Espertise magazine No. 19 MAR 2011 EDITORIAL Dear Readers, every two years, the dental community meets in Cologne to celebrate the IDS, the world s largest dental trade show. This exhibition is used as a stage by all those who want to present their innovations and new approaches. Visitors are thus offered a unique opportunity of gaining orientation and learning about the developments in the rapidly changing international dental market. Questions are answered, ideas exchanged and new impulses given. Although dental professionals from around the globe have different needs and opportunities and meet diverse challenges, all of them pursue the same goal: To offer advanced dental care to their patients. To optimally support users from all over the world in reaching this goal, 3M ESPE develops and provides products of uncompromised high quality. The company believes that clinical excellence is achieved by solutions which simplify procedures, ensure high precision and enable aesthetic outcomes. Therefore, its employees work with enthusiasm and passion to integrate these features into the whole product range of 3M ESPE. The products clinical use and benefits can be experienced at the IDS booth as well as in this issue of the Espertise Magazine, which offers a potpourri of case reports and country insights, invites readers to discover our new website and provides interesting information about the city of Cologne. Enjoy reading! Gerhard Kultermann, Editor 3M ESPE, Seefeld, Germany CONTENT New dynamics, new directions...2 Two materials, one highly beautiful result...4 Dentistry in the Italian Republic...8 Dentistry in the Republic of Poland...9 Passionate about quality...10 Discovering the old town on foot in 30 minutes...12 Complex restoration procedure in the anterior region...14 A contribution to long-lasting restorations...16 Clinical use of a novel flowable composite in the posterior region...17 Dentistry in the Federal Republic of Germany...18 Dentistry in the French Republic...19
Lifestyle Online activities at 3M ESPE New dynamics, new directions Dieter Klasmeier, 3M ESPE, Seefeld, Germany 2 In the last issue of the Espertise Magazine, several trends observed in the development of the internet were discussed. These include the concept of Web 2.0 enabled by interactive communication, the growth of social networks like facebook (www.facebook.com) and the ubiquitous availability of the internet due to technological advancement. As a result of these newly created opportunities within the internet, many people from all over the world start to get more deeply involved in online activities. They use internet platforms e.g. to search for specific information, share files with other users, or exchange opinions and ideas with colleagues and friends. In addition, smartphones enable their users to surf the web anywhere at any time. And these changes are also affecting the dental sector. As an answer to the recent developments, 3M ESPE has redesigned its website and invested into social networks with an eye toward the future. The new website Launched in January 2011 in the West European countries, the novel 3M ESPE website presents itself with a completely new design and structure. It provides reliable, up-to-date information and indepth content on materials, devices and procedures within a few clicks. Driven by more powerful technology, it allows for a faster and more dynamic user experience. Quick and easy access to the desired information is also ensured by optimization of the website for search engines as well as the user-friendly layout and intuitive navigation, explains Sonja von Eichmann, e-marketing Manager EMEA at 3M ESPE. The novel website offers a completely new design and clearer structure. Structure Visitors entering the 3M ESPE start page have direct access to a number of functions: Different fields of interest can be selected on the left side via a specific product category, ranging from prevention to digital dentistry. Recent news and events as well as an Espertise area are also just one click away from the first page and listed on the left, while a toolbar on the right is used to contact 3M ESPE in the desired way. Those visitors who would like to stay up to date with regard to activities at 3M ESPE are invited to subscribe to an online newsletter. When a specific product page is opened, different kinds of content, including a product overview, detailed product information, facts about the clinical use, studies and science as well as a download area are available. Moreover, a new symbol appears on the toolbar on the right which leads the visitor to a page revealing where to obtain the desired material or device. Related products which might be of interest for the user are shown on the bottom of each product page. Espertise section In addition to strongly product-related content, the website contains an entirely new section built on the Espertise brand. Here, useful information on events and continuing education courses and literature is provided. Visitors will learn more about the different programmes designed to optimally support students, dentists and dental technicians in their daily routine. In the area, a selection of scientific literature, clinical documentations and study results as well as news about current developments is also offered. Furthermore, a digital copy of the Espertise Magazine can be downloaded. Connections to social media Within a short time, 3M ESPE is going to present a redesigned page on facebook (www.facebook. com). It will include e.g. an interactive forum for individuals where they can comment on products, post questions, follow the company activities including events and much more. Share functionalities connected to the page will be available on the website of the company. No. 19 MAR 2011
Espertise magazine Networking for consultants In addition to the enhanced involvement of 3M ESPE on facebook, the company has expanded its online presence by establishing two full Web 2.0 platforms: The Espertise Study Club and the Espertise Consultant Network. The Espertise Consultant Network The latter, launched in August 2010, is used by a small group of consultants who are actively involved in product development at 3M ESPE. Bound to the company by contract, these practitioners test and evaluate materials and devices in different stages of development. The online community is used as a platform to facilitate communication in an effective way and contribute to a faster pace of product development.... and dental practitioners The Espertise Study Club is a similar platform currently accessible to an exclusive number of members. The social network, which will soon be opened to interested dentists from all over the world, provides extensive information about trends in dentistry. Furthermore, it offers specific and relevant publications on products, such as study results and scientific articles. Furthermore, discussion groups give room for professional knowledge exchange on various topics, e.g. experience with a particular technique in the clinical environment. Via the community, practitioners are offered the opportunity to test and evaluate novel products soon after their launch in their own practice. Each evaluation is made available to all members of the study club. Information and feedback posted by members of the club is utilized by 3M ESPE e.g. for product optimization, so that they can support advancement in dentistry with their ideas. and serves as a platform for product evaluations. Future prospects After the launch of the novel website and social networks, 3M ESPE is already involved in further online activities. At the IDS 2011, for example, two apps for iphone will be presented. All videos available on the webpage can be viewed via YouTube (www.youtube.com/user/3mespedentaleurope) as well. Moreover, further rich media content such as additional videos, a review function and much more will be added to the new website, soon. This will allow for even more interactive communication between the company and the users of its products. 3 is used by consultants to support product development at 3M ESPE. The Espertise Study Club offers relevant and up-to-date information Product pages offer a whole range of interesting functions.
