Dental Asia January/February 2023

www.dentalasia.net
JANUARY / FEBRUARY 2023
Breakthrough in intraoral scanners
New era unfolds for Minimally Invasive Cosmetic Dentistry (MiCD)
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ANCHORING THE PRESENT,
ALIGNING FOR THE FUTURE
17-19 FEBRUARY 2023
Marina Bay Sands, Singapore
www.aoscongress.com
LEARN FROM 17
DISTINGUISHED SPEAKERS!
SCAN TO
REGISTER
Organised By:
Held In:
Supported By:
Managed By:

CONTENTS
TRENDS
12 World Diabetes Day reminds of the link
between chronic diseases and oral health
16 Pilot teledentistry programme incorporating AI
UNDER THE SPOTLIGHT
18 Enhancing treatment efficiency with AI
DENTAL PROFILE
21 Breakthrough in intraoral scanners
CLINICAL FEATURE
24 Navigated digital full mouth implant
rehabilitation
30 Treatment of Class II increased overjet by
Carriere 3D Motions
34 New era unfolds for Minimally Invasive
Cosmetic Dentistry (MiCD)
12
18
USER REPORT
38 Five benefits of prosthetic-driven implant
planning
42 Astounding new smile with direct
composite veneers
BEHIND THE SCENES
44 Digital dentistry is here to stay
46 Brilliant, true-to-shade press results at any
time
IN DEPTH WITH
49 ACTILINK Reborn: Enhancing
osseointegration and hydrophilicity of
dental implant
50 How Osteopore technology is used in oral
and maxillofacial surgery
SHOW PREVIEW
60 Hundred years of IDS: Shaping the dental
future
62 AOSC 2023: Anchoring the present,
Aligning for the future
REGULARS
4 Editor’s note
6 Dental Updates
54 Product Highlights
63 Events Calendar
64 Advertisers’ Index
21
34 44 60

TRIOS 5
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EDITOR’S NOTE
Success stories
continue
Happy new year, our dear readers! The Dental
Asia team is ecstatic to welcome 2023 as there
is a lot in store ahead of us — starting with the
40th edition of the International Dental Show
(IDS) concurrent with its centennial anniversary
happening on 14-18 Mar. Attendees can look
forward to a plethora of products and solutions
from over 1700 exhibitors as well as various
networking opportunities (p.60).
For instance, one of the key players in the
intraoral scanner market, 3Shape, will also
be present in IDS to showcase the recently
launched TRIOS 5 Wireless. Kasper Chaney
Sørensen, 3Shape’s general manager of
International Markets, shares how this device
has once again redefined the standards of
intraoral scanning (p.21).
What’s more, after the success of its
online edition in 2021, the Association of
Orthodontists (Singapore) Congress (AOSC)
returns this year in its established physical
format on 17-19 Feb, highlighting the current
technological advancements in the industry,
focusing on the niche of orthodontics (p.62).
On another note, Dr Selene Kuo (Taiwan)
presents a navigated digital full mouth implant
rehabilitation utilising BEGO Semados RSX
implant in combination with the components of
the MultiPlus concept, which won the 4th BEGO
clinical case award (p.24).
Dr Walter Lam (Hong Kong), on the other
hand, elaborates on the success of his
research on Artificial intelligence-designed
single molar dental prostheses: A protocol of
prospective experimental study that bagged
the IADR Neal Garrett Clinical Research
Prize and was the first runner-up in the 2022
IADR-SEA Hatton Award – Senior Category
(p.18).
The winner of Dentsply Sirona’s annual
Global Clinical Case Contest — a
competition aimed at dental students with
less than two years of clinical practice
— Nanthiphorn Pongam (Thailand) also
shares her winning case performed
under the guidance of her professor, Dr
Munin Chaichalothorn (p.42). Indeed, we
can expect nothing less from the next
generation of dentists.
As we enter this exciting year, rest assured
that we will continue to bring you the latest
news and developments in the dental field —
so stay tuned!
Czarmaine Masigla
Assistant Editor
PABLO SINGAPORE
Publisher
Assistant Editor
Graphic Designer
Circulation Manager
Media Representative
PABLO BEIJING
General Manager
PABLO SHANGHAI
Senior Editor
Cover credit
William Pang
williampang@pabloasia.com
Czarmaine Masigla
czarmaine@pabloasia.com
Cayla Ong
cayla@pabloasia.com
Shu Ai Ling
circulation@pabloasia.com
Jamie Tan
jamietan@pabloasia.com
Ellen Gao
pablobeijing@163.com
Daisy Wang
pabloshanghai@163.net
3Shape
HEAD OFFICE
PABLO PUBLISHING &
EXHIBITION PTE LTD
3 Ang Mo Kio Street 62 #01-23
Link@AMK, Singapore 569139
Tel: (65) 62665512
Email: info@pabloasia.com
Website: www.dentalasia.net
Company Registration No.: 200001473N
Singapore MICA (P) No. 104/12/2021
Malaysia KDN: PPS1528/07/2013 (022978)
REGIONAL OFFICES
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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

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DENTAL UPDATES
Amann Girrbach to showcase end-to-end process chain for dental restorations
at IDS 2023
Amann Girrbach will showcase an optimised
and integrated end-to-end process chain
for dental restorations at the International
Dental Show (IDS) 2023 in Cologne, Germany,
happening on 14-18 Mar 2023.
“As ‘the open workflow company’ in the dental
industry, Amann Girrbach will introduce visitors
to digital workflows spanning the entire work
process. Our objective is to holistically connect
dental laboratories and dental practices for the
benefit of patients: the reason being, that in a
perfect dental (work) flow, everything is smart,
simple and seamlessly interwoven to allow
users to concentrate fully on their work. To
combine analogue and digital steps, products
and services in a safe and open system, to
ultimately make everyone’s daily work easier
through high reproducibility of work and to
create better patient care,” shared Wolfgang
Reim, CEO of Amann Girrbach.
At the newly designed, approximately
640sqm stand, new digital standards in
dental technology will be showcased and
demonstrated live on site together with
interested visitors. Room for an exchange
with colleagues and product experts is also
foreseen. Under the umbrella of the motto
“Connect to the (Work-)Flow”, Amann Girrbach
would like to offer an invitation to become part
of a movement that connects and benefits
collectively from digital achievements.
“We are familiar with dental practice and all
its hurdles and see our task not only in
providing excellent products, but also in
optimising the entire workflow right through to
numerous service offerings,” emphasised Reim.
With innovations such as the workflow
management platform AG.Live and the
interdisciplinary Ceramill DRS (Direct
Restoration Solution) system, the company
is consistent in pursuing this objective.
Reim added: “We enable users in dental
practices and laboratories to do something
that a single product alone cannot achieve: we
deliver an open overall system with established
analogue and innovative digital products that
ensures significant time and cost savings.” DA
WHO and members of the WHPA sign new MoU on health workforce priorities
The World Health Organization (WHO) has
signed a memorandum of understanding (MoU)
with the five members of the World Health
Professions Alliance (WHPA): FDI World Dental
Federation (FDI), International Pharmaceutical
Federation (FIP), International Council of
Nurses (ICN), World Physiotherapy, and World
Medical Association (WMA). Together, these
five organisations represent more than 41
million health professionals worldwide and
assemble essential knowledge and experience
from the key health professions in more than
130 countries.
The signing ceremony represents an historic
event, bringing together the five global
organisations representing the world’s dentists,
pharmacists, nurses, physiotherapists and
physicians with WHO to enhance their joint
collaboration on protecting and investing in the
health workforce to provide safe, quality and
equitable care in all settings.
the five organisations and the WHO. They
specifically commit to collaborate on priority
health workforce issues as well as universal
health coverage, noncommunicable diseases,
and ageing populations. The framework will
also contribute to reinforcing national and
regional health systems and services.
“The COVID-19 pandemic has shown us that
today’s public health problems cannot be
solved by one country or one organisation or
one profession by itself,” said Enzo Bondioni,
chair of the WHPA and executive director of FDI.
“Through collaboration between stakeholders
we can tackle interlinked global health
challenges by taking joint action to protect
and strengthen the health workforce and make
progress towards universal health coverage.”
The WHPA and WHO have pursued common
goals prior to and through the pandemic.
Both have worked to ensure vaccination of
health and care workers across all countries
and continued advocacy with countries to
strengthen health systems, including by
providing better recognition, workplace
environments and decent working conditions
for health and care workers. DA
The new MoU reflects the importance of
investing in the health workforce through
a multi-stakeholder integrated approach. It
provides a framework for joint action between
6 DENTAL ASIA JANUARY / FEBRUARY 2023

DENTAL UPDATES
DentalMonitoring now offers Smart STL
DentalMonitoring now offers Smart STL*
powered by AI-driven technology. The company
brings the only platform in the oral healthcare
industry capable of creating updated STL files
100% remotely. This addition to remote oral
healthcare technology supports clinicians
in providing treatment in convenient and
cost-effective ways that have previously been
impossible.
DentalMonitoring is known for innovation in
dentistry and orthodontics and has expanded
that reputation with this new offering.
Previously, all STL file creation required a
patient to visit their doctor’s office. However,
doctors can now request an updated STL
file at any stage of treatment through the
DentalMonitoring dashboard. This eliminates
the need for in-practice visits and delivers
convenience to patients and efficiency to
practices. Smart STL technology expands
remote solutions and can assist doctors with
efficient treatment progress.
This unique technology creates 3D intraoral
models with the sophistication of AI-powered
scans, ensuring the new STL file represents the
most up-to-date model possible based on a
patient’s current smile.
“This achievement revolutionises practice
efficiency, saving chair time and time
previously spent on intraoral scans, all while
avoiding unnecessary visits to the practice
for the patients. In the future, this could also
help streamline management of mid-course
corrections, refinements, retention and relapse,”
said Philippe Salah, CEO of DentalMonitoring.
Since 2014, DentalMonitoring has taken the
industry by storm on its mission to make
dentistry smarter with solutions that help
enhance the quality of care, enable practice
growth and improve the patient experience.
This latest innovation comes amid a series of
impressive launches as the company bolsters
its suite of intelligent solutions, which range
from AI-powered remote monitoring to its
industry-first data analysis system. DA
*Product availability claims and regulatory status
may differ across countries depending on local
regulations.
VITA North America partners with Dental Direkt
VITA North America has announced its
exclusive distribution partnership with Dental
Direkt, supplier of dental products and the
biggest zirconia manufacturer in Europe.
This collaboration between two of the dental
industry’s strongest brands extends VITA
North America’s product portfolio to offer the
largest and broadest zirconia selections on
the market.
“We are excited to partner with a quality
material manufacturer, who completes
our consumable portfolio ideally to fulfil
all material needs of our customers,” said
Patrick Bayer, vice-president of Sales and
Marketing for VITA North America. “With this
exclusive partnership, the US and Canada
will have access to the most expansive and
advance zirconia portfolio in the market today,
combined with accelerated distribution time
and superb customer service.”
VITA’s premium zirconia line, VITA YZ,
is available in a variety of sizes and four
different translucency levels, including white,
colour and multicolour variants. VITA is also
the only manufacturer to offer pre-coloured
and multicolour zirconia in all VITA classical
A1-D4 and VITA SYSTEM 3D-MASTER shades.
In addition to the VITA product line, customers
will now have access to Dental Direkt’s
value-priced midrange zirconia product lines.
Its eight zirconia offerings are available in a
range of sizes in white, colour, multicolour
and multilayer, as well as all 16 VITA classical
A1-D4 shades and VITA Bleached Shades.
The non-shaded zirconia is accompanied by
the corresponding shade liquids for individual
characterisation. The newest addition to the
Dental Direkt Zirconia line is the industry
leading Nacera Pearl, a multilayer, multicolour
disc with different translucencies and colours
in one zirconia disc. In addition to a large
offering of zirconia, a complete product line
of high-impact thermoplastic polymers will
also be available.
With the exclusive partnership between
VITA North America and Dental Direkt,
customers now have greater access to the
largest zirconia portfolio available, expedited
turnaround times from a US warehouse,
exceptional customer service available in
three languages and a local, technical support
team comprised of trained dental technicians.
“Our exclusive partnership with VITA
North America allows us to partner with
an established dental manufacturer with
operations in the US. Dental Direkt is known
for always working in the best interest of
the customer and processing orders and
customer inquiries as quickly and as best as
possible. Due to the time difference between
the US and Germany, we weren’t always able
to guarantee this and are pleased to have
found a partner in VITA North America to
support us here. By working together with
VITA North America, customers will benefit
from faster and easier processing of our
product orders and services,” said Marcel
Brüggert, CEO of Dental Direkt. DA
DENTAL ASIA JANUARY / FEBRUARY 2023 7

DENTAL UPDATES
Dentsply Sirona’s presence at IDS 2023 to highlight
the power of digital universe for best possible
connectivity in dentistry
Dentsply Sirona will have a significant presence
at IDS 2023, with all activities tied to the theme
“united for better dentistry” — recognising the
need for even more connectivity, collaboration,
and partnership to move the dental industry
forward and improve oral health globally.
Attendees are invited to experience the digital
universe at Dentsply Sirona’s immersive
20,451sqft (1900sqm) booth. Situated in hall
11.2, the booth will feature the company’s
entire portfolio of products and solutions,
which visitors will be able to see in action
through product demonstrations and live
presentations.
A key highlight on display will be DS Core
— an open, cloud-based platform powered
by a collaboration between Dentsply Sirona
and Google Cloud. DS Core is designed to
seamlessly integrate with Dentsply Sirona
devices, services, and technologies to improve
practice efficiency, foster collaboration with
specialists and labs, and support dental
professionals throughout the entire patient
journey. DS Core Create complements this
offering by providing easy access to expert
quality-designs for Primeprint. With DS Core
Care, users receive a comprehensive, integrated
equipment service and support solution.
Additional booth experiences include Dentsply
Sirona’s intraoral scanner Primescan Connect,
as well as Primeprint Solutions which is
designed for dental practices and labs who
want to expand their treatment and service
offerings with medical-grade 3D printing.
“Dentsply Sirona is a pioneer when it comes
to digital dentistry, they truly invented it back
in the 1980s, and I am proud to partner with
them for IDS 2023,” said Dr Gertrud Fabel,
dentist from Munich, Germany. “I have long
been impressed by the company’s innovative
solutions and seamless workflows, which help
improve the treatment experience for both me
and my patients. I am excited to see what they
have in store for IDS 2023.”
Dentsply Sirona will also bring together leading
voices for thought-provoking panel discussions
on crucial topics: How will the latest digital
innovations shape dentistry in the future?
How do cloud solutions drive practices and
labs forward? How do we collectively have
an impact on better treatment outcomes?
And also: What does sustainability mean for
dentistry and what actions can practice teams
take to become a more sustainable business?
With thought leaders from both inside and
outside the dental industry, the conversations
promise to deliver unique perspectives on how
these rapid societal changes are affecting the
dental world.
“IDS offers a fantastic moment to unite with the
global dental community and we are eagerly
looking forward to the next edition in 2023,”
said Gerry Campbell, group vice-president,
Commercial EMEA at Dentsply Sirona. “We
know that through close collaboration and
partnership, we can take dentistry to the next
level and ultimately help bring healthy smiles to
more people around the world.”
Dentsply Sirona will implement a number of
sustainability measures to reduce its footprint
for the event, in line with the goals set out in
its BEYOND sustainability strategy. The booth
will be made mostly of reused furniture, while
European-based employees will be encouraged
to travel to IDS by train, local public transport or
do carpooling. The company will also prioritise
digital communications — adopting a paperfree
approach wherever possible, alongside
other measures and activities that customers
can learn more about at the IDS. DA
Curaden and ITI collaborate
Curaden, an oral hygiene company based
in Switzerland, has collaborated with the
International Team for Implantology (ITI),
an academic organisation promoting
evidence-based education and research in
implant dentistry. The partners have signed
a sponsorship agreement to make greater the provision of education materials to the ITI
advances in preventive dental care.
community in its field of expertise. Curaden
thus joins a select group of companies known
Curaden is one of the first sponsoring partners as industry partners of the ITI.
in a new ITI initiative aimed at building longerterm
relationships with a small number of “This global ITI initiative is based on a modular
companies in the industry. Curaden will work sponsorship approach that allows us to
more closely with the ITI for an initial period address the individual needs of our sponsors,”
of three years. The agreement will primarily said Charlotte Stilwell, president of ITI. “It
cover ITI congresses and symposia, as well as represents a mutually beneficial, longer-term
commitment made by carefully selected
companies that share similar educational and
scientific evidence-based principles as the
ITI. We are delighted to welcome Curaden on
board.”
“For Curaden, this new collaboration is a
big step in the right direction,” said Ueli
Breitschmid, owner and CEO of Curaden. “It
will further develop our global network and
strengthen the power we already have as
a unique player in the fight for prevention
thinking. Maintenance is an important topic,
also for the ITI — this is where we can put
a lot of our know-how. We will benefit from
each other especially in education and in
the area of appearances and recognisability
worldwide.” DA
8 DENTAL ASIA JANUARY / FEBRUARY 2023

DENTAL UPDATES
Planmeca introduces new laboratory
milling unit
ids-cologne.de
Planmeca PlanMill 60 S is a dental milling unit specifically designed
for the needs of dental laboratories and technicians. Supporting
an even broader range of indications than chairside milling units,
Planmeca PlanMill 60 S is also a great tool for dentists willing to
produce more advanced dental restorations and applications in
house.
The five-axis milling unit can be used to mill discs and blocks as
well as prefabricated titanium and cobalt chrome abutments. The
milling unit is capable of both wet and dry processing of different
materials, including zirconium dioxide, glass ceramics, composites,
PMMA and wax. The unit produces various dental restorations,
custom implant abutments and bars, partial frames, bite splints, and
dentures precisely.
The milling unit can be used with a variety of material holders, which
extend the application possibilities of Planmeca PlanMill 60 S even
further. With a half-open blank holder, the milling unit can be used
for producing even the most demanding restorations for the anterior
area. The user can easily and quickly change the clamping holder in
the milling chamber, when needed.
“Planmeca PlanMill 60 S is a powerful milling unit for the varying
needs of dental laboratories, technicians, and in-house laboratories.
The platform-based design of Planmeca PlanMill 60 S allows
introducing new functionalities to the milling unit also in the future
with software updates and interchangeable clamping fixtures,”
shared Jukka Kanerva, senior vice-president at Planmeca.
The Planmeca PlanMill 60 S milling unit is used together with
Planmeca PlanCAM software, which calculates necessary milling
paths for selected materials and indications. The software supports
open STL files and guarantees a fast and easy workflow in the busy
laboratory environment. DA
SINCE 1923
COLOGNE
14. – 18.03.2023
14 March 2023: Trade Dealer Day
40 th International Dental Show
inclusive IDSconnect
SHAPING THE
DENTAL FUTURE
Koelnmesse GmbH · Messeplatz 1 · 50679 Köln · Germany ·
Tel. +49 1806 773577 · ids@visitor.koelnmesse.de
DENTAL ASIA JANUARY / FEBRUARY 2023 9
IDS_2023_Anzeige_Dental_Asia_91x234mm_Int_GB.indd 1 19.12.22 11:50

