N 9/2006 July Espertise

Transcription

1 N 9/2006 July Espertise Editorial Dear Readers, How do you best measure and monitor the long term clinical success of a product on the market? For a manufacturer that s not an easy challenge to overcome. Of cause you can start long term clinical studies at universities to obtain some data regarding the clinical success. But that can only be one part of the total picture the scientific world. Can we always transfer the results of scientific studies to the routine in a general practitioner s daily work? For a long term success both, dentist as well as patient have to be satisfied with the clinical result and this not only depends on the quality of a product! At the end it comes to three main important parameters which can help the manufacturer to get a picture about the clinical success: first the results of scientific studies, second the economic success of a product (measured by turnover, market share, growth rate) and last but not least the voice of the customer reflected by market research and incoming complaints. Therefore, being a very sensitive probe in the market, professional complaint handling is an important part of the overall quality management for 3M ESPE. In this edition of our Magazine you can read more about how quality management is escorting products from the very first idea, during the product development to the final market launch. Also for the Espertise Magazine we want to do some quality management: we added to this edition a questionnaire to evaluate how satisfied you, our readers, are with the. Please help us with your answers to best serve and meet your needs in the future. Enjoy reading! Gerhard Kultermann, Editor 3M ESPE, Seefeld, Germany Contents The perfect match...2 Find your way in the dschungel of adhesives...4 Click and treat about mixing ceremonies...6 Aesthetics chameleon-style...7 Importance of user contact on the increase...8 Anterior aesthetic restoration using two all-ceramic crowns and two porcelain veneers...10 Angina pectoris harbinger of the heart attack...11 General Information...12

2 Product Information RelyX Fiber Post and RelyX Unicem Self-Adhesive Universal Resin Cement The perfect match Vivian Porsfeld, 3M ESPE, Germany Despite these clear advantages of fiber posts and the paradigm shift from metal to fiber posts that is also reflected in the scientific community there is one drawback: they have to be adhesively cemented into the root canal which is difficult for multi-step, moisture sensitive adhesive protocols. Market research has shown that many dentists expect difficulties with the complex cementation procedure of fiber posts in the root canal and as a consequence do not use them. RelyX Fiber Post with RelyX Unicem and RelyX Unicem Aplicap Elongation Tip: The perfect match! 3M ESPE now provides one of the best state-of-the-art fiber posts with one of the best cementation solutions to overcome the last drawback multistep adhesive cementation in the root canal! RelyX Fiber Post offers enhanced aesthetics as well as mechanical properties similar to dentin that reduce the risk of root fractures. Benefits of RelyX Fiber Post: Convenient and void-free root canal cementation with RelyX Unicem Aplicap Elongation Tip. RelyX Unicem now lends its strength to the new RelyX Fiber Post System delivering faster post cementation and fewer worries! Over the past decade fiber reinforced composite (FRC) posts have gained popularity in the dental market because of their benefits regarding mechanical properties, aesthetics and removability, offering predictable clinical performance. Clinical success rate: The use of fiber posts in the dental practice reduces the risk of root fractures compared to metal posts. The dentine-like flexural strength of fiber posts avoids the wedge effect of stiff and hard metal posts. Aesthetics: With the use of full-ceramic restorations growing more and more, the fiber posts offer an important advantage being translucent and therefore very well suited for full-ceramic restorations especially in the anterior region. Fatigue resistance (strength): Fatigue is most likely the ultimate enemy for dental materials. Fatigue testing therefore provides a very realistic picture of the clinical performance. RelyX Fiber Post survives more than 10 million test cycles in modern fatigue testing machines and are far superior to other fiber posts, some of them breaking after only cycles. RelyX Fiber Post has a tapered design to avoid unnecessary removal of root dentin and is available in three sizes. RelyX Fiber Post is a translucent and uni-directed quartz fiber post that allows light transmission. RelyX Fiber post is radiopaque. RelyX Fiber post has a micro-rough surface that adds additional retention Removal: Fiber posts can be easily removed with drills if endodontic revision is required. 2

