Dental News March 2013

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68.Treatment of an Edentulous Patient with CAD/CAM Technology A Clinical Report

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Management of impacted maxillary central incisor due to Supernumerary teeth

Dr. Nawaf Albaloul, Dr. Faraj A. Sedeqi, Dr. Bader Alawadhi, Dr. Abdulelah M. Binmahfooz

Dr. Dina Jafar Mohammad

Dr. Hadia Decharriere

Dr. Jérome Elias, Dr. Jean-Jacques J-J Bonnin

Dr. Tasneem AL Farhan, Dr. Kholoud Al-Foudari, Dr. Nour AL Hasan

InterContinental Citystars, Cairo

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24th Saudi Dental Society International Dental Conference

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Dental News, Volume XX, Number I, 2013

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International Calendar 11

Dubai Implantarium

The 17th Kuwait Dental Association Conference

13th International Convention (LUSD) Lebanese University

7th Congress of the Lebanese Dental Association North Lebanon

AAPD 66th Annual Session

BIDM 2013

International Congress Digital Dentistry (ICDD)

Int’l Quintessence Dental Arab Congress

FDI Annual World Dental Congress

6th ConsEuro

8th CAD/CAM & Digital Dentistry International Conference

The 2nd Arabian Academy of Esthetic Dentistry meeting (ARAED)

April 4 - 6, 2013at the Atlantis, The Palm, Dubai, AUE.Email: [email protected]

April 13 - 15, 2013at the Radisson Blu Hotel, Kuwait.Email: [email protected] Website: www.kda.org.kw

May 8 - 11, 2013at President Rafic Hariri Campus, Beirut, Lebanon Email: [email protected]

May 30 - June 1, 2013at Las Salinas, Anfeh, Lebanon Email: [email protected]

May 2 - 3, 2013JW Marriott Hotel, Dubai, UAE Email: [email protected] Website: www.cappmea.com

May 3 - 4, 2013at the Kempinski Hotel, Dead Sea, Kingdom of Jordan.Website: www.araed-org.com

August 28 - 31, 2013Istanbul, Turkey Email: [email protected] www.fdi2013istanbul.org

September 26 - 28, 2013Beirut, Lebanon Email: [email protected] www.lda.org.lb

September 6 - 7, 2013Kitzbühel, Austriawww.icdd-2013.com

April 24 - 26, 2013Al Faisaliah Hotel, Riyadh, KSA Email:[email protected]

May 9 - 10 - 11, 2013at Cap 15, 1/13 Quai de Grenelle, 75015,ParisWebsite: www.paris2013.conseuro.org

May 23 - 26, 2013 Walt Disney World Swan Dolphin Resort www.aapd.org/events/66th_annual_session

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DENTAL NEWS IS A QUARTERLY MAGAZINE DISTRIBUTED MAINLY IN THE MIDDLE EAST & NORTH AFRICA IN COLLABORATION WITH THE COUNCIL OF DENTAL SOCIETIES FOR THE GCC.Statements and opinions expressed in the articles and communications herein are those of the author(s) and not necessarily those of the Editor(s) or publisher. No part of this magazine may be reproduced in any form, either electronic or mechanical, without the express written permission of the publisher.

Alfred Naaman, Nada Naaman,Jihad Fakhoury, Dona Raad, Antoine Saadé, Lina Chamseddine, Tarek Kotob, Mohammed Rifai, Bilal Koleilat, Mohammad H. Al-JammazSuha NaderIbrahim MantoufehMicheline Assaf, Nariman NehmehJosiane YounesAlbert SaykaliGisèle Wakim, Marielle KhouryTony Dib1026-261X

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Volume XX, Number I, 2013

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Case report

Orthodontics

Dr. Tasneem AL Farhan

Dr. Kholoud Al-Foudari

Dr. Nour AL Hasan

[email protected] teeth are those that are additional to the normal series and can be found in almost any region of the dental arch.1 They are classified according to their morphology, location and number (Fig. 1).2,3

The prevalence of their occurrence varies between 0.1 and 3.8%.4 The male-to-female ratio has been reported as 2:1.5 The literature reports that 80% - 90% of all supernumerary teeth occur in the maxilla.1 Half are found in the anterior region.1 Extra teeth may present in both the permanent and the primary dentitions but are 5 times less frequent in the primary dentition.1 In a survey of 2,000 schoolchildren, Brook found that supernumerary teeth were present in 0.8% of primary dentitions and in

Management of impacted maxillary central incisor due to Supernumerary teeth

12

Fig 1: Classification of supernumerary teeth.

Fig 1

2.1% of permanent dentitions.6,7

Occasionally, supernumerary teeth are asymptomatic and may be detected as a chance finding during radiographic examination. Supernumerary teeth can be managed by either removal, or maintaining them in the arch with frequent observation. The removal of the supernumerary teeth is recommended where: 7,8

due to the presence of supernumerary tooth,

tooth is evident,

of supernumerary teeth which makes the area inaccessible to maintain oral hygiene,

to align the teeth,

grafting and implant placement and

status.

Case history K.A is a 9-year-old boy presented to the dental clinic accompanied by his parent, complaining of the appearance of his front teeth. He presented in the early mixed dentition stage with unerupted/missing upper left central incisor. He had fair oral hygiene and heavily restored primary dentition.Extra oral examination K has oval face shape with normal skin tone and color, slightly convex facial profile with apparently normal vertical dimension and lip support. His lips are competent with slight asymmetry and average smile line (Fig. 2).

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14

Case report

Orthodontics

2a: Frontal view

Fig 2: (a, b and c) Pre-treatmentextra oral photographs.

Fig 3: (a, b and c) Pre-treatment intra oral photographs.

Fig 4: (a, b and c) Pre-treatment radiographs.

2b: Frontal view when smilling2c: Profi le view

Intra-oral examination K has U- shaped average sized dental arches. He presented in the mixed dentition stage with a Class I incisor relationship and delayed eruption of UR1, drifting of UR2, UL1 into the space of UR1. Upper midline was shifted to the right by 2 mm. In occlusion, he had a unilateral posterior cross bite on the right side without mandibular shift on closure (Fig. 3). Palpation of the buccal sulcus in the area of UR1 shows a bulge of the buccal mucosa. In addition, palpation of the palatal mucosa showed prominent bulge in the palate.

Radiographic assessment Panoramic, occlusal, and periapical radiographs revealed the presence of an impacted UR1 with normal shaped crown and incomplete root formation with two mesiodens supernumeraries obstructing its eruption (Fig. 4). The buccolingual position of unerupted supernumeraries can be determined using parallax technique. Whereas an occlusal film together with a panoramic view are routinely used for vertical parallax. If the supernumerary moves in the same direction as the tube shift, it lies in a palatal position, but if it moves in the opposite direction then it lies buccally.7

DiagnosisOn the basis of the clinical and radiographic findings, diagnosis of mesiodens supernumerary was established. 1st: Tuberculate mesiodens, superimposed on the unerupted central incisor which rarely erupts and are frequently associated with the delayed eruption of the incisors.9 2nd: Conical inverted mesiodens, which had a significantly higher rate of eruption, compared to the tuberculate type.5

Treatment planArch expansion to correct the crossbite and create space for the impacted UR1 followed by surgical removal of supernumeraries under local anesthesia and orthodontic interceptive treatment for alignment of the impacted incisor was planed. The possibility of UR1 being ankylosed or needed to be extracted during the surgery both discussed with the patient previously and agreed up on, then informed consent was signed by the parents.

3a: Anterior view

4a: Dental panoramic tomography.

3b: Right side buccal centric occlusion

4b. PA view of UL1.

3c: left side buccal centric occlusion

4c. Upper occlusal radio-graph.

2a

2b

3a

3c

4a

4b 4c

3b

2c

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16

Case report

Orthodontics

Treatment The treatment started with oral hygiene instructions including tooth brushing by using fluoridated dentifrices, dental floss and dietary advice. Once the oral hygiene was improved an upper alginate impression was taken to construct a quadhelix appliance in the dental laboratory to correct the unilateral cross bite and to gain more space for the impacted UR1 (Fig. 5a). At the following visit, the quadhelix was cemented

Edgewise appliance was bonded (APC II 3M victory series twin 0.018’’ MBT). The orthodontic bracket were bonded on the fully erupted permanent maxillary teeth; UR5, UR4, UR2, UL1, UL2, UL4 and UL5 (Fig. 5b). Once enough space was gained for the impacted UR1 (Fig. 5c), surgical removals of the supernumeraries were done under local anesthesia.A palatal flap was raised (Fig. 6a) and both tuberculate and conical supernumeraries were extracted (Fig. 6b and 6c). The impacted UR1 was exposed from the buccal aspect and bonded with a gold chain. The area was irrigated and the flap was sutured back in position. The gold chain extending from the impacted UR1 was tied to the arch wire passively (Fig. 6d). The patient was recalled at 4-week intervals for tightening the gold chain; Thereby causing forced extrusion of the impacted UR1 (Fig. 7a and 7b). After three visits, the UR1 erupted into the oral cavity, 0.014” nickel titanium wire was engaged piggy back on the erupting incisor with a 0.016”x0.022” stainless steel base wire (Fig. 7c).Eight weeks later the impacted UR1 was properly aligned in the arch (Fig. 7d) with the final finishing and detailing followed few weeks later (Fig. 8a and 8b). Retention was by means of upper Howley’s retainer.

5a: Intraoral photograph of the upper arch with quadhelix applience cemented in place.

6a: Intraoral photograph of the upper arch showing the palatal fl ap being raised.

7b: Partialy erupted UR1.

5b: Intraoral photograph at initial brackets placement.

6b: The extracted tuberclate supernumerary.

7c: Bracket bonded on UR1.

5c: Intraoral photograph 4 months in treatment showing the space gain in UR1 area.

6c: The extracted conical supernumerary sectioned.

7d: Fully erupted UR1

6d: Intraoral photograph post surgery with the gold chain attached passively to the arch wire.

Fig 7: (a, b, c and d) Photographs of fi xed appli-ance stage after surgery.

Fig 5: (a, b and c) Fixed appliance stage before surgery.

Fig 6: (a, b, c and d) Photographs during the surgery.

7a: Initial traction of the UR1.

5a

5b 5c

6a

6b 6c

6d

7a 7b

7d7c

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18

Case report

Orthodontics

REFERENCES

1. KATHLEEN A. RUSSELL, MAGDALENA A. FOLWARCZNA. MESIODENS - DIAGNOSIS AND

MANAGEMENT OF A COMMON SUPERNUMERARY TOOTH. J CAN DENT ASSOC 2003; 69(6): 362–6.2. KALRA N, CHAUDHARY S, SANGHI S. NON-SYNDROME MULTIPLE SUPPLEMENTAL SUPER-NUMERARY TEETH. J INDIAN SOC PEDO PREV DENT- MARCH 2005.3. SHAH A, GILL DS, TREDWIN C, NAINI FB. DIAGNOSIS AND MANAGEMENT OF SU-PERNUMERARY TEETH. DENT UPDATE. 2008 OCT; 35(8): 510-2, 514-6, 519-20.4. NON-SYNDROME MULTIPLE SUPERNUMERARY TEETH: LITERATURE REVIEW. J CAN DENT

ASSOC. 1990 FEB; 56(2):147-9.5. RAJAB LD, HAMDAN MA. SUPERNUMERARY TEETH: REVIEW OF THE LITERATURE AND A

SURVEY OF 152 CASES. INT J PAEDIATR DENT. 2002 JUL; 12(4): 244-54.6. BROOK AH. DENTAL ANOMALIES OF NUMBER, FORM AND SIZE: THEIR PREVALENCE IN

BRITISH SCHOOLCHILDREN. J INT ASSOC DENT CHILD 1974; 5:37-53.7. GARVEY MT, BARRY HJ, BLAKE M. SUPERNUMERARY TEETH--AN OVERVIEW OF

CLASSIFICATION, DIAGNOSIS AND MANAGEMENT. J CAN DENT ASSOC. 1999 DEC;65(11):612-6.8. ABHISHEK PAROLIA, M KUNDABALA, MARISHA DAHAL, MANDAKINI MOHAN, AND

MANUEL S THOMAS. MANAGEMENT OF SUPERNUMERARY TEETH. J CONSERV DENT. 2011 JUL-SEP; 14(3): 221–224.9. FOSTER TD, TAYLOR GS. CHARACTERISTICS OF SUPERNUMERARY TEETH IN THE UPPER

CENTRAL INCISOR REGION, DENT PRACT DENT REC 1969; 20:8-12.

