Dental News March 2009 by Dental News

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Volume XVI, Number I, 2009

MANAGEMENT OF

CALCIFIED CANALS

ISSN 1026 261X

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Volume XVI, Number I, 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

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

CONTENTS CONTENTS CONTENTS CONTENTS

Management of Calcified Canals: Negotiating the Unforgiving Dr. Richard E Mounce

Variation in Consistency of Dental Needles in Kuwait Dr. Ebraheem M.Behbehani, Dr. Abdel-Majeed A.Safer, Dr. Aamir A.Haddad. Dr. Mohammad Rafique

Stability and Retention After Orthodontic Treatment Dr. Najat Al Sayed Alhashimi

Clinical Evaluation of a Chairside Whitening Lamp and Bleaching Efficacy J.C. Ontiveros, R.D. Paravina, M.T.Ward

The 3rd Riyadh International Dental & Pharmacy Meeting

Yemen Dental Association - First Scientific Co onference

The 1st Jordanian and 7th Arabic Congress of Pediatric Dentistry

5th Conference of the Gulff Dental Association

62 71

15th Oman Dental Society Conference

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.

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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March 10 - 12, 2009 AEEDC Dubai, Dubai International Convention & Exhibition Center Email: index@emirates.net.ae Website: http://aeedc.com March 24 - 28, 2009 The IDS 2009, Cologne. Website: http://www.ids-cologne.de April 20 - 22, 2009 20th Saudi Dental Society and 2nd National Guard International Conference. To be held at the King Fahad cultural center, Riyadh. Email: info@sdsam.org Website: http://www.sdsam.org May 01 - 03, 2009 Beirut Arab University - 1st International Dental Congress Recent Advances in Dentistry:"New Horizons & Beyond…” Pavillon Royal - Biel Beirut, Lebanon Website:http://www.bau-idc.org May 04 - 07, 2009 The 4th Jeddah Dental Esthetic Conference Jeddah Hilton Hotel, KSA Email: hfaour07@yahoo.com Website: http://kfshrcj.org May 11 - 14 , 2009 The Saudi Healthcare and Saudi Hospital Jeddah Center for Forums & Events, KSA Email: publicity@acexpos.com Website: http://acexpos.com

June 19 - 21, 2009 Lebanese University Congress Faculty of Dental Medicine Campus President Rafic Hariri - Hadath Email: doyenfmd@ul.edu.lb 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: www.syr-sda.com October 21 - 23, 2009 4th RIDPM (Riyadh International Dental and Pharmacy Meeting) Riyadh, Saudi Arabia Email: meeting@riyadh.edu.sa Website: http://riyadh.edu.sa/meeting November 6 - 7, 2009 1st Dental - Facial Cosmetic International Conference Jumeirah Beach Hotel UAE Tel: 971 4 3616174 Fax: 971 4 3686883 Email: info@cappmea.com Website: www.cappmea.com

June 18 - 21, 2009 Syrian Medicare,The 9th Medical Exhibition & Conference Fairground - Airport Road, Damascus, Syria Email: syrianmedicare@gmail.com Website: http://syrianmedicare.com

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GET YOUR ISSUE ONLINE DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

Volume XVI, Number I, 2009 11 11

Management of Calcified Canals: Negotiating the Unforgiving <By Richard E. Mounce*

ecently, I received this e-mail from a reader asking about the management of calcified canals: “I am going to present about calcified canals and their management, treatment and prognosis...It is hardly difficult to find information in my country…It would be very kind of you to give me more information (all about calcified canals, if it is possible). I'm looking forward to hear from you and your help soon.” Management of calcified canals is best accomplished with the following instruments and principles governing the endeavor: 1) The greater the lighting, magnification and improved visualization that can be brought into the procedure, the better. Ideally, the surgical operating microscope (SOM) will be used (Global Surgical, St. Louis, MO, USA). To one degree or another, all other options available are a compromise away from the gold standard that the SOM represents. Without enhanced lighting and visualization, the clinician is making educated guesses about the location of calcified canals. Without enhanced visualization, dentin removal is based on where we think the canal should be, rather than removal of dentin where we know it is because we can clearly see it. Adequate lighting and magnification removes all guesswork. 2) The rubber dam should always be employed. Visual and tactile control over all phases of the endodontic process, calcified canals as well, are compromised without it. There are no cases where it is appropriate to perform endodontic treatment without it. It is the legal and ethical standard of care in North America. 3) Ultrasonics are often preferable to removing dentin than a bur. Burs will remove more dentin and do so less precisely than ultrasonic tips. A comprehensive discussion of every ultrasonic tip design and its

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

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

application in the removal of dentin to uncover calcified canals is beyond the scope of this article, but suffice it to mention that the tips of greatest value for uncovering calcified canals are the more broad and rounded variety. Orifices that have been made flat and which are entered with a hand K file at 90 degrees are far more easily negotiated than those that are entered at some other more acute angle. I favor the use of the Red Star #2* ultrasonic tips on the Elements Ultrasonic Unit* at full power. The Red Star #2 is highly durable and can remove dentin both axially as well as on the pulpal floor. The Red Star #2 can create a flat and easily negotiated orifice. Ultrasonic tips with finer and more pointed tip styles remove less dentin and may minimize perforation risk as opposed to using a bur. The trade off though is that they are not efficient in creating a flat platform for passive hand K file entry at 90 degrees to the orifice. 4) I use Kerr (Orange, CA, USA) #6-15 stainless steel hand K files for initial negotiation and glide path creation of calcified canals. Copious numbers of these files are available for every case. If the clinician prefers to use carbon steel hand K files there is not harm in doing so. In my hands though, carbon steel instruments do not offer any advantages over the files recommended above. Hand K files can be made more effective in canal negotiation if they are pre curved with an EndoBender pliers* and possibly trimmed with a scissors to custom fit them to the particular canal. Figure 1. For example, if a ledge, blockage or other canal transportation has been discovered at 18 mm in a 22 mm root, the clinician can trim the #6-15 hand K file (depending on the particular case) to 19 mm. With the trimmed and pre curved hand K file, the clinician will be able to place a far more intentional pressure on the instrument at the point needed. As a result, the chances for negotiation are optimized. Alternatively, using a 25 mm hand K file in a canal with this 19 mm

Correspondence address: Lineker@comcast.net 12503SE Mill Plain, Suite 215 Vancouver, WA, USA 98684 MANAGEMENT OF CALCIFIED CANALS: NEGOTIATING THE UNFORGIVING

perforate if the clinician is not acutely aware of the alignment of the roots in relation to a crown and especially so if the tooth being accessed is part of a bridge.

Fig. 1: The EndoBender pliers (SybronEndo, Orange, CA, USA)

blockage will cause the hand file to buckle and severely reduce its effectiveness. 5) Ideally, the clinician should take three radiographic angles before beginning, one from the mesial, one from the distal and one from straight on. This will allow the clinician to map the canal anatomy three dimensionally. This gives the clinician strong clues about the complexity of the space to be negotiated and subsequently enlarged. Digital radiography is immensely helpful in this regard. Caution is advised. Because the canal may appear calcified radiographically, means little in terms of negotiability, the canal may be easily negotiable, and it may not. The clinician should make decisions as to their ability to negotiate a canal from a comprehensive evaluation of all the factors discussed here, not simply a radiograph. 6) Access through crowns is notoriously challenging. Crowns are fabricated to fit the occlusion, not to be accessed through. The anatomy built into crowns has no bearing on the position of canals that lie in the roots below. As a result, when accessing a crown, diligence is required to locate the canals. All discovered landmarks should be fully appreciated and guide subsequent steps. For example, if the clinician is accessing an upper molar, they might attempt to find the palatal canal first and once this landmark is located, the position of the MB and DB canal will be located more easily, whether they are calcified or not. Regardless of whether the clinician is using the SOM, loupes or even the naked eye, the color of the pulpal floor, the anatomic lines on the pulpal floor, the texture of the dentin, the position of the crown and restorations in relation to the expected position of the canals should all be considered and guide dentin removal. The clinician must observe the buccal to lingual and mesial to distal dimensions of the tooth to help guide dentin removal. If there is a cusp, there is a canal below. If there is an asymmetry of the located canals, there is another orifice to be found. Rotated, tipped, and otherwise altered tooth positions can and do often change the expected position of canals. It is relatively easy to

Fig. 2: The M4 reciprocating handpiece attachment (SybronEndo, Orange, CA, USA)

MANAGEMENT OF CALCIFIED CANALS: NEGOTIATING THE UNFORGIVING

7) Access must be straight line. Ideally, all restorations, caries and unsupported tooth structure should be removed. While this may be the ideal, many referring doctors and patients will desire to have access made through a crown carrying with it the aforementioned challenges. In essence though, removing everything that obscures the location of the calcified canal is vital both to its location and negotiation. It is also possible, that after access procedure, the tooth may be deemed non-restorable or it may become known if additional periodontal procedures are needed to make it restorable. In any event, the true restorability of the tooth will emerge from ideal access procedures in addition to optimal chances for canal location and negotiation. 8) Before managing a calcified canal, it is essential that the clinician have some idea of the root length. This approximation in mm represents the estimated working length (EWL). The EWL gives the clinician some rough idea of the position of the minor constriction (MC) of the apical foramen. This vital landmark, the MC, is the position to which the canal is irrigated, instrumented, and obturated. Only patency files, #6-10 hand K files, should go beyond this point. As negotiation, especially of a calcified canal takes shape, it is essential for the clinician to know where they are in the canal at all times and have an idea what the true working length (TWL) will ultimately be. This concept will be elaborated on further below. 9) Calcified canals are unforgiving. They must be managed correctly from the first inserted file. Always have irrigant in the canal at the time of the attempted negotiation. Once a canal is located, from the first file insertion to the last, in the most challenging cases, one false step can lead to blockage or iatrogenic outcomes. In my hands, a pre curved #6 hand K file is the first hand K file size inserted, even if the root is fairly open and easily negotiable. It should be entered passively, inserted with intentional pressure, and yet never forced. It should be inserted slowly, if it wants to advance it should be allowed to do so and if it does not, it should be withdrawn. Once the #6 (or given and appropriate) hand K file used in negotiation reaches the MC, it should be attached to an electronic apex locator and the first determination of TWL made.

