MAY / JUNE 2021
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12 Expanding the reach of telehealth in Asia
16 Welcoming a sustainable future
UNDER THE SPOTLIGHT
18 Inform, inspire, educate
22 Preserving health, enhancing smile
26 3Shape advances digital revolution
32 DentalMonitoring: Building the future of
36 Vertical ridge augmentation using guided bone
41 The next generation of CBCT system
46 Individual periodontitis aftercare
49 AutoSWEEPS modality of SkyPulse Endo
53 Maximum curve control
BEHIND THE SCENES
61 Zirconium oxide meets sintering metal
66 Pressing and veneering on a whole new level: A
true model of the future for all-ceramic
IN DEPTH WITH
68 Protecting exposed root surface
69 More digital solutions with the INITIAL Guided
77 Successful CEREC Roundtable with more than
79 AG.Live CON highlights the key trends of
transformation in the dental industry
4 First Words
6 Dental Updates
70 Product Highlights
82 Giving Back to Society
83 Events Calendar
84 Advertiser’s Index
DENTAL ASIA MAY / JUNE 2021
REG & PX designs for
With more than 30 years of experience
in implantology, Anthogyr launched the
Axiom® implant system 10 years ago to
improve access to implantology by
offering innovative and accessible
solutions, a greater comfort for practitionners
and performance in their
Closer look on both sides
of the spectrum
The recent developments on COVID-19, including the sudden surge
of cases coupled with the detection of new virus strain, made it even
harder to predict when this long battle with the pandemic will end.
But for the dental industry, one thing might be certain. There is no
going back to the “normal” we have known before as highlighted by
the line-up of articles we have in this issue.
For instance, with the increased demand for integrated and hygienic
solutions, two of the industry’s innovative companies, 3Shape (p.26) and DentalMonitoring
(p.32), has continued to flourish as the real-added value of digital technology amplified
amid the global lockdown. With enhanced patient experience and streamlined workflows,
it’s no doubt that going digital is the best way forward.
But on another side of the spectrum, despite the advancements in the field, dental caries
remains an issue in many communities, particularly among underprivileged groups in
developed and developing countries.
Shu Ai Ling
So, driven by the need to address this issue – TePe, a Swedish-based dental company
that recently opened a regional support office in Singapore, aspires to raise oral health
awareness among the population and develop solutions to maintain good oral hygiene,
especially for those who have limited access to health facilities (p.18).
In fact, preventive dental care has also been emphasised by Dr Melvin Sia, clinical director
of M Dental Clinic from Malaysia, who believes that the best possible care dentists can give
their patients is doing the least possible treatment (p.22).
As we move forward to battle the same enemy, it is also our responsibility to look out for
each other and see that no one gets left behind.
PABLO PUBLISHING & EXHIBITION PTE LTD
3 Ang Mo Kio Street 62 #01-23
Link@AMK, Singapore 569139
Tel: (65) 62665512
Company Registration No.: 200001473N
Singapore MICA (P) No. 075/05/2019
Malaysia KDN: PPS1528/07/2013 (022978)
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Dr William Cheung
Dr Choo Teck Chuan
Dr Chung Kong Mun
Dr George Freedman
Dr Fay Goldstep
Dr Clarence Tam
Prof Nigel M. King
Dr Anand Narvekar
Dr Kevin Ng
Dr William O’Reilly
Dr Wong Li Beng
Dr Adrian U J Yap
Dr Christopher Ho
Dr How Kim Chuan
Dr Derek Mahony
Prof Alex Mersel
STAYS ON TRACK
Æ Safer use
Æ Preparation following the anatomy
Æ Regeneration for reuse
SARS-CoV-2 positivity in asymptomatic-screened dental patients
Asymptomatic carriage of SARS-CoV-2 is a
potentially significant source of transmission
yet remains relatively poorly understood.
The study, “SARS-CoV-2 Positivity in
Asymptomatic-screened Dental Patients”,
published in the Journal of Dental Research
(JDR), investigated SARS-CoV-2 infection
in asymptomatic dental patients to inform
community surveillance and improve
understanding of risks in the dental setting.
Thirty-one dental care centres across
Scotland, UK, invited asymptomatic screened
patients over the age of five to participate.
During the patient visit, trained dental
teams took a combined oropharyngeal and
nasal swab sample using standardised Viral
Transport Medium containing test kits.
Over a 13-week period, 4,032 patients were
tested, of which 22 (0.5%; 95%CI 0.5%, 0.8%)
were tested positive for SARS-CoV-2. The
positivity rate increased over the period,
commensurate with uptick in community
prevalence identified across all national
testing monitoring data streams.
The COVID-19 positivity rate in this patient
group reflected the underlying prevalence in
the community at the time.
This surveillance programme had several
advantages including deployment of trained
dental teams for the collection of high quality,
complete data and samples. In addition,
there was no need for the clinical teams to
use additional personal protective equipment
(PPE) as they were already wearing it to
provide dental care, and the patients could
receive care despite periods of lockdown
“Enhanced community surveillance is a
key pillar of the public health response
to COVID-19. The results of this study
demonstrate the value in, and feasibility of,
developing and implementing SARS-CoV-2
surveillance testing within dental settings,”
said Nicholas Jakubovics, editor-in-chief
of JDR, Newcastle University, England.
“These data are also a salient reminder of the
importance of appropriate ongoing infection
prevention control and PPE vigilance.” ■
exocad rolls out Dentalcad 3.0 Galway
exocad GmbH, an Align Technology, Inc.
company, has rolled out the DentalCAD 3.0
Galway — with new additional improvements
to reduce design time.
With this new release, initially made
available to distributors in December
2020, the company has introduced the
new Instant Anatomic Morphing, offering
automatic adaptation of teeth in real time,
with improved speed and precision for the
anatomic tooth placement.
“We have systematically analysed in which
steps dental technicians globally spend the
most time on during restorative design,” said
Tillmann Steinbrecher, chief executive officer
of exocad. “Based on the extensive analysis,
we developed technologies such as the new
Instant Anatomic Morphing, which enables
users to reduce design time by as much as
20% to 30%, on average*.”
With the new Galway
release, exocad is also
introducing AI technology
for its Smile Creator. Facial
features are automatically
detected to achieve an
aesthetic proposal faster.
Another new feature offers
printable clip-on mockups
of the planned anatomic result. Instead of
a purely visual representation of the smile
makeover on screen, patients can physically
experience their new smile with try-ins,
resulting in higher patient engagement and
opening up new possibilities in consultation.
Inspired by Google Material Design, DentalCAD
3.0 Galway comes with a new, modern user
interface and improved integration with
exoplan, exocad’s implant planning software.
All features of the new release are built to
improve ease of use in CAD design and to
expand the possibilities of digital dentistry. ■
DentalCAD 3.0 Galway is available immediately
worldwide and can be accessed by all users
with a valid upgrade contract. exocad names
its releases after current “European Capitals of
Culture” and selected the Irish city of Galway
for this release.
*User test performed in February 2020. Data
DENTAL ASIA MAY / JUNE 2021
Ivoclar Vivadent launches one-stop
educational resource centre
Ivoclar Vivadent has launched the Ivoclar Vivadent Academy, a new
one-stop educational resource centre offering trusted, cuttingedge,
and in-person learning, partnered with contemporary virtual
education from dental experts globally.
With first-class education for the dental practice and laboratory, the
Ivoclar Vivadent Academy offers courses and resources specifically
developed for clinicians, hygienists, and technicians across all levels
Through this new learning centre, all dental professionals now
have the ability to shape the learning experiences they need for
professional growth. Available across a multitude of platforms, they
can now advance their education at home, the office, or even on
From articles and publications to on-demand videos and interactive
webinars, the Ivoclar Vivadent Academy global team of experts have
it covered. Even live webinar sessions remain available on demand
for three weeks following the live presentation to provide further
The Academy also offer comprehensive and practice-oriented
continuing education programmes in a personalised environment for
those who prefer in person, hands-on learning across the globe.
In addition, participants can receive a certificate of attendance with
ease upon completion of each eligible programme. This certificate
can be used towards CE credits, as Ivoclar Vivadent is an approved
CE provider through AGD PACE.
“Supporting our customers’ desire to learn by bringing them bestof-class
education through a multi-learning online platform is the
cornerstone of Ivoclar Vivadent innovation,” said Dr George Tysowsky,
DDS, MPH, head of Global Training and Education. “We are excited to
continue to expand our efforts to provide our dentist and laboratory
customers with relevant and useful learning experiences.” ■
DENTAL ASIA MAY / JUNE 2021 7
New study shows rise in video calls makes Singaporeans feel self-conscious
about their teeth and seek treatment
New research commissioned by Invisalign
Singapore – a subsidiary of Align Technology,
makers of the Invisalign clear aligner system –
unveils a rise in the number of Singaporeans
considering cosmetic treatment due to the
increased need to join video calls, and feeling
Among those more likely to consider
cosmetic procedures after COVID-19, seven in
10 report that they are now more interested
in straightening their teeth, while two in five
say that video calls for work have made them
more aware of their smiles.
THE “ZOOM PHENOMENON” AND
ACHIEVING HEALTHY, BEAUTIFUL
Video calls in the work-from-home era have
driven many Singaporeans to become more
self-conscious about how they appear online,
with a fair number visiting their dentist to ask
about teeth straightening options. This trend
has been dubbed by some dentists as the
“I am seeing more patients seeking options
to improve their smile, and crooked uneven
teeth is definitely something that bothers
them greatly. Whether it is
their smile, laughter, bite, or
even the way they speak,
Singaporeans are now seeing
themselves more than ever
before, and in real-time on
screen in video calls,” said Dr
Jerry Lim, dentist and clinical
director of Orchard Scotts
Dental. “Video calls may be
a strong motivating factor,
but misaligned teeth and
malocclusion can also have an
adverse impact on patients’
daily lives and health, even
affecting how they speak or
In fact, a majority of
respondents (77%) admitted
that they think about
improving their smiles — and
it is not just out of vanity.
(79%) was the most often
cited benefit of a healthy
and beautiful smile, above
appearances (63%), and
better career and professional
opportunities (42%). Notably,
millennials (47%) were the
most likely to seek better career opportunities
from improving their smiles, higher than Gen
STRAIGHTENING TEETH IS NOT THAT
As Singaporeans seek to improve their
smiles, medical professionals stress the
importance of understanding differences in
the treatment options available, especially
as more consumers seek to straighten their
teeth with clear aligners. While three in four
Singaporeans believe that it is essential to get
advice from a dentist on teeth straightening
options, not everyone feels the same.
“Even though clear aligners may look the
same, they don’t use the same material or
technology. Invisalign clear aligners are the
only system that have treated more than nine
million patients globally. Teeth straightening
is not self-care that you can do on your own.
It is a medical procedure, therefore ongoing
supervision by a dentist is essential,” said Dr
Hwang Yee Cheau, orthodontist at TP Dental
Surgeons and adjunct associate professor at
NUS Faculty of Dentistry.
Dr Hwang added that if the condition is not
well treated, there are many possible adverse
side effects on the teeth, gum, and bone.
To help patients ascertain which teeth
straightening procedure is fully supervised by
dental experts, Invisalign shared a checklist
for five must-ask questions before choosing a
clear aligner treatment (Fig. 1).
“We believe that teeth straightening is not
just a procedure that transforms patient’s
smile. It also has the potential of changing
their life by improving self-confidence,” said
Dr Lionel Hui Bon Hoa, senior director, clinical,
Asia Pacific at Align Technology. ■
DENTAL ASIA MAY / JUNE 2021
Carestream Dental partners with
Practices can now conveniently design and print clear aligners inoffice
when they combine CS Model+ v5 software and Rapid Shape’s
D30+ ortho, the latest printer to be validated by Carestream Dental.
→ THE EVOLUTION
“We continue to see rising demand for in-house clear aligners so
this partnership with Rapid Shape will help us expand the digital
ecosystem for our mutual customers,” said Ed Shellard, DMD, chief
dental officer of Carestream Dental.
→ AIR-POLISHING AND
ULTRASOUND IN ONE UNIT
A recent report* found that standalone practices gained the most
share in 2019 in providing clear aligners to patients. This is due in part
to technological advancements, like in-house 3D printers and intraoral
scanners, that make it easier and more affordable for practices to offer
Users of the CS 3600 or CS 3700 intraoral scanner can offer their
patients that same convivence. Once a scan is captured, CS Model+ v5
uses artificial intelligence (AI) to automate much of the design process.
Because the software provides a degree of difficulty index, users
have more confidence of success when starting cases and creating
intermediary treatment steps.
→ easy switch from supra to subgingival
air-polishing by a simple click
→ subgingival perio air-polishing tip – flexible, soft
and anatomically adjustable to the periodontal pocket
→ more than 40 inserts for scaling, perio, endo and prosthetics
→ SOFT MODE: the ultra-gentle scaling
for sensitive patients
After the case is designed, it can be sent to the D30+ ortho. The D30+
ortho is a high quality DLP printer with patented Force Feedback
technology, featuring long lifetime and consistent quality over time at
an attractive price level.
Tailormade for ortho indications, this system features an extra-large
build area and produces validated ortho models and individual trays.
Furthermore, the temperature-controlled resin reservoir provides
process stability. The fast, accurate and reliable ortho printer can print
up to six models in 20 minutes. ■
*Clear View Research. (2020). Global $6 Billion Clear Aligners Market
to 2027 - Growing Demand for Customized Aligners (Report No.
5144625). Research and Markets https://www.researchandmarkets.
DENTAL ASIA MAY / JUNE 2021 9
ad_ct_dental_asia_95x250_en_201210.indd 1 10.12.20 14
Digital Smile Design forges new alliance with Zimmer Biomet Dental
Digital Smile Design (DSD), a company
providing education, consulting and lab
services as well as digital technologies, has
forged a new alliance with Zimmer Biomet
“It is a great honour for us to start this
collaboration with Zimmer. This partnership
aims to improve the integration of smile
design, dental implants and comprehensive
dentistry,” said Christian Coachman, founder
and chief executive officer of DSD, as he
delivered the keynote address of the Zimmer
Biomet 11 th Annual Global Implantology Week
at NYU College of Dentistry, United States.
A leader in the field of dental implants,
Zimmer Biomet Dental facilitates the work of
clinicians and technicians through its suite of
innovative dental implant and rehabilitation
This new collaboration signifies DSD’s
commitment to joining forces with key
organisations who share the same values,
vision for the future of dentistry, and
dedication to advancing the profession.
“Investing in meaningful relationships with
established industry partners is the catalyst
that will allow us to grow together, and help
us to support great clinicians and business
owners to reach even greater heights and
ultimately provide the best level of care for
patients,” added Coachman. ■
Meet 3Shape Automate, the world’s first AI powered design service for labs
3Shape has introduced 3Shape Automate
– the world’s first dental design service
platform exclusively powered by artificial
intelligence (AI) technology. Available from
their website, the easy to use, self-service
3Shape Automate design service is geared to
dental technicians needing to cope with rush
periods and an overflow of orders.
On the Automate website, dental technicians
can simply set up an unlimited number
of orders, add their customised design
instructions, upload the scans, and choose
their desired turnaround time. Automate
AI technology then creates and returns all
design proposals at the selected delivery
time, regardless of the number of designs
3Shape Automate is consistent, fast, and
scalable. It helps to reduce overtime and
stress for lab technicians by delivering
unlimited and predictable dental designs
quickly and inexpensively, 24/7 from the
“AI technology is revolutionising the world.
At 3Shape, we began applying AI two years
ago to make intraoral scanning with TRIOS
effortless. We then used it with our dental
software to make workflows much more
efficient. Now with the launch of 3Shape
Automate, dentistry takes a huge leap
forward,” said Jakob Just-Bomholt, chief
executive officer of 3Shape.
Game changer, he added that Automate is
about making life easier for lab technicians,
and in keeping with their open philosophy, the
service is open to both 3Shape dental system
and exocad users.
3Shape Automate pricing is based on design
turnaround time. Lab professionals can
upload files from 3Shape Dental System,
exocad software, and directly from select
Regardless of the number of cases uploaded,
the AI powered designs are created and
returned at the appointed time. Users can
review every design and only pay for designs
they approve and download. 3Shape LabCare
customers receive a 10% discount on
Automate design costs.
“3Shape Automate has already produced
more than 65,000 successful designs for
United States (US) labs with the service
boasting a more than 92% design acceptance
rate,” said Rob Laizure, chief executive officer
The AI powered design service was rigorously
tested for months under the name Express
Crown by the 3Shape owned design service,
The self-service 3Shape Automate platform
is available 24/7 in the US and several
European countries as listed from the 3Shape
website. Users can try Automate for free with
a US$50 (€40) credit to start. The service
is currently available for monolithic, single
posterior crowns - premolars and molars.
Automate design technology is FDA listed
and CE marked. FullContour provides support
and sales for 3Shape Automate.
DENTAL ASIA MAY / JUNE 2021
Nobel Biocare and KaVo Imaging release DTX Studio Clinic 1.8
Nobel Biocare and KaVo Imaging have
released their latest software development
for imaging, diagnostics, treatment planning,
delivery, and follow-up.
With this partnership between Nobel Biocare,
the world leader in the field of innovative
implant-based dental restorations, and
Kavo, a premier dental solutions provider,
DTX Studio Clinic is developed to redefine
connectivity and offer continuity of care for all
patients in the dental office, during all visits,
and for the entire dental treatment team.
Available in North America and selected
European markets first, DTX Studio Clinic
1.8 is designed to speed up and manage
daily imaging procedures in one software,
through fast intraoral X-ray diagnostic
workflows. Both healthcare professionals and
distributing partners benefit from a simplified
and comprehensive software landscape.
DTX Studio Clinic, a part of the DTX Studio
suite, is an open, interactive, and dynamic
imaging software platform with impressive
navigation across imaging modalities: 2D and
3D, X-ray, and optical patient image data from
Clinicians will benefit from how the software
intuitively allows for seamless image
acquisition, diagnostics, organisation,
cooperation, and treatment workflows in a
single environment – for every patient visit.
“Nobel Biocare and KaVo Imaging, both
innovators and pioneers in computerassisted
surgeries and dental imaging,
have joined forces to create the DTX Studio
ecosystem. DTX Studio Clinic establishes
a new benchmark in dental imaging,” said
Dr Pascal Kunz, vice president for Digital
Solutions, Nobel Biocare.
He continued, “It offers continuity in
diagnostics, treatments, and treatment
workflows by following a truly open approach.
It invites industry partners to collaborate
and master all imaging modalities in one
place, for all dental specialties. Our goal is to
simplify the interaction with imaging, digital
technology, and make relevant information
easily accessible for more efficient and
predictable treatments.” ■
39 TH INTERNATIONAL DENTAL SHOW
4 DAYS IN COLOGNE
22. – 25.09.2021
IN UNCERTAIN TIMES
50679 Köln · Germany
Tel. +49 180 677 3577
DENTAL ASIA MAY / JUNE 2021 11
IDS_2021_Anzeige_Dental_Asia_190x125mm_Int_GB.indd 1 22.04.21 10:51
the reach of
By Roland Berger
With the COVID-19 pandemic
accelerating the healthcare
industry’s digital transformation,
opportunities have emerged
for stakeholders to bring a
fundamental shift in healthcare
Telemedicine was originally
intended as a method to treat
patients in remote locations.
While it is still used today to address this
problem, it has now evolved as a tool for
convenience. Patients turn to telehealth
for immediate treatment so as to avoid
the hassle of travelling down to clinics
and spending time in the waiting room.
Commercial payors support telehealth
because of its lower-cost potential
due to decreased drug markups and
incurred expenses, which is especially
true for patients in rural areas where
virtual appointments can replace
physical consultation. Providers also
appreciate the higher efficiency resulting
from quicker diagnosis and treatments.
The COVID-19 pandemic sped up the
adoption of telehealth as physical
consultations were restricted to
reduce the risk and spread of infection.
Roland Berger’s latest study explores
the challenges and opportunities of
the present telehealth systems, using
orthopaedics as a focal example.
DENTAL ASIA MAY / JUNE 2021
C: Telemedicine business model archetypes
Addressing and resolving the risks such
as the potential loss of data or incorrect
data input may help to change their
EVOLVING SYSTEMS AND ROLES
TO WORK HAND IN HAND
To advance telemedicine from a service
to an ecosystem enabler, the roles of
the healthcare stakeholders and system
would need to evolve and keep up with
D: Service coverage along patient journey by business model [non-exhaustive]
Fig. 1: Source: Telemedicine Roland Berger business model archetypes
along patient journey by business model (non-exhaustive)
CHALLENGES AND LIMITATIONS
OF TODAY’S TELEHEALTH
The study raised three challenges and
limitations of today’s telehealth systems.
Operating solely on an episode-based
model amplifies that telehealth is not a
The current telehealth models are built
for acute episodic care and may not
be effective on patients that require
constant reviews and chronic care, such
as ageing societies.
> Healthy lifestyle advice
Teleconsultations are also not able to
deliver the best results without physical
examinations and updated images.
Prevention Diagnosis Treatment
In almost 20% of the orthopaedic cases,
physicians expressed a need for physical
Complexity to achieve
> Health information platform
> Doctor & hospital rating
> GP teleconsultation (ediagnosis,
> Specialist teleconsultation
> Online booking
> Telehealth kiosks, etc.
