula. A few studies present a combination of didactic teaching on the application of SDF in a simulation environment (e.g., extracted teeth) or in a clinical care context involving patients, albeit mostly children.

Based on what we learned from the literature review pertaining to pedagogical approaches to teaching about caries-control medications, we developed a 9-item questionnaire in English only (Appendix), adapted from a 2016 study by Nelson et al.16 The questionnaire included identifying which medications were covered in the curricula and whether didactic instruction took place in lecture, seminar or simulation formats or together with clinical application of these substances. We also asked participants to describe any perceived barriers to teaching minimally invasive management of active lesion strategies using these caries-control medications, seeking information on SDF use in particular.

The questionnaire was pilot tested by 5 faculty members and graduate students to ensure clarity and comprehensiveness before it was sent to all 10 dental schools and 32 dental hygiene programs in Canada via an email attachment in the summer of 2018. We identified potential respondents by examining the websites of these programs; in addition, the questionnaire was sent to deans/directors and department heads with a request to forward it to an appropriate faculty member when no names were identified from their websites. After 2 weeks, a reminder email was sent to those programs and schools that had not responded. A third and final request was sent 4 weeks after the initial email.

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Community Dentistry

An Overview of Pedagogical Approaches to Caries-Control Medications in Canadian Dental and Dental Hygiene Programs

Respondents could either complete the questionnaire as an MS Word document (Microsoft Corp., Redmond, Washington, USA) and email it back or print it out and fax it back. Only 1 response was collected for each institution; those with both undergraduate dental and dental hygiene programs counted as a single response. Descriptive analyses were completed to show the percentages and distribution of the responses.

Results The response rate from Canadian dental schools was 80% (8 out of 10) and from Canadian dental hygiene programs 72% (23 out of 32). All schools and programs reported including the topic caries-control medications. The agents most commonly reported were fluoride varnish (92.3%), acidulated phosphate fluoride foam (88.5%), silver nitrate (26.9%) and povidone iodine (23.1%) with an even distribution between the schools and programs (Table 1). In terms of SDF, 1 dental school and 3 dental hygiene programs reported not addressing its use at all, either didactically or clinically in a formal course or module at the time the questionnaires were returned.

Among dental schools and dental hygiene programs that taught the use of SDF, didactic formats varied widely and included lectures, case discussions, videos and problembased learning (Table 1).

Five of the dental schools reported teaching clinical use of SDF for children, while 2 also taught its clinical use in adults. Of the dental hygiene programs, 14 taught the clinical use of SDF for children, while only 1 did so for adult patients.

The most commonly reported barriers to teaching about the use of SDF included lack of consensus on clinical guidelines in terms of the number and frequency of SDF applications needed to arrest caries (4 dental schools; 9 dental hygiene programs) and lack of training and experience using SDF (4 dental schools; 5 dental hygiene programs). Other barriers included lack of curriculum time, unclear patient benefits, heavy staining of caries

by SDF, unclear reimbursement processes and lack of interest. Three respondents described lack of institution support — or a champion — for incorporating teaching of SDF across their curricula. About half of respondents from both the dental schools (n = 5) and the dental hygiene programs (n = 15) agreed or strongly agreed with the use of SDF as a mainstream therapy for all patients with active caries lesions, not just for high-risk individuals or children.

Discussion This study reviewed the available literature on pedagogical approaches to caries-control medications, particularly SDF and then surveyed Canadian dental and dental hygiene programs on their teaching practices regarding caries control and perceived barriers to incorporating SDF into their curricula. The questionnaire had a return rate similar to other studies on the same topic, above 70%,15,16 which is much higher than the estimated 10% response rate for mailed out surveys.26 Other studies have also shown that the topic of cariescontrol medications has primarily been taught using

Table 1: Teaching and use of caries-control medications in Canadian dental schools (8 respondents) and dental hygiene programs (23 respondents).

32

Dental News

March 2021

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Community Dentistry

An Overview of Pedagogical Approaches to Caries-Control Medications in Canadian Dental and Dental Hygiene Programs

didactic methods, ranging from lectures to videos and case studies, as we found herein; fewer studies have reported the clinical use of SDF when describing pedagogies, despite overwhelming evidence of safe, efficacious use of SDF as a minimally invasive topical agent to arrest active carious lesions. 13,14 As highlighted

by Fontana and colleagues,21 there is critical momentum to include non-surgical caries management in didactic and clinical approaches so that the traditional restorative and prosthetic methods can be contested,20 and riskbased caries management and personalized prevention may be more readily adopted.25 With the exception of fluoride varnish, our results showed that other medications were used at a higher rate than reported in the study that used the questionnaire on which ours was based16; however, that study involved a graduate program in pediatric dentistry. It found that 48.6% of programs used acidulated fluoride foam, 9.5% used silver nitrate and 1.3% used povidone iodine. These discrepancies might be because Nelson’s study16 focused on graduate programs only, and more specifically on clinical use of SDF, which was equally low in our study, in terms of didactic teaching (Table 1).

Both dental and dental hygiene programs reported that clinical use of SDF was predominantly focused on children (70%), which correlates with currently available literature.

A lack of consensus on the frequency of application was listed as the main barrier to inclusion of SDF in teaching clinics. Other studies have also noted the lack of a widely accepted, evidence-based protocol for SDF as another barrier preventing its use clinically. This lack of evidence remains a major hurdle to the full adoption of this nonsurgical dental caries treatment.21,23 Surprisingly, the black-staining side effect27 was not reported as a major barrier to clinical use, contrary to other studies.28,29 This might be because dark staining is frequently reported as influencing the acceptability of this treatment by patients,26 but does not necessarily influence how oral health care providers view its application.28,30 In addition, some respondents mentioned the lack of a champion to advocate the teaching of SDF as a barrier, particularly when there is a lack of institutional support. Champions have indeed been instrumental in the implementation of evidence-based dentistry31 and in prompting daily oral health care practice in long-term

34

Dental News

care homes.32,33 Similar to United States dental schools mentioned in a study by Ngoc and colleagues,15 most Canadian institutions varied in teaching involving SDF, while consistently focusing on its use to arrest coronal dental decay in primary teeth only. Weintraub et al.18 recently concluded that the existence of an easy-to-use protocol is a strong determinant of SDF uptake in clinical settings. In health care systems where basic dentistry remains unaffordable for many, as in Canada, the use of SDF as a mainstream procedure may fall within a dental public health mandate, leading to the need for robust undergraduate pedagogies aimed at sensitizing future dentists to a career focused on dental public health.34 The idea of promoting the widespread use of SDF is supported by the fact that most respondents (66%) from both dental schools and dental hygiene programs agreed or strongly agreed with its use as a mainstream therapy for all patients, regardless of age or socioeconomic status. As more studies emerge, SDF might indeed show evidence of arresting and preventing root and coronal caries in adults and older adults, as long as patients are well informed about the risks and benefits.35 The strengths of this study are related to its relatively high response rate. The limitations of the review method used to develop the questionnaire include the languages used to select the literature, which might have excluded studies in languages other than English, Spanish and Portuguese.

The limitations of the questionnaire include its design and lengthy questions, response bias and potential recall bias among respondents. It also includes the potential for socially desirable responses, as respondents from the schools and programs might have felt pressured to participate in instances where they knew the researchers.

Another limitation was the fact that the questionnaire was available only in English, and only 2 French-language institutions replied. In addition, some dental and dental hygiene programs are based at the same university and might have returned more than 1 questionnaire but were only counted as a single submission. As widely accepted and standardized evidence-based guidelines for the use of SDF and its evaluation must be further agreed on, follow-up studies should explore the extent to which dental professionals use SDF in their practices.

Further studies should discuss the need to better align operative dentistry education with preventive dentistry education and should consider the inclusion of ways to teach proper SDF use for internationally trained dentists holding a licence to practise in Canada.

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Community Dentistry

An Overview of Pedagogical Approaches to Caries-Control Medications in Canadian Dental and Dental Hygiene Programs

Conclusions

References

Dental education worldwide appears to have included the topic of caries-control medications, either as a stand-alone component of the curricula or as a topic within other disciplines, with some including the teaching of SDF use.

1. van Palenstein Helderman W, Benzian H. Implementation of a basic package of oral care: towards a reorientation of dental NGOs and their volunteers. Int Dent J. 2006;56(1):44-8.

Most Canadian dental and dental hygiene schools include cariescontrol medications in their curricula; however, the use of SDF is taught both didactically and clinically in fewer schools.

2. Report on the findings of the oral health component of the Canadian Health Measures Survey 2007–2009. Ottawa: Health Canada; 2010. Available from: http://publications.gc.

Unclear guidelines are the main barrier preventing comprehensive teaching and use of SDF clinically. Widely accepted and standardized evidence-based guidelines for the use of SDF must be agreed on.

ca/site/eng/369649/publication.html 3. Benjamin RM. Oral health: the silent epidemic. Public Health Rep. 2010:125(2):158-9.

4. Yeung SST, Argáez C. Silver diamine fluoride for the prevention and arresting of dental caries or hypersensitivity: a review of clinical effectiveness, cost-effectiveness and guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2017. Available from: https://www.cadth. ca/sites/default/files/pdf/htis/2017/RC0903%20Silver%20 Diamine%20Final.pdf 5. The state of oral health in Canada. Ottawa: Canadian Dental Association; 2017. Available from: https://www.cdaadc.ca/

stateoforalhealth/_files/TheStateofOralHealthin-

Canada.pdf 6. Gao SS, Zhang S, Mei ML, Lo ECM, Chu CH. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment — a systematic review. BMC Oral Health. 2016;16:12.

