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N°9/2006July

Espertisemagazine™

Dear Readers,

Howdoyoubestmeasureandmonitorthelongterm

clinicalsuccessofaproductonthemarket?

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

theclinicalsuccess.But thatcanonlybeonepartof

thetotalpicture–thescientificworld.Canwealways

transfertheresultsofscientificstudiestotheroutine

inageneralpractitioner’sdailywork?

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

success of a product (measured by turnover, market

share,growthrate)andlastbutnotleastthe“voiceof

thecustomer”reflectedbymarketresearchandinco-

ming complaints. Therefore, being a very sensitive

probeinthemarket,professionalcomplainthandling

isanimportantpartoftheoverallqualitymanagement

for3MESPE.InthiseditionofourMagazineyoucan

readmoreabouthowqualitymanagementisescorting

products fromthevery first idea,during theproduct

development to the final market launch. Also for

the Espertise Magazine we want to do some quality

management:weaddedtothiseditionaquestionnaire

toevaluatehowsatisfiedyou,ourreaders,arewiththe

magazine. Please help us with your answers to best

serveandmeetyourneedsinthefuture.

Enjoyreading!

GerhardKultermann,Editor

3MESPE,Seefeld,Germany

Contents

Theperfectmatch...............................................................2

Findyourwayinthedschungelofadhesives.....................4

Clickandtreat–aboutmixingceremonies........................6

Aestheticschameleon-style................................................7

Importanceofusercontactontheincrease.........................8

Anterioraestheticrestorationusingtwoall-ceramic

crownsandtwoporcelainveneers.....................................10

Anginapectoris–harbingeroftheheartattack................11

GeneralInformation..........................................................12

Editorial


Product Information

2


RelyX Unicem now lends its strength to the new RelyX Fiber Post System delivering faster post cementation and fewer worries!

Overthepastdecadefiberreinforcedcomposite(FRC)postshavegained popularity in the dental market because of their benefitsregardingmechanicalproperties,aestheticsandremovability,offer-ingpredictableclinicalperformance.

• Clinical success rate:Theuseoffiberpostsinthedentalpracticereduces the riskof root fracturescompared tometalposts.Thedentine-like flexural strength of fiber posts avoids the “wedgeeffect”ofstiffandhardmetalposts.

• Aesthetics: With the use of full-ceramic restorations growingmore and more, the fiber posts offer an important advantagebeingtranslucentandthereforeverywellsuitedforfull-ceramicrestorationsespeciallyintheanteriorregion.

• Removal:Fiberpostscanbeeasilyremovedwithdrillsifendo-donticrevisionisrequired.

Despitetheseclearadvantagesoffiberpostsandtheparadigmshiftfrommetaltofiberpoststhatisalsoreflectedinthescientificcom-munitythereisonedrawback:theyhavetobeadhesivelycementedintotherootcanalwhichisdifficultformulti-step,moisturesensi-tiveadhesiveprotocols.Marketresearchhasshownthatmanyden-tistsexpectdifficultieswiththecomplexcementationprocedureoffiberpostsintherootcanalandasaconsequencedonotusethem.

RelyXFiberPostwithRelyXUnicemandRelyXUnicemAplicapElongationTip:Theperfectmatch!

3MESPEnowprovidesoneofthebeststate-of-the-artfiberpostswith one of the best cementation solutions to overcome the lastdrawback–multistepadhesivecementationintherootcanal!

RelyXFiberPostoffersenhancedaestheticsaswellasmechanicalpropertiessimilartodentinthatreducetheriskofrootfractures.

Benefits of RelyX Fiber Post:

• Fatigueresistance(strength):Fatigue ismost likely theultimateenemy fordentalmaterials.Fatigue testing thereforeprovidesavery realistic picture of the clinical performance. RelyX FiberPostsurvivesmorethan10milliontestcyclesinmodernfatiguetestingmachinesandarefarsuperiortootherfiberposts,someofthembreakingafteronly24000cycles.