> Provider education
disease detection, referral)
> Online drug delivery
> Specialist teleconsultation
> Online drug delivery
> Provider education
All of the standalone services integrated in one app; coverage is limited to own providers network to achieve cost reduction
> Remote patient monitoring
> Self-tracking app
Data from all standalone services collected in one app to be analyzed and push health advice (prevention and wellness) to patients
examination follow-ups to assess several
motor tests more accurately. A lack of
centralised access to imaging repositories
also delayed accessibility to patients’
More efforts need to be invested in
infrastructure development for telehealth
systems in the Asia Pacific.
Various markets are underserved and
suffering from a shortage of diagnostic
facilities such as the DEXA scan
machines, which detect bone disorders.
It is also crucial to obtain the buy-in
of telemedicine from sceptical key
decision-makers and renowned doctors,
as they can influence patients to adopt
Six telemedicine business model
platforms were identified in South East
Asia (SEA), namely: Health Information,
Primary Care Access, Primary Care+
Connector, Health Ecosystem
Orchestrator and Asset-light Healthcare
Provider (Figs. 1-2).
Popular model archetypes implemented
in Asia Pacific include the Primary Care+
Access, a platform that provides an
amplified care model.
In addition to GP (general practitioner)
services, they provide referrals or
assistance with patient’s access to
tertiary care including diagnostic centres,
specialty care providers, hospitals,
rehabilitation centres and pharmacies.
The platform in most cases, however,
does not have full integration with the
rest of the healthcare stakeholders.
An integrated option is the Health
Ecosystem Orchestrator, a telemedicine
model which coordinates more complex
interactions and transactions between
patients, providers, payors and other
healthcare stakeholders (Fig. 3).
The orchestrator usually enables care by
going beyond the traditional channels
and partnering with adjacent players
who have stakes in a healthier population
such as banks, telecoms and retail.
DENTAL ASIA MAY / JUNE 2021 13
E: Role of Telemedicine in Integrated Healthcare (Orthopedic case)
Due to its integrated and seamless interface,
the Orchestrator model stood out as the
recommended way forward for SEA.
This model also ensures affordable healthcare
for the community by keeping patients within
the network and removing redundancies.
Through the Orchestrator model,
telemedicine can integrate several facilities
in one platform such as payors, diagnostic
centres, hospitals, home-care service
providers and pharmacies (Fig. 4).
Services such as insurance claims, followup
consultations or drug deliveries are all
easily accessible and can be arranged via one
The challenges of standalone models can be
mitigated. Developing payor-led incentives
and wellness programmes would also
become easier due to lower constraints
of brand positioning and operating model
“Through simulations and observations using
the Orchestrator model, the average waiting
time can be reduced by 50-70% while doctor
capacity increased by 20-25%,” said Mr
Yoshihiro Suwa, partner and co-author of the
For the ideal telemedicine platform to run
smoothly, this would also require stakeholders
to transit towards supporting the digital
transformation of the healthcare system:
1. Policy makers and regulators should
develop supporting policies to enable
telemedicine and define standards and
protocols to help reduce inefficiencies at
a broader scale for equitable healthcare.
2. Healthcare providers should seize the
opportunity with instituting synchronous
models and invest in infrastructure for a
seamless online to offline integration.
3. Payors with incentive-linked
programmes can significantly influence
patient’s behaviour on choosing
preventative care and wellness.
Health insurers can digitally steer their
customers toward a network of preferred
specialist / surgeon
Fig. 3: Health Ecosystem Orchestrator as a one-stop solution provider
Source: Roland Berger
4. Tech start-ups and medical tech
firms’ collaborations enable telemedicine
to provide more value-added services to
patients with less capital and technology
investment. This can help drive access
and care in unwanted markets.
5. Pharmaceutical companies can drive
patient and healthcare professional
engagement at scale and adopt
strategies to go beyond the pill, such as
utilising data on medical research and
development for new treatments.
As the hype cycle of telemedicine in Asia
Pacific begins to taper, business models in
the space would have to evolve towards value
addition beyond remote care consultation.
“Given the fragmented nature of healthcare
delivery in some of the emerging markets of
Asia Pacific, telemedicine models of the future
could aim to bring the various parts of the
value chain under one virtual roof,” stated Mr
Aditya Agarwal, principal and co-author of the
Telemedicine as one-stop solution
of orthopedic care for patients
> Online booking
> Cashless service
> Remote consultation (initial and follow-up)
> Home-care PT (post-operative PT)
> Drug delivery (initial and follow-up)
F: Health Ecosystem Orchestrator as a one-stop solution provider
Prevention Diagnosis Treatment
Follow - up
Source: Roland Berger
Fig. 4: Role of telemedicine in Integrated Healthcare (Orthopaedic case)
Medical cost containment
> Preventative bone and joint health screening
> Early detection on bone diseases (e.g. osteoporosis)
– Referral and
> Health management
centred on O2O
> Medical services:
> Doctor system:
Four layer structure:
> AI based
> Global KOLs
Should they succeed, they shall bring
tremendous efficiencies for healthcare systems
already reeling under budgetary pressures. DA
About Roland Berger
Roland Berger, founded in 1967, is the only
leading global consultancy of German
heritage and European origin. With 2,400
employees working from 34 countries,
they have successful operations in all
major international markets. Their 50
offices are located in key global business
hubs. The consultancy is an independent
partnership owned exclusively by 250
DENTAL ASIA MAY / JUNE 2021
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Working towards a
sustainable future, W&H
Dentalwerk utilises the latest
and renewable energy
sources for its upgrades at
the Bürmoos site in Austria.
Phillip Wersinger and Daniela Reidl maintain an overview of the energy figures of the new PV system at all times
DENTAL ASIA MAY / JUNE 2021
W&H is boosting its ecological profile with the new photovoltaics system at the Bürmoos site in Austria
W&H generates green electricity to meet its
energy needs at the Bürmoos site in Austria.
This is all thanks to the new photovoltaics
(PV) system, which consists of around 1,800
modules and produces an output of 536kWp.
“During the past year, we generated enough
energy to power 190 households with an
average of four people for a year,” explained
Phillip Wersinger, PV project manager, W&H.
Environmental protection is a key part of
many sustainability initiatives and there are
measures taken by the company.
“We are implementing a variety of measures in
the business to help protect the environment
and conserve resources. This is also the case
when making upgrades to the site,” shared
Daniela Reidl, project manager responsible for
the site expansion.
Another measure is waste management,
which works with the cooperation of the
employees. Preventing and separating waste
is part of the everyday practice throughout
W&H is taking important steps towards
sustainable working with measures in the
areas of energy and resource efficiency, as
well as climate protection.
W&H uses solar power to cover 10% of
the electricity needs in plant 2. The new
system has given a boost to the company’s
ecological profile and also contributes to the
long-term climate and energy strategy of the
federal state of Salzburg, Austria.
For instance, compressed air and ventilation
systems in the W&H production department
use heat recovery, and materials like metals
are utilised in a way that saves resources,
separated into types, reprocessed and
The new photovoltaic system is another
component of this. And many small steps
can bring about big changes – with positive
impacts for the community as a whole, the
federal state and competitiveness at the
company premises. DA
DENTAL ASIA MAY / JUNE 2021 17
Under the Spotlight
Inform, inspire, educate
TePe, a family-based dental company from
Malmö, Sweden, is driven by their passion in
developing solutions for long-term wellbeing
and better quality of life. With the recent
opening of its regional support office in
Singapore, they aspire to bring more healthy
smiles in Asia.
With eight subsidiaries and distribution in 80
countries across the globe, TePe, a global
company founded in Sweden in 1965, offers
a variety of high-quality oral healthcare
products developed in close collaboration
with dental professionals.
Recently, the company is reinforcing their
presence in Asia by setting up an office in
Stationed locally is the engaging duo,
Dr Sanjay Haryana and Mr Douglas Musiolik,
carrying the company’s vision of bringing
more healthy smiles for life.
Together, they aim to raise awareness on
the importance of preventive dental care,
interdental cleaning, and the connection
between oral and general health in the region.
BUILDING ON THE FUNDAMENTALS
Dr Sanjay Haryana is part of TePe’s
odontology and education specialists team.
He holds a Master of Science in Aesthetic and
Restorative Dentistry as well as in Business
Quick-witted, Dr Haryana shared an anecdote
on why he became a dentist.
“My older cousin is a dentist and used to have
several dental practices in Dallas, United
States. I was a confused teenager, and he
said that if I studied dentistry, I could work for
him, and he would give me a Porsche 911 as a
joining gift. I applied, was accepted, and then
never went there. I still don’t have a car and
even less a Porsche 911,” he shared in jest.
Dr Haryana was a full-time dentist and clinical
director at a private independent group
practice in London, UK, before making the
decision to move back to Sweden after 13
years. It was then that the opportunity to join
TePe in its Nordic subsidiary, presented itself.
While frustrating initially as “the corporate
DENTAL ASIA MAY / JUNE 2021
Under the Spotlight
world has slower processes,” he
understands the need for them and sees
it as a challenge to push things through
quicker. In addition, he also found
himself needing to brush up his skills in
using office applications.
Dr Sanjay Haryana (left), Odontology and
Education specialist; and Mr Douglas Musiolik
(right), area sales manager of TePe Asia
But there are many bright spots in his
career hop and one of the highlights is
when he conducted a lecture for the
final year students at the Copenhagen
University in Denmark.
He expounded, “The lecture was about
selling compliance in dentistry. The fact
that we work with different personalities
and the stress within the field were
something all the students felt but
no one had talked to them about it. It
really felt like I bridged the gap between
education and real life. The following
year, the University incorporated this
into their curriculum, which was very
Still, the move to Singapore as well as
the new role feels completely different to
Dr Haryana, which invigorates him.
“The Nordic office was a mature
organisation on a mature market, while
the Asian market is relatively new. I
work with a much younger team – that
sometimes makes me feel old – and it
can be hard to keep up with them,” he
In terms of curating materials for oral
health awareness in the region, he
shared that it is about going back to the
basics and tackling the importance of
oral hygiene, especially for interdental
“We are mainly using materials from
TePe Share while ensuring that we
respect the language barrier as we roll
them out in local languages,” he said.
Elaborating on TePe share, Dr Haryana
calls it a living organism within TePe.
It is a knowledge-sharing platform
featuring a variety of information and
educational materials to help dental
professionals keep up with the latest
news and relevant issues in preventive
For instance, practitioners can find the
Odont News, a quarterly newsletter that
summarises a few oral hygiene-related
In addition, they also hold clinical
symposiums where they gather key
opinion leaders to share their expertise.
“I know as a professional that it is hard
to keep up with science and this is a
great way to stay updated,” he said.
To widen their network, TePe share
also includes TePe Family, which
targets dental professionals through
ambassadors’ programme; and TePe
Clinic which features a three-module
programme aimed at students to look
for a local talent who can lecture in their
With this platform, the company
reinforces the importance of good oral
hygiene to dental professionals who can
then leverage on the information to better
communicate it to their patients.
SCALING AND NETWORKING
Working alongside Dr Haryana is Mr
Douglas Musiolik. As the area sales
manager of the region, he is excited
about the opportunity to strengthen
relationships with their valuable
distributors and to work closely with other
stakeholders to support TePe’s vision.
Travelling and learning about new cultures
have always been his passion and these
factors have paved the way for his career
in international business.
DENTAL ASIA MAY / JUNE 2021 19
Under the Spotlight
He shared, “I believe it started at a young
age when my parents were determined
that myself and my brother needed to
explore other cultures and parts of the
world. So, we did a lot of travelling when
I was young. This developed further into
my late teens, and I ended up going on
several longer backpacking trips to both
South East Asia and Central America.”
“Combining my urge to travel with my
interest in meeting new people and
build relationships resulted in a career
path in international business, which is
something I enjoy doing and suits me
perfectly,” he added.
However, it was never Mr Musiolik’s
intention to work in the dental industry
and joining TePe has revealed a whole
new world to him.
He was fascinated by how oral health can
affect general health and realised that
the dental industry has potential in many
“To work in this industry and for a familyowned
company that sells high-quality
Swedish dental products to encourage
oral and general health is something I
really can stand behind, and that is a
great feeling,” he shared.
Over the years, his roles and
responsibilities changed from working
on various internal sales and marketing
activities to working with business
development and distributor markets in
But for the past three years, his focus has
been on the Asian market.
According to him, South East Asia and
Asia, in general, is a high potential region
that combines developed and developing
countries in terms of economy and level
of dental awareness.
Hence, TePe considered it as a tactical
decision to establish a regional support
office in Singapore.
“Singapore is a known business hub and
a gateway not only to South East Asia but
to the whole of Asia, and we felt that it
ticked all the boxes in terms of location,
infrastructure, workforce, and business
environment,” Mr Musiolik revealed.
The new regional support office in
Singapore will be an additional enabler to
accelerate the great growth potential in
the region by being closer to the markets.
“We have strong partnerships with
distributors in the region and we want
to support them and other stakeholders
even closer than what we have been
able to do from our head office in Malmö
(Sweden). My colleague, Mr Jason Hsu,
also area sales manager and part of the
Export department, is also responsible
for our development in the Asian region
while working from the head office.
Having the Export department and other
key competences supporting us from
the head office will be important going
forward so we can allocate resources and
plan activities accordingly,” he added.
Through various marketing and
odontological activities, TePe aims to
educate their target groups about their
products and solutions which promote
long-term oral health and thus improve
quality of life.
In fact, the COVID-19 pandemic has given
Mr Musiolik some lessons to take away
for TePe, “From a business perspective
I think being flexible and able to adjust
quickly, as well as being open-minded are
some of the key learnings.”
“The business environment is always
DENTAL ASIA MAY / JUNE 2021
Under the Spotlight
changing, and your strategic plan will
always deviate due to various external
factors that you cannot control and
foresee. Going forward, I believe it is
important to embrace this change
and adjust accordingly to reach your
objectives,” he shared.
With this, he reiterated the importance of
having a strong digital brand in today’s
“We are a professional brand and we
understand that the more channels we
are available in, the stronger and more
important the digital brand becomes,
which helps to get our message across,”
He added that regardless of where their
consumers buy their product – whether
it be in a dental clinic, pharmacy, retail or
online – they should have the same good
experience and quality of communication.
MAKING AN IMPACT
All of TePe’s production is carried
out in Malmö, Sweden. The global
company is constantly improving their
processes through feedback from team
members, professionals, distributors and
This ensures that TePe’s oral healthcare
products remain fuctional and high
quality while providing maximum benefits
to the user.
But in order to bridge the different sociodemographics
across the countries in
Asia, TePe believes the first step is to
build their foundation through education.
According to Dr Haryana, TePe is aware
that some may not be able to afford their
products but the company still believes
in educating - from their distributors, the
professionals to the patients.
“Everyone has the right to know the
benefits of good oral hygiene,” he said.
“Our aim is to create knowledge for
everyone – knowledge is power to
improve yourself, especially in regards
to oral hygiene. We will do everything in
our power to motivate home care and the
benefits of it.”
In fact, Dr Haryana hopes that they
are able to reach out to consumers
and professionals digitally too, without
drowning in the noise.
As the world moves towards a circular
economy, TePe’s response is to lead by
The global company sees it as their
responsibility to contribute towards a
sustainable future through all aspects
of their business as well as integrate
it across their employees’ work. This
includes reducing their CO2 emissions,
increasing energy efficiency and
For instance, TePe is currently looking into
using different bio-based materials while
expanding their range of products.
“Sustainability is probably our best
example now in terms of innovation
like how we are in the transition from
fossil-based to bio-based materials. It is
amazing that we can use sugar cane and
pine oil to produce the same high-quality
products,” explained Dr Haryana.
With incremental progressions, he
believes that in five to 10 years down
the road, TePe will be a completely CO2
neutral organisation and a leader in oral
hygiene, education, and sustainability.
He also envisions the company with
partnerships around the globe.
“This is what is sustainable – using all our
resources responsibly,” he continued.
To conclude, Mr Musiolik, added, “We’re
striving towards a circular economy but
acknowledge that one single company
can’t drive the transition, we need to work
together. Our journey towards becoming
more sustainable continues and we are
confident that we can inspire others along
the way.” DA
DENTAL ASIA MAY / JUNE 2021 21
Under the Spotlight
Adopting the modern concept of
minimally invasive cosmetic dentistry in
his daily practice, Dr Melvin Sia, dentist
and clinical director of M Dental Clinic, is
on a mission to deliver dental treatment
that can restore a patient’s smile and
function without compromising on
healthy tooth structure.
DENTAL ASIA MAY / JUNE 2021
Under the Spotlight
In an article written by Dr Sushil Koirala,
founder of MiCD global network, MiCD was
defined as “a holistic approach that explores
the smile defects and aesthetic desires
of a patient at an early stage and treats
them using the least intervention options
in diagnosis and treatment technology by
considering the psychology, health, function
and aesthetics of the patient.”
With this modality, Dr Sia divides his
treatment protocol into three phases:
Phase I – understand: to recognise the
problem by performing a detailed dental
examination and come out with a wellthought
With increasing demands for dental
cosmetic procedures, modern-day
dentistry stressed the need for
treatment modality that will not compromise
the patient’s long-term oral health while
fulfilling their wishes to have great smiles.
So, for practitioners like Dr Melvin Sia, a
general dentist specialising in aesthetic and
restorative dentistry, embracing the concept
of minimally invasive treatments became his
From a kid who was afraid of dentists, he now
manages his own dental practice in Petaling
Jaya, Malaysia, aiming to deliver healthy and
Dr Sia has always wanted a profession that
can change someone’s life. His initial thought
was to become a medical doctor but chose
the dental career to enjoy the work-life
With his inclination for aesthetic and
restorative dentistry, he continuously
improves himself by attending numerous
continuing education courses, allocating
time to practice his carvings on typodont and
reviewing his work constantly.
He strives for excellence and is motivated to
find ways to improve himself further to provide
high-quality treatments to his patients.
Dr Sia is fascinated with the intricacy of tooth
morphology and the uniqueness of each tooth.
While challenging to do so, being able to
successfully recreate it gives him a great sense
But to achieve success, Dr Sia highlights the
need on having good communication skills too.
“Communicating well to your patient will allow
them to have a better understanding of their
dental issues and how your proposed treatment
plan can benefit them,” he explained.
In order to fully address patient’s complaints
and expectations, it pays to be a good listener.
Sensing the joy of his patients after treatment,
and seeing how their brand-new smile boosts
their confidence is what he considers the best
part of his job.
LESS IS MORE
Dr Sia practices Minimally Invasive Cosmetic
Dentistry (MiCD) to advocate a patient-centric
“Do no harm” restorative approach.
Phase II – achieve: to execute the planned
treatment, either rejuvenate, restore, or
Phase III – keep in touch: to follow up on
patients and appoint them for review; reevaluate
and repair as needed
On top of this, he also employs four levels of
intervention: non-invasive, micro invasive,
minimally invasive and invasive.
“I always begin with a non-invasive approach,
which is education. It’s part of our job to
educate our patients on proper oral health
care and maintenance,” he explained.
Micro invasive procedure in his aesthetic
work includes whitening and resin infiltration
DENTAL ASIA MAY / JUNE 2021 23
Under the Spotlight
while minimally invasive treatment covers
restorative work with composite and less- or
In addition to his hard-earned skills, this novel
approach to treatment ensures the quality
of Dr Sia’s work by complementing it with
reliable materials and technology.
He shared, “I can’t work without my loupes
and microscope. The latter allows me to see
better not only during root canal treatment,
but also during my direct and indirect
restorative work. It allows my preparations to
be more precise so I can preserve more tooth
His current favourite instrument set is the
LM Arte composite instrument kit, which he
considers crucial in doing his restorations.
Other essentials include stick resins from
GC and rubber dam by Sanctuary. He also
uses Shofu Beautifil II LS, Tokuyama Palfique
Asteria, and Micerium Ena Hri.
Also, his clinic is equipped with a cone-beam
computed tomography (CBCT) system to
allow him to make more accurate diagnosis.
Digitalising his practice in the near future
is already in the plan as he believes that
intraoral scanner and in-house milling
machines can benefit his patients further.
TEAMWORK MAKES THE
Dr Sia’s willingness to explore novel techniques
and the latest technology pushed him to start
his entrepreneurial journey and opened
M Dental Clinic back in 2016.
“Having my own practice, I can do what I
love freely without any restrictions as well as
hesitations,” he shared.
However, this freedom comes with a price.
With his new role, Dr Sia initially struggled to
supervise the clinic’s operation as he had to
juggle it while being the clinician rendering
treatment as well.
Besides providing the best service to his
patients, he also thinks about the clinic’s
performance, turnovers, and overhead
“It’s not an easy task to be both the clinician
as well as the owner of a dental practice,” he
But he stays focus and pushes forward.
“I feel so blessed to be surrounded by
supportive family, capable associates, and
reliable staff members, especially when I first
started out. It’s the teamwork that made the
dream work,” he shared.
This was also reflected in how his team
handled the pandemic situation effectively.
“During the peak of the pandemic, we are very
much prepared. My clinic manager ensured
the smooth operation of the clinic while
my head assistant supervised the infection
control protocols, overall reassuring our
patients that they are well taken care of,” he
Now that M Dental Clinic has gained ground
with patients from different walks of life, Dr
Sia is working on his digital brand.
“I try to be consistent in posting my cases
daily. Nowadays, as I get busier, I delegate the
task to my clinic manager,” he added.
With the shift to digital trend, Dr Sia advised
capitalising on the opportunities that come
along with it. In fact, a lot of his patients
found his practice through Google, Facebook
He also shared that having dental photography
skills can provide real added value to the
“Not only it is for having good photos to share
online, but it can also act as a tool to review
our progress consistently,” he stated.
