Dental Asia September/October 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.


Dental Profile:

3D Systems as a

forerunner in digital


User Report:

Harness the power

of air with the Primea

Advanced Air turbine


Behind the Scenes:

Maxillary premolar

inlay restorations with

Permanent Crown


Photo Courtesy of 3D Systems

A leading and reputable media platform in Asia and internationally that provides educational

multidisciplinary scope for every profession in the dental industry.

Consistently sharing continuous progression in the industry through informative, objective features

with a team of internationally acclaimed dental professionals in the Advisory Board.

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audiences in the dental industry.

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16 The digitisation of practices

18 Bioflavonoid spray efficacy against

respiratory viruses


22 Envisioning the future of orthodontics


26 exocad with its largest-ever presence

at the IDS 2021: 12 software demo

stations for DentalCAD, ChairsideCAD,

and exoplan

30 3D Systems as a forerunner in digital



34 Updated literature review on

accelerated orthodontics with

relevant case reports

38 Aesthetic restoration at the gingiva

42 Be selfie ready


48 Harness the power of air with

the Primea Advanced Air turbine


52 Apicoectomy — Chronic apical

periodontitis treatment


54 New era in all-ceramics

56 Maxillary premolar inlay restorations

with Permanent Crown Resin


60 Treatment solutions for Molar Incisor


62 Axiom BL ® : when convenience meets


63 Digital endo assistance: CanalPro

Jeni Endo Motor navigates through


64 Versatile solutions for successful

bone and tissue regeneration


69 AOSC 2021 Online Edition performed

beyond expectations


70 IDS 2021 prepares for the

international dental industry

72 Rediscover dentistry at the 23 rd CSA

Annual Meeting and 2021 China

Dental Show

73 Dentsply Sirona World 2021: Back to

a live event


4 First Words

6 Dental Updates

65 Product Highlights

74 Giving Back to Society

75 Events Calendar

76 Advertisers’ Index







First Words

Momentum builds success

The evolving variants of the COVID-19 virus

have continued to affect healthcare systems

worldwide. As if in a race, the vaccination

drive and virus mutation are moving headto-head.

Thus, policies are constantly

changing, and strict border controls are still


For the dental industry, however, there is no

slowing down. In fact, the 39 th International

Dental Show (IDS) will open its door in

Cologne, Germany, from 22 to 25 September

2021, where dental professionals and

companies can network and have personal

dialogues under the necessary measures

deemed relevant by the responsible health

authorities (p.70).

In line with this, dental companies such as

exocad are looking forward to the event. Mr

Novica Savic, the company’s CCO, shares

what visitors can expect at the exocad

booth and other insights regarding their

participation at the IDS 2021 (p.26).

This issue also features Mr Stef Vanneste,

vice-president and general manager of

Dental at 3D Systems, giving light on how

the company revolutionises the industry with

their wide range of trusted and reliable digital

solutions (p.30).

Moving forward, dental professionals

have also continued to demonstrate

unwavering efforts in adapting to this

challenging situation.

For instance, Dr Zeeshan Sheikh, Dr

Henriette Lerner, and Dr George Freedman

tackle a practical approach of using

an oral spray to create a barrier on the

mucosa of the mouth and throat, and

boost host protection (p.18).

Dr Seojung Park, the executive director

of the Orthodontic Branch at Korea

Association of Digital Dentistry, shares her

journey in digital orthodontics and how it

became beneficial to her and her patients

during this time (p.22).

In the past year, the key players in the

dental industry have shown resilience and

solidarity. May we find inspiration from

each other to move forward and face the

future with optimism.

Czarmaine Masigla

Assistant Editor



Publications Director

Senior Editor

Assistant Editor

Graphic Designer

Circulation Manager


General Manager



William Pang

Jamie Tan

Pang Yanrong

Czarmaine Masigla

Liu Yu

Goh Meng Yong

Shu Ai Ling

Ellen Gao

Daisy Wang



3 Ang Mo Kio Street 62 #01-23

Link@AMK, Singapore 569139

Tel: (65) 62665512



Company Registration No.: 200001473N

Singapore MICA (P) No. 089/01/2021

Malaysia KDN: PPS1528/07/2013 (022978)



Tel: +86-10-6509-7728






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

Dental Updates

SOTA Imaging launches extraoral aerosol evacuator designed to help

mitigate COVID-19 risk

SOTA Imaging, leading manufacturer of

dental imaging hardware, software, and

accessories, has launched Cazoo, an

extraoral aerosol evacuator that reduces

dental aerosols, helping protect dentists,

dental staff, and patients from dangerous

particulates that can transmit COVID-19.

Safeguards to protect dental staff are

of particular importance today with the

majority of hiring dentists reporting

recruitment challenges. Dental staff who

are in the workplace, or are considering

returning to the workplace, need to feel

safe and protected.

“Many shortages, especially in dental

hygiene and chairside assistant, existed

prior to the COVID-19 virus,” said Duc

“Duke” M. Ho, DDS, chair of the ADA

Council on Dental Practice, to ADA News.

“However, these shortages have been

exacerbated by the pandemic, as more

employees have left the workforce for

a variety of reasons, including early

retirement, concerns about safety at

the time and a desire for more work-life


Cazoo connects directly to standard

high-volume evacuator (HVE) lines,

allowing dental practices to quickly begin

reducing aerosols. With an extraoral HVE

attachment in place, dental practices can

significantly reduce airborne particulates.

In fact, research shows a reduction

of particulates by up to 90.8% when

compared to an intraorally positioned

standard saliva ejector. Cazoo can be

applied using a lip attachment or can be

attached to most leading cheek retractors.

“Cazoo was designed to help mitigate the

risk of COVID-19,” said Albert Kim, vicepresident

of SOTA Imaging. “It not only

helps reduce dental aerosols in a costeffective

way, it’s also easy to incorporate

into virtually any dental practice.”

A splash guard (sold separately) can

also be attached to Cazoo for additional

protection from aerosols. The ability to

apply directly on the lip or use a cheek

retractor allows for hands-free use. An

arm accessory (sold separately) is also

available, providing practitioners the

ability to precisely position Cazoo and

further enable two-hand dentistry and

hygiene procedures. ■

SprintRay introduces new NightGuard Materials

SprintRay, manufacturer of dentistry’s

leading solution for in-office production,

has introduced two all-new 3D printing

resins: NightGuard Flex and NightGuard

Firm. These revelatory materials will allow

dental professionals to use the SprintRay

frictionless ecosystem to design, print,

process, and place 3D-printed flexible and

rigid nightguards in-house.

These new resins will allow clinicians to

unlock revenue streams and cut treatment

lead times for occlusal care, empowering

them to compete with DTC (direct-toconsumer)

offerings on convenience while

delivering fully supervised care.

SprintRay, thanks to its unique Cloud

Design lab service and full ecosystem of

3D manufacturing products, is uniquely

positioned to help dental professionals

deliver more occlusal guards to those who

need them with these two new materials:

• NightGuard Flex, formulated to be the

fastest, most comfortable 3D-printed

nightguard in dentistry

• NightGuard Firm, a fast-printing rigid

splint resin with industry-leading

strength and aesthetics

“With NightGuard Flex, we’re able to

provide a comfortable occlusal guard

that’s easy for the dentist to deliver while

being comfortable and flavourless for

patient satisfaction. This material has

been clinically developed from scratch

to help dentists address rising occlusal

issues,” said Ehsan Barjasteh, head

of SprintRay Resin Development. “As

parafunctional habits like grinding and

clenching are on the rise, our NightGuard

resins will play a key role in helping

doctors provide fast, cost-effective,

long-term relief to thousands of patients

across the world.” ■



Anthogyr Simeda Luxembourg

and DOCERAM Medical Ceramics

expand their strategic cooperation

Anthogyr Simeda Luxembourg and DOCERAM Medical Ceramics

GmbH from Dortmund, Germany, have further expanded their

strategic cooperation. This means that customers will receive ceramic

restorations combining the best of both worlds — implants and dental

ceramics. The result will be high-quality restorations that fulfil all the

requirements in terms of technical perfection and aesthetics. Both

companies have considered that the cooperation will put them in an

excellent position for all the future challenges in the dental market.

Dr Karl-Heinz Klotz, director of Business Unit at DOCERAM Medical

Ceramics GmbH, said: “We are very happy about the flourishing

cooperation with Anthogyr Simeda. We have come to know and

appreciate them as a very agile and innovative company in the dental

market. With Anthogyr Simeda, another internationally active milling

centre recognises the potential of Nacera® Pearl Natural. We see

the integration of Pearl Natural as a starting point for a mutually

successful future.”



COMBI touch



→ 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

The first project carried out by this closer partnership is the use of

Nacera® Pearl Natural ceramic for Simeda® implant-supported

zirconium oxide restorations, including the AxIN® single tooth

restoration with non-adhesive bonding, without adhesive or cement,

as well as angulated screw access.

These include implant bridges on multi-unit abutments or inLink

retaining screws, which can also be used with the option of nonadhesive

bonding, without adhesive or cement, as well as angulated

screw access. As a result, the customer receives a biologically safe

restoration that takes into account the natural anatomy of the tooth.

Sebastian Gronsfeld, executive manager of Anthogyr Centre, said:

“There are numerous suppliers of zirconium oxide. At Anthogyr

Simeda, we always want to deliver the best quality to our customers,

for which we need a top-quality base product. Nacera® Pearl Natural

is a perfect fit. With DOCERAM Medical Ceramics, we believe that

we have a material expert as a partner with whom we are ideally

prepared for future challenges in the fast-moving dental market.” ■



ad_ct_dental_asia_95x250_en_201210.indd 1 10.12.20 14:42

Dental Updates

A-dec partners with Surgically Clean Air

A-dec, one of the largest privately-owned

dental equipment manufacturers in the

United States, has partnered with Surgically

Clean Air to provide air purifying products to

the dental industry.

Surgically Clean Air’s JADE Air Purifier,

which will be offered to the dental industry

exclusively by A-dec, is an industry-leading

air purification system, with premium,

contemporary styling, and performance at

the forefront of its design.

Marv Nelson, president of A-dec, has

announced the partnership to employees

and partners: “A-dec’s mission is to support

the betterment of dentistry worldwide.

Our partnership with Surgically Clean Air

represents our unwavering commitment to

helping our customers maintain a safe and

healthy environment for their practice, team,

and patients. Combining the innovation that

Surgically Clean Air has accomplished with

A-dec’s reputation for quality, reliability and

taking care of the customer will serve as a key


In response to the pandemic and shutdown

of dental offices in 2020, A-dec pivoted their

engineering and manufacturing capabilities

to develop and manufacture face shields for

hospital workers fighting COVID-19.

Continuing to focus on dental staff health and

patient safety, the company launched A-dec

360, a growing line of products designed

to guard the dental office. With personal

protective equipment, sanitation stands, large

bore with third-hand HVE holders and now air

management solutions, A-dec continues to

expand products and services to promote a

safe and healthy environment for the dental


This complementary device and associated

consumables and services was launched

initially to the dental market in United States

and Canada.

Douglas Eaton and Marshal Sterio, cofounders

of Surgically Clean Air, addressed

the news about the partnership: “We couldn’t

be happier to be partnering with A-dec to

continue our quest to keep dental health

care workers safe from the dangers of bioaerosols.

Aligning our dental product offering

and combining our expertise in this field with

A-dec’s brand reputation for exceptional

products and service is a perfect fit. We look

forward to a long-lasting partnership that

will accelerate the bio-aerosol messaging we

have been talking about in dental since 2010,

to the global market.” ■

Dentsply Sirona strengthens global partnerships

in supply chain and procurement

As a global industry leader, Dentsply Sirona is

focused on ways to become a more sustainable

business. The company is committed to

minimising supply chain risks that could impact

customers, reducing environmental impacts

from its global operations and to fostering

global ethical standards and diversity and

inclusion throughout its workforce and supply

chain. In order to increase the impact of these

commitments, Dentsply Sirona is working to

engage its global supply chain partners in these


In that context, the Global Supplier Forum 2021

took place as a hybrid event on 30 June and

1 July with a number of speakers on site

at the Dentsply Sirona headquarters in

Charlotte, United States, while the keynote

address took place through a virtual venue.

The event began with an introduction

from Don Casey, chief executive officer;

Dan Key, senior vice-president and chief

supply chain officer; and Joanne Couture,

vice-president of global procurement at

Dentsply Sirona.

“I was very pleased to have this opportunity

to speak to representatives from many of

our top suppliers. We are excited to work

with our partners to improve processes

and meet goals on sustainability, in order

to ultimately grow together,” said Key.

Eileen Bartholomew, a principal at

Bessemer Alliance and frequent speaker

as well as writer on the topic of growth

through innovation, gave the forum’s

keynote address on exponential change

in technology and how companies

can adapt their thinking to the pace of


Dentsply Sirona also introduced its

new Supplier Awards Programme for

suppliers deemed to be “Exceptional

Partners”. Suppliers have the opportunity

to compete across all direct and indirect

spend categories. The award programme

criteria are based on Dentsply Sirona’s

supply chain goals: sustainability, quality,

delivery, innovation, value, diversity. Each

supplier will work with its Global Category

Manager to learn how to meet the criteria

and compete against other suppliers to

win. Official nominations will be submitted

in early Q2, year 2022, and winners will be

announced that June. The competition is

open to all Dentsply Sirona suppliers. ■



Dental Updates

Dentistry largely

exempted from the new

COVID-19 workplace

regulations in the

United States

The American Dental Association (ADA)

is pleased that dental practices have

been exempted from the new emergency

temporary standard (ETS) for COVID-19 issued

for healthcare settings by the Occupational

Safety and Health Administration (OSHA).

“The strengthened infection control

guidance and very low COVID-19 infection

rate for dentists and dental hygienists prove

that dental practices are safe workplaces,”

stated Dr Daniel J. Klemmedson, DDS, MD,

president of ADA.

The new OSHA workplace ETS provides

guidance to be implemented in healthcare

settings where all employees may not be

screened for COVID-19, and non-employees

and patients with suspected or confirmed

COVID-19 are allowed to enter and may

be treated. Dental offices most likely to be

affected by this standard would include

hospital-based oral surgery practices

or those who provide care for COVID-19


According to the OSHA’s guidelines, every

dental office must have a COVID-19 plan,

regardless of practice setting. Dental practices

must also conduct a workplace-specific

hazard assessment for COVID-19. Based on

OSHA’s Hazard Identification and Assessment,

the ADA has already created a guide and

checklist to walk dentists through this process,

accessible from the ADA website.

OSHA’s recommendations stated that

dentists should continue pre-appointment

patient screenings to identify individuals

with suspected or confirmed COVID-19,

rescheduling their appointments if possible or

referring them as necessary.

As the pandemic restrictions across the United

States are reviewed at the federal, state

and local government levels, the safety of

patients, dentists and dental team members

will remain ADA’s utmost concern. The ADA

notes that per the OSHA guidelines, employers

are encouraged to follow Centers for Disease

Control and Prevention (CDC), state and local

regulatory guidelines. ■

MediDent International launches Orasyl, Singapore’s first bacteria and

virus-killing povidone-iodine mouthwash

MediDent International, a Singapore-based

medical and dental equipment supplier,

has launched the first locally manufactured

povidone-iodine mouthwash that can kill

both oral bacteria and viruses. Povidone-

Iodine, the active ingredient in Orasyl Orange

is particularly effective against COVID-19, and

has also been proven to keep other viruses

and oral bacteria at bay after each use while

promoting good oral hygiene health.

Founded by award-winning dentist and

entrepreneur, Dr Samintharaj Kumar,

MediDent International is a leading supplier of

medical and dental equipment in Singapore,

with an aim to provide consumers with easy

and effective healthcare solutions.

As the success of oral povidone-iodine

against COVID-19 started surfacing in

mid-2020, this birthed the idea within the

MediDent team to create a practical and

functional mouthwash that would protect

their loved ones and patients from the effects

of the global pandemic in the long run.

Orasyl is available as either Orasyl Orange

or Orasyl Green, providing added protection

to users from a whole host of viruses and

bacteria. Both types of mouthwash offer the

added benefit of stabilising the mouth pH

and reducing dry mouth syndrome due to the

addition of red algae. They are also mintflavoured;

and are soothing, refreshing and

alcohol-free. Despite their strong green and

orange hues, both mouthwashes do not leave

a stain on teeth and tongue. Users simply

have to gargle and rinse with 5-10ml of the

solution for 30-60 seconds, up to three times

a day.

“My intention is to provide the mass market

with a solution that is free of alcohol and

artificial preservatives suited for daily usage.

Orasyl was formulated to be used by people

from all walks of life, providing them with a

medical and dental grade solution that will

arm them beyond this pandemic. Besides

promoting the importance of dental care in

tackling the effects of viruses and bacteria,

our mouthwashes have been created to fit in

seamlessly with everyone’s daily routine, and

is perfect for future safe travelling plans,” said

Dr Samintharaj Kumar, managing director and

founder of MediDent International. ■



New research links dental amalgam

mercury fillings to arthritis



SILENT CAM extraction units

The International Academy of Oral Medicine and Toxicology (IAOMT)

is raising awareness of research linking cases of arthritis to dental

amalgam fillings. These silver-coloured fillings are 50% mercury and

are still used in the United States, often in disadvantaged children

and adults.

In this new study, researchers David and Mark Geier report on a

significant relationship between the number of dental amalgam

filling surfaces and diagnoses of arthritis. They find that incidences of

arthritis peak among adults with four to seven dental amalgam filling


It is important to note that the number of surfaces is not the same

as the number of fillings. Each tooth has five surfaces, which means

that a person with only one filling could have up to five surfaces.

The authors examined data from the 2015-2016 National Health and

Nutrition Examination Survey (NHANES) including demographics,

dental exams, and arthritis diagnoses. Data about the patient’s type

of dental filling recently became accessible. With this information,

the researchers were able to discover higher incidences of arthritis in

people with silver-coloured mercury amalgam fillings than those with

other fillings such as tooth-coloured composites.

In September 2020, the Food and Drug Administration (FDA) updated

risks of dental amalgam fillings for susceptible groups. However,

arthritis was not specifically mentioned when the FDA warned of

“harmful health effects of mercury vapour released from the device.”

SILENT CAM extraction units communicate

in an intelligent way with the CAM

milling machine via a PLC interface.

All you need to do is connect the

extraction unit to the CAM

milling machine.

The groups that FDA advised to avoid getting dental amalgam fillings

include pregnant women; women planning to become pregnant;

nursing women and their newborn and infants; children; people with

neurological disease such as multiple sclerosis, Alzheimer’s disease

or Parkinson’s disease; people with impaired kidney function; and

people with known heightened sensitivity (allergy) to mercury or

other components of dental amalgam.

Find out more:

FDA is currently open for comments on how information about

medical devices including dental amalgam fillings should be shared

with patients and providers. The Geiers’ study was partially funded by

the IAOMT, a non-profit organisation that evaluates biocompatibility

of dental products, including mercury filling risks. ■

making work easy


20210122_CAM-Absaugtechnik_95x250mm.indd 1 03.02.2021 16:37:52

Dental Updates

Extension of the integrated Ceramill CAD/CAM

workflow: Digital solutions lead the way into the

dental practice

With its Ceramill Direct Restoration Solution

(DRS), Amann Girrbach has extended its

integrated digital workflow to the dentist,

thus closing the existing communication

gap between the dental practice and the

laboratory. In this process, both partners

contribute their core competencies to

provide patients with definitive and functional

dentures even more quickly and with less

complication — smaller units are also possible

on the same day, depending on the local

distance between the two partners.

Depending on the type of collaboration

desired, three team workflows are available in

combination with the corresponding Ceramill

DRS Kits. In each case, the central basis of

these workflows is the new AG.Live digital

platform, which offers both infrastructure

and patient case management at a realisable

consistency and efficiency that was previously

unattainable and takes the flow of information

and work between the practice and the

laboratory to an entirely new level.

The Ceramill DRS Connection Kit acts as the

basic and entry-level variant, with which

dentists and laboratories can already take full

advantage of digitisation. It consists of the

intraoral scanner, the Ceramill Map DRS, the

associated scan software and the connection

to AG.Live. Any order data including all the

required information can therefore be shared

seamlessly and in real time with the laboratory

via AG.Live.

This eliminates the need for handwritten job

sheets and conventional impressions. All that

is necessary is a single physical transport:

getting the restoration to the practice for

insertion in the patient’s mouth, even on the

same day in the case of simple restorations.

This leads to a better dental experience for the

patient and ultimately attracts new patients to

the practice, generating more orders for the


And if the preferred material is zirconia, the

High-Speed Zirconia Kit, consisting of the

Zolid DRS high-speed sintering zirconia and a

corresponding Ceramill Therm DRS sintering

furnace, can optimally support the laboratory

in fabricating straightforward zirconia

restorations on the same day.

To provide patients with dentures even quicker

in a further step, the system can be expanded

in the dental practice with the Ceramill DRS

Production Kit at a later stage. This allows

simple restorations to be fabricated in the

practice and placed in the patient’s mouth in a

single session. ■

Chemist Sumita Mitra, known for application of nanotechnology in dentistry,

receives European Inventor Award 2021

The European Patent Office (EPO) has

honoured Indian-American chemist, Sumita

Mitra, with the European Inventor Award 2021

in the “Non-EPO countries” category.