7. Zhao IS, Gao SS, Hiraishi N, Burrow MF, Duangthip D, Mei ML, et al. Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int Dent J. 2018;68(2):67-76.

8. Horst JA. Silver fluoride as a treatment for dental caries.

Adv Dent Res. 2018;29(1):135-40.

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10. Gao SS, Zhao IS, Hiraishi N, Duangthip D, Mei ML, Lo ECM, et al. Clinical trials of silver diamine fluoride in arresting caries among children: a systematic review. JDR Clin Trans

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11. Monse B, Heinrich-Weltzien R, Mulder J, Holmgren C, van Palenstein Hel-

23. Raphael SL, Foster Page LA, Hopcraft MS, Dennison PJ, Widmer RP, Evans

derman WH. Caries preventive efficacy of silver diammine fluoride (SDF) and

RW. A survey of cariology teaching in Australia and New Zealand. BMC Med

ART sealants in a school-based daily fluoride toothbrushing program in the

Educ. 2018;18(1):75.

Philippines. BMC Oral Health. 2012;12:52.

24. Ferreira-Nóbilo NdeP, Rosário de Sousa MdaL, Cury JA. Cariology in cur12. Fung MHT, Duangthip D, Wong MCM, Lo ECM, Chu CH. Arresting dentine

riculum of Brazilian dental schools. Braz Dent J. 2014;25(4):265-70.

caries with different concentration and periodicity of silver diamine fluoride.

JDR Clin Trans Res. 2016;1(2):143-52.

25. Riley 3rd JL, Gordan VV, Ajmo CT, Bockman H, Jackson MB, Gilbert GH, et al. Dentists’ use of caries risk assessment and individualized caries preven-

13. Hendre AD, Taylor GW, Chávez EM, Hyde S. A systematic review of silver

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tematic review. Comput Hum Behav. 2010;26(2):132-9.

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27. Patel J, Anthonappa RP, King NM. Evaluation of the staining potential of silver diamine fluoride: in vitro. Int J Paediatr Dent.

15. Ngoc CN, Mehta R, Donovan TE, Ferreira Zandona AG. Teaching silver

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2018;82(12):1305-9.

28. Crystal YO, Janal MN, Hamilton DS, Niederman R. Parental perceptions and acceptance of silver diamine fluoride staining. J Am

16. Nelson T, Scott JM, Crystal YO, Berg JH, Milgrom P. Silver diamine fluoride

Dent Assoc. 2017;148(7):510-518.e4.

in pediatric dentistry training programs: survey of graduate program directors. Pediatr Dent. 2016;38(3):212-7.

29. Bagher SM, Sabbagh HJ, AlJohani SM, Alharbi G, Aldajani M, Elkhodary H. Parental acceptance of the utilization of silver diamine

17. Burgette JM, Weintraub JA, Birken SA, Lewis TA, White BA. Development

fluoride on their child’s primary and permanent teeth. Patient Prefer Adher-

of a silver diamine fluoride protocol in safety net dental settings. J Dent Child

ence. 2019;13:829-35.

(Chic). 2019;86(1):32-9.

30. Chhokar SK, Laughter L, Rowe DJ. Perceptions of registered dental hy18. Weintraub JA, Birken SA, Burgette JM, Lewis TA, White BA. Use of the

gienists in alternative practice regarding silver diamine fluoride. J Dent Hyg.

consolidated framework for implementation research to assess determinants

2017;91(4):53-60.

of silver diamine fluoride implementation in safety net dental clinics. J Public Health Dent. 2019;79(4)298-306.

31. Frantsve-Hawley J, Newman MG, Meyer DM. Proceedings of the Evidence-based Dentistry Champion Conference. Introduction.

19. Tikhonova S, Aggarwal N, Girard F. Cariology education in Canadian dental

J Evid Based Dent Pract. 2008;8(3):113-4.

schools: interinstitutional symposium. J Can Dent Assoc. 2019;84:j9.

32. Amerine C, Boyd L, Bowen DM, Neill K, Johnson T, Peterson T. Oral health 20. Brown JP. A new curriculum framework for clinical prevention and pop-

champions in long-term care facilities-a pilot study.

ulation health, with a review of clinical caries prevention teaching in U.S. and

Spec Care Dentist. 2014;34(4):164-70.

Canadian dental schools. J Dent Educ. 2007;71(5):572-8. J Can Dent Assoc 2021;87:l1 ISSN: 1488-2159 6 of 11 / An Overview of Pedagogical Approaches to

33. MacEntee MI, Thorne S, Kazanjian A. Conflicting priorities: oral health in

Caries-Control Medications in Canadian Dental and Dental Hygiene Programs

long-term care. Spec Care Dentist. 1999;19(4):164-72.

/ J Can Dent Assoc 2021;87:l1 January 11, 2021 34. Brondani MA, Pattanaporn K, Aleksejuniene J. How can dental pub21. Fontana M, Guzmán-Armstrong S, Schenkel AB, Allen KL, Featherstone J,

lic health competencies be addressed at the undergraduate level? J Public

Goolsby S, et al. Development of a core curriculum framework in cariology for

Health Dent. 2015;75(1):49-57.

U.S. dental schools. J Dent Educ. 2016;80(6):705-20.

35. Seifo N, Cassie H, Radford JR, Innes NPT. Silver diamine fluoride for man22. Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications and consent. J Calif Dent Assoc.

2016;44(1):16-28.

aging carious lesions: an umbrella review. BMC Oral Health. 2019;19(1):145.

Pediatric Dentistry

Dr. Jonelle Anamelechi info@mychildrenschoicedental.com

Dentistry Is Kids’ Stuff I have a deep passion for the dental industry and the contribution each of us makes to our patients’ health and well-being. That’s why I serve on public policy boards that focus on children with special needs and their access to care.

I’m also committed to nurturing the next generation of dentists, so I’ve been a professor at Children’s National Hospital in Washington, D.C., for seven years and am an adjunct faculty member at MedStar Georgetown University Hospital with the Department of Pediatrics and the School of Law and Equity.

I did my undergraduate degree in cultural anthropology at Duke University, which opened my eyes to how people from

other cultures interact with health care.

While earning my master’s in maternal and child health, it became clear to me that good health starts in the womb. I had a “light bulb moment” when I realized that pediatric dentistry would allow me to help children begin a lifetime of positive oral health habits and support those born with certain risk factors.

Today, my scope of interest has expanded, and I see oral health from a variety of perspectives, including overall public health, the cultural and nutritional environment of our patients, and the developmental growth and needs of the individual child sitting in my chair. I also view it as a mother of two children myself.

Everything starts in the womb The more I’ve learned and practiced, the more it’s evident that pediatric dentistry is about more than baby teeth. Children born to mothers who have poor oral hygiene or are in poor health may be at risk for a variety of future general and oral health problems.

Moreover, while a child’s diet is responsible for 95% of caries, some oral problems have their root cause in utero. As dentists, we need to monitor these problems and collaborate with our cohorts in the health care community to manage their treatment.

You can draw a straight line between the mother’s health and the future health, growth and development of the child she is carrying, because the baby’s teeth begin to develop in utero at just six weeks.

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March 2021

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Pediatric Dentistry

Dentistry Is Kids’ Stuff

How family dentists can help Family dentists have an opportunity to support both women of reproductive age and expectant moms by making sure they understand that their overall health— including their oral health—has a direct impact on their baby’s teeth.

When the opportunity arises, dentists can chat about everything from the roles of nutrition and lifestyle to how a lactation consultant can help a mom through breastfeeding challenges. They can provide guidance about teething and let parents know that they can reach out to a pediatric dentist, who has a wealth of resources to offer.

It isn’t unusual for parents to ask their family dentist about their worries. Dentists are often the first people to hear about teething, sleeping or feeding concerns, or that teeth might be missing or are erupting in an abnormal pattern. General dentists also have first-mirror knowledge of the parent’s dental history. Any time a general dentist hears about teeth concerns with a child or red flags in genetic history, it is an opportunity to engage and refer the patient to a pediatric dental specialist.

We are part of the larger health care community General dentists have the opportunity to remind those in their patient care teams about the importance of oral health for children and that the first dental visit should take place at just 1 year of age.

As dentists, working together to address comprehensive family health concerns is a required component of our job as part of a larger medical community. We’re not just the “teeth doctors”!

Questions about infants One thing that’s unique about my practice is my work in releasing tethered ties through laser frenectomy.

This procedure is used to release a tongue or lip tie to help children feed, speak and breathe more clearly and cleanse their mouth better.

Because of the proven health benefits of breastfeeding, frenectomy is, at times, a necessary procedure for moms looking to improve nursing for their newborn. This has become a hot topic in the new mom community, and families may look to their general dentists for guidance and reassurance. The important message to get across is that this procedure should be explored as a team, which may include a lactation consultant, a pediatric dentist and possibly an infant chiropractor or bodyworker.

In fact, any time families talk about infants is a teaching moment! Most families need guidance understanding the life cycle of teeth, how the introduction of solids increases the need to have an oral health routine and how common dental trauma is at such a young age, especially as young children are learning to walk. I find that most parents are receptive to this guidance because parenting books often lack detailed information about the topic of oral care.

Baby’s first visit to the dentist Generally speaking, a child’s first dental visit should be as close to age 1 as possible. Exceptions to this rule include children born with teeth or those born with craniofacial abnormalities, who should be under a pediatric dentist’s care earlier. At that first appointment, I’m looking at the child’s oral development and seeking information on a range of topics from birth and family dental history to sleep problems and respiratory issues such as snoring.