Five to 10 years down the road, Dr Sia
is considering to further his studies
through distance learning programmes
and to transform M Dental Clinic into a
multidisciplinary dental centre.
But for now, he is focused on three goals: to
produce the best quality work for his patients
using the latest technologies, tools and
materials; to deliver dental treatment that
can restore a patient’s smile and function
while preserving as much tooth structure as
possible; and with his passion for teaching, to
share his learnings with the next generation
To send a gentle reminder to his fellow
practitioners, he concluded, “I strongly believe
that the best possible care dentists can give
their patients is doing the least possible
treatment. We must always put patient’s oral
health as the priority and actively involve
them in treatment decisions.” DA
Photo credits to Dr Harry Kam
DENTAL ASIA MAY / JUNE 2021
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The innovative company is at the
forefront of revolutionising dentistry.
With their award-winning scanning and
CAD/CAM solutions, 3Shape is raising
the bar in providing superior patient
care in this digital era.
DENTAL ASIA MAY / JUNE 2021
Since its founding two decades ago, 3Shape, an innovative developer and manufacturer of 3D scanners and
CAD/CAM software solutions, has undisputedly transformed the way clinicians operate.
Over the years, the company has grown exponentially, with Asia Pacific as one of its critical growth areas.
Dedicated to making healthcare more accessible to the population, Dr Georgia Hinton is leading
the region in empowering dental professionals in future-proofing their practice and shares how
3Shape plays a vital role in accelerating the digital transformation.
RECOGNISING AND OVERCOMING BARRIERS
Despite the promising outlook of digital dentistry, there are still numbers of practitioners
who are hesitant in adopting the technology, particularly in South East Asia (SEA).
Dr Hinton mentioned that the challenges faced by clinicians in SEA are not unique,
but there is a perception that digital is difficult and expensive. Additionally, clinicians
across the region are at different stages of their digital journey — having varied needs
“For many, going digital can seem like a big step, especially in the current pandemic
situation where many businesses remain closed,” she noted.
To address this, 3Shape aims to educate clinicians on the advantages and value that
digital dentistry can bring to them, their business and patients.
The company is diligent in connecting and partnering with practitioners as they
embark on their digital journey.
“As a dental professional, you want to be confident with the brand you
choose as it can be a significant investment. You want a technology with
a proven track record, one that can support you and help you grow as
your digital workflow experience grows. And, this is what 3Shape is all
about,” she explained.
Besides their two decades of history, 3Shape solutions have won
numerous awards, including TRIOS being given the Cellerant Best of
Class Technology Award for intraoral scanners, an unprecedented eight
years in a row.
Globally, many dental technicians choose 3Shape lab software, and
leading clinicians in their respective fields use their Studio Apps.
“Practitioners can be confident that when they choose a 3Shape
solution, it is one of the very best,” she noted.
Additionally, the company supports their clients with
numerous educational opportunities through online and
“Our digital events have thousands of participants,
and the 3Shape Academy is constantly creating
new courses, tutorials, and sessions to help
Dr Georgia Hinton, general
manager of 3Shape Asia Pacific
DENTAL ASIA MAY / JUNE 2021 27
professionals optimise their digital
workflows,” she added.
In fact, with 3Shape’s open platform and
integrations, planning and production
options are endless.
With their innovative mindset, 3Shape
has introduced several ground-breaking
For instance, 3Shape’s most advanced
scanner to date, TRIOS 4, remains the
industry’s first and only wireless intraoral
scanner with caries diagnostic aid
technology for surface caries.
Dr Hinton, explained, “TRIOS 4 caries
diagnostic technology is a gamechanger.
We have built-in fluorescent
scanning technology that aids in the
identification of possible caries. With
TRIOS 4, an intraoral scanner is really,
much more than just a digital impression
In addition, the scanner’s tips are also
scan-ready in seconds with the use of
instant-heat technology. Combining this
with improved battery life (+30%), users
can scan two to three times as many
3Shape also added an automatic use
counter, with a tip-change alert so users
will know when it’s time to change the
Besides TRIOS 4, 3Shape also launched
the patient excitement apps and a
range of Studio Apps that allow for
in-house design and production of
restorations, implants, clear aligners,
splints and orthodontics.
Dr Hinton explained that the excitement
apps are about engaging patients,
hence, they tend to refer to them now
as engagement apps.
In fact, the engagement apps take the
patient’s excitement to a whole new
She noted that every doctor who has
used an intraoral scanner has probably
heard their patient say, “that is so cool!”
when they see their scan onscreen.
But more importantly, engagement apps
can also help professionals improve their
From treatment simulator to patient
monitoring and smile design, dentists
are not only treatment planning, they
are also showing patients what can be
It also comes with a video onscreen
that, depending on the app, can also be
sent to patient’s mobile phone for them
to share with friends and family.
DENTAL ASIA MAY / JUNE 2021
is simply in
3Shape TRIOS® 4 provides
efficient and simplified routine
intraoral scanning, enabling
you to focus on achieving
outcomes and making
more patients smile.
THE EASY WAY TO MAKE A GREAT IMPRESSION
and surface caries
scan in just one
seconds for a
wireless in one
options for nonstop
Contact your reseller regarding
availability of 3Shape products
in your region.
The caries diagnostic aid feature is
not cleared by the FDA for clinical
use in the US.
© 3Shape A/S, 2020. The 3Shape name and logo and/or other trademarks mentioned herein
are trademarks of 3Shape A/S, registered in US and other countries. All rights reserved.
TRIOS 4 – skilled hands made stronger
“This is a whole new level of promoting
treatment acceptance and lightyears
away from how professionals used to do
it,” she highlighted.
On the other hand, Studio Apps are
the means to plan and produce these
treatments efficiently and effectively.
From implant planning and splints
to clear aligners and bracket
placement, these apps enable users
to take advantage of deeply integrated
workflows and to stay in the 3Shape
universe, if they choose, for planning
“Since 3Shape is an open platform, any
designing or manufacturing can be
easily sent to a third party at any stage
in the workflow,” she said.
But Dr Hinton emphasised that there are
certain advantages if they do all their
planning using the Studio Apps.
She explained, “With our apps, users are
working in an interface that they are
already comfortable and experienced
with, and a software that has been
optimised to create the fastest, most
efficient, and predictable treatment
She also shared the digital implant
planning experience of Dr Jonathan
Ferencz using the 3Shape software.
developing innovative new solutions,
the company guarantees the best
customer experience possible for both
the clinicians and their patients.
“If you speak with anyone that uses a
3Shape TRIOS, you’ll know that the one
thing we never do is standstill. We are
constantly tweaking and improving the
scanner through software updates,” she
Examples of software updates that
TRIOS users benefited from over the
years are the engagement applications,
.STL file output, and AI scanning that
automatically trims the scan while
To ensure that their users keep up
with these advances, the company
introduced the 3Shape Academy
which includes the ongoing creation of
educational webinars executed by both
global and local application specialists,
together with dental professionals.
They also organise virtual classes
and one-on-one training for those
Complementing this is fostering a
community among their customers by
encouraging them to connect and share
their learnings on platforms such as
the 3Shape Community and study
groups on social media.
REIMAGINING THE FUTURE
Reflecting on the lessons learned during
the peak of the pandemic, Dr Hinton
emphasised that digitalising the practice
is the best way forward.
“The pandemic situation highlights the
need for a digital workflow as it is more
hygienic. In sharing cases with partners
like laboratories, there is obviously much
less handing of materials and shipping,”
With the positive response of dental
professionals on their digital events
and study sessions, she learned that
professionals like spending time on
their own learning new protocols and
As a result, the company is committed
in developing their online teaching
capabilities to ensure it is more
convenient for dental professionals to
learn more about digital dentistry.
“Ensuring a smooth experience while
allowing our customers to maximise the
potential of digital dentistry will remain
as our focus, and we will keep working
endlessly to transform digital dentistry
for clinicians across the globe,” she
He said, “The difference digital dentistry
has made to making a crown is
tremendous. But the difference it has
made in implant dentistry is night and
They have also launched a blog
(blog.3shape.com) where visitors
can explore essential insights
and know-how from digital dental
ACCELERATING THE DIGITAL
As the world moves forward to hopefully
the post-pandemic era, the industry can
expect nothing less from 3Shape.
With their engineers constantly
Topping this is the global events
they hold throughout the year to
help dental professionals navigate
the latest innovations in digital
dentistry, helping them unfold the
opportunities and benefits to them,
their patients and practices.
DENTAL ASIA MAY / JUNE 2021
A leading and reputable media platform in Asia and internationally that provides educational
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Consistently sharing continuous progression in the industry through informative, objective features
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Building the future of
Founded in 2014, DentalMonitoring is the first patented AI-based
company targeting the needs of orthodontists and dentists. Led by Mr
Philippe Salah, the company aims to help doctors improve the quality of
care they provide to patients. In this article, he shares how the company
co-creates the future of orthodontics with dental professionals who are
already experiencing the full benefits of the virtual practice solutions.
JUMPSTARTING THE DIGITAL
Powered by artificial intelligence (AI),
DentalMonitoring (DM) is a suite of software
solutions that allows dental professionals
to follow and assess patients’ treatment
Since its founding in 2014, the company
has grown exponentially with about 350
employees across the United States, Europe
and Asia Pacific.
Over the years, DentalMonitoring has
successfully revolutionised the delivery
of dental care and redefined patient
experience. According to Mr Philippe Salah,
chief executive officer of DM, the group’s
strategy is based on innovation and new
technology reflected by the number of their
team members focused on research and
He shared, “Out of 350 ‘DMers’ – that’s what
we call our employees – more than 170 are
focused on the development of our platform.
R&D and innovation are the heart of our
model, and we’ve managed to maintain a
Mr Philippe Salah, CEO of DentalMonitoring
spirit of collaboration in which everyone,
regardless of their position, can come
up with the idea that will be developed
As an innovative company driven by a
pioneering vision, their suite of software
is designed to help dental professionals
throughout the patient’s journey.
From initial virtual consultations to patient
engagement and remote monitoring for
all types of treatments, DentalMonitoring
brings efficiency to the practice, and
bridges the communication gap between
In addition, the platform can adapt to the
needs and preferences of each dental
DENTAL ASIA MAY / JUNE 2021
professional, offering multiple
advantages, such as the use of
SmileMate, which allows the first
intra-oral assessment to be conducted
“From a few photos taken by the patient
with their smartphone, and submitted
via the AI engine; the practitioner can
detect 19 common observations and
automate. This makes it easier to detect
emergencies, reassure patients, and
attract new ones,” explained Mr Salah.
Still, some practitioners are overlooking
the advantages of virtual practice
solutions and keeping a conservative
approach in adopting the technology.
“Changing one’s habits is never easy,
especially when a process is already in
place and works well,” he noted.
But with the increasing demand for
convenience from patients as well as
the need to gain efficiency, it poses a
compelling reason to go digital.
“In a few years, practices that have not
yet shifted to digital technologies might
be left behind,” he commented.
On top of bringing unmatched
technology to all practices,
DentalMonitoring is committed in
assisting dental professionals in their
transition, allowing for a smooth and
“We don’t intend to change the
organisation of the practice. Rather, our
technology adapts to every practitioner,
following their preferences and
treatment philosophy,” said Mr Salah.
He also emphasised that their expert
team members are dedicated in
providing timely and relevant solutions
for each of their customer’s digital
Bringing real-added value to the
dentists, their clinic, and patients,
DentalMonitoring’s connected platform
is essential for any practitioner who
wants to digitise their patient care.
Mr Salah, highlighted, “From a return
on investment (ROI) point of view, the
calculation is simple. The time saved;
the patient’s comfort; the efficiency of
appointment scheduling; compared to the
investment in our platform, leaves no room
for doubt: It’s a winning bet.”
In fact, in every new collaboration, the
DentalMonitoring team starts with a
consulting session where they listen to their
clients and help them design their virtual
This is followed by their implementation
specialist who then assists the doctor and
his clinical staff with the onboarding of their
With this level of support, practitioners
can quickly see the benefits to their clinic’s
“We are also launching a self-training
platform where both the practitioner and the
clinical staff can learn everything about our
solutions, at their own pace. Of course, once
our solutions are implemented, we keep
a close eye on all our clients and remain
available to help them throughout their
journey with us,” said Mr Salah.
DentalMonitoring ensures that practitioners
can keep up with the advancements by
working closely with their existing clients
to help reinforce their communication and
promotional campaigns with concrete
“We are fortunate to work with highlyrecognised
professionals who are spreading
the word about our solutions. They enjoy
demonstrating how they have already
transformed their practices, both from
clinical and financial point of views,” he
He added that the practitioners often
participate in question-and-answer sessions
during their virtual and face-to-face events
“Our solutions meet a real need. Most
doctors who are interested in our
technology are now well aware that
we are offering them ‘the future of
orthodontics’,” remarked Mr Salah.
Indeed, since May 2021,
DentalMonitoring has taken a huge step
forward by unveiling a new facet of
solutions, such as allowing orthodontists
and dentists to remotely monitor
patients receiving braces treatment.
“Our technology was quickly adopted
for aligner treatments because it allows
for accurate monitoring of aligner
fitting while alerting practitioners to any
problems encountered in the treatment
plan,” explained Mr Salah.
In addition to these alerts, users can
now customise treatment monitoring for
each patient by activating notifications
for specific clinical parameters, including
archwire and auxiliaries passivity, which
paves the way for more individualised
and dynamic management of
QUALITY CARE TO QUALITY TIME
With the pandemic situation directly
impacting market trends, it has
projected dental professionals
towards rapid and massive adoption of
“The COVID-19 crisis has certainly
helped redefine our relationship with
time – the time we devote to our work,
family, loved ones, or leisure time – and
it has also placed the notion of ‘quality
time’ at the heart of everyone,” said Mr
For DentalMonitoring, the situation
further strengthened their resolve to
help more practitioners experience
the full benefits of their platform and
demonstrate the true value of their
“Our solutions, as they existed a year
ago, were perfectly positioned to
help dental practitioners continue to
‘see’ their patients virtually, despite
confinements and distancing measures
globally. We also made our solutions
more accessible, to support the dental
community, which has been particularly
affected by the pandemic,” he said.
With positive feedback from
practitioners, it inspires
DentalMonitoring to continue their
efforts and accelerate the marketing of
Mr Salah, stated, “Our teams
have invested 200% to make the
developments of our solutions viable
and to best meet the expectations of
orthodontists and general practitioners.
The DNA of DentalMonitoring has not
changed, but our solutions have been
redesigned and enhanced. They are
now even better integrated into the
connected care path that practitioners
want to implement in their clinics.”
Moving forward, he believes that
dentistry and orthodontics will
increasingly integrate time management
as a key factor for development and
satisfaction, both for the patient and the
Still, Mr Salah acknowledged that in this
dematerialised world, no technology can
replace the practitioner and their expertise.
“The doctor is, and will remain the captain of
their ship,” he emphasised.
In fact, he shared that besides the
entrepreneurial aspect of his job, one of the
best parts of it is being able to meet dental
professionals who are dedicated to finding
new technologies and tools to enhance their
“I really enjoy the way we’re co-creating
the future of orthodontics. It’s an amazing
journey,” he shared.
Although DentalMonitoring is keeping a
tight lid on future innovations, Mr Salah
guaranteed that they will continue to feed
the market with groundbreaking products in
the years to come.
“We are here to help!
Contact us now to start
virtualising and automating
all non-clinical procedures
in your practice!” DA
DENTAL ASIA MAY / JUNE 2021 35
Vertical ridge augmentation
using guided bone
By Dr Chang I C Teoh and Dr Kevin Ng
The following clinical report is a part of vertical ridge augmentation
(VRA) case series using different techniques by Drs Chang I C Teoh
and Kevin Ng. In this paper, they addressed a vertical bone defect
on an area with high aesthetic demands by employing guided bone
regeneration (GBR) technique.
Dental implant has been established to be
a predictable treatment option for partially
edentulous patients 1 . However, one of the
pre-requisite conditions for successful
implant treatment is to have a sufficient bone
volume for optimal 3D implant placement 2 .
Many clinical situations present inadequate
bone volume and require bone augmentation
in varying degree, with or without
simultaneous implant placement. To many
clinicians, ridge augmentation of medium to
large vertical defects is often considered to
be challenging and difficult.
Several techniques 3,4 have been described for
augmenting vertical ridge defects including
guided bone regeneration (GBR) which uses
a combination of membrane barriers and
different grafting materials; autogenous bone
block grafts; autogenous particulate grafts;
3D Split bone block; distraction osteogenesis;
3D CAD/CAM titanium scaffold with different
types of biomaterials; or a combination of
Bone dimensional changes after tooth
loss is well documented 5,6 . The final ridge
morphology is often the end result of
a combination of predisposing factors
subjected to the area affected.
For instance, bone destruction caused
by advanced periodontitis, multiple tooth
loss, peri-implantitis, trauma, long-term
denture wearing, unfavourable loading, or a
combination of these factors may result in
advanced bone loss and severe ridge defect
in either horizontal, vertical, or combination
There are a number of classifications of bony
defect described in the literature. Cologne
classification of alveolar ridge defects
(CCARD) 9 offers a more comprehensive
description of the types of ridge defect
presented to the clinicians and their
In general, vertical ridge augmentation
(VRA) is more demanding in soft tissue
management because of the need to stabilise
the augmentation material as compared to
horizontal ridge augmentation (HRA).
The inclusion of autogenous bone materials
in VRA is often recommended to improve
the outcome. However, the complication
rate 10 associated with this procedure is
considerably higher than HRA.
VRA is challenging primarily due to the
difficulty to stabilise the bone graft material
without the support of the bony wall, and the
angiogenesis has to reach a distance from
the native bony bed.
Additionally, an absolute tension-free soft
tissue advancement is essential to achieve
a primary closure and prevention of wound
dehiscence during the entire period of
healing 11 .
The following clinical report is a part of VRA
case series using different techniques. GBR
was employed in this case.
DENTAL ASIA MAY / JUNE 2021
This is a case of a 30-year-old Afro-
Caribbean female who used to work as a
school teacher. She was generally in good
health upon consultation with no significant
In 2017, she experienced mobility on her tooth
21. Her dental history revealed that her teeth
21 and 22 suffered from a traumatic injury
when she was a teenager.
Tooth 21 was avulsed but was reimplanted
successfully at the time of injury by her
dentist. The dentist also restored the
fractured tooth 22 with a partial veneer
restoration. Both teeth were uneventful after
However, tooth 21 started to become
increasingly mobile over the last few years.
Periapical radiograph showed that the tooth
has advanced bone loss with poor prognosis
Patient would like to have a fixed implant
treatment option to replace the failing tooth.
After careful discussion, a treatment plan was
To meet the highly-aesthetic demands of
the anterior region, a stage approach was
employed to rehabilitate the area:
Stage 1: Removal of tooth 21 and temporary
replacement with metal acrylic adhesive
bridge. Reassessment after three months of
Stage 2: VRA with GBR technique using
titanium reinforced cytoplast d-PTFE
membrane plus Emdogain (Enamel Matrix
Stage 3: Implant placement eight months
after VRA. Soft tissue augmentation plus
provisional and final crown on implant.
Clinical presentation after tooth 21 extraction:
• Medium to high lip line
• Thin biotype
• Medium vertical bone defect
• Papilla loss on the mesial of tooth 22
• Reduced interproximal bone peak mesial
to tooth 22
• Class I incisal relationship
• Tooth 22 is restored with a partial
• Ridge defect – Cologne classification:
V.2.i - vertical defect of 4-8mm, inside
the ridge contour
The failing tooth 21 was extracted and an
adhesive temporary Maryland bridge was
cemented to neighbouring teeth. The area
was allowed to heal for three months, as this
would permit the soft tissue to mature and
the area to revascularise.
Though the healing was uneventful, the
reassessment of the alveolar ridge defect
revealed that both of the palatal bone plates
were missing (Figs. 2-5) with a vertical
bone defect of around 5mm in the deepest.
In general, the stage approach is highlyrecommended
for a vertical defect of over
Guided bone augmentation (GBA) technique
was carried out as described by Urban 3,11 .
Fig. 2 Fig. 3
Fig. 4 Fig. 5 Fig. 6
DENTAL ASIA MAY / JUNE 2021 37
Fig. 8 Fig. 9
Fig. 11 Fig. 12
Fig. 13 Fig. 14 Fig. 15
A crestal with releasing incision placed at
least one tooth behind the defect was made.
A full thickness three-sided flap was raised to
expose the full extent of the bony defect. The
bony defect was mainly in vertical dimension
of moderate amount (around 5mm), both
buccal and palatal bones were missing (Figs.
Bony peaks were present on the mesial part
of teeth 11 and 22, determining the vertical
limit of bone regeneration. Adequate bone
width was available to support grafting
material. Granulation tissue was removed as
it is important to eliminate any soft tissue
remnants in the area to be augmented.
At the same visit, the exposed root surface of
tooth 22 was cleaned, curetted, and Enamel
Matrix Derivatives was applied to promote
tissue regeneration on the root surface.
Autogenous bone chips were harvested from
the anterior mandible with a 6mm diameter
trephine (Fig. 8). These bone chips provide
excellent osteogenic properties for bone
The autogenous bone chips harvested was
fixed with xenograft (Bio-Oss particles),
in around 50:50 ratio, to increase the bulk
volume of the grafting material.
To aid in rebuilding the ridge defect, a
non-resorbable titanium reinforced d-PTFE
(cytoplast) membrane was used. This
protects the grafting material and increases
its mechanical stability (Fig. 9).
