Dental News June 2009 by Dental News

www.dentalnews.com

AEEDC

2009

Volume XVI, Number II, 2009

POSTOPERATIVE PAIN MANAGEMENT

ISSN 1026 261X

Fee g settin

IDS 2009

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Volume XVI, Number II, 2009 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

CONTENTS CONTENTS CONTENTS CONTENTS

Postoperative Pain Management Dr. Richard E Mounce

Fee Setting Dr. Ehab Haikal

26 42 58

AEEDC 2009

1st Dental Administration Conference Kuwait

72 76

Product Review

IDS 2009 Saudi Dental Society

DENTAL NEWS – Sami Solh Ave., G. Younis Bldg. POB: 116-5515 Beirut, Lebanon. Tel: 961-3-30 30 48 Fax: 961-1-38 46 57 Email: info@dentalnews.com Website: www.dentalnews.com

INTERNATIONAL REVIEW BOARD 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.

1st International Dental Congress Beirut Arab University

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.

TEBODONT

Melaleuca alternifolia (tea tree oil) • antimicrobial • fungicidal • antiviral • antiseptic

• a herbal alternative in gum problems • no discoloration of the teeth • no change of the sense of taste Dr. Wild Dental research, CH-4132 Muttenz/Switzerland, www.wild-pharma.com Dr. Wild’s Mideast Regional Office: Actco, P.O. Box 40746, Larnaca 6306, Cyprus. Tel.: (24) 623515 / 654252, Fax: (24) 623844. E-mail: joeissa@yahoo.com

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Bahrain: Awal Pharmacy, East Riffa, Bahrain. Egypt: Sesic, Alexandria. Jordan: Nairoukh Drugstore, Amman. Kuwait: Al-Maseela Pharmaceutical Co., Safat. Lebanon: A.M.G. Medical.Jdeideh-Azur Center Oman: Ibn Sina Pharmacy L.L.C., Muscat. Qatar: Ahmed Khalil Al Baker & Sons, Doha. Saudi Arabia: Depot Pharmaceutique du Moyen Orient, Jeddah. Sudan: Pharma Care Co, Khartoum. United Arab Emirates: Al Hayat Pharmaceuticals, Sharjah. Yemen: Al Rawdha Trading Group, Sana’a.

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June 18 - 21, 2009 Syrian Medicare, The 9th Medical Exhibition & Conference Fairground - Airport Road, Damascus, Syria Email: syrianmedicare@gmail.com Website: http://syrianmedicare.com June 19 - 21, 2009 Lebanese University Congress, Faculty of Dental Medicine Campus President Rafic Hariri - Hadath Email: doyenfmd@ul.edu.lb September 2 - 5, 2009 FDI Annual World Dental Congress in Singapore 2009 Advancing Dentistry at the crossroads of the world Email: hmarot@fdiworlddental.org Website: www.fdiworlddental.org September 24 - 26, 2009 The Beirut International Dental Meeting 2009 Contact: Dr. Antoine Karam, President of The Lebanese Dental Association Website: www.LDA.org.lb October 14-16, 2009 The 17th Scientific International Conference of Syrian Dental Association, Damascus Ommayad Palace for conferences, Damascus Ebla Hotel Contact: Syrian Dental Association, Damascus, Syria, POB: 11104 Tel: 963 11 222 1446 - Fax: 963 11 222 48 45 Email: syrdent@scs-net.org Website: http://www.syr-sda.com October 15 - 17, 2009 37th International Expodental Rome Pavilions 7-8-9 of the new Fiera Roma Exhibition Center Email: pressoffice@expodental.it Website: http:// www.expodental.it October 21 - 23, 2009 The 4th Riyadh International Dental and Pharmacy Meeting Riyadh, Saudi Arabia from October 21st to 23rd, 2009 [02-04/10/1430]. Email: meeting@riyadh.edu.sa Website: http://riyadh.edu.sa/meeting

November 6 - 7, 2009 1st Dental - Facial Cosmetic International Conference Where Science Meets Art of Beauty Jumeirah Beach Hotel UAE Email: info@cappmea.com Website: http://www.cappmea.com November 10 - 12, 2009 1st Dubai International Implant Summit Crowne Plaza Dubai - UAE Email: matios.tcholakian@index.ae Website: http://www.diis.ae November 10 - 12, 2009 DENTISTRY 2009 ADNEC, Abu Dhabi - UAE Email: dentistry@iirme.com Website: http://www.dentistryme.com November 11 - 13, 2009 Egyptian Dental Association - 14th International Dental Congress Problem solving in Dentistry Intercontinental Hotel - Cairo - City Stars Email: eda@internetegypt.com.eg Website: http;//www.eda-egypt.org November 29 - December 2nd, 2009 Greater New York Dental Meeting 570 Seventh Avenue - Suite 800 New York, NY 10018 Tel: 212-398-6922 Fax: 212-398-6934 Email: info@gnydm.com Website: http://www.gnydm.com March 9 - 11, 2010 AEEDC Dubai Dubai International Convention & Exhibition Centre Email: index@emirates.net.ae Website: http://www.aeedc.ae

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Volume XVI, Number II, 2009 11 11

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POSTOPERATIVE PAIN MANAGEMENT <By Richard E. Mounce*

ecently, I received this letter from a reader. It raises important questions regarding prevention of postoperative pain for general practitioners doing routine endodontic therapy in their offices. “Dear Dr. Mounce, I would like to thank you for your great help with the article you wrote in the Dental News magazine about management of calcified canals. You won't believe it as those days I had a horrible calcified canal case. But when I read your article, it helped me to solve it.” “Dr. now I really need your help in postoperative pain management or actually avoiding it. I am doing root canal treatment using the rubber dam, SOM (surgical operating microscope), apex locator, patency technique, but in some cases, which really are like one in a hundred, the patient will complain from severe pain the night I close the case if I do it in 2 visits. In the first visit, I reach the working length and finish shaping and cleaning by rotary files Hero Shaper reaching file 0.4/30 then closing the tooth with a temporary filling. I usually leave some NaOCl in the canal as a medicament or Ca(OH)2 paste. Then after one week I go for the 2nd visit that is obturating the canal with single cone technique. Before, I used the SystemB but the thermoplastic gutta percha caused severe pain to the majority of patients, so I stopped it. In the 2nd visit I check the patency also with #8 or #10 files. Some patients go through such severe pain that they don't sleep at night and in the early morning they call me. I don't use antibiotic blindly with all the cases unless there is evidence of inflammation, swelling or purulence and bad smell coming out from the canal. Would you please HELP!” The clinician that wrote this e-mail is employing a number of clinically appropriate techniques. These correct strategies include the use of

*DDS. Private endodontic practitioner, Vancouver, WA, USA.

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

calcium hydroxide as an inter appointment visit (assuming that the case is necrotic or retreatment) for two visit treatment, the use of patency files and the surgical operating microscope and rubber dam, amongst others. That said, severe postoperative pain of the type being reported should be extremely rare. From the description that is given it is not possible to identify one clearly incorrect strategy being used by this doctor. The above notwithstanding, there are proven strategies that can minimize postoperative pain and identify those cases that are better treated in two visits. A clinically relevant series of recommendations for one and two visit endodontic treatment follow. One visit treatment is indicated for vital teeth if: 1) The tooth is asymptomatic. 2) There is no swelling present. 3) There is no percussion sensitivity. 4) There is no apical palpation sensitivity. 5) The tooth is clean and dry before obturation. 6) The treatment can be carried out well without time restrictions and in an optimal environment. One visit treatment is indicated for non-vital teeth, with and without a lesion if: 1) The tooth is asymptomatic. 2) There is no swelling. 3) There is no percussion sensitivity. 4) There is no apical palpation sensitivity. 5) The tooth is clean and dry before obturation. 6) The treatment can be carried out well without time restrictions and in an optimal environment.