8Fig 8: Post treatment intra oral clinical photographs

Treatment result The patient completed the treatment within one year. The unerupted UR1 was aligned successfully (Fig. 8) and all the objectives of the treatment plan were achieved. The patient requires continued monitoring of the growth and the development of the dentition in case a comprehensive orthodontic treatment is required once all the remaining permanent teeth erupt.

Discussion The etiology of supernumerary teeth is not completely understood.7 Various theories exist for the different types of supernumerary. One theory suggests that the supernumerary tooth is created as a result of a dichotomy of the tooth bud.7,8 Another theory, well supported in the literature, is the hyperactivity theory, which suggests that supernumeraries are formed as a result of local, independent, conditioned hyperactivity of the dental lamina.8 Heredity may also play a role in the occurrence of this anomaly, as supernumeraries are more common in the relatives of affected children than in the general population.7 However, the anomaly does not follow a simple Mendelian pattern.7

A mesiodens should be suspected when there is asymmetry in the eruption pattern of the maxillary incisors.1 Early diagnosis of a mesiodens minimizes the treatment required and prevents development of associated problems. Extraction of the mesiodens in the early mixed dentition stage may facilitate spontaneous eruption and alignment of incisors, while minimizing intervention. In this case the patient presented in late mixed dentition stage, with space loss, midline shift and delayed eruption of the right

central incisor, which required surgical and orthodontic intervention. Extraction is not always the treatment of choice for supernumerary teeth. unerupted supernumerary teeth that are asymptomatic, do not appear to be affecting the dentition in any way and are found by chance sometime best left in place and kept under observation.5

The fixed appliance phase was indicated to align the unerupted UR1 and to correct the appearance of his front teeth. As outlined above, in most cases the incisors will erupt spontaneously or can be orthodontically erupted following extraction of the mesiodentes. In the rare case that a central incisor cannot be erupted orthodontically because of its position or ankylosis, 2 treatment options exist: surgical repositioning or extraction and placement of an implant. Replacing an ankylosed tooth with an implant may be a better option, as the risks of root resorption, discolouration and periodontal compromise associated with repositioning may be reduced. However, treatment options must be considered individually in each case.1


20

A Clinical Report

Prosthodontic Dentistry

Treatment of an Edentulous Patient with CAD/CAM Technology. A Clinical Report

Dr. Nawaf Albaloul

Dr. Faraj A. Sedeqi

[email protected]

Dr. Bader Alawadhi

Dr. Abdulelah M. Binmahfooz

IntroductionComputer aided design (CAD) and computer aided manufacturing (CAM) was first developed in the 1970s, and since then it has been used in many fields. CAD/CAM technology has been used in dentistry since early 1990s to manufacture an implant prosthesis allowing fabrication of prosthetic frameworks that are constructed from solid blocks of metal without any porosity.1,2 Traditionally, implant prosthetic substructure are constructed using a wax and cast method which may lead to inaccuracies due to polymerization shrinkage or expansion which may limit the ability to achieve a passive fit. In addition, weak points in the cast metals due to micro-porosity leads to a future failure during functional loading. Cast metals substructure may also need to be cut and welded or soldered.3,4 Implant substructure are required to fulfill biological, functional, and esthetic demands with an extreme passive fit and accuracy to prevent complications during function such as crestal bone loss, screw loosening, and abutment fracture.5,6,7

CAD/CAM technology has the ability to manufacture extremely accurate dental substructure with a truly passive fit with more control of divergences than traditional techniques.8,9,10

Clinical PresentationA 60-year-old female patient reported to the department of prosthodontics; with a chief complaint, «I hate my dentures, I want implants». The patient was a nurse by profession and was much concerned about the retention of the prosthesis especially for the mandibular arch. (fig1) The patient presented with a non-contributory medical history and no

contraindications for implant surgery. On clinical examination, it was seen that both maxillary and mandibular ridges were completely edentulous and patient was wearing maxillary conventional complete denture opposing mandibular conventional complete denture. Considering patient’s complaint, background, space analysis and CT Scan; the treatment plan was presented to the patient that included complete denture for the maxilla and five mandibular implants to support a fixed prosthesis. Limitations and benefits of the treatment were explained, and the patient agreed on the treatment plan.

The treatment rendered included the following four phases: treatment planning phase, surgical phase, prosthodontic/restorative phase, and maintenance phase.

Fig 1: CT scan of the mandibular arch.

fig 1


22

A Clinical Report


Fig 2: Maxillary edentulous arch.

Fig 4: Occlusal view of mandibular implants and healing abutments placed at the second stage.

Fig 3: Mandibular edentulous arch.

fig 2

fig 3

Treatment Planning PhaseOn the first diagnostic appointment, preliminary impressions of both maxillary and mandibular edentulous arches were made using alginate material (Jeltrate®, Dentsply Caulk, Milford, DE). At the laboratory, primary models of both arches were prepared and custom trays were fabricated (Triad®, Dentsply Caulk, Milford, DE).

On the second diagnostic appointment, boarder molding with green sticks modeling compound (Kerr Corporation) and impressions of maxilla arch was made using Polysulfide rubber material (COE-FLEX® Lead-Free Polysulfide Impression Material, GC America). At the laboratory, master models of both arches were prepared and occlusal wax rims were prepared using extra hard modeling wax (Truwax® Baseplate Wax, Dentsply Caulk, Milford, DE).On the third diagnostic appointment, vertical dimension of occlusion (VDO), aesthetics, and phonetics were evaluated. Jaw relation registered at centric relation (CR). Teeth set-up and try-in were performed. Protrusive record (PR) condylar guidance was registered. Re-evaluation and confirmation of the VDO, aesthetics, and phonetics were done. Face-bow preservation using occlusal plaster index was fabricated for the maxillary trial denture. Buccal putty index, and lingual putty index

fig 4

was fabricated for the mandibular trial denture (EXAFLEX® VPS Impression Material, GC America). The mandibular trial denture was duplicated to fabricate the radiographic template for computer tomography Scan (CT Scan) to select implants size, quantity, and positions to fulfill of the maximum anterior posterior spread (A-P spread). Space analysis was done to select the most appropriate implant prosthesis utilizing the mandibular putty indexes for anterior posterior measurements, clear shell index from the mandibular trial denture duplication and dewaxing, followed by the surgical guide fabrication.11

Surgical phaseFive implants surgically placed using the surgical guide (OSSEOTITE NT, 3i Implant Innovations, Inc.).

All were 4.1 mm external hex diameter and 11.5 mm in length. Seventeen weeks post-surgical placement, the implants were uncovered and healing abutments were placed.

Prosthodontic/restorativeAt the clinic, all the mandibular healing abutments were removed for implant level impression. In order to minimize the distortion and achieving the most passive fit prosthesis, a custom open tray pick-up impression protocol using polyvinyl siloxane (PVS) impression material was utilized (Aquasil Ultra, Dentsply Caulk, Milford, DE). Dental floss around all transfer impression copings and auto-polymerizing acrylic resin were used to splint all the transfer impression copings (PATTERN RESIN™ LS, GC America). At the laboratory, the peri-implant soft tissues


24

A Clinical Report


Fig 5: Mandibular master cast.

Fig 7: Virtual designs of the mandibular substructure using (CAM structSURE, 3i implant Innovation, Inc)

Fig 8: Passive fit verified with radiograph.

Fig 6: Verification jig for one screw test.

fig 5

were replicated with a polyvinyl siloxane impression material (Aquasil Ultra, Dentsply Caulk, Milford, DE) for the mandibular Master model. Utilizing the mandibular teeth set-up trial denture, occlusal plaster index, buccal putty index, and lingual putty index. Verification index was fabricated on the master model by splinting non-engaging temporary abutments (PreFormance temporary cylinder non-hexed) with auto-polymerizing acrylic resin.

On the try-in appointment the one screw test technique was performed and radiographic verification of the titanium alloy framework passive fit was obtained. Wax bite rim duplicate of the mandibular teeth set-up of the trial denture set over the titanium alloy framework and maxillary teeth set-up trial dentures were both used to verify the vertical dimension of occlusion (VDO), aesthetics, phonetics, as well as to register jaw relation at centric relation (CR). The protrusive record (PR) and condylar guidance were registered. Lingualized occlusal scheme is used to improve the masticatory ability, the comfort, and the esthetics. SR Phonares Lingual NHC artificial teeth (Ivoclar Vivadent) were used for their excellent aesthetics and wear properties for implant supported prosthesis.

fig 6

To minimize the shrinkage, the verification index was allowed to set for 24 hours. The verification index then was sectioned into individual segments to be connected later in the patient mouth. To verify that the fit is the same on the master model as it is in the patient mouth, the connected non-engaging temporary abutments was placed on the master model and one screw test technique was utilized.12

The mandibular trial denture, along with the master model and the verification index were shipped to Biomet/3i work site for virtual design using a sophisticated computer software program and milling of the titanium alloy framework (CAM structSURE, 3i Implant Innovations, Inc)13, 14,15

fig 7

fig 8

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26

A Clinical Report

Prosthetic Dentistry

Fig 9: Wax duplicate of the mandibular teeth setup of trial denture and maxillary teeth setup trial dentures to verify VDO, aesthetics, phonetics and CR

Fig 10: Mandiular prosthesis is invested and fi nished.

Fig 11: Right intraoral buccal view of defi nitive prosthesis.

Fig 12: Mandibular prosthesis inserted and access holes were covered with resin material.

Fig 13: Delivery of fi nal prosthesis.

At the laboratory, the maxillary and mandibular dentures waxed-up, face-bow was preserved for the clinical remount. The mandibular titanium alloy framework was silicoated then both dentures were invested, finished and polished.

The clinical remount and the final occlusal adjustments were made. Dentures were delivered with home care instructions, baseline data was recorded.

Maintenance phaseDuring the first 12 months following restoration of the implants, the patient should be assessed every three months. The maintenance visit includes peri-implant evaluations, prosthetic evaluations, calculus removal, home-care reinforcement, and radiographs if needed. A comparison of findings to baseline data can indicate potential problems with the implants.

ConclusionThe patient was enthusiastic about her new dentures. Her demands for improved function and phonetics were fully met. Implant dentistry requires the precision of fit that CAD/CAM delivers. CAD/CAM technology eliminates the challenges associated with the traditional metal casting, indexing, cutting, and soldering techniques. The mandibular framework illustrated in this case report exhibited a truly passive fit because it was milled from one solid, homogenous titanium alloy blank. Another advantage with this CAD/CAM technology, the miscast with conventional casting technology, rises additional expense because usually the original components get destroyed or damaged making it less expensive than conventional metal casting. Because the technology does not involve any manual labor for fabrication of wax or resin patterns prior to computer design/milling, results in significant fast turn over time and by eliminating this labor-intensive step, the qualified technicians can focus more on their artistry. The technology is available for most major implant brands, and it can be duplicated at half the original price without the need to make new impressions and records.

On the delivery appointment, the maxillary and mandibular dentures were checked using pressure-indicating paste (PIP). New CR record was taken.

