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Download e-copy - Smile Dental Journal

Smile Dental Journal | December 2010 - Volume 5, Issue 4 | | Distributed free of charge

Dental Journal



Values for Emirati Adults with

Normal Occlusion and

Well-Balanced Faces

An Interdisciplinary

Approach for Restoring

Function and Esthetics

in a Patient with

Amelogenesis Imperfecta:

A Case Report


Ceramic Veneers:

a Successful Team Concept

Pre-Orthodontic Assessment

of a Non-Syndromic Multiple

Supernumerary Teeth with

Cone Beam Imaging

Advancement in

the Removal

of Permanently Cemented

Crowns and Bridges

Diffuse Inflammatory

Facial Swelling Secondary

to Local Anesthetic Injections

in Patient with Polyalkylimide

Gel Used for Cheek Augmentation

ISSN: 2072-473X

Panoramic imager

Discover the new X7 Series

Cephalometric Teleradiography

Advanced kinematics

X7 Cephalometric Teleradiography

More Safety in Deep Proximal Cavities:

Innovative Bulk-Fill Composite Shows Good

Wetting Behaviour and Reduced Shrinkage

Stress by Dr. Michael Naumann

Clinical Case

The following case report, illustrated by Figures 1 to

6, describes the use of SDR (DENTSPLY DeTrey,

Konstanz, Germany) in combination with Ceram•X

duo+ (DENTSPLY DeTrey). The only bonding system

currently used in my practice is XP BOND ® , if light

curing is sufficient, or XP BOND ® plus Self Cure

Activator, if dual curing is necessary (adhesive

placement of posts for core build-ups, cementation

of inlays). Both situations require the use of the totaletch

technique (also known as the etch-and-rinse

technique). In this case, proximal recurrent caries

was diagnosed under a discoloured, seven-year-old

composite filling in tooth 35. The old filling and the

decay were removed, a rubber dam was applied, and

a matrix band ensuring a well-contoured contact

area was tightly wedged in the proximal-apical

region. My experience is that it will pay off to spend

some extra time on these preliminary steps; it will

easily be compensated for by the time saved in the

subsequent finishing procedure. The overall quality

of the restoration will also be improved, because

proximal surfaces are hardly or not at all accessible

for intensive finishing. The next treatment step was

acid etching. First the enamel was conditioned, and

then the dentin; the latter for no more than 15

seconds. The etchant was thoroughly rinsed away,

and the cavity was dried. Great care was taken not

to over-dry or desiccate the cavity, since excessive

drying is one of the main causes of postoperative

sensitivity. To perfectly pre-treat a cavity for wet

bonding, it is also advisable to slightly rewet the

dentin surfaces. This is best achieved if the assistant

holds the adhesive applicator in the water spray

produced by the air/water syringe at a distance of

30cm. The cavity will be sufficiently moisturized in

this way; it is definitely unnecessary to sprinkle it

with water! After dentin rewetting, the bonding agent

was applied to both dentin and enamel and lightcured

for 10 seconds.

Then the proximal box of the cavity was bulk-filled

with SDR . The new filling technique greatly

facilitates the restorative procedure, because the

material can be placed in increments of up to 4mm.

The occlusal box was filled with a second increment.

SDR was very easy to use, thanks to its flowable

consistency, good wetting behaviour and selflevelling

properties. Without any conditioning of the

SDR surface, Ceram•X duo+ (DENTSPLY DeTrey)

was applied, using the shades D3 for another dentin

layer, and E3 for a thin final enamel layer. This

combination ensured good aesthetics and abrasion

resistance. However, any other composite material

indicated for posterior teeth would have been equally

suitable. The transitions to the tooth structure were

improved with a sickle-shaped scalpel, and the

occlusal contacts were adjusted with a diamond.

PoGo ® rubber polishers (DENTSPLY DeTrey) were

used to polish the restoration.


Although treatment time was not the main aspect in

this case, SDR provided a highly efficient filling

technique. In my view, the handling properties are

more important, considering that conventional

composites are often difficult to apply to proximal

areas and may not adequately adapt to cavity walls

and, above all, cavity floors. SDR seems to

considerably increase safety in direct restorative

therapy. Composite restorations with SDR can be

expected to show a good marginal seal and a

reduced risk of recurrent caries. This report

describes my first experience of the new material.

My current opinion:


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For better dentistry

Smile Dental Journal

December 2010

Volume 5, Issue 4

Quarterly Issued

Distributed Free of Charge

+962 7 96367954

Amman, Jordan


Dr. Ma’moon A. Salhab

Director in Charge &

Chief Editor

Dr. Issa S. Bader


Dr. Lara M. Haddadin

Marketing Director

Solange R. Sfeir


Solange R. Sfeir

Art & Design

Yazid M. Masa

Published by MENA Co. for

Dental Services

Jordanian National Library

Registration # 3954/2008/P

ISSN 2072-473X

Printed By:

Ad-Dustour Commercial Printing Press

Amman, Jordan

Mission Statement

Bridging the gap between advanced uptodate

peer-reviewed dental literature and

the dental practitioners enabling them to

do their jobs better- is our ultimate target.

Besides, Smile provides readers with

information regarding the available dental

products, armamentarium, news

and proceedings of dental symposia,

workshops and conferences.


Smile Dental Journal makes every

effort toreport clinical information and

manufacturers’ product news accurately, but

cannot assume responsibility for the validity

of product claims or typographical errors.

Opinions or interpretations expressed by the

authors are their own and do not necessarily

reflect nor hold Smile team responsible for

the validity of the content.

Editorial Review Board

• Dr. Eyas Abu-Hijleh

DDS, PhD, Orthodontics & Dentofacial Orthopedics

• Dr. Layla Abu-Naba’a

BDS, MFD, RCS, PhD, Prosthodontics

• Dr. Ali Abu Nemeh

BDS, NDB, MSc, Endodontics

• Dr. Hazem Al-Ahmad

BDS, MSc, FDSRCS, Maxillo-Facial Surgery

• Dr. Muna Al-Ali


• Dr. Suhail H. Al-Amad

BDS; DCD (Melb), MRACDS (Oral Med), JMC Cert.

(Oral Med), GradDip ForOdont (Melb)

• Dr. Zaid Al-Bitar

BDS, MSc, MOrth, RCS, Orthodontics

• Dr. Raed Al-Jallad

BDS, MSc, FFDRCS, FDSRCS, Oral & Maxillofacial


• Dr. Hani Al Kadi

BDS, Dip ODONT, MDS, Endodontics

• Dr. Mohammad Al-Rabab’ah

BDS, MFD RCSIre, MRD(Pros), RCSEd, JB(Cons) PhD

• Dr. Hatem Al-Rashdan

BDS, MSc, Jordanian Board of Maxillofacial Surgery

• Dr. Majd Al-Saleh

BDS, DDS, MSc, Pediatric Dentistry

• Dr. Ahmad Al-Tarawneh

DDS, M.Clin.Dent, Jordanian Board of Orthodontics

• Dr. Hayder Al-Waeli

BDS, MSc, Jordanian Board of Periodontology

• Dr. Muayad Assaf

BDS, MSc Endodontics

• Dr. Manal Azzeh

BDS, MSc, Jordanian Board of Periodontology

• Dr. Menah Barmawi

BDS, Jordanian Board of Maxillofacial Surgery

• Dr. Bader Eddin Borgan

BDS, MDS, MOrth, RCSEd, Orthodontics

• Dr. Lama Jarrah

BDS, MSc, Jordanian Board of Orthodontics

• Dr. Ghada Karien

BDS, JDB, Pediatric Dentistry

• Dr. Ahmad Kutkut

DDS, MS, Prosthodontics, USA

• Dr. Hassan Maghaireh

BDS, MFDS, MSc Implants (Manchester)

• Dr. Hakam Mousa

BDS, MSD, Operative Dentistry

• Dr. Jumana Sabbarini

BDS, MSc, Jordanian Board of Pediatric Dentistry

• Dr. Samer Sunna

BDS, MSc, M.Orth, RCS, Orthodontics

• Dr. Leema Yaghmour

BDS, DUA, DUB, Pediatric & Community Dentistry

International Advisory Board

• Prof. Abdullah R. Al-Shammery / KSA

BDS, MS Restorative Dentistry

Rector, Riyadh Colleges of Dentistry & Pharmacy

• Prof. Magid Amin Ahmed / Egypt

Oral & Maxillo-Facial Surgery

Vice President MSA University

Dean, Faculty of Dentistry MSA University

• Prof. Jamal Aqrabawi / Jordan

DDS, DSc, DMD Endodontics

Dental Faculty, University of Jordan

• Prof. Stephen Cohen / USA


Diplomate, American Board of Endodontics

• Prof. Nabil J. Barakat / Lebanon

DDS, MSc, FICD Maxillo-Facial Surgery

President of LAO & EMAO

• Prof. Azmi Darwazeh / Jordan

BDS, MSc, PhD Oral Pathology Oral Medicine

Former Dean, Faculty of Dentistry JUST

Examiner, Faculty of Dentistry RCS Ireland

• Prof. Mohamed Sherine Elattar / Egypt

BDS, MSc, PhD Prosthodontics

Dean, Faculty of Dentistry, Pharos University

President of AOIA

• Prof. Fouad Kadim / Jordan

BDS, MSc, PhD Conservative Dentistry

Vice Dean, Faculty of Dentistry, University of Jordan

• Prof. Howard Lieb / USA

DMD General Dentistry & Management Sciences

College of Dentistry, New York University

• Prof. Edward Lynch / UK

PhD (Lon), MA, BDentSc, TCD, FDSRCS (Ed), FADFE, FDSRCS (Lon)

Head of Dental Education and Research Warwick University

• Prof. Lamis D. Rajab / Jordan

DDS, PhD, Pediatric Dentistry

Former Dean, Faculty of Dentistry, University of Jordan

• Prof. Issam Shaaban / Syria

BDS, PhD, Maxillo-Facial Surgery

Former Dean, Faculty of Dentistry Damascus University

President of Syrian OMFS Society

• Prof. Yousef F. Talic / KSA


Editor-in-Chief, Saudi Dental Journal

Consultant in Prosthodontics & Implantology

College of Dentistry, King Saud University

• Prof. Abbas Zaher / Egypt

BDS, MS, PhD Orthodontics

Professor of Orthodontics & Vice-Dean, Alexandria University

Vice-President, World Federation of Orthodontists

• Dr. Nadim Abou-Jaoude / Lebanon

CES, DU, FICD Prosthodontics

Lecturer, Lebanese University

Clinical Associate, American University of Beirut

• Dr. Hasanen H. Al-Khafagy / UAE

BDS, MSc, PhD Conservative Dentistry

Ajman University of Science & Technology

• Dr. Jaser Al-Ma’itah / Jordan

BDS, MSc Oral Surgery

Head of Dental Dept., Jordanian Royal Medical Services

• Dr. Maher Almasri / UK

DDS, MSc, PhD, FADFE, Director of Oral Surgery Courses, Bone

Graft Modules Leader, Warwick University

President of the Syrian Section of IADR

• Dr. Abdelsalam Elaskary / Egypt

BDS, FICOI, President of ASOI

• Dr. Yasin El-Husban / Jordan

DDS, MSc Prosthodontics

Former Head of Dental Dept. & King Hussein Hospital

• Dr. Zbys Fedorowicz

Director, The Bahrain Branch of the UK Cochrane Centre

• Dr. Wolfgang Richter / Austria

DDS, PhD, Restorative Dentistry, President of ESCD

• Dr. Mohammad Sartawi / Jordan


Senior Consultant Maxillo-Facial Surgery




Dentofacial Cephalometric Values for Emirati Adults

with Normal Occlusion and Well-Balanced Faces

By Amjad Al Taki, Eyas Abuhijleh, Khulood Jamal Bin Haider



Pre-Orthodontic Assessment of a Non-Syndromic Multiple

Supernumerary Teeth with Cone Beam Imaging

By Elie Hayek, Georges Khawam, Ibrahim Nasseh



Diffuse Inflammatory Facial Swelling Secondary to Local

Anesthetic Injections in Patient with Polyalkylimide Gel Used for

Cheek Augmentation

By Kamis Gaballah, AbdulRahman Saleh



An Interdisciplinary Approach for Restoring Function and Esthetics

in a Patient with Amelogenesis Imperfecta: A Case Report


Sunil Kumar Gupta, Shashi Rashmi Acharya, Jaya Siotia, Amar A Sholapurkar



Advancement in the Removal of Permanently Cemented

Crowns and Bridges

By Jean Luc Girard


Dental Laboratory

Biomimetic Ceramic Veneers: a Successful Team Concept

By Lamberto Villani

Affiliation & Distributors

• Bahrain

Bahrain Dental Society

+973 17723767,

• Egypt

Alexandria Oral Implantology Association

+203 5451277,

• Iran

Shayan Simin Teb Co.

+98 21 66380364/5,

Iranian General Dental Association

+98 2188287794/5,

• Iraq

Iraqi Dental Association

+964 015379267,

Kurdistan Dental Association

+964 7504510315,

• Jordan

Basamat Medical (Pharmadent)

+962 6 5605395,

• Kuwait

Kuwait Dental Association

+965 5325094,

• Lebanon

Lebanese Dental Association

+961 1 611555,

Lebanese Dental Laboratory


+961 5955 151,

Richa Dental Store

+961 5 452555,

• Oman

Oman Dental Society

+968 95769039,

• Qatar

Qatar Dental Society

+974 4393144,

Ali Bin Ali Medical The i-partner

+974 4867871 ext. 247,


To Organize or To Organize?

That is the Question


Interventions for Replacing

Missing Teeth: Antibiotics at

Dental Implant Placement

to Prevent Complications


Immediate Placement

of Dental Implants

Into Debrided Infected

Dentoalveolar Sockets

Do Periodonto-Pathogens

Disappear After Full-Mouth

Tooth Extraction?




Product Review


Summaries in


Flash News

Event Reviews


• Saudi Arabia

Saudi Dental Society

+966 1 4677743,

• Sudan

Sudanese Dental Association

+249 83 779769,

• Syria

Najjar Trading Est.

+963 (11) 2244140,

• United Arab Emirates

Noble Medical Equipment

+971 4 8854544,

Dubai Medical Equipment L.L.C.

+971 6 554 0206,

Editorial Policy

• Our objective is to publish a dental journal of consistent high quality and help to increase the exposure of literature written by dental professionals from our region at a global level.

• Literature review, original research, clinical case reports, case series, short communication, randomized clinical trials, and book reviews are among our scope of published material,

where the clinical aspect of dentistry is presented in a scientific way, starting each article with an abstract, backed up by references in accordance with the Vancouver

citation style.

• The journal encourages the submission of papers with a clinical approach, practical or management oriented, besides papers that bridge the gap between dental research and

clinical application.

• Received manuscripts are first revised by the editor to check if it is appropriate for publishing in Smile and that it complies with the author›s guidelines. The manuscript is then

forwarded to two or more professional reviewers. Anonymity of both the author and reviewer is preserved (double blinded peer-review process).

• Our editorial policy which controls the quality of articles and assures their accuracy, clarity, and smooth readability through high level enthusiast regional and international

team of experts is our golden key for success.

• Finally, we believe that a controlled content of advertisements could be informative and beneficial especially in dentistry, where the armamentarium and pharmaceuticals are a

major and integral part of the dental science.

Ethics in Dentistry

The dental profession in many of the developed countries holds a special position of

trust within society. As a consequence the society affords those who practice this

profession certain privileges that are not available to members of the public-at-large.

In return, the profession makes a commitment to society that its members will adhere to high

ethical standards of conduct.

These ethical standards take different definitions in the different countries but most of them are embedded under the

concept of Principles of Dental Ethics, and the profession members act according to a code of professional conducts

which govern their required or prohibited actions.

The importance of ethics as an integral part of the medical profession – and thus by implication also the dental

profession, as dentistry is part and parcel of general health – has been highlighted already by Hippocrates more than

2,000 years ago. The core values of “first, do no harm” and “put the patient first” apply to this very day. Practicing

dentistry gives rise to a wide spectrum of potential ethical dilemmas.

Modern technology, age, old cultural beliefs and diverse lifestyles could easily give rise to misunderstanding and

conflict. Any manual for dental ethics should not list what is right and what is wrong, but provides values and practical

examples that will give food for thought and will guide practitioners in making sound ethical decisions in the best

interests of their patients. Dental education and training will never be complete unless the curricula of dental schools

incorporate a course on dental and medical ethics.

In our countries (Arabic countries) ethical standards and behavior in dental practice come from our traditional, religious

or trials believes and most of the profession practitioners did not know the ethics as a science that should have code

and that this code should be an essential part of their organizing committees. In accordance to that, the presence of such

awareness among the dentists is important to gain the community trust in the profession and that awareness needs to

be developed through continuous engagement with the activities that raise the attention among the authorities about

the importance of involving code of ethical professional conducts in each legislation body for the profession or the

applicable laws in the country. This issue of Smile Dental Journal is published in conjunction with the launching of the

Arabic version of the FDI Manual of Dental ethics in the Arabic region and Smile supported this distinguished event

based on its believe to support each effort that helps the profession including its both parts; dentists and patients.

Dr. Hayder Alwaeli

Editorial Review Board Member

Smile Dental Journal

| 4 | Smile Dental Journal | Volume 5, Issue 4 - 2010

Calendar of Events

February 1 - 3

AEEDC 2011

Dubai, UAE

February 16 - 18

EDTA 2011

Cairo, Egypt

February 18 - 20

India International Dental Congress

Mumbai, India

February 24 - 26

146 th Chicago

Midwinter Meeting

Chicago, USA

March 2 - 4

14 th Congress of ECDS

Cairo, Egypt

March 18 - 19

1st PUA International Dental

Congress & 2nd PUA International

Dental Students Competition

Alexandria, Egypt

March 22 - 26

IDS 2011

Cologne, Germany


March 9 - 11

2 nd Jordanian International

Dental Implantology Conference

Dead Sea, Jordan

April 6 - 7

7 th Jordanian Orthodontic


April 14 - 16

Healthcare, Dentalcare and

Pharma Syria 2011

Damascus, Syria

April 15 - 16

1 st Iraqi Dental Reunion

IDA Annual Conference

Erbil, Iraq

April 13 - 15

15 th kuwait Dental

Assocciation International

Scientific Conference

Al-Hashimi, Kuwait

Amman, Jordan

May 9 - 12

5 th Jeddah Dental Esthetic


May 12 - 13

5 th CAD/CAM

Dubai, UAE

May 25 - 26

1 st Aesthetic

Dentistry Congress

Amman, Jordan

June 2 - 4

12 th Lebanese Dental

University Congress

Beirut, Lebanon

Jeddah, KSA

For more events visit or our page on Facebook.

