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
IS WHAT DRIVES US
Imagine the CADABILITIES
DENTAL ASIA NOVEMBER / DECEMBER 2021 51
I love using many different
tools to create art. In my
lab, I enjoy the infinite
possibilities DentalCAD
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
time and boosting design speed.
Explore how this powerful design software will
make your life easier and improve your productivity.
exocad.com/dentalcad
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
#whdentalwerk
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Select the transmission instrument according to the application, set the motor speed
and work with the recommended bur rotation. For optimal treatment results!
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
PABLO PUBLISHING & EXHIBITION PTE LTD
3 Ang Mo Kio Street 62 #01-23
Link@AMK, Singapore 569139
Tel: (65) 62665512
Email: info@pabloasia.com
Website: www.dentalasia.net
Company Registration No.: 200001473N
Singapore MICA (P) No. 075/05/2019
Malaysia KDN: PPS1528/07/2013 (022978)
REGIONAL OFFICE (CHINA)
PABLO BEIJING
Tel: +86-10-6509-7728
Email: pablobeijing@163.com
REGIONAL OFFICE (CHINA)
PABLO SHANGHAI
Tel: +86-21-52389737
Email: pabloshanghai@163.net
@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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• Simple restoration of cervical cavities, undercuts etc.
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• 12 shades, including new shade GA5 for cervical restorations
• Excellent polishability and permanent lustre
VOCO GmbH · Anton-Flettner-Straße 1-3 · 27472 Cuxhaven · Germany · Tel. +49 4721 719-0 · www.voco.dental
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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© 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
B2B online dental and medical supplies
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
https://www.pay32clinic.com/clinic-request.
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
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DENTAL ASIA NOVEMBER / DECEMBER 2021
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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
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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.
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DENTAL ASIA NOVEMBER / DECEMBER 2021
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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
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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
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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
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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
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Rohlin M, Dr O, Nilner K, et al (2012) Treatment
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Pera P, Menini M, Pesce P, et al (2018)
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Daudt Polido W, Aghaloo T, Emmett TW,
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Papaspyridakos P, Mokti M, Chen C-J, et al
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Arisan V, Karabuda CZ, Ozdemir T (2010)
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Al Yafi F, Camenisch B, Al-Sabbagh M
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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
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Prosthodontics and implant dentistry. Clin
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Oral Implants Res 29 Suppl 16:215–223.
9
Tahmaseb A, Wismeijer D, Coucke W,
https://doi.org/10.1111/clr.13298
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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
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classification of the edentulous jaws.
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Javed F, Romanos GE (2010) The role of
Maxillofacial Surgery 17:232–236. https://doi. primary stability for successful immediate
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Terzioğlu H, Akkaya M, Ozan O (2009) The review. Journal of Dentistry 38:612–620.
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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
64
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 2021 – Dental 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
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84
DENTAL ASIA NOVEMBER / DECEMBER 2021
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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
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86 an DENTAL insurance ASIA company. NOVEMBER Dental Protection® / DECEMBER is a registered 2021trademark of MPS.
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