Parents are often surprised by the amount of time we spend talking about feeding, swallowing, nutrition and their functional relationship to oral health.

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March 2021

In truth, the entire conversation is geared toward identifying risk areas and potential future concerns.

Let’s talk about kids and sugar Toddlers, preschoolers and grade-school children need to see a dentist every six months to closely monitor their growth and development. Our conversations in the treatment room range from brushing and flossing to feeding, nutrition and how to avoid sugar.

Parents who say their children never eat candy are always surprised when I remind them that there may be hidden culprits that contribute to caries, including acidic fruits and granola bars, which may use honey or another sugar substrate to bind them. Because of the high sugar content, these should be an occasional treat rather than an everyday snack. Reading labels for both

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nutritional content and tooth friendliness is essential!

Gummy vitamins are another unexpected source of cavity-causing sugar. They get stuck in teeth and cause problems.

General practice dentists can do their part to reinforce good nutrition when they speak with their adult patients.

Sugar is a problem at all ages and the benefits of good nutrition helps grown-ups and kids alike.

Thumbs, fingers and pacifiers warrant intense discussion in the pediatric dentist’s office. The use of pacifiers for infants reduces the risk of sudden infant death syndrome (SIDS) in infants up to 6 months of age, but prolonged use can create changes in the mouth’s shape and cause misaligned teeth. When it comes to finger sucking, things can get a little trickier because you can’t take fingers away. It takes patience, and I have several gentle tricks from finger ointments to appliances.

Pediatric Dentistry

Dentistry Is Kids’ Stuff

ones to see a pediatric dentist any time they have had dental trauma. Any event forceful enough to chip a baby tooth could also damage the adult tooth nested beneath.

A holistic approach to care A team approach is central to my philosophy. Not long ago, I noticed a young boy was grinding his teeth.

Nighttime mouthguards aren’t appropriate for children this age because all their growth occurs while they sleep.

I engaged the sleep specialist on my team and we ruled out stress. Then we invited the child’s pediatrician to collaborate. We discovered he had a vitamin deficiency; the boy was grinding because his teeth were struggling to grow.

In most cases, braces can reverse alignment problems caused by sucking, but heading off this issue prevents a lifetime of malalignment.

According to the American Academy of Orthodontics, evaluations for braces start when a child is around 7 years old.

In fact, as the pandemic has deepened, pediatric dentists across the country are reporting an increase in stressrelated behaviors such as grinding and thumb-sucking.

Even the youngest children sense tension in the adults around them.

For the most part, treatment may not begin this early, but the assessment allows parents to prepare mentally and financially. It also gives the child time with the pediatric dentist to develop the brushing and flossing skills they’ll need to keep braces clean.

Older children’s routines are disturbed. They can’t see their friends and may be worried Mom, Dad or their grandparents will die. The family’s entire health care team needs to be watchful for the signs and symptoms of stress, depression and other conditions.

Discussing dental trauma One of the most challenging parts of treating children is watching for neglect, trauma or abuse. This is a vulnerable population, and these patients can’t always speak for themselves.

Toppling over while learning to walk or ride a bike is a normal part of growing up but can result in dental trauma.

Even what looks like a little bump on the chin can make baby teeth smash into the unformed adult teeth below, causing them to emerge crooked in the years to come.

General dentists, pediatricians and other health professionals should encourage families to take their little

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Despite the pandemic, regular dental appointments are vital to uncovering problems as well as monitoring the development of fast-growing mouths. During this time, I’ve been a lot more lenient and do everything I can to be flexible and make our families feel safe. From video and telehealth appointments to bringing snacks and coloring books to families waiting in cars to a 15-point safety protocol, we’ve taken pandemic precautions to the max.

Caring for the big kids Working with older children, tweens, teens and young adults means finding ways to share the same messages about brushing, flossing and nutrition in a manner that resonates so we can help them begin to take care of March 2021

Number

M330P

themselves. I’ve discovered that a follow-up text or even a daily call to young people who refuse to brush can encourage them to adopt good habits. So far, parents have been happy to give permission.

My go-to tactic is to find out what interests or worries them and use that information to influence the decisions they make about their health. It is incredibly humbling when they trust me enough to open up. I’ve had memorable conversations with my teen patients about everything from exam worries to a gender transition to how difficult it is to try out for cheerleading.

I have a library of photos and brochures to show young people the oral consequences of recreational drugs, smoking and vaping. Whenever I get the chance, I use all my persuasive powers to dissuade them from getting tongue and lip piercings.

By the time these young people age out of pediatric care and into the hands of my general dental colleagues, I’d like to believe that they’ve learned the habits and skills they need to take care of themselves.

Final thoughts I think the most important thing we can all do as dentists is to be mindful of how we communicate and reinforce advice for good health with our patients and their families.

Building relationships, developing trust and finding ways to influence and motivate is the secret sauce needed to help children grow up to enjoy the best health possible.

I love my work and the opportunities I have to shape health policy, teach pediatric dentistry and influence my own families in practice one tooth at a time. I’ve built a great team around me. I feel genuinely honored to be part of a national and international “parent squad,” and I am optimistic that I am influencing a generation of families that know the mouth-body connection.

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Oral Pathology

NYU Dentistry Study Describes Cellular Mechanisms Leading to Enamel Deficiency A mutation in the ORAI1 gene — studied in a human patient and mice — leads to a loss of calcium in enamel cells and results in defective dental enamel mineralization, finds a study led by researchers at NYU College of Dentistry.

The study, published in Science Signaling, identifies ORAI1 as the dominant protein for calcium influx and reveals the mechanisms by which calcium influx affects enamel cell function and the formation of tooth enamel.

Calcium is critical for many cellular functions, including mineralizing teeth

and bones. Calcium enters cells via ORAI proteins, which form pores in a cell’s plasma membrane to enable calcium influx when activated.

“Our previous research has shown that deficiencies in the modulation of calcium influx or calcium transport result in dental enamel malformation,” said Rodrigo Lacruz, PhD, associate professor of basic science and craniofacial biology at NYU College of Dentistry and the study’s senior author. “Despite this knowledge, the biology of enamel cells as it relates to the role of calcium signaling remains poorly understood.”

Studies show that several genes, including ORAI (which encode ORAI proteins), are involved in the formation of tooth enamel.

Enamel — the hard, outer layer of teeth — first forms as a soft, gel-like matrix.

ORAI proteins then help the enamelforming cells to mineralize.

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Dental News

Mutations in the human ORAI1 gene result in immune dysfunction and immune diseases, but people with ORAI1 mutations also have defects in their tooth enamel. In this study, the researchers investigated the case of a patient with a complex medical history, including combined immunodeficiency and a mutation in the ORAI1 gene.

Throughout his childhood, the patient had defects on his tooth enamel, resulting in severe cavities and related dental March 2021

“The findings provide a foundational understanding of what happens in enamel cells, which could help create a pathway for researchers interested in regenerating tooth enamel or developing therapies to treat patients with enamel defects.”

— Dr. Rodrigo Lacruz abscesses. Based on his clinical presentation, the researchers concluded that the ORAI1 mutation likely accounted for the defective enamel mineralization.

Given the lack of dental samples from patients with ORAI1 mutations, Lacruz and his colleagues then developed mouse models to study the role of ORAI proteins in enamel formation, both by observing tooth enamel and examining its influence on the environment inside enamel cells.

The researchers studied the ORAI family of proteins (ORAI1, ORAI2, and ORAI3) and genetic mutations in the corresponding genes to investigate the mechanism by which calcium is modulated by each of these proteins.

When mice had a mutation in the ORAI1 gene and were therefore deficient in ORAI1 protein, calcium entry into enamel cells was significantly reduced (by roughly 50 percent), and tooth enamel was abnormal, including cracks in the outer enamel layer.

By contrast, mice with ORAI2 mutations and ORAI2 deficiency showed an increase in calcium by approximately 30 percent in the enamel cells, which did not result in obvious enamel defects. This suggests that ORAI1 is the dominant channel for modulating the influx of calcium into enamel cells.

The findings provide a foundational understanding of what happens in enamel cells, which could help create a pathway for researchers interested in regenerating tooth enamel or developing therapies to treat patients with enamel defects.

“We’ve long observed deficiencies in tooth enamel associated with abnormal calcium levels in the enamel cells, but can now detail a mechanism for how this occurs,” said Lacruz.

To better understand how calcium influx — and conversely, deficiency in calcium — changes the functioning of enamel cells, the researchers examined the activity of cells lacking ORAI1. They found that calcium dysregulation in ORAI1-deficient cells affects their function at multiple levels, including increased mitochondrial respiration and subsequent changes in redox balance.

In addition to Lacruz, study authors include Miriam Eckstein, Francisco Aulestia, Veronica Costiniti, Serena Kassam, Timothy Bromage, and Amr Moursi of NYU College of Dentistry; Martin Vaeth and Stefan Feske of NYU School of Medicine; Pal Pedersen of Carl Zeiss Microscopy, LLC; Youssef Idaghdour of NYU Abu Dhabi; and Thomas Issekutz of Dalhousie University.

An elevation in reactive oxygen species can be detrimental to cells, and to protect proteins in an intracellular environment that is more oxidizing, a mechanism called S-glutathionylation is promoted.

This research was funded by the National Institutes of Health’s National Institute of Dental and Craniofacial Research.

Dental Marketing

7 Reasons Your Dental Practice Should Engage In Social Media In its early days, social media was primarily a platform dedicated to connecting people wherever they may be in the world. Social media is still that today, as it continues to provide its users a quick and easy way to communicate with friends and family.

