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Dental Asia January/February 2019

For more than two decades, Dental Asia is the premium journal in linking dental innovators and manufacturers to its rightful audience. We devote ourselves in showcasing the latest dental technology and share evidence-based clinical philosophies to serve as an educational platform to dental professionals. Our combined portfolio of print and digital media also allows us to reach a wider market and secure our position as the leading dental media in the Asia Pacific region while facilitating global interactions among our readers.

For more than two decades, Dental Asia is the premium journal in linking dental innovators
and manufacturers to its rightful audience. We devote ourselves in showcasing the latest dental technology and share evidence-based clinical philosophies to serve as an educational platform to dental professionals. Our combined portfolio of print and digital media also allows us to reach a wider market and secure our position as the leading dental media in the Asia Pacific region while facilitating global interactions among our readers.

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Under the Spotlight<br />

Dr. Vandana Katyal:<br />

An Exciting Age in Orthodontics<br />

Photo Courtesy of <strong>Dental</strong> Monitoring<br />

User Report<br />

COLTENE: Prefabricated Resin Veneer<br />

- A Case Report of a Simplified Restorative Technique<br />

Show Review<br />

exocad Insights 2018: A Global Community<br />

Discusses Digital Future with Open Systems<br />

JANUARY / FEBRUARY <strong>2019</strong><br />

www.dentalasia.net


CONTENTS<br />

JANUARY / FEBRUARY <strong>2019</strong><br />

DENTAL ASIA<br />

www.dentalasia.net<br />

18<br />

22<br />

26<br />

28<br />

32<br />

37<br />

40<br />

46<br />

50<br />

56<br />

64<br />

70<br />

72<br />

72<br />

04<br />

06<br />

66<br />

73<br />

76<br />

Under the Spotlight<br />

Dr. Vandana Katyal: An Exciting Age in Orthodontics<br />

<strong>Dental</strong> Management<br />

Dentist’s Role in the Management of Obstructive Sleep Apnoea<br />

Up Close & Personal<br />

Intego Pro Ambidextrous: Adding Flexibility and Comfort to the Practice<br />

<strong>Dental</strong> Profile<br />

Dr. Alexander Völcker: Integrating Digital Technology into Modern Dentistry<br />

Mr. Tillmann Steinbrecher and Mr. Novica Savic: Open Systems Are the Future of Digital Dentistry<br />

Clinical Feature<br />

A Literature Update on Nuvola Clear Aligners<br />

User Report<br />

COLTENE: Prefabricated Resin Veneer: A Case Report of a Simplified Restorative Technique<br />

Ivoclar Vivadent: Guided Concept in the Aesthetic Zone<br />

VOCO: Correction of Bite Height: Fully Digitalised Work Steps, Integration of the <strong>Dental</strong> Scanner,<br />

Smile Design and CAD/CAM<br />

Behind the Scenes<br />

Amann Girrbach: Logical, Feasible and Digital (Part II)<br />

In Depth With<br />

SINOL: Providing High Technology and Professional Service for a Better Life<br />

Show Review<br />

exocad Insights 2018: A Global Community Discusses Digital Future with Open Systems<br />

Giving Back to Society<br />

VOCO: The Reasonable Alternative to Christmas Gifts<br />

Amann Girrbach: Worldwide Aid for Children with Cleft Lip and Palate<br />

Regulars<br />

First Words<br />

<strong>Dental</strong> Updates<br />

Product Highlights<br />

Events Calendar<br />

Advertiser’s Index<br />

2<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


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First Words<br />

An Exciting <strong>2019</strong> Ahead<br />

I believe the start of each year marks the<br />

end of the past and signals new beginnings,<br />

allowing us another chance to reset and<br />

aim for personal growth. The same goes<br />

for the dental industry which connues to<br />

evolve, develop and expand year aer year.<br />

In the field of orthodoncs, for example,<br />

there are numerous techniques and<br />

appliances that are being innovated and<br />

introduced to praconers all year round.<br />

My interview with Dr. Vandana Katyal, a<br />

Sydney-based orthodontist, can help us<br />

understand her thoughts on upcoming<br />

digital trends and popular innovaons such<br />

as clear aligners and <strong>Dental</strong> Monitoring (DM)<br />

(pages 18-20). Addionally, Dr. Kevin Ng,<br />

one of <strong>Dental</strong> <strong>Asia</strong>’s Advisory Board<br />

members, also talked about the<br />

Nuvola clear aligner system which is<br />

considered a “Disruptive Innovation”<br />

product in the market (pages 37-39).<br />

Likewise, we have also seen many disrupve<br />

technologies in other fields of denstry<br />

that have helped confer many benefits to<br />

both users and praconers. For one, the<br />

Integro Pro Ambidextrous accommodates<br />

the unique needs of le-handed dental<br />

practitioners (pages 26-27). Also,<br />

Sirona CONNECT allows for the full<br />

integraon of CEREC into a dental pracce<br />

and dental laboratories as discussed by<br />

Dr. Alexander Völcker, Dentsply Sirona’s<br />

Group Vice President Digital (pages 28-30).<br />

Aside from Dentsply Sirona, exocad<br />

also made headlines with its first<br />

ever exocad Insights in Germany. We<br />

spoke to Mr. Tillmann Steinbrecher,<br />

Chief Execuve Officer, and Mr. Novica Savic,<br />

Chief Commercial Officer from exocad<br />

about the latest soware soluons and<br />

advantages of an open-architecture<br />

system (pages 26-27). The exocad Insights<br />

event turned out to be a success, fully<br />

supported by praconers and a number<br />

of the company’s leading partners<br />

(pages 70-71).<br />

2018 has been a wonderful year for<br />

<strong>Dental</strong> <strong>Asia</strong> and we are expecng <strong>2019</strong><br />

to be even more exciting with<br />

IDS (International <strong>Dental</strong> Show), the<br />

world’s biggest dental show happening<br />

in March, and other upcoming events<br />

in the region (page 73). Finally, we<br />

want to wish all our readers a very<br />

Happy New Year!<br />

Dr. Chala R. Platon<br />

Assistant Editor<br />

FOLLOW US<br />

@dentalasia<br />

ADVISORY BOARD<br />

Dr William Cheung<br />

Dr Choo Teck Chuan<br />

Dr Chung Kong Mun<br />

Dr George Freedman<br />

Dr Fay Goldstep<br />

Prof Urban Hägg<br />

Prof Nigel M. King<br />

Dr Ramonito Rafols Lee<br />

Dr Kevin Ng<br />

Dr William O’Reilly<br />

Dr Ryan Seto<br />

Dr Adrian U J Yap<br />

Dr Christopher Ho<br />

Dr How Kim Chuan<br />

Dr Derek Mahony<br />

Prof Alex Mersel


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The implications from improperly<br />

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Research shows that the extremely narrow<br />

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which can impact the well-being of your<br />

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© 2018 Crosstex International, Inc. 0818 DADV00298<br />

All claims made based on use with potable water.<br />

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1<br />

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All product names are trademarks of Crosstex International, Inc., a Cantel Medical company,<br />

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crosstex.com


<strong>Dental</strong> Updates<br />

Dentsply Sirona Opens New Centre of Dentistry in Hong Kong<br />

APAC Centre for Dentistry in Hong Kong<br />

On the 5 th December 2018, Dentsply Sirona<br />

opened its doors to celebrate the newly<br />

opened, state-of-the-art Dentsply Sirona<br />

APAC showroom and training centre in<br />

Kowloon Bay, Hong Kong.<br />

On more than 430 square meters,<br />

Dentsply Sirona displays dental solutions,<br />

from equipment to consumables with a<br />

dedicated training centre for lectures and<br />

hands-on courses for dental professionals<br />

to gather and learn more about current<br />

and future technologies. The new<br />

training facility can accommodate up to<br />

100 guests in a lecture set up and 45<br />

participants for hands-on sessions.<br />

Greater focus on advancing<br />

dental care in <strong>Asia</strong> Pacific<br />

With the recent opening of the<br />

advanced training centres in<br />

Hong Kong and Singapore and<br />

more to follow in Malaysia<br />

and Indonesia in early <strong>2019</strong>,<br />

Dentsply Sirona shows its investment<br />

and focus on advancing dental care<br />

in <strong>Asia</strong> Pacific. Mr. Henning Mueller,<br />

Group Vice President RCO <strong>Asia</strong> Pacific<br />

at Dentsply Sirona explained during<br />

his opening speech, “With the merger<br />

two years ago, two power houses<br />

came together. While this might<br />

be challenging, it also gives us the<br />

fantastic opportunity of offering<br />

full-fledged solutions to dental<br />

professionals with the vision to assist<br />

in providing better, safer and faster<br />

dental care.”<br />

Furthermore, the official opening<br />

speeches were followed by the ribbon<br />

cutting ceremony and the evening was<br />

accompanied with classical music by<br />

Hong Kong Amateur Orchestra.<br />

Excited guests<br />

Dr. Yeung Ka Chun said, “It’s a nice<br />

and well equipped training centre for<br />

dentistry. I am looking forward to working<br />

with Dentsly Sirona in the near future.”<br />

Dr. Tse Tak On believes that Dentsply Sirona<br />

will enable dental professionals to advance<br />

to next level with the clinical education<br />

provided in Dentsply Sirona’s new training<br />

centre.<br />

Local dental professionals can look forward<br />

to a variety of clinical and technical<br />

continuing education curriculums, including<br />

hands-on teaching, live lectures, taught by<br />

internationally-known experts in all fields of<br />

dentistry, Dentsply Sirona is committed to<br />

empowering dental professionals through<br />

innovation and education. ■<br />

DenMat Holdings, LCC Named 2018<br />

EconAllicance Award Recipient<br />

DenMat Holdings, LLC (DenMat) was<br />

named a 2018 EconAlliance Award<br />

Winner on 8 th November 2018, at an<br />

annual forum hosted by the Economic<br />

Alliance of Northern Santa Barbara<br />

County (“EconAlliance”). A nonprofit<br />

organisation in Central California,<br />

EconAlliance comprises economic<br />

and community leaders interested in<br />

increasing family-wage jobs driven by<br />

innovation and support of key growth<br />

industry sectors in the region.<br />

This mission is accomplished<br />

through collaboration and<br />

utilisation of regional assets that<br />

cumulatively enhance economic<br />

development efforts within Santa<br />

Barbara County.<br />

“We are thrilled to receive the EconAlliance<br />

award and honoured to be recognised as<br />

a leading innovator in Santa Barbara<br />

County,” shares Mr. David Casper, Chief<br />

Executive Officer, DenMat.<br />

DenMat, through its innovative Additive-<br />

Reductive Template (A.R.T.) protocol,<br />

provides its dentist customers the ability<br />

to perform dentistry using a template<br />

that eliminates guesswork and increases<br />

quality. Dentists purchasing Lumineers<br />

minimal-prep veneers for their patients<br />

seeking a smile makeover most commonly<br />

prescribe A.R.T. This state-of-the-art<br />

template may be placed over the patient’s<br />

existing smile and provides dentists a<br />

step-by-step guide for tooth preparation,<br />

as well as other notable benefits.<br />

EconAlliance, during the award<br />

presentation, called DenMat’s A.R.T.<br />

innovation a testament to the forwardthinking<br />

approach of DenMat’s leadership<br />

and management teams. Furthermore, it<br />

was noted that such services demonstrate<br />

a commitment to improving business<br />

processes for customer retention. ■<br />

6<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>Dental</strong> Updates<br />

3Shape Trios Now Integrated with 3M and Clarity Aligners<br />

3Shape TRIOS ® users can now submit their<br />

digital scans to the 3M Oral Care Portal<br />

for treatment planning and delivery of<br />

Clarity Aligners.<br />

The portal integration enables professionals<br />

to cloud-send their 3Shape TRIOS intraoral<br />

scans with just a click to the Oral Care Portal.<br />

Clarity Aligners join the more than 50<br />

orthodontic treatment solutions, sleep device<br />

providers, and 500 plus bracket libraries<br />

integrated with the 3Shape TRIOS intraoral<br />

scanner.<br />

“3Shape is focused on providing professionals<br />

with open options and superior treatment<br />

solutions for their patients. The seamless<br />

connection to 3M’s Clarity Aligners makes a<br />

terrific addition to the 3Shape TRIOS intraoral<br />

scanner and is a testament to the strong<br />

partnership between 3M and 3Shape,” says<br />

Mr. Allan Junge Hyldal, Vice President of<br />

3Shape Orthodontics.<br />

“We’re excited to offer this new integration<br />

with 3Shape as part of advancing the Oral<br />

Care Portal,” says Ms. Beth Edgar, Custom<br />

Orthodontics Business Director of 3M.<br />

“Having a process to easily upload and<br />

transfer files eliminates manual steps and<br />

enables the office to complete their order for<br />

Clarity Aligners in a streamlined manner.”<br />

Before sending 3Shape TRIOS intraoral<br />

scans to 3M for Clarity Aligner production,<br />

professionals can take advantage of the<br />

3Shape TRIOS Treatment Simulator app<br />

to first excite their patients and promote<br />

acceptance of the proposed treatment. Using<br />

the app, professionals can show onscreen<br />

the envisioned results of the orthodontic<br />

treatment. Furthermore, 3M’s portal is webbased,<br />

HIPAA compliant, easily accessible<br />

from anywhere, and supports treatment<br />

for aligners, combination treatment, and<br />

retainers. ■<br />

IDEC Returns for Second Edition in <strong>2019</strong><br />

After a successful launch in 2017,<br />

the Indonesian <strong>Dental</strong> Exhibition and<br />

Conference (IDEC) will return from<br />

13 th – 15 th September <strong>2019</strong> to help<br />

improve <strong>Dental</strong> Health Standards in<br />

Indonesia through Scientific Education<br />

Seminars for dental professionals and<br />

an Exhibition with the latest products,<br />

services and solutions from international<br />

manufacturer, distributors and traders.<br />

Co-organised by the Indonesian <strong>Dental</strong><br />

Association (PDGI) and Koelnmesse<br />

Pte Ltd/Traya Eksibisi Internasional, the<br />

Indonesia <strong>Dental</strong> Exhibition & Conference<br />

(IDEC) <strong>2019</strong> will be conducted at<br />

Jakarta Convention Center<br />

(JCC), Jakarta, from 13 th – 15 th<br />

September <strong>2019</strong>. The first<br />

edition of the show successfully<br />

delivered a central networking<br />

platform for the Indonesian<br />

dental industry. There will be 229<br />

exhibiting brands, five national<br />

pavilions from 13 countries and<br />

4,015 visitors from 30 countries<br />

participated in the very first IDEC.<br />

Following in its footsteps, the second<br />

edition of IDEC aims to once again be the<br />

must-attend dental event for Indonesian<br />

dental practitioners.<br />

IDEC <strong>2019</strong> will occupy an expanded<br />

exhibition area of more than 7,000 sqm<br />

and will showcase a variety of exhibitors<br />

from dental materials, furnishing and<br />

equipment for dental practice and<br />

dental laboratory, infection control and<br />

maintenance, dental instruments and<br />

tools, and other accessories and auxiliary<br />

materials for dental practice use.<br />

“As the fourth most populous country<br />

in the world, Indonesia is a market of<br />

interest for many dental companies from<br />

across the globe. This was reflected in the<br />

strong international support we received<br />

at the previous edition of IDEC with five<br />

international pavilions having participated<br />

from Germany, Italy, Switzerland,<br />

South Korea and China. For this<br />

edition, we have already secured two<br />

new national pavilions; Japan and the<br />

United States of America. In addition, we<br />

hope to have exhibitors from a total of 15<br />

countries participating in IDEC <strong>2019</strong>,”<br />

said Mr. Mathias Kuepper, Managing<br />

Director, Koelnmesse Pte Ltd.<br />

“IDEC aims to be the must-attend dental<br />

event in Indonesia for every dental<br />

professional. With relevant scientific<br />

content at the conference and the latest<br />

technologies, services and solutions on<br />

display at the exhibition, visiting IDEC<br />

will help every dentist stay up to date<br />

with the ever-changing dental industry,”<br />

said Dr. drg. Hananto Seno, Sp.BM, MM,<br />

Chairperson, PDGI. ■<br />

8<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>Dental</strong> Updates<br />

Straumann Group Set to Enter Clear Aligner Market in China<br />

The Straumann Group has accelerated<br />

its strategy to enter the world’s<br />

second largest market for orthodontic<br />

clear aligners by partnering with<br />

Tianjin ZhengLi Technology Company<br />

Limited (ZhengLi Technology), whose<br />

clear-aligner system has regulatory<br />

approval in China. Straumann has<br />

obtained exclusive distribution rights in<br />

China for their aligners and will leverage<br />

its strong marketing, training, distribution<br />

and service capabilities to penetrate the<br />

highly attractive market. The two partners<br />

will collaborate to develop enhanced<br />

solutions in aesthetic dentistry.<br />

“The need for orthodontic treatment in<br />

China is huge and ZhengLi Technology<br />

provides us with convenient, affordable,<br />

high-quality, state-of-the-art<br />

clear-aligner solutions that we can<br />

commercialise immediately. We have<br />

the sales and logistics network to reach<br />

customers across the country, as well as<br />

the organisation and infrastructure to<br />

provide training, education and customer<br />

service. Straumann also offers digital<br />

solutions, including intraoral scanning,<br />

3D printing, and milling options to support<br />

dentists offering aligner, restorative and<br />

replacement procedures. With this and<br />

our in-house expertise in clear aligners<br />

we are in a great position to penetrate<br />

and expand the market successfully”,<br />

explained Mr. Patrick Loh, Head of the<br />

Straumann Group’s <strong>Asia</strong> Pacific Region.<br />

Straumann’s dynamic clear aligner<br />

business<br />

The Group entered the clear aligner<br />

business in 2017 by acquiring<br />

ClearCorrect in the US. With international<br />

expansion as a key priority, it is<br />

launching ClearCorrect in<br />

Brazil and recently signed<br />

an agreement to supply<br />

one of the largest dental<br />

service organisations in<br />

Spain. Other countries<br />

will follow, pending<br />

regulatory approvals<br />

where applicable.<br />

Apart from this, the Group has also<br />

partnered with <strong>Dental</strong> Monitoring to offer<br />

dentists and their patients a convenient<br />

smart-phone application for monitoring<br />

aligner treatment progress without<br />

visiting the practice. This service is<br />

expected to launch in China this year. ■<br />

Oxyfresh and Benco <strong>Dental</strong> Announce Strategic Partnership<br />

Oxyfresh, the leading provider of naturally<br />

safe and environmentally-friendly<br />

products for people and pets, announced<br />

on 19 th December their partnership with<br />

Benco <strong>Dental</strong> to expand their distribution<br />

in the United States.<br />

Oxyfresh is known for modernising the<br />

way dental patients approach at-home<br />

oral care. Loved by dentists, their unique,<br />

patented formulas are clinically-proven<br />

and free of alcohol, dyes and artificial<br />

flavors. Oxyfresh dental products stand<br />

alone and feature Oxygene ® , a safe<br />

yet powerful ingredient that gently<br />

neutralises the cellular debris and organic<br />

compounds that cause bad breath and<br />

contribute to an unhealthy smile.<br />

“Benco is excited to partner with Oxyfresh<br />

and offer their patented, safe and effective<br />

formulas with Oxygene and zinc to our<br />

dental offices for their patients,” shared<br />

Ms. Colette Wintersteen, Product Manager<br />

at BENCO <strong>Dental</strong>.<br />

Over the past decade, Benco <strong>Dental</strong> has<br />

been the nation’s fastest growing dental<br />

distributor, now servicing more than<br />

35,000 dentists and dental laboratories.<br />

It is also the largest privately-owned<br />

dental distribution company in the<br />

United States, offering a full array of<br />

supplies, equipment and services to<br />

dentists across the nation.<br />

“We are incredibly excited with this<br />

new partnership. We are bringing two<br />

best-in-class companies together<br />

to uniquely solve oral health issues<br />

in innovative ways,” explained<br />

Mr. Mariano Tellarini, President of<br />

Oxyfresh. “Today’s announcement<br />

with industry leader Benco <strong>Dental</strong> is<br />

continuing to fulfill our mission of<br />

delivering high quality dental products<br />

to professionals and consumers. This<br />

partnership will help us build our vast<br />

network of dental professionals and<br />

further their efforts with our innovative<br />

dental care line.”<br />

For 35 years, Oxyfresh has established<br />

a reputation and loyal brand following<br />

in the dental industry. Expanding the<br />

availability of their products through key<br />

dental distributors is the company’s long<br />

term plan. ■<br />

10<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>Dental</strong> Updates<br />

Roland DGA Corporation Appoints Mr. Andrew Oransky as CEO<br />

Roland DGA, a provider of digital imaging<br />

and 3D devices for professionals, announced<br />

on 4 th <strong>January</strong> that Mr. Andrew Oransky<br />

has been appointed the company’s new<br />

CEO. Mr. Oransky has served as president,<br />

responsible for day-to-day operations at<br />

the Irvine, California-based company since<br />

2016. In his expanded role as CEO, he will<br />

assume overall responsibility for company<br />

strategy and performance and will report<br />

directly to the board of directors at parent<br />

company Roland DG.<br />

“All of us at Roland have great confidence<br />

in Andrew’s excellent leadership qualities<br />

as well as his extensive knowledge across<br />

the multiple industries we serve,” said<br />

Mr. David Goward, previously CEO of<br />

Roland DGA and currently Executive<br />

Vice President, Director at Roland DG.<br />

“Under his capable guidance and with the<br />

cooperation of the rest of the leadership<br />

team, we expect continued growth and<br />

success in the years to come.”<br />

Mr. Oransky assumes the CEO position<br />

during an exciting time for Roland. During<br />

the past year, the company’s DGSHAPE<br />

3D division launched several advanced<br />

technology milling machines for dental<br />

labs plus a laser decorator for retail<br />

settings. In addition, the company’s inkjet<br />

printing division recently won several<br />

notable awards, including top honours from<br />

Buyers Lab for its TrueVIS VG printer/<br />

cutters and two SGIA Product of the Year<br />

Awards for its VersaUV ® LEC-540 wide<br />

format printer/cutter and ECO-UV inks. ■<br />

70 Years of Innovation<br />

70 years of practical innovations from<br />

dentists for dentists and deliveries to<br />

more than 100 countries confirm the<br />

success of the manufacturer of dental<br />

instruments.<br />

In 1948, the dentist Dr. Julius Walser,<br />

born in December 1894, founded the<br />

“Dr. J. Walser <strong>Dental</strong>fabrikation” in the<br />

Fürstenbergstraße in Radolfzell. Already in<br />

1938, the founder Dr. Julius Walser owned<br />

the first telephone in Radolfzell with the<br />

short number “300.” This telephone was<br />

an important means of communication,<br />

also for the citizens of Radolfzell.<br />

The first participation at dental exhibitions<br />

already took place in 1948 in Munich.<br />

In 1960 the company moved to the<br />

Teggingerstaße. In 1978 the company<br />

was rebranded “Dr. Walser <strong>Dental</strong> GmbH.”<br />

Sen. Gerhard R. Daiger took over the<br />

entire company in 1999 and since then<br />

has been managing director of<br />

Dr. Walser <strong>Dental</strong>. This was the first<br />

time in 51 years in the company’s<br />

history that the company was not run<br />

by a family member. In the same year,<br />

the company moved to the industrial<br />

area North in Radolfzell.<br />

Since its takeover in 1999 by<br />

Senator Gerhard R. Daiger,<br />

Dr. Walser <strong>Dental</strong> has been able to<br />

significantly expand its internationality<br />

and win new customers in an additional<br />

87 countries. The complaints rate has<br />

been virtually zero for 20 years and since<br />

2006 the company has been honoured<br />

with more than 60 awards. Especially<br />

because of its high product quality and<br />

fast delivery time, the company enjoys an<br />

excellent reputation worldwide.<br />

Today, the medical device manufacturer<br />

participates as an exhibitor at all major<br />

dental fairs worldwide. For example,<br />

in New York, Dubai, Hawaii, Singapore<br />

etc. as well as at all dental fairs in<br />

Germany.<br />

L-R: The management team of Dr. Walser<br />

<strong>Dental</strong>, f.l.t.r. Senator h.c. Gerhard R. Daiger MD,<br />

Beate Daiger, Dr. Uwe Böhm MD Business Unit<br />

International IHK Schopfheim, Katja Wieczorek Training<br />

Officer and Account Manager at Dr. Walser <strong>Dental</strong>.<br />

Numerous inventions of dental<br />

instruments, all patented, facilitate the<br />

dentist’s work worldwide, helping him to<br />

save time and money.<br />

On the occasion of the company’s<br />

anniversary Dr. Walser <strong>Dental</strong> is doing<br />

without a big celebration with many guests<br />

from business and politics. Instead, we<br />

will soon donate to the poorest in Africa<br />

and report back. ■<br />

12<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>Dental</strong> Updates<br />

Nobel Biocare Expands Global Symposium into Larger Global Symposia Series<br />

Nobel Biocare announced that it<br />

will expand its signature event, the<br />

Nobel Biocare Global Symposium,<br />

into a series of symposia around<br />

the globe to bring the next wave of<br />

groundbreaking innovation to more<br />

dental professionals worldwide.<br />

The larger Nobel Biocare Global<br />

Symposia event series will span<br />

from <strong>2019</strong> to 2021 and take place<br />

in Europe, North America and <strong>Asia</strong>.<br />

The originally scheduled Global Symposium<br />

will still take place in June of <strong>2019</strong>, however,<br />

instead of the previously announced,<br />

Las Vegas, the first stop will be changed<br />

to Europe where the initial wave of gamechanging<br />

solutions from Nobel Biocare will<br />

be available first.<br />

The Global Symposium in Las Vegas will<br />

be held in April 2020, followed by another<br />

Global Symposium in <strong>Asia</strong> during 2021.<br />

The enhanced event strategy follows the<br />

tremendously positive feedback received<br />

from clinicians involved in the early stages<br />

of the groundbreaking solutions to come.<br />

Having a full series of global symposia<br />

provides an optimal platform to effectively<br />

reach and train dental professionals<br />

around the world.<br />

Participants at the symposia will be<br />

the first in their regions to discover<br />

original solutions ranging from redefined<br />

surface science, revolutionary implant<br />

design and site-preparation techniques<br />

to implant care and digital solutions<br />

designed to further enhance the patient<br />

treatment journey. The new innovations<br />

will be onsite for attendees to experience<br />

through in-depth demonstrations as<br />

well as new state-of-the-art training and<br />

educational activities.<br />

Mr. Hans Geiselhöringer, President of<br />

Nobel Biocare said: “A larger Nobel Biocare<br />

Global Symposia event series will help<br />

us better leverage the enthusiasm and<br />

anticipation already being generated<br />

around our upcoming new breakthrough<br />

innovations. With exciting new symposia to<br />

be held in Europe, North America and <strong>Asia</strong>,<br />

more dental professionals than ever will<br />

be able to take part in what will mark a<br />

real turning point in implant treatment<br />

care.”<br />

Dates and locations for the event series<br />

will be available soon. ■<br />

GC Ranked 2 nd in the 10 th Quality Management Level Research 2018<br />

GC America is pleased to announce the<br />

results of the 10 th Quality Management<br />

Level Research in 2018 conducted<br />

by the Union of Japanese Scientists<br />

and Engineers (JUSE). GC Corporation<br />

(the parent company of GC America)<br />

was highly evaluated and ranked second.<br />

GC is proud to be the only company<br />

ranked in the top 10 five times in a<br />

row, including a first-place ranking<br />

in 2016 and second-place ranking<br />

in 2014.<br />

According to the newspaper “The<br />

Nikkei Sangyo”, the reasons GC earned<br />

a high evaluation were that: GC set<br />

long-term targets to evaluate its<br />

corporate quality, introduced a<br />

system to certify Global GQM (GC’s<br />

Quality Management) Promoters, and<br />

conducted Global Customer Satisfaction<br />

Survey. These efforts are highly evaluated as<br />

a basis for the corporate quality. In the<br />

six major categories listed below,<br />

GC received the following high<br />

evaluations:<br />

• Commitment of Top Management (2 nd )<br />

• Dissemination of Quality Management (1 st )<br />

• Cultivation of human resources for<br />

realisation of quality management (3 rd )<br />

• Establishment and thorough implementation<br />

of a process (8 th )<br />

• Creation of customer value (3 rd )<br />

• Collaboration capability among<br />

departments (5 th )<br />

GC received the “Deming Application Prize”<br />

(current Deming Prize) in 2000 and<br />

the “Japan Quality Medal” (current<br />

Deming Grand Prize), the highest<br />

honour of Japan’s Total Quality<br />

Management (TQM), in 2004. Other<br />

GC companies have earned TQM<br />

awards in years past, including<br />

GC America Inc., which received<br />

the Deming Prize in 2014.<br />

Chairman Makoto Nakao received<br />

the Deming Prize for Individuals in<br />

2012 for spearheading GC Group’s<br />

efforts for promotion of TQM and<br />

building it into a global company over<br />

thirty years. Furthermore, Chairman<br />

Nakao received the “Marcos E.J. Bertin<br />

Quality in Governance Medal” from<br />

the International Academy for Quality<br />

(IAQ) in 2016. ■<br />

14<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>Dental</strong> Updates<br />

