Dental Asia March/April 2019

CONTENTS
MARCH / APRIL 2019
18
24
29
34
40
44
48
56
62
68
Under the Spotlight
Dr. Christopher Ho: Passionately Striving to Be the Best in Dentistry
Dental Profile
Ms. Julie Tay: Celebrating Digital Transformation
Dr. Frank Thiel: Taking Digital Impression to A Higher Level
Clinical Feature
Atraumatic Extraction of Mandibular Third Molars
Glass Ionomer Sealant for Proactive Intervention
7 th Generation Adhesive Systems
User Report
Ivoclar Vivadent: Cention N: Redefining Dental Restorations
Anthogyr: An Elegant Transcrestal Sinus Floor Elevation Technique Using Osteo Safe ®
Behind the Scenes
Replacement of Existing Porcelain Veneers to All-Ceramic Veneers with Digital Workflow
A Journey Through Elemental Reinforcement of Functional and Aesthetic Harmony
DENTAL ASIA
www.dentalasia.net
75
81
83
84
92
94
95
04
06
86
96
97
100
In Depth With
Dentsply Sirona: Primescan Perfects Digital Impressions
SINOL: Providing High Technology and Professional Service for a Better Life
DenMat: Extending Dental Operating Fields with Loupes
Align Technology: The New iTero Element 5D Imaging System for Comprehensive
and Restorative Oral Care at IDS
Show Review
Structo Partnered with 3Shape and Henry Schein to Showcase
3Shape’s New Open Clear Aligner Workflow
Show Preview
The Most Influential Dental Exhibition in Asia-Pacific
Nobel Biocare Global Symposium in Madrid to Open New Chapter in Implant Dentistry
Regulars
First Words
Dental Updates
Product Highlights
Giving Back to Society
Events Calendar
Advertiser’s Index

TM
Clean Water. Clear Choice.
Dental unit waterline safety
has never been easier.
The multi-award winning
DentaPure cartridge protects
your dental unit water for an
entire year!*
Did You Know?
The DentaPure cartridge uses
the same technology developed
for NASA to ensure that water
consumed in space is safe from
harmful levels of bacteria and
many other harmful organisms.
The implications from improperly
treated Dental Unit Waterlines are
far too great to ignore.
Research shows that the extremely narrow
design of waterline tubing promotes water
stagnation and bacterial accumulation 1 ,
which can impact the well-being of your
patients, staff and practice.
© 2018 Crosstex International, Inc. 0818 DADV00298
All claims made based on use with potable water.
* Or 240L of water, if usage records are kept.
1
http://www.osap.org/?page=Issues_DUWL_1
All product names are trademarks of Crosstex International, Inc., a Cantel Medical company,
its affiliates or related companies, unless otherwise noted.
crosstex.com

First Words
The New Age of Digitalisation and Innovative Solutions
There is no doubt that digitalisation has
emerged as a global trend. On social media,
influencers rave about the latest products,
gadgets, and innovave services currently
available on the market. It is no different
in denstry, as praconers the world over
usher in an excing and highly-ancipated
phase – the age of digitalisaon!
Let us take a look at impression taking; gone
are the days where we need to mix alginate
or polyvinyl siloxane (PVS) materials, loading
materials on dental impression trays while
waiting for the impression to completely
set - only to find out that we need to redo
the impression due to voids, bubbles, or just
being unable to take a complete impression
of the site we need.
Nowadays, digital dental impressions (DI) are
more commonly used in denstry not only for
prosthodoncs but also in orthodoncs, as
discussed by Dr. Frank Thiel, Vice President
R&D CAD/CAM and Orthodontics of
Dentsply Sirona (pages 29-32). Addionally,
my interview with Ms. Julie Tay, Senior Vice
President and Managing Director Asia Pacific
of Align Technology, emphasised the digital
transformaon in the field of orthodoncs
through their pioneering Invisalign clear
aligner system as they celebrate reaching
their recent milestone – six million paents
on Invisalign treatment (pages 24-27).
Fortunately, for this issue, Dental Asia’s
distinguished advisory board members
have contributed informative articles on
products and the dental pracce. Firstly, our
interview with Dr. Christopher Ho, Specialist
Prosthodonst and founder of CARE Denstry
(Australia), reveals the importance of building
a practice, finding the right team and
ulising the right tools and the applicaon
of digital denstry (pages 18-22). Secondly,
Dr. George Freedman’s article reviews
the different generations and the
benefits of the current 7 th generation
adhesive systems (pages 44-47).
Lastly, Dr. Fay Goldstep’s article provides
insight on the efficiency of glass ionomer
sealant for pits and fissures (pages 40-43).
Adding to the findings of Dr. Goldstep,
the user report by Prof. Dr. Mohan
Bhuvaneswaran furthers the exploration
of the high-performing and retentive
approach using glass ionomer filling materials
(pages 48-54).
On the subject of dental surgery, innovave
soluons such as the transcrestal sinus floor
elevation technique using the Osteo Safe
were discussed by Dr. Christophe Fores,
focusing on how it enhances treatment
plans by being ergonomic, fast, effective
and safe (pages 56-60). Moreover, the case
on the atraumac extracon of mandibular
third molars by Dr. Loris Prosper and
Dr. Nicolas Zunica, zeroed in on a dental
surgery product which allows minimal trauma
and significantly reduces post-operatory
discomfort (pages 34-38).
Our ‘In Depth With’ articles (pages 75-85)
and product highlights section
(pages 86-91) feature advanced game
changing dental products and innovative
soluons, revealing excing mes ahead for
the enre industry, as 2019 witnesses the
dawning of a new age of digital denstry.
Dr. Chala R. Platon
Assistant Editor
FOLLOW US
@dentalasia
ADVISORY BOARD
Dr William Cheung
Dr Choo Teck Chuan
Dr Chung Kong Mun
Dr George Freedman
Dr Fay Goldstep
Prof Urban Hägg
Prof Nigel M. King
Dr Ramonito Rafols Lee
Dr Kevin Ng
Dr William O’Reilly
Dr Ryan Seto
Dr Adrian U J Yap
Dr Christopher Ho
Dr How Kim Chuan
Dr Derek Mahony
Prof Alex Mersel

Dental Updates
3Shape and OrthoApnea Team Up to Manage Sleep Apnea Faster and Easier
3Shape, the leading the leading
3D scanner and CAD/CAM global dental
software provider, and OrthoApnea,
the designer and manufacturer of oral
appliances for sleep apnea and snoring,
have created a 100% digital workflow
and online communication system for
doctors to provide sleep treatment to
their patients.
The collaboration enables doctors using
the 3Shape TRIOS intraoral scanner
to seamlessly upload their digital
impressions to ApneaDock – an online
platform developed by OrthoApnea.
The ApneaDock platform creates a oneclick-away
digital communication channel
between 3Shape TRIOS doctors and
OrthoApnea’s sleep therapies. The digital
connection enables a faster production
workflow, which in turn, gets patients
into sleep therapy more quickly. Doctors
can also use the channel to manage their
cases and communicate with OrthoApnea
technicians.
The platform also stores patients’ sleep
treatment clinical history including all
uploaded 3Shape scans.
“The goal of this new collaboration
between 3Shape and OrthoApnea is to
make treatment management much easier
and faster, giving doctors the opportunity
to communicate with the technician in
charge 24/7,” says Mr. Antonio Lucena,
Managing Director of OrthoApnea.
“A few years ago, the American Dental
Association began recommending
doctors to assess their patients for sleepbreathing
disorders. Our collaboration
with OrthoApnea and its ApneaDock
platform makes it simpler for doctors
to provide their patients with sleep
therapy and in turn, improve their
quality of life,” says Mr. Rune Fisker,
3Shape Vice President Product
Strategy. ■
The ApneaDock platform includes a stepby-step
tutorial for doctors on how to
evaluate and assess patients, scan, take
measurements, and order treatments.
vhf and Patterson Dental Announce Sale Partnership
vhf is pleased to announce Patterson Dental
as a new strategic partner for the distribution
of their high-end milling machines in the
U.S. On the occasion of the 2019 CDS
Midwinter Meeting from 21 st to 23 rd February,
the German milling and grinding machine
manufacturer and the prestigious dental
supply company showed the Z4, a machine
for highest precision and unparalleled ease
of use.
Both parties are delighted to announce
the new partnership to meet the strong
demand for seamless same-day dentistry
options. The Z4 is a sophisticated
milling and grinding machine that allows
restorations to be fabricated from any
block material within minutes. Users
benefit from previously unattained
quality standards, intuitive operation
and validation with established scanners
and design software.
The CEO of vhf Inc., Dr. Nicolas Rohde, is
excited about the cooperation: “Patterson
Dental and vhf share the same passion
for digital dentistry, and vhf’s Z4 in
combination with Patterson’s experienced
sales force and their dedication to
industry leading after sales support will
be a very attractive offering for dental
professionals in the U.S.”
Mr. Josh Killian, Vice President of
Marketing for Patterson Dental continues:
“I’m pleased to have vhf join Patterson’s
expanded CAD/CAM portfolio of products
with their Z4 open milling unit. vhf’s
30 years of dental CAD/CAM machine
manufacturing capabilities will provide
our customers another path to creating
quality same-day in-office restorations.” ■
6
DENTAL ASIA MARCH / APRIL 2019

Dental Updates
New VOCO Prophylaxis Stand
at the IDS
The countdown to the IDS in Cologne has
started. At the 38 th International Dental Show,
countless visitors from all around the
world will have the chance to discover
new products from the dental
industry. VOCO will
also be present on
three trade fair
stands – and
for the first
time, this
will include
a special
prophylaxis
stand.
Fluoridation,
protection,
care, sealing will
be the focus of exhibits
in Hall 5.2. VOCO also has a stand this
year and will be exhibiting its complete
oral care portfolio. From Clean Joy,
the tooth cleaning and polishing paste,
through to VOCO’s Profluorid Varnish and
Perfect Bleach, the tooth whitening gel,
you will find everything there. Come to the
VOCO stand and talk to the prophylaxis
experts and, of course, also try out the
products yourself. Haven’t you always
wanted to know what the mint, caramel,
melon, cherry and bubble gum flavours
of the fluoride-containing
varnish actually taste like?
VOCO has created an exciting trade
fair promotion for all fans of the cuddly
VOCO tooth, Molarius. Anyone who takes
a selfie with the giant-sized Molarius and
then uploads the photo to Instagram with
the hashtag “VOCOmeetsIDS” will be in
with a chance to win the main prize of
a spa weekend for two in Cuxhaven, the
home of VOCO. So you see, our stand
C040 is well worth a visit.
In addition to the new prophylaxis
stand, VOCO is also exhibiting at its two
familiar stands in Hall 10.2. VOCO will
be presenting a real world first here.
With VisCalor bulk, VOCO is launching
the very first thermoviscous composite,
which combines the benefits of both
flowable and carvable materials.
The special properties of the restorative
material allow the dentist to be as
flexible as possible when placing a
restoration. At the same time, VOCO
has expanded its range of precision
impression materials. The portfolio
of successful V-Posil products is now
complemented with the putty material
V-Posil Putty fast in large cartridge
format. ■
Cantel’s Dental Division Expands Leadership Position Following Omnia Acquisition
Cantel Medical Corp., announced on
1 st February that it has completed its
previously announced acquisition to
acquire Omnia S.p.A. (“Omnia”), an Italianbased
market leader in dental surgical
consumable solutions.
The portfolio infection prevention solutions
of Cantel’s Dental division, Crosstex
International Inc. (“Crosstex”) will be
further expanded to include Omnia’s wideranging
portfolio of sutures, irrigation
tubing and customised dental surgical
procedure kits, with a focus on procedure
room set-up and cross-contamination
prevention.
“Omnia’s comprehensive product lines
of high-quality, innovative infection
prevention and surgical solutions will
be a strong addition to our growing
dental portfolio,” said Mr. Gary Steinberg,
President of Crosstex, Cantel’s Dental
division. “We believe Omnia’s existing sales
channels and focus on specialty dentistry
will better equip us to service an additional
segment of the dental market where
maintaining aseptic procedures is critical.”
“We are very excited to join Cantel’s
Dental division,” stated Mr. Robert Cerioli,
new Managing Director for Cantel’s
European Dental business (formerly
President of Omnia) “As a part of the Cantel
organisation, we are better equipped to
service the dental practices and expand the
adoption of both the Omnia and Crosstex
portfolios within the European markets.” ■
8
DENTAL ASIA MARCH / APRIL 2019

WOULD YOU LIKE TO REGROW NATURE?
Calcimol LC
• Indirect pulp capping
•
• Radiopaque
• Effective protection of the pulp
•
•
applying the total-etch technique
VOCO GmbH · Anton-Flettner-Straße 1-3 · 27472 Cuxhaven · Germany · Tel. +49 4721 719-0 · www.voco.dental

Dental Updates
AACD Welcomes 2019 Credentialing Class
to Ranks of Elite Practitioners
The American Academy of Cosmetic
Dentistry (AACD) recently recognised
12 dental professionals who have
demonstrated their dedication to
continuing education and responsible
patient care by becoming credentialed
by the AACD. This year, the AACD will
honor eight newly Accredited Members
and four newly Accredited Fellows during
the 35 th Annual AACD Scientific Session
in San Diego.
AACD Accreditation is an honour and
can only be achieved by completing a
rigorous credentialing process including
a written examination, the submission
of clinical cases for peer-reviewed
evaluation, and an oral examination.
The Accreditation process, which was
developed by the AACD and is the world’s
most recognised advanced credentialing
program, encourages further education,
interaction with like-minded colleagues,
and the opportunity for professional
growth. Accreditation requires dedication
to continuing education
and responsible patient
care.
The newly Accredited
Members include:
Vinay N. Chirnalli, DMD, AAACD;
Ramon A. Duran, DMD, AAACD;
Sandra M. Finch, DMD, AAACD;
Ingrida Ivance, DDS, AAACD;
Courtney L. Lavigne, DMD, AAACD;
Roberto Palmieri, DMD, AAACD;
Robert L. Rioseco, DMD, AAACD and
Keerti S. Sahasrabudhe, DDS, AAACD.
The AACD is also welcoming four new
Accredited Fellows. The purpose of
Fellowship is to provide the highest
level of achievement for members in
accordance with the AACD’s mission of
education and excellence.
AACD’s new Accredited Fellows include:
• Adamo E. Notarantonio, DDS, FAACD
• Tara N. Hardin, DDS, FAACD
• Kathy S. Sanders, DMD, FAACD
• Sandra Hulac, DDS, FAACD
“These dental professionals’ commitment
to responsible esthetics and cosmetic
dentistry is undeniable with their
most recent achievement as AACD
Accredited Fellows,” said AACD Fellowship
Chair Bradley J. Olson, DDS, FAACD.
“Our Accredited Fellow members must
complete one of the most rigorous, yet
life-changing journeys of their career—
and of their lives.”
These newly credentialed dental
professionals will be recognized and
receive their awards during special
ceremonies at the 35 th Annual
AACD Scientific Session held 24 th – 27 th
April in San Diego. ■
Roland DGA Corporation as the National Association of Dental Laboratories’
“2019 Supplier of the Year”
Roland DGA Corporation, a provider
of advanced milling machines and
3D devices for the dental market, has
received the National Association of
Dental Laboratories’ (NADL) Supplier
of the Year Award for 2019. This
prestigious award is presented annually
to a company that has made significant
contributions to and demonstrated
leadership in the dental laboratory
industry. NADL presented the award to
Roland DGA during an evening ceremony
at the recent NADL Vision 21 Meeting
in Las Vegas.
“Roland DGA has earned the 2019
NADL Supplier of the Year Award not
only for bringing innovative products
to the market, but also for its very
strong customer service culture,” said
NADL President Travis Zick. “The company
embodies high standards in terms of
its own workforce, the education and
support it provides to the industry, and its
social responsibility within their
community.”
In addition to advancing digital dentistry
with its cutting-edge DGSHAPE DWX
dental mills and 3D devices, Roland DGA
is renowned for its best-in-class customer
service and support, which includes a
dedicated in-house support team as well
as a channel of certified technicians.
The company is a leader when it comes
to education as well, offering online
resources, regularly scheduled webinars,
continuing education clinics, instructional
workshops, and more.
Supplying labs with state-of-the-art
dental equipment is just part of Roland
DGA’s overall operation. The company
is also a top supplier of wide-format
inkjet printers for the sign and graphics
industry, rotary engravers and impact
printers for gifts, awards, ADA signs and
part marking, and 3D milling machines for
industrial design and engineering.
“Being recognised by the NADL as the
industry’s top vendor for 2019 is a great
honour,” said Roland DGA president,
Mr. Andrew Oransky. “At Roland DGA, we are
committed to providing products and services
that enable the success of our customers
and the industry as a whole. We’re equally
committed to the wellbeing of our employees,
our partners and our community.”
According to Mr. Oransky, all these
factors have made it possible for
Roland DGA’s dental business to grow
from virtually non-existent just eight
years ago into a leading provider of dental
mills today. “Roland DGA isn’t the type of
company that rests on its laurels,” added
Mr. Oransky, “We are constantly working
on improving our products, developing
new technologies, and coming up
with ways to deliver more value to users
and the industry.” ■
10
DENTAL ASIA MARCH / APRIL 2019

Dental Updates
Komet USA and Bien-Air Dental Announce Patnership
In a special announcement at the
Chicago Midwinter Dental Meeting
(21 st - 23 rd February), Komet USA LLC
formally publicise its partnership with
Bien-Air. Together, the companies aim
to advance the quest for a superior
combination of precision, power, and
performance in procedures from tooth
preparation to finishing and polishing.
The grouping of Komet USA’s renowned
dental rotary instruments, delivered direct
from their factory in Lemgo, Germany, and
Bien-Air’s Swiss-made dental handpieces
is far more than a simple pairing of
instruments: the partnership represents
a relationship between two familyowned
companies with proud traditions
of precision engineering, high-quality
manufacturing, reliable performance, and
expert customer service.
Komet USA’s sales and marketing teams
offered demonstrations of Bien-Air’s
air-driven and electric handpieces, and
Bien-Air’s teams likewise demonstrated
select Komet instruments as ideal adjuncts
to their high-performance instrumentation.
The partners showcased Bien–Air’s
air-driven Tornado X, Prestige, Bora,
and Black Pearl models, EVO and
Classic Series electric handpieces, and
Optima Motor System in conjunction with
Komet ® carbides, diamonds, and
a range of finishing and polishing
instruments.
When asked what was different about
this partnership from others that have
existed previously, Mr. Daniel Call,
Director of Sales at Bien-Air, said: “There
are thousands of handpiece & rotary
instrument combinations available in
the landscape of the US market. Each
handpiece behaves differently; they have
different speeds, torque, power dynamic,
vibration, etc. How can a single bur,
like a ‘Zirconia’ bur, produce the same
efficiency in two vastly different types
of handpieces? Rotary instrument and
handpiece companies who have partnered
before have left this terrain unexplored.
We intend to provide a comprehensive
solution for every material during our
partnership with Komet USA.
With sights set on a long and successful
partnership, the two companies are a
natural fit thanks to their shared values,
humble origins, traditions, and longevity
in the dental marketplace.
According to Komet USA’s CEO,
Mr. Todd Blanton, “Komet USA’s
mission has always been to put the best
technology in the hands of our doctors
so they can provide exceptional care
to their patients. This commitment is
something we share with Bien-Air, and
we are happy to partner with them. Like
great dental products, mutually beneficial
partnerships lead to higher expectations
in innovation and performance.” ■
Recognised Business Leader Mr. Spencer Ellena Joins VITA as
Director of Channel Management
VITA North America is pleased to
announce that it has hired prominent
sales director Mr. Spencer Ellena as its
new Director of Channel Management.
Mr. Ellena has been tapped to strengthen
and build on VITA’s existing dealer
network and to foster renewed energy for
the VITA North America brand.
“We are excited to have Spencer Ellena as
our new Director of Channel to continue to
build great partnerships with our valued
dealer network,” says Mr. Greg Rome,
VITA North America’s Director of Sales.
“We consider our dealer partners to be
an extension of the VITA family, and look
forward to having Spencer help galvanise
those already strong relations.”
Well known for his positive and infectious
attitude, Mr. Ellena will be working with
many of the industry professionals
with whom he’s forged relationships as
a decade-long healthcare and dental
industry executive to drive a number of
initiatives for VITA’s industry-leading
products. In addition to previous sales
roles with the Danaher, Kavo Kerr Group
and Hu-Friedy, Ellena also serves as an
advisor for the Chicago Dental Society
Foundation, Oral Health America, and
Children’s Place Association.
Supported by a strong internal team
of outside sales, tele-sales, marketing
and education efforts, Mr. Ellena will
be responsible for driving strategic
partnerships with VITA’s respected dealer
network. Along with his considerable
management expertise, Mr. Ellena has
garnered a number of accolades for his
sales and marketing acumen, including
Sales Rep of the Year, Region of the Year,
and Achiever of the Year, to name a few.
“Spencer brings a great and unique skill
and mindset with him, which he combines
with years of experience in the industry,
technical knowledge, and a very dynamic
and professional personality,” says
Mr. Patrick Bayer, Vice President, Sales
and Marketing for VITA North America.
“We look forward to working together to
bring better services and solutions to our
channel partners to develop our common
businesses.” ■
12
DENTAL ASIA MARCH / APRIL 2019

Periodontal Disease Bacteria Linked to
Alzheimer’s Disease
A recent study has periodontists encouraging patients to
maintain gum health in an effort to reduce their Alzheimer’s
disease risk.
The study, published in the journal Science Advances,
uncovered a potential link between P. gingivalis, the bacteria
associated with periodontal disease (commonly known as
gum disease) and Alzheimer’s. Researchers analysed brain
tissue, spinal fluid, and saliva from Alzheimer’s patients—both
living and deceased—and found evidence of P. gingivalis.
Gingipains, the toxic enzyme secreted by P. gingivalis, were
found in 96% of the 53 brain tissue samples examined,
with higher levels detected in those with the pathology and
symptoms of Alzheimer’s disease.
Additionally, researchers including co-author
Mark I. Ryder DMD, Professor of Periodontology at the
University of California, San Francisco, noted that the presence
of P. gingivalis increased the production of amyloid beta,
a component of the amyloid plaques whose accumulation
contributes to Alzheimer’s. The study confirmed via animal
testing that P. gingivaliscan travel from the mouth to the
brain and that the related gingipains can destroy brain
neurons. These findings are noteworthy in that they suggest a
biological mechanism for how periodontal disease bacteria
may play a role in the development and progression of
Alzheimer’s.
According to Richard Kao, DDS, PhD, president of the
American Academy of Periodontology (AAP), the professional
society representing more than 8,000 periodontists, this
study underscores the important role of gum health on overall
wellness. “Periodontists have long known that a healthy mouth
contributes to a healthy body, and research has suggested
an association between periodontal disease and dementia
conditions, such as Alzheimer’s,” Dr. Kao said. “These recent
findings present strong evidence on how periodontal disease
can impact the pathogenesis of Alzheimer’s disease and should
highlight how crucial it is to manage periodontal disease,
especially in older adults or individuals who have increased
risk for dementia.”
Although the study results add to the evidence supporting a
link between gum disease and Alzheimer’s, additional research
is needed to better understand the etiology of Alzheimer’s and
how periodontal disease bacteria can exacerbate progression.
An upcoming FDA Phase II clinical trial will assess the benefits
of using a novel small molecule inhibitor of these P. gingivalis
gingipains in hindering the development and progression of
Alzheimer’s. This clinical trial may add further insight to the
link between gum disease and Alzheimer’s. ■

Dental Updates
Cooperation Between Dentsply Sirona and exocad Promotes the Digital Workflow
in the Practice and Laboratory
Dentsply Sirona, the world’s largest
manufacturer of dental products and
technologies, and exocad, one of the
leading dental CAD/CAM software
manufacturers for the dental lab, has
announced their extensive cooperation
in the field of digital dental workflows.
International customers of both
companies will now benefit from the
direct transmission of digital impressions
from Dentsply Sirona’s intraoral scanners
to exocad labs. Furthermore, both
companies will align elementary interfaces
between the inLab hardware and exocad
software and, among other aspects,
implement Dentsply Sirona tooth lines and
material-specific parameters in the
DentalCAD software from exocad.
Flexible open systems
play an important role
in digital dentistry.
At the same time,
ensuring the maximum
compatibility of the
systems used in
practices and labs is
becoming increasingly
important to design
reliable and efficient
digital workflows.
Considering these
objectives, the cooperation between
Dentsply Sirona and exocad offers
completely new options in the digital
production chain.
Validated workflow for digital
impressions
Thanks to this cooperation, dental
practices with Dentsply Sirona intraoral
scanners will now, for the first time, be
able to work with exocad laboratories
in a validated workflow and transmit
digital impressions conveniently and
directly for a broad range of indications.
Using the new software application,
Connect Case Center Inbox from Dentsply Sirona,
exocad labs have direct access to the
complete intraoral scan and order data in
the Connect Case Center Portal.
An application-oriented approach to
developing digital dental technology
This cooperation also comprises the
alignment of data interfaces between
the exocad DentalCAD software and
the inLab CAD/CAM components from
Dentsply Sirona, such as the highly
accurate scanner, inEos X5, and the
laboratory production units, inLab MC X5
and inLab MC XL. Above and beyond this,
the material-related design parameters
of selected Dentsply Sirona CAD/CAM
materials and dental databases will be
integrated in the exocad software. “The
integration of material parameters and
tooth lines in the DentalCAD software
offers exocad users additional advantages
as well as enhanced process safety in
terms of indication-tailored designs and
reliable workflows in the lab”, explained
Mr. Tillmann Steinbrecher, the CEO of
exocad.
The cooperation between these two
dental companies not only promotes
digital dental technology and dentistry
as a whole, but also the position of the
individual user groups – for even safer
and more efficient dentistry. ■
Panthera Dental Invests US$20.6 Million For Brand New Headquarters
To support their ongoing growth in
the dental and medical field, Panthera
Dental will soon have new headquarters.
This US$20.6 million investment will
quadruple current production capacity
and create 150 new jobs over the next
five years. The new headquarters will be
in a new industrial & innovation park in
Quebec City, Canada.
Combining well-being and functionality,
the future building will include
collaborative workspaces, bicycle parking,
showers, EV charging stations and an
outdoor terrace. With more than 40,000
square feet, Panthera Dental will be able
to increase its research and development
activities and optimise its administrative
spaces. It will also double the size of
its factory and laboratories and ensure
production 24 hours a day, seven days
a week.
“We have been working on this project
for a few years and we are very proud to
unveil it today. Our factory and offices
have been at their full capacity for the
past few months. Our employees are
also very excited about moving into
a brand-new, ultramodern building.”
Mr. Gabriel Robichaud, President &
Co-founder of Panthera Dental.
Groundbreaking ceremony is scheduled
for March 2019; construction will be
complete by the end of 2019.
Panthera Dental now has more than
100 employees. The company has a
network of 3,200 customers, including
dental laboratories and hospitals across
seven countries. The company’s income
is based on continuous R&D investments
and the creation of superior quality
products. In order to protect
these products, Panthera Dental
currently has 27 patents and industrial
designs. ■
14
DENTAL ASIA MARCH / APRIL 2019

