Dental Asia November/December 2021

PabloPublishing

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.

www.dentalasia.net

NOVEMBER / DECEMBER 2021

Under the Spotlight:

Forging ahead to make the world smile

Clinical Feature:

Innovative dental implant solutions

Behind the Scenes:

Best strategies to jumpstart digital orthodontics

Photo Courtesy of exocad


DentalCAD

The powerful CAD software

PASSION

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Imagine the CADABILITIES

DENTAL ASIA NOVEMBER / DECEMBER 2021 51


I love using many different

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lab, I enjoy the infinite

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gives me.

Carla Arancibia

Dental technician

and illustrator

DentalCAD, with its cutting-edge features accelerated my

lab’s workflows. Instant Anatomic Morphing adapts tooth

anatomy in real time during anatomic tooth placement

and AI detects facial features in Smile Creator, saving valuable

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Explore how this powerful design software will

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Contents

DENTAL UPDATES

6 Advertorial: Dental Technology

Made in Germany

36

TRENDS

18 Industrial design bridges the

gap between technology and

user

20 Four tips on lowering risks to

osseointegration

22 Advertorial: Pay32: Clinic

powered by artificial

intelligence

24

UNDER THE SPOTLIGHT

24 Forging ahead to make the

world smile

26 How digital technologies help

Tee Hee Dental Works

46

62

DENTAL PROFILE

28 Dentsply Sirona continues to

future-proof dentistry

CLINICAL FEATURE

31 Digital scans and human

identification

36 Innovative dental implant

solutions

42 Advertorial: CS MAR reveals

pathology and reduces risk of

misinterpretation

USER REPORT

46 Simplifying digital implant

prosthetics

49 Fast and predictable

aesthetics with injectable

composites

54 Efficient conversion of a

conventional complete

denture to Straumann ® Pro

Arch using Smile in a Box

BEHIND THE SCENES

60 More than a simple

manufacturing alternative

18

61 Automatic denture cleaning that

works

62 Best strategies to jumpstart digital

orthodontics

IN DEPTH WITH

66 Advancing oral prophylaxis

67 Rolence Enterprise: Commitment

to quality and added value

68 Silicone hoses with spray water

flow adjustment

SHOW REVIEW

76 Dentsply Sirona World 2021: The

highly anticipated return of the

Ultimate Dental Experience

SHOW PREVIEW

79 GC Corporation celebrates

centennial anniversary and

welcomes dental professionals

to the Fifth International Dental

Symposium

80 Mectron Spring Meeting

2022: The appointment with

innovation

REGULARS

4 First Words

70 Product Highlights

81 Giving Back to Society

82 Events Calendar

84 Advertisers’ Index

76

2

DENTAL ASIA NOVEMBER / DECEMBER 2021


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Available as smart Add-on, with flexible installation options or as Built-in Solution

for full integration in your dental unit. More info: wh.com/yelecticmotor

DENTAL ASIA NOVEMBER / DECEMBER 2021 3


First Words

A year of trailblazers

Czarmaine Masigla

Assistant Editor

With the world wearied by the COVID-19 pandemic, developments

to re-establish the pre-pandemic normalcy has now come

to fruition as restrictions slowly eased. Regular testing, mass

vaccination and continued social distancing measures mitigate

the burden on the healthcare system, allowing us to live with the

virus.

It has been astonishing to witness this progress and how the

dental industry has sustained the momentum to emerge

stronger than ever from this challenging circumstance.

PABLO SINGAPORE

Publisher

Publications Director

Senior Editor

Assistant Editor

Graphic Designer

William Pang

williampang@pabloasia.com

Jamie Tan

jamietan@pabloasia.com

Pang Yanrong

yanrong@pabloasia.com

Czarmaine Masigla

czarmaine@pabloasia.com

Jolin Tan

jolintan@pabloasia.com

For instance, Dentsply Sirona’s DS World 2021 concluded with an overwhelming

success, connecting more than 7,000 world-leading experts, industry leaders, dental

practitioners, and students in one memorable hybrid event (p.76).

GC Corporation also celebrated its centennial anniversary this year alongside the

announcement of its Vision 2031. In line with this milestone, the company is organising

the Fifth International Dental Symposium in Tokyo, Japan, from 16 to 17 April 2022 to

present the latest treatment concepts and practise techniques in the field (p.79).

There is no stopping the dental industry especially with the open-minded and

forward-thinking mentality of its practitioners as reflected in Dr Valerie Tey and Dr

Keng Mun Wong utilisation of a fully outsourced digital workflow by Smile in a Box

on a Straumann® Pro Arch protocol for the immediate conversion of a conventional

complete denture into a fixed full-arch restoration (p.54).

Dr Hanke Faust, on the other hand, shared how he optimised the advanced CS Metal

Artifact Reduction technology of Carestream Dental’s CS 8100 to obtain a more

accurate diagnosis and deliver a more predictable treatment to his patients (p.42).

Indeed, the dental field has no shortage of innovations and evidence-based solutions.

As the vibrant dentist of Teehee Dental Works, Dr Yang Xiao, emphasised: “Change is

always happening, and you have the choice to either be proactive or reactive (p.26).”

As we welcome the year 2022, let us make every step forward count, and embrace the

uncertainty ahead with enthusiasm!

LET’S CONNECT!

Circulation Manager

PABLO BEIJING

General Manager

PABLO SHANGHAI

Senior Editor

Shu Ai Ling

circulation@pabloasia.com

Ellen Gao

pablobeijing@163.com

Sharon Wu

pabloshanghai@163.net

HEAD OFFICE

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@dentalasia

Dr William

Dr Choo Teck Dr Chung Kong Dr George

Dr Fay

Dr Clarence Prof Nigel M.

Dr Anand

Dr Kevin

Dr William

Dr Wong Li

Dr Adrian U

Dr Christopher

Dr How Kim

Dr Derek

Prof Alex


invis is

comprehensive

care

reimagined.

Rethink comprehensive dentistry with pre-restorative orthodontic treatment.

Invisalign treatment offers digital tools and support to help you design a more comprehensive treatment

experience that works for your patients and your practice.

Learn more about how you can become a provider today.

5

© 2021 Align Technology, Inc. All rights reserved. Invisalign, the Invisalign logo, among others, are

trademarks and/or service marks of Align Technology, Inc. or one of its subsidiaries or affiliated companies

and may be registered in the U.S. and/or other countries. | MKT-0005927 Rev A

DENTAL ASIA NOVEMBER / DECEMBER 2021 5


Dental Advertorial Updates

Dental technology Made in Germany

The German family business DÜRR DENTAL in Bietigheim-Bissingen is one

of the few international market leaders in the dental industry. This year, the

family business celebrates a momentous occasion: its 80 th anniversary.

For 80 years, the brand DÜRR DENTAL

has been known for its high-end “Made

in Germany” products and technical

innovations. How did it all start? With a root

canal treatment and a broken dental drill.

Frida Dürr, the wife of precision engineer

Wilhelm Dürr, had to visit the dentist in the

autumn of 1946. However, during the root

canal treatment, the dental drill broke. Since it

was very difficult to find new equipment after

the war, the dentist had to finish the treatment

manually. Knowing about Wilhelm‘s technical

skills, the dentist gave his patient the broken

drill to take home. Surprisingly, although

Wilhelm had never repaired dental equipment,

he managed to fix the drill and it all worked

out.

That was how Wilhelm, who ran a precision

workshop with his brother Karl, discovered a

gap in the market almost accidentally. From

1948 onwards, the brothers established their

business in the dental sector. Today, DÜRR

DENTAL is one of the international leaders in

the market, celebrating its 80th anniversary.

A PIONEER AND RELIABLE PARTNER

DÜRR DENTAL can look back on a successful

company history. The name DÜRR DENTAL

stands for innovation and a proud history of

countless developments and enhancements

in modern dentistry. The invention of the

suction system enabled dentists to treat their

patients lying down for the first time – a major

step forward in dental care. DÜRR DENTAL

has pioneered the development of effective

spray mist extraction systems, in addition to

the invention of oil-free compressors. DÜRR

DENTAL has steadily refined and developed this

technology and remained the industry specialist

for the oil-free “heart of the practice” to this day.

DÜRR DENTAL also has a pioneering role in

value-preserving hygiene, low-pain therapy

and products offering the best protection for

the practice team and the patient. This position

has been further strengthened in recent times.

Milestones in imaging, such as image plate

technology, round off DÜRR DENTAL’s extensive

portfolio.

SUCCESSFUL FAMILY BUSINESS

DÜRR DENTAL is currently led by Martin

Dürrstein, the third generation of the Dürr family.

He continues to place great importance on

innovation: “We strive to understand the dentists’

requirements and offer them exact and reliable

solutions so that they can provide excellent

treatment to their patients.”

DÜRR DENTAL is known for innovative products

such as the first suction unit or its long-time

bestseller, the disinfectant Orotol. In general,

the experts for dental technology offer products

across four different ranges: compressed air and

suction, imaging, dental care and hygiene, as

well as prevention and therapy.

At present, the team focuses on smart solutions

for the dental practice 4.0. The experts are

developing cloud-based software solutions and

equipment, which can be connected and linked

with each other. For example, VisaSoft Cloud

allows the sharing of X-ray images quickly and

directly with the lab. With VistaSoft 3.0, DÜRR

DENTAL brings artificial intelligence into the dental

practice and supports the practice team efficiently

in their daily work. Numerous other pioneering

techniques are currently being discussed and

undergoing further development. Even after 80

years, the pioneering spirit lives on at DÜRR DENTAL.

DÜRR DENTAL also wants to pass on the

necessary know-how in addition to selling

products. Thus, DÜRR DENTAL Academy plays

a crucial role for their business. It offers around

140 seminars for dental staff,

technicians and students

around the year.

“We accept responsibility

with each product we sell

in the dental field,” said

Martin Dürrstein. “Therefore,

it is essential for us to provide

training, expertise and excellent

service. Our customers’ and their

patients’ satisfaction are of

utmost importance to

us.” DA

Martin Dürrstein,

CEO of DÜRR DENTAL

6

DENTAL ASIA NOVEMBER / DECEMBER 2021


Discover the color ful world

of Dürr Dental!

www.duerrdental.com/80

Dürr Dental celebrates its 80th company anniversary: Many innovations in dental

practices can be traced back to developments from Dürr Dental. As a leader in quality

and innovation, Dürr Dental supports dental practices and dental laboratories worldwide

with its system solutions. Discover the colorful world of Dürr Dental and click

through special moments of the 80-year company history.

www.duerrdental.com/80


Dental Updates

Align Technology announces exclusive supply and distribution agreement

with Ultradent Products

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 an exclusive

supply and distribution agreement

with Ultradent Products Inc., a leading

developer and manufacturer of high-tech

dental materials, devices, and instruments

worldwide.

As part of the multi-year agreement,

Align will offer Invisalign-trained doctors

an exclusive professional whitening

system with the leading Opalescence

PF whitening formula from Ultradent,

optimised for use with Invisalign clear

aligners and Vivera retainers.

The system will carry the co-branded

name of “Invisalign Professional Whitening

System – powered by Opalescence”

and will offer the same great whitening

outcomes and streamlined practice

experience dental professionals expect

from the Opalescence PF product during

active tooth movement with Invisalign

aligners, as well as during passive retention

using Vivera retainers. The Invisalign

Professional Whitening System will be

commercially available globally in 2022.

“A brighter, whiter smile is an important

part of the Invisalign patient journey. In

fact, a survey of North American Invisalign

practices1 shows that half of their patients

ask for teeth whitening during or after they

complete Invisalign treatment,” said Raj

Pudipeddi, chief product and marketing

officer, SVP, and managing director of the

Asia Pacific region at Align Technology.

“We believe that by providing an all-in-one

solution that combines a leading teethwhitening

system with the most advanced

clear aligner system in the world, we enable

Invisalign-trained doctors to enhance

their patients’ treatment experience with

a seamless workflow that also enables

practice efficiency and growth. We’re

very excited to partner with Ultradent

to offer the first professional whitening

system optimised for use with Invisalign

clear aligners and Vivera retainers.

Invisalign system trained doctors can use

Opalescence PF for in-office teeth whitening

treatment and for doctor supervised athome

whitening.”

“We’re honoured to partner with Align to

make the top professional teeth whitening

products available to more clinicians and

patients around the world,” said Dirk Jeffs,

president and chief executive officer of

Ultradent. “Providing Align with teeth

whitening products, ideal for use with

Invisalign aligners and Vivera retainers, is

a considerable step toward our mission of

improving oral health globally and we look

forward to pursuing this mission together.” ■

Ultradent is an ISO13485 certified facility

and will manufacture the products

according to those standards.

1

2017 online survey of Invisalign doctors,

data on file at Align Technology

Amann Girrbach introduces fully automatic Ceramill Map 600+

The fully automatic Ceramill Map 600+,

Amann Girrbach’s new scanner flagship

for open articulator scanning, excels

with outstanding precision for perfect

restorations and optimally supports dental

technicians in their work.

The new high-performance scanner

heralds the advent of Industry 4.0 in the

laboratory. The intelligent software algorithm

automatically assigns the upper and lower

jaws, thereby eliminating the vestibular

scan and up to 30% of the manual steps

in the laboratory. Due to its integrated

universal carrier plate for all common types

of articulators, the Map 600+ saves timeconsuming

plate changes and the intelligent

scan height control automatically moves the

object to be scanned into the best possible

scanning area.

In parallel, Amann Girrbach has equipped

the Map 600+ with an Ultra HD camera.

The highly sensitive industrial 3D sensor

with blue light technology ensures

outstanding depth of field and a

scanning accuracy of four micrometres.

The optimal use of the advantages of

digitisation and a seamless workflow

requires precise conversion of the model

situation from the real articulator into a

data set.

The new, more efficient calculation

algorithm also reduces the matching

time by up to 35%, depending on the

indication. This reduces the active waiting

time of a scanning process by up to 25

seconds. Depending on the indication,

the Ceramill Map 600+ therefore provides

time savings of between 15-38%. ■

8

DENTAL ASIA NOVEMBER / DECEMBER 2021


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Dental Updates

SmileDirectClub allows new patent for innovative SmileBus concept

SmileDirectClub, Inc., the next generation

oral care company with the first medtech

platform for teeth straightening, has

announced that the United States Patent

& Trademark Office (USPTO) will issue

a patent on the company’s innovative

SmileBus concept. SmileDirectClub’s

investment in its SmileBus fleet and its

SmileBus concept, which the USPTO

has recognised as novel, underscores its

commitment to its mission of increasing

access to oral care. The patent will further

strengthen protection for SmileDirectClub’s

intellectual property as one of the

methods for bringing premium, affordable,

accessible oral care to more people

through its telehealth platform.

Since its launch in the United States in

2018, SmileDirectClub’s fleet of SmileBuses

has travelled across the continental US.

Subsequently, a similar SmileBus concept

was launched in the United Kingdom in

2020. The US and UK fleets have made

nearly 1,200 stops and empowered

SmileGuides to take nearly 100,000 3D

images to date, helping consumers get

a smile that they love wherever they live,

including the many areas without access

to an orthodontist.

“For far too long, access to orthodontic

care was limited to only those areas

that could support an in-person

practice. Thanks to the SmileBus and

SmileDirectClub’s industry-first telehealth

platform for teeth straightening, more

communities than ever now have a

premium, affordable, accessible

option,” said Susan Greenspon

Rammelt, chief legal officer and

executive vice-president of Business

Affairs at SmileDirectClub. “We are

pleased the USPTO has acknowledged

the novelty of our SmileBus concept

by allowing this patent. The SmileBus

has helped thousands of people in the

US and UK get started on their smile

journey – many of whom live in ‘dental

deserts’ without convenient access to

orthodontic treatment.”

This newest patent will join the

company’s robust intellectual

property portfolio, which includes

SmileDirectClub’s patentprotected

and innovative digital

customer journey, ground-breaking

advancements in the manufacture

of clear aligners, award-winning

whitening system and many other

premium oral care offerings. ■

exocad’s ChairsideCAD is 2021 Cellerant Best of Class Technology

Award Winner

exocad GmbH (exocad), an Align

Technology, Inc. company and a leading

dental CAD software provider, was the

2021 Cellerant Best of Technology Award

winner for its ChairsideCAD, an openarchitecture

CAD software for single-visit

dentistry. This is the third consecutive year

that ChairsideCAD has been recognised

for this award.

“We are honoured to receive this

prestigious industry award from dental

industry leaders once again for our

best-in-class software solution, and

we’re excited to share the power of

ChairsideCAD with clinicians. This

software can enhance the chairside

design process, making it faster and more

accurate,” said Larry Bodony, president

of exocad America, Inc. “The intuitive

design workflow of ChairsideCAD, plus the

freedom to use any open hardware, makes

this a fantastic tool to streamline even the

most challenging cases.”

exocad stands as the software of choice

for leading manufacturers of dental

CAD/CAM systems because it is flexible,

reliable and intuitive. Dental professionals

consistently turn to exocad software to

streamline their workflows for a broad

range of indications.

Based on exocad’s renowned lab software

DentalCAD, ChairsideCAD is the first

complete open-architecture CAD software

platform for single-visit dentistry. The

software includes a step-by-step guide

through the design process, simple

integrations with a broad spectrum of

devices and the ability to seamlessly share

information between clinicians and labs.

Since the inaugural presentation in 2009,

the Cellerant Best of Class Technology

Awards have grown to occupy a unique

space in dentistry by creating awareness

in the community of manufacturers who

are driving the discussion in how practices

operate now and in the future. The 2021

Cellerant Best of Class Technology Award

was judged by a panel of prominent

technology leaders in dentistry. ■

10

DENTAL ASIA NOVEMBER / DECEMBER 2021


Study in JDE finds gender

differences in dental students’

self-assessments

Male dental students overestimate their performance more

significantly than females, and both genders self-assess their

skills more positively compared to scores given by faculty,

according to a study published in the Journal of Dental Education

(JDE), a peer-reviewed monthly journal that publishes a wide

variety of educational and scientific research in dental, allied

dental and advanced dental education.

PIONEER SINCE 1985.

A TRUSTED BEAUTY.

The study, “The effect of gender on student self-assessment

skills in operative preclinical dentistry”, focused on third-year

dental students from six class years (Classes of 2016-2021), and

its participants included students at the Harvard School of Dental

Medicine, United States.

“Recognising factors that affect self-assessment ability is

important because dentists must learn to accurately evaluate

their clinical work in order to improve through self-directed

learning,” the authors wrote. “The results of this study illustrate

that self-assessment skills differ between males and females,

with males on average overestimating their performances to a

greater extent than females in operative preclinical dentistry.”

The results of the study, according to the authors, fall in line

with previous studies that show gender differences in selfassessments

in other health care training settings. The authors

of the study are David L. Kornmehl, BS; Ruchika Agrawal, BS;

Jacqueline R. Harris, BS; and Aisha K. Ba, BS (all with the Harvard

School of Dental Medicine in Boston, MA, US); Eshani Patel, DMD

(VA Loma Linda Healthcare System in Loma Linda, CA, US) and

Hiroe Ohyama, DDS, MMSc, PhD, DMD (Department of Restorative

Dentistry and Biomaterials Sciences, Harvard School of Dental

Medicine, US).

The student self-assessments used the same rubrics as faculty

on four operative dentistry competency examination procedures:

Class II amalgam preparation and restoration and Class III resincomposite

preparation and restoration. The study found that the

student-faculty (S-F) gap was 8.28% for males and 6.08% for

females. The S-F gap is defined as the difference between the

student’s self-assessment score and the faculty’s mean grade.

“Knowledge of the findings in this study may allow faculty to

be aware of how gender impacts self-assessment, which may

impact curriculum design and implementation,” according to the

article. “By recognising and addressing gender differences in selfassessment

at earlier stages of dental training, a more equitable

learning environment can be created. In addition to increasing

faculty awareness, male and female students may be more

attuned to their cognitive biases and become more conscious of

them during self-assessment.” ■

VITABLOCS®

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Simply scan to discover this and other

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© Dr. Julio Gomez Paris, Santa Fe, Argentina

DENTAL ASIA NOVEMBER / DECEMBER 2021 11

3591E_VITABLOCS_Gomez-Paris_95x250.indd 1 21.09.2021 10:58:43


Dental Updates

DentalMonitoring launches ScanBox pro

DentalMonitoring, the company that

pioneered artificial intelligence in dental

and orthodontic care, has launched the

ScanBox pro . Built upon the success of

their previous DM ScanBox, their latest

FDA-registered innovation is a portable

device that patients can take with them

for precise AI-powered scans anytime and

anywhere.

This hardware accompanies the flagship

software solution DentalMonitoring, a

customisable cloud-based platform for

remote clinical monitoring of orthodontic

treatments designed to create a single

automated workflow per patient and

boost practice scalability.

The device consists of two components

— a cheek retractor tube designed to draw

the cheeks and lips from the buccal and

labial surfaces of the teeth and gums

during scanning and a phone holder

designed to accommodate a smartphone.

Paired with the unique DM app for patients,

the ScanBox pro offers:

• Consistent imaging over time for precise

tracking of treatment progress including

aligners, braces and retainers of all brands

• Excellent occlusal and lateral views,

including molar occlusion

• Increased portability

• An adapted design for all patients from six

years old

• Easy storage capability with 41% less

volume

• Autoclavable capacity

“We couldn’t be prouder to introduce our

latest innovation as we continue to go

further and break new ground with our

solutions,” said Phillipe Salah, chief executive

officer of DentalMonitoring. “The ScanBox pro

is a game-changer for patients. It is

lightweight, portable and can easily join them

on-the-go, anywhere, for high-quality scans

powered by the first and most robust AI in

the industry. In turn, it allows doctors to have

control at every stage of treatment and helps

automate their workflow while enhancing their

patient experiences.”

The ScanBox pro is the newest addition to

DentalMonitoring’s family of devices and

software solutions including SmileMate, for

engagement, triage and patient conversion;

and DentalMonitoring, the only available AIbased

remote monitoring solution available

to both fixed and removable orthodontic

appliances of all brands. ■

FDA grants 510(k) market clearance to Vivos Therapeutics’ mmRNA Oral

Appliance

Vivos Therapeutics, Inc., a medical

technology company focused on

developing and commercialising innovative

diagnostic and treatment modalities for

patients suffering from sleep-disordered

breathing, including mild to moderate

obstructive sleep apnoea (OSA), has been

granted 510(k) market clearance by the

US Food and Drug Administration (FDA)

to its Vivos’ mmRNA (modified mandibular

Repositioning Nighttime Appliance) device.

This FDA clearance paves the way for

expanded insurance reimbursement

coverage for the mmRNA device, including

Medicare, as well as for potential future

government contracts and reimbursement

from commercial payers that follow

Medicare guidelines.

More than one billion people globally

and 54 million Americans suffer from

sleep apnoea, 80% of whom remain

undiagnosed. A serious chronic illness, sleep

apnoea increases the risk of comorbidities,

including high blood pressure, heart failure,

stroke, diabetes, dementia and other lifethreatening

diseases. Vivos’ oral appliances

address the dental tissue anomalies and

malformations known to be associated

with OSA. Unlike current standard-of-care

interventions, patients treated with the Vivos

System typically complete their therapy in

12 to 24 months and, in most cases, do not

require lifetime intervention.

“The FDA’s market clearance of Vivos’

newest device, the mmRNA appliance,

represents a significant milestone in

our ongoing efforts to provide the best

possible treatment for people who

continue to suffer needlessly from OSA,

a debilitating condition that causes or

contributes to a wide range of chronic

health issues,” said Kirk Huntsman,

chairman and chief executive officer

of Vivos. “Next-generation products

like the mmRNA are vital for allowing

medical doctors and dentists to continue

pushing forward in their joint mission

to give patients a better alternative for

effectively treating their OSA. Further,

this FDA clearance for the mmRNA

enables us to expand commercial

insurance reimbursement, soon to

include Medicare, making this a more

cost-effective solution for patients

suffering from OSA.” ■

12

DENTAL ASIA NOVEMBER / DECEMBER 2021


3Shape TRIOS

Dental Updates

Patient engagement

you can sense.

We’re creating an

emotional connection

with our patients.

Dentist, Chatswood, Australia

Boost case acceptance by engaging

– even more – with your patients.

Together, TRIOS 3D color scans and the TRIOS

engagement apps create a perfect opportunity

to show patients their unique dentition and

help them understand their treatment needs.

These visual tools make it easy to personalize

patient experiences and address all their

concerns. They’ll notice the difference. And

you’ll feel the engagement.