However, it has become so much more.

Social media is now a powerful business tool that entrepreneurs can use to market their brand. Just about any business—your dental practice included—can engage in social media marketing and benefit from it. Here are seven reasons your dental practice should establish a presence on social media.

1. Increasing Brand Awareness Social media platforms have billions of users. Facebook alone is used by nearly three billion people. Instagram is also a member of the billion-user club. Once you put your business on social media, you’re getting the opportunity to make your brand more visible to as many people as possible. With your posts on social media, more people will be aware of your brand and will likely remember it when the time to undergo a dental procedure comes.

2. Attracting New Patients When you’re on social media, use it to post regularly about topics your target

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Dental News

audience would want you to cover, namely, oral health and dentistry procedures.

Tips about the best type of toothpaste to use or reassuring people that dental procedures are safe will help you earn their trust, and they will likely keep your dental office in mind for their next dental visit. Your social media account is also an excellent place for you to post about promotional offers, from free consultations to discounts on selected services, all of which can draw in more people to your dental office.

3. Engaging With People Social media platforms allow audiences to communicate directly with the owners of accounts, either via direct messaging or through the comments section. Your posts on social media are bound to get the attention of your audience. You can expect them to have questions related to the topic at hand, express their agreement with you, or even start an argument in some cases.

As much as possible, engage with your social media audience. Answer their queries, clarify things, or present counter arguments, and remember to be cordial and professional at all times.

4. Boosting Your Credibility Your social media account is a good place March 2021

to flex your dentistry muscles. With your posts related to dentistry and oral health in general, you can position yourself as an expert in the field. When your posts and comments accurately answer your audience›s questions, your reputation as a dentist will rise, and more people will likely consider visiting your dental office to avail of your expert services.

5. Making Your Practice More Relatable To Your Audience Your audience already knows about your expertise through your posts, but do they really know you or the members of your team enough to trust you with their dental health? Social media can be crucial to making your dental practice more familiar and relatable to the people who follow you.Posts featuring photos and videos of your dental office would be a good start. Images of your dental office staff in action will also go a long way in getting people to know your practice better.

If you can host an AMA (Ask Me Anything) session, then go ahead. Just be ready to answer more than just dentistry-related questions, as AMAs tend to gravitate toward the personal side of things.

6. Trackable Results Unlike traditional marketing, social media marketing results are much easier to monitor, thanks to the treasure trove of free and paid tracking tools out there. With such tools in your hand, you can easily measure social media metrics such as volume, reach, engagement, and

influence, all of which help provide a clear picture of how your social media campaigns are doing.

With the data you get from these tools, you will know if you’re doing things right or if you need to make adjustments to your approach to maximize results.

7. Keeping Up With Competitors Do you know who your competitors are? If you do, then search for them on any given social media platform, and the chances that they’re already there are great. When your competitors are on social media, and you aren’t, you’re already missing out on what Facebook et al. can do for your business.

If your competitors don’t have a social media presence, then create one for your dental practice and get a leg up on everybody else.

Considering the power of social media, it’s already safe to say that it’s no longer optional for entrepreneurs, dentists included. These days, a social media presence is already a must to have a much better shot at success.

You can do your social media activities yourself, but keep in mind that it takes a lot of work and patience.

If you want to engage in social media, but you barely have the time for it, you can always let a digital marketing agency take care of your social media campaigns for you.

Their social media expertise has already helped countless businesses achieve their goals, and they can do the same for your dental practice.

Oral Medicine

Patients with Facial Pain Report Most Benefit from Self-care Techniques While oral appliances such as splints and bite guards are the most common treatment for facial pain from temporomandibular disorders (TMD), patients rate them as less helpful than self-care treatments, such as jaw exercises or warm compresses, finds a new study by researchers at NYU College of Dentistry.

The study, published in the journal Clinical Oral Investigations, suggests that selfcare techniques should be the first line of treatment for muscle-related TMD. TMD (sometimes called TMJ after the temporomandibular joint) is a group of common pain conditions that occur in the jaw joint and surrounding muscles.

The muscular condition, called myofascial temporomandibular disorder (mTMD), affects over 10 percent of women. People with TMD often have other pain conditions; research shows that 7 to 18 percent of people with TMD also meet criteria for fibromyalgia, a condition characterized by widespread pain.

Republished from

Dentists and patients use a variety of treatments to manage facial pain, including oral appliances, such as splints and bite guards; pain medications, such as nonsteroidal anti-inflammatory drugs; and self-care techniques, such as jaw exercises and warm compresses.

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“Oral appliances are a common firstline treatment for TMD, despite mixed

research results regarding their benefit.

Even when oral splints have been found to have some benefit, they have not been found as effective for patients who also have widespread pain in the treatment of mTMD,” said Vivian Santiago, research assistant professor in the Department of Oral and Maxillofacial Pathology, Radiology and Medicine at NYU College of Dentistry and the study’s lead author.

In this study, the researchers examined what non-medication treatments women with mTMD use to manage their pain and how effective patients perceive the treatments to be. The researchers examined and interviewed a total of 125 women with mTMD, including 26 who had both mTMD and fibromyalgia, in order to determine whether treatment differed for patients with widespread pain.

The most common treatments reported were oral appliances (used by 59 percent of participants), physical therapy (54 percent), and at-home jaw exercises (34 percent). Less common treatments included acupuncture (20 percent), seeing a chiropractor (18 percent), trigger point injection (14 percent), exercise or yoga (7 percent), and meditation or breathing (6 percent). Participants often used more than one treatment (2.4 on average).

Participants reported the most improvement in their pain from common self-care activities, including jaw exercises, March 2021

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Oral Medicine

Patients with Facial Pain Report Most Benefit from Self-care Techniques

yoga or exercise, meditation, massage, and warm compresses, with over 84 percent reporting that these activities helped them at least a little. In contrast, only 64 percent of those who used oral appliances — the most popular treatment — reported that they helped at least a little. A small proportion of women who used oral appliances (11 percent) said that oral appliances made their pain worse, an area that warrants further research.

“Oral appliances did not outperform self-management care techniques in improving facial pain. Our results support the use of self-management as the first line of treatment for mTMD before considering more expensive interventions,” said Karen Raphael, PhD, professor in the Department of Oral and Maxillofacial Pathology, Radiology and Medicine at NYU College of Dentistry and the study’s co-author. The researchers did not find significant differences between the number of treatments reported by women with and without fibromyalgia.

While the use of alternative treatments,

such as acupuncture and seeing a chiropractor, was reported more frequently among women with fibromyalgia and mTMD, they did not necessarily find more relief. Interestingly, physical therapy was used equally by women with and without fibromyalgia, but self-reported improve-ment tended to be higher for those with fibromyalgia.

“While fibromyalgia is diagnosed by a physician, usually a rheumatologist, TMD is usually diagnosed and treated by a dentist. Our research suggests that dentists should ask patients with facial pain about whether they also have widespread pain, as this could provide more information to help plan their treatment,” said Santiago.

“Although clinical trials are critical for understanding treatment efficacy, our study highlights the importance of listening to people suffering with TMD to understand which treatments are the most beneficial,” added Raphael.

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Update on Haptic Technology for Periodontal Education: Periodontology

An NYU Dentistry – NYU Abu Dhabi Collaboration With support from the NYU Global Seeds Grant for Collaborative Research, NYU Dentistry has been collaborating for the past two years with NYU Abu Dhabi on “The Haptodont Project,” which is designed to improve clinical periodontal education through haptic technology (the science of interactions involving touch).

The project focuses on the research, development, and evaluation of a realistic and precise simulator to overcome limitations in training dental and dental hygiene students in periodontal procedures.

While the use of a haptic simulator has been proven to increase patient safety and reduce risk associated with human errors by allowing dental and dental hygiene students to develop skills more efficiently in a shorter period of time, existing haptic

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simulation tools have numerous limitations.

These include less than optimal visualization and tactile sensation, use of a stylus instead of a dental instrument, inability to view positioning of hands in virtual simulation, often only dominant hand used with no training for the non-dominant hand, and inability to practice proper ergonomics and positioning.

The objective of the new technology is to enable the learner to visualize a 3D virtual human mouth and feel physical tactile sensations as she/he touches the surface of teeth, gingiva, bottom of the periodontal pocket, and calculi in addition to the cheek, tongue, and floor of the mouth via virtual dental instruments.

The NYU Dentistry portion of the project is being led by Peter M. Loomer, DDS, PhD, and Dianne L. Sefo, RDH, MEd. Dr. Loomer is a former professor and chair of the NYU Ashman Department of Periodontology and Implant Dentistry, and is currently Dean of the School of Dentistry at UT Health San Antonio and adjunct professor of periodontology and implant dentistry at NYU. Professor Sefo is interim chair of the Department of Dental Hygiene and Dental Assisting and clinical associate professor of dental hygiene at NYU. They are collaborating with Mohamed Eid, PhD, of NYU Abu Dhabi, to develop software that uses virtual reality and haptic technologies to create a periodontal March 2021

simulator that allows learners to acquire tactile skills while performing diagnosis and/or treatment procedures for periodontal diseases. Dr. Eid is assistant professor of electrical and computer engineering and director of the NYU Abu Dhabi AIM Lab. “Because there are no commercial products currently available for periodontal instrumentation,” explained Dr. Loomer, “it was necessary to identify engineers who could use haptic technology to create this kind of periodontal simulation model, and, once designed, have the model evaluated by periodontal and dental hygiene faculty at NYU, whose feedback would be used to guide further development.

the pocket-depth measurements. They were also asked to complete a questionnaire about their experience and to make suggestions for further development.

