Easy application into the sulcus
THE CORD FROM THE CAPSULE • Thin cannula with flexible tip – easy and pinpoint application into the sulcus
VOCO Retraction Paste
• Viscosity Change – paste consistency varies during application and sulcus widening • Good visibility – contrasty to the gingiva • A clean product – quick and easy to spray off
For more information please contact VOCO‘s Business Development in Middle East/Northern Africa, Mohamad El Fil (+961-3-805758 / m.elfil@voco.com).
VOCO GmbH · Anton-Flettner-Straße 1-3 · 27472 Cuxhaven · Germany · Tel. +49 4721 719-0 · www.voco.com
NEW
SWISS
PROFESSIONAL
ORAL CARE
Follow us on
Social Media
www.wild-pharma.com #wildredesign
Experience the new packaging design of Dr. Wild Oral Care Redesign Tebodont Packaging
18 ml
400 ml
25 ml
25 ml
18 ml
75 ml
400 ml
250 ml
75 ml
400 ml
Redesign Emoform Packaging
85 ml
75 ml
85 ml
75 ml
85 ml
75 ml
85 ml
75 ml
75 ml
75 ml
75 ml
75 ml
SWISS
PROFESSIONAL
ORAL CARE
Redesign Emofluor Packaging
75 ml
75 ml
500 / 250 ml
400 ml
Redesign Depurdent Packaging
75 ml
75 ml
Based on the close and fruitful cooperation with dental institutes and practicing dentists since the 1940s, we have a uniquely broad portfolio of specially developed, innovative toothpastes, gels, sprays, mouthwashes and mouth baths. These products,
75 ml
75 ml
•
•
which are marketed under the brands Tebodont®, Emofluor®, Emoform®, Depurdent® and Emofresh® are sold exclusively in pharmacies in Switzerland and in more than 40 other countries outside Switzerland, their various innovative formulations and compositions offer excellent solutions for daily dental care, addressing specific needs and problems (e.g. caries prevention,
•
•
sensitive teeth, gum problems) and general oral health. With the REDESIGN we have clarified the positioning of the oral care products: every toothpaste and every mouthwash now has a clear application area. At the same time, our new
•
packaging is "digitalized": each product has a QR code that allows detailed information to be downloaded directly to the mobile phone. The redesign of the products should make the Wild brand tangible and perceptible.
•
50 ml
75 ml
500 ml
400 ml
WILD will be used as umbrella brand on all products, which results in an easier promotion among the whole product range Same design for all brands leads to recognition and synergy effects across product range Clear unique main indication on the packaging avoids confusion among dental profession, pharmacists and end consumers due to overlapping benefits New design underscores clinical benefits and professionalism of the products which leads to cross-brand and cross-portfolio products awareness and helps to create trust among the dental profession, pharmacists and end consumers Unifying of the packaging system - all toothpastes in the same size and shape of tubes, all mouthwashes in the same size and packaging - leads to a uniform, eye-catching and space-saving shelf-impact Product portfolio becomes fresh, easy to recommend and attractive for the POS
Follow us on
Social Media
INTERNATIONAL CALENDAR Vo l u m e X X I X , N u m b e r I , 2 0 2 2 EDITORIAL TEAM Alfred Naaman, Nada Naaman,
COORDINATOR ART DEPARTMENT SUBSCRIPTION ADVERTISING PHOTOGRAPHY TRANSLATION DIRECTOR ISSN
Khalil Aleisa, Jihad Fakhoury, Dona Raad, Antoine Saadé, Lina Chamseddine, Tarek Kotob, Mohammed Rifai, Bilal Koleilat, Mohammad H. Al-Jammaz Suha Nader Marc Salloum Micheline Assaf, Nariman Nehmeh Josiane Younes Albert Saykali Gisèle Wakim Tony Dib 1026-261X
DENTAL NEWS IS A QUARTERLY MAGAZINE DISTRIBUTED MAINLY IN THE MIDDLE EAST & NORTH AFRICA IN COLLABORATION WITH THE COUNCIL OF DENTAL SOCIETIES FOR THE GCC.
Statements and opinions expressed in the articles and communications herein are those of the author(s) and not necessarily those of the Editor(s) or publisher. No part of this magazine may be reproduced in any form, either electronic or mechanical, without the express written permission of the publisher.
DENTAL NEWS – Sami Solh Ave., G. Younis Bldg. POB: 116-5515 Beirut, Lebanon. Tel: 961-3-30 30 48 Fax: 961-1-38 46 57 Email: info@dentalnews.com Website: www.dentalnews.com www.facebook.com/dentalnews1
Expodental 2022
May 19 – 21, 2022 Rimini, ITALY www.expodental.it
AIO CHIA 2022
June 9 – 11, 2022 Chia Laguna, Sardinia, ITALY www.congressaio.it
Egyptian Dental Syndicate International Conference EDSIC 2022
Sofia Dental Meeting
September 7 – 9, 2022 Cairo, EGYPT
October 6 – 8, 2022 Sofia, Bulgaria www.sofiadentalmeeting.com
CADEX 2022 Central Asia Dental Expo
October 12 – 14, 2022 Almaty, KAZAKHSTAN www.cadex.kz/en
Beirut International Dental Meeting
October 13 – 15, 2022 Beirut, LEBANON www.bidm-lda.com
Makkah International Dental Conference 2022
October 20 – 22, 2022 Makkah, KSA www.makkahdental.com
World Congress of Esthetic Dentistry IFED 2022
October 27 – 29, 2022 Abu Dhabi, U.A.E. www.ifed2022.com
www.instagram.com/dentalnews twitter.com/dentalnews
This magazine is printed on FSC – certified paper.
W W W. D E NTA LN E WS .CO M
ARTICLES
CONGRESSES 42. ADF
8.
Novembre 23 - 27, 2022 Paris - France
Dentigerous Cyst Associated with Radicular Invaginatus P Dhanrajani, A Rynberg
16.
Conservative Approch for Management of Separated Endodontic Instruments
42. Egyptian Orthodontic Society January 20 - 21, 2022 Cairo - Egypt
Rym Mabrouk, Souha Yahia, Jihene Ghabri, Afef Oueslati, Nadia Frih
28.
Digital Treatment Plan: Progressive Smile Makeover Protocol
42. AEEDC February 1 - 3, 2022 Dubai - UAE
Rami Chayah
28.
Digital Dental Color, Practical Applications with State-of-the-art Colorimeters Jordi Manauta
ADVERTISING INDEX A-DEC 17 ORTHO ORGANIZERS 9 BA INTERNATIONAL 23 BELMONT 15 BISCO 11 DENTAURUM 12 DENTSPLY SIRONA C3 DMP 1
Quarter II
DXP 45 DURR 21 EDGE ENDO 67 FKG 47 HENRY SCHEIN 25 NSK C2 PROMEDICA 44 ROLENCE 27
SCHEU 22, SEPTODONT 72 TRIDENT C4 ULTRADENT USA 33 VOCO 2, 49 WILD 3, 4, 5
Dental News
7
Oral Pathology
Dr P Dhanrajani BDS, MDS, MSc, MSC, FRACDS, FDSRCS, FFDRCSI Oral Surgeon dan.dhanrajani@gmail.com
Dr A Rynberg, BDS Senior Dentist
Dentigerous Cyst Associated with Radicular Invaginatus Abstract
Clinical Relevance
Radiographic signs, detectable on an Developmental malformation of the teeth has a wide and complex spectrum, making exact diagnosis sometime difficult. The radicular invaginatus is one of a such entity. Owing to its unusual radiographic appearance, such teeth are often incorrectly diagnosed as a double root, a radicular invagination or fused teeth. These are described as severe variants of dens invaginatus. The anomaly typically occurs during the stage of tooth development of odontogenesis. The exact aetiology is unknown. A case is reported of a radicular invaginatus associated with dentigerous cyst.
Dens invaginatus is a rare anomaly, clinically present in varied forms of disturbed morphology. Where these entities occur, they should be noted and addressed. The literature documents very few reported cases of radicular invaginatus associated with dentigerous cyst. Proper examination and radiographic investigation are essential to make a conclusive diagnosis.
Introduction Radicular invaginatus is an extremely rare developmental malformation representing as a severe variant of dens invaginatus. This malformation is the result of an infolding of the enamel epithelium during odontogenesis. Two main variants of dens invaginatus are described, coronal and radicular. Hallet was the first to put forward the classification of dens invaginatus but most widely used classification is suggested by Oehlers. Etiopathogenesis of dens invaginatus is thought to be either genetic or mechanical. Mechanical factors included trauma and/or infection1, 2, 3. A recent hypothesis proposes dental invagination as a consequence of the degeneration of the dental lamina which can lead to fusion, gemination or agenesis4, 5, 6, 7. Most common teeth involved are upper lateral incisors, other teeth affected less commonly are upper maxillary canine and central incisors and rarely mandibular teeth2, 3, 5. This paper presents a rare case of dentigerous cyst arising from radicular invaginatus involving right maxillary lateral incisor.
8
Dental News
Quarter II
Better together. Motion 3D & SLX
Standardize and simplify your SLX® Clear Aligner cases, reducing total treatment time and the number of aligners required. The Carriere® Motion 3D™ Appliance is used at the beginning of treatment for rapid A/P correction prior to braces or aligners when there are no competing forces operating, and patient compliance is at its highest. By resolving the most difficult part of treatment first, you can achieve an ideal Class I platform in 3 to 6 months, which can then shorten overall treatment time by up to 6 months with SLX 3D Brackets or SLX Clear Aligners. Employing SAGITTAL FIRST™ also means many fewer trays and simple, ��-minute bonding is perfect for same-day starts.
To learn more, contact your Orthodontic Sales Specialist: Call +(1) 760.448.8600 | or visit HenryScheinOrtho.com
3 — 6 MONTHS*
66� FEWER ALIGNERS*
* Based on treated cases and case simulations by Dr. Luis Carrière © 2022 Ortho Organizers, Inc. All rights reserved. PN M2482 03/22
Oral Pathology
Dentigerous Cyst Associated with Radicular Invaginatus
Case Report A 11-year-old girl was referred to oral and maxillofacial clinic for the management of the cystic lesion in the right anterior maxillary region by her orthodontist. She was medically fit and well and was accompanied by her both parents during her consultation visit. Patient was asymptomatic and on examination there was buccal expansion in the region of right upper lateral incisor (Fig 1). On palpation, eggshell crackling was felt while pressing in the buccal sulcus in the region of upper lateral incisor, suggestive of a cystic lesion. The right upper canine was unerupted, and upper lateral incisor was partially erupted, mesially inclined and retained upper deciduous canine. Orthopantomogram and CBCT brought by patient revealed a radiolucency associated with right upper lateral incisor with abnormal tooth morphology with external teat extending into radiolucency (Fig 2). CBCT confirmed a radiolucency measuring 2cm Height x 1.7cm Width and 2.2cm Depth associated with malformed upper right lateral incisor consistent to radicular dens invaginatus (Fig 3a,b). 3D reconstruction of upper lateral incisor confirmed radicular invaginatus showing malformation crossing cementoenamel junction and apex of the tooth (Fig 4). Upper right canine was impacted in favourable situation to erupt and there was retained upper right deciduous canine. Patient brought an orthopantomogram taken during 2019 revealing radiolucency around malformed upper lateral incisor (Fig 5). Based on clinical and radiographic finding a diagnosis of dentigerous cyst associated with upper right lateral incisor was established. Aspiration biopsy was offered during examination, but the patient was anxious, and parents did not consent to do along chair side. Surgical exploration of the lesion was consented by parents under general anaesthetics. The aspiration revealed straw coloured fluid and cyst was enucleated and sent for histological examination. Upper right deciduous canine was removed. Post-operative phase was uneventful, and patient recovered very well (Fig 6). Histopathological findings revealed collapsed cyst lined in most part with nonspecific, non-keratinising squamous epithelium consistent to dentigerous cyst.
Figure 1: Intraoral photograph showing buccal expansion in upper right lateral incisor.
Figure 2: Orthopantomogram showing well demarcated radiolucency involving radicular part of invaginatus has increased in size at presentation.
Figure 3a: CBCT showing size of cystic lesion in axial, sagittal and coronal views.
Figure 3b: CBCT showing size of cystic lesion in axial, sagittal and coronal views.
10
Dental News
Quarter II
Oral Pathology Dentigerous Cyst Associated with Radicular Invaginatus
Discussion
IT‘S MY CHOICE. The decision on which abutment is best for your patient – conical or platform – is yours.
