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Volume XVIII, Number II, 2011
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13
Orthodontic Camouflage Treatment of a

Class II Malocclusion - A Cas e Report
Dr. Saud A. Al-Anezi, Dr. Manar M. Al-Nouri
19
Unilateral Subperiosteal Implant

Dr. Haseed Dary
26
Application of CBCT in Dental Practice

A Literature Rev iew
Dr. Mohammed A. Alshehri, Dr. Hadi Alamri,
Dr. Mazen Alshalhoub
36
25th Anniversary, International Meeting

of the Egyptian Orthodontic Society
40
120 Years W&H, Pre-IDS Meeting
43
International Dental Show 2011
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15th Kuwait Dental Association

International Scientific Conference
60
1st Iraqi Dental Reunion
62
10th Lebanese Orthodontic Society

Meeting
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ITI First Middle East Congress Beirut,

Lebanon
78
Product Review
INTERNATIONAL REVIEW BOARD

Pr. M.A. Bassiouny BDS, DMD, MSc, Ph.D. Director International Program, Temple University, Philadelphia, USA.
Pr. N.F. Bissada D.D.S., M.S.D Professor and Chairman, Department of Periodontics, Case Western Reserve
University, USA.
Pr. Jean-Louis Brouillet D.C.D, D.S.O. Chairman, Department of Restorative Dentistry, Aix-Marseille II, France.
Pierre Colon D.C.D., D.S.O. Matre de confrence des universits, Paris, France.
Dr. Jean-Claude Franquin, Directeur de lUnit de Recherche ER116, Marseille, France.
Pr. Gilles Koubi D.C.D., D.S.O. Department of Restorative Dentistry, Aix-Marseille II, France.
Pr. Guido Goracci. University LA SAPIENZA, School of Medicine & Dentistry, Roma, Italia.
Brian J. Millar BDS, Ph.D. Guys, Kings, and St. Thomas College School of Medecine & Dentistry, London, UK.
Pr. Dr. Klaus Ott, Director of the Clinics of Westflischen Wilhelms-University, Mnster, Germany.
Wilhelm-Joseph Pertot DEA, Matre de confrence, Aix-Marseille II, France.
Pr. Dr. Alfred Renk, Bayerische Julius-Maximilians-University, Wrzburg, Germany.
Dr. Philippe Roche-Poggi DEA. Matre de confrence des universits, Aix-Marseille II, France.
Michel Sixou D.C.D., D.E.A. Department of Priodontology, Toulouse, France.
Pr. M. Sharawy B.D.S., Ph.D. Professor and Director, Department of Oral biology, Medical College of Georgia,
Augusta, Georgia, USA.
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June 15 - 18, 2011
International Association of Pediatric Dentistry 2011
Wednesday, June 15-18,
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87th Congress of the European Orthodontic Society
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DENTAL NEWS, VOLUME XVIII, NUMBER II, 2011
ORTHODONTICS
m a l o c c l-uA case
s i oreport
n
*Dr Saud A. Al-Anezi BDS, MFD RCSI, DDS , MOrth RCSEd., Dr Manar M. Al-Nouri
*Bneid AL-Gar Specialty Dental Center. - Orthodontic Department - Kuwait
saudalan@gmail.com
Introduction
Case history
Class II division 1 malocclusion is described as the incisal edges

of the lower incisors occlude posterior to the cingulum plateau
of the upper incisors and the upper central incisors are proclined1.
The prevalence of this malocclusion varies amongst different
populations but it is reported to be 20% in the UK2. There are a
number of features commonly associated with Class II malocclusion
including the Class II skeletal pattern and dentoalveolar compensation may mask the severity of the malocclusion but the profile
may still be unfavourable. Deep overbite and increased overjet
are commonly seen in this malocclusion. Soft tissues can exert an
influence on the position and inclination of the incisors. A lower
lip trap may procline the upper incisors further and lip incompetence
can have an effect on the inclination of the incisors due to imbalance
of the pressure on the teeth3. The management of this type of
malocclusion will depend on a number of factors including the
patients age, the severity of the skeletal pattern, the amount of
crowding and the overjet. It can be broadly divided into growth
modification, orthodontic camouflage or orthognathic surgery
involving either one jaw or double jaws. In the following case,
orthodontic camouflage was chosen and the reasons for this
treatment plan are explained.
15.7 years old male presented complaining of prominent upper