“The feedback has been extremely positive,” said Professor Sefo. “The majority of faculty participants felt that the new technology provided a more realistic experience than the traditional model and that it had the potential to meet the clinical simulation needs of current and future students. They also recommended that the next step should be to develop system guidance for demonstrating correct probing technique.”

“The majority of faculty participants felt that the new technology provided a more realistic experience than the traditional model and it had the potential to meet the clinical simulation needs of current and future students.”

— Professor Dianne Sefo Dr. Eid identified Muhammad Hassan Jamil, a research engineer at NYU Abu Dhabi, and Said Chehabeddine, an engineering student at the University of Toronto currently in a study abroad program at AIM lab, and recruited them to modify the software and hardware portions of commercially-available products.

“With that accomplished,” said Professor Sefo, “it was time to begin faculty testing of the new technology.”

Thirty-six clinical and preclinical dental hygiene and periodontology faculty, all experts in assessing the periodontal tissues, participated in the testing to familiarize themselves with haptic technology and virtual reality. They were asked to probe a sextant of the teeth using the modified technology and their probing technique was evaluated to determine the accuracy of

The team is currently working on the further development of the model and on preparing a new proposal using data collected from the faculty training program to apply for a National Science Foundation (NSF) grant.

Testing by NYU students will begin soon and the expectation is that the new model will be available for use in the predoctoral and dental hygiene curricula within the next two years. Dr. Loomer noted that in addition to testing at NYU Dentistry, “the new haptic learning tool will be tested at the School of Dentistry at UT Health San Antonio and the dental school at the University of Ajman in the United Arab Emirates. Future plans include using the technology to perform surgical procedures and enabling long-distance education.”

Direct composite restorations in orthodontic indications Orthodontics

Dr Sylvia Rahm www.zahnarzt-balzer-rahm.de

concept and case reports In the past, we used to prepare teeth and sacrifice tooth substance to protect our prosthetic work due to the required minimum wall thickness.

Today we protect the teeth with additive, adhesive restorations!

Here we encounter agenesis with and without gaps or in the form of altered teeth - such as the so-called conical teeth in region 12 or 22. Often we also find persistent deciduous teeth with agenesis of the permanent dentition.

In our daily practice we repeatedly perform restorations based on orthodontic or anatomical indications.

Apart from mandibular second pre-molar agenesis, the lateral incisors are the most frequent places where aplasia occurs apart from the wisdom teeth.

There are different aplasias of permanent teeth, which is one of the most common cranio-facial malformations with a prevalence of approximately 1-11%.

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In terms of the development process, this results from the lip-jaw-palate cleft and is the smallest form of this characteristic, which can also occur without the forma-

Fig. 1

Fig. 4

Fig. 2

Fig. 5

Fig. 3

Fig. 6

March 2021

tion of a cleft. However, as this is in the visible and aesthetic region, the patient’s desire for correction is considerable.

In the following cases, different options for restoration using direct composite restoration techniques will be presented. Of course, ceramic restorations are also possible, but considering the young age of the patients, a minimally invasive therapy is advisable. The teeth can still elongate during secondary eruption, which can lead to the preparation margins becoming visible.

Orthodontists choose different therapeutic approaches.

In some cases gaps are closed, but the trend tends towards keeping them open. This can have consequences for the entire dental arch and also for aesthetic rehabilitation.

There are different parameters to consider as to whether the gap should be closed or kept open.

On the one hand, a micrognathic maxilla is more likely to speak against a gap closure, as the distal movement of the anterior teeth and mesial movement of the posterior teeth can result in an inverted anterior overjet.

A compensatory extraction of the lower premolars could be indicated. However, in the case of a distal bite, compensation by closing the gap can approximate the dental arches.

The profile of the patient should also be taken into consideration. The upper lip tends to revert back when closing gaps, which is more disadvantageous with a concave profile type than with a convex profile type.

If the necessary movement of the teeth is taken into account, a penetration position of the canine near the middle incisors tends to favour closing the gap, a distance position tends to favour keeping the gap open.

The colour and shape of the canines are only of limited importance, as both can be changed minimally invasively.

Visually more challenging is the gingival profile, which can be positively influenced by orthodontic intrusion or extrusion.

Nonetheless, the changed position of the canine teeth often results in a less favourable dental arch or leads to gaps between the canines and the premolars. The transition in the buccal corridor is altered and narrows the visual appearance. This should also correspond to the width of the nose and the shape of the face.

The following cases show that significantly improved results can be achieved by additive restoration with composite, even under unfavourable conditions. In most cases this is also possible without preparation of the tooth structure.

Case presentations The timing of the intervention may vary. In the case of reduced conical teeth, it may sometimes prove difficult for the orthodontist to position a bracket at all. It is therefore necessary to build up the teeth prior to orthodontic treatment to be able to move the teeth correctly and thus to set the correct axial direction and position in the arch.

This can be achieved quite easily with BRILLIANT COMPONEER or a direct composite build-up with BRILLIANT EverGlow.

In this case (Figs. 1 – 6) there were two differently developed, reduced lateral incisors, which were additively restored prior to orthodontic treatment and subsequently provided with brackets.

In a second case a 14-year-old female patient presented following recommendation after orthodontic treatment had already been completed (Fig. 7).

Fig. 7

The initial situation was a unilateral aplasia of the left lateral incisor, a mesially erupted canine, so that the deciduous canine could be preserved in its position. The gaps were closed, however the patient regarded the interincisal larger retractions and triangular formations in particular as displeasing. The different shade of the more saturated canine was less relevant for her.

We opted for an additive structure of the teeth.

Unfortunately, the width of the canine was greater than

Orthodontics

Fig. 8

that of the contralateral lateral incisor, so that small lateral deviations could not be avoided as non-invasive surgery was specified (Fig. 8).

Direct composite restorations in orthodontic indications

Fig. 9

Fig. 10

On tooth 12, the incisal edge was lengthened slightly and the edge was straightened. A stronger mesial lightreflecting ridge was applied with enamel masses to create a larger appearance.

Tooth 23 was also lengthened to an edge incisally, the lateral facets were filled in and the marginal ridges were shaped. To avoid a greyish appearance due to too much enamel, it was necessary to add Universal shade A1/B1 to the BRILLIANT EverGlow Translucent enamel masses.

The deciduous canine was lengthened significantly and built up vestibularly to ensure a transition into the buccal corridor. Minor gingivectomy was necessary cervically to create an aesthetic garland profile.

We are aware of the paradigm that form is decisive for aesthetics - as opposed to colour. Once the macroscopic shape has been realised, close attention must be paid to the micromorphology, particularly in young patients.

And this is where the special properties of the composite material become relevant. BRILLIANT EverGlow is an extremely supple and easy to shape composite, which can be processed well and delicately with very thin Heidemann spatulas, brushes and pads, yet still remains dimensionally stable.

In a further case the canines were pulled to the second position, however these canines were rather delicate and symmetrically placed. The white decalcifi-cation present around the brackets on the vestibular surface created an additional problem (Figs. 11 - 12).

Fig. 11

Fig. 12

Once we have implemented the micromorphology (Fig. 9), a little polishing is sufficient to achieve a captivating and durable gloss.

This is very important as all the light reflection characteristics otherwise often disappear again due to too much polishing and the tooth appears rather lifeless (Fig. 10).

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Here we had to deviate slightly from the non-invasive concept and work from micro-abrasively to minimally invasive. Therapy planning was as follows: The middle incisors were prepared micro-abrasively and restored only with BRILLIANT EverGlow Bleach Translucent. The canines were transformed completely vestibularly with BRILLIANT EverGlow A1/B1 and Bleach Translucent as the patient wished for a whitening effect.

The interincisal retraction of the premolars was also minimised in terms of optical appearance. The mesial marginal ridge was highlighted for light reflection purposes and was converted to more transparent enamel ridges in terms of colour - resembling the natural tooth (Figs. 13 - 14).

Fig. 13

Fig. 14

In cases where the gap is to be kept open early, composite teeth can be included in the gap using brackets at the beginning and then followed by inserting a single-wing Maryland composite bonded bridge. This can also be regarded as a long-term provisional restoration to keep the gap free for a future implant.

The implant should not be placed too early as it remains in it position but the jaw continues to grow. This gives it a much too caudal position and the alveolar ridge develops a concavity, which is difficult to remedy with renewed bone augmentation.

Milled, single-wing composite Maryland bridges have the same flexural strength due to a tooth-like modulus of elasticity, which supports prolonged durability. One can still colour the bridge individually with stains or have it milled in cutback design and veneered with individual layers.

Late intervention: Even at an advanced age, we can realise aesthetics in a minimally invasive manner, even if it has not been practised in this case by colleagues before. Thus, this female patient presented in my practice with the notion that no improvement could be achieved without extracting teeth, crowns or implants (Fig. 15).

Fig. 15

Orthodontics

Fig. 15

Direct composite restorations in orthodontic indications

make it look as if the tooth also has a wider root. If one leaves a slightly larger bar in the rubber dam between the two middle incisors, one can model directly on the rubber dam.

Due to the pronounced micromorphology of these teeth, it is important to extend these into the diasthema. The whitish coloured band must also be continued, otherwise the widening of the teeth looks artificial.

Several problems were posed at once here: • Agenesis of the lateral incisors without orthodontic gap closure • Downward opening diasthema • Teeth very prominent in terms of colour with enamel stains and decalcification as well as brown discolouration.

• Surface-structured teeth with asymmetrical abrasion of the incisal edge.