• RelyX Fiber Post has a tapered design to avoid unnecessaryremovalofrootdentinandisavailableinthreesizes.

• RelyX Fiber Post is a translucent and uni-directed quartz fiberpostthatallowslighttransmission.

• RelyXFiberpostisradiopaque.

• RelyXFiberposthasamicro-roughsurfacethataddsadditionalretention

2

Convenient and void-free root canal cementation with RelyX™ Unicem Aplicap™ Elongation Tip.

The perfect matchVivian Porsfeld, 3M ESPE, Germany

RelyX™FiberPostandRelyX™UnicemSelf-AdhesiveUniversalResinCement

N°9/2006July

Espertisemagazine™Espertisemagazine™

3

Cementation with RelyX Unicem offersa very easy and reliable procedure thatresults in high adhesive strength whichhelps to stabilize the tooth and minimizesthe risk of debonding, being the secondbiggestconcernwhenspeakingofadhesivecementationintherootcanal.Tomakethecementation procedure even more simpleand reliable, 3M ESPE offers the RelyXUnicemAplicapElongationTipthatenablesa virtually void-free bottom-to-top fillingtechnique of the root canal – eliminatingwaste,frustrationandbubbles.

3

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:

• HighbondstrengthtorootdentinandRelyXFiberPostwithoutanypre-treatmentoftoothandpost

• Easy,void-freeandreliablecementapplicationwiththeRelyXUnicemAplicapElongationTip

• Time-savingandstrongadhesiveone-stepcementationwithoutetching,primingandbondingintherootcanal

• Light-curingandself-curingmodeleadingtoexcellentbondinginanycase

• RelyXUnicemprovenreliableforholdingpermanentrestorationsbymorethan60in-vitroandin-vivostudies

TheRelyXFiberPostcomesininnovative,differentiated blisters for easy, spill-free,hygienic handling. It is available in threesizes that are defined with colour codedrings. 3M ESPE also provides the corre-sponding RelyX Fiber Post Drill in threesizesaswellastheRelyXUnicemAplicapElongation Tip in the RelyX Fiber PostIntrokit.

TheRelyXFiberPostStarterKitaddition-allycontainsaRelyXUnicemTrialkitwitheverythingyouneedtostartrightaway.

Get the solution. Get the system.

N°9/2006July


Product Information

4

N°9/2006July

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?

Whenusingtoothcolouredrestorativematerialslikeresincompo-sites, it needs to overcome the shrinkage, keep themargin sealedandprotectagainstthepenetrationofbacteriaotherwisetherestora-tionwillfail.Thatiswhatadhesivesaredevelopedtodo.

How much bond strength is really needed for long term clinical success?

Canweexactlynameandprovetherequiredbondstrengthwhichisneeded for long termclinical success?So farnobodyhas.Andwhatdoes long termmean:Five, tenor even15years?However,therearesomefactsbasedonexperience,whichwehavetoincludeinthediscussion:

• Theshrinkageofresincompositesdecreasedduetoprogressinmonomerdevelopmenttoaround1.5volumepercentonly.

• Theclinicalexperiencewithexistingselfetchadhesivesystemsislookingpromising:Sincetheproductlaunchalmostsevenyearsago, 3M ESPE sold more than 90 million L-Pops of Prompt /AdperPromptglobally.Theclinicalsuccessofthecustomersoverthis period seems tobe excellent:Theproduct has a complaintrate close to zero which reflects the clinical satisfaction of thecustomers.

• Alltheadhesivesystemsaretosomedegreetechniquesensitiveandhavetobeappliedverycarefully,followingtheinstructionsforuseofthemanufacturers.Theriskofclinicalfailuresduetomistakesin thebondingprocedureor thecompositeapplicationandlayeringtechniqueseemstobehigher,thantheriskoffail-uresduetothetechnicalperformanceoftheproducts.

Which different adhesive systems are on the market and how to separate?

