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Volume XVI, Number IV, 2009
BASIC
INFECTION CONTROL
ISSN 1026 261X
ROUNDUP OF THE School oral health survey in Sidi Bouzid, Tunisia
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CONTENTS V o l u m e X V I , N u m b e r I V, 2 0 0 9 EDITORIAL TEAM Alfred Naaman, Nada Naaman, Jihad Fakhoury, Dona Raad, Antoine Saadé, Lina Chamseddine, Tarek Kotob, Mohammed Rifai, Bilal Koleilat, Mohammad H. Al-Jammaz COORDINATOR Lina Jadaa ART DEPARTMENT Krystel Kouyoumdjis SUBSCRIPTION Micheline Assaf, Nariman Nehmeh ADVERTISING Josiane Younes PHOTOGRAPHY Albert Saykali TRANSLATION Gisèle Wakim, Marielle Khoury DIRECTOR Tony Dib ISSN 1026-261X
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School oral health survey in Sidi Bouzid, Tunisia Fethi MAATOUK, Ahlem BAAZIZ, Hichem GHEDIRA, Naziha JDEY
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How to make your marketing money work harder than ever for you Bhavna Doshi
24
Basic infection control procedures in dental practices in Sharjah, UAE Atefeh Tahami, Raghad Hashim
30
Cosmetic Dentistry (Case Report) Dr Elie V. Warde
36
Beirut International Dental Meeting
43
17th Arabic and International Dental Meeting in Syria
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5th Bahrain Dental Society Conference 2009
58
Dental - Facial Cosmetic International Conference in Dubai
72
Product Review
Pr. M.A. Bassiouny BDS, DMD, MSc, Ph.D. Director International Program, Temple University, Philadelphia, USA. Pr. N.F. Bissada D.D.S., M.S.D Professor and Chairman, Department of Periodontics, Case Western Reserve University, USA. Pr. Jean-Louis Brouillet D.C.D, D.S.O. Chairman, Department of Restorative Dentistry, Aix-Marseille II, France. Pierre Colon D.C.D., D.S.O. Maître de conférence des universités, Paris, France. Dr. Jean-Claude Franquin, Directeur de l’Unité de Recherche ER116, Marseille, France. Pr. Gilles Koubi D.C.D., D.S.O. Department of Restorative Dentistry, Aix-Marseille II, France. Pr. Guido Goracci. University LA SAPIENZA, School of Medicine & Dentistry, Roma, Italia. Dr. Olivier Hue, Faculté de chirurgie dentaire de Paris VII, rue Garancière, Paris, France. Brian J. Millar BDS, FDSRCS, Ph.D. Guy’s, King’s, and St. Thomas’ College School of Medecine & Dentistry, London, UK. Pr. Dr. Klaus Ott, Director of the Clinics of Westfälischen Wilhelms-University, Münster, Germany. Wilhelm-Joseph Pertot DEA, Maître de conférence, Aix-Marseille II, France. Pr. James L. Gutmann, Professor and Director, Graduate Endodontics, Baylor College of Dentistry, Dallas, Texas, USA. Pr. Dr. Alfred Renk, Bayerische Julius-Maximilians-University, Würzburg, Germany. Dr. Philippe Roche-Poggi DEA. Maître de conférence des universités, Aix-Marseille II, France. Michel Sixou D.C.D., D.E.A. Department of Priodontology, Toulouse, France. Pr. M. Sharawy B.D.S., Ph.D. Professor and Director, Department of Oral biology, Medical College of Georgia, Augusta, Georgia, USA.
3 Contents
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INTERNATIONAL CALENDAR January 21 – 22, 2010 Egyptian Orthodontic Society & Accademia Italiana di Ortodonzia Intercontinental City Stars Hotel, Cairo, Egypt www.egortho.org February 8 – 10, 2010 Saudi Dental Conference King Saud University 13th International Dental Conference. 21st for the Saudi Dental Society. Riyadh, King Fahd Cultural Center, Feb 8 - 10, 2010. Tel: +966 1 4677763 Email: esamson@ksu.edu.sa Website: www.ksudm.com February 18 – 20, 2010 Egyptian Dental Show at the City Stars Mall Cairo, Egypt Email: sales@eds-eg.org www.eds-eg.org March 9 – 11, 2010 AEEDC Dubai Dubai International Convention & Exhibition Centre Email: index@emirates.net.ae Website: http://www.aeedc.ae March 24 – 26, 2010 AOIA Alexandria March 24 - 26, 2010 _ ICOI - AOIA STARS meeting in Alexandria, Egypt Email: coordinator@aoiaegypt.com Website: www.aoiaegypt.com
March 30 – April 2, 2010 Jordanian Dental Congress 22nd Jordanian Dental congress to be held at Le Royal Hotel, Amman, Jordan on March 30 - April 2, 2010 Email: drirfan@go.com.jo Website: www.jda.org.jo May 13 – 14, 2010 4th CAD/CAM conference May 13 - 14, 2010 4th CAD/CAM Computerized Dentistry International conference at the Address Dubai Marina Hotel Email: info@cappmea.com Website: www.cappmea.com September 2 – 5, 2010 FDI Annual World Dental Congress Salvador da Bahia, Brasil congress@fdiworldental.org November 2 – 6, 2010 Alexandria International Dental Congress info@aidc-egypt.org www.aidc-egypt.org
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V o l u m e X V I , N u m b e r I V, 2 0 0 9 DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
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COMMUNITY DENTISTRY
School oral health survey in Sidi Bouzid, Tunisia Fethi MAATOUK1, Ahlem BAAZIZ1, Hichem GHEDIRA1, Naziha JDEY2 1. Professor, Paediatric Dentistry Department. Dental School. Monastir (Tunisia) 2. Dentist, Sidi Bouzid (Tunisia) Pr. Fethi MAATOUK – Paediatric Dentistry, School of Dentistry. 5019 MONASTIR /TUNISIA Tel 21673461832 - Fax 21673461150 - fethi.maatouk@fmdm.rnu.tn
This study carried out in Sidi Bouzid district (tunisian southwestern area) aimed to assess the dental health status, notably dental fluorosis among 300 schoolchildren (156 females and 144 males), 15 years aged and randomly chosen. Dental health was assessed according to the WHO methodology and the results were compared with previous Tunisian studies. The findings showed that 64.6% of schoolchildren presented malocclusion, 40.7% had dental caries, 76.3% were affected by periodontal diseases and 85.7% suffered from dental fluorosis. The analysis of results revealed that the prevalence of dental caries in Sidi Bouzid district was lower than the national average while the periodontal diseases were much frequent; analysis also confirmed that the dental fluorosis prevalence in Sidi Bouzid was remarkably higher than the national average and close to that recorded in Gafsa and Gabes which represented important areas of endemic dental fluorosis in Tunisia.
Key words: • • • • •
Epidemiological Investigation Schoolchildren Dental fluorosis Oral Health Sidi Bouzid (Tunisia)
Introduction In Tunisia, fluoride is largely widespread in nature. The drinking water constitutes its principal source with variable rates according to the areas conditions. Fluoride is also present in many foods in particular in the fish, the fruits and vegetables with variable rates according to the environment where they are produced. The tea, which is a popular drink in this country, is very rich in fluoride. In 2003, the Tunisian fourth national school survey on the oral health condition conducted by the Ministry of Health and the World Health Organization1 revealed that in Sidi Bouzid district (area in the western south of the country) 30.7% of 15 year-olds
schoolchildren had dental fluorosis with 1.17 ppm of fluoride in the drinking water of this area. Our study which consisted of a cross-sectional survey was aimed: • To assess the oral health indicators in 15 year-olds schoolchildren in this region and to compare them with national and regional surveys results. • To verify if the prevalence of dental fluorosis had really decreased in Sidi Bouzid district as shown by the second national survey from 64% in1994 to 30.7% in 20032.
Subjects and methods A total of 300 schoolchildren, 156 females and 144 males, were randomly chosen by stratified random sampling with adjustment to age. The target age to study dental fluorosis in permanent dentition is 15 years. Training of two dental students as examiners, calibration and standardization of examining techniques are dealt within the BASCD criteria in the school of dentistry of Monastir3. After making contact and obtaining the necessary authorization, a clinical examination was performed in classroom according to the WHO methodology (1994) to detect oral affections with usual dental examining instruments4. Data were recorded on simplified WHO form. Decayed (D), missing (M) and filled (F) index (DMF) and the Community Periodontal Index for Treatment Needs (CPITN) were calculated5. Furthermore, information about teeth brushing, drinking tea and smoking were also collected. Analysis of 27 water samples to determine fluoride concentration in Sidi Bouzid district were collected from National Society of drinking water distribution (SONEDE). Data were analyzed using EPI INFO 2004 software and compared to previous study. Chi square test of Pearson was used to compare different percentages with the 5% level of significance6.
