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a sMile MakeoVeR Case RepoRt >>> page 19

is the state oF aRt in Dental anD oRal sCienCes

issUe July 2016

Resilan anD GUtta-peRCha >>> page 6

Issue August 2016

p U b l i s h i n G D i R e C to R

Dr.h icham nuaimi

dr.h ichamnuaimi@

gmai l .com

D e s i G n / p R o D U C t i o n

ahmet s aga

elena stanica

Co n t R i b U t i n G

w R i t e R s

Dra Mar ia chairez

Jennifer sta infor th

k r ist ina Dani l i shin

R ana al jabaj i

sai f a abdl R azaq

sura salem

p R i n t i n G

onl ine and Digita l

Vers ion

(w w w.dentalnews-

week .com)

publ ished three t imes

a year by by Dental

United spz .o.o

, atensk a, 03-798

warsaw, poland

D R h i C h a M n Ua i M i associate

editor & scientif ic Manager of

D ental newsweek . our a im is

to capture h igh- qual i t y wor k

t h a t d o e s n’ t o t h e r j o u r n a l s

focusing on dental research.

D R b a R b a R a p o D o b a s -

M ü D e R R i s o ğ l U a d v i s o r y

b o a r d C h a i r m a n o f D e n t a l

n e ws we k . o u r M a g a z i n e w i l l

publish more than cl inical and

academic research.

D R M U s ta Fa k a M i l pu b l i c

relation & international affairs

( i r a q R e gi o n ) . th i s m a g a z i n e

l a u n c h e s a n o p e n - m i n d e d

s t a n c e t o w a r d s t h e s c o p i n g

in dental sc iences.

2

D e n t a l n e w s w e e k M a G a Z i n e | a U G U s t 2 0 1 6

Mee t the teaMinFoRMation

DR.bURhan koMbaRJi Chief editor of Dental newsweek

is a new broad-scope publ ica-

t i o n a i m i n g to p u b l i s h h i g h -

q u a l i t y r e s e a r c h a n d e x p e r t

k n o w l e d g e o n d e n t a l t o p i c s

that guarantee the refreshing

and bui ld ing modern k nowl-

ege that enhance dental care

t h e M a g a z i n e h a s a s t r o n g

emphasis on interdisc ipl inar y

issues as we’re conscious that

c h a l l e n g i n g c a s e s w h i c h a re

in c lose contac t with dent is t

s a n d d e nt a l te c h n i s i o n s w h o

are deals with update solution

for previous impossible cured.

U l t i m a t e l y , t h e M a g a z i n e

wants to cover a l l aspec ts of

o r a l s c i e n c e a n d t e c h n o l o g y

c o n c e r n e d w i t h t h e d e n t a l

f ie ld.

we look for ward to welcoming

your submiss ions.

3


MessaGe FRoM eDitoR

» p.11 » p.22 » p.23

11 3D anatoMiC a l Z i R C o n i a iMplants

22 D e n t a l e V e n t s a n D ConFeRenCes

23 polanD on spot

4


Contents

5


e n d o d o n t i c t r e a t m e n t necess i tates an instrumen-tat ion of the root canal in o r d e r t o e l i m i n a t e i n f e c -t i o u s p r a e s e n i t a d e s e d ming debr is , leaving c lean

canal walls. after the instru-

mentation and protocol irr iga-

t ion of debris is complete, the

root canal i s f i l led with end-

odontic material f i l l ing, which

inser ted properly with an end-

odontic sealer.

the f i rst endodontic f i l l ing

m a t e r i a l s h a v e b e e n u s e d

amalg am, as be s tos, Cement ,

Copper, Gold Foi l , i ron, lead,

oxy- Chloride of Zinc, paraffin,

R e s i n , R u b b e r, s i l v e r p o i n t s ,

an ideal obturat ion mater ia l .

e n d o d o n t i c Fi l l i n g R e s t o r a t i o n , i s t h e r e a ny d i f fe r e n c e bet ween Resi lon and Gutta-percha?

written by Dr. h icham nuaimi and Dr. avin aydin nanak al i

6


D e n t a l n e w s w e e k M a G -a Z i n e | a U G U s t 2 0 1 6

aR tiCle

7


D e n t a l n e w s w e e k M a G -a Z i n e | a U G U s t 2 0 1 6

but none of them seen to be

re q u i re d a s a n i d e a l o b t u r a -

t ion mater ia l .

a c c o r d i n g t o G r o s s m a n ,

R o o t c a n a l f i l l i n g m a t e r i a l

s h o u l d h a v e t h e f o l l o w i n g

charac ter ist ics , (1) :

(1) i t should be easi ly intro -

duced into a root canal

(2) i t should be preferably a

semisol id upon inser t ion and

b e co m e s o l i d a f te r wa rd s ; ( 3 )

i t should seal the canal later-

a l ly as wel l as apical ly

(4) it should not shrink after

being inser ted

(5) i t should be imper vious

to moisture

( 6 ) i t s h o u l d b e b a c t e r i o -

stat ic , or at least not encour-

age bac ter ia l growth

(7) i t should be radiopaque

(8) i t should not sta in tooth

struc ture

( 9 ) i t s h o u l d n o t i r r i t a t e

per iapical t i ssue

(10) i t should be ster i le, or

e a s i l y a n d q u i c k l y s t e r i l i z e d

immediately before inser t ion

canal i f necessar y

b ( 1 1 ) i t s h o u l d b e e a s i l y

removable from the root canal

i f necessar y

subsequent, scientists discov-

ered (Gutta-percha) as a suit-

able root canal f i l l ing material.

Gutta-percha name is der ived

f rom (Ge tah) that mean gum,

whi le (peR tJa) f rom the name

of the tree in that used it mate -

r ia l . Dr. wi l l iam Montogmerie,

who was a medica l of f icer in

indian ser vice. he was the f irst

t o a p p r e c i a t e t h e p o t e n t i a l

of th is mater ia l in london in

1843, (1) .

h o w e v e r , t h e n e e d f o r

improve me nt and g e t t ing an

ideal root canal f i l l ing mate -

r ial propagates during sophis-

t icat ion endodontic therapy.

w h i l e c u r r e n t l y u s e d f i l l i n g

m ate r i a l s s e e m to a f fo rd t h e

p r a c t i t i o n e r s a h i g h l e ve l o f

s u c c e s s a n d l o n g d u r a b i l i t y.

Updating in endodontic f i l l ing

m a te r i a l s , e n d o d o n t i c s e a l e r

a n d t e c h n i q u e s a re c o n t i n u -

ing over this centur y.

