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Orthodontic Camouflage Treatment of aClass II Malocclusion - A Case ReportDr. Saud A. Al-Anezi, Dr. Manar M. Al-Nouri

Unilateral Subperiosteal Implant Dr. Haseed Dary

Application of CBCT in Dental Practice A Literature ReviewDr. Mohammed A. Alshehri, Dr. Hadi Alamri,Dr. Mazen Alshalhoub

25th Anniversary, International Meetingof the Egyptian Orthodontic Society

120 Years W&H, Pre-IDS Meeting

International Dental Show 2011

15th Kuwait Dental AssociationInternational Scientific Conference

1st Iraqi Dental Reunion

10th Lebanese Orthodontic SocietyMeeting

ITI First Middle East Congress Beirut,Lebanon

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DENTAL NEWS Sami Solh Ave., G. Younis Bldg.POB: 116-5515 Beirut, Lebanon.Tel: 961-3-30 30 48Fax: 961-1-38 46 57Email: [email protected]: www.dentalnews.comwww.facebook.com/dentalnews1

DENTAL NEWS IS A QUARTERLY PUBLICATION DISTRIBUTED MAINLY IN

THE MIDDLE EAST & NORTH AFRICA IN COLLABORATION WITH

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this magazine may be reproduced in any form, either electronic ormechanical, without the express written permission of the publisher.

INTERNATIONAL REVIEW BOARDPr. M.A. Bassiouny BDS, DMD, MSc, Ph.D. Director International Program, Temple University, Philadelphia, USA.Pr. N.F. Bissada D.D.S., M.S.D Professor and Chairman, Department of Periodontics, Case Western ReserveUniversity, USA.Pr. Jean-Louis Brouillet D.C.D, D.S.O. Chairman, Department of Restorative Dentistry, Aix-Marseille II, France.Pierre Colon D.C.D., D.S.O. Matre de confrence des universits, Paris, France.Dr. Jean-Claude Franquin, Directeur de lUnit de Recherche ER116, Marseille, France.Pr. Gilles Koubi D.C.D., D.S.O. Department of Restorative Dentistry, Aix-Marseille II, France.Pr. Guido Goracci. University LA SAPIENZA, School of Medicine & Dentistry, Roma, Italia. Brian J. Millar BDS, Ph.D. Guys, Kings, and St. Thomas College School of Medecine & Dentistry, London, UK.Pr. Dr. Klaus Ott, Director of the Clinics of Westflischen Wilhelms-University, Mnster, Germany.Wilhelm-Joseph Pertot DEA, Matre de confrence, Aix-Marseille II, France.Pr. Dr. Alfred Renk, Bayerische Julius-Maximilians-University, Wrzburg, Germany.Dr. Philippe Roche-Poggi DEA. Matre de confrence des universits, Aix-Marseille II, France.Michel Sixou D.C.D., D.E.A. Department of Priodontology, Toulouse, France.Pr. M. Sharawy B.D.S., Ph.D. Professor and Director, Department of Oral biology, Medical College of Georgia,Augusta, Georgia, USA.

Alfred Naaman, Nada Naaman, Jihad Fakhoury,Dona Raad, Antoine Saad, Lina Chamseddine,Tarek Kotob, Mohammed Rifai, Bilal Koleilat, Mohammad H. Al-JammazVanessa AbdelahadKrystel KouyoumdjisMicheline Assaf, Nariman NehmehJosiane YounesAlbert SaykaliGisle Wakim, Marielle KhouryTony Dib1026-261X

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DENTAL NEWS, VOLUME XVIII, NUMBER II, 2011

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ORTHODONTICS


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IntroductionClass II division 1 malocclusion is described as the incisal edgesof the lower incisors occlude posterior to the cingulum plateauof the upper incisors and the upper central incisors are proclined1.The prevalence of this malocclusion varies amongst differentpopulations but it is reported to be 20% in the UK2. There are anumber of features commonly associated with Class II malocclusionincluding the Class II skeletal pattern and dentoalveolar compen-sation may mask the severity of the malocclusion but the profilemay still be unfavourable. Deep overbite and increased overjetare commonly seen in this malocclusion. Soft tissues can exert aninfluence on the position and inclination of the incisors. A lowerlip trap may procline the upper incisors further and lip incompetencecan have an effect on the inclination of the incisors due to imbalanceof the pressure on the teeth3. The management of this type ofmalocclusion will depend on a number of factors including thepatients age, the severity of the skeletal pattern, the amount ofcrowding and the overjet. It can be broadly divided into growthmodification, orthodontic camouflage or orthognathic surgeryinvolving either one jaw or double jaws. In the following case,orthodontic camouflage was chosen and the reasons for thistreatment plan are explained.

Case history 15.7 years old male presented complaining of prominent upperincisors. He had no relevant medical history and there was nohistory of previous orthodontic treatment.

Extra-oral assessmentThe patient had moderate Class II skeletal pattern with averageFrankfort-mandibular planes angle and lower anterior face height.There was no facial asymmetry and the lips were incompetentwith the lower lip trapped at rest behind the upper central incisors(Figure 1).

Intra-oral assessmentThe oral hygiene was fair but needed improvement prior toorthodontic treatment. All teeth from the left permanent secondmolar to the right have erupted in both the upper and lowerarches. The patient had carious lesions in both upper firstmolars, upper left second molar and lower left first molar. Themaxillary arch was spaced with a midline diastema. Furthermore,there was mild lower labial segment crowding (4mm). The incisorrelationship was Class II division 1, the overjet was 12 mmwhereas the overbite was increased and complete to the palate

*Dr Saud A. Al-Anezi BDS, MFD RCSI, DDS , MOrth RCSEd., Dr Manar M. Al-Nouri*Bneid AL-Gar Specialty Dental Center. - Orthodontic Department - [email protected]

Orthodontic camouflagetreatment of a Class IImalocclus ion

- A case report

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and causing trauma to the palatal mucosa. The centrelines werecoincident and the buccal segment relationship was 1/2 unitClass II on both sides (Figure 2).

Radiographic assessmentThe Dental Panoramic Tomogram (DPT) confirmed the presenceof all permanent teeth including the developing third molars(Figure 3). Root morphology appeared normal. The upper rightcentral incisor had a root canal filling. The upper standard occlusal

radiograph revealed that the upper right central incisor had anadequate root filling with no periapical area. In the cephalometricassessment (Figure 4), the ANB value of 7 suggested a moderateClass II skeletal pattern. The vertical proportions were withinnormal values. The upper incisors were proclined at 122 and thelower incisors were of average inclination at 94. The interincisalangle was reduced at 119. The lower incisor to APo and thelower lip to E line were within normal limits.

AetiologyThis patient presented with a Class II division 1 malocclusion ona moderate Class II skeletal pattern complicated by increased andcomplete overbite, increased overjet, and mild crowding in thelower labial segment. The genetically inherited skeletal patterncontributed to the presenting malocclusion. Furthermore, thelower lip trapped behind the upper incisor contributing to the

Fig 1. Pre-treatment extra-oral clinical photographs. Note the lip trapbehind the upper incisors in the left photograph.

Fig 3. A pre-treatment OPG (above) and upper standard occlusal radiographs.

Fig 2. Pre-treatment intra-oral clinical photographs.Fig 4. The pre-treatment cephalometric radiograph (up) and the valueswith the normal figures for Caucasians taken from Houston et al4.

SNASNBANBUpper incisor to maxillaryplane angleLower incisor to mandibularplane angleInterincisal angleMaxillary mandibular planesangleFace height ratioLower incisor to Apo line Lower lip to Ricketts E Plane

78717

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55%1-1

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133 1027 5

55%0-2mm-2mm

PRE-TREATMENTVARIABLE NORMAL

increased overjet. Therefore, the main problems in this case wereas follows:1. Moderate Class II skeletal pattern with mild crowding in thelower arch.2. Increased and complete overbite and increased overjet.3. Midline diastema and retained upper left second deciduousmolar.4. 1/2 unit Class II left and right molar relationships.

Aims of treatment1. Camouflage the skeletal pattern with fixed appliances.2. Relieve crowding and level and align the arches.3. Reduce overbite and the overjet.4. Achieve Class I incisors, canines and full unit Class II molars.

