litY DENTAL ASSOCIATION OF MALTA The Professional Centre, Sliema Road, Gzira Tel : 21 312888 Fax: 21 343002 Editorial Email: [email protected]

By Dr David Muscat LATEST/PLANNED EVENTS Dear colleagues, 22APRIL 17 JUNE Maritime Museum lecture on Catafast- Lecture by Dr Adam We have had a whirlwind of events 'l'he ·n·avels Uj Van Ignatia Mijsud Bartolo on pain management in the last 3 months and every week by Mr Liam Gauci curator followed -Intercontinental Hotel- Novartis by a dinner at Don Berto restaurant we add on more. On the right is a list 24JUNE Vittoriosa kindly sponsored by of events organized by the DAM in Fenkata tac-Cnus, Zebbug with Pharma M.T. represented DAM Quiz- Noprilam conjw1etion with our sponsors. (Correct by Mr Marco Manara. at time of writing article). 25JUNE 23APRIL Zhermack lecture and dinner Phillips.Sonic Care Brush 2 latmch D'agostinos- Page Technology Most events were co-ordinated by Dr madliena cottage-Bart (Same day hosting of Slovenian dental Lino Said and I. Organizing events takes 6MAY association for lecture/lunch.) up a lot of our time. I am very grateful Rodogyllecture and dinner 1 JULY to Lino for his input. Together, the effect -Palace Hotel- Sanofi Aventis EGM- Language issue and has been logarithmic. BMAY sterilisation and radiographic Cuccagna dinner and DAM regulations at MFPB -Reception with Cafe The DAM has negotiated rates with GO quiz- pro health Jubilee catering and fine wines sponsored and HSBC on your behalf. You have the 11 MAY by GO who present package to DAM opportunity to save a lot of money and to Voco lecture and reception 15JULY be treated as top notch customers whom - MFPB -Page Technology Myofunctional Lecture- Bart we all deserve to be. NnG promotions 14MAY 25JULY will give 10% discount on DAM group Pro£ Aimetti - Periodontology Three maxillofacial lectures I reception at bookings for any of their concerts and -MFPBGSK Dolmen sponsored by Bart Enterprises events as a 'DAM group booking'. 19MAY in conjunction with Dr James Galea Contact Dr Lino said for more details. Dr Eirik Aasland Salvesen- END SEPTEMBER San Gorg- Nobel Biocare - Cherubino Lecture by Collis Williams (Oki, Please note that the opinions and 20MAY Aloclair Oral Medic )and reception statements made by the contributors DAM wine tasting Farsons Direct at hotel to be armounced and advertisers in the issue are not 28MAY 160CTOBER necessarily those shared by the editor or POLA and RlVA launch at Dr Mark Zammit Maempel 'Reducing by the Dental Association of Malta. Westin - Ba_rt Enterprises forces in orthodontics' at MFPB SJUNE sponsored by Pro-Health. Spm Many dentists ask why we organize so Vinum Cultural Lecture by Liam OTHER PLANNED EVENTS many events. The answer is simple my Gauci, Curator of Maritme Museum A day trip to Sicily. A Weekend in Barcelona. A lecture on Maltese fossils by friend. Because we can - we shall. We with presentation and reception Dr Charles Galea Bonavia. An abseiling will. We are the DAM. by Abbott- V. J. Salomone 11 JUNE day in Mtahleb. A lecture on the food Fittydent Westin lecture /dinner served on the galleys of the Knights Oavicl - PharrnaMT with a reception featuring such food.

DAM Cuccagna Quiz 2009 with Pro health

1. From which tree is the wood derived 5. If you smoke, how many times 9. How much sodium fluoride from to make inter-dental wedges? more likely are you to have (in PPM) is found in Sensikin periodontal disease? toothpaste? 2. Which 2 cranial nerves are involved in U1e 'gag reflex'? 6. What % of alcohol does Cariax 10. How much fluoride (In PPM) is mouthwash contain? found in Fluor-Kin toothpaste? 3. What % of the world's population suffers from SOME sort of 7. What is the % of clllorhexidine in Answers: periodontal disease? Periokin gel? 1. Sycamore tree 6.0% 4. What % of the world's 8. What used to there be in Cariax- 2. 9,10 7. 0.2% 3. 70% 8. Potassium nitrate population suffers from SEVERE sensitive to decrease sensitivity 4.10-15% 9.1450ppm periodontal disease? besides Sodium Fluoride? 5. Four 10. SOOppm Acid Erosion. Exposed. Evolving challenges in oral health One of dentistry's many successes is to have reduced the prevalance of caries and periodontal diseases, extending the longevity of the natural dentition. Infectious diseases have given way to a spectrum of degenerative conditions, one of which is the multifactorial challenge of tooth surface loss.

The healthy diet paradox Tooth wear has much to do with the modern, health-conscious lifestyle. Diets today are often high in acid from sources including certain soft drinks and fruit juices. These demineralise and soften the tooth surface making it more susceptible to physical damage and tooth wear. Acid erosion is normally an insidious process, often only highlighted by clinicians when restorative dentistry is indicated. Early intervention is key Increased awareness at routine examination added to lifestyle advice may help prevent sensitivity, changes in colour and tooth shape; and ultimately the need for major restoration. Expert advice is now available As awareness grows, acid erosion is featuring increasingly significantly in the management of long-term dental health. With this in mind, product innovation and public education are high on our agenda.

Recognising the early stages of acid erosion can be as simple as switching on a light. For expert guidance on signs, symptoms and management , visit www.aciderosion.com

GlaxoSmithKiine FiqhtimJ• Jquin~t acid e1osion Creating a customised protective face mask following maxillofacial trauma - a case report

By Or Tim Vello Briffo B.\.h ll

HISTORY AND EXAMINATION ascertain proper bony alignment. The bridge (Fig. 7-9). Two slots were next step was patient preparation · prepared just anterior to the ears A 29 year old professional football for the facial impression. and an elastic band passed through player was referred by his dental to keep the face mask in place. practitioner complaining of IMPRESSION TECHNIQUE tenderness on the left side of The mask is secured to the face with his face and restricted mouth Since the patient was under general Velcro. The nasal bridge area and opening after sustaining an elbow anaesthesia the airway was protected. the slots for the elastic bands were to the face during a professional The nostrils and ears were blocked reinforced with a doubled thickness football match one week earlier. out using cotton wool to prevent entry of the same thermoforming material. of alginate. Facial hair in and around Clinical examination revealed the area was covered with petroleum PO ST-OP trismus (24mm) with discomfort jelly to prevent entrapment of on opening. Palpation revealed impression material and subsequent The patient was recalled after flatness of the zygomatic arch on distortion on removal of impression. one week to try on the face mask. the left side with no other palpable Minor alterations were necessary steps in the facial skeleton. No Alginate was mixed with cold water to improve comfort and vision. ocular lesions were present. to a runny consistency and spatulated Sutures were removed. Final on the forehead (Fig.l). The alginate adjustments were done in the lab Occipiomental20°, occipitomental was allowed to flow gently down and the face mask was polished. 30° and submentovertex radiographs the face and around the patient's were taken which confirmed facial features. Care was taken to The patient was asked to wear the that the fracture was limited to avoid any air bubbles. Once the face mask for 4 weeks to allow time the zygomatic arch and that the area was covered with a sufficient for healing. In the meantime he was fracture was displaced centrally. thickness of alginate (3mm) a few able to resume his daily training layers of gauze were laid down routine. Within a few weeks the SURGICAL TECHNIQUE which adhered to the alginate. patient regained full mouth opening and all discomfort was gone. Closed reduction of the fracture was A layer of fast setting plaster was performed under general anaesthesia placed over the gauze and allowed DISCUSSION via the temporal (Gillies) approach. to set, giving the alginate a backing A 2-cm incision was placed behind that supports the impression The zygomatic bone occupies a the temporal hairline approximately and prevents distortion as it was prominent and important position 6 cm above the zygoma. The incision being removed (Fig.2-4). The in the facial skeleton. It forms a was carried through the skin, impression was disinfected, kept significant portion of the floor and temporoparietal fascia (superficial moist and sent to the laboratory. lateral wall of the orbit and a portion temporal fascia), and temporalis of the zygomatic arch, otherwise muscle fascia (deep temporal fascia). In the laboratory the impression known as the' malar eminence. was cast in dental stone (Fig.5) A Howarth's elevator was used and a few mm of relief were The zygoma is the main buttress to dissect a tunnel superficial to provided over the fracture site between the maxilla and the skull, but the temporalis muscle and deep using plaster of paris (Fig.6). despite its sturdiness, its prominent to the zygomatic arch. A Rowe's location makes it prone to fracture zygomatic elevator was inserted A thermoforming material (Perspex) [1-2]. Cerulli et al [3] assessed the and lateral pressure applied to of 1.5mm thickness was moulded rate of craniomaxillofacial fractures reduce the bone fragments. over- the cast. All excess material in soccer and the areas where was trimmed leaving enough they occur, describing above all Gentle palpation of the zygomatic material to provide protection for the injury pattern of this sport. arch and visual observation for the zygomaticomaxillary complex, any facial asymmetry was done to superciliary arches and nasal Continues on the next page. CREATING A CUSlrOMISED PROTECTIVE FACE MASK FOLLOWING MA)(ILLOFACIAL TRAUMA- A CASE REPORT Continues from the previous page. an alginate impression was taken whilst be, they are very expensive to run. the patient was anaesthetised. This Some methods unnecessarily expose They examined a range of 7 sports same technique can be employed with the patient to radiation (Cf). Surface disciplines, but football was responsible the fully conscious patient with nunor laser scanners have the advantage for sports-related maxillofacial fractures modification. The patient is normally of being relatively inexpensive, fast, in 34 of 46 cases (73.9%). The zygomatic sat in an upright position as gravity accurate, non-invasive, non-contact, and nasal regions are mainly involved. affects the soft tissues of the face and and non-ionizing. They consist of a Direct contact between players generally the impression can be consequently low-power laser beam which is moved caused football-related maxillofacial distorted. The patient must also prevent along the face to be scanned and is fractures: head-elbow impacts (21 cases) facial movement for the same reason. followed from an offset angle by a video or head-head impacts (14 cases). It is a claustrophobic experience which camera that calculates the coordinates might be too much for some patients to of the surface by triangulation and The main challenge in these particular handle, therefore reassurance is essential. saves the data to the computer. patients is to give them the possibility of a very short convalescence period Other methods exist to obtain a Rapid manufacturing equipment is and to make possible their agonistic facial image for maxillofacial use. able to use the data after processing activity as soon as possible. This can best Imaging techniques reported included to form three-dimensional objects be achieved by providing the patient stereophotograrnmetry and moire by additions of layers of material. with a protective face mask. These are contourography; ultrasonography; These manufactmed objects are thus available commercially but tend to have conventional axial computed custom designed for the patient but a loose fit, providing little protection [4]. tomography (Cf), magnetic resonance are engineered as compared with craft­ Therefore the best option would be to imaging (11RI), lateral facial plates, based models made by traditional create a customised face mask from a facial plethysmography; surface methods. The facial image has a number facial impression. One such impression radiography and laser surface scanners. of maxillofacial uses such as fabrication technique was described earlier whereby As accurate as these methods may of facial prosthesis' and bums masks [5].

