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A s i a ’ s P r e m i e r J o u r n a l f o r D e n t a l P r a c t i c e a n d T e c h n o l o g y<br />
MICA (P) No: 033/05/2008 KDN: PPS 1452/09/2008(001054) ISSN: 0219-5682 • www.dentalasia.net • MAY / JUNE 2008<br />
Post-Minor Oral Surgery<br />
Pain Management<br />
• The Use of Motivation Theories in Dentistry<br />
• Eliminating <strong>Dental</strong> Stains<br />
• IDEM 2008 Review
Editorial<br />
Editor<br />
Desmond Teo<br />
desmondteo@pabloasia.com<br />
Senior Editor (Chinese Edition)<br />
Yu Dongzhan<br />
yudongzhan@pabloasia.com<br />
Sales & Marketing<br />
Publication Executive — Singapore<br />
Jamie Tan<br />
jamietan@pabloasia.com<br />
General Manager — Pablo Beijing<br />
Ellen Gao<br />
pablochina@tom.com<br />
Publication Executive — Pablo Beijing<br />
Snow Hou<br />
pablochina@tom.com<br />
General Manager — Pablo Shanghai<br />
Kelly Shen<br />
pabloshanghai@tom.com<br />
Design & Production<br />
Designer<br />
Edwin De Souza<br />
edwin@pabloasia.com<br />
Management<br />
Publisher<br />
William Pang<br />
williampang@pabloasia.com<br />
Executive Director<br />
Alistair Bryson<br />
pablogermany@t-online.de<br />
Associate Publisher<br />
Pamela Buckley<br />
pamela@pabloasia.com<br />
Circulation Executive<br />
Ai Ling<br />
circulation@pabloasia.com<br />
Published by:<br />
Pablo Publishing Pte Ltd<br />
Block 16 Kallang Place #07-01,<br />
Singapore 339156<br />
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Fax: +65-6396-7177<br />
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CONTENTS<br />
May / June 2008<br />
18 The Promise of Salivary Diagnostics<br />
30<br />
Eliminating <strong>Dental</strong> Stains<br />
48 IDEM 2008 Review<br />
OTHER COLUMNS<br />
4 FIRST WORDS<br />
6 INDUSTRY BRIEF<br />
12 EVENT REPORT<br />
16 CORPORATE PROFILE<br />
24 CLINICAL FEATURES<br />
43 USER’S REPORT<br />
47 EXHIBITION PREVIEW<br />
57 PRODUCT UPDATE<br />
62 EVENTS CALENDAR<br />
64 AD INDEX<br />
The use of saliva as a diagnostic fluid for<br />
various human ailments is gaining popularity<br />
as it offers distinct advantages over serum.<br />
These include the non-invasive nature of<br />
saliva collection compared with phlebotomy,<br />
simplicity of collection and the cost-effective<br />
applicability for screening large populations.<br />
So, is saliva a reliable diagnostic tool?<br />
<strong>Dental</strong> stains are of great concern to the<br />
vast majority of the population. Tooth<br />
discoloration has been made socially and<br />
culturally unacceptable by the ubiquitous<br />
presence of bright, white smiles on<br />
television, in films, and the print media.<br />
From a professional perspective, dental<br />
stains contribute to plaque accumulation, the increased retention of<br />
bacteria and their associated acidic environment, and eventually, to tooth<br />
demineralization and decay. Dr George Freedman puts a commerciallyavailable<br />
dentifrice to test.<br />
IDEM 2008 has finally concluded. After much<br />
hype and anticipation, did the event live up<br />
to its name and outperform that of 2006’s?<br />
<strong>Dental</strong> <strong>Asia</strong> files this first-hand review of the<br />
misses and hits that were witnessed during<br />
the duration of the show.<br />
Cover photo: Courtesy of T32 <strong>Dental</strong> Center<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
1
ADVISORYBOARD<br />
Dr Graham J.<br />
Mount<br />
(Australia)<br />
Dr George<br />
Freedman<br />
(Canada)<br />
Prof Alex<br />
Mersel<br />
(Israel)<br />
Prof Urban<br />
Hägg<br />
(Hong Kong)<br />
Dr Chung Kong<br />
Mun<br />
(Singapore)<br />
Dr William<br />
O’Reilly<br />
(Australia)<br />
Dr Choo Teck<br />
Chuan<br />
(Singapore)<br />
Dr Saw Lip<br />
Hean<br />
(Malaysia)<br />
Prof Nigel M.<br />
King<br />
(Hong Kong)<br />
Dr Hien Ngo<br />
(Australia)<br />
Dr Adrian<br />
U J Yap<br />
(Singapore)<br />
Stefan<br />
Borenstein<br />
(Canada)<br />
Dr How Kim<br />
Chuan<br />
(Malaysia)<br />
Dr Elliot<br />
Mechanic<br />
(Canada)<br />
Dr Pranee<br />
Wattanapayungkul<br />
(Thailand)<br />
Dr Hong Yong<br />
Huat<br />
(Malaysia)<br />
2 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
FIRSTWORDS<br />
The Thing About Exhibitions...<br />
Exhibitions in and around the region are coming thick-and-fast and before we realize it, half the year<br />
is up. Since January, dental exhibitions and conferences — big or small — in this region were<br />
speeding in full throttle. IDEM has just concluded and will be followed by APDC in May, Sino <strong>Dental</strong>,<br />
MDA Convention and SIDEX in June. Prior to all these shows, there were the AEEDC in Dubai, ADX<br />
(Australia), APOC, etc. Interspersed with all these were events by the dental associations in<br />
Indonesia, the Philippines, Vietnam. No wonder manufacturers are feeling the exhaustion and the<br />
pinch. Even the delegates and visitors were spread thin by all these events.<br />
The starting point of the event organizers is good but much consideration must be given when<br />
initiating a totally new show just to plug the needs of the domestic market. Is revenue-making the<br />
main driving force behind such decisions? Can regional exhibitions not be able to suffice the needs? Do more exhibitions<br />
mean better for the dental industry in <strong>Asia</strong> or will they backfire eventually? Organizers should learn to listen more<br />
attentively. The noises of the exhibitors and visitors could not be wrong.<br />
In this issue, we highlighted a couple of events that took place during the past two months — Warwick University-UKM<br />
Implant Symposium and the celebration of IDS <strong>Dental</strong>’s 40th Anniversary.<br />
Prof Lakshman Samaranayake, Dean of Faculty of Dentistry of Hong Kong University, explores the effectiveness of using<br />
saliva as a diagnostic tool various human ailments and what does it hold for the future?<br />
Pain management is crucial especially after surgery. Applying the right method and the correct pain control products will<br />
greatly help in reassuring the patient. This article looks at the different ways where pain control can be administered.<br />
Also in this issue, we give you a first-hand review of IDEM 2008 right from the showfloor. For those who were not present<br />
during the event, the review will give you a glimpse of what you have missed.<br />
Happy reading!<br />
Desmond Teo<br />
Editor<br />
Disclaimer: All rights reserved. Views of writers do not necessarily reflect the views of the Publisher.<br />
No part of this publication may be reproduced in any form or by any means, without prior permission in writing from the Publisher and copyright owner. Whilst every care is<br />
taken to ensure accuracy of the information in this publication, the Publisher accepts no liability for damages caused by misinterpretation of information, expressed or<br />
implied, within the pages of the magazine.<br />
All advertisements are accepted on the understanding that the Advertiser is authorised to publish the contents of the advertisements, and in this respect, the Advertiser<br />
shall indemnify the Publisher against all claims or suits for libel, violation of right of privacy and copyright infringements.<br />
<strong>Dental</strong> <strong>Asia</strong> is a controlled-circulation bi-monthly magazine. It is mailed free-of-charge to readers who meet a set of criteria. Paid subscription is available to those who do<br />
not fit our terms of control.Please refer to subscription form provided in the publication for more details.<br />
4 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
INDUSTRYBRIEF<br />
Celfa <strong>Dental</strong> Group Acquires Castellini<br />
Italy — Celfa <strong>Dental</strong><br />
Group has reinforced its<br />
position in the dental unit<br />
sector with its latest<br />
100% acquisition of<br />
Castellini SpA, which<br />
specializes in the<br />
development of systems<br />
for disinfection and<br />
sterilisation applications,<br />
as well as with regard to ergonomics.<br />
Despite the acquisition, Cefla <strong>Dental</strong> Group will maintain and<br />
implement the<br />
distinctive features of<br />
Castellini products,<br />
ensuring<br />
improvement in terms<br />
of quality and<br />
performance.<br />
Furthermore, the<br />
current distribution<br />
set-up will be<br />
retained while, on the<br />
other hand, Castellini will benefit from a significant “service<br />
package” upon entry into a Group of larger dimensions.<br />
DA<br />
Easy and Happy Brushing<br />
Singapore — A new toothbrush, the Happy Brush, specially<br />
designed for little teeth (children) has been introduced by the<br />
Health Promotion Board (HPB) of Singapore.<br />
The Happy Brush is designed to enable children to use the<br />
‘scrub’ technique which they are most comfortable with and<br />
yet allows them to achieve the same results as the more<br />
complicated techniques. This is made possible through a<br />
specially customized brush head and bristles. The Happy<br />
Brush has a single head with a semi-circular arc. Bristles are<br />
inserted into this arc to allow it to cap all the surfaces of a<br />
few teeth at a time. The shape and design of the Happy<br />
Brush also enables impatient toothbrushers, who tend to<br />
neglect the harder to reach areas, to brush those areas<br />
easily.<br />
“It is important to inculcate the habit of toothbrushing from a<br />
young age. The Happy Brush debunks the notion that<br />
toothbrushing is a chore, making it easier for children to get<br />
into a toothbrushing routine that they will more likely followthrough<br />
to adulthood. Good dental health in adulthood<br />
begins from childhood,” said Dr Eu Oy Chu, Senior Deputy<br />
Director, School <strong>Dental</strong> Service, HPB.<br />
The Happy Brush, designed and developed by HPB’s School<br />
<strong>Dental</strong> Service (SDS). DA<br />
Int’l Expodental Incorporated 1st Expodental Forum<br />
Italy — Italy’s premier dental exhibition, International<br />
Expodental, will be incorporating the first Expodental Forum<br />
in its edition this year. The forum will be a series of courses,<br />
conventions and workshops for all dental professionals and<br />
those working dentistry.<br />
The Forum, planned and organised in collaboration with<br />
Quadra Service and promoted by the UNIDI (Italian <strong>Dental</strong><br />
Industries Association) will take place every morning for the<br />
entire duration of the exhibition, from 9:30 to 13:30. It will be<br />
held in the various halls of the Convention Centre, with<br />
individual or joint sessions for professional categories<br />
(<strong>Dental</strong> Surgeon / <strong>Dental</strong> Technician, <strong>Dental</strong> Specialist /<br />
Surgery Assistant, Industrials / Commercial Operators, etc.).<br />
The afternoons will be used for technological workshops set<br />
up and organised by exhibitors.<br />
The Scientific Committee will be coordinated by Dr Andrea<br />
Paolinelli, President of Quadra Service, and will include<br />
esteemed professionals like Mr Roberto Bonfiglioli, Dr Aldo<br />
Nobili, and Dr Marisa Roncati Parma Benfenati.<br />
To attend or request further information on the 1st<br />
Expodental Forum, email to:<br />
expodentalforum@quadraservice.com. DA<br />
<strong>Dental</strong>bite ...<br />
• KaVo <strong>Dental</strong> GmbH has acquired Shirokusu <strong>Dental</strong> Supply Works, a Japan-based distributor of dental medical<br />
devices, thus giving the former a wider access into the Japanese market.<br />
6<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008
INDUSTRYBRIEF<br />
T32 <strong>Dental</strong> Center Opens <strong>Dental</strong> Academy<br />
Singapore — T32 <strong>Dental</strong> Center has officially opened the<br />
International <strong>Dental</strong> Academy (IDA) — a private dental<br />
teaching facility that aims to raise the standards of dentistry<br />
in Singapore and around the region.<br />
The lab facilities that dentists and<br />
technicians will have access to at the<br />
International <strong>Dental</strong> Academy<br />
Based on the theory<br />
that there is only so<br />
much theory a dentist<br />
can learn in a<br />
classroom, the IDA<br />
has been set up with<br />
the purpose of<br />
providing dentists from<br />
around the region an<br />
opportunity to develop<br />
their skills in a real<br />
environment.<br />
“Dentists from all over<br />
the region regardless<br />
of their background and experience levels feel that there is<br />
always something new to learn. They are always looking for<br />
new ways to develop their skills, and ways to leverage new<br />
technology. The IDA provides dentists with the opportunity<br />
to do this and more” said Dr Wong Keng Mun, Director,<br />
IDA.<br />
With the recent implementation of the dental specialist<br />
register and compulsory continuing professional education<br />
for Singapore dentists, the International <strong>Dental</strong> Academy<br />
provides a valuable platform for dentists aiming to develop<br />
their skills.<br />
“Many dentists from around the world come to IDA to impart<br />
their knowledge, experience and skills to their fellow dentists.<br />
This provides a great opportunity to share best practices and<br />
raise the bar within the field of dentistry in the region”, noted<br />
Dr Wong.<br />
Since its soft launch in October 2007, the IDA has seen over<br />
250 dentists from countries all over the region participate in<br />
its courses, lectures and practical training sessions. Dentists<br />
have the option of signing up for individual courses or taking<br />
up the one-year program, where they will be invited to use<br />
the technology and facilities of T32 <strong>Dental</strong> Centre on a<br />
weekly basis to treat patients and further develop specialist<br />
skills. Dentists around the region can monitor courses at the<br />
IDA website at www.t32dental.com. DA<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008 7
INDUSTRYBRIEF<br />
Nobel Biocare Ties Up with DCI<br />
India — The <strong>Dental</strong> Council of India (DCI) has entered into<br />
partnership with Nobel Biocare to establish a Centre of<br />
<strong>Dental</strong> Excellence in the country. An agreement has been<br />
signed in this regard and a location is being sought in Delhi<br />
or Mumbai for the Centre.<br />
“The objective behind such a move is to constantly educate<br />
the dental fraternity on the latest techniques and<br />
developments in dentistry and simultaneously stressing the<br />
need for maintaining the highest standards in dental<br />
education and ethics,” said Dr Anil Kohli, President of DCI.<br />
According to Dr Kohli, the number of dental colleges has<br />
increased and more than 15,000 students pass out each<br />
year but there is an acute<br />
shortage of teachers with<br />
the result that educational<br />
quality suffers.<br />
“The council had<br />
apprised the central and state governments on this aspect<br />
though nothing has been done to rectify the problem,” he<br />
added.<br />
He also felt the need for a continuing dental education where<br />
dentists should undergo about 20 hours each year. He also<br />
recommended that dentists maintain strict vigilance<br />
concerning infection control and waste management.<br />
DA<br />
Operation <strong>Dental</strong> Smile in Vietnam a Success<br />
Vietnam — Nearly 5,000 children and young adults in Hue<br />
and Hanoi received free dental check-ups under American<br />
NGO Operation Smile’s 12th annual <strong>Dental</strong> Mission to<br />
Vietnam recently.<br />
The mission involved more than 30 dental professionals from<br />
US, including oral surgeons, endodontists, pediatric dentists,<br />
general dentists, and students from the University of Maryland.<br />
In Hanoi, it is being held at the Vietnam-Cuba Hospital and<br />
Hanoi Medicine and Pharmacy University, while in Hue,<br />
children received dental care at Operation Smile’s<br />
Comprehensive Care Centre.<br />
The volunteers said they considered the event an opportunity<br />
to share their experiences in dental care with their local<br />
colleagues.<br />
Dr Daniel Taub from Philadelphia, one of the team leaders,<br />
said: “I always glean interesting experiences from<br />
Vietnamese experts during my missions to Vietnam. This is<br />
the 13th time I am coming to the country. It recognise many<br />
things have improved.”<br />
Every person screened at the clinics is given a toothbrush<br />
and toothpaste, and told about the importance of oral<br />
hygiene. DA<br />
W&H <strong>Dental</strong>-Mechanik (<strong>Asia</strong>) Officially Opens<br />
Singapore — W&H <strong>Dental</strong>-<br />
Mechanik (<strong>Asia</strong>) was officially<br />
opened by, Mr Peter Malata, W&H<br />
<strong>Dental</strong>werk President, amid much<br />
fanfare. In his speech, Mr Malata<br />
outlined the importance of the new<br />
service center in Singapore and<br />
that it will play a major role in the<br />
future by holding workshops as<br />
well. The service center offers<br />
W&H premium services for the<br />
<strong>Asia</strong>-Pacific region.<br />
Mr Peter Malata (center) posing with his W&H team and local<br />
distributor, IDS <strong>Dental</strong><br />
The center is currently<br />
managed by Mr Stephan<br />
Rauchenzauner, the technical<br />
services manager, and<br />
reporting to Mr Martin Rolfe,<br />
the Area Manager for <strong>Asia</strong>-<br />
Pacific region. The new<br />
service center will also be<br />
actively be looking for suitable<br />
candidates to fill the positions<br />
available during the next few<br />
months. DA<br />
<strong>Dental</strong>bite ...<br />
• KaVo <strong>Dental</strong> GmbH has acquired Shirokusu <strong>Dental</strong> Supply Works, a Japan-based distributor of dental medical<br />
devices, thus giving the former a wider access into the Japanese market.<br />
8<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008
INDUSTRYBRIEF<br />
PDA Held 100th Annual Convention & Scientific Mtg<br />
Philippines — The theme for this year’s Philippine <strong>Dental</strong><br />
Association (PDA) annual convention and scientific meeting<br />
was “Taking Philippine Dentistry to the Next Level”; and by<br />
that it hopes to provide continuing dental education to all<br />
dentists, in order to keep them updated on developments in<br />
the field, raise the standards of the profession, and share<br />
and replicate best practices.<br />
Several parallel symposiums were lined up for the<br />
weeklong event, geared to better understand current issues<br />
in dental practice. They covered the following major<br />
aspects of dentistry: Oral surgery, implant dentistry,<br />
pediatric dentistry, orthodontics, esthetic dentistry,<br />
endodontics, prosthodontics and dental laboratory<br />
technology, periodontics, and temporomandibular joint<br />
disorders. A panel discussion on understanding patients<br />
with disabilities was also held.<br />
Some of the topics discussed during the symposiums are<br />
pre-orthodontic treatment (to extract or not to extract), oral<br />
manifestations in patients maintained by hemodialysis for<br />
chronic renal failure, the legal aspects of risk management in<br />
today’s dental practice, knowledge of ethical responsibility as<br />
an essential element in today’s dental practice, practical<br />
infection control in the dental office and clinic, and forensic<br />
science and insights into forensic odontology. DA<br />
Revamped Detax Website Goes Online<br />
Germany — The new Detax website is<br />
online with a fresh design, even more<br />
information and improved simplicity. The<br />
focus is on maximum customer benefit,<br />
intelligent user guidance and ease-ofuse.<br />
With new, smart functions we aim to<br />
offer our customers useful added value.<br />
The complete product range, events in<br />
Germany and abroad, customer service,<br />
press center or just “what’s new” —<br />
WDES Donates $250k<br />
to NUS<br />
Singapore — The World <strong>Dental</strong> Education Society Singapore<br />
(WDES) donated S$250,000 (US$184,000) to the National<br />
University of Singapore (NUS). The donation, which is eligible<br />
for the dollar-for-dollar grant by the Singapore Government,<br />
will support undergraduate dental students to go on the<br />
overseas exchange programs. A portion of the donation comes<br />
from the partnership fees that WDES received as co-organizer<br />
of the last IDEM Scientific Conference.<br />
Dr Choo Teck Chuan, President of the WDES since its<br />
inception, hopes that the S$250,000 endowed gift, together<br />
with government matching grant of the same amount, will<br />
benefit 10 worthy students each year. The Award, to be<br />
known as the WDES-FDI World <strong>Dental</strong> Federation Award will<br />
be administered by the Faculty of Dentistry at NUS.<br />
whatever the user look for can be easily<br />
selected out of numerous options.<br />
Instructions of use and data sheets can<br />
be downloaded as well.<br />
The barrier-free website is open as far as<br />
the type of presentation selected is<br />
concerned. It provides optimum access<br />
on any media, no matter whether the<br />
user calls it up with a conventional web<br />
browser, a PDA or a mobile phone. DA<br />
VITA Renames Product<br />
Germany — VITA is re-naming<br />
the product “Dentine”. It shall now<br />
been called “Transpa Dentine”.<br />
This applies to the all-ceramic<br />
veneering materials VITA VM 7<br />
and VM 9, as well as the metal<br />
ceramic VM 13m — with effect<br />
from April 2008. The alteration, however, relates exclusively to<br />
the product name — the materials themselves remain<br />
identical, and shall continue to be available in the current<br />
versions.<br />
In addition, the more shade-intensive 2-layer VITA VM<br />
BASIC layering consisting of “Base Dentine” and “Enamel” is<br />
used. The VITA VM BASIC layering is ideal for high quality<br />
standard veneering and for the reproduction of tooth shades<br />
in the case of thin walls.<br />
DA<br />
SOMETHING TO SHARE?<br />
We want to hear from you! Email your story to the Editor:<br />
desmondteo@pabloasia.com<br />
10<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008
INDUSTRYBRIEF<br />
Cavity-Fighting Candy Helped Cut Tooth Decay?<br />
USA — Most children are told to stay away from chewy<br />
candies to keep their teeth cavity-free, but children in<br />
Venezuela who ate a special cavity-fighting candy had 62%<br />
fewer cavities than those who brushed their teeth regularly,<br />
according to researchers at Stony Brook University School of<br />
<strong>Dental</strong> Medicine.<br />
Children in the study were testing the effectiveness of<br />
BasicMints, an experimental fluoride-free treatment designed<br />
to mimic a component in human saliva that neutralizes acids<br />
in the mouth that can erode tooth enamel.<br />
The researchers, who developed the active compound in the<br />
mints known as CaviStat, tested them in 200 children in<br />
Venezuela aged 10 1 / 2<br />
to 11 who were getting their adult<br />
molars but still had some baby teeth left.<br />
Half the children in the study took two of the medicated mints<br />
in the morning after brushing with a fluoride toothpaste. They<br />