Explore more at 3Shape.com

DENTAL ASIA NOVEMBER / DECEMBER 2021 13


Dental Updates

W&H Sterilization in Brusaporto, Italy, celebrates its production of

100,000 sterilisers

W&H Sterilization in Brusaporto, Italy,

has reached a milestone of producing

100,000 sterilisers. These sterilisers

ensure the highest levels of hygiene

and safety and fit in every workflow. This

achievement is celebrated with the W&H

community on social media alongside an

exclusive competition where the winner

will receive a W&H steriliser of their

choice.

ITALIAN INNOVATION

Brusaporto is W&H’s know-how centre

for sterilisers. An experienced 120-strong

team guarantees excellent quality

and compliance with medical device

standards and only high-end devices with

the best properties make it to the market.

A steriliser leaves the factory every eight

minutes and is delivered all around the

world – now for the 100,000 times.

W&H Sterilization has been manufacturing

medical devices since 1999. The best-selling

steriliser is without a doubt Lisa – the

result of Italian passion and the first B type

steriliser on the market. Lisa has become

a real stand out product over the past two

decades. With its innovative functionalities,

it meets the highest medical standards and

fits in seamlessly in every hygiene workflow.

The Lisa has now been backed up by a

range of other devices such as the Lara,

Lina, Lyla and Lexa sterilisers for different

practice requirement. ■

Premier Dental ® continues strong innovation push with four new inspired

solutions

Premier Dental ® , a global privately-held

developer, manufacturer and distributor of

dental and medical products, has discussed

its 2021 innovation agenda, encompassing

four new products that will provide dental

professionals with important new solutions

that help deliver efficacy, convenience and

improved patient outcomes.

Julie Charlestein, chief executive officer of

Premier Dental, stated: “Even during the

challenges of the COVID-19 pandemic, we

remain committed to delivering meaningful

innovations that help enable first-rate care

from the dental community to patients

worldwide. As an agile fourth-generation,

family-run business, we continue to identify

unmet or under-served customer needs

and deliver differentiated new products that

become standard-setting solutions in the

marketplace.”

The new products include:

• Premier X5 Sectional Matrix System:

Built as a complete, high-quality, fivecomponent

system, X5 is designed to deliver

reliability, convenience and better value. The

anatomically-shaped matrices ensure proper

contouring and tight contacts each time.

The proprietary resin rings are strong, flexible

and reusable for up to five autoclave cycles.

Compatible with other wedges and matrices,

X5 is easy to use compared to Tofflemire-type

retainers.

• BioGREEN Biodegradable Micro-Applicators:

Strong and bendable, these are smart,

environmentally-friendly alternative to

traditional plastic micro-applicators. Made from

a food production straw-by-product, they are

biodegradable and compostable. Even the

packaging is made from post-recycled Kraft

paper to embrace the sustainability mission.

• NexTemp ® Clear Temporary Resin Cement: A

reliable temporary cement with firm retention

that lasts between patient visits and can easily

be removed when needed. It is the only eugenolfree

resin cement with a proprietary potassium

nitrate, chlorohexidine and fluoride formula,

which studies show may help prevent post-op

sensitivity. It is available in two shades: opaque

and clear.

• BioCoat ® Opaque Bioactive Pit & Fissure

Sealant: Now in a new opaque white shade that

fluoresces under a black light for easy verification

of placement and sealant integrity, BioCoat

remains the only bioactive resin pit and fissure

sealant that delivers daily remineralisation. This

technology provides the benefits of extended

release of calcium, phosphate and fluoride ions

to strengthen tooth enamel and protect against

acid attacks. It features excellent handling and

adhesion properties for reliable results. ■

14

DENTAL ASIA NOVEMBER / DECEMBER 2021


Dental Updates

DENTAL ASIA NOVEMBER / DECEMBER 2021 15


Dental Updates

How a microscopic fungus could lead to a breakthrough in oral cancer

research

Microscopic fungus may have more to do

with oral cancer and ageing than initially

thought, according to new research from

Case Western Reserve University, United

States. Researchers from the School of

Dental Medicine, Case Comprehensive

Cancer Center and School of Medicine are

hoping a new study can lead to a medical

breakthrough in understanding certain

types of oral cancer.

Pushpa Pandiyan, an associate professor

of biological sciences at the dental school,

led a team of local researchers studying the

function of specific T cells, known as Tregs,

during the development of oral cancer in

ageing mucosa — the moist inner lining of

some organs and body cavities, such as

the nose, mouth and lungs. Their findings

recently appeared in Frontiers in Oncology.

Pandiyan and the researchers examined the

role of dectin-1, a cell’s pattern-recognition

and immune receptor, and its ability to

trigger an inflammatory response that

resists fungal infection. Dectin-1 is among

the fungi receptors that expresses on a

host cell. Typically, human white blood cells

have regulatory (Tregs) and myeloid derived

suppressor cells, which curb the immune

responses of cancer-fighting immune

cells. Problems occur when these cells

accumulate during tumour growth.

“What we’re finding now is that the dectin-1

receptor, usually responsible for antifungal

immunity, is now responsible for

accumulation of these cells at excessive

levels in tumours,” she said.

Researchers pointed out that the culprit is

likely the result of immune cells somehow

overreacting to fungal microbiota.

Although dectin in normal levels serves

as a protective measure, Pandiyan said

excessive amounts can promote tumour

growth “because of its ability to recruit

immunosuppressive cells”.

“Accumulation of these cells were much

worse during ageing. Our bodies produce

more dectin-1 the older that we get. In other

words, anti-tumour defence mechanisms

are weakened with age,” explained

Pandiyan.

While the research was limited to studying

ageing oral mucosa, Pandiyan said the

findings may have broader implications

for additional cancer research: “We don’t

know about other cancers yet, but in oral

cancers, if there is dectin-1, there’s a better

chance that anti-tumour cells can be

staved off.”

The research was funded by the Case

Comprehensive Cancer Center’s Specialized

Program of Research Excellence (SPORE)

pilot programme. Other researchers

involved in the work include: Natarajan

Bhaskaran, Sangeetha Jayaraman,

Cheriese Quigley and Prerna Mamileti from

the School of Dental Medicine; Mahmoud

Ghannoum and Quinton Pan, from the

School of Medicine; Aaron Weinberg, from

the dental school and Case Comprehensive

Cancer Center; and Jason Thuener from

the Case Comprehensive Cancer Center. ■

Neoss ® shows off innovation at work at the IDS 2021

At the latest International Dental

Show (IDS) 2021 in Cologne, Germany,

Neoss held a press conference with

special guest, Dr Marcus Dagnelid, a

prosthodontist from Sweden. Neoss

presented their past and present

innovations and introduced their strategic

partnership with Purgo Biologics that

will expand the Bone Regeneration

product line. Neoss ® made the

announcement at IDS as part of the

company’s continued support for

Koelnmesse and the event.

In 2021, Neoss ® has seen significant

growth in sales and expansion

into new business areas. The

Neoss ProActive ® Edge implant

and the NeossONE concept

also received industry leading

attendance and attention

during its global campaigns.

As well as investing heavily in

continued innovation of the

Neoss ® product lines, Neoss

actively creates key strategic

partnerships across the globe to

better service their customers with an

extended offering.

The first product out of the Purgo

Biologics partnership is THE Graft, a

natural porous bone matrix that likens

the physical and chemical aspects of

the mineralised matrix of human bone.

The exciting Xenograft product line

will add new dimensions to Neoss ® ,

existing bone regeneration offering.

Dr Dagnelid showed how THE Graft

was utilised in his ridge preservation

after tooth extraction. This can be used

both within conventional dentistry

as well as implant dentistry. This

procedure is a real benefit for the

patient and for the long-term success

of the treatment. ■

16

DENTAL ASIA NOVEMBER / DECEMBER 2021


Henry Schein announces new

distribution leadership structure

Henry Schein, Inc., the

world’s largest provider of

health care solutions to

office-based dental and

medical practitioners, has a

new organisational structure

to accelerate the company’s

strategic goals of enhancing

customer experience and

operational performance.

→ THE REVOLUTIONARY

INVENTION IN

BONE SURGERY

PIEZOSURGERY® touch

The new structure seeks to harness the benefits of consolidating

the management of Henry Schein’s Dental and Medical distribution

businesses while continuing to increase the company’s exposure to

faster-growing and higher-margin markets through organic growth

and acquisitions.

Henry Schein will create two groups to lead the management

globally of its Dental and Medical distribution businesses, as

follows:

• The North America Distribution Group

• The International Distribution Group

→ 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

“As part of the continuous operational improvement of Henry

Schein, we have been pursuing a strategy called ‘One Distribution’

to more tightly integrate the management of our distribution

businesses globally,” said Mr Stanley M. Bergman, chairman of

the board and chief executive officer of Henry Schein, Inc. “One

Distribution is designed to more fully leverage functions, talent,

processes, and systems across Henry Schein’s distribution

businesses to enhance our customer experience and maximise

efficiency and performance.”

The company will continue to focus on addressing customer needs

by expanding its three specialty products and services businesses

that participate in higher-growth, higher-margin markets, as

follows:

• Henry Schein One

• The Global Oral Reconstruction Group

• The Strategic Business Units Group

“These three business groups reflect the company’s long-standing

commitment to provide software, specialty products, and services

designed to help customers operate more efficient practices and

support clinical care, while contributing to the Company’s financial

performance,” said Mr Bergman. “Our customers increasingly rely

upon Henry Schein’s comprehensive offering of innovative solutions

and services, along with our distribution network, for their success

in a digital world. We look forward to continuing to advance the

seamless, unified integration of our suite of products and service

solutions.” ■

→ www.mectron.com

DENTAL ASIA NOVEMBER / DECEMBER 2021 17

ad_PStouch_dental_asia_95x250_en_201210.indd 1 10.12.20 14:42


Trends

Karl Malmén, industrial design manager at Planmeca

Industrial design bridges the gap

between technology and user

Every product is created to meet a need, and industrial design

attempts to identify and address them. But what does it take to go

from good to great industrial design?

Kari Malmén, Planmeca’s long-time

industrial design manager, has seen

a fair share of the company’s product

development over time and knows well

what can make or break a product. With

more than 33 years at the company, he has

worked alongside Timo Silvonen, senior

industrial designer; Toni Leinvuo, industrial

designer; Tapio Laukkanen, Planmed’s

industrial and UI design manager; Tero

Pihlajamäki and Veli Rundelin, usability

specialists; and Henni Palomäki, UX/UI

designer. Malmén shares what it takes to

get from good to great industrial design.

AT THE CORE OF USER NEEDS

According to Malmén, great design comes

from bringing in industrial designers into

the development process from day one.

“You get the absolute best result when

the designer gets to work on, with and

around the concept from the outset,” said

Malmén. “An industrial designer is an idea

man, and this is the time when you both

can and should vent your wildest ideas.”

In developing high-tech medical devices,

such as Planmeca’s dental equipment,

maintaining the all-important user

perspective is critical. This is where the

industrial designer plays a key role in

bridging the gap between the technology

and the user. At Planmeca, this means,

among other things, a good deal of

legwork as the designers visit partner

clinics to interview dental professionals,

hear their thoughts and concerns and see

them in action.

“We try to go quite deep into the user role

to get at the core of what they need from

the device: what does the user do, what’s

the workflow, what’s the currently available

technology. Then there’s the patient angle:

how does the device look and feel to the

patient and what can we do to make them

more comfortable. Because, as we know,

the calmer the patient, the better the result,”

explained Malmén.

DESIGNING FOR THE BIG FOUR

Dental technology has made gigantic strides

forward in recent years in transforming the

practice of dentistry. Interestingly, however,

the major design principles in the industry

have stayed largely the same. The driving

engines remain the big four: ergonomics,

usability, safety, and aesthetics.

18

DENTAL ASIA NOVEMBER / DECEMBER 2021


“Something I’ve always said is that one

design element is the seam, and that

remains true to this day. You can’t put a

seam just anywhere, you have to look at the

bigger picture – what’s behind the seam,

who needs to access that, for instance, for

maintenance and how often. You have to

understand the environment the product is

for,” shared Malmén.

It is no surprise, however, that customer

expectations have changed, especially in

terms of user experience (UX) and user

interface (UI).

He noted: “In the early days, the UI of a

dental unit was basically just buttons and

a membrane keypad, but since then we’ve

entered this whole new visual world of

graphic UIs, touchscreens and what not.

People now demand the same kind of

usability and intuitiveness of a dental unit

UI that they would expect of a smartphone.

That’s something that we industrial

designers need to carry over to the product.”

FUNCTION AND FORM

According to Malmén, a great industrial

designer has a good visual eye and knowledge

of manufacturing techniques, is cooperative

and can put their thoughts and ideas down

on paper.

Everything starts from defining the

product requirements, which is followed by

brainstorming and ideation. The mechanics

designers then determine the construction

and dimensions, while the usability specialists

work on the user interface. Finally, the product

is tested and refined in cooperation with

partner end-users.

Yet, although many types of industrial design

follow a similar trajectory, designing health

technology comes with a unique human

factor that sets it apart from other products.

Take a dental unit for example. One dentist

may be looking for easy access to essential

instruments, another for left-handed

operation. Larger clinics and dental schools

are likely to need customisation options, such

as personalised settings that are easy to

enable in any unit. Then there is the patient,

who is probably hoping to feel as comfortable

and safe as possible during a potentially

uncomfortable treatment. Besides all that,

everyone is looking for reliability that can be

counted on for years to come.

A cleverly designed dental unit can respond

to all these needs while conforming to today’s

ever-increasing medical device regulation.

How does one get there? Through great design

that respects and reflects user needs in both

function and form. DA

HIGH-PERFORMANCE

DYNAMIC INSTRUMENTS

SIMPLIFYING DENTAL MOTION

TeKne Dental srl – Italy

info@teknedental.com www.teknedental.com

DENTAL ASIA NOVEMBER / DECEMBER 2021 19


Trends

Four tips on lowering risks to

osseointegration

With the increasing demands for dental implants, oral surgeon, Dr

Annette Felderhoff-Fischer, offers four tips on avoiding early risks to

osseointegration and how the Nobel Biocare N1 system can improve

the treatment outcome.

By Dr Annette Felderhoff-Fischer

Dental implants have become an extremely

successful therapy in recent years, both in

partially edentulous and edentulous cases 1,2,3,4 .

In order to continue and even improve this

success for as many patients as possible,

some basic considerations should be included

in the procedure, starting with the indication

and planning. Based on my clinical experience

and the training I have been involved in and

provided over the past 20 years, I have some

advice on optimising your chance for success

from the start.

TIP #1: CARRY OUT DETAILED

IMPLANT TREATMENT PLANNING

Careful patient selection and well-founded

planning are essential. Before each procedure,

always check whether the patient is suitable

for implant treatment based on their general

medical history, periodontal condition and oral

hygiene. In addition, I strongly recommend

diagnosis and planning of the procedure with

3D imaging and planning software. Bone

volume can be analysed with CBCT and allow

for implant selection in terms of length and

diameter preoperatively, taking into account

anatomical risk structures (Fig. 1). Furthermore,

the planning takes the tissue management and

the final prostheses into consideration, allowing

you to optimise the planned implant placement

based on the final treatment outcome desired.

TIP #2: ASSESS BONE QUALITY

BEFORE IMPLANT SITE PREPARATION

Implant site preparation should aim to keep

bone trauma to a minimum and assist primary

stability. Therefore, site preparation requires

knowledge of bone quality. A big challenge at

this stage is the degree of guesswork that this

entails. While the experienced implantologist

might “feel” the bone quality with the first drill,

if you are not an implant specialist or have less

experience in implant treatment, you should

regularly attend hands-on training to improve

this ability, and I particularly recommend

attending cadaver training courses.

This knowledge is important because the

drilling protocol is adapted depending on bone

quality, to not over- or under-size the implant

site. Conventional site preparation requires the

use of multiple drills with different diameters

which, together with irrigation, cause trauma

to the surrounding alveolar bone 5 : a so-called

“zone of death”. If the trauma is too great,

which can occur especially in a lower jaw with

predominantly cortical bone (bone quality I),

osseointegration might be impeded. If the

trauma is mainly around the platform, vertical

resorption can occur. Excessive preparation of

predominantly cancellous bone (bone quality

IV) also leads to a lack of primary stability of the

implant, and potentially early implant loss 6 .

TIP #3: IMPLANT TORQUE AND

PRIMARY STABILITY

The next step is the selection of the implant

itself, which is again influenced by bone quality

and the preparation of the implant site. The

choice of the implant (geometry, diameter,

platform) and implant site preparation (underpreparation

of the osteotomy) influences

primary stability and is, therefore, an important

factor for osseointegration 7 . A muchdiscussed

figure is the torque value. High

torque values are often viewed as positive for

Fig. 1: Detailed treatment planning is crucial.

CBCT scanning can be used to analyse bone

volume

immediate loading. However, overtightening

may damage or fracture the implant and

could cause necrosis of the bone site and

early dental implant failure 6 . A 35Ncm

value is often recommended as standard,

however, I personally do not see the torque

values of the individual implant systems as

being comparable with one another, as the

individual geometry of an implant causes

different reactions in the bone. The implant

manufacturer provides guidance on maximum

torque values, and you should follow this.

TIP #4: PASSIVE FIT

A gap-free and tension-free connection

between the implant and the superstructure,

and regular follow-ups soon after treatment,

alongside stable oral hygiene are important

for success. You should aim for a gap- and

tension-free prosthetic reconstruction, both

with immediate loading and with delayed

restorations. If this is not the case, vertical

bone loss or screw loosening occurs and

results in peri-implant complications.

20

DENTAL ASIA NOVEMBER / DECEMBER 2021


Trends

Particularly with connections featuring a

deep cone, taking an impression of multiple

implants carries the risks of inaccuracies

and tension, which should be taken into

account when planning a screw-retained

restoration. If screw loosening occurs, the

restoration must be removed, the cause

determined, and a new original screw of the

implant system inserted again.

NOBEL BIOCARE N1 DENTAL

IMPLANT SYSTEM

Assessing bone quality: How can site

preparation with the Nobel Biocare N1

implant system help?

One of the critical factors in treatment

planning and site preparation is the

assessment of bone quality. Regardless of

pre-surgical investigation, clinical decisions

are often dependent upon tactile and visual

judgement during surgery. Unfortunately,

this is a skill that can only be acquired

through experience 8 .

This is one of the drawbacks that the Nobel

Biocare N1 surgical protocol has been

designed to address. After creating a pilot

osteotomy with the OsseoDirector, the

OsseoShaper site preparation instrument

shapes the osteotomy at low speed and

matches the shape of a co-packed implant.

This protocol provides a gauge to indicate

bone quality, minimising guesswork and

decision making. If the OsseoShaper 1

instrument can be fully seated at the

planned depth, the implant can then be

placed. In a survey of clinicians, the implant

could be placed after just these two steps

in the majority of cases – 87.8%*.

If OsseoShaper 1 does not reach the

planned implant depth before achieving

a torque of 40Ncm, the OsseoShaper

2 instrument can be used. If the same

also occurs with the OsseoShaper 2

instrument, then the N1 Twist Drill can

be used (Fig. 2). Not only does this assist

clinical decision making, but because the

instrument operates at low speed and

without irrigation, it has been shown to

create less trauma, leading to earlier bone

formation compared to conventional highspeed

techniques 5 . It has been designed to

preserve vital bone chips in the osteotomy

to promote fast osseointegration.

Fig. 2: Torques generated using the

OsseoShaper concept guide the surgical

workflow, assist in bone evaluation, and

provide an early prediction of implant

stability. Based on a survey of clinicians, the

majority of cases require just two steps in site

preparation before implant placement

Why have I chosen to use the N1 implant

system?

As an oral surgeon, I am fascinated by the

biological benefits of gentle implant site

preparation based on osseointegration

research by the team led by Prof Jill Helms. As

well as knowing that bone experiences less

biological trauma compared to conventional

techniques, I also find the clinical procedure

much simpler; and based on patients’

feedback, that the reduced noise and vibration

makes it more comfortable for them. Coming

from navigated implantology in which the

drills are guided through sleeves, I also like

minimising guesswork when not using guides.

The OsseoDirector indicates direction, and

the OsseoShaper and implant follow. In most

cases, I can place the implant in just these

three steps. I like the simplicity, and the

benefits it brings to my patients. DA

REFERENCES

1

Simonis P, Dufour T, Tenenbaum H. Long-term

implant survival and success: a 10-16-year follow-up

of non-submerged dental implants Clin Oral Implants

Res; 2010 Jul;21(7):772 Read on PubMed

2

Wennerberg , Alrektsson T, Chracanovic B.

Long-term clinical outcome of implants with

different surface modification. Eur J Oral Implantol

2018;11(Suppl 1): S123–S136 Read on PubMed

3

Karl M, Albrektsson T. Clinical performance of dental

implants with a moderately rough (TiUnite) surface:

a meta-analysis of prospective clinical studies. Int J

Oral Maxillofac Implants 2017;32(4):717–734. Read on

PubMed

4

Malo P, de Araujo Nobre M, Lopes A, et al. The Allon-4

treatment concept for the rehabilitation of the

completely edentulous mandible: A longitudinal study

with 10 to 18 years of follow-up. Clin Implant Dent

Relat Res 2019;21(4):565-577. Read on PubMed

5

Chen, C.-H.; Coyac, B.R.; Arioka, M.; Leahy, B.; Tulu,

U.S.; Aghvami, M.; Holst, S.; Hoffmann, W.; Quarry, A.;

Bahat, O.; Salmon, B.; Brunski, J.B.; Helms, J.A. A Novel

Osteotomy Preparation Technique to Preserve Implant

Site Viability and Enhance Osteogenesis. J Clin Med.

2019 Feb 1;8(2):170 Read on PubMed

6

Ikar M, Grobecker-Karl T, Karl M, Steiner C. Mechanical

stress during implant surgery and its effects on

marginal bone: a literature review Quintessence Int.

2020;51(2):142-150 Read on PubMed

7

Fawad Javed, George E. Romanos, The role of

primary stability for successful immediate loading

of dental implants. A literature review, J Dent., 2010

Aug;38(8):612-20 Read on PubMed

8

Velikov S, Susin C, Heuberger P, Irastorza-Landa A.

A New Site Preparation Protocol That Supports Bone

Quality Evaluation and Provides Predictable Implant

Insertion Torque. J Clin Med. 2020;9(2). Read on

PubMed

*303 implants in 160 patients using CE-marked

pre-launch portfolio. April 2019 – May 2020.

Data on file.

Disclaimer: Some products may not be

regulatory cleared/released for sale in all

markets. Please contact the local Nobel Biocare

sales office for current product assortment and

availability. See Instructions For Use for full

prescribing information, including indications,

contraindications, warnings and precautions.

About the author

Dr Annette

Felderhoff-

Fischer is an oral

surgeon with a

referral practice

for oral surgery in

Munich, Germany,

and has been working in the field

of implantology for over 25 years.

As a trainer and speaker, she

has a special focus on navigated

implantology.

DENTAL ASIA NOVEMBER / DECEMBER 2021 21


Advertorial

Trends

Pay32: Clinic powered by

artificial intelligence

Cloud-based solution digitising clinics’ inventory data and vendor

payments.

Industry watchers asserted that the current

pandemic crisis could wholly change

the clinical and dental practice sector.

Furthermore, it could also change its role in

healthcare systems globally. The bottom line is

to maintain the momentum established during

the pandemic.

At present, Malaysia is pushing its medical

and dental healthcare industry and there is

a greater demand for dental supplies that

are not readily available due to supply chain

disruption. In fact, according to a Google and

Temasek market study from 2020-21, there

has been five times growth in the search

trend for “online selling-related queries” in the

region, possibly attributed to the lockdowns.

Due to this growing need, Lumiere32, a

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marketplace that is a first in South East

Asia, has bridged the gap by introducing

its platform in Malaysia (www.lumiere32.

my) wherein local dental and medical device

suppliers can sell directly to more than 7,000

healthcare practitioners. Dental professionals

can procure high-quality dental supplies

directly from multiple dealers, offering a wide

range of products and discounts, delivered to

them in just three to five days.

With a secure online platform, a vast array of

products, and a passionate team, Lumiere32

has already become Singapore’s leading dental

supplies marketplace and is now envisioning

a similar experience of high-quality products,

and services to the Malaysian dental fraternity.

A spokesperson from Lumiere32 said: “In

the second quarter of 2021, we launched

Lumiere32 in Malaysia to connect suppliers

and healthcare professionals digitally but we

realise how difficult it is to ‘manage inventory’

for all healthcare professionals. To solve this

problem, Lumiere32 came up with one solution

named Pay32 Clinic, a cloud-based software

that makes inventory data and vendor

payment processing a not so time-consuming

and complicated task to manage.”

