Dental Asia May/June 2018

Dental Profile:
Mr. Chuck Hall - Ahead of His Time
Clinical Feature:
ENT and Dentistry: Sample Cases for
the Need to Work Together
Behind the Scenes:
Simplifi ed Dental Protocol for
the Construction of Removable Prosthesis
with Implant and Mucosal Support

Contents
www.dentalasia.net
Under the Spotlight
18 Dr. Lawrence Lau: Rockstar in Dentistry
24
Dental Profile
28
32
Clinical Feature
36
41
46
Dr. Grant Duncan: Shaping the Future
of Orthodontics
Mr. Chuck Hall: Ahead of His Time
Dr. Angelo Mariotti: Personalising
Dentistry
Small, Powerful and Sterile: The Mighty
Mini 90 Disposable Prophy Angle
ENT and Dentistry: Sample Cases for
the Need to Work Together
Factors of Poor Breastfeeding
Efficiency and Appropriate Management
for Tongue-tie and Lip-tie
Behind the Scenes
54
58
Indepth With
64
65
Elastic, Aesthetic Ceramics
Simplified Dental Protocol for the
Construction of Removable Prosthesis
with Implant and Mucosal Support
AUTO spin by Renfert: Universal
System for Model Production with
Acrylic Plates
Nobel Biocare: Ease, Speed and
Hygiene, All-in-one with PureSet
Show Review
70
71
IDEM 2018 Takes Clinical Excellence
to the Next Level
40 th Asia Pacific Dental Congress 2018:
“Intensifying Professionalism in
Synergy with Dental Science and
Technology”
Show Preview
72
Regulars
04
06
10
66
73
74
76
DAMA 2018: Inaugural Dental
Aesthetics Meeting in Asia Releases
Conference Programme
First Words
Giving Back to Society
Dental Updates
Product Highlights
Events Calendar
Books for Sale
Advertiser’s Index
2 DENTAL ASIA
MAY / JUNE 2018

Rainer Wöran, AUS
Amann Girrbach Asia
Fon +65 6592 5190
singapore@amanngirrbach.com
www.amanngirrbach.com

First Words
Education is essential and
necessary in any profession. But I
always believed Aristotle’s quote
saying ‘Educating the mind without
educating the heart is no education
at all.’ Being educated is not solely
based on awards and recognitions
a person receives but how you make
use of all the knowledge gained in
helping and giving back to others.
Shaping the Future
Through Education
I have so much respect
and appreciation to those who
are willing to go out of their way
just to help out those in need.
Dental Asia wants to recognise
these outstanding individuals,
organisations and foundations
contributing humanitarian efforts
such as Dr. “T. Bob” Davis, who not
only helps underserved people in
Latin America but is also moulding
the next generation of dentists by
giving them purpose through sharing
(page 6).
There are so many ways in
educating and spreading knowledge
– conventional lectures/workshops
and modern online platforms.
A very good example is how
Dr. Lawrence Lau maximises all these
approaches through his lectures and
the Cerec-files, a Facebook group
that eventually became a community
managed by clinicians for dentists
solely to help in everything about
CEREC (pages 18-22).
Nowadays, modern platforms and
innovations are
adapted in the
industry. Mobile
applications
now are used
in dentistry
specifically to
monitor patients
undergoing orthodontics known as
Dental Monitoring (DM). Thanks to
Dr. Grant Duncan, the pioneer DM
user for Invisalign, patients are more
compliant, see better results and are
guided by their dentists with fewer
dental visits (pages 24-27).
Another dental innovation in
dentistry that keeps on expanding
is 3D printing. We are so grateful for
the imagination and persistence of
Mr. Charles “Chuck” Hull, the
inventor of stereolithography
(commonly known as 3D printing)
for his remarkable breakthrough
that changed the design and
manufacturing world (pages 28-31).
Aside from being persistent, I
believe that loving one’s profession is
imperative in order to be successful
and of help to others. Through my
interview with Dr. Angelo Mariotti,
a periodontal specialist and an
IDEM speaker, he shared that he
loves his work and most especially
the interactions he has with his
patients. He continues promoting
awareness of periodontal disease
in hoping to help prevent its spread
(pages 32-34).
It was also a very educational
few months for me attending
IDEM 2018 and APEC 2018, two
of the biggest dental events held
in Asia. It was a privilege and an
honour to be present among the
international speakers, exhibitors,
manufacturers and colleagues in
the industry (pages 70-71). I am
excited and looking forward to
further expanding my knowledge in
the industry and in return pass it on
to all Dental Asia readers. DA
ADVISORY BOARD
Dr William Cheung
Dr Choo Teck Chuan
Dr Chung Kong Mun
Dr George Freedman
Dr Fay Goldstep
Prof Urban Hägg
Prof Nigel M. King
Dr Ramonito Rafols Lee
Dr Kevin Ng
Dr William O’Reilly
Dr Ryan Seto
Dr Adrian U J Yap
Dr Christopher Ho
Dr How Kim Chuan
Dr Derek Mahony
Prof Alex Mersel

Giving back to Society
Dental Students Provide Dental Humanitarian Missions in Latin America
by David Burger
“Do what you can while you still can.”
– Dr. T. Bob Davis
It is a philosophy that has driven, General dentist Dr. Davis – more
commonly known as “T. Bob”- for over 36 years to bring more than
1,500 dental students and about 500 dentists to Latin America to
provide dental humanitarian missions.
The tradition continued this year, as Dr. Davis returned from a
late March trip to Guatemala accompanied by 50 dental students
—21 from Texas A&M University College of Dentistry and 29 from
The University of Texas School of Dentistry at Houston. Along with
16 dentists recruited by Dr. Davis, the large contingent treated 820
people in the impoverished region of San Raymundo, Guatemala
delivering more than US $329,000 worth of dental care.
Dr. Davis, president of Academy of Dentistry International,
said the trip during the
students’ spring break
was “probably the best
trip ever in most every
respect.” This is his sixth
annual trip to Guatemala
after years in Mexico
and Nicaragua, and he
said sustainability in his
beloved San Raymundo is
what inspired him to come
back year after year. While
the need for dentistry is
still deep in this southern
area, it brings Dr. Davis joy
to see returning patients
who now require simple
cleanings rather than root
canals.
“It was unbelievable,”
said Brady Atkins, a fourthy
e a r d e n t a l s t u d e n t a t
UT-Houston who went
Vital assistance: First-year dental student
Dorothy Hino and Dr. Rachel Sells treat a
young patient in a Guatemala operatory
d u r i n g t h e i r h u m a n i t a r i a n t r i p t o t h e
Central American country in March.
with Dr. Davis on the spring break trip for the fourth time.
“Wanting to serve people and making a tangible dierence is what
immediately drew me to dentistry.”
During Mr. Atkins’ trips, he saw many people helping others and
knew ‘that it was what he wanted to do’.
John Ratli, a second-year dental student at Texas A&M, also
went to Guatemala in March, his second time with Dr. Davis. “My
learning can make a dierence in changing people’s lives. You see
everything you see in school, in practice. The trips are a testament
to people believing in T. Bob’s message: ‘Take a leap of faith and
be of service to others’,” Mr. Ratli said.
Dr. Davis’ trips have been annual rites of passage among many
Texas A&M and UT-Houston dental students, who gravitate
toward the trips in part because of Dr. Davis’ long time ties to the
Christian Dental Society.
Initially, Mr. Ratli was sceptical until he saw people in pain
transformed after attending the Guatemala trips. “I was a little
nervous but Dr. Davis is so organised and the dentists are all
inspirational with their commitment to impacting the youth,”
shared Mr. Ratli.
Though volunteer dental students are busy accommodating
patients and, at times, skipping their meals, students love helping
during dental missions. Dr. Davis makes time to schedule worship
services and fun team-building exercises, such as soccer games,
giving the locals and dental students time to bond and enjoy.
Dr. Davis went on his rst dental mission four decades ago, after
his wife signed him up for it, and he immediately became hooked.
It only took him ve years before he started taking dental students
with him.
“They get a sense of who they are becoming. They share their
heart and love for people. They come here with a purpose in mind,”
Dr. Davis said of the students.
For more information about the Academy of Dentistry International,
visit www.adint.org
To learn more about international volunteerism and nd an
opportunity, visit the ADA Foundation’s international volunteer
website: www.internationalvolunteer.ADA.org.
If anyone is interested in helping or funding products and
equipment for the dental missions in Asia Pacic, please contact
Ms. Jamie Tan at jamietan@pabloasia.com for more information. DA
Hugging line: Dental students, from left, Chris Shin, Megan Luna,
Abigail Livesay, Blake Hamblin and Raven Grant receive thanks from local
students in San Raymundo, Guatemala, for treating them with dental
care on a humanitarian trip in March.
6 DENTAL ASIA
MAY / JUNE 2018

Get hooked!
Hartzell Instruments Makes Gutta-Percha Removal Easy!
Get hooked today!
©2016 Den-Mat Holdings, LLC . All rights reserved. 805000129 08/16SN
Make your next retreatment stress-free and
order your Gutta-Percha removal instruments!
Email: international@denmat.com
To find a local distributor, visit www.denmat.com

Giving back to Society
Dental Units Donated to Pobba Thiri Dental Hospital in Myanmar
The Pobba Thiri Dental Hospital
was established in 2016 as
the first national hospital
in Nay Pyi Taw, the capital
of Myanmar, which has
developed remarkably in recent years. This
hospital is expected to further develop
a s a b a se o f o ra l h ea lth c a re i n M y a n m a r.
GC Corporation, one of the largest and most
successful manufacturer for dental products
today, contributed three Dental Units
(Sovereign) to the Pobba Thiri Dental Hospital.
A contribution ceremony was held at
the site on 19 th February 2018. Myanmar
administration ocial, President Nakao and
Mr. Watanabe, Chairman of Japan Myanmar
Association attended the ceremony.
After the ribbon cutting opening
ceremony, a site inspection and a lunch
gathering was held with many hospital
staff. In the afternoon, GC Corporation
visited Dr. Myint Htwe, Union Minister of
Myanmar (Ministry of Health and Sports).
GC has promised to continually cooperate
and support Myanmar government, not
only materials but also in education and
training of dental health care staff for
improvement of oral health in Myanmar.
After the discussion, President Nakao
received a certicate of appreciation from
the minister.
Four GC associates namely Mr. Saruya
P r e s i d e n t o f G C I C o m m u n i c a t i o n s ,
M r . K u r a s h i m a , M r . M i z u t a n i a n d
Mr. Koshiba worked diligently towards the
success of the event. They were responsible
for the communication and negotiation
w i t h M y a n m a r G o v e r n m e n t , H o s p i t a l a n d
Japan Myanmar Association and the
installation of dental units in the hospital. DA
Dental Missions by the Rise Above Foundation Cebu
Originally connected with a
foundation in Manila from
2000-2008, Rise Above
Foundation Cebu Inc.,
became an independent
group in Cebu in July 2008. Behind the
foundation is a group of dedicated
individuals, local and from around the
world, whose main concern is bringing
humanitarian help to everyone in need.
The rst Dental Mission took place in
July 2002 and since then Dental Missions
have been held two to three times a year.
Dentists, dental technicians, hygienists
and other volunteers from Denmark,
Sweden, Norway, England, Germany,
Switzerland, Australia, New Zealand, Japan,
Singapore, Iran and USA have travelled to
Cebu, Philippines to help treat the poor
in depressed areas in the cities of Cebu,
Mandaue, Talisay and Lapulapu, as well as
several small islands near Cebu and other
bigger islands in the Visayas region.
Through the years, over 35,000 people
have received free treatment, sponsored
by companies and individuals from all over
the world.
THE NEED:
1. Dental Missions welcome dentists,
dental hygienists, dental technicians,
dental assistants and anyone else who
wants to give their services to the
underserved population in the Visayas
region of the Philippines. It has all the
equipment and instruments needed,
but needs volunteers to come and help.
2. Financial aid. The average cost per
patient is 300 Pesos. Often patients have
more than one tooth that needs to be
treated. The Mission gives treatment like
restoration, extraction and prophylaxis.
The patients receive the needed
medication free of charge. Any help will
be greatly appreciated.
For more information on how
t o b e p a r t o f t h i s , p l e a s e w r i t e t o :
riseabove@riseabove-Cebu.org DA
8 DENTAL ASIA
MAY / JUNE 2018

Dental Updates
New 3Shape and Oventus Integration Gets Patients Into Sleep Therapy Faster
New digital integration between
Oventus and the 3Shape TRIOS intraoral
scanner creates a faster devicemanufacturing
turnaround time to get
patients into sleep therapy faster.
The just-announced integration enables
dental professionals using the awardwinning
3Shape TRIOS intraoral scanner to
send digital impressions direct to Oventus
for the ordering and designing of its sleep
devices for snoring and sleep apnea.
3Shape TRIOS users can simply choose
Oventus from the more than 45 treatment
providers in the intraoral scanner’s menu to
instantly cloud-send the digital impressions
to Oventus.
According to Dr. Chris Hart, Clinical
Director and inventor of Oventus,
“ T h e d i g i t a l w o r k f l o w w i t h
3Shape TRIOS increases overall
efficiency in its production
workow, particularly quicker
turnaround times from start
to finish. This enables
patients with sleep apnea
to be treated more quickly,
which is appreciated by patients
and referring providers alike.”
The digital workow with 3Shape TRIOS
also increases accuracy, which in turn
means fewer remakes and less chair time for
patients, according to Oventus. Adding that
the digital workow eliminates analoguerelated
challenges such as impressions
being distorted because of gagging, tongue
thrusts, saliva contamination, shipping
temperature, or imprecise lab pour-ups.
“We are excited to bring
another terrific treatment
opportunity like Oventus to
doctors and their patients.
The digital workflow,
because of its accuracy, speed
and connectivity, makes it so
much easier for professionals
to provide quality care to their patients. As
more and more solutions choose to connect
with TRIOS, its accuracy, ease of use, and
open and expanding ecosystem, make it
the right choice for dental professionals,”
M r . A l l a n H y l d a l , V i c e P r e s i d e n t o f
3Shape Orthodontics.
2018 ADIA Research Grants Tackles Periodontitis
Pioneering research to address chronic
periodontitis has been awarded to the
Australian Dental Industry Association
Research Grant bestowed by the
Australian Dental Research Foundation (ADRF),
the nation’s leading funding body for earlycareer
researchers into dental and oral
health issues. The grant is funded by the
Australian Dental Industry Association (ADIA),
the peak business organisation representing
innovative dental product manufacturers
and suppliers.
The most recent award was provided to
Associate Professor Neil O’Brien-Simpson
from the University of Melbourne
Dental School into research associated
with antimicrobial peptides that target
periodontal pathogens. He’s a project
manager for the Oral Health Cooperative
Research Centre. The research project
will be supported by Dr. Jason Lenzo
a n d D r . J a m e s H o l d e n , b o t h f r o m t h e
Melbourne Dental School.
The research seeks to address chronic
periodontitis, an inflammatory disease
associated with a pathogenic subgingival
bacteria leading to the destruction of the
tooth’s supporting tissues and ultimately
tooth loss. It is a major public health
problem in all societies and is estimated to
aect at least 30% of the adult population,
including 5% to 6% who experience severe
forms of the disease. The prevention of
chronic periodontitis relies on removing
the bacterial burden by effective tooth
cleaning, sometimes in combination with
antibiotics and/or antiseptics; however,
long-term use of antibiotics is undesirable
due to the emergence of resistant bacteria.
Indeed, several reports have highlighted
an increasing trend towards antibiotic
resistance in oral bacteria.
The increasing reports of multi-drug and
antibiotic resistant bacteria and the limits on
the use of antiseptics, such as chlorhexidine,
have resulted in extensive research to
discover and develop new and novel classes
of antimicrobials that are eective and safe
for human use.
“The objectives of the research
a l i g n w i t h t h e c o n d i t i o n s o f t h e
Australian Dental Industry Association
Research Grant that provides
funding for projects that may,
following commercialisation, support
the development of new and/or
innovative dental and oral healthcare
treatment pathways or products,” said
Mr. Troy Williams, ADIA Chief Executive
Ocer.
The Australian Dental Industry
Association Research Grant provides
funding to explore the potential of a
n o v e l c l a s s o f a n t i b i o t i c s c a l l e d
antimicrobial peptides (AMP). The research
team have already identied several AMPs
by altering their sequence and adding
chemical moieties that reduce toxicity
to mammalian cells while targeting and
enhancing antibacterial activity towards
periodontal pathogens.
“ADIA has a long track-record of
supporting the development of innovative
patient diagnostic and treatment
options and it’s in this context that we’re
c o mm i tted to th e lo n g -term fu n di n g o f th e
Australian Dental Industry Association
Research Grant is funded,” Mr. Williams
said.
10 DENTAL ASIA
MAY / JUNE 2018

Dental Updates
Convergent Dental Expands Executive Leadership Team with Two New Additions
Convergent Dental, Inc., developers
of Solea ® , the industry-leading CO 2
all-tissue dental laser system, is pleased
to announce two new appointments
t o i t s e x e c u t i v e l e a d e r s h i p t e a m .
Mr. Daryl Donatelli recently joined the
Company as Vice President of Marketing,
and Mr. Charles Kerbage now
holds the title of Vice President of
Research and Development.
In his new role as Vice President
of Marketing, Mr. Daryl Donatelli
w i l l d r i v e a l l m a r k e t i n g e f f o r t s f o r
Convergent Dental’s agship product Solea,
the No.1 selling dental laser for hard, soft,
and osseous tissue procedures. Mr. Donatelli
will lead Convergent Dental’s marketing
team eorts including product strategy,
marketing communications, business
partnerships, and sales enablement.
“I’m very excited to be part of creating
what will denitely be a new standard of
care for dentistry,” remarked Mr. Donatelli.
“I am even more excited about enabling
an experience for patients that will forever
change what it means to go to the dentist.”
Mr. Donatelli brings over fifteen
years of executive marketing experience
to Convergent Dental, including the
commercialisation
and growth of major
medical devices
a n d c o n s u m e r h e a l t h p o r t f o l i o s a c r o s s
North America, Asia and Europe.
Mr. Donatelli holds a BA in Economics
from the University of Rochester, and an
MBA from Simon Business School.
In addition, Mr. Charles Kerbage
h a s j o i n e d C o n v e r g e n t D e n t a l a s
Vice President of Research and Development.
Mr. Kerbage will lead the Company’s R&D
team in identifying opportunities for
innovation that will both improve existing
product performance and bring new
capabilities into the company’s product
portfolio.
“Having come from the laser industry, I
was attracted to the innovative culture and
commitment to creating excellent products
that exists at Convergent Dental,” remarked
Mr. Kerbage. “The folks at Convergent are
true pioneers in dental laser technology,
and their reputation for a superior customer
experience is second to none. I am thrilled
to be working with such a high-powered and
motivated team of professionals.”
As a technical leader with strong business
acumen, Mr. Kerbage has over 15 years of
experience in scientic and technological
innovation and has transitioned numerous
technical developments into gamechanging
solutions in the medical devices,
life sciences, and photonics industries.
M r . K e r b a g e h o l d s a P h D i n
Applied Physics from Columbia University,
and an MBA from Boston University.
Complete Make-over: University of Pretoria Installs Dentsply Sirona’s Technologies
I n J a n u a r y 2 0 1 8 , t h e
University of Pretoria and Dentsply Sirona
completed an ambitious renovation project.
In just four weeks, Dentsply Sirona equipped
two levels of the Faculty of Health Sciences,
Prinshof Campus, School of Dentistry with
its technologies – in particular 22 Intego
treatment centres.
The University of Pretoria (South Africa)
has chosen Dentsply Sirona’s
technologies for its ambitious renovation
p r o j e c t . T h e S c h o o l o f D e n t i s t r y o f t h e
F a c u l t y o f H e a l t h S c i e n c e s ,
P r i n s h o f C a m p u s , h a s a l r e a d y u s e d
Dentsply Sirona’s CAD/CAM technologies
and imaging systems. Now, Dentsply Sirona
installed 22 Intego treatment centres and
additional equipment on two levels: On
level 02 in the Department of Maxillo-Facial
and Oral Surgery as well as on level 03 in the
Department of Prosthodontics.
Renovation while running operations
Requirements for the comprehensive
r e n o v a t i o n p r o j e c t w e r e a m b i t i o u s .
“Our hospital could
not stop operations.
So, we had to t all
patients in on the
available oors. Any
delay would not only
have affected the
students who started
in February, but
also the patients”,
explained Professor AJ Ligthelm, CEO and
Chairperson of the School of Dentistry.
Besides the treatment centres
Dentsply Sirona equipped also the sterilising
rooms and the joinery on the two levels.
In the Department of Prosthodontics,
Dentsply Sirona also installed third party
equipment for the clinical lab.
Ready to use in just four weeks
Dentsply Sirona completed the renovation
i n v e r y s h o r t t i m e . M r . A n d y C y p r i a n o s ,
C o m m e r c i a l D i r e c t o r D e n t s p l y S i r o n a
South Africa, describes the challenge: “We
were dependent on other contractors to be
nished before we could
start. Therefore, we had
to cope with a very short
time frame to complete
our installations by the
end of January 2018”.
Intego and more –
new equipment for
students
In the Department of Maxillo-Facial and
Oral Surgery Dentsply Sirona set up six
operatories and in the Department of
Prosthodontics in total 16 cubicles.
The renovation works in the
Department of Prosthodontics were even
more extensive. Dentsply Sirona equipped
cubicles for the sta and for the students.
I n t h e d e p a r t m e n t ’ s c l i n i c a l l a b ,
Dentsply Sirona put in third party
equipment such as polishing lathes,
micromotors and extraction units. In the
Department of Prosthodontics, third party
suppliers contributed also cleaning devices
such as instrument washers.
12 DENTAL ASIA
MAY / JUNE 2018