Figure 3(A-B): Retreatment performed on an upper first molar. The previously untouched MB 2 canal was located and negotiated with the concepts and materials discussed. DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

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10) Alternatively, if the canal will not allow easy negotiation as the #6 is inserted, additional skill sets are called for. The key determinant of whether the calcified canal will be negotiable is how much “give” the file has moving apically and how “spongy” the canal feels. If the file feels tactilely that it can be inserted deeper in the canal it usually can be. The trick is to not keep pushing on the hand K file in one linear apical motion with force if it does not want to advance. Clinically, if the #6 hand K file allows some insertion, it can be taken as far as possible without undue force and then removed. Its removal will allow additional irrigant to flow into the canal in the void created by the withdrawal. After irrigation of the canal and the chamber, the next pre-curved #6 is inserted and with intentional pressure it can usually make apical progress past the point of previous insertion. If the canal seems to stop abruptly, as if one has hit a brick wall, and the file simply will not allow advancement, the pre curved hand K file should be inserted again and again in many different orientations (known as doing the “endo dance”) to find to find a way through the blockage or calcification. Many times such calcified canals will be negotiable and other times not, but the clinician should assure themselves that the #6 hand K file has been inserted in every orientation possible with the right amount of intentional pressure to break through the calcification or blockage and make its way toward the MC. Most often, the mistake made by clinicians is that they reach a calcification or blockage during hand K file negotiation and do not use enough #6 or #8 hand K files and/or do not press hard enough to allow the file to advance. Once negotiation has been accomplished and the hand K file reaches the MC, the use of reciprocation in the form of the M4 Safety Handpiece* attachment is immensely valuable. Figure 2. Using a 30-degree clockwise and 30-degree counter clockwise motion (not a full rotation) can take a severely calcified canal from a #6 hand K file diameter to that of a #8 hand K file. It can take a #8 hand K file diameter to that of a #10 hand K file, etc. Reciprocation saves time, hand fatigue, and creates a more reproducible glide path than which could be made by hand enlargement alone. Reciprocation mimics the watch winding of hand K files. The M4 attachment joins with any electric motor that has an E type coupling. I use it at 900 rpm at the 18-1 setting with the torque control off. Irrigant is always placed in the canal as with any shaping procedures. The file is reciprocated in the M4 approximately 1-3 vertical

MANAGEMENT OF CALCIFIED CANALS: NEGOTIATING THE UNFORGIVING

mm for 15-30 seconds per file size. After each reciprocation, the canal is irrigated and the canal recapitulated. One note of caution, the hand K file is not placed in the M4 and driven to length, it is attached to the hand K file after the file has been placed to the MC. In other words, clinically, the hand K file is placed, under the rubber dam, to the MC or the EWL and then the M4 is attached and reciprocated as described above. After the canal is enlarged to the size of a #15 hand K file (reciprocating the #6, 8 and #10 as needed) the rest of the preparation can be done with a rotary nickel titanium file (RNT) such as the Twisted File* or the RNT of ones choice. If the clinician is not reciprocating the creation of the glide path but is making this step by hand filing alone, the #6 hand K file is made to spin freely in the calcified canal, followed by the #8 hand K file, etc until a #15 hand K file spins freely and the canal has been made ready for RNT instruments. Practice in extracted teeth and plastic blocks is advised before attempting this clinically. 11) One factor supersedes all of the considerations above, taking the time needed to locate and manage these canals. Management of calcified canals is made simpler and ultimately far more efficiently by their patient and diligent sequential negotiation. This is not a step than can be hurried. If you do not have the time, experience, desire, and/or the equipment to manage this clinical event, the case should be referred. Figure 3A-B. A clinically relevant review of the management of calcified canals has been presented. Emphasis has been placed on straight-line access; copious use of pre curved #6-10 hand files, use of the M4 reciprocating handpiece and sequential enlargement of the canal. I welcome your questions and feedback. Dr. Mounce offers intensive customized endodontic single day training programs in his office for groups of 1-2 doctors. For information, contact Dennis at 360-891-9111 or write RichardMounce@MounceEndo.com. Dr. Mounce lectures globally and is widely published. He is in private practice in Endodontics in Vancouver, WA, USA.

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

Variation in consistency of dental needles in Kuwait: An elemental x-ray microanalysis (edx) study <By Ebraheem M. Behbehani*, Abdel-Majeed A. Safer**, Aamir A. Haddad***, Mohammad Rafique****

ABSTRACT Variation in consistency of anesthetic needles invariably causes needle-breakage, raising concern as regards their quality, composition, homogeneity and strength. On the basis of their strength, elemental composition, and morphology. Test needles were randomly selected from three different manufacturers, and subjected to standard tests, for studying their cross-section profiles, qualitative and quantitative tests. The X-ray mapping of needles, facilitated the identification of elements present in each of the three types of manufactured needles. These tests led to the classification of needles into three groups 1, 2 and 3. Our results revealed their elemental composition, and weight percentage. i.e higher concentration of iron and chromium in group 1 needles, with relatively lesser percentage of carbon, than the other two groups. It is significant to note that group 2 and group 3 needles showed higher weight percentage of carbon, the element which is known to affect adversely the needle quality. We may, therefore, conclude that the presence of iron, chromium and nickel, were the essential components that characterized good quality needles, and we found these elements in group 1 needles. We recommend that unified guidelines be evolved and applied in manufacturing good quality needles, as a standard quality assurance measure, to minimize and eliminate probability of needle-breakage risk during use on patients. Keywords: Anesthesia, broken needles, edx; standardless analyses, electron microscopy, quality assurance, Quantax QX2's software, coloured x - ray mapping.

INTRODUCTION Variation in consistency of anesthetic needles is believed to affect their quality, and is the predominant cause of needle-breakage. The

*Department of Diagnostic Sciences, Faculty of Dentistry, **Department of Biological Sciences, Faculty of Science, ***Department of Chemical Engineering, Faculty of Engineering & Petroleum, ****Electron Microscopy Unit,

use of disposable dental needles, during the 1960s, reduced the frequency of needle breakage, in comparison to the first half of the 20th century [1]. Yet, needle-breakage has continued to remain a virtual risk for patients, and a persistent cause for concern to experts, who rely on varying quality of anesthetic needles, manufactured with different elemental composition and techniques, affecting the needle-quality, homogeneity and strength [4]. Anesthetic needles, used locally in Kuwait, are generally imported by local suppliers from Britain, France, Germany, Japan, USA and Korea, who do not follow any specific guidelines or standards, while importing needles. It is believed, the suppliers, acquiring these needles from outside, do not have the provision of standard quality guidelines to follow, when importing their needle-merchandise from these countries. This fact is revealed in an earlier study from Kuwait [2], where most dentists reportedly attributed needle-breakage to manufacturing errors. This study also demonstrated lack of adherence to any unified quality-control measures, as well as the need for further studies for determining the quality of needles through experimental tests, conducted on various needles used in Kuwait. These findings provided the basis for our study to determine the quality of needles, through experimental tests conducted on various needles generally used in Kuwait. Our focus was on determining the extent of variation in needles that contributed to their tensile strength, when compressive forces are exerted. Our experimental tests were aimed at throwing significant light on needle quality, on the basis of their elemental composition, morphology and homogeneity, as a step towards determining the attributes of good quality needles, as well as advancing our knowledge in this little-researched area. We strongly believe, that our results need to be further substantiated through more advanced research, to provide the legitimate basis for establishing a unified standard for quality-assurance in needle-importation in Kuwait, apart from safeguarding patients against the potential risk of needle-breakage, while undergoing treatment.

* Corresponding Author:- Ass. Prof. Ebraheem Behbehani, Dept.of Diagnostic Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University e-mail:- eb26@hsc.edu.kw; babhani@qualitynet.net

Faculty of Science, University of Kuwait, KUWAIT

VARIATION IN CONSISTENCY OF DENTAL NEEDLES IN KUWAIT

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

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MATERIALS AND METHODS The tests needles for our study were randomly selected from three different suppliers, who imported needles from manufacturers in

France, UK, Japan, and Korea. The test needles were of gauges 25, 27 and 30, and lengths, ranging from 21mm to 35mm. These needles were randomly selected from a 100-piece box, and collected in groups of 10, and classified as groups 1, 2 and 3 (Table 1), based on their manufacturers, and the type of needles. Transverse section of all test needles were prepared, using a Struers cutter, model Minitome slow-speed diamond saw and were cleaned by ultrasonication. Small holes of 600-μm sizes were drilled in carbon stubs, with PCB drill, to fix the needles in vertical positions. The cut needles were placed, both horizontally and vertically, on carbon stubs without embedding them in acrylic or epoxy resin. The samples on the carbon stub were loaded in a Leo Supra 50 VP Field Emission Scanning Electron Microscope, manufactured by Zeiss, Germany, and examined at 20 kV, with working distance of 18 mm (system capacity is 1 - 48 mm) and a fixed takeoff angle of 35 degree for the EDS detector. The Images of vertical and horizontal faces were taken by backscattered, secondary electron detector, and built-in lens detector. Elemental X-ray microanalysis, and X-ray mapping images, were captured by remote microscopy on Quantax QX2 EDS system, attached with X-flash dry detector (LN2 free) of 127ev resolution, manufactured by Rontec, Germany, using Rontec software, available with Leo Supra 50VP FESEM. For all needle samples, qualitative, quantitative analyses, and X-ray mapping were done, both horizontally and vertically, and reports prepared by Quantax QX2's software for quantification and colored X-ray mapping after system calibration by Mnstandard for standardless analyses. The elemental composition and weight percentage of the test needles were studied, and the results compared, for all three needlegroups (Table 1), as indicators of their relative quality.