According to the Lumiere32 Singapore Dental

study, more than 75% of clinics have been

spending six hours and more to manage and

order supplies in a week, and 90% of private

clinic owners are still writing more than 30

cheques in a month to settle vendor payments.

With Pay32 Clinic, users can digitise

inventory data and vendor payments; do

a straightforward tracking of the product

expiration dates; optimise clinic inventory

and control the bottom line seamlessly; track

vendor payments and acquire clear records.

Pay32 Clinic has helped a lot of clinics to go

digital in Singapore, and its launch in Malaysia

by the fourth quarter of 2021 is already

underway.

Lumiere32 is confident that Pay32 Clinic can

address the struggles of dental clinics in

managing tasks manually. Interested parties

may visit https://www.pay32clinic.com/ for

more information or schedule a demo at

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Pay32 Clinic offers a six-month free trial on

board with the new normal (Note: Pay32 clinic

is currently available in Singapore market

only). DA

22

DENTAL ASIA NOVEMBER / DECEMBER 2021


Trends

Hybrid Event

THE

5 TH INTERNATIONAL

DENTAL SYMPOSIUM

2022.4.16 17

100 th ANNIVERSARY

of GC CORPORATION

SAT

SUN

[Location] Tokyo International Forum

Some sessions will be broadcasted online

Changes might occur due

to COVID-19 pandemic

GC official

website

and app

23

DENTAL ASIA NOVEMBER / DECEMBER 2021

GC Get

Connected

DENTAL ASIA NOVEMBER / DECEMBER 2021 23


Under the Spotlight

Forging ahead

to make the

world smile

Dr Otani Kazunori, a

prosthodontist and director of

Otani Dental Clinic, has more

than two decades of dental

practice. Passionate in restoring

and maintaining oral function,

he shares a glimpse of his career

and what dental professionals

can expect from his lecture in

the upcoming Fifth International

Dental Symposium on 16 to 17 April

2022 in Tokyo, Japan.

What are the factors that have

influenced your decision in pursuing a

career in dentistry?

Dr Otani: My father is a dentist, and I grew

up in an environment where his dental

clinic was located on the same premises

as my home. Since then, I started thinking

about dentistry as a career option. I was

also influenced by the daily clinical training

and clinical inquisitiveness of the senior

students in the Department of Crown and

Bridge programmes at Nihon University

School of Dentistry, Japan, where I was

enrolled after my undergraduate degree.

Why did you choose to specialise in

prosthodontics, and what is the most

fulfilling aspect of it?

I have been interested in the field

of prosthodontics since I was an

undergraduate student, so I joined the

prosthodontics programme at graduate

school. The professor of that course took

good care of my extracurricular activities

(club activities) in university.

Currently, patients with various complaints

visit my daily clinical practice. Most of the

treatments is for missing tooth or teeth,

but some patients may be treated for the

entire jaw. In full-mouth reconstruction,

defect treatment on an oral basis and

recovery of function must be considered.

When I get the expected treatment results,

I feel glad that I gained experience in

handling those cases by specialising in the

prosthodontic field.

What is the most challenging case

you have handled, and how did you

overcome it?

A symptomatic TMJ patient had a difficult

case of a full-mouth reconstruction

with occlusal height modifications. We

were able to overcome this problem by

adapting a diagnostic splint, pursuing

jaw position by occlusal analysis, and

setting the final prosthesis after multiple

evaluations with provisional restorations.

As chairman of the Study Group

Esthetic Explorers, what is your

vision for it?

Since many young dentists participate

in this study group, I am conscious of

organising a study group that is not

biased towards any particular field,

but rather provides a good balance

of prosthetic treatment, conservative

treatment, periodontal treatment, and

implants. I hope that dentists of the

study group will be able to increase the

number of their treatment options.

24

DENTAL ASIA NOVEMBER / DECEMBER 2021


Under the Spotlight

With the advent of digital technologies,

how has your practice, Otani Dental

Clinic evolved?

I have not yet been able to actively introduce

digital technology in my chairside work, but

I am beginning to use it for the fabrication

of prosthetics. As a result, the quality of

prosthetics has improved and the choice of

materials has increased.

How do you keep yourself updated with

the latest technologies and techniques?

I update myself on new technologies and

treatment techniques as soon as possible by

reading dental journals, attending seminars,

and participating in hands-on seminars.

Recently, I have also been attending more

web seminars.

What is your view on minimally invasive

treatments?

I propose minimally invasive (MI) treatment

to patients not only for dental conservative

treatment but for prosthodontic and implant

treatments too. I believe that MI treatment

can extend the life of the teeth because it

can preserve sound tooth structure as much

as possible.

indispensable in the future because not all

patients will have the mobility to visit a dentist.

What do you hope future dental

innovation will achieve?

We hope that further innovations in digital

technology will lead to the mechanisation

(e.g., surgical robots) of precise treatment in

the oral cavity (caries treatment, root canal

treatment) by direct methods.

Can you give us an overview of

your lecture in the upcoming Fifth

International Dental Symposium and its

relevance in today’s practice?

In the Fifth International Dental Symposium,

I will talk about the clinical application of

adhesive bridges for the prosthetic treatment

of single tooth defects. Thus far, conventional

three-unit bridges or implants have been the

most common treatments for single missing

anterior teeth. Since around 2013, I have been

actively applying adhesive bridges, which are

less invasive than other treatments, in clinical

practice. I am convinced that the adhesive

bridge has joined the list of treatment options

with high patient satisfaction.

What excites you the most about this

event?

I am looking forward to learning about

the current trends in dentistry around the

world.

As we move forward from the

pandemic situation, what do you think

is the best lesson to take away?

It is necessary to adapt constantly in

response to the rapid changes in society.

Any other closing message for our

readers?

Many dental events have been postponed

or cancelled, and in this day and age,

there is a lot of negative information flying

around. However, just as the rain always

stops, there will always come a day when

the sky is blue and the sun is shining. I

am looking forward to enjoying the Fifth

International Dental Symposium with you.

Let’s meet on that day. DA

Interested participants may visit

https://www.gcdental.co.jp/100thsymposium/

for more information.

Could you share with us on the three

must-have devices, systems or

materials that have been useful for your

practice and why?

G-CEM ONE, the self-adhesive resin cement,

is very convenient because it can be used

to set not only ceramic inlays made with

LiSi Press (lithium disilicate) but also various

restorations with one cement. In addition,

the G-Multi PRIMER is a primer that can be

applied to all major restorative materials

currently being used, so the dentist does not

have to use individual primers. The progress

and simplification of the bonding system will

not only lead to more effective treatment

but also to a more stable prognosis, which

will be of great benefit to the patient. Lastly,

G-Fix is useful for anchoring mobile teeth,

and because it is a composite resin with

a little toughness, it is sometimes used

for reinforcing and splinting provisional

restorations.

How do you think an ageing society will

impact dentistry in the years to come?

We believe that home visit dentistry will be

DENTAL ASIA NOVEMBER / DECEMBER 2021 25


Under the Spotlight

How digital technologies help

Tee Hee Dental Works

In this digital era, technology and enhanced patient

experience often go hand in hand. From contactless

payment to fast and efficient dental treatments, the

possibilities are endless. For practitioners like Dr

Yang Xiao, he beams with optimism as he explores the

potentials of digital dentistry.

Dr Yang Xiao, dentist at Teehee Dental Works

Influenced by his father, an automotive

engineer, Dr Yang Xiao developed a passion

for craftwork and experimenting with new

technologies from an early age. Deciding to

pursue dentistry though is another interesting

story.

He recalled: “My fondest memories as a child

were the times I spent with my father fixing

model bikes and aeroplanes. Funnily enough,

I stumbled across dentistry through a chance

encounter, around the time I had to pick

my university degree as a teenager. I spent

an afternoon with a friend’s dad who was a

dentist and he shared with me how the job

was both hands-on and people-oriented. It

sounded wonderful.”

Now the owner of Teehee Dental Works

Singapore, Dr Yang graduated from King’s

College London, UK, and was awarded the

A.H.R. Rowe Prize for clinical excellence.

The prestigious British Endodontic Society

also awarded him a National UK Prize for

demonstrating excellence in root canal

treatment.

Humbled by these achievements, he shared:

“Given the standard of work by many of the

other dentists, I think it was a combination

of luck and determination to have won these

awards. I enjoy trying new things to challenge

myself and I was fortunate to have been

recognised for trying.”

On top of this, Dr Yang enjoys educating not

just his patients but also the general public

on the importance of good oral health. Thus,

with the advent of digital technologies that

can enhance communication with the patient

and improve their overall experience, Dr Yang

is enthusiastic as he shares his journey in

embracing digital workflow.

ONE FOR ALL, ALL FOR ONE

As a clinic owner and a practising dentist, Dr

Yang’s role entails a lot of responsibility, such

as attending to his patients and managing the

clinic while continually bettering himself as a

practitioner. For this reason, he is most grateful

to see how his supportive team members grow.

“I’m very lucky that my team has stuck by

me through the good times and bad times.

I would like to give special thanks to Chin,

our clinic manager, for supporting our desire

to continually introduce change and new

technologies into the clinic. I would also like to

thank Naufal, our resident dental technician

for his top-notch lab work. I think that’s

really important when implementing new

technologies to improve patient outcomes –

you need a team who believes and supports

you through all difficulties,” he shared.

In fact, even before COVID-19, their team at

Teehee Dental Works had built a new clinic

with a self check-in system.

Dr Yang, said: “This allowed us to function

well when the pandemic hit, given our

systems were already equipped to provide

a completely contactless experience for our

patients. We also invested early on in robotic

arms to automate our production process

in our laboratory and that has been really

helpful in improving our productivity and

efficiency.”

With these systems in place, Dr Yang takes

pride in watching his patients leave the

clinic happy. He revealed that addressing his

patient’s problems and concerns is always a

“wonderful and fulfilling feeling” for him.

26

DENTAL ASIA NOVEMBER / DECEMBER 2021


Under the Spotlight

THE FUTURE IS NOW

As a practitioner, Dr Yang is an advocate of

preventive and minimally invasive dentistry.

He believes that communication is a key factor

in the success of his treatments. With digital

tools, he is more confident in providing a better

patient experience, ensuring they are always

on the same page every step of the treatment.

“With the introduction of 3D printing and new

CAD software in recent years, I am able to

show the patient an almost exact replica of

the final result even before treatment begins

through the use of digital simulations or

through 3D-printed mockups. It is a great

communication tool which allows patients to

visualise the treatment plan along with me, and

give instantaneous feedback,” he said.

Though a game-changer in improving

the workflow in the clinic, digital tools and

technology have a steep learning curve. Dr

Yang acknowledges this, and he constantly

immerses himself in learning the ropes.

He shared: “Firstly, continuing education is

really important – I love hearing how other

dentists are overcoming their problems and

coming up with great innovative solutions.

Secondly, having a good relationship with

your suppliers is essential – this means being

open to try out new equipment and learn how

new technologies can improve your existing

workflows. Lastly, having a network of dentists

to bounce ideas off is invaluable – I found

it particularly rewarding working with other

dentists (both local and international, for some

different perspectives) and sharing new ideas.”

Dr Yang said that these new ideas often lead

to new solutions that solve old age problems

more creatively and improves patients’

experience. For instance, the NextDent 5100

3D printer from 3D Systems has tremendously

improved his practice. He partnered with 3D

Systems because they offer a wide selection

of complete digital dental solutions to match

specific patient requirements with their digital

scalable workflows, materials and software.

and retainers. We have four of these units

because they are just so reliable and good

to use. Our reputation as a clinic and lab is

dependent on the quality of work we produce

so consistency and reliability are keys.”

Dr Yang also added that the clinic has two

intraoral scanners to streamline their workflows

together with a robotic arm.

“Our Kuka robotic arm, affectionately termed by

the team Naulfina, does all the pressure forming

for dental models, for example, clear aligners

and clear retainers. It’s also constantly in use

and one of the centrepieces at our clinic,” he

said.

At present, the team is looking forward to the

new 3D Systems’ NextDent Ortho Flex resin

for making splints, as they heard a lot of great

reviews about it.

Dr Yang shared with enthusiasm: “We are really

excited to try it here in Singapore when it lands

on our shores!”

MAKING STRIDES IN TREATMENT

Moving forward, Dr Yang sees a positive trend in

correcting malocclusions and that the demand

for clear aligners is set to increase in the years

to come leading to potentially higher costs.

However, he added: “With the advancements

being made in the spheres of 3D printing

and CAD software, I am confident that

the manufacture of clear aligners will also

concurrently become more affordable and

accessible to a wider number of dental

practices. This will hopefully help to improve

access to treatment for patients at lower costs.”

In line with this, Dr Yang shared that patients’

perception of treatment might also change as

they will be expecting their dentists to be able

to offer more conservative, economical, and

efficient solutions. He also noted that tapping

digital marketing channels is substantial,

especially for new practices in growing their

practice as fast as possible.

prepare for this is to test and try new ways

of doing things now,” he said.

Dr Yang keeps an open mind to new

possibilities and aspires to be an inspiration

to other practitioners too in achieving their

fullest potentials. He also strives for work-life

harmony so he can always present the best

version of himself to his patients.

“Change is always happening and you have

the choice to either be proactive or reactive.

You have to change before change changes

you,” he advised.

To end with, Dr Yang concluded: “I’d like to

share a quote from Winston Churchill that goes

’Success is not final and failure is not fatal, it’s

the courage to continue that count’. I wish

everyone reading this good health and that

they may find the happiness they seek!” DA

3D Systems’ NextDent 5100 3D Printer

High precision stacked printing on

NextDent 5100

He explained: “We would not have been able

to start our clinic lab without these wonderful

printers. They print equipment which are

absolutely essential to our work, from wax-up,

study models, 3D printed splints, clear aligners

“I look forward to embracing these challenges

to come. I believe automation is going to be

huge in dentistry like it is already becoming in

many other industries. I believe we will be able

to do much more with less. And the best way to

3D Systems’ NextDent Ortho Flex for

splints and retainers

DENTAL ASIA NOVEMBER / DECEMBER 2021 27


Dental Profile

Dentsply Sirona continues to

future-proof dentistry

With the recent success of DS World 2021,

Dentsply Sirona has once again secured

their foothold as one of the leading dental

companies around the globe. Dr Terri Dolan,

the company’s chief clinical officer, talks

about the latest ground-breaking technology

from Dentsply Sirona and how the team

continuously supports practitioners as the

industry reopens.

Dentsply Sirona’s pioneering role throughout

its history has transformed dental practices

worldwide. From developing complete solutions

that seamlessly integrate hardware and software

to optimising practice efficiency, the company

has tremendously helped dental professionals

deliver the best possible treatment and care to

their patients.

Inspired by this vision and success, Dr Terri Dolan

takes pride in her role as the chief clinical officer

of the company since 2013. With her background

as a dentist and experience as a professor

and dean of the University of Florida’s College

of Dentistry (United States), she is the voice

of clinicians and technicians within Dentsply

Sirona, responsible for ensuring that they

comply with regulations and ethical standards

so customers will feel confident in their products

and services.

“In dentistry, we have a wonderful opportunity

to help people maintain or restore healthy

teeth and beautiful smiles. I have always been

fascinated about how dentists are able to

accomplish so much through their expertise

in science, clinical skills, art, and of course,

the use of modern technology. With the

increasing evidence demonstrating the

importance of oral health to overall health

and well-being, I was most excited about

joining a leading company with a vision to

transform dentistry to improve oral health

globally,” she shared.

Dr Dolan oversees professional education

activities and supports clinical initiatives

and strategies of each Dentsply Sirona unit.

She enjoys having a diverse and inclusive

work environment and culture; and finds

it incredibly fulfilling to be involved in

the company’s support for student-led

research through the Student Competition

for Advancing Dental Research and its

Application Awards (SCADA), which Dentsply

Sirona helped initiate in 1959 and is cosponsored

by the American Association for

Dental, Oral and Craniofacial Research.

“I truly enjoy working closely with experts

from across the entire spectrum of dentistry

around the world and collaborating with

universities, dental schools and dental

organisations to ensure that the courses

and programmes we offer are not only of

the highest quality but meet the needs of dental

professionals today,” she said.

ROAD TO RECOVERY

Safety for the practitioners and their patients is

of utmost importance as the industry recovers

from the impact of COVID-19 pandemic. With

their infection control solutions, Dentsply Sirona

has made it possible for dental practitioners to

re-open their practices confidently.

According to Dr Dolan, safety begins with

a comprehensive and thorough infection

prevention concept. Consequently, Dentsply

Sirona builds hygiene and infection prevention

into their design language.

She explained: “For example, Dentsply Sirona

products have very smooth surfaces and are free

from stylistic elements that could make cleaning

challenging. Gaps and cracks are also avoided so

that dirt and debris cannot get trapped in difficult

to access areas. Our dental treatment centres

are designed and equipped with materials that

prevent moisture from penetrating into the chair

and they even let the dentist or assistant know

28

DENTAL ASIA NOVEMBER / DECEMBER 2021


that the hoses should be flushed for at least

20 seconds after every patient’s appointment.

Parts such as light handles and trays are

removable so that they can be properly

disinfected separately between uses.”

Dr Dolan also highlighted how their intraoral

scanner, Primescan, proved to be a true

all-rounder as it ensures high-quality

digital impressions and exceeds minimum

recommended hygiene guidelines.

“It is the only scanner that provides a variety

of disinfection and sterilisation procedures

with three different sleeve options. Thanks to

the smooth surfaces of Primescan and the

acquisition centre, the hygienically critical

areas, which are often difficult to clean, can

be reprocessed safely, quickly and easily,” she

added.

In achieving highest level of safety, Dr Dolan

noted that the practice design can also

influence the workflow to make cleaning even

easier.

“I would recommend having a sterilisation

room that is located quite centrally, so that

the team has short distances that ideally

avoid many crossroads between staff and

patients. In light of the COVID-19 pandemic,

many practices have rethought their waiting

room concepts as well to accommodate social

distancing needs,” she said.

When it comes to the important topic

of reprocessing instruments, Dentsply

Sirona offers the DAC Universal family

of reprocessing units. With this device,

all cleaning steps are standardised and

fully automated at the touch of a button,

minimising application errors to the greatest

possible degree. Last year, independent

testing confirmed full virucidal activity of the

DAC Universal. This includes activity against

all enveloped viruses such as SARS-CoV-2,

and non-enveloped viruses.

CONTINUING EDUCATION

With the pandemic situation accelerating

the digital revolution in the field, Dentsply

Sirona ensures that the professionals can

keep up with the advancements through their

continuing education programmes.

Dr Dolan, shared: “We have the strongest

clinical education programme in the industry

and are constantly upgrading the courses

to meet the needs of dental professionals.

During the COVID-19 pandemic, we quickly

shifted much of our clinical education training

to an online environment, but we also still

have 60 training facilities, dental academies

and showrooms around the world where

dental professionals can take live courses and

experience our cutting-edge technology that

is transforming dentistry.”

Furthermore, Dentsply Sirona is committed

to supporting their customers’ needs all over

the world as reflected in the new training

facilities within the Asia Pacific they opened

over the past several years in Singapore, Hong

Kong, Jakarta, (Indonesia) and Kuala Lumpur

(Malaysia). With the COVID-19 pandemic

reducing their ability to train together in

person, Dentsply Sirona quickly recalibrated

their clinical education offerings at the

beginning of the pandemic by moving most of

their courses online and tailoring them to meet

the current needs of dental professionals.

“In 2020 alone, we had over a million

participants in our clinical education courses.

Especially in the APAC region, which was

hit with COVID-19 before anywhere else

in the world, we reacted fast. Numerous

digital formats, such as online training,

digital congresses, and trade fairs, as well

as internal training and meetings, were

set up immediately at the beginning of the

pandemic,” she said.

Dr Dolan added that one of the many initial

highlights included a new online training

programme that was developed and

implemented in China when the COVID-19

outbreak began in January 2020; the first

real-time online course took place already on

February 9, 2020. In less than three weeks, 46

courses were set up, which were viewed by sixdigit

strong audience of dental professionals.

TRENDS AND SUSTAINABILITY

Dentsply Sirona offers an extensive range of

recent innovations in their solutions pipeline

including Axeos, Astra Tech ImplantEV, Surefil

one, SureSmile, Palodent 360, ProTaper Ultimate,

CEREC MTL Zirconia, as well as updates to their

CEREC and Connect software with many more

highlights coming next year.

Dr Dolan asserted that dental professionals can

expect Dentsply Sirona to expand its research

on the use of artificial intelligence for dental

applications. In fact, this technology is already

used in Primescan helping to compare intraoral

impressions from different points in time for

patient monitoring.

“That gets me to another point about data –

technologies like our Primescan capture an

incredible amount of data and in the future,

we will be able to even more efficiently utilise

this wealth of data for even better diagnostics.

There is also great potential in materials that

can be digitally processed to provide longevity,

DENTAL ASIA NOVEMBER / DECEMBER 2021 29


Dental Profile

compatibility and great aesthetics for

patients,” she said.

Dr Dolan also noted that patients want

treatments that not only give a great result

but also are more comfortable and even

less time-consuming. Therefore, it is not

just digitalisation of individual products,

but entire workflows, which they strive for

when developing new innovations.

“There is tremendous potential for implant

dentistry and integrated workflows by

bridging the gaps between implant

dentistry, imaging, and CAD/CAM, as

well as connected software for smart

procedures,” she said.

Furthermore, in line with the global call

for circular economy and sustainability,

Denstply Sirona has recently released

their inaugural sustainability report and

announced their updated sustainability

strategy aligned with 10 UN Sustainable

Development Goals (UNSDGs) during the

DS world.

Dr Dolan, explained: “Dentsply Sirona’s

sustainability strategy focuses on three

strategic pillars: ‘Healthy Planet’, which

strives to mitigate the environmental

impact of our operations; ‘Healthy Smiles’,

which focuses on improving oral health

quality and access globally, supporting

our customers and fostering a healthy

company culture; and, ‘Healthy Business’,

which ensures our business is built via

responsible and transparent practices and

the effective integration of sustainability

principles across all aspects of our

business.”

With regards to the environment, Dentsply

Sirona established a robust baseline for

Scopes 1 and 2 greenhouse gas (GHG)

emissions and implemented a range of

on-site emissions reduction initiatives.

They aim to reduce Scopes 1 and 2 GHG

Emissions by at least 15% by 2025, and to

achieve net zero carbon emissions (scopes

1-3) by 2050. Dentsply Sirona also aims to

reduce total waste by at least 15% by 2025

and established a goal to reduce water

withdrawal for manufacturing/warehouse

operations by a minimum of 15% by 2025.

“We have also become a founding partner

in the FDI World Dental Federation’s

‘Sustainability in Dentistry’ initiative, joining

GSK, Procter & Gamble, Colgate and TePe to

create a Code of Good Practice, which will

provide guidelines and objectives for achieving

a sustainable procurement and supply process

throughout the dental industry,” shared Dr

Dolan.

FUTURE AND BEYOND

The digital revolution is occurring in many

industries and the dental field is no exemption.

According to Dr Dolan, one can expect nothing

less from the next generation of dental

practitioners who are ready to embrace new

technologies and seek out trainings to keep

their techniques and practices at the cutting

edge.

However, she noted that it is also important to

understand the specific needs of the patients

and to tailor their dental experience to meet

those needs especially for older patients.

“One of the factors that will influence

innovation and the types of solutions that

need to be developed in the coming years is

the increase in life expectancy in many places

around the world. More and more patients

expect to keep their natural teeth longer. How

dentists care for older patients may therefore

need to evolve to meet these expectations

and challenges – for example, advances in

endodontic care and restoring function with

implant supported prostheses.

“Having a significantly larger elderly patient

population means that dental practices will have

to consider how to best cater to this group – that

may require rethinking how the practice is set up

and designed to accommodate the specific needs

of an older population, but also in the types of

services provided,” she explained.

Dr Dolan also emphasised the importance

of attending clinical education events for

exchanging best practices in light of the

pandemic situation reinforcing dental care as an

essential health service.

“Oral health is an important precondition for

general health and teeth require thorough care.

Prevention and other important dental treatments

are crucial for the health and well-being of

patients,” explained Dr Dolan.

To conclude, Dr Dolan extends her gratitude

to their customers in the region: “It has been

a challenging 1.5 years for all of us in the

industry and yet, we all came together as a

united community to bring the practice of

dentistry forward and to continue to give healthy

smiles to patients. Dentsply Sirona salutes

you – and we remain committed to providing

dental professionals with the most advanced

technologies, training and support so we can

always be prepared for the future.” DA

30

DENTAL ASIA NOVEMBER / DECEMBER 2021


Clinical Feature

Digital scans and

human identification

The advances in digital technology have evolved dental

models into highly reliable tools for human identification.