Service Engineers from
Roland D G Australia and Aarque in
New Zealand Win Big in
Global SE Awards
Mr. Mark Johnson
→ THE EVOLUTION
OF PROPHYLAXIS
NEW COMBI touch
→ AIR-POLISHING AND ULTRA-GENTLE
ULTRASOUND IN ONE UNIT
→ www.mectron.com
Mr. Peter Holbrook
Roland DG Australia, a leading manufacturer of wide
format inkjet printers and 3D devices, are excited to announce
that Roland DG Australia Service Agent, Mr. Peter Holbrook,
and Mr. Mark Johnson of Aarque in New Zealand both won
awards as a part of the Roland DG Global SE Awards.
The Global SE Awards 2018 is the third global contest to
be held, following the most recent event in 2015. From a total
of 778 Roland certied Service Engineers (SEs) around the
world, 28 nalists from the local competitions were brought
together for the nal contest, held from 23 rd to 25 th Ap ri l a t
Roland DG Corporation in Hamamatsu, Japan.
T h e t h r e e - d a y c o m p e t i t i o n i n c l u d e d w r i t t e n a n d
hands-on exams to test the participants’ skills and knowledge
of maintenance services. Representing the Oceania region
(Australia and New Zealand), Mr. Mark Johnson of Aarque in
New Zealand, took out 1 st place in the inkjet printer category,
whilst 2 nd place went to Mr. Matthew Wrench from Roland DG UK
and 3 rd place went to Mr. Vincent Votruba from Slovakia.
As a part of the competition, Mr. Peter Holbrook,
o f R e d P e r i l , R o l a n d D G ’ s S e r v i c e A g e n t f o r
Western Australia, was awarded the Engineer whose
customer satisfaction score was highest for the Asia Pacic
region (Korea, ASEAN, NZ, Australia, China and Japan), based
on the results from satisfaction surveys sent to customers.
Roland DG Australia would like to congratulate both
Mark and Peter on their well-deserved awards, as well
finalists Mr. Allan Cooke, SE for the QLD region, and
Mr. Darren McInnes, SE for the VIC region, for their continued
hard work and for making it to the top 28 SEs in the world.
120° 90° PERIO
→ easy switch from supra to subgingival
air-polishing by a simple click
→ the best access thanks to 3 available nozzles
→ soft mode: maximum comfort for sensitive
patients
→ more than 40 inserts for the widest range
of ultrasound indications
DENTAL ASIA
MAY / JUNE 2018

Dental Updates
CS 8100SC 3D Wins 2018 Edison Award for its Innovative Design
The CS 8100SC 3D
e x t r a o r a l i m a g i n g s y s t e m b y
Carestream Dental has been awarded a
bronze 2018 Edison Award in the category of
Dental/Medical Digital Imaging by the
internationally renowned Edison Awards.
T h e d i s t i n g u i s h e d a w a r d , i n s p i r e d b y
Thomas Edison’s persistence and
inventiveness, recognises innovation,
creativity and ingenuity in the global
economy.
“It’s exciting to see companies
l i k e C a r e s t r e a m D e n t a l c o n t i n u i n g
Thomas Edison’s legacy of challenging
c o n v e n t i o n a l t h i n k i n g , ” s a i d
Mr. Frank Bonafilia, executive director,
Edison Awards. “Edison Awards recognises
the game-changing products and services,
and the teams that brought them to
consumers.”
The award was announced on 11 th April
2018, at the Edison Awards Annual Gala,
held in the historic ballroom of The Capitale
in New York City, N.Y. Mr. Matthew Greer,
regional product manager for extraoral
imaging, was in attendance to accept the
award on Carestream Dental’s behalf.
“Carestream Dental always strives
to deliver innovative technology that
s u p p o r t s d o c t o r s i n t h e i r d i a g n o s e s , ”
Ed Shellard, D.M.D., chief dental ocer,
Carestream Dental said. “Winning a bronze
2018 Edison Award reinforces that the
company is meeting the needs of doctors
and their patients around the world.”
To earn a bronze 2018 Edison Award,
the CS 8100SC 3D was judged on its concept
and development, value and impact on the
industry.
The CS 8100SC 3D oers two-dimensional
panoramic imaging, cephalometric imaging,
cone beam computed tomography (CBCT)
imaging and model/impression scanning
all in one compact system. Its minimal
f o o t p r i n t a n d a f f o r d a b i l i t y m a k e s
3D imaging available to smaller practices
that either couldn’t aord or didn’t have
space for an extraoral imaging system in
the past. That means doctors can go from
diagnosis to treatment faster, without
having to send patients to an imaging
centre. Not only is the system more
convenient, but it’s also faster—featuring
the fastest scanning cephalometric
m o d u l e o n t h e m a r k e t — a n d s a f e r . T h e
CS 8100SC 3D’s low dose program can
deliver 3D imaging at a dose equal to or
lower than panoramic imaging.
“The success of the CS 8100SC 3D
began more than a decade ago with
the initial development of the awardwinning
CS 8100,” Dr. Shellard said. “That
one system would eventually grow a
‘family’ of units, all with dierent imaging
capabilities. The CS 8100SC 3D represents
Carestream Dental’s ultimate goal
by combining the best features of
its predecessor systems into one
multifunctional solution making it a costeective,
powerful imaging available for
more doctors.”
Edison Award nominees are judged
by more than 3,000 senior business
executives and academics from across
th e n a ti o n , wh o se vo tes a c kn o wledg e th e
CS 8100SC 3D’s success in meeting the
organisation’s stringent criteria of quality.
The voting panel includes members of:
Chief Marketing Officer Council (CMO);
Design Management Institute (DMI);
American Productivity & Quality Center
(APQC); American Society of Mechanical
Engineers (ASME); Georgia State Marketing
Roundtable (GSU); Product Development
and Management Association (PDMA);
Association of Technology Management
a n d A p p l i e d E n g i n e e r i n g ( AT M A E ) ; p a s t
Edison Award winners; marketing
professionals; scientists; designers;
engineers; and academics.
Henry Schein Buys 50% of Ortho2
Henry Schein Inc, Melville, NY, and
Ortho2, Ames, Iowa, have signed a
den i t i v e a g r e e m e n t a i m e d a t i n c r e a s i n g
Henry Schein’s position in the orthodontic
practice management software market. As
a result of the denitive agreement signed
by the two companies, Henry Schein will
own a 50% interest in Ortho2.
“We welcome our new Ortho2
colleagues to Henry Schein, and look forward
t o c o n t i n u e d s u c c e s s t o g e t h e r , ” s a i d
Mr. Stanley M. Bergman, chairman of
the board and chief executive oce r o f
Henry Schein. “With this investment in
Ortho2, we round out our dental software
portfolio and gain a leadership position
in orthodontist practice management
software. This transaction supports our
to advanced technology, and to
category leadership. We look forward to
oering advanced software solutions to
orthodontists, just as we currently do to
general practice dentists.”
Founded in 1982 by Mr. Dan Sargent and
Dr. William Iversen, Ortho2 currently has a
sta of over 70 and oers the Edge Cloud
practice management solution, as well
as ViewPoint, a Windows-based software
option. According to a press release,
Ortho2 serves nearly 1,700 orthodontists
in approximately 2,400 locations, and had
recorded revenues of $14 million.
“We are delighted to be joining forces
with Henry Schein,” said Ms. Amy Schmidt,
president, Ortho2. “We’re proud of what
we’ve accomplished in our 35 years as
The ongoing technology explosion
and evolving orthodontic market now
m a kes j o i n i n g fo rc es wi th Hen ry Sc h ei n a
win-win for us and, most signicantly, for
o u r c u s t o m e r s . T h e a b i l i t y t o l e v e r a g e
Henry Schein’s comprehensive ecosystem
will allow us to offer a turnkey solution
including software, digital imaging,
equipment, supplies, and many other
benefits to our current and future
customers.”
“Practice management software is
the backbone of an efficient, profitable
practice,” Mr. Bergman added. “Henry Schein
embraces an open architecture approach
to all software and advanced technology,
which allows for the purchase of products
and services that best meet the needs of
each individual practice.”
commitment to dental specialty markets, a c o m p l e t e l y i n d e p e n d e n t c o m p a n y .
14 DENTAL ASIA
MAY / JUNE 2018

Dental Updates
Glidewell Dental to Present 2 nd Annual Educational Symposium
Glidewell Dental, a leading technological
innovator in restorative dentistry for
o v e r 4 8 y e a r s , h a s a n n o u n c e d t h e
2 nd Annual Glidewell Dental Symposium.
Scheduled for 19 th -20 th October,
2018, at the Gaylord National
Reso rt & Co n ven ti o n Cen tre i n
National Harbor, Maryland, near
Washington, D.C., this event
will include more than a dozen
prominent educators providing two days
of intensive instruction, with a rst day of
fast-paced presentations and a second day
of in-depth clinical and business training.
“Dentists have more options for
treating patients today than ever before,”
said Dr. Neil Park, scientific chair of the
Glidewell Symposium and vice president
of clinical affairs at Glidewell Dental.
“This period of rapid innovation in dental
technology presents many opportunities
for clinicians to expand their knowledge
and practice offerings, and to explore
more eective and ecient solutions for
elevating the standard of care within our
profession.”
The symposium brings together
notable experts from many different
backgrounds and specialties,
including aesthetic dentistry, digital
dentistry, dental implants, tissue
regeneration, sleep-related dentistry,
practice management, and more. The event
kicks o Friday, 19 th October, with
a presentation on the current
and future state of dentistry
from Mr. Jim Glidewell,
C D T , p r e s i d e n t a n d C E O o f
Glidewell Dental, followed by
an energising lineup of informative
presentations and a very special keynote
address delivered by Dr. Jack Hahn, a
legendary pioneer in dental implantology.
On Saturday, 20 th October, in-depth,
hands-on workshops will be led by some
of the most distinguished leaders in
clinical dentistry, representing faculties
of such esteemed organisations as the
M i sc h In tern a ti o n a l Im p la n t In sti tu te, th e
International Congress of Oral Implantologists,
and the American Academy of Implant Dentistry.
The workshops will provide practical clinical
information on the latest innovations,
protocols, products and procedures in the
field, so that clinicians can immediately
implement focused techniques into their
practice when they return to the oce on
Monday.
“Following the success of last year’s
sold-out symposium, we received an
abundance of feedback from attendees
who expressed their desire for refining
their clinical skills and adopting the latest
technology to grow their practice,” said
Dr. Park. “They inspired us to expand the
event to two days, to cover even more
clinical and business topics, with nearly a
dozen hands-on Saturday workshops to
choose from. And we’ve moved to a more
spacious venue to accommodate a vast
array of interactive exhibits and technology
demonstrations — to create an even bigger
and better experience than last year.”
During both days of the event, the
exhibition floor will be packed wall to
wall with displays of 3D printing, intraoral
scanning, in-office milling, the CAD/CAM
workow, dental implants, and regenerative
and restorative materials, as well as live
demonstrations and a virtual reality tour of
Glidewell Dental’s expansive R&D campus,
technology centre and laboratory.
The 2018 Glidewell Dental Symposium is
designed for dentists, hygienists, and chairside
and front-office auxiliaries, and attendees
enrolled for both days will earn up to 12 hours
of continuing education (CE) credits.
Renfert Education – Opening Event
On 10 th April 2018, Renfert opened
their new training rooms at the Renfert
headquarters in Hilzingen with guests
from the press, cooperation partners and
opinion leaders.
Renfert took the opening ceremony
as an opportunity to present their new
training rooms and show guests the Renfert
philosophy, the courses on oer and the
unique transmission technique using the
video microscope EASY view 3D.
Renfert Course Themes
Renfert training venue offers space for
12 participants to work at state-of-theart
workstations. These workstations
are equipped with the most modern
devices, including a video microscope
with 3D monitor. The video microscope
transmits the magnification via the
m o n i t o r i n t h e o p t i o n a l 2 D o r 3 D m o d e s .
The “Demonstrator” workstation is
additionally equipped with a PC for live
transmission to the monitors. There is
also a at screen that can be used for live
transmission and presentations.
Course program
Every restoration follows a process that has
to be mastered. Teaching individual modules
as well as complete work processes makes
it possible to create restorations that are
even better in technical terms and that are
close to nature. Renfert will in future oer
courses for dental technicians, dentist and
dental assistants. Courses are developed by
Renfert specically or in collaboration with
cooperation partners.
• Histoanatomic topography of the
teeth
• Monolithic, aesthetic and hyper
realistic near to nature wax-up
• Biomorphology of the teeth
• Implementation using layering
ceramics, pressed ceramics, CAM
technology
• Functional gauge, occlusal compass,
NAT- natural wax-up technology
• Model fabrication (systems based on:
plaster and plastic base-plates)
• Dental photography (studio and
patient photography)
• Dental communications training
(coaching, marketing)
16 DENTAL ASIA
MAY / JUNE 2018

Under the Spotlight
Rockstar in
Dentistry
Interviewed by Ms. Jamie Tan
Written by Dr. Chala R. Platon
THROUGH upholding the philosophy
of pursuing excellence in personalised
dental care, with comprehensive treatment
planning using both restorative and
cosmetic dentistry to achieve optimal
health, Dr. Lawrence Lau together with his
wife (Dr. Gloria Shih) are the principal dentists
a n d o w n e r s o f S y d n e y L a s e r D e n t a l C a r e .
It is located at Sylvania Waters which later
on successfully expanded to two more
branches in Pyrmont and Illawong.
Looking back
Prior from entering dentistry,
D r . L a u a t t e n d e d b o a r d i n g s c h o o l a t
St. Joseph’s College. In 1997, he graduated
with honours from the University of Sydney
with a Bachelor of Dental Surgery.
Since graduation, he has not stopped and
spent extensive time on continuing education,
to
keep his dental practice at the
forefront of dental technology.
This includes the use of CEREC
technology to optimise the
outcomes of his cosmetic and
restorative procedures, laser
dentistry, guided implant surgery
and
a range of orthodontic
treatments. His enthusiasm in
expanding knowledge comes from
understanding that dentistry is a
relentlessly evolving practice.
“So when we graduated, we were
warned not to take on anything too
challenging. Our professors/ mentors
guided us to keep within our boundaries. As
a result, I feel we did come out with better
skills sets,” reminisced Dr. Lau.
He shared that graduates nowadays
come out of dental universities more
condent but still lack clinical experience.
During his time, graduates tended to be
very conservative and had to search for
answers on their own.
Provision of excellent care
Dr. Lau’s practice is a general practice
rst and foremost. He specialises in the
provision of excellent care for his patients
whether it be in orthodontics, implantology
or endodontics.
“Basically, we don’t specialise in any one
thing but we specialise in trying to give our
patients the best experience possible,” he said.
Presently, his practice strongly
considers digitalisation as a contributing
factor in their success. He believes that
laser gives the perception to the general
public that a practice is incorporating a
very niche, unique and advance technology.
18
DENTAL ASIA
MAY / JUNE 2018

The universe at your fingertips.
The highest technology dental laser system
Supreme clinical results:
TwinLight ® Perio Treatments
TwinLight ® Endo Treatments
No-sutures soft-tissue surgery
Patient-friendly conservative dentistry
Pre-sets for over 40 applications
Unmatched simplicity of use:
Balanced and weightless OPTOflex ® arm
Nd:YAG handpiece detection system
Quantum Square Pulse technology for fast
minimally invasive treatments
X-Runner TM - the first digitally controlled
Er:YAG dental laser handpiece
Visit www.fotona.com to find out more!
Fotona App
www.fotona.com
88897/25

Under the Spotlight
Patients often come into the clinic inquiring
about laser dentistry. Dr. Lau sees this as a great
conversation opener wherein he can talk about
their advance practice giving them a favourable
market position.
“A lot of patients do come in and ask ‘what
is laser dentistry?’. It has made our practice
successful and it has denitely made us stand out
from the rest,” he stated.
Dr. Lau constantly upgrades his materials
and equipment in his practice. Moreover, his
practice is very aesthetically-driven which means
he surrounds himself with pleasing and functional
equipment. It is no surprise why Dentsply Sirona
has been part of his practice as he appreciates how
useful and appealing the company’s products and
equipment are.
In fact, during IDEM 2018, Dr. Lau purchased
two additional chairs to be installed in his main
practice – making it a five chair practice. He
will be incorporating the Teneo, the top of the
line dental chair from Dentsply Sirona, which
includes numerous functions (massage, implant,
endodontic functions with intraoral cameras
and screens). He is looking forward to this new
enhancement to his practice and believes that it
will be benecial for the patient and for him. In
addition, he recently invested in a 3D printer which
will further contribute to the ecient and modern
workow of his practice.
Fully embracing continuing education
Aside from frequent upgrades to his materials
and equipment, Dr. Lau certainly considers that
continuing education is an integral part for all
professionals. With the fast pace of technology and
change in the eld of medicine and dentistry, he
recognises that it is a duty to keep oneself updated.
“It is not just sitting down and listening to
lectures but it is also speaking to peers, to the
industry and learning as much as you can. In my
opinion, I nd that the younger generations fully
embrace continuing education. Unfortunately, and
sadly, some of my older colleagues may not share
the same view,” he shared.
Though this might be the case, Dr. Lau believes
that it is slowly changing. He believes that through
the help of the government body, organisations,
associations and societies they can provide better
continuing education and help everybody to
participate even more.
He mentioned that it is good to see colleagues
wanting to learn further on new advancements
20 DENTAL ASIA
MAY / JUNE 2018

Under the Spotlight
and technologies. He encourages
everyone, young and experienced, to
embrace continuing education as part of
their commitment and responsibility as
professionals.
“Having said this, even though I’m very
much embracing the best in advances in
dentistry, a wise person once told me,
‘I don’t care what you do as
long as you do it well’
If some of my colleagues still cling to
traditional methods, it doesn’t matter. If
it works for them and they are providing
the best for their patients, it is absolutely
alright,” explained Dr. Lau.
According to him, traditional doesn’t
mean bad or wrong. He’d rather have
someone do good traditional dentistry
than poor up-to-date dentistry. No matter
what method a dentist prefers, the utmost
priority is providing excellent care and
quality service for patients.
Cerec-files community
Dr. Lau has been an avid CEREC user since
2004 and also runs the only independent
CEREC training course in Australia. With
his experience and wanting to help
others, he founded Cerec-files. It is a
Facebook group that turned into a genuine
community wherein like-minded dentists,
more forward-thinking and open-minded
practitioners communicate to each other
about CEREC cases.
“We have a good community. Everybody
helps and looks out for each other. I admit
we do have a little bit of fun. We don’t take
DENTAL ASIA
MAY / JUNE 2018
21

Under the Spotlight
ourselves too seriously but we take CEREC
dentistry very seriously,” he revealed.
Cerec-files is based in Australia and
founded around ve years ago. The group
have accumulated a number of members
not only in Australia or New Zealand but
all over Asia, Europe and North America.
It is a community managed by clinicians
and not by companies. Dr. Lau admits
that they even have members that are
utilising other CAD/CAM systems that have
joined their community. He explained that
other systems don’t have such a strong
community to support users like CEREC
presently does. He shared that he feels
fullled and accomplished when he sees
fellow dentists helping each other in the
Cerec-les group. He said this is the main
purpose why he set-up the group in the
rst place.
Digital Smile Design (DSD) workflow
In addition to founding a support group
for CEREC users, Dr. Lau has been applying
DSD into his practice. He considers this as
an innovation and development in dentistry
workflow wherein scientifically based
algorithms and dened parameters are used
to help in treatment planning and providing
digital smile simulations (shape and size of
teeth according to the patient’s prole).
“It is mathematically-driven. It is based
in science. It is a revolution to us (dentists).
All of a sudden, we can give patients their
predicted smile that suits them. Now with
CEREC, we can reproduce them (crowns,
veneers, onlays and inlays) accurately and
faster,” he added.
Looking ahead
Dr. Lau keeps an open-mind for the future.
He thinks that 3D printing will be huge in
the next few years. It will not solve all the
problems in dentistry but it will propel the
industry to the next level. He sees CAD/CAM
continuously growing and eventually being
present in all the practices in years to come.
“Other trends will be minimal
preparations and minimally invasive
dentistry. There is also fascinating work
with stem cells and regeneration/growing
teeth. I believe it will eventually happen
and it would be a major disruption into the
profession,” he shared.
Giving back
Dr. Lau emphasised that all he wants is
to give back to the profession he knows
and loves. He is not trying to seek fame
and considers himself a conservative and
introvert person. Some of my younger
colleagues see me as approachable, he
believes it is because he is not a fulltime
lecturer or in academia but rather he is
a fulltime clinician. He tries to make his
lectures lively and engaging which makes
him popular and well-liked among his peers,
some even call him a “Rockstar.”
“I love talking to people. I love sharing
what we do on a daily basis. We do get a
lot of people visiting our practice. To all the
readers of Dental Asia and whoever wants
to visit me in our practice, please spend a
day with us. We’d love to have you!”
Dr. Lau not only gives back to the
industry but makes sure that he applies this
principle in his life. He also makes sure to
give back by providing excellent care and
services to all his patients. Likewise, with
his family, he wants to provide the best for
his family and imparts values to his children.
“We try to adhere to being a good
person and just try to do the best we can,”
emphasised Dr. Lau. DA
22
DENTAL ASIA
MAY / JUNE 2018