Correspondence address: Lineker@comcast.net 12503SE Mill Plain, Suite 215 Vancouver, WA, USA 98684 POSTOPERATIVE PAIN MANAGEMENT

Fig 1A-B: Clinical retreatment case treated in two visits with an inter appointment dressing of calcium hydroxide. Evidence of coronal microleakage was clearly evident upon access. Two-visit treatment is indicated for non-vital teeth, with and without a lesion if: 1) The tooth is symptomatic and/or swelling is present. 2) The tooth is percussion sensitive. 3) Apical palpation sensitivity is present. 4) The tooth cannot be made clean and dry before obturation. 5) The treatment cannot be carried out well without time restrictions and in an optimal environment. If two-visit treatment is indicated, clinical management of these cases will vary based on the diagnosis: 1) For non-vital teeth, with and without a lesion, calcium hydroxide should be placed between visits. 2) For vital teeth: calcium hydroxide is optional between visits. 3) For retreatment: calcium hydroxide is placed between visits. Inter appointment pain can be minimized utilizing a number of strategies in both vital and necrotic teeth, including those listed here. 1) The pulp chamber must be unroofed and all canals located, especially before proceeding into the canals. 2) To the greatest degree possible, if two-visit treatment will be undertaken, the canals should be instrumented to the minor constriction (MC) of the apical foramen and apical patency achieved and maintained. It is debatable what taper and master apical diameter must be achieved in the first step of two visit treatment, but at a minimum it should be a taper and diameter that allow irrigation to reach the apex efficiently. 3) The canals should be irrigated copiously throughout the entire treatment (in both visits) with a bactericidal irrigant, either 5.25% sodium hypochlorite or 2.0% chlorhexidine depending on the clinical diagnosis. 5.25% sodium hypochlorite is generally used for vital cases due to its tissue dissolving capacity. I use 2.0% chlorhexidine for nonvital and retreatment cases. 4) Consideration should be given in rare cases to leaving the canals open, but only when all other treatments fail. Clinical opinions will vary, but it is my experience that if the canal is draining pus and will not stop despite all measures to the contrary, the tooth can be left open for 24 hours and then after appropriate clinical measures, the

POSTOPERATIVE PAIN MANAGEMENT

case can be closed or possibly finished, if indicated. Leaving a tooth open should be a rare occurrence. Teeth that have apical palpation sensitivity, extreme percussion sensitivity, pre-operative swelling are possible indicators that the tooth may drain despite all efforts to end such drainage and as a result may need to be left open. 5) Every effort must be made to avoid extrusion during endodontic treatment. Irrigants, the dissolved gutta percha and sealer slurry that results from using chloroform in retreatment, dentin shavings, previous restoratives or pulpal tissue can all be extruded unnecessarily and cause apical inflammation and discomfort. Extrusion can be minimized by avoiding apical perforation, maintaining the MC in its original position and size and irrigating correctly. Using a side venting, closed ended needle and making sure not to lock the irrigating needle apically are all strategies that can minimize extrusion from irrigation. 6) Using rotary nickel titanium (RNT) files passively in canal preparation can go far toward minimizing untoward postoperative inflammation. Passively in this context means to insert the RNT file gently toward the apex without pumping the file repeatedly up and down. Repeated forceful insertion of a RNT can push debris and irrigants out of the canal especially if the apex is open and negotiable. It is a predisposing factor toward the prevalence of greater degrees of postoperative inflammation. I use the Twisted File* to shape canals. For most roots (using the mesial root of a lower molar as an example) the basic preparation is achieved with a .08/25 and the master apical diameter is a #35 or a #40 final preparation created with the TF .06/35 or .04/40. For the vast majority of roots encountered, especially in general practice, the .08/25 TF can shape a canal in 3-5 insertions assuming that the access is correct, the cervical dentinal triangle has been removed and the orifice is shaped correctly. After preparation of the basic shape with the .08/25, the .06/30, .06/35 and .04/40 are inserted to achieve the desired master apical diameter. It is interesting that the writer discusses the use of the SystemB and correlates it with the occurrence of more post operative discomfort between visits. This is not the common experience of clinicians worldwide who use this obturation technique nor is it mine. It is an empirical guess as to why this is occurring for this clinician, but several mechanisms are possible that explain this phenomenon. It is possible

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

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that the canal has not been dried properly and that irrigants are being extruded apically during the apical downpack. Excessive amounts of sealer as well as improper cone fit can also cause avoidable extrusion. Improper cone fit to or beyond the MC combined with improper use of the heat pluggers can extrude excessive amounts of sealer, obturating material and possibly the remaining canal contents. The writer does not explain what sealer they are using, but if the sealer is a powder liquid ZOE mixture, it is possible that excessive amounts of eugenol liquid could be a mechanism of the discomfort reported with this technique. The writer also does not tell us if the incidence of postoperative pain is occurring in vital, necrotic or retreatment cases. It would be helpful to know which pre operative diagnosis is leading to these events. It is expected that such problematic postoperative sequalae would occur primarily in non-vital teeth and those cases where the tooth was symptomatic prior to access.

And finally, it would be helpful to know if the writer is routinely obtaining sealer puffs after obturation and if these sealer puffs are correlated with postoperative pain. If they are, it means that the contents of the canal are being extruded upon obturation and/or that the sealer being used may not be mixed ideally. It is also possible that excessive amounts of sealer are being extruded into the apical tissues. In any event, technique modification can help modify the presence of postoperative pain in these instances. A clinically relevant discussion of a letter received from a reader of a previous column discussing one and two visit treatment and its implications for postoperative discomfort has been presented. Emphasis has been placed on canal location and achievement and maintenance of apical patency and the placement of an inter appointment dressing of calcium hydroxide for non-vital and retreatment cases that are treated in two visits. I welcome your feedback. * Sybron endo, Orange, CA, USA

POSTOPERATIVE PAIN MANAGEMENT

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

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Fee Setting <By Dr. Ehab Heikal*

Negotiating Fees with Patients "Doctor, your fees for this treatment plan seem awfully high to me. I know that Dr X could do it for a lot less." For many doctors, this statement leads to the ultimate test of self confidence. When a patient questions your fees, you may feel that they are questioning your personal and professional integrity, your technical competence and/or the value of your services. You have invested years of education and financial sacrifice to master your craft. Yet, invariably, you continue to encounter patients who question your right to be adequately compensated. In addition, the patient is making you feel that you are overpriced for the market place and can't compete. You worry about losing the time you've invested in preparing the treatment plan, building customer relationship, and gaining patient's confidence; if the patient goes to another practice that's willing to cut fees to compete. While all of these thoughts and emotions may come to mind, the reality of the situation may be entirely different. In reality, the patient is setting the stage to negotiate. The patient is saying that in his/her opinion, your fees "seem awfully high." The reality is that the patient hasn't the slightest clue of what it costs you to provide the treatment. Her/his only justification for that statement is that Dr. X offers a comparative bid. Did Dr. X perform a complete exam and prepare a treatment plan over the phone? Or was his treatment to other patients the same as required for this patient? Or even are the conditions the same? Most important, is the quality of the work or the quality of products used by Dr. X the same as yours? When patients make this type of statement, they are really making their opening move to negotiate a lower fee. They are "bottom fishing" for the best deal.

*BDS. MBA. DBA Lecturer, Practice Management School of Dentistry, MSA University

FEE SETTING

You have several choices at this point. 1. Cave in and cut your fee. 2. Become irate and lose the patient to Dr. X. 3. Play the game, understanding that the stake is the patient's personal health care. The first thing you must understand is that choice number one is never acceptable. Cutting your fee is cutting your throat. It is tantamount to telling the patient that your craftsmanship is overpriced and your fees are negotiable. On top of that insult, you are adding injury to the basic economics of managing your practice. It costs money to deliver quality health care. Inadequate compensation can only lead to a reduction in qualified support staff, the use of lesser materials, and reliance on inadequate or obsolete equipment. Choice number two is a "Lose-Lose" for both you and the patient. You become angry because you feel the patient has attacked your personal and professional value. Rather than deal with the negotiating ploy, you send the patient to Dr. X, for what could possibly be inferior treatment. This reaction denigrates you and embarrasses the patient. Even worse, you have lost the patient and the patient's health care may have suffered. Again, an unacceptable alternative. Your final choice is to play the game, understanding that you and the patient are really negotiating on the quality of the patient's health care. You must structure the negotiation so that both you and the patient can "WIN". Remember that in the psychology of negotiating, the person who blinks first often loses. With that in mind, let's replay the dialogue: Patient: "Doctor, your fees for this treatment plan seem awfully high to me. I know that Dr X could do it for a lot less." Doctor: "Mrs. Y, we are very proud of our fees." Or: “Mrs. Y, we have set our fees very carefully after extensive calculations” At this point the doctor must be absolutely silent. What you have just said is that you feel good about your fees and that they are correctly calculated. At this point, eighty percent of the patients will stop negotiating and accept treatment. The worst case is that the patient asks: "What do you mean by that?" Your reply is, "Our fees are based on the quality of the materials we Contact information: eheikal@gmail.com

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

OptiDam™

The first rubber dam with 3-dimensional shape. Making dental work fast and efficient. • OptiDam creates a dry and clean operating field, enabling safe dental procedures. • OptiDam isolates all soft tissue for perfect accessibility: The patient’s tongue no longer needs to be restrained. And the patient’s cheeks, lips and gums no longer interfere with your work. • OptiDam establishes a non-contaminated field – a basis for durable clinical access: Moisture-sensitive materials can be used correctly. The area being worked on is kept completely dry. • OptiDam offers optimum protection for both patient and dental staff: Your patients are protected against aspiration or ingestion of foreign objects. Airborne debris is reduced.