The most helpful way to classify the adhesive systems from theclinicalperspectiveisbythenumberofclinicalstepsneededandtheway thematerial interactswith the toothstructure.Thus therearefourdifferentgroupsofmaterialsonthemarketatpresent(figure):

Group 1: threetofour clinicalsteps (forexampleAdper™Scotchbond™ Multi-PurposeAdhesive) Theclassicalapproach:totaletchorselectiveetch, smearlayerremoval.

Group 2: two clinicalsteps (forexampleAdper™Scotchbond™1XT Total-EtchAdhesive) Oneortwobottlesystemswith

separateetchingstep:totaletchorselectiveetch,smearlayerremoval.

Group 3: twoclinicalsteps Twobottleselfconditioningsystemswithout separateetchingstep: totaletch/conditioning,smearlayerdissolving.

Group 4: one clinicalsteps (forexampleAdper™Prompt™L-Pop™

Self-EtchAdhesive)“allinone”: Totaletch/conditioning,smearlayerdissolving.

Find your way in the jungel of adhesives Gerhard Kultermann, 3M ESPE, Germany

AMatterofTrust:

Group 4

• 1 clinical step

• „all-in-one“ or pre mix solutions

smear layerdissolving

Group 3

• 2 clinical steps

• the bottle self conditioningsystems

smear layerdissolving

Group 2

• 2 clinical steps

• „total-etch“

smear layerremoval

Group 1

• 3 (4) clinical steps

• total-etch or selective etch

smear layerremoval

Classification of adhesive systems by the number of clinical steps and the way of interactions with the tooth structure.


N°9/2006July


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Do we need self etch adhesive systems?

Asthemarketshows,thereobviouslyseemstobeaneedtosimplifytheclinicaladhesiveprocedure for daily practice, to reduce thepossibility for mistakes and make it easierfor the general dental practitioner and histeam to handle the materials chairside. Ofcourseonehastoknow,thatwiththeclas-sicalphosphoricacidetchingandaseparatehydrophobicbondingagentinvitroyoucanreachahigherbondstrength.Thereforealotofuniversitiesareclaiming,thatthereisnoneedforselfetchadhesivesandsomedonoteventeachtheirstudents,howtohandleselfetchsystemswithoutmakingmistakes.Butbecauseonce“onthemarket”manyyoungdentists will also start to use self condi-tioning systems, and they have never beentaughthowtoapplytheseaccuratly.

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-dlingandtheetchingperformanceofdentinand enamel. In general one can say, thatthe lower the pH is, the better the etch-ing pattern and therefore the adhesion toenamel. But on the other hand a low pHmay include thepossibility forhydrophilicinteractionwiththedentinliquor:Themate-rial may take up water over time from thedentin, which can lead to so called “watertrees” inside thehybrid layer.This interac-tion is under scientific investigation at themoment.So far there isnoprovenclinicalrelevanceofthese“watertrees”,whichmayincrease the number of long term failures.TheriskofoveretchingofthedentinwithlowpH solutions is lower, thanwith sepa-

ratephosphoricacid.Theacidicmoleculesareincludedinamoleculechainandthere-forecannotpenetratedeeperthanthehybridlayerwillbe.

Which adhesive system is best for you?

If you are a dentist, who always wants tohavetobestpossibleresultsbasedonscien-tificdata,who ispatient,has the timeandteamtodoevencomplicatedproceduresinthesurgerywithoutanymistakes:Themultistep approach (like Adper™ Scotchbond™Multi-PurposeAdhesive)foryoufitsbest.

If you do not want to miss a separatephosphoricacidetchingsteptoenamelbutwanttoreducetherestoftheprocedureasmuch as possible to also limit the numberofpossiblemistakes:asystemlikeAdper™Scotchbond™1XTTotal-EtchAdhesiveforyouisthebest.

If you rely on technical progress, want tosimplifychairsideprocedureasfaraspossi-ble,donotwanttostorecomplicatedbottlesystems inyour surgeryandwant toavoidthepossibilityofoveretchingoroverdryingto reduce thepossibility for post operativesensitivity: for you, a system like Adper™Prompt™ L-Pop™ Self-Etch Adhesive fitsbest.

