Dental Asia November/December 2023

www.dentalasia.net 

NOVEMBER / DECEMBER 2023 

Under The Spotlight: 

Can AI help a nation prevent 

oral health disease? 

Dental Profile: 

A bright and intelligent 

outlook for digital dentistry 

in Asia-Pacific 

Clinical Feature: 

Digital palate analysis 

to verify the mirror twin 

phenomenon

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CONTENTS 

TRENDS 

11 A growing regional demand for aesthetic dentistry 

UNDER THE SPOTLIGHT 

13 Can AI help a nation prevent oral health disease? 

18 Leading through an oral health crisis 

21 A second artificial yet intelligent opinion 

DENTAL PROFILE 

22 Primed and aligned to make the most of an Asian opportunity 

24 The start of something new 

26 A bright and intelligent outlook for digital dentistry in Asia-Pacific 

CLINICAL FEATURE 

28 3D-printer technique for restoration of second-class cavities in 

molars without conventional septal techniques: Case report 

31 Quadrant Dentistry: Managing structurally compromised root 

canal treated molar tooth using biomimetic principles, fibre 

reinforcement and adhesive treatment 

36 Digital palate analysis to verify the mirror twin phenomenon 

13 

USER REPORT 

39 Taking the first step into digital manufacturing 

41 The IOS price war: Advancements and 

differentiators in today’s intraoral scanners 

43 Rubber dam isolation 

26 

BEHIND THE SCENES 

45 Communicating towards better collaboration 

47 Pressure or vacuum? How to choose the right dental 

thermoforming machine for your practice 

39 

52 

IN DEPTH WITH 

50 The compass for tomorrow’s dental surgery 

52 What does it mean to be of ‘Swiss Quality’? 

54 Updates and upgrades for the VITA VIONIC SOLUTIONS portfolio 

SHOW REVIEW 

62 IDEC 2023 concludes with growth in visitors and exhibitions 

REGULARS 

4 Editor’s Note 

6 Dental Updates 

56 Product Highlights 

63 Events Calendar 

64 Advertisers’ Index

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EDITOR’S NOTE 

Something in the Air 

PABLO SINGAPORE 

PUBLISHER 

William Pang • williampang@pabloasia.com 

The ‘Diffusion of Innovations’ theory seeks to 

explain how, why, and at what rate new ideas and 

technology spread. In this issue, one technology 

that is increasingly evident is AI. 

From digital tools to prediction models, the 

different stakeholders we spoke with along the 

dental supply chain have been quick to use AIbased 

technologies in novel ways to solve unique 

problem statements. 

At a population health level, Dr Wilson Lu and Dr 

Mohammad Shaheryar Furqan from the National 

University Health System in Singapore have 

roped in the help of a supercomputer to train their 

machine learning model SMILE AI, as a preventive 

tool which could enable more care modalities 

like precision dentistry in the future (p.13). For 

Dr Shaun Thompson, CEO and co-founder of 

expatdental, generative AI technology such as 

smile design and visualisation tools are what 

enables his clinic to provide its aesthetic dentistry 

treatment, in what he sees as a growing trend 

across the South East Asia (p.11). 

For dental manufacturers however, the groundwork 

for AI-based tools comes much earlier with 

foresight, planning, and investment into the 

technology’s nascent stages of R&D and testing, 

to present practitioners and patients with such 

solutions when market opportunities arise. 

Raj Pudipeddi, chief product and marketing 

officer, EVP and managing director in Asia- 

Pacific for Align Technology, views AI as an 

opportunity to “streamline” processes and deliver 

“predictable” results, in the company’s 

integrated platform and workflow enhanced 

with AI tools (p.22). Kim Gunwoo, head 

of sales for exocad Asia found himself 

at his first Indonesia Dental Exhibition & 

Conference (IDEC), where his team was eager 

to showcase their AI-powered smile design 

technology among new places and faces. 

“We see many opportunities in these growing 

economies, like Indonesia, and look forward to 

future developments,” Kim said (p.26). 

There is certainly much to keep track of as AIbased 

technologies shape and progress dental 

care and practice. As the technology 

continues to spread, finding its use in a 

various means and methods, my personal 

takeaway is the enthusiasm diffused by Kim 

and the other stakeholders interviewed, in the 

process of developing and spreading these 

new AI-based solutions. 

Scan for digital copy 

of Dental Asia 

James Yau 

Assistant Editor 

LET’S CONNECT! 

@dentalasia 

ASSISTANT EDITOR 

James Yau • james@pabloasia.com 

BUSINESS DEVELOPMENT MANAGER 

Pang YanJun • yanjun@pabloasia.com 

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Cayla Ong • cayla@pabloasia.com 

CIRCULATION MANAGER 

Shu Ai Ling • circulation@pabloasia.com 

MEDIA REPRESENTATIVE 

Jamie Tan • jamietan@pabloasia.com 

PABLO BEIJING 

GENERAL MANAGER 

Ellen Gao • pablobeijing@163.com 

PABLO SHANGHAI 

SENIOR EDITOR 

Daisy Wang • pabloshanghai@163.net 

HEAD OFFICE 

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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 

Dr Alan Kwong Hing

Simplifying the complex challenge 

Case Gallery 

As of today, iTero TM scans have been used in more than 12.6 million restorative case scans, including crown, bridge 

and custom implant cases*. iTero TM 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 by 

Dr Jack Milgate (Australia). 

Full mouth restoration: Removable partial denture and crowns 

Dr Jack Milgate 

Barwon Heads Dental, Australia 

Chief complaint 

Patient complained of unsatisfactory restorations and missing teeth 

Medical history 

The patient was healthy with no relevant medical history. 

Initial examinations and diagnosis 

Complete loss of teeth with respect to region #12, #14, #15, #16, #22, #24 and #25 

Dental caries in #11, #13, #23 

Treatment plan 

New crowns for #13, #11, #21 and #23 and a removable partial denture to replace the missing teeth 

Initial clinical status and treatment outcome 

Before restoration 

After restoration 

Pre-treatment scan 

Prep scan 

Treatment workflow 

• [Initial consultation] 

Consultation and initial examination was completed using iTero TM 

intraoral scanner, followed by a complete oral prophylaxis. 

• [Tooth preparation and temporary restoration] 

Pre-treatment scan was taken to record the upper arch, lower 

arch and bite. Existing crowns were removed, and teeth 

preparation was done on #13, #11, #21 and #23. iTero TM scan was 

taken to fabricate the crowns and partial denture. Temporary 

crowns were placed. 

• [Try-in] 

Temporary restoration were removed to check the fit of the final 

crowns along with wax try-in with denture framework. Temporary 

restorations were placed back. Crowns and denture were sent 

back to the lab to make adjustments. 

• [Final restoration] 

Crowns were cemented on #13, #11, #21 and #23, and denture 

was inserted. 

Try-in image 

Exocad 

Final Removable partial denture 

Conclusion 

• The accuracy and consistency of the iTero TM scanner allowed 

designing the crowns with precision undercuts enabling lab to 

design a denture framework with minimal aesthetic invasion. 

• Pre-treatment scan acted as a guide, enabling the lab to design 

new crowns, resulting in satisfactory restorations. 

• A single restorative scan for all treatment steps including crown 

and denture prevented multiple patient visits. 

View more complex 

restorative cases 

Contact us for 

more information 

*Data on file at Align Technology, as of June 30, 2022. 

© 2023 Align Technology, Inc. Align, iTero, iTero Element, and Invisalign are trademarks of Align Technology, Inc.

DENTAL UPDATES 

Straumann Group 

acquires Chinese 

IOS manufacturer 

AlliedStar 

Manufacturer and supplier of dental 

equipment and solutions Straumann Group 

has signed an agreement to acquire full 

ownership of AlliedStar, an intraoral scanner 

(IOS) manufacturer in China. The acquisition 

is said to enable the group to offer customers 

in China a competitive IOS solution and to 

address additional price-sensitive markets 

and customer segments in the future. 

AlliedStar will continue to serve existing 

channels as the acquisition will be spread 

over several instalments over the next eight 

years. The closing to obtain a controlling 

stake is expected in the coming months, 

where the parties agreed not to disclose the 

financial details. 

“The acquisition will allow us to offer a 

competitive IOS solution in China. We are very 

happy to welcome the AlliedStar team to the 

Straumann Group which is sharing the mindset 

of building entrepreneurial businesses with 

customer centricity in mind,” said Straumann 

Group CEO, Guillaume Daniellot. 

AlliedStar specialises in offering scanning 

and CAD/CAM solutions to dental clinics. The 

company was founded in 2019 by Wang Guijian 

and provides its digital solutions and services to 

(Image: AlliedStar) 

over 90 countries globally. It has a headquarter 

and R&D centre in Shanghai, China, and a 

manufacturing facility in the China Dental Valley. 

“These are very exciting times. Having built 

this system over the last four years, from idea 

to execution with a team that put its heart into 

this, it is more than rewarding to have found 

a strong partner with the same values that 

will help bring our solution to the next level by 

building a digital platform which can ultimately 

be offered to customers,” said Wang. DA 

New home saliva 

test developed 

for gingivitis 

detection 

A new home saliva test which can warn 

consumers about early risks of tooth 

decay from diseases such as gingivitis and 

periodontitis has been developed by engineers 

from the University of Cincinnati (UC). The 

device uses antibodies that react to the 

endotoxins found in the bacteria responsible 

for gingivitis. 

The new device was developed by research 

professor Andrew Steckl from the UC 

College of Engineering and Applied Science 

and UC senior research associate Daewoo 

Han, in collaboration with Sancai Xie, a 

principal scientist at Procter & Gamble Co. 

They described their results in a paper first 

Senior research associate Daewoo Han (left) and 

research professor Andrew Steckl with the new athome 

test for gingivitis (Image: Andrew Higley/UC 

Marketing + Brand) 

published in the Royal Society of Chemistry 

journal Sensors and Diagnostics on 21 Aug. 

According to the paper, the test demonstrates 

an antibody-based sandwich lateral flow 

assay (LFA) assay to detect P. gingivalis 

lipopolysaccharides (LPS), a major biomarker 

for oral health. It adds that detection in human 

saliva was evaluated in combination with 

potato starch and syringe filtering to reduce 

the interference from biomolecules in saliva, 

especially for α-amylase enzymes. The LFA 

immunoassay reactions with saliva samples 

resulted in comparable results to that of waterbased 

samples. 

“It has been quite the challenge to get to the 

point where we can detect this toxin created 

by the bacteria responsible for gingivitis,” said 

Steckl. “There are good reasons to use saliva. It 

is relatively plentiful and easy to obtain through 

noninvasive methods. And saliva has a lot of 

important elements that can act as indicators 

of your health.” 

The device is currently undergoing further 

developments which aims to improve 

assay sensitivity using saliva samples. The 

development of aptamer-based sandwich 

LFA will also be investigated for improved 

flexibility and performance as the sensitivity of 

the antibody-based detection is significantly 

affected by the performance of the conjugate 

antibody. Also, the ability to detect multiple 

LPS molecules related to diseases for more 

accurate diagnostics of patients’ health will 

also be explored. DA 

6 DENTAL ASIA NOVEMBER / DECEMBER 2023


Dentsply Sirona launches 

DS Campus to provide 

online clinical education 

(Image: 

Dentsply 

Sirona) 

American dental equipment manufacturer Dentsply Sirona has 

announced the launch of DS Campus, an online portal which will 

offer educational content on innovative trends and topics in digital 

dentistry. It aims to provide educational opportunities for those 

unable to attend in-person. 

A range of on-demand content and live webinars on topics such as 

implant dentistry, restorative, orthodontics, and digital dentistry is 

available from October of 2023, and will be hosted by Dental Tribune 

International. 

This launch is an expansion of the DS Academy’s 55 education 

centres in 33 countries, which provides almost half a million clinical 

education and training engagements to dental professionals each 

year, in fields from diagnosis and treatment planning to endodontics, 

implants and aligners. 

“Clinical education is paramount for professional development and 

for ensuring the best care for patients. As digitalisation transforms 

workflows and dental practices, Dentsply Sirona wants to ensure 

that learning new skills and techniques, is as convenient as possible, 

and in an engaging way through the DS Campus,” said Erania 

Brackett, senior vice-president of orthodontic aligner solutions & 

customer experience. “The live webinars feature a carefully curated 

lineup of experts who will delve into important topics starting with 

one that is on everyone’s mind: Artificial Intelligence.” 

Dr Michael Parchewsky from Canada spoke at DS Campus on 26 

Oct, through a live webinar on ‘Artificial Intelligence: From Oral 

Health to Systemic Health; How AI Can Help Support Dentistry’. Dr 

Sara Mahmood from Dallas, Texas will follow on 15 Nov discussing 

‘Predictable Results with Clear Aligner Therapy’. 

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by a distinguished expert speaker. Many of the on-demand courses 

and webinars are eligible for Continuing Education (CE) credits in 

certain locales. DA 

Find out more! 

DENTAL ASIA NOVEMBER / DECEMBER 2023 7


Mirco Stiehle and Michael Bickel appointed new CCO and 

CFO for Ivoclar 

Dental device company Ivoclar has announced 

the appointment of Mirco Stiehle to the position 

of CCO high growth markets, and Michael Bickel 

as the new CFO of the Ivoclar Group. 

As of 1 Jan 2024, Stiehle will join the corporate 

management team and assume responsibility 

for the APAC sales organisations in addition to 

the Latin American (LATAM) region where he 

is the head of LATAM. Furthermore, Christian 

Brutzer will focus on the established markets, 

including North America, Europe and Middle 

East, in his new position as CCO mature 

markets. 

“Going forward, we will divide our sales division 

into ‘mature markets’ and ‘high growth markets’ 

to foster closer integration among the sales 

areas and support them more effectively,” said 

Ivoclar Group CEO Markus Heinz, who has been 

at the helm since March. 

Mirco Stiehle (left) and Michael Bickel (right) will join 

Ivoclar’s corporate management team as part of 

their new appointments (Image: Ivoclar) 

Michael Bickel will succeed Franz Berger as of 1 

Dec 2023, who will ensure a smooth transfer of 

responsibilities during a joint transition period. 

With this appointment Berger will leave the 

Ivoclar Group after 12 years of CFO at the end 

of June 2024 to take on new challenges. 

“I would like to thank Frank Berger for his 

significant contributions. Under his tenure 

as CFO, Ivoclar has not only completed 

strategically important acquisitions and 

the implementation of the integrated 

performance management but also established 

and expanded areas such as global tax 

management, treasury, compliance, risk 

management and data and cyber security,” said 

Heinz. “The joint transition period from Franz 

Berger to Michael Bickel ensures continuity for 

Ivoclar in ongoing projects, for example also 

in the challenging regulatory tax and reporting 

projects such as BEPS 2.0.” 

Bickel and Stiehle will complete the existing 

corporate management team, consisting 

of Markus Heinz as CEO, Franz Berger as 

outgoing CFO, Christian Brutzer as CCO with 

new responsibility for mature markets, Patric 

Frank as chief marketing officer, Dr Thomas Hirt 

as chief technology officer and Alexandra H 

Machnik as chief digital officer. DA 

VITA Scientific News app 

launched to give users indepth 

knowledge at a glance 

Dental product manufacturer VITA Zahnfabrik 

has announced the launch of the VITA 

Scientific News app, designed to provide a 

consolidated expertise on the smartphone for 

the entire VITA ecosystem. The app provides 

dental technicians, dentists, and researchers 

with technical publications on the materials 

that are structured according to application 

area, which can be further sorted based on 

research or application queries for specific 

materials with the ‘Features’ function. 

For example, clicking on ‘VITA ENAMIC’ will 

show all studies related to VITA ENAMIC. 

Choosing the ‘Features’ selection followed by 

‘polish’, will show all studies on polishing the 

VITA ENAMIC hybrid ceramic. This setup aims 

to provide research-based applications, as 

well as rapid access to the right sources. In 

addition, the ‘breaking study news’ function 

provides the latest study results. 

Furthermore, the VITA Scientific News app 

contains online learning and case reports 

on individual products with background 

information and valuable tips. The ‘VITA 

Expert Talk’ features demonstrations from 

international experts on how they work with 

VITA materials. A complete range of product 

(Image: VITA 

Zahnfabrik) 

information and instructions for use is 

available in the VITA download centre. 

The VITA Scientific News app is available 

on Android and iOS, and in six languages. 

Users will have the ability to connect directly 

to VITA Zahnfabrik through a hotline, email 

or navigate to company headquarters. 

Researchers will also have open access 

to companies to present their research 

proposals or directly submit a study 

application. DA 



Emirati sovereign wealth 

fund Mubadala invests in 

Osstem Implant 

Emirati state-owned holding company Mubadala Investment 

Company has announced an investment in Korean dental implant 

material manufacturer, Osstem Implant (Osstem), in partnership 

with MBK Partners and Unison Capital. 

Osstem is reportedly the world’s fourth largest dental implant 

material manufacturer, which focuses on the value segment 

in more than 30 international markets. The company has 

manufacturing facilities in Korea and the US, and it provides 

dental materials, digital equipment, and a full range of auxiliary 

services in addition to implants. 

“With the growing prevalence of dental disorders and demand for 

cosmetic dentistry across the globe, access to comprehensive 

dental solutions plays a vital role in improving public health,” said 

head of life sciences at Mubadala Investment Company, Camilla 

Macapili Languille. “We are pleased to partner with MBK Partners 

and Unison Capital to support Osstem in scaling its best-in-class 

dental solutions in the high-growth value segment to better serve 

doctors and patients across the globe.” 

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Osstem also focuses on helping dentists provide their patients 

with total dental treatment solutions. The company trains more 

than 110,000 dentists globally every year through its network of 

120 dedicated training centres. 

Although the size of the investment in Osstem was not disclosed, 

Mubadala Investment Company ranks as one of the UAE’s top 

sovereign wealth funds, with managed assets totaling US$284.4bn 

ranking as high as 13th among global sovereign funds. 

Osstem was delisted from the KOSDAQ market on 14 Aug 

following 16-years on the Korean exchange, after a consortium 

formed by MBK Partners and Unison Capital Korea (UCK) 

announced their plans to buy the remaining 3.92% of shares 

from minority shareholders. The consortium held 96.2% of the 

company’s shares after two earlier public purchases. The market 

capitalisation of Osstem was reported at $2.26bn (2.93tn won) at 

the time of its final trading period. DA 

(Image: 

Mubadala 

and Osstem) 

→ www.mectron.com 



Chamlion partners with GPAINNOVA for joint research and 

development of surface finishing technology 

Dental digital solutions provider Chamlion 

and global surface metal finishing expert 

GPAINNOVA signed a strategic cooperation 

agreement to establish a joint venture in China 

to research, develop, and promote metal dental 

product surface finishing technology. As part 

of the agreement, Chamlion will become 

GPAINNOVA’s exclusive dental strategic partner 

in China. 

According to the companies, the collaboration 

will leverage the technical and resource 

advantages of both companies to provide the 

dental industry with more efficient, reliable, 

and safe digital solutions, driving the digital 

transformation of the dental industry into the 

fast lane. 

GPAINNOVA was established in Barcelona, 

Spain in 2013 and has subsidiaries in the US 

and China. The expert in metal surface finishing 

GPAINNOVA is known for pioneering dry 

(Image: Chamlion) 

electropolishing technology with a worldwide 

patent, which can reach areas that are 

inaccessible by mechanical or manual means. 

It is said to represent a revolutionary solution 

for surface finishing in the dental industry 

because it reportedly enables full automation, 

simplifying the complex multi-step traditional 

process and replacing the labour-intensive 

polishing and grinding stages in traditional 

dental prosthesis manufacturing with a onestep 

polishing solution. 

Chamlion is a Chinese manufacturer founded in 

2017 based in Nanjing, Jiangsu. The company 

has expanded to 27 countries worldwide, with 

over 300 cloud factories producing 100,000 

crowns and 10,000 frameworks daily, serving 

1,500 dental prosthetic factories. 

In the production of dental prostheses, 

polishing is a crucial step that directly affects 

user comfort. Traditional dental prosthesis 

manufacturing relies on manual polishing, 

which is not only reportedly inefficient but 

also has drawbacks such as incomplete 

polishing and the health risks associated with 

the generated dust. High-quality polishing 

heavily depends on skilled technicians, and it 

takes several years to train a mature manual 

technician, incurring high time and labour costs, 

according to the companies. DA 

Ivoclar Group unveils Ivoclar Joy, global 

aid programme for underserviced 

regions 

Dental and medical device company Ivoclar 

has announced that it will operate its own aid 

programme called Ivoclar Joy. The programme 

has been established with the primary goal of 

providing dental care to children and young 

people in underserviced regions worldwide. 

In addition, the programme aims to raise 

awareness about oral health in these groups 

to enhance their potential for a positive and 

successful future. 

The focus of Ivoclar Joy is to provide onlocation 

dental care in the form of preventive 

measures, minor restorative procedures, 

basic fillings and surgical interventions. 

The programme’s main beneficiaries will 

be children and young people across three 

continents dedicated to ensuring that people 

have the best possible oral health and quality 

of life worldwide for a century. The company 

has already set up base stations in Ghana, 

Cambodia and Peru, treating over 2,000 

patients as of June 2023. 