SoftClamp™

Universal Rubber Dam Clamp. The gentle alternative to metal clamps • Secure. Unique design with grip-tight coating on the jaws minimizes rotation, ensuring secure, solid retention. • Safe. No sharp edges. Evenly distributed clamping force. Minimizes risk of harm to soft tissue, tooth structure or delicate restorations. • Versatile. Provides a secure, stable fit for varying molar tooth anatomies and sizes. • Compatible. Accommodates all types of rubber dam forceps. Prevents forceps tips from penetrating through the clamp, which could affect the gingiva. • Autoclavable. Well-suited for multiple use.

Fixafloss®

The new fixation of rubber dams. First multifunctional floss for the gentle fixation of rubber dams. • Innovative: first waxed dental floss with conical clamping element included (silicone). • Gentle: for gentle rubber dam fixation without clamp in the anterior area. • Universal: depending on the anatomical situation also indicated for posterior teeth rubber dam fixation.

KerrHawe SA

P.O. Box 268 6934 Bioggio Switzerland Freephone: 00800 41 05 05 05 Fax: ++41 91 610 05 14 www.KerrHawe.com

Your practice is our inspiration.™

use and our experience in performing this treatment." And don't say another word. Or say what Dr. M.S. Attar of Alexandria said to a patient when she argued about his prices of implants and asked if there were less costly alternatives: “ M'am, I will never place in your mouth except the quality of products that I would place in my mother's mouth” It is rare that a patient will persist in questioning your fees after this statement. The implication to the patient is that if you want your treatment performed with lesser quality materials or by a less experienced doctor; you are welcome to go elsewhere. In any case, you have made the statement in such a way as to reinforce your personal and professional integrity without embarrassing the patient. If Mrs. Y persists in arguing about fees, the question now becomes is this the type of person you want in your practice? Assuming you offer a full range of payment alternatives to make the treatment plan affordable, the persistent bickering over fees indicates the patient places a higher value on money than health care. Do you want this type of person in your practice? Most likely not. In this case, you end the conversation with this statement: "Mrs. Y, we appreciate your concern over the cost of your treatment plan. If you like, we'll be happy to refer your file to Dr. X's office." This statement tells the patient the negotiation is over and that you are confident in your position. It should always be followed by, "If for any reason you would like to return to our practice, or to continue other treatment plans with us, please don't hesitate to call us. We'll be glad to have you back." The final statement graciously leaves your door open to the return of the patient. Plus, there is a good chance that she will return within a year, after having thought about the possibility that she is receiving poor materials or inexperienced treatment at Dr. X's office. In developing financial strategies for our consulting clients we are often asked, "What should my fees be?" Our answer is invariably, "Whatever you feel confident in charging." There is essentially no limit to what you can charge for your services. The basic premise is that you are confident that your fees are representative of the quality of the materials you use and your experience in performing the treatment. The key word is "confident". Any lack of confidence or hesitation will be detected by the patient and exploited in the negotiation. One of the most successful doctors I know accepts no insurance or contracts and require payment of all fees be paid in full prior to beginning treatment. And the cost of his treatment plans is very high. He presents his treatment plan by saying, "My fee for performing this treatment is $950. I will attach a copy of the lab bill detailing the materials and their preparation cost to your bill." His case acceptance level is in the 90% range. Just like when you go to the car repair shop and they give you a detailed invoice including the spare parts used!!! Also mark the number, it is 950. This is psychological pricing. He could have asked for $1000, yet $990 or $950 is in the bracket of hundreds for the patient. But the patient will perceive the 1000 as a figure in thousands. Exactly like when you go to a super market and you find items for $1.99. This is perceived by you totally different than $2.

FEE SETTING

Patients immediately perceive that this doctor knows his worth. I must also add that every stage of the patient's interaction with the doctor's staff, facility and post-treatment care are of the very highest quality. This high level of quality supports the 90% acceptance level and reinforces the sense of value the patient perceives in the doctor's capability to deliver the treatment. The best confidence-builder to help you feel comfortable with your fees is very simple. Just remember that quality treatment must be supported by commensurate fees.

How Much of a Fee Increase? An auto mechanic changing a muffler has more control over the fees he charges than many doctors. In a recent course, I asked the doctors to explain exactly what procedures they followed when they increased their fees. Each explained that he took his old fee schedule and guesstimated a general % increase in fees on those services he performed most. But no one explained on what basis do they increase the price? Is it the market trend? Inflation? Or increased cost? In my previous book, I explained (in the Price section) the strategies and the steps to be followed when setting the price. Among which; was estimating cost. And I explained how you can determine exactly the cost of each service provided. However, I will go now into further details regarding increasing the fees. One of the toughest questions we face in dentistry is "How much should we raise our fees?" In the previous section of this topic we dealt with the issue of overcoming fee objections from patients by enhancing the perceived value of the dentistry. In this section, we look at the question of how much of a fee increase is reasonable, other limitations aside. There are three key elements to consider. 1. Is your practice producing a reasonable economic return? 2. What has been the inflation rate for your cost of providing service since your last fee increase? 3. Are you being adequately compensated for the quality of materials you use and your personal experience in providing your primary treatments? How large a fee increase you "need" will depend on whether you need to increase profits, or merely maintain profits in the face of inflation. 1. "Is your clinic producing a reasonable economic return?" If your clinic is running a chronic monthly deficit, clearly the answer is "no". On the other hand, are you narrowly avoiding a deficit in the practice by under compensating yourself? In either case, the clinic is not realizing a reasonable return and we must address the basic issue of economic survival. You are providing a necessary health care service to the community. However, to continue doing so, you must be able to pay all of your bills each month and take home a reasonable personal income. How much is "reasonable"? A reasonable income compensates you

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

If you like Genie,™ you’ll love these Sultan products…

Silgimix™ Alginate Replacement Impression Material Quicker, better impressions—without the mess. It’s the dust-free alternative to alginate materials.

Genie™ Bite A bite registration that sets, rock hard, in 60 or 90 seconds. Comes in easy-to-use automix cartridges.

3-Way™ Disposable Impression Trays Single use—ideal for accurate impressions, counter impressions and bite registrations.

Genie’s™ superior flow… for incredible impressions, every time. To capture the very best impressions, it’s critical that your impression material exhibits superior “flow”—the ability to capture all details, including those past the prepared margin. Flow is the single most important feature of your impression material, because the better the flow, the better you’ll capture important details. For flow that stands above the rest, choose Genie™. An independent study confirms it: when compared to leading brands of impression material, Genie™ proved to have superior flow.* Isn’t it time you got the best performance for the best price?

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for the risks you have taken. These include the cost of your education, the cost of purchasing a clinic and/or equipment, operating loans taken against your practice, and the investment in time and energy that you and your family have made to establish your clinic. Just as important, a "reasonable" income includes setting aside enough each month to provide for retirement and/or financial independence. Ninety-two percent of the dentists in the world continue to work past the age of 65. Some of them are doing so because they enjoy treating patients. In reality, many probably do not have a choice, and must continue working to maintain their lifestyle. Raising fees alone may not increase profits enough to eliminate your chronic monthly practice deficit, fully cover your personal lifestyle needs, and allow you to accumulate the funds needed for long-term financial independence. That's a big bill to fill. However, fees are a primary strategy. The unique thing about raising fees as a strategy to increase profits is that, assuming collections are well managed; virtually 100% of a fee increase goes straight to bottom-line profits. In contrast, most other strategies for increasing profits require an increase in production, and that means additional costs - in the areas of treatment supplies, lab fees, and staff costs. Moreover, it means the dentist or other providers in the practice have to see more patients. Raising fees gives you more dollars without doing more work. That means more profits without increasing stress. 2. The second element in the fees equation is the dental inflation rate since your last fee increase. This is the percentage increase in your overall operating expenses, including staff salaries, rent, utilities' cost, supplies and lab fees. It is important to remember that inflation acts as a hidden tax on your income. If the cost of providing your services goes up by 5% and you raise your fees only 3%, the 2% difference comes out of your pocket. To calculate the inflation rate for dentistry, take the consumer inflation rate of 3% (as of 2005 as an average in most countries in the area) and divide it by 12 to get the monthly average rate of inflation (0.25). Then multiple the monthly consumer inflation rate by the number of months since your last fee increase (let's say 12 months) to generate consumer inflation since your last fee increase (0.25 X 12 = 3). Unfortunately we can't stop there. "Dental" inflation, (according to the ADA) is 1.74 times consumer inflation. So we have to multiple the consumer rate of inflation since your last fee increase times the 1.74