Henry Schein and International College of Dentists Partner with Fleur de Vie<br />

Henry Schein and the International College<br />

of Dentists’ (ICD) Global Visionary Fund<br />

(GVF) have once again joined together<br />

to support the oral health of children.<br />

This time, products were donated to<br />

the Fleur de Vie’s health awareness<br />

and education initiative during their<br />

back to school program. From<br />

September to December 2018, more<br />

than 400 grammar school age children<br />

attended a one-day program and<br />

took part in health education,<br />

physical fitness, and recreational<br />

activities.<br />

During the day, the pupils received<br />

school supplies for the year as well<br />

as new tooth brushes and tooth<br />

paste. Information in French and<br />

Haitian Creole was also<br />

provided for parents to further<br />

encourage them to teach their<br />

children proper oral health practices.<br />

As part of this program,<br />

the children also received<br />

oral health screenings and education<br />

on how to properly use their new<br />

tooth brushes and how to floss by<br />

local dentist and faculty member<br />

of the Faculté d’Odontologie de<br />

l’Université d’État-d’Hite (<strong>Dental</strong><br />

Faculty of the State University of Haiti),<br />

Dr. Mario Sajous. This oral care<br />

promotion i s a n ongoing project<br />

that will continue in <strong>2019</strong>.<br />

Henry Schein’s product donation is an<br />

initiative of Henry Schein Cares, the company’s<br />

global corporate social responsibility<br />

program. Health care activities supported<br />

by Henry Schein Cares focus<br />

on three main areas: advancing<br />

wellness, building capacity in the<br />

delivery of health care services, and<br />

assisting in emergency preparedness<br />

and relief. The support for<br />

Fleur de Vie is part of Henry Schein Cares’<br />

long-term partnership with the ICD<br />

Global Visionary Fund. ■<br />

exocad settles Software Piracy and DMCA Infringement Lawsuit<br />

exocad has announced that it<br />

has settled a software piracy<br />

and Digital Millennium Copyright<br />

Act (DMCA) infringement lawsuit<br />

with one of its former customers,<br />

a USA-based dental lab.<br />

The USA-based customer had<br />

purchased a ‘cracked’ version of<br />

exocad <strong>Dental</strong>CAD software from a<br />

website offering counterfeit<br />

exocad software, which came to the attention<br />

of exocad’s License Compliance team.<br />

As part of the settlement, the former<br />

customer will pay exocad the sum<br />

of US $220,000.00 in damages.<br />

“We closely monitor usage of pirated exocad<br />

software,” said Tillmann Steinbrecher,<br />

CEO of exocad. “To enforce our<br />

zero-tolerance policy, we are starting<br />

to take legal action. We strongly<br />

suggest that all users of pirated<br />

exocad software replace their installations<br />

with legitimate licenses, instead of<br />

putting their businesses at risk.” ■<br />

<strong>Dental</strong>EZ to Acquire Forest <strong>Dental</strong><br />

<strong>Dental</strong>EZ<br />

announced the<br />

acquisition of<br />

Forest <strong>Dental</strong>,<br />

a 45-year-old<br />

manufacturer<br />

of dental<br />

operatory equipment. Located in<br />

Hillsboro Oregon, Forest is known<br />

for its highly reliable yet simple technology.<br />

The acquisition of Forest <strong>Dental</strong> gives<br />

<strong>Dental</strong>EZ an exciting new addition to a<br />

diverse and growing portfolio of dental<br />

products.<br />

“We’re in a time when practices<br />

recognise the importance of elevating<br />

and enhancing the patient experience,”<br />

said Ms. Heather Trombley, President<br />

and COO of <strong>Dental</strong>EZ. “Forest <strong>Dental</strong><br />

uses beautifully crafted design to create<br />

a fun factor for both the patient and the<br />

staff. But the brilliance of their design<br />

extends well beyond the aesthetic. Their<br />

products embody the design idea of<br />

simplicity, no more or less than exactly<br />

what the customer needs.”<br />

The acquisition of Forest <strong>Dental</strong> allows<br />

<strong>Dental</strong>EZ to continue with its new<br />

long-term strategic goals. The<br />

complementary product offering extends the<br />

<strong>Dental</strong>EZ reach across a variety of customer<br />

segments. In addition, the companies will be<br />

able to leverage the benefits of shared supply<br />

chains and operational functions.<br />

Current Forest customers will have the<br />

benefit of availing themselves to the<br />

more diverse line of products available<br />

from <strong>Dental</strong>EZ. Plus, the two entities<br />

will be able to utilise a single sales<br />

team, Professional Sales Associates,<br />

that is already familiar with Forest <strong>Dental</strong><br />

Products.<br />

The Forest <strong>Dental</strong> brand will continue<br />

as part of the <strong>Dental</strong>EZ portfolio of<br />

products, and the company will go to<br />

market as Forest <strong>Dental</strong> Equipment.<br />

The current Forest <strong>Dental</strong> leadership<br />

team will remain in place in Hillsboro,<br />

OR, including Mr. Hank Barton who<br />

bought Forest <strong>Dental</strong> in 2004. ■<br />

16<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


Under the Spotlight<br />

An Exciting Age<br />

in Orthodontics<br />

Interviewed by Dr. Chala R. Platon<br />

With the advent of<br />

innovative techniques<br />

and appliances aided by<br />

progressive technologies,<br />

the field of orthodontics in<br />

particular is an interesting one to watch.<br />

Sydney-based orthodontist specialist,<br />

Dr. Vandana Katyal will agree heartily,<br />

having spent many years researching on<br />

oral appliances alongside delivering the<br />

latest, most efficient and most comfortable<br />

invisible dental orthodontic treatments.<br />

Besides being a specialist orthodontist,<br />

Dr. Katyal is also entrepreneur (or a<br />

‘dentaprenuer’ as she calls herself) who<br />

founded Best Orthodontic Seminars &<br />

Sessions (BOSS), which aims to help dental<br />

practitioners develop the best evidencebased<br />

orthodontic treatment goals and<br />

more.<br />

As head lecturer at BOSS coupled<br />

with many research achievements in<br />

the field, Dr. Katyal’s knowledge and<br />

experience in orthodontics is unparalleled.<br />

<strong>Dental</strong> <strong>Asia</strong> sat down with her<br />

to find out more about her<br />

journey into orthodontics and<br />

her thoughts on upcoming digital<br />

trends and popular innovations<br />

such as clear aligners.<br />

Kindly walk us through<br />

your beginnings as a dental<br />

professional.<br />

I graduated from Sydney<br />

University with my Bachelor of<br />

<strong>Dental</strong> Surgery in 2001. Since<br />

then, I’ve been in dental practice,<br />

finally choosing to specialise as<br />

an orthodontist in 2013. I also<br />

hold a Master of Science in Clinical<br />

Epidemiology – which is all about<br />

the study and clinical research<br />

on the incidence and prevalence<br />

of a disease – and I am currently about<br />

to finish my Master’s degree in Business<br />

Administration in <strong>February</strong> <strong>2019</strong> from one<br />

of Australia’s most innovative business<br />

schools.<br />

I also lecture for Best Orthodontic<br />

Seminars & Sessions (BOSS), a<br />

company which I founded, teaching<br />

dentists and orthodontists the future<br />

of orthodontics while maintaining<br />

my clinical orthodontic practice in<br />

Sydney, Australia.<br />

What influenced you to specialise<br />

in the field of orthodontics?<br />

I enjoy creating smiles and have<br />

always been fascinated by the<br />

influence of science and art in<br />

dentistry which can change lives!<br />

For me, there is no speciality other<br />

than orthodontics wherein the<br />

artistic elements are combined<br />

with science and evidence-based<br />

research. Orthodontics was just a<br />

natural decision and path to take as I am<br />

very passionate about straightening teeth,<br />

improving function and giving people<br />

beautiful smiles. For me, orthodontics is<br />

a more natural way of giving patients the<br />

most natural smile without having to use<br />

crowns or veneers.<br />

Presently, there are numerous<br />

innovations and advancements in<br />

orthodontics such as clear aligners.<br />

What are your views on this?<br />

I think we are in a very exciting age in<br />

orthodontics – never before has there<br />

been the ability to create an individualised<br />

appliance for each patient. For the very first<br />

time, we have a customisable appliance<br />

that is not only comfortable for patients<br />

but also suits the various lifestyles of<br />

teen and adult patients. The clear aligner<br />

is a revolutionary innovation that has<br />

dramatically changed the face of the<br />

industry.<br />

As expected, there are advantages and<br />

disadvantages to consider when choosing<br />

between fixed traditional appliances and<br />

clear aligners. However, in the hands of<br />

an experienced orthodontist, both<br />

appliances are equally as effective<br />

and efficient in achieving the best results<br />

in straightening teeth.<br />

18<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


Under the Spotlight<br />

What are the advantages and indications<br />

of using clear aligners?<br />

Currently, there are a lot of evidencebased<br />

studies and research that can help<br />

us better understand how clear aligners<br />

work. Let us look at the benefits of clear<br />

aligners for patients. Firstly, the pain level<br />

is reduced. There is no doubt that all<br />

studies show proof that clear aligners are<br />

more comfortable, less painful and have<br />

a positive effect on the patient’s quality<br />

of life. Secondly, the gingival health or<br />

periodontal health are improved especially<br />

for patients who are predisposed or often<br />

have periodontal disease/problems.<br />

Thirdly, there is less enamel damage on<br />

the teeth as there are no brackets or<br />

molar bands attached to tooth structure,<br />

resulting in reduced enamel decalcification.<br />

Aside from all these benefits, the invisibility<br />

of clear aligners is a plus for most patients<br />

who are very conscious about how they<br />

look. Nowadays, with the advent of social<br />

media applications such as Snapchat,<br />

Instagram and Facebook, there is no<br />

denying that many care about their<br />

physical appearances. Finally, there are<br />

some studies showing clear aligners can<br />

work a little bit faster than traditional<br />

fixed braces/appliances – shortening<br />

orthodontic treatment down by about<br />

five months for some simple to moderate<br />

Class I cases.<br />

Clear aligners are primarily indicated for<br />

simple to moderate malocclusion cases,<br />

which is majority of the cases that we see<br />

in our practice. Clear aligners are now<br />

becoming common and popular for teens.<br />

But for cases that require uprighting<br />

molars or more complex movements<br />

such as extrusion of impacted canines,<br />

traditional braces would still be used. Also<br />

in cases where surgery is needed, oral<br />

surgeons still prefer traditional braces over<br />

clear aligners.<br />

In your practice, do you prefer using<br />

clear aligners over traditional braces?<br />

Why?<br />

Clear aligners are very powerful and can<br />

move teeth comfortably. At the moment,<br />

80% of our cases are clear aligners and<br />

only 20% are fixed appliances. We find<br />

that with clear aligners, we don’t have<br />

to make unnecessary appointments.<br />

There are also studies that show patients<br />

are more motivated while wearing clear<br />

aligners over traditional appliances and<br />

we have noticed this as well. Overall, we<br />

are a happy practice and we have happy<br />

patients who love the fact that they can<br />

have comfortable treatments with reduced<br />

emergencies and oral health impacts.<br />

It has been said that digitalisation is<br />

already the way of the future in dentistry.<br />

Presently, <strong>Dental</strong><br />

Monitoring (DM)<br />

is being used in<br />

orthodontics.<br />

Kindly tell us more<br />

about it and how it<br />

works.<br />

<strong>Dental</strong> Monitoring is<br />

a simple application<br />

for monitoring<br />

patients, which<br />

gives dentists a lot<br />

of control in their<br />

patients’ treatment such as when to<br />

change aligners, how often and what stage<br />

the patient needs to be checked. I consider<br />

myself as a pioneer in the orthodontic<br />

industry, being one of the very first<br />

orthodontists in Australia to use DM mainly<br />

on clear aligners. Now we use DM for every<br />

treatment, including maxillary expanders<br />

and retainers. For example, in our practice,<br />

we ask our patients to take a weekly video<br />

of their face and teeth with and without<br />

an appliance using their smartphone and<br />

upload them into the application. The DM<br />

application uses artificial intelligence (AI)<br />

to recognise photographs, videos and<br />

backgrounds and from there, monitor<br />

gum health, teeth movement, and rate<br />

of teeth movement and predictability of<br />

movement of each patient week after<br />

week. For me, as an orthodontist, this<br />

is the definition of providing ultimate<br />

care for my patients. Not only now we<br />

are giving them customised treatment<br />

but also personalised to their biological<br />

response and compliance. Before DM, we<br />

would traditionally see patients every six<br />

to eight weeks for adjustments and have<br />

no idea what the condition of the patient<br />

is like in between dental visits. Now, we<br />

can monitor patients outside the clinic and<br />

catch problems early and troubleshoot<br />

early. This is a clear advantage of DM. With<br />

the weekly monitoring, patients have the<br />

peace of mind and are reassured as they<br />

know their dentists are keeping a close<br />

eye on them.<br />

However, there is a misconception that<br />

DM is fully-automated and completely<br />

driven by AI. DM is only semi-automated<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 19


Under the Spotlight<br />

and there is still the human element<br />

and guidance from dentists. I highly<br />

recommend using DM because there is<br />

less room for error in treatment by being<br />

able to detect certain things early. The<br />

feedback from our patients in an internal<br />

study shows it takes 2-5 minutes per week<br />

and patients feel much more assured<br />

and motivated during treatment. They<br />

receive constant feedback via the in-App<br />

messaging advising them of how they are<br />

progressing.<br />

Is <strong>Dental</strong> Monitoring (DM) only used<br />

for clear aligners or also for traditional<br />

appliances?<br />

It can be used for anything from clear<br />

aligners, traditional braces to other<br />

appliances such as retainers. I am fond<br />

of using DM in patients with retainers as<br />

it can pick up the slightest movement<br />

(0.1 mm), which allows me to retreat<br />

patients early, quickly and conveniently. I<br />

am truly grateful that DM is an innovation<br />

which is now available for all orthodontists.<br />

When I first heard of DM in 2017, I jumped<br />

on to it straight away as I could see the<br />

potential benefits for the patient and for<br />

the team.<br />

What are some guidelines you could give<br />

to other dentists who are new to utilising<br />

clear aligners and <strong>Dental</strong> Monitoring (DM)?<br />

As a practitioner, I follow the golden<br />

rule from a legendary orthodontist,<br />

Prof. William Proffit, who said, ‘We should<br />

always keep the patient’s biology in mind.’<br />

This means we should not push the envelope<br />

where it comes to tooth movement – we<br />

need to be biologically sensitive. Secondly,<br />

I use evidence-based research in designing<br />

my treatment plans for aligners. Finally, I<br />

troubleshoot early and DM helps in detecting<br />

problems early, allowing me to finish my<br />

treatment effectively and efficiently.<br />

As a lecturer with great interest<br />

in education, how vital do you think<br />

continuing dental education (CDE) is to<br />

dental professionals?<br />

Education is paramount and knowledge<br />

is powerful and meant to be shared. In<br />

Australia, there is a regulation that every<br />

dentist should have at least 20 hours of CDE<br />

per year. This is a regulatory requirement<br />

and the ethical thing to do as practicing<br />

dental professional. I believe in maintaining<br />

the proper skills, scope of knowledge<br />

and standard of care for patients. I highly<br />

recommend dentists to continue education in<br />

various areas and to go beyond their comfort<br />

zones to achieve great outcomes. I truly enjoy<br />

teaching and helping other dentists deliver<br />

amazing results to their patients.<br />

I believe that if we do not move with<br />

technology and current trends, we may<br />

become inefficient and be left behind. Dentists<br />

need to be updated with evidence-based<br />

knowledge, innovation and advancements.<br />

Being active in the dental scene, how do<br />

you or organisations you are involved<br />

in promote awareness of current dental<br />

innovations among your peers?<br />

I am influenced by the renowned speaker,<br />

Mr. Simon Sinek, and according to him, it is<br />

important to always ask the question, ‘Why?’<br />

Everyone knows the how and what but very<br />

few ask and understand why they do things.<br />

So, being able to communicate why we do<br />

things is very powerful. I always say, ‘Don’t<br />

forget to ask the whys.’ This is the principle I<br />

continually apply to my practice and daily life.<br />

I love sharing my experiences and cases<br />

with my peers. I promote awareness through<br />

classes and various media. We have a public<br />

YouTube channel with multiple videos on<br />

numerous clinical cases and we also organise<br />

paid and free events. Currently, I run a<br />

prescribed diploma on digital orthodontics,<br />

heavily based on digital technology to help<br />

dentists move forward in that area. The digital<br />

space is very hard to get into in the beginning<br />

and I advise all practitioners to move along<br />

with the times. My company, Best Orthodontic<br />

Seminars & Sessions (BOSS), is available<br />

worldwide, where we utilise social media,<br />

clinical articles and clinical research to help<br />

spread the knowledge.<br />

In the next five years, where do you see<br />

the development of digital dentistry<br />

or digital technology in orthodontics<br />

headed towards?<br />

We are in the age of technology and AI in<br />

every industry is no different. All these digital<br />

innovation such as DM only make us more<br />

capable in providing the best dental care for<br />

our patients. At the moment, DM is able to<br />

detect over 170 different intra-oral clinical<br />

situations, including gum recession, tooth<br />

abrasion . I believed eventually it can be used<br />

in other dentistry to detect tooth decay and<br />

tooth shades. I am sure that in the future, DM<br />

will extend to preventive dentistry and be used<br />

to maintain oral health applications globally.<br />

Technology/artificial intelligence will never be<br />

able to replace dentists but will enable and<br />

support us in becoming better practitioners.<br />

Let us learn from technology because this is<br />

the future of orthodontics.<br />

Given your achievements, the next<br />

generation of dental professionals<br />

look to you for advice. Do you have any<br />

words of wisdom to impart to aspiring<br />

practitioners?<br />

Always remember to do your best, never<br />

cut corners, go the extra mile and give your<br />

patients the best outcome they can have.<br />

Word of mouth is the best way to grow your<br />

practice and the only way to achieve that is<br />

by providing amazing work. Furthermore,<br />

educate yourselves and continue learning<br />

and stay updated with technology. Finally,<br />

learning how to assess the emotional needs<br />

of patients before beginning any treatment<br />

plan helped me. We can be quick to jump<br />

to solutions for a patient but we need to<br />

first uncover their true emotional need<br />

first. Mastering this skill has allowed me to<br />

communicate effectively, accomplish patient<br />

needs and address their concerns while<br />

providing them with the ultimate care. DA<br />

20<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>Dental</strong> Managment<br />

Fig. 1<br />

The Dentist’s Role in the<br />

Management of Obstructive<br />

Sleep Apnoea<br />

By Dr. Leopoldo P. Correa; BDS, MS<br />

Tufts University School of <strong>Dental</strong> Medicine<br />

Boston, Massachusetts. USA<br />

Obstructive sleep apnoea<br />

(OSA) is a common sleep<br />

disorder characterised<br />

by repetitive episodes of<br />

upper airway obstruction<br />

with efforts to breathe, resulting in<br />

reduction of blood oxygen saturation<br />

and ending with sleep arousal. OSA<br />

has been linked to a number of morbid<br />

conditions such as stroke, hypertension,<br />

cardiovascular disorders, increased road<br />

traffic accidents, secondary depression,<br />

anxiety, sexual dysfunction, and overall<br />

mortality. 1-3 The mechanism by which<br />

obstructive sleep apnoea condition<br />

develops is believed to be multifactorial<br />

and complex; a common etiology is the<br />

narrowing of the upper airway due to the<br />

presence of excessive soft tissues like<br />

an enlarged tongue, inflamed adenoids/<br />

tonsils or excessive accumulation of<br />

adipose tissue in the neck area inducing<br />

pressure on the dimensions of the upper<br />

airway 4 . The condition may also develop<br />

due to structural abnormalities in the<br />

head and neck area, such as retrognatic<br />

jaw position developing into a narrow<br />

airway space 5 (Fig. 1).<br />

Prevalence and Symptoms<br />

The prevalence of OSA is approximately<br />

of 3-7% in adult males and 2-5% in adult<br />

females, and the prevalence estimates<br />

are similar to data reported worldwide<br />

- common symptoms include snoring,<br />

excessive daytime sleepiness among<br />

others 6-7 . The complaint of snoring<br />

precedes the complaint of daytime<br />

sleepiness, and the intensity increases<br />

with weight gain and bedtime alcohol<br />

intake. Excessive daytime sleepiness<br />

is one of the most common clinical<br />

manifestations of obstructive sleep<br />

apnoea. Obstructive sleep apnoea is<br />

usually associated with disturbed sleep<br />

architecture, the more severe the sleep<br />

fragmentation, the more likely that<br />

daytime sleepiness will be reported.<br />

Diagnosis<br />

To diagnose OSA, a comprehensive sleep<br />

evaluation is needed, including a full<br />

medical history, sleep questionnaires,<br />

physical examination and sleep<br />

testing. The standard diagnostic test<br />

for obstructive sleep apnoea is the<br />

overnight polysomnography. It<br />

involves the recording of multiple<br />

physiologic signals during sleep,<br />

including electroencephalograph (EEG),<br />

electrooculogram (EOG), electromyogram<br />

(EMG), oronasal airflow, oxyhaemoglobin<br />

saturation, and respiratory effort<br />

measurement among other measures.<br />

The severity of obstructive sleep apnoea<br />

is measured by the apnoea-hypopnoea<br />

index (AHI), obtained by sum of apnoeas<br />

and hypopnoeas per hour of sleep. An<br />

AHI lower than five events per hour of<br />

sleep is normal, an AHI of five to fifteen<br />

events per hour of sleep indicates mild<br />

OSA, an AHI of 15-30 events per hour of<br />

sleep indicates moderate OSA, and an AHI<br />

greater than 30 events per hour of sleep<br />

indicates severe OSA 8 .<br />

Treatment<br />

Treatment options include the use of<br />

continuous positive airway pressure<br />

(CPAP), it has been considered the<br />

standard treatment option for OSA<br />

with some limitations including patient<br />

tolerance and cumbersome fitting of the<br />

device. The use of oral appliances has<br />

evolved as a practical alternative to CPAP,<br />

especially in cases with mild to moderate<br />

OSA. Such treatment modality has been<br />

shown to be effective in clinical practice 9 .<br />

Other treatment modalities include weight<br />

loss, uvulopalatopharyngoplasty (UPPP)<br />

and maxilla-mandibular advancement<br />

surgery among others 10 .<br />

Oral Appliances for OSA<br />

Oral appliances are classified as<br />

mandibular advancement devices (MAD)<br />

and tongue retainer devices (TRD). The<br />

primary action of MAD is to reposition<br />

and maintain the lower jaw forward during<br />

sleep 11 . Different oral appliances’ designs<br />

are available and their differences rely<br />

on material of fabrication, connectors,<br />

Fig. 2<br />

Fig. 3<br />

Fig. 4<br />

Fig. 5<br />

22<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>Dental</strong> Managment<br />

and size (Figs. 2-5). The mechanism<br />

of action of a tongue retainer device<br />

is the protraction of the tongue due<br />

to a slight negative pressure in the<br />

bulb compartment of the device. The<br />

displacement of air is achieved once the<br />

tongue is placed in this compartment. A<br />

tongue retainer device is indicated for<br />

patients with compromised dentition,<br />

including insufficient teeth, or periodontal<br />

disease (Fig. 6).<br />

Dentist’s Role<br />

Due to their prime position as examiners<br />

of the oropharyngeal area, dental<br />

professionals have been recognised<br />

as being an important team player in the<br />

screening and management of obstructive<br />

sleep apnoea 12 . The assessment<br />

of tongue size, soft palate, uvula,<br />

maxillary and mandibular arches are<br />

commonly included as part of screening<br />

(Fig. 7). <strong>Dental</strong> sleep medicine is a field<br />

in dentistry that has evolved rapidly<br />

during the last few years thanks to the<br />

advancement in research related to<br />

the use and efficacy of oral appliance<br />

therapy for the management of OSA.<br />

Oral appliances hold the mandible in<br />

a forward position to help maintain<br />

Fig. 6 Fig. 7<br />

a patent airway during sleep for<br />

patients with obstructive sleep apnoea.<br />

Oral appliance therapy is mainly indicated<br />

for patients with mild to moderate OSA<br />

and patients with severe OSA who cannot<br />

tolerate PAP therapy or in conjunction<br />

with PAP treatment. It is important<br />

to distinguish and recognise which<br />

patients would benefit from OA therapy<br />

in order to provide a suitable treatment<br />

option effectively 13 .<br />

As the field of dental sleep medicine<br />

continues to grow, it is essential<br />

that dentists who use oral appliances<br />

for obstructive sleep apnoea<br />

also understand the management of side<br />

effects, including occlusal symptoms<br />

and temporomandibular disorders (TMD);<br />

and comprehend the current standards<br />

of dental sleep medicine practice<br />

developed by the American Academy<br />

of <strong>Dental</strong> Sleep Medicine (AADSM) 14 . DA<br />

References:<br />

1. American Academy of Sleep Medicine. International classification of sleep disorders, revised: Diagnostic and coding manual. Chicago, Illinois: American Academy<br />

of Sleep Medicine, 2001.<br />

2. Shigemoto S, Shigeta Y, Nejima J, Ogawa T, Matsuka Y, Clark GT. Diagnosis and treatment for obstructive sleep apnea: Fundamental and clinical knowledge in<br />

obstructive sleep apnea. J Prosthodont Res 2015;59:161-171.<br />

3. Wright J, Johns R, Watt I, Melville A, Sheldon T. Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic<br />

review of the research evidence. BMJ 1997;314:851-860.<br />

4. Abramson Z, Susarla S, August M, Troulis M, Kaban L. Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea.<br />

J Oral Maxillofac Surg 2010;68(2):354-62<br />

5. Berger RM. Mandibular Retrognathia and sleep apnea. JAMA 1982;247(16):2234<br />

6. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328(17):1230-<br />

5 doi: 10.1056/NEJM199304293281704[published Online First: Epub Date]|.<br />

7. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177(9):1006-14<br />

doi: 10.1093/aje/kws342[published Online First: Epub Date]|.<br />

8. Tsara V, Amfilochiou A, Papagrigorakis MJ, Georgopoulos D, Liolios E. Guidelines for diagnosis and treatment of sleep-related breathing disorders in adults and children.<br />