Three portable dental units will allow the 

local teams of professionals to deliver dental 

procedures in all three of the above countries, 

including remote regions. The portable units, 

which have demonstrated their effectiveness in 

international aid projects, are regularly supplied 

with instruments and materials from Ivoclar. 

The programme encompasses additional 

activities such as advancing the skills of 

local dental professionals and delivering oral 

healthcare education at schools, fully covering 

all related expenses. 

(From left to right) Dr Tatiana Repetto-Bauckhage 

(Project Management, Peru), Christian Brutzer, 

CCO (Steering Committee), Dr med Dent Philipp 

Schneider (Project Management, Ghana and 

Cambodia), Markus Heinz, CEO (Steering 

Committee) and Christina Zeller, supervisory board 

member responsible for CSR (Steering Committee) 

(Image: Ivoclar) 

“Going forward, the goal is to involve interested 

Ivoclar employees around the world in the 

years to come and establish our aid program 

in additional locations,” said supervisory board 

member responsible for CSR, Christina Zeller. DA 


TRENDS 

A growing regional 

demand for aesthetic 

dentistry 

Seeing a rise in the popularity 

of dental aesthetics, CEO 

and co-founder Dr Shaun 

Thompson shares his strategy 

for expatdental’s growth, and 

how it plans to bring its Smile 

Transformation programme 

first to Bali, Indonesia, and 

beyond. 

Based in Singapore, expatdental was started in 

2013 with a focus on providing dental care for 

globally-mobile individuals and their families. 

The multi-lingual, international team of expat 

dentists, dental specialists, and dental surgeons 

offers a range of treatments from general 

consultations to dental implants, where it 

leverages its globally-minded approach to keep 

pace with changes in an evolving Asian market. 

“Singapore is like the Monaco of Asia. We 

are seeing a tremendous consolidation from 

neighbouring Asian nations, so servicing that 

demographic, is a big growth sector for us,” said 

CEO and co-founder of expatdental, 

Dr Shaun Thompson. 

Catering to demographic changes such as a 

growing number of expatriates from Mandarinspeaking 

countries over the last decade, gives 

the practice an edge where expatdental has 

grown its team and capabilities to reflect a 

diversity in expertise, experience, and language 

competencies. “This gives us an advantage in 

addressing this future face of the business 

and this growing demographic sector,” said 

Dr Thompson. 

A growing trend that expatdental is eager to 

capitalise on by catering to demand in emerging 

locations across South East Asia is its aesthetic 

dentistry programme that digitally designs and 

delivers new smiles — Smile Transformation. 

“Smile Transformation is my passion project. It 

changes the way a person walks into a room, 

smiles, and interacts. It is a powerful and highimpact 

journey that empowers people to create 

more opportunities in life,” said Dr Thompson. 

The Smile Transformation programme is a 

customisable treatment plan spanning across 

veneers to aligners, following a six-step digital 

process which allows patients to try on their 

new smile in the clinic before committing to a 

design. 

Patients can wear their ‘new smile’ home for a 

night to show their friends and family, removing 

uncertainty from the process and before the 

realisation of their new permanent smiles. 

Based on the digital visualisation of their 

desired smile, the clinic can create a short-term, 

temporary prosthetic that fits over patient’s 

natural teeth, enabling them to give their 

prototype smiles a ‘trial run’. 

The Smile Transformation process uses the 

clinic’s in-house intraoral 3D scanners, 3D 

printers, cone beam computed tomography 

(CBCT) and generative AI for smile design and 

treatment planning. 

The goal is not only to achieve a smile that 

enhances a person’s appearance, but their 

overall oral health as well. Dr Thompson noted 

that as people increasingly embrace a more 

holistic approach to health, aesthetic dentistry 

is becoming a popular treatment. 

“One of the outcomes of the COVID-19 

pandemic has been a reassessment of 

priorities — some of these being a bigger 

focus on wellness and health in general,” said 

Dr Thompson. Obtaining a better smile is one 

of the ways in which people are investing in 

themselves to boost their self-confidence and 

improve their overall oral health. 

Other factors can also be attributed to the 

growth of dental aesthetics, such as better 


TRENDS 

successful proof-of-concept in Singapore, we 

will be entering various new markets with Smile 

Transformation as the hero product,” said 

Dr Thompson. 

This includes potential branches in Malaysia, 

Thailand and Indonesia over the next two to 

five years. 

awareness and access to information online; 

the rise of minimally invasive technologies; 

greater economic prosperity; and improved 

access to dental care. The numbers back this 

with growth reported in the overall health, 

emotional health, and wellness categories. 

A 2021 McKinsey report 1 valued the global 

wellness market at US$1.5tn, with an annual 

growth of 5-10%, buoyed by a rise in evolving 

consumer priorities and rising purchasing 

power. This category of wellness included 

segments such as ‘better health’, ‘better 

fitness’, ‘better nutrition’, ‘better appearance’, 

With more emphasis on health and wellness, expatdental has 

witnessed a growth in demand for dental aesthetic treatments 

‘better sleep’, and ‘better mindfulness’. The 

survey of 7,500 consumers in six countries 

found that volume of consumer spending for 

’better appearance’ ranked second after ‘better 

health’. 

This trend appears to have a significant 

bearing on the dental market, particularly for 

dental aesthetics. An August 2023 report 

from Fortune Business Insights, 2 revealed that 

Asia-Pacific is projected to grow at a CAGR of 

9.2% from now till 2030 and is currently the 

largest region for the global dental market. The 

report attributes some of this growth to the 

high demand for aesthetic dentistry – which 

remains high across all age groups. 

The clinic intends to capitalise 

on the trend by consolidating 

its Singapore locations and 

expanding across emerging 

markets in South East Asia 

TAKING SMILE 

TRANSFORMATION 

REGIONAL 

Dr Thompson shared that 

expatdental intends to 

leverage on the popularity 

of aesthetic dentistry 

treatments by 

consolidating both of 

its current locations in 

Singapore into a single, 

larger flagship clinic at 

Novena Medical Centre 

in January 2024, to lead 

and drive the concurrent 

expansion into the 

region. 

“From the start, our vision 

has always been to have a 

single flagship expatdental 

clinic in every major Asian city, 

starting with South East Asia. With our 

An upcoming clinic in Bali, slated to open 

in Q1 2024, will serve as the first overseas 

replication of their Smile Transformation 

concept in Singapore. This is a timely entry as 

the Indonesian government moves to develop 

the Sanur Special Economic Zone in Bali, which 

seeks to transform the beachfront area into a 

comprehensive tourist destination that focuses 

on health tourism. 

This zone is set to offer comprehensive care 

across a spectrum of healthcare that will cater 

not only to the domestic market — roughly 

2 million of whom currently seek medical 

services abroad annually — but a growing 

international market as well. 

A large segment of this upcoming healthcare 

market will be cosmetic- and aestheticsfocused, 

building on the success of the already 

thriving wellness market in Bali. As it is, Bali 

is a popular destination for both medical and 

cosmetic dentistry, making it a destination of 

choice for expatdental’s first regional arm. 

“It is an exciting time for us and it feels good 

to get back to growth mode coming out of the 

pandemic,” said Dr Thompson. “We have been 

quite fortunate to be in the right place at the 

right time with the right offering and the right 

team; our expansion comes at a time where we 

are able to make the most of growing regional 

opportunities and markets.” DA 

REFERENCES 

1. Callaghan, S., Losch, M., Pione, A., & Teichner, 

W. (2021, April 8). Feeling good: The future of the 

$1.5 Trillion wellness market. McKinsey & Company. 

https://www.mckinsey.com/industries/consumerpackaged-goods/our-insights/feeling-good-thefuture-of-the-1-5-trillion-wellness-market 

2. Fortune Business Insights (2023, August). Asia 

Pacific Dental Market Size, Share & COVID-19 

Impact Analysis, By Type (Dental Consumables and 

Dental Equipment), By End-User (Solo Practices, 

DSO/Group Practices, and Others), and Regional 

Forecast, 2023-2030. Retrieved from https://www. 

fortunebusinessinsights.com/asia-pacific-dentalmarket-107900

Can AI help 

a nation 

prevent 

oral health 

disease? 

(Image: NUHS) 

At the National University Health System (NUHS), a supercomputer has been 

added to the healthcare cluster’s arsenal, where it is currently processing 

and computing data at breakneck speeds to train machine learning models 

(MLMs) to advance healthcare practices for its patients. Dental Asia speaks 

to Dr Wilson Lu and Dr Mohammad Shaheryar Furqan to learn more on 

the supercomputer’s technology, projects, and its potential to prevent dental 

diseases throughout a nation. 

By James Yau 

As one of three national healthcare clusters 

in Singapore, NUHS manages public 

healthcare for approximately one million 

residents in the Western region of the 

country through its network including four 

hospitals, three specialty centres, seven 

polyclinics and more supporting institutions. 

NUHS announced on 17 Aug the launch 

of what is said to be Singapore’s first 

supercomputer devoted to medical research 

— PRESCIENCE — where it aims to bring 

this quality of foreknowledge to its patients 

with AI. 

Fully operation since 31 Jul, PRESCIENCE 

represents a new dawn for healthcare at NUHS 

with several of its initiatives expected to be 

gradually rolled out by the end of 2023 to 

support its staff. 

The ability of AI-based technologies to swiftly 

process and analyse complex data from the 

sector is invaluable. One such AI application 

is NUHS’ own version of a learning language 

model, the NUHS RUSSELL-GPT. It aims to 

boost productivity of healthcare professionals 

and improve patient care, by summarising 

patient case notes and writing referral letters 

for doctors in a few seconds. The RUSSELL- 

GPT also allows NUHS staff to ask questions 

on topics like medical conditions and medical 

protocols, to aid them in their work. 

“The PRESCIENCE supercomputer was 

conceived to provide dedicated highperformance 

computing to process sensitive 

medical data at NUHS. It has enabled 

researchers to train large AI models without 

the overheads of pre-processing medical data, 

and to build more accurate models quickly,” 

said group CTO of NUHS, associate professor 

Ngiam Kee Yuan. “The decision to build this 



DGX A100 based supercomputer was made 

before the advent of large language models 

and has fortuitously made it possible for NUHS 

to fine-tune its own large language model, 

RUSSELL-GPT. In short, the PRESCIENCE 

supercomputer has accelerated the development 

of AI models to support multiple healthcare use 

cases.” 

SMILE (WITH) AI 

The idea to integrate a supercomputer into a 

healthcare research platform started several 

years prior to PRESCIENCE, explained lead data 

scientist at NUHS, Dr Mohammad Shaheryar 

Furqan, when the cluster first realised the 

importance of live electronic medical record 

data for building, testing and deployment of 

AI models. 

The NUHS healthcare cluster built and 

developed the DISCOVERY AI platform in 2018 

for research and AI model training. With the 

addition of PRESCIENCE, the computational 

ability of DISCOVERY AI was enhanced, enabling 

large AI model training to be undertaken. 

The computing and graphical power of 

PRESCIENCE is what enables AI projects for 

dental care that involve training MLMs by 

processing data, and eventually developing 

meaningful tools that assist practitioners. 

(From left): Dr James Lee, assistant group CTO, NUHS; Assoc Prof Ngiam Kee Yuan; Assoc Prof Tan Tin Wee, 

chief executive, National Supercomputing Centre Singapore; Dr Mohammad Shaheryar Furqan; and 

Dr Wilson Lu (Image: NUHS) 

Currently at National University Centre for Oral 

Health (NUCOHS), Singapore, the specialty 

dental centre of NUHS, two projects are in 

testing under SMILE AI. One of which uses 3D 

intraoral scanners (IOS) to capture image data to 

segment individual tooth for processes like teeth 

charting. The 3D teeth charting model generates 

digital representations of the condition of teeth 

and their positions in the mouth, replacing 

manual tooth charting by dentists and 

facilitating enhanced visualisation. Instead of 

waiting for up to a day to get a dental cast done, 

the process for dentists to scan a patient’s teeth 

and collect information to initiate treatments is 

expedited into a matter of minutes. 

The other project uses dental panoramic 

tomogram to identify different severity of gum 

diseases from x-rays of the upper and lower 

jaw. This gum disease prediction model has the 

potential to be implemented on a population 

level so that a patient’s risk of developing gum 

disease can be classified into low, medium, 

or high, and interventions recommended 

accordingly. 

“We want the AI tool to increase work 

productivity and save some of the clinicians’ 

time in the examination process, so that they 

can focus on other important tasks in the 

patient’s care journey like treatment counselling 

and provision,” said director of informatics for 

NUCOHS, Dr Wilson Lu. 

Dr Furqan added: “We are trying to use AI as 

much as possible, and in as many places as 

possible. We are going for hyper automation 

projects to reduce workloads and automate 

tasks that are repetitive. However, when we 

talk about AI in medicine it will always be to 

augment the clinician. It will never replace the 

clinician. The final say will be the clinical person 

involved in the collection of data.” 

Assoc Prof Ngiam and Dr Lu want AI tools 

to increase work productivity of its staff 

(Image: NUHS) 

To date, 400 3D dental scans of anonymised 

patients, from children to adults, have been 

collected to train the AI models. Another 200 

dental panoramic tomograms of anonymised 

patients, the majority with gum problems, 

have also been collected. Based on its 

benchmarking, the current AI model can 

perform 95-98% accurate teeth segmentation. 

To remove biasness from the model, the 

data processed is representative of a given 



demographics so as to not sway results 

towards a particular group. A variety of IOS 

from different companies was also used in 

the data collection so the model is not centred 

on a single user or single company. 

Another training procedure of the models is 

that they are trained in three different phases, 

where the results accuracy is validated by 

an expert clinician. “In every phase several 

dental surgeons were involved in manual 

reannotation and result validation. With all 

these steps, we make sure that we have a 

good final prediction,” said Dr Furqan. 

This ‘iteration process’ would have a 

downstream effect of improving the overall 

care quality throughout the NUHS cluster, 

noted Dr Lu. “It takes around 10 years to train 

a novice clinician to become an expert in 

diagnosing a clinical problem accurately and 

making the most appropriate evidence-based 

recommendation for the patient. With this 

iteration process, we can eventually deploy 

AI-assisted detection and planning tools 

modelled after clinical experts across all 

community dental services. Deploying clinical 

expertise throughout the community dental 

services is something which is currently 

not possible due to limitations in dental 

manpower.” 

“NUCOHS is at a position where we are 

involved in the end-to-end pipeline of patient 

care and dental workforce training. We have 

tertiary specialist centres, primary dental care 

at the polyclinics, and the Faculty of Dentistry 

and School of Oral Health Therapy that oversee 

the training of the future dental workforce. The 

primary care dental physicians and therapists 

are the ones who identify oral diseases at the 

community level. As we transform our dental 

care model in the healthcare service, we will 

need to fine-tune the dental training curriculum 

to keep abreast with developments in the 

industry that has evolved with the increasing 

adoption of digital technology,” he said. 

In the future, Dr Lu added, all data gathered and 

analysed paints a fuller picture of the patient 

which allows for more holistic and customised 

treatment plans. In addition, risk prediction, 

preventive measures, and early disease 

detection will be performed more accurately as 

we leverage on digital tools and platforms to 

promote dental health. 

“In precision dentistry, patient data will be 

analysed regularly through dental imaging 

modalities, wearables and biosensors 

that will monitor for changes in dental and 

oral conditions like tooth wear and saliva 

biomarkers, social behaviours such as 

toothbrushing habits, and lifestyle modifiers 

like diet composition and smoking. Targeted 

measures to modify behaviours and restore 

dental health will be recommended based on 

the presenting data.” 

A PREVENTIVE VISION OF AI IN 

PRIMARY DENTAL CARE 

To reach this vision of AI as a preventive tool 

for population health, Dr Lu highlighted that 

time is still needed for systemic shifts, beyond 

the dental clinic. At the national level, data 

management practices can be further defined 

and harmonised across the industry. 

Dr Furqan highlighted that a major issue 

faced was in collating data from different 

data silos. It took them three years to onboard 

all stakeholders and consolidate what was 

needed. 

“In AI, what we need is a large and good 

quality of data sets. We can always go for the 

synthetic data or open-source data, but it will 

always be very far from what is happening on 

the ground,” he said. “If you compare the dental 

clinical data from the American or European 

patients, we can see significant difference 

when compared to an Asian population.” 

In other words, the American and European 

data sets will perform differently from the 

Asian data sets, and hence cannot be used. 

Furthermore, security protocols in dealing with 

patient data and difficulty in aligning interest 

with commercial solutions necessitated the 

development of in-house solutions. 

Challenges such as institutional internet 

separation places commercial AI solutions out 

of reach. “What will help us in the future is to 

revisit current rules and regulations to make 

it more conducive to use existing commercial 

solutions on patient identifiable data. If 

enterprise need to share the solution with 

hospitals, they need to package their solution 

such that it has no dependencies and can be 

deploy in restricted environments. Currently 

there are very few or even none out there that 

we can conveniently plug into the hospital’s 

network,” said Dr Lu. 

Data management practices and security concerns posed challenges for Dr Furqan and Dr Lu in 

developing SMILE AI

Moreover, companies may not be 

willing to open their APIs to deploy on 

a large setting like NUHS, where even 

then, NUHS would be at the mercy of 

developers restricting or even closing 

off its APIs. “We want to ensure 

that the model that we are training 

is usable even with any third-party 

IOS that is available over the market. 

It is very difficult for us because 

developing AI algorithm is one thing, 

and developing the actual sensor to 

collect this information is another,” 

said Dr Furqan. 

He added: “About 60-70% of the 

work that we [data scientists] do in 

medicine is translational work. We 

need people who can envision big. In 

terms of the SMILE AI programme, 

methodologies we use for doing 

teeth segmentation have been used 

for different applications as well. If 

the clinicians come up with a very 

good problem statement, then we can 

help them to develop good tools that 

require use of latest technology.” 

Despite the barriers that Dr Lu and 

Dr Furqan face in realising the 

cluster’s vision for AI in primary dental 

care, they remain confident in their 

test results, and are looking forward 

to deploying their AI for the wider 

NUHS cluster soon. 

“We have already finished the second 

round of validation and are very 

confident with the results that we are 

getting. There will be a final round 

of validation where we plan to use a 

few more datasets. Before we finally 

deploy it, we can do the clinical trials 

with in-house dentists for a couple of 

months,” said Dr Furqan. 

Ultimately for dental care to progress, it requires the right people with 

the right vision and precise problem statements 

Having onboarded and harmonised its 

institutions onto the Next Generation 

Electronic Medical Records (NGEMR) 

system, Dr Lu said that NUHS is primed 

with an infrastructure to achieve its 

vision of providing dental care that 

emphasise on preventive strategies. 

Existing tools like the hospital’s 

patient app functions like chatbots, 

teledentistry, and other mobile health 

tools further augments its ability to 

utilise digital technology to promote 

dental health in the future population. 

As AI-based technologies continue to 

develop, its implementations manifest 

across different stakeholders in 

different ways. Dr Lu noted that for a 

preventive model of dental care to be 

adopted, it requires economic and social 

definitions of the value of prevention. 

“Currently, dental care for the population 

is limited by the manpower capacity 

and we may see that even with the 

advances in dental care over the 

years, disease trends do not show 

signs of abating. The predominant 

fee-for-service model that sustain our 

healthcare services could at times 

diminish preventive efforts. The value 

of our preventive dental services has 

not been adequately appraised,” said 

Dr Lu. 

“Should we be having a dental care 

model where we are incentivised 

by the disease we prevent and not 

by the disease we treat? If we can 

successfully make you quit smoking 

and prevent you from developing 

lung cancer and other co-morbidities, 

how much should we charge for our 

smoking cessation strategies? If 

dental health promotion efforts allow 

you to maintain a full healthy set of 

teeth till old age, what value do you put 

to that quality of life?” DA 



Leading through an oral 

health crisis 

Flanked by rising costs and 

labour shortages, New Zealand 

is experiencing an oral health 

crisis that has been exacerbated 

by COVID-19 in recent years. 

Fresh off the polls from a general 

election where oral health 

formed major policies on which 

officials campaigned, Dr Amanda 

Johnston, president of the New 

Zealand Dental Association 

(NZDA), speaks to Dental Asia on 

the struggles and hopes for oral 

health in New Zealand. 

By James Yau 

Since assuming her new office at 

the NZDA on 31 Aug, president 

Dr Johnston found herself “surprised” 

by the uptick of national attention for 

oral health in the run up to the recently 

concluded general elections. 

“At that stage, we did not realise that 

oral health was going to make up such 

major parts of some of the party’s 

policies. We were just trying to bring 

oral health to the attention of some 

politicians,” Dr Johnston shared. 

In what is said to be an oral health 

crisis where nearly half of its 

population delay dental treatment for 

reasons such as cost, accessibility, or 

waiting times, Dr Johnston described 

the climate of the oral health in New 

Zealand as being “stretched”. 

“The cost-of-living crisis is affecting 

patients’ ability to seek and pay for 

treatment. Another is workforce 

shortages. At the moment, everybody 

is overworked and under-resourced, 

and the problem we have is our nearest 

neighbours, Australia, is looking a lot 

rosier than it is in New Zealand. It is a 

big incentive for staff to just quit and 

leave New Zealand. We really need to 

keep our experienced and well-trained 

workforce here.” 