More information at
www.dentaurum-implants.com
Dens invaginatus is an anomaly presented with a widely varied morphology. It has also been referred to as dens in dente, dilated/invaginated composite odontoma, gestant odontoma, tooth inclusion etc. Hallet1 was first to introduce the term “dens invaginatus” and classified them in to various types based on coronal and radicular invaginations. The most widely used classification in the literature was given by Oehler3 in 1957 describing dens invaginatus in three different forms ranging from type 1, anomaly limited within the crown of the tooth, type 2, invagination extending apically past the cemento-enamel junction, but remains within root and lastly type 3 where invagination perforates apically to create an apical or periodontal foramen. The most severe form, type 3, also known as dilated odontoma, the tooth is usually bulbous and malformed. Unfortunately, dilated odontome are not represented in any of the classifications as an entity but are categorised as a severe form of dens invaginatus. Dens invaginatus can affect both primary and permanent teeth and its prevalence is reported to be 1.7 to 10%. Males are more affected by a ratio of 3:16. All the published studies have shown that the maxillary lateral incisors were the most commonly affected teeth, followed in descending order by permanent central incisors, canines and molars7, 8, 9. Development of an invaginated tooth has been explained based on a number of theories in the last 75 years including: growth pressure on dental arches resulting in buckling of the enamel leading to invagination, failure of internal epithelium growth, rapid proliferation of internal enamel epithelium, distortion of enamel organ during development, infection and/or trauma, and incomplete fusion of two tooth germs or to the attempted division of a single tooth germ8, 9. The genetic and syndromic association with dens invaginatus has always been debated upon without much clinical evidence available so far10, 11, 12. The most significant clinical concern of dens invaginatus is the risk of developing pulpal pathology13, 14. The invagination commonly communicates with the oral cavity, allowing the entry of irritants and microorganisms directly into the pulpal tissue.
12
Dental News
Quarter II
NEW
PIÑA COLADA
FIRST CLASS IN EFFECTIVENESS AND TASTE
VOCO Profluorid® Varnish
• Effective – quick desensitisation and fluoride release (5 % NaF ≙ 22,600 ppm) • Excellent handling – moisture tolerant • Aesthetic – tooth-shaded varnish • Universal – available in tube version, SingleDose and cartridge • Variety of flavours – mint, caramel, melon, cherry, bubble gum, cola lime and piña colada For more information please contact VOCO‘s Business Development in Middle East/Northern Africa, Mohamad El Fil (+961-3-805758 / m.elfil@voco.com).
VOCO GmbH · Anton-Flettner-Straße 1-3 · 27472 Cuxhaven · Germany · Tel. +49 4721 719-0 · www.voco.com
Oral Pathology
Dentigerous Cyst Associated with Radicular Invaginatus
Conclusion Dens invaginatus lesions are commonly seen under palatal cusp tips as pits. There may be an extensive involvement of tooth structure resulting in grossly distorted morphology is rare as seen in this case. Proper examination and radiographic investigation are essential to conclude the diagnosis.
Abbrevations
Conclusion
Figure 4: 3D reconstruction of upper right lateral incisor showing radicular invaginatus.
Dens invaginatus lesions are commonly seen under palatal cusp tips as pits. There may be an extensive involvement of tooth structure resulting in grossly distorted morphology is rare as seen in this case. Proper examination and radiographic investigation are essential to conclude the diagnosis.
SC: Standard coronectomy MC: Modified coronectomy IAC/N: Inferior Alveolar canal/Nerve LN: Lingual Nerve OPG: Orthopantomogram CBCT: Cone Beam CT scan
References 1. Hallet GE. The incidence, nature and clinical significance of palatal invagination in maxillary incisors. Proceedings of the Royal College of Medicine 1953;46:491-499. 2. Bimstein E, Shteyer A. Dilated type of dens invaginatus in the permanent dentition. ASDC J Dent Child 1976;43:410-413. 3. Oehlers FA. Dens invaginatus I Variations of the invagination process and associated anterior crown forms. Oral Surg Oral Med Oral Path 1957;10:1204-1218. 4. Hulsmann M. Dens invaginaus: aetiology, classification and prevalace diagnosis and treatment considerations. Int J Endodont 1997;30:70-79. 5. Vaidyanathan M, Whatling R and Fearne J. An overview of the dens invaginatus with case examples Dental Update 2008;35:655-663. 6. Wall A, Ng S and Djemal S. The value of cone beam CT in assessing
Figure 5: Orthopantomogram showing radiolucency associated with malformed upper right lateral incisor 18 months earlier.
and managing a dilated odontome of a maxillary canine Dental Update 2015;42:126-128. 7. Galindo-Moreno PA, Parra-Vázquez MJ, Sánchez-Fernández E, AvilaOrtiz GA. Maxillary cyst associated with an invaginated tooth: A case report and literature review. Quintessence Int 2003;34(7):509-514. 8. Jayachandran S, Kayal L, Sharma A, Khobre P. Dilated odontoma: A report of two cases from a radiological perspective. Contemp Clin Dent 2016;7(1):107-110. 9. Mupparapu M, Singer SR. A review of dens invaginatus (dens in dente)
Abbrevations
in permanent and primary teeth: A case report in a microdontic maxillary lateral incisor. Quintessence Int 2006;37(2):125-129. 10. Kristoffersen Ø, Nag OH, Fristad I. Dens invaginatus and treatment
SC: Standard coronectomy MC: Modified coronectomy IAC/N: Inferior Alveolar canal/Nerve LN: Lingual Nerve OPG: Orthopantomogram CBCT: Cone Beam CT scan
options based on a classification system: Report of a type II invagination. Int Endod J 2008 Aug;41(8):702-709. 11. Ireland EJ, Black JP, Scures CC. Short roots, taurodontia and multiple dens invaginatus. J Pedod 1987;11(2):164-175. 12. Chaniotis AM, Tzanetakis GN, Kontakiotis EG, Tosios KI. Combined endodontic and surgical management of a mandibular lateral incisor with a rare type of dens invaginatus. J Endod 2008 Oct;34(10):1255-1260. 13. Fregnani ER, Spinola LF, Sônego JR, Bueno CE, De Martin AS. Complex endodontic treatment of an immature type III dens invaginatus: A case report. Int Endod J 2008 Oct;41(10):913-919.
Figure 6: orthopantomogram immediate post-operative.
14. Zengin ZA, Sumer PA, Celenk P. Double dens invaginatus: Report of three cases. Eur J
14
Dental News
Dent 2009 Jan;3(1):67-70.
Quarter II
Endodontics
Conservative Approach for Management of Separated Endodontic Instruments case reports Abstract
Dr. Souha Yahia University of Monastir. Faculty of Dental Medicine of Monastir, Tunisia Souha-yahia@hotmail.fr
Pr. Rym Mabrouk Associate Professor in Endodontics and Restorative Dentistry. Department of Dental Medicine. Hospital of Charles Nicolle Tunis, Tunisia. rim.mabrouk.rm@gmail,com
Pr. Jihene Ghabri Hospital of Charles Nicolle Tunis, Tunisia. Pr. Afef Oueslati Hospital of Charles Nicolle Tunis, Tunisia. Pr. Nadia Frih Hospital of Charles Nicolle Tunis, Tunisia.
16
Dental News
The fracture of endodontic instruments is an unpleasant occurrence that may hinder the endodontic therapy with an impact on the prognosis of the treatment. Therefore, an attempt to remove the broken file should be considered in most cases. Various techniques and modalities have been developed to facilitate the removal of the separated fragment. The orthograde method and bypass technique are two recommended approaches with a successful outcome
when managed properly. Several factors have to be considered before choosing to remove a fractured instrument. The chances of success have to overweigh the possible complications. The purpose of this article was to describe through clinical cases, the management of separated endodontic instruments with orthograde method and non-invasive technique.
Introduction Endodontic instrument separation is a frequent and potentially avoidable mishap. It’s a frustrating incident for both clinician and patient. The presence of a foreign instrument in the root canal system blocks the access to the root apical third and thus compromises the effectiveness of cleaning and shaping procedures, which could impair the success of the endodontic treatment1, 2. As a consequence, the level of difficulty of such cases increases, while the tooth healing is challenged3, 4. The composition and design of endodontic instruments have been modified, with the aim of achieving a better performance and fewer undesirable complications including instrument separation. However, the advent of nickel-titanium (NiTi) alloys has not resulted in a lower incidence of instrument fracture5, 6. The prevalence of retained endodontic stainless steel (SS) hand instruments has been reported to range between 0.25% and 6%. While the separation rate of NiTi rotary instruments varied between 1.3% and 10.0%4,7. The management strategy of broken files includes abstention, conservative approach or orthograde method, surgical management and tooth extraction. Although a variety of techniques and devices have been described and used, there is no standardized safe procedure and consistently successful for separated instrument retrieval. The selection of the management approach depends on the case selection, success-risk assessment, prognosis of the treated teeth, clinician experience and patient consent8, 9, 10.
Quarter II
EXPERIENCE THE NEXT LEVEL A-DEC 500.
In a world of complex technology and noise, we bring you intelligent simplicity and infallible peace of mind. With optimal access, flexible integration and intelligent control, it’s everything you expect. Redefined.
Envision more for your practice @ a-dec.com/500EXPERIENCE
© 2021 A-dec Inc. All rights reserved.
Endodontics
Conservative approach for management of separated endodontic instruments: case reports
This paper aim was to illustrate the conservative approach of the management of several separated endodontic instruments based on two clinical cases.
Case presentation Case report 1 A 24 year old man was referred to the Department of Dental Medicine and Endodontics of Charles Nicolle Hospital of Tunis for multiple endodontic retreatments. The patient’s medical history was non-relevant. Clinical examination revealed the presence of a temporary restoration on mandibular second left premolar tooth #35 and first mandibular left molar tooth #36. Teeth were asymptomatic upon percussion and palpation. The preoperative radiograph showed three separated NiTi instruments in the cervical third, median third and the entrance respectively, of the mesio-buccal, the disto buccal and distal roots of the first left mandibular molar #36 (Figure 1, a). All broken files were fortunately on a straight part of the root canal system. The diagnosis of asymptomatic apical periodontitis was retained. The following treatment plan was proposed to the patient and approved: non-surgical root canal retreatment with the attempt to remove the separated files with a conservative approach. First, the temporary restoration was removed to gain access to the canal entrance of the mesio-buccal canal. The coronal cavity walls were finished with an Endo-Z bur (Dentsply Maillefer, Ballaigues, Switzerland) and straight line access to the instrument fragment was achieved with Endoflare ® (Micro-Mega ® Besançon, Cedex). The access cavity was irrigated with 2.5% sodium hypochlorite solution NaOCl and the bypass technique of the broken-file was initiated with a hand K-file # 15 (MicroMega ® Besançon, Cedex) which was inserted in the root canal as far as the coronal extremity of the broken file. A little space was created between the broken fragment and the root canal wall and then enlarged with the use of hand K-file #20 and #25. During this procedure, periapical radiograph was taken to control the progress of the instrument and prevent a possible perforation. A copious irrigation with a 2.5 % hypochlorite solution was applied during this procedure. The NaOCl was neutralized with saline solution and the access cavity was irrigated with a 17 % EDTA chelating solution. After a few trials of bypass and alternative irrigation, the broken instrument was completely bypassed and its apical point was reached (Figure 1, b). So the apical third of the root canal system was shaped and cleaned to the full working length. Next, an ultrasonic hand piece with a K-file #15 (Figure 1, c) was introduced into the space created between the brokenfile and the root canal wall and it was activated,
18
Dental News
frequently irrigated with 2.5% sodium hypochlorite solution. The procedure was carefully repeated with a minor push up and down of one mm. The fragment was then detached in the access cavity within the irrigant solution. For the broken file localized in the disto-buccal root, the same procedure was applied. However, the separated instrument was longer than the first one. After by-passing technique and ultrasonic vibration, the file was discharged from the root canal dentin wall but not completely separated outside. For that, a hand file Hedstrom # 20 was introduced in the space created by the bypass technique alongside the instrument, which was finally retrieved by a push-up action.
Figure 1, a: Pre-operative radiograph showing several separated instrument in tooth # 36.
Finally, the third broken file within the distal root canal system was removed by a simple by-pass technique associated with the use of the ultrasonic vibration as its access was coronal (Figure 1, d). The radiograph showed complete removal of the three broken instruments. The complete shaping and cleaning of the root canal system was then achieved followed by vertical condensation obturation of warm gutta percha (Figure 1, e, f).