Treatment planThe treatment of the patient was executed in the followingorder:1. Scale, polish and oral hygiene instructions session with thedental hygienist. 2. Restoration of the carious lesions and extraction of the upperleft deciduous molar by the general dental practitioner.3. Anterior bite plan to reduce the overbite and bonding thelower arch (Figure 5).4. Fit a Transplalatal Arch (TPA) with Nance button to reinforcethe anchorage.5. Refer to the general dental practitioner for extraction of upperleft and right first premolars.6. Bonding upper arch.7. Continue with the fixed appliances to close the space andachieve the treatment aims.8. Retain with an upper and lower Essix retainers.

Treatment rationaleThe patients main concern was the prominence of the upperincisors. Anchorage was a critical issue in this case because ofthe increase overjet and the planned amount of tooth movement.In addition, after assessing the space requirement, it was necessaryto extract teeth in the upper arch to enable the reduction of theoverjet. Furthermore, the fact that the crowding in the lowerarch was mild and there was increased overbite, it was decidedto avoid extraction in the lower arch. It was also planned to useClass II traction during treatment to maximise the anchorage.

Alternative treatment planThe use of headgear to distalise the upper buccal segments andcreate space to reduce the overjet. However, the patientdeclined to wear HG and he accepted the extraction of upperpremolars approach. Alternatively, Temporary AnchorageDevices (TADs) could be employed to either distalise the upperbuccal segments between the upper second premolar and firstmolar to achieve space closure in order to minimise the mesialmovement of the upper buccal segments.

Treatment progressThe oral hygiene of the patient and the carious lesions wereaddressed prior to the start of the fixed appliances treatment.The patients compliance was good and treatment progressedwithout encountering major problems. The reduction of theoverbite was achieved initially with the anterior bite plane thena reverse curve of Spee was placed in the lower archwire to controlthe overbite. A Trans-Palatal Arch (TPA) with Nance button was fittedprior to the extraction of the upper premolars in order to reinforcethe anchorage (Figure 6). The treatment continued with the useof Class II traction on both sides and space closure mechanics.

Treatment resultTreatment objectives were achieved and the patient was satisfiedwith the treatment outcome. The overbite and overjet werereduced, Class I incisors, canines and full unit class II molars wereobtained. Overall treatment time was twenty four months

DiscussionThis was a case of camouflaging the underlying Class II skeletalpattern. There was a concern of damaging the patients profile

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Fig 5. Clinical photographs showing the anterior bite plane and thebonding of the lower arch. Note the increased overjet in the top photo.

Fig 6. TheTrans-Palatal Arch in situ just before the extraction of theupper premolars (left) and during space closure.

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with the treatment option adopted that involved the extractionof the upper premolars and space closure. The relation of theprofile and extraction of teeth is an ongoing debate in orthodontics.An investigation carried out a cohort study on two groups of 12patients, where one group was treated with extractions and thenon-extraction5. They investigated whether any changesoccurred in the facial profile three-dimensionally, using an opticalsurface scanner; and demonstrated that there was no evidencethat the extractions resulted in flattening of the facial profile.The authors recognised that the sample size was small and thatthe findings should be looked upon as a preliminary study andnot be extrapolated for the population as a whole. Furthermore,it can be seen from the pre-treatment records (Figure 1) that thepatient had a convex profile prior to treatment hence retractionof the upper anterior teeth might in theory improve the facial profile.There was a potential risk with the root filled upper right centralincisor. Evidence is equivocal as endodonticalLy treated teethundergo more, or less, root resorption6. However, it is now generallyaccepted that root treated teeth can be moved orthodonticallywithout the increased risk of root resorption7.The treatment of the case was planned in stages. Stage oneconsisted of improving the oral hygiene of the patient and man-agement of all carious lesions and assesses the compliance andattitude of the patient towards orthodontic treatment. The nextstage involved the reduction of the overbite. The patient presentedwith a deep overbite that was causing damage to the palatalmucosa (Figure 2). This was achieved with an anterior bite planeremovable appliance and bonding of the lower arch. This appliancewill free the occlusion of the buccal segment teeth and if wornconsistently, will passively limit further eruption of the incisorsbut allow the lower premolars to erupt, thus reduce theincreased overbite (Figure 5).

The next phase of treatment involved the fitting of the Trans-PalatalArch (TPA) and the removal of the upper first premolars. Becauseof the increased overjet, this was a case of maximum anchorageand any mesial movement of the upper buccal segments wasnot desirable (Figure 6). It remains equivocal in the literaturewhether TPA appliances can provide anteroposterior anchorage.In fact, recent evidence suggested the contradictory8.Alternatively the anchorage issue in this case could have beenaddressed with a Temporary Anchorage Device. The increase

Fig 7. Clinical radiographs showing Nickel Titanium coil spring on theright side to close the remaining space.

Fig 9. Post-treatment intra-oral clinical photographs.

Fig 8. Post-treatment extra-oral clinical photographs.

ORTHODONTICS

popularity and use of Temporary Anchorage Devices (TADs)make them attractive in maximum anchorage case. There is anearly evidence to suggest that they are effective and safe9.The space closure phase of treatment was conducted carefully inorder to prevent anchorage loss (Figure 7). Traditionally, cliniciansretract the canines until they are in Class I relationship then theretraction of the incisors is followed. On theoretical grounds,retracting all six teeth together simultaneously would be expect-ed to increase anchorage demands although this increase is notapparent clinically. However, some clinicians choose to retract allsix together for two reasons namely simplicity and to avoid re-tracing steps of tooth movement. It is debatable which methodis better but in this case, retracting all six anterior teeth as ablock was adopted. Upon the completion of the space closure stage, some finishingdetails were carried out. Although some more correction wasstill needed to be done e.g. the marginal ridge of the upper leftsecond premolar and the palatal root torque in the upper inci-sors (Figure 9). Furthermore, taking an OPG towards the end oftreatment to assess the roots angulation, nonetheless, thepatient preferred to have the appliances removed and he wassatisfied with the outcome.

ConclusionClass II skeletal pattern cases can be treated by orthodonticsalone. There are a number of factors the orthodontist needs to

consider in treatment planning such cases. In this particular case,the skeletal pattern was camouflaged and the treatmentinvolved extraction in the upper arch and anchorage reinforcedwith Trans-Palatal Arch (TPA). Nowadays, Temporary AnchorageDevices (TADs) can be used with several potential advantages inClass II malocclusion.

AcknowledgmentI would like to thank all the staff at the OrthodonticsDepartment of the Royal United Hospital, Bath, UK. In particular,Dr Anthony Ireland.

REFERENCES1. British Standards Institutes. Glossary of Dental Terms 1983. BS4492; BSILondon.2. Todd JE, Lader D. Adult DentalHealth 1988; HMSO, London.3. Lip trap (Turner et al 1997)4. Houston WJB, Stephens CD, Tulley WJ. A textbook of orthodontics. Wright,Oxford 1992.5. Ismail S F H and Moss J P. The 3D effects of orthodontic treatment on thefacial soft tissues-a preliminary study. BDJ 2001; 192(2): 104-108.6. Drysdale C, Gibbs SL, Ford TR. Orthodontic management of root-filledteeth. Br J Ortho 1996; 23: 255-260.7. Costopoulos G, Nanda R. An evaluation of root resorption incidence toorthodontic intrusion. Am J Orthod Dentofacial Orthop 1996; 109: 543-548.8. Rodkoswski MJ. The influence of transpalatal arch on orthodontic anchor-age. Thesis abstract from St Louis University. Am J Orthod Dentofacial Orthop2007; 132: 562.9. National Institute for Health and Clinical Excellence. Guidance onMini/micro implantation for orthodontic anchorage 2007: IPG 238.www.nice.org.uk.