Smile Dental Journal | Volume 5, Issue 4 - 2010 | 5 |

Dentofacial Cephalometric Values for

Emirati Adults with Normal Occlusion and

Well-Balanced Faces




SN Plane

Frankfort Plane


Y axis Plane










Amjad Al Taki


Assistant Professor

Department of Orthodontics

School of Dentistry

Ajman University of Science

and Technology Network

Ajman, UAE

Eyas Abuhijleh


Specialist Orthodontist and

Assistant Professor

Tawam Hospital in Affiliation

with Johns Hopkins Medicine

International Dental Centre

Al Ain, UAE


Objective: To determine the dentofacial cephalometric values for Emirati adults, and to

compare them with those of Caucasians.

Materials and Methods: Standardized Lateral cephalometric radiographs for 30

Emirati women and 32 Emirati men with normal occlusion were traced.

Results: Skeletal comparisons between Emirati adults and Caucasians showed that

Emiratis tend to have decreased SNB angle, increased ANB angle, and increased

anterior and posterior facial heights, while dental comparisons showed that Emiratis

have bimaxillary dental protrusion and decreased inter-incisal angle. When comparing

men with women, both anterior facial height (N-Me) (P

(Table 1) Mean and SD of Cephalometric Measurements for 62

Emirati Adults

Variable Norms Mean SD



SNA 82 (°) 81.30 3.37

SNB 80 (°) 78.40 3.28

ANB 2 (°) 2.90 0.89

Wits -1-0 (mm) -0.74 2.47


GoGn-SN 32 (°) 32.39 4.73

Y axis 59.4±3.8 (°) 59.66 3.13

N-S-Ar 123±5 (°) 124.14 5.01

S-Ar-Go 143±6 (°) 142.14 6.85

Ar-Go-Me 130±7 (°) 128.69 4.67

S+Ar+Go 396±4 (°) 394.98 5.00

S-Go 75±4 (mm) 81.73 6.13

N-Me 121±4(mm) 128.60 7.36

Jarabak % 62-65% 63.57 3.49


1-NA 22 (°) 26.56 6.47

1-NA 4 (mm) 5.30 2.24

1 _ -NB 25 (°) 33.10 5.64

1 _ -NB 4 (mm) 6.36 2.07

1-1 _ 131 (°) 118.18 8.23

Materials And Methods

Lateral cephalometric radiographs were taken from 62

nongrowing Emirati adults (30 women and 32 Men;

aged between 18 to 25 years). All subjects were selected

from the dental students of Ajman University of Science

and Technology on the basis of the following criteria:

• Emirati citizens with Emirati grandparents

• Balanced facial profiles with competent lips

• Class I occlusion with minimum or no crowding

• Normal overjet and overbite

• No history of previous orthodontic treatment

All cephalometric radiographs were taken with the lips

in light contact and teeth in centric occlusion. Tracings

of the radiographs were made on 8’’X10’’ 0.003’’

matte acetate sheets (Orthotrace, Rocky Mountain

Orthodontics, Denver, Colo).

This study consisted of twelve angular measurements,

five linear measurements, and a ratio (Figures 1-4).

To assess the intra-observer errors, the first author traced

10 randomly selected radiographs at two different time

intervals. Intra class correlation coefficient was applied to

the first and second measurements in order to evaluate

the author variability of repeated measurements.

Correlations were found to be greater than 0.95 in all

the measurements.

Descriptive statistics (mean and standard deviation)

were calculated using the SPSS program version 12.0

(SPSS Inc, Chicago, Ill). The results were tabulated and

compared with Caucasian norms which were derived

from the values of Steiner, 1 Jarabak, 2 Downs, 3 and Wits 10

analyses. To compare the measurements between men

and women, an independent samples t-test was used.


The results of this study showed there were some

differences between Emirati cephalometric values

and Caucasian norms (Table 1). Regarding skeletal

measurements, results showed that Emiratis tend to have

decreased SNB angle (78.40° ± 3.28), increased ANB

angle (2.90° ± 0.89), and an increased anterior and

posterior facial heights (128.60 ± 7.36mm and 81.73

± 6.13mm), respectively.

Dentally, both angular and linear parameters for

1-NA and 1 _ -NB were larger in Emirati adults than in

Caucasians, indicating that both upper and lower

incisors were more proclined and more protruded in

Emiratis. On the other hand, the inter-incisal angle was

smaller in Emirati adults (118.18° ± 8.23).

An independent samples t-test was used to compare

Emirati men and women. Table 2 compares the mean

and standard deviation of cephalometric measurements

for both sexes. Of all skeletal and dental parameters,

2 showed significant sexual dimorphism, were both

anterior and posterior facial heights increased significantly

in men compared to their counterparts (P


• When compared with Caucasian cephalometric

norms, Emirati adults showed an increase in ANB

angle due to mandibular retrusion, increase in

anterior and posterior facial heights, decreased interincisal

angle, and bimaxillary dental protrusion.

• There were no difference between men and women

except for the facial heights which were longer in men

than women.

• These Emirati cephalometric values found in this

study are recommended for use when formulating a

treatment plan for this ethnic group.

• There is a need to develop age-dependent

cephalometric standards for the Emirati population.


1. Steiner CC. Cephalometrics for you and me. Am J Orthod

Dentofacial Orthop. 1953;39:729-55.

2. Jarabak JR, Fizzel JA. Technique and treatment with light wire

edgewise appliances. 2 nd . ed. St. Louis: Mosby, 1972.

3. Downs WB. Variation in facial relationships: their significance in the

treatment and prognosis. Am J Orthod. 1948;34:812-40.

4. Ricketts RM. Planning treatment on the basis of the facial pattern

and an estimate of its growth. Angle Orthod. 1957;27:14-37.

5. Sassouni V. A Roentgenographic cephalometric analysis

of cephalofacial-dental relationships. Am. J. of Ortho.


6. Bishara S, Abdalla E, Hoppens B. Cephalometric comparison of

dentofacial parameters between Egyptians and North American

adolescents. Am J Orthod Dentofacial Orthop. 1990;97:413-21.

7. Hamdan AM, Rock WP. Cephalometric norms in an Arabic

population. J Orthod. 2001;28:297-300.

8. Behbehani F, Hicks P, Beeman C. Racial variations in cephalometric

analysis between whites and Kuwaitis. Angle Orthod.


9. Hassan AH. Cephalometric norms for Saudi adults living in the

western region of Saudi Arabia. Angle Orthod. 2006;76:109-13.

10. Jacobson A. The Wits appraisal of jaw disharmony. Am J Orthod.


11. Basciftci FA, Uysal T, Buyukerkmen A. Craniofacial structure of

Anatolian Turkish adults with normal occlusions and wellbalanced

faces. Am J Orthod Dentofacial Orthop. 2004;125:366-72

12. Hussein E , Abu Mois M. Bimaxillary protrusion in the Palestinian

population. Angle Orthodontist. 2007;77:817-20.

| 10 | Smile Dental Journal | Volume 5, Issue 4 - 2010

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Pre-Orthodontic Assessment of a

Non-Syndromic Multiple Supernumerary Teeth

with Cone Beam Imaging

Elie Hayek


Dep. of Dento-Maxillo-Facial


Lebanese University

School of Dentistry

Beirut, Lebanon

Georges Khawam


Dep. of Dento-Maxillo-Facial


Lebanese University

School of Dentistry

Beirut, Lebanon

Ibrahim Nasseh

Dr. Chir. Dent., DSO, FICD

Chairman, Dep.of Dento-

Maxillo-Facial Imaging

Lebanese University

School of Dentistry

Beirut, Lebanon


Multiple supernumerary teeth or hyperdontia can be associated with several syndromes,

or it can be present in patients without systemic diseases.

The presence of supernumerary teeth, which is relatively a frequent disorder of

odontogenesis, is characterized by an excess number of teeth that appears in any

area of the dental arches. It can affect any dental organ and usually is associated

with different alterations such as: over retained teeth or delayed eruption, dental

malposition or occlusal problems.

The use of non-conventional radiographic imaging techniques (cone beam) during any

pre-orthodontic assessment is a valuable tool that helps make the early diagnosis of

these types of abnormalities in order to formulate an ideal orthodontic treatment plan.

A routine panoramic radiograph for a 24-year-old male showed the presence of

multiple supernumerary teeth which were located in the four quadrants of his mouth.

The family’s medical history was non-contributory, and an extra-oral examination did

not reveal any abnormality. A cone beam computed tomography examination was

performed for more details.

Keywords: Supernumerary teeth, Non-syndromic hyperodontia, Supplementary tooth,



Dental anomalies may occur in man due to genetic and environmental factors. 1 The

most common ones are supernumerary teeth. These may occur in both dentitions, but

more frequently in the permanent teeth: respectively, 0, 8 to 2, 1% in deciduous and

permanent dentition. 2 Approximately, males are affected twice compared to females. 3

The etiology of development is not clear yet. 4

Multiple supernumerary teeth are usually associated with conditions such as cleft lip

and palate or syndromes like cleidocranial dysplasia and Gardner’s syndrome, but in

very rare cases they are not associated with diseases or syndromes such as our case

report. 5

In general, supernumerary teeth may be single or multiple, unilateral or bilateral,

erupted or unerupted, and in one or both jaws. 6 When the number of multiple

supernumerary teeth is one or two, the most common site is the anterior maxilla, but

when it is five and more, the most common site is the mandibular premolars. 7

Supernumerary teeth classification can be based on both positional or shape variations.

Positional Variations: 8-10

1. Mesiodens: the incisor region

2. Paramolars: beside a molar

3. Disto-molars: distal to the last molar

4. Parapremolars: beside a premolar

Shape or Form Variations: 11,12

1. Conical: peg shaped teeth

2. Tuberculate: made of more than one cusp or tubercule

3. Supplemental: resemble normal teeth

4. Odontome: does not resemble any tooth but is only a

mass of dental tissue

Many problems can be caused by supernumerary teeth

such as: failure of eruption, displacement and crowding,

adjacent teeth root resorption, and formation of

dentigerous cyst. 13

Case Report

A 24 year-old male visited our dental clinic with

complaints of having displacement and crowding of his

permanent dentition.

In order to receive an orthodontic treatment, a clinical

examination (Figure 1) followed by a panoramic

radiograph (Figure 2) revealed the presence of an

excess number of teeth that appears in all quadrants.

A thorough general examination and the family history

confirmed the absence of any kind of disease or

syndrome associated with this case.

A cone beam computed tomography (CBCT) was

undertaken to accurately determine both the position

and number of the supernumerary teeth.

In the upper arch, unerupted supernumerary teeth had

a slightly smaller size than typical premolars and were

located between 14-15 and 24-25 and they were conical

in shape (Figures 3-5).

In the lower arch, there were two supernumerary

teeth in the right quadrant (Figures 6-8) and three

supernumerary teeth resembling typical premolars in the

left quadrant (Figures 9,10).

In summary, the patient had a total of 7 supernumerary

teeth of which two were erupted and five were

unerupted. All of them had a completely formed root.

Third molars were in their respective positions.

After orthodontic consultation, it was decided to have

all unerupted teeth surgically extracted. Two erupted

supernumerary teeth in the lower premolar region were

planned to be extracted after orthodontic alignment of

the adjacent teeth.


In 1990, Yusof 14 reported that premolar region in the

lower arch is the most common place for supernumerary

teeth. In our case the prevalence of supernumerary teeth

appeared in the premolar area but in both arches.

(Fig. 1) Clinical view.

(Fig. 2) Panoramic radiograph with supernumerary teeth in

all quadrants.

(Fig. 3) Axial slices - Supernumerary teeth in the upper arch

on right and left sides.

| 12 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 13 |

(Fig. 4) Cross sectional slices showing position of

supernumerary tooth between 14-15.

(Fig. 5) Cross sectional slices showing palatal position of

supernumerary tooth between 24-25.

(Fig. 6) Axial slice – Two supernumerary teeth in the lower

right side.

(Fig. 7) Cross sectional slices showing position of

supernumerary tooth between 45-46.

(Fig. 8) Cross sectional slices showing position of

supernumerary tooth lingual to 44.

(Fig. 9) Cross sectional slices showing lingual position of

supernumerary teeth between 34-35.

(Fig. 10) Cross sectional slices showing position of

supernumerary teeth between 35-36, presenting coronal


Because displacements, rotation, ectopic eruption,

and malocclusion can be the result of maintaining

supernumerary teeth in the mouth, a clinical and

radiographic examination is essential for a good

orthodontic treatment planning. 15

Treatment may be difficult and may vary from just

extraction of supernumerary teeth or extraction

followed by orthodontic correction to establish a good

occlusion. 16,17

In this case, it was decided to extract all the erupted and

unerupted supernumerary teeth besides the orthodontic


Based upon the supernumerary teeth classification, this

reported case presented the parapremolars position type

along with both supplemental and tuberculate shape.


Non syndromatic multiple supernumerary teeth is a very

rare anomaly that appears usually in the lower premolar


In this case report, the patient presented supplementary

and tuberculate teeth in four quadrants of his mouth.

The use of a cone beam imaging technique is essential

during any pre-orthodontic assessment in order to

evaluate the situation and number of the supernumerary

teeth with all possible details, in three planes (axial,

coronal and sagittal views), irrespective of whether the

patient has any syndrome or not.


1. Ezddini AF, Sheikha MH. Prevalence of dental developmental

anomalies: A radiographic study. Community Dent Health


2. Leco Berrocal MI, Martín Morales JF, Martínez González JM. An

observational study of the frequency of supernumerary teeth in

a population of 2000 patients. Med Oral Patol Oral Cir Bucal.


3. Açikgöz A, Açikgöz G, Tunga U, Otan F. Characteristics and

prevalence of non-syndrome multiple supernumerary teeth: a

retrospective study. Dentomaxillofac Radiol. 2006;35(3):185-90.

4. Peker I, Kaya E, Darendeliler-Yaman S. Clinic and radiographical

evaluation of non-syndromic hypodontia and hyperdontia

in permanent dentition. Med Oral Patol Oral Cir Bucal.


5. Yagüe-García J, Berini-Aytés L, Gay-Escoda C. Multiple

supernumerary teeth not associated with complex syndromes:

a retrospective study. Med Oral Patol Oral Cir Bucal.


6. Rajab LD, Hamdan MAM. Supernumerary teeth: a review

of the literature and a survey of 152 cases. Int Pediatr Dent.


7. Hyun HK, Lee SJ, Ahn BD, Lee ZH, Heo MS, Seo BM, Kim JW.

Nonsyndromic multiple mandibular supernumerary premolars. J

Oral Maxillofac Surg. 2008;66(7):1366-9.

8. Giancotti A, Grazzini F, De Dominicis F, Romanini G, Arcuri

Multidisciplinary evaluation and clinical management of

mesiodens. J Clin Pediatr Dent. 2002;26:233-7.

9. Srivatsan P, Aravindha Babu N. Mesiodens with an unusual

morphology and multiple impacted supernumerary teeth in a nonsyndromic

patient. Indian J Dent Res. 2007;18(3):138-40.

10. Asaumi JI, Shibata Y, Yanagi Y, Hisatomi M, Matsuzaki H, Konouchi

H, Kishi K. Radiographic examination of mesiodens and their

associated complications. Dentomaxillofac Radiol. 2004;33:125-7.

11. Suprabha BS, Sumanth KN, Boaz K, George T. An unusual case of

non-syndromic occurrence of multiple dental anomalies. Indian J

Dent Res. 2009;20(3):385-7.

12. Scheiner MA, Sampson WJ. Supernumerary teeth: a review of the

literature and four case reports. Aus Dent J. 2007;42:160-5.

13. Varela M, Arrieta P, Ventureira C. Non-syndromic concomitant

hypodontia and supernumerary teeth in an orthodontic population.

Eur J Orthod. 2009;31(6):632-7.

14. Yusof WZ. Non-syndrome multiple supernumerary teeth: literature

review. J Can Dent Assoc. 1990;56:147-9.

15. Mason C, Rule DC, Hopper C. Multiple supernumeraries: the

importance of clinical and radiographic follow-up. Dentomaxillofac

Radiol. 1996;25:109-13.

16. Díaz A, Orozco J, Fonseca M. Multiple hyperodontia: report of a

case with 17 supernumerary teeth with non syndromic association.

Med Oral Patol Oral Cir Bucal. 2009;14(5):229-31.

17. Sivapathasundharam B, Einstein A. Non-syndromic multiple

supernumerary teeth: report of a case with 14 supplemental teeth.

Indian J Dent Res. 2007;18(3):144.

| 14 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 15 |






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Diffuse Inflammatory Facial Swelling

Secondary to Local Anesthetic Injections in

Patient with Polyalkylimide Gel Used for

Cheek Augmentation

Kamis Gaballah

BDS, MSc, PhD(Lon), FFD


GCAP (Lon)

Assistant Professor in Oral and

Maxillofacial Surgery and Oral


Ajman University

Ajman, UAE

AbdulRahman Saleh

BDS, MSc, PhD.

Assistant Professor in

Restorative Dentistry

Ajman University

Ajman, UAE


Nowadays the uses of cosmetic fillers have increased dramatically including those placed

in the facial region. Although commercial advertisements claim that injectable fillers are

biologically inert and pose no significant health risks, we report a case of a patient with

bilateral cheek augmentation using Polyalkylimide gel fillers presented with recurrent

episodes of facial swelling following routine dental treatment. The clinical scenario

presented here highlighted the significance of the interference of the facial gel fillers with

the routine dental treatment.

Keywords: Dermal Fillers, Polyalkylimide, Cosmetic surgery, Local anesthesia, Dentistry.