Quarter II
Figure 1, c: Ultrasonic endodontic K-file #15.
Figure 1, d: Removed separated instruments.
Figure 1, b: Per-operative radiograph showing by-pass technique.
Case report 2 A 40 year old female patient was reported to the Department of Dental Medicine and Endodontics of Charles Nicolle Hospital of Tunis with the chief complaint of pain in the mandibular left region. On clinical examination, we noticed the presence of a deep carious lesion on the second left mandibular molar. Based on the clinical and radiographic findings, the diagnosis of symptomatic irreversible pulpitis on tooth #37 was retained. Conventional root canal therapy was planned. Access cavity preparation was done under local anesthesia (Figure 2, a). During the procedure of irrigation and creating the glide path, the extremity of the endodontic irrigation needle (30 GA) was separated in the coronal third of the mesiobuccal root canal. The radiographic examination confirmed the presence of the separated instrument in the mesio-buccal canal entrance (Figure 2, b). The patient was informed about the incident, the possible management strategies and complications. The mesio-buccal canal orifice was enlarged using a Gates Glidden drill up to #3. The access cavity was protected with cotton wool plug to prevent the removed segment lodging in another canal. A modified Gates-Glidden drill #3 (Dentsply Maillefer) was used to create a staging platform in order to expose 2-3 mm of the coronal most part of the broken instrument (Figure 2, c). Then, an ultrasonic insert tip (ET40, Satelec®) was placed against the head of the instrument, and moved in a counterclockwise (CCW) direction. Following the ultrasonic activation and continuous copious irrigation with a 2.5% sodium hypochlorite, the needle fragment floated in the access cavity (Figure 2, d).
Chemo-mechanical debridement was then achieved followed by vertical thermo-compacting obturation technique and coronal restoration (Figure 2, e).
Figure 1, e: Working length radiographic view.
Figure 1, f: Post-operative radiographic view after root canal sealing.
Discussion Separation of endodontic files during root canal treatment is a frustrating and challenging incident. The optimum management option is retrieval in order to enable sufficient cleaning and shaping of the root canal system. Several methods were described to remove broken instruments or objects within the root canals. However, no gold standardized safe procedure and consistently successful instrument fracture management was reported1, 2, 4. The selection of the management approach depends on the case selection, success - risk assessment, prognosis of the treated teeth, clinician experience and patient consent. Management of separated instruments includes orthograde and surgical approaches.
Endodontics
Figure 2, a: Pre-operative radiograph tooth #37.
Conservative approach for management of separated endodontic instruments: case reports
Figure 2, b: Per-operative radiographic view: the apical part of the endodontic needle was broken in the canal.
In The Orthograde or conservative approach includes removal of fractured instruments from canal space, bypass of the fractured file and if above two were not possible, then prepare and obturate the accessible part of the canal3, 4. Bypassing the separated endodontic instrument is a recommended technique. It is considered to be the first step towards the removal of the separated instrument fragment from the root canal as it reduces the contact between the instrument and the root dentin walls and creates a space for inserting other instruments. However, it is a very demanding technique where success depends on the clinician’s sense of touch and perseverance. In addition, the success of this procedure depends on the ISO size and taper of the separated instrument and the section of the root canal system1, 2, 6, 11. The clinical application of the ultrasonic method allows detaching the file from the surrounding dentin wall. In the first present case, the separated instruments were successfully removed using the association of the two described techniques. The second case was well managed using the Ruddle technique, during which a modified Gates Glidden drill was used to create a flat platform in the
Figure 2, c: Gates-Glidden drill # 3.
20
Dental News
Figure 2, e: Post-operative radiographic view after root canal sealing.
dentin that surrounds the coronal edge of the separated instrument, before the use of ultrasonic insert1, 3, 8, 10. The success of the removal depends on several factors: the tooth position and the root canal with the instrument; the root canal shape, diameter and curvature; the thickness of the dentin wall; the type, length and location of the fragment within the canal; the status of the periapical and periodontal tissues. Favorable factors are straight canals, incisors and canines; localization before the curvature; length of fragment of more than 5 mm; localization in the coronal or mesial third of the root canal; reamer or lentulo spirals; and hand NiTi K-files3, 6, 8. The prognosis of a tooth with a separated file depends on the moment of separation, the status of the periapical and periodontal tissue and the prognosis of the treated teeth. The removal of a broken instrument from the root canal must be performed with a minimum of damage to the tooth and the surrounding tissues. The patient needs to be informed of the associated risks and the appropriate referral made. If the separated file is retained, a periodic radiographic and clinical follow up is necessary to prevent further complications1, 3, 6. Surgical management could be indicated in case of failure of conservative technique.
Figure 2, d: Removed endodontic needle tip. Quarter II
COM PRE SS E D A I R
|
SUC TI O N
I’ve never seen Philip like this before.
The VistaPano S Ceph is the efficient X-ray solution for jaw orthopaedics and more. It supplies fast Ceph shots (4.1 seconds) with outstanding image quality and low exposure to radiation. At the same time, thanks to S-Pan technology, its 2-D panorama shots provide excellent definition. More at www.duerrdental.com
|
IM AG I N G
|
D E NTA L C A RE
|
H YG I E N E
Endodontics
Conservative approach for management of separated endodontic instruments: case reports
Conclusion Various techniques of management of separated instruments are available. Conservative procedure should be the first attempt. As removal of a fractured file is associated with considerable risk, the selection of the technique should be discussed based on the case selection and the patient consent.
References 1. Vouzara T, El Chares M, Lyroudia K. Separated Instrument in Endodontics: Frequency, Treatment and Prognosis. Balk J Dent Med, 2018;123-132 2. Arunagiri D, Misra A, Singh A, Kapoor S. Retrieval of separated instruments: A case series Part II. Rama Uni J. Dent Sci, 2015; 2 (2): 31-34. 3. Lambrianidis T. Management of Fractured Endodontic Instruments. A Clinical Guide. Springer International Publishing AG, 2018. 4. Madarati AA, Hunter MJ, Dummer PM. Management of intracanal separated instruments. J Endod , 2013,;39(5):569-581. 5. Tzanetakis GN, Kontakiotis EG, Maurikou DV, Marzelou MP. Prevalence
and
management
of
instrument
fracture
in
the
postgraduate endodontic program at the Dental School of Athens: a five-year retrospective clinical study. J Endod, 2008; 34:675–687. 6. Nevares G, Cunha RS, Zuolo ML, Bueno CE. Success rates for removing or bypassing fractured instruments: A prospective clinical study. J Endod, 2012; 38: 442- 444. 7. McGuigan MB, Louca C, Duncan HF. Endodontic instrument fracture: causes and prevention. Br Dent J, 2013; 214(7):341-348. 8. Arya A, Arora A, Thapak G. Retrieval of separated instrument from the root canal using ultrasonics: Report of three cases. Endodontology 2019 ;31:1:121-124 9. Chhina H, Kumar Hans M, S. Ultrasonics: A Novel Approach for Retrieval of Separated Instruments. J Clin Diagn Res. 2015; 9(1): ZD18– ZD20. 10. Cohen JS. Rips, Strips and Broken Tips. Handling the Endodontic Mishap Part I: the separated instrument. Oral health. 2005; 10-17. 11. Agrawal V, Kapoor S, Patel M. Ultrasonic technique to retrieve a rotary nickeltitanium file broken beyond the apex and a stainless steel file from the root canal of a mandibular molar: a case report. J Dent (Tehran).2015 ; 12(7): 532–536
Full article with references available on www.dentalnews.com
22
Dental News
Digital Treatment Plan Esthetic Dentistry
Progressive Smile Makeover Protocol Introduction
Dr. Rami Chayah dental.spa@hotmail.com
Manal is 35 years old and Mom for three kids. She presented in our office looking for a consultation about her overall teeth health and about the possibility of esthetic smile enhancement. All new patients visiting our office go through the following protocol: 1- In office consultation with the patient on a “non dental” chair for the initial verbal exam (collecting dental and medical
history along with patient’s special esthetic requests) 2- In operatory clinical check up using mirror, probe, digital radiography and intraoral camera. 3- Documenting the teeth that need to be treated on a dental chart (patient’s file) 4- Taking digital photos to use later on the computer for smile analysis. 5- Taking impressions and bite registration before patient dismissal till the next appointment.
Examination and Diagnosis: Intra-oral general Clinical examination revealed several carious lesions and mild gingivitis on lower anterior teeth: • Teeth # 2, 5, 12, 13, 15 & 31 have class I carious lesions. • Tooth # 4 & 14 have Class II carious lesions • Tooth # 20 is root canal treated with a distal ridge cracked. 1
After checking all the teeth and documenting down all the ones that need treatment, we started to take the clinical digital photos. We took the following shots: 1- Full face 2- Smile view 3- Intra-oral upper and lower arches with cheeks retracted 4- Upper arch with black contrastor and cheeks retracted 5- Right and left side views with cheeks retracted (pic 1, 2, 3) After taking the required images, the patient was dismissed. Now the pictures are uploaded to the computer, and a new file on keynote software is opened to start the process of smile analysis. (pic 4)
24
Dental News
2
3
Quarter II
Your solution for navigating the rapidly changing world of digital dentistry
To learn more contact us: ghassan.nasser@henryschein.com Visit us on social media:
Esthetic Dentistry
Smile Analysis workflow The digital smile analysis procedure using keynote will improve the diagnostic evaluation and help the dentist /ceramist team to visualize the esthetic, functional and biologic issues of a given case. This smile analysis study result will guide the team to transfer the findings into an esthetic design of the restorations. Smile analysis protocol involves the assessment of the pink gingiva and white teeth asymmetry, shape and size. First step in the smile analysis procedure is determining the digital facebow. We noticed that there is shifting and canting in the dental midline along with discrepancy between the facial midline and the dental midline. The discrepancy measures 2.2 mm. Next step is the Pink assessment, which means determining the right and left symmetry of the anterior gingival margins (soft tissue around the teeth). Once pink assessment is performed, white analysis starts to determine the symmetry of the teeth, shape and size, between the right and left sides of the arch.
Digital Treatment Plan: Progressive Smile Makeover Protocol
Treatment Plan Based on the clinical and digital smile assessment, the treatment was divided into three stages: The operative stage (caries treatment), the surgical stage (crown lengthening) and the restorative stage (Veneers fabrication). a- Since the facial and dental midline discrepancy is 2.2 mm within the 4mm range, we are going to disregard it and keep the dental midline where it is however we will correct the canting by removing the extra incisal corner of tooth # 8 as long as this tooth is wider than its neighboring central. b- Transfer digital occlusal plane to the lab technician to correct and prevent canting. c- Since the central incisors should be identical, we will bring the two dominant centrals into symmetry to the ideal proportion of 80 %. d- Bring all the right side of upper arch (pink and white) into symmetry with the left side according to the digital smile design (perform crown lengthening and fabricate natural 10 upper veneers.
4
Pink and white esthetic evaluation
5
Pink Analysis: Soft tissue disharmony 1- The up down up rule for the gum around centrals laterals and canines is not respected on the left side of the upper arch. 2- The gum level around the right side teeth is not symmetric with the left side. (pic 5) White analysis: teeth proportion discrepancy 1- The two centrals #8 & #9 have different length to width ratios of 90 and 79 respectively. (pic 6) 2- Teeth on the right side are canted to the right and asymmetrical with the contralateral teeth.
6
Based on the smile analysis findings, new teeth outlines are drawn over existing teeth to correct the patient’s central incisors proportion and gum level. (pic 7) 7
26
Dental News
Quarter II
X-Ray Seris
RXS1000
XR-01
Build-In Type
LED Curing Light Series
PS-25B Q-6
Q-6B
Q6-NLG
Q-4
Q-4W 1000E
Piezo Scaler Series
P S - 30
PS-1
LED Curing Light Series
P S - 1 D ual
1800E
Tray-LED
LQ-BOX
Esthetic Dentistry
Treatment: I) Operative/preparatory stage includes: a- Oral hygiene including scaling and polishing. b- Composite restorations on all carious lesions and a crown on #20. c- In office and at home Full whitening protocol. Once the operative stage is finished, the esthetic phase starts. Based on the smile assessment evaluation, the conclusions and decisions made were communicated with the lab through the digital assessment file performed on keynote along with all the pictures and videos (video 1) to be used and translated into an analogue primary wax up.
