Dental News September 2009

www.dentalnews.com

ISSN 1026 261X

Endodontic surgery versus retreatment

Volume XVI, Number III, 2009

CLEFT LIPS AND PALATES

25 Anniversary th

School of Dentistry Lebanese University

The nano-optimized composite system

Tetric EvoCeram

®

MORE THAN A COMPOSITE Nano-optimized mouldable ceramic

Tetric EvoFlow

®

M O R E T H A N A F L O WA B L E Nano-optimized flowable composite Ideally complements Tetric EvoCeram

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

Modulmix and Hydrorise, the brand new impressions system for high precision results

Zhermack, leading company in the technology of A-silicones, introduces a unique impression system delivering outstanding quality, accurate results and easy handling. The combination between Modulmix and Hydrorise assures the following great performances: s¬ excellent flow properties - the hyper hydrophilic behaviour provides the most accurate impressions ever s¬¬time saving - thanks to high speed dispensing for rapid tray-filling s¬¬less waste - thanks to the new patented dynamic/static mixing tip

Tel. +39 - 0425 597611 - Fax +39 - 0425 597642 comm.expo@zhermack.com - www.zhermack.com

CONTENTS Vo l u m e X V I , N u m b e r I I I , 2 0 0 9 EDITORIAL TEAM Alfred Naaman, Nada Naaman, Jihad Fakhoury, Dona Raad, Antoine Saadé, Lina Chamseddine, Tarek Kotob, Mohammed Rifai, Bilal Koleilat, Mohammad H. Al-Jammaz COORDINATOR Lina Jadaa ART DEPARTMENT Krystel Kouyoumdjis SUBSCRIPTION Micheline Assaf, Nariman Nehmeh ADVERTISING Josiane Younes PHOTOGRAPHY Albert Saykali TRANSLATION Gisèle Wakim, Marielle Khoury DIRECTOR Tony Dib ISSN 1026-261X

13

Adopting minimum intervention in dentistry Dr. Steffen Mickenautsch

20

Cleft lips and palates Dr. Abu-Hussein Muhamad

28

Lumineers Dr. David Silber

36

Endodontic surgery versus retreatment Dr. Richard Mounce

54

25th Anniversary - School of Dentistry Lebanese University

72

Product Review

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

Pr. M.A. Bassiouny BDS, DMD, MSc, Ph.D. Director International Program, Temple University, Philadelphia, USA. Pr. N.F. Bissada D.D.S., M.S.D Professor and Chairman, Department of Periodontics, Case Western Reserve University, USA. Pr. Jean-Louis Brouillet D.C.D, D.S.O. Chairman, Department of Restorative Dentistry, Aix-Marseille II, France.

Pierre Colon D.C.D., D.S.O. Maître de conférence des universités, Paris, France.

Dr. Jean-Claude Franquin, Directeur de l’Unité de Recherche ER116, Marseille, France.

Pr. Gilles Koubi D.C.D., D.S.O. Department of Restorative Dentistry, Aix-Marseille II, France.

Pr. Guido Goracci. University LA SAPIENZA, School of Medicine & Dentistry, Roma, Italia.

Dr. Olivier Hue, Faculté de chirurgie dentaire de Paris VII, rue Garancière, Paris, France.

Brian J. Millar BDS, FDSRCS, Ph.D. Guy’s, King’s, and St. Thomas’ College School of Medecine & Dentistry, London, UK. Pr. Dr. Klaus Ott, Director of the Clinics of Westfälischen Wilhelms-University, Münster, Germany.

Wilhelm-Joseph Pertot DEA, Maître de conférence, Aix-Marseille II, France.

Pr. James L. Gutmann, Professor and Director, Graduate Endodontics, Baylor College of Dentistry, Dallas, Texas, USA. Pr. Dr. Alfred Renk, Bayerische Julius-Maximilians-University, Würzburg, Germany.

Dr. Philippe Roche-Poggi DEA. Maître de conférence des universités, Aix-Marseille II, France.

Michel Sixou D.C.D., D.E.A. Department of Priodontology, Toulouse, France.

Pr. M. Sharawy B.D.S., Ph.D. Professor and Director, Department of Oral biology, Medical College of Georgia, Augusta, Georgia, USA.

3 Contents

INTERNATIONAL REVIEW BOARD

DENTAL NEWS IS A QUARTERLY MAGAZINE DISTRIBUTED MAINLY IN THE MIDDLE EAST & NORTH AFRICA IN COLLABORATION WITH THE COUNCIL OF DENTAL SOCIETIES FOR THE GCC. Statements and opinions expressed in the articles and communications herein are those of the author(s) and not necessarily those of the Editor(s) or publisher. No part of this magazine may be reproduced in any form, either electronic or mechanical, without the express written permission of the publisher.

PantOs DG XP Ceph P R O F E S S I O N A L

T E C H N O L O G Y

The latest technologies for digital imaging in PantOs DG xp Ceph, featuring two specific imaging detectors for panoramic and cephalometric radiology.

Digital Cephalometric radiology is on the same system in addition to multiprojection panoramic.

The one-shot digital Ceph features a 10x10 inch detection area and instant imaging on computer with a short exposure.

A solid and reliable solution with fixed digital sensors.

No slow scanning, no risk of movement, no image distortion.

D

More precise results, quickly.

l

igita 1-SHOT 1-SHOT C eph

Blue X Imaging Srl Via Idiomi 1/8-33 • 20090 Assago • Italy Ph. +39 02 4571 2171 • Fax +39 02 4570 3385 e-mail: bluex@bluex.it • www.bluex.it

Have a nice imaging

A-dec 300 stylish

functional

innovative

ΓήϜΘΒϣ

ΔϴϠϤϋ

ΔϘϴϧ΃

A healthy new choice for dentistry

ϥΎϨγϷ΍ ΐσ Ε΍ΩΎϴόϟ ϲΤλ ΪϳΪΟ έΎϴΘΧ΍ Find out why the A-dec 300 is a great choice for your practice.

For details visit www.a-dec300.com or contact your local authorised A-dec dealer

˯ΎΟήϟ΍ ϞϴλΎϔΘϟ΍ Ϧϣ ΪϳΰϤϠϟ .ϚΗΩΎϴόϟ ϞΜϣϷ΍ έΎϴΘΧϻ΍ A-dec 300ϞόΟ ΐΒγ ϰϠϋ ϚδϔϨΑ ϑήόΗ www.a-dec300.com ΖϧήΘϧϹ΍ ϰϠϋ ϲϧϭήΘϜϟϹ΍ ϊϗϮϤϟ΍ ΓέΎϳί ϭ΃ ϚϳΪϟ ΪϤΘόϤϟ΍ ϲϠΤϤϟ΍ A-dec ωίϮϤΑ ϝΎμΗϻ΍

ΔϔϠΘΨϣ ΔϘϳήτΑ ήϴϜϔΘϟ΍

!"

A-dec Inc. 2601 Crestview Drive, Newberg, Oregon 97132 USA Tel: +44 2476 322089 Fax: +44 2476 345106 Web: www.a-dec.com

Seal-Tight

Dry air on demand. It will blow you away.

Disposable air/water syringe tips.

• Disposable. For maximum infection protection.

• Saves Time. Dramatically reduces time needed for reprocessing autoclavable tips.

• Flexible. Can be bent to a 90° angle without affecting water flow and improving ergonomics.

• Dry Air. The yellow rubber seal acts as a new O-ring ensuring dry air every time.

Cleanic®

The universal prophy paste is now available in tubes.

With Perlite technology.

• Universal prophy paste with integrated cleaning variability.

• Single application: cleaning and polishing in a single application (ca. 15 seconds/3 teeth).

• Perlite technology: high cleaning power converting into gentle polishing action thanks to Perlite technology (dynamic behaviour of Perlite-particles).

• Gentle: the prophy paste is gentle to the tooth structure while maintaining a high efficiency.

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.

Flexible Clearance Tabs™

Ideal for surgery use • Give you an easy and accurate way to make direct intra-oral measurements of occlusal and interproximal tooth preparation clearance.

• Each colour coded tab is used like a feeler gauge to check clearance dimension.

• Available in a convenient dispenser box designed especially for the dental surgery.

• Each tab is for single use only.

KerrHawe SA

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

Your practice is our inspiration.™

INTERNATIONAL CALENDAR September 23–26, 2009 The Beirut International Dental Meeting 2009 Congress Palace Dbayeh Contact: Dr. Antoine Karam, President of the Lebanese Dental Association Email: lda@lda.org.lb Website: www.LDA.org.lb October 14–16, 2009 The 17th Scientific International Conference of Syrian Dental Association, Damascus Ommayad Palace for conferences, Damascus Ebla Hotel Contact: Syrian Dental Association, Damascus, Syria, POB: 11104 Tel: 963 11 222 1446 – Fax: 963 11 222 48 45 Email: syrdent@scs-net.org Website: http://www.syr-sda.com October 15 - 17, 2009 37th International Expodental Rome Pavilions 7-8-9 of the new Fiera Roma Exhibition Center Email: pressoffice@expodental.it Website: http:// www.expodental.it October 21 - 23, 2009 The 4th Riyadh International Pharmacy Meeting - 4th RIDPM Riyadh, Saudi Arabia from October 21st to 23rd, 2009 [02-04/10/1430].

Email: meeting@riyadh.edu.sa Website: http://riyadh.edu.sa/meeting October 27 - 29, 2009 The 5th Bahrain Dental Society Conference 2009 27- 29 October 2009 Email: bahds@batelco.com.bh Website: http://www.bahrain-dental.com November 3 - 6, 2009 1st Pan Arab Endodontic conference LandMark Hotel (RadissonSAS) Amman, Jordan Dr. Ibrahim Abu Tahun Email: ihtahun@yahoo.com Website: http://www.jda.org.jo/endo

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

ADVERTISING INDEX ACTEON 71 - A-DEC 7 - BELMONT 27 - BEYOND 25 - BIEN AIR 23 - BIOMET 3I 54 - BLUE X 6 - CASTELLINI 21 - CAVEX 35 - COLGATE 41 - COLTENE WHALEDENT 53 - DISCUS DENTAL 75 - DR. WILD 4, 5 - DUERR 17 - GC 31 - GSK C2, 51 - HU-FRIEDY 59 - INTENSIV 49 - INVISALINE 26 - IVOCLAR – VIVADENT 1, C4 - KAVO C3 - KAVO – GENDEX 55 - KERR 9, 19 - KETTENBACH 34 - KOMET 78 - LEONE 10 - MECTRON 42 - METASYS 33 - MICRO MEGA 67 - MOCOM 63 - MORITA 29 - NISSIN 39 - NOBEL BIOCARE 37 - NSK 80 - SIRONA 15 - SOREDEX 8 - STRAUMANN 69 - SULTAN 12 - VITA 47 - VOCO 65 - W&H 61 - ZHERMACK 2 - ZIMMER 43

11

www.dentalnews.com w w w. d e n t a l n e w s . c o m T e l : 9 6 1 - 3 - 3 0 3 0 4 8 F a x : 9 6 1 - 1 - 3 8 4 6 5 7 Email: info@dentalnews.com

GET YOUR ISSUE ONLINE

Volume XVI, Number III, 2009 DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

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

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

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

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

Genie’s™ superior flow… for incredible impressions, every time.

To capture the very best impressions, it’s critical that your impression material exhibits superior “flow”—the ability to capture all details, including those past the prepared margin. Flow is the single most important feature of your impression material, because the better the flow, the better you’ll capture important details.

For flow that stands above the rest, choose Genie™.

An independent study confirms it: when compared to leading brands of impression material, Genie™ proved to have superior flow.* Isn’t it time you got the best performance for the best price?

Genie™

* Study available upon request.

To order Genie™ , contact your dental supply dealer or visit www.sultanhc.com/genie.

www.sultanhealthcare.com

Genie™ Magic Mix Genie is available in 380 ml cartridges for automix machines.

Get 5% more material than foil bag systems.

OPERATIVE DENTISTRY

Adopting minimum intervention in dentistry: Diffusion, bias and the role of scientific evidence Dr S Mickenautsch, BDS, PhD

Abstract Minimum Intervention (MI) in dentistry aims to empower patients through information, skills, and motivation to take charge of their own oral health and consequently require only minimum intervention from the dental profession. Although MI in dentistry has until now focused mainly on caries-related topics, it follows the 3-step philosophy of disease risk assessment, early disease detection and, if required, minimally invasive treatment.

This philosophy is applicable to any type of disease. The subsequent benefit of MI is its focus on disease causes and ultra-conservative, patient-friendly treatment. Successful diffusion of MI depends on substantiation of its beneficial claims through low-bias evidence.

Such evidence provides the first step for a wider adoption which, furthermore, depends on complex factors related to adopter behavior.

Introduction Since the beginning of this millennium information about the procedures and benefits of minimum intervention, an innovative, modern healthcare approach for dentistry, has been increasingly disseminated1-8. As with any innovation, wide adoption of minimum intervention by the dental profession is reliant upon factors related to the process of diffusion9. This paper aims to contribute to the discussion of this topic by highlighting the role, which both bias and scientific evidence can play in this process.

Minimum intervention Minimum Intervention (MI) in dentistry aims to empower patients, through information, skills and motivation, to take charge of their own oral health in order to require only minimum intervention from the dental profession (Hien Ngo, National University of Singapore; oral communication, September 2004).

Although the focus of MI in dentistry has so far been on cariesrelated topics10, the approach follows the 3-step philosophy of disease risk assessment; early disease detection and possible minimally invasive subsequent treatment. Such philosophy is applicable to any type of disease2. MI enables the healthcare

provider to advise healthy patients about their risks regarding possible future ailments11. Such risks may be due to aspects related to a patient's lifestyle or to other factors with the potential to have an impact upon health12. These aspects are then assessed to determine the basis on which addressing the identified risk factors with targeted prevention is possible13.

Patients with manifest disease are helped by as early as possible identification of such manifestation14-16. As disease at an early stage is often relatively contained, treatment can consequently be simple, very conservative and minimally invasive1.

Laboratory findings, clinical considerations and protocols, materials and technologies for all three steps of MI in dentistry have been reported elsewhere3-6,17. Patients benefit from MI because of its focus on the cause of disease instead of on merely addressing disease symptoms7. A further benefit for patients is its patientfriendly nature, due to its minimally invasive treatment options.

MI procedures are considered to be atraumatic, since patients experience less discomfort and pain than traditional treatment options incur8. Experience and expectation of pain and discomfort during dental treatment has been associated with dental fear18.

A study investigating the dental fear levels of children and adults during atraumatic restorative treatment (ART), in comparison to those receiving traditional restorative treatment using high-speed drilling, found patients treated with ART to be significantly less fearful than the others19. Patients with low levels of dental fear are more cooperative during treatment than those with high fear levels20. Positive patient attitude and cooperation resulting from reduction of fear during treatment sessions may further benefit the healthcare provider, as a direct correlation between dental fear and operator stress in daily dental practice has been observed21.

The MI benefits for patients, attributable to addressing causes of disease and to the reduced discomfort, and the benefits for healthcare providers, resulting from stress reduction through reduced patient fear and consequent higher patient cooperation, have been stated as reasons for adopting MI into daily dental practice.

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

13 Adopting minimum intervention in dentistry

Division of Public Oral Health, University of the Witwatersrand, 7 York Rd, 2193 Parktown/Johannesburg, South Africa Email: neem@global.co.za

OPERATIVE DENTISTRY Diffusion of innovation Despite its stated benefits the still new philosophy of MI faces, as most innovations commonly do, the process of diffusion.

Rogers9 (2003) defined “innovation” as an idea, practice or object that is perceived as new, and “diffusion” as the process through which innovation spreads. Diffusion comprises (i) innovation itself; (ii) the type and availability of channels through which the innovation is communicated to others; (iii) time and (iv) the prevailing social system9.

The social system constitutes the community of potential adopters of innovation, categorized as follows: the innovators themselves, early adaptors, early majority, late majority and laggards9. Rogers (2003) estimated the percentage distribution of these groups as being 2.5%, 3.5%, 34%, 34% and 16%, respectively9. Except for the innovators themselves, these adopter groups' responses to innovation can vary between adoption, non-adoption or rejection22. An innovation is considered self-sustaining once it has been accepted by 10-20% of all potential adopters9. As well as adoption of an effective innovation, rejection and resistance against such an innovation are possible.

