N° 9/2006 July
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Dear Readers,
How do you best measure and monitor the long term clinical success of a product on the market? For a manufacturer that’s not an easy challenge to overcome. Of cause you can start long term clinical studies at universities to obtain some data regarding the clinical success. But that can only be one part of the total picture – the scientific world. Can we always transfer the results of scientific studies to the routine in a general practitioner’s daily work?
For a long term success both, dentist as well as patient have to be satisfied with the clinical result and this not only depends on the quality of a pro-duct! At the end it comes to three main impor-tant parameters which can help the manufacturer to get a picture about the clinical success: first the results of scientific studies, second the economic
the customer” reflected by market research and inco-ming complaints. Therefore, being a very sensitive probe in the market, professional complaint handling is an important part of the overall quality management for 3M ESPE. In this edition of our Magazine you can read more about how quality management is escorting products from the very first idea, during the product development to the final market launch. Also for the Espertise Magazine we want to do some quality management: we added to this edition a questionnaire to evaluate how satisfied you, our readers, are with the magazine. Please help us with your answers to best serve and meet your needs in the future.
Enjoy reading!
Contents
The perfect match ...2
Find your way in the dschungel of adhesives ...4
Click and treat – about mixing ceremonies ...6
Aesthetics chameleon-style ...7
Importance of user contact on the increase ...8
Anterior aesthetic restoration using two all-ceramic crowns and two porcelain veneers ...10
Angina pectoris – harbinger of the heart attack ...11
General Information ...12
Editorial
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RelyX Unicem now lends its strength to the new
RelyX Fiber Post System delivering faster post
cementation and fewer worries!
Over the past decade fiber reinforced composite (FRC) posts have gained popularity in the dental market because of their benefits regarding mechanical properties, aesthetics and removability, offer-ing predictable clinical performance.
• Clinical success rate: The use of fiber posts in the dental practice
reduces the risk of root fractures compared to metal posts. The dentine-like flexural strength of fiber posts avoids the “wedge effect” of stiff and hard metal posts.
• Aesthetics: With the use of full-ceramic restorations growing
more and more, the fiber posts offer an important advantage being translucent and therefore very well suited for full-ceramic restorations especially in the anterior region.
• Removal: Fiber posts can be easily removed with drills if
endo-dontic revision is required.
Despite these clear advantages of fiber posts and the paradigm shift from metal to fiber posts that is also reflected in the scientific com-munity there is one drawback: they have to be adhesively cemented into the root canal which is difficult for multi-step, moisture sensi-tive adhesive protocols. Market research has shown that many den-tists expect difficulties with the complex cementation procedure of fiber posts in the root canal and as a consequence do not use them. RelyX Fiber Post with RelyX Unicem and RelyX Unicem Aplicap Elongation Tip: The perfect match!
3M ESPE now provides one of the best state-of-the-art fiber posts with one of the best cementation solutions to overcome the last drawback – multistep adhesive cementation in the root canal! RelyX Fiber Post offers enhanced aesthetics as well as mechanical properties similar to dentin that reduce the risk of root fractures.
Benefits of RelyX Fiber Post:
• Fatigue resistance (strength): Fatigue is most likely the ultimate enemy for dental materials. Fatigue testing therefore provides a very realistic picture of the clinical performance. RelyX Fiber Post survives more than 10 million test cycles in modern fatigue testing machines and are far superior to other fiber posts, some of them breaking after only 24000 cycles.
• RelyX Fiber Post has a tapered design to avoid unnecessary removal of root dentin and is available in three sizes.
• RelyX Fiber Post is a translucent and uni-directed quartz fiber post that allows light transmission.
• RelyX Fiber post is radiopaque.
• RelyX Fiber post has a micro-rough surface that adds additional retention
Convenient and void-free root canal cementation with RelyX™ Unicem
Aplicap™ Elongation Tip.
The perfect match
Vivian Porsfeld, 3M ESPE, Germany
RelyX
™Fiber Post and RelyX
™Unicem Self-Adhesive Universal Resin Cement
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Cementation with RelyX Unicem offers a very easy and reliable procedure that results in high adhesive strength which helps to stabilize the tooth and minimizes the risk of debonding, being the second biggest concern when speaking of adhesive cementation in the root canal. To make the cementation procedure even more simple and reliable, 3M ESPE offers the RelyX Unicem Aplicap Elongation Tip that enables a virtually void-free bottom-to-top filling technique of the root canal – eliminating waste, frustration and bubbles.