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IMPLANT DENTISTRY


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Implant

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Keywords: Unilateral subperiosteal implant - Insufficient bone - Bone impression

When the volume of the residual alveolar ridge is insufficient toreceive endosteal implants, use of the unilateral subperiostealimplant is one of the treatments of choice.1, 2

This modality of implants has comparable success and survivalrates.1, 3, 4 It was specifically developed to treat patients withinsufficient available bone in the alveolar ridge; it shouldnt beused for patients with overabundant bone.1

The surgical protocol in the case presented is comprised of atwo-stage surgery, the first of which results in taking a direct boneimpression and the second in placing the custom-made implant. The subperiosteal implant is designed to rest on the surface ofbone, under the periosteum rather than gaining endosteal supportas teeth or most alloplastic implants used in the body, thisimplant distributes stresses from the prosthesis to large areas ofbone in a manner similar to a snowshoe.5

A customized casting made of surgical metal adheres to the bonewith a combination of fibrous tissue and direct bone support2,NO OSSEO INTEGRATION.Permucosal abutment posts and intraoral bars are designed forprosthesis retention.5

So subperiosteal implants are used when there is an insufficientavailable bone which differs by volume from case to case. Thatswhy it was classified into four divisions.In our case there is a deficiency in the height of bone which classifythe case under the division C-h available bone This division of available bone maybe treated by a number ofdifferent implant approaches. The most common is root formimplants of reduced height.The second option is augmentation. Or the third option is the subperiosteal implant5, which is goingto be presented in this article.

SUBPERIOSTEALDr. Haseeb Dary**[email protected]

A (Abundant Bone)Division A forms soon afterthe tooth is extracted.Division A corresponds toabundant available bone in alldimensions

B (Barely Sufficient Bone)Slight to moderate atrophy isused to describe this clinicalcondition

C (Compromised Bone)The Division C available boneis deficient in one or moredimensions (width, length,height, angulations, or crown-implant ratio)

D (Deficient Bone)Long term bone resorptionmay result in this completeloss of the alveolar processaccompanied with basal boneatrophy.Sever atrophy describes theclinical condition of theDivision D ridge.

>5 mm width>10 -13 mm height>7 mm length12 mm length or = 1

Severe atrophy Basal BoneFlat maxillaPencil thin mandible

DIVISION DIMENSIONDIVISIONS OF AVAILABLE BONE According to misch(5)

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TerminologyThe terminology for the subperiosteal implant includes portionsof the implant below and above the soft tissue.5

The substructure is the portion of the implant that is responsiblefor the support of the implant and is located below the periosteum,on top of the bone. It consists of several struts:Primary struts are the major components of the substructure andcan be either peripheral or abutment.The peripheral struts are the outermost regions of the implantand lay on the most extended areas of the cortical bone.The abutment struts connect the labial and lingual peripheral strutsand a vertical permucosal post on the crest of the edentulous ridge.Secondary struts help dissipate the forces from the primary abutmentstruts, improve the rigidity and casting of the substructure, andserve as an additional support mechanism of the implant. (Notused in this case)The permucosal abutment posts exit through the mucosa, andact as prosthetic retainers.The superstructure connects the abutment posts designed abovethe soft tissue. This structure both retains and supports the pros-thesis during function and distributes occlusal loads to the sub-structure below the soft tissue.

Mode of tissue integrationSubperiosteal implants heal in the periosteal mode of tissueintegration. They are enveloped in a dense fibrous collagenoustissue sheath constituting the outer layer of the periosteum.Functional forces are absorbed by the underlying bone throughthe periosteum.1, 6, 7

Case reportA 60 years old healthy female came into the clinic asking for a

fixed dental appliance to restore the bilateral edentulous posteriorspaces of her own (Kennedy class 1).There was a missing 6 and 7 on each side with compromised 4and 5 on each.The volume of available bone was insufficient to place a rootform implant on the site of 7 (C-h available bone) a ridge mappingtechnique was used and a (C-w available bone) was alsoencountered.The use of short implant in this case was not a treatment ofchoice; the crown - implant ratio is > 1.A unilateral subperiosteal implant was suggested.

SurgeryA two stage surgical appointment is usually suggested, (Bermanintroduced the Two-surgery technique in the 1950s8) separated by atleast 6 weeks.5

First surgeryInfiltration was administered with long acting anesthetic(UbistesinTM forte 4%) to anesthetize the residual ridge posteri-or to the mental foramina from buccal and lingual sides and thelateral aspect of the ascending ramus.An intraoral and extra oral scrub of the patient is performed withChlorhexidine.5

Soft tissue reflectionIncisionThe incision begins at the retro molar papilla at the base of theretro molar pad to the premolar.A full thickness incision through the periosteum scores theunderlying bone.

ReflectionsA full thickness periosteal reflection exposes the underlyingresidual ridge and lateral regions of the mandible.

Evaluation of the crestA knife edge ridge was exposed, thin knife like edges resorbshortly after implant insertion, if not before.5

An osteoplasty was performed to recontour the bone so thecrest is broad enough to have a blood supply from the underlyingtrabecular bone. The osteoplasty was performed at the boneimpression appointment. In this way the several weeks intervalpermit initial remodeling.

ImpressionTypes of Impression MaterialsThree major types of elastic materials are used in implant dentistry forobtaining the direct bone impression: polysulfides, silicones, andpolyethers.The material which was used in this case is addition silicone(GhenesylTM silicone first impression: putty soft. low viscosity).

preoperative o.p.g.

preoperative left sidepreoperative right side

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Making the ImpressionA retraction sutures (3-0 atraumatic black silk sutures1) are madeto attach the reflected tissues to the mucosa of the cheek frombuccal side and the lingual side reflected tissues are anchoredon the teeth of the contra lateral side, this technique wouldopen a space to take the impression.The gloves are moistened toprevent the impression material from sticking. A small rolled por-tion of putty was placed into the tunnel of the reflection andmolded along the exposed underlying residual ridge no trays areneeded in this technique.After complete setting the impression is gently lifted.Saline irrigations used to rinse and moisten the tissue, and allreflected regions are inspected for remnants of impression material.The direct bone impression is evaluated for all necessary land marks.The retraction sutures were removed and the tissue re-approximatedand sutured.The contra lateral side was treated in a similar fashion.

Implant FabricationThe subperiosteal implant is fabricated-casted with pure titanium.Laboratories should be members of ASTM (American Society forTesting and Materials) and should not determine their ownprocedures and techniques.9

The implant design in this case composed of one abutment con-nected to the peripheral struts by 4 abutment struts for eachimplant. One hole was drilled on each implant on a peripheralstrut (distal aspect) for the placement of titanium fixation screw.Implants should be thoroughly cleaned and sterilized beforeplacement.

Implant insertion (second surgery):The surgical insertion of the implant is very similar to the directbone impression surgery but is more rapid and causes lessswelling and discomfort to the patient.After the implant is placed on the ridge a titanium screw is usedto fix the implant on the ridge to obtain the primary stability thisscrew would be of no use after the healing of tissues becausethe implant would be stable on place by the attachment of thesoft tissues to the bone which holds the struts of the implant inbetween.The site is then sutured again.Sutures were removed after 1 week.

ProsthesisAfter 2 weeks of implant placement the patient came back.A preparation was done to the premolars at both sides and theimpression was taken. 4 units bridge was fabricated for each side splinting the implantabutment to the 2 natural teeth of each side.

Post-operative o.p.g.

Suturing

Try in right side Try in left side

Right side after healing Left side after healing

Impressions Implant

Implants and screws in place

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Cementation(DentoTemp of ITENA) long term temporary cement which isused as a Permanent cementation of implant-retained crowns.

DiscussionIn summary, the advantages of subperiosteal implants include:The predictability of the results and the high success rate, thesurvival and success rates of modern-day subperiosteal implantsare equal to or greater than root form implants when placed intoC-h bone.5

Noninvasive surgeries are preferred compared to the use of iliaccrest bone grafts10, the trauma would be in one site (which is theoral cavity) not in 2 sites. When using the iliac graft the patientwould go with pain while he walks out of the operation in addi-tion to the pain in his mouth.No possibility of parasthesia. This may be the case when nerverepositioning is performed to enhance the bone height to placethe root form implants in the mandible. No bone grafts needed with any possibility of bone graft failurewhich requires re-grafting of the area with all accompanyingtrauma and time consumption.Less expensive procedure when comparing restoring one segmentor one side of the arch with bone grafting or sinus lifts and sev-eral root form implants to a one subperiosteal implant with 1 ormore abutment, the expenses would be way less than the bonegrafting procedures.

Time preserving Disadvantages include the initial complexity of the surgical pro-cedures. This complexity presumes a certain level of experiencethat the practitioner can obtain only over a long period of time.The procedures require specialized technicians and a titaniummelting oven.

