Smile Dental Journal | December 2010 - Volume 5, Issue 4 | www.smiledentaljournal.com | Distributed free of charge Dental Journal Dentofacial Cephalometric Values for Emirati Adults with Values for Emirati Adults with Biomimetic Normal Occlusion and Normal Occlusion and Ceramic Veneers: Well-Balanced Faces Well-Balanced Faces a Successful Team Concept a Successful Team Concept An Interdisciplinary An Interdisciplinary Approach for Restoring Approach for Restoring Function and Esthetics Function and Esthetics Pre-Orthodontic Assessment in a Patient with in a Patient with of a Non-Syndromic Multiple of a Non-Syndromic Multiple Amelogenesis Imperfecta: Supernumerary Teeth with Supernumerary Teeth with Cone Beam Imaging Cone Beam Imaging A Case Report Diffuse Inflammatory Advancement in Facial Swelling Secondary Facial Swelling Secondary the Removal to Local Anesthetic Injections to Local Anesthetic Injections of Permanently Cemented of Permanently Cemented in Patient with Polyalkylimide in Patient with Polyalkylimide Crowns and Bridges Crowns and Bridges Used for Cheek Augmentation Gel Used for Cheek Augmentation Gel ISSN: 2072-473X Panoramic imager Discover the new X7 Series Cephalometric Teleradiography Advanced kinematics X7 Cephalometric Teleradiography www.my-ray.com More Safety in Deep Proximal Cavities: Innovative Bulk-Fill Composite Shows Good Wetting Behaviour and Reduced Shrinkage Stress by Dr. Michael Naumann Clinical Case then the dentin; the latter for no more than 15 suitable. The transitions to the tooth structure were The following case report, illustrated by Figures 1 to seconds. The etchant was thoroughly rinsed away, improved with a sickle-shaped scalpel, and the 6, describes the use of SDR™ (DENTSPLY DeTrey, and the cavity was dried. Great care was taken not occlusal contacts were adjusted with a diamond. Konstanz, Germany) in combination with Ceram•X™ to over-dry or desiccate the cavity, since excessive PoGo® rubber polishers (DENTSPLY DeTrey) were duo+ (DENTSPLY DeTrey). The only bonding system drying is one of the main causes of postoperative used to polish the restoration. currently used in my practice is XP BOND®, if light sensitivity. To perfectly pre-treat a cavity for wet curing is sufficient, or XP BOND® plus Self Cure bonding, it is also advisable to slightly rewet the Conclusion Activator, if dual curing is necessary (adhesive dentin surfaces. This is best achieved if the assistant Although treatment time was not the main aspect in placement of posts for core build-ups, cementation holds the adhesive applicator in the water spray this case, SDR™ provided a highly efficient filling of inlays). Both situations require the use of the total- produced by the air/water syringe at a distance of technique. In my view, the handling properties are etch technique (also known as the etch-and-rinse 30cm. The cavity will be sufficiently moisturized in more important, considering that conventional technique). In this case, proximal recurrent caries this way; it is definitely unnecessary to sprinkle it composites are often difficult to apply to proximal was diagnosed under a discoloured, seven-year-old with water! After dentin rewetting, the bonding agent areas and may not adequately adapt to cavity walls composite filling in tooth 35. The old filling and the was applied to both dentin and enamel and light- and, above all, cavity floors. SDR™ seems to decay were removed, a rubber dam was applied, and cured for 10 seconds. considerably increase safety in direct restorative a matrix band ensuring a well-contoured contact therapy. Composite restorations with SDR™ can be area was tightly wedged in the proximal-apical Then the proximal box of the cavity was bulk-filled expected to show a good marginal seal and a region. My experience is that it will pay off to spend with SDR™. The new filling technique greatly reduced risk of recurrent caries. This report some extra time on these preliminary steps; it will facilitates the restorative procedure, because the describes my first experience of the new material. easily be compensated for by the time saved in the material can be placed in increments of up to 4mm. My current opinion: subsequent finishing procedure. The overall quality The occlusal box was filled with a second increment. Recommendable! of the restoration will also be improved, because SDR™ was very easy to use, thanks to its flowable proximal surfaces are hardly or not at all accessible consistency, good wetting behaviour and self- for intensive finishing. The next treatment step was levelling properties. Without any conditioning of the acid etching. First the enamel was conditioned, and SDR™ surface, Ceram•X™ duo+ (DENTSPLY DeTrey) was applied, using the shades D3 for another dentin layer, and E3 for a thin final enamel layer. This combination ensured good aesthetics and abrasion Visit us at resistance. However, any other composite material indicated for posterior teeth would have been equally AEEDC 2011 stand numbers 369, 370, 375 and 376 Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Please visit our website www.dentsplymea.com for more information Stop layering. Start filling. * Chemically compatible with methacrylate based adhesives and composites. • Increments up to 4 mm without layering For better dentistry • Excellent flow-like cavity adaptation • Compatible with your current adhesive* Editorial Review Board International Advisory Board 06 44 Contents Orthodontics Dentofacial Cephalometric Values for Emirati Adults Product Review • Dr. Eyas Abu-Hijleh • Prof. Abdullah R. Al-Shammery / KSA To Organize or To Organize? DDS, PhD, Orthodontics & Dentofacial Orthopedics BDS, MS Restorative Dentistry with Normal Occlusion and Well-Balanced Faces Rector, Riyadh Colleges of Dentistry & Pharmacy That is the Question By Amjad Al Taki, Eyas Abuhijleh, Khulood Jamal Bin Haider 46 • Dr. Layla Abu-Naba’a • Prof. Magid Amin Ahmed / Egypt Radiology 12 BDS, MFD, RCS, PhD, Prosthodontics Oral & Maxillo-Facial Surgery Research Vice President MSA University Pre-Orthodontic Assessment of a Non-Syndromic Multiple Summaries in • Dr. Ali Abu Nemeh Dean, Faculty of Dentistry MSA University Focus • Prof. Jamal Aqrabawi / Jordan Supernumerary Teeth with Cone Beam Imaging BDS, NDB, MSc, Endodontics Interventions for Replacing DDS, DSc, DMD Endodontics By Elie Hayek, Georges Khawam, Ibrahim Nasseh Dental Faculty, University of Jordan Missing Teeth: Antibiotics at • Dr. Hazem Al-Ahmad Surgery Dental Implant Placement BDS, MSc, FDSRCS, Maxillo-Facial Surgery • Prof. Stephen Cohen / USA to Prevent Complications 18 MA, DDS, FICD, FACD Diffuse Inflammatory Facial Swelling Secondary to Local • Dr. Muna Al-Ali Diplomate, American Board of Endodontics (Review) BDS, MFDS Anesthetic Injections in Patient with Polyalkylimide Gel Used for • Prof. Nabil J. 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Into Debrided Infected • Prof. Azmi Darwazeh / Jordan (Oral Med), GradDip ForOdont (Melb) Esthetics 24 Quarterly Issued BDS, MSc, PhD Oral Pathology Oral Medicine Dentoalveolar Sockets Former Dean, Faculty of Dentistry JUST Distributed Free of Charge • Dr. Zaid Al-Bitar Examiner, Faculty of Dentistry RCS Ireland An Interdisciplinary Approach for Restoring Function and Esthetics BDS, MSc, MOrth, RCS, Orthodontics in a Patient with Amelogenesis Imperfecta: A Case Report +962 7 96367954 • Prof. Mohamed Sherine Elattar / Egypt Do Periodonto-Pathogens • Dr. Raed Al-Jallad BDS, MSc, PhD Prosthodontics By Sunil Kumar Gupta, Shashi Rashmi Acharya, Jaya Siotia, Amar A Sholapurkar Amman, Jordan Dean, Faculty of Dentistry, Pharos University Disappear After Full-Mouth firstname.lastname@example.org BDS, MSc, FFDRCS, FDSRCS, Oral & Maxillofacial Tooth Extraction? 30 President of AOIA Prosthodontics 54 email@example.com Surgery • Prof. Fouad Kadim / Jordan www.smiledentaljournal.com BDS, MSc, PhD Conservative Dentistry Advancement in the Removal of Permanently Cemented • Dr. Hani Al Kadi Flash News Vice Dean, Faculty of Dentistry, University of Jordan Crowns and Bridges BDS, Dip ODONT, MDS, Endodontics Director Dr. Ma’moon A. 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As a consequence the society affords those who practice this profession certain privileges that are not available to members of the public-at-large. In return, the profession makes a commitment to society that its members will adhere to high ethical standards of conduct. These ethical standards take different definitions in the different countries but most of them are embedded under the concept of Principles of Dental Ethics, and the profession members act according to a code of professional conducts which govern their required or prohibited actions. The importance of ethics as an integral part of the medical profession – and thus by implication also the dental profession, as dentistry is part and parcel of general health – has been highlighted already by Hippocrates more than 2,000 years ago. The core values of “first, do no harm” and “put the patient first” apply to this very day. Practicing dentistry gives rise to a wide spectrum of potential ethical dilemmas. Modern technology, age, old cultural beliefs and diverse lifestyles could easily give rise to misunderstanding and conflict. Any manual for dental ethics should not list what is right and what is wrong, but provides values and practical examples that will give food for thought and will guide practitioners in making sound ethical decisions in the best interests of their patients. Dental education and training will never be complete unless the curricula of dental schools incorporate a course on dental and medical ethics. In our countries (Arabic countries) ethical standards and behavior in dental practice come from our traditional, religious or trials believes and most of the profession practitioners did not know the ethics as a science that should have code and that this code should be an essential part of their organizing committees. In accordance to that, the presence of such awareness among the dentists is important to gain the community trust in the profession and that awareness needs to be developed through continuous engagement with the activities that raise the attention among the authorities about the importance of involving code of ethical professional conducts in each legislation body for the profession or the applicable laws in the country. This issue of Smile Dental Journal is published in conjunction with the launching of the Arabic version of the FDI Manual of Dental ethics in the Arabic region and Smile supported this distinguished event based on its believe to support each effort that helps the profession including its both parts; dentists and patients. Dr. Hayder Alwaeli Editorial Review Board Member Smile Dental Journal firstname.lastname@example.org | 4 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Calendar of Events February 1 - 3 February 16 - 18 February 18 - 20 AEEDC 2011 EDTA 2011 India International Dental Congress Dubai, UAE Cairo, Egypt Mumbai, India www.aeedc.com www.edta-eg.com www.iidc.in March 2 - 4 14th Congress of ECDS Cairo, Egypt www.ecds2011.com February 24 - 26 March 18 - 19 146 Chicago th 1st PUA International Dental March 22 - 26 Midwinter Meeting Congress & 2nd PUA International IDS 2011 Dental Students Competition Chicago, USA Cologne, Germany www.cds.org Alexandria, Egypt www.english. ids-cologne.de www.pua.edu.eg March 9 - 11 April 14 - 16 April 15 - 16 April 13 - 15 2nd Jordanian International Healthcare, Dentalcare and 1st Iraqi Dental Reunion 15th kuwait Dental Dental Implantology Conference Pharma Syria 2011 IDA Annual Conference Assocciation International Damascus, Syria Scienti c Conference Dead Sea, Jordan Erbil, Iraq www.jos.org.jo www.dentalcaresyria.com www.cappmea.com Al-Hashimi, Kuwait www.kda.org.kw April 6 - 7 7th Jordanian Orthodontic Congress Amman, Jordan www.jos.org.jo May 12 - 13 May 25 - 26 June 2 - 4 5th CAD/CAM 1st Aesthetic 12th Lebanese Dental Dubai, UAE Dentistry Congress University Congress www.cappmea.com Amman, Jordan Beirut, Lebanon www.jda.org.jo www.ul.edu.lb May 9 - 12 5th Jeddah Dental Esthetic Conference Jeddah, KSA www.kfshrcj.org For more events visit www.smiledentaljournal.com or our page on Facebook. Smile Dental Journal | Volume 5, Issue 4 - 2010 | 5 | Dentofacial Cephalometric Values for S SN Plane N Emirati Adults with Normal Occlusion and 7 Po Frankfort Plane 6 Or 5 Well-Balanced Faces 8 11 12 Ar Y axis Plane 9 A Occlusal Plane Abstract Objective: To determine the dentofacial cephalometric values for Emirati adults, and to compare them with those of Caucasians. Go B Mandibular Plane Materials and Methods: Standardized Lateral cephalometric radiographs for 30 (Fig. 3) Vertical skeletal measurements: (5) GoGn-SN; (6) Emirati women and 32 Emirati men with normal occlusion were traced. Yaxis angle; (7) N-S-Ar (Saddle angle); (8) S-Ar-Go (Articular Me Gn angle); (9) Ar-Go-Me (Gonial angle); (10) Sum of angles Results: Skeletal comparisons between Emirati adults and Caucasians showed that (Fig. 1) : The cephalometric Planes and Landmarks used in [(7)+(8)+(9)]; (11) S-Go (Posterior facial height); (12) N-Me Emiratis tend to have decreased SNB angle, increased ANB angle, and increased the study. (Anterior facial height); (13) Jarabak ratio ([S-Go/N-Me] X 100). anterior and posterior facial heights, while dental comparisons showed that Emiratis have bimaxillary dental protrusion and decreased inter-incisal angle. When comparing men with women, both anterior facial height (N-Me) (P<.001) and Posterior facial Amjad Al Taki height (S-Go) (P<0.001) were significantly increased in Emirati men compared with DDS, PhD Emirati women. Assistant Professor Department of Orthodontics Conclusions: Relative to Caucasian cephalometric norms, Emirati adults tend to have 1 School of Dentistry Ajman University of Science increased ANB angle because of retrognathic mandibles. Emirati adults showed longer 2 and Technology Network anterior and posterior facial heights, decreased inter-incisal angle and bimaxillary 14 Ajman, UAE dental protrusion as compared with Caucasians. Emirati men have longer anterior and email@example.com posterior facial height in relation to Emirati women. It is recommended to use these 3 cephalometric values into daily orthodontic practice when formulating a treatment plan for Emirati patients. Eyas Abuhijleh DDS, PhD Keywords: Cephalometric norms, Emirati adults, Anterior facial height. 4 Specialist Orthodontist and Assistant Professor 18 17 Tawam Hospital in Affiliation with Johns Hopkins Medicine Introduction International Dental Centre Cephalometric evaluation of the craniofacial structure plays an important role as a Al Ain, UAE diagnostic guide in orthodontic treatment planning. Nevertheless, orthodontic treatment 16 firstname.lastname@example.org is best when the facial and cephalometric characteristics of the ethnic background of patients are considered. Khulood Jamal Bin Haider (Fig. 2) Antero-posterior skeletal measurements: (1) SNA; 1-NA; (15) 1-NA (mm); (Fig. _ Dental measurements: (14) _ 4) _ The study of cephalometric norms has been part of orthodontics for more than half DDS (2) SNB; (3) ANB; (4) Wits appraisal. (16) 1-NB; (17) 1-NB (mm); (18) 1-1. a century. Steiner,1 Jarabak,2 Downs,3 Ricketts,4 Sassouni,5 and a host of others have Dentistry Resident Dubai Health Authority developed cephalometric analyses and corresponding norms. However, these norms Dubai, UAE were usually based on samples of Caucasians only. Behbehani et al.8 studied the racial variations in the cephalometric values for Emirati adults. And as a cephalometric analyses between whites and Kuwaitis large numbers of Emirati adults are nowadays seeking Differences in the dentofacial relationships of various ethnic groups have been and reported that the Kuwaitis showed a significant orthodontic treatment, it is important to determine the observed by many investigators, and as a result, a number of standards have been bimaxillary protrusion. dentofacial cephalometric values for this particular ethnic developed for various racial and ethnic groups. group and to base our treatment plans accordingly. Hassan9 established Cephalometric Norms for Saudi To date there are few published cephalometric norms for Arabic population. Bishara Adults Living in the Western Region of Saudi Arabia and The aim of this study is to evaluate the dentofacial et al.6 presented cephalometric standards for Egyptian adolescent boys and girls and found that Saudis tend to have an increased ANB angle cephalometric values for Emirati adults, to compare compared them with a matched Iowa adolescent sample. They found a great similarity because of retrognathic mandibles and bimaxillary these values with the norms of other ethnic groups, and in the overall facial morphology between the Egyptian and lowa populations. Hamdan protrusion as compared with European-Americans. to determine any sexual differences between Emirati men and Rock7 studied the cephalometric norms for a Jordanian population and compared In literature, there are no data available describing and women. them to the Eastman standards and found that Jordanians have a reduction in lower face height, proclined upper and lower incisors in comparison with the British sample. | 6 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 7 | (Table 1) Mean and SD of Cephalometric Measurements for 62 Descriptive statistics (mean and standard deviation) (Table 2) Comparison of Mean and SD Differences between Emirati Men and Women Emirati Adults were calculated using the SPSS program version 12.0 Men (n=32) Women (n=30) Variable Norms Mean SD (SPSS Inc, Chicago, Ill). The results were tabulated and Variable Norms t Value P Value Mean SD Mean SD Skeletal compared with Caucasian norms which were derived from the values of Steiner,1 Jarabak,2 Downs,3 and Wits10 Skeletal Antero-posterior analyses. To compare the measurements between men Antero-posterior SNA 82 (°) 81.30 3.37 and women, an independent samples t-test was used. SNA 82 (°) 81.57 3.77 81.02 2.91 0.64 .528 SNB 80 (°) 78.40 3.28 ANB 2 (°) 2.90 0.89 SNB 80 (°) 78.87 3.54 77.88 2.96 1.19 .238 Results Wits -1-0 (mm) -0.74 2.47 ANB 2 (°) 2.69 0.86 3.13 0.87 -1.03 .281 The results of this study showed there were some Vertical differences between Emirati cephalometric values Wits -1-0 (mm) -1.27 2.34 -0.22 2.52 1.67 .100 GoGn-SN 32 (°) 32.39 4.73 and Caucasian norms (Table 1). Regarding skeletal Vertical Y axis 59.4±3.8 (°) 59.66 3.13 measurements, results showed that Emiratis tend to have N-S-Ar 123±5 (°) 124.14 5.01 GoGn-SN 32 (°) 31.81 4.68 33.02 4.03 -1.03 .283 decreased SNB angle (78.40° ± 3.28), increased ANB S-Ar-Go 143±6 (°) 142.14 6.85 angle (2.90° ± 0.89), and an increased anterior and Y axis 59.4±3.8 (°) 60.13 3.51 59.18 2.69 1.18 .244 Ar-Go-Me 130±7 (°) 128.69 4.67 posterior facial heights (128.60 ± 7.36mm and 81.73 N-S-Ar 123±5 (°) 123.23 5.45 125.05 4.45 -1.42 .162 S+Ar+Go 396±4 (°) 394.98 5.00 ± 6.13mm), respectively. S-Ar-Go 143±6 (°) 143.13 6.16 141.15 7.46 1.12 .266 S-Go 75±4 (mm) 81.73 6.13 Ar-Go-Me 130±7 (°) 127.82 4.38 129.57 4.86 -1.47 .148 N-Me 121±4(mm) 128.60 7.36 Dentally, both angular and linear parameters for _ 1-NA and 1 -NB were larger in Emirati adults than in S+Ar+Go 396±4 (°) 394.18 5.40 395.77 4.52 -1.23 .223 Jarabak % 62-65% 63.57 3.49 Dental Caucasians, indicating that both upper and lower S-Go 75±4 (mm) 85.53 4.42 77.67 5.01 6.57 .000 1-NA 22 (°) 26.56 6.47 incisors were more proclined and more protruded in N-Me 121±4 (mm) 133.28 5.41 123.60 5.70 6.85 .000 1-NA 4 (mm) 5.30 2.24 Emiratis. On the other hand, the inter-incisal angle was Jarabak % 62-65% 64.22 3.16 62.90 3.73 1.52 .133 _ 1-NB 25 (°) 33.10 5.64 smaller in Emirati adults (118.18° ± 8.23). _ Dental -NB 1 _ 4 (mm) 6.36 2.07 An independent samples t-test was used to compare 1-NA 22 (°) 28.12 5.98 25.00 6.67 1.91 .062 1-1 131 (°) 118.18 8.23 Emirati men and women. Table 2 compares the mean 1-NA 4 (mm) 5.73 2.24 4.87 2.19 1.41 .129 _ and standard deviation of cephalometric measurements 1-NB 25 (°) 31.83 6.07 34.37 4.96 -1.77 .082 Materials And Methods for both sexes. Of all skeletal and dental parameters, _ 1-NB 4 (mm) 6.20 2.30 6.52 1.84 -0.59 .556 Lateral cephalometric radiographs were taken from 62 2 showed significant sexual dimorphism, were both _ nongrowing Emirati adults (30 women and 32 Men; anterior and posterior facial heights increased significantly 1-1 131 (°) 118.27 7.67 118.10 7.55 0.08 .938 aged between 18 to 25 years). All subjects were selected in men compared to their counterparts (P<.001), and from the dental students of Ajman University of Science this finding reflected the expected average size difference angle because of retrognathic mandibles as compared lower incisors and a reduction in inter-incisal angle in and Technology on the basis of the following criteria: between men and women. with European-Americans. comparison with the British sample. Hussein and Abu Mois12 studied the bimaxillary protrusion in Palestinian • Emirati citizens with Emirati