14 Adopting minimum intervention in dentistry

Research bias One of the factors governing the response to an innovation by potential adopters is insecurity concerning uncertainties about the advantages of new ideas, practices or objects as compared to those of current ones22. Doubts regarding claims of superiority of, for example, new products or clinical procedures are justified if these are based on studies containing high degrees of bias or systematic error. Bias has been defined as “any process at any stage of inference tending to produce results that differ systematically from the true values”23. The most important types of bias in clinical studies are selection-, performance-, detection-and

attrition bias (Table 1) 24.

Bias may affect studies by causing either an over-or under estimation of the treatment effect of an investigated clinical procedure. This may lead to a situation where a new ineffective treatment procedure is presented as effective or an effective treatment is presented as ineffective. The overestimation of a treatment effect through bias has been observed to be the most common25, thus providing the rationale for late adopters to doubt superiority claims at the onset. Schulz et al. (1995) reported a 41% treatment effect overestimation due to selection bias alone26. Such overestimation would mean that a study comparing the treatment effect of a new clinical procedure against a standard one would report a Risk ratio (RR) of 0.82 while the true RR would only be 1.13. The term “Risk” (R) describes the number of patients having an event (e.g. remaining ill after treatment) (nill) divided by the total number of patients treated (ntotal)27.

R = nill : ntotal If the effect of treatment with a new procedure is compared with the effect of a conventional, standard procedure, a “Risk ratio” (RR) can be calculated by dividing the patient Risk of remaining ill after treatment with the new procedure (Rnew) by the patient Risk of remaining ill after treatment with the standard procedure (Rold)28.

RR = Rnew : Rold The so calculated RR indicates whether treatment with the new procedure, in comparison to treatment with the standard procedure, increases or decreases the risk (or chance) that patients may remain ill28 . A presented RR of 0.82 would imply that the new procedure has reduced the chance of remaining ill for 18% of patients. (A risk ratio of 1.00 would indicate no difference in risk between the two procedures.) However, in a case of a 41% overestimation through bias, a real RR of 1.13 would mean that

Table 1. Types of bias in clinical trials

Bias

Description

Selection bias

New clinical procedures are usually tested in clinical trials consisting of 2 groups of patients: One group, forming the control group, is treated with a conventional, most commonly used procedure being considered as “currently accepted standard of care”. A second group (test group) is treated with the new procedure. At the end of the study the success (or failure) rates of both procedures are compared. Selection bias occurs when patients are selected into the 2 groups with known or unknown different characteristics. For example, if patients in the test group have conditions, which favor the success of treatment and which are lacking in patients of the control group then the new clinical procedure cannot be credited with the treatment success43.

Performance bias

Similar to selection bias, performance bias leads to wrong study results if the characteristics of patients in one group of a clinical study support or hinder the treatment effect of a clinical procedure. However, unlike in selection bias, performance bias is induced through active intervention, e.g. through additional treatment during the study in preference to one group only44.

Detection bias

Detection bias is created if the outcomes of both test-and control group are assessed differently. In other words, if the outcome of one group is assessed more favorably then the other44.

Attrition bias

Attrition bias occurs when patients allocated to either test-or control group are excluded from the outcomes assessment. For example, if patients in the control group are excluded for whom the standard clinical procedure lead to a treatment success. In such case the overall success rate of the standard treatment would be comparable lower than the new clinical procedure, thus falsely indicating that the later is superior24.

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

OPERATIVE DENTISTRY Table 3 - Evidence hierarchy

the new procedure has in fact increased by 13% the chance of patients' remaining ill. If such new clinical procedure were to be adopted into daily practice on the basis of the biased overestimated results, then 13 out of 100 patients treated with the new procedure would have been worse off than they would have been if treated with the standard procedure.

Negative experiences of early adopters of an apparently ineffective innovation, as shown in the example above, would in time lead to its rejection. Early adopters have been described as interacting more frequently with peers than late adopters9. Therefore, negative experiences of an innovation by early adopters would be communicated to other adopter groups and this would prevent further diffusion.

In that case, the critical mass of 10-20% of adopters29 would not be reached and the innovation would thus remain unsustainable.

16 Adopting minimum intervention in dentistry

Evidence and diffusion To avoid negative feedback from early adopters during the diffusion process, an innovation needs to be based on low-bias research because high internal validity of research provides the prerequisite for the successful generalization and adoption of the innovation24 . Bias reduction in clinical studies focused on treatment is realized through a range of interventions (Table 2) to be considered while planning and conducting a study24,29,30.

In addition, it has been acknowledged that various study designs contain various degrees of bias31-33. For that reason an 'evidence hierarchy' of study designs has been established (Table 3) 31-33.

It also has been recommended that once a study is conducted, its reporting should follow guidelines in order to assure recognition of study quality34. Such guidelines include the CONSORT statement for randomized control trials35 and the STROBE statement for observational studies, such as Cohort and case-control studies36.

Studies with low bias are identified through systematic reviews, using explicit, systematic methods designed to limit bias and the chance effects37. Where possible the results of the identified studies are statistically combined, using META analysis and thus providing more precise estimates of healthcare effects37.

Despite the value of low-bias evidence, it has been shown that on its own this is not sufficient to facilitate diffusion of innovaTable 2. Bias-reducing interventions

Bias

Intervention

Selection bias

(a) Selection of study subjects using a random allocation sequence (b) Concealment of allocation sequence from investigators24

Performance bias Blinding (masking) of study subjects and care providers as to the differences per test-or control group24 Detection bias

Blinding (masking) of study assessors as to the differences per test-or control group24

Attrition bias

Inclusion of all randomized study subjects into the analysis regardless of their adherence to the study protocol, thus following “intention-to-treat” principle29,30

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

Study Design Highest evidence value / lowest bias

Large randomised trials with clear results Small randomised results with unclear results COHORT studies Case-control studies Case series and reports

Lowest evidence value / highest bias

Expert reports

tion38. Nevertheless, diffusion of innovation is more likely if the evidence supporting it is regarded as being strong38,39.

Furthermore, it has been observed that clinicians do recognize a hierarchy of evidence and most frequently regard randomized control trials (RCT) as the “gold standard”38. Locock et al. (1999) described RCTs as providing the only form of evidence that may convince clinicians to adopt change40. Therefore strong evidence is an important prerequisite for achieving wider adoption of an innovation. Once strong positive evidence regarding an innovation is available, further aspects of diffusion need to be considered. These are related to complex factors of adopter behavior.

According to Morris et al. (1989), they may include past educational and professional experiences, work environment and professional and personal aspirations41. Fitzgerald et al. (2002) add further considerations related to whether the innovation threatens the established skill base and, consequently, the status and professional position of potential adopters, and to the impact of financial incentives which may facilitate or inhibit adoption of an innovation42. The latter may be further reinforced by perceptions of potential adopters as to whether the innovation offers advantages that the current methods do not22.

MI Evidence The need for strong (low-bias) evidence as an important prerequisite for wide adoption of innovation38-40 applies also to MI. The Cochrane library (online: www.cochrane.org) and Midentistry's compendium database (online: www.midentistry.com/compendium.html) are known sources for evidence generated through systematic reviews and META analysis and cover aspects of disease risk assessment; early disease detection and minimally invasive treatment.

The compendium database follows Cochrane recommendations and guidelines regarding the conduct of systematic reviews and META analysis but focuses exclusively on MI topics, including disease treatment and etiology, prognosis and diagnosis.

Conclusions Minimum intervention (MI) in dentistry focuses on causes of disease and allows for ultra¬conservative treatment that is more patient-friendly than traditional dentistry. Successful diffusion of MI requires substantiation of its beneficial claims through lowbias evidence. Such evidence provides the first step for a wider adoption, which furthermore depends on complex factors of adopter behavior.

OPERATIVE DENTISTRY

18 Adopting minimum intervention in dentistry

REFERENCES 1. Frencken JE, Holmgren CJ. ART: A Minimal Intervention Approach To Manage Dental Caries. Dent Update 2004; 31: 295-301.

2. Mickenautsch S. An Introduction to Minimum Intervention Dentistry. Singapore Dent J 2005; 27: 1-6.

3. Mount GJ, Ngo H. Minimal Intervention: A New Concept For Operative Dentistry.

Quintessence Int 2000; 31: 527-33.

4. Mount GJ, Ngo H. Minimal Intervention: Early Lesions. Quintessence Int 2000; 31: 535-46.

5. Mount GJ, Ngo H. Minimal Intervention: Advanced Lesions. Quintessence Int 2000; 31: 621-9.

6. Murdoch-Kinch CA, McLean ME. Minimally Invasive Dentistry. J Am Dent Assoc.

2003; 134: 87-95.

7. Tyas MJ, Anusavice KJ, Frencken JE, Mount GJ. Minimal Intervention Dentistry A Review. Int Dent J 2000; 50: 1-12.

8. Whitehouse J. Minimally Invasive Dentistry. Clinical Applications. Dent Today 2004; 23: 56-61.

9. Rogers EM. Diffusion Of Innovation. 5th ed. New York: Free Press 2003.

10. World Dental Federation. Minimal Intervention In The Management Of Dental Caries. FDI policy statement; 2002.

11. Sonbul H, Al-Otaibi M, Birkhed D. Risk Profile Of Adults With Several Dental Restorations Using The Cariogram Model. Acta Odontol Scand 2008; 66: 351-7.

12. Walsh LJ. Lifestyle impacts on oral health. In: Mount GJ, Hume WR, editors.

Preservation And Restoration Of Tooth Structure. Brighton: Knowledge books and software; 2005. p. 83-109.

13. Ngo HC, Gaffney S. Risk Assessment In The Diagnosis And Management Of Caries. In: Mount GJ, Hume WR editors. Preservation and restoration of tooth structure. Brighton: Knowledge books and software; 2005. p. 61-82.

14. Angmar-Månsson B, ten Bosch JJ. Quantitative Light-Induced Fluorescence (QLF): A Method For Assessment Of Incipient Caries Lesions. Dentomaxillofac Radiol 2001; 30: 298-307 15. Mendes FM, Nicolau J, Duarte DA. Evaluation Of The Effectiveness Of Laser Fluorescence In Monitoring In Vitro Remineralization Of Incipient Caries Lesions In Primary Teeth. Caries Res 2003; 37: 442-4.

16. Mendes FM, Sigueira WL, Mazzitelli JF, Pinheiro SL, Bengtson AL. Performance of DIAGNOdent For Detection And Quantification Of Smooth -Surface Caries In Primary Teeth. J Dent 2005; 33: 79-84.

17. Kitasako Y, Nakajima M, Foxton RM, Aoki K, Pereira PNR, Tagami J. Physiological Remineralization Of Artificial Demineralized Dentine Beneath Glass Ionomer Cements With And Without Bacterial Contamination In Vivo. Oper Dent 2003; 28: 274-80.

18. Vassend O. Anxiety, Pain And Discomfort Associated With Dental Treatment.

Behav Res Thu 1993; 31: 659-66.

19. Mickenautsch S, Frencken JE, van't Hof M. Atraumatic Restorative Treatment And Dental Anxiety In Outpatients Attending Public Oral Health Clinics In South Africa. J Public Health Dent 2007; 67: 179-84.

20. Yamada MKM, Tanabe Y, Sano T, Noda T. Cooperation During Dental Treatment; The Children's Fear Survey Schedule In Japanese Children. Int J Paediatr Dent 2002; 12: 404-9.

21. Moore R, Brødsgaard I. Dentists' Perceived Stress And Its Relation To Perceptions About Anxious Patients. Community Dent Oral Epidemiol 2001; 29: 73-80.

22. Parashos P, Messer HH. The Diffusion Of Innovation In Dentistry: A Review Using Rotary Nickel-Titanium Technology As An Example. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 395-401.

23. Murphy EA. The Logic Of Medicine. Baltimore: Johns Hopkins University Press, 1976.

24. Jüni P, Altman DG, Egger M. Assessing The Quality Of Controlled Clinical Trials.

Br Med J 2001; 323: 42-6.

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

25. Chalmers TC, Matta RJ, Smith H Jr, Kunzler AM. Evidence Favoring The Use Of Anticoagulants In The Hospital Phase Of Acute Myocardial Infarction. N Engl J Med 1977; 297: 1091-6.

26. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical Evidence Of Bias: Dimensions Of Methodological Quality Associated With Estimates Of Treatment Effects In Controlled Trials. J Am Med Assoc 1995; 273: 408-12.

27. The Cochrane collaboration. Cochrane Handbook For Systematic Reviews Of Interventions. Updated version 4.2.6; 2006. p. 102-103.

28. The Cochrane collaboration. Cochrane Handbook For Systematic Reviews Of Interventions. Updated version 4.2.6; 2006. p. 103-105.

29. May GS, Demets DL, Friedman LM, Furberg C, Passamani E. The Randomized Clinical Trial: Bias In Analysis. Circulation. 1981; 64: 669-73.

30. Sackett DL, Gent M. Controversy In Counting And Attributing Events In Clinical Trials. N Engl J Med 1979; 301: 1410-2.

31. Cook DJ, Guyatt GH, Laupacis A, Sackett DL. Rules Of Evidence And Clinical Recommendations On The Use Of Antithrombotic Agents. Chest 1992; 102: 305S311S. 32. Sackett D. Rules Of Evidence And Clinical Recommendations Can J Cardiol 1993; 9: 487-9.

33. Woolf SH, Battista RN, Anderson GM, Logan AG, Wang E. Assessing The Clinical Effectiveness Of Preventive Manoeuvres: Analytic Principles And Systematic Methods In Reviewing Evidence And Developing Clinical Practice Recommendations. A Report By The Canadian Task Force On The Periodic Health Examination. J Clin Epidemiol 1990; 43: 891-905.

34. Moher D, Simera I, Schulz KF, Hoey J, Altman DG. Helping Editors, Peer Reviewers And Authors Improve The Clarity, Completeness And Transparency Of Reporting Health Research. BMC Medicine 2008; 6:13.

35. Moher D, Schulz KF, Altman DG. The CONSORT statement: Revised Recommendations For Improving The Quality Of Reports Of Parallel-Group Randomised Trials. Lancet 2001; 357: 1191-4.

36. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Bull World Health Organ 2007; 85: 867-72.

37. The Cochrane collaboration. Cochrane Handbook For Systematic Reviews Of Interventions. Updated version 4.2.6; 2006. p. 15.

38. Dopson S, Fitzgerald L, Ferlie E, Gabbay J, Locock. No Magic Targets! Changing Clinical Practice To Become More Evidence Based. Health Care Manage Rev 2002; 27: 35-47.

39. Dopson S, Gabbay J, Locock L, Chambers D. Evaluation of the PACE programme: Final report. Southampton: Templeton College, University of Oxford and Wessex Institute for Health Research and Development, University of Southampton, 1999.

40. Locock L, Chambers D, Surender R, Dopson S, Gabbay J. Evaluation Of The Welsh Clinical Effectiveness Initiative National Demonstration Projects: Final Report.

Southampton: Templeton College, University of Oxford and Wessex Institute for Health Research and Development, University of Southampton, 1999.

41. Morris A, Vito A, Bomba M, Bentley J. The Impact Of A Quality Assessment Program On The Practice Behaviour Of General Practitioners: A Follow Up Study. J Am Dent Assoc 1989; 119:705-9.

42. Fitzgerald L, Ferlie E, Wood M, Hawkins C. Interlocking Interactions, The Diffusion Of Innovations In Health Care. Human Relations 2002; 55: 14: 29-49.

43. Altman DG, Bland JM. Statistic notes. Treatment Allocation In Controlled Trials: Why Randomize? Br Med J 1999; 318: 1209.

44. Noseworthy JH, Ebers GC, Vandervoorst MK, Farquhar RF, Yetsir E, Roberts R. The Impact Of Blinding On The Result Of A Randomized, Placebo-Controlled Multiple Sclerosis Clinical Trial. Neurology 1994; 44: 16-20.

OptiDam™

The first rubber dam with 3-dimensional shape.

Making dental work fast and efficient.

• OptiDam creates a dry and clean operating field, enabling safe dental procedures.

• OptiDam isolates all soft tissue for perfect accessibility: The patient’s tongue no longer needs to be restrained. And the patient’s cheeks, lips and gums no longer interfere with your work.

• OptiDam establishes a non-contaminated field – a basis for durable clinical access: Moisture-sensitive materials can be used correctly. The area being worked on is kept completely dry.

