Dental News June 2010

www.dentalnews.com

AEEDC

2010

Volume XVII, Number II, 2010

DIAGNOSIS AND TREATMENT OF THREE-ROOTED MAXILLARY PREMOLARS

ISSN 1026 261X

How patients view their dentist

SDS - KSU Riyadh 13th Int’l Dental Conference

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CONTENTS Vo l u m e X V I I , N u m b e r I I , 2 0 1 0 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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How patients view their dentist: expectations and preferences Dr. Abdulrahman A. Al Bedawi, Dr. Anne Koerber, Dr. Anwar Al Bana

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An innovation for the initial endodontic treatment - Revo-S® Dr. Zouiten Skhiri S, Dr. Hammo M, Dr. Ourfelli S, Dr. Douki N, Dr. Jammali B, Dr. Baccouch Ch

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Diagnosis and Treatment of Three-Rooted Maxillary Premolars Dr. Kusum Valli Somisetty

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SDS - King Saud University 13Th International Dental Conference

42

Nouvelles Techniques et Technologies en Médecine et Chirurgie Buccales, Tunis

48

AEEDC - 2010

65

A Moisture Tolerant, Resin-Based Pit and Fissure Sealant Dr Ira Hoffman

76

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

INTERNATIONAL REVIEW BOARD

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.

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INTERNATIONAL CALENDAR June 10 – 13, 2010

November 2 – 6, 2010

67th Malaysian Dental Association Annual General Meeting and World Dental Federation International Scientific Convention & Trade Exhibition Venue: Kuala Lumpur Convention Centre Email: mda@streamyx.com Website: www.mda.org.my

AIDC 2010 Dentistry Art & Science Alexandria International Dental Congress Email: info@aidc-egypt.org Website: www.aidc-egypt.org November 5 – 6, 2010

September 2 – 5, 2010 FDI Annual World Dental Congress Salvador da Bahia, Brasil Email: congress@fdiworldental.org Website: www.fdiworldental.org

2nd Dental Facial Cosmetic International conference The address hotel, Dubai Marina Email: info@cappmea.com Website: www.cappmea.com/awards2010 November 9 – 11, 2010

September 22 – 25, 2010 Beirut International Dental Meeting BIDM 2010 under the theme "Sustainable Dentistry" Beirut, Lebanon Email: lda@lda.org.lb Website: http://www.lda.org.lb

Dentistry 2010 Abu Dhabi National Exhibition Center Email: dentistry@iirme.com Website: www.dentistryme.com

October 13 – 14, 2010 5th Riyadh International Dental Meeting and Exhibition RIDM entitled New Era in Esthetic Dentistry at the Intercontinental Hotel, Riyadh, Kingdom of Saudi Arabia Tel: 966 533336151 Email: meeting@riyadh.edu.sa Website www.riyadh.edu.sa/meeting

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Volume XVII, Number II, 2010 DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

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GENERAL DENTISTRY

How patients view their dentist: EXPECTATIONS AND PREFERENCES Abstract Purpose: The study contrasted Kuwaiti dentists’ and patients’ characterizations of the perfect dentist.

Methods: Public dental clinic patients and doctors in Kuwait City rated characteristics of the perfect dentist on a 75-item survey, answered on a 5 point Likert scale. Nine scales were derived via factor analysis.

Results: 78% of 400 patients and 80% of 90 dentists responded.

Four of the nine scales showed significant differences between dentists and patients, but the differences were large on only two scales, Toughness (p<.000) and Skillful/Careful/Male (p<.000).

Patients agreed more than dentists that these were characteristic of the perfect dentist.

Conclusions: In many ways, Kuwaiti dentists and patients describe the perfect dentist similarly, particularly when compared to Scandinavian patients and dentists from prior studies. However, Kuwaiti patients and dentists did vary in that patients were somewhat more accepting of an authoritarian approach, and more desirous of skill and care, than Kuwaiti dentists. Kuwaiti women dentists are seen as not as the acceptable standard by their patients, and the dental community may need to reassure patients about the competence of women dentists.

for the relationship. In Finland, patients were found to rate the importance of dentists’ communicativeness more highly than did the dentists.1 Previous research found that patients’ satisfaction increased when2 their expectations were met and further that, patients who are satisfied are more compliant and have improved oral hygiene behavior and objective dental health.3 Previous studies reviewed the expectations of dentists and patients in the western world. This study reviewed the expectations of dentists and patients in Kuwait.

The objectives were to compare dentists’ and patients’ views of the perfect dentist in Kuwait, determining in which arenas their views were similar or divergent, in order to provide the Kuwaiti dental community with information to improve dentist-patient relationships. We expected to find the same differences that Lahti found between Finnish dentists and patients;4 namely that patients would rate gentleness and communicativeness as preferred, and dentistdominance as less preferred, than dentists.

Methods A survey of dentists and patients was conducted in Kuwait July 2001, in four of the five major public dental clinics. Permission was obtained from the Kuwaiti Ministry of Health, and the study design was approved by the University of Illinois at Chicago College of Dentistry.

Introduction

Survey

The relationship between dentist and patient is important in promoting patient trust and compliance with treatment regimens.

One way of examining dentist-patient relationships is to examine the similarity between dentist and patient expectations and norms

The questionnaire was taken from a previous study developed in Lahti’s study of Finnish5 dentists, using only the questionnaire regarding the perfect dentist. The survey consisted of 70 statements about the perfect dentist, which the subject could agree or

Table 1. Demographic information on Kuwaiti dentists and patients

Age in years, mean (SD) Sex Education

Employment

Practice Characteristics

Dentists n=72 36 (9) 61% Male 100% post College 100% (Total of Category) 99% Full Time 1% Part Time

100% (Total of Category) 77% Specialists 23% in practice <5 years 42% in practice >15 years 87% Public Clinic Practice

Patients n=312 31 (9) 37% Male 4% did not finish High School 31% finished High School 65% at least some college 100% (Total of Category) 52% Full Time 31% Part Time 8% Housewives 5% Unemployed 4% Retired 100% (Total of Category)

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

13 How patients view their dentist: EXPECTATIONS AND PREFERENCES

Dr. Abdulrahman A. Al Bedawi, Dr. Anne Koerber, Dr. Anwar Al Bana

GENERAL DENTISTRY disagree with on a 5 point scale. Demographic questions were added. (See table 1) Four questions concerning the importance of location and scheduling convenience were added to the survey, and one question concerning the importance of addressing the initial complaint also was added. The patients’ questionnaire was translated into Arabic and then back translated to English by a second party to ensure accuracy of the translation. The dentist questionnaire was administered in English. The survey took about twenty minutes to complete. The questions were answered on a 5 point Likert scale, with lower numbers indicating stronger agreement with the item.

Survey Respondents and Procedures

14 How patients view their dentist: EXPECTATIONS AND PREFERENCES

The survey was offered to all adult patients who visited any of four public dental centers throughout Kuwait during a two week period in July, 2001, and to dentists who were employed in those centers. The receptionists offered the survey together with a cover letter to the first 400 adult patients who checked into the centers during the period. The dentist survey was placed in the mailboxes at the clinics of the ninety dentists employed there, with a collection box for the returned surveys.

Statistical analysis Factor analysis was used to identify how the items naturally grouped together. Scales were formed according to the identified factors. Patients and dentists were compared on each scale.

Results The response rate for patients was 78% (312 of 400) and 80% for the dentists (72 of 90). Of the 312 patient questionnaires, 18 subjects answered fewer than 10 items, and were removed from the study, leaving 294 complete patient questionnaires (74% of the original sample). Missing data for the remaining questionnaires were replaced by the median scores of the other respondents of the same dentist-patient status, sex and age.

Factor analysis was performed, resulting in over 20 factors with Eigen values of over 1. The first ten factors were considered for this analysis. (See Table 2) Scaled scores were formed from each factor, using items that loaded on each factor greater than or equal to .490. Since on one item, no items loaded above .490, it was discarded, leaving nine scales. The scales were formed by adding the

Likert values for each item associated with the factor, so that higher scores indicated more disagreement with the scale and lower scores indicated stronger agreement with the scale. The factor scores were converted to 100-point scales by dividing the summed Likert scales by the number of items and multiplying by 100. Chronbach’s intrascale reliabilities were performed for each scale. The authors chose labels for each of the factors based on their content.

In order to compare dentists and patients, logistic regressions were performed on each of the nine scales, after collapsing the scales into binary variables above and below the medians. Dentist versus patient status was entered as an independent variable, as were age and sex. If the dentist-patient variable was significant in the regression after sex and age were entered, that scale was deemed to reveal differences between patients and dentists. Younger persons were more likely to endorse Scales 3 (p<.001) and 8 (p<.004), and women were less likely to endorse Scale 4 (p<.000), and more likely to endorse Scales 6 (p=.046), and 7 (p<.000).

Kuwaiti dentists and patients were in agreement that the ideal dentist should be empathic and personal, have no odors, touch only when necessary, and be affordable and competent. Both patients and dentists averaged neutral scores on Scale 4, Convenience and Touching Acceptable. Both agreed on the importance of practicing to standard of care. Dentists were more willing to consider it ideal to blame patients for the condition of their teeth, but less likely to consider toughness as ideal. Kuwaiti patients were considerably more likely to perceive maleness, specialization, experience and pain control as qualities of the ideal dentist than were Kuwaiti dentists. Additionally, the patients were more concerned with the possibility of over-treatment than the dentists (included in Scale 1).