The perfect team: RelyX™ Fiber Post System and
RelyX™ Unicem Aplicap™ with Elongation tip.
a multi-step paste/paste cement RelyX Unicem
Benefits of RelyX Unicem
and RelyX Unicem Aplicap
Elongation Tip:
• High bond strength to root dentin and RelyX Fiber Post without any pre-treatment of tooth and post
• Easy, void-free and reliable cement application with the RelyX Unicem Aplicap Elongation Tip
• Time-saving and strong adhesive one-step cementation without etching, priming and bonding in the root canal
• Light-curing and self-curing mode leading to excellent bonding in any case
• RelyX Unicem proven reliable for holding permanent restorations by more than 60 in-vitro and in-vivo studies
The RelyX Fiber Post comes in innovative, differentiated blisters for easy, spill-free, hygienic handling. It is available in three sizes that are defined with colour coded rings. 3M ESPE also provides the corre-sponding RelyX Fiber Post Drill in three sizes as well as the RelyX Unicem Aplicap Elongation Tip in the RelyX Fiber Post Introkit.
The RelyX Fiber Post Starter Kit addition-ally contains a RelyX Unicem Trial kit with everything you need to start right away.
Get the solution. Get the system.
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N° 9/2006 July
Many different adhesive systems have come to market in the last years. For the practicing dentist, it is hard to keep his knowledge “state of the art” in the “battle of the bottles”.
Why do we need adhesion?
When using tooth coloured restorative materials like resin compo-sites, it needs to overcome the shrinkage, keep the margin sealed and protect against the penetration of bacteria otherwise the restora-tion will fail. That is what adhesives are developed to do.
How much bond strength is really needed for long
term clinical success?
Can we exactly name and prove the required bond strength which is needed for long term clinical success? So far nobody has. And what does long term mean: Five, ten or even 15 years? However, there are some facts based on experience, which we have to include in the discussion:
• The shrinkage of resin composites decreased due to progress in monomer development to around 1.5 volume percent only.
• The clinical experience with existing self etch adhesive systems is looking promising: Since the product launch almost seven years ago, 3M ESPE sold more than 90 million L-Pops of Prompt / Adper Prompt globally. The clinical success of the customers over this period seems to be excellent: The product has a complaint rate close to zero which reflects the clinical satisfaction of the customers.
• All the adhesive systems are to some degree technique sensitive and have to be applied very carefully, following the instructions for use of the manufacturers. The risk of clinical failures due to mistakes in the bonding procedure or the composite application and layering technique seems to be higher, than the risk of fail-ures due to the technical performance of the products.
Which different adhesive systems are on the
market and how to separate?
The most helpful way to classify the adhesive systems from the clinical perspective is by the number of clinical steps needed and the way the material interacts with the tooth structure. Thus there are four different groups of materials on the market at present (figure):
Group 1: three to fourclinical steps
(for example Adper™ Scotchbond™
Multi-Purpose Adhesive)
The classical approach: total etch or selective etch, smear layer removal.
Group 2: twoclinical steps
(for example Adper™ Scotchbond™ 1 XT
Total-Etch Adhesive)One or two bottle systems with separate etching step: total etch or selective etch, smear layer removal.
Group 3: two clinical steps
Two bottle self conditioning systems without separate etching step:
total etch / conditioning, smear layer dissolving.
Group 4: oneclinical steps
(for example Adper™ Prompt™L-Pop™
Self-Etch Adhesive) “all in one”:
Total etch / conditioning, smear layer dissolving.
Find your way in the jungel of adhesives
Gerhard Kultermann, 3M ESPE, Germany
A Matter of Trust:
Group 4
• 1 clinical step • „all-in-one“ or
pre mix solutions
smear layer dissolving
Group 3
• 2 clinical steps • the bottle self
conditioning systems smear layer dissolving Group 2 • 2 clinical steps • „total-etch“ smear layer removal Group 1 • 3 (4) clinical steps • total-etch or selective etch smear layer removal
Classification of adhesive systems by the number of clinical steps and the way of interactions with the tooth structure.
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Do we need self etch adhesive
systems?
As the market shows, there obviously seems to be a need to simplify the clinical adhesive procedure for daily practice, to reduce the possibility for mistakes and make it easier for the general dental practitioner and his team to handle the materials chairside. Of course one has to know, that with the clas-sical phosphoric acid etching and a separate hydrophobic bonding agent in vitro you can reach a higher bond strength. Therefore a lot of universities are claiming, that there is no need for self etch adhesives and some do not even teach their students, how to handle self etch systems without making mistakes. But because once “on the market” many young dentists will also start to use self condi-tioning systems, and they have never been taught how to apply these accuratly.
What are the differences
between the different self
conditioning material systems?