FIG.4 FIG. S FIG. 6

FIG. 7 FIG. B FIG. 9

REFERENCES: [4] Cascone P., Petrucci B., Ramieri V, and TitoMatteo ACKNOWLEDGEMENTS: [1] Cohen J., and Mercandetti M. Facial trauma, M. Security hi-tech extra-light device mask: A new Dr. MarkS. Diacono, RGN, B.Ch.D Hons. (Leeds), Zygomatic arch fractures . http://emedicine.medscape. protection for [soccer1 players . J. Craniofacial Surgery, FDS RCPS (Glasg). com/article/1283924. [2] Chao MT., Paletta C., and 2008, 19(3):772-776. [5] Chandra A., Watson J. , Dr. Nikolai Attard, B.Ch.D, MSc Prosthodontics Garza J.R. Facial IJ·auma, Sports-related injuries. Rawson ]E, Holland J., Harris RA and Williams (Toronto), PhD (Toronto) .. http:!/emedicine.medscape.com/article/1284288 DJ. Application of rapid manufacturing techniques Victor J. Galea, SRDT o.b.o. Dental Technology [3] Cerulli G., Carboni A., Mercurio A., Perugini in support of rnaxillofacial treatment: evidence of the Studios. M., and Becelli R. Soccer-related craniomaxillofacial requirements of clinical applications. J. Engineering injuries. ]. Craniofacial Surgery, 2002, 13(5):627-630. Manufacture, 2005, 219, 469-475.

June 2009 - Issue 31 The Dental Probe DIFFLAM™ ORAL RINSE BENZYDAMINE HYDROCHLORIDE

Proven in post-surgical patients (n = 13) Proven across a range of oral conditions Assessed 1n a nmple of periodontal post-surg1cal patients Clinical studtes have confirmed the effkacy of Difttam ... Oral Rinse showed significant improvement Dlftlam Oral Rinse and Spray (compared with placebo). 1n: e pon tonsillectomy' e gingival inflammation e in post-radiation mucositis' pain score e e >n post-chemotherapy mucositis' healing index e e in gingival inflammation' • plaque inde x e relieving pain associated with aphthous ulcers'

Proven in community patients (n =41 ) In a double-blind. crossover study of pat1ents With DifflamT " Oral Rinse aphthous gfcers. Diftlam''" Oral Rinse showed:' • Pleasant tast e e pain re lief score • Sugar free Doesn't stain teeth and e e duration of pain relief and the only oral rinse with analseslc, anti-inflammatory and local anaesthetic action.

AVAILABLE ON Effective relief of pain PRESCRIPTION 1 2 and inflammation • TREATMENT PLANNING FOR THE PERIODONTAL PATIENT

The periodontally-compromised patient conventional ultrasonic scalers and 2c. Exh·action - the only reason presents a particular challenge with delivers a diluted pumice slurry exh·actions come this far down the respect to a stable long-term treatment which facilitates thorough pocket list is that it is surprising how many outcome. debridement nd reduces treatment mobile teeth that would easily be time considerbly condemned to forceps survive for The first considerations should be: several years after debridement and i. Slight, Moderate (5mm) or Severe le. Antibiotic TI1erapy, whether systemic regeneration. (7mm+) Pockets? or local cannot be considered a ii. Generalized or Localized (30% of substitute for the above and has 2d. Surgical removal of local sites)? no place in routine treatment. The exacerbating factors such as fraena iii. Chronic or Aggressive? obvious exception is the presence of with high attachments . iv. Intact Dentition or Partially suppuration. Edentulous? 3. OCCLUSAL AND (Augmentin and Metronidazole ORTHODONTIC THERAPY The sum of these considerations has in combination or Spiramycin a distinct bearing on the treatment and Metronidazole preparations These are considered together because plarining, which can be dealt with along - these wide-spectrum antibiotics many times occlusal contributors the following lines: are necessary in the clinical setting to periodontal conditions can only • Initial Therapy where we do not have ready access be resolved orthodontically. After • Surgical Therapy to microbiologic examination) addressing the periodontal condition • Occlusal Therapy and obtaining resolution consider • Orthodontic Therapy Localised Chlorhexidine and/or orthodontic h·eatment to correct occlusal • hnplant Therapy Doxycycline application may help abnormalities which may have arisen • Prosthetic Therapy to resolve chronic bleeding sites but from the periodontal situation. • Supportive Therapy these and other mouthwashes/gels are also to be considered only an 3a. Removable appliances incorporating 1. INITIAL THERAPY adjunct to faultless mechanical anterior biting platforms can act debridement. as DalU appliances to increase Mechanical debridement and vertical dimension as a first step in elimination of obvious aetiologic factors. The role of bacterial plaque is reducing overjet (palatal trauma only relative to the host factors etc) and overbite. la. Scaling and Polishing- a thorough (immunological- altered production full mouth scale and polish, if of cytokines and other anti­ 3b. Fixed appliances may be the only necessary in two or more visits, is the inflammatory factors) Treatment way to close diastemata or to move cornerstone on which all periodontal regimes may have to change from teeth that have drifted into the spaces treatment is based. It is preferable antibiotic to anti-inflammatory left by missing teeth with a view to to visit the same quadrants on two since a breakdown or cl1anges in the satisfactory prosthetic and aesthetic separate occasions several days apart immtmological response may lead replacement. In fixed appliance than to attempt complete quadrant/s to chronic inflammatory processes therapy it may be possible to exclude scaling in one visit. Checking the and the infective process is only certain periodontally-compromised patient's oral hygiene regimen and secondary to the inflammation teeth from the appliance design suggesting improvements and motivating the patient to persevere ld. Simple aetiologic factors, such as 3c Accurate occlusal analysis and are all part of any successful filling overhangs, should be removed judicious occlusal adjustment will treatment regime. as soon as is practically possible. eliminate pltmger cusps and other traumatic situations in conjunction lb. Root Planing and Curettage- in 2. SURGICAL THERAPY with orthodontic tooth movement or · relatively deeper pockets, deeper on its own in cases where this is not debridement procedures under 2a. Gingivectomy and Gingivoplasty warranted or practical. local anaesthesia may be required, depending on the patient's pain 2b. Regeneration- E-PTFE membranes, 3d Uprighting posterior teeth in threshold and response to scaling. bone substitutes and enamel matrix conjtmction with debridement and TI1e Durr® Vector System is based proteins (eg Emdogain) The latter possible adjtmctive therapy may reduce on vertical ultrasonic inshument may require a long learning curve mesial pocket depths considerably tip movement, as opposed to to master, but the results obtainable oscillating tip movement in are excellent. Continues on the next page. TREAT.MENT PLANNING FOR SPOFA­ THE PER,IODONTAL PATIENT DENTAL: AN Continues from the previous page. 5. PROSTHETIC THERAPY Once the occlusion is stabilized replace 3e Extrusion of teeth below the occlusal missing or unsaveable teeth APPRAISAL plane helps bone to grow in localised defects around the same teeth. Sa Splinting teeth after occlusal/ Subsequent extraction results in a orthodontic therapy may be required. By Dr David Muscat more favourable implant bed Bridgework may be one way of doing this especially where endodontically SPOFA is no spoof. This is a Kerr 4.1MPLANTTHERAPY treated teeth are present. company based in Eastern Europe. Some materials are available Although it has been shown that Sb The type, material and occlusal in Malta. immediate post-extraction implant features of any prosthesis must be placement does not prevent alveolar carefully evaluated and selected OPTICOR FLOW bone remodelling, implants prevent based on the outcome of periodontal A light cured microhybrid low vertical bone loss. treatment, patient motivation and viscosity composite. It provides possible habits such as smoking. fluoridation emission. It has a It has been shown, in aS-year study, decreased modulus of elasticity. that in cases of Chronic Generalised Se Control occlusion- set up prosthesis Periodontitis (CGP) there is a 100% occlusion for function and It is radiopaque, and handles well. implant success rate as opposed to aesthetics. Avoidance of secondary Applied with a syringe it is cured 88.8 success in cases of Generalized occlusal trauma results in a self­ in layers of 2mm.Line deep cavities Aggressive Periodontitis (GAP) maintaining occlusion with calcium hydroxide. - Mengel and Flores de Jacoby, J Perio 2001 vol72: 977-989. 6. SUPPORTIVE THERAPY SUPER-COR A light cured microhybrid In another 10-year study, GAP showed Success rates are dependent on the composite. I find the material a bit more attachment loss on remaining success criteria defined and laid down to soft and prefer to use it for anterior natural teeth and more bone loss around the patient teeth as I find it difficult to build implants than CGP-J Perio 2007 vol 78: out contact points posteriorly. It is 2229-2237. 6a A customized maintenance and recall good for buccal composites. system should be presented to the 4a It is always necessary to perform patient and their full understanding KAVITAN PLUS initial therapy and appropriate and commitment to compliance A radiopaque glass polyalkonate surgical treatment to reduce pocket should be demanded glass ionomer material. It handles depth around natural teeth to no well, and provides good aesthetics. more than Smm maximum before 6b Control of pathogenic flora is the key It does take at least 4 minutes to set. considering implant placement. to inflammation control. I find it suitable for core build ups.