3 N 9/2006 July Espertise The perfect team: RelyX Fiber Post System and RelyX Unicem Aplicap with Elongation tip. a multi-step paste/paste cement RelyX Unicem Cementation with RelyX Unicem offers a very easy and reliable procedure that results in high adhesive strength which helps to stabilize the tooth and minimizes the risk of debonding, being the second biggest concern when speaking of adhesive cementation in the root canal. To make the cementation procedure even more simple and reliable, 3M ESPE offers the RelyX Unicem Aplicap Elongation Tip that enables a virtually void-free bottom-to-top filling technique of the root canal eliminating waste, frustration and bubbles. Benefits of RelyX Unicem and RelyX Unicem Aplicap Elongation Tip: High bond strength to root dentin and RelyX Fiber Post without any pre-treatment of tooth and post Easy, void-free and reliable cement application with the RelyX Unicem Aplicap Elongation Tip Time-saving and strong adhesive one-step cementation without etching, priming and bonding in the root canal Light-curing and self-curing mode leading to excellent bonding in any case RelyX Unicem proven reliable for holding permanent restorations by more than 60 in-vitro and in-vivo studies The RelyX Fiber Post comes in innovative, differentiated blisters for easy, spill-free, hygienic handling. It is available in three sizes that are defined with colour coded rings. 3M ESPE also provides the corresponding RelyX Fiber Post Drill in three sizes as well as the RelyX Unicem Aplicap Elongation Tip in the RelyX Fiber Post Introkit. The RelyX Fiber Post Starter Kit additionally contains a RelyX Unicem Trial kit with everything you need to start right away. Get the solution. Get the system. 3

4 Product Information A Matter of Trust: Find your way in the jungel of adhesives Gerhard Kultermann, 3M ESPE, Germany Many different adhesive systems have come to market in the last years. For the practicing dentist, it is hard to keep his knowledge state of the art in the battle of the bottles. Why do we need adhesion? When using tooth coloured restorative materials like resin composites, it needs to overcome the shrinkage, keep the margin sealed and protect against the penetration of bacteria otherwise the restoration will fail. That is what adhesives are developed to do. How much bond strength is really needed for long term clinical success? Can we exactly name and prove the required bond strength which is needed for long term clinical success? So far nobody has. And what does long term mean: Five, ten or even 15 years? However, there are some facts based on experience, which we have to include in the discussion: The shrinkage of resin composites decreased due to progress in monomer development to around 1.5 volume percent only. The clinical experience with existing self etch adhesive systems is looking promising: Since the product launch almost seven years ago, 3M ESPE sold more than 90 million L-Pops of Prompt / Adper Prompt globally. The clinical success of the customers over this period seems to be excellent: The product has a complaint rate close to zero which reflects the clinical satisfaction of the customers. Which different adhesive systems are on the market and how to separate? The most helpful way to classify the adhesive systems from the clinical perspective is by the number of clinical steps needed and the way the material interacts with the tooth structure. Thus there are four different groups of materials on the market at present (figure): Group 1: three to four clinical steps (for example Adper Scotchbond Multi-Purpose Adhesive) The classical approach: total etch or selective etch, smear layer removal. Group 2: two clinical steps (for example Adper Scotchbond 1 XT Total-Etch Adhesive) One or two bottle systems with separate etching step: total etch or selective etch, smear layer removal. Group 3: two clinical steps Two bottle self conditioning systems without separate etching step: total etch / conditioning, smear layer dissolving. Group 4: one clinical steps (for example Adper Prompt L-Pop Self-Etch Adhesive) all in one : Total etch / conditioning, smear layer dissolving. Group 1 Group 2 Group 3 Group 4 All the adhesive systems are to some degree technique sensitive and have to be applied very carefully, following the instructions for use of the manufacturers. The risk of clinical failures due to mistakes in the bonding procedure or the composite application and layering technique seems to be higher, than the risk of failures due to the technical performance of the products. 3 (4) clinical steps total-etch or selective etch 2 clinical steps total-etch 2 clinical steps the bottle self conditioning systems 1 clinical step all-in-one or pre mix solutions smear layer removal smear layer removal smear layer dissolving smear layer dissolving Classification of adhesive systems by the number of clinical steps and the way of interactions with the tooth structure. 4