Addressing the limitations of traditional stone models and

DNA analysis, it is now possible to utilise 3D digital palatal

model to distinguish monozygotic twins.

By Dr Botond Simon, Dr Ajang Armin Farid, Dr George Freedman, and Dr Janos Vag

The exponential growth of digital

technology in dentistry is inherently

accompanied by a significant

expansion of 2D and 3D dental image

records. Traditional stone models are

impractical to keep long-term due to

storage volume and fragility.

Comprehensive and accurate

models offer an excellent record of

the preoperative dentition for the

complete restoration of a smile that

matches the original (Renne, Evans

et al. 2017, Revilla-Leon, Raney et

al. 2020). The longer-term storage

of dental models facilitates the

resolving legal cases, and might aid

bite mark analysis in some criminal

cases (Khatri, Daniel et al. 2013). Yet

another application of dental models

is for human identification.

In addition to DNA and fingerprints,

dental examination is a primary tool

for disaster victim identification (DVI)

(Interpol, Tsokos, Lessig et al. 2006).

Dental models that are discarded or

lost may deprive biologically driven

oral rehabilitation of historical tooth,

bite, and bone reference points, and

may hamper positive identification.

Population-wide databases for

fingerprints (Peralta, Triguero et al.

2016, Thalesgroup.com 2021) and

DNA (Smith 2006, Amankwaa and

McCartney 2018) are limited and

very fragmented. After the 2004

tsunami disaster in Thailand, 46% of

the victims were identified by dental

records, as compared to only 19%

by DNA and 34% by fingerprints.

The dental identification method is

an analogous visual comparison of

the ante- and post-mortem dental

records (Miki, Muramatsu et al. 2017,

Alsalamah and Nuzzolese 2020).

The basis of this concept is that

dental treatments are always very

specific and unique (Pretty and

Sweet 2001, Ata-Ali and Ata-Ali

2014). To further complicate matters,

teeth are continually impacted by

abrasion, disease, trauma, and dental

treatment. Thus, the available antemortem

data might not correlate

well to the post-mortem data.

Furthermore, treatment notation and

information are not standardised,

and it is exceedingly difficult to

run an automatic search in a large,

fragmented database.

Identifying the victim’s dentist,

or, at the very least, the area

where the victim was treated, is a

mandatory prerequisite for a DVI

search. Antemortem dental records

can be very challenging if no other

victim information is available. In

fact, younger patients may have

only orthodontic records. The

search process can be accelerated

dramatically by accessing the everincreasing

number of digital scans and

cloud-based data storage systems.

Digital dental records must be

retained, depending on national

regulations, from years to decades

(Charangowda 2010, Devadiga

2014). With digital dental records,

new pathways are open for DVI. The

next logical step is to find oral cavity

characteristics with universality,

uniqueness, invariability (stable

throughout the life), and ease of

access.

Monozygotic (MZ) twins cannot be

distinguished by DNA analysis (Bell

and Spector 2011) and they look very

similar (phenotypes). Hence, one

way to prove the uniqueness of an

identification method is its ability to

reliably distinguish MZ twins. This is

compounded by the recent revelation

that palatal morphology (palatal vault

and surface texture) can differentiate

MZ twins through intraoral scans

(Simon, Liptak et al. 2020).

Rugoscopy (also known as

palatoscopy, calcorrugoscopy) is

DENTAL ASIA NOVEMBER / DECEMBER 2021 31


Clinical Feature

based on the difference in palatal

rugae pattern, and can distinguish

among ethnic and race groups,

offering great assistance during

DVI (Hermosilla Venegas, San Pedro

Valenzuela et al. 2009, Bajracharya,

Vaidya et al. 2013, Azab, Magdy et

al. 2016, Suhartono, Syafitri et al.

2016, Kommalapati, Katuri et al. 2017,

Saadeh, Ghafari et al. 2017, Barbo,

Azeredo et al. 2018, Basman, Puspita

et al. 2018).

The palate is more resistant to burn

deformation injury when compared to

the skin (Muthusubramanian, Limson

et al. 2005). It is stable over time and

varies little after orthodontic treatment

(Bailey, Esmailnejad et al. 1996, Abdel-

Aziz and Sabet 2001, Ali, Shaikh et al.

2016, Lanteri, Cossellu et al. 2020).

OBJECTIVE

The aim of this pilot study was to

compare teeth and palate uniqueness

using the intraoral scans (IOS) of MZ

twins.

METHODS

Three MZ pairs, aged 17, 22, and

26 were enrolled in the study. The

complete maxillary arch, including the

palate, was scanned by the Emerald

intraoral scanner (Planmeca, Helsinki,

Finland, software version: Romexis

5.2.1). The palate was carefully isolated

on each scan and was exported to

a separate model. The left maxillary

first molar was intact in five subjects

and filled in one subject. The left

maxillary second molar was intact in

each subject. These two teeth were

segmented, and the images were

exported to respective new files.

Palatal digital models and tooth

digital models were aligned between

nonrelatives (Fig. 1) and between

siblings (Fig. 2). The superimpositions

were made using the GOM Inspect

software (GOM GmbH, Germany),

utilising the local best-fit algorithm.

The mean absolute deviations were

calculated for each superimposition

with the surface comparison tool. The

Fig. 1: The surface comparison maps of nonrelative subjects of the maxillary first molars, of the

maxillary second molars, and of the palate. None of the teeth had restorations. Deep red and

blue areas indicate distance deviation higher than the range of the colour scale

data were statistically analysed by

the generalised linear mixed method

using SPSS (IBM SPSS Statistics for

Windows, Version 27.0., United States).

RESULTS AND DISCUSSION

The mean absolute deviations

(± the standard deviation) of the

first and second molars between

non-relatives (Fig. 1) were not

significantly different (0.259±0.039

mm, 0.277±0.037 mm, p=0.733),

but the mean absolute deviation of

the palates was significantly higher

(1.061±0.314 mm, p


Clinical Feature

higher than the IOS trueness, they

jeopardise the confidence in MZ twin

identification.

The palatal deviation between

siblings was three to four times higher

(0.393±0.079 mm, p


Clinical Feature

the determination of human identity.” Br

Dent J 190(7): 359-366.

• Renne, W. G., Z. P. Evans, A. Mennito and

M. Ludlow (2017). “A novel technique

for reference point generation to aid

in intraoral scan alignment.” J Esthet

Restor Dent 29(6): 391-395.

• Revilla-Leon, M., L. Raney, W. Piedra-

Cascon, J. Barrington, A. Zandinejad

and M. Ozcan (2020). “Digital workflow

for an esthetic rehabilitation using a

facial and intraoral scanner and an

additive manufactured silicone index:

A dental technique.” J Prosthet Dent

123(4): 564-570.

• Saadeh, M., J. G. Ghafari, R. V. Haddad

and F. Ayoub (2017). “Palatal rugae

morphology in an adult mediterranean

population.” J Forensic Odontostomatol

35(1): 21-32.

• Simon, B., L. Liptak, K. Liptak, A. D.

Tarnoki, D. L. Tarnoki, D. Melicher and

J. Vag (2020). “Application of intraoral

scanner to identify monozygotic twins.”

BMC Oral Health 20(1): 268.

• Smith, M. E. (2006). “Let’s Make the DNA

Identification Database as Inclusive as

Possible.” The Journal of Law, Medicine

& Ethics 34(2): 385-389.

• Smith, R. N., G. Townsend, K. Chen

and A. Brook (2009). “Synetic

superimposition of dental 3D data:

application in twin studies.” Front Oral

Biol 13: 142-147.

• Suhartono, A. W., K. Syafitri, A. D.

Puspita, N. Soedarsono, F. P. Gultom,

P. T. Widodo, M. Luthfi and E. I. Auerkari

(2016). “Palatal rugae patterning in a

modern Indonesian population.” Int J

Legal Med 130(3): 881-887.

• Taneva, E., C. Evans and G. Viana (2017).

“3D Evaluation of Palatal Rugae in

Identical Twins.” Case Rep Dent 2017:

2648312.

• Thalesgroup.com. (2021, 06 March

2021). “Biometrics: definition, trends,

use cases, laws and latest news.” from

https://www.thalesgroup.com/en/

markets/digital-identity-and-security/

government/inspired/biometrics.

• Tsokos, M., R. Lessig, C. Grundmann,

S. Benthaus and O. Peschel (2006).

“Experiences in tsunami victim

identification.” Int J Legal Med 120(3):

185-187.

• Uhm, S. H., J. H. Kim, H. B. Jiang, C. W.

Woo, M. Chang, K. N. Kim, J. M. Bae and

S. Oh (2017). “Evaluation of the accuracy

and precision of four intraoral scanners

with 70% reduced inlay and four-unit

bridge models of international standard.”

Dent Mater J 36(1): 27-34.

• Vag, J., Z. Nagy, B. Simon, A. Mikolicz, E.

Kover, A. Mennito, Z. Evans and W. Renne

(2019). “A novel method for complex

three-dimensional evaluation of intraoral

scanner accuracy.” Int J Comput Dent

22(3): 239-249.

• Zhongpeng, Y., X. Tianmin and J.

Ruoping (2019). “Deviations in palatal

region between indirect and direct

digital models: an in vivo study.” BMC

Oral Health 19(1): 66.

About the authors

Dr Botond Simon

Dr Ajang Armin

is a PhD student

Farid is the

at Semmelweis

chief forensic

University,

odontologist

Hungary. He

of Hungary’s

is a specialist

Interpol DVI

in Restorative

dental unit, and

Dentistry and

a member of

Prosthodontists. His research

Interpol’s DVI Odontology subworking

group. He is a fellow of

combines digital dentistry with

dental twin research and human the American Academy of Forensic

identification. He is co-founder

Sciences and a member of the

of Scrunch Ltd., an early-stage

American Society of Forensic

start-up company for providing

Odontology. He lectures at

personalised online dental care

Semmelweis Medical University,

for patients. Dr Simon maintains a Hungary, and maintains a private

private practice.

dental practice.

Dr George

János Vág

Freedman is a

DMD, PhD,

founder and past

is associate

president, AACD,

professor

a co-founder

and head,

CAED, regent

Department of

and fellow,

Conservative

International Academy for Dental Dentistry, Semmelweis University,

Facial Esthetics, and Diplomate and Hungary. He is a specialist in

Chair, American Board of Aesthetic Restorative Dentistry, Endodontics,

Dentistry. He is adjunct professor and Prosthodontists. His research

of Dental Medicine, Western

focuses on the microcirculation

University, Pomona, California of the gingiva, intraoral scanner

and Professor and Programme accuracy, and digital forensic

Director, BPP University, London, odontology. He has published 45

UK, MClinDent Programme

refereed papers. He is co-founder

in Restorative and Cosmetic

of Scrunch Ltd., a start-up company

Dentistry.

for providing personalised online

dental care for patients.

34

DENTAL ASIA NOVEMBER / DECEMBER 2021


A

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.

DENTAL ASIA NOVEMBER / DECEMBER 2021 35


Clinical Feature

Innovative dental implant

solutions

Through innovation and creativity, Anthogyr offers a complete range

of implants, instruments and digital solutions to support dental health

professionals in restoring their patients’ smiles. Dr Albert Chou and

Dr Sebrina Malik share how these solutions have allowed them to deliver

effective and predictable implant treatments in their daily practice.

First experience with

Anthogyr Axiom® TL

implant

By Dr Albert Chou

The dental profession has been helping

patients restore their chewing functions and

aesthetics using modern dental implants

since the 60s. There are a variety of designs

and shapes of implants produced since then.

Macroscopically, the most distinctive feature

of a modern dental implant is either a soft

tissue level implant or a bone level implant.

Fig. 1 Fig. 2

However, any attempts to justify which

implant design is superior will probably

end up with a non-conclusive agreement

between different dentists as the decision

to choose one design over the other can be

due to the operator’s training and experience.

What is crucial to know is that both bone level

and tissue level implant offer good implant

survival rate 1 .

Fig. 3 Fig. 4

CLINICAL CASE

A 46-year-old female without any pertinent

medical issues wanted to have her missing

lower right first molar (tooth 46) replaced.

During the first consultation, her dentition

presented a moderate amount of attrition.

Abfraction was also noted, and she

mentioned that she did brux at night from

time to time.

Fig. 5 Fig. 6

Her lower left second molar (tooth 47) was

replaced with a Straumann Tissue level

implant some years ago and it had served

Fig. 7 Fig. 8

36

DENTAL ASIA NOVEMBER / DECEMBER 2021


Clinical Feature

her well without any issues. It was then

proposed to her to have Anthogyr Axiom ®

TL implant with simultaneous guided bone

regeneration on the lower right first molar

site (Figs. 1-8).

Upon detailed examination of the CBCT

(cone beam computed tomography) image,

a radiolucent area was noted at the distal

aspect of the root and the bone of the lower

right second premolar (tooth 45) (Figs.

9a-c).

Fig. 9a

Fig. 9b

The patient was referred to see the

endodontist to assess if the tooth was

restorable. Unfortunately, the tooth was

deemed untreatable and would need to be

extracted. The tooth was then extracted

carefully and with as little trauma as

possible (Fig. 10). Upon inspection of the

extracted tooth, a perforation at the coronal

third of the root at the distal aspect of the

tooth was observed (Figs. 11-12).

Fig. 9c

Fig. 10

Theoretically, it was possible to place an

implant at the tooth 46 site and perform

immediate implant placement at tooth 45

with simultaneous bone graft procedure,

but doing so would be challenging. Since

bone graft was already planned, it was

decided to wait for 12 to 16 weeks (Type 3C

– early placement with partial bone healing

plus conventional loading) of healing before

the implant placement to have a higher

degree of survival rate 2 .

Fig. 11

Fig. 12

SURGICAL PLANNING

CBCT was taken to check the location of the

inferior alveolar nerve. For implant viewing

and planning, both Dentsply Sirona Gallileos

and Dental Wings coDiagnostiX were used

(Figs. 13-14). From the CBCT scan, it was

noted that bone agumentation on the

buccal side of the two proposed implants

was needed. For implant planning purpose,

Anthogyr Axiom ® TL PX R2 4.0mmX8mm

was used (Fig. 15). At tooth 46, Anthogyr

Axiom ® TL PX R2 4.6mmX6.5mm was used

for surgical planning (Fig. 16).

Fig. 13 Fig. 14

Fig. 17

On the day of surgery, a surgical stent was

used to aid the implant placement (Fig.

17). Two Anthogyr Axiom ® TL were placed

following manufacturer’s surgical protocol

(Fig. 18).

Fig. 15 Fig. 16

Fig. 18

DENTAL ASIA NOVEMBER / DECEMBER 2021 37


Clinical Feature

After the two implants were placed with

good primary stability, guided bone

regeneration procedure was carried out

(Figs. 19-20). Two implants placed were

Anthogyr Axiom ® TL PX 4.6X6.5mm with

R2.5 at tooth 46 and Anthogyr Axiom ® TL

PX 4.0X8mm with R2.5 at tooth 45. Cover

screws were used for both implants at the

end of the surgery. Geistlich Bio-Oss 0.25g

was used as the bone graft material with

Geistlich Bio-Gide 13X25mm for membrane.

Primary closure was achieved at the tooth 46

site but it was not possible at the tooth 45

site. Flap was closed with non-absorbable

monofilament 5/0 Prolene by Ethicon and

absorbale glyconate monofilament 5/0

Monosyn by B. Braun (Fig. 21).

When the implants were placed in March

2021 in Singapore, the only collar height for

the Anthogyr Axiom ® TL was R2.5. Hence,

it was different from what was planned

when using the coDiagnostiX. The healing

phase for the patient was uneventful and

after the suture removal, she was seen

again two months after the surgery. The

soft tissue was healing well but the metal

collar at 45 implant was exposed (Figs.

22-23).

Implants at 45 and 46 were left to heal

for three months before the stage two

surgery was carried out (Fig. 24). The

healing abutment used at 45 was 2mm

in height and 4.8mm in diameter. At

46, it was 4mm in height and 4.8mm in

diameter.

Digital implant impression was utilised

and two Anthogyr Axiom ® TL scan bodies

were used (Figs. 25-26). The data was

acquired using Medit i500 scanner (Figs.

27-29).

The patient preferred to have a toothcoloured

restoration, with monolithic

zirconia crown as the material of choice. It

was also decided that it will be beneficial

to splint the two crowns together due

to the shorter implant used at 46. The

abutment used for both 45 and 46 was

non-engaging Flexibase TL R plural (Figs.

30-34).

CONCLUSION

In dentistry, one may face an unplanned

situation. In this case, tooth 45 was not

supposed to be replaced by a dental

implant. Using Anthogyr implant system

has made day-to-day clinical practice

more flexible and straightforward when

dealing with unexpected changes.

Fig. 19 Fig. 20 Fig. 21

Fig. 22 Fig. 23

Fig. 24

Fig. 25

Fig. 26 Fig. 27

38

DENTAL ASIA NOVEMBER / DECEMBER 2021


Clinical Feature

Fig. 28 Fig. 29

Regrettably, the soft tissue height at 45 was

not ideal. However, Anthogyr Axiom ® TL implant

demonstrated excellent tissue response around

the gingival soft tissue. In hindsight, implant 45

could have been placed a bit deeper or if there

was preferably an option to use a shorter collar

height. Unfortunately, a shorter collar height

was unavailable in Singapore when the surgery

was done. Nevertheless, it will be of great

interest to monitor and observe the longevity of

this implant system for the years to come. DA

ACKNOWLEDGEMENT

The author would like to extend his gratitude to

Patrick Dental Lab for their prosthetic work and

support.

REFERENCES

1

Vouros, Ioannis D.; Kalpidis, Christos D. R.; Horvath,

Attila; Petrie, Aviva; Donos, Nikolaos. Systematic

Assessment of Clinical Outcomes in Bone-Level

and Tissue-Level Endosseous Dental Implants.

International Journal of Oral & Maxillofacial Implants.

2012, Vol. 27 Issue 6, p1359-1374

2

German O. Gallucci; Adam Hamilton; Weniji Zhou;

Fig. 30

Daniel Buser; Stephen Chen. Implant placement and

loading protocols in partially edentulous patients: A

systematic review. Clin Oral Impl Res 2018:29 (Suupl.

16): 106-134

About the author

Fig. 31

Fig. 32

Fig. 33

Fig. 34

Dr Albert Chou

obtained his

Bachelor of Dental

Surgery from the

University of Otago,

New Zealand,

in 2004, and

completed his Graduate Diploma in

Dental Implantology with the National

University of Singapore in 2013. He

was president for the NUS Graduate

Diploma in Dental Implantology from

2018 to 2020 and now serves as an

executive committee in the Alumni.

A partner at Canaan Dental Surgery,

he has always been involved in the

private practice. He is a member of the

International Team for Implantology

(ITI) and the Asia Pacific Society of

Osseointegration.

DENTAL ASIA NOVEMBER / DECEMBER 2021 39


Clinical Feature

Immediate implant

surgery with Anthogyr

Axiom®BL PX Implant

System

By Dr Sebrina Abdul Malik

A 60-year-old healthy female patient presented

a fractured upper left second premolar (tooth

25). She visits the dental office regularly and is a

non-smoker with good oral hygiene.

Fig. 1

Clinically, she had lost over three-quarters of

the lingual wall and the caries had extended

subgingivally (Figs. 1-2). There was insufficient

ferule to restore the tooth as it would need

crown lengthening as well as a root canal

with a post and core. Thus, the prognosis was

considered to be guarded.

Treatment options were explained to the patient.

She preferred to extract the broken tooth and

place an implant crown, as she felt that it

was a more predictable treatment option with

longer longevity. The panoramic radiograph

showed that she has a healthy generalised

periodontium.

Fig. 2 Fig. 3

Treatment protocol for the implant procedure

and technique were discussed in detail,

including whether a delayed or an immediate

approach was to be done. In this case, an

immediate implant placement was equally

predictable as the delayed approach in the right

hands. Since the patient was asymptomatic

with no existing acute periapical lesion or

infection, she was considered suitable for an

immediate implant procedure. She was elated

as she only had to go through one surgical visit

as opposed to two.

An immediate implant procedure entails a

flapless extraction of the tooth followed by

implant insertion into the socket at the same

visit. Since there is no surgical incision nor

buccal flap raised, this results in less surgical

trauma, shorter surgical time, reduction in postoperative

swelling and pain as well as the need

for suturing. Most patients are inclined towards

this technique due to the above advantages.

TREATMENT

A flapless atraumatic extraction of the broken

Fig. 4 Fig. 5

Fig. 1: Pre-op

Fig. 4: Extracted tooth 25

Fig. 2: Fractured tooth 25

Fig. 5: One-stage surgery with healing screw

Fig. 3: Extracted tooth 25 socket

abutment was used to maintain the gingival

tooth 25 was carried out with Coupland

emergence profile and aid in healing for the

elevators and upper premolar forceps (Figs.

future prosthetic crown. Implant positioning

3-4). The empty socket was irrigated with

was verified by a post-operative panoramic

saline and curetted leaving only healthy

radiograph (Fig. 6).

surrounding alveolar bone. It was followed by

insertion of an optimally positioned Anthogyr

Three months later, a closed tray impression

Axiom ® BL PX 4.6x 10.0mm with great

technique was carried out and successful

primary stability of 35Ncm (Fig. 5). Since

delivery of a screw-retained zirconia crown

the ‘’jumping gap’’ was less than 2.0mm,

was achieved (Figs. 7-10).

a bone graft was not required. A healing

40

DENTAL ASIA NOVEMBER / DECEMBER 2021


Clinical Feature

Fig. 6

CONCLUSION

This case delivered a high-quality dental

implant and crown treatment without the

need for more surgical downtime, including

minimal surgical trauma and reduced

post-operative swelling and pain. Anthogyr

Axiom ® BL PX dental implant is designed

to engage well in the socket for immediate

implantation with great stability. Studies

have shown the success rate of immediate

implant technique is nearly as successful

as the delayed approach if done the correct

way. DA

ACKNOWLEDGEMENT

The author would like to extend her sincere

appreciation to Yttria Lab for their highquality

prosthetic work.

Fig. 7

Fig. 8

REFERENCES

1

Fernando Salimon Ribeiro et al. Implant Dent.

2008 Mar. Success rate of immediate nonfunctional

loaded single-tooth implants: immediate versus

delayed implantation._

2

Stephen T Chen et al. Int J Oral Maxillofac

Implants. 2004. Immediate or early placement

of implants following tooth extraction: review of

biologic basis, clinical procedures, and outcomes.

About the author

Fig. 9

Fig. 10

Fig. 6: Post-op

Fig. 7: Pop-in impression closed tray technique

Fig. 8: Crown received from lab

Fig. 9: Final restoration

Fig. 10: Post-op radiograph to verify the fully seated restoration

Dr Sebrina Abdul

Malik graduated

from the Trinity

College Dublin,

University of

Ireland, with

a Bachelor of

Dental Science in 2009 and has been

practicing general dentistry since

then. With special interest in dental

implants and dentoalveolar surgery,

she co-founded Azure Dental in

Singapore where she currently works.

A certified implant dentist, she is also

a fellow of International Congress

of Oral Implantologist and an active

member of the International Team

of Implantology and Academy of

Osseointegration.

DENTAL ASIA NOVEMBER / DECEMBER 2021 41


Advertorial

Clinical Feature

CS MAR reveals

pathology and reduces

risk of misinterpretation

Carestream Dental’s CS 8100 3D features the CS MAR (Metal

Artifact Reduction) technology, which drastically reduces metal

artefacts caused by dental restorations, implants, and fillings.

As discussed by Dr Hanke Faust, this feature compares images

dynamically to obtain a more accurate and advanced diagnosis.

By Dr Hanke Faust

A 50-year-old patient with extended

soft tissue swelling around teeth 43

and 44 came to the practice (Figs.

1-2). The patient reported no pain

and irritability on the lesion but the

panoramic image revealed multiple

coronal and apical pathological

findings (Fig. 3). An extraoral image

was captured with the CS 8100 3D.

Fig. 1 Fig. 2

A CBCT volume was taken with

a 150-micron resolution for

further diagnostics using the FDK

reconstruction, as well as the new

CS MAR (Metal Artifact Reduction)

algorithm, which greatly increased

the spectrum of diagnostic

possibilities. The 3D view revealed

osteolysis (Fig. 4).