grandparents Discussion Vertically, all the values of Emirati adults were generally population and concluded that Palestinian women have • Balanced facial profiles with competent lips This study was carried out to evaluate the cephalometric similar to the Caucasian values. However, significant a tendency for a slightly decreased interincisal angle • Class I occlusion with minimum or no crowding features of Emirati adults characterized as having normal differences in both anterior facial height and posterior and incisor proclination. Moreover, Behbihani et al.8 • Normal overjet and overbite occlusions and well-balanced faces. In this study, the facial height were found. The values for the anterior and concluded that Kuwaitis have greater dental protrusion in • No history of previous orthodontic treatment inclusion criteria and methodology were oriented to posterior facial heights were 128.60 ± 7.36mm and both arches than the Caucasians. identify normative values that can assist in diagnosis and 81.73 ± 6.13mm, respectively. Basciftci et al.11 studied All cephalometric radiographs were taken with the lips treatment planning for Emirati adults seeking orthodontic craniofacial structure of Anatolian Turkish adults and Regarding sexual dimorphism, the only significant in light contact and teeth in centric occlusion. Tracings treatment or orthognathic surgery. found that Anatolian Turkish young adults have long differences were observed in the vertical facial of the radiographs were made on 8’’X10’’ 0.003’’ lower anterior facial height compared to Caucasians. dimensions. Emirati men had longer anterior and matte acetate sheets (Orthotrace, Rocky Mountain The findings of this study were consistent with many On the other hand, Bishara et al6 found that the upper posterior face heights compared to their counterparts, Orthodontics, Denver, Colo). other studies that compared Middle Eastern populations anterior facial height (N-Ans) was significantly greater and this was expected as males, in general, larger than with the Caucasians. in Egyptian girls than in Iowa girls, while Iowa boys had females. This result was in agreement with the findings This study consisted of twelve angular measurements, significantly greater total (S-Go) and posterior (Ar’-Go) of Bishara et al.6 who emphasized that most of the five linear measurements, and a ratio (Figures 1-4). Regarding the antero-posterior jaw relationship, the face heights than Egyptian boys. observed differences between boys and girls in Egyptian present study showed that Emirati adults tend to have and Iowan population were in linear dimensions. Also To assess the intra-observer errors, the first author traced a slightly retruded mandible and an increased ANB As for the dental values, the present study showed that Basciftci et al.11 found that Turkish men have greater 10 randomly selected radiographs at two different time angle as compared to Caucasians. Similar findings were Emirati adults have bimaxillary dental protrusion and total anterior facial height values than the women, who intervals. Intra class correlation coefficient was applied to obtained by Behbihani et al.8 who found that Kuwaiti decreased inter-incisal angle. This finding was consistent had smaller midfacial (Co-A) and mandibular (Co-Gn) the first and second measurements in order to evaluate population has a more facial convexity as well as a more with many other studies which were carried out in Middle lengths compared with Turkish men. Therefore, similar the author variability of repeated measurements. retruded and smaller mandible compared to Caucasian Eastern populations. Bishara et al.6 concluded that diagnosis and treatment planning are feasible for populations. In another study carried out to determine Egyptian boys have a tendency toward bimaxillary dental Emirati male and female patients except for the linear Correlations were found to be greater than 0.95 in all the cephalometric norms for Saudi adults, Hassan9 protrusion as compared with Iowa boys. Hamdan and dimensions. the measurements. concluded that Saudis tend to have an increased ANB Rock7 found that Jordanians have proclined upper and | 8 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 9 | Conclusions • When compared with Caucasian cephalometric norms, Emirati adults showed an increase in ANB angle due to mandibular retrusion, increase in anterior and posterior facial heights, decreased inter- incisal angle, and bimaxillary dental protrusion. • There were no difference between men and women except for the facial heights which were longer in men than women. • These Emirati cephalometric values found in this study are recommended for use when formulating a treatment plan for this ethnic group. • There is a need to develop age-dependent cephalometric standards for the Emirati population. References 1. Steiner CC. Cephalometrics for you and me. Am J Orthod Dentofacial Orthop. 1953;39:729-55. 2. Jarabak JR, Fizzel JA. Technique and treatment with light wire edgewise appliances. 2nd. ed. St. Louis: Mosby, 1972. 3. Downs WB. Variation in facial relationships: their significance in the treatment and prognosis. Am J Orthod. 1948;34:812-40. 4. Ricketts RM. Planning treatment on the basis of the facial pattern and an estimate of its growth. Angle Orthod. 1957;27:14-37. 5. Sassouni V. A Roentgenographic cephalometric analysis of cephalofacial-dental relationships. Am. J. of Ortho. 1955;41(10):735-64. 6. Bishara S, Abdalla E, Hoppens B. Cephalometric comparison of dentofacial parameters between Egyptians and North American adolescents. Am J Orthod Dentofacial Orthop. 1990;97:413-21. 7. Hamdan AM, Rock WP Cephalometric norms in an Arabic . population. J Orthod. 2001;28:297-300. 8. Behbehani F, Hicks P Beeman C. Racial variations in cephalometric , analysis between whites and Kuwaitis. Angle Orthod. 2006;76:406-11. 9. Hassan AH. Cephalometric norms for Saudi adults living in the western region of Saudi Arabia. Angle Orthod. 2006;76:109-13. 10. Jacobson A. The Wits appraisal of jaw disharmony. Am J Orthod. 1975;67:125-38. 11. Basciftci FA, Uysal T, Buyukerkmen A. Craniofacial structure of Anatolian Turkish adults with normal occlusions and wellbalanced faces. Am J Orthod Dentofacial Orthop. 2004;125:366-72 12. Hussein E , Abu Mois M. Bimaxillary protrusion in the Palestinian population. Angle Orthodontist. 2007;77:817-20. | 10 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Introducing Pro-Argin™ a breakthrough in dentine Pro-Argin™ Technology plugs dentine tubules to help block pain stimuli* Colgate offers a safe and effective new in-office treatment for sensitive patients with innovative Pro-Argin™ Technology Based on a natural process of Tubule occlusion with the key components arginine and calcium carbonate. Immediate and lasting relief with one application. Clinically proven relief that lasts for 28 days. Sensitivity treatment and gentle polishing in one step. NEW! Colgate® Sensitive Pro-Relief™ Desensitising Polishing Paste with Pro-Argin™ Technology * Graphical representation based on SEM photography; for illustration only YOUR PARTNER IN ORAL YOUR PARTNER IN ORAL HEALTH HEALTH Pre-Orthodontic Assessment of a Shape or Form Variations:11,12 1. Conical: peg shaped teeth 2. Tuberculate: made of more than one cusp or tubercule Non-Syndromic Multiple Supernumerary Teeth 3. Supplemental: resemble normal teeth 4. Odontome: does not resemble any tooth but is only a with Cone Beam Imaging mass of dental tissue Many problems can be caused by supernumerary teeth such as: failure of eruption, displacement and crowding, adjacent teeth root resorption, and formation of dentigerous cyst.13 Abstract Multiple supernumerary teeth or hyperdontia can be associated with several syndromes, Case Report or it can be present in patients without systemic diseases. A 24 year-old male visited our dental clinic with complaints of having displacement and crowding of his The presence of supernumerary teeth, which is relatively a frequent disorder of permanent dentition. odontogenesis, is characterized by an excess number of teeth that appears in any area of the dental arches. It can affect any dental organ and usually is associated In order to receive an orthodontic treatment, a clinical with different alterations such as: over retained teeth or delayed eruption, dental examination (Figure 1) followed by a panoramic malposition or occlusal problems. radiograph (Figure 2) revealed the presence of an (Fig. 1) Clinical view. excess number of teeth that appears in all quadrants. The use of non-conventional radiographic imaging techniques (cone beam) during any A thorough general examination and the family history pre-orthodontic assessment is a valuable tool that helps make the early diagnosis of confirmed the absence of any kind of disease or these types of abnormalities in order to formulate an ideal orthodontic treatment plan. syndrome associated with this case. Elie Hayek BDS, DUA, DUB A routine panoramic radiograph for a 24-year-old male showed the presence of A cone beam computed tomography (CBCT) was Dep. of Dento-Maxillo-Facial multiple supernumerary teeth which were located in the four quadrants of his mouth. undertaken to accurately determine both the position Imaging Lebanese University The family’s medical history was non-contributory, and an extra-oral examination did and number of the supernumerary teeth. School of Dentistry not reveal any abnormality. A cone beam computed tomography examination was Beirut, Lebanon performed for more details. In the upper arch, unerupted supernumerary teeth had email@example.com a slightly smaller size than typical premolars and were Keywords: Supernumerary teeth, Non-syndromic hyperodontia, Supplementary tooth, located between 14-15 and 24-25 and they were conical Georges Khawam CBCT. in shape (Figures 3-5). (Fig. 2) Panoramic radiograph with supernumerary teeth in BDS, DUA, DUB all quadrants. Dep. of Dento-Maxillo-Facial In the lower arch, there were two supernumerary Imaging Introduction teeth in the right quadrant (Figures 6-8) and three Lebanese University Dental anomalies may occur in man due to genetic and environmental factors. The 1 supernumerary teeth resembling typical premolars in the School of Dentistry most common ones are supernumerary teeth. These may occur in both dentitions, but Beirut, Lebanon left quadrant (Figures 9,10). more frequently in the permanent teeth: respectively, 0, 8 to 2, 1% in deciduous and firstname.lastname@example.org permanent dentition.2 Approximately, males are affected twice compared to females.3 In summary, the patient had a total of 7 supernumerary The etiology of development is not clear yet.4 teeth of which two were erupted and five were Ibrahim Nasseh unerupted. All of them had a completely formed root. Dr. Chir. Dent., DSO, FICD Multiple supernumerary teeth are usually associated with conditions such as cleft lip Third molars were in their respective positions. Chairman, Dep.of Dento- and palate or syndromes like cleidocranial dysplasia and Gardner’s syndrome, but in Maxillo-Facial Imaging very rare cases they are not associated with diseases or syndromes such as our case Lebanese University report.5 School of Dentistry After orthodontic consultation, it was decided to have Beirut, Lebanon all unerupted teeth surgically extracted. Two erupted In general, supernumerary teeth may be single or multiple, unilateral or bilateral, email@example.com supernumerary teeth in the lower premolar region were erupted or unerupted, and in one or both jaws.6 When the number of multiple planned to be extracted after orthodontic alignment of supernumerary teeth is one or two, the most common site is the anterior maxilla, but the adjacent teeth. when it is five and more, the most common site is the mandibular premolars.7 Discussion Supernumerary teeth classification can be based on both positional or shape variations. In 1990, Yusof14 reported that premolar region in the lower arch is the most common place for supernumerary Positional Variations:8-10 teeth. In our case the prevalence of supernumerary teeth 1. Mesiodens: the incisor region appeared in the premolar area but in both arches. 2. Paramolars: beside a molar (Fig. 3) Axial slices - Supernumerary teeth in the upper arch 3. Disto-molars: distal to the last molar on right and left sides. 4. Parapremolars: beside a premolar | 12 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 13 | Conclusion Non syndromatic multiple supernumerary teeth is a very rare anomaly that appears usually in the lower premolar region. In this case report, the patient presented supplementary and tuberculate teeth in four quadrants of his mouth. (Fig. 8) Cross sectional slices showing position of The use of a cone beam imaging technique is essential supernumerary tooth lingual to 44. during any pre-orthodontic assessment in order to evaluate the situation and number of the supernumerary teeth with all possible details, in three planes (axial, (Fig. 4) Cross sectional slices showing position of coronal and sagittal views), irrespective of whether the supernumerary tooth between 14-15. patient has any syndrome or not. References 1. Ezddini AF, Sheikha MH. Prevalence of dental developmental anomalies: A radiographic study. Community Dent Health 2007;24:140-4 2. Leco Berrocal MI, Martín Morales JF, Martínez González JM. An observational study of the frequency of supernumerary teeth in a population of 2000 patients. Med Oral Patol Oral Cir Bucal. 2007;12(2):E134-8. 3. Açikgöz A, Açikgöz G, Tunga U, Otan F. Characteristics and (Fig. 9) Cross sectional slices showing lingual position of prevalence of non-syndrome multiple supernumerary teeth: a (Fig. 5) Cross sectional slices showing palatal position of supernumerary teeth between 34-35. retrospective study. Dentomaxillofac Radiol. 2006;35(3):185-90. supernumerary tooth between 24-25. 4. Peker I, Kaya E, Darendeliler-Yaman S. Clinic and radiographical evaluation of non-syndromic hypodontia and hyperdontia in permanent dentition. Med Oral Patol Oral Cir Bucal. 2009;14(8):393-7. 5. Yagüe-García J, Berini-Aytés L, Gay-Escoda C. Multiple supernumerary teeth not associated with complex syndromes: a retrospective study. Med Oral Patol Oral Cir Bucal. 2009;14(7):331-6. 6. Rajab LD, Hamdan MAM. Supernumerary teeth: a review of the literature and a survey of 152 cases. Int Pediatr Dent. 2002;12:244-54. 7. Hyun HK, Lee SJ, Ahn BD, Lee ZH, Heo MS, Seo BM, Kim JW. Nonsyndromic multiple mandibular supernumerary premolars. J Oral Maxillofac Surg. 2008;66(7):1366-9. (Fig. 10) Cross sectional slices showing position of 8. Giancotti A, Grazzini F, De Dominicis F, Romanini G, Arcuri Multidisciplinary evaluation and clinical management of supernumerary teeth between 35-36, presenting coronal mesiodens. J Clin Pediatr Dent. 2002;26:233-7. radiolucency. 9. Srivatsan P Aravindha Babu N. Mesiodens with an unusual , morphology and multiple impacted supernumerary teeth in a non- syndromic patient. Indian J Dent Res. 2007;18(3):138-40. Because displacements, rotation, ectopic eruption, 10. Asaumi JI, Shibata Y, Yanagi Y, Hisatomi M, Matsuzaki H, Konouchi and malocclusion can be the result of maintaining H, Kishi K. Radiographic examination of mesiodens and their (Fig. 6) Axial slice – Two supernumerary teeth in the lower supernumerary teeth in the mouth, a clinical and associated complications. Dentomaxillofac Radiol. 2004;33:125-7. radiographic examination is essential for a good 11. Suprabha BS, Sumanth KN, Boaz K, George T. An unusual case of right side. non-syndromic occurrence of multiple dental anomalies. Indian J orthodontic treatment planning.15 Dent Res. 2009;20(3):385-7. 12. Scheiner MA, Sampson WJ. Supernumerary teeth: a review of the Treatment may be difficult and may vary from just literature and four case reports. Aus Dent J. 2007;42:160-5. extraction of supernumerary teeth or extraction , 13. Varela M, Arrieta P Ventureira C. Non-syndromic concomitant hypodontia and supernumerary teeth in an orthodontic population. followed by orthodontic correction to establish a good Eur J Orthod. 2009;31(6):632-7. occlusion.16,17 14. Yusof WZ. Non-syndrome multiple supernumerary teeth: literature review. J Can Dent Assoc. 1990;56:147-9. In this case, it was decided to extract all the erupted and 15. Mason C, Rule DC, Hopper C. Multiple supernumeraries: the importance of clinical and radiographic follow-up. Dentomaxillofac unerupted supernumerary teeth besides the orthodontic Radiol. 1996;25:109-13. treatment. 16. Díaz A, Orozco J, Fonseca M. Multiple hyperodontia: report of a case with 17 supernumerary teeth with non syndromic association. Based upon the supernumerary teeth classification, this Med Oral Patol Oral Cir Bucal. 2009;14(5):229-31. (Fig. 7) Cross sectional slices showing position of 17. Sivapathasundharam B, Einstein A. Non-syndromic multiple reported case presented the parapremolars position type supernumerary tooth between 45-46. supernumerary teeth: report of a case with 14 supplemental teeth. along with both supplemental and tuberculate shape. Indian J Dent Res. 2007;18(3):144. | 14 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 15 | HU-FRIEDY ORTHODONTIC PLIERS • IMMUNITY STEEL® • FEEL THE COMFORT • EXPERIENCE THE QUALITY Orthodontic Cassette Holds 10 pliers, a Mathieu needle holder and 3 hand instruments in an accessory area. IMORTHO2 Orthodontic Cassette for Orthodontic instruments DIN Cassette for up to 6 pliers. IMDINORTH8 Manufacturer: Hu-Friedy Mfg. Co., Inc. I 3232 N. Rockwell Street I Chicago, IL 60618 I USA European Headquarters & Customer Care Department: Hu-Friedy Mfg. B.V. I P.O. Box 29025 NL-3001 GA Rotterdam Tel. +800 HUFRIEDY (00800 48 37 43 39) I Fax 00800 48 37 43 40 E-Mail: firstname.lastname@example.org I www.hu-friedy.eu Hu-Friedy Middle East: email@example.com I Mobile : 00 962 79 50 45 700 Perfect Together Planmeca Sovereign carries luxury within Planmeca ProMax 3D all volume sizes Welcome to our fully-equipped Planmeca Gulf show room. Planmeca Gulf, Holiday Center / Commercial Tower Sheikh Zayed Rd. / Plot 335-148 Office 2101 21st floor P.O.Box 49845, Dubai, tel. +971 4 3327244, fax +971 4 3327366 Planmeca Oy, Asentajankatu 6, 00880 Helsinki, Finland, tel. +358 20 7795 500 fax +358 20 7795 555, firstname.lastname@example.org, www.planmeca.com Diffuse Inflammatory Facial Swelling A B Our patient had a Polyalkylimide-based dermal filler to Secondary to Local Anesthetic Injections in augment her both cheeks aiming for more youthful and beautiful appearance. She admitted that she had this procedure done because of an advice from a relative and Patient with Polyalkylimide Gel Used for her cosmetic specialist. The patient had also reported multiple episodes of facial swelling following the injection of the dermal filler gel and received several courses of Cheek Augmentation antibiotics and steroids to overcome these adverse effects. Polyalkylimide gel is a non resorbable biocompatible polymeric gel and consists of 96% apyrogenic water and Abstract 4% Polyalkylimide.5 The compound has a reticulated Nowadays the uses of cosmetic fillers have increased dramatically including those placed structure that resembles the adipose tissue in which it is in the facial region. Although commercial advertisements claim that injectable fillers are C D commonly implanted; it has a pH of 7 and an oxidative biologically inert and pose no significant health risks, we report a case of a patient with value of almost 0.2. Polyalkylimide can be injected under bilateral cheek augmentation using Polyalkylimide gel fillers presented with recurrent the skin for soft tissue replacement. It is described as an episodes of facial swelling following routine dental treatment. The clinical scenario endoprosthesis; after implantation, a thin membrane presented here highlighted the significance of the interference of the facial gel fillers with (biofilm) of 0.02mm of collagen is formed around the the routine dental treatment. material, connecting it to the surrounding tissue and keeping the material together.4 Keywords: Dermal Fillers, Polyalkylimide, Cosmetic surgery, Local anesthesia, Dentistry. Even a long time after implantation, the gel can be removed by puncturing the biofilm and squeezing the Introduction gel out. It was reported that the biofilm is responsible Kamis Gaballah The last two decades showed a rapid worldwide expansion of cosmetic procedures (Fig. 1) The post operative outcome of the patient for many filler side effects, particularly those that present BDS, MSc, PhD(Lon), FFD including the use of injectable filling materials for various facial aesthetic and management. The pictures show a mild asymmetry due to a as late-onset complications.1 A biofilm is a complex RCSI(OSOM),FDS RCSEng reconstructive indications. The soft tissue filler products can be divided into short-term residual inflammation and fibrosis on the left cheek (B) as aggregation of microorganisms marked by the excretion GCAP (Lon) degradable and long-lasting permanent injectable fillers. While the original fillers were compared with the right side (A). (C) the frontal profile of the of an extracellular protective and adhesive matrix.2 Assistant Professor in Oral and Maxillofacial Surgery and Oral usually based on either collagen or hyaluronic acid gels, the modern fillers are based patient showing the same changes. (D) shows the skin marks Medicine on polymerization to obtain a denser filling effect. Recently the use of permanent fillers left behind as result of the use of transcuteneuos aspiration. This structure of excreted polymeric substance allows Ajman University including silicon and Polyalkylimide gels has significantly expanded. Dermal fillers are complex community interactions with enlargement of Ajman, UAE they presented an oral hygiene challenges and depicted the biofilm as more and more cells join. This may lead generally considered to be safe, although rare but significant adverse reactions have an early occlusal cavities. Both teeth were atraumatically to the development of increasing antibiotic resistance, email@example.com been reported.1-4 We report a case of repeated significant adverse reaction for a patient extracted under local anaesthetic infiltration. Both teeth sometimes requiring up to a 1,000 times greater with Polyalkylimide facial filler when she was subjected to routine dental and oral surgical were gently elevated and delivered intact without the need concentration of a given drug, which demonstrates procedures. for additional surgical tissue manipulation. a high degree of specificity and activity when used AbdulRahman Saleh BDS, MSc, PhD. Case Report against bacteria in the non-biofilm state. In addition, the Interestingly, the patient reported 48 hours later the Thirty years old lady of Iraqi origin was referred by her General Dental Practitioner (GDP) adhesive extracellular matrix traps leucocytes, making Assistant Professor in same scenario of cheek swelling but in the left side only Restorative Dentistry regarding a sudden diffuse swelling in her right cheek one day after a routine dental visit them ineffective through immobility.6,7 Biofilm microbial this time. The same treatment approach was considered Ajman University involving the placement of a filling for her upper first premolar on the same side. The populations can shift from active to dormant depending and comparable outcome results observed except for Ajman, UAE restorative treatment was done under local anaesthetic infiltration and no medications on exogenous threats. When bacterial proteins turn off two isolated points of collection that required additional firstname.lastname@example.org were prescribed to the patient who did not report any allergies to any dental products or their cell metabolism and the cell becomes dormant, drainage. All surgical interventions were carried out any known medications. The review of the patient’s medical history did not reveal any it becomes antibiotic resistant, as well as difficult, if intraorally with no attempt to aspirate the fluid through the chronic illness or regular medications on past or present. Upon presentation, the patient not impossible, to culture. Biofilm detection in biopsies facial skin. However, the patient herself has attempted this showed an extensive cellulitic swelling in the right buccal and canine fossa space regions requires the use of special methods like fluorescent DNA approach which resulted in two tiny skin dimples on her for the last four days despite the intake of Amoxicillin + Clavulanic acid 625mg, TDS as stains or Polymerase Chain Reactions.5 left cheek. Figure 1 shows the postoperative results of the . prescribed by her GDP The swelling was firm and tender with evidence of fluctuation. The patient. oral examination did not conceal any dental origin for this facial swelling. Drainage was Manipulation, trauma, or the injection of another done under local anaesthesia through a buccal sulcus incision and a corrugated rubber substance in close proximity can activate biofilms. This can Discussion drain was inserted and secured in place for 48 hours. Upon drainage, a yellowish pus result in a clinical picture of local infection, including an All injectable dermal fillers have side effects.1-4 This can be like fluid was obtained and sent for microbiological testing and the patient was advised abscess, cellulitis, or a systemic infection.2 explained by the nature of the filler material; for instance to continue taking the antibiotic course as prescribed. The follow up showed excellent the natural and protein–based fillers tend to cause tissue response. Because of the lack of growth in microbiological testing, more detailed Biofilms may also account for many of today’s filler hypersensitivity reaction owed to their antigenicity, on the complications, including granulomas, nodules, case history reveled that the patient had similar symptoms following the injection of a other hand, the synthetic filler may cause more irrational dermal filler to build up her cheeks and her cosmetic specialist had given her repeated inflammation, and other delayed reactions (Figure 2). effects and mediate infection attributed to implantation of courses of antibiotics and occasional steroid courses. The patient was happy about the foreign bodies. When the filler lasts longer, it gives more We regard the repeated clinical scenario seen in the healing progress however she noticed a slight facial asymmetry owed to the loss of the stable reconstructive and aesthetic results. But this may patient we report here as a disturbance of the biofilm filler substance from her right cheek. Three months later the same patient was referred subject the patient to more adverse reactions, some with surrounding the gel filler injected in the patient’s cheek back again by the restorative dentist for the removal of her upper third molar teeth as recurrent or delayed nature. four years ago. The biofilm irritation is more likely | 18 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 19 | Nodule Granulomas Foreign Body Reaction Biofilm Disruption and Detachment Abscess Cellulitis (Fig. 2) The different forms of complication related to the disruption of the gel biofilm. related to the local anaesthetic injection rather than the dental or surgical procedures. In this context, it is worth to mention that the same patient did not experience any adverse reaction when she had her lower teeth treated under local anaesthesia which was injected anatomically away from the gel filler areas. The word the authors wanted to spread is that patient receiving intradermal gel should be warned about the potential interaction of the dental intervention and patient should inform their GDP about the presence of the gel filler. The other massage is to Oral Surgeons who may treat patients with such condition; should consider a serious approach including surgical incision and drainage of the abscess and filler through an intraoral access with adequate adjuvant antibiotic despite the negatively reported microbial culture. Finally, the attempt to aspirate the gel content through the facial skin should be avoided as this might need to be repeated several times to evacuate all infected content and may also leave unwanted skin marks. References 1. Monheit GD, Rohrich RJ. The nature of long-term fillers and the risk of complications. Dermatol Surg. 2009;35(2):1598-604. 2. Narins RS, Coleman WP 3rd, Glogau RG. Recommendations and treatment options for nodules and other filler complications. Dermatol Surg. 2009;35(2):1667-71. , 3. Bachmann F Erdmann R, Hartmann V, Wiest L, Rzany B. The spectrum of adverse reactions after treatment with injectable fillers in the glabellar region: results from the Injectable Filler Safety Study. Dermatol Surg. 2009;35(2):1629-34. 4. Schelke LW, van den Elzen HJ, Canninga M, Neumann MH. Complications after treatment with polyalkylimide. Dermatol Surg. 2009;35(2):1625-8. 5. Christensen L, Breiting V, Janssen M, Vuust J, Hogdall E. Adverse reactions to injectable soft tissue permanent fillers. Aesthetic Plast Surg. 2005;29:34-48. 6. Christensen LH. Host tissue interaction, fate, and risks of degradable and nondegradable gel fillers. Dermatol Surg. 2009;35(2):1612-9. 7. Patrick T. Polyacrylamide gel in cosmetic procedures: experience with Aquamid. Semin Cutan Med Surg. 2004;23(4):233-5. | 20 | Smile Dental Journal | Volume 5, Issue 4 - 2010 AEEDC 2009 Stand # 309-407 IDS 2009 Hall No. 11.2 Stand # R-040 - S-041 Aisle R Middle East Area Manager Mahmoud Lutfi Middle East Area Manager Tel: +962 6 5656404/5 Mahmoud Lutfi Fax: +962 6 5656402 Tel: +962 6 5656404 Mob: +962 7 95536867 Mob: +962 7 95536867 E-mail: email@example.com E-mail: firstname.lastname@example.org DO YOU SUFFER FROM BLEEDING GUMS? . O SS L S E, OTH ISEA TO UM D OF FG USE NO .1 CA SI G THE FIRST TH E NO CAN BE H IS BLEEDING GUMS WHIC HELPS STOP BLEEDING GUMS A DAILY TOOTHPASTE WITH MINERAL SALTS AND 6 NATURAL HERB EXTRACTS An Interdisciplinary Approach for Numerous treatment options have been described for the restoration of the aesthetics and function of teeth in Restoring Function and Esthetics in a patients suffering from AI.8,9,10 We report a case of hypoplastic variant of AI and Patient with Amelogenesis Imperfecta: describe the sequenced interdisciplinary approach to restore the function and aesthetics to an acceptable level. This clinical report describes the sequenced treatment for A Case Report a patient with hypoplastic type of AI. Case Report A 24-year-old male patient presented with yellowish discoloration of his teeth. He also complained of Abstract sensitivity to hot and cold, wear of posterior teeth and Amelogenesis Imperfecta has been defined as a group of hereditary enamel defects (Fig. 1) Pretreatment frontal view in maximum intercuspation compromised masticatory function. with Amelogenesis Imperfecta. not associated with evidence of systemic disease. Restoration for patients with this condition should be oriented toward the functional and aesthetic rehabilitation. He was very conscious about the appearance of his teeth and on questioning he reported that his primary The importance of treating the Amelogenesis Imperfecta patient is not only important dentition was affected in same manner. A detailed from a functional standpoint, but also from a psychosocial health standpoint. The medical history, dental history and social history was complexity of the management of patients with Amelogenesis Imperfecta requires obtained but was non-contributory. The patient was careful considerations of patient expectations for a successful outcome of the questioned further about the presence of similar treatment. abnormalities in his family where he stated that his sister has a similar defect in her teeth. The purpose of this case report is to present the aesthetic and functional rehabilitation Sunil Kumar Gupta of the teeth with an overall enhancement of personality of a 24-year-old patient with Extra oral examination revealed no abnormalities. BDS, MDS, FAGE Amelogenesis Imperfect. Intraoral examination revealed yellowish discoloration Assistant Professor of entire dentition, peg shaped maxillary lateral incisors Dep. of Conservative Dentistry & Keywords: Amelogenesis imperfecta, Hereditary enamel defects, Interdisciplinary and pitted enamel surface of both maxillary central Endodontics approach, Oral rehabilitation, Porcelain laminate veneers. Manipal College of Dental Sciences incisors (Figure 1). There was generalized loss of contact Manipal, India and contour of teeth (Figure 2). The enamel layer was email@example.com nearly absent in the occlusal portion of the molars and Introduction the exposed dentin was hypersensitive. Amelogenesis imperfecta (AI) is a heterogeneous inherited disorder of tooth (Fig. 2) Pretreatment maxillary occlusal view showing Shashi Rashmi Acharya generalized loss of contact and contour of teeth. development affecting both primary and permanent dentition.1 The manifestations BDS, MDS Tooth 26 was decayed and tender on percussion. On vary greatly among individuals, with discoloration (yellow, brown, or gray), Professor & Head of Department IOPA examination revealed apical periodontitis. Teeth 17 generalized areas of exposed dentin, pitted enamel with an increased susceptibility Dep. of Conservative Dentistry & and 47 were also proximally decayed. Endodontics to plaque accumulation, caries, and hypersensitivity to temperature changes.2 This Manipal College of Dental Sciences genetic disorder is known to be associated with the malfunction of the enamel- Manipal, India Teeth number 36, 37 and 46 were missing (Figure 3). forming proteins ameloblastin, enamelin, tuftelin, and amelogenin.3 Tooth 38 was mesially tilted. There was no cusp fossa firstname.lastname@example.org relationship bilaterally. The patient’s oral hygiene was fair. These anomalies can be classified as hypocalcified, hypoplastic, or hypomature Jaya Siotia based on clinical findings, radiographic findings and hereditary criteria.4,5 In the Panoramic radiograph showed generalized defective BDS, MDS, FAGE hypoplastic type, there is a deficiency in the quantity of enamel, the mineralization enamel in all teeth with its radiodensity being the same Assistant Professor of enamel appears to be normal, hard and shiny however it is malformed. In as that of dentin (Figure 4). Dep. of Conservative Dentistry & the hypocalcified type, the enamel is formed in relatively normal amounts but is Endodontics poorly mineralized, soft, and friable and can be easily removed from the dentin. Faculty of Dentistry After thorough clinical and radiographic examination, the Melaka Manipal Medical College In the hypomaturation type, enamel appears mottled, opaque white to red-brown patient was diagnosed as having a hypoplastic type of AI. Manipal, India coloration, and is softer than normal and tends to chip from the underlying dentin. email@example.com Maxillary and mandibular complete-arch impressions A recently published survey reported the importance of treating the AI patient not only were made using irreversible hydrocolloid (Jeltrate, from a functional standpoint, but from a psychosocial health standpoint as well.6,7 (Fig. 3) Pretreatment mandibular occlusal view. Amar A Sholapurkar Alginate, Fast Set; Dentsply Intl, York, Pa) impression BDS, MDS, FAGE material. Diagnostic casts were fabricated from Type- protrusive and lateral records (Coprwax Bite Wafers; Results of the survey reported that patients with AI experience higher levels of social Assistant Professor III dental stone (Pankaj Industries, Mumbai, India) and Heraeus Kulzer, South Bend, Ind). The diagnostic avoidance combined with a reduced perceived quality of life compared to those Dep. of Oral Medicine & Radiology mounted on a semi-adjustable articulator (Articulator waxing was done. The interdisciplinary approach was Manipal College of Dental Sciences without AI, and that treatment has a positive psychosocial impact.7 #3140; Whip Mix Corp) using a face-bow transfer followed because of the complex needs of the patient. Manipal, India (#8645 Quick Mount Face-Bow; Whip Mix Corp) The treatment was aimed to improve esthetics, reduce firstname.lastname@example.org This rare dental abnormality poses a major restorative challenge for the dentist. and a centric relation record (Take 1 Bite; Kerr Corp, the reported sensitivity of the teeth and restore the Using conservative techniques desirable aesthetics can be achieved. Orange, Calif).The articulator was programmed using masticatory function. | 24 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 25 | The appropriate shade was then selected using the VITA Vivadent AG) and a bonding agent (Heliobond; Ivoclar shade guide (Vita Zahnfabrik, Badsackingen, Germany) Vivadent AG) with the use of rubber-dam isolation. prior to preparation. Maxillary and mandibular posterior Photo-polymerization was performed with a light teeth were prepared for metal-ceramic restorations. Teeth polymerizing unit (Hilux 350; First Medica, NC) at 350 were prepared for fixed dental prosthesis in mandiblular mW/cm2 for 40 seconds for incisal, mesial, and distal left quardrant for replacing missing teeth. After all the surfaces (Figures 6-9). posterior teeth were prepared, impressions were made with addition polyvinyl siloxane material (Reprosil, The anterior porcelain laminate veneers, veneer Dentsply/Caulk; Milford, DE, USA) in special trays. crowns, full metal crown, metal-ceramic crown and metal-ceramic fixed dental prosthesis were satisfactory Heat-cured provisional restorations were fabricated both aesthetically and functionally at the end of 1 year using methyl methacrylate acrylic resin. The provisional of clinical service and the patient’s oral hygiene was (Fig. 4) Pretreatment Panoramic radiograph showing restorations were temporarily cemented using Provicol, satisfactory. Pt was very happy with his appearance, generalized defective enamel in all teeth with its radiodensity eugenol free Ca(OH)2 cement (Voco, Cuxhaven, more confident during smile and highly enthusiastic being the same as the dentin. Germany). concerning his work. (Fig. 6) Posttreatment maxillary occlusal view with cemented From the impressions, casts were made and mounted in Discussion crowns, bonded porcelain laminates veneers and veneer crowns. an articulator to produce full metal crown, metal-ceramic Management of a patient with AI is a challenge for the crown and a metal-ceramic four-unit fixed dental clinician. The restoration of aesthetics and function in prosthesis for replacement of the missing teeth 36 and these patients may be achieved with a dedicated team 37. The metal frameworks were evaluated intraorally to approach. In our case, meticulous attention to detail, determine the marginal fit. A metal trial insertion, prior from diagnosis to postdelivery monitoring, allowed a to glazing of the ceramic material was performed, which controlled and logical treatment sequence.11 enabled the final occlusal refinement. The crowns were then completed in the laboratory and cemented with Based on the clinical presentation and family history a luting glass ionomer cement (GC, Tokyo, Japan). diagnosis of AI (hypo plastic) was made. (Fig. 5) Lateral view showing incision for gingivoplasty. In order to avoid trauma to the gingival sulcus a thin According to Seow6 the primary clinical problems of retraction cord was inserted into the sulcus prior to AI are aesthetics, dental sensitivity, and loss of vertical First, restoration of decayed teeth and root canal preparation. The facial surfaces of the maxillary and dimension. These patients are highly susceptible to treatment of indicated teeth was planned then mandibular anterior teeth were prepared. A 0.5mm (Fig. 7) Posttreatment mandibular occlusal view with cemented dental caries, gingival inflammation, as well as an fabrication of metal ceramic, full metal crowns and fixed facial reduction was performed, creating a chamfer crowns, bonded porcelain laminates veneers. anterior and posterior open bite. dental prosthesis for the restoration of posterior teeth in cervical finish line. The incisal edges of the teeth were functional occlusion and porcelain laminate veneers and prepared to allow overlap of the restoration. Self-limiting The treatment options vary considerably depending on veneer crowns for esthetic rehabilitation of anterior teeth depth-cutting disks of 0.5mm thickness were used to several factors such as the age of the patient, socio- were planned. The pt was informed of the diagnosis and define the depth of the cuts. All tooth preparations were economic status, periodontal condition, loss of tooth the treatment plan, which he accepted. completed without sharp line angles. structure, severity of the disorder, and, most importantly, the patient’s cooperation.12 First oral prophylaxis was done and oral hygiene For maxillary peg shaped lateral incisors, preparation instructions were given, the patient was placed on a was done for veneer crowns which was simply a veneer There are a number of alternatives for the treatment of 0.12% chlorohexidine gluconate oral rinse, with a that covers the entire tooth. A 0.5mm facial and 1.0mm anterior teeth affected by AI.8,9,10 For many years the recommended use of twice daily. lingual reduction was performed. most predictable and durable aesthetic restoration of anterior teeth has been achieved with complete crowns.13 Since the heights of the crowns of the maxillary and Provisional restorations were fabricated using direct mandibular teeth were inadequate for the fabrication composite resin for all anterior teeth to improve interim (Fig. 8) Posttreatment frontal view in maximum intercuspation. However, as this approach requires the removal of of the prosthesis, gingivoplasty was done as a part of aesthetics and decrease sensitivity. Final impressions substantial amounts of tooth structure, it is more the crown lengthening procedure with consideration for for prepared teeth were made with addition polyvinyl invasive. The popularity of porcelain laminate veneers biologic width dimensions (Figure 5). The surgical site siloxane material (Reprosil, Dentsply/Caulk; Milford, DE, has increased since being introduced because tooth was allowed to heal for three months. USA). Casts were made and mounted in an articulator. preparation is conservative, and the restorations are All restorations were fabricated with IPS Empress 2 esthetic.14 In addition, patient acceptance of porcelain After evaluation of radiograph and diagnostic wax materials (Ivoclar Vivadent AG, Schaan, Liechtenstein) veneers has been shown to be high in clinical studies.15 up it was anticipated that remaining dentin thickness according to the manufacturer’s directions. would be insufficient for protection of pulp during tooth The percentage of patients completely satisfied with preparation. So intentional endodontic therapy was After completion, the porcelain laminate veneers and the porcelain veneers varied from 80% to 100%.16 In performed for teeth 27,38, 47 and 48. Endodontic veneer crown were evaluated for fit on the prepared our case, veneer crowns were given for maxillary peg treatment was also done for tooth 26 because of apical teeth. They were then luted with a resin luting agent shaped lateral incisors because tooth was very small periodontitis. (Variolink II high viscosity; Ivoclar Vivadent AG) in and retention of laminate veneer was questionable. combination with a dentin adhesive (Syntac; Ivoclar (Fig. 9) Posttreatment Panoramic radiograph. According to Summitt17, a veneer crown is simply a | 26 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 27 | veneer that covers the entire tooth. It has a conservative References preparation design compared to all ceramic restoration. 