Dental Updates
Henry Schein One Acquires Kopfwerk
Henry Schein One announced on
13 th February that it has acquired Kopfwerk,
the leading dental practice management
solutions company in Vienna, Austria.
Kopfwerk is a full-service software company
that delivers state-of-the-art practice
management solutions, along with technical
support, training, and installation, to boost
office productivity, automate clinical and
office processes, and enhance patient care.
Founded in 1987 by Peter Schiller and
Thomas Gessl, Kopfwerk had 2018
revenues of approximately US$2.2 million.
Henry Schein expects this transaction to be
neutral to its 2019 earnings per share and to
be accretive thereafter. Additional financial
details and terms were not disclosed.
Henry Schein One is a joint venture between
Henry Schein, Inc. and Internet Brands
that delivers integrated technology to
enhance dental practice management. The
company includes Henry Schein’s marketleading
solutions of Dentrix, Dentrix Ascend,
Dentrix Enterprise, Easy Dental, and
TechCentral, as well as international
companies, including Software of Excellence,
Logiciel Julie, InfoMed, Exan, and LabNet,
among others. Also included in Henry Schein
One are the dental businesses of Internet
Brands, including web-based solutions such
as Demandforce, Sesame Communications,
Officite, DentalPlans.com and more.
“We are delighted about our new partnership
with Kopfwerk. It’s the newest addition to
Henry Schein One’s software portfolio and we
believe it will further enhance our ability to
power successful practices by providing our
customers in Austria with the latest in valueadded
services and technology solutions,”
said Mr. Stanley M. Bergman, Chairman of
the Board and Chief Executive Officer of
Henry Schein. “Kopfwerk will bolster our
suite of comprehensive solutions that health
care professionals rely on to operate a more
efficient practice and provide patients with
quality care.”
“Kopfwerk will become an integrated
part of Henry Schein One’s portfolio of
technology solutions, which include the
Dentrix family of practice management
systems, Easy Dental, Demandforce,
Sesame Communications, Officite, and other
global companies dedicated to delivering endto-end
management and marketing systems
to improve management, profitability,
and the entire patient experience,” said
Mr. James A. Harding Jr., Chief Executive
Officer, Henry Schein One. “Kopfwerk’s highly
regarded solution will complement these
offerings as well as our mission to enable a
true digital workflow that helps dental teams
become more productive and improve each
stage of the patient experience.”’
Kopfwerk’s Mr. Peter Schiller will continue to
serve as General Manager of the Company.
“Henry Schein’s excellent reputation and
extensive reach among dentists bodes
well for our continued success and we are
excited to become a part of this team,”
Mr. Schiller said. “We share with Henry Schein
One a commitment to help accelerate the
adoption of digital technology and solutions
to help dental practices grow and prosper for
the ultimate benefit of the patient.” ■
Pulpdent Welcomes Clinical Education Consultant
Dr. Rumpa Wig
Dr. Rumpa Wig delivers highly sought-after
lectures and conducts comprehensive
workshops the world over. She has
been trained at Pulpdent’s headquarters
in Watertown, MA, and has worked
intensively with Pulpdent materials for
several years. Dr. Wig has extensive
experience explaining the clinical nuances
and the practical techniques involved in
using Pulpdent materials to their utmost
pitch of excellence.
“Dr. Wig’s enthusiasm for teaching
and practicing dentistry is infectious,”
says Ms. Christie Bailey, Professional
Relations & International Sales Manager
at Pulpdent. “People are drawn in by her
caring, patient-centered approach and
impressed by her technical prowess. We
are delighted that she has
joined Pulpdent’s global
education team.”
As the Global and ASEAN-
Pacific Key Opinion
Leader for several leading
international companies,
Dr. Rumpa Wig has delivered
over 600 presentations and
hands-on workshops on
restorative and esthetic
dentistry in over a dozen
countries. A passionate
and devoted clinician, Dr. Rumpa Wig
maintains two private practices in Bhopal,
India, where she focuses on aesthetic,
restorative, adhesive and minimallyinvasive
dentistry.
Dr. Rumpa Wig holds a BDS from the
Government College of Dentistry in Indore
and a post-graduate certificate in aesthetic
dentistry from New York University. She also
has a degree in classical Indian vocal music. ■
16
DENTAL ASIA MARCH / APRIL 2019

Journal of the California Dental
Association Features E-Cigarettes and
Tobacco-Use Cessation
The February 2019 issue of the Journal of the California
Dental Association discusses the harmful effects of
e-cigarettes and other smoking trends. Cessation aids for
dental professionals are highlighted with the goal to help
their patients stop their tobacco use. Other topics featured
in the issue include the use of probiotics in the treatment of
peri-implant diseases and the benefits of using cone beam
computed tomography in orthodontics.
“This issue highlights the health effects of e-cigarettes
and emphasises the major role dental professionals play in
educating patients about tobacco’s impact on their overall
and oral health,” said Kerry K. Carney, DDS, editor-in-chief
of the Journal.
The article “Electronic Cigarettes: Trends, Health Effects and
Advising Patients Amid Uncertainty” reviews the harms of
e-cigarettes and urges clinicians to educate patients about
the dangers of tobacco and nicotine in smoking devices.
“Tobacco Counseling in Dental Settings” discusses the
effectiveness of tobacco-cessation interventions by dental
professionals and the impact they have on a patient’s
likelihood of quitting.
“Smoking and Tooth Loss in California: The Role of Dental
Professionals in Promoting Tobacco Cessation” analyses
the association between smoking and severe tooth loss
in California in 2014 and 2016. Additionally, the article
recommends intervention to reduce the use of cigarettes.
The article “Efficacy of Probiotics in the Treatment of
Peri-implant Diseases: A Systematic Review” evaluates
the need for ongoing studies on the role of probiotics as
an alternative treatment strategy for the resolution of
peri-implant diseases.
“Considerations for Use of CBCT in Orthodontics” discusses
clinical scenarios in which cone beam computed tomography
may benefit both patient and orthodontist.
The Journal is an award-winning peer-reviewed scientific
publication that keeps dentists up to date about scientific
advances, business management strategies and new
products. ■

Under the Spotlight
18
DENTAL ASIA MARCH / APRIL 2019

Under the Spotlight
PASSIONATELY STRIVING TO
BE THE BEST IN DENTISTRY
- Dr. Christopher Ho
Specialist Prosthodontist, Founder of CARE Dentistry
Interviewed by Ms. Jamie Tan
Prosthodontics has continued
to evolve as a multidisciplinary
field of dentistry which involves
fixed and removable prosthesis,
maxillofacial prosthesis,
implants and aesthetic dentistry.
Nowadays, modern prosthodontics
utilises all innovative solutions to meet
all patients needs. Dental Asia sat down
with one of our advisory board members,
Dr. Christopher Ho, a leading Sydney-based
prosthodontist, to know more about his
beginnings, advice for practice owners,
his thoughts on digital dentistry, his
advocacy on continuing education and
how he balances work and life.
Dr. Christopher Ho is a prosthodontist
and the founder and principal of
CARE Dentistry. He has completed his
Bachelors of Dental Surgery with first
class honours, a Graduate Diploma in
Clinical Dentistry (Implant Dentistry),
Doctorate in Clinical Dentistry
(Prosthodontics) from the University
of Sydney, and also a Masters of
Clinical Dentistry (Prosthodontics) with
Distinction from Kings College London.
He is a Fellow of the Pierre Fauchard
Academy, and a Fellow of the American
College of Dentists, a national and
international lecturer. Dr. Ho has held
faculty positions with the University of
Sydney, the Global Institute for Dental
Education, Academy of Dental Excellence
and is a Visiting Lecturer at Kings College
London.
Working in a referral-based practice in
implants and prosthodontics, Dr. Ho is
a highly active member of the dental
community, and was a former Oral B
(Proctor and Gamble) Media Spokesperson
in Australia. He has published in
dental journals and several chapters
in textbooks, and is the editor of the
Wiley-Blackwell textbook ‘Practical
Procedures in Aesthetic Dentistry’.
Kindly discuss your beginnings as a
dental professional. Did you always
dream of being a dentist and why?
During my teenage years, I wore braces
and spent a lot of time visiting my
orthodontist and grew to know him well.
His practice was busy, he had great
taste in art and it seemed he enjoyed
his profession with the constant and
numerous interactions he had with his
patients, myself included. My family
always had the highest respect for
dentists and I always remembered my
visits with our family dentist, who had a
great demeanour - this influenced and
shaped my career inspirations. With
this in mind, I originally wanted to be
an orthodontist but eventually chose
to specialise in prosthodontics as it is
the specialty where clinicians lead a
treatment plan as the so called “captain
of the ship”.
Oftentimes, dentistry involves a
multidisciplinary treatment and the
prosthodontist directs other specialties
while working various other stages of
treatment. Hence, cases that are referred
to prosthodontists are normally more
complex or ones that have gone wrong
and we not only help in restoring patient’s
function and smile but also give back
their self-esteem and confidence. For me,
transforming patients’ lives is one of the
most rewarding experiences in practice.
Aside from prosthodontics, I have a great
interest in surgery. About 90% of my
practice is related to implant therapy
which entails a significant amount in
implant surgeries. I like to incorporate
perio-plastic surgery in my approach to
enhance my final results with soft tissue
aesthetics which I have learned from my
colleagues, who are periodontists, as I
strive to continually achieve perfection
in my practice.
Being established in the dental
industry, what advice could you give
other practice owners?
Budding practice owners should focus on
building a great team and getting systems
in place to provide a high level of service
to their patients. I have always considered
that the little things count, from ensuring
how a greeting is made on the phone
to how patients are introduced to the
practice. Good examples are how airlines
or fine hotels address their patrons and
deliver a great service. Furthermore they
need to have a marketing plan in place
to bring patients through the door to
experience a level of dentistry they have
not been used to. One of my tips is to
provide patients something that they
have never experienced before. Maybe
this might be an intra-oral camera, or
using intra-oral DSLR photographs and
sitting patients up rather than supine in
non-threatening manner, where patients
can sit and discuss treatment. It might be
the use of smile design applications that
allow patients to visualise treatment, or
the use of Wand local anaesthetic that
can provide a virtually painless injection.
MARCH / APRIL 2019 DENTAL ASIA 19

Under the Spotlight
It is easy for someone to complain about
a dentist, but to find something positive
about what a dentist does is something
that I want my patients to experience, and
then talk about their great experience to
their friends and colleagues. It is always
my goal that patients can talk positively
about their visit.
Moreover, budding practice owners
should find a mentor or a colleague
to bounce ideas across as they may
provide invaluable advice in how to build
a practice. These mentors may have
made mistakes in the past, and instead of
making similar ones it makes good sense
to learn from them. These mentors can
help accelerate your practice growth and
guide you to success.
Currently, CARE Dentistry is one of
the leading dental centres in Sydney,
Australia. This does not happen
overnight. How did you achieve this
success and recognition from your
patients and peers?
Initially, I began working as a general
dentist for very committed well known
dentists and clinicians. It was a great
start being exposed to dentists who
are dedicated and passionate about
the profession. Eventually, I decided
to venture out on my own and create a
practice with a brand, ideas, goals and
visions that I envisaged. This is now
CARE Dentistry which I founded and I am
a principal dentist overseeing 13 other
general dentists, specialists and dental
hygienists.
First of all, I have always believed in
“hard work”, nothing comes easy and
one has to endeavour through hardships
in building the practice of your dreams.
It all starts with the patient and providing
a service that over-delivers and is one
that a patient can talk about to their
friends and colleagues. Communicating
the treatment plan, wowing patients with
customer service, and then providing
them with beautiful dentistry will always
bring in more referrals. Secondly, having
the right team is crucial. My team of over
40 staff have been an inspiration and
are the impetus to our success. Working
synergistically with my team, we are
pushing together making work efficient
and effortless.
Digitalisation is the future of modern
dentistry. What are the latest digital
innovations that your practice has
been utilising?
I think there is a changing paradigm
with digital dentistry and we have seen
the explosion of this within our dental
practices. My practice is at the forefront
of this technology with the use of
Trios 3Shape intra-oral scanning, as well
as the use of 3Shape applications such
as SmileDesign and patient monitoring.
We also utilise 3D printing with both the
Formlab2 and Nextdent 5100 printers,
and also have the Roland 5 axis mill for
milling restorations. Additionally we have
digital radiography and CBCT imaging
available and run a virtual office with most
of our records being computerised.
Particularly, intraoral scanning with
Trios has been a game changer for
our practice with the ability to digitally
take impressions for patients for
study models, occlusal splints, mandibular
advancement devices, conventional crown
and bridge as well as implants. The digital
experience provides faster and better
patient experience with no gagging, poor
taste or impression materials locking into
undercuts. It also provides better dentistry
as digital impressions have a high level of
accuracy without the worry of bubbles,
drags, pulls, moisture contamination, or
disinfection risk. Furthermore, the time for
impression taking is reduced at the same
time enabling us to archive patient’s data
and communicate data digitally.
Additionally, digital planning of dental
implant placements has allowed merging
of intraoral scans with CBCT to fabricate
surgical guides for accurate implant
placement. 3D printing has allowed
printing of dental models, and the ability
to fabricate surgical guides at a fraction of
the cost of previous technologies.
Our practice constantly upgrades
equipment and materials. We see
technology as evolving and one must
keep up with advancements in dentistry.
Modern equipment helps provide efficient
workflows allowing patients to have
improved outcomes. There are advantages
with a lot of newer workflows that are
possible especially in CAD/CAM dentistry
with the possibility of using monolithic
20
DENTAL ASIA MARCH / APRIL 2019

estorations. Thanks to the progressive
nature of our profession, we have
witnessed numerous developments with
materials and equipment over the past
few years that have allowed us to deliver
state-of-the-art care to our patients.
Being an avid lecturer and
an advocate of education, why
do you think continuing dental
education (CDE) is vital to dental
professionals?
Continuing dental education is vitally
important as dentistry continuously
evolves, and often techniques and
materials launched are completely
different to the ones that were taught
when we were in dental school. In
recent times, for example, we have seen
the explosion of clear aligners, laser
dentistry, rotary endodontics, digital
smile design, CAD/CAM dentistry and
intra-oral scanning. With these new
developments, it is a prerequisite to
have dental training to master these new
concepts. The confidence one develops
with further training translates into
improved communication with patients
and maintaining the best practice.
Additionally, I think that CDE motivates
clinicians, keeping them interested in their
profession as continually learning and
improving ones skill keeps the enthusiasm
and passion alive. This passion comes
through with your approach to patients
and how one interacts with the team.
Hence, my advice is to keep the passion
by continually learning and developing
as a dentist.
What is your principle in life and
how do you incorporate this into
your practice?
I’ve always valued doing the best that
I can while doing unto others as what
you want others to do unto you, and I
believe that true success can only be
achieved if you are professional, ethical,
and empathetic. As dentists we have been
given an important responsibility, and
it is an honour to be in our profession.
Personally, I am always trying to improve
in my craft along with my interactions with
both my team and patients.
It is no secret that being successful
requires a lot of hard work, practice,
and dedication. The “10,000-Hour Rule”
by Anders Ericson (also mentioned in
Malcom Gladwell’s “Outliers”) concludes
that “many characteristics once believed
to reflect innate talent are actually the
result of intense practice extended for a
minimum of 10 years.” I believe that to be
the best requires motivation and a lifetime
commitment to continually improve both
as a dentist and a leader.
What is next for you and for digital
dentistry/technology in the near
future?
My practice will be expanding the teaching
institute – CARE dental academy to
accommodate more dentists for training.
We’ve also incorporated livestream
technology to conduct and broadcast live
surgeries and training.
Digital dentistry will explode in Asia, with
the stream of new market players offering
competitive cost entry to intra-oral
scanning units. I see a steady growth
on the uptake of digital applications for
patient education and treatment planning,
allowing clinicians to provide better
dentistry through safer implant placement
with guided surgery. The adoption of
CAD/CAM dentistry and 3D printing will
also allow dental practices in-house
fabrication of their own aligners, splints,
and restorations.
As I have had the opportunity to be
involved with product development and
testing alongside different manufacturers,
I can say that the next three to five
years will be exciting for dentists
with the emergence of new products
that will certainly invigorate dental
practices. DA
MARCH / APRIL 2019 DENTAL ASIA 21

Word of Mouth
by
Dr. Christoper Ho
This issue we look into some products that Dr. Christopher Ho considers very useful in making his practice efficient.
Dentistry is a constant battle with tongues, fluids and bacteria, not to mention, practitioners have to
deal with the patient’s psyche and staff as well. Finding those products that make a practitioner’s life
a little bit easier can hopefully bring a smile to all our faces by the end of the day.
Biogide compressed (Geistlich)
A new resorbable membrane has been developed by Geistlich for tissue regeneration. It is
a twin to Biogide in that it consists of porcine collagen with the same barrier function and
resorption time. However, the differences are in the handling and application. It possesses
a smoother surface, a firmer feel and it is easier to cut. For those that prefer a sturdier
membrane, this may be preferred and in particular may suit those wanting to carry out
larger regenerations and tacking of the membranes. It is all about clinician preference and
Geistlich has released this membrane to cater for those that prefer a slightly stiffer membrane.
myQuickmat Forte Kit (SDI)
There is a new sectional matrix system on the market available from SDI called myQuickmat
and as an alternative to the current systems on the market it has some advantages for use.
The rings provide strong tooth separation in order to create excellent contact points in the
restoration of Class II restorations. It is autoclavable and the plastic tines ensure a perfect
adaptation of the matrix to palatine/lingual and buccal walls, reducing the need for finishing
steps and therefore saving time. What is unique is that the tines are replaceable so that this
ensures durability to the system. Often with other systems, the plastic tines pick up bond and
also degrade reducing the life of these systems. With the plastic tines being interchangeable, this
should ensure improved longevity of the rings, by just changing the tines. In addition, the metal
rings can be activated to increase the active separation if needed when they loosen over the time.
Moreover, the system comes with LumiContrast sectional matrices which are dark-blue matrices
that increase contrast and reduce glare effect, especially while using loupes or microscopes.
Wand Milestone Scientific
“I didn’t feel a thing” is a nice compliment that patients give when patients receive an injection
and often commented upon receiving injections from this computer assisted system for local
anaesthesia. The machine enables users to control the flow rate and more importantly the
pressure of the anaesthetic fluid being injected. It is normally the pressure of the anaesthetic
being injected too quickly that causes discomfort with injections. Hence, even the dreaded
palatal injections are often a breeze and virtually painless. This technique also allows the use
of intraligamentary techniques for single tooth anaesthesia as well as techniques such as
the Anterior Middle Superior Alveolar (AMSA) injection technique which can achieve pulpal
anaesthesia from the maxillary central incisor to the second premolar - including the palatal
tissue from a single injection in the palate between the premolars.
22
DENTAL ASIA MARCH / APRIL 2019

Under the Spotlight
MARCH / APRIL 2019 DENTAL ASIA 23

CELEBRATING DIGITAL
TRANSFORMATION
- Ms. Julie Tay
Senior Vice President and Managing Director
Asia Pacific of Align Technology
Interviewed by Dr. Chala R. Platon
24
DENTAL ASIA MARCH / APRIL 2019

Dental Profile
An in-depth interview with Align Technology’s Ms. Julie Tay on the company’s milestones,
innovations and exciting times ahead.
Align Technology is a global
medical device company
that has produced industryleading
innovations such
as Invisalign clear aligners,
iTero Intraoral scanners, and OrthoCAD
digital services that are helping dental
professionals achieve the clinical results
they expect and deliver effective, cuttingedge
dental options to their patients. For
over 21 years, they have always set a
high bar for leadership and change in the
dental industry by constantly innovating
to bring new and better solutions to
doctors and their patients.
Today, Align Technology has helped
treat over six million patients with the
Invisalign system and is driving the
evolution in digital dentistry with the
iTero Intraoral scanner − helping to
modernise today’s practices by replacing
physical impressions, taking treatment
planning online, and creating the potential
to enable and improve almost every type
of dental treatment offered.
Previously, Dental Asia spoke to
Mr. Joe Hogan, Director, President and Chief
Officer of Align Technology at the 2018
Invisalign APAC Summit. This time, we had
a chance to sit down with Ms. Julie Tay,
Senior Vice President and Managing
Director, Asia Pacific of Align Technology
to find out more about what sets the
company apart from other aligner
companies, how it stays ahead, significant
milestones reached, her views on the
Asia Pacific region and future plans.
The pioneer brand in
clear aligner systems
Align Technology is dedicated to
transforming lives by improving the
journey to a healthy, beautiful smile.
Their goal is to become an indispensable
partner to dental professionals
worldwide while continuing to build a
great company.
According to Ms. Tay, Align Technology is
the pioneer in clear aligner systems and
currently, Invisalign system is offered in
more than 100 countries worldwide by
Invisalign-trained doctors to their adult
and teenage patients. She explained
that there are several factors that set
Align Technology’s Invisalign system
apart from other clear aligner systems
available now in the market.
“Firstly, our product development is
unique and we are using a proprietary
material. Secondly, we are the largest
3D manufacturer in the world, producing
hundreds of thousands of customised
clear aligners every day. Furthermore,
we have invested over a billion dollars in
R&D focusing on innovation. Lastly, we
are a fully digitalised integrated system
with the world’s largest database of the
oral cavity and teeth. I believe that we are
very well positioned to lead in the artificial
intelligence play in the digital world,”
explained Ms. Tay.
The experience and know-how that
Align Technology has developed includes
a wealth of information about individual
tooth movements and all types of
malocclusions, and about what moves
teeth predictably and what doesn’t. This
information is a tremendous resource that
gives rise to new insights, new treatment
planning ideas, feature sets, software
protocols, and more. No other single
individual or company is currently able
to harness digital treatment data on this
scale. This depth of experience aids and
accelerates our technology innovation
every day.
The SmartTrack
proprietary material
Ms. Tay further discussed that
the SmartTrack material for
Invisalign clear aligners took the
company’s in-house scientists more
than five years to develop. Launched
commercially in 2013, Align’s proprietary
SmartTrack material is an innovative
multi-layer polymer that delivers gentler,
constant force to improve control of tooth
movements with Invisalign clear aligners.
The SmartTrack material was designed
specifically for orthodontic treatment
with Invisalign aligners and more
precisely, conforms to tooth morphology,
attachments, and interproximal spaces
compared to other aligner materials.
“It is soft and very comfortable to wear.
The technology lies in the material, the
piece of plastic that is unique to Invisalign
clear aligners. It is not hard, yet it has
the ability and technology to move teeth
very gradually. At the end of the day, the
patient has the comfort and efficacy of
the product. SmartTrack is one of a kind,
not something you can buy off the shelf,”
she proudly explained.
Expanding innovative solutions for
the region
Aside from developing the SmartTrack
material, Align Technology continues
to expand its innovative solutions and
technologies. They have introduced
Mandibular Advancement (MA), the
first clear aligner solution for Class II
correction in growing tween (age group
between a child and a teenager) and teen
patients. This combines the benefits of
the most advanced clear aligner system
with features of moving the lower jaw
forward while simultaneously aligning
the teeth. Invisalign Teen Clear Aligner
system with mandibular advancement
offers a simpler, more efficient and
patient-friendly treatment option than
functional appliances and without the
need for elastics typically used to treat
teen Class II patients.
“The Mandibular Advancement is similar
to a twinblock appliance but is less
complicated and less painful. With MA, we
are just using a piece of clear aligner to
MARCH / APRIL 2019 DENTAL ASIA 25

Dental Profile
achieve very good results. This may not be
commonly used but it is seen and needed
for kids and teenagers. In the past, it was
always a struggle to treat kids because
treatment might be painful. It is a good
thing that we now have MA to offer to this
particular age group.”
Another innovative solution Ms. Tay
mentioned is the Invisalign G6 Clear
Aligner system, the first premolar
extraction solution engineered to improve
clinical outcomes of severe crowding
or bi-maxillary treatments requiring
extraction and planned for maximum
anchorage. This is beneficial as it allows
orthodontists to treat adult patients who
need to undergo extractions.
“Invisalign G6 Clear Aligner system is a
solution for extraction cases. For instance,
if two to four teeth have been extracted,
patients can still opt to use Invisalign
clear aligners. G6 is an innovation for
Asia as almost half of all the orthodontic
cases in the region need extractions,” she
highlighted.
According to her, the launch of the
iTero intraoral scanner in China, the
Asian Protocol (protrusive profile –
common in the Asian population), and all
these innovations rolled out for the region
have been well accepted and utilised by
dentist and patients.
On the Invisalign APAC Summit
Together with all its innovations and
solutions, Align Technology demonstrates
its commitment to the region by organising
the Invisalign APAC
Summit every other
year - one of the most
anticipated events by
partner orthodontists
in the region. Hence,
the company has
been keeping an
eye on the steady
growth of participants at
every summit.
“Looking back, there were a couple
of hundreds who attended our first
summit in 2014 (Singapore). In 2016,
fewer than 800 turned up at the second
summit (Macau) and last year we had
over 1,500 participants in Singapore. It
is a huge three-day event wherein users
can appreciate what we want to bring
and what we can do for dentists through
numerous case studies presented.”
Ms. Tay considers the Invisalign APAC Summit
helpful and beneficial in reaching dental
professionals in the region. Every summit
is a reminder that technology is around
us and adaptation to technology is a big
part of our lives. While Asian patients
are considered one of the most difficult
cases to treat with the complexity of cases
increasing, it is comforting to know that
Asian dentists have become very capable
in providing a higher standard of care.
Celebrating milestones
Apart from the successful 2018
Invisalign APAC Summit, Align Technology
recently celebrated another achievement
with over six million patients on Invisalign
treatment - the most advanced clear
aligner system in the world. This is a
significant milestone for the company and
over 150,000 Invisalign-trained dentists
worldwide, reflecting accelerating
adoption of Invisalign treatment by adults
and teens alike.
Additionally, Ms. Tay narrated that
the six millionth Invisalign patient,
Ms. Yuzhe Wang, is a 12-year-old student
at the International School of Beijing, who
began treatment in October 2018, and is
currently halfway through her treatment
using Invisalign Comprehensive with
Mandibular Advancement treatment by
Dr. Jiawei Wo. In support of this major
milestone for the company, Ms. Wang
will be featured in an upcoming Invisalign
global campaign that will follow her
Invisalign treatment journey.
“We’ve been in business for more than
20 years and we’ve celebrated every one
million patient as a milestone. Previously,
it took us over 10 years to reach our
first million but now it has just taken us
less than a year. We really appreciate
the acceleration of the adaptation of
technology. This is definitely a huge
milestone for us. We are the only company
who has been here with proven technology
and a product that is very well accepted
by consumers – with over six million users
around the world,” Ms. Tay stated proudly.
Staying ahead
Ms. Tay clearly understands that the
clear aligner industry is huge with great
opportunities. Thus, there are various
other clear aligner providers present
in the market today. For this reason,
Align Technology shows no signs of slowing
down and being complacent in providing
industry-leading innovative products,
better solutions and unparalleled service.
“There will always be competitors and at
the moment I think there are 21 currently
in the market. We like competition. For us,
we believe that there are over 100 million
patients in Asia who can benefit from
clear aligner therapy and competitors
only opens up the category for everybody
to benefit. We are way ahead as we are
26
DENTAL ASIA MARCH / APRIL 2019

Dental Profile
the only fully integrated clear aligner
system - from the beginning with a scan
to the end when the patient finally finishes
treatment. Users don’t have to switch in
between systems or devices. We are the
only one who can offer a smooth workflow
in the market.”
She also emphasised that the Invisalign
System brand is very well recognised and
considered as the top brand in the clear
aligner category. Align Technology has
invested over a billion dollars in research
and development and will continue to do
so in the pursuit of bringing innovation
through beautiful smiles that everyone
can trust.
“I think at the end of the day, people
understand that consumers are getting
sophisticated and they understand
the Invisalign System as a brand. We
invest heavily in product development
to have a product consumers can
trust. When users decide to choose
Invisalign Treatment, they get what
they pay for, value for their money and
the assurance of the brand,” explained
Ms. Tay.
Overcoming challenges
Staying ahead of the pack does not come
without facing some challenges along
the way. Ms. Tay shared that some of
the challenges that the company has
overcome include helping doctors adapt
and understand technology in order to
fully utilise it. Aside from investing in
R&D, the company also spends millions
to provide doctors with the latest training.
“In fact, a very good example is the
Invisalign APAC Summit last year wherein
we showcased what Invisalign Treatment
can accomplish. The event was also a
perfect venue to let dentists learn from
their peers. We believe that dentists learn
best through peer-to-peer learning. A lot
of Invisalign System doctors came and
shared their experiences with Invisalign
Treatment, making it a very successful
event.”
Ms. Tay added that alongside hosting
events, Align Technology has also built
world class training centres. The state
of the art Invisalign treatment planning
facility in Chengdu, China is Align’s first
manufacturing operations in China and
represents the company’s commitment
to geographic expansion and investment
in the Asia Pacific region. The Chengdu
Treatment Planning and Training Centre of
Excellence will provide treatment planning
services for Invisalign providers in China,
which was previously done in San Jose,
Costa Rica. It will also serve as a major
training facility to educate Invisalign
System doctors across the region and
showcase the company’s latest product
and technology innovation.
On the Asian market
In Align Technology, there are three
regions namely: Americas, Asia Pacific
and EMEA (Europe and Middle East).
According to Ms. Tay, the Asia Pacific
region is the fastest growing region for
the company for four consecutive years
now. The company intends to continue
this trajectory in the market and in future,
doubling the business every two years.
“Overall, we are one of the huge drivers in
the market. Like I’ve previously mentioned,
there are enormous opportunities here.
With over 100 million opportunities, we
are barely scratching the surface of the
clear aligner market. I think the ability
of providing solutions and options
to adults, working adults, teenagers
and even kids is monumental for us.
Invisalign System is clear, it works, it is
comfortable and it gives results:
beautiful healthy smiles,” she
remarked.
Moreover, all the innovative launches
in Asia have been very well received
as mentioned by Ms. Tay. In particular,
Mandibular Advancement (MA),
Invisalign First, Invisalign G6,
Asian Protocol and iTero intraoral scanner
are all fully utilised and appreciated
in the region. As a result, both
Invisalign doctors and patients have
been benefitting from Align’s
industry-leading innovative
solutions and services in the dental
industry.
Exciting times
Ms. Tay revealed that it is going to be an
exciting year for Align Technology as they
continue to invest heavily in technology
specific to iTero intraoral scanners and
Invisalign Clear Aligner system. They
want to enable doctors to do so much
more with a scanner and for Invisalign
Treatment to reach more consumers
through experiencing the brand.
“We are looking forward to this year. We
truly believe in the digital workspace and
we want to continue pushing for digital
transformation. Digital is everywhere, it
is around us and the digital dental space
is no different. We as leaders want to
guide, help and reassure consumers who
are hesitant in embarking on the digital
transformation journey. We believe we
have a lot to offer in making their transition
smoother and easier through technology
or experience,” she commented.
Finally, Ms. Tay summarised that the
Invisalign System brand stands for giving
superior results through the world’s most
advanced digital orthodontic treatment
system, Invisalign Clear Aligner system
which is precise, predictable, and gradually
moves teeth while providing beautiful
healthy smiles. All in all, everything the
company does is centred around doctors.
“Align Technology wants to partner with
doctors. They are the centre of everything
we do. We develop innovations for them.
We provide the best training programs
for them. We want to journey this new
digital age together with them,” she
concluded. DA
MARCH / APRIL 2019 DENTAL ASIA 27