Results and analysis The distribution of the schoolchildren according to the sex and DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
13 School oral health survey in Sidi Bouzid, Tunisia
Summary
COMMUNITY DENTISTRY Table 1. Distribution of schoolchildren by sex and residence
Sex*
14 School oral health survey in Sidi Bouzid, Tunisia
Male Female No. (300) 144 156 % 48 52 * Sex ratio: 1.08
Table 4. Prevalence of malocclusion, dental caries and dental fluorosis
Residence
Malocclusion
Urban area Rural area 109 191 36.3 63.7
Moderate to severe Mild No % No % Male 36 25 60 41.7 Female 73 46.8 25 16 Total 61 20.3 133 44.3
residence environment is shown in table 1. It should be noted that 63.7% of them were from rural environment. In fact, the rural population is most dominant in Sidi Bouzid district whose economy is based primarily on agriculture. The results showed that 67% of school children were issued from modest socio-economic background. It should be noted that 48.7% of them brushed their teeth with predominance for girls (p< 0,001) but this percentage seemed over-estimated because of misreporting by the schoolchildren (Table 2). About 70 pupils drank tea (23.3%); drinking tea was more frequent in boys and in rural area (p< 0,001). Concerning smoking, 8% of schoolchildren smoked but this percentage seemed underestimated because of presence of the teachers during our examination. The average rate of daily consumption of the tobacco is 0.75 ± 2.6 cigarettes day. As in the literature, the boys smoked more than the girls; indeed of the 24 pupils who smoked, 96% were boys (p<10-6)7. The findings revealed a remarkably high prevalence of periodontal diseases (76.3%) in schoolchildren (Fig.1). Among them more than a half (62.3%) presented calculus (Table 3), which was not in concordance with the percentage of the pupils who brush daily their teeth. According to sex, a statistically significant difference (p<10-3) was noted between males and females, these latter had better periodontal health than boys. This is due probably to the interest which the girls lend to their appearance and their smile by more frequently brushing their teeth; but this should have also involved a less dental caries prevalence in the girls, which was not the case. The analysis of the median number of concerned sextants (MNS) revealed that on average, each pupil presented periodontal disorder on 2.1 ± 0.9 sextants. With regard to periodontal treatment needs, 76.3% of the Table 2. Toothbrush possession, tea drinking and smoking among surveyed schoolchildren
Possess a toothbrush Male Female Total * p < 0.05
No 55 91 146
% 38.2 58.3* 48.7
Drink tea
Smoking
No 51 19 70
No 23 1 24
% 35.4* 12.2 23.3
% 16* 0.6 8
Table 3. Periodontal health status
Total lesions calculus pocket Female Mean bleeding 62.3 % 18 15.7 68 76.3 2.1 ± 0.9 MNS* 0.29 ± 0.8 1.48 ± 1.8 0.25 ± 0.7 *MNS: mean number of sextants ** p<10-3 Male 85.4**
DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
Dental caries Fluorosis No 53 69 122
% 36.8 44.2 40.7
No % 122 53 135 69 257 85.7
Fig.1: Nearly two thirds of schoolchildren had periodontal lesions.
Fig.2: Moderate to severe malocclusions concerned about 20% of schoolchildren.
Fig.3: In our study dental decay seemed to be more frequent in girls.
Fig.4: Dental fluorosis was endemic in Sidi Bouzid.
schoolchildren required oral hygiene instruction (CPITN1), 62.3% needed scaling (CPITN2) and 5.7% of them required complex treatment (CPITN3). More than half of schoolchildren (64.6%) presented malocclusion (Fig.2); 44.3% of them had mild malocclusion while 20.3% had moderate to severe malocclusion requiring orthodontic care (Table 4). The caries experience of schoolchildren was high; indeed 40.7% of them presented dental caries (Fig.3). According to sex, girls seem more exposed to the dental caries than boys with respectively 44.2% and 36.8% but the difference was not significant (p> 0.05) (Table 4). It should be noted that of a mean DMFT of 1.04 the “F” (Filled) component was very low, which suggested a very important treatment need (93%); in fact only 14 subjects had teeth fillings and only one permanent tooth was filled for 12.6 decayed teeth. Table 5. DMF and DMFT index Number subjects M Number teeth M
D 122
M 17
F 14
DMF 153
0,4 D 277
0,06 M 17
0,05 F 22
0,51 DMFT 316
0,92
0,05
0,07
1,04
COMMUNITY DENTISTRY Table 6. Comparison with previous studies Surveys, year, number, age
Author
Malocclusion (%)
Parodontal lesions (%)
Kairouan 1998 (N=300, 15 years)
Maatouk et al11
Jendouba 1998 (N=212 15.3 years)
30
56.7
33.8
0.8
57.7
Ouerghi H12
47.6
77.5
66
2.52
54.7
Nabeul 1999 (N=300, 15 years)
El Abed N13
42.3
62.3
30.3
0.92
18,7*
Gabes 2001 (N=300, 15 years)
Bouabdallah A14
70.3*
63
33
0.42
76*
Gafsa 2003 (N=121, 15 years)
Hasni Y15
na
na
32.2
0.91
96.6*
National Survey 2003 (N= 961, 15 years)
Public Health Ministry1
45
38
56
2.02
43.8
Our study 2006 (N=300, 15 years)
Maatouk et al
64.6*
76.3*
40.7
0.51
85.7*
16 School oral health survey in Sidi Bouzid, Tunisia
na: not available
Dental caries Prevalence (%) DMF
Dental fluorosis (%)
* p<0.05
DMF index was about 0.5 (Table 5). Our results also showed that 257 schoolchildren had a dental fluorosis (85.7%). According to the Dean index of the fluorosis, the distribution of the pupils revealed that index 4 was predominant with 29.3% (Fig.4). Any statistical significant relationship was noted neither to the socio-economic background nor with the residence environment (p> 0.05). The drinking water samples analysis from 27 sites in Sidi Bouzid district showed a rate of fluoride varying from 0.56 to 3.46 ppm with an average of 1.17 ± 0.45 ppm8. These results showed well that the fluoride rates were higher than the maximum authorized concentration (1.7 ppm) in 11 water samples9. The analysis of previous surveys revealed that the tooth brushing in Sidi Bouzid district was much lower than national average (90.1%) while the consumption of tea was more important than in Nabeul but lower than Gabes and the national average (38%). Regarding smoking, the prevalence reported in this study was higher than that reported by Abid in 2004 in the national survey (4.1%)10. Analysis also showed that the prevalence of the malocclusion in Sidi Bouzid district was close to that of Gabes (70%); however it was higher than that recorded in the national survey at 15 years old pupils (45%) (p<0.001) which is the highest prevalence reported in the countries of the East Mediterranean Region (Table 6)11, 12, 13. The frequency of periodontal problems was close between the various surveys carried out even if all records were much higher than the national rate (38%) (p<0.001). In the other hand, the prevalence of the dental caries in Sidi DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
Bouzid district was lower than the national average but higher than that recorded in Gabes and Nabeul. Furthermore, the DMF and the DMFT indices value in Sidi Bouzid were lower than the national indices. In our study the dental fluorosis prevalence (85.7%) was remarkably higher than the national average (34%) (p<10-3) and Nabeul (p<10-4) and close to that recorded in the mining layer of Gafsa (96.7%) and Gabes (76%) which also represented important areas of endemic dental fluorosis in Tunisia.
Discussion The dental fluorosis constitutes a public health problem in Sidi Bouzid. The plurality of the sources of fluoride notably drinking water remains the essential cause of the endemic fluorosis in this area as well as in Gafsa and Gabes14, 15. With the findings of this study and considering the aesthetic and psychological damage that involves the dental fluorosis, several recommendations and measurements seem to be useful: In individual level, these measurements include: - A complete diagnosis and early management with multidisciplinary collaboration of health workers. - A personalized assessment of the sources of fluoride intake in particular its rate in drinking water, fruits and vegetables, the type and quantity of used oral hygiene products and the presence of other significant source (drugs…). In collective level, the control of drinking water seems to be essential measurement to undertake, calling upon the deepened research for cost moderated technique to decrease fluoride rate in drinking water. It is also necessary to fight atmospheric pollution in the mining areas.
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The findings of the present paper revealed that dental fluorosis prevalence in Sidi Bouzid had not really decreased in 2003 as shown in the last national survey1, 2. However, in Tunisia, in general and at Sidi Bouzid district in particular the natural fluoride did not lead to lower sufficiently the prevalence of the dental caries. Furthermore, the important frequency of periodontal problems in our study which was much higher than the national average seemed to invalidate the “protective effect” of fluoride intake for periodontal tissues16, 17. It is thus necessary to implement other preventive measures, like the maintenance of a good oral hygiene, the adoption of a balanced nutrition low in carbohydrates, the regular systematic visits to dentist… Lastly, the frequency of the malocclusions among schoolchildren in Sidi Bouzid needs a special attention and must be more analysed.
Acknowledgement «Authors are infinitely grateful with all those which helped them in this study, especially the schoolchildren and the teaching team."