• OptiDam offers optimum protection for both patient and dental staff: Your patients are protected against aspiration or ingestion of foreign objects. Airborne debris is reduced.

SoftClamp™

Universal Rubber Dam Clamp.

The gentle alternative to metal clamps • Secure. Unique design with grip-tight coating on the jaws minimizes rotation, ensuring secure, solid retention.

• Safe. No sharp edges. Evenly distributed clamping force. Minimizes risk of harm to soft tissue, tooth structure or delicate restorations.

• Versatile. Provides a secure, stable fit for varying molar tooth anatomies and sizes.

• Compatible. Accommodates all types of rubber dam forceps.

Prevents forceps tips from penetrating through the clamp, which could affect the gingiva.

• Autoclavable. Well-suited for multiple use.

Fixafloss®

The new fixation of rubber dams.

First multifunctional floss for the gentle fixation of rubber dams.

• Innovative: first waxed dental floss with conical clamping element included (silicone).

• Gentle: for gentle rubber dam fixation without clamp in the anterior area.

• Universal: depending on the anatomical situation also indicated for posterior teeth rubber dam fixation.

KerrHawe SA

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

Your practice is our inspiration.™

PEDIATRIC DENTISTRY

Cleft Lips and Palates; The Roles Of Specialists DR. ABU-HUSSEIN MUHAMAD - DDS, MScD Limited to Pediatric Dentistry Athens-GREECE Abu-hus@hotmail.com

left lips and cleft palates are among the most common of birth defects and if left untreated can lead to serious medical and concurrent speech and language problems.

However, while the consequences of cleft lips and palates can be severe and long-lasting, these can be averted by medical intervention, especially if it is done as early as possible.

This paper explores the various options for surgical, medical, dental, and speech and audiological management of cleft of the secondary palates in children with Apert's syndrome and the ways in which these interventions can help children with these particular birth defects.

We should begin this discussion by establishing what a cleft palate is, in medical terms. Per the Cleft Palate Foundation website (accessed August 17, 2007) a cleft palate occurs when the palatal plates of an individual (which lie in the roof of the mouth) for various reasons fail to come together or “close” during the second month of fetal development. From an early age and up to adulthood, the skull, face, jaws, hands and feet undergo frequent surgical correction. These operations require planning and coordination amongst various specialists, including a neurosurgeon, a craniofacial plastic surgeon, an anesthesiologist, a maxillofacial oral surgeon, an orthodontist, a dentist, an orthopedist and an orthopedic surgeon.

Continuing care throughout the first twelve years of a child with Apert's life (as well as past the first twelve years) is facilitated by a social worker, psychologist, audiologist and speech language pathologist. In addition to the planning and performance of many operations at specialist clinics, each child and his or her family should have regular contact with the craniofacial team.

There will often be meetings with several members of the multidisciplinary craniofacial team as well as other medical professionals: the occupational therapist, the pediatrician, the nutritionist, the guidance counselor, the psychologist and the physiotherapist. For the purposes of this research paper there will be a focused discussion of six medical professionals' roles on the craniofacial team in the first twelve years of a child with Apert's life. These professionals are: geneticist, speech language pathologist, audiologist, plastic surgeon, dentist and orthodontist.

20

Cleft Lips and Palates;The Roles Of Specialists

C

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

Role of the Geneticist Consultation with a geneticist is crucial in order to do a DNA test of the child with Apert's as well as the parents of the child. Per the Mountain States Genetics Regional Collaborative Center's website (accessed August 11, 2007) in Apert's syndrome, there is bicoronal synostosis, midface retrusion, and symmetric syndactyly (webbing of the digits) in both the hands and feet. The craniofacial dysostosis syndromes are inheritable. Per Carinci et al (2005 ), the gene mutation for each syndrome has been identified.

Apert's syndrome is inherited in an autosomal dominant fashion, meaning that there is a 50% likelihood of recurrence of the syndrome in the offspring of the affected individual. Often, the parents of these children are not affected, and the gene mutation arises spontaneously during development. However, the severity of the syndrome may vary from one generation to the next. The researchers state that the gene encoding for FGFR2 is mutated, and this results in a wide spectrum in the expression of phenotype and making anomalous development more complicated.

Furthermore, Apert's may not have been detected in a parent, until a child with more remarkable Apert's traits was born.

Therefore DNA testing is of the utmost importance to give parents the data to make informed decisions about the odds of bearing another child with Apert's or other genetically inherited disorders. Lastly, it is of great importance to determine the cooccurrence of other congenital and genetic anomalies that may affect the progression of the child's development.

Role of the Speech Language Pathologist Therapy and follow-up care is coordinated with the speech language pathologist (SLP). Per Shipster et al (2002), a cohort of ten children with Apert's syndrome was studied and a thorough analysis of their speech and language characteristics was done. They often have hyponasal resonance due to an under-developed midface, small nose, and excessively long soft palate. If there is a cleft palate, they may also have hypernasal resonance. Articulation of speech sounds is often distorted due to the malocclusion and high arched palate. Impaired hearing or a general developmental

22

Cleft Lips and Palates;The Roles Of Specialists

PEDIATRIC DENTISTRY delay will also affect speech and language development.

Individuals with Apert's Syndrome often require glasses to correct near- or long-sightedness and thus the Speech Language Pathologist must bear this in mind when doing drills using written media.

The researchers state that there are specific areas requiring therapy based on their examination and standardized testing of these children. Resonance and voice are at issue due to marked nasal obstruction, affecting the nasality of words produced by the children. Diplophonia and wet voice quality were apparent in the cohort's voice and resonance. As a result therapy must focus on nasality and voice therapy as well. Testing of the cohort determined severely impaired receptive and expressive language skills in nearly 50% of the group. This involves an approach to therapy which must address these issues to strengthen receptive and consequently receptive abilities. Attention was delayed by 2;0 to 3;0 chronological years. The cohort displayed single channel attention control that lags behind normal children. This means that therapy must focus on eye contact, pragmatics and posture issues. There were delays in the phonetic and phonological skills of these children. Phonetic errors mainly involved blade production of alveolar consonants as well as some lateralization of alveolar fricative and affricates. While these issues mostly would be helped by alveolar ridge surgery, in the meantime therapy may focus on proper articulation of these phonemes. Phonologically problems involved stopping of fricatives and affricates, final consonant deletion, voicing of voiceless consonants, and fronting of velars and palatoalveolar sounds. These are all major areas for work on the part of the SLP. It is important to note that areas of therapy for the cohort members during earlier years of life were: Portage and Makaton signing (which was relinquished to instead work on spoken language).

Role of the Audiologist Per Rajenderkumar, Bamiou and Simimanna (2005), the major concern related to audiological treatment of Apert's is the risk of hearing impairment caused by repeated infections in the middle ear. However, the researchers point to the significant debate regarding the efficacy of repeated pressure equalization tube insertion vs. the efficacy of amplification to ensure hearing ability.

Otoloaryngologists will handle the middle ear infections by inserting pressure equalization tubes into the eardrum to equalize middle-ear air pressure and drain liquid. The audiologist will check the ears for placement of the tubes as they often fall out of place.

Per the researchers, some individuals may require hearing aids, as a hearing impairment will affect speech and language development.

They argue based on their data from a cohort of seventy cases that hearing aids are more effective than tube insertion in the long run. Hearing impairments caused by sensorineural damage (the inability of the nervous system to mediate sound impulses) are uncommon. Further impairments of hearing that are monitored and managed by the audiologist (with consultation with a DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

Otoloaryngologist) are: low-set ears, microtia, macrotia, posteriorly rotated external ears, ossicular fixation, wide cochlear aqueduct, and abnormal surface configuration of the pinna. Regular audiological testing is done according to schedule in order to assess ongoing changes in the child's hearing.

Role of the Plastic Surgeon Per the Children's Craniofacial Association website (accessed August 19, 2007) the physical characteristics of Apert's include defects of the skull, eyes, and face. The skull is: short from back to front, wide on the sides. The eyes are: bulging, eyelids tilt downward abnormally at the sides. The face is: mid-face has a sunken-in appearance, the upper jaw slopes backward, lower teeth project in front of the upper teeth. Early surgery relieves the pressure on the brain and eyes by allowing the bone plates of the skull to be detached from one another. Even in severe cases of Apert's syndrome a significant cosmetic and functional improvement is possible and a decreased risk of optic difficulties or blindness secondary to orbital hypoplasia can be achieved.

Per Paravatty et al (1999) plastic surgery procedures include release of the prematurely fused sutures; the traditional surgery involves advancing the frontal bones, correcting the bulging eyes and upper facial deformities including the retrusion or hypoplasia of the midface. Depending on the severity of Apert's syndrome and the associated congenital abnormalities, other operations such as rhinoplasty - plastic surgery of the nose, genioplasty plastic surgery of the chin, eye muscle surgery to correct strabismus or eyelid surgery to correct the abnormal downward tilt, and surgical separation of the fingers and/or toes are performed according to a staged treatment plan. To give the brain space to grow and to improve the shape of the head, the fused bones are subjected to early surgery, often when the child is six months old.

Corrections of the midface and jaws are currently not undertaken until adolescence, when all the permanent teeth are in place. It is also important to note that plastic surgery of the hand in Apert's syndrome often has to be started early, to allow the child to develop a grip.

Per the Mountain States Genetics Regional Collaborative Center's website (accessed August 11, 2007), the fingers are all separated and shaped, using skin and possibly also bone transplants.

This may enable the child to have three to five fingers on each hand. After such surgery, the child will require training under the supervision of an occupational therapist to develop grip and coordination; the Speech Language Pathologist will work on similar issues of tone and articulation related to muscle strength in the speech mechanism.

Per Sadove, Van Aalst, and Culp (2004) the plastic surgeon is involved in early repair of the cleft lip in the first few months of life and works with the dentist and orthodontist to manage appliances to close the cleft in the secondary palate. The surgeon also is involved with surgery to the hands and feet to create digits.

Regarding the secondary palate surgery, there are a number of

PEDIATRIC DENTISTRY approaches. These include the von Langenbeck repair, the VeauWardill-Kilner palatoplasty, two-flap palatoplasty, vomer flap surgery, Z-furlow (Z-plasty), and four-flap palatoplasty surgeries. It is important to note that the researchers report the discussion between two schools of thought on repair timing. One is to repair early in life to accommodate the onset of speech at 1 year of age, vs. delaying repairs to allow for maxillo-facial growth with a complete transverse facial growth at 5 years of age. The current approach stated by the researchers, is to do the soft palate repair at 0;3 to 0;6 and the secondary hard palate by 1;6 CA.

24

Cleft Lips and Palates;The Roles Of Specialists

Role of the Dentist Dental treatment is necessary in the case of Apert's syndrome.

Per Kaloust, Ishii, and Vargervik (1997) the oral cavity of these children is characterized by supernumary teeth, missing teeth, impaction and crowding, and delayed eruption. The maxilla is affected and the mandible has an abnormal shape and size.

The dentist works closely with the orthodontist to time adjustments to the oral cavity and dentition. The researchers point to two significant findings: a delay of 0.96 years vs. a normal timeline of dentition, as well as a marked slowdown in dental maturity that slows more notably with age. This means that the dentist must time their involvement with the patient along these parameters.

They will work on extraction of supernumary teeth and impaction and crowding, but the work is done at different ages as normal children. The dentist also works closely with the orthodontist and plastic surgeon to assess dentition all the while that processes are worked on for closing the alveolar ridge after age 5;0 as well as palatal closure and velopharngeal port surgeries.

Per Shipster et al (2002), there are a remarkable number of cases that present with Class III malocclusion, specifically Class III incisor relationship, anterior bite and bilateral posterior crossbite.

The degree of incisor crowding and irregularity is variable among cases. The dentist considers how difficult it is for the child to maintain good oral hygiene owing both to crowded teeth and to restrictions in fine motor skills. An electric toothbrush may be a useful aid. Frequent appointments with the dentist and/or a dental hygienist are important and, as there is an increased risk of caries, preventive fluoride treatment should be given.

school age. The purpose of this device is to bring the maxilla in alignment with the rest of the head, with consideration of the mandible and dentition in the process of the orthopedic treatment.

There is debate as to the proper timing for orthopedics and the efficacy of using extra-oral pin-retained appliances versus passive appliances. Per the researchers 54% of craniofacial centers use neonatal maxillary orthopedics.

The second process involves orthodontic treatment of the deciduous dentition stage, which the researchers state has a direct correlation with the patency of circummaxillary sutures. This occurs in the latter period of 5;0 to 7;0 years. It is significant to reiterate the research of Kaloust, Ishii, and Vargervik (1997), bearing in mind once again that there is a 0.96 year delay in dentition of Apert's vs. normal children's dentition. Treatments are needed for the lack of deciduous dentition in the area of the alveolar cleft, and these treatments may include a face mask to protract growth. Treatment to manage crossbite includes equilibration for occlusal interference.

The third process is in the mixed dentition period in the 9;0 to 11;0 years age range. This is concurrent with alveolar bone grafting, 6 months prior to graft insertion with fixed appliances placed on the maxillary arch. The researchers explain that this eliminates crossbite and other unfavorable consequences of malpositioned incisors, and helps with dental aesthetics.

Eruption of the canine adjacent to the cleft of the secondary palate is of importance as this will control the timing for further orthodontic treatment. The researchers point to evidence that the canines erupt in synchronicity with bone graft placement.

The fourth process is in the permanent dentition stage, anywhere from 10;0 to 13;0 years of age or even older. In this period there is a determination whether orthognathic surgery is indicated.

The researchers state that there is a high percentage of patients that require this surgery vs. the general population, but that it is not needed in more than 10% of the Apert's and cleft palate patients. This is particularly relavent in Apert's patients as they have a high incidence of Class III skeletal issues and thus the orthodontist carefully exams the other evidence from the craniofacial team in order to determine candidacy for treatment.

Conclusion Role of the Orthodontist Orthodontists play a significant role in the treatment of a child with Apert's syndrome. Per Kuijpers-Jagtman (2006) there are four distinct processes that the orthodontist will participate in up to and beyond the child's twelfth year of life. The orthodontist will confer with the dentist and plastic surgeon that care for a child with Apert's. This is to determine proper timing for the implementation of orthodontic treatment.

The first process begins from 0;0 to 7;0 years, after the initial treatment plan is devised with the craniofacial team. This is the period during which the orthodontist constructs neonatal maxillary orthopedics for the child ages infant through elementary DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

There is clearly a need for further and more controlled research on the disciplines involved in the craniofacial teams. There is a need for larger cohorts to gather more data specific to Apert's syndrome as this will give better evidence about treatment efficacy and treatment outcomes. The craniofacial teams should be advised to produce studies that have to do strictly with Apert's syndrome so that the body of research regarding genetics in particular so that models for future treatment can be perfected even more for the benefit of these patients.

PEDIATRIC DENTISTRY REFERENCES

26

Cleft Lips and Palates;The Roles Of Specialists

Cleft Palate Foundation (2007). About Cleft Lip and Palate. Retrieved August 13, 2007, from http://www.cleftline.org/parents/about_cleft_lip_and_palate.

Carinci, F., Pezzetti, F., Locci, P., Becchetti, E., Carls, F., Avantaggiato, A., Becchetti, A., Carinci, P., Baroni, T., & Bodo, M. (2005). Apert and Crouzon's Syndromes: Clinical Findings, Genes and Extracellular Matrix. The Journal of Craniofacial Surgery, 16(3), p. 361-368.

Children's Craniofacial Association (2007). A guide to understanding Apert's Syndrome.

Retrieved August 19, 2007, from http://www.ccakids.com/Syndrome/Apert.PDF. Kaloust, S., Ishii, K., & Vargervik, K. (1997). Dental development in Apert Syndrome. Cleft Palate-Craniofacial Journal, 34(2), p. 117-121.

Kuijpers-Jagtman, A. (2006) The orthodontist, an essential partner in CLP treatment.

B-ENT, 2(4), p. 57-62.

Mountain States Genetics Regional Collaborative Center (2007). What to Expect

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

from a Genetics Consultation. Retrieved August 11, 2007, from http://www.mostgene.org/dir/expect.htm.

Paravatty, R., Ahsan, A., Sebastian, B., Pai, K., Dayal, P. (1999). Apert syndrome: A case report with discussion of craniofacial features. Quintessence International, 30(6), p. 423-426.

