Dental Asia May/June 2021


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

MAY / JUNE 2021



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12 Expanding the reach of telehealth in Asia


16 Welcoming a sustainable future


18 Inform, inspire, educate

22 Preserving health, enhancing smile


26 3Shape advances digital revolution

32 DentalMonitoring: Building the future of

connected orthodontics


36 Vertical ridge augmentation using guided bone

regeneration technique

41 The next generation of CBCT system


46 Individual periodontitis aftercare

49 AutoSWEEPS modality of SkyPulse Endo

Er:YAG Laser

53 Maximum curve control


61 Zirconium oxide meets sintering metal

66 Pressing and veneering on a whole new level: A

true model of the future for all-ceramic



68 Protecting exposed root surface

69 More digital solutions with the INITIAL Guided

Surgery Kit


77 Successful CEREC Roundtable with more than

200 participants

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




Bone Level

REG & PX designs for

biological integration

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

everyday practice.

First Words

Closer look on both sides

of the spectrum

Czarmaine Masigla

Assistant Editor

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.



Publications Director

Senior Editor

Assistant Editor

Graphic Designer

Circulation Manager


General Manager


Senior Editor

William Pang

Jamie Tan

Pang Yanrong

Czarmaine Masigla

Liu Yu

Shu Ai Ling

Ellen Gao

Sharon Wu

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.



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)



Tel: +86-10-6509-7728




Scan for digital copy



Tel: +86-21-52389737



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

HyFlex EDM


Æ Safer use

Æ Preparation following the anatomy

Æ Regeneration for reuse

006650 03.21

Dental Updates

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

on file.



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

of experience.

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

the go.

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 Updates

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

more self-conscious.

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.

Fig. 1




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

“Zoom Phenomenon”.

“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.

Increased self-confidence

(79%) was the most often

cited benefit of a healthy

and beautiful smile, above

improving aesthetic

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

X-ers (29%).



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. ■



Carestream Dental partners with

Rapid Shape

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.



COMBI touch

“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.



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

chairside aligners.

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.




ad_ct_dental_asia_95x250_en_201210.indd 1 10.12.20 14

Dental Updates

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

Automate website.

“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

of FullContour.

The AI powered design service was rigorously

tested for months under the name Express

Crown by the 3Shape owned design service,

FullContour. ■

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 Updates

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

various sources.

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.” ■





22. – 25.09.2021



Koelnmesse GmbH

Messeplatz 1

50679 Köln · Germany

Tel. +49 180 677 3577





IDS_2021_Anzeige_Dental_Asia_190x125mm_Int_GB.indd 1 22.04.21 10:51



the reach of

telehealth in

Asia Pacific

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.



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

Asset light



Care impact




care access









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

today’s challenges.

Integrated Standalone


D: Service coverage along patient journey by business model [non-exhaustive]

Fig. 1: Source: Telemedicine Roland Berger business model archetypes


business models




care access

Primary care+







Asset light




2: Service




along patient journey by business model (non-exhaustive)




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

one-size-fits-all solution.

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.

Patient journey

> 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

(symptom driven)

> Doctor & hospital rating

> GP teleconsultation (ediagnosis,


> Specialist teleconsultation

> Online booking

> Telehealth kiosks, etc.

> Provider education

platform (diagnosis,

disease detection, referral)

> Online drug delivery

> Specialist teleconsultation

> Online drug delivery

> e-ICU

> Provider education

platform (Tx)

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+

Access, Organisation-to-Organisation

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.



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.


Diagnostic centre

(e.g. DXA)

Health insurers can digitally steer their

customers toward a network of preferred




specialist / surgeon

Physical Therapist





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






Health check-up

Health awareness:

dietary, lifestyle

Clinical wellness

Nutrition planning





General, TCM,











Expert +



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)

> …

Express drug
















> Seamless


– Closed-loop

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Welcoming a



Working towards a

sustainable future, W&H

Dentalwerk utilises the latest

environmental technology

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




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

the company.

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


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.


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



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

native language.

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.


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.


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



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 explained.

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.


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

minimising waste.

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


Under the Spotlight

Preserving health,

enhancing smile

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.



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

treatment plan

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

standard protocol.

From a kid who was afraid of dentists, he now

manages his own dental practice in Petaling

Jaya, Malaysia, aiming to deliver healthy and

life-changing smiles.


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

of accomplishment.

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.


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


Under the Spotlight

while minimally invasive treatment covers

restorative work with composite and less- or

minimum-prep veneers.

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.



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

or Instagram.

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

of dentists.

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



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Dental Profile

3Shape advances

digital revolution

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 Profile

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.


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

and challenges.

“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

in-person training.

“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 Profile

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

scanner tips.

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.





is simply in

your hands



3Shape TRIOS® 4 provides

efficient and simplified routine

intraoral scanning, enabling

you to focus on achieving

outstanding treatment

outcomes and making

more patients smile.




Color impression

and surface caries

scan in just one


Instant heat

smart tips

Scan-ready in

seconds for a

no-wait scanning


Wired and

wireless in one

Flexible power

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

Dental Profile

“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

and production.