SHAPING THE FUTURE OF
ORTHODONTICS
Interviewed by Ms. Jamie Tan
Advancement in technology
is incessant in the industry.
Digital dentistry is
continuously expanding its
reach and function in all the
dierent elds. Recent examples include
digital impressions in prosthodontics,
CBCT scans for implant guided implants,
3D printing of prosthesis (onlays,
i n l a y s , v e n e e r s a n d d e n t u r e s ) a n d n o w
Dental Monitoring for orthodontics. To
find out about Dental Monitoring, what
it can bring to practices and patients
a n d h o w i t w o r k s , D e n t a l A s i a s p o k e t o
D r . G r a n t D u n c a n , t h e p i o n e e r
Dental Monitoring user for Invisalign in the
Asia Pacic region.
Dr. Grant Duncan is a specialist
orthodontist in Adelaide, Australia.
H e g r a d u a t e d i n D e n t i s t r y f r o m t h e
University of Adelaide, and subsequently
went to the University of Manitoba
to achieve his Master of Science in
Orthodontics.
H e i s a c e r t i f i e d t r a i n e r f o r
Align Technology (Invisalign), a clinical
tutor in the University of Adelaide,
past co-director of the Adelaide
Seattle Study Group, a founding
president of the Australian
Orthodontist Study Group,
member of the prestigious
Pierre Fauchard Academy of
D e n t i s t r y a n d c o - f o u n d e r o f
The Invisible Orthodontist.
Orthodontic community
Dr. Duncan’s dedication
to his work is shown
through his passion for
education. This also led
h i m t o b e a c o - f o u n d e r o f
The Invisible Orthodontist (TIO),
an international network of
orthodontists throughout
Australia, USA and UK that are committed to
treating patients using invisible techniques
like Invisalign – orthodontic treatment
which uses clear plastic aligners that are
nearly invisible – to move teeth into the
desired position.
24 DENTAL ASIA
MAY / JUNE 2018

Under the Spotlight
Some may say that the orthodontic
community has been slow in embracing
Invisalign as a legitimate treatment option
as many orthodontists are still reluctant
to treat complex cases with Invisalign.
TIO group actually believes that not only
is Invisalign a possible treatment option in
the majority of cases but in many instances,
it is preferable to traditional metal braces.
“The TIO community has turned
itself, through community involvement
and engagement, into a leading voice
for specialist orthodontist and dental
innovation. Now with close to 100 members
worldwide and still rapidly growing, we
seem to attract people who not only
want to expand their practices but also
want to be part of shaping the future of
orthodontics,” stated Dr. Duncan.
Years of experience using Invisalign
Dr. Duncan has been a practicing
orthodontist for over 25 years with a special
interest in aligner treatment and completes
about 500 Invisalign cases a year. Hence,
it is no surprise that he is one of the rst
Invisalign providers in Australia to be honoured
with a Black Diamond Provider Certication
(more than 400 patients) from Invisalign
in 2015. This only shows his commitment
and clinical experience with Invisalign
treatment.
He has preferred Invisalign since
2000, when he started using the system,
because of the company’s long history and
commitment in research and development
of aligner treatments.
“As professionals, we have a lot to be
grateful for with Align Technology. There
are some major companies moving into
the space and I expect 2018 will be a big
year for orthodontists interested in aligner
treatments. I am excited for new and
dierent products with new price points.
There will be fun times ahead.”
D r . D u n c a n i s a l s o p a r t o f t h e
National Invisalign Accreditation team,
lectures nationally and internationally
on the system, and teaches Invisalign to
g r a d u a t e o r t h o d o n t i c s t u d e n t s a t t h e
University of Adelaide, School of Dentistry.
Integrating technology into
the practice
A s i d e f r o m h i s i n t e r e s t i n e d u c a t i o n ,
Dr. Duncan believes that digitalisation
is the way of the future in dentistry. His
practice has been in the digital space for
close to 20 years by utilising digital photos,
digital radiographs, digital communication,
digital appliances (like Invisalign and
Insignia), 3D printing, digital orthodontic
s e t - u p s , i n - h o u s e a l i g n e r f a b r i c a t i o n ,
Dental Monitoring for treatment
monitoring, marketing through social media
and digital advertising.
“TIO is almost entirely digital, through
educational portals, community forums and
in fact our expertise is in the entire digital
marketing space,” he added.
What is Dental Monitoring?
As previously mentioned, Dr. Duncan
has been using Dental Monitoring (DM)
as a tool in orthodontics to monitor
patient’s treatment after he came
DENTAL ASIA
MAY / JUNE 2018
25

Under the Spotlight
across it in an orthodontic conference a
c o u p l e y e a r s a g o . D M i s t h e b r a i n c h i l d o f
Mr. Philippe Salah, a French innovator and
entrepreneur. Dr. Duncan believes that
everyone should be thankful to Mr. Salah
for coming up with DM.
DM uses articial intelligence (AI) and
deep learning to monitor orthodontic
tooth movement, archwire passivity, tooth
movement velocity, and aligner t, amongst
a myriad of other intra oral observations. DM
is divided into three integrated platforms: a
mobile application for patients, a patented
movement tracking algorithm, and a webbased
Doctor Dashboard where practitioners
receive updates of patient’s progress.
The DM application for patients is a
revolutionary tool designed to help patients
capture dental
pictures easily
and efficiently.
DM is developed
for Android and
iPhones, making
it accessible to
everyone. The app
guides the patient
through the
process of taking
the pictures on a
regular schedule
suggested by
the orthodontist
according to the
treatment plan.
From a patient’s
perspective, they
use a smartphone app and video camera
to record necessary data for analysis. As a
result, patients only need to be seen by their
orthodontist when a clinical action (broken
archwire, dislodgment of bracket, or aligner
t issues) is required.
Dental Monitoring in the practice
Dr. Duncan has been using DM in his
practice since July 2017. Subsequently, all
his aligner cases are managed using DM on
a weekly basis.
“It has been the most radical change in
my practice since introducing Invisalign in
2000. It is a game change and will continue
to evolve rapidly.” he remarked.
In addition, Dr. Duncan has been
running a trial on doing an entire aligner
treatment with as few appointments
as possible. Currently, this trial (with
20 patients) is tracking about three to
five appointments in total including
i n s e r t i o n , p l a c e m e n t a t t a c h m e n t s ,
interproximal reduction (IPR) and nishing.
He believes that this is a ground-breaking
success in Invisalign treatment and will
make orthodontics more accessible to the
public.
“In the last few months, I am starting
to move selected patients into this format.
We oer patients the opportunity to only
come as needed when using DM. Hence, our
appointment schedules, sta time and my
time are all rapidly changing,” he continued.
The basis of DM is improving quality
treatment outcomes. Dr. Duncan shared
that with the help of DM, he could see
clinical problems and issues within a few
days of it occurring, and at a pixel level,
which is clearly far higher than the human
eye can detect. As a result, his patients are
more compliant, treatments track better,
and fewer and less complicated treatment
renements are needed.
“Anything the human eye can see, DM
can do it better and it is denitely capable
of learning from any recorded data,” he
added.
In addition, patients get a quality
outcome and they also appreciate the
reduction of appointments with improved
digital communication. Dr. Duncan considers
time to be one of a person’s most valuable
commodities and DM respects this to
eectively manage patient appointments.
26 DENTAL ASIA
MAY / JUNE 2018

He sees DM being integrated into other elds of dentistry.
According to him, it will be useful for oral hygiene and
periodontal concerns. DM will also be helpful in diagnostic
dentistry.
Words of advice
Dr. Duncan strongly regards education as a valuable part
in being successful in this industry. He shared that going
to meetings, talking to people, visiting other practices and
businesses, engaging with Key Opinion Leaders (KOL),
keeping an open mind, being innovative and entrepreneurial
and saying “yes” will truly be helpful to one’s growth.
“You have to decide if you are a follower or a leader.
During one of my presentations, I was asked: ‘Will AI
replace orthodontists?’. I answered no. It would not replace
orthodontists but it will replace those orthodontists who
don’t use AI. The same will hold in any part of dentistry –
examination, diagnostic or treatment planning,” he stressed.
He mentioned that being true to oneself, helping others,
giving back and being prepared to fail are all part of learning
and building oneself.
Moreover, Dr. Duncan wished that he had come across
Schopenhauer’s three stages of truth (ridicule, violent
opposition and self evidence) earlier in his career. It would
have given him some inner peace and guided him in helping
others to reach the self-evident stage of truth earlier.
“Time and time again, I have seen and started something
new that tests the status quo. I teach my children to welcome
failure. If you are not failing you are not learning and will not
try new things. I believe in helping others and giving back in
everything and at every opportunity. It is far more rewarding
and one of life’s greatest joy. Start today,” Dr. Duncan rmly
concluded. DA
Extreme flexibility,
precise results.
Reliable model production thanks
to the ingenious AUTO spin system.
AUTO spin
Model System
Precise working models
made easy: The AUTO spin
model system ensures
highly precise acrylic plate
drilling holes with optimal
working comfort.
High flexibility through
compatible components
with other model systems
such as Giroform ® or
Zeiser ® .
+
For more information
renfert.com/autospin
DENTAL ASIA
MAY / JUNE 2018

Mr. Hull is inducted into the
National Inventors Hall of Fame
at the U.S. Patent oce in 2014.
Ahead of His Time
Interviewed by Ms. Jamie Tan
For over 30 years, 3D Systems
has bridged the gap between
inspiration and innovation
by connecting customers
with the expertise and digital
manufacturing workflow required to
solve their business, design or engineering
problems. Through the inspiration of
Mr. Charles “Chuck” W. Hall, co-founder and
inventor of stereolithography (3D Printing),
3D Systems has grown into one of the global
leaders in 3D solutions.
Read on to get a clearer picture of
t h e i n s p i r a t i o n b e h i n d t h e i n n o v a t i o n ,
3D printing’s widespread (and still
expanding) application, and to know more
about Mr. Chuck Hull, the pioneer behind
one of the most inuential technological
advancements of the last three decades.
Inspiration behind the innovation
As a design engineer in the early 1980s,
Mr. Hull realised that the production
process to design plastic parts with injection
moulding was very time consuming and
tedious. Working at a company that made
equipment for UV curable inks and coatings,
he wondered whether the UV curable
plastic could be formed into thin sheets and
fused together to form three-dimensional
objects. This is where his idea to make
prototypes for plastic parts came from as
he believed this would greatly speed up
plastic part design.
Mr. Hull described that the previous
process involved: designing the part,
making blueprints, discussing the designs
with the toolmaker, producing the mould
for the plastic part, and then injecting the
mould with the material. A waiting period
of six to eight weeks passes before the part
could be produced.
The process, needless to say, eats up a
lot of time. In addition, sometimes parts
would come in with aws or would require
adjustments, which entails going through
the same process of redesigning and
executing the changes. He admits that often
it could take months to just develop a rst
part/article before they could actually test it.
“That was the way to design plastic
parts and everybody struggled with it.
My goal was to see if I could come up
with a way to get that rst article faster,
do iterations quickly, test the design and
then n a lly h a vi n g a to o l fo r p ro du c ti o n ,”
Mr. Hull recalls.
He admits that he tried a couple of
ideas that didn’t work before he nally got
on to what was ultimately known now as
stereolithography. Finally, in 1983 he made
the rst 3D printed part.
28 DENTAL ASIA
MAY / JUNE 2018

Dental Profile
Video monitor shroud 3D printed in 3D Systems’ DuraForm ® ProX ® FR1200
nylon material – signicantly lighter weight as compared to traditional
manufacturing processes.
3D Systems’ 3D printing technology enables production of the largest
number of orthodontic aligners in the world.
An eye wash cup, the rst 3D printed part ever produced, was created by
Mr. Chuck Hull in 1983.
Unlimited opportunities and application of 3D printing
Right from the start, Mr. Hull imagined that 3D printing would
signicantly change design and manufacturing as the world knew
it. But he confessed that he didn’t anticipate the profound impact
3D technology would have in people’s lives. He is both humbled
and exhilarated to be a part of this incredible transformation
and innovation.
“When we rst started 3D printing all those years ago, I didn’t
expect it to become mainstream for a long time. I still can’t
believe that it is still in motion today. We’ve seen an increase
in adaptation of the technology for prototyping but now the
industry is heading into the realm of production,” explained
Mr. Hull.
Nowadays, manufacturers are incorporating 3D printing
into their workows, producing tremendous benets through
improvement of productivity, accuracy, and repeatability – all
while lowering the cost of operation. As such, industries from
healthcare to automotive – even aerospace, have all made
advancements by using 3D printing and it appears they will
continue to do so.
During the Lab Day at the Midwinter’s Dental Meeting
i n C h i c a g o i n F e b r u a r y , D e n t a l A s i a ’ s P u b l i c a t i o n D i r e c t o r
Ms. Jamie Tan had the opportunity to meet with Mr. Vyomesh Joshi
(President & CEO) and Mr. Rik Jacobs (VP, General Manager Dental)
of 3D Systems and talk about the benets the dental market is
seeing from adopting 3D printing and launching new products
from the company.
Overcoming obstacles
Mr. Hull shared that at rst no one knew what 3D printing was or
why anyone would need it. He said it was dicult to get started,
to raise capital and to begin a new enterprise in an entirely
new eld.
“The early work was pioneering with the hope and expectation
it would then have value. Fortunately, the U.S. automotive
industry embraced the technology to help speed up and to help
reduce the cost of designing new automobiles,” he narrated.
Eventually, the aerospace industry took on the innovation,
followed by companies in general manufacturing. Mr. Hull
admits being tremendously grateful to these early adopters of
3D printing which drove the technology forward.
After overcoming the hurdles and finally establishing
3D printing in the manufacturing industry, Mr. Hull was
i n d u c t e d i n t o t h e N a t i o n a l I n v e n t o r s H a l l o f F a m e a t t h e
U.S. Patent Oce in 2014. He also received the European Inventor
Award for Non-European countries in the same year.
3D printing in the dental industry
3D Systems, founded in 1986, eventually evolved into a global
leader in the 3D printing industry. Looking back, perhaps
the rst major success of 3D printing in the dental industry
resulted from a collaboration between 3D Systems and a major
orthodontic aligner company to develop and implement the
30
DENTAL ASIA
MAY / JUNE 2018

stereolithography-based technology that could be used
to manufacture aligners. Mr. Hull revealed that presently,
3D Systems is still a major supplier to that company, now
also a huge success in its field.
“Most of our historical dental lab offerings have been
based on using inkjet-based 3D printers and this will
continuously remain. We are adding Figure 4 TM based
technology because it can address more dental lab
applications resulting in total cost of operation being lower.
Moreover, with the introduction of NextDent TM 5100, we
are redefining digital industry and also enabling enhanced
patient care which is very powerful,” he added.
Words of wisdom
Mr. Hull has spoken with many renowned inventors and he
revealed that their stories, though diverse, are remarkably
the same: All of them have breakthrough ideas while facing
discouragement and criticism. When asked what he could
advise new generations of would-be innovators, Mr. Hull
was impactful and concise: “Persist”, he decisively replied.
Mr. Hull is truly an innovator well ahead of his time. DA
DENTAL ASIA
MAY / JUNE 2018
31

Dental Prole
Personalising
Dentistry
Interviewed and written by Dr. Chala R. Platon
Despite advances in dentistry
and dental hygiene, many
people still do not have good
periodontal health. Most
patients are not aware that
they have gum problems and some even
think bleeding gums during brushing and
flossing are normal. On the contrary, it
is actually an early sign of gum problems
which can later on lead to periodontitis
(gum diseases/periodontal disease). Read
on to find out more about periodontal
h e a l t h i n D e n t a l A s i a ’ s i n t e r v i e w w i t h
Dr. Angelo Mariotti, a periodontal specialist
and speaker at IDEM 2018.
Dr. Angelo Mariotti received his
Ph.D. in Pharmacology and Toxicology
including his Doctor of Dental Surgery from
West Virginia University. He later on obtained
his speciality training in Periodontology
from Virginia Commonwealth University.
He is currently Professor and Chair of
t h e d i v i s i o n o f P e r i o d o n t o l o g y a t
Ohio State University. Dr. Mariotti is also a
member of the Council on Scientic Aairs
for the American Dental Association, on
the Advisory Board for the Journal of
Periodontology and Clinical Advances in
Periodontics and an editor for Pharmacology
and Therapeutics for Dentistry.
Enjoying his craft
In addition to his research and teaching,
Dr. Mariotti still finds time to maintain
his private practice. This clearly shows his
passion and dedication to his work. He nds
Periodontology (periodontics) fascinating
- the disease and research process, the
therapeutic components (surgical and
non-surgical) and developing relationships
with patients throughout the course of
treatment.
Dr. Mariotti treasures these connections,
as due to the regular check-ups needed
in treating periodontal disease, he sees
patients regularly for a number of years in
order to monitor and stabilise his patient’s
condition.
“The thing that I really enjoy about my
specialty is having a research component
to explore the disease progression and
treatment options related to the disease. I
like the fact that in patient treatment I’ve
had patients in my practice for decades
that become like family to me. It’s pleasant
to see people and develop friendships and
this is the positive aspect of it all,” said
Dr. Mariotti.
Dr. Mariotti appreciates and enjoys what
he does and couldn’t imagine doing any
other specialisation besides periodontics,
which he describes as both unique and
delightful.
Making use of his expertise
A background in pharmacology has
proven useful in treating his patients.
Originally trained as a male reproductive
pharmacologist, Dr. Mariotti has extensive
knowledge on the signicant and related
effects of steroid hormones on the
periodontium and gingiva for both men and
women. In fact, Dr. Mariotti was an editor
for an issue of Periodontology 2000 in 2013
that dealt with reproductive hormones and
their eects in the periodontium.
Dr. Mariotti mentioned that there are
bone-sparing drugs (like Fosamax and
Zometa) that may cause lesions in the
oral cavity. Some patients might be taking
these medications for osteoporosis or
for some type of bone cancer in dierent
concentrations.
“Steroid hormones definitely have a
signicant eect in the oral cavity. Having
this knowledge and a pharmacology
background helps me bring to light both
the benets and risks of medications and
treatments whenever I give patient care
instructions or advice because I have a very
rm understanding of how it aects their
dental treatment,” explained Dr. Mariotti.
Promoting awareness
In the U.S. where Dr. Mariotti is based,
he admits that it is very difficult to get
patients to understand periodontal disease.
Generally speaking, periodontal disease
causes no pain at times. Often patients
discover that they have periodontal
disease already in its aggressive or
latter stages. There are certain types of
periodontal disease that cause pain like
Acute Necrotising Ulcerative Gingivitis (ANUG)
and periodontal abscess but these are not
necessarily the most common forms of
the disease. Moreover, people who have
gingivitis and chronic periodontitis even
the aggressive forms sometimes feel little
to no discomfort.
“Since some patients don’t visit
dentists and have regular check-ups, giving
32 DENTAL ASIA
MAY / JUNE 2018

information and education to the patient is
not always easy or possible. This is where
the local dental societies and national dental
organisations play an important role in
promoting awareness to the patients,” he said.
Dr. Mariotti is the Vice-Chair for the
A m e r i c a n D e n t a l A s s o c i a t i o n ( A D A )
Council on Scientific Affairs. He shared
that they are very interested in providing
evidence-based information for the
diagnosis and effect of treatment of
periodontal disease.
“When you think about it, what are the
major dental diseases that aect us? There
are two major ones and these are: dental
caries and periodontal disease. Being able
to get information out to patients and
dentists, I believe is necessary,” he added.
Contributing factors of the disease
At present, periodontal disease is prevalent
i n A s i a a n d i n t h e U . S . A c c o r d i n g t o
Dr. Mariotti’s expert opinion on why this is
the case, he mentioned that the following
contribute to the present situation:
susceptibility, environmental factors, and
practice of correct (or lack of) home care
regimen.
“Some people are more susceptible
than others because of a genetic
component. Periodontal disease is a
complex genetic disease which means that
there are multiple genes interacting with
one another to produce it. On the other
hand, environmental factors like smoking
and diabetes aect the progression and
initiation of the disease,” he explained.
Dr. Mariotti recommends daily routines
like practicing correct home care regimen
to keep plaque off teeth and therefore
reduce the incidence of periodontal disease
particularly in the portion of the population
that is extremely susceptible to the disease.
Prevalence of the disease in men
and women
It is a common misconception that men are
more susceptible to periodontal disease.
Dr. Mariotti discussed that it depends on the
type of the disease as chronic or aggressive
periodontitis seems to be equally distributed
between men and women. But there is a
theory that men are more susceptible to
chronic forms just because most men don’t
take care of themselves as much as women
do. In fact, Dr. Mariotti mentioned that an
informative article in Periodontology 2000
by Professor Haytac about periodontal
disease in men explains that the dierence
is basically the hygiene. For gingival disease,
it is somewhat prevalent in women because
women undergo dierent stages in life like
pregnancy and later on menopause which
make them susceptible to the disease at
those particular stages of their lives.
Prevalence of the disease in senior
active patients
Age used to be a widely accepted risk
factor for periodontal disease as senior
active patients (55 years and up) lose more
attachment and bone around their teeth
Dr. Mariotti (left) with our assistant editor, Chala Platon
compared to younger patients. But recent
studies have shown that attachment loss in
senior patients versus younger patients are
remarkably the same. Everyone consumes
food and drinks every single day. The type
of food and drink, whether hot or cold,
acidic or basic, soft or coarse, together
with plaque build-up will eventually have
an eect on wearing down one’s teeth and
tissue and bone attachment as one ages.
“So being mature does not make you
more susceptible to periodontal disease.
Oral hygiene plays an important role but
having continuous constant stress on your
teeth for over 50 years will eventually cause
loss of attachment and bone. This only show
that you’ve been around longer, that’s all,”
said Dr. Mariotti.
Eect of the disease on implants
Nowadays, more and more patients
are opting to have implants. One
must not forget though that even
i m p l a n t s g e t a f f e c t e d b y p e r i o d o n t i t i s ,
(called peri-implantitis) and bone loss can
occur in approximately three quarters of
patients who actually receive implants.
“When implants rst came out, everybody
thought it was the answer to everything.
Today, I am not so sure. We’ve found out
that even patients who have periodontal
disease can keep their teeth as long, if
not longer, with less complication, even
with restorations, than implants,” added
Dr. Mariotti.
DENTAL ASIA
MAY / JUNE 2018
33