followed the same routine at night. The other half brushed<br />
normally twice daily with fluoride toothpaste and took plain<br />
sugarless mints.<br />
After 12 months, children who took the cavity-fighting mints<br />
had 61.7% fewer cavities than the placebo group.<br />
The soft mints are designed to be dissolved and chewed into<br />
the biting surfaces of the back teeth, where about 90% of<br />
cavities in children occur.<br />
“Unlike regular candies, we want this product to be stuck in the<br />
teeth,” said Mitchell Goldberg, President of Ortek Therapeutics<br />
Inc, that licensed the technology from Stony Brook.<br />
He said the company plans to seek US Food and Drug<br />
Administration approval to begin testing the product in the<br />
United States by year end. It may take several years of<br />
testing before it wins US marketing approval. DA<br />
Dentists Warn About Teeth Bleaching<br />
Hong Kong — The public has been warned to consult a<br />
dentist before getting teeth bleached to avoid possible<br />
complications.<br />
<strong>Dental</strong> Association President, Dr Sigmund Leung said the<br />
public should understand that patients with gum problems,<br />
cavities and defective fillings were unsuitable candidates for<br />
bleaching.<br />
He said the highly concentrated bleach used in the<br />
procedure could cause complications to the gums and teeth<br />
leading to pulpitis, an inflammation of the dental pulp or<br />
toothache, which might eventually require the affected teeth<br />
to be removed.<br />
He contended that teeth-whitening treatments should be<br />
done at dental clinics instead of beauty salons.<br />
No Clinics for Saudi<br />
Dentists<br />
Saudi Arabia — Despite 220 established new dental clinics<br />
across Saudi Arabia, unemployed dentistry graduates are still<br />
unable to find jobs. According to the Health Ministry, new<br />
centers are only employing specialized dentists, while new<br />
graduates keep looking for opportunities in big cities, while<br />
other regions are left unexplored. The government is allotting<br />
SR27 million (US$7.2 million) for the construction of new<br />
clinics all over the kingdom. DA<br />
Dr Leung said<br />
bleaching or<br />
whitening<br />
products sold over<br />
the counter<br />
contained low<br />
concentrations of<br />
bleach that might<br />
not give the<br />
expected results.<br />
Most whitening toothpastes contained abrasives used to rub<br />
the surface of the teeth for brighter effect, but that could<br />
cause thinning of the enamel.<br />
He also remarked bleaching was not necessarily the only<br />
way to make teeth look brighter, with tea and coffee stains<br />
and tartar able to be removed through scaling. DA<br />
Light Catalysted<br />
Toothpaste<br />
Japan — Tokyo-based Yoshimi has released “Aura Rose”, a<br />
low irritant gel-type toothpaste containing a titanium apatite<br />
light catalyst. The light catalyst helps remove plaque deposits<br />
by absorbing the proteins and sugars making up plaque itself<br />
and aids in the re-calcification of the tooth’s surface. Other<br />
ingredients include a vitamin C derivative, a low molecular<br />
hyaluronic acid to moisturise the inside of the mouth and a<br />
silver ion breath freshener. DA<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008 11
EVENTREPORT<br />
by Drs Lee Soon Boon • Lim Swee Seng •<br />
Dennis Lee • Eugene Tang • Ng Fooi Chin<br />
Renowned speakers present during the opening<br />
ceremony of the Symposium<br />
UKM-Warwick<br />
University<br />
Successfully<br />
Conclude Implant<br />
Symposium &<br />
Occlusion Course<br />
The University of Warwick and University Kebangsaan Malaysia jointly<br />
hosted a 3-days Implant Occlusion-Prosthodontic workshop and a 1-day<br />
Implant Symposium from 28 February 2008 to 2 March 2008 at UKM, Kuala<br />
Lumpur.<br />
The Implant Symposium attracted 300 dentists and trade exhibitors from China,<br />
Malaysia, Singapore, Indonesia, Korea, Pakistan, Bangladesh and the United<br />
Kingdom. The dental practitioners and supporters from the trade came to advance<br />
the art and science of implant dentistry for the benefit of patients.<br />
The international panel of speakers covered various aspects of implant dentistry<br />
with emphasis on current trends and techniques related to implant dentistry. They<br />
shared first hand knowledge of their clinical and research experience on immediate<br />
loading, bone graft regeneration, smile design and aesthetic implant restorations.<br />
The UKM Dean, Prof Ghazali commented that it was the largest attendance for a<br />
“one topic” programme held at the faculty.<br />
The intensive 3-days Occlusion-Prosthodontic course was one of the compulsory<br />
modules to fulfil the University Warwick MSc in Implant Dentistry degree.<br />
University of Warwick MSc in<br />
Implant Dentistry in Singapore<br />
Application for 2008 intake is now open!<br />
Intake 2008/09 Academic Calendar<br />
• August 2008<br />
• October 2008<br />
• January 2009<br />
• April 2009<br />
Contact: sgdentistry@warwick.ac.uk<br />
http://www.warwick.ac.uk/go/dentistry<br />
University of Warwick runs a rigorous flexi part-time implant course at both Diploma<br />
and Masters levels to meet the needs of the upwardly mobile practitioners who wish<br />
to enhance their implant practice. University of Warwick has established an<br />
international panel of implant faculty in UK, Middle East and Far East to provide<br />
didactic and clinical support for their programme. Warwick’s International Training<br />
Centre in Singapore coordinates the training programme for Southeast <strong>Asia</strong>. About<br />
200 practitioners are currently registered on the University Warwick’s MSc program.<br />
Both the MSc and Diploma in Implant Dentistry are both recognized as additional<br />
qualifications by the General <strong>Dental</strong> Council, UK.<br />
A Fellowship Dinner was also held in conjunction with the Implant Symposium. The<br />
dinner was held in a rustic ambience overlooking the silhouette of the imposing KL<br />
twin towers. The participants and implant exponents from the East and the West<br />
12 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
EVENTREPORT<br />
exchanged ideas as they partake in the gorgeous fusion menu.<br />
Every passing moment energized the atmosphere more to<br />
further loosen reservations. With gaiety and joviality on the<br />
ascent, many hidden talents surfaced. Each country strut the<br />
stage to put up impromptu “national” items, vying to make their<br />
contribution the “memorable item” of the evening.<br />
The warm fellowship and camaraderie forged during the dinner<br />
augusts well as many of us only met for the first time. At the<br />
dinner, a keynote speaker eloquently summed up the spirit of<br />
the symposium: “I am here not only to teach, but also to learn.”<br />
In the end we all learn… from different parts of the world. DA<br />
• Dr Lee Soon Boon, Dr Lim Swee Seng, Dr Dennis Lee are<br />
University of Warwick 2nd year MSc implant dentistry<br />
postgraduate students, Malaysia<br />
• Dr Eugene Tan is University of Warwick 2nd year MSc<br />
implant dentistry postgraduate student, Singapore<br />
• Dr Ng Fooi Chin is University of Warwick Hon Assoc<br />
Professor and Director of MSc in Implant Dentistry, University of<br />
Warwick International Training Centre, Singapore<br />
The Symposium was well attended by senior<br />
and junior dental professionals<br />
Fellowship dinner with live piano recital<br />
Rendition by Prof Chan Yew Ai (right)<br />
The trade exhibition is a draw among the visitors and delegates<br />
<strong>Dental</strong> <strong>Asia</strong> • May / Junel 2008<br />
13
EVENTREPORT<br />
by Desmond Teo<br />
IDS <strong>Dental</strong><br />
Celebrates 40th<br />
Anniversary<br />
It’s not everyday you get to<br />
celebrate 40th anniversary and<br />
having past this point, it is a<br />
historical milestone worth<br />
celebrating and rejoicing. IDS <strong>Dental</strong>,<br />
a leading SIngapore-based distributor,<br />
did just that by inviting all its<br />
principals, as well as customers to<br />
come together for a nite of big bash.<br />
Despite their hectic schedules during<br />
the day at IDEM, everyone present<br />
interacted freely and let their hair<br />
down gamely. Apart from nostalgic live<br />
band performance, the guests were<br />
A group photo with the principals. Sophia Lim is<br />
standing second from left. Linda Teo is sitting third<br />
from left.<br />
very obliging and sporting to go on stage to perform karaoke singing, accompanied<br />
by the live band, and one must be present to realize the hidden talents in the dental<br />
industry that could possibly beat the daylight out of the contestants of American<br />
Idol.<br />
The night also saw IDS <strong>Dental</strong> presenting long service awards to its principals,<br />
some of whom have been with the former for 20 to 30 years long and they inlcude,<br />
Coltene Whaledent, Takara Belmont, W&H, Durr <strong>Dental</strong>, Planmeca etc. And from<br />
the speeches of these principals who received their awards, it would not be hard to<br />
realize how much they appreciated the service and effort that IDS <strong>Dental</strong> have put<br />
in in all these years of partnership.<br />
So, let’s look forward to another 40 years of excellent service from IDS <strong>Dental</strong>.<br />
Ms Linda Teo, herself a long<br />
service employee with IDS <strong>Dental</strong><br />
giving her speech<br />
Mr Hidetaka Yoshikawa, Chairman & CEO of Takara<br />
Belmont giving his note of thanks to Sophia Lim,<br />
Country Managing Director of IDS <strong>Dental</strong><br />
Mr Yoichi Okamura belting out a Japanese classic with full<br />
gusto. This was just one of the several live karaoke singing<br />
by the guests with live band.<br />
14 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CORPORATEPROFILE<br />
by Desmond Teo<br />
DenMit - Plugging<br />
the Needs of<br />
Dentists<br />
Dynamism, sensitivity to customers’ needs and being mobile — these are the<br />
plus factors of DenMit Trading that one will come away with when you<br />
speak to one of the pioneers of the company, Claudia Ng, who is also the<br />
marketing manager.<br />
Said Claudia, who has experience as a solution provider for the dentists from her<br />
previous company, about DenMit: “Being a small outfit, we can adapt and change<br />
according to the situations better. We are not bound by hard-and-fast regulations<br />
and we take it upon our duties to provide an excellent before- and after-sales<br />
support for our clients.”<br />
Although DenMit Trading was incorporated in 2006, its staff are experienced in the<br />
field of dental solutions. “We may be a young outfit but our staff have years of<br />
experience in dental sales and technical competency. So far, I am proud to say that<br />
all our clients are satisfied with our service and support,” Claudia added. The<br />
technical support staff are qualified and trained to handle the different products that<br />
the company is carrying.<br />
Apart from meeting customers’ needs, another area that DenMit is proud of is in<br />
providing cost-effective customized solutions for its clients. In fact, it will go out of<br />
the way to facilitate its customers in their dental setups and making it hassle-free for<br />
them. “By being cost-effectiveness, I meant that we will try to meet the customers’<br />
margin, the budgets they have, as well as offering innovative instalment plans for<br />
them.”<br />
Spreading its Wings<br />
DenMit is not contented with just making a name for itself in Singapore; in fact, it is<br />
looking further afield. According to Claudia, they have already made in-roads into<br />
Thailand, Australia and India “successfully” and are now eyeing the Indonesian<br />
market as well.<br />
“I am grateful with the support I have been getting from the local dentists since we<br />
started but it’s also our vision to have a share of the dental market in this region,<br />
and I am confident we can achieve that within the next three years,” revealed<br />
16 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CORPORATEPROFILE<br />
Small and new as it might be<br />
but DenMit Trading is in no<br />
way hampered by that; on the<br />
contrary, it is systematically<br />
realizing its goals and<br />
growing from strength-tostrength<br />
Claudia confidently. Claudia also revealed that should<br />
opportunity arise, DenMit might look into “setting up a<br />
company” there.<br />
Already DenMit is carrying several established product lines,<br />
which are well-received by the dentists. Amongst them were<br />
Owandy, Rolence, Nouvag, just to name a few.<br />
But, being a young company, is it moving too fast and too far?<br />
Claudia thinks not. “I would say I am ambitious but not to the<br />
point of over-stretching ourselves. We take things one step at<br />
a time so that we don’t lose our focus and with the help of<br />
clients and associates, I am sure we heading in the right<br />
direction.”<br />
for nurses and/or dental assistants. “With technology advancing<br />
so rapidly, even the dentists have a hard time coping with it, let<br />
alone training or instructing their assistants on the handling and<br />
operation of the machines. So, this is where DenMit hopes to<br />
come in and assist in the training part, given our expertise in<br />
dental products.”<br />
In a Nutshell<br />
Small and new as it might be but DenMit Trading is in no way<br />
hampered by that. On the contrary, it is systematically realizing<br />
its goals and growing from strength-to-strength.<br />
Flexibility and variation of solutions are what dental<br />
professionals look out for nowadays, and DenMit understand<br />
these two areas perfectly. It is able to capitalize on its strength<br />
and nimbleness by adapting to circumstances better and turns<br />
things around quickly through its creative and customized<br />
digital dental solutions.<br />
As in the words of Claudia: “What set us apart from the others<br />
is that we don’t consider ourselves being just a product<br />
distributor or one that just provides technical support. We see<br />
ourselves as a clinical integrator because when we take on a<br />
project, we will assess it as a whole in terms of costs, technical<br />
support, as well as the product assurance.”<br />
Total concept — that’s the emphasis when one speaks to<br />
Claudia about DenMit Trading; and total concept may be the<br />
winning concept as the company aims to plug the needs of<br />
dental professionals. DA<br />
The Future<br />
Claudia sure has a clear vision of what<br />
holds for the DenMit in the future. “We are<br />
definitely looking at expanding our range of<br />
product lines so that we could offer our<br />
clients a more varied dental solution.” The<br />
company will be conducting market research<br />
on the type of products to bring in next.<br />
On the card, too, are two growth areas for<br />
dentistry — periodontics and aesthetic<br />
dentistry. Said Claudia matter-of-factly:<br />
“Currently, we are specialized in digital<br />
dental integrated solutions for general dental<br />
practitioners but in the middle to long run,<br />
we are looking at moving into periodontics<br />
and aesthetic dentistry. We foresee these<br />
two areas that have a huge potential for<br />
growth.<br />
According to Claudia, the company will also<br />
leverage on its technical support expertise<br />
by providing training and refresher courses<br />
Claudia Ng (right) with her principal, Boris Loyez, International Sales Manager of Owandy<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
17
CLINICALFEATURE<br />
by Prof Lakshman Samaranayake<br />
The Promise of<br />
Salivary Diagnostics<br />
The use of saliva as a diagnostic fluid for various human ailments is<br />
gaining popularity as it offers distinct advantages over serum. These<br />
include the non-invasive nature of saliva collection compared with<br />
phlebotomy, simplicity of collection even for individuals with a modest<br />
training and, the cost-effective applicability for screening large populations.<br />
Whole saliva, is most frequently used for diagnosis of systemic diseases, since<br />
it is readily collected and contains serum constituents while gland-specific<br />
saliva is useful for investigating pathology of major salivary glands. Broadly,<br />
saliva analysis is currently used for the diagnosis of infectious and malignant<br />
diseases, hereditary disorders, auto-immune diseases, and endocrine<br />
disorders, as well as for the assessment of therapeutic drug levels, particularly<br />
in monitoring drug abuse. This review addresses the current status of salivary<br />
diagnostics and its future potential.<br />
In ancient Greece, phlegm and saliva were regarded by Hippocrates as one of<br />
the four humors fundamental to disease and health. Saliva indeed is a mirror<br />
of our blood as these biofluids and their molecular components share many<br />
similarities 1 . Realization of this fact and the possible utility of saliva as a<br />
diagnostic bio-fluid during the past couple of decades have led many<br />
researchers to develop saliva-based technology to detect the transition<br />
between health and disease. Furthermore, recent advances in technology<br />
including genomics, proteomics, transcriptomics and microfluidics have led the<br />
way for using saliva beyond basic assessment of oral health characteristics to<br />
where it could be used to evaluate features of overall health including disease<br />
progression.<br />
It is generally thought that the quality of saliva is highly variable and difficult to<br />
handle in the laboratory, due to its highly degradable nature, with millions of<br />
bacteria and other organic components. Further, compared with blood other<br />
factors that affect salivary quality include the type of saliva, i.e. mixed vs pure<br />
(glandular), the specific collection methodology used and the physiological<br />
factors such as diurnal quality variations 2 . However, recent research has now<br />
established defined ways to work with saliva that are consistent, reproducible,<br />
and which keep these molecules in a undegraded, stable state. Perhaps the<br />
widest current use of such technology is in the detection of viral infections, in<br />
particular human immunodeficiency virus (HIV) disease.<br />
As will be seen later the commercially available kits that are in current use<br />
have very high sensitivity with negligible false positivity rates (i.e., high<br />
specificity). Other recent studies from US have yielded promising results on<br />
the feasibility of the use of saliva for the diagnosis of cancers including breast<br />
cancer, and oral carcinomas. The relative advantages of saliva as a diagnostic<br />
fluid compared with blood are many and these include simplicity in collection<br />
essentially being non-invasive and pain free, relatively cheap technology<br />
compared to blood tests, and cost effective applicability for screening large<br />
18 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALUPDATE<br />
populations.<br />
In order for a diagnostic method including salivary diagnostics<br />
to be widely applicable it should satisfy the following criteria:<br />
(i) the analytic precision and accuracy; (ii) excellent sensitivity<br />
and specificity (iii) good operational predictive value and<br />
efficiency and (iv) value for money or cost/benefit ratio in<br />
terms of rapid point of care diagnosis.<br />
What follows is a highlight of the uses of saliva in assessing<br />
the health and disease of individuals, and related uses in<br />
diagnostic sciences for miscellaneous applications such as<br />
drug abuse. It must, however, be stated at the outset that<br />
salivary diagnostic sciences is yet to mature and its true<br />
potential not yet realized.<br />
Viral Diseases<br />
A number of viruses that cause disease are either shed in<br />
saliva or egress into saliva through crevicular or serum<br />
exudates of the healthy or diseased periodontium 3 . Of these,<br />
the most important saliva diagnostic test that has been<br />
developed to date is a kit for detecting the human<br />
immunodeficiency virus (HIV) infection. Whole saliva can be<br />
used for detecting antibodies directed toward specific HIV<br />
viral protein epitopes and the test has very high sensitivity<br />
and specificity 3, 4 . For instance, in one study using an<br />
enzyme-linked fluorescence technique in combination with<br />
Western blot assays, saliva was superior to serum and urine<br />
with regard to both sensitivity and specificity 5 .<br />
Indeed the Federal Drug Administration (FDA) of USA<br />
approved saliva HIV testing kits for public use in as earl as in<br />
2003. Other developments in this regard include a<br />
commercially available, self-contained kit for use in<br />
community outreach and surveillance studies that does not<br />
require trained laboratory personnel. Further, saliva can be<br />
used to monitor the disease activity either in HIV-infection or<br />
other chronic inflammatory diseases through assessment of<br />
beta 2 microglobulin and/or soluble tumor necrosis factor a-<br />
receptor levels 6, 7 .<br />
Saliva is also a useful alternative to serum for the diagnosis of<br />
variants of viral hepatitis. For instance, acute hepatitis A<br />
(HAV) and hepatitis B (HBV) can be diagnosed based on the<br />
presence of IgM antibodies in saliva. Comparison of serum<br />
and saliva levels of antibody to HAV revealed excellent<br />
agreement 8 . Recently. Hepatitis A Virus RNA detection in<br />
saliva has been suggested as a useful marker for tracing<br />
A number of viruses that cause<br />
disease are either shed in<br />
saliva or egress into saliva<br />
through crevicular or serum<br />
exudates of the healthy or<br />
diseased periodontium<br />
and monitoring infection in community settings 9 . Similarly,<br />
analysis of saliva is highly sensitive and specific for the<br />
diagnosis of viral hepatitis B as well as hepatitis C with a<br />
sensitivity and specificity approaching 100%. 3, 10,11 Other<br />
uses of saliva for detecting viral diseases include determining<br />
immunization efficacy for measles, mumps, and rubella<br />
(MMR) vaccine 12 , and to monitor the immune response to<br />
vaccination and infection with the rotavirus infection – a<br />
common infant diarrhoeal disease in the developing world 13 .<br />
Whist the saliva diagnostics for the foregoing infections are<br />
far advanced there is a spectrum of other viral infections that<br />
await further technical refinements. These, essentially based<br />
on plolymerase chain reaction (PCR) methodology or its<br />
advancements such as mutiplex PCR include, tests for<br />
evaluation of human herpes viruses. As most human viruses<br />
ranging from HHV1 to HHV8 are shed in saliva the latter<br />
would be an ideal source for testing and monitoring the<br />
dormancy or the sub-clinical activity of these viruses either in<br />
health or disease states.<br />
A number of investigators have measured the shedding of<br />
Epstein-Barr virus, cytomegalovirus and herpes viruses 6, 7,<br />
and 8 in the saliva of HIV infected patients 14, 15 . It is highly<br />