incisors. He had no relevant medical history and there was no
history of previous orthodontic treatment.
Extra-oral assessment
The patient had moderate Class II skeletal pattern with average
Frankfort-mandibular planes angle and lower anterior face height.
There was no facial asymmetry and the lips were incompetent
with the lower lip trapped at rest behind the upper central incisors
(Figure 1).
Intra-oral assessment
The oral hygiene was fair but needed improvement prior to
orthodontic treatment. All teeth from the left permanent second
molar to the right have erupted in both the upper and lower
arches. The patient had carious lesions in both upper first
molars, upper left second molar and lower left first molar. The
maxillary arch was spaced with a midline diastema. Furthermore,
there was mild lower labial segment crowding (4mm). The incisor
relationship was Class II division 1, the overjet was 12 mm
whereas the overbite was increased and complete to the palate
13 ORTHODONTIC CAMOUFLAGE TREATMENT OF A CLASS II MALOCCLUSION
Orthodontic camouflage
treatment of a Class II
ORTHODONTICS
Fig 3. A pre-treatment OPG (above) and upper standard occlusal radiographs.
Fig 1. Pre-treatment extra-oral clinical photographs. Note the lip trap

behind the upper incisors in the left photograph.
and causing trauma to the palatal mucosa. The centrelines were

coincident and the buccal segment relationship was 1/2 unit
Class II on both sides (Figure 2).
radiograph revealed that the upper right central incisor had an

adequate root filling with no periapical area. In the cephalometric
assessment (Figure 4), the ANB value of 7 suggested a moderate
Class II skeletal pattern. The vertical proportions were within
normal values. The upper incisors were proclined at 122 and the
lower incisors were of average inclination at 94. The interincisal
angle was reduced at 119. The lower incisor to APo and the
lower lip to E line were within normal limits.
Radiographic assessment
Aetiology
The Dental Panoramic Tomogram (DPT) confirmed the presence

of all permanent teeth including the developing third molars
(Figure 3). Root morphology appeared normal. The upper right
central incisor had a root canal filling. The upper standard occlusal
This patient presented with a Class II division 1 malocclusion on

a moderate Class II skeletal pattern complicated by increased and
complete overbite, increased overjet, and mild crowding in the
lower labial segment. The genetically inherited skeletal pattern
contributed to the presenting malocclusion. Furthermore, the
lower lip trapped behind the upper incisor contributing to the
VARIABLE
SNA
SNB
ANB
Upper incisor to maxillary
plane angle
Lower incisor to mandibular
plane angle
Interincisal angle
Maxillary mandibular planes
angle
Face height ratio
Lower incisor to Apo line
Lower lip to Ricketts E Plane
Fig 2. Pre-treatment intra-oral clinical photographs.
PRE-TREATMENT
78
71
7
122
NORMAL
82 3
79 3
3 1
108 5
94
92 5
119
28
133 10
27 5
55%
1
-1
55%
0-2mm
-2mm
Fig 4. The pre-treatment cephalometric radiograph (up) and the values

with the normal figures for Caucasians taken from Houston et al4.
ORTHODONTICS
increased overjet. Therefore, the main problems in this case were
as follows:
1. Moderate Class II skeletal pattern with mild crowding in the
lower arch.
2. Increased and complete overbite and increased overjet.
3. Midline diastema and retained upper left second deciduous
molar.
4. 1/2 unit Class II left and right molar relationships.
Fig 6. TheTrans-Palatal Arch in situ just before the extraction of the