5 N 9/2006 July Espertise Do we need self etch adhesive systems? As the market shows, there obviously seems to be a need to simplify the clinical adhesive procedure for daily practice, to reduce the possibility for mistakes and make it easier for the general dental practitioner and his team to handle the materials chairside. Of course one has to know, that with the classical phosphoric acid etching and a separate hydrophobic bonding agent in vitro you can reach a higher bond strength. Therefore a lot of universities are claiming, that there is no need for self etch adhesives and some do not even teach their students, how to handle self etch systems without making mistakes. But because once on the market many young dentists will also start to use self conditioning systems, and they have never been taught how to apply these accuratly. What are the differences between the different self conditioning material systems? There are mainly differences in the chemistry, the ph, the etching solvent, the handling and the etching performance of dentin and enamel. In general one can say, that the lower the ph is, the better the etching pattern and therefore the adhesion to enamel. But on the other hand a low ph may include the possibility for hydrophilic interaction with the dentin liquor: The material may take up water over time from the dentin, which can lead to so called water trees inside the hybrid layer. This interaction is under scientific investigation at the moment. So far there is no proven clinical relevance of these water trees, which may increase the number of long term failures. The risk of over etching of the dentin with low ph solutions is lower, than with separate phosphoric acid. The acidic molecules are included in a molecule chain and therefore cannot penetrate deeper than the hybrid layer will be. SEM photomicrograph of hybrid layer formed with Adper Prompt L-Pop Self-Etch Adhesive. Which adhesive system is best for you? If you are a dentist, who always wants to have to best possible results based on scientific data, who is patient, has the time and team to do even complicated procedures in the surgery without any mistakes: The multi step approach (like Adper Scotchbond Multi-Purpose Adhesive) for you fits best. If you do not want to miss a separate phosphoric acid etching step to enamel but want to reduce the rest of the procedure as much as possible to also limit the number of possible mistakes: a system like Adper Scotchbond 1 XT Total-Etch Adhesive for you is the best. If you rely on technical progress, want to simplify chairside procedure as far as possible, do not want to store complicated bottle systems in your surgery and want to avoid the possibility of over etching or over drying to reduce the possibility for post operative sensitivity: for you, a system like Adper Prompt L-Pop Self-Etch Adhesive fits best. Conclusion Whatever your choice or personal preference is: there is clinical evidence for all of these 3M ESPE materials, they are clinically proven in daily practice, in millions of applications, for many years. Bonding strength of Adper Prompt L-Pop Self-Etch Adhesive on uncut enamel is higher than of many competitors. The higher microtensile bonds is presumed due to its significantly greater demineralization potential proven in SEM (left: Adper Prompt L-Pop, right: Clearfil SE, pictures kindly provided by Dr. Pertigao, University of Minnesota). 5

6 Product Information Ketac Cem Plus Luting Cement in the Clicker Dispenser Click and treat about mixing ceremonies Laslo Faith, 3M ESPE, Germany The 3M ESPE patented Clicker Dispenser will save your time and money. Besides time saving during dosage and application, your assistant will be able to mix a more homogenous paste, with less efforts in shorter time. This will also help to increase the reliability of your crown and bridge cementations, and you still get the Ketac Cem brand you trust so much improved with the features of a resin-modified glass ionomer cement: Low post-op sensitivity, easy excess removal, low film thickness, fluoride release, low solubility. With just one click, the Clicker Dispenser will dose two paste components directly on to the mixing pad and you just click again if you need more. The two pastes are easy to mix as the viscosities of both pastes are similar and there is no more forcing the powder into the liquid. As no powder is used, clean-up is also simple and easy. Also the Clicker will show you how many clicks you have left. And when it is empty, you dispose of it and take the next one. Since Roman times powder and liquid have been the components used to mix a cement. The Romans used to be very successful with this technique and their cement walls, houses and fortresses can still be visited today. This technology has also been the basis of Glass-Ionomer cementation in dentistry. Assistants had to learn it, they did it for decades and they still do. Please think of your last cementation procedure Didn t the handmixing procedure resemble a little bit of a time consuming, even crazy ceremony?: Take the bottle, dispense a drop, close the bottle, put it back. Take the small jar and a spoon, take the right quantity of powder, clean the spoon, close the jar and start mixing. Doors and windows of course must be closed; otherwise the powder will be blown away. Together with convenience, Ketac Cem Plus Luting Cement delivers an enhanced formulation that provides low solubility and improved adhesion to tooth structure and higher strength to aid retention. It is the perfect choice when luting metal-based and glass-free highstrength ceramics with retentive preps. Finally Ketac Cem Plus Luting Cement as a resin-modified glass ionomer cement has been clinically proven to have a much lower risk of post-operative sensitivity while maintaining high levels of fluoride release associated with conventional glass ionomer cements. So take your time for traditional ceremonies with your family and friends and become more effective in your operatory: Improve your cementation procedure for standard indications. Clicking is in This nice ceremony nowadays can be done with JUST ONE CLICK. And you get some improved cement too. Of course in general ceremonies often are nice and people like to stick to them when celebrating traditions. But in dentistry, ceremonies cost time and money but do not make those people who have to wait very happy, ie the dentist and patient. 6