Dental Prole
According to Dr. Mariotti, over the
lifetime of an implant, it is cheaper to keep
a tooth versus an implant. Aesthetically,
with the patient’s preference, there is not
a whole lot of dierence between implants
and natural teeth. For Dr. Mariotti, keeping
the actual natural tooth is an advantage for
the patient and for the dentist as managing
it is easier, as implants, once aected by
peri-implantitis, are very dicult to treat
and maintain.
Susceptibility to the disease
One of the risk factors for peri-implantis are
patients who have concurrent periodontal
disease. Part of the reason why people lose
their teeth is because they had uncontrolled
periodontitis and a patient who lost some
or most of his teeth from periodontal
disease is most likely to be susceptible to
the disease again if implants are placed.
The dentist should nd out the patient’s
history and determine the root cause of
the disease before suggesting implants.
Dr. Mariotti believes in the importance
of the conversation between patient and
dentist wherein the dentist thoroughly
explains the risk as well as the benefits
of having implants. The patient must be
fully informed and understand the whole
situation before moving forward. Having
that in mind though, Dr. Mariotti highlighted
that there is a quality of life issue as well.
If the patient understands the risks and
is willing to make a dierence in the way
they treat their implant, then providing
an implant for the patient can benet and
improve the quality of their life.
Maintenance of teeth and implants
Meanwhile, when asked about the
differences in maintaining natural teeth
compared to implants, Dr. Mariotti
answered that they’re basically the same.
He believes that there are a number of
things patients, with or without implants,
should do. The most important of which is
to develop a personalised treatment plan
with the help of their dentist.
For example, most patients are not fond
of removing interproximal plaque with
flossing. In this situation, dentists have
to gure out how they are going to help
motivate their patients with interproximal
plaque removal in a different manner.
For example, dentists could suggest
interproximal brushes or waterpiks.
Patient needs vary and depend on what
they are dealing with. Dr. Mariotti suggests
that if a patient is young and not suering
from periodontitis, they need to brush for
at least two minutes with a toothpaste that
contains uoride (caries prevention). But if
a patient has periodontal disease they need
a toothpaste that will reduce inammation
as well as plaque.
“Since patients don’t usually brush for
the full two minutes, I think patients need
something with substantivity that will
endure in the oral cavity. So if patients suer
from periondontitis, I recommend products
like Colgate Total which has Triclosan and
reduces inammation,” stated Dr. Mariotti.
Dr. Mariotti adds that mouthrinses should
only be used if the dentist advises it. The use
of mouthrinses add cost and demand more
time from patients. There have been studies
that demonstrate patients will primarily use
o n ly two devi c es to c lea n th ei r teeth . So ,
Dr. Mariotti believes that less products/
equipment make the patient more compliant
and focused on their oral regimen.
With regard to manual and electric
toothbrushes, Dr. Mariotti prefers the
latter. Based on systematic reviews, they
say electric brushes with oscillating heads
are statistically better. But if patients do
prefer manual toothbrush he suggests
that soft bristles are the best. To each his
own. Regardless of which toothbrush a
patient prefers, it will always depend on the
quality and proper technique of brushing
that matters.
Dr. Mariotti emphasised brushing,
interproximal cleaning, the use of certain
suggested products, and regular visits to
dentists to have the best achievable oral
health.
“Everyone is dierent and that’s what
makes humanity wonderful. Everyone has
a slightly dierent response to dierent
stimuli. And I think dentistry is going in
the direction where they are starting to
personalise dentistry to the person. I think
“precision dentistry” is going to be the
next realm where dentists start to, due
to a patient’s genetic make-up and things
they do, prescribe a specic regimen for
patients to do.”
Looking ahead
Dr. Mariotti looks forward to what dentistry
can bring in the near future. He believes
that there will be more innovations on
diagnosis and making home care simpler
and less laborious. Also, he anticipates
the development of more dental devices
and more innovation in toothpastes and
toothbrushes to reduce the incidence of
periodontal disease.
Dr. Mariotti expects the industry and
governments to be better in promoting
prevention of the disease. He started a
safety net clinic where he works with a
physician group for patients who could
not aord dental care. Dr. Mariotti shared
how he emphasised to the physicians the
importance of preventive care.
“For example, if someone has lung
cancer you just don’t ignore the fact that the
person is smoking. Same thing in dentistry,
if someone lost their teeth due to dental
caries you have to talk to them about what
they consume, how they consume sugar
and how they clean their teeth. So, I think
awareness is another thing that has to come
up in the future,” he added.
Dr. Mariotti believes that dentistry will
be moving forward with regenerative
therapies, not only bone regeneration
b u t e v e n t u a l l y r e g e n e r a t i n g t o o t h
(enamel, dentin and pulp). He said it is
unlikely to be any time in the near future
but he would be expecting it and that it
would be a game-changer in dentistry when
it happens. DA
34 DENTAL ASIA
MAY / JUNE 2018

Clinical Feature
Most progressive
dental practices
today are recallbased.
This
means that
they depend on their hygiene
department for a significant
portion of their incomes. It stands
to reason that a more ecient and
more eective hygiene program
will have a major positive impact
on practices. Furthermore, in a mature practice, patients typically
spend much more time with the hygienist than the dentist, receiving
routine re-care and maintenance treatment. It is essential that the
patient be completely comfortable at all stages of the hygiene
procedure. This means as little time as possible in the dental chair,
rapid and eective cleansing and polishing of the teeth, and as little
vibration and noise as possible.
The hygienist’s most time-consuming tasks include scaling and
prophylaxis. The most common operator complaints about tooth
polishing include limited clinical access, visibility, hand fatigue due
to vibration, poor ergonomics and prophylaxis paste spatter.
The problem is further complicated by the fact that purchase
decisions for hygiene products are often made by the dentist or
a designated sta member, neither of whom actually uses these
products, or has great familiarity with them. Oftentimes, purchase
decisions are often made on price alone, without thinking about
eciency, eectiveness and comfort. “Purchasing momentum”,
the re-ordering of products simply because they were previously
stocked, without any consideration for upgraded or improved
alternatives, is also a major limitation on practice growth and
development.
Easier, faster and better polishing
The Mighty Mini 90 Disposable Prophy Angle is considered to be an
interchangeable consumable. Each hygienist uses at least one for
every patient. The time of use is several minutes or until all tooth
surfaces in the mouth are thoroughly cleaned. However, recent
innovations and developments have created a clear distinction
between “typical” prophy angles and those that have been
specically designed to make tooth polishing better, faster, and
easier.
T h e M i g h t y M i n i 9 0 D i s p o s a b l e P r o p h y A n g l e
(PacDent International Inc.) is the smallest and most powerful
compact prophy angle available to the dental profession in the
market. PacDent International Inc. canvassed dental professionals
to better address problems and drawbacks with existing products.
The result is an ecient and user-friendly second generation prophy
angle that denes a new standard.
Innovative patented bevelled gear design
The Mighty Mini 90 Disposable Angle’s patented bevelled gear
design provides steady cup rotation that allows the instrument
Small, Powerful and
Sterile The Mighty
Mini 90 Disposable
Prophy Angle
By Dr. George Freedman BSc, DDS, FAACD, FIADFE, FACD
to operate smoothly and quietly,
with the necessary torque for
optimal polishing (Fig. 1). It runs
smoothly without over-heating.
The direction-changing gear does
not slip which provides predictable
but limited rotational power to
the cup. Assumingly, the hygienist
inadvertently apply too much
pressure to the tooth, the Mighty
Mini 90 Disposable Prophy Angle
simply stalls without damaging the dental surfaces or causing
discomfort for the patient. The quiet, bevelled gear precision design
not only reduces
the operational
noise levels, but
also diminishes the
vibration felt by both
the operator and the
patient, making the
entire prophylaxis
procedure less
intrusive.
Fig. 1
Ergonomic and slimmest profile for better vision, easier
handling and functional reach
In order to improve visibility inside the oral cavity, the Mighty Mini 90
oers the slimmest head prole available (Fig. 2). Hygienists do not
need to reposition their heads or assume non-ergonomic postures
because the prophy angle is small enough to see around clearly. The
ergonomic prole of the prophy angle makes handling comfortable
and less tiring which is truly appreciated at the end of a long day. In
addition to preventing fatigue, the innovative design reduces hand
and arm micro-traumas (Fig. 3).
Fig. 2 Fig. 3
The business head of the Mighty Mini 90 is 20% smaller and
shorter than previous generation prophy angles for better access
to tight posterior areas such as the buccal areas of maxillary
molars and the lingual areas of mandibular molars (Fig. 4). The
25% slimmer neck of the cup further enhances direct visibility.
The smaller head size and increased visibility are essential for
polishing children and patients with a limited opening of the jaw.
36
DENTAL ASIA
MAY / JUNE 2018

Performance.
It runs in the family!
From the more affordable E scanners to the award-winning D scanners, 3Shape
delivers documented-accuracy, speed, and ease of use. An open ecosystem,
backed by a wide selection of integrated partners and CAD/CAM solutions,
3Shape powers you past the competition. Learn more at: go.3shape.com/lab
#changingdentistrytogether

Clinical Feature
Signicantly, the reduction in prophy angle
size of Mighty Mini 90 has been accomplished
without compromising power.
The advanced design of the second
generation prophy cup also boosts clinical
eciency. It has been designed with an
edge are that makes subgingival, lingual
and interproximal access much easier and
more thorough. As
the prophylaxis is
Fig. 4
extended slightly
beyond the gingival margin, the patient feels
more thoroughly cleansed. Signicantly,
from a clinical perspective, the marginal
area which is considered to be at greatest
risk of re-colonisation is eectively polished
and more resistant to plaque deposition.
The cup is thin and exible for improved
access to interproximal embrasures, areas
of crowding or misalignment.
Conveniently reduces “splatter” and
enhances stain removal
The innovative external ribbing on the Mighty Mini 90 cup enhances
cleaning and polishing. The internal design reduces splattering
signicantly. The “splatter” problem is signicant for hygienists;
even a small amount of inadvertent spray on a uniform makes it
unt when seeing additional patients. The inconvenience and cost
of storing multiple uniforms at the practice can be prohibited. Thus,
it is highly benecial to minimise or altogether eliminate prophy cup
splattering. The shape of the Mighty Mini 90 is designed to contain
the prophylaxis paste instead of allowing it to escape at the cup
edges, even when the teeth are moist with saliva. The counterclockwise
rotation of the cup also helps to eliminate splatter.
The overall eect of the innovations listed above is that the
process of stain removal is easier and more efficient for the
hygienist hence less time spent on the procedure and makes it
less demanding. Stain removal is enhanced by the internal ridges
on the Mighty Mini 90 Prophy Cup such that no additional force or
pressure on the handpiece is required.
Safer to use
The Mighty Mini 90 Disposable Prophy Angle is 100% latex free as
is the new cup material. This is benecial for many dental team
members and patients who are sensitive or allergic to latex,
sometimes unknowingly. It is easier and safer for practices to simply
eliminate latex from all clinical procedures rather than risking an
adverse reaction.
Most prophy angles are disposable; this is a good idea when
they are virtually impossible to disinfect externally and internally.
Some are individually pre-packaged to prevent cross-contamination
when one is removed from the box but only Mighty Mini 90 is
sterile (Fig. 5). It is interesting that dentists and hygienists who
would never break the chain of infection control with any of their
other equipment or materials do not think twice about polishing
teeth with a non-sterile disposable prophy angle. Gamma radiation
sterilisation removes the risks associated with the utilisation of a
non-sterile prophy angle, and eliminates this potential hazard from
the practice.
Since every practice uses large numbers of disposable prophy
angles (50 or more per week for an average hygienist), cost
is, and should be, a concern. And it
would be normal for all the advantages
listed above to command a premium
price tag. Fortunately, this is not a
dicult decision for the dentist (or the
individual responsible for ordering) to
make; the Mighty Mini 90 Disposable
Prophy Angles are significantly less
expensive than their competitors. The
manufacturer is also the distributor,
eliminating the middleman. The
beneciary is the dental practice.
The PacDent’s Mighty Mini 90
Fig. 5 Disposable Prophy Angle is disposable,
pre-packaged and sterile. It embodies
the many advances and innovations that make the Mighty Mini 90
a 2 nd generation prophy angle. More comfortable for the patient,
more ecient and eective for the hygienist, and more economical
for the dentists, the Mighty Mini 90 Disposable Prophy Angle is a
win-win-win concept. DA
38 DENTAL ASIA
MAY / JUNE 2018

Trefoil – the next full-arch revolution
nobelbiocare.com/trefoil
*Depending on clinician preference and close cooperation with the laboratory.
GMT 53206. Disclaimer of liability: This product is part of an overall concept and may only be used in conjunction with the associated original products according to the instructions and recommendation of Nobel
Biocare. Non-recommended use of products made by third parties in conjunction with Nobel Biocare products will void any warranty or other obligation, express or implied, of Nobel Biocare. The user of Nobel Biocare
products has the duty to determine whether or not any product is suitable for the particular patient and circumstances. Nobel Biocare disclaims any liability, express or implied, and shall have no responsibility
for any direct, indirect, punitive or other damages, arising out of or in connection with any errors in professional judgment or practice in the use of Nobel Biocare products. The user is also obliged to study the latest
developments in regard to this Nobel Biocare product and its applications regularly. In cases of doubt, the user has to contact Nobel Biocare. Since the utilization of this product is under the control of the user, it is
his/her responsibility. Nobel Biocare does not assume any liability whatsoever for damage arising thereof. Please note that some products detailed in this Instructions for Use may not be regulatory cleared, released

Clinical Feature
ENT and Dentistry:
Sample Cases for the Need to Work Together
by Dr. Derek Mahony (Orthodontics) and Dr. David McIntosh (ENT)
Ear, Nose and Throat specialists (ENT) and dentists alike,
dedicate their professional careers to the management
of the upper aerodigestive tract and its appendages. It
is very simple to provide clinical conditions where there
is an overlap between the two professions, with the
following immediately coming to mind: obstructive sleep apnoea,
reux disease, bruxism and interceptive orthodontics as it relates
to facial growth and development, and upper aerodigestive tract
malignancies.
As to be expected, the paradigm by which one group of
specialists look at one thing is moulded by their education and
learning. The old analogy of three blindfolded people feeling a
dierent part of an elephant, and coming to dierent conclusions
as to what is before them, comes to mind. For the dental profession,
the focus of assessment is the teeth, and for ENT it is everything
above the palate.
The truth is, however, that we are all dealing with the same
anatomical landscape, and by understanding each other’s
perspective, a greater appreciation of the whole picture can emerge
especially with respect to clinical management.
The following summarises supportive literature as to why
dentists that do more than “drill and ll” should include an ENT
surgeon as part of their clinical team. Likewise, it behoves an ENT
who has an interest in working with dentists, to appreciate their
perspectives on clinical conditions.
Clinical Assessment
One of the biggest areas of dental medicine is the eld of upper
airway obstruction. There is a signicant number of untreated
obstructive sleep apnoea, in the community, and this applies to both
children and adults, alike. Of all the medical professions, dentists
are by far the group that pays more attention to examining the oral
cavity than any other. Such examinations, however, may only be
conned to the teeth and adjacent mucous membranes, which is a
shame as it presents a signicant opportunity to detect additional
pathology and provide advice on subsequent management that
can make a medical dierence to patients.
Deviated septum
DENTAL ASIA
MAY / JUNE 2018
41

Clinical Feature
On this premise, the best place to start is how to assess the
upper airway. Medical and Dental history, as always, is the initial
clue provider, and in this regard questions about snoring, mouth,
breathing, and teeth grinding are crucial. Issues with choking on
food, troubles with chewing and breathing at the same time are
also useful clues. The relevance of all of these symptoms will be
claried in the subsequent discussion.
to dismiss such clinical presentations. With respect to bruxism,
more and more studies are showing an association with sleep
disordered breathing, and in children there is literature indicating
an 80% resolution of bruxism, after their airway obstruction has
been addressed.
Clinical Examination
The next stage in clinical assessment is the examination. The rst
impression is to simply look at the patient before you. Do they
have an open mouth posture for their breathing? Can you hear
them breathing (the “Darth Vader” noise, that is clinically known as
stertor)? As you then look inside the mouth, apart from the dental
health, are there malocclusions, altered facial bone development,
a high arched palate, evidence of grinding or suggestion of reux
damage to the teeth. The next step is to look beyond the teeth: Is
there a tongue tie? How big is the tongue relative to the space of
the oral cavity? And then nally, what is the size and position of the
tonsils? With respect to the tonsils, the important issue is the space
between them, as this is the functional area of the transitional space
from mouth to oropharynx.
Sleep Apnoea and Bruxism
Armed with a wealth of this information, dentists nd themselves in
the privileged position of being able to alter the course of a patient’s
life, for the better. Let’s start with children. To be absolutely clear
on this matter, a starting point that is important to realise is children
are not supposed to snore, mouth breathe, or grind their teeth.
Habitual snoring, which is dened as snoring four nights of the week
or more, is now classied as being part of the spectrum of paediatric
sleep disordered breathing, with the extreme of this spectrum being
sleep apnoea. With respect to mouth breathing, this is brought
about as a response to obstructed nasal breathing in more than 90%
of cases and should not be written o as a habit. The main cause
of obstructed nasal breathing is enlarged adenoids, something
that can be assessed through taking x-rays – Orthopantomogram
(OPG/ Panoramic), Lateral Cephalometric (Lat. Ceph.) and cone
beam computed tomography
(CBCT)- with the next most
common cause being enlarged
turbinates related to allergy
(again, this is evident on OPG
and more so on cone beam CT).
Children with nasal obstruction
have breathing diculties, and
this can impact their cardiorespiratory
physiology to the
point that they can develop
a serious medical condition
called pulmonary hypertension.
Hence, it is important not
Large adenoids
Enlarged nasal turbinates
Facial Growth and Developmental
Factors
There is a debate in literature regarding
the interplay between nasal obstruction,
resultant mouth breathing, and
subsequent aberrations in facial growth
and development. In order to help
address this question, we need a greater
understanding into what inuences facial
growth and development. In its simplistic
form, it is a combination of genetic and
epigenetic programming on how things
develop, susceptibility to abnormal
42 DENTAL ASIA
MAY / JUNE 2018

A small step for dentists,
a great step for dentistry!
PRESIDENT ®
The Original
The introduction of PRESIDENT in 1975 – the first A-Silicone in the market – is considered a milestone in the
development of high-precision dental impression materials. After 40 years of innovation and know-how the
well-known A-Silicone brand has now been renewed.
PRESIDENT appears in a new look with fresh colours for a better contrast and readability as well as new viscosities
in the portfolio to satisfy dentist’s needs.
002525
info.ch@coltene.com | president.coltene.com