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REFERENCES

1. US DEPARTMENT OF HEALTH AND HUMAN SERVICES, PUBLIC HEALTH SERVICE. BROADENING THE SCOPE. LONG-RANGE RESEARCH PLAN FOR THE NINETIES, NO. 1188. US DEPARTMENT OF HEALTH AND HUMAN SERVICES, PUBLIC

HEALTH SERVICE, NATIONAL INSTITUTES OF HEALTH, GOVERNMENT PRINTING OFFICE, 1990, PP. 372. VERSTREKEN K, VAN CLEYNENBREUGEL J, MARCHAL G, NAERT I, SUETENS P, VAN STREENBERGHE D. COMPUTER

ASSISTED PLANNING OF ORAL IMPLANT SURGERY. A THREE-DIMENSIONAL APPROACH. INT J ORAL MAXILLOFAC IMPLANT

1996; 11:806-810.3. BLACKMAN R, BAEZ R, BARGHI N: MARGINAL ACCURACY AND GEOMETRY OF CAST TITANIUM COPINGS. J PROSTHET

DENT 1992;67:435-4404. GELBARD S, AOSKAR Y, ZALKIND M, ET AL: EFFECT OF IMPRESSION MATERIALS AND TECHNIQUES ON THE MARGINAL

FIT OF METAL CASTING. J PROSTHET DENT 1994;71:1-65. CARR A, GERARD D, LARSEN P: THE RESPONSE OF BONE IN PRIMATES AROUND UNLOADED DENTAL IMPLANTS SUP-PORTING PROSTHESES WITH DIFFERENT LEVELS OF FIT. J PROSTHET DENT 1996;76:500-5096. JEMT T: IN VIVO MEASUREMENTS OF PRECISION OF FIT INVOLVING IMPLANT-SUPPORTED PROSTHESES IN THE EDENTULOUS

JAW. INT J ORAL MAXILLOFAC IMPLANTS 1996;11:151-1587. TAN K, RUBENSTEIN J, NICHOLLS J, ET AL: THREE-DIMENSIONAL ANALYSIS OF THE CASTING ACCURACY OF ONE-PIECE,OSSEOINTEGRATED IMPLANT-RETAINED PROSTHESES. INT J PROSTHODONT 1993;6:346-363 8. MAY K, EDGE M, RUSSELL M, ET AL: THE PRECISION OF FIT AT THE IMPLANT PROSTHODONTIC INTERFACE. J PROSTHET

DENT 1997;77:497-5029. KAN J, RUNGCHARASSAENG K, BOHSALI N, ET AL: CLINICAL METHODS FOR EVALUATING IMPLANT FRAMEWORK FIT.J PROSTHET DENT 1999;81:7-1310. EISENMANN E, MOKABBERI A, WALTER M, ET AL: IMPROVING THE FIT OF IMPLANT-SUPPORTED SUPERSTRUCTURES USING THE SPARK EROSION TECHNIQUE. INT J ORAL MAXILLOFAC IMPLANTS 2004;19:810-81811. SADOWSKY SJ. THE IMPLANT SUPPORTED PROTHESIS FOR THE EDENTULOUS ARCH: DESIGN CONSIDERATIONS. J PROSTHET DENT 1997; 8:28-33.12. SHOR A, GOTO Y, SCHULER R: REHABILITATION OF THE EDENTULOUS MANDIBLE WITH A FIXED IMPLANT-SUPPORTED

PROSTHESIS. PRACT PROCED AESTHET DENT 2004;16:729-73613. DURET F, BLOUIN JL, DURET B: CADCAM IN DENTISTRY. J AM DENT ASSOC 1988;117:715-72014. MORMANN WH, BRANDESTINI M: VERFAHREN ZUR HERSTELLUN MEDIZINISCHER UND ZAHN-TECHNISCHER AL-LOPLASTISCHER ENDOUND EXO-PROTHETISCHER PABKORPER. PATEENTANMELDUNG (CH 1980), EP-A O 054785, 198515. ANDERSSON M, BERGMAN B, BESSING C, ET AL: CLINICAL RESULTS WITH TITANIUM CROWNS FABRICATED WITH

MACHINE DUPLICATION AND SPARK EROSION. ACTA ODONTOL SCAND 1989;47:279-286

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Deciduous teeth cure rate enhancement in children

30

General characteristic of the researchActuality of the research.Carious lesion of deciduous (primary) teeth in children is widespread (E.M. Kuzmina, 1995; Lukinykh L. M. et al., 2001; I.V. Afonina, 2005; S. N. Kiwanukai et al., 2004; B.L. Edelstein, 2005; Mahejabeen R. et al., 2006 ). Progression of deciduous (primary) teeth carious lesion rate in infancy and preschool age (E.E. Maslak et al., 1998; Frias-Bulhosa and joint authors, 2002; Lee M., Sissons S.N., 2003 ) is registered in many countries throughout the world. Difficulty in treatment of caries in deciduous (primary) teeth is due to not only anatomico-physiological characteristics of primary teeth and oral cavity of a child but difficulty in management strategies in young children (V.V. Korchagina, 2005). It predisposes to the development of carious complications and premature primary teeth extraction, which in its turn, produces a negative effect on permanent teeth germs, systemic child health condition, leads to the development of odontogenic inflammatory maxillofacial diseases and dentofacial anomalies in children (Vinogradova T.F., 1987; Yelizarova V.M. et al., 1998; Dmitriyenko S.V. et al., 1999; Sayfullina Kh.M., 2001; Schechter N., 2000; Welbury R.R et al. 2005). That’s why, the problem of childhood caries treatment is considered to be the most significant and actual one in dentistry. To overcome own children’s and parents’ fear to dental care is one of the most serious problem (Luneva N.A., 2001; Kent G., 1985; Lindsay S., Jackson S., 1993). As a sound of a working dental drilling machine is one of the powerful factors in dentophobia development (Mikhaylova M.A., 2006), so great attention is paid to designing noiseless “friendly” carious treatment techniques, especially for children (Pakhomov G.N., Leontyev V.K., 2004; Mount G.J., 2002; Frencken J.E., Holmgren C.J., 2004).

However, many current carious treatment techniques (ozonotherapy, preparation with a jet device, laser or ultrasound) proved to be less acceptable for young children. Other techniques have some particular disadvantages and do not always lead to good results. So, applying a silver method dyes carious tooth tissues into black, so in principle many parents reject it. On the other hand, a silver method results in a great number of complications (E.E. Maslak et al., 2000 ).Atraumatic restorative treatment of dental caries and chemical mechanical preparation of carious cavities (Lysenkova I.I., 2004; Kleymenova O.A., 2005; Schriks M.S., van Amerongen W.E., 2003; N. Lopez et al., 2005) have proved to be more promising techniques for pediatric dentistry. There is not enough evidence concerning application of these techniques for dental caries treatment to children’s primary teeth in literature, the influence of various carious preparation techniques on children’s behavior modification in oral cavity sanation has been poorly studied, indications and contraindications for their use are not clearly identified. In deep caries management it is suggested to use a protective calcium liner or carry out deep fluoridation of the pulp floor (Kuryakina N.V., 2001; Zolotova L.Yu., Korshunov A.P., 2005; Knappwost A., 1995, 2000, 2001; Maltz M. et al., 2001). However, these techniques are rarely used in primary teeth, as it is considered that “there is no deep caries in primary teeth”. On the other hand, hard tissues of primary teeth have specific anatomico-physiological characteristics, promoting a high infectious process distribution, development of complications in small carious cavities (M.S. Duggal et al., 1999, 2004). That’s why, median caries treatment is to protect the pulp and foster mineralization of dentin affected by caries. From this point of view a deep fluoridation of dentin before median caries

RESEARCH STUDY

Pediatric Dentistry


32

RESEARCH STUDY

Pediatric Dentistry

treatment is perspective, but clinical efficacy of this technique in median caries treatment of primary teeth has not been studied yet. Glass ionomer restorations are used as tooth-colored filling materials for primary teeth (I.N. Kuzmina, 2001; Tran L.A., Messer B.L., 2003; Wang L. et al., 2004; Burke F. J. T. et al., 2005). In recent years a possibility of esthetic restoration of caries in primary teeth with light – cured filling materials in children has been under study (Mass Ye. et al., 1999, Fuks A., 2000). However, there is no evidence in need for esthetic restoration of caries in primary teeth in literature reviews; also there are insufficient data on comparison characteristics of different median caries treatment techniques for primary teeth.

The object of the researchJustification of comprehensive therapy in the course of median caries treatment of primary teeth to enhance effectiveness of treatment for children aged 1-5.

The following tasks have been outlined:1. to assess children’s behavior aged 1-5 in the process of oral cavity sanation applying various carious cavity preparation techniques;2. to compare quality of various carious cavity preparation techniques in children aged 1-5;3. to determine effects of deep fluoridation of the pulp floor on enhancing clinical effectiveness of caries treatment of primary teeth in children;4. to clarify children’s needs aged 1-5 for es-thetic restoration against caries in primary teeth and to estimate results of esthetic light-cured fill-ing material use in median caries treatment of primary teeth;5. to work out a comprehensive median caries treatment technique for primary teeth and eval-uate effectiveness of its use in children aged 1-5.

Scientific newness of the researchChildren’s behavior in oral cavity sanation subject to application of various carious cavity preparation techniques for primary teeth has been studied for the first time. It is proved that atraumatic restorative treatment of dental caries and chemical mechanical preparation of carious cavities improve children’s behavior, but the use of a dental drilling machine contributes to the development of negative attitude to teeth

treatment. A comparative study of various carious cavity preparation techniques (conventional, atraumatic, chemical mechanical) using caries detector on primary teeth in children aged 1-5 has never been conducted before. The use of caries detector is considered medically necessary for the purpose of assessing a complete removal of carious dentine in all studied preparation techniques. Indications for the use of various preparation techniques in treatment of caries in primary teeth in children aged 1-5 have been worked out. Deep fluoridation of the pulp floor before filling has been applied for median caries treatment of primary teeth in children firstly and high clinical effectiveness of this method has been established. Children’s need for esthetic restoration of caries in primary teeth was ascertained. Clinical effectiveness of median caries treatment of primary teeth with the use of light-cured filling material in children, which corresponded to the results of using glass ionomer chemical curing cement, was determined. A comprehensive schedule of caries treatment of primary teeth was designed and approbated, its high clinical effectiveness -94,8 % was ascertained in comparison with conventional treatment method (effectiveness- 83,5%) in children aged 1-5.

Scientific theoretical significance of the researchTheoretical significance of the research consists in obtaining new data on comparative efficacy of different carious cavity preparation techniques for primary teeth in children, effect of a preparation technique on children’s behavior in the process of oral cavity sanation, children’s need for esthetic treatment, significance of deep fluoridation to enhance a particularly beneficial effect on median caries treatment of primary teeth in children.Practical significance of the research consists in designing a comprehensive schedule of caries treatment of primary teeth in children; its use has considerably enhanced effectiveness of treatment. On the base of obtained data indications for the use of various preparation techniques in treatment of median caries in


34

Pediatric DentistryRESEARCH STUDY

primary teeth has been presented. The necessity to use caries–detector has been proved for evaluation of preparation technique quality. Resources to use esthetic fillings for primary teeth have been determined.

Theses to be substantiated 1. Children’s behavior in the process of oral cavity sanation is improved subject to application of atraumatic restorative treatment of dental caries and chemical mechanical reparation of carious cavities. Use of conventional preparation by means of a dental drilling machine contributes to the development of negative attitude to dental treatment.2. Use of caries–detector is considered medically necessary for the purpose of assessment a complete removal of infected tissues and promotes preparation quality in all studied preparation techniques. 3. Deep fluoridation of the dentin floor enhances effectiveness of caries treatment in primary teeth in children. 4.Comprehensive schedule enhances effectiveness of median caries treatment of primary teeth in children aged 1-5 in comparison with conventional treatment. Approbation of the research results. Implantation of findings. Publications on the thesis. Materials of the research were presented and discussed in: conferences of young researchers of VolSMU (2004-2006), XI regional conference of young researchers in Volgograd region (Volgograd, 2005), VI international scientific conference “Health and education in III millennium” (Volgograd, 2005).The research was approbated at a chair meeting of pediatric, therapeutic, surgical dentistry, propaedeutics, prosthodontics and refresher training chair of Volgograd State Medical University (September, 2006).The objective and methods of the research According to the aim and tasks of the research a multistage research was set up, in which 448 children aged 1-5 were recruited. Children were evenly sampled within strata of sex and age.