R e s i l o n f i l l i n g m a t e r i a l i s a

thermoplastic, polyester poly-

m e r - b a s e d r o o t c a n a l f i l l i n g

mater ia l . Resi lon is composed

o f b i o a c t i v e g l a s s a n d r a d i -

opaque f i l lers .

i ts implementation is similar

to gutta-percha in function, in

addit ion to the same handling

proper t ies (2) .

h o w e v e r, s e v e r a l s t u d i e s

have shown that , whi le us ing

gutta-percha as a f i l l ing resto-

ration, the canal walls may not

b e co m p l e te l y f re e o f d e b r i s

( 2 , 3 ) . s e ve ra l p ro ce d u re s a re

used to remove gutta-percha

by using either hand or rotar y

i n s t r u m e n t s w i t h o r w i t h o u t

heat appl icat ion. i n addit ion,

chemical solvents materials as

chloroform is one of the most

effec t ive procedure for gutta-

p e r c h a r e m o v a l ( 4 ) . c h l o r o -

f o r m s o l v e n t m a t e r i a l h a s

a l s o b e e n r e c o m m e n d e d fo r

the removal of Res i lon f i l l ing

mater ia l .

i n o r d e r t o o b t a i n g o o d

o b t u rat i o n , p ra c t i o n e r s h ave

t o u s e p r o p e r e n d o d o n t i c

sealers l ike :

Resin obturat ion can strengthen the remaining tooth st ruc ture, improv-ing the long-term prognosis for teeth obturated with Res i lon

8


Calc ium hydroxides

Zinc- oxide eugenol cements

Glass ionomer Cements.

once Resi lon f i l l ing mater ia ls

w e r e i n t r o d u c e d d u r i n g t h e

recent decay, a lot of concern

w a s s t a t e d f o r t h e p r o p e r

o b t u r a t i o n m a t e r i a l t o f i l l

c a n a l s r i v a l e d t o g u t t a - p e r -

c h a . Fo r g u t t a - p e r c h a , p r a c -

t ioners could provide Zoe or

epox y res in root canal sealer.

t h e p r o p e r s e a l e r u s e d f o r

Resi lon is a methacr ylate resin

sealer l ike :

epiphany, Realseal , endoRez

studies have shown the prop -

e r t i e s o f R e s i l o n e n d o d o n t i c

mater ia l in compare to gutta-

percha restorat ion.

biocompatibi l i t y

aDa has focused on the c yto -

toxic i t y for se lec t ing a dental

mater ial due to direc t contac t

w i t h h u m a n i t y . s o t h a t i t

s h o u l d n o t n e g a t i ve l y a f fe c t

t h e h o s t s c e l l s fo u n d i n t h e

pDl.

s t u d i e s h a v e s h o w n t h a t

affected the host cel ls. key J

et .a l , 2006 showed that ef fec t

of R es i lon and g ut t a -pe rcha

o n t h e f i b r o b l a s t c e l l s w e r e

t h e s a m e . w h i l e t h e s e a l e r s

t h a t u s e d m a y p o t e n t i a l l y

h a v e a c y t o t o x i c p o t e n t i a l

w h e n s e t t i n g re a c t i o n s we re

n o t c o m p l e t e . e p i p h a ny w a s

f o u n d t o b e l e s s c y t o t o x i c

than Grossman’s sealer (Zoe-

b a s e d ) . o n t h e o t h e r h a n d

e p i p h a n y w a s f o u n d t o b e

more c ytotoxic than sealapex,

w h i c h i s c a l c i u m hy d r ox i d e -

b a s e d ( 5 ) . s o u s a e t . a l , 2 0 0 6

s h o w e d t h a t e n d o R e Z p r o -

d u c e d h i g h i n f l a m m a t o r y

r e a c t i o n i n t r a o s s e o u s b o n e

w h e n c o m p a r e d w i t h t h e

o t h e r s e a l e r, w h i l e e p i p h a ny

showed the lowest inf lamma-

t o r y e f fe c t a n d h i g h b i c o m -

patibi lty when compared with

others (6) .

o n e o f t h e m a j o r i d e n t i t y

for success or fa i lure of end-

odontic restorat ion is coronal

l e a k a g e d u e t o i n v a s i v e o f

bac ter ia .

leak age

M i c ro l e a k a g e re m a i n s o n e

o f t h e m a i n r e a s o n f o r t h e

fa i lure of root canal therapy,

w h e r e v e r t h e c h a l l e n g e h a s

been to achieve a proper seal

b e t we e n e n d o d o nt i c o b t u ra -

t ion mater ia l and interdental

dent ine sur faces.

b a c t e r i a m i g r a t e a p i c a l l y

t h r o u g h c o r o n a l m i c r o l e a k -

age. khayate et .al , 1993 found

t h a t w h e n r o o t c a n a l f i l l i n g

e x p o s e d t o a r t i f i c i a l a n d

natural sal iva, leak age appear

a n d t h e n b a c t e r i a c o n t a m i -

nate to the root apex (7) . br ito

et .a l , 2003 demonstrated that

u s i n g o f a n a d h e s i v e s e a l e r

s h owe d s i gn i f i c a nt l y s l ow o r

s top coronal -apica l bac ter ia l

m i g r a t i o n , i n s p i t e o f u s i n g

Gutta-percha (8) .

te i x e i r a e t . a l , 2 0 0 4 d e m -

o n s t r a t e d t h a t e n d o d o n t i c

s e a l e r s f o r m a c l o s e a d h e -

sion to the intra dentinal wall ,

b u t n o n e i s a b l e t o b o n d t o

t h e g u t t a - p e rc h a co re m a te -

r ia l . Dur ing sett ing of sealer,

s h r i n k a g e a d m i t s t h e s e a l e r

to p u l l away f ro m t h e g u t t a -

p e r c h a m a t e r i a l t h a t l e a d

t o c re a t e a m i c ro g a p, w h i c h

p e r m i t s b a c t e r i a p a s s a p i -

c a l l y ( 9 ) . s h i p p e r e t . a l , 2 0 0 5

f o u n d t h a t u s i n g g u t t a - p e r -

c h a a n d a h - 2 6 s e a l e r h a v e

m o re i n f l a m m ato r y re s p o n s e

aR tiCle

9


compared with Res i lon and

e p i p h a n y . t h e y c o n c l u d e d

t h i s r e s u l t d u e t o t h e s u p e -

r i o r r e s i s t a n c e o f R e s i l o n t o

c o r o n a l m i c r o l e a k a g e ( 1 0 ) .

k u r t z m a n e t . a l , 2 0 0 6 f o u n d

t h a t t e e t h t h a t w e r e o b t u -

r a t e d u s i n g R e s i l o n s h o w e d

s i g n i f i c a n t l e s s s h r i n k a g e i n

c o m p a r e w i t h c o n v e n t i o n a l

Gutta-percha. (11)

ac c o rd i n g t o t h e p re v i o u s

s t u d i e s , R e s i l o n - e p i p h a n y

s y s t e m w a s r e c o m m e n d f o r

improvement in leak age resis-

tance compared to gutta-per-

cha techniques.

obturat ion

C a l c i u m h y d r o x i d e h a s

b e e n a d vo c a t e d a s a n i n t r a -

canal medicament whi le end-

o d o n t i c p r o c e d u r e r e q u i r e d

a n e x t r a v i s i t . i t i s r e c o m -

m e n d e d t h a t i r r i g a t i o n w i t h

1 7 % e t h y l e n e d i a m i n e t e t r a -

c i t ic ac id (eDta) , when obtu-

rat ion is not occurred dur ing

single visit to remove any rem-

nants of the ca lc ium hydrox-

ide. when this technique was

a c h i e v e d i t w a s d i s c o v e r e d

t h a t c a l c i u m h y d r o x i d e d i d

n o t b a d l y a f f e c t t h e s e a l o f

t h e r o o t - c a n a l s y s t e m w i t h

Resi lon(12) . Moreover, dur ing

o b t u r a t i o n p r o c e d u r e s , i t i s

required to use a dis infec t ion

mater ia l as sodium hypochol-

or ite (naoCl) or chlorhexidine

before obturat ion. i sc i s et .a l ,

2 0 0 6 f o u n d t h a t a 1 - m i n u t e

i m m e r s i o n i n e i t h e r s o l u -

t i o n d i d n o t s h o w a n y s i g -

n i f icant deter iorat ion on the

Resi lon cone’s sur face (13)

n ie lsen et .a l , 2006 showed

t h a t R e s i l o n s e a l e r s e t i n 3 0

minutes in anaerobic environ-

ments (normal ly found in the

canal ) , whi le in a i r i t required

1 week to set , they concluded

that the key of sett ing t ime is

l i m i t i n g ox yg e n i n t h e c a n a l

system(14) .