8
9
28
Dental News
Digital Treatment Plan: Progressive Smile Makeover Protocol
Lab communication: The most critical step in the Smile makeover process is to find an expert and gifted lab technician who can translate the digital and clinical treatment plan into reality. One basic condition to achieve the desired outcome is a shared philosophy, and a common goal with the lab technician. This mandates that the technician can read the digital smile assessment performed and has the ability to demonstrate their talent into producing the outlined new design. Today, in the presence of Digital dental photography, communication and visualization of smile nuances and details is easy and affordable. For this purpose Mr Fouad Hourani, ceramist from Dubai was assigned on board for this case. As soon as we poured the impressions in the office for preliminary study models fabrication, we translated the digital smile assessment result to the study models using pencil. We marked the new gingival level at the gum area on the plaster model and wrote down the additive white material needed on each tooth. Then we sent them along with the keynote file including a detailed treatment plan with a voice over and all photos and videos to the ceramist in Dubai. Upon receipt; the ceramist prepared a preliminary wax up. He fabricated the wax up based on the Digital smile assessment done on the computer. He took the new teeth measurements and proportions and applied them with wax on top of the study model (pic 8). The guided diagnostic wax-up will be an invaluable reference for the upcoming surgical and restorative stages. Once we received the wax up back from the technician, the next important step is to evaluate the precision of the digital smile design by performing a clinical try -in. A silicon guide is produced over this wax–up to perform a direct mock–up in the patient’s mouth to confirm the esthetic and functional results. Static photos and dynamic video were documented to check the smile design dynamically and esthetically (pic 9, 10, 11). We reviewed the photos and videos with the patient on the computer screen. Then the patient was dismissed with the mock up in mouth for a week or two to better evaluate the esthetic outcome and to get feedback from people she trusts the most. Two weeks later, the patient approved the new smile design.
Quarter II
10
12
13
11
II) Surgical stage After the patient approved the mock up, we assigned the surgery appointment to perform the crown lengthening procedure according to the digital smile design performed on keynote and tried-in clinically through the mock up. First, we marked the new smile design results on the functional model of the initial teeth, and then we duplicated the model of the wax-up in plaster(pic 12). We compared the measurements of the two models and confirmed their similarity. A thermoplastic sheet of 0.5 mm thickness was pressed on the vacuum machine over the model to use as a
surgical guide. This is much more precise than the free hand technique. We performed gingivectomy guided by the surgical guide, and then a flap was raised to remodel the bone to maintain the 3 mm biologic width. Using resorbable vicryl 4.0 to prevent infection and expedite healing, we followed up with the progress for one month(pic 13). Then waited three months until the gum had fully healed and stabilized to avoid any after surgery gum recession. Once healing is assured, the patient came back to start the restorative stage. At this point, we asked the lab technician to fly from Dubai to Beirut to work on the case and deliver it in an expedited manner within three days upon patient request for traveling purposes.
Restorative stage:
Preparation Teeth preparation should be minimal to preserve healthy enamel structure. The amount of tooth reduction is determined by the final volume of tooth restoration determined by the additional wax up. The preparation through the mock up depends on using depth cutter burs. The average space needed ranges from 0.3 to 0.9 mm(pic 14, 15). There are different factors that determine the thickness of the final fabricated veneers. If we use the depth cutter burs directly on the tooth surface structure,
Esthetic Dentistry
Digital Treatment Plan: Progressive Smile Makeover Protocol
Fabricating the framework cores and finishing it:
14
15
16
it will remove the same amount regardless of the tooth position and regardless whether the tooth is lingual or buccally inclined. The cut through the approved mock up technique will remove only necessary extra structure needed to be removed to find space for the successive ceramic material needed for the final restorations.(pic 16) A one–stage PVS final impression was made. This along with the color guide images was taken for the lab technician to assist him in lithium disilicate ceramic restorations fabrication.
Lab stage: The lab technician poured the impressions and started working on the case.
The laboratory steps:
1- Checking the accuracy of the master model to avoid any imperfections or errors. 2- Fabricating & firing the framework cores and finishing it 3- Layering the veneering ceramic 4- Final checking
Checking the accuracy of the master model to avoid any imperfections or errors: As soon as the ceramist checked the accuracy of the master model, he started the reduction and completion of the individual dies to avoid any errors especially around the margins. Any error occurring at this step would definitely affect the accuracy of the final restorations.
30
Dental News
At this step, the silicon keys obtained from the diagnostic wax –up are important to achieve identical restorations in volumes and contours as the mock up and temporaries. To achieve lifelike restorations, it is very important to select the proper ingot and the deep dentin and enamel ceramics for layering. The selection of the ideal material (IPS e.max Press and IPS e.max Ceram) can help in achieving the brightness and opacity needed to achieve the best results. First step was the selection of the ingot shade. Based on the opacity of the underlying teeth, discoloration and preparation clearance MO 0 shade was selected for the base color. To reproduce the restorations down to the tiniest details, the ceramist used a combination of soft and hard waxes. This will give precision to the wax-up and prevent deformation in the thin marginal areas when sprueing and relocating the wax from the die to the investment ring and when pouring the investment material. Now the investment ring is prepared for preheating in the preheating furnace. Before the preheating cycle of the investment ring has been completed, the preparatory steps for pressing starts. Once the pressing step is done, the investment ring is cooled to room temperature before divesting. The restorations should be divested with glass beads gently to avoid any deformations to the thin margins. After that, fit check of the cores on model is necessary to review the accuracy.
Layering the veneering ceramic onto the framework cores: In the layering technique, the IPS e.max Ceram layering materials are fired onto the framework made of IPS e.max Press ingots. Before layering step, the restorations are cleaned with type 100 Al2O3 at 1-2 bar (15-30 psi) pressure, and then cleaned thoroughly with steam jet or under running water before the wash firing. The layering technique requires opacity and brightness control. For this purpose a shade map was prepared showing detailed information of the powder ceramics and impulse material used. Layering Map is archived for every case for documenting purposes and saved to each patient’s file. Building the enamel porcelain layer requires arranging opaque porcelain and internal stains, especially to the incisal area. Firing of each step of the layering technique is performed according the IPS e.max Ceram manufacturer’s instructions for use. Quarter II
Luster control after enamel porcelain build–up, texture and surface effects are manually performed to partially control the glossiness and luster. Staining and glazing are conducted at the end following the firing parameters recommended by the IPS e. max manual instructions.
Final in-lab checking: Final lab step is achieved with optical effect verification. Under various lighting conditions, the restorations optical effects and properties were observed to check their reflect of the natural reflection of the teeth to be mimicked.
19
Veneers adhesive bonding: At this step, the ceramic restorations received from the lab are prepared for adhesive bonding. Before final bonding, we performed a try–in for the restorations to check the accuracy of fit, shape and final achieved brightness. Photos & videos were taken to review on big screen with the patient for approval. Seating was completed with light curing bonding agent translucent shade. The ceramic restorations were conditioned according to the IPS e.max manual instructions. The veneers were bonded using the regular adhesive protocol after field isolation.(pic 17, 18, 19, 20)
20
Conclusion: Achieving natural esthetic veneers requires artistic skills with lots of attention. Knowledge, experience and skills along with communication between the dentist and ceramist can transform a well-executed digital treatment plan into reality. Choosing esthetic ceramic materials like IPS e. max from Ivoclar Vivadent is essential to build -up esthetic natural veneers restorations using the layering ceramic technique. This article presented showed a comprehensive case treatment. Staging the case was key to achieve the desired natural veneers restorations based on the clinical and digital smile analysis.
17
18
Ultradent Named a Fortune Magazine Best Workplaces in Manufacturing and Production By Daniel Lewis Fortune Magazine, September 10, 2021
Workplace environment and culture are so often touted in job postings, recruiter messages, and ‘about us’ pages—but they can often be shallow houses built of cards, ready to topple with the slightest breeze of inquisition into their deeper meaning. Recognized as one of Fortune Magazine’s Best Large Workplaces in Manufacturing and Production for 2021, Ultradent’s claims to a caring work environment and engaging culture have been carefully curated since the company was formed in 1978. “This recognition is joyous for the whole Ultradent community,” says Ultradent Founder and CEO Emeritus, Dr. Dan Fischer. “I’m so proud of our team members and the inspirational accomplishments they’re able to achieve together.” Walking through the sprawling halls of Ultradent’s Salt Lake City area headquarters, you will eventually come across a long, curved hallway adorned with dozens upon dozens of smiling photos of longtime employees. Some recognized for 10 years of dedication, others for 20. New employees may wonder what keeps all of them around so long—could it simply be a paycheck and a few perks that would spur the kind commitment showcased in this hallway? It won’t take them long to figure out what it is: abundant care for employees combined with widespread trust in our mission of improving oral health globally. Ultradent colleagues take interest in each other in ways that are unique from the common workplace, reflected in Fortune’s top-10 recognition as a premier manufacturer to work for. “Culture is rooted to the core of this company, that’s evident from the first day you start here,” says Ultradent President and CEO Dirk Jeffs. “Our core values are as prominent in our actions as they are in our words, and that’s not always common.” Those core values of care, integrity, quality, innovation, and hard work are found in numerous locations around Ultradent HQ and are used to guide Ultradent’s action plans and decision-making processes.
32
Dental News
“More than four decades ago when I first started Ultradent in our home, it was my family, my children helping me,” Fischer says. “As we grew, we brought in more family members, then friends. Eventually, we had to start hiring from outside our immediate circle, and we wanted to ensure the same family environment remained throughout our various expansions.” “By adhering to these core values, we’ve been able to create a consistent culture despite growing to more than 1,600 global employees with offices on 5 continents. It’s really remarkable, and it’s a credit to the amazing people we’ve been lucky enough to call colleagues over the past four-plus decades,” Fischer adds. Ultradent invests in a progressive Human Resources team whose purpose is to constantly find the ideal balance between human experience and profitable outcomes. «Not every company can find the balance for culture and profitability,” says Ultradent VP of Human Resources David Alsop. That is one of the unique and extraordinary elements of working for this company. We invest in the development of leaders and employees who partner to find maximum success here, as well as at home. We do everything we can to support the financial, physical, and mental wellness of our people. As an example, we’re now able to offer profit bonuses for team members worldwide as we achieve profit goals. The profit bonus is just one example of how we invest in our people as they invest in our shared company success. Our benefits and development programs go above and beyond to ensure the best quality of life for everyone here at Ultradent.» Recognition as a Fortune Magazine Best Workplace in Manufacturing and Technology doesn’t come easy—the culture and environment acknowledged by Fortune have been meticulously crafted over more than 40 years. Dr. Fischer often says “Companies are not made of concrete, glass, and steel, they’re made of people serving people.”
Quarter II
© 2022 Ultradent Products, Inc. All rights reserved.
NEW WHITE
NONSTAINING FORMULA—
SAME PROPERTIES AS ORIGINAL MTAFLOW REPAIR CEMENT
New MTAFlow ™ White repair cement has the same unique properties as the original MTAFlow repair cement: both are designed to mix and deliver easily with your desired consistency. Specifically designed for use above clinical margins. Ensure precise placement with Ultradent’s NaviTip™ 29 ga tip.
8 00. 552 .551 2 | U LT RAD E N T.COM
Digital Dentistry
Digital Dental Color, Practical Applications with State-of-the-art colorimeters Introduction
Jordi Manauta, DDS pmanauta@hotmail.com
Walter Devoto, DDS
Daniele Rondoni, MDT
Anna Salat, DDS
Zsolt M. Kovacs, PhD, ENG
Angelo Putignano, DDS, PhD
34
Dental News
In its vast complexity, color science embraces physics, mathematics, geometry, measurements, perception, chemistry, optics, art, and human psychology among many others. In a nutshell color is psychophysics. According to color science, misinterpreted concepts, and their wrong application, are often found in the dental literature. In fact, it is often harder to explain complex concepts relevant to the dental field using understandable words. In the following pages, we will try to translate some of these concepts in an amusing and, most of all, understandable language. Dental color requires extreme precision in their measurements, computing and execution, in other words, the final restoration has to be perfect to the eye of the clinician, technician and patient. This task can be done digitally or analogically. Eyeball-metrics is, for obvious reasons, the most commonly used among clinicians. Despite it being the most widespread method, the scientific community seems not to appreciate it, due to its lack of objectivity, as several factors can affect the way we perceive dental color. But it has the biggest advantages of all: It is the final judge regardless the color method selected or used. Determination of a dental shade is extremely important, regardless of the color matching method used. What
matters the most is, in fact, the appearance of the final restoration in place. Despite being present for more than 30 years, digital color methods only became popular from the moment their measurements got a real application in clinical or laboratory situations. Without a true benefit in the clinical outcome, dentists and technicians have always turned back to visual color methods.