Dental Profile
TAKING DIGITAL
IMPRESSION TO
A HIGHER LEVEL
- Dr. Frank Thiel
Vice President R&D CAD/CAM
and Orthodontics
Interviewed by Ms. Jamie Tan
Written by Dr. Chala R. Platon
MARCH / APRIL 2019 DENTAL ASIA 29

Dental Profile
CEREC from Dentsply Sirona
has been very successful in
the market for more than
30 years. Through further
development of both the
hardware and the software, the company
made intraoral scanners popular in the
first place. About 35,000 CEREC units
worldwide and a digital impression
taken every four seconds with one of
Dentsply Sirona’s intraoral scanners, send
a clear message.
When introducing a new product to the
market, there are always considerations
behind the development. From their
customers, Dentsply Sirona knows that
flexibility and freedom of choice for every
treatment is very important. They also
know that digitalisation is an important
matter for all of their users. With this
in mind, Dentsply Sirona continues
optimising digital workflows available to
dentists, independent of CEREC, thereby
giving users many more options in terms
of intraoral scanners. In addition to
restorative treatment, Dentsply Sirona
also wants to improve implantology,
orthodontics and endodontics. The
company knows which features are
important to its customers: easier to
handle, considerably faster and, of
course, more accurate than ever before.
After speaking to Dr. Alexander Völcker,
Dentsply Sirona’s, Group Vice President
CAD/CAM and Orthodontics, at the
Dentsply Sirona World 2018, Dental Asia
also had a one-on-one interview with
Dr. Frank Thiel, Vice President R&D
CAD/CAM and Orthodontics, at
the product launch of its new
intraoral scanner - Primescan - at
Klassikstadt Frankfurt, Germany in
February 2019. Read on to know more
about Dr. Thiel’s role, consolidation
of Strategic Business Units (SBUs),
the new intraoral scanner, current trends
and Dentsply Sirona’s plans for continued
growth and expansion.
Optimising organisational structure
According to Dr. Thiel, after the merger
of Dentsply and Sirona three years ago,
Dentsply Sirona has constantly been
optimising their organisational structure
to fully utilise all their resources and
to continue to provide the optimum
solutions for users. Early this year, when
Dr. Alexander Völcker took over the
position as Group Vice President
CAD/CAM & Orthodontics, Dr. Thiel
became the Vice President R&D CAD/CAM
and Orthodontics. Dr. Thiel has been in the
CAD/CAM business for almost 15 years
and he looks forward to contributing to
many more future developments.
“I started with SBU CAD/CAM 15 years
ago and I am heavily focused on the
business. My role allows me to utilise my
expertise and my experince in developing
tools that empower dental professionals,”
Dr. Thiel explained.
Consolidation of CAD/CAM
and orthodontic SBUs
Early this year, Dentsply Sirona shifted
its focus from promoting mainly
full-chairside-systems consisting of an
intraoral scanner, the design software as
well as a milling unit to also focusing on
Digital impressions (DI) alone. Looking
at the orthodontic workflow, one of
the major key components is providing
clear aligner solutions. And at every
beginning of orthodontic treatment,
digital impressions are taken.
“Digital impressions are the starting point
for both CAD/CAM and orthodontics.
Therefore the recent combination of these
two particular SBUs is an advantage. It
drives a more unified product strategy
and more focused product development
by bringing together SBUs with similar
characteristics”
The development of intraoral
scanners
Dr. Thiel briefly discussed that the
development of intraoral scanners by
the company begun more than 30 years
ago with the introduction of CEREC.
The Bluecam was launched in 2009,
still with some technological limits but
definitely state-of-the-art at that time. In
particular, using the powder system inside
the mouth can be tedious as water and
saliva easily washes of the powder during
intraoral scanning. However, in 2012,
Dentsply Sirona introduced the Omnicam
– the smallest intraoral scanner at that
time. It was a great step forward, as it
was used powder-free and scanned in
colour. The Omnicam was designed to
work perfectly with the CEREC workflow.
“Back then, having a powder-free
scanning system as well as scanning in
full colour was a breakthrough. Before
Omnicam, we could not distinguish teeth
from gingiva. Omnicam is a very good
scanner and turned out to be a huge
success,” he shared.
Dr. Thiel revealed that as time went by,
the users and the market demands have
evolved. There was still a lot of potential
in scanner technology that the company
wanted to exploit. With these demands
in mind, Dentsply Sirona introduced
the CEREC Ortho software in 2015. The
company never rested on its laurels and
constantly researched and developed
based on the needs of dentists and
patients: speed, accuracy and ease of use.
The new intraoral scanner
Primescan
Based on all these aspects,
Dentsply Sirona developed the new
Primescan which was recently launched
in February 2019. Primescan is no doubt
a game changer in digital dentistry with
its significant features, taking digital
impression to a higher level.
With Primescan, it is possible to
capture an entire upper jaw in under
30 seconds, and a full arch scan in less
than a minute. During the scanning
process, the dynamic lens completes
more than 10 movements per second,
thereby enabling the “Dynamic Depth Scan”
– capturing more than 1 million 3D data points
per second. Thanks to its Intelligent Processing
which filters, processes and compresses the high
volume of data models can be calculated faster.
30
DENTAL ASIA MARCH / APRIL 2019

Dental Profile
The high-precision Smart Pixel Sensor
of Primescan captures data at an
extremely high resolution and assesses
the contrast in each pixel. For every
3D image, Primescan consolidates more
than 50,000 images per second, thereby
offering a level of scanning precision that has
never been achieved before. The new, patent
pending technology in the form of optical high
frequency contrast analysis is used to calculate
the 3D points, resulting in an increased level
of accuracy.
Additionally, Primescan enables a flexible,
intuitive and very simple scan procedure,
allowing faster access to tooth surfaces
without the need for significant tilting. The
captured images are calculated in a flash
and put together without any visible scan
interruptions.
Lastly, Primescan is an intraoral
scanner that can be subjected to
all necessary hygienic reprocessing
(wipe disinfection, autoclaving,
hot air sterilisation, high-level
disinfection). Thanks to the smooth
surfaces the hygienically critical areas,
which are often difficult to clean, can be
reprocessed safely, quickly and easily.
“When it comes to accuracy, Primescan
is the most accurate scanner on the
market. This has also been proven by a
recent study at the University of Zurich
(Mehl et al. 2019). When it comes to
speed, a full jaw (upper and lower) only
takes about a minute . We are at a point
where we can say, digital impressions
are in no way inferior to conventional
impression taking. Primescan is a pivotal
product for us. Hence, the question is not
what can the device do but rather what
can you not do with Primescan,” Dr. Thiel
confidently stated.
He added that Dentsply Sirona represents
intelligent workflows and Primescan enables
access to many digital workflows, which, above
all, can be safely and easily implemented.
Specifically, this means that, after the intraoral
scan, the user can decide what to do with it.
The company offers a high level of flexibility.
For example, the user can send the data to
a laboratory, and the Connect Case Center
(former Sirona Connect) is available for this
purpose. Communication with the dental
technician takes place simply, directly and
securely via the Connect Case Center Inbox.
Another option is exporting the scan data to
treatment planning software. This now also
includes SureSmile for the manufacture of
therapeutic braces. And of course, the dentist
can continue to design and manufacture the
restoration in the practice.
“The fact is whoever works with Primescan
is not under any commitment to a specific
option. An upgrade is possible at any time,
but it is not absolutely necessary. With the
Connect Case Center Inbox, any lab can
have full access to the case data. For the
dentist that means freedom and flexibility
when working with a lab. Besides a chat
function enables direct communication
about the case via the portal.”
Dr. Thiel shared that all the feedback from
first time users/testers of Primescan were
all overwhelmingly positive. Primescan is
slightly heavier and larger than Omnicam
but this was not an issue for users due
to its speed, accuracy and ease of use
The time inside a patient’s mouth is
considerably shortened. Furthermore,
it was highlighted that female dentists
found Primescan easy to handle which
is important as more and more female
practitioners are joining the field of
dentistry.
A new age of digitalisation
Dentsply Sirona has continued to
provide digital products for over 30
years and has always kept the mission
of empowering dental professionals to
Digital impressions with Primescan: easier,
faster and more accurate than ever before.
MARCH / APRIL 2019 DENTAL ASIA 31

Dental Profile
In addition, Dentsply Sirona will continue
investing US$150 million annually in R&D
for the whole company to constantly
provide innovations and solutions and
meet the demands of dental professionals.
Finally, Dr. Thiel revealed that at the
International Dental Show (IDS) 2019
Primescan is their breakthrough product.
He is looking forward to seeing other
intraoral scanners and he is confident that
Primescan will convince everybody that it
is the best in the market today.
(L-R) Ms. Jamie Tan, Publications Director of Dental Asia, Dr. Frank Thiel, Vice President R&D CAD/CAM
and Orthodontics and Ms. Marion Par-Weixlberger, Vice President Corporate Communications &
Public Relations of Dentsply Sirona
provide better, safer and faster dental
care. Nowadays, dental practitioners
and patients have evolved and grown
to know what they need and want; they
are the ones asking manufacturers for
innovations and solutions. According
to Dr. Thiel, digitalisation is the trend
not solely in his SBU but for the whole
dental industry. In orthodontics, he
considers clear aligner solutions
providing great opportunities.
“The best way for dental practitioners
to market their practice is through
innovation and we are here to provide
innovative product solutions for them. In
orthodontics for instance, we now have a
complete clear aligner workflow through
SureSmile, as we acquired OraMetrix one
year ago. Now with Primescan, users can
scan and upload the data to the SureSmile
portal and have simplest and seamless
orthodontic workflow integration. Stay
tuned to see more innovative product
solutions and workflows from us in the
future,” Dr. Thiel remarked.
Looking at the bigger picture
In the Asia Pacific region, he shared
that CAD/CAM is a growing market and
the company sees the region playing an
integral role in orthodontics, endodontics
and implantology.
“We respect the differences in every
region and as a company we try to
look at the bigger picture, what every
dental professional needs, develop a
product and then adapt it per region.
Asia Pacific is very important for us.
Japan being the 2 nd biggest dental
market in the world after US will
remain in our focus,” he added.
Plans for continued growth
and expansion in Asia
Dr. Thiel emphasised that
Dentsply Sirona values training
and education as CAD/CAM and
orthodontics are a
growing market
in the region. The
company expects
the speed of
digitalisation in Asia
will be faster than in other
regions in the world but they are well
prepared through providing products
like Primescan and optimalisation
in terms of software. In particular,
the company has highly invested in
education and training in Japan and
has built two more training centres
together with around 11 showrooms.
Dentsply Sirona is also very
active in building up educational
environments in China, Australia,
Korea and the rest of the region.
“I remember when we launched
CEREC Omnicam- I thought I won’t be
able to develop such a great product
again for the rest of my life. Today, I am
very proud to say that I feel the same way
and even better. I am fortunate enough to
have been able to develop Primescan with
the help of the rest of my team. It is very
exciting to show to the dental industry
how Primescan takes digital impression to
a higher level,” he excitedly revealed. DA
The new Primescan
intraoral scanner
32
DENTAL ASIA MARCH / APRIL 2019

Dental Profile
MARCH / APRIL 2019 DENTAL ASIA 33

Clinical Feature
ATRAUMATIC EXTRACTION OF
MANDIBULAR THIRD MOLARS
By Dr. Loris Prosper and Dr. Nicolas Zunica
A case on preventing iatrogenic damage to the inferior alveolar
and lingual nerves during third mandibular molar extraction.
Lesions of the inferior alveolar
nerve and the lingual nerve are
the most feared complications
when extracting mandibular
third molars. Iatrogenic injury of
the IAN (inferior alveolar nerve) or the
LN (lingual nerve) often leads to legal
actions for damage and compensation for
sensory disturbances involving the chin,
the lower lip, gums and tongue. However,
improved diagnostic and surgical
techniques have considerably decreased
the prevalence of this complication. What
follows is a description of a diagnostic
and therapeutic methodology aimed
at limiting surgical complications of
inferior third molars, starting with an
accurate diagnosis, followed by the use
of minimally invasive surgical instruments.
Introduction
The IAN is a sensitive nerve made of
parallel nervous fibres (central/peripheric)
originating from the posterior terminal
end of the posterior mandibular nerve
while the LN is a branch of the mandibular
division of the trigeminal nerve. The IAN
and the LN are the nerves presenting more
risk of unintended iatrogenic injury lesion
during mandibular molar extraction.
These nerve injuries were first classified
in 1943 in the following three categories:
1. Neuropraxia - an interruption in
conduction of the impulse down the
nerve fiber. The recovery in such
cases takes place without wallerian
degeneration and hence is considered
to be the mildest form of nerve injury.
2. Axonotmesis - loss of the relative
continuity of the axon and its covering
of myelin, but with the nerve’s
connective tissue framework still
intact.
3. Neurotmesis - loss of continuity
of not only the axon, but also the
encapsulating connective tissue. 1-3
The International Association for Study
of Pain (IASP) distinguished the following
symptoms:
1. Anaesthesia - total absence of
sensibility;
2. Paraesthesia - alteration of sensibility,
implying a sensation of tingling,
tickling, prickling, pricking, or burning;
3. Hypoaesthesia - a reduced sense of
touch or sensation, or a partial loss of
sensitivity to sensory stimuli;
4. Hyperaesthesia - a condition that
involves an abnormal increase in
sensitivity to stimuli;
5. Dysaesthesia - abnormal sense of
touch involving sensations such as
burning, wetness, itching, electric
shock, and pins and needles.
The incidence of reported postoperative
damage to the IAN and LN varies widely
in literature. A 2005 survey aiming to
estimate the occurrence of neurologic
damage to the inferior alveolar and
the lingual nerve surgical revealed that
94.5% of the 535 oral surgeons in
California reported damage to the inferior
alveolar nerve and 56% to the lingual
nerve. 4
In a study published in 2000 by
J. Gargallo-Albiol et al., the incidence of
temporary disturbances affecting the IAN
or the LN was in the range of 0.278% to
13%. 5 In another study by John R. Zuniga,
the incidence of permanent injury to the
IAN and LN has been mentioned to fall
within the ranges of 0.4% and 25% as
well as 0.04% and 0.6% respectively. 6
The two important factors can
significantly increase the risk of IAN
damage: anatomy and old age. 7 Anatomy
refers to the relationship between neurovascular
bundle and rooths of the third
mandibular tooth, identifiable through
orthopantomogram (OPG). As early as
1990, Rood & Shehab 8 identified a list of
clear indications for significatively higher
risks of the inferior alveolar nerve, all
identifiable through OPG (Table 1).
Table 1
34
DENTAL ASIA MARCH / APRIL 2019

Clinical Feature
The importance of these risk indicators
was recently confirmed by Blaeser et al. 9
which calculated the value of some of Rood
& Shehab’s indicators 8 such as:
• deviation of the mandibular alveolar
canal;
• root radiolucency;
• interruption of the radiopaque lines
that mark the alveolar canal.
In the presence of these conditions, the
neurologic damage is between 1.4% and
2.7%, so it is at least 40% higher than
the general risk probability.
Sedaghafar et al. 10 takes the clinicradiographic
evaluation a step further,
showing that the damage forecast is more
accurate if further information such as the
development of roots and their shape,
deepness of the inclusion etc are taken
into account. 8
A study by Andrew et al in 2004 was
carried out to determine the incidence
of inferior alveolar nerve paraesthesia
during third molar surgery in patients with
an exposed inferior alveolar nerve bundle.
He concluded that such a situation hints
a high probability of intimate relationship
between the nerve and the tooth, carrying
20% risk of paraesthesia with a 70%
chance of recovery one year after the
surgery. 11
The patient’s age is another significative
risk factor. Literature shows that postextraction
complications are more
frequent after the age of 25. 12-14 A recent
retrospective survey carried out on 4995
extractions performed on 3513 patients
reported neurologic damage in 55 cases
(1.1%). Most of the times the damage
was reversible. 50% of patients recovered
in six months, while in some cases, it
took over a year for them to recover full
sensibility. A partial recovery of sensibility
was more frequently observed in older
patients. 15
Pre-operative diagnosis includes
orthopantomogram (OPG) and
3D imaging. OPG clearly shows the
tooth position, diseases such as caries
and cysts, and risks for the mandibular
alveolar nerve according to Rood &
Shehabs indicators (complete overlapping
of the roots to the alveolar canal, alveolar
canal that crosses the roots near to
the bifurcation) but does not show the
bucco-lingual position of roots and
neurovascular bundle. 3D imaging and
particularly Cone Beam technology
proves very useful by indicating the exact
position of the alveolar canal and allows
one to plan a correct bone resection and
odontotomy.
3D imaging is seldom indicated for
patients below the age of 25 due to
reduced risks of neurologic damage and
because there is generally less need for
extraction instruments to penetrate as
deep in the root apex.
While several studies come to the general
conclusion that the deeper the third molar,
the higher the rate of nerve damage, other
authors stress the importance of surgical
factors as significant contributors to
nerve injury.
An investigation carried out in 2001 by
Renton et al concluded that the predictors
for permanent lingual nerve injury in
order of importance were perforation
of the lingual plate during surgery, the
skill of the surgeon, difficulty of the case
(distoangular impactions), exposure of
the nerve and an increased age of the
patient. The authors further added that
surgical factors are the main contributors
to lingual nerve injury during third molar
extraction. 16
Some authors even concluded that,
rather than the mandibular depth of third
molar, the true cause of nerve damage is
the surgical maneuver required during
extraction such as lingual flap retraction,
ostectomy, and tooth sectioning and
not the mandibular depth of third
molar. 17-20 The technique used would,
in other words, determine at least to
some extent the probability of nerve
injury.
Instruments and methodology
The extraction technique when removing
an impacted or semi-impacted mandibular
third molar is extremely important in order
to prevent damage to the surrounding
anatomical structures, such as the lingual
nerve, the inferior alveolar nerve and
the periodontium of the second molar.
The surgical instruments used are of
paramount importance.
In the case that follows, an innovative
instrument, the mechanical periotome
Luxator LX (Directa), was used to perform
a mandibular third molar extraction.
The instrument allows for the cutting of
Sharpey fibers surrounding the tooth,
found between the cement and alveolar
bone, (Feneiss et al 1952) by luxating the
periodontal ligament (Figs. 4-6).
Case description
A 22-year-old female patient,
in good health, visited our clinic in
Via San Gottardo 83, Monza (Italy), and
reported pain coming from tooth 38 and
spreading through the whole lower arch.
The first panoramic picture shows
compression of the mandibular nerve
that touches the lower roots of 38 –
physical inclusion of the mucosa and
partial bone inclusion in close correlation
with the inferior alveolar nerve. Physical
examination showed edematous and
erythematous mucosa distal to element
37. No sensibility alteration in the emiarch
concerned (Fig. 1).
A second X-ray performed through
Dental Scan shows the position of the
inferior alveolar nerve at the distolingual
apex as confirmed by CT (Figs. 2-3).
Fig. 1: OPG performed with phosphor system CT.
MARCH / APRIL 2019 DENTAL ASIA 35

Clinical Feature
Treatment
The patient was given anaesthesia
and plexus nerve block with a 2%
vasoconstrictor. A pouch flap was made
Figs. 4-5: Surgical manoeuvre through the use of Luxator LX 360 ® .
Fig. 2: CT radiographs performed with
Dental Scan to assess the shape of the inferior
alveolar nerve and root morphology.
Fig. 3: Localisation of the nerve at root level by CT.
together with an intrasulcular incision
at tooth 37 and a releasing incision
distal to the same tooth. The distal
incision must run at a 45 degree angle
to the second molar and be at full
thickness, with partial thickness at the
end. This incision is the junction of the
flap and avoids the risk of dissecting
the lingual nerve. After skeletonising the
jaw and placing a tongue protection, the
Sharpey’s fibres are cut using the
mechanical periotome Luxator LX by
following the tooth circumference,
while luxating the periodontal ligament
(Figs. 4-5). The tooth is subsequently
extracted using an elevator without
luxating the surrounding tissues and,
above all, with no damage to the
mandibular nerve.
Thanks to its controlled reciprocating
movement, Luxator LX penetrates the
space that lodges the periodontal ligament
(0.15 – 0.38 mm) and separates the fibre
bundle in the least traumatic way for
the tooth. The gentle vertical movement
applied to the periodont does not cause
neural trauma. Using the mechanical
periotome luxator LX, we managed to
perform the extraction with no tissue
damage and most importantly, with no
damage to the mandibular nerve.
The periapical X-ray (Fig. 6) shows
how the Luxator LX blade - detached
from the contra-angle to facilitate the
X-ray – penetrates into the alveolus,
facilitating tooth removal. Figure 8
shows the absence of root rests. The
extraction was performed without
sectioning/dividing the tooth. Figure
9 shows that the tooth was extracted
in one piece. No traumatic operations to
search for root rests were needed (Figs. 8-9).
The alveolus was cleaned, washed with
cold physiologic solution and sutured
Fig. 6: X-ray of the tip of the Luxator LX inside the
socket showing the depth of the Luxator LX insert.
with silk thread 4/0. The edge could
also be sutured, enabling the patient
to recover without post-operatory pain
(Fig. 7). After seven days, the suture
stitches were removed and the patient
reported a good post-operatory recovery
with slight pain during the first three
days, which was mitigated with common
pain killers.
The patient was advised to use an innovative
gel toothpaste (HOBAGEL by HOBAMA),
Fig. 7: Suture flap
36
DENTAL ASIA MARCH / APRIL 2019

Fig. 8: X-ray after extraction show no residue left in the root socket despite
abnormal root morphology.
IDS 2019, Cologne
Germany
March 12 – 16, 2019
Hall 10.2 · Stand T010
... is the brilliant result of
preparations using
COOL-DIAMANT instruments.
Fig. 9: Extracted tooth 38 showing complex crown and root morphology.
with a mix of humectant and antibacterial subastances
(i.e. cetylpyridinium chloride, Triclosan, essential oils)
in technologically innovative microcapsules, to help
fight pperiodontal plaque and reduce bleeding. Its
medium-low RDA (+/-3o) is less abrasive on natural tooth
and restorations material. 21
The dental hygienist will focus on reducing plaque
close to the post-surgery recovery areas, detect poor
home hygiene and promptly intervene to correct them.
Professional dental hygiene sessions are extremely
important to remove bacteria around the tooth,
preferrably by Air Polish (EMS) with glicine powder to
preserve the health of gingival tissues. Final polishing is of
extreme importance to leave a smooth surface as a rough
surface will be more receptive for bacteria. A silica-sbased
polishing paste with a low RDA such as Prophy Paste CCS
Yellow RDA 40 (Directa) is recommended. 22
Conclusion
Mandibular third molar extractions are undoubtedly
associated with neural injury risks that can cause temporary
or permanent discomfort for the patient and legal actions for
the dentist. A thorough pre-operative diagnosis is mandatory
The superior grinding performance
of these first-class instruments
is assured by a significantly
structured Busch functional surface with
a precision coating of high-quality
diamond grit.
Please ask for our leaflet or enter
www.busch.eu/en/innovations.
There is no substitute for quality
Unterkaltenbach 17-27
51766 Engelskirchen
GERMANY
Telefon +49 2263 86-0
Telefax +49 2263 20741
mail@busch.eu
www.busch.eu
MARCH / APRIL 2019 DENTAL ASIA 37

Clinical Feature
and complication risk factors
including age and anatomy - such as
depth of impaction and presence of
overlying ramus bone - need to be taken
into account. The surgical approach
used is of paramount importance to
minimise tissue damage and
neurosensory impairment. The
mechanical Periotome Luxator LX
proves to be a valid tool in surgical extractions,
allowing minimal trauma and significative
reduction of post-operatory discomfort. DA
References:
1. Sunderland S. A classification of peripheral
nerve injuries producing loss of function.
Brain 1951; 74:491-516.
2. Andrew K, Churchill L. Classification of
Nerve Injuries. Essential Neurosurgery.
1991; pages 333-334.
3. Mark S. Greenberg. Injury Classification
System. Handbook of Neurosurgery. Third
edition. 1994; pages 411- 412.
4. Robert RC, Bacchetti P, Pogrel MA.
Frequency of trigeminal nerve injuries
following third molar removal. J Oral
Maxillofac Surg 2005;63:732-
5. John R. Zuniga. Management of Third
Molar–Related Nerve Injuries: Observe or
Treat? Alpha Omegan ; 102 (2).
6. J. Gargallo-Albiol, R. Buenechea-Imaz,
C. Gay-Eseoda. Lingual nerve protection
during surgical removal of lower third
molars. A prospective randomized study.
Int. J. Oral Maxillofac. Surg. 2000, 29:
268-271.
7. R. Barone, C. Clauser, A. Baleani, Surgical
extraction of mandibular third molar:
a rational and safe technique. http://
en.zerodonto.com/2013/01/surgicalextraction-of-mandibular-third-molar-arational-and-safe-technique/
8. Rood JP, Shehab BA.The radiological
prediction of inferior alveolar nerve injury
during third molar surgery. Br J Oral
Maxillofac Surg 1990;28:20-5.
9. Blaeser BF, August MA, Donoff RB, Kaban
LB, Dodson TB. Panoramic radiographic
risk factors for inferior alveolar nerve
injury after third molar extraction. J Oral
Maxillofac Surg 2003;61:417-21.
10. Sedaghafar M., August M.A., Dodson
T.D. Panoramic radiographic findings
as predictors of inferior alveolar nerve
exposure following third molar extraction.
J Oral Maxillofacial Surg 2005;63:37.
11. Andrew B.G.T, Wee S.G. Effect of exposed
inferior alveolar neurovascular bundle
during surgical removal of impacted
lower third molars. Journal of Oraland
Maxillofacial Surgery 2004;62: 592-600.
12. Chuang SK, Perrott DH, Susarla SM,
Dodson TB. Age as a risk factor for third
molar surgery complications. J Oral
Maxillofac Surg 2007;65:1685-92.
13. Bruce RA, Frederickson GC, Small GS. Age
of patients and morbidity associated with
mandibular third molar surgery. J Am Dent
Ass 1980;101:240-45.
14. Chiapasco M, De Cicco L, Marrone G. Side
effect complications associated with third
molar surgery. Oral Surg O4al Med Oral
Pathol 1993;76:412-20.
15. Queral-Godoy E, Valmaseda-Castellón E,
Berini-Aytés L, Gay- Escoda C. Incidence
and evolution of inferior alveolar nerve
lesions following lower third molar
extraction. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2005;99:259-64.
16. Renton T, McGurk M. Evaluation of factors
predictive of lingual nerve injury in third
molar surgery. British Journal of Oral and
Maxillofacial Surgery 2001) 39, 423–428.
17. Carmichael FA, McGowan DA. Incidence
of nerve damage following third molar
removal: a West of Scotland oral surgery
research group study. Br J Oral Maxillofac
Surg 1992;30: 78-82.
18. Fielding AF, Rachiele DP, Frazier G. Lingual
nerve paresthesia following third molar
surgery. A retrospective clinical study.
Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 1997;84:345-8.
19. Waseem J, Tahwinder U, Priya S, Farai N,
et al. Risk factors associated with injury
to the inferior alveolar and lingual nerves
following third molar surgeryrevisited.
Oral Surg Oral Med Oral Pathol Oral Radiol
Endod2010; 109:335-345.
20. Mason DA. Lingual nerve damage following
lower third molar surgery. Int J Oral
Maxillofac Surg 1988;17: 290-294.
21. Pasini G, Zorzo C, Gola G, Polizzi
E.Valutazione clinica di un gruppo di
pazienti, affetti da gengivite, dopo
utilizzo di un gel a base di cetil- piridinio
cloruro, triclosan e olii essenziali.
Quintessenza Internazionale 2012;1:23-
30.
22. L Prosper, I Setaro, E Polizzi, N Zunica, E
Cassinelli, CA Cortella. Materiali estetici
restaurativi: analisi in vistro sull’adesione
batterica e danni iatrogeni indotti
dalle tecniche d’igiene professionale.
Quintessenza Internazionale 2013; 3:
43-51.
About the authors
Dr. Loris Prosper is a professor at G. D’Annunzio University in Chieti, Italy. He teaches dental prosthetics at
Vita-Salute San Raffaele University in Milan and he is responsible for the Aesthetic Odontology Department of
San Raffaele hospital in Milan. He is also a scientific advisor for the Italian editions of “Quintessence of Dental
Technology” and “International Journal of Prosthetic Dentistry”. He is the author of various scientific publications
in international odontology magazines. The Italian version of his new book “Bioesthetics in Oral Rehabilitation:
Science, Art, and Creativity” was published by Quintessence in April 2016 and has since been translated into
several languages.
Dr. Nicolas Zunica is a DDS, dental technician and dental hygienist. He cooperated with Dr. Loris Prosper’s dental
studio in Monza before opening his own dental clinic in Milan. He is also a researcher on aesthetic materials
with Prof. Loris Prosper
38
DENTAL ASIA MARCH / APRIL 2019