Rajenderkumar, D., Bamiou, D., & Sirimanna, T. (2005). Management of hearing loss in Apert syndrome. The Journal of Laryngology and Otology, 119, p. 385-390.

Sadove, A., Van Aalst, J., & Culp, J. (2004). Cleft palate repair: art and issues.

Clinics in Plastic Surgery, 31, p. 231-241.

Shipster, C., Hearst, D., Dockrell, J., Kilby, E., & Hayward, R. (2002) Speech and language skills and cognitive functioning in children with Apert syndrome: a pilot study.

International Journal of Language and Communication Disorders. 37(3), p. 325-343.

ESTHETIC DENTISTRY

Lumineers, The easy, painless way to transform patients’ smiles.

David Silber, DMD doctor@davidsilber.com 2800 Routh Street - Suite 255 Dallas, TX 75201, USA

28 Lumineers, The easy, painless way to transform patients’ smiles.

T

he hottest craze in dentistry has been Esthetic Dentistry. It has been taught by many dentists around the world. However, it is still not a main topic in the dental school curriculum. Many continuing education programs are teaching different techniques to give the patient the same result; a beautiful smile. This result can be done with Orthodontics, Crowns, Composite Bonding or Veneers. Each of these categories has its benefits, but when it is said and done, which procedure would you like to get done.

Orthodontics has come along way. In the seventies, it was routine to extract premolars and align teeth. The use of extra oral apparatology was routinely used as an adjunct and patient compliance was very low. Today, Orthodontist use digital radiography to assist them in diagnostic and treatment planning. We even have computer programs that can predict orthodontic results, like invisalign.

Composite bonding for esthetics reasons is a good fix. However, these restorations stain easily and don’t last as long as we would like. Porcelain and Porcelain fused to metal crowns give an excellent esthetic result. However, they are far too aggressive in their preparation. Needing anywhere between 1.5-2.0 mm of sound tooth structure to place these restorations, normally that reduction is sound tooth structure. Veneers started as a conservative alternative cosmetic restoration. These porcelain restorations were minimally invasive. However, at some point, dentist started complaining of failures or bulky restorations. Porcelain manufacturers and dental technicians came up with a “conservative“ preparation that would lead to a long lasting esthetic veneer.

Hence, the prepped veneer. This preparation resembled a three quarter crown.

Dental technicians loved it, because they always say, they can give you a beautiful restoration if you give them space. So, they asked for 1.0-2.0 mm of buccal and incisal reduction. They also asked for the doctors to open the interproximal contacts. Once again, all this required the removal of solid, sound tooth structure. This DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

preparation led to some postoperative sensitivity and a weaker bond between the tooth and the veneer. Both of the above were due to exposed dentin. Instead of bonding to Enamel, now they were bonding to dentin. Dentin is a weaker bond, hence the increase in failures.

Again; dental manufacturers and technicians looked for different alternative for the esthetic treatment. Enter pressed porcelains, which can be strong and thin at the same time. Lumineers, which are made of Cerinate pressed porcelain, can be as thin as 0.3 - 0.5mm. At this thickness, it maintains beauty and strength.

There are many dental laboratories that promote minimal preparation or no preparation veneers. However, you must read the guidelines; many require some sort of tooth alterations.

Lumineers is the only no preparation porcelain veneer that has studies showing its longevity.

With the advent of the internet, patients are becoming more educated and asking wiser questions. They want to know that they have options when selecting an esthetic restoration. If the doctor doesn’t give them options they will find one that does.

Case in point, patient MT had been to a handful of dentist to correct the irregularities that he notices on his incisal edges. He claims that nobody has given him options. One doctor offered composite bonding, another ortho the other offered veneers.

The complimentary smile consultation is done in our treatment plan room, where the patient has no dental distractions. The patient’s smile consultation begins with him filling out Denmat’s smile evaluation. It gives the patient the opportunity to state what he likes about his smile and what he doesn’t like. This is a good conversation piece. I tell him about his options; he opted for Lumineers because he was a minimal preparation candidate.

The thought of shots and the sound of the drill were not his favorite. They always want to know if they are candidates for the no preparation procedure.

To determine if the patient is a candidate for no preparation

ESTHETIC DENTISTRY

30 Lumineers, The easy, painless way to transform patients’ smiles.

Before

Lumineers we go to the dental chair. There I do a quick evaluation to see if I can deliver what they WANT and how I can do it. They must understand that they have options, so now I educate. They are told that they can correct their smile by the use of orthodontics, Porcelain fused to metal crowns, all porcelain crowns, veneers and Lumineers. I make sure they understand each one, making them more educated and once they decide they have really had informed consent of the procedure.

At this juncture the patient has made the decision for WANTING Lumineers. He wants to know what would be the steps required for the procedure. I make sure they understand that they need a full set of radiographs, complete oral exam and an oral prophylaxis.

This is done to ensure the predictability of Lumineers; absence of decay and disease. No surprises in the near future. At this point, I am looking for a solid foundation; absence of decay and disease. All periodontal, functional and restorative issues should be taken care of, prior to any esthetic treatment.

If you have not done many Lumineers smile makeovers and are unsure if the case is a preparation case or no preparation case, you may simply take alginate study models and ship them to the studio for evaluation. If there are no modifications to be done, you will receive your models with a note stating that, where all that is left is a good final PVS impression. If some work is to be done, they will return your model with another model and red lines showing you were to make the modification. You can also ask for a prep guide, where they can actually show you where to make those modifications.

The final impression, from which the Lumineers would be made, was then created with Lumineers Impressions (Den-Mat Holdings, LLC). This Polyvinylsiloxane material reproduces margins with great accuracy. This is especially important for no-prep veneers that are placed supragingivally. The patient then left the practice with my favorite anterior provisionals – his own teeth.

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

Two weeks later, he returned for the Lumineers placement.

However, before we brought him into the operatory, we verified that the Lumineers had been etched by the Cerinate Smile Design Studios. We then treated the inner surface of the Lumineers with Porcelain Conditioner (Den-Mat) for 30 seconds, rinsed and air-dried. This citric acid conditioner prepares the porcelain for the silane. Applied next, Cerinate Prime (Den-Mat) was left on for 30 seconds and air-dried. The surface of the Lumineers looked glossy as a result of this layer of lightcure unfilled resin. Since the Lumineers porcelain veneers were now ready for placement, each was gently placed back in the original box to shade them from the light. Finally, I carefully considered the surfaces I was planning to bond to (enamel and cementum) and arranged to have all the necessary materials readily available.

In order to do the try in procedure we must clean all the teeth that we are going to bond to. This is done by using denmat’s porcelain polishing paste on a dialite cup, this will remove all the organic materials that lie on top of the tooth, thus maximizing our bond. Next we will do our try in procedure. The try in is done for the patient’s final shade selection. We know patients want WHITE, MONOCHROMATIC teeth. I do the try in to satisfy the patients intrigue for, “Did I pick the right color?”

For the try in procedure, I use denmats Ultrabond try in paste.

This try in paste has the same shade characteristics as the actual ultrabond Plus, resin cement. However, it has no curing characteristics. I Place Ultrabond try in paste in both central incisors. I use two different shades; A-1, the same as the lumineers and B-O. I now give the patient a mirror and allow him to pick which shade he prefers. He picks shade B-O. We now clean the teeth and Lumineers with a dry cotton applicator and apply tenure s to the Lumineers. This step reactivates your bond. We must keep the Lumineers clear of any contaminants and away from any light because Tenure S Is a light cured bond enhancer.

Finally you can achieve a twofold long-lasting high-strength bond in

one step to tooth

structure AND to aesthetic restorations, especially zirconium.

Resin luting re-defined: new

G-CEM Automix from GC. Use G-CEM Automix and enjoy: - one step mixing – the work is done for you - one step application – direct delivery, even in the root canal - one step cleanup – precise removal of all excess With an ideal setting time and the reliable results you’ve come to expect from GC.

GC EUROPE N.V. Head Office Tel. +32.16.74.10.00 info@gceurope.com www.gceurope.com

32 Lumineers, The easy, painless way to transform patients’ smiles.

ESTHETIC DENTISTRY

After

We are now ready to start preparing our intraoral surfaces. First we apply paint-on dental dam, to protect the palatal surface from any excess resins during the procedure. This makes the clean up and finishing much faster. All the surface that are covered with the paint-on dental dam will be as clean as when we started, therefore we like to cover the occlusal surfaces, to protect them from any excess resin or Ultrabond. At this point we clean all the teeth that are to be bonded to with porcelain polishing paste on a dialite cup, to ensure the cleanest possible surface to bond.

Now, we are ready to prepare the teeth for bonding, I recommend the total etch technique. I use denmat’s etch and seal for 10 seconds and rinse for 20. Then apply 5 coats of tenure A/B to all the surface that you have etched. I use the low speed suction on the lingual surfaces of the teeth to create a glossy surface. By using the suction, this evaporates the acetone carrier leaving a stronger base for bonding. If you air dry, you will remove all the resin from the surface that you prepared. Proceed to add a coat of Tenure S to all the teeth that have been prepared. At this point I have just re-activated the bond, so I must keep the teeth clean and avoid any moisture. Now the entire DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

surfaces are ready for bonding.

I began the actual placement of the Lumineers by loading each Lumineer with Ultrabond Plus, shade B-O and transporting them to the corresponding tooth. Our practice has recently begun using the LUMIgrip, which greatly simplifies the process of transferring veneers. It utilizes suctioning forces to hold the veneers and I can easily grasp the handle from my assistant.

The excess cement was cleaned off with Tenure S. I took special care to wipe the brush towards the gingival margin to prevent the removal of too much cement and the unintentional creation of a void. The Lumineers were tacked into place using the Sapphire Supreme Plasma Arc Light with a 2mm tip for two seconds. With the Lumineers firmly in place, I returned with the Tenure S to remove extruded cement without the fear of dislodging the veneers. The final cure was completed with the Sapphire light’s 9mm collimating tip. With this high intensity plasma arc light, I was able to cure each veneer for only five seconds, thereby curing all 10 Lumineers in less than a minute.

ESTHETIC DENTISTRY The finishing technique for Lumineers is markedly different from that of standard veneers. We are used to modifying the teeth for traditional veneers and with Lumineers we don’t remove much tooth structure. We must tell our patients that we are going to use the drill to clean and polish the margins and make the Lumineers look good, we will be polishing and adjusting the bite on the teeth. They must understand that even though you are using the drill you are not doing any excessive tooth removal; just cleaning and polishing. The clinician should also understand this, as this is the major difference between prepping and Lumineers. Traditional veneers have a subgingival margin that is finished by the ceramist.

The best of two worlds.

Identium. ®

Polyether

A-Silicone

After placement, the clinician must only clean up the resin cement. With Lumineers, the clinician creates a supragingival margin chairside. The Cerinate porcelain and cement is smoothed to the tooth to create a stress-resistant, nonmicroleaking margin. The finishing was accomplished with the carbide and diamond burs in the Lumineers Finishing Kit (Den-Mat).

These burs were used with a high-speed handpiece and a lot of water. Any cement still remaining was removed with a 12-fluted flame-shaped bur and a Schure 349 instrument.

A medium grain needle bur was used to the slight porcelain ledge at the gingival margin. This was further smoothed with an extra-fine needle diamond to create a seamless emergence profile.

I defined the interproximal margins with the ‘mosquito’ bur.

Occlusion was checked with articulating paper. Slight adjustments were made using the American football-shaped bur where the opposing dentition contacted the porcelain.

The interproximal contacts were opened by gently rocking a CeriSaw (Den-Mat) between the teeth. These were then smoothed with the CeriSander (Den-Mat).

Four days later, he returned for the final finish. The interproximal contacts were verified and smoothed. I also reviewed the look of the porcelain and further defined a few areas with the interproximal ‘mosquito’ diamond. I again verified the occlusion. Satisfied with the final result, I polished the restorations with Porcelain Polishing Paste in a polishing cup.

020819_2209

Identium® VSXE®

Utilizing the best characteristics of two well-known impression materials, Kettenbach has developed an entirely new one: Vinylsiloxanether® (VSXE®). Designed especially for the one-step impression technique: Identium.® www.kettenbach.com

If you are considering doing more cosmetic dentistry and hate removing healthy tooth structure to place porcelain, consider this; patients want to have a beautiful smile but many would rather avoid a painful dental experience. The minimally-invasive dentistry that the Lumineers system makes possible gives these patients the smile makeovers they have dreamed of. He is thrilled with his new smile and greatly appreciative that I did not hurt him. Most important of all I have made another friend who admires me for the procedure that I painlessly performed.

ENDODONTIC DENTISTRY

Endodontic Surgery Versus Retreatment: Assessing Options in Treatment Planning Decisions Richard E. Mounce, DDS Lineker@comcast.net Vancouver, WA, USA

36 Endodontic Surgery Versus Retreatment

T

here is confusion amongst many clinicians regarding which failed clinical endodontic cases should be retreated and which may need endodontic surgery.

ES carried out on a tooth that should ideally have OR (or vice versa) has a direct impact on the long-term success of treatment. For either of these treatments to have clinical success, they must be carried out with the correct indications and avoided where contraindicated. Several important treatment planning principles that should be considered when choosing between these two options are provided below:

assumed to be harbored periapically, retreatment is unfeasible or restricted, or a retreatment attempt has failed…retreatment offers a greater benefit-a better ability to eliminate …root canal infection with minimal invasion…smaller risk, significantly less post operative discomfort and a lesser chance of injuring nerves, sinuses or other structures…Case selection is based on considerations that either preclude retreatment or restrict its feasibility in a way that decreases the potential benefits and increases the potential risks…” Ref 5.

“Endodontic surgery is the answer when a condition can be corrected, repaired and remedied only by gaining access to the problem surgically. Few circumstances can be called outright endodontic surgical indications. However conservative treatment plans meet with difficulties and frustrations that defy conventional methods of therapy…the only difference between surgery and conventional therapy is the approach; the principles of cleaning, shaping, sterilizing, filing and sealing the canal are the same.

In Endodontic surgery, these procedures are simply conducted at the end of the root instead of through the crown.” Ref. 1.

Endodontic surgery (ES) and orthograde retreatment (OR) are very different treatment modalities. Each has its own technical difficulty, risk factors, degree of invasiveness, prognosis, expected outcome for the patient and each requires a different and unique set of equipment and skills. This said, the needed clinical examination and decision making required for ES or OR are very similar irrespective of the final treatment rendered. Such universal treatment planning considerations should include, at a minimum:

“A surgical approach is only indicated when it is agreed that orthograde retreatment is either not possible or will not solve the problem.” Ref. 2.

“Retreatment is usually initiated if the original treatment appears inadequate, if the initial treatment has failed, or if microorganisms from the oral environment have contaminated the root canal.” Ref. 3. |“Management of these "failed" cases is a challenge to the clinician, at the levels of diagnosis, case selection, communication and decision, and that is even before techniques are considered.” Ref. 4. “ …surgery is a compromise unless the microorganisms are DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

1) All of the various indications and contraindications for either treatment should be mentally taken into account given the clinical situation at hand.

2) The medical and dental history of the patient and the presence of coronal leakage and/or the quality of the existing coronal seal.* 3) Root length 4) Periodontal status including bone height, tissue contours and health, probings, etc 5) The bone anatomy including the external oblique ridge, sinus and root proximity.

6) Post presence and type.

7) Presence of a paste root canal filling and/or warm gutta percha carrier based device.

8) The tooth's strategic value, restorability, and expected functionality after treatment.

9) Proximity of vital structures (nerve bundles, arteries, etc).

ENDODONTIC DENTISTRY 10) Previous endodontic and surgical history of the tooth. *As a full time endodontist, it is commonplace to observe overt coronal leakage under crowns. Empirically, in my practice, 99.9% of the restorations accessed for endodontic treatment show such leakage in the form of unset restoratives, purulence, caries, voids, and moisture. Interestingly, these findings are ubiquitous in teeth that appear to have acceptable restorations both clinically and radiographically. In addition, these findings are common where the patient is asymptomatic.

ES includes a number of procedures in addition to root resection and root end filling, these include: 1) biopsy 2) root amputation 3) hemisection 4) perforation repair 5) trephination 6) apical curettage almost always coincident with a biopsy 7) intentional replantation 8) attainment of surgical drainage

38 Endodontic Surgery Versus Retreatment

It is noteworthy that several of these procedures may be carried out at the same time on the same tooth depending on the clinical indication.