Clinical Excellence Aesthetics Two materials, one highly beautiful result Carlos Sabrosa, Rio de Janeiro, Brazil 4 In many cases, especially the treatment of young, beautiful patients with defects in the aesthetic zone presents a challenge to the dentist. Multiple factors have to be taken into consideration and an aesthetic, natural result of the treatment seems to be more important when the patient has still got his whole life ahead of him. Therefore, it is essential to carefully plan the intervention and make use of high-quality materials only. In this way, the dentist can be sure that the desired result will be obtained, even if different types of restorative materials are chosen, as described in the following patient case. Figure 1: Initial clinical situation: old composite fillings at teeth 21 and 22 have to be removed for aesthetic reasons. Patient case The 26-year-old female patient presented in our practice one and a half months before getting married. When she was a young child, teeth 21 and 22 were fractured in an accident. Since then, several composite restorations had been placed and redone over time. Now, she had the desire to replace the aesthetically insufficient fillings and asked for alternatives which could be realized in a very short period of time so that there were no more obstacles for her to look beautiful at her wedding. Indeed, the surface of the composite fillings was rough and a slight discolouration was visible as well (Figs. 1 and 2). Since the dimensions of the previous restorations were different, we decided to place an all-ceramic crown on tooth 22 and, in order to preserve as much of the natural tooth structure as possible, restore tooth 21 with a veneer. To avoid problems in the temporization stage, we opted to fabricate Figure 2: The old restorations are slightly darker than the natural teeth and less shiny. the zirconia-based substructure for tooth 22 before preparation and impression taking of tooth 21. The crown: preliminary steps The treatment started with the preparation of tooth 22. Prior to taking the impression, the soft tissue was retracted using the double cord technique. A cord of the size 00 was placed first, followed by a cord of the size 02 (both Gingi-Aid Z-Twist, Gingi-Pak, California, USA) (Figs. 3 and 4). This technique enables better retraction, control of seepage and bleeding and leads to improved visibility of the preparation margin, so that more Figure 3: Placement of cord #00 into the sulcus. Figure 4: Placement of cord #02 for gingival retraction. accurate impressions are obtained. The precision impression was taken using Impregum L DuoSoft and Impregum Penta H DuoSoft Impression Materials (3M ESPE) (Fig. 5). These materials are routinely used in my dental practice, because they are highly hydrophilic and especially No. 19 MAR 2011
Espertise magazine the light body material exhibits a better flowability than other products I have tested so far. Thus, they enable a precise reproduction of every detail. For the production of the provisional restoration, a direct-indirect technique was chosen: a cast and a wax-up were fabricated and an impression was taken with Express Bite Registration Material (3M ESPE) to produce a mould of the desired anatomy. Subsequently, Protemp 4 Temporization Material (3M ESPE) was dispensed into this impression (Fig. 6). After setting, the temporary was removed from the impression and finished. Protemp 4, a nano-filled temporization material, is the strongest material I have tested so far. Due to the small size of the fillers, there usually is no need for polishing: wiping the surface with ethanol is sufficient in most cases to obtain a natural, lasting gloss. Another reason for me to use this material is the fact that relining and repair is possible with any flowable composite filling material or the material itself with no need for pretreatment. Figure 7 shows the temporary restoration in situ one week after the placement. A healthy gingiva was obtained taking into consideration that the margin was placed slightly subgingival and a well-adapted temporary was produced. 5 Figure 8: Placement of the retraction cord on tooth 21 and fixation of the zirconia-based substructure with silicone to avoid movement during the pick-up impression. Figure 5: Impression of tooth 22 with Impregum L DuoSoft and Impregum Penta H DuoSoft Impression Materials. Provisionalization Figure 6: Dispensing of Protemp 4 Temporization Material into the silicone mould. Figure 7: The temporary restoration on tooth 22 exhibits natural gloss. The veneer: preparations After having fabricated the zirconia-based substructure for the crown using Lava Zirconia (3M ESPE), tooth 21 received a veneer preparation and a retraction cord was placed (Fig. 8). Again, we opted for the double cord technique. Afterwards, a second precision impression was taken with Impregum L DuoSoft and Impregum Penta H DuoSoft (Fig. 9) and a new temporary restoration (Protemp 4) was fabricated splinting both teeth (Fig. 10). Since the preparation of tooth 21 only affected the enamel and there were no Figure 9: Impression of the veneer and pick-up of the zirconia-based substructure. Figure 10: Completed temporary restoration. sensitivity issues present, the complete temporary restoration was just cemented on tooth 22 with RelyX Temp NE, a eugenol-free temporary cement (3M ESPE) (Fig. 11).
