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Dental Asia September/October 2022

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.

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.

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www.dentalasia.net

SEPTEMBER / OCTOBER 2022


16 18 22

30 48 55

CONTENTS

TRENDS

16 Online comments and reviews

– how dental professionals can

respond

18 Pledge for sustainable dentistry

20 Shapeshifting microrobots can

brush and floss teeth

UNDER THE SPOTLIGHT

22 What it takes to be a dental

influencer

DENTAL PROFILE

24 Transforming the future of implant

dentistry

26 Peek into the digital future

30 The hundred years of Shofu

CLINICAL FEATURE

34 Effects of PBM on implant and bone

grafting after sinus elevation

38 Root coverage on a gingival

recession type 2

42 Endodontic perforation: The hole

that pricks

USER REPORT

44 Biomimetic oral care: Preventing

oral diseases with hydroxyapatite

48 Alternative solution for managing

implant failure

BEHIND THE SCENES

51 Indirect hybrid nano-ceramic

adhesive restorations

55 Emotional dentistry

IN DEPTH WITH

58 Increasing patient comfort with

advanced technology

59 Award-winning CAD software for

single-visit dentistry

60 Full range of oral surgery

applications

62 Discovering perfection in

prophylaxis

63 LED headlights as clinical

illumination

64 Precise, fast and clean

– that’s Simplex

SHOW PREVIEW

66 IDEM 2022 returns with exciting,

new programmes and initiatives

75 exocad Insights 2022: Learn.

Connect. Enjoy.

SHOW REVIEW

78 VOCO welcomes dentists

from different countries to

their International Fellowship

Symposium

REGULARS

4 Editor’s note

6 Dental Updates

68 Product Highlights

79 Events Calendar

80 Advertisers’ Index

2

DENTAL ASIA SEPTEMBER / OCTOBER 2022


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EDITOR’S NOTE

The digital future

is bright

PABLO SINGAPORE

Publisher

Publications Director

Assistant Editor

William Pang

williampang@pabloasia.com

Jamie Tan

jamietan@pabloasia.com

Czarmaine Masigla

czarmaine@pabloasia.com

Two years ago, it was unimaginable

when will the battle with COVID-19 end.

However, today, we are now seeing the

end of the tunnel.

For instance, after four years of hiatus,

the much-awaited physical event of

the International Dental Exhibition and

Meeting (IDEM) finally returns. With the

theme “Building resilience in dentistry”,

participants can look forward to a series

of lectures, face-to-face networking

activities, and so much more (p.66).

vice-president of Dentsply Sirona’s

Global Implant Solutions, shared that

the advances in technology have

helped in increasing patients’ dental

knowledge, hence, they were more

accepting of treatment (p.24).

Indeed, it pays to empower patients

– as how Dr Kayla Teh, dentist and

content creator, found online and

real-life success by raising dental

awareness and elevating the public’s

perception of dental care (p.22).

Graphic Designer

Circulation Manager

PABLO BEIJING

General Manager

PABLO SHANGHAI

Senior Editor

Cayla Ong

cayla@pabloasia.com

Shu Ai Ling

circulation@pabloasia.com

Ellen Gao

pablobeijing@163.com

Daisy Wang

pabloshanghai@163.net

Looking back, the dental industry rose

beyond the challenges of the pandemic

by tapping on modern technologies and

innovative solutions.

In fact, Rune Fisker, SVP of 3Shape,

said that digital adoption was pushed

forward by three to five years. With

dental professionals benefitting

from streamlined and more hygienic

workflow, they managed to bounce back

to practice quicker (p.26).

What’s more, apart from optimised

workflow, digital tools positively

affected patients’ behaviour towards

treatment too. As Tony Susino, group

These recent developments in

the industry have opened a lot of

opportunities for market growth that

we can expect to see in the years to

come. Exciting times are ahead of us!

Czarmaine Masigla

Assistant Editor

Scan for digital copy

of Dental Asia

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

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REGIONAL OFFICES

PABLO BEIJING

Tel: +86-10-6509-7728

Email: pablobeijing@163.com

PABLO SHANGHAI

Tel: +86-21-52389737

Email: pabloshanghai@163.net

ADVISORY BOARD

Dr William Cheung

Dr Choo Teck Chuan

Dr Chung Kong Mun

Dr George Freedman

Dr Fay Goldstep

Dr Clarence Tam

Prof Nigel M. King

Dr Anand Narvekar

Dr Kevin Ng

Dr William O’Reilly

Dr Wong Li Beng

Dr Adrian U J Yap

Dr Christopher Ho

Dr How Kim Chuan

Dr Derek Mahony

Prof Alex Mersel


DENTAL UPDATES

Align Technology collaborates with the European Aligner Society

Align Technology has collaborated with the

European Aligner Society (EAS) at the Society’s

Summer Meeting in Portugal held on 1-2 Jul

2022. The Align EAS Collaboration is intended

to elevate educational standards in orthodontic

aligner therapy, which are consistent

with the EAS/European Board of Aligner

Orthodontics (EBAO) Clinical Excellence Master

requirements.

Align Education has developed orthodontic

development programmes which includes

advanced and masters plan programmes for

continued learning in clear aligner therapy with

Invisalign aligners. The EAS recognises these

programmes are consistent with the EBAO

clinical aims and objectives.

Prof Tommaso Castroflorio commented:

“EAS has established the EBAO to certify the

expertise, skills, attributes, and comprehensive

knowledge of orthodontics, with an emphasis

on orthodontic aligner treatment, through

certification and periodic re-evaluation, and by

encouraging the achievement and maintenance

of diplomate status.

“A suitable candidate is to be committed to the

advancement of orthodontic aligner treatment,

to life-long learning and a lifetime of ethical

practices. Furthermore, EBAO aims to dignify

the art and science of orthodontics and elevate

the quality of orthodontic care by promoting

high standard evidence-based practice in

orthodontic aligner treatment and encouraging

research in this field. EBAO also collaborate

with other entities and organisations to improve

the whole profession of dentistry.”

Now that it has established recognition of

the educational programmes, Align will be

advocating them as preparation for the EAS/

EBAO Clinical Excellence Master certification.

During these development programmes, Align

will share guidance on the five case submission

required for the EBAO Clinical Programme

examination. This will be positioned as

aspiration and best practice within Align’s

development programmes.

By meeting the education standards, this

collaboration will prepare orthodontists for the

EBAO Clinical Excellence Master certification

and recognise their expertise and experience in

treating complex cases. ■

Amann Girrbach now offers in-house fabrication processes

With its 4.2 upgrade of the Ceramill Mind and

Ceramill Match software, Amann Girrbach

now offers dentists and dental technicians

new opportunities for the in-house fabrication

of restorations while significantly reducing

cost. For example, the new software features

allow titanium materials to be machined with

the Ceramill Matik milling unit. The in-house

fabrication of titanium-based implant-supported

restorations is associated with external cost

savings of up to 40%. The entire milling unit

can therefore be financed in full by even a small

number of cases. Another new feature is the

Speedlining mode: with the aid of specifically

developed tools, users of the Ceramill Matik,

Ceramill Motion 3 and Ceramill Motion 2 can

cut-grind hard block materials at full speed.

Dentists and dental technicians thus benefit

from almost 50% faster production while

maintaining restoration quality and reliability.

Moreover, the planning of dentures can now be

performed directly on the implant and without

abutments – regardless of whether single

crowns, multi-part bars and bridges or full dental

arches are involved. This implant solution is

the result of a cooperation between Amann

Girrbach and Tri Dental Implants. With matrix, Tri

Dental Implants has launched the first approved

dental implant specifically designed for digital

fabrication technologies such as CAD/CAM

milling or 3D printers. With the matrix concept,

Amann Girrbach now offers its customers a

comprehensive CAD/CAM-compatible implant

system in both a digital and validated workflow.

Implant-based Zolid zirconia crowns can thus be

produced in less than two hours in combination

with the Therm DRS sintering furnace.

In addition to the fully digital and validated

Amann Girrbach workflow for printing

implant models and laboratory analogues,

the upgrade also offers numerous other CAD/

CAM functions. To give an example, these

include the AI-assisted design of bridges using

the Instant Anatomic Morphing feature or the

implementation of the smile creator report in

PDF format. This allows patients to see the

expected result in advance in a before-and-after

comparison and to participate in the planning

process if they so wish. In addition, the upgrade

also offers quick to perform quality checks with

the aid of the new nesting visualisation: this

makes it possible to repeatedly check whether a

restoration can be milled successfully. Additional

process reliability can thus be created with just

a single click. However, as the digitisation of

production increases, so does the output of

milling units and 3D printers. To stay on top of

things, the Ceramill System now enables milled

and printed restorations to be marked with notes.

“With the upgrade of our Ceramill Mind and

Ceramill Match software to Version 4.2, we are yet

again focusing on the core principles of in-house

fabrication and by doing so, also on the vision of

Amann Girrbach. We are delighted to have come

a great deal closer to this vision now with the new

features, improvements and functions,” explained

Nikolaus Johannson, head of the Global Business

Unit Lab CAD/CAM at Amann Girrbach. ■

6 DENTAL ASIA SEPTEMBER / OCTOBER 2022


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DENTAL UPDATES

HKU Faculty of Dentistry utilises AI technology to automate the process of

denture design and enhance treatment efficiency

Researchers from the Faculty of Dentistry

at the University of Hong Kong (HKU) and

the Department of Computer Science of

Chu Hai College of Higher Education, have

collaborated to develop a new approach using

artificial intelligence (AI) to automate the

design of individualised dentures to enhance

the treatment efficiency and improve patient

experience.

The AI technology used in the process

was based on 3D Generative Adversarial

Network (3D-GAN) algorithm and tested on

175 participants recruited at HKU. The study

shows that AI technology could reconstruct

the shape of a natural healthy tooth and

automate the process of false teeth design

with high accuracy.

“The 3D GAN algorithm was selected due

to its superior performance on 3D object

reconstruction compared to other AI

algorithms. In the preliminary study, 3D

GAN was able to rebuild similar shapes to

the original teeth for 60% of the cases. It is

expected to mature with more AI training

data,” explained Dr Reinhard Chau, coinvestigator.

The new approach only requires the digital

model of a patient’s dentition to function. It can

learn the features of an individual’s teeth from

the rest of the dentition and generate a false

tooth that looks like the missing tooth.

“This will facilitate the treatment workflow for

dentists in replacing a missing tooth, as the

preparation and fitting process will require

minimal time, and a patient will not need to stay

at the clinic for long hours,” said Dr Walter Lam,

principal investigator.

The study entitled “Artificial intelligencedesigned

single molar dental prostheses: A

protocol of prospective experimental study”

is published in the journal PLoS ONE. The

preliminary results of the study were presented

in the recent International Association of Dental

Research (IADR) General Session. The study

won the IADR Neal Garrett Clinical Research

Prize and first runner-up in the 2022 IADR-SEA

Hatton Award - Senior Category. ■

Henry Schein advances ESG stewardship

Henry Schein has announced the publication

of its 2021 Sustainability and Corporate

Social Responsibility (CSR) report, titled

“Bold Leadership for a Healthier World”.

The company’s 2021 Sustainability and CSR

report details work done over the past year

to advance its environmental, social, and

governance (ESG) stewardship, including

expanded ESG disclosures, several distinct

health equity initiatives, and continued

collaborations with business partners and

suppliers to help address climate change.

As part of the company’s work to enhance

its ESG transparency, Henry Schein reported

for the first time on its sustainability efforts

in 2021 in accordance with Sustainability

Accounting Standards Board and Global

Reporting Initiative Standards. The company

also issued its first task force on Climate-

Related Financial Disclosures report,

outlining Henry Schein’s governance and

related strategies to address climate risks

and opportunities.

“Our commitment to the success of our

stakeholders – our customers, TSMs, supplier

partners, shareholders, and society at large –

has long been the foundation of our purposedriven

approach to corporate citizenship and

commercial engagement, and continues to

inform our bold efforts to create a healthier

world,” said Stanley M. Bergman, chairman of

the board and chief executive officer of Henry

Schein. “Throughout our 90 years in business,

we’ve faced many challenges as an industry

and a society, and Team Schein remains

determined to support our customers and

our business through our robust stakeholder

engagement model. Henry Schein will continue

to pursue our higher ambition as a socially

responsible and sustainable organisation while

giving back in times of crisis and doing our

part to build a healthier future for all.”

Over the past decade, Henry Schein has

further invested in its commitment to a

higher ambition model of “ethical capitalism”,

formalising its ESG strategy into five focus

areas: Empowering Team Schein, Advancing

Health Equity, Accelerating Environmental

Sustainability, Supply Chain Resilience, and

Ethical Governance. The 2021 Sustainability

and CSR report underscores the values

instilled at the company’s founding and

highlights how Henry Schein gives back to

the professions and communities it serves. ■

8 DENTAL ASIA SEPTEMBER / OCTOBER 2022


DENTAL UPDATES

DentalMonitoring launches DM

Intelligent Platform

DentalMonitoring has launched a new service for dental

professionals and industry partners: the DM Intelligent Platform. It

is the only digital workflow which can interface and integrate with all

dental digital solutions available on the market today.

This accomplishment reinforces DentalMonitoring’s vision of

making dentistry smarter, helping improve clinical outcomes and

patient experience and enabling practice growth and efficiency.

Since 2014, DentalMonitoring has revolutionised the management

of clinical care and practice workflows through its AI-powered

solutions, championing the utilisation of data to improve the quality

of care.

The company’s patented platform will greatly increase the freedom

to operate and choice of partners for all dental professionals,

and allow digital solution providers the ability to leverage

DentalMonitoring’s AI technology.

The DM Intelligent Platform includes the following solutions:

• DataHub, a data analytics tool enabling continuous and immediate

feedback and information to doctors, practices and partners related

to clinical efficacy and operational efficiency

• Export of manufacture-ready STL files from monitoring scans

without the need for an in-practice appointment*

• API/SDK Interfaces enabling integration of the DM Intelligent

Platform with any digital partners, including patient management

systems, CRM systems, digital treatment planning systems for

aligners, braces and any other dental appliances, as well as devices

such as connected electric toothbrushes

PERFECTION IN

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07-09 OCTOBER

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“We’re excited that our unique technology trusted by thousands

of doctors and more than 1.5m patients worldwide will now

be available to enhance product capabilities, workflows and

solutions throughout the dental world,” said Philippe Salah, CEO

of DentalMonitoring. “We believe that our only truly open digital

platform in dentistry today positions us well to continue to positively

impact the sustainability of dental care and improve the lives

of millions of patients. We invite all our doctors and partners to

leverage our technology to its full potential and help us in our vision

to make dentistry smarter.” ■

*Products availability, claims

and regulatory status may differ

across countries depending on

local regulations. Contact your

local representative for further

information

→ www.mectron.com

DENTAL ASIA SEPTEMBER / OCTOBER 2022 9

ad_PStouch_dental_asia_IDEM_95x250_en_220704.indd 1 04.07.22 12:11


DENTAL UPDATES

Dentsply Sirona appoints Simon Campion as chief executive officer

Dentsply Sirona

has appointed

Simon Campion

president and chief

executive officer

and will join the

company’s board of

directors, effective

12 Sep 2022. He

succeeds John Groetelaars, who has served

as interim chief executive officer since Apr

2022. Groetelaars will continue to serve on

the board.

Campion joins Dentsply Sirona from Becton,

Dickinson and Company (BD), where he

most recently served as executive vicepresident

and president of the medical

segment and prior to that served as

president of the interventional segment

following BD’s acquisition of C. R. Bard.

He previously held several leadership roles

across the C. R. Bard organisation, including

leading the surgery business unit.

With the hiring of Campion, the board has

requested a full review of the company’s

business and operations including

competitive positioning and portfolio,

margin enhancement opportunities, and

capital structure.

Eric K. Brandt, chairman of the Dentsply

Sirona Board, said: “Simon’s appointment

follows a comprehensive search process to

identify the right leader to help the company

deliver on its strategic and financial goals.

Simon is a high-integrity, transformational

leader with a record of world-class

operational expertise and sustainable

growth. In his 25 years in the medical device

industry, Simon has led global business

units, driven commercial execution, and

developed and executed strategies to expand

innovation and generate revenue growth

at scale. During his tenure at BD, Simon

delivered above-market annualised revenue

growth, accelerated the segments’ M&A

activity, and expanded the organic innovation

agenda. We believe Simon’s values and

leadership, will be highly impactful in moving

the company forward particularly as the

company prepares to complete the ongoing

audit committee review, improve operational

rigor, and drive accountability.”

Campion said: “It’s an honour to join

Dentsply Sirona and have the opportunity to

lead this great team. During my career, I’ve

developed a clear understanding of what

it takes for a global healthcare company

to succeed, and I am confident that with

its strong foundation of industry-leading

products and patient-driven innovation,

Dentsply Sirona is well-positioned to

capitalise on the market opportunities ahead

and deliver long-term growth and value

creation.”

Brandt continued: “The board is most grateful

to the employees of Dentsply Sirona for their

patience, resiliency, and commitment to our

providers and patients during this time of

uncertainty as the company prepares for

completion of the ongoing audit committee

review. Additionally, the board thanks John

Groetelaars for his service as interim chief

executive officer. During his tenure, John put

in place management systems that are key

to focusing and advancing the company’s top

priorities and set an exemplary standard of

integrity and accountability. We look forward

to continuing to benefit from his expertise on

the board.”

Groetelaars said: “It has been a privilege

to serve as Dentsply Sirona’s interim CEO.

Over the last several months, I’ve gained

deep insight into Dentsply Sirona’s business,

operations, and opportunities. Dentsply

Sirona has a solid strategy in place, and I am

eager to apply the perspectives I’ve gained

as I continue to support the company’s

progress from the board.” ■

FDI and Lancet Migration launch joint policy brief

on oral health for people on the move

Globally, more than one billion people are on

the move 1 due to forced global displacement.

Unfortunately, vulnerable groups such as

refugees, migrants, and other people on the

move often face oral health inequalities and

are at heightened risk of developing diseases.

The current health systems must address this

issue and increase access to oral healthcare

for vulnerable groups through integration into

general healthcare systems.

To address the oral health needs for people on

the move, FDI has joined forces with Lancet

Migration to develop a policy brief aimed

at policymakers, governments and health

systems, non-governmental organisations

and charities, and academics and research

institutions.

It sheds light on the urgent need for action

to reduce oral health inequalities amongst

this particular group and provides key

recommendations through calls-to-action.

World Refugee Day is the perfect occasion to

launch this publication and incentivise all those

who can help to raise awareness and to act on

the recommendations made in the Oral Health

for People on the Move policy brief.

Emphasising that strong and coherent action is

required to improve the oral health of people on

the move through a comprehensive universal

health system approach, the policy brief

highlights the current gaps in the system. Its

key calls-to-action include increasing adequate

epidemiological surveillance systems, oral

health education, access to care, access to

digital technologies and many more. ■

1

WHO Refugee and Migrant Health Fact Sheet,

https://www.who.int/news-room/fact-sheets/

detail/refugee-and-migrant-he…

10 DENTAL ASIA SEPTEMBER / OCTOBER 2022


DENTAL UPDATES

exocad to host global CAD/CAM conference

Insights 2022 in Palma de Mallorca

exocad has announced that Insights 2022,

the third edition of the company’s global

community event for dental labs and

dentists, will be held in Palma de Mallorca,

Spain, on 3-4 Oct, under the motto “Learn.

Connect. Enjoy.” Held every two years,

Insights 2022 will include a full, two-day

programme of lectures from top-tier dental

speakers, break-out learning sessions, a

comprehensive partner exhibition and an

evening event.

The agenda for Insights 2022 includes a

diverse programme of dynamic lectures

by international speakers, software

sessions with exocad’s team of application

specialists that will present highlights of

the latest Rijeka 3.1 software releases, and

presentations by 11 international companies

on the latest CAD/CAM trends. Up to 800

dental technicians and dentists from Europe,

North and South America, Asia, Africa, and

Australia are expected to attend the exclusive

event.

“Connection is one of our top priorities at

exocad: connecting with our community,

connecting through technology, and

connecting to learn and educate about the

latest advancements in digital dentistry,”

said Tillmann Steinbrecher, CEO of exocad.

“Insights is our main event to strengthen

those connections, offer a platform for

exchange and a vision of the future.”

Insights 2022 will focus on the possibilities

of digital dentistry using an open software

platform. With exocad’s open architecture,

digital technologies like DVT, milling machines,

3D printers, intraoral scanners and desktop

scanners can be connected on a single

software platform, allowing dental technicians

and dentists to easily collaborate with one

another and implement treatment concepts more

efficiently and predictably. Over the two days

of Insights 2022, attendees will experience the

variety of possible solutions for the CAD/CAMsupported

manufacturing of dental restorations

and how to create consistent digital workflows.

They’ll hear from internationally renowned dental

guest speakers Steven Campbell, Dr Christian

Coachman, Dr Gulshan Murgai, Prof Dr Guilherme

Saavedra, MDT Sascha Hein, Dr Diana Tadros,

Dr Lori Trost and Waldo Zarco Nosti.

Sessions will be held in English with simultaneous

translations in German, Italian and Spanish, and

will include CE credits for select countries. ■

HIGH-PERFORMANCE

DYNAMIC INSTRUMENTS

SIMPLIFYING DENTAL MOTION

TeKne Dental srl – Italy

info@teknedental.com www.teknedental.com

DENTAL ASIA SEPTEMBER / OCTOBER 2022 11


DENTAL UPDATES

Formlabs announces fifth annual User Summit

Formlabs has announced the return of its

global Formlabs User Summit, a free virtual

event from 26-27 Oct 2022. The 3D printing

user conference reconvenes for its fifth year

to celebrate more than 100 million innovations

printed on Formlabs 3D printers, the positive

impacts of these designs and 3D printing

applications.

At the 2022 User Summit, Formlabs will

unite users and enthusiasts to inspire the

next generation of innovations. The event

will feature discussions about extraordinary

3D printing innovations, from generative and

nature-inspired product design and hyperrealistic

props and prosthetics from TV shows,

to how access to additive manufacturing tools

prepares students for future careers, and

how in-house rapid tooling adds flexibility to

manufacturing workflows.

Formlabs has assembled an enticing speaker

lineup for the User Summit, tapping thought

leaders who are using Formlabs 3D printing

in a variety of industries, including Sheri

Thorn, aerospace engineer, NASA Goddard;

Amy Alexander, unit head biomechanical

development & applied computational

engineering, Mayo Clinic; Dr Alejandro Pineda,

director, Clinica Lhasa; Jessica Rosenkrantz

and Jesse Louis-Rosenberg, co-founders,

Nervous System; Ryan Mandell, director,

Innovation Hub Makerspace, Penn State; and

Jaco Snyman, founder and lead production

designer, Dreamsmith.

The Summit will offer sessions in eight

languages, including a multi-level Formlabs

University track that will help users boost

their 3D printing skills, a User Talk Track

highlighting case studies and applications

across engineering, product design,

manufacturing, education, entertainment,

jewellery, automotive, aerospace, and more.

Innovations in dental and medical industries

will also be featured, including a womenled

Medical Talk track that will address

3D printing’s application in personalised

healthcare.

Formlabs co-founder and CEO Max Lobovsky

said: “Each year, the Formlabs User Summit

is an opportunity to celebrate everything

that our community has accomplished and

inspire future innovators. Our users achieved

an amazing milestone, printing more than

100 million parts with Formlabs printers. This

year’s Summit and expanded Impact Awards

will shine the spotlight on the many ways

that their 3D printed designs, prototypes, and

devices have made an impact on the medical,

automotive, and entertainment industries, to

name a few.” ■

Neocis announces FDA 510(k) clearance for YomiPlan Go workflow

Neocis has announced that their latest

software offering, YomiPlan Go, has received

510(k) clearance from the US Food and Drug

Administration (FDA) after the successful

completion of a recent clinical study. This marks

the 13th FDA clearance Neocis has received to

date.

Yomi, the first and only FDA-cleared robotic

system for dental surgery, assists clinicians in

both planning and operative phases of dental

implant placement via interactive digital planning

(using YomiPlan software) and robotic guidance

of surgical instrumentation, respectively.

YomiPlan Go, which is expected to be

commercially available soon, is a softwarebased

workflow that allows doctors to directly

visualise a patient’s anatomy, set the desired

location and angulation of an implant using

their drill tip, and then perform an osteotomy

under robotic guidance. This mode differs from

the platform’s other workflow options (YomiPlan

Complete and YomiPlan Dynamic) as it frees

clinicians from having to take a CT scan for

case planning in YomiPlan, allowing them to get

underway with surgery faster.

“This new FDA-cleared workflow demonstrates

our commitment to continuous innovation,” said

Alon Mozes, co-founder and CEO of Neocis. “We

are dedicated to providing all of our partners

with versatile solutions that allow them to use

Yomi for the wide variety of clinical cases they

take on every day.”