Mitra was the first to successfully integrate

nanotechnology into dental materials to

produce stronger and more aesthetically

pleasing fillings, which are now used by

dentists around the world. She and her team

developed a technique for creating linked

clusters of nanoparticles, which they called

nanoclusters. These clusters combine single

nanoparticles of varying diameters, resulting

in a strong, durable, and shiny material. By

adding tiny amounts of pigment, and altering

the chemical composition of the nanoparticles,

they were also able to create a range of

different shades that can be matched to

individual teeth and layered to create a more

natural finish.

“The use of nanotechnology gave me

the opportunity to make a new material,”

said Mitra. “It restores people’s smiles and

improves the quality of their lives”.

The 2021 European Inventor Award ceremony

was held digitally, and for the first time, was

open to the public who tuned in to the event

from around the world. The Award, one of

Europe’s most prestigious innovation prizes, is

presented annually by the EPO to distinguish

outstanding inventors from Europe and

beyond who have made an exceptional

contribution to society, technological progress

and economic growth.

“Sumita Mitra took an entirely new path in her

field and demonstrated how technological

innovation, protected by patents, can

transform a sector, and in this case bring

benefits to millions of dental patients,” said

António Campinos, president of EPO. “Her

invention remains commercially successful

nearly 20 years after its launch – another

reason why she is an inspiration to the next

generation of scientists.” ■



Dental Updates

Roland DG expands factory in Thailand

Roland DG Co., Ltd., which manufactures

and sells commercial inkjet printers and 3D

manufacturing tools, is expanding the floor

space of its factory in Thailand under the

jurisdiction of its manufacturing subsidiary

Roland Digital Group (Thailand) Ltd. (Samut

Sakorn Province, Thailand).

This increase in floor space is in response

to one of the basic policies of the mediumterm

management plan (FY2021 to

FY2023) announced on 12 February 2021,

“Transformation into a muscular corporate


By completely transferring the mass

production function of their domestic

factory (Miyakoda Office, Kita-ku,

Hamamatsu City, Japan) to the Thailand

factory, the company will promote the

reduction of product costs and improve

price competitiveness.

On the other hand, the company has set

“transformation of business portfolio” as the

basic policy of the medium-term management

plan, and is proceeding with the development

of products for emerging markets where

further market growth is expected. The

expanded Thailand factory is also intended

to serve as a receiver for the production of

products for these emerging markets.

The Thailand factory is their first overseas

factory that started operation in October 2012.

By maximising the strengths of their unique

cell production method, Digital Stand, which

backs up the work of operators with digital

technology, Roland DG can provide a stable

supply of high-quality products, as in the case

of Japanese production. They are promoting

local procurement of parts other than the main

parts, and have established an autonomous

production system that does not depend on

the Miyakoda Plant. In line with the expansion

of production volume, they increased the floor

space for the first time in 2014, and the latest

expansion will be its second.

The layout will change after increased floor

space and floor area of the entire plant. By

transferring the production of mass-produced

products such as inkjet printers and dental

processing machines currently produced at

the Miyakoda Plant, the number of production

models will be increased from the current

16 models to 32 models, and the production

capacity will be converted to large commercial

inkjet printers. ■


Dental Updates

Dr Christian Ullrich joins Straumann Group’s Executive Management Board

as the new group chief information officer

The Straumann Group has appointed Dr

Christian Ullrich as the new group chief

information officer and member of the

Executive Management Board (EMB). Digital

transformation is a key part of the Straumann

Group’s growth strategy, spanning all

businesses, geographies and facets of the

Group’s activities. This new executive role

will drive and lead the acceleration of the

company’s digital transformation. He will join

the group on 1 October 2021.

Guillaume Daniellot, chief executive

officer of Straumann Group,

commented: “Christian has

an impressive track record in

leading digital transformation of

large global companies. He has

successfully developed digital

strategy and go-to-market

models driven

by platform

approaches to

increase product sales performances and

create a positive experience for customers

and health consumers. He will play a key role

to further advance the digital strategy of the

Group connecting it closely to the business

strategy. Christian is also a personality with

outstanding leadership skills and will be a

great addition to the team, supporting our

cultural journey.”

Dr Ullrich joins Straumann from Bayer,

a life science company with core

competencies in the fields of

health care and agriculture, where

he was senior vice-president,

global chief information officer at

Bayer Consumer Health. He was

instrumental in shaping the digital

agenda of the Consumer Health

Division and accelerating

the business

transformation with

digital technology

and data analytics across the entire

value chain. He began his career at the

company in 2006 and rose through a series

of managerial positions with increasing

responsibility, including divisional head of

Accounting and Controlling, head of Post-

Merger Integration United States as well as

vice-president, global head of Marketing

and Sales IT. Prior to joining Bayer, Dr Ullrich

worked for Deloitte, a professional services

company providing consulting, audit,

advisory, and tax services.

Born in 1972, Dr Ullrich is a German citizen

and holds a master’s degree in Business

Administration and Mechanical Engineering

from the Technical University of Darmstadt,

Germany, and a PhD in Economics from the

University of Lüneburg, Germany. He joins the

company following the announcement of the

group to expand the role of chief information

officer and elevate it to the Executive

Management Board. ■

Keystone Bio advances a more complete explanation of Porphyromonas

gingivalis toxic virulence factors as major driver of sporadic Alzheimer’s

and chronic inflammation

Keystone Bio (KB), a biotechnology company

and frontrunner in developing precision

biologics to eliminate Porphyromonas

gingivalis (Pg), has presented a groundbreaking

data that shows bacterial toxic

proteins from Pg in the mouth are released

into the blood and cross the Blood Brain

Barrier (BBB) as the major driver of sporadic

Alzheimer’s and chronic inflammation.

This new data supports a “Peripheral” model

of Pg blood-transported toxic proteins

delivered into the blood and brain versus the

earlier literature in which human and animal

model studies support the “local gingipains”

Alzheimer’s Disease brain model. What this

means for Alzheimer’s patients and those at

early risk is that KB is developing a specific

diagnostic and treatment to eliminate Pg

and the flow of these toxic proteins to the


This data can now be integrated into a more

unifying “Concept” and explanation for the

“Infection Hypothesis” for Alzheimer’s Disease

(AD) and other Dementia-related disease(s).

A larger HagA Domain virulence factor is

found in many AD and some aged matched

control brain tissues. Its complex role in

local and systemic inflammatory diseases is

well understood and further demonstrates

systemic blood borne delivery for the

bacterial source of “gingipains” in the brain.

This ground-breaking data was presented in

three posters at the Alzheimer’s Association

International Conference 2021:

• Porphyromonas gingivalis Outer Membrane

Vesicles as the major drivers of and source

for the toxic insult and iron accumulation/

deposition in Alzheimer’s Disease

• Further Preclinical Development of a

Clinically Effective Bio-therapeutic Against

Porphyromonas gingivalis

• A Study on the Distribution of

Porphyromonas gingivalis Repeated

Epitope in Hemagglutinin/Adhesion and

HagA gingipains Domain Antigen and DNA

in Alzheimer brains




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A06SG/en/A/00 08/21


The digitisation of practices

Artificial intelligence is at the heart of patient care:

what solutions will meet patient expectations?

In recent years, the way patients view

healthcare has rapidly evolved. They

are no longer willing to leave the house

unless it is necessary, and they expect

to use the latest technology for fast and

easy communication with their medical


And this also applies in the orthodontics


Technological innovations changed

the face of healthcare, but the key to

unlocking “Orthodontics 2.0” was still

missing. The industry needed the right

tool to completely digitise every stage of

patient care.

The good news is, the missing piece was


DentalMonitoring is a virtual practice

solution that brings the digital world to

the dental world, providing patients with

the ease and efficiency they expect from

their medical providers.



DentalMonitoring uses artificial

intelligence (AI) to automate parts of

a patient’s treatment plan and issue

alerts in the case of any irregularities

detected during oral scans. This

technology allows doctors to perform

initial oral exams remotely, simulate

treatment options, and even plan

future treatments from a distance.

Using the industry’s largest dental

image database, DentalMonitoring’s

artificial intelligence helps doctors

locate, calculate, and evaluate

96 different observations with an

accuracy that the human eye cannot




achieve. It allows the practitioner to take control over data they

lack when the patient is outside the practice, while significantly

improving the communication established with the patient.

The result: a better managed schedule and optimised care

efficiency thanks to a highly scalable workflow throughout the

entire patient journey.




Like other solutions appearing on the market, notably in the

United States, DentalMonitoring’s solutions have several


Photos are not enough to follow the oral health of a patient from a

distance. Without artificial intelligence, they are limited to being a

simple visual control tool. While some follow-up solutions focus on

a single particular treatment; with a virtual practice, all treatments

can be controlled, such as retainer use and oral hygiene.

Brilliant dental restorations

deserve brilliant

press ceramics

The platform offers features that patient expects: video

consultation, a clear written report encouraging a better

understanding of their oral condition, and ultra-realistic

simulations of their smile during and after orthodontic treatment.

It also includes a dedicated patient application so patients can

receive advice from their orthodontist regularly.

All the tools are there to offer a comfortable and connected

treatment path.


Practitioners quickly understood the many advantages of

the “VirtualPractice DentalMonitoring” platform. Convinced

of the advantages of AI and enthusiastic about its efficiency,

they see virtual offices as the digital shift that will ensure the

sustainability of their business and their short-term competitive

advantage. DA

DentalMonitoring ® , Smilemate ® and Vision are products designed and

manufactured by Dental Monitoring SAS, under the DentalMind ® brand for

health care professionals (HCPs). They are also used by patients under medical

supervision by health care professionals (HCPs).

DentalMonitoring ® and SmileMate ® are designed to help health care

professionals remotely observe intraoral situations (and orthodontic treatments

for DentalMonitoring). Consult your health care provider and/or the operating

instructions before using them.

DentalMonitoring ® and SmileMate ® are medical devices, registered as such and

bearing the CE mark.

Vision simulations are generated by artificial intelligence. They are not binding

and may differ from the final results of the patient’s treatment. Vision is

registered with DentalMind ® .

Product availability, claims and status may vary from country to country

depending on local regulations. Contact local representative for more


VITA AMBRIA – the press ceramic

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3586E_VITA ambria_anzeige_95x250.indd 1 09.06.2021 15:32:49


Bioflavonoid spray

efficacy against

respiratory viruses

In the event of exposure, preventing respiratory viruses from

adhering to the oral or nasal mucosa may decrease the risk of

infection. Hence, with the evolving pandemic situation, this

paper tackles a practical approach of using an oral spray to

create a barrier on the mucosa of the mouth and throat, and

boost host protection.

By Dr Zeeshan Sheikh, Dr Henriette Lerner, and Dr George Freedman

COVID-19 has raised new concerns

about respiratory viral infections (RVI).

This virus can reproduce within the

cells that line the human respiratory

tract and the resulting infections

cause respiratory issues that may

infect multiple other sites. At this time,

there are more than 200 known viral

strains that cause respiratory infection,

including the coronavirus, influenza

virus, and human rhinovirus. Other

viruses of interest include parainfluenza

viruses, metapneumovirus, adenovirus,

respiratory syncytial virus (RSV) and

human enteroviruses (HEV) 1 .

Coronavirus can cause symptoms

ranging from the common cold to

pandemics. Influenza viruses are

categorised into types:

• A/B cause seasonal epidemics (flu)

• A is also implicated with seasonal


• C/D are generally mild and do not

affect humans

Each category has multiple subtypes.

Rhinovirus has three main species

including A/B/C with more than 160 viral

types causing the common cold 2-4 .




Key respiratory viruses are transmitted

via aerosols, respiratory droplets, and

fomites. Factors known to increase

the risk of infection include: proximity,

ventilation, surface contact, and time of

exposure. Thus, gathering areas without

adequate ventilation, where distancing

is not possible, increase infection risk.

These include workplaces, grocery

stores, shopping malls, restaurants,

indoor gyms, schools, and airplanes.

Indoor activities with significant

aerosolisation increase risk; and while

outdoor activities offer ventilation,

physical distancing is not always


In the event of an exposure, the

respiratory viruses must come in contact

with oral or nasal mucosa of a new

host to pose a risk of infection. While

the mucosal epithelium offers a partial

physical and innate immune barrier

against viral infection, the virus can still

attach and infect the individual 5 . It is

extremely important to emphasise that

for an infection to occur, the respiratory

viruses must gain access to the mucosa,

attach, internalise, and replicate within

the host.

A novel protection strategy is to break

the chain of infection by neutralising the

virus prior to adhesion and penetration

of the host cell, either by a virus-




encapsulating barrier, and/or via direct

neutralisation. Both ultimately prevent

infection and disease.



The current challenge is two-fold: to

reduce risk for COVID-19 and develop

multiple strategies that reduce the risk

associated with new viruses with the

potential to cause another pandemic

crisis. COVID-19 occurred a full 100 years

after the Spanish Flu (H1N1), but the next

pandemic may present sooner. Current

approaches for minimising transmission

are based on three common strategies:

• Routine and widespread use of

personal protection equipment

(PPE), including masks, to create a

physical barrier to transmission 6

• Frequent and thorough disinfection

of hands, surfaces and fomites

to mechanically remove and

chemically inactivate shed

virus particles and prevent their

translocation to new hosts 7

• Delivery of aerosolised therapeutics

to the mucosal microenvironment

to dampen an aggressive immune

response in respiratory infections,

thereby improving clinical

outcomes 8

It is desirable to prevent viruses that

have entered the human body via the

nasal and oral passages from gaining

access to the mucosal layers, adhering,

and causing infection. One practical

approach is an oral spray that targets

the mucosa in the mouth and throat to

create an additional barrier that protects

the host from viruses.

The ideal spray must be safe and

use Generally Recognised as Safe

ingredients (GRAS) with pleasant

taste and sensation. Additionally, it

must be easy to use, acceptable for

all ages, and must provide rapid onset

to target specific situations. Further

desirable properties include: vegetarian

compatibility, sustainability, non-GMO

sourcing, and no banned substance




Flavobac is a plant-based, patented

combination of specific water-soluble

bioflavonoid molecules with known

anti-microbial and anti-viral activity 9 .

The pharmacological effects of

flavonoids are linked to their antioxidant

and free-radical scavenging activity

in addition to their interaction with

enzymes, adenosine receptors and

bio-membranes 10 . Flavonoids have also

been shown to possess anti-viral activity

against influenza viruses HSV-1, HSV-2

and the rotavirus 9 .

There are several products designed

Fig. 1: Cold & Flu Guard combines bioflavonoids with

an effective mucosal barrier

Fig. 2: Nasal and oral antiseptic spray solutions



Cytotoxicity a Neut.

Virus VC



Ctrl b

Titer C Titer c

FLAVOBAC BCL 5% 1 min 1/100 None 1.9

FLAVOBAC BCL 2% 1 min 1/10 None 2.9

a Cytotoxicity indicates the highest dilution of the endpoint titer where full (80-100%) cytotoxicity was observed

b Neutralisation control indicates the highest dilution of the endpoint titer where compound inhibited virus CPE in the wells after neutralisation

(ignored for calculation of virus titer and LRV)

c Virus titer of test sample or virus control (VC) in log10 CCID50 of virus per 0.1 mL

d LRV (log reduction value) is the reduction of virus in test sample compared to the virus control

Table 1: Virucidal efficacy against SARS-CoV-2 after contact with virus at 22 ± 2°C






Cytotoxicity a


Ctrl b


Titer C


Titer c


OSI-20210203A 5 min 1/10 None 3.0

OSI-20210203B 5 min 1/10 None 3.0

a Cytotoxicity indicates the highest dilution of the endpoint titer where full (80-100%) cytotoxicity was observed

b Neutralisation control indicates the highest dilution of the endpoint titer where compound inhibited virus CPE in the wells after neutralisation

(ignored for calculation of virus titer and LRV)

c Virus titer of test sample or virus control (VC) in log10 CCID50 of virus per 0.1mL

d LRV (log reduction value) is the reduction of virus in test sample compared to the virus control

Table 2: Virucidal efficacy against SARS-CoV-2 after contact with virus at 22 ± 2°C

Fig. 3: Nasal and oral sprays function as

supplementary layers of protection (in

addition to face masks) to short circuit cold

and flu viruses

to assist in preventing the onset

of infection caused by rhinovirus/

coronavirus/influenza virus by creating

a physical barrier to viral and bacterial

adhesion at the nasal and throat

mucosal membranes.

Oral Science International (Brossard,

Canada) has a unique formulation,

Cold & Flu Guard TM (Fig. 1), that unites

bioflavonoids with the mucosal

barrier. Glycerin and hyaluronic acid

components form a barrier/film over

the mucous membrane, and act as a

delivery method for the bioflavonoids

and menthol.



In vitro efficacy studies of Flavobac

aqueous solutions have demonstrated

concentration-dependent activity

against a range of bacterial, fungal

and protozoal pathogens 11 . Antiviral

studies have confirmed activity against

various viruses 12-14 . Retroscreen

Virology Laboratories (now hVIVO,

London, United Kingdom) and

Biobest Laboratories (Edinburgh,

United Kingdom) have independently

demonstrated that Flavobac

formulations are efficacious in the

inactivation of two different subtypes

of Influenza A: H5N1 (Bird Flu) and H1N1

(Swine Flu) 13,15 .

In 2004, Retroscreen Virology Ltd.,

Barts, and The London Queen Mary’s

School of Medicine and Dentistry,

evaluated the viricidal activity of

Flavobac against Urbani SARS virus,

Influenza A virus, Human Rhinovirus

and HIV. The results demonstrated

significant viricidal activity against all

the viruses at all concentrations and

time-points 14 .

The first anti-SARS-CoV-2 evaluation

of an oral spray formulation containing

Flavobac as the sole active ingredient

(developed specifically for routine

intranasal or intraoral use) was reported

in March 2021 by the Institute for

Antiviral Research (IAR) at the Utah

State University (Logan, Utah, United

States) [*data pending publication].

The IAR employs recognised scientists

to identify antiviral agents and vaccines

against a wide range of human

pathogenic viruses and has participated

in the pre-clinical development of

numerous FDA-approved antiviral


Test compounds: Nasal and oral rinse

antiseptic solutions (Fig. 2) consisting

of aqueous Flavobac BCL concentrate

as the sole active ingredient and

OSI2021003 oropharyngeal spray

solution and other natural ingredients

were supplied by Oral Science


Results: Flavobac aqueous solution

reduced SARS-CoV-2 titer below the

limits of detection at all concentrations

tested (Table 1). These results generate

dose optimisation and guide product

dosage and concentrations.

After incubation with Flavobac

commercial solutions OSI-20210203A

and OSI-20210203B, SARS-CoV-2 virus

titers and LRV were reduced below

the limits of detection (LRV>3.0) (Table

2). Each Flavobac containing solution

evaluated was effective at reducing

>3 log10 CCID50 infectious virus, from

4.7 log10 CCID50/0.1 mL to 1.7 log10

CCID50/0.1 mL or less (Table 2). This

represents a >99.9% efficacy of viral



The challenge in developing oral and

nasal sprays is to create effective

topical preparations that are safe




and have the required efficacy against

respiratory viruses. Ethanol >70%, for

example, is known to be an effective

viricidal agent but cannot be used safely

in the nose. Flavobac solutions and

formulations have been shown to be

effective against a variety of viral strains

and are non-toxic (GRAS status in the

United States via the FDA).

Given their efficacy and safety profile,

Flavobac oral and nasal spray products

such as Cold & Flu Guard TM and Flavobac

Health Guard TM , can be considered as

a supplementary layer of protection in

addition to face masks in combatting

respiratory viruses (Fig. 3). This is

particularly beneficial and important for:

• High aerosolisation situations

• Individuals at higher risk of

respiratory viral complications

• Those not yet vaccinated

• Children

• Gatherings where appropriate

distancing is not possible DA



Mäkelä, M.J., et al., Viruses and bacteria in

the etiology of the common cold. 1998. 36(2):



Couch, R.B.J.e.L., Rhinoviruses. 2001.


Peiris, J.J.M.m., Coronaviruses. 2012: 587.


Zhang, Y., et al., New understanding of the

damage of SARS-CoV-2 infection outside the

respiratory system. 2020: 110195.


Gwaltney Jr, J.M.J.T.A.j.o.m., Clinical

significance and pathogenesis of viral

respiratory infections. 2002. 112(6): 13-18.


Organization, W.H., Rational use of personal

protective equipment (PPE) for coronavirus

disease (COVID-19): interim guidance, 19

March 2020. 2020, World Health Organization.


Cohen, M.S. and L. Corey, Combination

prevention for COVID-19. 2020, American

Association for the Advancement of Science.


Oslund, K.L. and N.J.F.v. Baumgarth,

Influenza-induced innate immunity: regulators

of viral replication, respiratory tract pathology

& adaptive immunity. 2011. 6(8): 951-962.


Bylka, W., I. Matlawska, and N.J.J. Pilewski,

Natural flavonoids as antimicrobial agents.

2004. 7(2): 24-31.