The indications for ES (in the presence of a periapical lesion and/or symptoms which have developed subsequent to root canal treatment or retreatment) include: 1) apical blockage 2) iatrogenic apical events including severe transportation, perforation, canal zipping 3) non negotiable calcified canals 4) severe extrusion of filling materials 5) establishment of drainage through trephination 6) patient convenience 7) saving costly restorations where previous root canal therapy has failed but has already been retreated. In such cases, the clinician must be sure that the coronal seal is intact. In essence, disassembly is unwarranted.

8) Retreatment is not possible, for example, the previous filling materials cannot be removed despite the best attempt of the clinician. Such materials might include unremovable silver points, pastes, and warm carrier based devices.

9) Irretrievable posts or posts whose removal would risk iatrogenic outcomes 10) Iatrogenic outcomes such as separated files or metallic objects which despite all efforts resist removal and whose removal is predictable and indicated by root resection and root end filling procedures.

11) Anatomy that cannot be addressed by typical means of cleaning, shaping and obturation. For example, a blunderbuss DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

canal, depending on the clinical indication might be better treated by orthograde treatment and surgical means to provide a predictable apical seal.

12) Resorptive defects that cannot be managed through orthograde endodontic therapy.

13) Biopsy 14) Exploratory surgery that is carried out for diagnostic reasons or teeth that remain symptomatic despite what appears to be adequate treatment 15) Clinical cases where teeth have had endodontic therapy and/or retreatment and either symptoms or evidence of long term radiographic healing are not evident.

Contraindications to ES include the following: 1) Medical conditions including significant disease states such uncontrolled diabetes, heart disease, clotting abnormalities, amongst others.

2) Individuals who are poor behavioral candidates for surgery.

Such patients might be considered for ES with IV sedation or other sedative means.

3) Surgical inexperience on the part of the clinician 4) Lack of equipment and needed materials to carry out the surgery out to the highest level of care.

5) Teeth that can be retreated predictably should be retreated.

ES should never be used as a cover for poor quality orthograde first time endodontic therapy.

Common contraindications to both Endodontic Surgery and Orthograde Retreatment Treating teeth with either modality that are unrestorable should be avoided at all costs. It is noteworthy that the clinical dogma and beliefs of what constitutes restorability is highly variable amongst different clinicians. In any event, the clinician should be absolutely certain that the proposed treatment will give the patient the best possible chance to retain the tooth after either ES or OR. It is incumbent on the clinician to determine if the anticipated procedure will leave the tooth with the needed crown/root ratio and resistance to vertical fracture to function in the intended manner after the treatment. Such an approach can go far to prevent vertical fracture as well as subsequent loss of function. If the comprehensive picture of the long-term clinical case is considered, it may be better, in the particular situation to remove the tooth and place an implant.

Indications for OR include teeth that: 1) Show evidence of coronal microleakage.

2) Show evidence of a lesion of endodontic origin where one was not previously evident.

3) Show evidence of a lesion of endodontic origin that has not resolved after a period in which it predictably should have (1248 months).

4) Are symptomatic to one degree or another or have symptoms

ENDODONTIC DENTISTRY that are growing more acute in nature after a suitable period of observation. In addition, a tooth that has developed symptoms where symptoms were not initially evident before is a strong sign that treatment is failing and retreatment should be considered.

5) Show evidence of a chronic sinus stoma where one was not evident before.

6) Show evidence of swelling where it was not evident before.

7) If there is any evidence of coronal leakage with bacterial contamination of the obturation and the tooth is treatment planned for a new coronal restoration, especially if the new restoration will be a bridge or a tooth of high strategic value.

8) Clinical cases where, even if the tooth is asymptotic and does not show evidence of failure, the long-term success of the case is not predictable based on the evidence. These factors include singularly or in combination the following: missed canals, calcified or otherwise, ledges which can be bypassed, separated files and metal objects which can be removed of all types, and perforations which can be repaired with OR procedures.

40 Endodontic Surgery Versus Retreatment

Endodontic healing, like success and failure, is not always clear-cut.

For example, a tooth may appear to be well sealed, asymptomatic, radiographically within normal limits and yet be filled far short of the apex. In such clinical cases, it is advisable to watch and observe such teeth for evidence of continued long term healing.

Another interesting diagnostic dilemma is the tooth that initially has a lesion of endodontic origin and which resolves to some degree but which does not resolve entirely despite what should

be an adequate period of time for its healing. It is a matter of clinical opinion what is the optimal treatment in such cases.

The indications and contraindications for endodontic surgery and orthograde retreatment have been reviewed. Emphasis has been placed on a comprehensive analysis of the clinical case prior to starting either OR or ES. The skill of the clinician blended with performing treatment where indicated on restorable teeth is predictive of long-term clinical success. I welcome your feedback.

Figure 1-2A-B: Cases that were retreated using the Twisted File* and RealSeal* bonded obturation material. Treatment strategies in all cases were designed to disassemble the previous treatment, remove the gutta percha, achieve patency and create a coronal and apical seal. *SybronEndo, Orange, CA, USA Dr. Mounce lectures globally and is widely published. He is in private practice in Endodontics in Vancouver, WA, USA.

REFERENCES 1: Practical Lessons in Endodontic Surgery, Quintessence Books, 1998, p. 3.

2: A Clinical guide to Endodontics, BDJ Books, 2003, p. 83.

3: Color Atlas of Endodontics, WB Saunders Company, 2002, p. 117 4: Aust Endod J. 2000 Dec; 26(3): 104-9. Friedman S. 5: Shimon Friedman, Chapter 20, p. 346-347, Orthograde Retreatment “Principles and Practice of Endodontics”, 3rd ed. 2002

Fig. 1A

Fig. 1B

Fig. 2A

Fig. 2B

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

In 44 controlled clinical studies in more than 100 publications including 58 scientific posters and 56 scientific articles1…

There’s one thing to remember…

Provides 12-hour antibacterial action2 – helps prevent bacterial plaque formation that may lead to gingivitis3,4

Clinically proven to reduce gingival inflammation in long term clinical trials5

Up to 98% More Plaque Reduction; Up to 88% More Gingivitis Reduction¨

50% Reduction in Gingival Inflammation at 24 Months¨

% Reduction Compared With Control

Gingival Inflammation Index

Only Colgate Total® with triclosan is proven to provide antibacterial protection and fight gingival inflammation.

-10 -20 -30 -40 -50 -60 -70 -80 -90 -100

Plaque

Gingivitis

1.6 1.4

Control

1.2 1.0 0.8 0.6

Colgate Total®

0.4 0.2 0.0 Baseline

6 Months

12 Months 18 Months 24 Months

Gingival Inflammation

No other toothpaste can provide the antibacterial and anti-inflammatory protection of Colgate Total®.

Gingivitis.

Reduction in severity index vs. ordinary toothpaste.

† §

1

Data on file. Piscataway, NJ; Colgate-Palmolive Technology Centre. 2Amornchat C, et al. Mahidol Dental Journal. 2004;24:103–11.

3 Volpe AR, et al. J Clin Dent. 1996;7(suppl):S1–S14. 4Davies R, et al. J Clin Periodontol. 2004;31:1029–1033.

5 Kerdvongbundit V, et al. J Clin Periodontol. 2003;30:1024–1030.

© 2007 Colgate-Palmolive Company. All rights reserved.

12-hour Antibacterial Protection Plus Fights Gingival Inflammation.†

§eƒ°V Òæe Qƒ°ùahÈdG ™e á∏HÉ≤e

44

§eƒ°V Òæe Qƒ°ùahÈdG ™e á∏HÉ≤e

¤EG Ωƒ˘«˘dG ™˘∏˘£˘à˘fh .¢SQGóŸG ‘ ɢ¡˘≤˘M ¿É˘æ˘°SC’Gh º˘Ø˘dG á˘˘ë˘ °U ¤EG ∫É≤àfE’G πÑb ,Éæ›ÉfÈH á«fÉ› ∞°üædG ¢SQGóŸG á«£¨J .á°UÉÿG ¢SQGóŸG 12 `dG ôªY ájɨd 3`dG ¿hO Ée ¢Sƒ°ùJ ∫ó©e ¤EG ≈©°ùf øëf á£ÿG AÉ¡àfG ™e ±ó¡fh ,5^72 ∫ó©e ‘ øëf kÉ«dÉM .áæ°S ≥≤ëf ¿G πeCÉfh .3`dG ¿hO Ée ¤EG 2010`dG ‘ …G ,á«°ùªÿG øe ó◊G ‘ ájÉ¡ædG ‘ íéææ°S ÉæfG ≈∏Y ∫óJ QOGƒÑdG πμa .∂dP .á«dÉ©dG á«dÉ«ÿG áÑ°ùædG √òg ‘ ¿É˘æ˘ °SC’G Aɢ˘Ñ˘ WCG ¿CG iQCG :§˘˘eƒ˘˘°V Òæ˘˘e Qƒ˘˘°ùahÈdG ±É˘˘°VCG ´QR ∫É› ‘ ¿É˘˘c ¿EG ,π˘˘Fɢ˘°Sƒ˘˘dG π˘˘°†aCɢ H ¿hõ˘˘¡› ¿É˘˘ æ˘ ˘Ñ˘ ˘d π°†aCG ¢†jôŸG »£©æa ,áMGô÷G hCG Ö°ü©dG á÷É©e hCG ¿Éæ°SC’G π˘g’G QGô˘°UG á˘jɢbƒ˘˘∏˘ d »˘˘°Sɢ˘°S’G π˘˘eɢ˘©˘ dG ɢ˘eCG .êÓ˘˘©˘ dG ¥ô˘˘W ‘ º¡e ɪgQhO q¿CG PG ,¿Éæ°S’ÉH AÉæàY’G ≈∏Y á°SQóŸGh ᫪gGh ¿Éæ°S’G Ö«ÑW QhO »°SÉæJ øμÁ ’h .ÖdÉ£dG á«YƒJ .á∏FÉY πμd √OƒLh ᫪gCG øY åjó◊G á°Uôa ÉæFÉ£YE’ Dental News ôμ°ûf øëfh ƒYóf ɪc ,¿Éæ°SC’Gh ºØdG áë°üd »æWƒdG èeÉfÈdG øYh ájÉbƒdG .IóYÉ°ùª∏d á«ŸÉ©dG äɪ¶æŸGh ,kÉ«FÉbh ÌcCG πYÉØà∏d AÓeõdG

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

≈˘∏˘Y ó˘jGQƒ˘«˘∏˘Ø˘dG ɢæ˘∏˘NOCG ,á˘ã˘dɢ˘ã˘ dG ᢢ∏˘ MôŸG ‘h ,á˘˘æ˘ °ùdG √ò˘˘g ¿hó«Øà°ùj ò«ª∏J 30000 :¿ÉæÑd ‘ É¡©«ªL ᫪°SôdG ¢SQGóŸG ò«ª∏àdG Ohõ«a .á°†ª°†ŸG ∫ÓN øe ójGQƒjƒ∏ØdG ∫ƒ∏fi øe q 10 `H kÉ«YƒÑ°SCG Iôe (äGƒæ°S) 9-7 »°SÉ°SCG ™HGôdG ∞°üdG ≈àM Gòg ,%0^2 áÑ°ùæH õcôe ,ójGQƒjƒ∏a ΩƒjOƒ°ùdG ∫ƒ∏fi øe πe á˘Ñ˘°ùf ¢VÉ˘Ø˘î˘fG á˘jô˘ª˘©˘dG á˘ë˘jô˘˘°ûdG √ò˘˘¡˘ d ø˘˘eDƒ˘ «˘ °S ´hô˘˘°ûŸG áë°ü∏d á«ŸÉ©dG ᪶æŸG ¿CG ó«÷Gh %50 ¤EG %40 ¢Sƒ°ùàdG .äGƒæ°S çÓãd á°†ª°†ŸG ´hô°ûe âªYO :πeGƒY IóY ¤EG Oƒ©j á«ë°U á≤jô£H á«FÉbƒdG Ö«dÉ°SC’G ≥«Ñ£J CGóÑJh ,IOQGh ¿Éæ°SC’Gh ºØdG ¢VGôeCG øe ájÉbƒdG ¿CG πgC’G ´ÉæàbEG ,ájÉbƒdG ´ƒ°Vƒe ¢ù°ù– É¡«∏Y ÖLƒàj »àdG πeÉ◊G ICGôŸG óæY AGô˘L π˘°üë˘j …ò˘dG ±õ˘æ˘dG á˘HQÉÙ kG󢫢L ɢ¡˘fÉ˘æ˘°SCG ∞˘«˘ ¶˘ æ˘ Jh .πª◊G ÖÑ°ùj Lactose `dG ¿CG PEG ,ΩƒædG πÑb Ö«∏◊G ódƒdG AÉ£YEG ÖæŒ ≈àM ¬àÑbGôeh ¿Éæ°SC’G ¢ûjô˘Ø˘J á˘q«˘Ø˘«˘c ¬˘ª˘«˘∏˘©˘J ™˘e ,¢Sƒ˘°ùà˘dG ™e ¿Éæ°S’G ¿ƒé©e Ö°SÉæàj ¿G kGóL º¡ŸG øeh .äGƒæ°S â°ùdG .ódƒdG ôªY ¬ª«ª©àdh ,πgC’G iód kGóL ∫ƒéN πμ°ûH OƒLƒe Ωƒ¡ØŸG Gòg IóFÉa ≈∏Y ó«cCÉà∏dh ,É¡©«ªL ΩÓYE’G πFÉ°Sh ∫ɪ©à°SG Éæ«∏Y .êÓ©dG πÑb ájÉbƒdG Ö«˘Ñ˘W π˘Nó˘J GC ô˘£˘ j ,á˘˘æ˘ °S 12h 6 `dG ÚH ᢢ≤˘ M’ ᢢ∏˘ Mô˘˘e ‘h …Qƒ∏ØdG ΩÓ¡dG ™°†jh ¥ƒ≤°ûdGh ÖjRÉ«ŸG ºàîj …òdG ¿Éæ°SC’G Éà √É°VôŸ É¡jó°ùj »àdG íFÉ°üædG ¤EG káaÉ°VEG ,¢Sƒ°ùàdG ™æŸ ,∑ÓÑ∏d áØ°TÉμdG OGƒŸG ∫ɪ©à°SGh ,¿Éæ°SC’G ¢ûjôØàH ¢üàîj .’ ΩCG ᪫∏°S á≤jô£H ¬fÉæ°SG ∞¶æj ódƒdG ¿Éc GPEG Ée øgÈJ »àdG ∫ó©e ¿C’ ,…hÉ°SCÉe ¿ÉæÑd ‘ ™°VƒdG q¿CG ¤G IQÉ°T’G Qóéj ∫ó©e ƒg Gògh 5^72 ƒg áæ°S 12 `dG ôª©d ÉfóæY ¢Sƒ°ùàdG á˘ª˘¶˘æŸG Ö°ùë˘H ƒ˘gh ᢫˘°ûÙGh IOƒ˘≤˘ ØŸG ,Iô˘˘î˘ æ˘ dG ¿É˘˘æ˘ °SC’G ™«ª÷ k’ó©e â©°Vh É¡fCG å«M ,kGóL ™ØJôe áë°ü∏d á«ŸÉ©dG .3 `dG ¿hO Ée ¿Gó∏ÑdG ,»˘ë˘°üdG Oɢ°TQE’Gh ᢫˘Yƒ˘à˘dG Üɢ«˘Z :»˘g ᢫˘°Sɢ°SC’G ÜÉ˘Ñ˘°SC’Gh ô˘cÉ˘μ˘°ùdGh äɢjƒ˘∏◊G π˘cCG ≈˘∏˘Y õ˘cô˘J »˘à˘dG ᢫˘FGò˘¨˘dG ᢢª˘ ¶˘ fC’G øe ÒãμdG »£©J »àdG ,OGƒg ¿hO ¿Éæ°SC’ÉH á≤°UÓdG äÉjƒ∏◊Gh ™æà πgC’G ≈∏Y kɪFGO ¥É«°ùdG Gòg ‘ ìÎ≤fh .Lactic acid `dG ‘ ¿Éæ°SC’G ¢ûjôØJ ≈∏Y õcôfh kAÉ°ùe á©HGôdG ó©H äÉjƒ∏◊G πcCG .ìÉÑ°üdGh AÉ°ùŸG áë°üd »æWƒdG èeÉfÈdG ƒg Ωƒ«dG á≤Ñ£ŸG èeGÈdG ºgCG øeh πc ‘ ᫪°SQ á°SQóe 1200 ‘ ¬H πª©oj …òdG ¿Éæ°SC’Gh ºØdG ≈˘à˘M ᢰVhô˘dG á˘∏˘Mô˘e ø˘e ò˘«˘ª˘∏˘J 250000 »˘˘£˘ ¨˘ jh ¿É˘˘æ˘ Ñ˘ d √ƒæ˘fh .á˘ã˘dɢã˘dG á˘∏˘MôŸG ‘ Ωƒ˘«˘dG í˘Ñ˘°UCG è˘eɢfÈdG .…ƒfÉãdG á«HÎdG ôjRhh áØ«∏N OGƒL óªfi ≥HÉ°ùdG áë°üdG ôjRh Oƒ¡éH É«£YCGh kɪ¡e kÉjƒæ©e kɪYO Éeób ¿Gò∏dG ÊÉÑb ódÉN ≥HÉ°ùdG