Research basismunicipal health care institution “Children’s clinical dental polyclinic 2” in Volgograd. Participation in the study was voluntarily.

Informed consent on children’s participation in a conducted study was received from parents. Test protocols were confirmed by regional Ethics Committee. The first stage included the study of parents’ attitude (192 families) towards different carious cavity preparation techniques for primary teeth and children’s behavior in the process of oral cavity sanation. In the process of carrying out the oral cavity sanation, children’s behavior depending upon the use of different carious cavity preparation techniques for primary teeth was assessed. 47 children underwent the oral cavity sanation with the use of a conventional preparation of carious cavities in their primary teeth, 48 children were performed an atraumatic preparation and 97 children - a chemical mechanical reparation. Conventional preparation of carious cavities in primary teeth in children was performed with the use of a dental drilling machine, high-speed and low-speed headpieces, diamond dental drills, hard-alloy dental drills and steel burs. Atraumatic method of carious cavity preparation of primary teeth was performed due to ART methodology (Pakhomov G.N., Leontyev V.K., 2004). Chemical mechanical method of carious cavity preparation of primary teeth was performed with “Carisolv”, “Medteam”, Switzerland. Glass ionomer cement was used for a tooth filling. Children’s behavior in the process of oral cavity sanation was recorded during their first four visits. Performance measurement of parents in the area of pediatric oral health was the following: 1) satisfaction with the experience care by children, complete agreement with a doctor in all questions (in a manner consistent with the parents’ and child’s psychology needs); 2) dissatisfaction with the method of treatment chosen by a doctor for some reasons, (unmet treatment need in children) necessity to change it. Children’s behavior was assessed on the base of three criteria: 1) good: a child is sociable, confides in his doctor, sits well and opens his mouth; 2) satisfactory: a child is not easy-going, sits badly and opens his mouth badly, parent’s and paramedical personnel assistance is required to provide comprehensive treatment.The second stage included the study of the qualitative assessment of different carious cavity preparation techniques for primary teeth

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Pediatric DentistryRESEARCH STUDY

2436

in median caries with caries-detector in 53 children. Conventional preparation technique was applied to 30 carious cavities, atraumatic technique – to 15, chemical mechanical – to 62. To evaluate the quality of carious cavity preparation of primary teeth a caries-detector: “Color-test” (“VladMeVa”) was applied. On the base of analysis of received data indications to use different carious cavity preparation techniques for primary teeth in case of median caries treatment in children were identified. The third stage of the research presented the results of the study of deep fluoridation of the pulp floor in 78 children in the course of median caries treatment in children (145 teeth), when compared with conventional treatment (215 teeth). Deep dentin fluoridation of the pulp floor was performed with “dentin bonding agent” (dentin sealant liquid), “Humanchemie”, Germany. During the fourth stage parents’ attitude to esthetic treatment of primary teeth in children (according to questionnaire data of 100 respondents) was ascertained and effectiveness of median caries treatment of 56 primary teeth in 23 children aged 3-5 with the use of different carious cavity preparation techniques and further restoration with light-cured filling material “Vitremer TM”, “3M ESPE” was established. Conventional preparation technique was performed in 10 teeth, atraumatic – in 13, chemical mechanical – in 33. During the fifth stage, on the base of conducted surveys, a comprehensive median caries treatment schedule for children with primary teeth aged 1-5 was developed. Comprehensive treatment included: sparing preparation of carious cavities (ART, CMP methods); use of caries-detector to control the quality of a carious cavity preparation; deep fluoridation of the pulp floor after preparation; carious cavity filling with glass ionomer cement. A comprehensive schedule was applied to 381 teeth in 142 children. Conventional treatment of median caries (preparation with a dental drilling machine, GIC (glass ionomer cement) filling) was performed in the same group of children in 315 teeth. Carious lesions’ location, depending on a method of median caries treatment of primary teeth, was approximately equal. In 18 months effectiveness of comprehensive median caries treatment of primary teeth in comparison with

conventional treatment was established.To evaluate results of median caries treatment of primary teeth in children the following parameters were considered: presence or absence of complications after treatment (pulpitis or periodontitis) and secondary decay, quality of fillings related to anatomic shape, dental surface health, and gingival attachment. According to the results of children’s examination the quality of median caries treatment of primary teeth was evaluated by means of two measurements: 1) positive result: filling is conserved, restoring the anatomical dental form, preserving gingival attachment or there is a small defect not involving the dentin, there are no signs of secondary decay or carious complications; 2) negative result: extensive filling decay, gingival attachment defect, involving dentin, irregular surface with pronounced pits, fissures, splits, partial filling breakage, falling out of filling (wear), recurrent caries and caries complications development. All statistical data processing were conducted with a computer IBM\ AT Pentium-4, using a statistical mathematical software package (Microsoft excel 2000). Marginal category (%), mean error amount (m), significance test (t), and credibility value of diversity (p) were identified. Diversity is considered to be statistically reliable in t> 2; p<0, 05.

Results of own investigationsParents’ attitude and children’s behavior in the process of oral cavity sanation. The results of interview showed that most parents met the oral health needs of children covered by a doctor and had positive attitude to any provided oral health care. Only 4,2% of parents were not satisfied with the experience of care by their child.Children’s behavior varied in the process of oral cavity sanation. In the group of conventional preparation most (74,4%) children showed a negative attitude to dental treatment during a first dental visit, their behavior was poor. In the process of oral cavity sanation with a dental drilling machine a number of well-behaved children increased and to the fourth visit amounted to 78,6%. At the same time a number of well-behaved children decreased: during the second visit- up to 12, 7%, during the third visit – up to 6, 3 %. During the fourth


RESEARCH STUDY

Pediatric Dentistry

38

visit there was no one with good behavior. Satisfactory behavior was recorded in 21,4% of children in conventional carious cavity preparation. Most (72,9%) children showed good behavior when used ART method on their first visit. Gradually, the number of well-behaved children increased and amounted to 93,8% on their fourth visit. The number of children with satisfactory behavior amounted to 16,6% on their first visit, then it had reduced to 2,1 % by their fourth visit. Bad behavior was observed in 10,5% of children on their first visit, reduction of frequency of negative attitude in children’s towards treatment began only with the third visit and by the fourth visit had amounted to 4,1%. Good behavior-47,4% was observed in a group of children who were performed a chemical mechanical carious cavity preparation in most cases on their first visit, its frequency increased from visit to visit 52,5%, 74,2%, 97,9% in compliance with the second, third, fourth visits. The number of children with satisfactory behavior amounted to 27,8 % on the first visit, then gradually decreased and amounted to 1,0% during the fourth visit. Also the number of children with poor behavior reduced from 24,7% during the first visit to 1,0% during the fourth visit. Comparative analysis of results showed, that children met sparing preparation methods (ART and CMP) much better than preparation with a dental drilling machine (pic.1). In the process of oral cavity sanation with the use of sparing preparation methods practically all children demonstrated good behavior and positive attitude to dental treatment, but in conventional preparation opposing tendency was observed: the number of well-behaved children had reduced to zero by sanation termination, but poor behavior and negative attitude of children to treatment were kept at high level during the whole course of sanation -74,4 % -78,6% cases. Quality assessment of various carious cavity preparation techniques for primary teeth. Use of caries – detector revealed remained infected dentin in all applied carious cavity preparation techniques for primary teeth in children. Though more often preparation defects were revealed reliably (p < 0,001) by conventional preparation technique (66,7%) that was 2,8 times greater than in CP, 5 times greater than in ART (pic.2).

fig 1: rate of good (A) and Bad (B) children’s behav-ior in the process of oral cavity sanation with the use of various preparation methods

Statistic reliability of diversity (13,3±8,8% and 24,2± 5,4 % respectively, p < 0,05) was not found out between preparations results by ART and CMP methods. It should be noted, that in carious cavity preparation more successful removal of infected tissues was revealed after chemical mechanical preparation technique. Thus, caries-detector use allows improving the quality of carious cavity preparation and therefore enhancing the effectiveness of caries treatment in children. Summing up the use of various carious cavity preparation techniques for primary teeth in children peculiarities of conducting different procedures, advantages and disadvantages of their use were determined. Quick removal of infected tissues could be considered as an advantage of a conventional preparation technique. Use of a dental drilling machine leads to the development of a negative attitude to a dental treatment and increases the level of dentophobia in population and is the most essential disadvantage. ART method has significant advantages due to its quietness, tenderness elimination, risk minimization of accidental tooth cavity opening and damage of surrounding tissues, fear and anxiety reduction in children and parents. At the same time this technique is applied only to “opened cavities”;

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doesn’t always allow removing tertiary dentin; tenderness may appear in excavation of infected dentin near the horn of the pulp and along the dentin enamel junction; it requires more time for preparation itself. Advantages of CMP are: painlessness and quietness, comfort enhancement to children and parents, safety for tunica mucosa of mouth; maximal preserving health tooth tissues; easy removal of affected tissues after their softening with gel, possibility of manual tooth tissues broadening of enamel margins, providing good cavity and butt access. Disadvantages of CMP are considered to be the following: it was not always possible to open the cavity with hand instruments, softening gel isn’t always effective in extraction of dens tertiary dentin, manual carious dentin removal on medial tooth wall of carious cavities in primary molars was ineffective; some children mentioned unpleasant drug odor; time for extraction of affected dentin had extended. Results of deep dentin fluoridation of the pulp floor before filling with GIC in median caries treatment of primary teeth appeared to be highly effective (pic. 3). Positive results after using deep fluoridation occurred reliably more often, then in conventional treatment: 94,5± 1,9% and 82,8± 2,6% respectively, p < 0,001. Negative results after using deep fluoridation occurred reliably 4,2 times more seldom then in an experimental group 5,5± 1,9% and 17,2± 2,6% and respectively, p < 0,001. Nevertheless, it should be pointed out, that the use of deep fluoridation was effective in median caries treatment of primary teeth and Class II and V cavities, but improvement of results in Class II and III cavities was less pronounced. The problem of esthetic fillings of primary teeth in case of caries. Results of parents’ attitude to the oral appearance of the child’s teeth showed that the majority of respondents (73,0%) considered esthetic treatment of primary teeth necessary.

fig 2: Rate of incomplete removal of infected dentin in carious cavity prepara-tion by different methods (according to data of caries-detector use).

fig 3: Results of median caries treatment according to use of deep dentin fluoridation before filling with GIC.