Harborne, J.B. and C.A.J.P. Williams,

Advances in flavonoid research since 1992. Zika virus infection. 2020. 177: 113962.


2000. 55(6): 481-504.

Carrouel, F., et al., Antiviral Activity of


Hooper, S.J., et al., Antimicrobial activity of Reagents in Mouth Rinses against SARS-

Citrox ® bioflavonoid preparations against oral CoV-2. 2020: 0022034520967933.

microorganisms. 2011. 210(1): E22-E22.


Lalani, S. and C.L.J.V. Poh, Flavonoids as

antiviral agents for Enterovirus A71 (EV-A71).

2020. 12(2): 184.



Reis, A.C.C., et al., Anti-Zika virus activity

and chemical characterization by ultra-high *Pending publication: Efficacy of FLAVOBAC

performance liquid chromatography (UPLC- Nasal and Oral Preparations Against Severe

DAD-UV-MS) of ethanol extracts in Tecoma Acute Respiratory Syndrome-Coronavirus

species. 2020. 20(1): 1-15.

2 (SARS-CoV-2), A. Barbour, M. Mendenhall,


Zou, M., et al., Structure-activity relationship G. Darlington MD, M. Glogauer (Pending

of flavonoid bifunctional inhibitors against Publication in medRxiv).

About the authors

Dr Zeeshan Sheikh is trained as a dental clinician and a

biomaterial scientist with degrees of BDS, MSc and PhD in

dentistry from Baqai Dental College, Pakistan; Queen Mary

University of London, United Kingdom; and McGill University,

Canada. He also has completed two post-doctoral fellowships

at the Faculty of Dentistry, University of Toronto, Canada, and at

the Mount Sinai Hospital, United States. He is currently a periodontics and implant

surgery resident at Dalhousie University, Canada, and his research expertise

lies in developing novel biomaterial options for bone grafting and maxillofacial

regenerative applications.

Dr Henriette Lerner is a graduate of Temeschburg University

(DMD), and Carol Davila University (Postgraduate Programme

in Oral Surgery). Director of HL Dental Clinic and Academy in

Baden-Baden, Germany, she is also a tutor in the Master of

Aesthetic Dentistry Programme at Johann Wolfgang Goethe

University, Frankfurt on Main, Germany. Dr Lerner is the

immediate past president of the Digital Dentistry Society International (DDS).

Dr George Freedman is co-founder and past president,

American Academy of Cosmetic Dentistry; co-founder,

Canadian Academy for Esthetic Dentistry; regent and fellow,

International Academy for Dental Facial Esthetics, and

diplomate and chair, American Board of Aesthetic Dentistry.

He is adjunct professor of Dental Medicine, Western University,

Pomona, California, United States, and professor and programme director,

BPP University, London, UK, MClinDent Programme, Restorative and Cosmetic

Dentistry, and author of 14 textbooks, more than 900 dental articles, and

numerous webinars.


Under the Spotlight


the future of


Dr Seojung Park, executive director of the Orthodontic

Branch at Korea Association of Digital Dentistry

The world is changing faster

than ever. With the latest trends

and technology in orthodontics,

it is paramount for dental

practitioners to stay ahead of the

curve. In this regard, Dr Seojung

Park from South Korea shares her

journey in digital orthodontics

and how it drastically improved

her practice.



Under the Spotlight

Dr Seojung Park, the executive director of

the Orthodontic Branch at Korea Association

of Digital Dentistry (KADD), graduated from

the Dental College of Chonnam National

University, South Korea, in 1989. She initially

specialised in paediatric dentistry and

performed a wide range of treatments from

tongue tie surgery to orthodontics for five

years, which sharpened her clinical skills and

developed her holistic view on patients.

While she was completing her PhD thesis on

orthodontic wires, she became fascinated

with orthodontics, inspiring her to pursue

expertise of the field. On top of that, the

subject excited her as orthodontic treatment

engages more closely with the patient’s life

and requires a bilateral relationship with


She explained: “An orthodontic treatment

cannot be done without the patient’s

cooperation. When we work as a team, a

successful treatment brings tremendous

fulfilment and joy to both the patient and the

doctor. I tend to think of it as a marathon and

I truly enjoy finishing the race together with

my patient.”

Dr Park completed a two-year course in Korea

Orthodontic Research Institute and became

a regular member of Korean Association of

Orthodontics (KAO). In 2010, she worked as a

visiting fellow in the Orthodontic Department

of Baylor Dental College of Texas A&M,

United States, as well as a researcher and

a trainee at Orametrix, the parent company

of SureSmile in Richardson, Texas, for three


This remarkable experience served as

a turning point of her career in digital



Adopting digital technology has widely

known advantages such as efficiency and

more precise treatments. However, when Dr

Park started to adapt the digital practice, she

noticed how it drastically improved the way

she communicated with her patients too.

“First of all, I get more face-to-face time with

my patients, but before it was more like next

to the face!” she joked. “Kidding aside, the

biggest change is that I can literally have

the patient’s case at the palm of my hand by

using a digital model.”

As influenced by the late Dr William Proffit,

the author of “Contemporary Orthodontics”,

Dr Park emphasised that it is crucial to listen

thoughtfully to the patient and/or their

parents’ concern before even starting the

diagnosis and treatment plan.

“This allows me to approach each patient with

an unbiased mindset, free of any prejudice or

misconception. There is no perfect solution in

orthodontic treatment. Every case is different

and each patient requires a treatment that is

specifically designed for them,” she shared.

To communicate her treatment plan with the

patients, she reinforces the discussion with

digital tools.

“As strangely as it might sound, the most

challenging case for me is not necessarily

a difficult case. Even with the perfect

treatment of malocclusion, patients often are

not satisfied with the result. In most cases,

the issues are minute but from a patient’s

perspective it is not so trivial,” she said.

For instance, she had a patient with a

slightly asymmetric torque, black triangles,

minimally different vertical positions of

anteriors and tiny premature contacts

after debonding. With the help of digital

technology such as IOS, SureSmile, and 3D

printing, she resolved the issue efficiently

and effectively.


Under the Spotlight

She highlighted: “There is a saying in Korean

that goes: ‘Showing it once is better than

hearing it thrice’. Allowing the patients to

visualise the treatment by using digital

orthodontics tools is the key to ensuring that

their expectations are met.”


On top of meeting the patient’s expectation,

Dr Park’s adoption of digital workflow in her

practice has significantly streamlined their

clinic operations. Now, the clinic staffs can

preview her orders and prepare for the case

before the patient’s visit. She can also access

the record of her patients virtually at any time,

as the digital model is stored in the Cloud.

“We try to standardise and systemise our

workflow to minimise interruptions and

achieve seamless operations. Going digital

also means tidier workspace as there is no

need for impression materials and plaster

stone,” she added.

In terms of treatment, digitalisation of

orthodontics also proved to be highly

beneficial to the patient.

Recently, Dr Park has been recommending a

‘Hybrid Treatment’ — a combination of a fixed

treatment using brackets and finishing up with

a clear aligner. The benefits include:

1. Leading instead of pushing treatment

2. Quicker soft tissue adaption

3. Better oral hygiene

4. Finer tuning

5. Shorter bonding period

6. Faster occlusal seating

7. Wrapping up treatment with patients’

agreement and satisfaction

She noted: “I have encountered a lot of

orthodontists from various places and I

got an impression that they see digital

orthodontics as a new system just like

when SWA (straight wire appliance), TAD

(temporary anchorage device), and selfligating

system were first introduced.”

However, Dr Park strongly believes that

digital orthodontics can assist doctors to

have an in-depth view of their patients, and

to execute their treatments precisely.

“Digital and conventional orthodontics can

always coexist. Digital concept will support

various applications, innovations and

integrations in orthodontic profession,” she



With her advocacy in digital orthodontics,

Dr Park became a key opinion leader of

SureSmile, a clear aligner brand from

Dentsply Sirona, to help her fellow

practitioners maximise the benefits of

contemporary orthodontics.

She expounded: “In this aspect, SureSmile

gives precise digital control for the doctors.

The software offers extremely accurate

digital model including bone and roots, with

convenient functions for digital diagnosis and


Dr Park added that SureSmile started its own

digital platform from custom-made arch

wire for labial and lingual bracket treatments,

allowing it to collect numerous data over

the years about precise digital modelling.

SureSmile also offers various services from

the start to the end of treatment such as

digital diagnostic tools, digital set-up, autosimulation

function, IDB (indirect bonding) and

surgery simulation.

“This allows me to be free of any restriction,

thus achieving a better and faster treatments.

Like an unlimited open source, I can perform

various procedures precisely,” she remarked.

However, Dr Park noted that although these

aligners are made using the latest technology

and proven materials, any cutting-edge digital

tool cannot treat a patient on its own and it

still requires the doctor’s knowledge and skill to

maximise its benefit.

She recognises the steep learning curve

that might pose as a challenge to both

orthodontists and general practitioners:

“Although we are using 3D digital models and

3D digital imaging, we are still looking at the

3D model in a 2D plane. This often creates

an optical illusion that we are not familiar

with — it lacks detailed tooth morphology,

especially occlusal shape and proximal shape.

Sometimes, there are exaggerated overjet,

occlusal contacts and gaps between teeth.”

Nonetheless, she is positive that it would be

possible to look at the 3D model and 3D images

on a 3D platform in the future as evidenced

by rapid advancements in 3D printing, artificial

intelligence and low dose CBCT. She is also

hoping to see the introduction of artificial

reality (AR) in orthodontics.

Upper and Lower IDB tray design


With the introduction of these newer

technologies, orthodontics has evolved



Under the Spotlight

rapidly over the years. For instance, novel

techniques along with easier access to

materials and equipment has increased the

number of general practitioners performing

orthodontic treatment.

As a specialist, Dr Park said that she

is aware of this practice and many

orthodontists are also concerned about

the competition for patients, possible

malpractice, and lowering of cost.

She acknowledges that it has become a

norm and there is no way to avoid it, but

noted that orthodontists should be the

ones to lead the trend by being flexible to


In fact, Dr Park embraces the phenomenon

with optimism: “This creates a much bigger

pie in orthodontic market by making the

treatment more approachable, and it will

eventually accelerate the development

in orthodontics in various ways. A little

bit of competition brings new ideas and


Dr Park is looking forward to technology

showing the post treatment image of not only

dentition, but also the face of her patients.

“I integrated a face scanner with CBCT

and IOS. They are not adequate yet for

consultation and planning of treatment, but I

look forward to the day when the technology

will allow us to do so,” she shared.

On top of this, she also mentioned that there

will probably be many different directions in

orthodontic field. As an example, she raised

the ‘prosumer’ philosophy of the late Mr Alvin

Toffler, an American author, businessman,

and futurologist, can be applied in the future.

“A combination of producer and consumer,

thus the term ‘prosumer’, I believe that

doctors can be a consumer of digital

equipment or software and at the same time,

a producer who creates a new digital concept

with it,” she said.


Dr Park shared that she read an interesting

article saying that the technological

advancements in the past 20 years exceeded

that of in the past 100 years. She agreed

to this completely, adding that digital

technology is no longer a new thing and we

are now living in the digital era.

“The pandemic has fast-forwarded the

digital transition in almost every aspect of

life. People are getting hired after a Zoom

interview without meeting face-to-face.

Online shopping has allowed us to purchase

almost anything with a click. A usual business

trip has been replaced with a Zoom call,” she


For this reason, the patients are also wellinformed

and accepting of digital treatment.

Dr Park shared that her consultations with

her patients and their parents are done via

Facetime to minimise the number of visitors in

her practice.

“I understand that abrupt change is never

easy. But I strongly believe that digital

technology will help us break many barriers

and limitations not only in orthodontics but

also in other field of dentistry,” she said.

Sending a gentle reminder to her fellow

practitioners that they have a responsibility

to educate and lead the next generation to

digital dentistry, Dr Park concluded: “As my

favourite saying goes: The human mind is

like parachute and can only function when

it is open. I look forward to meeting and

making more colleagues in digital world and

share and discuss our ideas. Stay healthy

everyone!” DA

In the long term, she foresees that

the correction of malocclusions will

be addressed by combining multiple

treatments rather than a single procedure.

She said: “Hybrid treatment for patients

will increase steadily as the alignment

of teeth plays a role in better implant

placement, as well as in aesthetic and

prosthetic restorations especially with the

rise of elderly patients. This is in addition

to targeted treatments on anteriors, single

arch or specific tooth.”


Dental Profile

exocad will participate in

the International Dental

Show (IDS) 2021. Their

commitment to IDS as the

most important leading

trade fair in the industry

is unwavering.

Novica Savic, CCO of exocad

exocad with its largestever

presence at the IDS

2021: 12 software demo

stations for DentalCAD,

ChairsideCAD, and exoplan



Dental Profile

Committed to expanding the

possibilities of digital dentistry and

providing its distribution partners

with flexible, reliable, and easy-touse

software, exocad GmbH (exocad),

an Align Technology, Inc. company,

has expanded its presence at the

International Dental Show (IDS) 2021

taking place from 22 to 25 September

2021 in Cologne, Germany.

The trade show is one of the most

important dates on exocad’s calendar.

Novica Savic, the CCO of exocad,

explains why the company’s

commitment to IDS as the dental

industry’s most important leading trade

fair remains unchanged and what

visitors can expect at the exocad booth.

exocad is taking part in IDS 2021

with a larger booth – why this


After IDS 2019, exocad decided that

we needed a larger booth space. There

were so many users, technnology and

sales partners who visited our booth

two years ago that large crowds formed

around the software presentations. To

ensure that visitors now have a better

view of the demonstrations and that

hygiene regulations can be complied

with, we are enlarging the stand by over


Our commitment to IDS as the most

important leading trade fair in the

industry is unwavering. I also see it as a

driver for innovation; many companies

are aligning their development and

innovation cycles with IDS. This

underlines its function as the world’s

leading trade fair. Therefore, there was

never any question at exocad whether

we would participate in IDS. The

platform has successfully supported

us in presenting our products to

customers and pushing them further

into the market. In fact, we are working

closely with the organiser KölnMesse

to comply with the necessary hygiene


How did exocad adapt the booth

concept to the current situation?

exocad still has a very open presence

at the trade fair stand, in line with

our philosophy of an open software

platform. A total of 12 different software

islands are planned with plenty of space

between them. Visitors will still be able

to move freely around the stand to

find out about our products and talk to

our software specialists. After all, it is

precisely this personal exchange that

makes the trade fair so appealing.

Due to the pandemic, however, the

stand will have a transparent glass

railing at the aisles. If necessary, we will

measure the flow of visitors to the stand

and adapt the respective distancing

measures. Thanks to the larger stand

area, we are able to ensure that visitors

have adequate space. Transparent

protective walls, disinfection facilities,

and following the doctrine of ‘hands,

face, space’ (disinfecting hands, wearing

a face mask, and keeping a distance) will

provide a safe experience at the booth

for both our employees and visitors.

I would also like to note that, in my

view, KölnMesse can implement the

applicable hygiene measures with a

well-developed hygiene concept. I

believe that with the measures planned

and rules in place, we will feel safe there


What can IDS visitors expect at the

exocad booth?

The booth will be the meeting point for

the exocad community. After all, IDS is

one of the few opportunities for users

to engage in direct, personal exchange

with our software specialists and

developers. Our software developers are

also looking forward to this date and to

meet the end customer. Getting direct

feedback from users motivates and

inspires them to improve and enhance

the product even further.

Which products are the focus of the

IDS presentation?

Our software portfolio has expanded

greatly over the past few years.

exocad now has three core products:

DentalCAD and ChairsideCAD for singlevisit

dentistry, and exoplan for implant

planning. New features for individual

software products are planned as well

as some surprises, which we can’t reveal

just yet.

Since the IDS will be held as a hybrid

trade fair, what are exocad’s online


The new hybrid element of IDS will

allow those who cannot travel yet to

experience the trade fair feeling to

some extent online. KölnMesse has

developed a platform by which IDS can

be streamed live worldwide. It’s exciting

that online participants can actually

stroll virtually through the trade fair

and visit the stands of all participating

companies. exocad will also use the IDS

platform to interactively attract online

visitors. Offering such an online option

is a new challenge but we already had

a very positive experience with exocad

Insights 2020, the hybrid congress we

organised last year.

What trends should dentists and

dental technicians keep an eye on?

For dentists, the topics of intraoral

scanners and, for some time now, 3D

printers continue to be topical – for

example, printing splints, models,

or mock-ups for smile design. While

for dental technicians, the topic of

digital total prosthetics is particularly

interesting. There are still new

developments to be expected in the

area of software, but also in terms of

equipment and materials. In general,

there’s the overall topic of increasing

efficiency, particularly on how to achieve

higher productivity through digital


Dental Profile

technologies and reach goals even

faster and more precisely.

What do you personally expect from

IDS 2021?

What we are currently witnessing is

that people everywhere are seizing

every opportunity to finally meet up in

person again. I think that many dental

technicians and dentists are looking

forward to attending IDS onsite to see

colleagues and their contacts at the

companies in person again. I expect an

amazing event and a great atmosphere.

Of course, IDS 2021 will be different than

before. But one thing remains: we will

definitely see many new products and

that makes us look forward to IDS.

What are you most looking forward

to in the next three years with


We are proud to continue on the path

that we are on as an open system

provider and continue to expand our

broad base of strategic partnerships.

exocad continues to embrace the open

platform idea and, as part of Align

Technology, will take things further into

orthodontics; it will be very exciting.

And of course, I’m looking forward to

continuing to work with my awesome

team. We are very productive and laugh

a lot together. All of this makes me feel

extremely positive and motivated. DA



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Dental Profile

3D Systems as a forerunner

in digital revolution

Now that the dental field is going through fundamental changes,

coming from analogue and moving towards digital workflows,

Mr Stef Vanneste shares 3D Systems’ role in revolutionising the

industry with their wide range of trusted and reliable digital solutions.

In driving new levels of speed,

productivity, efficiency, and precision

at a lower cost, 3D Systems remains

a forerunner in the ongoing digital

revolution in dentistry. Thus, with the

increased demands for digital dental

solutions, Mr Stef Vanneste, vicepresident

and general manager of

Dental at 3D Systems, faces exciting

times ahead of him.

Passionate about making a meaningful

difference in a patient’s life, he believes

in building a strong team and strives

to inspire his colleagues to be the best

version of themselves through open

leadership and coaching. Despite his

extensive background in the healthcare

field, deciding to focus on the dental

industry came easy for him since

his grandfather was also a dental


He said: “It is rewarding to make

people smile — and in the most literal

sense. When the opportunity to join

3D Systems crossed my path, I didn’t

hesitate. What better way to step into

3D printing in dentistry than with the

company that invented and pioneered


Mr Stef Vanneste, vice-president and general manager of Dental at 3D Systems


Despite the promising outlook of digital

dentistry, there are still practitioners

who are taking a conservative approach

to adopting it. Mr Vanneste recognises

this issue but is positive that with the

right support and guidance, they will

eventually appreciate its true value and

jumpstart their journey.

“Traditional lines are blurring making

3D printing more and more embedded

within essential parts of providing oral

healthcare. As conventional dentistry



Dental Profile

NextDent 5100 printed models

has a long and proven history, it is

not surprising that new technology is

approached in a rather conservative

manner. Still, I expect that most dental

care providers will find the intraoral

scanner as a more accurate and

convenient alternative to analogue

impression materials,” he said.

Considering the use of an intraoral

scanner as the first step towards digital

dentistry, the next question would now

be: what can be done with this digital


And that is where the expertise of 3D

Systems comes in.

“I believe it is a great opportunity for

us to show the many advantages of

3D printing to dental professionals.

The foremost being better patient

outcomes,” he shared.

Jumpstarting one’s digital journey is

not an easy feat, thus, 3D Systems

emphasises education and provision of

training to support dental professionals

through 3D Systems Academy and

NextDent Academy.

Mr Vanneste, explained: “Our 3D

Systems Academy and NextDent

Academy were specifically designed

to provide such training and guide

both clinicians and technicians in their

journey towards digital dental workflows.

With our experience in the dental field,

our global trusted reseller network, and

24/7 support system, we can assist the

dental professional in every field.”

With these programmes, dental

professionals can explore every

possibility of 3D printing and how it can

help them optimise their treatment.

Mr Vanneste shared that although

3D printing is widely used as dental

model for aligners, he sees the growing

adoption of 3D printing for temporary

and final prosthetics. Dentures have

demonstrated incredible growth in

the market since last year too, closely

followed by the gain in popularity of

splints and night guards.

He commented: “The transformation

towards 3D printing is progressing

rapidly. Dental 3D Printing will play

an important part in the digital future

of dentistry as 3D printing materials

will become more advanced and the

number of applications will grow.”


3D Systems provides complete digital

solutions and end-to-end workflows for

dental laboratories and dental clinics


Dental Profile

to leverage their practice. They offer

both smaller and bigger dental labs and

clinics a selection of complete digital

dental solutions to match their specific

requirements; from entry-level dental

3D printers and mid- and large-platform

batch 3D printers, to rapidly scalable

workflows, materials, and software.

In fact, even smaller practices can

benefit from using a digital workflow or

outsourcing to a lab with a 3D printer

because of the higher speed, accuracy,

and lower costs.