DENTAL UPDATES
Henry Schein partners with Biotech Dental Group
Henry Schein, provider of healthcare
solutions to office-based dental and medical
practitioners, has announced a definitive
agreement with the shareholders of Biotech
Dental, provider of clinical software and oral
surgery and orthodontic products based
in Salon-de-Provence, France, to acquire a
majority ownership stake in the company.
Henry Schein and Biotech Dental will partner
to bring Biotech Dental’s full line of software,
products, and services, including dental
prostheses, clear aligners, dental implants,
regenerative solutions, and biomaterials, to
more dentists and dental laboratories as
well as new geographies. The closing of this
transaction is subject to certain regulatory
approvals.
Biotech Dental has several important solutions,
including Nemotec, a comprehensive,
integrated suite of planning and diagnostic
software using open architecture that connects
disparate devices to create a digital view of the
patient’s oral health condition, offering greater
diagnostic accuracy and an improved patient
experience. Biotech Dental is also one of the
fastest-growing implant and custom abutment
brands in France, as well as the manufacturer of
the Smilers brand of clear aligners.
In addition, Biotech Dental has launched
LaGalaxy, a comprehensive, open, and secure
software platform where both clinical and
administrative tasks can be performed. Within a
single platform, dentists and dental laboratories
benefit from end-to-end integrated digital
solutions that help improve case outcomes
while speeding treatment time, shortening case
completion, and lowering the costs of implants,
orthodontic, and prosthetic treatments.
“Henry Schein and Biotech Dental are committed
to offering customers best-in-class, userfriendly,
customer-centric solutions based on
open architecture that help improve patient
outcomes,” said Stanley M. Bergman, chairman
of the Board and CEO of Henry Schein. “Henry
Schein will, over time, incorporate Biotech’s
Nemotec software as part of our solutions
offering, including integrating Biotech’s
software solutions with Henry Schein One’s
industry-leading practice management
software solutions to create a leading endto-end
clinical system and to help dental
practitioners streamline their clinical as well as
administrative workflow.”
“We have continually grown to meet the
specialised and unique needs of dentists,
orthodontists, and dental laboratories,” said
Philippe Veran, founder and president of
Biotech Dental. “For the past 35 years, the
growth of our business has been rooted in our
rich French heritage. This will remain as we
continue to manufacture our products in France
while bringing innovation and new technologies
to the global dental community. Together,
with Henry Schein, we look forward to helping
our customers enhance their surgical skills,
achieve better outcomes for their patients, and
maximise business success.” DA
W&H will exhibit at IDS 2023
Bigger than ever before and with plenty
of products to discover — W&H will take
part in IDS 2023. True to the slogan “From
innovative products to sustainable solutions“,
the company is presenting forward-thinking
and sustainable technologies for the dental
industry.
“We are taking our trade fair booth to a whole
new level for IDS 2023. Visitors can look
forward to fascinating topics, digital highlights
and a new look and feel,” said Anita Thallinger,
director of Marketing and Market Service.
W&H has plenty to offer when it comes to
innovative products. One example of the
innovations referred to in its IDS slogan is the
new Piezomed module, the game changer in
piezosurgery. With this easy add-on solution
for the Implantmed, W&H is revolutionising
the surgical workflow and creating entirely
new treatment options for patients. Visitors
to their booth can also experience the Lara
XL, another product innovation in the field of
sterilisation.
But it does not stop there. The Assistina One
provides perfect processing and maintenance
of straight and contra-angle handpieces,
turbine handpieces, air motors and air-powered
scalers. This device automatically dispenses
the exact amount of W&H Service Oil and W&H
Activefluid required. This means instruments
can be sustainably maintained while also
saving on both resources and costs.
The OsstellConnect is another smart product
innovation from W&H, which takes the strain
out of day-to-day treatments in the dental
practice. This tool enables users to access data
at the push of a button to improve their dental
implant treatment.
W&H attaches particular importance to quality,
longevity, reparability, and reliability for its
products. Customers benefit from reduced
costs and save resources, modular solutions
and innovative technologies enable safe and
efficient treatments.
Visitors can expect an entirely new trade fair
look and engaging live demonstrations. The
medical technology company will also be
unveiling its first ever climate-neutral booth.
This will involve reducing emissions wherever
possible and offsetting them through a
selected climate protection project. W&H is
thereby setting the agenda for active climate
protection and underlining once more its
position as a pioneer in the dental industry. DA
10 DENTAL ASIA JANUARY / FEBRUARY 2023

Simplifying the complex challenge
Case Gallery
As of today, iTero scans have been used in more than 12.6 million restorative case scans, including crown,
bridge and custom implant cases*. iTero scanners have been helping to simplify the workflow of many complex
cases.
In this edition of the Simplifying the complex challenge, we are showcasing complex restorative cases for instance,
by Dr Shihjaw Tsai (Taiwan).
Smile makeover: Veneers
Dr Shihjaw Tsai
Esthetic Dent Dental Clinic, Taiwan
Chief complaint
Patient complained of discoloured front teeth and chipped filling
Medical history
The patient was healthy with no relevant medical history
Initial examinations and diagnosis
Chipped defective composite resin restorations with respect to tooth #11 and #21.
Secondary caries detected in tooth #11 #12 and #21 and were confirmed using X-ray.
Treatment plan
Caries excavation with respect to tooth #11, #12 and #21 followed by tooth preparation for veneers with respect to tooth #14, #13 #12, #11
,#21, #22, #23 and #24
Initial clinical status and treatment outcome
Before restoration
After restoration
Treatment workflow
• [Initial consultation]
Initial scan and consultation using iTero element TM 5D
imaging system.
• [Smile Design]
iTero scan was used for Digital Smile Design and digital
mock-up try in was done using exocad TM software to
adjust the form and shape of mock-up veneers.
• [Digital mock-up]
Exocad software allowed the patient to visualise what
the final smile would look like prior to restoration.
Initial scan
Final scan
• [Tooth preparation]
Tooth preparation was done for tooth #14, #13 #12, #11
,#21 , #22, #23 and #24 followed by iTero scan for
veneer fabrication.
Treatment progress images
Digital mock-up Prep image Prep scan
• [Provisional]
Clear silicone impression with flowable composite
using injection moulding technique was used to create
the temporary veneers via 3D printed mock-up using
iTero scan.
• [Final restoration]
Veneers were cemented on the next visit and
satisfactory results were achieved, and post-treatment
follow-up was done.
*Data on file at Align Technology, as of June 30, 2022.
Invisalign, the Invisalign logo, iTero, the iTero logo, among others, are trademarks and/or service marks of Align Technology, Inc.
or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries.
© 2022 Align Technology, Inc. All rights reserved.

TRENDS
World Diabetes Day reminds
of the link between chronic
diseases and oral health
Diabetes is a chronic disease that affects millions
of people around the world. Self-diagnostics and
self-care play an important role in the management
of the disease — one part of this is thorough oral
healthcare.
By Nina Garlo-Melkas
In Finland, a country with a population of
about 5.5 million, there are about 450,000
people diagnosed and receiving treatment
for diabetes: about 50,000 type 1 and about
400,000 type 2 diabetics. In addition, there
are between 50,000 and 100,000 people with
type 2 diabetes left undiagnosed. Moreover,
gestational diabetes is diagnosed in
thousands of expectant mothers every year.
Type 2 diabetes is a national disease all over
the world, where living standards are rising.
Especially in the Western world, where obesity
is a common public health problem, said Dr
Timo Sorsa, professor of Oral and Maxillofacial
Diseases at the University of Helsinki.
Gum diseases such as periodontitis have
long been known to be linked to many
chronic illnesses. A large epidemiological
study conducted at the University of Helsinki
examined the predictive value of oral health
for the onset of various chronic diseases
through a 10-year follow-up 1 .
According to the study, a clear link between
periodontal disease and diabetes in particular
was found. No equally strong association
was found between gum diseases and
other common chronic diseases such as
rheumatoid arthritis, inflammatory bowel
disease or serious mental illness. However,
in addition to diabetes, periodontitis also
appears to exert less efficient association
with the risk of pre-diabetes, i.e., metabolic
syndrome.
Heart surgeon Tommi Pätilä is one of the one of the developers of the Lumoral method, which has
revolutionised Finnish preventive dental care. Used in addition to regular tooth brushing, Lumoral is
suitable for everyone, but is especially beneficial for those prone to cavities or gingivitis
Because the link between oral health and
diabetes is so evident, the study stated
that the general health and oral health of
patients diagnosed with diabetes should
be considered as a whole to achieve the
best possible treatment outcomes. In fact,
12 DENTAL ASIA JANUARY / FEBRUARY 2023

TRENDS
the research demonstrated that even latent
diseases have a harmful and long-term effect
on one another.
The mutual effects of various diseases also
increase costs for society and patients by
making it more difficult and expensive to
diagnose and treat each other. The effects are
significant in terms of both national health and
the national economy, the study continued.
TWO-WAY EFFECT — MULTIPLE COSTS
Diabetics are about three times more likely
to develop gingivitis and periodontitis. The
effect between periodontitis and diabetes
is two-way. Diabetes increases the risk
of periodontal disease, while the chronic
inflammatory condition associated with
periodontitis impairs blood sugar regulation.
Similarly, periodontal disease, whether at
an early stage or latent, exacerbates the
chronicity of diabetes and makes it more
difficult to diagnose and manage.
Successful treatment of periodontitis has a
positive impact on diabetes outcomes and
reduces the cost of its treatment. Similarly,
successful management of diabetes slows
the progression of periodontal disease,
while also reducing the cost of treatment 1 .
Researchers expect that more such two-way
effects between diseases are likely to be
identified in the future.
Prof Sorsa added that dentistry training today
already aims to encourage future dentists to
pay more and more attention to the general
health and well-being of their patients. For
example, if a dentist sees that his or her
patient has typical signs of a chronic disease
such as diabetes, he or she should be more
sensitive in referring the patient for further
tests. The same applies if a patient has skin
changes suggestive of cancerous melanoma,
for example. In this case too, it is the dentist's
duty to refer the patient for further treatment.
The same applies to any visible symptoms.
Failure to treat oral gum disease is a waste of
healthcare resources, Prof Sorsa stressed. It
is easier for both patients and society if the
link between oral health is better recognised.
If a doctor tries to balance diabetes with all
available medical interventions and following
existing treatment protocols, but ignores the
gum disease in the mouth, diabetes is harder
to "control". Insulin and money are wasted if a
person has a latent gum disease that may not
even be visible in the patient.
PREVENTION OF AGE-RELATED
DISEASES
A similar link applies to other chronic
diseases. As people live longer, their teeth
should stay in their mouths longer. Diabetes,
cancer, and various gum diseases increase
with age. It is important to invest in the
prevention of chronic diseases by maintaining
good oral health with thorough oral care and
maintaining good general health, for example
by regularly exercising.
Prof Timo Sorsa from the Department of Oral and
Maxillofacial Diseases at the University of Helsinki
Oral health has generally improved in Finland
since the 1960s and 1970s, but there is still
room for improvement. According to Prof
Sorsa, the ageing of the population has also
created new challenges, as the number of
implants in people's mouths has increased
accordingly. This creates new opportunities
for gum diseases such as gingivitis to
develop.
Earlier it was common to lose teeth as we
aged. Now implants are being put in their
place, creating a breeding ground for new
gum diseases and problems. If a patient
has four implants in their mouth, and the
The positive treatment effect by the Lumoral device and its active photodynamictherapy (aPDT) of four weeks reflected in the significant decrease in the (A)
active-matrix metalloproteinase-8 (aMMP-) levels in mouthrinse and (B) visible plaque index (VPI) levels in chronic adult periodontitis patients 3
DENTAL ASIA JANUARY / FEBRUARY 2023 13

TRENDS
gums surrounding each implant are infected,
bacteria have a constant connection to the
bloodstream.
The only way to avoid the challenges of gum
disease is to take good care of your oral
hygiene by keeping teeth and interdental
spaces free of plaque. This can be promoted
by careful self-care and further enhanced by
regular Lumoral treatment.
Lumoral is CE marked Class IIa medical
device that improves home care when used
in addition to mechanical cleaning. The
device that is developed by Finnish scientists
removes microscopic plaque, slows down the
formation of new plaque and thus slows down
the formation of tartar. It also has proven to
effectively prevents gingivitis, periodontitis
and tooth decay. Additionally, active
photodynamictherapy (aPDT) can reduce
gingivitis-related pathologically elevated
collagenolytic tissue destructive enzyme,
aMMP-8.
RAPID TEST FOR EFFECTIVE
DIAGNOSIS AND TREATMENT OF
DIABETES
Prof Sorsa believes that the current oral
healthcare protocol model could be significantly
improved by incorporating the aMMP-8 rapid
test, which is currently under development and
can easily identify periodontal disease as well as
diabetes and its precursors from oral enzymes.
The aMMP-8 enzyme test would also speed
up the diagnosis of gum disease in implant
patients. The bacteria causing the problems
can be screened for in patients' mouths by
culturing in laboratories before implants
are placed, but this can take days to weeks.
aMMP-8 enzyme testing can be done in a
dentist's office, and an answer about the
health of the gum tissue can be obtained
within five minutes of the test 2 .
The results of the studies are already promising
in terms of the test's effectiveness and a test of
this kind could be in general use in the next five
years. Successful rapid diagnosis, screening
and treatment of periodontal disease will
have a positive impact on diabetes treatment
outcomes in the future and is likely to reduce
treatment costs. Similarly, screening and
successful treatment of periodontitis will slow
down the progression of periodontal disease,
while reducing the cost of its treatment. DA
World Diabetes Day is celebrated on 14
November each year. World Diabetes Day
became an official United Nations Day in
2006. The theme day seeks raise awareness
of diabetes and to highlight the opportunities
to strengthen the prevention, diagnosis, and
treatment of diabetes.
REFERENCES
1.
Heikkilä Pia, Niskanen Leo, But Anna, Sorsa Timo,
Haukka Jari, Oral health associated with incident
diabetes but not other chronic diseases: A registerbased
cohort study. Frontiers in Oral Health
3/2022. DOI: 10.3389/froh.2022.956072.
2.
Sorsa T, Nwhator SO, Sakellari D, Grigoriadis A,
Umeizudike KA, Brandt E, Keskin M, Tervahartiala
T, Pärnänen P, Gupta S, Mohindra R, Bostanci N,
Buduneli N and Räisänen IT (2022) aMMP-8 Oral
Fluid PoC Test in Relation to Oral and Systemic
Diseases. Front. Oral. Health 3:897115. doi: 10.3389/
froh.2022.897115
3.
Lähteenmäki, H.; Pätilä, T.; Räisänen, I.T.; Kankuri,
E.; Tervahartiala, T.; Sorsa, T. Repeated Home-
Applied Dual-Light Antibacterial Photodynamic
Therapy Can Reduce Plaque Burden, Inflammation,
and aMMP-8 in Peri-Implant Disease—A Pilot
Study. Curr. Issues Mol. Biol. 2022, 44, 1273-1283.
14 DENTAL ASIA JANUARY / FEBRUARY 2023

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TRENDS
Pilot teledentistry programme
incorporating AI
Capturing, storing, interpreting and comparing oral images using artificial
intelligence (AI) to detect the presence of tooth decay, gum disease and
abnormalities for timely intervention is a first for Singapore’s dentistry.
The National Dental Centre Singapore (NDCS)
and Temasek Foundation are jointly piloting the
Tele-Dentistry Oral Care for Seniors (T-DOCS)
programme, the first tele-dentistry programme
in Singapore, to provide preventive oral care for
vulnerable seniors who are homebound or living
in nursing homes with mobility challenges.
In partnership with St. Andrew’s Community
Hospital (SACH) and Vanguard Healthcare,
the T-DOCS programme is a new model of
care to improve the oral care of seniors in
the community through early detection and
regular monitoring. Temasek Foundation has
committed S$1.23m to the programme over
three years.
Oral health is a key indicator of good health.
Older adults may have poorer oral health,
which can affect their general health, wellbeing
and quality of life. A 2017 study found
that seniors in Singapore have relatively poor
oral health, of which 31% were found to be
edentulous or using dentures and 38% having
fewer than 20 natural teeth 1 . Thus, in addition
to teledentistry, the T-DOCS programme trains
SACH and Vanguard Healthcare nurses on oral
care procedures and use of oral hygiene aids
to build community capability in improving
and maintaining the oral health of vulnerable
seniors.
Cl A/Prof Christina Sim, principal investigator,
T-DOCS and senior consultant, Department of
Restorative Dentistry, Prosthodontics, NDCS,
said: "The T-DOCS programme leverages on
technology for teledentistry to provide regular
screening and monitoring of the seniors’ oral
health. This enables early detection of oral
diseases and fills the crucial gap in preventive
oral care for our vulnerable seniors, of which
dental issues (such as dental caries and
gingival inflammation) were found among
80% of about 200 seniors recruited for the
pilot T-DOCS programme. This new model
of care provides timely oral care to seniors,
convenience to caregivers and our partners and
optimises resources for better community care."
Lim Hock Chuan, head, Programmes at
Temasek Foundation, said: "Many vulnerable
seniors have physical or cognitive disabilities
and need to depend on their caregivers or
healthcare aides for oral care. Some of them
are unable to communicate their oral care
needs; others require special arrangements
in order to access oral care in the community.
Recognising these needs, Temasek Foundation
is happy to support the T-DOCS programme to
bring preventive oral care to these seniors."
The T-DOCS programme piloted with SACH
and Vanguard Healthcare in early 2021.
16 DENTAL ASIA JANUARY / FEBRUARY 2023

TRENDS
Participating seniors are first examined by a
dentist and thereafter regularly screened and
monitored every six months by trained SACH
or Vanguard Healthcare staff using an intraoral
camera with fluorescence technology.
The intraoral camera can detect early signs
of tooth decay and gum inflammation and
is able to differentiate between existing
and newly formed dental plaque. The
intraoral scans along with the patients’
medical information are then uploaded to an
electronic system from which NDCS dentists
retrieve the patients’ records for remote
assessment. The findings and recommended
treatment plan are then relayed back to SACH
and Vanguard Healthcare staff for followup
with the participating seniors and their
families, including oral hygiene education and
necessary referrals for dental treatment.
The electronically captured images also serve
as a repository of oral health information
which can be aggregated and analysed with
the use of AI software that is being developed
by this pilot programme to automate the
interpretation of the images. The AI will alert
the remote dentist on the problematic areas,
hence reducing the time taken to examine and
interpret the images. It can also provide the
home care nurse with a visual prompt on the
areas that require greater attention.
Mdm Teo, aged 89, is a patient of SACH Home
Care Services and participant of T-DOCS. She
is unable to walk and has lost the use of her
hands. Under the T-DOCS programme, a SACH
nurse visits her at her home every six months
to conduct health checks which include the
T-DOCS oral screenings. The oral health
information is then uploaded and sent to the
NDCS dentist for remote assessment.
Her son, Richard Lim, shared: "We discovered
T-DOCS through the home medical team, who
recommended the programme to us. After
we embarked on the programme, we found it
quite beneficial as the nurse was able to make
(oral hygiene care) recommendations and
make appointments, if needed, to the nearest
Community Health Assist Scheme (CHAS)
dental clinic on our behalf."
Dr Patricia Lee, head, Home Medical Services,
SACH, shared: "We saw T-DOCS benefiting
patients in SACH Home Care who participated
in the pilot programme. With one single visit
by the Home Care team, the patients can have
their medical and dental issues addressed.
For caregivers with loved ones constrained by
physical movements, this can help manage
or even reduce their stress in having to make
arrangements when their loved ones require
dental treatment."
The pilot T-DOCS programme currently has
199 participating seniors and has trained
more than 40 nurses in the nursing homes
and home care team to perform oral health
screenings with intra-oral imaging of seniors’
oral cavities and provide basic oral and
denture hygiene care. NDCS is looking to
expand the T-DOCS programme to more
seniors such as those in senior activity
centres and special needs centres. DA
DENTAL ASIA JANUARY / FEBRUARY 2023 17

UNDER THE SPOTLIGHT
Enhancing treatment
efficiency with AI
Artificial intelligence (AI) has made its way into dentistry.
In his award-winning research, Dr Walter Lam studied its
potential to streamline workflow and elevate the patient
experience.
By Czarmaine Masigla
A clinical assistant professor in
prosthodontics at the University of Hong
Kong (HKU), Dr Walter Lam Yu Hang is
the principal investigator of the study:
Artificial intelligence-designed single
molar dental prostheses: A protocol of
prospective experimental study.
In collaboration with the Department
of Computer Science of Chu Hai
College of Higher Education, Dr Lam
led the researchers from the Faculty
of Dentistry at HKU to develop a novel
approach automating the design of
individualised dentures using AI. The
study won the International Association
of Dental Research (IADR) Neal Garrett
Clinical Research Prize and was the first
runner-up in the 2022 IADR-SEA Hatton
Award — Senior Category.