Discussion More often than not, Kuwaiti dentists and patients agreed on the qualities of an ideal dentist. However, Kuwaiti patients preferred male dentists over female dentists. Speculatively, this may be related to the male dominance in dentistry in Kuwait, or to the differences in the status and role of women in Kuwait. Furthermore, this preference may have changed since this data were collected.

Patient preferences concerning dentists’ sex are not reported in European and American studies, and were not reported in a simi-

Table 2. Comparison of Kuwaiti dentists’ and patients’ responses on nine scales characterizing the ideal dentist, controlling for age and sex.

Scale Scale Scale Scale Scale Scale Scale Scale Scale

1– 2– 5– 8– 2– 4– 6– 7– 9–

Standard Dental Practice Skillful/Careful Male Toughness No Blame Empathic and Personal Convenience and Touching Acceptable No Odors No Touching Competent and Affordable

Dentists n=72 Median Mean (SD) 22 25(12) 54 57(12) 75 71(20) 70 68(24) 26 29(13) 55 57(14) 20 29(18) 20 33(22) 20 28(16)

Patients n=294 Median Mean (SD) 23 27(10) 31 33(10) 60 58(23) 60 62(28) 26 31(13) 60 60(20) 20 29(17) 20 34(21) 20 26(14)

Sig.* .047 .000 .000 .004 .770 .964 .335 .579 .228

20-30=Strongly Agree, 31-50=Agree, 51-69=Neutral, 70-89=Disagree, 90-100=Strongly Disagree. *Significance was tested in nine logistic regressions of dentist-patient status, sex and age on each scale, collapsed into binary variables at the median.

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

CEREC MEETS GALILEOS

Have you ever used CEREC for an implant?

Conservative dentistry and prosthetics have played a major role in the development of your practice. Imagine expanding this success strategy to implant planning and surgery. GALILEOS opens the door to a new world of 3D diagnostics and, combining data from CEREC and GALILEOS, allows simultaneous surgical and prosthetic planning of implants. Implant surgery is now faster and safer than ever: improved risk management, increased therapy proposal acceptance and optimized results – for satisfied patients and enhanced practice success.

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GENERAL DENTISTRY lar study of Finnish dentists.6 These findings reveal cultural differences in expectations of dentists when compared to studies done in other parts of the world.

Conclusions Some general conclusions can be stated: The dentist and patients in Kuwait were generally in agreement about the characteristics of the perfect dentist; the relationship between dentists and patients in Kuwait could be described with the model of “guidance-cooperation” in which the patient does participate but the power is mostly in the hands of the care giver; Kuwaiti patients tolerate a tougher dentist; Kuwaiti patients were more forgiving than the dentists about communication and gentleness; and Kuwaiti patients were more concerned about treatments aspects, e.g., receiving anesthesia, getting treated by an experienced dentist, and receiving only necessary treatment. Kuwaiti patients preferred male dentists.

Acknowledgments Kuwaiti Ministry of Health; Dr. Yousef Al Duwairy, Director General Denistry - State of Kuwait, Dr. Rahood Al Rashood, Director Adan Dental Center.

REFERENCES 1. Sahm, G., Bortsch, A., Koch, R., Witt, E.: Subjective appraisal of orthodontic practices – an investigation into perceived practice characteristics associated with patient and parent treatment satisfaction. Euro J O. 13;15-21:1991. Corah, N. L., O’Shea, R. M., Bessell, G. D., Thines, T. J., Mendola, P.: The dentist-patient relationship: perceived dentist behaviors that reduce patient anxiety and increase satisfaction. J Am Dent Assoc. 116;73-76:1988. Durant, R.H., Pierce, K.L., Powell, B.J., Sanders, J.M.: Dentists’ Professioanl Satisfaction with Adolescent Dentistry and its Association with Adolescent Dental Health Behavior. J Adolesc Health Care. 10:46-50:1989.

2. Lahti, S., Hausen, H., Kääriäinen, R.: Dentist and patient opinion about the ideal dentist and patient developing a compact questionnaire. Commun Dent Oral Epidemiol. 20;229234:1992.

3. Gerbert, B., Bleecker, T., Saub, E.: Dentists and the patients who love them: professional and patient views of dentistry. J Am Dent Assoc. 125;264-272:1994. Sinha, P. K., Handa, R. S., McNeill, D W.: Perceived orthodontist behaviors that predict patient satisfaction, orthodontist-patient relationship, and patient adherence in orthodontic treatment. Am J Orthod Dentofacial Orthop. 110(4);370-376:1996.

4. Lahti, S., Hausen, H., Kääriäinen, R.: Opinions of different subgroups of dentists and patients about the ideal dentist and the ideal patient. Commun Dent Oral Epidemiol. 23;8994:1994. Lahti, S., Hausen, H., Kääriäinen, R.: Ideal role behaviours as seen by dentists and patients themselves and by their role partners: do they differ?. Commun Dent Oral Epidemiol.

24;245-248:1996.

5. Lahti, S., Hausen, H., Kääriäinen, R.: Dentist and patient opinion about the ideal dentist and patient developing a compact questionnaire. Commun Dent Oral Epidemiol. 20;229234:1992. Lahti, S., Tuutti, H., Hausen, H. Et al.: Comparison of ideal and actual behavior of patients and dentists during dental treatment. Comm Dent Oral Epidemio. 23:374-278:1995.

6. Lahti, S., Hausen, H., Kääriäinen, R.: Opinions of different subgroups of dentists and patients about the ideal dentist and the ideal patient. Commun Dent Oral Epidemiol. 23;8994:1994. Lahti, S., Hausen, H., Kääriäinen, R.: Ideal role behaviours as seen by dentists and patients themselves and by their role partners: do they differ?. Commun Dent Oral Epidemiol.

24;245-248:1996.

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The VistaScan Mini Plus image plate scanner processes all intraoral formats with the highest image quality. And thanks to its compact design it is ideal for chairside use. A sophisticated operating concept makes handling particularly simple. The VistaScan Mini Plus is easily interfaced to surgery PCs via USB or network. Further details found at: www.duerr.de Duerr Dental Middle East, P.O.Box: 87355, Al Ain - U.A.E., Mobile: +971 (0) 50 - 550 84 12, Fax: +971 (0) 3 767 - 5615, email: koll.m@duerr.de

Sinus floor elevation upon Prof. Fouad Khoury's Biologic concept • • • •

2 days Advance surgical course in sinus floor elevation Intensive Course with several surgical demonstrations on different kind of sinus floor elevation with Retromolar and Chin bone Harvesting Hands on training on phantom mandible and Sheep heads 9 and 10 July 2010 Lecturers: Prof Antoine Khoury, Dr. Charles Khoury Location: Lebanese Dental Association – BEIRUT - LEBANON It is an exceptional course with limited number of attendance (20 participants). This course starts in the LDA location in "Cornich el Nahr" at 8:30 in the morning with several videos on sinus floor elevation combined with autogenous bone grafting harvested from different area in the mouth using the “MicroSaw” and without the need to harvest from the hip or from the parietal regions. These surgical operations explain in details different approaches for sinus floor elevation with simultaneous implant insertion by using autogenous bone grafting and by decreasing the healing period to 3 months for implant loading. During this course, an attention is also made on the indications and contra indications of internal sinus lifting and the influence of bone quality, height and shape of sinus cavity.

A Hands-on-training will follow each technique and will be done by each attendant on phantom mandible and sheep heads.

Program of the course 1- Videos transmission of surgical operations on sinus lift.

2- Anatomy of the sinus and surrounding structure 3- Internal sinus floor elevation (SFE) with bone condensers & limitation upon sinus shape and bone quality 4- External SFE : window technique step by step 5- SFE with or without simultaneous implant insertion in extreme cases. Augmentation materials : autogenous bone particulated or block graft, biomaterials, membranes…

6- SFE in combination with other procedures like tunnel technique approach, Intra oral Bone harvesting using trephine drills, Safe Scraper, the Microsaw (Step by step) & Physiopathology of bone grafting 7- Complications and Solutions like the perforation of the sinus mucosa…

8- Hands on training on phantom models and sheep heads (sinus floor elevation, bone harvesting MicroSaw…) 9- Free assistance for one SFE operation brought by the attendant

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

Limited places for 20 persons - 700US$/person For registration or more information please contact: Fiamed : 00961 1 290412 Email: info@fiamed.com Full program available on WebSite: www.Fiamed.com

ENDODONTICS

An innovation for the initial endodontic ® treatment - Revo-S :

ABSTRACT The analysis of advantages and disadvantages of different existing systems Nickel-Titanium has enabled the development of a new instrument Revo-S® (Micro-Mega, Besançon, France) with an innovative characteristic; an asymmetrical cutting profile. This system enables a fast shaping quality, a real cleaning and offers an apical finish corresponding to the anatomical and ecological criteria of the canal.

In the article below we will focus on the description, the operation protocol of Revo-S® and finally we will present 3 clinical cases of shaping through the reduced sequence of Revo-S®.

Keywords: Endodontic, Nickel-Titanium, apical finish, dissymmetrical profile, canal cleaning.

INTRODUCTION Today we cannot do without nickel titanium mechanized instruments during the cleaning and shaping stages of the canal system. This opinion has become unanimous because of time saved using these instruments, and because of the quality of the preparation obtained[8, 9] The aim is to simplify endodontic procedures while respecting the shaping objectives of the treatment[8 ,13] These objectives are to : • obtain a regular tapering preparation from the canal orifice to the apical foramen, • maintain the original canal anatomy, • respect the spatial position of the foramen on the root surface, • maintain the foramen as small as practical Today, two main instrument series are available on the market.