§eƒ°V Òæe Qƒ°ùahÈdG ™e á∏HÉ≤e IÉ«M ‘ á«°SÉ°S’G πeGƒ©dG øe ¿Éæ°S’Gh ºØdG áë°U øWGƒŸG á«YƒJ á«Ø«c ¢SQO Gk óL …Qhô°†dG øeh .OôØdG áÑ°ùæH IóLGƒàŸG ¿Éæ°S’G ¢Sƒ°ùJ á∏μ°ûe ºbÉØJ øe óë∏d ¤G ¿ÉæÑd ‘ ¿ƒ«FÉ°üN’G π°UƒJ ∂dòd .ÉfOÓH ‘ á«dÉY ò«eÓàdG á«Yƒàd πeÉμàe »°SQóe èeÉfôH áeÉbEÉH πq M .óYGƒdG πÑ≤à°ùŸG ºg øjòdG øY π㇠º°†J ,¿Éæ°SC’Gh ºØdG áë°üd á«æWƒdG áÄ«¡dG AÉÑWCG áHÉ≤f øY πã‡h ¿ÉæÑd ‘ ¿Éæ°SC’G AÉÑWCG áHÉ≤f øY π㇠,áë°üdG IQGRh øY π㇠,∫ɪ°ûdG ‘ ¿Éæ°SC’G ,᢫ŸÉ˘©˘dG á˘ë˘°üdG á˘ª˘¶˘æ˘˘e ø˘˘Y π˘˘ã‡ ,ᢢ«˘˘HÎdG IQGRh .á«eƒμ◊G ÒZ äÉÄ«¡dG øY Ú∏ã‡h

§eƒ°V Òæe Qƒ°ùahÈdG ™e á∏HÉ≤e

‘ ¿Éæ°S’Gh ºØdG áë°üd »°SQóŸG èeÉfÈdG øY QÉ°ùØà°SÓdh á˘ª˘¶˘æ˘e ió˘d ÒÑÿG ,§˘eƒ˘°V Òæ˘e Qƒ˘°ùahÈdG ɢfô˘°ûà˘°SG ,¿É˘æ˘ Ñ˘ d Ωɢb √Qhó˘H …ò˘dGh ,¿É˘æ˘°S’Gh º˘˘Ø˘ dG ¢VGô˘˘eC’ ᢢ«ŸÉ˘˘©˘ dG á˘˘ë˘ °üdG á«YƒàH ¿Éæ°S’Gh ºØ˘dG á˘ë˘°üd ᢫˘æ˘Wƒ˘dG á˘Ä˘«˘¡˘dG QhO Ò°ùØ˘˘à˘ ˘H :´ƒ°VƒŸG Gòg ‘ …ƒæ©ŸGh …OÉŸG ºYódGh ™ªàÛG ,§eƒ°V Qƒ°ùahÈdG ∫ƒ≤j ,¿ÉæÑd ‘ ¿Éæ°S’G ¢Sƒ°ùJ á∏μ°ûe ¿EG øe ÌcCG ᫪°SôdG ¢SQGóŸG ‘ kGÒãc áªbÉØàeh kGóL á«dÉY É¡àÑ°ùf ÉeG .…OÉŸG iƒà°ùŸG ‘ ¥ôØdG ¤EG Oƒ©j Gògh á°UÉÿG ¢SQGóŸG á«YƒàdG ÜÉ«¨d ∂dPh ¥QÉa øe ɪa ,ájÉbƒdG ¥ôW ¤EG áÑ°ùædÉH Ö«∏◊G ¿Éæ°SCG ¤EG ¿ƒªà¡j ’ øjòdG πgC’G iód »ë°üdG OÉ°TQE’Gh .AGô≤a ΩCG AÉ«æZCG GƒfÉc ¿EG ¬°ùØf Ωƒ¡ØŸÉa .™≤à°S ÉgQÉÑàYÉH

45

ÉæfCG Éà ,±GógC’G ójóëàH á∏μ°ûŸG √òg ™e º∏©dG ‘ Éæ«WÉ©J óbh ¤EG π˘≤˘à˘æ˘fh ,k’hCG ᢫˘ª˘°Sô˘dG ¢SQGóŸÉ˘H º˘à˘¡˘æ˘°S ,᢫˘æ˘Wh ᢫˘©˘ ª˘ L ‘ ÈcCG ¢Sƒ°ùàdG áÑ°ùf ¿CG kÉ°Uƒ°üN ,á≤M’ á∏Môe ‘ á°UÉÿG ≈£Z ìhô£ŸG èeÉfÈdGh .á°UÉÿG ‘ É¡æe ᫪°SôdG ¢SQGóŸG .áaÉc QɪYC’Gh ±ƒØ°üdG ᪶æŸG É¡dhCG ,±GôWCG IóY øe AÉL ,…OÉŸG ´hô°ûŸG Gòg ºYO É¡H Éæªb »àdG äGQhódG É¡ªYO ∫ÓN øe ºØdG áë°üd á«ŸÉ©dG á«ë«°ùŸG á«©ª÷G πÑb øe AÉL ¬°ùØf ºYódGh .á«Ø«≤ãàdG OGƒŸGh ,áeÉ©dG áë°üdG á«∏c - óæª∏ÑdG á©eÉL ,á«dhódG á«°ùchOƒKQC’G øeh ,UNIFIL `dG øe kÉ°†jCG ,USDA `dG ,á«cÒeC’G áYGQõdG IQGRh .á«fÉæÑ∏dG áë°üdG IQGRh ,∑ÓÑdG ,âbƒdG πeÉY :»gh ¢Sƒ°ùàdG π°üë«d ™ªàŒ πeGƒY á©HQCG √òg ióMEG ≈∏Y Iô£«°ùdG Éæ©£à°SG GPEÉa .¿Éæ°SC’G á«Yƒfh ,ΩÉ©£dG .∞˘∏˘μ˘e ÒZ ´ƒ˘°VƒŸGh .¢Sƒ°ùàdG ≈∏˘Y ∂dò˘H ô˘£˘«˘°ùf ,π˘eGƒ˘©˘dG ¢Sƒ˘°ùà˘∏˘d ÖÑ˘°ùŸG AGò˘¨˘dG á˘Ñ˘bGô˘eh …ƒ˘ª˘Ø˘dG »˘ë˘°üdG ∞˘«˘≤˘ã˘à˘dɢa á∏Môe ‘ ’G π°üëj ød ÉÃQh ¢Sƒ°ùàdG ôNDƒ«°S ,πcC’G á«Yƒfh .ôª©dG øe áeó≤àe …QhódG ∞°ûμdG èeÉfÈdG ¤G ÉæØ°VCG ,¢Sƒ°ùàdG ≈∏Y Iô£«°ùdG ó©H ‘h ¿ÉæÑd ‘ ¿Éæ°SC’G áHÉ≤f ™e ¿hÉ©àdÉH ¿Éæ°SC’Gh ºØdG ≈∏Y Gƒ©°†Nh ,Ö«ÑW 450 ‹GƒM á∏ª◊G ‘ ∑QÉ°ûa .‹Éª°ûdG ¿ÉæÑd ¿Éæ°SCG ≈∏Y ∞˘°ûμ˘∏˘d Ió˘MƒŸG IQɢª˘à˘°SE’G á˘Ä˘Ñ˘©˘J ᢫˘Ø˘«˘μ˘d ,IQhó˘d áë°üH ΩɪàgE’G ≈∏Y ºgõ«Ø– ™e πgC’G ¤EG É¡ª«∏°ùJh ,ò«eÓàdG .¿Éæ°SC’Gh ºØdG

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

ADVERTORIAL

TEBODONT®: Successful against oral microorganisms The essential oil of the australian tea tree (Melaleuca Alternifolia) is more and more used in oral hygiene with a remarkable success. In the Medical Dental Clinic of Bethanien (Professor Sailer) in Zurich / Switzerland it has become an universal remedy within a short lapse of time.

“I don't use Chlorhexidin anymore” said the Head of the Clinic, Dr. Arno König, who uses above all the Gel and the Mouthrinse out of the different Tea Tree Oil products (TEBODONT®).

“

Tea Tree Oil is an universal remedy in our Clinic

When do you use Tea Tree Oil products?

”

48 Advertorial - Tebodont

Always after surgical interventions. And always after implantations: the parts to be screwed on the implants are soaked in Tea Tree Oil before. We also use it in case of troubles after the treatment - in Candidiasis. Our Dental Hygienist gives it in cases of periodontitis. And, since a few patients told us that they could significantly reduce their aphtae problem with the Tea Trea Oil toothpaste, we also recommend it for this indication.

Tea Tree Oil has become an universal remedy in our Clinic. The Gel is primarily used during the treatment and postsurgical, the other products are given to the patients for home care.

How do your patients react on Tea Tree Oil? Dr. König, how did you discover Tea Tree Oil? We received samples of TEBODONT® Gel two years ago.

Clinically, I noticed quickly that it is less irritating than Chlorhexidin. In addition, and very important for us: it does not produce any discolorations.

This plays an important role to our patients who notice even smallest discolorations on their bleached teeth. Another advantage of Tea Tree Oil: it acts successfully against Candida albicans.

Nowadays, I don't use Chlorhexidin anymore.

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

There are patients who do not like the taste of Tea Tree Oil. Others, like myself, appreciate the refreshing taste. The positive feedback we get from the patients: In contrast to Chlorhexidin, Tea Tree Oil does neither discolour the teeth, nor change the sense of taste.

Tea Tree Oil is an universal remedy in our Clinic.

Dr. med. dent. Arno König, Head of the Medical Dental Clinic Bethanien, Zurich/Switzerland

Close Co-Operation with Science Innovations with clinical approval Premium Swiss Quality Intensiv is a Swiss company, manufacturing dental diamond instruments of superior quality for more than 60 years. Its product portfolio consists of wide range of preparation sets, covering a broad spectrum of indications from cavity, crown and bridge preparations to contouring and finishing.

All of them have been conceived and developed with the scientific support of dental universities and well-known opinion leaders.

New

Intensiv UniglossPaste Clinically tested and scientifically approved by the University of Zurich

One step universal extra fine grit diamond paste with uniquely surface adapted micro grain for high gloss shining of all aesthetical restorations

New

Intensiv ProxoStrip

Strip v Proxo

Intensi ProxoS iv 5-6 te. ns InRef PX 401

Ref. PX

Pat. Pen

Pat. pend. N° 2007 0219/07 Scientifically tested by the University of Ancona, Italy

7

7 0219/0

d. N. 200

4015-6 ps ted stri

nd coa Diamo / 15 μm 40 μm

A unique, diamond-coated metal strip for final polishing of proximal surfaces Practical, fast, ergonomic!

6 pcs

trip

SA

Intensiv Grancia 6916 rland Switze

ch tensiv. .ch info@in ntensiv www.i

012

0

Intensiv Modular Veneer Set Dr. A. Schöler, Biel, Switzerland

Diamond instruments for veneer preparation ■

Presently Intensiv is looking for new business partners in: Qatar, Bahrain, Oman, Yemen, Iran

Intensiv representative for Gulf and Middle East: Mr. Imad Assy: i.assy@intensiv.ch 00961 3 288367

Intensiv SA via al Molino 107 P.O. Box 741 6916 Grancia Switzerland

Tel. + 41 91 986 50 50 Fax + 41 91 986 50 59 info@intensiv.ch www.intensiv.ch

IMPLANT CONTINUUM 2010 THE LEBANESE UNIVERSITY IS ORGANIZING THE 2nd COURSE IN IMPLANT DENTISTRY

Location: LUSD-School of dentistry- Lebanese University-Choueifat.

15 days - 3 days per month- 120 Credit Hours .

Faculty Members of the Postgraduate Periodontology, Oral Surgery, Radiology and Prosthodontics Departments.

Certificate: Delivered by the Lebanese University.

Course Description: The overall educational goals of this program are: 1) To acquaint the participant with the biologic scientific and clinical bases for dental implant therapy 2) To develop an understanding of diagnosis, treatment planning, maintenance procedures and complications in implant dentistry.

3) To acquaint the participant with clinical; surgical and prosthetic procedures through hands-on sessions, live surgery and case treatment.

Participants bring their own cases for review, treatment planning, and discussion and will have the opportunity to treat their patients.

For more information: Tel: 00961 1 694888 Fax: 00961 1 694222 Email: sales@3i-mena.com andree.chidiac@tamerholding.com

8PSME JOOPWBUJPO ÕÌÌ> Ü Á 5XP JO 0OF o $PME 'MPXBCMF 0CUVSBUJPO 4ZTUFN GPS 3PPU $BOBMT (VUUB'MPX¥ DPNCJOFT HVUUB QFSDIB BOE TFBMFS JO POF QSPEVDU BOE IBT FYDFMMFOU NBUFSJBM QSPQFSUJFT FYDFMMFOU GMPXBCJMJUZ OP TISJOLBHF BOE PVUTUBOEJOH CJPDPNQBUJCJMJUZ *O BEEJUJPO XF IBWF EFWFMPQFE B EFMJWFSZ TZTUFN UIBU HJWFT TJNQMF TBGF BOE IZHJFOJD BQQMJDBUJPO (VUUB'MPX¥ QSPWJEFT UIF EFOUJTU XJUI B SFMJBCMF BOE UJNF TBWJOH SPPU DBOBM GJMMJOH TZTUFN ÕÌÌ> ÜÊÁ t JT UIF GJSTU OPO IFBUFE GSFF GMPX HVUUB QFSDIB UIBU EPFT OPU TISJOL t HVBSBOUFFT SFMJBCMF EPTBHF BOE NJYJOH XJUI B EJTQPTBCMF DBQTVMF TZTUFN t BMMPXT HSFBU FBTF PG IBOEMJOH BT POMZ POF NBTUFS QPJOU JT OFFEFE t DPOEFOTBUJPO JT OPU SFRVJSFE t BMMPXT HPPE QPTU QSFQBSBUJPO t OBOP TJMWFS DPOUFOU JOIJCJUT SF JOGFDUJPO t TUVEJFT BWBJMBCMF PO SFRVFTU

$PMUÒOF 8IBMFEFOU (NC) $P ,( 3BJGGFJTFOTUSB F -BOHFOBV (FSNBOZ 5FM

'BY

QSPEVDUJOGP!DPMUFOFXIBMFEFOU EF XXX HVUUBGMPX DPN

&

t DBO CF SFNPWFE FBTJMZ EVSJOH SF USFBUNFOU

Inauguration de l’Espace Fawzi Tamer de soins dentaires et de vidéo transmission à la Faculté de Médecine Dentaire de l'Université Saint-Joseph

54 Inauguration de l’Espace Fawzi Tamer

C’est lors d'une cérémonie spéciale et conviviale qu’a eu lieu l’inauguration de l’Espace Fawzi Tamer de soins dentaires et de vidéo transmission à la Faculté de Médecine Dentaire de l'Université Saint-Joseph.

Il s’agit d’un espace équipé d’une technologie de pointe et de cameras à haute performance par la Fondation Fawzi Tamer, une salle de chirurgie bucco-dentaire spécialement conçue pour la diffusion directe et instantanée des opérations vers les salles d’enseignement et les salles de conférence de l'université.Par cette contribution, la Fondation Fawzi Tamer, a voulu rendre hommage aux 90 ans d'échange entre l’USJ et la Droguerie Tamer, premier fournisseur depuis 1920 d’équipements et de produits dentaires de l’Université Saint Joseph.