1. Coley-Smith A, Brown CJ. Case report: radical management of an adolescent with amelogenesis imperfecta. Dent Update. The most common indication of veneer crown is peg 1996;23(10):434-5. shaped lateral incisors.17 2. Hart PS, Wright JT, Savage M, Kang G, Bensen JT, Gorry MC, Hart TC. Exclusion of candidate genes in two families with autosomal The clinician has to consider the long-term prognosis dominant hypocalcified amelogenesis imperfecta. Eur J Oral Sci. 2003;111(4):326-31. of the treatment outcome. This clinical report describes 3. Gokce K, Canpolat C, Ozel E. Restoring function and esthetics in the fabrication of metal ceramic and full metal crowns a patient with amelogenesis imperfecta: a case report. J Contemp for the restoration of posterior teeth in functional Dent Pract. 2007;8(4):95-101. occlusion and porcelain laminate veneers, veneer crowns 4. Soares CJ, Fonseca RB, Martins LR, Giannini M. Esthetic rehabilitation of anterior teeth affected by enamel hypoplasia: a for anterior teeth as it is a conservative approach to case report. J Esthet Restor Dent. 2002;14(6):340-8. modify teeth’s color, shape, and length and to close the 5. Wright TJ, Robinson C, Shore R. Characterization of the enamel space. Sacrificing as little tooth structure as possible ultrastructure and mineral content in hypoplastic amelogenesis and conserving the supporting tissues will facilitate imperfecta. Oral Surg Oral Med Oral Pathol. 1991;72(5):594-601. 6. Seow WK. Clinical diagnosis and management strategies of prospective treatments for young adult patient. Patients amelogenesis imperfecta variants. Pediatr Dent. 1993;15(6):384-93. with AI require meticulous maintenance of oral hygiene. , 7. Coffield KD, Phillips C, Brady M, Roberts MW, Strauss RP Wright The importance of treating the AI patient is not only from JT. The psychosocial impact of developmental dental defects in a functional standpoint, but also from a psychosocial people with hereditary amelogenesis imperfecta. J Am Dent Assoc. 2005;136(5):620-30. health standpoint. The complexity of the management of 8. Encias RP Garcia-Espona I, Rodriguez de Mondela JM. , patients with AI requires careful considerations of patient Amelogenesis imperfecta. Diagnosis and resolution of a case with expectations and requests, an interdisciplinary approach hypoplasia and hypocalcification of enamel, dental agenesis, and which is critical for a successful outcome and patient skeletal open bite. Quintessence Int. 2001;32(3):183-9. 9. Greenfield R, Iacono V, Zove S, Baer P Periodontal and . satisfaction. prosthodontic treatment of amelogenesis imperfecta: a clinical report. J Prosthet Dent. 1992;68(4):572-4. Conclusion , 10. Bouvier D, Duprez JP Pirel C, Vincent B. Amelogenesis imperfecta-a This clinical report described an interdisciplinary prosthetic rehabilitation: a clinical report. J Prosthet Dent. 1999;82(2):130-1. approach of AI with the use of porcelain laminate , 11. Williams WP Becker LH. Amelogenesis imperfecta: functional veneers, veneer crowns, full metal crown, metal-ceramic and esthetic restoration of severely compromised dentition. crown and metal-ceramic fixed dental prosthesis to Quintessence Int. 2000;31(6):397-403. restore the masticatory function, improve the esthetics 12. Sari T, Usumez A. Restoring function and esthetics in a patient with amelogenesis imperfecta: a clinical report. J Prosthet Dent. and to reduce the reported sensitivity of the teeth 2003;90(6):522-5. with careful consideration of patient expectations and 13. 13. Peumans M, Van Meerbeek B, Lambrechts P Vanharle, requests. G. Porcelain veneers: a review of the literature. J Dent. 2000;28(3):163-77. 14. Zalkind M, Hochman N. Laminate veneer provisional restorations: Acknowledgements a clinical report. J Prosthet Dent. 1997;77(2):109-10. The authors would like to thank Dr. Rupali Agnihotri, 15. Meijering AC, Creughers NH, Roeters FJ, Mulder J. Survival of Dr. Subraya Bhat from department of Periodontics, three types of veneer restorations in a clinical trial: 2.5-year interim evaluation. J Dent. 1998;26(7):563-8. for periodontal consideration and Mr. Umesh, dental 16. Rucker LM, Richter W, MacEntee M, Richardson A. Porcelain and technician for fabrication of the prosthesis presented in resin veneers clinically evaluated: 2 year results. J Am Dent Assoc. the case. 1990;121(5):594-6. 17. Jeffrey S. Rouse. Anterior ceramic crowns. In: Summitt JB, Robbins JW, Hilton TJ, Schwartz RS (3rd eds). Fundamentals of Operative Abbreviations Dentistry: A Contemporary Approach. Chicago: Quintessence, Amelogenesis imperfect (AI) 2006:493. 1st Iraqi Dental Reunion IDA Annual Conference 2011 "Breaking New Opportunities" www.cappmea.com/idr2011| email@example.com | Tel.: +971 4 3616174 | Mob.: +971 50 279 3711 | 28 | Smile Dental Journal | Volume 5, Issue 4 - 2010 The Laser Microfused Titanium Surface by LEADER implants Tixos is a porous surface characterized by Faster Bone Growth interconnected cavities, inside the cavities with predetermined of the geometry, that enhance microfused titanium fast bone formation*. surface Extraordinary bonE growth i n s i d E t h E i m p l a n t c o n c av i t i E s titanium bone 100 µm * References available upon request. AEEDC DubAi 2011 1 - 3 february Visit us! booth nr 531 L E AD E R LEADER ITALIA s.r.l. Via Aquileja, 49 - 20092 Cinisello Balsamo (MI) ITALY I T A L I A ph. +39 02 618651 - fax +39 02 61290676 - www.leaderitalia.it - firstname.lastname@example.org Advancement in the Removal of Permanently 3. The abutment’s structure and shape can contraindicate all removal attempts: A similar technique involves asking the (Fig. 3) • A high, thin abutment, for example, is much more patient to bite into Cemented Crowns and Bridges vulnerable to fracture than a low, wide one. • If incorrectly perceived, the angle divergence between an adhesive paste (Figure 3), as if it were the long axis of the tooth and that of the buildup can a caramel or nougat, lead to iatrogenic removal forces. and then asking the • The very nature of the stump – be it metal, resin or patient to try to open, natural tooth – will make it more or less resistant to hoping that the traction the forces exerted during the removal process. will occur in the axis of coronal draw. However, Abstract A – Traditional Solutions there is no guarantee Traditional techniques for removing permanent prosthetic devices do not provide reliable 1. Traction-based methods and devices (manual that the dentist made or satisfactory results. At best, they make it possible to keep a tooth at the cost of a time- crown removers, sticky paste squeezed between the preparations in the consuming procedure that also inflicts wear and tear on rotary instruments; at worst, they the teeth, various pliers, etc.) same axis as that in can cause abutments or restorations to fracture. which the jaws open Regardless of the instrument used to remove the and close. Moreover, Comprised of three carefully designed keys, WAMkey offers a truly unique approach prosthetic device – be it manual, assisted or mechanized in the case of buildups or crowns on antagonist teeth, to this challenge while fulfilling numerous expectations. A concrete clinical case will – dentists face three unavoidable challenges: the result of this technique relies purely on chance or, illustrate all of the advantages of this innovative method. more accurately, on a fundamental law: the weakest link a. A significant portion of the dentist’s energy or that always gives. Keywords: Wamkey, Crown remover, Bridge remover, Periodontal ligament. of the instrument being used is absorbed by the periodontal ligament (Figure 1). Not only does this In short, besides the fact that crown “pullers” and other Jean Luc Girard similar devices are often ineffective and may cause account for the pain felt by the patient, it can also DDS Introduction cause a luxation of the ligament. Moreover, it explains considerable patient trauma, above all their use presents Marseille University Hospital Removal of a crown or bridge, often following a failed therapeutic or cosmetic the ineffectiveness of the many traction-based devices serious risk factors for the periodontal ligament and the Private practice procedure, is seldom a positive experience for the patient or the dentist. When Miramas currently available on the market, in which only a very tooth, and their outcome is highly unpredictable. France traditional techniques are employed, this procedure often bears considerable risk for low percentage of the energy produced is utilized to the supporting tooth and its periodontal ligament, and frequently results in the complete actually break the cement. 2. Destruction of the crown email@example.com and irremediable destruction of the prosthetic device. This procedure can also be costly While some consider this to be the safest and least in terms of time and equipment, as burs and contra-angle handpieces undergo intense b. When the crown is supported by a core buildup, the traumatizing method for the patient and the tooth, it wear and tear. dentist does not know in advance what will come destroys the margin of the crown and eliminates all off: the buildup or the crown. In addition, when the chances of reusing the crown. In addition, depending Comprised of three carefully designed keys, WAMkey offers a truly unique approach to buildup is anchored with a post, the root is more on the type of alloy used, this operation can be long this challenge while fulfilling numerous expectations. To use the device, a small slot must fragile, which increases the risk of fracture during and can inflict superfluous wear and tear on rotary be drilled through the axial wall of the crown at the level of the cement layer between removal attempts. instruments. the occlusal aspect of the prepared tooth and the inner surface of the crown. Introducing and rotating one of the keys into this slot (almost) always loosens the crown. In most c. Modern technology does not enable dentists to see 3. Ultrasonics cases, one to two minutes per crown is more than enough time for complete removal. through metal crowns in order to have a precise view This may seem like a good solution because of its Several precautions are emphasized and recommended herein to ensure the procedure of the axis of the preparation. It is virtually impossible atraumatic nature. However, the application of vibrations is risk-free for the tooth and trauma-free for the patient. As the icing on the cake, this for the dentist to be certain that forces are being over long periods of time can damage the ceramic technique allows the crown to be reused following a simple repair procedure. directed precisely to the same axial direction as the or even cause it to become detached from the metal crown’s path of insertion. For this reason, the dentist coping.4 Ultrasonic energy also generates considerable Generally speaking, the obstacles to crown removal common to all devices used generally proceeds with a series of light, off-center heat which can cause permanent damage to the nearby are: retention, the type of seal and the supporting abutment’s ability to withstand the tapping movements. Abutment fractures are therefore pulp, periodontal ligament and bone. In addition, mechanical constraints required for successful removal. common (Figure 2). removing the crown with this method often requires more time than a dentist is willing to spend on an act that may 1. Retention is essentially determined by: (Fig. 1) (Fig. 2) have no value in the eyes of patients. a. The shape of the preparation: the retention force is inversely proportional to the preparation’s degree of taperness1 and can potentially be increased by the presence In 2000, a concept developed by Dr. William Muller (Aix- of retention devices (grooves). en-Provence, France) was introduced enabling dentists to b. The contact surface between the abutment and the prosthetic device: the retention accomplish this act with greater peace of mind and often force is naturally proportional to this value. astonishing results. Its name is WAMkey. 2. The seal B – WAMkey a. The adhesion index can as much as triple, depending on the product being used The device (i.e. an oxyphosphate vs. an adhesive such as Panavia).2 The force required for A set of three keys (Figure 4) with oval-shaped cam-like removal therefore varies in the same proportions. tips whose sections range from 2.5 to 5mm² (Figure 5). b. The cohesion of this cement or glue seal deteriorates over time.3 | 30 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 31 | 2. Locate the stump/crown occlusal interface b. As opposed to crown removers, the forces are of a non-precious alloy or a more recent material (e.g. (Fig. 4) Chances are, the dentist will locate this interface in essentially exerted in the axis of the preparation,5 zirconium) will be more swayed by this argument. Step 1, in which case he/she can directly proceed provided that the tunnel between the crown and the to Step 3. However, in some cases, the opening will preparation was drilled as close as possible to the 5. Reuse of the crown or bridge have to be progressively enlarged until the cement center of the preparation. Thus, when the couple The most important parts of the crown are not altered. If seal becomes visible. The most complex procedure of forces go into action, the crown, propelled from the dentist does not modify the margin of the abutment, is the removal of crowns on post-cores. The fact that its center, is free to “choose” its trajectory (Figure and the crown still fits the abutment, then a simple repair the seal is located between two structures of identical 10). And so it follows the path of least resistance. will enable the crown to fulfill all of its original functions. material and that it is generally very thin can be a Combined with the fact that there is little to no energy This can be an advantage, particularly in the following challenge. Visual assistance devices such as a surgical loss, this means that crowns can be removed with very cases: (Fig. 5) (Fig. 6) loupes or a microscope can be extremely helpful. little effort. • Immediate reuse of the removed crown when the visit 3. Create a tunnel between the occlusal surface of c. No trauma for the ligament: Contrary to crown does not allow enough time to fabricate a temporary the preparation and the inner side of the crown removers, pressure – not traction – is exerted on the crown. (Figure 7) ligament. The patient therefore enjoys maximum • Canal retreatment procedures performed through Using a cylindrical bur (approximately 1.2mm in comfort during the procedure. In most cases, no a crown are often more delicate than if the crown is (Fig. 7) diameter), the dentist drills an oval-shaped tunnel anesthesia is required. removed (improved visibility and access to the canal). between the occlusal surface of the preparation and When the outcome of the treatment is uncertain, the inner side of the crown. The difference in hardness d. No risk for buildups. The crown is removed thanks to permanent or long-term reuse of the crown (18-24 between the dentine and the crown’s structure will a couple of forces exerted between the preparation months) can be an effective transitional solution.4,7-10 help the dentist ascertain the bur’s position with and the crown. In the case of restorations, the • Bridges with partial detachment: If a bridge becomes regard to the dentine. On a vital tooth, to avoid all pressure is applied to the buildup apically, thus loose on one abutment without posing any particular risk of pulpitis, a water syringe should be used for eliminating all risk of loosening it. adjustment issues, reusing it can be a worthwhile (Fig. 9) irrigation purposes in addition to the contra-angle alternative and compromise for the patient.5 (Fig. 8) handpiece spray. Advantages of the device • Long bridges can be temporarily reused following a The advantages of this concept stem from what we rebase procedure, while adjustments are made to the Verify the depth of the tunnel using a rubber-stop described above. various abutment restorations. inserted onto the smallest WAMkey device. It is essential to achieve maximal proximity to the center of the 1. Quick and simple In most, if not all cases, the temporary reuse of the preparation, so as to work as close as possible to The device is very easy to use. Two or three uses are crown is clearly a major advantage. the long axis of the preparation during the removal enough to become familiar and comfortable with the (Fig. 10) procedure. concept. In general, one-and-a-half to two minutes For all of these reasons, WAMkey represents a major suffice to remove a crown. Only full-metal or porcelain advancement compared to all previous techniques. 