Clinical Feature
development in adverse conditions, and resilience against abnormal
development in adverse conditions. In essence, it’s a bit like: “Why
do some people get cancer and others don’t?”. There are certainly
plenty of literature that suggests nasal obstruction is implicated
as a cause of abnormal growth and development of the face, jaw,
and dentition. The mechanism by which this transpires is that the
resultant open mouth posture interferes with proper mandibular
and maxillary arch development by disrupting muscle forces and
soft tissue positioning. The consequences of these are an increased
anterior vertical facial height, an open bite and incompetent lip
posture, so called “adenoid facies”, narrow external nares, and a
V-shaped, high arched palate.
Correlation between Dental Occlusion and Site of Airway
Obstruction in Children
There are a multitude of studies that can be quoted to conrm and
refute these suppositions. In an interesting study by Nunes Jr., a
correlation was found between the type of dental occlusion in
children and the site of airway obstruction. In this study, children
who were presented to an ENT clinic for assessment of their airway
obstruction were also oered the opportunity to be assessed from
an orthodontic point of view. From the 114 children, aged between
three to 12 years (who exhibited mouth breathing and snoring), the
ndings were as follows:
1. All types of obstruction were related to a high prevalence of
posterior crossbite (37%)
2. There was a statistically signicant association found between
dental occlusion and the site of lymphoid tissue obstruction
(P < .05).
3. There was a higher rate of Class II relationship (43%) in the group
with combined adenoid and tonsil enlargement.
4. Isolated tonsil obstruction showed a higher rate of Class III
relationship (38%).
Large tonsils, as are evident in this photo, may contribute to
airway obstruction and have been reported to be associated with
Class III malocclusion.
More relevant studies were also done on airway obstruction,
which can be seen in the following:
Nunes Jr RW, Di Francesco, RC. Variation of Patterns of
Malocclusion by Site of Pharyngeal Obstruction in Children.
Arch Otolaryngol Head Neck Surg. 2010; 136(11):1116-1120.
This is a helpful study also for ENT doctors, as it highlights the
signicant amount of dental pathology present that a general ENT,
would possibly not normally assess or consider. This is probably
a detriment to patient care, as shown by a study of 32 children,
all of which were assessed independently by both an ENT and
orthodontist because of airway compromise and were thought to
need both surgery and orthodontics for airway problems. This group
of 32 were split into two groups, where one modality of treatment
was utilised, time allowed to pass, and then the children were
reassessed to see if the additional treatment was still indicated.
Basically, half had surgery, and the other half had orthodontics;
subsequently only two of the original 32 did not need the other
treatment modality for their airway issues. Incidentally, the two
children of the original 32 that did not need further treatment both
had orthodontic intervention rst, and hence did not need surgery.
Guilerminault et al. 2008. Sleep. Orthodontic expansion and
adenotonsillectomy in the treatment of obstructive sleep
apnoea in prepubertal children.
Lest dental colleagues get excited about oering “surgery free”
treatment based on this study, 30 still needed their operation.
Furthermore, the literature shows that ENT intervention can
obviate the need for orthodontic interventionIn a similar study
design with respect to assessment, children who had orthodontic
treatment and adenotonsillectomy (operation for the removal of
adenoids and tonsils) for obstructive sleep apnoea (OSA) had preand
post-surgical (two years post-op) dental casts taken. A control
group of children who had no airway obstruction was used for
comparison. The children with airway issues had a higher proportion
of malocclusion, especially open bite and crossbite, before surgery.
Two years after surgery, 77% of the open bites and 50–65% of the
buccal and anterior crossbites were normalised, without the need
for orthodontic intervention of any sort. The best results were seen
in children operated on before the age of 6.
E. Hultcrantz, et al. International Journal of Pediatric
Otorhinolaryngology. 22 (2): 125-34. 1991. The influence of
tonsillar obstruction and tonsillectomy on facial growth and
dental arch morphology
Moving along in age, we come to adult sleep apnoea. Now the
stereotypical man who is obese is not inaccurate, but also not
the full story. It is important to be mindful of nose and throat
problems, as per children (particularly if they have a blocked nose,
and intend to use a dental oral appliance, and hence are essentially
putting a plug in their alternate airway!). Associated reux also
needs to be assessed and managed appropriately. With respect to
decient facial growth and development, the types of malocclusion
seen in kids that snore is what we are seeing in adults with OSA.
Furthermore, the facial phenotype is closely linked to upper airway
44 DENTAL ASIA
MAY / JUNE 2018

Clinical Feature
anatomy in adults. In a study utilising magnetic resonance imaging
(MRI) to assess the airway, and comparing this to facial dimensions,
and neck circumference, there were signicant positive correlations
between facial width, facial height, nose width, interocular and
intercanthal width and upper airway structures. Specically, the
strongest associations were between tongue volume and midface
width (r = 0.70, P < 0.001), and lower-face width (r = 0.60, P

Clinical Feature
Tongue-tie (ankyloglossia) can cause distress for a
mother attempting to breastfeed and lead to early
cessation and reliance on bottle feeding. If quickly
diagnosed, anatomic anomalies can be corrected using
appropriate surgical intervention. The mother can then
feed more eciently, and the child will benet and continue to thrive.
palate, and spends little time in contact with the infant’s teeth. 4,5
However, if an infant is only latched to the nipple, rather than the
surrounding breast tissue, the nipple is situated more anteriorly in
the mouth so milk comes into contact with the teeth more frequently.
Structural defects such as lip-tie and tongue-tie can restrict
t h e m o v e m e n t o f t h e u p p e r l i p a n d t o n g u e , r e s p e c t i v e l y ,
Factors of Poor Breastfeeding
Effciency and Appropriate Management
for Tongue-tie and Lip-tie
By Dr. Lisa M Bowden, Assoc. Prof. Robert P Anthonappa, Prof. Nigel M King
Introduction
Although maternal breastfeeding is known to be a natural activity
that provides the infant with sustenance and immunological factors
that promote health and normal development, it is not practiced
in all communities. For example, in some developing countries,
breastfeeding has been shunned in favour of bottle feeding with
formula milk; the latter being considered to be more sophisticated.
Furthermore, “customs have an important inuence when it comes
to mothers rearing their children. This inuence is often negative” 1 .
However, due to concerns regarding the purity and hence the safety
of some brands of formula milk, bottle feeding has started to decline
in popularity. Although there have been advancements in the
equipment available, the risk of contamination from poorly sterilised
bottles and teats remains a potential hazard. An association of
bottle feeding with formula milk with childhood obesity has also
been identied. 2 These issues have led to at least one country to
ban the advertising of infant formula, in favour of breastfeeding. 3
Nevertheless, there may be both maternal and infant factors
that prevent successful breastfeeding. Thus, it is important
to identify and correct these problems because ineffective
breastfeeding can lead to maternal distress and complications for
the infant, including early childhood caries (ECC).
Two separate meta-analyses that were conducted in 2015
concluded that breastfeeding was associated with a decreased risk
of ECC. 4-5 However, these meta-analyses only assessed whether or
not an infant was breastfed, and did not specically investigate
infants with poor feeding techniques. Unfortunately, very little
research has been conducted into the relationship between poor
nursing ecacy and the risk of ECC. Epidemiological studies have
identied an association with increased frequency and duration
of breastfeeding with increased rates of dental caries. 6-9 The
association between dental caries and increased breastfeeding
frequency may be due to poor nursing ecacy because the infant
needs to feed more frequently in an attempt to increase the intake
of nutrients. The main argument against breastfeeding contributing
to ECC is that the breastmilk is ejected into the mouth near the soft
which in turn may cause milk to stagnate in the buccal sulcus
around the teeth and prevent self-cleaning by the tongue. 10 Other
physiological factors can aect an infant’s ability to accomplish
successful breastfeeding. For example, it has been claimed that
the presence of natal or neonatal teeth can make breastfeeding
uncomfortable or there may even be laceration of the nipple,
while the infant may suer ulceration of the ventral surface of the
tongue. 11 Case studies have reported mothers ceasing breastfeeding
early due to complications from natal teeth. 12-13
Recently, the roles of tongue-tie and lip-tie in breastfeeding
ecacy have been a controversial topic. Often it is recommended
that these physical abnormalities be surgically corrected to allow
normal breastfeeding to commence. However, the oral physiology
of breastfeeding is a complex and debatable topic. Nevertheless,
it is important to consider all possible factors that may relate
to poor feeding ecacy and their appropriate management. If
it is determined that a frenal attachment is the cause of poor
breastfeeding technique, dierent surgical methods are available
to manage this condition. Therefore, the aim of this article is to
focus on tongue-tie and lip-tie in the infant as factors that can
cause unsuccessful breastfeeding. To fully understand the nature
of these problems, the physiological mechanism of breastfeeding
will be reviewed prior to explaining the management of these two
conditions.
Oral physiology of breastfeeding
The precise nature of the mechanism by which an infant obtains
milk from a breast is still somewhat controversial. Nevertheless, it
is proposed to review the current knowledge on the mechanism
of breastfeeding.
Infant reexes are important for successful breastfeeding;
the reexes involved in breastfeeding are rooting, suckling and
swallowing. 14-15 The rooting reex occurs when something touches
an infant’s lips or cheek. The infant’s head will turn to locate
the stimulus, the mouth will open and the infant will lower and
protrude the tongue. When something touches an infant’s palate,
46
DENTAL ASIA
MAY / JUNE 2018

Clinical Feature
the suckling reex causes the child to suck on it. Finally, when an
infant’s mouth lls with milk, the swallowing reex is initiated and
the infant swallows the uid.
After rooting, the infant will take the nipple and surrounding
breast tissue into the mouth and evert the upper and lower lips
to create a seal around the nipple. 16 A vacuum is created by the
posterior of the tongue being lowering. This vacuum draws the
nipple out into a teat that stretches up to three times its original
length so that it reaches as far back as the junction of the hard and
soft palates. 16 The base of the teat rests between the maxillary
alveolar ridge, and the tongue which lies over the mandibular
alveolar ridge. 16 Finally, the lateral margins of the tongue roll
upwards to create a central trough in which the nipple then lies.
The sucking cycle is initiated by the anterior rim of the tongue
curving upwards, followed by elevation of the mandible, which
creates compression on the ventral surface of the nipple. 15 The
wave of compression propagates posteriorly, gradually occluding
the central trough in which the nipple lies. The tongue elevation
continues posteriorly to move the milk bolus into the pharynx. As
swallowing is triggered, the soft palate rises and closes o the
nasal cavity. 17 The larynx moves upwards and anteriorly to close
the trachea, allowing the milk bolus (ball of food or substance)
into the oesophagus. Meanwhile, a fresh peristaltic wave will have
commenced at the tip of the tongue.
There has been controversy regarding the role of the
peristaltic tongue movements versus intra-oral negative pressure
in feeding. Previously, it was believed that peristaltic movements
of the tongue create a “stripping” action on the nipple, causing
milk to be ejected from the teat via compression. 18 This
hypothesis is based on the process of milking
cows that involves applying pressure to the teat Type
in a “stripping” motion to release milk that has Class I
lled the teat’s lactiferous sinuses. 15 In humans,
Class II
negative pressure was thought to act primarily
to retain the nipple and breast position within Class III
the mouth. 18 A cineradiographic (radiographs of Class IV
moving objects) film produced by Ardran and
colleagues, depicted an infant at the moment of detaching from
the breast. 16 This release was preceded by an air pocket appearing
in the oropharyngeal space accompanied by sudden and marked
retraction of the nipple in the mouth and general relaxation of the
oral tissues. This led to the assumption that human nipples have
lactiferous sinuses like other mammals. However, recent studies
have demonstrated that human nipples do not contain lactiferous
ducts. 19 It is therefore more likely that the ow of milk occurs as a
combination of peristaltic movements and the intraoral negative
pressure within the mouth. Contemporary ultrasound studies
have demonstrated that milk ow from the nipple into the infant’s
mouth coincides with both the lowering of the tongue and peak
vacuum, indicating that the intra-oral vacuum plays a much greater
role than simply maintaining the position of breast tissue in the
mouth. 20 Nevertheless, the exact mechanism of this process still
remains unclear.
Factors that may impact feeding ecacy: Maternal factors
A number of maternal factors can aect the ow rate of milk
and the infant’s ability to latch onto the breast. For example,
the size and shape of the maternal nipple, including whether it
is at or inverted. Most at nipples can be stretched out when
pulled with the ngers and so considered to be protractile. Infants
should have no diculties feeding from a protractile nipple as the
vacuum applied intraorally stretches out the nipple. 21 However,
non-protractile nipples do not stretch out when pulled, instead
the tip goes in an inward direction, thus making it dicult for
an infant to attach and feed. 21-22 Mothers with protractile nipples
can be encouraged to try various feeding positions allowing the
nipple to drop downwards toward the infant’s mouth. 21 As the
infant grows, the mouth becomes larger thus able to hold more
of the breast, enabling them to feed more easily. If mothers with
non-protractile nipples wish to breastfeed, they may require either
surgical intervention or the use of a device that applies suction to
the nipple to encourage it to evert. 23
Tongue-tie and Lip-tie
For an infant to achieve an adequate supply of milk, the nipple and
a signicant amount of the breast tissue must be taken into the
infant’s mouth and a surrounding seal created with the lips. An
infant who is poorly attached is likely to suckle ineectively. If the
lips are unable to ange due to a high frenal attachment (lip-tie),
this may impact on the infant’s ability to create a seal.
Lip-tie is diagnosed when the maxillary anterior labial frenum
aec ts th e mo vemen t o f th e u p p er lip du e to its a n a to mic a l fo rm.
Table 1. Kotlow’s classication of maxillary lip-ties. 25
Characteristics
Minimal visible frenum attachment
Attachment of the frenum where the free and attached gingiva meet
Frenum inserts just anterior to the incisive papilla
Attachment of the frenum into the incisive papilla or hard palate area
DENTAL ASIA
MAY / JUNE 2018
47

Clinical Feature
In severe instances, the frenum may be attached high on the
alveolar ridge, even into the region of the incisive papillae. When a
lip-tie restricts the movement of the upper lip, it may be dicult for
an infant to evert its upper lip and latch properly onto the breast.
If the infant can only take the mother’s nipple into its mouth,
rather than the surrounding areola, traumatic breakdown of the
nipple may occur, causing pain and discomfort for the mother and
an inadequate transfer of milk for the infant. 24 In 2004, Kotlow
proposed a classication for lip-ties, this is displayed in Table 1. 25
Tongue-tie, also known as ankyloglossia, is an abnormal lingual
frenum which limits the normal range of movement and function
of the tongue (Fig. 2). There is currently no consensus on a precise
denition of ankyloglossia; however, several attempts have been
made to categorise various types of tongue-tie based on both
anatomy and functional limitations. Kotlow developed one of
the most commonly used classications of tongue-tie (Table 2),
based on the measurements of 322 children ranging from ages 18
months to 14 years. 26 Class I and II tongue-tie is considered to be an
anterior tongue-tie, while Class III and IV are referred to as posterior
tongue-tie. 27 This dierentiation between anterior and posterior
t o n g u e - t i e i s a r e l a t i v e l y a n e w d i s t i n c t i o n . U n l i k e a n t e r i o r
tongue-tie, posterior tongue-tie is not obvious at rst glance as
the frenum is hidden beneath the mucosal layer. There may not
be a frenal membrane present, instead the diagnosis may be made
based on the mid-tongue’s inability to elevate.
Type Characteristics Range of tongue
movement
Clinically
acceptable
Table 2. Kotlow’s classication of the
dierent types of ankyloglossia. 26
Normal range of free
tongue movements
Greater than 16mm
Class I Mild tongue-tie 12-16mm
Class II Moderate tongue-tie 8-11mm
Class III Severe tongue-tie 3-7mm
Class IV Complete tongue-tie Less than 3mm
Fig. 2 (a)
Fig. 2 (b)
Fig. 2: (a) shows a tongue tie that has not been released and is attached
close to the tip and (b) is preventing the tongue from being raised and is
distorting the tip into a “W” shape.
Tongue-tie has been linked to difficulties in breastfeeding
due to the infant’s inability to move the tip of the tongue during
suckling. While many studies have suggested that the presence of
ankyloglossia adversely aects an infant’s ability to breastfeed,
the same studies indicate that not every child with ankyloglossia
is adversely aected. 28-30 The quality of research-based evidence
in the literature is limited, with retrospective audits or case series
making up the bulk of the published literature.
Consequences of poor feeding ecacy
Poor feeding can have physical and psychological implications on
both the infant and mother (Table 3). In particular, the psychological
impact of poor breastfeeding practices is often overlooked. The
worry of an infant failing to thrive, combined with a lack of sleep,
complicated by frequent night feeds and persistent crying, can
lead to maternal stress and post-natal depression. This stress can
result to decreased milk production which perpetuates the poor
feeding cycle.
Table 3. The maternal and infant consequences of
poor breastfeeding ecacy21,31-34
Maternal Consequences
Mastitis
Breast abscess
Fissured and cracked nipples
Stress
Post-natal depression
Rejection of breastfeeding
Reduced milk production
Infant Consequences
Poor weight gain or weight loss
Failure to thrive
Death
Frequent or prolonged feeding
due to hunger
Frustrated crying
Management of Lip-tie
Removal of an offending frenum can be achieved either by a
frenotomy which is the incision and subsequent relocation of the
frenal attachment, or by a frenectomy which involves the complete
excision of the frenum along with the attachment to the underlying
bone.
Traditionally, a high buccal frenal attachment in the maxilla that
prevents eversion of the upper lip has been managed either by a
medical, dental or nursing practitioner by snipping the oending
attachment with scissors or a scalpel. 35 However, this frenotomy
procedure does not remove the dense collagenous tissue and elastic
bres that insert into the bone between the central incisors. 36 This
may result in the maintenance of bres that may prevent the upper
lip from everting, as well as maintaining the diastema between the
central incisors.
Management of Ankyloglossia
Similarly, if a tongue-tie is simply snipped, posterior lingual frenal
bres may not be severed, consequently the movement of the
tongue may still be limited. A complete frenectomy ensures that
adequate tongue and lip movement is achieved without the need
for further frenum revision.
48 DENTAL ASIA
MAY / JUNE 2018

6th Biennial Meeting of ADSS | 15th Biennial Meeting of AAAD
Pre-Congress Day: 27 September 2018
Main Congress: 28-29 September 2018
Post-Congress Day: 30 September 2018
Level 4, Marina Bay Sands, Singapore
LEARNING | COLLABORATION | INSPIRATION
REGISTRATION NOW AVAILABLE ONLINE!
2018 SPEAKERS
LUCKY DRAW
Frank Milnar
USA
Stefen Koubi
France
Hilal Kuday
Turkey
Shamsul Alam
Bangladesh
REGISTER AS A
DELEGATE FOR
DAMA 2018 AND
STAND A CHANCE
TO WIN!
Cheung Lai Chun
Philippines
Ratna Dissanayake
Sri Lanka
Onny Eryanto
Indonesia
Ho Feng Chuan
Taiwan
Kim Ki-Seong
South Korea
Jerry Lim
Singapore
Joan Lim Zhi Yin
Malaysia
Paulo Monteiro
Portugal
NEWLY LAUNCHED
EYESPECIAL C-III
worth SGD 3,500.
The EYESPECIAL C-III
is sponsored by Shofu
Dental Asia-Pacific
Pte Ltd
Park Chul-Wan
South Korea
Giulio Pavolucci
Italy
Rita Singh
Nepal
Kazunobu Yamada
Japan
www.dama.sg
Organiser Co-host Event Manager

31.5.2018
15.5.2018
IDEAS
www.hkideas.org
Professor Tomas Albrektsson
Dr. David Craig
Dr. Michel Dard
Dr. James Foster
Dr. Christopher Ho
Dr. Jerry Hu
Dr. Sabrina Huang
Dr. Terence Jee
Dr. Alfred Lau
Dr. Donald Li
Dr. Jingping Li
Professor Xiaobing Li
Dr. Edmond Pow
Dr. Alan Reid
Dr. Mario Roccuzzo
Dr. Frankie So
Dr. Chong-meng Tay
Professor Wim Teughels
Professor Maurizio Tonetti
Dr. Victoria Yu

Clinical Feature
Frenectomy / Frenotomy procedure
A frenectomy can be performed under topical or local anaesthesia
using a scalpel, electrosurgery, or soft tissue laser. Procedures
completed with electrosurgery probes have been advocated due to
their safety, only mild bleeding and the absence of post-operative
complications in comparison to conventional surgical methods.
However, electrosurgery can be associated with complications
such as burns and the production of surgical smoke from the burnt
tissue. The use of soft tissue lasers such as laser diodes, Er:YAG lasers
and CO 2
lasers have the advantage of shorter procedure duration,
absence of post-operative infections, and minimal pain, swelling and
scarring. 10 There may be slightly delayed healing in comparison to
conventional scalpel techniques; however, sutures are not required.
After excision of the frenum, the mother is encouraged to move
the lip and/or tongue by physically lifting the lip to separate it from
gingival tissues, and encouraging the infant to move their mouth
by touching their cheeks and lips during play. 10
Three randomised control trials have evaluated the eects of
frenotomy on mothers and infants when tongue-tie was considered
to be responsible for feeding problems. Hogan and colleagues
showed that 96% of infants in the frenotomy group had reduced
symptoms soon after the procedure, compared to 3% of infants in the
control group. 37 Dollberg, who conducted a double-blind crossover
randomised control trial involving 25 patients, demonstrated
decreased nipple pain and improved latching immediately following
frenotomy as compared to a sham procedure. 38 In the third study
of 58 neonates with breastfeeding difficulties, Buryk showed
signicantly greater reduction in nipple pain immediately following
frenotomy. 39 However, the main limitation of these randomised
control trials are based on subjective scoring from the mothers,
and potential bias due to the diculties of blinding an obvious
surgical procedure. Furthermore, there are no randomised studies
comparing the eectiveness of frenectomies vs frenotomies, or
the dierent success rates for the dierent treatment techniques
have been conducted. Therefore, further research is necessary
before specic techniques can be recommended for frenotomies
or frenectomies to release the lip and tongue in an infant.
Conclusions
Despite epidemiological studies pointing to an association with poor
breastfeeding ecacy and ECC, the specic link to either maternal or
infant factors has not been adequately investigated. If a relationship
could be demonstrated between poor feeding ecacy and ECC, this
would enable practitioners to better identify infants with a higher
caries risk and implement early preventative strategies.
Breastfeeding is a natural process that enables optimum
growth and health of the infant. If tongue-tie or lip-tie is identied
early as being a factor that impedes breastfeeding, then surgical
intervention can facilitate successful nursing for the mother and
infant, while avoiding stress for the mother and ensuring that the
infant thrives. DA
References:
1. Larsson E. Breast-feeding, suckling and the sucking urge: Their
development and their influence on the developing dentition. Mariestad,
Sweden: E. Larsson; 1999.
2. Armstrong J, Reilly JJ. Breastfeeding and lowering the risk of childhood
obesity. Lancet. 2002;359(9322):2003-4.
3. The Infant Formula and Follow-on Formula Regulations 1995. SI 1995/77.
4. Avila WM, Pordeus IA, Paiva SM, Martins CC. Breast and bottle feeding
as risk factors for dental caries: a systematic review and meta-analysis.
PLoS ONE. 2015;10(11):e0142922.
5. Tham R, Bowatte G, Dharmage S, et al. Breastfeeding and the risk of
dental caries: a systematic review and meta-analysis. Acta Paediatr.
2015;104(467):62-84.
6. Matee M, Mikx F, Maselle S, Van Palenstein Helderman W. Rampant
caries and linear hypoplasia. Caries Res. 1992;26(3):205-8.
7. Abbey LM. Is breast feeding a likely cause of dental caries in young
children? J Am Dent Assoc. 1979;98(1):21-3.
8. Duperon DF. Early childhood caries: a continuing dilemma. J Calif Dent
Assoc. 1995;23(2):15-16, 18, 20-2.
9. Tanaka K, Miyake Y. Association between breastfeeding and dental
caries in Japanese children. J Epidemiol. 2012;22(1):72-7.
10. Kotlow LA. The influence of the maxillary frenum on the development
and pattern of dental caries on anterior teeth in breastfeeding infants:
prevention, diagnosis, and treatment. J Hum Lact. 2010;26(3):304-8.
11. Leung AK, Robson WL. Natal teeth: a review. J Natl Med Assoc.
2006;98(2):226-8.
12. Primo LG, Alves AC, Pomarico I, Gleiser R. Interruption of breast feeding
caused by the presence of neonatal teeth. Braz Dent J. 1995;6(2):137-42.
13. Kates GA, Needleman HL, Holmes LB. Natal and neonatal teeth: a
clinical study. J Am Dent Assoc. 1984;109(3):441-3.
14. World Health Organization. The physiological basis of breastfeeding.
Infant and Young Child Feeding: Model Chapter for Textbooks for
Medical Students and Allied Health Professionals. Geneva: World Health
Organization; 2009.
15. Woolridge MW. The ‘anatomy’ of infant sucking. Midwifery.
1986;2(4):164-71.
16. Ardran G, Kemp F, Lind J. A cineradiographic study of breast feeding.
Br J Radiol. 1958;31(363):156-62.
17. Logan WJ, Bosma JF. Oral and pharyngeal dysphagia in infancy. Pediatr
Clin North Am. 1967;14(1):47-61.
18. Gwynne-Evans E. The organisation of the oro-facial muscles in relation
to breathing and feeding. Br Dent J. 1951;91(6):135-42.
19. Ramsay D, Kent J, Hartmann R, Hartmann P. Anatomy of the
lactating human breast redefined with ultrasound imaging. J Anat.
2005;206(6):525-34.
20. Geddes DT, Kent JC, Mitoulas LR, Hartmann PE. Tongue movement
DENTAL ASIA
MAY / JUNE 2018
51

