An innovative Magazine for Dentists from 3M Espe

N o 6/2005, February An innovative Magazine for Dentists from 3M Espe Editorial Contents Dear Readers, Challenge Interfaces was the umbrella topic of the international 3M ESPE Dental Innovation Symposium, which recently took place in Munich. About 150 experts from more than 30 different countries discussed state-of-the-art and future challenges on the interactions with dental materials. You can read more about this meeting in this magazine. In addition, a CD-ROM documentation picturing all the lectures given during this international meeting will be published in 2005. Challenge interfaces may also be the headline when developing new products: the flow behaviour of impression materials on moist surfaces in the oral cavity, the bonding of dental materials to the tooth structure or the interaction of final restorations with the patients environment are always raising the bar for developers. You can also read in this edition how well they met these challenges with our new fast setting Polyether impression material. Not only when you introduce such new products into your daily practice, you have to deal with change management. You will find more about that in the Dental Practice Forum. Last but not least, we want to invite you to visit us at the IDS in Cologne, the biggest dental exhibition world wide. Enjoy reading! Gerhard Kultermann, Editor 3M ESPE, Seefeld, Germany Editorial & Contents 1 Zen or the Art to Make an Impression 2 Facing Hypersensitive Teeth? Simply Seal It! 4 Host to the Scientific Elite of the European Dental World 5 How to Improve the Penta System? 6 Restoration of Anterior Teeth with Full Ceramic Crowns 8 Composite Core Build-Up on Adhesively Luted Metal Post 10 The Express and Easy Way to Impressions! 12 The Best Documentation for an Attractive Smile 14 How to Overcome: That s How We ve always Done It? 15 General Information 16

N o 6/2005, February, Page 2 Product Information Express Penta Putty Vinyl Polysiloxane and Impregum Penta Quick Polyether Impression Materials Zen or the Art to Make an Impression Laslo Faith, 3M ESPE, Germany The art to make a dental impression is much diversified. People will develop with time their very special technique, mixing what they learned at university, during their work as a young dentist and what they found to be the best during years in their own practice. Figure 1: Homogeniously mixed material from the Pentamix Automatic Mixing Unit Recently I had the chance to interview a number of dentists in Europe. It was amazing to see how many versions of the standard techniques are used, sometimes with some surprising and intelligent improvements. Dental industry offers a number of very different and very similar products for dental impressions. Main guideline for the industry are the three well-known techniques or methods: Two-step putty/wash Double mix technique Monophase There are of course indications which will fit to the one technique or to the other, but in general dentists decide to use a method which supplies reliable results with high precision and well fitting final restorations. As we all know already very small errors and mistakes in the process can have a significant effect on the final result and jeopardize the whole process. This is also linked to some financial risks if a large prosthetic work, a bridge, does not fit. For this reason, if a reliable process has been found, hardly ever this process will be abandoned. Personnel in this process are the patient, the assistant, the doctor and the dental technician. Other factors are anesthesia, retraction, sometimes electrosurgery, the preparation, the situation in the mouth and the impression material. If one component or one step or one person is replaced or malfunctions the result of the process is put at risk. For the patient, preparation work and impression taking is a stressful situation. For the doctor too, let us think of retraction with cords, the use of haemostatic agents and keeping the area dry for the impression. What maybe most dental workers are looking for is serenity or peace of mind when taking an impression. In technical terms for this would be reliability, reproducibility, and above all, precision! 3M ESPE has got a long history in impression materials. In 2004 this history is continued with two new and major products: Express Penta Putty and Ultra-Light Body, a new product combination for the putty/wash method (launched in Europe in September 2004) and Impregum Penta Soft Quick (launch in Europe in April 2005) a new material for smaller prosthetic restorations for the monophase and heavy-body/light-body techniques. Figure 2: Introductory Kit of the new Express Penta Putty Vinyl Polysiloxane Impression Material Express Penta Putty is a real, rigid, fast setting putty material mixed automatically by the Pentamix Automatic Mixing Unit. The mixing is processed by pressing a button. The result is a void free impression material, mixed with a first-rate precision in mixing ratio therefore always providing the same working and setting times. Figure 3: Introductory Kit of the new Impregum Penta Soft Quick Express Ultra-Light Body is the intelligent wash material (with a very high viscosity) which will stay where it should and flow away from areas where it should not be. Impressive tear strength and an extraordinary hydrophilicity and wettability will support superb results. New molecular structures and reinforced siloxane network creation is the basis for these achievements. 2