“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.


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,”

she said.

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

concluded. DA

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

( where visitors

can explore essential insights

and know-how from digital dental




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.



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Dental Profile


Building the future of

connected orthodontics

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.



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

development (R&D).

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-clinic appointments.

In addition, the platform can adapt to the

needs and preferences of each dental



Dental Profile

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

seamless shift.

“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


Dental Profile

“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

orthodontic patients.


With the pandemic situation directly

impacting market trends, it has

projected dental professionals

towards rapid and massive adoption of

connected solutions.

“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

connected solutions.

“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

their innovations.

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

patient’s experience.

“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



Clinical Feature

Vertical ridge augmentation

using guided bone

regeneration technique

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.



Clinical Feature


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

health issues.

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

the treatment.

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

(Fig. 1).

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

Derivatives) treatment.

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

porcelain veneer

• 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. 1

Fig. 2 Fig. 3

Fig. 4 Fig. 5 Fig. 6


Clinical Feature

Fig. 7

Fig. 8 Fig. 9

Fig. 10

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.



Clinical Feature

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

regenerated bone.

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

(Fig. 21).

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

(Figs. 22-23).

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

natural tooth.

It is also important to use a mechanically

stable membrane such as titanium-reinforced

d-PTFE membrane to offer a closed and

Fig. 16

Fig. 17 Fig. 18

Fig. 19

Fig. 20 Fig. 21

Fig. 22 Fig. 23 Fig. 24


Clinical Feature

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

Res 94:187S-193S

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-

64; 151-173

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.

His post-graduate

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.



Clinical Feature

The next generation of

CBCT system

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.


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

to 16x17cm.

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


Clinical Feature

target a single tooth on the arch. The

images are excellent for implantology

as well.”

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

analyse both.

Root canal assessment using 5x5cm field of view and

75-microns resolution

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

the orbit.

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




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

became clear.

“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



Clinical Feature

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

Dr Diss.

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





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

organised workflow.

“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.



Clinical Feature

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.”



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,”

he remarked.


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


User Report


periodontitis aftercare

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

many years.

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.



User Report

In addition, root caries was diagnosed at a

number of points. The patient has now been

attending recall appointments with me regularly

since 2014.




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

masticatory function.

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.




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

external conditions.

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

carious lesions.

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


User Report

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

(Fig. 2)







3. Joss A, Adler R, Lang NP. Bleeding on probing.

A parameter for monitoring periodontal

conditions ibn clinical practice. J Clin

Periodontol 1994:21(6):402-8.

4. Lang NP, Joss A, Orsanic T, Gusberti FA,

Siegrist BE. Bleeding on probing fort he

progression of periodontal disease. J Clin

Periodontol 1986:13(6):590-6.

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

the years.

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.



User Report

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

endodontic treatments.

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


User Report

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 .


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

irrigant streaming.

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



User Report

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

17, 22

primary bubble generated by the first laser pulse (Tres ≈ 0.9 x TB)

(Fig. 5).

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

(Fig. 7).


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,

19, 21

. 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


User Report

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,

Dec. 2009.

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,

Mar. 2012.

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,

doi: 10.1007/s00784-015-1562-9.

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,”

Photobiomodulation Photomed. Laser Surg., vol. 37, no. 9, pp. 544–550,

Sep. 2019.

22. M. Lukač, N. Lukač, and M. Jezeršek, “Characteristics of Bubble Oscillations

During Laser-Activated Irrigation of Root Canals and Method of

Improvement,” Lasers Surg. Med., Feb. 2020.

23. Q Yang, MW Liu, LX Zhu, and B Peng, “Micro-CT study on the removal of

accumulated hard-tissue debris from the root canal system of mandibular

molars when using a novel laser-activated irri-gation approach,” Int. Endod.

J., vol. 53, no. 4, pp. 529–538, 2020.

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 ® .



User Report


curve control

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.


User Report

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

instrumentation are:

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.


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




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.



User Report

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

al., 2010).

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

invasive dentistry.

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.


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

called superelasticity.

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).


User Report

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

specialist, COLTENE.

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

canal instrumentations.

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

from M-wire.

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

relevant temperatures.

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



User Report

for the instrumentation of highly curved and

complicated canals.


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

and 60/.02).

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

(Fig. 3).

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

trickier situations.



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. 4a

Fig. 4b

Fig. 4c

Fig. 4d Fig. 4e Fig. 4f


User Report

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


Fig. 4g

Figs. 4 a-h: Tactile Controlled Activation (TCA) technique explained

Fig. 4h

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

confirmation follows.

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.





One Curve

A range of single files, in continuous rotation

C.WIRE Heat Treatment

The Endo DNA









more resistant*

to fracture (cyclic fatigue)

*in comparison with conventional NiTi

Data MicroMega R&D

(One Curve 25.06 vs One Shape 25.06)

Safety optimisation

Treats all canal anatomies

006649 03.21

User Report

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

anatomy itself.