7 Paradigm C Glass Ceramic Block for CEREC Systems Aesthetics chameleon-style Kristina Schmidt, 3M ESPE, Germany N 9/2006 July Espertise At 3M ESPE s popular exhibition stand experts demonstrated the new prosthetic solution: The aesthetically brilliant material made of leucite glass ceramic has been specially developed for indications involving inlays, onlays, crowns and veneers. Paradigm C is characterised by a striking translucency and fluorescence that results in a chameleon-like effect in clinical applications. Attendees were delighted by the furry chameleon, which was given away to every visitor to the stand. A tombola that awarded a two metre long furry chameleon as its prize also created a stir. 3M ESPE would now like to take the opportunity of congratulating the winner, Dr. Ina Meißner, a dentist from Bad Hersfeld who specialises in treating children and adolescents. The chameleon couldn t have found a better home! The launch team celebrates 3M ESPE Paradigm C Class Ceramic Block for CEREC Systems with a large furry chameleon being the price of a tombola. The innovative Paradigm C glass ceramic block for CEREC systems will allow 3M ESPE to further develop its market position in the field of indirect restorations. Besides aesthetic brilliance this new product is also distinguished by outstanding physical material characteristics. As confirmed by comparative in-vitro studies involving in-house measurements by 3M ESPE, the Paradigm C glass ceramic block offers good flexural strength, high long-term stability as well as low solubility and greater translucency than other glass ceramic blocks. Its balanced translucency and excellent polishability in clinical applications has been confirmed in user studies. The glass ceramic blocks are available in six perfectly coordinated shades (according to the Vitapan Classical Shade Guide) and in five sizes. Thanks to the natural aesthetics and good colour coordination, restorations carried out using Paradigm C are virtually undetectable. Use of the aesthetic glass ceramic for long-lasting chairside CAD/ CAM restorations is simple, fast and reliable, particularly in combination with the self-adhesive resin cement RelyX Unicem Self- Adhesive Universal Resin Cement from 3M ESPE. During a symposium held to celebrate the 20th anniversary of CEREC technology, 3M ESPE presented its latest product development, the Paradigm C Glass Ceramic Block for CEREC Systems, to a wider professional public for the first time. The Paradigm C glass ceramic block from 3M ESPE, an innovative material solution for the CEREC systems from the manufacturer Sirona which is tailored to surgery requirements, is also an interesting example of cooperation between companies in the dental industry that is as innovative as it is successful. 7