UNDER THE SPOTLIGHT
The research team uses 3D GAN to learn the relationship of teeth in a dental arch on the 175 student participants.
After training, 3D GAN is able to generate a tooth (red) based on the feature of remaining teeth (dark grey).
Research team proposes further investigate the presence of opposing teeth helps the AI to generate a more
natural tooth (red)
Coming from humble beginnings, Dr
Lam shares more about this feat, his
inspiration in the field and his vision for
the digital future of dentistry.
What are your early influences in
pursuing a career in dentistry, and why
did you specialise in prosthodontics?
Dr Lam: My grandfather was a denture
wearer. He usually slept early and put
his complete dentures underwater in
his teacup. When I was a child, I would
check if his dentures swim (like his
goldfish) when my whole family is
asleep. I specialised in prosthodontics
as my hobby is building up Lego
and Gundam models. Likewise,
prosthodontics also allows me to build
up (re-construct) the missing oral and
facial structures.
What inspired you to focus your
research on digital dentistry and AI?
Dr Lam: I like to play computer games
when I was in high school. In fact, I once
considered studying computer science
when I went to university. I find it so
interesting that technology develops so
quickly. For instance, my smartphone
has much better computation power
than my old desktop computers.
Technology enables us to work anytime
and anywhere, which has changed our
lifestyle. The same thing is happening
in dentistry which I believe will
revolutionise the practice soon. I hope
that my research in AI can help dentists
to finish jobs quicker and easier, so
more patients can benefit from a dental
care with less waiting time and less
cost.
Can you briefly discuss your study
on Artificial Intelligence-Design
of Maxillary Single-tooth Dental
Prostheses and its potential long-term
implications?
Dr Lam: While making indirect
restorations and prostheses, I try to
capture as much information from
my patients and then I program my
articulator to simulate their masticatory
systems. However, there are some
limitations in our articulator and clinical
adjustment is still needed when I deliver
the prostheses.
Our current approach is a bit complicated.
We want a false tooth that fits into the
patient’s mouth, but what we are doing
now is simulating the patient’s jaw
movement. Therefore, I am thinking what
if we can directly do something about the
morphology of teeth? I believe natural
is the best and it will work well in the
patient’s mouth for a long time. Hence, I
used AI to learn the features of teeth in
an arch and then use the feature of the
remaining teeth to design false teeth.
What other opportunities do you see in
extending your work in this research, and
what other topics you’re interested in
tapping on?
Dr Lam: While my work is for a single
tooth at this moment, I am interested
in extending my research to multiple
missing teeth. Particularly, when there is
DENTAL ASIA JANUARY / FEBRUARY 2023 19

UNDER THE SPOTLIGHT
no adequate number of teeth to use as
a reference in designing the denture.
I am also interested in virtualising
patient information for diagnosis
and treatment planning, as well as
programming a virtual articulator. That
said, I am one of the first few dentists
who published a dental technique
combining 3D teeth to the 3D face
using a radiation-free method.
Can you provide an outlook on the
future of digital technology, particularly
in prosthodontics?
Dr Lam: Computer-aided design/
manufacturing (CAD/CAM) will
become the norm in dentistry and
prosthodontics. This will allow us to
select various high-strength tooth
coloured dental materials for various
clinical scenarios, as well as shorten
the time needed for the fabrication of
dental prostheses. The accuracy of
intraoral scanners is improving and can
be used for full-arch cases. Dentists
can plan cases with reference to the
3D face.
On the other hand, the development of
digital dentistry is so rapid that dental
education does not follow its pace and
we need to exert a huge amount of
effort to keep our knowledge updated.
Although digital equipment is now
more affordable and user-friendly, many
dentists may still stick to the approach
that works well for them already.
Hence, their preference and perception
are critical to the clinical use of digital
equipment.
What advice would you give to fellow
practitioners who are hesitant to adopt
digital technology in their practice?
Dr Lam: Most of us have already
adopted digital technology in our
practice, such as digital radiography,
electronic dental record and conebeam
computed tomography. The new
generation of the intraoral scanner is
getting cheaper, more user-friendly
with a minimum learning curve and
provides add-on value such as caries
detection. The benefits of adopting
digital technology outweigh the steep
learning curve.
What other trends do you foresee
happening in the dental field in the
next 5-10 years?
Dr Lam: Dentistry may become
more and more tailored and made
for an individual person, so-called
personalised dentistry. Early and
close monitoring of cases may stop
or even prevent dental diseases. The
identification of more and more risk
factors and their prevention may be
feasible in the near future, which
renders the future of dentistry to be
truly preventive and personalised. DA
(from right) Dr Walter Lam, Dr Khaing Myat Thu, Dr Reinhard Chau, Prof Colman McGrath and Dr Richard Hsung
20 DENTAL ASIA JANUARY / FEBRUARY 2023

Breakthrough
in intraoral scanners
With the launch of TRIOS 5 Wireless, 3Shape has
once again redefined the standards of intraoral
scanning. How will it affect the current IOS
market, and how will the company continue to
lead the digital future? Dental Asia spoke with
Kasper Chaney Sørensen, general manager of
International Markets, 3Shape.
By Czarmaine Masigla
In recent years, the demand for
intraoral scanners (IOS) has
skyrocketed, driving the adoption of
digital dentistry in practice. A reliable
tool in diagnosis and treatment
planning, IOS has made it possible
to create a digital impression to
streamline and optimise dental
treatment.
One of the key players in the IOS
market is 3Shape, which recently
launched the TRIOS 5 Wireless.
The result of perfecting over five
generations of scanners, TRIOS 5 sets
a new standard in intraoral scanning
with its intelligent scan technology.
Kasper Chaney Sørensen, general
manager of International Markets at
3Shape, shared that they managed
to make numerous improvements
in TRIOS 5 while ensuring that the
scanner is smaller and perfectly
balanced to fit comfortably in the
clinician’s hand.
DENTAL ASIA JANUARY / FEBRUARY 2023 21

He explained: “Firstly, the hygiene
part which is even more important
now because of COVID-19. TRIOS 5 is
easy to clean because of its smooth
and closed design — it hardly has any
openings or crevices and has a closed
tip. It is also more ergonomic and
easier to handle, which is especially
beneficial for dentists who use it for
many hours. And then, we did a lot
on the service and connectivity side
which is much easier with the new
system. I think our R&D did a fantastic
job in making this device.”
The 3Shape TRIOS 5 IOS digital
images are indicated for use
in restorations, orthodontics,
implantology, and assessment of
dental status.
GROWTH AND INNOVATION
By pushing the limits of innovation,
3Shape has influenced the strong
market growth of IOS globally.
Sørensen foresees that this positive
momentum will be sustained in the
years to come, attributing it to three
factors.
In fact, according to Sørensen, the
socioeconomic differences of the
countries particularly in South East Asia
are one of their primary considerations
as they continue to expand their
foothold in the region. Boasting with
a much broader portfolio, 3Shape can
address different parts of the market,
including premium users.
“We really try to make it relevant for all
dental practices with different models
and more flexible solutions,” added
Sørensen.
Specifically, TRIOS 5 Wireless is 30%
smaller and 20% lighter compared
to TRIOS 4 and is 3Shape’s smallest
and lightest scanner to date. It also
features an LED ring and haptic
sensory feedback guiding users
while they scan, and with ScanAssist
technology, which minimises
misalignment and distortion in 3D
models, users can scan their patients
in any direction they want.
First is the improvement of product
quality over the years — not just for
them but for scanners in general —
making it easier for more dentists
to use this technology; second is
the availability of more evidencebased
clinical protocols that support
adaptation to the digital workflow; and
lastly, the more competitive pricing
of the device as compared to three to
five years ago.
On top of it, Sørensen stated how vital it
is for 3Shape to participate in in-person
events such as the recently concluded
International Dental Exhibition and
Meeting (IDEM) because it gives them
the opportunity to connect with dental
professionals directly.
“In many markets, we sell through our
partners. We have a lot of fantastic
partners. But when we go to the
22 DENTAL ASIA JANUARY / FEBRUARY 2023

DENTAL PROFILE
exhibitions, we get that direct contact
and dialogue with the dentists. We get
to demo our software with scanners
and our team loves that we receive
direct feedback. We really appreciate
that,” he said.
Five to 10 years down the road,
Sørensen believes that digital
penetration would continue as the
markets are accepting that this is
the new and best way of practicing
dentistry. And to that point, he
highlighted the need for integrated
solutions.
“We believe in an open platform and
open ecosystem because that will
benefit dental businesses by giving
them options to choose what is right
for them. So that’s our philosophy and
we are dedicated to it,” he emphasised.
This vision is reflected with the
launch of 3Shape Unite which aims
at connecting scanners, practice
management systems, laboratories,
clear aligner manufacturers, 3Shape
apps, and other dental companies all on
one single software platform.
He said: “I think there’s a lot
technology companies like ours do to
improve to make the communication
between dentists and technicians
more seamless and much easier.
That’s a major focus area for us.”
Sørensen shared that he feels
privileged to be surrounded by likeminded
individuals and can discuss
with them how they can continue to
drive digital dentistry together.
SHAPING THE DIGITAL FUTURE
3Shape believes that every clinic and
laboratory should have access to
intuitive technology that will empower
them to confidently meet and exceed
patient expectations. By advancing
technologies and connecting dental
professionals with flexible options,
they can facilitate better outcomes and
experiences for all.
Before joining 3Shape back in 2017,
Sørensen accumulated two decades
of global healthcare and medtech
experience ranging from private/private
equity companies to large international
public-traded corporations. Venturing
into the dental field, he describes it
as being more dynamic because the
products are quicker to develop and
take to market.
Sørensen recalled being astonished
by the innovative spirit of the 3Shape
company and its commitment to
enabling dental professionals to unlock
the opportunities of digital dentistry.
Sørensen concluded with this advice:
“Let’s be open to new ways. I believe
that we should start already in
dental schools and universities, and
incorporate digital workflows in the
curriculum. In fact, a lot of the young
dentists that we talk to say that they
would like to be taught both ways. This
is where we really see the opportunity
to change.” DA

CLINICAL FEATURE
Navigated digital full mouth
implant rehabilitation
Impressing the international jury and bagging the 4th BEGO clinical case award,
Dr Selene Kuo presents her winning case using the BEGO Semados RSX implant
in combination with the components of the MultiPlus concept to rehabilitate fully
edentulous jaws.
A 65-year-old healthy male patient presented
with missing anterior teeth and lack of proper
posterior support which jeopardised his
mastication and aesthetics. The patient was
wearing ill-fitting removable partial denture
and wished to have a fixed dental treatment.
Upon thorough diagnosis and examination, it
was revealed that the remaining teeth were no
longer salvageable. Hence, implant-supported
fixed dental prosthesis would be provided as
treatment for both maxilla and mandible.
Figs. 1-2: Initial situation
TREATMENT PROCEDURE
Navigation system was incorporated into
the treatment workflow to achieve optimal
precision of implant and surgical procedures
as well as time control during surgery. Presurgical
plan was carried out utilising implant
design software (Navidant), predetermining
proper implant numbers, position, angulation,
depth and the potential intervention of
grafting procedures plus timing of implant
loading.
Fig. 3: Prototype design
Fig. 4: Printed PMMA prototype try-in
Fig. 5: Implants position planning
24 DENTAL ASIA JANUARY / FEBRUARY 2023

CLINICAL FEATURE
Fig. 6: Design of the provisional prosthesis
Fig. 7: Dynamic navigation approach
Information of available implant prosthetic
parts (MUA) were further incorporated to
the pre-surgical plan, designing on top of
the desired implant sites for ideal angulation
and tissue depth among implants. The aim
of the implant plan for definitive prosthetic
design was splinted screw-retained implantsupported
fixed dental prosthesis.
Figs. 8a-b: Upper jaw implants in position, using computer-aided dynamic guided surgical technique
Milled titanium alloy (Grade 5) framework with
design of splinted screw-retained implant
prosthesis and with the feature of individual
supporting structure for cementing additional
zirconia crowns will be adopted for the current
case achieving optimal biology, mechanics,
aesthetics and longevity.
Fig. 9: PS MultiPlus Abutments in position, fitting test of the provisional prosthesis and MultiPlus Healing
Post in position for suturing and graft procedures
Universal design file (STL) of implant and
abutment plan utilising Navidant software was
exported. Design of diagnostic wax up for
splinted provisional restorations were
superimposed with implant design file for
determining the relieved implantcorresponding
holes using 3Shape dental design software.
Milled pmma splinted provisional restorations
with the shade A2 were fabricated preparing
for the use of immediate loading procedures on
the surgical day.
Fig. 10: MultiPlus Titanium Abutment in position and then direct pick-up
technique using autopolymerised PMMA
Fig. 11: Upper jaw provisional prosthesis in position
DENTAL ASIA JANUARY / FEBRUARY 2023 25

CLINICAL FEATURE
Fig. 12: PS MultiPlus Abutments in position, fitting test of the provisional prosthesis and
MultiPlus Healing Post in position for suturing and graft procedures
Figs. 13-14: One week follow-up
Implants were placed with the assistance of navigation
system (Navidant, Claronav) following the registration and
calibration protocols recommended by the manufacturer.
Extraction of the remaining teeth was performed followed
by the implant placement and grafting procedures. Surgical
site was sutured with resorbable collagen suture material.
Implant position was verified using milled pmma provisional
restorations through the relieved corresponding holes
predetermined by implant plan. Full mouth provisional
restorations carried the feature of the extended palatal soft
tissue. Supporting structure was designed, fulfilling the
purpose of maintaining profile support, vertical dimension
and centric relationship.
Fig. 15: Six months after implant placement, osseointegration was accomplished
Transmucosal abutments (MUA, BEGO) were selected
with various angulation and collar height adapting to each
implant according to the plan and clinical judgement.
Transmucosal abutments were torqued to 30N/cm
according to manufacturer‘s recommendation.
Fig. 16: Abutment level closed-tray impression technique with MultiPlus Closed-tray
impression components for fabrication of the impression jig
SUCCESS IN OSSEOINTEGRATION
Six months after implant placement, osseointegration was
expected to be accomplished. Provisional restorations
were removed and implants were tested individually for
its success in both hard and soft tissue apparatus. Three
submerged implants were activated by connecting them
with MUA abutments.
Impression technique were performed according to
the recommended guidelines by American College of
Prosthodontics and the predominant current scientific
literatures for splinted screw-retained implant-supported
fixed dental prosthesis.
Fig. 17: Impression jig fabrication for open-tray impression technique with MultiPlus Opentray
impression components
26 DENTAL ASIA JANUARY / FEBRUARY 2023

CLINICAL FEATURE
Figs. 18-19: Accuracy of the impression jig with the MultiPlus Open-tray impression components checked with x-rays, splinting of the jig and abutment level
open-tray impression technique
Fig. 20: MultiPlus implant analogues connected to the MultiPlus Open-tray impression
components after impression taking, master casts poured with artificial gingiva and type
III stone, accuracy verified among implants and master cast with verification jig
Fig. 21: Articulation of master casts and vinyl index fabrication
FABRICATION AND DELIVERY OF PROSTHESES
Bench dual scan were performed for full-mouth
implant master casts and artificial teeth trial. Metal
framework were designed from the cut-back of teeth
position along with the position of all implants using
dental design software (exocad).
Fig. 22: Clinical trial of the artificial teeth set-up
Individual zirconia crowns were milled using gradient
monolithic zirconia (Prime, Ivoclar) through the autocomputerised
milling machine (PM7, Ivoclar), strictly
following manufacturer’s recommendation. Highly
polished and glazed zirconia crowns were individually
cemented on mental framework with self-curing
resin cement (Multi-link, Ivoclar). Occlusion was
verified on the articulator achieving anterior
guidance.
Fig. 23: Final prosthesis metal framework design
Final torque of all MUA abutments were applied to
30N/cm according to manufacturer‘s recommendation
and the gingival apparatus were assessed. Splinted
screwed-retained implant-supported fixed dental
prostheses were delivered for maxilla and mandible.
The passive fit of the prostheses were achieved and the
preload of the prosthetic screw were applied by 15N/
cm according to manufacturer’s recommendation.
DENTAL ASIA JANUARY / FEBRUARY 2023 27

CLINICAL FEATURE
Fig. 24: Metal framework finalised and in position
Fig. 25: X-ray images of the metal framework passive fitting
Fig. 26: Fabrication of the individual zirconia crowns
Fig. 27: Highly polished and glazed zirconia crowns were individually cemented
on metal framework with self-curing resin cement
Fig. 28: Artificial soft tissue was applied with heat processed pink composite
Fig. 29: Final prostheses clinical occlusal equilibration on the articulator
Fig. 30: Delivery of the final prostheses
Fig. 31: Final prostheses in position — two years follow-up
Occlusal equilibration was performed
achieving anterior guidance with proper
posterior disocclusion. Screw access holes
were sealed with PTFE tape and composite
resin. Oral hygiene instruction was given
and periodic follow up appointments for
maintenance was scheduled by three to six
months intervals. DA
ABOUT THE AUTHOR
Dr Selene Kuo received her dual degrees in prosthodontics from
Kaohsiung Medical University College of Dentistry (Taiwan) and
Columbia University College of Dental Medicine (New York, US).
She then continued her academic appointment as clinical assistant
professor in New York University College of Dentistry, Columbia
University College of Dental Medicine, and currently in Taipei Medical
University College of Dentistry. With her expertise in digital implant field,
she holds the position as KOL of multiple top notch dental companies.
28 DENTAL ASIA JANUARY / FEBRUARY 2023