N o 6/2005, February, Page 3 Product Information Impregum Penta Soft Quick Polyether Impression Material is the newest product of the Impregum family. This material is a fast setting Polyether, offering a significantly shorter oral setting time. This saves time and improves patient comfort. Stunning hydrophilicity (typical for polyethers) combined with top-of-the-line precision and remarkable flowability are characteristic of this material. With these two new products and the improved quality components the 3M ESPE impression material portfolio is going to supply the basis for relaxed work and excellent results with no doubts about the outcome. So the dental community shall work in serenity and with success. Impressive performance in the sulcus will supply clear preparation edges on the model. Archeologists who make copies of tiny bones of million year old dinosaurs are impressed by the extraordinary detail reproduction of micro-structures when they use Impregum. As we talk about an Impregum product, I do not even need to mention reliability and precision of this material. Both Express and Impregum products are used with the new Penta accessories, which will become standard for all 3M ESPE Penta impression materials in 2005: The improved red mixing tip, the new reinforced cap foilbags and the stainless steel Penta cartridges. The main objective of this change is quality improvement: this system shall work always, under any conditions and with all 3M ESPE materials, with a first-rate reliability and with a robust performance. The technical changes eliminate all potential failure sources and impressively increase the performance quality of the whole system. The new system components offer impressive design changes regarding all their features: the system works with less pressure, reduces material fatigue and creates improved interfaces between the components. These system components upgrade the Penta system to a quality level which will be industry-standard for the future. Figure 5: The new steel reinforced cartridge is placed into the Pentamix Automatic Mixing Unit➐ Figure 6: Replace used mixing tips directly before each mixing procedure ❿ 3

N o 6/2005, February, Page 4 Product Information Adper Prompt L-Pop Self-Etch Adhesive: Results of a European Practice Based Study Facing hypersensitive Teeth? Simply seal it! Andreas Syrek, 3M ESPE, Germany What causes tooth hypersensitivity? Tooth hypersensitivity is caused by fluid movement in the dentinal tubules. This movement can be stimulated by drying, temperature shifts, as well as by compounds such as sugar [Brannstrom 1) 1986]. Studies indicate that hypersensitive root surfaces can have eight times as many open tubules as non-sensitive dentine. Since the reason for tooth hypersensitivity is the open dentinal tubules, a treatment that occludes the open tubules should be effective in reducing or even eliminating the sensitivity. By scanning electron microscopy (SEM) Adper Prompt L-Pop has proven its ability to seal dentinal tubules. Figure 1: Open dentinal tubules, lateral view Clinical practice based study The effect of Adper Prompt L-Pop s sealing ability on the reduction of cervical hypersensitivities was evaluated in a clinical study that was run in general dental offices in five European countries. Design of the study 108 patients treated by 22 general dental practitioners in five European countries (Germany, France, Italy, Spain, UK) participated in this study. The dentists were asked to score the level of tooth sensitivity for each patient after exposing the cervical area to tactile (dental probe) and air/water stimuli. The results were recorded on a Visual Analog Scale (VAS), ranging from level 1 = no pain to 4 = very painful. Immediately after recording the baseline sensitivity Adper Prompt L-Pop was applied to the cervical tooth surface. Following light curing and removal of the oxygen inhibition zone the sensitivity level was scored again. Results of the study (Figure 3) The application of Adper Prompt L-Pop resulted in a significant reduction of sensitivity. This effect was more evident for the air/water stimuli, as these stimuli generated already higher pain scores at baseline. Correlation with dentine permeability The clinical results of this practice based study are in line with a dentine permeability study 2 conducted at the University of Regensburg, Germany. In this study the ability of Adper Prompt L-Pop to reduce fluid flow in the dentinal tubules was compared to several commercial desensitizers. The teeth were subjected to three conditions. First, a dry surface with no water pressure in the pulp chamber. Second, a moist tooth surface, but again no water pressure in the pulp chamber. Finally, a test condition where pressure was applied to the pulp chamber. Under any condition, Adper Prompt scored highest in its ability to reduce permeability and reduced permeability means less sensitivity. Resume Adper Prompt L-Pop provides an effective, reliable and fast treatment for hypersensitive teeth through a perfect seal of the dentinal tubules. Patients appreciated that the positive effect was immediately noticeable and that there was no need for local anaesthetics. During application of Adper Prompt L-Pop there is no reason for pain, as the procedure does not require a seperate phosphoric acid etching step. 4 3,5 3 Pain Level Italy France Spain Germany UK 90 % of dentin permeability reduction 80 70 dry, no pressure moist, no pressure pulp pressure simulation 2,5 60 50 2 40 1,5 30 1 20 Figure 2: Sealed dentinal tubules after Adper Prompt L-Pop application, lateral view. [Reference figure 2: UNC data on file] Detailed references available through your local 3M ESPE Dental Products office. 0,5 0 Mean tactile before Mean tactile after Mean air/water before Mean air/water after Figure 3: Patients expressed tooth sensitivity of exposed cervical area 10 0 Adper Prompt L-Pop Seal&Protect Gluma Desensitizer SuperSeal Figure 4: Dentine permeability study of University Regensburg, Germany (2) AADR 2003, Abstract 0632 4