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1. Ministry of Public Health. National school oral health survey in Tunisia (DMSU 2003). WHO collaborative oral health programme( TUN/HPR/OOO/RB/02). 2. Ministry of Public Health. National school oral health survey in Tunisia (DMSU: 1994/TUN/ORH/001). 3. BASCD. Criteria for standardised clinical assessment of dental health. British Association for the study of community dentistry, 1992/93 BASCD, 1992. 4. World Health Organization (WHO). Oral health surveys: basic methods, 4th ed. Geneva, World Health Organization, 1998. 5. Ainamo J. Barmes D. Beagrie G. Cutress T. Martin J. Sardo-Infirri J. Development of the World Health Organization (WHO) community periodontal index of treatment needs (CPITN). International dental journal, 1982, 32:281-91. 6. Everitt B. Dunn G.A. Statistical Analysis of Medical Data: New Developments. Oxford University Press, New York.1998; 352p. 7. Maatouk F. Maatouk W. Ghedira H. Ben Mimoun S. Effect of 5 years of dental studies on the oral health of Tunisian dental students. Eastern Mediterranean Health Journal. 2006;12 (5): 625-31. 8. SONEDE. Sidi Bouzid District. Results of physico-chemical analyses of drinking water samples. Sfax laboratory. 2005. 9. American Dental Education Association. Professionally applied topical fluoride: Evidence-Based clinical recommendations. J Dent Educ. 2007; 71(3): 393-402. 10. Abid A. Oral health in Tunisia. Int Dent J. 2004 Dec; 54(6 Suppl 1):389-94. 11. Maatouk F. Ghedira H. Argoubi K. Jmour B. Abid A. La fluorose Dentaire à Kairouan (Tunisie). Act Odonto Stomatol.1998; 203: 315-20. 12. Ouerghi H. Enquête épidémiologique sur l’état de santé bucco-dentaire des élèves d’un lycée secondaire à Jendouba (Tunisie). [Thèse]. Monastir : Faculté de Médecine Dentaire. 1998. 13. Maatouk F. Ghedira H. Argoubi K. Jmour B. Sassi S. El Abed N. School oral health survey in Nabeul (Tunisia). Dental News. 1999;4,1:43-5. 14. Bouabdallah A. Enquête sur l’état de santé bucco-dentaire à Gabès. [Thèse] Monastir. Faculté de Médecine dentaire. 2001. 15. Hasni Y. Enquête épidémiologique sur la fluorose dentaire dans le bassin minier de Gafsa. [Thèse] Monastir. Faculté de Médecine dentaire, 2003. 16. Miyaqi M. Tsuruda K. Kawamura M. Morishita M. Iwamoto Y. Effects of fluoride intake on the mineral content, acid solubility and resorption caused by experimental periodontitis of rat alveolar bone. Arch Oral Biol. 1994;39(2):163-6. 17. Foo M. Jones A. Darendeliler MA. Physical properties of root cementum: Part 9. Effect of systemic fluoride intake on root resorption in rats. Am J Orthod Dentofacial Orthop. 2007;131(1):34-43.
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PRACTICE MANAGEMENT
marketing
How to make your money work harder than ever for you Dr. Bhavna Doshi B.D.S Lon. CEO - Dental WEALTH Builder bhavna@dentalwealthbuilder.com
20
How to make your marketing money work harder than ever for you
S
o many dentists invest in ventures with the hope of drawing in more patients to their practice. However, just because you have spent your hard earned money does not necessarily mean you are actually INVESTING, let alone anticipating new patients actually booking appointments and bring you an income. When considering marketing strategies we need to have an investor mindset. Investors spend money for a return on investment, i.e. spend money to generate more money. In this case spend money to generate more income from our patients. This is a very important topic which must not be overlooked because you will most definitely be wasting your potential investment opportunity and losing out on other strategies which may have generated you more income from the right calibre of patients.
Marketing Marketing is simply getting the right message to the right people via the right promotional media and methods. It can be done using a variety of resources - not all of which are expensive. There are in today’s economic markets thousands of different strategies and techniques available to let people know about who you are and what you can do for them. The question is not “what can I do to attract patients?” the question should be “which strategy is going to best suit me?” This way you will invest in the appropriate mediums which will make the best use of your resources. But before you consider these mediums, you will need to create the appropriate message to deliver to the appropriate audience.
Dentists are scientists at heart and some find it very uncomfortable to blend business acumen together with the science of dentistry. But if the science is to be delivered aptly to the correct patient and in the most appropriate manner then, it would ultimately be in the best interest of your patient and their long term health, to combine business and science to produce effective and efficient dentistry. The way to use lead generation strategy is to first understand your unique positioning in the market. Thereafter to understand who it is in the general population that you can benefit with your uniqueness. The final job is to simply pick and choose the correct marketing strategy that best works for you. Most dentists tend to pick the marketing strategy first and then look at their budget and fit the chosen strategy into their budget. The consequences of this can easily be seen in our current struggle for more new patients and in our attempts to come to terms with the best marketing strategies.
Development of your Unique Position The following questions need to be answered: • What is it in dentistry which sets you apart? • Why are you different? • What can you offer that no one else can? These are important questions and the answers are not simply a case of - I am a dentist offering dentistry. Every dentist has a unique style and way of doing things. E.g. you may be extremely good at cooperating with very nervous patients or you may enjoy endodontics. Determine what it is that you can offer – your unique position within the market, which compels your potential patients to choose you over and above any other dentist.
Lead Generation This is the essence of what all marketing should be based upon. Lead generation is basically all the possible ways in which you can create potential prospects. This term is essentially a business term and sometimes dentists fail to see themselves as business owners who have the ability to advertise and inform patients of what they can do for them, but who also needs to generate income to be able to best provide for their patients. DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
Target Marketing The concern we as dentists should have is – how are we going to market our services to an audience that will actually be interested in what we have to offer. The question is how to capture a TARGET AUDIENCE with target marketing. A target audience is that part of the population you believe will most benefit from your services.
PRACTICE MANAGEMENT Once we have this essential tool we will be marketing in a way that will count towards increasing the likelihood of potential patients. And they are potential patients because the process does not terminate at this point alone. We will then have to “entice” these prospects to actually become patients of the practice. But marketing correctly will give us this opportunity to benefit these new patients. If we simply market our services and attempt to target everyone, we may be drawing in patients who do not fit into our philosophies. This may utilize considerable effort and time on our parts in attempting to offer our services and advice to patients who may not be interested. This is a primary reason why many patients often refuse to go ahead with recommended treatment.
22
How to make your marketing money work harder than ever for you
Discover your target audience There are essentially two ways of doing this: a) Deciding who will best benefit from your unique position b) Deciding on what actual service your patients require from you. These factors will enable you to generate leads correctly and cost effectively. Once the above factors have been considered, you will be equipped with the knowledge of who you are targeting with your strategies and this will allow you to work out the demographics of how to find your target audience. Once you know this, it is simply a matter of choosing the most cost effective and productive marketing tool.
Monitoring the effectiveness of the marketing plan Your practice can incorporate a very simple system which denotes what source each new patient came from. This can be worked out on a monthly basis to keep you in touch with how effective your planning has been, especially if you don’t want to waste any further marketing money on something that isn’t generating any new custom. COST PER LEAD= BUDGET SPENT ÷ NUMBER OF LEADS GENERATED E.g. If your marketing budget allowed you to spend £7000 on directory advertising and in one month you generated 100 patients from that lead (source) then your cost per lead is £70. The importance of this figure is to give you some useful information on how to set your fees and on what income you must generate from each new patient before you will see any profits. Other factors obviously come in to play such as running cost of each surgery, laboratory bills etc. However cost per lead is still a good marketing indicator and tool which gives you considerable information on how well you have invested. There are many other simple strategies and ways of making your marketing investment count but target marketing is one of the easiest to implement because it does not take up much resource and its benefits are tremendous.
The life line of any practice Drawing in new patients is actually the life line of any practice. And if we are to be successful at becoming well known for our services and advice to potential patients, then we need to implement our marketing plan with great care so as not to miss any opportune strategies. The number one is an extremely disliked number in marketing. It implies the entire budget spent on one strategy. If that particular method didn’t work then we would have a negative return on investment. Our ability to attract new patients may diminish, which in turn will not allow you to grow as a practice. It often ends up tying you into a vicious circle, which many find very difficult to break away from. For this reason embark upon as many strategies and techniques as your planning and budget will allow. Your marketing plan should work out all the possible ways you are going to reach your target audience and at what cost.
Marketing Plan Who is your target audience? Why are they your target market? What is your unique position? How are you going to reach your market? When are you going to implement the strategies? Where are you going to implement the strategies? How are you going to monitor the effectiveness of the methods you choose? What are your backup plans? DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
In summary Target marketing is a simple and very easy strategy to make sure all that you invest actually counts and works hard for you. This technique indirectly also will assist in increasing the number of patients accepting your recommendations, simply because you have cleverly attracted the right type of patients who want and need the services you offer within your unique position. Target marketing allows you to efficiently generate leads of the most compatible nature. As a special Dental WEALTH Builder launch gift, I have packaged together a “7 Gift” compilation, one of which is “The Top Ten Biggest Advertising Mistakes in Dentistry” manual. To obtain your FREE gifts please go to www.dentalwealthbuilder.com and sign in for these Gifts.
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GENERAL DENTISTRY
Basic infection control procedures in dental practices in Sharjah,UAE Dr. Atefeh Tahami
Dr. Raghad Hashim
Ajman University, Ajman, United Arab Emirates
Assistant Professor, Head Growth and Development Department Ajman University, Ajman, UAE e-mail: raghad69@yahoo.co.nz
ABSTRACT Objectives: The aim of the study was to assess the infection control procedures used in private dental practices in the Emirate of Sharjah, United Arab Emirates.