FEE SETTING

dental rate (3 X 1.74 = 5.22%) to get the true rate of dental inflation. Another way to look at it is that you are currently discounting your fee by the rate of dental inflation since your last fee increase. Please apply the above model using the actual consumer inflation rate in your country. 3. The final and one of the most important areas to consider in setting your fees is "How much more should you be compensated for the quality of materials you use and your experience in providing treatment?" The real issue we are addressing here is that not all dentists are created equal. How should you be compensated, relative to other dentists, for the fact that you have 10-20 years of experience, have obtained extraordinary number hours of continuing education per year, and/or maintain the latest technology in materials and equipment? Shouldn't your higher level of experience, training and technical delivery warrant a premium when setting your fees? Is this worth an additional 3%, 6% or even 10% over less experienced and less qualified practitioners in your area? Only you know how you compare in this area. How much of a fee increase is the "right" amount? Assuming that your fees were reasonable a year ago, a simple 3.5% to 5% increase to cover inflation on your costs is a reasonable place to start. Of course, if your fees have not kept pace with inflation for two or more years, a larger increase may be necessary to catch up. On top of this, add whatever premium you feel is warranted for the quality of materials you use and your experience as a practitioner. This is a highly subjective matter and there is no "right" answer. Some doctors will need to add a third layer to their fee increase to derive a reasonable economic return. These are the doctors who need to increase the bottom line so that the practice is profitable and compensates the dentist fairly. You deserve to take home enough income to keep up with inflationary increases in your personal living expenses such as food, clothing, and child care, and also put away some dollars for financial independence. Remember that quality treatment must be supported by fees. The fees you charge should adequately compensate you and allow you to maintain your staff, facilities and continuing education at the highest levels.

Article taken from Dr. Ehab Heikal’s new book (Practice Management Tips) under publication

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

CHIROPRO L INCREASE YOUR EXPECTATIONS More simplicity: the only control system offering the pre-programmed clinical sequences of the seven biggest implant brands. More performance: the most powerful motor on the market with highly durable LED lighting, controlled by exceptional electronics with peerless precision. More ergonomics: the only contra-angle handpiece provided with internal irrigation, a featherweight with the smallest head. Chiropro L, the best system in the world? You won’t be the only ones to think so.

Bien-Air Dental SA Länggasse 60 Case postale CH-2500 Bienne 6 Switzerland www.bienair.com

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29.4.2009 11:11:21

™

BEYOND Polus Whitening Accelerator Unprecedented Innovation and Flexibility in Whitening Technology Designed to offer the highest degree of functionality to dental professionals, the BEYOND™ Polus™ Whitening Accelerator features a halogen-powered whitening accelerator, dual-wavelength LED curing light, and Low-Level Laser Therapy (LLLT)* option. With the BEYOND™ Polus™ system, whitening treatment and patient preparation times are minimized, while results and patient satisfaction are maximized. The BEYOND™ Polus™ system features a powerful halogen light output and is clinically proven to provide superior whitening results to LED and plasma arc systems. An advanced light filtration system in the lamp head removes all harmful heat and ultraviolet output, while BEYOND™'s proprietary formula, 35% hydrogen peroxide whitening gel produces shiny, white results. Dental professionals can choose from gentle, normal, and intense dual-arch, light-output settings when designing the perfect treatment plan for each individual patient. A single-tooth whitening option using the LED curing light is also available for precise, tailored treatment results. A user-friendly device, BEYOND™ Polus™ has a Touch User Interface (TUI) control panel for intuitive programming and treatment tailoring. Height adjustment of the lamp head is motorized and can be controlled from the TUI panel or by using the convenient buttons located on the lamp head. The lamp arm boasts a 360° range of motion and the machine's multidirectional lamp head allows for perfect positioning with every patient. A remote control is also included with the BEYOND™ Polus™ system, allowing the dental professional flexibility during the treatment time. The remote control features a call button and emergency pause and resume buttons and can be utilized by the patient in the event that the dental professional is called away during the treatment. Designed to withstand years of service, the BEYOND™ Polus™ system also includes an advanced temperature monitor and cooling system to prevent the system from overheating following prolonged use. The BEYOND™ Polus™ Whitening Accelerator comes fully assembled in its shipping crate and is ready to use immediately upon delivery. BEYOND™ also includes a complete marketing package with each machine to promote the treatment in your practice. Customer satisfaction is BEYOND™'s highest priority and you can be confident in your investment by enjoying our 30-day money back guarantee and complimentary three year manufacturer's warranty against factory defect. For more information or to order your BEYOND™ Polus™ Whitening Accelerator today, contact BEYOND™ Dental & Health at info@beyonddent.com. *Adding the LLLT feature is optional and may incur an additional cost.

ubai - United Arab Emirates, March 12th 2009. Mr. Abdul Salam Al Madani, Executive Chairman of AEEDC® Dubai and Dr. Burton Conrod, President of the World Dental Federation (FDI), had signed a memorandum of understanding on March 11th, 2009, on the occasion of the AEEDC® Dubai Night, at the Jebel Ali Golf Resort and Spa Hotel, in the presence of Dr. Tariq Khoory, Director of Dental Department at the Dubai Health Authority, and a number of local and international representatives. The FDI represents one million Dentists Worldwide, and now the MOU will provide Continuing Learning Programs to dentists who are registered members of the FDI and AEEDC® Dubai. AEEDC® Dubai was granted an exclusive authorization in the Middle East and North Africa to employ this program. Mr. Al Madani said “we are looking forward to be the Number One Dental Congress in the world by 2020, in our efforts to follow the steps of His Highness Sheikh Mohammed Bin Rashid AL Maktoum, Vice President of UAE, Prime Minister, Ruler of Dubai, to be the first always in all the events.” The Speech of His Highness Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai, Minister of Finance, President of the Dubai Health Authority was delivered by Dr. Tariq Khoory, Director, Dubai Dental Centre, Dubai Health Authority, on behalf of H.E. Qadhi Saeed Al Murooshid, Director General of the Dubai Health Authority, through which he warmly welcomed all to the AEEDC® Dubai Night.

Dr. Tariq Khoory on behalf of H.E. Qadhi Saeed Al Murooshid, stated that “The Dubai Health Authority has been supporting the UAE International Dental Conference and Arab Dental Exhibition AEEDC® Dubai since 1996 and this is due to our commitment to the continuing medical education of the health professionals in general and to the Dental Professionals in particular”. He also added that “the Dubai Health Authority through its commitment to AEEDC® Dubai was successful in winning the hosting of the FDI Dental Meeting during 2007 where more than 31,000 dental professionals from all over the globe gathered in Dubai in one of the biggest events in the history of FDI and this was possible due to the commitment of all of you” Dr. Tariq Khoory assured all of the present that the Dubai Health Authority was committed to the growth and success of AEEDC® Dubai. He stated “this commitment is in line with the vision and the wisdom of H.H. Sheikh Mohammed Bin Rashid Al Maktoum, VicePresident, Prime Minister of United Arab Emirates, Ruler of Dubai, His Highness taught us that” The word 'impossible' is not in leaders' dictionaries. No matter how big the challenges, strong faith, determination and resolve will overcome them” Dubai Health Authority with the support and commitment of all shall ensure that AEEDC® Dubai shall become the Number 1 Event by 2020.