Two titanium fixation pins were placed to
stabilise the membrane (Fig. 10). A resorbable
collagen membrane (Bio-Gide) was placed
over the titanium reinforced d-PTFE
membrane without covering the grafting
material (Fig. 11).
The flap was rendered tension-free by
dividing the periosteum at the base of the
buccal flap with a single incision, and the
underlying connective tissue was further
stretched with a blunt instrument. Then, the
flap was closed with d-PTFE sutures. A postoperative
radiograph was taken to provide a
baseline record (Fig. 12).
The area was allowed to heal for eight months
and it was uneventful. Throughout that
period, the patient function well with the
adhesive temporary bridge.
DENTAL ASIA MAY / JUNE 2021
The ridge defect and the soft tissue
attachment mesial to tooth 22 improved
markedly, although there was still a small
gap present between the intaglio surface of
the temporary bridge and the tissue surface
(Fig. 13). A connective tissue graft at implant
surgery would correct such defect.
During the implant surgery, a full thickness
flap was raised and the non-resorbable
membrane was removed (Figs. 14-15). This
procedure revealed an impressive newly
After verifying that the bone achieved
adequate volume, the dental implant
(Straumann BLT RC Roxolid implant) was
placed in correct 3D position to ensure good
primary stability (Figs. 16-17). Then, a piece of
connective tissue graft was harvested from
the palate to increase the tissue volume in
the crestal region (Fig. 18).
Primary closure was achieved, and healing
was uneventful. The increase in soft tissue
volume eliminated the gap between the
intaglio surface of temporary bridge and the
tissue surface of the ridge (Fig. 19).
Two months after insertion, the implant was
exposed using an H-incision technique with
minimal soft tissue manipulation to leave the
papillary area undisturbed (Fig. 20).
Impression was then taken after implant
exposure, and a temporary crown was
fabricated with the correct emergence profile
to encourage soft tissue ingrowth and mould
The soft tissue was supported by a stable
hard tissue foundation of sufficient volume.
This would encourage proper soft tissue
development around the implant including
the lost papilla mesial to tooth 22
The final impression was taken after the soft
tissue moulding matured. A screw-retained
all-ceramic crown was then delivered with
good aesthetic result (Figs. 24-27). The
patient was pleased with the outcome.
This article presented the treatment of
vertical bone defect on an area with high
aesthetic demands by employing stage
approach of tissue regeneration.
Firstly, hard tissue regeneration was done
using the GBR principle (autogenous bone
chips and xenograft protected by titanium
reinforced d-PTFE membrane). To regain
attachment loss, Emdogain (EMD) was
utilised and meticulously executed next to a
It is also important to use a mechanically
stable membrane such as titanium-reinforced
d-PTFE membrane to offer a closed and
Fig. 17 Fig. 18
Fig. 20 Fig. 21
Fig. 22 Fig. 23 Fig. 24
DENTAL ASIA MAY / JUNE 2021 39
Fig. 25 Fig. 26 Fig. 27
undisturbed environment for the bone graft
to mature, as well as to provide enough time
for the hard tissue to be regenerated.
During implant placement, soft tissue
regeneration using connective tissue graft
can be used to increase the volume of soft
tissue in the crestal region.
It is essential to regenerate sufficient volume
of hard tissue both in vertical and horizontal
dimension not only to house and surround
the implant (2-4mm of buccal bone), but also
to provide a good foundation and adequate
support for the soft tissue 12,13 .
Acquiring enough vertical soft tissue volume
is paramount to the long-term stability of
crestal bone around dental implants 14 .
Lastly, the emergence profile on the
provisional and final restoration plays a
significant role in achieving good aesthetic
outcome 14 . A well-designed contour aids in
developing and maintaining the correct soft
tissue profile with sufficient volume. DA
1. Pjetursson BE, Thoma D, Jung
R, Zwahlen M, Zembic A (2012) A
systematic review of the survival and
complication rates of implant-supported
fixed dental prostheses (FPDs) after a
mean observation period of at least 5
years. Clin Oral Implants Res 23(suppl.
2. Resnik RR, Misch CE. (2017) Misch’s
avoiding complications in Oral
Implantology. Elsevier, St. Louis, Missouri
3. Urban IA, Lozado JL, Jovanovic SA,
Nagursky H, Nagy K (2014) Vertical ridge
augmentation with titanium-reinforced,
PTFE membrane and a combination
of particulated autogenous bone and
anorganic bovine bone-derived mineral:
A prospective case series in 19 patients.
Int J Oral Maxillofac Implants 29:185-193
4. Jensen SS, Terheyden H (2009) Bone
augmentation procedures in localized
defects in the alveolar ridge: Clinical
results with different bone grafts and
bone-substitute materials. Int J Oral
Maxillofac Implants 24(suppl.):218-236
5. Araujo MG, Lindhe J (2005) Dimensional
ridge alterations following tooth
extraction. An experimental study in the
dog. J Clin Periodontol 32:212-218
6. Chappuis V, Engel O, Shahim K, Reyes
M, Katsaros C, Buser D (2015) Soft tissue
alterations in aesthetic postextraction
sites: a 3-dimensional analysis. J Dent
7. Atwood DA (2001) Some clinical factors
related to rate of resorption of residual
ridges 1962. J Prosthet Dent 86(1):119-
8. Cologne Classification of Alveolar Ridge
Defects (CCARD) (2013) 8th European
Consensus Conference of BDIZ EDI
9. Fontana F, Maschera E, Rocchietta I,
Simion M (2011) Clinical classification
of complications in guided bone
regeneration procedures by means of a
nonresorbable membrane. Int J Period &
Rest Dent 31(3):265-273
10. Fontana F, Santoro F, Maiorana C, Iezzi G,
Piattelli A, Simion M (2008) Clinical and
histologic evaluation of allogenic bone
matrix versus autogenous bone chips
associated with titanium-reinforced
e-PTFE membrane for vertical ridge
augmentation: A prospective pilot study.
Int J Oral Maxillofac Implants 23:1003-
11. Urban IA (2017) Vertical and Horizontal
Ridge Augmentation: New Perspectives.
Quintessence Publishing Co Ltd. UK:61-
12. Spray JR, Black CG, Morris HF, Ochi S
(2000) The influence of bone thickness
on facial marginal bone response: Stage
1 placement through stage 2 uncovering.
Ann Periodontol 5(1):119-128
13. Grunder U, Gracis S, Capelli M (2005)
The influence of the 3 D bone to implant
relationship on esthetics. Int J Period &
Rest Dent 25(2):113-119
14. Linkevicius T (2019) Zero Bone Loss
Concepts Quintessence Publishing Co,
Inc Batavia Illinois. 43-66
About the authors
Dr Chang I C Teoh
spent over 10 years of
his career in England
as an implantologist.
He has particular
interest in ridge
regeneration and immediate-loading
implants and is now in a private practice
in Hong Kong.
Dr Kevin Ng has been
a visiting lecturer
on oral surgery and
cariology at Hong Kong
University since 1981.
qualifications include Membership of the
Faculty of Dental Surgery (MFDS) of The
Royal College of Surgeons of Edinburgh.
He runs a private practice in Hong Kong.
DENTAL ASIA MAY / JUNE 2021
The next generation of
Many practitioners face the challenge of finding an imaging
system with a larger field of view along with the latest
technologies to enable a scalable digital workflow. But the
Carestream Dental’s CS 9600 CBCT scanner ticked all the
boxes and Dr Antoine Diss, founder of Génération Implant from
France, shares how his practice has benefitted from utilising it.
Dr Antoine Diss works with dentists
at the Génération Implant, a
French leading training provider
for implantology which he founded in
2006. At his practice, he trains dentists in
implantology, periodontology, and implant
prosthetics including procedures such as
bone fillings, management of extractions,
and sinus fillings.
Before implementing cone beam
computed tomography (CBCT) in his
practice in 2010, Dr Diss would send
his implant patients to a radiologist for
imaging, which means an additional
appointment is required.
Once he added his own system into his
workflow, it became indispensable for
many reasons, especially in terms of
Besides eliminating the extra
appointment for imaging, Dr Diss, said,
“During a surgery, or after it, we can
produce images for verification rapidly. In
addition, this imaging has enabled me to
be more precise in my diagnoses.”
The ability to save time is something
Dr Diss values and seeks to achieve
throughout his workflow. In fact, it is the
willingness to adopt new technology that
plays a key role in his success.
IMAGE QUALITY AND VERSATILITY
The CS 9600 can accommodate Dr Diss
imaging needs—as well as those of the
doctors he works with—for implant and
oral surgery because it features 14 fieldof-view
options that range from 4x4cm
In addition, Dr Diss upgraded his system
from the standard 90 kV model to 120 kV
and appreciates the impact the upgrade
brings: it enhances the image quality
without increasing the dose.
“We now have a system that is truly
capable of adapting to the different
workflows we have. It has clearly taken
CBCT imaging to the next level,” said
Dr Diss. “In endodontics, for example,
you can take a full arch image [10x10cm
volume size] at 75-micron resolution,
which is very significant. You can also
DENTAL ASIA MAY / JUNE 2021 41
target a single tooth on the arch. The
images are excellent for implantology
Additionally, metal artifact reduction
(MAR) plays a role in improving image
Dr Diss, said, “Without CS MAR
[Carestream Dental’s patented software
option on the CS 9600], we could not
really manage artifacts in our images.
We just had to work with them.”
He explained that CS MAR works like
a magnifier that enables users to pass
through an image and see it— with and
without the anti-artifact filter. They can
compare the native image to the image
with the algorithm applied and easily
Root canal assessment using 5x5cm field of view and
Zygomatic implants case using large field of view (16x12cm)
Multiple fields of view were especially
beneficial for a case that was referred
to Dr Diss where there was a complete
failure of the maxillary. The patient
was edentulous with almost no bone
Dr Diss was able to treat her with a
system called Quad Zygoma. To position
four zygomatic implants, he needed
precise, localised images as well as
larger ones, since the zygoma are
situated under the orbits.
Certain anatomical risks made it
imperative that he sees the limits with
He shared, “I know that with my previous
imaging system, which had a smaller
field of view, my diagnosis could not
have been as precise. My explanation
to the patient would not have been as
comprehensive, and I would not have
had such ideal conditions in which to
perform the surgery.”
With the potential of the CS 9600, Dr
Diss is looking to expand his orthodontic
services. In fact, the CS 9600 is able to
accommodate this expansion, thanks
to the breadth of imaging capabilities it
“We may consider offering adult
orthodontics with aligners, given that
we have an orthodontist who works with
us in surgery,” said Dr Diss. “We envision
combining analyses of the bone bases
with aesthetic analyses from the
Face Scan, and being able to propose
therapeutic orthodontic solutions for
EASY, STABLE PATIENT
Dr Diss’s previous imaging system did
not have an integrated seat. So, when
he first saw the CS 9600, which has
a seat option, he did not immediately
envision the potential benefit. Then, it
“The seat provides stability for the
patient and reduces movement during
the scan resulting to clearer images. It
also eases the process of positioning
the patient,” he explained.
The CS 9600 facilitates proper patient
positioning by guiding the user via
several intelligent features. Now, Dr
Diss and his team do nearly all of their
examinations with the patient seated.
“The system is designed with a high
degree of fool-proofing so that when
DENTAL ASIA MAY / JUNE 2021
you follow the protocol, you avoid
errors—even for beginner assistants. The
CS 9600 also guides you in using the
supports specific to each modality,” said
For instance, with the Face Scan, if the
user did not position the correct support
on the machine, a red light will alert him
that he is using the wrong accessory.
The CS 9600 has a pre-shoot function
that helps prevent a bad first image.
“You can set a scout view on the scanner
to better position your patient. There’s
also a system of video cameras that
helps you determine the Frankfurt plane
for panoramic exams. A similar feature is
available to position the field of view for
the CBCT,” shared Dr Diss.
He noted that if users wish to take a CBCT
image positioned towards the sinus,
they can move the cross on the patient’s
face via the touch screen, and the unit
automatically positions to the right area.
He added, “Another remarkable feature
that sets the CS 9600 apart is its ability to
make intelligent recommendations.”
After a pre-shoot, the system determines
the form of the arch and proposes the
“It’s practically semi-automatic. We
manage to generate highly reproducible
and very high-quality images. So,
whether it’s me or an assistant, the
system enables us both to obtain the
same quality of imaging,” expounded Dr
POWERFUL YET USER-FRIENDLY—
SOFTWARE THAT SPEEDS
Dr Diss describes the system’s software
as easy-to-use and powerful at the same
The user is able to choose the most basic
of visualisation functions but to get the
most from the system, there are many
tools to choose from.
The software is open too, which means
Dr Diss can use it with majority of the
implant planning software, facilitating his
“I can consult with patients about
implants and prepare a treatment plan. I
can send them to imaging, which enables
me to provide them with a precise cost,”
said Dr Diss.
Additionally, the system also validates
his treatment plan as he can use the
software to virtually place the implants
directly in front of his patients to educate
them on the procedure.
“If they accept the plan, my assistant
sends it along with a digital impression
(STL file)—if it is necessary—from the CS
3600 intraoral scanner,” he shared.
DENTAL ASIA MAY / JUNE 2021
Besides instilling confidence in patients,
images from the CS 9600 have the same
effect on Dr Diss.
He shared, “The system brings me
comfort in my work.”
ENVIRONMENTAL IMPACT AND
Like so many people today, the
environment is top of mind for Dr Diss. He
recently began replacing plastic cups in
his practice with small glasses, which are
washed, decontaminated and sterilised.
It’s more work, but less waste.
Digitalisation also plays a role in the zerowaste
process. Dr Diss uses less plaster
and fewer materials for both impressions
and couriers for cases that involve his
All of this is done via the Carestream
Dental’s single software platform, which
makes the process extremely simple and
“It sets the standard. Once I have
completed planning my implant through
the Prosthetic-Driven Implant Planning
module, I export the DICOM file directly
into Blue Sky Plan and send it to the lab—
without having to revalidate the position
of my implant,” he said.
Dr Diss stated that the software is also
fluid as he can access the images from
the CS 9600 and the CS 3600 on all his
“The CS 9600 images are reproducible.
There are no errors because this is a
reliable machine—one that integrates with
my other imaging machines solutions
from Carestream Dental. Examinations
are very rapid,” he said.
With the CS 96000, Dr Diss envisions 10
to 15 procedures per week with 80% of
them being implants with surgical guides.
“Thanks to the software, which saves us
a great deal of time, we can imagine this
happening with real precision for each
patient. It’s no longer just a diagnostic
tool. It is becoming a tool of production—
and one that helps us to ultimately
provide better treatment for our patients,”
TRUST AND CONFIDENCE
Enabling patients to feel comfortable
with the diagnosis and treatment plan is
essential to treatment acceptance as it is
difficult for them to fully comprehend their
clinical situation solely from explanation.
Dr Diss, said, “You can talk to them about
infection, for example, and that the tooth
cannot be saved because there is bone
loss. If you can attach an image to the
words, immediately the message is much
clearer, and you gain their trust. Patients
will never commit to a surgery without
trusting the surgeon.”
“It all contributes to the reduction of our
carbon footprint,” he said.
Going digital has also impacted the lives
of Dr Diss and his patients.
“We have a duty to treat our patients
according to medically proven data. The
data evolves and so must the dentist. It
takes a lot of time and energy to change
your way of doing things and learn new
technology. In the beginning, it actually
feels like you’re wasting time; but it’s an
investment that pays off in the end,” he
He added that he no longer works the
same as he did few years ago. In fact, he
is much faster and more reliable now.
“I value the contribution of Carestream
Dental in developing products of genuine
quality. They enable me to play a role in
changing the lives of my patients. Plus, I
can spend the time that I save in better
communicating with my employees—and
we can all devote a little more time to our
families,” he said. DA
DENTAL ASIA MAY / JUNE 2021 45
By Eva Lädrach
Professional oral prophylaxis is often painful to patients with
advanced periodontal disease. With Tigon+, W&H has developed a
piezo scaler that ensures gentle but powerful cleaning.
Despite improvements in oral health and
better awareness of the importance of good
oral hygiene, 10% of the global population –
around 743 million people – still suffers from
severe periodontitis 1 .
Even after 30 years, periodontitis and caries
are two diseases that I still encounter on a
daily basis at work. Older people in particular
often suffer from periodontitis 2 . If caught in
good time, the world’s sixth most common
disease 1 can be treated successfully.
Regular dental hygiene aimed at stabilising
the periodontal situation is particularly
important in patients with periodontal
However, as such patients often present
with deep periodontal pockets, exposed
tooth necks, bleeding on probing (BOP), and
particularly sensitive teeth, professional teeth
cleaning often proves painful.
Special instruments such as the Tigon+, allow
efficient treatment which is also gentle and
comparatively agreeable at the same time.
This is reflected positively in recall
attendance, which helps maintain the
stability of the periodontal situation and
allows retention of the natural dentition for as
long as possible.
My role as a dental hygienist in the
Periodontology Clinic at the University of
Berne, Switzerland, predominantly involves
treating patients with periodontal disease.
The patients are either referred to us from
a general practice following diagnosis of
a periodontal condition, or come to us on
their own accord after noticing increased
tooth mobility, gingival bleeding, pain, or
Following initial treatment by the dentist, the
patients then attend recall appointments
with me and are monitored and treated by me
and the entire dental team over the course of
Monitoring them for the rest of their lives and
providing appropriate aftercare means I am
faced with new challenges every day.
The following case report concerns a male
patient born in 1967 with chronic, already
very advanced periodontitis with furcation
involvement. The initial diagnostic findings
Piezo scaler Tigon control unit
revealed periodontal pockets measuring
6-8mm across the dentition.
The patient visited us in the clinic for the first
time in 2011. Prior to treatment in our clinic,
he had not seen a dentist for 10 years. The
patient also reported smoking around half a
pack of cigarettes a day.
At the start of the treatment, a number of
teeth were extracted that were not worth
preserving. A hygiene phase was conducted
for the first time in 2012.
Following subsequent re-evaluation,
flap surgery (modified Widman flap) was
performed in all four quadrants. As a result
of the active periodontal therapy, massive,
3-4mm deep recessions with exposed tooth
necks appeared throughout and the patient
displayed very sensitive reactions.
DENTAL ASIA MAY / JUNE 2021
In addition, root caries was diagnosed at a
number of points. The patient has now been
attending recall appointments with me regularly
GENTLE REMOVAL OF PLAQUE
AND BIOFILM TO MAINTAIN THE
Periodontal therapy comprises a number of
different steps. Following the examination and
evaluation of the indicated findings, the patient
is briefed with the decision taken about the
treatment and treatment goals.
The patient’s motivation to perform oral
hygiene measures at home is decisive. If the
findings require it, the patient’s dentist is also
involved. The patient’s wishes are also decisive
for the type of treatment, but the primary goal
is always preservation of the dentition and
My patients can expect professional
treatment that is both painless and complete
and in no way superficial. This is done so with
high-quality devices and instruments to help
satisfy these requirements.
In this case, the Tigon+ allows extensive and
atraumatic removal of the biofilm and flushing
of the pockets while still being relatively
comfortable for the patient.
Prior to 2016, the treatment in the recall
appointment involved deep scaling using
electronic and hand instruments (Gracey
curettes), which was painful for the patient.
In addition, hand instruments cannot reach
the bottom of the pockets. As such, the
treatment in the recall appointments was
always a great challenge for the patient and
treatment provider alike.
Figure 1 shows the periodontal improvement
since treatment with the Tigon+ was initiated.
MORE COMFORTABLE TREATMENT
CONTRIBUTES TO BETTER RECALL
The excellent accessibility thanks to the long,
slender 1P tip and possibility of adjusting the
power setting makes it possible to clean the
biofilm out of the deep pockets and flush
them carefully (Fig. 2).
A control algorithm for the Tigon+ tip’s
oscillating system specific to W&H allows
the frequency to be adjusted to reflect the
The frequency of the oscillations is adjusted
continuously depending on the pressure,
water supply and other factors, which allows
much finer determination of the frequency.
Following the diagnosis, briefing and
discussion, hard and soft deposits are removed
carefully and gently. This is done by means of
supragingival and, if necessary, subgingival
scaling in the active, deep pockets using
electronic and hand instruments.
The combination of electronic and hand
instruments allows optimal and complete
biofilm and plaque management. The treatment
is concluded with final polishing with a
polishing compound for removal of the biofilm
and any persistent stains.
In my opinion, this is both a decisive and
intrinsic part of the treatment and an agreeable
treatment step for the patient.
The pleasant feeling in the mouth motivates
most patients to keep up oral hygiene measures
at home following their recall appointment,
maintain the stability of the periodontal
situation and to prevent the appearance of
As patients with periodontal disease often
present with exposed tooth necks, it is essential
to remove hard and soft deposits as gently as
This patient was treated with the Tigon+ for
the first time in August 2016 and reported
considerably less pain during treatment.
Cleaning and flushing the pockets, which
is atraumatic for the hard and soft tissues
but still effective with the water heated to
around body temperature and the frequency
of the Tigon+, which is perceived as pleasant,
represent a considerable added value for the
The gentle and more relaxed treatment has
a positive effect on the BOP and the active
pockets are reduced.
International literature confirms BOP as a
clinical indicator for the progression and
stability of periodontal disease 3 .
It has been shown that an increase in the
number of BOP points is linked to recession
of the periodontium and an elevated risk of a
periodontal collapse 4,5,6 , whereas an absence
of BOP is an indicator of periodontal stability 7, 8 .