L’Inauguration a eu lieu en présence du Professeur René Chamussy, recteur de l’université, du professeur Antoine Hokayem, Vice recteur aux relations internationales, du professeur Khalil Karam, vice recteur au développement, de Madame le Doyen professeur Nada Naaman entourée du conseil d’administration de la Faculté de médecine dentaire et du corps professoral. Parmi l’assistance des personnalités médicales et économiques comme les Présidents Roger Nasnas, Camille Menassa et Selim Zeeni. M. Nicolas Nahas, Maître Choucri El Khoury et Maître Alexandre Sakr, M. Raffy Boutros et la famille Tamer dont Gaby Tamer, président de la Fondation, et PDG de la Société Droguerie Tamer sal- Membre de G. Tamer Holding, Mimi Tamer, vice présidente de la Fondation Fawzi Tamer, Maya, Raya, Youmna, Fawzi et Elias Tamer. Dans son allocution Gaby Tamer a remercié le Professeur Chamussy et les professeurs Hokayem et Naaman pour leurs inestimables apports à la faculté et à l’université et leur décerna pour cette occasion au nom de la Fondation des plaques commémoratives.

Finalement, tous les invités ont bu un toast à la santé des relations distinguées entre l’USJ et la Fondation Fawzi Tamer, relations que la famille Gaby Tamer a promis de perpétuer.

Commemorial picture of the Heads of Departments at the Saint Joseph University Dental School

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

From left to right: Pr. Antoine Hokayem, Pr. René Chamussy, Mr. Gaby Tamer, Pr. Nada Naaman and Mrs. Mimi Tamer

From left to right: Mr. Camille Menassa, Mr Roger Nasnas, Mrs. Mimi Tamer, Pr. René Chamussy, Pr. Nada Naaman, Mr. Gaby Tamer, Mr Salim Zeeni

The XIth International Meeting & 25th Anniversary School of Dentistry - Lebanese University June 19 - 21, 2009

th 56 LU 25 anniversary

§«eƒ°V Òæe Qƒ°ùahÈdG áª∏c ô“DƒŸG ¢ù«FQ ,¿Éæ°SC’G ÖW á«∏c ó«ªY ≈æ÷ÉH ’EG ¢Sô¨dG Ö«£j πgh ó¡©àfh ¢Sô¨f kÉ©«ªL øëfh øjô°ûYh ká°ùªN mäGƒæ°S ÉgÉæ«°ûeh ¬«∏Y Qƒéj ’ …òdG ø°ü¨dGh ,kÉæ◊ å©Ñj ’h kÉJƒ°U »JCÉj ’ ±RÉ©dG √qó°ûj ’ …òdG ôJƒdÉa ,Ωõ©dGh .kGôªK ó≤©j ’h nGôgR πªëj ’ ÊÉà°ùÑdG Ωƒ∏Y ô°ûf ‘ óFGQh ΩÉg QhóH É¡JÒ°ùe ∫ÓN á«fÉæÑ∏dG á©eÉ÷G ‘ ¿Éæ°SC’G ÖW á«∏c âeÉb ¿Éæ°SC’G áHÉÑW øjOÉ«e ™«ªL ‘ kGÒÑc kÉMÉ‚ ¿B’G ≈àM â≤≤M óbh ,¿ÉæÑd ‘ ¿Éæ°SC’G ÖW :É¡æe IóY m ™«°VGƒe ‘ mó–h ΩGõàdG ∑Éæg ¿Éμa kÉ«dhOh kÉ«HôY ,kÉ«∏fi áaÉc ≈∏Y »©eÉ÷G º«∏©àdG ègÉæe ‘ π°UÉ◊G Ò«¨à∏d áªFÓŸGh áªFGódG áHÉéà°SE’G :k’hG .…ôjô°ùdGh …ôjô°ùdG πÑb Ée ,…ô¶ædG ¢ùjQóàdG ‘ kÉjQhO ô¶ædG IOÉYEGh äÉjƒà°ùŸG ≈∏Y IQOÉ≤dG á«æWƒdG QOGƒμdG OGóYCGh »ª∏©dG åëÑdG á°UÉNh á«ÑæLC’Gh á«Hô©dG ∫hódG ΩɪàgEG πμ°ûJ É¡fEÉa É«∏©dG äÉ°SGQódG ‘ ÉeCG áØ∏àıG äÉ°ü°üîàdG ‘ É«∏©dG äÉ°SGQódG èeGôH ≈∏Y á«∏μdG äõcQ ∂dòdh .¿Éæ°SC’G ÖW ä’É› ‘ çÉëHC’G AGôLEGh ¢ùjQóàdÉH ΩÉ«≤dG ‘ äÉjƒà°ùŸG ø°ùMCGh πÑ°ùdG π°†aCG É¡æeh á«∏μdG É¡«dG ƒÑ°üJ »àdG á«bGôdG ±GógC’G ¤EG ∫ƒ°Uƒ∏dh ™ªàÛG äÉLÉ«àMG ™e Ö°SÉæààd ’ Qɪ°†ŸG Gòg ‘h .»ãëÑdGh »æ¡ŸG ΰSÉŸG ≥«Ñ£Jh ò«ØæJ iƒà°ùe ≈∏Y …ó÷G πª©dG Oó°üH Ωƒ«dG øëfh .É«∏©dG äÉ°SGQódG ∫É› øe ójó©dG ‘ á«∏μdG ‘ IòJÉ°SC’G ácQÉ°ûe ≈∏Y »æKG ¿G ’EG »æ©°ùj Aɢ£˘YEG ∫Ó˘N ø˘e ∂dò˘ch á˘ª˘μÙGh IQƒ˘˘°ûæŸG ᢢ«˘ ª˘ ∏˘ ©˘ dG çɢ˘ë˘ HC’G .á«ÑæLC’Gh á«Hô©dG ∫hódG áaÉc ‘ äGô°VÉfi èeGôH ∫ÓN øe ÊóŸG ™ªàÛG ™e π°UGƒàdGh ácGô°ûdG õjõ©J :kÉ«fÉK á©eÉ÷G ÚH ¿hɢ©˘J äɢ«˘bÉ˘Ø˘JG ó˘≤˘Yh ᢫˘dhC’G ᢫˘ë˘°üdG á˘jɢYô˘dG ,áë°üdG IQGRh) á«æ©ŸG äGQGRƒdGh ¿Éæ°SC’G ÖW á«∏c á«fÉæÑ∏dG IQGRhh á«YɪàLE’G ¿hDƒ°ûdG IQGRhh ‹É©dG º«∏©àdGh á«HÎdG IQGRh ¿hóH É¡°†©H ôcPCGh á«eƒμM Ò¨dG á«∏gC’G äÉ«©ª÷Gh (á«∏NGódG :âbƒdG ≥«°†d π«°üØJ ¿Éæ°SC’G êÓY ÚeCÉàd á«YɪàLE’G ¿hDƒ°ûdG IQGRh ™e ¥ÉØJEG ó≤Y ¯ .IQGRƒ∏d á©HÉàdG á«YɪàLE’G äÉeóÿG õcGôe ‘ .…ôμ°ùdGh É«ª«°SÓàdÉH ÚHÉ°üŸG ∫ÉØWC’G á÷É©Ÿ CCC áªFGódG ájÉYôdG õcôe ™e ¥ÉØJG ó≤Y ¯ .᫪°SôdG ¢SQGóŸG IòeÓàd »FÉbh êÓY ÚeCÉàd ÉædÉ«LCG á«©ªL ™e ¥ÉØJEG ¯ .äÉ«Ø°ûà°ùŸG ‘ ΩÉ©dG èæÑdG ÒKCÉJ â– hCG á«∏μdG ‘ º¡LÓY ÚeCÉàd Úbƒ©ŸÉH ≈æ©J äÉ«©ªL IóY ™e ¥ÉØJG ó≤Y ¯ .¿Éæ°SC’Gh ºØdG áë°üH ¬àbÓYh ÚNóàdG QÉ°†e øe á«YƒJ á∏ªMh á«°SQóŸG áë°üdG èeGôH ‘ á«ŸÉ©dG áë°üdG ᪶æe ™e ¥ÉØJG ó≤Y ¯ .…ƒªØdG »ë°üdG ∞«≤ãàdG ´hô°ûeh á«FÉbƒdG äGAGôLE’G ºYód YMCA á«ë«°ùŸG ¿ÉÑ°ûdG á«©ªL ™e ¥ÉØJG ó≤Y ¯ .AÉæé°ù∏d ¬«ehQ øé°S ‘ êÓ©dG ÚeCÉàd »∏NGódG øeC’G iƒ≤d áeÉ©dG ájôjóŸG ™e ¥ÉØJG ó≤Y ¯ .äGƒ≤dG √òg óLGƒJ á≤£æe ‘ ¢SQGóŸG IòeÓàd »FÉbh »FÉYQ èeÉfôH ‘ UNIFIL ¿ÉæÑd ‘ á∏eÉ©dG IóëàŸG ·C’G äGƒb ™e πª©dG π°UGƒJ ¯ áë°U º°ùb øY IQOÉ°üdG äGQƒ°ûæŸGh äÉ≤°ü∏ŸGh äÉYƒÑ£ŸG ™«ªLh ¿Éæ°SC’Gh ºØdG áë°U øY OÉ°TQE’Gh á«YƒàdG á∏ªM ≈°ùfG ødh ¯ »YƒdG ô°ûæd á°UÉÿGh ᫪°SôdG ¢SQGóŸG ‘ á«FÉbƒdG h á«FÉYôdG ™jQÉ°ûŸG ‘ iÈμdG ó«dG ¬d …òdGh á«∏μdG ‘ ¿Éæ°SC’Gh ºØdG .¿Éæ°SC’Gh ºØdG áë°U ≈∏Y á¶aÉÙGh ΩɪàgE’Gh ™ªàÛG áeóNh ôªà°ùŸG º«∏©àdG :kÉãdÉK .á«©eÉ÷G áæ°ùdG QGóe ≈∏Yh äÉ°UÉ°üàNE’G áaÉc ‘ ¿Éæ°SC’G AÉÑWC’ ôªà°ùŸG º«∏©àdGh ÖjQóàdG äGQhO øe áYƒª› º«¶æàH á«∏μdG Ωƒ≤J ÚæWGƒª∏d á«LÓ©dG äÉeóÿG :kÉ©HGQ ‹B’G Ö°SÉ◊G º°ùb çGóëà°SG kÉãjóM ” kGÒNCGh :kÉ°ùeÉN .É¡°ùØf ±GógC’G »æfhôWÉ°ûj ºgh πª©∏d ÚfÉØàe ÚØXƒeh IòJÉ°SCGh ΩÉ°ùbC’G AÉ°SDhQ AÓeõdG øe AƒØc ≥jôa äôcP Ée πc AGQh IQGOEG Öàμeh áªgÉ°ùŸG äÉcô°ûdG ,ájQGOE’G áÄ«¡dG ,᫪«∏©àdG áÄ«¡dG OGôaCG øe ô“DƒŸG Gòg ìÉ‚EG ‘ GƒªgÉ°S øjòdG ™«ªL ôμ°TCG ¿CG OhCGh .AÉ°†YCGh kGôjóe á«©eÉ÷G áæjóŸG ¿hDƒ°T ¿ÉæÑd ¢TÉY - á«fÉæÑ∏dG á©eÉ÷G â°TÉY ,¿Éæ°SC’G ÖW á«∏c â°TÉY ,ºà°ûY DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

The XIth International Meeting & 25th Anniversary School of Dentistry - Lebanese University June 19 - 21, 2009

Dr. Antoine Berberi, Chairperson Scientific committee

Dr. Bassel Doughan Chairperson Audio Visual committee

Classical music performance for the opening ceremony

th 58 LU 25 anniversary

Pr. Elia Sfeir President of the organizing committee

Picture from the opening ceremony that took place at the main auditorium of the Rafic Hariri campus DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

HU-FRIEDY ORTHODONTIC PLIERS • IMMUNITY STEEL® • FEEL THE COMFORT • EXPERIENCE THE QUALITY

Orthodontic Cassette Holds 10 pliers, a Mathieu needle holder and 3 hand instruments in an accessory area.

IMORTHO2

Orthodontic Cassette for Orthodontic instruments DIN Cassette for up to 6 pliers.

IMDINORTH8

Manufacturer: Hu-Friedy Mfg. Co., Inc. · 3232 N. Rockwell Street · Chicago, IL 60618 · USA EC Representative: Hu-Friedy Mfg. Co., Inc., Zweigniederlassung Deutschland Rudolf-Diesel-Straße 8 · D-69181 Leimen · E-Mail: info@hufriedy.eu · www.hufriedy.eu

Hu-Friedy Middle East: zqwaider@hu-friedy.com · Mobile +962-79-5045700

The XIth International Meeting & 25th Anniversary School of Dentistry - Lebanese University June 19 - 21, 2009

th 60 LU 25 anniversary

DR. ZOUHAIR CHOUCR

PRESIDENT OF THE

LU

DISTRIBUTING TROPHIES TO

Dr. Fadia Bou Dagher

Pr. Mounir Doumit

Pr. Nabil Barakat

Dr. Khaldoun Rifai

Sister Adrienne Aoun

Dr. Jean-Marie Megharbaneh

Pr. Ibrahim Nasseh

Dr. Ghassan Oueni

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

The XIth International Meeting & 25th Anniversary School of Dentistry - Lebanese University June 19 - 21, 2009

th 62 LU 25 anniversary

Recipients of the trophies posing for a commemorial picture

Faculty of the LU Dental School. Left to right: Elia Sfeir, Ibrahim Nasseh, Georges Tehini, Edmond Koyess, Hani Hasbini, Antoine Berberi, Elie Maalouf, Jean-Claude Fahed and Antoine Cassia DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

creartcom.it

we have a passion for sterilization Millennium: the safest, complete and most rapid B type sterilizer. Ideal point of reference in terms of safety, performance and flexibility

via delle azalee, 1 20090 buccinasco (mi) ph. (+39) 0245701505 r.a. - fax (+39) 0248840514 mocomcom@mocom.it - www.mocom.it

The XIth International Meeting & 25th Anniversary School of Dentistry - Lebanese University June 19 - 21, 2009

th 64 LU 25 anniversary

Picture of the deans of Arab Dental Schools

Mr. Luca Graziani from Italy lecturing on sterilization

STERILIZATION LECTURE

Picture from the audience DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

Chairpersons of the session

The XIth International Meeting & 25th Anniversary School of Dentistry - Lebanese University June 19 - 21, 2009

th 66 LU 25 anniversary

EXHIBITION FLOOR

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

Straumann continuous education in the Middle East In the frame of Straumann continuous education in the Middle East region, several events were organized in the first half of 2009.

The first event took place after the AEEDC congress in Dubai on March 13th and 14th at the University of Sharjah. This was the first ITI Esthetic Master course in the Middle East conducted by Prof. Dean Morton from Louisville University and Assistant Professor William Martin from Florida University.

The course covered the state of the art techniques in the treatment of high end esthetic implant situations.

Besides receiving high level theoretical tuition based on the ITI consensus and treatment planning approach through beautifully documented clinical guidelines and cases from Dr. Martin's and Dr. Morton's remarkable experience, the 30 participants had the opportunity to exercise these often advanced techniques during clinically based practical sessions.

Procedures such as making provisional restorations for optimal soft tissue forming, esthetic surgical templates and customizing impression transfers for post mucosa forming impression taking were performed.

Due to the success that this course obtained, these two remarkable speakers will be returning next year to conduct another ITI Esthetic Master course.

For the second event we were proud to receive one of the world's most notorious experts in the field of oral surgery and implant dentistry, Prof. Daniel Buser, Chairman of the Department of Oral Surgery at the University of Bern, Switzerland.

Prof Buser was an invited speaker to Saudi Arabia's National Congress organized by the Saudi Dental Society and the Saudi National Guard, where he conducted a 1 day lecture about the importance of Guided Bone Regeneration surgical techniques in dealing with highly demanding esthetic implant cases in compromised

hard and soft tissue sites.

The participants were exposed to proven methods and techniques on how to achieve best results from his long clinical and research experience.