Fig. 3 Fig. 4

When comparing the panoramic

images extracted from the 3D scan

(Figs. 5-6), the image with CS MAR

applied (Fig. 6) showed significantly

lower artefacts caused by implants,

fillings and dental crowns. Various

pathological findings, such as apical

brightening at teeth 15, 26, 37 and

47; coronal brightening at teeth

15 and 45; and osteolysis at 15, 43

Fig. 5 Fig. 6

Figs. 1-2: Initial clinical finding

Fig. 3: Coronal and apical pathological findings

Fig. 4: Osteolysis in the region indicated by the blue arrows

Figs. 5-6: Panoramic reconstruction from the 3D volume showed FDK and CS MAR

42

DENTAL ASIA NOVEMBER / DECEMBER 2021


Clinical Feature

Advertorial

Fig. 7 Fig. 8

and 44, were easily identified. For

confirmation of the diagnosis, the

transverse and horizontal planes

were also examined in both FDK and

with CS MAR applied (Figs. 7-11).

The artefacts shown in the FDK

reconstruction consisted mainly

of hardening, extinction, noise and

motion artefacts.

DIAGNOSIS

The osteolytic-pathogenic

processes in 3D X-ray diagnostics

were assessed preoperatively

within the framework of the WHO

classification of odontogenesis

Fig. 9

Fig. 10

Fig. 11

lesions:

1. Neoplasms and other tumours of

the odontogenic apparatus (benign/

malign)

2. Tumours and other lesions of the

bone (osteogenic tumours, nonneoplastic

bone lesions)

3. Epithelial cysts (developmental or

inflammatory)

There was a need to distinguish

between giant cell granulomas,

fibromas and ameloblastic fibromas,

as well as other osteolytic tumours.

In this case, a polycystic

ameloblastoma at teeth 43 and

44 was suspected. The displaced

expulsion of the bone and

degradation of the bone and teeth

where the tumour had penetrated

them were all typical clinical

characteristics.

Fig. 12 Fig. 13

Figs. 7-8: Coronal cross section of FDK reconstruction and with CS MAR algorithm applied at

150microns

Figs. 9-10: 1x1 slice for detailed display

Fig. 11: Coronal plane shows the vertical section of teeth 37 and 47

Figs. 12-13: The CS MAR reconstruction (Fig. 13) provided additional diagnostic capability

compared to the FDK reconstruction

DENTAL ASIA NOVEMBER / DECEMBER 2021 43


Advertorial

Clinical Feature

Fig. 14 Fig. 15 Fig. 16

Fig. 17 Fig. 18 Fig. 19

Fig. 20

When comparing the two

reconstructions, the CS MAR

reconstruction clearly revealed

radicular processes in teeth 37 and

47; the osteolysis at 43 and 44; a

mesioperiodontal lightening; as well as

a distal fracture line at tooth 45 (red

arrows in Fig. 13).

Using CS MAR in the CS 3D Imaging

software allowed for more advanced

diagnostics while decreasing the

chance of misidentifying artefacts

with moiré patterns and motion

artefacts. For example, several

implants (34, 35, 36) in the FDK

reconstruction caused a strip-like

hardening and extinguishing artefacts

that made it hard to make a diagnosis.

When applying CS MAR, the hardening

and artefacts were significantly

reduced. With the aid of CS MAR, the

suspicion of root canal fracture was

confirmed at tooth 45 (Fig. 14).

Fig. 14: Extracted tooth 45

(horizontally cut at the level of the

fracture line)

Fig. 15: Surgical removal of the

pathology

Fig. 16: Excised polycystic

ameloblastoma

Figs. 17-20: Post-op follow-up

TREATMENT AND RESULTS

Teeth 15, 37, 45 and 47 were extracted.

Based on the main finding of the

CBCT volume, the space-demanding

osteolysis with a suspected tumour

at teeth 43 and 44, a fine-tissue

examination (histological clarification)

of the tumorous tissue was conducted

to confirm the initial diagnosis. The

tumour was then surgically treated

(Fig. 15). After the tumour was

removed (Fig. 16), the bone defect was

reconstructed.

The patient returned about three

months later for a post-op follow-up

showing good signs of healing (Figs.

17-20).

However, current literature shows

a recurrence rate of up to 30% for

these types of tumours. Therefore, the

patient will be recalled and observed

for several years. DA

About the author

Dr Hanke Faust

successfully

completed an

apprenticeship

as a dental

technician and

studied at the

University of Hamburg, Germany,

where he also received his

doctorate in dental studies with a

focus on fully ceramic restorations.

Instead of an in-university career,

he decided early on to work in his

own practice where he mainly

focuses on aesthetic prosthetic

care and the field of adhesive

composite trusts.

In addition to guided surgery, Dr

Faust is particularly interested

in radiological imaging using

Carestream Dental imaging system.

He has also written for and been

published by the German Medical

Publishers.

44

DENTAL ASIA NOVEMBER / DECEMBER 2021


User Report

Simplifying digital implant

prosthetics

Digital technologies have enabled simplified and predictable protocols

for interdisciplinary treatment planning, surgical placement and

prosthetic implant rehabilitation. This case study highlights how to use

the TRIOS intraoral scanner and 3Shape scan bodies, and seamlessly

transfer the digital data to 3Shape Dental System software.

By Dr Anthony Mak

CASE INFORMATION

This case study describes a prosthodontic

restoration of the lower right first premolar

(tooth 44) with a screw-retained, implantsupported

crown. Planning was driven by TRIOS

implant scanning, software and 3Shape scan

bodies.

CLINICAL PHASE OF TREATMENT

Upon completion of the eight-to-12-week

post-surgery healing phase and the integration

of the fixture, a master digital impression

using the TRIOS implant scan strategy was

performed.

Fig. 1

In this scan strategy (Figs. 1-6), the following

sequence of digital scans was taken:

1. A pre-preparation scan with the healing

abutment in situ

2. An emergence profile scan taken immediately

after the healing abutment was removed to

record gingival contours around the implant

before any collapse of the tissues

3. The scan body scan

Fig. 2a

Fig. 2b

All other prosthodontic records including the

bite registration and the opposing arch were

also captured with the intraoral scanner. The

data were then sent to the ceramist through

the 3Shape Communicate portal for the

fabrication of the screw-retained crown.

Fig. 3a

Fig. 3b

LABORATORY FABRICATION OF THE

FINAL PROSTHESIS

A direct access screw-retained crown (Lithium

Disilicate crown to a zirconia abutment with a

Fig. 1: Shade image prior to intraoral 3Shape TRIOS surface scan

Figs. 2a-b: Pre-preparation scan with healing abutment in situ

Figs. 3a-b: An emergence profile scan that was taken immediately after the healing abutment

was removed to record gingival contour around the implant before any collapse of the tissues

46

DENTAL ASIA NOVEMBER / DECEMBER 2021


User Report

titanium interface) was then fabricated and

the contact and occlusion were verified by

means of printed models (Figs. 7-8).

The completed prosthesis was then sent back

for the restoration to be inserted (Figs. 9-10).

CONCLUSION

Digital implant impressions constitute a major

role in developing a fully digital workflow

for fixed implant prosthetic restorations

(Christensen 2009). Intraoral scan bodies

have been developed for most major implant

brands that facilitate the transfer of the

implant specifics, position and alignment by

scanning; and the transmission of information

to the laboratory CAD software.

Fig. 4a Fig. 4b Fig. 4c

Once received in the CAD software, 3Shape

Dental System, the corresponding abutment

library is matched to allow the dental

technician to design the implant prosthesis

and manufacture the abutment and crown.

However, each company traditionally

manufactures a specific scan body for their

digital library, causing problems between

the clinical team and the dental laboratory

fabricating the implant prosthesis in many

occasions. The common problem is when

dentists and technicians are not in harmony

and do not have the same clinical and

laboratory parts, as well as information to put

the digital pieces of the puzzle together.

Fig. 5

An example is when a dentist scans an

implant fixture with one type of scan body

and then sends it to a laboratory without

all the information, parts (e.g., implant

analogue) or access to the library of that

scan body. This has been challenging and

has made clear communication with the

dental technician crucial, particularly prior

to implant scanning of a case, and in

the final design and manufacture of the

prosthesis.

Fig. 6a Fig. 6b Fig. 6c

3Shape has solved this with their universal

scan body that will marry up all original and

third-party implant libraries with whom they

collaborate. This has allowed for a much

simpler system, where one scan body can

be used with multiple implant abutment

libraries in the laboratory lab software

3Shape Dental System.

Fig. 6d

Fig. 6e

Figs. 4a-c: 3Shape scan body positioned and screwed into position

Fig. 5: Periapical radiograph confirming the seat of the scan body

Figs. 6a-e: The scan body scan digitally capturing the position and orientation

of the implant fixture

DENTAL ASIA NOVEMBER / DECEMBER 2021 47


User Report

This is a world-first that has eliminated many of

the limitations and boundaries for both the clinical

and laboratory team in dentistry. Most importantly,

it has made digital implant prosthetics more “open

sourced” as the libraries in 3Shape Dental System

is available at no additional cost to the user.

3Shape scan bodies (Figs. 11a-b) provide the

following benefits in simplifying the digital

implant impression process:

• Auto-recognition of the implant system

and connection: The new 3Shape scan bodies

feature a unique ID code to determine the implant

system and connection. When scanned with the

3Shape TRIOS intraoral scanner, the software

will detect and read the ID code on the scan

body and automatically fill out the order form

with the correct implant system and connection.

Fig. 7

• Scan bodies are manufactured

from titanium, highly durable and

autoclavable: Scan bodies can be used

up to 100 times if proper care and cleaning

is maintained between each use. Since

they are made from titanium, the 3Shape

scan bodies will not bend or deform if the

screw is over-tightened. Most other scan

bodies are made from PEEK (polyetherether-ketone),

which is a softer material

that can be more prone to bending. Once

a scan body is bent, the alignment will be

off, which will result in errors in the final

restoration design.

• Visible in clinical X-rays to confirm fit

to implant: It is vital to be able to see the

implant scan body connecting accurately

with the implant fixture.

Fig. 8

• One piece, one material manufacture:

This allows for optimal accuracy and

minimises tolerance issues if different

materials are used and need to be placed

together in a scan body. DA

ACKNOWLEDGEMENT

This article was co-written with Dr Andrew Chio from

Melbourne, Australia. The author would like to extend

his gratitude to him for his support and input.

About the author

Dr Anthony Mak

graduated with multiple

awards from the

University of Sydney,

Australia, in 2002 and

went on to complete his

Post Graduate Diploma

in Clinical Dentistry

(Oral Implants). He is a much sought-after

speaker, especially in the field of digital

and restorative dentistry, and has lectured

extensively in Australia, New Zealand and

across Asia. His hands-on workshops have

gained such popularity that they are almost

always booked out soon after registrations

open. He is also gaining great popularity on

the International circuit.

Fig. 9a

Fig. 9b

Dr Mak is the author of two compelling

compendiums detailing direct composite

and indirect ceramic restorations, the

clinical photography and documentation

can only be described as exceptional. He

has published numerous case studies and

articles for local and international dental

bodies and associations. His interest lies in

dental technologies, advances in materials

and techniques; and he has a unique

understanding of CAD-CAM digital dentistry.

Fig. 10 Fig. 11a Fig. 11b

Figs. 7-8: A direct access screw-retained crown (Lithium Disilicate crown to a zirconia abutment

with a titanium interface) was then fabricated and the contact and occlusion verified by means of

printed models

Figs. 9a-b: Final screw-retained restoration inserted

Fig. 10: Final peri-apical radiograph of completed implant retained restoration on the lower right

first premolar (tooth 44)

Figs. 11a-b: 3Shape intraoral scan body

At present, Dr Mak runs two practices in

metropolitan Sydney, focusing on quality

modern comprehensive care, including

implant dentistry. He is also a clinical

consultant and key opinion leader for

several global dental companies focusing on

development of new dental technologies.

48

DENTAL ASIA NOVEMBER / DECEMBER 2021


User Report

Fast and predictable

aesthetics with

injectable composites

Restoring young permanent teeth with distinct internal and surface

characteristics can pose a challenge in daily clinical practice. With the

new Beautifil range of bioactive nano-hybrid Injectable composites,

clinicians can efficiently achieve a high degree of aesthetic

predictability with a fast and simple technique.

By Dr Amit Gulati

Aesthetic dentistry is a highly demanding clinical science especially

when it comes to restoring anterior dentition in young individuals.

Young permanent teeth display an array of characterisations.

These characterisations range from visible dentinal effects like

mamelon patterns to enamel effects like high translucency,

opalescence, surface effects and macro-micro textures.

These variations and characterisations make it challenging for

clinicians to create natural, life-like restorations in the anterior

aesthetic zone with predictability and long-term success.

Achieving the desired aesthetic outcomes in such cases generally

requires intricate layering of packable composites that consequently

takes up a significant amount of clinical chairside time. However,

with advances in composite resin technology today, clinicians have

the option to replicate natural aesthetics with increased efficiency.

The Beautifil range of bioactive nano-hybrid composites

from Shofu provides additional benefits of minimising plaque

accumulation 1 with anti-bacterial 2 and acid-neutralising

properties to reduce secondary caries 3 , promoting gingival health

and enhancing the longevity of the restorations. The following

clinical case demonstrates an anterior Class IV restoration

where bioactive Beautifil Injectable X composites and colour

tints were used to achieve a high degree of aesthetic success

in a fraction of the chair time as compared to the conventional

layered technique commonly used for anterior restorations.

PATIENT CASE

A young, 15-year-old female patient was presented with

an Ellis Class I fracture involving tooth 21 (Fig. 1), caused

due to a minor traumatic sports injury that occurred almost

immediately after debonding of her orthodontic appliance

Fig. 1

Fig. 1: Ellis Class-I fracture in tooth 21

a few months ago. The patient had no symptom of pain or

discomfort to said tooth and the concern was purely aesthetic.

Upon intraoral examination, there was no pain or sensitivity

observed in relation to tooth 21. It was not tender to percussion

and the radiographic examination revealed healthy peri-radicular

tissues. Vitality test was performed and the tooth gave similar

readings as the adjacent teeth. It was concluded that the tooth

was healthy and free from any pulpal or peri-radicular pathology.

After careful examination and discussion with the patient, it was

decided that the fractured tooth will be restored with a minimally

invasive treatment approach utilising MiCD (Minimally Invasive

Cosmetic Dentistry) concept. As the patient was a 15-year-old, the

restorative procedure was modified to reduce the clinical chairside

time using a new type of bioactive injectable composite materials.

MATERIALS AND RESTORATIVE PROCESS

Shade selection, mock-up and putty index

Tooth 21 was thoroughly examined for internal and external

DENTAL ASIA NOVEMBER / DECEMBER 2021 49


User Report

characterisations. A high degree of enamel translucency was

observed in the incisal third, along with a fair amount of surface

texture and incisal opalescence. Before commencing isolation of

the anterior segment with rubber dam, shade selection was

completed using the VITA classical shade guide. The closest shade

tab in terms of hue and chroma match was identified as A2 (Fig. 2). A

quick freehand mock-up was created using Beautifil II LS Composite

shade A2 (Shofu Inc. Japan) and aesthetic evaluation was done

for shade verification (Fig. 3). After occlusal adjustment, a palatal

putty index was made with A-Silicon impression material (Fig. 4).

Isolation and tooth preparation

The anterior sextant was isolated with a rubber dam (Sanctuary

Dental, Malaysia) with its margins everted, and floss ties were

secured to maintain retraction (Fig. 5). The teeth were polished

with pumice slurry using a prophy rubber cup to remove the

plaque biofilm (Fig. 6). Sharp enamel edges were removed

and a long bevel was created on the facial surface with TR11F

fine-grit bur (Mani Inc. Japan) (Fig. 7), followed by smoothing

of the prepared surface and defining short and long bevels

with Super-Snap coarse disk (Shofu Inc. Japan) (Fig. 8).

Etching and bonding

The prepared tooth was ready for the bonding protocol. First, the

prepared palatal putty index was checked to confirm the fit (Fig. 9).

Then, the enamel was etched with 37% ortho-phosphoric acid

(Etch-Rite, Pulpdent, USA) for 30 seconds (Fig. 10). The adjacent

central incisor, tooth 11, was protected with Teflon tape. The

etching was done slightly beyond the long bevels prepared on

the tooth to help achieve a smooth restorative margin. FL-Bond

II Primer was applied on a slightly exposed dentin surface and

left undisturbed for 10 seconds followed by FL-Bond II bonding

agent (Shofu Inc. Japan) applied in an even layer over the entire

etched tooth surface (Fig. 11) and photocured for 20 seconds.

Fig. 2 Fig. 3 Fig. 4

Fig. 5 Fig. 6 Fig. 7

Fig. 8 Fig. 9 Fig. 10

Fig. 2: Shade selection using Vita Classical shade guide

Fig. 3: Free hand mock-up created with Beautifil II LS shade A2

Fig. 4: Putty index made with A-Silicon impression

Fig. 5: Isolation achieved with rubber dam

Fig. 6: Teeth polished with pumice slurry to remove the plaque

biofilm

Fig. 7: Minimal surface preparation and bevels done with a fine

diamond point

Fig. 8: Smoothening of prepared surface and defining of the short and

long bevels with Super-Snap coarse disk

Fig. 9: Palatal putty index checked before the bonding protocol

Fig. 10: Etching of enamel surface with 37% phosphoric acid

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DENTAL ASIA NOVEMBER / DECEMBER 2021


User Report

Creating the palatal shell

A small amount of Beautifil Injectable XSL shade A2 (Shofu Inc. Japan), a

bioactive restorative material, was injected in a small amount and placed

on the palatal putty index in the area of the tooth to be restored (Fig. 12).

The putty index was then placed on the palatal aspect of anterior teeth.

The restorative material was spread and teased with a thin probe onto the

palatal aspect of the preparation and photocured for 20 seconds (Fig. 13).

The self-levelling flow properties of this novel restorative material permits

gentle spread and preparation of a thin even palatal base layer. The

putty index is removed and the prepared palatal shell is examined (Fig.

14). Photocuring is done for 20 seconds from the palatal aspect. Excess

material was gently trimmed using No.12 surgical blade. This palatal

shell will serve as a base for further placement of restorative material.

Inject and shape with bioactive injectable composite

A layer of Beautifil Injectable X was then placed on the palatal shell

layer and gently spread using a probe and No. 5 Unibrush (Shofu Inc.

Japan). The unique properties of this restorative prevented the material

from flowing freely and allowed the material to holds its shape. The

material was injected and shaped to be slightly thick on the apical

aspect of the defect and gently spread over the fracture line while

forming a thinner layer towards the incisal aspect (Figs. 15-16). The

injectable composite layer was then photocured for 20 seconds.

The translucency effect was created by adding Lite Art blue stain

(Shofu Inc. Japan) on the incisal aspect and gently spread using

No. 5 Unibrush before photocuring for 20 seconds (Figs. 17-18). Two

more layers of Beautifil Injectable X A2 were added subsequently

to get the desired shape and anatomy of the fractured segment

(Figs. 19-20). Each layer was photocured for 20 seconds and final curing

of 40 seconds for each surface was carried out after application of

glycerine to minimise the oxygen inhibited layer on the surface (Fig. 21).

Fig. 11

Fig. 12 Fig. 13

Fig. 14 Fig. 15

Fig. 16

Fig. 17

Fig. 18

Fig. 19

Fig. 20

Fig. 21

Fig. 11: Bonding with FL-Bond II sixth generation bonding system

Fig. 12: Small amount of Beautifil Injectable XSL bioactive composite

injected on to the putty index

Fig. 13: Putty index placed on palatal aspect injected material spread

evenly and photocured

Fig. 14: Palatal shell created to form a thin and even base layer

Fig. 15: Beautifil Injectable X was injected and placed on the palatal shell layer

Fig. 16: Material was gently spread using a probe and No. 5 Unibrush

Figs. 17-18: Translucency effect was created by adding Lite Art blue

stain

Figs. 19-20: Beautifil Injectable X was injected in layers to obtain the

desired anatomy and minimise adjustments

Fig. 21: Oxy-barrier applied and light-cured to minimise the inhibition

layer

DENTAL ASIA NOVEMBER / DECEMBER 2021 51


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Finishing and polishing protocol

Gross finishing was completed under

rubber dam using Super-Snap medium

disk (purple) and TR21F (Mani Inc. Japan)

fine-grit bur on slow speed handpiece

(Figs. 22-23). OneGloss Midi point (Shofu

Inc. Japan) was then used to smoothen

the surface and create secondary surface

anatomy (Fig. 24). After fine finishing,

the rubber dam was removed, occlusion

was adjusted and the final aesthetic

outcome was examined (Figs. 25-26).

The patient was recalled after three

days for the final finishing and polishing

of the restoration (Fig. 27). The aesthetic

outcome observed after hydration appeared

satisfactory. Final finishing was done using

One-Gloss with minimal pressure and

fleeting strokes (Fig. 28). This method of

finishing with One-Gloss can be easily termed

as pre-polishing as it creates a smooth

surface ready to be polished (Fig. 29). The

polishing step was initiated with Super-

Snap X-Treme Disk fine (Green) followed

by extra-fine (Pink) (Figs. 30-31). As the

disks are flat and tend to flatten the surface

characterisations, they should be held at a

slight angle while polishing the facial surface

so as not to flatten the lobular anatomy.

Fig. 22

Fig. 23

Fig. 23 Fig. 24

Fig. 25

Fig. 26

Fig. 27

Fig. 28

Fig. 29

Fig. 30

Fig. 30 Fig. 31

Fig. 22: Gross finishing with fine diamond CA point

Fig. 23: Finishing with Super-Snap medium disk (purple)

Fig. 24: OneGloss Midi point was used to smoothen the surface and

obtain surface texture

Fig. 25: Fine finishing completed before removal of the rubber dam

Fig. 26: Immediate post-op

Fig. 27: Restoration at the three-day recall visit for finishing and polishing

Fig. 28: Final finishing was done using One-Gloss with minimal

pressure and fleeting strokes

Fig. 29: Pre-polished surface after finishing with OneGloss Midi

Fig. 30: Polishing step was initiated with Super-Snap X-Treme disk

fine (Green)

Fig. 31: Further polish was achieved with Super-Snap X-Treme super

fine disk (Pink)

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DENTAL ASIA NOVEMBER / DECEMBER 2021


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attempt was made to create an incisal halo using any opaque tints,

except for mimicking the natural incisal edge slope towards palatal,

the incisal halo was still distinctly visible in the final restoration.

This points towards the good refractive opalescence properties of

the restorative material. The final finish and polish of the restoration

were easily achieved with the comparable lustre of the natural

enamel surface. DA

Fig. 32

REFERENCES

1

Miki S et al. Antibacterial activity of resin composites containing surface prereacted

glass-ionomer (S-PRG) filler. Dent Mater. 2016 Sep;32(9):1095-102

2

Koji Yoshida et al: Anti-plaque property of newly developed fluoride releasing

adhesive system; Japanese Journal of Conservative dentistry magazine. Vol.51,

No.5, 493-501, 2008.

3

Hiraishi N et al. Interactions of boron released from surface pre-reacted glass

ionomer with enamel/dentin and its effect on pH. Sci Rep. 2021 Aug 3;11(1):15734.

Fig. 33

Fig. 32: Final lustre was achieved with Super-Snap Buff disk used with

fleeting strokes

Fig. 33: Final restoration with natural aesthetics that blend well with

the rest of the dentition

Final lustre was achieved with Super-Snap Buff disk (Shofu

Inc. Japan) used with fleeting strokes (Fig. 32).

RESULT AND CONCLUSION

An aesthetically pleasing restoration was easily created using the

above protocol, where the restoration was almost undetectable

from the rest of the tooth and also the adjacent tooth (Fig. 33).

The translucency of the incisal third appeared optimal with

the body of the restoration having the depth of colour which

matched perfectly with the rest of the tooth structure making

the restoration invisible. The fracture line appeared well masked

where the restoration margins were well blended with the natural

tooth surface. Overall, the aesthetic outcomes achieved were

beyond the patient’s expectations and she was very happy.

The new injectable restorative materials, Beautifil Injectable

XSL and Beautifil Injectable X, used in this clinical case

demonstrated very good handling and optical properties

to make a complicated restoration plan simple and

predictable with a mono shade restorative procedure.

The optical properties of these bioactive composites are truly

impressive as the restoration does not appear too translucent or

greyish in colour, however at the same time permits the optical

effects of tints used in sub-surface layer to create the effect of

the natural translucency required to perfectly match the adjacent

tooth. The fracture lines were masked well, along with seamless

integration of restoration margins and tooth surface. Though no

About the author

Dr Amit Gulati, is a BDS and MDS from the

University of Mumbai, India. He completed

an advanced training in aesthetic perioplastic

surgery, implantology and osseous

regeneration at the University of Hamburg,

Germany, and further expanded his

expertise with advanced prosthodontic

training under eminent clinicians in Germany.