24 Basic infection control procedures
METHODS: A self-administered questionnaires were distributed personally to 100 randomly sampled dentists and variables were submitted to Chi2 test. RESULTS: Seventy-six dentists 95% reported that they usually asked patients about their medical history, 90% were vaccinated against hepatitis B. Approximately 98% wear and change gloves during treatment and between patients, 91.3% wear face-mask but only 36.3% of the dentists change their face-mask between patients. Only 47.5% use eye-wear. All dental practitioners 100% changed extraction instrument and saliva ejectors. However, 65% reported that they changed handpieces between patients; about 88% used autoclaves for sterilization, 95% used plastic bags to wrap sterilized instrument. Approximately 59% disinfected impression before sending it to dental labs, 35% used rubber dams in their dental clinics and about 94% had special containers for sharps disposal. CONCLUSION: It is pleasing to note that a high proportion of dentists are using personal protective equipment and follow recommended guidelines by their appropriate authorities as well as taking into consideration international standards for equipment sterilization. However changing face-mask between patients, the use of eyewear and rubber dams and proper sterilization of hand pieces is still some way off from becoming a universal practice and there is thus room for improvement. The need exists for further education, training and regulations in the use of personal protective equipment and equipment sterilization.
INTRODUCTION Infection control in dentistry has become a topic of great interest worldwide over the last ten years. The primary reason behind this has been the increased attention and greater awareness of the disease associated with the Human Immunodeficiency Virus DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
(HIV) and hepatitis viruses by the public and health care professionals. In dentistry, both patients and dentists may be exposed to a number of blood borne and upper respiratory pathogens through exposure to blood and saliva1, 2. Avoiding exposure to contamination by potentially infectious body fluids remains an important principle in the prevention of diseases transmission. During dental treatment medical gloves must always be worn by dentists when there is potential for contacting blood, blood-contaminated saliva, or mucous membranes. Masks and protective eyewear should be worn when splashing or spattering of blood or other body fluid is likely, as is common in dentistry3, 4. Increasing compliance of general dental practitioners (GDPs) with glove wearing while treating patients in the United Kingdom has been demonstrated5. However, there is little data on infection control methods employed in dental surgeries in the United Arab Emirates. Therefore, the purpose of this study was to examine the infection control procedures used in general dental practice in the emirate of Sharjah, United Arab Emirates.
METHOD Self-administered questionnaires were distributed personally to randomly selected dentists who were currently working in Sharjah, and agreed to participate, resulting in a study population of 80 dentists. The questionnaire was designed to collect information about the respondents demographic data such as their age, gender, in addition to the key measures of infection control in the dental practices including: wore and changed gloves and masks during and between patients; wore protective eye wear; had been vaccinated against HBV; checked medical history at the beginning of the treatment; used autoclaves for sterilization; used sterilization wrappings; changed burs, handpieces, saliva ejectors and extraction instruments between patients; disinfected impressions; used rubber dams, and used a sharps waste disposal system. The questionnaire was pilot tested by distributing it to 20 dentists who provide dental care in Ajman university – based – Clinics. Responses from the pilot–test were reviewed to assess the clarity
GENERAL DENTISTRY and relevance of the questions and no modifications were made based on the feedback from pilot-test participants. The main researcher distributed the questionnaires personally by visiting private dental practitioners practicing in Sharjah; the questionnaire was completed by the practitioner in his/her presence in the surgery. Data collection was conducted from January to March 2008. The collected data was analyzed using SPSS (statistical package for the social sciences, version 11.0). The results were expressed as a percentage of the replies included in the completed questionnaires.
26 Basic infection control procedures
RESULTS Eighty out of one hundred dentists were agree to participate in this study, thus, the response rate was 80 percent. Of the total respondents forty two (52.5 percent) were males, and thirty eight (47.5 percent) were females - Table 1. Table 2 showed that seventy-six dentist (95 percent) reported that they usually asked patients about their medical history at the beginning of the dental treatment and that 90 percent were vaccinated against hepatitis B. Approximately 98 percent wear and change gloves during treatment and between patients, 91.3 percent reported that they wear face-masks but only 36.3 percent of the dentists change their face-masks between patients. Only 47.5 percent use eye-wear. All dental practitioners (100 percent) reported that they changed extraction instrument and saliva ejectors. However, 65 percent reported that they changed handpieces between patients; the remaining cleaned them with a disinfectant. About 88 percent reported that they used autoclaves for sterilization, 95 percent used plastic bags to wrap sterilized instrument. Approximately 59 percent disinfected impression before sending it to dental labs, 35 percent used rubber dams in their dental clinics and about 94 percent had special containers for sharps disposal.
DISCUSSION This cross-sectional study examined GDPs compliance to infection control measures in the Emirate of Sharjah, United Arab Emirates by means of a self-administered questionnaire. One of the major limitations of this type of study is that what people report may differ from what they actually do. To the best of our knowledge this study represents the first study of its kind in United Arab Emirates that assessed dental practitioners’ compliance to infection control measure. Thus, this study might Table 1. Age and gender distribution of the participants
Characteristic Age in years 25 - 35 36 - 45 46 - 55 > 55 Gender Male Female
Number
Percentage
46 17 13 4
57.5 21.3 16.3 5.0
42 38
52.5 47.5
DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
provide a valuable insight into current practices of infection control measures, and in the corresponding need for improvements to educate dental practitioners. In an attempt to ensure a high and accurate response rate and to overcome possible communication and posting difficulties, the survey was conducted as a field study whereby each dental practitioner completed the questionnaire in the presence of the researcher (T.A) in their dental surgery. The concept of universal precautions is that all blood and bloodcontaminated body fluids should be considered potentially infectious because identification of many patients with blood borne infections is not possible. Using various forms of personal protective equipment minimizes contact of practitioners with patient blood and body fluids. If all patients are treated as if they are infected with HBV, HCV or HIV, the potential for cross infection in dental practice will be low6, 7. Although the possibility of transmission of blood borne infections from dental health care worker to patients is considered to be small, precise risks have not been quantified by carefully designed epidemiological studies. The lack of knowledge of the established risks and the belief that risks can be assessed accurately by a medical history causes problems with infection control procedures. All these indicate a need for further continuing education8, 9. Inquiring about the medical history of all patients who seek dental treatment should be the first strategy before the start of the treatment. In this study 95 percent of dentists asked about the medical history of their patients, this percentage is higher than what has been reported in previous study10. Table 2. Adherence to infection control procedures among dentists in private dental clinics in Sharjah.
Procedure Asking about medical history
Number Percentage 76.0 95.0
Vaccination for hepatitis B
72.0
90.0
Gloves Wearing Changing after each patient
78.0 79.0
97.5 98.8
Face mask Wearing Changing between patients
73.0 29.0
91.3 36.3
Wearing eye protection
38.0
47.5
Changing instruments Extraction instruments Handpieces Saliva ejectors Burs
80.0 52.0 80.0 72.0
100.0 65.0 100.0 90.0
Use of autoclave for sterilization
70.0
87.5
Use of plastic wrappings for sterilized instruments
76.0
95.0
Disinfect impressions
47.0
58.8
Use of rubber dam
28.0
35.0
Use of special container for disposal of sharp objects
75.0
93.8
28 Basic infection control procedures
GENERAL DENTISTRY In the current study, 90 percent reported to be vaccinated against HBV. This is very good percentage compared with other studies where vaccination rate were 63.5 percent in Saudi Arabia11, and 52 percent in Sudan12 but almost similar to other study conducted in Canada13. This high percentage indicates the high level of awareness among dentists working in Sharjah, UAE. In this study, about 98 percent reported that they wear and change gloves. This is higher than many other studies11, 14. In addition, approximately 91 percent wear face-masks during treatment, in comparison to 74.8 percent in Canada13 and 64.8 percent in New Zealand15. However, only 36.3 percent change it between patients which indicate a need for further continuing education. Adequate eye protection is necessary, as is the wearing of face masks, to protect dentists’ oral and nasal mucosa from splatter of blood and saliva16. The current survey showed that only 47.5 percent of the dentists using eye wear which indicate that its use is not universal. Changing extraction instrument, saliva ejectors was reported by all dentists. However, there were still about 10 percent of dentists who did not change burs and thought that cleaning burs and wiping handpieces with disinfectant before providing dental treatment for other patients was satisfactory. This finding demonstrated the lack of awareness about cross-infection. In our study, the use of autoclaves for sterilization reported by around 88 percent of the dentists, this percentage is much higher that what reported by UK dental practitioners17, the remaining 12 percent used combination of methods, including dry heat and chemicals to perform sterilization. Transmission of infection from dental surgery to the community has been considered a possibility through improper handling and disposal of contaminated and clinical waste. The current study showed that about 94 percent maintained special containers for sharps disposal in contrast to 56.2 percent of Saudi dentists. Contamination of the laboratory could occur if cross-infection control is neglected18. The result of this study revealed that about 59 percent of the dentists used disinfectant for impression before sending to dental laboratories. This is almost similar to Yengopal et al,19 finding were about 54 percent of the dentists reported doing so. The use of the rubber dams significantly reduces bacterial contamination of the atmosphere during restorative procedures. The result of this study showed that only 35 percent used rubber dams in their restorative procedures, compared to 40 percent among private dentists in Durban19. The results of this study indicated that a high proportion of dentists in Sharjah are practicing infection control in accordance with guidelines laid down by the British Dental Association4 and the Canadian Dental Association20. Emphasis should be placed on consistent adherence to recommended infection control strategies, including the use of protective barriers and appropriate methods of sterilization or disinfection. Each dental facility should develop DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
a written protocol. Such efforts may lead to the development of safer and more effective medical devices, work practices, and personal protective equipment.