U s i n g r e s i n o b t u r a t i o n

m a t e r i a l s a re n o t p re fe r a b l e

in most cases due to concern

of retreatment procedure that

m a y o c c u r a f t e r o b t u r a t i o n .

Resi lon obturat ion consists of

a sof t core mater ia l (Res i lon)

with a methacr yl ic resin sealer

( e p i p h a ny ) . d e o l i ve i ra e t . a l ,

2006 showed that the abil ity of

progress ion of a f i le through

t h e R e s i l o n - o b t u r a te d c a n a l .

essent ia l ly, Resi lon was faster

to remove than gutta-percha

and resulted in c leaner canal

wal ls in the apical third of the

teeth obturated with R es i lon

when compared to gutta-per-

c h a ( 1 5 ) . M a l te zo s e t . a l , 2 0 0 6

found that mineral t r ioxalate

(Mta) does not show a s igni f -

i c a n c e i n b a c t e r i a l l e a k a g e

i n t h e a p i c a l p o r t i o n o f ro o t

when compared with R es i lon

sealer, but Resi lon leaked s ig-

nif icantly less than super-eba

(16) s o that Res i lon may be a

v iable option as a retrograde -

i l l i n g m a t e r i a l w i t h g o o d

s u r g i c a l i s o l a t i o n a n d m o i s -

ture control .

physical proper t ies

e n d o d o n t i c a l l y t r e a t e d

t e e t h h a v e b e e n s t a t e d t o

b e m o re s u b j e c t to f ra c t u re /

cracked because of reduc tion

i n d e n t i n a l t o u g h n e s s , l e s s

w a t e r c o n t e n t , a n d d e e p e r

cavit ies(17) .

s o t h a t d u r a b i l i t y o f e n d -

o d o n t i c a l l y t r e a t e d t e e t h

d u r i n g f u n c t i o n m a k e t h e

t o o t h w i t h d r a w w e a k n e s s ,

w h i c h m a y l e a d t o f r a c t u r e

( 1 8 ) . M i c r o f r a c t u r e s c u r r e n t

p r i o r t o e n d o d o n t i c t h e r a p y

m a y p r o p a g a t e u n d e r l o a d ,

l e a d i n g t o c l i n i c a l l y s i g n i f i -

c a n t c r a c k s t h a t c a n f i n a l l y

lead to the loss of the tooth.

instrumentat ion process lead

t o w e a k e n t h e t o o t h a s t h e

canals by enlarged and dis in-

fect the root canal system(17).

F u r t h e r m o r e , t h e w e a k e s t

por tion of endodontic tooth is

the cer vical aspect due to s ig-

ni f icant compress ive, tensi le,

a n d t o r s i o n a l f o r c e s d u r i n g

f u n c t i o n a n d b r u x i s m t h a t

may lead to the fat igue then

f r a c t u r e . t h e r e f o r e , t h e k e y

element is obturation to assist

i n re i n fo rc i n g t h e re m a i n i n g

tooth struc ture (18) .

10


Refrences

1- Grossman l(1970) : endodontic prac t ice, 7th ed, phi ladelphia : lea & Febiger Co. , pp. 329-33. 2-shipper G, orstavik D, teixeira F, trope M

(2004) an evaluation of microbial leak age in roots f i l led with a thermoplast ic synthetic polymer-based root canal f i l l ing mater ial (Resi lon) .

J endod 30, 342- 347. 3-Fr iedman s , Rotstein i , shar-lev s (1989) bypass ing gutta-percha root f i l l ings with an automated device. J endod

15, 432-437. 4- Cunha R , De Mar t in a, barros p, da s i lva F, de Cast i lho Jacinto R , da s i lvei ra bueno Ce (2007) i n v i t ro evaluat ion of the

c leansing work ing t ime and analys is of the amount of gutta-percha or Res i lon remnants in the root canal wal ls af ter instrumentat ion for

endodontic retreatment. J endod 33, 1426-1428 5-sousa C, Montes C , pascon e (2006) Compar ison of the intraosseous biocompatibi l i t y

of ah plus, endoReZ, and epiphany root canal sealers . J endod;32(7) :656-662. 6-k hayat a, lee s , torabinejad M (1993) human sal iva pen-

etrat ion of coronal ly unsealed obturated root canals . J endod;19(9) :458-461. 7-br i t to l , Gr imaudo n, Ver tucci F (2003) Coronal micro -

leak age assessed by polymicrobia l markers. J Contemp Dent prac t . 2003;4(3) : 1-10. 8-teixeira F, teixeira e , thompson J (2004) Dent inal

bonding reaches the root canal system. J esthet Restor Dent ;16(6) :348-354. 9-shipper G, orstavik D, teixeira F (2004) an evaluat ion of

microbia l leak age in roots f i l led with a thermoplast ic synthet ic polymer-based root canal f i l l ing mater ia l (Res i lon) . J endod;30(5) :342-

347. 10-kur tzman G, von Fraunhofer J , ol ivei ra D (2006) endodontic leak age Resistance of Fiber obturators. poster presentat ion aaDR,

or lando, Fl , #1443. 11-wang C, Debel ian G, teixeira F (2006) ef fec t of intracanal medicament on the seal ing abi l i t y of root canals f i l led

with Res i lon. J endod ;32(6) :532-536. epub 2006. i2- sc i s , Yoldas o, Dumani a (2006) ef fec ts of sodium hypochlor i te and chlorhexidine

solutions on Resi lon (synthetic polymer based root canal f i l l ing material) cones: an atomic force microscopy study. J endod;32(10) :967-969.

13-n ielsen b, beeler w, Vy C , (2006) sett ing t imes of Res i lon and other sealers in aerobic and anaerobic environments. J endod;32(2) :130-

132. 14- de ol iveira D, barbizam J, trope M (2006) Compar ison bet ween gutta-percha and res i lon removal us ing t wo di f ferent techniques

in endodontic retreatment. J endod;32(4) :362-364. 15-Maltezos C , Gl ick man G, ezzo p (2006) Compar ison of the seal ing of Res i lon, pro

Root Mta, and super-eba as root- end f i l l ing mater ia ls : a bac ter ia l leak age study. J endod;32(4) :324-327. 16-Madison s , wi lcox l (1988) an

evaluat ion of coronal microleak age in endodontical ly t reated teeth. par t i i i . i n v ivo study. J endod;14(9) :455-458. 17- Gutmann J (1992)

the dent in-root complex : anatomic and biologic considerat ions in restor ing endodont ica l ly t reated teeth. J prosthet D ent ;67(4) :458-

467.18-teixeira F, teixeira e , thompson J (2004) Frac ture res istance of roots endodontical ly t reated with a new res in f i l l ing mater ia l . J

am Dent assoc;135(5) :646-652.