Moreover, for the island nation in 

the South-western Pacific with 

over 5.2 million residents, the crisis 

was compounded by the COVID-19 

pandemic, where residents in rural and 

provincial areas felt its impact more 

gravely compared to their counterparts 

in the cities. 

“I think again it is an international 

situation. In New Zealand it was 

exacerbated by our extended lockdowns 

meaning that we could not access as 

much of an international workforce 

as we often could. Also, practices 

were closed so there was a backlog of 

treatment. Two years on, we are sort 

of getting to the end of that, but the 

workforce was affected and there is an 

after-effect of COVID being felt around 

the world,” she added. 

Although the election trail is over, 

regardless of the results, Dr Johnston’s 

mind is still preoccupied with making a 

difference, to achieve a better outcome 

in addressing the oral health crisis 

regardless of political climates: “We 

are keen on driving change. To do so, 

you need to provide a solution to the 



problem, plus you need the political will to 

make it happen.” 

AN ORAL HEALTH CRISIS 

In New Zealand, dental care is fully 

subsidised by the state for all children 

ages 0-18 through the Community Oral 

Health Service and through private 

practices utilising the Combined Dental 

Agreement (CDA). Funding becomes 

private after these ages except for some 

community sections such as special 

needs patients and hospital inpatients 

oral cancer treatments. 

The policy proffered by the NZDA in 

dealing with the crisis since before 

the pandemic and global inflationary 

pressures was to raise the age cutoff for 

state-subsidised dentistry to age 25. 

“Across the board, evidence shows a big 

drop off in accessing treatment after 

age 18. We find that people in the young 

adult age group are not accessing dental 

treatment, not having routine care, and 

is the highest proportion age group that 

requires acute hospital treatment for 

dental disease that could have been 

prevented,” Dr Johnston said. 

She felt that targeting this demographic 

would be effective as it would provide 

early diagnosis and treatment for 

preventable diseases. 

“Through your life, it is hard to change 

your oral health status. People who have 

poor oral health at age 20 are likely to 

have poor oral health at age 50 and at 

age 70 because dental diseases are 

cumulative. If you have made it to age 25 

with a minimal amount of dentistry, you 

have had good preventative programmes 

established and a much better chance of 

maintaining good oral health through the 

rest of your life,” she added. 

In addition to increasing the coverage 

for dental care, being heard and seen 

in the parliament is just as important. 

“Our department has gotten smaller 

and smaller. Now we have one national 

clinical director of oral health who works 

three days a week, who is the oral health 

voice in the Ministry of Health in New 

Zealand,” Dr Johnston said. 

The system of district health boards 

was abolished about a year before as 

the preceding government initiated a 

“complete overhaul” of the health system 

by establishing a co-governance model 

with Health New Zealand and the Māori 

Health Authority. Dr Johnston described 

the current system for oral health as 

being “diluted” through the whole health 

system. 

“At the moment, the current system that 

they have reestablished has oral health 

split into public health, community 

service and surgical service. Within 

the Ministry of Health in the past 10-15 

years, there has been a significant 

decrease in the voice of oral health,” 

Dr Johnston said. “We are really keen 

to try and get a bigger workforce at 

the national government level, and 

to have a better voice and better 

presence in the central government.” 

A recent success in NZDA advocacy 

was the increase in non-recoverable 

payment for patients on benefit from 

NZ$300 to $1,000 per year, under the 

Emergency Dental Needs Grant from 

the Ministry of Social Development. 

However, Dr Johnston stressed that a 

“significant uplift in funding” was first 

needed before more workload can be 

expected to be put on the dental table. 

She was referring to the strain put 

on the operation of dental practices 

by the CDA funding model, which 

many dentists view as a “community 

service”. 

“The CDA is basically a capitation 

system with a minimal fee-for-service 

added on, where the funding is about 

50% of what our private patients pay. 

But because we want to keep patients 

in our practice and keep them healthy, 

most of us in our communities are 

treating patients and expect to barely 

cover the treatment cost. We need 

to have that system revised and the 

funding brought into line,” she said. 

MAKING A CHANGE 

In the NZDA’s fight to resolve the 

crisis, Dr Johnston noted that it 

requires a “combination” of drivers 

beyond legislation, including 

community partners and public 

mindsets, to implement preventative 

strategies that would alleviate 

pressure on the public oral health 

system. 

Dr Johnston believes funding is needed before practitioners can manage an increase in work capacity 

(Image: NZ Herald) 

“It is ideal if you can get good 

preventative strategies that help to 

prevent disease. The cost is limited 

for the government, so they are the 

winners if we can get less disease out 

there. It also has benefits throughout 

every age group, where they can 

be influenced and hopefully helped 

across the board. My personal view is 



prevention strategies should come from 

the government,” Dr Johnston said. 

Water fluoridation was a preventive 

action advocated by the NZDA which 

was recently mandated by the Director 

General of Health in 2022, where 

funding was provided for local district 

councils to flouridate community water 

supplies. 

Areas that the NZDA would like to work 

with other non-government agencies 

on similarly desired health outcomes 

include NZDA’s preventative strategy 

of sugar minimisation throughout the 

society, removing unhealthy food and 

beverage options from public areas, 

anti-smoking and anti-vaping education, 

and only water being served in schools, 

tertiary institutes and all government 

departments. 

Additionally, Dr Johnston highlighted 

education and accessibility as important 

barriers in cases where cost is not a 

factor. Despite the funding provided by 

the CDA, the NZDA found that 30-40% of 

eligible participants still do not attend. 

Dr Johnston noted that as a dental 

association, the right balance was 

needed to help patients, minimise 

disease and offer good prevention 

strategies, while allowing the workforce 

to be well resourced. “You cannot be 

expected to run a practice if it is not 

financially viable. It is really important 

for the association and for the jobs 

that practitioners are doing to get the 

balance right so that our workforce is 

not stretched. The students come out 

with big student loans that need to be 

paid off. We cannot afford to give it 

away,” she said. 

NZDA: FOR THE COMMON GOOD 

Dr Johnston’s resolve in leading 

the NZDA through the crisis was 

unwavering seeing her role as both an 

“honour” and “joy”. 

“We have got a very strong association 

with a membership of about 98% 

of all dentists in New Zealand, and 

are committed to engaging with our 

stakeholders, our workforce and our 

government and partners in New 

Zealand to improve oral healthcare. We 

have a really high standards of ethics, 

clinical ability, and a strong commitment 

to our organisation,” she said. 

“As far as New Zealand culture goes, we 

have our underlying constitution of our 

country, the Treaty of Waitangi which 

underpins all policy in New Zealand 

and the way we get anything done. 

The indigenous people have a special 

place. Unfortunately, statistics show 

that the Māori are underserved in 

health equity. We are working hard to 

kind of establish some way of getting 

equity across the country, specifically 

with Māori as our focus.” 

The association held their first oral 

health summit in August about 

two months before the elections 

where stakeholders from various 

political parties, press, Māori Health 

Association, and Oral Hygiene 

Association, gathered in Wellington 

to discuss policy and public health 

strategies. 

“It was a really great timing and 

we had to take advantage of an 

opportunity. We tried to get as many 

sectors across oral health as we 

possibly could to try and open some 

communication and establish a 

forum to try and get some change,” 

Dr Johnston said. “We are hoping that 

some things come out of it. Nothing 

has changed immediately, but it is a 

good place to start.” 

Despite the challenges faced by the 

NZDA and the New Zealand population 

in the oral health crisis, Dr Johnston 

remained encouraged by the interest 

shown in oral health recently. 

More than 5,000 members of the Association of Salaried Medical Specialists employed 

by Health New Zealand were on a planned strike on 21 Sep from midnight until noon over 

concerns about pay and workload (Image: RNZ/ Delphine Herbert) 

“We do have a really good workforce 

here. At the moment half of the 

population struggle to access dentistry 

when they need it, and the other 

half are receiving good dentistry 

from an ethical and well-trained 

workforce. There are certainly some 

improvements we can make to provide 

care to some parts of the community 

but the system is not completely 

broken. It is just not working for some 

parts of the community,” Dr Johnston 

said. “We are committed to engaging 

with the government to try and get oral 

health brought up to good standards 

so that everybody in our country can 

get the best oral health possible.” DA 



A second artificial yet 

intelligent opinion 

Before committing to 

a dental treatment, 

second opinions 

are sought to 

confirm a diagnosis 

or learn about a 

different treatment 

plan. Through their 

partnership, KELLS 

and The TeleDentists 

are seeking to bring the 

benefits of second opinions 

virtually to the masses, by 

integrating the power of AI 

into a 24/7 telemedicine 

platform. 

“The TeleDentists had spoken 

with several AI companies 

about radiographic readings and 

photographic screenings. KELLS 

had the best service for our needs,” 

said CEO and co-founder of The 

TeleDentists, Dr Kunstadter. 

The Dental Second Opinion 

Programme launched by the 

partnership covers sub-specialties 

such as fillings, root canals, crowns, 

extractions and implants. Through 

The TeleDentists platform, users 

can upload an electronic copy 

of their x-rays from the dentist 

prescribing the procedure, where 

its AI evaluation partner KELLS will 

assess the images. A dentist from 

the platform will then provide a 

written report on the findings with 

treatment recommendations. 

In providing to an easy “noncontact” 

and “virtual” access to 

second opinions on the platform, 

Dr Kunstadter said the deployment 

of AI in this manner is meant to 

(Image: American Dental Association) 

empower patients to “take control” of 

their outcomes. 

“Many people have delayed their dental 

care due to COVID and they are getting 

expensive and extensive treatment 

plans. An arbitrary, AI-assisted opinion 

on treatment can reassure them of the 

care that needs to be given or if they 

should find another provider and ask 

more questions of the one they are 

seeing,” she said. 

For KELLS, partnering with a platform 

like The TeleDentists makes the level of 

care provided more holistic. 

“We are looking to expand our AIpowered 

remote diagnostic care to 

more patients. The TeleDentists is 

a natural partner for us given their 

national presence [in the US] and 

strong connection to the patients. 

Their ability to offer virtual consultation 

also provides a more complete care 

experience on top of AI evaluation,” said 

CEO and co-founder of KELLS, Dr Feng. 

During the COVID-19 

pandemic, many practitioners 

have realised the benefits of 

the modality of teledentistry. It 

is well-adopted for emergency 

visits for its convenience and 

affordability, providing value 

into people’s everyday life 

for routine care according 

to Dr Feng. Furthermore, 

it allows different 

opportunities for virtual care 

such as “virtual screenings, 

preventive education and care 

for patients, and education for 

mid-level providers”, according 

to Dr Kunstadter. 

“With AI’s ability to augment 

clinical expertise and provide more 

personalised care, there are various 

opportunities to level up oral health 

with preventative check-ups, remote 

diagnostics and treatment planning, 

patient education, integrating dental 

into medical care for better population 

health,” said Dr Feng. 

Moreover, now armed with the right 

tools, Dr Kunstadter sees it as the start 

of a seven-year deadline in contributing 

to the WHO’s ‘Global Oral Health Action 

Plan 2023-2030’ mandate to integrate 

oral health into the universal healthcare 

programme by 2030. 

“We look forward to taking our proven 

model and expanding it to provide virtual 

dental care globally,” said Dr Kunstadter. 

The partners also shared that they look 

forward to sharing the initial results 

of its marketing campaign for the 

programme, which it hopes to receive 

by Q4. DA 


Since its inception in 1997, Align Technology 

— a global medical device company known 

for its Invisalign System of clear aligners, 

iTero intraoral scanners, and exocad CAD/ 

CAM software for digital orthodontics and 

restorative dentistry — has helped doctors 

transform the smiles of 16 million patients 

worldwide with the Invisalign System. 

Seeing a huge market opportunity in the 

APAC region with 35,000 active Invisalign 

trained doctors, Align Technology is 

committed to continuous innovation in 

digital orthodontics to enhance the Invisalign 

treatment experience across the Align Digital 

Platform — a proprietary combination of 

software, systems, and services designed to 

provide a seamless experience and workflow 

that integrates and connects all users from 

doctors and labs, to patients and consumers. 

“Align Technology has always been at the 

forefront of digital orthodontics and dentistry, 

setting the bar and leading industry change 

through constantly innovating and bringing 

new and better solutions to doctors and their 

patients,” said Raj Pudipeddi, chief product 

and marketing officer, EVP and managing 

director, Asia-Pacific for Align Technology. 

“With 200 million consumers who can benefit 

from teeth straightening in APAC alone, there 

is indeed an incredible opportunity for us at 

Align Technology.” 

ALIGN IN APAC 

Trends like the rising standards of living, 

increasing brand and quality consciousness, 

and rapidly increasing digital adoption 

by consumers and doctors have all been 

factored into the company’s strategic 

approach and decisions made in the region. 

Primed and 

aligned to 

make the most 

of an Asian 

opportunity 

By James Yau 

New products like the ‘Invisalign Standard’ 

and ‘Invisalign Adult’ in China, and ‘Essentials 

by Invisalign’ in China, India, and Thailand, 

were launched to better serve the expanding 

market and broaden its appeal to more 

consumer segments. 

Based on customer feedback gathered, 

Pudipeddi highlighted that patients’ 

expectations of treatments and services 

have also risen in accordance with 

increasing digital literacy. Patients want 

to be “guaranteed” of outcomes within a 

defined window before choosing to commit 

to a particular brand or treatment method. 

Moreover, patients want to be able to 

visualise the results of their treatment so that 

they know what to expect. 

The Invisalign iTero Outcome Simulator 

Pro available on iTero Element Plus series 

scanners and imaging systems expands 

on this capability, by adding the company’s 

ClinCheck ‘In-Face’ Visualisation tool which 

combines a photo of a patient’s face with 

their 3D treatment simulation, creating a 

personalised view of how their new smile 

could look. “Having a 3D model view of 

the patient’s teeth encourages in-depth 

dialogue between doctors and patients,” 

said Pudipeddi. 

Such digital tools form the Align Digital 

Platform and ultimately its digital workflow, 

which the company sees as the foundation 

which secures Align Technology’s strong 

presence in APAC. 



Furthermore, with the opportunity of 200 million 

consumers in APAC, Pudipeddi drew focus 

to one demographic as a key area for Align 

Technology: “Teens represent the largest portion 

of the 8 million annual orthodontic cases in 

APAC. Hence, looking ahead, one of our key 

focus areas is to support the orthodontic needs 

for teenagers in the APAC region.” 

ONE FULLY INTEGRATED PLATFORM 

According to Pudipeddi, Align Technology has 

invested close to US$200m in technology just in 

the first half of 2023, and over $2bn to date. 

“Over the past few years, we have been building 

AI applications that underpin our products 

and technology innovations,” said Pudipeddi. 

“The Align Digital Platform revolutionises 

digital treatment planning for orthodontics 

and restorative dentistry by providing doctors 

with greater flexibility, real-time treatment plan 

modification capabilities, and digital solutions to 

help grow their practices and deliver exceptional 

patient outcomes and experiences.” 

One such digital tool is Invisalign Virtual 

Care AI. The tool enables patients to stay 

connected with their doctors virtually, receive 

consultations, and have follow-up treatments 

in a timely fashion. The doctor-directed, AIassisted 

remote patient monitoring solution 

connects doctors and their patients to facilitate 

even greater continuity of care and deliver a 

streamlined experience. 

With Invisalign Virtual Care AI integrated in 

the Align Digital Platform, it enables doctors 

to prioritise Invisalign treatment tracking 

exceptions without the need for a separate 

portal and login, or third-party workarounds, by 

creating a single platform for Invisalign doctors 

and their staff through the Invisalign Doctor Site. 

“The Align Digital workflow offers a seamless 

end-to-end experience with dedicated tools 

and capabilities. We enable interested potential 

patients to visualise their transformed smile on 

MyInvisalign app and find experienced doctors 

in their location,” said Pudipeddi. 

“We continue to innovate on the Align Digital 

Platform to help enable our doctors and 

customers to deliver exceptional clinical 

outcomes while improving practice efficiency,” 

Pudipeddi added. 

The Align Digital Platform, Align’s integrated suite of unique, proprietary technologies and services 

delivered as a seamless, end-to-end solution for patients and consumers, orthodontists and GP dentists, 

and lab/partners 

But building this workflow of integrated AI 

tools comes at the cost of capital and more 

importantly, a keen intuition of asking the right 

questions to keep pace with the innovation of 

such tools. 

“Manufacturing companies need to consider 

how cutting-edge technologies can help 

doctors deliver exceptional clinical outcomes, 

practice efficiency, growth, and superb patient 

experience simultaneously,” said Pudipeddi. 

“The opportunity with AI is to streamline and 

therefore make processes more efficient while 

enabling doctors to elevate patient experiences 

and deliver predictable results.” 

With the vision of AI in elevating patient 

experiences, Pudipeddi highlighted more 

innovations launched by the company recently 

such as the Invisalign Personalised Plan (IPP) 

which automatically applies a doctor’s specific 

treatment preferences for comprehensive 

cases, ClinCheck Live Update for 3D controls 

which enables real-time treatment plan 

modifications, and the integration of cone 

beam computed tomography (CBCT) into 

treatment plans. 

Seeing the APAC region as the forefront of 

digital innovation, Align Technology’s longterm 

buildup of its Digital Platform places 

the company ripely to reap the opportunity 

presented. “With the recent digital innovations 

launched at Align, the Align Digital Platform 

offers a seamless and integrated digital 

solution to doctors and patients. It represents a 

multi-year journey to improve practice efficiency 

and growth for our doctors, improving quality 

and consistency of treatment planning to 

deliver exceptional clinical outcomes and at 

the same time enable great patient experience. 

I believe that Align is very well-positioned to 

continue to support the digital orthodontic 

needs in the APAC region as we continue to 

help our doctor customers transform more 

smiles and change more lives.” DA 

With the suite of innovations added to its Digital 

Platform, Align Technology is excited to bring this 

enhanced workflow to practitioners in APAC to help 

transform more smiles


The start of 

something 

new 

Armed with wheels of CAD/CAM machines, its first two employees, and a 

new view, the opening of imes-icore’s new Competence and Service Center 

in Singapore was modest yet assured. James Yau speaks with Joerg Brenn, 

general manager of imes-icore Asia on how the manufacturer is settling in 

for a long stay in the region. 

With over 30 years of experience building teams and offices from 

scratch in new regions across Asia-Pacific for different players in the 

dental manufacturing industry, it comes as little surprise that the new 

general manager for imes-icore Asia, Joerg Brenn, seems at home 

in the corner plot down the end of a corridor of an office tower in 

Woodlands, Singapore. 

“I think in the context of my experience in the dental industry, my 

reputation as well as my network will certainly help to get the new 

imes-icore Competence and Service Center off the ground and for 

imes-icore to move forward in an increasingly competitive market 

environment,” said Brenn. 

Since 31 Aug, the office became the new Competence and Service 

Center for the German manufacturer of CAD/CAM systems and 

represents a new base of operation in what the company guarantees as 

an extended presence in the Asian market. 

Standing with 

the HDB blocks, 

imes-icore’s CAD/ 

CAM machines 

felt right at home 

in its new Asian 

office 

As expected with any recent move to a new home, the new centre 

comes with temporary working areas, boxes of equipment and empty 

spaces for future workstations. Despite his familiarity with such 

sights and tenure in this stage of the process, Brenn is level-headed 

in his role and strategies to contribute to the growth of the CAD/CAM 

manufacturer. 

“Thirty-over years of experience does not mean that I know everything. 

Hence, I am still learning, now in particular the nitty gritty details 

of CAD/CAM technology, and here I am really blessed to be able to 

tap into the knowledge pool of certainly one of the best CAD/CAM 

manufacturers available — imes-icore,” Brenn said. 

Of all the things on his checklists of to-dos, Brenn focus is on showing 

that imes-icore now has a “physical presence” in Asia. 



“Our main priority is to provide confidence 

and trust among our existing and potentially 

new customers. imes-icore was always 

strongly represented by our wonderful 

distribution network. Now we have arrived 

to directly support our dentist and lab 

customers, and also to our distribution 

partners in the region,” said Brenn. 

Responding to the strong demand for 

high-quality CAD/CAM machines in the 

Asian market, the centre was established to 

support its regional customers in covering 

all aspects of the CAD/CAM solutions that 

imes-icore provides, from installation, service 

and maintenance support to the training for 

end users. 

With this lucrative opportunity, Brenn noted the 

dynamic it would create for both manufacturers 

and buyers of CAD/CAM machines. 

“With this increasing demand, more and 

more manufacturers are entering the market. 

Subsequently consumers have more choices, 

which in general is good, but it also means 

that consumers want to make an informed 

and well-founded decision as to which CAD/ 

CAM system serves their needs and which 

system provides the best service,” Brenn said. 

It is in staying attuned to the nuances of the 

market that Brenn sees imes-icore as being 

able to provide value to customers in the region. 

Brenn highlighted that because investment 

into CAD/CAM systems is considered a capital 

investment, customers usually plan their 

purchases in advance. It is here that imes-icore’s 

new centre aims to help dental labs and clinics 

to make a “well-informed decision”. 