The last two decades showed a rapid worldwide expansion of cosmetic procedures

including the use of injectable filling materials for various facial aesthetic and

reconstructive indications. The soft tissue filler products can be divided into short-term

degradable and long-lasting permanent injectable fillers. While the original fillers were

usually based on either collagen or hyaluronic acid gels, the modern fillers are based

on polymerization to obtain a denser filling effect. Recently the use of permanent fillers

including silicon and Polyalkylimide gels has significantly expanded. Dermal fillers are

generally considered to be safe, although rare but significant adverse reactions have

been reported. 1-4 We report a case of repeated significant adverse reaction for a patient

with Polyalkylimide facial filler when she was subjected to routine dental and oral surgical


Case Report

Thirty years old lady of Iraqi origin was referred by her General Dental Practitioner (GDP)

regarding a sudden diffuse swelling in her right cheek one day after a routine dental visit

involving the placement of a filling for her upper first premolar on the same side. The

restorative treatment was done under local anaesthetic infiltration and no medications

were prescribed to the patient who did not report any allergies to any dental products or

any known medications. The review of the patient’s medical history did not reveal any

chronic illness or regular medications on past or present. Upon presentation, the patient

showed an extensive cellulitic swelling in the right buccal and canine fossa space regions

for the last four days despite the intake of Amoxicillin + Clavulanic acid 625mg, TDS as

prescribed by her GDP. The swelling was firm and tender with evidence of fluctuation. The

oral examination did not conceal any dental origin for this facial swelling. Drainage was

done under local anaesthesia through a buccal sulcus incision and a corrugated rubber

drain was inserted and secured in place for 48 hours. Upon drainage, a yellowish pus

like fluid was obtained and sent for microbiological testing and the patient was advised

to continue taking the antibiotic course as prescribed. The follow up showed excellent

tissue response. Because of the lack of growth in microbiological testing, more detailed

case history reveled that the patient had similar symptoms following the injection of a

dermal filler to build up her cheeks and her cosmetic specialist had given her repeated

courses of antibiotics and occasional steroid courses. The patient was happy about the

healing progress however she noticed a slight facial asymmetry owed to the loss of the

filler substance from her right cheek. Three months later the same patient was referred

back again by the restorative dentist for the removal of her upper third molar teeth as




(Fig. 1) The post operative outcome of the patient

management. The pictures show a mild asymmetry due to a

residual inflammation and fibrosis on the left cheek (B) as

compared with the right side (A). (C) the frontal profile of the

patient showing the same changes. (D) shows the skin marks

left behind as result of the use of transcuteneuos aspiration.

they presented an oral hygiene challenges and depicted

an early occlusal cavities. Both teeth were atraumatically

extracted under local anaesthetic infiltration. Both teeth

were gently elevated and delivered intact without the need

for additional surgical tissue manipulation.

Interestingly, the patient reported 48 hours later the

same scenario of cheek swelling but in the left side only

this time. The same treatment approach was considered

and comparable outcome results observed except for

two isolated points of collection that required additional

drainage. All surgical interventions were carried out

intraorally with no attempt to aspirate the fluid through the

facial skin. However, the patient herself has attempted this

approach which resulted in two tiny skin dimples on her

left cheek. Figure 1 shows the postoperative results of the



All injectable dermal fillers have side effects. 1-4 This can be

explained by the nature of the filler material; for instance

the natural and protein–based fillers tend to cause

hypersensitivity reaction owed to their antigenicity, on the

other hand, the synthetic filler may cause more irrational

effects and mediate infection attributed to implantation of

foreign bodies. When the filler lasts longer, it gives more

stable reconstructive and aesthetic results. But this may

subject the patient to more adverse reactions, some with

recurrent or delayed nature.


Our patient had a Polyalkylimide-based dermal filler to

augment her both cheeks aiming for more youthful and

beautiful appearance. She admitted that she had this

procedure done because of an advice from a relative and

her cosmetic specialist. The patient had also reported

multiple episodes of facial swelling following the injection

of the dermal filler gel and received several courses of

antibiotics and steroids to overcome these adverse effects.

Polyalkylimide gel is a non resorbable biocompatible

polymeric gel and consists of 96% apyrogenic water and

4% Polyalkylimide. 5 The compound has a reticulated

structure that resembles the adipose tissue in which it is

commonly implanted; it has a pH of 7 and an oxidative

value of almost 0.2. Polyalkylimide can be injected under

the skin for soft tissue replacement. It is described as an

endoprosthesis; after implantation, a thin membrane

(biofilm) of 0.02mm of collagen is formed around the

material, connecting it to the surrounding tissue and

keeping the material together. 4

Even a long time after implantation, the gel can be

removed by puncturing the biofilm and squeezing the

gel out. It was reported that the biofilm is responsible

for many filler side effects, particularly those that present

as late-onset complications. 1 A biofilm is a complex

aggregation of microorganisms marked by the excretion

of an extracellular protective and adhesive matrix. 2

This structure of excreted polymeric substance allows

complex community interactions with enlargement of

the biofilm as more and more cells join. This may lead

to the development of increasing antibiotic resistance,

sometimes requiring up to a 1,000 times greater

concentration of a given drug, which demonstrates

a high degree of specificity and activity when used

against bacteria in the non-biofilm state. In addition, the

adhesive extracellular matrix traps leucocytes, making

them ineffective through immobility. 6,7 Biofilm microbial

populations can shift from active to dormant depending

on exogenous threats. When bacterial proteins turn off

their cell metabolism and the cell becomes dormant,

it becomes antibiotic resistant, as well as difficult, if

not impossible, to culture. Biofilm detection in biopsies

requires the use of special methods like fluorescent DNA

stains or Polymerase Chain Reactions. 5

Manipulation, trauma, or the injection of another

substance in close proximity can activate biofilms. This can

result in a clinical picture of local infection, including an

abscess, cellulitis, or a systemic infection. 2

Biofilms may also account for many of today’s filler

complications, including granulomas, nodules,

inflammation, and other delayed reactions (Figure 2).

We regard the repeated clinical scenario seen in the

patient we report here as a disturbance of the biofilm

surrounding the gel filler injected in the patient’s cheek

four years ago. The biofilm irritation is more likely

| 18 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 19 |



Foreign Body Reaction


Disruption and Detachment



(Fig. 2) The different forms of complication related to the

disruption of the gel biofilm.

related to the local anaesthetic injection rather than

the dental or surgical procedures. In this context,

it is worth to mention that the same patient did not

experience any adverse reaction when she had her

lower teeth treated under local anaesthesia which was

injected anatomically away from the gel filler areas.

The word the authors wanted to spread is that patient

receiving intradermal gel should be warned about

the potential interaction of the dental intervention and

patient should inform their GDP about the presence

of the gel filler.

The other massage is to Oral Surgeons who may treat

patients with such condition; should consider a serious

approach including surgical incision and drainage of

the abscess and filler through an intraoral access with

adequate adjuvant antibiotic despite the negatively

reported microbial culture. Finally, the attempt to

aspirate the gel content through the facial skin should

be avoided as this might need to be repeated several

times to evacuate all infected content and may also

leave unwanted skin marks.


1. Monheit GD, Rohrich RJ. The nature of long-term fillers and the

risk of complications. Dermatol Surg. 2009;35(2):1598-604.

2. Narins RS, Coleman WP 3 rd , Glogau RG. Recommendations

and treatment options for nodules and other filler complications.

Dermatol Surg. 2009;35(2):1667-71.

3. Bachmann F, Erdmann R, Hartmann V, Wiest L, Rzany B. The

spectrum of adverse reactions after treatment with injectable

fillers in the glabellar region: results from the Injectable Filler

Safety Study. Dermatol Surg. 2009;35(2):1629-34.

4. Schelke LW, van den Elzen HJ, Canninga M, Neumann MH.

Complications after treatment with polyalkylimide. Dermatol

Surg. 2009;35(2):1625-8.

5. Christensen L, Breiting V, Janssen M, Vuust J, Hogdall E. Adverse

reactions to injectable soft tissue permanent fillers. Aesthetic Plast

Surg. 2005;29:34-48.

6. Christensen LH. Host tissue interaction, fate, and risks of

degradable and nondegradable gel fillers. Dermatol Surg.


7. Patrick T. Polyacrylamide gel in cosmetic procedures: experience

with Aquamid. Semin Cutan Med Surg. 2004;23(4):233-5.

| 20 | Smile Dental Journal | Volume 5, Issue 4 - 2010

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An Interdisciplinary Approach for

Restoring Function and Esthetics in a

Patient with Amelogenesis Imperfecta:

A Case Report

Sunil Kumar Gupta


Assistant Professor

Dep. of Conservative Dentistry &


Manipal College of Dental Sciences

Manipal, India

Shashi Rashmi Acharya


Professor & Head of Department

Dep. of Conservative Dentistry &


Manipal College of Dental Sciences

Manipal, India

Jaya Siotia


Assistant Professor

Dep. of Conservative Dentistry &


Faculty of Dentistry

Melaka Manipal Medical College

Manipal, India

Amar A Sholapurkar


Assistant Professor

Dep. of Oral Medicine & Radiology

Manipal College of Dental Sciences

Manipal, India


Amelogenesis Imperfecta has been defined as a group of hereditary enamel defects

not associated with evidence of systemic disease. Restoration for patients with this

condition should be oriented toward the functional and aesthetic rehabilitation.

The importance of treating the Amelogenesis Imperfecta patient is not only important

from a functional standpoint, but also from a psychosocial health standpoint. The

complexity of the management of patients with Amelogenesis Imperfecta requires

careful considerations of patient expectations for a successful outcome of the


The purpose of this case report is to present the aesthetic and functional rehabilitation

of the teeth with an overall enhancement of personality of a 24-year-old patient with

Amelogenesis Imperfect.

Keywords: Amelogenesis imperfecta, Hereditary enamel defects, Interdisciplinary

approach, Oral rehabilitation, Porcelain laminate veneers.


Amelogenesis imperfecta (AI) is a heterogeneous inherited disorder of tooth

development affecting both primary and permanent dentition. 1 The manifestations

vary greatly among individuals, with discoloration (yellow, brown, or gray),

generalized areas of exposed dentin, pitted enamel with an increased susceptibility

to plaque accumulation, caries, and hypersensitivity to temperature changes. 2 This

genetic disorder is known to be associated with the malfunction of the enamelforming

proteins ameloblastin, enamelin, tuftelin, and amelogenin. 3

These anomalies can be classified as hypocalcified, hypoplastic, or hypomature

based on clinical findings, radiographic findings and hereditary criteria. 4,5 In the

hypoplastic type, there is a deficiency in the quantity of enamel, the mineralization

of enamel appears to be normal, hard and shiny however it is malformed. In

the hypocalcified type, the enamel is formed in relatively normal amounts but is

poorly mineralized, soft, and friable and can be easily removed from the dentin.

In the hypomaturation type, enamel appears mottled, opaque white to red-brown

coloration, and is softer than normal and tends to chip from the underlying dentin.

A recently published survey reported the importance of treating the AI patient not only

from a functional standpoint, but from a psychosocial health standpoint as well. 6,7

Results of the survey reported that patients with AI experience higher levels of social

avoidance combined with a reduced perceived quality of life compared to those

without AI, and that treatment has a positive psychosocial impact. 7

This rare dental abnormality poses a major restorative challenge for the dentist.

Using conservative techniques desirable aesthetics can be achieved.

Numerous treatment options have been described for

the restoration of the aesthetics and function of teeth in

patients suffering from AI. 8,9,10

We report a case of hypoplastic variant of AI and

describe the sequenced interdisciplinary approach to

restore the function and aesthetics to an acceptable level.

This clinical report describes the sequenced treatment for

a patient with hypoplastic type of AI.

Case Report

A 24-year-old male patient presented with yellowish

discoloration of his teeth. He also complained of

sensitivity to hot and cold, wear of posterior teeth and

compromised masticatory function.

He was very conscious about the appearance of his

teeth and on questioning he reported that his primary

dentition was affected in same manner. A detailed

medical history, dental history and social history was

obtained but was non-contributory. The patient was

questioned further about the presence of similar

abnormalities in his family where he stated that his sister

has a similar defect in her teeth.

Extra oral examination revealed no abnormalities.

Intraoral examination revealed yellowish discoloration

of entire dentition, peg shaped maxillary lateral incisors

and pitted enamel surface of both maxillary central

incisors (Figure 1). There was generalized loss of contact

and contour of teeth (Figure 2). The enamel layer was

nearly absent in the occlusal portion of the molars and

the exposed dentin was hypersensitive.

Tooth 26 was decayed and tender on percussion. On

IOPA examination revealed apical periodontitis. Teeth 17

and 47 were also proximally decayed.

Teeth number 36, 37 and 46 were missing (Figure 3).

Tooth 38 was mesially tilted. There was no cusp fossa

relationship bilaterally. The patient’s oral hygiene was fair.

Panoramic radiograph showed generalized defective

enamel in all teeth with its radiodensity being the same

as that of dentin (Figure 4).

After thorough clinical and radiographic examination, the

patient was diagnosed as having a hypoplastic type of AI.

Maxillary and mandibular complete-arch impressions

were made using irreversible hydrocolloid (Jeltrate,

Alginate, Fast Set; Dentsply Intl, York, Pa) impression

material. Diagnostic casts were fabricated from Type-

III dental stone (Pankaj Industries, Mumbai, India) and

mounted on a semi-adjustable articulator (Articulator

#3140; Whip Mix Corp) using a face-bow transfer

(#8645 Quick Mount Face-Bow; Whip Mix Corp)

and a centric relation record (Take 1 Bite; Kerr Corp,

Orange, Calif).The articulator was programmed using

(Fig. 1) Pretreatment frontal view in maximum intercuspation

with Amelogenesis Imperfecta.

(Fig. 2) Pretreatment maxillary occlusal view showing

generalized loss of contact and contour of teeth.

(Fig. 3) Pretreatment mandibular occlusal view.

protrusive and lateral records (Coprwax Bite Wafers;

Heraeus Kulzer, South Bend, Ind). The diagnostic

waxing was done. The interdisciplinary approach was

followed because of the complex needs of the patient.

The treatment was aimed to improve esthetics, reduce

the reported sensitivity of the teeth and restore the

masticatory function.

| 24 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 25 |

(Fig. 4) Pretreatment Panoramic radiograph showing

generalized defective enamel in all teeth with its radiodensity

being the same as the dentin.

The appropriate shade was then selected using the VITA

shade guide (Vita Zahnfabrik, Badsackingen, Germany)

prior to preparation. Maxillary and mandibular posterior

teeth were prepared for metal-ceramic restorations. Teeth

were prepared for fixed dental prosthesis in mandiblular

left quardrant for replacing missing teeth. After all the

posterior teeth were prepared, impressions were made

with addition polyvinyl siloxane material (Reprosil,

Dentsply/Caulk; Milford, DE, USA) in special trays.

Heat-cured provisional restorations were fabricated

using methyl methacrylate acrylic resin. The provisional

restorations were temporarily cemented using Provicol,

eugenol free Ca(OH)2 cement (Voco, Cuxhaven,


Vivadent AG) and a bonding agent (Heliobond; Ivoclar

Vivadent AG) with the use of rubber-dam isolation.

Photo-polymerization was performed with a light

polymerizing unit (Hilux 350; First Medica, NC) at 350

mW/cm 2 for 40 seconds for incisal, mesial, and distal

surfaces (Figures 6-9).

The anterior porcelain laminate veneers, veneer

crowns, full metal crown, metal-ceramic crown and

metal-ceramic fixed dental prosthesis were satisfactory

both aesthetically and functionally at the end of 1 year

of clinical service and the patient’s oral hygiene was

satisfactory. Pt was very happy with his appearance,

more confident during smile and highly enthusiastic

concerning his work.

From the impressions, casts were made and mounted in

an articulator to produce full metal crown, metal-ceramic

crown and a metal-ceramic four-unit fixed dental

prosthesis for replacement of the missing teeth 36 and

37. The metal frameworks were evaluated intraorally to

determine the marginal fit. A metal trial insertion, prior

to glazing of the ceramic material was performed, which

enabled the final occlusal refinement. The crowns were

then completed in the laboratory and cemented with

luting glass ionomer cement (GC, Tokyo, Japan).

(Fig. 6) Posttreatment maxillary occlusal view with cemented

crowns, bonded porcelain laminates veneers and veneer crowns.


Management of a patient with AI is a challenge for the

clinician. The restoration of aesthetics and function in

these patients may be achieved with a dedicated team

approach. In our case, meticulous attention to detail,

from diagnosis to postdelivery monitoring, allowed a

controlled and logical treatment sequence. 11

Based on the clinical presentation and family history a

diagnosis of AI (hypo plastic) was made.

(Fig. 5) Lateral view showing incision for gingivoplasty.

First, restoration of decayed teeth and root canal

treatment of indicated teeth was planned then

fabrication of metal ceramic, full metal crowns and fixed

dental prosthesis for the restoration of posterior teeth in

functional occlusion and porcelain laminate veneers and

veneer crowns for esthetic rehabilitation of anterior teeth

were planned. The pt was informed of the diagnosis and

the treatment plan, which he accepted.

First oral prophylaxis was done and oral hygiene

instructions were given, the patient was placed on a

0.12% chlorohexidine gluconate oral rinse, with a

recommended use of twice daily.

Since the heights of the crowns of the maxillary and

mandibular teeth were inadequate for the fabrication

of the prosthesis, gingivoplasty was done as a part of

the crown lengthening procedure with consideration for

biologic width dimensions (Figure 5). The surgical site

was allowed to heal for three months.

After evaluation of radiograph and diagnostic wax

up it was anticipated that remaining dentin thickness

would be insufficient for protection of pulp during tooth

preparation. So intentional endodontic therapy was

performed for teeth 27,38, 47 and 48. Endodontic

treatment was also done for tooth 26 because of apical


In order to avoid trauma to the gingival sulcus a thin

retraction cord was inserted into the sulcus prior to

preparation. The facial surfaces of the maxillary and

mandibular anterior teeth were prepared. A 0.5mm

facial reduction was performed, creating a chamfer

cervical finish line. The incisal edges of the teeth were

prepared to allow overlap of the restoration. Self-limiting

depth-cutting disks of 0.5mm thickness were used to

define the depth of the cuts. All tooth preparations were

completed without sharp line angles.

For maxillary peg shaped lateral incisors, preparation

was done for veneer crowns which was simply a veneer

that covers the entire tooth. A 0.5mm facial and 1.0mm

lingual reduction was performed.

Provisional restorations were fabricated using direct

composite resin for all anterior teeth to improve interim

aesthetics and decrease sensitivity. Final impressions

for prepared teeth were made with addition polyvinyl

siloxane material (Reprosil, Dentsply/Caulk; Milford, DE,

USA). Casts were made and mounted in an articulator.

All restorations were fabricated with IPS Empress 2

materials (Ivoclar Vivadent AG, Schaan, Liechtenstein)

according to the manufacturer’s directions.