Mr Vanneste shared that since 3D

printing of orthodontic models for

thermoforming is volume-oriented,

they leverage not only large-scale

manufacturing, but also offer high

productivity on the clinic/lab-sized

NextDent 5100 3D printer, with the

stacking feature.

He expounded: “3D Systems’ NextDent ®

5100 is part of a fully integrated and

certified digital workflow that facilitates

high-speed 3D printing for dental

devices and fixtures. The NextDent

5100 enables dental labs, dental clinics,

and production centres to provide the

best solution for dental applications,

such as models, crowns and bridges,

temporaries (long term provisionals),

surgical guides, splints and many more.”

In terms of dental materials, he shared

that permanent restorative and

prosthetic resins are some of the highlyanticipated

products in their portfolio.

“NextDent C&B MFH and NextDent

Denture 3D+ for denture bases are still

new applications in 3D printing but are

expected to have a huge impact on

the way dental labs and denturists are

fabricating dentures. With workflows and

materials still evolving every year, the

interest in these applications is growing

and the implementation ongoing,” he


Recently, 3D Systems also launched

NextDent Ortho Flex to address the

growing demands for dental splints and

retainers. It was developed with unique

raw materials, some exclusively by 3D

Systems, to solve some problems from

older generation 3D printing resins and

can be almost perfectly glass clear

printed on a 405nm light source.

“NextDent Ortho Flex is a true nextgeneration

3D printing resin. The

material and workflow are developed

100% with the application in mind and

therefore it has the perfect mechanical

properties for dental splints and

retainers,” he said.


To stay ahead of the curve, 3D Systems

pushes the boundaries with expert

additive manufacturing solutions and

consultation to make the existing

solutions even better. Noting that the

inventor of 3D printing, Chuck Hull,

founded 3D Systems, Mr Vanneste

3D Systems Academy and NextDent Academy



Dental Profile

NextDent Denture 3D+ Classic Pink

NextDent Ortho Flex

strongly believes that their core

expertise in 3D printing technology can

help practitioners propel their practices


“We have different 3D printing

technologies that we can utilise to

determine the best solution for any

application. So, by building further on

our partnerships with industry-leading

manufacturers in 3D scanning and

dental CAD we will keep ensuring the

best solution for our customers,” he


When it comes to technology, Mr

Vanneste expects to see a shift

towards bigger build volumes in the

years to come due to technological


However, he is convinced that the

ground-breaking innovations will be

found within the development of

dental materials and through this,

new applications will emerge while

the existing ones will benefit from

improved formulations.

Moving forward, he remains

optimistic that there would be

a positive long-term effect on

the digital market trend with the

pandemic situation accelerating the

need for more efficient treatment


He said: “It goes without saying

that the pandemic has impacted

everyone heavily. My heart goes out

to all who have lost loved ones and

are going through dire straits but I’m

convinced we’ll eventually make it

through this horrible period.

“The pandemic forced us to stay

indoors, keep our distance and

avoid contact as much as possible.

Still, the need for dental care

remained, triggering the digital

revolution due to the advantages

that come with its workflows, such

as the need for fewer visits and

sending of virtual files to be printed

instead of shipping parts.”

Inspiring the practitioners in the

Asia Pacific region to kickstart

their digital journey, he said:

“I strongly believe in sharing

information and providing training

that’s why we actively work

on our applications team and

NextDent Academy to provide

you with the needed support.

Our regional representatives

are always available to help. I’m

looking forward to our joint digital

journey!” DA


Clinical Feature

Updated literature review

on accelerated orthodontics

with relevant case reports

Several conflicting studies on the use of vibration to shorten the

treatment time of orthodontics had been noted in the recent

literature. For this reason, Dr Kevin Ng, Dr How Kim Chuan and

Dr David Tan share two case reports demonstrating how to safely

accelerate tooth movements using an orthodontic vibrator.

By Dr Kevin Ng, Dr How Kim Chuan, and Dr David Tan

Orthodontic tooth movements take a

long time to complete with an average

treatment time of about 24 to 36

months, and this has been one of the

main reasons that hinder patients from

receiving treatment.

To avoid long-term suffering and

enhance patient cooperation and

compliance, tooth movement can be

accelerated by mechanical vibrations to

shorten treatment times.

Although every clinician holds different

views regarding the effects and

outcomes of accelerated orthodontics,

two complicated cases were reported in

this paper performed using 0.2N 30Hz

vibrator for 20 minutes daily.

It was revealed that there is a 50%

treatment time gained for the whole

Invisalign treatment course with

acceptable results.


Mr YKC, 24, came to the clinic requesting

for correction of his teeth in preparation

for his wedding photoshoot scheduled

in about a year’s time.

The chief complaint was anterior

cross bite with severe crowding in

both arches. The treatment plan was

to remove all four first premolars and

use Invisalign with vibrator (0.2N Force

30Hz) to accelerate the treatment time.

The ClinCheck was set up after the

extractions and there were 68 pairs of

aligners for the first set. The patient was

advised to wear two aligners per week

(previously one aligner per week) with

vibrator for 20 minutes daily.

After 34 weeks, all the extractions

spaces were closed but presented with

posterior open bites. A second scan was

done to order refinement aligners. The

second set included 28 aligners and

the patient completed the treatment in

48 weeks. Radiographic findings were


The Vivera retainer was ordered and all

Case 1:

Fig. 1 Fig. 2 Fig. 3 Fig. 4

Figs. 1-2: Extraoral photos before and after treatment

Figs. 3-4: Intraoral photos before and after treatment



Clinical Feature

Case 2:

Fig. 7

Fig. 5 Fig. 6

Fig. 8

Figs. 5-6: Extraoral

photos before and after


Figs. 7-8: Intraoral photos

before treatment showing

5mm space between the

central incisors

Fig. 10 Fig. 11

Fig. 9: Intraoral photo after treatment

Figs. 10-11: ClinCheck before and after treatment

attachments were removed. The patient

had a perfect smile in time for his

wedding photoshoot (Figs. 1-4).


Mr JHC, 50, suffered from

supernumerary central, which was

removed due to mobility.

The wide 5mm diastema has caused

concern and he was suggested to close

the gap by Invisalign with the use of

0.2N 30Hz vibrator for 20 minutes daily.

The first 40 sets of aligners were

finished in 20 weeks to close the space

and a total of 26 refinement aligners

were ordered to correct the root torque.

The case was completed in 33

weeks. The patient was happy with

the outcome and now on Vivera for

retention phase. No root resorptions

were found in X-ray examinations (Figs.



Prolong tooth movement under

constant pressure could cause root

resorption 9 . During force application,

fluid movement was reported in the

periodontal ligament space causing

distortion of the cellular matrix.

Biomodulators activities were

increased, and these chemicals include:

Prostaglandin E1, E2, Misoprostol, IgA,

and parathyroid hormones 10 .

Pati et al. reported that injection of

parathyroid hormones could act directly

on osteoblasts and osteoclasts which

could promote osteoblastogenesis

and bone remodelling. In addition,

Prostaglandins E2 were shown to

increase during tooth movement

facilitating bone resorption. PGE 1 were

also shown to increase by mechanical

stress to induce bone remodelling 10 .

In the past, surgical procedures such as

corticotomy were used to facilitate tooth

movement. However, the post-operative

complications and discomfort could be


Several other non-surgical stimuli

were attempted including laser

stimulation, electric current stimulation,

pulsed electromagnetic fields and


Among all these methods, vibration

stimulation that is used mainly

commercially in recent years, showed

promising results. Most dentists

choose this non-invasive approach

to accelerate tooth movement. Thus,

it gained popularity in the market of


They were used in experimental

animals 8,10 and few clinical reports

had confirmed the positive effects

of accelerated tooth movements by

vibrators 2 .


Clinical Feature

Although root resorption has caused

concerns for prolonged tooth

movement, a study done by Pavlin et

al. suggested that while there was a

significant enhancement in retraction

velocity, there was no canine root

resorption after patients received

vibration treatment 11 .

The popular brands of vibrator include

AcceleDent (Fig. 12) and VPro (Fig. 13)

from the United States (US).


The common brand of orthodontic

vibrator used in the US with FDA

approval are AcceleDent and VPro. The

patient utilises the device by biting

lightly on to the plastic plate for about

20 minutes per day. It will deliver a

light force of 0.25N with a vibrating

frequency of 30Hz.

Alihani et al. studied the vibrators with

a controlled group, and they found

that the mechanical vibrations could

affect tooth movement time due to the

induction of anabolic and catabolic

effects on bone around the teeth 1 .

Liao founded that the periodontal

ligament responses were amplified due

to the vibrations applied. The responses

were recorded by computational

stimulation, the volume-average

hydrostatic stress in the periodontal

ligament was found at higher level

with vibration when compared with the

control group 6 .

Proffit studied the principles of vibrators.

They were used in traditional fixed

orthodontic appliances and in removable

Invisalign aligners. The treatment time

was 20 minutes per day, with a vibration

of 30Hz and has force of 20g 12 .

They could neither confirm nor fully

understand the exact mechanism of

alveolar remodelling at that time but

he had proposed two hypotheses: the

first one referred to piezoelectricity

that could generate within the alveolar

bone, the second one is related to the

pressure‐tension established within the

periodontal ligament 12 .

Grimm, stated: “Piezoelectricity is

generated by orthodontic forces

bending alveolar bone to produce an

electrical charge which, in turn, induces

an osteogenic response’’ 3 .

This is agreed by Shapiro and he

recommended “that orthodontic

forces should not be continuous as the

piezoelectric charges are only created

when stress is applied and released” 13 .

Kau, concluded: “mechanical vibrational

appliance may be suitable for initiating

these stress‐induced charges as forces

could be applied and released at a rapid


A number of cases were reported which

support the use of microvibration to

accelerate tooth movement 4 .

Leethanakul reported an increase in

movement for patients using vibratingelectric

toothbrush head (125Hz) on one

side when compared with the control side.

Gingival crevicular fluid was collected and

measured at the mesial and distal aspects

of each canine at monthly intervals.

Interleukin-1β levels were analysed using

an enzyme-linked immunosorbent assay.

The exact movement of canine was

measured monthly revealing accelerated

movement 5 .

Pavlin et al. found that AcceleDent could

shorten the time of tooth movement

when the technique was used during

orthodontic treatment, and noted

increasing reports on the use of the

vibrating devices.

However, Woodhouse and Miles et al.,

did not agree with Pavlin and pointed

out that there was not enough data that

vibration is accelerating tooth movement

significantly 7,14 .

Fig. 12: AcceleDent vibrator

Fig. 13: VPro vibrator

Woodhouse compared the time for lower

arch teeth alignment to the insertion of

the correction wire in orthodontics for

extraction cases. They concluded that

there was no evidence supporting that

additional vibrational force can increase

the rate of tooth alignment significantly

or aid in the reduction of total treatment

period 7,14 .



Clinical Feature

At present, it is important to note

that the researches associated with

tooth movement acceleration by nonsurgical

methods are insufficient and

most papers only provide low quality


More well‐designed randomised control

trials (RCT) are encouraged to determine

the predictability and safety of the nonsurgical

interventions, and whether they

are clinically significant in the reduction

of orthodontic treatment time.


Accelerated tooth movement can

be achieved safely with vibration

including canine retraction. No severe

harmful effect such as root resorption

and pain were reported by the latest

available literature. It is important to

point out that there are limitations of

such methods and require patient’s full

cooperation to use it properly.

A detailed comprehensive treatment

option should be provided to the

patients, so they can understand

the risks and complications involved.

Patients should be able to make an

informed choice about the most suitable

methods for them to achieve the most

satisfactory outcome of the treatment

as planned. DA



Alihani M et al (2015) Vibration Paradox in

Orthodontix : Anabolic and Catabolic effects

Am J Orth & Dentofac Orthop 148:440-449


Bowmann SJ (2014) The efffect of vibration

on the rate of leveling and alignment J Clin

Orthod 48:678-688


Grimm FM (1972) Bone bending, a feature of

orthodontic tooth movement. Am J Orthod;

62: 384– 93.


Kau CH, Nguyen JT, English JD (2010)

The clinical evaluation of a novel cyclical

force generating device in orthodontics.

Orthodontic Practice US; 1: 1– 4.


Leethanakul C, Suamphan S et al (2016)

Vibration stimulation increases interleukin- conventional and self-ligsating brackets Am J

1beta secretion during orthodontic tooth Orthod Dentofac Orthop 134:646-651


movement Angle Orthod 86:74-80 https://doi. Pati AK, Singh A et al (2018) Accelerated


Orthodontics DOI: 10.5772/intechopen.8092

6. 11.

Liao at el (2017) Computational and clinical Pavlin D, Anthony R et al (2015) Cylic loading

investigation on the role of mechanical

(vibration) accelerates tooth movements in

vibration on orthodontic tooth movement orthodontic patients: a double blind, RCT.

Journal of Biomechanics 60:57-64

Semin Orhtod 21:187-194

7. 12.

Miles P (2017) Accelerated orthodontic

Proffit WR (2007) Contemporary

treatment ‐ what’s the evidence? First

orthodontics. 4th edn. St Louis: Mosby pp331–

published: ADJ Vol 62 issue S1 pp63-70



March 2017|| Shapiro E, Roeber FW, Klempner


Nishimura M, Chiba M et al (2008)

LS.Orthodontic movement using pulsating

Periodontal tissue activation by vibration: force‐induced piezoelectricity. Am J Orthod

intermittent by resonance vibration

1979; 76: 59– 66.


accelerates experimental tooth movements in Woodhouse NR, DiBiase AT et al (2015)

rats Am J Othod Dentofac Othop 133:572-583 Supplemental vibrational force during


Pandis N, Nasika M et al (2008) External othodontic treatment: a randomized trial J

apical root resorption in patients treated with Dent Res 94:682-689

About the authors

Dr Kevin Ng is a visiting professor at the Ghongzhou Medical

University and Hon. a/clinical professor at the University of

Hong Kong (2017-2019). 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.

Dr How Kim Chuan graduated from the National University

of Singapore in 1991, where he went on to specialise in

orthodontics at the University of London Eastman Dental

Institute and obtained his MSc in orthodontics in 1995. He later

obtained his MOrth RCS from the Royal College of Surgeons of

England as well as Edinburgh in 1996. Dr How is currently the

chief consultant at the Imperial Dental Specialist Centre. He is also a speaker for

the Invisalign System and has conducted multiple certification courses and study

clubs in South East Asia and India. Presently, he is also an examiner for MOrth

RCS Edinburgh.

Dr David Tan Wei Hong received his Bachelor of Dental Surgery

from the International Medical University, Malaysia. He

continued to improve his knowledge on clear aligner therapy

and has attended multiple Invisalign courses. He is currently

practicing in Imperial Dental Specialist Centre under the

guidance of Dr How.


Clinical Feature

Aesthetic restoration

at the gingiva

The aesthetic correction of gingival recession,

wedge-shaped defects or exposed cervical areas

remains a challenge in today’s practice. But

thanks to a novel gingival rectification technique

of rebalancing the pink aesthetics at the gingiva,

clinicians can now overcome this issue without the

need for local anaesthetic or additional discomfort

to the patient.

By Dr George Freedman and Dr Paiman Lalla



The data is clear; porcelain and composite

resin are both biocompatible at the gingival

margin and well-tolerated 1-3 . The caveat

is that composite tends to cause tissue

irritation if it intimately or directly impinges

on the gingiva 4-6 . This ultimately causes an

unaesthetic gingival recession. Porcelain is

less problematic but marginal plaque buildup

activated by the thin layer of resin cement

leads to a similar free gingival irritation and

eventually, recession 7,8 .

Even skilful subgingival margin placement

will typically, within three to five years, lead

to unaesthetic recession and full visible

exposure of the darker dentinal tissue 9,10 due

to ageing, gingival irritation, or lack of home

maintenance on the patient’s part. Thus, the

restorative conclusion is to locate composite

margins supragingivally 3,11 , with the resin

material reasonably away (0.25-0.50mm)

from soft periodontal structures and thereby

unlikely to cause tissue irritation.

Today’s adhesives and restoratives make this

a straightforward task 12-19 . Later generation

adhesives bond equally well and predictably

to both enamel and dentin 14,15 . Significantly,

seventh and eighth-generation adhesives

have similar bonding strengths to both

enamel and dentin, eliminating the potential

stresses caused by unequal polymerisation

contraction 17-19 . It is clinically possible to

create a continuous restoration through the

dentino-enamel junction (DEJ), covering

as much of the enamel and the dentin as

necessitated by decay or abfraction (or both).

However, a significant aesthetic predicament

quickly presents itself. Dental restorative

materials are designed to match the shade of

the enamel position of the tooth. While some

manufacturers offer “dentin” shades, these

hues typically do not closely match the darker

colouration of exposed dentin, particularly

those observed in endodontically treated

teeth. A typical central incisor measures

approximately 10.5mm cervico-incisally (CI) 20 .

A substantial increase in the apparent length

of a tooth, specifically in the anterior labial

region, detracts from the aesthetic smile.

When restoring a Class V decay or abfraction,

or perhaps a small gingival recession, an

enamel-coloured resin is commonly placed

at the labial DEJ. Increasing the maxillary

central incisor’s vertical aspect (Fig. 1) by a

mere 3mm adds 30% to the apparent vertical

dimension, significantly altering the cervicoincisal

to mesio-distal (CI:MD) ratio, totally

upsetting the aesthetic parameters of the

smile (Fig. 2). In situations where there is a

moderate recession, the visual imbalance

is even further impaired. The CI:MD ratio

impact is even greater on maxillary laterals

and mandibular incisors (average 9.0mm CI).

Maxillary and mandibular cuspids (average

10-11mm CI) are often the teeth that are most

affected by gingival recession and are also

highly visible both anteriorly and laterally.

Individuals who have gingival recession,

Fig. 1: Normal length maxillary central incisors –

expected appearance

Fig. 2: Maxillary incisors apparent length increased

by 30% - very unnatural and unaesthetic

Fig. 3: Beautifil II Gingiva Shades (Shofu Dental

Asia-Pacific, Singapore)



Clinical Feature

abfraction and/or decay tend to look older

than they really are (long in the tooth).

Covering the darker root dentin with an

enamel-like resin simply makes their

teeth more visible, seemingly longer and

correspondingly less aesthetic.

The practitioner must solve this problem

practically, aesthetically, and with minimum

invasiveness. The restoration must be

functional, replacing missing dental

structures with natural dimensions and

contours. It should restore the lost enamel

with enamel-shaded composite resin, and

the receded gingiva with gingival-shaded

composite resin. By creating an artificial

enamel-gingival junction in composite

restorative material, the patient’s aesthetics

and smile can be restored.



Beautifil II Gingiva (Shofu Dental Asia-Pacific,

Singapore) has been specifically designed

for the rebalancing of pink aesthetics in

the cervical areas of the dentition (Fig. 3).

Beautifil II Gingiva is indicated for wedgeshaped

defects, cervical decay, aesthetic

rectification of gingival recession, shielding

exposed cervical areas and splinting of

mobile teeth. The resin material is available in

five tones (dark pink, light pink, brown, orange

and violet) (Fig. 4) which can be layered and/

or blended to achieve custom shades that

allow the treatment of patients with various

hues of gingival pigmentation, according to

their clinical needs (Fig. 5).

Beautifil II is a highly aesthetic, fluoridereleasing

composite resin material indicated

for all classes of restorations. Numerous

studies over the past 20 years have shown

the absence of secondary caries, failures,

post-operative sensitivity and high retention

of both colour match and surface lustre.

The material is based on Shofu’s proprietary

Giomer technology (Fig. 6).

The significant advantage of the Giomer

class of resins is that they not only release

fluoride to protect the tooth at the restorative

margin, but that their fluoride content can

be recharged by toothpastes, fluoride rinses

and varnishes too. Thus, the Giomer’s fluoride

releasing capacity does not decrease over


Another important consideration is that the

gingival margin of the restorative material

(whether pink or enamel in colour) must be

kept supragingival and slightly away from

the free gingival margin 3,4,6 . While a very

narrow band of darker root structure may be

visible towards the apex, the restoration’s

enamel (coronal) and pink gingival (radicular)

colouration will focus attention away from

this area. With gingivally blended restorations,

the professional can deliver both aesthetic

and supragingival margins within the

same restoration. A supragingival margin

facilitates ready access and effective home

maintenance for the patient.

It is imperative that a restoration that is so

close to the free gingival margin be placed

under conditions controlled for moisture

and bleeding. Rubber dam placement is

impractical (target area is positioned apically)

and retraction cord may physically or

chemically compromise the working area.

Ideally, the patient’s oral hygiene creates

a healthy gingival microenvironment,

with minimal pocketing and no bleeding

on probing. In most cases, however, the

Fig. 4: The resin material is available in five shades (dark pink, light pink, brown, orange and violet)

Fig. 5: Resins layered and/or blended to achieve

custom gingival shades

Fig. 6: Giomers continue to release fluoride because

their fluoride content can be recharged with fluoride

toothpastes, rinses and varnishes

Fig. 7: BeautiBond seventh generation dental



Clinical Feature

Fig. 7a: Fusion5 Curing Light

(Dentlight, Plano TX)

Fig. 8: Maxillary left lateral with decay and recession

Fig. 9: Maxillary left lateral with mesial restoration

and gingival restorative rectification

Fig. 10: EyeSpecial Dental Camera (Shofu Dental

Asia-Pacific, Singapore)

Fig. 13: Mandibular anteriors with gingival restorative


practitioner must modify the actual situation

to increase the likelihood of clinical success.