Rate of the incomplete removal of infected dentin, %fig 2 fig 3

Only 17% of respondents benefited esthetic treatment of primary teeth, 10% found difficulty in replying. At the same time choosing an appropriate method of treatment, only 33% of families could make their own decision, 60% relied on their doctor, 7% found difficulty in replying. Less (21%) families could choose a filling material themselves. On the other hand, deciding on treatment method and filling materials was limited by household income level. In spite of that 80% of families had satisfactory and good household income level; most of them preferred free medical service (17%) or cheap caries treatment of primary teeth of children (49%). Only 34% of respondents accepted esthetic teeth treatment of children. Knowledge of light-cured material use in primary teeth in children has presented some difficulties: work “in four hands” is required; timetable for filling extends; a child should sit quietly for some time, following doctor’s orders properly and rapidly; appropriate isolation of working area from oral fluid is necessary. According to it, filling was difficult to perform in younger children under age 3, in less sociable children, in active and curious children who are not able to sit with their open mouth for a long time. Repeated examination of children in 12 months revealed that number of satisfactory results of Vitremer use after CMP was 87,8%, after ART -84,6%, after CP-80,0% , number of negative results – 12,2%, 15,3%, 20, 0% respectively. However, diversities detected were not statistically reliable (p > 0,05). On average, use of Vitremer was effective only in 85,7% cases. Negative results comprised 14,3% of cases, the main problem was falling out of fillings, that could be explained by difficulty in following work technique with light – cured

Positive Negative

RESEARCH STUDY

Pediatric Dentistry

Conventional chemical-mechanical

ART


RESEARCH STUDY

Pediatric Dentistry

42

materials in younger children. Results of light – cured material use for primary teeth filling in median caries corresponded to the results of GIC filling (number of positive results 85,7% and 83,5% respectively, p > 0,05). On the one hand, use of esthetic light – cured materials is restricted due to low esthetic parents’ needs and their limited paying capacity, on the other hand, complexity of work and difficulties connected with children’s behavior while filling a tooth. Comprehensive treatment of median caries in primary teeth in children. A comprehensive treatment schedule of median caries in primary teeth in children including CMP and ART techniques, using of caries –detector to evaluate prepared carious cavities’ “rate”, application of sealants to the pulp floor and carious cavity filling with GIC was established basing on the results of the presented investigations. After providing comprehensive treatment for median caries in primary teeth in children positive results were revealed in 18 months in 94,8% of cases, after providing conventional treatment – in 83,5% of cases (p < 0,001). Negative results after providing comprehensive treatment for median caries occurred reliably 3,2 times less than after providing conventional treatment -5,2% and 16,5% and respectively, p < 0,001. It should be pointed out, that after providing comprehensive treatment for median caries in children negative results are associated with falling out of fillings (wear), there were no caries complications “under the filling”, secondary caries did not develop, but after conventional treatment these complications were registered along with others. Results of median caries treatment of primary teeth in children depended on carious cavity localization Number of negative results providing comprehensive treatment in Class I cavities (according to Black) was reliably 8,5 times less than after providing conventional treatment (1,1±0,8% and 9,3± 2,3%, p < 0,01), in Class II cavities- 1,5 times less (16,3±5,3% and 24,4± 6,7%, p > 0,05), in Class III cavities – 1,9 times less(17,9±6,1% and 34,0± 6,7%, p > 0,05), in Class IV cavities – 6,2 times less (2,6±1,5% and 16,1± 4,7%, p < 0,01). Thereby, high effectiveness of median caries treatment of primary teeth in children aged 1-5 has been ascertained by the results of comprehensive treatment, that permits to recommend applying

comprehensive treatment conventional trearment

fi g 4

fi g 4: Rate of negative results of median caries treatment of primary teeth in children due to carious cavity localization and treatment pattern.

class cavities according to black classifi cation

a comprehensive schedule into dental pediatric practice widely.

Conclusions1. Children’s behavior in the process of oral cavity sanation depends on carious cavity preparation techniques for primary teeth: use of sparing preparation techniques (ART, CMP) results in children’s positive attitude development in 93,8% - 97,9% of cases; in conventional preparation in 78,6% of children negative attitude towards teeth treatment is observed. 2. Quality of carious cavity preparation of primarily teeth detected by carious – detector is better in use of sparing preparation techniques (ART, MCP) than in conventional preparation. Preparation defects have been defined in conventional method reliably (p < 0,001) 2,8 less than in chemical mechanic preparation, and 5 times less, then in atraumatic preparation. 3. Deep dentin fluoridation of the pulp floor after preparation increases the effectiveness of median caries treatment of primary teeth in children. Number of negative results after deep fluoridation has reduced reliably in 4,2 times, in comparison with conventional treatment method: 5,5±1,9% and 17,2± 2,6% respectively, p < 0,001. 4. Need in esthetic caries treatment of primary teeth in children aged 1-5 constitutes 34%. Effectiveness of light – cured preparation material “Vitremer” use corresponds to 85,5 % of negative results – 14,3%, that is equal to the results from glass ionomer cement filling. 5. Comprehensive treatment schedule of median caries in primary teeth has been established

Rene Zakhem, Representative Middle East / AfricaRitter®Concept GmbH · Bahnhofstraße 65 08297 Zwoenitz / GermanyGER +49 15 258 967 247LB +961 3 593 187KSA +966 582 646 [email protected], www.ritterimplants.com

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RESEARCH STUDY

Pediatric Dentistry

44

including sparing preparation techniques (ART, CMP), using of caries –detector in the process of preparation, deep dentin fluoridation of the pulp floor and filling with GIC. Providing a comprehensive treatment schedule for median caries treatment in children aged 1-5 reliably has enhanced effectiveness of treatment in 11,3 % in comparison with conventional treatment: 94,8% and 83,5 % respectively, p < 0,001.

Practical recommendations1. In children aged 1-5 in the process of oral cavity sanation a carious cavity preparation in case of median caries should be performed by sparing techniques:- ART technique is recommended for active and capricious infants under age 3, in preschool children with high level of fear and anxiety in presence of good access to carious cavity;- CMP technique is recommended for infants under age 3; any age children during their first visit to enter into good relations; patient who are afraid of dental drilling machine sounds, injections or having allergic anamnesis and anesthesia intolerance emotionally unstable or mental defectives (psychiatric disorders); - conventional preparation of carious cavities in primary teeth with a dental drilling machine on reception at polyclinic is recommended for emotionally stable children beginning from preschool years who are tolerable to all procedure, including anesthesia; 1. in the absence of good access to the carious cavity one should combine preparation techniques: to create an access to a cavity, then use sparing preparation techniques. 2. In a final stage of carious cavity preparation of primary teeth in children regardless of preparation method, one should use caries-detector to evaluate the quality of infected dentin filling. Absence of bright dentin staining is the mean of termination of carious cavity preparation of primary teeth. 3. Treating median caries in primary teeth in children aged 1-5 one should perform deep dentin fluoridation of carious cavities with sealant liquid that enhances effectiveness of treatment. 4. In children aged 1-5 to enhance effectiveness of median caries treatment of primary teeth one should use a comprehensive treatment schedule, including sparing preparations (ART and CMP) and caries

– detector use, deep fluoridation of carious cavities and glass ionomer cement filling.

REFERENCES1. MOHAMMAD D.J.\ PRACTICAL APPLICATION OF CHEMICAL - MECHANIC PREPARATION

TECHNIQUE TO PRIMARY TEETH IN CHILDREN\ E.E.MASLAK, D.J. MOHAMMAD \ ACTUAL

PROBLEMS OF DENTISTRY: MATERIALS OF SCIENTIFIC PRACTICAL CONFERENCE OF DENTISTS

INTATARSTAN DEVOTED TO 50 ANNIVERSARY OF DENTAL DEPARTMENT OF KSMU.-KASANY.-2004.-P.60-63.2. MOHAMMAD D.J.\ CARIES – DETECTOR APPLICATION TO PRIMARY TEETH IN CARIOUS

CAVITY PREPARATION\ D.J. MOHAMMAD, N.V. KUYUMDZHIDI\\ ACTUAL PROBLEMS OF

EXPERIMENTAL, CLINICAL, AND PREVENTIVE DENTISTRY. – VOLGOGRAD.-2005. – VOLUME

62, -ISS.2.-P.163-165.3. MOHAMMAD D.J.\ ENHANCEMENT OF CARIES TREATMENT OF PRIMARY TEETH IN

CHILDREN AGED 1-5. \ D.J. MOHAMMAD, N.N. KLIMOVA\\ X REGIONAL SCIENTIFIC

CONFERENCE OF YOUNG RESEARCHES IN VOLGOGRAD REGION.- VOLGOGRAD.- 2005.- P.107-108.4. MOHAMMAD D.J.\ COMPREHENSIVE CARRIES TREATMENT OF PRIMARY TEETH.\E.E.MASLAK, D.J. MOHAMMAD, F.S. ATANASOVA, N.V. KUYUMDZHIDI \\ MATERIALS

OF VI INTERNATIONAL SCIENTIFIC PRACTICAL CONFERENCE “HEALTH AND EDUCATION IN XXICENTURY”.- M.-2005.- P.328.5. MOHAMMAD D.J.\ESTHETIC CARIES TREATMENT OF PRIMARY TEETH IN CHILDREN AGED

1-5\ E.E.MASLAK, D.J. MOHAMMAD, F.S. ATANASOVA, N.V. ROZHDESTVENSKAYA

\\ NEW TECHNOLOGIES IN MEDICINE (MORPHOLOGICAL, EXPERIMENTAL, CLINICAL AND SOCIAL

ASPECTS): ISSUE OF VOLGMU.- VOLGOGRAD.- 2005.-ISS.I.- P.383-385.6. MOHAMMAD D.J.\ COMPREHENSIVE CARRIES TREATMENT OF PRIMARY TEETH.\E.E.MASLAK, D.J. MOHAMMAD, N.V. KUYUMDZHIDI, F.S. ATANASOVA, .A.LAVROV \\ INSTITUTE OF DENTISTRY.-2005. 4.-P.71.7. MOHAMMAD D.J.\ EXPERIMENTAL USE OF NATIONAL GLASS IONOMER CEMENTS ‘AR-GCEM” IN CARIES TREATMENT OF PRIMARY TEETH\\ E.E.MASLAK, N.N. KLIMOVA, N.V.KUYUMDZHIDI , D.J. MOHAMMAD\\ ACTUAL PROBLEMS OF DENTISTRY: MATERIALS

OF INTERREGIONAL SCIENTIFIC PRACTICAL CONFERENCE DEVOTED TO 100- ANNIVERSARY OF

SARATOV ODONTOLOGIC SOCIETY ESTABLISHMENT.- SARATOV-2005.-P.186-188.8. MOHAMMAD D.J.\ CHILDREN’S AND PARENTS’ ATTITUDE TO DIFFERENT CARIOUS CAV-ITY PREPARATION TECHNIQUES OF PRIMARY TEETH\ E.E.MASLAK, D.J. MOHAMMAD,F.S. ATANASOVA, N.V. KUYUMDZHIDI\\ ACTUAL PROBLEMS OF EXPERIMENTAL, CLINICAL,AND PREVENTIVE DENTISTRY: MATERIALS OF SCIENTIFIC PRACTICAL CONFERENCE DEVOTED

TO45- ANNIVERSARY OF DENTISTRY DEPARTMENT OF VOLSMU . – VOLGOGRAD.-2006.–P.163-165.

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MeToo!

Esthetic Dentistry

46

MeToo! A new chairside whitening system

Dr. Hadia Decharriere

[email protected] is a new whitening line which includes both chairside whitening treatment and take-home packages.The chairside protocol for MeToo includes:- MeToo Light: a complete one-patient kit, using a 30% hydrogen peroxide gel to be activated by light-emitting diodes (LEDs). - MeToo DeLuxe: a new patented whitening lamp that is dedicated to enhancing the results obtained with MeToo Light kits (but can also be used with any other chairside whitening gels)- MeToo Perfect: a small take-home kit, with 3 prefilled trays to deliver gel (8% Hydrogen per-oxide) used 30 minutes per day, for 3 days to stabilize the results of the chairside procedure. The difference in the MeToo DeLuxe lamp lies in the light-emitting diodes, where other lamps use UV, combining light and heat. MeToo De-Luxe lamp has separated these two functions by incorporating blue LEDs and infra red light, thus preventing any risk of skin or soft tissue damage, which can be a potential problem with UV light.The lamp LCD control panel allows the practi-tioner to choose the balance between the blue LEDs and infra red light. The objective is to be able to control operative sensitivities by possibly

Customizing MeToo! Deluxe Lamp Radiance

reducing the heat without reducing the blue light exposure. The MeToo Light procedure con-sists of three 15 minutes sessions.

Full Power Medium Cold Light

MeToo! Deluxe System’s LEDs

MeToo! Deluxe System’s Mode of Operation

Blue LED

Infra Red Light


NeoDam before and after polymerization

Esthetic Dentistry

48

MeToo!