Clinical Feature
and intra-oral vacuum in breastfeeding infants. Early Hum Dev.
2008;84(7):471-7.
21. World Health Organization. Management of breast conditions and
other breastfeeding difficulties. Infant and Young Child Feeding:
Model Chapter for Textbooks for Medical Students and Allied Health
Professionals. Geneva: World Health Organization; 2009.
22. Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for
suboptimal infant breastfeeding behavior, delayed onset of lactation,
and excess neonatal weight loss. Pediatrics. 2003;112(3):607-19.
23. Hernandez Yenty QM, Jurgens WJFM, van Zuijlen PPM, de Vet
HCW, Verhaegen PDHM. Treatment of the benign inverted nipple: a
systematic review and recommendations for future therapy. Breast.
2016;29:82-9.
24. Kotlow LA. Diagnosing and understanding the maxillary lip-tie (superior
labial, the maxillary labial frenum) as it relates to breastfeeding. J Hum
Lact. 2013;29(4):458-64.
25. Kotlow L. Oral diagnosis of abnormal frenum attachments in neonates
and infants. J Pediatr Dent Care. 2004;10(3):26-8.
26. Kotlow LA. Ankyloglossia (tongue-tie): a diagnostic and treatment
quandary. Quintessence Int. 1999;30(4):259-62.
27. Pransky SM, Lago D, Hong P. Breastfeeding difficulties and oral cavity
anomalies: The influence of posterior ankyloglossia and upper-lip ties.
In J Pdiatr Otorhinolaryngol. 2015;79(10):1714-7.
28. Messner AH, Lalakea M, Aby J, Macmahon J, Bair E. Ankyloglossia:
incidence and associated feeding difficulties. Arch Otolaryngol Head
Neck Surg. 2000;126(1):36-9.
29. Ballard JL, Auer CE, Khoury JC. Ankyloglossia: assessment, incidence,
and effect of frenuloplasty on the breastfeeding dyad. Pediatrics.
2002;110(5):e63.
30. Pransky SM, Lago D, Hong P. Breastfeeding difficulties and oral cavity
anomalies: The influence of posterior ankyloglossia and upper-lip ties.
Int J Pediatr Otorhinolaryngol. 2015;79(10):1714-7.
31. Centuori S, Burmaz T, Ronfani L, et al. Nipple care, sore nipples, and
breastfeeding: a randomized trial. J Hum Lact. 1999;15(2):125-30.
32. Inch S, Von Xylander S. Mastitis: causes and management. Geneva,
Switzerland: World Health Organization (WHO) Department of child
and adolescent health and development. 2000.
33. Taveras EM, Capra AM, Braveman PA, Jensvold NG, Escobar GJ, Lieu
TA. Clinician support and psychosocial risk factors associated with
breastfeeding discontinuation. Pediatrics. 2003;112(1):108-15.
34. Douglas P, Hill P. Managing infants who cry excessively in the first few
months of life. BMJ. 2011;343:d7772.
35. Benoiton L, Morgan M, Baguley K. Management of posterior
ankyloglossia and upper lip ties in a tertiary otolaryngology outpatient
clinic. Int J Pediatr Otorhinolaryngol. 2016;88:13-6.
36. Henry SW, Levin MP, Tsaknis PJ. Histologic features of the superior
labial frenum. J Periodontol. 1976;47(1):25-8.
37. Hogan M, Westcott C, Griffiths M. Randomized, controlled trial of
division of tongue-tie in infants with feeding problems. J Paediatr Child
Health. 2005;41(5-6):246-50.
38. Dollberg S, Botzer E, Grunis E, Mimouni FB. Immediate nipple pain relief
after frenotomy in breast-fed infants with ankyloglossia: a randomized,
prospective study. J Pediatr Surg. 2006;41(9):1598-600.
39. Buryk M, Bloom D, Shope T. Efficacy of neonatal release of
ankyloglossia: a randomized trial. Pediatrics. 2011;128(2):280-8.
52 DENTAL ASIA
MAY / JUNE 2018

Behind the Scenes
As a pilot
u s e r ,
I have
already
b e e n
using the Vita’s
Enamic hybrid ceramic
(Panadent), launched
i n 2 0 1 3 , s i n c e 2 0 1 1
(Fig. 1). Although I tend
to be sceptical on principles regarding
anything new, the special properties of this
innovative material attracted my interest. In
the meantime, the product has successfully
proven its worth in chairside treatments in
my practice. In this respect, the particularly
easy and fast processing that it oers has
turned out to be of enormous benefit.
However, in order to achieve perfect
shade results, some experience is certainly
required initially.
Fig. 1: Vita Enamic is a hybrid ceramic that
represents a new generation of materials.
Initial situation
During a routine check-up of a 21-yearold
male patient, who regularly visits
our dental practice for check-ups and
undergoes dental cleaning once every year,
caries was noted in his UL6 tooth (Fig. 2).
Following a comprehensive consultation,
including presentation of the Vita Enamic
h y b r i d c e r a m i c , t h e p a t i e n t c h o s e a
CAD/CAM chairside restoration, with an
inlay comprised of this innovative material.
Fig. 2: Initial situation – caries in tooth UL6
ELASTIC,
AESTHETIC CERAMICS
In this article, Dr. Otmar Rauscher uses a patient’s case as
an example to explain the entire treatment workflow
utilising Vita Enamic for inlays.
by Dr. Otmar Rauscher
Material properties
P r o f . R u s s e l l A . G i o r d a n o f r o m
Boston University (USA) had already begun
working on the idea of elastic aesthetic
ceramics in 1996. In his collaboration
with Vita, it was finally possible for the
new generation of materials to reach
m a rket m a tu ri ty . Th ey a re b a sed o n a du a l
ceramic-polymer network structure, in
which the silicate ceramic content (86%)
forms a three-dimensional framework
similar to a grid. The polymer content (14%)
is added to this open structure as part of
a special industrial production process,
creating an interpenetrating adhesive bond
with the ceramic.
In itself, the polymer also forms a
cohesive 3D grid structure, which in
turn penetrates the ceramic in a fully
homogenous and isotropic fashion. The
material bond results in a hybrid ceramic
with an elastic modulus of 30 GPa, which is
in the range of the elastic values of human
dentine.
At the same time, the exural strength
of Vita Enamic is 150-160 MPa. Load tests
c a r r i e d o u t a t t h e U n i v e r s i t y o f F r e i b u r g
(Dr. Petra Güß, associate professor)
(Bilkhair and Güß), demonstrate that
adhesively cemented crowns fabricated
using Vita Enamic have significant loadbearing
capacity, even in cases of reduced
wall thickness. Regarding processing
with the Cerec MC XL unit (Sirona Dental,
Salzburg, Austria), the special material
properties favour a chipping-free milling
of restorations with a wall thickness that
can, in the case of veneers, be reduced
to 0.2 mm in the marginal area. Further
investigations by Vita Zahnfabrik conrm
m y o w n e x p e r i e n c e r e g a r d i n g f a s t e r
CAD/CAM processing using Cerec MC XL
in comparison with conventional ceramics
both in fast and normal
mode.
Commercially
speaking, it is also relevant
that compared with other
ceramics, Vita Enamic
achieves the longest
service life with the
diamond milling tools used
with the Cerec MC XL unit.
Moreover, material tests carried out
by the University of Zurich (Switzerland)
u n d e r P r o f . W e r n e r H . M ö r m a n n
(Mörmann W et al, 2013) have also
demonstrated that the hybrid ceramic
results in less abrasion of the tooth enamel
of natural antagonists than conventional
silicate ceramics, and that its own occlusal
wear is within the range of natural enamel.
Accordingly, with regards to attrition
of the occlusal surfaces, differences in
height between the tooth substance and
restoration generally do not occur in my
experience. Hybrid ceramics otherwise
require regular intraoral adaptive measures
in the case of materials that oer greater
abrasion resistance.
Fig. 3: Results in two translucency levels
Fig. 4: Vita Toothguide 3D-Master shade scale
Preparation and finishing
The planned treatment began as
usual with shade-taking. Vita Enamic is
provided in two levels of translucency,
H T ( H T = h i g h l y t r a n s l u c e n t ) a n d
T (T = translucent), each of which is available
54
DENTAL ASIA
MAY / JUNE 2018

Behind the Scenes
in the ve Vita system 3D-master shades
0M1, 1M1, 1M2, 2M2 and 3M2 (Fig. 3). Shade
determination in accordance with this
scientically-substantiated shade system
is recommended, not just for this reason,
but in general.
I n o u r p r a c t i c e , w e u s e t h e
Vita Toothguide 3D-master (Fig. 4) for this
purpose; alternatively, the Vita Linearguide
3D-master can be used as well.
To facilitate digital verification, our
practice uses the Vita Easyshade Advance 4.0
shade measurement device.
Fig. 8: Image of the
buccal view with
teeth clenched
Fig. 12: Final virtual model following calculation
Fig. 9: The three
images...
Fig. 5: Prepared tooth following removal of caries
In this example, the relevant shade for
the patient was 2M2. It has been shown that
in case of doubt, a level brighter rather than
a level darker is always preferable. It must
be taken into consideration that the greater
the wall thickness of the restoration, the
more intensive or darker the shade eect
will be. In regards to inlay restorations, the
HT variant should generally be used.
In the next step, the caries in tooth
UR6 is removed and prepared (Fig. 5).
Fig. 6: Image of
the prepared
quadrant
Fig. 10: ... are correlated with one another
Preparation is performed in accordance with
the established guidelines for all-ceramic
restorations. Impression-taking is carried
out digitally using Cerec Omnicam (Sirona).
Figures 6 to 10 show images of the
preparation, antagonist and nal bite as
well as the correlation of the three model
elements. Following determination of the
model axis, the fully-calculated virtual
model was ready in V 4.24 of the Cerec
software (Fig. 11-13) for the design phase.
Fig. 13: Dened preparation margin and setting
the insertion axis
The suggested design was conrmed
and, as a nal step, veried in the milling
preview (Fig. 14-15). For fabrication using
the Cerec MC XL milling machine, the EM-10
block geometry measuring 8 x 10 x 15 mm
was selected, which is only available in HT.
EM-14 measures 12 x 14 x 18 mm.
Fig. 14: Suggested design, showing the occlusal
contacts
Fig. 7: Image of
the antagonist
Fig. 11: Determining the model axis
Fig. 15: Inlay construction in the milling preview
DENTAL ASIA
MAY / JUNE 2018
55

Behind the Scenes
Cementation
Drainage is achieved using a rubber dam and
clamps without wings (Fig. 16). The milled
inlay was separated from the block and the
cone piece is milled manually while occlusal
contacts only required minimal adjustment.
Restorations fabricated using the hybrid
ceramic may not be reworked using carbide
instruments; instead, only diamond-tipped
milling tools or special polishing instruments
such as the Vita Enamic polishing set clinical/
technical may be used.
Fig. 16: Complete drainage using a rubber dam
S h a d e c h a r a c t e r i s a t i o n u s i n g t h e
Vita Enamic stains kit was not performed
in this case. Manual reworking was
followed by a try-in. Whether the correct
block shade has been selected cannot be
determined at this point. As only air rather
than cementation material is present as
a medium between the tooth substance
and the restoration, as there is no shade
correlation between the dentine and the
inlay, the shade result at this stage is not
yet convincing.
Cementation was performed
u s i n g t h e a d h e s i v e t e c h n i q u e , w i t h
Syntac Classic (Ivoclar Vivadent) for dentine
bonding and Vita Duo Cement in shade A3 for
cementation. In preparation, the inlay was
etched for 60 seconds using hydrouoric
acid, then silanised for 60 seconds using
Monobond Plus, and then finally coated
with Heliobond (Ivoclar Vivadent). After
using a medium shade for cementation,
which aects the depth shade from within
the remaining tooth structure, a change in
shade was immediately visible (Fig. 17). By
the time the restoration has been fully cured
and cleared of all excess adhesive, after nal
polishing is done and the rubber dam has
been removed, the tooth has dried to such
an extent that the shade result at this point
is not yet convincing (Fig. 18). However,
the photographic image from the checkup
a week after placement demonstrates
the excellent shade result (Fig. 19). At this
point, the occlusal contacts were once again
successfully veried using articulating paper
(Fig. 20).
Fig. 18: Incorrect shade impression following
removal of the rubber dam due to dehydration
of the tooth
Fig. 20: Successful verication of the occlusal contacts
Conclusion
The positive results achieved in tests using
Vita Enamic have been confirmed in my
day to day clinical experience. Thanks
to excellent processing properties, it is
particularly easy to quickly achieve superior
quality results that are also impressive in
terms of aesthetics. As usual, a certain
level of experience and the trained eye of
a seasoned practitioner are benecial in
this aspect. DA
References
1. Bilkhair A, Güß P. Fatigue behavior and
damage modes of a monolithic CAD/CAM
hybrid ceramic (Vita Enamic) material
compared to CAD/CAM all-ceramic
posterior crown restorations. Publication
forthcoming
2. Mörmann W, Stawarczyk B, Ender A,
Sener B, Attin T, Mehl A (2013). Wear
characteristics of current aesthetic dental
restorative CAD/CAM materials: Two-body
wear, gloss retention, roughness and
Martens hardness. In: J Mech Behav Biomed
Mater. Apr 20(4): S. 113-125
Fig. 17: After using a medium shade for
cementation material, there is an immediate
visible change in shade.
Fig. 19: Perfect shade result one week after
placement
56 DENTAL ASIA
MAY / JUNE 2018

The 3rd
“MYANMAR’S LEADING MEDICAL, DENTAL,
LAB AND PLASTIC SURGERY EVENT!”
Behind the Scenes
6 th 2018
Co-Located With
The 3rd
Edition of
2018
Edition of
PHARMA 6th
The 4th Edition of
MYANMAR 2018
10-12
OCTOBER 2018
Novotel Yangon Max
ConventionCentre,
Yangon, Myanmar
Tel : (+95) 9 250 175 661
E-mail : myanmar@asiafireworks.com
Endorsed d and
dSupported dby :
In nAss
Association so With : Brought To You By :
DENTAL ASIA
MAY / JUNE 2018
Myanmar Pharmaceutical
& Medical Equipment
Entrepreneurs Association
Myanmar Dental Association SAVOR International Limited Fireworks Myanmar
Part of Fireworks Trade Media Pte Ltd
57

Behind the Scenes
Simplified Dental Protocol for the Construction of Removable Prosthesis
WITH IMPLANT AND MUCOSAL SUPPORT
By Dr. Maurizio Sedda and Mr. Simone Fedi
The removable prosthesis with implant - mucosal support combines the aesthetic advantages of a removable
prosthesis with the stability given by the implants. The protocol for this type of prostheses may be intricate, both
for the clinician and for the dental technician. This work illustrates a simplified dental protocol with, at its starting
point, the recognition of a diagnostic prosthesis. This is used as a guide for the placement of implants and, once
duplicated, for impression registration of occlusal relationships and for obtaining an aesthetic prototype. Also, the
management of milled bar becomes simplified, thanks to the use of attachments with reduced dimensions, and the
superstructure, made of PEEK (Polyether ether ketone - thermoplastic composite polymer). By following what is
illustrated in the article, it is possible to provide the patient with an aesthetic prosthesis which is stable and easily
maintainable from a hygiene point of view.
Introduction
Gradually, more edentulous patients are
specifically asking clinicians for a fixed
prosthesis. Mostly in the lower jaw, the
implant prosthetic treatment presents
no high technical difficulties. However,
in the upper arch, there are a number
of variables that are essential to keep in
mind during the commencement of the
treatment plan. If these elements are
undervalued, potential failure may easily
occur. The shape of the jawbone and soft
tissues can hold the patient back during
cleansing of the prosthesis that, too often, is
fabricated trying to meet only the aesthetic
requirements, ignoring the importance
of hygiene and basic requirement for the
long-term success of the treatment 1,2 . For
these reasons, prosthesis with implants
should be designed prior to their placement
where insertion must be “guided” by
the prosthesis itself 3 . Additionally, in the
upper arch, more than in the inferior, the
shape and the position of the lip strongly
contribute to the aesthetics; indeed the
perioral tissues must be correctly supported
in order to restore facial harmony and the
phonetics 4 .
As mentioned above, the removable
prosthesis with implant and mucosal
support nds its application in dentistry.
This type of prosthesis is called “hybrid”: on
one hand the implants perform a supporting
function (like a Toronto Bridge), and not
only as retention (for overdenture), while
the prosthesis remains removable from
the patient. The Anglo-Saxon definition
i s o f t e n “ m i l l e d b a r o v e r d e n t u r e ” o r
“fixed - removable overdenture”. In
particular, according to the classication
of Misch, we speak of removable prosthesis
“RP-4” when the prosthesis is completely
implant supported and removable
prosthesis “RP-5” when the prosthesis
is implant and mucosal supported 5 . The
latter type and the subject of this work,
is indicated when simultaneously 1) the
patient requests for an implant-supported
and 2) there is a need for a good support for
the lips with a ange. In fact, a vestibular
xed ange will impede the patient’s ability
to maintain a proper hygiene, causing the
loss of the implants. Combining the use of
implants and of a removable prosthesis, the
clinician is able to oer the patient a stable,
aesthetic and easily hygienic prosthesis
without the palate ange.
The purpose of this article is to provide
a simplied technical protocol, compared
to the classical one, with the intention to
58 DENTAL ASIA
MAY / JUNE 2018