N o 6/2005, February, Page 5 Scientific Activities in Europe International Dental Innovation Symposium in Munich: Host to the Scientific Elite of the European Dental World Gerhard Kultermann, 3M ESPE, Germany The list of participants at the international specialist congress reads like a Who s Who of the European dental world. 3M ESPE invited over 150 scientists and academics from 32 different countries to the International Dental Symposium from 15 th to 16 th November in Munich. The focus of the event was the exchange of ideas and experiences on developments and trends in dental practice. A particular highlight was the insight given into the projects currently underway at the 3M ESPE development department on the second day. View from behind into the lecture hall The motto of the symposium in Munich was Challenge Interfaces a phrase which refers to one of 3M s core competencies. In his opening presentation, Dr. Alphonsus V. Pocius, corporate scientist from St. Paul, introduced the assembled dental specialists to the world of adhesive bonds beyond their application in dentistry. Using many examples, he impressively demonstrated the outstanding innovation shown by 3M as regards the adhesion of interfaces. For many participants it became obvious that it is not a matter of coincidence that 3M ESPE plays a leading role in the development of new dental adhesive materials. Following this, renowned experts from universities and the 3M ESPE research and development department discussed, in brief presentations, the challenges presented by dental interfaces. 5 A patented future Some of the contributions dealt with a still experimental composite material for direct tooth restorations. Thanks to a new chemical ring-opening silorane which has been patented by 3M ESPE, composites can be produced with almost no undesirable volume shrinkage. Shrinkage occurs with light polymerisation and should ideally not exceed 1.0%. This goal has already been achieved in the laboratory with this new material. Clinical testing together with the respective adhesive material is now underway. Nanotechnology, which is already in use in the 3M ESPE development departments, also presents great potential for the future. Bioactive materials, which, for example, promote self-healing of the tooth and minimally invasive treatment methods have also been labelled as extremely promising for the future. With a new enzyme solution for selective caries removal without a drill which is still in the development stage, 3M ESPE is hot on the trail of these developments. 3M ESPE European Business Director Andreas Dinges (left) with Global Director of Research and Development Dr. Oswald Gasser (right) together with both chairmen Prof. Dr. Reinhard Hickel, Munich (2. from left) and Prof. Alan Boghosian (USA) (2. from right) are happy about a successful meeting To sum up The International Dental Innovation Symposium represents the only objective assessment of the state of the art of dental technology of its kind. Once again this year renowned speakers from the academic world and 3M ESPE presented exciting results and findings. They also exchanged experiences and ideas on the best course to take in the development of new materials in order to ensure the optimal well-being of the patient. Participants looking at a presentation using 3D glasses Participants informing themselves about 3M ESPE products at the exhibition desk

