Dental Asia March/April 2020

www.dentalasia.net 

MARCH / APRIL 2020 

Asia Pacific is Now 

Henning Müller shares Dentsply 

Sirona’s plans for Asia Pacific 

Sandblasting 

– An Alternative to Cutters or Burs 

Anterior Full Ceramic Crown 

After a Complicated Fracture of the Natural Tooth 

Photo courtesy of Dr. Juergen Manhart

CONTENTS 

MARCH / APRIL 2020 

Dental Management 

20 

An Online Journey to Healthcare and 

Wholeness 

Dental Profile 

26 

30 

Clinical Feature 

34 

44 

48 

52 

Anterior Full Ceramic Crown After a 

Complicated Fracture of the Natural Tooth 

User Report 

54 

Asia Pacific is Now 

Smarter, Faster, and More Accurate Digital 

Diagnostics 

Amlodipine Induced Gingival Enlargement 

Biomimicry Simplified using a Novel, Huebased 

Direct Composite Resin System 

Considering Alternative Options for Teeth 

Lightening 

Onlay for Upper Right Molar Using Chairside 

Workflow with 3Shape TRIOS Design Studio 

In Depth with 

63 

64 

65 

Show Preview 

71 

Regulars 

6 

8 

66 

Efficient Aesthetics with Direct Filling 

Treatments 

Harnessing the Power of Sound 

Diagnostic Excellence with Humanised 

Technology 

Experience the Latest Dental Innovations 

at Sino-Dental in Beijing 

First Words 

Dental Updates 

Product Highlights 

Behind the scenes 

58 

61 

Sandblasting – An Alternative to Cutters 

or Burs 

Going Digital – From Holding a Model to 

Holding a Mouse 

74 

75 

76 

Giving Back to Society 

Events Calendar 

Advertiser’s Index

First Words 

Taking the rough with the smooth 

Pang Yanrong 

Senior Editor 

With COVID-19 

rapidly travelling 

around the globe, the 

WHO (World Health 

Organization) has 

now considered the 

virus a pandemic (as 

of this writing). 

The effects felt has been unprecedented — 

with countries on lockdown, cruise ships 

quarantining their passengers and crew 

members, and events being postponed. For 

instance, exocad Insights 2020 has moved 

from mid-March to the second half of the 

year. IDEM (International Dental Exhibition 

and Meeting), which was planned for April, 

has been postponed to June. 

But as the world grapples with the changes 

COVID-19 brings, there are still the movers 

and shakers in the industry who are making 

the best of the situation. Take for instance, 

Henning Müller, group vice president of Asia 

Pacific RCO at Dentsply Sirona, who sees Asia 

Pacific as the future for growth (p.26). 

“Many markets across Asia are becoming 

increasingly important, not only as 

emerging markets, but also as trendsetters 

as they continue to mature. To tap into 

the growing potential of the region, 

and connect better with local dental 

professionals, Dentsply Sirona opened a 

showroom in Singapore’s Post Centre, as 

well as a state-of-the-art training centre 

and showroom in Hong Kong in 2018,” 

he revealed. 

Prof. Dr. Juergen Manhart and CDT Hubert 

Schenk continue to bring great smiles to 

people despite the situation. They shared 

how they had to do an anterior full crown 

after a complicated fracture of a natural 

tooth (p.34). 

Dr. Douglas G Watt also shared his 

experience with a female patient who 

had came in requesting for orthodontic 

treatment and restoration of her dentition, 

which he succeeded in doing so with 

3Shape TRIOS Design Studio (p.54). 

“The use of 3Shape TRIOS scanner and 

TRIOS Design Studio software as part of the 

continuous and seamless workflow, along 

with the direct integration with DGShape, 

is an easy and predictable option for inhouse 

manufacture, and same day crown 

workflow. The update to allow use of TRIOS 

Patient Specific Motion made this case even 

more predictable as the patient’s actual 

excursive and protrusive movements can 

be utilised rather than a virtual articulator,” 

he said. 

And then there’s Guido Testa who came up 

with the idea of using sandblasting as an 

alternative to cutters or burs (p.58), and 

Dr. Kevin Ng who shares about the three 

dental instruments that have been useful 

for him at his practice (p.24). 

As we continue our fight with COVID-19, 

I hope everyone stays safe during this 

period, and please continue to often wash 

your hands with soap and water so as to 

reduce the spread of the virus and other 

infectious diseases! 

FOLLOW US 

@dentalasia 

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


Align Technology Acquires exocad 

Align Technology will be acquiring dental 

CAD/CAM software platform exocad GmbH 

for approximately €376 million, bringing 

exocad’s expertise in restorative dentistry, 

implantology, guided surgery, and smile 

design to the Align technology portfolio, 

extending Align’s Invisalign and iTero digital 

solutions. 

“Dentistry today is evolving digitally, 

with technology advances and consumer 

awareness driving new opportunities in orthorestorative 

and comprehensive treatment,” 

said Joe Hogan, Align Technology’s 

president and CEO. exocad will broaden and 

deepen Align’s digital platform by addressing 

restorative needs. 

“I am excited by the enormous growth 

opportunity for exocad and its customers 

that comes with being a part of Align 

Technology,” said Tillmann Steinbrecher, CEO 

Joe Hogan 

and co-founder of exocad. “Together, we will 

further strengthen exocad’s position as a key 

technology provider for the dental CAD/CAM 

industry and drive continuous innovation with 

the open and integrated approach that is the 

foundation of our company.” 

exocad will continue to operate as it exists 

today, and co-founders Tillmann Steinbrecher 

and Maik Gerth, along with their team, are 

expected to remain after the transaction 

closes. 

“The acquisition of exocad adds a talented 

and passionate team as well as a highly 

innovative, industry-leading product suite 

to our portfolio,” said John Morici, Align 

Technology’s senior vice president and CFO. 

“We will continue to invest in and build on 

exocad’s leadership in the dental CAD/CAM 

market and look to them to make significant 

contributions to Align’s overall strategy.” ■ 

Tillmann Steinbrecher 

exocad Insights moves dates to 21 - 22 September, 2020 

Due to the spread of the coronavirus 

worldwide and increasing travel restrictions, 

exocad GmbH has decided to postpone the 

Insights 2020 event, originally planned for 

mid-March, to 21 st – 22 nd September. The 

venue remains unchanged at darmstadtium 

in Darmstadt, Germany. The decision is also 

supported by the 43 cooperation partners. 

“The safety and health of our participants, 

partners and employees is our top priority,” 

explained Novica Savic, CCO of exocad. 

Insights 2020 focuses on the almost limitless 

possibilities of exocad’s open software 

platform, on which intraoral and model 

scanners, milling machines, 3D printers and 

DVT devices from different manufacturers 

can be combined to form a consistent digital 

workflow. ■ 

An evening with dinner and live music will round off the event in the 

festive presence of the approximately 850 international participants 

The two-day event, which is aimed at both dental technicians and dentists, offers a varied 

programme consisting of software education, partner sessions and international guest 

speakers 

8 DENTAL ASIA MARCH / APRIL 2020


Modern and Intuitive: Double Triple for W&H Design 

When man meets machine, user-friendly operation plays a crucial 

role. For Austrian company W&H, this is precisely where the focus 

lies when designing medical technology products. W&H’s designs 

have succeeded in winning over not one but two international juries, 

with three products winning prizes at the Good Design Award 2019 

in the USA and the German Design Award 2020. 

They fit perfectly in the hand, are intuitive in their operation, provide 

optimal freedom of movement and also look great: these are the 

main reasons why W&H products — Proxeo Ultra, Proxeo Twist 

Cordless and Assistina Twin — were awarded two internationally 

renowned Design Awards. 

Proxeo Ultra, 

Proxeo Twist 

Cordless, and 

Assistina Twin 

Head of W&H product design team, Kerstin Molzbichler, said, “When 

developing our products, our focus is firmly on the customer and 

their needs. Ultimately, our products are the interface between man 

and machine, between dentist and patient. 

Maria Protiwa-Kinzl, Nils Deringer, Kerstin Molzbichler, Kerstin Oberhofer, Leon 

Koopman, and Doris Rausch 

“Innovation is reflected in cost-effective solutions that customers 

can also relate to on an emotional level and appreciate for their 

function and economy. We are delighted that three products have 

been awarded two renowned prizes.” ■ 

The TeleDentists Lead Educational Awareness Campaign on Dry Mouth 

Virtual dental service The TeleDentists 

is providing education to help increase 

the identification, diagnosis, and 

treatment of dry mouth, also known as 

xerostomia, beginning with the city of 

New York. The condition is a common 

oral condition among the elderly 

together with periodontal disease and 

dental caries, and can cause serious 

complications in the oral cavity. 

Dr. Maria Kunstadter 

To combat this silent epidemic, The 

TeleDentists has partnered with calcium phosphate rinse maker 

SalivaMAX to provide teledentistry and relief to xerostomia and other 

oral health conditions. 

“As dentists, we see the damaging effects of dry mouth every day. If 

you’re not aware that you have the condition, and don’t see a dentist 

before the damage sets in, you may end up needing extensive dental 

work,” said The TeleDentists Co-founder Dr. Maria Kunstadter. After 

a virtual consultation, a solution, such as a prescription rinse, can 

be found. 

A rinse for 

dry mouth 

The connected care platform does not take the place of the local 

dentist, but facilitates emergency care and coordinates the followup 

trip to the dentist. It can be especially helpful for those who lack 

access to a dentist. Teledentistry has also been tested as a means of 

pushing oral health video visits into underserved areas like low-income 

neighbourhoods and community health centres. ■ 



Formlabs Partners with BEGO for 3D Printed Crowns and Bridges 

Dental customers of 3D printing system 

manufacturer, Formlabs, will soon be able 

to 3D print crowns and bridges for patients 

with BEGO’s best-in-class dental materials 

in a new partnership. The completely digital 

dental workflows will enable a rapid, low-cost, 

and iterative process for better patient care 

and case acceptance. 

“Directly printing temporary crowns and 

bridges are one of the most sought-after 

applications from Formlabs customers. By 

partnering with BEGO and leveraging their 

130 years of dental experience, we will be 

able to not only address this need, but take 

it a step further by offering materials for 

permanent crowns. We are excited to see 

how this partnership can continue to advance 

the dental industry and overcome the major 

challenges labs and dentists face as digital 

dentistry becomes a standard 

for patient care,” said Dávid 

Lakatos, chief product officer 

at Formlabs. 

chief executive officer of BEGO Dental, Axel 

Klarmeyer, said, “We could not be happier 

to partner with Formlabs, especially at this 

time, where digital dentistry is reaching a 

breakthrough. It took some time and a lot 

of effort and commitment of all involved 

people to be able to offer to the market a 

fully validated workflow for final restorations. 

This partnership underlines BEGO’s leading 

position in the dental 3D printing materials 

market.” ■ 

Dávid Lakatos and Axel Klarmeyer 

3D printed crowns 

3D-Printers for Labs of All Sizes 

Printers from German prototyping company 

Rapid Shape allow lab owners to make an 

impact in the dental prosthetic industry. Small 

labs can start 3D printing with professional 

equipment on a small budget, while dentists 

can print locally even without specialist 

knowledge. Besides its D20+ printer, which is 

the most economic professional 3D printing 

solution for dental labs, the company also 

manufactures D30+ and D40II, which are fast, 

flexible, and semi-automated, and D30+ ortho, 

which prints up to six models in 20 minutes. 

Rapid Shape has an open material system with a growing material library, 

and compatibility with common CAD programmes 

Rapid Shape products communicate with each other, simplifying complex processes 

A machine that works 24/7 

The key to printing large quantities efficiently 

is automation. For example, the D90+, which 

is meant for industrial dental production, has 

an automation system for up to eight selfloading 

platforms. The ready built job is taken 

out directly and the next print starts without 

any delay. This means that the machine is 

able to work without breaks, and even in 

night shifts. Another labour-saving feature 

can be seen in the automated part separation 

module (ASM, patent pending) for the D100+ 

ortho. Multiple print jobs are collected in an 

integrated catch tank, eliminating the need 

for a human operator. It is also fast, and able 

to print up to 24 precise ortho models in 25 

minutes. ■ 



Carestream Dental Introduces Digital 

Dentistry Difference Campaign 

With an educational campaign, digital dental solutions provider, 

Carestream Dental, will educate consumers about the benefits 

of digital dentistry, and arm doctors with resources to prompt 

conversation with their patients, solving a significant awareness 

gap. 

According to surveys, patients across the globe believe that the 

oral healthcare industry lags behind both optical and orthopaedic 

in terms of the technology used. Even more surprising, less than 

half of patients even believe their doctor uses very advanced 

technology. 

The campaign will explain how 3D CBCT imaging 

allows a more complete and detailed picture 

“It is a missed opportunity when you consider that doctors 

are investing in digital dentistry to improve patient care, yet 

many patients do not understand the level of advanced digital 

technology the industry offers, or how it can change their lives,” 

said Ed Shellard, D.M.D., chief dental officer of Carestream Dental. 

“This campaign will change that by speaking directly to consumers 

about why they should be asking about the technology used by 

their doctor.” 

This education is likely to help increase patient retention, bring in 

new patients, and enhance patient perception of care. The tools 

available include a video and infographics which can be shared 

through social channels, in a doctor’s waiting room, or referenced 

during patient consultations. ■ 

The campaign will explain how a digital scan is 

more comfortable and quicker


Gain Practical Knowledge and Improve Treatment Success 

Dr. Peter Wöhrle, who will be a speaker 

and moderator at the upcoming Nobel 

Biocare Global Symposium 2020 in Las 

Vegas, US, gave insights into what implant 

professionals can expect at this world-class 

event. 

He said, “What I always find exciting about 

Nobel Biocare symposia are the first 

revelations of innovative new solutions that 

have real potential to improve the way we 

can treat patients, and subsequently make 

my practice stand out from the rest. This 

year is no exception.” 

In particular, he is heartened that the panel 

of speakers will include the next generation 

of experts, who have already excelled in 

implant dentistry and are bringing a new 

approach and perspective to the field. 

“On a personal level, it’s extremely 

rewarding to network with other dental 

Dr. Peter Wöhrle 

professionals. I learn so much from the 

experiences my colleagues are having, 

we compare the challenges we have 

to deal with, share different opinions 

about this exciting and rapidly evolving 

market. It can be challenging for a lot 

of practitioners and technicians to find 

the time to interact with their peers, but 

don’t underestimate how much you can 

learn from networking and socialising. I find 

this such a valuable part of the symposia 

Delivering predictable aesthetic outcomes, 

combined with shorter time-to-teeth, is 

paramount in today’s market place 

At the Global Symposium, you can gain 

practical knowledge to improve treatment 

success and skill sets with a mix of hands-on 

sessions, discussions and presentations from 

many experts 

experience,” he said. 

The programme will feature topics of interest 

such as hard and soft tissue regeneration, 

treatment planning, managing complications, 

extreme cases, ceramic implants, and digital 

dentistry. These solutions are based upon 

scientific principles, which are presented in a 

logical and convincing way. ■ 

The panel of speakers is comprised of a 

diverse group of experts from different 

specialties, both from clinical practice and 

scientific research, many of whom have been 

world-renowned for many years 

The question of how dental implant professionals around the world can advance their skills and practice 

implant dentistry at the highest level is answered at the symposium 



A Place for Every Endodontic Material 

Specially developed to bring order to the materials used 

for endodontic treatment, VDW.FLO Endo Organisers from 

endodontic solutions provider VDW keeps all necessary materials 

tidy and readily at hand during treatment. The organiser has 

compartments that are precisely matched to the packaging of 

relevant materials, and fits standard drawer and trolley sizes. 

Loose instruments, irrigation, obturation, and post-endodontic 

materials can be organised on the multifunctional insert for a 

clear overview of inventory. It can also be adapted to individual 

workflows with a set of blank and pre-printed sticker labels. Made 

of easy-to-clean and robust plastic, the organiser is equipped 

with a non-slip silicone underside to facilitate compliance with 

hygiene measures in practice. 

Integrated solutions for endodontics 

For over 150 years, VDW has represented experience in the 

development and manufacture of products for endodontics. 