CONCLUSION The results of this survey are a source of comfort and concern. It is pleasing to note that a high proportion of dentists are using personal protective equipment and follow recommended guidelines by their appropriate authorities as well as taking into consideration international standards for equipment sterilization. However changing face-mask between patients, the use of eye-wear and rubber dams and proper sterilization of hand pieces is still some way off from becoming a universal practice and there is thus room for improvement. The need exists for further education, training and regulations in the use of personal protective equipment and equipment sterilization. This should be done in context of safe work practices for all members of the dental team.
REFERENCES 1. Kearns HPO, Burker FJT, Cheung SW. Cross-infection control in dental practice in the Republic of Ireland. Int Dent J 2001; 51:17-22. 2. McCarthy GM, Koval JJ, John MA et al. Infection control practices across Canada: do dentists follow the recommendations. J Can Dent Ass 1997; 65:506-511. 3. Bellissimo-Rodrigues WT, Bellissimo-Rodrigues F, Machado AA. Infection control practices among a cohort of Brazilian dentists. Int Dent J; 59(1):53-58. 4. Centers for Disease Control. Recommended infection-control practices for dentistry. MMWR 1993; 42(RR-8) 1-12. 5. Burker FJT, Wilson NHF, Cheung SW. Trends in glove use by dentists in England and Wales: 1989-1992. Int Dent J 1994; 44:195-201. 6. Thomas M, Jarboe G, Frazer R. Infection control in the dental office. Dent Clin North Am; 2008; 52(3): 609- 628. 7. Leggat, PA, Chowanadisai S, Kukiattrakoon B et al. Occupational hygiene practices of dentists in south Thailand. Int Dent J 2001; 51:11-16. 8. Szymanska J, Sitkowska J, Dutkiewicz J. Microbial contamination of dental unit waterlines. Ann Agric Environ Med 2008; 15: 173-179. 9. Araujo MW, Anreana S. Risk and prevention of transmission of infectious diseases in dentistry. Quintessence Int 2002; 33:376-382. 10. Gordon BL, Burke FJ, Bagg J et al. Systematic review of adherence to infection control guidelines in dentistry. J Dent 2001; 29(8): 509-16. 11. Al-Rabeah A, Mohamed AGI. Infection control in the private dental sector in Riyadh. Ann Saudi Medical 2002; 22: 1-2. 12. Elkarim IA, Abdulla ZA, Yahia NA et al. Basic infection control procedures in dental practice in Khartom-Sudan. Int Dent J 2004; 54:413-417. 13. McCarthy GM, MacDonald JK. The infection control practices of general dental practitioners. Infect Control Hosp Epidemiol 1997; 18:699-703. 14. Morris E, Hassan FS, Al Nafisi A et al. Infection control knowledge and practices in Kuwait: a survey on oral health care worker. Saudi Dent J 1996; 8:19-26. 15. Treasure P, Treasure ET. Survey of infection control procedures in New Zealand dental practices. Int Dent J 1994; 44:342-348. 16. Molinari, JA. Dental infection control at the year 2000. J Am Dent Assoc 1999; 130:1291-1298. 17. Hudson-davies SCM, Jones JM, Sarll DW. Cross infection control in general dental practice: dentists’ behaviour compared with their knowledge and opinions. Br Dent J 1995; 178: 365-9. 18. Al-Dwairi Z, Infection control procedures in commercial dental laboratories in Jordan. J Dent Educ 2007; 71(9):1223-1227. 19. Yengopal V, Naidoo S, Chikte UM. Infection control among dentists in private practice in Durban. SADJ 2001; 56(12):580-584. 20. Canadian Dental Association Board of Governors. Recommendations for infection control procedures. J Can Dent Assoc 1995; 61: 509.
ESTHETIC DENTISTRY
Cosmetic Dentistry (Case Report) Dr. Elie V. Wardé DDS Cosmetic Dentistry USJ-FMD - Paris VI elievictor.warde@gmail.com
A 50 years old female presented to the consultation complaining of her disharmonious smile.
Medical and dental examination Past medical history included controlled diabetes and hypertension. The dental exam showed: Open bite occlusion Upper maxilla: 11,13, 23 buccally tilted 22, 11 rotated
30 Cosmetic Dentistry - Case Report
Lower maxilla: 43, 42, 41, 31, 32,33 43, 44 31, 41
rotated buccally tilted gingival recession (pic.1-pic.2)
Treatment plan - Hygiene - Upper jaw: Porcelain veneers for the 6 anterior from 13 to 23 to establish a straight teeth border line and a nice smile. The cervical margins will be at the gingival line. We will try to keep those teeth vitals. - Lower jaw: • RCT for the 6 anterior teeth from 43 to 33 • All-porcelain crowns for the 6 anterior from 43 to 33
Treatment - Scaling 1- Upper jaw: • Local infiltration of anesthesia using Mepivacaine 2%, 1/100,000 adrenaline. • Preparation of the 6 anterior teeth for porcelain veneers. The gingival margins limits are cervical round chamfers at the border line. • RCT for 21: the pulp was exposed during preparation. The incisal edges were also bridged from the palatal side (Pic.3pic.4-pic.5) • The impression is taken using the cordless H&H technique DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
Pic. 1
Pic. 2
with VPS A-silicone “Blue Velvet (J.Morita)” corrected by ”FlexiVelvet (J.Morita)” to register the fine details, over the cervical margins. • The impression is disinfected in a gluteraldehyde solution, pouched and sent to the lab. The 6 units porcelain veneers “IPS Empress Ivoclar” shade 2 L1.5 “Vita 3D Master” are bonded with the light cured “Variolink Veneer” resin. (Pic-6,7,8) 2- Lower jaw: • Local infiltration of anesthesia using 2% Mepivacaine 2%, 1/100,000 adrenaline. • RCT for the 6 anterior teeth using the rotary Ni-Ti Protaper (Maillefer Dentsply), filled by themafil obturators. • Preparation of the 6 anteriors for all-ceram crowns. The cervical round chamfers are 0.3mm to 0.5mm sub gingival. (Pic-6) • As done before the H&H impression is taken with the VPS “Blue Velvet” Corrected by ”Flexi-Velvet (J.Morita)” to register the subgingival margins • This impression is disinfected in a gluteraldehyde solution, pouched and sent to the lab. This 6 single units all ceramic “IPS emax Ivoclar” crowns shade 2L1.5 from the “Vita 3D Master” shade guide, are cemented with the “RMGI Fuji Cem” luting cement. (pic. 6, 7, 8)
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ESTHETIC DENTISTRY
Pic. 3
Pic. 4
32 Cosmetic Dentistry - Case Report
Discussion Porcelain veneers are the perfect solution to problem teeth that are rotated, stained, crooked, chipped, uneven, too big or too small. Specially designed to change the overall aesthetic look of teeth, veneers can improve: Color, Shape, and Texture. Although veneers achieve the same outcome as crowns, they are sometimes a better choice due to their natural look and feel. Veneers are a wonderful and natural looking alternative to crowns. The choice of porcelain veneers restorations, for this specific case, was an extreme challenge for the correction of the crowded anterior teeth, but we took advantage of the open bite. To be more specific, a treatment plan would be considered ideal if it achieves the best possible long term out-come for the patient, while addressing all patient concerns, with the minimum necessary intervention. Facings porcelain veneers are a very conservative option; they preserve the vitality of the pulp. The adhesive bonding resins from the 7th generation guarantee an excellent sealing without any post-op sensitivity.
Pic. 5
Because of this, clinicians should inspect the margins for any microleakage that would contribute to a change in color. In fact it was not the porcelain that was changing in color, but the resin cement. In a study by Nathanson, “the aged dual-cured resin cement samples” tested revealed significantly higher changes in color compared to light-cured luting resins. Even with light-cured luting resins there has been some variation in the color change over time. The literature concluded that the “amine reaction” of some resin cements caused a noticeable yellowing with time. Today, manufacturers of resin cements are addressing these concerns in color change. The patient should always try to choose low-abrasion toothpaste that will remove plaque, stain and tartar gently but effectively. Cosmetic dentistry allows us to achieve, throughout simple modifications, impressive esthetic transformations and gives the patient a beautiful harmonious healthy smile which contribute to the patient’s self-confidence and esteem. The lab works were by Mr. Ousama Kharouta
Porcelain veneers-color stability Does porcelain stain or change color? Porcelain veneers do not change color. Sometimes, months after bonding, porcelain veneers restorations appear as though they are getting darker.