Operative ProtocolThe MeToo DeLuxe procedure kit includes:

size (S) with a saliva pump

dental dam with patented color change to indicate full polymerization

be used with a brush during or after treatment

30% hydrogen peroxide gel

MeToo Patient Kit

MeToo! Retractor

A prophylactic clean is performed before each treatment and after examination of all teeth is completed. Cavities and periodontal disease are treated prior to the cleaning. The chairside whitening session starts with shade evaluation. Then, the most important part begins, which is isolation of the soft tissues. MeToo retractor is a single use retractor. Its shape and the use of pro-vided saliva rolls, allows good lip spacing. The integrated saliva pump offers added comfort to the patient. The gums are isolated with NeoDam which changes colour to control polymerization. Orange glasses are provided to protect the pa-tient’s eyes. The soft tissue isolation is reliable and reproducible.

After drying the teeth, the 30% hydrogen per-oxide gel is applied. For better efficacy, take the peroxide gel out of the fridge a few hours before the session. Each of the three sessions has its own whitening gel syringe so the practitioner won’t run out of gel. Each session lasts 15 min-utes. If sensitivity is observed during the session it is possible to reduce the lightening power. The lamp is silent so patients can relax and listen to music, for example. Once the three sessions have been completed, the teeth are rinsed, and the whole isolation system taken off. The new shade is examined. Patient are then given their take-home kit, MeToo Perfect, to start the day following the procedure, for 3 days, in order to stabilize results. A take-home 3-6 day whiten-ing per annum, along with a good oral hygiene regime and regular scaling procedures should enable well maintained whiteness.

Clinical Observations – Clinical casesAll patients received the full three, 15-minute sessions. No operative sensitivity was experi-enced by the patients which allowed all sessions to be completed on « full power ». The dental shades were evaluated with Vita Classical fol-lowed by Vita bleached guide 3D-Master when bleached shades were reached.


50

MeToo!

Esthetic Dentistry

ConclusionsPatients considering teeth whitening have a cos-metic aim; this implicates practitioners to offer a painless whitening technique that provides good results and maximum comfort during the proce-dure. The MeToo! DeLuxe whitening system has

given us, to date, encouraging results. Patients were very satisfied with their new shades and found the chairside procedure to be relaxing. The fact that the lamp is silent and the absence of operative sensitivity seem to be essential.

Patient 1 : Before, A3 After, A1

Patient 2 : Before A2 After, 1M1

Patient 3 : Before, A1&A3.5 (canines) After, 0,5M1&1M1 (canines)

Patient 4 : Before A2 After : 0,5M1

fits inThis is where

52

One Shape® – MICRO-MEGA®

Endodontics

ONE SINGLE INSTRUMENT FOR A SAFE ROOT CANAL PREPARATION

In endodontic treatments, Nickel-Titanium in-struments in continuous rotation1 optimize root canal shaping. Generally, rectilinear and barely curved root canals with a round or oval section does not cause difficulties and can be prepared by using all standard techniques.However, particularly thin and moderately or strongly curved canals with a laminar section are more difficult to shape and involve a con-siderable risk of failure. Despite its super elastic qualities, Nickel-Titanium alloy has one impor-tant inconvenience, namely its low resistance in case of repeated use which results in instrument separation. Instrument fracture can occur either through material fatigue caused by a signifi-cant number of compression-tension cycles or through torsion due to obstruction of the in-strument’s tip in the canal.2,4 A certain number of factors such as the pressure exercised on the contra-angle head5, the speed of rotation and the number of clinical applications favour the oc-currence of instrument separation. In addition to these procedural mistakes, instrument diameter, taper, profile6,7 and machining as well as canal curvature are crucial for the occurrence (or not) of instrument fracture.8Continuous rotation ver-sus reciprocating technique In recent years, we have seen several alternating movement systems (clockwise counter-clockwise rotation) come forward, destined to limit instrument separa-tion, for example M4® (Sybron Endo), Endo-Eze AET® (Ultradent), EndoExpress® (Essential Dental System), WaveOne® (Dentsply) and Re-ciproc® (VDW). The alternative movement tech-nique varies between 30° and 90°, being thus either symmetric or asymmetric, depending on the manufacturer. The kinetics of reciprocation reproduces the manual movement of the intra-

canal file, restricts the risk of instrument fracture and facilitates the penetration into calcified ca-nals.9

The systems with a 90° alternative and sym-metric movement require a large instrumental sequence whereas the systems limited to a 30° movement have a restricted cutting capacity and a tendency to extrude dentine and pulp debris towards the periapex.10 The latest generation systems with an asymmetric range do not re-quire any pressure being exercised on the con-tra-angle head. Although an evolution of the GI-ROMATIC® technology seemed to be possible, the new One Shape® instrument is used in con-tinuous rotation. The acknowledged benefits of this rotational dynamic are an excellent tactile sensation and a remarkable cutting efficiency. The difficulty in the instrument’s development lies in its profile which is specifically dedicated to root canal shaping with only one single instru-ment in continuous rotation.Instrument profileThe instrument’s variable cross-section with a diameter of 25/100 mm and a .06 taper con-stitutes the innovation of One Shape®. The resistance of a NiTi instrument to separation as a result of torsion and bending depends on its diameter and cross-section.11,12 2 cutting edges provide an outstanding resistance to bending whereas a triple helical pitch better withstands torsion.13

One Shape® presents 3 different cross-section zones along its length to ensure greater flexibil-ity and limit aspiration. The 16 mm cutting zone consists of:A first zone with a length of 2 mm presenting a variable 3-cutting-edge design to ensure a cen-tred progression of the file towards the apex.

Dr. Jérome Elias

Dr. Jean-Jacques J-J Bonnin


pic 1

[email protected]


54


Endodontics

At the same time the file respects the initial ca-nal path and curvatures, due to the guidance of its non-working tip. A second transitional zone with a length of 7.5 mm which progressively changes from 3 to 2 cutting edges. A third coro-nal zone with a length of 6.5 mm provided with 2 symmetric and positive cutting edges for an efficient upward debris removal.The innovative concept of an instrument with variable cross-sections facilitates the downward movement in the root canal, guarantees greater flexibility and respects the original canal path, thanks to a centred progression and the con-tinuous rotation technique.A single use instrumentOne Shape® is a single use instrument. Howev-er, it can be used for the endodontic treatment of teeth with one or more roots. Above all, the single instrument concept implies a considerable simplification of the application protocol and thus ensures safe and efficient root canal shap-ing, whereas the single use concept avoids a sys-tematic control of the tip or the file for unwind-ing signs. The single use concept – One Shape® is supplied in sterile blister packaging14 – which also prevents cross-contamination as a conse-quence of insufficient instrument decontamina-tion. Finally, the single use concept evades the weakening of NiTi instruments due to their con-tact with sodium hypochlorite irrigating solution and autoclaving.15,16

Instrumental dynamicThe use of One Shape® requires an endodontic contra-angle connected to a “traditional” motor with a rotational speed of 400 rpm. The instrument gradually descends into the root canal by simultaneously brushing the canal walls in a range of 1 to 2 mm without pressure on the contra-angle head. This brushing process eliminates dentine overhangs and constraints.17

One Shape® shapes the root canal and limits obstructions towards the apex. Once the working length is reached, a wide range brushing movement with pressure exercised on the canal walls is recommended in order to verify the free space of the One Shape® instrument in the canal and eliminate the pulp parenchyma. This mechanical preparation process with a wide taper ensures extensive irrigation and efficient cleaning of the root canal system.19

Respecting the anatomy and the constriction of

the apical zone is essential for the success of each endodontic treatment. An over instrumentation beyond the apical limit with wide tapered NiTi files always results in apical zipping20, over obturation with apical transgression and a defect in the three-dimensional sealing.21 This type of complication during the operation often leads to the failure of the endodontic treatment, particularly in case of a preoperative, periapical radiolucency.22 Expert opinions differ considerably concerning the perfect diameter and taper for the preparation of the last apical third. A circular preparation of the constriction or an apical limit prepared with a diameter of 40/100 mm and a .06 taper is not “cleaner” than a preparation with a diameter of 20/100 mm and a .08 taper.23

However, the precise determination of the apical limit and its verification during the operation are vital for a successful endodontic treatment.25

The working length actually evolves during the root canal preparation due to the instrument’s linear action.24

ProtocolThe One Shape® method helps to carry out a safe root canal preparation provided that the simple protocol is applied. As for all the root canal preparation methods the pulp chamber opening has to be sufficient for a direct access to the canal system. Dentin overhangs have to be eliminated. The real challenge in endodontics is to locate the canal path, make it permeable and secure it down to the working length.26

The exploration of the root canal is accomplished by using either a MMC 15 type manual file or mechanized instruments such as G-Files® 12/100 mm or/and 17/100 mm. In the case of a strongly curved canal path, the coronal part of the canal has to be widened and straightened by using EndoFlare®. This procedure also restricts the bending stress on the instrument during the preparation of the canal’s most apical portion.28

After validation of the exploration process, the pulp chamber has to be thoroughly irrigated using sodium hypochlorite (3 % to 5.25 %).The action of the One Shape® instrument starts with a downward movement of a few millimetres into the canal at a rotational speed of 400 rpm. As soon as a resistance is encountered, a low range up and down movement has to be carried out. This brushing movement on the canal

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walls facilitates the access to the apical third. To accurately measure working length and achieve apical patency, a thin diameter file connected to an electronic apex locater will guarantee maximum precision. This determination method of the apical limit after enlargement of the coronal 2/3 yields reliable and reproducible results, particularly in long and curved canals.29

As a matter of fact, the working length varies significantly during root canal shaping. A MMC 15 file retraces the canal path, frees the foramen from any obstruction and activates the irrigation solution.30 This verification of the apical anatomy is particularly important when using a single in-strument method, since over instrumentation leads to significant post-operative symptomatol-ogy.31 The use of an electronic apex locator is highly recommended32, especially regarding their current precision after elimination of con-straints in the coronal third.33

ConclusionOne Shape® – the single file system for root canal shaping – is a solution destined to practitioners who face the following difficulties:- reluctance to adopt new techniques- aseptic chain organization- insufficient and inadequate root canal preparation. appearance of overhangs and constraints- mechanized instrument separation- complex instrumental protocol- long and difficult shaping. The single instrument One Shape® is an innovative concept for root canal shaping. Thanks to its diameter of 25/100 mm and its .06 taper, this instrument with a simple and rapid protocol allows even the shaping of thin and curved root canals. The instrument design combined with a continuous rotation movement guarantees a reliable efficacy all the way down to the apex without stress on the instrument.