After completion, the porcelain laminate veneers and

veneer crown were evaluated for fit on the prepared

teeth. They were then luted with a resin luting agent

(Variolink II high viscosity; Ivoclar Vivadent AG) in

combination with a dentin adhesive (Syntac; Ivoclar

(Fig. 7) Posttreatment mandibular occlusal view with cemented

crowns, bonded porcelain laminates veneers.

(Fig. 8) Posttreatment frontal view in maximum intercuspation.

(Fig. 9) Posttreatment Panoramic radiograph.

According to Seow 6 the primary clinical problems of

AI are aesthetics, dental sensitivity, and loss of vertical

dimension. These patients are highly susceptible to

dental caries, gingival inflammation, as well as an

anterior and posterior open bite.

The treatment options vary considerably depending on

several factors such as the age of the patient, socioeconomic

status, periodontal condition, loss of tooth

structure, severity of the disorder, and, most importantly,

the patient’s cooperation. 12

There are a number of alternatives for the treatment of

anterior teeth affected by AI. 8,9,10 For many years the

most predictable and durable aesthetic restoration of

anterior teeth has been achieved with complete crowns. 13

However, as this approach requires the removal of

substantial amounts of tooth structure, it is more

invasive. The popularity of porcelain laminate veneers

has increased since being introduced because tooth

preparation is conservative, and the restorations are

esthetic. 14 In addition, patient acceptance of porcelain

veneers has been shown to be high in clinical studies. 15

The percentage of patients completely satisfied with

the porcelain veneers varied from 80% to 100%. 16 In

our case, veneer crowns were given for maxillary peg

shaped lateral incisors because tooth was very small

and retention of laminate veneer was questionable.

According to Summitt 17 , a veneer crown is simply a

| 26 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 27 |

veneer that covers the entire tooth. It has a conservative

preparation design compared to all ceramic restoration.

The most common indication of veneer crown is peg

shaped lateral incisors. 17

The clinician has to consider the long-term prognosis

of the treatment outcome. This clinical report describes

the fabrication of metal ceramic and full metal crowns

for the restoration of posterior teeth in functional

occlusion and porcelain laminate veneers, veneer crowns

for anterior teeth as it is a conservative approach to

modify teeth’s color, shape, and length and to close the

space. Sacrificing as little tooth structure as possible

and conserving the supporting tissues will facilitate

prospective treatments for young adult patient. Patients

with AI require meticulous maintenance of oral hygiene.

The importance of treating the AI patient is not only from

a functional standpoint, but also from a psychosocial

health standpoint. The complexity of the management of

patients with AI requires careful considerations of patient

expectations and requests, an interdisciplinary approach

which is critical for a successful outcome and patient



This clinical report described an interdisciplinary

approach of AI with the use of porcelain laminate

veneers, veneer crowns, full metal crown, metal-ceramic

crown and metal-ceramic fixed dental prosthesis to

restore the masticatory function, improve the esthetics

and to reduce the reported sensitivity of the teeth

with careful consideration of patient expectations and



The authors would like to thank Dr. Rupali Agnihotri,

Dr. Subraya Bhat from department of Periodontics,

for periodontal consideration and Mr. Umesh, dental

technician for fabrication of the prosthesis presented in

the case.


Amelogenesis imperfect (AI)


1. Coley-Smith A, Brown CJ. Case report: radical management

of an adolescent with amelogenesis imperfecta. Dent Update.


2. Hart PS, Wright JT, Savage M, Kang G, Bensen JT, Gorry MC, Hart

TC. Exclusion of candidate genes in two families with autosomal

dominant hypocalcified amelogenesis imperfecta. Eur J Oral Sci.


3. Gokce K, Canpolat C, Ozel E. Restoring function and esthetics in

a patient with amelogenesis imperfecta: a case report. J Contemp

Dent Pract. 2007;8(4):95-101.

4. Soares CJ, Fonseca RB, Martins LR, Giannini M. Esthetic

rehabilitation of anterior teeth affected by enamel hypoplasia: a

case report. J Esthet Restor Dent. 2002;14(6):340-8.

5. Wright TJ, Robinson C, Shore R. Characterization of the enamel

ultrastructure and mineral content in hypoplastic amelogenesis

imperfecta. Oral Surg Oral Med Oral Pathol. 1991;72(5):594-601.

6. Seow WK. Clinical diagnosis and management strategies of

amelogenesis imperfecta variants. Pediatr Dent. 1993;15(6):384-93.

7. Coffield KD, Phillips C, Brady M, Roberts MW, Strauss RP, Wright

JT. The psychosocial impact of developmental dental defects in

people with hereditary amelogenesis imperfecta. J Am Dent Assoc.


8. Encias RP, Garcia-Espona I, Rodriguez de Mondela JM.

Amelogenesis imperfecta. Diagnosis and resolution of a case with

hypoplasia and hypocalcification of enamel, dental agenesis, and

skeletal open bite. Quintessence Int. 2001;32(3):183-9.

9. Greenfield R, Iacono V, Zove S, Baer P. Periodontal and

prosthodontic treatment of amelogenesis imperfecta: a clinical

report. J Prosthet Dent. 1992;68(4):572-4.

10. Bouvier D, Duprez JP, Pirel C, Vincent B. Amelogenesis imperfecta-a

prosthetic rehabilitation: a clinical report. J Prosthet Dent.


11. Williams WP, Becker LH. Amelogenesis imperfecta: functional

and esthetic restoration of severely compromised dentition.

Quintessence Int. 2000;31(6):397-403.

12. Sari T, Usumez A. Restoring function and esthetics in a patient

with amelogenesis imperfecta: a clinical report. J Prosthet Dent.


13. 13. Peumans M, Van Meerbeek B, Lambrechts P, Vanharle

G. Porcelain veneers: a review of the literature. J Dent.


14. Zalkind M, Hochman N. Laminate veneer provisional restorations:

a clinical report. J Prosthet Dent. 1997;77(2):109-10.

15. Meijering AC, Creughers NH, Roeters FJ, Mulder J. Survival of

three types of veneer restorations in a clinical trial: 2.5-year interim

evaluation. J Dent. 1998;26(7):563-8.

16. Rucker LM, Richter W, MacEntee M, Richardson A. Porcelain and

resin veneers clinically evaluated: 2 year results. J Am Dent Assoc.


17. Jeffrey S. Rouse. Anterior ceramic crowns. In: Summitt JB, Robbins

JW, Hilton TJ, Schwartz RS (3 rd eds). Fundamentals of Operative

Dentistry: A Contemporary Approach. Chicago: Quintessence,


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| 28 | Smile Dental Journal | Volume 5, Issue 4 - 2010 | Tel.: +971 4 3616174 | Mob.: +971 50 279 3711

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Advancement in the Removal of Permanently

Cemented Crowns and Bridges

Jean Luc Girard


Marseille University Hospital

Private practice




Traditional techniques for removing permanent prosthetic devices do not provide reliable

or satisfactory results. At best, they make it possible to keep a tooth at the cost of a timeconsuming

procedure that also inflicts wear and tear on rotary instruments; at worst, they

can cause abutments or restorations to fracture.

Comprised of three carefully designed keys, WAMkey offers a truly unique approach

to this challenge while fulfilling numerous expectations. A concrete clinical case will

illustrate all of the advantages of this innovative method.

Keywords: Wamkey, Crown remover, Bridge remover, Periodontal ligament.


Removal of a crown or bridge, often following a failed therapeutic or cosmetic

procedure, is seldom a positive experience for the patient or the dentist. When

traditional techniques are employed, this procedure often bears considerable risk for

the supporting tooth and its periodontal ligament, and frequently results in the complete

and irremediable destruction of the prosthetic device. This procedure can also be costly

in terms of time and equipment, as burs and contra-angle handpieces undergo intense

wear and tear.

Comprised of three carefully designed keys, WAMkey offers a truly unique approach to

this challenge while fulfilling numerous expectations. To use the device, a small slot must

be drilled through the axial wall of the crown at the level of the cement layer between

the occlusal aspect of the prepared tooth and the inner surface of the crown. Introducing

and rotating one of the keys into this slot (almost) always loosens the crown. In most

cases, one to two minutes per crown is more than enough time for complete removal.

Several precautions are emphasized and recommended herein to ensure the procedure

is risk-free for the tooth and trauma-free for the patient. As the icing on the cake, this

technique allows the crown to be reused following a simple repair procedure.

Generally speaking, the obstacles to crown removal common to all devices used

are: retention, the type of seal and the supporting abutment’s ability to withstand the

mechanical constraints required for successful removal.

1. Retention is essentially determined by:

a. The shape of the preparation: the retention force is inversely proportional to the

preparation’s degree of taperness 1 and can potentially be increased by the presence

of retention devices (grooves).

b. The contact surface between the abutment and the prosthetic device: the retention

force is naturally proportional to this value.

2. The seal

a. The adhesion index can as much as triple, depending on the product being used

(i.e. an oxyphosphate vs. an adhesive such as Panavia). 2 The force required for

removal therefore varies in the same proportions.

b. The cohesion of this cement or glue seal deteriorates over time. 3

3. The abutment’s structure and shape can

contraindicate all removal attempts:

• A high, thin abutment, for example, is much more

vulnerable to fracture than a low, wide one.

• If incorrectly perceived, the angle divergence between

the long axis of the tooth and that of the buildup can

lead to iatrogenic removal forces.

• The very nature of the stump – be it metal, resin or

natural tooth – will make it more or less resistant to

the forces exerted during the removal process.

A – Traditional Solutions

1. Traction-based methods and devices (manual

crown removers, sticky paste squeezed between

the teeth, various pliers, etc.)

Regardless of the instrument used to remove the

prosthetic device – be it manual, assisted or mechanized

– dentists face three unavoidable challenges:

a. A significant portion of the dentist’s energy or that

of the instrument being used is absorbed by the

periodontal ligament (Figure 1). Not only does this

account for the pain felt by the patient, it can also

cause a luxation of the ligament. Moreover, it explains

the ineffectiveness of the many traction-based devices

currently available on the market, in which only a very

low percentage of the energy produced is utilized to

actually break the cement.

b. When the crown is supported by a core buildup, the

dentist does not know in advance what will come

off: the buildup or the crown. In addition, when the

buildup is anchored with a post, the root is more

fragile, which increases the risk of fracture during

removal attempts.

c. Modern technology does not enable dentists to see

through metal crowns in order to have a precise view

of the axis of the preparation. It is virtually impossible

for the dentist to be certain that forces are being

directed precisely to the same axial direction as the

crown’s path of insertion. For this reason, the dentist

generally proceeds with a series of light, off-center

tapping movements. Abutment fractures are therefore

common (Figure 2).

(Fig. 1) (Fig. 2)

A similar technique

(Fig. 3)

involves asking the

patient to bite into

an adhesive paste

(Figure 3), as if it were

a caramel or nougat,

and then asking the

patient to try to open,

hoping that the traction

will occur in the axis of

coronal draw. However,

there is no guarantee

that the dentist made

the preparations in the

same axis as that in

which the jaws open

and close. Moreover,

in the case of buildups or crowns on antagonist teeth,

the result of this technique relies purely on chance or,

more accurately, on a fundamental law: the weakest link

always gives.

In short, besides the fact that crown “pullers” and other

similar devices are often ineffective and may cause

considerable patient trauma, above all their use presents

serious risk factors for the periodontal ligament and the

tooth, and their outcome is highly unpredictable.

2. Destruction of the crown

While some consider this to be the safest and least

traumatizing method for the patient and the tooth, it

destroys the margin of the crown and eliminates all

chances of reusing the crown. In addition, depending

on the type of alloy used, this operation can be long

and can inflict superfluous wear and tear on rotary


3. Ultrasonics

This may seem like a good solution because of its

atraumatic nature. However, the application of vibrations

over long periods of time can damage the ceramic

or even cause it to become detached from the metal

coping. 4 Ultrasonic energy also generates considerable

heat which can cause permanent damage to the nearby

pulp, periodontal ligament and bone. In addition,

removing the crown with this method often requires more

time than a dentist is willing to spend on an act that may

have no value in the eyes of patients.

In 2000, a concept developed by Dr. William Muller (Aixen-Provence,

France) was introduced enabling dentists to

accomplish this act with greater peace of mind and often

astonishing results. Its name is WAMkey.

B – WAMkey

The device

A set of three keys (Figure 4) with oval-shaped cam-like

tips whose sections range from 2.5 to 5mm² (Figure 5).

| 30 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 31 |

(Fig. 4)

(Fig. 5)

(Fig. 6)

(Fig. 7)

(Fig. 8) (Fig. 9)

(Fig. 10)

The protocol

The idea is relatively simple, and consists of four steps.

1. Create a small window in the crown (Figure 6)

Using the appropriate bur depending on the material

encountered, the dentist creates a window (1-2mm

in diameter) where the preparation/crown occlusal

interface is assumed to be located. Of course, the

opening should be made closer to the occlusal surface

for metal crowns, and perhaps about halfway between

the occlusal surface and the margin for porcelain or

porcelain fused to metal crowns.

2. Locate the stump/crown occlusal interface

Chances are, the dentist will locate this interface in

Step 1, in which case he/she can directly proceed

to Step 3. However, in some cases, the opening will

have to be progressively enlarged until the cement

seal becomes visible. The most complex procedure

is the removal of crowns on post-cores. The fact that

the seal is located between two structures of identical

material and that it is generally very thin can be a

challenge. Visual assistance devices such as a surgical

loupes or a microscope can be extremely helpful.

3. Create a tunnel between the occlusal surface of

the preparation and the inner side of the crown

(Figure 7)

Using a cylindrical bur (approximately 1.2mm in

diameter), the dentist drills an oval-shaped tunnel

between the occlusal surface of the preparation and

the inner side of the crown. The difference in hardness

between the dentine and the crown’s structure will

help the dentist ascertain the bur’s position with

regard to the dentine. On a vital tooth, to avoid all

risk of pulpitis, a water syringe should be used for

irrigation purposes in addition to the contra-angle

handpiece spray.

Verify the depth of the tunnel using a rubber-stop

inserted onto the smallest WAMkey device. It is essential

to achieve maximal proximity to the center of the

preparation, so as to work as close as possible to

the long axis of the preparation during the removal


4. Insert a key into the tunnel and rotate to loosen

the crown (Figure 8)

Simply insert the key all the way to the end of the

tunnel drilled in Step 3 and rotate it one quarterturn.

This creates a couple of forces between the

preparation and the crown’s inner side. If the tunnel

was properly drilled, this movement should occur in

the long axis of the preparation.

Mechanical analysis

The effectiveness of the concept can be explained in a

relatively simple manner by comparing it to a crown


a. There is little or no energy loss resulting from this

mechanical principle (Figure 9). The only energy loss

is caused by friction between the key and the crown’s

inner side, and between the key and the preparation’s

occlusal surface. This loss is considerably reduced by

the instrument’s shape and surface condition, and

can be reduced even more by lubricating the tip of the

device with Vaseline for the most delicate cases. The

logical outcome is that a much lower degree of force

is required to loosen a crown using WAMkey than with

a traditional crown “puller”.

b. As opposed to crown removers, the forces are

essentially exerted in the axis of the preparation, 5

provided that the tunnel between the crown and the

preparation was drilled as close as possible to the

center of the preparation. Thus, when the couple

of forces go into action, the crown, propelled from

its center, is free to “choose” its trajectory (Figure

10). And so it follows the path of least resistance.

Combined with the fact that there is little to no energy

loss, this means that crowns can be removed with very

little effort.

c. No trauma for the ligament: Contrary to crown

removers, pressure – not traction – is exerted on the

ligament. The patient therefore enjoys maximum

comfort during the procedure. In most cases, no

anesthesia is required.

d. No risk for buildups. The crown is removed thanks to

a couple of forces exerted between the preparation

and the crown. In the case of restorations, the

pressure is applied to the buildup apically, thus

eliminating all risk of loosening it.

Advantages of the device

The advantages of this concept stem from what we

described above.

1. Quick and simple

The device is very easy to use. Two or three uses are

enough to become familiar and comfortable with the

concept. In general, one-and-a-half to two minutes

suffice to remove a crown. Only full-metal or porcelain

fused to metal crowns can sometimes take a bit longer

as the dentist must first locate the cement seal. Removal

of ceramic crowns can also be delicate if one wants to

keep the ceramic fully intact.

2. Efficiency

Based on what we explained above, this concept offers

unprecedented efficiency. Nevertheless, one limitation

must be mentioned: anterior teeth. Because of their

configuration, it is generally not possible to use this

method to remove crowns from anterior teeth. In all

other cases, users frequently report a high success

rates, even when used on the most modern cementing


3. Little to no risk

The innocuousness of this device stems from what we

described above. The forces exerted are reduced to

a minimum and are applied to the long axis of the

preparation, 6 with pressure applied apically to the

abutment tooth.

4. Less wear and tear on rotary instruments:

This varies depending on the type of alloy. Obviously,

dentists who frequently remove prosthetic devices made

of a non-precious alloy or a more recent material (e.g.

zirconium) will be more swayed by this argument.

5. Reuse of the crown or bridge

The most important parts of the crown are not altered. If

the dentist does not modify the margin of the abutment,

and the crown still fits the abutment, then a simple repair

will enable the crown to fulfill all of its original functions.

This can be an advantage, particularly in the following


• Immediate reuse of the removed crown when the visit

does not allow enough time to fabricate a temporary


• Canal retreatment procedures performed through

a crown are often more delicate than if the crown is

removed (improved visibility and access to the canal).

When the outcome of the treatment is uncertain,

permanent or long-term reuse of the crown (18-24

months) can be an effective transitional solution. 4,7-10

• Bridges with partial detachment: If a bridge becomes

loose on one abutment without posing any particular

adjustment issues, reusing it can be a worthwhile

alternative and compromise for the patient. 5

• Long bridges can be temporarily reused following a

rebase procedure, while adjustments are made to the

various abutment restorations.

In most, if not all cases, the temporary reuse of the

crown is clearly a major advantage.

For all of these reasons, WAMkey represents a major

advancement compared to all previous techniques.

Clinical Case

Extensive work was planned to be performed for the

patient. A complete maxillary prosthesis must be made,

and for obvious biological and cosmetic reasons (Figures

11,12) the lower bridge must be removed. The nickelchrome

framework features a long support span, in

one block, with no anterior abutments. Before removal,

we cannot be certain of the condition of the six existing

abutments or whether it will be possible to save them.