Clinical Feature
Glass Ionomer Sealant
for Proactive Intervention
Occlusal decay and its
consequences have a major
impact on the dental health
of our patients. It is the
single most common chronic
childhood disease worldwide 1 and its
results affect our patients throughout
their lives. Molars and premolars are
vulnerable, especially during their eruption
phase. Deep pits and fissures provide an
ideal environment for bacteria to thrive,
digesting carbohydrates and creating
acid which leads to the demineralisation
of susceptible immature dental surfaces.
Purpose of placing pit and fissure
sealants
The most efficient way to prevent pit
and fissure caries is through the sealing
of the vulnerable tooth surfaces, from
the cariogenic bacteria and fermentable
carbohydrate substrates left on the teeth
during mastication. This is best achieved
by placing a physical barrier in the form
of a seal on the pits and fissures. 2
Dentists have been attempting to find
conservative, minimally invasive ways to
treat pit and fissure areas for many years.
In 1955, Dr. Michael Buonocore suggested
that it would be possible to prevent caries
by sealing pits and fissures with a bonded
resin material. The appropriate materials
became available only later, and he
published a further paper on the use of
pit and fissure sealants in 1967. 3
The first permanent molars are a
cornerstone in the development of the
adult dentition. First permanent molars
often erupt before the patient and/or the
parent is even aware of their existence.
The partially erupted permanent first
By Fay Goldstep DDS, FIADFE, FASDA
molar is very difficult to keep caries-free
during its eruption phase. Therefore, it
requires between 12 and 18 months to
fully erupt into occlusion with the existing
teeth in the arch. 4 On the other hand,
bicuspids only need three to six months
to reach full occlusal height.
During this time, the patient experiences
difficulty in cleaning and reaching the first
molar due to its reduced height unless
major effort is made by the patient to
achieve contact. However, this is not
likely possible in a young child. Hence,
the occlusal surface of the first permanent
molar is rarely brushed and is often
covered with plaque and food debris in
a low pH environment. 5 This is further
exacerbated if the tooth remains under an
operculum (gum flap covering an erupting
tooth) for a long period of time. These
factors lead to an erupting tooth that
can easily become carious on its occlusal
surface by the time it fully erupts. 5
Materials to use
The objectives for the pit and fissure
sealant material are: to seal the area, to
make the tooth surface caries resistant
and to be easy to use. 6 Evidence regarding
the efficacy of sealants in reducing
occlusal caries is well established. 7
Composite resin is the most commonly
used sealant material. It seals the pits
and fissures through micro mechanical
means. Micro mechanical retention
is created through tags after enamel
etching. However, these tags are easily
destroyed by contamination with saliva
and this leads to the eventual failure of
the resin sealant. 8 Glass ionomer (GI)
sealant material is hydrophilic. Hence, it is
not as moisture sensitive as hydrophobic
resin materials and it offers an alternative
treatment for the wet conditions in the
oral cavity. 9
Resin sealants have higher retention to pits
and fissures than GI sealants. However,
resin-based sealants have been shown to
lose almost all of their protective effect
once retention is lost. 10-11 In contrast to
resin, even when the GI sealant appears
clinically as partially or totally lost, small
amounts of the material remain. The
GI material stays within the depths of
the fissure since it bonds chemically to
the tooth and consequently the sealing
effect continues. 6 This remaining material
provides a barrier to the bacteria and also
promotes remineralisation through the
release of fluoride. 10-11
Most studies have used ‘retention of
the sealant’ as the end point for fissure
sealant effectiveness. In addition, many
studies have assumed that only a totally
intact sealant (as opposed to a lost or
partially retained sealant) is the criterion
for effective caries prevention and clinical
success. 12 But systematic reviews have
not found that the sealant retention rate
is a valid predictor of clinical outcomes. 12
Hence, it should not be used to measure
sealant success in preventing caries.
Two systematic reviews 10-11 found that
neither resin nor GI sealants were
superior in the prevention of dental caries
in children. Therefore, the choice of which
material to use may have more to do with
ease of use, moisture control, and patient
compliance. 13
Hydrophobic resin sealants do not
provide the best solution for sealing
permanent first molars since they are only
partially erupted for a prolonged period
of time and adequate isolation is not
attainable. 5 Moreover, it has been shown
that improperly placed resin sealants can
leak and allow caries to develop unnoticed
under the leaking sealants. 14 Therefore,
many dentists have stopped using resin
fissure sealants: too many surprises when
opening up carious lesions under failed
40
DENTAL ASIA MARCH / APRIL 2019

Clinical Feature
resin sealants, and finding very extensive
decay that has been left undisturbed for
a prolonged period of time.
Resin sealants also cover the immature
under mineralised tooth surface, not
allowing fluoride, calcium, phosphate and
other minerals from the saliva to contact
the tooth surface and mineralise the
tooth. 5 Enamel requires almost three years
to reach full mature mineralisation. During
this time, the enamel is incompletely
formed and becomes more susceptible to
demineralisation under low pH. 15
Advantages of Glass Ionomer
sealants
Glass ionomer fissure sealants offer
several major advantages over resin
sealants especially in partially erupted
teeth. A summary follows: 5
1. GI sealants are hydrophilic and
they can chemically bond to tooth
structure in a moist environment.
This is especially advantageous when
placing sealants in young children
where isolation due to location and/or
behaviour can be challenging. Resin
sealants only bond mechanically
to tooth surfaces. This requires a
completely dry, isolated environment.
2. GI sealants release and recharge
fluoride. Resin sealants only provide
a barrier to bacterial infiltration while
GIs provide a barrier to bacteria,
and also release and recharge
fluoride. GIs adhere to enamel and
dentin via ionic and polar bonding. 16
This creates intimate contact and
the fluoride is exchanged with the
hydroxyl ions in the adjacent enamel
hydroxyapatite, forming fluorapatite
which is a stronger, more acid
resistant structure (Diagram).
3. GI sealants allow for an easy diffusion
of calcium and phosphate ions (in
addition to the fluoride ions) from
the saliva into the tooth. This helps
to achieve faster, more complete
mineralisation and maturation of
the enamel surface. Resin sealants
consist of a solid material that seals
the tooth and does not allow for the
ionic exchange of minerals. GIs are
porous and have large spaces to allow
the diffusion of calcium, phosphate,
fluoride, etc and this assists enamel
in the maturation process. 5 Newly
erupting enamel is immature as it
is composed of carbonate apatite
that is easily dissolved. GI sealants
can be applied as a thin film over
the exposed enamel as well as under
the operculum of a partially erupted
tooth. The GI sealant has a semipermeable
membrane or “skin”
that allows calcium and phosphate
from saliva to diffuse through it,
into the enamel, and react with the
released fluoride to form mineralised
fluorapatite enamel. This mature
mineralised enamel is more caries
resistant (Diagram).
4. A study has shown that GI sealants
penetrate more deeply into enamel
fissures and occlusal convolutions
than resins. 17 As a result, sometimes
the GI is not visible on clinical
examination. However, when the
teeth were sectioned for this study,
the GI sealant was present deep
in the fissure, providing maximum
protection where it is most needed.
Clinical application
A young patient presented at his
6 th month recare appointment with
erupting first permanent molars in all
quadrants. In view of the child’s history
of decay and deep pits and fissures on the
occlusal surfaces, all the erupting teeth
were sealed with self curing glass ionomer
fissure sealants.
GC Fuji Triage, white shade (GC America)
was applied on the lower molars (Case 1)
and Riva Protect, pink shade was applied
on the upper molars (Case 2). Different
materials were used in this case to
illustrate the technique for this article and
for further educational purposes - both
materials come in white and pink shades.
Step-by-step procedure for case 1 & 2:
1. To prepare the newly emerged
molars for treatment, prophylaxis is
performed using pumice and then
thoroughly rinsed.
2. Cotton rolls and a triangular shield
are placed to retract the cheek
and tongue and to control excess
moisture.
3. Either a 20% polyacrylic acid cavity
conditioner (for 10 seconds) or
37% phosphoric acid etch (for five
seconds) is applied and thoroughly
rinsed. This optimises adhesion of
the glass ionomer to tooth structure.
Excess moisture is removed. The tooth
should have a moist shiny surface.
4. The capsule of the glass ionomer
material is tapped on a hard surface
to loosen the its contents. The
The mechanism of enamel mineralisation and maturation that
occurs with glass ionomer sealants
MARCH / APRIL 2019 DENTAL ASIA 41

Clinical Feature
Fig. 1.1: An erupting mandibular
first molar is sealed with GC Fuji
TRIAGE. Erupting mandibular first
molar prior to treatment.
Fig. 1.2: Prophylaxis with pumice
is performed and then thoroughly
rinsed.
plunger is pushed into the capsule to activate it. (The
GC Fuji Triage capsule must be further activated by one click
in the applicator).
5. The capsule is placed into the triturator and mixed for
10 seconds.
6. The capsule is removed and loaded into the applicator and
the trigger is clicked until paste extrudes.
7. The GI fissure sealant paste is dispensed onto the prepared
tooth. A micro brush can be used to ensure the material
gets into all the pits and fissures.
8. Once the material has lost its gloss, one drop of the “coat”
(GC Fuji Coat or SDI Riva Coat) is dispensed and applied to
the treated area and cured.
9. The sealant is inspected for complete coverage and absence
of voids.
Fig. 1.3: 37% phosphoric acid etch
is applied for 5 seconds.
Fig. 1.4: The tooth is thoroughly
rinsed. Excess moisture is removed.
The tooth is kept moist not desiccated.
Fig. 1.5: The capsule of the glass
ionomer material is tapped on a
hard surface to loosen its contents.
Fig. 1.6: The plunger is pushed into
the capsule to activate it.
Fig. 2.1: An erupting maxillary first
molar is sealed with Riva Protect.
Erupting maxillary first molar prior
to treatment.
Fig. 2.2: After prophylaxis with
pumice and thorough rinsing, Riva
Cavity Conditioner is applied for
10 seconds with a micro brush
and then thoroughly rinsed. Excess
moisture is removed. The tooth
is kept moist not desiccated.
Fig. 1.7: The capsule is put into
the applicator which is then
clicked once for further activation.
Fig. 1.8: The capsule is placed into the
triturator and mixed for 10 seconds.
Fig. 2.3: The capsule of glass
ionomer is tapped on a hard surface
to loosen the contents inside.
Fig. 2.4: The plunger is pushed into
the capsule to activate it. There is
no need to put the capsule into the
applicator for further activation
when using the Riva Protect system.
Fig. 1.9: The capsule is loaded into
the applicator, the trigger clicked
until the paste extrudes, and paste
is dispensed onto the prepared tooth.
Fig. 1.10: Once the material has lost
its gloss, one drop of GC Fuji Coat is
applied and cured. The completed
restoration is inspected.
Fig. 2.5: After the capsule has been
mixed in the triturator for 10 seconds,
it is loaded into the applicator,
the trigger clicked until the paste
extrudes, and the extruded paste
dispensed onto the prepared tooth.
Fig. 2.6: A micro brush is used to
ensure that the material gets into
all the pits and fissures.
42
DENTAL ASIA MARCH / APRIL 2019

Clinical Feature
Fig. 2.7: Once the material
has lost its gloss, one drop of
SDI Riva Coat is applied
and cured. The completed
restoration is inspected.
Conclusion
Fissure sealant application is an excellent proactive dental
treatment. It is an underutilised treatment because of the
difficulties in isolation with resin sealants and the unwelcome
surprises of advanced decay that is sometimes found under failed
resin sealants. Glass ionomer sealants offer the advantages of
easier isolation and the ionic exchange of fluoride and other
minerals to help in the mineralisation of the immature tooth
surface. It is time to bring fissure sealants back out, as proactive
intervention treatments for our young patients, this time with
patient friendly glass ionomer materials. DA
References:
1. Muthu MS, Sivakumar N. Pediatric dentistry. Principles and Practice.
1st ed. New Delhi: Elsevier; 2009
2. Gore DR. The use of dental sealants in adults: a long-neglected
preventive measure. Int J Dent Hyg 2010; 8: 198-203
3. Cueto El, Buonocore MG. Sealing of pits and fissures with an
adhesive resin: its use in caries prevention. J Am Dent Assoc 1967;
75(1):121-8
4. Ekstrand KR, Christiansen J, Christiansen ME. Time and duration
of eruption of first and second permanent molars: a longitudinal
investigation. Community Dent Oral Epidemiol. 2003 Oct;
31(5):344-50
5. Antonson DE. Imagine a world without occlusal caries: are glass
ionomer sealants the answer? Oral Health Journal 2012 Dec; 31-36
6. Berg JH. Glass ionomer cements. Pediatric Dent 2002; 24(5):430-
438
7. Ahovuo-Saloranta A, Hiri A, Nordblad A, Makela M, Worthington
HV. Pit and fissure sealants for preventing dental decay in the
permanent teeth of children and adolescents. Cochrane Database
Syst Rev 2008; 4:CD001830
8. Bishara SE, Oosombat C, Ajlouni R, Denehy G. The effect of saliva
contamination on shear bond strength of orthodontic brackets when
using a self-etch primer. Angle Orthod 2002; 72:554-557
9. Smith DC. Development of glass-ionomer cement systems.
Biomaterials 1998; 19:467-478
10. Yengopal V, Mickenautsch S, Benzerra AC, Leal SC. Cariespreventive
effect of glass ionomer and resin-based fissure sealants
on permanent teeth – a meta analysis. J Oral Sci 2009; 51:373-382
11. Mickenautsch S, Yengopal V. Caries-preventive effect of glass
ionomer and resin-based fissure sealants on permanent teeth: an
update of systematic review evidence. BMC Research Notes 2011;
4:22
12. Mickenautsch S, Yengopal V. Retention loss of resin-based fissure
sealants – a valid predictor for clinical outcome? The Open Dentistry
Journal 2013; 7:102-108
13. Niederman R. Glass ionomer and resin-based fissure sealants:
equally effective? Evid Based Dent 2010; 11(1):10
14. Edwina A. M. Kidd. Essentials of Dental Caries: The Disease and its
Management. Oxford University Press p 170, June 30, 2005
15. Edwina A. M. Kidd. Dental Caries: The Disease and its Clinical
Management. John Wiley & Sons. P299, Apr 11, 2008
16. Sachin S. Glass ionomer cement and resin-based fissure sealants are
equally effective in caries prevention: a critical summary of Yengopal
V, Mickenautsch S, Benzerra AC, Leal SC. Caries-preventive effect
of glass ionomer and resin-based fissure sealants on permanent
teeth – a meta analysis. J Oral Sci 2009; 51:373-382. JADA 2011
May; 142(5):551-552
17. Antonson, SA, Kilinc E, Antonson, DE. Depth of Penetration of
Fissure Sealants on Contaminated Enamel Surface. J Dent Res
2006; 85(Spec Iss B):1580
About the author
Dr. Fay Goldstep is a clinician, author and educator.
Dr. Goldstep has lectured nationally and internationally
on proactive/minimal intervention dentistry, soft-tissue
lasers, electronic caries detection, healing dentistry,
and innovations in hygiene. Dr. Goldstep has served on
the teaching faculties of the post-graduate programs in
aesthetic dentistry at SUNY Buffalo and the Universities
of Florida (Gainesville), Minnesota (Minneapolis), and
UMKC (Kansas City). She sits on several editorial boards,
has been a contributing author for four textbooks, and
has published more than 100 articles. Dr. Goldstep
is a consultant to a number of dental companies, and
practices in Toronto, Canada.
MARCH / APRIL 2019 DENTAL ASIA 43

Clinical Feature
7 TH GENERATION
ADHESIVE SYSTEMS
By George Freedman DDS, FAACD, FIADFE, Dipl.ABAD
Over the past five decades,
the evolution of adhesive
techniques has transformed
the scope of dental practice.
The vast majority of direct
and indirect restorations are bonded
to natural tooth structure rather than
cemented or mechanically retained.
Extensive research and product
development have improved adhesives,
concurrently with patient demands for
improved oral appearance.
The widespread demand and use of
dental adhesives has fueled an intensive
development of better and easier dental
adhesives in rapid succession; inundating
dentists with successive “generations”
of adhesive materials. While the term
“generation” has no scientific basis in the
realm of dental adhesives and is to a great
extent arbitrary, it has served a useful
purpose in the organisation of the myriad
of commercially available materials into
more comprehensible categories.
The “generational” definitions assist in
identifying the chemistries involved, the
strengths of the dentinal bond, and the
ease of clinical use. Ultimately, this type
of classification benefits both dentist
and patient by simplifying the clinician’s
chairside choices.
The beginning of the generational
adhesive systems
The 1 st generation adhesives in the late
1970s were rather unsuccessful. While
their bond strength to enamel was high,
their dentinal adhesion was pitifully low
at typically less than 2 MPa. Generally, all
the adhesive generations bond well to the
microcrystalline structure of enamel; it is
their bond strength to the semi-organic
dentin that is the greater concern.
“Bonding” was achieved through chelation
of the bonding agent to the calcium
component of the dentin. While tubular
penetration did occur, it contributed little
to the retention of the restoration. It was
common to see debonding at the dentinal
interface within several months. 1 These
bonding agents were recommended for
small, retentive Class III and Class V
cavities. 2 Post-operative sensitivity was
common when these bonding agents were
used for posterior occlusal restorations. 3
In the early 1980s, a distinct 2 nd
generation of adhesives was developed,
attempting to use the smear layer
as a bonding substrate. 4 This layer
bonded to the underlying dentin at a
negligible level of 2-3 MPa. The weak
2-8 MPa dentinal bonding strength of
2 nd generation adhesives meant that
mechanical retention form was still
required. Restorations with margins in
dentin saw extensive microleakage, and
posterior occlusal restorations were
likely to exhibit significant post-operative
sensitivity. The long-term stability of 2 nd
generation adhesives was problematic;
one-year retention rates were as low as
70%. 5,6
In the late 1980s, revolutionary twocomponent
primary/adhesive systems
were introduced. Their marked
clinical improvement warranted their
classification as 3 rd generation adhesives.
Significant increases in dentin bonding
strength (8-15 MPa) diminished the
need for cavity retention form. Erosion,
abrasion, and abfraction lesions were
treatable with minimal tooth preparation,
hence the beginning of ultraconservative
dentistry. A noticeable decrease in
postoperative sensitivity with posterior
occlusal restorations was very welcome.
3 rd generation adhesives were the first
“generation” that bonded not only to
tooth structure, but (weakly) to dental
metals and ceramics as well. The downside
of 3 rd generation bonding agents was
their lack of longevity; intraoral adhesive
retention started to decrease after three
years. Despite significant levels of postoperative
sensitivity, patient demands for
tooth-coloured restorations convinced
some dentists to begin providing posterior
composite fillings routinely. 7,8,9
The transformation and popular
generations of the adhesive systems
In the early 1990s, 4 th generation bonding
agents transformed dentistry. Their high
bond strength to dentin (17-25 MPa)
and limited post-operative sensitivity
in posterior occlusal restorations
encouraged many dentists to switch from
amalgam to direct posterior composite
fillings. 4 th generation is characterised
by the process of hybridisation at the
dentin-composite interface.
Hybridisation is the replacement of the
hydroxyapatite and the water in the
surface dentin by resin. This resin, in
combination with the remaining collagen
fibres, constitutes the hybrid layer.
Hybridisation involves both the dentinal
44
DENTAL ASIA MARCH / APRIL 2019

Clinical Feature
tubules and the intratubular dentin,
dramatically improving bond strength
to dentin. 13-16 Total etching and moist
dentin bonding, concepts developed by
Fusayama and Nakabayashi in Japan in the
1980s, introduced to North America and
popularised by Gwinnett and Bertolotti
are the innovative hallmarks of the 4 th
generation adhesives. 17-20
The materials in this group are
distinguished by their components; there
are two or more ingredients that must be
mixed, preferably in very precise ratios,
easy in the research laboratory, but rather
more complicated chairside. The number
of mixing steps and precise measurements
tend to confuse the process, consequently
reducing the dentin bonding strengths.
The very popular 5 th generation dental
adhesives first appeared in the mid
1990s. These materials adhere well to
enamel, dentin, ceramics and metal, but
most importantly, are characterised by a
single adhesive component. Etching is still
required but there is no mixing, and thus,
less possibility for error. Bond strengths
to dentin are in the 20-25+ MPa range,
suitable for all dental procedures (except
in conjunction with self-curing resin
cements and self-curing composites).
Dental procedures tend to be both
stressful and technique sensitive. Where
some of this stress can be eliminated,
dentists, staff and patients all benefit.
5 th generation bonding agents are easy
to use and predictable. There is little
technique sensitivity in a material that
is applied directly to the prepared tooth
surface and post-operative sensitivity is
appreciably reduced.
byproducts are permanently incorporated
into the dental-restorative interface.
In the early versions of 6 th generation
adhesives, the dentin bond (18-23 MPa)
remained strong after time, while the
unetched, unprepared enamel bond was
prone to failure. Additionally, the multiple
components and multiple steps in some
6 th generation techniques can cause
confusion.
The current formulation of the
dental adhesive systems
A new, simplified adhesive system, the 7 th
generation, was introduced in 2002. Just
as the 5 th generation bonding agents made
the leap from previous multi-component
systems to a rational and easy-to-use
single bottle, the 7 th generation simplified
the 6th generation materials into a single
component, single bottle system. Both
6 th and 7 th generation adhesives are
available for self-etching, self-priming
adhesion for improved procedures with
minimal technique sensitivity, and no
post-operative sensitivity (Fig. 1).
No-mix, self-etching, self-priming, single
bottle 7 th generation adhesives represent
the most current formulation of dentinal
adhesives on the market. The elimination
of mixing uncertainty eliminates technique
sensitivity. There is no etching step.
Priming and bonding of the dental surfaces
are accomplished simultaneously, greatly
simplifying the adhesive procedure. It
is a predictable one-step, one-bottle
system for the complete etching and
bonding of both enamel and dentin
surfaces. Its specifications include an
excellent dentin bonding (18-35 MPa)
and similar adhesion to both prepared
and unprepared enamel. It can be used
effectively for both direct and indirect
composite restorations and it adheres
relatively well to ceramic.
Further, 7 th generation adhesives
are insensitive to the amount of
residual moisture on the surface of
the preparation. The bond strength
to both dentin and enamel are essentially
the same, regardless of the moisture
or lack of moisture on the prepared
surfaces. Thus, moist bonding is not
required.
7 th Generation Adhesive Technique
The following is an abbreviated technique
description for the use of 7 th generation
adhesives:
Dentists and researchers have sought to
eliminate the etching step, or to include it
chemically in one of the other steps. The
6 th generation adhesives, introduced in
2000, require no separate etching step,
at least at the dentinal surface. They
have a dentin-conditioning liquid in one
of their components; the acid treatment
of the dentin is self-limiting, and the etch
Fig. 1
MARCH / APRIL 2019 DENTAL ASIA 45

Clinical Feature
1. Decay is noted on the distal surface
of the right mandibular 2 nd bicuspid
(Fig. 2).
2. The decay is accessed and removed
with the Great White #2 bur (SSWhite)
(Fig. 3).
3. The conservative cavity preparation
is complete. The tooth is matrixed
and subsequently wedged (Fig. 4).
4. The preparation is bonded with a 7 th
generation adhesive (Fig. 5).
5. The bonding agent is light-cured with
the Fusion 5 (Dentlight) (Fig. 6).
6. The cavity is restored with composite
resin as the interproximal contact is
made with the CCI (Contact Curing
Instrument, Hu-Friedy) (Fig. 7).
7. The occlusal surface is pre-shaped
with the “Duckhead” instrument
(Hu-Friedy) prior to curing of the
surface layer (Fig. 8).
8. Final surface polishing (Fig. 9).
9. The completed restoration
(Fig. 10). DA
Fig. 2
Fig. 4
Fig. 3
Fig. 5
References:
1. Harris RK, Phillips RW, Swartz ML. An evaluation
of two resin systems for restoration of abraded
areas. J Prosthet Dent 1974;31:537-546
2. Albers HF. Dentin-resin bonding. Adept Report
1990;1:33-34.
3. Munksgaard EC, Asmussen E. Dentin-polymer
bond promoted by Gluma and various resins. J
Dent Res 1985;64:1409-1411.
4. Causlon BE, Improved bonding of composite
resin to dentin. Br Dent J 1984;156:93.
5. Joynt RB, Davis, EL Weiczkowski G, Yu XY. Dentin
bonding agents and the smear layer. Oper Dent
1991;16:186-191.
6. Lambrechts P, Braem M, Vanherle G. Evaluation
of clinical performance for posterior composite
resins and dentin adhesives. Oper Dent
1987;12:53-78.
7. Christensen GJ. Bonding ceramic or metal
crowns with resin cement. Clin Res Associatees
Newsletter 1992;16:1-2.
8. O’Keefe K, Powers JM. Light-cured resin cements
for cementation of esthetic restorations. J Esthet
Dent 1990;2:129-131.
9. Barkmeier WW, Latta MA. Bond strength of Dicor
using adhesive systems and resin cement. J Dent
Res 1991;70:525. Abstract.
10. Holtan JR, Nyatrom GP, Renasch SE, Phelps
RA, Douglas WH. Microleakage of five dentinal
adhesives. Op Dent 1993;19:189-193.
11. Fortin D, PerdigaoJ, Swift EJ. Microleakage
of three new dentin adhesives. An J Dent
1994;7:217-219.
Fig. 6
Fig. 8
Fig. 10
Fig. 7
Fig. 9
46
DENTAL ASIA MARCH / APRIL 2019

Clinical Feature
12. Linden JJ, Swift EJ. Microleakage of two dentin
adhesives. Am J Dent 1994;7:31-34.
13. Barkmeier WW, Erickson RL. Shear bond
strength of composite to enamel and dentin
using Scotchbond multi-purpose. Am J Dent
1994;7:175-179.
14. Bouvier D, Duprez JP, Nguyen D. Lissac M. An in
vitro study of two adhesive systems: third and
fourth generations. Dent Mater 1993;9:355-
369.
15. Gwinnett AJ. Shear bond strength, microleakage
and gap formation with fourth generation dentin
bonding agents. Am J Dent 1994;7:312-314.
16. Swift EJ, Triolo PT. Bond strengths of Scotchbond
multi-purpose to moist dentin and enamel. Am J
Dent 1992;5:318-320.
17. Kanca J. Effect of resin primer solvents and
surface wetness on resin composite bond
strength to dentin. Am J Dent 1992;5:213-215.
18. Kanca J. Resin bonding to wet substrate.
I. Bonding to dentin. Quintessence Int
1992;23:39-41.
19. Gwinnett AJ. Moist versus dry dentin; its effect
on shear bond strength. Am J Dent 1992;5:127-
129.
20. Pashley DH. The effects of acid etching on the
pulpodentin complex. Oper Dent 1992;17:229-
242.
About the author
Dr. George Freedman is a founder and past president of
the American Academy of Cosmetic Dentistry, a co-founder
of the Canadian Academy for Esthetic Dentistry and the
International Academy for Dental Facial Aesthetics, and a
Diplomate of the American Board of Aesthetic Dentistry. He
is a Professor and Program Director, BPP University, London,
UK, MClinDent programme in Restorative and Cosmetic
Dentistry and Adjunct Professor at Western University
(California). His most recent textbook is “Contemporary
Esthetic Dentistry (Elsevier). He is the author or co-author of
14 textbooks, more than 800 dental articles, and numerous
webinars and a Team Member of REALITY. Dr Freedman
received the Irwin Smigel Prize in Aesthetic Dentistry (NYU
College of Dentistry). He lectures internationally on cementfree
implant restoration, dental aesthetics, adhesion,
composites, implants, 3D printing, and porcelain veneers
and crowns. A graduate of McGill University in Montreal,
Dr. Freedman is a Regent and Fellow of the International
Academy for Dental Facial Esthetics and maintains a private
practice limited to Aesthetic Dentistry in Toronto, Canada.
MARCH / APRIL 2019 DENTAL ASIA 47

