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					Smile Dental Journal | December 2010 - Volume 5, Issue 4 | | Distributed free of charge

                                                                                                                      Dental Journal

                                                                                                                     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

                                                                                                                                                                             ISSN: 2072-473X
                                                                                                            Panoramic imager
                                                                                      Discover the new X7 Series
                                               Cephalometric Teleradiography
                                               Advanced kinematics

                                                

                                                    X7 Cephalometric Teleradiography

                      
                    
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 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

                                                                                                                                                                                                                         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

                                                •	 Dr.	Layla	Abu-Naba’a                                 •	 Prof.	Magid	Amin	Ahmed	/	Egypt

                                                   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

                                                                                                           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.	Barakat	/	Lebanon
     Smile	Dental	Journal                                                                                  DDS, MSc, FICD Maxillo-Facial Surgery                                                                         Cheek Augmentation                                                                                         Immediate Placement
         December 2010                          •	 Dr.	Suhail	H.	Al-Amad                                   President of LAO & EMAO                                                                                                                                           By Kamis Gaballah, AbdulRahman Saleh                   of Dental Implants
        Volume 5, Issue 4                          BDS; DCD (Melb), MRACDS (Oral Med), JMC Cert.                                                                                                                                                                                                                                    Into Debrided Infected
                                                                                                        •	 Prof.	Azmi	Darwazeh	/	Jordan
                                                   (Oral Med), GradDip ForOdont (Melb)                                                                                                                       Esthetics

         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                          BDS, MSc, FFDRCS, FDSRCS, Oral & Maxillofacial                                                                                                                                                                                                                                   Tooth Extraction?

                                                                                                           President of AOIA                                                                                 Prosthodontics

                                                                                                                                                                                                       54                     Surgery
                                                                                                        •	 Prof.	Fouad	Kadim	/	Jordan                                                                              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
      Dr. Ma’moon A. Salhab                     •	 Dr.	Mohammad	Al-Rabab’ah
                                                   BDS, MFD RCSIre, MRD(Pros), RCSEd, JB(Cons) PhD
                                                                                                        •	 Prof.	Howard	Lieb	/	USA
                                                                                                           DMD General Dentistry & Management Sciences
                                                                                                           College of Dentistry, New York University

                                                                                                                                                                                  38                   66    Dental Laboratory
                                                                                                                                                                                                                                                                                                       By Jean Luc Girard
                                                                                                                                                                                                                                                                                                                                                Event Reviews

       Director	in	Charge	&                                                                             •	 Prof.	Edward	Lynch	/	UK
           Chief	Editor                         •	 Dr.	Hatem	Al-Rashdan                                    PhD (Lon), MA, BDentSc, TCD, FDSRCS (Ed), FADFE, FDSRCS (Lon)                                                 Biomimetic Ceramic Veneers: a Successful Team Concept
          Dr. Issa S. Bader                        BDS, MSc, Jordanian Board of Maxillofacial Surgery      Head of Dental Education and Research Warwick University                                                                                                                                                                             Announcements
                                                                                                        •	 Prof.	Lamis	D.	Rajab	/	Jordan                                                                                                                                                               By Lamberto Villani
               Editor                           •	 Dr.	Majd	Al-Saleh