Pic. 6 DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
Pic. 7
Pic. 8
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GlaxoSmithKline to re-launch the leading dry mouth brand, Biotène, in the Middle East. GlaxoSmithKline Consumer Healthcare is planning to re-launch the Biotène® Oral Care products in the Middle-East early next year. The company finalized the agreement with Laclede, a privately held company, to purchase the leading Dry Mouth brand Biotène® end 2008. “The re-launch of Biotène extends our portfolio in therapeutic oral healthcare to include a proven treatment for Dry Mouth in the Middle East,” said Mazen Zaytoun, Biotène Brand Manager, GSK Consumer Healthcare. “This opportunity leverages our established capability with dental and medical professionals in the region and is a further step towards our mission of improving the quality of life of our Middle-East consumers.” Biotène is the world’s number one dentist and hygienist-recommended Dry Mouth product for the growing population that suffers from this condition. Biotène is a brand in strong growth, with global sales in 2007 of around $50 million up 17%. Approximately 65% of the brand’s current sales are in the United States. Biotène was occasionally available in some Middle-East markets but on a very small scale. GlaxoSmithKline Consumer Healthcare plans to grow the brand behind an awareness campaign on the growing problem of Dry mouth. Dry Mouth, a condition known as Xerostomia, is a significant health issue associated with chronic medical conditions that include diabetes, rheumatoid arthritis, Sjogren’s syndrome and Parkinson’s disease. Additionally, cancer chemotherapy or radiation treatment, as well as any of more than 400 medications that, as a side-effect, can cause Dry Mouth. Globally, Dry Mouth is as prevalent as dental sensitivity, affecting around one-in-five adults. Biotène joins a world-class portfolio of Oral Healthcare Brands, including: • Sensodyne®, the leading toothpaste to treat dental hyper-sensitivity • Aquafresh®, a leading range of toothpastes, toothbrushes, • mouthwashes and whitening products • Corsodyl®, Chlorhexamed® gingivitis treatment • Parodontax, a toothpaste for healthy gums • Corega®, a range of denture adhesives & cleansers How Biotène works Biotène is a proprietary system founded on three enzymes: glucose oxidase, lactoperoxidase and lysozyme, each found in healthy saliva. The augmentation of these enzymes through the introduction of Biotène into an oral healthcare regimen aids the symptomatic relief of Dry Mouth. The Biotène range includes mouthwash, toothpaste, gel, spray and gum formulations for convenient, effective relief. New innovation in 2008 added additional enzymes that attack and breakdown plaque biofilm. GlaxoSmithKline – one of the world’s leading research-based pharmaceutical and healthcare companies – is committed to improving the quality of human life by enabling people to do more, feel better and live longer. For further information please visit www.gsk.com
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36 BIDM - 2009
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ΩGõàd’EGh ÊÉØà˘dGh Ahó˘¡˘dG Ωõ˘∏˘à˘°ùj äGƒ˘NC’Gh Iƒ˘NC’G ɢ¡˘jG »˘Hɢ≤˘æ˘dG á«dÉY á«ÑbÉæà πªY kÉ°ùfÉéàe kÉ°ù∏› ôªKCG …òdG πª©dG ≥jôa ìhQh .ábOÉ°üdG Iƒq NC’Gh ¿hÉ©àdG ìhôHh »HÉ≤ædG πª©dG √óMh Éæ°ùLÉg ¿Éc .™«ª÷G ÜÉ©«à°SG ≈∏Y Éæ∏ªY ɪc á«°SÉ«°ùdG äGôJƒàdGh äÉeÉ°ù≤fEÓd íª°ùf ⁄h ,™«ª÷G áë∏°üe ¬«a Éà ¬˘ª˘Yó˘fh ¬˘«˘«˘ë˘f »˘Hɢé˘j’G ≈˘ë˘æŸG Gò˘g ¿Gh .ɢæ˘à˘Hɢ≤˘f ‘ ô˘KDƒ˘˘J ¿G πª©dG áeÓ°S ≈∏Y kÉXÉØM ¬H Ò°ù∏d øjôNB’G ƒYófh ¬«∏Y ™é°ûfh .ºFGO πμ°ûH √ôjƒ£Jh »HÉ≤ædG ,IƒNC’Gh äGƒNC’G É¡jG á«Hɢ≤˘æ˘dG äɢ«˘dɢ©˘Ø˘dGh iƒ˘≤˘dG ™˘«˘ª˘L ¤G ɢæ˘jó˘jG ó‰ ɢæ˘g ø˘eh ɢæ˘fG ¿hO áaÉc Ú«æ¡ŸG ΩóîJ »àdG äGQÉ«ÿG πc ≈∏Y ÚëàØæe ¿hÉ©à∏d .≥«°V »°SÉ«°S hG »Ñgòe hG »≤WÉæe hG »ØFÉW õ««“ p ’G äCɢJ ⁄ Oɢ©˘Ñ˘à˘°S’G ᢰSɢ«˘°S ¿G á˘≤˘Hɢ˘°ùdG ÜQɢ˘é˘˘à˘˘dG âà˘˘Ñ˘˘KG ó˘˘≤˘˘d É¡d ¢ù«d áæ¡ŸÉa .»HÉ≤ædGh »æ¡ŸG πª©dG ≈∏Y IÒÑμdG äÉ«Ñ∏°ùdÉH ¿hO ÜõëH hG iôNG ¿hO á≤£æà ¢üàîJ ’h Ögòe hG áØFÉW hG øjO ≈∏Y πH á≤«°†dG ÖjQGhõdG iƒà°ùe ≈∏Y ’ Ú«HÉ≤f ¿ƒμæd GƒdÉ©J.ôNBG .øWƒdG πc iƒà°ùe áHÉ≤ædG øμàdh ™«ªé∏d kÉ°†jCG áHÉ≤ædG øμà∏a ™«ªé∏d ™°ùàj øWƒdG ɪch .iƒ≤dG ´ÉLΰS’ ¢ù«dh iƒ≤dG ´Éªéà°S’ DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
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Dr. Christian Makary President of the Scientific Committee
Dr. Louis Hardan General Secretary of the Lebanese Dental Association
38 BIDM - 2009
Pictures from the audience during the opening ceremony at the Congress Palace - Dbayeh, Lebanon
Dr. Edgard El Chaar lecturing on the latest in dental implantology DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
Dr. Joe Hobeich after the live placement of Lumineers veneers
EXHIBITION FLOOR 40 BIDM - 2009
Picture from the official inauguration of the exhibition floor
DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
41 BIDM - 2009 DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
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th 43 17 Arabic and International Dental Meeting
±’G 5000 ‹GƒM ™e Ωƒ«dG Ωƒ≤à∏j á≤jó°üdG á«ÑæL’G ∫hódGh á≤«≤°ûdG á«Hô©dG ∫hódGh áªë∏dG √òg Gƒ°û«©jh GhÒd IóeÉ°üdG ≥°ûeO ‘ ¿ƒØà∏j »HôYh …Qƒ°S ¿Éæ°SG Ö«ÑW ¬JÉÄa πc ÚH …óH’G Ö◊G Gògh …Qƒ°ùdG Ö©°ûdG iód »æWƒdG AÉN’G Gògh á«æWƒdG ó°S’G QÉ°ûH ¢ù«FôdG øWƒdG óFÉbh øWƒdGh áHhô©dG áÑfi kÉ©«ªL É橪éj ¬aÉ«WGh
ɢ¡˘jCG äÓ˘«˘ eõ˘˘dGh AÓ˘˘eõ˘˘dG IOɢ˘°ùdG ä’É˘Ø˘à˘MG Iô˘ª˘Z ‘ Ëô˘μ˘dG π˘˘Ø◊G Üô˘ë˘H á˘jQƒ˘°S ‘ »˘Hô˘©˘dG ɢæ˘Ñ˘©˘ °T Ωƒ˘«˘dG í˘à˘à˘Ø˘f á˘jô˘jô˘ë˘ à˘ dG ø˘˘jô˘˘°ûJ ™˘˘Hɢ˘°ùdG ‹hó˘˘dGh »˘˘Hô˘˘ ©˘ ˘dG ô“DƒŸG ‘ ¿É˘æ˘ °S’G Aɢ˘Ñ˘ WCG ᢢHɢ˘≤˘ æ˘ d ô˘˘°ûY »ª∏©dG åëÑdÉH QÉ©°T â–h ájQƒ°S íààØf ɪc , Qƒ£àJh Ωƒ∏©dG ≈bôJ AÉ˘Ñ˘WC’ ÚKÓ˘ã˘dGh ø˘˘eɢ˘ã˘ dG ô“DƒŸG ™˘˘e ø˘˘eGõ˘˘à˘ dɢ˘Hh Üô˘˘©˘ dG ¿É˘˘æ˘ ˘°S’G »˘˘ ˘ ˘ ˘ μ˘ ˘ ˘ ˘ ˘jÒe’G …Qƒ˘˘ ˘ ˘ ˘ ˘°ùdG ô“DƒŸG ∂dòch ¿Éæ°S’G Ö£d ∫h’G …óæμdGh …Qƒ˘˘ ˘ °ùdG ´ô˘˘ ˘ ˘Ø˘ ˘ ˘ ∏˘ ˘ ˘ d ∫hC’G ô“DƒŸG áHhô©dG ᪰UÉY ≥°ûeO áæjóe ‘ Gòg πc ¿Éæ°S’G ÖW çÉëHC’ á«ŸÉ©dG á«©ªé∏d »ª∏©dG •É°ûædG Gòg , Úª°SÉ«dG áæjóeh ájóéHC’G ó∏H , ÚãMÉÑdGh Aɪ∏©dG á∏Ñbh ájQƒ°S ¢VQG ≈∏Y IójóY äGƒæ°S òæeh QGôªà°SÉH ΩÉ≤j …òdGh ÉæàHÉ≤æd õ«ªàŸG åMÉHh ⁄ÉY É¡«dG ΩOÉb πμd É¡«YGQPh É¡Ñ∏b íàØJ »àdGh »HôY πc ≈∏Y á«dɨdG ¢ù«FôdG ó«°ùdG IQGóLh QGóàbGh áªμëH ÉgOƒ≤j »àdG IóeÉ°üdG ájQƒ°S , º∏Y ÖdÉWh .QGô≤à°S’Gh ¿ÉeC’Gh øeC’G ºFÉYO É¡«a ≈°SQG …òdGh ájQƒ¡ª÷G ¢ù«FQ ó°S’G QÉ°ûH
Dr. Walid Nehmeh running an endodontic workshop
th 44 17 Arabic and International Dental Meeting
PICTURES FROM THE EXHIBITION FLOOR
ájQƒ°S ‘ ¿Éæ°S’G AÉÑWCG áHÉ≤æd ô°ûY ™HÉ°ùdG ‹hódGh »Hô©dG ô“DƒŸG
¿Éæ°SC’G ÖW ∞ëàe ‘ ô©°T ƒHCG Òæe QƒàcódG DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
th 46 17 Arabic and International Dental Meeting
PICTURES FROM THE EXHIBITION FLOOR
ájQƒ°S ‘ ¿Éæ°S’G AÉÑWCG áHÉ≤æd ô°ûY ™HÉ°ùdG ‹hódGh »Hô©dG ô“DƒŸG
DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
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PICTURES FROM THE EXHIBITION FLOOR
ájQƒ°S ‘ ¿Éæ°S’G AÉÑWCG áHÉ≤æd ô°ûY ™HÉ°ùdG ‹hódGh »Hô©dG ô“DƒŸG
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DOES YOUR PATIENT SUFFER FROM
DRY MOUTH?