The first, which is the oldest, presents flat areas on the periphery of the instruments. The role of these radial lands was to centre

the instruments inside the canal, which abraded and burnished the dentin more than they would cut it[4,7,14] This series, mainly represented by the Profile® (DentsplyMaillefer, Ballaigues, Switzerland), and K3® (Sybron-Endo, Orange, USA) is now being supplanted. The second series so-called the active blade series, is developing more and more, since the creation in 1996 of the HERO 642 (Micro-Mega®, Besançon, France). Today it includes more than ten different systems (Alpha® GT Rotary®, HERO 642 ®, Heroshaper®, Mtwo®, Protaper® Race® etc...). Many parameters characterize them (section type, taper, pitch length, helix angles, cutting angles, clearance angles, etc.), and render their machining quite specific[4].

These characteristics have required instrument sequence protocols which are also specific.

Although these instruments have demonstrated their superiority versus the standard steel manual instrumentation, in terms of following the root canal pathway[11,12,4] and obtaining less preparation aberration[15, 4] they do not allow the dynamic upward removal of the machined dentin debris[4,5, 10]: as soon as their groove (hollow part between two flutes) is packed, the debris is then pushed back laterally into the canal cracks and tubules[1,4,6], or apically beyond the instrument tip.

The idea of an instrument able to improve this upward removal of debris and to optimize the root canal cleaning has motivated the development of NiTi files, thus revolutionizing the features of the previous instrument designs.

The upward removal of dentinal debris depends on the characteristics of the main cutting edges on the active part of the instrument: The spacing between two edges (pitch length), the depth of the grooves, and the orientation of the edges (helix and cutting angles). An additional innovating parameter may also be added to these main characteristics: the asymmetrical cross section (fig.1). The instrument will then work out through the canal DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

19 AN INNOVATION FOR THE INITIAL ENDODONTIC TREATMENT -REVO-S®

Zouiten Skhiri S1; Hammo M2; Ourfelli S3; Douki N4; Jammali B5; Baccouch Ch6 1. Professor, department of Dental Medicine, Hospital Farhat Hached Sousse, Tunisia 2. Hammo M, private practice Amman-Jordanie 3. Resident, department of Dental Medicine, Hospital Farhat Hached Sousse, Tunisia 4. Professor, department of Dental Medicine, Hospital Sahloul Sousse, Tunisia 5. Professor, department of Dental Medecine, Rabta Hospital Tunis, Tunisia 6. Professor, department of Dental Medicine, Hospital Farhat Hached Sousse, Tunisia

ENDODONTICS

Fig. 1: Revo-S® : Asymmetrical cross section

20 AN INNOVATION FOR THE INITIAL ENDODONTIC TREATMENT -REVO-S®

Fig. 2: Instrumental working cycle

according to a cutting/clearance cycle of cleaning (fig.2). On one hand, this revolution improves canal penetration, upward removal of dentinal debris, avoiding their packing inside the grooves, and therefore the pushing of debris in front of the instrument tip apically and beyond. On the other hand, this asymmetry reduces instrument stress during the canal preparation[3, 4]

removal of dentinal debris.

2- SC2 (yellow ring, grey stop) presents: _ a 4% taper _ an apical diameter of 25/100 _ a length of 25 mm SC2 is gradually brought to the length of the preparation work for the expansion of the apical region. The SC2 instrument has a symmetrical cross section, with a 04 taper allowing better penetration. Its equilateral section (3 identical edges) ensures a perfect guidance of the instrument up to the apical region of the canal, owing to the balance of the forces.

Recapitulating and cleaning instruments (SU) • SU (red ring, black stop) presents: _ a 6% taper _ an apical diameter of 25/100 _ a length of 25 mm SU is led to the working length to shape the 1/3 apical area.

Owing to its asymmetrical section, it recapitulates the action of the first two instruments SC1 and SC2, thus respecting the tapered shape of the canal. It performs excellent upward removal of the dentine debris, and an improved cleaning.

Apical finishing instruments (optional AS 30, AS 35, AS 40) (fig. 5)

Revo S® Series Series Revo S® marketed by (Micro-Mega, Besançon, France) is made up of : Two instruments for apical penetration (SC1 and SC2) (fig.3 ,4)

Fig. 5: Apical finishing instruments with an asymmetrical cross section

• AS 30 presents: _ a 6% taper _ an apical diameter of 30/100 _ a length of 25 mm Fig. 3: Revo-S® instruments for apical progression (SC1and SC2), and cleaning (SU).

1- SC1 (white ring, black stop) presents: _ a 6% taper _ an apical diameter of 25/100 _ a length of 21 mm SC1 is intended for the preparation of 2/3 coronary owing to its asymmetrical section. It performs a very good upward Fig. 4: Crown down progression of the (SC1and SC2) , then Cleaning and recapitulating with the (SU) DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

• AS 35 presents: _ a 6% taper _ an apical diameter of 35/100 _ a length of 25 mm • AS 40 presents : _ a 6% taper _ an apical diameter of 40/100 _ a length of 25mm For the finishing instruments, the ring colour corresponds to the size of the tip according to the ISO standard.

ENDODONTICS

Fig. 8: Apical shaping : a step-back sequence ( 35 mm -1mm, 40 mm -2mm) is also possible

- Low speed rotation - Going with in apical downward: ‘’push & hold’’.

22 AN INNOVATION FOR THE INITIAL ENDODONTIC TREATMENT -REVO-S®

Fig. 6: Protocol :Basic sequence with only 3instruments

These apical finishing instruments: • Enable efficient widening of the apical preparation to 06 taper respecting the preparation performed with (SC1, SC2 and SU) • Make a good upward removal of the dentinal debris owing to their asymmetrical sections, and an efficient disinfection (the irrigating solution penetrates to the 1/3 apical) • Facilitate the root canal obturation (by the easy access obtained)

Operative Protocol Principle of use • Rotational Speed The Revo-S® are used in continuous rotation. The rotation speed must be constant and ranging between (250 and 400 rpm).

• Dynamic of the movement - Files introduced stopped in the canal

Fig. 7a: Endoflare® : Taper 12% , Diameter 25/100

Fig. 7b Dentinal overhang

Endoflare® penetration (1 to 3 mm)

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

Coronal interference elimination

Instrumental sequence standard sequence: 3 instruments (fig. 6) The standard sequence of the 3 instruments is proposed to answer more than 80% of the clinical cases encountered in general practice[4] 1- Preoperative radio and estimation of canal length 2- Initial negotiation with a manual steel file of a-10 or 15/100 diameter, which provides information about the canal anatomy complementary to that obtained by the pre-operative X-rays.

3- Use a rotating NiTi coronal flaring file: Endoflare® (MicroMega, Besançon, France) in the 1/3 coronary to eliminate coronal debris, to improve the access to canal entrances and to facilitate the insertion of Revo-S® instruments (fig.7).

4- Use of SC1 up to the 2/3 of the estimated working length (WL) 5- Determine evaluation of working length (apex locator and radiological confirmation) 6- Use of SC2 up to the WL 7- Use the SU up to WL. 8- If necessary, and according to the root canal anatomy, the apical finishing instruments (AS 30, AS 35, AS 40) can be brought to the WL. In the canals with thin root canals or with marked curvature, these instruments are used in Step Back. (AS 30 at WL, AS 35 at WL -1mm, and AS 40 at WL -2mm if necessary) (fig.8).

Recommendation for use Like all NiTi instruments, the use of the Revo-S® is regulated through strict rules: • Create direct access to root canal • Always start with a manual tracking • Relocate canal entries with coronary opening NiTi instruments (orifice Shaper®, Endoflare® ...)

• Respect the instrumental sequence • Maintain a constant speed of rotation ranging between 250 and 400 rpm • Never use the Revo-S® in the 1/3 apical without precisely determining the working length.

• Irrigate and check up between each instrumental passage.

• Systematic monitoring of the condition of the instruments (visual control, measurement of the length) and throw them away in case of doubt.

• If an AS instrument fails to reach the working length, contin-

ENDODONTICS Fig. 9: Clinical case N°1

apical hooks, the sudden changes of angle, the narrowing or the secondary canals lead to the punctual concentration of constraints that determine the number of cycles before fatigue failure[2].

Conclusion

Fig. 9a: Preoperative X-ray

Fig. 9b: Postoperative X-ray: Canal shaping using Revo-S® sequence with an apical shaping

ue the preparation using the former instrument in order to work without any apical pressure.

24 AN INNOVATION FOR THE INITIAL ENDODONTIC TREATMENT -REVO-S®

Discussion The daily use of Revo -S® enables us to highlight some points: • The Revo-S® instruments meet the biological and mechanical canal preparation objectives.

• The extreme flexibility and elasticity of this new generation of instruments generate a remarkable capacity to adapt to the most severe curves and considerably limit the risk of fracture and trajectory deviation.

• They can, through their mechanization, evacuate perfectly dentinal chips towards coronary direction and avoid the phenomenon of extrusion.

• They can quickly, easily and safely perform a daily endodontic quality.

• Finally, provide canal shaping for different root canal filling techniques.

The qualities of these instruments should not make us forget their limitations, notably the phenomenon of the screwing and fracture risk.

These accidents are related to : • The technique: the rough handling, excessive pressure, the non-respecting operating sequences, the blockade of the instrument, the unstable or high speed rotation are all parameters that could cause fractures.

• The instrument itself: the instruments suffer multifactorial influences where drawing, taper, diameter and fatigue memory simultaneously intervene affecting the risk of screwing and fracture.