YomiPlan Go’s fast, flexible workflow is

similar to freehand surgery but offers the

enhanced precision and repeatability of robotic

assistance. In this mode, Yomi’s guide arm

stabilises the drill, maintains positional and

angular precision as the clinician changes

bits, and prevents overdrilling. Users can also

accurately parallelise multiple fixtures by using

the initial implant as a reference point.

“By combining the feel of freehand surgery with

the advantages of haptic guidance, YomiPlan

Go adds a human touch to robotic implant

placement,” said Massachusetts-based general

dentist Dr Sathish Palayam. “It’s as simple as

point and place.”

The growing YomiPlan software suite gives

dental practices the flexibility to choose a robotic

workflow that best fits their needs, so they can

perform robot-assisted surgery with minimal

disruption to their existing clinical processes and

techniques.

“We’re thrilled to introduce another innovation

that directly resulted from our users’ input,” said

Wayne Craig, chief commercial officer of Neocis.

“I’ve never been with a company that so closely

partners with and listens to its clients to develop

innovative, solution-oriented offerings. We’re

excited to provide freehand surgeons with a more

precise and versatile alternative to this method,

without sacrificing speed and clinical efficiency.” ■

12 DENTAL ASIA SEPTEMBER / OCTOBER 2022


DENTAL UPDATES

Vivos Therapeutics announces multiple

regulatory clearances in Australia for its entire

line of oral appliances

Vivos Therapeutics has received multiple

Class I clearances by the Therapeutic Goods

Administration for multiple indications

to include the treatment of snoring and

obstructive sleep apnoea (mild, moderate and

severe) for both adults and children for its

series of oral appliances.

“These recent clearances provide further

validation to our technology and extend the

scope of our international market,” said Kirk

Huntsman, co-founder and CEO of Vivos

Therapeutics. “The Australian regulators

recognised and accepted the clinical data

we presented showing the clinical safety

and efficacy of our technology regardless of

age or the severity of the obstructive sleep

apnoea (OSA). We are progressively moving

forward with other domestic and international

regulatory agencies with high expectations

that our applications will be as well received

as they have been in Australia. Poor sleep

is a global epidemic. Vivos has developed a

safe, comfortable, non-invasive, non-surgical

solution, and we intend to offer it worldwide.

We have already received clearances in the US

and Canada, and now, Australia will become

part of our expanding international network.

We will continue to grow and spread into other

parts of the world.”

Australia follows the standards applied by the

International Organization for Standardization

(ISO), which is currently made up of 165

members/countries. These new clearances will

allow Vivos to share its innovative technology and

distribute devices that will help not only adults,

but also children who suffer from sleep breathing

disorders. These latest clearances include all

classes of OSA as defined by the newly received

Global Medical Device Nomenclature (GMDN)

Vivos has received in Australia.

symptoms of OSA and mild, moderate and

severe sleep-disordered breathing.

• Class I device clearances for the DNA

and Vivos Guide/Way for palate lifting (jaw

expansion causing airway enhancement),

repositioning/straightening teeth, and as

an anti-snoring orthosis. These appliances

can be used for the purposes of reducing

night-time snoring, to encourage nasal

breathing in adults and children (limiting

oral breathing) and for OSA and sleepdisordered

breathing in children and

adults. This is an important new clearance

for Vivos.

Equivalent to the Food and Drug

Administration (FDA) in the United States,

the Therapeutic Goods Administration

(TGA) regulates the manufacturing and

distribution of therapeutic goods in

Australia. These clearances allow Vivos

Therapeutics to distribute its appliances

for several approved indications inclusive

of snoring, sleep-disordered breathing

and obstructive sleep apnea within the

Australian market.

Members of the professional dental

community are excited to introduce The

Vivos Method into their practices. “After

20 years of practicing airway breathing

and dental sleep medicine, it excites me

to find Vivos,” said Dr Mark Levi, who runs

a predominantly airway dental practice

in Sydney. “Vivos has changed the way I

look at treating adults and allows me to

improve the wellness of young children.

I’m thrilled to be able to integrate Vivos

into my practice.” ■

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DENTAL UPDATES

Oral-B partners with the International Association

of Disability and Oral Health

Oral-B has partnered with the International

Association of Disability and Oral Health (iADH)

as part of the brand’s drive to make oral care

more inclusive, accessible, and positive for

people with disabilities, their caregivers, and

everyone in between.

Benjamin Binot, oral care senior vice-president

at P&G Europe, said: “We recognise the

importance of making oral care accessible

to all – and continuously listen to people’s

experiences with disabilities to understand how

we can help them. Through this work, we have

learned that oral health care struggles amongst

this audience are most common because

many haven’t been taught the skills, they need

to brush their teeth effectively, they experience

a sense of inevitability about their teeth

deteriorating and may be especially anxious

in the dentist’s chair. As a brand, we recognise

our responsibility to help ensure that oral care

is accessible to all and we are proud to partner

with the iADH to work to improve the experience

for people living with disabilities.”

The first step of this partnership is to co-create

a ‘Positive Practices’ training programme

designed to train and educate dental practices

on how to become more confident and

inclusive when it comes to their patients.

Alison Dougall, president of iADH, said: “We

are delighted to be working alongside Oral-B to

address the significant oral health inequalities

experienced by people with disabilities in

Europe, through innovation, education, research

and advocacy. By working together, we aim

to make a positive difference to the oral care

experience for people living with visible and

nonvisible disabilities.

“iADH exists to improve desired oral health

outcomes for people with disabilities and

Oral-B exists to create the best oral care

outcomes by providing the most rewarding and

enjoyable oral care experiences for everyone,

everyday – given our shared values, it felt like

a very natural fit when Oral-B approached us to

come together in partnership”

Benjamin Binot, oral care senior vice-president

at Procter & Gamble and Prof Alison Dougall,

president of the International Association

of Disability and Oral Health (iADH). Credit:

Djibrann Hass

The brand will also be present at this year’s

Biennial iADH Congress 2022 in Paris to learn

from the global members, who will be sharing

their knowledge and experience to improve oral

health outcomes for people with disabilities in

a KOL workshop hosted by Oral-B. The findings

gathered from the workshop will help to inform

Positive Practices and ensure that the training

programme is underpinned by insight to deliver

the best outcome for change. ■

Roland DG Corporation announces planned

relocation to a newly constructed headquarters

Roland DG Corporation will be relocating

to a newly constructed headquarters near

its current facilities in Hamamatsu, Japan.

The completion of Roland DG’s new nearly

ZEB-certified building in the Miyakoda

area of Kita-ku, Hamamatsu on Jul 2023

will integrate the company’s factory and

headquarters, which are currently located at

two separate venues.

ZEB certification is defined by four levels

of achieving zero-energy construction by

combining energy-saving technologies,

such as the use of natural energy and

efficient equipment systems, with energycreating

technologies, such as solar power

generation. Roland DG’s new building will

achieve a primary energy consumption of

75%+ through energy conservation (50%+)

and energy creation.

The new building will provide a space that

creates new value by organically combining

R&D, administration, and sales functions

together in a single office area. All floors

will have public areas, interaction areas, and

creative areas designed to enable employees

to freely change their work environment,

generate ideas, and communicate with each

other.

Shizuoka Prefecture sets a seismic zone

standard that is stricter than the national

standard, and the new building to be

constructed will be 1.5 times safer than

the national standard. The new building

will also be equipped with a solar power

generation system on the rooftop, automatic

lighting control and inverter airflow control

for exhaust fans, and a top-class efficiency

air conditioning system, all of which are

consistent with global efforts to achieve

carbon neutrality.

The building will provide a comfortable

workplace that accommodates a variety of

work styles, including a deck terrace taking

advantage of its location in front of Miyakodasogo

Park, cafeteria lounge, training room,

and showers.

At a time when the role of an office building

is rapidly changing due to the pandemic, the

design takes into account a hybrid working

style between office and telecommuting,

considering the way of working in the future.

The company aims to create an environment

that facilitates communication and promotes

team building to realise its slogan to “Inspire

the Enjoyment of Creativity” and spark

excitement. ■

14 DENTAL ASIA SEPTEMBER / OCTOBER 2022


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TRENDS

Online comments and reviews

– how dental professionals

can respond

With social media platforms as

well as review and comparison

sites, patients can easily post

their feedback on the service

rendered to them. Positive

reviews are heartening to read,

but how should the dental

professionals handle the

negative ones?

By Dr Bobby Nicholas and Dr Louise Eggleton,

medicolegal and dentolegal consultants at

Medical Protection

Feedback in general – good and bad –

can be useful in helping a dentist make

improvements to the service or treatment

they provide. However, receiving negative

comments can be challenging, even more

so if unfair criticism has been published

online, in full view of colleagues, patients

and friends. It can also be particularly

frustrating if it is felt that there is no right

to reply.

The language used on social media and

review sites can often be emotive,

confrontational, and not what we usually

expect in the course of spoken dialogue.

This, together with the fact that there are

limited safeguards to prevent patients from

making unpleasant or factually inaccurate

posts and potentially impacting the professional

reputation of the clinician or practice, makes

it understandable as to why clinicians are

becoming increasingly concerned.

Dental Protection is often asked to provide

support and advice for dental professionals

who feel that they are being unfairly portrayed

in online comments.

How a dental professional respond to negative

feedback can be an important factor in whether

matters escalate. Some types of comments

may warrant reporting to the website, although

this does not prevent the person from simply

posting the comments elsewhere. Of course,

any abusive or threatening comments are

completely unacceptable and should be reported

to the online administrator. A decision then

needs to be taken by the clinician or practice

if they consider police involvement is also

necessary.

If the online comments can be considered a

misrepresentation of facts, in the first instance,

one may be able to contact the website

administrator to request for the removal of the

review or comment.

Unfortunately, this may be quite challenging

if the comment is deemed to be the personal

opinion of an individual as it is difficult to argue

against the patient in question feeling that they

have had a particular experience.

Dental professionals can sometimes feel that

negative feedback amounts to a personal

attack or defamation. Taking legal action

16 DENTAL ASIA SEPTEMBER / OCTOBER 2022


TRENDS

over a comment is an option but is something

that needs to be considered very carefully,

and the chances of success and indeed any

benefits may well be far less than we might

first consider.

The defamatory nature of content is subjective,

and a challenge of this nature can risk inviting

further attention and publicity towards the

unfavourable comments with possibly only a

small chance of success for the clinician.

Practitioners may wish to encourage other

patients who have had a different experience

at the practice to post reviews instead. This

goes to demonstrate the majority of patients

value and appreciate the service they have

received whilst moving the negative review

further down the postings, eventually making

it less and less visible.

When receiving negative feedback, it is

tempting to defend one’s reputation by

engaging in a war of words with the patient

via the social media platform or website.

However, dentists need to be mindful of

their duty of confidentiality when

responding to feedback on public

forums. When writing in haste or

a defensive manner, it is possible

that comments may inadvertently

breach patient confidentiality by

revealing details of the treatment

or person. It is essential that

any response observes the data

protection guidelines which govern

our practice.

We will go on to look at how to respond

in these situations to help mitigate any

potential escalations and reduce the

risk of further challenge or disagreement with a

patient being played out in a public forum.

CALM AND PROFESSIONAL

RESPONSE

Dental professionals and practice staff need

to be prepared to deal with negative online

comments. A dental practice which is seen to

engage with negative feedback can also use it

as an opportunity to demonstrate all concerns

are taken seriously and that they want to

ensure the care which has been provided to all

patients meets their expected standards.

An effective response should express genuine

disappointment that the patient did not have

a positive experience, inviting the patient to

discuss their concerns in more detail offline.

If the patient does wish to engage with the

practice and their complaint or query is

subsequently resolved, the patient may perhaps

choose to remove the comments themselves.

Bear in mind that if you think a comment is

unreasonable or unfair, others may see it that

way too. Informal patients’ surveys in the US

found that 65% of patients tended to ignore

negative reviews that seemed unreasonable or

exaggerated 1 .

Similar US surveys found that almost one in

five patients will disregard a negative review

if the provider has responded in a thoughtful

manner 2 .

A calm and professional response will come

across well to others. Here are four steps that

will help you provide a good response:

1. Although a prompt response is important,

try to make sure the reply is calm, measured

and not written in haste. It is helpful to have

a named colleague at the practice regularly

monitoring and managing all social media

accounts the practice chooses to engage in.

2. A simple and brief acknowledgement of

the comments should be provided. Thank the

patient for their feedback and acknowledge

concerns they may have raised.

3. Invite the patient to contact the practice

directly in order to further discuss their

experience.

4. Bear in mind your duty of confidentiality and

do not disclose any personal information.

Finally, Dental Protection members can contact

us for further advice if they are unsure of how

to proceed upon receiving a negative online

comment. DA

REFERENCES:

1.

Software Advice: How patients use online reviews

www.softwareadvice.com/resources/howpatients-use-online-reviews/.

Accessed on 28

June 2021.

2.

PatientPop: 3 ways to respond to negative online

reviews. Available at: www.patientpop.com/

whitepapers/3-ways-to-respond-to-negativeonline-reviews/.

Accessed on 28 June 2021.

DENTAL ASIA SEPTEMBER / OCTOBER 2022 17


TRENDS

Pledge for sustainable dentistry

FDI World Dental

Federation launches

Consensus Statement

on sustainable oral

healthcare.

FDI World Dental Federation (FDI) has launched

its inaugural Consensus Statement on

Environmentally Sustainable Oral Healthcare,

aimed at moving the oral healthcare sector

towards more environmentally friendly

practices that ultimately reduce the carbon

footprint of the profession.

The Consensus Statement was released

at a special summit organised by FDI that

brought together a diverse range of influential

stakeholders, including leading figures from

industry as well as health professionals,

academic experts, legislative authorities, and

dental associations.

“It will come as a surprise to many people that

the healthcare sector is responsible for around

5% of global greenhouse gas emissions,

of which oral healthcare is an important

contributor,” said Prof Ihsane Ben Yahya, FDI

president and dean of the Faculty of Dentistry,

Mohammed VI University of Health Sciences,

Casablanca, Morocco.

“The dental industry has a collective

responsibility to reduce its environmental

impact and today’s Consensus Statement

is the first major step to achieving that. The

Consensus Statement reflects the growing

recognition within the oral healthcare

community that we must strive to improve oral

health in a sustainable manner in compliance

with UN targets. Healthier mouths mean a

healthier planet.”

Oral healthcare contributes to the environmental

burden through air pollution arising from the

release of CO2 associated with travel and

transport, incineration of waste, lack of

recyclable packaging, the greenhouse gas

impact of anaesthetic gases such as nitrous

oxide, and the high consumption of water.

The Consensus Statement identifies the

complex drivers that underpin current

behaviours and practices and recommends

remediation strategies based on the four Rs:

Reduce, Recycle, Reuse and Rethink.

Whilst highlighting some of the unavoidable

environmental impacts linked to providing

accessible dental check-ups and treatments

to facilitate good oral health and reduce

inequalities in healthcare, it also makes the

case for minimising avoidable oral healthcare.

This is best achieved through both the delivery

and maintenance of good oral healthcare,

focused on prevention with the promotion of

good oral hygiene, healthy low-sugar diets, and

avoidance of tobacco.

“Prevention is better than cure and it is the

most impactful and practical way of reducing

the need for clinical interventions and

associated environmental impacts,” said Prof

Nicolas Martin, chair of the FDI Sustainability

in dentistry task team and clinical professor

in restorative dentistry in the School of

Clinical Dentistry at the University of Sheffield

in the UK.

“When treatment is required, oral healthcare

should focus on the provision of durable

fillings, using high-quality products and

materials that will last longer and require

fewer replacements.” DA

This article was first published at the FDI

World Dental Federation website.

18 DENTAL ASIA SEPTEMBER / OCTOBER 2022


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TRENDS

Shapeshifting microrobots

can brush and floss teeth

The technology, developed by a multidisciplinary team at the University of

Pennsylvania, is poised to offer a new and automated way to perform the

mundane but critical daily tasks of brushing and flossing.

By Katherine Unger Baillie, senior science news officer, University Communications, University of Pennsylvania

A shapeshifting robotic microswarm

may one day act as a toothbrush, rinse,

and dental floss in one. It is a system

that could be particularly valuable for

those who lack the manual dexterity to

clean their teeth effectively themselves.

The building blocks of these microrobots

are iron oxide nanoparticles that have

both catalytic and magnetic activity.

Using a magnetic field, researchers could

direct their motion and configuration to

form either bristle-like structures that

sweep away dental plaque from the

broad surfaces of teeth, or elongated

strings that can slip between teeth like

a length of floss. In both instances, a

catalytic reaction drives the nanoparticles

to produce antimicrobials that kill harmful

oral bacteria on site.

Experiments using this system on mock

and real human teeth showed that the

robotic assemblies can conform to a

variety of shapes to nearly eliminate the

sticky biofilms that lead to cavities and

gum disease. The Penn team shared

their findings establishing a proof-ofconcept

for the robotic system in the

journal ACS Nano.

The nanoparticles have both magnetic and catalytic properties; catalysed hydrogen

peroxide produced free radicals that eliminated tooth decay-causing pathogens as well

(Image: Minjun Oh/Penn Dental Medicine)

Medicine and co-corresponding author

on the study. “You have to brush your

teeth, then floss your teeth, then rinse

your mouth; it’s a manual, multistep

process. The big innovation here is that

the robotics system can do all three in

a single, hands-free, automated way.”

and forth across a space, much like

flossing. The way it works is similar

to how a robotic arm might reach

out and clean a surface. The system

can be programmed to do the

nanoparticle assembly and motion

control automatically.”

“Routine oral care is cumbersome and

can pose challenges for many people,

especially those who have hard time

cleaning their teeth,” said Hyun (Michel)

Koo, a professor in the Department

of Orthodontics and Divisions of

Community Oral Health and Paediatric

Dentistry in Penn’s School of Dental

“Nanoparticles can be shaped and

controlled with magnetic fields in

surprising ways,” added Edward

Steager, a senior research investigator

in Penn’s School of Engineering and

Applied Science and co-corresponding

author. “We form bristles that can

extend, sweep, and even transfer back

DISRUPTING ORAL CARE

TECHNOLOGY

“The design of the toothbrush has

remained relatively unchanged for

millennia,” said Koo. While adding

electric motors elevated the basic

bristle-on-a-stick format, the

fundamental concept has remained

20 DENTAL ASIA SEPTEMBER / OCTOBER 2022


TRENDS

the same. “It’s a technology that has

not been disrupted in decades.”

Several years ago, Penn researchers

within the Center for Innovation and

Precision Dentistry (CiPD), of which

Koo is a co-director, took steps

toward a major disruption, using this

microrobotics system.

Their innovation arose from a bit

of serendipity. Research groups

in both Penn Dental Medicine and

Penn Engineering were interested in

iron oxide nanoparticles but for very

different reasons. Koo’s group was

intrigued by the catalytic activity of

the nanoparticles. They can activate

hydrogen peroxide to release free

radicals that can kill tooth decaycausing

bacteria and degrade

dental plaque biofilms. Meanwhile

Steager and engineering colleagues,

including Dean Vijay Kumar and Prof

Kathleen Stebe, co-director of CiPD,

were exploring these nanoparticles

as building blocks of magnetically

controlled microrobots.

With support from Penn Health

Tech and the National Institutes

of Health’s National Institute of

Dental and Craniofacial Research,

the Penn collaborators married

the two applications in the current

work, constructing a platform to

electromagnetically control the

microrobots, enabling them to adopt

different configurations and release

antimicrobials on site to effectively

treat and clean teeth.

“It doesn’t matter if you have straight

teeth or misaligned teeth, it will adapt

to different surfaces,” said Koo. “The

system can adjust to all the nooks and

crannies in the oral cavity.”

The researchers optimised the motions

of the microrobots on a small slab of

toothlike material. Next, they tested the

microrobots’ performance adjusting

to the complex topography of the

tooth surface, interdental surfaces,

and the gumline, using 3D-printed

Magnetic and catalytic properties of the iron oxide nanoparticles and their assembly into bristle and floss-like

forms (Image: Melissa Pappas/Penn Engineering)

tooth models based on scans of human

teeth from the dental clinic. Finally, they

trialled the microrobots on real human

teeth that were mounted in such a way

as to mimic the position of teeth in the

oral cavity.

On these various surfaces, the researchers

found that the microrobotics system

could effectively eliminate biofilms,

clearing them of all detectable pathogens.

The iron oxide nanoparticles have been

FDA approved for other uses, and tests

of the bristle formations on an animal

model showed that they did not harm the

gum tissue.

Indeed, the system is fully programmable;

the team’s roboticists and engineers

used variations in the magnetic field

to precisely tune the motions of the

microrobots as well as control bristle

stiffness and length. The researchers

found that the tips of the bristles could

be made firm enough to remove biofilms

but soft enough to avoid damage to

the gums.

The customisable nature of the system,

the researchers said, could make it

gentle enough for clinical use, but also

personalised, able to adapt to the

unique topographies of a patient’s

oral cavity.

To advance this innovation to the clinic,

the Penn team is continuing to optimise

the robots’ motions and considering

different means of delivering the

microrobots through mouth-fitting

devices. They are eager to see their

device help people in the clinic.

“We have this technology that’s as or

more effective as brushing and flossing

your teeth but doesn’t require manual

dexterity,” said Koo. “We’d love to see

this helping the geriatric population and

people with disabilities. We believe it will

disrupt current modalities and majorly

advance oral health care.”

Koo and Steager’s co-authors on the

paper are Penn Dental Medicine’s Min

Jun Oh, Alaa Babeer, Yuan Liu, and Zhi

Ren; and Penn Engineering’s Jingyu Wu,

David A. Issadore, Kathleen J. Stebe, and

Daeyeon Lee.

This work was supported in part by

the National Institute for Dental and

Craniofacial Research (grants DE025848

and DE029985), Procter & Gamble, and

the Postdoctoral Research Programme

of Sungkyunkwan University. DA

This article was first published at Penn

Today.

DENTAL ASIA SEPTEMBER / OCTOBER 2022 21


UNDER THE SPOTLIGHT

What it takes to be

a dental influencer

Dentist, entrepreneur, content creator – how does one find the

balance in juggling these roles? Dental Asia finds out more from

Dr Kayla Teh.

By Czarmaine Masigla

Transforming smiles one tooth

(and content) at a time, Dr Kayla

Teh Khe Sin has over 79,000

followers on Instagram, 27,000

followers on Facebook, and

33,000 subscribers on YouTube.

Also known as Dr Kayla to her

patients and followers, she has

established her name not just in

the online space but also as a

friendly dentist to her patients.

With her enthusiasm for raising

oral health awareness as well

as her passion for aesthetic

dentistry, she founded Dr Kayla

Dental Clinic and now leads

a team of dental specialists

providing comprehensive dental

care. Read on as she shares her

humble beginnings and how her

persistence brought online and

real-life success.

What sparked your interest to

become a content creator and

at the same time specialise in

aesthetic dentistry?

Dr Kayla Teh: When I was

a dental student, I joined a

volunteering programme at

a rural village in Malaysia.

There, I met a young kid with a

cleft lip who was all alone and

none of the other kids wanted

to be his friend because of

his appearance. That could’ve been

prevented if his parents were aware

of bringing him to an oral surgeon to

do repair surgery during the earlier

years of his life. That was the moment

when I realised how important dental

awareness is. I started making videos

on it, and that was back in 2018 when

videos on social media were not such a

common thing.

Then, I began to have some patients

walking in, telling me that they do not

have the confidence to get a job, partner

or simply smile in front of the camera.

So, when I did my first smile makeover

case with veneers, my patient regained

her confidence and came back to tell

me that she met a new partner in life.

That was when I felt true happiness and

realised my ability to help others as a

dentist. This experience and more after

inspired me to keep doing this every

day and keep improving in the field of

aesthetic dentistry.

What are your aspirations as an oral

health advocate and an influencer?

Dr Kayla: It is important to uphold the

standard of dentistry while having fun

on social media. Whenever I create

a piece of content on social media,

I always have three goals in mind:

educate, entertain and inspire.

I love to educate the public on certain

dental topics through videos or social

22 DENTAL ASIA SEPTEMBER / OCTOBER 2022


UNDER THE SPOTLIGHT

media posts. I also like entertaining

them from the point of view of a dentist

because that shows them that dentists

are human too and we just wanted to

help with their dental problems. That

can actually increase the patient’s

acceptance of dental treatment, which

in turn elevates public awareness of

dental care.

I hope to inspire the younger generation

on the beautiful aspect of dentistry –

which to me is an amazing field. I enjoy

every moment of it, creating smiles and

building connections with my patients

which last for generations. I hope that

more people can see and appreciate

this aspect of dentistry as much as I do!

Can you walk us through the

conceptualisation of your dream clinic,

and what is the significance of this

milestone in your career as a dentist?

Dr Kayla: I have always wanted to

make people feel safe. But dentistry?

Oh man, it can be scary to our patients.