RESULTS Morphologically, group 1 needles showed amorphous and smooth surface in most of the places. The needle-quality in this group was good, even when composite coloured x - ray mapping of elements were looked at (Fig.1A). The qualitative and quantitative analyses showed higher presence of iron and chromium, followed by nickel with much less carbon-content (Fig.1B). In group 2 needles, morphology showed a rather rough surface throughout, in comparison to group 1 needles. The needle cross-secTABLE 1. Elemental Composition of Needles by Group and Weight Percentage

Group 1 Elements C O FE CR NI SI

Weight % 1.8 0.63 70.63 18.51 7.58 0.83

Group 2 Elements C O FE CR NI SI

VARIATION IN CONSISTENCY OF DENTAL NEEDLES IN KUWAIT

Weight % 2.47 0 70.29 17.7 8.76 0.78

Group 3 Elements C O FE CR NI SI

Weight % 6.77 0.95 65.31 16.96 8.57 1.44

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

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Fig 1. Composite coloured x-ray maps and qualitative EDX analyses report of the dental needle samples from high quality (A,B), medium quality (C,D) and low quality

A. Group I. composite coloured B. Qualitative analysis of x-ray Map of Needle's Cross selected area of group I Section Needle

distribution (Fig.3A). Qualitative and quantitative analyses further showed that this group had the highest concentration of carbon, and comparatively lesser presence of iron, chromium, and nickel, than any of the two previous needle-groups (Fig.3B). The cross-section exhibited distorted and irregular surface, that appeared rough, showing clear signs of brittleness, generally associated with poor quality needles. The comparative test results, presented in Table 1 and Figs. 2-4 clearly demonstrated that the needle quality largely depended upon its elemental composition. The results also showed, that the presence of iron, chromium and nickel made the needle surface homogeneous, enhancing the needle-quality, as characterized by group 1 needles, while group 2 could be termed as intermediate in quality, and group 3 as suggestive of bad quality, due to highest concentration of carbon.

DISCUSSION

C. Group II . composite D. Qualitative analysis of coloured x-ray Map of Needle's selected area of group II Cross Section Needle

E. Group III. composite F. Qualitative analysis of coloured x-ray Map of Needle's selected area of group III Cross Section Needle throughout, in comparison to group 1 needles. The needle cross-section also exhibited a rough surface, while the composite colored x-ray mapping, further showed homogeneity in the distribution of all elemental components (Fig.2A). The qualitative and quantitative analyses showed the concentration of iron and chromium (Fig.2B). This group was characterized with the lowest weight percentage of carbon, the factor which is crucially linked to superior-quality needles. Another significant factor was the absence of aluminum, suggesting that the presence or absence of aluminum does not, in any way, affects the needle quality. In group 3 needles, morphology showed a rough, very irregular surface with air bubbles like defective structures throughout the cross section, in comparison to groups 1 and 2 needles. The composite colored x-ray mapping also showed lack of homogeneity in elemental

VARIATION IN CONSISTENCY OF DENTAL NEEDLES IN KUWAIT

The earlier study, among practicing dentists in Kuwait, showed that 60% of the respondents had attributed needle-breakage to manufacturing errors. Based on the results of this survey, we examined the physical and chemical properties of locally available needles, from three different manufacturers, and subjected them to microscopic analysis, to ascertain the major cause of needle breakage. Test needles were subjected to tensile tests to evaluate their physical properties [2], using international standards as reference (International Standardsa: ISO, 2000), and the results showed considerable variation in elemental composition of each of the needles tested. [9] In his study reported on needle strength in 27gauge, and frequency of needle tip breaking, and lodging in the subject, and recommended the avoidance of excessive force to prevent the needle from bending during insertions[10], [11] and [6] also reported resisting needle breakage in dental and drug user situations, especially with regard to needle tips that broke and became permanently lodged in tissues. Groswassen et al [5] studied injection techniques and needle lengths on delivery of vaccines to infants and children, and concluded that injection technique was as important as needle length in ensuring that needles did not break or cause pain to patients. Pietruszka et al.[8] in his study, suggested that a 30 G needle need not be used for nerve blocking injection, being the most narrow and least rigid needle, it was susceptible to breakage. While Bedrock et al. (1999) [1] suggested using a 27G, 35mm long needle for inferior alveolar nerve blocks. These authors recommended to avoid penetrating the needle to its hub, where the needle was weakest, and its sight could easily be lost when buried to the hub. In a related study [6], while presenting the results of the static and dynamic loading of hypodermic needles, indicated that needles and hub assemblies were invariably resilient to breakage, and that not a single needle broke, if used or loaded only once. However, if a permanently bent needle was straightened and reused, the risk of needle breakage was found to be high. The tests done in Kuwait, on the needles tensile and compressive properties [2], as well as the tests done earlier by Hoff et al. (1999) [6], proved that there was a significant difference in the properties of

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

needles tested, and largely their elemental variation attributed to their quality. In this regards, the longitudinal-and-cross-section profiles of the needles, in our study, provided revealing insights into their morphology, where group 1 needles showed clear and homogenous surface and cross-sectional profiles, group 2 was also good, but to a lesser extent, while group 3 reflected poor quality throughout. The chemical composition played a significant role in determining the needle quality, as group 2 contained iron, chromium, nickel, manganese, with a low percentage of carbon. This combination was symbolic of good quality. However, the weight percentage of these strength-inducing elements were found to decline gradually in elemental composition of groups 2 and 3 needles, which, with elevated concentration of carbon, led to their declining quality. It is to be noted that presence of higher percentage of carbon makes the needle brittle and distorted in cutting, indicating its bad quality, as found in group 3 needles. However, when the percentage of carbon is medium range, such needles could give us intermediate quality, as found in group 2 needles. The colored x-ray map for each needle-type showed its elemental distribution, with respect to its color code. In good quality needles, such as group 1, and to a lesser extent in group 2, each element was relatively homogeneously distributed among the others, whereas bad needles, such as group 3, reflected uneven, irregular surface, showing their poor quality. Considering that the accepted measure of quality is 22 Newton, according to the International Standard ISO 7885 [7], and the best needles in our sample measured up to Newton 9 (Group 2), it can logically be stated that any needle less than that (Group 2 or 3), could automatically be rated as poor quality. It is also significant to note that good quality needles' chemical composition was invariably found to contain iron, chromium and nickel, with reduced carbon content. This elemental combination is also found to be present in high quality Dublin needles, which is used as a world standard in needle-quality. Our study showed that group 1 needles came closer to this world standard, reinforcing our findings that group 1 signified good quality needles. We recommend further research to substantiate these findings.

VARIATION IN CONSISTENCY OF DENTAL NEEDLES IN KUWAIT

CONCLUSION On the basis of our findings, it is concluded that higher concentration of iron, chromium and nickel, with less percentage of carbon, resulted in better quality needles. In bad quality needles, the percentage of these elements relatively declined, with high carbon contents.

REFERENCES 1. Bedrock R.D., Skigen A., Dolwick M.F. 1999. Retrieval of Broken needle. J Am Dent Assoc 130: 685-687. 2. Behebehani E., Andersson L. & Hadad A. 2006. A survey of dental local anesthesia and experiences of fractured needles. Dent News 13(1): 13-22. 3. Behebehani E. & Hadad A. 2006. Effect of length and gauge on performance of dental anesthesia needles. Dent News. 13 (2) (Accepted). 4. Faura-Sole M., Maria A. S-Garces, L Berini-Aytes & C Gay-Escoda. 1999. Broken Anesthesia Injection Needle: Report of 5 cases, Quintessence Int. 30: 461-465. 5. Groswassen J., Kahn A. & Bouche B. et al. 1997. Needle length and injection technique for efficient intramuscular vaccine delivery in infants and children evaluated through an ultrasonographic determination of subcutaneous and muscle layer thickness. Dept. of Pediatrics, Queen Fabiola Children's Hospital. 1020 Brussels, Belgium. 6. Hoff S.J. & Sundberg P. 1999. Breakage and Deformation Characteristics of Hypodermic Devices under Static and Dynamic Loading. Am J of Vet Res. 60 -3: 292 - 298. 7. International Standards - ISO 7885: 2000 (E). Sterile, Single Use Dental Injection Needles: Section. 4.3, pg 3. 8. Pietruszka J.F., Hoffman D. & Mcgivern B.E. 1986. A broken dental needle and its surgical removal. NYS Dent J 52: 28-31. 9. Teh J. 1997. Breakage of Whitacre 27G Needle during Performance of Spinal Anesthesia of Caesarean Section. Anaestol Intensive Care 25: 1. 10. Van der Bijl P. 1995. Injection Needles for Dental Local Anesthesia. Compend. Contin. Educ. Dent. 16: 1106 - 1116 11. Walker P.J., White G.H. & Harris J.P. et al. 1992. Bilateral mycotic axillary artery false aneurysms in an intravenous drug user: unsuspected broken needle-tips pose a risk to the treating personnel. Eu J of Vasc Surg 6:434-437

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Stability and Retention After Orthodontic Treatment <By Dr. Najat Alhashimi*

INTRODUCTION Orthodontics is a specialty of dentistry that is concerned with diagnosis and treatment of malocclusion which may be a result of tooth irregularity, disproportionate jaw relationships, or both. Stability of the result of orthodontic treatment has been a topic of great interest to the profession since the inception of this specialty. The problem of instability after treatment was recognized by Kingsley in (1880) who said 'the occlusion of the teeth is the most potent factor in determining the stability in a new position' (1). Concerns about stability starts at diagnosis and does not end at the delivery of retainers. Orthodontists are familiar with relapse and the need for retention and stability after orthodontic treatment. They usually recommend long-term retention. The definition of retention in relation to orthodontics can be stated as follows: - the holding of teeth in ideal esthetic and functional positions. There are several factors affecting the outcome of treatment due to the severity and type of malocclusion, treatment techniques, patient cooperation, growth and adaptation of the hard and soft tissues, aging, periodontal disease, caries, and various types of restorations. Studies have shown that there is a tendency to relapse toward original malocclusion, even though that ideal occlusion has been achieved (2-5). It was found that there is a relation between the growth at the condyles and the forward movement of the mandible(6) . Some researchers have mentioned that this growth of the mandible is related to longterm crowding via several possible mechanisms(7-10) . It was found that when the condyles grow upward and forward the posterior teeth migrate mesially, often that leads to crowding in the lower arch. While if there is posterior condylar growth, dental eruption will tend to be in a vertical direction, and these patients will develop secondary

BDS, MDS, LIC, PHD Swedish Board in Orthodontics

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

mandibular crowding.(11) Other researchers have found no significant correlation between continued growth and the development of longterm crowding (12). Retention was tried by using retainers, or by undertaking additional or 'adjunctive' procedures to the teeth (13) or the soft tissues (fiberetomy) (14). The retainers can either be removable, or fixed to the teeth. The type of the retainer, and the duration of retention were considered important factors(15). In view of the debate about stability of the occlusion after orthodontic treatment I was interested in looking critically at the evidence that is available regarding post treatment stability.