Salvaged abutments will need to be endodontically

retreated, rebuilt and reinforced with fiber posts. Once

rebuilt, and depending on their mechanic potential, a

fixed prosthetic solution will be considered, such as a

tooth-supported bridge or an implant-tooth supported

prosthesis. A single visit, even if very long, will not be

enough to retreat and restore all six teeth and make a

temporary, reinforced 12-unit bridge.

We decided to remove the fixed bridge, assess the

clinical situation, apply periodontal treatment, minimally

adjust the marginal limits and rebase the original bridge

for temporary use until the endodontic therapy could be


| 32 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 33 |

(Fig. 10) (Fig. 11)

(Fig. 18) 19a)

(Fig. 25)

Of course, we could have removed the crown by

destroying all of its components. This undoubtedly

would have been lengthy and tiresome procedure for

the patient and the practitioner, and given the type of

alloy encountered, several burs would probably have

been used. We also could have tried to remove the

entire bridge using a crown remover, with all of the risks

inherent to such a procedure.

(Fig. 12)

(Fig. 19) 19b)

Instead, we create a small opening in all six abutments

(Figures 13,14). This operation required seven to eight

minutes. As recommended by the manufacturer, the

depth of each orifice is measured (Figures 15,16) using

a rubber-stop attached to the smallest WAMkey device

so as to ensure that the forces are exerted as close as

possible to the long axis of the abutments.

(Fig. 13) (Fig. 14)

(Fig. 26) Temporary anterior bridge

As compared to single crown removal, bridge removal

requires more controlled action on each abutment

in order to avoid generating tension on the adjacent

abutments. Each abutment is therefore handled

individually in order to break the cement seal. Once all

six seals are broken, the bridge is manually removed.

The procedure was performed without the slightest

discomfort for the patient, and no anesthesia was

necessary. On most abutments, an astonishingly low

amount of force is required to break the seal.

(Fig. 15)

(Fig. 16)

(Fig. 20)

(Fig. 27) Nobel Implants

Tiny nicks can be seen on the occlusal surface of each

abutment (Figures 17,18), caused by the bur. Although

unfortunate, this loss of matter has no major impact on

the outcome of the treatment. The entire bridge removal

procedure, including hole-drilling, took no more than

fifteen minutes.

(Fig. 17)

Next, we proceeded to reline #45 (Figure 19b) the

bridge that was just removed (Figure19a) before

temporarily re-placing it (Figure 20). Obviously, this

“recycling” is a genuine God-send in a case like this, as

it saved the several hours of additional work required to

fabricate a temporary prosthesis of this size.

(Fig. 21) (Fig. 22)

(Fig. 28) Procera Framework

The preparations were also modified (Figures 21,22)

and new prosthesis fabricated (Figures 23-25). The final

decision was to extract tooth no. 43, to make two toothsupported

lateral bridges and an implant-supported

anterior bridge with Procera zirconia reinforcement.

(Fig. 18)

(Fig. 23) (Fig. 24)

In a case like this one, this new removal technique

offered very concrete benefits in terms of patient comfort

and time-savings (removal time, immediate fabrication

of temporary). It also provided an extremely useful

immediate transitional solution for temporization and

therapeutic planning.

(Fig. 29) Completed Case


Until now, dentists were torn between safely removing

a crown or bridge, and destroying it. By fulfilling three

| 34 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 35 |






A safe and efficient specific sequence to


biologically desirable

with 5 NiTi files

criteria in the vast majority of cases – rapid and

cost-effective removal, preservation of support

teeth and preservation of the prosthetic devices for

temporary or permanent future reuse – WAMkey

crown removal keys offer a particularly comfortable

and efficient alternative, making them an integral

part of every dentist’s basic instrument set.


Dental prostheses by Patrick David (Chateaurenard

13 - France).


1. Ogolnick R, Vignon M, Taieb F. Prothèse Fixée. Principe et

Pratique. Paris: Masson, 1993.

2. Yim Nh, Rueggeberg Fa, Caughman Wf, Gardner Fm,

Pashley Dh. Effect of dentin desensitizers and cementing

agent on retention of full crowns using standardized crown

preparation. J Prosthet Dent. 2000;83:459-65.

3. Li Zn Et, White Sn. Mechanical properties of dental luting

cements. J Prosthet Dent.1999;81:597-609.

4. John S. Advanced Endodontics. Clinical Retreatment and

Surgery. Rhodes, 2006.

5. William Muller. La clef de descellement: une idée simple qui

décoiffe. Clinic. 2001;22(10).

6. Stéphane Simon. Wilhelm-Joseph Pertot. Dcd Endodontic

Retreatment. Quintessence International p.26.

7. William Muller. Simplification et réversibilité de l’acte

de dépose des prothèses scellées. Le Monde Dentaire.


8. S. Patel, J. Rhodes. A practical guide to endodontic access

cavity preparation in molar teeth. BDJ. 2007;203:133-40.

9. Philippe GATEAU. Démontage des prothèses fixées.

Information Dentaire. 2002;31:2247-50.

10. Robert Strauch Entfernen festsitzenden Zahnersatzes mit dem

WAM-Key. Zahnarztpraxis. 2003;6:78-87.

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Hall 2 stand G-049

Biomimetic Ceramic Veneers:

a Successful Team Concept

and also do not present with the same optical qualities

as feldspathic ceramics. 1 The patient also had concerns

about white patches on his teeth that was difficult to

address with just bonding composite resin in the area of

the diastemas.

Preparing crowns was an option but considering the

result desired and the age of the patient it was a rather

invasive option.

(Fig. 3) (Fig. 4)

(Fig. 5)

Lamberto Villani


Member of the European

Society for Cosmetic Dentistry

Private Dental Lab

Oral Design - Dubai


Initially developed to make full crowns, the full ceramic has revolutionized cosmetic

dentistry. Clinicians and technicians have quickly understood that this material can

also give an optimum contribution also for minimal invasive therapy. Many of our

colleagues have developed techniques to make veneers obtaining results which were

unthinkable only little time ago. In this article, the author is showing his technique to

make veneers obtaining excellent results and preserving as much as possible the tooth


Keywords: Minimally invasive, Esthetics, Ceramic veneers, Refractory material.

A 25 year old healthy male came to the dentist’s office with aesthetic concerns

and wanted to have a more confident smile. The case was referred to the lab for

preoperative evaluation (Figure 1).

The patient presented with diastemas in the upper arch and also had some concerns

about a few fine white bands on his teeth (Figure 2).

(Fig. 1) (Fig. 2)

Ceramic veneers present the most aesthetic option to

treat the condition that the patient presented with. They

are minimally invasive when compared to crowns, have

better optical qualities compared to bonded resin and

also have a better biological response of the tissues than

around composite resins.

Treatment Plan

• All relevant photographs were taken.

• After receiving study models a wax up was done for

11, 12, 21, 22 (Figures 3,4).

• Patient was called to the lab to review the wax up and

to get his approval.

• Shade selection was done in the laboratory at this stage.

• Preparation guides were made to assist the clinician in

ideal tooth reduction for the case (Figure 5).

Clinical Steps

• Local anesthetic was administered to the patient and

preparations were done with the help of preparation

guide made in the laboratory 2 (Figures 6-9).

• Addition silicone impression was made after adequate

and necessary gingival tissue management. 3

• Template provided, based on the wax up was used to

fabricate temporary veneers. They were spot etched

and bonded on the incisors.

(Fig. 6) (Fig. 7)

(Fig. 8) (Fig. 9)

(Fig. 10) (Fig. 11)


Taking into consideration the patient’s expectations and also clinical examination the

following diagnosis was made:

1. Diastemas present between 11, 12, 21 and 22.

2. Few hypo-plastic patches present in the incisal and body area of the incisors.

Laboratory Steps

1. Impression was poured with Type IV gypsum (Fuji Rock

GC) using a vacuum mixer (Figure 10).

2. Individual dies were made from this model giving a

conical shape to simulate root with two lateral slots.

They will be used for the final fitting of the veneers.

The margins were coated with a hardener (Margidur,

Benzer) (Figure 11).

3. They were then duplicated using high-quality

laboratory silicone and poured two times (Figure 12).

(Fig. 12) (Fig. 13)

Treatment Options

1. Bonding with composite resin to close gaps on central and lateral incisors.

2. Ceramic Veneers with layering technique on central and lateral incisors.

3. All ceramic crowns on lateral and central incisors (over-treatment).

Bonding has become very predictable and with many shades available, it is possible

to layer and make restorations life like. It is also the most conservative of the options

present. Traditionally composites are known to discolor while ceramic restorations don’t

First pouring with a refractory die material (GC CeraVest)

and the second with Type IV gypsum (Fuji Rock GC) to

use for the preliminary fitting of the veneers.

4. The two major advantages of this cast are:

a. Stone dies and refractory dies can be inserted and

interchanged, due to the identical design of their root

portions, which have the same anti-rotation grooves.

b. We can shape the veneer respecting the soft tissue

and give the right space for papilla.

5. The refractory dies were treated with dehydration

(Figure 14) and then margins have been marked with

a special pencil that is resistant to firing. A fine-grain

porcelain paste (Connector paste) was applied 1mm

apical to the margins and fired (970° C for 1 minute).

| 38 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 39 |

This step is repeated until we obtain a smooth surface.

(Fig. 14)

(Fig. 21) (Fig. 22)

(Fig. 27)

6. The ceramic build-up (Creation, Klema) started with

the application of dentin powders (Figure 15) using

the base shade dentin and several shades with higher

chroma in the cervical area and higher value in the

incisal area (Figures 16,17).

This basic form has been reduced, especially in the

incisal and proximoincisal level to give space for other


(Fig. 23)

7. Pure enamel is placed at the mesial and distal aspects

of the incisal edge. Their exact position and length are

guided by the palatal silicon index.

A palatal incisal wall is made from the placement of

other vertical enamel increments.

(Fig. 15)

(Fig. 28)

The lifelike appearance of this wall is achieved by

alternating enamel powders with various translucencies

and chroma.

(Fig. 24)

8. On this incisal wall (through infiltration) I placed some

dentin powders modified with intensive stains. Other

internal effects within the incisal edge have been

infiltrated with fluorescent and non-fluorescent stains

(Figure 18).

Photos of the patient teeth served as a guide to define

accurately these distinct internal characteristics and


(Fig. 29)

9. The facial surface has been completed with a

combination of other translucent and opalescent

Different combinations of shaded enamels were applied

alternately in tiny vertical increments (Figures 19,20).

Then it was placed in the furnace for the first firing.

(Fig. 16)

(Fig. 18)

(Fig. 17)

(Fig. 25)

After Firing

1. It was necessary to make a correction firing covering

with translucent and opaque enamel applied

alternately in vertical increments and placed in the

furnace for the second firing.

2. After contouring, diamond-silicon wheels were used

for mechanical polishing.

3. Glazing was carried out.

4. Highly reflective surfaces were finally achieved with

pumice and calcium carbonate using brushes and felt

tips at different rotating speeds.

5. The refractory die has been removed by sandblasting

with 50-µm glass beads.

The veneers were adapted accurately using a stereomicroscope

at 10x magnification (Figures 21-23).

(Fig. 19) (Fig. 20)

The Laboratory work was then sent to the Dentist for

cementation (Figures 24-26).

The veneers were cemented following a standard protocol

of Bonding and were polished thereafter.

(Fig. 26)

The patient made a follow up appointment at the laboratory

where the final pictures were made (Figures. 27-29).

| 40 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 41 |




Ceramic veneers which are fabricated using a layering

technique with all protocols being followed during the

course of treatment offer patients a very natural and

esthetic result. 4


We thank Dr. Souheil Husseini for his collaboration.


1. Meijering AC, Roeters FJ, Mulder J, Creugers NH.

Patients’ satisfaction with different types of veneer

restorations. J Dent. 1997;25:493-7.

2. Gurel G. The Science and Art of Porcelain Laminate

Veneers. Quintessence. 2003;7:246.

3. Azzi R, Tsao TF, Carranza FA Jr, Kenney EB.

Comparative study of gingival retraction methods. J

Prosthet Dent. 1983;50:561-5.

4. Horn HR. Porcelain laminate veneers bonded to etched

enamel. Dent Clin North Am. 1983;27:671-84.


| 42 | Smile Dental Journal | Volume 5, Issue 4 - 2010

Awards 2011

Public Voting

Now Opened

Tel.: +971 4 3616174 | Mob.: +971 50 279 3711 | Email:

Ehab Heikal BDS, MBA, DBA

Middle East Manager, Morita Corporation

Lecturer, Practice Management School of Dentistry, MSA University

To Organize or To Organize?

That is the Question

But there are no Shakespearian doubts here.

There is no choice. And if you want to choose, then please choose the non-option at the right…

Or the only option:

Business wise, the image at

the top right gives a terrible

impression about you, but

the other images to the left

tell your patient that you are

absolutely organized and

neat. In English this means

that dentists following the

images to the left can, will and

should charge their patients

higher than dentists following

the top right image. Don’t ask

why, instead put yourself in the

patient’s shoes and ask yourself -as a patient- the same


In terms of quality, this indicates the kind of care and

quality of work and work atmosphere you have, and this

is not something you just do for your own enjoyment and

ease of work, it is something your patients can see, and

they do admire such details, especially when they see the

opposite in other clinics.

In terms of standardization, this makes your life much

easier; your assistants should be trained to set up the

trays for each type of treatment in the same manner

using a checklist, even an image or a picture to show the

sequence of the items on the tray so it is delivered the

same … every time. Thus they, or even you, would reach

with your hand and get the item you want even without

looking at the tray because each item is in its exact place

every time. Imagine when you are driving and looking at

the road, you need to reach your hand out to shift gears, but

don’t need to look every time and search for the gear stick.

This is for one reason; it is always there in the same

place. So drive your clinic.

Color coding is one of the important tools in organizing

your work; imagine if all the endodontic files were one

color??? Endo treatment would have been a nightmare

(especially after the age of 40). So if color coding made

the endo treatment easier, why not colorize your office?

I wanted to give an example here, and at the same

time, I didn’t want to re-invent the wheel. So I found a

company that already has a very smart color coding and

organization system…Zirc ® Company. You can set your

own system, or follow any other available system, this is

just an example that I found available and convenient.

The system starts as follows:

1. Select a color for each procedure or service you


For example, you will select the teal color for endo,

neon purple for C&B, and neon blue for composite,

and so on. You can apply this not only for the trays or

instruments, but for all related issues.

2. If you have more than one dentist, select a color for

each dentist

For example, Dr. Heikal would be neon yellow; Dr.

Sami would be neon pink. But if you are a solo

practitioner, then skip this step.

3. Assess the number of procedures (on average) you do


Crown & Bridge = 12 per week

Endo = 6 per week

Composite = 12 per week

4. Determine quantity of Trays, Cassettes and Bur Holders

you will need for each procedure.

Take your configured numbers from step 3 and

divide them by 4. Four represents the number of days

your clinic operates every week (always round your

numbers up as in the endo case).


Crown & Bridge = 3 neon

purple Trays, Cassettes

and Bur Holders needed

Endo = 2 teal needed

Composite = 3 neon blue


If you run a group

Dr. Heikal (Neon Yellow) practice, then you should

follow steps 3 and 4 for

each doctor. So, for crown

and bridge all trays would

be ordered in neon purple

BUT for “Doctor Heikal”

he would apply neon

yellow tape on his trays

and “Doctor Sami” would

apply neon pink tape on

Dr. Sami (Neon Pink) his trays. Therefore each

doctor would use rings

and tape to mark their holders/containers.

The PRODUCT color signifies the procedure and the

Tape/Rings color signifies the doctor.

a. Solo Clinic: Place color code ID Rings on all hand

instruments in the corresponding procedure color.

b. Group Clinic: Group clinics would use two different

ID rings on each hand instrument. One color would

signify the procedure (Neon Purple is for Crown &

Bridge) and the other color would signify the doctor

(Neon Pink is for Dr. Sami).

c. Instrument Order: The ID ring should be placed at a

diagonal. This indicates to the assistant the order in

which the doctor will be using the instruments.

4. Material Management

The next step in setting up your color code system is

organizing your materials by procedure. This starts by

removing your materials from your operatory drawers

and utilizing a more efficient alternative, the “Procedure


You will need one Tub per procedure (High volume

procedures and group clinics may demand additional tubs).

All Tubs are suggested to be stored in a common area

such as “central sterilization”. Or they may be stored in

the operatory.

Tubs are used as a way to transport items from your

central sterilization to the operatory and back again.

Materials used during the procedure are delivered from

the Tub to the doctor, keeping your procedure tray free

for instrumentation.

At the end of the day, materials are wiped down and Tub

is stored. Both Trays and Tubs can be stored in Racks.

Using a color code system will result in achieving three

main objectives:

1. Improved productivity: Save a minimum of 1 hour

each day

2. Improved infection control

3. Reduced confusion for dental staff

A Final Word: More work on organization means less

mistakes, less time wasted, more productivity and better

representation of your practice. If you are looking for

assistance with setting up your own color code system,

Zirc has an interactive guide online which takes your

data and generates a suggested “Organizational

System” based on your selections.

| 44 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 45 |

Interventions for Replacing Missing Teeth: Antibiotics at

Dental Implant Placement to

Prevent Complications (Review)

Esposito M, Worthington HV, Loli V, Coulthard P, Grusovin MG

The Cochrane Library 2010, Issue 7


Some dental implant failures may be due to bacterial contamination at implant insertion. Infections around

biomaterials are difficult to treat and almost all infected implants have to be removed. In general, antibiotic

prophylaxis in surgery is only indicated for patients at risk of infectious endocarditis, for patients with reduced hostresponse,

when surgery is performed in infected sites, in cases of extensive and prolonged surgical interventions

and when large foreign materials are implanted.To minimise infections after dental implant placement various

prophylactic systemic antibiotic regimens have been suggested. More recent protocols recommended short term

prophylaxis, if antibiotics have to be used. With the administration of antibiotics adverse events may occur, ranging

from diarrhoea to life-threatening allergic reactions. Another major concern associated with the widespread use of

antibiotics is the selection of antibiotic- resistant bacteria. The use of prophylactic antibiotics in implant dentistry is



To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no

antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the

most effective.

Selection Criteria

Randomised controlled clinical trials (RCTs) with a follow up of at least 3 months comparing the administration of

various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement.

Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events. Four RCT

trials including 1007 patients were identified ; Abu-Ta’a 2008, Esposito 2008, Anitua 2009 and Esposito 2010.