Conclusion

Whatever your choice or personal prefer-enceis:thereisclinicalevidenceforallofthese 3M ESPE materials, they are clini-callyprovenindailypractice,inmillionsofapplications,formanyyears.

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).


Product Information

N°9/2006July

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N°9/2006July

Product Information

SinceRoman timespowderand liquidhavebeen thecomponentsusedtomixacement.TheRomansusedtobeverysuccessfulwiththistechniqueandtheircementwalls,housesandfortressescanstillbevisitedtoday.

ThistechnologyhasalsobeenthebasisofGlass-Ionomercementa-tionindentistry.Assistantshadtolearnit,theydiditfordecadesandtheystilldo.Pleasethinkofyourlastcementationprocedure…Didn’tthehand-mixingprocedure resemble a little bit of a time consuming, evencrazyceremony?:Takethebottle,dispenseadrop,closethebottle,putitback.Takethesmalljarandaspoon,taketherightquantityofpowder, clean the spoon, close the jar and startmixing.Doorsandwindowsofcoursemustbeclosed;otherwisethepowderwillbeblownaway.

ThisniceceremonynowadayscanbedonewithJUSTONECLICK.And you get some improved cement too. Of course in generalceremonies often are nice and people like to stick to them whencelebrating traditions. But in dentistry, ceremonies cost time andmoneybutdonotmakethosepeoplewhohavetowaitveryhappy,iethedentistandpatient.

The 3M ESPE patented Clicker™ Dispenser will save your timeand money. Besides time saving during dosage and application,yourassistantwillbeabletomixamorehomogenouspaste,withlesseffortsinshortertime.Thiswillalsohelptoincreasethereli-abilityofyourcrownandbridgecementations,andyoustillgettheKetacCembrandyoutrustsomuchimprovedwiththefeaturesofaresin-modifiedglassionomercement:Lowpost-opsensitivity,easyexcessremoval,lowfilmthickness,fluoriderelease,lowsolubility.

Withjustoneclick,theClickerDispenserwilldosetwopastecom-ponentsdirectlyontothemixingpadandyoujustclickagainifyouneedmore.Thetwopastesareeasytomixastheviscositiesofbothpastesaresimilarandthereisnomore“forcingthepowderintotheliquid”.Asnopowderisused,clean-upisalsosimpleandeasy.AlsotheClickerwillshowyouhowmanyclicksyouhaveleft.Andwhenitisempty,youdisposeofitandtakethenextone.

Togetherwithconvenience,KetacCemPlusLutingCementdeliversanenhancedformulationthatprovideslowsolubilityandimprovedadhesion to toothstructureandhigherstrength toaid retention. Itis theperfectchoicewhenlutingmetal-basedandglass-freehigh-strength ceramics with retentive preps. Finally Ketac™ Cem PlusLutingCementasaresin-modifiedglassionomercementhasbeenclinicallyproven tohaveamuchlowerriskofpost-operativesen-sitivitywhilemaintaininghighlevelsoffluoridereleaseassociatedwithconventionalglassionomercements.

Sotakeyourtimefortraditionalceremonieswithyourfamilyandfriendsandbecomemoreeffectiveinyouroperatory:Improveyourcementationprocedureforstandardindications.

Clicking is in…

Click and treat – about mixing ceremoniesLaslo Faith, 3M ESPE, Germany

Ketac™CemPlusLutingCementintheClicker™Dispenser


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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 ofCERECtechnology,3MESPEpresenteditslatestproductdevelop-ment,theParadigm™CGlassCeramicBlockforCEREC®Systems,toawiderprofessionalpublicforthefirsttime.

At 3M ESPE’s popular exhibition stand experts demonstrated thenewprostheticsolution:Theaestheticallybrilliantmaterialmadeofleuciteglassceramichasbeenspeciallydeveloped for indicationsinvolvinginlays,onlays,crownsandveneers.ParadigmCischar-acterised by a striking translucency and fluorescence that resultsinachameleon-likeeffect inclinicalapplications.Attendeesweredelightedbythefurrychameleon,whichwasgivenawaytoeveryvisitortothestand.Atombolathatawardedatwometrelongfurrychameleon as its prize also created a stir. 3M ESPE would nowlike to take the opportunity of congratulating the winner, Dr. InaMeißner, a dentist from Bad Hersfeld who specialises in treatingchildren and adolescents. The chameleon couldn’t have found abetterhome!