“We are also offering decision makers and 

owners the opportunity to see and try our 

various systems before they decide which 

system they may purchase,” Brenn said. “We 

also intend to utilise all available synergies to 

offer systemic and validated digital solutions. 

That includes not only our machines, but 

also milling tools and various materials 

manufactured and provided by another member 

of the imes-icore group, pritidenta, also located 

in Germany.” 

Brenn further detailed how imes-icore’s 

solutions enable its customers to meet their 

objectives. By utilising digital workflows to 

improve its efficiency, dental labs and clinics 

can optimise their revenue streams and create 

an economy of scale for their customers and 

themselves. 

Moreover, this profitability is achieved while 

providing better solutions for patients in terms 

of functionality, comfort, aesthetic appearance 

and accuracy, especially for implant supported 

prosthetic cases. 

“If we can help to achieve these goals for 

our customers, imes-icore will strengthen its 

position in the market beyond the image of 

offering one of the best CAD/CAM systems 

available. We will also be recognised as a 

competent business partner when it comes 

to the commercial aspects of introducing 

and effectively using CAD/CAM technology,” 

Brenn said. 

With a clear plan in place for its Asian 

market, Brenn stood confidently alongside 

his CAD/CAM machines, already planning 

for a larger scale launch with counterparts 

from imes-icore’s European office when 

things kick into full gear in 2024. Moreover, 

Brenn highlighted how imes-icore’s Asian 

presence would fit into the company’s 

overall vision of the service that it wants to 

provide for customers. 

“In general, considering our worldwide 

strategy, we plan to offer our customers a 

24/7 customer service within the various 

time zones around the world. Besides our 

European headquarters in Germany, there 

is already an imes-icore Competence and 

Service Center in the US for North and 

South America, and now we are able to 

cover Asia as well. We strongly believe 

that our customers will appreciate that 

we increase our technical and service 

support.” DA 

Technical service manager Surendran Silvaraju (left) and general manager Joerg Brenn (right) form the 

small but confident imes-icore team in Asia as it settles in for an extended stay


A bright and intelligent 

outlook for digital 

dentistry in Asia-Pacific 

By James Yau 

As digital dentistry continues to grow in 

Asia-Pacific and in its adoption in labs and 

practices in the region, behind the scenes, it 

represents a time of new places and faces for 

its manufacturers. 

Since relocating its Asia headquarters to 

Seoul, South Korea, in June 2022, exocad — an 

Align Technology company and a provider of 

dental CAD/CAM software — represents a 

trend of companies committed to the growth 

of the region by investing in its talent, building 

relationships and opening new offices, as they 

seek to turn these projections into real results. 

Dental Asia caught up with head of sales for 

exocad Asia, Kim Gunwoo, during exocad’s 

debut at the third edition of the Indonesia 

Dental Exhibition & Conference (IDEC), where 

he detailed the technology, developments, and 

optimism that the CAD/CAM provider has in 

store for the APAC market. 

Head of sales for exocad Asia, 

Kim Gunwoo, speaking with 

Dental Asia at IDEC 2023 

“It was the first time that our exocad team had 

a booth at IDEC. We were very excited,” shared 

Kim as the regional APAC team were on-site 

presenting its range of open-platform solutions. 

Their purple booth which was housed under 

the motto ‘Imagine the CADabilities’, aptly 

summarised how exocad envisions itself in the 

APAC region. 

“We see many opportunities in these growing 

economies, like Indonesia, and look forward 

to future developments. We want to continue 

to support this important, tech-savvy market 

with cutting-edge innovations to streamline 

workflows and improve outcomes,” Kim added. 

On display for visitors was the entire exocad 

software package in action — software 

applications for dental labs and practices such 

as the provider’s DentalCAD, ChairsideCAD and 

exoplan. 

“The new software solutions include all the 

hallmarks of exocad software — stability, 

robustness, ease of use and an open 

architecture that allows seamless workflows 

and smooth integrations with users’ hardware 

of choice. At exocad, we believe in always 

striving for more. That is why we keep 

expanding and improving our technology, 

increasing our network of strategic partners 

and resellers, and regularly releasing new 

software versions with exciting features and 

improvements,” said Kim. 

In exocad’s value proposition to the region, 

all its software applications would blend 

seamlessly together and can be expanded 

with additional modules, to provide a 



singular platform for digital dentistry solutions. 

Visitors at IDEC sampled this value as the new 

PartialCAD 3.1 Rijeka release from 31 Aug, 

exocad’s latest software for removable partial 

dentures, was on display. 

“Our ultimate goal is to help labs and clinics 

improve productivity while offering robust 

education possibilities through our exoBlog 

interviews, webinars, and new release highlight 

videos. That way customers get the most out of 

our software solutions,” Kim added. 

For exocad, striving to bring more for its customers means improving its technology, like the new 

PartialCAD 3.1 Rijeka release on 31 Aug 

Visitors to exocad’s first booth at IDEC highlights 

an increasing demand for digital dentistry in APAC 

markets 

In keeping up with the newest technologies, 

Kim was particularly invested and optimistic 

over one that company is eager to bring to its 

APAC and South East Asian customers — 

AI-powered smile design technology. 

“I think AI and cloud-based technology 

will have an influence on the market for 

CAD/CAM technology. We will continue to 

see developments for tools to support easy 

and fast workflows, increased productivity, 

patient engagement and improved 

outcomes,” said Kim. “Many people have 

been talking about AI for a long time now, and 

it is appearing much more in dentistry. We 

have been using AI technology for our Smile 

Creator tool for a few years to automatically 

detect some facial features of the patient.” 

During the International Dental Show (IDS) 

at Cologne, Germany in March 2023, exocad 

showed a sneak peek of the future in patient 

communication, with a new AI-enabled 3D face 

scan app via mobile phone and the TruSmile 

Video. 

The newly developed 3D face scan app enables 

realistic 3D scans of patients’ faces via a 

mobile phone camera, without any additional 

hardware. The camera is used to scan each 

patient’s face in the app, and the AI-based 

software calculates a detailed 3D model, which 

is then loaded into the Smile Creator software. 

This makes 3D face scanning an affordable 

and accessible alternative to using photos for 

smile design. 

With TruSmile Video, a new anterior tooth 

design is presented in a short video that shows 

the face of a patient who is speaking and 

smiling. From this video and the Smile Creator 

At IDS 2023, exocad showcased its AI technology 

where potential video mockups of treatment 

outcomes could be generated only using a mobile 

phone app and camera 

design, AI technology generates a realistic 

video to help increase patient understanding 

of potential treatment outcomes. According 

to Kim, visitors at IDS were “captivated” by the 

realism of the AI patient videos and the new 

possibilities it offers. 

However, for these new releases to be wellreceived 

and adopted by the market, Kim 

pointed out the importance of consulting 

stakeholders to ensure that these 

improvements are made in tandem. “We always 

develop our new releases in conversation with 

our customers. We collect input from our users 

and put that into action with our software 

development team,” said Kim. 

Since moving its Asia headquarters to Seoul, 

the company has put a concerted effort 

into hiring more regional experts to provide 

professional service to its users and increased 

its outreach in ASEAN countries. Operational 

aspects like workflow improvements in the 

collaboration between laboratories and clinics 

are further areas of focus for exocad in APAC. 

With its excitement, ambition, and upcoming 

developments at its global CAD/CAM event 

in Spain, Insights 2024, the outlook for digital 

dentistry in Asia-Pacific is one that is bright and 

possibly more intelligent, as the CAD/CAM 

provider settles into a new chapter in APAC 

from its base in Seoul, making its journey 

around the region in search of new partners 

and opportunities. DA 



3D-printer technique for 

restoration of secondclass 

cavities in molars 

without conventional septal 

techniques: Case report 

By Dr Nokame Yoshinori 

The use of a septum is conventionally 

required for the restoration of secondclass 

cavities in molars. 

However, a problem with the septal 

technique is the difficulty in obtaining 

a perfect fit at the microscopic level. If 

there is even a small gap, the restoration 

will leak and harden, creating a bur 

that is difficult to correct. Although it is 

possible to create a single abutment, it is 

difficult to create an abutment consisting 

of multiple abutments like a natural 

tooth. 

Especially in the case of maxillary first 

premolars, the second-class cavity on the 

proximal side is difficult to create. 

The reason is that maxillary first 

premolars are narrowed proximally 

down to the root of the tooth, 

which often cause concavity at the 

base of the fossa, making it difficult 

to fit a septal wall. The crowns 

often have two abutments on the 

proximal adjacent surfaces. This 

has a functional meaning in that 

the buccal marginal ridge is aligned 

with the smaller cuspid to form an 

aesthetic and easy-to-clean drumshaped 

void. 

Therefore, to restore the proximal 

second-level socket of the maxillary 

first premolar to its original natural 

tooth form with composite resin, new 

restorative methods other than septal 

technique are needed. 

CASE REPORT 

A patient presented with a large 

depression developed at the margin 

of the proximal fossa base, after the 

removal of a large caries from an old 

restoration at the first molar (Figs. 

1 and 2). If the septal technique was 

applied to this cavity, it would be 

very difficult to place the matrix band 

perfectly and without gaps, and it 

would not be possible to create a twotruncated 

form. 

Fig. 1: The preoperative condition of the patient. The previous 

doctor might have given up on making contacts, and there was an 

open space between the teeth 

Fig. 2: The old restoration and caries were removed, and the tooth 

was partially demineralised and covered with mineral trioxide 

aggregate (MTA) cement. The proximal fossa base was concave, 

making it very difficult to achieve septal conformity 



Using a 3D-printer technique, the treatment focused on 

the fact that high-flow resin initiates a curing reaction 

under the strong illumination of a microscope. The 

technique devised can be used in the mouth using a 

material injection method. 

First, a septum was placed and filled only the buccal 

contact area (Figs. 3 and 4). Next, the septum was removed, 

and an ivory separator was placed to create an interdental 

separation (Figs. 5 and 6). Once sufficient separation 

was achieved and space was available to manipulate the 

syringe, the 3D-printer technique was initiated. 

After the anatomy of the tooth was understood, its outline 

was followed to pour the high-flow resin. The high-flow 

resin began to harden immediately after it had blended 

with the surrounding area and stopped moving (Figs. 7 and 

8). It was stacked in the same way that a 3D printer could 

Fig. 3: With bulkheads in place, the matrix band had a large curve of 

one abutment. Flow resin was poured over this, resulting in a poorly 

cleanable morphology with compression of the lingual drusen void 

Fig. 4: Fill up to the contact area of the buccal side of the 

augmentation using the bulkhead method 

Fig. 5: Contacts obtained with the bulkhead removed 

Fig. 6: Interdental separation with ivory separator 

Fig. 7: High-flow resin was poured in a manner that traced the 

original shape of the crown, while filling the tooth with the light of 

the microscope 

Fig. 8: Raise the centrifugal ridge of #13 and the proximal ridge of 

#14, imagining that the height and shape of the ridge should be 

aligned 



freely create a shape by stacking the resin as it hardened, 

giving the adjacent surfaces a two-truncation morphology 

(Figs. 9-11). This case is now two years post-operatively and 

is still in good condition (Fig. 12). 

DISCUSSION 

The 3D-printer technique was devised in 2018 for the 

modelling of the marginal ridge after the contact was 

restored using the septal method. As the level of modelling 

gradually improved, the range of application expanded. 

In the past year, restorations for second-class cavities 

using only the 3D-printer technique and without using the 

bulkhead method entirely have been conducted. 

The treatment method is technique-sensitive. It is 

recommended that the readers practise well in advance, 

become familiar with their own modelling level, and start 

with the cases that are feasible. DA 

REFERENCE 

Nokame Y. Use of microscope illumination to gradually harden 

flow resin in free-hand class 2 cavity fillings: a case report. Int J 

Microdent 2023;14(2):82–91. 

Fig. 9: The 3D-printer technique enabled the finishing the twoabutment 

morphology and gave the contacts in the correct 

position 

Fig. 10: Occlusion adjustment in progress. Occlusion was granted 

tightly 

Fig. 11: Immediately after filling 

Fig. 12: Condition of the patient two years after the 3D-Printer 

technique 

ABOUT THE AUTHOR 

Dr Nokame Yoshinori graduated in 

2010 from Nihon University’s School of 

Dentistry at Matsudo, Japan. Since 2011, 

he has served as the deputy director of 

Nokame Dental Clinic. He is board-certified 

by the Japanese Association of Microscopic 

Dentistry (JAMD) and The Academy of 

Clinical Dentistry. 



Quadrant Dentistry: Managing 

structurally compromised root 

canal treated molar tooth using 

biomimetic principles, fibre 

reinforcement and adhesive 

treatment By Dr Anand Narvekar 

CASE HISTORY 

A 35-year-old female complained of pain 

during the consumption of hot and cold 

beverages for several months. Due to the 

COVID-19 pandemic, she delayed her visit 

to the clinic. 

Clinical examination revealed large carious 

two walls defect on tooth 46. IOPA showed 

the involvement of nerve with no signs of 

periapical infection and widening for PDL 

space. Tooth 47 showed marginal leakage 

from old composite restorations and tooth 

48 revealed a Class 1 defect (Figs. 1 and 2). 

TREATMENT PLAN 

Phase 1: Root canal treatment 

Caries-driven access for root canal 

treatment with complete removal of caries. 

Canal shaping was done with Endostar 

azure file system. 03 canal system with 

02 mesials and 01 wide distal. Root canal 

therapy was done in single visit. 

Phase 2: Quadrant direct restorations and 

overlay preparations 

The patient was recalled after 15 days for 

post-root canal build and direct restorations 

for teeth 47 and 48. 

Quadrant isolation was done from teeth 42- 

48, with the placement of a wingless active 

clamp on tooth 48. A heavy rubber dam was 

selected for a better inversion and perfect 

seal due to the structurally compromised 

tooth 46 (Fig. 3). 

When performing a quadrant treatment 

approach in one setting, it is recommended 

to start with the last tooth as the patient’s 

jaw would close as time elapses, which 

presents difficulty when working on the last 

posterior tooth 7 or 8. 

Old composite restoration was removed 

from tooth 47 and caries were removed from 

teeth 47 and 48, with the help of a caries dye. 

Incremental morphological-driven cuspby-cusp 

layering was selected to reduce the 

C-factor as Class 1 defects produce a high 

C-factor of 5, which leads to polymerisation 

shrinkage and shrinkage stress. 

The first layer was applied using Shofu 

Injectable XSL, a 2nd Gen high compressive 

strength composite. This layer must be 

minimally 0.5mm as it will seal the uneven 

dentine floor and protect the hybrid layer 

from the polymerisation shrinkage stress. 

The second layer was applied using the 

Fig. 1: Reflected mirror view of mandibular right 

quadrant showing large carious defect on tooth 46 

involving mesial, buccal and lingual portion of the 

tooth structure, along with leaky composite margins 

on tooth 47 

Fig. 2: Retracted mandibular right quadrant buccal 

view showing large carious defect on tooth 46 

involving mesial, buccal and lingual portion of the 

tooth structure. IOPA showed involvement of the 

nerve with no signs of periapical infection 

Fig. 3: Rubber dam quadrant isolation from teeth 

43-48 for restoring teeth 46-48. The small collage 

photo showed the clean pulp chamber just before 

obturation 



Shofu Beautifil LS II low-shrinkage composite 

(0.85%). In this manner, a natural form and 

function was created (Fig. 4). 

To build tooth 46, the temporary cement was 

removed and a caries dye was applied with 

caries endpoint removal. The mesial floor was 

almost subgingival, so a deep margin elevation 

was decided using a palodent wedge to seal 

this critical area from any sulcus fluid coming 

from the dam (Fig. 5). 

The entire preparation was sandblasted with 

50µ aluminum oxide powder for 7-8secs. 

Air abrasion compacted the smear layer 

in peritubular dentine and thinned the 

intertubular dentine. 

This ensured the removal of any leftover 

temporary cement to provide a cleaner surface 

to achieve a predictable bonding strength 

over 40MPa. The weakest part of the tooth 

was noted, which informed the building of a 

biobase incorporating polyethylene fibres 

(Fig. 6). With this procedure, the structurally 

compromised tooth was protected from 

shrinkage stress which otherwise would 

cause catastrophic failure of the entire tooth 

structure. 

A 6th Gen Shofu FL-Bond II was applied on 

the tooth using the proper protocol according 

to the provided instruction manual. The 

6th Gen Shofu FL-Bond is a gold-standard 

bonding agent with a high level of bonding 

strength to both dentin and enamel. The 

bonding strength would not decrease in the 

future as compared to a one bottle system. 

Once the bond was cured, a thin layer of 

2nd Gen Shofu Injectable XSL (slow levelling) 

high-strength composite was applied over 

the tooth. Care should be taken to ensure a 

thickness no more than 0.5mm and curing 

should only be done after placement of 

Ribbond fibres. 

Next, 3mm Ribbond fibres were cut using a 

special Ribbond scissors into small pieces 

and dipped in unfilled, 4th Gen bond resin, 

drying the excess of the bonding agent. 

In a process known as ‘wall-papering’, the 

Ribbond fibres were applied on the walls, 

circumferential inside the tooth including 

the pulpal floor (Fig. 7). Then, ramp curing 

was done for 40-60secs each on both 

the buccal and lingual sides to ensure a 

complete curing of deep defect, which 

would reduce the shrinkage. 

Next the Shofu Beautifil LS II lowshrinkage 

composite (0.85%) was 

incrementally layered circumferential 

over the Ribbond, leaving space in the 

middle for dual-cure core build-up (Fig. 

8). Thereafter, a dual-cure composite was 

injected in the middle and left to cure 

for 2-3mins (Fig. 9). With this technique, 

the harmful shrinkage stress in such a 

Fig. 4: Restoring teeth 47 and 48 with cusp-by-cusp 

incremental layering to create a natural form and 

function 

Fig. 5: Tooth 46 was cleaned free of caries and 

tooth-sandblasted for better adhesive procedure. 

A palodent wedge was placed for deep margin 

elevation 

Fig. 6: Tooth 46 showed extensive defects 

before the bonding procedure 

Fig. 7 Fig. 8: Building a biobase ensured an ideal 

Fig. 9 

packable composite on the periphery of the tooth 



structurally compromised root canal 

treated tooth was controlled. 

Next was to prepare for the bonded 

overlay. Since the distal marginal 

ridge/contact area tooth structure 

was healthy, it was not included in the 

preparation. The design used was a 

“full cuspal coverage marginal ridge 

preservation prep” (Fig. 10). 

The weak structure of less than 2mm 

on the buccal and lingual sides was 

removed till enamel supported by 

dentine was reached. Buccal and lingual 

margins were bevelled to get more 

enamel for bonding and merging of 

ceramic and the natural tooth. A ‘Mesial 

Shoulder’ design was selected. 

The bevel margins joined with the 

shoulder margin to provide a clear 

insight of margin placement for 

the dental technician. To prevent 

movement of the overlay during final 

fixing, a shallow 8x2x2mm ditch was 

made in the composite to provide some 

retention. 

With the preparation design, a 360° 

enamel was included for the bonded 

overlay. The impression was made in 

A-silicon. There was no need for the 

placing of gingival retraction cord as all 

margins were supra with clear view. 

Fig. 10: IOPA showed Ribbond placement as close as 

natural tooth structure 

The sticky ortho blue composite was spotbonded 

to the preparation on the adjacent 

tooth to avoid migration of the tooth till 

the overlay arrived from the lab (Fig. 11). 

The tooth shade was taken and a medium 

translucency lithium disilicate ingot was 

selected for better aesthetic and better 

penetration for the curing light during the 

final bonding of the overlay. 

Using Ribbond fibre for reinforced 

dentistry 

The main objective to construct a fracturetough 

and durable prosthesis was achieved 

by adapting the Ribbond as closely as 

possible against the tooth surface, which 

informed the prior use of the thin layer of 

injectable. 

The greater the strength of the thin 

cavity walls, the more resistant it is to 

polymerisation-induced microcracking 

and fracture. This also maximises the 

strengthening effect. Lining the pulpal 

floor and walls with Ribbond enhances the 

performance of onlay and crown buildup. 

Ribbond provides fracture toughness and 

prevents costly fracture failures; it also 

migrates harmful effects of C-factor that 

is related to polymerisation shrinkage and 

shrinkage stress. 

Ribbond is made from the same supertough 

and ultra-high molecular weight 

polyethylene fibres used to make bullet 

Fig. 11 

proof vests. A special Ribbond scissors is 

recommend to achieve sharp cuts which 

saves material in the long run. 

How to use Ribbond fibre 

1) After routine bonding procedure, 

apply injectables or bulk flow on the 

floor or wall of the cavity or on the 

crack area. The thickness should not 

be more than 0.5mm. 

2) Cut the Ribbond with special scissors 

according to size required. 

3) Dip Ribbond into unfilled resin. 

Because better penetration of the 

resin inside fibres is needed, avoid 

one bottle system which contains 

primer with bond that can be difficult 

to evaporate from the Ribbond fibres. 

4) Remove excess resin from Ribbond. 

5) Place it on the floor of the cavity or 

on the crack area and cure, followed 

by incremental layering of the 

composite. 

Phase 3: Bonding Overlay 

Once the overlay arrived, it was checked 

for dry fit and contacts inside the patient 

oral cavity. A rubber dam isolation was 

used for the bonding overlay. 