Dental Shade guides Stock shade guides, for a very long time, have been the first resource for dental color determination, and for several reasons, there has always been an excuse to improve them or a hack to make them more reliable. Vita Classical has always been the detour destination whenever every other method didn’t work. Common home-made strategies have been proposed throughout the years in order to optimize the use of stock shade guides. Adding an increment of pink composite gives the shade guide a better context, makes human perception slightly better, making it look more like a real tooth coming out from the gum (Fig 1). Although this does not solve the core issue of stock shade guides, it slightly helps focusing the attention on the full tooth. Commercial pink
Quarter II
Fig 1.- Vita Classical shadeguide with a pink add-on to improve its contextuality and increasing its efficiency in color matching. One of the many hacks proposed during the years, it had limited success.
Fig 2.- Vita Classical shade guide, with the cervical and incisal portion trimmed. This was proposed to increase color matching precision. Other of the many hacks proposed, it not only had limited success, but it was the origin to other problems.
Fig 3.- 2 layers personalized shadeguide. These make composite layering more predictable, but still add limits and invisible problems.
Digital Dentistry
shade guide holders, from different brands have been proposed to this end, yet they are easily fabricated by any clinician with acrylic resin. Another DIY method aiming to optimize stock shade guides is trimming the cervical and incisal portion (Fig 2), to leave the area where the color is more even throughout the surface only. This eliminates all the distractions, as for many people, the translucent mass in the incisal and the opaquer cervical area are a disturbance rather than an aid. This area trimming makes the shade guide look more like a solid color. This of course comes with a price to pay, as the useful area of color reference, which is the center of the shade guide decreases importantly. A ready-made solution, the Vita COLOR-guide already exists, and it’s made without the incisal and the cervical area.
Digital dental color, practical applications with state-of-the-art colorimeters
handling before use. Making a perfect personalized shade guide (bubble free, good thickness, uncontaminated composite) requires skill and experience, regardless of the personalized shade guide system used. Many other rationales of why personalized shade guides fail, have not been discussed yet, as their lack of agreement in thickness, making them fail often. Important performance limits are present personalized shade guides, and we list them here in no particular order: -Out of context: personalized shade guides have no gum or neighbor teeth, changing importantly their optical appearance. -Different thicknesses to those of the real restorations: changing importantly the real and perceived color. -Fabrication difficulties: Despite the initial enthusiasm, users struggle to sit down and work to produce their own personalized shade guides. -High number of combinations: the required number of samples to have a functional sample set is very high.
Fig 4.- Custom scale vs ideal thickness in an intra-oral restoration. The thicknesses do not have an optimal match.
Personalized shade guides are easy to self-manufacture, with the same materials from the actual intra-oral restoration. They were proposed as the ultimate solution, at least at theoretical level they were, but soon big problems were found as not having a perfect color correspondence with the stock shadeguide or having several discrepancies with the final restorations (Fig 3). Thickness of the restoration was hardly replicable in the personalized shade guide and viceversa, and so, it was common to obtain bad color matching both in ceramic and composite restorations (Fig 4). Custom shade guides came as the perfect solution for color matching, at least on a theoretical level. Yet, this attractive solution did not come free of trouble. We will describe now the two main issues regarding this effective tool. The first problem we ran into was not related to the shade guide itself, but to the end-user. Despite many clinicians had been buying stamps for the fabrications of custom shade guides, most of them quickly ended up forgetting them in a drawer. This was mainly due to laziness, meaning self-fabricating several samples turned out to be time consuming for most users. So that is the first explanation to the success of standard shade guides, such as the Vita shade guide, which require little to no
36
Dental News
Visual color matching has always been linked to artistic skills, a deep knowledge of the materials and their specific instruments such as shade guides. Their limits have already been discussed. Nowadays it is easy to determine dental color in few seconds, with a very compact and portable device and in an incredible easy way, not depending on the clinician’s skills, but in a small learning curve of the device operator, which could be the dentist, the assistant or the technician. This simplifies everyone’s life in the team.
Moving to digital It is impossible to precisely transfer complete information about color using words. Even when considering a very specific shade, in each mind, that particular color will be interpreted differently. And when the aim is practical, as in the dental field, there is no way of instructing an operator about color composition by using only words.
The L*a*b* scales rise above language barriers enabling anyone to easily communicate color, and color differences. • L* scale: Light vs. dark, 100 is white and 0 is black. • a* scale: Red vs. green, where a positive number indicates red, and a negative number indicates green. Quarter II
• b* scale: Yellow vs. blue, where a positive number indicates yellow, and a negative number indicates blue
Location L *79 a* 8 b*21
The dental color space, when graphically located in the full L*a*b* color space looks like a small irregular bean. This sub-space is extremely important for our profession. It is mainly located in the yellow-red and bright area, and is basically very low on chromaticity, touching the neutral axis in almost all of its way. In other words, very light beige pastel colors. In a 2016 study by Rizzi et Al., the human dental color subspace was outlined. Starting from the most used reference scales available on the market the everyday working condition of dentists were recreated. The boundaries were enlarged in order to reasonably include all the possible dental colors. For digital colorimetry knowing precisely the contents and the boundaries of the dental color space, makes the
L *79
a* 8
b*21
Fig 6.- Graphic representation (highly inaccurate) for didactical purposes, of the color mixture of the L* a* b* “channels” to obtain a dental color. (i.e. A3)
design of the machinery, calculations, calibration and hardware more specific.
H
DE94 or ΔE94 formula for graphic arts, is a color difference formula, which thanks to the previous study was found out to be the most isotropic and uniform along all axes of this sub-space. This will be addressed later in the chapter and with more specific explanations.
C
b+ a-
Digital Ceramic Mixing and Digital a+
b-
R eferenc e
S am ple
L W hen reading L *a*b* it m eans that s am ple is L * 77.7 a* 4 .2 b* 22.5
Fig. 5: Telescopic bar with retentions for the secondary structure
L * 78 .7 a* 6 b* 24 .7
1% W hiter S lig htly reddis h S lig htly y ellow er
Digital Dentistry
Digital dental color, practical applications with state-of-the-art colorimeters
Location
Color matching by replicating the same scenario
Digital Ceramic Mixing and Layering Among the several applications there are the ceramic layering and mixing predictions, composite layering recipes calculations, bleaching tracking, material quality control, just to mention few.
When we have an accurate and reliable method for color matching, when measuring the same subject we should obtain the same numerical values. Our task consists in repeating the same scene in every measurement, or in other words, color should be measured the following way: -A device that has a minimal discrepancy with its own measures (intra device precision) -A device that has a minimal discrepancy with other devices of its kind (inter device precision) -Same background -Same centering and positioning -Clean teeth -No external light contamination -Hydrated teeth
In an era in which communication is crucial, this device exploits every single sharing capability of modern mobile devices. In a matter of seconds it is possible to measure a tooth and provide the person you are trying to communicate with a color measure. Everything is operated under the safety and stability of iOS (Apple) environment. To make the system more versatile, OptishadeStyelitaliano is compatible with an integral mixing and layering system of ceramics (Matisse, Netherlands, www.matisse.ai) in such a way that personalization and color matching of aesthetic restorations, and ceramic prosthetic work can reach perfection.
Scene reproduction, application
practical
When measurements are done to the exact same subject, the resulting values have to be under a 0,4 DE94 threshold. When measurements with higher values are obtained, it is necessary to analyze what could have gone wrong in the standardization, as the tooth background, device positioning, tooth cleaning or hydration level of teeth. In the following situations, the different parameters when the measurements were done are displayed. The ones marked with an asterisk are critical to the reliability of the measurement.
Dental colorimeter for Apple iPhone, iPad and iPod devices, works with an app. Reads color with high precision 0,2-0,4 DE94. Can be disinfected.
38
Dental News
Quarter II
Situation: Same tooth / Same surface (clean) / Same timeframe / Same positioning / Same device / Same background. Color Difference 0.12 Reliable measurement.
Situation: Same tooth / Same surface (clean) / Same timeframe / Same positioning / Same device / *Different background. Color Difference 1.89 NON-Reliable measurement.
Situation: Same tooth / Same surface (clean) / *Different timeframe / Same positioning / Same device / Same background. Color Difference 0.29 Reliable measurement.
Situation: Same tooth / Same surface (clean) / Same timeframe / Same positioning / Same device / *Different background. Color Difference 0.89 NON-Reliable measurement.
Situation: Same tooth / Same surface (clean) / *Different timeframe / Same positioning / *Different device / Same background. Color Difference 0.31 Reliable measurement.
Situation: Same tooth / *Different surface (not clean) / Same timeframe / Same positioning / Same device / *Different background. Color Difference 2.32 NON-Reliable measurement.
Digital Dentistry
Digital dental color, practical applications with state-of-the-art colorimeters
Ceramic layering predictions One of the hardest challenges in the dental color world, is the integration of the unitary anterior restoration. This has been demonstrated to be very reliable when done with precise mathematical computation, particularly with ceramic mixing and layering.
Integrated restoration: is the result of the restoration and the substrate together in the mouth context, this happens when the restoration is in place with the final cement or with a try-in agent.
For the best outcome of the mixing and layering ceramic software, it is mandatory the use of a high precision color matching device. Optishade has been demonstrated to be the best for this application.
2 perfect color measurements must be provided:
U nfavorable c olor
D es ired c olor
Desired color: Which is the target color, the final goal. It is calculated from the nearby healthy teeth or the nearby pleasant restorations. Substrate color: is the color of the preparation where we will cement the restoration, this has the ability to modify the final color of the restoration and must be considered for the final calculation. U nfavorable s ubs trate
D es ired c olor
S ubs trate
R aw res toration
D es ired c olor
R es toration integ rated to the s ubs trate
R aw res toration
D es ired c olor
With all this information, it is possible to calculate a restoration with several layers that together with the stump, will generate a final color. With this raw restoration, which might look very strange when out-of-context, it is possible to modify the unfavorable substrate to be very similar or equal to the desired color. The raw restoration is calculated mathematically in order to have the right layers and opacities to balance the chromatic change that will happen when the restoration and substrate will be integrated. Raw restoration: has different aspect from the desired color, it is out-of-context and thus, without the influence of the substrate. Frequently, their aspect outside the restoration site is not good.
40
Dental News
Integ rated res toration
D es ired c olor
The integrated restoration must give as a final result the desired color, or at least be very close to it. Restorations before integration and in-context try-in have a different appearance from the desired color. Quarter II
Single anterior crown, a clinical case Probably the application where digital color stands out and becomes most useful, is in the creation of unitary aesthetic crowns in the anterior region. In this clinical case, the crown over implant of 1.1 has a mechanical and esthetic failure.
Optishade device, the external camera that attaches to the Apple device and will provide accurate and precise color measures.
The ideal situation for this colorize complex cases is to make it in a single try, without the technician ever seeing the patient and of course avoiding any kind of repetition. We can pull out this strategy by providing the Optishade measurements of the desired color and the preparation color.
Desired color: In this case is found in the neighbor tooth. It is important to have the measurement done with the temporary restoration and the tooth perfectly hydrated.
Optionally, a measure of the upper lateral is taken. Teeth in the same arch might look similar or even identical, but generally they have different colors.
The color of the preparation has to be taken into consideration, with an individual measure that will be inserted into the calculations of the restoration.
Digital Dentistry
In the ceramic mixing software Matisse, the Optishade color measurements are loaded and this will be together with the type of restoration crucial for planning a perfect raw restoration.
42
Dental News
Digital dental color, practical applications with state-of-the-art colorimeters
Color selection of the different regions in Matisse app. In Red, the 3 different regions of the desired color (dentin color), in blue, the 3 different regions of the preparation color.
Quarter II
Ceramic mixing strategy for a perfect personalized recipe The amounts are displayed in portions. The numbers in blue are the portions for the mixing, x 1 stands for a unit and that unit is the minimal amount of ceramic to be mixed. Portions can be big or small, as long as all the portions are the same. It is suggested to use a quality ceramic portioner.
Final crown shows a very good integration. This was achieved in only one try.