4b Just clearing a periodontal patient and 6c Cessation of smoking should be KAVITAN CEM turning him or her into an implant insisted upon and assistance and A chemical cured glass ionomer patient without motivating and encouragement should be provided. cement for crowns, bridges, posts, treating him/her is courting disaster screws and onlays. With higher life expectancies and net However, a past history of decreases in caries rates, we are facing It can also be used as a liner under periodontal disease is not a contra­ a tsunami of periodontal problems and composite fillings, and has a S indication to implant therapy and peri-implantitis in the medium-to-long minute setting time. In orthodontics has only a little effect on the long­ term. The extent of these will depend it can be used to cement bands and term survival of implants on our appreciation of the aetiological brackets. factors of periodontal breakdown 4c In long-term periodontal patients, and our meticulousness in treatment ELASTIC CHROMO the S- and 10-year survival rates planning, execution and maintenance. Alginate sets in 2.S minutes from of implants placed with a 2-stage when mixed at 23 degrees celsius. procedure are 97%, whereas the It has a 120 hour stability. This is respective survival rates for 1-stage Dr Joseph Xuereb BChD(Hons), a great property of the material. It implant protocols are 84 and 78% MFGDP(UK), MGDS RCS(Eng), has a colour indictor at different - Baelum and Ellegard 2002 FFGDP(UK), FICD stages of the set. DAM HSBC AGREEMENT

For Premier phone Sandy Pace on 25972603 or email [email protected]

HSBC PREMIER PACKAGE • Global and local benefits are also available for the children of premier • International recognition- you are customers. recognised as a special customer of the Bank at every HSBC branch HSBC FINANCIAL PLANNING SERVICE arOlmd the world. CONTACT PHILIP ABELA 79515128 HSBC CREDIT FACILITIES • Visa (electron) debit card (with philip.abela®hsbc.com overdraft €12000) - free withdrawals Maxicredit Loans: - loans secured by the worldwide from any HSBC ATM • HSBC will be glad to provide you equity value of your home and repaid with a free Financial Planning Service over a maximum period of 25 years to • Mastercard credit card (limit €15000) conducted by professional advisors purchase assets by maximising your - linked to exclusive worldwide licensed by the MFSA. We compare "dormant" equity. discotmts through HSBC's Home the importance of going through this & Away Programme, K Miles and service with an annual health check Buy to Let Loans: - Our Buy to Let Loan travel and purchase protection as it is important to look at your will enable you to acquire a residential "financial health" annually too. property and finance the repayments • Instant cash in an emergency when from the rental income received. overseas - $2000 equivalent - from HSBC TRUST SERVICES Yacht Finance: -Our Yacht Finance Loan an HSBC branch -and Global is ideal if you want to borrow to pur­ Emergency number (+ 1908 PREMIER) • A trust, in very simple terms, is a chase the boat of your dreams. What's newly introduced legal framework more you can do this without charging • Replacement of card within 24 hours by which one or more persons your property to the bank. when overseas - should card be transfer assets I property to stolen or damaged we will replace another person or entity that will your card. be responsible for managing and distributing these assets for the • Free HSBC account opening across benefit of someone else. the world and local country guide (for moving abroad) • HSBC is a global organization having a considerable number of • Access to any local and foreign years experience in Tmsts, and accounts held with HSBC on one this experience will enable us to screen on internet banking - and better assist you in setting up and free personal inter account transfers managing the Tmst. between HSBC accounts worldwide Why you should consider a Tmst: • Free supplementary card (spouse/ partner) including benefits Confidentiality - the trust deed is a private arrangement, so nobody has " 24 by 7 Premier Customer Support to know of its existence other than telephone line (21489100) and the parties concerned. comprehensive Premier website www.hsbcpremier.com Asset Protection- freedom from creditors as trust asset are not • VIP- Versatile Private Retirement usually included in bankmptcy Plan- a retirement plan specifically arrangements. tailor maid for our Premier customers Prevent assets from being wasted by beneficiaries the trust allows • Discounts on life protection the transfer of benefits on certain policies, VIP plans, Home loans and assets without transferring the legal Flexicredit loans ownership.

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A product appraisal by Or Oavid Muscat

BIAL is an international the box in braille and I found this Noprilam 500-amoxilSOOmg pharmaceutical company which has quite innovative. Also the tablets +clavulanic acid 125mg per just celebrated its 85th anniversary. are in blister packs of 4 which tablet (box 16 tablets ) makes it easier for the chemist It started off by producing and to dispense a few more easily. The Noprilam 500 is given 3 times a day. commercializing various drugs under license of other pharmaceutical Bial is represented locally by Ms 2. SEDOXIL companies such as antibiotics, Nadia Cassar and Ms Jana Chetcuti analgesics, anti-asthmatic, have the following products Active ingredient; mexazolam antihistamines, cholesterol and relevant to dentistry in Malta which is an effective and selective hypertension, antidepressants, anxiolytic without major side effects. anxiolitics etc ... mainly in 1. NOPRILAM Portugal followed by Spain. It is used to pre-med anxious patients Amoxicillin Clavulanate. (under the night before and two hours before Today, not only is it active in over license Smithkline Beecham plc UK). a complex surgical dental procedure. 40 countries over 4 continents There is quick oral absorption but it has also engaged in This is a bactericidal antibiotic and a rapid onset of action. research and development. with a broad spectrum of activity with various indications A GREEN FORM IS REQUIRED In the pipeline there are several including periodontal and apical FOR THIS LOCALLY patented products bringing abscesses, cellulitis, oral infections innovative solutions in different and post surgical therapy. 3. RINIALER therapeutic areas; central nervous system, cardiovascular system, The pediatric suspension has Active ingredient; RUPATADINE. respiratory system, musculo-skeletal a nice strawberry flavour and For serene breathing and system, immunotherapy etc ... the is sugar free.NOPRILAM 400 natural well being. first to emerge on the market will be (457MG/5ML) 70 mls bottle. Zebinix (an anti-epileptic) in 2010. This is taken once daily and Noprilam DT amoxil875mg is non-sedating. It is used for Bial products have their product +clavulanic acid 125mg per allergic symptoms and for name embossed on the side of tablet(box 16 tablets) persistent allergic rhinitis.

THE ADHESE ONE SELF ETCH An appraisal by Or Oavid Muscat

Self service. The Adhese system Vivapen provides light curing bonding adhesive system. Self cleansing. an ergonomic user friendly system Click to activate and apply a brushing Self assessment. that is quick and useful especially motion, all in 30 seconds. Now self-etch. when time is of essence. A ten second light cure is required, I'm quite conservative. Straight laced, Also if teeth are hypersensitive and followed by your composite filling. polished shoes, no nonsense and I don't want to "shock and awe" the "meat and two veg". patient with an etch I would gladly use It is a good pen system from a this system. reputable company Ivoclar Vivadent I've always etched, washed and dried and suitable for us dentists who always and bonded, and "you can't teach an It is good when treating restless go straight to the point. old dog new tricks" but "give a dog a children or agitated adults. Adhese bone" and he may change. is a single component, self etching, , '

Inflamed and bleeding gums

~--;_- 25C ml

eid' En)uaoue but31 _... cariax ~...... r."-~

biuque buul

Available only in Pharmacies MADE IN SWITZER LAND Q ,,..,5;'6if& O F S W ITZEIL AN D Health & 1~eauty Clinical T

Clinical CARE 6in1 Clinical Fresh GEL Clinical CT VE Still prescribing the 11normal" Chlorhexidine? CURASEPT with ADS 0.12% Chlorhexidine Mouthwash and Gel Toothpaste THE NON SURGICAL TREATMENT OF PERI01DONTAL DISEASE

BY PROFESSOR AIMETII, Professor of Periodontology at University ofTorino. And supported by Dr Nicholas Charles, Periodontist Summarized by Dr David Muscat