When I build my clinic, I want people

to feel like they’re coming back home

to a safe place where they can be

comfortable and more relaxed to share

their dental concerns.

That is why my clinic is homey, it is

also covered in a pastel pink tone –

which is unconventional. But that’s

the beauty of it. It doesn’t give off

that tense, strict vibe. But rather, it

makes you feel comfortable like you’re

walking into an area where you can

relax as well as enjoy the view.

As a dentist, this is a huge milestone

for me. It is a sign that I am no longer

just a clinician, but an entrepreneur,

marketer, manager, and so much more

too. I have a bigger vision now, to not

only excel in my clinical work but also

to build a team of doctors who strive

to achieve excellence in dentistry as

well as patient management. And this

is something we did not learn in dental

school; this is the real world where

we have to be independent, creative,

caring and better than who we are

yesterday.

As a practitioner of digital dentistry,

what are the must-have devices in your

practice, and how do they help you

enhance your service to your patients?

Dr Kayla: Intraoral scanner (IOS), digital

planning software and 3D printer are a

necessity in my daily clinical workflow.

IOS enables me to take dental record

conveniently and comfortably, and helps

in enhancing the communication among

clinicians, dental technologist and

ceramists.

I am also using exocad software to

plan out my cases, be it prosthodontics,

restorative or orthodontics. It helps

me to bring a more comprehensive

approach to my case planning.

For example, most of my patients

who came to me for veneers often

need orthodontics treatment. I will

incorporate digital dentistry into their

orthodontics treatment to measure

the space distribution for their final

veneers as well as monitor their

treatment progress. This gives me more

predictability and control in my clinical

cases, which also gives my patients

more confidence and reassurance.

How do you envision your career as a

dentist in the next five to 10 years, and

what else are you looking forward to in

the future?

Dr Kayla: I look forward to creating more

quality content in dentistry and inspiring

more young dentists to do better in their

clinical work. I hope to show people that

just because you’re out there on social

media, doesn’t mean that you’re all talk

and cannot produce good clinical work.

We are all clinicians and we are here

to help our patients through the skills

and experience we have. I also look

forward to meeting and learning from

more dentists across the globe, after all,

learning never ends.

How do you find the balance between

your role as a dentist and content

creator, and what advice would you like

to give to dental practitioners who are

keen to follow in your footsteps?

Dr Kayla: It is difficult to maintain social

media while upholding your clinical work

standards — at least for me. I plan out

my shooting time as well as clinical

time, but that also means that I have to

sacrifice my personal and family time.

My advice to those who wanted to

engage more patients online is to

be yourself on social media. Many

people think they have to pretend to be

someone with “personality” to engage

more audience but simply being yourself

and showcasing your best sides are

good enough. It also gives a sense of

authenticity when a patient, or a fellow

dentist finally meets you in person. After

all, people love making friends with a

person who is true to himself. DA

DENTAL ASIA SEPTEMBER / OCTOBER 2022 23


DENTAL PROFILE

Transforming the future

of implant dentistry

With innovation and technology, Dentsply Sirona ensures

that clinicians can provide dental implant therapy for life-long

function and aesthetics. Dental Asia speaks with Tony Susino,

group vice-president of Global Implant Solutions, to find out

the latest trends in implant dentistry and how the company

shapes the digital future of the field.

By Czarmaine Masigla

People and products — veteran business

executive Tony Susino shared that this

combination was the key factor when he

joined Dentsply Sirona, one of the world’s

largest manufacturers of dental products

and technologies, this year as the group vicepresident

of Global Implant Solutions.

Having spent the last 15 years in the dental

space, he has never been more optimistic

about the opportunities Dentsply Sirona

provides in terms of an ecosystem of products

and digital solutions.

“At Dentsply Sirona, the employees have a

great passion to create a superior experience

for our customers through optimised

workflows. With our cutting-edge products and

technologies, the company is uniquely suited

to win in this space,” he shared.

In today’s dental landscape, Susino said

that dental implants are set to become the

standard of care for tooth replacement and

edentulism in the years to come.

“Clinicians and their staff are more widely

aware and promoting these therapies over

traditional crown and bridge dentistry, and

that will continue to drive the steady market

growth. Dental disorders such as tooth decay

and cavities, unfortunately, continue to be on

the rise based on the availability of sugary

foods and overall poor nutrition and hygiene

choices,” he elaborated.

The advances in technology and accessibility

of treatment, Susino suggested, have

increased patients’ dental knowledge

too, thereby sustaining the momentum of

industry growth.

“As implant therapy becomes the more

accepted gold standard, governmentled

initiatives and public health dental

programmes will also make implant surgery

more easily available to those in need,”

he continued.

SEAMLESS SOLUTIONS

Dentsply Sirona is poised to meet the

rapidly growing dental implant

demands with their offering

of implant systems,

digital planning

platform, regenerative

and restorative

solutions and

educational

programmes.

Susino

highlighted that

Dentsply Sirona’s

dental implant

systems are

Tony Susino

24 DENTAL ASIA SEPTEMBER / OCTOBER 2022


DENTAL PROFILE

based on a solid scientific foundation with

long-term clinical documentation. In fact, their

products and solutions have been the subject

of more than 2,900 scientific publications

with data from 50,000 patients and 125,000

implants.

For instance, one of the company’s latest

innovations, the DS PrimeTaper Implant

System features a union of form and

function. It has a thread design that enables

it to quickly cut and engage with the bone,

allowing for immediate function and shorter

procedure times.

And with the comprehensive restage of its

implants business including three signature

digital workflows, Dentsply Sirona provided

dental professionals with an innovative way

of practising implantology from scan to crown

that meet expectations in efficiency, accuracy,

aesthetics, longevity and simplicity.

“Dentsply Sirona is committed to the

advancement of our industry as evidenced by

our significant investments in R&D and the

recently built Innovation Center in Charlotte,

NC (US). We also have various facilities

globally that are on the forefront of clinical

education to provide training and resources

for clinicians to continually be on the cutting

edge of their field,” he added.

For practitioners who are just starting out

with their digital implant journey, Susino

recommended accessing the DS Academy’s

Dental Implant Curriculum.

He explained: “It contains interactive,

procedure-based courses, designed by

world-renowned clinicians such as Dr Lyndon

F. Cooper and Dr Bryan Limmer. The virtual

curriculum is comprehensive, tuition-free and

aims to inspire dental professionals to build

and develop their clinical knowledge and digital

skills in implant dentistry, through eight levels

each consisting of 24 courses.

“Practitioners of all backgrounds and different

levels of knowledge can access this course —

from foundational to mastery. They can learn at

their own pace and gain new skills that will help

them give their patients the best possible care

for improved oral health.”

BEST WAY FORWARD

Dentsply Sirona is committed to enabling

clinicians, to focus on growth and enhance

their service. Streamlining implant treatments

equates to consistent patient satisfaction.

“I’ve already met and gotten to know many of

our practitioners. They are exceptional, care

deeply about our products and believe — like

I do — that their success is our success and

vice versa,” shared Susino.

To stay at the forefront of digital dentistry,

Susino encourages dental practitioners to

attend as many symposiums and events

as possible. He believes that they can learn

much from their peers, build professional

networks, tap into each other’s knowledge,

and create groups to discuss trends and

what’s coming next.

“Dentsply Sirona holds events such as

Dentsply Sirona World every year that do

exactly this. It draws in professionals from

all over the world who come to see the

latest in digital dentistry, hear from expert

speakers and see our newest products in

action,” he shared.

On top of that, they have also set up a registry

study which aims to involve more than 500

clinicians and over 2,500 implants for longterm

follow-up.

Embracing and adopting digital dentistry is

the best way forward according to Susino,

who reassured dental professionals that

Dentsply Sirona will be there for them at every

step of their digital transformation: “We are

shaping the technology behind our innovative

solutions, conducting research, and creating

resources to help practitioners expand their

clinical knowledge and digital skills. That is

where we are going, and we are leading the

charge into the future. The future is now!” DA

DENTAL ASIA SEPTEMBER / OCTOBER 2022 25


DENTAL PROFILE

Peek

into the

digital

future

What trends will

sustain the positive

momentum of digital

dentistry? Rune Fisker,

SVP of 3Shape, shares

his insights.

By Czarmaine Masigla

26 DENTAL ASIA SEPTEMBER / OCTOBER 2022


DENTAL PROFILE

The digital era is here. From artificial

intelligence, automated processes,

and so much more, an array of dental

treatment options are now accessible

at a practitioner’s fingertips. These

technologies have elevated the standards

of dental care to a new height which

would not be otherwise possible.

Leading this revolution is 3Shape, a

developer and manufacturer of 3D

scanners and CAD/CAM software for

the dental and audio industries based

in Copenhagen, Denmark. Since the

launch of 3Shape’s first dental lab

scanner software in 2005, the company

has continuously innovated and

reinvented their product solutions.

Over the years, 3Shape has supported

many dental professionals in embarking

on their digital journey, even more

so when facing the unprecedented

challenges brought by the pandemic.

According to Fisker, due to COVID-19,

digital adoption was dramatically

pushed forward by three to five years.

What will continue driving its growth?

He highlighted five major trends:

Intraoral scanning will keep driving

digitalisation. The use of intraoral

scanners (IOS) in dental clinics has

skyrocketed and already penetrated

30-35% in the US and mature markets.

A small, handheld device that builds a

digital model of the teeth and surrounding

structures, many clinicians consider IOS

their entry point in digital workflow –

streamlining the cumbersome procedure

of taking an impression and sending it to

the lab.

Speaking with Prof Dr Lucio Lo Russo,

an Italian dentist, regarding the hygiene

aspect of digital pathways, Fisker

shared that besides the time and money

clinicians save using a digital workflow,

another important aspect to consider

was safety.

Highlighting that digital workflow has

become a means for professionals to

avoid cross-contamination issues,

he explained: “Remember, there is

no impression material to handle

or ship with a digital workflow. So

aside from eliminating the possible

breakage of models with all the

handling, professionals no longer

need to touch, share, or ship models

back and forth.

“All those objects which were in

contact with the patient’s mouth are

theoretically, potentially infected.

If we are not transferring anything

from the clinic to the lab, we are

reducing and controlling any chance

of infection.”

Artificial intelligence (AI) is here.

A field that combines computer

science and robust datasets to enable

problem-solving, AI has finally made

its mark on CAD/CAM. This past year,

Fisker shared that with the launch of

3Shape Automate, scans can now be

uploaded to the cloud, and practitioners

can fully design a crown using AI.

DENTAL ASIA SEPTEMBER / OCTOBER 2022 27


DENTAL PROFILE

we live. Think Netflix or Spotify. With

Unite, our goal is to deliver a similar and

seamless service where professionals

can pick and choose their treatment

partner just like they would pick the next

movie to watch.”

SYNERGISTIC COLLABORATIONS

As the technology for digital pathways

continue to improve, Fisker is positive

that more practitioners will embrace it in

practice and put high appreciation for its

potentials.

“When it comes to introducing new

solutions, it is one thing to have an idea,

it is a whole other ball game to make it

happen. That is where 3Shape’s huge

brainpower trust, an army of engineers,

and data comes in,” he said.

3Shape has also utilised this technology

in TRIOS intraoral scanner to allow user

of any skill level to capture accurate

digital intraoral impressions with greater

ease in less time.

“There will be much more to come as

AI is making computers smarter and

faster across all applications in digital

dentistry,” he continued.

Aligners and dentures are rapidly

adapted. Fisker said that cosmetic

dentistry and clear aligners will continue

to push digitalisation forward, driven by

consumer demand for aesthetics.

While dentures remain the big missing

indication, he noted that their stats show

that this is changing fast with three-digit

growth in digital denture cases.

Considering Asia’s ageing population

affecting the demands for tooth

replacement, he said: “When treating

older patients, digital dentistry delivers

higher efficiency, better clinical results

and an overall improved patient

experience that further accelerates

digital adoption.”

3D printers are hot. A true game-changer

will be 3D printing materials, Fisker

emphasised, as new and improved

materials are being released every day.

He elaborated: “Driven by new printing

materials, high-quality splints are a

reality and I believe, 100% 3D printed

final dentures will soon take off.

Ultimately, all indications will have the

potential to be 3D printed, which would

make the major question being how

deep will 3D printers penetrate the

practice?”

With strong technology development

and approximately only 5% of the

world’s dentures presently being

manufactured digitally, Fisker foresees

that the industry will witness a lot

of growth in this area. As printing

materials become better, he added,

more and more types of restorations

will be printed due to their affordability,

speed, and practicality.

The dental platform race has begun.

3Shape is one of the key drivers of this

trend globally and is playing a crucial

role in its rapid adoption as reflected

with the successful launch of their

Unite platform.

Fisker elaborated: “Like all industries,

platforms have disrupted the way

For instance, 3Shape has recently

launched a Smart Phone App that enables

dentists and labs to communicate and

add pictures directly from the phone –

anywhere, anytime. They have also

released TRIOS Unite, which delivered

significant improvements to the workflow

and communications.

He explained: “Little additions like

enabling partners to chat, so they do not

need to keep checking emails, creating

a URL for the lab to share a case with a

practice that may not be using 3Shape

solutions, or DIY order forms for labs,

these types of initiatives go a long way

in making dental professionals and their

workflows more efficient.”

3Shape has also taken advantage

of social media to stay close to

dental professionals considering it

as a learning and sharing platform.

Fisker shared that on Facebook,

there are two study groups focusing

on 3Shape solutions, and combined

they have nearly 45,000 members. He

considers this as a great resource for

understanding their customers.

“That is a lot of people talking about

digital workflows, tips and tricks and

even complaining about something.

But it gives us a direct and instant

28 DENTAL ASIA SEPTEMBER / OCTOBER 2022


DENTAL PROFILE

apartment to being a business leader and

innovator across the globe. The cool thing

though, is somehow we have managed to

retain that entrepreneurial spirit of always

wanting to get better, grow and be open to

new ideas.”

Fisker considers South East Asia (SEA)

as a terrific market for digital dentistry

as many of the countries are already

electronically savvy that adopting new

technology is second nature. In addition,

digital pathways provide an opportunity

to deliver more cost-effective treatments.

connection to what is happening out

there. I would quickly run out of fingers

counting the amounts of times we have

received a suggestion for a new feature

from a study group and then made it

happen in the next software update,”

he commented.

Fisker highlighted that working alongside

dental professionals to translate their

ideas into reality is the cornerstone of

3Shape’s product development.

SHAPING THE FUTURE

Undoubtedly, 3Shape has become a

major player in the dental industry

shaping the future of digital dentistry.

Being one of the pioneers in 3Shape

– in fact, the third employee – Fisker

himself was astonished as to how

3Shape changed over the years as an

organisation and a trailblazer the field.

He shared: “What I have witnessed is us

go from a little start-up in a Copenhagen

He concluded: “In many of the rural areas,

a digitally printed prosthesis may be the

only affordable alternative for a person

and could literally mean the difference

between life and death for some patients.

The more digital penetration in the SEA

market, the more people will have access

to dental treatment.

“We see lots of innovative business

models for selling intraoral scanners

around the world, I think if entrepreneurs

and even governments could get behind

dental professionals and make them easier

to purchase, it would be a tremendous

benefit to millions of people.” DA

DENTAL ASIA SEPTEMBER / OCTOBER 2022 29


DENTAL PROFILE

The

hundred

years

of Shofu

Established on 15 May 1922 in Kyoto, Japan,

Shofu is a global manufacturer deeply

involved in the field of dentistry offering a

wide range of dental materials, equipment

and instruments.

By Czarmaine Masigla

Over the years, the treatment

philosophy in dentistry has shifted

from invasive to a more conservative

approach – with Shofu spearheading

development of products and

technologies, emphasising prevention

and preservation of natural tooth

structure.

Commemorating their centennial

anniversary, Mr Noriyuki Negoro, CEO

and chairman of Shofu, takes a trip

down memory lane with Dental Asia

to ponder on the company’s founding

years, and elaborates on how they will

continue to revolutionise the dental

industry in years to come.

FOUNDING YEARS

Mr Kajo Shofu III, the founder of

Shofu, was involved in numerous

businesses, including the export of

ceramics, industrialisation of ceramic

manufacturing, and the insulator

business based on Kiyomizu-yaki

porcelain technology, as Mr Negoro

shared.

In 1915, during a visit to North America

to expand sales channels for the export

of ceramics, the founder was advised by

Dr Mitsuru Okada, MD (later professor

of oral surgery at Keio University School

of Medicine) on the need for domestic

production of high-grade porcelain teeth.

30 DENTAL ASIA SEPTEMBER / OCTOBER 2022


DENTAL PROFILE

The journey was not a walk in the

park – as it required identifying

tooth shapes and sizes suitable

for the Japanese people, sourcing

biocompatible materials and

appropriate manufacturing methods.

Seven years later, after overcoming

several challenges, Mr Shofu III

realised his dream with the help

and cooperation of many people to

successfully manufacture the first

high-grade porcelain teeth in Japan –

laying the cornerstone for Shofu.

In 1965, Shofu succeeded in

developing the world’s first dental

spherical amalgam, “Shofu Spherical

Amalgam”, recognised by clinicians as

a revolutionary product with excellent

handling and mechanical properties,

and was considered a breakthrough in

the dental industry.

the Japanese dental industry to be

listed in the Osaka Stock Exchange

and subsequently in the Tokyo Stock

Exchange in 2007,” he added.

Since then, the company has diversified

its product range to include not only

artificial teeth, but a wide variety of

dental products, laboratory materials,

preventive products, and materials for

digital dentistry. Now an international

enterprise, Shofu has subsidiaries and

sales offices in the US, Germany, UK,

Singapore, China and in recent years

Italy, India, Brazil, the Middle East and

Taiwan.

Mr Negoro continued: “These

developments aim to contribute towards

improving the standards of dental care.

The R&D-oriented and innovation-driven

management approach adopted since

the company’s founding is proof that our

founder’s passion for ‘high aspirations

and drive for achieving them’ lives on in

our DNA.”

COMMITMENT TO BETTER

DENTISTRY

According to the Global Burden

of Disease study published by the

World Health Organization (WHO) in

2016, dental caries remains the most

common disease in the world, despite

regional disparities due to economic

status and healthcare systems. The

Lancet and Journal of Dental Research

also reported that more than 30% of

people have untreated dental caries.

Hence, Shofu’s vision is to continue

to provide proven products for better

dentistry worldwide with a commitment

to quality and excellence, emphasising

that beautiful teeth are the symbol of

health and happiness.

Additionally, the company’s rotary

instruments was well regarded,

and the brand reputation of “Shofu

Abrasives” was established not only

in North America but also in the

global market.

Such innovation helped propel the

company’s overseas expansion,

leading to the establishment of sales

offices in the US in 1971, Germany in

1978 and Singapore in 1980.

Mr Negoro also shared that during

the 1980s when Shofu was under

a crisis due to Japan’s healthcare

reform, then President Kajo Shofu V,

changed the company’s focus from

quantity to quality and implemented

management reforms to ensure the

company’s survival, under the slogan

of “Response to Change”.

“The foresight of the president and

commitment of the employees

resulted in the development of a

series of high-quality value-added

products that helped transform the

company into a highly profitable

business. As a result, in 1989, Shofu

became the first company from

Mr Noriyuki Negoro, CEO & chairman of Shofu (Left) with Mr Tetsuo Takami, president & COO of Shofu (Right)

DENTAL ASIA SEPTEMBER / OCTOBER 2022 31


DENTAL PROFILE

With the dental field continuously

evolving digitalisation, artificial

intelligence (AI), and dental material

science taking the centre stage in

product innovation, Shofu maintains

profitability and growth by identifying

expansion opportunities.

“As a company, we had focused our

business activities mainly in Japan,

a stable market with a generous

national medical insurance system

and successfully introduced many

revolutionary products over the years

contributing to the development

of dentistry. Our success in the

domestic market laid the foundation

for international expansion, with more

strategic business activities extended

beyond Japan to capture the global

market,” he explained.

Based on their management philosophy

and vision, Shofu is actively engaged

in business activities to increase

their global presence with continued

efforts to provide evidence-based

product innovations using cutting-edge

technology with end-to-end solutions

for the wider dental community.

And although the company promotes

globalisation in its business activities

internally and externally, Mr Negoro

highlighted that it is equally important

for them to adapt to local needs across

diverse markets.

For instance, the Shofu Dental Asia-

Pacific subsidiary has been a crucial

part of Shofu’s global footprint looking

S-PRG Technology

after its growth in the Asia-Pacific and

Middle-East markets. Recognising that

the local treatment trends had shifted

from aggressive to minimally invasive,

Shofu has become the official partner

of the Minimally Invasive Cosmetic

Dentistry (MiCD) Global Network and its

digital platforms.

Mr Negoro shared: “Our team at Shofu

Dental Asia-Pacific felt that the MiCD

philosophy matched very well with

the benefits of our range of bioactive

products, hence we have worked closely

with Dr Sushil Koirala and like-minded

clinicians to establish the MiCD Concept

and treatment protocol.”

BRIGHT SMILES FOR THE NEXT

CENTURY

Commemorating their rich history and

legacy of product innovations toward

enhancing smiles, Shofu launched their

100th-anniversary logo and slogan

representing their commitment to

contributing to the bright smiles of

people globally for the next century.

Mr Negoro noted that as the company

values the tireless efforts of its people,

the slogan was selected from the

employee submissions: “The ‘0’ in the

centre of the ‘100’ figure takes the form

of a tooth and a face depicting a ‘bright

smile’. The line extending from the roots

of the tooth towards the Shofu logo

indicates the progress of the company

over the years from 1922 to 2022, and

the journey ahead for the next 100 years.”

Looking ahead, Mr Negoro foresees that

public health focus would shift towards

prevention and oral health education.

He also predicts that AI-driven remote

examination with digital diagnostic

techniques and preventive treatment

will be implemented in each generation,

especially in the ageing population.

He elaborated: “Adequate oral hygiene

maintenance becomes more challenging

in older age group due to chronic

diseases such as diabetes, druginduced

xerostomia and other medical

conditions as they retain more teeth.

Unlike in the past, implant-supported

dentures and partial dentures are

becoming more popular increasing the

risk of oral disease.”

Therefore, Shofu targets to expand

their Giomer/S-PRG technology

into various areas and to enrich the

Giomer product tree, with a specific

elder care product range that includes

a homecare treatment regimen for

exposed root surfaces and denturerelated

products.

“S-PRG fillers are incorporated into

new bioactive materials based on

our proprietary technology (PRG

technology), and have been proven

to provide bioactive benefits such

as inhibiting bacterial growth and

adhesion, reduction in plaque formation,

acid neutralisation and increased acid

resistance by strengthening the natural

tooth structure,” he explained.

A gateway to overall health, oral health

is essential for people to lead rich

and fulfilling lives. As the world enters

the era of a 100-year human lifespan,

Mr Negoro concluded that the role

of dentistry will become increasingly

important in extending people’s healthy

life expectancy.

“For the next 100 years, we will continue

to contribute towards the advances in

dentistry while embracing the challenge

of creating bright smiles that improve

the quality of life of people around

the world. In the past 13 years, I have

served as the president and CEO of the

company and am proud to announce

that Mr Tetsuo Takami has now

become my successor as the president

and COO effective 24 Jun 2022.

“I will oversee the management of

the company as CEO and chairman,

while Mr Takami will be responsible for

business execution. We will continue

to focus on developing innovative

solutions that meet the changing trends

in dentistry and we are looking forward

to the future growth of Shofu under the

new management.” DA

32 DENTAL ASIA SEPTEMBER / OCTOBER 2022


CLINICAL FEATURE

Effects of PBM on implant

and bone grafting after

sinus elevation

Dr Kevin Ng and Dato’ Dr How Kim Chuan discuss the use

of photobiomodulation (PBM) device with 42 LED cores

producing 650nm wavelength light in shortening treatment

time and improving surgical outcome.

Maxillary bone resorption after

extraction of posterior teeth could

cause severe bone loss and greatly

reduce bone height and volume at

the sinus base if the edentulous

sites were not loaded for a long

period. It may not show apparent

sign and symptoms and not cause

any concerns to patient; however,

the resorption process is irreversible

unless treatment is performed.

Eventually, it will become an

obstacle in placing dental implants

and the average treatment time to

graft and gain bone is usually long

to achieve satisfactory results.

These factors have been bothering

dentists and patients since

treatment outcomes may not

always be successful if implant

stability is not achieved. To assist

graft, bone healing and growth,

and at the same time, enhance

patient cooperation and compliance,

photobiomodulation (PBM) can be

utilised to reduce pain and shorten

treatment time.

Although different clinicians hold

different views regarding to the

application of PBM to influence bone

regeneration and outcomes, the

following case showed satisfactory

patient feedback and acceptable

clinical result.