• The canal anatomy: curves exceeding 30°, small radii of curves,

The Revo -S® has a number of advantages related to their profiles: • Good cutting efficiency • Optimal upward removal of dentine debris • High break resistance • Maintain of the canal path (fig. 9,10) • Guidance in curves (fig.11) This new generation of NiTi instruments, based on asymmetrical cross section allow high quality canal preparations in a reduced time with greater comfort and safety. But only the prudence, knowledge and learning of the methodology as well as the respect of the endodontic concepts reduce risks and lead to success.

REFERENCES 1. Aktener BO, Cengiz T, Piskin B . - The penetration of smear material into dentinal tubules during instrumentation with surface active reagents: a scanning electron microsopic study - J Endod 1989;588-590.

2. Crinquette A, Claisse D - Série Quantec® Préparation canalaire : nickel titane et rotation continue au quotidien - Clinic 2000 vol 21 , N° 3 p 153-162 3. Diemer F, Georgelin-Gurgel M, Mallet JP - Influence de la dissymétrie sur le comportement des instruments endodontiques à profil de triple hélice. Communication CNEOC Clermont –Ferrand 2007.

4. Diemer F, Mallet J-P - Une innovation instrumentale pour le traitement endodontique initial: la séquence Revo-S® - Clinic - Novembre 2008-vol.29 :616-620 5. Gulabivaka k, Patel b, Evans G, Ng y-L - Effects of mechanical and chemical procedures on root canal surfaces. - Endodontic Topics 2005; 10,103-122.

6. In-Soo Jeon, Larz S.W. Spångberg, Tai-Cheol Yoon, Reza B. Kazemi, Kee-Yeon Kum Smear layer production by 3 rotary reamers with different cutting blade designs in straight root canals: a scanning electron microscopic study - Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology - November 2003 (Vol. 96, Issue 5, Pages 601-607) 7. Kum KY, Kasemi RB,Cha BY,Zhu Q. - Smear layer production of K3 and Profile Ni-Ti rotary instruments in curved root canals: A comparative SEM study. - Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2006 Apr;101 (4):536-41 8. Martin D; Amor J; Machtou P - Endodontie mécanisée le système Protaper® principes et guide d’utilisation - Rev Odont Stomat 2002; 31: 33-42 9. Martin D; Machtou P - Evolution des concepts de mise en forme du système canalaire.

Rev Odont Stomatol 1999;28:13-22 10. McComb D, Smith DC. - A preliminary scanning electron microscopic study of root canals after endodonticprocedure. - J Endod 1975: 238-243.

11. ShäferE, Lohmann D. - Efficiency of rotary nickel- titanium Flex Master instruments compared with stainless steel hand K- Flexofile : part 1.Shaping ability in stimulated curved canals.

Int Endod J 2002; 35:505-13 12. ShäferE - Shaping ability of Hero 642 rotary nickel-titanium instruments and stainless steel hand K –Flexofiles in simulated curved root canals. - Oral Surgy Oral Med Oral Pathol Oral Radiol Endod 2001; 92; 215-220 13. Schilder H. - Cleaning and shaping the root canal. - Dent Clin N Amer 1974;18:269-296.

14. Versümer J, Hülsmann M, Schäfers F. - A comparative study of root canal preparation using Profile 04 and lightspeed rotary Ni-Ti instruments - Int Endod J. 2002; 35: 37-46.

15. Weine FS, Heaey HJ, Gerstien H, Evanson L. - Pre-curved files and incremental instrumentation for root canal enlargement. - J Can Dent Assoc1970; 36: 155-7.

Fig.10: Clinical case N°2

Fig.10a: 46 Preoperative X-ray DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

Fig.10b: WL with a n°15 manual file (X ray file in place)

Fig.10c: mesiobuccal and mesiolingual canals: AS 30 distal canal: AS 35

Fig.11: Clinical case N°3 Maxillary molar shaped with Revo -S® files

ENDODONTICS

Diagnosis and Treatment of Three-Rooted Maxillary Premolars.

ABSTRACT Anatomical variations must be considered in clinical and radiographic evaluations during endodontic treatment. Maxillary premolars have a highly variable root canal morphology, but the presence of three canals is rare especially in the second premolar.

This article describes the diagnosis and clinical management of two clinical cases of three rooted maxillary premolars with three canals and three separate roots, with special reference to radiographic interpretation and access refinements.

Key words: Maxillary premolar; endodontic treatment; root morphology

INTRODUCTION Many of the difficulties found in root canal treatment are due to the variations in root canal morphology. Even treatment of uncomplicated multi-rooted teeth requires knowledge of the most frequent anatomical formations and possible variations.

In the case of the maxillary first premolar, three root canals are found at a frequency of 0.5-6%1, 2 and 1% for second premolars3. The anatomy of three-rooted maxillary premolars resembles that of maxillary molars.

Although pre-operative radiograph gives a two dimensional image of a three dimensional object, precise interpretation can reveal external and anatomic details that suggest the presence of extra canals/roots. For this reason, whenever there is an abrupt straightening or loss of a radiolucent canal in the pulp cavity, an extra canal should be suspected either in the same root or in other independent roots4.

Kuwait. The patient was referred to the specialty centre from the primary dental clinic after an emergency access opening on tooth 14 was completed. The pre-operative radiograph revealed that there is a possible anatomic tooth variation (Fig.1). After obtaining anesthesia with Lidocaine 2% plus epinephrine 1:80,000, isolation was done with a rubber dam. Buccal canals in three –rooted premolars normally lie close to each other and are often covered by a projection of cervical dentine. An Endo access bur number A0164 (Dentsply, Maillefer, Ballaigues, Switzerland ) was used to modify the edges of the access opening in tooth 14, in order to make a triangular conformation at the base, in the buccal direction5. Additionally, a uniform cut was made with a slow speed diamond (KG S 3203, Maillefer) at the buccal-proximo angle from the entrance of the buccal canals to the cavo-surface angle, resulting in a cavity with a T-shaped outline6.

After removing the coronal pulp, the buccal canals were explored with sizes 8 and 10 files and palatal with size 15 K file, resulting in clinical and radiographic confirmation of three canals (Fig. 2). The working length was established with apex locator (Root Z X, J. Morita, USA). Coronal flaring was carried out with Gates Glidden (Dentsply Maillefer, Switzerland burs sizes 50,70,90.

The remaining root canal system was prepared with K-Files with copious irrigation using 2.5% sodium hypochlorite solution. The master apical file in all canals was an ISO size 40. The canals were dried with paper points and obturated by laterally condensed gutta percha (Roeko,Germany) and AH26 root canal sealer (Dentsply, Germany). (Fig.3)

Case Report 2 Case Report 1 A 28 year old female patient presented at the Department of Endodontics, Bneid –Al-Ghar Dental Centre, Ministry of Health,

A 34 year old female patient with a non-contributory medical history referred by the primary dental centre presented to the Dept of Endodontics, Bneid –Al-Ghar Dental Centre, Kuwait. The

Fig.1 Preoperative periapical radiograph suggesting variation in root canal anatomy of tooth 14

Fig. 2 Perapical radiograph confirms three root canals and determination of working lengths DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

27 Diagnosis and Treatment of Three-Rooted Maxillary Premolars

Dr. Kusum Valli Somisetty. M.D.S

28 Diagnosis and Treatment of Three-Rooted Maxillary Premolars

ENDODONTICS

Fig. 3 Periapical radiograph after obturation of the three root canals

Fig. 4. Preoperative periapical radiograph suggesting variation in root canal anatomy of tooth 25

patient was referred to the specialty centre from the primary dental health centre after an emergency access opening on tooth 25 was completed. The pre-operative radiograph revealed that there is possible anatomic tooth variation (Fig.4). The tooth was isolated and access cavity was modified with a cut at the bucco-proximo angle from the entrance of the buccal canals to the cavo-surface angle resulting in a cavity with T-shaped outline6.

The buccal canals were explored with size15 K file resulting in clinical confirmation of three canals. The working lengths were confirmed using an apex locator (Root ZX, J.Morita, USA).

Coronal flaring was carried out with Gates Glidden (Dentsply Maillefer, Switzerland) burs sizes 50, 70, 90.The remaining root canal system was prepared with K-files with copious irrigation using 2.5% sodium hypochlorite solution. The master apical file in all canals was an ISO size 40.The canals were dried with paper points and obturated by laterally condensed gutta percha (Roeko, Germany) and AH26 (Dentsply,Germany) root canal sealer( Fig.5).

chamber does not appear to be aligned in its expected buccopalatal relationship. Additionally, if the pulp deviate from the normal configuration and seems to be either triangular in shape or too large in a mesiodistal plane, more than one root canal should be suspected11.

When confronted with unusual tooth anatomy as three rooted maxillary premolars, good illumination and magnification can make treatment easier. In these cases with three roots containing three root canals with independent apices, the premolar has the appearance of a molar. One wider canal is situated palatally and two thinner canals in a buccal position, one mesial and one distal.

As always, good endodontic treatment depends on the proper creation of an access cavity. Upper premolars with three canals require a modified “T” shaped access cavity with a mesiodistal extension in the buccal portion of the traditional cavity. This modification permits good access to both the buccal canals12. Correctly reaching all the root canals, cleaning and shaping, followed by a hermetic filling are necessary for successful root canal therapy.