Definition and classification of sleep related breathing disorders in adults: different types and indications for sleep studies (Part 1). Hippokratia 2009;13:187-191.<br />

9. Gjerde K, Lehmann S, Berge ME, Johansson AK, Johansson A. Oral appliance treatment in moderate and severe obstructive sleep apnoea patients non-adherent to<br />

CPAP. J Oral Rehabil 2016;43:249-258.<br />

10. Epstein LJ, Kristo D, Strollo PJ, Jr., Friedman N, Malhotra A, Patil SP et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep<br />

apnea in adults. J Clin Sleep Med 2009;5:263-276.<br />

11. Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J, Jr., et al. Practice parameters for the treatment of snoring and Obstructive Sleep Apnea<br />

with oral appliances: an update for 2005. Sleep 2006;29(2):240-3.<br />

12. Paskow H, Paskow S. Dentistry’s role in treating sleep apnea and snoring. N J Med 1991;88(11):815-7.<br />

13. Sutherland K, Vanderveken OM, Tsuda H, et al. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med 2014;10(2):215-27 doi: 10.5664/<br />

jcsm.3460[published Online First: Epub Date]|.<br />

14. Levine M, Bennett K, Cantwell M, Postol K, Schwartz D. <strong>Dental</strong> sleep medicine standards for screening, treating, and managing adults with sleep-related breathing<br />

disorders. J. Dent Sleep Med. 2018;5(3):61-68.<br />

Dr. Leopoldo P. Correa is an associate professor and director of the <strong>Dental</strong> Sleep Medicine fellowship program at Tufts University <strong>Dental</strong><br />

School in Boston Massachusetts. He completed his certificate of achievement in Craniomandibular Disorders and obtained his Master of<br />

Science degree at Tufts University. He incorporated the teaching of dental sleep medicine into the pre- and post-graduate programs at<br />

Tufts and developed various continuing education programs at the university including <strong>Dental</strong> Sleep Medicine Mini-Residency Program,<br />

<strong>Dental</strong> Sleep Medicine Comprehensive Introduction, Paediatric <strong>Dental</strong> Sleep Medicine Interdisciplinary Course.<br />

Dr. Correa is a Diplomate of the American Academy of <strong>Dental</strong> Sleep Medicine and visiting professor in different dental schools. He is an<br />

active member of different professional associations. His passion for education allowed him to share and teach the <strong>Dental</strong> Sleep Medicine<br />

Comprehensive Introduction program as a course director and on-site speaker in the USA, Europe, Latin America and <strong>Asia</strong>.<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 23


Intego Pro Ambidextrous:<br />

Adding Flexibility and<br />

Comfort to the Practice<br />

Fig. 1: Swivel from right-handed to left-handed treatment takes only 15 seconds and can easily<br />

be carried out between patients.<br />

Fig. 2: A pedal on the water unit sets the<br />

conversion in motion, positioning the patient<br />

chair correctly and rotating the water unit<br />

around the chair.<br />

Left-handedness is less common,<br />

making up only a small<br />

percentage of the population.<br />

It is no surprise that their needs<br />

are often overlooked in the<br />

design of everyday tools, objects and<br />

equipment. The owner of Bayshore <strong>Dental</strong>,<br />

Dr. Gauri Mona Patel works with<br />

Dr. Aaron Seubert who happens to be lefthanded<br />

while she is right-handed.<br />

Left-handed dental practitioners are<br />

often faced with the uncomfortable<br />

task of working with equipment<br />

designed for right-handers. Fortunately,<br />

Dentsply Sirona’s Intego Pro Ambidextrous<br />

treatment centre enables an ergonomic<br />

workflow for both right-handed and<br />

left-handed practitioners. In this article,<br />

Drs. Patel and Seubert write about the<br />

addition of the Intego Pro Ambidextrous<br />

to their dental practice and the added<br />

flexibility that the new treatment centre<br />

has given them as well as its benefits to<br />

both the work environment and to the<br />

patients.<br />

Dr. Patel has owned Bayshore <strong>Dental</strong><br />

for the past five years and has been<br />

in practice for a total of eleven years.<br />

Her team works across all aspects<br />

of general dentistry including adult<br />

orthodontics, implants, and cosmetics.<br />

Bayshore <strong>Dental</strong>’s mission is to provide<br />

high quality dental care, in a comfortable,<br />

friendly atmosphere, to promote the<br />

health of their patients.<br />

Dr. Seubert joined the Bayshore <strong>Dental</strong><br />

practice a year ago as an associate<br />

dentist. Since he is left-handed, it was an<br />

opportune moment to look into adding a<br />

treatment centre that would better suit<br />

him by making his work more comfortable<br />

and efficient.<br />

The need for adaptability<br />

It was important to provide Dr. Seubert<br />

an adequate working environment,<br />

which led the practice to invest in the<br />

Intego Pro Ambidextrous from<br />

Dentsply Sirona. The Bayshore <strong>Dental</strong><br />

practice opted for a swivel treatment<br />

centre rather than a strictly left-handed<br />

treatment centre, creating more flexibility<br />

and adaptability for the practice. If<br />

needed, both a left-handed and/or righthanded<br />

operator can provide treatment<br />

from this unit which is essential in keeping<br />

a smooth workflow.<br />

Fig. 3: Dr. Gauri Mona Patel, owner of Bayshore <strong>Dental</strong>.<br />

Fig. 4: Dr. Aaron Seubert, associate dentist at Bayshore<br />

<strong>Dental</strong>.<br />

To provide an example of how the<br />

treatment centre enables a smooth<br />

workflow, Dr. Patel, who is a right-handed<br />

provider, and Dr. Seubert worked in<br />

coordination on a veneer case. As a lefthanded<br />

provider, Dr. Seubert can offer<br />

26<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


Up Close & Personal<br />

a different perspective to patients. A<br />

large amount of his work is cosmetically<br />

focused as a left-hander allows him to<br />

make aesthetic observations that a righthanded<br />

provider might not see readily.<br />

This cosmetic case achieved a higher level<br />

of refinement than what either one could<br />

have accomplished individually due to the<br />

fact that they were both able to operate<br />

out of their common working positions for<br />

the duration of the case.<br />

As a practice owner and more importantly<br />

a clinician, Dr. Patel is always seeking ways<br />

to improve the working environment for<br />

her team members and fellow doctors<br />

and at the same time provide a better<br />

patient experience. “I’m thrilled that the<br />

Intego Pro Ambidextrous enabled us to<br />

do exactly those things,” said Dr. Patel.<br />

First impressions of the new<br />

treatment centre<br />

Drs. Patel and Seubert were immediately<br />

impressed with the design of the treatment<br />

centre and found it user friendly. The<br />

treatment centre gives them the tools<br />

needed as providers to perform a high<br />

standard of care for their patients. As a<br />

result, patients can see that the practice<br />

invests in their office and cares about all<br />

of the details of patient’s experience.<br />

For Bayshore <strong>Dental</strong>’s patients, there<br />

is an immediate ‘wow’ factor when they<br />

are seated in the chair. The sleek design<br />

and non-intimidating appearance of the<br />

treatment centre reduces the patients’<br />

anxiety levels, which in turn aids in<br />

facilitating the best care the practice<br />

can provide. For the doctors, hygienists,<br />

and assistants, having everything at<br />

their fingertips is a clinical asset and the<br />

treatment centres provide high ergonomic<br />

value which encourages mobility.<br />

Patients have been very pleased with<br />

the comfort of the treatment centre and<br />

Bayshore <strong>Dental</strong> has received a lot of<br />

positive feedback.<br />

The practice has five other operatories<br />

with fixed right-handed treatment centres.<br />

Normally, their Intego Pro Ambidextrous<br />

is kept in its left-handed configuration<br />

for Dr. Seubert to use. However, they<br />

have tested the conversion and it can be<br />

done in seconds. All of the team members<br />

are cross-trained to perform their<br />

responsibilities on both types of treatment<br />

centres and can convert the treatment<br />

centre in between appointments.<br />

Fig. 5: Dr. Seubert using the left-handed working position with<br />

a right-handed team member.be carried out between patients.<br />

According to Dr. Seubert, he prefers to use<br />

the ambidextrous unit as it is normally left<br />

set up for him. He only provides treatment<br />

on one of their non-ambidextrous units<br />

when he has an emergency case and<br />

needs the earliest available operatory.<br />

Sealants and minor occlusal restorations<br />

can also be performed in these centres<br />

but require maneuvering the hoses<br />

underneath the patient’s chair so the<br />

handpiece can be accessed by the<br />

provider and suction by the assistant.<br />

As a new provider, Dr. Seubert works<br />

on a rigorous schedule with taxing<br />

hours. However, he has not experienced<br />

any serious soreness or discomfort<br />

in relation to his work. The various<br />

positions a patient can be placed, along<br />

with the numerous headrest adjustments<br />

simplify access. As a result, Dr. Seubert’s<br />

position or posture does not need<br />

to be compromised and minimises<br />

stress on his musculoskeletal system.<br />

Specifically, his shoulders and lower<br />

back discomfort has decreased thanks to<br />

the improved ergonomic function of the<br />

Intego Pro Ambidextrous.<br />

The backrest of the chair automatically<br />

moves into the correct position before<br />

the operating light, monitor, and dental<br />

element are repositioned. During the quick<br />

process, no screws need to be loosened or<br />

re-secured. The practice does not have to<br />

keep patients waiting unnecessarily as the<br />

room is being prepared. The precise pivot<br />

guide is extremely ergonomic for<br />

the practice team and minimises<br />

the risk of damage to hoses or<br />

collision with other components.<br />

This is ensured particularly by<br />

the water unit, which moves<br />

in parallel and remains in the<br />

correct position.<br />

The Intego Pro Ambidextrous<br />

integrates many important<br />

technologies making the<br />

treatment centre the ‘hub’ of<br />

the digital practice and the<br />

foundation from which all<br />

treatment is directed. The more<br />

integration possibilities in digital workflow,<br />

the more efficient the practice can be.<br />

This is also very important for processes<br />

like documenting infection prevention<br />

protocols, making practitioners more<br />

accountable. Ultimately, efficiency has a<br />

direct correlation with the bottom line of<br />

any business and the integration of a more<br />

digital workflow creates an environment<br />

that allows the team to work at their<br />

optimal levels. DA<br />

Fig. 6: Dr. Seubert working from a comfortable<br />

position.<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 27


<strong>Dental</strong> Profile<br />

Integrating Digital<br />

Technology into<br />

Modern Dentistry<br />

- Dr. Alexander Völcker,<br />

Dentsply Sirona, Group Vice President Digital<br />

Interviewed by Ms. Jamie Tan<br />

Dentsply Sirona has been<br />

driving CAD/CAM innovation<br />

with CEREC for over 30<br />

years, pioneering digital<br />

solutions that have changed<br />

dentistry for the better. Think about<br />

digital impressions, seamless digital<br />

workflows and solutions that make<br />

exchanging data and information between<br />

the practice and dental lab both easier<br />

and faster for clinicians and technicians.<br />

Dentsply Sirona’s CAD/CAM solutions will<br />

continue to change what is possible within<br />

digital dentistry in order to provide better,<br />

safer and faster care to patients.<br />

With the help of Dr. Alexander Völcker,<br />

Dentsply Sirona’s Group Vice President<br />

Digital, <strong>Dental</strong> <strong>Asia</strong> was able to have<br />

a closer look at the latest CAD/CAM<br />

advances and developments, better<br />

understand what sets CEREC apart from<br />

other CAD/CAM systems as well as learn<br />

more about digital impressions and the<br />

company’s future plans for the CAD/CAM<br />

SBU for the upcoming year.<br />

Digitally shaping dental technology<br />

CAD/CAM technology has been a<br />

core aspect of dentistry and dental<br />

technology for more than 30 years now.<br />

Dentsply Sirona has shaped this<br />

development through CEREC, which<br />

enables dentists to produce restorations<br />

directly in their clinic. Digital technology<br />

and in particular CAD/CAM make dental<br />

procedures reproducible and therefore<br />

easier, safer and faster. Thus, taking digital<br />

impression with the CEREC Omnicam<br />

opens up a variety of treatment options<br />

– in restorative dentistry, implantology<br />

and orthodontics.<br />

However, what makes CEREC such<br />

a unique offering in dentistry is its<br />

integration – from diagnosis with<br />

3D imaging systems, treatment planning<br />

by using sophisticated software,<br />

implementation of the treatment with<br />

innovative instruments and materials up<br />

to the final treatment with a restoration.<br />

According to Dr. Völcker, “Dentsply Sirona’s<br />

concept is special because of the truly<br />

seamless interaction between hardware<br />

and software. Users don’t have to think<br />

about interfaces, compatibility or material<br />

specifications anymore – all the relevant<br />

parameters are stored in the system.<br />

We offer a workflow that minimises or<br />

even rules out surprises in order to have<br />

everything perform like clockwork for<br />

them.”<br />

One step further into digital<br />

Digital impressions go by one name:<br />

Sirona Connect by Dentsply Sirona. It is one<br />

of the most innovative and reliable solutions<br />

for dentists and dental technicians who wish<br />

to further integrate digital technology into<br />

their practice. The Sirona Connect software<br />

and the Sirona Connect portal (interface)<br />

simplify the cooperation between dental<br />

practice and laboratory.<br />

Once registered, both sides communicate<br />

directly through the portal. The model<br />

data is transferred within a few minutes<br />

and gives the laboratory an exact picture<br />

of the case. The direct transmission of<br />

model data to the laboratory allows the<br />

dental technician to view the case almost<br />

simultaneously with the practice. Thus,<br />

a first consultation with the laboratory<br />

can be done while the patient is in the<br />

treatment room – an advantage over<br />

conventional impression methods.<br />

Dr. Völcker explained, “Sirona Connect<br />

has always stood for comfortable, quick<br />

and secure transfer of scan data to the<br />

dental laboratory. Users only require<br />

the CEREC Omnicam for the intraoral<br />

scan. Sirona Connect is increasingly<br />

used in practices and laboratories for<br />

transferring the impression data to the<br />

dental laboratory, allowing dentists to<br />

take impressions quickly and comfortably<br />

– ensuring faster overall treatment.”<br />

Sirona Connect benefits the dental<br />

laboratory with direct connection to the<br />

practice. It clearly saves the practice<br />

and laboratory valuable time by enabling<br />

the immediate exchange of information<br />

during the patient’s visit, Dr. Völcker<br />

added.<br />

28<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>Dental</strong> Profile<br />

A complete, flexible and efficient<br />

workflow<br />

Utilising digital technology through digital<br />

impressions and Sirona Connect not only<br />

benefits the patient, dental professionals<br />

and dental laboratories but also improves<br />

the overall digital workflow.<br />

Dr. Völcker has observed that patients<br />

are now better informed and arrive in the<br />

dental practice with higher expectations.<br />

At the same time, patients also want<br />

optimal aesthetics and a high-level of<br />

long-term stability. To achieve this, the<br />

dentist has to be a good communicator,<br />

particularly in the planning phase, and<br />

equipped with the latest technology<br />

available to offer a complete, flexible and<br />

more efficient overall digital workflow for<br />

their patients.<br />

Dr. Völcker highlighted that the driving<br />

factors for the recent advancements of<br />

the SBU are the patient’s desire for a<br />

safer and quicker treatment. Increasingly,<br />

the factors are coming together in areas<br />

to form complete workflows, resulting in<br />

considerable added value especially for<br />

the future.<br />

“Dentists want their main focus to<br />

be on their patients and less on<br />

technology, material<br />

specifications or hardware and software.<br />

This is one of the reasons we want to<br />

offer a workflow to practices that works<br />

seamlessly. Our digital implant workflow<br />

precisely stands for this,” he emphasised.<br />

Dentists who choose to work with a dental<br />

technician can upload the scan data in<br />

the Sirona Connect portal to produce the<br />

restoration in the laboratory. The data<br />

transfer is safely encoded. Alternatively,<br />

the scan data can also be sent in the<br />

universal STL (stereolithography or<br />

3D printing) format.<br />

“An entire prosthetic treatment, including<br />

all dentists and dental technician aspects,<br />

can thus be planned and performed stepby-step.<br />

These workflows can take a<br />

variety of forms and can combine digital<br />

and analogue methods. Cooperation<br />

between the dentist and dental technician<br />

is changing and becoming more flexible.<br />

I think in the future, an ever-growing<br />

number of digital alternatives to<br />

analogue methods will become available,”<br />

he explained.<br />

Growing steadily<br />

As a company, Dentsply Sirona wants<br />

to grow continuously and considers<br />

innovation as an important factor<br />

for their expansion. With an annual<br />

spending of over US$150 million<br />

on research and development, the<br />

company introduces as many as<br />

30 new products and solutions per year.<br />

“Dentsply Sirona provides solutions<br />

to ensure high-quality aesthetics,<br />

increase patient acceptance and enhance<br />

customer experience. We will support our<br />

solutions and customers through the most<br />

comprehensive clinical education platform<br />

in the industry to assist practitioners in<br />

adopting new technologies and advancing<br />

patient care,” continued Dr. Völcker.<br />

For the year <strong>2019</strong>, the CAD/CAM SBU<br />

expects more than a million intraoral<br />

scans in total to be transferred via the<br />

Sirona Connect portal.<br />

Dr. Völcker also shared that the<br />

CAD/CAM SBU has recently launched a<br />

new surgical guide for chairside<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 29


<strong>Dental</strong> Profile<br />

digital implant workflow in September –<br />

CEREC Guide 3 which supports both the<br />

surgical preparation of the implant site as<br />

well as the insertion of all implant systems<br />

that Dentsply Sirona offers (Astra Tech<br />

Implant Sytem EV, Xive and Ankylos).<br />

It has already been available in Europe<br />

since September 2018, and other markets<br />

will follow depending on certification and<br />

registration periods.<br />

“CEREC Guide 3 rounds off the chairside<br />

digital implant workflow and ensures that<br />

the prosthetic planning is implemented<br />

in a clinically safe way, thanks to its fully<br />

guided insertion. The surgical guide<br />

can be manufactured directly in the<br />

practice in less than one hour using the<br />

CEREC SW 4.6.1 and a suitable milling<br />

machine. Dentsply Sirona is the only<br />

company to offer a complete digital<br />

implant workflow out of one hand,<br />

including production of a surgical guide<br />

directly in place,” he elaborated.<br />

He also shared that Dentsply Sirona<br />

will be presenting innovative answers<br />

to the latest dentistry trends and, in<br />

doing so, will be setting new standards.<br />

Dentsply Sirona demonstrated its<br />

innovative power at the IDS 2017 and<br />

most recently at the Dentsply Sirona<br />

World 2018.<br />

“The IDS <strong>2019</strong> is fast approaching and<br />

we are looking forward to everybody’s<br />

presence and support. Stay tuned and let<br />

us surprise you!” he exclaimed.<br />

Leading the way as a committed<br />

forerunner in the dental industry<br />

Dentsply Sirona’s focus is to be the<br />

pacesetter, forerunner and driver for<br />

digital dentistry. The company has a<br />

strong sales force which will be expanded<br />

in the future by investing more in sales<br />

and service distribution. Supplementary<br />

to this, their diverse product portfolio and<br />

geographical reach are proving to be a<br />

competitive advantage.<br />

Also, the company’s current programme<br />

includes compelling marketing and<br />

communication activities and a unique<br />

commitment to training and education.<br />

Both are designed to exploit the significant<br />

potential of their products and support<br />

valued dealer partners.<br />

“This is implemented also by our team<br />

in the <strong>Asia</strong> Pacific region, where we still<br />

see a lot of growth opportunities and<br />

subsequently, want to further strengthen<br />

our operations in Japan, Korea, Taiwan,<br />

China and Australia,” stated Dr. Völcker.<br />

He shared that a key differentiator for<br />

Dentsply Sirona is their commitment<br />

to clinical education. The company has<br />

several educational centres in Europe<br />

and the U.S. including more than a<br />

dozen satellite facilities around the<br />

world. Furthermore, he mentioned that<br />

the company has two training centres in<br />

Japan, the Dentsply Sirona Academy with a<br />

showroom in Shanghai and also a training<br />

centre in Indonesia. Supplementing these<br />

facilities is their continuing education<br />

effort that reaches hundreds of thousands<br />

of dental professionals annually.<br />

Finally, Dr. Völcker surmised, “When it comes<br />

to developing interdisciplinary workflows,<br />

Dentsply Sirona is already leading the way. Our<br />

customers can rely on the company’s unique<br />

innovative drive to further advance dentistry as<br />

Dentsply Sirona’s portfolio is not complete –<br />

and it will never be – as we grow continuously.”<br />

DA<br />

30<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>Dental</strong> Profile<br />

Open Systems Are the Future of Digital Dentistry<br />

Interviewed by Ms. Jamie Tan<br />

Written by Dr. Chala R. Platon<br />

Held in November, it was a sold out twoday<br />

event attended by more than 570<br />

participants from all over the world.<br />

The amount of support received by<br />

exocad from all their partners and<br />

customers came as a pleasant surprise<br />

to Mr. Savic. The company was initially<br />

only expecting around 500 guests.<br />

Mr. Tillmann Steinbrecher,<br />

Chief Executive Officer of exocad GmbH<br />

<strong>Dental</strong> CAD/CAM software solutions<br />

provider, exocad Gmbh is globally<br />

recognised for its innovative<br />

and advanced technologies<br />

that are currently being used<br />

in over 120 countries. Founded in 2010,<br />

the company is a spinoff from the worldrenowned<br />

Fraunhofer Organisation.<br />

At that time, Fraunhofer’s <strong>Dental</strong> CAD<br />

technology was transferred to exocad,<br />

where it continues to be actively<br />

developed.<br />

For over half a decade, exocad’s dedicated<br />

teams of engineers and researchers have<br />

consistently delivered state-of-the-art<br />

innovations to the dental industry.<br />

exocad GmbH is committed to expanding<br />

the possibilities of digital dentistry<br />

and providing its distribution partners<br />

with flexible, reliable, and easy-to-use<br />

software. exocad’s technology enables<br />

system integrators to turn equipment into<br />

Mr. Novica Savic,<br />

Chief Commercial Officer of exocad GmbH<br />

comprehensive, class-leading solutions.<br />

To show the company’s continued<br />

dedication and gratitude to all its loyal<br />

supporters and customers, the first<br />

ever exocad Insights was held from<br />

19 th – 20 th November 2018 at the<br />

International Congress Centre<br />

Darmstadtium in Darmstadt, Germany.<br />

To learn more about exocad Insights 2018<br />

event, the company’s vision, latest software<br />

solutions, advantages of open-architecture<br />

systems and future plans, <strong>Dental</strong> <strong>Asia</strong><br />

spoke to Mr. Tillmann Steinbrecher,<br />

Chief Executive Officer together with<br />

Mr. Novica Savic, Chief Commercial<br />

Officer of exocad GmbH.<br />

Overwhelming support<br />

After eight years of being in the market<br />

and becoming a global brand, exocad<br />

organised a global event for dentists<br />

and dental technicians for the first time.<br />

“At most of the dental events I’ve<br />

attended, the majority of the crowd<br />

would comprise locals from the country<br />

where the event is held. In our case, we<br />

were expecting 80% of our guests to be<br />

German but the majority turned out to<br />

be foreign guests from other countries.<br />

Overall, the exocad Insights 2018 saw an<br />

overwhelming and interesting turnout,”<br />

shared Mr. Savic excitedly.<br />

Currently, exocad has over 150 international<br />

partners worldwide and 24 of them, namely<br />

Amann Girrbach, Align, Medit, Shining 3D,<br />

CIM System, Elos Medtech, imes-icore,<br />

Nobil-Metal, smart optics, BEGO, CADstar,<br />

Carestream, <strong>Dental</strong> Direkt, DGSHAPE,<br />

DOF, envisionTEC, Formlabs, Imetric,<br />

Infinident, NextDent, Open Technologies,<br />

Schü tz <strong>Dental</strong>, vhf and Wacom were<br />

present at the exocad Insights to show<br />

their support and present their latest<br />

innovations and solutions in digital<br />

dentistry.<br />

“We are greatly honoured that our<br />

partner companies were present to<br />

showcase all their new accomplishments,<br />

developments and technology. Let us<br />

take Shining 3D as an example. They<br />

officially showcased their very first<br />

intraoral scanner at exocad Insights.<br />

Here at the event, we are the connecting<br />

element of the whole ecosystem. We<br />

32<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>Dental</strong> Profile<br />

are very proud that even though our<br />

partners are competing with each other,<br />

24 of them are here. We bring them here<br />

as friends and this is in itself a wonderful<br />

achievement,” emphasised Mr. Savic.<br />

Mr. Novica Savic at exocad Insights 2018<br />

Mr. Steinbrecher added that exocad<br />

believes both dentists and dental<br />

technicians would greatly benefit from<br />

the company’s portfolio and what the<br />

company has to offer. This enables<br />

dentists and dental technicians to work<br />

together as collaborators rather than<br />

competitors while providing the proper<br />

tools to aid communication between<br />

the two parties. exocad technology and<br />

solutions are relevant for both target<br />

audiences since a number of dentists<br />

already currently have their own<br />

laboratories.<br />

Providing more freedom with<br />

open system solutions<br />

Maintaining standards is important to<br />

exocad for the development of high<br />

quality products that their customers can<br />

rely on. Heading to the future of digital<br />

dentistry with exocad is not just a matter<br />

of trust – it’s a certified future-proof<br />

decision. The company continues to<br />

stand true to its motto, “Your freedom is<br />

our passion.” Mr. Steinbrecher stated that<br />

this truly describes what the company<br />

is all about and what the company has<br />

and will continue to accomplish. The<br />

company provides customers freedom<br />

of choice in determining which hardware<br />

and software to use with exocad’s open<br />

systems platform.<br />

Mr. Steinbrecher proceeded to highlight<br />

important features or characteristics<br />

that are important when developing<br />

exocad solutions. He elaborated, “Firstly,<br />

we always value absolute robustness<br />

which means the software must be able<br />

to handle the most complex patient<br />

care and cases. Secondly, we aim to<br />

provide users with maximum flexibility as<br />

there are numerous cases where dental<br />

technicians have different opinions on<br />

how things should be done and what<br />

tools should be used. Lastly, we want<br />

to maintain a degree of openness of<br />

software solutions and systems which<br />

will ultimately allow users more flexibility<br />

and freedom.”<br />

In the beginning, users would start off<br />

using the open systems to save on costs<br />

by milling from the most affordable<br />

milling centres. However, they soon<br />

realised that the opportunities offered by<br />

open systems were so much more than<br />

that. exocad deals with the ecosystems,<br />

dental practices and dental laboratories<br />

that use devices manufactured by<br />

different companies. Thus an open<br />

system is vital to sync data and maximise<br />

the benefits of the different equipment in<br />

the laboratories and clinics that range<br />

from x-ray machines, intraoral scanners,<br />

desktop scanners, digital cameras and<br />

CBCT machines.<br />

“With this reason, the freedom from open<br />

systems is not only about saving money<br />

but also maximising the advantages of<br />

the diverse equipment users own and<br />

thus enabling users to offer patients<br />

a more holistic treatment approach.<br />

Hence, it is important to ensure products<br />

are accessible to users, proper training<br />

is provided and the software solutions<br />

are designed to be user friendly,”<br />

commented Mr. Steinbrecher.<br />

Latest innovations and integrated<br />

solutions<br />

Some may think that CAD/CAM only<br />

applies to prosthesis such as onlays,<br />

inlays, crowns and veneers. According<br />

to Mr. Savic, exocad provides a complete<br />

software solution for digital dentistry<br />

in other specialisations such as<br />

orthodontics, implantology, treatment<br />

planning and so much more. One of<br />

their well-known products designed<br />

for the laboratory is <strong>Dental</strong>CAD – a<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 33