likely that further refinements of molecular technology should<br />
lead to wide use of saliva as an effective, simple and a<br />
valuable diagnostic tool for evaluation of human Herpes virus<br />
carriage in saliva or indeed their clinical manifestations 16 .<br />
Bacterial Infections<br />
The two most common plaque related oral bacterial infections<br />
are caries and gingivitis. Many investigators have studied the<br />
feasibility of salivary diagnostics as a predictor of caries<br />
INFORMATIVE • INSIGHTFUL • INCISIVE<br />
For more information, email: info@pabloasia.com<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
19
CLINICALFEATURE<br />
susceptibility or for gingivitis /periodontitis 17, 18 . With regard to<br />
caries saliva samples can be used to establish the numbers<br />
of Streptococcus mutans and Lactobacillus species – the two<br />
major caries associated pathogens.<br />
In order to detect caries associated flora, paraffin wax<br />
stimulated whole saliva samples are collected and a dip slide<br />
containing the selective growth medium (which permits the<br />
growth of only the specific organism) is dipped into the<br />
collected saliva. Afterwards the slide is incubated within the<br />
container at 37 º C for upto 24 hrs and the resultant colonies of<br />
the putative pathogen is assessed in a semi-quantitative<br />
manner. In general the approximate figures for the cariogenic<br />
flora are:<br />
• High caries activity > 10 6 /mL S mutans and/or 105m/L<br />
lactobacillus spp<br />
• Low caries activity : < 10 5 /mL S mutans and/or 104m/L<br />
lactobacillus spp<br />
The presence of high salivary levels of S mutans or<br />
lactobacilli does not necessarily mean that the patient has an<br />
increased risk of developing dental caries, as it is a disease<br />
of multifactorial aetiology 19 . Other factors such as the diet,<br />
buffering capacity of saliva, fluoride content of enamel and<br />
degree of oral hygiene should also be considered. Although<br />
this particular test is at best a generalized approximation of<br />
the caries risk it could be utilized to identify patients who have<br />
unusually high numbers of potential pathogens, so that these<br />
data can be taken into account when integrating all the<br />
factors that may contribute to carious process in an individual<br />
patient. In addition, the test could be utilized to monitor the<br />
efficacy of caries prevention techniques such as dietary and<br />
oral hygiene advice and the use of antimicrobial agents such<br />
as chlorhexidine 20 .<br />
Due to the foregoing reasons salivary-based tests for<br />
monitoring plaque-related infections can not be construed as<br />
truly diagnostic, rather they are harbingers of a patient’s risk<br />
potential for disease and the consequent need for preventive<br />
measures. This approach has proven successful as a public<br />
health, preventive measure especially in Scandinavian<br />
countries for many decades 21 .<br />
With regard to periodontal disease and the detection of major<br />
periodontopathogenic bacteria salivary diagnostics have<br />
proven less successful. Tests are however, now available for<br />
chair-side assessment of Porphymonas gingivalis, a<br />
pathogen closely associated with periodontal disease. Other<br />
salivary markers that have been studied as potential<br />
diagnostic tools for periodontal disease include proteins of<br />
host origin such as enzymes and immunoglobulins, host cells,<br />
hormones (cortisol), bacterial metabolites and volatile<br />
compounds.<br />
Of these, host-derived enzymes and other inflammatory<br />
mediators originating from the gingival crevice appear to hold<br />
the greatest promise as salivary diagnostic tests for<br />
periodontal disease both on an individual basis or on a<br />
community wide assessment of risk for periodontal disease.<br />
The recent exciting developments on the potential role of<br />
periodontal disease as a risk factor for cardiovascular and<br />
cerebrovascular diseases 22 and the incidence of pre-term lowbirth-weight<br />
babies 23 bring new impetus to this aspect of<br />
salivary diagnostics.<br />
It is now well recognized that Helicobacter pylori are the<br />
causative agents of a significant proportion of gastritis and<br />
duodenal ulcers (peptic ulcer disease) in humans and, it may<br />
also play a role in gastric cancer 24 . Studies have also shown<br />
that dental plaque biofilms may act as a reservoir of H pylori<br />
in some of these individuals. Hence attempts have been<br />
made to use saliva as a diagnostic aid for peptic ulcer<br />
disease. A nested PCR assay is now available to detect H.<br />
pylori DNA in saliva and confirm the presence of H. pylori<br />
infection in patients 25 . Other immunologic studies indicate that<br />
saliva may also be used for predicting risk for gastric<br />
adenocarcinoma 26 .<br />
Saliva from patients with a variety of other disorder including<br />
shigellosis, pigeon breeders disease and Lyme disease have<br />
been evaluated for the presence of specific antibodies, with<br />
mixed results 27 . But with the increased sensitivity of tests and<br />
advancing technology it is likely that saliva would be used as<br />
an important diagnostic fluid for such disease entities.<br />
Auto-immune Disorders<br />
When body defenses turn against itself as seen in many<br />
autoimmune disorders, diseases such as Sjögren’s syndrome<br />
may ensue. The latter is a chronic, illness characterized by<br />
20 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALUPDATE<br />
In earlier studies, it has also<br />
been shown that the<br />
epidermal growth factor<br />
(EGF) is higher in the saliva of<br />
women with primary breast<br />
cancer or a recurrence of<br />
breast cancer when<br />
compared with women<br />
without diseases<br />
salivary and lacrimal gland dysfunction, serologic<br />
abnormalities, and multiple organ-system changes including<br />
rheumatoid arthritis 28 . Many have attempted to use saliva as<br />
well as other salivary parameters including sialography, salivary<br />
scintigraphy, and biopsies of minor salivary glands for the<br />
diagnosis of Sjögren’s syndrome, with mixed results 29 .<br />
Of these, salivary flow rate determination or sialometry is the<br />
simplest whilst other tests need to be conducted in special<br />
laboratories or clinics. As these are invasive and expensive, a<br />
panel of simple chair-side tests that could be conducted that<br />
include flow rate, pH, buffer capacity, lactobacillus, and yeast<br />
concentration has been suggested as useful for the purpose 30 .<br />
These tests, performed on whole saliva, can provide<br />
persuasive evidence for the presence of Sjögren’s syndrome<br />
that affects mainly the middle-aged, elderly population.<br />
Cardiovascular Diseases<br />
Cardiovascular disease is the commonest cause of death<br />
worldwide. Salivary markers such as salivary amylase have<br />
been used for postoperative follow up of patients undergoing<br />
cardiovascular surgery. Work of Adam et al. 31 , indicate that if<br />
salivary amylase levels were low in preoperative patients with<br />
ruptured aortic aneurysm, then this is associated with<br />
increased mortality. Others have found that salivary-amylase<br />
activity could be used as a good marker of catecholamine<br />
activity during evaluation of patients under a various stressful<br />
situations 32 . Such investigations, while indicating the possible<br />
utility of saliva to assess the general health of the body, are yet<br />
in the early stages of development and more work is required<br />
to confirm their general usefulness.<br />
Endocrinology<br />
Measurements of salivary hormone levels are of clinical<br />
relevance if they accurately reflect the serum hormone levels or<br />
if a constant correlation exists between salivary and serum<br />
hormone levels. Although there is wide disparity in these values<br />
for some hormones salivary steroid levels are in general good<br />
indicators of their blood concentrations.<br />
Consequently, the use of saliva for monitoring of steroid<br />
hormone levels is now feasible and commercially available with<br />
dedicated websites on the internet (e.g. http://<br />
www.salivatest.com/journals/saliva_ref.html ). At present, the<br />
following steroid levels can be assessed using mixed saliva:<br />
cortisol, estradiol, estriol, dehydroepiandrosterone,<br />
progesterone and testosterone. As opposed to these serum<br />
levels of protein hormones such as prolactin and thyrotropin<br />
can not be evaluated by salivary analyses as the latter<br />
molecules are too large to reach saliva through passive<br />
diffusion.<br />
The clinical utility of steroid hormone evaluation have been<br />
demonstrated in a wide variety of situations ranging from<br />
assessment of child health and development, mood and<br />
cognitive emotional behavior, premenstrual depression,<br />
Cushing’s syndrome, ovarian function and monitoring full-term<br />
and preterm neonates.<br />
Oncology<br />
The use of saliva as a predictable and a sensitive marker for<br />
detection of either oral or systemic cancers appears to be a<br />
practical reality. In a recent landmark study Wong et al. 33 ,<br />
noticed seven messenger RNAs in particular that were present<br />
at a 3.5-fold higher level in patients with oral carcinomas.<br />
(mRNA is the molecular intermediate between gene and<br />
protein, serving as a chemical record that an individual gene<br />
has been expressed). The latter workers then reduced their list<br />
of signature mRNAs to four, based on statistical models that<br />
indicated the synchronized rise in expression of these four<br />
molecules increased the probability that the saliva belonged to<br />
a cancer patient.<br />
These four mRNAs were from the following genes: Interleukin<br />
1-beta (IL1B), Ornithine decarboxylase antizyme 1 (OAZ1),<br />
spermidine/spermine N1-acetyl transferase (SAT), and<br />
interleukin 8 (IL-8). To put this idea to the test, Wong et al. 33 ,<br />
Analytical • Authoritative • Acclaimed<br />
For more information, email: info@pabloasia.com<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
21
CLINICALFEATURE<br />
Table 1 Drug detection in saliva: Currently available methodolgy detects minute quantities of<br />
the following drugs and chemicals in saliva<br />
Therapeutic drugs<br />
Antipyrene<br />
Cyclosporin<br />
Digoxin<br />
Mathadone<br />
Paracetamol<br />
Quinine<br />
Carbamazepine<br />
Diazepam<br />
Lithium<br />
Oxprenolol<br />
Phenytoin<br />
Tolbutamide<br />
Recreational drugs and drugs of abuse<br />
Amphetamines<br />
Benzodiazepines<br />
Cocaine<br />
Nicotine<br />
Barbiturates<br />
Ethanol<br />
Marijuana<br />
Opioids<br />
Phencyclidine<br />
screened the saliva again to see how often they could correctly<br />
identify the samples from the cancer patients. The group could<br />
identify the saliva from cancer patients in nine out of 10 samples.<br />
Although this is a primary, exploratory study the data is exciting<br />
and paves way to further research in the direction. Previoulsy,<br />
Boyle et al. 34 , have shown the possible value of p53 in saliva as a<br />
marker for squamous cell carcinoma. Interestingly, they detected<br />
and identified tumor-specific mutations in p53 in preoperative<br />
salivary samples of individuals suffering from head and neck<br />
squamous cell carcinoma.<br />
Apart from these more recent molecular studies many have<br />
investigated the utility of proteins in saliva for the detection of<br />
systemic, non oral, malignancies. These results indicate that,<br />
for instance, higher levels of salivary kallikrein in patients with<br />
malignant tumors as compared with those with benign tumors<br />
or from healthy controls. Others have also shown that saliva<br />
contains the cancer antigen CA 125, a glycoprotein complex<br />
that is an often-used marker for ovarian cancer. Indeed<br />
according to some studies salivary CA 125 assay had a better<br />
diagnostic value than the comparable serum assay 35 .<br />
Saliva has also been used for monitoring patient response to<br />
chemotherapy for breast cancer or surgical treatment of the<br />
disease. Thus Streckfus et al. 36 , studied the protein product of<br />
the oncogene c-erbB-2, also known as HER-2/neu, and noted<br />
that it is elevated in the saliva of women diagnosed with<br />
breast cancer. In earlier studies, it has also been shown that<br />
the epidermal growth factor (EGF) is higher in the saliva of<br />
women with primary breast cancer or a recurrence of breast<br />
cancer when compared with women without disease 37 .<br />
The foregoing clearly illustrates the potential of salivary<br />
diagnostics in the management of both oral and non-oral<br />
malignancies. In particular, the salivary proteomic and mRNA<br />
studies and those in current development 38 including<br />
electrochemical enzyme immunoassay procedures 39 have the<br />
greatest promise in this regard.<br />
Hereditary Disorders<br />
Attempts have been made by several investigators to use<br />
saliva as a diagnostic fluid for hereditary diseases such as<br />
cystic fibrosis (CF), celiac disease and 21-Hydroxylase<br />
deficiency - an inherited disorder of steroidogenesis.<br />
However, these have been met with partial success.<br />
Drug Monitoring<br />
Various drugs taken internally either for medicinal or<br />
recreational purposes can appear in saliva. However, the<br />
salivary drug concentration is influenced by the molecular and<br />
physicochemical characteristics of the drug and its interaction<br />
with the salivary tissues, as well as the extravascular drug<br />
metabolism. Additionally salivary factors including the<br />
presence of food debris, sloughed epithelial cells, and pH<br />
determine the drug availability 40 . More improved saliva<br />
collection methods and preservatives that maintain the<br />
integrity have largely overcome these problems however.<br />
Monitoring of illicit drug use by salivary detection methods<br />
appears to be the most promising in this context. Currently,<br />
saliva can be used to detect opioids, barbiturates,<br />
22 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALUPDATE<br />
Whilst saliva is an appropriate<br />
diagnostic tool for some<br />
diseases, more research is<br />
warranted to identify the ideal<br />
candidate markers for monitoring<br />
and diagnosis of others<br />
benzodiazepines, amphetamines, cannabinoids, cocaine,<br />
phencyclidine, and ethanol (for a review see Kaumman and<br />
Lamster 27 ; Table 1). Saliva can also be used to detect recent<br />
marijuana use by means of radiommunoassay. In psychiatry,<br />
saliva has been used with partial success, to monitor<br />
responses in the treatment of anxiety and post-traumatic stress<br />
disorder by measuring salivary levels of 3-methoxy-4-<br />
hydroxyphenylglycol (MHPG) 41 .<br />
Conclusions<br />
Whilst saliva is an appropriate diagnostic tool for some<br />
diseases, more research is warranted to identify the ideal<br />
candidate markers for monitoring and diagnosis of others.<br />
Furthermore, advances in genomics, proteomics and<br />
nanotechnology will contribute much to the understanding of<br />
the role of saliva as a diagnostic biofluid. The maturation of<br />
salivary diagnostics has much promise, and is bound to be<br />
widespread in the not too distant future. DA<br />
Acknowledgements:<br />
I am grateful to Professor Stpehen Moss (editor), Professor Emeritus, New<br />
York University, USA, for the kind permission given to modify and update my<br />
original text that appeared as a chapter in the monograph ‘The benefits of<br />
chewing’, published by Health Education Enterprises, USA.<br />
References<br />
1. Slavkin HC. Toward molecularly based diagnostics for the oral cavity. J Am Dent Assoc 1998<br />
129: 1138-1143.<br />
2. Dawes C. Considerations in the development of diagnostic tests on saliva. Ann NY Acad Sci<br />
1993 694: 265-269.<br />
3. Scully C, Samaranayake LP. Clinical Virology in Oral medicine and Dentistry. Cambridge University<br />
Press, 1992.<br />
4. Scully C. HIV topic update: salivary testing for antibodies. Oral Dis 1997 3: 212-215.<br />
5. Martinez PM, Torres AR, Ortiz de Lejarazu R et al. Human immunodeficiency virus antibody<br />
testing by enzyme-linked fluorescent and western blot assays using serum, gingival-crevicular<br />
transudate, and urine samples. J Clin Microbiol 1999 37: 1100-1106.<br />
6. Grant RM, Piwowar EM, Katongole-Mbidde E et al. Comparison of saliva and serum for human<br />
immunodeficiency virus type 1 antibody testing in Uganda using a rapid recombinant assay. Clin<br />
Diagn Lab Immunol 1996 3: 640-644.<br />
7. Nishanian P, Aziz N, Chung J et al. Oral fluids as an alternative to serum for measurement of<br />
markers of immune activation. Clin Diagn Lab Immunol 1998 5: 507-512.<br />
8. Stuart JM, Majeed FA, Cartwright KA et al. Salivary antibody testing in a school outbreak of<br />
hepatitis A. Epidemiol Infect 1992 109: 161-166.<br />
9. Mackiewicz V, Dussaix E, Le Petitcorps MF et al. Detection of hepatitis A virus RNA in saliva. J Clin<br />
Microbiol 2004 42: 4329-4331.<br />
10. El-Medany OM, El-Din Abdel Wahab KS, Abu Shady EA et al. Chronic liver disease and hepatitis<br />
C virus in Egyptian patients. Hepatogastroenterology 1999 46: 1895-1903.<br />
11. Thieme T, Yoshihara P, Piacentini S et al. Clinical evaluation of oral fluid samples for diagnosis of<br />
viral hepatitis. J Clin Microbiol 1992 30: 1076-1079.<br />
12. Brown DW, Ramsay ME, Richards AF et al. Salivary diagnosis of measles: a study of notified<br />
cases in the United Kingdom, 1991-3. Bmj 1994 308: 1015-1017.<br />
13. Jayashree S, Bhan MK, Kumar R et al. Serum and salivary antibodies as indicators of rotavirus<br />
infection in neonates. J Infect Dis 1988 158: 1117-1120.<br />
14. LaDuca JR, Love JL, Abbott LZ et al. Detection of human herpesvirus 8 DNA sequences in tissues<br />
and bodily fluids. J Infect Dis 1998 178: 1610-1615.<br />
15. Lucht E, Brytting M, Bjerregaard L et al. Shedding of cytomegalovirus and herpesviruses 6, 7, and<br />
8 in saliva of human immunodeficiency virus type 1-infected patients and healthy controls. Clin<br />
Infect Dis 1998 27: 137-141.<br />
16. Pozo F, Tenorio A. Detection and typing of lymphotropic herpesviruses by multiplex polymerase<br />
chain reaction. J Virol Methods 1999 79: 9-19.<br />
17. Lendenmann U, Grogan J, Oppenheim FG. Saliva and dental pellicle—a review. Adv Dent Res<br />
2000 14: 22-28.<br />
18. Rudney JD. Saliva and dental plaque. Adv Dent Res 2000 14: 29-39.<br />
19. Samaranayake LP, MacFarlane TW. Clinical Oral Microbiology. Bristol; Wright, 1989.<br />
20. Samaranayake LP. Essential Microbiology for Dentistry. 3rd ed, Edinburgh : Churchill Livingstone,<br />
2002.<br />
21. Birkhed D, Edwardsson S, Andersson H. Comparison among a dip-slide test (Dentocult), plate<br />
count, and Snyder test for estimating number of lactobacilli in human saliva. J Dent Res 1981 60:<br />
1832-1841.<br />
22. Joshipura KJ, Douglass CW, Willett WC. Possible explanations for the tooth loss and cardiovascular<br />
disease relationship. Ann Periodontol 1998 3: 175-183.<br />
23. Offenbacher S, Jared HL, O’Reilly PG et al. Potential pathogenic mechanisms of periodontitis<br />
associated pregnancy complications. Ann Periodontol 1998 3: 233-250.<br />
24. Kountouras J. Detecting Helicobater pylori. Diagnostic tests for Helicobacter pylori. Gut 1998<br />
42: 900-901.<br />
25. Jiang C, Li C, Ha T et al. Identification of H. pylori in saliva by a nested PCR assay derived from a<br />
newly cloned DNA probe. Dig Dis Sci 1998 43: 1211-1218.<br />
26. Vaira D, Holton J, Menegatti M et al. New immunological assays for the diagnosis of Helicobacter<br />
pylori infection. Gut 1999 45: I23-127.<br />
27. Kaufman E, Lamster IB. The diagnostic applications of saliva—a review. Crit Rev Oral Biol Med<br />
2002 13: 197-212.<br />
28. Daniels TE. Sjogren’s syndrome: clinical spectrum and current diagnostic controversies. Adv Dent<br />
Res 1996 10: 3-8.<br />
29. Streckfus C, Bigler L, Navazesh M et al. Cytokine concentrations in stimulated whole saliva among<br />
patients with primary Sjogren’s syndrome, secondary Sjogren’s syndrome, and patients with primary<br />
Sjogren’s syndrome receiving varying doses of interferon for symptomatic treatment of the condition:<br />
a preliminary study. Clin Oral Investig 2001 5: 133-135.<br />
30. Sreebny L, Zhu WX. Whole saliva and the diagnosis of Sjogren’s syndrome: an evaluation of<br />
patients who complain of dry mouth and dry eyes. Part 1: Screening tests. Gerodontology 1996<br />
13: 35-43.<br />
31. Adam DJ, Milne AA, Evans SM et al. Serum amylase isoenzymes in patients undergoing operation<br />
for ruptured and non-ruptured abdominal aortic aneurysm. J Vasc Surg 1999 30: 229-235.<br />
32. Chatterton RT, Vogelsong KM, Lu YC et al. Salivary alpha-amylase as a measure of endogenous<br />
adrenergic activity. Clin Physiol 1996 16: 433-448.<br />
33. Li Y, St John MA, Zhou X et al. Salivary transcriptome diagnostics for oral cancer detection. Clin<br />
Cancer Res 2004 10: 8442-8450.<br />
34. Boyle JO, Mao L, Brennan JA et al. Gene mutations in saliva as molecular markers for head and<br />
neck squamous cell carcinomas. Am J Surg 1994 168: 429-432.<br />
35. Chen DX, Schwartz PE, Li FQ. Saliva and serum CA 125 assays for detecting malignant ovarian<br />
tumors. Obstet Gynecol 1990 75: 701-704.<br />
36. Streckfus C, Bigler L, Tucci M et al. A preliminary study of CA15-3, c-erbB-2, epidermal growth<br />
factor receptor, cathepsin-D, and p53 in saliva among women with breast carcinoma. Cancer<br />
Invest 2000 18: 101-109.<br />
37. Navarro MA, Mesia R, Diez-Gibert O et al. Epidermal growth factor in plasma and saliva of<br />
patients with active breast cancer and breast cancer patients in follow-up compared with healthy<br />
women. Breast Cancer Res Treat 1997 42: 83-86.<br />
38. Vitorino R, Lobo MJ, Ferrer-Correira AJ et al. Identification of human whole saliva protein<br />
components using proteomics. Proteomics 2004 4: 1109-1115.<br />
39. Ivnitski D SR, Ivnitski N. Hand-held amperometric sensor for saliva and other oral fluid-based<br />
diagnostics. Analytica Chimica Acta 2004 504: 265-269.<br />
40. Siegel IA. The role of saliva in drug monitoring. Ann N Y Acad Sci 1993 694: 86-90.<br />
41. Aurer A, Aurer-Kozelj J, Stavljenic-Rukavina A et al. Inflammatory mediators in saliva of patients<br />
with rapidly progressive periodontitis during war stress induced incidence increase. Coll Antropol<br />
1999 23: 117-124.<br />
Prof Lakshman Samaranayake is the<br />
Dean and, the Chair Professor of Oral<br />
Microbiology at The University of Hong<br />
Kong and, the Director of the Prince<br />
Philip <strong>Dental</strong> Hospital, Hong Kong. He is<br />
also an Honorary Professor at the<br />
Eastman <strong>Dental</strong> Institute, London. He is a<br />
renowned expert in oral infections and<br />
infection control, has lectured in some 25 countries, and has<br />
authored more than 400 publications, including seven<br />
textbooks and monographs, translated into six different<br />
languages. He is also a World Bank Consultant in Problem<br />
Based Learning and the Vice-Chair of the Oral Medicine and<br />
Pathology Group of the International Association for <strong>Dental</strong><br />