The easiest and best technique for predictable

tissue sculpting is the use of the diode

laser 21-23 . Utilising low power (1.0-1.5 watts), the

dentist can produce an ideal, dry, clean and

blood-free working area in less than a minute.


Visible recession and decay

Remarkably, the patient’s chief concern

was the gingival recession on the left

maxillary lateral, not the mesial caries (Fig.

8). Fortunately, the patient’s oral hygiene was

relatively good, and restoring the MLB decay

was straightforward (BeautiBond, Fig. 7, and

Beautifil Flow Plus X, Shofu Dental Asia-

Pacific, Singapore). The steps for the aesthetic

Fig. 11: Mandibular anteriors with labial gingival


rectification of the buccal recession are:

1. Gently micro-abrade the receded area

and the apical enamel to remove food

debris and plaque. The nozzle of the

abrader should be angled incisally to

prevent gingival irritation and bleeding.

Rinse thoroughly and lightly air dry,

leaving the surface slightly moist

(although the degree of moistness is not


2. Apply BeautiBond, a seventh-generation

dental adhesive, and leave for 10

seconds. Thoroughly air dry the adhesive

(very critical). Light cure with the Fusion

5 Curing Light (Dentlight, Plano TX),

offering deep cure of composite resins

within three seconds with a uniform

4000 mW/cm 2 output (Fig. 7a).

3. Select the appropriate Beautifil II

Gingiva shade (Light Pink and Violet for

this patient) and apply to the receded

area to restore the buccal dimension

and contour of the original soft tissue.

Light cure. It is important to leave a

small (0.25-0.50mm) gap between the

apical margin of the restorative and

the free gingival margin (Fig. 9). This

space prevents gingival irritation, is

easily maintainable by the patient, and

Fig. 12: Mandibular anteriors close-up

is generally not visible even with close-up

photographs. (All photography done with

the Shofu EyeSpecial camera, Fig. 10,

Shofu Dental Asia-Pacific, Singapore)

Mandibular anteriors recession

This is the most commonly encountered

recession in the oral cavity. The mandibular

anteriors are small, close together and not

effectively cleaned by the tongue and lower lip

(Fig. 11). Due to gravity, food debris and plaque

tend to accumulate labially and interproximally

(Fig. 12). In this case, the major culprit for the

recession is the frenum that pulls the attached

gingiva apically. The preliminary process is

a diode laser frenectomy to eliminate the

muscular forces 21-23 . The steps for the aesthetic

rectification of the buccal recession are:

1. Gently micro-abrade, in an incisal

direction, the receded areas and the

enamel nearest to the DEJ to remove food

debris and plaque. Rinse thoroughly and

lightly air dry, leaving the surface slightly


2. Apply BeautiBond and leave for 10

seconds. Thoroughly air dry the adhesive.

Light cure.

3. Select the appropriate Beautifil II Gingiva

shade (Light Pink in this case) and apply to



the receded area to restore the buccal

dimension and contour of the original

soft tissue. Light cure. Leave a small

(0.25-0.50mm) gap between the apical

margin of the restorative and the free

gingival margin (Fig. 13). This procedure

restores the expected gingival height

and contributes to making the patient’s

smile look younger.

Long-term home maintenance is best

accomplished with procedures that

are familiar to the patient and easy to

implement. Regular toothbrushing is effective

and practiced by most dental patients.

Interdental string flossing less so. Though

well-documented, patient resistance to

the process and irregular application limits

its benefits. Water flossing (Water Pik Inc.,

Fort Collins CO) not only facilitates in the

interdental leaning process but has been

shown to improve the results 24 . While there

are several models available, the Sonic Fusion

offers a simultaneous water flossing and

sonic brushing (Figs. 14-15).

Fig. 14: Sonic Fusion (Water Pik Inc, Fort Collins, CO)

Fig. 15: Combined sonic brushing and pulsating

interproximal water flossing


Beautifil II Gingiva enables the practitioner to

overcome the gingival aesthetic dilemma. The

gingival rectification technique is predictable

and can typically be accomplished without the

need for local anaesthetic or discomfort to the


These restorations are totally functional and

replace both hard and soft missing dental

structures to natural dimensions and contours

with minimum invasiveness. The restoration

of the coronal anatomy with tooth-coloured

composite resins is well established; the

development of an artificial enamel-gingival

junction and the reconfiguration of missing

gingival structures with composite resins is a

novel solution that restores the patient’s smile

and facial aesthetics. DA



Freedman G: Ultraconservative Porcelain Veneers,

Esthet Dent Update 2:224-228, 1997.


Freedman G: Ultraconservative Rehabilitation,

Esthet Dent Update 5:80-85, 1991.


Freedman G, Fugazzotto PA, Greggs TR: Aesthetic

Supragingival Margins, Pract Periodontics Aesthet

Dent 2:35-38, 1990.


Newcomb GM: The Relationship Between the

Location of Subgingival Crown Margins and Gingival

Inflammation, J Periodontol 45:151, 1974.


Renggli H, Regolati B: Gingival Inflammation and

Plaque Accumulation by Well Adapted Supragingival

and Subgingival Proximal Restorations, Helv Odont

Acta L6:99, 1972.


Waerhau SJ: Histologic Considerations which

Govern where the Margins of Restorations Should be

Located in Relation to the Gingiva, Dent Clin North

Am 4:161, 1960.


Berman M: The Complete Coverage Restoration and

the Gingival Sulcus, J Prosthet Dent 29:1301, 1973.


Marcum O: The Effect of Crown Margin Depth upon

Gingival Tissues, J Prosthet Dent 17:479, 1967.


Freedman GA, McLaughlin G: The Color Atlas of

Porcelain Laminate Veneers, St Louis, Ishiyaku

EuroAmerica, 1990.


Freedman G: Contemporary Esthetic Dentistry,

Elsevier Publishing, 2011 Chap 23; 551


Freedman G, Klaiman HF, Serota KT, et al:

EndoEsthetics: Part II. Castable Ceramic Post and

Core Restorations. Ont Dent 70:21-24, 1993.


Albers HF: Dentin-resin bonding. Adept Report

1990; 1:33-34.


Munksgaard EC, Asmussen E. Dentin-polymer Bond

promoted by Gluma and various resins. J Dent Res

1985; 64:1409-1411.


Barkmeier WW, Erickson RL: Shear bond strength of

composite to enamel and dentin using Scotchbond

multi-purpose. Am J Dent 1994; 7:175-179.


Swift EJ, Triolo PT: Bond strengths of Scotchbond

multi-purpose to moist dentin and enamel. Am J

Dent 1992; 5:318-320.


Gwinnett AJ: Moist versus dry dentin; its effect on

shear bond strength. Am J Dent 1992; 5:127129.


Freedman G, Leinfelder K: Seventh Generation

Adhesive Systems. Dentistry 2003; January:15–18

Clinical Feature


Freedman G: 7th generation Adhesive Systems.

Dental Asia (English) 2019; March-April:50-53


Freedman G: Adhesion: Past, Present, and Future.

Oral Health 2019: July 109:7 8-14,82


Wheeler RC: A Textbook of Dental Anatomy and

Physiology. W.B. Saunders 1965: 6:126


Goldstep F: Soft Tissue Diode Laser: Where Have

You Been All My Life?. Oral Health 2009: 99:7;34-38


Goldstep F: Diode Lasers for Periodontal

Treatment: The Story So Far. Oral Health 2009:



Goldstep F: Diode Lasers: The Soft Tissue

Handpiece. Dental Asia 2011: Jan-Feb; 28-32


Rosema NAM et al. The effect of different

interdental cleaning devices on gingival bleeding. J

Int Acad Periodontol 2011; 13(1):2-10

About the authors

Dr George Freedman

is co-founder and past

president, American

Academy of Cosmetic

Dentistry; co-founder,

Canadian Academy

for Esthetic Dentistry; regent and fellow,

International Academy for Dental Facial

Esthetics, and diplomate and chair,

American Board of Aesthetic Dentistry.

He is adjunct professor of Dental

Medicine, Western University, Pomona,

California, United States, and professor

and programme director, BPP University,

London, UK, MClinDent Programme,

Restorative and Cosmetic Dentistry, and

author of 14 textbooks, more than 900

dental articles, and numerous webinars.

Dr Paiman Lalla,

graduate of the

University of The

West Indies, Jamaica,

practices dentistry in

Trinidad and Tobago,

with a special focus on cosmetic and

implant dentistry. Following his training

at the Advanced Education in General

Dentistry (AEGD) from Lutheran Medical

Center, US, he has been accorded

fellowships in the International Congress

of Oral Implantology and the American

Academy of Implant Prosthodontics. He

serves on the medical panel of Ministry of

National Security at Trinidad and Tobago.


Clinical Feature

Be selfie ready

There are numerous ways to restore someone’s smile, and a one-size-fitsall

solution is almost impossible. Thus, the following addresses the common

dilemma of clinicians in restoring a “borderline” case and how effective

communication between patient, dentist and lab ceramist is crucial in

achieving the desired results.

By Dr Mansingh Patil

Minimally invasive restorative treatments

have become more of rule than an exception

in today’s modern dental practice. In fact, it

is not only restricted to restorative dentistry

but also other treatment modalities like

extractions and implants.

In cases of failed orthodontic or borderline

cases, restorative procedures also produce

excellent results, particularly for patients who

do not want to go through the orthodontic

treatment again and prefer a quick fix remedy.

The results are predictable and achieved in

shorter duration as compared to conventional

orthodontics. For this instance, the patient

plays a huge role in deciding what they want,

irrespective of what the clinician thinks is the

ideal solution.

The following discusses a similar case that

hovered around the borderline of whether to

treat the issue with conventional orthodontics

or minimally invasive prosthetics. After the

explanation of the pros and cons, the patient

chose the latter procedure.


A 27-year-old female patient approached

our practice with a chief complaint of hating

her right-side smile, as seen when she

takes a selfie. She was also conscious of

her unilateral open bite to the extent that

she wanted immediate rectification of the

situation (Fig. 1).

As a result of a relapsed orthodontic

treatment done a few years ago, the patient

flatly refused to undergo the same procedure



Intraoral examination revealed a unilateral

open bite on the right side and an absence

of occlusal contacts between maxillary and

mandibular canines.

The frontal view presented a canted midline

to the right side (Fig. 2). The right lateral



Clinical Feature

incisor (tooth 12) was positioned palatally, and

the right canine (tooth 13) and left central

incisor (tooth 21) are on off-the-arch form

as seen in occlusal view (Fig. 3). Mandibular

canine (tooth 43) was deficient in height and

short of the occlusal plane like tooth 13.

The patient was warned that the canines will

need aggressive preparation, which might

jeopardise the pulpal health and necessitate

endodontic therapy (Figs. 4-5, 1:1 Figs. 6-7b)


The decision to treat the case prosthetically

without mutilation of dental tissues and

safeguarding the dentin-pulpal complex

was paramount. Hence, before doing any

irreversible tissue destruction, it was decided

at the first appointment to do a direct freehand

composite mock-up to assess if the

case fitted into the restorative domain or not.

Without etching or bonding enamel, an

old, unused composite was sculpted onto

teeth 13, 12, 11, 21, and 43. The patient was

happy with how far the desired result could

be achieved. She took some selfies using

her mobile phone to seek her parents’ and

friends’ opinions.

Upon the patient’s approval of the direct

composite mock-up, an appointment was

scheduled to take a set of impressions in

alginate for diagnostic casts. The casts, along

with the entire preoperative photographs and

related information, were sent to the ceramist

to do the wax-up of the model (Figs. 8a-b).

Three silicone indices (full-contour L/P, labial

and palatal) were obtained from the wax-up

to transfer it to the mouth and facilitate the

preparation stages.

Protemp 4 temporisation material was loaded

in the full-contour index (Fig. 9) to create

a mock-up or Aesthetic Pre-evaluative

Temporaries (APT), a term coined by Dr Galip

Gurel, founder and the honorary president

of EDAD (Turkish Academy of Aesthetic


Aesthetic and phonetic analysis of the APT

were done to check the suitability of the

additions. The APT is modified to the desired

functional and aesthetic parameters by

adding or subtracting resin (Figs. 10-11).


Retreatment with orthodontics was outrightly

rejected. The patient was happy with the

mock-up and decided to go ahead with the

restorative option.

It was decided to use IPS E-max lithium

disilicate veneers (Ivoclar Vivadent) on teeth

13, 12, 11, 21, and 43 to improve her smile. The

patient was warned about the implications of

deep preparation on teeth 13 and 43.


The APT was retained in the mouth so

the preparations can be done through the

mock-up composite. Local anaesthesia (2%

lidocaine with 1/100000 epinephrine) was

administered around the concerned teeth.

A set of four burs — 0.5mm depth cutting, TR-

12, TR-14 and TR-25F were needed. A coarse

Soflex disc was used to round off sharp lines

and point angles.

With the APT in place, the preparation was

done through it as it established the labial

and incisal spatial position of the final

restorations. First horizontal depth cuts of

0.5mm were placed on the APT labial surface

following the natural planes of the surface.

The depth grooves were marked with a sharp

pencil (Fig. 12). The tip of TR-14 was used

Fig. 1: Pre-op right lateral smile

Fig. 2: Pre-op full smile frontal view

Fig. 3: Pre-op occlusal view

Fig. 4: Pre-op retracted left lateral Fig. 5: Pre-op frontal retracted Fig. 6: Pre-op 1:1 frontal


Clinical Feature

Fig. 7a: Pre-op 1:1 right lateral

Fig. 7b: Pre-op 1:1 left lateral

Fig. 8a: Maxillary wax up

Fig. 8b: Mandibular wax up

Fig. 10 Fig. 11

Fig. 9: Protemp 4 temporisation material was loaded

in the full contour index

Figs. 10-11: The APT was modified to the desired functional and aesthetic parameters by adding or

subtracting resin

to reduce the incisal edge to approximately


The APT was then flicked off with a sharp

explorer to see which areas need preparation

and which are untouched (Fig. 13). The TR-

14 bur was used for gross reduction while

the TR-12 was utilised to create a chamfer

equigingival finish line and to perform the

entire final reduction.

The preparation on teeth 13 and 43 were in

deep dentin but did not require endodontic

intervention. Finally, the TR-25 EF fine grit

bur was used to smoothen the enamel and

the coarse disc was used to round off sharp

edges (Fig. 14).

Gingival retraction capsule (3M) was used for

tissue deflection before taking the impression

using polyether impression material (3M).

An anterior stick bite and full occlusal Alu

wax bite was recorded. It was followed by

spot-etched and bonded direct composite



Photographs of the prepared teeth with and

without stump shade tabs were provided

to the ceramist. The prescription to the

laboratory contained the following:

• Photographs of pre-operative situation

• Shade tab photo aligned along with

prepared and unprepared teeth

• Stump shade photographs

• Photographs of approved APT

• Polyether impressions of prepared teeth

• Bite registration, stick bite


When the restorations arrived from the

laboratory, they were inspected on the

models under magnification for crack lines,

marginal fit and interproximal contacts.

The teeth were cleaned with pumice and a

prophylaxis brush. The veneers were first

individually seated dry and inspected for

precise fit under magnification. Next, they

were seated with water-based lubricant to

assess proper fit and aesthetics.

To create micro-porosities in the ceramic

surface, the internal surface was etched

with 5% hydrofluoric acid for 20 seconds and

thoroughly washed and air-dried.

Two coats of silane coupling agent



Clinical Feature

(Monobond S, Ivoclar Vivadent) were applied

for 60 seconds and allowed to evaporate and

air-dry. Two coats of Single Bond (3M) were

brushed on the surface, air-thinned and kept

in a dark place away from any light source.

Teeth 13 and 43 were etched with 37.5%

phosphoric acid for five seconds while the

remaining prepared teeth were etched for 15

seconds. All were copiously rinsed with water

and gently air-dried.

Adjacent teeth were isolated with

polytetrafluoroethylene tape to avoid contact

with the etchant. Two coats of Single Bond

were applied to the preparations, air-thinned

and light-cured for 20 seconds.

The restorations were filled with Variolink N

base and catalyst (mix of transparent shade)

and were gently seated, allowing the excess

resin to flow out from all the margins. The

excess resin was then grossly removed and

the proper fit of veneers was verified.

Subsequently, the veneers were spot-cured

facially and palatally for three seconds each

to achieve a rubbery consistency for easier

clean up. Excess resins were further removed

using a sharp explorer and #12 surgical blade.

To facilitate the complete cure, DeOx gel

(Ultradent) was applied to all the margins to

prevent an oxygen-inhibited layer. The final

cure of 20 seconds was completed on each

surface. While curing, the light tip was moved

in a fanning motion to avoid overheating the


Occlusion, centric and excursive jaw

movements were checked, adjusted, finished

and polished with polishing points. Finally,

post-operative X-rays were taken to check for

any excess resin cement.

Final photographs were taken at a

subsequent appointment to allow gingival

healing and teeth rehydration (Figs. 15-20).

The patient was recalled after three months

to assess the situation. There was an

excellent tissue response which is classic of

glazed and polished ceramic surface in the

cervical area (Fig. 21).


The dilemma of treating failed orthodontic

cases with prosthetics can be easily

overcome by effective communication

between the patient, dentist and the lab

Fig. 12: Depth grooves were marked with a sharp pencil

Fig. 13: The APT was flicked off with a sharp explorer to see which areas need

preparation and which were untouched

Fig. 14: Final preparation

Fig. 15: Post-op full smile frontal view

Fig. 16: Post-op right lateral smile

Fig. 17a: Post-op retracted right lateral view Fig. 17b: Post-op retracted left lateral view Fig. 18: 1;1: Post-op frontal


Clinical Feature

The result was not just pleasing to the patient

but very satisfying to the dentist and the

ceramist as well. Best of all, the patient is now


Fig. 19a: 1;1: Post-op right lateral

Fig. 19b: 1;1: Post-op left lateral


The author would like to acknowledge Mr

Rohit Naik, CDT, of Sai Dental Lab, Goa, India,

for his artistic ability in carving out excellent

piece of ceramic work. DA

About the author

Fig. 20: Post-op occlusal

ceramist. Following a set pattern of doing

direct composite mock-up first, followed by a

detailed wax-up to set up APT which helped

Fig. 21: Three months post-op

in the most conservative teeth preparation,

the future of dentistry has moved on to

another level.

Dr Mansingh Patil is a

graduate of Goa Dental

College and Hospital,

Goa India. He has been

in clinical practice for

over two decades.




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.

User Report

Harness the power of

air with the Primea

Advanced Air turbine


Combining the benefits of

an electric motor with those

of a turbine handpiece,

W&H Primea Advanced Air

turbine features precise

setting of the recommended

rotary bur speed according

to material and process

step as well as the constant

removal rate, even with

increasing pressure on the

bur during preparation.

Dr Grant Dean shares his

workflow and how using the

Advanced Air technology

has modified it.

Dr Grant Dean, dental head

and practice owner of the

Central Dental Group in

Wodonga, Australia



User Report

Nowadays, the challenges on tooth

preparations for prosthetic restoration

are diverse. Combining top-quality

preparations and safety with efficient

operations is among the desired goals.

Excellent ergonomics, good light

conditions in the oral cavity, as well

as simple and intuitive handling are

requirements for dental devices and


Good news is, the new W&H Primea

Advanced Air turbine can fulfil all these

expectations. A high-performance

turbine, which has been awarded

the Austrian National State Prize for

innovation, meets different speed

recommendations accurately and


All bur manufacturers recommend

predefined speeds for the optimum

performance of their instruments.

Dental burs are designed with different

flute angles and cutting characteristics

specific to its task 1 . Rotations per minute

(rpm) varies depending on the outside

diameter of the blade, material to be

cut 2 and vibration characteristics 3 . To

improve blade life, reduce wreckage 2

and heat generation as well as

maximise efficiency 3 and tactile sense 4 ,

it is important to run blades at the

appropriate rpm 2 and follow the bur

manufacturer’s specifications of speed 1 .

By accurately adjusting the Primea in

accordance with these recommended

speeds, the user can get a much better

clinical performance out of the bur.



Dr Grant Dean, dental head and practice

owner of the Central Dental Group in

Wodonga, Australia, uses 180,000rpm

to complete the initial shaping of the

restoration, then reduces the speed

to 100,000rpm for more intricate

shaping, and sometimes even as low

as 60,000rpm to get a super-smooth

finish. He completes each step with a

Fig. 1: Optimal speed ranges of the Primea Advanced Air according to the different steps of the treatment and related

intended burs 5

single bur, which is no problem for the

Primea Advanced Air turbine, due to

easy and quick adjustment of the speed

on the display (Fig. 1).