<strong>Dental</strong> Profile<br />

The biggest market leaders in Europe<br />

are Germany, Italy and Spain, all of<br />

which hold very dominant positions in<br />

laboratories. While in <strong>Asia</strong>, the biggest<br />

markets are in Korea, China and Japan.<br />

In the future, exocad plans to increase<br />

technical support in the North and<br />

South American regions which are<br />

showing a lot of growth potential.<br />

powerful software known for its speedy<br />

operation and ease of use which provides<br />

maximised productivity. <strong>Dental</strong>CAD<br />

software is expandable with numerous<br />

add-on modules, allowing great flexibility<br />

and making it economic.<br />

In addition, PartialCAD was recently<br />

launched this year for designing partial<br />

dentures. Aside from laboratory solutions,<br />

exocad also provides offerings for<br />

clinical purposes such as ChairsideCAD<br />

targeting same-day dentistry. The<br />

Guide Creator was officially launched<br />

at the event as a module for creating<br />

surgical guides; an add-on module<br />

for the pre-existing exoplan software.<br />

Mr. Savic also revealed that we should<br />

expect the Smile Creator soon, a new<br />

tool for planning aesthetic restorations.<br />

“Once Smile Creator is in the market,<br />

it will be unique compared to other<br />

Smile Creator software in the market.<br />

exocad’s Smile Design is going to be<br />

a fully integrated software. Whatever<br />

you’ve planned is already in 3D and is<br />

easily transferred into CAD without any<br />

guesswork. We plan to expand more<br />

on the laboratory side. We try to make<br />

everything you could do manually with<br />

wax possible digitally,” said Mr. Savic.<br />

Mr. Steinbrecher also commented that<br />

there are a lot of things already possible<br />

and established in the market but the<br />

greatest benefit for both users and patients<br />

lies in the combination or integration of<br />

technologies and different products from<br />

different manufacturers, which is what<br />

exocad can already fulfil through its open<br />

systems.<br />

“What we can offer with our open system<br />

platform is a solution that covers the<br />

different aspects of digital dentistry in<br />

an extremely integrated way. This makes<br />

it more accessible even to users who are<br />

not yet familiar with digital technology,”<br />

continued Mr. Steinbrecher.<br />

Presence in the dental industry<br />

Over the years, exocad has grown<br />

into a global corporation with more<br />

than 32,000 installations in over 120<br />

countries. People all over the world are<br />

using CAD/CAM technology everywhere.<br />

exocad discovered that CAD/CAM is not<br />

just used in western countries but also<br />

in Africa.<br />

Furthermore, according to Mr. Savic,<br />

exocad is focusing on the markets in<br />

Europe, US, North America and <strong>Asia</strong>.<br />

Mr. Savic revealed that countries wherein<br />

exocad has strong local partners<br />

present are countries where they have<br />

a firm position in the market. This is<br />

true across all the regions. He said<br />

confidently, “There are only a few system<br />

providers left in the market today. We are<br />

widespread in the laboratory market as<br />

we have many partners using exocad as<br />

a software base. It may look like there<br />

are many solutions but it always comes<br />

down to exocad at the heart of it all.”<br />

Establishing a brand<br />

In less than 10 years, exocad had<br />

established a strong brand and presence<br />

in the dental industry. During this time,<br />

exocad was recognised for its unique,<br />

seamless and flexible software platform<br />

which earned them a loyal customer base.<br />

Success, recognition and loyal customers<br />

are not attained overnight but slowly<br />

built by providing excellent products that<br />

customers want and need. In the process<br />

of marketing and establishing a company<br />

brand, Mr. Savic considers the highest<br />

level of accomplishment not solely based<br />

on gaining customers but also making<br />

friends and meeting fans along the way.<br />

“One can’t plan for it, it just happens.<br />

For instance, the exocad Experts Group<br />

on Facebook came about thanks to<br />

our customers. We neither created<br />

nor initiated it. It was established and<br />

owned by our customers. This is how<br />

our brand grew in a short span of time.<br />

For this reason, we try our best to maintain<br />

our customer base through events such<br />

as exocad Insights and making sure<br />

everybody feels they are a part of a<br />

community (as family and friends) and<br />

they are all appreciated,” he continued.<br />

34<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>Dental</strong> Profile<br />

Mr. Steinbrecher added that exocad<br />

Experts Group is one of the world’s<br />

largest online community revolving<br />

around digital dental technology, with<br />

more than 30,000 members to date.<br />

exocad participates in the group but<br />

members mostly use it as a platform to<br />

interact, exchange ideas and information<br />

and compare cases. It is an open group<br />

founded by MDT Waldo Zarco Nosti, one<br />

of the speakers at excocad Insights.<br />

“It is not an official forum as it was<br />

created by a user of exocad. It is not<br />

something that the company controls. It<br />

is a real online community created by the<br />

user base and this is more than we had<br />

hoped for,” he said.<br />

Aside from this, Mr. Steinbrecher explained<br />

that while other companies have sales<br />

representatives working to promote and<br />

generate sales, exocad adopts a different<br />

sales approach where its partners take<br />

charge of the sales. The company’s sales<br />

organisation is focused on managing,<br />

helping and supporting all departments<br />

where there is a need. However, this does<br />

not mean that the company does not have<br />

any contact with its end-users.<br />

exocad maintains contact and communicates<br />

with all users when it makes its presence at<br />

international exhibitions, be it in the form of<br />

a booth or as visitors. The company is also<br />

actively engaged in discussions in social<br />

networks other than the exocad Experts Group.<br />

The company continues to hear from the<br />

ground and collect feedback in order to learn<br />

from users, improve software and maintain<br />

high quality products – all important aspects<br />

in building up the brand.<br />

Future predictions and plans<br />

Looking ahead, digital technology will<br />

continue to play an important role<br />

in the industry. Digital technology<br />

enables dental technicians to offer<br />

better quality products and services<br />

to dentists. In the same way, dentists<br />

can offer patients more predictable<br />

treatments and additional materials in a<br />

shorter treatment time. For this reason,<br />

some may think that digital dentistry<br />

will replace dental practitioners and<br />

may consider analogue knowledge<br />

indispensable.<br />

Mr. Steinbrecher remarked, “Thanks to<br />

digital technology, the roles of dental<br />

practitioners (dentists and dental technicians)<br />

will change but software is always<br />

designed to help users achieve their goal<br />

in the most effective and efficient way<br />

and not to replace them.<br />

Moving forward, exocad aims to ramp up<br />

training for its end-users in light of the<br />

growing complexity of its products. There<br />

are also plans to expand the support<br />

team to assist sellers and partners.<br />

exocad strongly emphasises on support<br />

and training as they form the backbone<br />

of their success.<br />

Mr. Savic and Mr. Steinbrecher<br />

further commented, “We hope if there<br />

is one thing you’ll learn from<br />

this event, it is that open systems are<br />

the future. We have the easiest and<br />

right solutions. It is time to try exocad<br />

solutions.”<br />

Considering the overwhelming response<br />

from participants at the sold-out<br />

event, exocad Insights 2018 is unlikely to<br />

be the first and last event organised<br />

by exocad. It may not be held<br />

on an annual basis, but we should<br />

all expect something special in<br />

exocad Insights 2020, which will take place<br />

on 12 th - 13 th March 2020 in Darmstadt,<br />

as it marks exocad’s 10 th year anniversary.<br />

Let us all mark our calendars and<br />

not miss out on the next exocad<br />

event! DA<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 35


Clinical Feature<br />

A Literature Update on<br />

Nuvola Clear Aligners<br />

By Dr. Kevin Ng<br />

A report to review, evaluate and discuss the Nuvola aligner system from a<br />

clinician’s point of view.<br />

Invisalign first appeared at an<br />

orthodontic meeting in 1991 and<br />

a peer review was published later<br />

on in 2000. In the following years,<br />

aesthetic and socialisation demands<br />

have influenced more adult patients to<br />

seek orthodontic treatment. Different<br />

aesthetic orthodontic appliances have<br />

been advocated such as ceramic brackets<br />

and lingual appliances however, clear<br />

aligners seem to be most popular among<br />

them. 1<br />

As Invisalign has been used for over 18<br />

years, treating over six millions of people<br />

worldwide, most of the studies focus on<br />

one single aligner system. However, there<br />

are various systems with different features<br />

that can provide different treatment<br />

outcomes. 2<br />

The aim of this report is to review and<br />

evaluate the literature available online that<br />

discuss the Nuvola aligner system, from a<br />

clinician’s point of view.<br />

General indications and advantages<br />

of clear aligners<br />

Orthodontic tooth movement using<br />

sequential thermoformed aligners was first<br />

proposed by Kesling and McNamara. This<br />

was later marketed by Align Technology in<br />

1997. With the introduction of CAD/CAM<br />

software techniques, this concept became<br />

a feasible treatment modality. 10<br />

Patients with dental crowding can be<br />

treated by performing interproximal<br />

enamel reduction (IPR). Teeth movement<br />

such as leveling, aligning, intrusion<br />

and even bodily distalisation of upper<br />

molars (


Clinical Feature<br />

brushing, flossing and eating which<br />

promotes better oral hygiene. Aligners<br />

are clear, aesthetically pleasing and<br />

comfortable – with no metal brackets or<br />

wires that may cause irritation. Teeth can<br />

also be whitened with the appliance during<br />

treatment. Other recorded advantages<br />

include shortened appointment times,<br />

decreased allergic responses, decreased<br />

occlusal abrasion from parafunctional<br />

habits during treatment, facilitation of<br />

aligner retention, disarticulation of teeth<br />

which may be advantageous for patients<br />

with TMJ problems, it being technically<br />

much easier to use as compared to lingual<br />

appliances and the ability to present<br />

the final results to the patient prior to<br />

treatment.<br />

However, there is a lack of operator control<br />

and the inability to integrate hard and<br />

soft tissues of the head into the computer<br />

treatment and clinicians have no direct<br />

indication of where teeth are in relation to<br />

the basal bone or in relation to lips or other<br />

soft tissues of the head. 6<br />

Boyd reported that aligner users who<br />

are teens showed improved periodontal<br />

status compared to patients with fixed<br />

appliances. 7 Patients are able to remove<br />

the aligners when they eat drink or<br />

brush. Several studies indicate that the<br />

periodontal status improved after active<br />

orthodontic treatment with aligners due<br />

to the correction of crowding. Additionally,<br />

stripping can also improve the periodontal<br />

status by restoring adequate space to the<br />

gingival papilla. 2<br />

The Nuvola System<br />

The Nuvola clear aligner from Italy was<br />

launched in 2010 as an alternative to<br />

traditional orthodontic appliances. Already<br />

a well-established brand in Germany,<br />

Romania, Bulgaria and UK markets, Nuvola<br />

is continuing to expand its reach, having<br />

penetrated the <strong>Asia</strong>n market recently.<br />

Nuvola is a transparent aligner system<br />

designed to achieve gradual straightening<br />

of the teeth and correct overcrowding. The<br />

aligners allow mesial, distal, intrusion,<br />

extrusion and tipping-torque movements<br />

in order to achieve aesthetic and<br />

unobtrusive results. The aligners also<br />

enable interdental spaces to be closed or<br />

space to be created for implants.<br />

Nuvola aligners are made from a unique<br />

material specifically designed to optimise<br />

the correct alignment of teeth. Strong,<br />

flexible, stain resistant and transparent,<br />

Nuvola aligners follow the morphology<br />

of the teeth and allow for consistent<br />

application of gentle forces that move<br />

teeth progressively. They must be worn at<br />

least 20 hours daily for two weeks before<br />

being replaced by the next aligner to allow<br />

for progressive change.<br />

There are 12 progressive aligners per stage<br />

that provide strong and precise control<br />

at all times. Ercoli in 2014 evaluated<br />

the efficiency of the Nuvola system in<br />

controlling torque movement of the<br />

upper and lower anterior. He found that<br />

the system was able to produce clinical<br />

outcomes comparable to the planning of<br />

the digital setup for moderate crowding<br />

cases (up to 6 mm). 2<br />

In 2018, Tepedino investigated 39<br />

adult patients wearing only 12 Nuvola<br />

aligners and found the clinical outcomes<br />

were comparable to the digital setup<br />

planning of anterior torque movements.<br />

Levelling, aligning, intrusion and<br />

bodily distalisation of upper molars<br />

(


Clinical Feature<br />

chemical structure and mechanical<br />

properties, suggesting differences<br />

in their clinical behavior outcomes<br />

and performances. 9<br />

Digital workflow<br />

A scanned STL impression file<br />

(stereolithography) and completion<br />

of a prescription form can formulate<br />

a free online treatment plan in two<br />

to three days. Digital impression<br />

techniques are considered a clinical<br />

alternative to conventional impressions for<br />

orthodontic and fixed dental restorations. 13<br />

Dentists with no experience can undergo<br />

a one-day hands-on training course that<br />

will enable them to become a Nuvola user.<br />

As a registered user on the Nuvola Web,<br />

the patient’s details can then be uploaded,<br />

allowing for ongoing communication with<br />

the lab in Italy and monitoring of each<br />

case’s production progress. NuvolaView is<br />

a 3D video that displays the entire process<br />

of the treatment from the beginning to the<br />

end in an interactive format. From there,<br />

the single or double arch 3D models can be<br />

manipulated to ensure that movements are<br />

in line with the desired result. There is also<br />

a video guide to interproximal reduction<br />

(IPR) and techniques required to apply<br />

the attachments.<br />

Flugge evaluated the precision of<br />

iTero scanning and found out that<br />

the iTero intraoral scanner is less<br />

accurate than model scanning. He<br />

suggested that the intraoral conditions<br />

(saliva and limited space) contribute to the<br />

inaccuracy of a scan, with recorded median<br />

deviations of 37μm. 12<br />

Finally, Akyclcin studied 60 dry skulls and<br />

scanned the maxillary and mandibular<br />

arches using the iTero scanner. Direct<br />

digital acquisition of the dental arches<br />

with a chairside scanner provided almost<br />

1-to-1 diagnostic information of the<br />

investigated anatomy, which was superior<br />

to the conebeam CT measurements. 11<br />

Conclusion<br />

Reports on the Nuvola system provide<br />

The NuvolaView<br />

information that allows dentists an<br />

alternative tool to treat their patients.<br />

Nevertheless, the scientific papers<br />

available are not sufficient enough to<br />

draw a more evidence-based conclusion.<br />

It is recommended that more research be<br />

conducted on new products. The concept<br />

“Disruptive Innovation” applies to any<br />

new medical services, technology and<br />

products. Initially, the disruptive product<br />

is usually not on par with existing products,<br />

but may be satisfactory for many users<br />

provided it is more economical, and is likely<br />

to improve over time.<br />

From the user’s point of view, the product<br />

should be:<br />

1. Technologically simplified,<br />

standardised and provide solutions.<br />

2. Based on business models that are<br />

affordable, accessible and profitable.<br />

3. Backed by research that reinforce each<br />

other and form the infrastructure. 14<br />

From the clinician’s point of view, the<br />

treatment outcome should be predictable<br />

and safe to use with no complications. DA<br />

References:<br />

1. Mehta F, Mehta S 2014, Aligners: the<br />

rapidly growing trend in orthodontics<br />

around the world. Indian Journal of Basic<br />

and Applied Medical Research; September<br />

2014: Vol.-3, Issue- 4, P. 402-409<br />

2. Ercoli F, Tepedino M, Parziale VandLuzi<br />

C 2014, A comparative study of two<br />

different clearaligner systems<br />

3. Lombardo L, et al. 2017, Predictability of<br />

orthodontic movement with orthodontic<br />

aligners: a retrospective study. Prog<br />

Orthod. 18:35.<br />

4. Szuhanek C. & Grigore A. 2016,<br />

Vacuumformed thermoplastic aligners in<br />

orthodontics. DAAAM Int Scientific Book<br />

pp. 307-314<br />

5. Zhang X, He L, Guo H et al 2015,<br />

Integrated three-dimensional digital<br />

assessment of accuracy of anterior tooth<br />

movement using clear aligners Korean J<br />

Orthod. Nov;45(6):275-281.<br />

6. Nelson G 2005 Invisalign Summit<br />

2005, Part I, Pacific Coast Society of<br />

Orthodontists Bulletin Winter.<br />

7. Boyd RL, Oh H, Fallah M, Vlaskalic V<br />

2006, An update on present and future<br />

considerations of aligners. J Calif Dent<br />

Assoc. Oct;34(10):793-805.<br />

8. Elkholy F, PanchaphongsaphakT, Kilic F,<br />

Schmidt F, LapatkiB 2015, Forces and<br />

moments delivered by PET-G aligners<br />

to an upper central incisor for labial and<br />

palatal translation, Journal of Orofacial<br />

Orthopedics November, Volume 76, Issue<br />

6, pp 460–475<br />

9. Alexandros A el at 2015, Chemical<br />

and mechanical characteristics of<br />

contemporary thermoplastic orthodontic<br />

materials, Australian Orthodontic Journal<br />

Volume 31 Issue 2 (Nov)<br />

10. Tepedino M, Paoloni V, Cozza P, Chimenti<br />

C 2018, Movement of anterior teeth<br />

using clear aligners: a three-dimensional,<br />

retrospective evaluation, Progress in<br />

orthodontics 19.9<br />

11. Akyclcin S et al 2013, Diagnostic<br />

accuracy of impression-free digital<br />

models, American Journal of Orthodontics<br />

and Dentofacial Orthopedics, Volume<br />

144, Issue 6, December, Pp 916-922<br />

12. Flugge T et al 2013, Precision of intraoral<br />

digital dental impressions with iTero<br />

and extraoral digitization with the iTero<br />

and a model scan American Journal of<br />

Orthodontics and Dentofacial Orthopedics<br />

Volume 144, Issue 3, September 2013,<br />

p. 471<br />

13. Seelbach P, Brueckel C, Wöstmann B<br />

2013, Accuracy of digital and conventional<br />

impression techniques and workflow<br />

Clinical Oral Investigations September,<br />

Volume 17, Issue 7, pp 1759–1764<br />

14. Christensen C M, Grossman J & Hwang<br />

J 2009, A Disruptive Solution for Health<br />

Care, In the Innovator’s Prescription<br />

McGraw-Hill p.441<br />

About the Author<br />

Dr. Kevin NG,<br />

BDS(Adelaide), MDS,<br />

DDPH(Sydney),<br />

MSc.Imp.(Leeds),<br />

FRACDS, FHKAM(DS),<br />

FHKCDS(Comm. Dent)<br />

DipImpDent(RCS,England)<br />

Dr. Ng, is the Hon. a/Clinical Professor at<br />

the Faculty of Dentistry, University of Hong<br />

Kong in 2017 and also in Private Practice.<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 39


User Report<br />

Abstract<br />

Direct composite veneers<br />

presented some drawback<br />

when it comes to the<br />

difficulty of execution and<br />

colour instability of the<br />

composite over time. The<br />

simplified application of<br />

the PCRVs presented as<br />

an interesting alternative in cases of smile<br />

asymmetry, large deficient restorations<br />

and discoloured tooth. In the present<br />

investigation, the complete description of<br />

the PCRVs technique can help the dentist<br />

during the planning and execution of<br />

treatments with the Componeer system.<br />

Introduction<br />

<strong>Dental</strong> veneers have become an attractive<br />

treatment in dentistry, spurred on by the<br />

development of different materials and<br />

techniques associated with the aesthetic<br />

patterns imposed by society. 1 In general,<br />

patients that presented clinical scenarios<br />

in the anterior teeth such as increased<br />

interdental spaces, fractures, deficient<br />

restorations or colour changes are<br />

indicated for treatment with veneers. 2-3<br />

The success of the veneers is associated<br />

with the dentist’s knowledge, the<br />

technique used, the restorative material<br />

(dental ceramics and composite resin)<br />

and the patient’s collaboration. 4 The<br />

ceramic veneers were proposed by<br />

Dr. Charles Pincus in 1938. 5 Since then,<br />

treatment with ceramic veneers has<br />

become one of the greatest themes in<br />

dentistry which give excellent aesthetic<br />

results. Ceramics are biocompatible,<br />

exhibit high wear resistance and great<br />

colour stability. Nowadays, ceramic is<br />

the main restorative material used in<br />

veneer treatments. 8-9 However, some<br />

specific properties such as brittleness<br />

and superior hardness of the ceramic<br />

in relation to the dental tissue are the<br />

PREFABRICATED RESIN VENEER:<br />

A CASE REPORT OF A SIMPLIFIED<br />

RESTORATIVE TECHNIQUE<br />

By Dr. Pedro Paulo Albuquerque, Dr. Marina Baretto Pereira Moreno,<br />

Dr. Alexander Cassandri Nishida, Dr. Ezequias Rodrigues,<br />

Dr. Camila Kiyohara and Dr. Carlos Eduardo Francci<br />

The study aims to describe the step-by-step clinical cases using<br />

prefabricated composite resin veneers (PCRVs), manufactured<br />

with the composite Brilliant New Generation (COLTENE).<br />

disadvantages considered for this class<br />

of restorative materials. Additionally,<br />

the high cost of the ceramic prevents<br />

some patients from proceeding with the<br />

treatment. 10-11<br />

Restorative protocols with direct<br />

composite veneers have been introduced<br />

as an alternative for patients who cannot<br />

afford the high inherent cost of ceramics.<br />

Although cheaper, this technique presents<br />

some drawbacks, including the difficulty in<br />

mirroring, colour matching, construction<br />

of structures (ex. dentin mamelons<br />

and enamel characteristics such as<br />

translucency/opalescence) and the<br />

incorrect reproduction of the dental<br />

surface texture. 12 Additionally, the time<br />

required to execute the resin veneer,<br />

the colour instability of the material,<br />

marginal infiltration and secondary caries<br />

are critical factors that intimidate the<br />

dentist. 8,12<br />

The PCRVs simplify the veneer<br />

technique and their properties can<br />

improve the treatment’s longevity. 13<br />

The PCRV Componeer is manufactured<br />

from the composite Synergy D6 or<br />

Brilliant NG - nanohybrid materials. The<br />

PCRVs are fabricated under controlled<br />

laboratory conditions in relation to<br />

light, pressure and temperature. After<br />

these treatments, the material exhibits<br />

improved polymerisation, reaching a<br />

higher degree of conversion with lower<br />

pores and internal defects. PCRVs are<br />

available for the anterior teeth with<br />

0.3-1.0 mm of thickness with different<br />

sizes (small, medium,<br />

large and extra-large),<br />

two shades (transparent<br />

and bleach) and<br />

proportions based<br />

on the golden ratio<br />

concepts. 13-15<br />

In the reviewed<br />

literature, there are no clinical studies<br />

reporting the use of PCRV fabricated with<br />

the Brilliant NG composite resin. Only<br />

works with the PCRV produced with the<br />

Synergy D6 composite resin are available.<br />

According to the manufacturer, the<br />

Brilliant NG resin has a different organic<br />

matrix compared to Synergy D6, which<br />

influence the final behaviour of restorations<br />

over time. Therefore, the aim of the<br />

study is to describe two cases (stepby-step)<br />

with PCRV fabricated with the<br />

Brilliant NG resin.<br />

Fig. 1a: Initial situation<br />

Case 1: Single tooth restored with<br />

a PCRV<br />

A 42-year-old male patient presented<br />

with a debonded restoration in tooth #22<br />

(Fig. 1a). A clinical examination revealed<br />

acceptable periodontal condition and no<br />

carious lesions. After analysing the size of<br />

the restoration and the patient’s request,<br />

rehabilitation with PCRV (Componeer -<br />

Brilliant NG) was proposed.<br />

The colour matching was performed<br />

with a colour shade guide of the PCRV<br />

system, and the A2/B2 dentin shade<br />

40<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


User Report<br />

associated with the veneer (transparent)<br />

was selected. The colour matching of<br />

the Componeer relies on the concept<br />

of natural layering, in which two layers<br />

of the incremental technique is able to<br />

mimic the natural aspect of the teeth.<br />

Fig. 1b: Direct restoration with Brilliant NG composite<br />

(A2/B2 dentin)<br />

Fig. 1c: Size selection with the Contour Guide<br />

Moisture was controlled with a rubber<br />

dam and a new restoration was placed on<br />

tooth # 22 to reestablish the original<br />

anatomy (Fig. 1b). The treatment<br />

proceeded with the selection of the<br />

PCRV size (medium), using the contour<br />

guide specific to the Componeer (Fig. 1c).<br />

This contour guide presented different<br />

sizes of PCRV for the antero-superior<br />

and inferior tooth, which enables the<br />

dentist to select the correct size for each<br />

patient, respecting the fundamentals of<br />

the aesthetic smile.<br />

was etched with 37% phosphoric acid<br />

(Magic Acid, COLTENE) for 30 seconds,<br />

followed by abundant water rinse and<br />

air drying. The adhesive system One<br />

Coat Bond (COLTENE) was applied<br />

with a Technobrush (COLTENE) on the<br />

Fig. 1d: Tooth reduction to receive the PCRV<br />

tooth and on the internal surface of<br />

PCRV. The Brilliant NG composite resin<br />

(A2/B2 dentin) was used as the luting<br />

agent. Clinical steps of tooth wear,<br />

adhesive procedure and cementation<br />

were executed without the use of a rubber<br />

dam. However, it is important to note<br />

that the control of moisture was ensured<br />

through the insertion of the retraction<br />

cord (Pro Retract 0000, FGM). Such<br />

technique allows a satisfactory control<br />

of the gingival fluid and facilitates the<br />

correct positioning of PCRV.<br />

Fig. 1e: Placer Instrument of the Componeer system<br />

The veneer was fixed on the tooth with<br />

the instrument “Placer” included in the<br />

Componeer system (Fig. 1e). Excess resin<br />

was removed after a slight compression<br />

of the PCRV. The light-curing was carried<br />

out with an LED (Radii cal, SDI) with<br />

an irradiance of 1.200 mW/cm 2 for<br />

40 seconds. The excess resin was removed<br />

and no final polishing was required due<br />

to manufacturers’ pre-polishing of the<br />

PCRV (Fig. 1f). The patient was extremely<br />

pleased with the result.<br />

Case 2: Multiple restorations<br />

with PCRV<br />

In addition to single element (case 1),<br />

the PCRVs are also indicated for extensive<br />

rehabilitations. A 37-year-old female<br />

patient presented with an unhappy smile.<br />

Clinical examination revealed some<br />

deficient restorations (class III and IV)<br />

with multiple colour changes (Fig. 2a).<br />

As the patient requested urgency in the<br />

treatment, a one-visit technique using<br />

PCRVs was suggested.<br />

The restorations were removed with<br />

diamond burs (Fig. 2b), followed by the<br />

relief of the interproximal contact with<br />

abrasive stainless-steel strip (Fig. 2c).<br />

The teeth #13-23 were reduced to a<br />

minimum of 0.5 mm with a diamond<br />

bur in the buccal surface to facilitate<br />

the PCRV insertion. A haemostatic gel<br />

(Hemosthase, FGM) was applied in the<br />

gingival margin to contain possible bleeding<br />

(Fig. 2d), and a single retractor cord<br />

(ProRetract 0000, FGM) was inserted to<br />

control moisture (Fig. 2e).<br />

Subsequently, the contour guide was used<br />

A minimal preparation was performed<br />

on the buccal surface with a diamond<br />

bur #2068 (KG Sorensen) to facilitate<br />

the setting of the PCRV (Fig. 1d). The<br />

dental wear did not involve the dentin.<br />

It is important to highlight that there is<br />

no specific amount of dental wear for<br />

luting a PCRV, and the dentist should<br />

evaluate minimal wear to facilitate the<br />

luting procedure. The dental substrate<br />

Fig. 1f: Final aspect<br />

Fig. 2a: Initial situation<br />

42<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


User Report<br />

Fig. 2b: Tooth preparation<br />

Fig. 2c: Interproximal reduction with abrasive<br />

stainless-steel strips<br />

Fig. 2d: Application with haemostatic gel<br />

Fig. 2e: Insertion of retraction cord<br />

Fig. 2f: Dry proof of PCRV<br />

Fig. 2g: Acid-etching<br />

to select the veneer size (medium) and a<br />

dry proof with the PCRV was performed<br />

to view the possible final result (Fig. 2f).<br />

The colour matching was performed as<br />

described in case 1, and the Brilliant<br />

NG composite resin (A1/B1 dentin) and<br />

PCRV (Bleach) were selected. A mylar<br />

strip (Epitex, GC) was inserted into<br />

the proximal regions and fixed with a<br />

wood wedge (TDV) to facilitate cervical<br />

adaptation during cementation. The<br />

teeth were etched for 30 seconds with<br />

37% phosphoric acid (Magic Acid,<br />

COLTENE) (Fig. 2g), followed by abundant<br />

rinsing and drying. The adhesive<br />

One Coat Bond (COLTENE) was applied with a<br />

Technobrush (COLTENE) and gently airdried<br />

to remove the excess. The same<br />

adhesive system was also applied on the<br />

internal surface of the PCRV (Fig. 2h).<br />

The Brilliant NG composite resin<br />

(A1/B1 dentin) was manipulated in<br />

a sterile glass plate to facilitate the<br />

manipulation and adaptation into the<br />

PCRV. A Componeer system instrument<br />

was used to seat the PCRV and remove<br />

the excess resin. Photoactivation was<br />

performed as described in case 1<br />

(Fig. 2i). Cervical and proximal polishing<br />

was performed with abrasive disks<br />

(Diamond Pro, FGM), felts and diamond<br />

paste. The patient was satisfied and very<br />

happy with the result. Finally, the proper<br />

alignment of the teeth, desirable tooth<br />

shade and harmonious smile of the patient<br />

was achieved (Fig. 3).<br />

Discussion<br />

There are different techniques available<br />

for anterior restorations. The design of<br />

the tooth preparation can be extensive<br />

(ex. total crown) or minimally invasive<br />

(ex. veneers). 5 Although different, both<br />

crown and veneer treatments require<br />

multiple clinical and laboratory steps.<br />

Therefore, the single session required in<br />

the treatment with PCRV attracted a lot of<br />

attention in the dental community. 17,19-21<br />

Fig. 2h: Application of adhesive on the PCRV<br />

Fig. 2i: Light-curing with LED<br />

Ceramic veneers have been considered<br />

the gold standard due to their wellknown<br />

properties. 8-9 A previous study<br />

reported high survival rate of ceramic<br />

veneers, especially when the luting<br />

procedure is limited to enamel tissue. 9<br />

Additionally, the literature reported<br />

that the ceramic type and the extension<br />

of dental wear corroborate to the<br />

satisfactory results obtained. 2,3,9 A wellknown<br />

veneer alternative is based on<br />

the use of direct composite resin. This<br />

technique provides a high reproduction<br />

of details due to the greater number of<br />

composite with different shades. However,<br />

some drawbacks such as colour instability<br />

associated with the difficulty to execute<br />

the restoration, render this technique a<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 43