Clinical Excellence Aesthetics 6 Figure 14: Try-in of the restorations: in the mouth, the veneer and crown have a natural appearance. Figure 11: The temporary restoration in situ. Final restorations The crown made of a Lava Zirconia coping was layered with porcelain in the laboratory. Simultaneously, the veneer was produced from a different ceramic material (IPS e.max, Ivoclar Vivadent, Liechtenstein). Afterwards, both restorations were fitted on the model (Fig. 12). It turned out not only was the precision good, but also the shade and translucency of the two materials were very similar. This fact was highly advantageous, since the major challenge of this case had been the matching of the appearance of the two different materials with each other as well as with the adjacent teeth of the young patient. Lava Zirconia is selected in my practice for most indirect restorations, since it exhibits proven material strength, precise fit and appealing aesthetics. To allow for a minimally invasive procedure, we opted for a lithium disilicate ceramic veneer without a framework on tooth 21. Placement of the restorations In order to check the appearance of the crown and the veneer in the natural environment, the restorations were placed in the patient s mouth with RelyX Try-in Paste (3M ESPE) in the translucent shade (Figs. 13 and 14). The patient was highly satisfied with the result in terms of colour and shape and was ready for the definitive cementation. After complete isolation of the working field, the enamel on tooth 21 was etched with phosphoric acid for 15 seconds (Fig. 15), washed thoroughly and dried. Then, Adper Scotchbond Multi-Purpose Adhesive (3M ESPE) was applied and without prior light curing, the veneer was cemented using RelyX Veneer Cement (3M ESPE) (Figs. 16 and 17). The excess material was removed after tack-curing and the restoration light-cured. Subsequently, RelyX Figure 15: Application of phosphoric acid. Figure 12: Veneer and crown on the cast. Figure 13: Application of RelyX Try-in Paste for optimal predictability of the appearance of the restorations. Figure 16: RelyX Veneer Cement dispensed into the inner surface of the veneer. No. 19 MAR 2011
Espertise magazine Figure 17: Seating of the veneer with complete isolation. was tack-cured for about one second with Elipar S10 LED Curing Light (3M ESPE) and the excess material removed (Fig. 20). Finally, each surface of the restoration was light-cured for 20 seconds. The final result was highly aesthetic (Figs. 21 and 22) and the patient was extraordinarily happy that her teeth looked beautiful at her wedding. Conclusion The present case shows how the use of high-quality materials may optimally support the dentist in achieving beautiful results. The particular challenge presented here was to satisfy a young lady in one of her most important phases in life, when she was about to get married and was in need of an aesthetic solution which was produced within very short time 7 Unicem Self-Adhesive Resin Cement (3M ESPE) was applied into the inner surface of the crown without loss of quality. With the utilization of two different materials, the desired result was obtained. (Fig. 18). The cementation with this material is easy, because the need for prior etching, priming or bonding of the tooth is eliminated. The crown surface was just sandblasted with 30 µm aluminum oxide prior to cement application. Although many steps Figure 20: After tack-curing, easy removal of the excess cement is ensured. Acknowledgements My sincere thanks to the following individuals for their support: Luiz Alves Ferreira, CDT; Rosimere Ataliba, CDT and Juan Heriberto Kempem, Milling Center are left out, a very good bond strength is achieved. After placement of the crown (Fig. 19), the cement Figure 18: Application of the cement into the crown. Figure 21: Final situation after two days. Figure 19: Seating of the crown. Figure 22: Beautiful teeth with a natural look were obtained.
Country Insights Dentistry in the Italian Republic Stefano Valbonesi, Bologna, Italy 8 The Council of European Dentists (CED) has identified 34 dental schools which have been part of medical faculties in Italian universities in 2008. There, a university degree in dentistry and dental prosthesis is usually obtained after six years of theoretical as well as practical training. However, many professionals who are actively practicing as dentists today have not studied dentistry but hold a degree in medicine and surgery with a specialization in stomatology. It was not until 1985 that a separate dental curriculum with a dental degree was introduced. Today, all dentists entering the profession must have attended dental school and receive their permission to practice the profession only after registration. While post-graduate vocational training is not required, there are two recognized options for specialization: orthodontics and oral surgery, both completed after three years of education. In addition, diverse further training courses are available. Public health insurance In Italy, the cost for specific dental treatments is partly or completely covered by the public health service, which is funded from national and regional taxation as well as state budget and includes a comprehensive oral health care system. The services guaranteed by the government and provided free of charge are summarized in LEA (Essential Levels of Assistance). Within dental care, only implant treatments are officially excluded. However, the services which are part of the national insurance may vary widely between and even within different regions, since the local governments may decide what kind of treatments will be included. In most regions, dental examinations and urgency treatments as well as specific oral care for children, patients with health impairment and socially vulnerable people are covered by the public system. Dr. Stefano Valbonesi treating a patient. While there are several different private health insurance systems available, many of them exclude routine dental treatments. A small percentage of patients are enrolled in companybased insurances, but, at least in my dental practice, approximately 95% of the patients pay privately. Since very few dentists have a contract with the public health service, it is often difficult for patients to find a dentist in the public sector. The dental practice In 2007, the number of dentists actively practicing in Italy was 48,000 with a female proportion of 34% according to the CED. The common dental practice in Italy is owned by one dentist who employs two to three people: In many cases, one hygienist and one or two dental assistants are under contract. Partnerships with more than one practice owner are rather uncommon in the country, however, some regional differences do exist. Since most dentists in Italy are general dental Dr. Valbonesi runs a practice in Bologna, Italy, together with three partners. practitioners, many offices provide the whole range of dental treatments. In the dental office Studio Associato Nove Archi, the situation is somewhat different: I have established it with three partners in 2004. While every kind of treatment is offered, each of us focuses on his or her field of expertise: prosthodontics, periodontology, implantology as well as endodontic and restorative dentistry. For orthodontic treatments, the patients are referred to a colleague with an orthodontic specialization who works in the same building. In addition to the four practice owners, two dentists and two dental hygienists perform work under contract. No. 19 MAR 2011