Pathogens colonize dental plaque. Disease Sextant or quadrant scaling of roots. A LONGITUDIONAL PERIO TISSUE is initiated by subgingival bacteria, and ALTERATION STUDY DURING this modulates the host response. THE FULL MOUTH DISINFECTION SUPPORTIVE THERAPY (Quirynem et al.j clinical periodontology) (Rosley,Serino,Hellstrom,Lindhe,Socransky) FACTORS: Bone loss and age, prevalence of Clean all perio pockets /tongue/oral 232 patients with normal periodontitis pockets, and tooth loss, compliance, epithelium/dental surfaces/palate/tonsils. - normal group NG social, medical, smoking, medication, All above done within 24 hours. CyclosporinA, calcium antagonists,stress. These were seen once or twice yearly The microflora include P. Gingivalis, A full scaling and root planing done with supra and sub gingival scaling and Bacteroides and Actinomyces A within 48 hours tmder LA Bmsh root planing by trained hygienists. dorsum of tongue with 1% chlorhexidine 170 high susceptibility group HSG PERIODONTITIS: gel . Mouthrinse with 0.2% chlorhexidine non surgical therapy following LA 1. Levis-less than third root length for 1 minute. 4 times yearly recall visits bone loss the sites exhibiting bleeding on probing 2. Gravis-more than third root length · Subgingival irrigation of all pockets and a probing pocket depth of more bone loss-prognosis questionable 3 times for 10 minutes with 0.2% than Smm received repeated subgingival 3. Complicated-bony defects chlorhexidine twice daily for 1 minute instrumentation. and furcation involvements ,and then for following 2 months. - prognosis hopeless. • HSG exhibited a larger number of Oral hygiene instmct:ion and tongue sites with deep pockets than the A prognosis must be made for every cleaning. normal group NG. single tooth. • NG lost no teeth. Systemic review of effects of full • HSG lost one tooth or more than one . CRITERIA mouth debridement (Lang, Cheung) tooth . Biological: -all treatment approaches may be • HSG exhibited higher number of. • Systemic heart disease recommended for debridement. The progressive periodontal sites than • Occlusal dismarmony and tramna most important is optimal oral hygiene. NG. • Dental anatomy • Visibility and access The use of systemic microbials against IMPORTANT • Patientbehaviour the subgingival biofilm(Herrera,Alonso Occlusal trauma causes more • Clinical experience and competence ,Leon)-NOT to be used in most patients demineralization of bone. Always • Bone loss and mobility but only to be considered in aggressive check occlusion. Check lamina dura on periodontitis or severe and progressive. radiograph. PERIODONTAL THERAPY Antibiotics are always used in • Maintenance conjunction with mecl1anical Molars with furcation involvement -the • Osseous resective surgery debridement. The debridement must be results are not so good but the prognosis • Guided tissue regeneration carried out within 7 days. is not hopeless. • Extraction -implant HAND SCALERS-SONIC-ULTRASONIC PROBLEMS WITH NON SURGICAL NON SURGICAL THERAPY =SIMILAR RESULTS TREATMENT-- bleeding on probing, Elimination and prevention of pockets greater than Smms, and recurrence ot supra and sub gmgiVal Do not excessively insh11ll1ent the tooth interdental craters. bacterial deposits from the tooth surface. surface as this may cause sensitivity and the elimination of periodontal and pulpitis due to the removal of cementum. PERIODONTAL SURGERY anatomical defects. USED IF STILL BLEEDING ON Gingivallobular haemangiomas PROBING AFTER NON SURGICAL When infection has been controlled, the and cyclosporin A induced gingival INSTRUMENTATION, and for soft anatomical problem persists -aberration overgrowths do not need surgical tissue aberrations with reversed of tis~ues. treatment but good perio therapy. osseous topography. OSSEOUS RESECfiVE SURGERY GUIDED TISSUE REGENERATION -GORE IMPORTANT Recontour bone to have a prdictible MEMBRANE 30 % of patients who have lost teeth removal of periodontal pocket Reproduction of lost part to restore to periodontitis will then get peri­ architecture and function. irilplantitis. 5% of patients who have OSTEOPLASTY lost teeth to periodontitis will get peri Reshape alveolar process to achieve mor Regeneration of cementum, periodontal implantitis physiological form without removing ligament and alveolar bone. supporting bone. SUSCEPTIBILITY TO IMPLANT LOSS= GTR can to used to increse bone. SUSCEPTIBILITYTO PERIODONTITIS OSTECTOMY Eliminate interbony pockets,including removal of supporting bone

REVERSED OSSEOUS TOPOGRAPHY Reshapes abnormal bone due to periodontitis Left: On Thursday 14 May Professor Aim is to resemble normal bone, with Aimetti, Professor of Periodontology from the minimal probing depth, and a good University ofTorino gave a lecture entitled morphology with good oral hygiene "The non Surgical treatment Of periodontal disease". The picture shows Or Aimetti APICALLY POSITIONED FLAP together with Or David Muscat, vice Palatal flap thin-do not apically position. President DAM and Or Nicholas Charles, Use vertical mattress sutures. son of Or Tony Charles.

TI1e Dental Association of Malta recently held a lecture at the Maritime Museum in Birgu entitled 'Tasting The Grand Tour' by Mr Liam Gauci BA(history) cmator.

This was based on the exotic travels of Don Ignatia Mifsud, from Malta to Rome during tl1e time of tl1e knights.

TI1e DAM collected 500 euro during the event for 'Puttinu Cares' and tl1e photo shows Dr David Muscat vice President DAM handing over the cl1eque to Mr Paul Carnilleri ,the Puttinu representative. Also in tl1e picture are Mr Liam Gauci, Dr Matthew Cachia ,treasurer DAM and Dr Adam Bartolo DAM President.

Following the lecture Pharma MT, agents for Fittydent, represented by Mr Marco Manara (B Pharm Hons) hosted the dentists to a great meal at Don Berto restaurant in Birgu. The event was very well organized by Dr Lino Said , social events coordinator of the Dental association and very well attended. GODT SMIL DENMARK

The dental chain Godt Srnil is a Danish chain of dental clinics which employ an internationally mixed team of dentist from Denmark, Germany, Austria, Italy and Poland. We are currently looking for more dentists for the currents clinics and also for the future clinics we plan to open.

YOU and implants. Therefore the patients The dentist is only to pay for spend more money at Godt Smil than laboratory costs and only the • You are a dentist with at least 2 they do other places. laboratory costs that can be ascribed years of experience who would lo his/her work. The denlisl does like to work in an Intemational This means that our dentists earn a not pay for materials such as filling environment in Denmark. much higher salary than they do other materials, cements, sutures etc. places and Godt Smil generates a far • You must be fluent in English as higher average tumover. All dentists are guaranteed a this is the number one language in minimum salary of DKK 30,000 every all of our clinics. Additionally you As we want the patients to come for month, which will be paid in case the must be open to leam Danish as we the price but to stay for the quality dentists' commission is less than organise Danish courses for all of our we put all our efforts into providing DKK 30.000 per month or if the Intemational staff. our patients with a good quality and a dentists become sick or goes on pleasant atmosphere in the clinics. maternity leave. • You are good with prosthetics. CLINICS Our dentists work between 37-45 • Knowledge about implantology is a hours per week. benefit, but not a request. Godt Smil currently has a large clinic in Horsens with 6 chairs and one in WORK ENVIRONMENT • You are good at cooperating with all Arhus also with 6 chairs and is right levels of the staff; assistants as well now working on opening a clinic in The environment is international and as management and are willing to Odense that will open 1st October our main communication internally develop your skills within dentistry 2009 with 8 chairs. In January 2010 is English. The organisation is young as it progresses. the chains largest clinic is to open in and the hierarchy is flat and the team Copenhagen with 10 chairs. The plan spirit is jovial. TREATMENTS is that Godt Smil wants to open 10 clinics within 3 years. DENTISTRY IN DENMARK Godt Smil is specialized in greater prosthetic work such as bridges, Our clinics are all light and In Denmark dentistry is private crowns, veneers, implant crowns and pleasentently decorated with state­ meaning that people pay for their implant bridges. Additionally Godt of-the-art modern equipment and dental treatments themselves. Smil is specialized in restorative and high tech with XO-treatment units, However there is a small subsidy from implants including oral surgery such apple computers, flat srrP.Pn tvs in all the state which is deducted directly as sinus lifting, bone reconstruction, treatment rooms etc. from their bill. bone splitting etc. However conservative treatments such as EMPLOYMENT The fact that dentistry is private fillings, endodontic treatments etc. are means that there is literally no fuss also being performed on a daily basis. Our dentists work on a commission with insurance companies or other and contract base. However it is bureaucratic things that involves time CONCEPT AND FINANCE possible to work on a freelance demanding paper work. The dentist or temporary base. The dentist is can concentrate on treating his or her The concept is to offer high quality remunerated by commission of her/ patients. However there is a lack of dental treatments at affordable prices. his generated turnover pr month experienced dentists in Denmark, Godt Smil is in average up to 40% minus the laboratory costs. especially in certain geographic areas cheaper than other Danish clinics of Denmark, which means that many however the dentists working at Godt The commission rate is 32 percent clinics have long waiting lists. Smil have an average turnover of 30 % of the generated turnover minus the more than the average Danish Dentist. laboratory costs. For more information please contact Why is this? partner and HR Manager or visit our If the generated turnover is 200,000 website www.godtsmil.dk Well, Godt Smil may charge less for and the laboratory costs are 50,000, their treatments, but attracts more the commission is calculated the Sif Julie Gulmark patients who need comprehensive following way: 200,000 - 50,000 x 0.32 Phone +45 42 24 05 84 treatments such as prosthetic work = DKK 48,000. Mail sg®godtsmil.dk HEMISECTION A Case Report

By Dr Antoine Camilleri B Ch D

A 20 year old Maltese woman was paid to the complete removal of presented at the clinic with the furcal morphology which could severe dental pain.Her serve as a plaque trap later on. medical history was clear. A provisional glass ionomer Examination revealed an cement allowed the remaining erythematous mucosal swelling crown to be restored till root apical to the heavily restored lower socket healing took place. right first molar, which was tender to percussion and with Grade 1 A month later composite resin mobility. The oral hygiene was good. build up restoration was possible, FIG.1 henceforth achieving what is She reported that the molar had described 'premolarization' of the undergone endodontic treatment hemisected molar. See Fig. 2. some years before, confirmed by the diagnostic periapical Four years passed before the radiograph taken. [Fig. 1] patient visited again, this time for a check up! The restored hemisected The radiograph revealed a large molar was stable and functional, periapical radiolucency around the gingivae were healthy, and the mesial root of the molar, while the review radiograph revealed the distal root apex appeared complete resolution of the past unengaged by the area. bone radiolucency. [Figs 3 and 4] FIG. 2

On close inspection of the radiograph Interestingly, while no bone it was clear that a fractured augmentation was actually instrument was trapped in the apical done, there is surprising natural third of a mesial canal, contributing bone fill in the root socket. to insufficient apical canal debridement and proper sealing. While literature suggests crowning hemisected molars, it was agreed Furcal involvement was also apparent. that since the composite resin The treatment options of re-root restoration was very satisfactory and treatment and apicoectomy were afforded a degree of protection by not embraced,leaving extraction of partial cuspal coverage, ,no further the whole tooth- or hemisection! treatment would be done, save for FIG.3 more frequent dental checkups! A course of penicillin was prescribed and the more conservative No replacement of the missing part option of hemisection was of the molar crown was deemed suggested as the treatment plan, necessary either, with the occlusal which the patient agreed to. stability and function present.