User Report<br />

hard work for the dentist. In the present<br />

study the use of PCRVs was simple and<br />

effective in meeting the patient’s need in<br />

only one session.<br />

The use of indirect composite veneer is not<br />

new. 8 This procedure was proposed with the<br />

Mastique Laminate Veneer (Caulk) in<br />

the 1970s. 23 At this time, the veneers<br />

were produced with acrylic resin and the<br />

luting procedure was carried out using a<br />

light-sensitive composite resin. Although<br />

innovative, the inherent fragility of the<br />

acrylic veneers associated with the weak<br />

bonding to the dental tissue resulted in<br />

the failure of the system.<br />

Recently, two systems of PCRV were<br />

proposed. The Direct Veneer (Edelweiss)<br />

was developed in 2009 and the<br />

Componeer (COLTENE) in 2011 24 . Both<br />

systems presented PCRVs produced under<br />

laboratory conditions. It is<br />

inferred that the treatment<br />

used in the manufacturing<br />

of the Componeer could<br />

result in a high degree<br />

of conversion of the<br />

composite. In theory, this<br />

polymerisation can promote<br />

an increase in the density of<br />

cross-linked double bonds<br />

in the polymer network.<br />

This reaction can decrease<br />

the amount of non-reactive<br />

components, resulting in a<br />

Fig. 3a<br />

material with high strength, hardness and<br />

colour stability in relation to direct photo<br />

activated composites. 14,22<br />

Previous studies reported some difficulties<br />

in the colour matching of direct resin<br />

restorations. 13,22 An interesting feature<br />

of the Componeer system (Brilliant NG)<br />

is presented by the chameleon effect<br />

of the composite used for the veneer<br />

cementation. It is reported that this<br />

technology induces a selective refraction<br />

index of the inorganic particles in the<br />

composite formulation, which provides<br />

a lower number of the colour since<br />

the composite can reproduce different<br />

shades of the VITA scale (ex. Brilliant NG<br />

A1/B1 dentin). 13,16 This characteristic was<br />

confirmed in the present investigation and<br />

one composite shade was used for the<br />

luting of the PCRV. No colour difference<br />

can be observed in the final result.<br />

Fig. 3b<br />

Fig. 3c<br />

Fig.3: The final results of case 2 (facial, right and left view)<br />

The literature reported several<br />

indications for PCRV 13-16 . Previous clinical<br />

studies described the use of PCRV<br />

manufactured with the Synergy D6<br />

composite resin to solve different clinical<br />

scenarios. Aesthetic reestablishment<br />

of the smile 16-17 , elimination of tooth<br />

darkness resulting from an endodontic<br />

treatment 16,18-20 and the correction of<br />

fluorosis stains have been reported with<br />

satisfactory results. 21 However, fewer in<br />

vitro studies regarding the properties<br />

of PCRV are published in the literature.<br />

A previous work reported different<br />

results of bond strength for different<br />

materials. 22 The PCRV and the ceramic<br />

E.max Press (Ivoclar Vivadent) showed<br />

similar micro-shear bond strength after<br />

thermocycle aging. Despite the results<br />

obtained, it is important to observe that<br />

the author used different luting agents,<br />

which could affect the comparison of the<br />

final bond strength results.<br />

The longest follow-up reported with<br />

the PCRV was no more than one year. 17<br />

In relation to the composite resin, the<br />

literature reported a decrease in the<br />

surface gloss over time. Therefore,<br />

a new polish procedure is necessary<br />

to reestablish the original aesthetic<br />

appearance. Thus, despite the excellent<br />

immediate results obtained in the present<br />

study, further clinical studies with longer<br />

follow-ups should be developed and<br />

associated with laboratory researches<br />

in order to evaluate the mechanical and<br />

optical properties of the PCRV.<br />

44<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


User Report<br />

Conclusion<br />

Prefabricated composite resin veneers<br />

have been advocated as an alternative to<br />

direct composite veneers. The simplified<br />

execution and improved properties of<br />

the PCRV enable results with greater<br />

longevity. It is important to highlight<br />

that this procedure does not replace the<br />

already established veneer technique with<br />

dental ceramics. DA<br />

References:<br />

1. Moraschini V, Fai CK, Monte Alto<br />

R, Santos GO. Amalgam and resin<br />

composite longevity of posterior<br />

restorations: A systematic review<br />

and meta-analysis. J dent.<br />

2015;43:1043–1050.<br />

2. Peumans M, Van Meerbeek B,<br />

Lambrechts P, Vanherle G. Porcelain<br />

veneers: a review of the literature. J<br />

Dent. 2000;28:163–177.<br />

3. Albanesi R B, Pigozzo MN, Sesma<br />

N, Lagana DC, Morimoto S. Incisal<br />

coverage or not in ceramic laminate<br />

veneers: A systematic review and<br />

meta-analysis. J Dent. 2016;52:1–7.<br />

4. Francci CE, Riquieri H, Nishida AC,<br />

Saavedra GSFA. Harmonização<br />

do sorriso – Do planejamento<br />

digital à cimentação de laminados<br />

Prepless – Parte I. Eur J EsthetDent.<br />

2016;1(1):42–61.<br />

5. Pincus CR. Building mouth<br />

personality. A paper presented at:<br />

California State <strong>Dental</strong> Association<br />

1937; San Jose, California.<br />

6. Van Meerbeek B, Yoshihara K,<br />

Yoshida Y, Mine A, De Munck J,<br />

Van Landuyt KL. State of the art<br />

of self-etch adhesives. Dent Mater.<br />

2011;27(1):17–28.<br />

7. Pashley DH, Tay FR, Breschi L,<br />

Tjaderhane L, Carvalho RM, Carrilho<br />

M, Tezvergil-Mutluay A. State of<br />

the art etch-and-rinse adhesives.<br />

DentMater. 2011;27(1):1–16.<br />

8. Demarco FF, Collares K, Coelhode-Souza<br />

FH, Correa MB, Cenci<br />

MS, Moraes RR, Opdam NJ. Anterior<br />

composite restorations: A systematic<br />

review on long-term survival and<br />

reasons for failure. Dent Mater.<br />

2015;31(10):1214–24.<br />

9. Gurel G, Sesma N, Calamita Ma,<br />

Coachman C, Morimoto S. Influence<br />

of Enamel Preservation on Failures<br />

Rates of Porcelain Laminate Veneers.<br />

Int J Periodontics Restorative Dent.<br />

2013;1:31–39.<br />

10. Anusavice KJ. Standardizing failure,<br />

success, and survival decisions in<br />

clinical studies of ceramic and metalceramic<br />

fixed dental prostheses. Dent<br />

Mater. 2012;28(1):102–111.<br />

11. Rashid H, Sheikh Z, Misbahuddin<br />

S, Kazmi MR, Qureshi S, Uddin MZ.<br />

Advancements in all-ceramics for<br />

dental restorations and their effect<br />

on the wear of opposing dentition.<br />

Eur J Dent. 2016;10(4):583–8.<br />

12. Heintze SD, Rousson V, Hickel R.<br />

Clinical effectiveness of direct anterior<br />

restorations—A meta-analysis. Dent<br />

Mater. 2015;31(5):481–95.<br />

13. Rusher G. Direct restoration of<br />

lower anteriors with componeer by<br />

Coltene/Whaledent. User- Report<br />

2011:COMPONEER.<br />

14. Gomes G, Perdigao J. Prefabricated<br />

composite resin veneers--a clinical<br />

review. J of Est and Rest Dent:<br />

official publication of the American<br />

Academy of Esthetic Dentistry.<br />

2014;26(5):302–13.<br />

15. Shinde TV, AS D. Componeers<br />

crowning glory of esthetic dentistry.<br />

Int J <strong>Dental</strong> Clin. 2014;6(1):10–1.<br />

16. Shumilovich BR, Spivakova IA, YB YB.<br />

V Clinical Experience with a System<br />

of Direct Componeer (Coltene/<br />

Whaledent, Switzerland) Composite<br />

Veneers Work Difficulties and Ways<br />

of Overcoming Them. J Health Sci.<br />

2014;2:604–11.<br />

17. Martini CE, Parreiras SO, Sezsz AL,<br />

Pupo YM, Gomes GM, Mongruel OMG,<br />

Gomes JC. Aesthetic Treatment with<br />

Prefabricated Composite Veneers–<br />

Case Report. Dent O Cran Res.<br />

2016;2(3):282–286.<br />

18. Dietschi D, Devigus A. Prefabricated<br />

Composite Veneers: Historical<br />

Perspectives, Indications and<br />

Clinical Application. Eur J EsthetDent.<br />

2011;6(2):1–11.<br />

19. Gonçalves R, Correia I, Cardoso<br />

Ferreira J, Pires P, Carvalho MT,<br />

Pina‐Vaz I. Descoloração dentinária:<br />

aplicação de facetas Componeer®<br />

Rev Port Estomatol Cir Maxilofac.<br />

2015;56(2):132–8.<br />

20. Migliau G, Besharat LK, Sofan AAA,<br />

Sofan EAA, U R. Endo-restorative<br />

treatment of a severely discolored<br />

upper incisor: resolution of the<br />

“aesthetic” problem through<br />

Componeer veneering System. Ann<br />

Stomatol. 2015;3(4):113–8.<br />

21. Du Toit J, Patel N, Montalli V, S J.<br />

Aesthetic treatment of severely<br />

fluorosed teeth with prefabricated<br />

composite veneers: a case report.<br />

IntDent–AfricanEdition. 2012;2(6)<br />

22. Perdigao J, Sezinando A, Munoz<br />

MA, Luque-Martinez IV, Loguercio<br />

AD. Prefabricated veneers - bond<br />

strengths and ultramorphological<br />

analyses. J Adhes Dent.<br />

2014;16(2):137–46.<br />

23. Haas BR. Mastique veneers: a<br />

cosmetic and financial alternative<br />

in post-periodontal care. J N J Dent<br />

Assoc. 1982 Fall;53(4):25–7.<br />

24. Dietschi D, Devigus A. Prefabricated<br />

Composite Veneers Historical<br />

Perspectives Indications and Clinical<br />

Application. Eur J Esthet Dent.<br />

2011;6(2):2–11.<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 45


User Report<br />

Guided Concept in the<br />

Aesthetic Zone<br />

By Dr. Stefen Koubi and MDT Gérald Ubassy<br />

Introduction<br />

The restorative treatment of anterior<br />

teeth often presents a considerable<br />

challenge to general dentists. The aim<br />

is always to obtain the best possible<br />

result. A well-guided approach is<br />

necessary if the visualised outcome is<br />

to be achieved. Precision planning and<br />

a consistent protocol are indispensable.<br />

Modern dentistry has simplified the<br />

ways and means of attaining aesthetic<br />

results. Nevertheless, the success of<br />

the treatment, in the anterior region in<br />

particular, greatly depends on meticulous<br />

planning, which includes a detailed<br />

analysis of the patient’s smile as well as<br />

the fabrication of a working model. This<br />

model is used to plan and reproduce<br />

the shapes and contours of the future<br />

restoration with utmost precision. This<br />

article describes a comparatively simple<br />

treatment technique on the basis of<br />

a clinical case. The initial aesthetic<br />

treatment plan was jointly developed by<br />

the dental technician and the dentist. It<br />

served as a guide or “GPS” for all the<br />

clinical steps which helped the dental<br />

team to successfully “navigate” through<br />

the treatment.<br />

Clinical case presentation<br />

A woman in her forties consulted our<br />

practice due to extreme mobility of her<br />

front teeth, which had caused aesthetic<br />

problems (Figs. 1-2). The teeth had moved<br />

forward and the level of the smile line had<br />

dropped. Due to severe periodontitis, the<br />

upper front teeth showed considerable<br />

gingival recession (Fig. 3). A detailed<br />

examination revealed that the four upper<br />

front teeth could not be saved and had to<br />

be extracted. The treatment plan was to<br />

insert two implants in the sockets of tooth<br />

12 and 22 after the extraction process.<br />

Subsequently, an implant-supported<br />

bridge extending from tooth 12 to 22<br />

would be fabricated and tooth 13 and<br />

23 would be restored with single crowns.<br />

The main objective was to restore the<br />

harmonious appearance of the smile line<br />

and the convex shape of the gingiva. The<br />

patient’s smile was analysed by means<br />

of a photographic record. Furthermore,<br />

impressions of the situation were taken.<br />

Based on this information, a provisional<br />

bridge spanning from tooth 13 to 23 and<br />

incorporating the aesthetic and functional<br />

adjustments would be produced with<br />

PMMA (polymethyl methacrylate) material<br />

(Telio ® CAD).<br />

Fig. 1: The patient was dissatisfied with her smile<br />

Fig. 2: The anterior teeth were damaged due to<br />

periodontitis and moved labially and extruded.<br />

Fig. 3: Intraoral view: severe periodontitis caused<br />

gingival recession for the upper central incisors<br />

Surgical procedure<br />

At the second treatment session, the<br />

four upper incisors were extracted.<br />

The canines 13 and 23 were prepared<br />

to receive the provisional bridge<br />

(Fig. 4). During the same appointment, two<br />

implants (V3, MIS Implants Technologies)<br />

were inserted in the sockets of tooth 12<br />

and 22. The implants would serve as the<br />

abutments for the implant-supported<br />

bridge. The surgical procedure also<br />

included two connective tissue grafts<br />

in the area of tooth 11 and 21 in order<br />

to increase the horizontal volume of the<br />

jaw. The augmentation of the ridge tissue<br />

helped to restore the convex shape of<br />

the dental arch and established a sound<br />

basis for the development of a naturallooking<br />

emergence profile. Therefore, the<br />

alveolar sockets of tooth 11 and 21 were<br />

filled with a bone replacement material<br />

(xenograft product, Bio Oss) to prevent<br />

the gingival tissue from collapsing after<br />

the tooth extraction.<br />

Fig. 4: After extraction<br />

After the surgical procedure, the<br />

provisional bridge was placed (Fig. 5).<br />

The provisional restoration plays a<br />

significant part in this type of treatment<br />

and considerably influences its outcome.<br />

A flowable composite material was<br />

applied to the base of the provisional<br />

bridge to condition the gingival tissue<br />

and shape the desired emergence profile.<br />

Suitable conditioning of the gums helps<br />

to preserve the tissue volume.<br />

46<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


User Report<br />

Fig. 11: Translucency of the zirconium oxide<br />

Fig. 5: Placement of the provisionals during the<br />

implant insertion<br />

It should be noted that when the model<br />

for the provisional restoration was<br />

fabricated in the dental laboratory, the<br />

alveolar sockets had to be prepared<br />

accordingly. Since this type of minimal<br />

surgical intervention prevented the need<br />

for flap surgery, the wound healed cleanly<br />

and quickly. Hardly any postoperative<br />

complaints occurred.<br />

After six months<br />

The gingival conditioning/preservation<br />

effort showed to be successful when<br />

the provisional bridge was removed<br />

(Figs. 6-7). Even the interdental<br />

papillae between the upper implants<br />

were beautifully formed. This situation<br />

established an ideal basis for a smooth<br />

and aesthetic integration of the permanent<br />

all-ceramic restorations (Fig. 8). Since<br />

bone resorption had progressed to an<br />

advanced stage in the anterior zone due to<br />

severe periodontitis, tilted implants had to<br />

be used: a screw-retained denture could<br />

not have been considered as a viable<br />

option in this case.<br />

Fig. 6: After six months<br />

Fig. 8: Excellent soft tissue conditioning and<br />

successful formation of interdental papillae<br />

Fabrication of permanent<br />

restorations<br />

After the final impression-taking process, a<br />

virtual model of the provisional restoration<br />

was produced. The frameworks were cut<br />

back to create a suitable basis for the<br />

ceramic restorations. The abutments<br />

were fabricated with IPS e.max ®<br />

Press using the press technique. The<br />

abutments were bonded extraorally to the<br />

titanium bonding bases with the reliable<br />

Multilink ® Hybrid Abutment luting<br />

composite (Fig. 9). The zirconium oxide<br />

frameworks for the bridge as well as<br />

for the crowns on tooth 13 and 23 were<br />

produced with IPS e.max ZirCAD MT:<br />

a material featuring high translucency<br />

and outstanding aesthetic properties<br />

(Figs. 10-11). The frameworks were<br />

characterised and individually veneered<br />

with the highly aesthetic IPS e.max Ceram<br />

layering ceramic (Figs. 12-13).<br />

Fig. 9: Hybrid abutments made with pressed ceramic<br />

(IPS e.max Press) on the model<br />

Fig. 12: Veneering of the framework with the IPS<br />

e.max Ceram layering ceramic<br />

Fig. 13: Restorations before placement/cementation<br />

Seating of the restorations<br />

The try-in session again showed that the soft<br />

tissue was well-formed (Figs. 14-15). The<br />

zirconium oxide-supported restorations<br />

were placed with the self-adhesive<br />

SpeedCEM ® Plus luting cement. For this<br />

purpose, the IPS e.max Press lithium<br />

disilicate abutments were etched with<br />

hydrofluoric acid and then silanised with<br />

Monobond Plus in order to condition<br />

them for the bonding procedure to the<br />

bridge. The permanently seated zirconium<br />

oxide-supported crowns and the bridge<br />

exhibited a translucency level similar to<br />

lithium disilicate (Figs. 16-18). The result<br />

in this case was exceptionally aesthetic:<br />

the relationship between the restorations<br />

and the soft tissue looks harmonious and<br />

natural (Figs. 19-21).<br />

Fig. 7: Occlusal view: after removal of<br />

provisional bridge<br />

Fig. 10: Crown copings and bridge framework made<br />

with IPS e.max ZirCAD MT<br />

(translucent zirconium oxide)<br />

Fig. 14: All-ceramic abutments in situ<br />

48<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


User Report<br />

Fig. 15: Integration of the bridge in the periodontium<br />

Fig. 20: Patient smiling with a beautiful lip line<br />

Fig. 21: A satisfied<br />

and ecstatic patient<br />

Conclusion<br />

Precise planning and excellent<br />

collaboration among the members of the<br />

dental team are essential in the treatment<br />

of complex cases. It is important to carry<br />

out surgical interventions carefully and in<br />

stages which immensely contributes to the<br />

final aesthetic outcome. The ability to use<br />

translucent zirconium oxide in the anterior<br />

tooth region, due to the highly attractive<br />

optical properties of this material, opens<br />

up entirely new aesthetic possibilities.<br />

In complex restorative procedures in<br />

the anterior zone, straightforward,<br />

well-planned and digitally based<br />

treatment protocols are the method of<br />

choice for obtaining predictable and<br />

reproducible results. DA<br />

About the Authors<br />

Fig. 16: Natural-looking emergence profile<br />

Fig. 17: Inspection of the functional parameters<br />

Fig. 18: Occlusal view: convex shaped of the gingiva<br />

is restored<br />

Fig. 19: Smile close-up with ideal light-optical<br />

properties<br />

Dr. Stephen Koubi graduated from the Marseille University School<br />

of Dentistry, France, in 1998. From 1998 to 2001, he worked as a<br />

clinical assistant at the Hôpital Louis Mourier (Hôpitaux de Paris) in<br />

the Department of Stomatology headed by Prof. Poidatz. In addition,<br />

he was research assistant at the University of Paris V, School of<br />

Dentistry in Montouge. In June 2001, he received the AEA diploma<br />

(clinical traineeship) and the DEA diploma (postgraduate study program) at the department<br />

headed by Prof. de Lumley of the Hôpital Nord in Marseille, France. He earned a doctorate<br />

degree in dental surgery in 2001. In the same year, he became an assistant at the<br />

department of Conservative Odontology headed by Prof. Koubi at the University Clinic of<br />

Marseille, France.<br />

Dr. Koubi opened a private dental practice in Marseille in 2002. In 2004, he obtained a<br />

university diploma in oral implantology. In April 2004, he was appointed assistant professor<br />

at the Department of Conservative Odontology of the Marseille University School of Dentistry.<br />

He became the Associate Professor in 2008 and earned his PhD in 2011. Moreover, he was<br />

awarded the Gold Molar by the students of Marseille University. In 2009, he established a<br />

private dental practice in Paris, France.<br />

Dr. Koubi is the founder of “L'institut de la facette”, a private training centre established<br />

in 2013 which mainly focuses on laminate veneer restorations and the minimally invasive<br />

rehabilitation of worn dentitions. Dr Koubi is the author of various national and international<br />

publications and reports. He has lectured internationally on the topics of aesthetic dentistry,<br />

smile design, wear and erosion.<br />

MDT Gérald Ubassy is a dental ceramist, a gold medal prize-winner of the<br />

best workmen of France contest in 1986 and directs his own laboratory<br />

since 1982.<br />

He has authored three books :<br />

• “SHAPE AND COLOR” the keys to success in dental ceramic porcelain<br />

(Quintessence Publishing), translated into 7 languages and a book for<br />

communication regarding natural teeth,<br />

• “ANALYSIS”, the New Way in <strong>Dental</strong> Communication, Publishers “M.E.A” as well as a<br />

recent book about his work philosophy and all his hints :<br />

• “TIPS AND HINTS” translated into 14 languages, publishers “Teamwork media srl”.<br />

He is an organiser for more than 15 years of practical training courses in his International<br />

<strong>Dental</strong> Training Center in Rochefort du Gard. He continues to share and communicate<br />

his knowledge in lectures and training courses.<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 49