There are mainly differences in the chem-istry, the pH, the etching solvent, the han-dling and the etching performance of dentin and enamel. In general one can say, that the lower the pH is, the better the etch-ing pattern and therefore the adhesion to enamel. But on the other hand a low pH may include the possibility for hydrophilic interaction with the dentin liquor: The mate-rial may take up water over time from the dentin, which can lead to so called “water trees” inside the hybrid layer. This interac-tion is under scientific investigainterac-tion at the moment. So far there is no proven clinical relevance of these “water trees”, which may increase the number of long term failures. The risk of over etching of the dentin with low pH solutions is lower, than with
sepa-rate phosphoric acid. The acidic molecules are included in a molecule chain and there-fore cannot penetrate deeper than the hybrid layer will be.
Which adhesive system is best
for you?
If you are a dentist, who always wants to have to best possible results based on scien-tific data, who is patient, has the time and team to do even complicated procedures in the surgery without any mistakes: The multi step approach (like Adper™ Scotchbond™ Multi-Purpose Adhesive) for you fits best. If you do not want to miss a separate phosphoric acid etching step to enamel but want to reduce the rest of the procedure as much as possible to also limit the number of possible mistakes: a system like Adper™ Scotchbond™ 1 XT Total-Etch Adhesive for you is the best.
If you rely on technical progress, want to simplify chairside procedure as far as possi-ble, do not want to store complicated bottle systems in your surgery and want to avoid the possibility of over etching or over drying to reduce the possibility for post operative sensitivity: for you, a system like Adper™ Prompt™ L-Pop™ Self-Etch Adhesive fits best.
Conclusion
Whatever your choice or personal prefer-ence is: there is clinical evidprefer-ence for all of these 3M ESPE materials, they are clini-cally proven in daily practice, in millions of applications, for many years.
SEM photomicrograph of hybrid layer
for-med with Adper™ Prompt™ L-Pop™ Self-Etch
Adhesive.
Bonding strength of Adper™ Prompt™ L-Pop™
Self-Etch Adhesive on uncut enamel is higher than of many competitors. The higher microten-sile bonds is presumed due to its significantly greater demineralization potential proven in SEM (left: Adper Prompt L-Pop, right: Clearfil SE, pictures kindly provided by Dr. Pertigao, University of Minnesota).
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Since Roman times powder and liquid have been the components used to mix a cement. The Romans used to be very successful with this technique and their cement walls, houses and fortresses can still be visited today.
This technology has also been the basis of Glass-Ionomer cementa-tion in dentistry.
Assistants had to learn it, they did it for decades and they still do. Please think of your last cementation procedure… Didn’t the hand-mixing procedure resemble a little bit of a time consuming, even crazy ceremony?: Take the bottle, dispense a drop, close the bottle, put it back. Take the small jar and a spoon, take the right quantity of powder, clean the spoon, close the jar and start mixing. Doors and windows of course must be closed; otherwise the powder will be blown away.
This nice ceremony nowadays can be done with JUST ONE CLICK. And you get some improved cement too. Of course in general ceremonies often are nice and people like to stick to them when celebrating traditions. But in dentistry, ceremonies cost time and money but do not make those people who have to wait very happy, ie the dentist and patient.
The 3M ESPE patented Clicker™ Dispenser will save your time and money. Besides time saving during dosage and application, your assistant will be able to mix a more homogenous paste, with less efforts in shorter time. This will also help to increase the reli-ability of your crown and bridge cementations, and you still get the Ketac Cem brand you trust so much improved with the features of a resin-modified glass ionomer cement: Low post-op sensitivity, easy excess removal, low film thickness, fluoride release, low solubility. With just one click, the Clicker Dispenser will dose two paste com-ponents directly on to the mixing pad and you just click again if you need more. The two pastes are easy to mix as the viscosities of both pastes are similar and there is no more “forcing the powder into the liquid”. As no powder is used, clean-up is also simple and easy. Also the Clicker will show you how many clicks you have left. And when it is empty, you dispose of it and take the next one.
Together with convenience, Ketac Cem Plus Luting Cement delivers an enhanced formulation that provides low solubility and improved adhesion to tooth structure and higher strength to aid retention. It is the perfect choice when luting metal-based and glass-free high-strength ceramics with retentive preps. Finally Ketac™ Cem Plus Luting Cement as a resin-modified glass ionomer cement has been clinically proven to have a much lower risk of post-operative sen-sitivity while maintaining high levels of fluoride release associated with conventional glass ionomer cements.
So take your time for traditional ceremonies with your family and friends and become more effective in your operatory: Improve your cementation procedure for standard indications.