Also the disadvantages include the frequent necessity for 2 surgicalprocedures, this can be overcome by the use of (CAD-CAM)11

but again its not considered a mainstream procedure because oftechnique sensitivity and cost.Finally, removal of subperiosteal implants, although rarely indi-cated, can present difficulties.In a case report under the title REPLACEMENT OF A MANDIBULARSUBPERIOSTEAL IMPLANT12 the author replaced a subperiostealimplant, which had been in successful service for approximately15 years. Both the implant and prosthesis had been in service.Although the patient had been given the option of an augmentationusing an autogenous iliac crest graft with subsequent insertionof endosteal implants. The importance and potential benefits ofsubperiosteal implants are undeniable, being at this time theonly means of restoring jaws in situations where endosseousimplants cannot be placed.Subperiosteal implants often serve our most troubled patients.For patients who exhibit severe mandibular and maxillary alveolarridge atrophy, no other treatment options may exist.13

ConclusionAlveolar ridges with severe atrophy can be reconstructed pros-thetically (fixed and removable) with less time compared to bonegrafting procedures. Partial subperiosteal implants can be usedwith endosseous implants and even natural teeth with fixedbridges. The surgical technique and clinical stages are notcomplicated, generally being mastered by implantologists ingeneral dental practice.

Prothesis in place

Prosthesis in place o.p.g.

After 3 years

REFERENCES1 Principles and practice of implant dentistry Charles M. Weiss2 Cranin AN: Posterior region Maxilla: a proven implant alternative, dent implan-tol update 3:81, 19923 Bodine RL, Yanase T, Bodine A: Forty years of experience with subperiostealimplant dentures in 41 edentulous patients, J Prosthet Dent 75:33, 1996 4 Bodine RL, Melros RJ, Grenoble DE: Long-term implant dentures histology andcomparison with previous reports J Prosthet Dent 35:665, 19765 Contemporary implant dentistry, second edition Carl E. Misch6 Bodine RL, Mohammed CI: Histologic studies of a human mandible supportingan implant denture.Part I, J Prosthet Dent 21:203, 1969.7 James RA: Tissue behavior in the environment produced by permucosal dentaldevices. In McKinney RV, Lemons JE, editors: The Dental Implants, Littleton, Mass,1985, PSG Publishing.8 Berman N. An implant technique for full lower denture. DentureDigest.1951;57:438.9 Leonard I. Linkow, Jon R. Wagner, Manual Chanavaz: Tripodal MandibularSubperiosteal Implant: Basic Sciences, Operational Procedures, and Clinical data,Journal of Oral Implantology 199810 Leonard I. Linkow, Robert Ghalili: Critical Design Errors In MaxillarySubperiosteal Implants journal of oral implantology CLINICAL. 198 Vol. XXIV/No.Four/199811 Cranin AN et al: An in vitro comparison of the computerized tomography/CAD-CAM and direct bone impression techniques for subperiosteal implant model gen-eration, J oral implantol 24; 74, 1998.12 Robert F. Mansueto: Replacement of a Mandibular Subperiosteal Implant, jour-nal of oral implantology Vol. XXV/No. Three/199913 Charles M. Weiss, Terry Reynolds: A Collective Conference on the Utilization ofSubperiosteal Implants in Implant Dentistry, journal of oral implantology Vol.XXVI/No. Two/2000

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Applications of

in Dental PracticeCBCTA Literature Review

Abstract: This article presents a review of the clinical applicationsof cone-beam computed tomography (CBCT) in different dentaldisciplines. A literature search was conducted via PubMed forstudies on dental applications of CBCT published between 1998and 2010. The search revealed a total of 540 results, of which130 articles were clinically relevant and were analyzed in detail.CBCT is used in different dental disciplines for numerous clinicalapplications. The results of this systematic review show the differentapplications of CBCT imaging in dental practice, which are sum-marized and categorized under eight different dental disciplines.

IntroductionTwo-dimensional (2D) imaging modalities have been used indentistry since the first intraoral radiograph was obtained in 1896.Since then, significant advances have been made in dental imagingtechniques, including the introduction of panoramic imagingtechniques and tomography. Advances in digital imaging techniqueshave led to lower radiation doses and faster processing timeswithout changing the imaging geometry of these intraoral andpanoramic technologies.

Cone-beam computed tomography (CBCT) is a new medicalimaging technique that generates three-dimensional (3D) data atlower cost and lower absorbed doses than conventional computedtomography (CT). The CBCT imaging technique is based on acone-shaped X-ray beam that is centered on a 2D detector, andthe beam performs one rotation around the object, producing aseries of 2D images. The images are reconstructed in a 3D dataset using a modification of the original cone-beam algorithmdeveloped by Feldkamp et al. in 198427. CBCT images from thecraniofacial region are often acquired at a higher resolution thanconventional CT. In addition, these systems are more compactthan conventional CT systems, which make them more practicalfor use in dental offices48.

The application of CBCT imaging in different dental disciplinescan guide diagnosis, treatment and follow-up.

This article presents a systematic review of clinical applications ofCBCT in dental practice.

Materials and methodsA literature search was conducted via PubMed for CBCT imagingapplications in dentistry published between January 1, 1998 andJuly 15, 2010 using the keywords Cone-beam computerizedtomography in dentistry. The search revealed a total of 540articles, which were all screened in detail. Of these articles, 410were excluded because they were not relevant to the subject.The systematic review consisted of 130 clinically relevant articlesthat were analyzed further and categorized according to the dis-cipline of application.

ResultsThe search revealed 36 articles (27.7%) related to applications inoral and maxillofacial surgery (OMFS), 33 articles (25.4%) related toendodontic clinical applications, 22 articles (16.9%) related toclinical applications in implant dentistry, 15 articles (11.5%)related to orthodontic clinical applications, 10 articles (7.7%)about clinical applications in general dentistry, 8 articles (6.2%)about the temporomandibular joint (TMJ), 5 articles (3.8%)related to applications in periodontology, and 1 article (0.8%)about CBCT applications in forensic dentistry.

*Dr. Mohammed A. Alshehri, Dr. Hadi Alamri, Dr. Mazen Alshalhoub*Consultant at the Riyadh Military [email protected]

Table 1. Summary of CBCT application-related articles according todental specialty

Oral and maxillofacial surgery (OMFS)EndodonticsImplant DentistryOrthodonticsGeneral DentistryTemporomandibular joint(TMJ)PeriodonticsForensic Dentistry

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NUMBER OF ARTICLESDISCIPLINE PERCENTAGE

ReviewAPPLICATIONS IN ORAL AND MAXILLOFACIAL SURGERYCBCT in OMFS has been used to investigate the exact locationof jaw pathology in 3D images3,14, 29, 65, 81, 93, 90,102, 126, to assessimpacted teeth (Fig. 1), to assess supernumerary teeth and theirrelation to vital structures18, 61, 62, 65, 66, 69, 80, 90, 113, 115,123, to evaluatechanges in the cortical and trabecular bone related to bisphos-phonate-associated osteonecrosis of the jaws12, 29, 57, and to assessbone grafts34. CBCT has also been used to investigate paranasalsinuses6, 65 and to assess obstructive sleep apnea78, 88.

Because CBCT images are collected as a combination of several2D slices, the technique is superior in overcoming superimpositionsand calculating surface distances9, 10. This advantage has madeCBCT the technique of choice for the investigation of mid-facialfractures8, 41, orbital fracture assessment and management128, andin inter-operative visualization of the facial bones after fracture39, 40.Furthermore, because CBCT is not a magnetic resonance technique,it is the best option for intraoperative navigation during proce-dures involving gun-shot wounds72, 96.

CBCT is largely used in planning orthognathic and facial orthomorphicsurgeries, which require detailed visualization of the interocclusalrelationship to augment the 3D virtual skull model with adetailed representation of the dental surface. With the aid ofadvanced software, CBCT facilitates the visualization of soft tissue toallow for control of the post-treatment aesthetics7, 111, 112 and permitsthe evaluation of lip and palate bony depressions in cases of cleftpalate56, 73, 125.

The ability of CBCT to detect salivary-gland defects is also underinvestigation108. In addition, one article has reported a toothautotransplant case where CBCT demonstrated high accuracy,and the information provided allowed the rapid completion ofthe transplant operation45.