upper premolars (left) and during space closure.
Aims of treatment
Camouflage the skeletal pattern with fixed appliances.
Relieve crowding and level and align the arches.
Reduce overbite and the overjet.
Achieve Class I incisors, canines and full unit Class II molars.
Treatment plan
The treatment of the patient was executed in the following
order:
1. Scale, polish and oral hygiene instructions session with the
dental hygienist.
2. Restoration of the carious lesions and extraction of the upper
left deciduous molar by the general dental practitioner.
3. Anterior bite plan to reduce the overbite and bonding the
lower arch (Figure 5).
4. Fit a Transplalatal Arch (TPA) with Nance button to reinforce
the anchorage.
5. Refer to the general dental practitioner for extraction of upper
left and right first premolars.
6. Bonding upper arch.
7. Continue with the fixed appliances to close the space and
achieve the treatment aims.
8. Retain with an upper and lower Essix retainers.
Treatment rationale
The patients main concern was the prominence of the upper
incisors. Anchorage was a critical issue in this case because of
the increase overjet and the planned amount of tooth movement.
In addition, after assessing the space requirement, it was necessary
to extract teeth in the upper arch to enable the reduction of the
overjet. Furthermore, the fact that the crowding in the lower
arch was mild and there was increased overbite, it was decided
to avoid extraction in the lower arch. It was also planned to use
Class II traction during treatment to maximise the anchorage.
Alternative treatment plan

The use of headgear to distalise the upper buccal segments and
create space to reduce the overjet. However, the patient
declined to wear HG and he accepted the extraction of upper
premolars approach. Alternatively, Temporary Anchorage
Devices (TADs) could be employed to either distalise the upper
buccal segments between the upper second premolar and first
molar to achieve space closure in order to minimise the mesial
movement of the upper buccal segments.
Treatment progress
The oral hygiene of the patient and the carious lesions were
addressed prior to the start of the fixed appliances treatment.
The patients compliance was good and treatment progressed
without encountering major problems. The reduction of the
overbite was achieved initially with the anterior bite plane then
a reverse curve of Spee was placed in the lower archwire to control
the overbite. A Trans-Palatal Arch (TPA) with Nance button was fitted
prior to the extraction of the upper premolars in order to reinforce
the anchorage (Figure 6). The treatment continued with the use
of Class II traction on both sides and space closure mechanics.
Treatment result
Treatment objectives were achieved and the patient was satisfied
with the treatment outcome. The overbite and overjet were
reduced, Class I incisors, canines and full unit class II molars were
obtained. Overall treatment time was twenty four months
Discussion
Fig 5. Clinical photographs showing the anterior bite plane and the
bonding of the lower arch. Note the increased overjet in the top photo.
This was a case of camouflaging the underlying Class II skeletal

pattern. There was a concern of damaging the patients profile
1.
2.
3.
4.
ORTHODONTICS
Fig 8. Post-treatment extra-oral clinical photographs.

Fig 7. Clinical radiographs showing Nickel Titanium coil spring on the
right side to close the remaining space.
with the treatment option adopted that involved the extraction

of the upper premolars and space closure. The relation of the
profile and extraction of teeth is an ongoing debate in orthodontics.
An investigation carried out a cohort study on two groups of 12
patients, where one group was treated with extractions and the
non-extraction5. They investigated whether any changes
occurred in the facial profile three-dimensionally, using an optical
surface scanner; and demonstrated that there was no evidence
that the extractions resulted in flattening of the facial profile.
The authors recognised that the sample size was small and that
the findings should be looked upon as a preliminary study and
not be extrapolated for the population as a whole. Furthermore,
it can be seen from the pre-treatment records (Figure 1) that the
patient had a convex profile prior to treatment hence retraction
of the upper anterior teeth might in theory improve the facial profile.
There was a potential risk with the root filled upper right central
incisor. Evidence is equivocal as endodonticalLy treated teeth
undergo more, or less, root resorption6. However, it is now generally
accepted that root treated teeth can be moved orthodontically
without the increased risk of root resorption7.
The treatment of the case was planned in stages. Stage one
consisted of improving the oral hygiene of the patient and management of all carious lesions and assesses the compliance and
attitude of the patient towards orthodontic treatment. The next
stage involved the reduction of the overbite. The patient presented
with a deep overbite that was causing damage to the palatal
mucosa (Figure 2). This was achieved with an anterior bite plane
removable appliance and bonding of the lower arch. This appliance
will free the occlusion of the buccal segment teeth and if worn
consistently, will passively limit further eruption of the incisors
but allow the lower premolars to erupt, thus reduce the
increased overbite (Figure 5).
The next phase of treatment involved the fitting of the Trans-Palatal

Arch (TPA) and the removal of the upper first premolars. Because
of the increased overjet, this was a case of maximum anchorage
and any mesial movement of the upper buccal segments was
not desirable (Figure 6). It remains equivocal in the literature
whether TPA appliances can provide anteroposterior anchorage.
In fact, recent evidence suggested the contradictory8.
Alternatively the anchorage issue in this case could have been
addressed with a Temporary Anchorage Device. The increase
Fig 9. Post-treatment intra-oral clinical photographs.