What is dry mouth?
We can all suffer from dry mouth at some point, for example, if we are nervous or stressed. So most of us are familiar with the feeling of not having enough saliva in our mouth to keep it moist and lubricated. For some people, however, dry mouth can be a regular problem. As we get older we are more likely to experience dry mouth, but it’s also a problem that can affect people from their 30s onwards.
What causes dry mouth? Dry mouth occurs when the salivary glands stop working effectively. Medicines are known to cause over 60% of dry mouth cases, with more than 400 different medications linked to dry mouth. The number of medicines a patient takes is also directly related to the likelihood of experiencing dry mouth. Health conditions are also linked to dry mouth, such as diabetes or Sjögren’s syndrome. People who smoke, who are pregnant, stressed, anxious or dehydrated are also more likely to have dry mouth.
What are the symptoms? The symptoms of dry mouth can include: • difficulty in eating, especially with dry foods, such as • cereals or crackers • difficulty in swallowing and speaking • a burning sensation in the mouth • taste disturbances • painful tongue • dry, cracked, painful lips • bad breath • persistent difficulty in wearing dentures • feeling thirsty, especially at night • dry, rough tongue. Sometimes the amount of saliva a person produces may be reduced by up to 50% before these symptoms are noticed. These symptoms can sometimes have a profound effect on self confidence.
Does dry mouth cause other problems? Saliva plays a very important protective role in the body. It not only keeps our mouth moist, it also helps to protect our teeth from decay, helps to prevent infections and helps to heal sores in the mouth.
Are your patients dry mouth sufferers? • Do they have difficulty swallowing certain foods? • Does their mouth feel dry when eating a meal? • Do they need to sip liquids to help swallow dry foods? • Are they taking multiple medicines? If a patient answered yes to any of these, he/she may have dry mouth.
Products to ease dry mouth The Biotène system is specifically designed to treat dry mouth. The different products in the Biotène system allow you to choose the ones that best meet your lifestyle and dry mouth needs: • 1 product specifically designed to help relieve your dry mouth: • the gel provides long lasting relief • 2 products to help maintain healthy teeth and prevent tooth • decay in people with dry mouth: a toothpaste, with fluoride, • and mouthwash which can be used twice a day in place of the • usual products. These are designed to be gentle on your • mouth as they are alcohol-free and don’t contain harsh • detergents. Biotène supplements the make-up of normal saliva to replenish dry mouths. It has a patented enzyme formulation that: • helps supplement saliva’s natural defences • helps maintain the oral environment to provide protection • against dry mouth • helps supplement saliva’s natural antibacterial • system - weakened in a dry mouth. Biotène’s gentle formulation is also free from alcohol and harsh detergents.
What else can a patient do to manage dry mouth? • Sip water or sugar-free drinks often • Avoid drinks which dry out the mouth, such as caffeine-containing • drinks (coffee, tea, some fizzy drinks) and alcohol • Chew sugar-free gums or sweets to stimulate saliva flow • Avoid tobacco as this has a drying effect • Use a humidifier at night to keep the air full of moisture.
To help keep healthy teeth and avoid tooth decay: • Brush teeth with a soft toothbrush after meals and at bedtime • Floss teeth gently every day. If there is bleeding from gums • when flossing, this could be a sign of gum disease. • Use an SLS-free, fluoride toothpaste, like Biotène, with its • gentle formulation • Avoid alcohol-containing mouthwashes as these can dry • out the mouth • Avoid sweet, sugary foods • Visit the dentist at least twice a year for a check-up.
th 52 5 Bahrain Dental Society Conference 2009
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Picture from the inauguration of the exhibition floor at Isa Cultural Center DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
th 53 5 Bahrain Dental Society Conference 2009
Dr. Raja Kadhim President of the Bahrain Dental Society
Picture from the audience DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
th 54 5 Bahrain Dental Society Conference 2009
Dr. Andrew Forgie, Pr. Abdullah Al Shummary and Dr. Ali Matar
Dr. Raja’ Kadhim giving the trophy to the Representative of the Minister of Health
Left to right:
Left to right: Dr.
Dr. Suheila Al Safar receiving a certificate for discussing Art and Dentistry
Jamil Nasr, Dr. Moataz El Gezawi and Dr. Hassan Selim
Dr. Eric Whaites lecturing on the latest technologies in dental radiology
Dr. Ehab Haikal lecturing on standardization in the dental office
Pr. Nabil Barakat lecturing on implant dentistry
Dr. Munem Haffadh debating orthodontics vs restorative treatment
DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
th 56 5 Bahrain Dental Society Conference 2009
Pictures from the exhibition floor
Picture from the closing ceremony at the Bandar Resort DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
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58 Dental - Facial Cosmetic International Conference
Winners of Aesthetic Dentistry MENA Awards 2009 Announced! Winners of the Aesthetic Dentistry MENA AWARDS have been announced during the Grand Gala Ceremony at the Jumeirah Beach Hotel in Dubai. The judging and evaluation process of the first edition of the awards was completed and the much anticipated results were announced on November 05th, at the prestigious Jumeirah Beach Hotel, where winners, nominees and judges from the Middle East gathered with the elite of the aesthetic dentistry to pay tribute to the most outstanding achievements in dental treatment. Members of the jury panel faced a tough evaluation process due to the large number of quality cases submitted but finally came to a conclusion. The event showcased 29 short listed dental professionals from 88 entries, from 14 countries across the MENA Region. All winning Doctors attended the Gala Dinner Ceremony at the Jumeirah Beach Hotel. The trophies were presented by the Emirates Medical Association – Dental Society, Ministry of Health and CAPP – Centre for Advanced Professional Practices. Congratulations to the dentists below 1st Place Winner Conservative Best Case Lamberto Villani, Oral Design Laboratory, Dubai 2nd Place Winner Conservative Best Case
Dr. Michael Ziegler, American Dental Clinic Dubai 1st Place Winner Orthodontic Best Case Dr. Edgard Irany, Al Zahra Private Hospital, Sharjah 2nd Place Winner Orthodontic Best Case Dr. Mazen Hamadi, Ghoudousi Medical Centre, Dubai 1st Place Winner Prosthodontic Best Case Dr. Ajay Juneja The Dental Studio, Dubai 2nd Place Winner Prosthodontic Best Case Prof. Jean-Marie Megarbane, Lebanon 1st Place Winner Implantology & Red Aesthetic Best Case Dr. Angela Husung, German Dental Clinic Dubai 2nd Place Winner Implantology & Red Aesthetic Best Case Dr. David Rose, Drs. Nicholas & Asp, Dubai MENA "Aesthetic Dentistry" Awards 2009 is the biggest, one of the most remarkable dental assembly in the region which marks the dental calendars and puts the regional dental achievements on the World Dental Professional map.