A week later the inflammation had In the correct indications hemisection subsided and the molar was carefully is a viable tool in the dentist's and completely sectioned under local arsenal of lrealmenlmoJalilies, anaesthetic. The mesial root was giving him/her positive professional elevated and extracted. Attention satisfaction and a grateful patient. FIG.4 By Dr Paul Cassar

Over the last twenty years However magnification allows us a were the preserve of specialists since qualifying dentistry has new insight and allows us to better see however over the"years many have undergone many major changes that which we are trying to achieve. crept into general practitioners due to new technologies and better hands. I joined the endodontic understanding and better materials. Many clinicians today routinely revolution using nickel titanium use magnifying loupes to help in rotary instrumentation some 17 years To discuss all of the changes the every day practice of dentistry. ago and was one of the first general here would not be appropriate These loupes usually magnify 2.5 practitioners' in the UK to do so. however suffice to consider a times. At this magnification we few such as our current bonding get a larger field of vision when Adding my operating microscope to systems, the rotary nickel titanium looking at the whole mouth. my armamentarium greatly improved revolution in endodontics the my ability to achieve dependable and genesis of implantology and in Loupes do work much better if the stable long term results when doing my opinion the most exciting integral illumination system is also endodontics. Twenty years ago the advance is that of magnification. used as the increased light allows quoted success rate of endodontics was our eyes to resolve even greater in the order of 75% which also means Magnification can play a key detail. Personally when doing a quarter of all root treatments failed. role in dll d~ped~ of Jenli~L1y gene1dl Jenli~L1y I u~e Zei~~ 3.8 and should not be seen as the magnifying loupes as these give a It is no wonder so many teeth preserve of endodontists' alone. better half way house between my were extracted and why implants normal vision and my Microscope. with their known reliability have There is no golden standard in doing revolutionised our subject. However chmcal dentistry today we all stnve to 1 purchased my operatmg Ze1ss w1th today's modern endodontic achieve the best for our patients with Prim Opmi microscope some 13 techniques I can quote success rates the tools and materials at our disposal. years ago. At that time Microscopes as high as 99%. Teeth can be saved! VIEW THROUGH MICROSCOPE AT 10X MAGNIFICATION POST OP RADIOGRAPH OF 14 & 15

Continues on the next page. Continues from the previous page.

Once successful endodontics is achievable then it is only a matter of willing to secure and restore a tooth successfully.

I use a combination of Loupes and microscopy when doing general FURCATION DEFECT 46 HEMISECTED restorative dentistry. As this next sequence of images shows.

Even without the aid of loupes or mi_croscopes magnification in dentistry can be seen.

Increasingly clinicians are moving over to computerisation and digital imaging both radiographically and photographically and we all VIEW THROUGH MICROSCOPE PREMOLARISED CROWN 46 know a picture paints a thousand words so we can magnify our 1mage to see what our eyes would otherwise struggle to see.

If any of you have followed my antics with treating Tigers and bears over the last few years I suppose the final solution is to magnify the teeth themselves! 46 6 YEARS POST OP but you can control its effects with ~__...._,...... __,

With the passing of time, your gums do not cover as much of your teeth as they used to. Receding gums put you at risk of developing root cavities and could lead to further problems. The solution .. .ColgCl1te Time Control.

Colgate Time Control has been specially formulated to provide you with everyday protection against the signs of ageing in your mouth .

D

Col gate Time Control Gum & Teeth Protection, Rtefreshing Taste THE BART ENTERPRISES WESTIN LECTURE BY RIVA MISS SISSE HANSEN FROM SOUTHERN DENTAL INDUSTRIES OF MELBOURNE AUSTRALIA ARRIVA An appraisal by Or David Muscat

The Australians want to enrich us cure GI to surface ,apply Riva coat and RIVALUTING with fluoride so they sent a dazzling light cure, final finishing under water Danish rep with a wimung smile, spray .leave 5.5mins for final finishing • Used for metal bonded NOT Miss Sisse Hansen, to win us over. for regular set, and 3 minutes for fast all ceranlic crowns set, from the start of mixing. The first 24 • Low water solubility They have a new exciting launch of the hours is most critical for glass ionomers. • Long term wear new Riva and Pola ranges. The Pola • Remove excess at gel stage and floss is a Tasmanian devil of a material. THE SELF CURE IS: • Sets in 4 mins and 10 secs • 115 secs extra working time The Riva is ionglass enrid1ed-as clear as Non stick, initially flows well, then possible if the material is the waters of Botany Bay and as strong becomes an easily condensable mass, ma11ipulated on the pad. Low as the Coral of the Great Barrier Reef. has good radiopacity; when extruded film thickness of 17 microns it is glossy but then becomes matt. RIVA RIVA LUTING PLUS At this stage do not manipulate as • Use a conditioner like Riva you will weaken the matrix. The low Only in one simple yellow shade. No Conditioner to remove smear layer water solubility resists disintegration. Bisphenol A (which may cause hormonal • Or else just etch for 5 seconds only responses as it mimics oestrogen) • Use a light cured coat like 'Riva Coat'. RIVA LIGHT CURE (EDITORS Tip- remove excess asap as it is irritant to mucosa) SDIIONGLASS MAKES IT DIFFERENT • Increments of 2mm • 11 shades THE CO CURE TECHNIQUE High ion releasing reactive glass • natural-looking restoration which helps in remineralization • Leave affected dentine (not infected) of the natural dentition .Once RIVASILVER on the floor of cavity fluoride levels in glass ionomer d • Fill with Riva self cme up to ED junction • Same procedure as for self cure • Then resin bonded GI paste used as a eplete they then are replenished • High radiopacity creamy paste by fluoride from toothpaste. • Light in colour • Paint on with microbrush onto Fluoride held within a glass matrix • Initial low viscosity, then enamel walls and onto the GI becomes condensable • Then one can place a composite over THE STRENGTH OF RIVA MATERIALS this without having to wait for GI to RNA PROTECT set, and burrush margins to prevent • High flexural strength (due to glass) ditching a11d white lines. Use thumb • High surface hardness value • Fissure sealing. TI1ick lining which pressure. Cure for 40 seconds. The resulting in better wear resistance can diminish with time but will light curing component sets both the • High compressive strength­ leave fluoride rich area in fissure. composite and the resin modified enhances longevity of restoration by • Fluoride release glass ionomer .The setting of the self withstanding mastication forces. • Low viscosity cured glass ionomer at the bottom • High early strength • Available in pink and white is accelerated by the heat from the • High bond strength • Contains amorphous calcium light. A cascade of reactions goes • A ten second mix phosphate. This results in a slow through the restoration. • Capsulated variety affords optimal release of calcium and fluoride ratio of powder/liquid otherwise ions and can remineralise tooth Carbonated apatite reforms as material can be weakened structure. (S.H.Abrams,M.I Scarlett. fluorapatite at the base as you leave • Material is not expensive as & L.Trost 'Focus on Dental Caries affected dentine on the floor of the cavity. SDl Ltd make eve1ything Management' Beyond Extension For themselves in Melbourne. Prevention to minimal treatment'. With this system (With self curing materials on 1. You do not need to wait 5 minutes for THE SELF CURE ocClusal surfaces one can use a piece · GI to set. of cellophane on the surface and 2. You do not acid etch, wash and dry. Remove smear layer with conditioner, get patient to bite onto it to form a 3. The Riva glass ionomer creates a then wash and remove excess water, contour before the material sets. chemical bond to the tooth of 10 keep moist, mix material, apply self (Dr Geoffrey knight) mega Pascal. POLA BLEACHING to the final result straight away. A flour-based pumice (without Peroxide is broken down to glycerine) is used to first clean teeth. oxygen ions which are attracted to the carbon to carbon double HOME BLEACHING KITS bonds of stained molecules. Best to create a resevoir on the The oxygen desh·oys the double bonds. labial inner surface of the trays by The shorter stained molecules are whiter. painting a spacer on the model up to lmm below the gingival The bleaching process continues for margin before molding the h·ay 48 hours after the dentist has carried out the office bleaching procedure. NON VITAL TOOTH WHITENING Bleaching maintains the structure of the tooth. Cut access at palatal aspect of foot filled tooth and protect the root canal with a IN OFFICE BLEACHING little composite or GI 2mm below DEJ.

With oral mucosa bums apply After bleaching do not replace vitamin E cream or baking fillings for 2 weeks. powder mixed with water.

This will relieve the stinging. When (Editor's tip -always keep peroxide using a light you will see a result closer products in the fridge)

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BY Dr Eirik Aasland Salvesen Specialist Periodontist. A Cherubino event at Corinthia San Gorg. (MP 10\ Summarised by Dr David Muscat

Dr Salveson, who hails from Norway ORTHODONTICS-TIPPING THE CU RAPROX (and could quite easily have doubled up as an A-HA pop group member) 'It is not necessary to have attached ORTHOPAEDIC gave a concise talk on aesthetics. gingivae for the maintenance of gingival health around teeth' PACIFIER-BY OR MAIN POINTS (Wennestom and Lindhe 1983)

