Restoration nation

Dr Gerhard Kultermann highlights the non-metal restoration revolution.
Restoration nation
By James McCarthy
Tue 14 Oct 2008 04:00 AM

At the launch of 3M Espe’s first Dubai milling centre, Dr Gerhard Kultermann, head of the firm’s Customer Information Centre in Germany, highlights the non-metal restoration revolution and the emirate’s role as a hub for the regional dental industry.

As a company, how does 3M view the United Arab Emirate's dental market?

It was time [for 3M] to bring the Lava milling centre to the Emirates. In my opinion it has been too long. Choosing the UAE is a win-win for us. This whole business is not just about selling machines. We are looking for a market that will not just be able to house a machine, but one that will be able to fill a machine's workload.

Dubai has a chance to be at the forefront of the dental industry - a world hub for sharing ideas.

The population here is growing. I don't know where else in the world it is growing as rapidly, actually. The buildings are growing; the infrastructure is growing. That is directly related to the quality of medical and dental treatment. Dubai is developing into a very cosmopolitan society and if it continues to proceed in the right way, it has a chance to be at the forefront of the dental industry - a world hub for sharing ideas between professionals. We want to be part of that.

What are the key technologies and growing trends in the Middle East market?

There are a number of key technology trends that are being widely adopted by the dentists in the region. One of these is direct tooth-coloured restorations, where the latest generation of nano-fill composites has been developed. There is a huge demand for those as the aesthetic market grows.

Another major area in the local market is dental implants and we are seeing a big movement away from metal to metal-free restorations. The whole market will move in that direction before long.

What about the increasing implementaion of digital technology?

In the last few years there is a revolution going on in dentistry. Digital technology is finally reaching the industry. Other businesses have embraced it already, but dentistry still tends to remain traditional in its approach, particularly in the technician field, with a preference for handcrafting.

The revolution that has started in the field of prosthodontic restorations is the introduction of CAD/CAM systems and zirconia restorations. The material is able to replace a lot of indications which dentists and technicians have been repairing using metal for the last 100 years.

There are a lot of advantages for not only the patient, but for the dentist and the technicians. A recent five-year study shows that zirconia has a 100% success rate, while the digital mapping and automated production means that restorations are more accurate.

What are the main advantages of zirconia over metal restorations, for the patient and from a dental perspective?

One of the main advantages is that you don't have to remove any healthy tooth structure for aesthetic reasons. In the past, we had to find a balance between the patient's desire for a natural looking tooth and the stability of the restoration.Some opaque shade or metal may shine through, so you would have to remove an extra half a millimetre of material to give the technician more space to for the veneering.

This extra material is healthy tooth structure, so there has always been this little bit of conflict between results and necessity. That is one of the biggest changes in my practice. You can prepare the tooth very carefully, only remove what is really necessary and end up with a very high aesthetic restoration. While it might be very thin at 0.3mm, you cannot achieve that with metal.

How quickly do you see the adoption of this new technology happening here in the UAE?

Dentistry still tends to remain traditional in its approach, particularly in the technician field.

It's understandable to have concerns or to be conservative when following new trends. But the right approach is to study the details of it.

The gloss can sometimes not be as shiny the second time around, especially in the field of zirconia restorations.

Research shows that there are a lot of differences in the market. People believe that there just two or three sources in the world, assuming that zirconia must be all the same. However, it is not. There are differences in the quality of the material, as well as the process used to produce the final restoration.

It can make the difference when it comes to the long-term stability of the restoration and the reliability for the patient. That is a learning curve that the medical sector had with hip implants 20 years ago. Dentists should look for evidence, solid clinical data, of reliability in a system before investing in one.

With the introduction of Lava into the UAE, do you think there will be a reduction in the amount of work sent to labs in the Far East?

There is a trend to make restorations that are related to a higher amount of handcrafted work in a country where that handcrafting is cheaper. That is what dental technicians are afraid of; that their work may go to China or similar markets.

Again, one concern many people have is that digital technology will make it even easier to send data to China and [that] technicians will lose even more work to the Far East. Totally the opposite is true. The reason to transfer work abroad is that it is handcrafted and is cheaper in these countries.

However if you are doing machine-based milling and the work costs the same in Asia as here, there is no need to send your order around the world.

This [opening] gives dentists in the region the chance to have locally, price-competitive restoration work done, compared to that of the Asian-made products. In most cases it will be of a better quality, because the process stability in fully automated systems is much better than handcrafting as the latter depends on the individual.

It will be a major benefit to both dentists and technicians.

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