1. PETERS OA. CURRENT CHALLENGES AND CONCEPTS IN THE PREPARATION OF ROOT CANAL

SYSTEMS: A REVIEW. J ENDOD 2004;30:559–67.2. ALAPATI SB, BRANTLEY WA, SVEC TA, POWERS JM, NUSSTEIN JM, DAEHN GS.SEM OBSERVATIONS OF NICKEL-TITANIUM ROTARY ENDODONTIC INSTRUMENTS THAT FRAC-TURED DURING CLINICAL USE. J ENDOD 2005;31:40–3.3. BERUTTI E, CHIANDUSSI G, GAVIGLIO I, IBBA A. COMPARATIVE ANALYSIS OF TORSIONAL

AND BENDING STRESSES IN TWO MATHEMATICAL MODELS OF NICKEL-TITANIUM ROTARY IN-

56


Endodontics

REFERENCES

STRUMENTS: PROTAPER VERSUS PROFILE. J ENDOD 2003;29:15–9.4. PARASHOS P, MESSER HH. ROTARY NITI INSTRUMENT FRACTURE AND ITS CONSEQUENC-ES. J ENDOD 2006;32:1031–43.5. KOBAYASHI C, YOSHIOKA T, SUDA H. A NEW ENGINE-DRIVEN CANAL PREPARATION

SYSTEM WITH ELECTRONIC CANAL MEASURING CAPABILITY. J ENDOD 1997;23:751–4.6. PETERS OA, PETERS CI, SCHEONENBERGER K, BARBAKOW F. PROTAPER ROTARY ROOT

CANAL PREPARATION: ASSESSMENT OF TORQUE AND FORCE IN RELATION TO CANAL ANATOMY.INT ENDOD J 2003;36:93–9. 7. BLUM JY, COHEN P, MACHTOU P, MICALLET JP. ANALYSIS OF FORCES DEVELOPED

DURING MECHANICAL PREPARATION OF EXTRACTED TEETH USING PROFILE NITI ROTARY IN-STRUMENTS. INT ENDOD J 1999;32:24–31.8. YARED GM, BOU DAGHER FE, MACHTOU P. INFLUENCE OF ROTATIONAL SPEED, TORQUE

AND OPERATOR’S PROFICIENCY ON PROFILE FAILURE. INT ENDOD J 2001;34:47–53.9. ANN R AUSTRALAS COLL DENT SURG. 1991 OCT;11:82-95. ANATOMICAL BARRI-ERS IN ENDODONTICS. MARTIN AP10.REDDY SA, HICKS ML: APICAL EXTRUSION OF DEBRIS USING TWO HAND AND TWO

ROTARY INSTRUMENTATION TECHNIQUES, J ENDOD 24:3, PP. 180-183, 1998.11. GUILFORD WL, LEMONS JE, ELEAZER PD. A COMPARISON OF TORQUE REQUIRED

TO FRACTURE ROTARY FILES WITH TIPS BOUND IN SIMULATED CURVED CANAL. J ENDOD

2005;31:468 –70.12. TURPIN YL, CHAGNEAU F, VULCAIN JM. IMPACT OF TWO THEORETICAL CROSS-SEC-TIONS ON TORSIONAL AND BENDING STRESSES OF NICKEL-TITANIUM ROOT CANAL INSTRUMENT

MODELS. J ENDOD 2000;26:414 –7.13. BERUTTI E, CHIANDUSSI G, GAVIGLIO I, IBBA A. COMPARATIVE ANALYSIS OF TOR-SIONAL AND BENDING STRESSES IN TWO MATHEMATICAL MODELS OF NICKEL-TITANIUM ROTARY

MODELS: PROTAPER VERSUS PROFILE. J ENDOD 2003;29:15–914. LETTERS S, SMITH AJ, MCHUGH S, BAGG J: A STUDY OF VISUAL AND BLOOD

CONTAMINATION ON REPRO- CESSED ENDODONTIC FILES FROM GENERAL DENTAL PRACTICE,BR DENT J 199:8, PP. 522-525, 2005.15. SERENE TP, ADAMS JD, SAXENA A. NICKEL-TITANIUM INSTRUMENTS. APPLICATIONS IN

ENDODONTICS. ST. LOUIS, MO: ISHIYAKU EUROAMERICA, INC., 1995.16. CHAVES CRAVEIRO DE MELO M, GUIOMAR DE AZEVEDO BAHIA M, BUONO V. FA-TIGUE RESISTANCE OF ENGINE-DRIVEN ROTARY NICKEL-TITANIUM ENDODONTIC INSTRUMENTS.J ENDOD 2002;28:765–9.17. LI UM, LEE BS, SHIH CT, LAN WH, LIN CP. CYCLIC FATIGUE OF ENDODONTIC NICK-EL-TITANIUM ROTARY INSTRUMENTS: STATIC AND DYNAMIC TESTS. J ENDOD 2002;28:448 –51.18. YARED GM, BOU DAGHER FE, MACHTOU P. CYCLIC FATIGUE OF PROFILE ROTARY

INSTRUMENTS AFTER CLINI- CAL USE. INT ENDOD J 2000;33:204 –7.19. RUDDLE CJ: ENDODONTIC DISINFECTION: TSUNAMI IRRIGATION, ENDODONTIC PRACTICE

11:1, PP. 7-15, 2008.20. IQBAL MK, FIRIC S, TULCAN J, KARABUCAK B, KIM S. COMPARISON OF APICAL

TRANSPORTATION BETWEEN PROFILE AND PROTAPER NITI ROTARY INSTRUMENTS. INT ENDOD

J 2004;37:359–64.21. YARED GM, BOU DAGHER FE. APICAL ENLARGEMENT: INFLUENCE ON OVEREXTEN-SIONS DURING IN VITRO VERTICAL COMPACTION. J ENDOD 1994;20:269–71.22. DE CHEVIGNY C, DAO TT, BASRANI BR, ET AL. TREATMENT OUTCOME IN ENDODON-TICS: THE TORONTO STUDY—PHASE 4: INITIAL TREATMENT. J ENDOD 2008;34:258–63.23. ALBRECHT LJ, BAUMGARTNER JC, MARSHALL JG: EVALUATION OF APICAL DEBRIS

REMOVAL USING VARIOUS SIZES AND TAPERS OF PROFILE GT FILES, J ENDOD 30:6, PP.425-428, 2004.24. DAVIS RD, MARSHALL JG, BAUMGARTNER JC. EFFECT OF EARLY CORONAL FLARING

ON WORKING LENGTH CHANGE IN CURVED CANALS USING ROTARY NICKEL-TITANIUM VERSUS

STAINLESS STEEL INSTRUMENTS. J ENDOD 2002;28:438–42.25. WEINE FS, KELLY RF, LIO PJ. THE EFFECT OF PREPARATION PROCEDURES ON ORIGINAL

CANAL SHAPE AND ON APICAL FORAMEN SHAPE. J ENDOD 1975;1:255–62.26. WEST, JD: THE ENDODONTIC GLIDEPATH: SECRET TO ROTARY SAFETY, DENTISTRY TO-DAY 29:9, PP. 86-93, 2010.27. LEEB J. CANAL ORIFICE ENLARGEMENT AS RELATED TO BIOMECHANICAL PREPARA-TION. J ENDOD1983;9:463–70. 28. SATTAPAN B, NERVO GJ, PALAMARA JE,MESSER HH. DEFECTS IN ROTARY NICKEL-TITANIUM FILES AFTER CLINICAL USE. J ENDOD

2000;26:161–5.29. WEINE FS, KELLY RF, LIO PJ. THE EFFECT OF PREPARATION PROCEDURES ON ORIGINAL

CANAL SHAPE AND ON API- CAL FORAMEN SHAPE. J ENDOD 1975;1:255–62.30. BERUTTI E, CANTATORE G, CASTELLUCCI A, ET AL. USE OF NICKEL-TITANIUM ROTARY

PATHFILE TO CREATE THE GLIDE PATH: COMPARISON WITH MANUAL PREFLARING IN SIMULATED

ROOT CANALS. J ENDOD 2009;35:408–12.31. PAK JG, WHITE SN. PAIN PREVALENCE AND SEVERITY BEFORE, DURING, AND AFTER

ROOT CANAL TREATMENT: A SYS- TEMATIC REVIEW. J ENDOD 2011;37:429–38.32. RAVANSHAD S, ADL A, ANVAR J. EFFECT OF WORKING LENGTH MEASUREMENT

BY ELECTRONIC APEX LOCATOR OR RADIOGRAPHY ON THE ADEQUACY OF FINAL WORKING

LENGTH: A RANDOMIZED CLINICAL TRIAL. J ENDOD 2010;36:1753–6.

The Power. The Silence. The new TornadoSuper

Silent

COMPRESSED AIR

SUCTION

IMAGING

DENTAL CARE

HYGIENE

Tornado – the new generation of compressors from Dürr Dental

Dürr Dental, the inventor of oil-free dental compressors, presents an

unbelievably quiet and powerful compressor for dentistry in the form

of the new “Made in Germany“ Tornado.

▪ Oil-free, dry, and hygienic

▪ One of the quietest of its kind

▪ Dust- and Sandresistant

▪ Antibacterial inner tank coating

▪ Low-maintenance thanks to membrane-drying unit

Duerr Dental Middle East, P.O.Box: 87355, Al Ain - U.A.E.,

Mobile: +971 (0) 50 - 550 84 12, Fax: +971 (0) 3 767 - 5615,

email: [email protected]



CAD/CAM & Digital DentistryInternational Conference8th Edition

02 - 03 May 2013

JW Marriott Marquis Hotel Dubai, UAE

Dr. Mark Morin

USA

Digital CAD/CAM Revolution

Clinically The Power and Ability

of CAD/CAM Technology

Dr. Eduardo Mahn

Chile

Persuing Maximum Esthetics and

Simplicity for Everyone with

Modern CAD/CAM Materials

Predictable Preparation and

Cementation Protocols for

CAD/CAM Restorations

Joachim A. Maier, MDT

Germany

Dr. med. dent. Karsten Kamm

Germany

HANDS-ON COURSES

CAD/CAM PREPARATION

AND CEMENTATIONDr. Eduardo Mahn, Chile

01st May, 2013

INDIRECT VENEERSDr. Munir Silwadi, UAE

04th May, 2013

3M Innovation Center

DENTAL TECHNICIANS PARALLEL SESSION

Designed Program for Dental Technicians

03rd May, 2013, JW Marriott Hotel Dubai, UAE

KEYNOTE SPEAKERS

Centre for Advanced Professional Practices (CAPP) is an ADA CERP Recognized Provider. ADA CERP

is a service of the American Dental Association to assist dental professionals in identifying quality

providers of continuing dental education. ADA CERP does not approve or endorse individual

courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

ww

w.c

appm

ea.

com

/cad

cam

8

ZOLID: Base for Aesthetic

All-Ceramic with Long-Term

Success

ZOLID: Base for Aesthetic

All-Ceramic with Long-Term

Success

Tel: +971 4 3616174 | Fax: +971 4 3686883 | Mob: +971 50 2793711

Email: [email protected]

Helps stop bleeding gums

Adapted from Saxer et al 1994. All interdental spaces from 6+ to +6 were tested at baseline and 4 weeks for bleeding on probing on the right side (buccal) and left side (lingual). Findings were recorded as 0=no bleeding; 1=slight/isolated bleeding; 2=marked bleeding. Mean scores were determined. N=22.Baseline values [Mean SD]: Control (fluoride-containing toothpaste) group 24.75 (6.34); parodontax® group 25.40 (6.80). After 4 weeks: Control (fluoride-containing toothpaste) group 26.00 (9.14); parodontax® group 19.80 (7.38). *parodontax® vs control p<0.05.