Research. Previously he has held teaching positions at the<br />
University of Glasgow, United Kingdom, University of Alberta,<br />
Canada and, the University of Peradeniya, Sri Lanka. He has<br />
been a Director of the FDI World <strong>Dental</strong> Federation and the<br />
Chairman of its Science.<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
23
CLINICALFEATURE<br />
by Drs Fanny Young & Ricky Wong<br />
The Use of<br />
Motivational Theories<br />
in Dentistry<br />
This article reviewed the theories of<br />
motivation and suggested their applications<br />
in dentistry. These included Maslow’s<br />
hierarchy of needs theory, McGregor’s<br />
Theory X and Theory Y, Motivation-hygiene<br />
theory, Three-needs theory, Goal-setting<br />
theory, Reinforcement theory, Equity theory<br />
and Expectancy theory. An understanding of<br />
each theory can evolve a combined strategy<br />
that can motivate the most difficult patients.<br />
All dentists want to motivate their patients, for example, to improve the<br />
oral hygiene, to proceed to a certain treatment or to wear a certain<br />
appliance. Besides, as an employer or team leader, dentists would like<br />
to motivate their employees, subordinates or team members. In other<br />
words, understanding motivation can be a half way to success. Motivation is the<br />
process by which a person’s efforts are energized, directed, and sustained<br />
towards attaining a goal. It is the result of an interaction between the person and<br />
a situation; it is not a personal trait. In this article we would like to explore the<br />
theories of motivation in an attempt to improve our effectiveness in motivating<br />
others. We start with early theories of motivation, and then the more<br />
contemporary ones.<br />
Early Theories of Motivation<br />
Three early theories of motivation, namely: Maslow’s Hierarchy of Needs;<br />
MacGregor’s Theories X and Y; Herzberg’s Two-Factor Theory provide the bestknown<br />
explanations for motivation, even though their validity has been<br />
questioned.<br />
Maslow’s hierarchy of needs theory<br />
This was developed by psychologist Abraham Maslow 1 . This theory states that<br />
there is a hierarchy of five human needs, from bottom to top: physiological (basic<br />
food, drink, water, shelter, and sexual needs); safety (security and protection<br />
from physical and emotional harm); social (affection, belongingness, acceptance,<br />
and friendship); esteem (internal factors such as self-respect, autonomy, and<br />
achievement, and external factors such as status, recognition, and attention);<br />
24 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALFEATURE<br />
It is necessary to identify the<br />
motivators of the patients. Focus<br />
on intrinsic factors like<br />
achievement, recognition,<br />
responsibility, and advancement<br />
in motivating patients.<br />
and self-actualization (a person’s drive to become what he/she<br />
is capable of becoming). In terms of motivation, Maslow argued<br />
that each level in the needs hierarchy must be substantially<br />
satisfied before the next is activated and that once a need is<br />
substantially satisfied it no longer motivates behavior.<br />
Therefore, according to him, if one wants to motivate someone,<br />
one need to understand what level that person is on in the<br />
hierarchy and focus on satisfying needs at or above that level.<br />
As each need is substantially satisfied, the next need becomes<br />
dominant. In addition, he separated the needs into lower-level<br />
needs (including the physiological and safety needs) and<br />
higher-level needs (including social, esteem, and selfactualization).<br />
The difference was that higher-order needs are<br />
satisfied internally while lower-order needs are predominantly<br />
satisfied externally. Satisfied needs will no longer motivate,<br />
therefore, motivating a person depends on knowing at what<br />
level that person is on the hierarchy.<br />
Applications to Dentistry: It is important to visualize patients<br />
have different levels of needs. Motivation is more effective<br />
when the patient’s need can be satisfied. We need to identify<br />
the underlying need of the patient. Note that this hierarchy is<br />
just a general trend, in some cases people will want to satisfy<br />
the need that is higher in the hierarchy first.<br />
McGregor’s Theory X and Theory Y<br />
These were developed by Douglas McGregor 2 and describe<br />
two distinct views of human nature. The first one, Theory X is<br />
the assumption that people dislike work, are lazy, avoid<br />
responsibility, and need to be closely controlled to work<br />
effectively. The second one, Theory Y is the assumption that<br />
people are creative, enjoy work, seek responsibility, and can<br />
exercise self-direction. Theory X assumes that Maslow’s lowerorder<br />
needs dominate individuals, while Theory Y assumes that<br />
higher-order needs are dominant. McGregor himself held to the<br />
belief that the assumptions of Theory Y were more valid than<br />
those of Theory X. Therefore, he proposed that participation in<br />
decision making, responsible and challenging work, and good<br />
personal relations would maximize motivation. There was no<br />
empirical evidence exists to confirm that either set of<br />
assumptions is valid or that altering behavior based on Theory<br />
Y assumptions will increase people’s motivation.<br />
Applications to Dentistry: It is important to identify what type of<br />
patient you have. If the patient belongs to Theory Y then after<br />
you have reasoned and discussed with them the situations they<br />
tend to follow your recommendations, such as improving oral<br />
hygiene or wearing oral appliances. If the patient belongs to<br />
Theory X, then you need more frequent reinforcements.<br />
Motivation-hygiene Theory<br />
This is developed by Frederick Herzberg 3 . This is the<br />
motivation theory that intrinsic factors are related to work<br />
satisfaction and motivation, whereas extrinsic factors are<br />
associated with work dissatisfaction. He asked people for<br />
detailed descriptions of situations in which they felt<br />
exceptionally good or bad about their jobs. He concluded from<br />
his analysis that the replies they gave when they felt good<br />
about their jobs were significantly different from the replies they<br />
gave when they felt bad. He then believed that the data<br />
suggested that the opposite of satisfaction was not<br />
dissatisfaction, as traditionally had been believed. The opposite<br />
of ‘satisfaction’ is ‘no satisfaction’, and the opposite of<br />
‘dissatisfaction’ is ‘no dissatisfaction’. According to Herzberg,<br />
simply removing dissatisfying characteristics from a work would<br />
not necessarily make the work satisfying. Extrinsic (Hygiene)<br />
factors are factors that eliminate dissatisfaction. They include<br />
factors such as supervision, company/institution policy, money,<br />
working conditions, and security — i.e., extrinsic factors<br />
associated with work context, or those things surrounding a<br />
work. Intrinsic (Motivators) are factors that increase work<br />
satisfaction and motivation. They include factors such as<br />
achievement, recognition, responsibility, and advancement —<br />
i.e., intrinsic factors associated with work content, or those<br />
things within the work itself. Herzberg’s theory has been<br />
criticized for the statistical procedures and methodology used in<br />
his study. In spite of these criticisms, Herzberg’s theory has<br />
had a strong influence on our understandings about motivation.<br />
Applications to Dentistry: It is necessary to identify the<br />
motivators of the patients. Focus on intrinsic factors like<br />
achievement, recognition, responsibility, and advancement in<br />
motivating patients. On the other hand, identify the extrinsic<br />
factors of the patient will discover potential reasons for<br />
dissatisfaction or complaint.<br />
Contemporary Theories of Motivation<br />
A number of contemporary theories represent state-of-the-art<br />
explanations of motivation. These contemporary theories have<br />
a reasonably strong degree of validity through supporting<br />
documentation.<br />
Three-needs Theory<br />
This is developed by David McClelland 4,5 , which says there are<br />
three acquired (not innate) needs: achievement, power, and<br />
affiliation. These needs are major motives in work. The need for<br />
achievement is the drive to excel, to achieve in relation to a set<br />
26 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALUPDATE<br />
of standards, and to strive to succeed. The need for power is<br />
the need to make others behave in a way that they would not<br />
have behaved otherwise. The need for affiliation is the desire<br />
for friendly and close interpersonal relationships. A person’s<br />
levels of these three needs are typically measured by reacting<br />
to a set of pictures included in the Thematic Apperception Test.<br />
Predictions about motivation can be made from a study of the<br />
three-needs theory. McClelland found that high achievers<br />
differentiate themselves from others by their desire to do things<br />
better. High achievers like moderately challenging goals. They<br />
avoid what they perceive to be very easy or very difficult tasks.<br />
Individuals with a high need to achieve prefer and are strongly<br />
motivated in work situations with personal responsibility,<br />
feedback, and an intermediate degree of risk.<br />
Applications to Dentistry: On the one hand, try to identify the<br />
type of need your patient valued most and try to focus on that<br />
for motivation. On the other hand, similar to the Maslow’s<br />
theory, this theory gives us a remainder that there are different<br />
types of needs that the patient requires. Identification of<br />
individuals with a high need for achievement can be useful in<br />
selecting motivation methods.<br />
preferable to assigning goals whenever resistance is expected.<br />
People will do better when they get feedback on how well they<br />
are progressing toward their goals because feedback acts to<br />
guide behavior and self-generated feedback has been shown<br />
to be a more powerful motivator than externally generated<br />
feedback. Several contingencies exist in goal-setting theory.<br />
Feedback influences the goal-performance relationship. Goal<br />
commitment is most likely to occur when goals are made<br />
public, when the individual has an internal locus of control, and<br />
when the goals are set by the individual rather than assigned.<br />
The other contingency is self-efficacy. It is an individual’s belief<br />
that one is capable of performing a task. The higher one’s selfefficacy,<br />
the more confidence one has in one’s ability to<br />
succeed in a task. So, in difficult situations, people with low<br />
self-efficacy are likely to reduce their effort or give up<br />
;1altogether, whereas those with high self-efficacy seem to<br />
response to negative feedback with increased effort and<br />
motivation, whereas those with low self-efficacy are likely to<br />
reduce their effort when given negative feedback. Finally,<br />
national culture is a contingency that also affects goal-setting<br />
theory. One may conclude that intentions, as defined by hard<br />
and specific goals, are a powerful motivating force in goal-<br />
Goal-setting theory<br />
Would you have done better in dental school had<br />
your teacher in the phantom head course said, ‘you<br />
should strive for a grade B or above on all your tooth<br />
preparations’ rather than telling you just to ‘try your<br />
best’? Research on goal-setting theory addresses<br />
these issues, and the findings were impressive in<br />
term of the effect that goal specificity, challenge, and<br />
feedback have on performance 6 . This is the<br />
proposition that specific goals increase<br />
performance, and difficult goals, when accepted,<br />
result in higher performance than easy goals 6 . What<br />
is known about goals as motivators? Intention to<br />
work toward a goal is a major source of job<br />
motivation. Specific and challenging goals are<br />
superior motivating forces. Specific hard goals<br />
produce a higher level of output than do generalized<br />
goals. There is no contradiction that goal-setting<br />
theory says that motivation is maximized by difficult<br />
goals, whereas achievement motivation is<br />
stimulated by moderately challenging goals. As goalsetting<br />
theory deals with people in general;<br />
achievement theory is based only on people who<br />
have a high need for achievement. Difficult goals are<br />
still recommended to motivate the majority of<br />
people. The conclusions of goal-setting theory apply<br />
to those who accept and are committed to the goals.<br />
Difficult goals will lead to higher performance only if<br />
they are accepted. People will try harder if they<br />
participate in the planning and formulation of goals<br />
although it cannot be said that participation is<br />
always desirable. Participation is probably<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
27
CLINICALFEATURE<br />
setting efforts. In the proper conditions, intentions can lead to<br />
higher performance.<br />
Applications to Dentistry: Try to set specific goals for the patient,<br />
for example, to wear the headgear for how many hours, rather<br />
than just using the vague term ‘try your best’.<br />
Reinforcement theory<br />
Reinforcement theory is counter to goal-setting theory. It<br />
proposes that behavior is a function of its consequences. While<br />
goal-setting theory proposes that an individual’s purpose directs<br />
his or her behavior, reinforcement theory argues that behavior is<br />
externally caused. Reinforcement theory ignores factors such as<br />
goals, expectations, and needs; it focuses on what happens<br />
when a person takes an action. The concept of reinforcement<br />
can be used to explain motivation. According to Skinner 7 people<br />
will most likely engage in a desired behavior if they are rewarded<br />
for doing so. These rewards are most effective if they<br />
immediately follow a desired response. Behavior that is not<br />
rewarded or is punished is less likely to be repeated. The<br />
emphasis is on positive reinforcement, not punishment, people<br />
should ignore, not punish, unfavorable behavior. Even though<br />
punishment eliminates undesired behavior faster than no<br />
reinforcement does, its effect is often only temporary and may<br />
later have unpleasant side effects including dysfunctional<br />
behavior such as conflicts, absenteeism, and withdrawal.<br />
Applications to Dentistry: Patient should be immediately praised<br />
(positive reinforcement) every time when a good response (e.g.<br />
good oral hygiene) is encountered.<br />
Equity Theory<br />
Being human, one tends to compare oneself with others. If<br />
someone offered one US$10,000 a month on one’s first job after<br />
graduating from a dental school, one would probably jump at the<br />
offer and report to work enthusiastic, ready to tackle whatever<br />
needed to be done, and certainly satisfied with one’s pay. How<br />
would one react, though, if one<br />
found out a month into the job that<br />
a coworker, your classmate with<br />
comparable school results and<br />
with comparable work experience<br />
— was getting US$11,000 a<br />
month? One would probably be<br />
upset! Even though in absolute<br />
terms, US$10,000 is a lot of<br />
money for a new graduate to make<br />
(and one knows it!), that suddenly<br />
is not the issue. One sees the<br />
issue now as relative rewards and<br />
what one believes is fair — what is<br />
equitable. The term equity is<br />
related to the concept of fairness<br />
and equal treatment compared<br />
with others who behave in similar<br />
Fig. 1 Expectancy theory of motivation<br />
ways. Equity theory was developed by J. Stacey Adams 8 , it is the<br />
theory that a person compares his/her work’s input-outcomes<br />
ratio with that of relevant others and then corrects any inequity.<br />
Equity theory recognizes that individuals are concerned with their<br />
absolute rewards as well as the relationship of those rewards to<br />
what others receive. When people perceive an inequity, they will<br />
tend to correct the situation 9 . They may distort either their own or<br />
others’ inputs or outcomes; behave in some way to induce others<br />
to change their inputs or outcomes; behave in some way to<br />
change their own inputs or outcomes; the result might be lower<br />
productivity, reduced quality of output, increased absenteeism or<br />
withdrawal from work.<br />
Applications to Dentistry: Patients like to compare themselves<br />
with one another. Inequity may be one of the sources of<br />
dissatisfaction or complaint even the actual services provided are<br />
satisfactory. Conversely, favorable comparisons may significantly<br />
motivate patients.<br />
Expectancy Theory<br />
Last but not the least, the most comprehensive and widely<br />
accepted explanation of motivation to date is Victor Vroom’s<br />
expectancy theory 10 . Although the theory has its critics, most<br />
research evidence supports it 11 . This is the theory that an<br />
individual tends to act in a certain way based on the expectation<br />
that the act will be followed by a given outcome and on the<br />
attractiveness of that outcome to the individual. Three<br />
relationships are important to this theory. Effort-performance<br />
linkage (expectancy) is the probability perceived by the individual<br />
that exerting a given amount of effort will lead to a certain level of<br />
performance. Performance-reward linkage (instrumentality) is the<br />
degree to which an individual believes 1that performing at a<br />
particular level is instrumental in, or will lead to, the attainment of<br />
a desired outcome. Attractiveness of the reward (valence) is the<br />
importance that the individual places on the potential outcome or<br />
reward that can be achieved on the work. The explanation of this<br />
theory can be summed up in the following questions: What<br />
28 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALUPDATE<br />
perceived outcomes does the work offer a person?<br />
How attractive does that person consider these<br />
outcomes to be? What kind of behavior must the<br />
person exhibit to achieve these outcomes? How<br />
does the person view his/her chance of doing what is<br />
asked? The key to understanding expectancy theory<br />
to understand an individual’s goal and the linkage<br />
between effort and performance, between<br />
performance and rewards, and between rewards<br />
and individual goal satisfaction. According to<br />
expectancy theory, various choices of behavior are<br />
evaluated according to their expectancy,<br />
instrumentality and valence. This can be summed up<br />
as a mathematical equation. Motivation is related to<br />
the mathematical product of expectancy,<br />
instrumentality and valence (fig. 1). People are more<br />
motivated with higher value of the product.<br />
Applications to Dentistry: It is important to decrease<br />
the effort/cost needed, increase the association<br />
between the effort/cost and the reward/benefit and<br />
increase the attractiveness of the reward/benefit.<br />
Conclusion<br />
It can be seen that different motivation theories are<br />
complementary to each other. No single theory can<br />
explain all the responses of the patients. An<br />
understanding to each theory can evolve a combined<br />
strategy that can motivate the most difficult patients.<br />
DA<br />
References<br />
1. Maslow A. Motivation and Personality. New York; McGraw-Hill; 1954.<br />
2. McGregor D. The Human Side of Enterprise. New York; McGraw-Hill; 1960.<br />
3. Herzberg F, Mausner B, Snyderman B. The Motivation to Work. New York;<br />
John Wiley; 1959.<br />
4. McClellend DC. The Achieving Society. New York; Van Nostrand Reinhold;<br />
1961.<br />
5. McClellend DC. Power: The Inner Experience. New York; Irvington; 1975.<br />
6. Ambrose ML, Kulik CT. Old Friends, New Faces: Motivation Research in the<br />
1990s. Journal of Management 1999;25:231-92.<br />
7. Skinner BF. Beyond Freedom and Dignity. New York; Knopf; 1972.<br />
8. Adams JS. Inequity in Social Exchanges. In: Berkowitz L (ed.). Advances in<br />
Experimental Social Psychology, vol. 2. New York: Academic Press; 1965;267-<br />
300.<br />
9. Lord RG, Hohenfeld JA. Longitudinal Field Assessment of Equity Effects on the<br />
Performance of Major League Baseball Players. Journal of Applied Psychology<br />
1979; Feb:19-26.<br />
10. Vroom VH. Work and Motivation. New York; John Wiley; 1964.<br />
11. Van Eerde W, Thierry H. Vroom’s Expectancy Models and Work-related criteria:<br />
A Meta-Analysis. Journal of Applied Psychology 1996;Oct:575-586.<br />
Footnotes<br />
1 Business Administration, the Hong Kong Shue Yan<br />
University<br />
2 Orthodontics, the University of Hong Kong<br />
Dr. Fanny Y. F. Young is an assistant<br />
professor in Business Administration,<br />
the Hong Kong Shue Yan University.<br />
Dr. Ricky W. K. Wong is a clinical<br />
associate professor in Orthodontics,<br />
the University of Hong Kong.<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
29
CLINICALFEATURE<br />
by Dr George Freedman<br />
Eliminating<br />
<strong>Dental</strong> Stains<br />
<strong>Dental</strong> stains are of great concern to the vast majority of the population.<br />
Tooth discoloration has been made socially and culturally unacceptable by<br />
the ubiquitous presence of bright, white smiles on television, in films, and<br />
the print media. From a professional perspective, dental stains contribute to<br />
plaque accumulation, the increased retention of bacteria and their associated acidic<br />
environment, and eventually, to tooth demineralization and decay. The elimination of<br />
dental stains by the dentist and the auxiliary staff on a regular basis (twice per year)<br />
has contributed greatly to the improvement of dental health in the general<br />
population over the past 50 years.<br />
As patients have become more aware of their own dental health, they have<br />
increasingly demanded not only healthier teeth, but healthier-looking teeth as well.<br />
Typically, more than 80% of individuals surveyed indicate an active interest in the<br />
whiteness (and thus an active concern for discoloration) of their teeth. The<br />
appearance of non-stained teeth is the major visible component of dental health,<br />
and as such, is used by patients to gauge their oral health and hygiene. Routine<br />
scaling and prophylaxis, on a bi-annual basis, is well accepted by both<br />
professionals and the public, and is effective in the removal of dental stain at least<br />
for a short time after the recare visit. However, the daily accumulation of dental<br />
stain, particularly after meals, is a recurrent problem that is more difficult to address.<br />
When these stains accumulate in public situations where the dental appearance is<br />
an important factor, they can adversely affect the outcome of the event, whether<br />
business or social.<br />
Certainly, brushing and flossing after eating<br />
can eliminate the most obvious<br />