User Report
CENTION N:
REDEFINING DENTAL RESTORATIONS
Written by Prof. Dr Mohan Bhuvaneswaran, Chennai/India
A user report on a
self-curing resin-based
filling material from
Ivoclar Vivadent.
Direct restoratives play a
major role in our day-to-day
clinical practice. Most of our
clinical work revolves around
restoring tooth structure
that has been lost due to carious or
non-carious processes.
Restoring the tooth back to its original
shape, function and aesthetic properties
is the aim of every conservative dentist. A
wide range of direct restorative materials
has been developed to achieve this. The
beginnings of restorative dentistry reach
back into ancient times when precious
metal such as gold was used to replace
lost tooth structure. Later, silver amalgam
was developed and became a versatile
filling material. Bulk-fill composites are
the protagonists of the latest standard
of filling materials today.
Objective: minimally invasive
preparation
Current approaches in restorative
dentistry aim to preserve the biological
tissues, dentin and enamel for example,
and to use minimally invasive preparation
techniques. The idea of “extension for
prevention” has become obsolete. Nor is
it any longer necessary to remove tooth
structure just to accommodate the filling
material. Adhesive restorative materials
have promoted these advances and yet,
silver amalgam is still in use, even after
150 years since it was launched. Another
popular choice of filling materials is glass
ionomer, which was first introduced in the
1970s by Wilson and Kent.
Declining popularity of amalgam
Silver amalgam is indicated for the
restoration of Class I and II cavities in
load bearing situations and in areas
where aesthetics is not a concern. If
a silver amalgam filling is placed, the
width at the isthmus of the cavity should
measure 25% of the maximum intercuspal
distance. In wider cavities, the clinician
has to look for possible alternatives.
Dental amalgam is a technique-resistant,
cost-effective material that can be placed
without requiring any major equipment. In
spite of its simple application procedure,
the clinical performance of amalgam is
exceptional. Approximately 90% of all
amalgam fillings were still fully functional
after 10 years in situ in a report by
Anusavice. The report attributes these
findings to the capability of amalgam to
minimise micro leakage, even if it does not
adhere to the tooth structure.
Nonetheless, the popularity of amalgam
has been decreasing in recent years
due to aesthetic concerns and the
comparatively large loss of tooth
structure. The environmental pollution
caused by mercury is also a concern.
The latter is gaining in importance as the
use of mercury has generally become
a controversy, fuelling the debate in
the media about the biocompatibility of
amalgam. The decisions of the Minamata
Convention regarding the use of mercury
have been taken seriously. Gradual
phasing out of amalgam is widely
supported and has become inevitable.
Popularity of glass ionomers (GI)
in spite of its drawbacks
Available in a powder-liquid mixture,
glass ionomer has gained significantly in
popularity due to its chemical adhesion to
the tooth structure, its biocompatibility
and its anti-cariogenic properties.
Glass ionomer results in an excellent
marginal seal because it chemically bonds
to the tooth structure. Ion release and
caries inhibiting effects are additional
beneficial properties of glass ionomers.
Although it is white in colour, it is never
been seen as an aesthetic filling material. In
stress-bearing areas, glass ionomer
48
DENTAL ASIA MARCH / APRIL 2019

User Report
cements can only be used for temporary
restorations and this is one of their major
drawbacks. This restriction is attributed
to the poor physical and mechanical
properties of glass ionomer cements.
Affordable alternatives wanted
Composite resins and more modern
adhesive systems have led to significant
improvements in aesthetics, minimal
invasiveness and mechanical properties.
In fact, they have eliminated all drawbacks
that the clinician faces when using silver
amalgam or glass-ionomer cements.
However, composite materials have
always been perceived as expensive,
time-consuming and technique sensitive.
Although they have been available on the
market for a number of years, they have
never fully eliminated the demand for
conventional basic filling materials such
as silver amalgam and glass- ionomer
cements in spite of their drawbacks.
This left dentists waiting for an effective
alternative that can be used as basic filling
material. For many years, it was a pipe
dream that there would be an affordable,
easy-to-use, fluoride-releasing material
that would not necessitate the use of
complicated equipment, would provide
adequate aesthetic properties and would
be suitable for use in stress-bearing areas
without restrictions.
Finally, a material that offers exactly
these advantages has become available:
Cention N is an ideal alternative to basic
filling materials. It is the protagonist of
a new category of self-curing materials.
Cention N: an overview
Cention N is an alkasite filling material
that is available in a powder-liquid delivery
form. It is a self-curing resin-based
material offering optional light-curing
with a curing device emitting light in the
wavelength range from 400 to 500 nm.
It does not necessitate the use of an
adhesive protocol. As a result, retentive
preparation is required to place Cention N.
Yet, the adhesive technique can be used
if a minimally invasive approach involving
the use of a tooth-preserving preparation
method is required. Cention N is available
in commercial packages that contain a
bottle of each liquid and powder and a
spatula to mix the components.
Attractive for users
The main features that make Cention N
an attractive choice for users are:
1. Strength: The filling material is suitable
for use in stress-bearing areas due to its
strength. It offers a flexural strength of
100 MPa, which is considerably higher
than the strength of glass ionomer
cements.
2. Ion release on demand: If the critical
pH drops severely in response to
an acid attack, the fillers release
fluoride, calcium and hydroxyl ions.
The hydroxyl ions have a neutralising
effect on the surrounding pH:
H + → + OH - H2O
Calcium and fluoride ions promote
the remineralisation of the tooth
structure by forming calcium fluoride
and calcium phosphate. They reduce
demineralisation.
In-house studies have shown that
the formation of fluorapatite crystals
results in a surface deposit of almost
0.5 μm. A study that has been ongoing
for more than a year has shown that
ion release per se does not lead to a
significant change in the mechanical
properties of the filling.
The name of the filling material is
based on its flexural strength of
over 100 MPa and its ion release:
CENT + ION = Cention.
3. Lifelike appearance: The material
is supplied in shade A2. This shade
blends well into the surrounding tooth
structure. The material’s aesthetic
properties are therefore superior to
those of any glass-ionomer cement
currently available.
4. Easy to use: Only four working steps
are required: dispense – mix – restore
– finish. This makes the material
easy to use without the need of any
complicated equipment.
5. Affordable: Cention N is extremely
cost effective. A 30 g powder bottle
provides sufficient material for almost
160 fillings enabling clinicians to reach
all segments of patients.
Cention N in clinical use
Indication and contraindication
Cention N is suitable for use without an
adhesive in Class I and II restorations, in
conjunction with a retentive preparation
design, provided that the distance
between the cavity margins and the cusp
tip is larger than 1 mm. However, it is
contraindicated for restoring proximal
boxes and for replacing cusp tips if an
adhesive is not used.
Cavity preparation
Generally, a retentive preparation design
is required if no adhesive is used. The
preparation walls should be occlusally
convergent, with a minimum convergence
of 2 degrees. The depth of the cavity
should be at least 1.5 mm. The width of
the cavity should be at least 1.5 mm in the
isthmus area. If the clinician feels that it
is unnecessary to remove tooth structure
to achieve this cavity design, the cavity
may be prepared conservatively. In this
case, an adhesive should be used prior
to placing Cention N. If the cavity floor is
close to the pulp, all applicable protocols
for pulp protection should be followed.
Isolation and matrix application
Fillings placed with Cention N do not
necessitate any particular isolation
measures. A rubber dam is not required
and retracting the cheeks with an
OptraGate and cotton rolls is more than
enough. It is essential to place a matrix
band if a Class II cavity is restored. A
sectional matrix system is preferable.
Dispensing and mixing
As mentioned earlier, it is necessary to
shake the powder bottle prior to use. Only
MARCH / APRIL 2019 DENTAL ASIA 49

User Report
Amalgam GIC Cention N
Permanent restorations Yes Restrictions apply Yes
Fillings in permanent teeth Yes Restrictions apply to the range of indications Yes
Fillings in deciduous teeth No Yes Yes
High mechanical strength Yes No Yes
Lifelike appearance No No Yes
Calcium and fluoride release No Yes Yes
OH ion releasing No No Yes
Optional light-curing No No/Yes Yes
Table 1: Comparison of the properties of basic filling materials: amalgam, glass ionomer (GIC) and Cention N
UV-coated mixing pads should be used for
mixing the material. If other mixing pads
are used, the liquid would be absorbed.
The powder-liquid ratio is 1:1, one scoop
of Cention N powder to one drop of liquid.
It is essential that the liquid is devoid of air
bubbles. If restoring a large cavity, more
material can be used. The correct mixing
ratio must be used at all times to achieve
the desired consistency. The setting time
is five minutes from the start of mixing
the two components. The material should
be mixed evenly on a wide area. If the
components are mixed together properly,
a composite-like consistency results and
the mixture is not sticky and is easy to
handle and pack into the cavity.
Marginal seal
The marginal seal is always a concern for
the clinician when placing an adhesive
restoration. An important topic in relation
to Cention N is the marginal gap and the
processes taking place in the marginal
gap if no adhesive is used. Studies have
shown that the marginal gap ranges from
15 to 40 μm, theoretically, these gaps
may lead to discolouration. According
to the literature, however, this does
not automatically translate into caries.
For carious processes to take place in
the margin, the gap must be at least a
100 μm. In addition, the ion release of
Cention N provides an effective marginal
seal. There is therefore no reason to be
concerned about the marginal gap.
An effective alternative to amalgam
and glass-ionomer cement
If all the above facts are taken into
account, Cention N can be regarded as an
effective alternative to conventional basic
filling materials. This material is designed
to overcome the drawbacks of amalgam
and glass ionomer cements.
Case 1
A 35-year-old patient presented with
a fractured restoration in her right
posterior area. The clinical examination
revealed a filling that was fractured in the
disto-occlusal region on teeth 46
(Fig. 1). There were no related symptoms
and the tooth tested vital. This was a case
for a Class II restoration with Cention N. A
retentive cavity was prepared (Fig. 2) and
a sectional matrix was placed, followed by
an OptraGate retractor and cotton rolls
(Fig. 3). The filling was condensed. It
blends in well with the surrounding tooth
structure, as can be seen on the image
taken directly after the restoration was
placed (Fig. 4). At the two-week recall,
the restoration showed a satisfactory
integration. The patient was happy with
the function of the filling (Fig. 5). The
findings at the two-year recall were
satisfactory, as can be seen on the image
(Fig. 6) and the radiograph (Fig. 7). The
restoration was intact and the margins
were in excellent condition – all in all, a
very satisfying result.
Fig. 1: Preop of fractured filling on tooth 46
Fig. 2: Retentive cavity preparation on tooth 46
Fig. 3: Isolation and placement of Cention N
MARCH / APRIL 2019 DENTAL ASIA 51

User Report
Fig. 4: Filling immediately after the restorative
procedure
Fig. 5: Recall after two weeks
tooth 37. Both teeth had been restored
with GIC. The mesial aspect of tooth
47 had been restored with a temporary
material. Tooth 49 showed signs of decay
in the mesial area (Figs. 8-9). No other
clinical symptoms were noted and all
the teeth were vital. This case required
Class II restorations to be placed on teeth
36, 37, 46 and 47 and were therefore an
indication for Cention N. After retentive
cavity preparation and relative isolation
with an OptraGate and cotton rolls, the
fillings were placed in two stages. At
the first stage, teeth 36 and 37 were
restored, followed by teeth 46 and 47
on the following day. Once the material
was set, the restorations were finished.
The fillings blended in well with the
surrounding tooth structure, as can be
seen on the images taken immediately
after the restorative procedure
(Figs. 10-11). The restorations were
comfortable to wear for the patient. She
was free of postoperative sensitivities. The
six-month recall revealed sound results
(Figs. 12-13). Images 14 and 15 were
taken on occasion of the twelve-month
recall. The twelve-month radiographs
(Figs. 16-17) also showed satisfactory
results.
Fig. 10: Teeth 36 and 37 immediately after
restoration
Fig. 11: Teeth 46 and 47 immediately after
restoration
Fig. 6: Recall after two years
Fig. 12: Teeth 36 and 37 at the 6-month recall
Fig. 7: Radiograph after two years
Fig. 8: Preop of fractured filling on teeth 36 and 37
Fig. 13: Teeth 46 and 47 at the 6-month recall
Case report 2
A 30-year-old patient presented with
fractured fillings in the left lower posterior
area and a temporary filling on the right
lower molar. A clinical examination
revealed fractured restorations on teeth
36 and 37, with a disto-occlusal cavity on
tooth 36 and a mesio-occlusal cavity on
Fig. 9: Preop of the temporary on tooth 47
Fig. 14: Teeth 36 and 37 at the 12-month recall
52
DENTAL ASIA MARCH / APRIL 2019

User Report
Fig. 15: Teeth 46 and 47 at the 12-month recall
Fig. 17: Radiograph of teeth 46 and 47 at the
12-month recall
successful clinical performance of the material. I have been using
the material for almost two years now. An incident of a failure
occurred when a filling completely dislodged from the tooth
structure. This was caused by a non-retentive cavity design.
There was nil postoperative sensitivity. The clinical performance
of Cention N looks very promising. DA
Fig. 16: Radiograph of teeth 36 and 37 at the
12-month recall
In conclusion: a material with a highly promising
clinical performance
The new self-curing resin-based Cention N material redefines
the limits of basic filling materials - due to its high strength, ion
release, lifelike appearance, ease of use and cost effectiveness.
In-vitro investigations into the material’s properties have shown
favourable results. Long-term clinical studies are now the key to
success for this material. Adequate mixing and retentive cavity
preparation present the most important key factors to ensure a
References:
1. Anusavice K J. Phillips’ science of dental materials, 2003. Eleventh
Edition. Elsevier Science.
2. Bharti R, Wadhwani K, Tikku A, Chandra A. Dental amalgam: An
update. J Conserv Dent 2010;13(4):204-08.
3. Mjör IA, Jokstad A. Five-year study of Class II restorations
in permanent teeth using amalgam, glass polyalkenoate
(ionomer) cerment and resin-based composite materials. J Dent
1993;21(6):338-43.
4. Mjör IA, Moorhead JE. Selection of restorative materials, reasons
for replacement, and longevity of restorations in Florida. J Am Coll
Dent 1998;65(3):27-33.
5. Wahl MJ, Schmitt MM, Overton DA, Gordon MK. Prevalence of cusp
fractures in teeth restored with amalgam and with resin-based
composite. JADA 2004;135(8):1127-32.
About the author
Prof. Dr. Mohan Bhuvaneswaran graduated from DR. MGR Medical University, Chennai, India
and an accredited member of the American Academy of Cosmetic Dentistry. He was a lecturer in
Saveetha Dental college. After which, he was a professor, head of the department of Department of
Conservative Dentistry and Endodontics and also an associate dean at SRM Dental College, Kattankulathur.
Presently, Dr. Bhuvaneswaran is the clinical director of Vignesh Dental Hospital (India), adjuct professor
at MAHSA University (Malaysia), visiting professor at the faculty of dental sciences at Sri Ramachandra
University (India) and a member of many organisations. He has also many published articles. Aside from
these, he is a branded educator of the American Academy of Cosmetic Dentistry, Indian Association of
Conservative Dentistry and Endodontics.Delivers lectures in all Major National and International Podium.
He conducts hands on program on composites, ceramics, Smile design and full mouth rehabilitation.
54
DENTAL ASIA MARCH / APRIL 2019

User Report
An Elegant Transcrestal Sinus Floor
Elevation Technique Using Osteo Safe ®
Written by Dr. Christophe Foresti
Transcrestal sinus floor
elevation osteotomy is a
tried and tested technique
that allows compensation
of the lack of bone height
under the maxillary sinus. 1-2 Indications
of transcrestal sinus floor elevation
osteotomy are:
• sinus floor bone height above 4 mm
with no need for horizontal bone
increase
• 3D radiological examination required
• single edentulism
It must be noted that this procedure is
absolutely contraindicated for patients
with a pathologic sinus, sinus floor bone
height of less than 4 mm and an inner
ear disease and/or history of paroxysmal
positional vertigo. 3
Moreover, this procedure is relatively
contraindicated for patients with a
significantly slanted sinus, intrasinus
septum compared with the osteotomy 4 ,
large gaps and who are smokers.
History
In 1986, Tatum was the first to imagine
sinus floor elevation via a transcrestal
approach for implant placement; but it
was Summers, in 1994, who described the
osteotome technique as it is used today:
• indication of 5-6 mm bone height
associated preferably with low density
bone
• an osteotome is a straight, graduated
instrument with a round, calibrated
section, with a concave end and
cutting edges, which is tapped
with a mallet to create the implant
site. 5-6
However, in 1996, Lazzara proposed using
a sequence of osteotomes, drill burs and
screw-retained implants, indicated for
sinus floor height of at least 5 mm, which
remains the reference. 7
Technique
The initial pre-drilling measures 2-3 mm
in diameter, according to the heights
and stops at 1-2 mm of the sinus floor
(a preoperative X-ray with a depth
gauge is highly recommended). The
bone ridge is cut with osteotomes, with
the least possible trauma, making sure
no instrument penetrates the sinus
cavity during surgery. Before continuing
the procedure, the integrity of the
Schneiderian membrane is checked with
the Valsalva manoeuvre which consists
in closing the nasal airways (presence of
small bubbles at the bottom of the space
created) while exhaling out forcibly and
observing that no air leaks through the
drilling channels. If the test is positive,
surgery must then be suspended and
postponed for two months. 8
In order to buffer the shocks caused
by the osteotomy, bone tissue must
be interposed between the end of the
osteotome and the sinus floor. The
presence of bone on the tip of the
osteotome works as a hydraulic buffer
that limits the risks of perforation.
However, if the residual bone height is
between 6 and 8 mm, the osteotomy is
made with the help of osteotomes with
a concave end and cutting sides that
help collect the small fragments of bone
along the sides of the drilling channels.
In order to do this, the diameter of the
56
DENTAL ASIA MARCH / APRIL 2019

User Report
initial drilling channel must be inferior to
that of the first osteotome used. Thus,
the addition of bone substitute is only
required to further increase the volume of
sinus floor obtained. If the residual bone
height is between 4 and 6 mm, it may be
necessary to first place a bone substitute
in the drilling channel before inserting the
first osteotome, which will, in this case,
have a convex end.
Before implantation, an X-ray is taken to
view the arch obtained. Bone substitutes,
like xenografts and β-TCP, seem to be as
effective as autogenic bone to increase
an atrophic maxillary ridge with the sinus
floor elevation technique. 9-11
Advantages and disadvantages
A transcrestal sinus floor elevation
osteotomy is an approach most dental
practitioners use because of its benefits
namely:
• it is considered a low invasive
surgery with minimal postoperative
follow-ups 13
• it does not require end drilling, thus
better bone/implant interface with
lower risk of heating
• only a very small enlargement of the
alveolar crest is made with an improved
peri-implant bone density 14-15
• simultaneous implant placement is
possible
• reduced treatment time, as implant
integration occurs at the same time
as bone filling consolidation (3 to 6
months, according to residual bone
height)
• lower in cost because it is a single
surgery with a smaller amount of
biomaterial used, as the implant
contributes to increase the volume of
the sinus floor.
Despite all of its advantages, a transcrestal
sinus floor elevation osteotomy is not
without its drawbacks as it is a blind
technique – sinus membrane is not
visible 12 , patient feels discomfort due
to the shocks caused by the osteotome
hammering technique and it is not suitable
for treatment of extensive defects.
Conclusion
The essential factor to enable
simultaneous implant placements seems
to be the residual bone height of the
sinus floor before filling. The minimal
value stated varies between 4 and 6 mm,
according to studies. 1-16 However, more
than this value, primary stability is one
of the key conditions of success, hence
the importance:
• of the site preparation technique with
an atraumatic condensing osteotomy
• of the ability to compact the filling
material
• of the design of the implant itself.
Although this is a blind technique
that carries the risk of perforating
the Schneiderian membrane, in very
specific cases, transcrestal sinus floor
elevation osteotomy represents the most
cost-effective solution for the patient.
This article will focus on two clinical
cases which illustrate a new transcrestal
sinus floor elevation technique with
Osteo Safe ® , the automatic impactor
developed by Anthogyr (Fig. 1).
Fig. 1: Osteo Safe ® kit
Calibrated impactions enable a more
precise and homogeneous progression
into the bone, thereby minimising the risk
of perforating the sinus membrane, while
also being synonymous to higher surgical
comfort for the patient.
Case 1
A 59-year-old male smoker patient
presented preoperative X-ray (Fig. 2)
showing a sinus floor bone thickness
of 4.5 mm, where we will use concave
end osteotomes. As the crestal width
is favourable, we placed an Axiom PX
self-drilling implant measuring 4.6 mm in
diameter and 10 mm in length after bone
tissue development.
In a standard case, drilling is initiated with
a Ø2.0 mm drill up to 1 mm of the sinus
floor (Figs. 3-4) but, if bone density is
higher, it is preferable to place 0.5 mm,
resuming the drilling in order to use a
moderate impaction force, resulting
in a more comfortable experience for
the patient during bone perforation
(Figs. 5-6).
Fig. 2: Preoperative X-ray
Fig. 3: Depth gauge in place.
Fig. 4: Follow-up
X-ray with depth
gauge in place.
MARCH / APRIL 2019 DENTAL ASIA 57

User Report
An X-ray is taken to check the arch
obtained; the quantity of biomaterial used
is 1 cm 3 or 0.5 g (Fig. 13). The implant
(Fig. 14) is placed manually with the help
of a universal screwdriver included in the
kit. The postoperative X-rays show the
bone increase obtained (Figs. 15-16).
Fig. 5: Resumed initial drilling 2.0 deeper.
Fig. 9: Re-insertion of material in the drilling
channels.
Fig. 6: Follow-up X-ray with drill bur in place.
The first two osteotomes of the sequence
are used, carefully placing previously
hydrated biomaterial in the drilling
channels before impaction (Figs. 7-10).
Fig. 10: Osteotome No. 2
In order to avoid all risks of perforating
the Schneiderian membrane, the depth
of penetration of the osteotomes is
the same as the initial bone height
(4.5 mm in our case). The third osteotome
will complement the elevation of the
membrane through condensation, by
interposing bone filling each time. The
total volume of the biomaterial used must
allow elevation sufficient to place a 10 mm
implant (Figs. 10-12).
Fig. 13: X-ray of arch obtained.
Fig. 7: Placement of bone filling material before
osteotomy.
Fig. 11: Osteotome No. 3
Fig. 14: Implant placement.
Fig. 8: Osteotomy is initiated (osteotome No. 1). Fig. 12: Final osteotomy No. 3
Fig. 15: Postoperative panoramic X-ray.
58
DENTAL ASIA MARCH / APRIL 2019

User Report
Fig. 16: Postoperative retro-alveolar X-ray.
Case 2
A 43-year-old female non-smoker patient
presented to do implants. Treatment
planning for implants (Figs. 17-18) show
that two Axiom PX implants measuring
4 mm in diameter and 10 mm in length
can be placed after developing the bone
through the Summers technique with
concave end osteotomes (initial bone
thickness = 6 mm).
Fig. 19: X-ray
with drill burs
in place.
Fig. 20: Placement of a small amount of bone
filling material before osteotomy.
The second and third inserts are later
used automatically with interposition each
time with a small amount of filling material
in the drilling channels. The concave end
“scrapes” the sides and collects bone
particles that help increase bone volume
when mixed with the biomaterial - the
amount used is 0.5 cm 3 or 0.25 g per
implant (Figs. 24-26).
A follow-up X-ray of the arch obtained is
always taken before placing the implants
(Fig. 27). Thanks to the automatic
impactions of Osteo Safe ® held with one
hand, the surgery can take place quickly.
The universal screwdriver allows the
manual placement of implants with no
excess torque, thereby controlling the
insertion axis perfectly (Fig. 28).
Fig. 17: Preoperative panoramic X-ray
Fig. 21: Osteotome No. 1 (concave end).
Fig. 24: Re-insertion of bone filling material in the
drilling channels.
Fig. 18: Preoperative 3D with implant planning.
Drilling is initiated with a Ø2.0 mm bur
at a depth of 5 mm (Fig. 19). The first
osteotome is used with an amount of
biomaterial (Figs. 20-22) which allows
lifting the membrane by condensation.
As the sinus floor is highly corticalised,
the osteotomy is performed with a
percussion technique by means of
the same osteotome assembled on
the manual handle included in the kit
(hammer not included) (Fig. 23).
Fig. 22: Osteotomy is initiated.
Fig. 23: Floor perforation with hammering
technique.
Fig. 25: Osteotome No. 2 (concave end).
Fig. 26: Osteotome No. 3 (concave end).
MARCH / APRIL 2019 DENTAL ASIA 59

User Report
Fig. 27: Follow-up X-ray of the arch obtained and
measurement of sinus floor height.
Fig. 28: Implant placement.
Fig. 29: Follow-up panoramic X-ray.
With the use of Osteo safe ® , transcrestal
sinus floor elevation procedure enhances
the treatment plan for the patient through
progressive technique, being less
traumatising and thus better accepted
by patients. DA
References:
1. Del Fabbro M, Testori T, Systematic
rewiew of survival rates for implants
placed in the grafted maxillary sinus. Inc
J Periodontics Restorative Dent. 2004
Dec; 24(6): 564-77
2. Del Fabbro M, Corbella S, Weinstein T,
Ceresoli V, Taschieri S. Implant survival
rates after osteotome-mediated maxillary
sinus augmentation: a systematic review.
Clin Implant Dent Relat Res. 2012 May;
14, Suppl 1: and 159-68
3. Di Girolamo M, Napolitano B, Arullani
CA, Bruno E, Di Girolamo S. Paroxysmal
positional vertigo as a complication of
osteotome sinus floor elevation. Eur
Arch Otorhinolaryngo. 2005 Aug; 262
(8): 631-3
4. Hag and G. Greffe intrasinusienne par
abord crestal. Implant 2004; 10 (4):
259-63
5. Summers RB. The osteotome technique:
Part 4- Future site development.
Compend Contin Educ Dent 1995 Nov;
16(11): 1090-99
6. Tatum H. Maxillary and sinus implant
reconstructions. Dent Clin North Am
1986; 30(2): 207-29
7. Lazzara RJ. The sinus elevation procedure
in endosseous implant therapy. Curr
Opin Periodontol 1996; 3: 178 – 83
8. Garcia D, Garcia C. Valsalva :much more
than a simple maneuver. Antonio Maria
Valsalva (1666 – 1723). Rev Med chil
2006 Au; 134 (8): 1065- 8
9. Handschel J, Simonowska M, and coll.
A histomorphometric meta-analysis of
sinus elevation with various grafting
materials. Head Face Med 2009 Jun;
5: 12
10. Esposito M. Grusovin MG, and coll.
Interventions for replacing missing
teeth: augmentation procedures
of the maxillary sinus. Cochrane
Database Sys Rev.2010 Mar 17; (3):
CD008397
11. Valentini P, Abensur DJ. Maxillary sinus
grafting with anorganic bovine bone: a
clinical report of long-term results. Inc J
Oral Maxillofac Implants. 2003 Jul-Aug ;
18 (4): 556-60
12. Charbit Y, Daunay N, Hitzig C, Mahler P.
Sécurisation des élévations par abord
crestal grâce à la piézochirurgie. Titane
2007 March; 4 – No. 1 35-39
13. WiltfAng J, Schultze- Mosgau S, Merten
HA, Kessler P, Ludwig A, Engelke W. Oral
Surg Oral Med Oral Pathol Oral Radiol
Endot 2000; 89: 288- 91
14. Chalard JJ, Antoun H, Chalard M, Missika
P. Elévation du plancher sinusien à l’aide
d’ostéotomes. Implant 2002 August; (3):
161-73
15. Saadoun AP, Le Gall MG. Patti A.
L’ostéotome en implantologie: principes
et applications cliniques. Implant 1998
May (2) 16 Wallac and SS , Froum SJ,
Tarnou DP. Endoscopic and histologic
evaluation of sinus elevation procedure:
a clinical report. Inc J Periodontics
Restorative Dent. 1996 Feb; 16 (1): 46-
51
Summary
This new transcrestal sinus floor elevation
technique is elegant in more than one way.
• Ergonomics: freeing one hand offers
enhanced manual control.
• Fast and effective: the constant good
intensity impaction and the absence of
a separate hammer decrease surgical
time significantly.
• Safety: the practitioner is less focused
on new constraints (which strength
should be used for impaction? How to
handle the hammer while holding the
osteotome?) and can better focus on
the surgery itself.
About the author
Dr. Christophe Foresti is a dental surgeon in Rosheim
with a number of university diplomas. He is a member
of various scientific societies with 20 years’ experience
in implantology, pre- and peri-implant surgery and
implant prostheses.
60
DENTAL ASIA MARCH / APRIL 2019

Behind the Scenes
REPLACEMENT OF EXISTING PORCELAIN
VENEERS TO ALL-CERAMIC VENEERS
WITH DIGITAL WORKFLOW
By Dr. Luke Cronin
A case presentation
featuring 3Shape TRIOS,
3Shape Smile Design and
3Shape Dental Designer in
replacing porcelain veneers
with all-ceramic veneers.
Case information
Patient is a 26-year-old female that
presented with six existing, three-year
old porcelain veneers and was unhappy
with the appearance. The existing veneers
were too labially placed with a significant
midline cant and the canines were flared
giving the overall appearance of teeth that
were too large.
Treatment plan
In consultation with the patient, the
decision was made to replace the
existing six porcelain veneers with 10
all ceramic veneers. Addition of veneers
for the first premolars and first molars
(second premolars extracted) both
broadens the smile and allows a more
harmonious appearance, particularly
when viewed at the social angles
(45 degrees from the facial aspect).
plan to address patient’s concerns. In
this case the following photos were taken:
facial smiling, facial retracted, facial
repose, retracted occlusal, 12 o’clock
and retracted lateral and facial views
(Figs. 1-8).
Fig. 1
As the treatment required was reductive,
the final position of the veneers has
to be more palatal and a three-stage
smile design process was necessary.
Initially, a two-dimensional design was
created using 3Shape Smile Design to
determine the new outlines of the veneers
from the facial view. Secondly, the twodimensional
design was overlaid on the
3Shape TRIOS 3 .stl file using 3Shape Realview
to create an additive motivational mockup
for the patient to sign off on. Finally,
an ideal mock-up was created using
3Shape Dental Designer for use as a
preparation guide and temporary veneers.
Photographic Protocol
Precise digital photography is necessary to
fully understand the current situation and
in turn, create an appropriate treatment
Fig. 2
Fig. 3
62
DENTAL ASIA MARCH / APRIL 2019