Fig. 1

Fig. 2

Fig. 3

THE PBM DEVICE

The bite plane device consists of 42

LED cores and the power input is

4.2V. The current of each LED core is

7mA. The LED cores produce light of

650nm wavelength to stimulate the

target sites. The energy absorbed

after six minutes stimulation per

arch is about 306.5 joules (Figs. 1-3).

The manufacturer claims that the

science of PBM mechanism is to

enhance the biological activities at

cellular level of the treatment area

and improve the healing of bone and

soft tissues and further enhance

bone growth and repairs.

34 DENTAL ASIA SEPTEMBER / OCTOBER 2022


CLINICAL FEATURE

Figs. 4a

Figs. 4b

Figs. 4a-b: Pre-treatment (a) OPG planning and 4b CT view show only 2mm bony height (b) OPG planning for augmentation site

Figs. 5a

Figs. 5b

Figs. 5a-b: Post-treatment (a) Bone graft after five weeks (b) Week 10 - implants ready to load

Figs. 6a

Figs. 6b

CASE REPORT

A 55-year-old male patient presented

with severe bone loss at the upper

right molar region (teeth 15, 16, 17

area) with only 2-3mm remaining

bone height (Figs. 4a-b). The patient

had difficulty chewing on the right

side and requested for dental

implant. The medical history was

clear and he had received implants

before at teeth 45 and 46.

Sinus floor elevation was performed

by external window and 2cc of

graft were placed with membrane

protection. PBM was prescribed

to patient for 5-6mins daily. Pain

thresholds were recorded for two

weeks post-operatively. Two dental

implants were placed at teeth 15 and

16 areas five weeks after the graft

with insertion torques of 40N, that

were achieved with ISQ 65, 68. PBM

was continued for 5mins daily in

another five weeks before ISQ 70

were recorded for both implants

and successfully loading with two

splinted crowns restoration.

The total treatment time was 10

weeks, and the patient reported

that the chewing function was

satisfactory after the splinted

crowns were constructed. The

PBM device was utilised for 5mins

daily and the patient was advised to

return to clinic monthly to check

stability of implant and ensure

good oral hygiene. At the same

time, the patient was also informed

to record the degree of pain or

discomfort in the given form during

treatment. The feedback pain

scores were two to three for the

whole period. OPG was taken after

treatment revealing uneventful

healing with no sign of infection

(Figs. 5a-b, 6a-b).

DENTAL ASIA SEPTEMBER / OCTOBER 2022 35


CLINICAL FEATURE

Fig. 7a

Figs. 7a-b: Energy of light is absorbed

Fig. 7b

were released in the gingival crevice and

affect bone remodelling. PBM stimulations

have increased the levels of IL-1β, IL-8,

OPN, and PGE2 LLLT was statistically

related to an increase of IL-1β levels. It was

suggested cytochrome c oxidase present in

mitochondria of cells can absorb photons

and convert this EMF energy into chemical

energy (ATP). Surgical manipulation causes

wound tissue ischemic and hematopoietic.

Precursor cells and fibroblasts decrease ATP

and metabolism, PBM deliver energy to cells

and increase ATP production which aids

wound or tissue healing and bone formation

with increased blood supply to the area 17 .

Fig. 8a

Figs. 8a-b: Implant healing process

DISCUSSION

Dentists routinely use external sinus lift

technique for augmentation of maxillary

sinus to increase bone height and volume,

enhancing implant stability. The surgical

procedure is complicated and involves

buccal wall removal to place sufficient graft

materials for maximum bone volume to grow.

The post-operative pain and complications

cause concerns to dentists and patients.

With the usage of PBM devices in different

specialties of dentistry in the past decade,

Kau in 2013 assessed 73 patients and 17

controls who were fitted with traditional

orthodontic brackets and wires and treated

with 850nm wavelength near-infrared light

with a power density of 60mW/cm2 for 20-

30mins per day. He observed PBM achieved

clinically significant accelerated tooth

movements as compared to control group.

Lao proposed PBM is a non-invasive

stimulation of the dentoalveolar complex

with ATP production at the mitochondrial

cells. Due to increased metabolic activity,

ATP is increased at a localised level and

cause remodelling process. Infrared

light double cytochrome oxidase level

which mediates ATP production. Higher

Fig. 8b

ATP availability accelerate cell turnover

resulting faster remodelling process

and tooth movement. A total of 1.12mm

movement per week for PBM group were

observed compared to 0.49mm in control

group (Figs. 7a-b, 8a-b).

The mechanism of PBM is due to certain

biological wavelengths elicited by the

LED cores that have therapeutic effects at

cellular levels. The photon source after LED

produced favourable effects both in animal 3

and recently human clinical studies 12,14,15 .

The early clinical trial started with pain

control, tooth movement acceleration, and

increase bone remodelling and quality.

Recently, this therapeutic technology had

success reports on the improvement in

mini-screw stability, TMD disorders, root

resorption, bone consolidation during

maxillary expansion and distraction

osteogenesis. It is easy to operate and

non-invasive, the clinical use is wide. Shan

et al. in 2021 found that PBM had promising

effect on post-orthodontic root resorption

rehabilitation 1 .

Reis et al. in 2021 suggested during

orthodontic tooth movement, cytokines

Brawn et al. in 2017 investigated the use of

Biolux light emitting diode phototherapy

daily for 21 days on extracted socket with HA

grafting. They found there was accelerated

bone healing in the phototherapy-treated HA

socket graft. This may provide faster implant

osseointegration and healing compared to

control group 17 .

Ekizer et al. in 2016 studies found PBM had

potential of accelerating tooth movement

and had a positive effect on mini-screws 4,9

and these results were agreed by Asparanin

et al. in 2019. They found that there was

statistically significant difference between

PBM therapy compared to non-stimulated

group with a mean difference of 0.59 8 . It

was proposed that the action of LPT IL-1B

attract leucocytes and stimulate fibroblasts,

endothelial cells, osteoclasts cause the

effects 9 .

In another study, Ozturk in 2020 found PBM

applications has showed inhibitory and

reparative effects on OIIRR by modulating

the RANKL and COX-2 expression levels,

which include resorption lacunae volume (p

& lt; 0.001), number of resorption lacunae (p

& lt; 0.05), and percentage of the resorption

(PR) lacunae (p & lt; 0.001). The levels

decreased with PBM applications when

compared with the positive control groups.

They also found the effects of the different

wavelengths were similar 7 .

Sfondrini et al. in 2020 studied the pain

experience on subjects with banded maxillary

36 DENTAL ASIA SEPTEMBER / OCTOBER 2022


CLINICAL FEATURE

first molars. Each molar received one

session of PBM treatment on two buccal and

two palatal points. In the trial group, PBM

treatment has shown to be an alternative

to decrease pain sensation as compared to

control group 11 .

Reis et al. in 2021 suggested during

orthodontic tooth movement, cytokines

were released in the gingival crevice and

affect bone remodelling. PBM stimulations

have increased the levels of IL-1β, IL-8, OPN,

and PGE2 LLLT was statistically related to an

increase of IL-1β levels 10 .

Abellán in 2021 use intraoral scanner and

CBCT to study molar intrusion using mini

screw as anchorage. Again, they found

the technique is effective in accurately

monitoring the intrusion distance

(p > 0.05). CBCT records allowed volumetric

evaluation of the root resorption process

and found lesser in the PBM group. They

also suggested: ‘’application of PBM may

provide better periodontal records and

lower progression of root resorption at the

expense of little lower intrusion distance

and velocity’’ 5 .

Both Kwong in 2022 and Kulkarni in 2019

reported several in vivo and in vitro studies,

revealing that PBM improved bone wound

repairs after surgery when compared with

control groups. Dental implants stability

were also improved with less pain 17,18 .

Finally, Caccianiga in 2022 reported 30

patients treated rapid palatal expansion. Pain

was significantly lower in the experimental

group 16 . PBM was used in orthodontics

together with anchoring TAD micro-screws

as stability. After 60 days post-treatment,

significantly higher stability was noted in the

PBM group, and the authors had concluded

that application of the 808nM diode laser

increased micro-implant stability clinically.

PBM also decreased pain felt by patient 2 .

CONCLUSION

With the updated literature presented

above, it is possible to apply PBM safely to

assist sinus lifted patient and to improve

treatment time and outcome for patients

who have received implant treatments.

The findings here suggest that intraoral

PBM could be used to reduce pain and

discomfort and improve quality of bone

formation that could promote bone healing

and osseointegration of dental Implants.

The healing time and loading time had been

reduced to half in this case. However, due

to its research limitations, further extensive

research by multi-centred, randomised

clinical trial is suggested. DA

REFERENCES

1.

Shan Z, Wong K, McGrath C et al (2021)

Comprehensive Effects of Photobiomodulation

Therapy as an Adjunct to Post-orthodontic

Treatment Care: A Systematic Review. Oral Health

& Preventive Dent 19:203-216 quintpub.com 2021

2.

Matys, J.; Jaszczak, E.; Flieger, R.; Kostrzewska-

Kaminiarz, K.; Grzech-Leśniak, K.; Dominiak,

M. Effect of ozone and diode laser (635 nm) in

reducing orthodontic pain in the maxillary arch—a

randomised clinical controlled trial. Lasers Med.

Sci. 2020, 35, 487–496

3.

Melo Conti C, Suzuki H et al(2019) Effect of PBM

on root resorption induced by orthodontic tooth

movement and RANKL/OPG expression in rats.

Photochemistry and Wiley Online Library

4.

Atsawasuwan P, Shirazi S (2018) Advances in

orthodontic tooth movement: gene therapy and

molecular biology aspect Current approaches in

Orthodontics, pp 41-68 2018-books.google.com

5.

Abellan R, Gomez C, Palma J (2021) Effect of PBM

on the Upper first molar intrusion movement using

mini-screw anchorage: A randomised Controlled

Trial Photobiomodulation, Photomedicine, and

Laser Surgery Vol. 39, No. 8-liebertpub.com

6.

Kumar AN, Jadhav V et al ((2021) Light Emitting

Diode Mediated PBM Therapy in Orthodontics-A

Review of Contemporary Literature Journal of

Evolution of Medical and Dental Sciences(Vol. 10,

Issue 32)

7.

Ozturk T, Amuk GN (2020) Effect of PBM at

different wavelengths on orthodontically induced

root resorption In orthodontic retention period : a

micro-CT and RT-PCR study. Lasers Med Sci 2020

35: 1419-29

8.

AlShahrani I, Togoo RA Hosmani J (2019)

PBM in acceleration of orthodontic tooth

movement: A systemic review and meta analysis

Complementary Therapies in medicine Vol 47 2019

–Elsevier

9.

Ekizer A, Türker G, Uysal T, Güray E, Taşdemir

Z (2016) Light emitting diode mediated

photobiomodulation therapy improves orthodontic

tooth movement and mini-screw stability: a

randomized controlled clinical trial. Lasers Surg

Med 48(10):936–943

10.

Reis C, Furtado T,Mendes W (2021) PBM impacts

the levels of inflammatory mediators during

orthodontic tooth movement? A Systemic review

with meta-analysis Lasers in Medical Sc 2021

Springer

11.

Sfondrini MF, Vitale M, Pinheiro ALB (2020)

PBM and pain reduction in patients requiring

orthodontic band application: randomized clinical

trial BioMed res Int Article ID 7460938 2020 –

hindawi.com

12.

Heravi F, Moradi A, and Ahrari F, (2014) The

effect of low level laser therapy on the rate of

tooth movement and pain perception during

canine retraction Oral Health and Dental

Management, vol. 13, no. 2, pp. 183–188

13.

Shaughnesy T, Kantarci A et al (2016)

Intraoral photobiomodulation-induced

orthodontic tooth alignment: a preliminary

study, BMC Oral Health volume 16, Article

number: 3

14.

Kau CH, Kantarci A, Shaughnessy T et

al (2013) Photobiomodulation accelerates

orthodontic alignment in the early phase of

treatment Progress in Orthodontics volume 14,

Article number: 30

15.

Deana NF, Zaror C, Sandoval P, Alves N

(2017) Effectiveness of Low-Level Laser

Therapy in Reducing Orthodontic Pain: A

Systematic Review and Meta-Analysis. Pain

Res Manag

16.

Caccianiga G et al (2022) Pain Reduction

during Rapid Palatal Expansion Due to LED

Photobiomodulation Irradiation: A Randomized

Clinical Trial Life 2022, 12, 37. 17. Brawn P,

Kwong A (2007)

Histologic comparison of light emitting diode

phototherapy-treated hydroxyapatite-grafted

extraction sockets: a same-mouth case study

Implant Dent 2007 Jun;16(2):204-11

17.

Kwong A, Kantarci A (2022) PBM Implant:

Intraoral PBM Device Dental Asia May/June

2022 pp34-36

18.

Kulkarni S, Meer M, George R (2019) Efficacy

of photobiomodulation on accelerating bone

healing after tooth extraction: a systemic

review, Lasers Med Sci 34: 685-692

ABOUT THE AUTHORS

Dr Kevin Ng is

a specialist in

community dentistry,

a visiting professor

at Guangzhou

Medical University,

and was a Hon a/clinical professor at

the University of Hong Kong from 2017

to 2019.

Dato’ Dr How

Kim Chuan is the

president of ICD

Section XV and the

Osseointegration

Society of Malaysia,

and a visiting

professor at Zhejiang Chinese Medical

University; a visiting associate professor

at both the Air Force University and

Hong Kong University.

DENTAL ASIA SEPTEMBER / OCTOBER 2022 37


CLINICAL FEATURE

Root coverage on a

gingival recession type 2

Dr Francesca Daye See-Santos presents a coronally-advanced flap

with subepithelial connective tissue graft to address periodontal

attachment loss due to aggressive toothbrushing.

A 45-year-old female came to the

periodontics department of the

University of the East-Manila,

complaining about how her maxillary

canines appear longer than before.

The patient has an unremarkable past

medical history and no known vices

such as smoking or alcoholism.

Upon intraoral examination, several

dental caries and non-carious cervical

lesions (NCCL) were observed. The

patient was currently wearing upper

removable prosthesis and admits

of aggressive toothbrushing on her

remaining natural teeth.

Deep NCCL restorations have been

done to some of her posterior

teeth, while surgical root coverage

procedure was discussed to be done

on her maxillary canines. Patient’s

labial probing depths in millimetres

were 2, 2, 2 (distal to mesial) and

gingival margins were +2, +5, +1 (distal

to mesial). Clinical attachment loss

computed was as 4mm on mesial,

7mm at midroot and 3mm on distal.

DIAGNOSIS

As per gingival recession classification

by Cairo et al., where interdental

clinical attachment loss is measured,

the patient’s gingival recession on

the right maxillary canine is classified

as Recession Type 2 (RT2). RT2 is

characterised by the interproximal

attachment loss being less than or

equal to the buccal attachment loss

(Figs. 1a-d).

SURGICAL PROTOCOL

After disinfection with chlorhexidine

mouth rinse, supraperiosteal

infiltration on labial and palatal was

performed and the exposed root

of tooth 13 was scaled and planed

using 2R/2L universal curette. Local

anaesthesia given was 2% Lidocaine

HCl with 1:100,000 epinephrine.

Fig. 1a

Fig. 1b

The recipient site was prepared

by making a trapezoidal partialthickness

flap with two vertical

incisions mesiodistally with the use

of a 15c blade (Fig. 2). A sterile strip of

aluminium foil is used as a template

for harvesting donor tissue and

Fig. 1c Fig. 1d Fig. 2

Figs. 1a-d: Pre-operative intraoral photos and radiograph (Tooth 13)

Fig 2: Trapezoidal partial thickness flap (two releasing incisions)

38 DENTAL ASIA SEPTEMBER / OCTOBER 2022


CLINICAL FEATURE

Fig. 3a Fig. 3b Fig. 3c

Figs. 3a-c: Preparation of recipient site and application of root conditioner

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

Figs. 4a-c: Pre-operative photos of harvesting of connective tissue graft on palate donor site.

(a) Bleeding points noted (b) harvested palatal tissue with 3mm of keratinised mucosa (c) donor site

bleeding points were done (Fig. 4a).

The planned donor connective tissue

was characterised by an epithelial cuff

covering half of the harvested tissue

and is to be placed coronally at the

recipient site.

Using a 15c blade, a partial thickness

horizontal incision was made 6mm

apical to the gingival margin in the

palate, then another horizontal

incision at full thickness was made

3mm apical to the palatal gingival

margin. It was followed by a full

thickness vertical incision mesiodistally

approximating the width and length of

the necessary graft.

A primary partial-thickness flap

(1.5mm thick) was prepared toward

the centre of the palate, parallel

to the palatal gingiva so that the

underlying connective tissue is

exposed. The connective tissue

graft was reflected, and was

brought toward the centre of the

palate and separated from the

bone using a surgical blade 15. An

absorbable haemostatic gel was

placed on the palatal surgical site

to control bleeding (Figs. 4a-c).

At the recipient site, smear layer

was removed on exposed root

surface with tetracycline solution

on a piece of cotton, left for three

minutes, and washed thoroughly.

The connective tissue graft was

positioned at the recipient site with

the thin border of epithelium coronal

to cemento-enamel junction (CEJ).

Interrupted sutures using Vicryl

5-0, 3/8 reverse cutting 12mm needle

was placed on the interdental papilla

to secure the graft in place, followed

by multiple periosteal sutures at the

edges of the graft for stability. An

interdental concavity suture was

done to prevent dead space formation

under the graft. The partial thickness

flap was displaced coronally to

DENTAL ASIA SEPTEMBER / OCTOBER 2022 39


CLINICAL FEATURE

Before any elective oral surgical procedures,

systemic health, smoking and oral hygiene

must be considered because healing of the

surgical site may be compromised. For root

coverage procedures, gingival recession

classification should be taken into account

for predictable outcomes.

Fig. 5a

Fig. 5b

Fig. 5c Fig. 6

Figs. 5a-c: (a) Connective tissue graft placement (shaded region shows keratinised mucosa)

(b) subepithelial connective tissue graft secured with interdental concavity sutures and periosteal sutures

(c)Partial thickness flap secured with interrupted sutures

Fig. 6: Post-operative photo after seven days

Miller classified gingival recessions into 4

classes based on severity:

A. Class I: Marginal tissue recession does not

extend beyond the mucogingival junction

(MGJ) and no loss of interproximal tissue.

B. Class II: Marginal tissue recession

extend to or beyond MGJ, with no loss of

interproximal tissue.

C. Class III: Marginal tissue recession

extends to or beyond MGJ, with some loss

of interproximal tissue or tooth rotation and

interproximal bone is still coronal to the

apical extent of the recession

D. Class IV: Marginal tissue recession

extends to or past the MGJ, with severe loss

of interproximal tissue or tooth rotation.

cover the graft as much as possible and is

secured with sutures (Figs. 5a-c). Lastly,

several interrupted sutures were placed

on the palatal donor site to hold the blood

clot as well as the haemostatic gel (Fig. 4c).

Post-operative instructions for bleeding,

wound care, diet and oral hygiene were

given. Over-the-counter analgesics were

prescribed and patient was dismissed

with minimal bleeding on both surgical

sites. Patient was instructed to avoid

warm or hot food and beverages, place

cold compress only 20 mins of every

hour for the first day, avoid chewing at

the surgical site, avoid brushing on the

area for the first few days, have a cold,

soft diet, drink plenty of fluids, and gently

gargle 10ml of undiluted 0.12% Orahex

Mouthrinse for 30 seconds, twice a day

for two weeks.

The patient was informed to come back

for follow-up checkup after seven days

for review and to remove necessary

sutures if needed (Fig. 6).

DISCUSSION

Gingival recessions are seen as the

displacement of the gingival margin

apically, thereby exposing the tooth’s root

surface to the oral environment. They may

be accompanied with sensitivity, which

is one of the most common reasons for

a patient to seek treatment, along with

patient’s aesthetic complaints (Chan et al.,

2015 and Douglas et al., 2013). Causative

factors include low-level, long-lasting

trauma, chronic inflammatory periodontal

disease, periodontal treatment and

occlusal trauma (Jati et al., 2016).

As the patient disclosed, her aggressive

toothbrushing habit caused chronic

trauma to the delicate gingival tissues and

consequently making her teeth appear

longer. Cervical abrasions may be also

observed in patient with inappropriate

brushing techniques. Patients with bone

dehiscence, tooth malposition, thin gingival

tissue, inadequate attached gingiva and

frenal pull can predispose the patient to

receding gingival margins (Chan et al., 2015).

Classes I and II expect 100% root coverage,

Class II expects 70% root coverage and

Class IV less than 50%. Limitations for this

classification were noted such as difficulty

of Class I and Class II identification and

prognosis per classification no longer

matches the predicted outcome when

more advanced surgical techniques were

performed (Pini-Prato, 2010).

The patient has a dental history of tooth

extractions notably adjacent to the maxillary

canines, which hastened proximal bone loss.

Interproximal and buccal clinical attachment

level is suggested to have predictive value for

root coverage procedures (Cairo et al., 2011).

Written below is the modern, treatmentoriented

classification of recession based on

interdental clinical attachment level:

A. Recession Type 1 (RT1): Gingival recession

with no loss of interproximal attachment.

Interproximal CEJ is clinically not detectable

at both mesial and distal aspects of the

tooth.

B. Recession Type 2 (RT2): Gingival recession

associated with loss of interproximal

attachment. The amount of interproximal

40 DENTAL ASIA SEPTEMBER / OCTOBER 2022


CLINICAL FEATURE

attachment loss (measured from the

interproximal CEJ to the depth of the

interproximal sulcus or pocket) is less than

or equal to the buccal attachment loss

(measured from the buccal CEJ to the apical

end of the buccal sulcus or pocket).

C. Recession Type 3 (RT3): Gingival recession

associated with loss of interproximal

attachment. The amount of interproximal

attachment loss (measured from the

interproximal CEJ to the apical end of the

sulcus or pocket) is greater than the buccal

attachment loss (measured from the buccal

CEJ to the apical end of the buccal sulcus

or pocket).

Areas with Cairo RT1 (Miller Class I and

Class II) that had undergone treatment is

predicted to achieve 100% coverage. Teeth

with Cairo RT2 (Miller Class III overlap) may

be observed to have 100% root coverage

with different root coverage techniques. In

recessions classified as Cairo RT3 (Miller

Class IV overlap), complete root coverage is

not achievable.

The patient reported here cannot be

classified as Miller Class I, though recession

does not go beyond MGJ, interproximal

tissue is present. Therefore, Cairo RT2 is

well-suited for this case, interproximal

attachment loss is less than buccal

attachment loss.

Researches over the years have been made

in order to forecast results of root coverage

procedures. One stated that the final

position of the new gingival margin following

such procedures may be determined by

the interdental papilla as stated in some

researches (Zuchelli et al., 2010) because of

the blood supply provided by the interdental

soft tissue and stability it may provide

during healing. Gingival recession with

interproximal bone loss was reported to only

achieve partial root coverage (Miller 1985).

Coronally-advanced flaps (CAF) with

connective tissue graft enhanced complete

root coverage probability compared

coronally-advanced flaps alone (Cairo et al.,

2008). Restoration of the cervical abrasion

of tooth 13 was not done due to the lack of

Fig. 7a

Figs. 7a-b: (a) Pre-operative photo (b) post-operative photo after 18 months

deep wedge-shaped NCCL, although studies

regarding root coverage procedures with

Class V restorations have shown promising

results (Zuchelli et al., 2011). Tetracycline

hydrochloride application to the exposed

root surface was done for it reported

actions such as demineralisation of root

surface, removal of smear layer, fibrin

clot stabilisation, and increased fibroblast

adhesion and growth (Dantas et al., 2008).

The 18-month post operative periodontal

probing values on the labial (distal to

mesial) were 2, 2, 2 and gingival margin

values were +2, +2, +1. Computed clinical

attachment gain at distal site is 0mm,

3mm gain at midroot and 0mm gain at the

mesial site. Gingivoplasty was suggested

to the patient for more aesthetic gingival

form (Figs. 7a-b). DA

REFERENCES

• Chan HL, Chun YH, MacEachern M, Oates TW.

Does gingival recession require surgical treatment?

Dent Clin North Am. 2015;59:981–996.

• Douglas de Oliveira DW, Oliveira-Ferreira

F, Flecha OD, Gonçalves PF. Is surgical root

coverage effective for the treatment of cervical

dentin hypersensitivity? A systematic review. J

Periodontol. 2013;84:295–306.

• Jati, A. S., Furquim, L. Z., & Consolaro, A. (2016).

Gingival recession: its causes and types, and the

importance of orthodontic treatment. Dental Press

Journal of Orthodontics, 21(3), 18–29. https://doi.

org/10.1590/2177-6709.21.3.018-029.oin

• Zucchelli, G., Mele, M., Stefanini, M., Mazzotti,

C.,Mounssif, I., Marzadori, M. & Montebugnoli,

L.(2010) Predetermination of root coverage.

Journal of Periodontology 81, 1019–1026.