discolorations, but these activities are not<br />
always practical, particularly in the typical<br />
restaurant or home setting of most meals. It<br />
would be preferable to have a relatively<br />
innocuous, but effective, destaining<br />
procedure that can be readily accomplished,<br />
unobtrusively and quickly, even under<br />
conditions of intense public scrutiny. Most<br />
people, consciously or subconsciously, tend<br />
to wipe their tongues across their anterior<br />
teeth to remove stains, but without a<br />
dentifrice agent, this action is largely<br />
ineffective.<br />
Figure 1 SuperSmile Quikee dentifrice<br />
The objective of this clinical study was to<br />
examine the effects of a commercially-available dentifrice (SuperSmile Quikee)<br />
upon the removal of food induced dental stains (Figure 1). This study was designed<br />
to objectively evaluate the immediate effect of SuperSmile Quikee on recently<br />
30 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALFEATURE<br />
stained teeth, and its value as a rapid and effective decolorizing<br />
agent. It is a brushless dentifrice; a small amount of<br />
SuperSmile Quikee is squirted directly from the tube onto the<br />
teeth (or alternatively placed manually), and then spread over<br />
the maxillary and mandibular anterior teeth with the tongue and<br />
Brushing and flossing after<br />
eating can eliminate the most<br />
obvious discolorations, but<br />
these activities are not always<br />
practical, particularly in the<br />
typical restaurant or home<br />
setting of most meals<br />
Figure 2 The dentifrice is spread over the maxillary and mandibular<br />
anterior teeth with the tongue and the lips for several seconds<br />
the lips for several seconds (Figure 2).<br />
Materials and Methods<br />
Forty adult male and female subjects were selected to<br />
participate in this clinical trial and each subject acted as their<br />
own control. After qualification and a baseline dental<br />
examination, the subjects who met the criteria listed below<br />
were 8 males and 32 females with a mean age of 34.6 years.<br />
The inclusion criteria, among others, were as follows: Male and<br />
female subjects, aged 18-70 years, in good general and oral<br />
health, with all maxillary and mandibular anterior teeth present.<br />
Subjects were asked to refrain from brushing or rinsing for six<br />
hours prior to the initiation of the study.<br />
Exclusion characteristics included orthodontic appliances or<br />
anterior prosthetic crowns or veneers, tumors or significant<br />
pathology of the soft or hard tissues, moderate to advanced<br />
periodontal disease, extensive untreated carious lesions or<br />
restorations, bleaching within the previous 12 months or<br />
prophylaxis within the previous 30 days.<br />
The measurement of tooth shade can be highly variable between<br />
observers, and under differing metameric conditions. To avoid<br />
inter-investigator and sequential variability, two Vita Easyshade<br />
(Vident) intraoral dental spectrophotometer shade-matching<br />
devices were used to measure tooth coloration (Figure 3). A<br />
spectrophotometer consists of three principle elements: a light<br />
source; a wand to direct the source light to an object and in turn<br />
to receive the reflected light from the object; and a spectrometer<br />
to determine the received light intensity as a function of<br />
wavelength. The Easyshade’s CPU analyzes the spectrometer<br />
data, determining a shade match to Vita Classical or 3D systems,<br />
and displays the results on a touch screen (Figure 4).<br />
The Vita Easyshade is self contained, easy to use, and<br />
portable, consisting of a base unit and handpiece containing a<br />
fiberoptic probe assembly for illuminating and receiving<br />
light from a tooth. The two Easyshade units were calibrated<br />
with each other and were additionally self-calibrated prior to<br />
every shade measurement.<br />
For each subject, the shades of the six maxillary and six<br />
mandibular anterior teeth were each measured separately, in<br />
the middle third, at the mesio-distal center of the tooth, at three<br />
specific times. These measurements were at the Baseline<br />
(prior to stain accumulation), Post Eating or Stain Accumulation<br />
(after 15 minutes of stain accumulation), and Post Product<br />
Utilization (immediately after the use of the test brushless<br />
dentifrice). The shade of each tooth was scored by reading the<br />
Easyshade screen and recording the Classic Vita shade<br />
reference code. The overall change in shade was then<br />
obtained by averaging the scores as described previously by<br />
Eldiwany et al (2004).<br />
Figure 3 Two Vita Easyshade intraoral dental spectrophotometer shadematching<br />
devices were used to measure tooth coloration<br />
Analysis of variance (t-test) was employed to compare the<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
31
CLINICALFEATURE<br />
mean Vita Easyshade scores at baseline, post-staining and<br />
post product usage. The chromogenic “meal” consisted of:<br />
• 3 ounces of red grape juice or red wine<br />
• 3 ounces of blueberry pie<br />
• one piece of milk chocolate<br />
• 4-6 ounces of coffee or tea<br />
The brushless dentifrice that was tested is a commercially<br />
available, non-prescription product that requires no post-use<br />
rinsing. Its active ingredients include Dicalcium Phosphate<br />
Dihydrate, Urea Hydrogen Peroxide, and Calprox. The<br />
instructions for use indicate that a small drop of the product be<br />
placed on the anterior teeth or the tongue and smoothed over<br />
the remaining anterior teeth with the tongue and the lips.<br />
Results and Discussion<br />
Tooth shade was calculated by ranking the Vita Classic Shade<br />
guide according to the degree of brightness as recommended<br />
The measured results indicate<br />
that eating a chromogenic<br />
“meal” caused the<br />
accumulated food induced<br />
stains to darken the subjects’<br />
tooth shades by<br />
approximately 2 Vita tabs<br />
Statistical analysis by the t-test comparing:<br />
1. The Baseline data with the Post Stain Accumulation data<br />
indicated significant differences (p≥ 0.05) showing that<br />
chromogenic foods can indeed induce dental stains, darkening<br />
the appearance of the teeth.<br />
2. The Post Stain Accumulation data with the Post Product<br />
Usage data indicated significant differences (p≥ 0.05) showing<br />
that SuperSmile Quikee, the product under investigation, does<br />
remove dental stains acquired as a result of eating<br />
chromogenic foods.<br />
3. The Baseline data with the Post Product Usage data<br />
indicated significant differences (p≥ 0.05) showing that the<br />
product under investigation does remove previously acquired<br />
dental stains.<br />
Figure 4 The Easyshade’s CPU analyzes the spectrometer data, determining<br />
a shade match to Vita Classical or 3D systems, and displays the results on a<br />
touch screen<br />
by the manufacturer, assigning a numerical value to each tab<br />
and calculating the number of tabs as described by Manupome<br />
and Petty (2004).<br />
A summary of the changes in tooth shade during the study is<br />
provided in the following table:<br />
The measured results indicate that eating a chromogenic<br />
“meal” caused the accumulated food-induced stains to darken<br />
the subjects’ tooth shades by approximately 2 Vita tabs (Fig 5).<br />
The Baseline Vita Easyshade data for 480 (40 X 12) teeth in<br />
the study was 4.37 (SD±2.37), corresponding to a shade<br />
between Vita Classic tabs D2-A2.<br />
The Post Stain Accumulation Vita Easyshade data for 480<br />
(40 X 12) teeth in the study was 6.56 (SD±3.03), corresponding<br />
to a shade between Vita Classic tabs C1-C2. Statistical<br />
analysis by the t-test showed significant differences, indicating<br />
that eating a chromogenic diet as described above does, in<br />
fact, induce staining of teeth.<br />
The Post Product Usage Vita Easyshade data for 480 (40 X<br />
12) teeth in the study was 3.72(SD±2.33), corresponding to a<br />
shade between Vita Classic tabs B2-D2.<br />
Figure 5 Chromogenic ‘meal’ accumulated food-induced stain to be<br />
darkened<br />
32 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALFEATURE<br />
This color change is readily visible<br />
even to the untrained eye, and on<br />
anterior teeth, can visibly detract<br />
from the aesthetics of the smile.<br />
The t-test analysis (green<br />
shading) confirms the significance<br />
of the staining.<br />
After the use of SuperSmile<br />
Quikee, the test dentifrice, the<br />
mean shade of the anterior teeth<br />
was calculated to be almost 3 Vita Figure 6 A whiter shade after dentifrice test<br />
tabs whiter than the coloration<br />
immediately Post Eating (Figure 6). Not only is this destaining statistically significant (blue<br />
shading), but it is also very visibly evident, representing a major aesthetic improvement of<br />
tooth shade.<br />
It is important to note that it can be applied very quickly and discreetly, and that its<br />
destaining action is rapid and effective.<br />
It is of interest that the tooth coloration after the use of SuperSmile Quikee was not only<br />
whiter than it was post staining, but was in fact significantly whiter than the baseline values<br />
(purple shading) taken at the beginning of the study. This is a clear indication that it not<br />
only removes recently deposited dental coloration, but in fact destains the teeth to a state<br />
whiter than at the baseline. Thus, it is effective as a bleaching agent as well. It may be<br />
prudent to quickly eliminate dental stain with a brushless dentifrice prior to shade matching<br />
in the course of routine restorative procedures.<br />
The destaining and/or bleaching actions of SuperSmile Quikee are mediated by the well<br />
documented active ingredients Urea Hydrogen Peroxide and Calprox. There were no<br />
adverse reactions attributed to product usage.<br />
Conclusions<br />
From this study, it can be concluded that Supersmile Quikee removes food induced stains<br />
from dental surfaces and, in addition, has a whitening effect upon the teeth. Its very<br />
convenient application modality, its rapid whitening action, and its significant results in<br />
dental destaining make it a very practical and portable tool for oral hygiene and aesthetic<br />
maintenance.<br />
DA<br />
References<br />
1. Eldiwany MS, Paravina RD, Powers JM (2004) Performance assessment of a new intra-oral spectrometer. J. Dent Res. 83:1933 (abst)<br />
2. Manupome G, Petty IA (2004) A closer loot at diagnosis in clinical dental practice: Part 4. Effectiveness of nonradiographic diagnostic<br />
procedures and devices in dental practice. J Can Dent Assoc 70:470-474<br />
Dr George Freedman is an Associate Director of the Esthetic <strong>Dental</strong> Education<br />
Center at the State University of New York. He is also the Director of Post-graduate<br />
Programs in Esthetic Dentistry at the Eastman <strong>Dental</strong> Center (Rochester); University<br />
Programs in Seoul; Schann, Liechenstein and Chairman of the UK Clinical<br />
Innovations Conference. Dr Freedman is a member of <strong>Dental</strong> <strong>Asia</strong> magazine<br />
advisory board.<br />
We Have Moved. Our new<br />
address is:<br />
Block 16 Kallang Place #07-01,<br />
Singapore 339156<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
33
CLINICALFEATURE<br />
by Prof Alex Mersel<br />
Stress Absorbing<br />
Frame Approach<br />
for Partial Edentate<br />
Patients<br />
As the number of elderly increases, so does the<br />
concern for their healthcare. Partial edentate<br />
patients will in the future represent the most<br />
common figure — very few elderly will be<br />
candidates for fixed Prosthodontics or implants<br />
supported dentures. Consequently the dental<br />
profession will have to challenge with patients<br />
presenting mainly a posterior edentulousness —<br />
unilateral or bilateral. Although removable<br />
partial denture is a favored solution, to overule<br />
these problems a design of the denture is<br />
proposed: a stress-absorbing frame, based on a<br />
back-action of the lever, with a springing action<br />
that returns the basis to its original position, thus<br />
avoiding traumatic pressure on the underlying<br />
tissues.<br />
The ageing of the elderly population is already a dramatic demographic<br />
fact. One of the most important challenges of the dental profession in the<br />
coming years will be in providing care to senior people. The new trend is<br />
that these patients will have more retained teeth and their expectation<br />
will be greater. On the other hand, the increase of their lifespans will increasingly<br />
affect their medical status; consequently an implant solution will be difficult to<br />
realize. 1<br />
The dental profession will have to challenge mainly with patients presenting<br />
posterior edentulousness, unilateral or bilateral (Removable Partial Dentures<br />
Kennedy Class 1 & 2), with usually important ridge resorption and poor<br />
periodontal conditions. 2-3<br />
Despite that removable partial dentures are a favored option for restoration of<br />
many situations, many patients are not satisfied with their dentures, especially<br />
when the restoration is not stable during mastication and implicate sores and<br />
pain.<br />
34 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALFEATURE<br />
Main Problems in the RPD<br />
(Kennedy Class 1& 2)<br />
Instability<br />
The mandibular free-end distal extension RPD rests on both<br />
fixed and soft tissues.<br />
Consequently the RPD tends to<br />
rotate around a single place and<br />
move down on the soft<br />
underlying tissues. In a distal<br />
extension RPD case with one or<br />
more anterior teeth missing, the<br />
anterior part goes down as the<br />
posterior part goes up and vieversa:<br />
this is the “teeter-totter<br />
phenomenon. (Figure 1)<br />
Figure 1 (top & bottom) Lateral<br />
and horizontal movements of the<br />
frame<br />
Rocking can not only occur in a<br />
vertical plane but often also in a<br />
horizontal plane causing the wellknown<br />
internal posterior soars<br />
(Figure 2). RPD instability will<br />
develop unbalanced forces that<br />
will have consequence to slowly<br />
mobilizing the supporting teeth<br />
until they have to be pulled out. 4<br />
Usually the new missing teeth is<br />
already replaced and the clasp<br />
displaced to the next proximal<br />
teeth; increasing in this way the<br />
distal extension span, “a domino<br />
effect”.<br />
Carious Destruction of the Abutments<br />
Only a few of the most carious resistant teeth can survive the<br />
environmental changes brought by the presence of a clasp-type<br />
ackers and the constant food impaction between the saddle –<br />
guiding plane and the distal aspect of the teeth. (Figure 3)<br />
Destruction of Abutments by<br />
Periodontal Diseases<br />
A well known fact is the destructive potential of a RPD as<br />
consequence of the amplitude of the denture movement and<br />
the clasp mechanism which transfer these movements toward<br />
the abutment teeth. This suggests our analysis about the<br />
denture basis and its relationship to the denture instability. 5<br />
1. The Soft Tissue Support.<br />
Especially in the large distal extension cases, a very large<br />
mucosal support is recommended in order o provides the<br />
widest support under the saddle. The inaccuracy of the cast by<br />
a simple alginate impression, or an inadequate functional<br />
impression would produce negative consequences on the<br />
fitness of the final acrylic basis. (Figure 4)<br />
2. Altrough with good<br />
impression both anatomic<br />
and functional of the basis<br />
by the “altered cast<br />
technique “they are slight<br />
movement in function<br />
before that the basis<br />
reaches the rock-bottom<br />
of incompressibility of the<br />
soft underlying structures.<br />
Such kinds of movement<br />
in a simple clasp RPD<br />
drops the basis onto the<br />
soft tissue not in a<br />
simultaneous vertical<br />
drop, BUT act as a hinging<br />
mechanism or fulcrum<br />
around which the denture<br />
tips down in distal part and<br />
up in the mesial part.<br />
Stress breakers,<br />
Stress Equalizers,<br />
Trauma Absorbing<br />
Figure 2 (top & bottom) Internal<br />
Posterior lingual soars area<br />
These devices are promoted on the fact that they should allow<br />
to the denture basis to move slightly without straining on the<br />
abutment. There are mainly two types of stress-breakers:<br />
A. The most commons are the hinge type stress-breakers<br />
(Figures 5a & 5b). This concept provide a disarticulation<br />
between the basis and the retentive apparatus (clasp and<br />
precision attachment), but act only on vertical occlusal forces,<br />
they have no incidence in the lateral occlusal movements. 6<br />
B. Other stress breakers like the ball-and-socket type allow<br />
essentially the same tipping action and add to it lateral mobility<br />
which tends to allow lateral or rolling mobility and also some<br />
bucco-lingual rolling. (Figures 6a & 6b)<br />
In the two cases, the problem remain in terms that the stressbreaking<br />
leaves the denture basis in much the same situation<br />
with a fulcrum acting a few millimeters distally and much freer<br />
in its movement because the absence of retentive clasps. In<br />
addition this type of device allows an excessive space for the<br />
vertical drop and causes infra-occlusion on the posterior teeth<br />
and consequently an overloading of the anterior remaining<br />
teeth. Taking into the consideration the severe bone resorption<br />
in senior patients, this will be a major weakness of the system.<br />
(Combination Syndrome) (Figure 7a)<br />
The sequel of this action in particularly when bone resorption<br />
frequently occurs, is the continuing rocking of the denture when<br />
loaded occlusally. The rests of the last abutment are in this<br />
case acting as fulcrums. This phenomena establishes a selfperpetuating<br />
or rather a self-worsening situation where more<br />
36 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALFEATURE<br />
Figure 3a Destruction of the supporting Tissues<br />
b: guiding plane<br />
h: food impaction<br />
g: fulcrum<br />
f: periodontal desease<br />
movements causes more resorption and more resorption<br />
Conduct automatically to more movement.<br />
The cost of the dental laboratory is relatively expensive,<br />
especially when related to precision mechanism. Repairs are<br />
time-consuming and are charged for high fees by the dental<br />
technician.<br />
Another consideration is that these appliances are involving<br />
crowns for the abutment teeth. For the senior patients, this<br />
could be a financial burden, and often is not recommended for<br />
anatomical or periodontal considerations .<br />
Figure 3b Posterior bone resorption<br />
acting as Stress<br />
absorbing device. 7<br />
Rationale of the<br />
Concept<br />
In opposition with<br />
the classic concept<br />
of stress breaking<br />
based on the Lever<br />
Type I, the SAF is<br />
based on the Lever<br />
type III, determined<br />
by a back action<br />
(Figure 7b). In this<br />
case the occlusal<br />
forces are acting on<br />
the mesial end of<br />
the Saddle and are absorbed by the frame (Figure 8).<br />
The component of the occlusal forces are working vertically<br />
parallel to the teeth axis. Moreover the spring resilience effect<br />
is relocating automatically the RPD on is initial place. In this<br />
way avoiding soars and accelerates bone loose. (Figure 9) The<br />
realization of a separation between the basis (saddle) and the<br />
supporting teeth abutment is forbidding the tilting movement on<br />
the distal abutment teeth.<br />
The saddle is in fact relied to the major connector on his distal<br />
part, allowing on the mesial segment a freedom of movement<br />
on the vertical and lateral direction. The resilience of the frame<br />
is absorbing the occlusal trauma. (Figures 10 & 10b)<br />
4. Maintaining a balanced occlusal contact and preserving in<br />
this way the life –span of the remaining natural teeth.<br />
The Stress Absorbing Frame (SAF)<br />
In order to overrule this problematic situation it is<br />
recommended to design of a RPD with a Frame which is also<br />
Discussion<br />
The classic stress-breaking concept was widely analyzed a<br />
discussed in the literature 8 , but very few authors paid attention<br />
Figure 4 Fixed prosthodontics and removable semiprecision<br />
lower denture<br />
Figure 5a Precision attachment Hinge Axis type<br />
Figure 5b Precision<br />
attachment Hinge Axis type<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
37
CLINICALFEATURE<br />
Figure 6a Classic Dalbo<br />
attachment<br />
to the SAF 9 . At our knowledge this<br />
system is well admitted in some<br />
European Countries 10 . In the<br />
Geriatric <strong>Dental</strong> clinic of the<br />
Faculty of <strong>Dental</strong> Medicine of<br />
Jerusalem during five years the<br />
SAF was mainly indicated for<br />
senior patients with a high rate of<br />
success 11 .<br />
Advantages:<br />
1. Low cost ( both clinic and<br />
Laboratory )<br />
2. Simplicity of the clinical<br />
The main advantages of the<br />
SAF are low laboratory<br />
expenses, the simplicity,<br />
minimal invasive, non traumatic<br />
treatment, easy handling and<br />
facility for rebasing when<br />
necessary<br />
Figure 6b Lateral or rolling actvities of the saddle<br />
Figure 8 Occlusal forces absorbed by the frame<br />
Figure 7a The combination Syndrome<br />
Figure 9 Mandibular stress absobing frames<br />
procedures<br />
3. Easy manipulation for the patient, simple vertical insertionpathway<br />
4. Easy relining or rebasing under the saddle<br />
Figure 7b A spring Frame built in Back action<br />
Disadvantages:<br />
There are some negative aspects.<br />
1. Light food impaction between the distal aspect of the<br />
abutment teeth and the mesial end of the saddle.<br />
2. In the case of a severe bone resorption there is not enough<br />
38 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALFEATURE<br />
handling and facility for rebasing when necessary. In this way<br />
we can provide for our patients a comfortable solution taking<br />
care of the main conditions to a successful restoration:<br />
Affordability, Avaibility and Accessibility. DA<br />
Figure 10a Schema of the back action in a stress absorbing Frame<br />
place for the design of<br />
the back-axis lever.<br />
3. The metal might<br />
break after a long lasting<br />
period (five years in<br />
average)<br />
Conclusion<br />
The main advantages of<br />
Figure 10b Separation beteween the<br />
the SAF are low<br />
saddle and the guiding plane<br />
laboratory expenses, the<br />
simplicity, minimal invasive, non traumatic treatment, easy<br />
References<br />
1. R.Grahan ,and all. Determining the “need “ for a Removable Partial denture : a qualitative study<br />
of factors that influence dentist provision and patient use. British <strong>Dental</strong> Journal<br />
(2006);200,155-158.<br />
2. Mann,J.,Mersel,A.and Gabay,E.: <strong>Dental</strong> Status and dental needs of an elderly population in<br />
Israel. Community Dentistry and Oral Epidemiology. (1985 );13:156-158.<br />