CLINICAL FEATURE
Treatment of Class II increased
overjet by Carriere 3D Motions
Dr Kevin Ng and Dr Steve HC Law report the use of Carrier 3D Motion Appliance
(CMA) for correction of Class II malocclusion.
Functional appliances, mandibular
advancement by Invisalign were commonly
used for the correction of Class II
malocclusion in young children before peak
growth spur. This report demonstrates two
cases of using Carrier 3D Motion Appliance
(CMA) to correct Class II malocclusion with
satisfactory results.
The CMA was developed by Luis Carriere
in 2004, named Carriere Distaliser and
later renamed it as Carriere Motion 3D
Appliance. It has gained popularity over the
last decade. It consists of two metal bars
attached bilaterally to the upper canines
and first molars. Hooks at the canines were
designed for placement of inter-maxillary
elastics. This is bonded to the anterior third
of the clinical crown or to the first premolar
if the canines were not erupted yet. At the
first molar areas, the moulded pads with a
ball-and-socket joint were cemented at the
centre of its clinical crown to facilitate molar
distalisation and de-rotation.
The principle of CMA is to establish Class I
molar and canine relationship by activation
of the appliance with heavy inter-arches
force I,2 elastics (1/4“6oz and 3/16”8oz).
Class II elastics with anchorage is provided
by the clear retainer or fixed appliance at
the opposite arch. Full-time wear of Class
II elastics (22 hours daily) is required. It
is also recommended to change elastics
every four hours. Phase I treatment usually
takes six to eight months to complete. The
patient compliance and cooperation must be
high, and alignment of both arches must be
combined with the use of clear aligners or
fixed appliances after six to eight months 1 .
FIRST CASE
A 13-year-old male patient was referred
by other dentist to prescribe mandibular
advancement (MA) protocol by Invisalign.
The overbite was 100% deep and the lower
incisors were traumatising the upper soft
tissue. The overjet was 10mm with lower
face retruded and short. Previous patient
seen an orthodontist, who had suggested
to use Herbst appliance but the patient
declined.
From the lateral x-ray, we could expect
significant amount of adolescent growth
since there is concavities developing at the
lower border of C2 and C3. In addition, the
lower border of C4 is flat and C3 and C4 are
more rectangular in shape. Aligners with
mandibular advancement function design
were worn for 10 months without many
improvements.
Pre-operative extraoral photo
Post-operative photos after six months of Carriere
3D Motion distalisation
The Carriere Motion 3D appliance was then
prescribed using full day 6oz 1/4” Class II
elastics bilaterally together with vibration
accelerator for 5mins daily. Improvement
Pre-operative radiographs
Post-operative radiographs after 18 months of treatment
30 DENTAL ASIA JANUARY / FEBRUARY 2023

CLINICAL FEATURE
Pre-operative intraoral photo
Post-operative photos after six months of Carriere 3D Motion distalisation
was obvious after 2.5 months. After another
six months with slightly overcorrection,
the appliances were removed. Refinement
aligners were used to finalise the alignments
and the outcome was satisfactory. No root
resorptions and other pathology were
observed.
Cephalometric analysis before treatment
SECOND CASE
A 32-year-old female patient complained of
increased overjet. Patient is highly motivated
and compliant. Lateral cephalometric
radiograph confirmed Class II molars with
8mm overjet. Carriere Motion was prescribed
for seven months to improve the sagittal
discrepancy and the Class II canines. It
was followed by Invisalign to finalise the
alignment and improve the anterior overjet.
The case required 27 months to achieve
satisfactory outcomes.
Cephalometric analysis after treatment
Pre-operative extraoral photos
Post-operative extraoral photos
For the cervical maturation (CVM)
assessment, she belongs to post puberty
CVM stage 6 since the lower border of all
C2-4 vertebrate showed deep concavities;
at least one C3 or C4 was rectangular and
vertical in shape (height greater than width);
and peak growth should be over years ago.
DISCUSSION
The treatment objective for Class II Div 1
malocclusion is to improve the large overjet
and the deep overbite. Ideally, the molar and
canine relationship should be Class I at the
end of the treatment. In majority of Class II
cases, the upper first molars were rotated
mesio-palatally. This would exacerbate the
Class II situation by locking the mandible in a
regressive location. The MA of Invisalign only
works well if the wings were strong and rigid
enough so that it would work as a functional
appliance to correct the bite. It fails if the
wings were chew down or broken.
DENTAL ASIA JANUARY / FEBRUARY 2023 31

CLINICAL FEATURE
Pre-operative radiographs
Post-operative radiographs
Post-operative intraoral photos
The CMA creates a mesial out rotation
around the palatal roots of the first molars
and enhance the mandible to a forward
position as the molars were de-rotating. Also,
the lower teeth were extruded due to upward
vector pull from the elastics. Therefore, it
reduces overbite and promotes changes on
the occlusal plane. Stage I corrects sagittal,
and stage II corrects dental discrepancies.
Rodriguez in 2019 reported the long-term
sagittal stability of the treatment was good 9 .
Popowich in 2005 reported that for nonextraction
Class II patients, the average time
Class II elastic wear was about 10 months
and 25.7 months for fixed appliance. In the
CMA sample, the first phase averaged 5.1
months (±2.8 months), and the second phase
with fixed appliance was about 13.0 months
(±4.2 months). The total treatment duration
was 18.2 months (±4.8 months). Therefore,
the advantages of CMA treatment were the
reduced duration of elastic wear and overall
treatment time 8 .
McNamara et al. in 2012 traced 32 patients
with serial of cephalograms at three-time
intervals: T1 (initial), T2 (removal of CMA),
and T3 (post-treatment). The results were
digitised, and superimpositions were
constructed to compare the linear and
angular variables with untreated subjects
who were presented with normal facial
profile and occlusions. Variable of ≥2.0mm
or ≥2.0° was used as an indication of clinical
significance. They found the nature of
treatment effects of CMA are dento-alveloar
with only little skeletal changes 4 .
These findings were also investigated by
O’Brien and coworkers. They measured
skeletal and dentoalveolar changes and
used P value of

CLINICAL FEATURE
Cephalometric analysis before treatment
Cephalometric analysis after treatment
In summary, the following are the changes
observed from CMA treatment:
Sagittal changes in maxilla: There were no
obvious SNA changes for both cases. The
point A to nasal perpendicular were reduce
by 2mm for the first case while the distance
for the condylion to point A were increased.
The midfacial length was increased in both
cases.
Sagittal changes in mandible: SNB
increased slightly in the first case but
remained unchanged in the second case. The
mandibular length Go-Gn increased 4-5mm
for the first case and no increase for the
second case due to the age of the patient and
bone growth had completed. The pogonion
moved anterior slightly.
Maxilla and mandible relationship: The Wits
appraisal values were marked from 4-5mm to
zero in both cases. There were slight changes
of ANB values 1-2 degree. The maxillomandibular
differential, the differences
between Co-point A and Go-Gn, increased
and moved toward Class I relationship in
both cases.
Vertical skeletal assessment: The anterior
lower face height (ANS-menton) increased
for the first case without significant changes
in mandibular plane angles. A clockwise
rotation of FOP relative to Frankfort
horizontal was observed during phase I.
Dento-alveloar relationship: There were
net molar improvements for both cases. The
overjet improvements were obvious, from
10-0mm and 8-2mm. The overbites changed
from 90-10% and 50-20% respectively.
Proclination of lower incisors was also noted.
Skeletal relationship: There were reduced
forward movements of point A. The chin
point at the pogonion remained in the same
location, SNB decreased for both cases. Lower
anterior facial heights increased in the first
case (ANS-menton).
CONCLUSION
The Carriere Motion 3D distaliser is efficient
and effective for Class II malocclusion
correction with less discomfort. It also
increases patient’s compliance and cooperation.
The effect is mainly dentoalveolar in nature,
with changes in molar relationship, overbite,
and overjet combined with some intrusion of
lower incisors.
There was obvious skeletal change and
increase in lower anterior facial height. This
is crucial for case selection since growing
child with mandibular growth helps the
treatment. It could be used for adults but it
provides better results for growing teenagers.
Mandibular length was not affected by
treatment. The pogonion chin point did not
move forward due to the increase in lower
anterior facial height. DA
REFERENCES:
1.
Carriere LA. New Class II distalizer. J Clin Orthod.
2004; 38:224–231.
2.
Kim-Berman H, McNamara JA, Jr, Lints JP,
McMullen C, Franchi L. Treatment effects of the
Carriere® Motion 3D appliance for the correction
of Class II malocclusion in adolescents. Angle
Orthod. 2019; 89:839–846.
3.
Carriere LA. Interview: Carriere explains facially
driven treatment of Class II and Class III. Ortho
Tribune US Edition. 2015;10(3):1–7.
4.
McNamara JA, Franchi L, Kowalski SE and
Cheeseman C. Evaluation of adolescent and adult
patients treated with the Carriere Motion Class
III appliance followed by fixed appliances Angle
Orthod, 2012
5.
Hamilton CF, Saltaji H, Preston CB, Flores-Mir C,
Tabbaa S. Adolescent patients’ experience with
the Carriere distalizer appliance. Eur Paediatr Dent.
2013;14:219–224.
6.
Sandifer CL, English JD, Colville CD, Gallerano
RL, Akyalcin S. Treatment effects of the Carrière
distalizer using lingual arch and full fixed
appliances. J World Fed Orthod. 2014; 3:e49–e54.
7.
O’Brien K, Wright J, Conboy F, et al. Effectiveness
of early orthodontic treatment with the Twin-block
appliance: a multicenter, randomized, controlled
trial. Part 1: dental and skeletal effects. Am J
Orthod Dentofacial Orthop. 2003;124:234–243.
8.
Popowich K, Nebbe B, Heoc G, Glover K, Major P.
Predictors for Class II treatment duration. Am J
Orthod Dentofacial Orthop. 2005;127:293–300.
9.
Rodriguez H. Long term Stabilityo f two-Phase
Class II Treatment with Carriere Motion Appliance
JCO Vol LIII No 8: 481-485 2019
10.
Thurzo A, Urbanova W et al. Utilization of a 3D
Printed Orthodontic Distalizer for Tooth-Borne
Hybrid Treatment Class II Unilateral Malocclusion
Material 2022 15 1740.
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. His qualifications
include: BDS (Adelaide), DDPH, MDS
(Sydney), MSc Orth (Jinan U), M Cl Sc
Implant (Leeds), FRACDS, FHKAM,
FCDSHK, D Implant Dent (RCS, England),
MFDS (RCPSG/Ed).
Dr Steve HC Law runs
a private practice
in Hong Kong and
holds the following
qualifications: BDS
(HK) MFGDP (RCS,
England) MFDS (RCS, Glasgow) MFDS
(RCS, Edinburgh).
DENTAL ASIA JANUARY / FEBRUARY 2023 33

CLINICAL FEATURE
New era unfolds for Minimally
Invasive Cosmetic Dentistry (MiCD)
Jointly organised by the MiCD Global Network and Shofu Dental Asia-Pacific,
MiCD expert workshop was held on 19 Sep 2022, at the EQ Hotel, Kuala Lumpur,
Malaysia. The expert panel comprising of MiCD advocates and clinical trainers
shared their knowledge and expertise to collectively develop a strategy and
framework for the next phase of MiCD in clinical practice.
MiCD concept and treatment protocols were
first conceptualised in 2009 by Dr Sushil
Koirala and a group of like-minded clinicians
with the support of Shofu Dental as the official
partner — at a time when the practice of
aesthetic dentistry which was more invasive,
and minimally invasive dentistry primarily
focused on prevention and management of
dental caries. MiCD was introduced as “a
holistic approach that explores the smile
defects and aesthetic desires of a patient at
an early stage and treats them using the least
invasive option in diagnosis and treatment
technology by considering the psychology,
health, function and aesthetics of the patient”. 1
In February 2010, the MiCD Global Network
was formed to provide a platform for dental
professionals to adopt and learn about MiCD
and its applications in routine clinical practice.
Over the years, MiCD has gained popularity
as a treatment philosophy that encouraged
clinicians to provide holistic, patient-centric
treatment that integrates minimally invasive
treatment techniques with aesthetic dentistry
to enhance the patient smile while selecting
the most conservative restorative options that
preserve natural tooth structure.
The key benefits of MiCD includes:
preservation of natural tooth structure while
achieving the desired aesthetics; promotes
oral health, function and aesthetics with a
positive psychological impact; expands the
treatment options with BioSmart aesthetic
restorative materials; increases patient
confidence while reducing treatment fear and
anxiety; promotes trust, builds patient loyalty
and enhances the professional image; and
embraces the “less is more” strategy.
Dentistry has evolved at a rapid pace in the
past decade with new treatment techniques,
advances in dental material science and
increasing patient demand. To keep abreast
of recent changes, it became evident that
updates in the MiCD treatment philosophy
and protocols were needed. This new
framework is simple, comprehensive, easy
to implement and practical, to enable both
experts and new generation of practitioners
to better understand the essence of MiCD
and treatment protocols to incorporate the
guiding principles into daily clinical practice.
MICD EXPERT WORKSHOP DISCUSSION
With the expert panel — Dr Ronnie Yap
(Singapore), Dr Marcelo Lasmar (Brazil), Dr
Sonny Burias, Dr Kim Fajardo, Dr Cez Acero
(Philippines), Dr Amit Gulati, Dr Anand
Narvekar (India), Dr Hussein Naama (Iraq),
Dr Melvin Sia, and Dr Sonia Lee (Malaysia)
— the MiCD expert workshop started with
introductions and participants expressing
what MiCD meant to them. Some key words
that resonated with all participants were
“empathy, passion, value, health, preservation,
holistic, patient-centric, doing what’s right,
less is more and phased treatment”.
Keeping the momentum, Patrick Loke,
managing director of Shofu Dental Asia-
Pacific shared a presentation on “The Past,
Present and Future of MiCD” to highlight
34 DENTAL ASIA JANUARY / FEBRUARY 2023

CLINICAL FEATURE
the growth of the MiCD movement and the
integral role Shofu has played as the official
partner of MiCD in its global success, through
the MiCD Global Network with skill-based
training programmes and MiCD symposiums
over the years. Loke emphasised that Shofu
is committed to support the MiCD movement
through product developments, such as
Shofu’s range of bioactive composites and
smart solutions for direct and indirect
restorations, and is looking forward to
supporting the next phase of MiCD.
Dr Ronnie Yap, advocate and clinical trainer
for MiCD, followed with a presentation on
the “MiCD Movement through the MiCD
Global Network and the Clinical Trainers’
role in taking MiCD towards the next
phase”. The presentation highlighted how
the MiCD Global Network will drive the
MiCD movement with skill-based training
programmes and provide a common platform
for like-minded dental professionals to
network and share their MiCD experience.
Additionally, Dr Yap explained the importance
of providing personalised treatment that
meets the patient expectations often by
“doing what’s right” and how MiCD has been
adopted into his practice philosophy.
The panel of experts then proceeded to a
brainstorming session moderated by Dr Cez
Acero on creating the framework for the
next phase of MiCD. The panel deliberated
collaboratively on the following areas:
• Identify and develop the key guiding
principles that define MiCD as a concept
that are practical and realistic to adopt in
clinical practice
• Establish MiCD practice philosophy and
create the treatment workflow principles
• Develop a blueprint for the
standardisation of MiCD training
protocols for direct restorations
strength, function and preserve natural tooth
structure. Logical treatment philosophy that
is practical, realistic predictable and patientcentric
to finally create Beautiful restorations
that provide natural, life-like aesthetics to
rejuvenate patient smiles and, in turn, change
their lives (Fig. 1).
LESS IS MORE
There should be a change in mindset when
applying the MiCD practice philosophy of
“less is more” in routine clinical practice. The
clinician should always focus on preservation
of natural tooth structure whenever possible
starting from the stage of diagnosis and
treatment planning which would lead to
selection of the least invasive and most
appropriate treatment option resulting in less
biological and financial cost to the patient.
Benefits of the MiCD “less is more”
philosophy
• Patient: Preservation of natural tooth
structure, less invasive treatment, more
comfort and minimised cost
• Dentist: Phased treatment approach that
is attainable, predictable and relevant to
the times, with more control over the
treatment outcomes and provide value to
the patient
• Dental practice: Increased service value,
patient acquisition and retention leading to
increased profitability
THE MICD TREATMENT WORKFLOW
BioConservation
• Diagnosis and treatment plan: The
MiCD concept promotes personalised
dental treatment strategy with a focus
on holistic patient-centric care where
communication with the patient is
crucial to better understand their needs,
expectations, behaviour and overall health.
During diagnosis and treatment planning,
MiCD advocates the change in mindset,
greater empathy and value to the patient
by selecting the least invasive and most
conservative approach that preserves the
maximum natural tooth structure.
• Aesthetic blueprint: The aesthetic
blueprint is developed with the end
goal in mind and acts as an indicator to
ensure predictability when proposing the
treatment plan to the patient. Important
elements in the blueprint are smile design,
restorative plan, material selection and
mock-up.
• Less biological cost: Preservation of sound
tooth structure by selecting non-invasive
or minimally invasive techniques within the
restorative plan is essential when adopting
the “less is more” practice philosophy and
Fig. 1: BioLogically sound principles to produce functionally predictable and beautiful restorations in the
best interest of the patient
OUTLINING THE NEXT PHASE OF MICD IN
CLINICAL PRACTICE
The panel highlighted that three key areas
should be addressed as part of the MiCD
guiding principles with Biology, which looks at
restoring the health, structure and function of
oral tissues, placing restorations with bioactive
restorative materials that provide adequate
Fig. 2: Treatment workflow: BioConservation, BioAesthetics, BioSustainability
DENTAL ASIA JANUARY / FEBRUARY 2023 35