4. Insert a key into the tunnel and rotate to loosen fused to metal crowns can sometimes take a bit longer the crown (Figure 8) as the dentist must first locate the cement seal. Removal Clinical Case Simply insert the key all the way to the end of the of ceramic crowns can also be delicate if one wants to Extensive work was planned to be performed for the tunnel drilled in Step 3 and rotate it one quarter- keep the ceramic fully intact. patient. A complete maxillary prosthesis must be made, turn. This creates a couple of forces between the and for obvious biological and cosmetic reasons (Figures preparation and the crown’s inner side. If the tunnel 2. Efficiency 11,12) the lower bridge must be removed. The nickel- was properly drilled, this movement should occur in Based on what we explained above, this concept offers chrome framework features a long support span, in the long axis of the preparation. unprecedented efficiency. Nevertheless, one limitation one block, with no anterior abutments. Before removal, must be mentioned: anterior teeth. Because of their we cannot be certain of the condition of the six existing Mechanical analysis configuration, it is generally not possible to use this abutments or whether it will be possible to save them. The effectiveness of the concept can be explained in a method to remove crowns from anterior teeth. In all Salvaged abutments will need to be endodontically relatively simple manner by comparing it to a crown other cases, users frequently report a high success retreated, rebuilt and reinforced with fiber posts. Once remover. rates, even when used on the most modern cementing rebuilt, and depending on their mechanic potential, a The protocol products. fixed prosthetic solution will be considered, such as a The idea is relatively simple, and consists of four steps. a. There is little or no energy loss resulting from this tooth-supported bridge or an implant-tooth supported mechanical principle (Figure 9). The only energy loss 3. Little to no risk prosthesis. A single visit, even if very long, will not be 1. Create a small window in the crown (Figure 6) is caused by friction between the key and the crown’s The innocuousness of this device stems from what we enough to retreat and restore all six teeth and make a Using the appropriate bur depending on the material inner side, and between the key and the preparation’s described above. The forces exerted are reduced to temporary, reinforced 12-unit bridge. encountered, the dentist creates a window (1-2mm occlusal surface. This loss is considerably reduced by a minimum and are applied to the long axis of the in diameter) where the preparation/crown occlusal the instrument’s shape and surface condition, and preparation,6 with pressure applied apically to the We decided to remove the fixed bridge, assess the interface is assumed to be located. Of course, the can be reduced even more by lubricating the tip of the abutment tooth. clinical situation, apply periodontal treatment, minimally opening should be made closer to the occlusal surface device with Vaseline for the most delicate cases. The adjust the marginal limits and rebase the original bridge for metal crowns, and perhaps about halfway between logical outcome is that a much lower degree of force 4. Less wear and tear on rotary instruments: for temporary use until the endodontic therapy could be the occlusal surface and the margin for porcelain or is required to loosen a crown using WAMkey than with This varies depending on the type of alloy. Obviously, completed. porcelain fused to metal crowns. a traditional crown “puller”. dentists who frequently remove prosthetic devices made | 32 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 33 | (Fig. 10) (Fig. 18) Of course, we could have removed the crown by (Fig. 11) (Fig. 19a) (Fig. 25) destroying all of its components. This undoubtedly would have been lengthy and tiresome procedure for the patient and the practitioner, and given the type of alloy encountered, several burs would probably have been used. We also could have tried to remove the entire bridge using a crown remover, with all of the risks inherent to such a procedure. Instead, we create a small opening in all six abutments (Figures 13,14). This operation required seven to eight minutes. As recommended by the manufacturer, the (Fig. 12) depth of each orifice is measured (Figures 15,16) using a rubber-stop attached to the smallest WAMkey device (Fig. 19) (Fig. 19b) so as to ensure that the forces are exerted as close as possible to the long axis of the abutments. As compared to single crown removal, bridge removal requires more controlled action on each abutment in order to avoid generating tension on the adjacent abutments. Each abutment is therefore handled (Fig. 26) Temporary anterior bridge individually in order to break the cement seal. Once all six seals are broken, the bridge is manually removed. (Fig. 13) (Fig. 14) The procedure was performed without the slightest discomfort for the patient, and no anesthesia was necessary. On most abutments, an astonishingly low amount of force is required to break the seal. Tiny nicks can be seen on the occlusal surface of each abutment (Figures 17,18), caused by the bur. Although (Fig. 20) (Fig. 20) unfortunate, this loss of matter has no major impact on (Fig. 15) (Fig. 16) the outcome of the treatment. The entire bridge removal procedure, including hole-drilling, took no more than (Fig. 27) Nobel Implants fifteen minutes. Next, we proceeded to reline #45 (Figure 19b) the bridge that was just removed (Figure19a) before temporarily re-placing it (Figure 20). Obviously, this “recycling” is a genuine God-send in a case like this, as (Fig. 17) it saved the several hours of additional work required to fabricate a temporary prosthesis of this size. The preparations were also modified (Figures 21,22) (Fig. 21) (Fig. 22) and new prosthesis fabricated (Figures 23-25). The final decision was to extract tooth no. 43, to make two tooth- (Fig. 28) Procera Framework supported lateral bridges and an implant-supported anterior bridge with Procera zirconia reinforcement. In a case like this one, this new removal technique offered very concrete benefits in terms of patient comfort (Fig. 18) and time-savings (removal time, immediate fabrication (Fig. 23) (Fig. 24) of temporary). It also provided an extremely useful immediate transitional solution for temporization and therapeutic planning. Conclusion Until now, dentists were torn between safely removing (Fig. 29) Completed Case a crown or bridge, and destroying it. By fulfilling three | 34 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 35 | NEW NITI ROTARY SYSTEM criteria in the vast majority of cases – rapid and cost-effective removal, preservation of support teeth and preservation of the prosthetic devices for temporary or permanent future reuse – WAMkey crown removal keys offer a particularly comfortable and efficient alternative, making them an integral part of every dentist’s basic instrument set. Acknowledgment Dental prostheses by Patrick David (Chateaurenard A safe and efﬁcient speciﬁc sequence to 13 - France). REACH APICAL SIZES References 1. Ogolnick R, Vignon M, Taieb F. Prothèse Fixée. Principe et Pratique. Paris: Masson, 1993. biologically desirable 2. Yim Nh, Rueggeberg Fa, Caughman Wf, Gardner Fm, Pashley Dh. Effect of dentin desensitizers and cementing agent on retention of full crowns using standardized crown with 5 NiTi ﬁles preparation. J Prosthet Dent. 2000;83:459-65. 3. Li Zn Et, White Sn. Mechanical properties of dental luting cements. J Prosthet Dent.1999;81:597-609. 4. John S. Advanced Endodontics. Clinical Retreatment and Surgery. Rhodes, 2006. 5. William Muller. La clef de descellement: une idée simple qui décoiffe. Clinic. 2001;22(10). 6. Stéphane Simon. Wilhelm-Joseph Pertot. Dcd Endodontic Retreatment. Quintessence International p.26. 7. William Muller. Simplification et réversibilité de l’acte de dépose des prothèses scellées. Le Monde Dentaire. 2003;121:24-5. 8. S. Patel, J. Rhodes. A practical guide to endodontic access cavity preparation in molar teeth. BDJ. 2007;203:133-40. 9. Philippe GATEAU. Démontage des prothèses fixées. Information Dentaire. 2002;31:2247-50. 10. Robert Strauch Entfernen festsitzenden Zahnersatzes mit dem WAM-Key. Zahnarztpraxis. 2003;6:78-87. 5th CAD/CAM & Estimated 14 CME Hours Endo Stand Computerized Dentistry Basic Set Extended Set International Conference 12-13 May 2011 Standard features The Address Hotel Dubai Marina Dubai UAE NON-CUTTING SAFETY TIP nt NON-SCREWING DESIGN Dis cou ers ad 20 %he Reurnal t for the Jo SHARP CUTTING EDGES ELECTRO-CHEMICAL of POLISHING PLATINUM SPONSOR GOLD SPONSORS Tel: +971 4 3616174 | Fax: +971 4 3686883 | Mob: +971 50 4243072 www.cappmea.com/cadcam5 | firstname.lastname@example.org www.biorace.ch | 36 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Visit us at: IDS Hall 2 stand G-049 Biomimetic Ceramic Veneers: and also do not present with the same optical qualities (Fig. 3) (Fig. 4) as feldspathic ceramics.1 The patient also had concerns about white patches on his teeth that was difficult to address with just bonding composite resin in the area of a Successful Team Concept the diastemas. Preparing crowns was an option but considering the result desired and the age of the patient it was a rather invasive option. (Fig. 5) Ceramic veneers present the most aesthetic option to Abstract treat the condition that the patient presented with. They Initially developed to make full crowns, the full ceramic has revolutionized cosmetic are minimally invasive when compared to crowns, have dentistry. Clinicians and technicians have quickly understood that this material can better optical qualities compared to bonded resin and also give an optimum contribution also for minimal invasive therapy. Many of our also have a better biological response of the tissues than colleagues have developed techniques to make veneers obtaining results which were around composite resins. unthinkable only little time ago. In this article, the author is showing his technique to make veneers obtaining excellent results and preserving as much as possible the tooth Treatment Plan structure. • All relevant photographs were taken. • After receiving study models a wax up was done for Keywords: Minimally invasive, Esthetics, Ceramic veneers, Refractory material. 11, 12, 21, 22 (Figures 3,4). • Patient was called to the lab to review the wax up and (Fig. 6) (Fig. 7) to get his approval. A 25 year old healthy male came to the dentist’s office with aesthetic concerns Lamberto Villani • Shade selection was done in the laboratory at this stage. and wanted to have a more confident smile. The case was referred to the lab for MDT • Preparation guides were made to assist the clinician in preoperative evaluation (Figure 1). Member of the European ideal tooth reduction for the case (Figure 5). Society for Cosmetic Dentistry Private Dental Lab The patient presented with diastemas in the upper arch and also had some concerns Oral Design - Dubai about a few fine white bands on his teeth (Figure 2). Clinical Steps email@example.com • Local anesthetic was administered to the patient and (Fig. 8) (Fig. 9) (Fig. 1) (Fig. 2) preparations were done with the help of preparation guide made in the laboratory 2 (Figures 6-9). • Addition silicone impression was made after adequate and necessary gingival tissue management.3 • Template provided, based on the wax up was used to fabricate temporary veneers. They were spot etched and bonded on the incisors. (Fig. 10) (Fig. 11) Laboratory Steps 1. Impression was poured with Type IV gypsum (Fuji Rock GC) using a vacuum mixer (Figure 10). 2. Individual dies were made from this model giving a conical shape to simulate root with two lateral slots. They will be used for the final fitting of the veneers. (Fig. 12) (Fig. 13) Diagnosis The margins were coated with a hardener (Margidur, Taking into consideration the patient’s expectations and also clinical examination the Benzer) (Figure 11). following diagnosis was made: 1. Diastemas present between 11, 12, 21 and 22. 3. They were then duplicated using high-quality 2. Few hypo-plastic patches present in the incisal and body area of the incisors. laboratory silicone and poured two times (Figure 12). Treatment Options First pouring with a refractory die material (GC CeraVest) b. We can shape the veneer respecting the soft tissue 1. Bonding with composite resin to close gaps on central and lateral incisors. and the second with Type IV gypsum (Fuji Rock GC) to and give the right space for papilla. 2. Ceramic Veneers with layering technique on central and lateral incisors. use for the preliminary fitting of the veneers. 3. All ceramic crowns on lateral and central incisors (over-treatment). 5. The refractory dies were treated with dehydration 4. The two major advantages of this cast are: (Figure 14) and then margins have been marked with Bonding has become very predictable and with many shades available, it is possible a. Stone dies and refractory dies can be inserted and a special pencil that is resistant to firing. A fine-grain to layer and make restorations life like. It is also the most conservative of the options interchanged, due to the identical design of their root porcelain paste (Connector paste) was applied 1mm present. Traditionally composites are known to discolor while ceramic restorations don’t portions, which have the same anti-rotation grooves. apical to the margins and fired (970° C for 1 minute). | 38 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 39 | This step is repeated until we obtain a smooth surface. (Fig. 21) (Fig. 22) (Fig. 14) (Fig. 27) 6. The ceramic build-up (Creation, Klema) started with the application of dentin powders (Figure 15) using the base shade dentin and several shades with higher chroma in the cervical area and higher value in the incisal area (Figures 16,17). This basic form has been reduced, especially in the (Fig. 23) incisal and proximoincisal level to give space for other powders. 7. Pure enamel is placed at the mesial and distal aspects of the incisal edge. Their exact position and length are (Fig. 15) guided by the palatal silicon index. (Fig. 28) A palatal incisal wall is made from the placement of other vertical enamel increments. The lifelike appearance of this wall is achieved by alternating enamel powders with various translucencies and chroma. (Fig. 24) 8. On this incisal wall (through infiltration) I placed some dentin powders modified with intensive stains. Other internal effects within the incisal edge have been infiltrated with fluorescent and non-fluorescent stains (Figure 18). Photos of the patient teeth served as a guide to define (Fig. 29) accurately these distinct internal characteristics and effects. 9. The facial surface has been completed with a (Fig. 16) (Fig. 17) combination of other translucent and opalescent (Fig. 25) (Fig. 18) Different combinations of shaded enamels were applied alternately in tiny vertical increments (Figures 19,20). Then it was placed in the furnace for the first firing. After Firing 1. It was necessary to make a correction firing covering with translucent and opaque enamel applied alternately in vertical increments and placed in the furnace for the second firing. 2. After contouring, diamond-silicon wheels were used for mechanical polishing. (Fig. 19) (Fig. 20) 3. Glazing was carried out. (Fig. 26) 4. Highly reflective surfaces were finally achieved with pumice and calcium carbonate using brushes and felt tips at different rotating speeds. 5. The refractory die has been removed by sandblasting with 50-µm glass beads. The Laboratory work was then sent to the Dentist for The veneers were adapted accurately using a stereo- cementation (Figures 24-26). The patient made a follow up appointment at the laboratory microscope at 10x magnification (Figures 21-23). The veneers were cemented following a standard protocol where the final pictures were made (Figures. 27-29). of Bonding and were polished thereafter. | 40 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 41 | Before After Conclusion References Ceramic veneers which are fabricated using a layering 1. Meijering AC, Roeters FJ, Mulder J, Creugers NH. technique with all protocols being followed during the Patients’ satisfaction with different types of veneer course of treatment offer patients a very natural and restorations. J Dent. 1997;25:493-7. esthetic result.4 2. Gurel G. The Science and Art of Porcelain Laminate Veneers. Quintessence. 2003;7:246. Acknowledgement 3. Azzi R, Tsao TF, Carranza FA Jr, Kenney EB. We thank Dr. Souheil Husseini for his collaboration. Comparative study of gingival retraction methods. J Prosthet Dent. 1983;50:561-5. 4. Horn HR. Porcelain laminate veneers bonded to etched enamel. Dent Clin North Am. 1983;27:671-84. I LOVE MY DENTIST www.cappmea.com/mydentist Awards 2011 Public Voting Now Opened Tel.: +971 4 3616174 | Mob.: | 42 | Smile Dental Journal | Volume 5, Issue 4 - 2010 +971 50 279 3711 | Email: firstname.lastname@example.org Ehab Heikal BDS, MBA, DBA Middle East Manager, Morita Corporation Lecturer, Practice Management School of Dentistry, MSA University email@example.com Example: Crown & Bridge = 3 neon To Organize or To Organize? purple Trays, Cassettes and Bur Holders needed Endo = 2 teal needed That is the Question Composite = 3 neon blue needed If you run a group Dr. Heikal (Neon Yellow) practice, then you should But there are no Shakespearian doubts here. follow steps 3 and 4 for There is no choice. And if you want to choose, then please choose the non-option at the right… each doctor. So, for crown and bridge all trays would Or the only option: be ordered in neon purple Business wise, the image at BUT for “Doctor Heikal” the top right gives a terrible he would apply neon impression about you, but yellow tape on his trays the other images to the left and “Doctor Sami” would tell your patient that you are apply neon pink tape on absolutely organized and Dr. Sami (Neon Pink) his trays. Therefore each neat. In English this means doctor would use rings that dentists following the and tape to mark their holders/containers. images to the left can, will and The PRODUCT color signifies the procedure and the should charge their patients Tape/Rings color signifies the doctor. higher than dentists following such as “central sterilization”. Or they may be stored in the top right image. Don’t ask I wanted to give an example here, and at the same a. Solo Clinic: Place color code ID Rings on all hand the operatory. why, instead put yourself in the time, I didn’t want to re-invent the wheel. So I found a instruments in the corresponding procedure color. patient’s shoes and ask yourself -as a patient- the same company that already has a very smart color coding and Tubs are used as a way to transport items from your question. organization system…Zirc® Company. You can set your b. Group Clinic: Group clinics would use two different central sterilization to the operatory and back again. own system, or follow any other available system, this is ID rings on each hand instrument. One color would Materials used during the procedure are delivered from In terms of quality, this indicates the kind of care and just an example that I found available and convenient. signify the procedure (Neon Purple is for Crown & the Tub to the doctor, keeping your procedure tray free quality of work and work atmosphere you have, and this The system starts as follows: Bridge) and the other color would signify the doctor for instrumentation. is not something you just do for your own enjoyment and (Neon Pink is for Dr. Sami). ease of work, it is something your patients can see, and 1. Select a color for each procedure or service you At the end of the day, materials are wiped down and Tub they do admire such details, especially when they see the provide: c. Instrument Order: The ID ring should be placed at a is stored. Both Trays and Tubs can be stored in Racks. opposite in other clinics. For example, you will select the teal color for endo, diagonal. This indicates to the assistant the order in Using a color code system will result in achieving three neon purple for C&B, and neon blue for composite, which the doctor will be using the instruments. main objectives: In terms of standardization, this makes your life much and so on. You can apply this not only for the trays or instruments, but for all related issues. 4. Material Management 1. Improved productivity: Save a minimum of 1 hour easier; your assistants should be trained to set up the The next step in setting up your color code system is trays for each type of treatment in the same manner each day 2. If you have more than one dentist, select a color for organizing your materials by procedure. This starts by 2. Improved infection control using a checklist, even an image or a picture to show the removing your materials from your operatory drawers each dentist 3. Reduced confusion for dental staff sequence of the items on the tray so it is delivered the and utilizing a more efficient alternative, the “Procedure same … every time. Thus they, or even you, would reach For example, Dr. Heikal would be neon yellow; Dr. Sami would be neon pink. But if you are a solo Tub”. A Final Word: More work on organization means less with your hand and get the item you want even without practitioner, then skip this step. mistakes, less time wasted, more productivity and better looking at the tray because each item is in its exact place You will need one Tub per procedure (High volume representation of your practice. If you are looking for every time. Imagine when you are driving and looking at procedures and group clinics may demand additional tubs). 3. Assess the number of procedures (on average) you do assistance with setting up your own color code system, the road, you need to reach your hand out to shift gears, but weekly Zirc has an interactive guide online which takes your don’t need to look every time and search for the gear stick. All Tubs are suggested to be stored in a common area Crown & Bridge = 12 per week data and generates a suggested “Organizational Endo = 6 per week System” based on your selections. This is for one reason; it is always there in the same Composite = 12 per week place. So drive your clinic. 