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11


Replacement of lost teeth

u s i n g o r a l i m p l a n t s i s a n

accepted treatment modality

with wel l documented, h igh

long-term success rates of up

to 90 % at 10-year fo l low up.

Conventional dental implant

strategies that work success-

f u l l y i n d e l a y e d i m p l a n t o l -

ogy have ser ious l imitat ions

re g a rd i n g f u n c t i o n a l i t y a n d

esthetic outcome in immedi-

ate implantology. although,

i m p l a n t i n d i c a t i o n e x p a n d s

nowadays. the major advan-

tages of immediate implant

p l a c e m e n t a r e t h e r e d u c -

t i o n i n t re at m e nt t i m e w i t h

f e w e r s u r g i c a l i n t e r v e n -

t ions leading to an improved

quality of l i fe and overall cost

re d u c t i o n , a n d m o s t i m p o r-

tant socket preser vat ion due

to ear ly func t ional load.

the main reasons for these

s h o r t c o m i n g s a r e b a s e d o n

t h e f a c t t h at c u r re nt l y ava i l -

able dental implants are cyl in-

d r i c a l a n d m a d e o f t i t a n i u m .

a c t u a l l y, t h e y r e s e m b l e t h e

n a t u r a l ro o t n e i t h e r i n fo r m

n o r i n c o l o r. t h e l a c k o f t h e

c o r re c t f i t i n m o s t i n s t a n c e s

h a s t o b e c o m p e n s a t e d b y

m u l t i p l e c o m p l e x a d d i t i o n a l

t reatments such as bone aug-

m e n t a t i o n , g u i d e d t i s s u e

re g e n e r a t i o n a s we l l a s g u m

p a s t y. s o t h a t , t h e s e p r o c e -

d u r e s a r e t i m e c o n s u m i n g ,

c o s t l y a n d n o t f u l l y p re d i c t -

a b l e . t h e n a t u r a l e x t r a c t i o n

s o c k e t r e p r e s e n t s t h e i d e a l

a n a t o m y a n d s t a r t i n g p o i n t

f o r a r o o t f o r m e d i m p l a n t .

the anato mic bone s i t uat ion

is ideal for the absorpt ion of

the load of a root analogue

i m p l a n t . i n a d d i t i o n , t h e

c y l i n d r i c a l i m p l a n t s d o n o t

f i t at a l l , that leads to a hor-

i zo n t a l a n d ve r t i c a l a t ro p hy.

i n m a ny c a s e s t h e a t ro p h i e d

b o n e e s p e c i a l l y i n t h e p re s -

e nce of t h in s of t t i s s ue does

n o t s h o w e s t h e t i c a p p r o a c h

because of the grayish gingiva

or even vis ible implant shoul-

d e r s . t h e s e c o m p l i c a t i o n s

m a y o c c u r w i t h i n d a y s a f t e r

implantat ion or af ter years in

t h e co n te x t o f o l d a g e i nvo -

l u t i o n . a c o r r e c t i o n o f t h i s

f a i l u re re q u i re s a n u m b e r o f

invasive procedures as Guided

t issue regeneration, which are

quest ionable outcome, there -

fore i t i s advisable to use root

c o l o re d i m p l a n t s . D i s p l a y o f

different dental implant forms

c l e a r l y i n d i c a t e s t h a t o s s e o

i nte grat i o n d o e s n o t p r i m a r-

i l y d e p e n d o n t h e f o r m o f

t h e i m p l a n t . i n a d d i t i o n t o

sur face t reatment of implant ,

i t i s i m p o r t a n t t o p r e p a r e

t h e i m p l a n t s i te i n a n a t ra u -

matic way in order to achieve

a p e r f e c t b o n e t o i m p l a n t

contac t .

t h e r e i s a b s o l u t e l y n o

l o g i c a l r e a s o n a t a l l n o t t o

use the already exist ing intact

t o o t h s o c k e t a s i m p l a n t s i t e

a n d t o a d a p t t h e i m p l a n t t o

the tooth socket instead of the

vice versa approach including

d r i l l i n g , b o n e t r a u m a , b o n e

loss and adit ional bond

3 D a n ato M i C a l Z i R Co n i a i M p l a n t wr i t ten by prof al f red kocher and Dr. pi rker

12


a n o t h e r r e a s o n f o r t h e

h i g h r e g e n e r a t i v e p o t e n -

t i a l o f s p o n g y b o n e l i e s i n

i ts ex tens ive vascular izat ion.

Retent ions in the area of the

thin cor t ica l bone leads i r re -

v o c a b l e t o f r a c t u r e s , s o m e -

t i m e s a t r e m o t e s i t e s , w i t h

s u b s e q u e n t b o n e r e c e s s i o n .

i n o r d e r t o b e o n t h e s a f e

s i d e a n d a v o i d f r a c t u r e o f

the th in cor t ica l bone at any

c o s t , t h e i m p l a n t i s re d u c e d

at the buccal and l ingual face

by approximately 0 .1–0.2mm.

t h e p r i n c i p l e o f d i f f e r e n t i -

ated osseo integrat ion there -

fo r e d i c t a t e s t h e i n n o v a t i v e

i m p l a n t d e s i g n . i n a r e a s

w i t h o u t m a c r o r e t e n t i o n s

n o f r a c t u r e o r i m p r e s s i o n

i n d u c e d r e s o r p t i o n t a k e s

place and pr imar y osseo inte -

grat ion occurs without delay.

what are the advantages of

the novel implant?

no bone dr i l l ing equals no

o p e r a t i v e t r a u m a , n o b o n e

l o s s , n o d a m a g e t o n e i g h -

b o r i n g s t r u c t u r e s i n c l u d i n g

dental roots, mandible ner ve,

o r m a x i l l a r y s i n u s. th e ex a c t

f i t o f t h e i m p l a n t l e a d s t o

a n o p t i m i z e d i m p l a n t - b o n e

contac t sur face with maximal

pr imar y stabi l i t y.

a l l a t t e m p t s i n t h e l o n g

h i s t o r y o f d e n t a l s c i e n c e t o

f ix homologue, heterologous

o r a l l o g e n e i c r o o t a n a l o g u e

i m p l a nt s i nto a f re s h e x t ra c -

t ion socket fa i led due to the

c o n i c a l r o o t f o r m , r e j e c t i o n

a n d l a c k o f p r e c i s e n e s s a n d

w e r e t h e r e f o r e n o t e s t a b -

l ished. with the implementa-

t ion of the modern CaD/CaM

t e c h n o l o g y i t b e c a m e e a s i l y

p o s s i b l e t o m a n u f a c t u r e a n

exac t copy of the dental root .

i s t h e r e a n y d i f f e r e n c e i n

osseo integrat ion?

i t i s not only to reconstruc t

t h e a n a t o my o f t h e i n d i v i d -

ual tooth, but i t i s poss ible to

consider the under ly ing bone

quantity and qual ity. this way

t h e s u r f a c e o f t h e i m p l a n t

c a n b e m o d i f i e d a c c o r d -

ingly. M acro -retent ions (pro -

t r u s i o n s ) a re a c o n d i t i o n fo r

t h e s a f e f i x a t i o n o f a r o o t -

formed and therefore conical

i m p l a n t i n t h e b o n e. M a c ro -

re t e n t i o n s h ave t o b e f i r m l y

l imited to spongy bone, s ince

only spongy bone can absorb

p re s s u re w i t h o u t f r a c t u re a t

a remote s i te. M icro f rac tures

cannot be avoided, but in con-

t r a s t t o f r a c t u re s o f c o r t i c a l

bone fractures in spongy bone

re m a i n l i m i te d w i t h re d u ce d

d a m a g e a n d q u i c k r e g e n e r -

a t i o n d u e t o t h e e x c e l l e n t

b l o o d s u p p l y a l ways p re s e nt

in spongy bone.