Steps in bonding overlay 

For the LD Overlay 

1) After placing the rubber dam, check 

the dry fit of the overlay. 

2) Wash the overlay and keep in an 

ultrasonic bath for several minutes. 

3) Dry the overlay and etch intaglio 

surface with 5% Hydrofluoric acid 

for 20secs (refer to manufacturer’s 

instructions). 

4) Rinse overlay with water and keep in 

an ultrasonic bath for 3-4mins. This 

will remove acid and crystals from 

the surface which enables a deep 

penetration of silane. 

5) Apply silane on overlay and leave 

to react for 1min before letting it 

dry naturally. This step ensures 

a mechanical increase of wetting 

surface, which will create a siloxane 

bond between organic matrix, 

composite resin, and silica in ceramic. 



Fig. 12: Protecting the adjacent tooth with 

fender wedge from air abrasion, etching 

and bonding procedure 

For the Tooth 

1) Place fender wedge to protect the 

adjacent tooth from air abrasion 

and etching (Fig. 12). 

2) Use 50µ aluminum oxide powder 

for 10secs for air abrasion. 

3) Selectively etch enamel for 15secs 

using 35% phosphoric acid. 

4) Apply boding agent on the tooth 

and cure. A 6th Gen separate 

primer/bond with a two-step 

procedure was chosen. 

After tooth and overlay preparation, 

a heated packable composite was 

loaded inside the overlay and on 

the tooth. The composite was well 

distributed over the tooth. The 

overlay was fitted on the prepped 

tooth and pressed firmly seated. 

Excess which came out was removed 

with a micro brush. 

Superfloss was used interdentally 

to clean the area until no composite 

was attached to the superfloss. While 

performing the flossing, the assistant 

held the crown firmly with a flat-end 

instrument. 

After cleaning all excess, the overlay 

was firmed pressed and allowed to 

tack cure for 3secs. The excess was 

checked again before glycerin was 

applied to avoid an oxygen inhibition 

layer from forming. Next, threepoint 

curing for the mesial, buccal, 

lingual, distal, and occlusal each was 

performed for 20-40secs each for 

a total of nine surfaces. This step 

ensured a complete curing for the 

heated composite even in the deepest 

area. 

The reasons for using heating 

composite for bonding indirect 

restorations are as follows: Warm 

composite resins improve flow 

characteristics for faster, easier, and 

more precise control when placing 

the material into areas with limited 

access. It also increases the degree 

of monomer-to-polymer conversion, 

while reducing the amount of 

polymerisation contraction stress by 

reducing the curing light exposure 

Fig. 13: A clean preparation before bonding 

procedure. Note the healthy enamel from a 

360° view 

time. Furthermore, it frees up time to 

clean the excess resin so the fixation 

becomes stress-free and predictable. 

The margins can be polished well with 

less accessible plaque accumulation 

compared to dedicated bonding resin 

cement, because of the packable 

composite. 

The rubber dam was removed and 

checked for excess which was 

removed with a number 12 blade and 

large sickle instrument. The IOPA 

x-ray was checked for any excess 

composite (Fig. 15). 

An occlusion check was performed 

with 40µ paper followed by 8µ foil. 

High points were removed from 

nonfunctional cusps and cuspal 

Fig. 14: Reflected mirror view of mandibular right quadrant showing natural 

form with complete makeover of entire quadrant from teeth 46-48 

Fig. 15: Bitewing X-ray showed monoblock-like tooth structure 

and ideal contacts and contours free from excess cement 



inclines, both in static as well as in dynamic 

occlusion. To remove high points, Shofu 

Dura-Green fine stones were used on slow 

speed on 15,000rpm. Final finishing and 

polishing margins were performed with 

silicon cups. The patient was recalled after 

15 days for follow-up. 

CONCLUSION 

Restoring a structurally compromised root 

canal tooth for a better and long-term 

prognosis has always been a challenging 

procedure. Material science has evolved so 

much in recent years with the development of 

biomimetic techniques and multidisciplinary 

approaches towards conservative dentistry. 

By incorporating fibre-reinforced dentistry 

and controlling polymerisation shrinkage 

stress with the use of incremental and low 

shrinkage composite, tooth structure can be 

saved from future catastrophic failures. 

Using final bonded indirect lithium disilicate 

restoration enables dentists to customise 

design preparation and save the healthy 

structure without incorporating it in the 

preparation. A minimally invasive approach 

can be achieved even in structurally 

compromised teeth as shown in this case. 

There is nothing like replacing dentin with 

composite and enamel with ceramic to 

produce monoblock natural tooth structure 

for long-standing predictable restorations. DA 

ACKNOWLEDGMENTS 

The author thanks Dr Nikhil Modi for root canal 

treatment, Aims Dental studio for lab support, 

and Shofu Asia Pacific and Ribbond USA for 

material support. 

REFERENCES 

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al. Clinical status of ten dentin adhesive systems. J 

Dent Res 1994;73: 1690–1702. 

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Lam- brechts P, Vanherle G. Three- year clinical 

effectiveness of four total-etch dentinal adhesive 

systems in cervical lesions. Quintessence Int 1996; 

27:775–784. 

•Fortin D, Swift EJ, Denehy GE, Reinhardt JW. Bond 

strength and microleakage of current dentine 

adhesives. Dent Mater 1994;10:253–258. 

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etching of dentin and bonding to wet dentin 

surfaces. J Am Dent Assoc 1992;123:35–43. 

•Tjan AHL, Bergh BH, Lidner C. Effect of various 

incremental techniques on the marginal adaptation 

of class II composite restorations. J Prosth Dent 

1992;67:62–66. 

•Feilzer AJ, Dooren LH, de Gee AJ, Davidson CL. 

Influence of light intensity on polymeriza- tion 

shrinkage and integrity of restoration-cavity 

interface. Eur J Oral Sci 1995;105:322–326 

•Nikolaenko SA, Lohbauer U, Roggendorf M, 

Petschelt A, Dasch W, Frankenberger R. Influence of 

c-factor and layering technique on microtensile 

bond strength to dentin. Dent Mater 2004;20:579– 

585. 

•Materials (Basel).2020 Jul 7;13(13):3026. doi: 

10.3390/ma13133026. 

Influence of Dentine Pre-Treatment by Sandblasting 

with Aluminum Oxide in Adhesive Restorations. An 

In Vitro Study 

Bruna Sinjari 1 2, Manlio Santilli 1 2, Gianmaria 

D’Addazio 1 2, Imena Rexhepi 1 2, Alessia Gigante 1, 

Sergio Caputi 1 2, Tonino Traini 1 2 

•Quintessence Int.2012 Mar;43(3):197-208. 

A systematic approach to deep caries removal end 

points: the peripheral seal concept in adhesive 

dentistry 

David S Alleman 1, Pascal Magne 

•Deep Margin Elevation: A Paradigm Shift 

Pascal Magne, DMD, PhD/Roberto C. Spreafico, DM, 

DMD 

•Posterior indirect adhesive restorations (PIAR): 

preparation designs and adhesthetics clinical 

protocol 

Federico Ferraris, DDS Private Practice, Alessandria, 

Italy 

•J Adhes Dent.2006 Aug;8(4):247-53. 

The effect of c-factor and flowable resin or fiber use 

at the interface on microtensile bond strength to 

dentin 

Sema Belli 1, Nazmiye Dönmez, Gürcan Eskitaşcioğlu 

•J Adhes Dent.2018;20(6):495-510. doi: 10.3290/j. 

jad.a41630. 

Nonretentive Bonded Ceramic Partial Crowns: 

Concept and Simplified Protocol for Long-lasting 

Dental Restorations 

Gianfranco Politano, Bart Van Meerbeek, Marleen 

Peumans 

•Oper Dent. May-Jun 2013;38(3):242-8. doi: 

10.2341/12-139-TR. Epub 2012 Aug 23. 

Fiber-reinforced resin coating for endocrown 

preparations: a technical report 

G T Rocca 1, N Rizcalla, I Krejci 

•Int J Esthet Dent.2018;13(3):318-332. 

Luting of inlays, onlays, and overlays with preheated 

restorative composite resin does not prevent 

seating accuracy 

Pascal Magne, Mehrdad Razaghy, Marco Aurelio 

Carvalho, Luciana Mara Soares 


Dr Anand Narvekar is an adjunct 

faculty at various private dental 

institutes and is a clinical trainer 

for Minimally Invasive Cosmetic 

Dentistry (MiCD). He is a key 

•J Adhes Dent.2015 Dec;17(6):559-66. doi: 

10.3290/j.jad.a35258. 

Heat Treatment Influences Monomer Conversion 

and Bond Strength of Indirect Composite Resin 

Restorations 

Pascal Magne, Daniel Alexandre Menezes Pedrosa 

Malta, Reyes Enciso, Sylvio Monteiro-Junior 

PMID: 26734681 DOI: 10.3290/j.jad.a35258 

•Int J Esthet Dent.2018;13(1):86-97. 

Preheated composite resin used as a luting agent 

for indirect restorations: effects on bond strength 

and resin-dentin interfaces 

Marcelo Goulart, Barbara Borges Veleda, Deisi 

Damin, Glaucia Maria Bovi Ambrosano, Fabio 

Herrmann Coelho de Souza, Maria Carolina 

Guilherme Erhardt 

•J Conserv Dent.Jan-Feb 2021;24(1):100-104. doi: 

10.4103/JCD.JCD_489_20. Epub 2021 Jul 5. 

Morphology-driven preparation technique for 

posterior indirect bonded restorations 

Vibha Rahul Hegde 1, Sharmika Rajan Joshi 2, 

Sanjeevani A Hattarki 3, Ashwin Jain 4 

•Veneziani M. Posterior indirect adhesive 

restorations: Updated indications and the 

Morphology Driven Preparation Technique. Int J 

Esthet Dent. 2017;12:204–30. 

•Fróes-Salgado NR, Silva LM, Kawano Y, et al. 

Composite pre-heating: effects on marginal 

adaptation, degree of conversion and mechanical 

properties. Dent Mater. 2010;26:908-914. 

•Muñoz CA, Bond PR, Sy-Muñoz J, et al. Effect of 

pre-heating on depth of cure and surface hardness 

of light-polymerized resin composites. Am J Dent. 

2008;21:215-222. 

•Daronch M, Rueggeberg FA, Moss L, et al. Clinically 

relevant issues related to preheating composites. J 

Esthet Restor Dent. 2006;18:340-350. 

•Freedman G, Krejci I. Warming up to composites. 

Compend Contin Educ Dent. 2004;25:371-378. 

•Torii Y, Itou K, Itota T, et al. Influence of filler 

content and gap dimension on wear resistance 

of resin composite luting cements around a CAD/ 

CAM ceramic inlay restoration. Dent Mater J. 

1999;18:453-461. 

•Della Bona A, Anusavice KJ, Shen C. Microtensile 

strength of composite bonded to hot-pressed 

ceramics. J Adhes Dent. 2000;2:305-313. 

Alleman D, Nejad M. Biomimetic Dentistry CE. www. 

biomimeticce.com. Accessed November 28, 2016. 

•Inside Dentistry January 2017 Volume 13, Issue 1 

Biomimetic techniques are employed in the 

restoration of endodontically treated teeth for 

several important purposes 

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Adhesion of Whole Ceramic Inlays August 

2019Revista de Chimie -Bucharest- Original 

Edition- 70(6):1934-1941 DOI:10.37358/RC.19.6.7250 

opinion leader and advisor for many 

global manufacturers and routinely 

conducts courses on various aesthetic and 

occlusion-related techniques in India and 

internationally. 



Digital palate analysis to verify the 

mirror twin phenomenon 

By Dr Botond Simon DMD, Dr George Freedman BSc, DDS, DiplABAD, and János Vág, DMD, PhD, Med Habil 

INTRODUCTION 

Mirror-image twin is a unique phenomenon 

where the features on one identical, or 

monozygotic, twin’s left side are mirrored 

on the other twin’s right side. For example, 

one twin may have a birthmark on their left 

cheek, while the other twin has a birthmark 

in the exact location but on the right cheek. 

The prevalence of mirror twins can only 

be estimated from indirect evidence. 1,2 

Approximately 25% of monozygotic twins 

(n=75) in the US, 3 and 23% of monozygotic 

twins (n=375) in Belgium, 4 had discordant 

handedness, where one sibling is righthanded 

and the other is left-handed. 

However, handedness is determined mainly 

by the non-shared environment with fewer 

genetic influences. 

While mirror twins share identical DNA, they 

may have distinct personalities, interests 

and abilities, and they may also experience 

different health issues throughout their lives. 

Numerous studies have reported mirrorimage 

dental anomalies in twins: aplasia, 5 

supernumerary teeth, 6 or dental fusion. 7 

Contralateral craniofacial lesions such as 

cleft lip and palate, 8 hemifacial microsomia, 8 

and unilateral condylar hyperplasia have 

been reported. 9 The pathological phenomena 

suggest the importance of mirror-imaging. 2 

Recently, it has been demonstrated that 

palatal geometry measured on the intraoral 

scan can distinguish strangers and even 

identical twins with moderate certainty, 

facilitating human and victim identification. 10 

After selecting possible matches, an 

additional superimposition of the palatal 

scan can confirm the identity. 11,12 However, 

recognising a twin relationship might be 

concealed by the opposite laterality of 

siblings. Therefore, this study’s primary aim 

was to assess the effect of sagittal mirroring All three scans of the 174 subjects, 522 

on the fit between twin siblings’ scans. 

total scans, were cropped, and teeth were 

removed in the GOM Inspect Suite software. 

Compared to DNA analysis, the strength The cropped palatal model was duplicated, 

of the intraoral ante-mortem scan-based and one was mirrored in the y-axis, or the 

identification method is growing due to sagittal plane (Figs. 1A and B). The palatal 

the rapid spread of intraoral scanning. 

scans were aligned by the best-fit function 

However, the limitation is that dentists may using the iterative closest point algorithm. 17 

focus on quadrant rehabilitation, limiting The mean absolute distance between aligned 

the scan to only one palate side. Similarly, a scans’ surfaces was calculated by dividing the 

severe accident may damage the half palate. integrated absolute distance by the area of 

Although the palatal side-to-side asymmetry the valid distance (Fig. 1C). 

is relatively small, 13 the total geometry and 

surface morphology may differ between sides. Assessment of twin mirroring: Betweensiblings 

comparison 

Therefore, the study’s secondary aim was to 

assess the fit between the mirrored scan and The three scans of one sibling were 

the original scan of the same individuals. superimposed with three scans of the 

other sibling in the original group, for nine 

MATERIAL AND METHODS 

superimpositions per subject. Additionally, 

Sample collection and preparation 

the three original scans of one sibling were 

A total of 174 participants were recruited superimposed with three mirrored scans of 

through the National Twin Registry: 61 

the other sibling in the mirror group, for nine 

monozygotic twin pairs and 26 same-sex superimpositions per twin pair. A total of 

dizygotic twin pairs. 14,15 All participants agreed 2,610 measurements were made. 

to study participation by written informed 

consent and ethical approval 36699-2/2018/ Assessment of asymmetry: Between-replicates 

EKU was obtained. Zygosity was determined comparison 

using questionnaires. 16 Evidence of previous The original three scans within a subject were 

orthodontic treatment was also recorded. superimposed on each other in the original 

Each participant’s palate was scanned three group, for three superimpositions. The three 

times using a Planmeca Emerald intraoral mirrored scans were superimposed with a 

scanner, version number Romexis 5.2.1, as non-mirrored replicate in the mirror group, 

previously described. 11 for three superimpositions. 

Fig. 1A-C: The original scan (A) was mirrored on the y-axis (B). The complete surface comparison is shown 

after the best-fit alignment of the two scans (original vs mirrored) (C). The table indicates the integrated 

absolute distance (977.08mm 3 ) and the area of the valid distance (1,622.60mm 2 ). Their ratio makes up the 

mean absolute distance (0.602mm) 



Statistics 

The Wilcoxon test was used to compare the 

original and mirror mean absolute distance in 

the between-siblings and between-replicates 

comparisons. The Mann-Whitney U test was 

used to compare the monozygotic with the 

dizygotic twins. The number of twin pairs 

in which the difference between the scans 

increased following mirroring was tabulated, 

as well as the number of pairs in which the 

difference decreased. Then the ratio of 

increased to decreased was calculated. The 

proportion in monozygotic and dizygotic 

was compared by Chi-square statistics. All 

analyses were made by IBM SPSS Statistics, 

Version 27. A p-value less than 0.05 was 

considered statistically significant. The 

data in the text is given in the median and 

interquartile range. 

RESULTS 

Assessment of twin mirroring: Betweensiblings 

comparison 

The mean absolute distance between-siblings 

increased significantly (p


change the difference between the twin 

siblings’ scans, suggesting a minor role of 

the surface morphology on alignment. 19 

Therefore, the significant impact of 

mirroring may indicate the asymmetry 

in the palatal vault. Nevertheless, the 

perimeter of the palate determined 

by the tooth arch may also impact 

symmetry measurement. 21 Overall, the 

extent of the discrepancy between 

mirrored and non-mirrored counterparts 

indicates that if the contralateral 

side is available either in the ante- or 

postmortem database, the accuracy of 

the palatal scan-based identification 

process could be challenged or hardly 

possible. DA 

This analysis was supported by the ÚNKP-22- 

3-II-SE-3 New National Excellence Program of 

the Ministry for Culture and Innovation from the 

source of the National Research, Development 

and Innovation Fund. Supported by the SE250+ 

Excellence Scholarship Program. The research 

supported by Hungarian Scientific Research Fund 

(K_22, 142142) and Hungarian Human Resources 

Development Operational Program (EFOP-3.6.2-16- 

2017-00006). 

REFERENCES 

1. Sommer, I. E. C., N. F. Ramsey, R. C. W. 

Mandl and R. S. Kahn (2002). “Language 

lateralization in monozygotic twin pairs 

concordant and discordant for handedness.” 

Brain 125(12): 2710-2718. 

2. McNamara, H. C., S. C. Kane, J. M. Craig, R. 

V. Short and M. P. Umstad (2016). “A review 

of the mechanisms and evidence for typical 

and atypical twinning.” Am J Obstet Gynecol 

214(2): 172-191. 

3. Springer, S. P. and A. Searleman (1978). 

“Laterality in twins: the relationship between 

handedness and hemispheric asymmetry for 

speech.” Behav Genet 8(4): 349-357. 

4. Derom, C., E. Thiery, R. Vlietinck, R. Loos 

and R. Derom (1996). “Handedness in twins 

according to zygosity and chorion type: a 

preliminary report.” Behav Genet 26(4): 407- 

408.5 

5. Lauweryns, I., M. De Loecker and C. Carels 

(1992). “Mirror image in aplasia of a premolar 

in a monochorial twin: Case report and 

review.” J Clin Pediatr Dent 17(1): 41-44. 

6. Choi, W. K., R. C. Chang and S. T. Chuang 

(1990). “Bilateral mesiodentes of identical 

twins--a case report.” Zhonghua Ya Yi Xue 

Hui Za Zhi 9(3): 116-121. 

7. Sperber, G. H., G. A. Machin and F. J. 

Bamforth (1994). “Mirror-image dental fusion 

and discordance in monozygotic twins.” Am J 

Med Genet 51(1): 41-45.3 

8. Satoh, K., Y. Shibata, H. Tokushige and T. 

Onizuka (1995). “A mirror image of the first and 

second branchial arch syndrome associated 

with cleft lip and palate in monozygotic twins.” 

Br J Plast Surg 48(8): 601-605. 

9. Toh, A. Q. J., A. G. Becking and Y. Y. Leung 

(2020). “Mirror-image unilateral condylar 

hyperplasia in monozygotic twins.” Int J Oral 

Maxillofac Surg. 

10. Simon, B., K. Aschheim and J. Vag (2022). 

“The discriminative potential of palatal 

geometric analysis for sex discrimination and 

human identification.” J Forensic Sci 67(6): 

2334-2342. 

11. Simon, B., L. Liptak, K. Liptak, A. D. Tarnoki, 

D. L. Tarnoki, D. Melicher and J. Vag (2020). 

“Application of intraoral scanner to identify 

monozygotic twins.” BMC Oral Health 20(1): 268. 

12. Simon, B., A. A. Farid, G. Freedman and J. Vag 

(2021). Digital scans and human identification. 

Oral Health Journal, Oral Health Group. July 9. 

13. Simon, B., Mangano, F.G., Pal, A., Simon, I., 

Pellei, D., Shahbazi, A., Vag, J. (2023). “Palatal 

asymmetry assessed by intraoral scans: effects 

of sex, orthodontic treatment, and twinning. A 

retrospective cohort study” BMC Oral Health 

23(1) 305. https://doi.org/10.1186/s12903-023- 

02993-1 

14. Littvay, L., J. Métneki, Á. D. Tárnoki and D. L. 

Tárnoki (2013). “The Hungarian Twin Registry.” 

Twin Research and Human Genetics 16(1): 185- 

189. 

15. Tarnoki, A. D., D. L. Tarnoki, B. Forgo, H. 

Szabo, D. Melicher, J. Metneki and L. Littvay 

(2019). “The Hungarian Twin Registry Update: 

Turning From a Voluntary to a Population-Based 

Registry.” Twin Res Hum Genet 22(6): 561-566. 