The pocket depth, which is directly related to
the bleeding on probing 4 , is connected to the
periodontal stability. The periodontal chart in
The patient says that the frequency
adaptation and the heated water are
Fig. 1: The BOP ratio has decreased considerably
since August 2016. Whereas 18% of all measurements
displayed bleeding on probing at the start of the
treatment on 22.08.2016, the figure is just 5% almost
two years later
DENTAL ASIA MAY / JUNE 2021 47
Regular recall appointments at short intervals
mean almost no hard deposits are able to
form and consequently, only soft deposits
need to be removed.
Thanks to the Tigon+ and to the patient’s
delight, it has proven possible to maintain
the periodontal situation at the same level
and preserve adequate masticatory function.
The Tigon+ is also suitable for the longterm
treatment of patients with advanced
Even though we are aware of the
periodontically delicate situation, it is still
possible to postpone the loss of the patient’s
teeth and thus hopefully satisfy his wishes to
retain his own dentition for the years to come.
That is a very satisfactory and particularly
pleasing result for me too. DA
7. Lang NP, Adler R, Joss A, Nyman S. Absence
of bleeding on probing. An indicator of
periodontal stability. J Clin Periodontol
8. Swedish Council on Health Technology
Assessment. Chronic Periodontitis –
Prevention, Diagnosis and Treatment: A
Systematic Review [Internet]. Stockholm:
Swedish Council on Health Technology
Assessment (SBU) 2004. SBU Yellow Report
No.169. SBU Systematic Review Summaries.
9. Rugg-Gunn A, Bánóczy J. Fluoride
toothpastes and fluoride mouthrinses for
home use. Acta Med Acad 2013; 42(2):168-78.
10. Clark DC: A review on fluoride varnishes:
an alternative topical fluoride treatment.
Community Dent Oral Epidemiol 10;1982;117–
11. De Bruyn H, Arends J. Fluoride varnishes-a
review. J Biol Bucc 15;1987; 71–82.
Fig. 2: The example of a 52-year-old female patient
shows how the narrow, straight tip 1P can be used
to gently remove biofilm and rinse pockets
particularly agreeable and gentle. In addition,
the Tigon+ also permits treatment without
anaesthesia as the pain is bearable for the
patient and there is no need to use hand
The sensitivity of the tooth necks has
decreased over the course of the treatments
and the root caries has been brought
under control through the regular use of a
toothpaste containing 5,000ppm of fluoride.
The caries prophylactic effect of the
application of toothpastes and varnishes
containing fluoride has been confirmed by
numerous studies 9,10,11 . The patient uses a
sonic toothbrush and interdental brushes at
The clear communication with the patient
means that he is now thoroughly aware of the
critical periodontal situation. The less painful
treatment with Tigon+ also motivates the
patient to attend regular recall appointments.
First published in Quintessenz Team-Journal
49 (2019) No. 9.
Photo credits to Zahnmedizinische Kliniken
Bern / Klinik für Parodontologie (Fig. 1), W&H
3. Joss A, Adler R, Lang NP. Bleeding on probing.
A parameter for monitoring periodontal
conditions ibn clinical practice. J Clin
4. Lang NP, Joss A, Orsanic T, Gusberti FA,
Siegrist BE. Bleeding on probing fort he
progression of periodontal disease. J Clin
5. Haffajee AD, Socransky SS, Lindh J, Kent
RL, Okamoto H, Yoneyama T. Clinical risk
indicators for periodontal attachment loss. J
Clin Periodontol 1991:18(2):117-25.
6. Gonzalez S, Cohen CL, Galván M, Alonaizan FA,
Rich SK, Slots J. Gingival bleeding on probing:
relationship to change in periodontal pocket
depth and effect of sodium hypochlorite oral
rinse. J Periodontal Res 2015:50(3):397-402.
About the author
Eva Lädrach began
her training as a
dental hygienist at
the School of Dental
Hygiene in Berne,
Switzerland, in 1984,
the first year the new qualification was
offered. She has enjoyed her profession
as a dental hygienist ever since, and has
worked in various private practices over
In the course of her professional
career, Lädrach has trained prophylaxis
assistants and dental hygienists
as an adult educator and has been
an active voice for the interests of
dental hygienists in the professional
association. Her ultimate goal always
has been and remains the well-being of
the patients. She has been working as
a dental hygienist at the Periodontology
Clinic headed by Prof Anton Sculean at
the School of Dental Medicine in Berne
for nine years.
DENTAL ASIA MAY / JUNE 2021
AutoSWEEPS modality of
SkyPulse Endo Er:YAG Laser
By Dr Tomaz Ivanusic and Nejc Lukac
SkyPulse® is a new generation of compact and portable Fotona dental
lasers which comes in two variations. SkyPulse Endo Er:YAG Laser
features exceptionally low-energy and short duration laser pulses
optimised to generate a clinically effective photoacoustic effect for
Fig 1: The acoustic signal following the emission of a single Er:YAG
laser pulse. The initial rapid growth and final explosive collapse of the
laser-generated bubble (below) during the bubble’s oscillation time
(TB) result in two acoustic signal peaks (above)
Fig. 2: Temporal shape of the latest generation SkyPulse Endo’s dual-pulse SWEEPS mode
with nominal single-pulse durations of 25μs. Measurement was made for ESWEEPS = 2 x EL
= 2 x 20mJ at the SWEEPS mode repetition rate of 15Hz
Root canal preparation consists of mechanical instrumentation
followed by chemical irrigation. Because of the highly complex
anatomy of root canal systems, the standard method of hand syringe
irrigation has been found unsatisfactory for cleaning and disinfecting
the root canal wall from debris and bacteria. For this reason, laseractivated
irrigation (LAI) has been introduced to enhance the irrigation
action 1–8 .
During LAI, Er:YAG laser pulses are delivered through a fibre tip
(FT) into the irrigant-filled coronal access cavity. Due to the strong
absorption of the Erbium wavelength (λ = 2.94μm) in the irrigant, a
vapour bubble is generated at the end of the submerged fibre tip 9 .
The rapid expansion and collapse of the bubble (Fig. 1) results in
secondary cavitation and fluid motion along the entire root canal
system 10,11 leading to enhanced chemo-mechanical irrigation 4,12 when
EDTA and NaOCl solution are used as irrigants.
This long-distance action of LAI represents an important advantage in
comparison to other irrigation techniques that require a different tip/
needle to be inserted up to the apical area 13-15 .
However, due to friction on the cavity walls, the bubble oscillation
MAY / JUNE 2021 DENTAL ASIA 49
is significantly slower, reducing the intensity of the bubble collapse
within the root canal.
Therefore, the shock waves that are usually emitted in an
unconstrained environment following a bubble’s collapse are
diminished or not present at all 16, 17 .
DUAL-PULSE SWEEPS MODE
To intensify the bubble collapse within the root canal, a special dualpulse
Shock Wave Enhanced Emission Photo-dynamic Streaming
(SWEEPS) modality has been introduced, where the second laser pulse
is applied just before the collapse of the first laser pulse’s bubble 16-18 .
Figures 2 to 4 show the dual-pulse emission of the SWEEPS modality
as measured for the latest generation SkyPulse Endo Er:YAG laser
systems (manufactured by Fotona, Slovenia).
It is to be noted that SWEEPS pulses are designed to start with sharp
initial intensity peaks that additionally enhance the dynamics of photoacoustic
The sudden expansion of the second bubble generated by the second
laser pulse exerts additional pressure on the initial bubble, leading to
its accelerated collapse, during which shock waves are emitted.
In addition, shock waves are also emitted from the collapsing
secondary cavitation bubbles that are formed throughout the entire
length of the canal during laser-induced irrigation 17 .
The largest enhancement of shock waves and internal irrigant
pressures occurs when the temporal separation (TSWEEPS) between
the two SWEEPS laser pulses does not deviate substantially from the
optimal separation time, i.e., the resonant time (Tres).
Fig 3: a) Temporal shape of the first pulse of the SWEEPS pulse pair shown in Fig.
2; b) Temporal delivery of the cumulative laser energy during the pulse. The pulse
duration of 17μs represents the time when 75% of the total laser pulse energy of
EL = 20mJ has been delivered
Fig 4: Temporal shape of the first pulse (a) and of the second pulse (b) of the
latest generation SkyPulse SWEEPS mode as measured for ESWEEPS = 2 x EL =
2 x 10mJ at the SWEEPS mode repetition rate of 15Hz
Fig 5: Dependence of the measured pressures in the coronal (Pc), medial (Pm)
and apical (Pa) areas of the root canal, as a function of the temporal separation
(TSWEEPS) of the SWEEPS dual pulses. The largest pressure increase occurs
when the start of the rapid growth of the second bubble at t ≈ Tres coincides
with the collapse of the first bubble towards the end of its oscillation period TB 22
Fig 6: An example of the dependence of the cavitation bubble oscillation period
(TB) on the diameter D (3mm, 6mm and “Infinite”) of an irrigant-filled cavity 22
DENTAL ASIA MAY / JUNE 2021
Fig 7: Comparison of debris removal rate of AutoSWEEPS and SSP (PIPS) Er:YAG
laser modalities 19
Fig 8: Mean values of irrigant extrusion in groups using i) conventional needle
irrigation with open-ended needle (CNI-OE) or ii) side-vented needle (CNI-
SV), using flow rates of five or 15mL/min, and using LAI with iii) SSP (PIPS) LAI
(20mJ), and iv) AutoSWEEPS LAI (2x 10mJ) 21
It corresponds to the time when the second laser pulse of the SWEEPS
pulse pair is delivered near the end of the collapse phase of the
primary bubble generated by the first laser pulse (Tres ≈ 0.9 x TB)
Also, as measured in laboratory conditions, the simulated debris
removal rate of the AutoSWEEPS modality has been shown to be
almost three times higher compared to that of the SSP modality 19
The challenge involved in using SWEEPS in dental practice is posed by
the fact that the bubble oscillation time (TB) critically varies depending
on laser parameters that can be controlled such as laser pulse energy
(EL), and varying endodontic access cavity dimensions on the treated
tooth, with TB being longer for smaller cavity dimensions 17, 22 (Fig. 6).
As solution, a special AutoSWEEPS laser modality was developed 16,
. The temporal separation between the pair of laser pulses is
continuously swept back and forth between TSWEEPS = 200μs and
TSWEEPS = 650μs.
This ensures that during each sweeping cycle, there is always at least
a 50μs wide temporal separation range when the pulses are separated
by TSWEEPS ≈ Tres, as required for optimal enhancement.
The sweeping modality also ensures that the optimal conditions
are approximately reached along the depth of the access cavity by
matching the changing diameter conditions during the AutoSWEEPS
Under comparable conditions, the AutoSWEEPS modality has been
reported to be about 50% more effective than the standard singlepulse
SSP (Super Short Pulse, 50μs nominal pulse duration, also
known as PIPS) modality in generating pressures within the root canal,
resulting in significantly better penetration of irrigants into the dentinal
tubules 20 .
Similarly, in a recent study, the efficacy of the removal of accumulated
hard-tissue debris from the root canal system for AutoSWEEPS
irrigation was compared with the SSP laser-assisted irrigation and
with ultra-sonically activated irrigation (UAI) using microcomputed
tomography 23 .
The AutoSWEEPS modality resulted in significantly improved debris
removal in each portion of the root canals compared with SSP and UAI.
Additionally, studies in artificial models with apical constrictions of
ISO4021 and ISO4520 and a lateral canal opening of ISO3520 indicate
that the new SWEEPS method does not increase the risk of apical
extrusion as compared with single-pulse LAI or standard syringe
irrigation (Fig. 8).
The AutoSWEEPS modality, available in the latest generation SkyPulse
Endo Er:YAG laser systems, has been shown to result in shock-wave
generation and significantly enhanced flushing action 19 .
Due to increased pressure generation along the depth of the root
canal, enhanced penetration of irrigants into dentinal tubules is also
achieved 20 without increasing the risk of apical extrusion 21 . DA
1. RJG. De Moor, J. Blanken, M. Meire, and R. Verdaasdonk, “Laser induced
explosive vapor and cavitation resulting in effective irrigation of the root
MAY / JUNE 2021 DENTAL ASIA 51
canal. Part 2: evaluation of the efficacy,” Lasers Surg. Med., vol. 41, no. 7, pp.
520–523, Sep. 2009.
2. C. Kurzmann, M. A. Meire, S. Lettner, E. T. R. Farmakis, A. Moritz, and R. J.
G. De Moor, “The efficacy of ultrasonic and PIPS (photon-induced acoustic
streaming) irrigation to remove artificially placed dentine debris plugs out
of an artificial and natural root model,” Lasers Med. Sci., vol. 35, no. 3, pp.
719–728, Apr. 2020.
3. S. D. de Groot, B. Verhaagen, M. Versluis, M.-K. Wu, P. R. Wesselink, and L.
W. M. van der Sluis, “Laser-activated irrigation within root canals: cleaning
efficacy and flow visualization,” Int. Endod. J., vol. 42, no. 12, pp. 1077–1083,
4. E. DiVito, O. A. Peters, and G. Olivi, “Effectiveness of the erbium:YAG laser
and new design radial and stripped tips in removing the smear layer after
root canal instrumentation,” Lasers Med. Sci., vol. 27, no. 2, pp. 273–280,
5. B. S. Golob, G. Olivi, M. Vrabec, R. El Feghali, S. Parker, and S. Benedicenti,
“Efficacy of Photon-induced Photoacoustic Streaming in the Reduction
of Enterococcus faecalis within the Root Canal: Different Settings and
Different Sodium Hypochlorite Concentrations,” J. Endod., vol. 43, no. 10,
pp. 1730–1735, Oct. 2017.
6. D. Arslan and A. Kustarci, “Efficacy of photon-initiated photoacoustic
streaming on apically extruded debris with different preparation systems in
curved canals,” Int. Endod. J., vol. 51 Suppl 1, pp. e65–e72, Jan. 2018.
7. Y. Ozbay and A. Erdemir, “Effect of several laser systems on removal of
smear layer with a variety of irrigation solutions,” Microsc. Res. Tech., vol. 81,
no. 10, pp. 1214–1222, Oct. 2018,
8. S. De Meyer, M. A. Meire, T. Coenye, and R. J. G. De Moor, “Effect of laseractivated
irrigation on biofilms in artificial root canals,” Int. Endod. J., vol.
50, no. 5, pp. 472–479, May 2017
9. P. Gregorčič, M. Jezeršek, and J. Možina, “Optodynamic energy-conversion
efficiency during an Er:YAG-laser-pulse delivery into a liquid through
different fiber-tip geometries,” J. Biomed. Opt., vol. 17, no. 7, p. 0750061, Jul.
2012, doi: 10.1117/1.JBO.17.7.075006.
10. N. Lukac, J. Zadravec, P. Gregorcic, M. Lukac, and M. Jezeršek, “Wavelength
dependence of photon-induced photoacoustic streaming technique for
root canal irrigation,” J. Biomed. Opt., vol. 21, no. 7, p. 75007, 01 2016, doi:
11. H. Matsumoto, Y. Yoshimine, and A. Akamine, “Visualization of irrigant
flow and cavitation induced by Er:YAG laser within a root canal model,” J.
Endod., vol. 37, no. 6, pp. 839–843, Jun. 2011,
12. R. C. D. Swimberghe, A. De Clercq, R. J. G. De Moor, and M. A. Meire,
“Efficacy of sonically, ultrasonically and laser-activated irri-gation in
removing a biofilm-mimicking hydrogel from an isthmus model,” Int. Endod.
J., vol. 52, no. 4, pp. 515–523, Apr. 2019.
13. G. Bryce, N. MacBeth, K. Gulabivala, and Y.-L. Ng, “The efficacy of
supplementary sonic irrigation using the EndoActivator® system
determined by removal of a collagen film from an ex vivo model,” Int.
Endod. J., vol. 51, no. 4, pp. 489–497, Apr. 2018,
14. N. Lukač, P. Gregorčič, and M. Jezeršek, “Optodynamic Phenomena During
Laser-Activated Irrigation Within Root Canals,” Int. J. Thermophys., vol. 37,
no. 7, p. 66, May 2016.
15. J. D. Koch, D. E. Jaramillo, E. DiVito, and O. A. Peters, “Irrigant flow during
photon-induced photoacoustic streaming (PIPS) using Particle Image
Velocimetry (PIV),” Clin. Oral Investig., vol. 20, no. 2, pp. 381–386, Mar. 2016,
16. N. Lukac, B. T. Muc, M. Jezersek, and M. Lukac, “Photoacoustic Endodontics
Using the Novel SWEEPS Er:YAG Laser Modality,” J. Laser Health Acad., vol.
2017, no. 1, pp. 1–7.
17. N. Lukač and M. Jezeršek, “Amplification of pressure waves in laserassisted
endodontics with synchronized delivery of Er:YAG laser pulses,”
Lasers Med. Sci., vol. 33, no. 4, pp. 823–833, May 2018.
18. P. Gregorčič, N. Lukač, J. Možina, and M. Jezeršek, “Synchronized delivery
of Er:YAG-laser pulses into water studied by a laser beam transmission
probe for enhanced endodontic treatment,” Appl. Phys. A, vol. 122, no. 4, p.
459, Apr. 2016.
19. M. Jezeršek, N. Lukač, and M. Lukač, “Measurement of Simulated Debris
Removal Rates in an Artificial Root Canal to Optimize Laser-Activated
Irrigation Parameters,” Lasers Surg. Med., vol. n/a, no. n/a, doi: 10.1002/
20. M. Jezeršek, N. Lukač, M. Lukač, A. Tenyi, G. Olivi, and A. Fidler,
“Measurement of Pressures Generated in Root Canal During Er:YAG Laser-
Activated Irrigation,” Photobiomodulation Photomed. Laser Surg., Jun.
21. M. Jezeršek, T. Jereb, N. Lukač, A. Tenyi, M. Lukač, and A. Fidler, “Evaluation
of Apical Extrusion During Novel Er:YAG Laser-Activated Irrigation Modality,”
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During Laser-Activated Irrigation of Root Canals and Method of
Improvement,” Lasers Surg. Med., Feb. 2020.
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About the author
Dr Tomaz Ivanusic graduated from the
University of Ljubljana’s Faculty of Medicine,
Slovenia, in 2017. After graduation, he served
a one-year internship where he gained
experience in different dental specialties.
While as a student, Dr Ivanusic actively
participated in international congresses and events. In 2018,
he was chosen to join a group of 16 prospective young dentists
to attend an advanced course in aesthetic dentistry in Lisbon,
Dr Ivanušič currently works as dentist in a private clinic in
Slovenia, mostly performing endodontic, restorative and
periodontal treatments with a special focus on laser dentistry.
He also conducts lectures in preventive and restorative dentistry
and works part time as researcher, lecturer and trainer at Fotona,
where he has also been involved in research and development of
new laser systems, in particular SkyPulse ® .
DENTAL ASIA MAY / JUNE 2021
By Dr Antonis Chaniotis
The internal anatomy of human teeth often consists of a highly
complicated network of multi-planar curved and anastomotic
canals. Thus, reaching the biological and design objectives of root
canal instrumentation in severely curved canal systems might be
extremely challenging. In this paper, Dr Antonis Chaniotis discusses
a safer and more predictable instrumentation technique.
DENTAL ASIA MAY / JUNE 2021 53
The ultimate aim of endodontic therapy
is the prevention of periradicular
disease or the promotion of healing
To achieve these objectives, mechanical
instrumentation and chemical disinfection
are considered the basic principles (Schilder,
1974), whereas the former essentially
determines the efficacy of all subsequent
procedures (Peters, 2004).
For gutta-percha fillings, the shaping of the
canal should satisfy the following criteria:
i. The shape of the main root canal
resembles a continuously tapering
funnel from orifice to apex
The cross-sectional diameter of the main
canals should narrow apically
Preparation follows the original shape
The position of the apical foramen is
v. The apical opening should retain
its dimensions as much as possible
(Schilder, 1974; Hulsmann et al., 2005).
The biological objectives of root canal
i. Confinement of instrumentation to the
limits of the roots themselves
Avoidance of extruding necrotic debris
into the periradicular tissues
Removal of all organic tissue from the
main and lateral canals
Creation of sufficient space to
allow irrigation and medication by
simultaneously preserving enough
circumferential dentin for the tooth to
function (Hulsmann et al., 2005)
Achieving the aforementioned objectives
in straight canals is considered a
straightforward procedure. Problems arise
when canals are severely curved or even
bifurcated and anastomotic (Fig. 1).
In such teeth, the basic endodontic
techniques and instrumentation protocols
might be challenging to follow. For a safer and
more predictable instrumentation, a newly
introduced NiTi file sequence can be applied
in the so-called TCA technique.
CURVED CANAL MANAGEMENT
Based on canal curvature, Nagy et al. (1995)
classified root canals into four categories:
i. straight or I form (28% of root canals)
ii. apically curved or J form (23%)
iii. entirely curved or C form (33%)
iv. multicurved or S form canals (16%)
Schafer et al. (2002) found that 84% of root
canals studied were curved while 17.5% of
them presented a second curvature and were
classified as S-shaped. From all curved canals
studied, 75% had a curvature of less than
27 degrees, 10% a curvature with an angle
between 27 and 35 degrees and 15% a severe
curvature of more than 35 degrees.
Traditionally, root canal curvatures were
described using the Schneider angle
(Schneider, 1971): root canals presenting an
angle of five degree or less could be classified
as straight canals; an angle between 10 and
20 degrees as moderately curved; and a
curve greater than 25 degrees as severely
Decades later, Pruett et al. (1997) reported
that two curved root canals might have
the same Weine angle, but sport totally
different abruptness of curvature. To define
the abruptness, they introduced the radius
of a curvature: the radius of a circle passing
through the curved part.