Today, VDW offers a holistic range of solution covering the 

entire endodontic treatment spectrum, from obturation to postendodontic 

care. Its product range includes instruments for 

root canal preparation, an endodontic ultrasonic device, fillers 

and sealers for root canals, and quartz fibre posts. The company 

also runs application-related advanced training programmes in 

endodontics. ■


Rebranding as a Premium Dental Tourism Destination 

The rise of India, Malaysia and Thailand 

as medical tourist destinations comes at 

the expense of Singapore, which is rapidly 

losing market share to its neighbours 

which are able to offer cheaper healthcare 

and compelling savings to tourists. 

In particular, many tourists are drawn by 

lower costs of dental work, which are done 

by local dentists who had returned from 

overseas studies. Some 

medical groups have 

already set up offices 

in regions such as 

Vietnam and China, 

to take advantage of 

the demand. Others 

have diversified 

their foreign 

patients 

base to lesstraditional 

markets 

such as Myanmar, Cambodia, 

Bangladesh, and India. 

According to Dr. Melvin Look 

of PanAsia Surgery Group, 

to stay ahead, private 

groups here must continue 

to reinvent themselves and 

reinvest, and start looking 

into exporting Singapore 

medicine overseas, rather 

than wait for the patients 

to come. 

Others, such as Dr. Kelvin Loh of IHH 

Healthcare, believe that as healthcare 

standards in neighbouring countries move 

up the healthcare value chain, Singapore 

will stand out with its proven track record 

of delivering superior clinical outcomes. 

“Singapore can stay ahead of the curve by 

continuing to enhance its service offerings, 

such as investing in state-of-the-art 

Dr. Kelvin Loh 

facilities, disruptive medical technologies, 

and a strong team of doctors and healthcare 

professionals.” 

In the days to come, medical tourism to 

Singapore will be supported by regional 

growth trends, with the demand for quality 

private healthcare rising as populations 

age. ■ 

Dr. Melvin Look 

Relief Efforts for the Australian Bushfires 

In response to the devastation caused by 

the Australian bushfires, American dental 

supplier Henry Schein is raising money for 

recovery and rebuilding efforts, donating 

much-needed health care supplies, and 

supporting its dental customers who may 

be impacted by the ongoing crisis. 

The Disaster Relief Fund will seed 

a US$50,000 donation and match 

employee contributions up to 

US$25,000. In addition, Henry Schein 

plans to donate up to US$50,000 worth of 

health care product to relief organisations. 

Locally, Henry Schein Australia is also 

donating a portion of its January sales to 

local relief efforts. 

“Team Schein stands ready to assist our 

relief agency partners and local health 

care providers in their efforts to rebuild 

and recover from these terrible fires,” said 

Stanley M. Bergman, chairman of the board 

and CEO of Henry Schein. “Our company 

has long been committed to supporting 

disaster preparedness and recovery, and 

we are working with our supplier partners 

and Team Schein Members to provide 

relief agencies with the resources they 

need to support public health.” 

The fund is not limited to Team Schein 

Members. Credit card donations can 

be made on the Henry Schein Cares 

Foundation website, and cheques can 

be made payable to “Henry Schein Cares 

Foundation” and mailed to Kate Sorrillo, 

Henry Schein Cares Foundation, Inc., 135 

Duryea Road, Melville, NY 11747. ■ 



Arizona Mission of Mercy Dental Mission 

Dr. Jennifer Wynn (third from left) and her incredible 

team prepped and seated 17 crowns in under six 

hours using Dentsply Sirona’s CEREC technology 

and extractions to endodontics and 

restorations. Many patients waited through 

the night to ensure they were among the 

first to receive treatment. Approximately 

200 dentists and 1,300 assistants, 

hygienists and dental students volunteered 

at the event. 

During the 2019 Arizona Mission of Mercy, 

Dentsply Sirona provided free dental 

restoration treatment to hundreds of 

Arizonans in need. In partnership with 

Patterson Dental, Dentsply Sirona’s CEREC 

team set up five treatment stations for the 

recent event, helping volunteer healthcare 

professionals to perform more than 125 free 

restorations in just two days. 

About 2,000 patients received dental 

treatments ranging from cleanings, fillings 

General manager of Patterson Dental, Jay 

Connors, said, “We partner with Dentsply 

Sirona each year to bring in two to three 

panoramic x-ray units that the service 

team sets up and uses for imaging. Having 

five full CEREC stations allowed our 

volunteer CEREC dentists to complete more 

restorations. 

“The dental care our volunteers provide 

not only solves patients’ dental issues, but 

more importantly, helps them to regain 

Around 1,500 volunteers came together to provide 

free dental care for 2,000 patients during the 2019 

Arizona Mission of Mercy 

their confidence and empowers them to 

smile again. When you are not in pain or 

embarrassed to smile, life is better. We are 

grateful to support this wonderful event 

where people’s lives are literally changed 

for the better.” ■ 

MARCH / APRIL 2019 DENTAL ASIA 

17


Prescription of Opioids and Antibiotics for Emergency Dental Conditions 

A study in the March issue of The Journal of the American Dental 

Association (ADA) from the Centres for Disease Control and 

Prevention found that antibiotics and opioids are frequently 

prescribed during emergency department visits for dental 

conditions, further emphasising the need for continued efforts to 

combat both opioid abuse and overuse of antibiotics. 

The authors found that more than 50% of patients who visited 

the emergency department for a dental-related condition filled 

a prescription for antibiotics and approximately 40% filled a 

prescription for opioids. 

Acetaminophen 

A growing body of research supports ADA policy that dentists 

should consider prescribing non-steroidal 

anti-inflammatory drugs (NSAIDs) alone or 

In 2019, the ADA released a 

new guideline indicating that, in 

most cases, antibiotics are not 

recommended for toothaches, which 

are a common dental-related reason 

to visit an emergency department. 

in combination with acetaminophen over 

opioids as first-line therapy for acute pain 

management. In March 2018, the organisation 

adopted policy that indicates a combination of 

ibuprofen and acetaminophen can be just as 

effective as opioids for acute pain. 

The guideline was developed by a 

multidisciplinary panel, including 

an emergency medicine physician 

nominated by the American College 

of Emergency Physicians. 

American College of Emergency Physicians 

The ADA will continue to work together with 

physicians, pharmacies, policymakers and the 

public to address these issues that are critical 

to public health. ■ 

Preventing and Healing Tooth Decay with a Bioactive Peptide 

Cavities, or dental caries, are the most widespread noncommunicable 

disease globally, according to the World Health reduce demineralisation, or the dissolving of tooth enamel, while 

by the plaque-forming bacteria that cause cavities, and 2) 

Organisation. Having a cavity drilled and filled at the dentist’s increasing remineralisation, or repair. 

office can be painful, but untreated caries could lead to worse pain, 

tooth loss, infection, and even illness or death. Now, researchers The researchers based their anti-cavity coating on a natural 

in ACS Applied Materials and Interfaces report a bioactive peptide antimicrobial peptide called H5. Produced by human salivary 

that coats tooth surfaces, helping prevent new cavities and heal glands, H5 can adsorb onto tooth enamel and destroy a broad 

existing ones in lab experiments. 

range of bacteria and fungi. To promote remineralisation, the team 

added a phosphoserine group to one end of H5, which they thought 

Conventional treatment for dental cavities involves removing could help attract more calcium ions to repair the enamel than 

decayed tissue and filling the hole with 

natural H5. They tested the modified peptide 

materials, such as amalgam or composite 

on slices of human molars. Compared with 

resin. However, this procedure can damage 

natural H5, the new peptide adsorbed more 

healthy tissue and cause severe discomfort 

strongly to the tooth surface, killed more 

for patients. Hai Ming Wong, Quan Li Li and 

bacteria and inhibited their adhesion, and 

colleagues want to develop a two-pronged 

protected teeth from demineralisation. After 

strategy to prevent and treat tooth decay: 

brushing, people could someday apply the 

1) prevent colonisation of the tooth surface 

modified peptide to their teeth as a varnish or 

gel to protect against tooth decay. ■ 

H5 antimicrobial peptide 



Infection and Prevention Control 

Recommendations for Healthcare 

Professionals in the Current Coronavirus 

Situation 

Based on currently available information about COVID-19, 

guidance has been provided by the Centers for Disease Control 

and Prevention. These include minimising chance for exposures, 

adherence to standard and transmission-based precautions, 

patient placement, taking precautions when performing aerosolgenerating 

procedures, collection of diagnostic respiratory 

specimens, and management of visitor access and movement 

within the facility. 

Personal protective equipment 

There is an increased emphasis on early identification and 

implementation of source control, meaning putting a face mask 

on patients presenting with symptoms of respiratory infection. 

Updated recommendations include reserving airborne infection 

isolation rooms for patients undergoing aerosol-generation 

procedures, while patients with known or suspected COVID-19 

should be cared for in a single-person room with the door closed. 

Based on local and regional situational analysis of personal 

protective equipment (PPE) supplies, facemasks are an acceptable 

alternative when the supply chain of respirators cannot meet the 

demand. Available respirators should be prioritised for procedures 

that are likely to generate respiratory aerosols, which would 

pose the highest exposure risk to healthcare personnel. As major 

distributors in the United States have reported shortages of PPE, 

specifically N95 respirators, alternatives such as elastomeric halfmask 

and full facepiece air purifying respirators, and powered air 

purifying respirators should be considered. 

Eye protection, gown, and gloves continue to be recommended. ■

An Online 

Journey to Healthcare and Wellness 

DoctorxDentist started off as 

a simple blog in 2016 where 

doctors and dentists could 

contribute educational articles 

and answer health-related 

enquires. Today, the platform 

is supported by 300 doctors 

from 33 different specialties. 

Tristan Hahner, Co-founder of 

DoctorxDentist, shares his vision 

for the platform and beyond. 

An alternate window 

Healthcare is very personal and private 

to each individual. Marrying this into the 

Internet space provides people a convenient 

alternative to better understand their health 

conditions and even exchange treatment 

experiences. 

The majority of these online sources specific 

to healthcare are written to be general to be 

relatable to the masses. While the availability 

of such articles are useful in many ways, 

they can easily allow people to assume the 

worst too, bringing forth cyberchondria, a 

term coined for an Internet-induced anxiety 

from self-diagnosing health problems 

online, said Tristan Hahner, Co-founder of 

DoctorxDentist (DxD). 

He explained, “In the past, for example, 

people considering a wisdom tooth 

extraction surgery would proceed with 

treatment along with a sense of assurance, 

after hearing from the surgeon about 

their prognosis. Today, however, the mere 

mention of a possible nerve damage during 

surgery could spook patients into changing 

their minds and even opting out of surgery.“ 

Hahner stressed that patients ought to be 

thoroughly informed of all the risks and 

dangers of treatments before making a 

decision. In addition to the insights they 

are able to gain through researching their 

medical health online, he highlighted the 

key is to cross-check the online information 

with trained physicians and attend physical 

consultations as these opinions help to put 

things into perspective for patients, on a 

case-by-case basis. 

Turning to the Internet for diagnosis 

As early as 2002, about 93 million Internet 

users in the US are able to access health 

information from online sources, according 

to a study released by the Pew Internet & 

American Life Project. This statistic has 

definitely grown exponentially, Hahner 

said, as the world becomes more digitally 

connected and reliant on the web. 

He further pointed out that the platform has 

seen an upward trend in web traffic as more 

users in Singapore are researching their 

health problems online, and elaborated, “I 

notice an increased level of sophistication 

in users’ questions – a sign that users 

have aggregated knowledge about a given 

subject. One example is a recent question 

we have received on the dental effects 

of hydrogen peroxide in teeth whiteners 

where the user is clearly aware of potential 

negative side effects of hydrogen peroxide.” 


Dental Management 

Explaining the reasons for users to seek 

health advice online, Hahner credited 

the option to be anonymous, especially 

when identity protection is key to users. 

And on costs of treatments, which is a 

popular concern among DxD users, the 

platform features articles with detailed 

cost breakdowns and are well-received. 

Particularly for the Singapore market, he 

pointed out that Singaporeans are open 

to receiving multiple opinions from various 

doctors, and are “very meticulous” and 

like to be well-informed and fully prepared 

before making a decision. 

The lack of information is a dangerous thing 

Information in the world of the Internet 

travel fast, and at times, unverified or even 

fake. Hahner acknowledged the danger of 

using information that is not verified by 

accredited and licensed entities, and said 

that “casual” health information found 

online may have been overly simplified, 

misinterpreted, taken out of context, and 

even rife with conflicts of interests at times. 

He explained, “Many content writers of such 

unaccredited sources have no background in 

medicine and rely on second- or even thirdhand 

sources. For example, teeth whitening 

products have been declared harmful by 

some online sources when dentists have 

clarified that the levels are often too low to 

damage otherwise healthy teeth. Relying on 

and trusting unverified health information 

have the potential to cause public health 

scares, monger irrational fear and even 

complicate proper treatment.” 

This brings forth an opportunity for DxD as 

a platform that brings health professionals 

together to share their knowledge and 

expertise. Having an online voice on a 

content platform multiplies the ability of 

doctors and dentists to help and effect 

change, from helping individuals to helping 

populations all around the world. 

“As with doctors, I stress that patients 

should always consult doctors to clarify 

any medical doubts and queries. Reading 

up health content is a great way to expand 

our health knowledge and stay informed 

of the latest news in the medical sphere. 

Nevertheless, always check with a doctor, 

who can then put such information into 

context and present patients with completed 

information,” Hahner said. 

“Health is very personal and individual 

– what applies to one may not apply to 

another; only a doctor, equipped with the 

necessary tests, observations, knowledge 

and experience can safely and reliably 

prescribe the best course of action.” 

More than an information provider 

DxD envisions a world where everyone – 

regardless of language or location – is 

empowered to make better informed health 

decisions. As the only website in Singapore 

certified by the Health On the Net Foundation 

(HON) for trustworthy medical information, 

DxD takes its responsibilities as information 

provider seriously. 

Other than supplying the public with 

accurate health information, DxD also 

aims to support medical practitioners in 

Singapore. “We help them to be recognised 

for the excellent work they do, and we keep 

their practises alive, even in difficult times 

like this, where patients are afraid to go 

to hospitals because of the coronavirus 

outbreak. Through the DxD platform, 

Singapore doctors are able to connect 

to the public in a safe and productive 

environment,” said Hahner. 

DoctorxDentist is now available also 

in Indonesia, where there are just 0.2 

physicians per 1,000 people according to 

the World Health Organisation. Launching 

a local team and website will bring expert 

health content to Indonesians, while growing 

Indonesian patient referrals to Singaporean 

doctor partners. Indonesian patients bring 

revenues of $100 million each year to 

Singaporean doctors, but many medical 

practises in Singapore lack an effective 

marketing channel to reach them. 

“However, I would also highlight that 

engaging in DxD’s services does not 

constitute as nor take the place of a 

medical consultation, and are, therefore, 

not considered telemedicine. It is our 

longstanding belief that it is best for patients 

to visit a doctor for their medical issues.” DA 


Word of Mouth 

WORD OF MOUTH 

By Dr. Kevin Ng 

Dr. Kevin Ng’s post-graduate qualifications include Master of Dental Surgery (Sydney), Fellowship of the Royal Australasian College of 

Dental Surgeons (FRACDS), Diploma in Implant Dentistry at the Royal College of Surgeons of England, and Membership of the Faculty of 

Dental Surgery (MFDS) at the Royal College of Surgeons of Edinburgh. He has been part-time lecturing on oral and maxillofacial surgery 

and cariology at Hong Kong University since 1981. Here, he shares the three dental instruments that have been most useful to 

him at a private practice in Hong Kong. 

CS 9600 CBCT Scanner from Carestream 

The high resolution of the CS 9600 CBCT system provides crisp images with exact 

anatomy landmarks that help tremendously in assessment and planning for all my dental 

surgeries. Its ability to capture images at low doses meets my safety considerations 

for patients. 

As all my 2D images, 3D images, and 3D face scans are assessable from the accompanying 

software, CS Imaging version 8, communicating with patients has become easier. Patients 

trust us more when we stay up-to-date with the latest technological advancements. 

CAD/CAM data assessable from the same software also makes liaising with technicians 

more convenient than before, when it comes to making surgical stents and temporary 

restorations for implant surgeries. 

iTero Element 5D from Align Technology 

Besides saving costs on traditional impression materials, I have found that digital 

impressions produced by intraoral scanner are more accurate and precise. 

I’m also able to detect inter-proximal caries early. Instead of sending physical 

impressions to the laboratory, I can now send the digital impressions via email, 

which is a big time-saver. 

When I can explain treatment outcomes using the scans, patients are able to 

understand me better. It also makes diagnosis and treatment planning better 

and more efficient, which will ultimately translate into the clinic’s bottom line. 