N o 6/2005, February, Page 6 Ask the Expert Pentamix Automatic Mixing Unit and Penta System How to improve the Penta System? Interview with Ingo Wagner, 3M ESPE, Germany Figure 1: Penta System product range 6 The purpose of 3M ESPE s Penta system improvement project is to achieve higher quality and reliability of the Penta system to increase customer satisfaction with greater reliability by offering a more robust mechanical design. This improvement is also an enabling initiative for new products such as Express Penta Putty, VPS Impression Material with its real putty characteristics, the first 3M ESPE automix putty, which was launched very successfully in September 2004 and for the new fast setting Impregum Penta Soft Quick, Polyether Impression Material, which will be launched in Europe in April 2005. What will change technically and what will be the improvements? What were the challenges in this engineering process? The initiative covers the Penta accessories for use in all Pentamix Mixing Unit. The improved accessories are: A new low force red mixing tip Coloured foil bag caps and A stainless steel reinforced cartridge. The mechanical design of the red mixing tip is completely new with a focus on reduction of application forces in the Pentamix. The benefits of this design are a higher performance level in power and speed of mixing. The power of a Pentamix is theoretically sufficent to lift a car. The new reinforced foil bag caps provide safe and fully reliable use of the system. Another innovation is the new stainless steel tube used as a core of the new Penta cartridge. This steel tube will deliver better shelf life Figure 2: The new stee reinforced Penta cartridge and stability for the cartridge. The biggest challenge was to reduce the forces in the Penta system by up to 50% without changing the outer dimensions of system components and without changing the handling characteristics for the user. We successfully managed to overcome these issues supported by a 3D CAD-CAM system and of course the knowledge and experience of our engineers. You may be interested to know that the new innovative mixing geometry is protected by patents. How to find out the wishes and needs of users? We used the Design for Six Sigma philosophy to find out, in our words, the Voice of the Customer. We conducted interviews with consultant dentists and did comprehensive market research with general practitioners. What are the benefits to the users? We put a focus on e.g. user friendliness, because of the special design of components it is impossible to use them incorrectly the new Penta Mixing Tip Red will only fit on to the new foil bag caps. So the new red mixing tips fit to the new coloured foil bag caps and the current white mixing tips to the white foil bag caps.

N o 6/2005, February, Page 7 Ask the Expert The new system supplies highest reliability and robustness. What is the philosophy behind the research and development work in 3M ESPE? Our philosophy is to create and develop innovative products and systems for dental professionals with a focus on easy handling and robust design. We want to support our customers in their daily work in the best way possible. White mixing tips will be available for as long as necessary. For existing Penta materials the plastic cartridges can still be used and an immediate replacement is not necessary. The use of the steel cartridges is only mandatory for the new products Express Penta Putty and Impregum Penta Soft Quick. When you order a cartridge as a replacement some time after April 1 st you will receive an improved steel cartridge. How can you make sure that this conversion will run smoothly and without any problems? Here we also used the Six Sigma process to create comprehensive communication packages and supporting tools for dentists and dental distributors. The switch date will be April 1 st 2005 in Europe. From that date we will only ship the new foil bags and steel cartridges. Figure 3: New Penta Red Mixing Tip In order to make the conversion as smooth as possible in the foil bag refills there will be two new red mixing tips and a Step-bystep information card. During the conversion period both white and red mixing tips will be available in sufficient quantities. The most important message is: If you have a new coloured foil-bag cap, you need a new red mixing tip and only the red ones will fit. As long as you have foil bags with white caps you need to use the old white mixing tips and only those will fit. It is impossible to interchange mixing tips or to use them in the wrong way. Figure 4: Insertion of the Red Penta Mixing Tip into the Pentamix Automatic Mixing Unit Ingo Wagner Masters degree in mechanical engineering from the University of Karlsruhe/Germany. Joined the company in 1996 starting as an R&D engineer. Inventor of 14 independent dental patents. In charge of the Penta-Programs such as Pentamix 2 and Pentamatic. Current position: Manager of the Mechanical Design Department, Research and Development Division of 3M ESPE. At the moment also responsible for managing the Penta-System Improvement project. 7