Digital Dentistry
Digital dental color, practical applications with state-of-the-art colorimeters
Conclusion
References
1 - Digital color removes the subjectivity of the eye. As long as the measure is correctly taken, the colorimeter cannot be fooled as the human eye.
1-Manauta J, Salat A. Devoto W, Putignano A. Layers2, The Stryleitaliano clinical secrets. Quintessence Books, 2022. 2- Browning WD, Contreras-Bulnes R, Brackett MG, Brackett WW.
2 - Communicating with numbers is the most precise way to define a color.
Color differences: polymerized composite and corresponding
3 - With precise data, we can calculate ceramic mixing, layering and much more.
3- Paravina RD, Westland S, Imai FH, Kimura M, Powers JM.
Vitapan Classical shade tab. J Dent. 2009;37. 34-9.
Evaluation of blending effect of composites related to restoration size. Dent Mater. 2006 Apr;22(4):299-307. Miller L. Organizing
4 - New technologies, besides being precise and accurate, are now more user friendly, easy to share and save, are more universal and stay top of the line for many years.
color in dentistry. J Am Dent Assoc 1987;(spec issue):26E–40E. 4- Paravina RD, Pereira Sanchez NA, Tango RN, Harmonization of color measurements for dental application. Color Research and application Journal. Volume 45, Issue6, December 2020
References
Pages 1094-1100 5- A. Rizzi, C. Bonanomi, S. Brazzoli, A. Cerutti & Z. M. Kovacs-
1-Manauta J, Salat A. Devoto W, Putignano A. Layers2, The Stryleital-
Vajna, Assessing appearance in human dental colour space, 2016,
C
iano clinical secrets. Quintessence Books, 2022.
Computer Methods in Biomechanics and Biomedical Engineering:
M
2- Browning WD, Contreras-Bulnes R, Brackett MG, Brackett WW.
Imaging & Visualization, 6:1, 59-67.
Y
Color differences: polymerized composite and corresponding VitaCM
pan Classical shade tab. J Dent. 2009;37. 34-9.
6- R.D. Douglas, T.J. Steinhauer, A.G. Wee, Intraoral
3- Paravina RD, Westland S, Imai FH, Kimura M, Powers JM. Evalua-
Determination of the tolerance of dentists for perceptibility and
tion of blending effect of composites related to restoration size. Dent
acceptability of shade mismatch, Journal of Prosthetic Dentistry
Mater. 2006 Apr;22(4):299-307. Miller L. Organizing color in dentist-
2007 (97:200–8)
K
4- Paravina RD, Pereira Sanchez NA, Tango RN, Harmonization of
7- Paravina RD, Pérez MM, Ghinea R. Acceptability and
color measurements for dental application. Color Research and appli-
perceptibility thresholds in dentistry: A comprehensive review
cation Journal. Volume 45, Issue6, December 2020 Pages 1094-1100
of clinical and research applications. J Esthet Restor Dent. 2019
5- A. Rizzi, C. Bonanomi, S. Brazzoli, A. Cerutti & Z. M. Kovacs-Vajna,
Mar;31(2):103-112.
Assessing appearance in human dental colour space, 2016, Computer Methods in Biomechanics and Biomedical Engineering: Imaging &
8- A.G. Wee, D.T. Lindsey, K.M. Shroyer, W.M. Johnston, Use of a
Visualization, 6:1, 59-67.
porcelain color discrimination test to evaluate color difference
6- R.D. Douglas, T.J. Steinhauer, A.G. Wee, Intraoral Determination of
formulas, Journal of Prosthetic Dentistry 2007 (98:101–9)
the tolerance of dentists for perceptibility and acceptability of shade mismatch, Journal of Prosthetic Dentistry 2007 (97:200–8)
9- Paravina RD, Ghinea R, Herrera LJ, Bona AD, Igiel C, Linninger
7- Paravina RD, Pérez MM, Ghinea R. Acceptability and perceptibil-
M, Sakai M, Takahashi H, Tashkandi E, Perez Mdel M. Color
ity thresholds in dentistry: A comprehensive review of clinical and
difference thresholds in dentistry. J Esthet Restor Dent. 2015 Mar-
research applications. J Esthet Restor Dent. 2019 Mar;31(2):103-112. • Excellent working time and the setting time is individually 8- A.G. Wee, D.T. Lindsey, K.M. Shroyer, W.M. Johnston, Use of a poradjustable by light-curing • Immediately after placementtest in thetocavity celainpackable color discrimination evaluate color difference formulas, • No varnish required- fill, polymerise and finish Journal of Prosthetic Dentistry 2007 (98:101–9) • No need to condition the dental hard tissue • Does not to the RD, instrument and easy to LJ, model 9- stick Paravina Ghinea R, is Herrera Bona AD, Igiel C, Linninger M, • Suitable for large cavities Sakai M, Takahashi H, Tashkandi E, Perez Mdel M. Color difference Are you interested in our entire product range and thresholds in dentistry. J Esthet Restor Dent. 2015 Mar-Apr;27 Suppl detailed product information? Visit our website or contact us directly!
1:S1-9.
Apr;27 Suppl 1:S1-9. 10- Malacara D. Color Vision and colorimetry, Second edition. Spie Press. 2011. 16-8, 75-6, 91-97. 11- Berns R. Billmeyer and Saltzman’s Principles of color technology, fourth edition. Wiley. 2019. 42-5, 51, 74-5, 92-105, 111-144, 212-4.
Dental Material PROMEDICA 10- Malacara D.GmbH Color Vision and colorimetry, Second edition. Spie Phone: +49 43 21 / 5 41 73 - Fax: +49 43 21 / 5 19 08 - Email: info@promedica.de - Internet: www.promedica.de
Press. 2011. 16-8, 75-6, 91-97. 11- Berns R. Billmeyer and Saltzman’s Principles of color technology, fourth edition. Wiley. 2019. 42-5, 51, 74-5, 92-105, 111-144, 212-4.
44
Dental News
CY
CMY
ry. J Am Dent Assoc 1987;(spec issue):26E–40E.
Light-curing Glass Ionomer Filling Material
MY
Quarter II
Product News
VOCO Dental Germany www.voco.dental/en/home.aspx
VOCO Retraction Paste a must-have for every practice The basis for a perfect impression is an exposed and dry sulcus. With VOCO Retraction Paste, which is applied directly from the cap into the sulcus, VOCO is introducing a product for the effective, temporary opening of the sulcus and its isolation from moisture. This product is also the ideal complement to the V-Posil precision impression material. VOCO Retraction Paste offers the prerequisites for successful classic or digital precision impressions, as well as for cavity preparation of class II or V restorations, but also as preparation for either permanent or temporary cementing of restorations. The retraction paste impresses users not just through its results, but also through its handling: For example, the shade contrasts well against the gingiva, facilitating in particular the work in hard-to-see areas. Thanks to the very slender and slightly flexible cannula, the material can be easily dosed and applied, whereby the paste is easy to press out and subsequently scores points with very good flow viscosity, coupled with uniform stability for opening of the sulcus. During application, the aluminium chloride paste with astringent effect temporarily fills the sulcus, stops any bleeding and eliminates moisture. Patients themselves also benefit from numerous advantages: For example, VOCO Retraction Paste only requires a short exposure time, it has a neutral taste and can be easily and fully rinsed off.
46
Dental News
The paste can be used as an alternative to, or in combination with a retraction thread, for example. It can be used in the classic way or digitally, with an intraoral scanner. Soft tissue management is often the key to success for the resulting class II and V fillings as well as for permanent or temporary cementation of restorations, especially when using the adhesive technique with not very moisture-tolerant products. Hygienic SingleDose VOCO Retraction Paste can be applied directly into the sulcus easily and hygienically from the SingleDose Cap, developed inhouse by VOCO. The SingleDose Cap is compatible with commercially available composite dispensers such as the VOCO Caps Dispenser, and is sufficient for up to 3 sulci. Advantages of the SingleDose: each patient receives their very own product, an easy way to avoid the risk of crosscontamination as well as other potential for contamination.
Quarter II
www.fkg.ch
SOURIEZ, ON VA SE RETROUVER Novembre 23 - 27, 2022 Porte Maillot, Paris - France
350
exposants internationaux
View More Pictures On facebook.com/dentalnews1
100 450 séances de formation
conférenciers
ADF AFF_A4_Congres 2021.indd 1
10/06/2021 15:13
PROFESSOR TAREk ABBAS, DEAN OF THE BRITISH UNIvERSITY AND HIS COLLEAGUES WITH MR. HEIkkI kYOSTILA AND HIS TEAM AT THE PLANMECA BOOTH IN PARIS
Considered as a benchmark event for dentistry, the Congrès de l›ADF, the Annual Dental Meeting of the French Dental Association, took place at the Palais des Congrès de Paris from 23 - 27 November 2022. The ADF ranks as the premier European Continuing Professional Education event. One of its great strengths is to combine in one single venue a Scientific Programme that includes close to one hundred sessions with speakers from all over the world, and an International Exhibition where exhibitors welcome visitors over 22 000 m (four levels) of exhibition. Dr. Michel Salameh, ex-président de la Société Libanaise de Dentisterie Pédiatrique, invité à l’ADF par la Société Française d’Odontologie Pédiatrique comme enseignant à la Faculté de Médecine Dentaire de l’Université de Saint Joseph de Beyrouth.
PR. IMAD ABOUT LECTURING ABOUT THE BIODENTINE TO
DRAW WINNERS OF THE SFOP PRESIDENT DURING THE ADF
PRESERvE PULPAL vITALITY
48
Dental News
Quarter II
New Cartridge and Mixing Tip System: Applying Innovation
www.dentsplysirona.com
Impression Material Efficiently and Easily Dentsply Sirona now makes the application of conventional impression material even easier and, above all, more efficient: The mixing tip and cartridge system has been optimized. The mixing cube technology results in improved mix quality of the material. In addition, material waste is reduced. In this way, one cartridge can be used for more applications. The new application system is available from now on and will gradually replace the existing system. Three essential factors impact conventional impressions: the quality of the impression material, the processing time, and the simplicity and efficiency of the application. The new cartridge and mixing tip system available from Dentsply Sirona seeks to improve these application features for brands like Aquasil Ultra+. The decisive factor is the newly developed design of the mixing tip. It can be easily fixed to the cartridge thanks to a turning wing and small alignment pin. A corresponding connection mechanism reduces the risk of cross-contamination between the base and catalyst components. The new integrated 50mL cartridge and mixing tip system requires only a onetime bleed before first use, for life of the cartridge. In combination with the reduced-volume cannula, material waste can be reduced by up to 64 percent and the number of uses per cartridge increased by ten additional applications. This optimization enables consistent homogeneous mixing and efficient use of the impression material. The color-coded cartridges and mixing tips help to connect the cartridges with the appropriate tip. The new system is compatible with the standard hand dispensers and mechanical mixers already available on the market Significant increase in efficiency of the application In daily practice, the new application system brings two main benefits: easy handling and greater efficiency. «Thanks to the optimizations made to cartridges and tips, we are experiencing yet another improvement to what is already very good in itself,» explains Dr. Lori Trost, a dentist from Red Bud, IL (USA). «It changes very essential details of the mechanics of the tip that make the cartridge easier to handle and ensure that the impression material is used really efficiently. And: a well-mixed material becomes a predictable mix.» With the new mixing tips, the special product properties of Aquasil Ultra+ are even more apparent. The impression material is placed in the tray in an optimum mixing ratio and thus contributes to an accurate impression result even in critical clinical situations. The new cartridge and mixing tip system achieves ease of use and efficient application of the material. Less material waste means conserving resources and actually saving money. As a leader of digital and analog impression taking techniques, Dentsply Sirona has two successful options that just got better: Aquasil Ultra+ for conventional impressions and Primescan for digital impressions.