Adjusting the speed in this way ensures

good cutting efficiency, which is

impossible to achieve by using the foot

control to supervise a conventional air-


User Report

driven turbine handpiece. Dr Dean gave

an example of how this has expanded

the range of his treatments: “I reduced

the speed to control the bur in cutting

a glass ionomer restorative placed in

the distal of an upper tooth. Since it

was difficult to place, I added surplus

material so I could trim back to the tooth

shape. Using the 60,000rpm speed, I

have far greater control and can avoid

the bur ‘burrowing in’ to the restorative

– I could even use the root surface as

a ‘guide’ to ensure a seamless margin

without any effect on the root surface.”

He added that it is also possible to

perform a preparation with a constant

bur speed, regulated on the device.

With conventional air-driven turbine

handpieces, increasing pressure

during preparation was associated with

decreasing performance, but the Primea

Advanced Air turbine features constant

performance during increased load as

used with electric motors and speedincreasing


After setting the required or

recommended rotary speeds for the

various applications on the module’s

display, a sensor in the turbine head

continuously measures the bur’s actual

rotary speed on the tooth. The bur is

then aligned with the rotary speed

set. As soon as the speed threatens to

slow, the control module adjusts the air

supply immediately to ensure constant


In addition to the “Power” mode with

constant rotary speed, there is also a

“Tactile” mode, which permits reduction

of the speed so users can perform

sensitive steps with even greater control

— encouraging minimally invasive




Not only does this new technology

enables Dr Dean to work in a more

W&H Primea Advanced Air turbine

precise, straightforward, faster and

safer way, it also guarantees a smoother

cutting pattern and result for the


“With a conventional turbine, loading of

the bur slows the bur speed down. The

consequent foot pedal ‘feathering’ that

we all do, creates an uneven cutting

pattern. Sometimes the bur will bounce

or walk across the preparation creating

uneven cutting depths. I found this

almost never happens with Primea:

completing intricate work like crown

preps is made simpler and quicker,”

explained Dr Dean.

He added: “Bulk amalgam removal is

also much faster now with the Primea

Advanced Air. I have used a number of

different bur types and shapes (both

tungsten and diamond) but the Primea

turbine does not slow down with any

of them. I have gone back to an old

favourite bur (JET FG TC 330), simply

because I am used to working with small

instruments, which supports my minimal

intervention dentistry philosophy.

“The new W&H 5x Ring LED+ system

(RK-97 L) reduces reflection from

moist surfaces and offers me perfect

interpretation of the tooth surface,

which is among others crucial for a

minimally invasive performance as well.

Due to superior distribution of the light,

shadows are non-existent.”

The lightweight design of the handpiece

with its advantageous weight

distribution and non-slip surface

render the device highly ergonomic.

Furthermore, the W&H Roto Quick

coupling system RQ-24 allowing a 360°

handpiece rotation without twisting the

hose support an ergonomic operation.



Arranging the treatment to be as quiet

as possible and without high-frequency

noise creates a positive atmosphere for

the patient.

“A conventional turbine’s free-running

speed is 350,000rpm or more. The

Primea turbine is set to the application

speed (i.e. 180,000rpm) and is therefore

far quieter, and the pitch is far lower

– which must be more convenient for

the patient’s experience and which I

certainly appreciate too. I’ve always

linked the pitch/noise of the turbine

to the performance, i.e. the higher the

noise, the higher the cutting speed.

Not anymore. Tremendous cutting

performance but at a lower speed

means less noise pollution and creates

a far more pleasant atmosphere for me,

my staff and the patient,” shared Dr

Dean. DA



Elias K, Amis AA, Setchell DJ. The magnitude

of cutting forces at high speed. J Prosthet

Dent. 2003 Mar;89(3):286-91.


Manual of the UKAM Industrial Superhard

Tools Division of LEL Diamond Tools

International, Inc., Valencia, CA 91355 USA


Vaughn RC, Peyton FA. The influence

of rotational speed on temperature rise

during cavity preparation. J Dent Res. 1951



Krejci I, Lutz F, Boretti R. Resin composite

polishing—filling the gaps. Quint Int



W&H Dentalwerk Bürmoos GmbH




1981 2001 2021

DIATECH ® Diamonds

Open up new perspectives

Diamonds are industry’s first choice for efficiently milling even

hardest materials. In dental practices, wear-resistant and highprecision

diamonds can work through extremely tough materials

like Zirconia.

006904 08.21 |

User Report

Apicoectomy — Chronic apical

periodontitis treatment

Technological advancement in dentistry has opened up more

treatment possibilities to achieve better clinical results and

upgrade patient comfort. The following discusses how the Er:YAG

laser system can stimulate the healing process and reduce postoperative

complications in cases of endodontic microsurgery.

By Dr Igor Kriznar

A 46-year-old female patient was

referred to the clinic for the treatment

of chronic apical periodontitis on tooth

15. The tooth had been endodontically

treated approximately five to six years

ago and was not vital. The tooth was

tender to percussion as well as palpation

adjacent to the apex of the tooth. The

mobility of the tooth was not increased.

The gingiva was healthy in colour and

the probing depth was not more than


An X-ray showed an occlusal filling

reaching all the way to the pulp chamber

(Fig. 1). One root could be observed and

the apex has a slight curve to the distal.

The root filling deviated from the canal

trajectory and a root perforation could be

seen in the apical part. The periodontal

ligament was normal in width but the

periapical bone showed a small circular

resorption indicating chronic apical



Apicoectomy was performed to eliminate

bacterial infection in the root canal

system by removing the tissue with

inflammation as well as the excess root



User Report

root; quicker healing; and fewer postoperative

complications compared to

conventional therapy.

All steps of apicoectomy can be

performed using Er:YAG laser light,

including incision and granulation tissue

removal. The latest protocols also involve

the use of biomodulation (LLLT) with

Fig. 1: Before treatment

Fig. 2: Root resection after mucoperiosteal


Fig. 3: Degranulation tissue removal

(SWEEPS mode)

Nd:YAG laser to stimulate the healing

process. DA

About the author

Fig. 4: Retrograde filling

filling material from the periapical tissues

to promote healing. After infiltration of

anaesthetic, a marginal incision was

performed along tooth 15 and a vertical

incision at tooth 14. A muco-periosteal

flap was elevated to reveal the apical

region of tooth 15 (Fig. 2).

The osteotomy was performed using

Er:YAG laser wavelength with a cylindrical

tip. When the osteotomy window was

large enough, the granulation tissue

was removed using an excavator. For

the root resection, a cylindrical tip was

used and the energy was raised to

400mJ. The surface of the resected

root was inspected under an operative

microscope and a retrograde preparation

was made. For complete removal of the

granulation tissue as well as excess root

filling material from the bone lacunae, the

SWEEPS irrigation protocol using saline

can be adopted from endodontics to

encourage faster healing.

For this reason, after the retrograde

Fig. 5: One-week follow-up before

suture removal

preparation, the AutoSWEEPS mode was

used, performing 30-seconds cycles of

irrigation with saline solution in the bone

lacunae (Fig. 3). After local haemostasis,

the retrograde preparation was filled and

tightly condensed using MTA (mineral

trioxide aggregate) cement (Fig. 4) and

the wound was sutured.

Curasept rinsing solution (0.05%

chlorhexidine) was prescribed for a week.

On the follow-up appointment after a

week, the patient had minimal pain. The

healing of the wound was satisfactory;

slight swelling persisted for only two

days after surgery (Fig. 5). On the X-ray, a

resected root and a tight retrograde filling

could be seen (Fig. 6). The sutures were

removed and the patient was scheduled

for a follow-up appointment after a year.


Fig. 6: X-ray of one-week follow-up

This clinical case showed that Er:YAG

laser light can also be used in endodontic

microsurgery cases. The main benefits

include: less vibration, trauma and

anxiety for the patient; increased

decontamination of the apical part of the

Dr Igor Kriznar

graduated in 2006

from the Faculty

of Medicine

in Ljubljana,

Slovenia, and

began working as an assistant

at the Faculty of Medicine,

Department of Endodontics and

Operative Dentistry. He acquired the

professional title of Dental Specialist

in Endodontics in 2014. Until the end

of 2015, he worked as an assistant

at the Faculty of Medicine, where he

was engaged in work with students

of dentistry in clinical and preclinical

practice. At the same time,

he worked as a dental specialist at

the University Medical Centre in


Dr Kriznar was also involved in

research work and earned his PhD

in endodontics from the same

university in 2016. In December

2015, he entered into full-time

private clinical practice focusing

mainly on endodontics. In 2019, he

completed LA&HA Master in Laser

Dentistry. Actively participating

in many international and local

conferences and symposia, he has

also published numerous scientific

papers in various journals.


Behind the Scenes

New era in


IPS e.max ZirCAD Prime is

redefining all-ceramics. But

what makes this product

so special? Master Dental

Technician Vincent Fehmer

talks about the material and

what makes it distinctive from

other zirconia materials in

routine laboratory work.

Vincent Fehmer, MDT, has been

working at the Clinic for Fixed

Prosthodontics and Biomaterials at

the University of Geneva since 2015.

In addition, he runs his own dental

laboratory in Lausanne, Switzerland.

In his numerous publications and

presentations, the all-ceramics expert

emphasises the importance of an

efficient and effective workflow. This

includes deciding on the appropriate

material for the given indication,

which calls for a sound fundamental

knowledge of materials science.

He is convinced that modern zirconia

will play a key role in the development of

future digital workflows. He sees great

potential with regard to complex, multiunit

restorations in particular.

Fehmer belongs to a selected group of

dental technicians who were given the

opportunity to test the new all-ceramic

IPS e.max ZirCAD Prime during the

material’s development phase. IPS

e.max ZirCAD Prime was presented

to the public for the first time at IDS

(International Dental Show) 2019.

Fehmer describes his first impression of

the zirconia material and reports about

his experiences with it to date.

What was your first impression of

IPS e.max ZirCAD Prime?

The material’s exceptional development

potential within the field of zirconia is



Behind the Scenes

exciting. The effective combination

of properties – high strength and

translucency in the incisal region due to

Gradient Technology – is great. I really

like the look and feel of the material, its

excellent performance and lovely shade.

All in all, I was pleasantly surprised.

What impressed you the most about

IPS e.max ZirCAD Prime?

I am really impressed with the opacity

of the disc in the core area and its high

stability, which is essential in complex

restorations. These properties give me

the freedom to fabricate wide-span

bridges with up to two pontics and

with cantilevers. In addition, I have the

possibility of applying additional ceramic

layers. This material gives me utmost

flexibility – that is one of the strengths

of this product.

characterisation materials), I hope to

simplify my inventory and achieve highly

predictable aesthetic results.

What kind of potential does IPS

e.max ZirCAD Prime have in your


It has what everyone wants; laboratory

and practice owners would like to have

a disc with which they can manage all

their indications. We’ll see how well the

product performs in everyday laboratory

situations in the future. The disc has a

great potential, and I am looking forward

to using it in the future and testing it in

clinical situations. DA

What is the difference between

IPS e.max ZirCAD Prime and

conventional multi-layer zirconia?

Unlike conventional multi-layer zirconia,

this disc features a beautiful progression

of shade. Additionally, its colours

are amazing and the combination of

properties is fantastic.

What makes the colour gradient in

IPS e.max ZirCAD Prime so special?

The colours seamlessly blend into

each other. There are no visible layers

of pigmentation where a transition is

visible. This simplifies the handling as

well as the positioning of restorations

in the disc. All these characteristics are

very important to me.

What do you expect from IPS

e.max ZirCAD Prime in your dental


Primarily, I expect it to simplify my work

on a daily basis. I hope to keep fewer

products in stock in my lab. I would

like to achieve better aesthetic results

and have more versatility and flexibility

in my work. In combination with the

existing products (layering ceramic,


Behind the Scenes

Maxillary premolar inlay

restorations with Permanent

Crown Resin

3D printing of dental restorations

addresses the increasing patients’ needs

for more efficient treatment solutions.

Thus, this paper presents a step-by-step

overview of fabricating inlay restorations

using an indirect CAD/CAM process,

achieving an economical solution without

compromising the aesthetic results.

By Dr Édouard Lanoiselée in collaboration with Argoat Prothèse Dentaire

Digital dentistry methods and materials

have surpassed traditional ones in many

ways. Digital tools particularly enhance

interconnectedness and communication

between patients, doctors, and laboratories.

Additionally, the development of new dental

materials for restorative dentistry opens up a

new world of possibilities, allowing for shorter

delivery times and reduced costs while still

delivering high-quality restorations.

Today, intraoral scanners and 3D printing

systems perform at a high level while

maintaining the simplicity of use. The

Form 3B printer from Formlabs Dental is

an excellent example of this; its plug and

play operation puts it within equal reach of



Behind the Scenes

Fig. 1

Fig. 2 Fig. 3

Fig. 4 Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10 Fig. 11

Fig. 1: Initial clinical situation

Fig. 2: Teeth after preparation

Fig. 3: Maxillary impression with trace of the limits of

the teeth preparations

Fig. 4: Black and white imprint control

Fig. 5: Dynamic occlusion recording (Specific


Figs. 6 to 11: Inlay design

printing experts and beginners. Permanent

Crown Resin, also from Formlabs, is a

restorative material released in 2020 that

allows the direct printing of high-quality

permanent single unit restoration at a

reduced price.

The clinical case presented here shows an

indirect CAD/CAM step-by-step workflow

for the production of inlay restorations.

The intraoral impression was taken in the

practice with the data then transmitted to

the laboratory, where the prosthetic elements

with Form 3B and Permanent Crown

Resin were designed and 3D printed. The

restorations were sent back to the practice,

prepared for adhesive cementation, and the

treatment was delivered to the patient.



A 58-year-old-female patient with treated

hypothyroidism consulted us for sensitivity to

cold in the area of her tooth 24. Upon clinical

examination, we identified an occlusal-distal

fracture of the dental amalgam on tooth 24.

The restorations on teeth 25 and 26 were

carried out at the same time and appeared

to be infiltrated. Following the tests, we

diagnosed reversible pulpitis on tooth 24. On

the other hand, teeth 25 and 26 did not show

pulpal symptoms (Fig. 1).


The treatment plan consisted of the removal

of amalgam restorations and the transition

to direct composite restorations (26) and

indirect printed composite resin restorations

(inlays on 24 and 25).


Behind the Scenes

Fig. 12 Fig. 13 Fig. 14 Fig. 15

Fig. 16

Fig. 17 Fig. 18

Fig. 19 Fig. 20 Fig. 21

Fig. 22 Fig. 23

Fig. 12: Print preparation in Preform

Fig. 13: Inlay characterisation

Figs. 14-15: Surface preparation of inlays

Fig. 16: Preparation of tooth surfaces

Fig. 17: Application of orthophosphoric acid

Fig. 18: The tooth preparations after conditioning

Fig. 19: Cementation of the inlay on tooth 25

Fig. 20: Cementation of inlay on tooth 24

Fig. 21: Fitting view

Fig. 22: Polishing under surgical field

Fig. 23: Final view after occlusion check and


The treatment was carried out in two

sessions: a preparation session and a

cementation session.


The amalgams were placed under the

operating field. In order to conceal the

residual discolouration caused by the

amalgam and to fill undercuts, the cavities

were filled with composite.

Tooth 16 was filled using the direct composite

resin technique. The shade of the indirect

restorations was determined by the shade

selected to fill the cavities of teeth 24, 25 and

the filling of tooth 26. The composite filling

also protected against the risk of bacterial

contamination and prevents possible pulpal

sensitivities (Fig. 2).

The teeth were then prepared using

calibrated burs for onlays. After polishing,

an intraoral impression was taken (TRIOS

4, 3Shape) both statically and dynamically.

The patient’s mandibular movements were

recorded to improve the accuracy of the

occlusion (Figs. 3-5).

The impression was sent to the prosthetic

laboratory (Argoat Prothèse Dentaire) via the

secure 3Shape Communicate web portal.

The provisional restoration was made using

a flexible composite (Luxatemp inlay, DMG),

which was selected for easy removal during

the assembly session (Figs. 6-11).


The restorations were modelled in the

3Shape Dental System software. After the

digital design was completed, the inlays were

exported in STL format and imported into

the PreForm software (Formlabs) and printed

in Permanent Crown Resin A2 Shade in the

prosthetic laboratory (Fig. 12).



Behind the Scenes

The restorations were then characterised via

staining (Optiglaze, GC) and glazing, and sent

to the dental practice for cementation

(Fig. 13).



After the removal of temporary restorations,

the inlays were tried in to validate their

insertion and adaptation. Their internal

surface was then prepared in three steps

(Figs. 14-15):

1. Micro sandblasting (50micron alumina)

to create mechanical retention

2. Cleaning to remove residual alumina


3. Silanisation (G-multi primer, GC): after

thorough drying, the primer was applied

in a single layer, then the excess was

evaporated with a blower and the

prosthetic part was placed in a heater to

activate the silane

We then proceeded to the assembly by

cementing according to the following

protocol (Fig. 16):

1. Setting up an operating field using

multiple dental dams. This allowed us to

isolate the site from the moisture of the

oral cavity and improve visibility

2. The cavities were conditioned using

a micro-sander (27micron alumina).

The sandblasting reactivates the

composite for bonding, cleaning the

cavity of possible residues of temporary

cementation agent and restoration. We

rinsed abundantly to remove alumina

particles, which can decrease the

adhesion value

Orthophosphoric acid was applied for 30

seconds on the enamel and 15 seconds

on the dentin. The etching creates

micromechanical keying and helps to finish

cleaning the bonding surfaces (Fig. 17).

The surfaces exhibited a matte appearance

as a sign of the conditioning action of

microsanding and acid etching (Fig. 18).

For cementation, a universal cement agent

(G-cem Linkforce, GC) with dual setting

(chemical and light-curing) was used. The

adjacent teeth were insulated with Teflon

to avoid the adhesive and cementing agent

getting to undesired surfaces.

The adhesive was applied by actively rubbing

it into the surfaces and applying the dry

air blower to evaporate the solvents. The

adhesive was applied to the prosthetic

restoration, which was then gently placed

into the prepared cavity (Fig. 19).

The excess cementing agent was carefully

removed with a brush and then the

restoration was light-cured for 20 seconds.

The second inlay was then placed following

the same protocol (Fig. 20). Here again, the

excess was removed with a brush before

photopolymerisation. The two inlays were

then light polymerised for one minute from all

sides (Fig. 21).

A first polishing was carried out using silicone

polishers (Spiral Komet Kompoline) (Fig. 22).

The rubber dam was then removed, the

occlusion was checked and the final polishing

was carried out (Fig. 23).


The aesthetic integration was satisfactory.

The patient will be seen again in six months

for follow-up.


Permanent Crown Resin is an excellent

alternative to composite block for inlay

applications. 3D printing allows an

economical solution with a satisfactory

aesthetic result both in terms of morphology

and colour.

While a composite block can cost between 10

to 12 euros per piece, using 0.40ml per inlay

reduces costs significantly to four to seven

euros per inlay. The flow proposed here in

collaboration with the prosthetic laboratory

can easily be done within the dental practice

in a direct CAD/CAM framework. DA

About the authors

Dr Édouard

Lanoiselée is a

general practitioner

in a group practice

in Nozay, France. In

2008, he graduated

from the Faculty of Dentistry in Nantes,

France, but has always maintained a link

with the faculty since his graduation,

whether for clinical supervision of

students or theoretical instruction at

the graduate level. He is a lecturer for

the University Diploma in Aesthetic

Dentistry at the University of Nantes,

for the Master 1 in Biology and Health,

as well as for the higher education


He has obtained several certificates in

prosthetics (fixed, as well as partial and

complete removable), and is a former

teaching hospital assistant lecturer

at the care, research and teaching

centre of the same university under the

prosthetics department. He has been a

user of CAD/CAM systems since 2009

and regularly speaks at conferences on

topics related to aesthetic dentistry and

digital workflow.

Argoat Prothèse Dentaire is a dental

laboratory combining conventional

and digital techniques. To become

autonomous, they have created an

industrial machining and 3D printing

centre for their own production. A team

of technicians focused on prosthetists

links digital impression, the machine

and the prosthetist, the latter of whom

can devote more time to optimising

the aesthetic work. They machine

and print all the materials available in

the dental field. The digital workflow

is accelerating the comfort of the

patients and dental professionals.


In Depth With

Treatment solutions for Molar

Incisor Hypomineralisation

Molar Incisor Hypomineralisation (MIH) is a common developmental

condition presenting as a discolouration on one or more affected permanent

molars and the associated incisors. Children with MIH often develop dental

anxiety due to invasive and even painful dental experiences at a young

age. For this reason, GC Dental offers a variety of treatment solutions for

enhanced clinical management and better patient experience.

A global burden concerning one in seven

children 1,2 , MIH affects primarily one or more

first permanent molars. Central incisors may

also be affected but this usually occurs to

a lesser extent as with hypomineralisation

of the second deciduous molars (HSPM)

or canines 3 . Children with HSPM are up to

five times more likely to develop MIH in the

permanent dentition.

Great varieties in severity exist, ranging

from mild opacities to post-eruptive enamel

breakdown (Figs. 1-3). However, at present,

the aetiology of MIH is still unknown. Some

correlations with prenatal, perinatal and

postnatal illness; exposure to antibiotics

or chemicals such as dioxin, bisphenol A

and polychlorinated biphenyl have been

described, but sufficient evidence is still


Clinical management of MIH is challenging

due to: hypersensitivity and rapid

development of dental caries in affected

teeth; difficulty in achieving anaesthesia;

limited cooperation of the young child;

repeated marginal breakdown of restorations;

and often, it requires an increased number of

dental visits.