Facts and Figures AEEDC® Dubai 2009 • Deals worth 300 Million US Dollars over a period of 3 days • 20,000 Trade Visitors from 113 Countries • 6000 Professional Conference Delegates • Official representation from 44 countries, Dental Departments of the Ministries of Health • 700 Exhibitors from 65 Countries 26

AEEDC 2009

The Launching of 2010 Dubai Congress of the World Federation for Laser Dentistry from 09 to11 March, 2010 by Prof. Norbert Gutknecht and Prof Toni Zeinoun Chairman of the 2010 WFLD Congress DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

2° dental news 2009

30-04-2009

17:32

Pagina 1

Dr. Robert Edwab, Executive Director GNYDM, lecturing on dental emergencies

Sheikh Hamdan Bin Rashid Al Maktoum inaugurating the scientific exhibits

Mr. Samer Alwash introducing the new solutions from Nobel Biocare

Dr. Hani Ounsi receiving the trophy for his lecture “NickelTitanium illusion”

Dr. Ziad Salameh receiving the trophy for his lecture on “CAD/CAM Zirconia”

Picture from the gala dinner at Jebel Ali Golf Resort

AEEDC 2009

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

Visitors at our stand

left to right: Dr. Waheed Terro, Dr. Zaki Malallah, Dr. Wissam Jarroush and Dr. Tony Dib

Prof. Toni Zeinoun (third from left) with the Executive Members of the World Dental Federation for Laser Dentistry

Rino & Sino at the Dental News stand

Mr. Abdul Salam Al Madani (second from left) Executive Chairman- Aeedc Dubai with Dr. Robert Edwab Executive director GNYDM visiting the Dental News stand

AEEDC 2009

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

DIGORA® Optime and CRANEX® Novus

ULTIMATE TEAM PERFORMANCE

FAST, SMART DIGITAL IMAGING These two first-rate units form an unbeatable team. DIGORA® Optime and the new CRANEX® Novus are, together, the easiest and most cost efficient way of introducing digital dental imaging to your clinic. All the advantages that digital imaging has to offer are now yours – optimized workflow, brilliant image quality, compact size and contemporary design. DIGORA® Optime and CRANEX® Novus, the unbeatable team and your ultimate choice.

CRANEX® Novus Digital Panoramic X-ray unit Your benefits • Simplified operation • Easy patient positioning • Adult panoramic 9 s. • Optimized workflow

DIGORA® Optime Intraoral digital imaging plate system

Your benefits • Cordless and flexible • Fast read-out time 4-7 s. • Standard intraoral sizes 0, 1, 2, 3 • Improved patient comfort and workflow

www.soredex.com Manufactured by:

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SOREDEX Nahkelantie 160, Tuusula P.O.Box 148, FI-04301 TUUSULA, Finland

info@soredex.com Tel.: +358 10 270 2000

13.5.2009 10:44:58

AEEDC 2009

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

The perfect team-player!

Add-on system: design your individual solution!

EXCOM Central Suction: dry suction system - air/water separation - optional dynamic amalgam separation Innovative design, powerful suction and reliable operation: characteristics which describe the central suction and separation solutions from METASYS. Dry suction systems, integrated air / water separation and optional dynamic amalgam separation are the cornerstones of the METASYS central suction systems EXCOM for 1 - 5 treatment units. u u u u u

2 years guarantee constant and powerful suction easy to maintain silent operation amalgam recycling service by the manufacturer

METASYS Medizintechnik GmbH Florianistrasse 3 A-6063 Rum bei Innsbruck

www.metasys.com

MA 2009-054-Ins_Suction_DentalNe1 1

16.04.2009 14:46:36

PICTURES FROM THE EXHIBITION FLOOR 34

AEEDC 2009

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

NEW: Cavex ImpreSafe

Alginate and silicone disinfectant

FAST – SAFE – EFFECTIVE

CAVEXFOR DENTAL USE ONLY Cavex ImpreSafe is an alginate and silicone disinfectant. In only 3 minutes Cavex ImpreSafe kills bacteria, viruses and fungi without damaging the surface of the impression. Cavex ImpreSafe is a highly concentrated ﬂuid and 1 litre is suﬃcient for 33 litre ready-to-use disinfectant. As a result Cavex ImpreSafe is economical in use as well as in storage space. Cavex Holland BV, P.O. Box 852, 2003 RW Haarlem, The Netherlands. Tel +31 23 530 77 00 Fax +31 23 535 64 82 dental@cavex.nl www.cavex.nl

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PICTURES FROM THE EXHIBITION FLOOR 36

Picture from Sybron Endo hands-on course

AEEDC 2009

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

NobelProcera

Full zirconia product assortment in four colors. white

light

medium

intense

Certified for excellent material homogeneity and purity Innovative coloring technique Excellent flexural strength and no degradation in strength compared to white zirconia*

Excellent esthetic results supported by the coloring of the underlying framework

light colored

* **

intense colored

Nordic Institute of Dental Materials (NIOM) NobelProcera™ Zirconia testing: S306269B, S306205B. Products for NobelActive™ platform are currently under development.

Following the success of shaded NobelProcera Zirconia Crowns, the same colors are now available for the full assortment** – crowns, copings, bridges, abutments, implant bridges. The innovative coloring technique ensures excellent material homogeneity, consistent color throughout frameworks. External studies show no degradation in strength compared

NobelProc Shad Zir 210x280 D News.indd 1

to white zirconia*. NobelProcera offers solutions for all indications – single crowns, bridges up to 14 units, cemented or screw retained, fixed or removable prosthetics on natural teeth and implants. NobelProcera provides extensive experience and access to a quality-assured centralized industrial manufacturing. Precision of fit, quick turnaround times,

consistent and predictable results – you will enhance your customer satisfaction and the efficiency of your practice. Nobel Biocare is the world leader in innovative evidence-based dental solutions. For more information, visit our website. www.nobelbiocare.com/nobelprocera

09-04-14 11.14.09

PICTURES FROM THE EXHIBITION FLOOR 38

AEEDC 2009

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

Planmeca Oy, Asentajankatu 6, 00880 Helsinki, Finland tel. +358 20 7795 500, fax +358 20 7795 555 sales@planmeca.com, www.planmeca.com

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QÉ¡°TEG 2009 πjôHG 10 ïjQÉàH ≥°ûeO »à ” á∏¶e â– ¿Éæ°SC’G ¢Sô`¨d á«Hô©dG á«ÁOÉcC’G ÚeC’G Qƒ°†ëHh ¿É`æ°SC’G AÉ`ÑWC’ »`Hô©dG OÉ`–E’G »à ∂dPh »˘˘ °û÷G ø˘˘ °ùM ó˘˘ ªfiQƒ`à˘˘ có˘˘ dG ΩÉ˘˘ ˘©˘ ˘ dG .¿CÉ`°ûdG Gò`¡H ó`≤Y …òdG ådÉãdG ´ÉªàLE’G ¿Éæ°SC’G AÉÑWCG áHÉ≤f øe IQOÉÑŸG âfÉc ó≤a ôëÑdG »à ∫hC’G ´ÉªàLE’G ó≤Y å«M á«fOQC’G ¿Éæ°SC’G ¢Sô¨d á«fOQC’G á«©ª÷G øe º`YóH â«ŸG Égó©Hh »∏NGódG ΩÉ¶ædG IOƒ°ùe QGôbEG ” å«M å«M ájQóæμ°SE’G áæjóe »à ÊÉãdG ´ÉªàLE’G ó≤Y ìÎ≤ŸG ΩÉ˘˘¶˘ æ˘ dG ≈˘˘∏˘ Y äÓ˘˘jó˘˘ ©˘ à˘ dG ¢†©˘˘ H âØ˘˘ «˘ °VCG ≈∏Y ≥°ûeO áæjóe »à å`dÉãdG ´ÉªàLE’G ó`≤Yh ≈∏Y ¥ÉØJE’G ”h ¿Éæ°SC’G ¢SôZ ô“Dƒe øe ÖfÉL ∂dPh ¿Éæ°SC’G ¢Sô`¨d á`«Hô©dG á`«ÁOÉcC’G QÉ¡°TEG äÉ``«©ª÷Gh äÉ``HÉ≤ædG øè OóY »Hhóæe Qƒ°†ëH IQhó∏d ∫hC’G ô`≤ŸG ¿ƒ`μj ¿CG ¥ÉØJE’G ”h á``«Hô©dG á˘˘ jQƒ˘˘ °ùdG á˘˘ «˘ ©˘ ª÷G ¿ƒ˘˘ μ˘ ˘Jh ≥˘˘ °ûeO »à á˘˘ eOÉ˘˘ ≤˘ ˘dG ¤ƒàJ å`«M ÚeÉY IóŸ É`¡d Gk ô`≤e ¿Éæ°SC’G ¢Sô`¨d .á«Hô©dG äÉ«©ª÷G áaÉμH ∫É°üJE’Gh OGóYE’G »°û÷G ø°ùM óªfi QƒàcódG ¿Éæ°SC’G Ö£d »Hô©dG OÉ–EÓd ΩÉ©dG ÚeC’G

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DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