Main Results

Two hypotheses were tested in this systematic review:

Summarized & Presented by:

Hassan Maghaireh

BDS, MFDS, MSc Implants (Manchester)

Clinical Teacher, Dept. of Dental Implants, University of Manchester

1. Whether prophylactic antibiotics are effective in reducing failures and complications:

• One trial (Abu-Ta’a 2008) compared 1g of amoxicillin given 1 hour preoperatively plus 500mg of amoxicillin

4 times a day for 2 days versus no antibiotics. They included forty patients in each group and none dropped

out after 5 months. They reported no prosthesis failure. However, five implants failed in three patients who did

not receive antibiotics. One patient in the antibiotic group and four patients in the control group experienced a

postoperative infection. In this Random controlled trial, Abu-Ta’a et al. concluded that there were no statistically

significant differences observed for any of the outcome measures.

• Two placebo-controlled trials (Esposito 2008; Esposito 2010) compared 2g of amoxicillin given 1 hour

preoperatively with identical placebo tablets.

• Esposito et al. in their placebo-controlled trial conducted in 2008 have included one hundred and sixty-five

patients in each group, but seven patients from each group had to be excluded from the analyses for various

reasons. Two patients in the antibiotic group experienced a prosthesis failure versus four patients in the placebo

group. Two patients (two implants) in the antibiotic group experienced implant losses versus eight patients (nine

implants) in the placebo group. Three patients in the antibiotic group presented sign of infection versus two

patients in the placebo group. One minor adverse event was recorded in each group. Esposito et al. could not

find any statistically significant differences between the two groups.

• Another study conducted by Marco Esposito and his group in 2010 compared 2g of amoxicillin given 1 hour

preoperatively with identical placebo tablets, using a two groups as 254 patients were included in the antibiotic

group and 255 in the placebo group. Four patients in the antibiotic group experienced a prosthesis failure versus

10 patients in the placebo group. Five patients in the antibiotic group experienced seven implant losses versus

12 patients that lost 13 implants in the placebo group. Four patients in the antibiotic group presented clear signs

of infection versus eight patients in the placebo group. No adverse events were reported. This study observed no

statistically significant differences for any of the outcome measures.

• Finally, A placebo-controlled trial (Anitua 2009) compared 2g of amoxicillin given 1 hour preoperatively with

identical placebo tablets. Fifty-two patients were included in the antibiotic group and 53 in the placebo group.

Two patients in each group experienced an implant/crown failure and six patients in each group experienced a

postoperative infection. No adverse events were reported. No statistically significant differences were observed for

any of the outcome measures.

• The meta-analyses of the four trials on the effectiveness of prophylactic antibiotics in reducing failures and

complications showed a statistically significant higher number of patients experiencing implant failures in the group

not receiving antibiotics: RR = 0.40 (95% CI 0.19 to 0.84). The number needed to treat (NNT) to prevent one

patient having an implant failure is 33 (95% CI 17 to 100), based on a patient implant failure rate of 5% in patients

not receiving antibiotics. The other outcomes were not statistically significant, and only two minor adverse events

were recorded, one in the placebo group.

2. Which is the most effective antibiotic, dose and duration:

No trials could be identified.


All included trials appeared to be underpowered to detect a clinically significant difference, even though they showed

clear trends favouring antibiotics. A statistically and clinically significant difference in implant failures was found after the

meta-analyses. This underscores the importance of meta-analyses to increase sample size of individual trials to reach

more precise estimates of the effects of interventions.

Authors’ Conclusions

Implications for practice

There is evidence from a meta-analysis including four trials with 1007 patients suggesting that 2g of amoxicillin given

orally 1 hour preoperatively significantly reduce early failures of dental implants placed in ordinary conditions. More

specifically, giving antibiotics to 33 patients will avoid one patient experiencing early implant losses. No statistically

significant differences in postoperative infections and adverse events were observed. No major adverse events were

reported. It might be sensible to suggest a routine use of a single dose of 2g of prophylactic amoxicillin just before

placing dental implants. It remains unclear whether an adjunctive use of postoperative antibiotics is beneficial, and

which is the most effective antibiotic.

Implications for research

Priority should be given to large pragmatic double-blinded RCTs evaluating the efficacy of prolonged antibiotic

prophylaxis when compared to a single preoperative dose into those subgroups of patients where implant failures are

more likely to occur, particularly in those patients receiving immediate post-extractive im- plants and augmentation

procedures in conjunction with implant placement. It could be also useful to evaluate which could be the most effective

antibiotic type.

| 46 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 47 |

Immediate Placement of Dental Implants Into Debrided

Infected Dentoalveolar Sockets

Casap N., Zeltser C., Wexler A., Tarazi E., Zeltser R. March 2007

Journal of Oral and Maxillofacial Surgery. Vol. 65 No. 3 pp 384-392

The demand for immediate implant placement is driven by a desire to retain alveolar volume and expedite treatment

for the patient. Although many failing teeth are associated with pathology of either periodontal or endodontic origin

and it has been presumed to date that it would be inappropriate to place implants immediately into such extraction

sockets. However, recent animal and orthopedic studies have suggested that if an appropriate debridement regime

is utilized it might be possible to place implants on an immediate basis in a safe and predictable manner. This report

presents the results from an initial group of patients benefitting from a new protocol for the placement of implants

into infected sockets.

Materials and Methods

20 patients were consented for the extraction and immediate insertion of implants into debrided, infected sockets.

Patients were given pre-operative prophylaxis of 1.5g amoxicillin or 0.9g clindamycin daily for 4 days. After

extraction sockets were curetted to ensure thorough degranulation after which the wall of the socket was removed

with an oval bur to ensure that no contaminated hard tissue remained, particularly at the apex in endodontic cases.

Sockets were then thoroughly irrigated with sterile saline. Implant osteotomies were then prepared per socket

extending apically by at least 3mm to ensure good primary stability. A screw shaped implant (3i Osseotite) was used,

and dimensions ranged from 10 to 16mm in length and 3.7 to 4.7mm in diameter. Any residual defect existing

between the socket wall and the implant was grafted with BioOss (Geistlich) and sites were covered with a reinforced

Goretex (WL Gore) membrane. A flap was coronally advanced for primary closure and patients were given a

continuation of their antibiotic therapy post-operatively. Patients were followed up for up to 72 months.


Of a total of 30 extraction sockets treated, 16.7% were associated with a chronic periapical infection, 13.3% were

associated with a subacute perio/endo infection, 30% were associated with a chronic periodontal infection, 36.7%

had a subacute periodontal infection and one socket (3.3%) had a periapical cyst. Of the 30 implants inserted, 29

(96.7%) achieved osseointegration. The implant which failed was immediately restored and this may have been

contributory. In two cases a membrane became exposed and a late failure was recorded at the 24-month followup.

One patient suffered with pseudomembranous colitis as a result of the antibiotic therapy. No other long-term

complications were noted, with a mean follow-up of 29.3 months.

Discussion and Conclusions

The presence of infection from periodontally or endodon tically compromised teeth has always been considered to be

a contra-indication to surgery, since contamination of the surgical field can lead to post-operative infections, which in

the case of implants could result in implant failure. In the orthopedic literature it has been reported that debridement

of osteomyelitic vertebrae can be successfully followed by immediate reconstruction using titanium mesh to aid

early functional stability of the weakened vertebra. Certainly much literature exists for the immediate replacement

of extracted teeth with dental implants since it is thought that this might aid maintenance of alveolar bone volume,

which would otherwise undergo significant atrophy, potentially limiting future staged placement of implants. In

addition there is a considerable advantage to the patient to have immediate implant surgery since this can be shown

to significantly expedite completion of treatment. The current study considered the possibility that implants could in

fact be inserted into thoroughly debrided, infected extraction sockets under an appropriate antibiotic regime. The

long-term implant survival rate of 93.3% is certainly comparable to that quoted for implants placed in non-infected

sites and in no cases was a post-operative infection recorded. It can therefore be concluded that when utilizing the

protocol outlined, implants can be placed into extraction sockets previously associated with subacute or chronic

infections of periodontal and endodontic origin.

| 48 | Smile Dental Journal | Volume 5, Issue 4 - 2010

Do Periodonto-Pathogens Disappear After Full-Mouth

Tooth Extraction?

Van Assche N., Van Essche M., Pauwels M., Teughels W., Quirynen M.; Journal of Clinical Periodontology;

Vol. 36 No. 12 pp 1043-1047; December/2009

Numerous studies have been published demonstrating that periodontal pockets at natural teeth can act as reservoir

for periodonto-pathogens which can subsequently cross-infect implant sites. Therefore an appropriate pre-surgical

periodontal program and regime is essential. Previous studies using culture testing have also shown that, 6 months

after full mouth tooth extraction, there is no trace of the pre-existing periodonto-pathogens. An alternative modern

method for detecting periodonto-pathogens that is thought to be more sensitive than culture testing is the polymerase

chain reaction technique.

This study therefore aimed to establish whether full mouth tooth extraction eliminates pre-existing periodontopathogens,

by using the polymerase chain reaction technique, which has a lower threshold for the detection of

specific periodonto-pathogens.

Materials and Methods

Nine patients with aggressive advanced periodontitis and a failing dentition had samples taken prior to and 6

months after full mouth tooth extraction. Samples collected included: biofilm from the tongue using a cotton swab,

5ml of unstimulated saliva and subgingival samples from 2 deep pockets using 8 paper points. Samples were

dispersed in reduced transport fluid and processed within 12 hours. Microbiological analysis was carried out blind,

using quantitative polymerase chain reaction technique. Descriptive statistical analysis including the mean and

standard deviation were calculated using data recorded in the log 10 format.


Prior to extraction, all patients exhibited high levels of P. gingivalis and T. forsythia within their periodontal pockets

with sites in another 8 patients being colonized by A. actinomycetemcomitans and/or P. intermedia. Post-extraction,

all patients continued to demonstrate the presence of the same periodonto-pathogens with detection frequencies

from tongue and saliva remaining unchanged compared to frequencies prior to extraction, except for 1 sample of P.

intermedia. However, the number of bacterial genomes detected was substantially lower especially for P. gingivalis

and T. forsythia, by a 3-log reduction.

Discussion and Conclusions

With studies showing a similar microbial picture in periodontitis as in peri-implantitis, it is thought that the same

pathogens are responsible for peri-implant infections. Previous studies have typically used culture techniques to

assess the presence or absence of periodonto-pathogens while in the current study the polymerase chain reaction

technique was utilized. The differing outcome between the two testing methods is down to the number of cells needed

for detection. Culture based tests require a minimum of 1000-10,000 cells compared with the polymerase chain

reaction technique, where only 25-100 cells are needed and unlike culturing, this technique will also detect dead, as

well as live cells, making it a much more sensitive detection tool. Processing samples under aerobic conditions may

also make detection of anaerobic bacteria difficult.

The results of the current study clearly demonstrate the continued presence of periodonto-pathogens after full-mouth

extraction and this raises the question once more as to whether antibiotics are required prior to implant placement?

However, if one considers the high success rates achieved with implant therapy, as well as the low incidence of periimplantitis,

this does not appear justified. In part this is due to the fact that numerous studies have demonstrated the

potential for both healthy periodontal as well as peri-implant sites, even in the presence of higher concentrations

of these pathogens than have been detected in the current study and it is also questionable whether antibiotics can

eliminate bacteria at such low levels. Furthermore, although debatable, it is thought that the host immune response

may play a role in this.

The current study is also in agreement with a previous study using polymerase chain reaction technique, which

demonstrated that in 15 edentulous patients tested for various pathogens before and after implant placement, 7

patients were colonized with small quantities of P. intermedia, 2 with A. actinomycetemcomitans and none for P.


| 52 | Smile Dental Journal | Volume 5, Issue 4 - 2010

A-dec Introduces Its Newest

Family Member: A-dec 200

New Point-of-entry A-dec 200 Offers No-

Compromise Performance and Real A-dec Value.

A-dec, a global leader in dental equipment,

introduces A dec 200, the newest in A-dec’s

lineup of patient chairs and delivery systems, with

input from dental professionals around the world to

accommodate the wide range of practice styles found

in global markets.

The space-saving chair-mounted delivery system

includes a telescoping assistant’s arm and an

oversized tray to hold

everything the dental team

needs. The new multi-axis light

provides easy and precise

positioning of


and the



conveniently to

the patient when


The chair, light and

cuspidor functions are easily controlled from A dec’s

modern touchpad and small and large practices will

enjoy the open platform that leaves room to add or

change ancillary devices for peak performance now,

and in the future.

EndoActivator ®

by Dentsply Maillefer

For many years, research has been made in

investigating how to significantly improve

Endodontic disinfection methods. Clinically,

disinfection protocols should encourage

debridement, the removal of the smear layer

and the disruption of biofilm. Logically,

well-shaped canals potentially facilitate

3-D cleaning, filling root canal

systems and predictable success.

Importantly, the technology

selected to promote disinfection

should be easy-to-use, clinically safe and effective.

In an effort to improve Endodontic outcomes, the

EndoActivator ® was developed with the help of a team

of expert clinicians and scientists. Based on the sonic

activation of the irrigation dressing, the EndoActivator ®

provides a simple, safe and effective method to enhance

disinfection. Virtually any dentist who places emphasis on

shaping canals can efficiently integrate the EndoActivator ®

into clinical use.

Since its first introduction, research has shown that the

EndoActivator ® produces significantly cleaner canals

compared to the controls and the commonly employed

methods utilised by well-trained international dentists and

Endodontists alike. This research is available today in the

most prestigious journals (see bibliographic references).


De Gregorio Cesar et al., Journal Of Endodontics, Volume 35, June 2009, p.891-895

Desai P., Himel V. JOE, Volume 35, April 2009, p. 545-549

Shen Y. et al. JOE, Volume 36, January 2010, p. 100-104

DenTag... A Good Reason to be Different

For more than half a century, Den Tag in Maniago has been synonymous with:

• carefully-selected materials of the highest quality

• design and manufacture tested after each production phase

• latest technology machinery, continually updated

• expert craftsmanship based on an old tradition in stainless steel working

• constant and continuous research

• the closest possible attention to the quality of the finished product

All these factors have contributed to the constant growth of the company and its excellent

international reputation as a supplier of top-quality surgical instruments.

We have been - and continue to be - widely copied.

And it is for this reason that we want to help our clients avoid confusion by introducing a line of

products with newly-designed handles, and marketed exclusively with the DenTag trademark.

At least, until they copy this too...

| 54 | Smile Dental Journal | Volume 5, Issue 4 - 2010

MOCOM 24 Years Meeting the Needs of the Dental Practice

MOCOM, a leading figure in the development of innovative sterilization systems, has

created Millrack, a vertical sterilization system to optimize space within the practice.

Its elegant design allows combining various pieces of equipment for a perfect sterilization

procedure: from cleaning to thermo disinfection, from packaging to sterilization up to

storage, depending on the need.

The system is provided with integrated electrical and water filling and drain hook-ups that

allow devices to be directly connected. With Mocom Milldrop’s water osmosis system it is

possible to fill distilled water into Mocom’s Millennium sterilizers (with automatic filling)

without any operator intervention.

Millennium steam sterilizers are Mocom’s type-B unit dedicated to professionals in the dental

and medical field.

Completely designed according to EN 13060 standard and extremely easy to use, the

Millennium sterilizers represent a reference point in terms of safety, performance and flexibility.

Thanks to the high number of configuration available, the 11 programs and the patented

devices, they can satisfy any sterilization requirement.

The exclusive patented system of an instantaneous steam generator and of a double-head

vacuum pump, ensures the highest performances in every situation without any waiting time

between one cycle and the other.

Accutron Inc., the Innovator in Nitrous

Oxide Conscious Sedation Systems, Has

Announced the Redesign of the Digital

Ultra Flushmount Flowmeter

By separating the control unit from the gas supply module

the newly redesigned Digital Ultra Flushmount offers

more. Measuring just over one inch in depth, the control

unit of the in-cabinet mounted flowmeter provides a gain in

accessible cabinet storage space and expands installation

options. The new unit is also NFPA-approved to be mounted

in a wall. Other features of the Digital Ultra Flushmount

include: percentage controls (adjust the flow and percent gas

remains constant, adjust the gas and flow remains constant);

brightly colored

digital readouts and

electronic flow tubes;

easy-to-clean and

disinfect or barrierprotect


membrane; and

multiple safety features.

All Accutron flowmeters

carry a 2-year warranty, the

longest flowmeter warranty in

the industry.

Flow Dental Corporation manufactures high

quality, competitively priced imaging products

from dental x-ray film to digital imaging

machines. Flow X-Ray changed its name to Flow

Dental signaling the company’s plans to expand

its product portfolio and offer dental professionals

a more comprehensive catalog of merchandise

with the same quality and reliability they have

come to expect from Flow X-Ray.

Recently, they added a comprehensive line

of digital imaging accessories, including the

Safe’N’Sure line of phosphor plate envelopes,

the Comfee’s line of sensor sleeves, and the new

improved SUPA bite blocks that are uniquely

formed to work with both film and phosphor

plates. Flow also has a complete line of lead and

lead free protective aprons.

Flow’s core value is that the needs of every

customer are Flow’s number one priority.

Quality and reliability are guaranteed with

every product shipped and Flow is committed to

continue to serve the needs of dentists and dental

professionals worldwide.

| 56 | Smile Dental Journal | Volume 5, Issue 4 - 2010

W e i n v e n t , y o u s u c c e e d !

The G6 from Global Surgical Corporation

Global Surgical Corporation dental microscopes are used by more dentists around the world than any other

brand of microscope. For over a decade, Global Surgical has been committed to developing and

promoting microscopes for use in dentistry. In collaboration with dentists from around the world,

we have designed our line of microscopes to specifically suit their needs. The results have

revolutionized clinical practices in all disciplines and specialties. The G6 represents

the next contribution to this revolution.

The G6 features:

Six steps of magnification Optimal magnification range of 2.1x to 19.2. The

operator can view an entire arch or increase the magnification for precision and

close inspection.

Maneuverability Easy movement of the microscope head offers easy view of the mouth.

Ergonomically Designed Allows for comfortable positioning of the operator, reducing or

eliminating neck and back pain.

Modularity Will accommodate upgrades and retrogrades without high costs.

Depth perception - Greater depth perception is achieved by the wide-field optics

(10% better than the competitors).

The standard components include inclinable binoculars, adjustable (Helicoid) eyecups,

maneuvering handles, objective lens with fine focus (+/-20mm), light source, and light source



VersaWave ® Laser

HOYA ConBio dental

lasers represent state-ofthe-art

solutions to help

dental practitioners perform

procedures more efficiently

and effectively, with increased

patient comfort and satisfaction.