CLINICAL APPLICATION IN ENDODONTICSCBCT is a useful tool in diagnosing apical lesions (Fig. 2a, 2b)13,17, 19, 20, 23, 25, 31, 64, 83, 84, 92, 115, 120. A few research studies have shown thatcontrast-enhanced CBCT images can be used to differentiatebetween apical granulomas and apical cysts by measuring thelesion density (Fig. 3a, 3b)23, 92, 120, 106. Another article describes the

use of CBCT as a tool to categorize the origin of the lesion asendodontic or non-endodontic17.

The superiority of CBCT in detecting fractured roots comparedto 2D radiographs has been demonstrated by several clinicalcase reports focused on detecting vertical root fractures17, 77, 89, 92,106, 115, 120. CBCT is considered superior to periapical radiographs inthe detection of fractures in buccolingual or mesiodistal direc-tions35, 36, in the measurement of depth in dentin133 and in thedetection of horizontal root fractures17, 92, 115.

CBCT is able to detect lesions in cases of inflammatory rootresorption, whereas conventional 2D x-rays cannot detect themin early stages24, 115. In other cases such as external root resorp-tion17, 60, 115, 120, external cervical resorption17, 84, 91, and internalresorption17, 84, 115, 120, CBCT cannot only detect the presence ofresorption but also its extent.

CBCT can be used to determine root morphology; to measurethe number of roots, canals, and accessory canals; and to establishtheir working lengths and angulations6, 17, 70, 77, 92, 98, 115, 119, 120. CBCTalso provides accuracy in the assessment of root canal fillings19, 31,77, 120, in the detection of pulpal extensions in talon cusps107 andin the detection of the position of fractured instruments118.

CBCT is a reliable tool for the presurgical assessment of the proximityof the tooth to adjacent vital structures, the size and extent of alesion, and the anatomy and morphology of roots through veryaccurate measurements17, 20, 25, 46, 54, 77, 84, 92, 97, 106, 115, 118, 120. In emer-gency cases requiring tooth assessment after trauma, CBCTapplications can aid in reaching a proper diagnosis to determinethe most suitable treatment approach15, 16, 17, 92. Due to its reliabilityand accuracy, CBCT has recently been used to evaluate canalpreparation in different instrumentation techniques74, 76.

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Fig 1. Impacted teeth in close prox-imity to vital structures, requiringevaluation using CBCT.

Fig 2a. A periapical lesion in aperiapical radiograph (courtesy ofDr. Fredrek Barnett).

Fig 2b. The same periapical lesionin a CBCT image (courtesy of Dr. Fredrek Barnett).

Fig 3a. An apical cyst in an OPGradiograph.

Fig 3b. The same apical cyst in aCBCT image.

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APPLICATIONS IN IMPLANT DENTISTRYThe increasing demand for dental implants to replace missingteeth has necessitated a technique capable of obtaining highlyaccurate measurements to avoid any damage to vital structures.Previously, such measurements were obtained through conventionalCT; however, the ability of CBCT to provide greater accuracy inmeasurements at lower radiation doses has made it the preferredoption in implant dentistry (Fig. 4a, 4b)21, 28, 32, 37, 46, 47, 48, 63, 65, 67, 90, 101,103, 104 114, 116, 121, 126. Furthermore, the presence of new software toconstruct surgical guides has further reduced the possibility ofstructural damage2, 21, 30, 85, 86, 101. Another article describes theinteroperative use of CBCT in two cases to guide the insertion ofthe implant after microsurgical bone transfer38.

CBCT can be used to measure bone quality4, 37, 46, 47, 78, 90, 109, 110 andquantity37, 103, 109, 116, which has led to a reduction in implant failurebecause the reliable information provided by CBCT has led toimprovements in case selection. CBCT is also used to assess thesuccess of bone grafts and post-treatment evaluations (Fig. 5a to5d)90, 116.

APPLICATIONS IN ORTHODONTICSThe introduction of new software in orthodontic assessment hasenabled the use of CBCT images in cephalometric analysis26, 46, 59,65, 101 and has led to CBCT becoming the tool of choice for assess-ing facial growth, age, airway function1, 55, 105, and disturbances intooth eruption75.

CBCT is a reliable tool in assessing the proximity of the tooth to vitalstructures that may interfere with orthodontic treatment22, 94. In

cases that require the placement of tiny screw implants as temporaryanchors, CBCT acts as a useful visual guiding technique for safeinsertion of these anchors52, 53, 95 as well as to assess the bonedensity before, during and after treatment (Fig. 6)33, 99.CBCT incorporates multiple different views of an object in one scan(e.g., frontal, right lateral, left lateral, 45-degree, and submentalviews), which is an additional advantage of the technique58, 124.CBCT is therefore considered a more accurate option for the clinicianbecause the images are self-corrected for magnification, producingorthogonal images with a 1:1 ratio5.

APPLICATIONS IN TMJ IMAGINGOne of the major advantages of CBCT is its ability to define thetrue position of the condyle in the fossa, which often reveals thepossibility of dislocation of the disk in the joint90, 117, 120 and theextent of translation of the condyle in the fossa117. Due to itsaccuracy, CBCT facilitates easy measurement of the roof of theglenoid fossa51, 68 and provides the ability to visualize soft tissuearound the TMJ44, which may reduce the requirement for the useof MRI in these cases.

Due to these advantages, CBCT has become the imaging deviceof choice in cases of trauma, pain and dysfunction, and fibro-osseous ankylosis43, 82, 100, 114, as well as in the detection of condylar

Fig 4a. An OPG radiograph for a full-mouth rehabilitation case. Thedata that was obtained from this image was limited.

Fig 6. A CBCT image to assess bone density during treatment.

Fig 4b. CBCT images for the same patient. Considerably more data wasobtained from these images with regard to bone quality, implant lengthand diameter, implant locations and proximity to vital structures.

Fig 5a. A clinical image of multipleimplants placed 5 years ago.

Fig 5b. A periapical radiograph forimplants replacing teeth 8 and 9.The data that was collected fromthis image was limited.

Fig 5c. A CBCT image clearlyshowing the amount of bone loss.

Fig 5d. A CBCT image showingevidence of total buccal platedestruction.

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cortical erosion and cysts46. The use of 3D features facilitates thesafe application of the image-guided puncture technique, whichis a treatment modality for TMJ disk adhesion42.

PERIODONTICS APPLICATIONSThe high measurement accuracy of CBCT with minimal marginsof error allows its use in obtaining a detailed morphologicdescription of the bone120, 122, with measurement accuracy equalto that of direct measurement with a periodontal probe71, 120.CBCT also aids in assessing furcation involvement68, 115,120.

CBCT can be used in the detection of buccal and lingualdefects49, 120 where conventional 2D radiography shows limita-tions. CBCT allows accurate measurement of intrabony defects11,79 as well the ability to assess dehiscence, fenestration defectsand periodontal cysts50, 120. CBCT has also proved its superiority inevaluating the outcome of regenerative periodontal therapy49.

OPERATIVE DENTISTRY APPLICATIONSBased on the data in the available literature, the use of CBCT indetecting occlusal caries is not yet justified because CBCT delivers ahigher radiation dose to the patient compared to conventional2D radiographs with no additional benefit. However, CBCT hasproved to be useful in assessing the depth of proximal caries115.

Table 2 shows examples of typical radiation doses received fromvarious dental radiological procedures in operative dentistry.

FORENSIC APPLICATIONSDental age estimation is considered an important factor in thefield of forensic science, and this estimation can be performednon-invasively using CBCT; an estimate of a subjects age canthen be derived from the subjects pulp/tooth ratio127.

DiscussionCBCT scanners represent a significant advancement in dentaland maxillofacial imaging. Since their introduction for dental usein the late 1990s129, there has been an increased interest in thesedevices. The number of CBCT-related articles published per yearhas increased tremendously over the last few years. We have per-formed a systematic review of the literature related to CBCT imagingapplications in dental practice and summarized the applications ofthis new imaging technique in different dental specialties.CBCT was used as a keyword in this systematic review. Although

other keywords and terminology were entered into the PubMedsearch engine (e.g., cone beam volumetric scanning, true volumetriccomputed tomography, dental CT, dental 3D-CT, and cone beam vol-umetric imaging), they did not result in additional relevant articles130.