Behind the Scenes
increase the accuracy of the restoration and
to decrease the diculty of implementation
and the necessary time of processing.
Clinical case
A 54-year-old, male patient, non-smoker
with no major clinical diseases, came to
the clinician with an upper edentulous
arch with some lower teeth present (from
34 to 45). The upper total prosthesis was
incongruous, and caused some diculties
in chewing and phonation. The patient
manifested a psychological discomfort
due the prosthesis condition in relation
to his age, which hindered his speech
when socialising with his co-workers. He
also expressed the wish to replace the
removable upper dentures with implants,
quoting his own words, “something that
will stay xed in the mouth and without
palate.”
The clinician started constructing the
upper jaw with a new provisional but still
entirely removable prosthesis for diagnostic
purposes, and with the periodontal
treatment of the lower arch, with a
provisional and removable partial denture.
Once the aesthetics and correct occlusal
plane was restored, it is fundamental to
maintain the buccal flange to support
the upper lip. Some diagnostic tests were
performed to study the placement of
implants with a panoramic radiography and
a computed tomography. In accordance
to the patient’s approval, the clinician
proceeds with the following treatment plan:
insertion of four implants, in 14, 12, 22 and 24
areas and the construction of an implant -
mucosal supported prosthesis with a milled
bar on the upper arch; and the lower jaw
was maintained healthy and restored with
a removable partial denture.
Once the implants were placed, the
position was established according to the
availability of the bone and the prosthetic
requirements, the patient waited for the
successful osseointegration with the total
temporary prosthesis, suitably modied.
In this period, the patient was subjected
to periodontal maintenance therapy. The
same prosthesis was used as a base for the
nal restoration.
Implementation of the transparent
acrylic resin replica
The provisional prosthesis was positioned
with a precision silicone with a hardness of
70 Shore-A.
The prosthesis and model silicone
obtained were placed in a ask and then
an insulator (insulating silicone spray,
Transformer) was applied. Another silicone
was placed between the replica and the
cover of the ask, which was closed and
held in place until the full curing of the
silicone. The prosthesis was removed
from the ask and two holes through the
upper silicon (a 0.5 cm diameter for the
input channel along with a 0.3 cm for the
output channel) to allow the injection of
the transparent acrylic resin. The resin was
mixed and injected inside the ask, which
was maintained at 50°C for 25 minutes at a
pressure of 2.5 bars. Once cured, the ask
was opened and the replica was nished
with rotary instruments mounted on a
laboratory handpiece and delivered to the
clinician.
Fig. 1: Impression obtained with
the prosthesis replica
Fig. 2: Placing of the laboratory analogues and
the articial gingiva
Impression with the prosthesis replica
The transparent resin replica was used in a
single chairside appointment, as customised
tray, as a reference of the teeth set-up
(control of the vertical dimension, the
masticatory plane and the relationship
with the antagonist), and as a rst test of
the aesthetics (smile line, midline, etc). The
clinician proceeded with the insertion of
the replica in the oral cavity, checking the
occlusion and removing the wrong occlusal
contacts. The precise occlusion was then
recorded using an additional fast-curing
silicone. The replica had been perforated
in correspondence with the emergence of
the implants and daubed with adhesive.
For the impression an addition silicone has
been used and the replica was maintained
in position by the patient with his bite until
the complete polymerisation occurs; before
its removal, a face bow was recorded. After
removing the replica from the oral cavity,
the silicone inside the holes was removed
with a scalpel to allow the insertion of the
pick-up transfers. The replica was placed
back into the oral cavity and the
transfers were screwed on the
implants. Keeping the prosthesis in
place, the transfers were blocked
on the replica using light curing
resin with low shrinkage. The xing
screws were removed from the
transfers and the impression was
delivered to the laboratory after the
disinfection protocol (Fig. 1).
Fabrication of the master model
and aesthetic try-in
A silicone reproducing the soft
tissues was placed at the area
around the transfers then a proper
insulation was daubed (Fig. 2).
The master model was poured
by developing the impression
obtained with the replica with a
class IV plaster; according to the
manufacturer’s instructions (Fig. 3-4).
Once hardened, the transfers were
removed and the master model was
positioned on the articulator using
the replica and the face bow. The
antagonist model was placed on
the articulator with the silicone bite.
DENTAL ASIA
MAY / JUNE 2018
59

Behind the Scenes
With a light curing resin, the rims’ produced
the basis for an aesthetic set-up. Since the
treatment plan involved the construction of
a milled bar and a superstructure, in order to
reduce the encumbrance of the prosthesis,
a set of preformed composite veneers
were used. With the models positioned on
the articulator, the veneers were placed
on the resin basis, following the aesthetic
indications of the transparent replica, using
a hard wax (Fig. 5). In agreement with the
p a t i e n t , t h e f o l l o w i n g s e t o f t e e t h : t h e
I 4 7 s e t f o r t h e a n t e r i o r t e e t h a n d t h e
L3 form for the posterior teeth was
selected. The purpose of this rst assembly
is to obtain an aesthetic prototype to be
delivered to the clinician.
Fig. 3: Master model
Fig. 4: Master model with articial gingiva and
analogues in position
Aesthetic try-in
The patient was given the opportunity
to evaluate the aesthetic result of the
restoration prior to the finalisation. The
clinician with the set-up inside the patient’s
mouth evaluated the aesthetics, phonetics,
overall dimensions of the buccal anges and
the resulting support for the upper lip and
colour of the dental elements. The occlusal
relationships were also controlled, together
with the protrusive and lateral movements
(Fig. 6). The necessary adjustments were
made directly to the chair, being the
aesthetic facets mounted on wax. With
the patient’s agreement, the prototype
was delivered to the laboratory after the
disinfection protocol.
Fig. 5: Aesthetic prototype
Fig. 6: Try-in of the aesthetic prototype
Fig. 7: Reference mask on the articulator
Realisation of the bar
In order to preserve the changes made
by the clinician, a silicone key was
created (Universal, Transformer) using
an articulator (Fig. 7). Subsequently, the
master model and the aesthetic prototype
were positioned inside a ask, using the
plexiglass cover, suitable for the light
curing of the composite. Two wax pins for
spruing were connected to the prototype
to create the injection channels, then once
the flask was closed it is injected with
a t r a n s p a r e n t s i l i c o n e 2 2 s h o r e ( F i g . 8 ) .
After curing, the prototype and the master
model were removed from the ask and
digitised through a laboratory
scanner and then the les were
loaded to a modelling software,
exocad (Fig. 9). The design of
the primary bar has been relative
according to the teeth set- up in
order to put the attachments
perpendicular to the occlusal
plane. The bar surface facing
the gingiva was drawn convex
to minimise the accumulation of
plaque/food and to facilitate the
manoeuvres of hygiene. Using
the CAD/CAM technique, the
bar has been obtained by milling
from a solid titanium alloy block
(Fig. 10-11).
Four attachments, with the
respective housings, were put on
the bar. The attachment chosen
(OT Equator) has a reduced
vertical dimension compared
to the spherical attachments,
which allows saving space with
an even stronger retention.
Such attachments were screwed
into the thread inside the bar
created directly by the milling
centre - this avoided the use of
adhesive materials or to perform
a weld (Fig. 12). The threaded
attachments allow for quick
and easy replacement without
removing the bar. The bar with
the attachments screwed was
delivered to the clinician.
Verification of the liabilities of the bar
The clinician proceeded to screw the bar
on the abutments, verifying its passive
seating (Fig. 13). The distance between
the gingiva and the bar, plays a crucial role
in daily hygiene, was checked, and a test
60 DENTAL ASIA
MAY / JUNE 2018

Behind the Scenes
was performed to verify that the patient
was able to use floss and brushes. The
compressive points on the gingiva were
reduced. The bar was returned to the
laboratory after the disinfection protocol.
Fig. 8: Transparent ask for future nalisation
the modelling of the superstructure. The
thermoplastic mask was placed on the bar
screwed into the master model; all this
was repositioned on the articulator and
the veneers were xed in place within the
mould silicone (Fig. 16).
Fig. 11: Bar seated and screwed without
contacts with the soft tissues
The anatomic supports for veneers
were modelled in wax (Fig. 14) and then
inserted inside the casting cylinder along
with the investment. The cylinder was
preheated to 630°C for 90 minutes, and
then cooled down to 400°C and maintained
at this temperature for 60 minutes A
predetermined amount of polymer
based on PEEK was introduced inside
the cylinder and left in position
for 20 minutes The cylinder was
placed inside the unit for the vacuum
injection system and the pressing
was carried out at 4.5 bar. After
cooling, the coating was removed
and the superstructure obtained
w a s s u b j e c t e d t o s a n d b l a s t i n g
Fig. 9: Design of the bar with the attachments
Fig. 12: Detail of the attachments used
Fig. 15: PEEK superstructure
Fig. 10: Master Model with bar and attachments
Finalising the restoration
The bar was placed on the model and
undercuts were eliminated with wax.
The housings with retentive caps were
placed into position and the master model
duplicated with silicone. The duplicate
model was developed with class IV
plaster; according to the manufacturer’s
instructions. A rigid thermoplastic mask
with a thickness of 1 mm was adapted
over the duplicated model as the basis for
Fig. 13: Try-in of bar in the patient’s mouth
Fig. 14: Modelling of the superstructure
Fig. 16: Positioning of the facets inside the ask
(aluminium oxide, 110 pm, 2.5 bar)
(Fig. 15). A primer was dabbed into
the spaces of the metal housing and
cured for 90 seconds then the housings
were blocked with dual adhesive. The
bar and superstructure were placed on
the master model, inside the mue.
The gap between the two structures
was filled with silicone. The inner
part of the veneers was subjected
t o s a n d b l a s t i n g ( a l u m i n i u m o x i d e ,
110 pm, 2.5 bar) and a primer was
dabbed and then polymerised for
90 seconds The veneers were blocked
DENTAL ASIA
MAY / JUNE 2018
61

Behind the Scenes
by inserting transparent silicone inside the
cover ask and an absence of interference
between superstructure and veneer were
veried (Fig. 16).
Fig. 17: Master model, bar, superstructure and
veneers before nalisation
Fig. 20: Denture completed, frontal view
of the literature. Clin Oral Implants Res
2002; 13:1-9.
2. Mombelli A, Van Oosten MAC, Schurch
E, et al. The microbial associated with
successful or failing osseo-integrated
titanium implants. Oral Microbiol Immunol
1987:2:145-51.
3. Misch CE. Considerations of biomechanical
stress in treatment with dental implants.
Dent Today 2006;25:80-5.
4. Zarb GA, Bolender CL. Prosthodontic
Treatment fo Edentulous Patients:
Complete Dentures and Implant-Supported
Prostheses. Twelfth Edition. St. Louis,
Mosby, 2004.
5. Misch CE. Prosthetic options in implant
dentistry. Int J Oral Implantol 1991:7:17-21.
Fig. 18: Denture completed, internal view
On the outer surface of the
superstructure, a primer was rst applied
then a pink opaque material (Fig. 17) over
the ange areas (GUM colour) followed
by a dental shade in correspondence with
the facets and then cured for 90 seconds.
The anges have been characterised with
composite resin with the technique of
reverse stratication; on the inside of the
facets, a specic composite was used. Once
the flask is closed, the resin was mixed
Fig. 19: Denture
completed with
an aesthetic
vestibular
ange
Fig. 21: Denture completed, inside the patient’s mouth
and injected in the intake channel until the
system was kept at 50°C for 25 minutes at a
pressure of 2.5 bar. The prosthesis obtained
was finished with rotary instruments
mounted on a laboratory handpiece and
delivered to the clinician (Fig. 18-21).
Conclusion
The removable prosthesis with implant
and mucosal support is a solution that
combines aesthetics and the support for
the lip of a removable prosthesis with the
stability of a xed prosthesis over implants.
Furthermore, a greater ease in cleaning and
the absence of encumbrance of the palatal
ange gives comfort to the patient.
The execution of the simplied protocol
presented allows for a reduction of the
processing time without any loss of quality
and accuracy.
The use of low profile attachments
screwed directly into the bar without gluing
or welding, allows for an easy installation
and possible replacement, ensuring at the
same time an excellent retention within
small spaces. DA
References
1. Quirynen M, deSote M, Steeberghe D.
Infectious risks for oral implants: a review
62 DENTAL ASIA
MAY / JUNE 2018

In depth with
- Renfert
AUTO spin by Renfert: Universal
System for Model Production
with Acrylic Plates
Precise working models at low cost and time
investment along with a free choice of system!
Renfert’s new AUTO spin model production system not
only makes model production easier and more reliable,
but also faster and at a lower cost. The perfectly
coordinated pin drilling system makes the production
of highly precise working models with an acrylic
base plate easier. The pin drilling system features a dual-xture,
universal plate holder and Renfert‘s new, innovative
“Level Controller” – for more precision when
positioning challenging impressions and greater
control over conical pins. The extensive AUTO spin
accessory, which is compatible with other model
system manufacturers, guarantees a reliable and
reproducible working process.
Following the motto “making work easy”,
Renfert’s AUTO spin is not only just the latest
generation of automatic pin drilling devices but for
the rst time, the dental technician is provided
with an open model system with acrylic base
plates. Also, it is a flexible concept with
individual components which can easily be
integrated into other model systems such as
Zeiser ® and Giroform ® .
Open pin drilling system with precision
guarantee
The new AUTO spin is a precision device
which provides unique drilling accuracy due
to its perfectly coordinated components and
automated drilling process – for ecient
model production and pin friction.
For the first time, the new integrated
“Level Controller” allows impressions to be
positioned and aligned safely, even in challenging situations. Less
time, work, cost investment and material consumption thanks
to the prefabricated AUTO spin base plate, which comes in a
standard and comfort version (with metal disc). As a result, the
dental technician saves the working step of creating the plaster
base. In addition, the high-precision base plate eliminates the need
for a splitcast, whilst at the same time allowing precise and clean
repositioning of the working models in the articulator.
Better pin drilling: intuitive and integrative in the system
For exible use, a universal base plate holder with secure dual-
xation is integrated in the system which is compatible with almost
every plate size available on the market. The AUTO spin impression
holder made of stainless steel and the innovative cone pins with
a shaft length of 14mm (0.55’’) can also be used universally.
T h e r e f o r e , t h e p r e c i s i o n p i n s c a n b e u s e d w i t h t h e
AUTO spin system as well as with other systems such
as Giroform ® and Zeiser ® .
Other advantages of the model pins: Due to its
ne surface structure and minimal manufacturing
tolerances it provides controlled friction behavior,
which allows a conical retention eect and a secure
and uniform t in the base plate. The system is
rounded o with the silicone putty, AUTO spin
putty, for fixing, aligning and blocking out the
impression.
All in all, the AUTO spin provides the dental
technician with a modern, perfectly coordinated
system, wherein highly accurate acrylic-based
working models can be produced in a time and cost
ecient manner which optimally complements
model systems from other manufacturers. DA
64
DENTAL ASIA
MAY / JUNE 2018

PureSet Tray layouts are specially designed
to reflect the surgical workflow and make
components easy to identify, as shown here
in the NobelReplace CC PureSet Tray.
With success built on more than 60 years of
experience developed from ground-breaking
work with osseointegration, Nobel Biocare
has been the pioneer of implant science. The
company has introduced a number of solutions
that have become leading standards in the industry. Believing
hygiene must never be compromised, the company continues to
push boundaries striving to help dental professionals treat more
patients better.
Small practices and large health care facilities alike are on a
mission to meet the strict standards required, with eciency as
an important consideration in achieving this. Nobel Biocare has
developed a surgical kit that can help save time from surgery
to sterilisation. Designed for automated cleaning and intuitively
organised to follow the workow, PureSet has been created to
combine ease, speed and eciency.
In depth with
- Nobel Biocare
Supporting a dedication to hygiene
The main asset of the new surgical kit is the PureSet Tray, available
for Nobel Biocare’s conical connection implant systems
and the Trefoil system. Made from
high-grade stainless steel*, the tray
is designed to enable automated
cleaning with few manual steps and
for re-use in the clinical environment.
Eciency and ease, step-by-step, have
b e e n k e y d r i v e r s b e h i n d t h e d e s i g n o f t h e
PureSet Trays. At the pre-cleaning stage, manual
cleaning is only needed for dismountable parts of
the kit, which are suitable for ultra-sonic
cleaning (excluding PureSet Plate). Time
can also be saved in the cleaning and
disinfecting processes, as the tray and
instruments can remain together, and with no need
for manual drying. At sterilisation, the PureSet Tray is
compatible with standard sterilisation containers for
safe and reliable storage.
At each stage in the workow, from surgery through
to sterilisation, the instruments can stay securely
contained in the tray thanks to their retention by
special metal springs.
Organised to save time
It is not just the ease and eciency of the cleaning
workflow that can save time through PureSet.
To help meet practitioners’ needs for simplicity
during surgery, the straightforward and intuitive
layouts of PureSet Trays have been specially
designed to reect surgical workows and make
the components easy to identify. Furthermore,
to avoid the potential risks of distraction and
Surgical instruments
are contained and
secured using special
metal springs.
inconvenience caused by light reection on a metallic surface, the
PureSet Plate is purposefully coloured black in order to absorb the
bright light of the surgery.
Both the Trefoil and NobelReplace CC
implant systems each have a PureSet Tray
dedicated to reecting their surgical workow.
For even greater eciency, two of Nobel Biocare’s
leading implant systems – NobelActive and
NobelParallel CC – can both be stored in just one single
tray, requiring fewer instruments, thanks to their similar
drilling protocols.
In essence, PureSet Trays oer ease, eciency
and hygiene – all-in-one.
*PureSet Trays are made of stainless steel except
for the PureSet Plates and grommets. DA
DENTAL ASIA
MAY / JUNE 2018
The high-grade stainless steel* PureSet Trays, with secure
retention of components, are specially designed to enable
automated cleaning.
65

Product Highlight
Mectron
New Perio Anatomic Inserts for Full Mouth Periodontal Treatment
Since 1979, Mectron has actively and successfully developed and produced top-quality devices. In fact, the
company was responsible for some of the most important innovations in dentistry, especially the first ultrasonic
titanium handpieces, the first LED curing lamps and the first ultrasonic surgical unit for piezoelectric surgery.
Recently, Mectron launched its three
new ultrasonic inserts – P15, P16R and P16L
– which are specically designed to perform
gentle and safe periodontal debridement.
Why use Mectron’s new ultrasonic inserts?
With its unique shape, the inserts allow for
optimal access into difficult-to-reach areas
and deep periodontal pockets – furcations,
root surfaces and concavities. The inserts are
gentle on soft tissue, which helps in tissue
preservation and tissue attachment formation.
Thanks to its oxygen delivery system, the
cavitation eect provides mechanical biolm
disruption, bacteria dispersion and periodontal
pocket detoxication.
Taking a closer look
P15: Universal curette for supra and
subgingival treatment. It is recommended
for deep periodontal pocket debridement
and provides easy access to canine and
anterior teeth, while replacing manual
curettes n° 1-2, 3-4, 5-6, 7-8.
P16R – P16L: Right (P16R) and left
(P16L) angled periodontal curettes for
subgingival concrements and biofilm
removal from furcations and deep pockets.
It is recommended for supra and subgingival
interproximal spaces and for ecient root
planing on molars and premolars. These
replaces manual curettes n° 11-12, 13-14,
15-16, 17-18.
GC ASIA
Combining Precision, Ergonomics and Economy
The new Aadva IOS 100 intraoral scanner from GC has evolved to develop a faster, less obtrusive, more accurate
and predictable replacement for conventional impressions.
In the current digital age, everyday work
in the dental oce should ow as smoothly
as possible, with high accuracy, eciency and
fast communication channels. Especially when
it comes to laboratory-made restorations, all
parties concerned should benefit from the
technological process – the dentist, dental
team, dental technician and of course, the
patient.
With the new Aadva IOS 100 from GC, it
can create a digital impression in less than ve
minutes, which can then be directly forwarded
to the laboratory via the cloud.
The Aadva IOS 100 modern, robust cart
design features a built-in computer and
adjustable touch screen to meet all ergonomic
needs for any treatment in any position.
Its handpiece is one of the smallest
a n d l i g h t e s t a v a i l a b l e i n t h e m a r k e t ,
providing real time scanning
with no ongoing
calibration
requirements.
It does not
require any powder
spray prior to scanning,
which increases patient comfort.
C o m b i n e d w i t h a u s e r - f r i e n d l y
Graphics User Interface, the Aadva IOS 100
makes for a quick and easy scanning process.
Designed as an open system with two
USB ports, the Aadva IOS 100 allows dentists
to save STL les from the unit to a USB stick
to transmit them to the dental technician in
their preferred way – providing full control
a t t h e d e n t i s t ’ s h a n d s . T h e m u l t i t a s k ,
cloud-based Digital Services Platform allows
all les to be stored virtually and facilitates
speed of communication
between the practice and the
laboratory with the option
to discuss the digital patient
model and available prosthetic
options online. In addition, the
Digital Services Platform
oers training programmes
and technical services
online. With appropriate
training, the scanning process
can be performed by other members of the
dental team to further simplify workow.
The digital scanner will play an
increasingly important role as an interface in
the computer-assisted restorative dentistry.
GC’s Aadva IOS 100 is an extremely costeffective
high-tech system that is an
attractive solution for any dentist.
66 DENTAL ASIA
MAY / JUNE 2018

Product Highlight
Beautiful, Ecient and Now with Even Greater Flexibility!
Blank portfolio expansion of the SHT zirconium oxide Zolid FX Multilayer
Amann Girrbach
Amann Girrbach now supplements the
portfolio of Zolid FX Multilayer blanks with
zirconium blocks, which are available not
only with an Amann Girrbach mandrel, but
also with a universal mandrel. This allows
the material to be eciently processed with
all Amann Girrbach dry milling machines as
well as with third-party systems.
The polychrome, ultra-highly translucent
zirconium oxide with integrated shade
and translucency gradients simulates
enamel, dentine and cervical shades with
soft smoothly owing transitions without
any disturbing colour breaks. Aesthetic
restorations with a natural appearance can
therefore be achieved completely without
reworking.
Users can choose between the two block
sizes C (crown) for single-tooth restorations
and B (bridge) for bridges with a
maximum of three pontics. This
can considerably reduce costs
for stocks, especially for shades
that are relatively rare. Owing to
an intelligent nesting concept,
all 16 Vita shades can be covered
wi th j u st ten b lo c ks, a s wi th th e
Zolid FX ML blanks. The
combination with the
sophisticated holder concept
of the Ceramill Motion 2
milling machine enables milling
up to nine different shades
simultaneously. This further
optimises the exibility and eciency of
fabrication in the laboratory.
DENTATUS
Aesthetics Have Never Been Easier with the New Pron ® Reciprocating System
The Pron ® Reciprocating System from
Dentatus is the instrument of choice for
shaping, contouring and polishing natural
dentition and cosmetic restorations with
easy access and exibility. The Lamineer tips
can be set to rotate freely and follow tooth
contours naturally, or they can be locked
radially for direct and specic modications.
Moreover, the tungsten Lamineer tip
quickly cleans up residual ortho cement
without scratching healthy enamel.
Since Dentatus’ launch of Pron IPR ,
Lamineer tips for interproximal reduction,
interest in invisible orthodontics and
aesthetic orthodontics has increased.
Profin’s reciprocating motion allows for
easy interproximal reduction with greater
control and eciency.
Dentatus has developed IPR tips with
diamond coating (on both sides or on one side)
which ensures safe interproximal stripping
and eliminating the risk of iatrogenic
damage to adjacent teeth.
Advantages of the Pron IPR
• Minimal risk of adjacent tooth
damage
• Increased control during
interproximal reduction
• Increased patient comfort
• Simple and ecient
The IPR tips allows for safe interproximal
reduction with optimal control. Simply
choose the tip with the desired thickness
(0.25, 0.3, 0.4 or 0.5mm) for the prescribed
amount of reduction.
Like all Pron tips, they are harmless on
soft (gingival) tissue.
L a s t l y , a l l I P R t i p s h a v e a g r i t o f
50 microns and colour-coded, corresponding
to the thickness of the blade.
DENTAL ASIA
MAY / JUNE 2018
67