Country Insights Espertise magazine Dentistry in the Republic of Poland Paweł Niewada, Warsaw, Poland In the Republic of Poland, a degree in dentistry can be obtained at ten different dental schools, all of which are state-funded. In order to regulate the number of students, every applicant has to go through a competitive admission process which takes into account the scores in the high school graduation certificate and only those achieving a very good result are accepted as students of dentistry. Since the introduction of a new curriculum in 2002, graduation is possible after five years of dental training. While during the first two years, general and medical subjects are studied together with students of medicine, specific dental topics including practical clinical training are taught at the dental schools from the third year onwards. After graduation as a Dental Doctor (from 1996 to 2004, the awarded qualification has been Stomatologist), one year of vocational training and a final state examination (LDEP) are obligatory to be granted a licence to practice dentistry. For this qualification, every dentist has to register with the Chamber of Physicians and Dentists. Having obtained a licence, dentists may follow a three to five-year specialization program. However, applicants have to pass a qualification procedure and the result of the state exam is taken into account as well, since only a restricted number of study places are available. Thus, only the most successful graduates have access to specialist training. Healthcare system The Polish public health insurance is part of the National Health Fund (NFZ) which is financed by a compulsory fee paid by every Polish citizen with Lek. stom. Paweł Niewada an income. For all insured patients, basic dental services such as periodical examinations are free of charge, if they are accessed in clinics or practices with an NFZ contract. There, children and adolescents under 18 years of age as well as women during or shortly after pregnancy are offered further free treatments. Only a part of the dental practitioners in Poland works in public clinics or practices which have concluded a relevant contract with the NFZ. Others, like me, have established their own private practice or work as employed dentists in the private sector. Availability of insurances not founded by the government is limited in Poland, thus many patients pay for their dental treatment out of pocket. In my dental practice in Warsaw, only some patients coming from abroad have a private insurance. The dental practice in Poland According to the Polish Chamber of Physicians and Dentists, approximately 75% of the 34,512 dentists registered in Poland in 2008 were female. The reception area of the Niewada Clinic in Warsaw. In the larger cities in Poland, there are several polyclinics with approximately 60 dentists working under contract. Typical private practices consist of two to four dentists. In many cases, there is a single practice owner employing several dentists. For specialists, it is common to work at different places in their specific field of expertise. I have founded my own practice in Warsaw in 2006. Currently, five additional dentists, four chairside assistants and two receptionists are working in NIEWADA CLINIC Implantology and Esthetic Dentistry. All of them are under full or part-time contract. Especially for dentists working in state clinics with low income, a second job in a private practice is highly advantageous. At Niewada Clinic, all kinds of treatment including prevention, periodontology, prosthodontics, implantology, pediatric dentistry and orthodontics are offered. As a specialist in periodontology, my focus lies on this field of dentistry as well as implantology involving minimally invasive procedures. 9
News and Innovations IDS Cologne 2011 Passionate about quality Bernd Betzold, 3M ESPE, Seefeld, Germany 10 Under the motto passionate about quality, 3M ESPE is going to welcome dental professionals from around the globe during this year s IDS. The company s exhibition area in hall 4.2, booth G 90/91 will have a lot to offer: Ease of use Further along, on the same side, materials and devices that stand out especially due to their easy handling are presented. The most impor- Using e.g. hands-on demonstrations and interactive touch screen technology, the visitors will learn about inspiring solutions related to the core issues aesthetics, ease of use and precision. In 2009, crowds of dental professionals met at the booth of the company to obtain information about the most popular novelty, the Lava Chairside Oral Scanner C.O.S. Two years have passed since then and the 3M ESPE team has Visitors took the opportunity to attend live demonstrations of the Lava Chairside Oral Scanner C.O.S. tistry ease of use, precision, and aesthetics can be experienced in different areas. In addition, practicability of the solutions is illustrated by diverse practitioners, who present clinical cases and report on their individual experience with products by 3M ESPE. Bar Stage Digital precision Ea of been busy to develop new and optimize existing products which support dentists and dental tech- Aesthetics nicians from all over the world in their everyday Entering the booth via the main entry point, visi- work. In order to ensure this, 3M ESPE has set tors will find the area representing aesthetics on itself the target to create innovations which offer the right hand side. Here, the focus will be on ease of use and at the same time provide for materials which enable the creation of lifelike highly aesthetic and precise results. At the booth temporary and permanent restorations. For of the company at this year s IDS, these three example, interested dental practitioners are able most important issues for successful work in den- to test Filtek Supreme XTE Universal Restorative, a true nanocomposite which tant benefit of easy-to-use products is that they offers high gloss enable more efficient as well as less error-prone and optimized fluo- work processes. Solutions by 3M ESPE include rescence. Since it e.g. RelyX Unicem 2 Automix Self-Adhesive is available in many Resin Cement, which is used for adhesive different shades cementation of indirect restorations. Thanks to and opacities, the the specific formulation of the product and its dentist will achieve novel delivery system, work steps such as etch- natural results, ing, priming and bonding of the tooth as well as independent of the mixing of the two material components are elim- The 3M ESPE booth at the IDS 2009. selected technique. inated. No. 19 MAR 2011