TheinnovativeParadigmCglassceramicblockforCERECsystemswill allow3MESPE to furtherdevelop itsmarketposition in thefieldof indirect restorations.Besidesaestheticbrilliance thisnewproductisalsodistinguishedbyoutstandingphysicalmaterialchar-acteristics.Asconfirmedbycomparativein-vitrostudiesinvolvingin-housemeasurementsby3MESPE,theParadigmCglassceramicblockoffersgoodflexuralstrength,highlong-termstabilityaswellaslowsolubilityandgreatertranslucencythanotherglassceramicblocks.

Its balanced translucency and excellent polishability in clinicalapplicationshasbeenconfirmedinuserstudies.Theglassceramicblocksareavailableinsixperfectlycoordinatedshades(accordingto theVitapan® Classical Shade Guide) and in five sizes.Thankstothenaturalaestheticsandgoodcolourcoordination,restorationscarriedoutusingParadigmCarevirtuallyundetectable.

Useoftheaestheticglassceramicforlong-lastingchairsideCAD/CAMrestorationsissimple,fastandreliable,particularlyincom-binationwiththeself-adhesiveresincementRelyX™UnicemSelf-AdhesiveUniversalResinCementfrom3MESPE.

TheParadigmCglassceramicblockfrom3MESPE,aninnovativematerial solution for the CEREC systems from the manufacturerSironawhich is tailored to surgery requirements, is alsoan inter-esting example of cooperation between companies in the dentalindustrythatisasinnovativeasitissuccessful.

Aesthetics chameleon-styleKristina Schmidt, 3M ESPE, Germany

Paradigm™CGlassCeramicBlockforCEREC®Systems


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*Nar

iaki

Kan

o, J

apan

Basic requirementsComponents, which for the customer are to obvious to mention.

often not mentionned

not mentionnedElements for „enthusiasm“Features the customer did not.

articulatedRequirements of performanceMeasurable performance the customer expects.

Request from the customer3 Types of satisfaction factors *

“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 increasePetra Schneider, 3M ESPE Germany

QualityManagementinProductDevelopment

Direct contact with the customer is the driving force behind product development

Qualitymanagementinproductdevelopmentat3MESPEfollowstheprinciple thatqualitymeansmeetingcustomers’demands.3MESPE regularly seeksdirect contactwith thecustomer to activelyfindoutexactlywhattheserequirementsare.Theprimaryaimistofindoutwishesandpotentialforimprovementthatusersseeastooobvious tomention inastandardmarketsurvey.Fig.1:Customerrequirements–3typesofsatisfactionfactors.Developers and product managers often visit selected dentists inpersontofindoutfromthemdirectlywhatconcreteproductdevel-opmentstheywouldliketoseewhere.Aswellaswithdentists,3MESPEalsofostersclosecontactswithresearchersandopinionleadersroundtheglobe.

Staff who understand the dentist and dental technician

Directcontactwithcustomers isonlyapieceof thejigsawthat isthecomprehensivesystemwithwhich3MESPEensuresthequalityofitsproductsandworkstofulfilthewishesofdentistsanddentaltechnicians. Another is that staff are expected to become “quasidentists”.Not only do they have to have an in-depth knowledge of theirspecialist field, for instance chemistry, biology or marketing, butalso 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 specificationSpecification sheet