                                                                                                                                                                            Affiliation & Distributors
                                                                                                           DDS, PhD, Pediatric Dentistry
       Dr. Lara M. Haddadin                        BDS, DDS, MSc, Pediatric Dentistry                      Former Dean, Faculty of Dentistry, University of Jordan
        Marketing	Director                                                                              •	 Prof.	Issam	Shaaban	/	Syria
                                                •	 Dr.	Ahmad	Al-Tarawneh
         Solange R. Sfeir                                                                                  BDS, PhD, Maxillo-Facial Surgery
                                                   DDS, M.Clin.Dent, Jordanian Board of Orthodontics       Former Dean, Faculty of Dentistry Damascus University
            Photography                         •	 Dr.	Hayder	Al-Waeli
                                                                                                           President of Syrian OMFS Society
           Solange R. Sfeir                        BDS, MSc, Jordanian Board of Periodontology          •	 Prof.	Yousef	F.	Talic	/	KSA                                      •	Bahrain                                                          •	Kuwait                                                      •	Saudi	Arabia
                                                                                                           BDS, MSc, DASO, FICOI, FICD                                        Bahrain	Dental	Society                                             Kuwait	Dental	Association                                     Saudi	Dental	Society
            Art	&	Design                                                                                   Editor-in-Chief, Saudi Dental Journal                             +973 17723767,                                  +965 5325094,                                  +966 1 4677743,
                                                •	 Dr.	Muayad	Assaf
            Yazid M. Masa                                                                                  Consultant in Prosthodontics & Implantology
                                                   BDS, MSc Endodontics                                    College of Dentistry, King Saud University                       •	Egypt                                    •	Lebanon                                                                             •	Sudan
     Published by MENA Co. for                  •	 Dr.	Manal	Azzeh                                      •	 Prof.	Abbas	Zaher	/	Egypt                                          Alexandria	Oral	Implantology	Association   Lebanese	Dental	Association                                                           Sudanese	Dental	Association
           Dental Services                         BDS, MSc, Jordanian Board of Periodontology             BDS, MS, PhD Orthodontics                                         +203 5451277,                                      +961 1 611555,                                 +249 83 779769,
     Jordanian National Library                                                                            Professor of Orthodontics & Vice-Dean, Alexandria University                                                                           Lebanese	Dental	Laboratory	
                                                                                                           Vice-President, World Federation of Orthodontists                •	Iran                                                                                                                           •	Syria
     Registration # 3954/2008/P                 •	 Dr.	Menah	Barmawi
                                                                                                                                                                              Shayan	Simin	Teb	Co.                                                Association                                                  Najjar	Trading	Est.
          ISSN 2072-473X                           BDS, Jordanian Board of Maxillofacial Surgery        •	 Dr.	Nadim	Abou-Jaoude	/	Lebanon                                                                                                        +961 5955 151,
                                                                                                           CES, DU, FICD Prosthodontics                                      +98 21 66380364/5,                                                                                         +963 (11) 2244140,
                                                                                                                                                                             Iranian	General	Dental	Association                                   Richa	Dental	Store
                                                •	 Dr.	Bader	Eddin	Borgan                                  Lecturer, Lebanese University                                                                                                                                                                     •	United	Arab	Emirates
           Printed	By:                                                                                     Clinical Associate, American University of Beirut                 +98 2188287794/5,                                       +961 5 452555,
                                                   BDS, MDS, MOrth, RCSEd, Orthodontics                                                                                                                                                                                                                        Noble	Medical	Equipment
Ad-Dustour Commercial Printing Press                                                                    •	 Dr.	Hasanen	H.	Al-Khafagy	/	UAE                                                                                                     •	Oman
         Amman, Jordan                                                                                                                                                      •	Iraq                                                                                                                              +971 4 8854544,
                                                •	 Dr.	Lama	Jarrah                                         BDS, MSc, PhD Conservative Dentistry                                                                                                  Oman	Dental	Society
                                                                                                           Ajman University of Science & Technology
                                                                                                                                                                              Iraqi	Dental	Association                                                                                                          Dubai	Medical	Equipment	L.L.C.