Waterlase iPlus all-tissue laser from Biolase 

I use the minimally invasive dental laser system primarily in 

periodontal treatments, both on natural teeth and those affected 

by implantitis. Compared to traditional tools such as needles, 

drills and scalpels, the laser is relatively pain-free for patients. Its 

ability to remove soft tissue with no bleeding and allow enamel 

etching without the use of acid are also plus points. 

I also prefer using this in the debridement and irrigation of 

root canals in endodontic treatments compared to traditional 

chemomechanical methods. Finally, it comes with a good record 

system that helps me monitor treatment progress and saves 

me time. 

24 

DENTAL ASIA MARCH / APRIL 2020


Asia 

Pacifi c 

is 

Now 

Henning Müller 

Group Vice President Asia Pacific RCO 

Dentsply Sirona 

Since joining Sirona Dental 

Systems in 2008, Henning 

Müller had taken on a variety 

of roles, such as vice president 

of Sales for China, Hong Kong, 

Korea, and ASEAN. He then moved on to the 

implants business as vice president of Sales 

for Japan, Australia, New Zealand, India, as 

well as several markets in southern Europe, 

before becoming group vice president of 

Asia Pacific RCO at Dentsply Sirona in July 

2017. 

professionals, Dentsply Sirona opens 

showrooms and training centers all over 

Asia Pacific, e.g. in Singapore’s Post Centre, 

as well as a state-of-the-art training centre 

and showroom in Hong Kong in 2018. 

Our most recent showroom and academy 

was opened in Jakarta, Indonesia, in June 

2019. Dental professionals have responded 

positively to our new facilities and the live 

training sessions, demonstrating a keen 

desire to invest in their careers. In addition 

to our own training centers we are happy to 

collaborate with strong, independent 

partners such as International CEREC 

Institute (ICI) in Daejeon, South Korea; and 

the CEREC Asia Training Centre in Taipei, 

Taiwan to provide education courses. 

What are Dentsply Sirona’s plans for 

Asia Pacific in the next three to five 

years? 

We see tremendous opportunity in the 

region and are focusing to increase our 

presence across the region more and 

more, e.g. in Indonesia and Vietnam. 

Our employees have spent a lot of 

time listening to our customers, and 

engaging with dental professionals 

as part of our research process and 

product development. Digital is the 

future of dentistry, and technological 

innovation is the key to providing value 

for our customers. From a customer 

service perspective, we are implementing 

more digital tools to create a better 

patient experience, and developing more 

e-commerce solutions. 

How does Dentsply Sirona differentiate 

its products in the market? 

One of the special things that differentiates 

us is our ability to integrate products from 

different areas, thus creating a workflow that 

helps to improve the quality of treatment 

and its clinical results. For example, our 

Sharing with Dental Asia, he talks about 

digital plans for Asia Pacific, continuing 

education for dental professionals and 

Dentsply Sirona’s employees, as well as 

equipping the next generation of dentists. 

Opening of Dentsply Sirona’s showroom 

and training centre in Hong Kong 

What is the company’s overall growth 

and expansion strategy in the region? 

Asia Pacific is now. Many markets across 

Asia are becoming increasingly important, 

not only as emerging markets, but also as 

trendsetters as they continue to mature. 

To tap into the growing potential of the 

region and connect better with local dental 



integrated solutions in implantology take 

clinicians from data capturing, restorative 

and implant planning, guided surgery and 

intraoral scanning to implant selection, 

positioning, restoration design and 

manufacturing, to restorative solution. 

Our customers do not have to worry about 

interfaces or compatibility at any point in 

time – it simply works. 

When customers invest in Dentsply Sirona 

products, they are assured that their 

investment is for the long term. A great 

example would be our Orthophos imaging 

devices. A practice might be just getting 

started with digital dentistry, so we offer 

the flexibility of a hybrid 2D/3D unit that 

can be ordered with 2D capability, and 

to be upgraded to a 3D unit when the 

practitioner is ready. 

Another example is CEREC, which integrates 

scanning, design, milling, grinding and 

sintering through CEREC Primescan, 

CEREC Software, CEREC Primemill, and 

CEREC SpeedFire*. This allows users to 

produce impressive restorations with 

precise margins in a thoroughly thoughtout 

workflow, from a single source that 

is only available from Dentsply Sirona. 

These CAD/CAM solutions open up a world 

of possibilities for customers in digital 

dentistry. For example, the time required to 

fabricate a zirconia crown can be shortened 

to as little as five minutes. 

Investigator Initiated Studies. Currently, 

more than 170 such research projects 

are in progress, involving more than 300 

investigators in over 20 countries. 

While a product is going through approval 

and regulatory processes, key 

specialists are trained extensively 

on the product before it is brought to the 

market. We offer a mentorship programme 

for first-time users, who learn from 

experienced fellow practitioners. 

How do you encourage your team to 

remain motivated and enthusiastic? 

We value our employees and know 

that a company can never rest on its 

laurels regardless of success. We have a 

responsibility to create opportunities for 

our employees to develop professionally 

throughout their careers, at all levels. 

Therefore, we’ve invested in our own virtual 

training hub known as DS University, where 

employees can participate in a variety of 

courses, which we keep expanding year 

after year. 

In addition, we discuss the mission and 

vision of the company in depth with our 

employees. Recently, CEO Don Casey and 

the executive team engaged with more 

than 13,000 employees worldwide to 

discuss the company culture and our 

The renewed CEREC system - CEREC Speedfire, 

CEREC Primemill and CEREC Primescan 

purpose to make people smile in a 24-hour 

livestream event. From a TV studio created 

in the middle of our production facility in 

Bensheim, Germany, the leadership team 

connected with 90 global sites. Knowing 

that we are all working towards worthwhile 

goals is a powerful motivation. 

How has your team adapted in 

responding to emerging needs? 

More than a year ago, our team moved to a 

new office in Hong Kong, which is the hub 

for Dentsply Sirona in Asia. The organisation 

has undergone a restructuring, which gave 

us tremendous opportunities for growth, 

How does Dentsply Sirona show 

customers that its continuing education 

courses are backed by the latest 

science? 

Besides the ease of use and speed, dental 

professionals are also concerned with the 

steep learning curves, and the science 

behind products. Dentsply Sirona is 

dedicated to science, and runs a variety of 

research activities in close collaboration 

with universities, dental professionals 

and opinion leaders. An important part 

of our clinical research programme is the 

*Note: Availability depends on registration timelines. 

MARCH / APRIL 2020 DENTAL ASIA 

27


Intego treatment centre in Dentsply Sirona’s 

Singapore Showroom and Training Centre 

and led to a greater focus on the customer 

within our workforce. We are now better able 

to customise our offering and this enables 

the talent of the team to shine through. 

Our employees are our greatest assets when 

it comes to responding to emerging needs. 

They care deeply about the customers and 

have a sense of purpose for the work they 

are doing. Working as a solutions provider in 

healthcare gives us the privilege of helping 

dental professionals give the best possible 

care to their patients. As a team, our size 

and depth allow us to focus on developing 

specific expertise for emerging needs. 

the high level of customisation required, 

Dentsply Sirona’s Special Clinic Solutions 

team put together a complete solution 

from the ground up and supplied all of 

the equipment needed. Since clinicians 

understand best the needs of their patients, 

our Special Clinic Solutions team works 

closely with them to build the set-up of their 

dreams. 

What else can we expect from Dentsply 

Sirona’s Asia Pacific team in the days to 

come? 

I’d like to share one piece of exciting news. 

2020 marks the first year of our very 

own APAC Dentsply Sirona World edition, 

taking place in Taiwan. We will partner 

with CEREC Asia, the leading digital dental 

training institute in Asia, and integrate 

their annual congress into one single 

event at the Hilton Hotel in Taipei City from 

11 th – 13 th September, 2020. The format 

will be similar to other Dentsply Sirona 

World events, with world-class speakers, 

breakout sessions, and entertainment. 

Simultaneous translation will be provided 

in both English and Chinese throughout 

the event. To find out more about Dentsply 

Sirona World Taiwan, visit the website: www. 

dentsplysirona.com/dsworldtaiwan. DA 

How does Dentsply Sirona keep a finger 

on the pulse of the evolving needs of 

clinicians and their patients? 

We draw great insights about the next 

generation of dental professionals due to 

our cooperation with academics and dental 

schools, and the projects that we work on 

with universities. For example, we helped 

equip a university hospital and academic 

facility, Shanghai No. 9 People’s Hospital, 

with 60 simulation stations. 

Intraoral scanner from 

Dentsply Sirona, Primescan 

Another example is our project with the 

University of Otago in New Zealand, where 

we built their new facility entirely around 

the patient experience. To accommodate 



“Both dentist and patient are looking for quality and predicable treatment in a shorter time frame,” said Shane Gibson 

Smarter, Faster, 

and More Accurate 

Digital Diagnostics 

Carestream Dental, Inc., formerly part of Eastman 

Kodak Company, became an independent corporation 

in 2007. Today, the organisation is well known for its 

digital dental imaging solutions, such as scanners, 

cameras, and cone-beam computed tomography. 

Managing director for Carestream Dental ASEAN, Shane Gibson, 

shares about the organisation’s mission and role advancing 

diagnostic technologies in the dental scene. 

Please share with us briefly about your background. As 

head of South East Asia of Carestream Dental, what is your 

involvement in product development, marketing strategies 

and dental education? 

I first joined the company as general manager of the dental 

business at Carestream Health in Australia in 2013. My role is to 

lead the company in its mission to transform dentistry, simplify 

technology and change lives. 



At the core of what we do at Carestream Dental is our customers 

– our products are designed by clinicians, for clinicians. We work 

closely with the dental practitioners throughout Asia to understand 

their needs and workflows, and guide how products are developed. 

Their feedback also steers the educational services that we provide, 

to help them achieve better diagnostic and clinical outcomes for 

their patients. 

In what ways has Carestream Dental’s work transformed 

from what was offered in the pre-digital era? 

Together with the pioneers of our company – Eastman Kodak, 

Trophy Radiologie, and PracticeWorks – we have brought many 

new technologies to dental practitioners, such as modern film, 

digital radiography sensors, and orthodontic practice management 

software. We are committed to innovation, investing heavily in 

research and development to stay ahead of the curve, deliver bestin-class 

solutions, and expand into new areas. 

Thirdly, scalability. The needs and requirements of each practice 

can vary significantly. CS 9600 can be configured with the optimal 

fields of view and scanning resolutions for a clinician’s current 

clinical and financial requirements. As these needs change, the CS 

9600 Fields of View can be expanded up to 16x17cm and modules 

such as Face Scanning, Cephalometric imaging, Prosthetic Driven 

Implant Planning (PDIP), CS Airway, CS Model, and CS Model+ can 

be integrated with CS 9600 to enhance diagnoses and treatment 

planning capabilities. 

Another product Carestream Dental is known for is its 

intraoral scanner CS 3700. What has the feedback been like 

from dentists who have tried it? 

The response since we launched the CS 3700 last year has 

been positive. It combines high performance, ergonomics and 

intelligence all into one scanner, and comes with a 20% faster 

scanning speed than before. 

Additionally, we are at the forefront of CBCT technology, panoramic 

and cephalometric imaging, and intraoral sensors. In fact, more 

than 200,000,000 dental images are captured each year with 

Carestream Dental imaging. We also work on integrating products 

seamlessly into practices’ workflows, and enhance interactions 

with patients. 

Carestream Dental’s CS 9600 5-in-1 CBCT Imaging System 

was awarded the 2019 Cellerant Best of Class Technology 

Winner. What makes it stand out from others? 

Firstly, innovation and precision. Digital dentistry is constantly 

changing, and we want to enable dental professionals with 

technology that allows them to innovate and lead within their 

particular fields. The CS 9600 is our fifth generation CBCT imaging 

platform. It features intelligent automation, first-time right imaging 

technology, and highly simplified workflows. It is also customisable, 

and can be configured to suit any dental specialty. 

Secondly, speed and accuracy. The SmartPad feature on the CS 

9600 ensures scans can be taken both quickly and precisely. 

Instead of using traditional laser beams, the CS 9600 uses a live 

camera positioning system to align patients. These cameras are 

assisted with in-built AI technology, which allows a swift and highly 

precise patient setup, while reducing the need for retakes. 

Users have also noticed the completely new interface design on 

the software that comes with the intraoral scanner, CS ScanFlow. 

It consists of a four-step process: Scan, Check, Export, and Adapt. 

From a single scan, the interface gives clinicians the freedom to 

navigate among different workflows. Dental professionals can 

enjoy faster dataset processing, vibrant HD 3D digital impressions, 

and all of the other advanced features they enjoyed with our past 

scanning acquisition software updates. 

How important is continuing education for dental 

professionals? 

In the age of digital dentistry, technology changes fast, and we 

need to keep our customers informed. Carestream Dental actively 

does this by supporting professional development and learning 

events throughout Asia. We also conduct webinar training events 

throughout the year. These webinars are presented by clinicians 

and product experts, covering the latest in digital dental technology 

and trends. 

Even the way dental professionals are learning has changed. 

We have adapted by introducing our online learning portal. The 

Carestream Dental Institute provides users with self-paced learning 

modules and guided videos for the latest about Carestream 

Dental’s technology. 

*Note: Availability depends on registration timelines. 


31


What opportunities do you see in the dental industry in Asia? 

Please share some trends you foresee. 

Each country’s market is unique. Carestream Dental adapts its 

portfolio to each market, based on the maturity of the industry. 

From a digital standpoint, I believe most countries are seeing 

strong growth in CBCT technologies as well as intraoral scanning. 

The convergence of rapidly evolving digital technologies has 

elevated the overall quality of dentistry across the profession. Both 

dentist and patient are looking for quality and predicable treatment 

in a shorter time frame. 

As a digital data solution provider with a legacy of more than 

30 years in digital, Carestream Dental will continue to focus on 

providing diagnostic excellence within our digital equipment and 

software portfolio. Our priority will be the development of complete 

solutions for dental professionals across various specialties, such 

as implant surgical guides and orthodontic treatment planning. 

What will be the main challenges for Carestream Dental in 

the next five years? 

With any fast-paced industry, it is always a challenge to stay at 

the forefront of technology while being mindful of what dental 

professionals are looking for to simplify their workflow. This is an 

exciting time for the ASEAN dental market, and we look forward 

to working with our customers to help them transform dentistry. 

Our passion is to support our customers and their practice, drive 

better clinical outcomes, and make life easier for practitioners and 

patients. DA 

Shane Gibson 



Anterior Full Ceramic Crown After a 

Complicated Fracture of the Natural Tooth 

By Prof. Dr. Juergen Manhart & CDT Hubert Schenk 

In the maxillary anterior region, the 

integrity of the teeth is of great 

importance to many people. In 

the case of damage, restoring an 

attractive smile is a great need for 

patients. Depending on the defect size and 

its configuration, various clinically proven 

direct and indirect therapeutic options are 

available. For heavily damaged anterior 

teeth, all-ceramic crowns are a reliable 

and proven therapy option for restoring 

function and aesthetics. 

Lithium-disilicate glass ceramic 

The integrity of their anterior teeth is of 

paramount importance for most patients due 

to their prominent position. The impairment 

of teeth in the anterior aesthetic zone by 

carious defects, chipping or fractures, clear 

visible fillings, discolourations, anomalies 

in shape, alignment and position within the 

dental arch often results in considerable 

restrictions for the patients. Therefore, 

dentists should take into account all aspects 

of treatment, including a team of different 

specialists, in order to preserve or restore 

the natural dentition. 

Today, the range of therapies in modern 

dentistry offers a variety of methods 

to restore or optimise the function and 

aesthetics of the teeth in the anterior 

region. These include – depending on 

the initial situation and the degree of 

destruction of the individual teeth – 

polychromatic multilayer direct composite 

restorations, laboratory-made or industrially 

manufactured composite veneers, ceramic 

veneers, partial veneers (additional veneers), 

veneer crowns, full crowns (metal ceramics, 

all-ceramics) and orthodontic measures 1-3 . 

A majority of today’s patients asks for 

aesthetic restorations and metal-free 

alternatives to traditional prosthodontic 

approaches. All-ceramic restorations have 

gained popularity during the last 30 years 

for a number of reasons; especially their 

favourable optical properties, excellent 

and durable aesthetic appearance, wear 

resistance, colour stability, chemical 

inertness and durability, biocompatibility, 

and strengthening of the remaining 

tooth structure when they are adhesively 

bonded 4-17 . 