Discussion The possible anatomic configurations of maxillary premolars are well documented in literature. High quality preoperative radiographs and their careful examination are essential for the detection of additional root canals6, 7, 8. Walton recommended the use of two diagnostic radiographs9. If a radiograph shows a sudden narrowing or even a disappearing pulp space, the canal diverges at that point into two parts that may either remain separate or merge before the apex10. If an eccentric orifice is found, at least one more canal is present and should be searched on the opposite side. A third canal should be suspected clinically when the pulp

Fig. 5. Periapical radiograph after obturation of the three root canals DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

Conclusion Clinicians should be aware of the anatomical variations in maxillary premolars and be able to apply this knowledge in radiographic and clinical interpretation. Access cavity refinements may be required for a stress free entry to complex anatomy. Complex premolar anatomy may be predictably managed following its identification and negotiation.

REFERENCES

1. Hess W. Anatomy of the root canals of the teeth of the permanent dentitions.

Part1. New York: William Wood, 1925- 3-49, 2. Pineda F, Kutler Y . Mesiodistal and buccolingual roentgenographic investigation of 7275 root canals- Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1972,-33-. 101-110.

3. Belizzi R, Hartwell G . Radiograhic evaluation of root canal anatomy of in vivo endodontically treated maxillary premolars - J Endodont 1985,- 11-. 37-41.

4. Ferreira CM, Moraes I G, Bernardineli N . Three-rooted maxillary second premolar- Journal of Endodontics 2000,- 26-. 105-106.

5. Soares J.A, Leonardo R.T . Root canal treatment of three - rooted maxillary first and second premolars - a case report- International Endodontic Journal 2003,- 36-. 705-710.

6. Sieraski SM, Taylor GT, Kohn RA . Identification and Endodontic management of threecanalled maxillary premolars- J of Endodod 1985,- 15 -. 29-32.

7. Slowely RR . Radiographic aids in detection of extra canals- Oral Surgery,Oral Medicine and Oral pathology 1974,- 37 -. 762-772.

8. Slowely RR . Root canal anatomy- road map to successful endodontics- Dent Clin North America 1979,-23 -. 555-573.

9. Javidi M, Zarei M, Vatanpour. M. Endodontic treatment of a radiculous maxillary premolar. A case report- J Oral Sci 2008,-50-. 99-102.

10. Walton RE. Endodontic radiographic techniques - Dent radio Photoradio. 1973,-46-.51-59.

11. Vertucci FJ . Root morphology of mandibular premolars- J Am Dent Assoc. 1978,-97-. 47-50.

12. Al-Fouzan K.S (2001). The microscopic diagnosis and treatment of a mandibular second premolar with four canals- Int. End J 2001,- 34 -. 406-410.

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32 KING SAUD UNIVERSITY 13TH INTERNATIONAL DENTAL CONFERENCE

PROF. ABDULLAH S. AL YAHYA Dean, College of Dentistry & Chairman, Organizing Committee It is with great honor and privilege to welcome you all to the 13th King Saud University International Dental Conference & 21st for the Saudi Dental Society.

The College of Dentistry of King Saud University, being the first dental school established in the Arab Gulf Region 35 years ago, always aims for a high quality of education. This meeting is one of the means to achieve our goal of fast pace advancement, transforming the scope of dental sphere and its relation to progressing field of dental medicine.

This conference with the collaboration of the Saudi Dental Society, in addition to giving the opportunity to accommodate as many as possible for diversity of research covering all fields of dentistry to be given orally or in a form of posters and table clinics, it also offers a full state of exhibits on the current technology in dental materials, instruments and equipments which are being introduced into the current trend in dentistry.

To all speakers, participants and exhibitors, my very best wishes for a successful conference and I hope that our scientific and clinical deliberations will be productive and be beneficial to all.

God bless you all.

Prof. Yousef Talic Co-chairman, organizing committee

Dean Abdullah al Yahya (in the middle) distributing trophees during the opening ceremony DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

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34 KING SAUD UNIVERSITY 13TH INTERNATIONAL DENTAL CONFERENCE

Prof. Franklin Tay receiving the certificate from Dr. Assery for his lecture on the Dentin Bonding systems

Prof. Allan Farman receiving the trophy from the Dean for his lecture on CBCT Dental imaging

Dr. Waleed Sadek Chairman Scientific committee

Dr. Ronald Goldstein receiving a trophy from Dean Abdullah al Yahya for his lectures on Esthetic Dentistry

Dr. Hani Ounsi receiving the certificate from Dr. Khaled Balto for his lecture on Mechanical endodontics

Dr. Zaki Malallah lecturing on instrumentation in Endodontics

Dr. Faouzi Riachi lecturing on dentinal hypersensitivity

Dr. Nelson Rhodus receiving the certificate from Dr. Abdulaziz for his lecture on Oral cancer

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

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36 KING SAUD UNIVERSITY 13TH INTERNATIONAL DENTAL CONFERENCE

(left to right) Dr. Dib, Dean Al Yahya and Pr. Doumit during their visit to the Dental school at the King Saud University

(left to right) Dr. Maktabi, Dr. Soubt, Pr. Doumit and Dr. Nassif

Dr. Ronald Glauser receiving the certificate from Pr. Abdullah Al Dawsary for his lecture on Implant Dentistry

Dr. Hamad Al Harthi Chairman Oman Dental Society receiving the trophee

Picture from the exhibition opening

Picture from the exhibition

Pictures from the closing ceremony during the traditional sword dance DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

38 KING SAUD UNIVERSITY 13TH INTERNATIONAL DENTAL CONFERENCE

Dean Abdullah al Yahya during the closing ceremony offering trophies to:

Prof. Mounir Doumit Dean Lebanese University Dental School

Dr. Charles Sfeir from the USA receiving the trophy from the Dean for his lecture on craniofacial regeneration

Dr. Tony Dib

Dr. Safouh al Bounni President of the Syrian Dental Society

Prof. Nour Habib Dean Cairo University Dental School

Dr. Mohammad Saadeh President of the North Lebanon Dental Society

Dr. Sameer Mokeem Chairman exhibition committee

Prof. Maguid Amin from Egypt

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

40 KING SAUD UNIVERSITY 13TH INTERNATIONAL DENTAL CONFERENCE

Pictures from the exhibition floor

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

42 NOUVELLES TECHNIQUES ET TECHNOLOGIES EN MEDECINE ET CHIRURGIE BUCCALES - TUNISIA

Mot de La Présidente Pr. Faten BEN AMOR Au nom du comité d'organisation de l'ATORECD (Association Tunisienne Odontologique de Recherches et d'Etudes en Chirurgie et Douleur), permettez-moi de souhaiter la bienvenue à tous nos invités venus des deux rives de la méditerranée et spécialement nos partenaires du SENAME (South Europe North Africa Middle-East International Society of Implantology & Modern Dentistry) et en particulier son président le Pr Gilberto Sammartino, pour avoir contribué spontanément à la réussite de ce congrès organisé sous le patronage de monsieur le ministre de la santé publique, congrès que nous souhaitons, à l'image de notre pays la Tunisie, imprégné d'amitié, de convivialité et de chaleur humaine à la manière méditerranéenne.

Notre espoir est que ces rencontres soient le point de départ d'une collaboration fructueuse englobant toutes les spécialités odontologiques.

Notre souhait est que l'ATORECD soit une plateforme pour toutes les générations de médecins dentistes permettant des échanges entre nos pionniers de part leur sagesse et leur courage, nous autres de part notre expérience et les jeunes diplômés de part leurs fraiches connaissances et leurs accès aux nouvelles technologies, renforçant ainsi la trinité qui définit

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

notre profession : le savoir, le savoir faire et le savoir être.

C'est sans cesse que nous oeuvrons pour plus d'ouverture entre l'université et le secteur privé par l'instauration de mastères, de cycles de formation et de congrès : en un mot une formation continue structurée, c'est pourquoi notre congrès sera clôturé par une table ronde ayant pour thème : “Reflexion sur la formation continue odontologique dans le basin mediterranéen” Présidée par messieurs le doyen de la Faculté de médecine dentaire de Monastir le professeur A. Abid et le vice doyen chargé de la formation continue à la faculté de médecine dentaire de Clermont Ferrand, Pr K. Oulhadj Belhadj, avec la participation pour l'enrichissement du débat de tous les conférenciers et les enseignants de la Faculté de médecine dentaire de Monastir.

Notre jeune association aspire à des rencontres marquantes qui pourraient donner une impulsion nouvelle et un dynamisme collégial et inter méditerranéen à notre chère et noble profession.

Bon séjour à tous parmi nous

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44 NOUVELLES TECHNIQUES ET TECHNOLOGIES EN MEDECINE ET CHIRURGIE BUCCALES - TUNISIA

Traditional Tunisian glasswork plate presented to the Minister Of Health

Picture from the SENAM meeting

Dental professionals gathering around Pr. Faten Ben Amor

Pr. Michel Danguy , Dr. Tony Dib and Pr. Abdellatif Boughzala

Pr. Abid giving the certificate to Dr. Ben Afia for her lecture on implants

Pr. Sammartino presenting a gift to the winner of the poster presentation

Dr. Halim Ayyoub from Egypt discussing treatment plan in Implantology

Pr. Dallel from France talking about the novelties in pain management

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

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OPTIM is a registered trademark and “Because the stakes are too high” and “Your Infection Control Specialist” are trademarks of SciCan Ltd.