Clicking is in…
Click and treat – about mixing ceremonies
Laslo Faith, 3M ESPE, Germany
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N° 9/2006 July
The launch team celebrates 3M ESPE Paradigm™ C Class Ceramic Block for CEREC® Systems with a large furry chameleon being the price of a tombola.
During a symposium held to celebrate the 20th anniversary of CEREC technology, 3M ESPE presented its latest product develop-ment, the Paradigm™ C Glass Ceramic Block for CEREC® Systems, to a wider professional public for the first time.
At 3M ESPE’s popular exhibition stand experts demonstrated the new prosthetic solution: The aesthetically brilliant material made of leucite glass ceramic has been specially developed for indications involving inlays, onlays, crowns and veneers. Paradigm C is char-acterised by a striking translucency and fluorescence that results in a chameleon-like effect in clinical applications. Attendees were delighted by the furry chameleon, which was given away to every visitor to the stand. A tombola that awarded a two metre long furry chameleon as its prize also created a stir. 3M ESPE would now like to take the opportunity of congratulating the winner, Dr. Ina Meißner, a dentist from Bad Hersfeld who specialises in treating children and adolescents. The chameleon couldn’t have found a better home!
The innovative Paradigm C glass ceramic block for CEREC systems will allow 3M ESPE to further develop its market position in the field of indirect restorations. Besides aesthetic brilliance this new product is also distinguished by outstanding physical material char-acteristics. As confirmed by comparative in-vitro studies involving in-house measurements by 3M ESPE, the Paradigm C glass ceramic block offers good flexural strength, high long-term stability as well as low solubility and greater translucency than other glass ceramic blocks.
Its balanced translucency and excellent polishability in clinical applications has been confirmed in user studies. The glass ceramic blocks are available in six perfectly coordinated shades (according to the Vitapan® Classical Shade Guide) and in five sizes. Thanks to the natural aesthetics and good colour coordination, restorations carried out using Paradigm C are virtually undetectable.
Use of the aesthetic glass ceramic for long-lasting chairside CAD/ CAM restorations is simple, fast and reliable, particularly in com-bination with the self-adhesive resin cement RelyX™ Unicem Self-Adhesive Universal Resin Cement from 3M ESPE.
The Paradigm C glass ceramic block from 3M ESPE, an innovative material solution for the CEREC systems from the manufacturer Sirona which is tailored to surgery requirements, is also an inter-esting example of cooperation between companies in the dental industry that is as innovative as it is successful.
Aesthetics chameleon-style
Kristina Schmidt, 3M ESPE, Germany
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*
Nariaki Kano, Japan
Basic requirements
Components, which for the customer are to obvious to mention.
often not mentionned
not mentionned
Elements for „enthusiasm“
Features the customer did not.
articulated
Requirements of performance
Measurable performance the customer expects.
Request from the customer
3 Types of satisfactionfactors *
“At 3M ESPE, product development is requirement-driven, not technolo-gy-driven.” First the developer needs to know what the patient and dentist want. Then technical specifications are formulated, which must be imple-mented using the right methods.
Ask the Experts
Importance of user contact on the increase
Petra Schneider, 3M ESPE Germany
Quality Management in Product Development
Direct contact with the customer is the driving
force behind product development
Quality management in product development at 3M ESPE follows the principle that quality means meeting customers’ demands. 3M ESPE regularly seeks direct contact with the customer to actively find out exactly what these requirements are. The primary aim is to find out wishes and potential for improvement that users see as too obvious to mention in a standard market survey. Fig. 1: Customer requirements – 3 types of satisfaction factors.
Developers and product managers often visit selected dentists in person to find out from them directly what concrete product devel-opments they would like to see where.
As well as with dentists, 3M ESPE also fosters close contacts with researchers and opinion leaders round the globe.
Staff who understand the dentist and dental
technician
Direct contact with customers is only a piece of the jigsaw that is the comprehensive system with which 3M ESPE ensures the quality of its products and works to fulfil the wishes of dentists and dental technicians. Another is that staff are expected to become “quasi dentists”.
Not only do they have to have an in-depth knowledge of their specialist field, for instance chemistry, biology or marketing, but also the application of “their” products in the clinic or labora-tory. Developers, product managers and other groups therefore
Since users often regard product-related improvements as a matter of course, they do not write them down on the questionnaires used in standard market research. That’s why product developers go to dentists and dental technicians to ask them what their wishes and suggestions are.