N o 6/2005, February, Page 8 Clinical Case Report Lava Crowns and Bridges Restoration of Anterior Teeth with Full Ceramic Crowns Volker Bonatz; Germany A young female patient came to my practice as she was unhappy with the appearance of her anterior teeth. The aesthetic findings clearly show deficits on teeth 11 and 21 (Fig. 1, 2, 3). At the patient s request, an improvement in appearance is to be strived for using only prosthetic materials. Consequently, correction of the red white aesthetics will not be carried out. In order to ensure a delicate framework design as well as translucent and opalescent properties which are similar to that of teeth, the use of all-ceramic individual crowns made of zirconium oxide (Lava ) is suggested. Figure 1: Figure 1 Initial situation: On examining the anterior teeth situation, in which the gingival margin is concealed, the unattractive Class IV mesial composite restoration on tooth 11 and the unfavourable colouring of the veneer crown on 21 stand out. Figure 2: In the terminal hinge position, the lateral view after exposure of the gingival margin clearly shows the overmodelling of the crown. The dark metal framework which shows through the gingiva and the lacking translucency of the prosthetic restoration compared with the adjacent teeth are particularly noticeable. Figure 3: Figure 2 In the mirror image from palatal, the way in which the dark metal base shows through and the lack of transparency are particularly conspicuous. Due to the level of damage to both teeth, restoration with two individual crowns is being aimed for. Figure 3 Figure 4 8

N o 6/2005, February, Page 9 Clinical Case Report Figure 4: Conclusion of the preparation: Tooth 21 is devitalised, and, compared to 11, has a dark discolouration. Both teeth are prepared with a chamfer: the chamfer preparation on tooth 21 follows the contour of the margin of the previous crown and thus is significantly subgingival. Figure 5: Impression with Impregum Penta H DuoSoft /L Duosoft Polyether Impression Material: detail of the impression. Figure 6: Figure 8 Trial insertion of the Lava frameworks. The frameworks are subsequently fixed using an overimpression and veneered in the laboratory with Lava Ceram veneering ceramic. Figure 7: State immediately after cementation with RelyX Unicem Self- Adhesive Universal Resin Cement. The natural aesthetic appearance of the Lava crowns compared with the initial findings stands out in particular. Figure 8: and 8 weeks after the conclusion of treatment. Figure 7 Figure 5 Figure 6 9

N o 6/2005, February, Page 10 Clinical Case Report Cojet Adhesive Repair and Pretreatment Prior to Cementation Composite Core Build-Up on Adhesively Luted Metal Post Martin Groten, Germany General: Female patient, approx. 75 years old, treatment in March 1999 Treatment: Figure 1 Figure 2 Core build-up on non-removable metal root post with an almost round transverse section in tooth 11 with composite, following adhesive conditioning with Cojet. Indication: Restoration of tooth 11 and functioning thereof as a prosthetic abutment Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 10

N o 6/2005, February, Page 11 Clinical Case Report Documentation (12 figures): Figure 1: Initial situation of the patient s central maxillary incisors. The patient s oral hygiene is good. The crown on tooth 11 is to be removed and replaced mainly for aesthetic reasons; on account of the recession of the marginal gingiva and the extreme discolouring of the dentine. A PFM crown was planned as a replacement. Figure 2: The post cemented in tooth 11, which underwent root treatment, could not be removed. Due to its almost round transverse section and its small diameter, it was, however, not suitable for the application of a crown either. However, when removing the caries, tooth 11 proved to be suitable as an abutment. Figure 3: After the caries had been completely removed, a rubber dam was inserted from tooth 13 to 23 to ensure total moisture control. At the adjacent teeth 12 and 21, the rubber dam was additionally secured with a light-cured liquid rubber dam (Paint-On Dental Dam, Den-Mat Corporation, Santa Maria, USA). Figure 4: The metal surface of the post was completely sandblasted with Cojet Sand (3M ESPE, Seefeld, Germany), and thus not only roughened, but also silicated. The matt appearance, not only of the neighbouring dentine, but also of the rubber dam, indicates that unintentional sandblasting or at least covering of dust of the neighbouring structures is unavoidable. Blowing away the dust from the neighbouring structures should be avoided where possible, as it cannot be guaranteed that the compressed air applied is free of water/moisture. Moisture prevents the successful adhesive conditioning of the metal surface. Figure 5: The silicated post surface was then selectively conditioned using a silane bonding agent (ESPE Sil). The solvent evaporates very quickly. The spraying of air should also be dispensed with. The silane was applied in several thin layers with great care, since the dentine surfaces should remain untouched. They were selectively conditioned at a later stage. Figure 6 and 7: Next, opaquer (Sinfony System, 3M ESPE) was applied to the metal and then light polymerized. Given that the new PFM crown will be completely opaque, one could have dispensed with the opaquer, and instead applied and light cured a resin bonder (e.g. Visio Form, 3M ESPE). Prior to the core build-up with composite restorative material, the dentine was adhesively prepared in selected areas of the preparation shoulder with dentine conditioner (Syntac Classic, Ivoclar-Vivadent, Schaan, Liechtenstein). Figure 8: The core build-up was modelled with composite restorative material (Tetric Ceram, Ivoclar-Vivadent) around the post, at the base, and into the dentine, and then completely polymerized. Build-up and light polymerisation occur successively in several steps. Figure 9: State of the build-up and prepared tooth 11 before the restoration will be fitted. Figure 10: The finished restoration (single-tooth PFM crown) on the master cast. Figure 11: State of tooth 11 following the fitting of the PFM crown approx. three months after the build-up of the abutment tooth with Cojet and Composite restorative material. Figure 12: Figure 11 Figure 12 Situation of the central anterior teeth more than four years after the conclusion of treatment. The vestibular recession of the marginal periodontium at tooth 11 may be significant, but does not seem to be due to acute inflammation of the anterior marginal periodontium. As before, the patient s oral hygiene gives a good impression. 11