ORTHODONTICS
popularity and use of Temporary Anchorage Devices (TADs)
make them attractive in maximum anchorage case. There is an
early evidence to suggest that they are effective and safe9.
The space closure phase of treatment was conducted carefully in
order to prevent anchorage loss (Figure 7). Traditionally, clinicians
retract the canines until they are in Class I relationship then the
retraction of the incisors is followed. On theoretical grounds,
retracting all six teeth together simultaneously would be expected to increase anchorage demands although this increase is not
apparent clinically. However, some clinicians choose to retract all
six together for two reasons namely simplicity and to avoid retracing steps of tooth movement. It is debatable which method
is better but in this case, retracting all six anterior teeth as a
block was adopted.
Upon the completion of the space closure stage, some finishing
details were carried out. Although some more correction was
still needed to be done e.g. the marginal ridge of the upper left
second premolar and the palatal root torque in the upper incisors (Figure 9). Furthermore, taking an OPG towards the end of
treatment to assess the roots angulation, nonetheless, the
patient preferred to have the appliances removed and he was
satisfied with the outcome.
Conclusion
Class II skeletal pattern cases can be treated by orthodontics
alone. There are a number of factors the orthodontist needs to
consider in treatment planning such cases. In this particular case,

the skeletal pattern was camouflaged and the treatment
involved extraction in the upper arch and anchorage reinforced
with Trans-Palatal Arch (TPA). Nowadays, Temporary Anchorage
Devices (TADs) can be used with several potential advantages in
Class II malocclusion.
Acknowledgment
I would like to thank all the staff at the Orthodontics
Department of the Royal United Hospital, Bath, UK. In particular,
Dr Anthony Ireland.
REFERENCES
1. British Standards Institutes. Glossary of Dental Terms 1983. BS4492; BSI

London.
2. Todd JE, Lader D. Adult DentalHealth 1988; HMSO, London.
3. Lip trap (Turner et al 1997)
4. Houston WJB, Stephens CD, Tulley WJ. A textbook of orthodontics. Wright,
Oxford 1992.
5. Ismail S F H and Moss J P. The 3D effects of orthodontic treatment on the
facial soft tissues-a preliminary study. BDJ 2001; 192(2): 104-108.
6. Drysdale C, Gibbs SL, Ford TR. Orthodontic management of root-filled
teeth. Br J Ortho 1996; 23: 255-260.
7. Costopoulos G, Nanda R. An evaluation of root resorption incidence to
orthodontic intrusion. Am J Orthod Dentofacial Orthop 1996; 109: 543-548.
8. Rodkoswski MJ. The influence of transpalatal arch on orthodontic anchorage. Thesis abstract from St Louis University. Am J Orthod Dentofacial Orthop
2007; 132: 562.
9. National Institute for Health and Clinical Excellence. Guidance on
Mini/micro implantation for orthodontic anchorage 2007: IPG 238.
www.nice.org.uk.
Constant
Superior
Quality
Intensiv representative
for Gulf and Middle East:
Mr. Imad Assy
i.assy@intensiv.ch
Tel. +961 3 288367
Intensiv SA
6926 Montagnola
Switzerland
Tel. + 41 91 986 50 50
Fax + 41 91 986 50 59
info@intensiv.ch
www.intensiv.ch
IMPLANT DENTISTRY
Unilateral
SUBPERIOSTEAL
Implant
Dr. Haseeb Dary*
*dary_haseeb@yahoo.com
Keywords: Unilateral subperiosteal implant - Insufficient bone Bone impression
DIVISIONS OF AVAILABLE BONE According to misch(5)