Behind the Scenes
Fig. 4
3Shape Smile Design
3Shape Smile Design was used as
a communication tool for both the
patient and laboratory (Race Dental).
3Shape Smile Design utilises live mock-up
capabilities in two dimensions to illustrate
the appearance of the teeth from the facial
aspect. This is powerful for the patient as it
is a simple tool for visualisation of a possible
final outcome. The 3Shape Smile Design also
doubles as a communication tool for the
laboratory, simplifying the description of
the proposed final aesthetics determined
with the patient chairside (Figs. 9-12).
3Shape TRIOS 3 scan
Following the completion of the
two-dimensional smile design, a
three-dimension image of the
dentition is required to proceed to the
three-dimensional smile design
components. 3Shape TRIOS 3 scan was
used to capture this information (Fig. 13).
Fig. 13
Fig. 5
Fig. 6
Fig. 7
Fig. 9
Fig. 10
3Shape RealView smile design
3Shape RealView enables the technician
to incorporate the two-dimensional
photos, the 3Shape Smile Design and the
3Shape TRIOS scan .stl file in the same
software. This simplifies the transfer of
the information from two-dimensions
to three dimensions and creates both
predictability and repeatability within the
software platforms. This technology also
provides reassurance for the clinician that
the final outcome delivered will match
exactly what was viewed by the patient.
Additive mock-up
In this case, we needed to show the
patient the three-dimensional result using
a bis-acrylic temporary mock-up over
the existing unprepared dentition which
required the first design to be entirely
additive (Fig. 14).
Fig. 11
Fig. 8
The above photos illustrate clearly the
encroachment on the wet-dry lip line
particularly in the central incisors and
canines. The facial repose and 12 o’clock
views, in particular, clearly highlight the
problem.
Fig. 12
Fig. 14
When showing the patient an additive
mock-up in a reductive case, it is
imperative that the patient only views
the mock-up from a full facial photo and
not in real time, up close, or from other
MARCH / APRIL 2019 DENTAL ASIA 63

Behind the Scenes
angles due to the labial placement of the
teeth in the motivational mock-up. Failure
to only show the two-dimensional facial
photograph will result in the patient losing
confidence in the treatment and feeling
their teeth “are sticking out”. This is still
an essential part of the treatment as it is
the only stage in a reductive case where
you are able to show the patient a live
cosmetic smile trial without performing an
irreversible procedure (Fig. 15).
Fig. 15
Ideal mock-up
Following the sign-off of the additive
mock-up by the patient an ideal mockup
was created. This was done in the
laboratory using 3Shape Dental Design.
The existing additive mock-up was
repositioned palatally in the correct
position of the final restorations. The
new final tooth position model was
3D printed and a preparation guide
was made to ensure exact reduction
for minimal thickness lithium disilicate
veneers. This model is also used to
make the key for the temporary veneers
(Figs. 16-18).
Fig. 18
Veneer removal, tooth preparation
and temporisation
Following anaesthetic administration,
the existing veneers were removed using
a diamond bur and handpiece. After
assessment, the existing porcelain and
resin was removed and the ideal mock-up
putty key was checked for a passive seat
and filled with Expertemp (Ultradent). The
key was then removed following curing
and the final position of the veneers
assessed. Next, 0.5mm was removed
in the A, B and C planes through the
Expertemp to ensure minimal thickness
of the glass ceramic. Particular attention
must be paid to the C plane to ensure
adequate reduction in the incisal area
preventing flaring of the final restorations.
The remaining Expertemp was then
removed (Fig. 19).
health which was essential for this patient.
Following accurate assessment of the
gingivectomy, laser troughing was
performed to create a defined margin
prior to the 3Shape TRIOS 3 scan.
The preparations were then scanned
and uploaded to Race Dental using
3Shape Communicate for same day
merging with the pre-preparation
(ideal mock-up) in the laboratory. The
teeth were then temporised using the
ideal mock-up putty key and Expertemp
(Fig. 20).
Fig. 20
CAD and Milling
The ideal mock-up and digital
3Shape TRIOS 3 scan were uploaded
into 3Shape Dental Design to create the
individual CAD files ahead of milling.
Using this software integration enables
the predictable replication of the design
as shown to the patient and the clinician
throughout the planning process. This
repeatability and predictability showcases
the power of a fully digital workflow
(Figs. 21-22).
Fig. 16
Fig. 17
Fig. 19
Gingivectomy was required on the central
and lateral incisors. This was performed at
the time of preparation using the Gemini
dual wavelength diode laser (Ultradent).
The height of the gingivectomy was
defined by the gingival position on the
ideal mock-up created in the lab, using
3Shape Dental Design. The cutting and
cauterising characteristics of the super
pulsed diode laser enables precise and
predictable gingival removal, preventing
the need for second stage surgery.
Additionally, the diode laser will disinfect
the gingival sulcus and improve tissue
Fig. 21
Fig. 22
64
DENTAL ASIA MARCH / APRIL 2019

Behind the Scenes
High translucency bleach shade
lithium disilicate blocks coupled with
consistent tooth reduction provide lifelike
aesthetics when milled as a monolithic
restoration. Utilising monolithic
restorations also maintains the maximum
strength of the material and reduces
the introduction of errors in the design
through an optional layering process
(Figs. 23-24).
The 10 veneers were milled by
Race Dental using Roland DWX-4W
Wet Dental mills. The advanced technology
within Race Dental creates a flawless fit
making it easier for their technicians to
accomplish a perfect and predictable
cosmetic result (Fig. 25-26).
anaesthetised and the temporary veneers
removed. The veneers were checked
for fit and aesthetics using shade B0.5
3M Veneer try-in paste. The patient was
given an opportunity to assess their final
veneers prior to cementation; however
this is difficult due the anaesthetic and
demonstrates the importance of the very
specific digital planning regime outlined
above (Fig. 27).
Fig. 25
Fig. 23
Fig. 24
Fig. 26
Following manufacture and delivery of the
milled restorations the patient was again
Fig. 27
Following assessment of the fit and
aesthetics of the restorations, the
veneers were removed, and a decision
was made to cement all 10 veneers
simultaneously. The veneers were etched
with hydrofluoric acid; cleaned, dried
HIGH-PERFORMANCE
ROTATING INSTRUMENTS
SIMPLIFYING DENTAL MOTION
Visit us at Hall 11.2 Booth Q34
TeKne Dental srl – Italy
info@teknedental.com www.teknedental.com
MARCH / APRIL 2019 DENTAL ASIA 65

Behind the Scenes
and silanated for 60 seconds. The teeth
were isolated using a Kerr retractor and
cleaned and phosphoric acid etched for
20 seconds. 3M Single Bond was then
applied to both the restorations and
the tooth surfaces for 60 seconds and
air dried (Fig 28). 3M shade B0.5 Veneer
cement was placed individually on the
restorations starting from the central
incisors, moving from left to right and
from central to molar in an alternating
pattern. Seating of the restorations was
confirmed and the resin tack cured. The
excess resin was then removed and final
cure achieved. The interproximal contacts
were separated using a serrated edge
and all interproximal excess cement
was removed. The cement margin on
the palatal surface was polished and the
occlusion checked for interferences. The
patient was discharged and rebooked for
review in two weeks.
Review
During review, the restorations were
checked for excess cement, good oral
hygiene and correct occlusal function.
Then, ‘After’ photos were taken showing
the final position of the new restorations
(Figs. 28-32).
Fig. 32
Fig. 31
Conclusion
Utilising a complete digital workflow
with the integrated 3Shape hardware
and software solutions allows clinicians
to deliver extremely predictable and
repeatable outcomes. The digital
workflow enables the patient to be
engaged in the smile design process and
ultimate acceptance of the final cosmetic
outcome. Clinicians should be aware
of the importance of using a high-tech,
well-resourced digital laboratory with
experience in both dental aesthetics and
complete digital workflows to ensure
successful outcomes. DA
About the author
Fig. 28
Dr. Luke Cronin is a leading Sydney-based cosmetic
dentist specialising in stunning smile transformations.
His cosmetic work has attracted a global following with
cutting edge cosmetic dental techniques and technology
delivering flawless results. Dr. Cronin has a specific interest
in porcelain veneers, clear aligner therapy and teeth
whitening.
Fig. 29
Dr. Cronin’s passion for designing beautiful, natural looking
smiles has attracted models, actors, fitness personalities
and patients across Sydney, inter-state and internationally.
Offering first class treatments and patient care, Dr. Cronin
provides a refreshingly modern and sophisticated approach
to customer service at his lower north shore practice,
Quality Dental.
Dr. Cronin is an international speaker and a key opinion
leader for 3Shape TRIOS, Ultradent Gemini laser and
Philips Zoom Whitening.
Fig. 30
66
DENTAL ASIA MARCH / APRIL 2019

New 3Shape E4
Ultimate productivity with
the fastest 3Shape scanner ever!
Double the speed
The E4 * scans a full arch
in 11 seconds which is 2 times
faster than the E3’s 22 seconds.
Double the accuracy
The E4 delivers accuracy
of 4 microns compared to
the E3’s 7 microns accuracy.
Double the cameras
4x5MP cameras enable scanning
of dies in the model omitting extra
steps for scanning dies individually.
Learn more at go.3shape.com/e4
* The E4 will be available Summer 2019

Behind the Scenes
A JOURNEY THROUGH ELEMENTAL
REINFORCEMENT OF FUNCTIONAL AND
AESTHETIC HARMONY
By Dr. Anand Narvekar
It did take quite some time for me
to understand that dentistry is
similar to photography. One has
to be at the moment, intervene
and implicate the right treatment
regimen to provide another’s smile. In
order to do all that, I have learned that
patience is an important virtue that we
must possess through our entire smile
journey. This particular case has taught
me in all different aspects of dentistry and
motivates me to continue contributing
smiles, just like how photographers keep
on taking more photographs of their work.
Case details
A 62-year-old female patient came up
to my clinic with a chief complaint of
fracturing her ceramic crowns in the
upper right posterior region and was
experiencing mild pain/sensitivity on
hot/cold in the upper left molar tooth
region. Patient also complained of food
lodgement in the upper palatal and
gingival areas.
Observations
Clinical Examination revealed that the
upper right fixed prosthesis was devoid
of interocclusal spaces with the opposing
mandibular natural teeth (Fig.1). The
patient had a fixed prosthetic bridge
from tooth 13 – 16 with 14 & 15 as
pontics, which had leaky margins and
the ceramic was predominantly worn off
with inner metal exposure especially in
the pontic areas.Extensive enamel wear
was observed in the lingual aspect of
upper central incisors particularly in the
cingulum areas and generalised attrition
of lower anterior teeth was present.
This was a major concern with the bite
wherein the lower anteriors occluded
with the Lingual marginal areas of the
upper anteriors involving the cingulum
and gingival areas (Figs. 2-3).
Fig. 1
Fig. 2
Fig. 3
Lateral Profile presented with a high
overjet and dentofacial analysis revealed
an excessive and disproportionate display
of teeth structure (Figs. 4-5). However,
periodontal examination showed low risks
with no signs of inflammation, presented
by absence of bleeding on probing and
healthy surrounding hard and soft tissues.
The study casts were mounted on a
semi-adjustable articulator and
Supporting photographs revealed a
collapsed and traumatic bite with a
unilateral scissor bite on the right side.
This contributed to the overall extensive
generalised enamel loss and high
functional risk. The presence of multiple
diastemas and malaligned maxillary
anteriors were also observed (Fig. 6).
The patient had no signs of pain or
inflammation in the Temporomandibular
(TMJ) region, despite a traumatic bite.
Fig. 4
Fig. 5
Fig. 6
Treatment plan
Considering the overall observations,
clinically, through study models and
photographs, the patient’s condition had
68
DENTAL ASIA MARCH / APRIL 2019

Behind the Scenes
to be immediately addressed, which was
constituted by a holistic rehabilitative
approach in order to best save the
remaining natural dentition. A systemic
approach and assessment of periodontal,
biomechanical, functional and dentofacial
risk had to be carried out in order to
lay down the most ideal treatment plan
which will add to the overall “predictable
success” of the treatment which is our
top priority.
The collapsed/traumatic bite had to be
altered by increasing the overall vertical
height thus ensuring good occlusal
clearance especially in the right side
and overall replacement of the degraded
enamel had to be carried out. The patient
was initially briefed in detail about the
clinical observations and the need to
commence the treatment without any
further delay.
Orthodontic Intervention in order to
correct the bite and mal aligned teeth was
explained but the patient was not willing
to undergo the treatment. Replacement
of missing tooth nos. 14 and 15 with
implants was another option but it was
constituted by few retarding factors
such as high cost of sinus lift and Guided
Bone Regeneration (GBR) procedures,
which was a concern for the patient.
Furthermore, the possibility of implant
failure especially in the tooth 14 region
because of reduced bone width and
interocclusal clearance was another
factor. Another major factor was scissor
bite which will received load on implants
from different direction.
Hence, Treatment plan was laid out with
rehabilitation of all the teeth with ceramic
crowns. Selection of the type of ceramics
would be decided as the treatment
progressed with the bite raised to get a
clear picture on the clearance and other
bite related information. Since it involved
overall occlusal collapse/discrepancies,
centric occlusion was considered the
starting point of treatment. The treatment
commenced and was divided into four
phases right from preliminary basic
treatment procedures followed by raising
the bite and stabilising occlusion to
overall replacement and rehabilitation
with prosthetics.
Phase 1
The first phase involved all the preliminary
procedures comprising of removal of all
faulty/old restorations in both arches,
root canal treatment procedures and
necessary composite fillings. Then, crown
lengthening procedure was carried out on
tooth nos. 16, 36 and 37 to increase the
overall surface area of the tooth for the
prosthetic crown (Figs. 7-8).
Fig. 7
Fig. 8
Phase 2
A customised deprogrammer from pattern
resin was fabricated in order to deprogram
the muscles and destress muscles in order
to guide the TMJ and the mandible to an
optimum position of comfort (Fig. 9).
Centric Record was taken to mount the
lower cast to the articulator while the
Upper Cast was transferred using the face
bow record (Figs. 10-11). The centric
pin of the articulator was lowered down
and all premature contact points were
checked, ensuring that all the teeth were
occluding and then the pin was raised
by 5mm. (We have decided to raise the
bite by 5mm initially, once we loaded
the temporaries in patient’s mouth, after
checking dentolabial and facial analysis
we will increase or decrease VOD).
Wax mock-up was done on the cast as
per ideal proportions to emulate natural
anatomy. An occlusal putty index was
made after the mock up. Spot Etching
was done over the natural teeth followed
by application of bonding agent over the
spots (Fig. 12). A temporary bis-acrylic
composite( Protemp -4) is injected into
putty index and transferred into the
patient’s mouth and allowed to set for
3-4 minutes. The index was then removed,
the excess luting material was scraped
out and finishing was done for the mock
up. The white metal acrylic facing fixed
prosthesis is placed on 13 to 16 regions
because of the high chance of fracturing
the temporary material due to clearance
(Fig. 13).
After careful study of the facial and
dentolabial analysis at rest position,
display of maxillary anterior teeth
(4 mm), we have decided not to increase
any VDO to maintain smile design
principles (Fig. 14).
Fig. 9
Fig. 10
MARCH / APRIL 2019 DENTAL ASIA 69

Behind the Scenes
Fig. 11
Fig. 15
region and revealed that the patient was
completely normal. The final prosthesis
was then decided, which comprised of
porcelain fused to metal (PFM) fixed
prosthesis replacing tooth nos. 14-16
region which has less clearance at the
connector region with less pontic height.
Therefore, zirconia copings layered with
ceramic was selected for the remaining
dentition. Tooth preparation and tissue
management was done using a single
cord (Figs. 18-19) followed by impression
taking with polyvinyl siloxane (PVS heavy
and light body). New Provisionals were
fabricated on the prepared teeth, using
the previously made mock up.
Fig. 12
Fig. 16
Fig. 18
Fig. 13
Fig. 14
Phase 3
Kois Deprogrammer was fabricated and
the patient was instructed to wear it full
time for over a week (Fig. 15). The patient
was then scheduled for an equilibration of
the entire dentition. The anterior button
of the deprogrammer was trimmed till 1 st
posterior teeth came in contact and with
sequential use of 200 micron, 100 micron
& 40 micron Bausch paper. The dentition
was made to have simultaneous, uniform
and equal intensity contact points on both
sides (Figs. 16-17).
Fig. 17
A shim stock was used to confirm that
every tooth posterior to the canine had
a positive contact which confirms the
establishment of good occlusion in static
centric relation (CR) position. Pathway
adjustments were done on the mock-ups
with the patient in upright position using
a horseshoe-shaped 200-micron paper
while asking the patient to simulate her
chewing movements. All lateral marking
interferences were removed. Load test
of TMJ was done to ensure there was no
pain or discomfort on both the joints.
Few changes in anterior anatomy were
noted especially with regards to width and
height ratio which will be corrected in the
final prosthesis.
Phase 4
After three weeks, the patient was called
for review and investigation related to
any kind of pain or discomfort in the TMJ
Fig. 19
The objective is to rehabilitate by restoring
aesthetic and functional harmony to
achieve natural looking restorations. This
could only be achieved through proper
laboratory communication, ensuring your
ceramist is completely briefed and making
sure you have left no stones unturned!
Thus, shade matching and all other
detailing was communicated with my
ceramist to ensure accurate and precise
layering of ceramics. The models were
mounted on the articulator for proper
occlusion assessment; the maxillary
arch was first completed followed by the
mandibular arch (Figs. 20-21).
70
DENTAL ASIA MARCH / APRIL 2019

Behind the Scenes
Fig. 20
Post-operative conditions
All post-operative photographs were taken
after one year. The prosthetic crowns
presented a harmonious relationship
with the adjoining soft tissues and a well
intact, healthy and aesthetic contour of
the gingiva was observed (Figs. 27-28).
Sufficient interocclusal spaces depicted
the overall success of the raised bite and
also ensured harmonious atraumatic
chewing movements by the patient
(Figs. 29-32).
Fig. 24
Fig. 21
The lower anteriors were given a buccal
tilt ensuring that they made incisal
contact exactly on the palatal surface
of upper anteriors unlike the previous
existing occlusion wherein an extensive
wearing of enamel in both the upper and
lower teeth were seen (Fig. 22). Occlusion
was adjusted in Bisque trial and pathway
adjustments were made to ensure that
there are no interferences during chewing
motions. Final occlusion was checked
with Shim Stock in static occlusion
(Figs. 23-25).
The prosthetic crowns were then sent
to the laboratory for final glazing and
polishing. Under strict isolation protocols,
few crowns were bonded and the rest
cemented using resin glass ionomer
cement. Oral hygiene instructions were
given to the patient and a gingival flosser
was recommended to better maintain the
restorations and overall oral health. The
patient was called for a review every three
months for a complete examination was
done to maintain occlusal stability and
overall predictable success. After one
year of follow-up overall examinations,
a stable occlusion and a harmonious
condition of the prosthetic crowns were
revealed (Fig. 26).
Fig. 22
Fig. 23
Fig. 25
Fig. 26
Fig. 27
MARCH / APRIL 2019 DENTAL ASIA 71

Behind the Scenes
The overall aesthetics, structure,
translucency and fine detailing of the
crowns remained unaltered revealing
a healthy functional balance resulting
into a perfect natural looking smile.
All post treatment photos taken
after one year follow up including
articulating paper markings reflective
occlusal views.
Fig. 28
Fig. 29
Fig. 31
Words of wisdom
“A Smile remains the most subtlest
of gifts one can bestow on someone
and yet its powers can vanquish
kingdoms.”
– Og Mandino
As dentists we have been given
the opportunity to provide smiles
on another and in such a transient
and uncertain life one cannot ask
for more to make
life meaningful and
worthwhile. So buckle
up, train hard, keep
learning, keep falling
down only to get
up stronger, kindle
curiosity, wonder,
imagine and keep
giving the world a
reason to smile! DA
Fig. 32
About the author
Dr. Anand Narvekar graduated BDS from Bharati
Vidyapeeth Pune in 1996. Currently, he is in private practice
at Mumbai since 1997. He specialises in aesthetic dentistry
and Style Italiano techniques. He has done special training
from SAM Articulators Germany and conducts exclusive
clinical photography workshop all across India.
Acknowledgement – Author wish to thank Dr. Ali Tunkiwala
for his valuable advice for this complicated case.
Ceramic artistry from Mr. Madan Soman (Shofu Technical
Instructor). Mr. Sri Ram NC (Shofu India). Material Support
– Shofu Dental Asia-Pacific Pte. Ltd. Lab support – Dental
Ceramists Mumbai & Pearl Dental Airoli.
Fig. 30
72
DENTAL ASIA MARCH / APRIL 2019

#PrimeTimeMachine
The all new Matik. The first Digital Native Automation unit
is dawning a new era in in-house manufacturing.
inhouse-movement.com
Amann Girrbach Asia
Fon +65 6592 5190
singapore@amanngirrbach.com
www.amanngirrbach.com

In Depth With
Fig. 1: Primescan – the new intraoral scanner from
Dentsply Sirona that takes digital impressions to
the next quality level
Primescan Perfects
Digital Impressions
In the past, Dentsply Sirona
introduced digital impression
to dentistry with CEREC. Now,
with Primescan, the Company is
introducing an intraoral scanner
with outstanding technology, which
enables scans that are more precise
than anything we have known before
(Mehl et al. 2019).
Scans up to 20 millimeters in depth
Primescan’s optical impression system
has been decisively developed. The scan
of the surfaces of the teeth is done with
high-resolution sensors and shortwave
light, capturing up to one million 3D
data points per second. With optical
high-frequency contrast analysis, they
can now be calculated more accurately
than ever before. Dentsply Sirona
has submitted a patent application
for this process. With Primescan, it
is also possible to scan deeper areas
(up to 20 mm) enabling digital impressions
for subgingival or deep preparations.
Fig. 2: Digital impressions with Primescan: easier,
faster and more accurate than ever before.
Fig. 3: Thanks to the smooth surfaces of
Primescan and the acquisition centre, the
hygienically critical areas can be reprocessed
safely, quickly and easily.
Primescan captures the dental surfaces
immediately, in the required resolution
and with a high sharpness even at great
depths, thereby ensuring a much more
detailed 3D model.
To monitor the scanning process simply
and easily and to be able to assess the
model immediately, the accompanying
Primescan AC acquisition centre has
a modern touchscreen that pivots and
swivels ensuring favorable ergonomic
position. Primescan also scores in terms
of hygienic safety. Thanks to the smooth
surfaces of Primescan and the acquisition
centre, the hygienically critical areas can
be reprocessed safely, quickly and easily.
Comprehensive range
of applications
The precise scanning technology
enables Primescan to be implemented
universally. Not only does it produce
high-precision images of natural teeth and
preparations, it also provides extremely
accurate images of other materials
commonly used in dentistry. With this
new scanning technology, impressions
can be completed very quickly allowing
full jaw impression, including model
calculation, to be completed in just two
to three minutes.
Maximum flexibility for further
processing of the scanned images
With Primescan, the modular concept
offers a suitable solution for every
need within the practice. The digital
3D model can be transmitted to a
laboratory via the new Connect software
(formerly Sirona Connect), and can
also be further processed with different
software for orthodontic or implant
treatment planning. The newly developed
Connect Case Center Inbox enables
laboratories around the world to connect
to the Connect Case Center. In the
process, validated scan data from both
Primescan and Omnicam can be received
easily for further processed. Alternatively,
the restoration can be planned and
manufactured in the practice using the
new CEREC software 5, with its pleasingly
fresh, new design, intuitive touch
functionality and noticeably improved
screen resolution.
First impressions from Key Opinion
Leaders
“Primescan is great, fast and precise. The
scans are amazing and I really like how
they have put so much thoughts into the
little details that matter! The software is
intuitive and easy to use,” – Dr. Justin Giam,
Founder of Dental Designs Clinic.
“Primescan’s new digital impressioning
technology decreases scanning time
within the patient’s mouth allowing
dentists to finish a full mouth intraoral
scan within two minutes – it is faster than
the usual five to eight minutes scanning
time. It is one of the best scanners of our
time because its software features give
accurate results. Primescan allows you to
cut your design time and in return, focus
on what is really important – our patients,”
– Dr. Michael Tsao, Founder of CEREC Asia
and Sweet Space Dental Clinic. DA
MARCH / APRIL 2019 DENTAL ASIA 75

In Depth With
A Closer Look at Primescan
After learning about its advantages, what follows is an in-depth article by Dr. Hsuan Chen from
CEREC Asia Training Center, on his experience and views on Dentsply Sirona’s brand-new
intraoral scanner. For current CEREC users, the new features have been highly anticipated.
While for dental professionals who are thinking about going digital, the Primescan presents a
competitive choice against the CEREC Omnicam and other scanners available in the market.
What is Primescan?
The Primescan is the brand-new intraoral
scanner from Dentsply Sirona and
promises to be faster, easier to use, and
more accurate than the CEREC Omnicam.
The Interface
Though it keeps the same kart design as
the Omnicam, the brand-new Primescan
features an improved user interface –
including a touchpad replacing the old
track ball for easier cursor control, and
the removal of a keyboard, giving the
Primescan a clean and minimalist look.
The new touchscreen now affords users
a much-needed increase in real estate
to work with – boasting an improved
16:9 ratio compared to the previous 4:3.
Also, a more powerful battery can now
support the scanner without a power
socket connection.
Touchscreen operation is available on the new
PrimeScan. Source: Dentsply-Sirona
Users may navigate through the software
via the touchscreen, which pivots and tilts,
allowing for a more intuitive method of
moving 3D models around. The change
renders the old control gestures of
using the trackball obsolete, and ushers
Primescan into the age where users
control devices with swipe gestures – as
learned from the use of mobile phones
and tablets.
The Scanner
Side view
VS index finger
Bottom view
VS molars
The Primescan scanner might be mistaken
for an Omnicam at first glance due to its
similar design and colour scheme, but the
differences are quite apparent once you
hold it in your hand. The scanner head
is substantially larger in dimension than
its predecessor; the scanning area of the
Primescan measures 15 mm by 15 mm, while
that of the Omnicam is 10 mm x 11 mm.
One of the biggest problems with small
scanning fields on intraoral scanners is
that it places computational strain on the
stitching process because the amount of
image overlap is smaller. After discarding
extraneous noise, sometimes there simply
isn’t sufficient data left for accurate
calculations. Therefore, increasing the
scanner capture size helps to preserve
more data and thus better full-arch
accuracy. Moreover, the added bulk
seemed to have no effect on its usability.
(Though whether this is true for patients
with statistically smaller mouths, i.e. Asian
females, remains to be seen.)
In addition to its larger
scanning field, the Primescan
also uses specific wavelengths
of blue light that, according
to Dentsply-Sirona, can more
accurately capture the surface
data. Don’t confuse this blue
light with the CEREC Bluecam,
however, as the new Primescan
uses a completely new method
of image capture. As you will
see in our analysis later on in
this article, all this technology
does seem to make significant
differences, at least when
compared with the Omnicam.
The Software
Admittedly, one of the changes
that I am most excited about is
the new design of CEREC 5.0
software. The blue background
and button designs used in
previous CEREC 4.x definitely
looked dated (it was released in
2012, to be fair). Personally, I think they
did a good job cleaning up the software
interface.
During the event, Dentsply-Sirona
placed heavy emphasis on the new
A.I. (Artificial Intelligence) in the CEREC
software. A recent example of A.I. in
the news is the AlphaStar from Google
Deepmind that defeated two of the top
Starcraft II players in a game thought
to be impossibly complex for artificial
intelligence. It was able to achieve this
amazing feat by supervised training
through millions of games.
76
DENTAL ASIA MARCH / APRIL 2019

In Depth With
The blue light used by Primescan has less
penetration, and therefore better surface capture.
But in recent years, the word A.I. has
become this overused marketing buzzword
that conflates different categories of the
technology into one general term. To
make things more confusing, “A.I.” can
technically refer to any kind of software
that mimics intelligence and decision
making. The old CEREC 4.6 also had “A.I.”,
and look how that turned out.
For this reason, it is very exciting to see
the new CEREC 5.0 A.I., because it is
capable of self-learning. So the more
time you spend working with it, the better
its automatic margins and restoration
designs will be. The even better news is
that the learning processes is aggregated
and centralised at a main server controlled
by Dentsply-Sirona, then distributed to
all the end-users. This means that as a
new Primescan or Omnicam owner, you
can immediately take advantage of the
most mature and smartest version of the
software, trained by dentists all around
the world.
Is Primescan faster?
Yes. Primescan does feel noticeably faster
than the Omnicam, but keep in mind that
the Omnicam is currently already one of
the fastest scanners available. So how fast
do you need, really?
Is Primescan easier to use?
Despite the changes, veteran Omnicam
users will have no trouble adjusting
to the Primescan on the first try. The
new scanner’s large imaging area and
increased depth of field (up to 20 mm)
seems to keep the image capture more
continuous without breaks and the
addition of the touchpad and touchscreen
improves user experience. Do note,
however, that the Primescan is bulkier and
heavier than the Omnicam.
Is Primescan more accurate?
Accuracy can be divided into two
components: trueness and precision.
Trueness is how closely the data conforms
to reality (or the best approximation of
reality), while precision is how closely
the data conforms to each other. These
two concepts are mutually exclusive,
and therefore can be tested separately.
According to Dentsply-Sirona’s own
tests, the Primescan is able to achieve
the following accuracy:
Local Accuracy Global Accuracy
Trueness: 14 μm Trueness: 32 μm
Precision: 10 μm Precision: 30 μm
A trueness value of 14 μm (microns)
means that whatever you scan will be, on
average, within 14 microns of the target
object. While this is an excellent result, it
is not unheard of. In fact, similar numbers
have been achieved in other studies by
CEREC Omnicam, 3Shape Trios, and a
whole host of other scanners as shown
below:
For global accuracy, the numbers are
a bit more interesting. You can think
of local accuracy as how good a single
restoration fits. Global accuracy, then, is
how well a full-mouth appliance (i.e. clear
aligners, bite plates, implant frameworks)
fits. So an accuracy value as close to
zero (perfect representation of reality)
is desired.
First, a global trueness of 32 microns is very
respectable. For context, a study in 2017
compared four intraoral scanners and
found that their global trueness ranged
from 45.8 to 61.4 microns (see table 1).
Now you can definitely find studies that
shows even better results for a lot of
scanners, like this, this, this, this and this
study. Keep in mind, however, that there
are a few ways to do global accuracy
calculations (but let’s not get into it for
now). For the purpose of this discussion,
we can get a sense of a scanner’s
performance based on relative values,
and the Primescan’s results are looking
pretty good.
But numbers and figures can be
misleading, especially those with business
and financial implications. So we decided
to test it for ourselves.
Local accuracy values for desktop and intraoral scanners. Source: Heike, 2016.