From the idea to the technical realisation
Target specification Specification sheet
Low price Short treating time
Dentist Physical-technicalSpecification ChemicalSolution Patient
Short working time
No clinical visi-ble discoloration or factures Long lasting filling Polymerization in less than 30 seconds
New initiator system
Flexural strength > 120 MPa
New polymer
take advantage of every means in the company to learn all about dentistry and to get in touch with people who use “their” products day-to-day. And they have plenty of opportunity to do so in the information centre in Seefeld for instance: by attending regular staff training sessions, taking part in training programmes, when dentists’ or dental technicians’ groups, dealers or dental surgery assistants from diverse countries come to visit. Also, everyone is free to attend external dentists or our own internal clinic as a guest.
This kind of training and development is as much a part of quality assurance as correctly translating customer requests into technologi-cal specifications. The project teams are notified of the customer’s concrete wishes, for example, for a new, no-shrinkage composite or for “short chair time” or “short working time”, and not the techno-logical specifications like using certain chemicals. Figure 2: From customer requirement to technical specification.
Project management ensures that customers’
demands are met
In most cases it takes three or more years before a product is launched. There are several phases in the process of developing a new product. Figure 3: The development process – from idea to shelf. After idea screening, a concept is devised and feasibility tested. Next comes actual product development. If it fulfils expec-tations, scale-up follows, in which phase the material or system reaches product maturity. Before market launch each product must undergo a multitude of tests, inspections and certifications stipu-lated by law, standards and national authorities.
The entire process of product development is professionally organ-ised by a multifunctional team, who apply various quality assurance
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Petra Schneider started with 3M ESPE in 1981 as an analy-tical chemist.
In 1991, she was appointed head of quality management responsible for the quality management system, the quality control of all ESPE products (medical devices and drugs) and the analytical laboratories. She was responsible for the imple-mentation of a company-wide quality management system. In 1998, Petra was appointed businessteam manager restora-tives. Her responsibilities include amongst others entrepre-neurial responsibility, global successful marketing of the products in their respective area of indication, strategic and operative planning, passing, evaluating and terminating of R&D projects.
In 2002, Petra was responsible for the integration manage-ment 3M ESPE in the Seefeld center. Together with the inte-gration manager St. Paul, she was responsible for the project management of more than 40 projects of phase 2 of the integration process. Beside that responsibility, she was head of the businessteam and production local anesthetics. In 2002 Petra was appointed head of quality management with global responsibility for quality, regulatory and safety of drugs and medical devices, developed and manufactured at the Seefeld site.
Petra Schneider holds a Ph.D. in organic chemistry.
From the idea to the technical realisation
Developmental phases:
Ideas Pipeline of new products Products
1 Idea Screening 2 Concept Feasibillity3 4 Develop-ment 5 Scale-up 6 Launch 7 Post Launch
1972 – 1981 Studying chemistry in Clausthal-Zellerfeld PhD thesis in organic chemistry
since 1981 Employee of 3M ESPE
1981 – 1985 Quality control of drugs and medical devices
1986 – 1991 Head of pharmaceutical analytics department
1991 – 1997 Head of quality management
1998 – 2002 Head of business team restoratives and local anesthetics
since 2002 Head of quality management (including regulatory and safety)
CURRICULUM VITAE
Dr. Petra Schneider
methods. Among them, alongside the familiar ISO standards, is the so-called six sigma method. It is a statistically validated quality process taking in procedures and projects in the whole company, for instance in sales, production and development.
Quality and clinical safety over the entire life cycle
Quality management does not end once a product is sold, but spans its entire life. Dentists, dental surgery assistants or dental techni-cians frequently have questions relating to application, sometimes even reason for complaint. At 3M ESPE in Seefeld, the Service Centre deals with these scenarios. They take 120 to 140 calls a day, that is around 3,000 a month, and approximately 800 e-mails and faxes on top of that. In 80% of cases the question or problem can be answered or solved to the customer’s satisfaction the first time contact is made.
Only if really complicated and in-depth questions arise is the call forwarded to a product specialist, who gets in touch with the cus-tomer at an agreed time. Field sales is also linked in with the Service Centre and the process is continually evaluated and specific points improved. Telecommunications systems, databases and customer management and sales software work away in the background with the aim of continuously improving workflow and providing the best possible customer service.
3M ESPE is hoping to gain the trust of dentists and dental techni-cians all over the world with its approach to quality. It includes safe manufacturing and handling, and respecting environmental concerns. Having such high standards sometimes leads to long development times, especially in the case of highly innovative tech-nologies with which 3M ESPE breaks new ground. It is clear from all this that quality and clinical safety is the number one priority at 3M ESPE.