A diplomate of the Indian Society of Oral Implantologists (ISOI),

a fellow of International Congress of Oral Implantology (ICOI)

and associate fellow of World Clinical Laser Institute (WCLI), Dr

Amit is trained in Digital Smile Design (DSD) under Dr Christian

Coachman and was instrumental in introducing the Style

Italiano concept in India through his academy. He also had

extensive training on Minimally Invasive Cosmetic Dentistry

(MiCD) and is a certified MiCD clinical trainer.

During his 17 years of aesthetic and implant practice, Dr

Amit has delivered numerous scientific presentations and

conducted training programmes on implants and aesthetics

both locally and internationally. Apart from consulting for

various aesthetic clinics in Mumbai, he also runs a busy

practice with special focus on aesthetics, implantology

and oral rehabilitation. He is a passionate teacher and runs

“Synqronize”, an academy established with other like-minded

colleagues, to share knowledge and train extensively on

implant and aesthetic dentistry.

DENTAL ASIA NOVEMBER / DECEMBER 2021 53


User Report

Efficient conversion of a

conventional complete denture to

Straumann® Pro Arch using

Smile in a Box

Outsourcing digital workflows have found its way into the dental field.

Dr Keng Mun Wong and Dr Valerie Tey share how they utilised a fully

outsourced digital workflow by Smile in a Box on a Straumann® Pro

Arch protocol for the immediate conversion of a conventional complete

denture into a fixed full-arch restoration.

By Dr Valerie Tey and Dr Keng Mun Wong

Immediate implant-supported full arch

restorations represent a well-established

and increasingly endorsed treatment

modality for the rehabilitation of fully

edentulous patients 1,2 . Survival rates as

high as 97% and more have been reported

for this type of restoration, with an average

follow-up period of five years 3 . Attributed

to favourable bone quality and anatomy,

mandibular immediate full-arch restorations

have been documented to display even

higher success rates 4 .

Digital technologies like guided implant

placement and computer-assisted

prosthetic planning and manufacturing

can significantly facilitate diagnosis,

treatment planning and surgical procedures,

and therefore provide more predictable

and efficient treatments 5,6 . In particular,

surgically advanced procedures like full-arch

reconstructions may significantly benefit

from these advantages, which may reduce

chair time and invasiveness for the patient 5,7 .

Access to digital technologies may be

hindered by financial and time constraints,

as well as a steep learning curve that has

been associated with such technologies 8,9 .

Recently, digital workflows have become

available as part of an outsourced service

through Smile in a Box. This enables

practitioners using conventional

workflows to readily benefit from the

advantages of digital technologies

without having to overcome the hurdles

associated with their first-time access.

This case report describes a successful

immediate conversion of a conventional

complete denture into an immediate

full-arch restoration by applying an

outsourced fully digital workflow provided

by Smile in a Box. The application

of a Straumann ® Pro Arch protocol,

combined with Smile in a Box, allowed

ready access to a fully digital workflow

that could efficiently be integrated

into conventional prosthetic workflow,

providing a highly satisfying clinical result.

INITIAL SITUATION

A 65-year-old male patient, fully

edentulous restored with conventional

acrylic full dentures, visited the clinic

complaining of unsatisfactory mandibular

denture retention and associated

problems. It included poor speech and

masticatory function, specifically related

to his lower denture. Clinical examination

revealed a round to knife-edge mandibular

ridge form, and adequate vertical but

inadequate horizontal bone availability

specifically in the posterior aspects 10 .

Fig. 1

Fig. 2a

Fig. 2

Fig. 2b

Fig. 2c

Fig. 1: Pre-treatment diagnostic panoramic

radiograph

Figs. Fig. 2a-c: 4 Pre-treatment intra-oral situation:

(a) existing conventional complete dentures

(b) maxillary and mandibular arches at the

approximate occlusal vertical dimension

(c) horizontal mandibular

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DENTAL ASIA NOVEMBER / DECEMBER 2021


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The diagnostic panoramic radiograph

revealed a mandibular arch presenting

moderate atrophy of Class III to IV, with a fair

volume of relatively dense cortical bone of

type I - II present in the interforaminal area

(Fig. 1).

The patient both had well-controlled type

II diabetes and hypertension. No systemic

and local risk factors or contraindications

that would have excluded the patient from

implant treatment were identified. After a

thorough discussion on various treatment

options with their advantages and

limitations, the patient opted for an implantsupported

mandibular restoration combined

with a new conventional full upper denture.

TREATMENT PLANNING

The treatment strategy included the

determination of the maxillomandibular

relationship, occlusal vertical dimension, and

teeth position using conventional complete

denture techniques (Figs. 2a-c). The findings

were used as prosthetic references for the

delivery of the fixed mandibular restoration 11

(Figs. 3a-b, 4a-b).

Data acquisition for the generation of the

virtual patient model was based on dual

cone beam computed tomography (CBCT)

scans using a radiographic template of the

new conventional dentures 12 (Figs. 5a-b).

Equidistant radiopaque fiducial markers

(gutta-percha) were positioned along the

vestibular rim of the template, allowing for

precise matching of the individual DICOM

data sets from patient scans wearing the

radiographic template and the template

alone.

Conversion of the lower mandibular

conventional denture into a fixed implantsupported

restoration was accomplished

using Straumann ® Smile in a Box. DICOM

data sets from dual CBCT scans were used by

the Smile in the Box team to establish the

virtual patient model. Based on this model,

the team explored possible concepts for the

implant restoration and associated surgical

protocols and guides using coDiagnostiX ®

surgical planning software.

Fig. 3a Fig. 3b Fig. 4a

Fig. 4b

Fig. 5a

Fig. 5b

Fig.6a

Fig. 6b

Fig. 6c

Fig. 7a

Fig. 7b

Figs. 3a-b: Maxillomandibular occlusal records

and final wax-up on master casts

Figs. 4a-b: New set of acrylic dentures on the

master casts and in close-up

Figs. 5a-b: (a) Transparent radiographic template

on master cast (b) After the modification of

template with radiopaque fiducial markers in

preparation for the dual scan CBCT

Figs. 6a-c: Implant restoration planned in

coDiagnostiX ® (a) 2D projection (b-c) 3D

representations of the planned implant and

prosthetic restorations

Figs. 7a-b: (a) Pin guides for pin fixation (b)

surgical guide for implant placement designed

in coDiagnostiX ®

DENTAL ASIA NOVEMBER / DECEMBER 2021 55


User Report

Subsequently, the team designed the

immediate provisional restoration using

CARES ® Visual software. Specific details and

aspects of the planned restorations and

treatment concepts were explored, validated

and approved during virtual planning

sessions between the Smile in a Box team

and the clinicians.

Following approval, the surgical templates,

provisional restoration, implants, and

any additional prosthetic parts and

surgical tools required for the full surgical

treatment procedure were conveniently

assembled by the Straumann team and

delivered in an all-in-one shipment to the

clinic.

Specifically, the plan involved a firstmolar-to-first-molar

prosthetic restoration

supported by four interforaminal BLX

Roxolid ® SLActive ® implants, consisting

of two anterior Ø3.75 x 12mm implants in

positions 32 and 42, and two Ø4.75 x 12mm

implants in positions 35 and 45. Inclination

of the posterior implants by 17 degrees

Fig. 8a Fig. 8b Fig. 8c

Fig. 9a

Fig. 9b

Fig. 9c

Fig. 10a

Fig. 10b

Fig. 10c

Fig. 11a

Fig. 11b

Fig. 11c

Fig. 12a

Fig. 12b

Fig. 12c

Figs. 8a-c: Clinical situation on the day of surgery

Figs. 9a-c: Positioning of the lower pin guide in occlusion with the opposing transparent radiographic template. An occlusal record was used to

further stabilise the mandibular pin guide in the correct position

Figs. 10a-c: Fixation of the BLX surgical guide

Figs. 11a-c: Osteotomy preparation (position 32) (a) Access preparation using a mucosal punch (b) flattening of the alveolar crest using a milling

cutter and (c) pilot drilling with a Ø 2.2mm pilot VeloDrill

Figs. 12a-c: Finalisation of the osteotomy and implant placement (position 32) (a) Final drilling with a Ø 2.8mm VeloDrill (b) BLX Roxolid ®

SLActive ® implant Ø 3.75 x 12mm (c) implant placement using a motorised handpiece

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DENTAL ASIA NOVEMBER / DECEMBER 2021


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Fig. 13a

Fig. 13b

Fig. 13c

Fig. 14a

Fig. 14b

Fig. 14c

Fig. 15a

Fig. 15b

Fig. 15c

Fig. 15d

Fig. 15e

Fig. 15f

Figs. 13a-c: (a) Occlusal view after implant placement (b) mounting of screw-retained abutments (SRAs) and (c) fixation of the temporary

provisional

Figs. 14a-c: Installation of shortened titanium copings and fixation of the provisional restoration

Figs. 15a-f: (a-c) Before and (d-f) after the removal of anchoring flanges and polishing of the finalised temporary prosthesis with installed

titanium copings in occlusal, frontal, and intaglio views

increased the A/P spread and helped reduce

the distal prosthetic cantilevers, removing

the need for any augmentative procedures

(Figs. 6a-c) 13 .

The planned surgical templates consisted of

a combination of a pin guide for pin fixation

and a surgical guide for implant placement.

Both guides were supported by crestal

mucosa and four anchoring pins in positions

36, 33, 43 and 46 (Figs. 7a-b).

SURGICAL PROCEDURE

Surgery was carried out under local

infiltration anaesthesia (Figs. 8a-c). Proper

seating and positioning of the mandibular pin

guide on the alveolar crest were verified with

the upper radiographic template in occlusion

(Figs. 9a-c). After the correct positioning

of the anchoring pins, the pin guide was

removed and replaced with the surgical

guide, and secured with anchoring pins (Figs.

10a-c).

Osteotomy preparation was carried out

corresponding to the instructions and

surgical protocols provided by coDiagnostiX ® .

This included the preparation of a defined

access profile to the alveolar bone with a

mucosa punch (Ø4.7mm), flattening of the

alveolar ridge with a milling cutter (mesial

Ø3.5mm, distal Ø4.2mm) and pilot drilling

with a Ø2.2mm pilot VeloDrill at 800rpm

(Figs. 11a-c).

All osteotomies were prepared to a final

diameter of Ø2.8mm to achieve good

primary stability and retain a high degree

of surgical flexibility 14-16 . Straumann ® BLX

implants were placed using a motorised

handpiece, followed by manual insertion

and final verification of appropriate insertion

torque of >35Ncm (Figs. 12a-c).

PROSTHETIC PROCEDURE

The surgical procedure was directly

followed by immediate provisionalisation,

which includes the installation of screw-

DENTAL ASIA NOVEMBER / DECEMBER 2021 57


User Report

retained abutments (SRAs) with a

torque of 35Ncm and pin fixation

of the temporary provisional (Figs.

13a-c). An optimal fit of the premanufactured

provisional restoration

with the prosthetic emergence

profiles of the implant restoration was

achieved.

Next, titanium copings were adjusted

in length to suit the contours of the

provisional and mounted on the

implant restoration. Subsequently,

the immediate provisional was

mounted, secured with anchoring

pins and fixed to the titanium copings

using flowable composite (Figs. 14ac).

Fig. 16a

TREATMENT OUTCOMES

Optimal functional and aesthetic

results were achieved thanks to

the digital pre-planning. There was

a satisfactory occlusal fit with the

maxillary complete denture, and no

adjustments were required (Figs.

15a-f). The patient showed optimal

immediate phonetic and functional

adaptation to the new provisional and

reported that he was pleased and

satisfied with the results (Figs. 16a-c).

Fig. 16b

DISCUSSION

The presented case illustrated

the conversion of a mandibular

conventional complete denture into

an implant-supported fixed fullarch

restoration using Straumann ®

Pro Arch and Straumann ® Smile in

a Box. Conversion of the existing

restoration included the delivery of

a new set of stable conventional

dentures after re-establishing the

maxillomandibular relationships

and occlusal vertical dimensions by

conventional laboratory workflows.

Smile in a Box facilitated quick and

easy access to a digital workflow,

with the associated advantages

of precise prosthetically driven

implant planning, guided flapless

implant placement and immediate

restoration 6,8 . The outsourced

workflow could be perfectly

Fig. 16c

Figs. 16a-c: Delivery of the immediate provisional on the day of surgery

integrated into the clinic’s existing of the virtual planning models

clinical and prosthetic setup.

based on the visualisations from

coDiagnostiX ® and CARES ® Visual

Key success criteria that contributed to provided by the team.

seamless integration of the outsourced

workflows and an optimal result for Efficient communication with the

the patient included appropriate

team also ensured that all other

and accurate data collection and critical factors related to immediate

communication with the Smile

implant placement and restoration

in a Box team. This allowed a

were appropriately addressed,

straightforward definition and approval without having to overcome the

58

DENTAL ASIA NOVEMBER / DECEMBER 2021


User Report

initial learning curves associated with

digital techniques 8 .

CONCLUSION

The application of Smile in a Box on

a Straumann ® Pro Arch protocol has

enabled convenient and seamless

access to a digital workflow for

the immediate conversion of a

conventional complete denture into a

fixed full-arch restoration. DA

For more information:

https://bit.ly/siab-sg

REFERENCES

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Rohlin M, Dr O, Nilner K, et al (2012) Treatment

of Adult Patients with Edentulous Arches: A

Systematic Review. The International Journal

of Prosthodontics 25:553–567

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Pera P, Menini M, Pesce P, et al (2018)

Immediate Versus Delayed Loading of Dental

Implants Supporting Fixed Full-Arch Maxillary

Prostheses: A 10-year Follow-up Report.

Int J Prosthodont 32:27–31. https://doi.

org/10.11607/ijp.5804

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Daudt Polido W, Aghaloo T, Emmett TW,

et al (2018) Number of implants placed for

complete‐arch fixed prostheses: A systematic

review and meta‐analysis. Clin Oral Impl Res

29:154–183. https://doi.org/10.1111/clr.13312

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Papaspyridakos P, Mokti M, Chen C-J, et al

(2014) Implant and Prosthodontic Survival

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Prostheses in the Edentulous Mandible

after at Least 5 Years: A Systematic Review:

Implant and Prosthesis Survival Rates

in Edentulous Mandible. Clinical Implant

Dentistry and Related Research 16:705–717.

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Wismeijer D, Joda T, Flügge T, et al (2018)

Group 5 ITI Consensus Report: Digital

technologies. Clin Oral Impl Res 29:436–442.

https://doi.org/10.1111/clr.13309

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Colombo M, Mangano C, Mijiritsky E, et al

(2017) Clinical applications and effectiveness

of guided implant surgery: a critical review

based on randomized controlled trials. BMC

Oral Health 17:150. https://doi.org/10.1186/

s12903-017-0441-y

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Arisan V, Karabuda CZ, Ozdemir T (2010)

Implant surgery using bone- and mucosasupported

stereolithographic guides in

totally edentulous jaws: surgical and postoperative

outcomes of computer-aided vs.

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standard techniques. Clin Oral Implants Res Ramasamy M, Giri, Raja R, et al (2013)

21:980–988. https://doi.org/10.1111/j.1600- Implant surgical guides: From the past

0501.2010.01957.x

to the present. J Pharm Bioall Sci 5:98.

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Al Yafi F, Camenisch B, Al-Sabbagh M

https://doi.org/10.4103/0975-7406.113306

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(2019) Is Digital Guided Implant Surgery

Morton D, Gallucci G, Lin W-S, et al

Accurate and Reliable? Dental Clinics of

(2018) Group 2 ITI Consensus Report:

North America 63:381–397. https://doi.

Prosthodontics and implant dentistry. Clin

org/10.1016/j.cden.2019.02.006

Oral Implants Res 29 Suppl 16:215–223.

9

Tahmaseb A, Wismeijer D, Coucke W,

https://doi.org/10.1111/clr.13298

14

Derksen W (2014) Computer Technology

Javed F, Ahmed HB, Crespi R, Romanos

Applications in Surgical Implant Dentistry: GE (2013) Role of primary stability for

A Systematic Review. Int J Oral Maxillofac successful osseointegration of dental

Implants 29:25–42. https://doi.org/10.11607/ implants: Factors of influence and

jomi.2014suppl.g1.2

evaluation. Interventional Medicine and

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Cawood JI, Howell RA (1988) A

Applied Science 5:162–167. https://doi.

classification of the edentulous jaws.

org/10.1556/IMAS.5.2013.4.3

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International Journal of Oral and

Javed F, Romanos GE (2010) The role of

Maxillofacial Surgery 17:232–236. https://doi. primary stability for successful immediate

org/10.1016/S0901-5027(88)80047-X

loading of dental implants. A literature

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Terzioğlu H, Akkaya M, Ozan O (2009) The review. Journal of Dentistry 38:612–620.

use of a computerized tomography-based https://doi.org/10.1016/j.jdent.2010.05.013

16

software program with a flapless surgical

Ophir Fromovich, Karim Dada, Leon

technique in implant dentistry: a case report. Pariente, Marwan Daas (2019) BLX: a new

Int J Oral Maxillofac Implants 24:137–142

generation of self-drilling implants

About the authors

Dr Valerie Tey graduated with Bachelor and Master of

Dental Surgery degrees from the National University of

Singapore, where she is currently serving as a part-time

tutor. In the course of her study, she was placed on the

Dean’s list and awarded a number of medals, including

the Academy of Medicine Prize, Dr FAC Oehlers Medal

(Best clinical student), Terrell Silver Medal (Best student

with distinction in prosthodontics) and the Q&M Dental Surgery Medal for

Operative Dentistry (Best student with distinction in operative dentistry).

She holds a membership in Prosthodontics from the Royal College of

Surgeons, Edinburgh, and is also a fellow of the Academy of Medicine,

Singapore.

Dr Keng Mun Wong is a member of numerous

professional organisations. He is an affiliate assistant

professor at the University of Washington, United States,

and a visiting senior lecturer at the National University

of Singapore. In 2005, Dr Wong founded T32 Dental

Academy, a centre dedicated to educating, motivating,

stimulating and sharing knowledge with other dental

professionals. Dr Wong is currently the managing director of T32 Dental

Group. His practice focuses on all areas of restorative care including

aesthetic dentistry, full mouth reconstruction, fixed, removable and implant

prosthodontics.

DENTAL ASIA NOVEMBER / DECEMBER 2021 59


Behind the Scenes

More than a simple

manufacturing alternative

Thanks to validated Ceramill workflow, precisely fitting

3D-printed full dentures is now possible.

Ceramill workflow is a “for Ceramill” support

and Buildstyle for the printing process we

developed together with 3D Systems. These

are adapted to the workflow of Amann

Girrbach and also contribute to creating

an excellent fit. The focus here was on

the fit of the teeth and bases.

in the final fabrication of the full denture.

Additionally, there is a checklist which, in case

of problems, points out possible sources of

error and highlights the important steps for an

accurately fitting result. DA

Amann Girrbach has successfully developed

and marketed innovations for digital dentures

over the years. With the addition of 3D printing

capabilities, the Ceramill Full Denture System

offers the broadest range of digital denture

fabrication options in the industry – from

the highest quality, highly individual milled

dentures to cost-efficient 3D printed dentures.

So, how can these benefit the users?

Gerrit Scholz, MSc, development engineer at

Amann Girrbach’s Research and Development

department (above), answers this question

by giving light to the integrated and easy-toimplement

workflows of the Ceramill System.

What makes 3D printing of full dentures

within the Ceramill System so unique?

Scholz: The Denture 3D+ material from 3D

Systems has been extensively validated by

our research and development department.

This thorough examination has enabled us

to greatly optimise both the design and the

production process, so that reproducible and

accurately fitting full dentures are guaranteed

and can be fabricated by Ceramill customers

in a most efficient manner (Fig. 1).

On the software side, validated and

coordinated CAD parameters are essential for

the 3D printing result. To this end for example,

the Ceramill D-Flow software offers tooth

pocket gap parameters adapted to the tooth

concept (Ceramill FDS or Vigo) (Fig. 2). On the

production side, the special feature of the

In addition, during validation of the material at

our facility, the print or fit accuracy was found

to be dependent on the material level or level of

the 3D printer. To this effect, we have developed

a Level Tool (available in the C3 and/or AG.Live

portal) (Fig. 3), with which the appropriate

filling level for the respective printing job can

be achieved. In direct interaction with the “for

Ceramill” Buildstyle, the Filling Level Tool creates

precisely fitting results for the customer.

Automatic orientation and additional

assistance structures are further features

offered by the Ceramill workflow. What

roles do they play?

Both are important factors which influence an

accurately fitting result. Even slight deviations in

orientation can significantly influence the fit of

full dentures. For this reason, orientation of the

full dentures in the Ceramill workflow is selected

such to ensure an optimal tooth and base fit

on the model. This orientation is automatically

transferred from the Ceramill software to the 3D

Sprint 3D-printing software from 3D Systems,

thus avoiding incorrect orientation. The placing

of additional assistance structures (Fig. 4)

serves as stabilisation during the printing

process and thus prevents distortion during the

fabrication process with the NextDent5100 for

Ceramill.

How difficult is this step for beginners?

To provide customers with a quick and

easy introduction, detailed instructions are

available, which explain all the steps involved

Fig. 1: Checking the final fit of the printed full

dentures in the articulator

Fig. 2: Selecting the tooth pocket gap (here: FDS

system) in the Ceramill Mind Software

Fig. 3: The Filling Level Tool helps to find the

appropriate material level

Fig. 4: Assistance structures (yellow) in the 3DSprint

for Ceramill Software

60

DENTAL ASIA NOVEMBER / DECEMBER 2021


Behind the Scenes

Automatic denture cleaning

that works

SYMPRO is a compact denture cleaning unit from Renfert especially

suited for cleaning removable dental restorations, orthodontic

appliances, and splints. Dr Christopher Tuxford shares his experience

using the system and how he integrated it into his daily practice.

Upper denture with stubborn deposits before

initial cleaning

Upper denture after cleaning

FIRST IMPRESSIONS

Trade Exhibition Stuttgart: Full aisles, lots

of booths, practically information overload!

Everything new, everything great and

everything expensive. But then, I saw

something out of the corner of my eye

as I passed it by. Small, white-grey and

unspectacular but somehow, something

special. I only then realised that it was

the Renfert stand where I had stopped.

Laboratory stuff! I’m a dentist! What is that?

The friendly answer was on point: SYMPRO

Denture Cleaning Unit; also for, or only for the

practice. Great! The laboratory has something

like that in large. It takes two to three hours

to get the teeth back again. But then again,

they looked new. Hence, I asked for more

information. For 20 to 40 minutes of cleaning

time, post-polishing is not necessary. Wow!

And that works? Okay, the price was less than

I expected.

Whilst waiting for the device to arrive, I did

my research. It all sounded very positive. And

then, at last, my first practice run. It was all

true, within 20 to 40 minutes, depending on

the state of the denture, one can achieve

very good results, which are very close to

professional cleaning in the laboratory. It is

ideal for cleaning the dentures at the same

time as the professional oral prophylaxis

and be able to send the patient away with

completely clean teeth.

It is fair to say that now, approximately 80% of

denture cleaning is done in the practice. The

unit is now well and truly integrated within

the daily practice routine and works reliably.

FOLLOW UP

We see the dentures again, which were

cleaned a few months ago. There are no

increased deposits on the dentures that

indicate any micro-abrasion that may have

occurred. In the meantime, patients with

heavily discoloured dentures due to smoking

have spoken to us and asked directly for the

denture cleaning service.

The plan to use the device for regular

cleaning of the dentures from retirement

home residents is currently still failing due to

logistics. There is a need, but whether this will

be paid for remains to be seen.

A year has passed. With the exception

of new patients, there are hardly any

dentures requiring significant and

therefore longer cleaning times of more

than 20 minutes.

CONCLUSION

Denture cleaning only takes less than 20

minutes and can be easily carried out

during half a professional tooth cleaning

session. I would say the introduction of

the SYMPRO Denture Cleaning system

into my dental office has been a great

success. DA

About the author

Dr Christopher

Tuxford studied

dentistry in

Heidelberg,

Germany (1996

to 2001), after

completing his

professional training as a dental

technician. He has been working

as a dentist since 2002, initially as

an assistant dentist. At present, Dr

Tuxford now runs his own dental

office in Linkenheim-Hochstetten,

Germany, since 2006. As a dental

technician and dentist, he focuses

his work on prosthodontics, aesthetic

and conservative dentistry.

DENTAL ASIA NOVEMBER / DECEMBER 2021 61


Behind the Scenes

Best strategies to jumpstart

digital orthodontics

There is no way around it: the future of orthodontics is inevitably

digital. With cutting-edge digital solutions for digital impressions,

treatment planning, design, and 3D printing, what was once

prohibitively expensive is now accessible, transforming thousands

of orthodontic practices worldwide.