DIVISION
DIMENSION
A (Abundant Bone)
Division A forms soon after
the tooth is extracted.
Division A corresponds to
abundant available bone in all
dimensions
B (Barely Sufficient Bone)
Slight to moderate atrophy is
used to describe this clinical
condition
C (Compromised Bone)
The Division C available bone
is deficient in one or more
dimensions (width, length,
height, angulations, or crownimplant ratio)
D (Deficient Bone)
Long term bone resorption
may result in this complete
loss of the alveolar process
accompanied with basal bone
atrophy.
Sever atrophy describes the
clinical condition of the
Division D ridge.
>5 mm width
>10 -13 mm height
>7 mm length
<30 degrees angulation
C/ I (crown /implant) ratio <1
2.5 5 mm width
>10 -13 mm height
>12 mm length
<20 degrees angulation
C/ I ratio <1
Unfavorable in:
Width (C-w)
Height (C-h)
Length
Angulations(C-a ) >or = 30
degrees
C/ I ratio > or = 1
Severe atrophy
Basal Bone
Flat maxilla
Pencil thin mandible
19 UNILATERAL SUBPERIOSTEAL IMPLANT
When the volume of the residual alveolar ridge is insufficient to

receive endosteal implants, use of the unilateral subperiosteal
implant is one of the treatments of choice.1, 2
This modality of implants has comparable success and survival
rates.1, 3, 4 It was specifically developed to treat patients with
insufficient available bone in the alveolar ridge; it shouldnt be
used for patients with overabundant bone.1
The surgical protocol in the case presented is comprised of a
two-stage surgery, the first of which results in taking a direct bone
impression and the second in placing the custom-made implant.
The subperiosteal implant is designed to rest on the surface of
bone, under the periosteum rather than gaining endosteal support
as teeth or most alloplastic implants used in the body, this
implant distributes stresses from the prosthesis to large areas of
bone in a manner similar to a snowshoe.5
A customized casting made of surgical metal adheres to the bone
with a combination of fibrous tissue and direct bone support2,
NO OSSEO INTEGRATION.
Permucosal abutment posts and intraoral bars are designed for
prosthesis retention.5
So subperiosteal implants are used when there is an insufficient
available bone which differs by volume from case to case. Thats
why it was classified into four divisions.
In our case there is a deficiency in the height of bone which classify
the case under the division C-h available bone
This division of available bone maybe treated by a number of
different implant approaches. The most common is root form
implants of reduced height.
The second option is augmentation.
Or the third option is the subperiosteal implant5, which is going
to be presented in this article.
IMPLANT DENTISTRY
preoperative right side
preoperative left side
fixed dental appliance to restore the bilateral edentulous posterior

spaces of her own (Kennedy class 1).
There was a missing 6 and 7 on each side with compromised 4
and 5 on each.
The volume of available bone was insufficient to place a root
form implant on the site of 7 (C-h available bone) a ridge mapping
technique was used and a (C-w available bone) was also
encountered.
The use of short implant in this case was not a treatment of
choice; the crown - implant ratio is > 1.
A unilateral subperiosteal implant was suggested.
Surgery
A two stage surgical appointment is usually suggested, (Berman
introduced the Two-surgery technique in the 1950s8) separated by at
least 6 weeks.5
preoperative o.p.g.
Terminology
The terminology for the subperiosteal implant includes portions
of the implant below and above the soft tissue.5
The substructure is the portion of the implant that is responsible
for the support of the implant and is located below the periosteum,
on top of the bone. It consists of several struts:
Primary struts are the major components of the substructure and
can be either peripheral or abutment.
The peripheral struts are the outermost regions of the implant
and lay on the most extended areas of the cortical bone.
The abutment struts connect the labial and lingual peripheral struts
and a vertical permucosal post on the crest of the edentulous ridge.
Secondary struts help dissipate the forces from the primary abutment
struts, improve the rigidity and casting of the substructure, and
serve as an additional support mechanism of the implant. (Not
used in this case)
The permucosal abutment posts exit through the mucosa, and
act as prosthetic retainers.
The superstructure connects the abutment posts designed above
the soft tissue. This structure both retains and supports the prosthesis during function and distributes occlusal loads to the substructure below the soft tissue.
Mode of tissue integration