User Report<br />

Abstract<br />

A 47-year-old male<br />

presented with pain in the<br />

temporomandibular joint (TMJ).<br />

He also had an aesthetic request<br />

since part of his veneer on<br />

the middle upper incisors had<br />

broken off. Fully digitalised work<br />

steps were used to remedy this<br />

issue: the Digital Smile Design<br />

protocol was applied and,<br />

following a minimally invasive<br />

preparation, monolithic veneers<br />

and crowns made of lithium disilicate<br />

ceramic were produced by means of<br />

CAD/CAM. The aim of rehabilitation was<br />

to remedy the loss of bite height as well<br />

as the associated aesthetic and jaw joint<br />

impairments.<br />

Background<br />

The digitalisation of work steps in<br />

dentistry has gained ground in recent<br />

years due to the technical advances<br />

with regards to intraoral scanners and<br />

software programs. This development has<br />

also resulted in improved communication<br />

between the dentist and dental technician.<br />

Digital Smile Design (DSD) is a digital tool<br />

for planning the aesthetic restoration<br />

of facial symmetry. It not only aids<br />

communication between specialists, but<br />

also improves the treatment results which<br />

can be expected. 1 Dynamic documentation<br />

of the smile is an important step in the<br />

2D/3D Digital Smile Design process. The<br />

process can be fully digitalised and also<br />

supports the rehabilitation procedure. The<br />

advantages of video documentation lie in<br />

the fact that this renders documentation,<br />

the Smile Design, the analysis of the facial<br />

symmetry, treatment planning, team<br />

communication and patient education<br />

both more simple and more effective. 2 The<br />

DSD can be converted into a conventional<br />

or virtual diagnostic model to simplify<br />

the subsequent clinical treatments, e.g.<br />

CAD/CAM restoration. 3–7 The combination<br />

of the adhesive technique with lighttransmissive<br />

restoratives makes preparing<br />

for minimally invasive restorative dentistry<br />

interventions simpler. Materials such<br />

as lithium-disilicate ceramic 8–11 boast<br />

Correction of Bite Height:<br />

Fully Digitalised Work Steps,<br />

Integration of the <strong>Dental</strong> Scanner,<br />

Smile Design and CAD/CAM<br />

In this report, a clinical case is represented with<br />

fully digitalised work steps.<br />

By Dr. Miguel Stanley, Dr. Ana Gomes Paz, Dr. Inês Miguel<br />

and Dr. Christian Coachman<br />

similar properties to natural teeth which,<br />

in turn, enabled positive results to be<br />

achieved. 12-13<br />

Intraoral scanners are an important tool<br />

in the digital workflow. These handy<br />

devices allow the impression quality to<br />

be checked directly and, in addition,<br />

the models can be simply transferred,<br />

cost-effectively and quickly via e-mail to<br />

the laboratory. 14 However, there is little<br />

information in the literature about the<br />

ability of intraoral scanners to produce<br />

high-quality impressions. 15–24<br />

Computer-aided design (CAD) software<br />

is invaluable as it controls the fully<br />

automated devices which create the<br />

objects and assemblies in a virtual<br />

environment. 25<br />

In this report, a clinical case is represented<br />

with fully digitalised work steps. Following<br />

minimally invasive preparation, the<br />

Digital Smile protocol and the monolithic<br />

veneers and crowns made from lithiumdisilicate<br />

ceramic remedy the loss of bite<br />

height as well as the associated aesthetic and<br />

jaw joint impairments through CAD/CAM.<br />

Case presentation<br />

In 2015, a 47-year-old male presented<br />

with pain in the temporomandibular joint<br />

(TMJ). He also had an aesthetic request<br />

since part of his veneer on the middle<br />

upper incisors had broken off (Figs. 1-3).<br />

The clinical and radiographic analysis<br />

(Fig. 4) indicated a loss of bite height and<br />

tooth substance due to bruxism.<br />

Fig. 1: Intraoral photo prior to treatment<br />

(frontal view)<br />

Fig. 2: Occlusal view of the maxilla<br />

Fig. 3: Occlusal view of the mandibular<br />

Fig. 4: Initial situation – Panoramic image (2015)<br />

Digital intraoral photos were taken from<br />

the frontal view under retraction as well as<br />

from the occlusal and lateral perspectives.<br />

More photos were also taken using a<br />

digital single-lens reflex camera (DSLR)<br />

(frontal, lateral and 45°). A diagnostic<br />

impression of both jaws was produced with<br />

an intraoral scanner (Carestream 3500).<br />

The maximum intercuspal position (MIP)<br />

was determined intraorally using the<br />

50<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


User Report<br />

intraoral scanner Carestream 3500 and<br />

the new vertical dimension of occlusion<br />

(VDO) was achieved respectively through<br />

the wide opening of the virtual articulator<br />

in the CAD/CAM software.<br />

The dynamic documentation protocol of<br />

the Digital Smile Design (DSD) was used:<br />

videos were recorded with a smartphone<br />

from four different calculated angles<br />

to achieve harmonious facial smile<br />

symmetry: a frontal video of the smiling<br />

face with and without the lip and cheek<br />

retractor, a profile video, a 12 o’clock<br />

video and an anterior occlusion video<br />

perpendicular to the occlusal level without<br />

a mirror.<br />

Four supplementary videos were recorded<br />

for the functional, structural and facial<br />

analysis: a consultation that matched the<br />

patient’s expectations, a 180° phonetic<br />

video, an intraoral functional and intraoral<br />

structural video with lip and cheek<br />

retractor (Fig. 5). The information was<br />

transmitted to the DSD laboratory. The<br />

main goal of the DSD technique is to<br />

reconcile the photos from the three views<br />

(occlusal, frontal and 12 o’clock) with<br />

a digital ruler in order to recreate the<br />

correct smile proportions by means of a<br />

video analysis (Smile Frame).<br />

Fig. 5: DSD protocol:<br />

image of patient<br />

smiling wearing a lip<br />

and cheek retractor.<br />

Cupid’s bow and jaw curve. The<br />

2D proportions of the smile were<br />

converted in the CAD software into a<br />

digital 3D simulation model. The resulting<br />

3D file in STL format was transmitted to a<br />

printer which created the model with the<br />

new design. It was then used to produce a<br />

matrix made of Bis-acryl (Structur; VOCO)<br />

for the motivational mock-up (Fig. 6).<br />

Fig. 6: Motivational mock-up made of Bis-acryl<br />

(Structur 3, VOCO)<br />

The vertical dimension (VD) was increased<br />

in the new model and for this reason<br />

the patient tested the mock-up over the<br />

course of two weeks to ensure the new<br />

bite height met his expectations. The bite<br />

trial showed no stability problems and<br />

the patient was happy with the result.<br />

As such, there was no need for further<br />

deprogramming of the occlusion and<br />

definition of a new centric relation. The<br />

patient felt comfortable with this new VD<br />

and experienced no pain in the TMJ. The<br />

treatment plan was presented yet the<br />

patient chose not to continue treatment<br />

for financial reasons.<br />

(Structur; VOCO) using a vacuum formed<br />

matrix (V-print Ortho clear; VOCO). The<br />

abutment teeth were minimally prepared<br />

on the basis of the mock-up (Fig. 8).<br />

Figs. 8: No preparation of the posterior teeth,<br />

minimal preparation of the bottom anterior teeth,<br />

with the exception of 11, 12, 13, 21, 22, 23, which<br />

were already prepared.<br />

The old teeth preparations in the second<br />

sextant were retained; the upper posterior<br />

teeth (14–17, 24–27) and the lower<br />

posterior teeth (34, 35, 36, 37, 44, 45,<br />

46, 47) were not prepared and the lower<br />

anterior teeth were minimally prepared.<br />

A new intraoral scan was produced.<br />

The information was transmitted to<br />

the DSD laboratory (Fig. 9) which<br />

created an STL file with virtual models<br />

which were produced in the laboratory<br />

(Anatomic Lab). These 3D models<br />

(V-Print model; VOCO) were created in a<br />

3D printer (SolFlex 650; VOCO).<br />

The Smile Frame was then created as<br />

follows, taking the facial symmetry into<br />

account: digital face bow, form and<br />

position of the smile curve, determination<br />

of width using the recurring esthetic dental<br />

(RED) correlation, length proportions,<br />

gingival curve, papillary curve,<br />

Fig. 7: Two years later, prior to treatment (2017)<br />

The patient returned to the practice<br />

in 2017 to resume treatment (Fig. 7)<br />

and a new intraoral scan (Carestream<br />

3600) was produced. A new mock-up for<br />

the tooth preparation was printed on a<br />

3D printer (SolFlex; VOCO) with Bis-acryl<br />

Fig. 9: DSD planning<br />

The final veneers and crowns were<br />

digitally prepared using the design<br />

software Ceramill ® mind (Amann Girrbach)<br />

and produced in a milling machine<br />

(Ceramill ® Motion 2, Amann Girrbach)<br />

from machinable lithium disilicate ceramic<br />

blocks (VITABLOCS ® TriLuxe forte for<br />

Ceramill ® Motion 2, Amann Girrbach)<br />

(Fig. 10). After confirming the marginal<br />

seal and the visual properties through<br />

trial insertion, a lip and cheek retractor<br />

52<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


User Report<br />

(OptraGate, Ivoclar Vivadent) were placed<br />

in the patient’s mouth.<br />

Fig. 10: Final veneers and crowns digitally prepared<br />

using the design software Ceramill ® mind and<br />

produced in a milling machine (Ceramill ® Motion 2)<br />

from machinable lithium disilicate ceramic blocks<br />

(VITABLOCS ® TriLuxe forte for Ceramill ® Motion 2)<br />

The abutment teeth and ceramic<br />

veneers and crowns were prepared in<br />

accordance with the manufacturer’s<br />

recommendations: The ceramic surface<br />

was prepared with 50 μm aluminium oxide<br />

and for 20 seconds with hydrofluoric acid<br />

5%, it was then rinsed for 20 seconds<br />

before being treated with phosphoric acid<br />

37% (Total Etch, Ivoclar Vivadent) and<br />

alcohol 96% in order to be cleaned and<br />

finally conditioned for 20 seconds with<br />

silane (Monobond Plus, Ivoclar Vivadent).<br />

Fig. 11<br />

Fig. 12<br />

Figs. 11-12: The crowns (11, 12, 13, 21, 22, 23)<br />

and veneers (14, 15, 16, 17, 24, 25, 26, 27, 31,<br />

32, 33, 34, 35, 36, 37, 41, 42, 43, 44, 45, 46, 47)<br />

were secured to the abutments using a light-curing,<br />

polymerising resin adhesive (Futurabond U and Bifix<br />

QM, VOCO, Germany)<br />

The crowns (11–13, 21–23) and veneers<br />

(14, 15, 16, 17, 24, 25, 26, 27, 31, 32,<br />

33, 34, 35, 36, 37, 41, 42, 43, 44, 45, 46,<br />

47) were secured to the abutments using<br />

a light-curing, polymerising resin adhesive<br />

(Futurabond U and Bifix QM; VOCO).<br />

A high-performance LED light curing<br />

device (Celalux 3; VOCO) was used for<br />

polymerisation (Figs. 11-12).<br />

Excess luting material was removed and<br />

the occlusion was adapted and checked<br />

with the T-scan technology (Tekscan).<br />

A removable acryl splint was used to<br />

protect the final restorations. The final<br />

restorations were checked after six<br />

months. It was still stable and showed<br />

no signs of fractures (Figs. 13-15). The<br />

patient also reported that he no longer<br />

suffered from headaches with the new<br />

bite height.<br />

Fig. 13<br />

Fig. 14<br />

Figs. 13-14: Intraoral photo following treatment<br />

Fig. 15: Panoramic image at the end of treatment<br />

Conclusion<br />

Thanks to dental technological<br />

developments, fully digitalised treatment<br />

was possible, which can successfully<br />

solve problems such as a loss of bite<br />

height. However, further clinical studies<br />

are necessary in order to arrive at<br />

reliable results with regards to the digital<br />

work process compared to conventional<br />

techniques in the event of loss of bite<br />

height. The functionality of permanent<br />

restorations must also be assessed in the<br />

long term. DA<br />

References:<br />

1. Coachman C, Van Dooren E, Gürel G, Landsberg<br />

CJ, Calamita MA, Bichacho N. Smile design:<br />

From digital treatment planning to clinical<br />

reality. In: Cohen M, editor. Interdisciplinary<br />

Treatment Planning. Vol 2: Comprehensive<br />

Case Studies. Chicago: Quintessence; 2012.<br />

p. 119–74.<br />

2. Coachman C, Calamita A, Sesma N. Dynamic<br />

documentation of the smile and the 2D/3D<br />

digital smile design process. Int J Periodontics<br />

Restorative Dent. 2017;37:183–93.<br />

3. Pimentel W, Teixeira ML, Costa PP, Jorge<br />

MZ, Tiossi R. Predictable outcomes with<br />

porcelain laminate veneers: a clinical report. J<br />

Prosthodont. 2016;25: 335–40.<br />

4. Lin WS, Zandinejad A, Metz MJ, Harris BT,<br />

Morton D. Predictable restorative work flow<br />

for computer-aided design/computer-aided<br />

manufacture-fabricated ceramic veneers<br />

utilizing a virtual smile design principle. Oper<br />

Dent. 2015;40: 357–63.<br />

5. Arias DM, Trushkowsky RD, Brea LM, David SB.<br />

Treatment of the patient with gummy smile in<br />

conjunction with digital smile approach. Dent<br />

Clin N Am. 2015;59:703–16.<br />

6. Coachman C, Calamita MA, Coachman FG,<br />

Coachman RG, Sesma N. Facially generated<br />

and cephalometric guided 3D digital design for<br />

complete mouth implant rehabilitation: a clinical<br />

report. J Prosthet Dent. 2017;117:577–86.<br />

7. Zimmermann M, Mehl A. Virtual smile design<br />

systems: a current review. Int J Comput Dent.<br />

2015;18:303–17.<br />

8. Edelhoff D, Liebermann A, Beuer F, Stimmelmayr<br />

M, Güth JF. Minimally invasive treatment options<br />

in fixed prosthodontics. Quintessence Int.<br />

2016; 47:207–16. https://doi.org/10.3290/j.<br />

qi.a35115.<br />

9. Culp L, McLaren EA. Lithium disilicate: the<br />

restorative material of multiple options.<br />

Compend Contin Educ Dent. 2010;31:716–25.<br />

10. Zarone F, Ferrari M, Mangano FG, Leone R,<br />

Sorrentino R. Digitally oriented materials:<br />

focus on lithium disilicate ceramics. Int J Dent.<br />

2016;2016:9840594.<br />

11. Soares PV, Spini PH, Carvalho VF, Souza PG,<br />

Gonzaga RC, Tolentino AB, et al. Esthetic<br />

rehabilitation with laminated ceramic veneers<br />

reinforced by lithium disilicate. Quintessence Int.<br />

2014;45:129–33. https://doi.org/10.3290/j.<br />

qi.a31009.<br />

12. Morimoto S, Albanesi RB, Sesma N, Agra CM,<br />

Braga MM. Main clinical outcomes of feldspathic<br />

porcelain and glass-ceramic laminate veneers: a<br />

systematic review and meta-analysis of survival<br />

and complication rates. Int J Prosthodont.<br />

2016;29:38–49.<br />

13. Sulaiman TA, Delgado AJ, Donovan TE. Survival<br />

rate of lithium disilicate restorations at 4<br />

years: a retrospective study. J Prosthet Dent.<br />

2015;114:364–6.<br />

14. Tarantili VV, Halazonetis DJ, Spyropou-Los MN.<br />

The spontaneous smile in dynamic motion. Am<br />

J Orthod Dentofac Orthop. 2005;128:8–15.<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 53


User Report<br />

15. Ender A, Mehl A. Accuracy of complete-arch<br />

dental impressions: a new method of measuring<br />

trueness and precision. J Prosthet Dent.<br />

2013;109:121–8.<br />

16. Aragón ML, Pontes L, Bichara L, Flores-Mir C,<br />

Normando D. Validity and reliability of intraoral<br />

scanners compared to conventional gypsum<br />

models measurements: a systematic review.<br />

Eur J Orthod. 2016;38:429–34.<br />

17. Patzelt SB, Emmanouilidi A, Stampf S, Strub JR,<br />

Att W. Accuracy of full-arch scans using intraoral<br />

scanners. Clin Oral Investig. 2014;18:1687–94.<br />

18. Renne W, Ludlow M, Fryml J, Schurch Z, Mennito<br />

A, Kessler R, Lauer A. Evaluation of the accuracy<br />

of 7 digital scanners: an in vitro analysis based<br />

on 3-dimensional comparisons. J Prosthet<br />

Dent. 2016; https://doi.org/10. 1016/j.<br />

prosdent.2016.09.024.<br />

19. Güth JF, Runkel C, Beuer F, Stimmelmayr M,<br />

Edelhoff D, Keul C. Accuracy of five intraoral<br />

scanners compared to indirect digitalization. Clin<br />

Oral Investig. 2017;21(5):1445–55. https://doi.<br />

org/10.1007/s00784-016-1902-4.<br />

20. Imburgia M, Logozzo S, Hauschild U, Veronesi<br />

G, Mangano C, Mangano F. Accuracy of four<br />

intraoral scanners in oral implantology: a<br />

comparative in vitro study. BMC Oral Health.<br />

2017;17(1):92.<br />

21. Mangano FG, Veronesi G, Hauschild U, Mijiritsky<br />

E, Mangano C. Trueness and precision of<br />

four intraoral scanners in oral Implantology:<br />

a comparative in vitro study. PLoS One.<br />

2016;11 https://doi.org/10.1371/journal.<br />

pone.0163107<br />

22. van der Meer WJ, Andriessen FS, Wismeijer D,<br />

Ren Y. Application of intra- oral dental scanners<br />

in the digital workflow of implantology. PLoS<br />

One 2012;7. https://doi.org/10.1371/journal.<br />

pone.0043312<br />

23. Güth JF, Edelhoff D, Schweiger J, Keul C. A new<br />

method for the evaluation of the accuracy of<br />

full-arch digital impressions in vitro. Clin Oral<br />

Investig. 2016;20:1487–94.<br />

24. Ajioka H, Kihara H, Odaira C, Kobayashi T, Kondo<br />

H. Examination of the Position Accuracy of<br />

Implant Abutments Reproduced by Intra-Oral<br />

Optical Impression. PLoS One 2016;11. https://<br />

doi.org/10.1371/journal.pone.0164048<br />

25. Chew AA, Esguerra RJ, Teoh KH, Wong KM, Ng<br />

SD, Tan KB. Three-Dimensional Accuracy of<br />

Digital Implant Impressions: Effects of Different<br />

Scanners and Implant Level. Int J Oral Maxillofac<br />

Implants. 2017;32:70–80.<br />

About the Authors<br />

Dr. Miguel Stanley is the founder and CEO of White Clinic based in Lisbon, Portugal. As clinical director, he is responsible<br />

for a team of dental specialists focused on complex cosmetic oral rehabilitation. He has been practicing since 1998, having<br />

graduated from ISCS-Egas Moniz (the largest private institute dedicated to higher studies in medicine) and did postgraduate<br />

training at the Branemark CEOSA centre in Madrid in 1999, completing his training in cosmetic dentistry in 2000, at the<br />

same faculty. He then went on to train in functional aesthetics and occlusion (blood flow restriction) in Chicago in 2005.<br />

He was the first Portuguese active member and expert provider for <strong>Dental</strong> XP (online education platform) since 2006. As<br />

an exclusive lecturer for major implant companies, he focuses on his philosophy ‘No Half Smiles’ and complex cosmetic implant surgery<br />

and practice management, having spoken in 32 countries since 2002, in three different languages. He has been the creator and producer<br />

of seven makeover TV shows in Portugal on major networks since 2005. He was also part of American broadcaster CBS’ show ‘The Doctors’<br />

in Hollywood, USA in 2013. In 2012, he wrote his book ‘Health on the Path to Happiness’.<br />

Dr. Ana Gomes Paz graduated in dentistry from the University of Lisbon, Portugal. She has always been fascinated<br />

with clinical activity and the scientific research. While attending the university, she was active in the research group.<br />

For her master’s degree in Endodontics, she published a study titled, “Evaluation of Postoperative Pain After Using<br />

Bioceramic Materials as Endodontic Sealers”. Dr. Paz completed her post graduate in Advanced General Practice in the<br />

University of Lisbon, and a post graduate in Forensic Medicine in the Criminal Study Center in Madrid, Spain. Currently, she<br />

works in White Clinic, a high technology advanced dental clinic based in Lisbon, with an interdisciplinary team that treats<br />

from simple to full mouth complex cases, most of them planned digitally. She also runs the scientific research and development department,<br />

publishing articles in national and international magazines and journals.<br />

Dr. Inês Miguel graduated in dentistry from Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM) and realised<br />

early on that her area of interest was aesthetic dentistry. In 2007, she joined White Clinic and dedicated her clinical practice<br />

exclusively to aesthetic dentistry and fixed prosthodontics. Following graduation in 2008, in order to improve her knowledge<br />

and area of expertise, she attended a postgraduate course in Aesthetic Dentistry at ISCSEM. Between 2009 and 2011,<br />

she took up her Masters in <strong>Dental</strong> Aesthetics at the International University of Cataluña, in Barcelona. She attended some<br />

scientific conferences and participated as co -author in some clinical posters. Since 2009, she has been responsible for<br />

the Aesthetic Dentistry Department at White Clinic.<br />

Dr. Christian Coachman graduated Dentistry at the University of São Paulo/Brazil in 2002 and in <strong>Dental</strong> Technology in 1995.<br />

He is a member of the Brazilian Academy of Esthetic Dentistry. Moreover, Dr. Coachman attended the Ceramic Specialisation<br />

Program instructed by Dr. Dario Adolfi at the Ceramoart Training Centre, where he also became an instructor. In 1996, he<br />

opened his own laboratory. In addition, he worked as a technical consultant of Creation, Willi Geller Ceramics. In 2004, he<br />

was invited by Dr. Goldstein, Garber, and Salama, of Team Atlanta, to become Head Ceramist of their laboratory, a position<br />

he held for over four years. Dr. Coachman currently works as a consultant and develops products for companies. He has<br />

lectured and published internationally in the fields of esthetic dentistry, oral rehabilitation, dental ceramics and implants.<br />