RESEARCH QUESTION Are fixed retainers more effective than removable retainers in stabilizing tooth position after orthodontic treatment? I've chosen this question because orthodontists in Qatar and internationally have been trained, as well as I was trained in Stockholm, to use removable or fixed retainers more often than the use of fiberotomy and removable retainers. To put that question in PICO format: The question could also be written as, in patients who have completed active orthodontic treatment, are fixed retainers more effective than removable retainers in preventing relapse. P (problem): patients who have completed active orthodontic treatment I (Intervention): fixed retainers C (comparison): removable retainers O (outcome): treatment relapse

Medical Director at the Najat Dental Center P.O.Box:9036 Doha-Qatar Email: dr.nsayed@hotmail.com STABILITY AND RETENTION AFTER ORTHODONTIC TREATMENT

SEARCHING It was not convenient to do the search from my office, because I have to modify my search differently this time, I cannot go directly to Cochrane library. So I contacted Mr. Derek Richards and asked his help to provide me with articles I needed from the Cochrane library. He was so generous to provide me with them immediately. I also asked the help of the main librarian in Hamad Medical corporation (HMC), who had a package of special deal with Ovid technologies, and I have used it, so through Ovid I could access • All EBM Reviews-Cochrane DSR (Cochrane Database of systemic review), ACP journal Club, DARE (Database of abstracts of review of effects), and CCTR (The Cochrane Central Register of Controlled Trials). • EMB reviews full text-Cochrane DSR, ACP Journal Club, and DARE. • OVID Medline (R) In process & other non-indexed citations and OVID Medline (R) 1950 to present. I considered that I have enough resources to go on with my search. I preferred mainly PubMed, maybe because I have used it for many years (it was like the free available site all time even from home), and found it easy, and user friendly. What I did not like about OVID is that it is not free. So unless you are a member of an educational hospital or a university that has access to OVID, you won't be able to access the wide variety of information that this website offers. It is also possible to buy yourself a membership to access the website's medical information and articles. Otherwise, OVID is a wonderful resource for medical information. In addition, the website keeps its researches continuously updated. The website provides with a vast variety of articles on various topics. A search was conducted in the following databases: Medline (from 1966 to the first week of June 2007); PubMed (from 1966 to the first week of June 2007); Cochrane Database of Systematic Reviews (to the 2nd Quarter 2007); The Cochrane Oral Health Group's Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), Embase (from 1980 to June, 2007). Several journals were searched by hand (American Journal of Orthodontics and Dentofacial Orthopedics (formerly American Journal of Orthodontics) 1986-2007, Angle Orthodontist from 1988-2007, European Journal of Orthodontics 1989-2007, Journal of Orthodontics (formerly British Journal of Orthodontics) 1986-2007. No language restrictions were applied. Authors were contacted to ask for any unpublished Data.

SEARCH STRATEGY I started my search by using these terms; Mesh, Orthodontics, Retention, Stability, Orthodontics and stability, Orthodontics and retention, Frenectomy, Fiberotomy, Orthodontic and frenectomy, Orthodontic and interproximal stripping.

STABILITY AND RETENTION AFTER ORTHODONTIC TREATMENT

I found using the Mesh terms good to start with, how to search with free terms, or combining different terms Eligibility of the selected studies was determined by reading the abstracts of the articles that were found. All the articles that seem to meet the inclusion criteria of the topic of interest were selected, copied and collected. I checked the reference lists of the retrieved articles manually for additional relevant articles that may have been missed in the database searches. Hand search was extremely boring and time consuming. However, I had to do it as I did not want to miss out on any information or good research. I read also some orthodontic books that explained a lot about the subject of retention like (Retention and stability in orthodontics an overview) (16), Contemporary orthodontics By William R. Proffit (17) .

Criteria for considering studies: All patients who have had fixed or removable retainers or adjunctive procedures, that were received after orthodontic treatment. Because of the small number of articles that I found, I did not restrict my search to specific malocclusion, or orthodontic treatment, even though it would be interesting to investigate whether the type of malocclusion had an effect on retention. There were many articles that were excluded because the studies involved cleft lip and/or palate or other craniofacial syndrome patients. Others included orthognathic surgery cases, where many other variables that can affect the stability, these where also excluded. All those publications which do not have sound validation techniques, or short retention time (so any period less than five years was considered short), where excluded. I found five systematic reviews, three randomized controlled trials, and three were quasi-randomized and two systematic reviews were relevant to my search topic and they are appraised below.

1st Critical appraisal: Appraisal of the systemic review was carried out using the CASP review question which are based on a papers by Oxman et al (18) . Retention procedures for stabilizing tooth position after treatment with orthodontic braces (Review). Littlewood SJ, Millett DT, Doubleday B, Bearn DR, Worthington HV The objectives of this study are clearly defined: To evaluate the effectiveness of different retention techniques used to stabilize tooth position after orthodontic braces and prevent relapse. To evaluate the survival of retainers, side effects on oral health and patient's satisfaction. This review studied children and adults who have had retainers, or adjunctive procedures undertaken following treatment with orthodontic braces. Maybe it would have been better if the review has studied only adults or only children, because of some factors that may affect retention (of the children or growing patients, like growth), for example in females under the age of 16 and males under the age of 18 occlusion may be affected by continuing growth of the jaws.

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

Database Searched: The search was comprehensive, well documented and included only randomized clinical studies and quasi-randomized controlled trials. The methods are well explained. In my opinion there are some other factors that may affect the retention post orthodontic treatment. There are, for example, some systemic diseases that may affect the instability of the teeth, that the patient may have developed after orthodontic treatment, like diabetes or allergies, bone diseases such as osteoporosis that can have a direct or indirect effect on the retention. There is a table of 'Characteristics of included studies.' Additional table 'Quality of included studies.' these are useful because they give us a summary of their work with regard to concealment, generating random, blinding for patients clinician and outcome, as well as withdrawal/dropouts. This therefore, allows the information to be easily read and effortlessly understood. In addition, it becomes simple to differentiate between various studies and their quality level. Blinding of the clinicians and patients was not possible (as when an appliance is present the type of appliance is obvious). When blinding of outcome assessors was possible it was used in two studies (Sauget 1997; Taner 2000), I agree that blinding of the outcome of the results is possible, because that is easier to be done than blinding of the clinician and patients due to the nature of the research. Personal communication with authors confirmed no withdrawals or drop outs in three studies (Årtun 1997; Rose 2002; Sauget 1997). Patients who had orthognathic surgeries, those with a cleft lip or palate or both or other craniofacial syndrome were excluded. The study has mentioned the type of intervention which was retainers or adjunctive techniques or both after treatment with orthodontic braces. All of these were well explained in their review papers, so I believe they have chosen good articles for their review. Results were assessed and analyzed with data extracted and presented on variable forms. The outcomes were considered: By assessment of how well the teeth were stabilized, this by using index of tooth irregularity (e.g. little's index) (little 1981). Or using Par index (Richmond 1992). Survival of the retainers. Something worthy to know, usually we do not know what happens to the patients, some will just disappear, particularly after long orthodontic treatment. Patient's satisfaction. Most of the time the orthodontic patients are satisfied except few, at least this is what I see with our patients in Qatar-in general, yet there is still a small group of patients who remain unsatisfied. Side effects like development of new carious lesions. This was assessed using indices of demineralization. I refer my patient to be checked for caries and any periodontal problems, if needed. Periodontal tissues were assessed using periodontal indices or other markers of periodontal disease. They have used tables, analysis, and graphs to present their results.