In the last three decades, many different 

all-ceramic systems were introduced to the 

dental profession 19 . Dental ceramics can 

be classified according to their material 

composition, fabrication workflow (for 

example, powder-liquid slurry, slip-casting, 

pressable ceramics, CAD/CAM millable), or 

clinical indications 20-22 . Nowadays, the most 

common clinical indications for all-ceramic 

restorations consist of inlays, onlays, partial 

crowns, full crowns, bridges, veneers, 

posterior occlusal veneers (table tops/ 

posterior cuspal protection restorations), 

implant abutments and implants 23-36 . These 

restorations present a scientifically proven, 

high-quality permanent treatment option 

for the aesthetically challenging anterior 

and load-bearing posterior regions when 

the indications and limitations of the 

respective ceramic systems are respected 

and an appropriate luting procedure 

is employed; their reliability has been 

documented in literature 18, 32, 37-56 . All-ceramic 

restorations are used meanwhile on a 

routine basis in everyday dentistry. 

For single-unit restorations, lithium-disilicate 

(LS2) glass ceramic is the material of choice for 

many dental practitioners because of its good 

mechanical strength (IPS e.max Press: 470 

MPa mean biaxial flexural strength), excellent 

aesthetic properties and its versatility. It can 

be used in monolithic form, when maximum 

strength is required (for example, tabletop 

restorations for increasing the vertical 

dimension of occlusion or posterior crowns), 

or in a layered form (pressed LS2 coping 

with additional veneering porcelain) when 

aesthetics is of utmost importance. Singleunit 

LS2-crowns demonstrate an excellent 

longevity for anterior 57-59 and posterior 

teeth 56-59 , comparable to the survival rate of 

metal-ceramic crowns 60, 61 . 

This clinical report illustrates the restoration 

of a maxillary central incisor affected by a 

complicated crown fracture with a veneered 

lithium-disilicate glass ceramic crown after 

endodontic therapy. 

Fig. 1a – b: Initial situation: 24-year-old female patient after trauma. In addition to the 

fractured tooth 11, there is extensive injury to the lower lip. The first treatment of the soft 

tissue injury occurred at the venue of the accident abroad 



Fig. 2a: One week later, the patient appeared in our 

dental office. Tooth 11 had a complicated crown 

fracture with exposure of the pulp 

Fig. 2b: The incisal half of the clinical crown of 

tooth 11 had fractured horizontally 

Fig. 3: Exposure of the pulp was diagnosed at the 

mesial aspect of the fracture site 

Clinical case report 

Initial situation 

A systemically healthy 24-year old female 

patient presented in our dental clinic with 

a trauma-related fractured right maxillary 

central incisor. The accident had already 

occurred one week earlier abroad, where the 

patient, a medical student, was in a clinical 

traineeship. After the initial treatment of 

soft tissue injuries on the spot by a fellow 

student (Fig. 1a and b), the patient decided 

to cancel the stay abroad, where medical 

and dental facilities were lacking. 

During the examination in our clinic 

one week after the incident, the patient 

presented a still untreated traumainjured 

tooth 11 (Fig. 2a – b). The clinical 

inspection showed a complicated crown 

fracture with exposure of the pulp (Fig. 3); 

the incisal half of the clinical crown had been 

completely lost 62, 63 . Patient assessment 

revealed a sharp painful response to cold 

thermal stimulus using refrigerant spray 

and a pathologic response to percussion of 

the respective tooth 64 . Given that the pulp 

had already been exposed to the oral cavity 

environment for one week, the tooth showed 

unprovoked pain symptoms and root growth 

was completed. Together with the informed 

patient, we decided to completely remove 

the infected pulp with subsequent root canal 

treatment (Fig. 4a – c). 

The patient was informed about various 

therapeutic approaches (direct composite 

restoration, ceramic veneer, full ceramic 

crown, PFM crown) including their 

respective advantages and disadvantages, 

and associated costs. The patient decided 

in favour of an adhesively luted glass 

ceramic crown made of veneered lithiumdisilicate 

ceramics. This restoration type 

can be recommended as evidence-based 

treatment in the anterior region 65 . In 

literature, survival rates of between 93.8% 

and 96.8% are reported at five-, eight-, or 

10-year observation periods 57-59 . 

Fig. 4a: Root canal treatment was initiated since 

the pulp had already been exposed to the oral 

cavity environment for one week 

Fig. 4b: Periapical 

radiograph to determine 

the working length 

Fig. 4c: Control radiograph 

of the root canal filling 

in lateral condensation 

technique 

After completion of the root canal 

treatment, a long-term provisional buildup 

of the tooth was carried out with an 

adhesive direct composite restoration 

(Fig. 5a – b) in order to spare the patient a 

preparation and impressions until the soft 

Fig. 5a: Long-term provisional build-up of the 

tooth with a direct composite restoration 

Fig. 5b: The composite restoration remained 

until completed soft tissue healing 

Fig. 6: After three months, the soft tissue 

situation presented in perfect condition 


35


In principle, in the dental aesthetic analysis 

by the ceramist technician already a 

“virtual layering” of the restoration is 

done, with determination of the necessary 

ceramic masses. The result of this “virtual 

layering” is recorded in the ceramic buildup 

scheme (Fig. 8). This procedure is done on 

site in the dental laboratory under ideal 

lighting conditions (which are often not 

found in dental practices) by the ceramist 

technician, who will ultimately also fabricate 

the restorations. 

Fig. 7a – d: Aesthetic analysis by the dental technician. The distribution of the different shades and 

translucent or opaque tooth areas in the area to be restored are determined 

Fig. 8: Ceramic layering concept as result of 

dental aesthetic analysis 

tissue situation had completely healed. 

After a waiting period of three months, a 

new clinical examination was carried out, 

in which tooth 11 and its adjacent teeth, 

including the antagonists in the lower jaw, 

were inconspicuous (Fig. 6). The patient 

was asked to present herself the next day 

for shade determination and, in general, 

for dental aesthetic analysis in the dental 

laboratory 66 . A basic requirement for 

accurate colour determination is that the 

teeth are not dehydrated, otherwise they 

appear lighter and more opaque 67-69 . 

Aesthetic Analysis 

As part of the aesthetic analysis by the 

dental technician, the distribution of the 

different shades of colour and translucent 

or opaque tooth areas in the area to be 

restored is determined (Fig. 7a – d). The ageappropriate 

design of the restoration with 

corresponding individual characteristics - 

enamel cracks, white spots, mamelons, halo 

effect - as well as the appropriate surface 

texture, and the correct gloss level, are also 

analysed. 

If the colour analysis is performed directly 

by the dental technician, and not by the 

dentist or other practice staff, there is 

usually no misunderstanding and the 

responsibilities for this important aspect in 

the treatment process are clearly assigned. 

Such a procedure eliminates the risk of 

communication breakdowns and saves 

time. It is through direct contact with the 

patient that the dental technician is able to 

produce an aesthetically perfect matching 

ceramic crown 70 . It is optimal if this analysis 

is performed before treatment starts. This 

allows the dental technician to form his 

own impression of the initial situation, 

and also to query, unfiltered, the patient’s 

expectations of the new restorations. A 

patient-specific optimal tooth position 

and shape of the restorations is sought 71 . 

Implementation of the individual functional 

and aesthetic optimum for each patient 

thus requires close collaboration with 

the specialised dental technician from 

the beginning of the planning phase. The 

independent aesthetic analysis of the 

intraoral situation by the ceramist is a 

basic requirement for success 72 . 

Fig. 9a – b: Tooth 11 was prepared for a full ceramic crown with a circumferential 

shoulder with rounded inner edges 

Fig. 9c: Incisal view of the final preparation with a 

circumferential shoulder of 1 mm depth 



Tooth preparation 

In the next appointment, the tooth 11 

was prepared for receiving a full ceramic 

crown with a circumferential shoulder with 

rounded inner edges (Fig. 9a – c). 

The strength of all-ceramic restorations 

is determined by the type of ceramic used 

with the resulting inherent mechanical 

stability of the respective ceramic 

material. Furthermore, the fracture 

strength is determined by the geometry 

of the restoration and, thus, by the shape 

of the cavity or crown preparation. The 

basic principle of preparation design for 

all-ceramic restorations avoids tensile 

stresses in the material as much as 

possible and loads the restoration primarily 

in compression mode by an adequate 

preparation geometry 73, 74 . Fracture strength 

of the restorations is determined by size, 

volume, shape and surface characteristics 

of the ceramic material, and additionally 

by structural inhomogeneities introduced 

during the manufacturing process 75 . 

The dentist must be aware of the fact 

that the shape and finish of the tooth 

preparation have a major impact on the 

clinical success and longevity of all-ceramic 

restorations 76-78 . The preparation should 

exhibit a retention form and resistance 

form optimal for a ceramic crown 76, 79, 80 : 

• height of prepared tooth (abutment 

height) minimum 4mm 

• occlusal convergence angle between 6 

and 10 degrees 

• finish line: circumferential shoulder 

with rounded inner edges or obvious 

deep chamfer with 1mm width 

• incisal / occlusal reduction of 1.5 – 2.0mm 

(adhesively luted full contour lithiumdisilicate 

crown: minimum 1.0 mm) 

• axial reduction depth (sufficient circular 

crown thickness) of 1.2 – 1.5mm 

• in the anterior region: a rounded incisal 

edge 

• rounded internal line angles and point 

angles 

• smooth surface texture 

Tooth substance removal was controlled 

in all dimensions. Attention was paid to 

the possibility of a sufficient palatinal 

layer thickness of the crown framework to 

be produced, even in positions which the 

tooth occupies, in addition to the static 

occlusion, in dynamic occlusion (Fig. 10). 

After tooth preparation 

During the fabrication of highly aesthetic 

restorations, the influence of the shade of 

the prepared tooth on the final result is a 

decisive aspect. After finishing the crown 

preparation, the shade of the prepared 

tooth substance was documented by the 

dentist with a digital photo referencing 

to a special shade guide (IPS Natural Die 

Material shade guide, Vivadent, Schaan, 

Liechtenstein). The image file was then 

made available electronically to the dental 

laboratory. This enables the technician, 

who otherwise has no information about 

the colour of the tooth stump, to fabricate a 

model die similar in colour to the prepared 

tooth of the patient. This forms the basis 

from which the correct shade, translucency 

and brightness values of the all-ceramic 

restoration will be selected. 

In order to achieve a perfect impression, the 

marginal gingiva was displaced by insertion 

of a retraction cord to the sulcus (Fig. 11a – 

b). After taking impressions of the prepared 

tooth and the antagonistic dentition, an 

occlusion protocol with Shimstock foil was 

made, as well as intermaxillary registration 

by fabricating an interocclusal record in 

maximal intercuspal position and arbitrary 

transfer of the maxillary position using a 

facebow record were performed 81, 82 . 

A diagnostic template made from a gypsum 

duplicate of the analytical wax-up using 

a transparent polyethylene foil allows the 

chairside fabrication of a direct provisional 

restoration with correct dimensions and 

alignment (Fig. 12a). The provisional was 

seated using a eugenol-free temporary 

cement (Fig. 12b). 

Laboratory work 

In the dental laboratory, the ceramic 

crown for tooth 11 was produced. For 

this purpose, a crown framework made of 

lithium-disilicate reinforced high-strength 

glass ceramic was pressed corresponding 

to the anatomically correct shape of the 

respective tooth (Fig. 13a). This coping 

was subsequently finalised by individual 

veneering with layered porcelain (presslayer-technique) 

(Fig. 13b – g). 

Try-in and adhesive luting procedure 

One week after impressioning, the final 

appointment was scheduled. After the 

removal of the provisional restoration and 

cleaning of the tooth with a rotating brush 

and fluoride-free prophylaxis paste, the 

gingiva presented in healthy condition (Fig. 

Fig. 10: Tooth substance removal was controlled 

in dynamic occlusion to ensure sufficient 

thickness of the glass ceramic framework 

Fig. 11a – b: Placing a retraction cord to displace the marginal gingiva and expose the 

finish line before taking an impression 


37


Fig. 12a: Chairside fabrication of a direct 

provisional restoration 

Fig. 12b: The provisional was seated using a 

eugenol-free temporary cement 

Fig. 13a: Pressed crown framework made of 

lithium-disilicate reinforced high-strength glass 

ceramic 

Fig. 13b: First bake of the veneering porcelain Fig. 13c: Second bake of the veneering porcelain Fig. 13d: Finalised full ceramic crown made of a 

pressed lithium-disilicate coping and individually 

layered veneering porcelain 

Fig. 13e: The ceramic crown exhibits a naturallooking, 

life-like surface texture 

Fig. 13f: The circular 1mm shoulder is clearly 

detectable 

Fig. 13g: Palatal surface of the ceramic crown 

Fig. 14: Situation after removal of the 

provisional restoration. The marginal gingiva 

presents in perfect condition 

14). Using coloured, glycerin-based tryin 

pastes, the aesthetics of the ceramic 

crown was checked intraorally with 

reference to hydrated adjacent teeth and 

the correct shade of the luting resin was 

determined 83-85 . Subsequently, the precise 

Fig. 15: Placing a retraction cord to expose the 

finish line prior to the adhesive luting procedure 

fit of the crown on the prepared tooth and 

quality of proximal contacts were checked 

before minor functional interferences 

during protrusive and laterotrusive 

movement paths were eliminated. 

The method of cementation of the crown to 

the prepared tooth was by adhesive luting, 

as opposed to conventional cementation. 

This gives a positive effect on the overall 

strength of the restoration, in particular for 

glass ceramic materials, which are more 

prone to bulk fracture and chipping effects 

than zirconia. Ceramic materials with 

fracture strength less than 350 MPa are not 

indicated for conventional cementation 36 . 

Among those are feldspathic porcelains 

and leucite-reinforced glass ceramics that 

have to be placed adhesively using bonding 

agents and luting resins. Due to the adhesive 

bond between the ceramic restoration and 

enamel or dentin, a considerable increase 

in strength can be obtained because the 



inner surface of the ceramic restoration 

no longer acts as a mechanical boundary 

line at which fracture-causing cracks can 

initiate due to tensile stresses 86 . 

The adhesive cementation of ceramic 

restorations is a very technique-sensitive 

procedure. In order to achieve a reliable and 

long-lasting bond to the tooth structures, it 

is of utmost importance to prepare this step 

carefully and to observe the cementation 

protocol 87 . Prior to the luting procedure, the 

marginal gingiva was displaced to expose 

the complete shoulder using a retraction 

cord (Fig. 15). Afterwards, the inner surfaces 

of the lithium-disilicate glass ceramic crown 

were etched with hydrofluoric acid for 20s 

(Fig. 16). After thoroughly rinsing and drying 

the crown, the fitting surfaces were silanised 

(Fig. 17) 88-91 . After adhesive pretreatment of 

the prepared tooth by conditioning enamel 

Fig. 16: Etching the inner surface of the 

lithium-disilicate glass ceramic crown with 

hydrofluoric acid for 20s 

Fig. 17: The intaglio surfaces of the glass ceramic 

crown are treated with a silane coupling agent 

Fig. 18: Etching the tooth surfaces with 37% 

phosphoric acid 

Fig. 19a: Application of an Etch-and- 

Rinse-adhesive 

Fig. 19b: Air-thinning the adhesive 

Fig. 20a: The ceramic crown is positioned on the 

tooth with a dual-curing luting composite 

Fig. 20b: The excess resin cement is carefully 

removed using a foam pellet 

Fig. 20c: Placing a glycerin gel on the luting gap 

to avoid the formation of an oxygen-inhibited 

superficial composite layer 

Fig. 20d: Light polymerisation of the 

dual-cure resin cement 

and dentin with 37% phosphoric acid (Fig. 

18) the tooth was thoroughly rinsed with 

water-spray and air-dried. An Etch-and- 

Rinse-adhesive was applied meticulously 

on all surfaces covered by the restoration 

(Fig. 19a). After the correct exposure time 

the bonding layer was air-thinned and the 

solvent was evapourated carefully with 

compressed air (Fig. 19b). The ceramic 

Fig. 21a: The ceramic restoration exhibits a 

perfect functional and aesthetic integration 

into the neighbouring teeth 

Fig. 21b: The incisal view shows a copy of the 

natural central incisor 

crown was adhesively luted by covering its 


39


intaglio surfaces and the prepared tooth 

both with dual-curing resin cement in 

the previously determined shade and the 

restoration was positioned on the tooth with 

light finger pressure (Fig. 20a – d). 