Subperiosteal implants heal in the periosteal mode of tissue
integration. They are enveloped in a dense fibrous collagenous
tissue sheath constituting the outer layer of the periosteum.
Functional forces are absorbed by the underlying bone through
the periosteum.1, 6, 7
Case report
A 60 years old healthy female came into the clinic asking for a
First surgery
Infiltration was administered with long acting anesthetic
(UbistesinTM forte 4%) to anesthetize the residual ridge posterior to the mental foramina from buccal and lingual sides and the
lateral aspect of the ascending ramus.
An intraoral and extra oral scrub of the patient is performed with
Chlorhexidine.5
Soft tissue reflection

Incision
The incision begins at the retro molar papilla at the base of the
retro molar pad to the premolar.
A full thickness incision through the periosteum scores the
underlying bone.
Reflections
A full thickness periosteal reflection exposes the underlying
residual ridge and lateral regions of the mandible.
Evaluation of the crest

A knife edge ridge was exposed, thin knife like edges resorb
shortly after implant insertion, if not before.5
An osteoplasty was performed to recontour the bone so the
crest is broad enough to have a blood supply from the underlying
trabecular bone. The osteoplasty was performed at the bone
impression appointment. In this way the several weeks interval
permit initial remodeling.
Impression
Types of Impression Materials
Three major types of elastic materials are used in implant dentistry for
obtaining the direct bone impression: polysulfides, silicones, and
polyethers.
The material which was used in this case is addition silicone
(GhenesylTM silicone first impression: putty soft. low viscosity).
IMPLANT DENTISTRY
Suturing
Impressions
Implant
Making the Impression

A retraction sutures (3-0 atraumatic black silk sutures1) are made
to attach the reflected tissues to the mucosa of the cheek from
buccal side and the lingual side reflected tissues are anchored
on the teeth of the contra lateral side, this technique would
open a space to take the impression.The gloves are moistened to
prevent the impression material from sticking. A small rolled portion of putty was placed into the tunnel of the reflection and
molded along the exposed underlying residual ridge no trays are
needed in this technique.
After complete setting the impression is gently lifted.
Saline irrigations used to rinse and moisten the tissue, and all
reflected regions are inspected for remnants of impression material.
The direct bone impression is evaluated for all necessary land marks.
The retraction sutures were removed and the tissue re-approximated
and sutured.
The contra lateral side was treated in a similar fashion.
Implant Fabrication
The subperiosteal implant is fabricated-casted with pure titanium.
Laboratories should be members of ASTM (American Society for
Testing and Materials) and should not determine their own
procedures and techniques.9
The implant design in this case composed of one abutment connected to the peripheral struts by 4 abutment struts for each
implant. One hole was drilled on each implant on a peripheral
strut (distal aspect) for the placement of titanium fixation screw.
Implants should be thoroughly cleaned and sterilized before
placement.
Implants and screws in place

Post-operative o.p.g.
Implant insertion (second surgery):

The surgical insertion of the implant is very similar to the direct
bone impression surgery but is more rapid and causes less
swelling and discomfort to the patient.
After the implant is placed on the ridge a titanium screw is used
to fix the implant on the ridge to obtain the primary stability this
screw would be of no use after the healing of tissues because
the implant would be stable on place by the attachment of the
soft tissues to the bone which holds the struts of the implant in
between.
The site is then sutured again.
Sutures were removed after 1 week.
Prosthesis
After 2 weeks of implant placement the patient came back.
A preparation was done to the premolars at both sides and the
impression was taken.
4 units bridge was fabricated for each side splinting the implant
abutment to the 2 natural teeth of each side.
Right side after healing
Left side after healing
Try in right side
Try in left side
Coming
Soon
Simplicity is the real innovation
Only one sterile NiTi instrument per root canal in most cases
Decreases the global shaping time by up to 40%*
Reciprocating technology respecting the root canal anatomy
Single use as new standard of care