WITH MR. ALExANDRE MULHAUSER AT THE ITENA BOOTH WITH MR. DENIS CUENDET AT THE BIEN AIR BOOTH
MR. MANUEL OERTEL, MR. NICOLAS BRILLAUD AND DR. TONY DIB AT THE kOMET BOOTH MR. ZAHI JANHO, MRS. JUTTA ANTRETTER, AT THE DENTSPLYSIRONA BOOTH
LEFT TO RIGHT: MICHEL SALAMEH, GHADA BASSIL, TONY DIB
ENG. GEORGIO HADDAD, DR. TONY DIB, PR. JAAFAR MOUHYI
LEFT TO RIGHT: TONY DIB, GHADA BASSIL, JOSIANE DIB, kARL DIB, WALID NEHME
50
Dental News
Quarter II
DRS: TONY DIB, AHMED ELkHATIB, ELIAS kHOURY
Interview Gianfranco Berrutti Chairperson of UNIDI, the Italian Dental Industry Association
Interview with Gianfranco Berrutti During AEEDC 2022 How come the Italian dental industry is so varied in many different areas? Because Italy since more than 40, maybe 50 years ago started in the dental business sector, together with some other countries like Germany, or the United States and still until today, it is one of the biggest industrial manufacturers for medical and dental devices and material. So of course, during the years, many companies specialized in manufacturing and production of so many different devices, equipment and products for dental sector. As a consequence, today, you can find manufacturers in Italy, of almost any type of products used in the area of dentistry or in the dental sector, and this is the reason. Is the Italian dental industry following the trends in the digital area? Well, yes, absolutely. We can say the digital dentistry revolution started. And so, many companies were forced to get into this new technology, because in some sectors of dentistry, since some years back technology has shifted already. So, if you are not well into this kind of digital technology, you will not to be able to sell your products anymore worldwide, because now the demand is changing and it will change even more in the following years. Most of the Italian companies are investing in research and development to offer new products and to stay updated with the latest technologies and development.
Did the pandemic push the dental industry further into digital? Let’s say that well before the pandemic, most of the companies have already made great effort of digital products and digital technology. So, we see something which is a trend that was well established already before the pandemic. And during the pandemic, of course, they even invested more in this kind of technology. Are you seeing now the end of the impact of the pandemic on the dental industry? In the first months of the pandemic, both in Italy and maybe in the other markets worldwide, there has been a strong slowdown of every activity even in dentistry and we witnessed in the following months an important regression in sales for our companies. But now, since already I would say almost one year the situation has returned back to normal. And so, for example, in 2021 basically, all of our company’s business was back to the level of 2019 and even better. So, we can say that under the point of view of activities we are back to normal. What is not the normal yet maybe, is the possibility to travel to some countries which are still closed or difficult to reach. But in terms of sales and business cooperation with most of the countries the business is back to normal for almost one year.
Egyptian Orthodontic Society
January 20-21, 2022 Marriott Hotel, Cairo - Egypt
View More Pictures On facebook.com/dentalnews1
GROUP PHOTO OF ATTENDEES ON THE LAST DAY
Dear Colleagues from the Egyptian Orthodontic Society, it gives me a great pleasure to announce the start of another successful meeting, the 34 th Annual Congress of the Egyptian Orthodontic Society. Here I would like to thank our invited speakers who took the decision to contribute to our congress despite the pandemic uncertain situation all over the word. It is with sadness that we will start this year’s congress without one of our eminent and active member; Professor Amr Aboul Ezz whom we lost a few months ago, he was a dedicated board member a previous dean of Faculty of Dentistry in Cairo University, and a man who made a difference in the dental community and the country at large. The Society elected to honor his name with the most prestigious recognition “The EOS service Award”. I would like to also announce that the Board of the Society have unanimously decided to present Dr. Nikhilesh Vaid, WFO president, with an “Honorary Life Membership” in the Society for his services and dedication to the specialty and the EOS. Prof. Abbas Zaher
PROF. ABBAS ZAHER, PRESIDENT OF THE EGYPTIAN ORTHODONTIC SOCIETY IN THE OPENING CEREMONY
52
Dental News
DR. ABBAS ZAHER, AWARDING DR. NIkHILESH vAID, PRESIDENT OF THE WFO AN “HONORARY LIFE MEMBERSHIP” IN THE EGYPTIAN ORTHODONTIC SOCIETY Quarter II
DR. NIkHILESH vAID, PRESIDENT OF THE WORLD FEDERATION OF ORTHODONTISTS GIvING HIS LECTURE
PROF. kHALED ABOLAZM PRESENTING PROF HANAN ISMAIL, WITH RECOGNITION AFTER HER LECTURE
vIEW FROM THE LECTURE HALL
DRS. ABBAS ZAHER, NASIB BALUT, WEAL MASSOUD, NIkHILESH vAID AND kHALED ABOLAZM
PARTICIPANTS AND SPEAkERS DURING THE WELCOME RECEPTION
Makkah International Dental Conference is back for the 17th edition in collaboration with Umm Al-Qura University in collaboration with
Umm Al-Qura University
20-22 October 2022
• Meet our featured speakers from all around the world
• Earn CME Hours Credited by the Saudi Commission for Health Specialties • Attend a wide range of hands-on workshops
REGISTER NOW
and avail the Early Bird rate
Organized By
Strategic Partner
Partners
Main Sponsor
Media Partner
February 1 - 3, 2022 Dubai, United Arab Emirates
View More Pictures On facebook.com/dentalnews1
OPENING CEREMONY OF THE 26TH AEEDC 2022, THE INTERNATIONAL DENTAL CONFERENCE AND ARAB DENTAL ExHIBITION The 26th annual edition of the AEEDC Dubai took place on February 1-3 2022. Following is the message from the Honorary Chairman – AEEDC Dubai Dr Tariq Khoory We are thoroughly excited to gather again this year more than usual, for we are currently enwrapped in the midst of EXPO 2020, which has opened up an ample number of opportunities in business and education for specialists. AEEDC Dubai (the International Dental Conference and Arab Dental Exhibition) continues to record remarkable growth regarding the amount of dental experts gathering from around the world to share their expertise with one another, which is essential for everyone to maximize their knowledge and business growth potentials. It is even more of a privilege that this year’s exhibition falls within the tenure of Dubai EXPO 2020, which will lead to an even wider exposure and unique insights to gain from. That is why we urge you to take benefit from AEEDC Dubai and EXPO 2020 simultaneously in order to take full advantage of your stay in Dubai. We are delighted for everyone joining us so we may mutually share our love for dental medicine with one another, as well as to further build and develop our unique alliances. Additionally, we are grateful for the continuous support of our cherished partners, exhibitors, lecturers, and the global dentist community as a whole for their continued contributions. As always we wish you a pleasant stay with positive results, and we look forward to fruitful experience together.
Dr. Tariq Khoory DR. ABDUL SALAM ALMADANI DISTRIBUTING TROPHIES TO:
PROF. IHSANE BEN YAHYA, PRESIDENT WORLD DENTAL FEDERATION
56
Dental News
DR. NAHAWAND THABET, FDI COUNCIL MEMBER
PROF. RONALD YOUNES, PRESIDENT LEBANESE DENTAL ASSOCIATION AND DR ANTOINE CHOUFANI
DR. BASSEM MAATAR, PRESIDENT OF THE TUNISIAN DENTAL ASSOCIATION Quarter II
DRS: SAMEER ALTHUMAIRY, ZIAD ALLAHEM-PRESIDENT SAUDI DENTAL SOCIETY, MOHAMED ALOBEIDA, ABDULLAH kREIDIS, ABDULSALAM AL MADANI.
DRS: MANSOUR ASSERY, PRESIDENT SAUDI PROSTHODONTIC. SOCIETY, TAREk kHOURY, ABDULSALAM ALMADANI, ABDULLAH SHAMMERY
DRS. : ABIR DAOUD, BASSEM MAATAR, NAHAWAND THABET, IHSANE BEN YEHYA, ABDULSALAM ALMADANI, TAREk kHOURY, MOHAMED ABEDIN, MESHARI ALOTEIBI
RIYADH ELM UNIvERSITY PRESIDENT, PROF ABDULLAH AL SHAMMERY, WITH HIS TEAM AT THE UNIvERSITY.
LEFT TO RIGHT: DRS; MOHAMAD RABIAA, ABEER BOUkHARY, FAWAZ AL QAHATANI, MANSOUR ASERY, SARY BARZANJY, kHALID AL ZAHRANI, DR kELvIN
DR. FILIPPO CARDINALI LECTURING ABOUT BIOCERAMIC SEALERS IN ENDODONTICS
DR. MAHMOUD EZZATT GHAZI ExPLAINING HOW TO MAkE DIGITAL OCCLUSION EASY
DR. DINA DEBAYBO ExPOSING SUCCESSES AND FAILURES IN PEDIATRIC DENTISTRY DR. MARC HABIB ExPLAINING HOW TO MANAGE DIFFICULT ENDO CASES
DR. FAWAZ AL QAHTANI LECTURE ABOUT THE SINGLE-TOOTH IMPLANT TREATMENT
Lectures
DR. MARTIN kOCH LECTURING ON HOW TO kEEP YOUR DENTAL CLINIC FREE OF AEROSOLS
DR. MAJD NAJI LECTURING ON MINIMAL PREP. vENEERS
58
Dental News
Quarter II
DR, NAWAF J. AL-DOUSARI SHOWING CERAMIC RESTORATIONS IN THE ESTHETIC ZONE
Dubai, U.A.E. February 1 - 3
AEEDC 2022
DR. RICCARDO TONINI NAvIGATING SPEED FORMULA OF ROTARY FILES FOR DIFFERENT ROOT CANAL ANATOMIES DR. MOHAMMAD RAYYAN LECTURE: NEW CERAMIC MATERIALS ARE THE GAME CHANGERS?
DR. JOHN J. YOUNG ExPOSING DENTAL DILEMMAS AND CHAIRSIDE ETHICS
PROF. LORENZO BRESCHI LECTURE ABOUT BONDING AND LUTING PROTOCOLS FOR ESTHETIC DENTISTRY
DR. MARCO vENEZIANI, DR. vINCENZO MUSELLA, PROF. DR. IGNAZIO LOI, PROF. LORENZO BRESCHI
DR. MAHA DAOU ExPLAINING THE CLINICAL IMPLICATIONS OF COMPOSITE RESTORATIvE MATERIALS
C BOOTH TURAPROx O DR. kHALIL ALISSA FROM SAUDI ARABIA
LEFT TODRIGHT : DJUNEJA R. MOHAMED ALAAA , DEMO AT AEEDC 2022 R AJAY PERFORMING DR. IBRAHIM MILHEM FROM PALESTINE, DR. EHAB HEIkAL
3S HAPE BOOTH T O DR. AZEM QADDOMI FROM JORDAN HT ENRY SCHEIN BOOTH O DR. ROLA DIB kHALAF FROM LEBANON
Exhibition
NOOBEL BOOTH T DR.BkIOCARE AMAL B ENMANSOUR FROM MOROCCO TO DR.ITENA ADNAN BOOTH MARWAN FROM LIBYA
TIRO O DT R.RADING MOHAMED EID ELkHALIL FROM LEBANON P BOOTH
60
Dental News
Quarter II
TO DR. HASAN ELNATOUR FROM PALESTINE PERIOPTIx BOOTH
Dubai, U.A.E. February 1 - 3
WTHITE - FLäSH O DSRMILE . NAWAL RABIBOOTH FROM MOROCCO
AEEDC 2022
BOOTHALASkARY PROFI.NTENSIv ABDULSALAM
(L TO R) PROF. MOHAMMED MURSHED ALHARBI (SAUDI ARABIA), PROF. kLEBER MEIRELES (BRAZIL), PROF. MONA SAYEGH ULTRADENT GHOSSOUB (LEBANON), PROF. AkRAM ALHUWAIZI (IRAQ), PROF. HANAN ISMAEL (EGYPT), PROF. PETER BUSCHANG (USA)BOOTH AND DR. ABDALHADI kAWAIAH
BELMONT BOOTH
SCHEU BOOTH
HARvARD BOOTH
DR. ANDRE NASSIF, MR. LAZAR PIRO, DR. PIERRE FARHAT AT THE WATERPIk BOOTH
LEFT TO RIGHT: DRS; TONY DIB, kHALIL ALEISA, MESHARY ALOTAIBY, MOHAMAD OBEIDA, ABDULGHANI MIRA, JOHN YOUNG, kHALED ELBADR
LEFT TO RIGHT: DRS; TONY DIB, RONALD YOUNES, PETER TAWIL, GEORGE TAWIL, ANTOINE CHOUFANI
PROF. HANI OUNSI, DR. PIERRE FARHAT, DR. ANDRE NASSIF, DR. TONY DIB
Booth
DR RHEA SOUAID, MRS JOSIANE YOUNES DIB
62
Dental News
Quarter II
FkG BOOTH
Dubai, U.A.E. February 1 - 3
DMP BOOTH
AEEDC 2022
A-DEC BOOTH
vOCO BOOTH
DR SMILE BOOTH
NSk BOOTH
Interview Nick Olive Territory Manager A-dec
5 Questions to ask before buying new core equipment Whether you practice paediatric dentistry or implantology, you will be reliant on your dental equipment to enable you to carry out your work safely and efficiently. Here are my top five things to consider before buying new core equipment, to ensure that you can future-proof your clinic and meet your overall value goals.