16. Christiansen, L., H. Frederiksen, K. 

Schousboe, A. Skytthe, N. von Wurmb-Schwark, 

K. Christensen and K. Kyvik (2003).” Age- and 

sex-differences in the validity of questionnairebased 

zygosity in twins.” Twin Res 6(4): 275-278. 

17. Chen, Y. and G. Medioni (1992). “Object 

modelling by registration of multiple range 

images.” Image and Vision Computing 10(3): 

145-155. 

18. Cassetta, M., F. Altieri and A. Giordano (2015). 

“Mirror imaging of impacted and supernumerary 

teeth in dizygotic twins: A case report.” J Clin 

Exp Dent 7(1): e167-169. 

19. Simon, B., K. Aschheim and J. Vág (2022). 

“The discriminative potential of palatal 

geometric analysis for sex discrimination and 

human identification.” Journal of Forensic 

Sciences 64(4). 

20. Bjelopavlovic, M., D. Degering, K. M. 

Lehmann, D. G. E. Thiem, J. Hardt and K. 

Petrowski (2023). “Forensic Identification: 

Dental Scan Data Sets of the Palatal Fold Pairs 

as an Individual Feature in a Longitudinal Cohort 

Study.” Int J Environ Res Public Health 20(3). 

21. Lo Giudice, A., V. Ronsivalle, C. Conforte, G. 

Marzo, A. Lucchese, R. Leonardi and G. Isola 

(2023). “Palatal changes after treatment 

of functional posterior cross-bite using 

elastodontic appliances: a 3D imaging study 

using deviation analysis and surface-to-surface 

matching technique.” BMC Oral Health 23(1): 68. 

ABOUT THE AUTHORS 

Dr Botond Simon 

is a PhD student at 

Semmelweis University. 

He is a specialist in 

restorative dentistry 

and prosthodontists. 

His research combines 

digital dentistry with dental twin 

research and human identification. He 

is a co-founder of Scrunch, an earlystage 

start-up company for providing 

personalised online dental care for 

patients, and maintains a private 

practice. 

János Vág DMD, 

PhD is an associate 

professor and head 

of department of 

conservative dentistry 

at the Semmelweis 

University, Hungary. 

He is a specialist in restorative dentistry, 

endodontics, and prosthodontists. 

His research focuses on gingival 

microcirculation, intraoral scanner 

accuracy, and digital forensic odontology. 

He has published 45 refereed papers and 

is a co-founder of Scrunch, a start-up 

company for providing personalised 

online dental care for patients. 

Dr George Freedman 

is a founder and past 

president, American 

Academy of Cosmetic 

Dentistry; co-founder, 

Canadian Academy 

for Esthetic Dentistry; 

regent and fellow, International Academy 

for Dental Facial Esthetics (IADFE); 

diplomate and chair, American Board of 

Aesthetic Dentistry; and adjunct professor, 

Dental Medicine at Western University, 

Pomona, California. Dr Freedman is the 

author of 14 textbooks and more than 

900 articles, and an internationally 

renowned lecturer. 


USER REPORT 

Taking the first step into 

digital manufacturing 

For the dental technician behind 

the Center for Oral Care in Uden, 

Netherlands, Okke Kamps’s journey 

of integrating digital manufacturing 

into the implantology practice 

was one riddled with setbacks 

and hurdles, but ultimately 

yielded better results. Hear 

from his experience, lessons, 

and advice for like-minded 

practitioners seeking to 

follow suit. 

It may be all smiles for the dental technician, but his 

centre’s transition into digital manufacturing was in equal 

measures challenging and rewarding 

Based in Uden, Netherlands, the centre’s first 

step into digital dentures around seven years 

ago was unfamiliar but anchored by Kamps’s 

pursuit of new methods and technologies 

that would enable the centre to produce 

higher quality dentures more efficiently. 

“The advantage of digital dentures is that 

we need significantly fewer sessions for our 

patients’ restorations than with conventional 

production,” said Kamps. 

The centre’s shift to digital production 

started with its first scanner, with support 

from a Dutch supplier, Cordent Milling 

Center, based in Maartensdijk, Netherlands. 

Despite the initial uptick, Kamps’s 

introduction to digital dentures was 

admittedly riddled with as many lows as 

there were highs. Computer-aided design 

(CAD) software and materials were not yet 

at today’s levels of precision and satisfying 

aesthetic results could not be achieved. 

The manufacturing process did not run 

smoothly either. 

These teething pains would prove a 

familiar theme down the years, but Kamps 

understood it was a steep but necessary 

learning curve to become competent in a 

technology that offered numerous upsides. 

“The experience from our time as beginners 

was important for our progress,” said Kamps. 

“I am not a video gamer, but I had to really 

get myself into the whole digital world.” 

Convinced of its potential, Kamps had to overcome his 

fears to eventually reap the rewards of the technology 

A turning point for the centre’s venture into 

digital manufacturing came a year and a half 

ago, when a contact from the VITA dental 

factory provided an opportunity to produce 

digital dentures made of VITA VIONIC 

material with Cordent. 

Kamps and his team learnt about the entire 

design process of dentures, experiencing 

everything from its design, calculation, and 

preparation, to even the mistakes like files 


USER REPORT 

not being loaded properly. “We learned a 

lot about the design process of dentures 

during this time,” recalled Kamps. “We learnt 

constantly from these experiences. With 

VITA’s help and the high motivation of my 

team, it allowed us to take a big step forward 

with digital dentures.” 

As a result, the aesthetic properties of 

denture tooth like the VITA VIONIC VIGO 

were reassuring of the effort spent, which 

would ultimately translate to better 

satisfaction for patients. Moreover, digital 

manufacturing processes were supported 

through an extensive VITA dental library in 

the CAD software of 3Shape. According to 

VITA, there is no difference from a denture 

digitally manufactured, from one made by 

hand. 

Kamps and his team had to preserve through many mistakes and hurdles to gain the confidence and skills 

to work with new materials 

“The tooth was specially developed so that 

we can quickly and easily bond it into milled 

or printed denture bases. With VITA VIONIC, 

you can easily assemble a digital denture — in 

principle just like Legos,” said Kamps. The 

dental technician added that a prefabricated 

digital tooth can achieve better results than a 

milled dental arch. 

Today, the investments into digital 

manufacturing made by the centre have 

essentially paid off. “At first, you only see the 

investment [costs] because the VITA VIONIC 

material is in the upper price segment,” 

said Kamps. However, the figures from the 

practice now support the digital process. 

Previously, the centre managed an average 

of one denture per day in conventional 

production, where today it can make three 

to four dentures digitally. In addition, fewer 

treatment appointments are needed for 

patients. This saves dental technicians time 

for other treatment aspects like quality 

control. 

Despite the hurdles and setbacks, Kamps 

cuts a proud figure in staying on the path to 

full digital dentures with his team. “It feels 

good to be prepared for the digital future,” 

said the co-owner of the centre. He gives 

the following advice to fellow dentists who 

want to venture into digital dentures: “Start 

with small steps. When investing in digital 

dentures, you also decide to assume 

risk. Think about partnerships for, with a 

milling centre for example, if you do not 

have a 3D printer or milling unit now.” 

The centre is still working with VITA 

to further improve its competency in 

CAD software, prefabricated teeth, and 

materials, as it primes and prepares itself 

for new digital solutions in a burgeoning 

field. “Perhaps in the future we will 

completely switch to digital production 

of dentures,” Kamps said. “We do not 

necessarily want to expand, but we want 

to be even more efficient.” DA 

Despite the setbacks and 

hurdles, Kamps and his team 

are confident tackling new 

digital solutions head-on

USER REPORT 

The IOS price war: 

Advancements and 

differentiators 

in today’s intraoral scanners 

In recent years, intraoral scanning technology has advanced significantly, 

spurring the adoption and integration of digital dentistry in practices and 

clinics, and further enabling the development of AI projects and new care 

modalities. Dr Ahmad Al-Hassiny, private dentist and founder of the Institute 

of Digital Dentistry (iDD), a global digital dentistry education provider, breaks 

down these developments in the intraoral scanner (IOS) market and what 

implications it has for users. 

OVERVIEW AND CHANGES IN THE IOS 

MARKET 

It is established both anecdotally and in 

the literature that cost is the number one 

barrier for dentists adopting technology. 1 

Just like cell phones or electric cars, the 

market for IOS has matured in recent years 

where prices naturally fall as technology 

improves and more competition enters the 

market. 

The adoption of IOS in dental clinics 

has risen from 5% to around 45-50% in 

different markets over the past seven years, 1 

driven by the increase in affordability and 

improvement of IOS technology. 

As part of research for my educational 

curriculum, I carried out a test of different 

IOS in the market in 2019 and noticed 

a stark difference in the performance 

between ‘cheap’ and ‘expensive’ scanners. 

The difference was like night and day. Five 

years ago, cheaper IOS were barely fit for 

purpose, slow, lacked scan quality and had 

infantile software. 

Today, the differences have narrowed down. 

From under US$10,000 to $35,000 in costs, 

most modern intraoral scanners released 

by reputable companies work well, almost 

reaching a form of technological ceiling. 

In recent years, a price war type of competition 

has been evident. Seven years ago, the entry 

price for IOS technology was around $40,000. 

Now, a ‘good-enough’ IOS can be purchased 

for around $10,000, driven primarily by Korean 

and Chinese manufacturers. 

Speed is also no longer a factor that can be 

used to differentiate ‘good’ scanners from 

the ‘bad’. I have taken full arch scans using 

different devices in around 45-60 seconds, 

if not faster. 

Another way in which IOS technology has 

levelled off with price is in its accuracy. I 

scanned the same patient with up to eight 

different scanners from different pricings, 

then overlaid the different STLs scan files to 

compare the accuracy of devices and found 

little to no deviation between scanners 

for simple indications like a single crown 

or quadrant dentistry. This provides the 

conclusion that almost all new or reputable 

scanners can give a very accurate impression 

of the most common requirement for a 

dentist globally — a single crown. 

HOW TO CHOOSE THE ‘BEST’ SCANNER 

How to choose an IOS is now less about 

speed and more about workflow and 

integration. My first question for what 

scanner a dentist should buy is: Do they want 

to do in-house milling and CAD/CAM? 

For a large majority of users, their main 

interest lies in how an IOS can scan and be 

sent to the lab. There are good scanners 

available for these functions. Their next 

consideration is the question of software 


USER REPORT 

apps such as model builders, ortho 

simulators, and smile design simulators. 

With the rising accessibility of 3D printing, 

software apps are becoming competitive 

advantages for customers. 

The TRIOS range is often seen as a premium 

‘scan-and-send’ option having some of the 

ideal software on the market. They are also 

developing different aspects of their software 

such software apps, the Unite 3Shape store, 

AI designing via 3Shape Automate and 

an integration hub with various mills and 

printers. 

Medit scanners disrupted the scanning 

market in 2019, gaining a large market 

share quickly. It is also relatively affordable 

compared to the other scanners while having 

one of the most versatile scanning software 

available. With the new ClinicCAD app, Medit 

is also exploring the CAD space to offer 

dentists a way to fabricate designs for crown 

and bridge for milling or printing. What 

makes Medit stand out is its free software 

apps, including the CAD. 

A stand-out Chinese product is the Shining 

3D Aoralscan 3. It has one of the most 

developed scanner software out of all the 

Chinese brands with software apps and great 

integrations. There are more affordable 

Chinese products such as Alliedstar, Helios, 

or Runyes, which all generally work well with 

varying degrees of software development. 

For workflow and integration of in-house 

milling and CAD/CAM capabilities, it is 

hard to beat the CEREC system in chairside 

milling because of its smooth workflow and 

software. This is one instance where its 

Chinese brands like the Shining 3D Aoralscan 3 

offer affordable options and have caught up with 

other scanners in terms of hardware, but have yet 

to do so for its software (Image: Shining) 

capability is reflected in the price difference. 

The CEREC system in its entirety is the most 

expensive scanner-mill set up on the market 

for chairside use. However, even against 

multiple third-party option set-ups, the 

quality of CEREC is clear. 

Another workflow consideration is the brand 

of clear aligners. If using only one specific 

brand is critical for the practice, this limits 

dentists’ choices for iTero scanners if they 

want to use Invisalign for example, or TRIOS 

3 in some regions where the integration to 

Invisalign is still accepted. 

Fundamentally, one of the most important 

factors when buying an IOS is support. 

Literature has shown that the number 

one cause of inaccuracies when using IOS 

devices is the operator. 2 Having trained 

dentists on how to digitise, adopt and use 

IOS successfully in their practices, I see 

clinicians purchase scanners with little or 

no training. It is critical that to get good 

support from a distributor who will provide 

training on things like scan strategy, getting 

accurate scans and soft tissue management 

for precise digital impressions. This is part of 

why I started iDD, to provide digital dentistry 

education globally for all dental colleagues. 

FUTURE DEVELOPMENTS IN IOS 

The way to choose the ‘right’ scanner now 

for a practice comes down to a dentist’s 

requirements and budget. Barring a drastic 

difference in price, what separates the 

‘good’ IOS from the others are software and 

workflows. 

Most Chinese scanners work well from the 

scanning perspective but lack polish and 

development for its software compared 

with more established brands like Dentsply 

Sirona, 3Shape or Medit. The software feels 

more like a minimum viable product with 

barely any features and sometimes a lack 

of patient management. This is where the 

Chinese products that are flooding the 

market still lag behind. An exception is the 

Shining 3D scanner. 

In saying that, the entire industry is moving 

fast. Recent developments like Straumann 

Dr Ahmad believes that the CEREC system from 

Dentsply Sirona is hard to beat in chair-side milling 

(Image: Dentsply Sirona) 

Group’s acquisition of Alliedstar, a Chinese 

scanner company – means that these 

products are likely to develop quickly. Just 

like how such brands have caught up in 

terms of hardware, they are to likely catch up 

to the market leaders on software. 

The progression of low-cost scanners 

has come a very long way and I eagerly 

look forward to the developments in the 

near future. IOS prices will likely stay on a 

downward trend, prompting its adoption in 

practices and clinics even more. Moreover, 

this will spur further use and integration of 

the wider eco-system of digital technologies 

and workflows. DA 

REFERENCES 

1. Al-Hassiny, A., Végh, D., Bányai, D., Végh, Á., 

Géczi, Z., Borbély, J., Hermann, P., & Hegedüs, 

T. (2023). User Experience of Intraoral Scanners 

in Dentistry: Transnational Questionnaire Study. 

International dental journal, 73(5), 754–759. 

https://doi.org/10.1016/j.identj.2023.04.002 

2. Mangano, F. G., Admakin, O., Bonacina, M., 

Lerner, H., Rutkunas, V., & Mangano, C. (2020). 

Trueness of 12 intraoral scanners in the full-arch 

implant impression: a comparative in vitro study. 

BMC oral health, 20(1), 263. https://doi.org/10.1186/ 

s12903-020-01254-9 


Dr Ahmad Al-Hassiny 

is a full-time private 

dentist in Wellington, 

New Zealand, who runs 

a large chain of family 

practices with his 

father and brother. He 

is also the founder of the Institute of Digital 

Dentistry (iDD), a global provider of digital 

dentistry education. 


USER REPORT 

Rubber dam 

isolation 

By Dr Christopher Ho 

The utilisation of rubber dam has 

always been taught to be mandatory 

for endodontic procedures. 

However, the indication for use 

extends also to restorative dentistry 

in assisting to perform procedures 

optimally, efficiently, and safely. 

With the development of adhesive 

dentistry, moisture control and 

adequate isolation are needed to 

ensure long-term predictability 

and success with both direct and 

indirect dental procedures. 

The COVID-19 pandemic has 

also raised concern with dental 

practitioners exposed to the aerosol 

from patients mouths during clinical 

procedures. The use of a rubber 

dam, along with mouth rinses 

and disinfection, minimises the 

transmission of air-borne microbiological 

attack. 

Moisture control 

Preventing saliva, blood, and 

gingival crevicular fluid from 

interfering with clinical procedures 

is important for optimal adhesion, 

when potential for moisture 

contamination can reduce or 

inhibit correct adhesion and cause 

premature failure of restorations. 

It is quite a task to manage patients 

to prevent them from conversing, 

closing or swallowing. The use of 

a rubber dam precludes some of 

these scenarios to prevent possible 

moisture contamination. 

Patient protection 

The use of endodontic 

instrumentation and medicaments 

prevented from being ingested or 

aspirated may also minimise any 

debris raised from removing old 

restorations and fractures from 

inadvertently dropping in the oropharangeal 

area. Once accustomed 

to the rubber dam, the patient often 

Although not widely used in restorative dentistry practices, rubber 

dams offer numerous benefits for both clinicians and patients 

finds it quite relaxing and comfortable 

in contrast to having liquids at the 

back of their mouth needing to be 

constantly sucked up by high-speed 

evacuation. 

Visual access 

The use of rubber dam improves 

access and visualisation of the mouth 

by enabling patient’s lips, cheeks, and 


USER REPORT 

The HySolate Black Edition provides a higher contrast for improved visibility during procedures, and a non-reflective 

surface with no glare 

tongue to be retracted from the working 

region. The use of a coloured rubber dam 

with a contrasting colour also allows better 

visualisation and photography of the teeth. 

Moreover, gingival tissues can be retracted 

with appropriate rubber dam clamps 

allowing unimpeded access to carious or 

subgingival margins. 

Minimisation of infection transmission 

The creation of aerosols during dental 

procedures exposes the closely sited dental 

team to potential infective respiratory 

diseases and salivary microbiological load. 

The use of rubber dam provides an aseptic 

field and reduces the possibility of infection 

risks. 

RECOMMENDATION 

Common objections to the use of rubber 

dams are its placement difficulty, the 

time taken for its application, or patient 

discomfort. With the correct technique and 

options available on the market, rubber dams 

allow efficient application, in addition to the 

multiple advantages discussed. 

With the addition of a pre-printed rubber 

dam, the HySolate Dental Dam offers an 

improvement to competing products. The 

pre-printed template is marked on the 

rubber dam with the positions of the teeth 

which ensures that the holes are punched in 

the correct positions easily and accurately. 

The template saves time and provides 

convenience where non-templated 

rubber dams would require marking 

with a rubber stamp, which is prone to 

erasure. 

The HySolate Dental Dam is made 

of a powder-free latex. The material 

consistency is medium in strength, 

allowing optimal retraction of the 

tissues. The company also offers a nonlatex 

range which has a Flexi-dam for 

users who do not prefer the medium 

to heavy retraction from conventional 

rubber dams. The Flexi-dam is also 

suitable for the full arch isolation 

technique due to its ability to stretch 

without tearing. DA 


Dr Christopher Ho is a specialist prosthodontist who 

received his Bachelor of Dental Surgery with First Class 

Honours at the University of Sydney. He is a fellow of 

the Pierre Fauchard Academy, Special Field Member 

of the Royal Australasian College of Dental Surgeons 

in Prosthodontics and a fellow of the American 

College of Dentists. Dr Ho lectures extensively on 

aesthetic and implant dentistry both nationally 

and internationally, and was the editor of the Wiley 

textbooks “Practical Procedures in Aesthetic 

Dentistry” and “Practical Procedures in Implant 

Dentistry”. 



Communicating towards 

better collaboration 

Having swapped the dental chair for a seat at the ceramist table in the lab 

behind-the-scenes, Dr Kelvin Tantono has worn many hats in the dental clinic 

and with it, the perspective gleaned from these different roles. Hear from 

Dr Tantono on how communication underpins collaboration between dentists 

and technicians, and ultimately the quality of patient care provided. 

In 2017 when I quit being a dentist and 

started my journey as a full-time ceramist, 

I faced new communication challenges in 

my work. As a dentist I mostly educate and 

provide information to the patient for patient 

compliance. However, communication 

between the dentist and dental technician is 

different. 

With their respective skillsets, dentists and 

technicians collaborate to provide the best 

result possible for the patient. However, the 

journey towards this common goal can be 

full of challenges stemming from the way 

different parties communicate with one 

another. The impact of such communication 

processes should not be understated as it 

contributes to the success of the underlying 

collaboration. 

As a starting point for a fruitful collaboration, 

both sides must see themselves equal and not 

overpower each other. This mindset comes 

prior to any communication processes, 

towards better collaboration. 

The relationship between dentist and dental 

technician is essentially a human one. As 

with any other good human relationships, 

good communication strategies will provide a 

platform that encourages understanding and 

a clear relaying of purpose, information, and 

goals between the communication partners. 

Communication between dentists and 

technicians can be divided into three phases: 

before lab, in lab, and after lab. 

BEFORE LAB 

Before lab work begins, treatment begins 

with the choice of material. Even though 

there are various CAD/CAM restorations 

available, no one material is perfect for any 

given case. 

This is the first instance of communication 

and is important to communicate the ‘best’ 

choice of material for a patient. Dental 

technicians might not agree with a patient’s 

demand to make long span bridges of six 

consequently missing pontics with nonmetal 

material, for example. Some materials 

can be physically produced but require 

more consideration for factors like its risk of 

failure. The dental technician can provide a 

deeper understanding about the material’s 

properties. 