Espertise magazine Precision The area of the booth dedicated to precision is found on the left side and is divided into two parts. Near the entrance, the classic precision products of the company, including conventional impression materials, are shown. Here, visitors are invited to explore e.g. the properties of Impregum Polyether Impression Materials. A whole range of materials in different quick-setting and soft variants is available. are demonstrated live as a part of diverse digital workflows explained in this area. From local anaesthetics to denture stabilization 11 Near this interesting world of new technologies, Service Near the center stage, digital precision presents itself: dentists may be most interested in the Lava dentists obtain information about local anaesthetic solutions by 3M ESPE e.g. Ubistesin C.O.S. and its new indications, which allow for a 1:400 000 based on the agent articaine as well se use more comprehensive use of the device. Moreover, visitors will find different novel materials opening as MDI Mini Dental Implants. These are primarily used for denture stabilization and can be inserted new opportunities as well as soft- and hardware in a simple, minimally invasive procedure. In the contributing to precise restorations. same part of the booth, orthodontic solutions are demonstrated by 3M Unitek. Aesthetics Information Lab world For dental technicians who would like to test the Lava Design Software on the spot, the lab world Conclusion The spectrum of products for diverse procedures in on the opposite side of the main booth (G91) has the dental practice and laboratory offered by Classic precision a lot to offer: several design workstations and the scanner Lava Scan ST are available and may be used. In addition, the milling machines Lava CNC 3M ESPE is versatile, yet it combines the most important factors that contribute to successful results. This is what is called passionate about qual- 500 and the novel compact unit Lava CNC 240 ity. 3M Unitek MDI Mini Dental Implants Local anaesthetics Labworld Lounge Bar
Backstage Report Old town of Cologne Discovering the old town on foot in 30 minutes Carina Koppers, 3M ESPE, Seefeld, Germany 12 No matter whether approaching Cologne by car or train, the Cologne Cathedral (Kölner Dom) is usually the first thing that attracts the visitor s Archeological zone and Farina house directly beneath the gothic tower, is the only room where the historical substance has been preserved. It is now used for wedding ceremonies. attention. In fact, the cathedral is the most fre- Via Heumarkt, on their way to the Historische quently visited building throughout Germany. However, although impressive in its appear- Rathaus (old town hall) which was built in 1330, visitors pass the archeological zone. Here, the Alter Markt ance, it is not the only landmark Cologne has to remains of the medieval Jewish quarter, including From the town hall, steps lead down to Alter Markt offer. With its more than 2,000 years of history, a synagogue, are currently being excavated. Part (Old Market), a popular square in the historic centre especially the old town, where traces of history of the site is covered by a transparent pyramid and which has once been the hub of the city. In Roman mix up with modern life, is worth a visit. thus visible to the public. times, the area served as a haven outside the city wall. Over time, the haven silt and was finally filled This article serves as a guide for those who would Opposite of this zone, guests will find the parent up due to an expansion of the city. Today, its stir- like to explore the area on their own. It offers some house of the family Farina, which is famous for its ring, fascinating atmosphere - currently a bit background information about several sights, and Eau de Cologne (Kölnisch Wasser). Contrary to affected by the construction site of the new under- describes a short tour through the heart of many rumors that 4711 is the name of the original ground line attracts tourists from all over the Cologne. perfume from Cologne, it is only a copy of the real world. The mixture of different historic and modern one invented by Johann Maria Farina, an Italian buildings is beautiful, and numerous cafes, bars Puppet theatre citizen who established a fragrance company in 1709. Today, his successors are still producing and pubs invite guests to stay for a while. People interested in Cologne Carnival and culture should start their tour at Eisenmarkt, a small and the original fragrance at the site where the factory was founded, and the perfume can be experi- Groß St. Martin quiet place just a few steps away from Heumarkt, enced in the in-house fragrance museum. Groß St. Martin (St. Martin s Church or Great St. which is one of the biggest squares in the centre Martin), a Romanesque Catholic Church, is the next of the city. At Eisenmarkt, visitors will find the socalled Hänneschen theatre, the most famous tra- Town hall stop of the tour. During the Middle Ages already, this basilica has shaped the panorama of the old town, ditional stick puppet theatre of Cologne, which During the centuries after the establishment of the being its main landmark until the erection of the has been established in 1802 by Johann Chris- town hall, it has been expanded several times. famous Cologne Cathedral. Great St. Martin with its toph Winters. The fictitious characters of the plays The north and south walls of the building are current buildings was founded on a natural island on are universal and local archetypes and are not decorated with gothic tracery including big the Rhine in the 12th century, resting on Roman only popular with children, but fascinate grown- wooden sculptures from the 15th century, while remnants. For several centuries, it served as a Ben- ups as well. Although the language of the plays is the especially beautiful loggia, which serves as edictine monastery and became a parish church in Kölsch (the Cologne dialect), the story which is the main entrance to the town hall today, was built the 19th century after secularization in Germany. told is easily understood by tourists. Especially in the 16th century. The town hall is the oldest one The church was badly damaged during the war, during the Carnival season, the plays are usually in Germany today, however, it was heavily dam- when 90% of the building stock in the city centre fully booked. In front of the theatre, people can sit aged in the Second World War (only the renais- was destroyed. Reconstruction of the church was on a bench next to a statue of local actor Willy sance loggia remained intact) and was recon- completed in 1985. Since 2009, when a branch of Millowitsch (1909-1999), who is considered as structed close to its former appearance until the Monastic Fraternities of Jerusalem started using the embodiment of the Cologne way of life. 1980. Nowadays, the old wine cellar, located the church, it is open to the public again. No. 19 MAR 2011