• Miller, P. D. (1985) A classification of marginal

tissue recession. International Journal of

Periodonticsand Restorative Dentistry 5, 8–13.

• Cairo, F., Nieri, M., Cincinelli, S., Mervelt, J., &

Pagliaro, U. (2011). The interproximal clinical

Fig. 7b

attachment level to classify gingival recessions

and predict root coverage outcomes: an

explorative and reliability study. Journal of Clinical

Periodontology, 38(7), 661–666. https://doi.

org/10.1111/j.1600-051x.2011.01732.x

• Pini-Prato, G. (2010). The Miller classification of

gingival recession: limits and drawbacks. Journal

of Clinical Periodontology, 38(3), 243–245. https://

doi.org/10.1111/j.1600-051x.2010.01655.x

• Cairo, F., Pagliaro, U., & Nieri, M. (2008).

Treatment of gingival recession with coronally

advanced flap procedures: a systematic review.

Journal of Clinical Periodontology, 35, 136–162.

https://doi.org/10.1111/j.1600-051x.2008.01267.x

• Zucchelli G, Gori G, Mele M, Stefanini M, Mazzotti

C, Marzadori M, Montebugnoli L, De Sanctis M.

Non-carious cervical lesions associated with

gingival recessions: a decision-making process. J

Periodontol 2011: 82: 1713–1724.

• Dantas, A. A. R., de Paula Ishi, E., Batista, L. H.

C., Onofre, M. A., & Sampaio, J. E. C. (2008). Smear

Layer Removal and Collagen Fiber Exposure Using

Tetracycline Hydrochloride Conditioning. The

Journal of Contemporary Dental Practice, 9(5),

25–33. https://doi.org/10.5005/jcdp-9-5-25

ABOUT THE AUTHOR

Dr Francesca Daye C.

See-Santos

graduated with a

degree of Doctor of

Dental Medicine in

2014 and Masters of

Science in Clinical Dentistry major in

Periodontics in 2020 from the University

of the East, College and Graduate School

of Dentistry (Philippines), respectively.

She is a visiting periodontics consultant

at St Paul Augustine Dental Clinic in San

Pablo City, Laguna, and a periodontist

at Dayanghirang Dental Clinic, Manila

branch.

DENTAL ASIA SEPTEMBER / OCTOBER 2022 41


CLINICAL FEATURE

Endodontic perforation:

The hole that pricks

Dr Denzil Albuquerque and Dr Jojo Kottoor discuss the management and

prevention of endodontic perforations to increase the success rate and

predictability of treatment.

passive ultrasonic activation (PUI) followed by

heated obturation to obtain a hermetic seal up

to working length.

Tooth perforation is an artificial

communication between the root canal

system and the supporting tissues of teeth

or to the oral cavity. They can either occur

accidentally or due to pathologic causes

like resorptions or caries. Accidental root

perforations do occur in approximately

2–12% of endodontically treated teeth that

might have serious implications.

Perforations occurring during root canal

therapy may account for as many as 10% of

all failed endodontic cases. In multi-rooted

teeth, furcation perforations may occur

whilst searching for the canal orifices, as

dentin is removed from the pulpal floor.

Misidentification of orifices or canals and

routine endodontic causes (47%) along with

over-zealous post space preparation (53%)

are other common causes.

The biologic response of a perforated tooth

is inflammatory and can cause a breakdown

of the osseous and peri-radicular tissues.

This perforation acts as an open channel

encouraging bacterial entry either from root

canal or periodontal tissues or both eliciting

inflammatory response that results in fistula

including bone resorptive processes may

follow. When perforation occurs laterally

or in furcation area, there might be over

growth of gingival epithelium towards the

perforation site. There are only two options

in managing perforations, repair via a coronal

approach or surgically, or else extraction. If a

tooth is restorable, then visibility and access

to the perforation site determine treatment

success.

CASE REPORT

A 40-year-old patient was referred by a

dentist who encountered a bleeding point

in a previously root canal treated tooth. The

patient complained of mild, intermittent

pain with her right mandibular first molar.

Clinically, the tooth had a temporary occlusal

filling and was tender to percussion and

palpation. The gingiva had mild recession

with furcal probing on the buccal. A preoperative

x-ray and clinical exploration

showed a bur-hole size furcal perforation

along with thinning of the dentin on the

pulpal floor. The radiograph confirmed

an inadequate previously done root canal

treatment and persistent apical periodontitis

with both roots apices.

Root canal retreatment was completed in

a single visit. Key emphasis was placed on

irrigation with 5% sodium hypochlorite and

The furcal perforation was cleaned of any

inflamed or granulation tissue, the dentin

defect was smoothened out using slow

speed burs and then filled with white

mineral trioxide aggregate (MTA), (ProRoot

MTA, DentsplySirona). The MTA was then

immediately covered with a layer of resinmodified

glass ionomer cement (Fuji, GC)

followed by composite resin (Empress,

Ivoclar). The patient was then referred back

to the referring dentist for a bonded coronal

restoration and was advised regular follow-up.

DISCUSSION

The best treatment for any complication

is prevention. For instance, hasty and

impatient work or inappropriate patient

scheduling is avoidable. Sound knowledge and

understanding of the internal and external

tooth anatomy along with multiple angulated

pre-operative radiographs add clarity and

allow for improved planning before the

procedure.

Possessing the right tools and equipment and

using them appropriately; like accurate bur

orientation, slower speed, safe ended burs,

measured depth of penetration are important

factors in uneventful endodontics. Recognising

change in handpiece angulation and thus

access orientation due to restricted mouth

opening or by the bow of rubber dam clamps

is crucial.

Use of magnification, adequate illumination,

ultrasonics and long shank burs provide

42 DENTAL ASIA SEPTEMBER / OCTOBER 2022


CLINICAL FEATURE

enhanced visualisation and thus better

control. Negotiating calcified pulp chambers

should be done with caution especially

for completely attached pulp stones.

Visualising the pulpal floor aided with

magnification will prevent misidentification

of orifices or canals. Using non-diamond

rotary drills at slow speed and respecting

canal and root dimensions will prevent

perforations during post space preparation.

The first sign of a perforation is sudden,

profuse uncontrolled bleeding possibly

accompanied with pain. Bleeding can be

controlled by pressure or hypochloritesoaked

cotton pellets on the pulpal floor,

or paper points or calcium hydroxide

within canals.

If a perforation is suspected or perceived,

it can be confirmed in the following ways.

Direct visualisation using a dental operating

microscope. Using radiographs with hand

files extending through the perforation will

demonstrate the files extruding laterally

from the tooth outlines or a cone shift may

be necessary. An apex locator is another

useful gadget to accurately and quickly point

out an undesired communication with periradicular

tissues. CBCT scans are additional

means of confirming the location and extent

of the perforation defect.

Once a perforation has been diagnosed, the

most critical factor determining prognosis

in the long term is time to treatment.

Immediate or early sealing of the perforation

provides the tooth the best prognosis in the

long term. If a referral is needed, immediate

temporary filling to seal the access cavity

and an early appointment should be sought

for an endodontist.

The aim of perforation management is

regeneration of healthy periodontal tissues

against the perforation without persistent

inflammation or loss of periodontal

attachment. If there is a case of periodontal

breakdown, then the aim here is to reestablish

tissue attachment. The major

factors determining the prognosis include

size of the defect and its location; time and

the duration of exposure to contamination,

the material used to repair it. The material

used to repair the defect along with the

clinician’s skill are the only controllable

factors.

Numerous materials are available and

have been used for perforation closure or

repair. Among the most promising with

dependable clinical results are bioactive

materials including MTA, BioDentine

(Septodont) and BioCeramics. Each have

their advantages and disadvantages, but

in the present case MTA was preferred

because of its ease of availability and

familiarity with the material along with

long-term clinical evidence of success.

A clean dentin surface allows for a good

chemical and physical bond to form

between the material and tooth substrate.

An MTA carrier (MAPS System or Dogvan

Carrier) should be used to place MTA on

to the defect and compact it to a minimum

thickness of 2mm. An internal matrix, like a

collagen sponge or membrane (CollaCote)

can be used as an apical barrier to prevent

excess extrusion of MTA. Compacting MTA

with low density materials like microapplicator

tip, cotton pledget or butt end

of paper points or gutta percha is always

helpful. Additional use of low level, indirect

ultrasonics allows for a more compact

material fill. Once placed, MTA should be

left undisturbed for maturation for about

24-48 hours.

Immediate adhesive reconstruction of the

tooth provides less possibility for coronal

leakage and strengthens the tooth. When

MTA is used, it is preferable to place a

barrier of resin modified GIC over the

MTA and restore the tooth immediately.

Biodentine, on the other hand, allows for

immediate restoration after its setting time

of approximately 12mins.

Restoration of a perforated tooth should

be planned with adhesive techniques,

minimally destructive of remaining tooth

structure. Preserving peri-cervical dentin

and minimising transfer of excessive or

prolonged occlusal forces on the tooth

should be prioritised.

In cases of furcal or lateral perforations,

additional periodontal procedures may

be necessary along with guided bone

regeneration. Long-term follow up of all

perforations are essential, to allow for early

intervention whenever necessary.

As more complex endodontic treatment

cases are being attempted, it is not an

unrealistic expectation that there will be an

increased frequency of perforations in the

future. Management of perforations is a lot

more predictable if done early through a

coronal access and using magnification. DA

REFERENCES

• Kratchman SI. Perforation repair and one-step

apexification procedures. DCNA 2004; 48: 291–307.

• Tsesis I, Fuss Z. Diagnosis and treatment of

accidental root perforations. Endodontic Topics.

2006;13:95–107.

• Clauder T, Shin S J. Repair of perforations with

MTA: clinical applications and mechanisms of action.

Endodontic Topics 2006; 15: 32–55.

• Mohammed S, Ashley MP, Darcey J. Root

perforations: aetiology, management strategies and

outcomes. The hole truth. BDJ 2016; 220: 171-180.

ABOUT THE AUTHORS

Dr Denzil Albuquerque,

MDS, is a clinician,

writer and speaker

with a private practice

exclusively dedicated

to microscope assisted

endodontics, restorative and cosmetic

dentistry at Mumbai, India.

Dr Jojo Kottoor, MDS,

is an academician and

professor at Royal

Dental College, Kerala,

India. He runs a private

practice dedicated

to microscope assisted endodontics,

restorative and cosmetic dentistry at

Kochi, India.

DENTAL ASIA SEPTEMBER / OCTOBER 2022 43


USER REPORT

Biomimetic oral care: Preventing

oral diseases with hydroxyapatite

Hydroxyapatite is the main mineral component of tooth enamel and dentin.

Used as an active ingredient in oral care products, Dr Bernard Siew, together

with Dr Joachim Enax and Dr Frederic Meyer, discuss its effectiveness in the

prevention of tooth decay and gum disease.

Oral health in Singapore remains a big

issue. Dental caries and periodontal

diseases do not only affect children

but also adults and the elderly. As the

proportion of children with dental

caries decreased between 1970 and 1994,

recent data suggest an increase of this

disease in children.

Studies indicate a prevalence of dental

caries of up to nearly 50% of young

children (18 months to four years of

age) 1 . Early childhood caries is a very

serious problem 2 . A worse oral health

status were reported in adults and the

elderly. In a cohort of people aged 60

or older, the proportion of people with

natural teeth was only 10.3% in women

and 12.8% in men, and many of them were

edentulous (37% of women and 24% of

men) 3 . The high level of tooth loss can be

attributed to dental caries and periodontal

disease 4-6 .

Apart from the loss of teeth from oral

diseases, other issues can affect the

quality of life 7 . Dentin hypersensitivity,

usually due to excessive enamel loss by

attrition, abrasion or acid erosion, is well

known to have a negative impact on an

individual’s sense of well-being. Dentin

hypersensitivity is a result of exposed

dentinal tubules. Patients with dentin

hypersensitivity often experience short

and sharp pain when consuming cold or hot

food and beverage 8 .

The simplest process to prevent oral diseases

and their resultant symptoms is with correct

regular oral care. Tooth brushing for at least

two minutes twice a day using an effective

toothpaste is the basic standard of care.

As more is understood of the demineralisationremineralisation

process of our tooth structure,

more research and development has led to the

concept of pH control and supersaturation the

tooth surfaces with minerals.

These minerals were traditionally different

types of fluoride such as monofluorophosphate,


USER REPORT

control, confirmed the efficacy of HAP

containing toothpastes as anti-caries

agent. Limeback et al. recently published

a meta-analysis summarising these

results 16 . The results from this analysis

confirm the efficacy of HAP as cariespreventive

agent. HAP has been shown

to remineralise enamel defects 26-27 , and

to reduce bacterial adhesion on dental

surfaces 28-29 . Furthermore, HAP can buffer

acidic (caries) biofilms and simultaneously

release calcium which can prevent the

teeth from demineralisation and increase

remineralisation 30 .

Gum health

Besides anti-biofilm (anti-adherence)

properties of HAP, clinical trials report of

improved gum health, when HAP-products

are used for daily oral care. A German

multi-centre trial has confirmed these

results 31 .

Fig. 1: Modes of action of HAP used as active agent for the prevention of oral diseases. HAP does not

only form a protective layer on enamel and dentin, but also occludes dentin tubuli. The figure was

originally published elsewhere 15 .

sodium fluoride or stannous fluoride.

However, fluoride has certain limitations,

as calcium and phosphate are needed for

the remineralisation-process 9 . Additionally,

fluoride has to be applied in only small

amounts for children (due to its toxicity),

but rice-sized or pea-sized amounts

of toothpaste have a limited cleaning

efficacy 10 .

The concept of biomimicry and its

efficacy in toothpaste formulation was

studied since the 1980s 11 . There have been

developments of a biomimetic toothpaste

with the aim of tackling early childhood

caries as excessive fluoride exposure have

traditionally led to dental fluorosis and

fluoride toxicity 12-13 .

HYDROXYAPATITE

One possible option is choosing a

hydroxyapatite-based toothpaste.

Hydroxyapatite (HAP) is not only known

to be the hardest material in our body as

enamel (approximately 97% HAP), but also to

be the main part of dentin (approximately

70% HAP), and it can be synthetically

produced to be used as active ingredient in

oral care products 7,14 .

Recently published studies, including

clinical trials and meta-analyses report

of HAP containing oral care products to

be effective in preventing various oral

diseases 7,15-18 . While fluoride, an active

ingredient to prevent tooth decay 19 , has

many confirmed or discussed side-effects

(e.g. fluorosis) 12-13,20-22 , HAP shows good

biocompatibility as it is the main part

of human teeth 15,23,24 . In the scientific

literature including in situ studies and

clinical trials, HAP is described as an

effective agent used in oral care 25 . Figure

1 shows the modes of action of HAP as

published elsewhere 15 .

Caries prevention

Placebo-controlled clinical trials, and

comparative in vivo and in situ studies

with fluoride toothpaste used as positive

Erosion protection

Dental erosion is increasingly prevalent as

the reason for accelerated loss of enamel

and dentin. When the pH of the oral

environment drops below 5.5, the HAP

crystal structure of the enamel dissolves

leading to demineralisation of the

enamel. Among others, Fabritius-Vilpoux

et al. used a cyclic demineralisationremineralisation

model, with or without

the application of HAP. The results confirm

that HAP is able to protect the teeth from

mineral loss 18 .

Prevention of dentin hypersensitivity

Several clinical trials have shown that HAP

can relieve sensitivity effectively after

only three to five days when used twice

daily 11,32 . Compared to other actives used

for dentin hypersensitivity prevention,

such as stannous fluoride, HAP does not

stain teeth, but has a natural whitening

effect 33 . Stannous fluoride is known to

reduce dentin hypersensitivity, but at the

same time leading to a yellow or brown

stain on teeth 34 . Clinical trials and casereports,

and a recently published metaanalysis

come to the conclusion that HAP

is effective at reducing sensitivity from

external stimuli 17 .

DENTAL ASIA SEPTEMBER / OCTOBER 2022 45


USER REPORT

CONCLUSION

Hydroxyapatite (HAP) is an effective

active ingredient used in oral care

products (toothpaste, gel, mouth rinse)

to prevent tooth decay and gum disease.

Further benefits are well known from

clinical trials, such as preventing dentin

hypersensitivity. Compared to other

actives (i.e., fluorides), HAP shows

good biocompatibility and is safe if

swallowed. DA

REFERENCES

1.

B. Lai, W.K. Tan, Q.S. Lu, Clinical efficacy of a

two-year oral health programme for infants and

toddlers in Singapore, Singapore Med J 59(2)

(2018) 87-93.

2.

F. Meyer, J. Enax, Early childhood caries:

Epidemiology, aetiology, and prevention, Int. J.

Dent. 2018 (2018) 7.

3.

C.-T. Chiu, R. Malhotra, S.M. Tan, J. Lim, A. Chan,

K.H. Teoh, S.T. Gan, Y. Saito, Dental health status

of community-dwelling older Singaporeans:

findings from a nationally representative survey,

Gerodontology 34(1) (2017) 57-67.

4.

J.E. Frencken, P. Sharma, L. Stenhouse,

D. Green, D. Laverty, T. Dietrich, Global

epidemiology of dental caries and severe

periodontitis - a comprehensive review, J Clin

Periodontol 44 Suppl 18 (2017) S94-S105.

5.

P.C. Passarelli, S. Pagnoni, G.B. Piccirillo, V.

Desantis, M. Benegiamo, A. Liguori, R. Papa, P.

Papi, G. Pompa, A. D’Addona, Reasons for tooth

extractions and related risk factors in adult

patients: A cohort study, Int J Environ Res Public

Health 17(7) (2020) 2575.

6.

M.A. Peres, L.M.D. Macpherson, R.J. Weyant,

B. Daly, R. Venturelli, M.R. Mathur, S. Listl, R.K.

Celeste, C.C. Guarnizo-Herreño, C. Kearns, H.

Benzian, P. Allison, R.G. Watt, Oral diseases:

a global public health challenge, The Lancet

394(10194) (2019) 249-260.

7.

J. Enax, H.O. Fabritius, K. Fabritius-Vilpoux,

B.T. Amaechi, F. Meyer, Modes of action and

clinical efficacy of particulate hydroxyapatite

in preventive oral health care − state of the art,

Open Dent J 13 (2019) 274-287.

8.

D.G. Gillam, Dentine hypersensitivity: Advances

in diagnosis, management, and treatment,

Springer International Publishing2015.

9.

M. Epple, J. Enax, F. Meyer, Prevention of

caries and dental erosion by fluorides-a critical

discussion based on physico-chemical data and

principles, Dent. J. 10(1) (2022) 6.

10.

S. Sarembe, C. Ufer, A. Kiesow, H. Limeback,

F. Meyer, I. Fuhrmann, J. Enax, Influence of the

amount of toothpaste on cleaning efficacy: An in

vitro study, European journal of dentistry (2022).

11.

R.W. Huettemann, H. Doenges, Untersuchungen

zur Therapie überempfindlicher Zahnhälse mit

Hydroxylapatit, Dtsch. Zahnärztl. Z. 42 (1987)

486-488

12.

M. Ekambaram, A. Itthagarun, N.M. King,

Ingestion of fluoride from dentifrices by young

children and fluorosis of the teeth--a literature

review, J Clin Pediatr Dent 36(2) (2011) 111-21.

13.

R. Green, B. Lanphear, R. Hornung, D. Flora, E.A.

Martinez-Mier, R. Neufeld, P. Ayotte, G. Muckle,

C. Till, Association between maternal fluoride

exposure during pregnancy and IQ scores in

offspring in Canada, JAMA Pediatr (2019)

e191729.

14.

H.-O. Fabritius, J. Enax, F. Meyer, Eine Reise ins

Innere unserer Zähne/A Journey into our Teeth,

Titus Verlag (2021).

15.

F. Meyer, J. Enax, B.T. Amaechi, H. Limeback,

H.-O. Fabritius, B. Ganss, M. Pawinska, E.

Paszynska, Hydroxyapatite as remineralization

agent for children’s dental care, Frontiers in

Dental Medicine 3 (2022).

16.

H. Limeback, J. Enax, F. Meyer, Biomimetic

hydroxyapatite and caries prevention: a

systematic review and meta-analysis, Can J

Dent Hyg 55 (2021) 148-159.

17.

M.L. Hu, G. Zheng, H. Lin, M. Yang, Y.D. Zhang,

J.M. Han, Network meta-analysis on the

effect of desensitizing toothpastes on dentine

hypersensitivity, J Dent 88 (2019) 103170.

18.

K. Fabritius-Vilpoux, J. Enax, D. Mayweg,

F. Meyer, M. Herbig, D. Raabe, H.-O. Fabritius,

Ultrastructural changes of bovine enamel

and dentin surfaces under chemical erosion

in presence of biomimetic hydroxyapatite

crystallites, Bioinspir. Biomim. Nan. 10(4) (2021)

132-145.

19.

T. Walsh, H.V. Worthington, A.M. Glenny, V.C.C.

Marinho, A. Jeroncic, Fluoride toothpastes of

different concentrations for preventing dental

caries, The Cochrane database of systematic

reviews (3) (2019).

20.

A.L. Choi, G. Sun, Y. Zhang, P. Grandjean,

Developmental fluoride neurotoxicity: A

systematic review and meta-analysis, Environ.

Health Perspect. 120(10) (2012) 1362-1368.

21.

P. Grandjean, P.J. Landrigan, Neurobehavioural

effects of developmental toxicity, The Lancet

Neurology 13(3) (2014) 330-338.

22.

A.J. Malin, C. Lesseur, S.A. Busgang, P. Curtin,

R.O. Wright, A.P. Sanders, Fluoride exposure and

kidney and liver function among adolescents in

the United States: NHANES, 2013–2016, Environ

Int (2019) 105012.

23.

C.C. Coelho, L. Grenho, P.S. Gomes, P.A.

Quadros, M.H. Fernandes, Nano-hydroxyapatite

in oral care cosmetics: characterization and

cytotoxicity assessment, Sci. Rep. 9(1) (2019)

11050.

24.

J. Ramis, C. Coelho, A. Córdoba, P. Quadros,

M. Monjo, Safety assessment of nanohydroxyapatite

as an oral care ingredient

according to the EU cosmetics regulation.,

Cosmetics 5(3) (2018) 53.

25.

K. O’Hagan-Wong, J. Enax, F. Meyer, B. Ganss,

The use of hydroxyapatite toothpaste to prevent

dental caries, Odontology, 110, 223–230 (2022).

26.

B.T. Amaechi, P.A. AbdulAzees, D.O. Alshareif,

M.A. Shehata, P.P.d.C.S. Lima, A. Abdollahi, P.S.

Kalkhorani, V. Evans, Comparative efficacy of

a hydroxyapatite and a fluoride toothpaste for

prevention and remineralization of dental caries

in children, BDJ Open 5(1) (2019) 18.

27.

B.T. Amaechi, P.A. AbdulAzees, L.O. Okoye, F.

Meyer, J. Enax, Comparison of hydroxyapatite

and fluoride oral care gels for remineralization

of initial caries: a pH-cycling study, BDJ Open

6(1) (2020) 9.

28.

A. Kensche, C. Holder, S. Basche, N. Tahan,

C. Hannig, M. Hannig, Efficacy of a mouthrinse

based on hydroxyapatite to reduce initial

bacterial colonisation in situ, Arch. Oral. Biol. 80

(2017) 18-26.

29.

C.M.G. Nobre, B. König, N. Pütz, M. Hannig,

Hydroxyapatite-based solution as adjunct

treatment for biofilm management: An in situ

study, Nanomat. 11(9) (2021) 2452.

30.

F. Cieplik, C.M. Rupp, S. Hirsch, D. Muehler, J.

Enax, F. Meyer, K.-A. Hiller, W. Buchalla, Ca2+

release and buffering effects of synthetic

hydroxyapatite following bacterial acid

challenge, BMC oral health 20(1) (2020) 85.

31.

I. Harks, Y. Jockel-Schneider, U. Schlagenhauf,

T.W. May, M. Gravemeier, K. Prior, G. Petersilka, B.

Ehmke, Impact of the daily use of a microcrystal

hydroxyapatite dentifrice on de novo plaque

formation and clinical/microbiological

parameters of periodontal health. A randomized

trial, PloS one 11 (2016) e0160142.

32.

G. Orsini, M. Procaccini, L. Manzoli, S.

Sparabombe, P. Tiriduzzi, F. Bambini, A.

Putignano, A 3-day randomized clinical trial to

investigate the desensitizing properties of three

dentifrices, J. Periodontol. 84 (2013) 65-73.

33.

S. Sarembe, J. Enax, M. Morawietz, A.

Kiesow, F. Meyer, In vitro whitening effect of a

hydroxyapatite-based oral care gel, Eur. J. Dent.

(2020).

34.

J.E. Ellingsen, H.M. Eriksen, G. Rolla, Extrinsic

dental stain caused by stannous fluoride.,

Scand. J. Dent. Res. 90(1) (1982) 9-13.