In rotary instruments, the number of cycles
before failure significantly decreases as the
radius of curvature decreases and the angle
of curvature increases.
Further attempts to mathematically describe
curvatures in two-dimensional radiographs
introduced parameters such as the length of
the curved part (Schaffer et al., 2002) and the
location as defined by curvature height and
distance (Gunday et al., 2005).
Recently, Estrela et al. (2008) described a
method to determine the radius of root canal
curvatures using CBCT images analysed
by specific software. Three categories got
classified: small radius (r≤4mm), intermediate
(r>4 and r≤8mm) and large (r>8mm).
The smaller the radius of a curvature is, the
more abrupt the curvature becomes. All those
attempts to describe the root canal curvature
had one goal: to preoperatively assess the risk
for transportation and unexpected instrument
CANAL TRANSPORTATION AND
According to the glossary of endodontic
terms (AAE, 2012), transportation is defined
as the removal of the canal wall structure on
the outside curve in the apical half due to
the tendency of files to restore themselves to
their original linear shape.
Fig. 1: Complex root canal anatomies
For stainless steel hand files and conventional
NiTi hand- or engine-driven files, the
restoring force of a given instrument is
directly related to its size and taper. The
bigger the size or taper, the bigger the
restoring force due to the increase of the
metal mass of the instrument.
DENTAL ASIA MAY / JUNE 2021
If root canals were constructed precisely
on the dimensions of the instruments,
transportation would not be a problem.
Instruments would be well constrained inside
the root canal trajectories.
Unfortunately, instruments are not precisely
shaped to fit canal dimensions. As a result,
each instrument may follow its own trajectory
inside a curved canal guided by its restoring
force thus transporting the canal (Plotino et
Usually, dentin removal towards the outer
apical curve becomes more excessive if a
greater increase in apical enlargement shall
be created (Elayouti et al., 2011).
Consequently, the inner curvature widening
can get excessive too. To avoid these
complications, dentists sometimes tend
to increase flaring and reduce apical
instrumentation size in severe curves (Roane
et al., 1985).
Increasing flaring under such circumstances
often results in the reduction of the angle of
curvature, shortening the length, increasing
the radius and relocating the curvature
apically (Fig. 2).
Smaller apical preparations in highly curved
canals would be preferable for two reasons.
Firstly, smaller diameter preparations are
related to less cutting of the canal walls, less
file engagement and consequently, a lesser
likelihood for undesirable cutting effects;
and small diameter files are more flexible and
fatigue resistant and therefore less likely to
Fig. 2: The effect of flaring in the curvature parameters
cause transportation during enlargement
(Roane et al., 1985)
The aforementioned instrumentation
approaches, although safer, have inherent
disadvantages. Flaring the canal entrance to
achieve easier negotiation to the apical third
of curved canals will result in unnecessary
removal of dentinal structure.
Additionally, smaller apical preparations may
result in increased difficulties for the irrigation
solutions to be delivered to an appropriate
In highly curved canals, the ability of irrigation
solutions to reach the critical apical third
depends directly on the ability to create
adequate apical preparations and the
selection of appropriate delivery techniques
(Boutsioukis et al., 2010).
Adequate apical preparation for disinfection
without over-flaring the coronal part of highly
curved canals is one of the great challenges
in endodontics – especially under the current
concepts of dentine preservation and minimal
Moreover, the risk of unexpected instrument
separation of engine-driven NiTi files
poses significant problems to the canal
management. Two mechanisms have been
identified: cyclic fatigue and torsional failure.
When an engine driven instrument is
activated inside a curved canal, continuous
tensile and compressive stress at the fulcrum
of the curvature may lead to instrument
separation because of cyclic fatigue.
If the tip of an engine-driven instrument is
locked inside a canal and the shaft keeps
on moving, it may exceed an applied shear
moment resulting in torsional failure. As the
complexity of the curvature increases, the
number of cycles before failure decreases.
USING “CONTROLLED MEMORY” FILES
NiTi alloys are overall softer than stainless
steel, have a low elasticity (about 1/4 to 1/5 of
stainless steel) but greater strength, tougher,
more resilient and show shape memory and
superelasticity (Baumann, 2004).
The NiTi alloys used in root canal treatment
contain approximately 56% nickel and 44%
titanium (Walia et al., 1988).
They can exist in two different temperaturedependent
crystal structures called
martensite (low-temperature phase) and
austenite (high-temperature phase). The
lattice organisation can be transformed
from austenitic to martensitic by adjusting
temperature and stress.
During the reverse transformation, the alloy
goes through an unstable intermediate
crystallographic phase called R-phase. Root
canal treatment causes stress to NiTi files and
a stress-induced martensitic transformation
of conventional NiTi files takes place in no
A change in shape occurs with volume and
density changes. This ability of resisting
stress without permanent deformation is
The superelasticity is most pronounced at
the beginning, when a first deformation of as
much as 8% strain can be totally overcome.
After 100 deformations, the tolerance is about
6%. Then, after 100,000 deformations, it is
about 4%. Within this range, the so-called
“memory effect” can be observed (Baumann,
Besides stress induced martensitic
transformation, the lattice organisation of NiTi
alloys can also be altered with stress. When a
conventional NiTi austenitic microstructure is
cooled, it begins to change into martensite.
The temperature at which this phenomenon
begins is called the martensite start
temperature (Ms) while the temperature
at which martensite is again completely
reverted is the martensite transformation
finish temperature (Mf).
DENTAL ASIA MAY / JUNE 2021 55
When martensite is heated, it begins to
change into austenite. The temperature at
which this phenomenon begins is called the
austenite transformation start temperature
(As). Above the austenite finish temperature
(Af) the material will have completed its
shape memory transformation and will display
its superelastic characteristics (Shen et al.,
Before 2011, the Af temperature for the
majority of available NiTi instruments was
at or below room temperature. As a result,
conventional NiTi files were in the austenitic
phase during clinical use, showing shape
memory and superelasticity.
In 2011, so-called “Controlled Memory (CM)”
files were introduced by international dental
These files had been manufactured utilising
a unique thermo-mechanical process that
controls the material’s memory, making the
files extremely flexible and fatigue resistant
without the shape memory and restoring
force of other NiTi files.
The Af transformation temperature of CM
files is found to be clearly above body
temperature. As a result, these files are mainly
in the martensite phase in body temperature
(Shen et al., 2011).
When the material is in its martensite form, it
is soft, ductile, without shape memory, can
easily be deformed, but will recover its shape
and superelastic properties upon heating over
the Af temperature.
Moreover, a hybrid martensite microstructure
like in the HyFlex CM files is more likely to
have a better fatigue resistance than an
austenitic microstructure. At the same stress
intensity, the fatigue crack propagation speed
of austenitic structures is much faster than
that of martensite ones.
A quantitative analysis based on the model
of the fracture process zone showed that
the martensite transformation in the shape
memory NiTi alloy caused 47% increase in the
apparent fracture toughness (Wang, 2007).
Recently, the controlled memory thermomechanical
processing was combined with
an innovative machining procedure for the
manufacturing of rotary NiTi files. Electrical
Discharge Machining (EDM) results in
instruments of increased surface hardness
cutting efficiency and extreme fatigue
In the first paper published evaluating these
files (Pirani et al., 2015), spark-machined
peculiar surface was mainly noticed and low
degradation was observed after multiple
The authors also found surprising high values
of cyclic fatigue resistance and a safe in vitro
use in severely curved canals.
In agreement with previews researchers,
Pedulla et al. (2015) reported higher values of
fatigue resistance for HyFlex EDM files even
when compared with reciprocating files made
Most of the available literature on bending
stiffness and cyclic fatigue fracture resistance
of NiTi rotary or reciprocating instruments
was performed in room temperature, which is
not a clinically relevant value.
Current instruments are used in body
temperature rather than room temperature.
This makes most of the previous studies
obsolete and conclusions cannot be applied
in the clinical practice.
It seems that the transformation temperature
(Af) of rotary or reciprocating NiTi files
might alter their clinical behaviour at body
temperature. Hulsmann et al. (2019) reported
that environmental temperature has a 500%
impact on the lifetime of instruments.
A transformation temperature near body
temperature can result in instruments that
appear to be flexible and fatigue resistant
in room temperature. However, in clinically
relevant temperatures, the instruments
become stiffer and less fatigue resistant.
The austenitic finish temperature of HyFlex
EDM was found to be close to 52 degrees
Celsius; far above body temperature.
XRD analysis of EDM files revealed the
presence of monoclinic martensite B19
structure and rhombohedral R-phase (Iacono
et al., 2016). Especially used EDM instruments
are always in a rombohedral R-phase and
martensitic crystallographic state in clinically
A martensitic structure in body temperature,
like HyFlex EDM, will exert superior flexibility
and fatigue fracture resistance.
Fig. 3: HyFlex EDM Max Curve sequence and sizes breakdown (COLTENE)
The extreme flexibility and fatigue resistance
of these files combined with the lack of
restoring force render them ideal to be used
DENTAL ASIA MAY / JUNE 2021
for the instrumentation of highly curved and
HYFLEX EDM MAX CURVE SEQUENCE
EDM made the use of a single file
enlargement approach with rotational
movement feasible. Most cases can be
shaped quite quickly, effectively and safely by
using a single HyFlex EDM One File 25/~ with
short stroke pecking movements, frequent
flute cleaning and irrigation between the
The One File has a tip size of 25 with a .08
taper. The taper is a constant .08 in the
apical 4mm of the instruments but reduces
progressively up to .04 in the coronal portion
of the instrument.
The file has three different cross-sectional
zones over the entire length of the working
part (rectangular in the apical part and two
different trapezoidal cross sections in the
middle and coronal part of the instrument) to
increase its fracture resistance and cutting
efficiency (Pedulla et al., 2015).
Whenever larger apical preparations are
required, three finishing HyFlex EDM files of
constant taper can be used (40/.04, 50/.03
For constricted and obliterated canals, thin
and long roots, curved canals of more than
27 degrees and S-shaped canals with smaller
than 5mm radius of curvature, single file EDM
shaping is not sufficient.
For these challenging cases the HyFlex EDM
Max Curve sequence is introduced to be
used with the Tactile Controlled Activation
technique (TCA). With this combination, all
those cases can be handled effectively and
The new HyFlex EDM Max Curve set includes
the sizes 15/.03, 10/.05 and 20/.05. Under the
new concepts of dentine preservation, flaring
can be avoided to reduce unnecessary tissue
removal from the peri-cervical area.
The HyFlex EDM Max Curve sequence can be
used with a single stroke TCA technique. After
canal identification and negation, a minimum
glide path of 10/.02 should be achieved with
stainless steel hand files before moving to the
Max Curve rotary sequence.
After making the 10/.02 hand file super loose,
the 15/.03 HyFlex EDM file is used to shift the
manually achieved glide path to a smooth glide
path that all subsequent rotary files can follow.
When the 15/.03 reaches the predetermined
length, the 10/.05 HyFlex EDM follows to
enlarge the middle part of the canal safely
without binding the delicate tip.
The apical 3mm of the 10/.05 file function
as guiding tip (without engaging the canal
walls). The 20/.05 HyFlex EDM file follows as
finishing file to give the final smooth shape
Once a 20/.05 enlargement is achieved, the
canal can be filled with a 20/.05 gutta percha
cone and GuttaFlow bioseal bioceramic
sealer. The sequence is easy to remember
and works effectively and safely even in
To minimise file engagement, TCA was
developed. This instrumentation technique
can be defined as the activation of a
motionless engine-driven file only after it
becomes fully engaged inside a patent canal
(Chaniotis and Filippatos, 2015).
TCA utilises file activation only after maximum
engagement of the flutes is reached and a
tactile feedback of the anatomy is felt.
Inserting files passively inside the root canals
and using CM files that can be prebent
Fig. 4d Fig. 4e Fig. 4f
DENTAL ASIA MAY / JUNE 2021 57
before file insertion is useful especially when
complicated canal systems are encountered
and limited mouth opening hinders canal
negotiation and visualisation.
TCA can be divided to in-stroke and out-stroke
Figs. 4 a-h: Tactile Controlled Activation (TCA) technique explained
After accessing the pulp chamber and locating
the canal orifices, technical patency to length
is confirmed and the canal is enlarged up to
10/.02 (Fig. 4a).
The first file of the Max Curve sequence to be
used, the 15/03, is mounted on the hand piece
of an endodontic motor and inserted passively
inside the canal until maximum frictional
resistance (point A, Fig. 4b).
The file is activated and pushed apically (instroke)
until the activated file resists further
advancement (point B, Fig. 4c) and withdrawn
from the canal (Fig. 4d).
Fig. 5: S-curved mesio-buccal root in a second maxillary molar managed with HyFlex EDM Max Curve
sequence and TCA technique. a. Pre-operative radiograph, b. Postoperative radiograph, c. Access cavity
preparation, d. 15/.03 HyFlex EDM before activation, e. 20/.05 HyFlex EDM finishing stroke before activation,
f. 20/.05 gutta percha cones, g. Clinical image of the pulp floor after obturation procedures
After file withdrawal, the file is inactivated,
the flutes are cleaned and checked for any
possible deformations. Irrigation and patency
The second time that the same file will be
inserted passively inside the canal it will bind
deeper inside the anatomy (point B, Fig. 4e).
Activating the file again the same way will guide
the file even more apically closer to length
(point C, Fig. 4f,g,h).
The work to be done by this file is completed
when the file can reach working length (point D,
Fig. 4i,k) without having to activate it.
After reaching working length, the second file of
the Max Curve set is used the same way.
Fig. 6: S-shaped mesial root of a second mandibular molar managed with the HyFlex EDM Max Curve
sequence. a. Preoperative radiograph revealing deep distal carious lesion, b. Periapical radiograph with
15/.03 HyFlex EDM to working length revealing the anatomy after the deep distal margin elevation, c.
Postoperative radiograph after the completion of root canal obturation, d. Post restoration radiograph
The delicate apical 2mm of the 10/.05 will
always remain loose inside the canal, guiding
the file through the anatomy without risking
engagement and breakage.
The 20/.05 that follows will provide the final
canal shape to disinfect and obturate the canal.
DENTAL ASIA MAY / JUNE 2021
A range of single files, in continuous rotation
C.WIRE Heat Treatment
The Endo DNA
to fracture (cyclic fatigue)
*in comparison with conventional NiTi
Data MicroMega R&D
(One Curve 25.06 vs One Shape 25.06)
Treats all canal anatomies
Instrumentation to larger apical preparations
can be achieved the same way until the
desired apical instrumentation width.
For challenging cases as seen in Figs. 5-6, a
20/.05 enlargement might be ideal to balance
the disinfection clinical procedures with the
risks of damaging the challenging anatomy or
separating the instruments.
TCA technique aims at minimising the time
of engagement with an activated file by
using file activation only when needed for
With this instrumentation technique and
HyFlex EDM Max Curve sequence, most of
the anatomical root canal variations can be
enlarged safely (Chaniotis and Filippatos,
NiTi Files with “Controlled Memory”-effect are
extremely flexible and fatigue resistant. They
can be activated inside the canal and move
passively around the curves guided only by
The TCA technique minimises the time files
are under engagement. This procedure
maintains a continuous tactile feedback
For challenging anatomies, special sequences
like the HyFlex EDM Max Curve set help
clinicians to keep on track. DA
1. Schilder H (1974) Cleaning and shaping the
root canal. Dental Clinics of North America 18:
2. Peters OA (2004) Current challenges and
concepts in the preparation of root canal
systems: A review. Journal of Endodontics 30:
3. Hülsmann M, Peters O, Dummer P (2005)
Mechanical preparation of root canals: shaping
goals, techniques and means. Endodontic
Topics 10: 30-76.
4. Nagy CD, Szabó J, Szabó J (1995) A
mathematically based classification of root
canal curvatures on natural human teeth.
Journal of Endodontics 21: 557-60.
5. Schäfer E, Diez C, Hoppe W, Tepel J (2002)
Roentgenographic investigation of frequency
and degree of canal curvatures in human
permanent teeth. Journal of Endodontics 28:
6. Schneider SW (1971) A comparison of canal
preparations in straight and curved root
canals. Oral Surg Oral Med Oral Pathology 32:
7. Pruett JP, Clement DJ, Carnes DL Jr (1997)
Cyclic fatigue testing of nickel-titanium
endodontic instruments. Journal of
Endodontics 23: 77-85.
8. Günday M, Sazak H, Garip Y (2005) A
comparative study of three different root
canal curvature measurement techniques and
measuring the canal access angle in curved
canals. Journal of Endodontics 31: 796-8.
9. Estrela C, Bueno MR, Sousa-Neto MD, Pécora
JD (2008) Method for determination of root
curvature radius using cone-beam computed
tomography images. Brazilian Dental Journal
10. American Association of Endodontists (2012)
Glossary of Endodontic Terms: Eighth edition.
11. Plotino G, Grande N, Mazza C, Petrovic S,
Gambarini G, Testarelli L (2010) Influence
of size and taper of artificial canals on the
trajectory of NiTi rotary instruments in cyclic
fatigue studies. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 109: e60-e66.
12. Elayouti A, Dima E, Judenhofer MS, Löst C,
Pichler BJ (2011) Increased apical enlargement
contributes to excessive dentin removal in
curved root canals: a stepwise microcomputed
13. Roane JB, Sabala CL, Duncanson MG Jr
(1985) The ‘balanced force’ concept for
instrumentation of curved canals. Journal of
Endodontics 11: 203-11.
14. Boutsioukis C, Gogos C, Verhaagen B, Versluis
M, Kastrinakis E, Van der Sluis LW (2010) The
effect of apical preparation size on irrigant flow
in root canals evaluated using an unsteady
Computational Fluid Dynamics model.
International Endodontic Journal 43: 874-81.
15. Baumann MA (2004) Nickel-titanium: options
and challenges. Dental Clinics of North
America 48: 55-67.
16. Walia H, Brantley WA, Gerstein H. An initial
investigation of the bending and torsional
properties of nitinol root canal files. J Endodon
17. Shen Y, Qian W, Abtin H, Gao Y, Haapasalo M
(2011) Fatigue testing of controlled memory
wire nickeltitanium rotary instruments. Journal
of Endodontics 37: 97-1001.
18. Wang GZ (2007) Effect of martensite
transformation on fracture behavior of shape
memory alloy NiTi in a notched specimen.
International Journal of Fracture 146: 93-104.
19. Pirani C, Iacono F, Generali L, Sassatelli P,
Nucci L, Lusvarghi M, Gandolfi G, Prati C (2015)
HyFlex EDM: superficial features, metallurgical
analysis and fatigue resistance of innovative
electro discharge machined NiTi rotary
instruments. International Endodontic Journal
[Epub ahead of print].
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G, Grande N, La Rosa G, Rapisarda E (2015)
Torsional and cyclic fatigue resistance of a
new Nickel-Titanium Instrument Manufactured
by electrical Discharge Machining. Journal of
Endodontics 42(1): 156-9.
21. Iacono F et al. (2016) Structural analysis
of HyFlex EDM instruments. International
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step card. Available at: https://www.coltene.
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Endodontic Journal 50: 202-1
About the author
Dr Antonis Chaniotis
graduated from the
University of Athens
Dental School in 1998.
In 2003, he completed
postgraduate programme in Endodontics
at the University of Athens Dental
School. Since 2003, he owns a limited to
microscopic Endodontics private practice
in Athens, Greece.
For the last decade, he served as a
clinical instructor affiliated with the
undergraduate and postgraduate
programmes at the University of Athens,
Athens Dental School, Endodontic
department, Greece. In 2012, he was
awarded the title of Clinical fellow teacher
at the University of Warwick, Warwick
He lectures extensively nationally and
internationally and he has published
articles in local and international journals.
He currently serves as an active member
of the Hellenic Society of Endodontology
(ESE full member society, a certified
member of the European Society of
Endodontology (ESE) and international
member of American Association of
DENTAL ASIA MAY / JUNE 2021
Behind the Scenes
Zirconium oxide meets
By DMT David May
Many patients desire fixed implant prosthetic solutions
that calls on the creativity of the dental technician in
terms of the type of restoration and its cost, which
must not be exorbitant. In this article, DMT David May
(Germany) presents a concept for generating CAD/
CAM-guided implant-supported dentures that are both
aesthetic and cost-effective.
In the age of implantology, more patients
present the desire for fixed dentures. They
long for a better quality of life and wish
for a carefree smile.
At the time our patient consulted the
practice, she had been provided with a
telescopic prosthesis in the maxilla, which
had been converted into a full denture.
Her ultimate wish was to be provided with
fixed, functional dentures that can meet
her high aesthetic demands.
Such functional prosthetic rehabilitation
requires well thought-out therapy
planning. The patient’s wishes were
summarised and implemented together
with the treating dentist.
The individual digital and analogue work
steps are documented in the following
The patient first came to us when she had
already received six implants in region 11,
13, 16, 21, 23 and 26. During the healing
phase, she wore her telescopic prosthesis,
which had been reworked to a full denture.
RESTORATION ON IMPLANTS
In the following step, the patient was
prepared for the final work with a screwretained
temporary denture. An occlusally
screw-retained bridge was to be fabricated
for the final restoration.
For the occlusal screw connection, we used
Medentibase abutments from Medentika,
which are offered by Amann Girrbach.
The conical titanium bases and bonding
bases enable the fabrication of multipontic
screw-retained bridge constructions
on implants. In addition, they allow
compensating small divergences.
Medentika’s Medentibase abutments are
available in five gingiva heights to ensure
optimal adaptation to the vertical implant
position and the emergence profile.