IDS continues to grow: More than 106,000 visitors experienced an international trade fair full of momentum and the innovations of 1820 exhibitors The IDS continues to grow. After 5 days, the 33rd International Dental Show at the Cologne trade fair grounds closed with an increase in exhibitors, visitors and exhibition space. More than 1820 exhibitors (+ 4.5 percent) from 57 countries took part in the IDS 2009. With foreign participation at 65 percent and a more than 10 percent increase in international exhibitors, the IDS broadened its significance as a global trade and communications platform even further. Companies presented themselves on 138,000 square metres of exhibition space (+ 6.2 percent). The 6.9% growth in visitor numbers was reached with both domestic and international visitors. The international dental industry registered an order volume which in many cases by far exceeded expectations. Dr. Martin Rickert, Chairman of the Association of German Dental Manufacturers: "The 33rd International Dental Show gave us above all the positive signal we were looking for. Our projections about a

IDS 2009

positive development in dental markets have been outstandingly confirmed. I am certain that this IDS will serve as a lasting impetus for the global dental industry and for the international healthcare market along with it." For Oliver P. Kuhrt, Managing Director of Koelnmesse GmbH, the IDS 2009 is a superlative event: "The IDS is the prime example of a successful world trade fair and a magnet for the dental industry. It combines all the elements necessary for successful business and is a global communications, trade, innovations and product platform all rolled into one." A visitor survey showed that 74 percent of all IDS visitors are satisfied to very satisfied with the target achievement of their visit to the trade fair. The positive resonance is a result among other things due to the comprehensive exhibition offer, which 80 percent of visitors rated as very good and good. 95 percent indicated that they will recommend the IDS to others and 80 percent have already stated they will definitely or very probably attend the IDS 2011. The next IDS - 34th International Dental Show - will take place from 22 to 26 March 2011 (Tuesday to Saturday) in Cologne.

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

Dr. Mohamad Fayad (2nd to the right) welcoming his international dealers at the GC booth

Mr. Fabian Salaverry (to the right) CEO Swiss Medical Technology displaying the Dentaloscope Innovative technology

Mr. Hiroaki Yoshida and Mr. Nakanishi with dealers from Algeria at the NSK Booth

Mr. Koji Orita presenting the latest equipment from Belmont

IDS 2009

Dr. Ghassan Nasser welcoming a visitor at Sultan HealthCare booth DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

Û MECTRON PIEZOSURGERY® THE THIRD GENERATION OF THE ORIGINAL – THE EVOLUTION OF A REVOLUTION! Û NEW PIEZOSURGERY® 3 – FASTER, EASIER, MORE PRECISE! mectron s.p.a., via Loreto 15/A, 16042 Carasco (Ge), ITALIA, tel +39 0185 35361, fax +39 0185 351374, www.mectron.com, mectron@mectron.com

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29.04.09 17:11

Mr. Gilles Martelly (to the right) Export Manager on Acteon stand

Dr. Ibrahem Soubt (on the right) Sales Manager Ivoclar Vivadent

Mr. Charbel Zaidan and his son Joe with Mr. Giuseppe Giacomini (in the middle) at the BlueX booth

IDS 2009

Gerdent stand displaying dentists and dental lab furnitures from Aleppo Syria

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

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Dr. Bassel Khulief (to the left) on the innovative Sirona's CEREC Bluecam CAD/CAM system

Mr. André Siegrist at the colorful Mectron booth

Mr. Imad Assy Regional Representative of Intensiv

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Dr. Toufic Homsi with a guest from Egypt at the Komet booth

Dr. Nabih Nader demonstrating on the Phantom Head at the Zimmer Institute simulation lab

Mr. Christian Busse manning the Kettenbach booth

IDS 2009

Mr. Helmut Wiederin with guests from the Middle East at the Coltène Whaledent booth DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

Mr. Luca Graziani Area Manager of Mocom presenting the millennium sterilizer

Dr. Bashar Al-Rihani Sales Manager explaining the mode of operation of the new Kodak Digital Panoramic machine

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Mr. Michel Paten and Mr. Christian Stempf at the W&H Booth displaying innovative products

IDS 2009

Dr. Ehab Heikal with Dr. Yusri Zareef from Egypt at the Morita Stand DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

Mr. Rafic Saba (to the left) Consultant from Vita with Mr. Levon from Jeddah and Mr. Fadi Saba from Kuwait

Mr. Stephen Lawry demonstrating the new A-dec 300

Dr.Tony Dib with Mr. Robert Ganley CEO Ivoclar Vivadent

Mr. Wim Buitenkamp and Mrs. Renate Kes at the Cavex stand

IDS 2009

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

Remarkable presence of G. Tamer holding at the IDS exhibition in Cologne

Thanks to the presence of G. Tamer Holding, Lebanon was highly present at the International Dental Show 2009 (IDS 2009) which takes place in Cologne-Germany every two years with the participation of the most prominent Dental companies. Gaby Tamer, CEO of G. Tamer Holding attended the exhibition with Tarek Skaff, managing Director of G.Tamer Holding , Diaa Khreiche, general director of “Tamer Levant”, Carlos Abillama', director “3iMENA” and Abdo Irani , product manager for whitening and consumable products. “The team was present in many international stands where he gave demonstrations and established contacts with the Lebanese, Middle Eastern and North Africa dealers” reported Tarek Skaff upon his return from Cologne. The IDS gathers the largest dental manufacturers in the world (equipments, accessories and dental products) and attracts more than 120.000 visitors from all continents. “The highlight of this year” reported M. Skaff “was the launching by the American company A-DEC specialized in dental equipment, of a revolutionary dental unit which was unanimously recognized to be the most practical, the most solid and the most economical in its category”. M. Skaff recalls that G. Tamer Holding is the representative of ADEC for more than 20 years, and that the Saint Joseph University (USJ), the Lebanese University (UL), and the American University of

Beirut (AUB), are fully equipped with these widely sold machines. Among other novelties and updated dental products are the “Ivoclar-Vivadent” products. Ivoclar-Vivadent, leaders in the clinical dental products as well as laboratory products presented all their novelties in their impressive stand. The same for “Septodont”, world leader in Anesthesia that G. Tamer Holding represents since 1972. The participation of G. Tamer holding to this international exhibition confirmed once more the place of this group in the dental world in Lebanon and the Middle East and his determination to go forward. Tarek Skaff revealed that G. Tamer Holding “will be launching every 2 months new products from companies that they are representing”, he added “that the dedication to our work, our high standard scientific innovations as well as our seniority among other groups, helped us achieve the first place in Lebanon in the dental world”. M. Skaff added “on the regional level, we are present in many countries: Turkey, UAE, Iraq, Kurdistan, Syria where our premises are run by experienced young personnel from our offices in Lebanon”. “If we acquired this place in the local and regional market it is due to the dynamism of M. Gaby Tamer, CEO of G. Tamer Holding, his network of relationships built since long with the biggest international companies and his concern to be on the forefront of progress.

Carlos Abillama' at the BIOMET 3i booth in Cologne

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

G. Tamer Holding Team (left to right): Abdo Irani, Tarek Skaff, Gaby Tamer, Diaa Khreiche and Carlos Abillama'

Abdo Irani demonstrating at the Discus Dental booth

Picture from the Septodont dinner with V.P. of Septodont Mr. David Halimi

he 20th Saudi Dental Society International Conference and the 2nd National Guard International Conference and Workshops were held on April 20-22, 2009. The remarkable success of the 1st National Guard “New Dental Era” last conference held in Jeddah in March 2008 was repeated in 2009. It is a joint event of the Saudi Dental Society and King Abdulaziz Medical City Dental Services-CR, National Guard Health Affairs. Internationally renowned speakers with topics on Orthodontics, Dental Aesthetics, Dental Implant and Endodontics highlighted the scientific sessions. A special award was given to the best research project from the undergraduate and postgraduate students and another award for the best presentation in the poster session. Through this outcome the National Guard Health Affairs and the Saudi Dental Society continued to contemplate the interest of the growing population of dentists in the Kingdom. The international conference had been organized to keep Saudi dental professionals well-informed of the advances and challenges in the global society for this particular field of specialty. With more than 20 international and national speakers and scientific presentations, the New Dental Era was a valuable scientific gathering for the participants.

Prof. Yousef Talic President of the Saudi Dental Society in his welcome speech

20TH SAUDI DENTAL SOCIETY

Dr. Ali Al Ehaideb Chairman Dental Services, National Guard giving a speech during the opening ceremony

Workshops were conducted by local and international speakers. International manufacturing dental and medical companies partake in the exhibit. A compilation of approved abstracts was published to the Journal of Dental Research under the IADR Saudi Arabian Section. This conference was accredited by the Saudi Commission for Health Specialties.