ABOUT THE AUTHOR

Dr Bernard Siew

is a Malaysianborn

Australian

from Adelaide.

The director of

Smilefocus Dental

Clinic, he is qualified

from the University

of Adelaide and has practiced dentistry

in Singapore for over 20 years. He is

passionate about managing excessively

worn teeth due to lifestyle problems,

ranging from grinding to acid reflux. His

focus is on preventative and minimally

invasive therapy.

46 DENTAL ASIA SEPTEMBER / OCTOBER 2022


Torq Control®

Universal Torque

Wrench

Torq Control® is the Anthogyr universal

torque wrench offering the guarantee of

tightening precision, whatever the type

of implant connection or the difficulties of

access.

Precise tightening is a key factor to secure

implant treatment success. Torq Control®

has been specially designed by Anthogyr

to meet these requirements for all

prosthetic manipulations, in all safety

thanks to automatic declutching.

A must-have, especially for full-arch

restorations.


USER REPORT

Alternative solution for

managing implant failure

Dr Claude Authelain presents a surgical protocol utilising

the Anthogyr Mini Implant System to manage a case of failed

maxillary implants.

The 72-year-old smoking patient

presented a case of implant failure

with an all-on-six case treated 15

years ago. With advanced periimplantitis,

the patient has already

lost two implants. The proposed

treatment is a maxillary implantstabilised

removable overdenture

solution.

Surgical protocol:

Fig. 1: Pre-operative panoramic x-ray

Fig. 2

Fig. 3

Figs. 2-3: Former all-on-six that was placed 15 years ago after two failed implants

Fig. 4: Residual implants on the day of surgery. The anterior

implant will be re-embedded and the other two removed

Fig. 5: View of the bone crest after removal

of the implants

48 DENTAL ASIA SEPTEMBER / OCTOBER 2022


USER REPORT

Fig. 6: Mini implant on the sterile implant holder

Fig. 7: The cap served as initial implant holder

Fig. 8: The implants were screwed in using the special

tightening mandrel

Fig. 9: The alignment of the

implants was checked using

the depth and alignment

gauges included in the Mini

Implant System surgical kit

Fig. 10 Fig. 11

Figs. 10-11: Mini implants in place

Fig. 12: Post-surgical situation

Fig. 13: Post-surgical x-ray

DENTAL ASIA SEPTEMBER / OCTOBER 2022 49


USER REPORT

Fig. 14

Fig. 15 Fig. 16

Figs. 14-16: Gingival healing three months after the placement of the Mini Implants

Fig. 18a

Fig. 18b

Fig. 17: Intraoral view with mounting collars

which protect the implant neck from any resin or

adhesive residue

Figs. 18a-b: (a) Mini Implant with mounting collar and white insert mounted into the matrix housing. Valoc

recommends the use of low retention inserts (yellow or white) for the initial preparation stages and the

first placement of the denture

(b) These inserts will then be replaced by inserts of other colours, offering stronger retention force, if

required

Fig. 19: Mini implants with mounting collars and

matrices, positioned during the preparation stage,

before loading the prosthesis. The collars will be

removed during the final stage, before placement

of the denture in the patient’s mouth

Fig. 20: Bottom view of the complete

removable prosthesis stabilised by the mini

implants using an Optiloc connection

Fig. 21: Smile of the patient following the

placement of the maxillary removable prosthesis

CONCLUSION

Mini implants are an alternative to

conventional intra-axial precision

attachments, which are usually placed

on two implants in the mandible and

four implants in the maxilla. Their

small diameter does not hinder their

primary stability, thanks to the selftapping

design of the implant, and

enables their use in thin crests or for

the management of implant failures,

as in the case presented here. This

makes it possible to place the implants

in areas of reduced bone where there

is damage due to previous periimplantitis.

The Anthogyr Mini Implant System is a

good compromise for the practitioner

and an alternative solution for the

patient. The surgical protocol is very

user-friendly and simple, and the

prosthetic rehabilitation of Optilock

prosthetic system is of excellent

quality and seems to have long lasting

durability. DA

ABOUT THE AUTHOR

Dr Claude Authelain

has an exclusive

practice in France

focussing on

implantology, bone

reconstruction

and regeneration,

and mucogingival

surgery. He holds university diploma

in implantology, bone tissue and

biomaterials as well forensic dentistry.

50 DENTAL ASIA SEPTEMBER / OCTOBER 2022


BEHIND THE SCENES

Indirect hybrid nano-ceramic

adhesive restorations

In a mixed analogue-digital workflow, Dr Pierre Dimitrov, Dr Assen Marinov

and MDT Boyanka Vladimirova demonstrate how they utilised Cerasmart270

to aesthetically restore three posterior teeth in the lower quadrant, without

compromising on its longevity.

Indirect composite and ceramic restorations

are a valid solution in restoring medium

to heavily damaged teeth in the posterior

region, providing strength, longevity and

aesthetics. With the advancement of CAD/

CAM technologies and intraoral scanners,

we can produce and deliver these kinds

of restorations in one visit or a few days,

minimising the chance of sensitivity,

maintaining tooth vitality and protecting

the damaged tooth structures from cracks

and fractures.

Using contemporary adhesive systems and

composite materials, we are able to bond

indirect restorations with little to no

retention in the preparation, without

unnecessary sacrifice of tooth structures

and still be able to guarantee a predictable

long-term success to our patients.

In the following case, we used mixed

analogue-digital workflow to restore

three posterior teeth in a quadrant

where Cerasmart270 blocks (Fig. 1) in two

translucencies were used – A3 HT for the

molars and A3 LT for the endodontically

treated, darker shaded premolar. The

treatment was completed in two visits in

the span of three days.

INITIAL SITUATION

The patient initially presented with a few

direct restorations in the left lower jaw

(third quadrant) (Fig. 2). Complaints of the

patient were increased sensitivity to

thermal stimuli in this region and food

impaction.

The second premolar was endodontically

treated without radiologic or symptomatic

signs of apical periodontitis, the buccal

and lingual walls and the mesial marginal

ridge were thin and undermined, and the

shade of the tooth was visibly different.

The first molar was vital with a big direct

composite restoration of the mesial,

occlusal and distal surfaces with residual

caries on the distal. The buccal and

lingual wall were thin and suspected to

crack or fracture at any time. The second

molar was vital with a faulty direct

restoration, showing degradation of the

bond between restorative material and

tooth, uncovered dentin, suboptimal

proximal contacts and thin buccal and

lingual walls.

The soft tissues were inflamed. The

decided treatment plan with consent of

the patient was to restore the second

premolar and two molars with full

coverage Cerasmart270 overlays in

two visits – one for preparation and

impressions and another one for bonding

the restorations.

Fig. 1 Fig. 2

Fig. 1: CERASMART270 overlay, milled with Sirona Cerec 4

Fig. 2: Preoperative photograph, occlusal view

TREATMENT PROCEDURE

After isolation with rubber dam, the old

restorations and underlying caries were

removed with a round diamond bur on

high speed with plenty of water cooling,

followed by final cleaning of the decayed

dentin with a steel manual excavator

and gentle sandblasting with 27micron

aluminium oxide particles.

DENTAL ASIA SEPTEMBER / OCTOBER 2022 51


BEHIND THE SCENES

Fig. 3a

Fig. 3b

shade A2, was applied over the dentin,

sealing it and removing all uneven surfaces

and undercuts of the preparation. With

a diamond bur, the enamel margins were

prepared once again to ensure to adhesive

or composite has been left. Preparation

and marginal finishing were done after the

removal of the rubber dam (Fig. 4).

Fig. 4

Fig. 5

Fig. 6 Fig. 7

A one-step VPS impression of the lower

jaw, an alginate impression of the upper

jaw, a bite registration and a face bow

were transferred from the patient to the

laboratory. In the lab, stone models were

fabricated from GC FujiRock. The models of

the jaws were mounted in a semi-adjustable

articulator using average settings using

the bite registration and the face bow. The

preparation model was cut into separate

stone dies for optimal scanning and access

to the margins. A check model of the

prepared teeth was also poured from GC

FujiRock (Fig. 5).

Fig. 8

Figs. 3a-b: Intraoperative view – restoration and

caries removal, cusp reduction

Fig. 4: Immediate dentin sealing and deep margin

elevation

Fig. 5: Stone models mounted in the articulator

Fig. 6: Digital design of the restorations

Fig. 7: Milled restorations straight from the milling

machine

Fig. 8: The finished restorations on the check model

The models and the separate preparation

dies were scanned using Medit Identica

T500 laboratory scanner. The restorations

were then designed in exocad according

to the static occlusion and the dynamic

relationship of the teeth in protrusion

and lateral movements using the virtual

articulator function (Fig. 6).

A small portion of the mesiolingual pulp

horn was exposed. The undermined and

unsupported cusps and walls were reduced

to ensure stable dentinal support of the

tooth structures and provide restorative

material space of 1.5-2mm. A buccal chamfer

preparation was chosen for the second

premolar out of aesthetic considerations

(Figs. 3a-b).

An immediate dentin sealing procedure

was carried out to ensure optimal

adhesion to the freshly prepared dentin

and to create a hermetically sealed

biological system, protecting the tooth

structures from contamination. A deep

margin elevation was performed for the

distal margin of the second premolar.

Enamel margins were left uncovered to

be available as an adhesion substrate in

the cementation step. The pulp exposure

was only sealed using adhesive and flowable

composite.

The tooth structures were gently sandblasted

for 10-15 seconds with 27micron aluminium

oxide particles under pressure with plenty

of water cooling. Dentin was then etched

with 37% phosphoric acid for 15 seconds and

generously rinsed afterwards, followed by

gentle drying of the dentinal structure with a

three-in-one syringe to prevent desiccation

of the tooth structures.

With a microbrush, a coating of G-Premio

Bond was applied and rubbed for 20 seconds

onto the dentin. After thinning of the

adhesive with air it was cured for 20 seconds

using the high-power mode of D-Light Pro.

A layer of G-ænial Universal Injectable,

The restorations were milled from

Cerasmart270 with a Roland DWX-4W

milling machine using a milling strategy

for hybrid ceramics. The second premolar

restoration was milled from Cerasmart270

A2 LT and the two molars were milled

from Cerasmart270 A2 HT (Fig. 7).

The restorations were cut from the sprues,

finished with a rubber point, sandblasted

with 27micron aluminium oxide and

cleaned with a steam cleaner. A coating

of Ceramic Primer II was applied and set

to dry. Characterisation was done using

Optiglaze Colour and Optiglaze Clear.

Each layer of the stains was polymerised

for 20 seconds using D-Light Pro in highpower

mode. The restorations were finally

polished with diamond paste and a goathair

brush (Fig. 8).

52 DENTAL ASIA SEPTEMBER / OCTOBER 2022


BEHIND THE SCENES

Fig. 9

Fig. 10

Fig. 11a

Fig. 11b

Fig. 11c

Fig. 11d

Fig. 11e

Fig. 11f

Fig. 12a Fig. 12b Fig. 12c

Fig. 9: Inner surface treatment before adhesive cementation of the restorations

Fig. 10: Isolated and sandblasted preparations, prepared for adhesive cementation

Figs. 11a-f: Adhesive cementation of the restorations using G-Premio Bond & G-ænial Universal Injectable

Figs. 12a-c: Final view of the cemented restorations after rubber dam removal, inspection for excess cement with D-Light Pro in DT Mode

On the day of the cementation, the

restorations’ inner surfaces were

sandblasted with 27micron aluminium

oxide particles and subsequently cleaned

using phosphoric acid for 30 seconds.

With a microbrush, a coating of Ceramic

Primer II was applied to the clean surface

and let to evaporate. G-ænial Universal

Injectable A2 was used as the cementing

composite. It was applied right before the

cementation (Fig. 9).

The preparations were isolated with a

rubber dam and were sandblasted with

27-micron aluminium oxide particles under

pressure with plenty of water cooling in

order to achieve a clean and rough surface,

ensuring optimal adhesion between the

restorations and the teeth (Fig. 10).

The cementation of the restorations was

carried out one by one for each tooth

following the same protocol for treating the

tooth surface. Enamel and composite were

etched with 37% phosphoric acid for 30

seconds, followed by generous rinsing with

water. The preparation surface was air dried

with air. G-Premio Bond was applied to the

preparation surfaces in accordance with the

manufacturer’s instructions. The restoration

was put and held in place by hand. All

composite excess was removed using a

probe and a brush until visual control of the

sealed preparation’s margins was achieved.

Everything was polymerised after

complete cleaning on each surface of the

tooth (buccal, lingual and occlusal) for

20 seconds on each surface with D-Light

Pro in high-power mode (Figs. 11a-f).

Finishing and polishing of the margins

of the restorations were done using

abrasive metal and polishing plastic

strips, rubber points and a polishing

brush with diamond paste. Using the

detection mode of GC’s D-Light Pro,

we were able to inspect the margins of

the restoration and tooth structures for

excess cement. A good overall integrity

of the tooth-restoration complex was

achieved (Figs. 12a-c).

DENTAL ASIA SEPTEMBER / OCTOBER 2022 53


BEHIND THE SCENES

ABOUT THE AUTHORS

Fig. 13 Fig. 14

Fig. 13: Bitewing radiograph after cementation of the CERASMART270 restorations

Fig. 14: Two months recall of the cemented CERASMART270 restorations

A bitewing radiograph of the cemented

overlays was taken to assure proper

restoration adaptation and visualise

composite excess. The small excess of

composite viewed at the distal margin

of the second molar was removed

subsequently and the margin was polished

using rubber points and polishing brush

(Fig. 13).

A checkup of the restorations two months

after cementation showed good aesthetic

and functional integration. The patient

was comfortable and satisfied with the

treatment. No complains of sensitivity,

food impaction or any discomfort have

been reported. The restorations displayed a

pleasant aesthetic integration, including the

second premolar which had a significantly

darker shade before the treatment (Fig. 14).

CONCLUSION

Cerasmart270 is a great addition to

GC’s CAD/CAM solutions. Compared

to its original predecessor, it offers

increased strength, while maintaining

flexibility, simplified laboratory steps and

maintaining the same clinical protocols in

preparation and cementation procedures

Thanks to the great line and wide

selection of GC’s restorative materials –

flexible and simplified adhesive systems,

different kinds of clinical and laboratory

composite materials, highly aesthetic and

durable ceramics and other equipment,

we are confident to offer our patients a

long-term solution and provide them with

functional and aesthetic restorations with

a minimised risk of procedural mistakes

and complications. DA

Dr Pierre Dimitrov

graduated from the

Medical University of

Sofia (Bulgaria), Faculty

of Dental Medicine in

2016. He is working in the

dental clinic DentaConsult

in Sofia. His interests are in restorative

dentistry of posterior teeth, endodontics,

digital dentistry and dental technology. He has

attended postgraduate courses in the fields

of composite restorations, indirect ceramic

restorations, endodontic treatment and digital

workflow in restorative dentistry.

Dr Assen Marinov

graduated from the

Medical University of

Sofia (Bulgaria), Faculty

of Dental Medicine. He

is practicing in the fields

of dental implantology,

functional and aesthetic dentistry. Dr

Marinov has finished the basic curriculum

at the Vienna Interdisciplinary School of

Dentistry (VieSID) (Austria), implementing

the protocol of Prof Rudolf Slavicek in his

practice. He also finished the complete

course in functional diagnostic wax-up of

DTG Stephan Provancher and attended the

Master Programme in digital and aesthetic

dentistry with Paulo Kano. Together with

the team of DentaConsult, Dr Marinov is

developing a growing practice in Sofia. He is

combining digital and analogue workflow in

treatment planning and execution.

MDT Boyanka Vladimirova

became a dental technician

in 1994. She got her training

and Dental Council’s

registration at the Medical

Collage in Varna (Bulgaria).

She is a member of the

Dental Technologists Association (DTA). She

has been working at various laboratories and

owns her own company since the beginning

of 2018. She is also a ceramist at the team of

DentaConsult. Her focus is on aesthetic crowns

and bridges, with a strong attention to design,

detail and quality.

54 DENTAL ASIA SEPTEMBER / OCTOBER 2022


BEHIND THE SCENES

Emotional dentistry

The practice of dentistry today is not just repairing cavities or replacing missing

teeth with restorations – it became an active part of aesthetic comfort feeling as

Mr Alexander Wünsche elaborates.

Combined with plastic surgery or other

aesthetic treatments, aesthetic dentistry

is one of the most impactful tools to help

human beings feel beautiful and gain

confidence. When we are looking into

aesthetics and wellbeing, we automatically

associate emotions. So, it would be a more

proper way to describe aesthetic dentistry

as – emotional dentistry.

WHY EMOTIONAL DENTISTRY?

Most treatments take several weeks to

finish before the patient finally receives the

outcome he or she was looking for. During

this time, emotions are a crucial aspect

during treatment. We need these emotions

to help us to achieve the target outcome

and success.

The worst nightmare is when patients freak

out when the first temporary is placed.

So, we already have to pay attention that

the provisional restoration not only looks

good, but that the placement procedure is

also running smoothly and that we have all

the necessary tools, guides and other aids

to place a temporary in the correct place.

This requires pre-treatment planning and

planning of the final outcome from the first

moment we plan the treatment.

In the following case examples, I would like

to show how proper treatment planning

helps to arrive at a successful final outcome,

without stressing the patient’s emotions.

FIRST CASE

The presented case is a 24-year-old photo

model who went overseas to have his

smile corrected. The treatment plan was

to minimally prep 10 anterior teeth in the

maxilla and veneer via the direct bonding

technique with composite. As we can see,

the standard at which this was done, would

never satisfy a 24-year photo model whose

livelihood is his smile.

After nine months, he presented himself to

one of my clients with whom I do aesthetic

rehabilitations and explained that he was

not happy with his smile and was deeply

frustrated and depressed, since he has to

hide his smile ever since coming back.

The patient was invited to visit me in my

laboratory to take initial photos in my photo

studio, so that we could evaluate his current

situation and start planning (Figs. 1-4).

As we can see, the proportions and positions

are grossly misaligned, and the tooth shade is

not what the patient wishes for.

Planning started with a smile design and

evaluation of the dentition

Presenting the proposed outcome in a digital

manner not only allows dentist and patients

to get an idea of the final smile, but also gives

us technicians a guide which we can use

throughout the whole treatment.

After the digital smile design was approved

by the patient, it was printed with a 3D model

printer. We need three different models to

move forward – the current situation, the

digitally designed and proposed design and

a model with both situations combined. The

last model was crucial, as it supports the

treating dentist in prepping the current teeth

as a visual guide. I also prepared silicone

matrices of the proposed digital design

model. One I left untouched, the other I cut

horizontally into two pieces. This helped to

guide during prepping the teeth, so that the

exact amount will be prepped.

In our case, the treatment team decided for

24 crowns. The reason for not being able to

fabricate minimal invasive restorations, was

the pre-treatment with non-guided preps for

composite veneers.

After receiving the impressions, face bow and

bite records in the laboratory, models with

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

Figs. 1-4: Initial situation (first case)

DENTAL ASIA SEPTEMBER / OCTOBER 2022 55


BEHIND THE SCENES

the Giroform System from Amann Girrbach

were fabricated and articulated in the Artex

CR articulator. That allowed me to imitate

all the patient’s movements properly as they

were in the patients’ mouth.

The next step was to scan all the records

(Fig. 6) with the Ceramill Map 400 scanner

and start on the design. Throughout the

design process, the occlusion and function

can be fully controlled with the virtual

articulator in the Ceramill Mind design

Fig. 5: Scanned models

Fig. 6: Restorative design

software (Fig. 7). For maximum aesthetics,

we decided to fabricate fully layered

restorations. But to guarantee stable

and long-lasting crowns, the restoration

was designed with a minimal cutback for

micro layering. Therefore, the digital smile

design was digitally overlaid on the actual

restorative design, so that the crowns were

literally a copy of the smile design and just

minimally reduced (Fig. 8).

The case is nested in the Ceramill Match

2 software so it can be milled in Zolid HT+

in the Ceramill Motion 2 DNA. I decided in

favour of Zolid HT+, because the patient’s

stump shade was in the darker range and

the targeted final tooth colour is OM1.

After milling, the restorations were sintered

overnight. I usually utilise overnight sintering

with an eight-hour programme, to avoid any

chance of stress to the zirconia.

The next day, all copings were seated on

the master casts and GC ZrFs porcelain

was applied with my own micro layer

technique. Before glazing, we went through

a bisquebake try in, so occlusion, function

and aesthetics can be evaluated and minor

adjustments were completed before all

crowns went through a stain and glaze

process.

Finally, our patient got his well-deserved and

wanted smile (Figs. 8-9).

SECOND CASE

My second case is a combination of tooth

borne and implant borne reconstructions.

The patient presented with an edentulous

posterior region in the maxilla. This resulted

in a totally collapsed occlusion (Figs. 10-12).

Over the years, the patient had postponed

any dental treatment because of her fear

of dentists, so it took her years to get

comfortable with her current dentist and

she was able to start her treatment. Implants

were previously placed, two on each

posterior side in the maxilla. The collapsed

situation over such a long period resulted in

excessive wear of the lower anterior teeth.

After evaluating the patient’s photos and

speaking to the patient personally, the

decision was made to treat the patient

with a full mouth rehabilitation in stages.

So, a digital smile design was fabricated.

With this, we were able to decide for a bite

opening of several millimetres, so enough

space was given for veneers in the mandible

anterior area and proper-sized crowns in

the posterior area. For the anteriors in the

maxilla, we decided for crowns and threeunit

implant bridges in the posterior area.

Fig. 8 Fig. 9

Fig. 7: Overlay of actual restorative design and the

previous smile design

Figs. 8-9: Final restoration of the first case

Fig. 10 Fig. 11 Fig. 12

Figs. 10-12: Initial situation (second case)

56 DENTAL ASIA SEPTEMBER / OCTOBER 2022


BEHIND THE SCENES

Since the periodontist had to proceed with

crown lengthening for the anteriors in the

mandible, we started with the maxilla. Not

to lose track throughout the treatment is of

absolute priority.

Therefore, the dentist took an implant-level

impression. After model fabrication with the

Giroform System, the records were scanned

with the Ceramill Map 400 scanner and the

bite opened with the virtual articulator,

the same way as with the overlaid digital

smile design. At first, the three-unit screwretained

implant bridges were designed

following an anterior temporary shell.

Fig. 13 Fig. 14

Figs. 13-14: Milled temporaries and printed placement guide

This process was necessary to carefully open

the patient’s occlusion before fabricating

the final restorations. The digital design was

milled with the Ceramill Motion 2 DNA in

Ceramill Temp Multilayer.

Fig. 15: Guided anterior preparation

Fig. 16: Placed temporary implant bridges

With this process, we can evaluate the

patient’s smile with the executed opening of

the occlusion in conjunction with test driving

function. To be able to place a combination

of implants and temp shells in one arch, we

need to fabricate placement guides.

I designed a stent over my final temporary

design to help the dentist to seat everything

in the perfect location with the planned

occlusion.

This stent can be 3D printed or milled. In

this presented case, it was 3D printed. After

milling the implant bridges, I cemented the

bridges to Variobases (Straumann) on the

master cast to guarantee a perfect passive

fit (Figs. 13-14).

After delivering the case to the dentist, she

was able to prep the anterior teeth in the

maxilla with the help of our printed models

of the smile design, the current situation and

the overlaid smile design over the current

situation. She was also able to utilise all

fabricated matrices to guide her through the

prep protocol (Fig. 15).

Next, she placed the implant bridges first

(Fig. 16), put the temp shells into the 3D

printed stent and placed them over the

Fig. 17: Guided anterior placement

preparations. So, everything was perfectly

in place and slight occlusal adjustments

were finalised during this temporary fit

(Figs. 17-18).

The patient will go through the crown

lengthening procedure next before we

start the final restorations in the maxilla

and mandible.

CONCLUSION

Both treatments were emotionally very

involved throughout the whole process,

not just for the patient, but for the whole

treatment team. I want to say thank you for

the partnership and exceptional teamwork

in both cases to Dr Rita Dargham, Miami

FL, US and her team as well as the team of

Zahntechnique, Dental Laboratory, Miami,

FL, US. DA

Fig. 18: Guided anterior bridge placement

ABOUT THE AUTHOR

Alexander Wünsche

is the president of

Zahntechnique Dental

Laboratory located

in Miami, Florida. He

completed a four-year

multidisciplinary programme at the Otto

Umfried School of Dental Technology

in Nuertingen, Germany. He attained

accreditation as a CDT in Germany and in

the US, specialising in ceramics. Today,

Wünsche fabricates a wide variety of case

types and specialises in cosmetic and

complex implant restorations and speaks

internationally regarding innovations in

dental technology.

DENTAL ASIA SEPTEMBER / OCTOBER 2022 57


IN DEPTH WITH

Increasing patient

comfort with

advanced technology

Helping patients relax allows practitioners

to do their treatment efficiently, thus

providing a more pleasant experience.