*data on file
www.dentsplymea.com
IMPLANT DENTISTRY
After 3 years
Prothesis in place
Prosthesis in place o.p.g.
Cementation
(DentoTemp of ITENA) long term temporary cement which is
used as a Permanent cementation of implant-retained crowns.
Discussion
In summary, the advantages of subperiosteal implants include:
The predictability of the results and the high success rate, the
survival and success rates of modern-day subperiosteal implants
are equal to or greater than root form implants when placed into
C-h bone.5
Noninvasive surgeries are preferred compared to the use of iliac
crest bone grafts10, the trauma would be in one site (which is the
oral cavity) not in 2 sites. When using the iliac graft the patient
would go with pain while he walks out of the operation in addition to the pain in his mouth.
No possibility of parasthesia. This may be the case when nerve
repositioning is performed to enhance the bone height to place
the root form implants in the mandible.
No bone grafts needed with any possibility of bone graft failure
which requires re-grafting of the area with all accompanying
trauma and time consumption.
Less expensive procedure when comparing restoring one segment
or one side of the arch with bone grafting or sinus lifts and several root form implants to a one subperiosteal implant with 1 or
more abutment, the expenses would be way less than the bone
grafting procedures.
Time preserving
Disadvantages include the initial complexity of the surgical procedures. This complexity presumes a certain level of experience
that the practitioner can obtain only over a long period of time.
The procedures require specialized technicians and a titanium
melting oven.
Also the disadvantages include the frequent necessity for 2 surgical

procedures, this can be overcome by the use of (CAD-CAM)11
but again its not considered a mainstream procedure because of
technique sensitivity and cost.
Finally, removal of subperiosteal implants, although rarely indicated, can present difficulties.
In a case report under the title REPLACEMENT OF A MANDIBULAR
SUBPERIOSTEAL IMPLANT12 the author replaced a subperiosteal
implant, which had been in successful service for approximately
15 years. Both the implant and prosthesis had been in service.
Although the patient had been given the option of an augmentation
using an autogenous iliac crest graft with subsequent insertion
of endosteal implants. The importance and potential benefits of
subperiosteal implants are undeniable, being at this time the
only means of restoring jaws in situations where endosseous
implants cannot be placed.
Subperiosteal implants often serve our most troubled patients.
For patients who exhibit severe mandibular and maxillary alveolar
ridge atrophy, no other treatment options may exist.13
Conclusion
Alveolar ridges with severe atrophy can be reconstructed prosthetically (fixed and removable) with less time compared to bone
grafting procedures. Partial subperiosteal implants can be used
with endosseous implants and even natural teeth with fixed
bridges. The surgical technique and clinical stages are not
complicated, generally being mastered by implantologists in
general dental practice.
REFERENCES
1 Principles and practice of implant dentistry Charles M. Weiss

2 Cranin AN: Posterior region Maxilla: a proven implant alternative, dent implantol update 3:81, 1992
3 Bodine RL, Yanase T, Bodine A: Forty years of experience with subperiosteal
implant dentures in 41 edentulous patients, J Prosthet Dent 75:33, 1996
4 Bodine RL, Melros RJ, Grenoble DE: Long-term implant dentures histology and
comparison with previous reports J Prosthet Dent 35:665, 1976
5 Contemporary implant dentistry, second edition Carl E. Misch
6 Bodine RL, Mohammed CI: Histologic studies of a human mandible supporting
an implant denture.Part I, J Prosthet Dent 21:203, 1969.
7 James RA: Tissue behavior in the environment produced by permucosal dental
devices. In McKinney RV, Lemons JE, editors: The Dental Implants, Littleton, Mass,
1985, PSG Publishing.
8 Berman N. An implant technique for full lower denture. Denture
Digest.1951;57:438.
9 Leonard I. Linkow, Jon R. Wagner, Manual Chanavaz: Tripodal Mandibular
Subperiosteal Implant: Basic Sciences, Operational Procedures, and Clinical data,
Journal of Oral Implantology 1998
10 Leonard I. Linkow, Robert Ghalili: Critical Design Errors In Maxillary
Subperiosteal Implants journal of oral implantology CLINICAL. 198 Vol. XXIV/No.
Four/1998
11 Cranin AN et al: An in vitro comparison of the computerized tomography/CADCAM and direct bone impression techniques for subperiosteal implant model generation, J oral implantol 24; 74, 1998.
12 Robert F. Mansueto: Replacement of a Mandibular Subperiosteal Implant, journal of oral implantology Vol. XXV/No. Three/1999
13 Charles M. Weiss, Terry Reynolds: A Collective Conference on the Utilization of
Subperiosteal Implants in Implant Dentistry, journal of oral implantology Vol.
XXVI/No. Two/2000
ORAL RADIOLOGY
Applications of
CBCT in Dental Practice