Prince Mutieb Bin Abdullah Al Saud inaugurating the congress

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

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Picture of the international guests at the farm during the closing ceremony dinner

Dr. Michelle Ardene and Dr. Richard Shick (ICD) receiving trophies from Prince Mutieb Bin Abdullah Al Saud

Dr. Ali Al Ehaideb Co-Chairman of the conference offering the Trophy to Prince Mutieb Assistant Deputy Head of the National Guard

Prof. Abdulaziz Fayed riding the camel during the closing ceremony dinner

Photo of delegates from various Arab countries around Prof. Talic Co-Chairman of the Congress

20TH SAUDI DENTAL SOCIETY

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

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The Lebanese delegation with Dr. Raja' Kadhem (second from the right) President of the Bahrain Dental Society

Picture of the international guests at the Shura Council

Prof. Daniel Buser talking on Esthetic outcomes in Implant patients

Dr. Galip Gurel lecturing on Anterior Aesthetics in Clinical Practice

Dr. Hassan Halawany Chairman of the Saudi Dental Public Health Club launching the national campaign for caries prevention

Picture from the exhibition floor

20TH SAUDI DENTAL SOCIETY

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DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

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District 2 of the Middle East Section of the International College of Dentists, which has its seat at the Health Affairs of the Saudi National Guard, hosted the meeting of the Section within the framework of the 20th meeting of the SDS and the 2nd meeting of the National Guard in the presence of the College's International President Dr Richard Shick. The meeting started with a half day lecture program given by four prominent ICD fellows from Lebanon and was followed by a ceremony in which ten fellows from Saudi Arabia and Kuwait were inducted into the College

20TH SAUDI DENTAL SOCIETY

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

Straumann continuous education in the Middle East In the frame of Straumann continuous education in the Middle East region, several events were organized in the first half of 2009. The first event took place after the AEEDC congress in Dubai on March 13th and 14th at the University of Sharjah. This was the first ITI Esthetic Master course in the Middle East conducted by Prof. Dean Morton from Louisville University and Assistant Professor William Martin from Florida University. The course covered the state of the art techniques in the treatment of high end esthetic implant situations. Besides receiving high level theoretical tuition based on the ITI consensus and treatment planning approach through beautifully documented clinical guidelines and cases from Dr. Martin's and Dr. Morton's remarkable experience, the 30 participants had the opportunity to exercise these often advanced techniques during clinically based practical sessions. Procedures such as making provisional restorations for optimal soft tissue forming, esthetic surgical templates and customizing impression transfers for post mucosa forming impression taking were performed. Due to the success that this course obtained, these two remarkable speakers will be returning next year to conduct another ITI Esthetic Master course. For the second event we were proud to receive one of the world's most notorious experts in the field of oral surgery and implant dentistry, Prof. Daniel Buser, Chairman of the Department of Oral Surgery at the University of Bern, Switzerland. Prof Buser was an invited speaker to Saudi Arabia's National Congress organized by the Saudi Dental Society and the Saudi National Guard, where he conducted a 1 day lecture about the importance of Guided Bone Regeneration surgical techniques in dealing with highly demanding esthetic implant cases in compromised

hard and soft tissue sites. The participants were exposed to proven methods and techniques on how to achieve best results from his long clinical and research experience. Professor Buser then continued to Abu Dhabi in the UAE where he lectured to 150 dental clinicians on the same topic. This event was organized in collaboration with the Health Authorities from Abu Dhabi in their premises. This was Professor Buser's first visit to the Middle East. He was impressed and expressed the wish to return, therefore, next year a 2 day course with Professor Buser and Professor Belser from Geneva University is already been discussed and should take place in Dubai in the First half of 2010. Professor Buser's visit to the region also coincides with the development of the ITI foundation in the region as the Middle East ITI section is in the process of being created and soon will be able to provide the highest level of continues education through activities such as study clubs and mentoring programs for the local ITI members. With all these events, Straumann and the ITI foundation continue to assure their commitment to the development of training and education for the advancement of excellence in implant dentistry in the Middle East. For more information on the upcoming courses in the Middle East region please contact: David Dias Head of Regional Education - Middle East David.dias@straumann.com

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The 1 st Dental Administration conference was held between 5 - 7, March 2009 in Kuwait in Al Nakheel Hotel under the sponsorship of the Minister of Health Mr. Radwan Abdulaziz Al Radwan. The Theme of the Conference was “Towards Better General Dentistry“. Many international and local speakers highlighted the latest advances in dentistry. And the exhibitors who participated in

this conference formed a platform to showcase their modern dental technologies and services. This conference emphasized the increasing role of research in the field of dentistry. It was also a good opportunity for meeting colleagues from all over the world and for exchanging ideas and experiences. The conference was well organized and operated, the support of the ministry was important to the organization of this event.

Dr. Sakr Hmeida in his inaugural speech

Prof. Nour Habib , Dean Cairo School of dentistry offering the university trophy

Dr. Walid Al Saady from Syria receiving his trophy for his contribution in the congress

Dr. Fouad Salama from the University of Nebraska lecturing about the latest advances in pediatric dentistry

Dr. Issam Zaatar, Dr. Sakr Hmeida and Dr. Tony Dib (from left to right) in the exhibition hall

1ST DENTAL ADMINISTRATION CONFERENCE - KUWAIT

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

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GSK Launch Sensodyne Iso-Active, the Next Generation Toothpaste Sensodyne Iso-Active is proven to reduce the pain of sensitive teeth among younger sufferers, while providing the all-round protection benefits that they require. This new technology generates more than twice the foam volume during brushing compared with standard toothpastes. The gel transforms into active foam while brushing and penetrates hard-to-reach areas, helping to deep clean the mouth, providing freshness and all around protection for the whole mouth while also providing relief from sensitive teeth. Although younger adults have a higher incidence of sensitivity, they are least likely to treat the problem medically. The main aim of this socially active segment is to have white and healthy “looking” teeth, which is why they merely seek cosmetic and whitening toothpastes. However with Sensodyne Iso-Active they can enjoy all the benefits they require in addition to having their teeth protected from sensitive teeth. Karim Wally, Head of Marketing at GlaxoSmithKline, Consumer Healthcare, said: “Sensodyne is a leader in oral health and for decades we have worked to find the best solutions for dental problems that affect everyone, including younger adults. It is gratifying to be able to present a revolution in the oral care and sensitive teeth segment, in a new, modern, and effective way with the brand new Sensodyne Iso-Active foaming gel.''

As easy as ABC - OptraGate Junior ExtraSoft In order to meet the need for a more comfortable and gentle OptraGate for children that minimizes pressure, an ExtraSoft version of the tried-and-tested lip and cheek retractor OptraGate Junior has been developed. By modifying the intraoral ring using a soft material pad and by including recesses for the lip frenula, OptraGate Junior ExtraSoft is even more comfortable to wear for children. The even, three-dimensional retraction of the lips and cheeks creates a treatment field which is easier to access and clearly visible. Contrary to conventional, rigid lip and cheek retractors, OptraGate Junior ExtraSoft adapts perfectly to the individual oral situation, as it features three-dimensional functionality and flexibility. OptraGate Junior ExtraSoft can be used in many different procedures, such as patient examination, professional teeth-cleaning, preventive measures, direct and indirect restorative therapy or orthodontic treatments. Just like the Regular and Small sizes, OptraGate Junior ExtraSoft is hygienically and individually wrapped and available in the convenient dispenser box. For additional information: E-Mail: info@ivoclarvivadent.com www.ivoclarvivadent.com