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13


in the past thir ty-f ive years,

i have encountered hundreds

o f p a t i e n t s w h o w e r e p e t -

r i f i e d o f s i t t i n g i n a d e n t a l

c h a i r. w h e n i re f l e c t o n t h i s

population of fear ful patients,

they a l l seem to have a fa i r ly

c o n s i s t e n t p r o f i l e . t h e y a r e

most ly above the age of f i f t y

y e a r s o l d , t h e y o f t e n h a v e

ser ious dental needs and they

a l m o s t u n i ve r s a l l y c a n re c a l l

o n e o r m u l t i p l e t r a u m a t i c

v is i ts to the dentist as a chi ld.

the memor y of the t rauma or

t r a u m a s h a s / h a v e , i t w o u l d

seem, left an indelible imprint

which is diff icult , i f not impos-

s i b l e t o e n t i r e l y e x p u n g e .

Fi f t y years ago, dentists of ten

t r e a t e d y o u n g p a t i e n t s l i k e

s m a l l a d u l t s . a n d , w h e n t h e

child’s response to unpleasant

o r u n u s u a l e x p e r i e n c e s

was fear or poor control , the

d e n t i s t o f t e n b e c a m e f r u s -

trated, or impatient , or, in the

e x t r e m e , b r u t a l . t h a n k f u l l y,

t h i s c l i n i c a l a p p r o a c h h a s

become increasingly rare. the

specialty of pediatric dentistr y

has produced a group of den-

t ists who have been taught to

ef fec t ively and appropr iately

t r e a t c h i l d r e n . t h e r e s u l t i s

a m o d e r n d e n t a l p o p u l a t i o n

which v iews denta l care as a

st ress- f ree ac t iv i t y. the chi ld

w i t h m e m o r i e s o f t r a u m a t i c

dental care becomes an adult

w h o b e c o m e s , u n d e r s t a n d -

a b l y, o n e w h o avo i d s d e n t a l

t reatment. this avoidance, in

many cases, leads to increas-

i n g l y g r e a t e r d e n t a l n e e d s .

through the years, i have seen

a n u m b e r o f p a t i e n t s w h o

have not had a rout ine dental

v i s i t i n ove r t we n t y ye a r s . i f

i t were not for ex treme pain ,

or an inabi l i t y to chew ef fec-

t i v e l y, o r a s e r i o u s e s t h e t i c

p r o b l e m , t h e y w o u l d n e v e r

h a v e a r r i v e d a t my o f f i c e a t

al l . so how does one begin the

conve r s ion of t he de ntopho -

b i c i nto o n e w h o vo l u nt a r i l y

s e e k s a n d i s a b l e t o s u s t a i n

d e n t a l c a re ? we l l , a l l fe a r f u l

dental pat ients seem to have

a c o n c e r n t h a t t h e y w i l l b e

hur t in the chair and that they

have l imited abi l i t y to stop i t .

so, the f i rst step is to demon-

strate to a pat ient that dental

care can be del ivered without

d i s c o m f o r t . i n o r d e r t o d o

th is , moder n dent ist r y of fers

a n u m b e r o f p a i n c o n t r o l

s t r a t e g i e s . lo c a l a n e s t h e t i c s

(novocain) have been around

s i n c e t h e 1 9 5 0 ’s . i n t h e p a s t

s i x d e c a d e s , t h o s e s e n s at i o n

blockers, and the techniques

of deliver y, have become more

ef fec t ive. n itrous oxide anal -

gesic (sweet air, laughing gas)

i s a useful adjunc t for dental

c a r e f o r t h e f e a r f u l p a t i e n t .

n i t r o u s o x i d e g a s i s m i x e d

w i t h o x y g e n a n d d e l i v e r e d

t h r o u g h a n o s e p i e c e . t h e

precise way this gas works is

n o t e nt i re l y u n d e r s to o d, b u t

when i t i s breathed, i t causes

re l a x at i o n a n d a te m p o ra r i l y

altered perception of unpleas-

ant st imul i .

D e n to p h o b i a “ t h e o n lY t h i n G w e haVe to FeaR is FeaR itselF.” bY RobeRt a. heRsh, DDs

14


i h a ve fo u n d t h a t s t a r t i n g

t reatme nt wit h s hor t , s imple

procedures is helpful. as trust

i s d e v e l o p e d , l o n g e r, m o r e

complex procedures are more

e a s i l y t o l e r a t e d . t h e f e a r f u l

p a t i e n t s l o w l y u n d e r g o e s a

convers ion into a pat ient tol -

erant of dental care. so why,

one must wonder, am i preach-

i n g t o t h e c h o i r ? a f t e r a l l ,

p a t i e n t s r e a d i n g t h i s n e w s -

letter have demonstrated an

o n c e t h e n i t r o u s o x i d e i s

f l u s h e d o u t , b y b r e a t h i n g

s t r a i g h t ox yg e n , t h e a l t e re d

state i s quick ly reversed and

t h e p a t i e n t c a n d r i v e a w a y

without res idual ef fec ts.

sedation techniques such as

tak ing Valium prior to a dental

vis it is another effective strat-

egy for some. Val ium seems to

produce a calming effect prior

to a dental visit . Unlike nitrous

oxide however, Val ium, whi le

rather shor t ac t ing, cannot be

r e v e r s e d . pa t i e n t s w h o t a k e

Val ium pr ior to a dental v is i t

should be dr iven to and f rom

the dental of f ice. i n the past

f e w y e a r s , a n e w t e c h n i q u e

c a l l e d “ s e d a t i o n D e n t i s t r y ”

h a s r e c e i v e d a l o t o f p u b -

l i c i t y . s e d a t i o n d e n t i s t r y

i n v o l v e s t a k i n g a s e d a t i o n

drug cal led tr iazolan pr ior to

the dental v is i t . this drug has

a number of ef fec ts inc luding

a c h e m i c a l l y i n d u c e d s l e e p -

l i k e p e r i o d w h i l e t h e d e n -

t istr y is per formed. whi le this

drug has a fa i r ly good safet y

record, patients must be mon-

itored dur ing and af ter tak ing

t h e d r u g b e c a u s e o f d o c u -

m e n t e d i n s t a n c e s o f s l e e p

w a l k i n g , s l e e p d r i v i n g a n d

trance - l ike behavior. perhaps

the most effective mechanism

for helping the fear ful patient

is to establ ish t rust .

a b i l i t y t o r o u t i n e l y p a r t i c -

i p a t e i n d e n t a l c a r e . we l l ,

m a n y p a t i e n t s p r o b a b l y

k now fr iends or re lat ives who

n e e d c a re, b u t w h o s e d e nt a l

p h o b i a s p r e v e n t t h e m f r o m

gett ing help. this may be an

oppor tunit y to ass ist them in

el iminating pain or improving

their abi l i t y to eat or to help

t h e m t o l o o k b e t t e r. w h a t a

k ind gesture!

a

aR tiCle

15


oZone theRapY – an alteRnatiVe to ConVentional theRapY in peDiatRiC DentistRY bY Dr. sushma Gojanur.