                                                   BDS, MSc, Jordanian Board of Orthodontics                                                                                                                                                      +968 95769039,
Mission Statement                                                                                       •	 Dr.	Jaser	Al-Ma’itah	/	Jordan
                                                                                                                                                                             +964 015379267,                                                                                               +971 6 554 0206,
Bridging the gap between advanced upto-         •	 Dr.	Ghada	Karien                                        BDS, MSc Oral Surgery                                             Kurdistan	Dental	Association                                      •	Qatar
date peer-reviewed dental literature and           BDS, JDB, Pediatric Dentistry                           Head of Dental Dept., Jordanian Royal Medical Services            +964 7504510315,                               Qatar	Dental	Society
the dental practitioners enabling them to                                                                                                                                                                                                         +974 4393144,
                                                                                                        •	 Dr.	Maher	Almasri	/	UK                                           •	Jordan
do their jobs better- is our ultimate target.   •	 Dr.	Ahmad	Kutkut
                                                                                                           DDS, MSc, PhD, FADFE, Director of Oral Surgery Courses, Bone                                                                           Ali	Bin	Ali	Medical	The	i-partner
Besides, Smile provides readers with               DDS, MS, Prosthodontics, USA                            Graft Modules Leader, Warwick University                           Basamat	Medical	(Pharmadent)
                                                                                                                                                                                                                                                  +974 4867871 ext. 247,
information regarding the available dental                                                                 President of the Syrian Section of IADR                           +962 6 5605395,
products, armamentarium, news                   •	 Dr.	Hassan	Maghaireh
                                                   BDS, MFDS, MSc Implants (Manchester)                 •	 Dr.	Abdelsalam	Elaskary	/	Egypt
and proceedings of dental symposia,
workshops and conferences.
                                                                                                           BDS, FICOI, President of ASOI
                                                                                                                                                                             Editorial Policy
                                                •	 Dr.	Hakam	Mousa                                      •	 Dr.	Yasin	El-Husban	/	Jordan                                     •	 Our objective is to publish a dental journal of consistent high quality and help to increase the exposure of literature written by dental professionals from our region at a global level.
                                                   BDS, MSD, Operative Dentistry                           DDS, MSc Prosthodontics                                          •	 Literature review, original research, clinical case reports, case series, short communication, randomized clinical trials, and book reviews are among our scope of published material,
Disclaimer                                                                                                 Former Head of Dental Dept. & King Hussein Hospital                 where	the	clinical	aspect	of	dentistry	is	presented	in	a	scientific	way,	starting	each	article	with	an	abstract,	backed	up	by	references	in	accordance	with	the	Vancouver	
Smile Dental Journal makes every                •	 Dr.	Jumana	Sabbarini                                                                                                        citation	style.
                                                                                                        •	 Dr.	Zbys	Fedorowicz
effort toreport clinical information and           BDS, MSc, Jordanian Board of Pediatric Dentistry                                                                         •	 The journal encourages the submission of papers with a clinical approach, practical	or	management	oriented, besides papers that bridge the gap between dental research and
                                                                                                           Director, The Bahrain Branch of the UK Cochrane Centre
manufacturers’ product news accurately, but                                                                                                                                    clinical application.
cannot assume responsibility for the validity                                                           •	 Dr.	Wolfgang	Richter	/	Austria                                   •	 Received manuscripts are first revised by the editor to check if it is appropriate for publishing in Smile and that it complies with the author›s guidelines. The manuscript is then
                                                •	 Dr.	Samer	Sunna
of product claims or typographical errors.                                                                 DDS, PhD, Restorative Dentistry, President of ESCD                  forwarded to two or more professional reviewers. Anonymity of both the author and reviewer is preserved (double	blinded	peer-review	process).
                                                   BDS, MSc, M.Orth, RCS, Orthodontics
Opinions or interpretations expressed by the                                                            •	 Dr.	Mohammad	Sartawi	/	Jordan                                    •	 Our editorial policy which controls the quality of articles and	assures	their	accuracy,	clarity,	and	smooth	readability through high level enthusiast regional and international
authors are their own and do not necessarily    •	 Dr.	Leema	Yaghmour                                      BSc, BDS, MSc, FFDRCSI (OSOM)                                       team of experts is our golden key for success.
reflect nor hold Smile team responsible for        BDS, DUA, DUB, Pediatric & Community Dentistry          Senior Consultant Maxillo-Facial Surgery                         •	 Finally, we believe that a controlled	content of advertisements could be informative and beneficial especially in dentistry, where the armamentarium and pharmaceuticals are a
the validity of the content.                                                                                                                                                   major and integral part of the dental science.
                                       Ethics in Dentistry