N o 6/2005, February, Page 12 User Report Express Penta Putty and Ultra-Light Body Vinyl Polysiloxane An Empirical Report The Express and Easy Way to Impressions! Edgar Trübenbach, Germany It's heavy! this is the first thing that springs to mind once you ve used all your strength hand kneading a putty material. However: for the true putty user, impression begins with the almost artistic process of kneading so far. As a die-hard advocate of the two-step putty wash technique, I was curious at 3M ESPE s promise of a kneadable material without the kneading. Can a machine mixed impression material offer all those handling properties being so important for us putty users? For example that the material can be inserted into the tray in a ductile form, that doesn t run, and, can be well adapted to individual jaw dimensions? Apart from the fact that the tray can be customised, another critical factor for every putty user is that there should be a certain amount of resistance when inserted. I would like to report on our practice team s experiences with the new Express-Penta Putty and Ultra-Light Body VPS impression materials. These recommended times are based on a temperature of 23 Celsius. Under warmer conditions these times may decrease, under colder conditions increase. Once taken, the impression must rest for at least another two hours before being casted with a commercially available special stone plaster. Results At last, the practice team were able to fully benefit from the advantages of virtually stress-free, automatic mixing, and, not without a certain amount of pride, could present the boss with a perfectly mixed result: Throughout the impression preparation process there was No laborious preparation of the impression material, in fact the foil bag was ready for use straight away No measuring errors with base and catalyst components No more removal from containers which are difficult to open, no more unsightly tubes or blocked dropper bottles Totally hygienic format at all times, without potential cross-contamination from previous procedures The mixing procedure of the putty material was as easy as ever, as it is for all other materials mixed with the Pentamix, and did not require a long training period. Having a real putty material from the Pentamix 2 Automatic Mixing Unit is a new experience Material and method We tested the advantages and disadvantages of this automixed VPS from the Pentamix 2 Automatic Mixing Unit over a period of four months. As stipulated, the material was processed using the metal reinforced and therefore more pressure-resistant cartridges and the new Red Penta Mixing Tips in the Pentamix 2. We only used rigid trays with VPS tray adhesive by wearing vinyl gloves. The manufacturer is declining a working time for both the Express Penta Putty and Ultra Light Body wash material of 1 min 30 sec from the start of mixing, and a setting time in the mouth of approx. 2 min 30 sec. For loading of the tray, especially under warmer conditions, we recommend to apply Express Penta Putty in the tray in u-shaped movements. This way, it can be ensured that the application pressure is even. The surface profile soon is smooth and even, and subsequent shaping or contouring of the material is seldom necessary. Therefore working time was sufficient to load even Maxi trays reliably. Assuming you follow the aforementioned rules, while intraoral positioning of Express Penta Putty an even degree of resistance can be easily felt, like with most hand mix putties. On account of the great pressure exerted, the putty flowed well around the prepared teeth, and gave very good primary impression results, especially in the sulcal area. The particularly high ultimate hardness makes this impression material easy to carve without ragged edges. 12