54<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


Behind the Scenes<br />

Part II: Logical,<br />

Feasible and Digital<br />

By DMT Karl-Heinz Körholz<br />

Can full dentures also be created digitally? “Yes,”<br />

says DMT Karl-Heinz Körholz and illustrated the analogue steps of a<br />

challenging patient case in part one. In part two, everything revolves<br />

around the digital fabrication phases with the FDS System<br />

from Amann Girrbach.<br />

Digital set-up<br />

Setting up continues with the wizard step<br />

“Denture tooth placement”. The best<br />

fitting posterior teeth are automatically<br />

selected from the sets of teeth saved in<br />

the library. First, the various tooth shapes<br />

and sizes are displayed, which, according<br />

to the values determined in the model<br />

analysis, come into question in this case.<br />

Coloured data in green letters confirm that<br />

these tooth shapes fit best in terms of size,<br />

while those in red letters are not quite as<br />

suitable in terms of their dimensions, but<br />

could still be selected if desired.<br />

is the first premolar. The occlusal plane<br />

forms the specification for the horizontal<br />

alignment of all anterior and posterior<br />

teeth. This means that it is no longer<br />

possible for “the left side to droop”<br />

provided that the occlusal plane had<br />

previously been specified correctly in the<br />

dental practice.<br />

For control purposes, the model analysis<br />

or, as shown here, the common set-up<br />

region, can be visualised at any time by<br />

showing/hiding (Fig. 2b).<br />

and space conditions. Such an approach<br />

would of course also be possible in the<br />

classic set-up with wax and a wax knife,<br />

but it would be far more elaborate.<br />

Compared to the manual technique, the<br />

digital set-up of anterior teeth offers an<br />

enormous time advantage at this point<br />

(Fig. 3).<br />

Fig. 3: When setting up the anterior teeth, the<br />

technician can also view the less suitable sets of<br />

teeth to get an idea of the space available and select<br />

the optimum tooth shape and size for this patient.<br />

In the classical set-up, this could only be achieved<br />

with an enormous effort in time.<br />

If all previously determined parameters<br />

of the model analysis as well as the tooth<br />

library are taken into account, the result<br />

will generally lead to a harmonious and<br />

functional set-up. This gives the dental<br />

technician a very useful suggestion, which<br />

can in most cases be adopted in this form<br />

(Fig. 4).<br />

Fig. 2a<br />

Fig. 1: Wizard step “Denture tooth placement”:<br />

the tooth sets saved in the library are suggested<br />

automatically based on the results of the model<br />

analysis. First, the various tooth shapes possible<br />

according to the model analysis, are displayed.<br />

Coloured data in a green font indicate that these<br />

tooth shapes fit in terms of size, those in a red font<br />

deviate more strongly from the result of the model<br />

analysis, but can still be selected if desired. As a<br />

further option, one can select whether the second<br />

molars are set up always, never or only if possible<br />

according to the model analysis.<br />

This wizard step also offers the option<br />

of selecting whether, for example, the<br />

second molars should be set up in every<br />

case or only if this is possible or never<br />

(Fig. 1). The “Place Posteriors” button<br />

automatically sets the selected posterior<br />

teeth according to the model analysis. The<br />

six is set up in the determined position as<br />

Fig. 2b<br />

Figs. 2a-b: The “Place Posteriors” button<br />

automatically sets the selected posterior teeth<br />

according to the model analysis. The six is in the<br />

right place, as is the first premolar. The occlusal<br />

plane acts as the specification for the horizontal<br />

positioning of the posterior teeth.<br />

When setting up the anterior teeth,<br />

the technician can also have the tooth<br />

sets displayed that do not fit perfectly<br />

(indicated in red) to get an idea of the<br />

corresponding alternative tooth shapes<br />

Fig. 4: Harmonious and functional set-up, as<br />

recommended by the program by selecting the<br />

anterior and posterior teeth in green font. This gives<br />

the dental technician a very useful suggestion, which<br />

can also be adopted in most cases.<br />

The procedure of displaying the aesthetic<br />

template “over” the set-up during or after<br />

setting up the anterior and posterior<br />

teeth is extremely effective. This has the<br />

advantage that matches or deviations<br />

can be recognised directly on the screen.<br />

In the analogue working process, this<br />

can also be seen approximately by using<br />

previously fabricated silicone keys;<br />

however, this is considerably less precise,<br />

56<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


#OneOfAKind<br />

inhouse-movement.com<br />

12. - 16.03.<strong>2019</strong><br />

Hall 11.1 Stand G030<br />

Amann Girrbach <strong>Asia</strong><br />

Fon +65 6592 5190<br />

singapore@amanngirrbach.com<br />

www.amanngirrbach.com


Behind the Scenes<br />

far more time-consuming and involves<br />

a great outlay of material. Changes to<br />

individual teeth or larger regions can<br />

usually be corrected in seconds due to<br />

the digital information (Fig. 5).<br />

Fig. 5: It is extremely effective if the aesthetic<br />

template is displayed “over” the set-up during or<br />

after setting up the anterior and posterior teeth. This<br />

has the advantage that matches or deviations can<br />

be recognised directly and corrected where desired.<br />

Individual set-up of the<br />

anterior teeth<br />

Modifying the set-up<br />

I believe it is important that a set-up<br />

calculated by the Ceramill CAD Software<br />

can still be individually modified digitally.<br />

And this is very simple: we remove the<br />

maxillary model with a mouse click in<br />

the show/hide window and can change<br />

individual teeth or entire groups of teeth<br />

with the corresponding control points.<br />

manufacturers, cannot be changed into<br />

a dysfunction inadvertently. However,<br />

it remains possible to move these as<br />

complete blocks to lingual or vestibular or<br />

to rotate them around the first premolar to<br />

expand the set-up accordingly or to better<br />

capture the static region (Fig. 6). The<br />

occlusal contact relationship is always<br />

maintained during this process.<br />

Individual set-up of the<br />

anterior teeth<br />

The buttons, with which the anterior tooth<br />

positions can be varied, are intuitive and<br />

clearly marked by the additional icons.<br />

This makes it absolutely clear as to<br />

whether a single tooth is to be moved or<br />

rotated. One can also specify here how<br />

this is to be done: in all directions, mesial/<br />

distal, buccal/lingual or occlusal. This<br />

information corresponds to the mindset<br />

of the dental technician and to what then<br />

happens with the selected tooth on the<br />

screen. And of course, movement of the<br />

teeth is infinitely variable (Fig. 7a).<br />

Fig. 7a: The menu items<br />

for shifting individual<br />

teeth are very intuitive<br />

to use and clearly<br />

indicated by the icons.<br />

Here it is decided<br />

whether or where to a<br />

tooth is to be steplessly<br />

moved.<br />

Fig. 7b: Menu item<br />

“Chain Mode”: here,<br />

all the anterior teeth<br />

can be moved like a<br />

string of pearls by<br />

selecting a single tooth.<br />

This makes it possible<br />

to compensate for<br />

irregularities or to make<br />

sagittal steps more<br />

even. The individual<br />

teeth in this grouping<br />

remain connected to<br />

each other during this<br />

process.<br />

The use of the chain mode is represented<br />

by a turquoise bar inside the teeth. The<br />

teeth marked in this way can therefore be<br />

offset as a group. The teeth marked in red<br />

are no longer affected by the movement<br />

of the chain mode (Fig. 8).<br />

Fig. 8: The chain mode is represented by a turquoise<br />

bar. This means that the teeth can be moved together<br />

as a group. The teeth marked in red indicate those<br />

teeth that are no longer affected by the chain mode<br />

movement.<br />

In this example, the mandibular<br />

canines remain in their position while<br />

the mandibular anterior tooth arch is<br />

to be modified. In the same manner,<br />

Fig. 6: It also seems important to be able to<br />

individually modify a set-up although it is correct<br />

and well-intentioned by the program. This can be<br />

done very simply by hiding the “anatomy of the<br />

maxilla” with a mouse click. Now individual teeth or<br />

entire blocks can be shifted without endangering<br />

the optimised occlusal tooth in the posterior region.<br />

An exception is that we can never move<br />

individual teeth in the posterior region,<br />

but only the entire posterior blocks.<br />

This seems sensible, as the occlusal<br />

contact relations, which were specified<br />

in their optimal position by the tooth<br />

Single and chain mode<br />

Another feature for tooth placement is the<br />

“chain mode”, which allows the correction<br />

of an entire row of teeth or several teeth<br />

simultaneously. There, for example, the<br />

entire anterior teeth can be “grabbed”<br />

with a selected tooth and moved like a<br />

string of pearls. This makes it possible<br />

to compensate for irregularities or to<br />

make sagittal steps more even. However,<br />

the individual teeth in this group remain<br />

connected to each other during this<br />

process (Fig. 7b).<br />

Fig. 9: In the same manner, the teeth can be rotated<br />

along the labial axis either singly or in the chain<br />

mode by using the “Rotate” mode. If, for example,<br />

the tooth necks of individual or all four maxillary<br />

anteriors are to face in vestibular direction with<br />

the incisal edge, these can be moved in the desired<br />

direction with the mouse. If, as shown here, the<br />

model analysis is also displayed, the set-up can be<br />

individually adapted to its specifications.<br />

58<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


Behind the Scenes<br />

the teeth can be rotated individually along<br />

their labial axis or in chain mode in the<br />

“Rotate” mode. If, for example, individual<br />

or all four maxillary anterior teeth are<br />

to face in a vestibular direction with the<br />

incisal edge, these can be “grabbed” with<br />

the mouse and moved seamlessly in the<br />

desired direction. If the model analysis is<br />

superimposed, as shown here in Fig. 9, the<br />

set-up can also be adapted individually to<br />

its specifications.<br />

Occlusal and vestibular view<br />

The possibilities of customisation can<br />

also be viewed from the occlusal and<br />

extended additionally. One should make<br />

sure that the anterior and posterior<br />

teeth are located in their regions of the<br />

model analysis. As a rule and as already<br />

mentioned, this is done after the selection<br />

and the command “Set-up: anterior and<br />

posterior teeth”. Figure 10a shows the<br />

posterior teeth exactly in the set-up<br />

region. The mandibular anterior teeth<br />

are rotated slightly along their vertical<br />

axes here. The centre is now shifted<br />

slightly to the right due to the rotation of<br />

tooth 43, which reduces the dental arch<br />

on the right side. The chain mode (see<br />

turquoise bar) then shifts the entire row of<br />

front teeth marginally to the right. Now, of<br />

course, this situation can be customised<br />

additionally.<br />

Fig. 10a: Representation of occlusal placement: here<br />

one can check that the anterior and posterior teeth<br />

are positioned in their regions of the model analysis.<br />

The anterior teeth in the mandible are discreetly<br />

rotated along their vertical axes. The centre is shifted<br />

slightly to the right, which can of course be adjusted<br />

individually with the aid of the chain mode.<br />

The mandibular anterior teeth were<br />

customised somewhat more. This was<br />

done at the patient‘s request and was<br />

agreed in advance. In the process, the<br />

anatomical centre could also be corrected<br />

back to its original position. The result<br />

was that the region 43 to 46 rotated to<br />

vestibular. This now had to be rotated<br />

axially around tooth 44 to lingual.<br />

To recap: the front teeth can be shifted<br />

both in single or chain mode. The<br />

occlusion, which was corrected at this<br />

point in the mandible, is automatically<br />

corrected to the optimum static occlusion<br />

in the maxilla (Fig. 10b).<br />

Fig. 10b: At the patient‘s request, the mandibular<br />

anterior teeth were customised a little more. During<br />

this process, the anatomical centre could also be<br />

corrected back to its original position. The result<br />

was that region 43 to 46 had rotated to vestibular.<br />

Finally, this needed to be rotated axially to lingual<br />

around tooth 44.<br />

The maxillary set-up of this work after<br />

correction: here the anterior teeth<br />

basically remained in an even arch. Only<br />

the tooth axes of the lateral incisors were<br />

inclined along their vestibular tooth axis.<br />

Fig. 11: The set-up in the maxilla after correction.<br />

The anterior teeth were essentially left in an even<br />

arch. Only the tooth axes of the lateral incisors<br />

were inclined along their vestibular tooth axis (see<br />

Figs. 56 and 66). The anterior arch had to be<br />

harmonised evenly in the sagittal step.<br />

In addition, the anterior dental arch had<br />

to be harmonised evenly in its sagittal<br />

step (Fig. 11).<br />

The milling process<br />

Fig. 12a<br />

Fig. 12b<br />

Figs. 12a-b: The milling direction should be set at<br />

a 90° angle to the respective alveolar ridge so that<br />

the milled wax bases can later be placed easily on<br />

the model yet still fit well in the mouth. This results<br />

in massive undercuts for the mandible, which are<br />

displayed in different colours depending on their<br />

depth. The maxillary model must be rotated slightly<br />

in dorsal direction in order to better capture the<br />

undercuts of the anterior vestibular fold.<br />

Defining the main milling direction<br />

In order to mill the set-up bases in wax<br />

later on, the milling directions must be set<br />

such that as few undercuts as possible are<br />

blocked out. Determining the main milling<br />

direction is comparable to determining<br />

the most favourable insertion direction<br />

for setting out the set-up bases without<br />

having to grind away too much. If this<br />

is not taken into account, it will hardly<br />

be possible to place the milled wax<br />

base on the model. Usually, the classic<br />

right-angled alignment to the occlusal<br />

plane is not the ideal milling direction for<br />

real patient work. Figure 12a shows the<br />

mandibular model. This still results in<br />

massive undercuts, which are displayed<br />

in different colours depending on their<br />

depth. The same applies to the maxillary<br />

model: here too, the model should be<br />

rotated dorsally to better capture the<br />

undercuts in the anterior vestibular<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 59


Behind the Scenes<br />

fold. Figure 12b illustrates this: in the<br />

example given, the mandibular model<br />

was rotated to three positions to show<br />

how the undercut regions change. Figure<br />

13c shows the best position for milling<br />

the wax base.<br />

Fig. 14a<br />

Fig. 15a<br />

Fig. 13a<br />

Fig. 15b<br />

Fig. 14b<br />

Fig. 13b<br />

Fig. 13c<br />

Figs. 13a-c: The setting of the optimal milling<br />

direction is illustrated in three steps: Figures 13a-b<br />

show even more pronounced undercuts. In Figure<br />

13c, the best angle for the milling direction seems<br />

to have been found.<br />

Creating the denture base<br />

In the next work step, the denture<br />

bases are generated and the outer<br />

limits determined respectively. The more<br />

carefully and precisely this is done in<br />

advance, the less reworking of the milled<br />

wax bases is necessary. Here too, it is<br />

much easier to quickly determine this<br />

boundary line with single mouse clicks<br />

and then shift it point-by-point exactly<br />

to the desired final shape (Figs. 14a-b).<br />

Figs. 14a-b: The denture bases are generated and<br />

the outer limits are determined respectively. The<br />

more carefully and precisely this is done, the less<br />

reworking needs to be performed on the milled<br />

wax bases. The easiest way is to quickly determine<br />

the boundary line with individual mouse clicks and<br />

then shift it point-by-point exactly to the desired<br />

final shape.<br />

The desired base is displayed with the<br />

“Display” command. Understandably,<br />

the Ceramill D-Flow Software does not<br />

yet have our aesthetic sensitivity in<br />

dental technology and simply designs the<br />

denture base according to its strength<br />

and external limitations. However, this<br />

can also be easily done individually later<br />

using different tools and brush types by<br />

determining the “gingival margin” and<br />

using the “Anatomical” button in the<br />

“Modeling the Denture Bases” section<br />

(Fig. 15a).<br />

This has already been done in Figure 15a.<br />

Now the future denture base already looks<br />

quite reasonable. As previously shown in<br />

other work sequences, the details, models<br />

or teeth can also be shown or hidden<br />

here. This has been done here so that<br />

the thickness and papillary shape of the<br />

artificial gingiva can be clearly seen after<br />

hiding the teeth (Fig. 15b).<br />

Figs. 15a-b: The denture base, which was initially of<br />

simple design, can easily be reworked individually<br />

using different tools and brush types by determining<br />

the “gingival margin” and the “Anatomical” button<br />

in the “Modeling the Denture Bases” section. After<br />

remodelling has been completed, the future denture<br />

base already looks very acceptable. As previously<br />

shown in other work sequences, details can also be<br />

shown and hidden here. This has been done here so<br />

that the thickness and papillary shape of the artificial<br />

gingiva can be clearly seen after hiding the teeth.<br />

Basal processing of the teeth<br />

Now in most cases it is essential that<br />

individual teeth have to be adapted to<br />

their basal surface so that they do not<br />

stand on the ridge or are even too long and<br />

penetrate the base. It goes without saying<br />

that the teeth are adjusted beforehand<br />

so that they can later be inserted into<br />

the wax base without any problems. To<br />

do this and for the Ceramill Match 2 to<br />

perform this machining perfectly, the sets<br />

of teeth are supplied as corresponding<br />

“denture tooth blanks” and inserted into<br />

the corresponding blank holder (Fig. 16).<br />

The software now calculates which teeth<br />

need to be machined basally so as not<br />

to penetrate the alveolar ridge and to<br />

have sufficient distance to the model for<br />

later fabrication. Once this calculation<br />

has been performed, the basal surfaces<br />

can be reduced at the necessary points<br />

(Figs. 17a-b) in the further course of<br />

the working process. It can be seen in<br />

advance for each individual tooth in which<br />

regions and how much tooth substance<br />

will be removed (Fig. 18).<br />

60<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


Behind the Scenes<br />

Fig. 16: As some teeth penetrate the model basally<br />

after set-up, they need to be adapted individually.<br />

To do this, the tooth sets are supplied in special<br />

CAD/CAM blank frames and inserted into the<br />

corresponding blank holder.<br />

teeth except for the only molar in the<br />

second quadrant have to be shortened<br />

basally. However, the basal surfaces are<br />

only reduced by the exact amount that<br />

was previously calculated and which is<br />

therefore absolutely necessary. This is<br />

almost impossible to achieve so precisely<br />

for a dental technician with his milling<br />

machine. It should only be exactly so<br />

much that a minimal portion of wax also<br />

covers the tooth from basal (Figs. 19a-b).<br />

it can be used as a wax try-in after the<br />

teeth have been inserted without any<br />

further reinforcement (Fig. 20). However,<br />

if such reinforcement is desired, it can be<br />

scanned in with the jaw models and then<br />

sponged with the wax base.<br />

Fig. 17a<br />

Fig. 19a<br />

Fig. 17b<br />

Figs. 17a-b: The Ceramill Mind now calculates which<br />

teeth need to be basally reduced in order not to<br />

penetrate the alveolar ridge. Once this calculation<br />

has been performed, the basal surfaces are reduced<br />

at the necessary points in the further course of the<br />

working process.<br />

Fig. 19b<br />

Fig. 20: Then the set-up bases and the adjustments<br />

of the basal tooth surfaces are milled in the<br />

Ceramill Motion 2 (5X). After the successful milling<br />

process, the finished wax bases are separated from<br />

the blank with the aid of a hot wax knife.<br />

Set-up and try-in<br />

When examining the freshly milled wax<br />

bases in the blank, it is noticeable<br />

that they are already finished and look<br />

perfect. The basal surfaces are so smooth<br />

and clean that there is hardly a dental<br />

technician who could produce them like<br />

this in daily practice. In the occlusal<br />

top view, the “tooth pockets” for the<br />

Fig. 21a<br />

Figs. 19a-b: In our case, except for the only molar<br />

in the second quadrant, all other teeth must be<br />

shortened basally. However, the basal surfaces<br />

are only reduced by the exact amount that was<br />

previously calculated and which is therefore<br />

absolutely necessary. This is almost impossible for<br />

a dental technician to achieve so precisely when<br />

working manually with a handpiece.<br />

Fig. 21b<br />

Fig. 18: It can be seen in advance for each individual<br />

tooth in which regions and how much tooth<br />

substance will be removed.<br />

During the work for this patient we<br />

had already seen extreme abrasion<br />

in the mandible on the models, but<br />

the set-up region in the maxilla is so<br />

small by comparison, that all the other<br />

Milling of the wax bases<br />

The set-up bases and the adjustments to<br />

the basal tooth surfaces are milled one<br />

after the other in two separate working<br />

processes. The milled wax bases are<br />

milled from industrially manufactured<br />

blanks which, when removed from the<br />

blank holder after the milling process,<br />

only have to be separated from their<br />

connectors with a hot wax knife. The wax<br />

used here is a very strong, millable, yet<br />

easy to model wax. It is so stable that<br />

Figs. 21a-b: The “wax bases” can hardly be<br />

described as try-ins any more, as they already<br />

look finished and perfect. The basal surfaces are<br />

so smooth and clean that there is hardly a dental<br />

technician who could produce them like this in daily<br />

practice. The wax used here is very solid and can<br />

be used for try-in without additional reinforcement.<br />

In the occlusal top view, the “nests” for the preprepared<br />

teeth are milled precisely and cleanly.<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 61


Behind the Scenes<br />

pre-prepared teeth are milled precisely<br />

and cleanly (Figs. 21a-b). Not a single<br />

tooth had to be machined at its base in the<br />

mandible, whereas it is striking that only<br />

tooth 26 was “spared” for the base milled<br />

in the maxilla. The distance that should<br />

remain between the teeth and the alveolar<br />

ridge as a wax base was also entered<br />

manually in the Ceramill CAD Software<br />

beforehand. Although this space is<br />

wafer-thin, it is sufficient to allow the<br />

individual teeth to be fixated firmly.<br />

Furthermore, it protects the visible<br />

part of the tooth and thus improves<br />

the subsequent cosmetic image of the<br />

patient (Figs. 22a-b). The set-up bases<br />

separated from the wax blank are placed<br />

on the models and fit (Fig. 23a). Now only<br />

the teeth have to be boiled out of their<br />

denture tooth blanks and inserted into<br />

the prepared alveoli of the milled wax base<br />

and fixated (Figs. 23b-c).<br />

Fig. 22a<br />

Fig. 22b<br />

Fig. 23b<br />

Fig. 23c<br />

Figs. 23a-c: The set-up bases separated from the<br />

wax blank are placed on the models and fit! Now the<br />

teeth, which have been machined basally to fit, are<br />

inserted into the prepared alveoli and fixated with<br />

wax in a circular pattern. The teeth are also extracted<br />

from the D-Set blanks, cleaned and positioned in the<br />

tooth pockets provided for this purpose.<br />

The mandibular set-up is now successively<br />

supplemented and completed tooth<br />

by tooth in this manner. All teeth fit<br />

precisely into the placeholders assigned<br />

to them. This process can be performed<br />

quickly with a hot probe, although<br />

I prefer an electric wax knife here.<br />

The individual set-up can be seen clearly<br />

in the different settings (Figs. 24a-c)<br />

and also be compared very well with<br />

the previous planning on the screen<br />

(Figs. 10b and 24a).<br />

Fig. 24c<br />

Figs. 24a-c: The set-up in the mandible is completed.<br />

All teeth fit precisely into the provided respective<br />

tooth pockets. The teeth can be sponged cervically<br />

very quickly with a hot wax knife, whereby I prefer an<br />

electric wax knife. The individual set-up can be seen<br />

very clearly in the different settings and can also be<br />

compared very well with the previous planning on<br />

the screen (Fig. 10b).<br />

The process of “inserting teeth” is<br />

repeated in the maxilla – and everything<br />

fits despite so little space! I am convinced<br />

that a manual set-up would have taken a<br />

very long time, particularly in the maxilla,<br />

as almost every tooth would have had<br />

to be individually and painstakingly<br />

ground basally. Experience has shown<br />

that it is extremely difficult for the dental<br />

technician to manage the balancing act<br />

between a visually appealing set-up,<br />

aligning the tooth axes and achieving the<br />

correct contact relationship (Figs. 25a-b),<br />

especially when space is at a premium.<br />

Figs. 22a-b: The base is also milled in the maxilla.<br />

Not a single tooth had to be machined at the base of<br />

the mandible, whereas only tooth 26 in the maxilla<br />

was “spared”. The distance that should remain<br />

between the teeth and the alveolar ridge is defined<br />

during construction and can therefore be adapted<br />

individually to the preferred finishing procedure.<br />

Fig. 24a<br />

Fig. 25a<br />

Fig. 23a<br />

Fig. 24b<br />

Fig. 25b<br />

Figs. 25a-b: This process is repeated in the maxilla.<br />

So little space! The balancing act between a visually<br />

appealing set-up, aligning the tooth axes and<br />

achieving the correct contact relationship with this<br />

precision is extremely difficult to master by means of<br />

manual set-up - particularly when space conditions<br />

are so limited.<br />

62<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


Behind the Scenes<br />

The try-in and its results<br />

The try-in in wax was simply astonishing:<br />

not a single tooth had to be reset manually<br />

in this set-up. We had placed the teeth in<br />

the wax bases, fixated them, smoothed<br />

the connectors, cleaned, disinfected and<br />

tried in everything. The work was virtually<br />

finished and had been adapted so well to<br />

the gingiva that the patient was more than<br />

surprised because she could not take it<br />

home already. And who could blame her?<br />

The tooth lengths (Figs. 26a-c) were<br />

correct, the proportions between the<br />

maxilla and the mandible matched and<br />

the occlusal plane was at its correct level<br />

(Figs. 26c-d). The anterior teeth in the<br />

mandible looked very natural in their<br />

individual positions (Fig. 26a). And last<br />

but not least, the overall appearance<br />

was harmonious and balanced. Now the<br />

reader simply has to believe me that<br />

the phonetics was also fine, because we<br />

cannot present this either in written or<br />

illustrated form.<br />

Fig. 26a<br />

Fig. 26b<br />

Fig. 26c<br />

Fig. 26d<br />

Figs. 26a-d: The try-in in wax was amazing: we placed<br />

the teeth in the wax bases, fixated them, smoothed<br />

the connectors, cleaned, disinfected and tried in<br />

everything. The work could be adapted perfectly to<br />

the gingiva. None of the teeth had to be repositioned.<br />

The tooth lengths were correct, the proportions<br />

between the maxilla and the mandible matched<br />

and the occlusal plane was at its correct level. The<br />

entire front tooth set-up is absolutely natural in its<br />

position. And last but not least, the appearance is<br />

harmonious and balanced.<br />

Conclusion<br />

Not only have digital full dentures become<br />

exciting, they are also absolutely practical<br />

with the Amann Girrbach FDS process.<br />

It absolutely delivers a functional and<br />

aesthetic benefit for patients. Extensive<br />

and consistent preparation in the dental<br />

practice and the dental laboratory must<br />

be absolutely perfect, from the anatomical<br />

impression to assembly of the model. This<br />

is an absolutely necessary prerequisite,<br />

not only for the analogue working route,<br />

but also applies to the digital work<br />

process.<br />

What excited me most is:<br />

• that the meaningful and well thoughtout<br />

structure of the wizard sequence<br />

and thus of the individual steps,<br />

results in a high control function of<br />

the individual steps which build on<br />

each other<br />

• that not a single tooth can be set up<br />

before a complete model analysis has<br />

been performed<br />

• that the individual control steps<br />

are available at all times during the<br />

digital development of the set-up<br />

with the aid of “show/hide” situation<br />

models or aesthetic templates, which<br />

makes the procedure considerably<br />

safer even before the milling process<br />

• that the posterior tooth set-up<br />

remains in perfect static occlusion<br />

permanently and under all conditions<br />

despite all individual corrections,<br />

which ensures optimised toothing<br />

and thus the positional stability of the<br />

denture bases to the gingiva<br />

• that the work can be checked in an<br />

aesthetic and functional sense in the<br />

Artex before try-in, which safeguards<br />

the dental technician and the dentist<br />

and ultimately the patient from<br />

unpleasant and awkward surprises<br />

and reworking<br />

• that the FDS system, which previously<br />

could only be processed with the<br />

Pala Mondial, Premium and Idealis<br />

tooth lines (Kulzer), will soon be<br />

supplemented by the tooth brands<br />

of the VITA-Zahnfabrik, such as<br />

VITAPAN EXCELL and LINGOFORM,<br />

which will make the overall “FDS”<br />

package even more comprehensive<br />

and patient-friendly for the benefit<br />

of the patient<br />

• that the development in the field of<br />

digital full dentures will continue and<br />

will also be advanced further, which is<br />

certainly clear to all of us DA<br />

Note: Originally published in Das <strong>Dental</strong><br />

Labor (Neuer Merkur GmbH, Germany),<br />

June and July 2017. Reprinted with<br />

permission.<br />

About the Author<br />

DMT Karl-Heinz Körholz<br />

worked as a department<br />

head in different<br />

laboratories and started<br />

becoming intensely<br />

involved in full denture<br />

prosthetics. In addition,<br />

he invested his entire specialist knowledge<br />

into the development of denture<br />

fabrication systems and materials (such as<br />

PremEco-Line, CeraA Color Set)<br />

cooperating closely with industrial<br />

manufacturers. Co-founder of the<br />

TiF ® Setting-up method and proprietor<br />

of Trigodent, a specialised laboratory<br />

for functional, customised full denture<br />

prosthetics. Nowadays, he also works as<br />

a course instructor, lecturer and author<br />

passing his expert knowledge gained in<br />

over 35 years on to dental technicians from<br />

all over the world.<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 63


In Depth With<br />

Providing High Technology and<br />

Professional Service for a Better Life<br />

a provincial research and technical<br />

centre as well as the Shaanxi dental<br />

instrument engineering technology<br />

centre. More than 50 researchers, who<br />

have leading positions in research ability<br />

and manufacturing process, are currently<br />

working for SINOL. To date, they have<br />

more than 50 patented technology<br />

inventions, appearances and utility<br />

models. This is how SINOL is able to<br />

maintain its position as China’s leading<br />

dental instrument manufacturer over<br />

the years.<br />

Founded in 1965, SINOL <strong>Dental</strong> Limited<br />

was one of the first professional<br />

dental instrument manufacturing<br />

companies to be set up in China.<br />

For more than 50 years, the<br />

company has been devoted to research and<br />

development, manufacturing, marketing<br />

and servicing of dental equipment. The<br />

company’s many remarkable medical<br />

and oral achievements in the field are a<br />

testament to its credibility and it is no<br />

wonder SINOL has become a famous<br />

brand and continues to enjoy good<br />

reputation in the industry.<br />

As early as 2000, SINOL passed<br />

the rigid qualification for the<br />

ISO 9001 certification. In 2003, it<br />

attained TUV’s CE certification. Four<br />

years later, SINOL was rated as<br />

“China’s Famous Brand.” Not<br />

long after, SINOL achieved the<br />

American FDA certification. Finally<br />

in 2012, SINOL was recognised as<br />

“China’s Famous Trademark” by<br />

the State Administration in the industry.<br />

Aside from their prominent products<br />

such as dental units and handpieces,<br />

the company also offers cleaning and<br />

sterilising systems, dental teaching<br />

simulators, technician systems, clinical<br />

instrument systems, dental imaging<br />

systems, integrated service systems as<br />

well as dental implant materials.<br />

Recognising the importance<br />

of innovation, SINOL invests in<br />

research and importing<br />

of technology. In<br />

line with this,<br />

the company<br />

has set up<br />

In the domestic market, the company<br />

boasts a strong network comprising<br />

30 core marketing and after sales<br />

agencies that cover around one hundred<br />

distributors. This wide and complex<br />

network allows for the company to<br />

provide its customers with efficient and<br />

quick service responses. SINOL also<br />

has an expansive overseas network,<br />

having exported their products to more<br />

than 60 countries including Europe,<br />

South America, North America, Africa,<br />

Middle East, Russia, Southeast <strong>Asia</strong>,<br />

Germany, Japan, Argentina and more.<br />

Today, SINOL is a market leader in<br />

China’s dental and medical equipment<br />

industry, and well on its way<br />

to becoming a world<br />

famous dental medical<br />

equipment manufacturer<br />

and integrated system<br />

service provider. DA<br />

64<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


Product Highlight<br />

Amann Girrbach<br />

More Durable and Cost-Effective Ceramill PMMA Products<br />

With its relaunch, Amann Girrbach<br />

structures its Ceramill PMMA material<br />

range more accurately and increases the<br />

maximum wearing time to three years. At<br />

the same time, laboratories will benefit<br />

from the lower costs. The innovations<br />

in the portfolio include materials for<br />

temporary crowns and bridges, splints as<br />

well as casting and pressing.<br />

Ceramill A-Temp ML replaces<br />

Ceramill Temp ML as a material for longterm<br />

temporary restorations and will in<br />

future, be available as a monochrome<br />

as well as a multilayer blank in the most<br />

common A-D shades, according to the<br />

VITA shade guide. Due to the unique<br />

shade synchronisation with the materials<br />

of the Zolid zirconium oxide portfolio,<br />

A-Temp forms the perfect basis for the<br />

fabrication of highly aesthetic crowns and<br />

bridges. In addition, the material will also<br />

be available in block form, opening up new<br />

possibilities for intelligent stock-keeping<br />

with both AG and universal mandrel.<br />

Under the name A-Splint,<br />

Amann Girrbach introduces new<br />

PMMA blanks for the fabrication of<br />

CAD/CAM-manufactured splints with<br />

up to three years’ retention time in the<br />

patient’s mouth, replacing the Ceramill<br />

Splintec Standard product. In the area of<br />

casting and pressing, A-Cast succeeds<br />

the previous Ceramill PMMA blanks. The<br />

long-established products Ceramill Temp<br />

and Ceramill Splintec from Merz <strong>Dental</strong><br />

will continue to be part of the portfolio.<br />

In addition to longer wearing time<br />

and lower costs, there is yet another<br />

advantage: Amann Girrbach introduces<br />

standardised sizes and new intermediate<br />

sizes in the course of the relaunch. Thus,<br />

all blanks are available in heights of 14, 16<br />

and 20 mm (A-Cast only 14 and 20 mm).<br />

As a result, the right blanks can be found<br />

for every size of restoration. ■<br />

Directa<br />

Everything Needed for a Successful Extraction<br />

The ability to reduce<br />

trauma during tooth<br />

extraction has<br />

become extremely<br />

important, especially<br />

for patients requiring<br />

subsequent implant<br />

placement with<br />

minimal bone lost.<br />

Modern implant<br />

techniques require<br />

real alternatives to<br />

traumatic forcep extractions.<br />

The Luxator ® instruments were invented<br />

by a Swedish dentist to make extractions<br />

as trauma free as possible. He developed<br />

subtleties in the design that only a<br />

practicing dentist would appreciate.<br />

Available in eight different blade shapes,<br />

Luxator ® Periotomes from Directa<br />

offer a safe and precise solution for<br />

successful extractions. The fine tapered<br />

blade compresses the<br />

alveolar ridge, cuts the<br />

membrane, gently eases<br />

the tooth from its socket<br />

which reduces damage<br />

to surrounding tissue,<br />

and also keeps a better<br />

anatomy for an implant<br />

site. The shape and size<br />

of the handle is designed<br />

to minimise the force<br />

needed during extraction.<br />

The thin blade easily inserts between the<br />

bone and the root with minimal damage.<br />

The Luxator ® product line also includes<br />

the Luxator ® Dual Edge Periotomes which<br />

have an innovative dual purpose tip ideal<br />

for probing deeply fractured teeth and<br />

decayed roots.<br />

On the other hand, the Luxator ®<br />

Periotome Titanium is distinguished by<br />

their gold coloured blades, coated with<br />

titanium nitride, which allows for easier<br />

access into the socket and offers<br />

enhanced durability. Also, the titanium<br />

coated tip does not require sharpening.<br />

Finally, the Luxator ® LX Mechanical<br />

Periotome sets a new standard for trauma<br />

free extraction offering improved safety,<br />

precision and access. Its self-directing<br />

tip allows the periotome tip to follow the<br />

root surface, reducing the risk of bone<br />

damage. Its reciprocating tip enables a<br />

secure cutting of the fibres in a patient<br />

friendly way.<br />

Manufactured with Swedish stainless<br />

steel, Directa instruments are extremely<br />

durable, retaining their strength and<br />

sharpness even after repeated use<br />

and sterilisation. With their acclaimed<br />

ergonomic handle Luxator ® Instruments,<br />

Directa is recognised worldwide for<br />

providing one of the best surgical<br />

instruments on the market. ■<br />

66<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


Renfert<br />

Wax Set for Functional Modelling and<br />

Creating Restorations<br />

Renfert has now launched<br />

another wax range: the<br />

GEO Expert Functional<br />

Wax-Set. It shows both dental<br />

technicians and dentists<br />

how to create a functional<br />

wax-up according to<br />

NAT (natural wax-up technique).<br />

True to the company’s motto,<br />

“Making Work Easy”, the six modelling waxes are colour<br />

coded according to the natural wax-up technique by<br />

MTD Dieter Schulz and the accompanying guide by<br />

MTD Oliver Dreher. It provides users an interference-free,<br />

supported, stable and efficient reproduction of functional<br />

and lifelike occlusal reconstruction of morphology and<br />

restorations. Therefore, the new Design Wax Set is an<br />

ideal addition to the exclusive GEO Expert Wax-Up Set by<br />

A. Bruguera found in Renfert’s GEO Expert Wax line.<br />

→ THE EVOLUTION<br />

OF PROPHYLAXIS<br />

COMBI touch<br />

→ AIR-POLISHING AND<br />

ULTRASOUND IN ONE UNIT<br />

→ easy switch from supra to subgingival<br />

air-polishing by a simple click<br />

→ subgingival perio air-polishing tip – flexible, soft<br />

and anatomically adjustable to the periodontal pocket<br />

→ more than 40 inserts for scaling, perio, endo and prosthetics<br />

→ soft mode: the ultra-gentle scaling for sensitive patients<br />

Colour-structured segmented wax-up according to NAT<br />

The accompanying manual is printed in colour was developed<br />

by Renfert in collaboration with Oliver Dreher. It contains<br />

basic information on the segmented wax-up technique and<br />

the Occlusal Compass, as well as practical information on the<br />

individual modelling waxes. With this manual and its photos<br />

and illustrations, it is possible to follow how the NAT is created<br />

to produce lifelike occlusal surfaces.<br />

The opaque GEO Expert Functional modelling waxes have<br />

excellent modelling and carving properties – in particular,<br />

when using an electric modeling instrument such as the<br />

Waxlectric. In addition, the six modelling waxes are also<br />

available as individual refills.<br />

According to the Schulz/Polz philosophy, functional and<br />

structured wax-ups based on NAT can be created using hard waxes:<br />

• GEO Expert Functional Wax green: for segments influenced<br />

by mediotrusion (MT).<br />

• GEO Expert Functional Wax blue: for segments influenced<br />

by laterotrusion (LT).<br />

• GEO Expert Functional Wax gray: for cusps influenced by<br />

lateroprotrusion (LPT).<br />

• GEO Expert Functional Wax yellow: for cusps influenced by<br />

lateroprotrusion (LPT).<br />

• GEO Expert Functional Wax orange: for segments influenced<br />

by medioprotrusion (MPT).<br />

• GEO Expert Functional Wax red: for precise waxing of the<br />

preparational margin. ■<br />

→ www.mectron.com<br />

→ www.we-love-prophylaxis.com<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 67