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

The limited number of the papers where proper validation techniques are employed makes drawing conclusions from this review difficult. I am in full agreement with this because even during my search I noticed several articles which lacked the validity. In the discussion section the authors mentioned that, it was not possible to evaluate completely the effectiveness of the many different retention strategies used for tooth stabilization after orthodontic treatment. This was due to a shortage of quality studies on the subject. There is an inherent risk of bias in the remaining three studies (Edwards 1988; Sauget 1997; Taner 2000); this must be acknowledged when analyzing the results of these studies. The author's conclusion was; there are insufficient research data on which to base our clinical practice on retention now. There is a suggestion that circumferential supracrestal fiberotomy (CSF) reduces relapse when combined with a full-time removable retainer, compared to a full-time removable retainer alone. There is also a suggestion that a Hawley retainer, worn full time, allows more settling of the occlusion than a clear overlay retainer, worn at night, after 3 months. The evidence for this is very weak. The results can be applied to our population in Qatar, but again a study of this kind would have been difficult, due to difficulty in following up the patients, because people in Qatar are not cooperative with follow-ups. With some of these patients it is hard to get them keep their appointments during the active orthodontic treatment so you can imagine how difficult it is to let them to come for a follow up by the request of the orthodontist. These patients believe it is only in the orthodontist's interest that they should come in for a follow up. We are providing the same intervention that was provided in these different studies. We in Hamad Medical Corporation mainly use the Hawley retainer (removable upper appliance) in the upper arch and a fixed bonded lingual retainer, sometimes a removable retainer in both arches. I myself use fiberotomy in cases where there has been severe rotated teeth/ and or tooth before the commencement of the orthodontic treatment. As soon as I finish the orthodontic treatment I do the fiberotomy, and I deliver the removable or fixed retainer as retentive appliance. I consider this study very relevant to my practice. There still is more research needed to be done before we can come to a concrete conclusion. They did not try to calculate the costs of different appliances that were used for retention in different studies, especially that sometimes retainers were combined with adjunctive procedures. And whether there are any extra fees if there is an adjunctive procedure, or not, or if the retainer was lost or any other charges. In conclusion: the paper seemed to be methodologically sound. The study is cost effective, that was also mentioned by the author's statement that retention studies are not easy to undertake. Relapse is a longterm problem and long-term follow up of patients is practically difficult and financially demanding. However, given that the vast majority of orthodontic patients undergo a phase of retention, this vital area of orthodontic research should be given priority in the near future. STABILITY AND RETENTION AFTER ORTHODONTIC TREATMENT

2nd Critical appraisal: Long-term Stability of Orthodontic Treatment and Patient Satisfaction L. Bondemarka; Anna-Karin Holmb; Ken Hansenc; Susanna Axelssond; Bengt Mohline; Viveka Brattstromf; Gunnar Pauling; Terttu Pietilah The objectives of the systemic review were clearly stated: To evaluate the stability and patient satisfaction with a minimum of five years post orthodontic treatment. Five years duration time after orthodontic treatment has finished and teeth are still stable would be considered good. So I agree with that time period especially as long follow up is hard to achieve. The consideration of patient satisfaction is highly appreciated, though few articles discussed that, actually only one study was graded B (Moderate value of evidence). A literature search was performed by applying the Medline database (Entrez PubMed), and covering the period from January 1966 to January 2005. Two reviewers extracted the data independently and also assessed the quality of the studies. They presented that search in tables. Irrelevant literatures were excluded. What was an extra advantage in their search that they included several languages such as English, Swedish, Danish, Norwegian, and Finnish. So that is an extensive search, and respected. The articles that were included are appropriate and relevant. They limited their search to human, and explained in a proper manner the criteria for grading of assessed studies. The evaluation of studies and level of evidence based on criteria for assessing study quality from Centre for Reviews and Disseminations in York, UK. Explicit inclusion/exclusion criteria cut out most identified studies (38 met the inclusion criteria). Two investigators independently ranked studies for quality, external and internal validity plus the performance of each study were checked. They considered the defined diagnosis and end points, and checked the diagnostic tests, and reproducibility tests that were described in the selected papers. This would reduce bias. The studies were given scores from A to C. Grade A is high value of evidence, while grade C is low value of evidence. The criteria for inclusion of studies (study population and sampling, drop outs, description of intervention, outcome measures, and data handling and presentation) are comprehensive and relevant. The issue that I don't agree is that they include studies that were rated as grade C with low value of evidence, because we are already looking for high quality articles that we can base our clinical guidance and evidence on. However they based their conclusions only from articles that were rated B. They presented their results in variable tables and divided them depending on different malocclusion (crowded teeth, angle class II, class III, Cross-bite, Open Bite, and other malocclusions). In cases of crowding most of the studies focused on the relapse of the lower anterior teeth, and that is not surprising, because this is the area where most relapse or instability can occur. That is another reason

STABILITY AND RETENTION AFTER ORTHODONTIC TREATMENT

why many investigators considered lifelong lingual retainer to avoid relapse. In cases of cross bite only one randomized study was found, that shown that 79% of forced unilateral cross bites could be corrected by selective grinding, and in five years time 50% the results were stable, but again there are few studies for any evidence based conclusion. In cases of class III malocclusion, open bite, and a range of other malocclusions no evidence based conclusions could be drawn. I agree with this strategy, even though they could have subdivided these malocclusion even more, but considering the difficulty of high quality research in this field, and the inherent problems with this kind of research, their work is highly appreciated and respected. There is no formal meta-analysis. The use of confidence interval was not possible because of the small amount of studies that were found. I am not sure whether they've done a heterogeneity test or not as this was not mentioned. I like the discussion they have considered variables that could affect relapse such as craniofacial growth, and the eruption of the third molars and their effect on post orthodontic retention. Also they discussed the ethical issues where for the patients in randomized controlled studies do not have the right to influence the kind of the treatment. All of these aspects that they tried to focus on are of value. The evidence was insufficient for conclusion on long term stability after orthodontic treatment in class III, open bite, and unilateral posterior cross bite. The authors have put their recommendations for the high demands for well motivated patients, and an urgent need for well designed prospective studies with sufficient sample size and selection, also the need for the financial support. In general, the results of this study could be applied in Qatar. However, long term follow up is a problem for while we are using European and American standards in our orthodontic treatment, diagnosis and retention, human nature, the routine use of removable retainers and the fact that Qatari patients that are exempted from payment means this would be difficult. Fixed appliance therapy is more acceptable in Qatar but it is not unusual for patients to request removal of fixed retainers after a year despite providing information about possible relapse. The authors present their results clearly with a well constructed conclusion and recommendations with which I agree. There is no attempt to cost out this research. The authors do not seem to have financial information from the studies. The researchers did not discuss whether or not the costs of doing the research were actually worth the results research. In other words whether the costs were too high, too low or worth doing. Only in one sentence in the discussion they mentioned the need to sufficient financial support. Conclusion from the second critical appraisal: This is an acceptable review that has a sound method; it dismantles the problems that faced the researchers, in particular with retrospective and uncontrolled study design. The authors have done their best with the available evidence. But generalizability seems weak.

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

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Final conclusion from the whole Dossier: The retention is one of the most important issues in the long term success of orthodontic treatment. Several retentive appliances and methods were proposed. Some claimed that their technique is excellent for long term maintenance of the occlusion. However, by critically reading these above mentioned two articles I have developed an understanding that there is a need for more robust evidence which researchers in many parts of the world need to address in order to provide a clear evidence base on which retainers are most effective in orthodontic treatment. Recommendations have already been given in both articles and the need and demand of more studies in this area will be appreciated. I personally would like to add that there are other factors that were not mentioned here that could affect the retention of post orthodon-

tic treatment such as periodontal diseases, systemic diseases like Diabetes, the use of corticosteroids, diseases like osteoporosis, and various allergies. All of these diseases can develop later during their lifetime. These factors need to be put into consideration when analyzing the stability of the occlusion after orthodontic treatment has finished. At this point, it has been merely established there seems to be insufficient data on which to base our clinical guidance on retention. There is a huge need for a well designed randomized controlled studies, with a large sample size, and a sample selection that takes into consideration the age, growth factors, and different types of malocclusion. So, in my own opinion, until we find a new technique that could assure our orthodontic patient that no relapse will occur, I will continue to advise my patients to wear a retention device for a long period of time.

REFERENCES 1. Kingsley N: treatise on oral deformities, New York, 1880, Appletton). 2. McNamara JA Jr, Baccetti T, Franchi L, Herberger TA. Rapid maxillary expansion followed by fixed appliances: along-term evaluation of changes in arch dimensions. Angle Orthod. 2003;73:344-353. 3. Little RM, Riedel RA, Artun J. An evaluation of changes in mandibular anterior alignment from 10 to 20 years postretention. Am J Orthod Dentofacial Orthop. 1988;93:423-428. 4. McReynolds DC, Little RM. Mandibular second premolar extraction-postretention evaluation of stability and relapse. Angle Orthod. 1991;61:133-144. 5. Al Yami EA, Kuijpers-Jagtman AM, Van't Hof MA. Stability of orthodontic treatment outcome: follow-up until 10 years postretention. Am J Orthod Dentofacial Orthop. 1999;115:300-304. 6. Isaacson RJ, Zapfel RJ, Worms FW, Erdman AG. Effects of rotational jaw growth on the occlusion and profile. Am J Orthod 1977;72:276-286. 7. Schudy GF. Posttreatment craniofacial growth: its implications in orthodontic treatment. Am J Orthod 1974;65:39-57. 8. Siatkowski RE. Incisor uprighting: mechanism for late secondary crowding in the anterior segments of the dental arches. Am J Orthod 1974;66:398-410.