4. Determine quantity of Trays, Cassettes and Bur Holders Color coding is one of the important tools in organizing you will need for each procedure. your work; imagine if all the endodontic files were one Take your configured numbers from step 3 and color??? Endo treatment would have been a nightmare divide them by 4. Four represents the number of days (especially after the age of 40). So if color coding made your clinic operates every week (always round your the endo treatment easier, why not colorize your office? numbers up as in the endo case). | 44 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 45 | Summarized & Presented by: Hassan Maghaireh • Esposito et al. in their placebo-controlled trial conducted in 2008 have included one hundred and sixty-five BDS, MFDS, MSc Implants (Manchester) patients in each group, but seven patients from each group had to be excluded from the analyses for various Clinical Teacher, Dept. of Dental Implants, University of Manchester reasons. Two patients in the antibiotic group experienced a prosthesis failure versus four patients in the placebo group. Two patients (two implants) in the antibiotic group experienced implant losses versus eight patients (nine firstname.lastname@example.org implants) in the placebo group. Three patients in the antibiotic group presented sign of infection versus two patients in the placebo group. One minor adverse event was recorded in each group. Esposito et al. could not find any statistically significant differences between the two groups. Interventions for Replacing Missing Teeth: Antibiotics at • Another study conducted by Marco Esposito and his group in 2010 compared 2g of amoxicillin given 1 hour preoperatively with identical placebo tablets, using a two groups as 254 patients were included in the antibiotic Dental Implant Placement to group and 255 in the placebo group. Four patients in the antibiotic group experienced a prosthesis failure versus 10 patients in the placebo group. Five patients in the antibiotic group experienced seven implant losses versus Prevent Complications (Review) 12 patients that lost 13 implants in the placebo group. Four patients in the antibiotic group presented clear signs of infection versus eight patients in the placebo group. No adverse events were reported. This study observed no Esposito M, Worthington HV, Loli V, Coulthard P Grusovin MG , statistically significant differences for any of the outcome measures. The Cochrane Library 2010, Issue 7 • Finally, A placebo-controlled trial (Anitua 2009) compared 2g of amoxicillin given 1 hour preoperatively with identical placebo tablets. Fifty-two patients were included in the antibiotic group and 53 in the placebo group. Two patients in each group experienced an implant/crown failure and six patients in each group experienced a Background postoperative infection. No adverse events were reported. No statistically significant differences were observed for Some dental implant failures may be due to bacterial contamination at implant insertion. Infections around any of the outcome measures. biomaterials are difficult to treat and almost all infected implants have to be removed. In general, antibiotic prophylaxis in surgery is only indicated for patients at risk of infectious endocarditis, for patients with reduced host- • The meta-analyses of the four trials on the effectiveness of prophylactic antibiotics in reducing failures and response, when surgery is performed in infected sites, in cases of extensive and prolonged surgical interventions complications showed a statistically significant higher number of patients experiencing implant failures in the group and when large foreign materials are implanted.To minimise infections after dental implant placement various not receiving antibiotics: RR = 0.40 (95% CI 0.19 to 0.84). The number needed to treat (NNT) to prevent one prophylactic systemic antibiotic regimens have been suggested. More recent protocols recommended short term patient having an implant failure is 33 (95% CI 17 to 100), based on a patient implant failure rate of 5% in patients prophylaxis, if antibiotics have to be used. With the administration of antibiotics adverse events may occur, ranging not receiving antibiotics. The other outcomes were not statistically significant, and only two minor adverse events from diarrhoea to life-threatening allergic reactions. Another major concern associated with the widespread use of were recorded, one in the placebo group. antibiotics is the selection of antibiotic- resistant bacteria. The use of prophylactic antibiotics in implant dentistry is controversial. 2. Which is the most effective antibiotic, dose and duration: Objectives No trials could be identified. To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the Discussion most effective. All included trials appeared to be underpowered to detect a clinically significant difference, even though they showed clear trends favouring antibiotics. A statistically and clinically significant difference in implant failures was found after the Selection Criteria meta-analyses. This underscores the importance of meta-analyses to increase sample size of individual trials to reach Randomised controlled clinical trials (RCTs) with a follow up of at least 3 months comparing the administration of more precise estimates of the effects of interventions. various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events. Four RCT Authors’ Conclusions trials including 1007 patients were identified ; Abu-Ta’a 2008, Esposito 2008, Anitua 2009 and Esposito 2010. Implications for practice Main Results There is evidence from a meta-analysis including four trials with 1007 patients suggesting that 2g of amoxicillin given Two hypotheses were tested in this systematic review: orally 1 hour preoperatively significantly reduce early failures of dental implants placed in ordinary conditions. More specifically, giving antibiotics to 33 patients will avoid one patient experiencing early implant losses. No statistically 1. Whether prophylactic antibiotics are effective in reducing failures and complications: significant differences in postoperative infections and adverse events were observed. No major adverse events were reported. It might be sensible to suggest a routine use of a single dose of 2g of prophylactic amoxicillin just before • One trial (Abu-Ta’a 2008) compared 1g of amoxicillin given 1 hour preoperatively plus 500mg of amoxicillin placing dental implants. It remains unclear whether an adjunctive use of postoperative antibiotics is beneficial, and 4 times a day for 2 days versus no antibiotics. They included forty patients in each group and none dropped which is the most effective antibiotic. out after 5 months. They reported no prosthesis failure. However, five implants failed in three patients who did not receive antibiotics. One patient in the antibiotic group and four patients in the control group experienced a Implications for research postoperative infection. In this Random controlled trial, Abu-Ta’a et al. concluded that there were no statistically Priority should be given to large pragmatic double-blinded RCTs evaluating the efficacy of prolonged antibiotic significant differences observed for any of the outcome measures. prophylaxis when compared to a single preoperative dose into those subgroups of patients where implant failures are more likely to occur, particularly in those patients receiving immediate post-extractive im- plants and augmentation • Two placebo-controlled trials (Esposito 2008; Esposito 2010) compared 2g of amoxicillin given 1 hour procedures in conjunction with implant placement. It could be also useful to evaluate which could be the most effective preoperatively with identical placebo tablets. antibiotic type. | 46 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 47 | Immediate Placement of Dental Implants Into Debrided Infected Dentoalveolar Sockets Casap N., Zeltser C., Wexler A., Tarazi E., Zeltser R. March 2007 Journal of Oral and Maxillofacial Surgery. Vol. 65 No. 3 pp 384-392 The demand for immediate implant placement is driven by a desire to retain alveolar volume and expedite treatment for the patient. Although many failing teeth are associated with pathology of either periodontal or endodontic origin and it has been presumed to date that it would be inappropriate to place implants immediately into such extraction sockets. However, recent animal and orthopedic studies have suggested that if an appropriate debridement regime is utilized it might be possible to place implants on an immediate basis in a safe and predictable manner. This report presents the results from an initial group of patients benefitting from a new protocol for the placement of implants into infected sockets. Materials and Methods 20 patients were consented for the extraction and immediate insertion of implants into debrided, infected sockets. Patients were given pre-operative prophylaxis of 1.5g amoxicillin or 0.9g clindamycin daily for 4 days. After extraction sockets were curetted to ensure thorough degranulation after which the wall of the socket was removed with an oval bur to ensure that no contaminated hard tissue remained, particularly at the apex in endodontic cases. Sockets were then thoroughly irrigated with sterile saline. Implant osteotomies were then prepared per socket extending apically by at least 3mm to ensure good primary stability. A screw shaped implant (3i Osseotite) was used, and dimensions ranged from 10 to 16mm in length and 3.7 to 4.7mm in diameter. Any residual defect existing between the socket wall and the implant was grafted with BioOss (Geistlich) and sites were covered with a reinforced Goretex (WL Gore) membrane. A flap was coronally advanced for primary closure and patients were given a continuation of their antibiotic therapy post-operatively. Patients were followed up for up to 72 months. Results Of a total of 30 extraction sockets treated, 16.7% were associated with a chronic periapical infection, 13.3% were associated with a subacute perio/endo infection, 30% were associated with a chronic periodontal infection, 36.7% had a subacute periodontal infection and one socket (3.3%) had a periapical cyst. Of the 30 implants inserted, 29 (96.7%) achieved osseointegration. The implant which failed was immediately restored and this may have been contributory. In two cases a membrane became exposed and a late failure was recorded at the 24-month follow- up. One patient suffered with pseudomembranous colitis as a result of the antibiotic therapy. No other long-term complications were noted, with a mean follow-up of 29.3 months. Discussion and Conclusions The presence of infection from periodontally or endodontically compromised teeth has always been considered to be a contra-indication to surgery, since contamination of the surgical field can lead to post-operative infections, which in the case of implants could result in implant failure. In the orthopedic literature it has been reported that debridement of osteomyelitic vertebrae can be successfully followed by immediate reconstruction using titanium mesh to aid early functional stability of the weakened vertebra. Certainly much literature exists for the immediate replacement of extracted teeth with dental implants since it is thought that this might aid maintenance of alveolar bone volume, which would otherwise undergo significant atrophy, potentially limiting future staged placement of implants. In addition there is a considerable advantage to the patient to have immediate implant surgery since this can be shown to significantly expedite completion of treatment. The current study considered the possibility that implants could in fact be inserted into thoroughly debrided, infected extraction sockets under an appropriate antibiotic regime. The long-term implant survival rate of 93.3% is certainly comparable to that quoted for implants placed in non-infected sites and in no cases was a post-operative infection recorded. It can therefore be concluded that when utilizing the protocol outlined, implants can be placed into extraction sockets previously associated with subacute or chronic infections of periodontal and endodontic origin. | 48 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Do Periodonto-Pathogens Disappear After Full-Mouth Tooth Extraction? Van Assche N., Van Essche M., Pauwels M., Teughels W., Quirynen M.; Journal of Clinical Periodontology; Vol. 36 No. 12 pp 1043-1047; December/2009 Numerous studies have been published demonstrating that periodontal pockets at natural teeth can act as reservoir for periodonto-pathogens which can subsequently cross-infect implant sites. Therefore an appropriate pre-surgical periodontal program and regime is essential. Previous studies using culture testing have also shown that, 6 months after full mouth tooth extraction, there is no trace of the pre-existing periodonto-pathogens. An alternative modern method for detecting periodonto-pathogens that is thought to be more sensitive than culture testing is the polymerase chain reaction technique. This study therefore aimed to establish whether full mouth tooth extraction eliminates pre-existing periodonto- pathogens, by using the polymerase chain reaction technique, which has a lower threshold for the detection of specific periodonto-pathogens. Materials and Methods Nine patients with aggressive advanced periodontitis and a failing dentition had samples taken prior to and 6 months after full mouth tooth extraction. Samples collected included: biofilm from the tongue using a cotton swab, 5ml of unstimulated saliva and subgingival samples from 2 deep pockets using 8 paper points. Samples were dispersed in reduced transport fluid and processed within 12 hours. Microbiological analysis was carried out blind, using quantitative polymerase chain reaction technique. Descriptive statistical analysis including the mean and standard deviation were calculated using data recorded in the log 10 format. Results Prior to extraction, all patients exhibited high levels of P. gingivalis and T. forsythia within their periodontal pockets with sites in another 8 patients being colonized by A. actinomycetemcomitans and/or P. intermedia. Post-extraction, all patients continued to demonstrate the presence of the same periodonto-pathogens with detection frequencies from tongue and saliva remaining unchanged compared to frequencies prior to extraction, except for 1 sample of P. intermedia. However, the number of bacterial genomes detected was substantially lower especially for P. gingivalis and T. forsythia, by a 3-log reduction. Discussion and Conclusions With studies showing a similar microbial picture in periodontitis as in peri-implantitis, it is thought that the same pathogens are responsible for peri-implant infections. Previous studies have typically used culture techniques to assess the presence or absence of periodonto-pathogens while in the current study the polymerase chain reaction technique was utilized. The differing outcome between the two testing methods is down to the number of cells needed for detection. Culture based tests require a minimum of 1000-10,000 cells compared with the polymerase chain reaction technique, where only 25-100 cells are needed and unlike culturing, this technique will also detect dead, as well as live cells, making it a much more sensitive detection tool. Processing samples under aerobic conditions may also make detection of anaerobic bacteria difficult. The results of the current study clearly demonstrate the continued presence of periodonto-pathogens after full-mouth extraction and this raises the question once more as to whether antibiotics are required prior to implant placement? However, if one considers the high success rates achieved with implant therapy, as well as the low incidence of peri- implantitis, this does not appear justified. In part this is due to the fact that numerous studies have demonstrated the potential for both healthy periodontal as well as peri-implant sites, even in the presence of higher concentrations of these pathogens than have been detected in the current study and it is also questionable whether antibiotics can eliminate bacteria at such low levels. Furthermore, although debatable, it is thought that the host immune response may play a role in this. The current study is also in agreement with a previous study using polymerase chain reaction technique, which demonstrated that in 15 edentulous patients tested for various pathogens before and after implant placement, 7 . patients were colonized with small quantities of P intermedia, 2 with A. actinomycetemcomitans and none for P. gingivalis. | 52 | Smile Dental Journal | Volume 5, Issue 4 - 2010 A-dec Introduces Its Newest EndoActivator® Family Member: A-dec 200™ by Dentsply Maillefer For many years, research has been made in investigating how to significantly improve New Point-of-entry A-dec 200 Offers No- Endodontic disinfection methods. Clinically, Compromise Performance and Real A-dec Value. disinfection protocols should encourage debridement, the removal of the smear layer A-dec, a global leader in dental equipment, and the disruption of biofilm. Logically, introduces A dec 200™, the newest in A-dec’s well-shaped canals potentially facilitate lineup of patient chairs and delivery systems, with 3-D cleaning, filling root canal input from dental professionals around the world to systems and predictable success. accommodate the wide range of practice styles found Importantly, the technology in global markets. selected to promote disinfection should be easy-to-use, clinically safe and effective. The space-saving chair-mounted delivery system includes a telescoping assistant’s arm and an In an effort to improve Endodontic outcomes, the oversized tray to hold EndoActivator® was developed with the help of a team everything the dental team of expert clinicians and scientists. Based on the sonic needs. The new multi-axis light activation of the irrigation dressing, the EndoActivator® provides easy and precise provides a simple, safe and effective method to enhance positioning of disinfection. Virtually any dentist who places emphasis on illumination, shaping canals can efficiently integrate the EndoActivator® and the into clinical use. cuspidor rotates Since its first introduction, research has shown that the conveniently to EndoActivator® produces significantly cleaner canals the patient when compared to the controls and the commonly employed needed. methods utilised by well-trained international dentists and Endodontists alike. This research is available today in the The chair, light and most prestigious journals (see bibliographic references). cuspidor functions are easily controlled from A dec’s Bibliography modern touchpad and small and large practices will De Gregorio Cesar et al., Journal Of Endodontics, Volume 35, June 2009, p.891-895 enjoy the open platform that leaves room to add or Desai P., Himel V. JOE, Volume 35, April 2009, p. 545-549 change ancillary devices for peak performance now, Shen Y. et al. JOE, Volume 36, January 2010, p. 100-104 and in the future. www.a-dec.com www.dentsplymaillefer.com DenTag... A Good Reason to be Different For more than half a century, Den Tag in Maniago has been synonymous with: • carefully-selected materials of the highest quality • design and manufacture tested after each production phase • latest technology machinery, continually updated • expert craftsmanship based on an old tradition in stainless steel working • constant and continuous research • the closest possible attention to the quality of the finished product All these factors have contributed to the constant growth of the company and its excellent international reputation as a supplier of top-quality surgical instruments. We have been - and continue to be - widely copied. And it is for this reason that we want to help our clients avoid confusion by introducing a line of products with newly-designed handles, and marketed exclusively with the DenTag trademark. At least, until they copy this too... www.dentag.com | 54 | Smile Dental Journal | Volume 5, Issue 4 - 2010 MOCOM 24 Years Meeting the Needs of the Dental Practice MOCOM, a leading figure in the development of innovative sterilization systems, has created Millrack, a vertical sterilization system to optimize space within the practice. Its elegant design allows combining various pieces of equipment for a perfect sterilization procedure: from cleaning to thermo disinfection, from packaging to sterilization up to storage, depending on the need. The system is provided with integrated electrical and water filling and drain hook-ups that allow devices to be directly connected. With Mocom Milldrop’s water osmosis system it is possible to fill distilled water into Mocom’s Millennium sterilizers (with automatic filling) without any operator intervention. Millennium steam sterilizers are Mocom’s type-B unit dedicated to professionals in the dental and medical field. Completely designed according to EN 13060 standard and extremely easy to use, the Millennium sterilizers represent a reference point in terms of safety, performance and flexibility. Thanks to the high number of configuration available, the 11 programs and the patented devices, they can satisfy any sterilization requirement. The exclusive patented system of an instantaneous steam generator and of a double-head vacuum pump, ensures the highest performances in every situation without any waiting time between one cycle and the other. www.mocom.it Accutron Inc., the Innovator in Nitrous Oxide Conscious Sedation Systems, Has Announced the Redesign of the Digital Ultra™ Flushmount Flowmeter Flow Dental Corporation manufactures high quality, competitively priced imaging products from dental x-ray film to digital imaging By separating the control unit from the gas supply module machines. Flow X-Ray changed its name to Flow the newly redesigned Digital Ultra™ Flushmount offers Dental signaling the company’s plans to expand more. Measuring just over one inch in depth, the control its product portfolio and offer dental professionals unit of the in-cabinet mounted flowmeter provides a gain in a more comprehensive catalog of merchandise accessible cabinet storage space and expands installation with the same quality and reliability they have options. The new unit is also NFPA-approved to be mounted come to expect from Flow X-Ray. in a wall. Other features of the Digital Ultra™ Flushmount include: percentage controls (adjust the flow and percent gas