Low priceShort treating time

DentistPhysical-technicalSpecification

ChemicalSolutionPatient

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 advantageof everymeans in the company to learn all aboutdentistryandtogetintouchwithpeoplewhouse“their”productsday-to-day.And they have plenty of opportunity to do so in theinformationcentreinSeefeldforinstance:byattendingregularstafftrainingsessions,takingpartintrainingprogrammes,whendentists’or dental technicians’ groups, dealers or dental surgery assistantsfromdiversecountriescometovisit.Also,everyoneisfreetoattendexternaldentistsorourowninternalclinicasaguest.Thiskindoftraininganddevelopmentisasmuchapartofqualityassuranceascorrectlytranslatingcustomerrequestsintotechnologi-calspecifications.Theprojectteamsarenotifiedofthecustomer’sconcretewishes,forexample,foranew,no-shrinkagecompositeorfor“shortchairtime”or“shortworkingtime”,andnotthetechno-logicalspecificationslikeusingcertainchemicals.Figure2:Fromcustomerrequirementtotechnicalspecification.

Project management ensures that customers’ demands are met

In most cases it takes three or more years before a product islaunched. There are several phases in the process of developinga new product. Figure 3: The development process – from ideatoshelf.After ideascreening,aconcept isdevisedand feasibilitytested.Nextcomesactualproductdevelopment.Ifitfulfilsexpec-tations, scale-up follows, in which phase the material or systemreachesproductmaturity.Beforemarketlauncheachproductmustundergo a multitude of tests, inspections and certifications stipu-latedbylaw,standardsandnationalauthorities.Theentireprocessofproductdevelopmentisprofessionallyorgan-isedbyamultifunctionalteam,whoapplyvariousqualityassurance

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PetraSchneiderstartedwith3MESPEin1981asananaly-ticalchemist.In 1991, she was appointed head of quality managementresponsible for the quality management system, the qualitycontrolofallESPEproducts(medicaldevicesanddrugs)andtheanalyticallaboratories.Shewasresponsiblefortheimple-mentationofacompany-widequalitymanagementsystem.In1998,Petrawasappointedbusinessteammanagerrestora-tives.Her responsibilities includeamongstothers entrepre-neurial responsibility, global successful marketing of theproductsintheirrespectiveareaofindication,strategicandoperative planning, passing, evaluating and terminating ofR&Dprojects.In2002,Petrawas responsible for the integrationmanage-ment3MESPEintheSeefeldcenter.Togetherwiththeinte-grationmanagerSt.Paul,shewasresponsiblefortheprojectmanagement of more than 40 projects of phase 2 of theintegrationprocess.Besidethatresponsibility,shewasheadofthebusinessteamandproductionlocalanesthetics.In 2002 Petra was appointed head of quality managementwithglobal responsibility forquality, regulatoryandsafetyofdrugsandmedicaldevices,developedandmanufacturedattheSeefeldsite.PetraSchneiderholdsaPh.D.inorganicchemistry.

From the idea to the technical realisation

Developmental phases:

Ideas ProductsPipeline of new products

1Idea

Screening

2Concept

3Feasibillity

4Develop-

ment

5Scale-

up

6Launch

7Post

Launch

1972 – 1981 Studying chemistry in Clausthal-Zellerfeld PhD thesis in organic chemistrysince 1981 Employee of 3M ESPE1981 – 1985 Quality control of drugs and medical devices1986 – 1991 Head of pharmaceutical analytics department1991 – 1997 Head of quality management1998 – 2002 Head of business team restoratives and local anestheticssince 2002 Head of quality management (including regulatory and safety)

CURRICULUM VITAE Dr. Petra Schneider

methods.Amongthem,alongsidethefamiliarISOstandards,istheso-called six sigma method. It is a statistically validated qualityprocesstakinginproceduresandprojectsinthewholecompany,forinstanceinsales,productionanddevelopment.