Professor Buser then continued to Abu Dhabi in the UAE where he lectured to 150 dental clinicians on the same topic. This event was organized in collaboration with the Health Authorities from Abu Dhabi in their premises.

This was Professor Buser's first visit to the Middle East. He was impressed and expressed the wish to return, therefore, next year a 2 day course with Professor Buser and Professor Belser from Geneva University is already been discussed and should take place in Dubai in the First half of 2010.

Professor Buser's visit to the region also coincides with the development of the ITI foundation in the region as the Middle East ITI section is in the process of being created and soon will be able to provide the highest level of continues education through activities such as study clubs and mentoring programs for the local ITI members.

With all these events, Straumann and the ITI foundation continue to assure their commitment to the development of training and education for the advancement of excellence in implant dentistry in the Middle East.

For more information on the upcoming courses in the Middle East region please contact: David Dias Head of Regional Education - Middle East David.dias@straumann.com

The CLCC 2010 Comprehensive Licence CHUWL¿ FDWLRQ CRXUVH RI WKH 6WUDXPDQQ® 'HQWDO ,PSODQW 6\VWHP LZ ^ck^iZ ndj id WZcZÒ i [gdb i]Z >I>Éh gZcdlcZY ^c"YZei] ZmeZgi^hZ VcY ZmeZg^" ZcXZ Wn iV`^c\ VYkVciV\Z d[ i]Z XdbegZ]Zch^kZ ZYjXVi^dc d[[Zg egZhZciZY ]ZgZ# >c `ZZe^c\ l^i] i]Z >I> e]^adhde]n! i]^h XdjghZ ^aajhigViZh i]Z XdcXZeih d[ egdeZg Y^V\cdh^h! XVhZ hZaZXi^dc! igZVibZci eaVcc^c\ VcY XdcYjXi d[ igZVibZci ^c i]Z Ò ZaY d[ ^beaVci YZci^hign# I]^h XdjghZ VYYgZhhZh i]Z \ZcZgVa egVXi^i^dcZg Vh lZaa Vh i]Z heZX^Va^hi Xa^c^X^Vc# 6 XdcXZei d[ XdbegZ]Zch^kZ igZVibZci eaVcc^c\ Vh lZaa Vh XVhZ egZhZciVi^dch l^aa WZ egZhZciZY Yjg^c\ i]^h XdjghZ# EZZg"id"eZZg Y^hXjhh^dch! egVXi^XVa ZmZgX^hZh VcY a^kZ hjg\Zg^Zh l^aa ]Zae id VXfj^gZ ^c"YZei] `cdlaZY\Z ^c ^beaVci YZci^hignÉh Xa^c^XVa Veea^XVi^dc! jh^c\ i]Z HigVjbVcc 9ZciVa >beaVci HnhiZb# 6 a^XZchZY XZgi^Ò XVi^dc [gdb i]Z J6: B^c^hign d[ =ZVai] l^aa WZ VlVgYZY jedc eVhh^c\ i]Z Ò cVa ZmVb^cVi^dc#

HeZV`Zgh

<jZhi heZV`Zgh

Egd[Zhhdg J# 7g~\\Zg 6hh^hiVci Egd[Zhhdg <# HVak^ 9ZeVgibZci d[ EZg^dYdcidad\n VcY Egdhi]dYdci^Xh! Jc^kZgh^in d[ 7Zgc Hl^ioZgaVcY

9g# 7# :a 9V`g Ä 6Wj 9]VW^! J6: 9g# C# HVVWÄ 6Wj 9]VW^! J6:

8djghZ AdXVi^dc/ H]ZgVidc 9jWV^ 8gZZ` BdYjaZ &/ ?VcjVgn &, Ä &.! '%&% BdYjaZ '/ BVn & Ä (! '%&% BdYjaZ (/ DXidWZg (& Ä CdkZbWZg '! '%&%

8djghZ ;ZZh :Vgan gZ\^higVi^dc jci^a CdkZbWZg &*! '%%.

8=; (*%%#Ä AViZ gZ\^higVi^dc 8=; (,%%#Ä -% 8: XgZY^i ]djgh VlVgYZY Wn 6Wj 9]VW^Èh =ZVai] 6ji]dg^in

Egd\gVb 8dbb^iiZZ

B^c^hign d[ =ZVai] Jc^iZY 6gVW :b^gViZh

;dg [jgi]Zg ^c[dgbVi^dc XdcXZgc^c\ Vaa igV^c^c\ VcY ZYjXVi^dc ZkZcih ^c i]Z J6: eaZVhZ XdciVXi/ 9g# @]VaZY 6nndjW/ E]dcZ .,&*%+'-))'.

9g# Bd]VbbVY =jhhV^c/ E]dcZ .,&*%,'&&-,Bgh 9ZWdgV] B^X]^Zco^ / E]dcZ ).&,',.,*(-* ZbV^a/ YZWdgV]#b^X]^Zco^5higVjbVcc#Xdb

We

to create

Discover the blue revolution Time to see what was once invisible!

With SOPROLIFE®, diagnose occlusal or interproximal caries... differentiate with outstanding accuracy healthy tissue from infected tissue, so as to excavate only the decayed area.

Time has come for SOPROLIFE®!

ONE, you shoot TWO, you scan PSP!X is designed to make intra-oral imaging in the dental office easier and more efficient: • Reusable imaging plates • Readout process of 4.3 to 7.5 seconds • Consistent image quality • Smart and compact

www.soprolife.com

So easy, so safe • No more over-exposed X-ray images thanks to • Safer for the patient • An outstanding image quality • Two sensor sizes to improve patient comfort • So easy to use

A sign of quality and durability

Français Numan Center • 1st Floor No 111 Gardens Str. • PO Box 468 • 11953 Amman • JORDAN • Tel +962 6 553 4401 • Fax +962 6 553 7833 • E-mail: info@me.acteongroup.com •www.acteongroup.com

PRODUCT NEWS World premiere at the IDS 2009

KaVo ESTETICA E70: Simply comfortable! Comfortably simple!

The innovative suspended chair of the E70 offers incomparable leg room for the user. The newly developed operation logic with direct keys is intuitively designed so that the dentist and assistant can reliably access every function. Integrated in the dentist unit, the brushless, sterilisable KL702 motor with an endodontic function renders additional endodontic instruments superfluous and enhances the practice workflow.

In addition, the individual equipment and expansion options such as the USB interfaces or the differentiated system of headrests and backrests maximise investment security.

The automated, standardised and time-saving hygiene functions of the E70 make intensive and permanent sterilisation, cleaning and disinfection of the suction and drain system and suction hoses (Hydroclean) comfortable and efficient. The optionally available ERGOcom light multimedia system allows you to easily incorporate practice components such as an intraoral camera, microscope or x-ray and portray the required information directly on the unit's monitor.

With the ESTETICA E70, the user experiences superior comfort and functionality!

Email: info@kavo.com

Amaris Gingiva - Naturally, a beautiful smile

72 PRODUCT NEWS

Highly aesthetic, light-curing restorative in gingiva shades For the highest standards in aesthetic dentistry, Amaris Gingiva is the only restorative that permits chair side gingival shade matching. This new gingiva-shaded, composite-based restoration system facilitates individual shade-matching using a combination of a base shade (nature) with three mixable opaque shades in white, light and dark. The result is a representation of the gingiva that appears natural. Through this principle, behind which the proven Amaris-know how stands, extensively exposed cervical areas caused by gingival recession and wedge-shaped defects in the cervical area can be controlled in the future, both functionally and aesthetically. With Amaris Gingiva, the high standard placed on the capacity of modern composites no longer has to end at the cervical boundary. This new material permits the reconstruction of the "red-white" boundary with a predictable result.

Suitable for multiple indications Amaris Gingiva is also suitable for other indications. Reconstruction with gingiva-shaded composite thus represents an important extension of therapeutic measures after muco-gingival surgery. In addition, the so-called 'black holes" induced by the loss of interdental papillae as a consequence of periodontitis or gingival recession can be quickly and easily treated with Amaris Gingiva to provide an aesthetic restoration. Amaris Gingiva can also be used to significantly extend the lifespan of in situ crowns with visible and exposed edges caused by natural gingival shrinkage.

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

Outstanding material and handling properties Amaris Gingiva is not only impressive with its material properties, but also by its handling. It models extremely well and can be polished to high gloss. And thanks to the new non-dripping, non-running NDT syringe from VOCO, applying the material is just as economical as it is hygienic.

For more info: www.voco.com

What is ACP? Chemical Makeup ACP is an abbreviation for Amorphous Calcium Phosphate. ACP is created when dissolved calcium ions and phosphate ions react to form a non-crystalline insoluble salt. Due to the reactive nature of the chemicals involved, the calcium and phosphate must be stored separately until they are applied to the tooth surface.

Patented Technology Discus Dental, LLC. has licensed patented technology from the ADA Foundation allowing Discus Dental to incorporate ACP technology in professionally dispensed whitening gels.

How ACP Works Tooth demineralization from acid results in dulling, loss of tooth luster, and a higher susceptibility to caries. The oral environment can naturally rebuild enamel, through a process called remineralization, to some extent on its own, but the extent of remineralization is controlled by pH and the amount and availability of calcium and phosphate ions present in the mouth.

Remineralization can easily be reversed in an under-saturated environment.

The natural rebuilding of enamel is a slow kinetic reaction which can be rapidly sped up by the addition of ACP-forming components into the oral environment. Amorphous Calcium Phosphate (ACP) is the reacted complex of calcium and phosphate ions that precipitate and can grow on tooth surfaces in the oral environment.

These initial ACP complexes are thermodynamically unstable under the conditions normally prevalent in the oral environment; pH, temperature, etc.

Over time, these unstable compounds will undergo further reactions as well as phase transformation into other more stable forms of calcium phosphate. The precise path of the complex

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

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

eliminating the source of sensitivity by plugging dentinal tubules with calcium phosphate, the tooth mineral. This is similar to the process of sclerosis, where salivary mineral precipitates slowly over time in these tubules and reduces sensitivity. ACP simply speeds this process considerably with the same mineral at much higher concentrations.

ACP has been clinically shown to dramatically reduce dentinal hypersensitivity by occluding dentinal tubules.6 Discus Dental whitening gels, such as Nite White ACP, are the only professional take-home whiteners to combine patented ACP technology with the proven effectiveness of Potassium Nitrate to establish a new standard for patient comfort in professional take-home whitening.7 Improved Appearance - Restores Enamel Luster ACP has been clinically shown to improve the smoothness and luster of teeth8 by filling superficial tooth defects and improving the overall smoothness and luster of patients' smiles.3 Lasting Results In clinical studies, patients who used a takehome dental tooth whitener containing ACP experienced less fadeback six months after treatment compared to patients who used an identical take-home whitener without ACP.9

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

Effective Desensitizer ACP mimics the natural desensitizing process by

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

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

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

Gel with Added Amorphous Calcium Phosphate.

Jada Vol. 136, March 2005.

4 Grant LP, Thompson A, Tanzer JM. Caries inhibition in rats by a remineralizing toothpaste.

Journal of Clinical Dentistry. 1999;10(1 spec no):30-33.

2 M. Markovic, B.O. Fowler And M.S. Tung.

Preparation and Comprehensive Characterization of a Calcium Hydroxyapatite Reference Material.

Journal of Research of the National Institute of Standards and Technology, Volume 109, Number 6, November-December 2004.

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

8 Giniger M, Spaid M, Felix M, MacDonald J, Ziemba S. Tooth Surface Enhancement by a 16% Carbamide Peroxide Take-Home Bleaching Gel Containing ACP. Journal of Dental Research.

84(Spec Issue A): 1793,2005. .

9 Giniger M, Spaid M, Felix H, MacDonald J. A 180-Day Clinical Investigation of the Tooth Whitening Efficacy of a Bleaching Gel with Added Amorphous Calcium Phosphate. Journal of Clinical Dentistry, Volume XVI, No. 1, 2005.

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

6 M. Cherng, S. Takagi And L.C. Chow. Reduction in Dentin Permeability Using a Calcium Phosphate Slurry. Journal of Dental Research 83 (Special Issue A); IADR CD-ROM Abstract No. 0119, 2004.

7 Giniger, MacDonald, Ziemba, Felix. The Clinical Performance of Professionally Dispensed Bleaching

© 2009 Discus Dental, LLC. All rights reserved.

Visit: www.discusdental.com

PRODUCT NEWS

SIROLaser Advance sets new standards of user-friendliness and flexibility New, individually configurable diode laser facilitates an intuitive mode of working.

Sirona's new SIROLaser Advance combines state-of-the-art laser technology with outstanding user-friendliness. The color touchscreen, clearly structured menus and self-explanatory symbols provide the ideal basis for easy operation.

The SIROLaser caters for a broad spectrum of applications. The preset programs ensure quick and effective therapy in the area of periodontics, endodontics, surgery, and pain relief. If required the dentist can view additional information about each individual preset in a help menu.

The dentist is free to adapt the SIROLaser Advance to his or her individual mode of working. Up to 24 different applications can be programmed; twelve favorites are available at the touch of a button. In his role as system administrator the dentist can also configure profiles for five additional users, each protected by its own PIN code. In addition, the SIROLaser Advance anonymously stores the parameter data relating to

each treatment session. For patient documentation purposes this data can be easily transferred to a PC with the aid of a USB flash drive.

The SIROLaser Advance is operated via the light-touch finger switch (integrated directly into the handpiece) or via the optional foot control.

For more info: www.sirona.com

76 PRODUCT NEWS

Hydrorise, the innovation that did not exist

Starting today, dentists can count on an innovative new impression material: Hydrorise, the first hyperhydrophilic A-silicone that adapts to any kind of impression technique in all clinical conditions.

Hyperhydrophilic technology has been exclusively developed by Zhermack research, making hydrorise extremely flowable.

With a contact angle less than 10° and thanks to the effects of the AMDA System (Advanced Moisture Displacement Action), Hydrorise is able to remove fluids from the gingival sulcus and reproduce impression margins with maximum precision, like no other material on the market.

The attention paid by researchers in the Zhermack impression materials development phase is focused on the company's aim to create clinically relDENTAL NEWS, VOLUME XVI, NUMBER III, 2009

evant products. An impression material must guarantee extremely accurate and reliable results, even in particularly difficult clinical situations.

The perfect synergy between physical and mechanical properties found in Hydrorise ensures clinical success at each use.

Zhermack offers the chance to pair the new conditioner range Hydrosystem to optimise preparation surfaces, creating ideal conditions for use of the Hydrorise.

Hydrorise is available in different viscosities: putty - heavy body - regular body - light body - extra light body - monophase, each of which comes both in normal set or fast set. for more info: www.zhermack.com

PRODUCT NEWS The TwinPower Turbine by J. Morita: Test the Best

The main reason the Turbine is attractive, says Morita, is its world-wide unique double-impeller system which is driven by three drive nozzles and the generated exhaust air. The result is a continuous, low-vibration and as much as 50 % greater torque, which practitioners experience as very pleasant. The frequent sterilisation processes, says the manufacturer, in no way limit the Turbine's usability. Moreover, both - practitioners and patients - alike benefit from this new technology. The zero suckback technology was developed especially by Morita to reduce the like-

lihood of patient infections.

Morita says that the zero suckback system of the TwinPower Turbine family enables it to satisfy the hygienic requirements and provide the necessary assurance that current hygiene regulations are met.

For further information from: J. Morita Europe GmbH Justus-von-Liebig-Straße 27a 63128 Dietzenbach - Germany Phone: +49 (60 74) 8 36-0 Fax: +49 (60 74) 8 36-299 info@jmoritaeurope.com www.jmoritaeurope.com

79 PRODUCT NEWS

The technical and hygienic advantages of the TwinPower Turbine by J. Morita have recently been confirmed by the independent American testing institute “Reality”. They gave the turbine the highest number of points and awarded it the Five Star Award for 2008. The TwinPower Turbine was able to score points on its compact design and its lightweight, 50 gram handpiece. The turbine has such sophisticated ergonomics that it mitigates the strain experienced after several hours of intensive work. There are three different head sizes available depending on the application so that even regions which are difficult to access can be easily reached with the smallest size.

DENTAL NEWS, VOLUME XVI, NUMBER III, 2009

IPS

InLine ®

Conventional Metal-Ceramic

InLine PoM

IPS

IPS

InLine

®

®

Press-on-Metal Ceramic

Make it InLine!

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

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

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