Two weeks after placement, the restoration 

exhibited an optimal functional and aesthetic 

integration into the neighbouring teeth 

(Fig. 21a – b). Background illumination 

demonstrates the excellent light 

transmittance capacity of the glass 

ceramic crown, which impresses by having 

virtually the same optical properties 

as the surrounding natural dentition 

(Fig. 22). Ultraviolet light activates the 

inherent fluorescence properties of the 

restoration, which are equal to natural 

tooth structure (Fig. 23). Silicate ceramics 

exhibit translucency effects and lightoptical 

properties that are comparable 

to natural hard tooth substance, making 

them ideal for fabricating restorations 

that have to meet highest aesthetic 

demands. The light scattering of silicate 

ceramics also supports a natural vital 

appearance of the adjacent gingiva. 

The difference to this “pink aesthetics” 

becomes clear in comparison with metalsupported 

restorations, which block this 

light conduction towards the marginal soft 

tissue and often cause a greyish shading 

on the marginal gingiva 92, 93 . At the end 

of the successful treatment, the patient’s 

smile was no longer compromised. The 

crown harmonises in dialogue with the lips 

(Fig. 24). 

Five years after adhesive cementation of 

the ceramic crown, there is still an excellent 

integration in the surrounding teeth, both 

in habitual intercuspation and in dynamics 

(Fig. 25a – e). The patient was still fully 

satisfied with the result and thanked the 

treatment team with a happy smile (Fig. 26). 

Conclusion 

All-ceramic restorations have achieved 

an excellent quality and are an 

indispensable therapeutic means for 

modern conservative and prosthetic 

dental treatment procedures 94 . Aesthetics 

and biocompatibility characterise these 

restorations. At the same time, this 

type of restorations achieves excellent 

patient acceptance. Clinical trials exhibit 

an excellent longevity for all-ceramic 

restorations if a correct indication is 

selected and material- and patient-related 

limitations are observed 95, 96 . DA 

Fig. 22: Excellent light transmittance capacity of 

the ceramic crown, indistinguishable from the 

neighbouring dentition 

Fig. 23: Ultraviolet light activates the inherent 

fluorescence properties of the glass ceramic 

restoration, which equals natural tooth structures 

Fig. 24: The ceramic crown shows a perfect 

harmony with the architecture of the lips 

Fig. 25a – c: Five years after incorporation, there is still an excellent integration of the crown into neighbouring dentition 

Fig. 25d – e: In the right and left lateral views, the crown also presents inconspicuously 

Fig. 26: The 

patient was fully 

satisfied with 

the result and 

presented a warm 

and big smile 

as a reward for 

the completed 

treatment 



About the Authors 

Dr. Juergen Manhart is professor of the Department 

of Restorative Dentistry at the Dental School of LMU- 

University in Munich, Germany. He offers seminars 

and practical hands-on workshops in aesthetic 

restorative dentistry, such as direct composite 

restorations, all-ceramic restorations, ceramic 

veneers, management of severely worn dentition, 

and treatment planning in aesthetic dentistry. 

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relevant to clinical success. Br Dent J, 2008. 

204(6): p. E11. 

84. Xing, W., et al., Evaluation of the esthetic effect 

of resin cements and try-in pastes on ceromer 

veneers. J Dent, 2010. 38 Suppl 2: p. e87-e94. 

85. Sheets, C.G. and T. Taniguchi, Advantages and 

limitations in the use of porcelain veneer restorations. 

J Prosthet Dent, 1990. 64(4): p. 406-11. 

86. Mehl, A., et al., Stabilization effects of CAD/CAM 

ceramic restorations in extended MOD cavities. J 

Adhes Dent, 2004. 6(3): p. 239-45. 

87. Watanabe, M.U., Minimally invasive reconstruction 

of anterior teeth - A combination of 3D printing, 

press technique and adhesive bonding. 

International Dentistry - African Edition, 2019. 

9(1): p. 54-58. 

88. Brentel, A.S., et al., Microtensile bond strength of 

a resin cement to feldpathic ceramic after different 

etching and silanization regimens in dry and aged 

conditions. Dent Mater, 2007. 23(11): p. 1323-31. 

89. Matinlinna, J.P., Processing and bonding of dental 

ceramics, in Non-Metallic Biomaterials for Tooth 

Repair and Replacement., P. Vallittu, Editor. 2013, 

90. Woodhead Publishing Ltd.: Oxford. p. 129-160. 

Ho, G.W. and J.P. Matinlinna, Insights on Ceramics 

as Dental Materials. Part II: Chemical surface 

treatments. Silicon, 2011. 3(3): p. 117-123. 

91. Canay, S., N. Hersek, and A. Ertan, Effect of different 

acid treatments on a porcelain surface. J Oral 

Rehabil, 2001. 28(1): p. 95-101. 

92. Magne, P., M. Magne, and U. Belser, The esthetic 

width in fixed prosthodontics. J Prosthodont, 1999. 

8(2): p. 106-18. 

93. Magne, P., M. Magne, and I. Magne, Porcelain Jacket 

Crowns: Back to the Future Through Bonding. QDT 

Quintessence Dental Technology, 2010: p. 89-96. 

94. Santos, M.C., et al., Current All-Ceramic Systems 

in Dentistry: A Review. Compend Contin Educ Dent, 

2015. 36(1): p. 31-37. 

95. Friedman, M.J., A 15-year review of porcelain 

veneer failure - a clinician’s observations. 

Compendium of Continuing Education in Dentistry, 

1998. 19: p. 625-636. 

96. Swift, E.J., Jr. and M.J. Friedman, Critical appraisal. 

Porcelain veneer outcomes, part I. J Esthet Restor 

Dent, 2006. 18(1): p. 54-57. 



Amlodipine 

Induced Gingival 

Enlargement 

By Dr. Anand Narvekar and Dr. Richa Kapoor 

Patients medicated with certain 

drugs may suffer from Drug 

Induced Gingival Enlargement 

(DIGO), which may interfere 

with aesthetics, mastication, or 

speech. Besides affecting one’s appearance, 

such gingival overgrowth also often impairs 

nutrition and oral hygiene, resulting in an 

increased susceptibility to oral infection, 

caries and periodontal diseases. 

Drugs associated with gingival overgrowth 

can be broadly divided into three categories: 

Anticonvulsants, calcium channel blockers, 

and immunosuppressants. Amlodipine 

is a dihydropyridine calcium channel 

blocker that is used in the management 

of both hypertension and angina. Ellis et 

al., first reported gingival sequestration of 

amlodipine and amlodipine-induced gingival 

overgrowth. 

In this report, a case of amlodipine-induced 

gingival overgrowth has been treated in 

four steps: (1) Thorough Phase 1 therapy, 

(2) Substitution of the drug, (3) Surgical 

excision of the gingival overgrowth and (4) 

Maintenance and supportive therapy. 

Fig. 1: Periodontal examination revealed grade I 

mobility irt 33, 32, 31, 43, 42, 41, generalised pseudo 

and true pockets and subgingival deposits 

Fig. 3: Left lateral pre-operative view 

Fig. 2: Right lateral pre-operative view 

Fig. 4: Anterior teeth showing oedematous 

gingiva with bleeding on probing 

“Swollen Gums” 

A 64-year-old female patient reported to 

the dental office complaining of ‘swollen’, 

bleeding gums, with difficulty in chewing 

food. Past medical history revealed the 

44 DENTAL ASIA MARCH / APRIL 2020 

Fig. 5: Lower anterior teeth showed true and 

pseudo pockets with subgingival deposits and 

rolled out gingival margins 

Fig. 6: Pre-operative view of maxillary 

palatal area. Bead like appearance of the 

interdental papillae


Fig. 7: Lower mandibular anterior pre-operative view 

Fig. 8: One week after scaling, note the improvement 

in the gingival oedema and inflammation 

Fig. 9: After prophylaxis, there were no true 

pockets in lower anterior region 

Fig. 10: Maxillary anterior region intra-operative 

view of gingivectomy and gingivoplasty 

Fig. 11: Modified Widman flap in 14 to 17 and 

24 - 27 region. One wall defect seen irt 16, 17 and 

grade I furcation irt 16 

Fig. 12: Two weeks post-operative view of 

maxillary and mandibular anterior region 

condition of hypertension, for which she 

took 20mg of Amlodipine orally every day 

for the last three to four years. 

Clinical examination showed a generalised 

overgrowth of marginal and papillary gingiva 

throughout the maxilla and mandible in 

buccal, palatal, and lingual segment, with 

those on the mandibular anterior segments 

being more pronounced. 

The enlargement was firm in consistency, 

with slight bleeding on probing in mandibular 

anterior segment (Fig. 1 - 3). Periodontal 

pockets with a mean probing depth of 7mm 

were present in the posterior segments. (Fig. 

2 - 3). In maxillary and mandibular anterior 

segment, only pseudo pockets were present 

(Fig. 4 - 5). Palatal aspect of maxillary arch 

showed bead-like enlargement of marginal 

and papillary gingiva (Fig. 6). Marked 

enlargement was seen on buccal and lingual 

area of the mandibular arch. (Fig 7). 

Treatment 

Phase I – Scaling and root planing, followed by 

oral hygiene instructions, and chlorhexidine 

mouthwash. Drug modification. 

Phase II – Gingivectomy and gingivoplasty 

in maxillary and mandibular anterior region. 

Modified Widman Flap in posterior segments. 

Phase III – Maintenance phase 

After scaling and root planing, there was 

marked reduction in the inflammation and 

the tissues became firm in consistency 

(Fig. 8). 

Gingivectomy and gingivoplasty was done 

under local anaesthesia with a No. 15 

blade. Haemorrhage was controlled with 

pressure pack and non-eugenol periodontal 

dressing was given. Suitable analgesics with 

chlorhexidine mouthwash were advised. 

Postoperative healing after one week 

showed absence of enlargement, mild edema 

was visible but patient was asymptomatic. 

Modified Widman Flap was done in remaining 

posterior segments. Internal bevel incision 

was made 0.5 – 1mm away from marginal 

gingiva, followed by sulcular incision. Full 

thickness mucoperiosteal flap was raised. 

After debridement, most areas had horizontal 

bone loss, except in 16 and 17 regions, where 

a hemiseptal defect was present. Osteoplasty 

was done to remove the bony ledge in the 

same region for better flap adaptation. Figure 

of eight sutures were given. (Fig. 8 – 10). 

One week post operatively, all sutures were 

removed (Fig. 12). Mandibular and maxillary 

anterior segment showed uneventful healing 

(Fig. 13 – 14). 

Fig. 13 - 14: Mandibular and maxillary anterior 

region showing satisfactory healing 

MARCH / APRIL 2020 DENTAL ASIA 45


Fig. 15: Intra-operative view of mandibular 

posterior region 

Fig. 20: Six months post-operative. No 

bleeding on probing 

After care 

The treatment options for drug-induced 

gingival enlargement should be based 

on the medication being used, and the 

clinical presentation of the individual 

case. Consideration should be given to the 

possibility of substituting the drug. 

Besides surgical excision, maintenance 

carried out in the post-operative phase 

is crucial for preventing recurrence. The 

patient should be taught correct oral 

hygiene maintenance. Regular follow-ups 

are also needful. DA 

Fig. 16: After one week, satisfactory 

healing was seen 

Fig. 21: Six months post-operative right lateral 

view showing healthy tissue 

Fig. 22: Six months post-operative left view 

showing healthy tissue 

Fig. 17 – 18: Three weeks post-operative view 

of mandibular and maxillary anterior region 

Fig. 19: Maxillary palatal view three weeks 

post operatively 

Fig. 23: Six months post-operative left and right 

mandibular lateral view showing healthy tissue 

Fig. 24: Retracted frontal view showing stages 

starting from preoperative, during healing phase, 

post six months and post four years 

46 



Fig. 25: Reflected mandibular view showing stages 

starting from preoperative, during healing phase, 

post six months and post four years 

Fig. 26: Retracted maxillary anterior view showing 

stages starting from preoperative, during healing 

phase, post six months and post four years 

Fig. 27: Retracted mandibular anterior view 

showing stages starting from preoperative, during 

healing phase, post six months and post four years 

Reference 

1. Lafzi A, Farahani RM, Shoja MA. Amlodipine-induced gingival hyperplasia.Med Oral Pathol Oral Cir Buccal.2006;11:480–2. 

2. Ellis JS, Seymour RA, Thomason JM, Monkman SC, Idle JR. Gingival sequestration of amlodipine and amlodipine-induced gingival 

overgrowth (letter)Lancet.1993;341:1102–3. 

About the Authors 

Dr. Anand Narvekar graduated in dentistry from 

Bharati Vidyapeeth Deemed University in 1996, 

and has since focused on aesthetic dentistry. 

His interest lies in treating complex full-mouth 

rehabilitation and smile design cases. His keen eye 

for aesthetics extends beyond dentistry as he is an 

avid and globally acclaimed photographer. He is a 

fellow, advocator, and trainer for MiCD (Minimally Invasive Cosmetic 

Dentistry) Global Academy, and a key opinion leader for a number of 

companies, conducting workshops in the fields of articulators, direct 

resin restorations, and photography. 

Dr. Richa Kapoor Miglani is a periodontist 

from Mumbai. After completing her Master 

of Dental Surgery from Saveetha Dental 

College, she undertook a Fellowship in Laser 

Dentistry from the University of Genova, 

Italy. She heads a dental centre at Mumbai. 

Besides recognising the contributions of 

female clinicians through Indian Dental Diva Awards, she also 

leads hands-on training programmes on periodontal treatments. 



Biomimicry 

Simplified using 

a Novel, Huebased 

Direct 

Composite 

Resin System 

By Dr. Clarence Tam 

Rationale for Choice of Material 

The pursuit of natural restorations has been the mainstay of 

aesthetic dentistry for at least the last decade. It is known that 

the colour corollary of composite shades between manufacturers 

varies drastically, as well as with the reference Vita Classic shade 

guide 1 . To further complicate matters, the opacities and colour 

saturation of respective enamel and dentin shades also varies 

between systems, creating the need to generate a site-specific 

colour map of the tooth in a pre-dehydrated state. Enamel is an 

achromatic, inorganic dominant material. The hue or true colour 

of the tooth comes from the dentin. Value (brightness) and chroma 

(saturation) are modulated in nature according to the thickness 

of the enamel 2 . StyleItaliano is the first comprehensive anterior 

composite layering system to utilise a single, universal enamel shade, 

the thickness of which is designed to be modulated to generate 

greater or less chroma with a particular hue of dentin. To simplify 

matters, dentin options are distributed only between five options 

which vary significantly in colour space, making selection efficient: 

Si0, Si0.5, Si1, Si2 and Si3. Effect shades consist of MP (Multiplo), 

which is a translucent flowable with opalescent properties as well 

as M (Masque or Masking), which is a flowable featuring greater 

opacity that blocks out “shine through” in augmentation or fracture 

repair cases. Posterior restorations are simplified via the use of a 

single posterior shade (P), which has a beautiful chameleon effect 

and ideal sculptability. 

Enamel-Dentin Tooth Fracture 

An 11-year-old male, exhibiting an uncomplicated enamel-dentin 

fracture of tooth 21 (#9) MIBP, was presented to the practice. 

He had been opening a farm gate while duck shooting and the 

latch had sprung up, impacting his tooth. He had no immediate 

or delayed sensitivity, and the tooth remained vital. He was not 

interested in pre-prosthetic tooth whitening but was interested in 

exactly recreating the subtle optical nuances of the area that was 

fractured. Medical history was positive for controlled ADHD, with 

known drug allergies to cotrimoxazole, Ceclor and Amoxicillin. At 

the initial consultation, the tooth was smoothed, and 2% CHX (aq) 

was applied. Dentin conditioner and a glass ionomer provisional 

restoration were then placed to insulate the dentin (Fuji BULK, GC 

America). Possible optical and pulpal sequelae were discussed and 

full informed consent given. 