In Depth With
Immediately we can already see a
difference in detail between the Omnicam
and the Primescan. Notice also that the
vertical surfaces are also smoother on the
right (Primescan).
Table 1: Comparison of full-arch precision by Imburgia, 2017.
A Totally Non-Scientific Accuracy Test
Local Accuracy: Resolution
As I mentioned earlier, local accuracy is
about how much surface detail can be
accurately reproduced. To start off, here
is a close-up of two scans by the Omnicam
(left), and the Primescan (right).
Comparison of surface texture
At this magnification, you can see that
the dimples on the buccal surface of the
central incisor is better reproduced by
the Primescan. Also, near the top right of
each scan, the cervical margins are also
much more pronounced in the Primescan.
Comparison of mesh distribution
The STL file sizes are a quick way to check
the mesh density (or “resolution”) of
similar 3D models, and all the files sizes
were surprisingly very similar. So how
is it possible for Primescan to be more
“accurate” if it doesn’t use more data for
representation? The following image is
the same as the one above, but with the
mesh overlay on top.
Notice that even though we could visually
see that Primescan had more surface
detail, its smoother surfaces use much
larger triangular meshes. This allows the
STL file to become denser in places where
the detail really matters, like the dimples
and the cervical margins.
Assuming that same conversion method
to STL is used in both cases, we think that
this result has to do with the Primescan
capturing lower levels of noise than the
Omnicam. Therefore, while the resulting
mesh density (or “resolution”) isn’t
noticeably different, a better signalto-noise
ratio allows the Primescan to
preserve more detail.
Local Accuracy: Sharp Edges
A used emax block for the edge test
One of the Omnicam’s issues is that the
sharp edges (i.e. less than 90 degrees)
tend to be more rounded in the scanned
result. In fact, there is a study for this
particular phenomenon. During the
presentation, Dentsply-Sirona also made
an effort to point out how the Primescan
can capture edge details better. Naturally,
we put that claim to the test.
Comparison of details near the edges
Comparison of unreflective surfaces
If you’ve ever used an Omnicam, you’ll
know that it often has trouble with dark
spots, like stains on the enamel, blood,
or magic markers. The dark lettering on
the ceramic block is no exception, as you
can see on the left. For the Primescan, this
seems to be less of an issue.
Global Accuracy
Up until a few years ago, intraoral
scanners were still shown to have less full
mouth accuracy when compared with PVS
double impressions. Soon later, studies
began to notice that it’s not just what you
scan with, but how you scan that matters
more. At CEREC Asia, we developed our
Framework Scanning Method back in
2015 when our own research indicated
that global accuracy with the Omnicam
is heavily technique-sensitive. Our results
showed that the difference between
using Framework Scanning and scanning
randomly can be over 200 microns.
With Primescan’s purported trueness and
precision achievements, we were curious
if a systematic method such as Framework
Scanning would still be needed. For our
tests, we compared three pairs of data:
- InEos X5 VS Omnicam (Framework)
- InEos X5 VS Primescan (Framework)
- InEos X5 VS Primescan (random path)
78
DENTAL ASIA MARCH / APRIL 2019

In Depth With
The first set of data is our baseline, the
second set is the test group, the third
set simulates a user new to using the
intraoral scanner. See the results of the
three comparisons.
Primescan results are very similar, so let’s
look at some numbers (unit in microns):
Positive Avg Negative Avg Absolute Avg Std Deviation
Omnicam (F) 48.0 -43.9 46.0 59.0
Primescan (F) 26.6 -21.8 24.2 41.1
Primescan (R) 26.2 -24.1 25.2 39.3
Since the above results come from the
same scanner twice (albeit with a different
method), you can think of it as a
very rough precision estimation.
More data is definitely required,
but from our very rough tests, the
Dentsply-Sirona claims of 30-ish
microns of trueness and precision
seem to hold up quite well.
The method shown in the above three
images, called superimposition, overlays
one model onto another and shows how
much they differ using a colour spectrum
(legend on the right). The green regions
are where the models match (within
50 microns), and thus are more accurate.
There is also a histogram attached to the
spectrum legend on the right showing the
distribution of deviations. In short, the
tighter and narrower the distribution, the
more accurate the overall result.
Just from visual inspection of the
preliminary results above, we can already
see that the results for the Primescans
are more accurate. Interestingly, the two
The absolute average values in the table
above indicates how much average
deviation there is between the intraoral
scans and the desktop scan. Lower
absolute average means better accuracy
(or more specifically, trueness). So within
the scope of this simple study, we can
draw some conclusions:
• Primescan scans are cleaner and less
noisy than those from the Omnicam.
• Primescan is able to preserve more
local details than the Omnicam.
• Primescan is able to achieve better
global trueness than the Omnicam even
with Framework Scanning, but both are
more than clinically acceptable results.
• There is no significant difference in
global accuracy between different
methods of using Primescan.
It would seem that, if the results above
are verified with a larger sample size, that
Primescan is considerably less techniquesensitive
than its predecessor. This is
definitely good news as it may reduce
the learning curve for new users. Out of
curiosity, I ran a comparison between
random scanning and Framework
Scanning with the Primescan:
Positive Avg Random vs Framework
Negative Avg 29.1
Absolute Avg -33.3 31.2
Std Deviation 45.1
For those of you who are interested, these
average values are calculated by sampling
between approximately 600,000 and
800,000 polygons per model.
Final Thoughts
The release of Primescan at this
time, along with its complementary
software, is intriguing as it signals
Dentsply-Sirona’s push to capture a
bigger DI (digital impression) market from
other intraoral scanners.
For dental professionals looking to
purchase their first intraoral scanner,
the ease of use and accuracy offers
immediate short-term benefits. At the
same time, the A.I., the optional modular
software, and great communities such as
CERECDoctors.com and CEREC Asia are
valuable assets for the longer term.
For current CEREC users, Primescan
offers an interesting alternative. But
assuming that the Omnicam will indeed
still get all the latest software updates,
current users will be just as satisfied with
either the Omnicam or the Primescan.
In reality, whether practitioners purchase
or upgrade to the Primescan will ultimately
depend on two factors: price and
long-term plan. If a practice needs
something that replaces traditional
impression and nothing else, it really
doesn’t matter whether it opts to get
the Primescan, the Omnicam, or any
other major brand for that matter. But
for practices that aim to undergo a
gradual conversion to the new digital
workflow in restoratives, implantology,
or orthodontics, then the DI-focused
Primescan is a great first step into the
CEREC ecosystem. DA
MARCH / APRIL 2019 DENTAL ASIA 79

In Depth With
Providing High Technology and
Professional Service for a Better Life
research and technical centre as well as
the Shaanxi dental instrument engineering
technology centre. More than 50
researchers, who have leading positions
in research ability and manufacturing
process, are currently working for SINOL.
To date, they have more than 50 patented
technology inventions, appearances and
utility models. This is how SINOL is able
to maintain its position as China’s leading
dental instrument manufacturer over the
years.
Founded in 1965, SINOL Dental Limited
was one of the first professional
dental instrument manufacturing
companies to be set up in China.
For more than 50 years, the
company has been devoted to research and
development, manufacturing, marketing
and servicing of dental equipment. The
company’s many remarkable medical
and oral achievements in the field are a
testament to its credibility and it is no
wonder SINOL has become a famous
brand and continues to enjoy good
reputation in the industry.
As early as 2000, SINOL passed
the rigid qualification for the
ISO 9001 certification. In 2003, it
attained TUV’s CE certification. Four
years later, SINOL was rated as
“China’s Famous Brand.” Not
long after, SINOL achieved the
American FDA certification. Finally
in 2012, SINOL was recognised as
“China’s Famous Trademark” by
the State Administration in the industry.
Aside from their prominent products
such as dental units and handpieces,
the company also offers cleaning and
sterilising systems, dental teaching
simulators, technician systems, clinical
instrument systems, dental imaging
systems, integrated service systems as
well as dental implant materials.
Recognising the importance of
innovation, SINOL invests
in research and importing of
technology. In line with this,
the company has
set up a
provincial
In the domestic market, the company
boasts a strong network comprising
30 core marketing and after sales
agencies that cover around one hundred
distributors. This wide and complex
network allows for the company to
provide its customers with efficient and
quick service responses. SINOL also
has an expansive overseas network,
having exported their products to more
than 60 countries including Europe,
South America, North America, Africa,
Middle East, Russia, Southeast Asia,
Germany, Japan, Argentina and more.
Today, SINOL is a market leader in
China’s dental and medical equipment
industry, and well on its way to becoming
a world famous dental medical equipment
manufacturer and
integrated system
service provider. DA
MARCH / APRIL 2019 DENTAL ASIA 81

In Depth With
Extending Dental Operating
Fields with Loupes
TTL loupes, a light mounted at the centre
of the forehead ensures the light path is
always in the centre of the visual field
allowing eyes to focus without the need
to constantly change position.
Despite the growing popularity
of wearing loupes in practice,
especially within the field
of endodontics, some
misconceptions still exist. Those
who have not yet adopted magnification,
especially younger practitioners and
dental students, often think loupes are
unnecessary until their natural vision
begins to decline, which is generally
considered to be around the age of
40. But nothing could be further from
the truth. If a practitioner is trained to
perform the intricacies of endodontics,
whatever their age, they should consider
themselves ready to use magnification.
Loupes are designed to significantly
improve the visual acuity of practitioners,
regardless of their age, quality of eyesight
or whether they already wear prescription
glasses or contact lenses. It may come as a
surprise but wearing prescription glasses
is no barrier to practitioners planning
to use loupes in practice. Today’s loupe
manufacturers are able to adjust their
loupes to accommodate a prescription
regardless of the style of loupe chosen
or whether they are through-the-lens
(TTL) or front-lens-mounted (FLM) flip up
loupes. It’s all about flexibility, personal
preference and accommodating every
individual’s specific needs.
Making the investment
Working as specialists in fields such as
endodontics takes time and investment.
Hence, it is worth practitioners considering
investing in their eyesight as well. It
is not simply about magnification but
also improving visual acuity. Loupes
are beneficial for a long, enjoyable and
healthy dental career thanks to:
• Enhanced precision leading to more
accurate diagnosis and the ability to
deliver the most appropriate treatment
• Reduced eye strain thanks to loupes
providing far clearer access to the oral
cavity
• Reduced risk of musculoskeletal
disorders
There has been growing concern within
the dental profession about the risk of
eye strain and musculoskeletal disorders
as a result of dental posture. Correctly
fitted loupes can significantly improve
posture during treatment, by allowing
practitioners to work in an upright and
neutral position. This in turn helps to
reduce strain on the head, shoulders,
neck and back which can have serious
implications on the quality of life of
practitioners, potentially leading to more
serious injury and even early retirement.
Avoiding the strain
A long day in the surgery requires high
levels of concentration and can be
extremely tiring on the eyes and the body,
especially when working with insufficient
lighting. One of the most significant ways
of eliminating eye strain and muscle
fatigue on a daily basis is to use loupes
with an additional LED headlight. Whether
practitioners choose to use flip-up or
The latest and most innovative LED lights,
such as Firefly ® , increase light levels
significantly above those produced by
traditional dental lights, providing uniform
and natural-colour output, and should
be considered as an integral part of a
loupe purchase. A headlight to meet the
demands of endodontics needs preferably
to be lightweight, powerful and cordless,
eliminating the need for heavy power
packs and any unwanted disruptions
from cable snags or cables blocking the
field of view.
The ideal combination
Without a doubt, the use of magnification
is becoming the standard of care for all
dental treatments, and endodontics in
particular. The use of lightweight dental
loupes with several magnification options
can improve an endodontist’s diagnostic
and treatment capabilities to see and
treat conditions simply not visible to the
naked eye.
When it comes to choosing the right
loupes and headlight system, PeriOptix
offers an ideal solution. As a leader in
magnification and illumination, their
lightweight frames and headlight designs
support better ergonomics, resulting in
less strain on the neck and back ultimately
leading to an overall more comfortable
working experience. Available as readymade
and custom-made loupes in a choice
of magnifications, PeriOptix are suitable
for everyone from dental students through
to the most experienced endodontist
alike. The more you practice and the
earlier you practice with loupes and lights
- the better the outcome will be. DA
To find out more about PeriOptix loupes
visit:
www.denmat.com/loupe-configurator
MARCH / APRIL 2019 DENTAL ASIA 83

In Depth With
The New iTero Element ® 5D Imaging System
for Comprehensive and Restorative
Oral Care at IDS
Align Technology, Inc.
announced on 18 th February
that it is launching the
iTero Element 5D Imaging
System, which provides
a new comprehensive approach to
clinical applications, workflows and
user experience that expands the suite
of existing high-precision, full-colour
imaging and fast scan times of the
iTero Element portfolio. The entire
iTero product family, including the
iTero Element 5D Imaging System, will be
showcased at the 38 th International Dental
Show (IDS) in Cologne Germany, which runs
March 12 th – 16 th 2019.
iTero Element 5D Imaging System:
more than just a scanner
In addition to offering all of the features
and functionality that doctors have
come to expect and rely on with the
iTero Element 2 scanner, the iTero Element
5D scanner is the first integrated dental
imaging system that simultaneously
records 3D, intra-oral colour and
near-infrared imaging (NIRI) images
and enables comparison over time using
iTero TimeLapse. 1 NIRI technology of
the iTero Element 5D Imaging System
aids in detection and monitoring of
interproximal caries lesions above the
gingiva without using harmful radiation. 1
With one full arch scan, in as little as
60 seconds, the iTero Element 5D Imaging
System provides doctors with powerful
visualisation capabilities, including the
following:
• 3D impressions for restorative and
orthodontic work
• Analysis instruments, such as the
occlusal clearance tool 2
• NIRI imagery
• Intraoral camera imagery
• iTero TimeLapse technology
• Invisalign ® Outcome Simulator 2
• Invisalign Progress Assessment 2
“The iTero Element 5D Imaging System
84
DENTAL ASIA MARCH / APRIL 2019

In Depth With
combines the cutting-edge technology
of the iTero Element portfolio of intraoral
scanners, with advanced integrated
imaging features, such as NIRI, which
aids in interproximal caries detection
and clear intra-oral images with
the built-in intraoral camera,” said
Mr. Zelko Relic, Align Technology, CTO
and senior vice president, global research
and development. “With this new imaging
system, doctors can efficiently and
effectively scan every patient at every visit
and visualise treatment options together
that result in more informed decisions for
optimum oral care.”
“Diagnosing carious lesions or ‘cavities,’
especially ones that are interproximal
or between teeth, can be hampered
by numerous factors, including
variations in tooth shape and alignment,
traditional X-ray film limitations that
include variability in exposure levels,
poor angulations in image capture or
overlapping contacts in the image,
and more,” said Dr. Mitra Derakhshan,
Align Technology, vice president, global
clinical. “The iTero Element 5D Imaging
System aids doctors in detecting
and monitoring the progression of
interproximal cavities above the gingiva
without harmful radiation, thereby helping
to ensure that their patients receive even
better care.”
Dr. Tim Nolting, a general practitioner
from Freudenberg, Germany, who was
part of the iTero Element 5D Imaging
System limited market release said, “The
iTero Element 5D scanner has been a real
game changer and given me a totally new
reason to incorporate digital technology
in my practice. Patients value minimally
invasive treatment and radiation free
diagnosis. With the addition of the
iTero Element 5D system in my diagnostic
tool box, diagnosis itself is easier to make
and since I can show my patients what I
am seeing, they understand the situation
better and in turn accept the proposed
treatment.”
“The pace of innovation at Align continues
to accelerate, and the Element 5D
Imaging System expands the iTero
portfolio by offering dental professionals
a wide range of powerful scanning
technology at every price point,” said
Mr. Yuval Shaked, Align Technology,
senior vice president and managing director,
iTero Scanners and Services. “As the
leader in digital scanning technology with
over 20 years of experience, we understand
the nature of platform evolution and
how important it is to support our
doctors and provide an upgrade path
that protects their investment. With
iTero Element 5D Imaging System, dental
professionals now have the ability to
invest in more than an intraoral scanner,
thus maximising opportunities within their
dental practice. The platform nature of
iTero Element 5D system makes it easy
for dental professionals to upgrade to
the latest digital technology when they
are ready.”
MyiTero.com: New web-based
interface that frees the scanner for
scanning
Align Technology now also offers a
web-based platform called MyiTero.com
that complements the comprehensive
visualisation of the iTero Element 5D
Imaging System and can be used to set up
the prescription before the appointment
and review scans with the patient on
multiple devices, giving the practice
the flexibility to assist more patients
with this cutting-edge technology.
MyiTero.com frees up the scanner so
the practice can really maximise the
utilisation of their scanner and the overall
investment in the technology.
Direct doctor-lab workflow in limited
release: Workflow options that fit
doctor-lab needs
Align Technology is continuing to
streamline workflows for dentists and
labs with the addition of direct doctorlab
workflow. The new workflow will allow
the scan to be automatically sent to the
doctor’s lab of choice and the doctor
can engage with the lab through the
MyiTero.com account to determine if
the scan is acceptable or if additional
information is needed. This workflow
will continue to be supported with
on-demand services like iTero modeling
and iTero custom milled models, both
unique to iTero Element scanners, that
the labs have come to count on. Direct
doctor-lab workflow is currently in limited
market testing in North America and
Europe.
1
Data on file at Align Technology, as of
4 th December, 2018.
2
Comes standard in all iTero Element
scanners.
The iTero Element 5D Imaging System is
commercially available now in Canada,
European Union countries accepting
CE-Marking (excluding Greece),
Switzerland, Norway, Australia,
New Zealand, Hong Kong and Thailand.
The iTero Element 5D Imaging System is
not yet available in the United States or
Latin America. DA
Information about the iTero Element
5D Imaging System can be found at
http://www.itero.com/en.
Invisalign, iTero,
iTero Element,
the iTero logo, among
others, are trademarks
and/or service marks of
Align Technology, Inc.
or one of its subsidiaries
or affiliated companies
and may be registered
in the U.S. and/or other
countries.
MARCH / APRIL 2019 DENTAL ASIA 85

Product Highlight
Bausch
The Future of Occlusion Control
The newly developed registration system
by Bausch combines the traditional
and digital registration of the pressure
distribution of occlusal surfaces.
The OccluSense ® handheld is a
battery powered device which
uses a local wireless network to
transfer recorded data to
the OccluSense ® -iPad-
App. The inductive
charger provides
wireless power
transfer and its
fully charged
batteries
allow
the usage of the device for up to four
hours.
The OccluSense ® Electronic Pressure
Sensor is 60 microns thin and can
be used just like traditional
occlusion test materials.
The technologically
advanced OccluSense ®
pressure sensors
allow the recording of
masticatory forces in 256
pressure levels. The thin and flexible
material permits the recording of both
static and dynamic occlusions.
Additionally, the red colour coating marks
the occlusal contacts on the patient’s
teeth. The traditional colour transfer
on the occlusal surfaces facilitates the
assignment of the recorded data.
The data of the occlusal masticatory
distribution is displayed with the
OccluSense ® iPad App.
Furthermore, the
data can be displayed
as 2D and 3D
graphics, including
the masticatory
distribution, with up
to 150 images per
second and can be
stored in the patient
management system
of the iPad App for
review or export at
any time. ■
Busch
Better Preparation with Original COOL-DIAMOND Instruments
Gentle treatment without
distressing the patient is most
desirable when producing
dental preparations, and
modern dentists prefer to
use instruments permitting
an advantageous treatment
of their patients.
COOL-DIAMOND
instruments from Busch
feature a unique design,
with numerous diagonally
intersecting grooves that
interrupt the grinding
process up to seven times
during each rotation of the instrument,
supporting the process and facilitating
the removal of chips.
Their fine-gold coating also makes
them tissue compatible, and a seamless
diamond coating in the deeper grooves
ensures easy, high-performance
grinding with low vibrations, while also
helping to optimise the instrument’s
service life.
The range of COOL-DIAMOND instruments
comprises of 124 application-oriented
versions in coarse, medium and fine
diamond grit. ■
86
DENTAL ASIA MARCH / APRIL 2019

Product Highlight
BRAVIA ® XL Special Edition Turbine
TKD
With the celebration of its 50 th anniversary,
TKD presents its special edition of their
popular BRAVIA ® XL high-speed turbine -
a result of many years of know-how and
passion for micromechanics.
Its improved drive air nozzle geometry
and the use of a modified impeller now
produce a tangible higher power level.
The turbine also features a redesigned
high-precision spindle and incorporates a
special integral-structure high-precision
ceramic ball bearing. Moreover, together
with the use of selected perfectly
balanced rotor, BRAVIA ® XL’s turbine
provides unmatched stability
and concentricity.
Not only is the turbine very powerful and
reliable, it is also one of the lightest in
the world: 39 grams thanks to its solid
titanium main body! The turbine is also
equipped with a highly-efficient four spray
ports and cellular glass optic system.
In addition, lubrication can be carried out
by means of the common oil dispensers
or, more conveniently, by means of the
special recommended LubriONCE ® grease
lubricator. Furthermore, BRAVIA ® XL
turbine’s connection is fully compatible
with the popular MULTIflex ® one. ■
From Now on, Time is on Your Side
Amann Girrbach
With the new Ceramill Matik
processing unit Amann Girrbach
revolutionises the digital
laboratory routine. The
innovative full service unit
combines the actual processing
station with a fully automatic
stock management system, with
intelligent tool management and
a machine cleaning device, which
enables an automatic change
between wet and dry mode. This
means that the Ceramill Matik
works fully automatic and can
also manufacture autonomously
during the night or on weekends.
The dental technician is thus
freed from unproductive
secondary activities, which
previously occupied up to 40% of his/
her working time, and can now focus
100% on value-creating activities.
The brain behind the new all-round
carefree solution is the completely
redesigned 10-axis control unit. On one
hand, it masters the highly efficient 5-axis
production unit with all the innovative
processing modes of the Ceramill DNA
Generation and guarantees maximum
indication and material diversity. And on
the other hand, it controls the intelligent
material and tool management.
Among other things, this
includes the integrated blank
tank, which holds so many
materials that it can always
reload the processing station
over a weekend. Due to an RFID
chip on the holder of each blank,
all relevant material information
can be read out contact-free and
the dental technician has access
to a list of all materials available
in the laboratory at any given
time. The innovative patentpending
Tool Management
also brings intelligence to tool
administration. Never again do
unused milling cutters have to
be disposed.
For everyday laboratory routine all this
means: the dental technician regains
his/her role as the pacesetter in the
digital manufacturing process – not the
machine. ■
MARCH / APRIL 2019 DENTAL ASIA 87

Product Highlight
EnvisionTEC
EnvisionTEC presents the latest in its
line of high speed DLP 3D Printers. The
Envision One cDLM (Continuous Digital
Light Manufacturing) is a competitively
priced desktop 3D printer that uses the
EnvisionTEC patented cDLM technology
and premium materials.
The Envision One cDLM provides dental
and orthodontic professionals with
premium grade results at the touch of
a finger. The new domeless basement
enables the printer to provide unbelievable
speeds (up to 80 mm/hour, material
dependent) making it one of the fastest
3D printers available while still retaining
the exceptional accuracy you expect from
EnvisionTEC. The Envision One cDLM is
built with an expanded build platform,
which along with exceptional speed,
allows for high volume outputs:
• 10 denture bases in under an hour.
• 6 orthodontic arches in 15 minutes.
• 18 quads with dies in 18 minutes.
• 6 castable partials in less than an hour.
The printer also has a range of materials
including those for indirect bonding
trays and surgical guides. Designed to
transform beginners into experts in a
single machine, the Envision One cDLM
is the only professional 3D printer one
would ever need. It is accurate, user
friendly and incredibly fast. Combined
with the included software the Envision
One cDLM delivers an end to end solution
that delivers accurate parts every time
with minimal supports.
Highlights of Envision One cDLM
The Envision One cDLM boasts its layerless
technology that delivers super smooth
models which provides 75% less support
compared to regular DLP printers. Its
domeless technology delivers the highest
accuracy with high-resolution industrial
projector with UV glass. Additionally, its
LED light source at 385 nm wavelength
gives higher accuracy on clear parts
and crisper details across all parts.
Furthermore, its dual linear slides produce
The Dental Game Changer
superior stability during build process,
eliminating any shifting in parts. ■
For more information, visit:
www.chemtron.asia
Crosstex
Dental Unit Waterline Safety Like Never Before
The implications from
improperly treated dental
unit waterlines are far
too great to ignore.
Research shows that
t h e
extremely narrow
design
of waterline
tubing
promotes water
stagnation
and bacterial
accumulation,
which can
impact the well-
being
of patients, staff
a n d
the practice. Hence,
t h e
multi-award winning
DentaPure cartridge
from Crosstex which is fully compliant
with the EPA Rule for BMP for Dental
Amalgam Waste and also protects your
dental unit water for an entire year!
DentaPure ® DP365B is an in-line
attachment dental water purifier designed
for bottled water and should be changed
after one year. The constant presence of
iodinated water in the dental unit cartridge
is EPA labelled to purify incoming water to
200 cfu/ml bacteria or below.
Why use DentaPure cartridges?
Firstly, it is safe to use. Thanks to its
elemental Iodine (I 2 ): non-allergenic and
safe for patients to ingest. It contains no
silver, no harsh chemicals and cartridges
can be disposed along with regular trash.
Also, it is not restricted by the EPA Rule
BMP for dental amalgam waste.
Secondly, it is simple to use. DentaPure
can be installed in minutes, cost-effective,
compatible with bottle and municipal
systems and can be used either with tap or
distilled water. Once installed, no monitoring
or shocking protocol is required for 365 days,
or 240L of water if usage records are kept.
Thirdly, it is reliable to use. It reduces
the possibility of human error, lessens
your concern with dental corrosion
or etching and reminds users when to
change cartridges. DentaPure cartridges
does not interfere with dental materials
and bonding.
Lastly, DentaPure cartridges are effective,
independent ADA testing and perform at
≤10 CFU/mL 3 EPA registered to provide
≤200 CFU/mL. Furthermore, DentaPure
cartridges uses the same technology
developed by NASA to ensure the water
consumed in space is safe from harmful
levels of bacteria and many other harmful
organisms. ■
88
DENTAL ASIA MARCH / APRIL 2019