CLINICAL FEATURE
Fig. 3: Class IV restorations
developing a phased treatment approach
with the best interest of the patient.
Fig. 4: Direct veneer
BioAesthetics
• Preventive treatment: Prevention plays
an important role in preservation of
sound tooth structure and ensuring
long-term success of the restorative
treatment rendered to the patient. The
phased treatment approach has an
important component which is “keep
in view” specially in the management of
dental caries and tooth wear. The final
restorations are placed only once the
patient oral conditions are stabilised.
• Restorative treatment: MiCD restorative
approach has a focus on selecting the
most appropriate and minimally invasive
treatment option based on the patient
needs. Therefore, non-invasive or
minimally invasive direct restorations are
considered first, and indirect restorations
should be considered only if needed.
The advantage of direct restorations is
that the dentist has more control over
the final restorative outcome and minor
modifications can be easily made in the
patient’s mouth. However, if multiple
restorations are required, minimally
invasive indirect restorations would be
more suitable to reduce clinical chair time
and increase patient comfort.
BioSustainability
• Oral hygiene: It is known that suboptimal
oral hygiene affects the long-term success
of any restoration. MiCD treatment
workflow encourages all dentists to
educate their patients on the importance
of maintaining good oral hygiene to
protect their overall health and wellbeing.
• Maintenance of restorations: An oftenneglected
area in restorative treatment is
the maintenance of the restorations placed
over time. Most restorative materials
undergo wear and tear due to diet, habits
and oral hygiene of each individual.
Therefore, creating a maintenance plan
with periodic recall for each patient
is important where the dentist has an
opportunity to assess the restorations
placed, touch-up where required and
polish the restorations.
36 DENTAL ASIA JANUARY / FEBRUARY 2023

CLINICAL FEATURE
• Soft tissue management: Periodontal health is an
important aspect of oral health. Periodontitis is
becoming a common cause of restorative failure and
in many cases is linked to systemic conditions such
as diabetes. Soft tissue management is therefore
considered critical and dentists are encouraged to
consult periodontists when required to manage the
patient more holistically.
Fig. 5: Diastema closure
MICD DIRECT RESTORATIVE PROTOCOLS
The expert panel outlined the basic guidelines, unique
techniques and material selection for the following direct
restorations commonly placed in routine clinical practice
and smile modification procedures (Figs. 3-7).
• Class IV restorations (Anterior fracture)
• Direct veneer
• Diastema closure
• Management of erosive tooth wear
• Class II restorations
Fig. 6: Management of
erosive tooth wear
Biological layering technique with bioactive composites
As dental material science advances the aesthetic and
functional capabilities of direct composite provides
clinicians with more restoration options that can be
placed with increased predictability and longevity. The
Shofu range of bioactive direct composites provides
additional benefits of reduced plaque accumulation,
prevention of secondary caries and antibacterial
properties that increase longevity of the restorations.
The panel collectively agreed to recommend the use of
bioactive composites with the MiCD restorative protocols
and modify the MiCD composite layering technique. The
“BioLogical Layering Technique” was suggested as the
updated layering approach adapted to suit each patient
depending on the level of complexity and depth of the
restoration, to achieve natural life-like aesthetics that
match closely with adjacent natural teeth.
CONCLUSION
MiCD with its practice philosophy of “less is more” has
become more essential in this era where consumer
behaviour is driven by health and wellness, conservation,
sustainability and more bio-economics. The MiCD guiding
principle is based on BioLogical treatment goals that are
relevant tools in building a routine to a successful clinical
practice. Shofu remains committed to supporting the
dental community with future programmes and learning
events, through the MiCD Global Network while engaging
the Shofu-MiCD clinical trainers. DA
Fig. 7: Class II restorations
1
Dr Sushil Koirala, Minimally Invasive Cosmetic Dentistry-
Concept and Treatment Protocol, Cosmetic Dentistry 4-2009:
28-33
DENTAL ASIA JANUARY / FEBRUARY 2023 37

USER REPORT
Five benefits of prosthetic-driven
implant planning
The demand for implant treatments is on the rise and so are expectations.
Patients are now more informed about the procedure, and they demand
results that are both highly functional and aesthetic in the fewest number of
appointments possible. That’s a real challenge for the dental professional — and
the pressure is on to improve the process.
In this increasingly cosmetic-focused
environment, there are also highly
experienced dental professionals who might
not immediately see the value in changing
anything about the way they place implants.
They are satisfied with their success and
their patient outcomes. Why should they
stray from their proven approach that they
find so comfortable and familiar?
The answer is time savings. That’s the first
benefit that clinicians will find when they
embrace prosthetic-driven implant planning
and digital implant workflow, and the
implications of this time savings should not
be underestimated. This article examines
the value that prosthetic-driven planning
brings to the implant placement process —
benefitting the clinician and the patient.
extensions, custom abutments and other
compromises 1 when it is time to place the
restoration. Instead, the clinician has more
predictable — and often higher quality —
outcomes (Fig. 1).
The prosthetic-driven planning workflow
starts with taking a cone beam computed
topography (CBCT) scan of the patient.
The doctor uses this imaging to identify
anatomical obstacles and evaluate bone
structure, mandibular nerve and sinuses.
The next step is to create a digital model,
which can be accomplished in one of two
ways: The clinician can use an intraoral
scanner to create a digital impression;
or the clinician can take a traditional
impression and then scan the impression
using a CBCT system. Then, using implant
planning software, the data from the CBCT
scan and digital impression are merged
together (Figs. 2a-c).
ALL ABOUT THE OUTCOME
The traditional methodology behind an
implant workflow involves placing the
implant first in the available bone. At that
point, the clinician then determines where
the crown should be positioned. Prostheticdriven
planning, however, reverses this
process with a crown-down approach. With
prosthetic-driven planning, the outcome
lies at the heart of the workflow, driving
the process from start to finish. And by
taking this approach, there are no unwanted
surprises at the restorative end of the
process. There’s no need to courageously
step in and salvage a situation with
Fig. 1: Standard implant
planning workflow
vs prosthetic-driven
planning workflow
Figs. 2a-c: Using virtual treatment planning software, the data from the CBCT scan and digital impression
are merged together
38 DENTAL ASIA JANUARY / FEBRUARY 2023

USER REPORT
At this point, the clinician can then begin
to plan the implant and abutment, taking
into account the form, fit and function
of the final restoration. The interactive
implant planning software provides multiple
views, enabling the clinician to evaluate
potential implant receptor sites with greater
accuracy. Through the software, bone can be
“removed” or displayed with transparency,
which helps in determining the precise
placement of implants, abutments and
translucent virtual teeth in proximity to the
natural tooth root structure. A virtual crown
is used to guide the placement of the virtual
implant for optimal aesthetics and function.
This allows for well-informed conclusions
to be drawn about crown-to-implant ratio,
implant diameter and length, and the design
of the restoration in terms of screw or
cement retention 3 (Fig. 3a-b).
The next step involves exporting the 3D
data into third-party software for the
design and fabrication of the surgical guide
by the treatment network. Thanks to the
prosthetic-driven planning workflow,
implants can be placed with a level of
accuracy and consistency that is hard to
achieve through conventional implant
placement 4 . With all of that upfront
information and planning, successful
outcomes are much more likely to be
delivered without unforeseen challenges
(Figs 4a-d).
about the clinician and the diagnosis. They
also want to understand the associated
costs. Co-diagnosis is an important step in
treatment acceptance, and having the tools
to clearly communicate and educate patients
are essential in building trust and assuaging
concerns. They are also key in obtaining
acceptance of the proposed treatment.
A clinician whose treatment plan includes
crystal-clear 3D images and a highly defined,
step-by-step approach is quite compelling.
It helps patients visualise their aesthetic
outcome. This treatment plan delivers the
message that the clinician has thoroughly
thought through the process and has
invested in the technology to ensure success.
In addition, with a complete understanding
of the patient’s anatomy and clinical
situation — thanks to extraoral and intraoral
3D imaging — the clinician can confidently
estimate the costs. The prosthetic-driven
planning protocol removes surprises and
guesswork. This comprehensive treatment
plan engages patients and embodies the
peace of mind that they are looking for.
ENHANCED COLLABORATION
CAPABILITIES WITH TREATMENT
NETWORK
The clear, illustrative images obtained
through CBCT scanning and the digital
impression are excellent for communicating
with the referring doctor and all members of
the implant team 6 . They greatly enhance the
clinician’s ability to collaborate across the
treatment network.
CBCT scanning produces DICOM, which is a
universal format and is supported by many of
the 3D viewers available on the market — and
also facilitates collaboration. There’s no need
to worry that a member of the treatment
network will have difficulty reading the files.
Figs. 3a-b: Informed conclusions can be drawn about crown-to-implant ratio, implant diameter and
length and the restoration design
It is also important to highlight the strategic
role that the surgical guide plays. However,
the guide is only as good as the plan
that went into creating it, and it is not a
guarantee of a successful outcome but rather
a safety measure and facilitator. Greater
precision in the implant process is possible
only with the complete evaluation of the
receptor site, the implant dimensions, the
abutment type and the components required
to surgically complete the case. Obtaining
this insight upfront prepares all members
of the implant team for a no-surprise,
outstanding outcome.
IMPACT ON CASE ACCEPTANCE
Before patients agree to undergo implant
treatment, they need to feel confident
Figs. 4a-d: Exporting the 3D data into third-party software for the design and fabrication of the surgical guide
DENTAL ASIA JANUARY / FEBRUARY 2023 39

USER REPORT
As long as the files produced are in an
open format, the clinician can exchange
files quickly and easily with the treatment
network. Files with a closed format can also
be exchanged. However, those files require
users to stay within the closed environment,
which limits their flexibility in using other
partners.
Clinicians can create a digital impression
and — while the patient is still in the chair —
send that information to the lab for review. If
the lab wants an area to be rescanned or the
proposed design to be modified, the clinician
can do so immediately. There is no need
for an additional office visit, saving valuable
chair time and preserving the patient’s
confidence in the clinician’s methods.
The lab can also quickly evaluate and
anticipate the technical complications
and considerations in producing the final
prosthesis. Doctors can use this information
to more accurately estimate their cost and
patient pricing.
Digital technology plays a key role in
producing the final prosthesis. The intraoral
scanner enables the clinician to use a
scanbody, which is a post that attaches to
the implant fixture. The scanbody helps
the clinician acquire the implant position
and provides the information required to
design the restoration. Interactive software
typically enables the clinician to generate
an implant report to aid in the ordering of
the components needed for implantation.
The report can also be shared with labs and
referring clinicians.
INCREASED PATIENT SATISFACTION
Faster treatment: From the initial
appointment, the prosthetic-driven implant
workflow expedites the treatment process.
Digital impressions are significantly faster
to obtain than traditional impressions. They
eliminate the need for creating a physical
model or wax-up. The implant planning
software merges the files from the digital
impression and CBCT scan, and the clinician
can present the treatment plan to the
patient — all within the first appointment. If
the patient accepts the treatment plan, he/
she can schedule surgery. Because files are
sent electronically between each member
of the treatment network, there are no
shipping delays to factor in. The combined
use of 3D imaging technology and CAD/CAM
restoration promotes the immediate loading
of the restoration and saves significant time
in the post-operative phase (Fig. 5).
Greater comfort and higher quality
outcomes: Since prosthetic-driven planning
typically involves the use of a flapless
approach, the procedure is less invasive.
Patients experience less pain, swelling and
overall postoperative discomfort. Less invasive
procedures lead to better restorative outcomes:
“A recent study to assess prospective implant
sites using panoramic radiography versus
panoramic scans combined with CBCT imaging
revealed that CBCT increases the accuracy of
treatment planning in predicting the actual
implant dimensions required at surgery.
Performing a CBCT scan during the planning
phase increases the accuracy of predicting
implant length considerably, from 40% after the
initial 2D scan to 69.5%. The overall outcome
is a more predictable surgical and restorative
result 7 .”
Cost savings: Because prosthetic-driven
planning deals with digital files, there are
no shipping costs to factor in for impression
creation. With the extensive planning that
goes into the prosthetic-driven planning
workflow, there’s less chance for unintended
events, which can set back the final
treatment plan and substantially increase
treatment costs and time.
CONCLUSION
With the insight obtained through CBCT
scanning, intraoral scanning and the
prosthetic-driven planning workflow, the
clinician can place implants with a level
of precision, accuracy and consistency
that is hard to achieve through traditional
implant placement. Efficiencies are built in
throughout the process, resulting in fewer
appointments from start to finish. Intraoral
scanners and CBCT imaging streamline the
digital workflow with images that facilitate
diagnosis, treatment predictability, patient
education and surgical accuracy. The
prosthetic-driven planning workflow also
eliminates guesswork and increases clinician
confidence. Through faster treatment times,
improved patient comfort, reduced cost, and
higher quality, more predictable outcomes,
the benefits to be gained by both the
clinician and the patient are considerable.
Outstanding outcomes are attainable without
prosthetic-driven planning. However, the
clinician will undoubtedly discover that,
when prosthetic-driven planning is part
Visit 1 Visit 2 Visit 3 Visit 4 Visit 5 Visit 6
Traditional
Take multiple
impressions;
Scan with CBCT
Get bite registration
Confirm functionality
and aesthetics with
wax model
Perform a dual
scan protocol
with CBCT
Place implant and
take impression
with implant
in place**
Insert prosthesis
Prosthetic-driven
planning method
Create HD 3D
digital impression;
Scan with CBCT;
Plan implant*
Place implant and
create new HD 3D
digital impression
with implant
in place**
Insert prosthesis
— — —
* Complex cases may require an additional appointment for case presentation to the patient
** Depending on the loading protocol, impressions may require an additional appointment
Fig. 5: Protocol comparison for implants using surgical guide and immediate loading
40 DENTAL ASIA JANUARY / FEBRUARY 2023

USER REPORT
of the process, those outcomes can be
delivered more quickly and reliably — and
likely at a lower cost.
WHY CARESTREAM DENTAL’S 3D IMAGING
SOLUTIONS?
Carestream Dental can cover much of the
entire treatment workflow, from imaging and
diagnosis, to the fabrication of the surgical
guide. Clinicians can obtain the precision
they need to confidently plan and place
implants — ensuring optimal outcomes each
and every time.
Four easy steps
• Scanning and diagnosis: Carestream
Dental’s 3D imaging systems cover the
entire implant process. Clinicians can
see the complete picture of the clinical
situation with the CS 8200 3D or CS 9600
CBCT system, enabling them to evaluate
bone volume, mandibular nerves, and
sinuses. Then, the soft tissues and surface
detail of the teeth can be captured using
the clinician’s preferred intraoral scanner.
3D data is then stored centrally in single
imaging software to facilitate and expedite
data management and retrieval.
• Merge data: Simply import the digital
impression STL/PLY format files from
the third-party intraoral scanners into CS
Imaging software. Then, the CBCT and digital
impression data are merged automatically in
the implant planning software with little-tono
manipulation required.
• 3D planning: User friendly and intuitive,
CS 3D Imaging software takes the process
of planning implants to a whole new level
of efficiency and precision. Clinicians
can add virtual crowns and select from a
comprehensive library of implants (from
more than 90 manufacturers) to virtually
place implants in the appropriate axis and
then add abutments. They can also create
their own implants and manage their own
library. Clinicians can view the location
of the proposed implant in relation to
the bone and restoration — on the same
screen — to ensure optimal positioning
and aesthetic results.
• Guide creation: To create the surgical
guide, clinicians — with just one click
— simply export the 3D data into their
preferred third-party surgical guide
software including SMOP, Blue Sky Bio
and 360imaging thanks to the open file
format. Clinicians can easily generate
implant reports — again, with a single click
— which helps them effectively prepare
for surgery and share information with the
treatment network, referrals and patients.
Unique collaborative capabilities
With Carestream Dental software solutions
clinicians can:
• Exchange files effortlessly with the implant
network to speed up workflow
• Enable the implant network to open 3D
files simply with the CS MeshViewer and
CS 3D Imaging software
• Integrate the implant network and CAD/
CAM workflow easily with versatile 3D file
format options: STL, PLY, DICOM
User friendly and highly intuitive software
• The software automatically aligns the
digital impression with the CBCT scan so
clinicians can obtain the virtual setup with
little-to-no manipulation
• Intuitive tools enable clinicians to make
alignment adjustments manually if needed
• Clinicians can generate an implant report
in one click to order the components
needed for surgery and share with labs
and referrals
Enhanced patient communication and
education
Prosthetic-driven implant planning module
enables clinicians to facilitate patient
communication and education. It can help
patients understand the entire implant
process from start to finish, address their
concerns and build their confidence in
the treatment plan. For example, using
Carestream Dental’s implant planning
software, clinicians can show their patients
images of their crown build-up. Clinicians
can then assure them of the higher quality
outcome that results from using the
prosthetic-driven planning workflow: “If I
place a standard abutment, not an angled
abutment, you will have the strongest,
easiest and most cost-effective implant
option.” DA
REFERENCES
1
Jansen, Curtis. “Restorative-driven implant
therapy,” CAD/CAM, North America Edition, Vol. 4,
Issue 1, 2014, p. 21
2,3
Ganz, Scott D. “The Next Evolution in CBCT:
Combining Digital Technologies,” https://
eliezerganon.wordpress.com/2014/08/02/
the-next-evolution-in-cbctcombining- digitaltechnologies/
4
Abai, Siamak and Dalmau, Zach. “Immediate Final
Restorations: A Comprehensive Digital Approach
to Implant Dentistry,” http://glidewelldental.com/
education/ inclusive-dental-implant-magazine/
volume-4-issue-3/immediate-final-restorations/.
5, 6
Ganz, Scott D. “The Next Evolution in CBCT:
Combining Digital Technologies,” https://
eliezerganon.wordpress.com/2014/08/02/
the-next-evolution-in-cbctcombining- digitaltechnologies/.
7
“Diagnostic imaging in clinical practice,” Science
First, Volume 3, Issue 2, 2015, p. 12
DENTAL ASIA JANUARY / FEBRUARY 2023 41

USER REPORT
Astounding new smile with direct
composite veneers
Under the guidance of Dr Munin Chaichalothorn, Nanthiphorn Pongam wins
Dentsply Sirona’s annual Global Clinical Case Contest demonstrating her passion
and skillset in restoring radiant smiles.
Since 2004, Dentsply Sirona has organised
the annual Global Clinical Case Contest
(GCCC). The competition is aimed at
dental students with less than two years
of clinical practice. Participants document
their successful treatment case in text and
images, and are supported by a tutor from
their university.
In 2022, more than 520 students from 73
dental schools participated. Nanthiphorn
Pongam from Mahidol University,
Thailand, wins the first prize for a
challenging maxillary restoration. Using
DS Prime&Bond universal, Neo Spectra
ST Effects composites, Enhance Finishing
System and Enhance Pogo Polishing System,
the following is her winning case —
showcasing the impressive talent of young
dentists today.
CASE DESCRIPTION
A 21-year-old male patient was presented
with a compromised maxilla, severe carious
lesions and enamel defect on the upper
anterior teeth. The requirement was to
restore the front teeth as minimally invasive
as possible and with direct restorative
materials. The GCCC award winner
Nanthiphorn Pongam was supported in
her work by Dr Munin Chaichalothorn at
Mahidol University.
The 2021/2022 Dentsply Sirona Global Clinical
Case Contest winner Nanthiphorn Pongam.
University: Mahidol University, Bangkok, Thailand,
DDS (2nd class honours), Naresuan University, MSc
(Operative Dentistry), Mahidol University
TREATMENT PROCEDURE
Fig. 1: Initial situation
— The pre-operative
conditions included
severe carious lesions
and enamel defect
on the upper anterior
teeth.
Fig. 3: Wax-up and a
silicone key on teeth 13
to 23 —The diagnostic
wax-up was performed
and a silicone index
was fabricated using a
putty addition silicone
material.
Fig. 2: Aesthetic criteria
were determined
based on Digital Smile
Design (DSD) concepts,
especially for the tooth
shape and width-toheight
ratio. Then,
diagnostic models were
fabricated following the
design from DSD.
Fig. 4: Shade selection
— After cleaning,
proper shades were
selected by using VITA
shade guide paired
with universal CLOUD
shades. The enamel
shade (E1) and dentin
shade (D1) were
selected.
42 DENTAL ASIA JANUARY / FEBRUARY 2023