3. Mersel,A.:Oral Health and dental needs in a Geriatric Institutionalized Population in Paris.<br />
Gerodontology (1989): 9:3 83-87.<br />
4. Eich, F.:The role of removable partial denture in the destruction of natural dentition. <strong>Dental</strong> Clinics<br />
of North America (1962); 8-3, 717-731<br />
5. Fisher, R. Z. and all. Removable partial denture and periodontal stress to the Periodontium.<br />
Int .J. Periodontics and Restorative Dentistry. (1984 ); 4:1 :34-37.<br />
6. Owall,B.: Precision attachment retained removable partial dentures. Int. J.of Prosthetic Dentistry.<br />
(1991 ); 4:3 249-257<br />
7. Reed, V. : Stress-equalizing removable partial dentures . Quintessence International. (1991); 21:4<br />
283-287.<br />
8. De Franco, R.L.: Designing removable partial dentures . <strong>Dental</strong> Clinics of North America ( 1984 );<br />
307-32<br />
9. Tourtet, L. and all .: from the original to the removable stress breaking Framework. Journal of<br />
Canadian <strong>Dental</strong> Association (1988 ); 193-195<br />
10. Jourda, G.: Prosthetic comfort and restoration of the gnathologic Function; stress breaking framework<br />
and Gerodontics. J. Chirurgien – Dentiste de France .( 1989 );59: 456 33-37.<br />
11. Mersel, A. and Rudberg. O. : A stress repartition frame for the partial Edentate elderly. Israel<br />
Journal of <strong>Dental</strong> Medicine (1999 )16:1 25-31.<br />
Prof Alex Mersel is a current member of the FDI<br />
Council and a member of <strong>Dental</strong> <strong>Asia</strong> Advisory<br />
Board. He is also the Chairman for Continuing<br />
Education Working Group for FDI European<br />
Regional Organization. He also holds the post of<br />
Deputy Chairman for Israel <strong>Dental</strong> Association.<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
39
CLINICALFEATURE<br />
by Dr Bertrand Chew<br />
Post-Minor Oral Surgery Pain<br />
Management with Oral Medication<br />
Pof Analgesics, there are the Acetaminophen,<br />
ain control is of paramount importance in post surgical<br />
management. The common drugs groups used are<br />
Analgesic and Anti-inflammatory Drugs. In the family<br />
Acetylsalicylic acid, NSAIDs(inclusive of the COX II-inhibitors)<br />
and the Opioids.<br />
In the pharmaceutical control of pain in the oral region, it acts<br />
on the pain pathways at different levels. The Spinothalamic<br />
(trigeminal-thalamic) tract is that carries the sensation of pain.<br />
The Chemical pathways of pain involves a cascade of events in<br />
cells, involving products of cells, enzymes, soluble factors, and<br />
blood vessels and their contents (Enwemeka & Spielholz 1992;<br />
Schmidt et al 1994; Tillman & Cummings 1992).<br />
Acetaminophen, 4'-hydroxyacetanilide, is an analgesic and<br />
antipyretic which occurs as a white, odorless, crystalline<br />
powder, possessing a slightly bitter taste. It has the following<br />
molecular formula C8H9NO2 with a molecular weight of<br />
151.16. It is discovered by accident when a similar molecule<br />
(acetanilide) was added to a patient’s prescription<br />
approximately 100 years ago. The medication is commonly<br />
known as Paracetamol = para-acetyl-amino-phenol.<br />
To date, the exact mode of action is still being discussed. The<br />
pain-reducing effect is more directly on the central nervous<br />
system by increasing the threshold of pain. There is an<br />
inhibition of the actions of chemical mediators that sensitize the<br />
pain receptors to mechanical or chemical stimulation. It also<br />
blocks activity by reducing the active oxidized form of cyclooxygenase<br />
to an inactive form and hence has little<br />
inflammatory actions (Lucas R et al 2005). The antipyretic<br />
activity is exerted by blocking the effects of the chemical<br />
pyrogen on the hypothalamic heat-regulating center.<br />
Others mention inhibition of nitric oxide formation that results<br />
from activation of substance P and N-methyl-D-aspartate<br />
(NMDA) receptor stimulation. Acetaminophen is metabolized by<br />
the liver. Therefore drugs that increase the action of liver<br />
enzymes that metabolize acetaminophen (eg carbamazepine,<br />
isoniazid, rifampin) may decrease the action of acetaminophen.<br />
The potential for acetaminophen to harm the liver is increased<br />
when it is combined with alcohol or drugs that also harm the<br />
liver. Acetaminophen is used in all stages of pregnancy. Breastfeeding<br />
is not a contraindication. (Gramham et al 2005)<br />
Drug Safety<br />
There is no clear evidence that taking paracetamol causes<br />
asthma, but more studies are suggesting that may be some<br />
association. Studies of patients with asthma suggest that<br />
acetaminophen challenge can precipitate a decline in FEV(1) ><br />
15% among sensitive individuals. (Eneli et al 2005). Some<br />
patients may have a specific sensitivity to the active ingredient<br />
or to any of the other components of the paracetamol.<br />
Paracetamol can be combined with many other drugs.<br />
They include the following:<br />
1. Orphenadrine citrate-analgesic properties. Also possesses<br />
anti-cholinergic actions. Good for muscle aches. (Aanarex)<br />
2. Caffeine (Panadol Extra)<br />
3. Codeine Phosphate (Panadeine)<br />
4. both codeine and Caffeine. (PACOFEN)<br />
5. Pamabrom: a diuretic to ease water retention. (for<br />
menstrual)<br />
6. Tramadol (Ultracet)<br />
Acetylsalicylic acid is commonly known as Aspirin. The chemical<br />
name 2-(acetyloxy) benzoic acid, are used as an analgesic,<br />
antipyretic and anti-inflammatory. It has also an anticoagulant<br />
effect and is used in long-term low-doses to prevent heart<br />
attacks. The bitter powder is extracted from willow bark that<br />
could ease aches and pains and reduce fevers. It was further<br />
modified by by researcher Arthur Eichengrun and Felix Hoffmann<br />
in1897.Aspirin was patented on March 6, 1899 by Bayer.<br />
Aspirin suppresses the production of prostaglandins and<br />
thromboxanes. This happens because cyclooxygenase (COX),<br />
an enzyme that participates in the production of prostaglandins<br />
and thromboxanes, is irreversibly inhibited when aspirin<br />
acetylates it. This makes aspirin different from other NSAIDS,<br />
which are reversible inhibitors. (John Robert Vane 1982).<br />
The topic on the safety of extractions on ling term aspirin<br />
patient has been discussed many times. The following<br />
statement would be a very useful guide: The scientific literature<br />
does not support routine discontinuation of oral anticoagulation<br />
therapy for dental patients (Jeske et al 2003).The<br />
management of oral surgery procedures on patients treated<br />
with anti-coagulants should be influenced by several factors:<br />
extent and urgency of surgery, laboratory values, treating<br />
40 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
CLINICALFEATURE<br />
physician’s recommendation, available facilities, dentist<br />
expertise, and patient’s oral, medical, and general condition.<br />
(Scully C 2002)<br />
Contraindications<br />
The following are contraindicated:<br />
Aspirin should be avoided by those known to be allergic to<br />
NSAIDs. Nonsteroid anti-inflammatory drugs (NSAID)<br />
crossreact with aspirin in aspirin-sensitive patients and vice<br />
versa (Settipane GA. 1998). Caution should be exercised in<br />
those with asthma or NSAID-precipitated bronchospasm due to<br />
the inhibition of COX in airways of the sensitive patients<br />
.patients with peptic ulcers are also encouraged to avoid<br />
aspirin. Children, including teenagers, are discouraged from<br />
using aspirin in cold or flu symptoms as this has been linked<br />
with Reye’s syndrome (MacDonald S 2002). Patients with other<br />
bleeding tendencies are also recommended to avoid aspirin.<br />
Aspirin-Induced Asthma, (AIA) has been reported. The<br />
frequency among asthmatics is around 8%-20%. Aspirin blocks<br />
the enzyme cyclooxygenase and this reduces the synthesis of<br />
prostaglandins. A further potential result of this blockade<br />
however is to shunt the cascade of reactions into a leukotriene<br />
pathway and leukotrienes are known to induce<br />
bronchoconstriction. Other theories are based on AIA patients<br />
having abnormal platelets, having abnormal thromboxane/<br />
prostaglandin ratios in the lung or even having had a chronic<br />
viral infection.<br />
NSAIDs (including COX II), is the acronym for Non-Steroidal<br />
Anti-Inflammatory Drugs. They are peripherally-acting antipyretic<br />
analgesic anti-inflammatory drug.<br />
The latest addition are the COX II inhibitors, introduced in<br />
1998. It acts via the inhibition of the enzyme cyclooxygenase<br />
which in turn reduces the level of prostaglandins in the body.<br />
Therefore, it is a peripherally-acting antipyretic analgesic anti<br />
inflammatory drug. Likewise, it has weak anti-thrombotic effect,<br />
being a weak inhibitor of platelet aggregation. It is also safer on<br />
the stomach than aspirin . Cyclooxygenase, is an enzyme that<br />
occurs in at least two isoforms:<br />
1) COX1 (constitutive), which mediates formation of<br />
prostaglandins responsible for GI mucosal protection,<br />
hemostasis and renal blood flow.<br />
2) COX2 (inducible), which catalyzes production of<br />
prostaglandins that act as inflammatory mediators. The<br />
enzyme can play a homeostatic role in some situations<br />
(ulcer healing, maintenance of renal blood flow during<br />
stress, prostacyclin production).In general NSAID’s that<br />
inhibit COX2>COX1 are considered the drugs of choice in<br />
this class.<br />
The following are some common NSAIDs<br />
1. Diclofenac<br />
There is no clear evidence that<br />
taking paracetamol causes<br />
asthma, but more studies are<br />
suggesting that may be some<br />
association<br />
2. Diflunisal<br />
3. Etodolac<br />
4. Fenoprofen<br />
5. Floctafenine<br />
6. Flurbiprofen<br />
7. Ibuprofen<br />
8. Indomethacin<br />
9. Ketoprofen<br />
10. Meclofenamate<br />
11. Mefenamic Acid<br />
12. Meloxicam<br />
13. Nabumetone<br />
14. Naproxen<br />
15. Oxaprozin<br />
16. Phenylbutazone<br />
17. Piroxicam<br />
18. Sulindac<br />
19. Tenoxicam<br />
20. Tiaprofenic Acid<br />
21. Tolmetin<br />
The COX II Inhibitors include the following:<br />
1. Celecoxib Celebrex®<br />
2. Rofecoxib Vioxx®*<br />
3. Valdecoxib Bextra*<br />
4. Etoricoxib Arcoxia<br />
* withdrawn from market<br />
The drugs are recommended for use on patients with allergic<br />
reaction to aspirin or has had urticaria, rhinitis or asthma<br />
associated with NSAIDs .NSAID’s should be avoided in the<br />
presence of renal or hepatic dysfunction, coagulopathies, GI<br />
disorders, shock, hypotension/hypovolemia, hypoalbuminemia<br />
or pregnancy.<br />
In the Vioxx Gastrointestinal Outcomes Research (VIGOR)<br />
trial, there was a higher incidence of cardiovascular thrombotic<br />
events in the rofecoxib vs the naproxen-treated group: 1.67 vs<br />
0.70 per 100 patient years. (Konstam 2002)<br />
In a comprehensive analysis of 114 randomized trials with<br />
116,094 participants, rofecoxib was associated with increased<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
41
CLINICALFEATURE<br />
renal and arrhythmia risks. Future safety monitoring is<br />
warranted and may benefit from an active and continuous<br />
cumulative surveillance system. (Zhang et al 2006)<br />
Opoids are agent that binds to opioid receptors, found<br />
principally in the central nervous system and gastrointestinal<br />
tract. There arefour broad classes of opioids:<br />
1. endogenous opioid peptides, produced in the body; (eg<br />
endorphins)<br />
2. opium alkaloids, such as morphine (the prototypical opioid)<br />
and codeine;<br />
3. semi-synthetic opioids such as heroin and oxycodone<br />
4. fully synthetic opioids such as pethidine and Fentanyl;<br />
Tramadol that have structures unrelated to the opium<br />
alkaloids (Fentanyl)<br />
The non-clinical use and off-label clinical use were criminalized in<br />
the USA by the Harrison Narcotics Tax Act of 1914, and by other<br />
laws worldwide. In USA, the Controlled Substances Act of 1970<br />
markedly relaxed the harshness of the Harrison Act. Opoids act<br />
on the following opioid receptors in the nervous system:<br />
Pharmaco Sci 1993) The common steroids used in dentistry<br />
are Dexamethasone and Prednisolone.<br />
Enzymes for anti inflammatory are a naturally occuring<br />
protease enzyme that digests non-living tissue, blood clots,<br />
cysts, and inflammation in all forms. The common ones are:<br />
1. Serrapeptidase: It acts via the hydrolysis of peptides into<br />
amino acids. It is a powerful proteolytic enzyme obtained<br />
from silkworms<br />
2. Papain: It is also known ascysteine protease (EC 3.4.22.2)<br />
and ispresent in papaya (Carica papaya) which is useful in<br />
tenderizing meat and other proteins.<br />
The exact mode of Action is unknown. However, preliminary<br />
studies show some potential in inflammation reduction. It is<br />
concluded that Serratia peptidase has anti-inflammatory, antioedemic<br />
and fibrinolytic activity and acts rapidly on localized<br />
inflammation. (Mazzone A et al, 1990 J Int Med Res)<br />
Finally, here is a diagram of the inflammatory process and the<br />
action of drugs used in dentistry for pain management.<br />
1. MU<br />
2. Delta (still in discussion)<br />
3. Kappa<br />
4. Sigma-<br />
5. Epsilon (still in discussion)<br />
Common adverse reactions include: tolerance, dependence<br />
and withdrawal issues, nausea and vomitting, drowsiness,<br />
dizziness, headache, orthostatic hypotension, itch, dry mouth,<br />
miosis, urinary retention, and constipation. (Rossi, 2005).<br />
Tolerance can be detected within 12-24 hours of the<br />
administration of morphine (Rang et al, 2003) and results in the<br />
necessity for increasing the dose over time to achieve the<br />
desired clinical effect. It appears to develop first to the<br />
analgesic, sedative, emetic, euphoric and respiratory<br />
depressive effects of opioids. The miotic and constipating<br />
effects are more resistant to the development of tolerance.<br />
(Rang et al, 2003)<br />
For anti-inflammatory drugs, the following are used:<br />
1. Steriods<br />
2. Enzymes, eg Serro-peptidase<br />
3. NSAIDs (as discussed earlier)<br />
Steriods are terpenoid lipid characterized by a carbon skeleton<br />
with four fused rings. All steroids, being terpenoids, are derived<br />
from HMG-CoA which itself is derived from the acetyl CoA<br />
biosynthetic pathway. For anti-inflammtory, these are usually<br />
Glucocorticoids. The mode of action is (Anti-inflammatory<br />
mechanism) by decreasing gene transcription of cytopkines,<br />
chemokines, inflammtory enzymes, decreasing T/B cells,<br />
macrophages,direct vasoconstriction. (Barnes PJ Trends<br />
Legends<br />
-----------------<br />
Confirmed mode of action<br />
Associated mode of action<br />
Dr Bertrand Chew has a Masters in Oral and<br />
Maxillofacial Surgery and is a Fellow of the Royal<br />
Australian College of <strong>Dental</strong> Surgeons. Currently,<br />
he is working with the Singapore Armed Forces as<br />
an Oral Maxillofacial Surgeon. He also lectures on<br />
the FDI <strong>Asia</strong>-Pacific circuit and is active with the<br />
Singapore <strong>Dental</strong> Association.<br />
42 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
USERREPORT<br />
by Drs Birgit Grubeanu-Block & Daniel Grubeanu<br />
Long-term Esthetic<br />
Stability Through<br />
Structure Retention<br />
Patients interested in implant therapy are particularly interested in an<br />
esthetic, friendly and simply brilliant smile. Advanced dental technology is<br />
being used to make the visible white components of the dental prosthesis<br />
more demanding esthetically. However, a really natural appearance can<br />
only be achieved in combination with an emergence profile that is<br />
indistinguishable from the neighboring teeth. An essential condition for acceptable<br />
peri-implant soft-tissue esthetics is therefore the retention of the structures around<br />
the implant. But exactly how can bone and soft tissue remain stable over the long<br />
term? And above all what factors must be taken into account for this?<br />
Figure 1 Pre-operative situation<br />
Biological Width, Dentogingival Complex<br />
of Teeth and Implants<br />
The term “biological width” describes the dimension of certain periodontal and<br />
peri-implant soft-tissue structures, the gingival sulcus, marginal epithelium and<br />
supracrestal connective tissue. Because marginal epithelium and supracrestal<br />
connective tissue can adhere to teeth and implants, this is referred to as epithelial<br />
and connective-tissue attachment. The basic principle of the biological width is<br />
that bone projecting into the oral cavity is always covered by periosteum,<br />
connective tissue and epithelium (Tarnow et al. 2000). The epithelial and<br />
connective-tissue attachment in this case has a specific thickness (dimension).<br />
Animal studies have demonstrated that the thickness of the peri-implant soft<br />
tissues remains relatively constant at 3 mm (Buser et al. 1992; Berglundh et al.<br />
1996; Cochan et al. 1997; Hermann et al. 2000; Todescan et al. 2002).<br />
Peri-implant Bone Resorption<br />
Possible causes for peri-implant bone resorption are among the following:<br />
1. Surgical trauma during placement of implant and abutment (Brånemark et al.<br />
1969; Adell et al. 1986; Cochran et al. 1997)<br />
Figure 2 Mucosa conditions<br />
2. Positioning of the implant relative to the alveolar ridge with supracrestal,<br />
Figure 3 View of the alveolar arch of maxilla Figure 4 Subcrestal placement of the Ankylos implant Figure 5 Facial bone deficit<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
43
USERREPORT<br />
Figure 6 Grafting with autologous bone in<br />
contact with the implant surface<br />
Figure 7 Membrane placed over Frios Algipore as<br />
protection against resorption<br />
Figure 8 Suture with fitted gingiva former,<br />
open healing<br />
epicrestal or subcrestal positioning of the microgap and/or the<br />
transition from smooth to roughened implant surface<br />
(Hämmerle et al. 1996; Hermann et al. 1997; Davapanah et al.<br />
2000; Hermann et al. 2000a)<br />
Figure 9 Situation with external suture<br />
3. Biomechanical overloading of the bone with formation of<br />
microcracks (Adell et al. 1986; Brånemark et al. 1977; Pilliar et<br />
al. 1991a; Quirynen et al. 1992; Tonetti & Schmid 1994; Rangert<br />
et al. 1995; van Steenberghe et al. 1999) or lack of mechanical<br />
coupling between implant and bone by a roughened implant<br />
surface or screw threads (Wolff 1892; Cowin 1986; Pilliar et al.<br />
1991a; al-Sayyed et al. 1994; Hämmerle et al. 1996; Jung et al.<br />
1996; Vaillancourt et al. 1996; Hansson 1999; Wiskott & Belser<br />
1999; Hansson 2000b, 2000c)<br />
4. Violation of the biological width by insufficient dimensioning<br />
of the peri-implant mucosa (Berglundh & Lindhe 1996),<br />
microbial noxa (Tarnow et al. 1996) or mechanical noxa<br />
(Abrahamson et al. 1997; Tarnow et al. 2000)<br />
5. Type of connection between abutment and implant with<br />
varying width of microgap and force transfer to the crestal bone<br />
(Abrahamson et al. 1999; Jansen et al. 1997; Hansson 2000b)<br />
Figure 10 Occlusal situation before taking impression after three-month<br />
healing<br />
Requirements for Interdental and<br />
Interimplant Papillae<br />
The major factor in the presence of peri-implant papillae is the<br />
Figure 11 Facial View<br />
Figure 11 Impression making<br />
Figure 13 Zirconium oxide abutment try-in with seating<br />
instrument<br />
44 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
USERREPORT<br />
Figure 14 Abutment tryin<br />
Figure 15 Cercon scaffold try-in Figure 16 Unfired crown try-in Figure 17 Unfired crown<br />
distance of the contact point between bone and alveolar ridge.<br />
Tarnow et al. (1992) state that papillae are always present or<br />
are most likely to form between restored teeth if the distance<br />
from the cementum-enamel junction to the crestal bone is 3<br />
mm and interproximally the crown contact point is 5 mm to the<br />
interdental tooth tip. Other authors (Kois et al. 1994) have<br />
found that the probability of interdental papillary formation is<br />
particularly high if this distance is 4 mm. The distances<br />
described by Tarnow et al. have been defined for implants with<br />
an external implant-abutment connection.<br />
Microgap<br />
Two-component implant systems have a microgap between the<br />
abutment and the implant body. The microgap is contaminated<br />
with oral bacteria after initial uncovery and removal of the<br />
factory-installed retaining cover screw. If the implant is placed<br />
too deep and the microgap is subcrestal, the bone is resorbed<br />
around the implant by 1-2 mm over the first year (Lamb 2004;<br />
Buser et al. 2005). This is caused by the formation of a new<br />
biological width around the implant. A number of animal studies<br />
have demonstrated that the bone resorption is greater the<br />
further the microgap is apically (Hermann et al. 2000). Bacteriaproof<br />
implant-abutment connections have significantly less or<br />
no bone resorption compared to other systems (Weng 2005).<br />
Structure Retention and<br />
Soft-tissue Esthetics<br />
In addition to the optimum three-dimensional placement of the<br />
implant, the anatomical requirements of the neighboring teeth,<br />
the gingival biotype (Kan et al. 2003), the gingival genotype, and<br />
the correct dimension of the implants, the central problem of a<br />
predictable soft-tissue esthetics around implants appears to be<br />
the microbially colonized and mechanically loaded microgap. The<br />
existence of a microgap between the implant and abutment or<br />
implant crown and the surgical placement of the microgap in<br />
relation to the alveolar ridge are of critical importance and have<br />
significant biological and pathological consequences.<br />
The position and dimension of soft and hard peri-implant tissue<br />
(esthetics) and the degree of infectious reactions (periimplantitis)<br />
are directly affected. In the case of immediate<br />
implant placements in extraction alveoli the danger of a<br />
subcrestal placement of the microgap is large, particularly<br />
interdentally, because the vertical placement is oriented to the<br />
buccal height. If bone resorption occurs, the peri-implant soft<br />
tissue loses its support and unwanted gingival recession<br />
occurs, which over the long term results in unacceptable<br />
esthetic conditions. The Ankylos implant system has a special<br />
position here. With the reduced-diameter geometry of the<br />
implant-abutment connection with an integrated platform switch<br />
the biological width is not violated in the horizontal dimension;<br />
and with their bacteria-proof implant-abutment connection<br />
Ankylos implants can be placed subcrestally without violating<br />
the vertical dimension of the biological width. The peri-implant<br />
tissue is supported by bone and remains stable over the long<br />
term – a guarantee of long-term esthetic success.<br />
Case Study<br />
Assessment<br />