Designed for use in hard, soft,

and osseous tissue procedures, the

VersaWave ® Erbium All-Tissue laser

is an excellent choice for practitioners who want to

experience the full benefits of laser dentistry. The

VersaWave is also a popular choice for specialists in

orthodontics & pediatrics. This advanced laser can be

used for a wide range of procedures, including cutting,

shaving, and contouring osseous tissues, crown

lengthening, and laser removal of diseased soft tissue

within the periodontal pocket. The VersaWave is also

used for soft tissue smile design, smile lift procedures,

frenectomies and hard tissue application in closed

flap, open flap and pre-prosthetic surgical procedures.

A global pioneer in lasers, HOYA ConBio has a strong

heritage in continuing education and certification,

dedicated to increasing the use of laser technology in

dental practices worldwide.



Novocol Pharmaceutical is a world leading pharmaceutical

manufacturer, specializing in dental operatory and pain

control products, such as dental anaesthetic.

Our innovative and well established dental anaesthetics set

us apart in the area of sterile anaesthetics.

Our Mission is to be recognized globally as the company

that sets the standard for quality and innovation in dental


• Terminally Sterilized: ensuring the sterility of

each Novocol anesthetic cartridge

• Products are manufactured using the highest

standards to assure quality and purity

• No paraben preservatives

• Mylar wrapped cartridges reduce risk of

shattering, especially intraligamentally

• Color-coded packaging for easy

identification of anesthetic types

• Siliconized neutral glass cartridges for

smooth injections and patient comfort

• Lot numbers and expiration dates imprinted

on all packages and cartridges

On-going research and development ensures

we continue providing our customers with products and

services that are unsurpassed in meeting their expectations

for quality and performance.

| 58 | Smile Dental Journal | Volume 5, Issue 4 - 2010

BISCO offers all the products you need, from start to finish, for each clinical procedure.

Bottom up dentistry. Top down esthetics. Here are more great products from BISCO...


Self-Etching Adhesive


Flowable Microhybrid Composite


Veneer Cement

For more information email or visit

WAMKey ®

New Crown Remover

WAMkey is a three-instrument set, which allows

you to begin with the smallest instrument to keep

preparation to a minimum. The technique is quick

and easy to perform, with most crown removals

performed in less than three minutes.

2 minutes and 2 fingers are far enough to

remove a crown and "2" reuse it!

Designed for crown

and bridge removals,

the Wamkey ® is said

to provide a quick,

easy, cost-effective and

painless alternative to

current crown-removers.

This simple-to-use device

works by dissociation,

with minimal pressure on

the supporting teeth (no

traction and no rocking

movement). Thanks to

a vertical removal line,

there is no risk of fracture

or rupture of the ligament.

Moreover, this operation

takes less than 2 minutes and

the crown can be reused in

most cases (more than 80%

of ceramics), both entailing

important savings.

SDI Riva Luting Plus - Esin Modified

Glass Ionomer Luting Cement

Riva Luting Plus is a resin modified,

self curing, glass ionomer luting

cement, designed for final

cementation of metal, PFM and resin

crowns, bridges, inlays and onlays

plus ceramic inlays and crowns.

Riva Luting Plus chemically bonds

to dentin, enamel and all types of

core material.

Riva Luting Plus has extremely

high fluoride release. Caries

prevention is totally maximised

with Riva Luting Plus.

Riva Luting Plus quickly flows into the preparation. A low film

thickness allows the seating of tight fitting indirect restorations.

Riva Luting Plus is clinically insoluble improving the longevity

and aesthetics of the restoration by resisting the disintegration

and wear caused by oral acidity.

Adequate adhesion to human tooth structure is important

for long term retention of restorations. Riva Luting Plus has

excellent adhesion both the tooth and substrates. It is great for

luting ceramic crowns and inlays.

Riva Luting Plus does not contain any Bisphenol A or its

derivatives. Use this product on your patients with confidence

and peace of mind.

Riva Luting Plus is available in new & improved capsules and

in powder/liquid sets in one universal light yellow shade.

Planmeca’s Dental Imaging Software Expands Full Mac OS Support

and Tools for More Accurate Implant Placement

One of the world’s leading dental equipment and software manufacturers, the Finnish Planmeca Oy, is pioneering once

again. Planmeca Oy is the first dental manufacturer to offer Mac OS operating system support for all its X-ray units.

With the latest version of Planmeca Romexis, a software including all dental imaging modalities and embracing modern

IT standards, whatever the diagnostic requirement, the images can be acquired, viewed, processed and stored in either

Mac OS or MS Windows environment. The Apple compatibility also enables sending 2D and 3D images to an iPhone or

iPad simply with one click.

The software release 2.4 also includes new implant verification

tool allowing examination of the implant in relation to the

surrounding anatomy by visualising slice views and average HUvalues

in the proximity of the implant. Implant library with realistic

implant models from several manufacturers further facilitate

implant planning.

“Imaging software is the heart of any dental practice with X-ray

imaging devices. The numerous tools and functionalities of the

Planmeca Romexis software improve the diagnostic value of

the radiographs and smooth the acquiring process,” says Ms

Helianna Puhlin-Nurminen, Vice President for Digital Imaging

and Applications Division.

| 60 | Smile Dental Journal | Volume 5, Issue 4 - 2010

Visit us at AEEDC 2011, booth #30

W&H Counts on Education

Education really counts at W&H – that’s why W&H has cooperated with the European

Dental Students´ Association (EDSA) for a long time now. This time it was to support the

2nd EDSA Summer Camp, held in Alexandria, Egypt from 13 to 19 September 2010.

As learning by doing is still the best way of thoroughly understanding things, the EDSA

invited its members to find out about life in the dental practice. Because the EDSA Camp was part of a voluntary work

programme to enable free treatment for the low-income population.

Under strict supervision from trained personnel of the Faculty of Dentistry at the University of Alexandria, 7 European

students had the opportunity of putting their knowledge to the test on around 70 patients. Besides conservative dental

treatments, periodontal, endodontic and surgical treatments were on the agenda. W&H and its Egyptian partner IMECO

provided Alegra turbines, air motors and Alegra straight and contra-angle handpieces for the students free of charge.

The students went to work with a great deal of enthusiasm and pleasure: A unique experience and the best possible

teachers, Hana Mezlová (dentistry student / Czech Republic) describes her experience. A unique opportunity, nice

people, great instruments, was the reaction from Youssef Kassem (dental student / Egypt).

Dental X Autoclaves: It is not enough say class B!

Although, the class B autoclave (norm EN 13060) represent the

state of the art, it is wrong to think that all class B autoclaves are


There are big and significant differences that shall be taken in

consideration and diligently compared before purchasing an


New chamber/heating concept: Thank to the exclusive chamber

made of copper (nickel coated) and the revolutionary softadaptive

heating elements, dental X autoclaves eliminate the

thermal jumps and enable a fast and safe sterilization without

risk of early instruments damages. We underline that the copper

have a thermal conductivity 23 times higher than stainless steel and the soft-adaptive heating elements permit a more

precise temperature control during all sterilization and drying phases.

Performances: dental x autoclaves grant higher performances. It means faster cycles and bigger sterilization capacity.

Reliability: the exclusive DX heating system improves both performances and reliability and reduce the needs for service.

Bigger capacity: Due to the exclusive heating system it is possible to sterilize a bigger number of instruments for cycle. The

useful chamber volume of dental autoclaves is 20% bigger than others

Save your instruments life: The advanced heating technology allows a gentle sterilization. By eliminating thermal jumps, the

risks of instruments damages are null.

Respect for environment: The electrical consumption is very low (further below our competitors). The water net connection

(optional) in compliance with EN 13060 eliminate potential contamination risks.

Flexibility: Dental X autoclaves are able to perform class B and class S cycles. That enable to fit any kind of surgical needs.

Technology: Dental X conjugate cleverly the technology with the common sense. The technology, in all Dental X

autoclaves, is applied in order to simplify the use, to improve the performances and to increase the reliability and the

product life.

Service: Dental X grant a professional and rapid service through his sale and service network.

All Dental X autoclaves have been certified in class IIB by SGS. The choice to certify the autoclave under the most restrictive

class prove the quality and the safety of the Domina Plus.

| 62 | Smile Dental Journal | Volume 5, Issue 4 - 2010

Endoest-Motor FSM

Intigrated system for complex endodontic treatment which consists of:

1. Endomotor: which has two subsystems:

a. File management: maximal ease of work with modern

endodontic technologies of various forms-manufacturers, in

addition to a freely programmable regime.

b. Safety management: Through the high accuracy of the given

torque limitation, association with the built-in apex locator,

automatic counting of the file's "lifes", and the possibility of the

sterilization of files together with the cartridge.

2. Autonomous, precise and reliable apex locator for apex localization.

3. Obturator of root canals by heated gutta percha.

4. Curing LED lamp for polymerization of dental restorative materials.

5. Diagnostic LED lamp (orange light-diode LED) for localization of root orifices, latent carious cavities, cracks,

splits... etc

EndoAce ® Endo pleasure!

The introduction on the market of

Nickel-Titanium methods in the

1990s created a real revolution in

endodontics. These new methods

proved to be simpler and more efficient

than the traditional manual methods.

However, the risk of breakage remains

a permanent concern for every general

practitioner. That is why using an endo

motor with torque and speed control is

essential in order to achieve absolute

security in daily practice of endodontics

employing rotary systems.




80 Iraqi Dentists attended the Implantology

course and hands-on training by Dr. John

Dobbeleir (Belgium) and Dr. Imad Salloum

(Syria) at Holiday Inn Hotel – Amman on the

19 th and 20 th of October 2010 sponsored by


Recently introduced on the market,

ENDOAce ® is an endo motor with

torque and speed control and

integrated apex locator. It is compatible with all NiTi systems currently

available on the market. The ideal all-in-one!

No more breakages!

Automatic system reversing the direction of rotation to free the


Reliable and effective automatic electronic disengaging system.

Starting, slowing and changes of direction are gradual to avoid jarring

and vibration.

Apex under control!

A separate Apex locator is no longer needed.

Very accurate measurement of the apical position of the file in real time

on the screen with an audible warning.

Apical precision when dry or wet in the presence of electrolytes.

Ergonomic contra-angle!

Micro-head providing excellent visibility of the operating field.

High performance composite.

Innovation! The instrument starts automatically when entering the canal.

ENDOAce ® is the essential tool for every endodontic treatment

respecting the file and offering simplicity, gain in time and safety.

| 64 | Smile Dental Journal | Volume 5, Issue 4 - 2010





AEEDC 2009

Stand # 309-407

IDS 2009

Hall No. 11.2

Stand # R-040 - S-041

Aisle R

Middle East Area Manager

Mahmoud Lutfi

Tel: +962 6 5656404/5

Fax: +962 6 5656402

Mob: +962 7 95536867


23 - 25 September, 2010 | Dbayeh, Lebanon

BIDM 2010

The 20 th annual convention of the Lebanese Dental Association (LDA), BIDM 2010 was held at the Congress

Palace, Dbayeh, Lebanon.

In his opening speech The Scientific Chairperson of LDA/BIDM Dr. Ronald Younes stressed on the fact that this

year the scientific program had been designed to address the highly relevant issues that concern clinicians. With

the theme “sustainable dentistry” being of prime importance in designing the convention.

Where all past BIDM conventions were successes, this year’s was a remarkable event, attracting almost 1800

delegates coming from different countries around the globe like Japan, Mexico, USA, France, Germany, Spain,

Turkey, Greece, Italy, Swizerland, The Netherlands, KSA, Qatar, Jordan, Egypt, and Algeria. Gathering 24

international speakers with 55 speakers from Lebanon.

The speakers highlighted the areas of ongoing developments

and frontiers of researches and challenges in treatment

planning, clinical performance, and sustainable measures that

are essential for a long term treatment success.

The program included 125 oral sessions, 5 live video

transmissions, and 11 workshops which were of great benefits

to the participants.

A huge trade exhibition was held through the conference

with the world’s leading companies presenting the latest in

the field of materials and instruments as well as the latest

technologies in the field.

In his closing speech Younes thanked the president of LDA Dr.

Ghassan Yared for his support to the convention and the role of

LDA board in supporting the event to be a very successful one.

President of LDA & His Excellency the Minister of Health

Richa Dental group Mr. Karam & Dr. Niznick From the opening ceremony

GSK Closing ceremony W&H

LDA staff

Tamer group

Arab delegates

Dental X a partner with great experience


Dental X ...the sterilization company Anniversary


Aptica Plus B

the faster B class autoclave specially designed

for your handpieces sterilization.

Domina Plus B

designed for a safe, reliable and rapid

sterilization of all your instruments.


dental x

Dental X spa

via marzotto 11

36031 dueville vicenza

tel +39 0444 367400

fax +39 0444 367436

e mail


Area Manager Middle East:

Mr. Mahmoud Lutfi

Tel: +962 6 5656404

Mobile: +962 7 95536867


Visit us at AEEDC

Booth: 300

Visit us at IDS

Halle: 10.1

Booth: G58 - H59

19 - 22 October, 2010 | Amman, Jordan

22 nd Jordanian

& the 39 th Arab

Dental Congress

Under the patronage of H.R.H.

Princess Rym Ali, the 22 nd

Jordanian & the 39 th Arab Dental

Congress was held at Le Royal

Hotel - Amman.

The comprehensive scientific program included a series of

scientific lectures presented by 80 remarkable Arab and

Foreign speakers, 6 workshops, poster presentations as well

as pre-and post-congress courses. The main guest speakers

were Dr. Mahmoud Torabinejad, Dr. Stephen Rosenstiel and

Prof. Frances M. Andreasen.

More than 50 local and International dental supply agencies

displayed their products to around 1300 participants.

H.R.H. Princess Rym Ali, Dr. Jaabari, Dr. Tarawneh

Arab Delegates

Dr. Abu Tahoun, Dr. Balto, Prof. Torabinejad


of the Arabic

Translation of

FDI Dental

Ethics Manual

The Arabic translation

of the FDI Dental Ethics

manual was launched

during the scientific event Dr. AL-Dwairi

of the 22 nd Conference

of the Jordanian Dental

Association and the 39 th

Conference of Arab Dental Association held in

Amman-Jordan from 19-22 October 2010.

Diamond sponsor: Mudieb Haddad & Sons Co./Colgate.

The manual was translated by Dr. Ziad AL-Dwairi

and Dr. Hayder AL-Waeli from faculty of Dentistry-

Jordan University of Science and Technology on

behalf of the Jordanian Dental Association.

Khoury Dental

Denta Med

Dr. Al-Darwish & Dr. Jaabari

Arab Delegates

Guest Speakers

Dr. AL-Dwairi said that the manual is published

in a practical pocket size format and it is hoped

that it will become an invaluable aid to the work

routine of dental practices and dental schools

in the Arab World in order to give all involved

in dental education and care the opportunity to

benefit from the principles conveyed in this book.

Dr. AL-Dwairi added: The manual provides a

concise introduction to the basic concepts of

ethics and their application to the most common

issues encountered by dentists in their daily

practice. In addition to its emphasis on the

practical application of ethical principles, the

Manual focuses on the relationship among ethics,

professionalism and human rights.

At Ibn Rushd booth

Stern Weber



Basamat Pharmadent

Al-Shumukh Medical Co.

Dr. AL-Dwairi was a member of the international

advisory group formed for the publication of the

manual in its English language.

Mudieb Haddad & Sons Co.


dentalArt presents


new simulation unit

Meet us at


Stand 301-302

1-3 February 2011

dentalArt spa

Montecchio Precalcino

Vicenza - Italy

Agency for middle east

Mahmoud Lutfi

p.o. box 641 11941 amman jordan

ph. +963 6 5656 404/5

mobile: +962 7 95536867

email: mlutfi @m-lutfi

28 - 30 October, 2010 | Damascus, Syria

2 nd Syrian British Dental Conference

& 2 nd Scientific Meeting of the Syrian

Section of IADR

Prepared by: Dr. Adel Moufti

Vice President, Syrian Society

for Dental Research

Under the Patronage of Prof. Wael Moala; President of Damascus University, the conference was held in the

prestigious Omayd Palace in Damascus and was organised by the Syrian Association of Dental Research (Syrian

Section of IADR) and the Syrian British Medical Society in coordination with the Dental School of Damascus University.

With the theme “Aesthetic Dentistry – Top Tips for a Natural Smile” the conference featured talks by eminent

speakers. Amongst the guests were Dr. Amarjit Gill; Head of the British Dental Association, Prof. Edward Lynch;

Director of Dentistry at the University of Warwick, Prof. Ashraf Ayoub; Prof. of Oral & Maxillofacial Surgery at

Glasgow Dental Hospital, Prof. Richard Palmer; Professor of Implant Dentistry and Periodontology at King’s

College London, Prof. Marrie Hosey; Head of Paediatric Dentistry at King’s College London and Prof. Brian Millar;

Programme Director, MSc in Aesthetic Dentistry at King’s College, London. 40 more consultants and speakers

from across the UK, Syria, Lebanon, Tunisia, KSA, Pakistan, Egypt, Iran, and the UAE have contributed to the

multidisciplinary conference covering all aspects of aesthetic dentistry with oral and poster presentations.

From updates on Orthodontics and Botox to the latest developments in Dental Ceramics and Implants, emphasis

was given to the evidence-based inter-relation

between all dental specialties to achieve

optimum aesthetic results. Delegates have

particularly highly valued their participation in

the Clinical Debates session, which allowed

an interactive discussion with a number of

specialists in different disciplines using the state

of the art Audience Voting System.

The 750 delegates had the opportunity to visit

an exhibition of latest technologies and materials

from major dental industries.

The conference management appreciates the

support of the sponsors including Yafour Resort

in Damascus, Smile Dental Journal, Ivoclar UK,

DMG and Kochaji Publication Establishment.