HERBERT PICK 1. Team up with soft tissues and • Biological width is 2.04mm. respect the soft tissue guidelines. • If you go too deep with your implant 2. Use ceramic materials in into bone to hide metal you will get Appraisal by Or David Muscat the aesthetic zone. bone recession. 3. Respect biological guidelines • Translucent ceramics are used Dr Herbert Pick has developed an for implant placement and nowadays. orthodontically-optimised Curaprox crown preparation. • SPLIT FLAP - coronally advanced pacifier whose pressure is directed flap used to cover a recessed upper laterally onto the dental ridge during Nowadays the prosthodontist will tell the canine. A thin biotype can be sucking, as opposed to the pressure implantologist where to place the implant changed to a thick biotype. being transfers to the roof of the and not vice versa. Soft tissue is the • EXCESS GINGIVAE =GUMMY mouth as with conventional pacifiers. issue. The bone sets the tone. Periodontal SMILE. Gingivae excised. maintenance is very important. The standard pacifiers may cause In the anterior zone one must use all lateral crossbite, open bite, tooth Human error is nowadays eliminated ceramics. Ceramic abutments are used misalignment and jaw deformity. using scanners and robotic techniques. and ceramic copings. There is a change in the transmission of light into the roots. The Pick pacifier supports healthy SOFT TISSUES jaw growth and minimizes the risk Bone can be built up to concave- of a lopsided face. It helps to avoid • Colour,shape ,texture, parallelism, convex form to create soft tissue. Some orthodontic treatment in the future. zenit symmehy. periodontists use a bur to create soft tissue • Pink pale gingivae are beautiful shape (not recommended). Attachment The Curaprox pacifier has 'side wings' • Papillae important with collagen loss on neighbouring teeth will mean which prevent crossbite. There is a fibres visible as attached gingivae. tissue will recess. When placing implants slightly curved silicone shield which • Incisal edges parallel with cervical in upper labial segment space them out stands proud from the mandible so margins. and stay off the central line so you can so as not to impede the lip musculature • A line from tip of canine to tip central you can mange the papilla. The technician and consequently the occlusion. and lmm above lateral. will do a wax up and give you a guide • Caution when extracting upper for the gingivectomy procedure. The The superior aspect has soft edges. incisor so as not to lose bone and zirconium abutment is scanned. There are 4 ventilation vents for damage soft tissues. the skin resulting in no pressure • Shape, colour and texture decide the Exercise extreme caution with excess points or irritation or eczema. soft tissue. cement. This has to be carefully removed. Modem cements are self etching and cause There are shield clips to use with SOFT TISSUE AUGMENTATION severe problems and fistulas. pacifier band which can be removed for cleaning and when child is asleep .. Indications: increase in height and Experience will result in operator thickness of attached gingivae. predicting soft tissue outcomes when Please contact agents G. Farrugia and Techniques: gingival connective deciding on iJ;nmediate implant placement Sons for further details te/21437415 tissue grafting. · following an upper incisor extraction. FAST FORWARD Bifix~~

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By Dr. C. Corney, M.B., B.S., D.M.R.D., F.R.C.R., Specialist Radiologist, Sliema

CASE HISTORY ABNORMAL RIGHT NORMAL LEFT

A 45 year old man was admitted to No Pharyngeal Contraction the ward with a week's history of increasing difficulty in swallowing fluids and solids and an intermittent Pharynx gargley voice. For the last 30 years he Pooling in Vallecula Contracts had smoked 20-30 cigarettes per day. Quick Emptying of Vallecula Physical examination revealed a mild hemiparesis of the left leg and left arm. After multiple attempts he was able Laryngeal Closure Mechanism to swallow fluids and solids which made his voice gargley. When asked to cough, his voice returned to normal. DIAGRAM SHOWING BARIUM-FILLED PHARYNX ( viewed from the front ) Examination of the chest revealed diminished air entry and crepitations in the lower half of both lungs. overflowing causing a slow dribble of One month later the patient was barium into the larynx (penetration) and swallowing normally without INVESTIGATIONS down the trachea and bronchi into the the need for head turning. His lungs (aspiration) after the swallow. hemiparesis had resolved. A chest radiograph revealed bilateral extensive lower lobe consolidation. If the patient turned his head to CONCLUSION CT brain scan showed a small the right and swallowed no such hypodense area, with no mass effect, leakage into the larynx occurred. The patient had suffered a minor infarct in the right upper medulla. This in the right side of the medulla. The was considered to be an infarct. The barium bolus was seen to pass fact that he displayed a right sided down the left side of the pharynx only, weakness of the pharynx and a left A detailed examination by the speech indicating that the paralysed right sided hemiparesis indicates that the therapist revealed bolus hold-up in the side was squashed flat by turning infarct was in the upper medulla above pharynx. She confirmed the need for the head to the right. So the speech the decussation of the supranuclear multiple attempts to initiate a swallow, therapist advised swallowing only h·acts leading to the relevant cranial with consequent gargley voice relieved when the head was turned to the right. nerve nuclei in the lower medulla. by a vollmtary cough, indicating intermittent respiratory tract aspiration. This manoeuvre produced a dramatic The slow and faltering transit of the improvement in symptoms in that bolus through the right side of the A video barium swallow with the swallowing was easier and the voice pharynx with premature opening use of a slow play-back facility stopped being gargley permanently of the laryngeal closure mechanism revealed a slower than normal transit indicating an absence of aspiration (he had to breath sometime) led time (normal< 1 sec) of 6 secs of on swallowing and timely closure of to passage of the remaining bolus barium through the pharynx. the laryngeal closure mechanism. into the larynx and respiratory tract causing aspiration pneumonia. The right side of the pharynx did After a week there was considerable not undergo the normal pharyngeal improvement in swallowing and DISCUSSION peristaltic waves of conh·action in the hemiparesis. Considcrabl~ compared With the lett side. clearing of the aspiration pneumonia This case demonstrates that a stroke radiographically had occurred. can cause silent aspiration of food There was abnormal pooling of barium and fluids into the respiratory tract. in the right vallecula and pyriform His voice remained normal. The This is because the involuntary cough sinus-which are pocket-like structures patient was discharged home with reflex (we call choking) to clear the in the posterior wall of the pharynx (see instructions to continue swallowing larynx and respiratory tract does diagram). These structures filled to with his head turned to the right. not work because the involuntary cough cenh·e for this in the medulla has been damaged by the infarct. This leads AN ANTIBIOTIC ALPHABET: to accumulation of bolus on the vocal cords manifested by the gargley voice. ANTIBIOTICS WE USE IN He is still able to cough voluntarily (which GENERAL DENTAL SURGERY clears the gargley voice) because the voltmtary cough centre is situated in the BY Dr David Muscat cortex tmaffected by the medullary infarct.

Similarly the normal mechanism of AMOXIL: broad spectrum, oral staphylococcal skin infections swallowing in the pharynx is controlled infections, prophylaxis endocarditis and penicillin resistant by the involuntary swallow centre in staphylococcal infections. the medulla which in this patient has AMPICILLIN: broad spectrum, been damaged by the infarct. (There is sinusitis, oral infections A KLACID: sinusitis, tonsillitis, a voluntary swallow centre in the cortex combination of ampicillin and pharyngitis, dental abscess (Abbott). but this controls only oral phase of flucloxacillin is used to treat infections swallowing- not the pharyngeal phase). involving either streptococci or KLERIMED: Clarithromycin, staphylococci.( eg.CELLULillS). macrolide, respiratory tract Rather frighteningly, 40% of all strokes infections, streptococci. have a consequent dysphagia, many AUGMENTIN: broad spectrum, fortified of which have silent aspiration and amoxil with clavulanic acid.(GSK) KLONT-METRONIDAZOLE pneumonia which can easily be missed KLAMOKS (AMOXILAND CLAVULANIC clinically, so the doctor should be aware AZITHROMYCIN: macrolide, ACID): Dental infections (Bilirn). of this potentially lethal hazard. used against streptococci METROLYL-METRONIDAZOLE: Prophylactic treatment of the aspiration BACTIFLOX: Ciprofloxacine, broad suppositories. is easy in this case where there is a spectrum, Quinolone group tmilateral paralysis of the pharynx. MOXICLAV: amoxil and clavulanic Turning the head to the affected side CEPHALOSPORINS (CEFALEXIN acid, skin and soft tissue infections, and then swallowing leads to the bolus AND CEFRADINE): oral infections oral, dental and maxillary descending the good , unaffected side but not first choice-soft tissue, infections. ENT and respiratory only, without the risk of aspiration . also CECLOR (CEFACLOR).Cross tract, bone and joint infections. sensitivity with penicillin (10%). DIFFERENTIAL DIAGNOSIS NOPRILAM: fortified amoxil (Bial) CLARITHROMYCIN (KLARICID) mild The commonest cause of the above to moderate skin and soft tissue. PENICILLIN V: symptoms and signs is infarct. However Phenoxymethylpenicillin, similar other causes (such as Motor Neurone INFECfiONS- A MACROLIDE spectrum to benzyl penicillin, Disease, Myasthenia, Multiple Sclerosis effective for dento-alveolar abscess. and Malignancy) have to be considered but CQ..AMOXICLAV: Amoxil with beta they are all associated with body symptoms lactamase inhibitor clavulanic acid. RETENS -DOXYCYCLINE: which predate the difficulty in swallowing. respiratory tract infections, ENT, DALACIN C: Clindamycin Periodontal disease, skin and soft THE OUTCOME OF THE ABOVE Staphylococcal bone and joint tissue infections, stomach and MANAGEMENT OF SUCH CASES infections ,endocarditis prophylaxis. intestinal infections.(Chiesi).

1. The silent disease of aspiration DOXYCYCLINE: treatment of destructive RELOX: Cefpodoxime Proxetil, pneumonia is identified early, (refractory) forms of periodontal disease. sinusitis, tonsillitis abscess, pneumonia, reducing the risk of death. An adjunct also in treatment oral herpes cystitis(Aventis Pharma ltd) and recurrent aphthous ulceration. 2. Much earlier discharge from the ward RODOGYL: metronidazole and reduces hospital costs considerably. ERYTHROMYCIN: ORAL AND DENTAL spiramycin--oral and dental INFECfiONS BUT NOT FIRST CHOICE infections (SanofiAventis). For once I am inclined to agree with the French medical cynic, Voltaire, FLAGYL: metronidazole, acute RULID-ROXITHROMYCIN: oral that "the art of medicine consists of ulcerative gingivitis (good for infections but not first choice. amusing the patient whilst Nature anaerobe~:> )and pericoronitis.(TINID cures the disease," except that I would AZOLE also used for AUG.It has a TETRACYCLINE: periodontal disease. replace "amusing" with "assessing". longer duration than metronidazole) ZITHROMAX-ERYTHROMYCIN I am grateful for Susan Waitt's FUSIDIC ACID: cream fusidic acid AND AZITHROMYCIN: used for technical assistance. 2% or ointment sodium fusidate 2%, endocarditis prophylaxis in children). The Pharma.MT DENTIFRICES THE LATEST Fittydent event RESEARCH atWestin A RANDOMISED CLINICAL TRIAL comparing the inhibition of plaque using two different toothpastes by LECTURE BY MR EWALD SCHMITT, President ,CEO Bellamy, Khera, Day, Barker and organised by Pharma MT and Fittydent International 1n Mussett. Journal of contemporary conjunction with DAM. An appraisal by Dr David Muscat dental practice 1 March 2009