After a thorough functional analysis, we
began with the fabrication of the longterm
An aesthetic tooth set-up was created
on an individual acrylic base. This already
came close to the patient’s expectations.
As bonding bases had been incorporated
into the acrylic body, the aesthetic
set-up could be screw-retained firmly
in the mouth and, in a further step, the
function and aesthetics could be checked
Before the CAD/CAM-supported
manufacturing process, the patient’s
minimal requests for changes were
With the finished tooth set-up, which
DENTAL ASIA MAY / JUNE 2021 61
Behind the Scenes
Fig. 1 Fig. 2 Fig. 3
Figs. 1-3: Initial planning situation for solving the patient case: the scanned long-term temporary restoration formed the basis for the final restoration
Fig. 4: The temporary restoration for the veneer was
reduced in the Amann Girrbach Ceramill Mind software
Fig. 5: Due to the strong angulation of the implant in region
26, an angled titanium base had to be planned here
Fig. 8 Fig. 9
Figs. 6-7: The milled CoCr frame fitted precisely and
distortion-free after sintering
Figs. 8-9: After checking the fit, the base of the frame was polished to a high gloss
then acted as our blueprint for the final
restoration, we began the CAD/CAMsupported
planning and fabrication
Firstly, the aesthetic set-up was scanned
and fully anatomically milled from acrylic.
As the shade layers of the blanks are
modelled on the structure of natural
teeth, only minor corrections had to be
The gingival region was overlaid with
gingiva-coloured, light-curing composite.
With this screw-retained, temporary bridge,
our patient enjoyed her new outlook on life for
about three months.
The extension of the base, as well as the
shape and shade of the teeth almost
corresponded to the final restoration.
We used the Ceramill Temp Multilayer
acrylic blank (Amann Girrbach) which
is approved for long-term temporary
Finally, the adhesive caps were worked
in so that the temporary denture could
be screwed to the titanium bases in the
After the positive feedback from the patient,
we proceeded on the definitive work. The
model for this was the fully anatomical
situation of the temporary bridge.
DENTAL ASIA MAY / JUNE 2021
Behind the Scenes
Based on the ideal situation already
worked out, a new scan was performed
After completing the scanning process,
the frame was virtually adapted. The
design of the bridge framework was
started in the software.
As this was to be manufactured from the
millable Ceramill Sintron sintering metal,
the corresponding material parameters
had to be observed.
Initially, we designed a reduced wax-up
(Fig. 4). We reduced the tooth sections
so that the shape resembled a prepared
The gingival portion was also defined.
We had adopted the model, gingiva and
abutment situation for the scan.
Then, we screwed the matching
scanbodies onto the model analogues.
Due to the strong angulation of the
implant at 26, a 20° angled Camlog
titanium base had to be used.
This made it possible to optimise the
emergence of the occlusal screw
connection in the occlusal surface
PERFECT SYMBIOSIS OF
STABILITY AND AESTHETICS
For stability, Ceramill Sintron was used as
material for the bridge framework.
This is a so-called sintering metal, which
in its raw state has a wax-like consistency
and can be easily processed with desktop
As a result, the workflows have become
more efficient with significant increase in
the safety of the work process.
Sintering the milled structure led to a
biocompatible, stable, homogeneous
and distortion-free cobalt and chromium
(CoCr) frame (Figs. 6-7).
Hence, the casting and labour-intensive
finishing of CoCr is no longer necessary.
After checking the fit, we polished the
base to a high gloss and bonded the
bonding bases to the frame. Now, the
Sintron structure could be screwed onto
the model (Figs. 8-9).
This situation now formed the basis
for the aesthetic finalisation of the
The model including the Sintron bridge
was duplicated and another saw
model was produced; allowing for the
preparation margin of individual crowns
to be better displayed and checked.
This saw model was scanned and the
data obtained “matched” with the CAD
data of the temporary bridge enabling us
Fig. 10: For the construction of the single
crowns, the frame was duplicated together with
the model and a saw model was fabricated and
Fig. 11: The anterior teeth were labially reduced and the
posterior teeth were fully anatomically designed and
Fig. 12: The crowns were milled from the super highly
translucent zirconium oxide Zolid FX Multilayer
Fig. 13 Fig. 14 Fig. 15
Figs. 13-15: The finished ceramic crowns were bonded to the conditioned Ceramill Sintron frame using Multilink Hybrid Abutment
DENTAL ASIA MAY / JUNE 2021 63
Behind the Scenes
Fig. 16 Fig. 17
Figs. 16-17: The finished, fixed implant-supported bridge in situ. With the help of the described procedure, the patient was offered an inexpensive
restoration that meets the requirements for aesthetics and stability
to revert back again to the full anatomy of
the future crowns.
For aesthetic reasons, we reduced the
front labially to allow us to veneer it
individually with ceramics (Fig. 10).
Then, we chose the fully anatomical
shape for the posterior crowns which had
already proven itself for the temporary
For the monolithic crowns, we used
the highly translucent Ceramill Zolid
FX Multilayer zirconium oxide (Amann
This material enables the fabrication
of tooth structures and frames with an
integrated shade gradient. The soft colour
transitions are nature simulate enamel,
dentine and cervical shades, without
disturbing breaks in colour.
Such tooth-like pre-staining allows for
efficient and economical processing
without requiring a further manual
After the sintering process, the individual
crowns were adapted (Fig. 11).
The Zolid FX Multilayer crowns could be
individualised excellently with stains, so
that an aesthetic result could be achieved
without great layering efforts.
We added some life to the labially reduced
anterior crowns with minimal individual
layering by using zirconium oxide veneer
ceramic Noritake Cerabien ZR.
The CoCr frame was silanised in the
classic manner and opaqued (Fig. 12).
As a precaution, another try-in was made.
The crowns were provisionally bonded to
the frame and the gingival section was
modelled from pink wax.
The try-in is exciting for the patient,
clinician and for us. This is where it is
revealed whether the work was precise
and the transfer from analogue to digital
And for our case, the try-in showed
that our work approach, which always
followed the blueprint of the temporary
restoration, had proved to be effective.
The implant-supported bridge could thus
To condition the Zolid FX Multilayer
crowns, we used Monobond Plus (Ivoclar
Vivadent). The ceramic crowns were
finally bonded to the frame using Multilink
Hybrid Abutment (Ivoclar Vivadent).
Using different gingiva materials from the
Ceramage composite system (Shofu), we
created a natural-looking gingiva (Figs.
Such restorations inspire our patients
because they receive fixed dentures
despite tooth loss and do not have
to accept compromises in terms of
In the end, we all looked forward to the
day when the finished work could be
handed over to the patient.
After incorporating the implant
restoration, the screws were tightened
and the screw channels were closed. The
patient was happy and left the practice
with a completely new attitude to life. DA
About the author
2000. From 2000 to 2003, he was
employed by the Weber laboratory in
Ravensburg. He then worked in the
Stroppe-Jäger dental laboratory in
Lindau, where he gained experience in
all areas of dental technology. In 2010,
he successfully passed his Master’s
examination in Karlsruhe and Halle
– by taking external courses. Since
2017, he has been working with Rosa
Winterhalter as a business partner at
the Lindauer Zahntechnik GmbH in
DENTAL ASIA MAY / JUNE 2021
Behind the Scenes
Master Dental Technician Jürgen Freitag, Bad Homburg, Germany
Pressing and veneering on
a whole new level:
A true model of the future
for all-ceramic restorations
Master Dental Technician Jürgen Freitag from Bad Homburg,
Germany, shares his experiences using the VITA AMBRIA press
ceramic and describes his all-ceramic protocol in conjunction
with the VITA LUMEX AC universal veneering ceramic.
66 DENTAL ASIA MAY / JUNE 2021
Behind the Scenes
Despite the long-term success of CAD/
CAM, many dental laboratories still
use wax for modelling, investment,
burning out and pressing to manufacture
all-ceramic restorations. That is the reality of
Master Dental Technician Jürgen Freitag from
Bad Homburg, Germany, has already used
the new VITA AMBRIA press ceramic for more
than 50 restorations on 20 different patients.
In this interview, he shares his experiences
using the new material and describes his allceramic
protocol in conjunction with the VITA
LUMEX AC universal veneering ceramic.
Mr Freitag, switching to the VITA AMBRIA
lithium disilicate for your press ceramic,
have your work methods changed as a
My general work methods have not changed
at all with VITA AMBRIA. I simply use the
corresponding system components such as
the investment ring, investment materials,
liquid and plunger according to the working
instructions. There was also no difference in
the processing time.
Positive changes include the precision, vivid
aesthetics, and shade accuracy matching
the VITA shade standard that I am able to
What were the press results like after
devesting, and what did you notice
during the finishing process?
The reaction layer is minimal. During
devesting and sandblasting, the material
proved highly robust. I didn’t have to pay as
much attention as I usually would with other
During the testing phase, I used strong
sandblasting at 2.5 to 3 bar with a particle
size of 110μm without experiencing any
According to the usage instructions, the
particle size should only be 50μm and the
pressure 4 bar. Even when working with
abrasive rubber polishers, the material proved
to be extremely stable.
What was your experience with the fit and
marginal seal in the laboratory and on the
Because the reaction layer is minimal, the
restoration margins are clearly defined. The
interaction of the investment material and the
glass ceramic leads to dimensionally stable
After the finishing, I put the restorations on
the model and they fit. I received the same
feedback from the dental practice. There were
no problems with the fit during the integration
process, even with total reconstructions that
were more complex.
What possibilities do you see with the
interplay between VITA AMBRIA press
ceramic and the new VITA LUMEX AC
I have never truly experienced this kind of
modelling quality. Due to the particle size,
the veneering materials can be modelled
with a gentle touch. In combination with the
outstanding stability, I am able to achieve the
shape faster with fewer adjustments.
The cut-back with VITA AMBRIA and the
individualisation possible with VITA LUMEX
AC make it a true model of the future for me,
helping me to achieve high aesthetics quickly
and reliably. DA
Published in ZAHNTECHNIK MAGAZIN
07/2019, Spitta GmbH, Germany
VITA ® and other VITA products mentioned are
registered trademarks of VITA Zahnfabrik H.
Rauter GmbH & Co. KG, Bad Säckingen, Germany.
© Jürgen Freitag
© Jürgen Freitag
Veneers and full crowns, made with VITA AMBRIA and
VITA LUMEX AC, display an optimal fit and a versatile
interplay of shade and light
VITA LUMEX AC enables highly precise modelling thanks to
outstanding stability and based on optimal interlocking of
the ceramic particles through ideal particle size distribution
Cemented partial crowns on tooth 11 and 21 integrates
harmoniously with the natural tooth
DENTAL ASIA MAY / JUNE 2021 67
In Depth With
Photo courtesy of Dr. Andrew Brostek
GC Tri Plaque ID Gel
Root surface caries and cervical erosion
is a primary consideration for the ageing
population. Once exposed to the oral
environment, root surfaces are at greater
risk of demineralisation.
With exposed dentinal tubules, higher
incidence of cervical sensitivity is
observed, especially if saliva quality
and quantity is reduced. Exposed root
surfaces also have lower acid resistance,
and are much more susceptible than
Additionally, the area also serves as a
plaque trap as the exposed cementum
enamel junction (CEJ) is rough and rings
the root of a tooth.
For these reasons, exposed root surfaces
need extra protection. GC Dental offers a
variety of products to address this issue.
PROTECTION AND DESENSITISING
MI Varnish is a 5% NaF varnish, enhanced
with 2% RECALDENT (CPP-ACP) boosts
levels of calcium and peptide that work in
synergy with fluoride, thereby providing
significantly higher fluoride availability on
the tooth surface.
Featuring a durable hydrogenated
rosin matrix, this enhanced formulation
ensures MI Varnish provides longer lasting
protection from dentine hypersensitivity.
MI Varnish is easy to apply and can be
used at every recall appointment for
protecting exposed root surfaces and
avoiding dentine hypersensitivity.
ASSESSING RISK OF DEVELOPING
GC Tri Plaque ID Gel is a rapid plaquedisclosing
and plaque-fermentation test. It
helps the identification of areas where the
plaque has not been cleaned off.
For example, the areas that appear light
blue are of most concern, as these are
areas where a complex cariogenic biofilm
has developed. This plaque is producing
GC Tri Plaque ID Gel helps to educate
patients about plaque that remains on their
teeth after brushing, and it also shows how
compliant they have been in terms of home
care and reducing caries risk. DA
DENTAL ASIA MAY / JUNE 2021
In Depth With
More digital solutions
with the INITIAL Guided
As an integral part of the digital workflow, it allows practitioners
to anticipate and optimise their surgeries and to propose less
invasive and more treatment plans to their patients.
A SIMPLE SOLUTION FOR GUIDING
THE FIRST DRILLS
The new INITIAL Guided Surgery solution
guides the first drilling to ensure precise
positioning of the implant axis and
As an integral part of the digital workflow,
it allows practitioners to anticipate and
optimise their surgeries and to propose
more treatment plans to their patients.
The INITIAL Guided Surgery solution
enables practitioners to complete the
implant placement quickly and confidently.
COMPACT AND COMPLETE KIT
The INITIAL Guided Surgery Kit allows for
all types of surgeries to be performed on
both healed sites and immediately postextraction
Compact and ergonomic, it includes a
wide range of instruments.
This new offer, that will soon be
compatible with the main planning
software products available on the
market 1 , reflects how Anthogyr favours
INITIAL Guided Surgery is also beneficial
to the prosthodontist who will be able
to design and manufacture the surgical
Therefore, they will be able to use the
practical and manufacture the surgical
guides themselves in conjonction with
the practical and precise guide sleeves
developed specifically for this solution.
With its compact size in a narrow
mesiodistal space, the profile is specifically
designed to avoid any rotation in the
surgical guide during the operation. DA
1. Already compatible with Implant Studio,
coDiagnostiX, Romexis, Smop, and
Realguide. Soon available with Blue Sky
The INITIAL guided surgery solution was
launched in Europe in June 2020.
Dentsply Sirona Shofu
Streamline restorative workflow with “inject as you shape” convenience
The need for an easier, simpler and faster
workflow continues to grow in daily
restorative dental therapy.
Re-engineered nanotechnology with the
development of unique S-PRG nano-fillers
signals a new milestone for injectable
Beautifil Injectable X helps to streamline
restorative workflow by offering predictable
strength, durability, natural aesthetics
and the unique “Inject as you shape”
Patented S-PRG fillers impart anti-plaque
and anti-caries benefits for additional
protection and longevity of the restoration.
Uniform filler microstructure imparts
remarkable optical qualities for easy shade
match and effortless polish. What’s more,
restorations exhibit self-polishing capability
that helps maintain gloss and resists
Restore a wide spectrum of anterior and
posterior restorations with ease as users
can now shape while injecting the nondroopy,
shape retaining paste at the
Use of custom-made disposable Barrier
Sleeves with the ergonomically designed
Beautifil Injectable X syringe provides
additional protection against cross
contamination. Special syringe design
prevents oozing and minimal residual paste
in the tip for greater savings.
Beautifil Injectable X is available in two
distinct viscosities, 2.2 gm syringe:
• Beautifil Injectable X – Universal
• Beautifil Injectable XSL – Self-levelling
high strength Flow ■
Stainless-steel sleeve with a disposable window completes the
comprehensive hygiene concept of Primescan
Primescan, the intraoral scanner from
Dentsply Sirona, ensures high-quality
digital impressions and exceeds minimum
recommended hygiene guidelines. It is
the only scanner that provides a variety of
disinfection and sterilisation procedures
with three different sleeve options.
Completing its comprehensive hygiene
concept is the new autoclavable stainlesssteel
sleeve with a disposable window that
can be purchased separately.
The new stainless-steel sleeve completes
the comprehensive hygiene concept of
Primescan, which has a total of three
sleeves that can be reprocessed using
Autoclaving is the most commonly used
sterilisation process in dental practices and
helps minimise cross-contamination risk.
The high-quality, stainless steel sleeve with
exchangeable single-use windows can be
reprocessed in an autoclave.
On the other hand, the stainless-steel
sleeve with a scratch-resistant sapphire
crystal window can be reprocessed with
wipe disinfection, hot air sterilisation or
While the plastic sleeve is an alternative for
the highest hygiene requirements and can
be disposed of after each use.
All sleeves have a completely closed
viewing window to prevent liquid from
entering during scanning.
A SUITABLE SLEEVE FOR
These three options make taking digital
impressions as easy and hygienic as ever.
Primescan provides a variety of disinfection
and sterilisation procedures exceeding
minimum recommended hygiene guidelines.
Since legal requirements vary from country
to country and practice situations differ, it
is important that users can decide which
cleaning and disinfection option fits their
needs best. This way, practices are given
the option of following one of the five
common sterilisation procedures after
digital impression taking. ■
Due to different approval and registration
times, not all technologies and products are
immediately available in all countries.
DENTAL ASIA MAY / JUNE 2021
Checking the masticatory pressure conditions with OccluSense ®
Problems can often arise in restorations
with implants, as unbalanced masticatory
pressure can cause complications,
especially in cases of bruxism.
The periodontal ligament acts like a buffer
during occlusal loading to partially absorb
the force when a natural tooth is loaded.
This is not possible with an implant
that is connected with the bone by
osseointegration. This may result in fracture
of the prosthesis or damage of the alveolar
sensor colour coated in red, is a great help
in detecting incorrect loadings.
The patient’s masticatory pressure
distribution is digitally recorded in 256
pressure levels and transmitted via WLAN
to the OccluSense iPad app for further
The conventional colour transfer on the
patient’s occlusal surfaces makes it easier
for the dentist to assign the recorded data.
This data, which can be displayed as a
two- or three-dimensional graphic including
the masticatory pressure distribution at up
to 150 frames per second, can be saved in
the patient management of the iPad app,
viewed or exported any time.
With the means available in iPadOS, the
recorded data can be exported directly to a
shared network server or PC drive as a PDF
or video file and imported from there into
the patient management system. ■
Hence, checking the occlusal masticatory
pressure is essential to ensure that it is
balanced over the entire dental arch and for
protection of the superstructure and bone.
In this regard, Bausch’s OccluSense system,
with its 60µm thin disposable pressure
IPS Ivocolor: the universal stain and glaze system
IPS Ivocolor is a universal range of stain
and glaze materials for the press, CAD and
restorations. This allows them to work more
effectively, improve the economic efficiency
restorations due to select colour
layering ceramics from Ivoclar Vivadent. of the lab and achieve restorations of a
consistently high quality.
• Streamlined handling due to an
innovative paste formulation
Now, dental technicians only need one
assortment to customise and glaze their IPS Ivocolor is suitable for characterising
• High gloss obtainable at firing
temperatures as low as 710°
and glazing both high- and low-fusing
ceramic materials that fall within a CTE
• Untainted gloss results – no grey or
range between 9.5 and 16.6x10-6/K.
IPS Ivocolor is ideal for surface
Finely ground glass powders, select colour
compositions, pastes in a gel formulation
and matching liquids facilitate the working
characterisation of restorations, adjusting
the brightness of layering materials, and
customisation of cut-backs.
procedures and lead to aesthetically
outstanding results. The glazes provide
reliable firing results with exact shades.
In addition, it can be applied to shade
characterisations in layering technique for
individually shaded gingiva. IPS Ivocolor
Shade pastes is designed for shade
• Individual freedom in customising matching with A – D shades. ■
DENTAL ASIA MAY / JUNE 2021
CLEARFIL MAJESTY ES-2
Universal: single shade is all it takes
From the innovators of dental composite technology—Kuraray
Noritake Dental—comes a simplified solution for common
posterior restorations, independent of the underlying and
adjacent tooth structure.
→ THE REVOLUTIONARY
The single-shade concept of CLEARFIL MAJESTY ES-2
Universal composite does away with the need to determine
and select the right composite shade for posterior restorations,
thereby streamlining the restorative procedure and also saving
When using CLEARFIL MAJESTY ES-2 Universal, a single shade
is all it takes. The material also comes with exceptional handling,
excellent polishabilty and wear resistance properties.
Due to the material’s specific level of translucency and
the integration of Kuraray Noritake Dental’s Light Diffusion
Technology (LDT), a blocker or opaquer is not needed.
LDT makes restorations diffuse light in a way similar to natural
tooth structure, thereby enabling the composite to integrate
easily and smoothly into the preparation, resulting in virtually
→ best cutting efficiency and
maximum intraoperative control
→ perfect ergonomics
→ over 90 inserts specifically
designed for a wide variety
of clinical applications
→ more than 250 clinical and
“No other resin composite that I’ve tried restores posterior
cavities as simply and efficiently as CLEARFIL MAJESTY ES-2
Universal,” stated Dr Troy Schmedding. “The material eliminates
the need for shade selection and a simple monolayer technique
is all it takes to get optimal results. It also possesses a wide
blending effect and low shrinkage—everything I look for in
a composite—that’s why I consider it my ‘go-to’ material for
“We are committed to providing dental professionals with
innovative solutions that help them provide better care to their
patients,” said Dr Dinesh Sinha,
senior technical and marketing
manager of Kuraray Noritake.