Product Highlight<br />

Ivoclar Vivadent<br />

Wider Choice of Restorative Materials for PlanMill<br />

The Tetric CAD composite blocks and<br />

the IPS e.max ZirCAD zirconium oxide<br />

materials have now been released for<br />

use with the PlanMill milling units<br />

(Planmeca). This provides practitioners<br />

with even more opportunities to produce<br />

high-quality restorations at chairside.<br />

Tetric CAD makes aesthetics easy<br />

Tetric CAD is an aesthetic composite<br />

block designed for the efficient<br />

production of single-unit restorations.<br />

Due to its pronounced chameleon<br />

effect, restorations optically blend into<br />

the existing tooth structure for a natural<br />

aesthetic integration. The block is easy<br />

to use and efficient to process: restorations<br />

can be milled and polished quickly<br />

and then seated using an<br />

adhesive technique. The new<br />

composite blocks are available<br />

in an MT and HT level of translucency, in<br />

five and four shades respectively and in<br />

sizes I12 and C14.<br />

COLTENE<br />

Made for Each Other for a Perfect Fit<br />

Swiss dental specialist COLTENE will soon<br />

be combining its proven nickel-titanium files<br />

with perfectly matched paper and guttapercha<br />

points under the successful HyFlex<br />

system. Standardised working lengths<br />

and conicities thus ensure the success<br />

of endodontic treatment and at the same<br />

time ensure smooth procedures in dental<br />

practice.<br />

HyFlex paper points – absorbent<br />

under all circumstances<br />

After preparing the root canal with NiTi files<br />

such as the HyFlex CM or HyFlex EDM, the<br />

root canal is dried using paper points and<br />

then obturated with gutta-percha points.<br />

With the HyFlex system, COLTENE will<br />

soon be offering the perfect triad for safe<br />

endodontic treatment. HyFlex paper points<br />

have the optimum conicity to effectively<br />

dry channels that have been prepared<br />

Zirconium oxide for thin wall<br />

thicknesses<br />

IPS e.max ZirCAD LT (low translucency)<br />

is a monolithic zirconium oxide block<br />

designed for crowns and three-unit<br />

bridges. The material allows posterior<br />

crowns to be designed in a reduced<br />

wall thickness of 0.6 mm and anterior<br />

crowns in a reduced thickness of<br />

0.4 mm due to its high mechanical<br />

strength of 1,200 MPa(a) and high<br />

fracture toughness of 5.1 MPa1/2(b).<br />

A fluorescent effect can be achieved with<br />

IPS e.max CAD Crystall/Glaze Fluo. The<br />

restorations are placed using either a<br />

conventional cementation technique or<br />

a self-adhesive resin cement, such as<br />

SpeedCEM Plus. Sintering is carried out in<br />

the Programat CS4 furnace. The LT blocks<br />

are available in the shades BL, A1-3, B1-2<br />

as well as in C2 and D2.<br />

Extended range of shades for Telio CAD<br />

Shades B3, C2 and D2 have been added to<br />

the range of Telio CAD blocks for PlanMill.<br />

beforehand with HyFlex rotary instruments.<br />

The absence of adhesives in the production<br />

process also ensures that the paper points<br />

are reliably absorbent all throughout.<br />

HyFlex gutta-percha points – stable<br />

and flexible at the same time<br />

The gutta-percha points in the corresponding<br />

sizes can then be effortlessly inserted<br />

into the canal in combination with the<br />

corresponding sealer: in spite of their high<br />

stability, they adapt flexibly to even the most<br />

pronounced curves without breaking. The<br />

processing of the temperature-sensitive raw<br />

material under constant conditions ensures<br />

that the points do not become brittle and<br />

porous later on. With ISO sizes of over<br />

28 mm, they can easily be inserted to longer<br />

working lengths for precise obturation. All<br />

HyFlex paper and gutta-percha points will<br />

be available from the dental trade as single<br />

Dentists using PlanMill can now benefit from an<br />

even larger range of Ivoclar Vivadent materials to<br />

produce restorations.<br />

As a result, the cross-linked PMMA blocks<br />

are now available in nine LT shades (BL3,<br />

A1, A2, A3, A3.5, B1, together with the<br />

three new shades) and in two different<br />

block sizes (B40L and B55).<br />

All you need for restorations in a<br />

single visit<br />

Ivoclar Vivadent offers a treatment<br />

concept that empowers practitioners to<br />

restore the dentition of their patients in<br />

a single visit. In addition to the blocks<br />

and cementation materials, the range<br />

includes coordinated materials for the<br />

entire restorative workflow starting from<br />

the OptraGate lip and cheek retractor to<br />

luting materials and oral care products. ■<br />

sizes or in special<br />

assortments for<br />

the HyFlex CM<br />

or EDM series.<br />

For better identification of the sizes, the<br />

paper and gutta-percha points are clearly<br />

marked with the standard ISO colour<br />

coding on their upper part. Furthermore,<br />

the user-friendly sliding boxes developed<br />

by COLTENE can be opened conveniently<br />

with one hand. All in all, the HyFlex products<br />

impress with their customary high quality:<br />

instead of the comparatively inaccurate<br />

random sample inspection by hand, each<br />

individual gutta-percha point is measured<br />

fully automatically. Due to the sophisticated<br />

manufacturing process, the HyFlex system<br />

offers both beginners and experts reliable,<br />

durable solutions for all types of endodontic<br />

cases. ■<br />

68<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


Product Highlight<br />

W&H<br />

The New LatchShort Polishing System Offers More Freedom of Movement and<br />

Improved Access<br />

With the new Proxeo<br />

TWIST LatchShort<br />

polishing system, W&H is<br />

now presenting a system<br />

with a working height<br />

4 mm shorter than standard<br />

latch systems. The perfect<br />

combination of the contraangle<br />

handpiece WP-66 W<br />

with the W&H Prophy cups<br />

and brushes offers users<br />

even more freedom of<br />

movement in the oral cavity.<br />

Minimal working height for optimal<br />

access during rotary polishing<br />

As the latest member of the Proxeo TWIST<br />

family of W&H, the LatchShort polishing<br />

system gives users improved access to<br />

teeth surfaces, allowing them to polish<br />

even hard-to-reach areas of the upper<br />

jaw and lower molar regions perfectly.<br />

This is made possible by the considerably<br />

reduced working height of the new<br />

LatchShort polishing system of W&H.<br />

The small head of the prophylaxis contraangle<br />

handpiece WP-66 W combined<br />

with the new Prophy cups and brushes<br />

with shortened shaft allows even simpler<br />

polishing. This translates to even greater<br />

comfort during professional polishing of<br />

the teeth for users and their patients alike.<br />

Treatment quality for beautiful teeth<br />

with perfect surface areas<br />

In the new LatchShort polishing system,<br />

W&H is offering an ideally compiled<br />

system comprising the contra-angle<br />

handpiece WP-66 W and perfectly<br />

customised Prophy cups and brushes. The<br />

Proxeo TWIST Prophy cups adapt optimally to<br />

the surfaces of the teeth. The special design<br />

with internal fins ensures precise application<br />

of the paste.<br />

Ridges on the exterior aim to prevent the<br />

polishing paste from spattering. Equipped<br />

with a smooth surface at the end of the cap, it<br />

enables users to work in the sulcus region with<br />

precision. The Prophy cup fits flush against<br />

the head of the contra-angle handpiece<br />

to prevent saliva and polishing paste from<br />

entering the contra-angle handpiece head.<br />

The push-button chuck makes it easy to<br />

change Prophy cups and brushes in next to no<br />

time. The new W&H Prophy cups and brushes<br />

are available in different hardness. ■<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 69


Show Review<br />

exocad Insights 2018:<br />

A Global Community Discusses Digital Future with Open Systems<br />

exocad Insights 2018 kicked off in Darmstadt from<br />

19 th – 20 th November, with more than 550 dental<br />

technicians, dentists and open systems partners from<br />

over 40 countries attending the sold-out event held<br />

by exocad, the renowned software company. The<br />

first-rate program featured internationally recognised guest<br />

speakers, 24 leading industry partners and exocad’s own<br />

team of experts. The event focused on the latest developments<br />

from exocad, special software presentations and the myriad<br />

possibilities of digital technologies, including how these can<br />

be future-proofed via exocad’s open architecture software<br />

platform.<br />

“It is overwhelming to see that we are reaching users in every<br />

corner of the globe, who are both actively and enthusiastically<br />

involved in this growing community. Here in Darmstadt, we<br />

welcome participants from over 40 countries, including Iceland,<br />

China, Russia, the USA, and even from Chile and Australia.<br />

We really appreciate many of our guests for travelling a long<br />

distance to be with us here,” said Mr. Tillmann Steinbrecher,<br />

CEO of exocad.<br />

Knowledge, inspiration and partners<br />

exocad Insights presented state-of-the-art hardware from<br />

partners in the fields of scanning, milling, 3D printing,<br />

and materials. First of all, Mr. Larry Bodony, President of<br />

exocad America, presented various exocad solutions,<br />

applications, and new business models. Deeper discussions on<br />

the digital process were facilitated by renowned guest speakers<br />

such as Mr. Waldo Zarco Nosti, founder of the Facebook group<br />

exocad Experts, Mr. Uli Hauschild, Mr. Michael Anger and<br />

Dr. Jan Hajtó. At the end of the first day, brain<br />

researcher and neuro-science entertainer Dr. Henning<br />

Beck explained the functioning of the human brain.<br />

Partner sessions by Amann Girrbach, Align, Medit, Shining<br />

3D, CIM Systems, Elos Medtech, imes-icore, Nobil-Metal and<br />

smart optics were scheduled for the second day, which saw<br />

each of them presenting their new developments, and vision<br />

for the future. One of the highlights was how there were<br />

solutions that aim to combine same-day dentistry with open<br />

systems. Renowned speakers Mr. Paul Weigl, Dr. Ingo Baresel,<br />

Dr. Anoop Maini and Dr. Armen Mirzayan demonstrated the<br />

impetus for modern treatment options and the “single-visit<br />

dentistry” of the future. At the same time, visitors joined exocad<br />

specialists in various software sessions covering selected user<br />

areas and case studies. At the end of the event, guest speaker<br />

Mr. Vanik Kaufmann introduced users of digital technologies to<br />

the myths and reality of 3D printing.<br />

Combining digital technology with an open system<br />

platform<br />

exocad delivers a unique open platform solution that makes it<br />

easy to integrate 3 rd party products and services, providing a<br />

future-proof platform. The perfectly integrated and easy-to-use<br />

software solutions are characterised by maximum flexibility,<br />

robustness and design freedom.<br />

“What makes our software platform unique is its seamless<br />

and flexible integration with a wide variety of 3D scanners,<br />

milling machines and printers from leading manufacturers.<br />

This approach makes our software products future-proof by<br />

ensuring access to the latest and most innovative devices<br />

from different providers in the open market.” The advantage is<br />

clear according to Mr. Maik Gerth, CTO of exocad who said,”If<br />

you want to make changes to your workflows, equipment, or<br />

services, you can customise the connectivity of our software.<br />

The basis for this is the open architecture of the exocad<br />

software platform.”<br />

70<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


Show Review<br />

With <strong>Dental</strong>CAD, which currently has over 12 add-on modules,<br />

exocad has developed today’s leading dental CAD software<br />

for use in dental practices. Other software solutions include<br />

exoplan for implant planning and ChairsideCAD for same-day<br />

dentistry care in the clinical environment. Products such as<br />

exocam for production complete the portfolio in a practical<br />

way.<br />

At exocad there is no easing – the portfolio is constantly<br />

evolving. For example, PartialCAD was recently introduced<br />

for the design of high-quality partial dentures. The software<br />

is available as an add-on module for <strong>Dental</strong>CAD or as a<br />

standalone version. Smile Creator, a new tool for the planning<br />

of highly aesthetic restorations, is also due for imminent<br />

release. Additionally, users of exoplan can quickly access<br />

an add-on module for designing surgical guides, enabling<br />

in-house production of guides.<br />

All software applications have been developed on the same<br />

platform and therefore follow the same operating concept.<br />

exocad has created a simple, user-friendly and, above all,<br />

future-proof solution that fully meets the needs of customers<br />

in a rapidly developing market.<br />

Enabling in-house production of surgical guides<br />

Furthermore, exocad announced the introduction of its new<br />

exoplan Guide Creator module – a software solution for surgical<br />

guide design. It provides dental practices and laboratories with<br />

a digital workflow offering maximum flexibility. This new feature<br />

is available in selected geographies as an add-on module for<br />

exoplan, a powerful, open and efficient software package for<br />

virtual implant planning. Customised surgical guides can be<br />

designed using the new Guide Creator software module, after<br />

which they can be produced on-site in a laboratory, dental<br />

practice or external production centre. This increases the<br />

production value of existing equipment, with 3D printers in<br />

particular providing more profitability when producing surgical<br />

guides.<br />

All exocad solutions are based on the same open-architecture<br />

platform, ensuring seamless functionality of the digital<br />

workflow: from virtual prosthetic-oriented implant planning<br />

with exoplan, to designing surgical guides with Guide Creator,<br />

and planning and producing the implant-supported, temporary<br />

and final restorations with <strong>Dental</strong>CAD, exocad’s dental<br />

CAD software.<br />

“As the world’s leading supplier of dental CAD software,<br />

we provide the perfect symbiosis of prosthetic and implant<br />

planning,” said Mr. Tillmann Steinbrecher, CEO of exocad.<br />

“Users achieve predictable results in a cost and time-efficient<br />

manner, which ultimately results in increased customer<br />

satisfaction.”<br />

exocad users in dental practices and laboratories can depend<br />

on a high-performing and reliable software platform which has<br />

a proven track record of around ten years. All exocad software<br />

solutions follow the same operating concept and exocad has<br />

always valued vendor independence that allows clients to build<br />

the solution that fits their needs. exocad software offers direct<br />

integration with a variety of 3D scanners, milling systems and<br />

3D printers. Open architecture benefits exoplan users who<br />

may freely choose from a wide range of imaging devices,<br />

materials and implant systems available on today’s market.<br />

The software also provides dentists and dental technicians<br />

with a comprehensive library of implant, abutment and sleeve<br />

systems from numerous established manufacturers.<br />

exoplan processes large image datasets at an impressive speed.<br />

Hard and soft tissues are simultaneously displayed in both 2D<br />

and 3D and in high resolution. These optimal visualisations of<br />

the initial situation support the user in simple and safe planning<br />

of implant positions.<br />

exocad places great emphasis on a transparent cost structure without<br />

pay-per-use or hidden fees. The company provides its software<br />

solutions as a traditional OEM (Original Equipment Manufacturer)<br />

exclusively via partner companies all around the world.<br />

Ultimately, the main takeaway for participants of exocad Insights 2018<br />

was that the future of digital dentistry lies in open systems. DA<br />

JANUARY / FEBRUARY <strong>2019</strong> DENTAL ASIA 71


Giving Back to Society<br />

The Reasonable Alternative to Christmas Gifts<br />

At the end of the year, it is a nice tradition to say<br />

‘thank you’ to customers and business partners.<br />

A reasonable and sustainable alternative to<br />

such Christmas gifts is a donation, which offers<br />

children the chance for a better future. VOCO, the<br />

manufacturer of dental materials, also would like to make<br />

the world for children a little better. Similar to last year,<br />

the company supported UNICEF’s campaign ‘Donations<br />

instead of Christmas gifts’ with 20,000 euros.<br />

‘Donations instead of Christmas gifts’ has existed for<br />

more than 15 years. The money collected is transferred<br />

to the UNICEF programme ‘Children in crisis regions’. The<br />

donations support school attendance or the arrangement<br />

of blankets and tents, providing comfort and warmth for<br />

the children. Even with the support of aid organisations,<br />

there are still millions of children who barely have access<br />

to clean water, regular meals, necessary health measures<br />

or education.<br />

Christmas gifts for its customers and business partners. “When<br />

you see the terrible pictures from conflict areas, one realises how<br />

urgent people there need help. With our donation, we are glad to<br />

contribute to the improvement of these children’s lives,” explained<br />

Mr. Olaf Sauerbier, member of VOCO’s management,<br />

while handing over the<br />

cheque to UNICEF volunteer<br />

Ms. Elke Schmidt from Stade. In<br />

the name of the aid organisation,<br />

she thanked him for the generous<br />

donation. DA<br />

VOCO supported UNICEF’s campaign<br />

‘Donations instead of Christmas<br />

gifts’ also in 2018. UNICEF volunteer<br />

Ms. Elke Schmidt (left), here together<br />

with Managing Director Mr. Olaf<br />

Sauerbier (right), highly appreciates<br />

VOCO’s commitment.<br />

Against this backdrop, the management of VOCO GmbH<br />

decided to donate the year’s budget set aside for buying<br />

Worldwide Aid for Children with Cleft Lip and Palate<br />

Amann Girrbach supports the Deutsche Cleft Kinderhilfe, a German aid organisation that<br />

helps treat children with cleft lip and palate.<br />

The Deutsche Cleft Kinderhilfe e.V. is committed<br />

to the worldwide treatment of children with cleft<br />

lips, jaws and palates. Most of them are very poor<br />

and are often socially isolated, brought about by<br />

their disfigurement. The surgery that can give<br />

the affected children an opportunity to lead a “normal” life<br />

costs around €250. In addition, children with a cleft, in most<br />

cases, suffer from serious health impairments as a result of<br />

difficulty in eating and drinking, such as hearing deficiencies<br />

and language development impairment. In addition to financing<br />

operations and providing comprehensive cleft therapy, the<br />

organisation promotes the establishment of interdisciplinary<br />

teams of physicians and therapists consisting of surgeons,<br />

paediatricians, dentists, orthodontists, speech therapists,<br />

psychologists and social workers.<br />

Amann Girrbach believes in the vital importance of corporate<br />

social and economic responsibility and is pleased with<br />

Mr. Kai Kietz, Head of International<br />

Sales at Amann Girrbach, presents<br />

the donation to Ms. Ulrike Claassens,<br />

Donor and Project Administration at<br />

Deutsche Cleft Kinderhilfe e.V.<br />

the great success of its<br />

first fundraising campaign,<br />

organised specifically for the<br />

benefit of the Deutsche Cleft<br />

Kinderhilfe at the international<br />

AG dealer meeting held in<br />

October. For this purpose,<br />

the AG CHARITY GAMES were<br />

organised wherein points<br />

could be accumulated during<br />

various skill exercises, and<br />

later on converted into euros by Amman Girrbach. Thanks<br />

to the enthusiastic participation of all dealer representatives<br />

present as well as AG employees from around 60 countries, a<br />

total of €11,224.50 was donated. DA<br />

For further information on the organisation and for donation<br />

opportunities please visit www.spaltkinder.org<br />

72<br />

DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>


<strong>2019</strong> Events Calendar<br />

JANUARY<br />

18 – 20 26 th MDA Scientific Convention & Trade Exhibition<br />

Kuala Lumpur, Malaysia<br />

Website: www.mda.org.my/mdascate/<strong>2019</strong>/index.html<br />

FEBRUARY<br />

5 – 7 AEEDC <strong>2019</strong> – 23 rd UAE International <strong>Dental</strong><br />

Conference & Arab <strong>Dental</strong> Exhibition<br />

Dubai, United Arab Emirates<br />

Website: www.aeedc.com<br />

21 – 23 154 th Chicago Midwinter Meeting<br />

Chicago, USA<br />

Website: www.cds.org/meetings-events/midwinter-meeting<br />

22 – 24 AOSC <strong>2019</strong> – Association of Orthodontists<br />

(Singapore) Congress<br />

Singapore, Marina Bay Sands<br />

Website: www.aoscongress.com<br />

MARCH<br />

3 – 6 24 th <strong>Dental</strong> South China International Expo <strong>2019</strong><br />

Guangzhou, China<br />

Website: www.dentalsouthchina.com<br />

12 – 16 IDS <strong>2019</strong> - 38 th International <strong>Dental</strong> Show<br />

(Biennial Meeting)<br />

Cologne, Germany<br />

Website: www.ids-cologne.de<br />

14 – 15 25 th World Congress on Dentistry and Oral Health<br />

Berlin, Germany<br />

Website: https://dentistrycongress.dentistryconferences.com/<br />

22 – 24 9 th Borneo <strong>Dental</strong> Congress<br />

Kota Kinabalu, Malaysia<br />

Email: borneodentalcongressmdaez@gmail.com<br />

29 – 30 ITI Congress South East <strong>Asia</strong><br />

Kuala Lumpur, Malaysia<br />

Website: www.iti.org/congress-southeastasia<br />

APRIL<br />

4 – 6 IndoHealthcare Expo <strong>2019</strong> – 11 th International<br />

Exhibition on Medical, <strong>Dental</strong> & Hospital<br />

Equipments, Medicine, Health Care, Supplies<br />

& Services<br />

Jakarta, Indonesia<br />

Website: www.indohealthcareexpo.com<br />

12 – 13 14 th CAD/CAM & Digital Dentistry Conference<br />

& Exhibition<br />

Dubai, United Arab Emirates<br />

Website: www.cappmea.com<br />

19 – 21 4 th Malaysian International <strong>Dental</strong> Show <strong>2019</strong> (MIDS <strong>2019</strong>)<br />

Kuala Lumpur, Malaysia<br />

Website: www.mdda.com.my/<br />

24 – 27 <strong>Dental</strong> Show West China <strong>2019</strong><br />

Chengdu, China<br />

Website: www.wcise.com<br />

29 – 30 40 th World <strong>Dental</strong> Science and Oral Health Congress<br />

Seoul, Korea<br />

Website: https://dentalscience.dentalcongress.com/<br />

MAY<br />

3 – 7 119 th American Association of Orthodontists -<br />

AAO Annual Session<br />

Los Angeles, USA<br />

Website: www.aaomembers.org<br />

8 – 12 APDF <strong>2019</strong> - 41 st <strong>Asia</strong> Pacific <strong>Dental</strong> Congress<br />

Seoul, Korea<br />

Website: www.apdfnews.online<br />

10 – 12 SIDEX <strong>2019</strong> - The 16 th Seoul International <strong>Dental</strong><br />

Exhibition & Scientific Congress<br />

Seoul, Korea<br />

Website: http://eng.sidex.or.kr/<br />

16 – 18 Expodental Meeting <strong>2019</strong><br />

Rimini, Italy<br />

Website: www.expodental.it<br />

JUNE<br />

9 – 12 SINO-DENTAL <strong>2019</strong> - The 24 th China International<br />

<strong>Dental</strong> Exhibition and Scientific Conference<br />

Beijing, China<br />

Website: www.sinodent.com.cn/f<br />

JULY<br />

3 – 7 The 27 th Congress of International Association of<br />

Paediatric Dentistry (IAPD)<br />

Cancún, Mexico<br />

Website: www.iapdworld.org<br />

AUGUST<br />

15 – 17 ICOI Wold Congress <strong>2019</strong> – International Congress of<br />

Oral Implantologists<br />

New York, USA<br />

Website: www.icoi.org/events/<br />

17 – 18 5 th <strong>Asia</strong>-Pacific CAD/CAM & Digital Dentistry<br />

Conference & Exhibition<br />

Singapore, Suntec Convention & Exhibition Centre<br />

Website: www.capp-asia.com<br />

22 – 24 DICE <strong>2019</strong> - <strong>Dental</strong> International Congress and Exhibition<br />

Singapore, Marina Bay Sands<br />

Website: www.dice-dental.asia<br />

23 – 25 VIDEC <strong>2019</strong> - The 12 th Vietnam International <strong>Dental</strong><br />

Exhibition & Congress<br />

Hanoi, Vietnam<br />

Website: www.facebook.com/events/383245365417270<br />

SEPTEMBER<br />

5 – 9 American <strong>Dental</strong> Association Annual Meeting<br />

San Francisco, USA<br />

Website: https://www.ada.org/en/meeting/attendeeinformation/future-meetings<br />

5 – 8 FDI <strong>2019</strong> – Annual World <strong>Dental</strong> Congress<br />

San Francisco, USA<br />

Website: www.fdiworlddental.org/what-we-do/fdi-world-dentalcongress<br />

13 – 15 IDEC <strong>2019</strong> - Indonesia <strong>Dental</strong> Exhibition & Conference<br />

Jakarta, Indonesia<br />

Website: www.indonesiadentalexpo.com<br />

16 – 21 AAOMS <strong>2019</strong> – 101 st American Association of Oral and<br />

Maxillofacial Surgeons Annual Meeting<br />

Boston, USA<br />

Website: https://www.aaoms.org/meetings-exhibitions/annualmeeting/101st-annual-meeting<br />

OCTOBER<br />

10 – 12 <strong>Dental</strong> World Hungary <strong>2019</strong> – 19 th Edition<br />

Budapest, Hungary<br />

Website: www.dentalworld.hu/<br />

17 – 19 Colloquium <strong>Dental</strong> <strong>2019</strong> - Italian <strong>Dental</strong> Show<br />

Montechiari, BS – Italy<br />

Website: www.colloquium.dental/colloquium-dental<br />

30 – DenTech China <strong>2019</strong><br />

Nov 2<br />

Shanghai, China<br />

Website: www.dentech.com.cn/en-us/index


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DENTAL ASIA JANUARY / FEBRUARY <strong>2019</strong>

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