STABILITY AND RETENTION AFTER ORTHODONTIC TREATMENT

9. Sampson WJ. Current controversies in late incisor crowding. Ann Acad Med Singapore 1995;24:129-137. 10. Driscoll-Gilliland J, Buschang PH, Behrents RG. An evaluation of growth and stability in untreated and treated subjects. Am J Orthod Dentofacial Orthop 2001;120:588-597. 11. Björk A : a sutural Growth of the upper face studied by the implant method Acta Odontol Scand 24:109-127, 1966. 12. Sinclair PM, Little RM. Dentofacial maturation of untreated normals. Am J Orthod 1985;88:146-156. 13. Boese LR. Fiberotomy and reproximation without lower retention 9 years in retrospect: Part 1. Angle Orthodontist 1980;50:88-97. 14. Edwards JG. A long term prospective evaluation of the circumferential supracrestal fiberotomy in alleviating orthodontic relapse. American Journal of Orthodontics and Dentofacial Orthopedics 1988;93:380-7. 15. Lang G, Alfter G, Goz G, Lang GH. Retention and stability-taking various treatment parameters into account. J Orofac orthop.2002 Jan,63(1):26-41. 16. Retention And Stability In Orthodontics Ravindra Nanda, Charles J., D.D.S. Burstone, Ravindra, B.D.S. Nanda, Charles J. Burstone. W.B. Saunders Company 17 .Contemporary Orthodontics, William R. Proffit, Henry W Fields. C.V.Mosby. 18. Oxman AD, Cook DJ, Guyatt GH, Users guides to the medical litera-

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

Your impression is our concern

CAVEXFOR DENTAL USE ONLY Cavex Holland BV has been producing alginate impression materials for more than 55 years. As a result all our alginates have been developed to perfection. In

2007 Cavex ColorChange has been awarded

the rating excellent by the Dental Advisor. * 82% of the clinical consultants rated ColorChange equal or better than their current alginate - * 71% would switch to ColorChange – 76% would recommend ColorChange to their colleagues. For further information, please contact Cavex: +31 23 530 77 00 or surf to www.cavex.nl 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

Clinical Evaluation of a

Chairside Whitening Lamp and Bleaching Efficacy <By J.C. Ontiveros*, R.D. Paravina**, M.T. Ward***

OBJECTIVE To evaluate the effectiveness of a 25% hydrogen peroxide (HP) in-office tooth whitening system, with and without the use of a Chairside Whitening Lamp.

METHODS Twenty subjects were treated with two separate 45-minute exposures of 25% HP (Zoom2). At the first appointment, half of the subjects received treatment of the 6 maxillary anterior

Fabrication of a custom positioning jig

teeth with light (ZoomAP) and the remainder of the participants received treatment of the same teeth without light. One week later, all subjects received treatment to the 6 mandibular anterior teeth according to the contra assignment of the first appointment. Visual and instrumental color matching were performed before bleaching and 7 days after. The visual color matching was conducted by three color normal evaluators using the Vitapan Classical (VC) and the Vita Bleachedguide 3DMaster (BG) to determine the best match. An intraoral spectrophotometer (Vita Easyshade) was used for the instrumental color measurements. Each subject had a custom positioning jig made for each arch to provide a repeatable area for placement of the instrument tip.

INTRODUCTION

A. Acrylic rod attached to the tooth

B. Initial injection of clear silicone registration material

C. clear silicone registration material set

D. Custom made jig with the acrylic rod removed for

In the context of presenting a technique for bleaching discolored teeth, the 19th century dental researcher, E.P. Wright stated, “there is no higher glory for one who professes the healing art [of dentistry] than that of preserving the natural tissues.”1 Aside from the obvious desire to improve the appearance of teeth, the conservative nature of in-office bleaching remains one of the primary reasons why in-office bleaching is appeals to both patients and dentist alike. Hydrogen peroxide (H2O2) has been used to treat discolored teeth as early as 1884.2 Throughout the 1960's and 70's, techniques were introduced using direct or indirect heat in attempt to accelerate the oxidation process.3-6 The direct application of heat soon fell out of favor, because of evidence which suggests that it may cause cervical resorption. Techniques using chemicals alone, such as sodium perborate and, or superoxyl followed with some success on non-vital teeth. While these techniques have proven to be helpful for single non-vital teeth, accelerated techniques for multiple vital teeth were still lacking. In the mid 1990's improvement in bleaching products and delivery systems, such

* The University of Texas Dental Branch Houston USA ** The University of Texas Dental Branch Houston USA *** Discus Dental, Culver City, CA, USA 36

CLINICAL EVALUATION OF A CHAIRSIDE WHITENING LAMP AND BLEACHING EFFICACY

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

CONCLUSIONS Treatment with Zoom AP light showed significantly higher whitening dependent color changes compared to treatment without light for instrumental findings, p<0.05 and visual findings using the BG.

REFERENCES as light-cured barrier materials increased the usage of in-office bleaching for multiple vital teeth among dentists.7 Combined with the then recent introduction of the at-home bleaching tray, bleaching emerged among the most sought after procedures in dentistry.8

RESULTS Means and (sd) for visual and instrumental whitening-dependent color changes “With“and “Without“light are listed in the table; SGU=shade guide units.

1. Wright EP. Bleaching of discolored dentine practically considered. Int Dent J 1890; 11:70-4. 2. Harlan AW. The removal of stains from the teeth caused by the administration of medicinal agents and bleaching of pulpless teeth. Am J Dent Sci 1884; 18:5214 3. Nutting EB, Poe GS. A new combination for bleaching teeth. JSCSDA 1963;31:289-91. 4. Cohen S. A simplified method for bleaching discolored teeth. Dent Dig 1968;74:301-3. 5. Hodosh M, Mirman M, Shklar G, Povar M. A new method of

bleaching discolored teeth by the use of a solid state direct heating device. Dent Dig 1970;76:344-6. 6. Chandra S, Chawla TN. Clinical evaluation of heat method for bleaching of discoloured mottled teeth. J Indian Dent Assoc 1974;46:313-8. 7. Barghi N. Making a clinical decision for vital tooth bleaching: at-home or in-office? Compend Contin Educ Dent 1998;19:8318; quiz 40. 8. Haywood VB, Heymann HO. Nightguard vital bleaching. Quintessence Int 1989;20:173-6.

18 - 20 October 2008, Intercontinental Hotel - Riadh, KSA

On behalf of Riyadh College of Dentistry and Pharmacy (RCDP), the sponsor of this conference and the Organizing Committee, it is my distinct pleasure and honor to welcome you all to the three-day conference of the 3rd Riyadh International Dental and Pharmacy Meeting (RIDPM). This conference is the 3rd of ten annual meetings on Dentistry and Pharmacy that have been officially approved between now and September 2015. The approval is an obvious mark of the recognition and importance attached by the Kingdom of Saudi Arabia to Dentistry in all its aspects – Education, Care, Research, Prevention Strategies and Health Promotion. The conference features keynote presentation on digital dental education, symposium on dental education integration between dental schools & dental societies: comprehensive dental training at undergraduate level as a model, symposium on GCC oral health status and prevention program: strategic programs for dental disease prevention 10 years future planning, clinical general and specialized dental practice and continuing education courses. The Organizing Committee has therefore invited to this conference well-known international speakers as well as the Chief Dental Officers and Dean’s Dental School in many Arab 40

RIYADH INTERNATIONAL DENTAL & PHARMACY MEETING

Prof. Abdullah Al Shammery Dean of the Riyadh College of Dentistry and Pharmacy

Opening ceremony of the scientific exhibit

countries to participate at the difference sessions. National speakers are of course billed to participate fully at the meeting also. Prof. Abdullah R. Al Shammery Chairman of Organizing Committee

18 - 20 October 2008, Intercontinental Hotel - Riadh, KSA

Prof. Abed Yakan from Aleppo lecturing on temporomandibular joints

Dr. Helmut Gotte from Bavaria lecturing on bleaching

Picture from the exhibit floor

Picture from the audience

Picture from the reception at Prof. Adbullah’s mansion

Prof. Junji Tagami enjoying the Saudi traditional sword dance

RIYADH INTERNATIONAL DENTAL & PHARMACY MEETING

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

Smile cosmetic orthodontics for fast and invisible treatment of minor misplacements and lapses Courtesy of Dr. Fabio Giuntoli

LowFriction 2D biomechanics to align and unravel anterior teeth in few weeks Small size brackets with reduced thickness, used in combination with Slide™* ligatures, assure the best comfort for patient Practical and precise positioning with the specific transfer system Effective alternative to transparent aligners Minimal impact on speech No need for patient cooperation

18 - 20 October 2008, Intercontinental Hotel - Riadh, KSA

Prof. Junji Tagami with a backdrop of Riyadh city

Prof. Junji Tagami with Dr. Mohammed Jishi

Prof. Junji Tagami lecturing on Direct Aesthetic Restorations

Prof. Junji Tagami discussing key points with the audience

Hands-on CE course

RIYADH INTERNATIONAL DENTAL & PHARMACY MEETING

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

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Dr. Mohammad ben Hafeed Chairman of Yemen's dentists Syndicate

â–h ájQƒ¡ª÷G ¢ù«FQ ÖFÉf …OÉg Qƒ°üæe ¬HQ óÑY /øcôdG ≥jôØdG ájÉYôH AÉÑWC’ »ª∏Y ô“Dƒe ∫hCG äÉ«dÉ©a âª«bG (¿Éæ°SC’G Ö«ÑWAGOG ôjƒ£J) QÉ©°T á«ÑæLCGh á«HôY ácQÉ°ûÃ Ú«æª«dG ¿Éæ°SC’G AÉÑWG áHÉ≤f ¬ª¶æJ …òdGh ¿Éæ°SC’G .á©°SGh áª°UÉ©dG áfÉeCÉH áWô°ûdG •ÉÑ°V …OÉf áYÉ≤H ΩÉ≤j …òdG »ª∏©dG ô“DƒŸG πª°Th á«ª∏©dG äGô°VÉÙG øe ójó©dG (2008Èªaƒf 28-26) IÎØdG ∫ÓN »FÉ°üNCGh AÉÑWG QÉÑc øe ÉcQÉ°ûe (40) ƒëf ácQÉ°ûÃ á«ÑjQóàdG äGQhódGh . Ú«æª«dGh Üô©dG ¿Éæ°SC’G É«dhO É°Vô©e »ª∏©dG ô“DƒŸG ∫ÉªYCG ¢ûeÉg ≈∏Y ¿Éæ°SC’G AÉÑWG áHÉ≤f º¶fh ÜÓWh ¿Éæ°SC’G »FÉ°üNCGh AÉÑWC’G ´ÓWG ±ó¡H ¿Éæ°SC’G ÖW äÉeõ∏à°ùŸ . ∫ÉÛG Gòg ‘ ójóL πc ≈∏Y ÉfOÓH ‘ ¿Éæ°SC’G ÖW äÉ«∏c áæ¡Ã AÉ≤JQ’G ¤EG øª«dG ‘ Iôe ∫hC’ ΩÉ≤j …òdG »ª∏©dG ô“DƒŸG ±ógh Gòg ™aQ ¬fÉ°T øe ÉŸh »æª«dG Ö«Ñ£dG AGOCG Ú°ù–h øª«dG ‘ ¿Éæ°SC’G ÖW .≈°Vôª∏d áeó≤ŸG áeóÿG iƒà°ùe

Opening Ceremony

Picture for the audience during the opening ceremony

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YEMEN - FIRST SCIENTIFIC CONFERENCE

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

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Dr. Mohammad. Jishi President of the Arab Dental Federation

Picture from the exhibits

YEMEN - FIRST SCIENTIFIC CONFERENCE

Picture from the exhibits

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

Marriot Jordan Valley November 19th - 21st 2008

he Arabic Societies of Pediatric Dentists' UNION celebrated its biannual congress, this year, in the least point in the world (~ more than 400 meters under sea level), in the Dead Sea Resort, in Jordan.