The clinical applications of CBCT imaging in dentistry are constantlyincreasing. The results of this systematic review showed that ofthe 540 articles published in the last 12 years, 130 were clinicallyrelevant. The most common clinical applications of CBCT were inOMFS, implant dentistry, and endodontics. CBCT has shown limiteduse in operative dentistry because of the high radiation dose com-pared to conventional 2D radiography without any additional benefit.

The dental literature on CBCT is promising and indicates thatmore research is required to explore the benefits of CBCT in forensicdentistry. Although no literature was found on prosthodonticapplications of CBCT, the improved standard of care seen inprosthodontic treatment can be attributed to applications of CBCTfound in other dental specialties and related to prosthodontic,such as bone grafting, soft tissue grafting, prosthetic-drivenimplant placement, maxillofacial prosthodontics andTemporomandibular joint disorders. CBCT images are importantin special cases that require the assessment of restorability ofmultiple teeth (Fig. 7a to 7e).

The newest CBCT systems show higher resolution and lowerexposure than previous systems, and the new systems are lessexpensive and more specific for dental use than their predecessors.The flat-panel detectors are less prone to beam hardening artifacts.CBCT also shows disadvantages such as susceptibility to motionartifacts, low contrast resolution, and limited internal soft-tissuevisualization capability. Furthermore, due to the distortion ofHounsfield units, CBCT cannot be used for the estimation ofbone density.

As far as the radiation dose of CBCT imaging is concerned, it iscrucial that a radiation dose as low as reasonably achievable(alara) is respected. Although CBCT imaging will certainlyimprove patient care, dentists must possess the anatomicalknowledge and the experience to interpret the scanned dataaccurately. Dentists must evaluate whether these imagingmodalities add to their diagnostic knowledge and raise the standardof dental care or simply place the patient at a higher risk. Suchevaluation requires continuous training, education for dentistsand thorough research.

One of the most clinically useful aspects of CBCT imaging is theavailability of highly sophisticated software that allows the largevolumes of acquired data to be broken down, processed andreconstructed131. This ability makes data interpretation much moreuser-friendly, particularly if competent technical and educationaltraining is provided to the dentists and technicians.

Table 2. Typical doses from various dental radiological procedures

Intraoral (F speed, rectangular collimator)Intraoral (E speed, round collimator)Full-mouth set (E speed, round collimator)Lateral ceph (F speed, rare-earth screen)DPT (F speed, rare-earth screen)Cone-beam CT both jawsHospital CT both jaws

0.001 mSv0.004 mSv0.080 mSv0.002 mSv0.015 mSv0.068 mSv0.600 mSv

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The increasing popularity of CBCT has resulted in the manufactureof a large number of CBCT units, numerous presentations atconferences and a significant increase in published articles.These factors have led to an uncontrolled and non-evidence-basedreporting of radiation dose values that can be attributed to thelimited technical knowledge of medical imaging devices amongnew users. To counter this uncontrolled exchange, the EuropeanAcademy of Dental and Maxillofacial Radiology has developedguidelines outlining the basic principles for the use of CBCT indental applications132; these guidelines are shown in Table 3.

ConclusionsThe majority of CBCT applications in the practice of dentistry arefound in the specialties of OMFS, endodontics, implant dentistry,and orthodontics. CBCT examinations must not be performedunless they are necessary and unless the benefits clearly outweighthe risks. The images acquired using CBCT must undergo a thoroughclinical evaluation of the entire image dataset (i.e., a radiologicalreport should be completed) to maximize the clinical dataobtained from these images.

Future research should focus on obtaining accurate data regardingthe radiation doses of CBCT systems. These systems have a smalldetector size, and the field of view and scanned volume aresomewhat limited. Due to these factors, ideal CBCT systems fororthodontic and orthognathic surgery are not yet available.CBCT applications in forensic dentistry and prosthodonticsrequire further investigation.

For the references listing please refer to the article on www.dentalnews.com

Fig 7a. Multiple endodontically treatedteeth in a patient with a history of peri-apical surgery.

Fig 7b. A periapical imageshowing a compromisedcrown-to-root ratio.

Fig 7c. A CBCT image showing theabsence of the buccal plate and acompromised palatal plate; thisimage indicates the teeth to beextracted and the grafting sitebefore implant placement.

Fig 7d. A photograph showingthe location of bone grafting. Theleast traumatic extractions wereperformed for teeth 7, 8, 9 and10.

Fig 7e. A photograph shows the in-progress healing of the grafted sitesintended for the future placement of implants.

Table 3. Basic principles on the use of CBCT in dental applications (from eadmft)

1- CBCT examinations must not be carried out unless a history and clinical exami-nation have been performed2- CBCT examinations must be justified for each patient to demonstrate that thebenefits outweigh the risks3- CBCT examinations should potentially add new information to aid the patientsmanagement4- CBCT should not be repeated routinely on a patient without a new risk/benefitassessment having been performed5- When accepting referrals from other dentists for CBCT examinations, the refer-ring dentist must supply sufficient clinical information (results of a history andexamination) to allow the CBCT Practitioner to perform the Justification Process6- CBCT should only be used when the question for which imaging is required can-not be answered adequately by lower dose conventional (traditional) radiography7- CBCT images must undergo a thorough clinical evaluation (radiological report)of the entire image dataset8- Where it is likely that evaluation of soft tissues will be required as part of thepatients radiological assessment, the appropriate imaging should be conventionalmedical CT or MR, rather than CBCT9- CBCT equipment should offer a choice of volume sizes, and examinations mustuse the smallest volume that is compatible with the clinical situation if this providesless radiation dose to the patient10- Where CBCT equipment offers a choice of resolution, the resolution compatiblewith adequate diagnosis and the lowest achievable radiation dose should be used11- A quality assurance programme must be established and implemented for eachCBCT facility, including equipment, techniques and quality control procedures12- Aids to accurate positioning (light beam markers) must always be used13- All new installations of CBCT equipment should undergo a critical examinationand detailed acceptance tests before use to ensure that radiation protection forstaff, members of the public and patient are optimal14- CBCT equipment should undergo regular routine tests to ensure that radiationprotection, for both practice/facility users and patients, has not significantly deteriorated15- For staff protection from CBCT equipment, the guidelines detailed in Section 6of the European Commission document Radiation Protection 136. EuropeanGuidelines on Radiation Protection in Dental Radiology should be followed16- All those involved with CBCT must have received adequate theoretical andpractical training for the purpose of radiological practices and relevant competencein radiation protection17- Continuing education and training after qualification are required, particularlywhen new CBCT equipment or techniques are adopted18- Dentists responsible for CBCT facilities who have not previously received adequatetheoretical and practical training should undergo a period of additional theoreticaland practical training that has been validated by an academic institution (University orequivalent). Where national specialist qualifications in DMFR exist, the design anddelivery of CBCT training programmes should involve a DMF Radiologist19- For dento-alveolar CBCT images of the teeth, their supporting structures, themandible and the maxilla up to the floor of the nose (e.g. 8cm x 8cm or smallerfields of view), clinical evaluation (radiological report) should be made by a spe-cially trained DMF Radiologist or, where this is impracticable, an adequately trainedgeneral dental practitioner20- For non-dento-alveolar small fields of view (e.g., temporal bone) and all cranio-facial CBCT images (fields of view extending beyond the teeth, their supportingstructures, the mandible, including the TMJ, and the maxilla up to the floor of thenose), clinical evaluation (radiological report) should be made by a speciallytrained DMF Radiologist or by a Clinical Radiologist (Medical Radiologist)

The Egyptian Orthodontic Societycelebrates its 25th AnniversaryThe International Congress of the Egyptian Orthodontic Societywas a Joint Meeting with the Cyprus Orthodontic Society, theGreek Orthodontic Society, the Lebanese Orthodontic Societyand the South African Society of Orthodontists

On January 21 23, 2001, the five Societies joined theInternational Orthodontic Congress organized by the EgyptianOrthodontic Society, in Alexandria, Egypt. A very successfulevent organized by Dr. Abbas Zaher, professor in AlexandriaUniversity and treasurer of the Egyptian Orthodontic Society.240 Participants from Egypt and other Societies took part in thisevent. The largest group came from Greece with 36 persons. 24local and international companies exhibited at the congress. 18 internationally renowned speakers took the podium to sharetheir clinical and research experiences. Guest speakers for thecongress: Eric Liou, Taiwan, Eustaquio Araujo and Varun Kalra,USA, Nasib Balut and Juan Carlos Solorio, Mexico, Arturo Vela, Spain,

Maja Ovsenik, Slovenia, Bakr Rabie, Hong Kong, ChristodoulosLaspos, Cyprus, Edmond Chaptini, Lebanon, Athanasios EAthanasiou and Michael Kalavritinos, Greece, Phumzile Hlongwaand Rashid Chamda, South Africa, joined by Walid El Kenany,Yehia Mostafa, Amr Abol Ezz and Abbas Zaher from Egypt.On Thursday January 20, an opening reception was organized towelcome the attendees and the presidents of the joining soci-eties gave short welcome speeches. Drs. Christodoulos Lasposthe president of the Cyprus Orthodontic Society, Dr. PaulKarvelas the president of the Greek Orthodontic Society, Dr.Dayalan Sundrum the president of the South African Society ofOrthodontists and Dr. Samir Aboul Azm, the president of theEgyptian Orthodontic Society addressed the congress guests. Inaddition, Dr. Athanasios E. Athanasiou the immediate past pres-ident of the World Federation of Orthodontists and Dr. MajaOvsenik, the immediate past-president of the EuropeanOrthodontic Society were among the guest speakers.