Quality and clinical safety over the entire life cycle

Qualitymanagementdoesnotendonceaproductissold,butspansits entire life. Dentists, dental surgery assistants or dental techni-cians frequentlyhavequestions relating toapplication, sometimeseven reason for complaint. At 3M ESPE in Seefeld, the ServiceCentredealswiththesescenarios.Theytake120to140callsaday,that isaround3,000amonth,andapproximately800e-mailsandfaxesontopofthat.In80%ofcasesthequestionorproblemcanbeansweredorsolved to thecustomer’ssatisfaction the first timecontactismade.Only if reallycomplicatedand in-depthquestionsarise is thecallforwardedtoaproductspecialist,whogets in touchwith thecus-tomeratanagreedtime.FieldsalesisalsolinkedinwiththeServiceCentreandtheprocessiscontinuallyevaluatedandspecificpointsimproved. Telecommunications systems, databases and customermanagementandsalessoftwareworkawayinthebackgroundwiththeaimofcontinuouslyimprovingworkflowandprovidingthebestpossiblecustomerservice.3MESPEishopingtogainthetrustofdentistsanddentaltechni-cians all over the world with its approach to quality. It includessafe manufacturing and handling, and respecting environmentalconcerns. Having such high standards sometimes leads to longdevelopmenttimes,especiallyinthecaseofhighlyinnovativetech-nologieswithwhich3MESPEbreaksnewground.Itisclearfromallthisthatqualityandclinicalsafetyisthenumberonepriorityat3MESPE.

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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:Thepatientpresentedwiththemainwishtohaveheranteriorcrownsreplacedandthespacebetweenthecentralandlateralincisorsclosed.Afterathoroughclinicalexaminationandconsultation,includingorthodontic,itwasagreedtorestorethecentralincisorswithall-ceramiccrownsandrestoretheaestheticsofthelateralincisorswithporcelainveneersandafterconsult-ingwiththedentaltechnician,aconsciousdecisionwasmadetosettleforaslightdisplacementofthemidline.Thisenablesthedifferent-sizedspacesbetweenthelateralincisorstobeevenedoutharmoniously.

Fig. 2:Theall-ceramic lab fabrication fixed to the labmodel clearly shows the intendedandachieveddisplacementofthemidlinetotheleftinordertokeeptheteeththesamewidth.

Afterpretreatingtheceramicwithhydrofluoricacidandasilanematerial(Espe-Sil,3MESPE)abondinglayerwasappliedtothetwoporcelainveneers,whichwasthenpolymerisedfor40seconds(EliparTriLight,3MESPE).Thisstepwasnotusedfortheall-ceramiccrown,whosepretreatmentwascompleteaftersolventevaporationofthesilane.Purelylight-curedmaterialsaresuitableforbondingporcelainveneers:firstly,ceramicveneersareveryrarelysothickastonecessitatedualcuring,secondly,whenusingpurelylight-curedmaterialsthedentistcandecidewhenthemomentisrighttocurethematerial.Inaddition,theriskofmarginaldiscolorationisreducedbyvirtueofavoidingtheamineperoxide-inducedpolymerisationmechanismofadarkcuringreaction.Inrecentyears,thepurelylight-curedRelyXVeneer(3MESPE)hasprovedtobetheidealmaterialforbondingceramicveneers.Inmyopinion,ofthemanyshadesavailable,oneonlyrequiresShadeT(=translucent),asinmostcasesatrulywrongveneershadecannotberectifiedbychoosingacertaincompositeshade.Tobequitesure,onemustfirstselecttheappropriate“Try-In-Paste”from theRelyXVeneerSystem; thismakes itpossible toassess theoverall impressionof therestorationasiftheveneerhadalreadybeencemented.

Fig. 3:AsRelyXVeneerfollowsatraditionaladhesiveconcept,itwasappropriatetoisolatetheteethwitharubberdam.Theveneersurfacetobebondedontooth12and22wereconditionedwith32%phosphoricacidafter thoroughcleaningwitha fluoride-freeprophylaxispaste, andthensealedusingaconventionaladhesivesystem.AfterremovingexcessRelyXVeneer,aglycer-inegellayerwasappliedandlightpolymerizationwasperformed.Inprinciple,RelyXUnicemis,ofcourse,justassensitivetocontaminationofthebondingsurfaceasanyothercompositecement–butthankstotheself-adhesivepropertiesofthiscompositecementitispossibletocreateanareafreeofcontaminationwithinashorttimeframe.ThusRelyXUnicemiscurrentlytheonlymaterialthatallowssuchquickadhesivebondingofall-ceramiccrownsusingmoisturecontrol.