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The case report presented here details the replacement of two anterior
crowns on the central incisors as well as the aesthetic restoration of
the two lateral incisors using ceramic veneers
Fig. 1: The patient presented with the main wish to have her anterior crowns replaced and the
space between the central and lateral incisors closed. After a thorough clinical examination and consultation, including orthodontic, it was agreed to restore the central incisors with all-ceramic crowns and restore the aesthetics of the lateral incisors with porcelain veneers and after consult-ing with the dental technician, a conscious decision was made to settle for a slight displacement of the midline. This enables the different-sized spaces between the lateral incisors to be evened out harmoniously.
Fig. 2: The all-ceramic lab fabrication fixed to the lab model clearly shows the intended and achieved displacement of the midline to the left in order to keep the teeth the same width. After pretreating the ceramic with hydrofluoric acid and a silane material (Espe-Sil, 3M ESPE) a bonding layer was applied to the two porcelain veneers, which was then polymerised for 40 seconds (Elipar TriLight, 3M ESPE). This step was not used for the all-ceramic crown, whose pretreatment was complete after solvent evaporation of the silane. Purely light-cured materials are suitable for bonding porcelain veneers: firstly, ceramic veneers are very rarely so thick as to necessitate dual curing, secondly, when using purely light-cured materials the dentist can decide when the moment is right to cure the material. In addition, the risk of marginal discoloration is reduced by virtue of avoiding the amine peroxide-induced polymerisation mechanism of a dark curing reaction. In recent years, the purely light-cured RelyX Veneer (3M ESPE) has proved to be the ideal material for bonding ceramic veneers. In my opinion, of the many shades available, one only requires Shade T (= translucent), as in most cases a truly wrong veneer shade cannot be rectified by choosing a certain composite shade. To be quite sure, one must first select the appropriate “Try-In-Paste” from the RelyX Veneer System; this makes it possible to assess the overall impression of the restoration as if the veneer had already been cemented.
Fig. 3: As RelyX Veneer follows a traditional adhesive concept, it was appropriate to isolate the
teeth with a rubber dam. The veneer surface to be bonded on tooth 12 and 22 were con ditioned with 32% phosphoric acid after thorough cleaning with a fluoride-free prophylaxis paste, and then sealed using a conventional adhesive system. After removing excess RelyX Veneer, a glycer-ine gel layer was applied and light polymerization was performed. In principle, RelyX Unicem is, of course, just as sensitive to contamination of the bonding surface as any other composite cement – but thanks to the self-adhesive properties of this composite cement it is possible to create an area free of contamination within a short timeframe. Thus RelyX Unicem is currently the only material that allows such quick adhesive bonding of all-ceramic crowns using moisture control.
Fig. 4: The picture shows the direct application of the activated and mixed (RotoMix, 3M ESPE)
RelyX Unicem material into the crowns concerned.
Fig. 5: Follow-up after one week shows that the colour of the restoration blends harmoniously
with the other teeth and the width of the teeth looks uniform in relation to the remaining gaps without there being any undesirable effect at the marginal gumline.
Anterior aesthetic restoration using two all-ceramic
crowns and two porcelain veneers
Claus-Peter Ernst, Mainz, Germany
RelyX
™Unicem Self-Adhesive Universal Resin Cement/RelyX
™Veneer Cement
1
2
3
4
5
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Dental Practice Forum
If your patient suddenly grabs his chest and
complains of severe pain, it doesn’t necessarily
mean a heart attack; it could be angina pectoris.
Angina pectoris is the main symptom of coronary heart disease. The most common cause of disease of the coronary vessels is arte-rial calcification (arteriosclerosis): Over the course of many years, cholesterol deposits (plaques) build up on the vascular walls. If plaque forms in the coronary vessels, circulation is restricted as the vessels get progressively narrower: the cardiac muscle no longer gets a sufficient supply of oxygen and nutrients.
The result is sudden acute pain in the heart area (mostly behind the breastbone), cold sweat, nausea and vomiting, “tight” feeling, extremely difficult breathing, pallid complexion, and panic to the point of fear of death.
The pain may radiate, and be misconstrued as arm, shoulder, neck pain or toothache. Also sudden (upper) stomach pains can be a sign of a cardiac emergency.
Initially, a sufferer will only notice narrowing of the coronary ves-sels during physical exertion. At the advanced stage of the disease, even slight physical exertion or mental stress is enough to trigger the symptoms.
The following risk factors cause hardening of the
coronary arteries:
• Overweight and/or Lack of exercise • Smoking
• High blood pressure • Diabetes
Angina pectoris – harbinger of the heart attack
Michael Hillenbrand from “reanimed” in Dieckholzen, Germany
Emergency Cases in Dental Surgery
Angina pectoris – what to do:
1. If your patient complains of sudden acute chest pain com-bined with a tight feeling, nausea, sweating, panic, treat it as a cardiac emergency.