Espertise magazine Fischmarkt and promenade Cologne Cathedral View from LVR tower 13 Several steps lead from the church down to Fischmarkt (the former fish market) with its beautiful buildings which have been erected in 1100. They once belonged to the terrain of the abbey church just seen and remind visitors of the history of Cologne as a trade metropolis. Next to the small buildings of the Fischmarkt is the Stapelhaus, which was used for storage purposes. Due to the Town hall Stapelrecht (storage law) introduced in 1259, all goods shipped through Cologne had to be released for vending and processing. For the city, this law generated an important source of income. Within the building, e.g. fish was cleaned, filleted, salted and stored as well as repacked and resold. Today, the reconstructed Farina house storage building is owned by the Kreishandwerkerschaft Köln (local trade association). From the market square, a wide promenade invites visitors to take a walk in the direction of Hohenzollern bridge, past several restaurants and bars. On the other side of the Rhine, a large tower (LVR-Turm) is visible. It might be worth a visit as well, because it is possible to take a lift to the top of the tower and enjoy a unique view over the whole city. Obenmarspforten Roncalliplatz Am HofGroße Neugasse Untergoldschmied Quartermarkt St. Martin's Kleine Budengasse Town hall Archeological zone + Farina house Judengasse Cologne Cathedral Martinstraße Alter Markt Past the Philharmonie and the Romano-Germanic Museum, the path leads to the main entrance of the most famous landmark of Cologne. The construction of the Cathedral, which is a UNESCO World Heritage Site today, began in 1248. The choir was consecrated in 1322, however, work was interrupted several times and the building was officially completed in 1880, after more than 600 years. Still, many people state that the building will remain unfinished, because repair will always be necessary. Due to its impressive size, Steinweg Bolzengasse Alter Markt Unterer Käster Brigittengäßchen Fischmarkt Fischmarkt Heinrich-Böll- Platz Bischofsgartenstraße Mühlengasse Lintgasse Ostermannplatz Kastellsgässchen Heumarkt Auf dem Brand Wehrgasse St. Martin's Church Mauthgasse Am Frankenturm Salzgasse Auf dem Rothenberg Buttermarkt Puppet theatre Markmannsgasse Am Bollwerk the Cathedral itself needs constant renewal. Currently, approximately 80 craftsmen are employed in Cologne to maintain the Cathedral. Interesting insights Fischmarkt Although the short tour has been able to take up only some of the fascinating landmarks of Cologne, it may have shown that the city offers something for everyone. Interested visitors can obtain additional information e.g. at. www.cologne-tourism.com/.
Clinical Excellence Precision Complex restoration procedure in the anterior region Carlos Sabrosa, Rio de Janeiro, Brazil 14 Figure 1: Initial clinical situation: A middle-aged male patient presented in the dental practice with large insufficient composite fillings in the anterior region. Figure 2: Removal of the old fillings. It was decided to build up the teeth with Filtek Silorane Low Shrink Posterior Restorative (3M ESPE) before preparing them for complete crowns. Figure 3: Preparation of the anterior teeth for all-ceramic crowns. Tooth 22 was endodontically treated and needed a post to replace lost tooth structure. Figure 4: Fabrication of a customized fibre post for tooth 22. Composite material was added to a glass fibre post, the fit and size of the post were checked and adjustments were made. Figure 5: Cementation of the customized fibre post using RelyX Unicem Aplicap Self-Adhesive Resin Cement (3M ESPE). Figure 6: Adper Easy Bond Self-Etch Adhesive (3M ESPE) was applied in order to seal the dentin tubules and thus provide for a smoother surface. This hybridization of the dentin enables a stronger bond. Figure 7: Cementation of a temporary restoration. For the fabrication of the provisional made of Protemp 4 Temporization Material (3M ESPE), an indirect technique involving a wax-up and a silicone impression was chosen. Figure 8: Retraction of the soft tissue using the double cord technique (Gingi-Aid Z-Twist sizes 00 and 02, Gingi-Pak, California, USA). Figure 9: Impregum L DuoSoft Impression Material (3M ESPE) was extruded around the prepared teeth. No. 19 MAR 2011
Espertise magazine 15 Figure 10: An impression was taken with Impregum Penta H DuoSoft Impression Material (3M ESPE). Every detail is reproduced with high precision. Figure 11: The full-contour wax-up was taken as a basis for the production of the final restoration. Figure 12: A complete reduction of the wax-up was carried out. A silicon key made of VPS impression material was used to check the volume of the reduction, which should be at least 1.2 mm. Figure 13: Milled Lava Zirconia crown copings (3M ESPE). Figure 14: Precise fit of the zirconia copings on the master cast. Figure 15: Aesthetic final restorations on the master cast. The crowns show a colour which is typical for the natural teeth of a middle-aged patient. Figure 16: After having prepared the inner surface of the crowns with the CoJet System (3M ESPE), they were cemented with RelyX Unicem Aplicap Self Adhesive Resin Cement (3M ESPE). With this material, an excellent bond is established between the tooth structure and the restoration. Figure 17: The restorations in the patient s mouth Figure 18: have a highly natural look. Acknowledgements My sincere thanks to the following individuals for their support: Luiz Alves Ferreira, CDT; Rosimere Ataliba, CDT and Juan Heriberto Kempem, Milling Center