In any healthcare environment, patient

comfort is incredibly important. While

hygienists are highly trained with this in

mind, technology can make it even easier

to ensure patients are relaxed when in

the chair. In fact, when dental offices stay

up to date on the latest technological

advancements, it assures patients they are

getting the highest level of care and comfort.

It also leads to better outcomes for those

patients — who are more likely to return for

care and to have lifelong and multigenerational

relationships with the practice.

One excellent use for today’s dental technology

has to do with a cause near and dear to our

hearts: relieving patient anxiety safely.

No matter how much clinicians try to make

patients feel at ease, some of them will still

have tremendous anxiety about dental care.

Clinicians can focus on how comfortable

the chair and neck support are, give them

sunglasses to block out the harsh lighting, and

even create ambience with lighting and music,

but they are still tense and uncomfortable.

And the tenser the patients are, the more

likely they will jolt and jump during the

procedure, which makes it hard to work with

instruments, drills, and other equipment.

This is a real concern.

In those situations, one way to deliver

treatment safely is to use nitrous oxide

or oxygen sedation, which can make the

patient’s experience much less stressful. It

keeps them calm throughout the procedure,

while helping them feel as if the time has

passed faster. This happens with minimal

side effects – just five minutes of 100%

oxygen eliminates nitrous oxide from the

bloodstream.

Using nitrous oxide is also beneficial for

the practice. More cooperative and relaxed

patients create a less stressful environment

for clinicians. The higher patient satisfaction

can then lead to more referrals and better

reviews for the practice.

Nitrous oxide and oxygen delivery is easily

adjustable so users can provide the right

mix for each patient. While analogue and

digital technology accomplish the same

job, the Accutron Digital Ultra Flowmeter

actually has more safety features than the

other models. Plus, the completely flat

surface allows for easy disinfection or barrier

protection.

The American Dental Association’s published

best practices for using nitrous oxide

dictates that the practices use a single-use

nasal mask and tubing that is sterilised per

the manufacturer’s recommendations.

Nasal masks are beneficial to patients in the

age of COVID-19 in that they require patients

to breathe through their nose and lessen

their exposure to respiratory droplets.

The ClearView Nasal Mask uses a patient

demand system for administering gas, which

is designed to match the patient’s flow of

breathing. And the soft inner mask creates

a better seal against the patient’s face for

better administration of gas. Features of the

ClearView Nasal Mask include mask-in-mask

design to reduce ambient N2O with clear

outer mask that shows patient “breathing

through nose”. It also has low profile that

provides easier access to the patient’s mouth.

The Axess Low Profile Nasal Mask is a

single-use mask that works with positive

flow systems. Its low profile offers better

visibility and better access to a patient’s

mouth. The nasal mask fits comfortably

and snug, and its lightweight circuit tubing

makes it easier for patients to move without

displacing the mask.

To help make patients even more comfortable

and relaxed, both the ClearView and the Axess

Nasal Masks come in scents and colours that

appeal to patients.

There is no doubt that patient comfort

is among the top priorities among dental

practices today. Combining best practices

with technology is the most effective way

to ensure patient comfort while providing a

superior patient experience. DA

Courtesy of

HuFriedyGroup

58 DENTAL ASIA SEPTEMBER / OCTOBER 2022


IN DEPTH WITH

Award-winning CAD software

for single-visit dentistry

ChairsideCAD from exocad receives a Cellerant Best of Class Technology Award

for the fourth consecutive year.

exocad, an Align Technology company

and a dental CAD/CAM software provider,

has announced that ChairsideCAD, its

CAD software for single-visit dentistry,

received a 2022 Best of Class Technology

Award from Cellerant Consulting Group.

This is the fourth consecutive year that

ChairsideCAD has been recognised for

this award.

“To receive this prestigious industry

award from dental industry leaders for a

fourth consecutive year makes us truly

proud,” said Larry Bodony, president

of exocad America. “We designed

ChairsideCAD with clinicians in mind,

aiming to simplify the chairside design

process, while making it faster and more

accurate. We’re confident the intuitive

design workflow of ChairsideCAD, plus the

freedom to use any open hardware, makes

this a fantastic tool to streamline even the

most complex cases.”

exocad is the software of choice for

manufacturers of dental CAD/CAM

systems because of its flexibility, reliability

and ease of use. Dental professionals

use exocad software to streamline their

workflows for a broad range of indications.

Based on exocad’s lab software DentalCAD,

ChairsideCAD is the first complete openarchitecture

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 announcement has grown to

occupy a unique space in dentistry by

creating awareness in the community

of manufacturers who are driving the

discussion on how practices operate now

and in the future. The 2022 Cellerant Best

of Class Technology Award was decided

on by a panel of technology leaders in

dentistry. DA

DENTAL ASIA SEPTEMBER / OCTOBER 2022 59


IN DEPTH WITH

Full range of oral surgery

applications

With the Piezomed module, a new add-on

for Implantmed Plus, W&H breaks new

ground: implantology and piezo surgery

are now combined in a single device.

For the first time, W&H can cover the

entire workflow for minimally invasive

oral surgery with a modular solution,

simplifying clinical work and opening up

new prospects for treatment. Andreas

Brandstätter, strategic product manager

for Oral Surgery and Implantology,

expounds on the product’s positioning

and its benefits for users.

What makes the Piezomed module

from W&H a genuine breakthrough in

oral surgery?

Andreas Brandstätter: At W&H, we want

to push boundaries and think outside

the box with our users. We definitely

achieved this in the development of our

Piezomed module. It is easy and costeffective

to fit onto the Implantmed

Plus. The result is a

modular system that combines

implantology and piezo surgery in one

device for the first time, simplifying

workflows. It is a component that was

missing on the market until now.

This, coupled with the implant stability

measurement and documentation

features, makes us the first

manufacturer to cover the entire

surgical workflow. Oral surgeons can

now discover a new world of treatment

possibilities. For me, this marks a

genuine breakthrough in oral surgery

that meets our users’ requirements.

How does W&H’s surgical portfolio differ

from that of competitors?

Brandstätter: We have the complete range

of oral surgery portfolio fully tailored to the

user’s workflow. For instance, Implantmed

Plus ensures efficient, safe implantology

work, while the Piezomed module gives

oral surgeons all the benefits of W&H piezo

technology.

Our surgical contra-angle handpieces allow

procedures to be performed with precision,

while the wireless foot control ensures

greater comfort and freedom of movement.

The Osstell Beacon for measuring implant

stability provides certainty in assessing

the correct loading time for an implant.

Comprehensive documentation guarantees

full traceability. That means we are offering

60 DENTAL ASIA SEPTEMBER / OCTOBER 2022


IN DEPTH WITH

a modular system with dovetailed

components, guaranteeing maximum

efficiency and reliability in everyday

clinical practice.

What market strategy are you pursuing

with the Piezomed module?

Brandstätter: We want to embed piezo

surgery as the new oral surgery standard

in dental practice and establish it as a fixed

element of surgical workflows. The aim is

for our new modular system to become the

synonym for oral surgery and implantology

in the future.

What are the strengths of W&H piezo

technology?

Brandstätter: First and foremost, it is easy

and intuitive to use. Another technical

highlight is the patented automatic

instrument detection. This automatically

sets the right power class when the

instrument is inserted and reduces the

risk of instrument overload.

In addition, with more than 30 different

instruments and saws, our product range

covers a broad spectrum of tasks. The

specially developed saw-cutting geometry

ensures outstanding cutting performance.

For example, bone block removals can be

carried out with little bone loss, which is

Andreas Brandstätter, strategic product manager for Oral Surgery and Implantology

ideal for ensuring procedures are minimally assisting with tooth extractions, or for

invasive. And, we use a special spray design intensive use, both versions are designed to

to cool the treatment site perfectly.

simplify processes in dental practice.

What advantages does the W&H modular Another benefit is the standardised operation.

system have in store for users?

What’s more, only irrigation tubing and a

Brandstätter: We are offering two versions saline solution are required, which enables

of our Piezomed module: Piezomed Plus optimised handling. In addition, users always

and Piezomed Classic. Whether it is for have the right device (implantology motor

general dental scenarios, for example or piezosurgical instrument) to hand in a

compact and space-saving form, whatever

the application.

What is your personal highlight of the

product innovation?

Brandstätter: With our modular system, we

are pushing the boundaries of oral surgery.

The way of working is changing and becoming

simpler, helping modern dentistry to progress.

In addition, we are offering our customers an

attractive solution in terms of price.

Even as early as the product development

stage, we kept an eye on the manufacturing

costs and deliberately avoided using multiple

components. For example, only one display,

touch screen and coolant pump are used

for a surgical application. We are delighted

we can pass on this manufacturing cost

reduction to our customers – a classic winwin

situation. DA

DENTAL ASIA SEPTEMBER / OCTOBER 2022 61


IN DEPTH WITH

Discovering perfection

in prophylaxis

Mectron introduces the new Combi Touch, an ultrasonic

unit and powder blasting device in one.

The Combi Touch combines ultrasound

and air-polishing in one unit to provide a

complete prophylaxis treatment from the

removal of supragingival and subgingival

calculus to gentle removal of stain and

biofilm, and even implant cleaning.

The ergonomic touch panel allows for fast

and intuitive control of every function and

at the same time cleans and disinfects the

device in no time.

The ultrasound unit, thanks to its Soft

Mode function, allows for ultra-gentle

scaling, which reduces the insert’s

oscillation amplitude, rendering its motion

compatible with even the most sensitive

patients. On the other hand, while also

guaranteeing optimal performance with

prosthetics and extractions treatments,

Combi Touch’s Pulse Mode function

transforms the ultrasound oscillation to a

new profile.

Combi Touch is also provided with the

new slim handpiece with circular LED

light weighing only 55g, minimising the

discomfort for the operator and allowing

for optimal illumination of the treatment

area at all times. It can either be hooked up

to the office’s regular water system or used

with a 500ml external bottle.

The air-polishing unit allows the use of

different types of powder (supra or

subgingival), depending on the desired

treatment type. The greatest advantage

is the ability to manage the use of both

powders on the same patient with a

simple click.

Furthermore, it is not necessary to change the

air-polishing handpiece. Instead, users can

simply insert any one of the newly available

handpieces with different orientations (120°,

Perio and the optional 90°). The Combi Touch

Technology makes it possible for the operator

to decontaminate the oral cavity effectively,

while being able to work ergonomically, easily

reaching all necessary sites.

The greatest advantage for the operator,

therefore, is that the technology provides a

complete set of tools for effective, fast and

minimally invasive non-surgical periodontal

therapy. It is suitable in periodontal pockets

deeper than 5mm, thanks to the dedicated

subgingival perio tips attached to the perio

handpiece. Soft, flexible, and anatomically

adjustable to the periodontal pocket, this

tip gently removes bacterial biofilms from

the periodontal and peri-implant pockets.

This combined technique allows the

operator to obtain an excellent clinical

result, benefitting the timing of the

procedure much appreciated by patients.

The device maintenance is fast and simple,

thanks to containers that can be removed

without having to switch off the device,

and an exclusive anti-clogging system for

the powder. DA

62 DENTAL ASIA SEPTEMBER / OCTOBER 2022


IN DEPTH WITH

LED headlights

as clinical illumination

Dr B. Jin Chang, PhD, president and chief scientist of SurgiTel,

answers commonly raised questions about LED headlights.

Is there an ideal

clinical LED

headlight?

Dr B. Jin Chang:

No. For dental

procedures,

neutral or warm

LED lights are

recommended.

Neutral LED lights

offer the best colour

accuracy and are safe for the eyes. If you

want to minimise the blue light hazard, you

can use warm LED lights which are similar

to halogen light: good colour accuracy and

the safest for eyes. For surgical procedures,

cool LED light may be a better choice.

Are brighter lights better?

Dr Chang: The definition of good illumination

is neither too bright nor too dim. Eyes can

adapt to the wide range of brightness by

controlling light which is entering the eyes

by adjusting the iris of the eyes (1-3mm

under the bright illumination). If you can

control the overhead illumination to meet

the recommended target to background

ratio by adjusting the brightness of

background illumination, all LED lights

available today are bright enough for most

procedures. If you compare cool LED lights

with warm or neutral LED lights, cool LED

lights will make you feel brighter because

these lights have a stronger blue light. Cool

LED lights not only distort the colour but

are also harmful to the eyes.

Which LED lights do you recommend for

dental procedures?

Dr Chang: Neutral or warm LED lights are

recommended. SurgiTel neutral LED lights

have a balanced spectral distribution and

thus offer the best colour accuracy and

are relatively safer for eyes. If you want to

minimise the blue light hazard, you may

choose SurgiTel’s new warm LED lights

which offer good colour accuracy and are

the safest for eyes as shown in Figs. 1a-b.

Which LED lights do you recommend for

surgical procedures?

Dr Chang: Cool LED lights are recommended

for surgical applications because cool LED

lights will enhance the image of veins and

nerves. Because red tissues absorb most

blue lights, surgeons will face less blue

light hazards.

I am a surgeon and feel that SurgiTel LED

headlights are not bright enough for my

surgical procedures. Do you have brighter

LED headlights?

Dr Chang: SurgiTel will continue to design

new LED headlights with new features.

If you reduce the brightness of the

overhead illumination to meet the target

to background ratio (3:1), you will find

that our LED headlights become very

bright. My personal opinion is that surgical

overhead lights are too bright. Too bright

background illumination will strain your

eyes and dry tissues quickly. Surgeons

who have been practicing with reduced

overhead lights told me that their eyes are

no longer strained.

Can the colour rendering index (CRI)

be used to evaluate the quality of LED

headlights?

Dr Chang: The CRI was developed to

evaluate traditional thermal light sources

for architectural lighting by using sunlight

as the reference. Using CRI for evaluating

the quality of LED lights used as clinical

illumination is not proper because

lights with low CRI can show anatomical

features better.

The use of LED lights as clinical

illumination should be evaluated by

illuminating specific anatomical subjects.

Some will compare two light sources

using a supposedly neutral target such

as a piece of white paper. However, this

type of test does not take into account

the actual use of the light. Two lights

that have the same appearance on a

white piece of paper may look drastically

different when cast on anatomical objects.

For example, red tissue may appear dull

under a white light composed of yellow

and blue light. Under equally white light,

but composed of a continuous spectrum,

red tissue will appear a true red.

Therefore, if we are evaluating the colour

quality of light for clinical applications, we

should test light sources on anatomical

objects and not a neutral subject, like a

piece of white paper. DA

Figs. 1a-b: Comparison of neutral and

warm LED Light

DENTAL ASIA SEPTEMBER / OCTOBER 2022 63


IN DEPTH WITH

Precise, fast and clean

– that’s Simplex

Orthodontic offices and laboratories that value eco-friendly 3D model

printing free of harmful fumes will find the Simplex 3D filament

printer system from Renfert the ideal printer for their everyday work.

3D printing opens up a whole new world

of possibilities in orthodontics. With 3D

printer, users only need to press a button

to generate a physical model (e.g. a

planning or aligner model) from the digital

data set in the dental office or laboratory.

But which printer is best suited for model

printing in orthodontics?

There are various 3D printing methods

(e.g. filament printing, resin printing).

However, many resins used in 3D printing

are not biodegradable and are a hazard to

the environment unless properly disposed

of. In addition, odour-intensive vapours

are released during printing, which are

annoying and can affect health. A more

environmentally friendly alternative is

filament printing (FFF/FDM). Bio filaments

are often used. The great advantage of

filament printing is that both office and

laboratory remain free of unpleasant

chemical odors.

“The Simplex 3D filament printer stands

out thanks to its simplicity and intuitive

operation. And there are no chemicals

and no post processing. This means no

isopropanol and no light curing. This allows

us to meet our objectives, not only regarding

environmental and climate protection but

also regarding health protection within

our office team,” said Dr Oliver Raeth,

orthodontist from Engen, Germany.

THE HEALTHY AND MORE

ENVIRONMENTALLY FRIENDLY WAY

TO THE PRINTED MODEL

The Simplex 3D filament printing system

from Renfert is the first 3D printing system

specifically tailored to orthodontics.

The 3D printing system offers several

advantages all at once. In addition to being

easy to use and cost-effective, Simplex

special filaments are the strong answer

to the demand for more environmental

protection. Unlike resin printing, the

air remains free of irritant components,

64 DENTAL ASIA SEPTEMBER / OCTOBER 2022


IN DEPTH WITH

because filament printing does not release any harmful

vapors during the printing process.

The high-quality Simplex filaments are suitable for the

special requirements of the orthodontic field. They offer

excellent mechanical and physical properties and at

the same time are biologically harmless. For example,

the Simplex Study Model Filament is recyclable and

biodegradable under the special conditions of industrial

composting. Since no post-processing is required for

filament printing, no chemicals are needed for cleaning.

NEW

3D printing with

Ease of use, automated presets, mainly biologically-based

filaments and a clean printing process make the Simplex

3D filament printer system a state-of-the-art “colleague”

in day-to-day orthodontic work. With its dental-specific

slicer software and special filaments, the printer ensures

consistently reproducible, reliable results.

“The Simplex 3D filament printer stands out thanks

to its simplicity and intuitive operation. And there

are no chemicals and no post processing. This means

no isopropanol and no light curing. This allows us to

meet our objectives, not only regarding environmental

and climate protection but also regarding health

protection within our office team,” said Dr Oliver Raeth,

orthodontist from Engen, Germany. DA

The first filament

printer system

specifically designed

for orthodontic

model fabrication.

SPECIFICATIONS

• Simplex consisting of: Simplex 3D filament printer,

Simplex sliceware, Simplex print, Simplex study

model, Renfert Connect app

• Process reliability thanks to filament monitoring

system and automated troubleshooting

• Intuitive touchscreen navigation

plug

and

print

Getting started is so

easy – simply at the

touch of a button –

find out more:

• Safety thanks to closed building chamber, lockable

door, and removable cover

• Heatable print bed: optimal adhesion and simple

cleaning

• Simple handling thanks to removable print platform

• Wi-Fi (currently EU and US) for print control

• Working with filaments that are harmless to health

making work easy

DENTAL ASIA SEPTEMBER / OCTOBER 2022 65

20220412_SIMPLEX_Anzeige_95x250_EN.indd 1 12.04.2022 09:16:33


SHOW PREVIEW

IDEM 2022 returns

with exciting,

new programmes

and initiatives

The biennial International Dental Event and

Meeting (IDEM) trade fair and convention

returns with its 12th edition this year. Themed

“Building Resilience in Dentistry”, the physical

event will be held from 7–9 October at Sands

Expo and Convention Centre, Marina Bay

Sands, Singapore.

After the in-person hiatus caused by the

pandemic, participants will now be able to

come together again to explore more and

better business opportunities, and network with

likeminded professionals face-to-face to learn

about the latest trends and updates in dentistry.

In addition to conferences conducted by

renowned speakers, there will also be handson

and interactive workshops for delegates,

showcases and exhibits for visitors to

experience and learn about new technologies

and the latest innovations in the dental sector.

Participants can look forward to a curated

series of programmes:

Full-day SDA Masterclass conducted by

leading clinical researcher in periodontology,

Dr Maurizio Tonetti, on the topic— “Implants

in Stage III and IV Periodontitis Patients:

Benefits and Risks”. Dr Tonetti will present

key concepts for attendees to understand the

importance of appropriate periodontal therapy

before implant placements, benefits, and risks

of biological complications in Stage III and IV

66 DENTAL ASIA SEPTEMBER / OCTOBER 2022


SHOW PREVIEW

periodontitis patients. He will also share on

specific approaches to decrease the risk of

peri-implantitis in these high-risk subjects.

Trade Exhibition in a 14,000sqm allencompassing

exhibition hall showcasing

close to 500 international exhibiting brands

from more than 30 countries. Participants can

meet manufacturers and cornerstone brands

in person, speak directly with the producer of a

product, and learn about the finer nuances of

a tool and how it can enhance their business

or practice. Participants can also look to build

international partnerships with exhibitors from

countries such as Brazil, France, Germany, Italy,

Japan, Korea, Switzerland, China, US and more.

AOHTS@IDEM (Association for Oral Health

Therapists Singapore Symposium in

collaboration with IDEM) brings together the

AOHTS’ flagship event with IDEM’s Dental

Hygienist and Therapist Forum (DHTF)

providing hygienists, therapists, and oral health

therapists a central platform to network and

learn about the latest developments in their

field of practice. There will be 10 conferences

conducted by notable speakers to cover

topics such as dental care for the elderly

with neurological diseases, child protection

for dental professionals, oral health care

responsibility for the dental profession and

more.

Singapore Speaker Series is a brand-new

programme featuring local speakers who will

cover specialised topics on comprehensive,

conservative approaches to dentistry.

Participants can look forward to learning

about a multidisciplinary approach to aesthetic

rehabilitation, contemporary techniques on

perio-restorative outcomes, patient-centric

orthodontics and treating ameloblastomas.

Innovation Arena is a first-of-its-kind initiative

curated for young companies and start-ups in

the dental and non-dental sectors to showcase

the latest innovations and products targeting

the dental market. The Innovation Arena aims

to bridge start-ups with participants in order to

promote cross-sector collaborations between

the dental sector and businesses at large.

IDEM360+, a digital community platform

supplements IDEM 2022 in providing

participants with a holistic experience:

• Watch conference content shared by industry

experts after the event has ended

• Preview the latest products and solutions

prior to the exhibition

• Shortlist and book meetings with exhibitors

before heading down to the event

• Bookmark conference sessions for easier

navigation and schedule planning

• Build connections and network with fellow

participants

• Access IDEM information 24/7 from anywhere

with no additional cost

Delegate registrants will be able to attend all

on-site activities and have full access to the

digital platform IDEM360+. DA

DENTAL ASIA SEPTEMBER / OCTOBER 2022 67


PRODUCT HIGHLIGHTS

Garrison Dental Solutions

Five-in-one multi-function composite instrument

The special coating process withstands

diverse cleaning and sterilisation methods,

including ultrasonic cleaning.

Moreover, its lightweight large-diameter

stainless steel handles provide improved

ergonomics and precise control for delicate

contouring and shaping.

The five-in-one composite instrument includes

two blades, two condensers and one acorn.

Garrison Dental Solution’s five-in-one

composite instrument has been carefully

designed to provide the most streamlined

and versatile instrument assortment for

composite restorations.

Its titanium nitride coating is 40% harder

than stainless steel and testing has

proven it to be the best non-stick surface

for placement, shaping and carving of

composites.

Garrison Dental Solutions specialises in the

design, development and manufacturing of

product solutions to improve the quality

and efficiency of dentistry. Established in

1996, the company is the industry leader in

sectional matrix systems and its products are

sold globally. ■

SprintRay

Excellent fit and reproducible results

remarked Sumeet Jain, vice-president

of Materials at SprintRay. “By reducing

the cost and lead times associated with

restorative procedures, we’re enhancing

dentistry for patients and doctors.”

SprintRay Crown is Class IIa medical

product with outstanding marginal

integrity. It is easy to handle and polish,

and formulated for radiographic visibility.

A material collaboration between

SprintRay and Bego, SprintRay Crown

is a ceramic-filled hybrid material for

3D printing permanent single crowns,

inlays, onlays, and veneers. It delivers

an excellent fit and reproducible

results, allowing dental professionals

to provide budget-friendly custom

restorations confidently.

“With this new material introduction,

SprintRay continues to shape the future

of the dental industry, widening the

reach and scope of digital technology,”

Dental 3D printing solutions, especially

for durable restorations, are becoming

increasingly important. In addition to the

excellent material properties and good

aesthetics, are the low material costs, the

speed in production and the customisability

of the dental objects that make SprintRay

Crown future-proof,” said Thomas Kwiedor,

head of Business Development 3D Printing

for Bego. “The expansion of the partnership

with SprintRay and the introduction of

SprintRay Crown will further accelerate this

trend.” ■

68 DENTAL ASIA SEPTEMBER / OCTOBER 2022


PRODUCT HIGHLIGHTS

Parkell

Articulation simplified

AccuFilm has introduced its simplest and thinnest film

to date. At only eight microns, AccuFilm FastCheck

incorporates the accuracy dental professionals routinely

rely on with the added convenience of a built-in frame.

CONSISTENT STRENGTH

SEAMLESS BEAUTY

The built-in frame facilitates easy positioning over the

occlusal surfaces of posterior teeth without the need

for forceps. Its thin film consistently produces sharp,

easy-to-interpret markings even on hard-to-test highly

polished metal and ceramic surfaces.

Practitioners can easily identify the smallest occlusal

discrepancies with precise marking on the points

of contact. Its double-sided colour coating for

simultaneous marking of both arches and it is equally

effective on both wet and dry metal, porcelain, and

zirconia surfaces.