Procedure 

It is well known that the optical properties of enamel drastically 

change in a dehydrated state. The refractive index of water is 1.33 

and that of air is 1.00. Therefore, as the enamel interprismatic spaces 

lose water and gain air, they assume a lower refractive index, and gain 

a higher reflective index, essentially becoming more opaque. Shade 

selection was completed prior to application of topical anaesthetic, 

as the extended time of lip retraction (typically two minutes) could 

possibly affect the full state of hydration and thus incorrect colour 

selection. Shades selected were: dentin (Si2), enamel (E), masking 

Fig. 1: Pre-dehydrated 

view. Shade selection via 

shade button technique 

Fig. 1 Fig. 2 

Fig .2: Split rubber dam 

isolation. Pre-operative 

view 



Fig. 3: Intraoperative 

view. Lingual shelf 

construction utilising 

Enamel (E) shade. Halo 

effect completed using 

a rolled worm of Si2 in 

corresponding areas 

Fig. 4: Masking liner 

applied using the 

flowable Masque (M) 

shade 

Fig. 3 

Fig. 4 

Fig. 5: Masque (M) liner 

after first application 

Fig. 6: Dentin body 

construction utilising 

shade Si2 

Fig. 5 

Fig. 6 

Fig. 7: Multiplo (MP) 

utilised in the negative 

space between the 

dentin fingerlings 

incisally. White tint 

utilised in a manner 

similar to the adjacent 

teeth using the predehydrated 

photograph 

as reference 

Fig. 8: Enamel (E) layer 

applied, and primary 

anatomy completed. 

Start of planning 

secondary anatomy 

Fig. 7 

Fig. 8 

(M) and Multiplo (MP). Marked horizontal perikymata-like maverick 

effects were noted and white tint was also planned to mimic the 

hypocalcified streaks of the natural optics in the adjacent tooth 

structure. The patient was anesthetised using one carpule of a 4% 

Articaine solution with 1:100,000 epinephrine. A split dam rubber 

dam format was utilised for isolation before conservatively rounding 

the fracture margins, blending the preparation to infinity before 

utilising micro air abrasion (27 micron aluminum oxide). A total 

etch technique was utilised before bonding using G-Premio Bond 

(GC America). The lingual shelf was created freehand using a precrimped 

Mylar strip and the E (Enamel) shade. The proximal axial 

and incisal halo were accentuated by rolling a thin worm of Si2 and 

placing it along the incisal and mesiolateral borders of the tooth with 

the strip still in place. To maximise the ability to block out the shinethrough 

of the oral cavity through the new restoration, a masking 

liner (M) was utilised in multiple thin layers prior to placement of the 

dentin volume proper using Si2. Incisally, the dentin lobules were 

sculpted and cured. It is critical to always judge each respective layer 

from the incisal view prior to curing to ensure that it has not been 

overbuilt, and that the volume is accurate. A translucent, opalescent 

flowable was applied to the negative space created between the 

dentin lobules and cured. A white tint was utilised and streaked in a 

similar horizontal pattern using the pre-operative colour reference 

photograph as inspiration. Finally, the enamel layer was completed 

in a single increment to minimise the risk of join lines from incomplete 

blending. Primary anatomy was developed using Sof-Lex discs 

(Sof-Lex, 3M). Secondary anatomy was created using a series of 

fine diamond burs. Tertiary anatomy refers typically to texture. Fine 

horizontal texture was created to mimic that seen in the contralateral 

tooth using a coarse green-stripe diamond bur running lightly across 



Fig. 9: Immediate postoperative 

result. Texture 

of perikymata visible 

Fig. 9 

Fig. 10 

Fig. 10: Incisal view 

showing re-creation 

of line angle and 

integration of buccal 

embrasures with the arch 

form 

Fig. 11: Muted indirect 

light post-operative 

photograph 

Fig. 11 

Fig. 12 

Fig. 12: Post-operative 

retracted frontal view 

the semi-finished surface at stall speed. The restoration 

was then polished to high shine incorporating the 

horizontal scratches into the surface texture design 

using diamond-impregnated silicone polishing cups 

(Double Diamond D-Fine, Clinicians Choice). 

Conclusion 

All in all, the patient received a restoration that was 

able to mimic the natural halo effect and translucency 

seen in the incisal window, married with hypocalcified 

tinting and a surface texture that allowed the restored 

tooth to aesthetically-integrate harmoniously into the 

dental arch once again. The patient was thrilled with 

the result and cannot wait to fracture another tooth so 

we can do this all over again. Just kidding. DA 

Reference 

1. Carney, M.N. and Johnston, W.M. Appearance 

Differences between Lots and Brands of Similar 

Shade Designations of Composite Resin Systems. 

J Esthet Restor Dent. 2017 Apr; 29(2): E6–E14. 

2. Sikri, V.K. Color Implications in Dentistry. J Conserv 

Dent. 2010 Oct-Dec; 13(4): 249–255. 

About the Author 

Fig. 13 

Fig. 13: Post-operative 

retracted lateral oblique 

view 

Dr. Clarence Lam heads a practice in Auckland, New Zealand, 

which specialises in cosmetic and restorative dentistry. She 

is originally from Canada, where she completed her Doctor of 

Dental Surgery and General Practice Residency at the University 

of Western Ontario and the University of Toronto respectively. 

Dr. Tam is the Chairperson and Director of the New Zealand 

Academy of Cosmetic Dentistry. She is currently the only person 

in Australasia to hold Board-Certified Accredited Member Status 

with the American Academy of Cosmetic Dentistry. She frequently and continually 

lectures internationally. 

50 



Considering Alternative 

Options for Teeth Lightening 

By Dr. Aodhan Docherty 

The appearance of our patient’s teeth is becoming ever more 

important to them and we know from a multitude of clinical studies 

that people make judgements about others from the appearance of 

their teeth. One of the major factors which influences this is the shade 

of the teeth. The perception of shade of the teeth is the result of the 

amount and wavelength of light that is reflected back to the eye. Here, 

we discuss a minimally invasive technique to improve the appearance 

of the smile and enhance self-confidence for our patients. 

Why teeth darken 

Shade is produced by a combination of the natural baseline colour 

of teeth which mainly comes from the colour of the dentine, plus 

staining. The baseline colour of teeth is the result of how light 

interacts with the inherent structure of the tooth substrates. Stains 

are organic pigments which can be located either on the surface of 

the tooth within the biofilm layer (extrinsically) or within the tooth 

structure (intrinsically) 1 . 

Extrinsic stains are derived from smoking, dietary intake of tanninrich 

drinks and foods (for example, coffee, tea, and red wine), cationic 

antiseptics such as chlorhexidine, and metallic salts such as iron. 

Intrinsic stains are usually located within the dentine and are often 

from systemic or pulpal origin, such as tetracycline, fluorosis, pulpal 

haemorrhage products, molar incisal hypoplasia, amelogenesis 

imperfecta, dentinogenesis imperfecta, internal resorption, and 

ageing. 

At a molecular level these pigment molecules have multiple 

conjugated bonds which reflect light within the visible spectrum and 

this is the shade (hue and value) which we can see, which are called 

chromophores 2 . The larger the pigment the more chromophores 

they have, and therefore the darker they appear. With time, these 

extrinsic pigments join together and the larger they become the 

darker they are perceived 3 . Furthermore, the extrinsic pigments tend 

to penetrate the tooth structure with time and form a tightly woven 

network or matrix 3 . This creates a complex network of pigments 

which have large numbers of chromophores and hence appear dark. 

There are many options available for lightening the shade of teeth 

including scaling and polishing, teeth whitening or bleaching, 

composite resin veneers, porcelain veneers, crowns, micro-abrasion 

and air powdered polishing. 

Figs. 1-3: Before 

A minimally invasive solution 

The following case demonstrates the use of teeth whitening using 

opalescence 10% carbamide peroxide (Ultradent Products, USA). 

The patient is a male in his early twenties who originally presented 

asking to have porcelain veneers. After lengthy discussion, it was 

established that the features of his teeth which he did not like 

were primarily the shade and minor chipping. As an alternative to 

52 



Fig. 4: Opalescence 10% 

embarking upon irreversible invasive 

treatment to this young man’s teeth, 

teeth whitening, followed by reshaping 

of the chipped edges was 

proposed. This leaves the option 

of embarking upon some minor 

orthodontics and composite resin 

bonding if deemed appropriate at 

re-assessment. 

The patient used the gel nightly for approximately eight hours for 

four consecutive weeks with minimal sensitivity or side effects. The 

anterior chipping was re-contoured at review. 

Simple, cost-effective, and non-invasive 

An acceptable result was achieved with combination of minor reshaping 

of the chipped edges. The patient did not have to undergo 

aggressive tooth preparations for porcelain veneers or have any 

restorative material added to his teeth to achieve a satisfactory 

outcome. We have minimised the restorative burden for this patient 

whilst still leaving the door open to allow him to embark upon any 

further dental cosmetic treatment in the future. 

This case epitomises the minimally invasive paradigm shift which is 

rapidly taking over the dental world. It demonstrates that simple, 

cost-effective and non-invasive treatment modalities can have a 

tangible effect upon the lives of our patients. DA 

References 

1. Brennan M, Hallas D, Jacobs S, Robbins M, Northridge M. 2014. 

Home-use whitening toothpastes for whitening teeth in adults. 

Cochrane Database of Systematic Reviews 2014, Issue 1. Art. 

No. CD010934. 

2. Alqahtani M. 2014. Tooth-bleaching procedures and their 

controversial effects: A literature review. Saudi Dent J. Apr; 

26(2): 33–46. 

3. Kurthy, R. (2012). Kor whitening reference manual. Evolve Dental. 

Figs. 5-7: After 


Dr. Aodhan Docherty completed his Bachelor of Medical Science and Bachelor of Dentistry at the University of 

Sydney, graduating with honours and University Medal. During his first five years of practice, he developed a passion 

for cosmetic and aesthetic treatment, and has since become alumni of the Kois Center. Dr. Docherty furthered his 

education by gaining distinctions across the board in his postgraduate diploma in clinical dentistry in the field of 

Dental Implants at the University of Sydney. He currently practices in Sydney, Australia where he uses 3D digital 

dentistry and a facially-driven workflow. 


User Report 

Onlay for Upper Right Molar Using Chairside 

Workflow with 3Shape TRIOS Design Studio 

By Dr. Douglas G Watt 

A 

female patient, age 63, came 

to the practice requesting an 

orthodontic treatment and 

restoration for her dentition, 

which had had multiple failing 

posterior restorations. The case focused 

on her upper right first molar, which had a 

large amalgam restoration with secondary 

caries present. The patient requested 

a more aesthetic restoration to replace 

this and understood the need for cuspal 

coverage to protect the remaining tooth 

tissue. 

Fig. 1ii 

in-house manufacture of the restoration. 

The upper right first molar responded 

positively to the vitality test, and there was 

no sign of apical pathology on radiographic 

examination (Fig. 1i – ii). 

Fig. 3 

Treatment plan 

For the treatment, to prepare the tooth and 

to minimise the amount of tooth surface 

removed, a lithium disilicate onlay was 

used. This was carried out using a full 

digital workflow with direct integration 

between the 3Shape TRIOS Design Studio 

and the DGShape DWX-42W mill to allow for 

How 3Shape TRIOS Design Studio works 

The case was set up in TRIOS Design Studio 

as an inlay/onlay indication (Fig. 2i – ii). 

Following the software’s guided workflow, 

the margin line and insertion direction were 

defined and adjusted as necessary (Fig. 3). 

Fig. 4 

Fig. 2i 

Fig. 5 

Identification of the margin line was aided 

by the use of a HD overlay photo taken with 

3Shape TRIOS at the time of scanning (Fig. 

4 – 5). 

Fig. 1i 

Fig. 2ii 

The 3Shape TRIOS Design Studio software 

proposed an onlay design, which was 

adjusted as necessary to place occlusal 

contacts and interproximal contact point 


User Report 

as required. The preferred level of contact 

between the teeth was chosen, and the 

set minimal thickness was in line with the 

manufacturer’s recommendations (Fig. 6). 

To assess dynamic occlusion, the software 

ran its virtual articulator. The design was 

corrected for occlusal interproximity and 

morphology by removing any working side 

and non-working side interferences (Fig. 

7i – ii). 

Fig. 8i 

Fig. 10i 

Achieving results 

Once design stages were completed, the 

crown was nested in preparation for milling 

and the block loaded into the DGShape 

DWX-42W in the correct position (Fig. 8i 

– 9). Following the milling, the restoration 

was cut off the reduced sprue, and the 

remaining sprue was smoothed. The 

Fig. 8ii 

Fig. 10ii 

restoration was then glazed, stained, and 

fired on a 15-minute firing cycle, before it 

was left to cool. 

Fig. 6 

Fig. 7i 

To confirm the fit, the restoration was tried 

in the mouth (Fig. 10i – ii). The fit surface 

of the restoration was then prepared with 

Ivoclar Vivadent Monobond Etch and 

Prime. After isolating the tooth with rubber 

dam, the tooth surface was prepared 

through sandblasting with 29-micron 

aluminium oxide, and acid etching with 

37% phosphoric acid etchant gel (Fig. 11i 

– ii). The prepared restoration was then 

bonded to the tooth using 3M Scotchbond 

universal, applied twice. Air thinned and left 

uncured, the fit surface of the restoration 

was loaded with 3M Rely-x Unicem. 

Fig. 7ii Fig. 9 

After the restoration was seated, it was 

flash cured. Any excess was removed, 

and the contacts were flossed prior to full 

curing. A final cure of the margins was 

carried out for 60 seconds on all accessible 

margins, with a glycerine gel covering to 

eliminate the oxygen inhibition layer (Fig. 

12). After removing the rubber dam, static 


55

User Report 

Fig. 11i 

Fig. 14: left: before; right: after 

and dynamic occlusion were checked. No 

adjustment was necessary (Fig. 13). The 

final result can be seen in Fig. 14. 


Fig. 11ii 

Fig. 12 

Fig. 13 

Conclusion 

The case was completed in one day, in a 

single appointment, and over a duration of 

two and a half hours. The initial prep and 

scan were completed in less than an hour, 

the design took 10 – 15 minutes, and the 

milling was completed in 20 – 25 minutes. 

Glazing and firing took 20 minutes with 

another half an hour used for placement 

of the rubber dam and bonding of the 

restoration to the tooth. 

The use of 3Shape TRIOS scanner and 

TRIOS Design Studio software as part of 

the continuous and seamless workflow, 

along with the direct integration with 

DGShape, is an easy and predictable option 

for in-house manufacture, and same day 

crown workflow. The update to allow use 

of TRIOS Patient Specific Motion made 

this case even more predictable, as the 

patient’s actual excursive and protrusive 

movements can be utilised rather than a 

virtual articulator. DA 

Dr. Douglas Watt graduated 

from Birmingham University in 

2003. He is a partner at a private 

practice in Royal Leamington 

Spa. His interest in dentistry are 

restorative dentistry, implant 

dentistry, endodontics, and 

digital dentistry. He is a board 

member of the International 

Digital Dental Academy; 

regional representative and full 

member of the British Academy 

of Cosmetic Dentistry; and a 

member of the Faculty of General 

Dental Practitioners. He lectures 

on digital dentistry and mentors 

dentists on the application of 

digital technology. 


Behind the Scenes 

As an apprentice dental technician in northern Italy in 1979, 

Guido Testa was trained in traditional methods such as casting 

of metal crowns using the lost-wax technique. With the advent of 

technology, he started to implement new tools into his workflow, 

such as the 3D microscope from Renfert, which allows him to 

see even the smallest details inside a crown. 

S andblasting Testa came up with the idea of using the sandblasting device 

as a method of material removal after he heard German dental 

technician Oliver Brix’s technique of carving the occlusal 

surface of CAD/CAM manufactured lithium disilicate units via 

an alternative sandblasting. 

to cutters or burs 

By Guido Testa 

“My therory is based on experience. Lithium disilicate is mainly 

used for restorations on anterior teeth. Their anatomical shape 

means the preparation usually has a narrow incisal area,” said 

Testa. “In many cases, the CAD/CAM milling or grinding tools 

in the milling devices cannot reach these areas well. If you allow 

the cutter or diamond bur to mill all the way to the end of the 

preparation, depending on the diameter of the bur, too much 

material could be removed.” 

If more material than neccessary is removed and the wall 

thickness is maintained, it reduces the space available for 

aesthetic individualisation and characterisation. Another option 

is to mill the material in the machine with small instruments, 

but this process takes much longer. To ensure the restoration 

fits perfectly on the die, it is possible to grind the inner surface 

of the crown manually with a diamond bur and handpiece. An 

innovative way would be using a sandblasting device. 