N o 6/2005, February, Page 13 User Report procedures that have resulted in an improvement in the structure and process quality of the treatment we offer. With this in mind it has been possible to achieve: A constantly homogeneous and completely void-free mixed impression material of a high quality which can be reproduced in the portioning you need Compared to hand mixing a greatly reduced overall time requirement for preparation, mixing, disposal of single-use items and reassembly of the cartridge for reuse, as well as time spent to ensure compliance with hygiene standards The homogenious machine mixed material is easy to carve The impressions were trimmed more economically than usual: only those tags which were undercut or which tapered off very thinly were removed. This economical trimming of the putty impression is possible due to the high performance of the new Express Ultra-Light Body wash material, which even in very thin layers is flowing very smoothly. The wash is dispensed from a gun, making application on to the preparation and impression very easy and quick. Due to the hydrophilic nature of the material on moist dentine surface of the abutment, a good material stability and a high tear resistance after setting, even finest tissue structures could be visualized very well. Less rubbish; thus conserves resources and is kind to the environment Material input Now that testing has been completed, as a die-hard advocate of the two-step putty wash technique, it is my great pleasure to say that: The Express Penta Putty and Express Ultra-Light Body product combination will become a permanent feature in our practice. Due to the strong colour contrast between the putty and light-body wash material, the layer thickness of the wash material was easily visible. Also potential distortions while repositioning the first impression could be identified. Discussion and conclusion Our conclusion after the testing phase: The Pentamix Mixing Unit can be mastered easily even by trainees following a short period of training The product combination Express Penta Putty and Express Ultra-Light Body takes into consideration the requirements for quality management procedures in practices. The automated delivery systems have made significant improvement to working 13

N o 6/2005, February, Page 14 Clinical Case Report Filtek Supreme Universal Restorative The Best Documentation for an Attractive Smile Dr. Tomasz Smigiel, Poland Patient profile: 10 years old, male Diagnosis: Traumatic fracture in the crown region of teeth 11 and 12. X-ray examination showed no root fractures. The tooth had a mobility of 2 on a scale of 0 to 3. Treatment: Because treatment was not possible on the first session, a plaster impression was made, a cast fabricated and the missing tooth fragment was reconstructed with white wax. Then a silicone matrix was fabricated on the basis of a complete wax-up to make it easy to shape the tooth. Initial situation The tooth shades were applied with layers of the Filtek Supreme body shades A1B, A2B and A3B and enamel shades A2E and A3E with multicolour layer technique. The highest opacity level of the filling material for the dentine shade (A2D) was selected to reconstruct the dentine core. Shade G from Filtek Supreme was applied over the incisal edges under the layer of enamel shade. Wax-up with silicone matrix Silicone matrix in situ Restoration after two weeks 14

N o 6/2005, February, Page 15 The Dental Practice Forum Change Management in the Dental Surgery How to Overcome: That s How We ve always Done It? Dorothee Heckhausen, Germany When dentists want to make changes in their surgeries, there is frequently a lack of willingness amongst the surgery staff to participate actively. There are several reasons for this phenomenon. Time and again, surgery staff see the management's desire to optimise surgery procedures as a criticism of their current work, or they feel, for example, controlled and patronised by work studies and standards. Even if the surgery team recognises that changes in the work place are necessary, they are reluctant to give up their favourite, well-established working methods, which give them a sense of security. Surgery staff fear that changes to the surgery procedures are not really an improvement, but lead to more work and a higher error rate. Perhaps they also feel that they are not equipped professionally and personally to meet the new requirements. The surgery team has often had negative experiences with previous plans for changes because they were imposed without being discussed beforehand. Maybe the surgery staff's concerns were not heeded or taken seriously, or the dental surgery assistants invested a lot of time in planning an improvement, which was not implemented. A strained, unsupportive and competitive working atmosphere likewise reduces the staff's willingness to actively participate in implementing changes. If surgery staff have such concerns, they become defensive, which manifests itself, for example, as disinterest or a lack of commitment. The surgery staff do not participate in the development of sensible plans for changes and do not make any suggestions themselves. Plans for changes are delayed, for example, by constantly finding reasons why they cannot be implemented. Old working procedures are overrated with the attitude that s how we ve always done it. If there is resistance, dentists mostly try to persuade the surgery staff to accept the changes more or less assertively. This dominant behaviour, which is frequently regarded as pompous, leads to an increase in the resistance of the surgery staff to the coming improvements. It is a good idea to, first of all, create general acceptance of the changes. The owner of the surgery encourages the surgery staff to express any concerns or doubts they have regarding the changes and discusses the changes openly and seriously with them. This approach strengthens the dentist s position, increases team spirit, makes everyone think about the necessary changes and highlights potential difficulties concerning their implementation in good time. Change management a matter of survival for the dragon fly When the aims of the surgery and the necessary measures are planned, agreed and carried out as a team, the surgery staff become active participants in the process of change. The team compiles a realistic schedule and must not take on too much at once. Exact plans of action, including the responsibilities that go with them, are developed. Conflicts, concerns and discontent - a normal part of any process of change are dealt with promptly and are brought up at regular team meetings. The achievements of the team are highlighted again and again and then areas are addressed where further endeavours are necessary. This resource-orientated approach raises the team's self-confidence and motivates the members to make more effort. It must be ensured that the surgery staff are professionally, personally and practically equipped to implement plans for change, for example by means of further training. 15