The 23-year-old patient was primarily interested in having the<br />
single-tooth gap at region 21 closed.<br />
Diagnosis<br />
The patient did not suffer from any disease, her oral hygiene<br />
Figure 18 Cemented-in<br />
crown<br />
Figure 19 Facial view after cleaning<br />
Figure 20 Status one week after<br />
cementing-in<br />
Figure 21 Three weeks<br />
after restoration<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
45
USERREPORT<br />
Figure 22 After one<br />
month<br />
Figure 23 After six months Figure 24 Twelve months after cementing-in Figure 25 Eighteen months<br />
after cementing-in<br />
was acceptable. Status after motor vehicle accident with<br />
multiple enamel fractures in the front of the maxilla.<br />
Treatment Plan<br />
1. Hygiene phase, oral hygiene instruction and motivation<br />
2. Evaluation of compliance<br />
3. Implant placement in region 21 with open healing<br />
4. Fabrication of a porcelain Cercon crown (Degudent)<br />
Surgical Protocol<br />
An Ankylos plus implant (DENTSPLY Friadent), diameter 4.5<br />
mm, length 14 mm, was placed with primary stability in<br />
accordance with the standard placement protocol. The implant<br />
shoulder was placed 1 mm subcrestally. Small facial bone<br />
deficits and fenestrations were augmented with autologous<br />
bone, which was locally harvested with a bone scraper<br />
(Stoma). The bone replacement material Frios Algipore<br />
(DENTSPLY Friadent) was used as resorption protection for the<br />
grafted region and covered with a resorbable collagen<br />
membrane. The implant healed uncovered to establish<br />
optimum soft-tissue conditions.<br />
Healing Time<br />
Further treatment was delayed for four months to guarantee<br />
stress-free healing of the implant. There were no complications<br />
with the healing process.<br />
Prosthetic Protocol<br />
After four months an impression of implant 21 was taken with<br />
an open customized tray. One week after the impression, the<br />
zirconium oxide abutment (DENTSPLY Friadent) and the<br />
zirconium oxide crown (Degudent) were test-fit. After minor<br />
corrections the crown was finished and permanently placed.<br />
There were no complications or loss of soft tissue over the<br />
observation phase of over one year by now.<br />
Conclusion<br />
1. The Ankylos implant system simplifies restorations in the<br />
esthetic zone because the system with its TissueCare<br />
Figure 26 Eighteen months after cementing-in<br />
connection guarantees that the natural constant, the “biological<br />
width”, is not violated, which means the friction-locked and<br />
keyed, bacteria-proof tapered connection between the implant<br />
and abutment.<br />
2. The surgical process is minimized, because subcrestal<br />
implant placement is possible even in extraction alveoli and<br />
interimplant or interdental bone resorption processes of 2 mm<br />
do not occur.<br />
3. The spacing parameters described in studies are not<br />
obligatory for this type of implant.<br />
4. The thick soft-tissue collar formed by the special geometry of<br />
the implant-abutment connection alters the “thin” gingival<br />
biotype positively and ensures additional long-term stability.<br />
5. The open healing in the esthetic zone with a reduced-diameter<br />
healing cap allows the soft-tissue conditions to stabilize.<br />
6. A buccal resorption protection coating should be placed for<br />
long-term stability.<br />
The dental technology work was supplied by:<br />
Britz Zahntechnik dental laboratory, Trier/Germany<br />
Analytical • Authoritative • Acclaimed<br />
For more information, email: info@pabloasia.com<br />
46 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
EXHIBITIONPREVIEW<br />
by Desmond Teo<br />
Watershed Period for<br />
<strong>Asia</strong> Pacific <strong>Dental</strong> Congress<br />
Despite its long history, <strong>Asia</strong> Pacific <strong>Dental</strong> Congress<br />
(APDC) appears to be losing its appeal to many an<br />
exhibitor in recent years. This is due in part to the<br />
many regional and domestic exhibitions that have<br />
been sprouting up in the region, which have indirectly relegated<br />
APDC to a less significant role. Nonetheless, the influence of<br />
this regional dental grouping — <strong>Asia</strong> Pacific <strong>Dental</strong> Federation<br />
(APDF), the main sponsor of APDC — cannot be ignored all<br />
together.<br />
The 30th APDC this year will be held in Bangkok, Thailand from<br />
May 6-10 at the Bangkok Convention Center at Central World.<br />
The <strong>Dental</strong> Association of Thailand, organizer for this year’s<br />
APDC, is confident that it will be able to put up a good show<br />
this year, after witnessing what the successful conclusion of the<br />
29th APDC in Jakarta last year. The absence of the Thai<br />
contingent at the recently concluded IDEM in Singapore speaks<br />
volume of the support that APDC will be receiving from the Thai<br />
dental community.<br />
According to exhibitors, many felt that APDC has through the<br />
years transformed from a major regional exhibition to one that<br />
is more domestic in nature. This has in turn put them in the<br />
same league as other domestic dental exhibitions in the region.<br />
A number of major exhibitors are giving the show a miss and<br />
focusing their resources on major shows elsewhere. They are<br />
being represented by their local distributors/dealers instead.<br />
On the scientific program side, it is heartening to see that<br />
APDC still maintains a high standard for the papers presented.<br />
This time round, some established dental professionals and<br />
academics will be lending their support and sharing their<br />
knowledge and experiences with the delegates.<br />
Being Relevant<br />
Like all other dental shows in this region, <strong>Asia</strong> Pacific <strong>Dental</strong><br />
Congress needs to constantly evolve and maintain its<br />
relevance for the dental community in this part of the world.<br />
Since its debut in 1955, APDC has undergone many changes.<br />
Dr Adirek S. Wongsa, President of the<br />
Local Organizing Committee for APDC<br />
2008 is confident that this year’s event will<br />
be one of the better ones in terms of<br />
participation and turn-out. “APDC will be<br />
the biggest event in the dental calendar of<br />
Thailand this year, hence, I expect strong<br />
support from the local dental industry, as<br />
well as the member countries.”<br />
Dr Adirek S. Wongsa<br />
APDC still has an important role to play, especially in bringing<br />
dental awareness and dental education to the lesser-developed<br />
countries in the <strong>Asia</strong>-Pacific region. Complacency, if there were<br />
any, must be banished at this critical juncture, if it were to avoid<br />
the fate of oblivion. APDC cannot stand still; it has to keep reinventing<br />
itself in order to restore its pre-eminent position in the<br />
face of on-coming ‘competition’.<br />
The ball is in your court, APDF.<br />
DA<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
47
EXHIBITIONREVIEW<br />
by Desmond Teo<br />
IDEM 2008 Punches<br />
Above its Weight<br />
Rewind back to April 2006 where the dust of IDEM 2006 had barely settled<br />
and already the organizing team was planning and strategizing for 2008.<br />
Fast forward to IDEM 2008 — the biggest show since its inception in 2000<br />
— where many records were broken along the way. Kudos to koelnmesse<br />
(the organizer) for a job well done.<br />
Apart from the final day where the visitorship was thinner, days one and two were<br />
well-attended by both delegates and visitors from Singapore and around the region.<br />
With 35% larger exhibiting space than 2006’s, IDEM 2008 was well represented by<br />
more than 380 exhibitors from more than 30 countries, parading some of the latest<br />
technologies and equipment in the dental industry today.<br />
The Exhibitors<br />
For the visitors, it would not be difficult to notice that this year’s booths at IDEM were<br />
generally bigger and more creatively done. And one thing was for sure — it’s also<br />
getting higher. Said Mr Edwin Balchin, Director of GC <strong>Asia</strong> <strong>Dental</strong>: “Apart from<br />
location of the booth, we also need to spruce it up creatively in order to attract the<br />
visitors, and one way is to construct<br />
our booth ‘upward’ so that even from<br />
afar, you would not miss us.”<br />
The effort put in by the manufacturers<br />
to design their booths could not be<br />
discounted. In fact, it would be<br />
interesting if the organizer were to<br />
have a “Best Booth Design” award to<br />
spice things up a little.<br />
On a more serious note, the general<br />
consensus amongst the exhibitors this<br />
year was upbeat. The good mix of<br />
representation of returning and firsttime<br />
exhibitors from different parts of<br />
the world went to confirm the important<br />
status of IDEM. Apart from the<br />
Germany and USA pavilions, there<br />
Michael J Williams (left), Chairman of Board of GC<br />
<strong>Dental</strong> (Suzhou) posing with Edwin J Balchin,<br />
Director of GC <strong>Asia</strong><br />
were also the Argentina, Brazil, South Korea, Taiwan, Australia, Swiss and French<br />
pavilions.<br />
Said first-time exhibitor, Mr Mikael Kaivola of Sendoline: “It’s our first time<br />
participating at IDEM together with our distributor IDS <strong>Dental</strong>. I must admit that I am<br />
very pleased with the quality of the visitors and the interests generated.”<br />
Another manufacturer, Owandy, made its presence through its local distributor,<br />
48 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
EXHIBITIONREVIEW<br />
DenMit Trading. Remarked Mr Boris Loyez, International<br />
Sales Manager for Owandy, with a tinge of regret: “With the<br />
amount of enquiries that we are getting, I regret that I didn’t<br />
get a bigger booth and bring in our machine for a better<br />
demo. But we will be back in 2010 with a bigger booth and<br />
better exhibits.”<br />
However, there were also gripes from the exhibitors as well.<br />
Said Mr Milan Rajek, Managing Director of Bausch Articulating<br />
Papers: “IDEM is an important show for us and this year is no<br />
exception. We were expecting a better turn-out this time as<br />
compared to 2006 but I must say apart from Day 1, the rest of<br />
the days were generally disappointing in terms of visitors.”<br />
Conspicuously absence were the Thais and Vietnamese.<br />
Observed Heddie Ricci, General Manager of Bionnovation<br />
Biomedical: “We have a good share of visitors from India,<br />
Singapore, Malaysia and Indonesia but we didn’t get to see<br />
many Thais or Vietnamese attending this event.”<br />
IDEM — being an off-shoot of<br />
the more successful and<br />
illustrious IDS in Cologne,<br />
Germany — may find it difficult<br />
to emulate the immense success<br />
enjoyed by IDS but that should<br />
not stop it from aiming for the<br />
sky and developing its own<br />
characteristics<br />
The Vietnamese and the Thais have good reason to be<br />
absence as they have their own dental exhibitions in their own<br />
backyards, happening close to IDEM — April and May<br />
respectively. However, I believe that the absence of these two<br />
groups of visitors did<br />
not undermine the<br />
overall performance of<br />
the show.<br />
The Visitors<br />
Virtually all the visitors<br />
knew what they came<br />
for but there were some<br />
who came with an open<br />
mind and were<br />
pleasantly surprised<br />
with what they saw.<br />
Said Mr M. R.<br />
Chowdhury, General<br />
Manager (<strong>Dental</strong>) of<br />
UniMed Limited of<br />
Bangladesh: “I must say<br />
I am impressed with<br />
what I saw and I also<br />
managed to get in touch<br />
with some of the<br />
principals which I have been trying to meet up for quite some<br />
time.”<br />
Others like Dr Aris Sutanto from Indonesia and Dr Lilli Ann Dim<br />
Fernando from the Philippines were there to update themselves<br />
on the latest in the industry, as well as purchasing expendable<br />
products in bulks. “I am glad that I came as I am able to obtain<br />
first-hand information<br />
on the products that I<br />
have shortlisted for<br />
my clinic back home,”<br />
expressed Dr Lilli.<br />
Trade and Industry Minister Mr Lim Hng Kiang (center) officially opening IDEM 2008. On his<br />
right is Mr Oliver P. Kuhrt while Dr Benjamin Long is on his left. Dr Ng Jet Wei, Chairman of<br />
IDEM 2008 Committee, is standing first from the right and Dr Burton Conrod, President of FDI<br />
World <strong>Dental</strong> Federation is next to him.<br />
Seen on the<br />
showfloor, too, were<br />
personnel of military<br />
dental units from<br />
Singapore and the<br />
region. It was<br />
understood that<br />
several orders were<br />
being placed by these<br />
personnel for<br />
installation back in<br />
their military<br />
operations.<br />
Speaker Associate<br />
Professor Khalid<br />
Almas, for the Division of Periodontology at the University of<br />
Connecticut Health Center, School of <strong>Dental</strong> Medicine, also<br />
Analytical • Authoritative • Acclaimed<br />
For more information, email: info@pabloasia.com<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
49
EXHIBITIONREVIEW<br />
wished he could have more time on hand to have a thorough<br />
tour of the exhibition halls. “From the little time I managed to<br />
squeeze out of my schedule, I managed to have a quick<br />
glimpse of the exhibits in the [exhibition] halls and I like what I<br />
saw. I would also like to congratulate SDA for putting together<br />
an excellent scientific program, which had catered virtually to<br />
all areas of dentistry.”<br />
The Organizer<br />
Of course, nothing is perfect and there will always be that<br />
minority of exhibitors who feel that the show could have been<br />
better. Said Mr Adrian Sng, Senior Manager of koelnmesse Pte<br />
Ltd: “In any exhibition in the world, there will bound to be a<br />
small group of exhibitors who will be unhappy. No matter how<br />
hard we try make everything perfect, we cannot please<br />
everyone but we also get very encouraging and good feedback<br />
from many of our exhibitors. Overall, I would consider IDEM a<br />
success given the record delegates and visitors.”<br />
Conclusion<br />
Well, just as in back in 2006 when the organizing team did not<br />
immerse themselves wildly in a job well done, this time round,<br />
there is no difference. Already the koelnmesse team is back on<br />
the drawing board — planning for a more ambitious and bigger<br />
IDEM 2010. And the rumor is rampant that IDEM 2010 will be<br />
held at the new Marina Bay Sands integrated resort (which<br />
incorporates one of the two casinos in Singapore) at Downtown<br />
Marina. The organizer is not revealing much for now until<br />
everything is cast in iron. So, watch this space!<br />
On a personal note, I would like to see IDEM grow — not only<br />
in size but also in stature that is befitting of its regional<br />
importance. The past eight years have seen IDEM grown<br />
gradually in terms of exhibiting space and visitorship — which<br />
indicate the correct direction that the organizer has taken —<br />
but it’s time to bring the event to the next level.<br />
not stop it from aiming for the sky and developing its own<br />
characteristics. And for that, I have my little wish list that I have<br />
made (and hopefully I could see it being implemented for IDEM<br />
2010):<br />
• Product Premieres<br />
To proclaim that a show has truly arrived, apart from the<br />
number of visitors and exhibitors, another good barometer<br />
would be the number of product premieres at the exhibition.<br />
This time round, we only witnessed less than a handful of new<br />
products being launched at IDEM.<br />
Many manufacturers may have their own reasons and<br />
strategies to defer their launches till IDS but that do not stop<br />
them from having interim launches at IDEM. Product launches<br />
at such major exhibition is one way of attracting more visitors to<br />
the event. Visitors do not want to fly all the way to IDEM just to<br />
look at something which they can get back home. (So,<br />
exhibitors who lamented the lack of visitors, must have a relook<br />
at their gripes).<br />
• Broadcast of Live Surgery On-Site<br />
Currently, IDEM prohibits live surgery on-site due to hygiene<br />
and safety concerns. Perhaps, exhibitors could arrange for live<br />
broadcasts of final stages of dental surgery/implants to be<br />
beamed from dental clinics or dental schools. This will better<br />
explain the products and bring attention to the booths.<br />
More non-invasive demonstrations could also have been<br />
performed just like what Ivoclar Vivadent had when showing its<br />
OptraDam rubber dam. Although it was a simple<br />
demonstration, it attracted quite an attention with the visitors.<br />
As Singapore Minister for Trade and Industry, Mr Lim Hng<br />
Kiang, remarked in his opening speech: “IDEM augments our<br />
exciting pipeline of business events and enables us to<br />
showcase Singapore’s position in the field of dentistry in the<br />
<strong>Asia</strong>-Pacific region. IDEM 2008 is an excellent opportunity for<br />
the interaction among dentists — to learn not only the evidence<br />
or scientific basis of clinical practice but also new innovations<br />
that can change the way one practises dentistry.”<br />
Granted that what the Minister said was true but with more<br />
similar exhibitions sprouting up by the day in this region, IDEM<br />
must rise above the challenge and constantly find ways to stay<br />
ahead and increase its prominence. Only then will it hold truth<br />
to what Minister Lim had said.<br />
IDEM — being an off-shoot of the more successful and<br />
illustrious IDS in Cologne, Germany — may find it difficult to<br />
emulate the immense success enjoyed by IDS but that should<br />
The Scientific Program is a highly successful component of IDEM and are,<br />
more often than not, sold-out. A delayed excerpts of the papers presented<br />
would be a welcome move for the visitors, who might have missed the boat.<br />
50 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
EXHIBITIONREVIEW<br />
IDEM is a good platform to<br />
matchmake manufacturers with<br />
dealers/distributors in this region.<br />
A glance at the show floor and it<br />
would not be difficult to notice<br />
manufacturers putting up signs to<br />
look for dealers/distributors. This<br />
was more apparent in the case of<br />
first time exhibitors<br />
• Delayed Excerpts of Scientific Program<br />
Many visitors who thronged the showfloor might not be there for<br />
Scientific Program that was going on next door. The IDEM<br />
Scientific Program is internationally recognized as being one of<br />
the best around. Many of the sessions at IDEM were sold out,<br />
leaving other would-be delegates outside the door.<br />
The organizer and Singapore <strong>Dental</strong> Association (SDA) could<br />
explore the possibility of having excerpts of some top-notch<br />
sessions being broadcast on big screens on the showfloor for<br />
2010. This could make the floor livelier and also stir up the<br />
interests of visitors towards the Scientific Program.<br />
• Matchmaking Agency<br />
Well, if you are thinking of a matchmaking agency for available<br />
singles at IDEM, please have your focus realigned. What I am<br />
painting here is about manufacturers and distributors.<br />
IDEM is a good platform to matchmake manufacturers with<br />
dealers/distributors in this region. A glance at the show floor and<br />
it would not be difficult to notice manufacturers putting up signs to<br />
look for dealers/distributors. This was more apparent in the case<br />
of first time exhibitors.<br />
And who’s in a better position to offer such a value-added<br />
service? The organizer, of course! I am sure the exhibitors, local<br />
dealers or visiting distributors would be very grateful to the IDEM,<br />
if it could provide such service on top of its usual agenda.<br />
If, some, if not all, of the items in my above wish list could be<br />
materialized, I am confident that IDEM 2010 would have scaled<br />
another level. And the day we get to see product premieres at the<br />
exhibition, it would be the day IDEM has truly arrived.<br />
IDEM 2010 will be held from 16-18 April 2010. DA<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
51
EXHIBITIONREVIEW<br />
From the Showfloor of IDEM 2008<br />
1 2<br />
3<br />
7 8<br />
4<br />
5a<br />
5b<br />
Figure 1 “Hmm... Am I in the right session?”<br />
Figure 2 IDEM is also a shopping haven for some dentists<br />
Figure 3 Live demo at Ivoclar Vivadent’s booth attract a big crowd<br />
Figure 4 “Okay, my X-ray goggle should be able to find something.”<br />
Figures 5a & 5b Cultural diversity during the opening ceremony<br />
Figure 6 Having a cuppa and talking business at the Swiss Pavilion<br />
lounge<br />
Figure 7 Free dental screening was held during the duration of IDEM<br />
6<br />
Figure 8 Dressed-up models making their presence felt with their<br />
smiles<br />
52 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
EXHIBITIONREVIEW<br />
1a<br />
1c<br />
1b<br />
1d<br />
4a<br />
4b<br />
2<br />
5<br />
3<br />
6<br />
Figures 1a-1d Putting on their best smiles - Weston Pettersen, Zimmer<br />
<strong>Dental</strong>; Roland Reu (left) & Oon Lai Hong, Dürr <strong>Dental</strong>; (L-R) Joerg<br />
Brenn, Christian Brutzer & Marcel Ohri, Ivoclar Vivadent; Andrew Soh,<br />
Remedent <strong>Asia</strong><br />
Figure 2 Never too young to start on good dental habit<br />
Figure 3 VIPs and Guest-of-Honor posing for the camera<br />
Figures 4a & 4b Letting their hair down during IDEM Nite<br />
Figure 5 The Scientific Program was always well received<br />
Figure 6 Never a dull moment for Mark Albanese of Microbrush<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008<br />
53
EXHIBITIONREVIEW<br />
7<br />
1 2<br />
8<br />
3<br />
4<br />
5<br />
6<br />
Figure 1 <strong>Dental</strong> <strong>Asia</strong> Advisory Board member, Dr George Freedman,<br />
presenting his paper at the <strong>Dental</strong> Innovations Forum<br />
Figures 2 & 3 Prof Edward Swift and Prof Steven Offenbacher respectively<br />
enthralling the delegates with their presentations<br />
Figure 4 Bob Weber of NTI-TSS (left) and his distributor, Sunny Chow of<br />
Cross Protection (right), posing with Her Excellency, Patricia L. Herbold,<br />
US Ambassador to Singapore<br />
Figure 5 Finally, a break from all the hustle-and-bustle of the<br />
showfloor<br />
Figure 6 Let me send a message to my wife first...<br />
Figure 7 Minister Lim Hng Kiang (center) chatting with one of the<br />
exhibitors<br />
Figure 8 Non-stop action at the registration counter<br />
54 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
PRODUCTUPDATE<br />
Temporary Esthetics from Ivoclar Vivadent Enquiry No. 01/05<br />
SR Ivocron has been successfully used to fabricate functional<br />
and aesthetic temporary restorations for many decades. An<br />
increasing number of dental laboratories use the popular PMMA<br />
veneering material as a temporization material in dental implant<br />
cases. The range of 20 Chromascop shades enables the<br />
application of SR Ivocron both for metal-free and metal-supported<br />