As CAD/CAM technology continues to replace

traditional workflows and become the standard

of care, digital solutions have become a

necessary consideration for any orthodontic

practice or laboratory for the following:

• High quality and precision: No two

orthodontic treatments are the same.

Achieving consistent, high-quality and

affordable orthodontic products with so

many potential sources of error is incredibly

difficult. Fully digital orthodontic treatments

reduce the risks and uncertainties caused by

human factors, providing higher consistency,

accuracy, and precision at every stage of the

workflow.

• Improved efficiency: In terms of time

and cost savings, digital orthodontics

can be a no-nonsense business choice,

improving efficiency in clinical procedures

and streamlining workflows. For instance,

fast and efficient impression taking with 3D

intraoral scanners reduces chair time, provides

instant feedback and omits manual errors like

voids, bubbles, or tears, reducing the need for

secondary or duplicate impressions.

• Better patient experience and

outcomes: Quicker appointments, more

comfortable treatments, and better, faster

results can be accomplished. A satisfied

patient is more likely to return and recommend

a clinic to others, contributing to the long-term

success of any orthodontic business.

THE DIGITAL DENTISTRY WORKFLOW

While the design of different orthodontic

treatments varies depending on the

application, they all follow the same basic

workflow:

1. Scan (Fig. 1): 3D intraoral scanners can

be used to capture scans digitally from the

patient, replacing manual impressions with

fast, accurate, digital impressions. Alternatively,

desktop optical scanners, typically used by

dental and orthodontic labs, can be used to

scan traditional impressions or plaster models.

62

DENTAL ASIA NOVEMBER / DECEMBER 2021


Behind the Scenes

2. Plan and design (Fig. 2): After scanning,

patients’ digital impression is imported into

orthodontic CAD software for planning

treatments. For simple diagnostic models,

users can also convert intraoral 3D scan

files directly into printable models such as

in PreForm, Formlabs’ print-preparation

software. Most software packages use design

processes similar to traditional workflows,

employing highly visual interfaces. After

the treatments are designed, models can

be exported for manufacturing. If a remake

is needed, the same digital design can be

reused without additional effort.

Fig. 1

3. Manufacture (Fig. 3): 3D models are

uploaded to the CAM or print-preparation

software and then sent to a 3D printer or

a milling machine. They work by solidifying

parts layer by layer to form the shape of the

appliances and models.

With the traditional workflow, the practice

takes a physical impression of the patient

and ships it to a lab that creates the required

models or other indications. The lab then

ships back to the practice for the treatment.

In digital workflows, the individual steps can

alternate easily between lab and practice,

depending on the complexity of the case,

indication and tools available at a practice.

Fig. 2

Thus, digital technologies simplify the

process, improve communication and make

interactions nearly instantaneous between

the practice and lab (Fig. 4).

DENTAL AND ORTHODONTIC 3D

PRINTING TECHNOLOGIES

Additive manufacturing is the latest piece

of the workflow in digital orthodontics that

has become a logical business choice for

orthodontic practices and labs, combining

high quality with low costs and streamlined

processes. The market has been expanding

rapidly, bringing this technology within reach

for more businesses.

Today, two 3D printing technologies are

common in orthodontics: stereolithography

(SLA) and digital light processing (DLP).

Fig. 3

Fig. 3

Fig. 1: 3D intraoral scanners capture

scans digitally from the patient

Fig. 2: Digital design results in easier,

more precise treatments and simplified

communication

Fig. 3: 3D models are uploaded to the

CAM or print-preparation software and

then sent to a 3D printer or a milling

machine

Fig. 4: The digital orthodontics workflow

can move back and forth between

practice and lab, increasing efficiency

and collaboration

In SLA, a vat of liquid resin is selectively

exposed to a laser beam across the print

area, solidifying resin in specific areas. Low

Fig. 4

DENTAL ASIA NOVEMBER / DECEMBER 2021 63


Behind the Scenes

For example, the Form 3B LFS 3D printer can

produce a single orthodontic model in about

20 minutes with Draft Resin and eight models

per print in approximately one hour, while the

large build volume of the printer also allows

users to produce up to 18 models at once

for overnight “lights out” production. The

Form 3BL, Formlabs’ large-format dental and

orthodontic 3D printer, can produce up to 52

models per print.

Fig. 5: The most common dental and orthodontic 3D printers work by selectively exposing liquid

resin to a light source — SLA and LFS a laser, DLP a projector— to form very thin solid layers of

plastic that stack up to create a solid object

Force Stereolithography (LFS) technology,

used by Formlabs’ Form 3B 3D printer, is the

next phase in SLA 3D printing that reduces

the strain created on a part when peeling it

from the resin tank between layers, producing

parts with unmatched surface finish, clarity,

and accuracy.

DLP operates with the same chemical process

as SLA and LFS, but uses a digital projector as

a light source to solidify the resin rather than

a laser.

SLA, LFS and DLP 3D printers work similarly

— the differences in print quality, workflow,

available materials, costs, and other factors

are bigger from machine to machine more

than technology to technology (Fig. 5).

HOW TO EVALUATE ORTHODONTIC 3D

PRINTING SOLUTIONS

Accuracy and precision: Guaranteeing

high-quality, accurate, final parts is the

most important concern for any orthodontic

practice. Unfortunately, not all 3D printers

marketed for dentistry or orthodontics can

deliver the quality, precision, and accuracy

needed for orthodontic applications.

Additionally, comparing different 3D printing

solutions goes beyond looking at technical

spec sheets.

Fundamentally, accuracy and precision

depend on many different factors: the quality

of the 3D printer, the 3D printing process,

materials, software settings, post-processing,

and how well-calibrated all of these systems

are, so a 3D printer can only be judged on its

final printed parts.

Users must always evaluate accuracy studies

with real scan data of printed parts; or better

yet, ask for a free sample part or a custom

sample of their own design to check the fit

or measure themselves against the original

design.

Speed and productivity: When thinking

about speed in 3D printing, it is important to

consider not just raw print speed, but also

the overall productivity of an orthodontic 3D

printer. Raw print speed for SLA, LFS and

DLP 3D printers is comparable in general. As

the projector exposes each entire layer all at

once, print speed in DLP 3D printing is uniform

and only depends on the height of the parts,

whereas SLA and LFS 3D printers draw out

each part with a laser. As a rule of thumb,

this results in SLA and LFS 3D printers being

comparable or faster when printing a single

part or smaller parts, while DLP 3D printers are

faster to print multiple parts that fill up much of

the platform.

However, there is a trade-off between

resolution and build volume for DLP printers: a

small DLP 3D printer might be able to print fast,

but users can only fit a few models on the build

platform. A different machine with a larger build

volume might be able to print more parts, but

only at a lower resolution, which means that

it might not be accurate enough for printing

indications that require higher accuracy.

SLA and LFS 3D printers can produce all

of these options in one machine and offer

orthodontic practices the freedom to decide

whether they want to optimise for resolution,

speed, or throughput, depending on the case.

Ease of use: Another important

consideration is the ease of using a 3D

printer, as users should know how to use the

equipment and maintain it on a daily basis.

Practices can get a sense of the learning

curve that will come with a new 3D printer by

watching videos online, visiting a trade show,

contacting sales teams, or asking colleagues

about their experience.

It is also critical to consider the types of

everyday interactions and maintenance the

printer will need once it is up and running.

For example, automatic resin dispensing on

Formlabs SLA and LFS 3D printers means

that users never need to worry about running

out of material (Fig. 6).

Costs and return on investment: When

adopting a new technology, it needs to

make sense for the business. The cost

of orthodontic 3D printers has dropped

significantly since early days and the systems

on the market today offer the lowest costs for

many applications.

Fig. 6: Modern 3D printers, like the Form

3B, are designed intuitively so that any

orthodontic lab or practice can get familiar

with the process easily

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DENTAL ASIA NOVEMBER / DECEMBER 2021


Behind the Scenes

For example, a practice printing models to

produce thermoformed aligners in-house can

often reduce costs by 80% for each treatment

compared to outsourcing to labs or service

providers — enough to pay for a 3D printer in a

few months and save many times its price tag

over the years.

When comparing different 3D printing

solutions, remember to consider:

• Upfront costs, including not just the

machine cost, but also training, setup, and

potentially software

• Running costs, best estimated with per-part

material costs

• Service and maintenance costs

Materials and applications: Professional 3D

printers are some of the most versatile tools

found today in orthodontic practices and labs,

and the key to their versatility is dedicated

materials. Formlabs 3D printers can produce

a variety of orthodontic indications, including

models for thermoforming aligners and

retainers, diagnostic models, splints, indirect

bonding trays, and more.

Some 3D printers work only with proprietary

materials, where options are limited to the

offerings of the printer manufacturer. Others

have an open system, and can use materials

made by third-party manufacturers.

However, when using third-party materials, it

is important to ensure that the results achieve

clinically acceptable quality and accuracy.

Furthermore, using biocompatible materials

on non-validated 3D printers that claim to

be “open” breaks the usage requirements

and thus will produce non-biocompatible

appliances. It is vital to know the risk that

the practice takes by using non-validated 3D

printers and materials.

products to 3D print because they do not

require a third-party design software to

prepare a digital impression for printing.

For instance, Formlabs Dental 3D printer

customers can use the Scan to Model feature

in PreForm to turn their digital impressions

into physical models for free.

Once simple models and retainer fabrication

were mastered, expanding to clear aligners

is only a matter of adding the treatment

planning component. After aligners, users

can also expand to other indications using

the same 3D printer, like indirect bonding

trays, occlusal guards, or even direct-printed

brackets.

Define and test a digital workflow: With

a specific application in mind, piece together

the complete step-by-step digital workflow

for that application, ensuring that all the

pieces needed for scanning, design, and

manufacturing are understood.

First, consider whether it makes sense to

invest in an intraoral scanner for the practice

or it will be better to send stone models or

physical impressions to the lab for scanning.

For designing parts in-house, ensure to

get a demonstration of the workflow of any

design software to understand the stepby-step

process before adopting it. Then,

select a software package compatible with

the scanning and manufacturing equipment

according to preference.

When considering different 3D printers,

always source samples before buying

equipment. Technical data and marketing

specs can be misleading and hard to

decipher. Instead of comparing sales

brochures, compare actual parts — do not

hesitate to ask for a physical sample.

ever before and affordable machines enable

users to add capacity as needed.

GET STARTED WITH DIGITAL

ORTHODONTICS AND 3D PRINTING

With thousands of orthodontic practices

and labs already adopting digital workflows,

there has never been a better time to start

exploring how to take advantage of new

technology in the business. While 3D printers

were only affordable to the largest dental and

orthodontic labs and milling centres a few

years ago, they are now a common sight in

orthodontic practices and labs (Fig. 8).

Consider the factors discussed above and the

needs of the practice, some solutions might

suit some businesses better than others.

Ensure to do research, evaluate actual parts,

and avoid paying a hefty premium. DA

Fig. 7: An in-house 3D printer empowers users

to create advanced applications like indirect

bonding trays

Manufacturers release new materials on a

regular basis, so there is a good chance the

printer bought today will become capable of

creating an increasing variety of orthodontic

products in the near future.

HOW TO IMPLEMENT DIGITAL

WORKFLOWS IN AN ORTHODONTIC

PRACTICE OR LAB

Pick an application: Simple models are

the best place to start. These are the easiest

Start small and scale up: To start, trial the

workflow for a few weeks before going to

full production, leaving time to learn each

step and iron out any wrinkles. As the user

gets comfortable with the results, it is time

to switch the workflow fully to digital, and

start scaling up. In digital workflows, scaling

up is a simple matter of adding scanning,

design, or production capacity, depending on

where bottlenecks appear (Fig. 7). Desktop 3D

printers offer more production flexibility than

Fig. 8: Manufacturing thermoformed appliances

like clear retainers and aligners over 3D printed

orthodontic models is fast and affordable

DENTAL ASIA NOVEMBER / DECEMBER 2021 65


In Depth With

Advancing oral prophylaxis

Mectron has launched ultrasound inserts specially designed for

gentle and effective removal of supra- and subgingival biofilm as

well as for safe periodontal debridement.

PERIO P3: THE FULL SCOPE

MAINTENANCE INSERT

Perio P3 is indicated for the removal of supraand

subgingival biofilm. Its slim shape allows

easy access in deep periodontal pockets and

interproximal spaces in all the quadrants.

Thanks to its remarkable linear movement,

it is minimally invasive for the soft tissues

and root cementum. Hence, it is ideal for

preserving the epithelium.

It is best utilised for interproximal and

subgingival cleaning. It effectively removes

extrinsic stains too.

Perio P3 gives the clinician an optimal

intraoperative control and a secure feeling

while working interproximally, supra- and

subgingivally.

With its Soft Mode function which

reduces the amplitude of the ultrasound

oscillations and allows the insert to

move gently and efficiently, it is highly

recommended for sensitive patients

for a more pleasant and comfortable

treatment.

PERIO ANATOMIC INSERTS P15,

P16R, P16L FOR FULL MOUTH

PERIODONTAL TREATMENT

Perio anatomic inserts P15, P16R,

P16L are indicated for periodontal

debridement. The inserts guarantee

maximum efficacy without risk of injury to

the soft tissues and periodontal ligament.

Its shape allows optimal access to hardto-reach

areas, characterised by deep

periodontal pockets such as furcations,

root surfaces, and concavities, thereby

preserving epithelial tissue and promotes

new attachment formation.

Additionally, the cavitation effect allows

for mechanical biofilm disruption, bacteria

dispersion, and periodontal pockets

detoxification.

The inserts in detail:

P15: Recommended for the debridement

of deep periodontal pockets. Easy access

to canine and anterior teeth. Replaces

manual curettes n° 1-2, 3-4, 5-6, 7-8

P16R – P16L: Recommended for supraand

subgingival interproximal spaces and

an efficient root planing on molars and

premolars. Replace manual curettes n°

11-12, 13-14, 15-16, 17-18 DA

Perio P3 for interproximal and

subgingival cleaning

P15: Universal curette for supra- and

subgingival treatment

P16R – P16L: angled periodontal curettes for

subgingival concrement and biofilm removal

from furcations and deep pockets

66

DENTAL ASIA NOVEMBER / DECEMBER 2021


Rolence Enterprise:

Commitment to quality and

added value

In Depth With

Rolence Enterprise Inc. has been highly

devoted to the research, development, and

manufacturing of high-quality equipment

for dental professionals for over 40 years.

Their factory has been awarded Taiwan’s

GMP of excellence. All of their products

are extremely high quality and efficient.

They also supply ODM dental products,

OEM design, and development with their

professional expertise.

The company is always actively engaged

in product research, development and

innovation. Not only have they achieved an

excellent outcome in innovating curing light

technology, but they are also continuously

developing new high-tech products.

Rolence Enterprise is are fully fully committed

to continuing their innovative research

and development in advanced dental

technology, and to vigorously improve

the worldwide competitiveness of their

products. All Rolence products have been

awarded ISO 13485:2016 certification and

meet FDA, CE standards, besides, their

current products chain are distributed

through a worldwide network of partners

in the United States, Europe, Japan, India,

China, Middle East and others.

Rolence always carefully examines their

customers’ needs and adapts their products

to real world demands. The key ingredient

to their success has been, and will always

be, their commitment to quality and added

value. They look forward to offering this

commitment to their customers.

Rolence Enterprise is the partner that every

dental professional can trust. Head on to

www.rolence.com.tw for more information. DA

X-Ray Series

Magneto Scaler Systems

Portable X-RAY

Large capacity battery of Panasonic able to take more than 1000 shots after fully charged.

Latest TOSHIBA X-RAY Tube specifically for Portable X-ray.

Unique double scatted shield provide extremly low dose during operation.

MS-1

LAB Curing Box Series

Digital Sensor

Extremely durable cable passed 70,000+ bending test

Exchangeable cable easily replaced.

Up to 50,000 shots with no quality loss.

Theoretical 33/lp in high resolution

Tray-LED

LQ-BOX





DENTAL ASIA NOVEMBER / DECEMBER 2021 67


In Depth With

Silicone hoses with spray

water flow adjustment

Reducing aerosols in dental clinics has become a priority in today’s

practice with the current pandemic threat. With TeKne Dental’s silicone

hoses, clinicians can finely adjust the spray water level from their

handpieces to minimise potential contamination from the COVID-19 virus.

Aerosol-generating procedures carry

exposure risks that are almost inevitable in

dental practices. Hence, with the pandemic

threat, it has become a priority for dental

professionals to reduce their exposure and

potential contamination.

TeKne Dental (TKD), an independent Italian

manufacturer of dental handpieces, offers

silicone hoses with adjustable spray water

level to aid dental professionals in minimising

exposure to harmful aerosols. Exporting their

products worldwide, the company offers four

types of silicone hoses:

• Pneumatic: A wide range of pneumatic

straight silicone hoses is available for

turbines, air micromotors and scalers. Sizes

of the internal polyurethane tubing have

been optimised to get the best performance

of the attached instrument and minimise the

kinking effect of sharp bends.

• Electric: A wide range of straight silicone

hoses is available for supply of electric

micromotors, piezo-electric scalers and

curing lamps. The electric contacts are goldplated

and crimped according to a precise

standard to guarantee the best electric

connection. All electric wires are extraflexible

and adequately sized to the passing

current, and are insulated with a special

oil-resistant material.

• Swivelling: Straight silicone hoses with

540° (270° clockwise, 270° anti-clockwise)

swivelling connection are available for

pneumatic instruments and electric

micromotors.

• Multifunction: There is a range of straight

silicone hoses with a special multi-function

connection on the unit side. This special

connection permits to manufacture dental

units with easily detachable hoses. Four

pneumatic ways and up to 11 electric ways are

available on each multi-function connection.

Multifunction silicone hoses come only in grey

with special connectors suitable for use with

KaVo, Anthos, Stern Weber, Castellini dental

units.

Pneumatic, electric, and swivelling hoses

feature a silicone sheath and the connectors

can be easily and safely cleaned with any

commercial cleansers. Nuts and sleeves are

chrome-plated and specially stained to reduce

uncomfortable surface glare.

In addition, the internal tubing is extruded in

a controlled environment without added latex

and phthalates, meeting main food regulations

(Directive 2002/72/EC and FDA standard)

and therefore comply with Directive 2007/47/

EC. The inner waterline tubing can also be

extruded with an antimicrobial additive on

special request to prevent the proliferation

of bacteria on the inner surface. DA

68

DENTAL ASIA NOVEMBER / DECEMBER 2021


User Report

DENTAL ASIA NOVEMBER / DECEMBER 2021 69


Product Highlights

Meyer

Meyer Dental CBCT 3D PRO: Smart all-in-one tailored for

professional needs

The Meyer extraoral 3D PRO CBCT

system collects complete oral data in

one scan and reconstructs all aspects

of high-resolution images as needed for

accurate clinical diagnostics. The resulting

3D images and analytical data provide

essential basis for dental filling, implant,

and orthodontics. The device is fully

upgradable to include the cephalometric

device with acquisition modes including

CBCT, Pano, Ceph, Part CT, and model

scanning.

Offering multiple FOV (field of view)

configurations, the advanced algorithms

of 3D PRO integrate with advanced

hardware technology to achieve higher

quality, closer-to-reality images, providing

dentists with more accurate clinical

information for diagnosis.

In addition,

the patented

hybrid pulsed

X-ray source

technology enables lower dose

radiation, while allowing accurate

diagnosis with high-definition

images. The X-ray dose can be

adjusted according to the patient

age and physique to minimise

radiation exposure.

With self-built mass data of clinical

images, 3D PRO overturns the traditional

iterative reconstruction algorithm by its

image reconstruction technology that has

greatly enhanced computing capacity.

The instantaneously reconstructed mass

images have also significantly saved the

waiting time.

ROBUST DIAGNOSTIC

SOFTWARE

Meyer’s MyDent Viewer 3D diagnostic

software implements advanced

software engineering through modular

design, with functional modules

including multiplanar reconstruction,

curved surface reconstruction, implant

simulation, TMJ modelling, and 3D

orthodontic simulation.

Functions associated with various

modules also include 3D panoramic

view, 3D positioning, automatic neural

tube labelling, and bone density

measurements. ■

The machine is now available in

Singapore under A2Z Dental & Medical

Supplies and Oracare Group.

W&H

The breakthrough in oral surgery

The Implantmed Plus is now a true allrounder

thanks to the new Piezomed on hand in a compact and space-saving

as users always have the right device

module from W&H. The new module can form. The modular system’s standardised

also be retrofitted to the implantology motor operation simplifies the practice team’s

easily and affordably, combining piezo daily workflows. In addition, only one

surgery and implantology in one device. irrigation tubing and one saline solution are

This, coupled with the implant stability required, enabling optimised handling.

measurement and documentation features,

makes W&H the first manufacturer to cover With the Piezomed Plus and Piezomed

the entire surgical workflow. Oral surgeons Classic, W&H has two module versions

can look forward to discovering a new world available to meet all piezo surgery

of treatment possibilities.

requirements in practice, whether for

day-to-day or intensive use including easy

The Piezomed module simplifies the

operation, patented automatic instrument

processes in oral surgery and implantology, detection, precise cutting performance and

optimal cooling of the treatment site from a

special spray design.

SURGICAL WORKFLOW REDEFINED

The combination of Implantmed Plus

and Piezomed module changes working

methods in oral surgery and implantology.

All products and functionalities that

come with the new modular system

are fully tailored to the user’s workflow:

W&H’s surgical contra-angle handpieces

allow procedures to be performed with

unrivalled precision, while the wireless

foot control ensures greater comfort and

freedom of movement.

The Osstell Beacon for measuring the

implant stability provides certainty in

assessing the correct loading time for an

implant. Comprehensive documentation

guarantees full traceability. The easy addon

ensures seamless transition between

the two technologies, representing a real

step forward. Implantology and piezo

surgery combined in a single unit – a true

breakthrough in every respect. ■

70

DENTAL ASIA NOVEMBER / DECEMBER 2021


COLTENE

Great on their own,

inseparable in a team

SOLOCEM®

SoloCem® is a resin cement for almost all indirect luting

indications, such as cementing crowns and bridges, root posts,

inlays and onlays on tooth structure or implant abutments.

Depending on the situation, SoloCem can be used either selfadhesively

or adhesively, in combination with ONE COAT 7

UNIVERSAL.

SoloCem offers aesthetically pleasing luting due to its fluorescent

properties. The fillings remain invisible under special lighting

conditions, such as black light in a nightclub. Available in three

shades – Dentin, Trans, and White Opaque – it virtually matches the

natural tooth shade, and offers good colour stability and resistance

to foods with a strong discolouration effect to achieve perfect

integration.

A safe luting for universal use, SoloCem results in long-lasting

restorations. With SoloCem’s simple and straightforward range,

clinicians can avoid marginal gaps from low shrinkage and

streamline their procedures.

Product Highlights

→ THE EVOLUTION

OF PROPHYLAXIS

COMBI touch

→ AIR-POLISHING AND

ULTRASOUND IN ONE UNIT

→ 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

ONE COAT 7 UNIVERSAL

ONE COAT 7 UNIVERSAL is a light-cured, one-component bonding

agent used with the self-etching, selectively etching or total etch

technique for adhesive restoration.

It features a low-evaporation formula; nanofilled technology,

delivering a homogenous bond layer and improves mechanical

properties; an outstanding shear bond strength; and superior

marginal integrity with low risk of marginal sensitivity.

ONE COAT 7 UNIVERSAL is proven to be antibacterial by the Quality

Labs (Germany) after conducting a proliferation assay for testing

the antimicrobial activity with S. epidermidis.

Available in a user-friendly bottle or single dose, ONE COAT 7

UNIVERSAL can be used as an adhesive attachment of composite

materials and compomers on enamel and dentine; ceramic and

composite restorations to enamel and dentin; composite material

on ceramic, composite material, metal and amalgam; and dentin

sealing.

The application techniques include:

• Self-etch: ONE COAT 7 UNIVERSAL is

applied on enamel and dentin

• Selective-etch: Enamel is

etched, ONE COAT 7 UNIVERSAL

is applied on enamel and dentin

• Total-etch: Enamel and dentine

is etched, ONE COAT 7 UNIVERSAL is

applied on enamel and dentin. ■

→ www.mectron.com

DENTAL ASIA NOVEMBER/ DECEMBER 2021 71

ad_ct_dental_asia_95x250_en_201210.indd 1 10.12.20 14:42


Product Highlights

Dentsply Sirona

Performance unlimited with ProTaper Ultimate

With ProTaper Ultimate, Dentsply Sirona and uninstrumentable portion of the root

has introduced a technologically driven, canal space, utilising the novel SmartLite

fourth generation system. The treatment Pro EndoActivator, which will be launched

concept is based on three pillars: shaping, soon.