                                                  he dental profession in many of the developed countries holds a special position of
                                                  trust within society. 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

| 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                                   

                                           March 2 - 4
                                           14th Congress of ECDS
                                           Cairo, Egypt

                  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
                      Alexandria, Egypt                               www.english.

 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                                Al-Hashimi, Kuwait
 April 6 - 7
 7th Jordanian Orthodontic
 Amman, Jordan

                                  May 12 - 13                      May 25 - 26                      June 2 - 4
                                  5th CAD/CAM                      1st Aesthetic                    12th Lebanese Dental
                                  Dubai, UAE                       Dentistry Congress               University Congress
                                          Amman, Jordan                    Beirut, Lebanon
 May 9 - 12
 5th Jeddah Dental Esthetic
 Jeddah, KSA

For more events visit or our page on Facebook.

                                                                                   Smile Dental Journal | Volume 5, Issue 4 - 2010 | 5 |
   Dentofacial Cephalometric Values for                                                                                                        S
                                                                                                                                                                           SN Plane

   Emirati Adults with Normal Occlusion and

                                                                                                                                     Po                       Frankfort Plane
                                                                                                                                                                                  Or                                     5

   Well-Balanced Faces

                                                                                                                                                                   Y axis Plane

                                                                                                                                                        Occlusal Plane
                                       Objective: To determine the dentofacial cephalometric values for Emirati adults, and to
                                       compare them with those of Caucasians.                                                                      Go
                                                                                                                                                        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                 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                  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
                                                                    compared with Caucasian norms which were derived
                                                                    from the values of Steiner,1 Jarabak,2 Downs,3 and Wits10        Skeletal
                                                                    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
    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
                                                                    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
    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 |
                                                         •	 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.

                                                         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.
                                                         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.
                                                         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.
                                                         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
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                              YOUR PARTNER IN ORAL
   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
                                       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
                                       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
   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                                                                                                          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
                                                                                                                                                                                            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                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,                                                                                                      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
                                       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 |
                                                                                                                                Non syndromatic multiple supernumerary teeth is a very
                                                                                                                                rare anomaly that appears usually in the lower premolar

                                                                                                                                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.

                                                                                                                                1. Ezddini AF, Sheikha MH. Prevalence of dental developmental
                                                                                                                                    anomalies: A radiographic study. Community Dent Health
                                                                                                                                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.
                                                                                                                                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.
                                                                                                                                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.
                                                                                                                                6. Rajab LD, Hamdan MAM. Supernumerary teeth: a review
                                                                                                                                    of the literature and a survey of 152 cases. Int Pediatr Dent.
                                                                                                                                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 |

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   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,               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
                                                                                                                                        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                 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
                                       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


                                                                    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.

                                                         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.
                                                         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
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   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
                                                                                                                                     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
                                         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                                                                                                           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
                                                                                                                                     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
                                         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.                                                                                                          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               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
   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.
   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.
   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
                                                                     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.
   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.
                                                                 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.

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 | 28 | Smile Dental Journal | Volume 5, Issue 4 - 2010
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   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,
                                                                                                                                      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
                                     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.

                                                                                                                         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.

                                                                                        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.
                                                                                        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.

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   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                                                                                                                  •	 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

   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

   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.

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                            | 42 | Smile Dental Journal | Volume 5, Issue 4 - 2010   +971 50 279 3711 | Email:
     Ehab	Heikal	BDS,	MBA,	DBA
     Middle East Manager, Morita Corporation
     Lecturer, Practice Management School of Dentistry, MSA University                                                                                                                                             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

                                                                                                                                                                     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
                                                                                                                                       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
                                                                                                                                 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.

   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.

   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.

| 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.
   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.

       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...


| 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.

      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.

| 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

   HOYA ConBio                                                  Novocol
   VersaWave Laser          ®
   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,
   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.

| 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 or visit
     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.

     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.

| 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).


   Dental X Autoclaves: It is not enough 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
   There are big and significant differences that shall be taken in
   consideration and diligently compared before purchasing an
   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.

| 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.
     2.	 utonomous,	precise	and	reliable	apex	locator	for	apex	localization.
     3.	 bturator	of	root	canals	by	heated	gutta	percha.
     4.	 uring	LED	lamp	for	polymerization	of	dental	restorative	materials.
     5.	 iagnostic	LED	lamp	(orange	light-diode	LED)	for	localization	of	root	orifices,	latent	carious	cavities,	cracks,	
       splits...	etc

   EndoAce® Endo pleasure!                                                      FRIADENT
    The introduction on the market of
    Nickel-Titanium methods in the

    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
    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.

| 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:
                                            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

  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.

                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:                Visit us at IDS
                e mail
                                                                                  Halle: 10.1
dental x                                                                          Booth: G58 - H59
                                                         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.

     dentalArt presents

 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
                         ph. +963 6 5656 404/5
                          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 |
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28 - 30 October, 2010 | Beirut, Lebanon
                                                7th International Meeting of

                                                 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

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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
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3 - 4 November, 2010 | Muscat, Sultanate of Oman

                                                   Dental Association
                                                   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

                                     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
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                                     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
9 - 11 November, 2010 | Abu Dhabi, UAE

                                         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

                                         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
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
                                            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
                                                                                                                                                       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

                                            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

      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
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