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46 NOUVELLES TECHNIQUES ET TECHNOLOGIES EN MEDECINE ET CHIRURGIE BUCCALES - TUNISIA

Pr. Abid (left) giving the certificate to Dr. Baccouche for his lecture on lasers

Pr. Nabiha Douki presenting new methods for caries treatment

Pr. Michel Danguy during his lecture on TMJ pain

Pr. Michel Danguy receiving the trophy from Pr. Adel Ben Amor

Pr. Gilberto Sammartino lecturing on esthetics in Implantology

Dr. Arzu Demircioglu from Turkey talking about geriatric implantology

Pictures from the exhibition DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

OPENING CEREMONY

48 AEEDC - MARCH 2010

AEEDC 2010 H.H Sheikh Hamdan Bin Rashid Al Maktoum inaugurated on March 9, the AEEDC Dubai 2010, at the Dubai International Convention and Exhibition centre.

He explored the latest medical devices, technologies and equipments displayed by over 800 specialized companies from 65 countries, especially after it has successfully been ranked fifth worldwide in dentistry and cosmetic dentistry, according to the International Dental Manufacturers.

The number of dentists participating in the conference, is estimated to reach 20,000 dentist. Moreover, H.E Qadhi Saeed Al Murooshid, Director General – Dubai Health Authority said “the AEEDC Dubai is a great opportunity for all dentists and decision makers in the private and public sectors, as it cater their needs of all medical equipments and services displayed by major international companies.”

The scientific program for AEEDC 2010 included a variety of new activities including the advanced specialty courses, the AEEDC International Orthodontic Meeting, the world Federation for Laser Dentistry WFLD and the GCC meeting.

Professor Abdulla Shammary, said “The GCC Oral Health Meeting members comprise of the Board member for GCC States, executive board of the health ministers’ council for GCC countries, representatives of the Ministry of Health from different GCC Countries specifically United Arab Emirates, Kingdom of Bahrain, Kingdom of Saudi Arabia, Sultanate of Oman, Yemen, Qatar and Kuwait, in addition to several Health organizations such as Dubai Health Authority, Abu Dhabi Health Authority, and Riyadh College of Dentistry & Pharmacy in the KSA. These committee members will discuss various provisional agenda including preventive oral health services in the GCC and will provide latest scientific research and discuss the updates on the preventive dentistry fields”.

Dr. Tariq Khoory, the Director of the Dental Department at the Dubai Health Authority stated that “We are focusing on having diversity of DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

topics during the conference this year, as we are trying to create new dimensions in the dental field in the UAE and the region”.

He also mentioned that “Dubai Health Authority gives full support to AEEDC Dubai as we work hard to emphasize the healthcare sector in Dubai on both regional and International levels, and AEEDC Dubai is the perfect venue to realize this approach, especially that the participants number is increasing every year”.

Mr. Abdul Salam Al Madani, Executive Chairman of AEEDC Dubai said “AEEDC Dubai emphasizes the integration of various elements of success, in terms of economic, trade, health, tourism which will motivate the country’s economy because of its great economic returns.”

“Moreover, AEEDC Dubai supports universities and scientific institutions in the region, and provides the latest research and findings in the field of dentistry and creates a suitable platform for discussions with specialists and experts, to maintain the scientific process in this direction.” Continued AL Madani He also mentioned that the overall space of AEEDC exhibition is more than 20.000m2 with 25% increase in space compared to last year. Participants have also increased by 25% percent.

PRODUCT NEWS

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50 AEEDC - MARCH 2010

CONFERENCES

Dr. Nassir el Malik, conference chairman In the WFLD session

Dr. Tarek Khoory from the Dubai Health authority

Pr. Tony Zeinoun at the opening ceremony of the World Federation of Laser Dentistry

Dr. Mohamed Rafei from the KSA at the Oral Health Meeting

Dr. Joseph Bassil reviewing Implant Dentistry

Dr. Derek Mahony talking about new techniques in orthodontics

Dr. Hani Ounsi receiving a trophy for his lecture on the latest advancement in mechanical endodontics

Dr. Tarek Khoory and Pr. Abdullah Shammery at the conclusion of the GCC Oral Health session

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

MI lecture and course in Lebanon Pharmacol s.a.l. organized the launching of the GC MI range which took place at the Monroe Hotel on Wednesday 7th of April 2010, with an attendance of more than 200 Lebanese dentists, and in the presence of Dr. Mohamad Fayad- GC Area Sales Manager Middle East.

Renowned lecturer, Dr. Michel Blique captured the audience’s full attention with his extensive experience with MI Products during his presentation: Minimum Intervention Treatment Plan : Evolution Tools for General Dental Practice. The great interest he raised with the attendees made way for a very interesting Q&A session which followed.

Dr. Blique also shared his full knowledge of the GC MI range of products, during workshops which were held at the Lebanese University School of Dentistry, and the Saint Joseph University Dental School. This hands-on exercise allowed both students and faculty members to participate in the active use of the MI products, and gave them a glimpse up close of the added value these products can bring to the dentist and his patient, in their daily practice.

Intensiv ProxoStrip

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Indications I Finishing and polishing of fillings and crown borders in proximal areas I Removal of excess material and overhangs in filling surfaces and crown borders I Beveling in adhesive restorations in the proximal cervical areas

Ref. PX 4015/6 Package of 6 Strips Ref. PX 4015/12 Package of 12 Strips

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40

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52 AEEDC - MARCH 2010

EXHIBITION FLOOR

International deleguates from verious countries visiting the exhibition floor DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

PRODUCT NEWS

W&H Alegra

A world first: a contra-angle handpiece which produces its own LED light The new Alegra contra-angle handpieces from W&H allow for relaxed work with daylight quality LED light – in all practices, without extra time and effort, with no additional investments and irrespective of which motor is used on the unit.

In this case, a generator in the contra-angle handpiece acts as a selfsufficient energy source. The functional principle is similar to that of a bicycle dynamo.

The self-generated LED light is neutrally-coloured and many times brighter than a conventional halogen light. The LED light also has a larger illumination field than conventional halogen light. In addition, the LED light has a much longer service life.

The new Alegra contra-angle handpieces offer proven “made in Austria” W&H quality: robust and low on noise and wear. Alegra instruments are thermo washer disinfectable and sterilizable. The data matrix code makes it easier to identify products and trace hygiene and maintenance processes. The laser-engraved code is a special type of barcode. It means that if the instrument is scanned it can be classified automatically.

54 AEEDC - MARCH 2010

EXHIBITION FLOOR

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

56 AEEDC - MARCH 2010

EXHIBITION FLOOR

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

58 AEEDC - MARCH 2010

EXHIBITION FLOOR

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

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EXHIBITION FLOOR

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

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62 AEEDC - MARCH 2010

EXHIBITION FLOOR

Visitors at the Dental News booth DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

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“Laser in Dentistry” sessions The Department of Oral Pathology and Diagnosis at the Lebanese University School of Dentistry has organized two Continuing Education Sessions on “Laser in Dentistry”, on February 13 and 20, 2010 and April 17 and 24, 2010.

Twenty participants attended each session that consisted of didactic courses, practical hands-on tutorials and live transmission of clinical cases with diode laser and Er,Cr:YSGG. These two sessions, sponsored

by Biolase, allowed the attendees to obtain the Associate Fellowship of the World Clinical Laser Institute.

The lecturers were Associate Professor Antoine Cassia, Dr Walid Chaïban, Assistant Professor Sami El-Toum, from the Lebanese University and Dr Anthony Rahayel and Dr Habib Zarifeh as visiting lecturers.

Further sessions are scheduled for 2010-2011.

For more information contact: acassia@dm.net.lb

64 “LASER IN DENTISTRY” SESSIONS

Pr. Antoine Cassia

Dr. Sami El Toum conducting the hands-on session DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

Dr. Walid Chayban

PEDIATRIC DENTISTRY

A Moisture Tolerant, Resin-Based Pit and Fissure Sealant Pit and fissure sealants have been shown to be highly effective in preventing caries, and there is considerable research documenting sealant success over extended periods.1,2,3,4 The primary measure of sealant efficacy is retention. If the sealant material stays bonded to the tooth and provides a good seal, then it is reasonable to expect that caries incidence can be decreased.

primarily hydrophobic in nature, and require a dry field. Many manufacturers recommend their use with hydrophilic bonding agents as a way to overcome the dry field requirement; however, the bonding agents add considerable time and cost to the procedure, and the procedure becomes more technique sensitive.

The practitioner must overcome certain challenges to achieve the desired high degree of success. The decision to place sealant is based on caries risk analysis. The first and second permanent molars are at the greatest risk of developing caries, and the optimal time to seal them is during the early eruption. Unfortunately, there are anatomical considerations that make the placement of sealants less reliable at that time. During the eruption process, permanent molars break through the gingival tissues leaving excess tissue, an operculum, over the distal surfaces that can interfere with the success of a sealant. Furthermore, isolation is mandatory for traditional sealants, but is extremely difficult, if not impossible, with erupting teeth.

Embrace WetBond is based on a unique chemistry that incorporates di-, tri- and multi-functional acidic acrylate monomers in a proprietary formula with a carefully designed hydrophilichydrophobic balance. The result is a resin-based material that is moisture tolerant and behaves favorably in the moist oral environment. In fact, Embrace is activated by moisture. Embrace WetBond contains no Bis-GMA and no bisphenol A and is unlike hydrophobic monomers typically used in traditional sealants.

Because moisture contamination is a contra-indication for traditional pit and fissure sealants, which require a clean, dry, etched enamel surface for success, some clinicians prefer to wait for the teeth to fully erupt so that isolation can be achieved. By this time, however, caries has often invaded the at-risk pits and fissures, and as a result, a more invasive treatment and restoration is required.