t h e w o r d o z o n e i s d e r i v e d

f r o m t h e G r e e k “ o z e i n ”

meaning odorant . ozone is a

t r i a t o m i c m o l e c u l e c o n s i s t -

i n g o f t h r e e o x y g e n a t o m s

w i t h a m o l e c u l a r w e i g h t o f

4 7 , 9 8 g / m o l 1 . ozo n e i s t h e r-

modynamical ly h ighly unsta-

b l e c o m p o u n d w h i c h d i s s o -

c iates readi ly back to ox ygen

and s inglet ox ygen which is a

strong oxidizing agent quick ly

re n d e r i n g v a r i o u s b e n e f i c i a l

e f fe c t s . i t i s a b l u e g a s, w i t h

a s t r o n g o d o r a n d a b s o r b s

t h e h a r m f u l u l t r a v i o l e t r a y s

present in the l ight spec trum

from the sun and protec ts the

l iving creatures from the ultra-

violet rays. ozone therapy can

be def ined as a versat i le bio -

o x i d a t i v e t h e r a p y i n w h i c h

oxygen/ozone is administered

v ia gas or d issolved in water

or oi l base to obtain therapeu-

t ic benef its . interest of ozone

use in medic ine and dent istr y

i s d u e t o i t s a n t i - m i c r o b i a l ,

d i s i n f e c t a n t , b i o c o m p a t i b i l -

i t y and heal ing proper t ies.

Mechanism of ac t ion:

t h e r e a r e s e v e r a l a c t i o n s

h e a l i n g , i m p r o v e d o x y g e n

o f ozo n e s u c h a s a nt i - m i c ro -

bia l , ant i - inf lammator y, anal -

g e s i c , i m m u n e s t i m u l a t -

i n g, a n t i - hy p ox i c , d e t ox i c a t -

i n g , b i o - e n e r g e t i c a n d b i o -

s y n t h e t i c ( a c t i v a t i o n o f t h e

metabol ism of carbohydrates,

proteins & l ip ids) ac t ions2.

Mode of ac t ion: ozone gas :

t h e r e a r e t h r e e d i f f e r e n t

systems for generat ing ozone

i . Ultraviolet system i i . Corona

D i s c h a r g e s y s t e m i i i . C o l d

p l a s m a s y s t e m . s o m e o f t h e

commercial ly avai lable ozone

U n i t s a r e : h e a l o z o n et e C 3

( C u r o z o n e , U s a ) , p r o z o n e

( w&h) , oz icure ozone device.

ozone aqueous solut ion: the

fol lowing proper t ies of ozone

a r e u s e d : d i s i n f e c t a n t a n d

ster i l iz ing effec t , haemostatic

e f fe c t , e s p e c i a l l y i n c a s e s o f

h e m o r r h a g e s a c c e l e r a t e d

16


aR tiCle

supply and suppor t of meta-

bol ic processes.

o zo n e o i l : o zo n a te d o i l s a re

p u re p l a n t e x t r a c t s , t h ro u g h

which pure ox ygen and ozone

are passed. the plant ex trac ts

u n d e rg o a c h e m i c a l re a c t i o n

t o fo r m a t h i c k , v i s c o u s o i l ,

or in some cases, a petroleum

j e l l y - l i k e p r o d u c t . t h e f i n a l

p r o d u c t s c o n t a i n o z o n i d e s .

this method of external appli-

cat ion is harmless.

Cl in ical appl icat ions :

pre ve nt i o n a n d m a n a g e m e nt

of dental car ies : the appl ica-

t ion of ozone therapy in the

management of dental car ies

i s widely studied. Most of the

c h i l d p a t i e n t s h ave fe a r a n d

anxiet y towards dental t reat-

ment. Dahnhar t Je et a l4 eval-

u a t e d t h e a n x i e t y l e v e l o f

c h i l d r e n ( a n d t h e i r p a r e n t s )

t reated with ozone and found

t h a t a l l c h i l d r e n & p a r e n t s

r e p o r t e d s i g n i f i c a n t a n x i e t y

p r i o r t o o z o n e t r e a t m e n t .

however, fo l lowing the t reat-

m e n t , t h e c h i l d r e n r e p o r t e d

t h e y w o u l d b e p l e a s e d t o

re t u r n fo r f u t u re t re at m e nt s .

also, 80% of the parents sa id

they would be wi l l ing to pay

m o r e f o r t h i s t h e r a p y c o m -

p a r e d w i t h t r a d i t i o n a l d r i l l -

ing and f i l l ing. huth et al5 ran

a spl i t mouth c l in ica l t r ia l to

assess the effect of a s ingle 40

second application of gaseous

o z o n e o n n o n c a v i t a t e d

f issure car ies in permanent

m o l a r s . th e ozo n e - t re ate d

t e e t h s h o w e d r e d u c e d

c a r i e s p r o g r e s s i o n w h e n

compared to the untreated

c o n t r o l l e s i o n s i n t h e s e

s a m e p a t i e n t s . k r o n u s o v a

M6 found that ozone treat-

ment e i ther a lone or com-

b i n e d w i t h a r e m i n e r a l i z -

i n g s o l u t i o n w a s fo u n d t o

b e e f f e c t i v e f o r r e m i n e r -

a l i z a t i o n o f i n i t i a l f i s s u r e

c a r i e s l e s i o n s . o z o n e h a s

b e e n s h o w n t o r e v e r s e

p i t a n d f i s s u r e s c a r i e s i n

deciduous teeth7. ozone is

a l s o fo u n d to b e e f fe c t i ve

against the microflora asso -

c i a t e d w i t h p r i m a r y r o o t

car ies lesion8. i t a lso oxides

volati le sulphur compounds

precursor methionine to i ts

c o r re s p o n d i n g s u l p h ox i d e

and thus prevents malodor

associated with root car ies.

t h e m e c h a n i s m o f a c t i o n

i s d u e to i t s a n t i m i c ro b i a l

p r o p e r t i e s a n d i t s a b i l i t y

t o o x i d i z e t h e b a c t e r i a l

ce l l wal l . pyruvic ac id that

is produced by bacteria and

i m p l i c ate d i n t h e p ro gre s -

s i o n o f c a r i e s i s o x i d i z e d

b y o z o n e t o a c e t a t e a n d

carbon dioxide. ozone gen-

erating equipment conver ts

oxygen to ozone. the ozone

is thereaf ter led to a hand

piece f i t ted with a s i l icone

cup. sur faces. this ensures

c lose contac t bet ween

t h e s i l i c o n e c u p a n d t h e

c a r i o u s a r e a o f t h e t o o t h

s o t h a t t h e o z o n e d o e s

n o t e s c a p e . t h e o z o n e i s

l e d t h r o u g h t h e s i l i c o n e

c u p o v e r t h e t o o t h f o r a

m i n i m u m o f 1 0 s e c o n d s .

t h e o z o n e i n t h e s i l i c o n e

cup is col lec ted again and

re c o nve r t e d t o ox yg e n b y

the apparatus.