USER REPORT
Fig. 5: Caries removal and cavity preparation — A
rubber dam isolation and gingival retraction cords
were applied. After that, caries were selectively
removed for preservation in a vital pulp tissue.
Minimally invasive preparations were performed on
teeth 13-23.
Fig. 6: Bonding procedure — The cavities were
selectively etched with 36% phosphoric acid, then
rinsed with water spray and air-dried. Adhesive
procedures were performed with a universal
adhesive (Prime&bond Universal, Dentsply Sirona).
Fig. 7: Palatal wall and proximal wall build up —
The Neo Spectra ST Effects composites (shade
E1) were placed to build up the palatal wall and
proximal wall using a silicone index and mylar strip,
respectively. Then, the dentin shade (D1) was used
to create a dentin lobe.
Fig. 8: Finishing and polishing — Morphological
characteristics were marked to specify the line
angle and developmental groove. Then, the
Enhance Finishing System and Enhance PoGo
Polishing System (Dentsply Sirona), were used
to mimic the natural micro texture and glossy
surface.
Fig. 9: Final result — The upper anterior teeth
revealed a natural smile line, which coordinates
with the lower lip line.
Fig. 10: Post-treatment — The final result not only
provides natural aesthetics but also restores
effective function. The patient is highly satisfied
with his new smile and the overall result.
Munin Chaichalothorn
(l.), tutor of Nanthiphorn
Pongam, DDS (2nd class
honours), Mahidol University;
MSc (Operative Dentistry),
Mahidol University,
Diplomate, Thai Board of
Operative Dentistry
CONCLUSION
The direct solution was done for
several reasons. First, the patient
wanted a minimally invasive
treatment. Furthermore, it also had
to be cost effective. This meant
that a restoration with ceramic
veneers was out of the question,
and crowning the teeth was also not
an option in view of the patient’s
age and the loss of tooth substance
that would have been necessary.
The patient’s poor oral hygiene at
the beginning of treatment also
had to be considered. In the end,
the patient was very compliant and
highly satisfied with his new smile
and the overall result. DA
DENTAL ASIA JANUARY / FEBRUARY 2023 43

BEHIND THE SCENES
Digital dentistry is here to stay
It is clear — digital dentistry is
widely accepted around the globe.
For more than four decades, the
practice strived and challenged
all the doubts given. In today’s
practice, its value has become even
more undeniable, particularly on
the laboratory side, as Dr Kelvin
Tantono writes more.
We might remember the time when
experienced technicians doubted how digital
technology and workflow can reinforce or
make the world of dental technicians better.
It might be understood well why such doubt
rose because, at the early time of digital
dentistry, we were led to a dogma that digital
technology will only provide speed. On
top of it, early dental technicians who are
more hands-on in their procedures lacked
exposure to computer technology and found
it hard to adapt. In turn, the so-called “speed
technology” only slowed them down.
Over the years, as digital workflow became
more established, it has lured the attention
of the young generation who are more
technology savvy. By having them in the
field, the adaption of digital dentistry in the
laboratory accelerated. Today, we see many
new technicians fabricating high-quality
work in a short time by utilising CAD/CAM
technology to simplify their workflow. By
doing so, they can focus on improving their
skills in other essential factors like anatomy
and shade.
EFFICIENCY IS KEY
Digital technology reinforces the
communication between technicians and
dentists. Many factors that cannot be shown
and communicated well before in the era
of analogue, now can be presented clearly.
As we all agree, many times these are tiny
factors like undercuts that cause leakage and
lower the success rate of the restorations.
These are hard to analyse in analogue, but
with digital technology, we can scan and
zoom the models to see the details so both
dentist and technician can discuss and
solve the problem. Even before making an
impression, if the dentist is using a digital
intraoral scanner (IOS), the undercuts can
be analysed directly in the patient mouth.
Furthermore, digital technology lowers
the chances of redoing restorations in
several ways. By being able to communicate
problems like an undercut, lack of space,
and other possible risks, digital technology
improves the success rate of restoration.
By avoiding redo, the technician can save
much time to work on other cases and focus
on other issues, even having more time to
practice new skills. Digital technology also
enables a dental technician to show the
final result to the dentist and patient at the
very beginning of the case by utilising the
digital design. The design can be shown
in 360-degree view so both dentist and
technician can work together to analyse
the case.
Another significant way how technology
can help the technician to save time is by
simplifying the reproduction process. Since
the workflow is in digital form and involves
saving works in file format, then whenever
we need to remake the same restoration,
it is possible to simply reload the file and
reproduce the restorations without having
to start from scratch.
44 DENTAL ASIA JANUARY / FEBRUARY 2023

BEHIND THE SCENES
a digital system gradually. I recommend
starting with a laboratory scanner and
CAD software. By doing so, we can get
the benefit of model undercut analysis,
a better “zoomed” view of the margin,
better communication of the final result
with dentists and patients, and the
repeatability of production.
In the beginning, production can be
outsourced by simply sending the .stl file
to your local production or milling centre.
In this way, it will help you avoid several
start-up issues like raw material stock,
huge investments in milling machines and
sintering furnaces and switch “safely” into
the digital system.
UPWARD TREND
Various indicators are showing that the
dental laboratory world has accepted
the digital way of working. In fact, not
just accepted — but also nurtured its
development. A very obvious indicator of an
unavoidable emerging digital technology in
the dental laboratory is by looking at how
the manufacturers supply the market.
In every new technology or system,
manufacturers do surveys and predictions
about how ready the market is to adopt or
accept the new system. As we are witnessing,
manufacturers all over the world are
constantly launching and innovating both
premium and economical level products.
Moreover, we are also seeing more dentists
utilising IOS in their daily practice as
the improvement in product quality and
scanning speed over the years has made it
easier for them to adopt this technology.
There is also a notable drop in its price
making it more affordable. Hence, dentists
are more inclined to purchase even though
they might not have their own design
software or production centre. As a lab, if
we only have the CAD and a 3D printer, we
can have ourselves ready to receive digital
scans instead of impressions only.
Creating great results with an analogue
system might be no problem for masters
and experienced passionate ceramists. But
we all must admit that passionate ceramist
is now getting less and less in number. It is
now very rare to find a ceramist who still
understands and can perform the analogue
technique in proper ways, so when we
need to grow our lab or maintain our lab in
running daily tasks, we need to train new
employees. Digital systems and workflow
can help a laboratory to train the new
generation faster and easier.
FINDING THE BALANCE
So, will the digital erase the analogue?
The best attitude and point of view
regarding unavoidable digital technology
interference in the world of the
dental laboratory is to see digital and
analogue not as opposite things, but
as reinforcement of each other. See
analogue as our right hand; and digital
as our left hand. In our daily life, using
both hands have enabled us to do many
tasks effectively. By utilising digital and
analogue together, many benefits will be
sowed.
Instead of buying a whole digital system
at once, it is possible to switch and adopt
After getting comfortable with CAD, it
is possible to add CAM production into
your lab in the future. It is recommended
to use open systems to be able to adopt
digital step-by-step into your lab. There
is no right or wrong whether to stay in
the analogue style of an artist or embrace
the technology interference now. But
one thing is for sure, digital is here to
stay in the fascinating industry of dental
laboratory. DA
ABOUT THE AUTHOR
Dr Kelvin Tantono is
the founder and chief
dental technician at
Zirmon Dental Atelier.
He graduated from
Trisakti University
in 2012 and gained
clinical experience
in Jakarta and
Binjai followed by his private practice in
Medan, Indonesia. After more than five
years of clinical practice, he decided to
follow his heart and pursue the field of
dental ceramics and has not looked back
since. He completed the international
programme at the Osaka Ceramic
Training Centre and underwent various
training under international experts in the
ceramics field.
DENTAL ASIA JANUARY / FEBRUARY 2023 45

BEHIND THE SCENES
Brilliant, true-to-shade press
results at any time
A zirconia-reinforced lithium disilicate press ceramic system, VITA AMBRIA is
indicated for the production of delicate reconstructions, such as veneers and
inlays/onlays, as well as highly aesthetic, full/partial crowns and three-unit
bridges as Master Dental Technician Stephan Juckel shares more.
Press ceramics made from lithium disilicate
are a real success story and have secured a
permanent place in the dental laboratory.
Dental technicians love the ceramic press
technique because of the variety of aesthetic
possibilities it offers and its clear costeffectiveness.
That’s true in theory; however,
in practice, things do not always go as well as
planned.
All the time and effort put into an anterior
restoration for it to look too grey in the
patient’s mouth. The posterior crown
appears to be too bright, although the
correct shade was selected. Or the
frustration of the generally rather lifeless
appearance of a pressed restoration. Perhaps
you have experienced these or other
difficulties too.
Fig. 1: The wax-up is completed and the muffle system is prepared
One practitioner who no longer wanted to
accept these limitations is Master Dental
Technician Stephan Juckel (Neukirchen-
Vluyn, Germany). Find out how, in VITA
AMBRIA, he found a lithium disilicate press
ceramic that meets his high aesthetic
expectations, and why he says: “I finally feel
at home with the press technique“.
THE ROAD TO SUCCESS IS SELDOM
SMOOTH
Juckel runs a dental laboratory in
Neunkirchen-Vluyn near Moers, Germany. A
likeable and genuine person, he shared that
“detail is very close to his heart”.
Fig. 2: The waxed-up restorations are sprued
Fig. 3: The press ceramic pellets are selected in the
desired translucency and shade.
46 DENTAL ASIA JANUARY / FEBRUARY 2023

BEHIND THE SCENES
Fig. 4: The wax-up is embedded with VITA AMBRIA INVEST
Fig. 5: The selected VITA AMBRIA pellet before heating in the press furnace
Fig. 6: The embedded wax-up is burned out in the furnace
Fig. 7: Finishing of a pressed restoration with a fine rotary instrument
His love of detail is the reason why he
became a dental technician. He loves the
variety that his profession offers, and
always strives for perfection. In his work, he
focuses on patient-specific solutions and
close collaboration with dental surgeons.
He shared: “Our work touches people’s lives!
That makes me happy and satisfied.”
Juckel is a big fan of press ceramic
technology. What in hindsight almost began
with bitterness, has now become a real
stroke of luck: a modern lithium disilicate
press ceramic. Juckel’s initial experiences
with the press technique were with press
ceramics from a variety of manufacturers.
“With our first attempts, we were practically
doing voodoo dances around the furnace,
praying that the objects would press
properly,” he remembered, smiling.
Even the smallest changes in the process
were the difference between success and
failure. This unpredictability was a regular
cause for frustration. Despite an effective
shade system, the aesthetic results were
not always satisfactory. A grey sheen and, in
some cases, a dull appearance — the results
just were not true to life.
The dental technician stuck to the task and
broadened his horizons. He tested more press
ceramics, weighed up different methods,
and compared results. The differences in the
procedure were particularly noticeable.
“Some systems required special laboratory
equipment,” a knock-out criterion for him. “I
want to be able to work with the equipment
I have (e.g., press furnace) and always get
the same good results; easily and without
complication.”
The condition of the surface, the reaction
layer on the pressed object, the accuracy
of the fit, and of course, the photo-optical
properties were all compared.
He shared: “I wanted a brilliant true-to-life
appearance without any greyish hue.”
Eventually, by coincidence, he discovered
VITA AMBRIA lithium disilicate (VITA
Zahnfabrik).
WHY VITA AMBRIA PRESS CERAMIC
OFFERS IMPRESSIVE AESTHETICS
VITA AMBRIA impressed from the very
first press. Juckel shared: “We followed the
working instructions and used our existing
press furnace. The result was perfect. The
pressed restoration surprised with incredible
photo-optics; a result that matched the
marketing brochure. Our first thought
was that this had to be a coincidence. Yet,
all subsequent tests showed equally good
results. Every surface was exactly the way we
wanted it.”
“What was amazing was the almost complete
absence of a reaction layer. All that was
needed was a gentle once-over with glass
polishing beads, that was it. The fit and shade
are excellent. It was love at first sight,” added
Juckel, thrilled.
During the test phase, Juckel completed
several restorations using VITA AMBRIA. It
was soon possible to say — tested and found
to be flawless.
He elaborated: “The results were always
equally good and we decided relatively
DENTAL ASIA JANUARY / FEBRUARY 2023 47

BEHIND THE SCENES
Fig. 8: The restoration made of VITA AMBRIA during the fit check on the model
Fig. 9: The finished restoration made of VITA AMBRIA on the model
Fig. 10: VITA AMBRIA during the individualisation with the veneering ceramic
VITA LUMEX AC
Fig. 11: The shade accurate restoration after individualisation and
characterisation
quickly to introduce VITA AMBRIA to our
laboratory. The switch went smoothly. An
introductory training was offered but was
not necessary. Pressing worked well right
from the start. The results were exemplary
and met all our requirements. After two
and a half months, the press ceramic
had established itself as part of our daily
laboratory routine. Although I am usually
critical in my evaluation of materials, I did
not have anything to complain about. That
might sound odd, but it’s a fact.”
Juckel highlighted that the biggest
challenge for ceramicists is the individual
front tooth, and this is where VITA
AMBRIA shows its strength. He explained
that in these situations, the cut-back
technique is used. For veneering, VITA
LUMEX AC (VITA Zahnfabrik) is also
utilised. The veneering ceramic is adapted
to the press ceramic so that aesthetics are
conveniently created that impress with
their internal play of colours and natural
appearance.
Brightness, translucency, opalescence — it
is all exactly as it should be. Monolithic
restorations made from the VITA AMBRIA
press ceramic can also impress with
exceptional vibrancy. He added: “Pressing,
devesting, polishing, placement and that’s it.”
According to Juckel, most dental surgeons
noticed the change immediately as the new
material has a very natural appearance. As
a master dental technician, Juckel really
appreciates this kind of feedback, which
validates his decision.
VALUABLE LIFE LESSON
For Juckel, the aesthetic appearance of the
ceramic is of primary importance.
“Today, we no longer get upset about
undesirable shade gradients, but benefit with
VITA AMBRIA from brilliant results with a
true-to-life appearance,” he said.
Even without layered ceramic, the result is
restorations with the effect of depth. The
press technique also offers a simple,
efficient application.
“Since working with VITA AMBRIA, I have
more time again for other things,” he said
happily.
The time saved is due to the wellorganised
process, the almost complete
absence of a reaction layer, and the
excellent results directly from the press
furnace.
Juckel is happy to have selected the VITA
press ceramic. It takes courage to begin
with to be open to something new. But the
courageous decision to approach things
differently was a significant step forward.
As a result, the dental technician has not
only discovered a new press ceramic but
also learned a life lesson. He concluded:
“The success gave me the confidence
to dare more often to question familiar
things and to try new approaches.” DA
48 DENTAL ASIA JANUARY / FEBRUARY 2023

IN DEPTH WITH
ACTILINK Reborn:
Enhancing
osseointegration
and hydrophilicity of
dental implant
Even for implants with SLA surface
treatment that maximises biological
compatibility, hydrocarbons in the air cover
60-75% of the total surface area on the
implant surface after one month or more.
This phenomenon is a biological ageing
that hinders osseointegration between the
implant and bone.
Plasmapp, manufacturer and supplier of
solutions for sterilising medical devices and
regenerative activation of dental implants,
raised a fundamental question about the
removal of implant impurities constantly.
They studied plasma technology that can
improve osseointegration performance by
removing hydrocarbons formed in titanium
implants, and has recently launched
ACTILINK Reborn.
ACTILINK Reborn is a plasma regenerative
activator for implant utilising vacuum plasma
to maximise surface treatment performance.
The titanium surface has an electrostatic
negative charge, and after vacuum
plasma surface treatment through Bio-
RAP (Regenerative Activation by Plasma)
technology, the implant surface is changed
to a positive charge, and hydrocarbons and
impurities that deters osseointegration are
removed.
The vacuum plasma generates plasma
energy while strongly sucking air inside
the vacuum tube resulting to enhanced
hydrophilicity, blood wettability, and
increased protein adsorptions that attract
the factors forming the bone.
By having such dramatical
biocompatibility, the stabilisation period
of surgery can be greatly shortened
eventually, and the implant can be
regenerated and reactivated through
plasma treatment within one minute
before implant surgery.
ACTILINK Reborn key points:
• First universal plasma irradiator for any
implant
• Remove hydrocarbons, convert
hydrophobicity to hydrophilicity
• Faster healing and osseointegration
time in three to four weeks
• Excellent blood wettability, it promotes
superb hydrophilicity for increasing
bone to implant contact
• Increase initial fixation strength and
success rate
• More than three days surface retention,
with vacuum plasma surface treatment
technology
• Visible and reliable vacuum plasma
treatment process
• No occurrence of ozone and harmless
to the human body DA
DENTAL ASIA JANUARY / FEBRUARY 2023 49

IN DEPTH WITH
How Osteopore
technology is
used in oral and
maxillofacial
surgery
By Dr Nattharee Chanchareonsook and Dr Aileen Padilla
Tissue engineering is playing an increasingly
major role in reconstructive, cosmetic
and plastic surgeries for patients suffering
head, neck, facial and oral trauma, cancer,
congenital defects and even common oral
problems. These surgeries can be lifechanging
for people of all ages, and at
Osteopore, we are passionate about helping
patients recover in the best way available
to them. Our two decades of expertise in
bone regeneration means we can harness
our technological capabilities to assist. Our
products have been used successfully in
oral and maxillofacial surgeries — including
orbital floor reconstruction procedures and
mandibular bone reconstructions.
benign pathologies (e.g., cysts and tumours
of the jaws); oral cancer/head and neck
cancer; obstructive sleep apnoea; salivary
gland disease; and temporomandibular joint
disorders (TMD).
Within the scope of treatment, bone
reconstructive treatment in OMF surgery is
one of the most important fields. In complex
cases, defects of the jaw following tumour
resection or trauma may require bone
grafting all the way to microvascular free
flap surgery. In smaller defects, i.e., bone
reconstruction at dentoalveolar region,
autografts or alternatively bone substitutes
can be selected to graft at defect sites.
The type of graft used will depend on
factors including, but not limited to, the
type of surgery being performed, age,
medical history, and bone quantity/
quality 1 . Autografts are still considered
the gold standard due to the essential
combination of osteogenic, osteoinductive,
and osteoconductive properties. However,
autografts have some disadvantages on
donor site morbidity and limited amount of
graft tissue. In some cases, bone substitutes
such as allografts, xenografts, and alloplastics
are used as alternatives for autologous
bone grafts, but these bone substitutes lack
osteogenic, osteoinductive, and angiogenic
potential 2 .
OSTEOPORE TECHNOLOGY
Oral and maxillofacial surgery (OMF) is a
surgical specialty covering the diagnosis and
treatment of diseases, injuries and defects
involving both the functional and aesthetic
aspects of the oral cavity, jaw, face, and neck
regions. Training in medicine and dentistry
enables OMF surgeons to treat conditions
requiring expertise in both fields. These
include: common oral surgical problems
(e.g., impacted teeth, dental implants);
facial injuries/trauma/infection; jaw and
congenital facial disproportion; congenital
facial deformities including cleft lip-cleft
palate; oral and maxillofacial pathology;
Honeycomb microstructure of Osteopore’s implant (a) top view (b) side view
50 DENTAL ASIA JANUARY / FEBRUARY 2023