8 Ask the Experts Quality Management in Product Development Importance of user contact on the increase Petra Schneider, 3M ESPE Germany Direct contact with the customer is the driving force behind product development Quality management in product development at 3M ESPE follows the principle that quality means meeting customers demands. 3M ESPE regularly seeks direct contact with the customer to actively find out exactly what these requirements are. The primary aim is to find out wishes and potential for improvement that users see as too obvious to mention in a standard market survey. Fig. 1: Customer requirements 3 types of satisfaction factors. Developers and product managers often visit selected dentists in person to find out from them directly what concrete product developments they would like to see where. As well as with dentists, 3M ESPE also fosters close contacts with researchers and opinion leaders round the globe. From the idea to the technical realisation Patient Low price Short treating time Long lasting filling Dentist Short working time Specification sheet No clinical visible discoloration or factures Physical-technical Specification Polymerization in less than 30 seconds Flexural strength > 120 MPa Chemical Solution New initiator system New polymer Target specification At 3M ESPE, product development is requirement-driven, not technology-driven. First the developer needs to know what the patient and dentist want. Then technical specifications are formulated, which must be implemented using the right methods. Staff who understand the dentist and dental technician Direct contact with customers is only a piece of the jigsaw that is the comprehensive system with which 3M ESPE ensures the quality of its products and works to fulfil the wishes of dentists and dental technicians. Another is that staff are expected to become quasi dentists. Not only do they have to have an in-depth knowledge of their specialist field, for instance chemistry, biology or marketing, but also the application of their products in the clinic or laboratory. Developers, product managers and other groups therefore Request from the customer 3 Types of satisfaction factors * Basic requirements Components, which for the customer are to obvious to mention. Requirements of performance Measurable performance the customer expects. Elements for enthusiasm Features the customer did not. often not mentionned articulated not mentionned Since users often regard product-related improvements as a matter of course, they do not write them down on the questionnaires used in standard market research. That s why product developers go to dentists and dental technicians to ask them what their wishes and suggestions are. * Nariaki Kano, Japan take advantage of every means in the company to learn all about dentistry and to get in touch with people who use their products day-to-day. And they have plenty of opportunity to do so in the information centre in Seefeld for instance: by attending regular staff training sessions, taking part in training programmes, when dentists or dental technicians groups, dealers or dental surgery assistants from diverse countries come to visit. Also, everyone is free to attend external dentists or our own internal clinic as a guest. This kind of training and development is as much a part of quality assurance as correctly translating customer requests into technological specifications. The project teams are notified of the customer s concrete wishes, for example, for a new, no-shrinkage composite or for short chair time or short working time, and not the technological specifications like using certain chemicals. Figure 2: From customer requirement to technical specification. Project management ensures that customers demands are met In most cases it takes three or more years before a product is launched. There are several phases in the process of developing a new product. Figure 3: The development process from idea to shelf. After idea screening, a concept is devised and feasibility tested. Next comes actual product development. If it fulfils expectations, scale-up follows, in which phase the material or system reaches product maturity. Before market launch each product must undergo a multitude of tests, inspections and certifications stipulated by law, standards and national authorities. The entire process of product development is professionally organised by a multifunctional team, who apply various quality assurance 8

9 N 9/2006 July Espertise methods. Among them, alongside the familiar ISO standards, is the so-called six sigma method. It is a statistically validated quality process taking in procedures and projects in the whole company, for instance in sales, production and development. CURRICULUM VITAE Dr. Petra Schneider Quality and clinical safety over the entire life cycle Quality management does not end once a product is sold, but spans its entire life. Dentists, dental surgery assistants or dental technicians frequently have questions relating to application, sometimes even reason for complaint. At 3M ESPE in Seefeld, the Service Centre deals with these scenarios. They take 120 to 140 calls a day, that is around 3,000 a month, and approximately 800 s and faxes on top of that. In 80% of cases the question or problem can be answered or solved to the customer s satisfaction the first time contact is made. Only if really complicated and in-depth questions arise is the call forwarded to a product specialist, who gets in touch with the customer at an agreed time. Field sales is also linked in with the Service Centre and the process is continually evaluated and specific points improved. Telecommunications systems, databases and customer management and sales software work away in the background with the aim of continuously improving workflow and providing the best possible customer service. 3M ESPE is hoping to gain the trust of dentists and dental technicians all over the world with its approach to quality. It includes safe manufacturing and handling, and respecting environmental concerns. Having such high standards sometimes leads to long development times, especially in the case of highly innovative technologies with which 3M ESPE breaks new ground. It is clear from all this that quality and clinical safety is the number one priority at 3M ESPE. From the idea to the technical realisation Ideas Developmental phases: Pipeline of new products 1 Idea Screening 2 Concept 3 Feasibillity 4 Development 5 Scaleup 6 Launch Products 7 Post Launch Studying chemistry in Clausthal-Zellerfeld PhD thesis in organic chemistry since 1981 Employee of 3M ESPE Quality control of drugs and medical devices Head of pharmaceutical analytics department Head of quality management Head of business team restoratives and local anesthetics since 2002 Head of quality management (including regulatory and safety) Petra Schneider started with 3M ESPE in 1981 as an analytical chemist. In 1991, she was appointed head of quality management responsible for the quality management system, the quality control of all ESPE products (medical devices and drugs) and the analytical laboratories. She was responsible for the implementation of a company-wide quality management system. In 1998, Petra was appointed businessteam manager restoratives. Her responsibilities include amongst others entrepreneurial responsibility, global successful marketing of the products in their respective area of indication, strategic and operative planning, passing, evaluating and terminating of R&D projects. In 2002, Petra was responsible for the integration management 3M ESPE in the Seefeld center. Together with the integration manager St. Paul, she was responsible for the project management of more than 40 projects of phase 2 of the integration process. Beside that responsibility, she was head of the businessteam and production local anesthetics. In 2002 Petra was appointed head of quality management with global responsibility for quality, regulatory and safety of drugs and medical devices, developed and manufactured at the Seefeld site. Petra Schneider holds a Ph.D. in organic chemistry. 9