Ask the Expert Customized fibre post A contribution to long-lasting restorations Gerhard Kultermann, 3M ESPE, Seefeld, Germany 16 Interview with Dr. Carlos Eduardo Sabrosa, Associate Professor at the State University of Rio de Janeiro Dental School and owner of a private practice in Leblon, Rio de Janeiro, Brazil. Dr. Sabrosa, the case report on the previous two pages shows a complex restoration procedure in the anterior region. Why did you opt for an indirect restoration procedure with all-ceramic crowns? During removal of the old fillings, we realized that the area to be restored was too large for a direct restoration procedure. Not only were the margins of the fillings insufficient, we also detected secondary decay and had to remove part of the tooth structure as well. As we were not able to guarantee for an aesthetic and long-lasting result using composite material, we decided to place allceramic crowns. This was in line with the desires of the patient, who asked for an aesthetic and, at the same time, strong and durable solution. In order to achieve this, high precision during the whole restoration process was given top priority. What were the special measures employed to ensure high precision? First of all, the fit of the endodontic post was optimized by customizing it. This procedure may be unfamiliar to many dentists and there is no literature available on this topic so far. However, the idea behind this technique is that the cement gap between post and tooth may cause restoration failure. If the gap is too large, a considerable amount of cement is needed in order to fill it and the shrinkage of the cement during polymerization might ultimately Yes, we started to implement this approach two lead to debonding and loss of the whole restoration. and a half years ago. Since then, the success In order to avoid this, a special technique was developed which allows for a minimized cement gap. high-quality materials for steps such as impres- rate has been 100%. Of course, the use of other sion taking and the production of the final restoration are decisive for the result as well. To sum Please describe the different steps that lead to an endodontic post with improved fit. up, the combination of the customized post technique with other materials and methods that In my practice, we use a glass fiber-reinforced stand for high precision lead to the desired restorations which convince dentists and patients composite post as a basis for the production of a customized post. After the usual preparation of the alike. tooth, a post of an appropriate size is selected and Silorane System Adhesive Self-Etch Bond is applied Dr. Sabrosa, thank you very much for the on it to ensure a high bond strength. Then, a restorative (Filtek Silorane Low Shrink Posterior informative conversation. Restorative, 3M ESPE) is added. The compo site filling material, which is the material of choice for this technique due to its extraordinarily low shrinkage of less than one percent, is light-cured and Fit Checker (GC, Tokyo, Japan), a black C-silicone material, is applied on the post. After having placed the post in the prepared tooth, the spots where the composite material is shining through are marked. The fit checker is removed, adjustments are made and the individual, precisely fitting post is seated and cemented. Has this technique already proven its worth in your practice? Dr. Carlos Eduardo Sabrosa No. 19 MAR 2011
Clinical Excellence Espertise magazine Filtek Supreme XTE Flowable Restorative Clinical use of a novel flowable composite in the posterior region Gunnar Reich, Munich, Germany 17 Figure 1: Initial clinical situation. Figure 2: After the placement of rubber dam, the old composite filling is removed. Figure 3: Selective enamel etching with phosphoric acid to provide for an optimal bond. Figure 4: Application of Adper Easy Bond Self-Etch Adhesive with the L-Pop Applicator (3M ESPE). Figure 5: After polymerization of the adhesive, the first layer of Filtek Supreme XTE Flowable Restorative in the shade A3.5 is placed on the cavity floor Figure 6: and light cured for 10 seconds with Elipar S10 LED Curing Light (3M ESPE). Figure 7: The completed restoration after application of a second layer of flowable composite in the shade A3.5 and light curing (10 seconds). Figure 8: After finishing, the filling is virtually undistinguishable from the natural tooth structure.
Country Insights Dentistry in the Federal Republic of Germany Ulrich Baumheuer, Münster, Germany 18 In Germany, dentistry can be studied at 29 publicly funded universities and one private dental school. The curriculum is divided into a pre-clinical and a clinical part, each taking five semesters and being concluded with a state examination. After a total of five years of undergraduate training, a certificate in dentistry is obtained. Before being allowed to register as a dentist, however, a graduate has to work as an assistant dentist for two years ination, diagnosis, prevention, direct restorations, periodontology and endodontics. Advanced dental care (e.g. orthodontic treatment and the production of indirect restorations) is covered in part by the health insurance, while the placement of implants is usually excluded. In the past years, the number of patients with a complementary private insurance has increased significantly, since the range of treatments financed by the health Dental workforce in Germany According to the Bundeszahnärztekammer, approximately 66,318 dentists have been actively practicing the profession in Germany in 2008, with a female proportion of about 40%. The average number of chairside assistants per dental practice has been 3.44 in the West German states and 2.57 in the new East German ones. under the supervision of an experienced colleague. Registration is compulsory for all those who want to treat legally insured patients (98% of practices). Those who want to become specialized dentists can opt for one of four different officially recognized subjects: Oral surgery, orthodontics, periodontology (only recognized in Westphalia) and dental public health. A certificate is obtained after four years of training in university clinics or particular practices. In addition, numerous continuing education courses and Master programmes are insurance funds is no longer regarded as sufficient by many patients and dentists. In my dental practice in Münster, Germany, about 35% of the patients have a private insurance. However, all of my patients are convinced that high-quality treatments are worth an extra payment covered by themselves or a complementary insurance. Most dentists practice in single or joint practices and provide a broad range of treatments. Many of them are self-employed and the single practice is still more common than any kind of partnership with colleagues. I have decided to acquire a single practice in 1987 and since then, I am practicing without a partner. In this way, I can pursue my own goals. My philosophy is based on a holistic approach and complex individual care for every patient. My patients are treated in a three-surgery practice by me and my five assistants. available today. Insurance The German healthcare system is based on a public insurance provided by state-approved notfor-profit insurance organizations. Every employee with a gross monthly income of less than 4,162.50 (in 2010) has to become a member of a health insurance fund. A part of the monthly fee is paid by the employee, while the remaining part is settled by the employer. The dental practice is located in Münster, Germany. In general, all publicly insured citizens have access to free dental treatments such as exam- Dr. Ulrich Baumheuer. No. 19 MAR 2011