“CLEARFIL MAJESTY ES-2
Universal composite builds
upon Kuraray Noritake’s
extensive knowledge of nanohybrid
polymer technology to
deliver a superior restorative
experience for dentists and
patients alike.” ■
DENTAL ASIA MAY / JUNE 2021 73
Kulzer introduces Ivory ReLeaf Minis hands-free suction solution
Kulzer, manufacturer of innovative dental
products, has launched Ivory ReLeaf
its location never has to be changed by the
Minis, which can be used with its topselling
and award-winning Ivory ReLeaf
hands-free suction system when treating
paediatric patients and adult patients with
small arches. The system delivers safety
and comfort to patients while enhancing
efficiency and ergonomics for dental
Ivory ReLeaf is an innovative, hands-free
HVE suction solution that assists with
evacuation, retraction and maintaining
a dry field during various hygiene and
dental procedures, including restorative
procedures, endodontics, periodontics,
orthodontics, ultrasonic scaling, sealants,
root planing and whitening.
The Ivory ReLeaf system consists of an HVE
hose with a quick disconnect adaptor on
one end for convenient connection to the
practice’s existing dental vacuum system,
and a u-shaped connector on the other end
into which a single-use “Leaf” is inserted.
The Leaf, which is BPA- and latex-free
designed to be soft for patient comfort, is
placed into the oral cavity and positioned
between the teeth and cheek. The Leaf
maintains highly effective suction and a
dry field while allowing the practitioner to
comfortably work in all four quadrants with
a full view of the oral cavity. Importantly, the
Leaf’s 280 degrees of suction means that
The ReLeaf Mini Leaf, which is approximately
25% smaller than the conventional Leaf but
fits the ReLeaf system’s same u-shaped
connector, is designed to work comfortably
with paediatric patients, elderly patients,
patients with TMJ problem, special needs
patients, and other patients with small arches.
ReLeaf Mini refills come in 100-count
packages featuring an assortment of green,
magenta and light blue colours. The handsfree
design and exceptional ergonomics of
the Ivory ReLeaf system can save practices
up to 15 minutes per patient.
In addition, patients appreciate not only
its superior comfort, but the fact that it
minimises backflow and aerosol risk while
making it much easier to communicate. ■
Bien-Air MX-i micromotor for implantology: integrated solution for
dental care units
Planmeca has a new addition to their
comprehensive Planmeca Compact i
instrument range − the Bien-Air MX-i
micromotor for implantology.
With this integrated solution, Planmeca’s
dental care units are even better adapted
to the requirements of different dental
specialties than before. The easy-to-use
micromotor and contra-angle bring several
benefits to daily clinical work, perfectly
complementing Planmeca’s fully digital
The Bien-Air MX-i implantology micromotor
is designed for implant surgery and used in
all its stages from initial drilling to implant
The micromotor can be integrated into all
Planmeca Compact i dental units with a
graphical user interface. It is used with the
Bien-Air CA 20:1 L contra-angle and a dental
unit integrated sterile water system.
BENEFITS OF A DENTAL UNIT
• Better ergonomics and a smoother
workflow compared to a tabletop device
• Quicker and easier setup and cleaning
• Used from the dental unit user
• Can be controlled using the same
foot control that is also used for other
• Easy to move from one room to
In a nutshell, Bien-Air MX-i LED and Bien-Air
CA 20:1 L Micro Series contra-angle are
powerful, durable and comfortable to use.
It is small, lightweight and fits perfectly
into smaller treatment areas, such as the
Unlike in most other handpieces, the sterile
water tube is attached to the bottom of the
handpiece instead of the tip, which helps
to ensure better ergonomics and more
efficient cooling. ■
DENTAL ASIA MAY / JUNE 2021
VOCO Retraction Paste: a must-have for every practice
The basis for a perfect impression is
an exposed and dry sulcus. With VOCO
Retraction Paste, which is applied directly
from the cap into the sulcus, VOCO is
introducing a product for the effective,
temporary opening of the sulcus and its
isolation from moisture.
Thanks to the slender and slightly flexible
cannula, it can be easily dosed and applied
directly into the sulcus. Also, the paste is
easy to press out due to its excellent flow
viscosity coupled with uniform stability for
opening of the sulcus.
During application, the aluminium chloride
VOCO Retraction Paste comes in a hygienic
SingleDose Cap, which is developed inhouse
by VOCO. The SingleDose Cap is
compatible with commercially available
composite dispensers such as the VOCO
Caps Dispenser, and is sufficient for up to
three sulci. ■
An ideal complement to the V-Posil
precision impression material, VOCO
Retraction Paste offers the prerequisites for
successful classic or digital impressions;
cavity preparation of class II or V
restorations; and for either permanent or
temporary cementing of restorations.
paste with astringent effect temporarily fills
the sulcus, which stops any bleeding and
Patients benefit from numerous advantages
too as VOCO Retraction Paste only requires
a short exposure time, has a neutral taste,
and can be easily and fully rinsed off.
The material impresses users not just
through its results, but also through its
handling. For example, the shade contrasts
well against the gingiva, facilitating the work
in hard-to-see areas in particular.
The paste can be used as an alternative to,
or in combination with a retraction thread,
and can be used in the classic way or
digitally, with an intraoral scanner.
CELEBRATING 30 YEARS WITH
AOS CHANGE - ARE WE READY?
2 – 11 JULY 2021
REGISTER ONLINE BEFORE 2 ND JUNE TO SECURE EARLY-BIRD DISCOUNT
CONNECT WITH US: aoscongress aoscongress +65 9622 9782 www.aoscongress.com Organised by: Event Manager:
DENTAL ASIA MAY / JUNE 2021 75
EASY view 3D: the innovative video microscope
Renfert’s EASY view 3D is an innovative Additionally, with this device, a dental
video microscope featuring a 3D monitor, technician’s work assumes a new
which is not only suited for viewing objects, dimension. The flexible boom arm can be
routine processing, and quality control; adjusted to any work situation and object,
but is also equally useful for educational, and the monitor is ergonomically and ideally
training, and documentation purposes.
located for an unobstructed view. The latter
is also especially developed for system
The EASY view 3D’s three-dimensional
compatibility, ensuring sharp high-definition
mode enables easy and natural hand-eye
coordination. Its three-dimensional spatial
representation is perfect for critically
The system is conveniently operated by
examining work objects. This helps
mouse and footswitch, thereby ensuring a
streamline the entire production process,
relaxed and healthy working posture.
and makes many routine tasks much more
On top of this, the easy-to-use and intuitive
Depending on the indication, a simple functionality of the EASY view 3D video
mouse click allows users to toggle between microscope helps users document work,
the 3D and 2D modes. The 2D mode is ideal share information and data with their team
for checking and viewing objects.
as well as the dentist’s practice.
“Enabling direct communication with the
dentist is one of EASY view’s top features.
You can show images directly and discuss
them whenever you want. In addition,
you sit much more comfortable at the
EASY view 3D video microscope than
over a microscope,” shared Master Dental
Technician Manja Stuhr, Thomas Scherz
Dental Ceramics from Berlin, Germany. ■
GC Asia Dental
The one that simplifies all cementation procedures
A common need among clinicians
worldwide is for a simplified adhesive and
self-adhesive cementation procedure
through one product that delivers high
aesthetics, exceptional bond strength, and
G-CEM ONE, the new self-adhesive resin
cement from GC, brings together high
adhesive performance and excellent selfcuring
ability for a wide range of indications
in one product solution.
G-CEM ONE gives clinicians the flexibility
of being effective in all adhesive and
self-adhesive procedures for any type of
restorations; from metal-based to resin and
all-ceramic inlays, onlays, crowns, bridges,
It demonstrates excellent bond strength to
enamel, dentin, and indirect restorations;
and delivers efficient bonding to retentive
preparations in just one syringe.
For increased bond strength in challenging
clinical situations, such as low retentive
surfaces, the optional Adhesion Enhancing
Primer (AEP) and its innovative GC Touch
Cure feature play an important role.
When applied to the tooth surface, the
chemical initiator in the AEP accelerates
the chemical cure of the cement to ensure
optimal bonding. The AEP is easy to use, no
additional light-curing is needed – simply
apply and air-dry.
Additional features are the optimised paste
rheology, an easy clean-up with one second
tack cure option and increased moisture
tolerance when the AEP is used.
The product offers clinicians a reduced
inventory with less components for a
reproducible workflow, making it a good
investment for clinics that value efficiency.
G-CEM ONE sets a high aesthetic standard;
resulting in invisible margins with high
wear resistance and long-lasting aesthetic
outcomes with virtually no post-operative
It is available in four shades: A2,
Translucent, AO3, BO1 (White Opaque). ■
DENTAL ASIA MAY / JUNE 2021
Mr Boris Ip, general manager of Thailand,
Malaysia, Hong Kong, Singapore and
Vietnam at Dentsply Sirona
more than 200
On 28 th March 2021, Dentsply Sirona
invited dental professionals to a special
virtual event: Five renowned experts as
well as a moderator debated the topic,
“Restoration of dark stump teeth with
CEREC”, in a roundtable discussion.
More than 200 dental professionals
from all over Asia were part of this
With the CEREC Roundtable, a
first-class online event took
place. Moderated by Dr Hsuan
Chen, a lecturer and trainer advisor to
the CEREC Asia Training Centre, the
speakers Drs Justin Giam (Singapore),
Suchada Kongkiatkamon (Thailand),
Ignatius Ronny Halim (Indonesia),
Perlin Loke (Malaysia) and Ryan Tse
(Hong Kong) shared their expertise on
a selected aesthetical case, which they
used to illustrate numerous aspects of
the CEREC workflow in detail.
This covered all aspects of the digital
workflow involving preparation
guidelines, scanning protocols,
selection of right materials, aesthetic
enhancement of CAD/CAM milled
restorations and cementation as well as
bonding protocols to ensure the longterm
success of restorations in dark
The participants of the virtual
event complimented the excellent
organisation and were particularly
impressed by the depth of the lively
discussion. Some clinicians outed
themselves as CEREC beginners and
were particularly interested in the
features of the CEREC Primescan and
the CEREC Primemill.
DENTAL ASIA MAY / JUNE 2021 77
Dr Agnes Wong, a general practitioner
from LQ Dental Singapore, enjoyed the
session very much.
“I haven’t used Dentsply Sirona products
before in my work. But attending this
Roundtable discussion has given me new
insights and I would like to start using
Primescan now,” she shared excitedly.
Mr Boris Ip, general manager of Thailand,
Malaysia, Hong Kong, Singapore and
Vietnam at Dentsply Sirona, was happy
about the positive feedback of attendees.
“Dentsply Sirona is committed to
empowering dental professionals through
innovation and education. Educational
courses like this CEREC Expert
Roundtable discussion support dentists
and their team members in their daily
work to provide the best possible care
to their patients and make people smile,”
he explained. “Last year, almost 7,300
courses [mainly online] were held in 80
countries with a total of more than one
million participants. This is unique.”
The CEREC Expert Roundtable,
organised out of Singapore, was held
in appreciation of the CEREC system
from Dentsply Sirona, which recently
celebrated its 35th anniversary. For many
users around the globe, CEREC has
since become a synonym for excellent
restorative treatment in a single visit.
It is of utmost importance to Dentsply
Sirona to support its customers in
efficiently and successfully using the
CEREC system in practice. In addition
to on-site training, this also includes an
extensive eLearning offering.
Many participants of the Roundtable
discussion reported that the future of
dentistry would be digital— and the future
Using digital technologies in dental
practices was essential to remain ahead
of the competition and, above all, to
achieve the best possible results for
patients, they said.
Mr Ip, concluded, “We are committed
to supporting our customers get the
knowledge, skills, inspiration and
certification they need to stay up-todate
as well as develop themselves and
their practices, during the pandemic and
DENTAL ASIA MAY / JUNE 2021
The benefits of digitisation are conclusive, according to the panel of
experts at the AG.Live CON panel discussion (from left to right: Prof Dr
med dent Florian Beuer, Siegbert Witkowski, Prof Dr med dent Daniel
Edelhoff, Wolfgang Reim, Prof Dr med dent Jan-Frederik Güth, Andreas
Kunz, Prof DDr Andreas Moritz, Falko Noack)
AG.Live CON highlights the
key trends of transformation
in the dental industry
Digitisation in the dental industry is
unstoppable. It heralds change and
offers enormous potential. The fact that
many dental technicians and dentists want to
seize these opportunities is reflected by the
large number of participants at AG.Live CON.
From 20 th to 24 th April 2021, 38 international
speakers presented the blueprints for a new
dimension of unified dentistry in numerous live
presentations and discussions.
The benefits of digitisation are clear, as Prof
Dr med dent Daniel Edelhoff explained in the
He stated, “In more clinical work processes,
analogue steps are being replaced by digital
technology, which brings about enormous
advantages such as the simplification of
procedures, reproducibility and a high degree
However, the communication gap between
dental technicians and dentists emerged as a
key issue in the panel.
“Laboratories have invested heavily over the
past few decades and digitised in the field
of CAD/CAM. However, digitisation currently
stops at the interface with the dentist,” said
Master Dental Technician Andreas Kunz
during the panel discussion.
The experts unanimously agreed that the
greatest deficit currently lies in combining
all available patient data in a meaningful
manner, and then using these data to provide
MORE THAN THE SUM OF ITS PARTS
Teamwork is the key factor for any successful
“For a complex restoration, you need a highly
competent partner in the laboratory and
DENTAL ASIA MAY / JUNE 2021 79
a highly competent clinician. Then, their
combined expertise is more than the sum of
the individual parts,” emphasised Prof Dr med
dent Florian Beuer.
The objective must be for the two to join
forces in the best possible manner.
This is precisely the mission that Amann
Girrbach has set itself. After five years of
development work, the company launched
The AG.Live is a web-based portal for
collaboration between laboratories and
dentists which offers seamless digital
services at all levels.
For instance, AG.Live used as a central tool
for digital case management; networking;
infrastructure and material management;
and support and knowledge database will
gradually replace the previous C3 customer
In addition, the platform networks machines
and materials in the laboratory, thereby
simplifying processes and increasing quality
However, the most notable feature is
providing a link in the growing global network
of digitally operating dental professionals.
This bridges the interdisciplinary gap
between dentists and dental technicians and
facilitates future-oriented cooperation.
In this network of optimised and new
partnerships, the participants can focus
on their strengths and better position
themselves on the market.
EXTENDING THE DIGITAL CERAMILL
CAD/CAM WORKFLOW TO THE
AG.Live also forms the basis and interface for
the Ceramill Direct Restoration System (DRS),
in which Amann Girrbach extends the digital
Ceramill CAD/CAM workflow to the dentist.
The Ceramill DRS Connection Kit – consisting
The Ceramill Direct Restoration System (DRS) joins dental technicians and practitioners together in an
interdisciplinary and future-oriented team and enables easy entry into same-day denture fabrication
of the Ceramill Map DRS intraoral scanner, the
appropriate scanning software as well as the
connection to the AG.Live platform – serves
as the entry-level variant.
Any order data including all the required
information can be shared seamlessly and in
real time, as the practice is linked fully digital
to the laboratory via AG.Live.
This permits same-day dentistry for simple
restorations, also with zirconia by using the
Ceramill DRS High-Speed Zirconia Kit.
Supplementing the range is the Ceramill
DRS Production Kit, which allows dentists
to perform the fabrication directly in the
Here, the laboratory can assist them in terms
of design, know-how, service and advice.
The workflow results to three Ceramill Team
Workflows, which can be used depending on
the kit equipment and team formation.
Due to the modular design, it is possible to
start on a small scale with the Ceramill DRS
Connection Kit and upgrade to the Ceramill
DRS Production Kit at a later stage.
Additionally, the Ceramill DRS system is fully
integrated - all components are compatible
with each other and originate from a single
Thus, Amann Girrbach takes full responsibility
for service, support and the final restoration.
Availability of the individual kits can be
requested from the respective dealership.
AG.Live and DRS as well as all digitisation
solutions from Amann Girrbach support
practices and laboratories on a journey that
Prof Dr med dent Jan-Frederik Güth described
as, “Patient-oriented, focused, personalised,
team-oriented, simplified and digital - that’s
where the journey is headed.” DA
AG.Live as a digital platform paves the way for smooth
DENTAL ASIA MAY / JUNE 2021 81
Giving Back to Society
Align Technology donation benefits America’s ToothFairy Oral Health
Tooth decay is the most prevalent childhood
disease, and—if left untreated—can lead to
pain, embarrassment, and life-threatening
In the United States, children aged two to
11 from low-income households have more
severe cases of tooth decay and are less likely
to have access to dental care.
In an ongoing effort to spread awareness
of the consequences of poor oral hygiene
and educate children about how to maintain
healthy smiles, Align Technology, a global
medical device company with industryleading
innovative products including the
Invisalign ® system, iTero ® intraoral scanners
and digital services, and exocad CAD/CAM
software, is working with America’s ToothFairy
as title sponsor of its Health Education
Resources and Outreach (HERO) Programme.
The community outreach programme
provides oral health education resources
to non-profit dental clinics, public health
organisations, educators and volunteers.
Align’s recent US$100,000 donation marks
their 13 th year of support for America’s
ToothFairy, a non-profit organisation that
provides resources to safety-net dental
clinics and oral health organisations serving
children with restricted access to dental care.
To date, Align has provided more than US$1.8
million dollars toward operational expenses
and children’s oral health programmes,
helping nearly 8.9 million children and their
caregivers learn about the prevention of
“At Align we understand that a healthy,
beautiful smile can have an enormous
impact on a child’s self-esteem and future
success,” said Julie Paulsen, vice president
of Corporate Social Responsibility at Align
Technology, and member of the Board of
Directors at America’s ToothFairy. “We are
proud to partner with America’s ToothFairy
and support their efforts to ensure that more
children have access to dental care and
Henry Schein donates more than 10 million personal protective
Henry Schein, Inc., the world’s largest
provider of health care solutions to officebased
dental and medical practitioners,
has donated more than 10 million items
of personal protective equipment (PPE)
and supplies worth millions of dollars to
enhance the safety of frontline health care
professionals, social service providers,
underserved populations, and people with
The donation includes face shields, hand
sanitiser, isolation gowns, thermometers,
coveralls, and face masks, and will be
received by seven non-governmental
organisations (NGOs) who will distribute
the supplies in more than 40 countries and
Henry Schein’s global distribution and supply
chain network managed the donation working
through Henry Schein Cares, the company’s
corporate social responsibility programme.
The recipients are: Americares, Direct Relief,
International College of Dentists, MAP
International, MedShare, Project HOPE, and
These NGOs will receive the PPE and
distribute the items among hospitals, longterm
care facilities, outreach and partner
clinics, and free and charitable clinics helping
to provide primary and oral care, maternal
and child health, and infectious disease
control and prevention in the United States
Donations will also support the current
response to the COVID-19 pandemic and
be pre-positioned in preparation for other
disease outbreaks and humanitarian crises as
well as natural disasters.
“This donation reflects our continued sense
of purpose and commitment to values that
make the world a better place,” said Stanley
M. Bergman, chairman of the board and chief
executive officer of Henry Schein, Inc. “In
keeping with our higher ambition of aligning
our capabilities with the needs of society,
we aim to ‘help health happen’ by enhancing
health equity, improving access to care,
and providing for the safety of health care
professionals and patients. Henry Schein is
pleased to be working with our valued NGO
partners in this important endeavour.” ■
DENTAL ASIA MAY / JUNE 2021
2021 EVENTS CALENDAR
3 – 8 Goethe University Frankfurt / ICOI Hybrid Implant
6 – 8 ADX 2021 - Melbourne
Venue: Melbourne Convention Exhibition Centre
10 – 13 Dental South China 2021
4 – 6 14th Asian Congress on Oral & Maxillofacial Surgery
4 – 6 18 th Seoul Inxternational Dental Exhibition & Scientific
Congress (SIDEX) 2021
Seoul, South Korea
9 – 12 26 th Sino-Dental ® 2021
Venue: China National Convention Center
10 – 13 28 th IAPD Virtual Congress
25 – 26 Dental International Congress and Exhibition
26 – 28 Dubai World Dental Meeting (DWDM) 2021
Venue: Novotel Hotel
29 June – 1 July
25 th UAE International Dental Conference & Arab
Venue: Dubai World Trade Center
2 – 11 Association of Orthodontists (Singapore) Congress
2021 Online Edition
21 – 24 The 2021 IADR/AADR/CADR General Session
26-27 27 th World Congress on Dentistry and Oral Health
12 – 14 Vietnam Medi-Pharm Expo 2021
Ho Chi Min City, Vietnam
Venue: Saigon Exhibition and Convention Centre
12 – 14 12 th IFEA World Endodontic Congress
21 – 22 3 rd International Conference on Dentistry & Oral
23 – 25 5 th International Conference on Dentistry
Charlotte, United States
28 – 29 Dentsply Sirona World Taiwan 2021
Venue: The Lin Palace
With the evolving COVID-19 situation, kindly check with organisers for updates on the related
events. Please refer to the local airports’ websites for the latest travel advisories too.
MAY / JUNE 2021 DENTAL ASIA
3Shape A/S 29
Amann Girrbach AG 65
Anthogyr France 3
AOSC 2021 75
Carestream Dental 43
brand through our
exocad GmbH 1
IDS Cologne 11
Shofu inc 71
SINO Dental 2021 80
For information, visit us www.dentalasia.net or
contact us at email@example.com
Company Registration No: 200001473N
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DENTAL ASIA MAY / JUNE 2021
Still the force
in bone surgery
Minimally invasive, maximally effective
Piezomed puts all the advantages of innovative ultrasound
technology at your fingertips: High-frequency microvibrations
allow cutting with incredible precision. In addition, with the
so-called cavitation effect you can also ensure an almost
blood-free surgical site.
Scan and connect
digitally. Or treat it
in a single visit.
Either way, it‘s prime.
Enjoy the scan.
With the connectivity options of Primescan.
Find out more on dentsplysirona.com/primescan