10 Clinical Case Report RelyX Unicem Self-Adhesive Universal Resin Cement/RelyX Veneer Cement Anterior aesthetic restoration using two all-ceramic crowns and two porcelain veneers Claus-Peter Ernst, Mainz, Germany The case report presented here details the replacement of two anterior crowns on the central incisors as well as the aesthetic restoration of the two lateral incisors using ceramic veneers 1 Fig. 1: The patient presented with the main wish to have her anterior crowns replaced and the space between the central and lateral incisors closed. After a thorough clinical examination and consultation, including orthodontic, it was agreed to restore the central incisors with all-ceramic crowns and restore the aesthetics of the lateral incisors with porcelain veneers and after consulting with the dental technician, a conscious decision was made to settle for a slight displacement of the midline. This enables the different-sized spaces between the lateral incisors to be evened out harmoniously. Fig. 2: The all-ceramic lab fabrication fixed to the lab model clearly shows the intended and achieved displacement of the midline to the left in order to keep the teeth the same width After pretreating the ceramic with hydrofluoric acid and a silane material (Espe-Sil, 3M ESPE) a bonding layer was applied to the two porcelain veneers, which was then polymerised for 40 seconds (Elipar TriLight, 3M ESPE). This step was not used for the all-ceramic crown, whose pretreatment was complete after solvent evaporation of the silane. Purely light-cured materials are suitable for bonding porcelain veneers: firstly, ceramic veneers are very rarely so thick as to necessitate dual curing, secondly, when using purely light-cured materials the dentist can decide when the moment is right to cure the material. In addition, the risk of marginal discoloration is reduced by virtue of avoiding the amine peroxide-induced polymerisation mechanism of a dark curing reaction. In recent years, the purely light-cured RelyX Veneer (3M ESPE) has proved to be the ideal material for bonding ceramic veneers. In my opinion, of the many shades available, one only requires Shade T (= translucent), as in most cases a truly wrong veneer shade cannot be rectified by choosing a certain composite shade. To be quite sure, one must first select the appropriate Try-In-Paste from the RelyX Veneer System; this makes it possible to assess the overall impression of the restoration as if the veneer had already been cemented. Fig. 3: As RelyX Veneer follows a traditional adhesive concept, it was appropriate to isolate the teeth with a rubber dam. The veneer surface to be bonded on tooth 12 and 22 were con ditioned with 32% phosphoric acid after thorough cleaning with a fluoride-free prophylaxis paste, and then sealed using a conventional adhesive system. After removing excess RelyX Veneer, a glycerine gel layer was applied and light polymerization was performed. In principle, RelyX Unicem is, of course, just as sensitive to contamination of the bonding surface as any other composite cement but thanks to the self-adhesive properties of this composite cement it is possible to create an area free of contamination within a short timeframe. Thus RelyX Unicem is currently the only material that allows such quick adhesive bonding of all-ceramic crowns using moisture control. Fig. 4: The picture shows the direct application of the activated and mixed (RotoMix, 3M ESPE) RelyX Unicem material into the crowns concerned. 5 Fig. 5: Follow-up after one week shows that the colour of the restoration blends harmoniously with the other teeth and the width of the teeth looks uniform in relation to the remaining gaps without there being any undesirable effect at the marginal gumline. 10