Preparing the crown 

Before fitting the crown in place, the outer surface of the die is 

coated with a surface marker (Fig. 1). 

Any interfering contacts can then be seen on the inner surfaces 

of the crown (Fig. 2). 

The crown is then checked using the video microscope EASY 

view 3D from Renfert with an enlargement factor of 15 or 20, 

in both 2D and 3D to view the starting situation. Next, the 

individual areas are sandblasted with a fine sandblasting device. 

A prerequisite for this method is that the sandblasting device is 

equipped with an immediate stop function, because maximum 

precision is needed in this material removal method. The nozzle 

should have a diameter of 0.4 mm, while the blasting sand used 

should be Cobra 25 mμ at 1.0 Bar. 



Fig. 1 

Fig. 4 

Fig. 2 

Fig. 5 

Fig. 3 

Fig. 6 

Areas that used to be trimmed with a bur and handpiece are now 

processed using a nozzle and blasting sand. While the principle is 

the same, the processing method is different. 

The die is first coated with a surface marker. After the crown is placed 

onto the die, its fit is checked visually (Fig. 3). 

Excess material is removed using the sandblasting device (Fig. 4). 

The process is repeated until the crown fits perfectly on the die 

(Fig. 5). 

The accuracy of the margin on restorations can be checked using 

the EASY view 3D Video Microscope (Fig. 6). 

When the results are completely satisfactory, the working steps are 

continued in the conventional manner (Figs. 7-9). 

A new way of working 

He explained his reasons for taking a new approach. 

1. There is no need to buy new equipment or materials. 

2. A lot of time is saved by using the sandblasting device to 

improve the internal fit of a crown. 

3. Less diamond grinding is needed to adapt the veneers or 

crowns onto the dies. 

4. The CAD/CAM milling machine is kept in good condition, and 

fewer fine milling tools with small diameters, which are costly, 

are needed. 

5. Since the crowns and veneers have an optimal wall thickness, 

they can be correctly built up with ceramic or characterised 

with stains. 

6. The resulting fit of the crowns are now of even greater accuracy 

on the prepared dies than before. 



Fig. 7 Fig. 10 

Fig. 8 

Fig. 11 

Fig. 9 

Fig. 12 

Figs. 10-12: Final result 

“My conclusion is that one small change in the procedure can 

create many positive results, both in terms of savings and quality,” 

said Testa. “I would like to thank Renfert, the manufacturer of the 

fine sandblasting device with immediate stop function, and my 

colleague, Oliver Brix, for his suggestion to use devices creatively 

in order to improve the quality of our work.” DA 

Devices and materials used: 

• EASY view 3D 

• Occlusion spray Occlutec 

• Sandblasting unit Basic quattro IS 

• Sandblasting material Cobra 25 μm 


Guido Testa was born in the province of Varese, Italy, in 1958. He 

graduated in Milan in 1977 and became the owner of a laboratory 

in Busto Arsizio in 1984. He has been learning from Italian and 

international experts in dental technology since 1979. He credits 

mentors such as Prof. Gino Passamonti, Paul Muja, Bepi Plug, 

Gérard Ubassy, Enrico Steiger, and Oscar Raffeiner for his ability 

to make the best of different materials. His focus and devotion is 

mainly concentrated on fixed prosthesis. 

Besides collaborating with Renfert on workshops and as a tester 

of new tools and equipment, Testa also organises courses and 

meetings for dental professionals. He believes firmly in the 

exchange of technical know-how and experience. 

60 



Nathan Barber (Nate), head of Tech Art Ceramics 

Dental Lab in Las Vegas, United States, started 

using a milling machine, sintering furnace, 

laboratory scanner, and digitally processable 

materials from Dentsply Sirona in July last year, 

and shares what the transition has been like. 

Transitioning as a team 

Tech Art Ceramics Dental Lab was founded in 1985, and 

specialises in cosmetic restorations, as well as crowns, 

bridges, and implants. Nate Barber had worked at the lab for 

17 years before purchasing the company in 2016. One of his 

priorities was to ensure everyone in the team was taken care 

of so that they can carry on with their work. They include 

Klara, a ceramist; Antonio, who does model work; Joseph, 

who does scanning; and Esmeralda, who does metal, waxing, 

and opaquing. He considers Wes, who is knowledgeable 

about the dental industry and lab businesses in Las Vegas, 

his mentor; his wife and daughters usually help out at the 

front office with pick up and deliveries. 

Before settling on the CAD/CAM equipment from Dentsply 

Sirona, Barber had contacted lab friends to find out what 

they were using. 

He said, “I primarily look for what’s going to make the lab 

more efficient. I also look for quality and durability. When 

we made the switch last year, I was scared to make the 

transition. But now I wish we had done it sooner. We would 

have been ahead of the curve.” 

Scaling the learning curve 

In terms of efficiency, inLab MC X5 from Dentsply Sirona, 

which processes zirconia and glass ceramics, has sped up 

the production at Tech Art Ceramics. 

From 

Holding a 

Model to 

Holding a 

Mouse 

Going 

Digital 


61


At the same time, Barber acknowledged that it took time to 

understand the scanning process with inEos X5, which uses 

blue light and camera optics designed specifically for dental 

applications, such as working models of veneers, crowns, and 

bridges. 

He elaborated, “Even though there are a lot of things you can do 

with digital, I still like to work with models by hand. It’s going to 

take time to get used to the process of scan and design. Since 

going digital, I’ve had to teach myself a different way of using my 

hands – from holding a model to holding a mouse.” 

Although there are different software platforms available that can 

help with design, Barber sees the benefit in hands-on tooling for 

aesthetic contouring, “I would say we use 90% digital, then 10% 

aesthetic contouring, tooling, and anatomy. This will change with 

time and practice.” 

The rewards of going digital 

Going from analogue to digital was slow at first, but Tech Art 

Ceramics is now on the upswing, and finds the process becoming 

smoother and faster, allowing the team to get work out sooner. 

He said, “We’re adjusting our workflow and changing the way we 

work. For example, Esmeralda does wax and metal finishing, but 

with digital, instead of waxing, she’s now grinding. You get used to 

your staff doing things in a certain way – but you learn to adjust.” 

Along with the milling machine, the sintering furnace inFire HTC 

speed also shortens the time it takes to turn around complete 

zirconia crowns and bridges, which can be done within one and a 

half hour. Thanks to the use of technologically enhanced heating 

elements, insulation materials, and sintering trays, the furnace is 

able to deliver time savings of up to 85%. 

Barber said, “Now that we don’t have to pay somebody else to mill, 

the money spent on outsourcing – which were getting as high as 

$11,000 – stays inhouse. We’ve definitely started to turn a profit.” 

Change can be positive 

Barber has plans to go completely digital. Currently using digitally 

processable materials such as Cercon xt Multilayer, which has an 

optimised colour gradient built into a proven material, he finds it 

more cost effective to outsource metal framework. 

He said, “I’d like to get a 3D printer – we would use 3D printing for 

models, implants, and implant supported bridges. I’m also looking 

to add more scanners and milling machines, so we can produce 

and speed up the turnaround time further.” 

He is looking forward to the technological development of digital 

dentures in the days to come. 

He advices fellow lab owners to be unafraid of change. “It’s taken 

me years to accept change. If you’re afraid, maybe you should step 

towards it rather than away from it.” DA 

62 DENTAL ASIA March / April 2020

In Depth With 

Efficient Aesthetics with 

Direct Filling Treatments 

Direct filling tools from 

Ivoclar Vivadent 

Direct filling treatments from Ivoclar 

Vivadent has a new motto – individually 

good, together better. Each product plays 

a part in a series of working steps to form 

a harmonious workflow. As a team, the 

solutions help clinicians save time and 

money while achieving consistently good 

results. 

Time savings of up to 55% 

Direct restoratives, Tetric N composites, with 

shades that blend in naturally, can have their 

efficiency increased when used together with 

precise contouring instruments OptraSculpt 

and OptraSculpt Pad. The flexible lip and 

cheek retractor OptraGate can also be used 

for relative isolation. 

The delivery of adhesive material Tetric 

N-Bond Universal in adhesive dispenser 

VivaPen allows almost three times more 

applications per millilitre content than 

conventional bottles. 

The Bluephase Style curing device, with 

its special Polywave LED, offers high 

performance with short exposure times for 

all light-curing materials. When a treatment 

procedure has been optimised for efficiency, 

a Class II restoration can be done in just 11 

minutes, compared to the regular 17. 

Reliable quality 

Ivoclar Vivadent’s solutions inspire dental 

practices worldwide. When products are 

optimally coordinated, direct restorative 

procedures can be done faster and better. 

Without compromising on quality and 

aesthetics, clinicians can treat three patients 

instead of two in the same time. 

A mouth rinse with better patient 

compliance 

Cervitec Liquid from Ivoclar Vivadent, a 

ready-to-use alcohol-free mouth rinse for 

professional oral hygiene in the dental office 

and at home, now features an enhanced 

formula. 

The new formula contains xylitol, the 

provitamin D-panthenol and 0.1 % 

chlorhexidine. In a survey of 150 test 

subjects, 97% liked its delicate mint flavour, 

with 86% rating it as mild. 89% reported 

that their breath felt clean and fresh after 

rinsing, with nine in 10 saying they would 

continue using it. 

Rinsing with Cervitec Liquid is recommended 

for patients before and after implant, 

periodontal or orthodontic surgery, as well 

as for those with a high caries risk. DA 

Cervitec Liquid 


63

In Depth With 

Harnessing 

the Power 

of Sound 

bottle-system, angled spray nozzles and 

subgingival perio tips. 

PIEZOSURGERY ® touch, with black 

glass touch screen, easy-to-handle 

user interface, and handpiece with 

rotatable LED 

mectron has been active in the dental field 

since 1979, developing top-quality devices 

such as ultrasonic titanium handpieces and 

LED curing lamps for composite materials. 

The company stands out for its innovation 

and excellent design. 

PIEZOSURGERY ® 

PIEZOSURGERY ® uses ultrasonic microvibrations 

to cut bone. Unlike traditional burs 

and saws, the technique does not damage 

soft tissues, allowing dental surgeons to 

work with a precision that facilitates not 

only the surgery itself, but reduces postoperative 

discomfort for patients as well. 

PIEZOSURGERY ® inserts – with clinicians, 

for clinicians 

All PIEZOSURGERY ® inserts are developed 

in response to specific clinical needs and 

result from collaborations with universities 

and clinical practitioners. The best proof of 

our expertise is over 90 high quality insert 

designs that are now available to surgeons 

worldwide – and new inserts are released 

every year. 

Ultrasound 

When a gentle movement is needed, 

clinicians can choose the SOFT MODE, 

mectron innovative SOFT MODE avoids 

excessive ultrasound oscillation, allowing 

a gentle and efficient insert movement. 

Results: nearly painless treatment for 

patients and maximum comfort for clinicians. 

All efforts are met perfectly. For extractions 

and prosthetics, the pulse mode can be 

used, transforming the standard ultrasound 

oscillation to one that with specific power 

peaks. A comprehensive range of inserts is 

available for every application. 

Multipiezo 

white 

LED curing 

Weighing just 77g, the cordless LED curing 

lamp is equipped with the ability to harden 

a 2mm thick layer in 10 seconds. It runs 

for 240 cycles of 10 seconds each in 

succession on lithium-ion battery. Clinicians 

can opt between fast-curing (10 seconds 

at maximum light intensity) and slow-rise 

(20 seconds with progress increase of light 

intensity) modes. 

Building on its strength as the innovator 

of ultrasonic surgical unit for piezoelectric 

bone surgery since 2001, Mectron continues 

to pursue scientific excellence to bring 

dental solutions to 80 countries around 

the world. DA 

starlight lamps are effective on 

camphorquinone, used as a photoinitiator 

in 98% of the materials on the market 

Air polishing 

Combining ultrasound and air polishing, 

Combi touch operates according to the 

piezoelectric principle to shift tartar gently. 

The patient will be able to experience 

greater comfort as hammering movements 

are not needed. It is equipped with two 

removable powder chambers, illuminated 

Dental hygienists can switch between 

supra and subgival air polishing by 

pressing the ‘prophy’ or ‘perio’ buttons 


In Depth With 

Combining automation, 

imaging technology and 

simplified workflows, the CS 

9600 cone beam computed 

tomography (CBCT) from 

Carestream Dental, a 

digital imaging solutions 

provider, ensures reliable 

patient positioning and 

reproducible results. 

Diagnostic 

Excellence 

with Humanised 

Technology 

The CS 9600 CBCT system 

Streamlined workflow 

The CS 9600 features SmartPad, an intuitive touchscreen interface 

that guides the operator through the exam. A live positioning system 

uses cameras to help users position patients in the correct position. 

And combined with face-to-face positioning, this technology 

facilitates patient alignment, thus enhancing exam precision and 

reducing risk of retakes. 

Implant planning software with 

customisable virtual crowns and 

comprehensive implant library 

High-res images of up to 75μm 

reveal more precise details for 

endodontic cases 

Live patient views 

are displayed on 

the touchscreen for 

“easy and exact” 

positioning 

Enhanced images 

The CS 9600 comes equipped with the CS Metal Artifact Reduction 

(MAR) technology. This algorithm provides specific metal artifact 

reduction, and a tool to compare live images with and without MAR 

filter. 

With up to 14 FOV, including full skull and 

temporomandibular joint (TMJ) imaging, 

the CS 9600 is ideal for maxillofacial 

surgery, including orthognathics 

3D Facial Scanning captures a 3D 

image of the patient’s face, and 

combines it with the CBCT image 

flexible scan sizes, adaptive X-ray filtration and 120kV imaging, the 

CS 9600 allows users to reduce dose to patients while optimising 

image quality. 

Ed Shellard, D.M.D, chief dental officer, Carestream Dental, said, “The 

CS 9600 is an intelligent and powerful imaging system that allows 

users of any experience level to capture high-quality diagnostic 

images. Digital dentistry is in a constant state of change. Not only 

do we want to enable doctors to keep up with these changes, we 

also want them to use these innovations to their fullest potential.” 

The CS MAR algorithm reduces metal artifacts 

Greater safety 

With its low dose programmes, the CS 9600 delivers 3D images at a 

significantly lower dose than 2D panoramic imaging. Combined with 

The CS 9600 comes in three different editions, featuring 10, 12 

and 14 fields of view (FOV), and can be upgraded to a larger field of 

view to ensure that the system covers all the needs of practices that 

place implants, perform oral and maxillofacial surgery or perform 

orthodontic, periodontal or endodontic procedures. DA 


65

Product Highlight 

DGSHAPE 

Intelligent & Effortless Wet Dental Milling 

DGSHAPE has developed the DWX- 

42W benchtop wet grinding machine 

for producing aesthetic glass ceramic 

restorations using CAD/CAM blocks. As 

the second-generation wet milling machine 

from DGSHAPE, the DWX-42W features 

an automatic tool changer with six tools, 

specialised tooling for finer restorations, 

updated coolant system, reduced air 

compressor requirements, and ethernet 

connectivity for remote operation. 

can be used in a clinical workflow with 

3Shape’s TRIOS intraoral scanner and 

DesignStudio software package. 

According to DGSHAPE, the DWX-42W’s 

ability to produce a single posterior 

crown in minutes gives dental clinics 

the possibility of providing same-day 

dentistry. Three blocks can be milled 

simultaneously for greater production 

turnaround. 

The DWX-42W can be integrated into 

multiple different workflows with any 

scanner and CAD/CAM equipment. It 

is also compatible with materials by 

manufacturers such as Ivoclar Vivadent, 

Dentsply, Straumann, Glidewell, and 

VITA. In particular, the wet grinding machine 

Wet grinding machine DWX-42W 

The machine comes with a touch panel and 

LED light warning system. Alternatively, 

users can perform routine maintenance 

and calibration, run jobs, and perform 

software updates through a virtual 

machine panel from the comfort of their 

desktop computer. ■ 

Amann Girrbach 

A Universal Zirconia without Aesthetic limitations 

With an aim to eliminate time-consuming search for the right blank 

for corresponding restoration, Amann Girrbach has built upon the 

success of the Zolid HT+ product line and developed Zolid GEN-X, 

a multilayer, translucent zirconia restoration material. Combined 

with the aesthetic properties and mechanical values of the Zolid 

HT+ product line, Zolid GEN-X is further equipped with a natural 

colour gradient, thus enhancing the blank in the areas of efficiency 

and aesthetics. 