2. Remain calm and collected.
3. Relieve the strain on the heart and put the dentist’s chair into the neutral position
4. Give your patient medical oxygen through a nasal tube and take his blood pressure.
5. If the systolic is above 160 mmHg administer nitroglycerin in capsule or spray form as an emergency medication. Nitrates relieve the strain on the heart, thereby improving the oxygen supply to the cardiac muscle. Nitrate preparations are fast-act-ing and direct!
• Genetic predisposition to calcification of the arteries • Lipid metabolic disorders (high cholesterol level)
Angina pectoris occurs suddenly and unexpectedly and can last from seconds to minutes. Triggers are physical exertion, heavy meals, cold, excitement or mental strain, such as a visit to the den-tist, which causes a lot of people immense stress.
Caution:
People with low blood pressure must not be administered nitrate preparations. As they dilate the blood vessels, blood pressure may drop, resulting in circulatory collapse.
There is a high risk of heart attack after angina pectoris, especially the first episode; the reason being that if a coronary vessel becomes blocked, the oxygen supply to the myocardial tissue behind is cut off, resulting in a heart attack, about which we will go into greater detail in the next issue.
So, in the event of acute pain between the lower jaw and belly button, think of the heart. If in doubt, treat your patient for angina pectoris or a heart attack.
Always seek medical advice – even if your patient feels better soon after administering the nitroglycerin! Angina pectoris is always a warning signal. Cardiac emergencies should always receive inten-sive medical care.
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General Information
Date Event Location Website
12.09.2006 – 15.09.2006 Dentalexpo Moskau (Krokus-Expo) www.dental-expo.ru
22.09.2006 – 25.09.2006 FDI World Dental Congress Shenzhen www.fdiworldental.org
04.10.2006 – 07.10.2006 Expodental Mailand www.expodental.it
06.10.2006 – 08.10.2006 International Dental Showcase London ExCel www.dentalshowcase.com
13.10.2006 – 15.10.2006 5th World Dental Meeting Yokohama www.pacifico.co.jp
16.10.2006 – 19.10.2006 ADA Las Vegas www.ada.org
26.10.2006 – 28.10.2006 Swedental Gothenburg www.swedental.org
01.11.2006 – 04.11.2006 Dentech China Shanghai www.dentech.com.cn
06.11.2006 – 09.11.2006 7th Asian Congress on Oral and Maxillofacial Surgery Hong Kong www.acoms2006.org
08.11.2006 – 12.11.2006 Expo Dental AMIC Mexico City www.dsn.com.mx/amic.htm
26.11.2006 – 29.11.2006 Greater New York Dental Meeting New York City www.gnydm.com
3M ESPE AG
ESPE Platz, 82229 Seefeld, Germany
Telephone: +49(0)8152/700-0 • Telefax: +49(0)8152/700-1586 E-Mail: [email protected] • Internet: http://www.3mespe.com
3M, ESPE, Adper, Elipar, Espertise, Filtek, Ketac, L-Pop, Paradigm, Prompt, RelyX, Roto Mix and Scotchbond are trademarks of 3M or ESPE AG.
Clearfil, Vitapan and Cerec are not trademarks of 3M or 3M ESPE.
Published by: 3M ESPE AG ESPE Platz 82229 Seefeld, Germany Telephone: +49 (0)8152/700-0 Telefax: +49 (0)8152/700-1586 E-Mail: [email protected] Internet: http://www.3mespe.com Editors: Gerhard Kultermann Annika Meyer Editorial team:
Dieter Klasmeier, Maria Bauer, Laslo Faith, John Rafelt, Laurence Bergmeier-Lega
Coordination:
Laurence Bergmeier-Lega,
Production:
Eberl, Immenstadt, Germany
Design and typesetting:
Eberl, Immenstadt, Germany
Global circulation:
120,000
We accept no liability for unsolicited manuscripts or photographs. Court of Jurisdiction: Munich © 3M ESPE AG, Seefeld, 2006
Calendar of Events 2006
Editorial Information
The Comprehensive Reader Survey of the Espertise Magazine
• You are an established dentist dental technician • You teach or study at the university as a
dentist dental medicine student Others: Please, describe your professional activity • Are you scientifically oriented?
yes not too much • Are you specialized in one (or more) of the following treatment areas?
Dentistry for children Periodontology Implantology Orthodontics Oral Surgery Endodontology • How often do you receive the Espertise Magazine?
once a year twice a year three times a year four times a year • Do you think this is:
not enough sufficient to often • How often would you prefer to receive the Espertise Magazine?