Recently, they added a comprehensive line remains constant, adjust the gas and flow remains constant); of digital imaging accessories, including the brightly colored Safe’N’Sure line of phosphor plate envelopes, digital readouts and the Comfee’s line of sensor sleeves, and the new electronic flow tubes; improved SUPA bite blocks that are uniquely easy-to-clean and formed to work with both film and phosphor disinfect or barrier- plates. Flow also has a complete line of lead and protect sealed lead free protective aprons. membrane; and multiple safety features. Flow’s core value is that the needs of every customer are Flow’s number one priority. All Accutron flowmeters carry a 2-year warranty, the Quality and reliability are guaranteed with longest flowmeter warranty in every product shipped and Flow is committed to the industry. continue to serve the needs of dentists and dental professionals worldwide. www.accutron-inc.com www.flowdental.com | 56 | Smile Dental Journal | Volume 5, Issue 4 - 2010 W e i n v e n t , y o u s u c c e e d ! The G6 from Global Surgical Corporation Global Surgical Corporation dental microscopes are used by more dentists around the world than any other brand of microscope. For over a decade, Global Surgical has been committed to developing and promoting microscopes for use in dentistry. In collaboration with dentists from around the world, we have designed our line of microscopes to specifically suit their needs. The results have revolutionized clinical practices in all disciplines and specialties. The G6 represents the next contribution to this revolution. The G6 features: Six steps of magnification Optimal magnification range of 2.1x to 19.2. The operator can view an entire arch or increase the magnification for precision and close inspection. Maneuverability Easy movement of the microscope head offers easy view of the mouth. Ergonomically Designed Allows for comfortable positioning of the operator, reducing or eliminating neck and back pain. Modularity Will accommodate upgrades and retrogrades without high costs. Depth perception - Greater depth perception is achieved by the wide-field optics (10% better than the competitors). The standard components include inclinable binoculars, adjustable (Helicoid) eyecups, maneuvering handles, objective lens with fine focus (+/-20mm), light source, and light source housing. www.globalsurgical.com HOYA ConBio Novocol VersaWave Laser ® Pharmaceutical HOYA ConBio dental Novocol Pharmaceutical is a world leading pharmaceutical lasers represent state-of- manufacturer, specializing in dental operatory and pain the-art solutions to help control products, such as dental anaesthetic. dental practitioners perform procedures more efficiently Our innovative and well established dental anaesthetics set and effectively, with increased us apart in the area of sterile anaesthetics. patient comfort and satisfaction. Our Mission is to be recognized globally as the company that sets the standard for quality and innovation in dental Designed for use in hard, soft, products and osseous tissue procedures, the VersaWave® Erbium All-Tissue laser • Terminally Sterilized: ensuring the sterility of is an excellent choice for practitioners who want to each Novocol anesthetic cartridge experience the full benefits of laser dentistry. The • Products are manufactured using the highest VersaWave is also a popular choice for specialists in standards to assure quality and purity orthodontics & pediatrics. This advanced laser can be • No paraben preservatives used for a wide range of procedures, including cutting, • Mylar wrapped cartridges reduce risk of shaving, and contouring osseous tissues, crown shattering, especially intraligamentally lengthening, and laser removal of diseased soft tissue • Color-coded packaging for easy within the periodontal pocket. The VersaWave is also identification of anesthetic types used for soft tissue smile design, smile lift procedures, • Siliconized neutral glass cartridges for frenectomies and hard tissue application in closed smooth injections and patient comfort flap, open flap and pre-prosthetic surgical procedures. • Lot numbers and expiration dates imprinted on all packages and cartridges A global pioneer in lasers, HOYA ConBio has a strong heritage in continuing education and certification, On-going research and development ensures dedicated to increasing the use of laser technology in we continue providing our customers with products and dental practices worldwide. services that are unsurpassed in meeting their expectations for quality and performance. www.conbio.com www.novocol.com | 58 | Smile Dental Journal | Volume 5, Issue 4 - 2010 BISCO offers all the products you need, from start to finish, for each clinical procedure. Bottom up dentistry. Top down esthetics. Here are more great products from BISCO... ALL-BOND SE® ÆLITEFLO™ CHOICE™ 2 Self-Etching Adhesive Flowable Microhybrid Composite Veneer Cement For more information email email@example.com or visit www.bisco.com WAMKey® SDI Riva Luting Plus - Esin Modified New Crown Remover Glass Ionomer Luting Cement WAMkey is a three-instrument set, which allows Riva Luting Plus is a resin modified, you to begin with the smallest instrument to keep self curing, glass ionomer luting preparation to a minimum. The technique is quick cement, designed for final and easy to perform, with most crown removals cementation of metal, PFM and resin performed in less than three minutes. crowns, bridges, inlays and onlays plus ceramic inlays and crowns. 2 minutes and 2 fingers are far enough to Riva Luting Plus chemically bonds remove a crown and "2" reuse it! to dentin, enamel and all types of core material. Designed for crown and bridge removals, Riva Luting Plus has extremely the Wamkey® is said high fluoride release. Caries to provide a quick, prevention is totally maximised easy, cost-effective and with Riva Luting Plus. painless alternative to Riva Luting Plus quickly flows into the preparation. A low film current crown-removers. thickness allows the seating of tight fitting indirect restorations. This simple-to-use device works by dissociation, Riva Luting Plus is clinically insoluble improving the longevity with minimal pressure on and aesthetics of the restoration by resisting the disintegration the supporting teeth (no and wear caused by oral acidity. traction and no rocking movement). Thanks to Adequate adhesion to human tooth structure is important a vertical removal line, for long term retention of restorations. Riva Luting Plus has there is no risk of fracture excellent adhesion both the tooth and substrates. It is great for or rupture of the ligament. luting ceramic crowns and inlays. Moreover, this operation Riva Luting Plus does not contain any Bisphenol A or its takes less than 2 minutes and derivatives. Use this product on your patients with confidence the crown can be reused in and peace of mind. most cases (more than 80% of ceramics), both entailing Riva Luting Plus is available in new & improved capsules and important savings. in powder/liquid sets in one universal light yellow shade. www.wamkey.com www.sdi.com.au Planmeca’s Dental Imaging Software Expands Full Mac OS Support and Tools for More Accurate Implant Placement One of the world’s leading dental equipment and software manufacturers, the Finnish Planmeca Oy, is pioneering once again. Planmeca Oy is the first dental manufacturer to offer Mac OS operating system support for all its X-ray units. With the latest version of Planmeca Romexis, a software including all dental imaging modalities and embracing modern IT standards, whatever the diagnostic requirement, the images can be acquired, viewed, processed and stored in either Mac OS or MS Windows environment. The Apple compatibility also enables sending 2D and 3D images to an iPhone or iPad simply with one click. The software release 2.4 also includes new implant verification tool allowing examination of the implant in relation to the surrounding anatomy by visualising slice views and average HU- values in the proximity of the implant. Implant library with realistic implant models from several manufacturers further facilitate implant planning. “Imaging software is the heart of any dental practice with X-ray imaging devices. The numerous tools and functionalities of the Planmeca Romexis software improve the diagnostic value of the radiographs and smooth the acquiring process,” says Ms Helianna Puhlin-Nurminen, Vice President for Digital Imaging and Applications Division. www.planmeca.com | 60 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Visit us at AEEDC 2011, booth #30 W&H Counts on Education Education really counts at W&H – that’s why W&H has cooperated with the European Dental Students´ Association (EDSA) for a long time now. This time it was to support the 2nd EDSA Summer Camp, held in Alexandria, Egypt from 13 to 19 September 2010. As learning by doing is still the best way of thoroughly understanding things, the EDSA invited its members to find out about life in the dental practice. Because the EDSA Camp was part of a voluntary work programme to enable free treatment for the low-income population. Under strict supervision from trained personnel of the Faculty of Dentistry at the University of Alexandria, 7 European students had the opportunity of putting their knowledge to the test on around 70 patients. Besides conservative dental treatments, periodontal, endodontic and surgical treatments were on the agenda. W&H and its Egyptian partner IMECO provided Alegra turbines, air motors and Alegra straight and contra-angle handpieces for the students free of charge. The students went to work with a great deal of enthusiasm and pleasure: A unique experience and the best possible teachers, Hana Mezlová (dentistry student / Czech Republic) describes her experience. A unique opportunity, nice people, great instruments, was the reaction from Youssef Kassem (dental student / Egypt). www.wh.com Dental X Autoclaves: It is not enough ...to say class B! Although, the class B autoclave (norm EN 13060) represent the state of the art, it is wrong to think that all class B autoclaves are equals. There are big and significant differences that shall be taken in consideration and diligently compared before purchasing an autoclave. New chamber/heating concept: Thank to the exclusive chamber made of copper (nickel coated) and the revolutionary soft- adaptive heating elements, dental X autoclaves eliminate the thermal jumps and enable a fast and safe sterilization without risk of early instruments damages. We underline that the copper have a thermal conductivity 23 times higher than stainless steel and the soft-adaptive heating elements permit a more precise temperature control during all sterilization and drying phases. Performances: dental x autoclaves grant higher performances. It means faster cycles and bigger sterilization capacity. Reliability: the exclusive DX heating system improves both performances and reliability and reduce the needs for service. Bigger capacity: Due to the exclusive heating system it is possible to sterilize a bigger number of instruments for cycle. The useful chamber volume of dental autoclaves is 20% bigger than others Save your instruments life: The advanced heating technology allows a gentle sterilization. By eliminating thermal jumps, the risks of instruments damages are null. Respect for environment: The electrical consumption is very low (further below our competitors). The water net connection (optional) in compliance with EN 13060 eliminate potential contamination risks. Flexibility: Dental X autoclaves are able to perform class B and class S cycles. That enable to fit any kind of surgical needs. Technology: Dental X conjugate cleverly the technology with the common sense. The technology, in all Dental X autoclaves, is applied in order to simplify the use, to improve the performances and to increase the reliability and the product life. Service: Dental X grant a professional and rapid service through his sale and service network. All Dental X autoclaves have been certified in class IIB by SGS. The choice to certify the autoclave under the most restrictive class prove the quality and the safety of the Domina Plus. www.dentalx.it | 62 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Endoest-Motor FSM Intigrated system for complex endodontic treatment which consists of: 1. Endomotor: which has two subsystems: a. File management: maximal ease of work with modern endodontic technologies of various forms-manufacturers, in addition to a freely programmable regime. b. Safety management: Through the high accuracy of the given torque limitation, association with the built-in apex locator, automatic counting of the file's "lifes", and the possibility of the sterilization of files together with the cartridge. A 2. utonomous, precise and reliable apex locator for apex localization. O 3. bturator of root canals by heated gutta percha. C 4. uring LED lamp for polymerization of dental restorative materials. D 5. iagnostic LED lamp (orange light-diode LED) for localization of root orifices, latent carious cavities, cracks, splits... etc www.alshumukh.com EndoAce® Endo pleasure! FRIADENT Implantology The introduction on the market of Nickel-Titanium methods in the Course 1990s created a real revolution in endodontics. These new methods proved to be simpler and more efficient than the traditional manual methods. 80 Iraqi Dentists attended the Implantology course and hands-on training by Dr. John However, the risk of breakage remains Dobbeleir (Belgium) and Dr. Imad Salloum a permanent concern for every general (Syria) at Holiday Inn Hotel – Amman on the practitioner. That is why using an endo 19th and 20th of October 2010 sponsored by motor with torque and speed control is DENTSPLY FRIADENT Company. essential in order to achieve absolute security in daily practice of endodontics employing rotary systems. Recently introduced on the market, ENDOAce® is an endo motor with torque and speed control and integrated apex locator. It is compatible with all NiTi systems currently available on the market. The ideal all-in-one! No more breakages! Automatic system reversing the direction of rotation to free the instrument. Reliable and effective automatic electronic disengaging system. Starting, slowing and changes of direction are gradual to avoid jarring and vibration. Apex under control! A separate Apex locator is no longer needed. Very accurate measurement of the apical position of the file in real time on the screen with an audible warning. Apical precision when dry or wet in the presence of electrolytes. Ergonomic contra-angle! Micro-head providing excellent visibility of the operating field. High performance composite. Innovation! The instrument starts automatically when entering the canal. ENDOAce® is the essential tool for every endodontic treatment respecting the file and offering simplicity, gain in time and safety. www.micro-mega.com | 64 | Smile Dental Journal | Volume 5, Issue 4 - 2010 THE THOUGHT OF THE DENTIST BRINGS A BROAD SMILE. AEEDC 2009 Stand # 309-407 Middle East Area Manager Mahmoud Lutfi IDS 2009 Tel: +962 6 5656404/5 Hall No. 11.2 Fax: +962 6 5656402 Stand # R-040 - S-041 Mob: +962 7 95536867 Aisle R E-mail: firstname.lastname@example.org BIDM 2010 23 - 25 September, 2010 | Dbayeh, Lebanon The 20th annual convention of the Lebanese Dental Association (LDA), BIDM 2010 was held at the Congress Palace, Dbayeh, Lebanon. In his opening speech The Scientific Chairperson of LDA/BIDM Dr. Ronald Younes stressed on the fact that this year the scientific program had been designed to address the highly relevant issues that concern clinicians. With the theme “sustainable dentistry” being of prime importance in designing the convention. Where all past BIDM conventions were successes, this year’s was a remarkable event, attracting almost 1800 delegates coming from different countries around the globe like Japan, Mexico, USA, France, Germany, Spain, Turkey, Greece, Italy, Swizerland, The Netherlands, KSA, Qatar, Jordan, Egypt, and Algeria. Gathering 24 international speakers with 55 speakers from Lebanon. The speakers highlighted the areas of ongoing developments and frontiers of researches and challenges in treatment planning, clinical performance, and sustainable measures that are essential for a long term treatment success. The program included 125 oral sessions, 5 live video transmissions, and 11 workshops which were of great benefits to the participants. A huge trade exhibition was held through the conference with the world’s leading companies presenting the latest in the field of materials and instruments as well as the latest technologies in the field. In his closing speech Younes thanked the president of LDA Dr. Ghassan Yared for his support to the convention and the role of LDA board in supporting the event to be a very successful one. President of LDA & His Excellency the Minister of Health Richa Dental group Mr. Karam & Dr. Niznick From the opening ceremony GSK Closing ceremony W&H LDA staff Tamer group Arab delegates Dental X a partner with great experience Dental X ...the sterilization company 31 Since1980 Anniversary Aptica Plus B the faster B class autoclave specially designed Domina Plus B for your handpieces sterilization. designed for a safe, reliable and rapid sterilization of all your instruments. dx Dental X spa Area Manager Middle East: via marzotto 11 Mr. Mahmoud Lutﬁ Visit us at AEEDC 36031 dueville vicenza Tel: +962 6 5656404 Booth: 300 tel +39 0444 367400 Mobile: +962 7 95536867 fax +39 0444 367436 Email: mlutﬁ@go.com.jo Visit us at IDS e mail email@example.com dentalx@m-lutﬁ.com internet www.dentalx.it Halle: 10.1 dental x Booth: G58 - H59 Launching 22nd Jordanian of the Arabic 19 - 22 October, 2010 | Amman, Jordan Translation of & the 39th Arab FDI Dental Dental Congress Arab Delegates Ethics Manual Under the patronage of H.R.H. Princess Rym Ali, the 22nd Jordanian & the 39th Arab Dental Congress was held at Le Royal Hotel - Amman. The Arabic translation The comprehensive scientific program included a series of of the FDI Dental Ethics scientific lectures presented by 80 remarkable Arab and manual was launched Foreign speakers, 6 workshops, poster presentations as well H.R.H. Princess Rym Ali, Dr. Jaabari, Dr. Tarawneh Dr. Abu Tahoun, Dr. Balto, Prof. Torabinejad during the scientific event Dr. AL-Dwairi as pre-and post-congress courses. The main guest speakers of the 22nd Conference were Dr. Mahmoud Torabinejad, Dr. Stephen Rosenstiel and of the Jordanian Dental Prof. Frances M. Andreasen. Association and the 39th Conference of Arab Dental Association held in More than 50 local and International dental supply agencies Amman-Jordan from 19-22 October 2010. displayed their products to around 1300 participants. The manual was translated by Dr. Ziad AL-Dwairi Diamond sponsor: Mudieb Haddad & Sons Co./Colgate. and Dr. Hayder AL-Waeli from faculty of Dentistry- Jordan University of Science and Technology on behalf of the Jordanian Dental Association. Dr. Al-Darwish & Dr. Jaabari Dr. AL-Dwairi said that the manual is published Guest Speakers in a practical pocket size format and it is hoped that it will become an invaluable aid to the work routine of dental practices and dental schools in the Arab World in order to give all involved in dental education and care the opportunity to benefit from the principles conveyed in this book. Khoury Dental Denta Med Dr. AL-Dwairi added: The manual provides a concise introduction to the basic concepts of ethics and their application to the most common issues encountered by dentists in their daily Arab Delegates practice. In addition to its emphasis on the practical application of ethical principles, the Manual focuses on the relationship among ethics, professionalism and human rights. Dr. AL-Dwairi was a member of the international At Ibn Rushd booth A-dec advisory group formed for the publication of the Basamat Pharmadent manual in its English language. Stern Weber Lutfi Al-Shumukh Medical Co. Mudieb Haddad & Sons Co. Neobiotech dentalArt presents Opera new simulation unit Meet us at AEEDC Dubai Stand 301-302 1-3 February 2011 dentalArt spa Agency for middle east Montecchio Precalcino Mahmoud Lutﬁ Vicenza - Italy p.o. box 641 11941 amman jordan firstname.lastname@example.org ph. +963 6 5656 404/5 www.dental-art.it mobile: +962 7 95536867 email: mlutﬁ@m-lutﬁ 2nd Syrian British Dental Conference 28 - 30 October, 2010 | Damascus, Syria & 2nd Scientific Meeting of the Syrian Section of IADR Prepared by: Dr. Adel Moufti Vice President, Syrian Society for Dental Research Under the Patronage of Prof. Wael Moala; President of Damascus University, the conference was held in the prestigious Omayd Palace in Damascus and was organised by the Syrian Association of Dental Research (Syrian Section of IADR) and the Syrian British Medical Society in coordination with the Dental School of Damascus University. With the theme “Aesthetic Dentistry – Top Tips for a Natural Smile” the conference featured talks by eminent speakers. Amongst the guests were Dr. Amarjit Gill; Head of the British Dental Association, Prof. Edward Lynch; Director of Dentistry at the University of Warwick, Prof. Ashraf Ayoub; Prof. of Oral & Maxillofacial Surgery at Glasgow Dental Hospital, Prof. Richard Palmer; Professor of Implant Dentistry and Periodontology at King’s College London, Prof. Marrie Hosey; Head of Paediatric Dentistry at King’s College London and Prof. Brian Millar; Programme Director, MSc in Aesthetic Dentistry at King’s College, London. 