The company launched the Zolid HT+ translucent zirconia oxide 

material in 2017, and has manufactured 2.5 million units since. With 

Zolid GEN-X and its integrated colour and translucency gradient, 

a material has now been created that addresses common zirconia 

indications. 

Zolid GEN-X, a multilayer, translucent zirconia for all indications 

Laboratories can use this material to reduce inventory and dispense 

with time-consuming selection processes based on the indication 

and position of the restoration. As with all materials of the Zolid DNA 

Generation, the 16 shades have been matched to the VITA shade 

guide, ensuring the user security in the fabrication of consistently 

reproducible results. And, of course, the entire portfolio of the Zolid 

DNA Generation remains available to the user for aesthetics such as 

monolithic crowns in the anterior region or discoloured stumps. ■ 



Structo 

Structo partners uLab Systems to bring 

AI into aligner treatment planning 

Dental 3D printing 

solutions provider 

Structo has sealed 

a partnership with 

uLab which will 

see the latter’s 

AI-powered 

aligner treatment 

planning software 

integrated into the 

former’s Velox inoffice 

3D printing 

ecosystem. 

Design software uLab 

Huub van Esbroeck, founder of Structo, explained, “In-office and 

same day aligners has been the trend in orthodontics in recent 

times. We want to give Velox users the option of capitalising on 

this trend for less complicated clinical cases.” 

ULab will be the first direct integration 

of appliance design software in the 

Velox ecosystem. Paired with the 

self-contained Velox 3D printer that 

integrates print, wash and cure of the 

3D printing process, users will be able 

to insource some of their clear aligner 

cases for more control over clinical 

outcomes and quicker appliance 

turnaround time. 

Dr. Eric Wu 

A doctor who was given an early preview 

of this integration is Dr. Eric Wu of Wu 

Orthodontics in Palo Alto, California, US, 

who commented, “After we’ve scanned 

a patient in the morning, we plan the 

entire treatment in uLab’s software, and 

we print the first two aligners for the 

patient immediately using our Velox. 

That way, we get to deliver the first 

set of aligners to the patient by lunch, 

while we have the high-throughput 

DentaForm print the rest of the case 

in the background. That is how we get 

to offer same-day aligners.” ■ 

Velox 3D printer


W&H 

Implantmed Plus: Smart ioDent System Saves Time 

W&H has introduced Implantmed Plus, a surgical device 

with the ioDent system, to its portfolio of networked 

products for dental practice. The ioDent system, with 

the Implantmed Plus, allows implantologists to plan 

treatments online via a computer or mobile device. 

The ioDent online platform’s intuitive user interface 

(UI) enables the 

user to predefine 

1 

all the treatment 

details. Implant 

positions and all 

the necessary 

programme steps, 

customised for each 

patient, may be planned 

and configured prior to the 

treatment. 

1 

2 

3 

With Implantmed Plus, implantologists have access to the ioDent system 

The ioDent system, which correspond to the ioDent gateway mini, 

allows treatments to be planned conveniently online 

ioDent, the smart solution for optimal treatment planning 

The package includes an implant 

manufacturer database in ioDent, where 

implantologists can select the 

appropriate implant system. These 

recommended steps are implemented 

into ioDent 1:1, and can be customised 

in the ioDent UI. The defined settings 

may simply be sent to the Implantmed Plus 

at the start of treatment. 

3 

Automated documentation 

process 

Be it torque progression, threading 

curve, drill protocol, or implant 

stability values, all the documentation 

data can be transferred from the 

Implantmed Plus surgical device to 

the online platform. The benefit is 

not only the time being saved each 

day, but also the safety of having 

access to an overview of all the data 

at all times. ■ 

2 

Dentsply Sirona 

Full Dentures with inLab SW 20.0 – Simply Digital 

The new inLab software 20.0 from Dentsply Sirona has expanded the company’s 

expertise in the field of dental indications to include the fabrication of digital dentures. 

The software provides the dental laboratory with digital support for all relevant process 

steps – from accurate imaging of the bite registration with the inEos X5 extraoral scanner, 

through automated and careful model analysis, to the initial proposal of a possible tooth 

set-up and the design of the denture base. 

The denture optimised software also enables a new and fast scan workflow for the exact 

correlation of upper and lower jaw – the basis for the subsequent design. 

The subsequent manufacturing process 

can be carried out using various 

methods: the denture base can be 

milled out of a blank, such as Lucitone 

199 Denture Base Disc from Dentsply Sirona, or manufactured in 3D printing material 

such as Lucitone Digital Print 3D Denture Resin. Depending on the tooth set-up selected, 

the tooth arch or segments are milled out of a disc or the prefabricated IPN 3D Digital 

Denture Teeth from Dentsply Sirona are used. ■ 

Due to various certification and registration periods, not all products are immediately available in all countries. 

The software guides the dental technician 

step-by-step through the entire digital process 

68 



VOCO 

VOCO introduces new flowable composite 

The repair of defects, alongside filling of small cavities, are recurring 

tasks in the dental practice. The primary goal is a minimally invasive 

treatment to minimise the loss of healthy tooth substance. For 

such precise applications, dentists require a flowable material 

that displays the physical properties and resilience of a packable 

restorative composite. 

In addition, the product is also packed with superb physical 

properties, in addition to its flowability. For example, with a filler 

content of 76% by weight and a 3-point flexural strength of 151MPa, 

it attains values similar to those of a packable composite. ■ 

To meet this need, VOCO has expanded its GrandioSO product range 

with a low-viscosity nano-hybrid composite – GrandioSO Light Flow. 

This new flowable composite, according to VOCO, is “thin-flowing, 

precise and high-strength”. 

The assets of GrandioSO Light Flow lie in the possibility of targeted 

and precise application with an extra fine cannula, which is even finer 

than a periodontal probe. VOCO added that this feature avoids the 

generation of excess residues, and saves on material. 

The GrandioSO Light 

Flow flowable composite 

from VOCO 


69


3Shape 

Facial-Driven Restorations with 

3Shape and Bellus3D Integration 

The app allows the clinician to align 

the face scan and the intraoral scan 

before sharing the aligned files into the 

Dental System software 

The integration from 3Shape TRIOS to Bellus3D Dental Pro 

Face scan enables clinicians to align TRIOS intraoral scans 

with the Bellus3D Face scan. 

Align face scan with intraoral scan 

The workflow starts with a TRIOS intraoral scan that is 

integrated into the Bellus3D Dental Pro app. 

Integrate in the 3D smile design process 

Dental Pro captures life-like quality 3D face scans, and 

provides tools to align the 3D face scan to dental surface 

scans to prepare them for import into dental design software. 

The aligned result can be used in 

3Shape Dental System lab software for 

the design of facial-driven restorations 

that reference patient’s individual 

smile and lip line for enhanced results 

and patient care 

Accelerate case acceptance 

Coupled with 3Shape TRIOS intraoral scanner and Dental 

System, the integration accelerates high-value case 

acceptance and clinician approval by using facial-driven 

restorations that reference the patient’s individual smile and 

lip line for improved results and patient care. ■ 

By incorporating 3D facial 

scans into the dental 

planning process, clinicians 

and dental labs can use the 

patient’s face in 3D as an 

integral part of the 3D smile 

design process 

Bausch 

Bausch adds new features to OccluSense iPad App 

A new iPad app version is available for the OccluSense system 

from Bausch, featuring new functions. The latest 1.7 version 

offers a simplified setup, and is able to pair the OccluSense 

handheld with the iPad app and the Wi-Fi network within seconds. 

An integrated support system has been added to provide answers to the 

most frequently asked questions about installation and application. A ticket 

system is also built into the OccluSense iPad app for users who require a 

direct contact with the support staff. 

Wider “XL” sensors BK 5035 are also available, at 60μm thin and colour 

coated. Like the smaller OccluSense sensors BK 5025, the colour transfer 

on the occlusal surfaces of the patient makes it easy to assign the recorded 

data. The masticatory force distribution, which can be displayed as a 2D or 

3D graphic with up to 150 images per second, can be saved in the patient 

database of the iPad app, reviewed at any time or exported. 

Bausch has packed its OccluSense iPad app with new features, 

including the improved pairing of the OccluSense handheld with 

the iPad and Wi-Fi network 

The OccluSense sensors are being used like a conventional occlusion 

test foil. The masticatory pressure distribution of the patient is digitally 

recorded in 256 pressure levels, and transferred to the OccluSense iPad 

app for further evaluation. ■ 

70 


Show Preview 

Experience the Latest Dental 

Innovations at Sino-Dental in Beijing 

To be held from 9 th – 12 th June 2020 

at the China National Convention 

Centre in Beijing, the 25 th edition of Sino- 

Dental will feature academic seminars and 

workshops covering topics such as oral 

surgery, prosthodontics, orthodontics, clinic 

management, and trend analysis. Over 

140,000 visitors from over 90 countries 

are expected to attend the event. 

A platform for business collaborations 

Sino-Dental is a platform for dental 

professionals to build business networks 

and explore new markets. Both international 

and local dental solutions providers regard 

Sino-Dental as their “first choice” in China 

for the launch of new products. 

Distribution of visitors 

This year, Sino-Dental will host 900 

exhibitors from over 30 countries. Besides 

establishing business networks, visitors to 

the show will be able to exchange latest 

research and market information, and 

experience technology advances at the 

innovation exhibition zone. 

Congress and Seminar 

Over 100 academic seminars and workshops 

covering more than 400 topics will be also 

Besides the different branches of dentistry, clinic 

management and trends will also be discussed 

held during the exhibition. Visitors can 

attend these seminars and workshops to 

enhance their skills, as the latest academic 

research and technology development in 

the dental field will be presented. Some of 

the academic topics that will be covered 

include oral surgery, oral implantology, 

periodontics, endodontics, paediatric 

dentistry, oral prevention, hospital 

management, and dental emergency. 

The majority of attendees are members of public and private 

hospitals and clinics 

Main objectives for attending the show

Show Preview 

Service 

International Dealers 

• International Dealer’s Lounge: private space, free access, 

complimentary snack and beverage 

• Free interpretation service (appointment requested) 

• Complimentary accommodation during exhibition period 

for whom invite 10 or more dealers to Sino-Dental® 

• Free information release service to facilitate the 

matchmaking with local partners and suppliers 

Online Visitor Pre-Registration 

• No registration fee. 

• On-site quick pass counter for badge claim. 

• Free catalog, drinking water and gift. 

Visa Assistance 

• Invitation letter service is provided and please check with 

Sino-Dental. 

Hotel Reservation 

Complimentary services for an enhanced experience 

International dealers will be able to access the International 

Dealer’s Lounge, a free, private meeting space that is served with 

complimentary drinks and snacks. Free interpretation services may 

also be arranged in advance. Sino-Dental will also provide visitors, 

who invite 10 or more dealers to the event, accommodation during 

the exhibition period. The free information release service will also 

be available to international dealers to facilitate their business with 

local partners and suppliers. 

Beijing: Where ancient and modern meet 

With its blend of ancient and modern, Beijing is one of the most 

popular tourist destinations in the world. If time permits, don’t miss 

the opportunity to tour the city. Guided tours by partner travel agents 

with multiple choices of routes will provide an opportunity for visitors 

to explore the sights, sounds, and tastes of the heritage city. DA 

• Reserve a hotel room with Sino-Dental for exceptional 

savings, great room selection and convenience. 

Tourist Service 

• Guided tour on discount by partner travel agencies with 

multiple choices of routes will be a good opportunity to 

explore the ancient & modern city of Beijing. 


Giving Back to Society 

Denticon Supports Teledentistry Team to Reach More Patients 

The Denticon cloud solution 

With the implementation of Denticon cloud 

solution that enables full teledentistry, 

clinicians at Healthy Smiles for Kids of 

Orange County (HSK) have been able to do 

away with paper charts and traditional onpremise 

software. X-rays are captured on 

site for children from low-income families, 

and reviewed remotely in real-time to 

develop comprehensive treatment plans. 

Dr. Harvey Lee, chief dental officer of HSK, 

said, “We were one of the first non-profits to 

begin a teledentistry programme in 2016, 

which wouldn’t have been possible without 

a cloud-based system like Denticon.” DA 

Additionally, the software’s advanced 

reporting capabilities empowered HSK 

with new insights into their various 

programmes, allowing them to track the 

overall effectiveness of each initiative 

and make more informed decisions. As a 

result, HSK is able to spend less time on 

administrative tasks and focus its efforts 

in giving their patients quality care and 

education. 

Through Denticon, images 

and patient notes can be 

remotely accessed 

Kids receive treatment 

in one of HSK’s mobile 

dental clinics 

Q&M Donates 50,000 Surgical Masks to Healthcare Workers 

Singapore-based Q&M Dental Group has donated 50,000 

surgical masks, along with hand scrubs, hand sanitisers, 

thermometers, and personal protective equipment such as 

gowns, goggles, and medical face shields to healthcare workers 

in 17 charity organisations, including Kreta Ayer Seniors 

Activity Centre, Lee Ah Mooi Old Age Home, Lions Home for the 

Elders, Singapore Children’s Society, and Thong Chai Medical 

Institution. 

Dr Ng Chin Siau, CEO of Q&M Group, said, “Even though the 

epidemic in Singapore is well controlled, there is still a risk and 

danger for those who are in the front line. As fellow healthcare 

workers, we empathise with our peers, and hope that our 

contributions can serve as a safety net for them.” 

Kreta Ayer Seniors Activity Centre 

The outbreak of the Covid-19 infection poses many challenges 

for all healthcare workers. The sick and elderly are reported 

to be more vulnerable to Covid-19. The demand for masks 

has led to a global shortage and rising costs, leaving some 

organisations vulnerable. DA 


2020 Events Calendar 

MARCH 

2 – 5 Dental South China 2020 - The 25 th Dental South 

China International Expo 

Guangzhou, China 

Venue: China Import & Export Fair Panzhou Complex 

13 – 15 ADX20 Sydney 

Sydney, Australia 

Venue: ICC - International Convention Centre 

14 – 15 AADS 2020 - Advanced Asian Dental Summit 

Manila - Philippines 

Venue: Manila Hotel 

27 – 29 Borneo Dental Congress & Trade Exhibition 

2020 - 10 th Edition 

Sarawak, Malaysia 

Venue: Imperial Hotel 

APRIL 

3-5 5 th Malaysia International Dental Show 2020 

Kuala Lumpur, Malaysia 

Venue: Sunway Pyramid Convention Centre 

16 -18 Nobel Biocare Symposium 

Las Vegas, USA 

Venue: Mandalay Bay Resort 

MAY 

29 – 31 Famdent Show Mumbai 2020 

Mumbai, India 

Venue: Bombay Convention and Exhibition Centre 

JUNE 

5 – 7 SIDEX 2020 - The 17 th Seoul International 

Dental Exhibition & Scientific Congress 

Seoul, Korea 

Venue: COEX (Seoul Convention and Exhibition Center) 

9 – 12 SINO-DENTAL 2020 - The 25 th China International 

Dental Exhibition and Scientific Conference 

Beijing, China 

Venue: (CNCC) China National Convention Centre 

9 – 13 APDC 2020 - 42 nd Asia Pacific Dental Congress 

Colombo, Sri Lanka 

Venue: BMICH Convention Center 

19 – 21 IDEM Singapore 2020 - International Dental 

Exhibition and Meeting 

Singapore, Singapore 

Venue: Suntec Singapore Convention & Exhibition Centre 

JULY 

11 – 12 Delhi Dental Show 2020 

New Delhi, India 

Venue: Pragati Maidan, Hall A3 

AUGUST 

14 – 15 The 2020 Dental Expo 

Auckland, New Zealand 

Venue: ANZ VIaduct Events Centre 

21 – 23 HK IDEAS 2020 - Hong Kong International 

Dental Expo And Symposium 

Hong Kong 

Venue: Hong Kong Convention and Exhibition Centre 

28 – 30 MIDEC 2020 - Malaysia International 

Dental Exhibition and Conference 

Kuala Lumpur, Malaysia 

Venue: Kuala Lumpur Convention Center - KLCC 

SEPTEMBER 

1 – 4 FDI 2020 - Annual World Dental Congress 

Shanghai - China 

Venue: National Exhibition and Convention Center 

23 – 26 IFEA 2020 - 12 th World Endodontic Congress 

Chennai - India 

Venue: Chennai Trade Centre 


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Hong Kong International Dental Expo & Symposium 57 

Ivoclar Vivadent AG 

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Dental Asia March/April 2020

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