PRODUCT HIGHLIGHT
Ivoclar Vivadent
Ivoclar Vivadent Launches New Product Portal to
Round O its Online Services
Ivoclar Vivadent has
announced the go-live of
a new portal. Under the
heading of “Highlights”,
the portal offers dental
professionals and laboratory
professionals the latest
news about the company’s
products.
The new online portal
is now operational. It
complements the wellestablished
and successful
Dentist and Dental Technician
blogs, which focus on topics and issues
concerning everyday work in the
dental practice and the dental lab.
Update on new developments
In the new Highlights portal, not only new
product innovations will be presented,
The new Highlights portal from Ivoclar Vivadent
but readers will also be provided with
the most recent findings from Research
& Development to keep them updated.
Dentists and laboratory technicians who
subscribe to the newsletter of this gateway
will automatically be informed about new
publications once a month.
Available in ve languages
Similarly to the existing blogs, the new
product portal will be available in
the following five languages:
English, German, Italian,
French and Spanish. The
portal features two sections,
which are in line with the
company’s relevant target
groups: A section is dedicated
to dentists and the other to
laboratory technicians. Thus, both
target groups will be supplied with
relevant information for their profession.
F o r m o r e i n f o r m a t i o n g o t o :
https://highlights.ivoclarvivadent.com
DenMat
NV ® PRO3 Microlaser: The Best Just Got Better
For nearly a decade, the NV ® Microlaser
from DenMat has set the bar for convenience,
portability and ease of use among all dental
soft-tissue diode lasers. The next-generation
NV ® PRO3 Microlaser continues that awardwinning
tradition. Optimised for all of your
periodontal, restorative and orthodontic
procedural needs, the latest evolution in
cordless soft-tissue lasers enables you to
deliver the benets of laser dentistry to each
patient, while increasing practice production
across all departments.
NV ® PRO3 Microlaser is truly portable
weighing only 1.9 ounces which comes
with a wireless foot pedal, for the ultimate
convenience between
operatories. Its base
charger stores the laser
unit and charges up to
three batteries at the same
time. It also comes with
lithium-ion batteries that
indicate overcharge and
undercharge for added
protection.
NV ® PRO3 Microlaser
provides 12 preset procedures for all
periodontics, restorative and orthodontic
needs. Additionally, surgical and periodontics
disposable bre tips are available to maintain
sterile and hygienic
purposes.
Dedicated support from
DenMat representatives
are available to cater
to all user’s needs and
demands. Furthermore, a
one-of-a-kind customisable
online training program is
included for users together
w i t h t h e a v a i l a b i l i t y o f
hands-on training options. DenMat continues
its award-winning tradition through providing
high-quality products and services to dental
professionals and the dental industry.
68 DENTAL ASIA
MAY / JUNE 2018

Buenos Aires
Argentina
5-8 September 2018
BUENOS AIRES 2018
World Dental Congress
A PASSION FOR MANY, A COMMITMENT FOR ALL
EARLY-BIRD REGISTRATION DEADLINE
1 June 2018
www.world-dental-congress.org

SHOW REVIEW
IDEM 2018 Takes Clinical
Excellence to the Next Level
The 10 th edition of the
International Dental
Exhibition and Meeting (IDEM)
successfully concluded after
three days of exhibition,
meetings, conference and insightful
discussions on the latest breakthroughs in
dental innovation and practices.
Co-organised by Koelnmesse and the
Singapore Dental Association, Asia Pacic’s
cornerstone event in dentistry drew 8,571
attendees from 71 countries. The exhibition
oor hosted 13 national pavilions and a total
of 506 exhibitors from 41 countries.
“We are proud of how IDEM has
developed since its inauguration 18 years
ago. The 10 th edition of IDEM once again
focused on integrating breakthrough
technologies into dental and biomaterial
sciences, as well as better care for patients.
Looking ahead, we will continue to provide
our audience with a world-class event
that is cutting-edge and contemporary.
This includes the further blending of
education, trade, and networking, and
full use of digital technologies to facilitate
maximum interactions between exhibitors
and visitors,” said Mr. Mathias Kuepper,
Managing Director, Koelnmesse Pte Ltd.
The exhibition oor featured the latest
innovations, including 3D printing, an
integrated blade that minimises the risk
of injuries during surgeries as well as
the latest range of intraoral scanners
that are ergonomic, portable and able
to provide real-time scanning with no
ongoing calibration requirements, which
are designed for patient comfort.
“The IDEM exhibition is the perfect
event to meet all the Asian customers at a
c e n t r a l l o c a t i o n , ” s a i d M r . S t e f a n L e b e n ,
A. Schweickhardt GmbH & Co. KG, an
exhibitor who participated at IDEM 2018.
Highlights from the conference floor
included key sessions by Dr. Christopher Ho,
Dr. Sergio Piano and Dr. Anthony Mak.
“IDEM provides dental professionals
with the best opportunities to further
their professional education and
development as well as strengthen their
p r a c t i c e s a n d i n d u s t r y k n o w l e d g e , ” s a i d
D r . K u a n C h e e K e o n g , C h a i r p e r s o n ,
IDEM 2018 Committee. “We are working
closely with the Koelnmesse team to
deliver an even more attractive programme
for dental professionals and will look for
opportunities to showcase
the latest technological
advances as well as increase
the engagement between
speakers and the audience
at the next edition of IDEM.”
Most of the exhibitor’s
booths were busy especially
those with their own
workshop sessions like
Shofu Dental. Dr. Anand Narvekar held
interactive sessions on ‘Mastering the Art
of Life-like Restorations’ wherein dentists
were able to use all Shofu products to feel
and use rst-hand the latest products from
the company.
“Basically, I use the Build-up System
by Shofu in making ceramics. Utilising
the four-side structure technique with
ceramics gives a very natural eect because
of its translucency. Additionally, Shofu
materials are easy to use and handle - like
the Beautil composites by just using two
shades making it simple to use. Moreover,
S h o f u r e c e n t l y i n t r o d u c e d t h e n e w
Beautil LS (Low Shrinkage) which has high
durability and polishing ability. They have
a wide range of products especially when
it comes to translucency – high value and
low value. And I believe that IDEM 2018 is a
great event to present the latest products
to the market, interact with my colleagues
a n d l e a r n f r o m t h e m a s w e l l , ” s a i d
Dr. Anand Narvekar, aesthetic dentist from
India and workshop speaker for Shofu.
IDEM 2018 exceeded expectations by
providing informative lectures, engaging
workshops and being well organised event.
The next edition of IDEM will
take place on 24 th – 26 th A p r i l 2 0 2 0 a t
Suntec Singapore Convention and
Exhibition Centre. DA
70 DENTAL ASIA
MAY / JUNE 2018

SHOW REVIEW
The 40 th Asia Pacific Dental
Congress 2018 (APDC) was
held concurrently with the 109 th
Philippine Dental Association
(PDA) Annual Convention and
Scientic Sessions at the SMX Convention
Centre in Manila on 7 th - 11 th May 2018.
With the theme, “Intensifying
Professionalism in Synergy with Dental
Science and Technology”, APDC
was a highly anticipated event that
included 32 lecturers streaming from
Asia, Europe and the U.S. together
with 37 lecturers from the Philippines.
APDC did not disappoint the
attendees, who were approximately
14,000 delegates, with the
40 th Asia Pacific Dental Congress 2018:
“Intensifying Professionalism in Synergy
with Dental Science and Technology”
Written by Dr. Chala R. Platon
jam-packed daily lectures and handson
workshops that were held in five
function rooms and ten meeting rooms.
Additionally, local and international
manufacturers and suppliers were present
in the event to display the latest innovations
a n d t e c h n o l o g i e s – s u c h a s C A D / C A M ,
3D printing, laser and implants.
Dental Asia was able to see familiar faces
like Mr. Milan Rajek, Managing Director of
Bausch Articulating Papers at
the OrDent booth, Philippines
exclusive distributor who prereleased
OccluSense, latest
product for digital occlusion. As
well as Mr. Martin Rolfe, Area
Manager- Asia Pacific of W&H
at the Dental Domain, Philippine
exclusive distributor present at
the busy halls of the event.
From the participants
“We promote Dentsply Sirona
in the Philippines by introducing
four to ve new products every
six to 12 months. Moreover,
Dentsply Sirona advocates
education with lectures, trainings
and workshops throughout
the year as well as in dental
schools to provide education on the latest
products, innovations and technologies
offered by our company. Through our
efforts, we have seen improvement and
development wherein patients now consider
conservative alternatives aside from sole
e x t r a c t i o n c o m p a r e d t o p r e v i o u s y e a r s .
We hope to continue helping and delivering
the best possible dental care to the
Philippines,” said Mr. Victor T. Mallillin,
Country Manager of Dentsply Sirona.
“Overall, compared to previous years,
APDC 2018 was organised and a well
thought event having around 14,000
delegates in attendance. It is good to see
regional players in the dental industry
that are not usually represented here in
the Philippines but they are here because
of APDC. There are a lot of excellent
international speakers and the Philippine
speakers are well represented as well,”
shared Dr. Kim Fajardo of Dental Center by
Dr. Kim Fajardo.
APDC 2018 was denitely a success and
participants are looking forward to what
next year will bring. DA
DENTAL ASIA
MAY / JUNE 2018
71

SHOW PREVIEW
INAUGURAL DENTAL AESTHETICS
MEETING IN ASIA RELEASES
CONFERENCE PROGRAMME
The Dental Aesthetics Meeting in Asia (DAMA)
releases its conference programme with keynote
s p e a k e r s D r . F r a n k M i l n a r , D r . S t e f e n K o u b i a n d
M r . H i l a l K u d a y h e a d l i n i n g t h e e v e n t f r o m
28 th -29 th September 2018 in Singapore.
Organised by the Aesthetic Dentistry Society,
Singapore (ADSS), the rst edition of DAMA 2018
is themed ‘Learning | Collaboration | Inspiration’
and will provide dental professionals with the
latest updates in dental science and practice
to assist dentists in achieving more aesthetic
outcomes for their patients. To encourage dentists
Dr. Frank Milnar
in the Asia Pacic region to update their skills and knowledge in
aesthetic dentistry, this edition of DAMA will also host the biennial
meeting of the Asian Academy of Aesthetic Dentistry (AAAD),
where the next president of the AAAD, Dr. Kim Myung Jin from
South Korea will be inaugurated.
“Today’s patients are increasingly more demanding with the
aesthetic outcomes of their dental treatment. DAMA intends
to assist dental practitioners to meet this demand by inspiring
attendees with the latest developments in aesthetic dentistry,”
explained Dr. Jerey Seow, Chairperson, Dental Aesthetics Meeting
in Asia 2018.
The Main Scientic Conference will cover topics such as:
• ‘Teamwork in the Everyday Practice: Cosmetic/Worn Dentition/
Implant, a Guided & Predictable Approach Between the Dental
C l i n i c i a n & t h e D e n t a l Te c h n i c i a n ’ b y D r . S t e f e n K o u b i a n d
Mr. Hilal Kuday
• ‘The Power of Pink: Techniques for
Pink Composite Restorations with Bioactive
Giomer Composites’ by Dr. Frank Milnar
• ‘Simplified Restorative Procedures
in the Daily Practice’ by Dr. Giulio Pavolucci
And much more. In addition, the
conference will feature an ‘Asian Showcase of
the AAAD’, where speakers from Asia will
highlight the interactions between
the various dental specialties and
Mr. Hilal Kuday
the area of practice of aesthetic dentistry with topics such
as ‘Aesthetic Consideration of Endodontically Treated
Anterior Teeth’, ‘Orthodontics in Dento-Facial Aesthetics’,
‘Incorporating Periodontal Surgery to Optimise the
Treatment Result’ and more.
“With the development of materials,
digital technologies and imaging hardware
and software, it is now easier to incorporate
aesthetic treatment into every dental
professional’s daily workflow. Working
together with ADSS for DAMA, the AAAD
aims to help every dentist achieve higher
standards of aesthetic dentistry with an informed and well-rounded
conference programme,” explained Dr. Ronnie Yap, President,
Asian Academy of Aesthetic Dentistry.
A total of seven Hands-on Workshops on
both Pre- and Post-congress Days have been
planned for dentists, who wish to supplement
the theoretical knowledge being shared at the
main conference. Workshops will be limited
attendance to ensure an optimal ratio of
presenter-to-attendee.
The organisers have also curated an
exhibition of leading dental companies
in aesthetic dentistry to enrich the
learnings at the conference by having
the latest products, services and
solutions on display alongside the
Dr. Stefen Koubi
main conference. Participants to DAMA will be able to attend the
Exhibition Networking Reception on the rst event day together
with exhibitors to help them expand their professional network.
Guests to the reception will have time to meet and discuss the
latest learnings over light refreshments within the exhibition hall.
T h e i n a u g u r a l D e n t a l A e s t h e t i c s M e e t i n g i n A s i a i s a l s o t h e
6 th Biennial Meeting of the ADSS and the 15 th Biennial Meeting of
the AAAD.
O n l i n e R e g i s t r a t i o n f o r t h e D A M A 2 0 1 8 i s n o w o p e n .
Visit www.dama.sg to nd out more. DA
72 DENTAL ASIA
MAY / JUNE 2018

2018 Events Calendar
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
DENTAL ASIA
MAY / JUNE 2018
73

BOOKS for SALE
AFG (Anatomic Functional
Geometry) Modelling
by Alberto Battistelli
Dario Severino
Oto La Manna
314 pages • 865 photos
Aesthetics and Techniques
of New Material
by MDT Paolo Smaniotto
Dr. Alexander Beikircher
216 pages • 1,000 photos
Available in 12 languages:
Italian, English, German,
Portuguese, Spanish, French,
Russian, Bulgarian, Arabic,
Czech, Greek, Korean
Though written as an operational
handbook for those who are just
starting out or want to begin again
without the typical “scientific”
books, this text has sunk its
roots into the hard sciences
(mathematics and geometry)
and the most ancient of artistic
techniques, entrusting a system
of innovative images not just with
the technique but also the magic
and excitement of expressiveness.
This book is crucial for every
dental technician and dentist.
Users of this technique and
geometric parameters will find
plenty of improvements in their
daily reconstructive practice. The
AFG supplements all the known
gnathological techniques.
Available in 3 languages:
Italian, English, German
The authors show the way to a
beautiful, aesthetic smile through
a detailed description of their
working methods. Their excellent
works presented show how to
solve every clinical case in a very
aesthetic way, choosing the most
suitable techniques.
Why are these two dental
professionals able to obtain
such exemplary results? On one
hand, it is due to their 30 years of
experience, while on the other,
it is because they are able to find
a balance between theoretical
concepts and practical applications
that can lead to success.
The Terminal Dentition
by Dr. Leonello Biscaro
404 pages • 1,862 photos
Aesthetic & Function:
Methodologies
for Dental Clinics
and Laboratories
by Claudio Nannini
336 pages • 827 photos
Available in 3 languages:
English, Italian and Spanish
The real reason for the choice of
the topic is make it understood
how dentistry, which seems to
be ever increasingly oriented
towards cosmetics, remains a
deeply medical discipline, making
“ill” patients (a paradoxical
tautology imposed by this
historic time in which we often
see “healthy” patients) the main
players who can reacquire good
health and joie de vivre thanks
to our treatment. This book was
written is merely quantitative
but with significant professional
repercussions. In contrast to
patients with purely cosmetic
needs, those with terminal or
very much compromised dentition
are much more numerous when
one considers the rate at which
the western world is ageing or if
the horizons are widened to the
millions of people in the world
who are coming out of poverty and
want to look after their oral health.
Available in 6 languages:
Italian, English, German,
Russian, Spanish, Portuguese
Chapter 1: The principles of
occlusion
Chapter 2: Face bows • Articulators
• Accesories
Chapter 3: Recording the
relationships between the arches
Methods for avoiding bite-raising
Chapter 4: Aesthetic analysis
Fundamental principles of
prosthetic reconstructions
Chapter 5: Diagnostic aesthetic
and functional wax-ups
with preview in the oral cavity
Chapter 6: Temporary restorations:
Immediate provisionals,
on prepared teeth, on implants,
orthotics
Chapter 7: Techniques for
transferring temporary
restorations into the oral cavity
Chapter 8: Clinical cases
74 DENTAL ASIA
MAY / JUNE 2018

Kindly contact Jamie Tan, jamietan@pabloasia.com
with your personal data for a quotation (including shipping cost).
Zirconia: The Power
of Light
by Aldo Zilio
272 pages • 1,200 photos
Veneers: Mini-Invasive
Reconstructions
by MDT Attilio Sommella
Dr. Guerino Paolantoni
240 pages • 1,336 photos
Available in 4 languages:
Italian, English, German, Spanish
This highly-requested international
speaker and author offers the
reader multiple solutions for
achieving success in working
with Zirconia. Thanks to his vast
experience with zirconia, the
author describes his step-by-step
approach to creating zirconia
solutions for several types of cases.
Available in 5 languages: English,
Italian, German, Spanish,
Portuguese.
Thanks to beautifully depicted
techno-clinical cases, this book
introduces restorations of a
single tooth or more extensive
rehabilitation cases. These
show the placement of one or
more veneers with a high level
of predictability that give the
ambitious dental technician the
ability to provide the aesthetic
and functional needs that patients
request. To achieve success
when working with veneers, the
technoclinical team requires an
extremely accurate execution
that can be obtained through a
standardised system described in
the book. By carefully following the
procedural algorithm outlined, the
dental team will be able to perform
minimally invasive restorations
easily and free from risk.
Available in 8 languages:
Italian, English, German,
Portuguese, Spanish,
Russian, Greek, Korean
Fascinating All-Ceramics
by Oliver Brix
The author describes in detail
how to use lithium disilicate by
presenting clinical cases that he
has worked on in cooperation with
other world-renowned clinicians.
Chapter 1: Introduction
Chapter 2: The correct procedures
for aesthetics restorations –
treatment goals
Chapter 3: e.max: The material
from A to Z
292 pages • 1,233 photos
Chapter 4: The layering technique
with e.max Ceram
Chapter 5: Colour examples,
enamel blends and chroma control
Chapter 6: Preparation instructions
Chapter 7: Veneers
Chapter 8: Crown restorations with
the e.max system from A to Z
Chapter 9: Crowns and veneers
Chapter 10: Zirconium and bridges
made of zirconium
Chapter 11: Implants
Chapter 12: Cross-mounting
Chapter 13: Minimally invasive and
no-prep method
Chapter 14: Dental miracles
Chapter 15: Instruments
Available in 3 languages:
English, Italian, Spanish
Today, the combined prosthesis
offers the edentulous/partially
edentulous patient comfort that
was unthinkable a few decades
ago. But combined prosthesis only
represent an excellent solution
if carried out by dental experts
and dental technicians with
cultural backgrounds and relevant
experience in every branch of
the sector – clinical, anatomical,
occlusion, gnathology, material
Techno-Clinical Aspects
of Fixed Removable
Prosthesis
by Various authors
616 pages • 1,550 photos
science, physics and chemistry.
In this book, 27 experts in
combined prosthesis present
clinical cases resolved using
currently available materials and
techniques. Due to the complexity
of prosthetic manufacturing, strict
cooperation between the dental
practice and dental laboratory is
necessary. Thanks to a team of
experienced dentists and dental
technicians, this book presents
various polyhydric techniques and
solutions rarely presented in one
single book.
**Prices are before tax and shipping cost.
DENTAL ASIA
MAY / JUNE 2018
75

N-Cement Collection
Luting materials from Ivoclar Vivadent
A strong bond provides
confidence and support
Variolink ® N | Multilink ® N | Multilink ® Speed
• Powerful
luting materials
• Tried-and-tested product combinations
• A wide collection for different demands:
ESTHETICS | UNIVERSALITY | SIMPLICITY
www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstr. 2 | 9494 Schaan | Liechtenstein | Tel. +423 235 35 35 | Fax +423 235 33 60
Ivoclar Vivadent Pte. Ltd.
171 Chin Swee Road | #02-01 San Centre | Singapore 169877 | Tel. +65 6535 6775 | Fax +65 6535 4991