1.
What if it fails?
When equipment in your practice fails, it can turn an otherwise normal day into a nightmare, especially if that equipment is something as vital as your dental chair. In a worst-case scenario, this could force you to cancel appointments, potentially lose those patients for good, and see you facing urgent repair costs.
2.
What will it really cost me?
TCO takes into account foreseeable maintenance and running costs of the product throughout its expected lifespan, as well as the initial purchase price.
What is the anticipated life expectancy of your chair? Brands can vary widely in their anticipated service life, with some able to offer up to 20 years service when If you are looking to buy any dental maintained properly. Ensure you ask about In a world of complex technology and noise, we bring you sure intelligent simplicity equipment this year, make you ask anticipated lifespan when discussing your yourself “what access, if it fails?”. purchase with your distributor. a general and infallible peace of mind. With optimal flexible integration Envision more forAs your practice It is so easy to assume that your new rule, the shorter the life expectancy of your @ a-dec.com/500EXPERIENCE and intelligent control, it’s everything you expect. Redefined. product will work perfectly for years to chair the sooner you are likely to start come; because it’s new and why shouldn’t incurring maintenance costs. © 2021 A-dec Inc. All rights reserved. it? Always check the length of warranty you However, every piece of dental equipment will receive. This too can vary between will fail eventually, with some brands brands from only 2 years, up to 5 years with encountering issues sooner rather than a brand like A-dec. later. The trick to truly saving money when buying new equipment for your practice Consider the cost of serviceable items and safeguarding against temperamental such as suction hoses, handpiece tubing technology is to think past which is simply and filters which you will need to replace the cheapest option or the ‘best deal’ but periodically. The cost of these items can find out which product has the lowest Total vary between the brands. Often you might Cost of Ownership (TCO). find that equipment which costs less up front, will have higher costs associated to ongoing maintenance.
EXPERIENCE THE NEXT LEVEL A-DEC 500.
64
Dental News
Quarter II
Interview
5 Question to ask before buying new core equipment
Combine all foreseeable costs and divide the figure by the number of years that the product is expected to last. This will give you an average price per year for the cost and maintenance of that particular product, which works as a much more reliable comparison to similar products on the market than purchase price alone.
3.
Is it future-proof?
Expanding your patient offering is a great way of boosting income and attracting new patients, so when it comes to choosing new equipment, make sure you consider which services and treatments you may want to offer in the future. Make sure that the product you choose will enable you to integrate all of the technology you need now and in the future. Beware of equipment which limits you to integrated digital solutions of one type. You will likely replace any high-tech digital equipment more regularly that your core equipment such as a dental chair. Also consider who will use your new equipment during its life. Might you need to accommodate left- and righthanded colleagues in the coming years? In which case an ambidextrous unit is a must! You will always need strong, reliable core equipment to operate successfully. Will your new equipment allow you to develop and change your digital equipment over the coming years?
4.
How will it impact my health?
Another important consideration when choosing new equipment is your own health. Keeping up with new technologies and always offering the latest treatments can give you a competitive advantage against other practices in the area but having the latest scanner won’t help you if aren’t well enough to work. Musculoskeletal disorders and the chronic pain associated with them is a common side-effect of practicing dentistry. To prevent back, neck and shoulder injuries and musclestrain from turning into a potentially career-ending problem, invest in supportive and ergonomic equipment that helps you maintain a good working posture. While the dental chair is normally associated with patient comfort, the shape and depth of the back of the dental chair can impact the way in which you work, and your own comfort too. The ability to position yourself with your knees tucked under the dental chair is important to gain closer positioning to the patient. Thicker-backed chairs push you farther away from the oral cavity and
thus require more forward lean or tilt to gain a good view of the oral cavity – resulting in more muscular exertion.
5.
What will my patients think?
Your patients are the ones who ultimately pay the bills and keep you in business. Try to imagine any new addition to your practice from the patient’s perspective. How will it enhance their experience? Is your patient chair comfortable enough to put nervous patients at ease? Is there a smooth transition from entry to exit? Can you mount the delivery system away from the chair or from underneath the chair to give a more open and welcoming feel? A-dec strives to create reliable and long-lasting dental chairs, through rigorous testing practices that every one of their product models goes through. Each variation of light, delivery system and dental chair is tested to failure, analysed and adjusted to ensure excellent durability and longevity. A great example of this is testing the strength of the new A-dec 500 dental chair. In testing, the chair was subjected to four times its guaranteed weight limit 227 kg (35.7 stone). A combined load of 907 kg (142.8 stone) was spread across the upper and lower sections of the chair. Engineers then analysed stress points and functionality. A-dec goes to extremes because your investment should never let you down.
Interview Dr. Charles Goodis EdgeEndo Solutions
Interview with Dr. Charles Goodis - EdgeEndo Solutions Henry Schein has been offering the endodontic solutions portfolio of EdgeEndo®, one of the world’s largest NiTi rotary file suppliers, successfully for two years and has just enlarged this range by EdgeFile® X7, the number one selling EdgeEndo® NiTi system in the United States. EdgeEndo® is conducting business in 35 countries around the world. The company’s mission is to deliver high quality dental products and solutions at affordable prices which in turn benefits practitioners and patients everywhere. US based Endodontist, Dr. Charles J. Goodis, Founder of EdgeEndo®, received his DDS from the University of Michigan, his GPR residency at the University of Minnesota, and his Endodontic residency at the University of Connecticut. Dr. Goodis has dedicated his career to constantly improving the root canal procedure. His findings led him to create more effective root canal instruments and procedures. He’s been working as an endodontist in Albuquerque, New Mexico, USA for 25 years.
1. Mr. Goodis, please tell us something about the company and the main products. My background in mechanical engineering and training in endodontics, as well as trying to help the patient and dentist do the best they can, inspired me to found EdgeEndo. Edge has been in the US market since 2012. In this short time, we have become one of the largest endo companies in the world. We now offer our products in 35 different countries. Our main products are NiTi files that are heat-treated through our proprietary FireWire process. Our best-selling system is the EdgeFile X7. It’s one of the leading files used by endodontist in the US, Canada, New Zealand, Australia and many countries in the Middle East. EdgeTaper Platinum and EdgeOne Fire have also been very successful systems in these markets.
66
Dental News
EdgeEndo has been well received in the industry. In addition to files, we also sell a full assortment of accessory products including gutta percha and paper points.
2. What are the benefits of the EdgeEndo files and which endodontist will benefit mostly from these files? The patient of course wants a quick root canal procedure because any time you can reduce chair time, they appreciate. And the patient wants a precise root canal cleanup to get rid of the pain but preserve the tooth. Both is supported by the flexibility paired with the stability, our files provide and thus allow endodontists to perform an accurate and fast procedure. In addition, the reasonably-priced files make the treatment also more efficient in respect of costs. Quarter II
PERFORMANCE.PRICE.TECHNOLOGY • Alternative to ProTaper® Universal and ProTaper Gold® • Proprietary heat-treatment process - FireWire™ NiTi Alloy improves strength • Convex Triangular (bloated triangular) cross section tip - Maximizes file cutting efficiency • 2X more resistance to cyclic fatigue compared to ProTaper Gold®*, 6X more resistant than ProTaper®* • No bounce back to preserve canal anatomy • Excellent flexibility, capable of 90° curves • SX, S1, S2, F1, F2, F3, F4, F5 • Available lengths: 21, 25 & 31 mm
Highly flexible
No bounce back
High strength
Scan the QR code to read Influence of Different Heat Treatments on Torsional and Cyclic Fatigue Resistance of Nickel–Titanium Rotary Files: A Comparative Study by Professor Gianluca Gambarini, DDS
Edgeendo.com Made in the USA *Based on resistance cyclic testing as shown on the FireWire™ NiTi Strength Graph: http://edgeendo.com/comparative-study-of-cyclic-fatigue-resistance/. ProTaper®Gold and ProTaper® Universal registered trademarks of Dentsply Tulsa Dental Specialties.
Interview
3. How do you achieve the balance between offering high-quality endodontic products at low price? Quality and value are paramount in importance at EdgeEndo. We have a very detailed quality system that allows us to produce a consistent, high quality product. Unfortunately, being an endodontist treating patients, I saw how high costs are and I thought to myself we can still offer a great product at a good price which provides value for the money. I think reasonable prices are important to a dental practice because as the dental fee structure changes in the US some dentists are making less money than they did before, and I believe offering a high-quality instrument at a lower price really helps dentists succeed.
4. Which is the most important instrument for root-canal preparation? How many files does one require as a rule? My personal preference is EdgeFile X7, it is super flexible, efficient and unbelievably strong. Each system varies somewhat. As a rule, most root canals can be completed with between 1 and 3 files. We’ve simplified the technique for systems to help the dentist and eliminate waste. As an endodontist, I never used all of the different sizes in an assortment pack. With my file systems you can purchase the files needed and follow the techniques we’ve worked on with other dentists to develop.
5. A common concern within root canal preparation is the cyclic fatigue. How resistant are the EdgeFiles (perhaps with reference to a clinical study)? Our file systems are very resistant to cyclic fatigue. We’ve done both internal and 3rd party peer reviewed testing to ensure our files are more resistant. Dentist can refer to all of the published research on our site that back up our claim
7. What if I already have a working system and technique? Are the EdgeFiles compatible?
Interview with Dr. Charles J. Goodis-EdgeEndo Solutions
8. Do customers need new motors for the application of the files? The motor currently being used by dentists should be able to work with our files. The only time we advise purchasing a new motor is when a dentist wants to use one of our reciprocating systems, such as EdgeOne Fire, which works in a reverse-reciprocating motion and can’t be used with a rotary motor.
9. The heat treatment process of the EdgeEndo files seems to play a big role in the quality and thus differs from files of other manufacturers. Can you describe the advantages to us? We spent a lot of time creating geometrically the best instruments out there. The proprietary FireWire heattreatment process vastly improves the NiTi metallurgy, delivering excellent strength and flexibility, improving resistance to cyclic fatigue or in other words, reducing the chances our files will separate. Another benefit of FireWire NiTi is it enables EdgeEndo files to not “bounce back”, preserving canal anatomy, and carefully follows the canal as they shape.
10. How do you minimize the risk of file breakage with your files and are there any improved properties here compared to the files of other manufacturers? Our files combine the attributes of being highly efficient and flexible, due to the proprietary FireWire heat treatment process, while being extremely safe and resistant to fracture. They are designed with a safeunwinding feature. The files start unwinding before breaking. Unwinding signals to a practitioner that the file is fatigued and can break if they keep instrumenting with the file. This helps with stress and results in a more enjoyable procedure for the practitioner and patient. The patient is only in the chair for the time intended and this saves time and cost for both.
Thank you, Dr. Goodis, for these interesting insights.
Yes, I designed many systems to be an easy transition for the doctor to integrate Edge into their practice utilizing the same technique and motor settings. If a dentist switched to Edge they can still use the gutta percha points, paper points and obturators they have in stock.
68
Dental News
Quarter II
Innovation www.trident-dental.com
X-VIEW 3D PAN CEPH Trident presents the most complete model of the X-VIEW family: X-VIEW 3D PAN CEPH. Along with its exceptional 3D imaging capabilities this unit features 2D digital panoramic imaging and cephalometric analysis.
X-VIEW 3D PAN adopts the most advanced image acquisition technology:
Two CMOS Detectors • CMOS Flat panel sensor for 2D and 3D images The following FOVs are available: - Single FOV 9x9 cm - Single FOV 11x11 cm - MultiFOVs 11x11, 9x9, 6x11, 5x5 cm
• DR CMOS flat panel sensor with single shot technology for Cephalograms Modern acquisition software X-VIEW 3D PAN includes functional and versatile software tools that allow to acquire, filter, store and manage thousands of images in less time and with the best possible result. Specific tools are useful to diagnose and analyze several pathologies; plan and perform dental treatments and surgeries and, follow up the results. MAR algorithm Pulsed mode DC X-Ray generator
70
Dental News
Quarter II
Scan and connect digitally. Or treat it in a single visit. Either way, it‘s prime. Enjoy the scan. With the connectivity options of Primescan.
Find out more on dentsplysirona.com/primescan