• Beginning periodontitis with loss of the papillae.

• Deep bite with protrusion

If one wants to close the diasthema, one has to consider the biological width so that the papilla has the opportunity to grow up to the contact point.

In this case, an elongated contact surface needs to be established in order to reach relatively far to cervical.

In addition, the gap must be closed in the form of small wings. These have to be fitted exactly to the gingiva to

Using the Miris2 effect shades White and White Opaque - also by COLTENE - it was possible to imitate the whitish structure. The effect shades are placed under the enamel layer and applied very finely with brushes.

Of course, such cases can also be solved with crowns, partial crowns or veneers, but the more minimally invasive we proceed, the more likely we are to protect the patient’s tooth and, for the benefit of the stability of our restoration, not remove any hard tooth substance.

Conclusion Using the BRILLIANT EverGlow composite, its very natural shades and the natural layering technique of opaque, universal and translucent shades, we can achieve invisible adhesive direct restorations. Due to their excellent polishability and good material properties, they are very durable on the one hand, and on the other hand, the patient can no longer distinguish between a restoration or his/her own tooth.

Dr Sylvia Rahm Wagenerstraße 9 65510 Idstein Germany T +49 6126 44 04 F +49 6126 57 111 www.zahnarzt-balzer-rahm.de

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GUIDED BIOFILM THERAPY CARIES AND PERIO PREVENTION AND MAINTENANCE

THE ORIGINAL. THE MASTER. THE GAME CHANGER

R

Evidence based protocols for biofilm management on teeth, soft tissues and implants.

The original from the Inventor.

Guaranteed Swiss Precision and superb design.

Reliability and know-how since 1981.

THE GBT COMPASS AND ITS 8-STEP PROTOCOL 01 ASSESS

08 RECALL

PROBE AND SCREEN EVERY CLINICAL CASE Healthy teeth, caries, gingivitis, periodontitis Healthy implants, mucositis, peri-implantitis Start by rinsing with BacterX® Pro mouthwash

HEALTHY PATIENT = HAPPY PATIENT Schedule recall frequency according to risk assessment Ask your patient if he or she liked the treatment

02 DISCLOSE

07 CHECK

MAKE BIOFILM VISIBLE Highlight to patients the disclosed biofilm and their problematic areas with EMS Biofilm Discloser The color will guide biofilm removal Once biofilm is removed, calculus is easier to detect

MAKE YOUR PATIENT SMILE Do a final check for remaining biofilm Ensure calculus is fully removed Accurately diagnose caries Protect with fluoride

06 PIEZON® PS

03 MOTIVATE

R

RAISE AWARENESS AND TEACH Emphasize prevention Instruct your patients in oral hygiene EMS recommends Philips Sonicare toothbrushes, interdental brushes and Airfloss Ultra

REMOVE REMAINING CALCULUS Use the minimally invasive EMS PIEZON® PS Instrument supra- and subgingivally up to 10 mm Clean > 10 mm pockets with mini curette Use EMS PIEZON® PI Instrument around implants up to 3 mm subgingivally and on restorations

04 AIRFLOW®

05 PERIOFLOW®

REMOVE BIOFILM IN >4 TO 9 MM POCKETS Use AIRFLOW® PLUS Powder on natural teeth in deep pockets and root furcations and on implants Use new and slimmer PERIOFLOW® Nozzle

ems-dental.com Copyright: 2018 EMS. Electro Medical Systems.

REMOVE BIOFILM, STAINS AND EARLY CALCULUS Use AIRFLOW® for natural teeth, restorations and implants Remove biofilm supra- and subgingivally up to 4 mm using AIRFLOW® PLUS 14 μm Powder Also remove biofilm from gingiva, tongue and palate Remove remaining stains on enamel using AIRFLOW® CLASSIC Comfort Powder

Download our GBT Catalog

MAKE ME SMILE.

Innovation

X-VIEW 2D PAN CEPH The 2-in-1 model of the X-VIEW family, is a multifunctional and integrated system that puts the advantages of 2D and cephalometric imaging within the reach of the general dentists, periodontists, orthodontics and other specialists working from medium offices to hospitals and clinics.

X-VIEW 2D PAN CEPH incorporates a high-frequency generator and a noise- and imperfection-free acquisition system, providing high quality clinical images.

CCD-TDI detector X-VIEW 2D offers the inherent advantages of CCD (Charge-coupled devices) to capture panoramic images of the skull and jaw with excellent resolution in less time and lower patient exposure: noiseless charge transfer, high signal-to-noise ratio and the unique features of time-delay integration (TDI): • Capturing clear and bright images with the best possible contrast and uniform density.

• Increased sensitivity for signal detection at lower light levels.

• Larger full-well capacity to provide high dynamic range.

Two detectors for Workflow optimization In addition to the CCD-TDI detector for all 2D programs, X-VIEW 2D PAN CEPH is equipped with a dedicated DR flat panel detector for Ceph images acquisition.

The DR (Digital Radiography) version is the highest quality technology available to obtain sharp images:

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• Better contrast • More details and filtering • No background disturbance • Exposure time: 200-500ms • Reading time: immediate • Detector-PC image transmission: 2sec • Image store after shot: 200 • Calibration Method: easy intuitive and manageable from remote

March 2021

D isc ov er a wor ld of im a ges

Advanced Software Technology MITO is the most advanced software to acquire and manage 2D images, as it can be universally used and integrated to all clinical management software and DICOM network imaging devices, offering a smart and high-performance work environment.

Mito is configurable to meet every need of doctors, radiologist or dental clinics.

X-VIEW

DFO: Dental - Facial – Orthopedics

2D PAN CEPH

Trident offers, as an optional, this functional tool for orthodontic tracing and cephalometric analysis Just run DFO and set all the points needed to complete your analysis which will be automatically calculated and drawn on the screen.

Quick easy patient positioning Make aanddifference!

Make that change

X-VIEW 2D PAN CEPH adapts to all size and type of patient, its linear and open design eases the access to wheelchair users

Programs • • • • • • • •

Digital Flat Panel | Single Shot | 200 ms of Exposure Time

Adult/Child Standard Panoramic Adult/Child Hemi Panoramic Frontal Dentition TMJ closed/open mouth 2D Sinus LL CEPH 30 x 24 AP CEPH Carpus

Optional: • • • • •

Reduced Dose Improved Orthogonality Right Bitewing Left Bitewing Right and Left Bitewing

Via Artigiani 4 - Castenedolo, 25014 BS - Italy Tel 39 030 2732485 | www.trident-dental.com

Webinar

SARS-CoV-2 Vaccines: Reality and Expectations The Fifth Live Webinar organized by Dental News was presented by the leading speakers and panelists in the world of dentistry on February 11th, 2021, with dentists and specialists registered from around the world.

The Topic of this Webinar was “SARS-CoV-2 Vaccines: Reality and Expectations”, with Prof. Alain Romanos as main speaker.

After the presentation, our international panelists: Dr Jon Suzuki, Dr Joseph Massad and Dr Hady Ghanem discussed the topic and answered the questions asked by the participants.

Abstract SARS-CoV-2 (COVID) Virus Infection Pandemic is a worldwide health problem and has caused havoc in all aspects of human life.

Pursuit of Vaccines, Therapies, and Diagnostics remain one of the primary objectives of the FDA, CDC, and NIH Health arms of the US Federal Government.

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FDA (USA) has approved two vaccines (Pfizer and Moderna) with a third vaccine (J & J) approval imminent. Current COVID viral pathogenesis and systemic manifestations will be presented.

Also, Immunologic mechanisms of antibody response from COVID vaccinations will be discussed.

March 2021

Speakers Prof. Jon B. Suzuki holds faculty appointments with the University of Maryland, University of Washington, Nova Southeastern University, and Temple University in the United States. He holds Diplomate status with the American Board of Periodontology, ICOI, and the American Board of Medical Microbiology.

He is a current panel member of the FDA as a Special Government Employee (SGE) and has served as Chairman of the FDA Dental Products Panel, Washington, D.C., USA.

Dr. Joseph J. Massad is in private practice in Tulsa, Okla, he is a Fellow of both the American and the International College of Dentists, a Regent/Fellow of the International Academy for Dental Facial Esthetics, and is an honorary member of the American College of Prosthodontics.

Currently, he holds faculty positions at Tufts University School of Dental Medicine in Boston, Mass; the University of Texas Health Science Center Dental School in San Antonio, Texas; the University of Tennessee Health Science Center, College of Dentistry, Memphis, Tenn, Loma Linda University School of Dentistry Loma Linda, CA., the Univ of Okla School of Dentistry, Okla City, Oklahoma, and University of Texas Health Science Center, Houston, Texas.

Dr. Hady Ghanem is an American-Board Certified Physician in Internal Medicine, Hematology and Oncology. He currently holds the position of Chief of the HematologyOncology division at the Lebanese American University Medical Center – Rizk Hospital (LAUMCRH). He attended medical school at the Faculty of Medicine, Saint-Joseph University in Beirut where he earned his Medical Degree (MD).

Dr. Ghanem then completed his internal medicine residency at Cooper University Hospital in New Jersey, USA. He then moved to Washington DC and completed a 3-year fellowship in Hematology-Oncology at the Georges Washington University Hospital, which was followed by a sub-specialty fellowship in Leukemia at the MD Anderson Cancer Center in Houston, Texas.

Watch it again on dentalnews.com

Autoclavable stainless steel sleeve Digital Dentistry

with disposable window for Primescan Primescan, the intraoral scanner from Dentsply Sirona, ensures high-quality digital impressions and exceeds minimum recommended hygiene guidelines. It is the only scanner that provides a variety of disinfection and sterilization procedures with three different sleeve options.