N o 6/2005, February, Page 16 General Information Your Partner for Dental Professionals You can find following 3M ESPE Booths at the IDS 2005 in Cologne: 3M ESPE Dentist s World: Hall 14.2 Aisle N/O Booth Number 10/11 3M ESPE Dental Technician s World: Hall 14.2 Aisle L/M Booth Number 50/51 Calendar of Events 2005 Datum Event Ort Website / Veranstalter 03.03.2005 www.targi.krakow.pl 05.03.2005 KRAKDENT 2005 Krakow Targi Krakow 09.03.2005 www.iadr.com 12.03.2005 IADR/AADR General Session Baltimore IADR/AADR 10.03.2005 www.bellacenter.dk 12.03.2005 Scandefa Kopenhagen Bella Center S/A 17.03.2005 www.saldent.mtp.pl 19.03.2005 saldent Poznan Internationale Messe Poznan GmbH 05.04.2005 Stomatology Uzbekistan 2005 www.itesa-osiyo.uz 07.04.2005 and 1st Tashkent Tashkent ITE Uzbekistan International Dental Forum 12.04.2005 www.ids-cologne.de 16.04.2005 IDS - Internationale Dental-Schau Köln VDDI 19.05.2005 WID Wiener Internationale www.wid-dental.at 21.05.2005 Dentalausstellung Wien Österreichischer Dentalverband 19.05.2005 British Dental Conference www.bda-events.org 21.05.2005 & Exhibition Glasgow British Dental Dental Association 01.06.2005 www.messe.ch 03.06.2005 Swiss International Basel Prodonta SA Editorial Information Published by: 3M ESPE AG ESPE Platz 82229 Seefeld Germany Telephone: +49 (0)8152/700-0 Telefax: +49 (0)8152/700-1586 E-Mail: info3mespe@mmm.com Internet: http://www.3mespe.com Editor: Gerhard Kultermann Editorial team: Keith R. Haig, Dieter Klasmeier, Annika Meyer, Markus Roepke, Laurence Settekorn, Inge Schwientek Coordination: Laurence Settekorn Final editing and production: Markus Roepke Design and typesetting: Attila Sirman Digital Consulting, Munich Global circulation: 100,000 We accept no liability for unsolicited manuscripts or photographs. Court of Jurisdiction: Munich 3M ESPE AG, Seefeld, 2005 3M ESPE AG ESPE Platz, 82229 Seefeld, Germany Telephone: +49(0)8152/700-0 Telefax: +49(0)8152/700-1586 E-Mail: info3mespe@mmm.com Internet: http://www.3mespe.com 3M, ESPE, Espertise, Express, Impregum, DouSoft, Pentamix, Penta, Adper, Prompt, L-Pop, Lava, RelyX, CoJet, Sinfony, Visio, Filtek, are trademarks of 3M or 3M ESPE AG. Tetric and Syntac Classic are trademarks of Ivoclar- Vivadent, Schaan, Liechtenstein. Seal & Protect is a trademark of Dentsply De Tray, Konstanz, Germany. Gluma Desensitizer is a trademark of Heraeus-Kulzer, Hanau, Germany. SuperSeal is not a trademark of 3M or 3M ESPE AG.