A lesser-known fact is every technician has 

a preferred material in which they have 

expertise. For example, for single crown 

Fig. 1: Clear margins, and an evenly pressed and 

homogeneous surface between light body and 

heavy body, are signs of a good impression 

matching cases, some technicians prefer 

to use lithium disilicate while others 

prefer to use zirconia, monolithic zirconia, 

or layered zirconia. Communication 

needs to be established to understand a 

technician’s capability and preference. 

After the patient, dentist, and technician 

have agreed on one material, the next 

step that requires communication is the 

working time. Working time is important 

as not every material has the same 

production time and not every case has 

the same difficulty level. 

To ensure the technician has enough time 

to produce the best quality treatment, 

patients need to be informed accordingly. 

It is recommended to clarify deadline 

requests from patients as well. 

For dentists, they should be given the 

ability to check their own impressions 

before sending them to the lab for 

further production. This will save time 

for everyone downstream by avoiding 

another patient’s visit to retake an 

impression if done incorrectly. If this step 

is compromised, the impression might fail 

together. Perfect margin and fitting mostly 

contribute to a good impression. 

Before releasing the patient, remember 

to take images for shade communication. 

A simple picture is better than none. The 

essence of shade communication is how 

the image is taken, not the equipment. 



Fig. 2: Incorrect way to capture a shade 

communication image 

Fig. 3: The correct way to capture an image that 

contains complete information 

Fig. 4: Stone model of a distorted impression 

A good shade communication image must 

be able to provide: 

1. Comparison between shade guide and 

the targeted tooth, not the abutment 

2. Clear visibility of shade tab name 

3. Incisal to incisal position between shade 

guide and targeted tooth, and 

4. The choice of the closest shade, one 

shade lighter, one shade darker, and one 

extra shade if necessary for character 

Another thing to remember is to not use a 

diffuser or polariser excessively, to avoid 

diminishing the real colour of the teeth. 

Also, before sending the impression to 

the lab either digitally or traditionally, it 

is highly recommended to fill in the order 

form completely. 

IN THE LAB 

The next phase of communication is when 

the case arrives in the lab. Communication 

here focuses on checks from the 

technician’s side. 

The first thing that technicians will do 

after receiving an impression, either 

digitally or traditionally, is to check the 

margin finish line. Technicians need a clear 

margin to produce an accurate model that 

resembles the condition in the patient’s 

mouth. Impression checking also includes 

any distortion or unevenly pressed surface 

during impression. 

Breaching the minimum thickness will lead to 

weak restoration and increase the possibility 

of failure. 

After all these checks in the lab, technicians 

must be able to conclude and inform dentists 

about the safety and chance of success of the 

material. Technicians must be the ones that 

understand the character, strength, and risk 

of a material used in each case. When agreed 

between technician and dentist, production 

can commence. 

AFTER THE LAB 

The biggest forms of communication 

between dentists and technicians must 

take place before and in, not after the lab. 

Communication after the lab concerns 

feedback, troubleshooting, and action 

reviews. 

But in practice, many dentists and technicians 

still ignore the communication in these two 

phases which results in avoidable mistakes 

after the lab, after the restorations have been 

received by dentist or tried in the patient 

mouth. 

As discussed in the beginning, the foundation 

of communication between dentist and 

technician is a human relationship. Like all 

other relationships, it must be built upon 

open and receptive communication in both 

directions. DA 

Fig. 5: Example of a model that looks parallel 

from side view. Note that this is not the insertion 

direction view 

Fig. 6: From insertion direction view, both 

abutments are not parallel and causing undercuts 

to each other 

If the margins are clear and visible, the 

next area to be checked is the undercut. 

Technicians need to ensure that the 

preparation is free of undercut, regardless 

of the type of restoration. This means 

technicians can see the margin from one 

particular insertion direction without any 

obstruction, from both the abutment itself 

and adjacent teeth. For bridges that involve 

multiple abutments, technicians might 

check for undercuts from several directions 

which show the least or no undercuts for all 

abutments. 

Another specification that technicians will 

check is the interocclusal clearance. Every 

material needs to achieve its minimum 

thickness to get its optimum strength. 


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. 



Pressure or vacuum? How 

to choose the right dental 

thermoforming machine 

for your practice 

Thermoforming is an integral component of many dental 

applications, including mouthguards, retainers, aligners, and 

splints. Choosing the right thermoforming machine, however, can 

be a challenge given the array of options available. 

By Peter Herring, advanced certificate complete dental prosthetics, diploma dental technology 

There is a diverse range of dental 

thermoforming applications — from 

temporary crowns, dentures, and 

bleaching trays to more advanced 

appliances such as surgical guides 

and snoring appliances. The type of 

machine best suited for your needs 

will largely depend on the kind of 

products you want to make and in 

what volume. 

For instance, dental surgeries 

looking to make basic in-house 

whitening trays, mouthguards, and 

the occasional splint 

might find an automatic 

rapid vacuum unit most 

beneficial, given its ease of 

use by various staff with 

minimal training. 

Meanwhile, orthodontic practices 

focused on bulk retainers and 

aligners based on 3D-printed 

models may lean towards 

automatic pressure units and 

particularly, for high volume 

production, pressure units with an 

external air supply. 

Production labs would potentially 

employ both types of machines, 

leveraging the strengths of each 

to produce a broader range of 

appliances. 

Fig. 1: The material is 

“pushed” onto the model 

in a closed chamber with 

positive pressure of up to 

six atmospheres. With these 

machines, the forming 

pressure is high enough, and 

they will normally produce 

good results but can be 

technically more demanding 

Comparing the intricacies of 

both pressure and rapid vacuum 

thermoforming machines, potential 

buyers can make an informed 

choice based on their specific 

needs. 

PRESSURE VS RAPID VACUUM 

Pressure machines 

Operation: These units operate 

using either an external 

compressed air source or an inbuilt 

compressor, exerting forming 

pressures of up to six atmospheres. 



Advantages: Pressure machines 

boast better thermoforming power. 

They are versatile and can produce 

virtually any appliance. They are 

particularly favoured in commercial 

dental labs equipped with top-notch 

model production facilities and skilled 

operators. Additionally, orthodontic 

surgeries prefer these machines 

for their inbuilt compressors which 

provides a good solution when no 

plumbed air supply is available. 

Considerations: More attention is 

necessary for model quality, blockingout 

procedures, and ensuring a clean 

compressed air supply. The model 

remains inaccessible during the 

process. These machines are ideally 

used by experienced operators and 

are pivotal for orthodontic bracket 

transfer appliances and techniques 

involving self-cure acrylics. For 

efficient high-volume production 

such as aligner sets, it is best to 

choose a machine with an external air 

supply. 

Rapid vacuum machines 

Operation: Rapid vacuum machines, 

which do not require an external air 

supply, operate by accumulating a 

vacuum in an internal reservoir using 

an inbuilt pump. After the heating 

cycle, the foil is rapidly drawn over 

the model using the stored vacuum, 

creating detailed and clinically 

equivalent results to pressure 

forming. 

Advantages: These machines do not 

need a compressed air source, are 

quieter, more user-friendly, and 

allow model access during forming. 

This accessibility facilitates the use 

of optional occludator attachments, 

enabling the incorporation of a bite 

registration into an appliance during 

thermoforming. 

Considerations: The less aggressive 

nature of these machines can 

lead to more comfortable, passive 

appliances for patients. Model quality 

requirements are also less stringent 

compared to pressure units. These 

machines are ideally suited for 

general productions, such as bleach 

trays, mouthguards, and orthodontic 

retainers. Its automatic operation and 

user-friendliness make it suitable for 

diverse dental office staff. 

CONCLUSION 

Choosing the right thermoforming 

machine boils down to understanding 

your current and potential future 

needs. By clearly outlining what one 


wishes to produce and keeping in 

mind the differences and benefits of 

each machine type, one can invest 

wisely and set yourself on a path 

for long-term success in dental 

thermoforming. 

Instead of being swayed by budget 

constraints or features, one should 

start by asking, “What do I want to 

use the machine for now and into 

the anticipated future?” This query 

provides a clearer path towards 

Peter Herring is an Australian qualified dental technician, 

Fig. 2: The material is “pulled” 

onto the model using the pressure 

differential created from the 

vacuum below the model. This 

leaves the formed material 

accessible for manipulation while 

still in a plastic state while the 

rapid nature of the vacuum release 

gives results clinically equivalent 

to pressure, and in some cases 

preferential 

selecting the ideal machine that caters 

to both current and future needs. DA 

dental prosthetist and a regular contributor to Australasian 

dental publications. He is the Australasian and Indonesian 

distributor for Erkodent products and divides his time between 

offices in Perth and Bali, Indonesia. With a background 

in dental thermoforming spanning over 20 years he also 

operates an Australian laboratory that is primarily dedicated to 

the production of thermoformed appliances. 


invis is 

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*Data on file at Align Technology as of March 31, 2023 

© 2023 Align Technology, Inc. Invisalign, the Invisalign logo, among others, are trademarks and/or service marks of Align Technology, Inc. 

or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries. | MKT-A017303

IN DEPTH WITH 

The compass for 

tomorrow’s dental 

surgery 

At the International Team for Implantology (ITI) 

World Symposium in Singapore in 2024, renowed 

speakers will present on W&H’s product compass 

for oral surgery and implantology, including 

their online platform OsstellConnect that aims to 

help clinicians worldwide gather data about their 

implant patients. 

From 9-11 May 2024, the W&H Group 

will present their new product compass 

at ITI World Symposium to an expected 

crowd of 3,000-4,000. The medical device 

manufacturer will highlight the synergies 

between all its products, designed to 

complement one another and deliver ideal 

surgical outcomes and reliable implantation 

procedures. 

The new product compass was assembled 

carefully over the decades by W&H, 

featuring pieces from its historic contraangle 

handpiece line to newer modular 

attachments. 

At the heart of the workflow-driven 

solution is the Implantmed Plus, the W&H 

motor for implantology and oral surgery. 

With the Piezomed module as an add-on 

solution, W&H aims to change the way oral 

surgeons work: with the Piezomed module 

in Implantmed Plus, users can have the 

advantages of precise ultrasonic technology 

at their disposal, thus covering a variety of 

surgical applications. 

EYES ON THE FUTURE OF IMPLANT 

DENTISTRY 

During the ITI World Symposium, Dr Marcus 

Dagnelid, a specialist in digital implant 

workflows and practice management, 

will moderate a lecture with three other 

specialists, titled “Eyes on the future of 

Implant Dentistry using state-of-the-artdevices 

and world of data”. 

The lecture will feature OsstellConnect, a 

cloud-based platform by Osstell that serves 

to improve implant treatment outcome and 

patient satisfaction by tracking patients and 

generating data, ultimately guiding clinical 

decision-making and creates clinical insights 

at both local and global levels. 

The speakers include Prof Dr Jörg 

Neugebauer, Dr Joan Pi Anfruns, 

Dr Nikos Mattheos, and Dr Dagnelid. Prof 

Dr Neugebauer will delve into his practical 

experiences with W&H solutions, shedding 

light on its application in daily practice. 

Dr Anfruns will emphasise the crucial 

role of implant stability measurements in 

optimising patient outcomes. Dr Mattheos 

will explore the combination of cutting-edge 

technology and the world of data in the field 

of implantology. 

Oral surgery and implantology in perfect harmony: At the ITI World Symposium the W&H Group 

will present their new product compass 

OSSTELL: GUIDE AND ORIENTATION HELP 

Coupled with the manufacturer’s handpieces 

and electric motors, the capabilities of its 

online platform and implant stability devices 

from Ostell is viewed as the “lighthouse” 

which completes the new product compass 


Dr Dagnelid (left) will be speaking at the upcoming ITI World Symposium in May 2024 on the world of data, OsstellConnect, and how it gathers data on patients 

to improve treatment planning 

for the W&H Group, providing a guide and 

orientation. 

As part of the W&H Group since 2018, 

Osstell supports dentists and oral surgeons 

worldwide in making implant treatments 

predictable and optimise the time-to-teeth. 

In particular the company uses resonance 

frequency analysis (RFA), a non-contact 

method of measuring the stability of an 

implant in the bone, to enable predictable 

implantation procedures. This means 

clinicians can objectively, quickly and 

easily determine which implants can be 

prosthetically loaded and which implants 

require even more healing time, resulting 

in better treatment prognosis and quality, 

according to W&H. Clinicians can use the 

implant stability quotient (ISQ) as a guide to 

make evidence-based decisions. 

The ISQ values is a key to how the online 

platform OsstellConnect can improve 

implant treatment outcomes. Reportedly 

free-of-charge for users of Osstell ISQ 

devices, the tool plans implant treatments 

to optimise healing protocols for different 

clinical situations and implants. It takes into 

account patient risk characteristics, the 

implant brand used and loading protocols, 

among other properties. According 

to W&H, the ISQ value can be easily 

monitored and tracked in the system after 

placing the implant. At the same time, the 

platform enables the exchange between 

implantologists and provides numerous 

practical insights based on reports. 

With a dataset of what is said to be over 

“400,000 ISQ measurements”, OsstellConnect’s 

data-driven approach can offer insights and 

predictability for the benefit of both clinicians 

and patients alike. One of the “more promising 

aspects” of the online platform can make 

better predictions of the implant treatment 

outcome, especially among high-risk patients, 

enabling clinicians to deliver more precise and 

individualised care. 

Furthermore, with Osstell’s ConsultationTool 

within the OsstellConnect platform, the 

implant treatment process can be visualised 

for patients, simplifying communication 

and ensuring transparency and trust. The 

software enables dental professionals to 

describe the different steps of an implant 

procedure in an easy-to-understand way, 

and helps to strengthen patients’ confidence 

and compliance to treatment. 

“The consultation software fills a gap in 

the market. It enables my team and me to 

explain to patients in a simple way what 

we want to achieve with the treatment 

and where we are at the moment,” said 

Dr Dagnelid. 

Having recently concluded the debut of 

its new product compass at the European 

Association for Osteointegration (EAO) 

congress in Berlin in September, W&H is 

looking forward to bringing the tool to 

Asian shores during the International Team 

for Implantology (ITI) World Symposium in 

Singapore in May 2024, as it aims to support 

and direct dental professionals around the 

world towards future-oriented products in 

the field of oral surgery and implantology. DA 


IN DEPTH WITH 

What does it mean to be 

of ‘Swiss Quality’? 

Dental Asia speaks with Swiss manufacturer Cendres+Métaux on 

what it takes to meet the high standards required for precision and 

quality in biocompatible materials. 

With over a 100 years 

of experience in metallurgy, 

Cendres+Métaux’s craft 

of processing precious 

materials is one that has 

been refined by calibre and 

time to produce solutions of 

the highest quality 

Cendres+Métaux is a global 

manufacturer of dentistry and medical 

technology, developing and producing 

its own as well as customer-specific 

products and services. It distinguishes 

itself by flying the nation’s flag high 

for its ‘Swiss Quality’ in processing 

precious materials with great 

precision into high-quality products. 

This experience in developing 

tailored solutions stems from 

Cendres+Métaux’s unique roots in 

metallurgy. 

Founded in 1885 as a smelter of 

precious metals in the town of 

Biel/Bienne, Switzerland, the 

Cendres+Métaux name came to be 

from a merger in 1924 where the 

French words, ‘Cendres’ for waste that 

has been burnt to ashes and ‘Métaux’ 

for the metals involved, were adopted. 

The production of alloys for the 

dental and jewellery industry was 

progressively established, where the 

company also started to produce 

wedding rings and dental attachements, 

and even luxury watch components for 

Swiss brands. But even with its history 

and experience, to be recognised 

internationally with the label of ‘Swiss 

Quality’, and the precision and quality 

associated with it, does not come as 

a birthright, but rather, a standard 

that is earned through the necessary 

qualifications and certifications. 

“Swiss made” and “Made in Switzerland” 

bares a world of difference despite the 


IN DEPTH WITH 

In addition to the paying close attention 

to the details at hand, providing quality 

and precise solutions for Cendres+Métaux 

also means keeping an eye on the future. 

The company is currently investing in 

new machines and working with premium 

original equipment manufacturers (OEMs) 

in the dental industry which is what 

makes constant high-quality products and 

associated services possible. 

Before any design and mixing of new alloys or materials, comes strict regulations to assure customers 

nothing short of the Swiss standard 

Across its dental and other divisions, 

Cendres+Métaux has taken measures to 

minimise its environmental footprint. The 

company is a member of the Science Based 

Targets Initiative (SBTi) and Swiss Triple 

Impact (STI) communities which enables 

organisations to set a clear and tailored 

sustainability strategy. 

close resemblance of the two terms. Where 

the latter refers to an origin source, the 

former is a controlled label with strict 

requirements to be met to be deserving 

of credibility associated with the label. 

For medical technology products, these 

regulations are no different. 

ISO 13485/14001/9001, ISO/IEC 17025, 

these are just some of necessary 

qualifications that Cendres+Métaux has been 

certified with to assure customers of its 

quality. This applies to all processes entailed 

in the means of production used and their 

environment like cleaning technology for 

cleanliness, testing laboratory accreditation, 

qualification and auditing of suppliers, and 

traceability across products, materials used 

and processes. This standard ensures that 

each product is subjected to strict control 

norms, resulting in a high level of precision, 

reliability, and durability. 

As a contract manufacturing organisation 

(CMO), Cendres+Métaux receives its product 

design from customers where checks on 

manufacturing feasibility are conducted. 

The company complies with all relevant 

procedures in the development and approval 

of dental and medical devices by carrying 

out thorough feasibility studies at an early 

stage, laying a crucial foundation for the 

subsequent product development process. 

When a customer has a material or 

precious alloy wanted for a product, 

Cendres+Métaux can prepare the precious 

metal alloy in-house, having equipped with 

certified laboratories. The properties of 

the alloys depend on its compositions. 

A main capability of Cendres+Métaux 

resides in having cutting-edge equipment 

for processing biocompatible metals such 

as titanium and precious metal alloys. 

When working with precious metals, the 

company can cast its own alloys in the 

form of ingots or using continuous casting, 

roll, draw, punch, bend, or form and 

perform heat treatment. The company is 

also able to carry out enhanced processing 

of all biocompatible materials, including 

turning and milling of diameters ranging 

from 0.5-42mm. 

Furthermore, as a specialist in metallurgy 

and precious metals, Cendres+Métaux 

can develop biocompatible materials 

for all kind of implants. Their skills in 

complex manufacturing and processing 

methods are backed by a fully equipped 

and certified laboratory for analytical 

and mechanical testing. An example of 

a tailored solution is its Ceramicor alloy 

which has been tested according to ISO 

10993-5 for cytotoxicity and ISO 10993-10 

for sensitisation. 

Cendres+Métaux plans to be climate neutral 

in 2030 in scopes one and two, and pledged 

four internal goals to be achieved by 2030 

under the SDG 13 established by the UN. 

These pledges are implemented across 

different businesses functions from core 

businesses to internal operations, like its goal 

to reduce its production materials by 10% by 

2027 in proportion to the total production 

volume, compared with 2021. DA 

With a certified laboratory, cutting-edge 

equipment and speciality in metallurgy, 

Cendres+Métaux can tailor solutions for its 

customers to solve novel and challenging tasks 


IN DEPTH WITH 

Updates and upgrades 

for the VITA VIONIC 

SOLUTIONS portfolio 

Reaching a new level in digital dentures with VITA Zahnfabrik, the 

manufacturer has launched new products to its VITA VIONIC SOLUTIONS 

portfolio and reorganised its VITA VIONIC DIGITAL VIGO Denture Library, 

to offer users more flexibility and choice in workflows and materials. 

Since September, VITA Zahnfabrik 

has added two new discs to its VITA 

VIONIC SOLUTIONS portfolio — the 

VITA VIONIC DENT DISC multiColor 

and the VITA VIONIC BASE DISC HI. 

The VITA VIONIC DENT DISC 

multiColor is constructed from 

composite material made from 

inorganically filled polymethyl 

methacrylate (PMMA). With the new 

silanised filler material, teeth milled 

from this material offer improved 

abrasion stability, polishing, 

and a longer denture lifespan. 

Furthermore, the VITA VIONIC DENT 

DISC multiColor range features an 

integrated shade gradient that offers 

natural toothlike aesthetics. This 

makes workflows more efficient 

as complex characterisation is no 

longer required. 

Meanwhile, the VITA VIONIC BASE 

DISC HI comes onto the market as an 

upgrade to its predecessor, the VITA 

VIONIC BASE DISC, with an improved 

material that is impact-resistant 

and more durable. The BASE DISC 

HI is available in three lively gingiva 

shades, with a fourth expected to be 

added in the future. 

With these new additions, within 

the VITA VIONIC SOLUTIONS 

VITA Zahnfabrik expands 

its VITA VIONIC SOLUTIONS 

portfolio with the addition 

of the VITA VIONIC DENT 

DISC multiColor (left) and 

the VITA VIONIC BASE 

DISC HI (right) 

portfolio, users themselves can mill 

teeth via CAD/CAM for full dentures, 

partial dentures, and denture bases, 

providing the flexibility to choose 

between prefabricated and customfabricated 

teeth. 