11 N 9/2006 July Dental Practice Forum Espertise Emergency Cases in Dental Surgery Angina pectoris harbinger of the heart attack Michael Hillenbrand from reanimed in Dieckholzen, Germany Genetic predisposition to calcification of the arteries Lipid metabolic disorders (high cholesterol level) Angina pectoris occurs suddenly and unexpectedly and can last from seconds to minutes. Triggers are physical exertion, heavy meals, cold, excitement or mental strain, such as a visit to the dentist, which causes a lot of people immense stress. Angina pectoris what to do: 1. If your patient complains of sudden acute chest pain combined with a tight feeling, nausea, sweating, panic, treat it as a cardiac emergency. If your patient suddenly grabs his chest and complains of severe pain, it doesn t necessarily mean a heart attack; it could be angina pectoris. Angina pectoris is the main symptom of coronary heart disease. The most common cause of disease of the coronary vessels is arterial calcification (arteriosclerosis): Over the course of many years, cholesterol deposits (plaques) build up on the vascular walls. If plaque forms in the coronary vessels, circulation is restricted as the vessels get progressively narrower: the cardiac muscle no longer gets a sufficient supply of oxygen and nutrients. The result is sudden acute pain in the heart area (mostly behind the breastbone), cold sweat, nausea and vomiting, tight feeling, extremely difficult breathing, pallid complexion, and panic to the point of fear of death. The pain may radiate, and be misconstrued as arm, shoulder, neck pain or toothache. Also sudden (upper) stomach pains can be a sign of a cardiac emergency. Initially, a sufferer will only notice narrowing of the coronary vessels during physical exertion. At the advanced stage of the disease, even slight physical exertion or mental stress is enough to trigger the symptoms. The following risk factors cause hardening of the coronary arteries: Overweight and/or Lack of exercise Smoking High blood pressure Diabetes 2. Remain calm and collected. 3. Relieve the strain on the heart and put the dentist s chair into the neutral position 4. Give your patient medical oxygen through a nasal tube and take his blood pressure. 5. If the systolic is above 160 mmhg administer nitroglycerin in capsule or spray form as an emergency medication. Nitrates relieve the strain on the heart, thereby improving the oxygen supply to the cardiac muscle. Nitrate preparations are fast-acting and direct! Caution: People with low blood pressure must not be administered nitrate preparations. As they dilate the blood vessels, blood pressure may drop, resulting in circulatory collapse. There is a high risk of heart attack after angina pectoris, especially the first episode; the reason being that if a coronary vessel becomes blocked, the oxygen supply to the myocardial tissue behind is cut off, resulting in a heart attack, about which we will go into greater detail in the next issue. So, in the event of acute pain between the lower jaw and belly button, think of the heart. If in doubt, treat your patient for angina pectoris or a heart attack. Always seek medical advice even if your patient feels better soon after administering the nitroglycerin! Angina pectoris is always a warning signal. Cardiac emergencies should always receive intensive medical care. 11