The TCA technique minimises the time files

are under engagement. This procedure

maintains a continuous tactile feedback

during instrumentation.

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

19: 114-8.

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

tomography study.

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].

20. Pedulla E, Lo Savio F, Boninelli S, Plotino

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

Endodontic Journal.

22. ColteneEndo. (2019) File sequence step by

step card. Available at: https://www.coltene.



23. Chaniotis A, Filippatos C (2017) Root Canal

treatment of a dilacerated mandibular

premolar using a novel instrumentation

approach. A case report. International

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

the three-year

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

dentistry UK.

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

Endodontists (AAE).



Behind the Scenes

Zirconium oxide meets

sintering metal

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

case study.

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.



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

temporary restoration.

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


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. 6

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. 7

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.



Behind the Scenes

Based on the ideal situation already

worked out, a new scan was performed

(Figs. 1-3).

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

(Fig. 5).



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

milling machines.

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

scanned in

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


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

has worked.

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

be completed.

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

DMT David

May (Germany)

completed his

dental technician

training in

Stuttgart, in

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




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.


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

the situation.

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

press ceramics.

During the testing phase, I used strong

sandblasting at 2.5 to 3 bar with a particle

size of 110μm without experiencing any

negative effects.

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

veneering ceramic?

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


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


In Depth With

Protecting exposed

root surface

Photo courtesy of Dr. Andrew Brostek

MI Varnish

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.



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.



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



In Depth With

More digital solutions

with the INITIAL Guided

Surgery Kit

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.



The new INITIAL Guided Surgery solution

guides the first drilling to ensure precise

positioning of the implant axis and

emergence point.

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.


The INITIAL Guided Surgery Kit allows for

all types of surgeries to be performed on

both healed sites and immediately postextraction

implant sites.

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

guides themselves.

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.

Product Highlights

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

surface staining.

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

restoration site.

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

different procedures.

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

high-level disinfection.

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.




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.



Product Highlights


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

Ivoclar Vivadent

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

white discolouration

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. ■



Kuraray Noritake


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 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

invisible margins.

→ 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

scientific studies

“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

posterior restorations.”

“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.


Universal composite builds

upon Kuraray Noritake’s

extensive knowledge of nanohybrid

polymer technology to

deliver a superior restorative

experience for dentists and

patients alike.” ■



Product Highlights


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

implant workflow.

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.




• 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

posterior regions.

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. ■



Product Highlights

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

eliminates moisture.

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.





2 – 11 JULY 2021




AOSC 2021













































CONNECT WITH US: aoscongress aoscongress +65 9622 9782 Organised by: Event Manager:


Product Highlights


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

image reproduction.

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

effortless clean-up.

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,

and posts.

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). ■



Show Review

Mr Boris Ip, general manager of Thailand,

Malaysia, Hong Kong, Singapore and

Vietnam at Dentsply Sirona

Successful CEREC

Roundtable with

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

interactive event.

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

stump cases.

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.


Show Review

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

is now.

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

beyond.” DA



Show Review

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

panel discussion.

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

of predictability.“

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

patient-specific treatment.


Teamwork is the key factor for any successful


“For a complex restoration, you need a highly

competent partner in the laboratory and


Show Review

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

and reproducibility.

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.




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

interdisciplinary collaboration


Giving Back to Society

Align Technology donation benefits America’s ToothFairy Oral Health

Education Programme

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

dental disease.

“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

education.” ■

Henry Schein donates more than 10 million personal protective

equipment items

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

intellectual disabilities.

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

Special Olympics.

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

and worldwide.

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.” ■





3 – 8 Goethe University Frankfurt / ICOI Hybrid Implant


Frankfurt, Germany

6 – 8 ADX 2021 - Melbourne

Melbourne, Australia

Venue: Melbourne Convention Exhibition Centre

10 – 13 Dental South China 2021


Guangzhou, China

4 – 6 14th Asian Congress on Oral & Maxillofacial Surgery


4 – 6 18 th Seoul Inxternational Dental Exhibition & Scientific

Congress (SIDEX) 2021

Seoul, South Korea

Venue: COEX

9 – 12 26 th Sino-Dental ® 2021

Beijing, China

Venue: China National Convention Center

10 – 13 28 th IAPD Virtual Congress

25 – 26 Dental International Congress and Exhibition

(Virtual Conference)

26 – 28 Dubai World Dental Meeting (DWDM) 2021

Dubai, UAE

Venue: Novotel Hotel

29 June – 1 July

25 th UAE International Dental Conference & Arab

Dental Exhibition


Dubai, UAE

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


Chennai, India

23 – 25 5 th International Conference on Dentistry

Charlotte, United States

28 – 29 Dentsply Sirona World Taiwan 2021

Kaohsiung, Taiwan

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.



Advertisers’ Index



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Align Technology


Amann Girrbach AG 65

Anthogyr France 3

AOSC 2021 75

Carestream Dental 43



DentalMonitoring 33

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It’s safe.

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brand through our

media platforms.

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