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

What is ACP? Chemical Makeup ACP is an abbreviation for Amorphous Calcium Phosphate. ACP is created when dissolved calcium ions and phosphate ions react to form a non-crystalline insoluble salt. Due to the reactive nature of the chemicals involved, the calcium and phosphate must be stored separately until they are applied to the tooth surface. Patented Technology Discus Dental, LLC. has licensed patented technology from the ADA Foundation allowing Discus Dental to incorporate ACP technology in professionally dispensed whitening gels. How ACP Works Tooth demineralization from acid results in dulling, loss of tooth luster, and a higher susceptibility to caries. The oral environment can naturally rebuild enamel, through a process called remineralization, to some extent on its own, but the extent of remineralization is controlled by pH and the amount and availability of calcium and phosphate ions present in the mouth. Remineralization can easily be reversed in an under-saturated environment. The natural rebuilding of enamel is a slow kinetic reaction which can be rapidly sped up by the addition of ACP-forming components into the oral environment. Amorphous Calcium Phosphate (ACP) is the reacted complex of calcium and phosphate ions that precipitate and can grow on tooth surfaces in the oral environment. These initial ACP complexes are thermodynamically unstable under the conditions normally prevalent in the oral environment; pH, temperature, etc. Over time, these unstable compounds will undergo further reactions as well as phase transformation into other more stable forms of calcium phosphate. The precise path of the complex

transformation is not fully understood, but the final form has been shown to be hydroxyapatite, a large constituent of the normal, mineralized structure of healthy teeth. In practice, introducing ACP onto a tooth surface will lead to rapid deposition of a new coating of hydroxyapatite over the original tooth surface.1,2 At normal oral pH and temperature, the addition of ACP-components to the salivary system can cause the hydrolysis of ACP into apatite within a few minutes, which is roughly 20,000 times faster than normal, physiologic formation of apatite.3 Besides adding to the external resistance of the teeth by building a barrier of acid resistant hydroxyapatite, ACP also biases the remineralization-demineralization equilibrium by releasing essential ions that favor remineralization by increasing the degree of saturation with respect to hydroxyapatite. Furthermore, calcium and phosphates can bind with other ions such as fluoride, and other proteins in saliva, to form complexes that can be stored in plaque and saliva, ready to release calcium, fluoride, and phosphate ions in response to acid challenges.4 coating of hydroxyapatite. Hydroxyapatite rebuilds enamel and fills surface defects.

ACP Benefits Rebuilds Enamel The deposition of hydroxyapatite onto teeth rebuilds enamel and restores luster through a process called remineralization. Preliminary research by Flaitz & Hicks at the University of Texas, Houston, showed that, “The addition of calcium phosphate to whitening agents reduces the susceptibility of enamel to “in-vitro” lesion initiation and progression.”5

eliminating the source of sensitivity by plugging dentinal tubules with calcium phosphate, the tooth mineral. This is similar to the process of sclerosis, where salivary mineral precipitates slowly over time in these tubules and reduces sensitivity. ACP simply speeds this process considerably with the same mineral at much higher concentrations. ACP has been clinically shown to dramatically reduce dentinal hypersensitivity by occluding dentinal tubules.6 Discus Dental whitening gels, such as Nite White ACP, are the only professional take-home whiteners to combine patented ACP technology with the proven effectiveness of Potassium Nitrate to establish a new standard for patient comfort in professional take-home whitening.7 Improved Appearance - Restores Enamel Luster ACP has been clinically shown to improve the smoothness and luster of teeth8 by filling superficial tooth defects and improving the overall smoothness and luster of patients' smiles.3 Lasting Results In clinical studies, patients who used a takehome dental tooth whitener containing ACP experienced less fadeback six months after treatment compared to patients who used an identical take-home whitener without ACP.9

“ACP is a revolutionary chemistry that goes beyond traditional restorative materials by using the body's own building blocks to desensitize the dentition through remineralization.”

Effective Desensitizer ACP mimics the natural desensitizing process by

Alan Boghosian, D.D.S., Assistant Professor of Clinical Surgery, Department of Surgery, Division of Dental Surgery, Northwestern University Feinberg School of Medicine

References 1 Tung, M.S., Eichmiller, F.C. Amorphous Calcium Phosphate for tooth mineralization. Compend Contin Educ Dent, Vol 25, No 9 Suppl 1, Sep 2004, pp 9-13. Journal Code 9600713, Journal Subset MEDJSD, ISSN 1548-8578. Corporate Author: American Dental Association Foundation.

Subset MEDJSD, ISSN 1548-8578. Corporate Author: American Dental Association Foundation.

Gel with Added Amorphous Calcium Phosphate. Jada Vol. 136, March 2005.

4 Grant LP, Thompson A, Tanzer JM. Caries inhibition in rats by a remineralizing toothpaste. Journal of Clinical Dentistry. 1999;10(1 spec no):30-33.

2 M. Markovic, B.O. Fowler And M.S. Tung. Preparation and Comprehensive Characterization of a Calcium Hydroxyapatite Reference Material. Journal of Research of the National Institute of Standards and Technology, Volume 109, Number 6, November-December 2004.

5 Flaitz C, Hicks J. Whitening Agent Effects on Enamel Caries Formation and Progression. IADR Unpublished Abstract #73739.

8 Giniger M, Spaid M, Felix M, MacDonald J, Ziemba S. Tooth Surface Enhancement by a 16% Carbamide Peroxide Take-Home Bleaching Gel Containing ACP. Journal of Dental Research. 84(Spec Issue A): 1793,2005. . 9 Giniger M, Spaid M, Felix H, MacDonald J. A 180-Day Clinical Investigation of the Tooth Whitening Efficacy of a Bleaching Gel with Added Amorphous Calcium Phosphate. Journal of Clinical Dentistry, Volume XVI, No. 1, 2005.

3 Tung, M.S., Eichmiller, F.C. Amorphous Calcium Phosphate for tooth mineralization. Compend Contin Educ Dent, Vol 25, No 9 Suppl 1, Sep 2004, pp 9-13. Journal Code 9600713, Journal

6 M. Cherng, S. Takagi And L.C. Chow. Reduction in Dentin Permeability Using a Calcium Phosphate Slurry. Journal of Dental Research 83 (Special Issue A); IADR CD-ROM Abstract No. 0119, 2004. 7 Giniger, MacDonald, Ziemba, Felix. The Clinical Performance of Professionally Dispensed Bleaching

Picture from the audience during the opening ceremony

It is with great honor and privilege to welcome you all to Beirut Arab University 1st International Dental Congress. This congress aims at achieving our goal of fast pace advancement, transforming the scope of dental sphere and its relation to progressing field of dental medicine. Beirut Arab University 1st International Dental Congress is reaching a wider international audience, a true global scope. But this implies some challenges and new problems.

Minister Kabbani cutting the ribbon of the scientific exhibit

Widening the audience allows us to reach scholars that previously had few occasions to attend international conferences, lacking the opportunity to know others from different parts of the world. Moreover, it will be a benefit by granting us access to research done in other countries. I am honored to welcome distinguished medical professionals from inside and outside the Arab world. I hope Beirut Arab University 1st International Dental Congress will put forward the visions of the future for providing a more competent dental healthcare service. Finally, I welcome all our guests to the beautiful city, Beirut and I call upon you to join in shaping an improved dental healthcare service based on credibility and constructive cooperation.

Photo of the Saudi delegation headed by Prof. Yousef Talic (left)

I am hereby honored to take the responsibility of launching the organization of Beirut Arab University 1st International Dental Congress 2009, with the theme of: " Recent Advances in Dentistry: New Horizons & Beyond ..." Dr. Abdel Aziz Fayed Ismail Dean, Faculty of Dentistry

BAU 1ST INTL. DENTAL CONGRESS 2009

The choir of the Beirut Arab University performing a folkloric Lebanese song during the opening ceremony DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

Prof. Fayez Saleh (in the middle of the 1st row) with the group of dentists who attended the workshop of Pr. Ferguson on accelerated orthodontics by decortication

Prof. Mohammed Nassar receiving a certificate for his lecture on “Modulating Diabetic Subjects for dental Implants”

Dr. Joe Massad receiving a certificate for his lecture on ”Predictable Complete Dentures and Implant Over-Dentures“

Prof. Esam Tashkandi receiving a certificate after his lecture on “Implant or Bridge for Single Tooth replacement”

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

BAU 1ST INTL. DENTAL CONGRESS 2009

Trophy offered to Dr. Mohamad El Jishi General secretary of the Arab Dental Federation

Trophy offered to Dr. Antoine Karam President of the Lebanese Dental Association

Trophy offered to Prof. Tarek Abbas President of the Egyptian Dental Association

Trophy offered to Prof. Medhat Abdullah General Secretary of the Congress

BAU 1ST INTL. DENTAL CONGRESS 2009

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

PICTURES FROM THE EXHIBITION FLOOR

DENTAL NEWS, VOLUME XVI, NUMBER II, 2009

BAU 1ST INTL. DENTAL CONGRESS 2009

IPS

InLine ®

Conventional Metal-Ceramic

InLine PoM

IPS

InLine

Press-on-Metal Ceramic

Make it InLine! IPS InLine – the leucite metal-ceramic featuring stability of shade, which is available in new modern Bleach shades to meet exacting demands. IPS InLine offers fast and uncomplicated processing, as well as ideal ﬁring stability and sintering.

IPS InLine PoM – the new press-on-metal technology based on the proven press technique, popular alloys and well-known equipment. IPS InLine PoM is a leucite ceramic that is pressed on metal frameworks to produce precision restorations.

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