MORE PICTURESAVAILABLE ONwww.facebook.com/dentalnews1

Drs. Samir Aboul Azm and Edmond Chaptini exchanging plaques fromthe Egyptian and the Lebanese Orthodontic Societies

Dr. Eric Liou during his presentation

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Drs. Bakr Rabie, Yehia Mostafa, Walid El Kenany and Khaled Aboul Azm

Dr. Edmond Chaptini delivering his lecture

Dr. Abbas Zaher delivering his presentation in the congress

The Exhibition floor

W&Hinnovation

preview

E x c l u s i v e

As in other IDS years, W&H presented many new productsand innovations to the special guests from around theworld during the weekend prior to the IDS.

In small groups, the visitors had the opportunity to see the latestproduct such as the class-B Lina sterilizer and the new watertreatment system Multidem. Also to see the actual brightness of LED+in reality, understanding the new instruments and technologies,watch how to use professional new treatment techniques andthe use of digital media as well as hands on use - W&H staff wasproud to guide customers through the world of W&H.

Unprecedented levels of successAlso captivating was the unique and passionate lecture duringthe lunch break by Thomas Bubendorfer - alpine extreme athlete.He showed that achieving unprecedented levels of successthrough passion, joy, self-motivation, responsibility and learningis for both parties a philosophy - for professional climbers as wellas W&H. Because People have Priority. Emotional eveningIn the evening, the guests went to a wonderful gala dinner witha show and an upbeat video on W&H journey through the 120-year history since 1890 in Berlin right up to the present day. Theevening was also full of emotion due to the retirement of Dr. Bernd Rippel and Michel Paten, who took leave of our part-ners and were surprised to be presented with gifts.

Dr. Rippel again officially passed over the sales portfolio to hissuccessor - Rudolf Flieger and Dr Rippel, thanked all the partners fortheir loyalty and cooperation, which he hopes will continue for W&H.

Distributors from around the world during the presentation

Mr. Peter Malata addressing the guests during the gala dinner

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Mr. Khaled Al Turki Receiving a trophy for his company achievement


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The world's leading dental trade fair IDS came to a close with anextremely upbeat mood and outstanding results after five daysin Cologne. "We've succeeded in making the InternationalDental Show even more attractive, both domestically and inter-nationally. The strong increase in international participants espe-cially shows that IDS is the world's leading dental trade show,"says Dr. Martin Rickert, Chairman of the Association of GermanDental Manufacturers (VDDI).

Once again, IDS offered a whole range of new products andexcellent opportunities to exchange information, communicatewith partners and place orders. That's why exhibitors, visitors andmedia representatives alike were all delighted with the trade fair.

Highly satisfied trade visitorsNot only the exhibitors but also trade visitors report that thetrade fair was a great success. This is confirmed by initialresponses to the visitor survey. Altogether 95 per cent of respon-dents indicated that they were satisfied or very satisfied with IDS.In addition, 93 per cent would recommend a visit to IDS to aclose business associate.

Feedback from exhibitors:Klaus Rbesamen, Managing Director, Komet/Gebr. Brasseler"As far as Komet is concerned, IDS 2011 was a great event. Infact it even exceeded our expectations. Once again, we were

able to present ourselves to a broad specialist public as an inno-vation leader when it comes to dental instruments and tools. Themany customers we met from Germany and abroad were verypositive about our innovations. As a result, we are optimisticabout the future."

Jost C. Fischer, Chairman & Chief Executive Officer, SironaDental Systems"The trade fair was very successful as far as we're concerned.The number of visitors was amazing. In fact, all of our employ-ees were involved in discussions around the clock. You couldclearly see that the economy had picked up again. As a result,the atmosphere at the fair was extremely positive. In my opinion,it was the best IDS ever."


Visitors, exhibitors and areaall up significantly

Biggest IDS everVisitors, exhibitors and area

all up significantly

In my opinion,i t w a s t h e

e v e rbest IDS

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Dim

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yD

imen

sional Stability5days

Cavex ColorChangechromatic dental alginate

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and 76% would recommend Cavex ColorChange to colleagues.

Cavex Holland BV, P.O. Box 852, 2003 RW Haarlem, The Netherlands. Tel +31 23 530 77 00 Fax +31 23 535 64 82 [email protected] www.cavex.nl

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MetaFix

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Honorable guests,I am pleased to welcome you all, to this scientific event which takes place in the State ofKuwait the land of friendship and peace under the patronage of the Minister of HealthH. E. Dr. Hilal M. Al-Sayer. My dear colleagues, conducting such an event habitually andcontinuously is a pride and credit for the dental association. Today, in this conference, wehave adopted a new slogan Invitation to the World of Dentistry which intended toreflect the KDAs Board of Directors extent and the keenness towards the importance ofdeveloping the scientific and professional training for dentists. We consider this is to be aturning point that thrust our brothers and sisters professional standard by means of thescientific and educational vision that sustained through scientific and interdependenceexchange among the dentists in the State of Kuwait and other countries as well. We deemthat this will motivate all our colleagues to work together and strive to provide all that is newin dentistry for a better future of this beloved country. In the meantime, we also take thisopportunity to congratulate all of you and us on the occasions of celebrating the 50thanniversary of the independence of the State of Kuwait, the 20th anniversary of theLiberation and the 5 years of the succession of his Highness the Amir of Kuwait SheikhSabah Al Ahmed al Jaber Al Sabah. Finally, I wish for my all doctor brothers and sistersand participants from outside the State of Kuwait, a pleasant stay in their second home.Dr. Ebrahim Esmail Taqi, President of the Kuwait Dental Association

Dr. Youssef Al Duweiri giving his speech Picture from the audience during the opening ceremony

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The 15th Kuwait Dental Association International Scientific Conference

Kuwait Radisson SAS 9 - 11 April 2011

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to Dr. Ahmed Kahtani President of the SDS

to Dr. Hani Ounsi from Lebanon to Dr. Hamad Al Harthy President of the Omani Dental Society

to Dr. Mohamed Darwish President of Qatar Dental Society to Dr. Mohamed Ben Hafidh President of the Yemen Dental Society

to Dr. Ghassan Yared President of the Lebanese Dental Association

to Pr. Youssef Talic from the KSA

T R O P H Y D I S T R I B U T I O N

to Mr. Ghassan Mamlouk CEO of ATC

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Picture of the Lebanese delegation from the closing ceremony

E X H I B I T I O N F L O O R


La Droguerie Tamer membre de G. Tamer Holdingrae trois trophes l International Dental Show (IDS).

Tarek Skaff, Gaby Tamer, David Halimi (V.P. Septodont) Diaa Khreish, Wael Houry

Stephen Lawry, Tarek Skaff, Gaby Tameret Scott Parrish (Prsident de A-Dec)

Lquipe Tamer: Carlos Abillama,Diaa Khreish, Gaby Tamer, Tarek Skaff,

Wael Houry

Wael Houry, Diaa Khreish, Eiichi Nakanishi Prsident de NSK, Gaby Tamer, Tarek Skaff, Hiroki Kano

Gaby Tamer, Alex Al Dahi, Tarek Skaff sur le stand Bego Stand Biomet 3i

Lquipe de la Droguerie Tamer membre de G.Tamer Holding sest rendue lInternational Dental Show (IDS)qui sest tenu Cologne. Cette exposition internationale la plus importante dans le domaine dentaire attire chaque anne plus de 120.000 visiteurs des quatre coins du globe et prsente les technologies rcentes

des marques les plus connues.