To ensure long-term compliance, it is

essential to adapt the treatment of MIH to the

individual patient’s conditions and create a

positive dental treatment experience for the

patient. For this reason, GC offers variety of

treatment solutions especially suited for each

individualised treatment plan.



Empowering the patient is the first step

• The teeth should be brushed twice a

day with a toothpaste containing at

least 1000ppm fluoride. Fluoride content

should be age-appropriate; in older

patients, higher levels of fluoride may be


• Using identification tools such as Tri

Plaque ID Gel (Fig. 4) can help identify

cariogenic plaque and motivate patients

to optimise brushing technique

• Frequent intake of sugar and acidic food

should be avoided

Strengthen and desensitise

• The application of Recaldent (CPP-ACP),

containing high levels of bio-available

calcium and phosphate, has been

shown to be effective in this case 4,5 .

Topical treatments such as Tooth

Mousse (Fig. 5) and Tooth Mousse Plus

(900ppm fluoride) (Fig. 6) are useful in

strengthening teeth and decreasing

sensitivity in MIH

While both can be used for the same

indications, Tooth Mousse is recommended

below the age of six to avoid the risk of

fluorosis and in cases where extra fluoride

Fig. 1: Mild MIH (Photo courtesy

: Prof van Amerongen, the


Fig. 2: Moderate MIH (Photo

courtesy: Prof Baroni, Italy)

Fig. 3: Severe MIH (Photo

courtesy: Prof Baroni, Italy)

Fig. 4: Tri Plaque ID Gel



In Depth With

supplementation is not needed or desired.

For overnight application, Tooth Mousse is

recommended until the age of 12 while Tooth

Mousse Plus can be used above that age.

• Fluoride varnish with Recaldent (CPP-

ACP) such as MI Varnish (22600ppm

fluoride) (Fig. 7) for quarterly in-office

application after prophylactic cleaning

seals the dental tubules tightly,

desensitises teeth and leaves a film of

varnish on the surface

Protect surfaces

• Fuji VII (Fig. 8), a fluid glass ionomer,

helps protect the surface against

caries formation and hypersensitivity.

Since it can bond chemically in a moist

environment, teeth can be protected

even before they are fully erupted

• The setting of Fuji VII can be accelerated

with the dental curing light. It offers fast

and easy application and is ideal for firstline



Long-term restorations

• Glass hybrid EQUIA Forte HT (Fig. 9)

is suitable as a long term, minimally

invasive restorative. Its quick bulk

Fig. 5: Tooth Mousse

placement is a huge advantage in

young, anxious patients

• The chemical adhesion and moisture

tolerance of EQUIA Forte HT offer

a great benefit since adhesion to

hypomineralised enamel is challenging

• In cases where teeth are difficult to

anaesthetise, the Atraumatic Restorative

Treatment (ART) approach can be used

— caries is manually excavated before

application of EQUIA Forte HT 6

Interim therapeutic restorations

• Glass ionomers or stainless-steel crowns

(luted with a glass ionomer cement)

can be indicated particularly to young

patients with severe cases of MIH if a

definitive treatment such as a composite

restoration is not yet possible


The recall frequency is usually higher for

patients with MIH due to the higher caries

susceptibility. Several points have to be kept

in mind:

• Restorations need to be controlled

regularly, as adhesion to

hypomineralised enamel is challenging

• It is important to maintain the patient’s

compliance to home treatment and to

Fig. 6: Tooth Mousse Plus

evaluate its effects regularly

• Oral hygiene (with Tri Plaque ID Gel)

and dietary habits should be regularly


• Interim therapeutic restorations need

to be monitored and replaced when

the circumstances have become

appropriate for definitive treatment

Ultimately, an important part of the

preventive strategy is home care. It is crucial

to motivate and educate both the child and

caregiver on implementing good oral hygiene

habits and healthy dietary intake. DA



Schwendicke F., Elhennawy K., Reda S., Bekes K.,

Manton DJ., Krois J. Global burden of molar incisor

hypomineralization. J Dent, 2018; 68: 10–18.


Zhao D., Dong B., Yu D., Ren Q. & Sun Y. The

prevalence of molar incisor hypomineralization:

evidence from 70 studies. Int J Paediatr Dent, 2018;

28: 170-179.


Garot E., Denis A., Delbos Y., Manton D., Silva M.,

Rouas P. Are hypomineralised lesions on second

primary molars (HSPM) a predictive sign of molar

incisor hypomineralisation (MIH)? A systematic

review and a meta-analysis. J Dent 2018;72:8-13.


Baroni, C. & Marchionni, S. MIH supplementation

strategies: Prospective clinical and laboratory trial.

J. Dent. Res, 2011;90: 371–376.


Wierichs, R. J., Stausberg, S., Lausch, J., Meyer-

Lueckel, H. & Esteves-Oliveira, M. Caries-Preventive

Effect of NaF, NaF plus TCP, NaF plus CPP-ACP, and

SDF Varnishes on Sound Dentin and Artificial Dentin

Caries in vitro. Caries Res, 2018; 52: 199–211.


Grossi JA, Cabral RN, Ribeiro APD, Leal SC. Glass

hybrid restorations as an alternative for restoring

hypomineralized molars in the ART model. BMC Oral

Health, 2018; 18;18(1):65.

Fig. 7: MI Varnish

Fig. 8: Fuji VII

Fig. 9: EQUIA Forte HT and EQUIA Forte Coat


In Depth With

Axiom BL ® : when

convenience meets


Launched more than a decade ago, the Axiom ®

implant system was designed to democratise

the practice of implantology through accessible

protocols and philosophy resolutely focused on

prosthetic results.



The Axiom BL ® Bone Level implant represents

the culmination of a technical consensus:

an internal conical and sealed connection

designed to preserve alveolar bone; a single

diameter connection which greatly facilitates

prosthetics by allowing a choice of prosthetic

components independent of implant diameter

and limiting the number of references; and

finally, the soft-tissue friendly “Platform

switching” system.

With this combination, Axiom ® achieved rapid

commercial success, becoming the leader in

its market segment in France. The added value

of Axiom ® and the industrial expertise of the

teams that have been producing implants on

a subcontracting basis since the mid-1980s

opened the doors to international markets.


Axiom ® Bone Level is an endosseous implant

designed to promote biological integration.

With its single, stable and sealed Morse

taper connection with “Platform switching”

system, it contributes to the stabilisation of

the alveolar bone and aesthetic durability of

the restoration. The principle of a constant

emergence profile between the healing screws

and abutment allows the prosthetic restoration

to be performed in a controlled manner, without

exerting undue tension on the soft tissue.


The design of the Axiom ® BL implants has

been studied to optimise primary bone

anchorage and ensure an even distribution

of occlusal loads on the surrounding bone.

Axiom ® implants are made of medical-grade

titanium allow, often referred to as “Grade

V”*, whose extremely high-level mechanical

properties allow for implant diameters

designed to minimise surgical invasiveness,

and benefit from a BCP ® surface treatment

that has been shown to provide effective




Available in two profiles: REG and PX, the

Axiom ® BL implants range covers all bone

situations. The highly versatile REG profile is

suitable for most clinical indications, while the

PX has been designed to promote anchorage

in immediate post-extraction situations. One

single surgical kit is needed for both designs,

which provides the great advantage of



Axiom ® BL implants require a single,

conveniently organised surgery kit for both

REG and PX profiles. The practitioner is able

to adapt the choice of implant right until

the last moment during the surgery process

in response to the clinical situation. The

simple surgical protocol and the

common prosthetic range offer

greater flexibility of use. Drills

with integrated stops ensure

easier and safer surgical


Axiom ® implants are

presented in a practical,

reliable and innovative

packaging format. This patented solution

provides a direct grip on the contra-angle and

allows for the possibility of repositioning during




The Axiom ® system is characterised by its

great flexibility of use. The single conical

connection enables the practitioner to benefit

from total independence between the implant

diameter and the various emergence profiles

of the prosthetic components available,

which makes it possible to propose the best

solution for each indication while limiting the

complexity of the prosthetic ranges.

The comprehensive Axiom ® prosthetic ranges

cover all the needs of the practitioners and

laboratories: Lab-side solutions for machining

customised prosthetics in the laboratory,

integration with all-digital workflows, ranges of

components for cemented or screw-retained

prostheses, single or multiple units.


In a study conducted on 60 partially

edentulous patients requiring two implantsupported

crowns, 120 Axiom ® BL REG

implants were placed at six different centres.

The results, presented in a publication in the

Clinical Trials in Dentistry journal, demonstrate

that Axiom ® BL implants offer exceptional bone

stability and excellent aesthetic results.

Discover the results here: https://www.

axiom-bl-reg-clinical-study-5years.html DA

*Exact name of so-called “Titanium Grade V”:

Medical-grade Ti6AI4V-ELI titanium



In Depth With

Digital endo assistance: CanalPro

Jeni Endo Motor navigates through


Autonomous driving, operations using a robot

arm, or computer-aided design — there is hardly

an area in which humans cannot be assisted by

an electronic co-pilot. The more complex the

application, the more useful the support is via

algorithms. Endodontic treatment is no exception,

requiring the utmost precision and reliability.



COLTENE has achieved a breakthrough

with a virtually self-propelled endo motor:

the fully automatic CanalPro Jeni. Named

after its developer, Prof Dr Eugenio Pedullà,

CanalPro Jeni finds its way through the root

canal autonomously and thus accompanies

mechanical and chemical preparation stepby-step.

Via touch screen, it connects directly

to the selected NiTi (nickel-titanium) file

system such as the HyFlex CM or EDM or the

files of MicroMega from the COLTENE group of


What is new is that the user can work forward

continuously from coronal to apical by

applying only slight pressure and the motor

decides independently on the progress of

the movement. For this purpose, the Jeni

assistance system uses complex algorithms

and controls the variable file movements at

millisecond intervals by constantly regulating

rotational movement, speed, torque and file


The endo motor adapts to the individual

root canal anatomy and guides the

preparation step-by-step. Integrated length

measurement is available at the same time.

The outstanding comfort and level of safety

that Jeni delivers during preparation is

unmatchable. In fact, it recognises the risk

of a potential fatigue fracture of the file and

informs the dentist with an acoustic signal

that a file change is necessary.

The CanalPro Jeni is also familiar with the

common endodontic irrigation protocol: the

device records mechanical reprocessing

progress, and notifies the chairside dentist or

assistant acoustically on when and how often

irrigation should be performed between file

changes. This is incredibly important when

the long-term success of treatment depends

largely on thorough irrigation of the prepared

root canals.


With the CanalPro Jeni Motor, COLTENE

has added another useful tool to its range of

ideally matched endodontic instruments and

dental materials. COLTENE has always worked

closely with international scientists, practice

owners, key opinion leaders and dental teams

to design and realise concrete solutions for

everyday treatment routines.


With its latest update, CanalPro Jeni Motor

was upgraded with extended options. The

motor now automatically finds its path

through the root canal, working in unison with

the mechanical and chemical preparation.

Here, the user can choose from a number

of popular sequences for the flexible NiTi

files. The highlight of the latest update is

the addition of Remover files, which make

a significant difference to an endodontic

revision treatment. The novel 30/.07 HyFlex

and MicroMega Remover files fit perfectly to

the established file systems, and quickly and

reliably remove inadequate gutta-percha

fillings, as well as similar ageing endodontic

restorations. Due to their intricate shape,

they adapt to the natural contour of the canal

and efficiently loosen the existing obturation


In addition, the reaction time of the motor and

the touchscreen has been further reduced.

Graphic optimisation and enhanced system

performance make the Jeni even more

attractive. The result of these improvements

is that treatment becomes even safer and, at

the same time, more comfortable.


COLTENE has developed a special service

page for dental practices, which provides

regular access to the latest updates and

information. Dentists can simply register with

the serial number of their CanalPro Jeni at

the company’s website. DA


In Depth With

Versatile solutions for successful

bone and tissue regeneration

Straumann® XenoGraft and XenoFlex are biomaterials designed to eliminate

antigenicity and provide a favourable environment for new bone growth.

Available in a selection of practical containers for enhanced handling, its slow

resorption increases stability, improving the likelihood of long-term implant

survival rates.


Straumann® XenoGraft, for bone defect

treatment, is methodically processed from

bovine bone, extensively tested to eliminate

antigenicity and provides a favourable

environment for new bone growth. Its limited

resorption rate delivers extended stability,

a critical advantage in cases that require

a strong framework for long-term tissue

support or aesthetic needs.

Why Straumann® XenoGraft?

• Volume preservation by providing a longlasting

framework for excellent space

maintenance (Fig. 1)

• Fast and straightforward application for

optimal handling

• Innovative packaging for easy product

handling and hydration

• Limited resorption rate provides extended


• Osteoconduction followed by organised

integration and remodelling process (Fig.


• Extended portfolio range


Straumann® XenoFlex is composed of

90% XenoGraft granules embedded in 10%

purified porcine-derived collagen (type I).

Straumann® XenoFlex is an optimal solution

for graft applications required in extraction

sockets and is available with a syringe

applicator or as a block.

Why Straumann® XenoFlex?

• Efficient, easy to handle, volume stable:

can be easily cut to match the size and

shape of the individual defect after


• It can be placed into the defect in one

piece using tweezers, shortening surgery


• Outstanding product stability after

thorough hydration, supporting product


• Extended block and cylinder shape


Versatile solutions for successful bone and

tissue regeneration, Straumann® XenoGraft

and XenoFlex are designed for the extraction

sockets, sinus-floor elevation, horizontal

augmentation, ridge preservation, periimplant

and intraosseous defects. Following

the well-established treatment protocol

using deproteinised bovine bone granules

for the efficient treatment of bone defects,

these biomaterials are easy to handle, have

long-term volume stability and had been

successfully applied in over 500,000 cases


For more details, please visit:

stmbiomaterial DA

Bone particles XenoGraft delivered in a

practical bowl container, consists of 100%

bovine bone granules

Fig. 1: Long-lasting framework for excellent

space maintenance

Fig. 2: Four-week timepoint, rabbit model, new

bone formation around Straumann® XenoGraft

Block and syringe

XenoFlex, consists

of 90% bovine bone

granules and 10%

porcine collagen



Product Highlights


DGSHAPE Corporation releases

new DWINDEX performance

and remote monitoring software

DGSHAPE Corporation, a wholly-owned subsidiary

of Roland DG Corporation developing innovative

3D products, has released the second version of its

performance monitoring and visualisation software,

DWINDEX2, which is now available for all users of DWX-

52DCi, DWX-52DC, DWX-52D, and DWX-42W devices.





The latest edition of the software builds on the

strengths of its predecessor DWINDEX, expanding

device monitoring features that capture business

productivity for production teams in dental CAD/CAM

milling environments and adding new support features

to expedite solutions for devices that require technical


DWINDEX2’s improved remote monitoring features

require a mounted camera (sold separately) that records

and reports any error activity from the milling device,

facilitating troubleshooting and reducing downtime.

New error and maintenance graphs help users keep

their milling device optimised for consistent, efficient


→ 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

In addition to improved support, DWINDEX2 includes

advanced device utilisation and job management

capabilities. The job list feature offers an automated,

clean way to track CAD/CAM production and helps dental

professionals digitally monitor and manage jobs between

milling and sintering processes. An improved material

utilisation feature also tracks crown and bridge milled

output by units for select CAM providers.

DWINDEX2’s new uptime feature, a 24-hour production

graph in the dashboard module, displays the daily

timeframe for all completed jobs on each connected

device, allowing users to remotely monitor the progress

of their milling device both during and after work hours. ■



Product Highlights


Go beyond with Surgic Pro2

The internationally acclaimed Surgic Pro surgical micromotor

system fron NSK has evolved into Surgic Pro2 offering three

progress points: in operation, safety and wireless extensibility.

As well as further improving the basic performance of Surgic Pro,

its supreme adaptability in connecting to various external devices

offers improved comfort, safety and efficiency for the operator

during dental treatment.

Synonymous with Surgic Pro, safer procedures are made

possible with increased torque precision combined with the

Osseointegration Monitoring Device, Osseo 100+. It also features

a more compact new micromotor. In fact, as compared with the

existing model, Surgic Pro2 is 24.9% shorter and 9.1% lighter.

The operability during treatment has been greatly improved by

moving the centre of gravity closer to the head of the handpiece.

This increases efficiency and alleviates the stress during

prolonged operation for strain-free, effortless operation. On top of

this, the visibility was significantly improved with high resolution

colour LED.

Ultimately, thanks to its wireless connection, Surgic Pro2 can

broaden user’s scope of implant treatment. It has extensive

wireless function including a wireless foot control and can be linked

with iPads or external devices.

Professionals demand the reliability and sense of safety in clinical

practice, and NSK has responded with their next-generation

performance technology. ■

Ivoclar Vivadent

IPS e.max® ZirCAD® LT: More shades, more options

The IPS e.max® ZirCAD® LT discs

Versatile and flexible

from Ivoclar Vivadent are now

The IPS e.max ZirCAD LT discs

available in an extended portfolio

offer high mechanical strength

that includes nine new shades.

(1200 MPa 1 ) and are therefore

The high-strength zirconium oxide

ideally suited for the fabrication

material is suitable for single-tooth

of stable multi-unit framework

restorations and long-span bridges.

structures. The material can also

be used for minimally invasive

Effective immediately, the IPS e.max

single-tooth restorations. The

ZirCAD LT discs are available in the

restorations can be completed

following nine additional shades:

using a variety of techniques,

A3.5, A4, B3, B4, C1, C3, C4, D3, and

including monolithic, infiltration,

D4. The new shades are available in

partial, and full-coverage

three thicknesses: 14mm, 18mm, and

veneering procedures.

25mm. With the extended portfolio,


it has never been easier to select a

Typical mean value of biaxial

disc that matches the thickness and

flexural strength in relation to the

desired shade of the clinical case at

degree of translucency, R&D Ivoclar


Vivadent, Schaan, Liechtenstein. ■



Product Highlights


STERI-SAFEwave: The innovative bur block

The BUSCH STERI-SAFEwave bur block

made from medical resin has outstanding

benefits for use, safety and hygiene.

The unique wave design enables up to 14

FG and 12 RA instruments with varying

insertion heights to be stored in the bur

block at once. The instruments do not need

to be secured with rubber rings and are

completely accessible to ensure that there

are no unwashed areas.

This optimal cleanability with precontaminated

medical devices was

validated and certified by an external

institute. The safety bar is locked closed

during transport and reprocessing,

preventing the instruments from falling out.

The medical resin can be disinfected and

sterilised and is suitable for all relevant

reprocessing measures in the practice. If

required, the user can label individuallyloaded

STERI-SAFEwave by using

different coloured silicone strips, which

simultaneously provide a non-slip grip on

suitable surfaces. ■




APRIL 2022








Connect with us

Endorsed by

Supported by

Held in

Organised by

IDEM Singapore

IDEM Singapore


Singapore Dental Assocation


Product Highlights


COLTENE launches MicroMega One RECI

At a funfair, some love the ups and downs from COLTENE, regardless of which type of

on the roller coaster, others love going motion they prefer to use.

round in circles on the carousel. Mechanical

root canal preparation follows a similar

Safe, flexible and minimally invasive

pattern of motion: dentists can choose Inspired from its patented cross section,

between reciprocating and continuously MicroMega One RECI is characterised by its

rotating systems. For fans of preparation cutting performance. Additionally, the C.Wire

using reciprocating motion, dental specialist heat treatment gives the file its flexibility,

COLTENE now features a new file in its controlled memory, pre-bendability and


curvature conservation.

And due to the system’s spectrum, optimal

preparation of the root canal is possible for

almost any clinical case. MicroMega One

RECI is available in five sizes from 20/.04 to

45/.04 and three lengths (21, 25, 31mm) and

is supplied exclusively in sterile blisters. ■

For all situations

Since the introduction of the first

reciprocating file over a decade ago,

reciprocating motion has become

established among many dentists.

COLTENE is now expanding its portfolio by

adding to its proven NiTi rotary systems:

MicroMega One RECI, the single shaping

file in reciprocating motion. This enables

dentists to choose their favourite file system

Owing to the small file diameter of 1mm,

MicroMega One RECI protects the pericervical

area and minimises mechanical

impact on the dental hard tissues. Its high

cyclic fatigue resistance provides additional

safety. As a result, dentists can enjoy an

excellent compromise between cutting

efficiency and safety, as well as flexibility

and minimally invasive use in root canal



Form 3B: More smiles, all around

The Form 3B is an advanced desktop 3D printer developed

for healthcare. Formlabs’ precise, reliable ecosystem takes the

guesswork out of dental fabrication so faster workflows are just a

few clicks away.

The easy choice for digital appliance production

Users can reclaim their time and produce parts without the hassle

or prohibitive costs. Formlabs brings unprecedented reliability,

quality and ease of use, with validated workflows tested by a team

of dental experts:

1. Scan: Collect patient anatomy digitally using an intraoral

scanner. Send scans to the lab with a digital prescription or to

a design station.