This venue gave us also, the opportunity to enjoy the Jordanian hospitality!? During the event, a meeting of all the presidents of Arab Societies (17) took place and it was decided that the eighth congress will be in Khartoum-SOUDAN in 2010.

This 7th congress, held at the Marriot Jordan Valley in the Dead Sea on November 19th - 21st 2008, was celebrated with the 1st congress of the Jordanian Society of Pediatric Dentistry. The Lebanese Society of Pediatric Dentistry - LSPD - was present as usual. This gathering was an important event in the Arabic world for pediatric dentistry in which scientists' specialists in the matter and general practitioners exchanged and deepened their knowledge. It offered innovative and state - of - art multidisciplinary program where eminent of international and local speakers discussed the latest evidence - based dentistry to tackle today's dental challenges.

The Lebanese delegation with, Dr Othman AL-AJLOUNI president of the congress and of the JSPD

Dr. Othman Al-Ajlouni president of the congress and of the JSPD offering the trophy of the congress during the Gala dinner to Dr Michel Salameh from Lebanon

Dr Salameh president of the LSPD offering a souvenir from Lebanon to the Jordanian society

Dr. Al-Ajlouni offering the trophy to Dr. Waleed Al Saadi from Syria

Dr. Al-Ajlouni offering the trophy to Prof. Ahmed Abdellah from Egypt

THE 1ST JORDANIAN AND THE 7TH ARABIC CONGRESS OF PEDIATRIC DENTISTRY

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

Kuwait Radisson SAS - November 23 - 26, 2008

Gulf Dental Association

5th conference of the

Dr. Mohammad H. Al-Jammaz, GDA Secretary General, receiving the trophy from Dr. Ibrahim Ismail president of the Kuwait Dental Association

Left to right; Dr. Ali jamal (Kuwait), Dr. Salahudeen Albulushi (Oman), Dr. Waleed (Kuwait) Dr. Abdulaziz Bakathir (Oman)

5TH CONFERENCE OF THE GULF DENTAL ASSOCIATION

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

5th Conference of the Gulf Dental Association Kuwait Radisson SAS - November 23 - 26, 2008

Delegates from the GCC countries during their visit to the Kuwait parliament

Dr. Omar Adeeb (UAE), Dr. Tony Dib (Lebanon), Dr. M. Al-Jammaz (KSA), Dr. Radwan Abueida (UAE) in the Hashimi ballroom under the Kuwait ruling family painting.

5TH CONFERENCE OF THE GULF DENTAL ASSOCIATION

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

5th Conference of the Gulf Dental Association Kuwait Radisson SAS - November 23 - 26, 2008

Dr. Rajaa Kadhim president of the Bahrain Dental Society offering the Bahraini trophy

Dr. Abdulaziz Bakathir offering the Omani Dental Society trophy

Prof Yousef Talic offering the Saudi Dental Society trophy

5TH CONFERENCE OF THE GULF DENTAL ASSOCIATION

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

5th Conference of the Gulf Dental Association Kuwait Radisson SAS - November 23 - 26, 2008

Dr. Bassim Abu Hawas discussing dry sockets therapy

Dr. Jameela Alawadi talking on the capacity of Ozone in the removal of the root canal smear layer.

Left to right, Dr. Tony Dib (Lebanon), Dr. Aisha Sultan (Dubai), Dr. Jameela Alawadi (RAK), Dr. Najat AlSayed (Qatar), Dr. Basim Abu Hawas (Dubai) and Dr. Radwan (Abu Dhabi)

The audience

5TH CONFERENCE OF THE GULF DENTAL ASSOCIATION

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

Optiview

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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.

Oral Health Examination Kit

Sterile. Single-use. Convenient. Diagnostic examination kit. • Ready-to-use. Minimises tray set-up time. • Hygienic. Eliminates cross-contamination issues. Simply use once and discard. • Convenient. Excellent for routine use, especially during busy surgery times, staff shortages, autoclave breakdowns, home visits and for high-risk patients. • Time-saving. Reduces time spent sterilising and handling sharps. • Cost-effective. Increases productivity and reduces inventory.

TempBond

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5th Conference of the Gulf Dental Association

Exhibition floor

Kuwait Radisson SAS - November 23 - 26, 2008

5TH CONFERENCE OF THE GULF DENTAL ASSOCIATION

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

Germ free. Fast. Effective.

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15th Oman Dental Conference Grand Hyatt Muscat, 17 - 18 December, 2008 ¬H õ«ªàj É‡h .áØ∏àıG ¬JÉ°ü°üîJh ¿Éæ°SC’G ÖW ∫É› ‘ äÉ«æ≤àdGh IƒYódG GƒÑd øjòdG ΩGôμdG á«é«∏ÿG äÉ«©ª÷G AÉ°SDhQ ∞jô°ûJ ô“DƒŸG Gòg √òg ájÉ¡f ‘ »æ©°ùj ’ .ô“DƒŸG Gò¡d º¡ªYOh ºgóLGƒàH øjQƒμ°ûe ôμ°ûdÉH ô“DƒŸG Gò¡d áª¶æŸG áæé∏dG º°SGh ºμª°SÉH Ωó≤JCG ¿CG ’EG áª∏μdG áªgÉ°ùŸG äÉ°ù°SDƒŸGh ô“DƒŸG Gò¡d áª¶æŸG áæé∏dG ¤EG πjõ÷G ºμd øjôcÉ°T ô“DƒŸG Gòg ” ÉŸ É¡ªYO ’ƒd »àdG á°UÉÿG äÉcô°ûdGh ¿CG ôjó≤dG »∏©dG ¬∏dG øe ÚLGQ ô“DƒŸG Gò¡d áÁôμdG ºμàjÉYQ Ö«W õjõ©dG ÉææWh áeóN ‘ ÉfÉ£N Oó°ùjh ô“DƒŸG Gòg Éæd ∑QÉÑjh Éæ≤aƒj ¢SƒHÉb ¿É£∏°ùdG ádÓ÷G ÖMÉ°U Iô°†M Éf’ƒŸ áª«μ◊G IOÉ«≤dG â– Ωƒ«dG òæeh ¬àdÓL ¤hCG …òdG -√ÉYQh ¬∏dG ¬¶ØM º¶©ŸG ó«©°S øH ájô°ûÑdG OQGƒŸG ôjƒ£àH kÉ°UÉN kÉeÉªàgEG á°†¡ædG ôéa ¥ÉãÑf’ ∫hC’G .ácQÉÑŸG á°†¡ædG ±GógCG ≥«≤ëàd »°SÉ°SCG Qƒëªc

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Dr. Hamad Al Harthy The Chairman of the 15th Oman Dental conference

Dr. Al Saidi greeting Prof. Antroine Karam President of the Lebanese Dental Association

Dr. Al Saidi welcoming Prof.Trevor Burke in the presence of Dr. Harthy and Bulushi

Prof Trevor Burke lecturing on all ceramic bridges

15TH OMAN DENTAL CONFERENCE

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

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15th Oman Dental Conference Grand Hyatt Muscatt, 17 - 18 December, 2008

Dr. Khalid Al Zoman talking on periodontal infections

Dr. Salahudeen Al Bulushi, Dr. Ahmed Mohammed Al Saidi Undersecretary for Health Affairs, Dr. Hamad Al Harthy In the inauguration of the scientific exhibits

Picture of the delegates from Lebanon and Bahrain with an Omani dentist in her traditional outfit