Product Highlight
COLTENE Unveils the New and Improved BRILLIANT COMPONEER
along with a Wider Range of ParaPost System Applications
COLTENE
In line with the company motto “Upgrade
Dentistry”, the internationally leading
dental specialist COLTENE will be
showcasing an optimised version of
its successful composite veneering
system for the first time at the IDS
2019. Currently for aesthetic anterior
restorations, dentists are using BRILLIANT
COMPONEER - a material based on the
sophisticated submicron filler technology
of the high-performance composite
BRILLIANT EverGlow, which provides
durable high gloss with extremely smooth
surface upon polishing.
Brilliant appearance
With the improved
formulation,
BRILLIANT
COMPONEER
b l e n d s
harmoniously
into the
existing series
of high-quality
composite
solutions from COLTENE. All products of
the BRILLIANT composite range impress
with their excellent blending qualities,
which allows the veneer shells to be
easily integrated into the natural redwhite
aesthetics of respective patients.
Choosing the right shade using the
suitable luting composite BRILLIANT
EverGlow is also intuitive due to the
practical “Duo Shade” shade concept. In
addition, the natural shade gradient of
the tooth is skilfully reproduced by the
progressive thickness of the translucent
veneers towards the incisal edge.
Moreover, as a link between endodontics
and restorative dentistry, post designs
offer maximum retention for reliable
long-term restorations. For different
treatment methods and varying
anatomical conditions, a wide-ranging
root post system helps dentists find the
right solution for virtually every clinical
situation.
Translucent composition vs. Heavy Metal
Aside from the new BRILLIANT
COMPONEER, COLTENE is also
presenting its sophisticated ParaPost
root post system with its wide range of
applications. The universal system for
all direct techniques, as well as casting
techniques, offers the dentist a wide
selection of reliable alternatives: from
tried and tested titanium root posts,
which promise high safety, to glass-fibre
reinforced composite posts, which enable
aesthetically demanding, metal-free
restorations. All posts are distinguished
by their great stability and adaptability.
Almost 60 years ago, COLTENE developed
ParaPost, the first standardised root post
system with cylindrical sizes. The global
market leader’s longstanding experience
is particularly evident in the innovative
design of the cylindrical ParaPost Taper
Lux post: where the rounded retention
head geometry minimises shrinkage
stress during polymerisation in the core
build-up material. At the same time, the
retention edges on the shaft increase
mechanical grip. Owing to the ingenious
triple head design, the posts can also be
adjusted quickly to the optimum length.
The special X-Shape retention pattern
of the titanium root posts acts as an
efficient retention mesh and also serves as
a drainage system to prevent apical back
pressure caused by excess cement. The
unique geometry is produced in a special
rolling process and strengthens the break
resistance of the post. When the focus
is on metal-free root posts in treatment
therapy, then light-conducting, glassfibre-reinforced
composite posts with
their dentine-like modulus of elasticity
are the material of choice – not only
because they can be adhesively bonded
and are ideal for aesthetically demanding
restorations, but they also reflect the
natural shade gradient of the tooth
substance. Moreover, they allow the use
of light-curing cements and core buildup
materials and are radiopaque - like all
posts of the ParaPost range.
Matched system for the optimal monobloc
With the help of the standardised system,
all indications can be treated with a
standard range of drills. Be it for the direct
technique or via the casting technique
in the laboratory, there is a ParaPost
variant for virtually every application.
Using the matching 3-in-1 ParaCore
material, the root posts are cemented, the
core build-up is modelled, and the final
restoration is securely fixed. The dualcuring,
glass-fibre-reinforced composite
creates an effective monobloc between
the dentine, root post and crown. Using
the sophisticated COLTENE range, this
creates a homogeneous, extremely
durable solution. ■
MARCH / APRIL 2019 DENTAL ASIA 89

Product Highlight
W&H
No Implantology Without Periodontology
Periodontitis is a chronic disease which
significantly increases the incidence
of biological complications in implant
placement with a risk of implant loss.
Increased implant success with
NIWOP
With “No Implantology Without
Periodontology” (NIWOP), W&H provides
a holistic workflow that allows the best
possible treatment for patients. Pretreatment,
implantation, follow-up
treatment.
W&H for every treatment step
W&H is the only manufacturer who
provides products for every single NIWOP
treatment step.
The functionalities of Implantmed are
perfectly adapted to the requirements of
implantologists when inserting implants.
In addition, the W&H Osstell ISQ module
provides information on the correct time
for loading an implant. With Piezomed,
along with Implantmed, bones may be
treated gently and effectively.
Presently, the new Proxeo Ultra Piezo Scaler is
certifiably safe for patients with pacemakers,
and its unique quick chucking system allows
super simple changing of instruments with
just one instead of six revolutions previously.
The Piezo Scaler Tigon+ is easy and
comfortable to use. Treatment with warm
fluid minimises irritation to sensitive teeth
and increases patient compliance.
The Piezo scaler tip range is perfectly
adapted to the various requirements of
periodontical treatment. With the new
Proxeo Aura air polishing handpiece,
pockets up to 3 mm in depth around teeth
and implants can be treated effectively
and with minimal invasion by using the
setting “perio”. The optionally available
perio spray head also allows treatment
of pockets deeper than 3 mm. The new
Proxeo TWIST LatchShort’s working height is
4 mm, lower than the standard latch systems.
The advantage for users
Evaluations by scientific publications
have shown that a treatment according
to the NIWOP workflow can contribute to
a significant increase in the success of
the implant. ■
Fig. 1: The W&H 1I tip with PEEK coating for the
treatment of mucositis.
Fig. 2: The evidence-based, systematic NIWOP
workflow contributes to lasting implant success.
exocad
Next Generation Smile Design in 2D and 3D
exocad announced on 20 th February
the release of DentalCAD 2.3 Matera
- named after the 2019 European
Capital of Culture in Soutern Italy. It
has many new and optimised features,
including the new Smile Creator
add-on module. Smile Creator enables
easy-to-use, time-saving and predictable
virtual planning of highly a esthetic
restorations by combining patient photos,
outlines, and 3D situations. Simple 2D
tools can be used to edit tooth shapes,
while the 3D result is visualised in real
time from different angles. The advantage
is clear: highly predictable esthetic and
functional results.
Further highlights of the new Matera
release include:
• FullDenture Module now supports
different types of production processes,
including two-step milling, printed
denture bases and monolithic printed
dentures
• New exoprint tool for a seamless
workflow with 3D printers.
• Implant libraries are now delivered
separately from the software which
greatly reduces the download package
size.
• Improved digital pen support (including
dynamic pressure) based on Windows
Ink. Dedicated presets are available for
a variety of WACOM devices
• Optimised support for 3D face scans,
including 3D face modelling
• Increased flexibility: scene files can now
be freely transferred between most OEM
versions of exocad
• Smarter implant libraries with more
The add-on module Smile Creator, now available
with exocad DentalCAD 2.3 Matera.
predefined design parameters and
optimal integration with exoplan
• DentalCAD 2.3 Matera contains
the “Immediate Load” feature as
BETA which allows importing of
implant planning data from exoplan
The new DentalCAD 2.3 Matera software
version is available immediately worldwide
and can be accessed by all users with an
upgrade contract. ■
90
DENTAL ASIA MARCH / APRIL 2019

Product Highlight
3Shape launches TRIOS 3 Basic intraoral
scanner and E4 lab scanner
3Shape
At the Midwinter Dental Meeting, 3Shape
introduced two new scanners: an entrylevel
version of their award-winning
intraoral scanner, TRIOS 3 Basic and a
brand-new lab scanner, the E4 – their
fastest and most accurate scanner ever!
Go Beyond analogue impressions
with TRIOS 3 Basic
TRIOS 3 Basic features the same core
scanning technology as in all TRIOS
models: Now making the market’s
best scanning technology available for
customers who previously may not have
had the budget to go digital. TRIOS 3 Basic
enables professionals to go beyond
conventional impression-taking with
a predictable and efficient “scan and
send-to-lab” digital workflow.
TRIOS 3 Basic comes with unique-to-TRIOS
features like, AI Scan, Real colors and
shade measurement, but does not include
TRIOS excitement apps like, TRIOS Patient
Monitoring, TRIOS Treatment Simulator
and Smile Design or restorative and
orthodontic software. TRIOS 3 Basic can
be upgraded to a TRIOS 3 model that
includes the TRIOS excitement apps.
Additional restorative and orthodontic
software are purchased separately.
Like all TRIOS models, TRIOS 3 Basic
features a lightweight scanner handle,
ultrafast insane speed scanning and
documented accuracy for indications from
implant scanning to orthodontics. TRIOS
3 Basic is available as a wired, pen-grip
model.
Go Beyond
s c a n n i n g
with patient
excitement apps
and open workflow
options
All 3Shape TRIOS
intraoral scanners and
software, including 3Shape
Studio apps, are open solutions. For
professionals that means an unrivaled
range of integrated components, clear
aligner solutions, bracket libraries,
teeth libraries and in-house and sendto
workflow options. It also ensures
professionals interfaces to virtually all
materials as well as trusted connections to
leading third-party mills and compatibility
with all 3D printers. 3Shape believes
that when it comes to patient care, who,
what, and where, should be up to the
professional to decide.
Digital solutions for dental and
orthodontic labs
In addition to the new 3Shape TRIOS 3,
the company also introduces its fastest
lab scanner ever, the E4. Designed for
a dental lab’s ultimate productivity,
the E4 comes with four, 5 MP cameras.
The E4 boasts double the speed and
double the accuracy of its predecessors
to improve efficiency and consistency
with every scan. From small labs seeking
the best-of-the-best, to high-volume
full-service labs
striving for a leaner
workflow, the E4 lab
scanner is the right
choice.
The E4 delivers
an accuracy of
four microns (ISO
12836), to give labs
the accuracy and precision they need
for implant cases. The E4 also scans
a full arch in eleven seconds and full
arch impressions in forty-five seconds.
Like all 3Shape’s E series scanners, the
E4 features auto-start scanning and
articulator holder support.
Unleashing a lab’s potential with
3Shape Dental System 2019
Along with the E4, 3Shape just released
a new version of its industry-leading
design software, Dental System 2019.
The updated 3Shape Dental System 2019
provides labs with significantly improved
solutions for dentures, splints and clear
aligners (optional add-on module) as well
as, predictable workflows for a complete
range of restorative indications from
veneers to implants.
Dental System 2019 also adds new
features geared especially for big labs
where it is now up to ten times faster when
starting new cases; re-opening previously
designed cases, and the import/export
of material settings. In addition, Dental
System 2019 can automatically create
design proposals for single crowns
and copings for gypsum cases. Dental
technicians can then use Dental System’s
powerful tools to inspect and correct the
automated designs during any step in the
workflow, if needed. ■
MARCH / APRIL 2019 DENTAL ASIA 91

Show Review
Structo partnered with 3Shape and Henry Schein to
showcase 3Shape’s new Open Clear Aligner Workflow
On
th
20 February, in partnership with Henry Schein
and 3Shape , Structo hosted an education event
to demonstrate 3Shape’s latest open clear aligner
workflow for the very first time in Asia Pacific.
The organisers and participants were joined by Mr. Stefano Negrini,
CEO and owner of Ortodonzia Estense from Italy. Mr. Negrini is a
Specialist Dental Technician, registered with the University of
L’Aquila. He was the Chairperson of ORTEC 2015/16 and is a
Key Opinion Leader for 3Shape. Mr. Negrini has worked in the
field of dentistry and brought with him more than 27 years of
experience in orthodontics. At the event, Mr. Negrini conducted
a full treatment planning using an actual case and shared with
the participants how they can optimise future treatments using
various techniques.
The event took place at Structo’s new Headquarters in Singapore,
welcomed more than 30 dentists and dental laboratory owners
from Singapore and neighbouring countries. Participants had
the opportunity to observe 3Shape and Structo’s equipment in
action and have their questions answered by industry experts.
Clear aligners have become the go-to dental appliance in
recent times thanks to its aesthetic appeal and ease of use
among numerous other factors. As many people are looking
into manufacturing their own aligners, through this workshop,
Structo and 3Shape demonstrated to participants how they
can take control of the process. And the easiest way to put
themselves on the front foot is to start with an optimised
manufacturing process that gives the cost advantage to
compete in this billion-dollar industry. Starting out is daunting
and with the simplified workflow, Structo and and 3Shape are
hopeful that they will be able to enable entry of more players.
Featuring a really great mix of learning and networking
opportunities, the event was a perfect venue for people who
are interested in entering the clear aligner space to meet likeminded
people and learn from industry veterans. The organisers
were overwhelmed by the support and look forward to making
this event accessible to people across APAC. DA
92
DENTAL ASIA MARCH / APRIL 2019

Show Preview
9 th -12 th June 2019
China National Convention Centre (CNCC), Beijing, China
The Most Influential Dental
Exhibition in Asia-Pacific
Visitor
As one of the most popular dental exhibitions in Asian-Pacific,
Sino-Dental is expecting more than 140,000 visits from over
90 countries and regions in 2019.
For the past 23 years, Sino-Dental ® has been the
exceeding the standard of dental exhibitions in China.
With its unwavering success, it has always been
considered as the most influential dental exhibition in
the Asia-Pacific region.
Over the past two decades, Sino-Dental has strived to introduce
and promote advanced technology and products in order
to provide a platform for domestic and international dental
companies. The event presents reliable market information
and advanced technology and innovative new products; giving
exhibitors and professionals an opportunity to communicate
and exchange ideas and experiences.
Exhibition
Sino-Dental ® has always been the most ideal business platform
for business cooperation and potential market exploring.
Nowadays, numerous exhibitors all over the world regard
Sino-Dental ® as their first choice in China for new products
launching.
In 2019, Sino-Dental ® will be held on 9 th -12 th June at the China
National Convention Centre (CNCC), Beijing, China. The total
exhibition area will be 50,000 square meters and with over
2,000 booths. More than 800 exhibitors from over 30 countries
and regions (such as China, Germany, Japan, Korea, USA, Brazil,
Italy, France, UK, Switzerland, Sweden, Singapore, Hong Kong,
Taiwan and many more) will be presenting their products and
services. Companies from Germany, Japan, Korea, USA, Brazil
and Switzerland will be attending as National Pavilions. The
state-of-the-art technology and products, as well as excellent
Chinese products with competitive price and service, will be
showcased on this platform.
In 2018, 821 exhibitors from over 30 countries and regions
participated in Sino-Dental ® , including companies from
Germany, Japan, Korea, USA, Switzerland and Israel.
Congress & Seminar
Besides the splendid showcase of products and technology
presented by the exhibitors, over 100 top-level academic
seminars and workshops covering 300 topics will also be held
during the exhibition period to introduce the most updated
academic and technology development in dental filed.
International Dealers
Sino-Dental ® has become a one-stop solution for dealers on
product purchasing. International Dealer’s Lounge with free
interpretation service will provide you with a private space
for business conversation. To encourage visitors to invite
more international dealers and traders, Sino-Dental ® will by
providing complimentary local accommodations during the
exhibition period for those who could invite 10 or more dealers
to Sino-Dental ® .
Service
Online Visitor Pre-Registration
• No registration fee.
• On-site quick pass counter for badge claim.
• Free catalog, drinking water and gift.
• Please visit www.sinodent.com.cn/en for visitor pre-registration.
Visa Assistance
• Free invitation letter service is provided and could be found on
www.sinodent.com.cn/en .
Hotel Reservation
• Hotels are located near exhibition site and visitors can get
Sino-Dental ® special hotel discount.
Tourist Service
Beijing, the capital of China, is no doubt one of the most
popular tourist destinations in the world. As a historic city with
glorious culture, and a perfect blend of ancient and modern,
with a wide variety of famous tourist spots, Beijing’s attractions
are second to none in China. Hence, Sino-Dental will provide
discounted guided tour with their partner travel agencies with
multiple choices of routes providing guests a good opportunity
to explore the ancient & modern city of Beijing.
For all the information and services, please visit:
www.sinodent.com.cn/en or contact through info@sinodent.com.cn. DA
Photo Credit: Mr. Wang Younan
94
DENTAL ASIA MARCH / APRIL 2019

Show Preview
Nobel Biocare Global Symposium in Madrid
to Open New Chapter in Implant Dentistry
Photo Credit: Nobel Biocare
Nobel Biocare is a world leader in the field of
innovative implant-based dental restorations –
from single-tooth to fully edentulous indications.
They offer dental implant systems, individualised
prosthetics and CAD/CAM systems, treatment
planning, guided surgery solutions and biomaterials. The
company’s goal is to empower dental professionals to give
quality of life back to their patients.
In summer, the company will open a new and revolutionary
chapter for implant dentistry. At the upcoming Global
Symposium, the first of three international events hosted by
Nobel Biocare, outstanding developments in the field of implant
design and site preparation will be unveiled. Supporting these
groundbreaking innovations will be new advancements in
implant surface technology as well as long-term implant care.
Leading international clinicians, all experts in their field, will
be onsite in Madrid to share their experiences with the new
solutions. They will also demonstrate how these can help
clinicians to further shorten time-to-teeth and to improve longterm
clinical results. Participants will be able to further explore
the innovations and more through a number of dedicated
hands-on sessions and product demonstrations.
Held at the Marriott Auditorium Hotel & Conference Center
from 27 th -29 th June, the Nobel Biocare Global Symposium
in Madrid is kicking off the new global event series which
was announced last year to extend the originally planned
Nobel Biocare Global Symposium 2019 in Las Vegas.
Following the meeting in the Spanish capital are two additional
Global Symposia in Las Vegas in 2020 as well as in Tokyo
in 2021. Through this unique event concept, more dental
professionals than ever will be able to experience this new wave
of innovations by Nobel Biocare first hand.
Commenting on the upcoming events and launches,
Mr. Hans Geiselhöringer, President of Nobel Biocare said: “We
are excited to welcome dental professionals from all over
the world to Madrid in June where we will present the next
revolutionary steps in dental implant care with a host of new and
forward-thinking innovations. With two more events to come, it
will be a once-in-a-generation opportunity to experience true
game changers in implant dentistry.”
More information about the Nobel Biocare Global Symposium
events series as well as how to register for the kick-off meeting
in Madrid can be found online at www.nobelbiocare.com/
global-symposia.
Dental professionals who already registered for the original
Nobel Biocare Global Symposium in Las Vegas will be given the
opportunity to transfer their registration to any of the three
upcoming events. DA
MARCH / APRIL 2019 DENTAL ASIA 95

Giving Back to Society
February is National Children’s Dental Health Month
Typically the month that celebrates love, history, and heart
health, February is also National Children’s Dental Health
month, sponsored by the American Dental Association (ADA).
At Children’s Dental Health, their dentists and staff are taking
this opportunity to share good oral health habits and raise
awareness of the importance of paediatric dental care at an
early age.
The ADA’s theme this year is, “Brush and clean in between to
build a healthy smile!” While daily brushing is an important
part of a child’s oral hygiene routine, bacteria that cause tooth
decay can still linger between teeth where the toothbrush
cannot reach. The ADA’s slogan reminds children and their
parents that it’s important to floss for this reason.
Today’s parents are often overwhelmed with an abundance of
information regarding their child’s health, making it difficult to
even begin a conversation on oral health. A parent’s first step
involves establishing a dental home for their child by their first
tooth or first birthday. During this time, parents/guardians will
have the opportunity to ask questions and address any dental
concerns at the primary visit.
Ultradent Products Inc. announced on 27 th November 2018,
known nationally as “Giving Tuesday,” that it would donate
US$10,000 to a Humanitarian Medical and Dental Education Fund
started by the Adams, Gladwell, Durham Foundation based in
Salt Lake City, Utah.
The money will go towards providing professional medical and
dental education to underserved populations through online
lectures and hands-on trainings provided to students through
virtual reality programmes.
“We’ve basically created online education with hands-on
education via virtual reality technology that allows the students
to perform procedures as if they were on an actual human,
in an actual lab, but via technology,” said Dr. Mark Durham,
a prosthodontist and co-founder of the Adams, Gladwell,
Durham Foundation.
“The challenge on the planet today is that there is progress in
some areas and the lack of progress in others which leads to
problems for people. The solution is scaling education. If we
In addition, the paediatric dentists at Children’s Dental
Health recommend the following oral health tips to maintain
a healthy smile and effectively prevent children from getting
cavities.
• Brush for two minutes, two times a day.
• Don’t forget to floss!
• Make regular dental appointments for teeth cleanings and
to minimise any damage with early treatment.
• Replace your child’s toothbrush every three to four months.
• Eat a tooth-healthy diet (limit sweet and sticky foods).
Children’s Dental Health has been providing quality paediatric
dental care to the community for more than 40 years. With more
than 20 practices and paediatric dentists located throughout
the state of Pennsylvania, they allow for convenient access to
dental care that is engaging, fun, and educational for patients.
With their “show, tell, do” method, their growing patients
actively learn routines to ensure a healthy smile for years to
come. Their gentle approach to paediatric dental care reflects
their core mission of education and prevention. DA
Ultradent Donates to Humanitarian Medical and Dental Education Charity
can share this information, we can start doing things that have
never been done before and really create another renaissance,
which would be beautiful for humanity. We’re investing in
systems and technology that we’re developing that allows
us to go into areas of the world and deliver education for a
fraction of the cost, with some of the best minds,” continued
Dr. Durnham.
As for their progress toward the goal of educating as many
people as possible, Dr. Durham reported, “So far, the foundation
has built three surgical modules for around US$50,000, which
can now be shared without charging a penny to download. This
year, because we are getting faster at building modules, our
team and our local collaborators have set a goal to build eight
modules for the same amount of money.”
Ultradent gladly supports hundreds of humanitarian efforts
every year, worldwide. This includes donations towards major
disaster relief efforts as well as smaller, individually run
humanitarian missions. DA
Establishing a Long Term and Sustainable Oral Health Program
In 2017, the Modern Dental Group Europe, to which Elysee Dental
belongs to, started a foundation to deliver a durable contribution to the
dental care in Madagascar: Modern Dental Care Foundation (MDCF). The
Modern Dental Care Foundation strives to perform preventive, medical
and dental treatments and to strengthen the help that benefits the
development in Madagascar, or another country where help is needed.
Besides financial contributions from our group of companies, we actively
promote and ask the dental industry and dental professionals for
donations. The Modern Dental Care foundation depends on gifts from
third parties and the help of volunteers for executing their activities. All
gifts, either small or big, are welcome to make dental help possible for
everyone.
For those interested to participate and contribute, please go to:
https://moderndentalcarefoundation.com/donations/
96
DENTAL ASIA MARCH / APRIL 2019

2019 Events Calendar
MARCH
3 – 6 24 th Dental South China International Expo 2019
Guangzhou, China
Website: www.dentalsouthchina.com
12 – 16 IDS 2019 - 38 th International Dental Show
(Biennial Meeting)
Cologne, Germany
Website: www.ids-cologne.de
14 – 15 25 th World Congress on Dentistry and Oral Health
Berlin, Germany
Website: https://dentistrycongress.dentistryconferences.com/
22 – 24 9 th Borneo Dental Congress
Kota Kinabalu, Malaysia
Email: borneodentalcongressmdaez@gmail.com
29 – 30 ITI Congress South East Asia
Kuala Lumpur, Malaysia
Website: www.iti.org/congress-southeastasia
APRIL
4 – 6 IndoHealthcare Expo 2019 – 11 th International
Exhibition on Medical, Dental & Hospital
Equipments, Medicine, Health Care, Supplies
& Services
Jakarta, Indonesia
Website: www.indohealthcareexpo.com
12 – 13 14 th CAD/CAM & Digital Dentistry Conference
& Exhibition
Dubai, United Arab Emirates
Website: www.cappmea.com
19 – 21 4 th Malaysian International Dental Show 2019 (MIDS 2019)
Kuala Lumpur, Malaysia
Website: www.mdda.com.my/
24 – 27 Dental Show West China 2019
Chengdu, China
Website: www.wcise.com
29 – 30 40 th World Dental Science and Oral Health Congress
Seoul, Korea
Website: https://dentalscience.dentalcongress.com/
MAY
3 – 7 119 th American Association of Orthodontists -
AAO Annual Session
Los Angeles, USA
Website: www.aaomembers.org
8 – 12 APDF 2019 - 41 st Asia Pacific Dental Congress
Seoul, Korea
Website: www.apdfnews.online
10 – 12 SIDEX 2019 - The 16 th Seoul International Dental
Exhibition & Scientific Congress
Seoul, Korea
Website: http://eng.sidex.or.kr/
16 – 18 Expodental Meeting 2019
Rimini, Italy
Website: www.expodental.it
JUNE
9 – 12 SINO-DENTAL 2019 - The 24 th China International
Dental Exhibition and Scientific Conference
Beijing, China
Website: www.sinodent.com.cn/f
JULY
3 – 7 The 27 th Congress of International Association of
Paediatric Dentistry (IAPD)
Cancún, Mexico
Website: www.iapdworld.org
AUGUST
15 – 17 ICOI Wold Congress 2019 – International Congress of
Oral Implantologists
New York, USA
Website: www.icoi.org/events/
17 – 18 5 th Asia-Pacific CAD/CAM & Digital Dentistry
Conference & Exhibition
Singapore, Suntec Convention & Exhibition Centre
Website: www.capp-asia.com
23 – 25 VIDEC 2019 - The 12 th Vietnam International Dental
Exhibition & Congress
Hanoi, Vietnam
Website: www.facebook.com/events/383245365417270
SEPTEMBER
5 – 9 American Dental Association Annual Meeting
San Francisco, USA
Website: https://www.ada.org/en/meeting/attendeeinformation/future-meetings
5 – 8 FDI 2019 – Annual World Dental Congress
San Francisco, USA
Website: www.fdiworlddental.org/what-we-do/fdi-world-dentalcongress
6 ITI Congress Denmark
Nyborg, Denmark
Website: www.iti.org/
13 – 15 IDEC 2019 - Indonesia Dental Exhibition & Conference
Jakarta, Indonesia
Website: www.indonesiadentalexpo.com
16 – 21 AAOMS 2019 – 101 st American Association of Oral and
Maxillofacial Surgeons Annual Meeting
Boston, USA
Website: https://www.aaoms.org/meetings-exhibitions/annualmeeting/101st-annual-meeting
OCTOBER
4 – 7 9 th International Orthodontic Congress
Pacifico Yokohama, Japan
Website: www.wfo2020yokohama.org/
10 – 12 Dental World Hungary 2019 – 19 th Edition
Budapest, Hungary
Website: www.dentalworld.hu/
17 – 19 Colloquium Dental 2019 - Italian Dental Show
Montechiari, BS – Italy
Website: www.colloquium.dental/colloquium-dental
23 – 26 American Academy of Implant Dentistry, 68 th Annual
Meeting
Las Vegas, USA
Website: www.aaid.com/Annual_Conference/Future_Annual_
Meetings.html
28 – 29 Annual Congress on Orthodontics and Endodontics -
2 nd Edition
Melbourne, Australia
Website: https://orthodontics-endodontics.dentalcongress.com/
30 – DenTech China 2019
Nov 2
Shanghai, China
Website: www.dentech.com.cn/en-us/index

Advertisers’ Index
Advertisers
Page
3Shape A/S 67
Align Technology
Front Cover
Align Technology 11
Amann Girrbach AG 73
Anthogyr France 61
Bausch 47
Busch 37
Cantel Medical 3
Coltene Whaledent 93
DenMat Holdings, LCC 53
Dental Monitoring 98, 99
Dental South China Guangzhou 2019 50
Publisher | William Pang
williampang@pabloasia.com
Associate Publisher | Pamela Buckley
pamela@pabloasia.com
Publications Director | Jamie Tan
jamietan@pabloasia.com
Assistant Editor | Chala R. Platon
chala@pabloasia.com
Assistant Editor | Natalie Chew
natalie@pabloasia.com
Graphic Designer | Selynn Chew
selynn@pabloasia.com
Admin & Circulation Manager | Shu Ai Ling
circulation@pabloasia.com
PABLO PUBLISHING PTE LTD
Dental Asia is a member of
Pablo Publishing Pte Ltd
3 Ang Mo Kio Street 62
#01-23 Link@AMK
Singapore 569139
Tel: (65) 62665512
E-mail: info@pabloasia.com
www.dentalasia.net
Dentsply Sirona 33
exocad GmbH 15
Fotona d.d. 55
Hong Kong International Dental Expo & Symposium (HKIDEAS 2019) 28
Ivoclar Vivadent AG
Outside Back Cover
Malaysia International Dental Show 2019 (MIDS) 80
Mectron S.p.A 17
Nobel Biocare Services AG 23
NSK Asia Inside Front Cover, 1
Renfert GmbH 13
REGIONAL OFFICE:
CHINA
General Manager | Ellen Gao
pablobeijing@163.com
Editor (Chinese Edition) | Wendy Wei
pabloshanghai@163.net
Pablo Beijing
Tel: +86-10-6509-7728 / 6509-7548
Fax:+86-10-6509-7719
Pablo Shanghai
Tel: +86-21-52389737
Fax:+86-21-52389736
Shofu Dental Asia-Pacific Pte. Ltd. 5
SIDEX 2019: Seoul International Dental Exhibition & Scientific Congress 82
SINO Beijing 2019 74
SINOL Dental Limited 7
Straumann 39
Tekne Dental 65
VOCO GmbH 9
W&H Dentalwerk
Inside Back Cover
Company Registration No: 200001473N
All rights reserved. Views of writers do not necessarily reflect the views of
the Publisher. No part of this publication may be reproduced in any form
or by any means, without prior permission in writing from the Publisher
and copyright owner. Whilst every care is taken to ensure accuracy of
the information in this publication, the Publisher accepts no liability for
damages caused by misinterpretation of information, expressed or implied,
within the pages of the magazine. All advertisements are accepted on the
understanding that the Advertiser is authorised to publish the contents of
the advertisements, and in this respect, the Advertiser shall indemnify the
Publisher against all claims or suits for libel, violation of right of privacy and
copyright infringements. Dental Asia is a controlled-circulation bi-monthly
magazine. It is mailed free-of-charge to readers who meet a set of criteria.
Paid subscription is available to those who do not fit our terms of control.
Please refer to subscription form provided in the publication for more details.
Printed by Times Printers Pte Ltd
100
DENTAL ASIA MARCH / APRIL 2019