IN DEPTH WITH
Tissue engineering evolved from the field of
biomaterials development and refers to the
practice of combining scaffolds, cells and
biologically active molecules into functional
tissues. The goal is to assemble functional
constructs that restore, maintain or improve
damaged tissues or whole organs 3 . In the
past decade, tissue engineering has become
a highly active field to develop products and
devices with all the required components
and following all principles of regenerative
medicine. This regenerated bone can be
used in small or large defects, in maxillary
cleft repair, maxillary and mandibular
ridge augmentation, and maxillary sinus
augmentation 4 .
The potential of our technology lies in the
application of bone in situ tissue engineering,
which improves on many of the limitations
of conventional reconstructive practices.
The technology harnesses the body’s
regenerative capacity to rebuild lost tissues,
by leveraging on the natural healing process
to guide the functional restoration of tissues
at the defect site. Surgeons and dentists
can reduce treatment time as they are not
required to extensively manipulate/culture
cells and material outside of the body, unlike
in-vitro tissue engineering.
Osteopore has technology to produce
3D polycaprolactone (PCL) bioresorbable
scaffolds which are biocompatible, proven
and non-toxic. There are no animal tissue
concerns such as disease transmission or
cross reaction. Bone remodelling takes place
before complete degradation between 18
to 24 months. The scaffold is engineered
and designed with a lattice structure
constructed from interconnected triangles of
regular porous morphology which promote
osteoblast formation within the socket and
help to facilitate natural bone 5 . Satisfactory
bone growth has been recorded with
cranioplasty.
The printing offers a mesh structure
(different thickness), block (different
dimensions) and is an alternative to currently
available patient specific implants (PSI).
Surgeons can select the design to match the
type of defect.
PATIENT SPECIFIC IMPLANT (PSI) FOR
MANDIBULAR RECONSTRUCTION
Surgical reconstruction of mandibular
bone defects is a routine procedure for the
rehabilitation of patients with deformities
caused by trauma, infection or tumour
resection. The Osteopore PSI combined
with biological cells and biological factors
can replace or reduce the volume need of
autologous bone reconstruction. Therefore,
it helps reducing donor site morbidity and
hospitalisation periods. Osteopore’s PSI
performed well for mandible defects with
little or no loss of soft tissue and when
placed in a well vascularised tissue bed. The
adjacent bone fragments can be stripped
off periosteum so that adequate bone to
bone contact is established. In the case of
significant soft tissue loss, the Osteopore
PSI can combine with vascularised bone
flap with the aim of regenerating bone. It
also helps to increase bone volume at the
reconstruction site and enhances bone
regeneration from surrounding blood vessels.
Osteopore PSI technology can assist in
this surgery, being a custom-made 3D
printed bone scaffold made from PCL
using CT scan data. The PSI is designed
alongside advice from the patient’s surgeon
and modelled according to CT scans.
With the Osteopore scaffold structure,
the implant can be safely combined with
biologic (synthetic, autologous i.e., bone
marrow aspirate, cancellous particulate
bone) substances or materials to safely
regrow the patient’s bones. The implant
is bioresorbable, biocompatible, and nontoxic.
The scaffold has an excellent track
record in the reconstruction of craniofacial
and maxillofacial bone defects 6 . The PSI
can be stabilised with reconstruction plates
and screws and gives soft tissue coverage
throughout the healing phase.
In the process of producing PSI, Osteopore
requires two-to-three weeks from the date
of design confirmation until the product’s
delivery to surgeons. The detailed timeline
for PSI products:
• Request for PSI – surgeon fills in PSI
request form and submits CT scan data to
Singapore Osteopore Headquarters (HQ)
• Assessment – HQ determines if case
is accepted/rejected/pending more
information and informs surgeon
• Design – PSI is designed based on CT and
Osteopore bioengineer and surgeon case
discussion
• Approval – HQ finalises design for
surgeon’s approval and indicates details of
pre-surgical planning
• Production of implant – production of
implant with 3D printed bone scaffold
in Singapore Osteopore HQ and quality
check
• Sterilisation – each implant produced is
sterilised with Gamma radiation (EN ISO
11137)
• Deliver to surgeon – PSI delivered to the
requested surgeon
Over the two and a half years, four cases
of mandibular PSI reconstruction have
been successfully implanted for patients
in Australia and Singapore. These cases
involved reconstruction for mandibular in
mandibular hypoplasia, second degrees
hemifacial microsomia, osteoradionecrosis,
recurrent squamous cell carcinoma (SCC)
at retromolar trigone and chin implant.
The mandibular hypoplasia patient case
was included in a case series published
recently and the findings reported no further
inpatient and postoperative complications.
A CT scan at three to four months showed
DENTAL ASIA JANUARY / FEBRUARY 2023 51

IN DEPTH WITH
regenerated bone adjacent to the scaffold.
The patient subsequently has good mouth
opening and improved facial symmetry 7 .
PSI FOR MAXILLARY BONE
RECONSTRUCTION
Apart from mandibular PSI, we believe the
same technology can be applied for maxillary
bone reconstruction and we are looking
forward to working with surgeons who are
interested in this technology.
Osteomesh for bone reconstruction:
Osteomesh is a biocompatible 3D-printed
scaffold implant made from PCL designed
to mimic the microarchitecture of natural
bone. Being semi-flexible, it is easy to handle
and enables sufficient strength to hold
particulate bone grafts without collapsing,
while retaining enough flexibility to be
curved and moulded to the desired shape.
Osteomesh compared to titanium mesh:
Titanium mesh has excellent mechanical
properties compared with other types of
materials. However, it needs a secondary
surgery for removal, and the cut edges
of this mesh sometimes cause mucosal
irritation. This can lead to exposure of the
membrane and possibly infection of the
titanium framework embedded inside the
membrane structure. Osteomesh slowly
resorbs into the body while it concurrently
supports bone in-growth and remodelling.
Since no permanent foreign object remains
in the body, infection rates are low, and the
need for follow-up appointments is reduced.
Osteomesh compared to present
techniques: From a clinical perspective, PCL
has a proven clinical history for maxillofacial
indications, and the interconnected microarchitecture
of Osteomesh facilitates
osteoblast proliferation and infiltration while
enabling bone graft stability and natural bone
regeneration. The Osteomesh predictable
resorption profile avoids the need for an
additional procedure, thus delivering clinical
ease and patient comfort.
Osteomesh has been carefully designed to
speed up procedures due to its semi-flexible
feel and easier cutting (with surgical blade
and surgical scissors) characteristics, which
is essential for the success of the treatment.
It works well with all types of graft materials
including autogenous bone and has an ideal
structure that can maintain its contour and
shape throughout the course of bone healing.
ORBITAL FLOOR RECONSTRUCTION
The aim of orbital floor reconstruction is to
restore the pre-injury shape of the fractured
floor to provide support of the globe
and prevent herniation of the periorbital
structures into the maxillary antrum.
Osteomesh is an integrating implant for
the repair of orbital fractures, leading to a
shift in orbital reconstructive surgery from
purely repairing bony defects to functional
regeneration of damaged tissues. It provides
structural stability throughout fracture
healing and bone remodelling. It is easy to
use as it is mouldable in warm saline and
shaped by surgical scissors 8 .
Osteomesh has more than two years follow
up showing host-implant compatibility
with no infection and migration of implant.
Its biomimetic design structure delivers
predictable bone regeneration while
providing structural support. The resulting
regenerated bone minimises complications,
such as orbit compartment syndrome of
permanent implants as evidenced by a 10-
year clinical series.
A 10-year retrospective review of all patients
who had undergone orbital fracture repair
with Osteomesh in a single tertiary trauma
centre from January 2005 to December 2014,
showed it is safe and clinically effective in
the reconstruction of orbital fractures. The
review supports that Osteomesh is a useful
alternative in the reconstruction of small
to large, simple or complex orbito-cranial
deformities 9 .
OSTEOMESH AND PRE-FORMED
OSTEOMESH FOR MANDIBULAR
RECONSTRUCTION
In a mandibular reconstruction with our
product, an alternative to a 3D PSI is using
Osteomesh as a bioresorbable bone tray.
Surgeons can shape and mould Osteomesh
intra operation to fit the reconstruction site
or can order a custom made pre-formed
Osteomesh (pre-surgical outline/shaped
and moulding base on patient CT scan).
Successful clinical cases resulted from
Osteomesh being combined with particulate
cancellous bone and marrow (PCBM).
Patients have had no signs of complications,
and CT scans are underway in around two
months’ time. Osteomesh is moulded in
warm saline to fit the defect area and formed
as a tray wherein autogenous bone is well
packed inside with other biologics. It can be
secured with screws and plates, if required.
It is also compatible with permanent and
bioresorbable fixation systems 10 .
REPLACEMENTS OF BONE WINDOW
Maxillary sinus floor augmentation
also termed sinus lift, sinus graft, sinus
augmentation or sinus procedure is a
surgical procedure which aims to increase
the amount of bone in the posterior maxilla
by lifting the Schneiderian membrane
and placing a bone graft 11 . Post sinus
augmentation, the buccal bone window can
be covered by Osteomesh and secured with a
self-drilling screw before soft tissue closure 12 .
Similar procedures were applied to close
the buccal after large cystic enucleation.
The surgeon used Osteomesh to cover
52 DENTAL ASIA JANUARY / FEBRUARY 2023

IN DEPTH WITH
the top of the bone defect without filling
materials to prevent soft tissue in growth
in the cystic cavity and to allow proper
contour of bone healing. Mesh was cut into
shape and moulded to fit the anatomical
contour of bone with warm saline. With
periosteal vertical mattress sutures, the
mesh was maintained in a stable position.
Primary wound closure was performed using
interrupted sutures.
ALVEOLAR CLEFT SURGERY
Alveolar bone grafting involves alveolar
bone repair and closing of oro-nasal fistula
at the cleft site at the area of premaxilla
where there is discontinuation of alveolar
process and defect nasal base. The usual age
for alveolar bone grafting is between seven
and nine years old, before the eruption of
the anterior teeth at cleft site. Late repair
surgeries are possible in adult cleft cases
that missed surgery at younger ages. Alveolar
cleft reconstruction has historically relied on
autologous iliac crest bone grafting (ICBG);
however, the risk of donor site morbidity,
pain, and prolonged hospitalisation has
prompted the search for alternative bone
grafts.
Earlier this year, surgeons adapted the use
of Osteomesh with the combination of
autologous bone for first use in alveolar cleft
cases. The alternate layered between our
product and autogenous bone technique
was used to enhance biologic bone cells
and healing factors from autogenous bone.
The honeycomb structures of Osteopore’s
product enhanced permeability blood
and bone factors which could stimulate
cells to produce mineralised extracellular
matrix (ECM). Surgeons ensured tight
packing at the grafted site for future bone
regeneration. According to surgeons, the
Osteopore product helped lessen the
amount of bone harvesting from the iliac
crest, hence the patients easily recovered.
The wound healing was reportedly
excellent. We are in the midst of reviewing
quality and quantity bone regeneration
from the upcoming CT-cone beam scan.
In future work, we aim to use Osteopore
products in combination with aspirated
bone marrow or other growth factors to
further avoid autologous bone harvesting
to establish a new chapter for cleft bone
regeneration.
OSTEOPORE PRODUCTS FOR
ORTHOGNATHIC SURGERY
Orthognathic surgery involves a spectrum
of surgical procedures on the upper jaw,
lower jaw and chin, to improve both form
and function. The Le Fort I osteotomy of
the maxilla is one of the core procedures in
orthognathic surgery for the management
of facial skeletal deformities13. Le Fort
I enables realignment of the maxilla
with the facial midline, correction of
the cant, and allows for advancement,
set back, increasing or decreasing the
vertical position. If large gaps are created
between the upper and lower part of
the maxillary bone in large inferior or
horizontal movements, bone grafts should
be considered to provide for more stable
movement 14 .
Osteostrip is an integrating implant used to
restore the gaps by promoting bone tissue
ingrowth. It was reportedly user friendly
for craniotomy cases. In OMF, Osteostrip
is an excellent alternative choice of using
autologous bone (i.e., facial bones, cranial
grafts, or from the iliac crest) on those gaps
between the upper and lower part of the
maxillary bone after Le Fort I Osteotomy. It
gives a perfect fit wherein the flanges are in
great position for screw fixation. DA
REFERENCES:
1.
https://www.medtronic.com/us-en/patients/
treatments-therapies/bone-grafting-dental/
bone-graft-options/o
2.
J. S. Vorrasi and A. Kolokythas, “Controversies
in traditional oral and maxillofacial
reconstruction,” Oral and Maxillofacial Surgery
Clinics of North America, vol. 29, no. 4, pp.
401–413, 2017.
G. Fernandez de Grado, L. Keller, Y. Idoux-Gillet
et al., “Bone substitutes: a review of their
characteristics, clinical use, and perspectives
for large bone defects management,” Journal of
Tissue Engineering, vol. 9, 18 pages, 2018.
Vivian Wu, Marco N. Helder, Nathalie Bravenboer,
Christiaan M. ten Bruggenkate, Jianfeng
Jin, Jenneke Klein-Nulend, Engelbert A. J.
M. Schulten, “Bone Tissue Regeneration in
the Oral and Maxillofacial Region: A Review
on the Application of Stem Cells and New
Strategies to Improve Vascularization”,
Stem Cells International, vol. 2019, Article
ID 6279721, 15 pages, 2019. https://doi.
org/10.1155/2019/6279721
3.
https://www.nibib.nih.gov/science-education/
science-topics/tissue-engineering-andregenerative-medicine
4.
Rai R, Raval R, Khandeparker RV, Chidrawar SK,
Khan AA, Ganpat MS. Tissue Engineering: Step
Ahead in Maxillofacial Reconstruction. J Int Oral
Health. 2015;7(9):138-142.
5.
Dental Osteoplug brochure, https://www.
osteopore.com/sites/default/files/supportdocs/Dental%20Osteoplug%20Brochure%20
%28Feb%202022%29%20v2.pdf
6.
Schuckert KH, Jopp S, Teoh SH. Mandibular
defect reconstruction using three-dimensional
polycaprolactone scaffold in combination
with platelet-rich plasma and recombinant
human bone morphogenetic protein-2: de novo
synthesis of bone in a single case. Tissue Eng
Part A. 2009 Mar;15(3):493-9. doi: 10.1089/ten.
tea.2008.0033. PMID: 18767969.
7.
Regenerative matching axial vascularisation
of absorbable 3D-printed scaffold for large
bone defects: A first in human series George
Castrisos, MBBSa , Isabel Gonzalez Matheus,
MBBSa,b,d,j,∗, David Sparks, MBBSa,c,d, Martin
Lowe, MBBS, FRACS, FAOrthoAe, Nicola Ward,
MBBS FRACS FAOrthoAe, Marjoree Sehu, MBBS,
FRACP, FRCPAd,f , Marie-Luise Wille, MSc, PhDg,i
, Yun Phua, MD, FRACS (Plast)h, Flavia Medeiros
Savi, BBSc, PhDh,i , Dietmar Hutmacher, PhDg,i ,
Michael Wagels, MBBS, FRACS (Plast)a,b,d,h,
8.
Osteopore Orbital Floor Repair Brochure
9.
Use of bioresorbable implants for orbital
fracturereconstruction Stephanie M
Young,1Gangadhara Sundar,1Thiam-
Chye Lim,2Stephanie S Lang,3George
Thomas,4Shantha Amrith1
10.
Osteopore PSI Brochure
11.
Boyne, PJ. De novo bone induction by
recombinant human bone morphogenetic
protein-2 (rhBMP-2) in maxillary sinus
floor augmentation. J Oral Maxillofac Surg
2005;63:1693-1707
12.
“Sinus Lift Surgery - Sinus Augmentation |
Colgate”. www.colgate.com. Archived from the
original on 2015-07-01
13.
Buchanan EP, Hyman CH. LeFort I Osteotomy.
Semin Plast Surg. 2013;27(3):149-154.
doi:10.1055/s-0033-13571
14.
Buchanan EP, Hyman CH. LeFort I Osteotomy.
Semin Plast Surg. 2013;27(3):149-154.
doi:10.1055/s-0033-1357112
DENTAL ASIA JANUARY / FEBRUARY 2023 53

PRODUCT HIGHLIGHTS
Axis Dental
Effective, risk-free teeth whitening
Axis Dental, a Swiss developer and
manufacturer of dental products,
has introduced flexible solutions
for tooth whitening treatment that
adjust to the patient’s lifestyle and
the workflow of dental clinics.
Now available in Singapore and
South East Asia, the PURE whitening
system provides a long lasting
whiter and brighter smile. PURE
whitening system separates the
active ingredient from the sensitivity
solution to obtain a more effective
bleaching solution.
Each treatment includes a
PURE Care syringe that reduces
sensitivity before, during, and
after the treatment — thanks to
its potassium nitrate and sodium
fluoride composition. Additionally,
its concentration of 30% xylitol,
remineralises and strengthens enamel
and makes colour consistent.
The PURE range of whitening system
features two treatment modalities —
in-office or home bleaching — allowing
patients to choose the option that
best suit their rhythm and routines to
complete the treatment and achieve
the desired results:
Fast use
• PURE Pen with LED lamp makes it
possible to restore a bright shine
to the teeth for only 15 minutes
daily. It is easy to use and
manipulate thanks to its brush
applicator
Home bleaching
• PURE Day: PURE 22% carbamide
peroxide — the ideal formula for
patients wishing to obtain an
optimal result for only 45 minutes
(twice a day) for eight days
• PURE Night: PURE 10% and
16% carbamide peroxide —
suitable even for patients with
sensitive teeth, it can be used
approximately four hours daily for
16 nights
In-office bleaching
• PURE Express: A bright smile
in just one hour — the product
is applied directly on the teeth,
and soft tissues are completely
protected. This procedure is
risk-free and does not affect the
structure of the teeth
The teeth whitening market
continues to grow as aesthetics and
self-image are more important than
ever in society. PURE is committed
to working with professionals only
and offers various qualitative, safe
and reliable solutions for all types of
teeth and shades. DA
54 DENTAL ASIA JANUARY / FEBRUARY 2023