3D cleaning, and filling root canal systems

while the standard sequence of the shaping The SmartLite Pro platform offers three

pillar includes three file types: slider, shaper attachments: the SmartLite Pro curing light,

and finishers. These feature-specific files the transilluminator, and the EndoActivator.

are designed to safely prepare a full range Finally, the obturation pillar enables dentists

of endodontic anatomy. Novel auxiliary files to successfully fill and seal the root canal

are available for larger and straighter canals system thanks to predictable shaping and

and all files are available to prepare canals cleaning.

mechanically and/or manually.

The ProTaper Ultimate Solution also

The ProTaper Ultimate Solution offers

includes dedicated gutta-percha master

extensive options. The cleaning pillar is cones based on the unique Conform Fit

focussed on eliminating pulp, bacteria, concept and technology. Jointly used with

debris, and breaking down products

a Conform Fit gutta-percha master cone,

when present. To facilitate cleaning, a the new AH Plus Bioceramic Sealer will help

highly flexible, polymer canula with a bifid ensure filling root canal systems where the

apical flow channel can safely deliver

sealer bonds to the cleaned dentin walls to

irrigant deep into the apical portion of ensure healing.

the preparation. With a fluid-filled canal,

a reagent of the clinician’s choice can be “From its inception so many years ago,

exchanged into both the instrumentable our thinking has always been continuous

improvement,” said Dr Clifford Ruddle,

endodontist and one of the inventors of

ProTaper Ultimate from Santa Barbara,

United States. “ProTaper Ultimate has

been designed to provide confidence and

predictability for the clinician and patient

alike. This comprehensive file system

balances safety and efficiency when

preparing canals that range from easy

and straightforward, to large and open, or

that exhibit challenging curvatures and

recurvatures.” ■

VITA

Bringing colour and character to hybrid ceramic, composites and

polymers

The light-curing composite stain system VITA

AKZENT LC brings colour and character to

the digital workflow. Monolithic restorations

made of hybrid ceramic, composites or

polymers are growing increasingly popular as

a straightforward and economical all-ceramic

alternative.

With 14 multi-faceted effect stains, VITA

AKZENT LC breathes new life into these types

of restorations with natural stain effects. With

four glazing chroma stains, shade adjustments

can be made within a shade group in

VITA classical A1-D4 and in VITA SYSTEM

3D-MASTER, if required.

VITA AKZENT LC GLAZE provides the final

surface sealing. The external and internal stain

system can also be used in the same way in

combination with veneering composites and

ready-made teeth. ■

72

DENTAL ASIA NOVEMBER / DECEMBER 2021


ONE-COMPONENT LIGHT-CURED UNIVERSAL ADHESIVE

Product Highlights

ONE COAT 7 UNIVERSAL

The bond for all situations

The light-curing ONE COAT 7 UNIVERSAL is the only bond you

need for direct and indirect filling therapy in your practice. No

priming, no silanising – just apply, disperse with air and cure –

finished.

up to 300

applications

per bottle

https://www.facebook.com/COLTENE.AsiaPacific

006957 09.21

DENTAL ASIA NOVEMBER/ DECEMBER 2021 73


Product Highlights

Ivoclar Vivadent

Ideal solution for the efficient and gentle cleaning and polishing of

teeth

Systematic and professional cleaning and

polishing of teeth, restorations and implants

are standard treatments for preventing

caries, periodontal and peri-implant

diseases. Smooth, clean and polished dental

surfaces offer few possibilities for bacteria

and plaque to accumulate. Apart from

promoting oral health, professional oral care

enhances pink and white aesthetics, making

the teeth and gums look their best.

The new Proxyt Single Dose pastes from

Ivoclar Vivadent have been developed with

the aim of ensuring the efficient and effective

cleaning and polishing of natural teeth,

dental restorations and implants. They help

keep teeth and restorations in impeccable

condition and maintain their natural-looking

and aesthetic shine.

The Single Dose cups can be inserted into

the corresponding prophy ring with ease.

The unique formula and smooth consistency,

as well as the easy-rinse properties, allow

plaque and tartar to be removed quickly and

effectively and the surfaces to be polished to

a high lustre. Furthermore, the Proxyt pastes

adhere well to the teeth and instruments,

making handling easy. All these features

combined speed up the treatment process

considerably. Moreover, the pastes do not

splatter or create a mess.

Customers can choose between two new

Proxyt Single Dose paste options: fine and

coarse. This helps to avoid unnecessary

wear or abrasion of the tooth structure,

restorations, implants or other prosthodontic

appliances. Patients who have implants

require special attention. Since they need

professional teeth cleaning at regular

intervals, the treatment they receive must be

gentle and comfortable.

Proxyt fine is a pumice-free polishing paste

that is exceptionally kind to sensitive fillings

and tooth structure, such as dentin and

dental enamel; as well as the surfaces of

high-quality composite resin and ceramic

restorations, for example, IPS e.max from

Ivoclar Vivadent. Proxyt fine is effective,

gentle and minimally abrasive. It is suitable

for restorations and implants. Furthermore,

it is kind to sensitive gum tissue. The

Proxyt pastes from Ivoclar Vivadent contain

xylitol, which disturbs the metabolism of

cariogenic bacteria.

Available in mild mint flavour leaving a

clean and fresh feeling in the mouth, Proxyt

pastes is also 100% gluten and lactose

free. A packet contains 1.8g, including an

adjustable prophy ring into which the cups

can be effortlessly inserted. ■

Amann Girrbach

The gold standard for precisely fitting dentures

The key to a perfect restoration is based The Artex CR universal diagnostic and

on flawless model management. Amann therapeutic device in Arcon design

Girrbach offers specifically developed features a reproducible centric system

and perfectly coordinated premium

that ensures a safe start and end position

solutions for every single work step in of each patient movement. Defects of less

the process chain – for both digital and than 20µm can be detected, controlled

classical workflows. This enables efficiency and eliminated with the Artex articulator.

from model fabrication to analysis of

the finished model in the articulator,

The Artex is lightweight, stable, ergonomic

preventing inaccuracies from sneaking in. and highly precise – features which

simplify and speed up working on the

Working with the articulator is

model. This drastically reduces errors and

indispensable for maximum fit accuracy saves on material and labour costs in the

of the denture in the classic analogue laboratory and dental practice. Therefore,

workflow. In this context, the Artex system not only the patient benefits from a

is an effective tool for the laboratory perfectly fitting restoration.

and dental practice to record static oral

situations with maximum precision and Amann Girrbach now presents the special

simulate jaw movements 1:1.

edition Artex CR Gold, limited to 1000

units. The carbon gold-look of the

articulators is symbolic of the Artex

premium quality and its status as the

most widely used chewing simulator

in the world. ■

74

DENTAL ASIA NOVEMBER / DECEMBER 2021


Show Review

Don Casey, chief executive officer of Dentsply Sirona

Dentsply Sirona World 2021: The

highly anticipated return of the

Ultimate Dental Experience

Keeping with the company’s commitment to

empowering dental professionals, Dentsply

Sirona hosted its annual Dentsply Sirona

World 2021 from 23 to 25 September 2021

with overwhelming success, connecting more

than 7,000 world-leading experts, industry

leaders, dental practitioners, students and

more in one memorable hybrid event.

“The past 18 months have pushed the dental

industry to new heights and challenges.

Dentsply Sirona World is our special way to

connect with an ever-growing community of

practitioners, elevate the future of dentistry

and celebrate as a community together,” said

Don Casey, chief executive officer of Dentsply

Sirona. “On behalf of Dentsply Sirona, we

would like to thank all participants and

partners who enabled us to come and learn

together how to better serve patients and

bring them healthier smiles.”

Guests were given the option to join this

year’s Dentsply Sirona World (DS World)

either in person at Caesars Forum in Las

Vegas, Nevada, United States, or virtually via

livestreams and special digital programming.

To ensure the health and safety of DS World

attendees, exhibitors, vendors and staff

present onsite, the company established

a health and safety protocol that aligned

with state and local mandates as well as

requirements of the venues.

GROUND-BREAKING TECHNOLOGY

AND SUSTAINABILITY GOALS

RELEASED

Dentsply Sirona kickstarted the three-day fest

with its most notable product and corporate

announcements of the year. The theme of DS

World 2021 was to “connect”, focussing not

only on the human connection of smiles and

coming together again after more than a year

apart, but also the power of the connected

workflows of Dentsply Sirona.

In front of thousands of participants from

across the dental community, Dentsply

Sirona announced the re-launch of their

Implant Business to focus on integrating

innovative technologies with quality and

reliability. It offers clinicians connected,

seamless workflows that enable dental

professionals to take full advantage of digital

dentistry and conduct more accurate and

efficient procedures, resulting in excellent

patient outcomes.

This was marked by a comprehensive

restage of the company’s Implant

Business, including three signature

workflows to provide dental professionals

with a completely new way of practicing

implantology and the unveiling of DS

76

DENTAL ASIA NOVEMBER / DECEMBER 2021


Our dental implants have

an outstanding survival rate

98%

Show Review

With maintained marginal

bone after 5 years

0.3 mm

Great today

and even better

tomorrow.

Thanks to

science.

After 30 years of research and more

than 1,000 scientific publications, we can

confidently say that Astra Tech Implant

System® EV delivers life-long function and

natural esthetics.

Thanks to science, our implants have an

outstanding survival rate and a marginal

bone maintenance far better than the

industry standard.

If you are looking for endless possibilities and

superior outcomes, this is the only system you

need. Today and tomorrow.

Follow Dentsply Sirona Implants

for the latest in implant dentistry

dentsplysirona.com/implants


Show Review

PrimeTaper, a self-tapping implant with a

tapered design that can be inserted with

ease.

Other notable product announcements

included:

• A series of updates to the SureSmile Aligner

Software, enhancing the user experience and

making treatment planning with SureSmile

easier than ever.

• The latest 5.2 upgrades to the Connect and

CEREC Software, providing users both new

and improved functionalities and even better

performance, making Primescan twice as

fast.

• The introduction of ProTaper Ultimate,

specifically designed for clinicians who

frequently perform endodontic procedures

and wish to expand the range of anatomical

treatment they provide their patients.

• Based on the validation of the Atlantis IO

FLO-S scanbody, Primescan is now the first

and only intraoral scanner validated for a full

digital workflow for full arch fixed implant

restorations with Atlantis suprastructures.

“After 18 months of being distanced from

colleagues during the COVID-19 pandemic,

it was extremely exciting to come together

with peers and continue learning how to offer

the best possible treatments to patients,”

said Dr Shivi Gupta, a dentist from San

Diego, California, US. “In this industry, it is so

important to remain current on new products

and technologies, and I am looking forward

to putting the noteworthy updates from

Dentsply Sirona to use in my practice as we

continue to innovate in digital dentistry.”

Beyond product updates, Dentsply Sirona

also announced its future-focused

sustainability strategy, coinciding with the

release of its inaugural Sustainability Report

(SASB-aligned) and including a five-year

partnership with Smile Train, the world’s

largest cleft-focused non-profit organisation.

13 educational tracks offering 159.5 hours of

educational content covering nearly every

area of dentistry. Other highlights included

an inspirational presentation by motivational

speaker and international best-selling author

Mel Robbins, whose most recent works

include The 5 Second Rule and The High 5

Habit.

Dentsply Sirona was also proud to enable

networking across the dental industry,

including among top female leaders in

dentistry. Women across dentistry gathered

for a dinner during DS World to honour their

important contributions to the field.

“I am thrilled to be here in person teaching

alongside many industry-leading experts

while continuing to deepen my knowledge

of the latest advancements in the dental

industry,” said Dr Dan Butterman, a dentist

from Centennial, Colorado, US. “It truly is a

different and more enriching experience to be

here in person, and I cannot wait to leverage

the new innovations announced at Dentsply

Sirona World in my practice.”

winning acts, including Gwen Stefani and

The Chainsmokers entertained onsite event

guests with their hit songs.

Additionally, early bird pricing for Dentsply

Sirona World 2022 Las Vegas from 15-17

September 2022 is already available. DA

Press conference speakers (from the left)

Don Casey, Dr Dan Buterman, Dr John West,

Dr Shivi Gupta, Dr Terri Dolan, and Marion

Par-Weixlberger

WORLD-CLASS EDUCATION

MIXED WITH CHART-TOPPING

ENTERTAINMENT

DS World is renowned for its first-class

educational programme in a unique modern

atmosphere. This year was no different as

inspiring leaders and experts in the dental

industry led more than 100 courses across

More than the educational activities, DS

World is also known for bringing today’s top

acts to close each day of the event, and this

year was no exception. On the first evening,

Emmy award-winning writer-comedian

John Mulaney kept the smiles and laughs

going with fresh jokes and witty stories. The

next two evenings major Grammy award-

78

DENTAL ASIA NOVEMBER / DECEMBER 2021


Show Preview

GC Corporation celebrates centennial

anniversary and welcomes dental professionals

to the Fifth International Dental Symposium

The origins of GC can be found in Tokyo,

Japan, where three young Japanese

chemists created the first standard cement

in 1921 that served as the stepping stone

to today’s one of the largest and most

successful dental materials companies

in the world.

Well-known for its high-performance

materials and an enduring ambition to

improve and promote oral health worldwide,

GC continues to develop materials and

equipment designed to give effective and

simple solutions to dental professionals.

Rejoicing its 100 years of history, GC

announced their Vision 2031 to all its

associates across the group of companies:

“To become the leading dental company

committed to realising a healthy and longliving

society”, on 11 February 2021.

President Kiyotaka Nakao, explained: “While

achieving sustainable growth, GC strives to

bring value in dental care to realise a healthy

long-living society. Instead of just seeking

to be the first in sales volume, the goal is to

become an ‘incomparable’ company for all

the stakeholders of GC.”

The celebrations continue in 2022, on

16 and 17 April, with GC hosting the Fifth

International Dental Symposium in Tokyo,

Japan.

With the overall theme of “Smile for the world

– beyond the century”, the event will bring

together over 100 prominent lecturers from

all over the world. In the programme, there

will be 28 sessions presenting advanced

insights on academic and dental practice

topics as well as relevant information on

improving oral health around the globe. From

one session to another, the participants will

be offered the opportunity to test the latest

GC products and equipment at the GC Dental

Show.

As a 100-year company, GC Corporation

encourages the entire organisation to realise

the challenge of becoming the world’s best

dental company that contributes to a healthy,

long-lived society, while being continuously

open to practitioners’ feedbacks. DA

To become the

leading dental

company committed

to realising a healthy

and long-living

society”

DENTAL ASIA NOVEMBER / DECEMBER 2021 79


Show Preview

Mectron Spring Meeting

2022: The appointment with

innovation

After the success of the first edition, Mectron

welcomes dental professionals to the Spring

Meeting 2022 on 6 and 7 May (Friday-

Saturday) in Venice, Italy. The scientific

programme is focused on the new REX

PiezoImplant, a revolutionary wedge-shaped

implant specifically developed to simplify the

surgical treatment of narrow ridges.

The second important topic involves a new

piezoelectric surgical protocol dedicated to

the third-molar extraction procedure, which

will make such an advanced technique safer

and faster in daily clinical practice.

Illustrious international and national

speakers will introduce different piezoelectric

surgical techniques such as: sinus lift by

crestal and lateral approach, peri-implantitis

therapy, bone augmentation procedures

and corticotomy-assisted orthodontics.

Each technique will be presented in detail

by the clinicians who developed them,

with particular attention to relevant clinical

protocols illustrated by a wide range of

clinical cases, arising from great experience

and continuous scientific research. This is an

innovative one-day chance to get the most

out of PIEZOSURGERY ® techniques in daily

practice.

PROGRAMME AT A GLANCE

Friday, 6 May 2022

Update in piezoelectric extraction techniques

(morning session):

• Germectomy

• Third molar extraction

• Root extractions with new piezoelectric

tools

Update in daily practice (afternoon

session):

• Sinus Lift procedures

• Periodontitis and peri-implantitis

procedures

• Corticotomy techniques

• Bone augmentation procedures

Saturday, 7 May 2022

REX PiezoImplant state of the art (morning

session):

• Advances in narrow ridges treatment

• Clinical outcome

• Digital workflow

• Clinical innovation and what is coming

next. DA

80

DENTAL ASIA NOVEMBER / DECEMBER 2021


Giving Back To Society

Dentsply Sirona announces five-year partnership agreement with

Smile Train and US$5 million donation

Globally, one in 700 babies are born with

a cleft lip and/or palate. Clefts can have

devastating effects on the quality of life

of a child by compromising the ability to

communicate and to eat properly, and

from social stigma resulting in feelings of

anxiety and a lack of self-confidence. A

child with a cleft requires more than just

surgery. Essential cleft care includes nutrition

programmes, dental and orthodontic care,

speech therapy, and social and emotional

support.

Smile Train’s sustainable model empowers

local medical professionals to provide free

cleft surgery and essential cleft care in their

own communities. Hence, Dentsply Sirona

has launched a partnership with Smile Train

to improve oral health globally and to build a

brighter, more sustainable future for children

and families affected by clefts worldwide.

The company goes beyond traditional

financial and equipment donations. The

Dentsply Sirona and Smile Train partnership

will advance the future of cleft care by:

• Supporting global treatment standards

and best practices for digitised cleft care

• Leveraging digital technologies to make

treatments more efficient and convenient

for children

• Providing high quality equipment to

develop state-of-the-art centres for cleft

treatment

• Making their entire online catalogue of

clinical education courses available to all

Smile Train oral health professionals

• Offering financial support for cleft

surgeries

The company is focused on making sure

that the benefits of Smile Train partnership

have a lasting impact. Therefore, in

addition to funding life-changing cleft

surgeries and providing free dental

equipment, the collaboration focuses on

global, oral healthcare training initiatives

to equip people in local communities with

the skills needed to provide treatment and

raise the standard of care to the highest

level through clinical education and the use

of cutting-edge technologies in the long

term.

Additionally, the partnership includes the

development of an International Smile Train

Scholars programme, which will support

in-person and virtual training, and learning

opportunities for Smile Train dental partners.

A group of 16 scholars attended DS World

2021, participating in clinical education

sessions and growing their professional

networks. ■

TePe expands its support for Pink Ribbon in favour of cancer

awareness and research

October has become known as the pink

month when companies and individuals

come together to raise awareness for

cancer. In 2020, TePe’s Pink Ribbon

initiatives was a success, resulting in

around 60,000 euros for cancer research

in Sweden and Finland. This year, the

TePe Group hopes for even better results

by extending its campaign collaboration

with cancer awareness organisations in

Europe and the United States.

and France, as well as distributors in

Greece, Ukraine, Portugal, and Serbia,

also participated in various Pink Ribbon

initiatives.

“We constantly work to raise awareness

of oral health and its connection to

general health. Since cancer research is so

important for global health development,

we are glad to support the Pink Ribbon

campaign as part of our sustainability

initiatives,” said Helena Ossmer Thedius,

director of Marketing and Innovation at

TePe. ■

In particular, the company has

expanded the Nordic collaborations

to include Denmark and Iceland, and

engaged several other markets across

the globe. TePe subsidiaries in Italy,

the Netherlands, the United States,

DENTAL ASIA NOVEMBER/ DECEMBER 2021 81


EVENTS CALENDAR

NOVEMBER

3 – 6 DenTech China 2021

Shanghai, China

Venue: Shanghai World Expo Exhibition and

Convention Centre

https://www.dentech.com.cn/en-us/index

5 (Virtual) Dental Technician International

Meeting 2021

https://www.cappmea.com/dtim-2021

11 – 14 (Virtual) 16 th CAD/CAM & Digital Dentistry

Conference

www.cappmea.com/digital-dentistry

18 – 21 (Virtual) 13 th Dental Facial Cosmetic Conference

https://cappmea.com/aesthetic-dentistry

19– 20 (Virtual) DICE 2021Dental International Congress

and Exhibition

https://cappmea.com/aesthetic-dentistry

24 – 26 IndoHealthcare Expo 2021

Jakarta, Indonesia

Venue: JIExpo Kemayoran

https://indohealthcareexpo.com

26 (Virtual) Digital Orthodontics Symposium 2021

https://cappmea.com/digital-ortho-2021

26 (Virtual) Dental Hygienist Seminar 2021

https://cappmea.com/dhs-2021

28- 1Dec 97 th Greater New York Dental Meeting 2021

DECEMBER

New York, United States

Venue: Jacob K. Javits Convention Centre

https://www.gnydm.com

1 – 3 Vietnam Medi-Pharm Expo 2021

Hanoi, Vietnam

Venue: Hanoi International Centre for Exhibition

http://hn.medipharmexpo.com/en

2 – 4 Barcelona Dental Show

Barcelona, Spain

https://www.dentalshowbcn.com/en

10 –12 10 th Hong Kong International Dental Expo

and Symposium

Hong Kong

Venue: Hong Kong Convention and Exhibition Centre

https://hkideas.org

15 – 17 Annual General Meeting and 112 th Academic

Conference

2022

JANUARY

Thailand

https://www.thaidental.or.th

20 – 22 SIDC 2022 – 33 rd Saudi Dental Society

International Dental Conference

FEBRUARY

Riyadh, Saudi Arabia

Venue: Hilton Riyadh Hotel and Residence

https://sidc.org.sa

1 – 3 AEEDC 2022 – The 26 th edition of the UAE International

Dental Conference & Arab Dental Exhibition

Dubai, United Arab Emirates

Venue: Dubai World Trade Centre

https://aeedc.com

11– 13 Famdent Mumbai 2022

Mumbai, India

Venue: Bombay Exhibition Centre Goregaon (East)

https://www.famdent.com/mumbai-show

24 – 26 157 th Midwinter Meeting – Chicago Dental Society

Chicago, United States

https://www.cds.org

82

DENTAL ASIA NOVEMBER / DECEMBER 2021

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.


NEW

VENUE

THE LEADING DENTAL

EXHIBITION AND CONFERENCE

IN ASIA PACIFIC

8-10

APRIL 2022

MARINA BAY SANDS

SINGAPORE

www.idem-singapore.com

Connect with us

Endorsed by

Supported by

Held in

Organised by

IDEM Singapore

IDEM Singapore

idem.sg

@IDEMSingapore

83 DENTAL ASIA NOVEMBER / DECEMBER 2021

Singapore Dental Assocation


Advertisers’ Index

COMPANY

PAGE

3Shape A/S 13

Align Technology 5

Anthogyr France 35

APAC Oral Care International Exchange Summit 69

Carestream Dental 45

Coltene 73

Dental South China 2022 75

Dentsply Sirona 77

Social Distancing?

No problem!

It’s safe.

Connect your

brand through our

media platforms.

DÜRR Dental (advertorial) 7

exocad IFC , 1

exocad

IBC

GC Asia 23

IDEM Singapore 2022 83

Mectron 17

Mectron 71

Medical Protection Society

OBC

Rolence inc 67

Shofu inc 15

Tekne Dental 19

VITA 11

For information, visit us www.dentalasia.net or

contact us at sales@pabloasia.com

@dentalasia

VOCO 9

W&H 3

Company Registration No: 200001473N

All rights reserved. Views of writers do not necessarily reflect the views of the Publisher. No part of this publication may be reproduced in any form or by any means, without

prior permission in writing from the Publisher and copyright owner. Whilst every care is taken to ensure accuracy of the information in this publication, the Publisher accepts no

liability for damages caused by misinterpretation of information, expressed or implied, within the pages of the magazine. All advertisements are accepted on the understanding

that the Advertiser is authorised to publish the contents of the advertisements, and in this respect, the Advertiser shall indemnify the Publisher against all claims or suits for

libel, violation of right of privacy and copyright infringements. Dental Asia is a controlled-circulation bi-monthly magazine. It is mailed free-of-charge to readers who meet a set

of criteria. Paid subscription is available to those who do not fit our terms of control. Please refer to subscription form provided in the publication for more details.

Printed by Times Printers Pte Ltd

84

DENTAL ASIA NOVEMBER / DECEMBER 2021


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and AI detects facial features in

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DENTAL ASIA NOVEMBER / DECEMBER 2021 85


Unpredictable tomorrows

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dentalprotection.org

Dental Protection Limited is registered in England (No. 2374160) and is a wholly owned subsidiary of The Medical Protection Society Limited (“MPS”) which is registered in England (No. 00036142).

Both companies use ‘Dental Protection’ as a trading name and have their registered office at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. Dental Protection Limited serves and

supports the dental members of MPS with access to the full range of benefits of membership, which are all discretionary, and set out in MPS’s Memorandum and Articles of Association. MPS is not

86 an DENTAL insurance ASIA company. NOVEMBER Dental Protection® / DECEMBER is a registered 2021trademark of MPS.

2109272550 10/21

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