Country Insights Espertise magazine Dentistry in the French Republic Frédéric Raux, Paris, France In France, dental students can obtain a degree at 16 dental schools, all of them being state-funded. Prior to graduation as a Doctor of Dental Surgery, six years of education are required. During the first year, dental students are trained together with students of other medical disciplines and have to pass an examination to be accepted at the dental faculty afterwards. What follows are five years of combined theoretical and practical training, with direct patient contact from the fourth year onwards. After graduation, dentists have to register at the Ordre National to be allowed to practice dentistry. Post-graduate vocational training is not necessary. Currently, the only dental specialization option which is officially recognized in France is orthodontics (requiring four years of part-time study at university), while there are ongoing discussions about the introduction of a specialization in oral surgery as well. Apart from dental surgeons, stomatologists are also allowed to practice dentistry in France. However, this degree, which is a specialty of medicine, is no longer offered in the country. Insurance There is a public health insurance which is compulsory for all citizens in France. Public services are provided by dentists practicing within a special agreement known as the Convention. The services completely cover some treatments like regular preventative care for children and adolescents as well as part of the costs for other treatments such as conservative care, orthodontics and prosthodontics. Since public health insurance is not available to patients treated by dentists who are not working under the Convention, 99% of all dentists have entered a specific agreement. The national insurance does not cover all fees, therefore, 90% of all Dr. Frédéric Raux patients have some kind of complementary insurance as well. People with low income are usually members of the Universal Sickness Insurance, while others adopt one of different models of voluntary complementary service. In my own dental office in Paris, patients usually make use of their public and an additional private insurance. Fees are paid by the patients and claimed back by them at different institutions. Due to this system, there are not many patients paying privately for their dental treatment in France. The dental office in France According to the French Dental Association (ADF), there are currently approximately 39,000 dentists practicing in France. The number of dental assistants, who do not have to register, is very low as compared to other European countries and was approximately 15,000 in 2008 (Council of European Dentists). has established his dental practice in Paris, France. I have founded my own practice in July 2009 and share the premises with a female dentist. However, we work independently, buy our own dental equipment and each of us employs an assistant. Only the rental fee and running costs are divided. The treatment spectrum offered by me includes aesthetic dentistry, prosthodontics and endodontia. In addition, I offer pre-operative implant planning and the placement of implant-based prostheses, while the surgical treatment is done by a colleague. In the last decades, the common dental practice in France has been a single practice. During the past years, however, we have seen a clear tendency towards the foundation of joint practices with two to four owners. In addition, insurance providers have begun to found their own practices, where dentists are employed and may work under contract. 19
General Information Espertise magazine Calendar of Events 2011 Date Event Location Website 30.03.2011 03.04.2011 34th Australian Dental Congress Brisbane www.adc2011.com/ ADA E D I T O R I A L Information Editor: Gerhard Kultermann 07.04.2011 09.04.2011 25.04.2011 28.04.2011 28.04.2011 30.04.2011 01.05.2011 06.05.2011 04.05.2011 08.05.2011 13.05.2011 14.05.2011 18.05.2011 20.05.2011 26.05.2011 28.05.2011 26.05.2011 28.05.2011 Scandefa Copenhagen www.scandefa.dk Bella Center Dental Salon 2011 Moscow www.dental-expo.com Dentalexpo Ltd. 2011 Annual Spring Meeting Toronto www.oda.on.ca Ontario Dental Association 33rd Asia Pacific Dental Congress 2011 Manila www.apdc2011.org Philippine Dental Association AMIC Mexico City www.amicdental.com.mx AMIC Dental WID Wiener Internationale Dentalausstellung Vienna www.wid-dental.at Österreichischer Dentalverband Journées Dentaires de Nice Nice www.journees-dentaires.com Journées Dentaires de Nice - CMIOM Salón Dental Chile Congresso degli Amici di Brugg Santiago de Chile Rimini www.salondentalchile.cl Mundo Dental www.amicidibrugg.it Associazione Amici di Brugg Editorial team: Nicole Jaganosch Oliver Kappler Dieter Klasmeier Carina Koppers André Rumphorst Production: www.eberl.de Immenstadt/Germany Design and typesetting: Comcord GmbH Düsseldorf/Germany We accept no liability for unsolicited manuscripts or photographs. Court of Jurisdiction: Munich 03.06.2011 05.06.2011 2nd Hong Kong International Dental Expo and Symposium Hong Kong www.hkideas.org Hong Kong Dental Association 09.06.2011 12.06.2011 24.06.2011 26.06.2011 10.08.2011 13.08.2011 06.10.2011 08.10.2011 10.10.2011 13.10.2011 25.11.2011 30.11.2011 Sinodental Bejing www.sinodent.com.cn/en IHEC SIDEX 2011 Seoul www.sidex.or.kr Seoul Dental Association Expodent 2011 Cordoba www.expodentcordoba.com.ar Cámara Dental de Córdoba INTERNATIONAL EXPODENTAL Rome www.expodental.it Promunidi S.r.l. ADA 152nd Annual Session Las Vegas www.ada.org American Dental Association 2011 Greater New York Dental Meeting New York City www.gnydm.com Greater New York Dental Meeting Published by: 3M ESPE AG ESPE Platz 82229 Seefeld E-Mail: info3mespe@mmm.com Internet: www.3mespe.com 3M ESPE AG ESPE Platz 82229 Seefeld Germany E-Mail: info3mespe@mmm.com Internet: www.3mespe.com 3M, ESPE, Adper, Aplicap, CoJet, DuoSoft, Elipar, Espertise, Express, Filtek, Impregum, Lava, L-Pop, Penta, Protemp, RelyX and Ubistesin are trademarks of 3M or 3M ESPE AG. Gingi-Aid, Z-Twist and IPS e.max are not trademarks of 3M or 3M ESPE AG. 3M ESPE AG 2011. All rights reserved.