2. Design: Import scan data into dental CAD software to

design treatments virtually, or send scans directly to print


3. Print: Import the designed CAD files into PreForm print

preparation software for print setup and send them easily to a

Formlabs printer.

4. Prepare: Wash, dry, and post-cure printed parts. These parts

can then be used intraorally or be used to produce various


The next generation of dental 3D printing

Advanced Low Force Stereolithography (LFS) technology uses a

flexible resin tank and a custom-designed, user-replaceable Light

Processing Unit (LPU) to produce consistent, accurate prints.

Reduced peel forces lead to incredible surface finish and part clarity,

right off the printer.

Built for production

Print two to three times more parts in a single build compared to

small build plate DLP (digital light processing) printers to spend

less time handling the printer and more time on high-value tasks.

Production environments can see 55% less labour time and costs

compared to DLP. A modular ecosystem allows for unmatched

consistency, scalability, and redundancy. ■



Show Review

AOSC 2021 Online Edition

performed beyond expectations

The Association of Orthodontists

(Singapore) Congress (AOSC), held

from 2 to 11 July 2021, successfully

concluded its first-ever online edition.

AOSC 2021 performed beyond

expectations despite the current

global climate and attracted close to

1,000 attendees from 50 countries.

The AOSC 2021 Conference featured

the highest number of speakers – 20

local and international speakers who

delivered 19 scientific sessions, made

available live and on-demand for

registered delegates.

The line-up of renowned speakers

from the orthodontic community

saw the likes of keynote speakers,

namely Dr Chris Chang, Dr Steven

Lindauer, and Dr Ute Schneider-

Moser enriching delegates by sharing

detailed case studies and critical


The conference sessions addressed

themes such as “A New Challenge

- Amidst the Pandemic”, “Are we

Defined by our Appliance?”, and

“Shaping the Future of Orthodontics”.

Delegates that attended the sessions

also earned continuing education

(CE) points to reflect their learning.

Similar to the conference, AOSC

2021’s exhibition also moved online

for the first time. Over 100 represented

brands, including leading orthodontic

companies such as Invisalign, Ormco,

Dentsply Sirona, came together for

the digital exhibition and showcased

their latest products and innovations,

highlighting the current technological

advancements in the industry.

“We are heartened by the

overwhelming response received for

our first-ever online edition of AOSC

with close to 1,000 participants from

all around the world. The growth of

AOSC over the years and even through

a pandemic marks a great triumph

and we are honoured to be becoming

more recognised in the orthodontic

community. We would like to thank all

attendees, exhibitors, speakers and

organisers for coming together and

making AOSC 2021 a success,” shared

Dr Bryce Lee, president of Association

of Orthodontists (Singapore) and

chairperson of AOSC 2021.

Featuring the best in the field of

orthodontics, the 2021 Scientific

Poster Competition saw 19 presenters.

Unlike the past competitions,

this edition’s competition was

fully conducted online with virtual

presentations and digital posters. The

poster competition was concluded

with the top 3 winners: Dr Shivam

Mehta from the University of

Connecticut, United States; Dr Cheryl

Lee from the National Dental Centre,

Singapore; and Dr Xiu Ling Florence

Kok from the University College

London, United Kingdom.

To round up the AOSC experience,

attendees participated in a variety

of virtual social programmes.

The virtual cook-off, Food Wars,

alongside a virtual networking and

sharing session, Bring Your Own

(BYO) Experience, brought together

participants from around the world

despite the backdrop of a pandemic.

The iconic AOSC run allowed

attendees to keep fit and take on

challenges like competing with other

runners virtually from the comfort

of their own home, gym, or favourite


“AOSC 2021’s success is a hopeful

motivation, but we have to

acknowledge that physical events have

an immersive quality that cannot be

replicated online. We look forward to

welcoming our colleagues in person

again for AOSC 2023,” said Dr Koo

Chieh Shen, chairperson of AOSC 2023.

The Association of Orthodontists

(Singapore) Congress will return for

its next edition in its established

physical format at Marina Bay Sands,

Singapore, from 17 to 19 February

2023. ■


Show Preview

IDS 2021 prepares

for the international

dental industry

and communicative encounters will

also be possible in September.

Snack points, temporary food service

offers and self-service restaurants

with front cooking will satisfy the

culinary needs of the visitors and

exhibitors. An extensive space is

designed and planned for all food

service areas to guarantee sufficient

social distancing. Additionally, a food

court in Hall 4.1 with diverse culinary

offers and generous layouts is at the

disposal of all trade fair participants,

where discussions can be continued

over lunch.

The 39 th edition of the International

Dental Show (IDS) will open its doors

in Cologne, Germany, from 22 to 25

September 2021. The leading global

trade fair of the dental industry is a

secure, stable anchor in turbulent

times and the best place to compare

one’s company with the competition,

and position it on the global market.

Dentists and dental technicians

can gather information and ideas

here that will enable them to make

future decisions for their practice or

laboratory. The international dental

industry is a strong community

characterised by common values,

which is reflected by IDS as the most

important industry platform and with

its role model function: flexibility,

innovation, creativity, service and

customer-orientation, cosmopolitan

and community-promotion.

The organisers of IDS 2021, the

GFDI (Gesellschaft zur Förderung

der Dental-Industrie mbH) and

Koelnmesse have taken all conceivable

precautions to make the extremely

important personal exchange and

networking between the international

industry participants in Cologne safe

and pleasant.

The personal dialogue, networking

within the industry and the extensive

world of experience of IDS, which

addresses all senses, are irreplaceable.

Visiting IDS 2021 will take place under

almost normal framework conditions.

Regarding business discussions at the

stands of the companies, hospitable

The networking will also continue long

after the trade fair closes. The city of

Cologne and the local restaurants are

looking forward to IDS 2021 and the

trade fair participants, who will also

come together in larger groups. The

exhibitors and visitors of IDS can enjoy

the late summer and the traditional

Rhenish lifestyle in the cosy breweries

and beer gardens.




To date, around 850 companies

from 57 countries have confirmed

their participation at IDS 2021 — a

remarkable intermediate result against

the backdrop of the past months.

In line with the pandemic-related

framework conditions, IDS is being



Show Preview

staged in Halls 2, 3, 10 and 11. All halls

are connected via a simple circular

route that has been optimised for

visitors. The four entrance areas of

IDS 2021 — the South, East and West

entrances and the entrance on the

trade fair Boulevard — ensure that

the visitors will be evenly distributed

throughout the exhibition halls in line

with the current protection regulation.

The hall planning accommodates

all necessary measures and official

requirements for the protection

of exhibitors and visitors, which

Koelnmesse has taken into account

in its safety and hygiene concept

#B-SAFE4business. For its events at

the Cologne fair grounds, Koelnmesse

will take all precautionary measures

deemed relevant by the responsible

health authorities in accordance with

the Coronavirus Protection Ordinance.

The necessity of these procedures

will be reviewed continuously until the

event and prepared accordingly.

In addition to the physical exhibition,

IDS 2021 is also offering the exhibitors

and visitors the digital platform,

IDSconnect. This hybrid approach

enables visitors all over the globe,

who are not able to travel to Cologne,

to discover attractive trade fair

profiles and products and connect

with contact partners via innovative


Because whether at a trade fair or

during everyday business, the success

of a company is based on three

essential building blocks: inspiration,

interaction and business. Where these

crucial elements fall short, IDSconnect

now offers additional opportunities.

Extensive features make it possible to

reach more potential customers easily,

experience trends and presentations

on demand and establish valuable

contacts — from anywhere in the

world. The digital platform of IDS is

very easy and intuitive for everyone

to use, even without previous digital

experience, bringing the world’s

largest dental show directly to their

screen for an authentic trade fair



Align Technology, Inc. has confirmed

its planned presence at the IDS.

Together, the Align and exocad

booths will represent Align’s biggest

IDS exhibition space to date. Align’s

interactive booth, located in sector

A-030-C-031, Hall 3.2, will showcase

its full portfolio of products and

services. Align’s presence at IDS will

be developed as a hybrid experience,

with a physical space that will

be compliant with public health

guidelines for the limited number

of in-person attendees, plus virtual

experiences specially designed for

those attending digitally.

IDS 2021 attendees — including

doctors, lab practitioners, and

industry partners — will be able

to learn about Align’s innovations,

including the Invisalign Go Plus

system, the latest addition to general

dentists’ portfolio for mild to more

complex cases. Attendees will also

have the opportunity to see how

digital workflows can be enabled

by the Align Digital Platform for the

Invisalign system, iTero intraoral

scanners, and a suite of proprietary

digital tools, including virtual solutions

for continuity of care with existing

patients. In addition, Align will also

showcase its end-to-end workflows,

including the ortho-restorative

workflow and software solutions from

exocad for restorative dentistry.

exocad, on the other hand, will

showcase its newest software

releases and innovations for dental

technicians and dentists in 360m² at

booth A-020 in Hall 3 with a multitude

of demo stations. Participants can

experience exocad’s variety of

software solutions such as DentalCAD,

ChairsideCAD and exoplan. Attendees

will also meet exocad’s very own

experts as well as the renowned

dental trailblazers Waldo Zarco Nosti

and Dr Gulshan Murgai. The company

will present a new booth design at

IDS 2021, reflecting the company’s

continued innovation and growth.

Additionally, Amann Girrbach is also

looking forward on its first major trade

show since the pandemic started. In

addition to a number of innovations

to its proven CAD/CAM products and

materials, the company will focus

on solutions for the interdisciplinary

cooperation between dental

laboratories and dental practices at

the IDS, on Stand No. A-010 – B-011

in Hall 3.2.

The focus will be on the AG.Live digital

platform and the Ceramill DRS (Direct

Restoration Solution) product family

which was launched in April. With

Ceramill DRS in combination with

AG.Live, Amann Girrbach extends the

laboratory’s integrated digital workflow

to the dentist and enables laboratories

and practices to easily enjoy the

benefits of same day dentistry as a

team. DA


Show Preview

Rediscover dentistry at the

23 rd CSA Annual Meeting

and 2021 China Dental Show

Held alongside The China Stomatological

Association (CSA) Annual Meeting, China

Dental Show (CDS) is the leading trade

show which covers brand and product

promotion, continuing education, trade

negotiation and equipment procurement.

The 23 rd CSA Annual Meeting and 2021

China Dental Show happening from 25

to 28 September, 2021 will open the door

in Shanghai to the largest number of

dentists from private and public hospitals

as well as clinics and distributors in China,

showcasing products and services from

the entire value chain of oral health.

and undertaken by Reed Sinopharm

Exhibitions, is held at the same time with

CDS in Shanghai, China, every year.

CSA is China’s only Level AAAAA dental

association, enjoying the highest

academic authority, influence and appeal

in the country.

In 2019, CSA altogether held 400

academic seminar sessions, operation

and demonstration shows, as well as

prize competitions. More than 350 leading

international and domestic experts

attended its Annual Meeting.

latest hi-tech amenities to facilitate a

global show such as CDS. The venue

is also planned in the most ergonomic

fashion, allowing exhibitors and visitors

within the same product portfolio to

interact on the same floor, thus obtaining

great results within limited time.

CDS has responded to the growing

demand for space by acquiring two entire

halls to provide comfortable exhibition

spaces and meeting rooms. Overseas

exhibitors are formed into international

pavilions, which indicate that CDS is

gaining international reputation.

Through the CDS, new products and

technologies are presented by over

500 companies, including leading

international and local brands to tens of

thousands of industry professionals who

are there to learn, trade and network.

CDS 2019 had an exhibition area of more

than 60,000 sqm. Exhibitors come from

over 30 countries and regions such as

China, Germany, United States, France,

Italy, South Korea, Japan, Switzerland,

Finland, Denmark, Israel, Brazil, Hong

Kong, and Taiwan.


It is no surprise that CDS is witnessing

exponentially growing demands for

exhibition space in National Exhibition

and Convention Centre (NECC) Shanghai.

NECC Shanghai is equipped with all the

CDS looks forward to introducing new

products and strengthening the product

portfolio from each specific country. With

better service, CDS will see another two

to three countries’ pavilions in addition

to the ones who have been participating

regularly. DA

Japan Dental Trade Association (JDTA)

and Trade Development Authority

of Pakistan (TDAP) have sent official

delegates to CDS every year while

obtaining USDOC/SIMAP/MEPRC/Seoul

Dental Association support.


The CSA Annual Meeting, hosted by CSA



Show Preview

Dentsply Sirona World 2021:

Back to a live event

“More than an event, the annual

Dentsply Sirona World is an

experience connecting dental

professionals to share ideas and

gain access to the latest education

and innovations related to digital

workflows. And, as can be expected,

all of this will take place in an inspiring

venue in Las Vegas. More than any

other year, we are looking forward to

the opportunity to be reconnected

and remind the world that dentistry

is essential,” said Eric Bruno, senior

vice-president of the North America

Regional Commercial Organisation at

Dentsply Sirona.

After a successful, completely virtual

Dentsply Sirona World in 2020 in which

more than 4,500 dentists, dental

technicians and practice teams took

part in over 70 courses, participants in

the 2021 edition will have the option of

once again joining this year’s Ultimate

Dental Experience in person.

The event will take place from 23 to

25 September at Caesars Forum in

Las Vegas, Nevada, United States

(US). Participants can choose to join in

person or via a live stream with special

digital programming for those who

cannot travel or who would prefer to

take part virtually. This year’s event MC

will be Dr Sameer Puri, vice-president

of Education at CDOCS. Nearly 100

speakers will lead over 100 courses

across almost every area of dentistry.

The educational tracks include:

dental lab, endodontics, implant

dentistry, dental hygiene, clear aligner,

restorative, dental assisting, digital

impressions CAD/CAM, CEREC CAD/

CAM, imaging systems, office design,

institutions – school and government,

and dental service organisations.

In addition to the first-class

educational experience, Dentsply

Sirona World is renowned for its

unique atmosphere. Participants

will have the chance to listen to

inspirational speakers such as Mel

Robbins, known for her TEDx talk,

which has been viewed more than

25 million times, and for books such

as The 5 Second Rule: Transform

Your Life, Work, and Confidence with

Everyday Courage.

Attendees will also be treated to

three evenings of unforgettable

entertainment. This year’s headliners

would be the The Chainsmokers, a

Grammy-winning electronic music and

production duo whose music blurs the

lines between indie, pop music, dance

music, and hip-hop.

Dr Kristine Aadland of Aadland

Dental in Vancouver, Washington, US,

stated that Dentsply Sirona World

is the event she has always looked

forward to every year: “It’s not just a

CE course. You can tangibly feel the

vibe and energy of the doctors and

team members who are excited to

learn. The entertainment is fantastic,

the exhibit hall is fun, and you can

actually take tips from the lectures

and apply them as soon as you get

home. There is truly nothing like it!”

In order to maximise the opportunities

to reconnect with the year’s most

exciting educational event, a basic

registration to live stream the daily

general sessions and live surgery

is available for free. For interested

participants who would like to join

the full virtual experience and take

advantage of the digital networking

possibilities, health and wellness

sessions, and access educational

breakout webinars worth CE credits,

tickets are available for purchase. DA


Giving Back to Society

Align Technology honours 10 million Invisalign smiles milestone with

donation of one million USD to Operation Smile

Align Technology, Inc., a leading global

medical device company that designs,

manufactures, and sells the Invisalign system

of clear aligners, iTero intraoral scanners,

and exocad CAD/CAM software for digital

orthodontics and restorative dentistry, has

announced that the Align Foundation, the

company’s donor-advised fund through

Fidelity Charitable, has donated US$1 million to

Operation Smile, a global surgical non-profit, to

help children around the world born with cleft

conditions receive safe, effective, and timely

cleft surgery and comprehensive care.

“Operation Smile’s mission strongly resonates

with Align’s purpose of transforming smiles

and changing lives,” said Raj Pudipeddi, chief

innovation, product and marketing officer and

senior vice-president of Align Technology.

“We are proud to support a future where

more smiles can be transformed through safe

surgery and medical treatment and hope to

inspire others through our donation to help

Operation Smile change the lives of more


The “10 Million Smiles. 10 Million Thanks”

campaign is based on the transformative

power of Invisalign treatment as seen through

the eyes of Invisalign patients. The donation

to Operation Smile builds on that goal and

aims to help more children around the world

to smile by raising awareness and generating

support and funding for Operation Smile.

Operation Smile provides surgery and ongoing

care for people affected by cleft lip and cleft

palate in resource-limited environments.

“We are so appreciative of the dedication and

support from Align Technology over the years

and are excited for what we can do to bring

families renewed hope, and help children

around the world smile even more as a result

of this latest donation,” said Kristie Magee

Porcaro, chief strategy officer of Operation

Smile. “Together, we’re improving the health

of many children and ensuring that they have

the opportunity for a better future.”

Align Technology initiated a wave of photo

sharing activity by asking its followers on

social media channels around the world to

share their smiles and to help change a child’s

life using the hashtag: #10MInvisalignSmiles.

The company is working with Operation

Smile, Invisalign ambassadors and regional

stakeholders to encourage their communities

of followers to join with them in the

awareness campaign. ■

Colgate Bright Smiles, Bright Futures® and Save The Children partner to

support migrant families and children

Colgate Bright Smiles, Bright Futures

(BSBF) has partnered with Save the Children

to provide oral health and hygiene products

to respite shelters serving migrant children

and families.

Hosting new arrivals entering the United

States (US) with documentation via border

towns in California and Texas, the respite

shelters will receive over 25,000 units of

toothpaste, toothbrushes and soap from

Colgate, as well as oral health educational

materials, via a product donation to Save

the Children. Hundreds of migrants from

Guatemala, Nicaragua, and Honduras arrive

weekly and sometimes daily at respite

centres in such cities as San Diego, Mecca

and Bell, San Antonio, Brownsville, El Paso,

and Laredo.

A temporary refuge, the respite shelters

provide a place to sleep and bathe, clean

clothing, oral health products, toiletries, and

diapers, and with assistance from Save the

Children and partners, safe care and activities

for children.

“As a global children’s health initiative,

Colgate Bright Smiles, Bright Futures has an

important role to play in helping to prevent

disease and protect the health and well-being

of vulnerable children and their families,”

said Dr Gillian Barclay, vice-president of

Global Public Health and Scientific Affairs at

Colgate-Palmolive Company. “Last year in

North America, Colgate Bright Smiles, Bright

Futures donated more than three million units

of oral care products and delivered oral health

education to more than 27 million children

and families. By partnering with Save the

Children, a leading humanitarian organisation

and authority on child health and education,

we can positively impact the lives and health

of vulnerable children now and in the future.

Together, we are promoting lifelong learning

opportunities and the promotion of wellbeing

for all.”

As a company, Colgate has supported Save

the Children since 1999. It began its global

partnership with the organisation in 2016,

working together to increase access to oral

health care for children in need in the US,

Africa and Latin America. ■




1 – 5 (Virtual) ITI World Symposium 2020NE

2 – 3 Dental Professional Days 2021

Copenhagen, Denmark

Venue: Bella Centre

9 – 11 Expodental Meeting 2021

Rimimi, Italy

Venue: Rimini, Fiera

22 – 25 39 th International Dental Show

Cologne, Germany

25 – 28 23 rd CSA Annual Meeting & 2021 China Dental


Shanghai, China

Venue: National Exhibition and Convention Centre

26 – 29 (Virtual) ADA FDI 2021 - World Dental Congress

Sydney, Australia

27 – 30 50 th Moscow International Dental Forum

and Exhibition


Moscow, Russia

Venue: Crocus Expo, Pavilion 2

9 – 10 31 st Annual NYU/ICOI Implant Symposium

New York, United States

Venue: NYU College of Dentistry

14 – 16 Central Asia Dental Expo

Almaty, Kazakhstan

Venue: Atakent-Expo

14 – 16 Pragodent 2021 -

28 th Annual International Dental Fair

Prague, Czech Republic

Venue: Exhibition Grounds PVA EXPO PRAHA


16 (Hybrid) 3 rd Annual ICOI Madrid Hybrid Symposium

Madrid, Spain

21 – 23 Dentex 2021

Brussels, Belgium

Venue: Tour & Taxis

22 – 24 5 th Malaysia International Dental Show

Petaling Jaya, Malaysia


Venue: Sunway Pyramid Convention Centre

3 – 6 DenTech China 2021

Shanghai, China

Venue: Shanghai World Expo Exhibition

and Convention Centre

5 – 6 ID Infotage Dental 2021

Frankfurt, Germany

Venue: Messe Frankfurt

24 – 26 IndoHealthcare Expo 2021

Jakarta, Indonesia

Venue: JIExpo Kemayoran

28 Nov – 97 th Greater New York Dental Meeting 2021

1 Dec New York, United States

Venue: Jacob K. Javits Convention Centre


2 – 4 Vietnam Medi-Pharm Expo 2021

Hanoi, Vietnam

Venue: Hanoi International Center

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 9

Amann Girrbach


Anthogyr France 47

Carestream Dental 5


exocad GmbH 29

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brand through our

media platforms.

IDEM Singapore 2022 67

Mectron 7, 65

Renfert 11

Shofu inc 3

Straumann 15

Tekne Dental 13


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