Picture of the Participants during the lunch break

EXHIBITION FLOOR

15TH OMAN DENTAL CONFERENCE

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

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www.dentalnews.com

Distinguish yourself

Blended learning: An ideal combination for general dental practice

ing's College London Dental Institute is the largest Dental Institute in Europe with its wide range of teaching programmes. Most popular of the postgraduate programmes are the blended learning degrees. Blended learning is described as 'a learning solution that incorporates a mix of online and face-to-face elements'. Busy practitioners can choose their time and place to study the academic components of the courses online and focus on the face-to-face intensive courses for the hands-on learning experience. These residential components are available annually in the UK and India. The MSc Advanced General Dental Practice (AGDP) is aimed at dental practitioners who wish to develop their clinical skills and expand on BDS level knowledge. It covers a range of topics from clinical skills to practice management to enable dentists to run a successful and rewarding dental practice. The MClinDent in Fixed and Removable Prosthodontics (FRP) is our most popular programme and covers more advanced skills. It is recognised worldwide as an additional postgraduate degree. It begins alongside the AGDP programme but goes on to train dentists in managing advanced clinical problems such as severe tooth wear, TMJ dysfunction, aesthetic challenges, endodontics and implant restoration. Similar programmes are currently available in Dental Public Health (DPH) and Dental and Maxillofacial Radiology (DMFR). In the coming year we are launching MSc's in Aesthetic Dentistry, Removable Prosthetics, Maxillofacial Prostheses and Dental Implantology. The mode of delivery for all our blended programmes, has been designed to enable dentists from all around the world to remain in dental practice while training, allowing them to maintain clinical contact and establish a dental practice using skills learnt on the programme. The residential courses of approximately 9 days duration, held at one of our training centres, will provide the supporting faceto-face tuition in clinical skills. The training centres are in London and India, both providing the same programme taught by King's staff and

lead to the same King's MSc degree. Examinations are held in the student's home country with one written paper per module. The success of the programmes comes from the balance between interactive online content, which includes ready access to the King's College London e-library, and the intensive annual 9 day block faceto-face teaching courses which provide the hands-on elements essential to a dental programme. Master's courses also include one-to-one tutoring for the final year of study. The MSc programme runs over 3 years (4 years for MClinDent FRP) through part-time training. For any dentist not wishing to sign up for the full MSc (180 European credits) or MClinDent (360 European credits) then it is possible to attend for a shorter course leading to a Certificate (60 credits) or Diploma (120 credits). The closing date for applications was 31 August 2008 for entry in January 2009; however late applications are being considered while places remain on the January 2009 UK intake and the February 2009 intake on the India residential programme. Applications can be made for 2010. All courses are quality assured, independently verified and are taught by experts from the King's College London Dental Institute and other centres of excellence around the UK. Scholarships are available and further information about the course is available on our website (below), from where an application form can also be downloaded. For further information please see: www.kcl.ac.uk/distancedentistry or email distancedentistry@kcl.ac.uk

Dr Brian Millar BDS, FDSRCS, PhD Director of Distance Learning, Senior Lecturer in Primary Dental Care, Consultant in Restorative Dentistry. Specialist in Prosthodontics

PRODUCT REVIEW PRODUCT REVIEW PRODUCT REVIEW

Beautifil and FL-Bond: reliable and successful 8-year clinical results The practising dentists are often not informed about the important results of long-term clinical studies which are neglected in times of outrunning material generations. A clinical study on the SHOFU restorative material, Beautifil, a composite, and FL-Bond, a self-etching adhesive system, is now available. Under the direction of Prof Dr Ivar A. Mjör, University of Florida, Gainesville, USA, this restorative material has been tested in Class I and II cavities with positive results. Two clinicians placed 26 Class I and 35 Class II restorations in 31 patients. The restorations have been examined after a period of 6 months respectively one, two, three, four and eight years. The restorations have been examined by using modified Ryge criteria for colour match, marginal adaptation, anatomy, surface roughness, marginal and interfacial staining, proximal and occlusal contacts, secondary caries, postoperative sensitivity and luster. 16 Class I and 25 Class II restorations were examined after the impressive period of 8 years. The self-etching adhesive system FL-Bond and Beautifil, a microhybrid composite, both manufactured by SHOFU Inc., Japan, have been used. About half of the silicate glass filler of the composite is coated by the PRG technology patented by SHOFU, thus enabling a continuous fluoride recharge and release.

During the eight-year period no changes with respect to surface roughness, postoperative sensitivity or secondary caries were detected. Associated with the latter observation the potential of the composite regarding the fluoride release is particularly discussed. The study documents the positive clinical performance of FL-Bond and Beautifil in Class I and Class II cavities after eight years. For more details, please ask for the special print of the study. Gordan V. V., Mondragon E., Watson R. E., Garvan C., Mjör I. A.: A clinical evaluation of a self-etching primer and a giomer restorative material - results at eight years. J Am Dent Assoc 138: 621 - 627, 2007 SHOFU Dental GmbH

Revo-S® An endo REVOlution Intended for the initial endodontic treatment, Revo-S® innovates with only 3 instruments. Highly performing and very simple, this sequence is adapted for most root canal anatomies. The first two files, SC1 and SC2 are dedicated to root canal cleaning and shaping. The third file, SU, recapitulates the action of the first two files, thus respecting the tapered shape of the canal. Adequate canal preparation with an apical finishing of 6%. Revo-S® features an innovating and unique characteristic: its asymmetrical section initiates a snake-like movement of the instrument inside the canal thus increasing flexibility and reducing the stress on the files. The instrument functions in a cyclic way: 1) Cutting 2) Debris elimination 3) Cleaning This sequence performs a very good upward elimination of the dentin debris, and an improved cleaning.

MICRO-MEGA® offers an additional solution adapted with specific instruments: AS30, AS35, AS40. They allow widening efficiently the apical preparation with respect of the pre-established 6% taper, without changing the preparation obtained using the standard sequence (SC1, SC2, SU). This finishing allows a better flow of the irrigating solution for a more efficient disinfection. Moreover, the obturation is facilitated by the improved access thus performed. Revo-S® files are available with Classics and InGeT® shafts.

For a successful canal preparation, the apical finishing is essential:

DENTAL NEWS, VOLUME XVI, NUMBER I, 2009

PRODUCT REVIEW PRODUCT

Mectron Spa piezo smart

A modern casing with a large display and an upright bottle made of plastic material: that is what the new piezo smart ultrasound device by mectron looks like. With its over 37 different instruments, the piezo smart caters of course for all the traditional applications: scaling, perio, endo and restorative. The highlight, however, is the new non-dripping bottle system, as the bottle remains upright and opens on top. This means that the liquid cannot flow out. The bottle is simply positioned on the fitting provided for it and twisted downwards. The path of the liquid is kept separate from the electrical components. The peristaltic pump is protected but accessible at all times, mounted on the bottom of the device. The automatic “Clean” function can be activated by pressing a button, thus excluding any deposits in the circuit from the start. The display indicates both the chosen quantity of liquid and the selected ultrasound performance level. The power can be set to nine different levels, corresponding to different fields of application (1-2 Endo, 3-5 Perio and 6-9 Scaling). The feed-back system and the Automatic Protection Control (APC) function make sure of constant top performance. So the piezo smart is smart to handle and smart to use and will make available a unique alternative to the known ultrasound devices. For more information- www.mectron.com

PRODUCT REVIEW PRODUCT REVIEW PRODUCT REVIEW

VITA Easyshade® Compact The new generation in digital shade-taking Since its introduction five years ago, the optoelectronic shade measuring unit VITA Easyshade® has convinced dentists and dental technicians through its simple handling and high degree of accuracy in the objective shade determination of natural teeth and dental restorations. With the arrival of the VITA Easyshade® Compact on the market, the second generation of the measuring device shall now further facilitate the work of dentists and dental technicians in future. At the fairs all over the world, you can now see and test for yourself the VITA Easyshade® Compact. For the VITA Easyshade® Compact, the established, lightweight and handy form of the previous model was retained. PMT he advanced spectrophotometric technology ensures that unmistakable and accurate results of the determination of natural tooth shades and the shade checking of dental restorations will be displayed within seconds. Other key improvements include its cordless design, which enables the user to move freely, and the modern LED light source. In addition to this, the VITA Easyshade® Compact has sufficient storage capacity for 25 measurements, which also remain stored when the unit is switched off.

E-Mail: info@vita-zahnfabrik.com www.vita-zahnfabrik.com

PRODUCT REVIEW PRODUCT REVIEW PRODUCT REVIEW

Nobel Biocare new dental implant NobelActive™ - with an advanced design Nobel Biocare announced the worldwide launch of its new, innovative implant, NobelActive. Designed together and tested by experienced clinicians, NobelActive will expand the possibility for implant treatment therapy to more dental patients. With its unique tip and double-variable thread design, NobelActive condenses bone during insertion unlike conventional self-tapping implants. This bone-condensing capability delivers high initial implant stability, even in compromised bone situations, and can eliminate the need for time-consuming and unpleasant implant procedures for patients, such as bone-grafting. The bone-condensing property and apical drilling blades also allow the experienced user to actively change direction during insertion to gain optimal orientation of the prosthetic connection, thereby facilitating the esthetic restoration process. The unique dual-function conical prosthetic connection, with hexagonal interlocking, supports a wide range of prosthetic options, including individually designed Procera abutments and Procera Implant Bridges Zirconia and Titanium. www.nobelbiocare.com

NobelReplace

The world’s most used implant system.*

Internal tri-channel connection for accurate and secure prosthetic restorations

Color-coded system for accurate and fast component identification and ease of use

TiUnite® surface and Groovy™ to enhance osseointegration

Color-coding: step-by-step drilling protocol for predictable surgical procedures

Implant design that replicates the shape of natural tooth roots

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* Source: Millennium Research Group

Versatility, ease-of-use and predictability have made NobelReplace™ Tapered the most widely used implant design in the world.* NobelReplace™ Tapered is a general use, two-piece implant system that performs both in soft and hard bone, one- and two-stage surgical procedures, while consistently delivering optimal initial stability.

NobelReplace™ Tapered is a system that grows to meet the surgical and restorative needs of clinicians and their patients – from single-tooth restorations to more advanced multiunit solutions. Whether clinicians are just starting or are experienced implant users, they will benefit from a system that is unique in flexibility and breadth of application.

Nobel Biocare is the world leader in innovative evidence-based dental solutions. For more information, visit our website.

www.nobelbiocare.com/nobelreplace

all ceramic all you need

IPS e.max restorations fabricated by Prof. Dr. D. Edelhoff / O. Brix, Germany

IPS e.max offers exceptional metal-free aesthetics and strength both for the press and CAD/CAM technique.

IPS e.max offers: • Outstanding aesthetics • Self-adhesive or conventional cementation • Choice of high-strength materials including zirconium oxide and glass-ceramic • Press and CAD/CAM processing techniques for optimum strength and accuracy of fit • One single layering ceramic for the IPS e.max System

www.ivoclarvivadent.com Ivoclar Vivadent AG Technical

Bendererstr. 2 | FL 9494 Schaan | Liechtenstein | Tel.: + 423 / 235 35 35 | Fax: + 423 / 235 33 60