The new stainless steel sleeve with a disposable window can be reprocessed in an autoclave and is now available. It completes the comprehensive hygiene concept of Primescan.

As an intraoral scanner, Primescan is a true all-rounder: it enables very accurate digital impressions that meet the high demands of speed, simplicity and hygienic safety. The variety of workflows is large.

Primescan has proven itself in restorative, implant and orthodontic treatments as well as in the therapy of obstructive sleep apnea. It also supports patient monitoring and patient communication.

Outstanding hygiene The new stainless steel sleeve is available now and can be purchased separately.

It completes the comprehensive hygiene concept of Primescan, which is characterized by great flexibility in the selection of a total of three sleeves that can be reprocessed using different procedures.

The high-quality, stainless steel sleeve with exchangeable single-use windows can be reprocessed in an autoclave.

Autoclaving is the most commonly used sterilization process in dental practices and helps minimize cross-contamination risk.

Stainless steel is a major factor for a long lifetime.

Fig. 1: In combination with the acquisition center, Primescan offers a hygienically excellent workflow in digital impression taking with outstanding clinical results.

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The stainless steel sleeve with a scratchresistant sapphire crystal window can be reprocessed with wipe disinfection, hot air sterilization or high-level disinfection.

The plastic sleeve is an alternative for the March 2021

Since legal requirements vary from country to country and practice situations differ, it is important that users can decide which cleaning and disinfection option fits their needs best.

This way, practices are given the option of following one of the five common sterilization procedures after digital impression taking.

For Dr. Daniel Aniol, dentist from Bornheim, Germany, sterilization is more important than ever because of the new environment in which dentists are working.

Fig. 2: Three different sleeve options for each of your hygiene needs, to ensure safe intraoral scanning. New to the family: The autoclavable stainless-steel sleeve with disposable window (right).

“Safety and flexibility in the way we work are of central importance to me and my practice team. The ability to choose from a variety of reprocessing methods with Primescan is an important benefit of the system.”

highest hygiene requirements and can be disposed of after each use. All sleeves have a completely closed viewing window to prevent liquid from entering during scanning.

A suitable sleeve for practice-specific reprocessing protocols These three options make taking digital impressions as easy and hygienic as ever. Primescan provides a variety of disinfection and sterilization procedures exceeding minimum recommended hygiene guidelines.

Dr. Alexander Völcker, Group Vice President CAD/CAM at Dentsply Sirona

“The autoclavable sleeve completes the versatile hygiene options,” summarizes Dr. Alexander Völcker, Group Vice President CAD/CAM at Dentsply Sirona.

“Dentists and practice teams can count on optimal infection control at all times. In combination with the Acquisition Center, Primescan offers a hygienically excellent workflow in digital impression taking with outstanding clinical results.”

More information about Primescan at www.dentsplysirona.com/primescan Dr. Daniel Aniol, dentist from Bornheim, Germany.

Innovation Ziad Al Aasali General Manager of EMS Middle East, Africa and India

According to CDC: periodontal disease is considered to be a worldwide pandemic causing disability, speech impairment, low self-esteem, and reduced quality of life Periodontitis affects 45-50% of the world population, & its more severe form affects 11%. And it is the sixth most common human disease. Recently published Thousands of high quality scientific research articles which clearly established the link between oral disease and over 50 systemic diseases; Periodontal health is more important than ever, providing periodontal care reduces the rate, morbidity, mortality of these systemic conditions , also reduces medical treatment costs.

Good oral hygiene and professional biofilm management significantly contribute to a stable immune system – The bacteria in oral biofilm damage the teeth and the supporting structures such as the gums and bone that hold the teeth in place.

But there is more: bacteria also find their way deeper into the body and may cause serious diseases over time. Studies have found that oral biofilm may lead to diabetes as well as cardiovascular and other common diseases. In addition, biofilm calcifies to become ugly tartar (Calculus) . Oral biofilm must be removed - on a regular basis, without pain, gently and effectively.

The best way? GUIDED BIOFILM THERAPY and this is particularly important in light of the COVID-19 pandemic. Therefore everyone should seek professional prevention based on current state-of-the-art science and technology, the Guided Biofilm Therapy (GBT).

ALL

01 ASSESS PROBE AND SCREEN EVERY CLINICAL CASE GBT can be done only by AFPM (Air Flow Prophylaxis Master) and not any other product

PPY PATIENT requency ssessment nt if he eatment

LOW®

GBT contributes in strengthening the immunity system and protecting the overall health

Healthy teeth, caries, gingivitis, periodontitis Healthy implants, mucositis, peri-implantitis Start by rinsing with BacterX® Pro mouthwash

02 DISCLOSE

Highlight topreventive patients the disclosed GBT is biofilm the game changer in and their problematic areas with EMS Biofilm Discloser color will guide biofilm removal modern The dentistry.

However, proper GBT Once biofilm is removed, calculus is easier to detect should be done by the special 8 steps protocol &03 MOTIVATE only works with the highRAISE AWARENESS AND TEACH precision original Swiss devices from EMS: Emphasize prevention Instruct your patients in oral hygiene EMS recommends the AIRFLOW® Prophylaxis Master with the Philips Sonicare toothbrushes, interdental brushes and Ultra PIEZON® PS Airfloss Instrument, the AIRFLOW®

MAKE BIOFILM VISIBLE

R

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04 AIRFLOW®

REMOVE BIOFILM, STAINS AND EARLY CALCULUS Use AIRFLOW® for natural teeth, restorations and implants Remove biofilm supra- and subgingivally up to 4 mm using AIRFLOW® PLUS 14 μm Powder

MAX, and the PLUS powder – all perfectly coordinated. Working according to the GBT protocol ensures best results here. To ensure that GBT is implemented consistently, the Swiss Dental Academy (SDA) which has a branches in IMEA region offers high-quality courses (Theoretical & clinical) to educate professionals about GUIDED BIOFILM THERAPHY and oral health where we have highly experienced trainers Certified by Swiss Dental Academy (SDA).

March 2021

Copies can damage both hard and soft tissue and clog the AIRFLOW® handpiece. For EMS, oral biofilm management has been the driving force for innovations since the company was founded in 1981, and these are still unparalleled today.

One example is the ultrasonic PIEZON® (Perio Slim) PS Instrument, probably the most copied ultrasonic device in the world. It is optimally suited for subgingival debridement in 95 percent of all cases.

Like the other piezoceramic devices from EMS, the PIEZON® PS is a technical masterpiece: with its precise interaction between the handpiece and the electronic control, it ensures perfect linear transmission of energy, without any lateral impact by circular or other amplitudes, and is therefore also quiet and virtually painless for the patient (NO PAIN).

No More outdated methods! ONLY GBT According to the conviction of practitioners and leading scientists, Guided Biofilm Therapy reflects current state-ofthe-art science and technology. It stands for clearly defined performance and quality assurance, which also includes disclosing. This is because we aim to remove 100 percent of the biofilm . Stiftung Warentest, the German consumer watchdog, found in a survey of German practices, only 50 percent of Biofilm is removed in critical areas.

Another example is our high-tech AIRFLOW® PLUS powder for the minimally invasive removal of biofilm, early calculus & stains. This all-rounder based on erythritol with a particle size of 14 μm is the most fine-grained powder on the market.

The fact that these products are copied so often certainly implies a high level of recognition for us. But it poses a considerable risk, because teeth and gingiva can be damaged and this jeopardizes our mission: happy and healthy patients.

If patients perceive their treatment as unpleasant, they will not attend the recall which will affect the whole cycle of GBT Protocol. Furthermore, copies can damage the perfectly matched EMS components or impair their performance.

Both will end up costing the practice dearly!

This is also reflected in the GBT Consensus – but only in connection with the technology used for this purpose.

The concepts behind GBT for preventive professional mechanical plaque removal and subgingival debridement are documented in a large number of preclinical and clinical studies. This applies both to their effectiveness and efficiency as well as their biocompatibility and patient friendliness.

Leaving scientific evidence aside, it is probably best to ask practitioners who use GBT and patients who have received GBT. You will, and of that I am absolutely sure only receive enthusiastic answers: from prevention experts stating that they never want to work with the outdated methods of scratching and abrasion again. And patients will tell you that GBT is at last a professional mechanical plaque removal treatment that they welcome over and over again, without being afraid. GBT practices experience correspondingly high and continuous patient demand and full recall appointment schedules.

Innovation

GBT contributes in strengthening the immunity system and protecting the overall health

Good treatment is Expensive, Cheap ones are more expensive !

The technology behind GBT was developed by EMS engineers in close and elaborate cooperation with dentists.

It takes profound knowledge to create highly efficient products that offer both simple design and easy operation.

We know that patients are more than ever concerned with health issues, especially in light of the COVID-19 pandemic.

Biofilm management should therefore first and foremost be clinically effective and gentle on tooth structure & gums , thus ensuring successful treatment. if I replace an original instrument with an inferior copy, the medical objective will never be achieved. This leads to unavoidable damage to the device and irreparable damage to teeth and gingiva. If fake instruments are used, we cannot fulfill our promise to patients of providing both thorough and painless treatment. The patient›s health and smile are at considerable risk.

The combination of know-how built over decades by passionate researchers and developers, the Swiss precision and quality (Swiss Made), and, last but not least, the Swiss Dental Academy, the training institute that ensures the correct use of our products, makes us market leaders, and not without reason.