For almost 75 years, Parkell has been designing and

manufacturing innovative, premium quality, and

internationally recognised dental materials and

equipment, with predominately all activities proudly

being performed in the United States on Long Island,

New York. Parkell has a diverse and robust variety of

product offerings, with advanced dental materials and

devices. Parkell’s products are sold in over 60 countries

through an extensive network of distributors, as well as

our European subsidiary. ■

VITA YZ® ST Multicolor

• High strength (1200 MPa) for precise processing

and predictable results

• Fascinating esthetics and high shade reliability

thanks to the VITA Shade Formula

• Speed Sintering in under 60 minutes

For more information,

scan the QR Code

DENTAL ASIA SEPTEMBER / OCTOBER 2022 69


PRODUCT HIGHLIGHTS

Bego

Compact DLP 3D printer

The high dental technology requirements

regarding precision, safety, and

reproducibility of 3D printing solutions

differ considerably from those of other

application fields.

Varseo XS from Bego is a compact DLP

3D printer specially developed for dental

uses. This high-resolution DLP 3D printer

comes with outstanding detail at an

attractive price. Its building speed is

independent of the number of elements

to be produced.

What’s more, Varseo XS has a handy

building platform — it is capable of

printing up to 20 crowns or two largespan

bridges with up to seven units.

The network capability via W-LAN or

Ethernet connection allows fast and

uncomplicated data exchange to the PC.

Right-sized and appealing design, Varseo

XS features a replaceable resin tank

which allows easy material change. It is

compatible with VarseoSmile Crownplus,

VarseoSmile Temp, VarseoWax CAD/Cast

and VarseoWax Model.

BEGO is a long-established family

company with 130 years of dental

expertise, a pioneer of CAD/CAM

technology with more than 20 years of

experience in the field of 3D printing,

and a specialist in all dental fabrication

techniques.

The BEGO Varseo 3D printing system

offers users a system specially developed

with and for dental laboratories; a

coordinated portfolio of 3D printer,

light-curing device, scientifically tested

materials, software tools, and services;

the means to achieve fast, simple and

cost-efficient fabrication of a wide range

of restorations made from resins and

ceramic filled hybrids — in their own

laboratory and with complete flexibility

and unrivalled precision; and validated

processes from scanning to finishing. ■

Directa

Initiate extraction process simply

The Luxator P-series from Directa are

periotomes intended to cut off the

periodontal ligament axially before

final extraction is made with forceps

or elevator. It features a grip-friendly

pen-liked designs that provides

maximum tactility, sight and control.

• Luxator P3, contra angle, dark blue

• Luxator P4, dual edge, lilac

Directa’s products are developed, tested

and evaluated by selected team of highlyqualified

and renowned Swedish and

international dental professionals. Their

aim is to make life easier for all dental

professionals in their daily clinical work.

Modern techniques as implants requires

instruments and equipment offering

possibilities to achieve fast healing

and placement of direct implants after

extraction. ■

The upper part of the instrument is

equipped with a knob that allows for

increased axial force by a surgical

mallet. Additionally, the tips are

coated with titanium nitride for

durability.

The Luxator P-series includes:

• Luxator P1, straight blade, dark green

• Luxator P2, inverted curved, light blue

70 DENTAL ASIA SEPTEMBER / OCTOBER 2022


PRODUCT HIGHLIGHTS

Ultradent

Dental bone grafting plug

The OsteoGen Plug by Impladent is a

dental bone grafting plug that combines

non-ceramic OsteoGen bioactive

resorbable calcium apatite crystals with

a Type I bovine achilles tendon collagen

matrix.

The bone graft crystals are contained

within the collagen matrix, allowing for

simple and effective placement without

a membrane or the need to mix and

pack the graft. The bioactive calcium

phosphate crystals create a structure

that mimics the organic and inorganic

characteristics of actual bone.

This resorbable quality allows the

structure to be replaced by host bone

tissue within a few months. The collagen

matrix also absorbs and delivers blood

to the graft during resorption, a crucial

factor for the successful formation of

new bone tissue, and provides a scaffold

for keratinised tissue to develop over the

grafted site.

The OsteoGen bone grafting plug is

radiolucent when placed but will become

radiopaque within three to five months

(when it has been replaced with host bone

tissue). Implant placement can then be

achieved.

The OsteoGen crystals are a calcium

phosphate-based bone graft that is not a

β-TCP and not a dense ceramic HA, nor is

it a biphasic mixture of the two. OsteoGen

has a unique Ca:P ratio that mimics the

composition of human bone. It comes in

three sizes with four-year shelf life from

manufacturing date:

• Slim size: 6x25mm

• Large size: 10x20mm

• Extra large size: 15x20mm ■

Busch

Diamond-interspersed polishers for ceramics in dental laboratories

Final corrections are frequently needed

on ceramic restorations, even after the

final glaze firing. To eliminate the need

for renewed final glaze firing, Busch

offers a two-step diamond-interspersed

polishing system for all popular

ceramics used in dental laboratories.

The diamond grit size and the bond

hardness are optimally matched to the

properties of the ceramics.

Their comprehensive range of products

includes carbide burs and cutters,

diamond burs, polishers, abrasives,

steel instruments and ceramic cutters.

As a manufacturer, absolute precision

and high-quality standards are the

benchmarks for their production. This

is why the entire production chain, from

the blank to the final product is done

at their site in Engelskirchen, Germany.

The company-owned engineering

department designs and realises highprecision

manufacturing facilities

according to their internal specification

for products. The company is certified

according to ISO 13485. ■

There are five application-specific

shapes each for pre-polishing and

high shine polishing. The desired high

shine can be easily achieved in just

two steps, eliminating the need for an

additional final glaze firing. For easier

identification, the diamond-interspersed

polishers come in two colours: reddishbrown/yellow

for pre-polishing and

light green/yellow for high shine

polishing.

Busch is a specialist for rotary precision

instruments and tools since 1905.

DENTAL ASIA SEPTEMBER / OCTOBER 2022 71


PRODUCT HIGHLIGHTS

Premier Dental

Unsurpassed radiopacity

Premier Implant Cement Plus is the

ultimate solution for implant crown

cementation. Versatile by design,

this implant cement provides strong,

secure retention yet enables easy, nondestructive

crown retrieval, if necessary,

at a later date.

The elastomeric cement flexes under

force, absorbs shock and creates a tight

marginal seal. Clinicians will appreciate

the predictable and easy application

with no etch, primer or bonding agent

required. They can easily remove excess

cement too and its gel stage is just two

minutes.

Premier Implant Cement Plus comes in

two shades and delivers unsurpassed

radiopacity — enabling clear visibility on

radiographs to help deliver better patient

outcomes.

As a fourth generation, family-owned

business founded in 1913 by the Charlestein

family, Premier Dental is one of the most

trusted and respected names in dentistry.

With a history of innovation, dental

professionals worldwide have turned

to Premier for quality, state-of-the-art

dental equipment to improve their daily

practices. ■

Glidewell

Enabling safe, efficient implant placement for fully edentulous patients

Glidewell now offers tissue- and bonesupported

surgical guides to help

dentists optimise implant positioning

for cases where a fixed or removable

implant restoration is planned. Further

strengthening the company’s position

as a comprehensive implant solutions

provider, the Digital Treatment

Planning (DTP) line extension provides

prosthetically driven implant positioning

and a smooth, predictable surgical

procedure for fully edentulous patients.

Glidewell’s DTP service leverages the

expertise of the most technologically

advanced dental lab in the US to aid

clinicians in determining where implants

should be placed to maximise safety, avoid

vital anatomical structures, save chair time,

minimise surgical trauma for the patient, and

ensure a predictable restorative outcome.

“With our new service for fully edentulous

cases, we use advanced 3D treatment

planning software to produce surgical guides

that position implants in the optimal location

needed to support the desired restoration,

be that an implant-supported overdenture

or the BruxZir Implant Prosthesis,” said Ilan

Sapir, manager of the Digital Treatment

Planning department.

The DTP service is available for all major

guided implant systems and is a key element

of Glidewell Implant Solutions, which

provides dentists with everything they need

to succeed in implant dentistry, from live

and online continuing education, to dental

implants, to cutting-edge restorations. This

“implant to crown” approach is exemplified

by the company’s comprehensive implant

warranty that guarantees the Hahn Tapered

Implant as well as custom abutments and

BruxZir restorations produced by Glidewell

for the life of the patient.

The expanded offerings available through

Glidewell DTP also include an addition for

tooth-supported guides. For cases where

immediate loading is planned, a customised

provisional crown can be added to the case

for delivery on the day of surgery. Designed

in collaboration with the experienced

laboratory technicians in Glidewell’s implant

lab, the immediate provisional helps contour

the gingival tissue for an optimal emergence

profile when the case is restored. This

service is available for the Hahn Tapered

Implant now and will be expanded to all

major implant systems later this year.

“Our goal has always been to make highquality

dental care available to as many

patients as possible,” said Jim Glidewell,

CDT, founder and president of Glidewell.

“Many dentists who choose to place

implants for their patients follow this same

philosophy, and we support them through

education and innovative but cost-effective

surgical and restorative solutions. The fully

edentulous have the most to gain from

implant treatment, and our new full-arch

surgical guides will help more dentists

place implants with the confidence they

need to provide care for this important

patient population.” ■

72 DENTAL ASIA SEPTEMBER / OCTOBER 2022


PRODUCT HIGHLIGHTS

Voco

Nano-ceramic hybrid CAD/

CAM block

Either as crown, inlay, onlay, veneer or implant-supported

crown – Voco’s Grandio blocs successfully cover numerous

indications in prosthetics and are solidly established in

practices and laboratories around the world

Thanks to its filler content of 86% w/w, Grandio blocs

score with an outstanding material strength. Furthermore,

the flexural strength shows values that usually are only

reached with silicate ceramics, although Grandio blocs are

much more antagonist-friendly.

The material can be milled very finely and is easy to polish,

so that the restoration fits optimally and meets high

aesthetic requirements. In addition, the wide shade rage in

two translucency grades supports a natural look. Grandio

blocs are available in two sizes, 12 and 14L.

Grandio blocs with the appropriate pin are compatible

with the milling devices PlanMill 30S and PlanMill 40S

from Planmeca. The devices, which are provided with

high-speed spindles, offer a milling speed that advances

the work efficiency in practice and laboratory. At the same

time, the linear motors ensure maximum precision.

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In addition to the milling devices from Planmeca, Grandio

blocs with the universal pin can be processed with other

milling units available on the market. These include, for

example, vhf, imes icore, Zirkonzahn or DGSHAPE. ■

→ www.mectron.com

DENTAL ASIA SEPTEMBER / OCTOBER 2022 73


PRODUCT HIGHLIGHTS

Dentsply Sirona

Print-on-demand denture teeth

The conversion of denture

manufacturing to printed

workflows is accelerating. The next

breakthrough is Lucitone Digital IPN

3D Premium Tooth material from

Dentsply Sirona. The new denture

tooth material enables labs to printon-demand

denture teeth with wear

resistance and aesthetics expected

in premium-level denture teeth. The

new material features the superior

durability of traditional IPN. It is

available in 16 A-D shades plus two

bleach options.

The Lucitone Digital IPN material is

fully integrated with the Lucitone

Digital Print Denture System and

is validated for Carbon M-Series

printers and Asiga PRO 4K and MAX

UV. It marks the next step towards

the migration of removable denture labs to

digital workflows, covering full dentures,

implant-supported dentures, and partial

dentures.

“The New Lucitone Digital IPN Resin

by Dentsply Sirona is incredible. The

aesthetics, translucency, workflow,

OnDemand manufacturing, and

customisation are simply ground

breaking,” said Trà Chambers, owner

at Express Dental Laboratory and

Dentsply Sirona’s key opinion leader.

“This is definitely a step in the right

direction for digital dentistry and

digital dentures.”

The Lucitone Digital IPN 3D Premium

Tooth material is supported by new

highly characterised (HC) libraries,

which utilise techniques of light

reflection and refraction. Optimised

for the Lucitone Digital Print Denture

workflow and specifically the new

Lucitone Digital IPN material, the

HC libraries enable printed denture

teeth to feature aesthetic textures and

translucencies expected in premiumlevel

denture teeth. ■

Ivoclar Vivadent

Protective varnish to reduce caries risk

The caries risk rises if the number

of mutans streptococci increases

significantly in the mouth. In these

cases, routine oral hygiene measures,

professional tooth cleaning and

fluoridation do not adequately protect

the teeth from damage.

Ivoclar Vivadent’s Cervitec Plus

varnish system contains the effective

combination of the active ingredients

chlorhexidine and thymol to selectively

control germs. It aids in reducing

an important caries risk factor and

controlling gingivitis.

Generally, Cervitec Plus is applied every

three months. If intensive treatment

is required, however, the varnish may

also be applied more frequently. It can

be applied on exposed root surfaces

and hypersensitive cervicals to reduce

bacterial activity and desensitise tooth

surface.

A colourless, transparent clear varnish,

Cervitec Plus offers optimum aesthetics

in the anterior region. Moreover, it

features enhanced moisture tolerance

for an easy application and provides

protection for at-risk areas with

optimum flow and wetting behaviour.

Cervitec Plus is based on its predecessor

Cervitec, whose effectiveness has been

well-documented for years. It is part

of Ivoclar Care which is a coordinated

range of products that enables dentists

to offer patients oral health management

measures tailored to their specific needs.

Cervitec Plus comes in single dose and

economical multi dose. ■

74 DENTAL ASIA SEPTEMBER / OCTOBER 2022


SHOW PREVIEW

exocad Insights 2022:

Learn. Connect. Enjoy.

exocad, an Align Technology company, will

host its third exocad Insights on 3-4 Oct 2022.

The global event will take place at the Palma

Congress Center in Palma de Mallorca, Spain.

Around 800 dental technicians and dentists

from around the world are expected on site,

as well as more than 40 strategic partner

companies who will showcase the latest digital

technologies. Novica Savic, chief commercial

officer at exocad, shares a preview of the twoday

event that is dedicated to digital dentistry

for labs and practices.

“Learn. Connect. Enjoy.” Can you explain the

motto behind exocad Insights 2022?

Novica Savic: “Learn,” stands for intensive

training. “Connect,” means networking in

person and on site with the global exocad

community — that includes registrants from

around 40 countries to date. “Enjoy,” reminds

us that we also want to enjoy our two days

together and have a good time at our evening

event.

Who are you targeting with the Insights

2022 event?

Savic: The event is aimed at

dental technicians and

dentists who already work

digitally in their practices

and laboratories or are

planning to enter the

digital world. The programme offers

interesting topics for both groups.

Guest speakers include leading digital

experts from the laboratory and clinical

environments, including internationally

renowned digital smile design specialist

Dr Christian Coachman from Brazil.

Speaking of topics, what will be discussed

on the main stage?

Savic: Industry trailblazers will give

participants tips on how to use digital

tools to achieve better aesthetic treatment

results for patients and how to work even

more productively. They will demonstrate

various ways to collaborate — explaining

how laboratories and practices can work

seamlessly with each other thanks to

modern digital tools. Among the cases

presented, participants will see complex

cases involving orthodontic, restorative

and aesthetic aspects.

At Insights, lab owners and dentists will

share how they’ve evolved workflows in their

Novica Savic, CCO exocad

exocad Insights will take place on 3-4 Oct 2022, on the Spanish island of

Mallorca and will offer a comprehensive, two-day programme for dental

technicians and dentists.

DENTAL ASIA SEPTEMBER / OCTOBER 2022 75


SHOW PREVIEW

labs or practices with digital technologies.

They’ll also discuss how labs are bringing

dentists with them on the digital journey.

Participating partner companies will also

offer sessions. What will those involve?

Savic: We’ll have 11 different partner sessions,

each lasting 30mins. Visitors can decide

which sessions they’d like to attend while at

the event. This way, participants can choose

the topics most relevant to their practices

or labs. Our experience from the first two

Insights events has shown us that this “circuit

training” is very well received because it allows

participants to take away a variety of new

impressions and ideas in a very short amount

of time.

What do the participants learn at the exocad

software sessions?

Savic: At this year’s Insights, there will again

be new software releases to present. That

means the topic for our software sessions

on Tuesday has been decided. Based on

typical lab and practice cases, users will

learn about the new features of the release

and hear helpful tips on how to get the most

out of the software. The clinical sessions will

be geared toward dentists, and we’ll have

laboratory sessions for dental technicians.

We’ll also have three software stations

at the exhibition where our application

specialists will be available to answer

individual questions and give concrete tips

to the participants.

Why is it worth investing in an exocad

Insights ticket?

Savic: The ticket price includes almost

everything: presentations, demo sessions,

food and drinks throughout the event,

exocad Insights attendees can look forward to hearing tips and tricks on exocad’s latest software releases, like DentalCAD 3.1 Rijeka

76 DENTAL ASIA SEPTEMBER / OCTOBER 2022


SHOW PREVIEW

and the evening event with dinner and live

music on Monday evening. Over two days,

participants will receive many new ideas on

how to advance their labs or practices using

digital technologies. They’ll discover new

ways to make workflows more productive and

learn how to improve treatment results

to benefit patients.

The future of digital

dentures at exocad

Insights 2022

Dr Lori Trost, a comprehensive restorative

dentist from the St Louis, Missouri area with

more than 30 years of experience, will share

a presentation on why colleagues can “Start

Loving Dentures.” Dr Trost talks about how

digital workflows are improving denture work

and why Insights is a must-see event.

What will you present at exocad Insights 2022?

Dr Lori Trost: The Insights event is an amazing

opportunity to share patient cases with the

audience, show the steps and the digital

workflow, and demonstrate the results that

can happen when you lean on technology. I

will talk specifically about digital dentures and

how that process has greatly improved. In

the past, there were many hands-on steps for

dentures. The process was laden with issues of

inaccuracies. Now, with digital technology, we

can produce something that is more accurate

and do so more efficiently. And accuracy in the

real world translates to happier patients, fewer

adjustments, and fewer appointments. We are

now able to deliver results faster, easier, better,

and patients are thrilled.

Can you share some examples of how your

work has improved with digital workflows?

Dr Trost: Last week, I delivered two immediate

dentures, and I saw both patients 24 hours

post-op. Neither needed adjustments. To get

those results and to have patients be that

satisfied is amazing. I am going to share those

types of experiences at Insights and hopefully

build excitement because this is the forefront

of what’s coming, and it will only get better.

Any other advice for colleagues looking to

evolve their practice?

Dr Trost: I believe that it is such an exciting

time to be a dentist now. For instance, if

you look at the past 15 to 20 years, we had

an onslaught of adhesive dentistry. Almost

everyone can now do really refined bonding. We

have mastered that. Now let’s back up and take

a look at those patients who need dentures.

In the same way that adhesive dentistry

developed, technology is now merging for these

edentulous patients. I see a lot of excitement

with other doctors who support this population

of patients. We can offer them substantially

better care now and to be able to deliver a highquality

product is very motivating.

What do people gain from attending Insights?

Dr Trost: Any time that you can gather

with colleagues and further your process,

knowledge, and understanding is worth it.

Going to a meeting like this is important

because it sets the stage for collaboration

across the aisle — by that, I mean with labs,

software platforms, and clinical dentistry. It is

a wonderful merging of interests that no other

meeting offers right now. I find it really exciting.

At Insights, you have some of the best minds in

our profession come together and have open

conversations. I encourage everyone to take

advantage of that and to have one-on-ones with

your peers.

Any final thoughts?

Dr Trost: If you are on the fence about whether

you should go — go! Because you’ll come away

with a great sense of what’s coming. These

developments are going to be a tidal wave and

really push dentistry in a great direction. DA

Guest speakers include leading digital experts from the laboratory and clinical worlds, including internationally renowned digital smile design specialist

Dr Christian Coachman from Brazil

DENTAL ASIA SEPTEMBER / OCTOBER 2022 77


SHOW REVIEW

VOCO welcomes dentists

from different countries

to their International

Fellowship Symposium

Lectures at the highest standard,

demanding discussions on current

topics and trends about modern

dentistry, as well as personal exchange

between colleagues from around

the world: This is what the VOCO

International Fellowship Symposium

has stood for many years.

For the fifth event, 50 dentists from

almost 30 countries again accepted

the invitation of the Dentalists from

Cuxhaven to further intensify the

dialogue between the manufacturer

and the dental practice.

The three-day event with more than

30 lectures focused on processes

and issues relating to conventional

restorative and innovative digital

dentistry. Furthermore, topics like

fabrication of endocrowns and updates

on molar incisor hypomineralisation

(MIH) were focal points.

In diversified lectures, the fellows

presented their current clinical cases

as well as solutions and treatment

methods. Numerous questions from

the audience proved the high relevance

of the topics presented, so that the

dental experts took home ideas and

new approaches. At the same time,

the presentations offered the VOCO

team important feedback on the

products used.

“The close and trustful exchange with

the dental clinic is indispensable for us

as manufacturer: This is the only way

we know the needs of everyday clinical

practice and can specifically consider

them in product development,” said Dr

Matthias Mehring, the event manager.

TALK FROM DR JOHN RUNDELL

PAREDES

Dr John Rundell Paredes is a general

dentist passionate in aesthetic

dentistry. He has a practice in Metro

Manila, Philippines, and conducts

training programmes and lectures with

the organisation PIPE about direct and

indirect composite as well as dental

photography.

His talk during the symposium about

“Augmenting Aesthetics in Direct Ormocer

Layering” detailed the techniques to make

composite restorations look stunning,

real and dynamic. He also discussed the

properties of translucencies, opacities,

stains and shade value. DA

78 DENTAL ASIA SEPTEMBER / OCTOBER 2022


EVENTS CALENDAR

SEPTEMBER

15 – 17 Dentsply Sirona World 2022

Las Vegas, NV, US

Venue: Caesars Forum

https://www.dentsplysirona.com/en-us/ds-world.html

16 – 18 56th Indian Orthodontic Conference

Pune, India

Venue: Bharati Vidyapeeth Campus

https://www.56thiocpune.com

26 – 29 Dental Expo 2022 – The 52nd Moscow

International dental forum and exhibition

Moscow, Russia

Venue: Crocus Expo Fairgrounds

https://en.dental-expo.com/dental-expo-en

28 – 30 China Dental Show 2022

OCTOBER

Suzhou, China

Venue: Suzhou Jinji Lake International Convention Center

http://www.chinadentalshow.com/en

3 – 4 exocad Insights 2022

Palma de Mallorca, Spain

Venue: Palma Congress Center

https://exocad.com/insights2022

7 – 9 IDEM 2022 – International Dental Exhibition

and Meeting

Singapore

Venue: Marina Bay Sands, Singapore

https://www.idem-singapore.com

13 – 15 Central Asia Dental Expo 2022

6th International Dental Exhibition

Almaty, Kazakhstan

Venue: ATAKENT Expo 11th Pavilion Timiryazev Str

https://cadex.kz/en

13 – 15 Dental World 2022

Budapest, Hungary

Venue: HUNGEXPO Budapest Fair Center

https://dentalworld.hu/dental-world-2022-en

27 – 29 IFED 2022 – 12th World Congress

of Aesthetic Dentistry

Abu Dhabi, United Arab Emirates

Venue: Conrad Abu Dhabi Etihad Towers

https://ifed2022.com

28 – 30 Korean Association of Orthodontists 55th Annual

Congress and Asian Pacific Orthodontic Society

13th Congress

NOVEMBER

Seoul, South Korea

Venue: COEX, Seoul

https://www.kao.or.kr/abstract/2022_fall/main_en/main.html

25 – 30 Greater New York Dental Meeting 2022

98th Annual Session

DECEMBER

New York City, US

Venue: Jacob K. Javits Convention Center

https://www.gnydm.com

1 – 3 The International Vietnam Dental Equipment and

Materials Exhibition

Hanoi City, Vietnam

Venue: ICE – 91 Tran Hung Dao Str., Dist Hoan Kiem

http://vietnamdental.com.vn

5 – 7 The 3rd Taiwan International Orthodontic Forum

Taipei, Taiwan

Venue: NTUH International Convention Center

http://www.asianpacificortho.org/events

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.

DENTAL ASIA SEPTEMBER / OCTOBER 2022 79


ADVERTISERS’ INDEX

COMPANY

PAGE

3Shape A/S

Inside Front Cover

3Shape A/S 1

Align Technology, Inc.

Front Cover

Amann Girrbach AG 7

Anthogyr France 47

BUSCH & CO. GmbH & Co. KG 13

Carestream Dental LLC 5

COLTENE 19

exocad GmbH 3

IDEM Singapore 2022 67

Mectron SpA 9

Mectron SpA 73

Medical Protection Society Limited

Outside Back Cover

Renfert GmbH 65

Shofu Inc. 33

SurgiTel 15

For information, visit us at www.dentalasia.net or

contact us at sales@pabloasia.com

Tekne Dental 11

VITA Zahnfabrik 69

@dentalasia

W&H

Inside Back Cover

Company Registration No: 200001473N

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

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

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

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

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Printed by Times Printers Pte Ltd

80

DENTAL ASIA SEPTEMBER / OCTOBER 2022


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