AIM

FITTYDENT only needed per day resulting The trial was to compare the in lower cost for the patient. plaque inhibition of a sodium Fittydent has a clearly defined Unique fluoride (1450ppm)/potassium Selling Proposition as the denture NATUR-DENT nitrate dentifrice versus a stabilized adhesive is NON WATER SOLUBLE stannous fluoride (0.454%)/sodium and specifically designed for lowers. A new toothpaste empowered hexametaphosphate/sodium fluoride by nature with enzymes derived positive dentifrice SnF2/SHMO with It is a healthy adhesive as it does from pineapple and papaya. 1450ppm F. not get to the stomach. It is good These proteolytic enzymes for flat and narrow lower jaws. break down the pellicle. METHOD AND MATERIALS

The adhesive cushions provide a. MISWAK- used for 1400 years and 25 subjects were used in a two period, a strong severe bond, and is contains 90 natural substances two treatment double blind crossover highly effective for patients beneficial to oral hygiene. sequence using the BLEND A MED with excessive saliva. EXPERT GUM PROTECTION b. NEEM-antibacterial-works DENTIFRICE and another dentifrice. A dispersible tablet with a PH of 9 is against gram positive and A standard manual toothbrush was used. required to remover the cream from negative bacteria. lt inhibits the cushion, and this does not corrode Streptococcus Mutans. Digital plaque image analysis (DPIA) was the metal components of a denture . used on 3 consecutive days to evaluate: c. XYLITOL- natural sweetener There are 3 applications of 1. Overnight plaque formation AM Fittydent- plastic, metal dentures Clinical studies have shown a PRE BRUSHING and also orthodontic braces. change in tooth shade from D3 2. Following 40 seconds of brushing to A3 using this product. AM POST BRUSHING Fittydent has both a suction and 3. Mid afternoon PM a bonding effect. Fittydent is With this toothpaste there is no made up of two components: bleach, nor chemical derivatives. Images were analysed using an Natur-Dent prevents caries, removes objective computer algorithm to 1. Polyvinylacetate (chewing gum) stains and eliminates bad breath. calculate the total area of visible plaque. A 4 day washout period was 2. CMC (cellulose) It also contains 1490 ppm fluoride. used for the crossover phase. It improves oral hygiene. The cellulose absorbs water so as RESULTS to keep the gum dry so the latter It has a low abrasivcncss .The can stick to the gum. The material RDA is 51. It strengthens gums All the subjects completed the study. remains stuck to the denture only. and prevents tartar build up. The Stannous fluoride/sodium hexametaphosphate dentifrice Fittydent is also free of taste and has The product was originally provided statistically significantly a strong and long lasting bonding successfully launched in Scandinavia lower levels of plaque area coverage effect. No food particles get trapped and will now be launched in the versus the sodium fluoride/potassium under the denture. One application rest of Europe and beyond. nitrate dentifrice. ~~ taste ~ mediterrine~n,vietn~mese&healthcuisine ~ J ~~ ~' Japanese Restaurant www.DineAroundTheWorld.com Reservations: 2346 6666 3012,Malta

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FAST PAIN RELIEF FROM MOUTH ULCERS Distributed by l!!llCol/is Williams /~f EST: 1860 T:21244847,21224104 GEL Bml, SPRAY 15ml & MOUTHWASH 60ml E: [email protected] When a patient presents with the mesial, distal and straight on of the visualization. Also, fractures tend to symptoms associated with a previously toolll ill quet>LimL Bite wing radiographs develop m area of natural cleave lilles endodontically treated tooth, several are also an ilnportant view. All these withil1 the tooth, mesial and distal options exist for treatment-nonsurgical different views are helpful in identify.il1g margil1al ridge areas and grooves endodontic retreatment, endodontic missed canals, abnormal root canal between cusps. surge1 y, m exl1adion. To Jetennlne anatomy, fractures and pertorahons. the most appropriate treatment option, The clinical examination for endodontic several factors need to be assessed Missed canals can be observed retreatment consideration includes before initiating treatment. These factors radiographically when the obturation evaluation of the coronal seal, include the patient's due£ complaint does not appear to be centered m the periodontal status and for fractures. and presenting symptoms, evaluation root. Since roots develop armmd a of the prior endodontic and restorative centrally located pulp, an eccenh·ically A good coronal seal is very ilnportant treatment, the prognosis for the located obturation can indicate a missed to the overall success of any endodontic proposed treatment and of course, the canal. In the case of roots known to have h·eatment. When this seal is violated, patient's desires. multiple canals, the presence of only one recontamination of the root canal space obutrated canal can be indicative of an occurs leadmg to compromise of the Symptoms associated with a previously untreated canal. endodontic treatment or "endodontic endodontically treated tooth may failure". The coronal seal can be include sensitivity to temperature, biting, This is best determined with the violated by caries, cracks, fractures or pressure, palpation and the presence angled radiographs which also help to poor or loose restorations. Inadequate of a sinus tract or swelling. With the determine if the untreated canal is to the crown margins can allow for leakage presence of these symptoms in an facial or lillgual. under the crown and recurrent decay. endodontically treated and restored Loose crowns and bridges can often be tooth after years of being asymptomatic, Short fills, voids, separated instruments, identified by the presence of bubbles endodontic treatment compromise evidence of endodontic surgery along the crown margins when pressure should be suspected. Compromise is a without retrograde restorations or with is applied on the occlusal surface of the better term than failure until the etiology retrograde restorations not in the canal restoration. This can best be visualized can be identified. and the presence of silver cones can all with magnification. be determined radiographically. Most cases of endodontic treatment Thorough periodontal probil1g is essential compromise or failure are related to Perforations can be quite obvious or not. in the clinical evaluation process. The a contaminated root canal space. The A radiolucent area adjacent to the apical periodontal probing needs to include causes of this compromise or failure extent of a post, a lateral radiolucent area the entire tooth and its furcations. An include missed root canal spaces, on the furcation side of a root, a furcation endodontic failure can be misdiagnosed inadequate obturation, perforation and radiolucency or a slims tract tracing as periodontal disease and the opposite is coronal leakage. Missed root canal to the furcation can be indicative of a true as well. Periodontal probing of the spaces and inadequate obturation should perforation. entire quadrant is also recommended. be considered as true endodontic failures When the overall periodontal health is due to the inadequacy of the original Root fractures are often difficult to good, findil1g an isolated, narrow and treatment. Perforations, coronal leakage diagnosis. These fractures extend from deep periodontal pocket over the root and fractures should be considered the crown into the PDL space. These surface is usually indicative of a fracture as endodontic compromise due to fractures can be just into the coronal or possibly a sinus h·act. either periapical breakdown due to an PDL space or extent the entire root iatrogenic cause or recontamination length. Radiographically, fractures may Another indication of a fracture/crack of the root canal space due to coronal be difficult to visualize. Their presence just into the PDL space is sharp pain leakage and decay. is often indicated by a verticallille to gentle periodontal probing which noted between the obturation material is elicited in one specific spot and When deciding to nonsurgically and the canal wall or a "halo" shaped not present elsewhere around the endodontically retreat a case, the radiolucent area surrounding thP root. tooth. This is usually fow1d in the previous endodontic and restorative interproxilnal area. Lrealment must be evaluated. This A fracture which has just begun to evaluation needs include a thorough affect the PDL space can be possibly This probing may cause a lasting radiographic and clinical examination. noted radiographically by a narrow throbbing discomfort similar to the angular bone defect in the interproxilnal patient's chief complaint with the Radiographic examination should area. Changing the angulation tooth. Periodontal probing can also include any past radiographs as well of the radiographs both vertically identify those perforations which as current radiographs angulated from and horizontally can aid in fracture commtmicate with the gingival sulcus. GRANDIOAND GRANDIO FLOW RESEARCH -A These perforations have an unfavorable A good prognosis for reh·eatment can be prognosis for treatment. The key given in the following cases: SUMMARY to fracture and crack identification is visualization either by h·gingival margin that those associated nonsurgical endodontic retreatment the like the remaining tooth substance with endodontic pathosis. The presence preferred treatment method for treating under stress, and is well suited for of isolated narrow periodontcil defects compromised endodontic treatment and posterior teeth. on both the facial and lingual aspects of endodontic failures. 4. Fracture toughness, due to low water the root indicates complete root fracture absorption due to high filler content. facial to lingual. Whenever possible, retaining the original 5.. High edge stability due to excellent tooth and supporting bone is the best cross-linking. The past dental treatment history of option for the tooth and patient. 6. Abrasion resistant, so good the tooth can be of great importance durability of polished material. in the diagnostic process. Why was When discussing a comprehensive 7. Low polymerization shrinkage with the original endodontic treatment retreatment plan, the patient needs to a tooth-like thermal expansion in performed- caries, cracked/fractured be informed of the status of the existing situ. The stress on cavity walls is tootl1 or previous endodontic endodontic and restorative treatment, reduced. A durable restoration witl1 treatment? The answer to these reasons for retreatment ,prognosis tight marginal seal when used with questions can aid in the diagnosis, for retreatment and the potential for Futurabond or Solobond. treatment planning and prognosis for any additional treatment procedures 8.. Compatible wifu selt-etch and total any proposed treatment. such as a new restoration, crown etch bonding. Low shrinkage affords lengthening and for the possible need good margin quality. After all the pertinent information has for endodontic surgery. The most 9. Grandio flow is also very strong but been gathered and analyzed, a diagnosis important consideration before initiating is flowable. can be rendered and prognosis for any retreatment is the informed patient's 10. A high bio-compatibility and low endodontic retreatment can be offered. desires- Retreat or extract. bacterial colonization. I AN OVERVIEW OF PHARMACOLOGICAL MANAGEMENT IN GENERAL DENTAL PRACTICE By Or Adam Bartolo- THE CATAFAST LECTURE EVENT AT INTERCONTINENTAL HOTEL. sponsored by Novartis. Summarized by Dr David Muscat.