In recent years, we have seen the development of new materials that behave favorably in the moist oral environment, taking advantage of the moisture that is ever-present in the mouth. An advanced, resin-based sealant technology has been developed that incorporates a moisture-tolerant resin chemistry that is placed on the slightly moist tooth, allowing placement during early eruption (Embrace WetBond Pit and Fissure Sealant, Pulpdent Corporation, Watertown, MA USA).

Traditional pit and fissure sealants are hydrophobic. They repel water and cannot be applied where there is moisture. These materials are based on Bis-GMA and other monomers that are

The moisture tolerant Embrace sealant does not require a bonding agent. Enamel is etched, rinsed and lightly dried. The tooth is left slightly moist and glossy but without any drops or pooling of water. Embrace is water-miscible. When placed on the tooth surface in the presence of moisture, the sealant spreads over the enamel surface and integrates with the tooth in a unique way. It has been noted that margins are smooth and virtually undetectable with an explorer.5 This tooth integrating phenomenon can be seen with scanning electron microscopy, which shows the intimate association between the sealant and the tooth that provides an exceptional seal against microleakage and protection against caries. After light-curing, however, Embrace sealant has physical properties similar to other commercially available sealants.6-8 A longitudinal clinical study using Embrace WetBond Pit and Fissure Sealant was begun in May 2002. The study was conducted in a suburban pediatric practice. There was no prescreening of patients. Even difficult patients and children with poor oral hygiene and dietary habits were included in the study. In this practice based study, 334 sealed teeth were followed at recall visits for 4-6 years and evaluated by a pediatric dentist. Of these, 299 sealants were intact and clinically acceptable. Of the remaining teeth, 32 required resealing with no evidence of occlusal DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

65 A Moisture Tolerant, Resin-Based Pit and Fissure Sealant

Dr Ira Hoffman

FAWZI TAMER FOUNDATION – SPACE AT THE LDLA A conference room in the name of Fawzi Tamer Foundation was inaugurated at the Lebanese Dental Laboratories Association (LDLA) in the presence of the President Elie Sabbagh, the members of the association, the President of the Lebanese Dental Association (LDA) Professor Ghassan Yared, the Dean of the Faculty of Dental Medicine of the Lebanese University Professor Mounir Doumit, the Professor Joseph Sader representing the Dean of the Faculty of Dental Medicine of Saint Joseph University Professor Nada Naaman, delegates of dental companies and many invited guests.

Equipped by the most up dated technological material, the space Fawzi Tamer demonstrates and shows the continual support that the Fawzi Tamer Foundation, member of G. Tamer Holding, held, since its establishment, towards the medical-dental science in Lebanon.

With a brief speech Gaby Tamer emphasized that the space Fawzi Tamer Foundation was offered by the 3rd and 4th generations of the group G. Tamer Holding, as a gesture of appreciation of the Association, its members and their efforts for the benefit of the profession. Note that G. Tamer Holding entered the dental field since 102 years.

Gaby Tamer, on behalf of the Foundation’s name, the team of G. Tamer Holding in Lebanon and abroad and his name, transmitted his best wishes to the Lebanese Dental Laboratories Association and its members and thanked the foreign companies that are represented by G. Tamer Holding since decades, namely “Ivoclar Vivadent” as well as all Lebanese customers and companies.

The President of the Lebanese Dental Laboratories Association Mr. Elie Sabbagh thanked Mr. Gaby Tamer-President of the Foundation and Mrs. Mimi Tamer-Vice President, for their continual support towards the association. Mr. Sabbagh also announced proudly that the headquarters of the Association in Lebanon has been designed as the siege of the General Secretary of Arab Federation of the Dental Prosthesis.

66

At the end of the Ceremony, Mr. Tamer offered Mr. Sabbagh a commemorative trophy in the name of Fawzi Tamer Foundation and G. Tamer Holding.

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

PEDIATRIC DENTISTRY

As a basic concept, 5-10% of sealant loss per year has been seen when one reviews published sealant data.10 This data reveals the importance of periodic reevaluation of sealed teeth and reapplication of sealant if necessary. This reevaluation of sealants should be standard care. When a sealant needs to be repaired or reapplied, the tooth should be treated as if an initial sealant is being placed.11

CLINICAL TECHNIQUE Embrace WetBond requires a small change from the traditional clinical protocol because the etched enamel surfaces of the teeth should be slightly moist during sealant placement. Following these directions will ensure clinical success.

1. Examine and evaluate the occlusal surfaces, and isolate the teeth to be sealed with rubber dam or cotton rolls. (Fig.1) 2. Clean the tooth surfaces using an oil-free, water–pumice paste with a disposable prophylaxis angle in a slow-speed handpiece. Other methods for cleaning teeth before sealant placement include using a non-fluoride, pumice prophylaxis paste and an air abrasion device. (Fig.2) 3. Rinse thoroughly with an air-water spray, removing all residual paste from pits and fissures, and dry. (Fig. 3) 4. Prepare questionable enamel and small lesions in the usual manner. Rinse and dry with oil-free compressed air.

5. Apply Pulpdent 35-40% Phosphoric Acid Etching Gel to the clean tooth surface for 15 seconds. (Fig.4) Rinse well with an airwater spray. (Fig. 5) Do not disturb this surface.

6. Lightly dry and remove excess water with a cotton pellet or clean compressed air. (Fig. 6) LEAVE TOOTH SURFACES SLIGHTLY MOIST. Slightly moist tooth surfaces should appear shiny or glossy, but there should be no visible pooling or drops of water on the tooth surfaces. With Embrace WetBond, the typical dull, frosted appearance of the etched surface is not desired. Embrace bonds to surfaces slightly moist from saliva; however, it is best to avoid bacterial contamination.

7. Place an applicator tip on the syringe and apply the Embrace WetBond sealant to the occlusal surface. After dispensing, use a microbrush applicator to place the sealant, covering all pits and fissures and extending onto the cusp ridges. The final sealant thickness upon application should be at least 0.3 mm. (Fig. 7) 8. After application, light-cure the sealant holding the light-curing probe at right angles and as close as possible to the occlusal surface. Embrace cures with all lights. (Fig. 8) Curing time for a halogen light with a minimum of 300 mW/cm2 is 20 seconds.

More powerful lights will cure faster.

9. Evaluate the sealant for coverage, retention, and occlusion.

(Fig. 9) The tooth is sealed and ready for function (Fig. 10)

Although the most common practice is to apply the pit-and-fissure sealant directly to the etched enamel, various studies have evaluated the efficacy of using a bonding agent before sealant placement. The use of a bonding agent has the potential to increase sealant retention with traditional sealants,12,13 but the disadvantage is that it increases the number of steps, is more technique sensitive, and adds cost in time and materials. With Embrace WetBond Pit and Fissure Sealant adhesive bonding agents are not required and, although saliva contamination should be avoided whenever possible, it does not affect the bond of Embrace WetBond sealant.

DISCUSSION Clinically, a moisture-tolerant sealant makes sense. Unless a rubber dam is being used, the clinician is working in the oral cavity with humidity near 100%. This ensures that even the driest tooth surfaces contain some moisture. Also, because the permanent first molars are the teeth at greatest risk, it is desirable to seal them immediately upon eruption when isolation is the most difficult. Therefore, a moisture-tolerant resin sealant is necessary to ensure the optimal chance for successful retention.

Until now, the only moisture-tolerant sealants were glass ionomers.14 Their mechanism of adhesion is ionic bonding, not micromechanical retention to an acid-etched enamel surface. In studies with glass-ionomer sealants it has been reported that the 3-year retention rate is only 31%.15 Pardi and coworkers also reported low sealant retention rates with glass ionomers.16 The information currently available suggests that the optimal characteristics for a pit-and-fissure sealant are a resin-based material that is moisture tolerant, light-cured, and lightly filled with color so that sealant detection and evaluation at recall is easily accomplished.14 The introduction of a moisture-tolerant, resin-based sealant (Embrace WetBond) has eliminated the problems seen in the past with traditional, hydrophobic resin-based sealants. In a dental practice, pit-and-fissure sealants are best applied by trained auxiliaries using an etch-and-rinse, moisture-tolerant sealant.

Adherence to the sealant technique described above can lead to success in preventing pit and fissure caries.

continued on page 69 DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

67 A Moisture Tolerant, Resin-Based Pit and Fissure Sealant

caries, and only three teeth, or less than one percent, developed occlusal caries.9

68 TAMER HOLDING AT AEEDC

AEEDC - DUBAI

Tamer Holding boosts AEEDC with an impressive stand The 14th edition of the UAE International Dental Conference & Arab Dental Exhibition AEEDC Dubai 2010 was made more prestigious thanks to an imposing stand by G. Tamer Holding which participated with a delegation of 7 members who made the trip especially to be part of a show of such international scale.

It is worth noting that the Group G. Tamer Holding has been, since 1908, the leading supplier of dental products, as well as paramedical & dental equipment in Lebanon and the region.

In particular, the event was marked by the attendance of Dr. Ghassan Yared, President of the Lebanese Dental Association. There was also noticeable presence from global dental experts coming from Arab and European countries and the US, in para-pharmaceutical and academic fields.

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

Fig.1

Fig.2

Fig.3

Fig.4

Fig.5

Fig.6

Fig.7

Fig.8

Fig.9

REFERENCES 1. Simonsen RJ. Retention and effectiveness of a single application of white sealant after 10 years. J Am Dent Assoc. 115:31, 1987.