VITA Zahnfabrik is also reorganising 

its dental database which will enable 

users to cover the entire workflow for 

full and partial digital dentures using 

VITA VIONIC SOLUTIONS, inclusive of 

its new disc launches. 

Through the VITA VIONIC DIGITAL 

VIGO Denture Library, users will 

be able to digitally design try-in 

dentures, denture bases, and teeth, 

before 3D-printing or milling. Users 

can choose from seven predefined 

setup concepts for partial and full 

dentures — including cross-bite and 

the recently added setup concepts 

for straight setup lingualised, straight 

setup buccalised and Dutch lingualised 

occlusion. 

The database enables simple and timesaving 

digital design and manufacture 

using all common open CAM and 3D 

print systems. The database is available 

for the denture modules of 3Shape as 

of July 2023, and will be available for 

exocad soon. DA 


SCAN TO REGISTER 

THE LEADING DENTAL 

EXHIBITION AND CONFERENCE 

IN ASIA PACIFIC 

19-21 

APRIL 2024 

www.idem-singapore.com 

Marina Bay Sands, 

Singapore 

FIRST WAVE OF SPEAKERS ANNOUNCED! 

David 

Alleman 

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Roberto 

Sorrentino 

Andrea 

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Taisuke 

Tsukiboshi 

Alberto 

Miselli 

Paulo 

Monteiro 

Stavros 

Pelekanos 

Choi 

Yo Han 

Alfonso 

Gil 

Kenneth 

Lew 

EARLY BIRD REGISTRATION NOW OPEN! 

Connect with us 

Held in 

Supported by 

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idem.sg

PRODUCT HIGHLIGHTS 

DEXIS launches 

ORTHOPANTOMOGRAPH 

OP 3D LX 

Other new features aim to support a more 

efficient workflow and integration with the 

DTX Studio Clinic software. Some of the AI 

features of this software integration include 

3D x-ray landmark detection, tooth-centric 

workflows, correction of patient positioning, 

and annotation of mandibular nerve canals. 

Dental imaging technology company DEXIS 

has launched its next-generation OP 3D LX 

built on OP 3D technology with expanded 3D 

diagnostic capabilities. 

The OP 3D LX includes 2D and 3D imaging 

options that cover a spectrum of dental 

extraoral needs, from endodontics to 

complex surgical cases. The OP 3D LX offers 

flexible FOV options ranging from 5x5cm up 

to 15x20cm, the largest FOV option on the 

DEXIS OP 3D platform to date according 

to the company. This functionality can 

reportedly capture the maxillofacial complex 

and large diagnostic areas with one nonstitched 

scan for efficient workflows. 

“The OP 3D LX offers all the powerful 

features practices know and trust from 

our OP 3D line, with the addition of 

new innovations that provide expanded 

flexibility, improved workflow efficiencies, 

(Image: DEXIS) 

and enhanced diagnostic confidence. With 

the addition of OP 3D LX in their practice, 

doctors will be able to enhance their 

diagnosis, planning, and treatment offerings 

for a wide range of patients and diagnostic 

needs,” said VP of commercial for North 

America at DEXIS, Lori Clements. 

The user interface in the OP 3D systems 

allows for anatomy visualisation, vertical 

adjustments, and bi-directional scout 

modifications for clinical staff to capture 

only the structures of interest and reduce 

retakes. The new head support design 

provides options to scan the patient 

without interfering with the patient’s soft 

tissue profile for orthodontic and surgical 

applications. 

OP 3D LX offers a noise reduction feature 

embedded into the system software. The 

enhanced Edge Preserving Noise Reduction 

(EPNR) minimises artifacts producing clean, 

high-quality images that give clinicians 

detailed visibility in areas of interest. 

Moreover, the OP 3D LX now comes with 

cloud-based service connectivity, enabling 

remote access to system information for 

simplified installation, easier maintenance, 

and increased practice uptime. DA 

Neoss Group unveils NeoScan 2000 

Provider of dental implant solutions Neoss 

Group has unveiled its new wireless 

intraoral scanner, the NeoScan 2000. Its 

wireless technology frees clinicians from 

the constraints of cables, allowing for 

unrestricted mobility during scanning. 

This capability is said to enable the 

capture of challenging proximal areas, 

to ensure comprehensive and precise 

digital impressions. Moreover, its longrange 

connectivity provides stable and 

uninterrupted data transfer, eliminating the 

need for constant repositioning or signal 

dropouts, according to the company. 

“We believe that our new impression 

machine will make it possible for more 

dental professionals to start using digital 

impressions. NeoScan 2000’s combination of 

wireless technology, extended battery life, 

ergonomic design, and affordability makes 

it the ultimate choice for dental practices 

looking to enhance their efficiency and 

precision,” said president and CEO of the 

Neoss Group, Dr Robert Gottlander. 

In addition, Neoss Group announced that 

they will increase the free cloud storage in 

their NeoConnect to 1 terabyte, equivalent to 

about 25,000 cases. This is now available to 

any user of the NeoScan. All NeoScans come 

with free upgrades of the NeoPro software 

and NeoConnect cloud service to help 

dental professionals experience seamless 

(Image: Neoss Group) 

integration and maximise the potential of 

their scanner without any extra costs. DA 



Pac-Dent introduces 

Rodin Bond Dental 

Adhesive 

→ DISCOVER PERFECTION 

IN PROPHYLAXIS - 

THE NEW COMBI touch 

(Image: Pac-Dent) 

Dental product provider Pac-Dent has announced an 

expansion of the Rodin product line with the launch of 

Rodin Bond dental adhesive system. Its versatility extends 

to range of dental materials, including dentin, enamel, 

composites, zirconia, and various dental metals commonly 

used in porcelain-fused-to-metal crowns and bridges. 

→ ultra-gentle prophylaxis 

→ ergonomic handling 

→ made in Italy 

→ 40 years experience 

The Rodin Bond is a versatile light-cured dental adhesive 

which incorporates glass filler technology, to reportedly 

improve bond strength and performance beyond that of 

conventional unfilled adhesive systems. This high bond 

strengthen is achieved by deeply permeating dentin tubules 

and reinforcing the hybrid zone. 

The new bonding system is also designed to work in 

conjunction with Pac-Dent’s Rodin Sensiguard. The 

2-in-1 desensitiser and primer is said to promote robust 

bonding while sealing dentin tubules to prevent sensitivity 

and reducing the risk of caries formation beneath the 

restoration. The integration of Rodin Sensiguard with Rodin 

Bond increases the shear bond strength and adhesion on 

both direct and indirect surfaces, which aims to extend the 

lifespan of dental restorations. 

Both Rodin Bond and Rodin Sensiguard are designed for 

efficiency, with its bottles featuring a flip-top cap design 

for clinicians to precisely dispense a single drip of adhesive 

with a single hand. Furthermore, Pac-Dent’s unit-dose 

packaging helps preserve the integrity of the adhesive 

material by shielding it from air and moisture, which aims to 

provide consistent and reliable bonding results. DA 

→ www.mectron.com 



Forward Science enhances 

BioStōm Formulation 

MedTech enterprise Forward Science has 

enhanced its BioStōm Formulation which 

primarily focuses on bolstering bioadherence 

and optimising viscosity. 

The BioStōm formulation was first 

introduced in 2021 as an oral hydrogel 

wound dressing that stands apart as a nonopioid, 

all-natural oral pain relief gel. The 

enhancement was achieved after extensive 

research and collaboration with primary 

industry partners, PuraGraft and MPS. 

“The Forward Science R&D team 

incorporated our feedback from customers 

and were able to enhance a product that was 

already proven to work. Not only did they 

improve the product, but they also did so in 

a timely manner, which was a tribute to the 

dedication they must support their customers 

and patients,” said Scott Ryan, general 

manager of PuraGraft and MPS, a subsidiary 

of Young Innovations. 

Forward Science added that it anticipates 

the continued collaboration with Young 

Innovations as they jointly advance scientific 

frontiers. Young Innovations was founded 

around 1900 as a manufacturer of dental 

products. The Young Innovations’ portfolio 

of leading dental brands includes Young, 

Denticator, Athena Champion, Obutra Spartan 

Endodontics, Microbrush, Plak Smacker, 

Biotrol, Defend, PREAT, Germiphene, Astek 

Innovations, Natures Tip, PuraGraft, American 

Eagle Instruments, and more. 

(Image: Forward Science) 

“At Forward Science, our team prides 

themselves on moving quickly to deliver the 

highest quality products to our partners. We 

are proud to exceed the standards of our 

partners to ensure clinicians and patients 

have access to the best products available,” 

said CEO of Forward Science, Robert J 

Whitman. DA 

NSK America launches new upgrades for 

Ti-Max Z2 Series of air turbine handpieces 

Manufacturer of dental equipment NSK 

America announced the launch of updates 

for the Ti-Max Z2 Series of air turbine dental 

handpieces. The Ti-Max Z2 Series — which 

includes the Z990L, Z890L, and Z micro — has 

been upgraded to deliver improved cutting 

power and performance. The Ti-Max Z2 

Series’ Z990L, features a full 44W of power for 

enhanced functionality. 

All three handpieces are equipped with 

NSK’s ‘DYNAMIC POWER SYSTEM’ rotor 

technology. This technology provides 

consistent power delivery at high speeds, 

according to the company. The handpieces 

are also equipped with air turbine technology, 

which aims to provide a more efficient airflow 

to provide less vibration and noise. 

Other key features of the Ti-Max Z2 

Series of air turbine handpieces include 

an enhanced chuck mechanism which 

ensures a sustained grip, reducing bur 

slipping and enabling precise procedures; 

a quick stop function that halts highspeed 

rotation in one second for safety 

and efficiency during surgeries; and an 

improved cleanability where the water 

circuit on turbine head side simplifies the 

cleaning process. 

“With the launch of the Ti-Max Z2 Series, 

NSK Dental once again demonstrates its 

commitment to pushing the boundaries 

of dental technology. We believe this 

handpiece will revolutionise dental care 

by providing dentists with unparalleled 

power and precision, ultimately enhancing 

case outcomes and patient satisfaction,” 

said Colan Rogers, president/GM, NSK 

America. DA 

(Image: NSK) 



ASI Dental Specialties 

introduces Gliderlite overthe-patient 

dental surgical 

table 

Developer of dental delivery systems ASI 

Dental Specialties has recently launched 

the GliderLite, an over-the-patient dental 

surgical table designed for stand-up or 

sit-down procedures. The GliderLite was 

constructed for smaller operatory spaces, 

in contrast with the Glider, the company’s 

larger offering of an over-the-patient dental 

surgical table. 

The GliderLite can be positioned over 

standard dental or surgical-style patient 

chairs. The large, heavy-duty casters move 

the system from a stored position to over 

the patient within easy reach of the dental 

team. Moreover, dual handles allow ease 

of manoeuvrability and with the touch of 

a button, and the electronic legs can be 

raised and lowered with both programmable 

settings and incremental adjustments to find 

the desired worktable height. 

The main worktop is non-porous and 

provides the space needed to set out sterile 

instruments, cassettes, and other equipment 

needed for a procedure. It measures 

45.5x23in and is easy to clean. The design 

aims to eliminate the need for multiple carts, 

stands, and tables to keep equipment within 

reach. A floating instrument can be added 

on at the rear of the table to access or store 

more accessory items when needed. 

(Image: ASI Dental Specialities) 

Moreover, the GliderLite has two side 

dovetail which can hold attach additional 

trays, sharps containers, dispensers, saline 

irrigation/IV hooks, or miniature waste 

receptacles. Electrical outlets are located on 

back corners for use of tabletop instruments 

and the GliderLite is constructed of thickwalled 

aluminum. DA 

ZimVie announces the launch of 

Biotivity A/C Plus membrane 

Life sciences manufacturer in the dental 

and spine markets ZimVie has announced 

the recent launch of the Biotivity A/C Plus 

Membrane, a growth factor rich membrane 

used for site coverage and protection from 

the oral environment in a variety of dental 

applications. 

Dental bone grafting procedures, in 

conjunction with protective barrier 

membranes, are used to repair or 

reconstruct the jaw and to provide a 

foundation for dental implant placement. 

This launch is said to broaden ZimVie’s 

presence in the dental biomaterials market, 

expanding into the large growth factor 

segment. ZimVie’s Biotivity A/C Plus 

Membrane is a barrier membrane containing 

a variety of growth factors, cytokines, 

chemokines, and hyaluronic acid shown to 

facilitate wound healing. 

“We remain focused on bringing new 

products to market to meet customer 

needs and ensure their teams have the best 

solutions at their disposal. Biotivity’s triplelayer 

structure is thicker than conventional 

A/C membranes and may contribute to 

enhanced conformability and growth factor 

content,” said SVP and president of ZimVie 

Dental, Indraneel Kanaglekar. 

Biotivity A/C Plus Membrane is a growth 

factor-charged membrane derived from 

human placental tissue. It consists of the 

amnion, intermediate, and chorion layers, 

and is reportedly minimally manipulated 

using proprietary processing that preserves 

(Image: ZimVie) 

natural mechanical properties, elasticity, 

growth factors, cytokines, and other 

biological enhancers. 

According to the company, the product has 

been sterilised using the Excellion Process, 

and terminally sterilised with Electron-Beam 

irradiation. Unlike other A/C membranes 

available on the market Biotivity A/C Plus 

is not treated with antibiotics during the 

processing. DA 



DMG launches new 

DentaMile Desk MC System 

American dental manufacturer DMG 

has announced the launch of its 

new DentaMile Desk MC System, 

an integrated 3D-printing, washing, 

and curing unit, designed for dental 

practices and small dental labs 

venturing into dental 3D-printing. 

The DentaMile Desk MC system aims 

to provide performance and precision 

in a convenient compact size, which 

can be integrated with plug-andplay 

technology for coordination and 

immediate use. 

The first component of the new 

system is the DentaMile Desk MC-5 

DLP printer. It offers a 5x3x3.5in build 

platform area for the simultaneous 

production of multiple devices. This 

printer is also compatible with all 

standard dental CAD programmes, 

STL files. 

In addition, the DentaMile Wash MC 

unit is said to provide fast and fully 

automatic cleaning of the 3D-printed 

devices via preset programmes and a 

large cleaning container. Its magnetic 

mixer and removable basket ensure a 

thorough isopropyl alcohol cleaning of 

both devices. 

Lastly, the DentaMile Cure MC unit’s 

Omni 360° technology, an advanced 

ultraviolet LED arrangement, is 

designed to ensure uniform curing 

of 3D-printed devices. The dualfrequency 

technology, featuring two 

wavelengths, cures a variety of resins. 

(Image: DMG) 

The DentaMile Desk MC system can 

be used with DMG’s LuxaPrint suite of 

light-curing 3D-printing resins. It can 

also be used with DentaMile connect, 

the company’s cloud-based design 

software with guided workflows and 

an algorithm that automatically nests 

and slices print jobs. The new system 

also comes with DentaMile CAM 

MC nesting and slicing software to 

prepare files for 3D-printing. DA 

Renfert introduces the STEAM tube: 

An intelligent steam station 

German manufacturer Renfert has 

introduced its new STEAM tube, an 

intelligent steam cleaning station 

which aims to provide the solution 

to challenges in the dental lab when 

steam cleaning work objects. 

As an intelligent steam cleaning 

station, the STEAM tube keeps 

workspaces clean as loose dirt 

particles and impurities are collected 

thanks to its design. Residues such 

as wax or polish from steam cleaning 

the object are no longer distributed 

randomly around the steam cleaning 

unit. 

The STEAM tube not only protects 

delicate small parts, but it also 

improves visibility of the object being 

processed using a controlled steam 

discharge. The centre of the STEAM 

tube is equipped with an asymmetric 

collection hopper. During steam 

cleaning, dirt particles are directed 

through its flat side into the hopper 

filter. A finely meshed safety filter 

catches any small parts that are 

lost and protects them against 

damage or loss. 

Moreover, the targeted 

steam discharge provides 

a clear view of the object 

being cleaned. Its compact 

construction and rotatable 

hopper design enable custom 

adaptation to ergonomic 

requirements and placement in 

the dental laboratory. For example, 

the STEAM tube can be placed 

directly at the sink or also freestanding. 

The STEAM tube can easily 

be cleaned by removing the hopper, 

filter, and collection container. DA 

(Image: Renfert) 


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005024 09.19 

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

IDEC 2023 

concludes with 

growth in visitors 

and exhibitions 

Following a successful three-day run, the 

Indonesia Dental Exhibition & Conference 

(IDEC) 2023, organised by Koelnmesse and 

Traya Eksibisi Internasional in collaboration 

with the Indonesian Dental Association (PDGI), 

welcomed 5,110 visitors from 26 countries, a 

22% increase in visitor numbers since the last 

edition in 2019. 

hand instruments added that this was the 

company’s second participation in IDEC, 

since beginning its operations in Indonesia in 

2014. He expressed delight in witnessing the 

growing enthusiasm of visitors since the last 

edition. Through IDEC, the Japanese company 

introduced its new products, including x-ray 

machines, to visitors. 

This event not only showcased the latest trends 

in dentistry but also served as a platform for 

dental healthcare professionals to update their 

competencies and network among industry 

players. The new business matching platform 

was also well received among exhibitors and 

attendees, with 70 meetings set up through the 

platform. 

Furthermore, IDEC serves as an extension of 

International Dental Exhibition and Meeting 

(IDEM) scheduled for 19-21 Apr 2024 in 

Singapore. The success of IDEC 2023 plays 

an essential role in bridging the gap between 

international companies looking to enter 

the Indonesian market. “I am positive that 

IDEC 2023’s success will pave the way for its 

continued growth in future editions, attracting 

even more local and international participants 

and exhibitors, and solidifying its status as the 

leading dental exhibition in Indonesia,” said 

managing director and vice-president 

Asia-Pacific of Koelnmesse, Mathias Kuepper. 

As the first edition held post-pandemic, 

IDEC 2023 generated enthusiasm among 

industry players, driven by dynamic and 

solution-oriented innovations in dental 

technology. This enthusiasm left both 

domestic and international exhibitions with 

positive impressions, and a 20% increase in 

participation compared with 2019. 

“Visitors to IDEC keep increasing year after 

year. We hope that this event can be a 

gateway for us to enhance our customer base 

in the future,” said Muhammad Mauludin 

from J Morita. The product specialist in 

Similarly, visitors to IDEC also expressed an 

overall satisfaction with the event. Cheviara 

Faliaschazty Hasnanigha, a dental student 

from Hang Tuah University in Surabaya 

travelled to Jakarta to attend IDEC 2023 to 

enrich her dental knowledge and explore the 

latest dental technology. “This exhibition is 

excellent because it showcases a wide range 

of technologies, especially as I am currently 

looking for dental health instruments,” said 

Cheviara. 

President director of Traya International 

Exhibition, Andy Wismarsyah, emphasised 

the continuous effort to innovate and align 

IDEC with the ever-evolving trends in dental 

healthcare. He expressed the hope that IDEC 

would continue to evolve and showcase various 

advancements in dental technology in the years 

to come. IDEC will be returning for its fourth 

edition in September 2025. DA 


EVENTS CALENDAR 

2023 

NOVEMBER 

9 – 11 SIE National Congress 2023 — 38th edition 

Bologna, Italy 

13 – 14 32nd American Dental Congress 

San Francisco, US 

24 – 29 Greater New York Dental Meeting (GNYDM) 2023 — 

99th annual session 

New York, US 

2024 

JANUARY 

25 – 27 International Congress of Oral Implantologists (ICOI) Winter 

Implant Symposium 2024 

San Diego, US 

FEBRUARY 

6 – 8 AEEDC Dubai 2024 

Dubai, UAE 

28 – 29 10th World Dental Conference (WDC) 2024 

Bangkok, Thailand 

MARCH 

3 – 6 Dental South China 

Guangzhou, China 

8 – 10 12th Borneo Dental Congress 

Sarawak, Malaysia 

14 – 16 Dental Expo 

Auckland, New Zealand 

20 – 23 ADX 2024 

Sydney, Australia 

22 – 23 BDIA Dental Showcase - London 2023 

London, UK 

APRIL 

19 – 21 IDEM 2024 

Singapore 

21 – 23 DentalForum USA Spring 

Texas, US 

MAY 

3 – 6 AAO Annual Session 2024 - American Association of 

Orthodontists 

Louisiana, US 

8 – 11 IDEX 2024 - International Istanbul Dental Equipment and 

Materials Exhibition 

Istanbul, Turkey 

9 – 11 International Team for Implantology (ITI) 

World Symposium 2024 

Singapore 

16 – 18 Expodental Meeting 2024 

Rimini, Italy 

31/5 Famdent 

Mumbai, India 

– 2/6 

JUNE 

9 – 12 Sino Dental China 

Beijing, China 

17 – 18 DentalForum UK 

Alicante, Spain 

SEPTEMBER 

8 – 10 DentalForum USA Fall 

Florida, US 

12 – 15 FDI World Dental Congress 

Istanbul, Türkiye 

19 – 21 International Congress of Oral Implantologists (ICOI) 

World Congress 2024 

Orlando, US 

OCTOBER 

10 – 12 Dental World 2024 

Budapest, Hungary 

13 – 15 DentalForum Europe 2024 

Sitges, Spain 

24 – 26 31th EAO annual congress 

Milan, Italy 


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