12 General Information Espertise Calendar of Events 2006 Editorial Information Date Event Location Website Dentalexpo Moskau (Krokus-Expo) FDI World Dental Congress Shenzhen Expodental Mailand International Dental Showcase London ExCel th World Dental Meeting Yokohama ADA Las Vegas Swedental Gothenburg Dentech China Shanghai th Asian Congress on Oral and Maxillofacial Surgery Hong Kong Expo Dental AMIC Mexico City Greater New York Dental Meeting New York City Your opinion is important for us! Espertise The Comprehensive Reader Survey of the Espertise Magazine Your opinion is important for us The reader survey of the Espertise Magazine is designed to provide important feedback from our readers. It will take only a few minutes to fill out. As a participant you have a chance to win a trip to IDS 2007 in Cologne. Please mark your answers with a cross: You are an established dentist dental technician You teach or study at the university as a dentist dental medicine student Others: Please, describe your professional activity Are you scientifically oriented? yes not too much Are you specialized in one (or more) of the following treatment areas? Dentistry for children Periodontology Implantology Orthodontics Oral Surgery Endodontology How (or where) do you receive the Espertise Magazine: by mail at trade fairs at special events personally by your sales rep digitally by as a download from the 3M ESPE homepage How would you prefer to receive the Espertise Magazine in the future? Do you like to read the Espertise Magazine? very much much not too much not at all How do you rate the columns of the Espertise Magazine? Fax back this reader survey to 3M ESPE: Fax-Nr.: + 49 (0) 721 / Closing date is 30 th of October Among all participants of this survey we will draw a trip to Cologne, including flight (economy), two overnight accommodations and a ticket to the world s most important dental trade fair, IDS, in spring Published by: 3M ESPE AG ESPE Platz Seefeld, Germany Telephone: +49 (0)8152/700-0 Telefax: +49 (0)8152/ info3mespe@mmm.com Internet: Editors: Gerhard Kultermann Annika Meyer Editorial team: Dieter Klasmeier, Maria Bauer, Laslo Faith, John Rafelt, Laurence Bergmeier-Lega Coordination: Laurence Bergmeier-Lega, Production: Eberl, Immenstadt, Germany Design and typesetting: Eberl, Immenstadt, Germany Global circulation: 120,000 We accept no liability for unsolicited manuscripts or photographs. Court of Jurisdiction: Munich 3M ESPE AG, Seefeld, 2006 How often do you receive the Espertise Magazine? once a year twice a year three times a year four times a year Do you think this is: not enough sufficient to often How often would you prefer to receive the Espertise Magazine? Product Information Entitled to take part are dentists, dental technicians and dental medicine students. The course of law is impossible. Employees of the company 3M ESPE are excluded from the participation. 3M ESPE AG ESPE Platz, Seefeld, Germany Telephone: +49(0)8152/700-0 Telefax: +49(0)8152/ info3mespe@mmm.com Internet: 3M, ESPE, Adper, Elipar, Espertise, Filtek, Ketac, L-Pop, Paradigm, Prompt, RelyX, Roto Mix and Scotchbond are trademarks of 3M or ESPE AG. Clearfil, Vitapan and Cerec are not trademarks of 3M or 3M ESPE.

13 The Comprehensive Reader Survey of the Espertise Magazine Espertise Your opinion is important for us The reader survey of the Espertise Magazine is designed to provide important feedback from our readers. It will take only a few minutes to fill out. As a participant you have a chance to win a trip to IDS 2007 in Cologne. Please mark your answers with a cross: You are an established dentist dental technician You teach or study at the university as a dentist dental medicine student Others: Please, describe your professional activity How (or where) do you receive the Espertise Magazine: by mail at trade fairs at special events personally by your sales rep digitally by as a download from the 3M ESPE homepage Are you scientifically oriented? yes not too much How would you prefer to receive the Espertise Magazine in the future? Are you specialized in one (or more) of the following treatment areas? Dentistry for children Periodontology Implantology Orthodontics Oral Surgery Endodontology Do you like to read the Espertise Magazine? very much much not too much not at all How do you rate the columns of the Espertise Magazine? How often do you receive the Espertise Magazine? once a year twice a year three times a year four times a year Do you think this is: not enough sufficient too often How often would you prefer to receive the Espertise Magazine? Product Information

14 page 2 User Report Event Calendar Clinical Cases Which columns do you like best? Please, mark your favourite columns with a cross: Product Information Clinical Cases Scientific Activities Event Calendar User Report Ask the Expert Dental Practice Which are the topics you would like to read more about? Ask the Expert Scientific Activities Dental Practice Recommendation of the Espertise Magazine: Has it ever been recommended to you by a colleague? Did you recommend it yourself to others? Would you like to publish an article of your own in the Espertise Magazine? yes no Please use this space for your personal comments and suggestions: Fax back this reader survey to 3M ESPE: Fax-Nr.: +49(0)721 / Closing date is 30 th of October Among all participants of this survey we will draw a trip to Cologne, including flight (economy), two overnight accommodations and a ticket to the world s most important dental trade fair, IDS, in spring Entitled to take part are dentists, dental technicians and dental medicine students. The course of law is impossible. Employees of the company 3M ESPE are excluded from the participation. We thank you very much for your feedback. Your Espertise Magazine Team