2. Simonsen RJ. Retention and effectiveness of dental sealant after 15 years. J Am Dent Assoc. 122: 34, 1991.

3. Simonsen RJ. Pit and fissure sealant: review of the literature. Pediatr Dent. 2002;24(5):393-414.

4. Strassler HE, Grebosky M, Porter J, et al. Success with pit and fissure sealants. Dent Today. 2005;24(2):124-140.

5. Dental Advisor 2004;21(8) 6. Murnseer C, Rosentritt M, Behr M, et al. Three-body wear of fissure sealants [abstract]. J Dent Res. 2007;86(Spec Iss):417.

7. Antoniadou M, Kakaboura A, Eliades G. In vivo characterization of resin-based sealants [abstract]. J Dent Res. 2006;85(Spec Iss C):310.

8. Antoniadou M, Kakaboura A, Rahiotis C, et al. Setting efficiency of resin-based sealants [abstract]. J Dent Res. 1985;84(Spec Iss B):212.

9. Strassler HE, O’Donnell JP. A unique moisture-tolerant, resin-based pit and fissure sealant: clinical technique and research results.

Inside Dentistry 2008;4(9):108-110.

10. Feigal RJ. Sealants and preventive restorations: review of effectiveness and clinical changes for improvement. Pediatric Dent. 20:85, 1998.

11. Srinivasan V, Deery C, Nugent Z. In-vitro microleakage of repaired fissure sealants: a randomized, controlled trial. Int J Paediatr Dent. 15:51, 2005.

12. Choi JW, Drummond JL, Dooley R, et al. The efficacy of primer on sealant shear bond strength. Pediatr Dent. 1997;19(4):286288.

13. Levy MP, Feigel RJ. Intermediate bonding agents increase clinical success on newly erupted molars [abstract]. J Dent Res. 1996;75(Spec Iss):1296.

14. Strassler HE, Grebosky M, Porter J, Arroyo J. Success with pit and fissure sealants. Dent Today. 2005; 24(2):124-140.

15. Taifour D, Frencken JE, van’t Hof MA, et al. Effects of glass ionomer sealants in newly erupted first molars at 5 years: a pilot study. Community Dent Oral Epidemiol. 2003;31(4):314-319.

16. Pardi V, Pereira AC, Mialhe FL, et al. A 5-year evaluation of two glass-ionomer cements used as fissure sealants. Community Dent Oral Epidemiol. 2003;31(5):386-391.

Fig.10

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

69 A Moisture Tolerant, Resin-Based Pit and Fissure Sealant

PEDIATRIC DENTISTRY

If you like Topex® Fluoride Foam, you’ll love these Sultan products…

Topex® APF Fluoride Gel Thixotropic formulation remains in the tray, reducing fluoride ingestion.

Fast, 60-second application.

Available in five great Topex flavors.

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DuraShield® 5% Fluoride Varnish Unit dose application with an UltraBrush™ prevents separation of fluoride. Sets on contact with saliva, lasts up to eight hours.

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It’s a fluoride taste sensation! Topex® APF Fluoride Foam comes in five, delicious Topex® flavors* —strawberry, spearmint, grape, Bubble Fun®, and Orange Dream™.

And with its 60-second application, Topex Fluoride Foam is a breeze to use. Its dense consistency provides excellent coverage, yet stays in the tray under bite pressure… so it won’t gag patients or clog your suction system.

Best of all, fluoride foam works… 1.23% acidulated phosphate Competitor Foam Fluoride Foam fluoride with a 3.5pH enhances fluoride uptake in enamel. And at about 110 applications per can, Topex Fluoride Foam is a great value, too—costing only pennies per treatment.

To learn more visit www.sultanhealthcare.com. *For patients with ceramic restorations, neutral mixed berry is also available.

Topex® Fluoride Foam’s dense consistency provides better overall coverage.

Topex® Topical Anesthetic Quick onset delivers maximum strength 20% benzocaine for fast, temporary relief of pain. Reduces salivation, keeping gel active longer.

Seven great flavors!

Topex® Dual Arch Fluoride Trays Its natural arch and more defined occlusal anatomy helps force fluoride onto all biting and interproximal tooth surfaces. Locking handles allow for easy placement and removal. Available in four sizes.

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Diamond Knurl Unique diamond knurl pattern with large diameter handle for a confident grasp.

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PRODUCT NEWS Adjustable Torque Wrench Offers Improved Design and Precision Zimmer Dental Inc., is pleased to announce the availability of the new Restorative Torque Wrench. The adjustable tool offers enhanced precision and retentiveness in a simple and intuitive design — making it easier than ever to confidently secure Zimmer Dental’s industry-leading “friction fit” components.

The Restorative Torque Wrench replaces the previously offered TW20 and TW30 models, thereby reducing the number of required instruments to one for optimum simplicity and efficiency. The all-in-one wrench features a ratcheting head, adjustable preset torque levels which are indicated on the handle with a visible gauge, and meets commonly used international sterilization requirements.

For decades, Zimmer Dental has gained the trust of thousands of clinicians worldwide who count on its comprehensive line of scientifically proven products to deliver successful patient outcomes and the best value in the industry. By streamlining the implant restorative process with a more user-friendly Torque Wrench design, Zimmer Dental has again reinforced its commitment to offering meaningful solutions to clinicians. www.zimmerdental.com

Making young people feel good 76 PRODUCT NEWS

The i-Kids range from Ivoclar Vivadent comprises products for comprehensive oral health management in children and adolescents.

Professional solutions for the individualized oral health management of children and adolescents of different age groups are in demand.

With the i-Kids range, Ivoclar Vivadent is committed to fulfilling the special dental treatment needs of young people. i-Kids comprises quality products and services that allow dental professionals to effectively and efficiently implement treatment strategies in children and adolescents.

The i-Kids products cover a wide spectrum: risk analysis and diagnostics, prevention, minimally invasive treatment or restoration, as well as general care and follow-up care. All the products are coordinated and can be individually combined to customize oral health management strategies.

The range comprises diagnostic, therapeutic, restorative and oral care products. All the products have shown their effectiveness in international studies and in clinical use. Nevertheless, i-Kids stands for more than simply a range of products: i-Kids is designed to create a positive dental experience. Therefore, the program also includes i-Kids Certificates of Bravery, i-Kids posters, i-Kids bags and i-Kids stamps. w w w.iv oclarv iv adent.com DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

PRODUCT NEWS

Bien-Air is launching the Blackline Turbine Bien-Air is launching the Blackline, the world's first carbon fibre dental attachment. This material has revolutionised all the high-tech industries, including aerospace, automotive, yachting and watchmaking. As light as a feather and stronger than steel, it does not fatigue, deform or corrode. A carbon handle makes the Blackline turbine 25% lighter. For dentists, that means less fatigue and increased comfort, manoeuvrability and precision.

Available for the Bora and Prestige, the Blackline range also features highperformance LED lighting supplied via Unifix, the standard coupling for BienAir turbine www.bienair.com

78 PRODUCT NEWS

Twinky Star – Coloured fillings for little patients Children as patients are a real challenge in the dental surgery. In addition to patience and empathy, an appropriate filling material that is suitable for treating children is needed in this situation that provides for good compliance from the patient and a durable treatment success. Twinky Star from VOCO is the coloured restorative development especially for children that has a proven track record in the surgery.

Twinky Star – The restorative especially for restoring deciduous teeth VOCO has developed a modern restorative in eight, glitter-effect colours especially for the restoration of deciduous teeth: Gold, Silver, Blue, Pink, Green, Orange, Lemon and now also Berry. The coloured restorative (colour guide in original colours) sparks the interest of children and increases their willingness to cooperate by including them in the treatment process. The decision of what colour the filling should be provides little patients with an active part in the treatment and makes the visit to the dentist a stress-free experience that does not cause fear. The children thus develop a lasting interest in the condition and care of their teeth.

The multi-coloured restorations are an effective motivational tool for oral hygiene at home. Children take special care of this tooth inlay and the other tooth surfaces also profit, which ultimately benefits the health of the entire deciduous dentition.

DENTAL NEWS, VOLUME XVII, NUMBER II, 2010

Moreover, Twinky Star is also distinguished by its excellent biocompatibility and contribution to the prevention of secondary caries with its supplemental fluoride release. With its stability and colour fastness, the Twinky Star fillings remain secure and last until exfoliation. www.voco.com

When performance matters, there is only one choice

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NEW

Introducing new Sensodyne Rapid Action – instant relief from the pain of dentine hypersensitivity How does Sensodyne Rapid Action work?

The strontium acetate formulation forms a deep occlusive plug within the dentinal tubules1,2

The robust occlusion formed by Sensodyne Rapid Action is still maintained after an acid challenge2

Unoccluded dentine

After treatment and a 30-second acid challenge

After treatment and a 10-minute acid challenge

In vitro study of dentinal tubule patency following an acid challenge (immersion in grapefruit juice, pH 3.3) applied after dabbing and massaging for 60 seconds with Sensodyne Rapid Action. Adapted from Parkinson and Willson 2010.

Sensodyne Rapid Action – instant and long-lasting relief from sensitivity r Clinically proven relief.3,4 Works in just 60 seconds*3 r Proven long-lasting relief with twice-daily brushing4 r Creates deep, acid-resistant occlusion1,2 r Contains fluoride *When used as directed on pack References: 1. Banfield N and Addy M. J Clin Periodontol 2004; 31: 325–335.

2. Parkinson C and Willson R. J Clin Dent 2010. Accepted for publication.

3. Mason S et al. J Clin Dent 2010. Accepted for publication.

4. Hughes N et al. J Clin Dent 2010. Accepted for publication.

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www.ivoclarvivadent.com Ivoclar Vivadent AG Bendererstr. 2 | FL-9494 Schaan | Principality of Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60