Baseline 4 weeks 4 weeksBaseline

Ch

ang

e vs

bas

elin

e in

ble

edin

g

on

pro

bin

g in

dex

aft

er 4

wee

ks

30.00

25.00

20.00

15.00

10.00

5.00

0.00

Reduced bleeding on probing index after 4 weeks with parodontax®9*

22%reduction in

bleeding

Fluoride-containingcontrol toothpaste

parodontax®

In ‘bleeding on probing’ trials over 4 weeks, parodontax®

demonstrated significant effects in reducing bleeding gums by 22% (p<0.01)

Bleeding on probing increased after 4 weeks of brushing with the fluoride control toothpaste

(p<0.01 vs. baseline)

Helps stop bleeding gums

OH

/CA

/00/

13/0

03


Cairo University 3rd International Dental Congress More Pictures

Available OnJanuary 22-25, 2013InterContinental Citystars, Cairo www.facebook.com/dentalnews1

64

Dear ColleaguesRevolutions by their nature aspire for change; a change to the better. Our faculty finds itself a part of the Egyptian revolution for change, and it aspires for a revolu-tionary approach to gather new evidence in the art and science of Dentistry and to present it to our fellow dental professionals in their coming event. This is part of our continuous mission to promote Dentistry and to thrive to play our pioneering role in leading scientific development in our profession. A mission that provided the den-tistry community with prominent figures who held and still hold leading positions in the region.Many scientists from all over the world share in this conference with lectures, scien-tific presentations and workshops in addition; the dental show allows the introduc-tion of all that is new and innovative in equipment and materials used in dentistry. The accumulation of what will be presented in the conference will be summarized and presented in the conference recommendation presented in the final celebration.Prof. Hicham Katamish, President of the congress

PICTURES FROM THEEXHIBITION FLOOR

PROF. HESHAM KATAMISH

PROF. MOHAMAD SHARAWY / BONE BIO ENGINEERING PROF. TAREK SHARKAWY / BOTOX IN DENTISTRY

DELEGATES FROM THE ARAB COUNTRIES ATTENDING THE CAIRO UNIVERSITY INTERNATIONAL CONGRESS

LEBANESE UNIVERSITY SCHOOL OF DENTISTRY 13th INTERNATIONAL CONVENTION MAY 8 - 9 - 10 - 11, 2013, BEIRUT, LEBANON

GATEWAY TO EXCELLENCE IN DENTISTRY

Venue: President Rafic Hariri Campus, Hadath, Beirut, Lebanon. Scientific Program: Formal Lectures, Pre-Congress hands-on workshops for limited groups (may 8, 2013), LUSD Departmental Specialized Seminars, Research Session, Posters Exhibition, Corporate seminars,Young Podium for Postgaduate Students and Residents, and Live Transmissions of Clinical Dentistry.Convention's Scientific Chairperson and contact person: Dr. ZIAD NOUJEIMConvention's President: DEAN and PROFESSOR MOUNIR DOUMITConvention's General Coordinator: ASSISTANT PROFESSOR MOHAMMAD RIFAIE-mails: [email protected]'s Registration Fees (May 9-10-11, 2013, including 2 meals):Undergraduate / Postgraduate students / residents and Lebanese University Alumni and Faculty : 50,000 Lebanese LirasPracticing Dentists: 100,000 Lebanese LirasPre-Congress Hands-on Workshops (May 8, 2013) Registration Fees : 50.000 Lebanese Liras per workshop.

SECOND ANNOUNCEMENT

Biomaterials and Biomedical EngineeringProfessor John E. Davies, Canada

Stem Cell TherapyDr. Tabasum Farzaneh, UKDr. Franck Chaubron, FranceProfessor Nada Ala'eddine, LebanonDr. Rima Hamdane Khalil, Lebanon

Regenerative Dentistry Professor Charles Sfeir, USAProfessor Thimios Mitsiadis, Switzerland

Computerized ProsthodonticsProfessor Gerard Duminil, France

Oral and Maxillofacial Pathology and MedicineProfessor Roger Kuffer, FranceProfessor Herve Reychler, BelgiumProfessor Mohammad Sandid, LebanonDr. Dima Mikati, UK

Restorative and Esthetic DentistryProfessor Jeff Blank, USA

Dental and Maxillofacial Radiology and ImagingProfessor Reinhilde Jacobs, BelgiumProfessor Marcel Noujeim, USA

Fixed Prosthodontics Professor Miltiadis Mitsias, Greece

Emergency MedicineDr. Daniel Kahale, Lebanon

Periodontology and Surgical Dental ImplantologyProfessor Edmond Benque, FranceProfessor Jean-Louis Giovannoli, FranceProfessor Korkud Demirel, TurkeyProfessor Roberto Rossi, ItalyProfessor Jean-Marie Megarbane, Lebanon

Implant DentistryDr. Arzu Naipoglu, TurkeyEngineer Holger Zipprich, GermanyDr. Christoph Ratka, GermanyDr. Souheil Bechara, Lithuania

Oral, Pre-Implant, Reconstructive SurgeryProfessor Jean-Pierre Bernard, SwitzerlandProfessor Georges Tawil, LebanonProfessor Michel Jabbour, France

Oral and Maxillofacial SurgeryProfessor Jean-Fancois Tulasne, FranceProfessor Nabil Hokayem, LebanonProfessor Nabil Barakat, LebanonDr. Said Halabi, LebanonDr. Fawzi Riachi, Lebanon

Orthodontics and Dentofacial OrthopedicsProfessor Roberto Justus, MexicoProfessor Dimitrios Mavreas, Greece

Dental, Oral, and Craniofacial ResearchProfessor Mutlu Ozcan, SwitzerlandProfessor Giampiero Cordioli, ItalyProfessor Bassam Badran, LebanonProfessor Moustafa Aboushelib, EgyptProfessor Hala Maher Ragab, EgyptDr. Nadim Moqbel, LebanonDr. Carole Chakar, Lebanon

Removable ProsthodonticsDean and Professor Corinne Taddei, FranceProfessor Tony Daher, USAProfessor Nadim Baba, USA

Pediatric DentistryProfessor Maryse Wolikow, FranceProfessor Jean-Louis Sixou, FranceDr. Krystel Chebib, FranceProfessor Nada Farhat Mchayleh, Lebanon

Dental HygieneLise Slack, Australia

EndodonticsProfessor Josette Camilleri, MaltaProfessor Yolanda Justus, MexicoProfessor Elias M. Maalouf, LebanonDr. Wilhelm Pertot, FranceDr. Hani Ounsi, KuwaitProfessor Ahmad Abdel Rahman Hashem, Egypt

Implant EstheticsProfessor Tareq Abu-Saleh, Jordan

LIST OF GUEST SPEAKERS

Convention's official languages: English and French

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24th Saudi Dental Society International Dental Conference

More PicturesAvailable On

January 28-30, 2013Riyadh International Convention & Exhibition Center, Riyadh, KSA www.facebook.com/dentalnews1

Dear Colleagues,First of all, I would like to thank you for your wholehearted support that made the Saudi Dental Society the “1st Scientific Society according to the results of evaluating the performance efficiency 143-1432AH”. We definitely cannot receive this award without your help. Our international speakers for this year’s conference will be of different specializations, with the latest and high technological aspects applied in the dental fields that will be shared to all the participants attending this conference. Advanced Continuing Education Courses will also be given to our General Practitio-ners, Dentists, Students, Dental Assistants, Technicians and Hygienists for further information about their vocations. Other highlight of this conference will be the Research Award’s Competition whose candidates will be coming from the Graduate Students, Young Dentists, Interns and students who will participate in the three dif-ferent categories of the competition. Again, I will be expecting your full support and cooperation to make this conference a fruitful and successful one. Dr. Ahmed M. Al-Kahtani, Chairman of the Organizing Committee

68

PICTURES FROM THEEXHIBITION FLOOR

AEEDC DUBAIMore PicturesAvailable On

February 5-7, 2013Dubai International Convention and Exhibition Centre (DICEC)

70

www.facebook.com/dentalnews1

The 10th Global Scientific Dental Alliance-GSDA meeting was held on 6 February 2013 during AEEDC Dubai 2013.More than 66 Heads and Directors from the Dental Associations, Ministry of Health (Dental Department) and Deans of the Den-tal Universities have actively contributed to this significant annual meeting. GSDA meeting facilitated the exchange of new ideas, knowledge and conveyed vital issues in Oral and Dental Health Care. This years meeting discussed the current program activities held during AEEDC Dubai and put emphasis on the involvement of the Executive Leaders from the WorldDental Manufacturing companies, aiming to integrate their scientific activities into AEEDC Dubai Scientific Program and to support Young Research Presentations at future AEEDC. At the final stage, tokens of appreciation were presented to the members of GSDA Executive Board, AEEDC International Scientific Advisory Board and the Associations / Organisations of the alliance. It was followed by a special recognition for the top 3 largest conference delegations starting from Saudi Dental Society, Iraqi Dental Association and Yemen Dental Association.

DR. DEREK MAHONY DR. RONALD YOUNES

LEFT TO RIGHT: MR. ABULSALAM MADANI, DR. MOHAMAD AL OBEIDA, PR. ABDULALLAH SHAMMERI

PR. IBRAHIM NASSIF

TROPHY TO DR. ELIE MAALOUF PRESIDENT OF THE LDA

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VITA ENAMIC® creates a new definition for resistanceThe first hybrid ceramic with dual network structure for unsurpassed absorption of masticatory forces

VITA ENAMIC sets new standards for resistance by

combining strength and elasticity and providing unsur-

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Superior protection

new One Shape® Discovery Kit 2!

The new fluoride varnish system Fluor Protector N from Ivoclar Vivadent offers professional protection of teeth against hyper-sensitivity, caries and erosion.

Dental units in their most appealing form.

Each kit compiles One Shape® files, the one and only NiTi instrument in continuous rotation for quality root canal preparations:One Shape® Discovery kit 2 – L 25 mm:* 3 blisters of 5 One Shape® instruments* 1 pack of 1 ENDOFLARE® + 1 G-File G1 + 1 G-File G2 * 1 watchREF. 51400091-2One Shape®, THE new asset in endodontic instruments. Simplicity and safety…

-tions: safety for patients and staff.

For more information [email protected]

The innovative varnish technology of Fluor Protector N is based on decades of experience in the development and manufacturing of dental varnishes by Ivoclar Vivadent and was developed in close cooperation with dentists and their teams. The varnish system contains fluoride in a homogeneous solution, which ensures immediate availability of fluoride. The varnish directly and effectively covers the dental enamel and releases fluoride within a very short time. Furthermore, a high-yield depot is formed from which calcium in addition to fluoride is released over an extended period of time. Fluor Protector N has a mild taste and smell and is therefore especially suitable for children and sensitive patients.For more information www.ivoclarvivadent.com

#78

The Cavex Bite&White Professional Dental Whit-ening System is a safe, fast and easy-to-use teeth whitening system by Cavex Holland. Cavex Bite&White is a bleach treatment that is easy to carry out. It takes up very little time in the dental chair and the treatment places a minimum of strain on the patient. Additionally, the desired result is quick to achieve. Treatment with Cavex Bite&White is carried out using custom-made bleaching trays. Dentists, more than anyone else, are capable of assessing whether a bleaching treatment will be successful. That is why Cavex Bite&White is exclusively provided to dentists. Cavex Bite&White contains 16% carbamide peroxide, a material that has proven itself as a bleaching agent on a global basis. It is effective without being harmful. Sodium fluoride to strengthen tooth enamel and potassium nitrate to reduce sensitivity are included as supplements. Mint is included for a fresh fragrance and a pleasant taste in the event some of the material escapes from the mould. Cavex Bite&White was already available as a starter kit and refill and now an advantageous bulk packaging is available for large-volume users. The bulk packaging comprises a box with 10 refill packages. For more information www.biteandwhite.nl

CAVEXYOUR IMPRESSION IS OUR CONCERN

Cavex ImpreSafe, make sure! Cavex ImpreSafe is a revolutionary disinfectant for alginate, silicone and polyether impressions. Being highly effective, Cavex ImpreSafe effectively kills bacteria, fungi and viruses in only 3 minutes. Due to the non-aggressive nature as well as a short contact time Cavex ImpreSafe is 100% save for impression surfaces. Cavex ImpreSafe was tested by the Dental Advisor and received an impressive 5+ rating as well as the award “Editor’s Choice”.

Features

practice

ImpreSafe to be highly reliable and efficient

Cavex Bite&White….we get smiles!Cavex Bite&White is a professional, fast (only 1 hour a day) and easy to use dental tooth-whitening system. Cavex Bite&White is a so-called dentist dispensed system with as the effective ingredient hydrogen peroxide.

Indications

Features

stays in place

and for restoring the micro hardness

Turn Complex Class II into Simple Class I Cases

* Images courtesy of Dr. Clark Colville.

© 2012 Ortho Organizers, Inc. All rights reserved.

With its non-invasive design, the Carriere Distalizer Appliance corrects Class II malocclusion at

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Start of treatment, prior to placement

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Class II to Class I achieved, and

Carriere Distalizer Appliance treatment

completed 8.30.10

Total orthodontic treatment

completed 3.7.12

SHIFTING THE WAY YOU THINK ABOUT ORTHODONTICS.The Carriere® Distalizer™ Appliance

Documents

Dental News March 2013