CAUSES OF OROFACIAL PAIN OTHER PRODUCTS • Co proxamol---paracetamol and dextropropoxyphene, Distalgesic, AClJTF • BF.>nzydamine hydrochloride Medonol (Codeine not good for Tantum Verde,Difflam dental pain. DF118 not available in a. inh·aoral-tissues supporting teeth, • Ketoprofen lysine salt-OKi UK- dangerous drug- as it has a oral mucosa, alveolar bone. • Choline salicylate- Bonjela -not narrow therapeutic action, a strong b. extraoral causes-psychosomatic, recommended as aspirin risk of action with alcohol) ears and eyes, TMJ, muscles of Reye's syndrome under age 16. • Paracetamol and orphenadrine mastication, salivary glands, vascular, (severe metabolic disorder with citrate-Norgesic--this is used for maxillary sinuses. brain damage) myofascial pain as it is a muscle relaxant and has no anxiolytic or DENTAL HYPERAESTHESIA SALICYLATE BURN may occur with pschosomatic effects. aspirin tab used for topical pain relief. Hydrodynamic theory, movement A burn may also occur with eugenol. NON-STEROIDAL ANTI-INFLAMMATORY fluid within dentinal tubules causes DRUGS deformation of both odontoblast TOPICAL ANAESTHETICS- LIDOCAINE process and adjacent nerve fibres. • Aspirin- Aspro • Dentinox teething gel • Ibuprofen-Irfen, Brufen, Nurofen DESENSITISING AGENTS • Xylonor spray • Dexketoprofen-Keral • Xylocaine spray • Mefenamic acid- Alfoxan.(least anti­ Sodium Fluoride-makes dentine more • Anginovag inflammatory effect-better to use resistant to decalcification, and may • Trachisan lozenges cataflam instead which has a good lead to increase in secondary dentine • BENZOCAINE- spray, lozenges safety profile formation, thus blocking dentinal (dequacaine ),gel (coracaine) tubules. The above all have the same side IMPORTANT- benzocaine is an ester effects of gastric irritation. Stannous Fluoride-similar to sodium type so there is a greater risk of allergies, fluoride but the tin element may also and also with a high oral dose a risk of OTHERS: inactivate enzyme activity in the metahaemoglobinaemia. odontoblast process. • NSAIDs The patient must never be given • Tiaprofenic acid Strontium chloride-the strontium anaesthetic lozenges if alcohol has • Piroxicam ions have strong affinity for been consumed and patient going to • Naproxen calcified tissues. Accelerates rate bed as if the patient vomits there is a • Diclfenac Sodium-Voltaren, of calcification, obliterates dentinal reduction in the efficacy of the VoltarenD tubules. gag reflex. • Diclfenac Potassium- Catflam, Catafast.The potassium salt is more Potassium Nitrate-desensitizes TOPICAL STEROIDS rapidly absorbed and so gives better dentinal nerve endings, and requires efficacy as it reaches a higher peak in continuous usage. It is found in most • Hydrocortisone acetate spray plasma concentrations desensitizing products. -Anginovag • Beclometasone spray - Becotide COX-2 SELECTIVE NSAIDS TOPICAL AGENTS FOR MANAGING inhaler( without spacer) MUCO-GINGIVAL PAIN AND • Dexamethasone mouthwash (only • Etoricoxib(Arcoxia),Celecoxib DISCOMFORT in hospital and made to order by lurniracoxib,Nirnesulide.(Remov). crushing tablets) meloxim(Mobic) Topical NSAIDs: • Triamcinolone in oromucosal paste­ • OPOIDS- not so good for dental Adcortyl in Orabasc. pain. a. stabilize cell membranes preventing • Codeine,DFillS,Tramadol, release of arachidonic acid, which SYSTEMIC ANALGESICS Morphine. starts inflammatory process. b. Inhibit cyclo-oxygenase, reducing • Paracetamol Opoids cause constipation, nausea, synthesis of prostaglandins . • Co codamol--paracetamol and vomiting, cardio-respiratory c. good for gingivitis, stomatitis. codeine-Solpadeine plus depression-related to dose of the drug. THE PALLIATIVE PATIENT

Morphine is started with 5-lOmg for THE VOCO LECTURE severe pain relief -this is equivilant to 1 gram of paracetamol, as a standard starting dose. Morphine solution By Mr John Fanning/ Voco consultont works faster so this is added to the tabs dose and one allows patient to get Summarized by Or David Muscat used to it till required dose achieved, and one tops up with a 5mg solution. Mr John Fanning took us on a journey in it is compatible and interacts with MORPHINE CANNOT BE CRUSHED OR of marvels of German teclmology gift the other. The Rebilda and post are CHEWED AS THERE WILL BE A SUDDEN wrapped in six pandora boxes straight made from the same material and the RELEASE. Once you achieve the right from their launch at the International Futurabond and silane bonding in the dose you convert the tab+soln to Dental fair in Cologne six weeks earlier. post work in harmony with these. The tablets. materials are all radiopaque. NON-DRIP TECHNOLOGY ACUTE INFECTIONS The endo posts are tapered at 35 An innovative way of saving up to degrees so eliminating trapped air • Pericoronitis-local measures best 15% of material otherwise wasted. bubbles. The bottom of the post is plusNSAIDS The plunger has a suck-back conical and anatomically shaped to • Dry socket-alvogyl, BIPP gauze, ZOE mechanism so you do not get the drip better allow post placement in the pack. at the nozzle end. root. Work is 'in progress' with no • ANUG-metronidazole,H202, time wasting. benzocaine, systemic analgesics. Material can be dispensed and Sinusitis-antibiotics, decongestants, precisely placed. Grandioseal, BIIFLUORID 10 is a fluoride varnish antihistamines. Grandioflow and Ionoseal are all used to treat hypersensitivity. It is • Herpes - HSV1-AND VZV-soft diet, delivered in this fashion. transparent ,dries fast and adheres fluids, topical antiviral or systemic to both enamel and dentine with antiviral if immunocomprirnised. BIFIX is a dual-curing, self adhesive, sustained dentinal tubule sealing. luting composite. It is estimated that RESCUE ANALGESIA the operator will save a lot of time as The sodium fluoride provides there is no need for an adhesive or immediate relief while the calcium ie what to give if patient gets pain in conditioner stage. The material self fluoride provides long term relief( do between analgesic doses: cures at 37 degrees within 4 minutes. not rinse for 45 mins after). It also Working time is 2 minutes and intra­ contains ethyl acetate , cellulose ester 1. NSAIDS +PARACETAMOL+/- Opoid oral working time is 30-60 seconds. and eugenol. 2. Morphine +morphine solution. NEW EN DO-TIPS allow direct After cleaning area the material is CATAFAST PRESENTATION application for post cementation, applied with a sponge at the end of a and are up to 2mm diameter. Bifix is red tip applicator. By Mr Jean Pierre Miceli from Novartis available in transparent, universal and white opaque shades. Voco have the patent for their Catafast works within 13 minutes. excellent blister pack presentation. Cataflam within 45 minutes and The Bifix adheres to dentine and The Bifluorid 10 can be used Voltaren within 2-3 hours. When enamel without the need for light before and after in office bleaching taken use a small amount of water curing. There is a normal film procedures. and avoid carbonated drinks which thickness of 10 microns. may in terfere with its action. A waterproof insulating protective IONOLUX is a light-cured glass coating is formed against thermal and There is a nice aniseed taste. ionomer which is used as a stand chemical stimuli. Catafast can be compared to an IM -alone product with excellent analgesic injection. It is indicated in aesthetics and durability. The material can also be used on post traumatic pain, inflammation cervical areas and crown margins, and swelling and migraines and AMARIS GINGIVA replaces COMP­ post deep scaling and sealing cavity toothachf'. ThPre is a 91 pPr cPnt NATUR for the restoration of gingivae. margins. tolerability with Catafast. It is It comes in 4 shades allowing the absorbed within 4 minutes of dentist to restore the cervical areas of The Voco plastic composite placement ingestion, and the onset of action is teeth with the correct gingival colour. instrument has a robust plastic end on within 5 minutes with a peak plasma one side . The other side resembles the concentration at 13 minutes. THE VOCO REBUILDA POST KIT is a antennae of an insect, with one ball very user-friendly kit presented in a ended side for shaping and finishing The World's fastest just got faster. stage by stage box where everything and one flat ended side for packing. (TePe] We care for healthy smiles

Interdental Cleaning- the easy way • Eight colour coded sizes • Plastic coated wire • User-friendly handle • Developed in collaboration with Swedish dental professionals • Now available with the new-generation G2 improved brush head on selected products

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TePe Munhygienprodukter AB Bronsaldersgatan 5, 213 76 Malmii, Sweden • Te l +46 (0)40-670 11 00 • Fax +46 (0)40-670 11 11 • [email protected] • www.tepe.com Distributed in Malta b Alfred Gera & Sons Ltd., 10 Tri ii-Mas ar, Oormi QRM3217, Malta Tel + 356 2144 6205 SUNS TAR (@~ GUM® Sensi Pr~o T M

HEALTHY GUMS. HEALTHY LIFE.• (Desensitizer) For the treatment of hypersensitive tooth surfaces. Lasts up to 6 months.

Swab

Sensitivity generally occurs when gums recede and cementum is not present. As gums recede, the underlying root of the tooth and dentinal tubules are exposed. GUM* Sensi Pro"" desensitizer is indicated for: Apply • Treatment of tooth sensitivity, for use before or after bleaching procedures. • Treatment of sensitivity occurring after professional tooth cleaning, scaling and root planing procedures. • Treatment of hypersensitive root surfaces. GUM., Sensi Pro"' desensitizer is a two-part chemistry- a liquid and a crystallized brush. The liquid becomes activated when the brush applicator is stirred in the liquid. lt is easy to apply and can provide desensitizatic1n up to 6 months. GUM"' Sensi Pror"' desensitizer protects the tooth in two ways: • Calcium and protein are precipitated to block dentinal tubules. • Protective varnish seals tooth surface on the outside. Dry

Tooth Surface SUN STAR

Before Application After Appltcat!On

HEALTHY LIFE.® ENSITIVE

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