• How (or where) do you receive the Espertise Magazine: by mail
at trade fairs at special events personally by your sales rep digitally by e-mail as a download from the 3M ESPE homepage • How would you prefer to receive the Espertise Magazine in the future?
• Do you like to read the Espertise Magazine? very much much not too much not at all • How do you rate the columns of the Espertise Magazine?
Product Information • Comprehensibility of the content
very good good worthy of improvement • Relevance for the daily practice
very high high worthy of improvement • Scientific level
should be higher corresponds to my needs is too demanding
The reader survey of the Espertise Magazine is designed to provide important feedback from our readers. It will take only a few minutes to fill out. As a participant you have a chance to win a trip to IDS 2007 in Cologne.
Please mark your answers with a cross:
Your opinion is important for us
Espertise
magazine
™Fax back this reader survey
to 3M ESPE:
Fax-Nr.: + 49 (0) 721 / 5 09 66 31 35
Closing date is 30
thof October 2006.
Among all participants of this survey we will draw a trip to Cologne, including flight (econo-my), two overnight accommodations and a ticket to the world’s most important dental trade fair, IDS, in spring 2007.
Entitled to take part are dentists, dental techni-cians and dental medicine students. The course of law is impossible. Employees of the company 3M ESPE are excluded from the participation.
The Comprehensive Reader Survey of the Espertise Magazine
• You are an established dentist dental technician
• You teach or study at the university as a dentist dental medicine student
Others: Please, describe your professional activity
• Are you scientifically oriented? yes not too much
• Are you specialized in one (or more)
of the following treatment areas? Dentistry for children
Periodontology Implantology Orthodontics Oral Surgery Endodontology
• How often do you receive the Espertise Magazine? once a year twice a year
three times a year four times a year • Do you think this is:
not enough sufficient too often • How often would you prefer to
receive the Espertise Magazine?
• How (or where) do you receive the Espertise Magazine: by mail
at trade fairs at special events
personally by your sales rep digitally by e-mail
as a download from the 3M ESPE homepage • How would you prefer to receive the
Espertise Magazine in the future?
• Do you like to read the Espertise Magazine?
very much much not too much not at all
• How do you rate the columns of the Espertise Magazine?
Product Information
• Comprehensibility of the content
very good good worthy of improvement • Relevance for the daily practice
very high high worthy of improvement • Scientific level
should be higher corresponds to my needs is too demanding
The reader survey of the Espertise Magazine is designed to provide important feedback from our readers. It will
take only a few minutes to fill out. As a participant you have a chance to win a trip to IDS 2007 in Cologne.
Please mark your answers with a cross:
Your opinion is important for us
page 2
User Report
• Comprehensibility of the content
very good good worthy of improvement • Relevance for the daily practice
very high high worthy of improvement • Scientific level
should be higher corresponds to my needs is too demanding
Clinical Cases
• Comprehensibility of the content
very good good worthy of improvement • Relevance for the daily practice
very high high worthy of improvement • Scientific level
should be higher corresponds to my needs is too demanding
Ask the Expert
• Comprehensibility of the content
very good good worthy of improvement • Relevance for the daily practice
very high high worthy of improvement • Scientific level
should be higher corresponds to my needs is too demanding
Scientific Activities
• Comprehensibility of the content
very good good worthy of improvement • Relevance for the daily practice
very high high worthy of improvement • Scientific level
should be higher corresponds to my needs is too demanding
Dental Practice
• Comprehensibility of the content
very good good worthy of improvement • Relevance for the daily practice
very high high worthy of improvement • Scientific level
should be higher corresponds to my needs is too demanding
Event Calendar
• Comprehensibility of the content
very good good worthy of improvement • Relevance for the daily practice
very high high worthy of improvement • Scientific level
should be higher corresponds to my needs is too demanding
• Which columns do you like best?
Please, mark your favourite columns with a cross: Product Information User Report Clinical Cases Ask the Expert Scientific Activities Dental Practice Event Calendar
• Which are the topics you would like to read more about?
• Recommendation of the Espertise Magazine:
Has it ever been recommended to you by a colleague? Did you recommend it yourself to others?
• Would you like to publish an article of your own in the Espertise Magazine?
yes no
• Please use this space for your personal comments and suggestions:
Fax back this reader survey to 3M ESPE:
Fax-Nr.: +49(0)721 /50966 3135
Closing date is30th of October 2006.
Among all participants of this survey we will draw a trip to Cologne, including flight (economy), two overnight accommodations and a ticket to the world’s most important dental trade fair, IDS, in spring 2007. Entitled to take part are dentists, dental technicians and dental medicine students. The course of law is impossible. Employees of the company 3M ESPE are excluded from the participation.
We thank you very much for your feedback.
Your