PRODUCT HIGHLIGHTS
DOF
Instantly convert patient’s face into
3D data
One for
All Ceramics
and More
FREEDOM F Face Scanner from DOF aligns the patient’s face
and teeth data to reproduce the exact location automatically.
Simple operation is all it requires to extract highly accurate
3D face data within just 10 seconds.
Users can get all the information they need for treatment by
utilising the face data obtained from FREEDOM F such the FH
plane, Camper’s plane, eye line, lip line, and midline.
In addition, FREEDOM F Face Scanner dramatically reduce
the probability of remake. In particular, it significantly
decreases the remake probability when complicated
cases such as anterior prosthetic appliances or full mouth
restoration of upper and lower edentulous are involved.
This small device is combined with tablet PC to scan the face
of the patient quickly, and features a virtual facebow.
Dr Roman Nestor, dentist from Ukraine, shared: “The modern
dental clinics’ trend is all about the ‘digital solution’, but there
was no device suitable for reproducing temporomandibular
joint movements in a virtual space. Since I earned a PhD in
gnathology, I’m well aware of the limitation of a virtual nonadjustable
articulator. Fortunately, we were able to overcome
such limitation by using DOF’s FREEDOM F. It greatly
contributes to my digital work process and is an amazing
product that contributes to providing a quality treatment
to my patients. FREEDOM F is a micro scanner having a
weight of 70g and a length of 16cm and since it is used in
combination with a tablet PC, it is possible to scan a patient
sitting on a chair.” DA
VITA LUMEX® AC
• For all frameworks
made out of ceramic and titanium
• For all techniques
from micro veneering to refractory veneers
• For all precise effects
stable in layering and firing
Find out more here:
www.vita-zahnfabrik.com/LUMEX_AC
DENTAL ASIA JANUARY / FEBRUARY 2023 55
3610E_LUMEX Anzeige_95x250_V01.indd 1 27.10.2022 16:14:32

PRODUCT HIGHLIGHTS
Orascoptic
Wide field, high resolution: Achieve the best of both
Designed for an ideal symmetry between
style and performance, the lightweight
magnesium bezel adds an aesthetically
pleasing style to this medical device.
The optical systems from Orascoptic are
made with Grade A fine annealed glass
lenses fused with anti-scratch and antireflective
coatings, and all carrier lenses
are made with high index polycarbonate
material.
Developed to assist healthcare professionals
view an operating site from multiple
perspectives, EyeZoom conforms to fit
the custom preference of each individual.
Whether for an endodontist performing
a procedure at 5x, or a cosmetic dentist
applying a veneer at 3x, the loupe maintains
a consistent working distance at each
magnification power level.
Co-engineered by Orascoptic and Konica
Minolta, the patent-pending EyeZoom
technology provides unprecedented edge-toedge
clarity and high-definition resolution.
Orascoptic is constantly pushing the
limits to provide clinicians with the latest
products that achieve superior visualisation
through enhanced ergonomics, improved
magnification and illumination. EyeZoom
is available on Orascoptic’s Legend, Rave,
Rydon, and Victory frames and can be
configured as a through-the-lens (TTL)
loupe. DA
GC Dental
One component light cured universal adhesive
or clinical cases where moisture control is
challenging.
Clinicians can achieve optimal aesthetic
results with a 3µm film thickness with
no post-operative sensitivity. On top of
it, G-Premio BOND boasts immediate
chemical bonding and better visibility
during application.
G-Premio BOND is a one-bottle universal
bonding agent compatible with all etching
modes. It offers the advantages of a universal,
but with a top performance in all situations
thanks to the combination of three functional
monomers (4-MET, MDP, MDTP).
G-Premio BOND can be used for direct
bonding, repair cases and hypersensitivity
treatment, and its universal etching modes
are designed for fast and easy application.
Particularly, its 25 seconds self-etch
application is ideal for paediatric bonding
Ultimately, the silicone cover of G-Premio
BOND was designed to protect the liquid
from the heat transmitted by dentist’s
fingers and to avoid evaporation of the
solvents. It also offers a better control
on the quantity dispensed: it is very easy
to dispense drop by drop, which ensures
reduction of waste, providing a premium
value of up to 300 applications per bottle. DA
56 DENTAL ASIA JANUARY / FEBRUARY 2023

PRODUCT HIGHLIGHTS
Medit
Magic made easy with a simple touch
The Medit i700 Wireless allows clinicians
to scan comfortably at any angle including
the proximal areas without constraints
in movement. It also features a scanning
speed of up to 70FPS, resulting to smooth
and fast scanning performance.
In addition, the Medit i700 Wireless is
compact and light weighing 328g, even
with a battery attached. It is designed
for all-day use, with a battery life of
one hour of continuous scanning, and
up to eight hours in standby mode. Its
intelligent power management function
automatically switches the device to sleep
mode when not in use, and it takes just
seconds to wake the device for scanning.
Medit i700 Wireless boasts powerful
hardware, optimised for convenience:
• Small tip: for easy application to the
posterior region for patients with small
oral cavity
• Reversible tip: no need to twist the
wrist for maxillary scans
• Wider scan area: enlarged scanning
window captures large areas at once
while maintaining the small size of the
scanner head
• Auto calibration: automatic tool makes
calibration a breeze
• Remote control: users can conveniently
check scan data from the scanner itself
and prevent cross-contamination
• Light and weight balanced: for stable,
comfortable use
• UV-C LED disinfection: lower risk of
contamination inside the handpiece
• 60 GHz wireless technology: for highspeed
wireless connection
• Battery: users can scan up to 30 cases
with one battery DA
Busch
Ceramic cutters for acrylics and pre-sintered zirconia
BUSCH has introduced the KERA series, the
cutter innovation made of white ceramic.
The KERA series features the characteristic
properties of the high-performance ceramic
used. The major advantages are that they are
up to 25% lighter than the carbide version,
and that they offer pleasant temperature
characteristics and smooth material surfaces.
The series includes eight different ceramic
cutters in “X” and “GQSR” cut designs. The
five ceramic cutters with the medium double
cut are optimal for processing/shape milling
all conventional dental acrylics, from biteguard
splints, prosthesis bases, and tray
acrylics to orthodontic work.
The three ceramic cutters with their coarse,
swift-cutting GQSR design are optimally
suited for processing soft and non-hardening
acrylics, such as deep drawn mouth guard
trays or non-hardening relinings.
Pre-sintered zirconia can be processed
with both cut designs, from separating,
contouring, to cleaning the points of
attachment and separating pre-sintered
zirconia from the blank.
The ceramic cutters are not suitable for use
on metal. All cutters are labeled on the shank
with the BUSCH logo and product name for
clear identification. DA
K424GQSR 060 and K429X 040
DENTAL ASIA JANUARY / FEBRUARY 2023 57

PRODUCT HIGHLIGHTS
DÜRR DENTAL
Foam-free cleaning concentrate for all types of suction system
Stubborn residues of prophylactic powders
or limescale deposits can lead to defects in
suction system components. Regular use of
MD 555 cleaner special detergent for suction
units prevents performance losses and
lengthen the lifespan of the suction system.
Introduced by DÜRR DENTAL, the MD
555 cleaner special detergent for suction
systems dissolves encrustations of lime
scale, prophy powder or prophylaxis pearl
products. It has highly intensive cleaning
effect against deposits and sludge with
certified material compatibility and is
recommended by leading equipment
manufacturers.
Made from organic and inorganic acids
and foam-free surfactants, MD 555
cleaner special detergent is best used
in combination with Orotol plus. This
coordinated dynamic duo is the ideal
solution for cleaning and disinfecting
suction system gently yet effectively. DA
Formlabs
The new standard for dental 3D printing
The Formlabs dental 3D printing ecosystem
is designed specifically to meet the
strenuous demands of dental professionals.
The versatile, reliable Form 3B+ desktop
3D printer and production-ready Form 3BL
large-format 3D printer take the guesswork
out of dental fabrication so faster
workflows are just a few clicks away.
Form 3B+: Dental and medical 3D printer
optimised for biocompatible materials
Rapidly fabricate accurate, high-quality
dental models, appliances, and prosthetics
with the Form 3B+, an advanced desktop 3D
printer developed for dental professionals.
Users can print a single model in 20
minutes or produce up to 60 models in a
single day.
The Form 3B+ is simple to set up and
maintain with no specialised training
required. Fully validated workflows remove
the need for trial and error, and give users
peace of mind.
Form 3BL: The dependable choice for highvolume
dental production
The Form 3BL is the large format dental 3D
printer that raises the bar for dependable
high-production dental 3D printing.
Designed to work day and night with
minimal intervention, users can print up to
120 models in a day on the Form 3BL with
only two printer interactions.
The Form 3BL is compatible with the
majority of Formlabs’ SLA materials
library, including biocompatible
materials manufactured in Formlabs’
ISO 13485 certified facility. Users can
scale up their production operation
with the Form 3BL and print highquality
dental parts and biocompatible
appliances in bulk. DA
58 DENTAL ASIA JANUARY / FEBRUARY 2023

SHOW PREVIEW
Hundred years of
IDS: Shaping the
dental future
High number of exhibitors confirms the
international leader status of the most
important global dental show.
The International Dental Show (IDS) in
Cologne, Germany, is demonstrating all
of its strengths: At the coming event
from 14 to 18 Mar 2023, almost all of the
relevant key players have confirmed their
participation. The 40th edition of IDS,
which at the same time the celebration
of its 100th birthday, is currently
recording well over 1700 exhibitors as
well as 15 country participations with
over 400 companies represented.
“The global appeal of IDS as the most
important industry platform is the driving
force for both a successful present
and future of the international dental
family. The 100 years of IDS stands for
innovation and constant performance
at the highest level and is thus also a
synonym for the strength of the dental
industry. And together we will position
IDS as the leading international dental
trade fair over the next decades,”
said Mark Stephen Pace, chairman
of the Association of German Dental
Manufacturers (VDDI); and Oliver Frese,
chief operating officer of Koelnmesse, in
a joint statement.
Opening ceremony of IDS 2021 with Mark Stephen Pace, OB Henriette Reker, Dr Gerhard
Seeberger, Prof Christoph Benz, Gerald Böse, Dr Markus Heibach, Oliver Frese, and Lutz
Müller

SHOW PREVIEW
“
The 100 years of IDS stands for innovation
and constant performance at the highest
level and is thus also a synonym for
the strength of the dental industry. And
together we will position IDS as the leading
international dental trade fair over the
next decades.”
Mark Stephen Pace, chairman of VDDI and Oliver Frese, COO of Koelnmesse
Once again, IDS will cover the comprehensive
spectrum of the dental world — from the
dental and dental technology section,
infection protection and maintenance, to
services, information, communication and
organisation systems as well as organisation
tools. An overview of all of the top players
registered to-date as well as the overall
preliminary list of exhibitors of IDS 2023 is
available at IDS Cologne website.
“We are delighted to take part in IDS 2023
and come together with dentists, laboratories
and specialised trade partners from all over
the globe again to engage in a knowledge
exchange and network for a whole week,” said
Walter Petersohn, chief commercial officer of
Dentsply Sirona. “The diversified programme
at our stand aims to support our customers in
offering their patients the best possible dental
treatment. You will be excited to see which
product innovations we are going to introduce
next year.”
“In its capacity as an industry association, VDDI
is indispensable because it assists its members
in dealing with the manifold, current and future
challenges: MDR and regulatory framework
conditions, export support and last, but not
least as organisers of the leading global dental
trade fair, IDS. If VDDI didn’t exist, it would have
to be urgently invented,” said Christoph Weiss,
chief operating officer of BEGO.
“The 100 years of IDS, i.e., 100 years of
world-class dental developments! There is
no better place to present new products
for the first time! We are looking forward to
an international audience of experts,” said
Werner Slapnig, sales director at Erkodent.
“We are looking forward to participating at
IDS next year. Not merely because IDS is
considered to be the leading trade fair of the
worldwide dental industry and because we look
back on a long-term successful partnership,
but also because it offers the perfect platform
for an international exchange. This enables
us to present products and solutions and
engage in a targeted exchange with dentists,
dental technicians and dental hygienists at one
location,” said Norbert Wild, managing director,
Ivoclar Germany.
“It really is a special honour to take part in
IDS again in the anniversary year 2023. Over
the past years we have always been able to
present our innovative technologies from the
professional world and engage in an intensive
exchange with the users at this international
trade fair. We are looking forward to sharing
our company’s latest product developments
and their applications with our customers
and partners at the next IDS,” said Carsten
Barnowski, head of Sales & Marketing DACH,
Kuraray Europe.
“As a founder member of the VDDI, IDS is an
indispensable, significant marketplace that
brings the dental professionals together. IDS
offers our trade, as a family-run business, a
platform where they can groom both national
and international business relationships and
establish new contacts,” said Stefan Kreutzer,
chief operating officer of SPEIKO-Dr Speier
GmbH.
Numerous group stands have also applied
to take part at the jubilee event of IDS
2023. So far, groups from Argentina, Brazil,
Bulgaria, China, Israel, Italy, Japan, Hong
Kong, Korea, Singapore and the US have
registered. IDS 2023 will be staged in Halls
1, 2, 3, 4, 5, 10 and 11 of the Cologne fair
grounds on exhibition space spanning
around 180,000sqm.
The success story of the dental world is
inseparably linked with IDS, because the
leading trade fair is based on a system
of values that makes it unique. The 100
years of IDS stand for the depiction of the
industry in its entirety, for innovations and
market trends, for a consistent and open
comparison of performance in the sense
of the Olympic principle and last, but not
least for a leadership claim as the largest
international industry platform that has
been repeatedly confirmed for decades. DA
DENTAL ASIA JANUARY / FEBRUARY 2023 61

SHOW PREVIEW
AOSC 2023: Anchoring the
present, Aligning for the future
Association of Orthodontists (Singapore)
Congress (AOSC) will return as an in-person
event for the first time since the onset of the
pandemic. Expecting close to 800 attendees,
AOSC 2023 is set to take place at Marina Bay
Sands across three days from 17-19 Feb 2023.
Organised by the Association of Orthodontists
(Singapore), AOSC 2023 will host a total of
17 renowned speakers from the orthodontic
community including keynote speakers Dr
Ute Scheider-Moser, Dr Simon Littlewood, and
Dr Ravindra Nanda. Boasting a well-rounded
conference programme under the conference
theme of Anchoring the Present, Aligning for
the Future, attendees can look forward to an
exciting three-day conference programme
covering a wide variety of essential topics for
the modern orthodontist.
“This year, we are excited to welcome dentists
and orthodontic colleagues from around the
region, back for an in-person AOSC. We will
continue to bring the best AOSC experience
to our attendees, with a robust conference
programme and dedicated orthodontic
exhibition, to equip fellow orthodontists with
the latest innovations, while striving for
clinical excellence,” shared Dr Koo Chieh Shen,
chairperson of AOSC 2023.
The well-established AOSC trade exhibition
will also be returning with a curated number of
companies within the speciality of orthodontics
exhibiting their latest products and services. A
total of 16 exhibiting companies representing
over 95 brands are set to participate in AOSC
2023. Attendees can also look forward to
discovering the latest products and solutions
from leading orthodontic companies including
Clearcorrect, Henry Schein, Invisalign and more.
After a four-year hiatus of physical events,
reconnecting in person is more appreciated
than ever before. The AOSC Gardens by the
Bay Run will return this edition on 18 Feb to
facilitate networking opportunities and elevate
the attendee’s event experience.
The AOSC Scientific Poster Competition will
also make its return with an in-person event
with the vision that continued research is an
important pillar of orthodontics. Featuring
the best in the field of orthodontics, the 2023
Scientific Poster Competition will feature 30
submissions, competing for two awards: best
research project and best case study. DA
Some key highlights of the programme will
include a post-congress day for workshops
and a dedicated half-day programme
focused on obstructive sleep apnoea for the
orthodontist, presented through the lens of
experienced medical and dental speakers
Dr Dawn Teo, Dr Shaun Loh, Dr Lye Kok Weng
and Prof Lee Kee Joon.

EVENTS CALENDAR
2023
JANUARY
19 – 21 SIDC 2023 - The Saudi International
Dental Conference
Riyadh, Saudi Arabia
Venue: KSU Dental College
20 – 21 ITI Congress Switzerland
Engelberg, Switzerland
Venue: Kursaal Engelberg
26 – 28 Barcelona Dental Show 2023
Barcelona, Spain
Venue: Centro de Convenciones Internacional Barcelona
26 – 28 The 35th Annual Congress
of the Egyptian Orthodontic Society
Luxor, Egypt
Venue: Jolie Ville Movenpick Hotel
FEBRUARY
7 – 9 AEEDC Dubai 2023
Dubai, United Arab Emirates
Venue: Dubai World Trade Centre
17 – 19 Association of Orthodontists (Singapore)
Congress 2023
Singapore
Venue: Marina Bay Sands
23 AAOSH 2023 - Hot Topics in Oral Systemic Health
Chicago, IL, US
Venue: Fairmont Hotel Chicago Millenium Park Chicago
23 – 26 Dental South China 2023
Guangzhou, China
Venue: China Import and Export Fair Pazhou Complex
APRIL
20 – 22 ITI Congress Argentina & Uruguay
Buenos Aires, Argentina
Venue: GOLDEN CENTER
21 – 22 ORAL-TECH 2023
Madrid, Spain
Venue: IFEMA - Feria de Madrid
21 – 25 AAO Annual Session 2023 -
American Association of Orthodontists
Chicago, IL, US
Venue: McCormick Place
MAY
4 – 7 IDENTEX 2023 - 18th International Oral and
Dental Health Exhibition
Aksu/Antalya - Turkey
Venue: CANFAŞ Antalya Expo Center
12 – 13 ITI Congress Germany & Austria
Dresden - Germany
Venue: Maritim Hotel & International Congress Center
18 – 20 Expodental Meeting 2023
Rimini, Italy
Fiera di Rimini
25 – 28 IDEX 2023 - International Istanbul Dental
Equipment and Materials Exhibition
Istanbul, Turkey
Venue: Istanbul Expo Center
26 – 27 ITI Congress BeLux
Bruges, Belgium
Venue: Bruges Meeting & Convention Centre
MARCH
14 – 18 International Dental Show 2023 - 40th edition
Cologne, Germany
Venue: Cologne Fair Grounds
24 – 25 BDIA Dental Showcase - London 2023
London - United Kingdom
Venue: ExCeL Exhibition Centre
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 JANUARY / FEBRUARY 2023 63

ADVERTISERS’ INDEX
COMPANY
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3Shape A/S 3
Align Technology Inc. 11
Anthogyr France
IFC
Association of Orthodontists (Singapore)
Congress 2023
1
Carestream Dental 29
COLTENE 15
Dental Asia House Ad 64
Dental South China 2023 59
exocad GmbH 5
FOTONA
IBC
IDS Cologne 2023 9
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64 DENTAL ASIA JANUARY / FEBRUARY 2023