The products PIEZON® PS Instrument, AIRFLOW® and PLUS powder, erythritol, are our minimally invasive originals for biofilm management. They ensure that modern professional mechanical plaque removal with the Guided Biofilm Therapy (GBT) protocol can be performed comfortably, safely, and efficiently – for patients and practitioners alike.

The latest development from EMS is the AIRFLOW® MAX, a new handpiece with patented GUIDED LAMINAR AIRFLOW® Technology. This ensures a laminar air-powderwater flow – a quantum leap, as aerosols can now be controlled even better and thus reduced to a considerable extent.

Customers will find the original PIEZON® PS Instrument in a torque wrench, the so-called Combi Torque. This protects the tip, which is thin and smooth like a probe. In addition, the EMS logo as well as the product designation «PS» are also engraved on the thread shaft of the original PS instrument.

A satisfied and healthy patient who gladly attends their appointment again is inimitable proof that original EMS products have been used. And that is what counts!

EMS LECTRO MEDICAL SYSTEMS JORDAN No.2 - second floor, 195 Arar (Wadi Saqra) str.

Tel.: +9626 4653035 FB: https://www.facebook.com/EMSDENTALIMEA/ IG: https://www.instagram.com/ems.dental.imea/ www.ems-company.com

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Lyla Dental Hygiene

Your customised solution – now and in the future Face all challenges ahead – with the new Lyla S type sterilizer from W&H. Smart upgrades respond to your business needs and make the W&H innovation the perfect partner for your hygiene workflow.

It simply and quickly upgrades Lyla to a B type sterilizer according to EN 13060. So, whatever happens in the future, you’ll be well-prepared with this unique Lyla feature.

With an easy upgrade from S to B type sterilizer, W&H covers high requirements with only one unit. This forward-thinking technology makes Lyla the futureproof, best performing solution for safe reprocessing and infection prevention.

Super-fast cycles

The nS type sterilization is a safe and sustainable method of reprocessing medical items. The new Lyla supports the practice team in making professional life safer and, at the same time, less complicated.

Different available cycles guarantee the possibility to sterilize several instrument types, including hollow bodies, both wrapped, unwrapped or placed in containers. The gentle cycle ensures the sterilization of sensitive items and porous loads, such as surgical clothes.

The smart upgrade system offers a costefficient, fast and customised opportunity to activate additional features to reflect your practice needs or comply with future requirements. Easy to operate and equipped with the best cycle time in its segment, Lyla is the professional device for your sterilization process.

Smart upgrades Discover the upgradeability with the Activation Code system! It provides several Activation Codes that offer a tailored opportunity to enhance additional features.

One highlight is the “B cycle” feature.

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Smart upgrades, super-fast cycles, secure traceability and simple operation make Lyla a future-oriented solution.

March 2021

Secure traceability The integrated built-in USB data logger ensures entire digital cycle documentation for legal protection. The label printer can be connected to the sterilizer for printing barcodes. In combination with the integrated data logger, it improves your traceability system. Thanks to the barcode reader you can scan labels into patient records – an easy tool to link cycle, pouch and patient.

Extended connectivity is given with the W&H Steri App. It allows controlling and remote monitoring the sterilizer thanks to a Wi-Fi connection. Moreover, cycle history back-up automatically saved on smartphone ensures extra-safety.

The new Lyla is now packaged in an even more environmentally friendly way.

of mind reprocessing and infection prevention – now and in the future. With Lyla you can respond flexibly to upcoming challenges and increase safety for your patients and your practice team – all within the W&H AIMS workflow.

W&H AIMS (Advanced Infection prevention Management Solutions) is the workflow for every dental practice. It guides you through every individual step of the reprocessing process in order to minimise the risk of infection.

Easy upgrade to a B type sterilizer according to EN 13060.

Simple operation Unrivalled usability thanks to 3.5“ colour touch screen and simplified menu structure, time-saving maintenance and advanced functionality raise to be Lyla considered as a benchmark in its class.

Manual water filling is simple with the integrated funnel and the water tank cover can be easily removed without tools. The smooth surface design and ergonomic shape enables easy cleaning and, thanks to modular feet, it fits in anywhere. Thanks to the high level of reliability, the service interval is set to 4,000 cycles or 5 years.

Needs and requirements may change. Prepare yourself with Lyla! It provides professional sterilization for a peace

W&H AIMS – safe infection prevention one step at a time

W&H products offer full functionality for your customised hygiene workflow. aims.wh.com

BRIGHT Temporary C&B a perfect solution

DMP, a European manufacturer of high-quality dental materials, successfully supplies the global dental market for over 35 years. Certified with ISO 9001, 13485 and MDSAP, DMP’s products carry the CE mark and have U.S. FDA clearance. DMP creates bright smiles achieving excellence and reliability through integrity, passion and commitment which are ingrained in DMP’s culture.

• Very high compressive and flexural strength for long lasting provisionals • Colour stability • Easy polishing due to low oxygen inhibition layer • Optimum elastic properties • Very high compressive and flexural strength • Easy to cut and trim

DMP expands its BRIGHT Temporary Crown & Bridge family with the 10:1 and 4:1 delivery systems. Exceptional aesthetic results, combined with optimal mechanical and physical properties, make them ideal products to fabricate provisional restorations.

Website: www.dmpdental.com

The unique and highly advanced technology of BRIGHT Temporary C&B also offers: • Natural tooth-looking aesthetics due to the perfect combination of shade opacity and fluorescence • Very low temperature during intra-oral setting which protects against damage of the dental pulp

BISCO is pleased to announce

that we received the President’s «E» Award for Exports BISCO has been selected to receive the 2020 President’s “E” Award for Exports in recognition of their dedication to increasing U.S. exports. This award is the highest honor given to U.S. exporters that demonstrate a sustained commitment to export expansion. BISCO strives to support their mission of improving dentistry worldwide by making their products available to both U.S. and foreign dentists. These efforts support the U.S. economy and create jobs for Americans.

Some of the notable achievements meriting the award include BISCO’s yearly hosted Symposium to gather international partners and engage in face-to-face training on products and methods, along with their innovative product development. BISCO’s International Sales Team and their foreign partners work in tandem to ensure that dentists worldwide are set up for success when they purchase BISCO products and to bring a greater variety of BISCO products to international markets.

Website: www.bisco.com

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March 2021

Umbrella™

Tongue, Lip, and Cheek Retractor The Umbrella retractor is designed with a priority on ease of placement and patient comfort.

To use the Umbrella retractor, a clinician simply presses the two tabs together, places it in the patient’s mouth, and it pops open. This retractor helps the patient’s mouth stay open in a natural and comfortable range while still allowing for the patient to fully open or close as needed.

The retractor also opens the space between the teeth, lips, and cheeks in a way that encourages saliva to accumulate away from dentition and improves access for HVE. A new, innovative tongue-retraction design allows the tongue to comfortably rest behind the tongue guard. The Umbrella cheek retractor is ideal for a variety of procedures that require clear access without compromising patient comfort.

Website: www.ultradent.com

XR-01

Portable X-RAY XR-01R Portable X-Ray XR-01 Offer hug rechargeable battery enables easy shooting and keeping everywhere.

Display image can be compatible with PSP , sensor and film leading to the convenience of operations.

XR-01 is design with a hand strap, also simple operation, compact size to make you easy operate it by one hand only. You can use hands for holding X-ray, or the other holder for positioning to controlling the position.

XR-01® units are the most important equipment in dentistry» is a perfect portable match to your current CBCT system.

Compact in size and its portable to use it in a comfortable manner. Beside, this unit is highly ensured with safety standards owing to its minimum exposure time with low radiation environment, and high efficiency for shot radiography gives high-quality images.

• Maximum battery capacity Rolence Portable X-Ray provides a 2,900 mAh rechargeable lithium battery as a power source.

More than 450 exposures can be obtained from onetime charge.

• High quality guarantee Offer latest and highest technical specification of Canon d-045 among portable X-ray devices.

Website: www.rolence.com.tw

Expodental Meeting

postponed to September!

Once again UNIDI is struggling with the uncertainty due to the Covid-19 pandemic in Italy and in Europe. Following several discussions and meetings with different companies, exhibitors, associations and partners, the UNIDI board decided to postpone Expodental Meeting to September 9th to 11th, 2021.

www.expodental.it

This was regarded as the best choice, considering that the rollout of vaccinations is underway and the month of September should allow us to meet in Rimini in much safer condition.

Expodental Meeting is keen on the health and well-being of its audience and firmly willing to guarantee the maximum safety for exhibitors and visitors, in order to allow as many people as possible to attend.

The Organizing Committee aims to make the leading dental fair in Italy not to disappoint the expectations of the whole dental sector. This is especially important

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for this year’s edition since our dental industries will benefit more than ever from a successful event.

«Today, considering what happened from the beginning of 2020, predicting the near future is no longer possible. Unfortunately, the recent weeks have made it more and more obvious that the month of June does no longer represent the ideal time for an effective restart» says Gianfranco Berrutti, UNIDI president.

«Postponing Expodental Meeting to September was a choice dictated by our desire to confirm the leadership of our event, a fundamental tool for promotion and business for the whole sector.»

Rendez-vous in Rimini, then, from 9 to 11 September 2021, with an exhibition area and a scientific and training program that will not disappoint the expectations.

March 2021

29 June - 1 July 2021

D isc ov er a wor ld of im a ges

X-VIEW 2D PAN CEPH

Make a difference!

Make that change Digital Flat Panel | Single Shot | 200 ms of Exposure Time

Via Artigiani 4 - Castenedolo, 25014 BS - Italy Tel 39 030 2732485 | www.trident-dental.com