Fig. 4:Thepictureshowsthedirectapplicationoftheactivatedandmixed(RotoMix,3MESPE)RelyXUnicemmaterialintothecrownsconcerned.

Fig. 5:Follow-upafteroneweekshowsthatthecolouroftherestorationblendsharmoniouslywiththeotherteethandthewidthoftheteethlooksuniforminrelationtotheremaininggapswithouttherebeinganyundesirableeffectatthemarginalgumline.

Anterior aesthetic restoration using two all-ceramic crowns and two porcelain veneersClaus-Peter Ernst, Mainz, Germany

RelyX™UnicemSelf-AdhesiveUniversalResinCement/RelyX™VeneerCement

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Clinical Case Report


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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.

Anginapectorisisthemainsymptomofcoronaryheartdisease.Themostcommoncauseofdiseaseofthecoronaryvesselsisarte-rialcalcification(arteriosclerosis):Overthecourseofmanyyears,cholesterol deposits (plaques) build up on the vascular walls. Ifplaqueformsinthecoronaryvessels,circulationisrestrictedasthevessels get progressively narrower: the cardiac muscle no longergetsasufficientsupplyofoxygenandnutrients.

The result is sudden acute pain in the heart area (mostly behindthebreastbone), cold sweat, nausea andvomiting, “tight” feeling,extremelydifficult breathing, pallid complexion, andpanic to thepointoffearofdeath.Thepainmayradiate,andbemisconstruedasarm,shoulder,neckpainortoothache.Alsosudden(upper)stomachpainscanbeasignofacardiacemergency.

Initially,asuffererwillonlynoticenarrowingofthecoronaryves-selsduringphysicalexertion.Attheadvancedstageofthedisease,even slightphysical exertionormental stress is enough to triggerthesymptoms.

The following risk factors cause hardening of the coronary arteries:

• Overweightand/orLackofexercise• Smoking• Highbloodpressure• Diabetes

Angina pectoris – harbinger of the heart attackMichael Hillenbrand from “reanimed” in Dieckholzen, Germany

EmergencyCasesinDentalSurgery

Angina pectoris – what to do:

1.Ifyourpatientcomplainsofsuddenacutechestpaincom-binedwithatightfeeling,nausea,sweating,panic,treatitasacardiacemergency.

2.Remaincalmandcollected.

3.Relievethestrainontheheartandputthedentist’schairintotheneutralposition

4.Giveyourpatientmedicaloxygenthroughanasaltubeandtakehisbloodpressure.

5.Ifthesystolicisabove160mmHgadministernitroglycerinincapsuleorsprayformasanemergencymedication.Nitratesrelievethestrainontheheart, therebyimprovingtheoxygensupplytothecardiacmuscle.Nitratepreparationsarefast-act-inganddirect!

• Geneticpredispositiontocalcificationofthearteries• Lipidmetabolicdisorders(highcholesterollevel)

Angina pectoris occurs suddenly and unexpectedly and can lastfrom seconds to minutes. Triggers are physical exertion, heavymeals,cold,excitementormentalstrain,suchasavisittotheden-tist,whichcausesalotofpeopleimmensestress.

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.

Thereisahighriskofheartattackafteranginapectoris,especiallythefirstepisode;thereasonbeingthatifacoronaryvesselbecomesblocked, theoxygensupply to themyocardial tissuebehind is cutoff,resultinginaheartattack,aboutwhichwewillgointogreaterdetailinthenextissue.

So, in the event of acute pain between the lower jaw and bellybutton,thinkoftheheart.Ifindoubt,treatyourpatientforanginapectorisoraheartattack.Alwaysseekmedicaladvice–evenifyourpatientfeelsbettersoonafter administering the nitroglycerin!Angina pectoris is always awarningsignal.Cardiacemergencies shouldalways receive inten-sivemedicalcare.


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

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