Droguerie Tamer qui reprsente sur le march libanais et rgional des marques importantes (comme A-Dec, NSK,Septodont, Bego, Biomet 3i, Discus Dental et Ivoclar Vivadent, Dentsply, Coltne Whaledent, Sunstar-Gum,Waterpik), fut reprsente par Tarek Skaff (directeur gnral), Diaa Khreich (directeur Tamer Levant),

Carlos Abillama (directeur 3i Mena) et Wael Houry(directeur des ventes),pour recueillir trois trophes:le premier trophe fut dcern par la socit Adecen commmoration de son 20e anniversaire departenariat et en reconnaissance de son soutien auxventes et services des produits dentaires Adec. Lesdeux autres trophes furent dcerns respectivementpar les socits NSK et Bego en apprciation dursultat remarquable des ventes accompli par le

groupe en 2010.

With the same spirit of G. Tamer Holding in the MENA region,and since day one in Iraq, Tamer Levant decided to take thelevel of dentistry in Iraq to a higher position by listening closelyto the dental community needs and investing more in theeducation and support of the Iraqi dentists and above allbelieving in them.With top international brand names in dental industry TamerLevant was among the first gold sponsors of the 1st IraqiDental Reunion IDR meeting held in Erbil last April. More than1200 participants from the different provinces of Iraq, Ministersof Health, Deans, Professors, Dentists and Dental Technicianshad the opportunity to reunite and see closely the latest indentistry. Tamer Levant through its supplier DENTSPLY,offered 2 lectures followed by a workshop presented by a highly professional lecturer from the Saint Joseph and theLebanese University in Beirut Dr Karim Corbani who lecturedon: "Direct Posterior Restorations" and "Achieving ConsistentResults with Direct Anterior Composite". And Dr. Edward Rizk,lectured on "Winning the Challenge of Mechanical Shaping ofNarrow and Curved Canals". While the workshops wereprepared to receive a maximum of 20, 250 dentists werestriving to get these places.The Exhibition was a great success. It gave us the opportunityto be at the service of the Iraqi dentist in both Governmental and private sector said Diaa Khreish Managing Director ofTamer Levant in Iraq. In addition to the presence of the President and CEO of G.Tamer Holding Mr Gaby Tamer, and the General Manager,Mr Tarek Skaff, Technical Manager Mr Antoine Eid, and theManaging Director of Tamer Levant Mr Diaa Khreish, topsupplier were among the attendee from A-dec Mr StevenLawry Territory Manager, from Dentsply Dr Harika GokcesuRegional Director of Dentsply UK export, Dr Ghada BassilSales and Professional Services Manager in addition to theteam of Tamer Levant in Iraq. Tamer Levant will keep on investing into education, trainingand will continue to provide the finest products and servicesfor all the dental communities in Iraq through its direct officesin Erbil and Baghdad and its chain of distributors in the restof the cities of Iraq.

Tamer Levant represents the following leading brands in Iraq:Dentsply , Dentsply Maillefer, A-dec, NSK, Biomet 3i,Tecnogaz,MGF, BlueX , Nordent.

Tamer Levant Stand

Dr. Karim Corbani

Endo hands-on by Dr. Edward Rizk

Dr. Edward Rizk, Wissam Shedid, Dr. Ghada Bassil, Diaa Khreish,Gaby Tamer, Steve Lawry, Dr. Karim Corbani, Dr. Harika Gokcesu,

Tony Eid, Tarek Skaff

Its our pleasure and honor to welcome you to our 10th scientificMeeting and we are deeply grateful to your presence today inthe opening ceremony.We thank the Lebanese Dental Association for its continuoussupport, the world Federation of Orthodontics for its invaluablehelp and the Luxembourg Orthodontic Society for having madethis event a real success.We have tried to focus through this meeting on basics as well ason recent advancements and new developments in orthodontics inorder to bring to our colleague Orthodontics after year 2000.The main objectives were:First: To honor our teacher, our friend, our colleague ProfessorPierre Rizkallah who passed away. Multi-talented man, honest andpassionate who left a major print on the field of orthodontics inLebanon.Second: To bring the latest developments in orthodonticsthrough pre- and post-congress Courses dealing with 3DImaging and Lingual Orthodontics.and Third: To open the door for multidisciplinary interaction withOral Radiology and Human Anthropology. All this, without for-getting the basic clinical teaching as well as Evidence BasedOrthodontics. Topics which will be developed by differentexperts in their fields.The success of the event is due to a highly motivated group ofpeople who worked hard as a solid team, I would like to thankevery one of them from the bottom of my heart.We hope that this meeting will be remembered and this occasion willbe an annual appointment to see and learn from each other.


Professor Joseph Bouserhal during his opening speech

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Dr. Edmond Chaptini

left to right - Dr. Elie Khoury, Dr. Nayla Bassil Nassif, Dr. Alain Taouk, Ms.Faten, Dr. Fady Dahboul from the Lebanese Orthodontic Society

left to right - Pr. Antoine Berbery, Dr. Jean Moussa, Dr. Said Halabi,Dr. Edgard Irani

Left to right : Dr. Athanassiou from Greece, Dr. Massoud formSaudi Arabia, Dr. Zaher From Egypt, Dr. Justus From Mexico,Dr. Becker from Luxembourg

Left to right : Dr. Justus From Mexico, Dr. Zaher FromEgypt, Dr. Sheib from Lebanon

10th LOSScientificMeeting

10th LOS ScientificMeeting

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With the ongoing enhancement of the premium treatment units U 1500,

U 5000 S and U 5000 F, dental manufacturer ULTRADENT has created a

modern class of unit that provides the highest possible quality in the

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makes it possible to equip units in line with dentists individual requirements

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The 2011 models have some interesting new features. The 19-inch

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Various details, such as the new touch-screen display, an optional wireless

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The dental treatmentworkstation has beenredefined: Premiumclass with new design

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The Planmeca ProMax 3D ProFace unit acquires patients facial 3D

photo in a radiation-free process giving the medical or dental professional

opportunity to plan operations and document the follow-up images.

Planmeca is first to introduce an integrated 3D unit producing a realistic

3D face photo in addition to traditional digital maxillofacial radiography.

One single scan generates both a 3D photo and a CBVT volume.

Alternatively, the 3D photo can be acquired separately in a completely

radiation-free process: the lasers scan the facial geometry and the digital

cameras capture the colour texture of the face.

The 3D photo visualises soft tissue in relation to dentin and facial bones,

providing an effective follow-up tool for maxillofacial operations. As

Planmeca ProMax 3D ProFace acquires both a CBVT image and a 3D

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Careful preoperative planning, where the medical professional can

study the facial anatomy thoroughly using Planmeca Romexis software,

facilitates a detailed operation and enhances the aesthetic results.

This new product clearly demonstrates our groundbreaking R&D and

best practices in imaging. Planmeca provides the most advanced tools

3D imaging units and software for visualising patient anatomy making

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New Planmeca ProMax3D ProFace systemenables safer and fasterfacial surgeries

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www.dentalnews.com Volume XVIII, Number II, 2011

Belmonts newCP-ONE PLUSThe CP-ONE PLUS is the latest addition to the dental unit range from

TEKARA BELMONT. The CP-ONE PLUS succeeds in taking the concept of

the CP-ONE and improving it with advanced technology and comfort.

The CP-ONE PLUS was designed by incorporating dentists requirements

and desires one by one, from the treatment space all the way down to

minute details that will be recognized through dentists fingertips. An

ideal treatment environment, the CP-ONE PLUS is a think-all dental

chair and unit, the answer to dentists aspirations.

The CP-ONE PLUS is a comfort ergonomically designed folding leg-rest

chair and base-mounted unit enabling patients to access to the chair

either from front or from side with ease. It can be put in a 6-oclock face-

to-face treatment. Standing directly in front of the patient gives the doc-

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To provide true comfort for all patients including children, the elderly and

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June Issue 2011.pdf

Documents

Transcript of June Issue 2011.pdf