Left to right : Dr. Nadim Aboujaoude, Dr. Ali Emamgholipour, Dr. D.Mollova, Dr. Aisha Sultan, Dr. Wolfgang Richter, Dr. Ali Al Nimairy, Dr. Adel Alhadlaq, Dr. Ameen Al Amiri, Prof. Yousef Talic, Dr. Ninette Banday, Dr. Mohamed A Abdallah, DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
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60 Dental - Facial Cosmetic International Conference
Dr. Edgard Irany from Sharjah receiving his trophy
Pr. Jean-Marie Megarbane from Lebanon receiving his trophy
Dr. Sanaz Soheilifar from Iran
Dr. Vihalakshmi Sunetra from Dubai
Mr. Dan Stenkilsson from M.E. Dental Lab Dubai
Picture from the gala dinner
DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
62 Dental - Facial Cosmetic International Conference
(Right) Dr. Mounir Selwadi offering the trophy to Prof. Wolfgang Richter from Austria for lecturing on Excellence in aesthetic dentistry
To Dr. Julian Caplan from the UK receiving the trophy for his presentation on anterior and posterior Cerecs
Dr. Luca Dalloca from Italy talking on Veneers and porcelain crowns
From left to right: Dr. Fahed Al Obeidi, Dr. Julien Caplan, Mr. Alan Thompson and Dr. Ali Mohammad
The beautiful dancing fountains near Dubai Mall
DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
64 Dental - Facial Cosmetic International Conference
Pictures from the exhibition floor
Dr. Tony Dib receiving the media certificate from Dr. Aysha Sultan
DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
ADVERTORIAL
TEBODONT®: Successful against oral microorganisms The essential oil of the australian tea tree (Melaleuca Alternifolia) is more and more used in oral hygiene with a remarkable success. In the Medical Dental Clinic of Bethanien (Professor Sailer) in Zurich / Switzerland it has become an universal remedy within a short lapse of time. “I don't use Chlorhexidin anymore” said the Head of the Clinic, Dr. Arno König, who uses above all the Gel and the Mouthrinse out of the different Tea Tree Oil products (TEBODONT®).
“
Tea Tree Oil is an universal remedy in our Clinic
When do you use Tea Tree Oil products?
”
68 Advertorial - Tebodont
Always after surgical interventions. And always after implantations: the parts to be screwed on the implants are soaked in Tea Tree Oil before. We also use it in case of troubles after the treatment - in Candidiasis. Our Dental Hygienist gives it in cases of periodontitis. And, since a few patients told us that they could significantly reduce their aphtae problem with the Tea Trea Oil toothpaste, we also recommend it for this indication. Tea Tree Oil has become an universal remedy in our Clinic. The Gel is primarily used during the treatment and postsurgical, the other products are given to the patients for home care.
How do your patients react on Tea Tree Oil? Dr. König, how did you discover Tea Tree Oil? We received samples of TEBODONT® Gel two years ago. Clinically, I noticed quickly that it is less irritating than Chlorhexidin. In addition, and very important for us: it does not produce any discolorations. This plays an important role to our patients who notice even smallest discolorations on their bleached teeth. Another advantage of Tea Tree Oil: it acts successfully against Candida albicans. Nowadays, I don't use Chlorhexidin anymore. DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
There are patients who do not like the taste of Tea Tree Oil. Others, like myself, appreciate the refreshing taste. The positive feedback we get from the patients: In contrast to Chlorhexidin, Tea Tree Oil does neither discolour the teeth, nor change the sense of taste. Tea Tree Oil is an universal remedy in our Clinic. Dr. med. dent. Arno König, Head of the Medical Dental Clinic Bethanien, Zurich/Switzerland
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PRODUCT NEWS
NEW, The Cavex RushBrush The Cavex RushBrush is a high quality ready-to-go toothbrush pre-pasted with a fresh minty toothpaste. Due to a small brush head the Cavex RushBrush effectively cleans even the hardest to reach regions of the mouth and the rounded of brush hairs are gentle for the gums. To ensure freshness the Cavex RushBrush has been hygienically packed in a plastic pouch and therefore easy to take with. So wherever you are and whatever the situation, simply open the pouch and start brushing. It does not get more easy than that. More information on www.cavex.nl.
Ivoclar Vivadent presents pre-shaded zirconium oxide blocks
72 PRODUCT NEWS
Ivoclar Vivadent has launched IPS e.max ZirCAD Colour Blocks, homogeneously shaded zirconium oxide blocks. The blocks are an alternative to the IPS e.max ZirCAD Colouring Liquids for white blocks and the shades are adjusted to those of IPS e.max glass-ceramics. The blocks can be processed in Sironas inLab system. Shaded zirconium oxide frameworks facilitate the reproduction of the required tooth shade and thus ensure highly aesthetic veneering results. Therefore, as an alternative to the IPS e.max ZirCAD Colouring Liquids for white blocks, Ivoclar Vivadent offers the new pre-shaded IPS e.max ZirCAD Colour Blocks. With the choice between pre-shaded blocks or
DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
Colouring Liquids for individual shading, laboratories now have a variety of processing options for zirconium oxide-supported restorations. The shade concept of the IPS e.max ZirCAD Colour Blocks is based on the IPS e.max glass-ceramics shade system. The basic shade of the framework optimally supports the aesthetic veneering result – particularly when combination restorations involving lithium disilicate and oxide ceramics are fabricated. In addition, the basic shade is suitable for fabricating zirconium oxide primary crowns and implant superstructures. For additional information: www.ivoclarvivadent.com
PRODUCT NEWS Leone ExaconeTM 6.5 implants, ideal for cases with limited bone availability Today dental implant treatment is considered to be the first choice therapy for replacing missing teeth. But sometimes there is not enough vertical bone height to place an implant and the clinician has to opt for challenging augmentation procedures or even renounce the implant treatment. As of today the ExaconeTM 6.5 short implant constitutes the solution for cases of limited bone height. Due to its reduced length of just 6,5 mm, it is possible to desist from carrying out complex surgical procedures, such as maxillary sinus lifting and inferior alveolar nerve transposition, avoiding sensitive anatomical structures with a high degree of safety: the reduced treatment time and costs will increase patient satisfaction. The Leone ExaconeTM 6.5 implant maintains the main features of the ExaconeTM implant system, especially the self-locking implant-abutment connection with no internal screw and the platform switching design, with all the well-known advantages regarding the preservation of the crestal bone and prosthetic simplicity and safety. The outstanding stability thanks to the Morse cone and the extremely long mating surface between implant and abutment leads to an optimal load distribution, an aspect of primary importance especially when using short implants, as their application inevitably will result in
unfavourable crown-implant ratios. In order to guarantee a high primary stability and a large bone-to-implant contact surface the height of the ExaconeTM 6.5 implant thread is increased by 125% in comparison to the standard ExaconeTM implant system. To make optimum use of the available bone height, ensuring safety for the anatomical structures, specific drills with integrated depth stop have been developed. Using the ExaconeTM 6.5 implant there is no need for special prosthetic accessories, since the inner connection is the same as the one of the standard 4,1 mm Leone implants: the whole yellow colour-coded range of healing caps, transfer and abutments can be used. Leone S.p.A. – Orthodontics and Implantology www.leone.it - E-mail: info@leone.it
76 PRODUCT NEWS
VITA and SensAble Partner to Integrate VITA's Tooth Libraries into the SensAble Dental Lab System SensAble Technologies and VITA®, the dental restoration leader for over 80 years based in Bad Sackingen, Germany, announced that SensAble has integrated VITA’s celebrated PHYSIODENS® and VITAPAN® digital tooth libraries into the SensAble Dental Lab System (SDLS). SensAble’s system is an integrated CAD/CAM solution to scan, design and fabricate a wide variety of dental restorations, including full-contour crowns and bridges, as well as metal and flexible partials. These two digital libraries were created specifically for inclusion in SensAble’s system by precisely scanning VITA’s hand-crafted denture teeth – renowned for their exacting conformance to the look, shape and function of natural teeth. Dental lab technicians use the 3D models of the teeth as a starting-point for digitally designing the perfect fitting restoration for a patient. By offering VITA’s tooth libraries in digital form within SensAble’s system, the two companies expand dental labs’ choice and flexibility to deliver the most functional and esthetically pleasing restorations to their dentists – restorations created with digital speed, precision and efficiency. Using the SensAble Dental Lab System, lab technicians can select a virtual tooth from the library, and then quickly adjust the size, morphology, and placement as needed. They can use the tooth libraries to quickly design porcelain or full metal crowns and bridges. Additionally, the VITA digital tooth libraries help speed the design of combination cases where the DENTAL NEWS, VOLUME XVI, NUMBER IV, 2009
teeth on a removable partial need to match the patient’s fixed restorations. SensAble’s unique CAD/CAM system allows technicians to hold a “Nintendo-Wii-like” haptic (force feedback) device instead of a computer mouse that enables them to literally “feel” the on-screen model as they apply, smooth and carve ‘digital wax’. This 3D virtual touch approach mimics the traditional method of hand modeling dental restorations – yet adds the consistency, precision and repeatability of a digital system.
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