Management of periodontal

diseases: studies found that

o z o n a t e d w a t e r s t r o n g l y

i n h i b i t e d t h e f o r m a t i o n

o f d e n t a l p l a q u e a n d w a s

h i g h l y e f f e c t i v e i n k i l l i n g

o f b o t h gra m p o s i t i ve a n d

g r a m n e g a t i v e m i c r o o r -

g a n i s m s 9 . ozo n ate d wate r

c a n b e u s e d i n t h e u l t r a -

s o n i c wate r re s e r vo i r, a l s o

a s a p r e t r e a t m e n t r i n s e

b e fo r e s c a l i n g, r o o t p l a n -

ning and the sulc i , pockets

are i r r igated us ing syr inge

a n d c a n u l a i n n o n s u r g i -

c a l p o c k e t c u re t t a g e. t h i s

p r o c e s s w i l l r e d u c e t h e

i n i t i a l p a t h o g e n i c l o a d o n

the pat ient local ly and sys-

temical ly. af ter t reatment ,

e a c h p o c k e t & s u l c u s i s

insuff lated with ozone gas

w h i c h d i r e c t l y g o e s i n t o

t issues, ster i l iz ing the area.

the pat ients are a lso given

ozonated o i l to apply top -

i c a l l y t o t h e s o f t t i s s u e .

huth et a l10 in their study

declared that the aqueous

form of ozone, as a potential

17


a n t i s e p t i c a g e n t , s h o w e d

l e s s c y t o t o x i c i t y t h a n

g a s e o u s o z o n e o r e s t a b -

l ished antimicrobials under

m o s t c o n d i t i o n s . D h i n g r a

et a l11 proposed that sub -

g i n g i v a l o z o n e i r r i g a t i o n

c a n b e p e r f o r m e d d u r i n g

m o n t h l y v i s i t s o n o r t h -

odontic pat ients to reduce

s u b g i n g i v a l i n f l a m m a t i o n

because of plaque retentive

or thodontic appl iances.

Dis infection of the infected

r o o t c a n a l s : o z o n e w a s

f o u n d t o b e e f f e c t i v e

against endodontic patho -

g e n i c m i c ro o rg a n i s m s l i k e

e . Fa e c a l i s , C a n d i d a a l b i -

c a n s , pe p t o s t r e p t o c o c c u s

m i c r o s a n d ps e u d o m o n a s

a e r u g i n o s a d i s i n f e c t i n g

o f r o o t c a n a l s a n d d e n -

t inal tubules12. ozone wi l l

a lso penetrate through the

a p i c a l fo r a m e n a n d e n te r-

i n t o t h e s u r r o u n d i n g a n d

s u p p o r t i v e b o n e t i s s u e

e n c o u r a g i n g h e a l i n g &

regenerat ion of bone.

b l e a c h i n g o f d i s c o l o r e d

teeth: Crown discolorat ion

i s o n e o f t h e m a j o r a e s -

thetic problem in root canal

t r e a t e d t e e t h . te e t h w h i t -

e n i n g c a n b e d o n e u s i n g

ozone gas due to i ts st rong

oxidiz ing proper t ies.

Desensit ization of sensit ive

teeth:

ozone removes smear layer,

o p e n s u p t h e d e n t i n a l

t u b u l e s , b r o a d e n s t h e i r

d iameter and then calc ium

and f luor ide ions f low into

t h e t u b u l e s e a s i l y, d e e p l y

a n d e f f e c t i v e l y t o p l u g

t h e d e n t i n a l t u b u l e s , p re -

vent ing the f lu id exchange

through these tubules fo l -

l o w e d e x p o s e d d e n t i n e

repet i t ive manner 15.

wo u n d h e a l i n g : th e i n f l u -

e n c e o f o z o n i z e d w a t e r

o n t h e e p i t h e l i a l w o u n d

heal ing process in the oral

c a v i t y w a s o b s e r v e d b y

Fi l i p p i 1 6 . o zo n e h a s b e e n

repor ted to accelerate the

healing of soft t issue condi-

t ions i .e . : aphthous ulcers ,

h e r p e s l a b i a l i s , a n U G a n d

o t h e r g i n g i v a l i n f e c t i o n s

because ozone encourages

p hy s i o l o g i c a l h e a l i n g r a t e

as wel l as control oppor tu-

nist ic infec t ions.

Contraindications: ozone is

co n t r a i n d i c a te d i n ce r t a i n

m e d i c a l c o n d i t i o n s l i k e

pregnancy, glucose -6-phos-

p h a te d e hyd ro g e n a s e d e f i -

c i e n c y ( f a v i s m ) , r e c e n t

m y o c a r d i a l i n f a r c t i o n ,

h y p e r t h y r o i d i s m , s e v e r e

anemia, severe myasthenia,

hemorrhage, acute a lcohol

i n t o x i c a t i o n a n d o z o n e

a l lergy3

o z o n e to x i c i t y : o z o n e

w a s r e p o r t e d t o c a u s e

c e r t a i n s i d e e f f e c t s l i k e

e p i p h o r a , u p p e r r e s p i r a -

to r y t r a c t i r r i t a t i o n , r h i n i -

t is , cough, headache, occa-

s i o n a l n a u s e a , v o m i t i n g ,

shor tness of breath, b lood

vessel swel l ing, poor c i rcu-

lat ion, hear t problems and

at t imes stroke3. because of

i ts ex treme oxidant capac-

i t y, good ozone hygiene is

required.

Conclus ions :Due to proven

t h e ra p e u t i c a d va nt a g e s o f

ozo n e i t i s u s e d i n a l m o s t

a l l a s p e c t s o f d e n t i s t r y .

ozone therapy al lows a new

vision, which complies with

needs and demands of the

p u b l i c f o r n o n - i n v a s i v e ,

e f f e c t i v e d e n t a l c a r e a n d

i t i s t ru ly a paradigm shi f t

i n d e n t a l p r a c t i c e . o z o n e

t h e r a p y h a s o p e n e d n e w

vistas in t reatment modal-

i t i e s f o r d e n t a l p a t i e n t s

o f a l l a g e s a n d a p p l i c a b l e

t o a w i d e r a n g e o f c o n d i -

t ions of intra ora l hard and

sof t t i ssues. i t i s especia l ly

s u i t a b l e t o t h e p e d i a t r i c

pat ie nt s who f ind conven-

t ional t reatment unaccept-

a b l e . Fu r t h e r r e s e a r c h i s

needed to standardize indi-

cat ions and treatment pro -

c e d u r e s o f o z o n e t h e r a p y

which would br ing a revo -

lut ion in dental prac t ice in

near future.

18


intRoDUC tion

i n modern dent istr y esthet ics

a r e n o t o n l y a b o u t c r e a t i n g

b a l a n ce a n d h a r m o ny w i t h i n

a smile, but also have much to

d o w i t h c re at i n g t h e i l l u s i o n

of per fection by using var ious

d e n t a l m a t e r i a l s a n d t e c h -

n i q u e s . s m i l e d e s i g n p r i n c i -

ples, such as determining the

placement of the incisal edge,

the development of p leas ing

w i d t h / h e i g h t r a t i o s , a n d t h e

development of esthet ic gin-

gival contours should be used

t o h e l p a c h i e v e t h e d e s i r e d

goals .