temporary restorations. The shades are coordinated with the<br />
Ivoclar Vivadent veneering materials and denture teeth.<br />
The three different liquids allow dental technicians to choose<br />
their individual working<br />
technique — casting,<br />
layering or pressing.<br />
Apart from long-term<br />
provisionals and<br />
repairs, SR Ivocron is<br />
also suitable for<br />
combination prosthetics<br />
and as a conventional<br />
veneering composite.<br />
Self-Adhesive Resin Cementing in a Breeze Enquiry No. 02/05<br />
Pentron Clinical Technologies<br />
has introduced Breeze Self-<br />
Adhesive Resin Cement, the<br />
versatile new self-etch, dualcure<br />
cement. It is formulated<br />
with 4-Meta technology to<br />
provide the strongest retention<br />
available in a self-adhesive<br />
cement with the quick and easyto-use<br />
auto-mix delivery system.<br />
This versatile cement exhibits low<br />
expansion properties ensuring<br />
compatibility with PFMs, composite, zirconia, alumina, and<br />
cementable ceramics such as 3GHS ®* crowns from Pentron<br />
IMTEC Solves Wrenching<br />
Problem Enquiry No. 03/05<br />
The use of FDA-approved long-term minis in securing<br />
loose dentures and the construction from single<br />
crowns to full mouth bridges has prompted IMTEC<br />
Corp to develop an adjustable torque wrench.<br />
No longer will there be a need for you to second<br />
guess the strength needed for the final seating of your<br />
minis in the jaw bones. With the adjustable torque<br />
wrench you can set the force needed so that no excess<br />
pressure will be applied to cause unwanted fractures of<br />
minis when you are self-tapping your minis in the mouth.<br />
The adjustable torque wrench allows you to set correct<br />
readings and thereby ensure that your minis are correctly<br />
seated in the jaw bones.<br />
Ceramics.<br />
Breeze Self-Adhesive Resin Cement is specifically designed to<br />
make the cementation of crowns, bridges, inlays, on-lays and<br />
posts faster and easier by eliminating individual etching, priming,<br />
bonding, and mixing steps. Its efficient auto-mix syringe with<br />
convenient intra-oral tips provides precise, direct and quick<br />
placement of cement, even in difficult to reach places. The<br />
unique formulation of Breeze Cement enables the dentist to prep,<br />
cement and place restorations quickly and efficiently to minimize<br />
chair time while also virtually eliminating post-op sensitivity.<br />
Available in three shades — A2, Translucent and Opacecous<br />
White.<br />
ZM390 Eliminates ‘Pointy’<br />
Issues Enquiry No. 04/05<br />
Cylindrical or conical instruments are<br />
not particularly well-suited for work on<br />
pointy contacts, when correcting high<br />
spots of malocclusion.<br />
The special contour of the Busch<br />
ZM390 instrument with its rounded tip<br />
enables precision work whilst fully<br />
preserving the natural convexity of the cusp slopes.<br />
The two medium (without ring) and fine grit (red ring) diamond<br />
rotary instruments are for grinding of new and existing tooth<br />
restorations. The extra-fine grit instrument (yellow ring) is most<br />
suitable for precision finishing.<br />
Analytical • Authoritative • Acclaimed<br />
For more information, email: info@pabloasia.com<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008 57
PRODUCTUPDATE<br />
Natural Feel from VITABLOCS TriLuxe Enquiry No. 05/05<br />
The new VITABLOCS TriLuxe forte from Vita are the ideal<br />
solution for fabricating esthetically pleasing, high-quality<br />
dental prosthetics in a short period of time.<br />
In the new TriLuxe forte, the shades are even<br />
more compatible, the individual layers fit<br />
together even more harmoniously and the chroma<br />
in the intensive dentine and neck areas are even more<br />
intense. The soft nuances in the degrees of color<br />
saturation create an optimal chameleon effect, while the<br />
different degrees of fluorescence, more intense at the tooth<br />
neck than at the edge, perfectly reproduce a natural tooth.<br />
Affordable High Performance Implant<br />
Motor System<br />
The TriLuxe forte are particularly suitable for the fabrication of<br />
veneers, anterior and posterior crowns, and can also be<br />
used for inlays and onlays. The forte are<br />
available in three sizes: TF-12 (10 x 12 x 15<br />
mm), TF-14 (12 x 14 x 18 mm) and TF-14/14<br />
(14 x 14 x 18 mm) and can be used with both<br />
CEREC and inLab (Sirona <strong>Dental</strong> Systems).<br />
The material is distinctive due to its excellent<br />
machinability, both during the CAM machinegrinding<br />
process and during later hand grinding,<br />
which can be done gently and precisely in-situ with<br />
the usual instruments.<br />
Enquiry No. 06/05<br />
The AEU-7000-70V model<br />
by Aseptico is introduced to<br />
complement the AEU-7000<br />
series of implant motors.<br />
Offering high-end features at<br />
an affordable price, this new<br />
configuration includes the<br />
AE-70V Variable Speed Foot<br />
Control in the price of the<br />
motor.<br />
The AEU-7000-70V has a<br />
A Non-Compromising<br />
<strong>Dental</strong> Unit Enquiry No. 07/05<br />
Sinol S2318 dental unit from Northwest Medical is a leading<br />
Chinese brand that has not compromised on its standard and<br />
quality. In fact, it has passed the<br />
CE certification for its category.<br />
S2318 is manufactured with<br />
foreign technology and has<br />
three national patents. Its<br />
attractive design and clinic<br />
practicability conforms to<br />
modern oral development<br />
features. Clinically-required<br />
functions are fully embodied and<br />
future module upgrades are<br />
possible. The dental unit allows<br />
for easy-to-clean maintenance<br />
and the use of high temperature<br />
resistance material will minimize the chances of cross-infection.<br />
powerful 40,000 rpm and a brushless micro-motor. Its userfriendliness<br />
comes with a bright, easy-to-read display and an<br />
intuitive user interface. Its advanced calibration technology can<br />
automatically detect the handpiece reduction ratio and adjusts<br />
the motor to the unique properties of the contra angle at the<br />
time of treatment.<br />
The motor system also performs the complete implant<br />
procedure using a single, high-efficiency 20:1 reduction<br />
handpiece. AE-70V allows hands-free variable speed control,<br />
motor direction change, preset selection, pump activation, and<br />
torque adjustment.<br />
Lean but<br />
Efficient Enquiry No. 08/05<br />
Whip Mix Corp has introduced new LeanRock — a Type 4 diestone<br />
formulated specifically for laboratories who want to pour<br />
small batches (about 6 full arches) and have<br />
working models ready in 15 minutes.<br />
Small batch processing is<br />
based on lean principles<br />
to improve work flow and<br />
reduce wait time because<br />
models can be trimmed and<br />
pinned after only 15 minutes,<br />
decreasing downtime waiting for stone to set.<br />
The decreased processing time also speeds up remakes for<br />
those emergency repairs needed in a hurry. LeanRock is<br />
scannable for use with Cad Cam systems eliminating the need<br />
for specialty scan stone or spray.<br />
58<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008
PRODUCTUPDATE<br />
dentCeram LF Offers Multi-Application Enquiry No. 09/05<br />
The new dentCeram LF ceramic system from Dentaurum<br />
offers a large number of applications for everyday use in the<br />
laboratory. It is suitable for veneering precious metal alloys or<br />
of base metal alloys with high thermal expansion. The very<br />
good modelling properties of this ceramic facilitate rapid, simple<br />
and safe layering. The layering is very stable and thus it is<br />
possible to work quickly. The high stability of the ceramic acts<br />
positively during firing. With dentCeram LF the material does<br />
not run or become misshaped. Developed exclusively for<br />
shading the Dentaurum ceramic material, the thermal coloration<br />
method guarantees homogeneous and permanently stable<br />
shading, even after firing several times. This excellent firing and<br />
shade stability sets new standards.<br />
The product range of the dentCeram LF layering ceramics is<br />
rounded off perfectly with the<br />
new dentCeram LF press. It is a<br />
modern pressed ceramic on the<br />
basis of high purity technical<br />
raw materials. The pressed<br />
ceramic method for single tooth<br />
restorations is distinguished by<br />
easy processing as well as high<br />
stability of the esthetic<br />
substructure material.<br />
All system components of<br />
dentCeram LF have been<br />
matched perfectly to one another in development to guarantee<br />
the highest degree of safety.<br />
All-Round Protection Enquiry No. 10/05<br />
A modern casing with a large display and an upright synthetic<br />
bottle: that is what the new piezo smart ultrasound device by<br />
Mectron looks like. With its over 37<br />
different instruments, the piezo<br />
smart caters for all the traditional<br />
applications: scaling, perio, endo<br />
and restorative. The highlight,<br />
however, is the new non-spill bottle<br />
system.<br />
Mectron has designed the bottle in<br />
such a way that it remains upright<br />
and opens through the top. This<br />
means<br />
that the liquid cannot flow out. The<br />
path of the liquid is kept separate from the electrical<br />
components. The peristaltic pump is protected but accessible at<br />
all times, mounted on the bottom of the device. The fullyautomatic<br />
“Clean” function can by started by pressing a button,<br />
thus excluding any deposits in the circuit from the start.<br />
Control of the quantity of liquid is achieved by means of pushbuttons.<br />
The chosen quantity of liquid is shown on the large<br />
display. The display also indicates the selected ultrasound<br />
performance level.<br />
The feed-back system and the Automatic Protection Control<br />
(APC) function make sure of constant top performance. The<br />
built-in feedback system controls progress of the power level<br />
and adjusts it as needed in only a few hundredths of a<br />
second.<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008 59
PRODUCTUPDATE<br />
Painless in Seconds Enquiry No. 11/05<br />
QuickSleeper by <strong>Dental</strong> Hi Tec is designed to perform<br />
transcortical anesthesia as first-line treatment in the best<br />
possible conditions.<br />
It is ideal for alll types of anesthesia, including mandibular<br />
molars, incisor-canine blocks, single or multiple extractions,<br />
implantology work, etc. This work could be performed with just<br />
one single injection point, with no numbness of the lip, no lag<br />
time, no lingual or palatial injection, even for a single extraction<br />
and with 2 to 6 teeth anesthetized depending on the the<br />
quantity injected.<br />
The ‘pen grip’ handpiece of QuickSleeper is ergonomic in<br />
design where all the anesthesia are performed using support<br />
points for maximum precision.<br />
QuickSleeper features four programmed<br />
injection speeds and there is also a ‘Low’<br />
mode for sensitive cases, like anesthesia<br />
of the frenum or with children.<br />
For difficult injections, the exclusive<br />
‘PAR’ system (Permanent Analysis of<br />
Resistance) automatically adapts the<br />
power of the motor according to<br />
resistance to the injection. It ensures a<br />
regular injection, whatever the density of the tissue infiltrated,<br />
and eliminates cartridge breakages.<br />
Reliable Precision - Every Time Enquiry No. 12/05<br />
A putty version of Flexitime ® A-silicone precision impression<br />
material is now also available from Heraeus that is suitable for<br />
automatic mixing with the new Dynamix ® Machine. The<br />
kneadable, high viscosity impression material now comes in the<br />
new Dynamix ® Cartridge on the market under the name of<br />
Flexitime ® Dynamix ® Putty.<br />
Flexitime Dynamix Putty is effortlessly mixed at the press of a<br />
button in the Dynamix automatic mixing unit for impression<br />
materials. The homogeneous, void-free mixture ensures<br />
reliable, reproducible precision and accuracy of fit.<br />
Rapid mixing and precise dispensing also save<br />
time as well as material and ensure a consistent<br />
quality and technique.<br />
It can be easily moulded in the same way as a manually mixed<br />
putty, as it has a low sticky consistency. Automatic mixing also<br />
makes the problem of sulphur on the hands of the operator a<br />
thing of the past.<br />
The real putty consistency of Flexitime Dynamix Putty has a<br />
high compressive strength — an advantage for controlled<br />
intraoral insertion. The impression can be removed easily from<br />
the mouth without causing the patient any discomfort. The<br />
material is easily cut for the putty-/wash impression.<br />
As the pre-filled Dynamix Cartridge is ready-to-use, the material<br />
can be applied easily and quickly. A dynamic mixer, the<br />
Dynamix Mixing Tip, and a fixation ring ensure that the base<br />
and catalyst pastes are mixed to the same homogeneous<br />
quality. This guarantees thorough mixing and stability with all<br />
consistencies. The cartridge is made of an eco-friendly, singlecomponent<br />
material; it is recyclable and marked with a green<br />
point to signify suitability for the dual-disposal system. It<br />
replaces the previous Magnum 360 foil bag.<br />
Rapid Pre-Grinding by Preparation Enquiry No. 13/05<br />
GlaxoSmithKline has introduced<br />
Sensodyne PRONAMEL, a nonprescription<br />
toothpaste to target acid<br />
erosion of the the teeth effectively. It<br />
is formulated with the optimum level<br />
of fluoride content and the FDAapproved<br />
sensitivity ingredient,<br />
potassium nitrate (5%).<br />
As everyone with natural teeth is at risk of tooth wear caused by<br />
acid erosion — and this condition is<br />
prevalent among people of all age<br />
groups — Sensodyne PRONAMEL’s<br />
unique formula will help to strengthen<br />
acid-softened enamel and makes it more<br />
resistant to acid attack.<br />
PRONAMEL is pH neutral and its nonabrasive<br />
formula protects against further tooth wear during<br />
brushing, making it suitable for daily use.<br />
60<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008
PRODUCTUPDATE<br />
Optimal Tissue Management<br />
for Implants Enquiry No. 14/05<br />
Straumann Bone Level Implant combines proven design<br />
elements with innovative concepts to achieve predictable highly<br />
esthetic results. One<br />
novel design feature<br />
that helps to ensure<br />
successful soft tissue<br />
management is its<br />
concept of Consistent<br />
Emergence Profiles .<br />
This harmonizes the<br />
emergence profiles of<br />
the prosthetic<br />
components throughout<br />
the treatment process, in<br />
addition to facilitating the production of temporary and permanent<br />
restorations, as well as minimizing the risk of complications.<br />
All prosthetic components of the Bone Level Implant line have<br />
consistent emergence profiles: the healing abutment, the<br />
temporary abutment, and the final restoration abutments. As a<br />
result, the soft tissue is prepared optimally from the outset<br />
through to the final restoration. Components with consistent<br />
emergence profiles can be inserted without pinching or causing<br />
the patient pain.<br />
Cost-effective Arch<br />
Trimmers Enquiry No. 15/05<br />
Millo and Millo pro are the two new dental arch trimmers from<br />
Renfert. Unlike the usual method of trimming with the<br />
handpiece, the dental arch is firmly held in position and guided<br />
on the trimmer by both hands. The cutter’s conical shape (no<br />
undercuts) makes it easy to free the arch from the plaster base<br />
without damage. This makes for absolutely smooth surfaces,<br />
even gradients and tapers, and thus, spotless models.<br />
These compact machines even rationalise the workflow during<br />
model fabrication and allow clean and efficient<br />
handling. The arch trimmer allows the<br />
technician to work twice as fast compared<br />
with a handpiece. Also, considerable<br />
material is removed during arch trimming.<br />
Specially positioned extraction vents on<br />
the arch trimmer ensure the field of vision<br />
around the object remains free and the<br />
workspace clean. Both machines allow<br />
simple and fast cutter replacement by<br />
lifting the work table and using the onboard<br />
tool.<br />
<strong>Dental</strong> <strong>Asia</strong> • May / June 2008 61
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EVENTSCALENDAR<br />
2008<br />
6 - 10 May — Bangkok, Thailand<br />
30th <strong>Asia</strong> Pacific <strong>Dental</strong> Congress<br />
Contact: Secretariat Office, SLM<br />
Mgt Co. Ltd<br />
Tel: +66-2-748-7183<br />
Fax: +66-2-748-7050<br />
Email: apdc2008@gmail.com<br />
URL: www.apdc2008.com<br />
16 - 20 May — Denver, USA<br />
108th Annual AAO Session<br />
Contact: AAO Snr Mtg & Exh Mgr<br />
Tel: +1-314-993-1700<br />
Fax: +1-314-997-1745<br />
Email: info@aaortho.org<br />
URL: www.aaortho.org<br />
29 - 31 May — Montreux, Switzerland<br />
<strong>Dental</strong> 2008<br />
Contact: Ueli Breitschmid, Swiss<br />
<strong>Dental</strong> Events Ag<br />
Tel: +41-41-319-4585<br />
Fax: +41-41-319-4590<br />
Email: info@dental2008.ch<br />
URL: www.dental2008.ch<br />
5 - 8 June — Beijing, China<br />
Sino <strong>Dental</strong> 2008<br />
Contact: Ms Sunny Yin, Int’l Health<br />
Exchange & Coopn<br />
Tel: +86-10-8839-3922<br />
Fax: +86-10-8839-3924<br />
Email: yinhaiyan@ihecc.org<br />
URL: www.sinodent.com.cn<br />
10 - 14 June — Lisbon, Portugal<br />
84th Congress and Exhibition of the<br />
European Orthodontic Society 2008<br />
Contact: Congress Secretariat,<br />
AIMS Int’l Congress Svcs<br />
Tel: +351-21-324-5052<br />
Fax: +351-21-324-5051<br />
Email:<br />
eos2008@aims-international.com<br />
URL: www.eos2008.com<br />
26 - 28 June — Madrid, Spain<br />
European Academy of Esthetic Dentistry<br />
Congress 2008<br />
Contact: Ms Deborah Augenblick,<br />
EAED Secretariat<br />
Tel/Fax: +39-2-295-23627<br />
Email: info@eaed.org<br />
URL: www.eaed.org<br />
27 - 29 June — Seoul, Korea<br />
SIDEX 2008<br />
Contact: The Organizer, SIDEX<br />
Tel: +82-2-498-9142<br />
Fax: +82-2-498-9147<br />
Email: sda@sda.or.kr<br />
URL: www.sidex.or.kr<br />
2 - 5 July — Toronto, Canada<br />
86th IADR General Session<br />
Contact: The Secretary, IADR<br />
Secretariat<br />
Tel: +1-703-548-0066<br />
Fax: +1-703-548-1883<br />
Email: research@iadr.org<br />
URL: www.iadr.org<br />
17 - 19 July — Orlando, USA<br />
Academy of General Dentistry 2008<br />
Contact: Ms Marge Palonis, AGD<br />
Tel: +1-312-440-4358<br />
Fax: +1-312-440-0513<br />
Email: margery.palonis@agd.org<br />
URL: www.agd.org<br />
30 July - 2 August — Orlando, USA<br />
IACA International Congress 2008<br />
Contact: The organizer, IACA<br />
Tel: +1-866-669-4222<br />
Fax: +1-702-233-9200<br />
Email: info@theiaca.com<br />
URL: www.theiaca.com<br />
9 - 12 Sep — Moscow, Russia<br />
<strong>Dental</strong> Expo 2008<br />
Contact: Dmitry Makarov, <strong>Dental</strong><br />
Expo<br />
Tel: +7-495-155-7900<br />
Fax: +7-495-152-8549<br />
Email: makarov@dental-expo.ru<br />
URL: www.dental-expo.com<br />
24 - 27 Sep — Stockholm, Sweden<br />
FDI World <strong>Dental</strong> Congress 2008<br />
Contact: FDI World <strong>Dental</strong> Events<br />
Tel: +33-4-5040-5050<br />
Fax: +33-4-5040-5555<br />
Email: congress@fdiworldental.org<br />
URL: www.fdiworldental.org<br />
2 - 4 Oct — London, UK<br />
BDTA <strong>Dental</strong> Showcase 2008<br />
Contact: Ms Diana Keates, BDTA<br />
Tel: +44-1494-782873<br />
Fax: +44-1494-786659<br />
Email: dkeates@bdta.org.uk<br />
URL: www.dentalshowcase.com<br />
8 - 11 Oct — Milan, Italy<br />
36th International Expodental<br />
Contact: Melissa Dotto, Promunidi<br />
Tel: +39-02-700-6121<br />
Fax: +39-02-7000-6546<br />
Email: expodental@expodental.it<br />
URL: www.expodental.it<br />
11 - 14 Oct — Tianjin, China<br />
China <strong>Dental</strong> Int’l Exhibition 2008<br />
Contact: Mrs Kelly He, Beijing<br />
Globalstar & Exh Svcs<br />
Tel: +86-10-6216-4099<br />
Fax: +86-10-6216-4099<br />
Email: info@globalstar.org.cn<br />
URL: www.globalstar.org.cn<br />
16 - 19 Oct — San Antonia, USA<br />
ADA 2008<br />
Contact: ADA Exhibit Office, ADA<br />
Tel: +1-312-440-2876<br />
Fax: +1-312-4402707<br />
Email: annualsession@ada.org<br />
URL: www.ada.org<br />
62 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008
ADVERTISERS’INDEX<br />
COMPANY<br />
Page Number<br />
DENTAL HI TEC 03<br />
DMG 33<br />
4T TECHNOLOGIES 15<br />
HERAEUS KULZER 07<br />
HERAEUS KULZER 39<br />
GC ASIA DENTAL PTE LTD 05<br />
GC ASIA DENTAL PTE LTD 51<br />
IVOCLAR VIVADENT AG<br />
Back Cover<br />
KOHLER GmbH 27<br />
NOBEL BIOCARE<br />
Inside Front<br />
NTI-TSS 55<br />
PROMUNIDI 63<br />
REMEDENT ASIA 29<br />
ROLENCE ENTERPRISE INC 59<br />
SHOFU INC. 25<br />
SINO DENTAL 2008<br />
List of Advertisers<br />
Inside Back<br />
VOCO 35<br />
ZIMMER DENTAL 09<br />
Dear Readers,<br />
If you have any news that wish to share with<br />
us, or feature story that you would like to<br />
submit for publication, please forward them<br />
to the Editor: desmondteo@pabloasia.com.<br />
We also welcome comments/feedback/<br />
opinion about the magazine and/or any of<br />
the stories of featured within the issue.<br />
Publishing Office & Media Representatives<br />
Publishing Office<br />
Singapore<br />
Pablo Publishing Pte Ltd<br />
Block 16 Kallang Place #07-01<br />
Singapore 339156<br />
Tel: +65-6396-7877 Fax: +65-6396-7177<br />
Mr William Pang, Publisher<br />
Email: williampang@pabloasia.com<br />
Europe<br />
Pablo Germany<br />
Kilian-Spiegel-Strasse 6<br />
D-64720 Michelstadt<br />
Germany<br />
Tel: +49-6061-925100<br />
Fax: +49-6061-925101<br />
Mr Alistair Bryson, Executive Director<br />
Email: pablogermany@t-online.de<br />
China<br />
Pablo Shanghai<br />
Rm 404, No. 858, Panyu Road<br />
Shanghai, P.R. China<br />
PC: 200030<br />
Tel: +86-21-6283-1681 / 6281-1839<br />
Fax:+86-21-6283-1836<br />
Ms Kelly Shen, General Manager<br />
Email: pabloshanghai@tom.com<br />
Pablo Beijing<br />
Room 1811, Jinglong Mansion<br />
225 Chaoyang Bei Road, Chaoyang,<br />
Beijing, P.R. China<br />
PC: 100026<br />
Tel: +86-10-6509-7728 / 6509-7548<br />
Fax:+86-10-6509-7719<br />
Ms Ellen Gao, General Manager<br />
Email: pablochina@tom.com<br />
Media Representatives<br />
UK, Ireland & Israel<br />
Lansdowne Media Services — Ms Marika Cooper<br />
2 Claridge Court<br />
Lower Kings Road Berkhamsted, Herts HP4 2AF<br />
England<br />
Tel: +44-1442-87-7777<br />
Fax: +44-1442-87-0617<br />
Email: marikac@lansdowne-media.co.uk<br />
Japan<br />
Echo Japan Corp. — Mr Ted Asoshina<br />
Grande Maison Room 303<br />
2-2 Kudan-Kita, 1-Chome Chiyoda-ku,<br />
Tokyo 102-0073<br />
Japan<br />
Tel: +81-3-3263-5065<br />
Fax: +81-3-3234-2064<br />
Email: echoj@bonanet.or.jp<br />
Italy, France, Spain<br />
Rancati Advertising Srl. — Mr Claudio Sanfilippo<br />
Milano San Felice Torre 7<br />
20090 Segrate Italy<br />
Tel: +39-02-703-00088<br />
Fax: +39-02-703-00074<br />
E-mail: csanfilippo@rancatinet.it<br />
64 <strong>Dental</strong> <strong>Asia</strong> • May / June 2008