40 more consultants and speakers from across the UK, Syria, Lebanon, Tunisia, KSA, Pakistan, Egypt, Iran, and the UAE have contributed to the multidisciplinary conference covering all aspects of aesthetic dentistry with oral and poster presentations. From updates on Orthodontics and Botox to the latest developments in Dental Ceramics and Implants, emphasis was given to the evidence-based inter-relation between all dental specialties to achieve optimum aesthetic results. Delegates have particularly highly valued their participation in the Clinical Debates session, which allowed an interactive discussion with a number of specialists in different disciplines using the state of the art Audience Voting System. The 750 delegates had the opportunity to visit an exhibition of latest technologies and materials from major dental industries. The conference management appreciates the support of the sponsors including Yafour Resort in Damascus, Smile Dental Journal, Ivoclar UK, DMG and Kochaji Publication Establishment. Prof. Albonni, Prof. Yousef & Dr. Almasri The organising committee members Prof. Edward Lynch Dr. Pierre Saloum Eng. Houssam Jurdi with the president of the British Dental Association Dr. Amarjit & Dr. Siobhan Dr. Joseph, Miss Solange & Mr. Farzat Dr. Farwati, Dr. Almasri & Dr. Hans Smile Dental Journal | Volume 5, Issue 4 - 2010 | 72 | Assurance Visit A-dec at AEEDC stand 230 Invest in reliability. Focus on the patient. Express your style. From the people and who build the most dependable dental IDS stand D10 equipment in the world, A-dec 200™ provides you with a complete system to secure a successul future. Discover how you can gain assurance with A-dec 200. Contact your authorised A-dec dealer today. Discover A-dec 200. Contact your local dealer A-dec Inc. 2601 Crestview Drive, Newberg, Oregon 97132 USA www.a-dec.com 28 - 30 October, 2010 | Beirut, Lebanon 7th International Meeting of SENAME Mediterranean Society of Implantology and Modern Dentistry For many years, SENAME’s annual session has been leaving its marks on the scientific calendar of Mediterranean dentistry. In 2010, under the patronage of the faculty of Dental Medicine, SAINT JOSEPH UNIVERSITY (USJ) and with the theme “State of the Art in Implantology and Modern Dentistry”, the Mediterranean Society of Implantology and Modern Dentistry held its 7th International Meeting of SENAME During a Lecture at Campus of Medical Science, USJ, Beirut – Lebanon gathering global leaders in oral implantology who shared their clinical expertise in surgical practice, as well as recent advancements in research, academics and overall industry. Oral presentations, live transmissions, Junior Podium and pre-meeting courses enriched the program where Dr. Maurice Salama & Dr. Henry Salama (USA) presented a surgical video live from Atlanta showing “Advanced Simultaneous Bone Ridge Augmentation and Sinus Elevation”. More than 20 leading companies exhibited their dental products to around 500 attendees. Dr. Makary, Prof. Naaman, Dr. El Khoury Main sponsor: Tixos Implants. At Richa Dental Store booth Dr. Henry Salama at Cedra booth Dr. Christian Makary (right) at Tekka booth During a Lecture Exhibitors Dental Tech Our motto is to provide best quality and services, which it makes Number 1 concern. Interested in being a distributor for Neobiotech products in some Arab countries? Please contact us: +962 79622 3402 email@example.com 28 - 29 October, 2010 | Beirut, Lebanon For the first time in the history of Arab and Mediterranean countries, Mediterranean and Arab societies of Pediatric Dentistry were gathered in one convention at the same time in Lebanon. Arab Societies of Pediatric Dentistry meet once every two years in a convention in an Arab country. Lebanon gathered them in 2002. Mediterranean Societies of Pediatric Dentistry meet once every four years in a Mediterranean country. Lebanon had the chance to organize it in 1994. In the year of 2010, the torch of knowledge has been entrusted to Lebanon to gather the Arab and Mediterranean countries and The Lebanese Society of Pediatric Dentistry had the honor to organize The 7th Mediterranean Congress of Pediatric Dentistry with the 8th Arab Congress of Pediatric Dentistry, on October 28-29, 2010 in Le Bristol Hotel/ Beirut. The Arab Societies (Lebanon, Syria, Egypt, Tunisia, Kuwait, Jordan and Sudan) had their General Assembly on Wednesday October 27, 2010 at Le Bristol Hotel where they discussed about making the Arab Society Association more professionally evaluated on many levels and where Lebanon took the lead for Presidency till 2012 (President: Dr. Mohamed Ezzeddine, Secretary General: Dr. Bechara Asmar, Treasurer: Dr. Georges Abi Hatem). During the meeting of the Mediterranean Societies (Lebanon, Syria, Egypt, Tunisia, France, Italy, Turkey and Greece) on Thursday October 28, 2010, Prof. Guiliano Falcolini proposed with an early discussed book to create during the meeting and join the Mediterranean Association Of Pediatric Dentistry. After voting, 3 members were elected as a board committee for 4 years: President Dr. Mohamed Ezzeddine, Secretary General Prof. Guiliano Falcolini, Treasurer Dr. Bechara Al Asmar. More than 30 Medical and Dental Companies sponsored this International event. Two head speakers; Prof. Stephen Moss [USA], Dr. Alice Harfouche [Canada] and 30 speakers from all over the world participated during these 2 days of conferences. Prof. Charles Pilipilie Dr. Mohamed, Miss Solange & Dr. Amr Opening ceremony Prof. Charles Pilipilie Dr. Alice Harfouche Prof. Stephen Moss Quality Quality and guarantee of effectiveness and trouble-free process of prosthetics is the main duty of Implasa Höchst company. Research & Development Is there a limit in development of dental practice? The answer to this question opens by itself, if we take a look to the way which the Implasa Höchst company passed for 10 years in the field of the newest technologies of the cure and prosthetics of teeth. Materials & Technologies The high-quality materials + constantly improving technologies = the guarantee of our quality and your success Production Cycle ImPlasa Höchst company specialists diligently control the quality of the released production at all the stages of technological process and production. Microscopy The surface of implants is prepared by unique technology of ImPlasa Höchst company, named ImPlapore, which allows to reach minimal traumatizing in Visit us at: the area of implant installation, and such AEEDC 2011 Hall 7 - Booth 521 way maximally eases the osseointegration IDS 2011 process. B059 - Hall 02.2 The Sole Representative in the Middle East and Africa Syria Lebanon Jordan Turkey Kingdom Medical & Kingdom Medical & Rancy Dental & ASYA DENTAL Dental Instruments Dental Instruments Medical Supplies +902164957287 +963 21 5732052 +961 6 426462 +962 795361016 firstname.lastname@example.org email@example.com firstname.lastname@example.org email@example.com E: firstname.lastname@example.org The 7th Gulf 3 - 4 November, 2010 | Muscat, Sultanate of Oman Dental Association Conference Under the auspecies of H.E. Dr. Ahmed Mohammed Obaid Al Saidi; Sultanate of Oman Minister of Health, the 7th Gulf Dental Dr. Al-Jammaz and Dr. Al-Harthy Association Conference was hosted in 2010 in The Sultanate of Oman and organized by the Oman Dental Association in Al-Bustan Palace Hotel. Dr. Hamad Al-Harthy; President of the Organizing Committee of the Congress and President of the Oman Dental Society, welcomed the audience during the opening ceremony and spoke about the rich support offered by the Sultan for the Congress. Dr. Mohammad H. Al-Jammaz; General Secretary of the Gulf Dental Association (GDA) mentioned: “Based on the GDA rules and policies, this annual scientific conference focused during its activities at aiming to improve continuing education, prevention, research, development of standards, and enhancement of dental Dr. Al Madany during the trophy ceremony care and awareness by the citizens and residents of GCC countries. With the sincere cooperation of all dental societies and the support from the governments in the GCC countries, the GDA conference becoming one of the most important events on the international dental calendar, giving the dental professionals the opportunity to meet, share and discuss the latest in the dental science, art, ethics and technology.” The conference involved the main scientific program, exhibition and pre-conference workshops as well as Poster Presentations covering various disciplines of the dental profession. The GDA Board held its 13th meeting during the event discussing Dr. Darwish during the trophy ceremony future issues of the association. Dr. Rajaa, Miss Solange and Dr. Aisha DeguDent booth GSK booth Miss Sfeir with Dr. Al Kahtani Visiting Smile booth 4 November, 2010 | Dubai, UAE 2 Aesthetic Dentistry nd MENA Awards On 4th November 2010 CAPP and EMA Dental Society hosted the annual Aesthetic Dentistry MENA Awards Gala Dinner, held at Jumeriah Beach Hotel, Dubai UAE. The star studded evening was attended by the leaders in dentistry, industrial professionals and government. The evening marked the dentistry elite and celebrated them in style with a glamorous awards ceremony and gala dinner. The evening began with welcome remarks from Dr. Ali Bin Shekar Head of Association-EMA Board Greetings were also delivered from Dr. Aisha Sultan, Head of Dental Services in Dubai and Northern Emirates Ministry of Health. Followed by the presentation of the awards a fantastic dinner and enchanting Tanoura dancer. This is the only awards that recognize the excellent achievements of dental practitioners across the region. The competition again is jointly hosted by the two organizations that created the concept and actively promote it: EMA Dental Association and CAPP (Centre for Advanced Professional Practices). Ministry of Health and professional organizations (Saudi Dental Society, German Implantology Association, Alexandria Oral Implantology Association etc.) supported the event for the second time. Dr. Sabry, 3rd place winner in Congenitial Jury Panel members & Maxillo-Facial Deformities best case Memorial picture Dr. Sobatiani, 1st place winner in Conservative Iraqi delegates Esthetic best case Announcing the winners Mr. Villani, 1st place winner in Prosthetic Dr. Hani Dalati & Spouse Restoration best case Dr. El-Mousa & Spouse Mr. Kafity & Dr. Mollova AEEDC 2011 STAND N. 381-382 Smiles & Technologies ZHERMACK INTEGRATED SOLUTIONS FOR YOUR PRACTICE HYDRORISE: the first hyperhydrophilic A-silicone with a very low contact angle (less than 10°) and the innovative AMDA System (Advanced Moisture Displacement Action) which guarantees precise detail reproduction in the oral cavity. ZETA HYGIENE: newly improved, widely effective range of disinfectants and sterilisers for dental surgeries and laboratories allows the user to deal with all the Tel. +39 - 0425 597611 - Fax +39 - 0425 597642 hygienic–sanitary requirements of the dental surgery. email@example.com - www.zhermack.com 2nd Dental - Facial Cosmetic International Conference 5 - 6 November, 2010 | Dubai, UAE The 2nd Dental - Facial Cosmetic International Conference was a great success, accomplish record attendance and further establishing a status as the dental industry’s leading international conference. It took place at the Jumeirah Beach Hotel Dubai from November 05th to November 06th, 2010. Organized by CAPP and EMA Dental Society, the conference was supported by the Ministry of Health and Saudi Dental Association. Dubai gathered for the second time the world experts, an Dr. Barakat presenting trophy to Dr. Aisha international conference, open to all specialists working in the field of aesthetic dentistry. As usual the best experts, speakers and specialists in the different fields of dental and facial cosmetic, the worldwide renowned specialists shared their experience. More than 600 participants from 25 countries – dental professionals, industry players, business and government got together at the 2nd Dental – Facial Cosmetic International Conference. Participants soaked up the latest opinions, trends, and insights from industry thought leaders, shared experiences with colleagues, made new contacts and strengthened existing relationships, and honed their ideas and knowledge. At GSK booth Memorial photo with the sponsors Dr. Jallad, Dr. Mollova, Mr. Villani and Dr. Dalloca Dubai Medical Equipment Noble Medical Equipment Dr. Aljobory at DeguDent booth At Dentoflex booth Dr. Silwadi at Sirona booth 3M ESPE receiving a recognition trophy Zimo Group Dr. Sabbagh & Dr. Aouad Dr. Hafseh & Dr. Ali DENTISTRY 9 - 11 November, 2010 | Abu Dhabi, UAE 2010 Crafted by IIR Middle East Life Sciences, the organizers of the annual Arab Health Exhibition & Congress, the Dentistry 2010 Exhibition & Conference was held at the Abu Dhabi National Exhibition Centre (ADNEC). Running beside the conference is a major exhibition showcasing a wide range of products including imaging software, impression materials, hand instruments and cosmetic dentistry products from leading regional and global suppliers. Al-Hayat Pharmaceuticals are a UAE-based company showcasing an array of dentistry products, including their latest tooth whitening products, at Dentistry 2010. 25 - 27 November, 2010 | Beirut, Lebanon LDLS 2010 Lebanese Dental Laboratories Show Mr. F. Khoury, Dr. A. Khoury, Mr. E. Sabbagh, 6th Scientific Congress Miss Sfeir, Dr. C. Sharaf The Lebanese Dental Laboratory Show (LDLS) is held every two years in Lebanon and is organized by the OPDL (Ordre des Prothesistes Dentaires du Liban). The 6th Scientific Congress of LDLS-2010 was held at Beit Al Tabib (tahwita) under the patronage of the Minister of Health Dr. Mouhamad Jawad Khalife where the president of OPDL; Mr. Elias Sabbagh welcomed all the Arab Dental Laboratories Union members (Jordan, Syria and Palestine) Certificate of appreciation to the young team and more than 500 dental technicians, eminent speakers, and exhibitors. Two courses were held, mainly to provide the basic knowledge, skill sets and confidence to allow general practitioner to successfully operate the related works and topics and improve their skills by Dr. Andreas Kullmann (surgical guide that helps performing finished fixed work prior to the operation) and Mr. Max Bosshart (Condylator system and teeth positioning that allow good stability for the dentures). A large exhibition of the latest technical equipment and products took place at the congress venue. Exhibition floor Opening ceremony Dr. Mollova & Mr. Al Hajj At Prodent booth Representative of the Medical Brigade of the Royal Representative of the Minister President of the Jordanian President of the Syrian Dental Jordanian Army of Health; Dr. A. Khoury Dental Laboratories Laboratories OPDL board member; Representative of the Palestinian Representative of the Royal Mr. Rodny Abdallah Dental Laboratories Jordanian Army; Colonel Manasiri RIDM 15 - 16 December, 2010 | Riyadh, KSA 2010 Opening ceremony Prof. Abdullah R. Al Shammery Excerpted Speech during the Opening & Final Ceremony Night His Excellency, Minister of Higher Education, His Excellency, the Deputy Minister of Higher Education Their Excellencies, the Deans of dental colleges in Arab countries, Their Excellencies, the Heads of Dental associations and unions of Gulf and Arab countries, Ladies & Gentlemen, Guests at the meeting. Allah Peace and mercy be upon you. I am pleased as we celebrate this blessed day to begin the ceremony for the 5th Riyadh International Dental Meeting by welcoming you at this great scientific gathering of Riyadh Colleges of Dentistry and Pharmacy which is annually organized on an ongoing basis. H.E. Dr. Mohamed Al-Ohali & It is known that the Riyadh Colleges of Dentistry and Pharmacy is the first private health colleges in Prof. Abdullah Al Shammery the Kingdom which was founded in 1424 (2004) and began offering the programs in the beginning of the first semester of year 1424H-1425H (2004-2005) and since that date, it began the career by Allah help and the support and encouragement of the Custodian of the Two Holy Mosques, King Abdullah Bin Abdulaziz and his government. Government of KSA who are paying more attestation to go private higher education to enable it to stand up to row with institutions of higher education to contribute to the rehabilitation and training of health cadres in various Health disciplines to offer them to the labor market in the Kingdom and other countries. Riyadh Colleges of Dentistry and Pharmacy has the pleasure to organize this meeting which involves pioneer and elite Doctors and productive speakers from inside and outside the Kingdom participating by researches in the specialties of different health sectors. There is no doubt that researches and the decisions that issued by scientific recommendations will have a positive and effective impact on the Dentistry and on the progress of scientific research, which confirms that Riyadh Colleges seek hard to achieve mission and objectives of multiple continuing education and training for student and effective contribution in scientific research and offering Bahrain Delegates At Smile booth Prof. Tareq Abbas distinguished services to the community in accordance with the specializations offered by the colleges in the Bachelor Degree, Master Degrees and the Saudi Board programs including the human force or material equipment which are vital to teach, train and treat provided by the Riyadh Colleges and its different university hospitals affiliated under the continued support of our government and the guidance of His Excellency Minister of Higher Education, Dr. Khalid Al Angari sponsor of this event and all deputy ministers and all the officials. We have completed with our praise to God the college preparatory stage of academic accreditation by the National Commission for Academic Accreditation & Assessment. They formed Committees in two different stages the first one is the institutional accreditation and that was six weeks ago, the second is the program accreditation, which was last week. The members of the panel were professors prominent in the Accreditation and Evaluation from the three countries United States of America, United Kingdom and Australia. This was held in the presence and direct supervision of the National Commission for Academic Accreditation & Assessment in KSA and we thank Allah that the initial report of the review panel was positive and had many compliments to college completion and of these achievements during the period of seven Dr. Al Kahtani; President of years which is short at the age of the universities. the Saudi Dental Society Dr. Omar Zidan Sirona Zirkon Zahn Thanks to Dear guests, professors, lecturers and all contributor companies of the 5 Riyadh th International Dental Meeting for their response and participation. ABDULREHMAN ALGOSAIBI G.T.C AL-TURKI MEDICAL Colgate Finally, Special thanks for His Excellency Minister of Higher Education for sponsoring the activities of this meeting and thanks also to His Excellency the Deputy Minister of Higher Education and to all the deputy ministers and officials. Thanks also to ladies and gentlemen in Riyadh Colleges for their great efforts and for the committees for their preparation and organizing this meeting and which I hope to interact elements, scientific sessions and attendant activities to achieve the desired ambitions that will satisfy all officials and government and confirm the leading role of Riyadh Colleges which is effectively carried out by serving science through holding of such scientific fruitful meetings. May Allah Bless you all! | 88 | Smile Dental Journal | Volume 5, Issue 4 - 2010 Smile Dental Journal | Volume 5, Issue 4 - 2010 | 89 | Visit us at AEEDC 2011 Booth 300 Hall 6 IDS 2011 A-041 Hall 11.3 RECOGNITIONS Prof. Abdullah Al Shammery Rector, Riyadh Colleges of Dentistry and Pharmacy, KSA Dr. Jihad Abdallah Diplomate of the American Board of Oral Implantology/Implant Dentistry (ABOI/ID) Dr. Mohamed Ezzedine President of the Mediterranean Association of Pediatric Dentistry Dr. Maher Almasri Director of Oral Surgery Courses Bone Graft Modules Leader The University of Warwick, UK Visit us at AEEDC 2011 at booths 206-212 & 221-227! Learn why Piro Trading International is one of the best representatives in the dental market! This is an excellent opportunity to meet our manufactures and discuss business solutions. Daily presentations will be held! Please come participate and learn about our newest products and technology. 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