a smile Makeover Case Repor t. . .by Dr. sa l ly almhana

References

1-stopk a p. ozone. progresdent 2003; 6 : 8-11. 2-seidler V, l inetsk iy i , hubalkova h, stankova R , Mazanek J . ozone and i ts usage in

general medic ine and dentistr y. a Review ar t ic le. prague Medical Repor t 2008; 109: 5-13. 3- nogales CG, Ferrar i ph, k antorovich eo,

lage -Marques Jl. ozone therapy in medicine and dentistr y. J Contemp Dent pract 2008; 9:75-84. 4-Dahnhar t Je, Jaeggi t, scheidegger

n, et a l . treat ing car ies in anxious chi ldren with ozone: parents’ att i tudes af ter the f i rst sess ion. J Dent Res 2003; 82 : b-265. 5-huth

kC, paschos e , brand k , h ickel R . ef fec t of ozone on noncavitated f issure car ious les ions in permanent molars : a control led prospec-

t ive c l in ica l s tudy. am J Dent 2005;18: 223-8 . 6-k ronusova M: apl ik ace atomárního k ys l íku v ordinaci prakt ickéhozubníholék aře.

progresdent 3 : 34–36, 2007. 7-abu-salem ot, M arashdeh MM, lynch e . ozone ef f icac y in t reatment of occlusal car ies in pr imar y

teeth. J Dent Res 2003; 82 : b-136. 8-baysan a, lynch e . C l in ical management of root car ies us ing ozone. Quintessence publ ishing

2004:173–180. 9-nagayoshi M, Fukuizumi t, k i tamura C, Yano J , terashita M, n ishihara t, et a l . e f f icac y of ozone on sur vival and

permeabi l i t y of ora l micorganisms. oral M icrobiol i mmunol 2004;19: 240-6 . 10-huth kC, Jacob FM, saugel b, Cappel lo C , paschos e ,

hol lwock R , et a l . e f fec t of ozone on oral cel ls compared with establ ished ant imicrobia ls . eur J oral sc i 2006;114:435

aR tiCle


Goals oF sMile DesiGninG

th e m a i n g o a l o f a n e s t h e t i c

m a k e o v e r i s t o d e v e l o p a

p e a ce f u l a n d s t a b l e m a s t i c a -

tor y system, where the teeth,

tissues, muscles, skeletal struc-

t u r e s a n d j o i n t s a l l f u n c t i o n

in harmony (peter Dawson) . i t

i s v e r y i m p o r t a n t t h a t w h e n

planning treatment for esthet-

ics cases, smi le design cannot

b e i s o l a t e d f r o m a c o m p r e -

h e n s i v e a p p r o a c h t o p a t i e n t

c a re . ac h i e v i n g a s u c c e s s f u l ,

heal thy and func t ional resul t

requires an understanding of

t h e i n t e r r e l a t i o n s h i p a m o n g

a l l the suppor t ing ora l s t ruc -

t u re s , i n c l u d i n g t h e m u s c l e s ,

bones, jo ints, gingival t i ssues

and occlus ion.

the Case RepoR t

the treatment plan:

1 i n t r a o r a l & p r o f i l e p h o t o s

before treatment ( init ial state)

2 improve oral hygiene

3 scal ing

4 endodontic retreatments

5 digital smile design analysis.

6 laser gingivec tomy/gingivo -

plast y (crown lengthening) .

7 preparat ion of teeth for a l l -

ceramic crowns

20


8 the impress ion

9 c h o o s e b l e a c h 3 a s a m a i n

color and give i t more natural

ef fec ts

1 0 c e m e n t a t i o n o f c r o w n s

using 3M opaque resin cement.

1 1 p i c t u r e s o f f i n a l r e s u l t -

af ter t reatment.

21


22


p o l a n d i s a n

e x c e l l e n t c h o i c e

b e c a u s e , w i t h a

re s i l i e nt e co n o my,

d e m a n d f o r

d e n t a l s e r v i c e s i s

g r o w i n g r a p i d l y ,

w i t h g r o w t h i n

t h e p r i v a te d e n t a l

s e c t o r e s t i m a t e d

b e t w e e n 2 0 a n d

3 0 % p e r y e a r. s o

i t m a k e s s e n s e t o

h o l d a n i n t e r n a -

t i o n a l e ve n t t h e re

a t t h i s t i m e . w e

a lso bel ieve that i t

h a s t h e p o t e n t i a l

t o a t t r a c t p a r t i c i -

pants f rom around

the wor ld.

i n a d d i t i o n , w e

k now that we have

a top qual i t y local

t e a m s o w e r e a l l y

e x p e c t a l a r g e

t u r n o u t f o r t h e

F D i a n n u a l wo r l d

Dental Congress in

po z n a n a n d c o u n t

o n i t b e i n g t h e

l a n d m a r k i n t e r -

n a t i o n a l e v e n t i n

dent istr y in 2016.

D r pa t r i c k h e s c o t

FDi pres ident

F D i 2 0 1 6 p o Z n a n co n gre s s i s t h e o n ce -ye a r l y g e t- to g e t h e r o f t h e

wo r l d D e nt a l pa r l i a m e nt , a d e c a d e s - l o n g p a r t o f F D i . i t i s a m i x t u re o f

formal and informal sess ions : centra l i s the General assembly, our federa-

t ion’s su preme legis lat ive and governing body, where the projec t leaders

f ro m a m o n g F D i m e m b e r s h i p re p o r t o n p ro g re s s o ve r t h e p a s t t we l ve

Dental e Vents

po l i s h l a n g u a g e i s o n e o f

the most diff icult languages

to learn. i t has seven cases

and grammar that has actu-

a l l y m o r e e x c e p t i o n t h a n

rules.

Cusion

i f t h e r e ’s a t h i n g a b o u t

poland we are real ly, real ly

proud of, the cuisine wil l be

probably number one. the

most popular pol ish meals

a r e p i e r o g i ( d u m p l i n g s ) ,

k o t l e t s c h a b o w y ( t y p e o f

breaded cutlet), bigos (a mix

of cabbage, meat and mush-

r o o m s ) , g o ł ą b k i ( c a b b a g e

l e ave s s t u f fe d w i t h m e a t ) ,

ros ół ( ch ick e n s oup) , zupa

ogór kowa (cucumber soup

– i t ’s r e a l l y s o u r ! ! ! ) a n d

ż u re k ( s o u r s o u p w i t h e g g

and sausage) .

( 9 t h l a r g e s t c o u n t r y i n

eu ro p e ) w i t h a p o p u l at i o n

of over 38.5 mil l ion people.

You should k now the name

of our capita l c i t y but just

to make sure you are wel l -

i n f o r m e d , w e w a n t y o u

t o k e e p i n m i n d t h a t i t ’s

wa r s z a w a ( wa r s a w ) – n o t

k rakow.

Faith

the great majority of pol ish

p e o p l e a r e C h r i s t i a n s –

86.7% belong to the Roman

Cathol ic Church.

language

t h e R e p u b l i c o f po l a n d, a

p a r l i a m e n t a r y re p u b l i c , i s

s i tuated in Centra l europe.

w e h a v e m a n y f r i e n d s

a r o u n d u s , f o l l o w i n g t h e

rule “the more, the merr ier ”

– Czech Republic, Germany,

s l ova k i a , b e l a r u s , U k ra i n e,

R u s s i a a n d l i t h u a n i a . o u r

c o u n t r y h a s a c c e s s t o t h e

balt ic sea in the nor th and

i s s u r r o u n d e d b y m o u n -

t a i n s ( ta t r y , b i e s z c z a d y,

k a r p a t y ) i n t h e s o u t h . i t ’s

b e e n a w h i l e s i n c e o u r

countr y became a member

o f eu ro p e a n U n i o n ( 2 0 0 4 ) .

the total area of poland is

312,679 square k i lometers

23


polanD on spot

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