Prof. Albonni, Prof. Yousef & Dr. Almasri

The organising committee members

with the president of the British

Dental Association

Prof. Edward Lynch

Dr. Pierre Saloum

Eng. Houssam Jurdi

Dr. Amarjit & Dr. Siobhan

Dr. Joseph, Miss Solange & Mr. Farzat

Dr. Farwati, Dr. Almasri & Dr. Hans

Smile Dental Journal | Volume 5, Issue 4 - 2010 | 72 |


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28 - 30 October, 2010 | Beirut, Lebanon

7 th International Meeting of


Mediterranean Society of

Implantology and Modern Dentistry

For many years, SENAME’s annual session has been

leaving its marks on the scientific calendar of Mediterranean

dentistry. In 2010, under the patronage of the faculty of

Dental Medicine, SAINT JOSEPH UNIVERSITY (USJ) and with

the theme “State of the Art in Implantology and Modern

Dentistry”, the Mediterranean Society of Implantology and

Modern Dentistry held its 7 th International Meeting of SENAME

at Campus of Medical Science, USJ, Beirut – Lebanon

gathering global leaders in oral implantology who shared

their clinical expertise in surgical practice, as well as recent

advancements in research, academics and overall industry.

Oral presentations, live transmissions, Junior Podium and

pre-meeting courses enriched the program where Dr.

Maurice Salama & Dr. Henry Salama (USA) presented

a surgical video live from Atlanta showing “Advanced

Simultaneous Bone Ridge Augmentation and Sinus Elevation”.

More than 20 leading companies exhibited their dental

products to around 500 attendees.

Main sponsor: Tixos Implants.

During a Lecture

Dr. Makary, Prof. Naaman, Dr. El Khoury

At Richa Dental Store booth

Dr. Henry Salama at Cedra booth

Dr. Christian Makary (right) at Tekka booth


During a Lecture

Dental Tech

Our motto is to provide best quality and

services, which it makes Number 1 concern.

Interested in being a distributor for Neobiotech products in some Arab countries?

Please contact us: +962 79622 3402

28 - 29 October, 2010 | Beirut, Lebanon

For the first time in the history of Arab and Mediterranean countries, Mediterranean and Arab societies of Pediatric

Dentistry were gathered in one convention at the same time in Lebanon.

Arab Societies of Pediatric Dentistry meet once every two years in a convention in an Arab country. Lebanon gathered them

in 2002. Mediterranean Societies of Pediatric Dentistry meet once every four years in a Mediterranean country.

Lebanon had the chance to organize it in 1994.

In the year of 2010, the torch of knowledge has been entrusted to Lebanon to gather the Arab and Mediterranean

countries and The Lebanese Society of Pediatric Dentistry had the honor to organize The 7 th Mediterranean Congress of

Pediatric Dentistry with the 8 th Arab Congress of Pediatric Dentistry, on October 28-29, 2010 in Le Bristol Hotel/ Beirut.

The Arab Societies (Lebanon, Syria, Egypt, Tunisia, Kuwait, Jordan and Sudan) had their General Assembly on

Wednesday October 27, 2010 at Le Bristol Hotel where they discussed about making the Arab Society Association

more professionally evaluated on many levels and where Lebanon took the lead for Presidency till 2012 (President: Dr.

Mohamed Ezzeddine, Secretary General: Dr. Bechara Asmar, Treasurer: Dr. Georges Abi Hatem).

During the meeting of the Mediterranean Societies (Lebanon, Syria, Egypt, Tunisia, France, Italy, Turkey and Greece)

on Thursday October 28, 2010, Prof. Guiliano Falcolini proposed with an early discussed book to create during the

meeting and join the Mediterranean Association Of Pediatric Dentistry.

After voting, 3 members were elected as a board committee for 4 years:

President Dr. Mohamed Ezzeddine, Secretary General Prof. Guiliano Falcolini, Treasurer Dr. Bechara Al Asmar.

More than 30 Medical and Dental Companies sponsored this International event.

Two head speakers; Prof. Stephen Moss [USA], Dr. Alice Harfouche [Canada] and 30 speakers from all over the world

participated during these 2 days of conferences.

Prof. Charles Pilipilie

Dr. Mohamed, Miss Solange & Dr. Amr

Opening ceremony

Prof. Charles Pilipilie

Dr. Alice Harfouche

Prof. Stephen Moss


Quality and guarantee of effectiveness and

trouble-free process of prosthetics is the

main duty of Implasa Höchst company.

Research & Development

Is there a limit in development of dental

practice? The answer to this question opens

by itself, if we take a look to the way which

the Implasa Höchst company passed for 10

years in the field of the newest technologies

of the cure and prosthetics of teeth.

Materials & Technologies

The high-quality materials + constantly

improving technologies = the

guarantee of our quality and your


Production Cycle

ImPlasa Höchst company specialists

diligently control the quality of the

released production at all the

stages of technological process

and production.


The surface of implants is

prepared by unique

technology of ImPlasa Höchst

company, named ImPlapore,

which allows to reach

minimal traumatizing in

the area of implant

installation, and such

way maximally eases

the osseointegration


Visit us at:

AEEDC 2011

Hall 7 - Booth 521

IDS 2011

B059 - Hall 02.2

The Sole Representative in

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Kingdom Medical &

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3 - 4 November, 2010 | Muscat, Sultanate of Oman

The 7 th Gulf

Dental Association


Under the auspecies of H.E. Dr. Ahmed Mohammed Obaid Al

Saidi; Sultanate of Oman Minister of Health, the 7 th Gulf Dental

Association Conference was hosted in 2010 in The Sultanate of

Oman and organized by the Oman Dental Association in Al-Bustan

Palace Hotel.

Dr. Hamad Al-Harthy; President of the Organizing Committee of the

Congress and President of the Oman Dental Society, welcomed the

audience during the opening ceremony and spoke about the rich

support offered by the Sultan for the Congress.

Dr. Mohammad H. Al-Jammaz; General Secretary of the Gulf

Dental Association (GDA) mentioned: “Based on the GDA rules

and policies, this annual scientific conference focused during its

activities at aiming to improve continuing education, prevention,

research, development of standards, and enhancement of dental

care and awareness by the citizens and residents of GCC countries.

With the sincere cooperation of all dental societies and the support

from the governments in the GCC countries, the GDA conference

becoming one of the most important events on the international

dental calendar, giving the dental professionals the opportunity to

meet, share and discuss the latest in the dental science, art, ethics

and technology.”

The conference involved the main scientific program, exhibition and

pre-conference workshops as well as Poster Presentations covering

various disciplines of the dental profession.

The GDA Board held its 13 th meeting during the event discussing

future issues of the association.

Dr. Al-Jammaz and Dr. Al-Harthy

Dr. Al Madany during the trophy ceremony

Dr. Darwish during the trophy ceremony

Dr. Rajaa, Miss Solange and Dr. Aisha

DeguDent booth

GSK booth

Miss Sfeir with Dr. Al Kahtani

Visiting Smile booth

4 November, 2010 | Dubai, UAE

2 nd Aesthetic Dentistry

MENA Awards

On 4 th November 2010 CAPP and EMA Dental Society hosted the annual Aesthetic Dentistry MENA Awards Gala

Dinner, held at Jumeriah Beach Hotel, Dubai UAE.

The star studded evening was attended by the leaders in dentistry, industrial professionals and government. The

evening marked the dentistry elite and celebrated them in style with a glamorous awards ceremony and gala dinner.

The evening began with welcome remarks from Dr. Ali Bin Shekar Head of Association-EMA Board Greetings were

also delivered from Dr. Aisha Sultan, Head of Dental Services in Dubai and Northern Emirates Ministry of Health.

Followed by the presentation of the awards a fantastic dinner and enchanting Tanoura dancer.

This is the only awards that recognize the excellent achievements of dental practitioners across the region. The

competition again is jointly hosted by the two organizations that created the concept and actively promote it: EMA

Dental Association and CAPP (Centre for Advanced Professional Practices). Ministry of Health and professional

organizations (Saudi Dental Society, German Implantology Association, Alexandria Oral Implantology Association

etc.) supported the event for the second time.

Jury Panel members

Dr. Sabry, 3 rd place winner in Congenitial

& Maxillo-Facial Deformities best case

Memorial picture

Iraqi delegates

Dr. Sobatiani, 1 st place winner in Conservative

Esthetic best case

Announcing the winners

Dr. Hani Dalati & Spouse

Mr. Villani, 1 st place winner in Prosthetic

Restoration best case

Dr. El-Mousa & Spouse

Mr. Kafity & Dr. Mollova

AEEDC 2011 STAND N. 381-382

Smiles & Technologies



HYDRORISE: the first hyperhydrophilic A-silicone with a

very low contact angle (less than 10°) and the innovative

AMDA System (Advanced Moisture Displacement

Action) which guarantees precise detail reproduction in

the oral cavity.

ZETA HYGIENE: newly improved, widely effective

range of disinfectants and sterilisers for dental surgeries

and laboratories allows the user to deal with all the

hygienic–sanitary requirements of the dental surgery.

Tel. +39 - 0425 597611 - Fax +39 - 0425 597642 -

5 - 6 November, 2010 | Dubai, UAE

2 nd Dental - Facial Cosmetic

International Conference

The 2 nd Dental - Facial Cosmetic International Conference was a

great success, accomplish record attendance and further establishing

a status as the dental industry’s leading international conference.

It took place at the Jumeirah Beach Hotel Dubai from November

05 th to November 06 th , 2010. Organized by CAPP and EMA Dental

Society, the conference was supported by the Ministry of Health and

Saudi Dental Association.

Dubai gathered for the second time the world experts, an

international conference, open to all specialists working in the field of

aesthetic dentistry. As usual the best experts, speakers and specialists

in the different fields of dental and facial cosmetic, the worldwide

renowned specialists shared their experience.

Dr. Barakat presenting trophy to Dr. Aisha

More than 600 participants from 25 countries – dental professionals,

industry players, business and government got together at the 2 nd

Dental – Facial Cosmetic International Conference. Participants

soaked up the latest opinions, trends, and insights from industry

thought leaders, shared experiences with colleagues, made new

contacts and strengthened existing relationships, and honed their

ideas and knowledge.

At GSK booth

Memorial photo with the sponsors

Dr. Jallad, Dr. Mollova,

Mr. Villani and Dr. Dalloca

Dubai Medical Equipment

Noble Medical Equipment

Dr. Aljobory at DeguDent booth

At Dentoflex booth

Dr. Silwadi at Sirona booth

3M ESPE receiving a recognition trophy

Zimo Group Dr. Sabbagh & Dr. Aouad Dr. Hafseh & Dr. Ali

9 - 11 November, 2010 | Abu Dhabi, UAE



Crafted by IIR Middle East Life Sciences, the organizers of the annual

Arab Health Exhibition & Congress, the Dentistry 2010 Exhibition &

Conference was held at the Abu Dhabi National Exhibition Centre


Running beside the conference is a major exhibition showcasing

a wide range of products including imaging software, impression

materials, hand instruments and cosmetic dentistry products from

leading regional and global suppliers.

Al-Hayat Pharmaceuticals are a UAE-based company showcasing

an array of dentistry products, including their latest tooth whitening

products, at Dentistry 2010.

25 - 27 November, 2010 | Beirut, Lebanon

LDLS 2010

Lebanese Dental

Laboratories Show

6 th Scientific Congress

The Lebanese Dental Laboratory Show (LDLS) is held every two years in

Lebanon and is organized by the OPDL (Ordre des Prothesistes Dentaires

du Liban).

The 6 th Scientific Congress of LDLS-2010 was held at Beit Al Tabib (tahwita)

under the patronage of the Minister of Health Dr. Mouhamad Jawad

Khalife where the president of OPDL; Mr. Elias Sabbagh welcomed all the

Arab Dental Laboratories Union members (Jordan, Syria and Palestine)

and more than 500 dental technicians, eminent speakers, and exhibitors.

Mr. F. Khoury, Dr. A. Khoury, Mr. E. Sabbagh,

Miss Sfeir, Dr. C. Sharaf

Certificate of appreciation to the young team

Two courses were held, mainly to provide the basic knowledge, skill sets

and confidence to allow general practitioner to successfully operate the

related works and topics and improve their skills by Dr. Andreas Kullmann

(surgical guide that helps performing finished fixed work prior to the

operation) and Mr. Max Bosshart (Condylator system and teeth positioning

that allow good stability for the dentures).

A large exhibition of the latest technical equipment and products took

place at the congress venue.

Exhibition floor

Opening ceremony

Dr. Mollova & Mr. Al Hajj

At Prodent booth

Representative of the

Medical Brigade of the Royal

Jordanian Army

Representative of the Minister

of Health; Dr. A. Khoury

President of the Jordanian

Dental Laboratories

President of the Syrian Dental


OPDL board member;

Mr. Rodny Abdallah

Representative of the Palestinian

Dental Laboratories

Representative of the Royal

Jordanian Army; Colonel Manasiri

15 - 16 December, 2010 | Riyadh, KSA



Prof. Abdullah R. Al Shammery

Excerpted Speech during the Opening & Final Ceremony Night

His Excellency, Minister of Higher Education, His Excellency, the Deputy Minister of Higher Education

Their Excellencies, the Deans of dental colleges in Arab countries, Their Excellencies, the Heads

of Dental associations and unions of Gulf and Arab countries, Ladies & Gentlemen, Guests at the


Allah Peace and mercy be upon you. I am pleased as we celebrate this blessed day to begin the

ceremony for the 5 th Riyadh International Dental Meeting by welcoming you at this great scientific

gathering of Riyadh Colleges of Dentistry and Pharmacy which is annually organized on an ongoing


It is known that the Riyadh Colleges of Dentistry and Pharmacy is the first private health colleges in

the Kingdom which was founded in 1424 (2004) and began offering the programs in the beginning

of the first semester of year 1424H-1425H (2004-2005) and since that date, it began the career

by Allah help and the support and encouragement of the Custodian of the Two Holy Mosques, King

Abdullah Bin Abdulaziz and his government.

H.E. Dr. Mohamed Al-Ohali &

Prof. Abdullah Al Shammery

Opening ceremony

Government of KSA who are paying more attestation to go private higher education to enable it to

stand up to row with institutions of higher education to contribute to the rehabilitation and training

of health cadres in various Health disciplines to offer them to the labor market in the Kingdom and

other countries.

Riyadh Colleges of Dentistry and Pharmacy has the pleasure to organize this meeting which

involves pioneer and elite Doctors and productive speakers from inside and outside the Kingdom

participating by researches in the specialties of different health sectors.

There is no doubt that researches and the decisions that issued by scientific recommendations will

have a positive and effective impact on the Dentistry and on the progress of scientific research, which

confirms that Riyadh Colleges seek hard to achieve mission and objectives of multiple continuing

education and training for student and effective contribution in scientific research and offering

distinguished services to the community in accordance with the specializations offered by the colleges

in the Bachelor Degree, Master Degrees and the Saudi Board programs including the human force

or material equipment which are vital to teach, train and treat provided by the Riyadh Colleges and

its different university hospitals affiliated under the continued support of our government and the

guidance of His Excellency Minister of Higher Education, Dr. Khalid Al Angari sponsor of this event

and all deputy ministers and all the officials.

Bahrain Delegates

At Smile booth

Prof. Tareq Abbas

We have completed with our praise to God the college preparatory stage of academic accreditation

by the National Commission for Academic Accreditation & Assessment. They formed Committees

in two different stages the first one is the institutional accreditation and that was six weeks ago, the

second is the program accreditation, which was last week.

The members of the panel were professors prominent in the Accreditation and Evaluation from

the three countries United States of America, United Kingdom and Australia. This was held in

the presence and direct supervision of the National Commission for Academic Accreditation &

Assessment in KSA and we thank Allah that the initial report of the review panel was positive and

had many compliments to college completion and of these achievements during the period of seven

years which is short at the age of the universities.

Thanks to Dear guests, professors, lecturers and all contributor companies of the 5 th Riyadh

International Dental Meeting for their response and participation.

Finally, Special thanks for His Excellency Minister of Higher Education for sponsoring the activities of

this meeting and thanks also to His Excellency the Deputy Minister of Higher Education and to all the

deputy ministers and officials.

Dr. Al Kahtani; President of

the Saudi Dental Society


Dr. Omar Zidan Sirona Zirkon Zahn



Thanks also to ladies and gentlemen in Riyadh Colleges for their great efforts and for the committees

for their preparation and organizing this meeting and which I hope to interact elements, scientific

sessions and attendant activities to achieve the desired ambitions that will satisfy all officials and

government and confirm the leading role of Riyadh Colleges which is effectively carried out by

serving science through holding of such scientific fruitful meetings.

May Allah Bless you all!

| 88 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 89 |

Visit us at

AEEDC 2011

Booth 300 Hall 6

IDS 2011

A-041 Hall 11.3


Prof. Abdullah Al Shammery

Rector, Riyadh Colleges of Dentistry

and Pharmacy, KSA

Dr. Jihad Abdallah

Diplomate of the American Board of Oral

Implantology/Implant Dentistry (ABOI/ID)

Dr. Mohamed Ezzedine

President of the Mediterranean Association of

Pediatric Dentistry

Dr. Maher Almasri

Director of Oral Surgery Courses

Bone Graft Modules Leader

The University of Warwick, UK

Visit us at AEEDC 2011

at booths 206-212 & 221-227!

Learn why Piro Trading International is one of the best representatives in

the dental market! This is an excellent opportunity to meet our

manufactures and discuss business solutions. Daily presentations will be

held! Please come participate and learn about our newest products and


Visit us at:

AEEDC Hall #6

Stand #333

333 Stand 6 # AEEDC Hall

Faculty of Dentistry - Pharos University

Canal Al-Mahmoudeyah St.

Tel: +203 387 7096

Fax: +203 387 7096

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Visit us at AEEDC at Piro Trading booth #206-212 and #221-227.

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Reduce clogging and improve cutting efficiency

A great option for any procedure.

• Unique diamond application process ensures

excellent diamond particle retention and cutting

surface throughout multiple uses

• A wide selection of grit sizes, including

Extra Coarse for rapid gross reduction

• Wide selection of shapes to accommodate any

clinical indication or prep design

• Outstanding cutting efficiency reduces chatter

and instrument wear and tear

Available in the most popular

shapes and sizes.

Diamonds sold Individually (1 per pack)

JET ® CARBIDE BURS Enduring esthetics. Effortless efficiency. Precisely.

Jet Carbides offer a full

selection of shapes and sizes,

including many specialty items.

Jet Carbides provide a clinician with the tools

necessary to adequately prepare any restoration.

Jet Carbides can aid in procedures from

rapid reduction to fine finishing of composites.

Jet Carbides are known for exceptional cutting

efficiency and dependability as well as their

outstanding value.

Available in the most popular

shapes and sizes.

Carbides come in 5,10 and 100 packs.

Sybron Canada LP/Beavers Dental

Visit us at AEEDC at Piro Trading booth #206-212 and #221-227.

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