A Literature Review
26 CONE-BEAM COMPUTED TOMOGRAPHY IN DENTAL PRACTICE
*Dr. Mohammed A. Alshehri, Dr. Hadi Alamri, Dr. Mazen Alshalhoub

*Consultant at the Riyadh Military Hospital
dr_mzs@hotmail.com
Abstract: This article presents a review of the clinical applications
of cone-beam computed tomography (CBCT) in different dental
disciplines. A literature search was conducted via PubMed for
studies on dental applications of CBCT published between 1998
and 2010. The search revealed a total of 540 results, of which
130 articles were clinically relevant and were analyzed in detail.
CBCT is used in different dental disciplines for numerous clinical
applications. The results of this systematic review show the different
applications of CBCT imaging in dental practice, which are summarized and categorized under eight different dental disciplines.
Introduction
Two-dimensional (2D) imaging modalities have been used in
dentistry since the first intraoral radiograph was obtained in 1896.
Since then, significant advances have been made in dental imaging
techniques, including the introduction of panoramic imaging
techniques and tomography. Advances in digital imaging techniques
have led to lower radiation doses and faster processing times
without changing the imaging geometry of these intraoral and
panoramic technologies.
Cone-beam computed tomography (CBCT) is a new medical
imaging technique that generates three-dimensional (3D) data at
lower cost and lower absorbed doses than conventional computed
tomography (CT). The CBCT imaging technique is based on a
cone-shaped X-ray beam that is centered on a 2D detector, and
the beam performs one rotation around the object, producing a
series of 2D images. The images are reconstructed in a 3D data
set using a modification of the original cone-beam algorithm
developed by Feldkamp et al. in 198427. CBCT images from the
craniofacial region are often acquired at a higher resolution than
conventional CT. In addition, these systems are more compact
than conventional CT systems, which make them more practical
for use in dental offices48.
The application of CBCT imaging in different dental disciplines
can guide diagnosis, treatment and follow-up.
This article presents a systematic review of clinical applications of

CBCT in dental practice.
Materials and methods

A literature search was conducted via PubMed for CBCT imaging
applications in dentistry published between January 1, 1998 and
July 15, 2010 using the keywords Cone-beam computerized
tomography in dentistry. The search revealed a total of 540
articles, which were all screened in detail. Of these articles, 410
were excluded because they were not relevant to the subject.
The systematic review consisted of 130 clinically relevant articles
that were analyzed further and categorized according to the discipline of application.
Results
The search revealed 36 articles (27.7%) related to applications in
oral and maxillofacial surgery (OMFS), 33 articles (25.4%) related to
endodontic clinical applications, 22 articles (16.9%) related to
clinical applications in implant dentistry, 15 articles (11.5%)
related to orthodontic clinical applications, 10 articles (7.7%)
about clinical applications in general dentistry, 8 articles (6.2%)
about the temporomandibular joint (TMJ), 5 articles (3.8%)
related to applications in periodontology, and 1 article (0.8%)
about CBCT applications in forensic dentistry.
Table 1. Summary of CBCT application-related articles according to
dental specialty
DISCIPLINE
Oral and maxillofacial
surgery (OMFS)
Endodontics
Implant Dentistry
Orthodontics
General Dentistry
Temporomandibular joint
(TMJ)
Periodontics
Forensic Dentistry
NUMBER
36
PERCENTAGE
27.7
33
22
15
10
8
25.4
16.9
11.5
7.7
6.2
5
1
3.8
0.80
OF ARTICLES
ORAL RADIOLOGY
Review
APPLICATIONS
IN ORAL AND MAXILLOFACIAL SURGERY
CBCT in OMFS has been used to investigate the exact location

of jaw pathology in 3D images3,14, 29, 65, 81, 93, 90,102, 126, to assess
impacted teeth (Fig. 1), to assess supernumerary teeth and their
relation to vital structures18, 61, 62, 65, 66, 69, 80, 90, 113, 115,123, to evaluate
changes in the cortical and trabecular bone related to bisphosphonate-associated osteonecrosis of the jaws12, 29, 57, and to assess
bone grafts34. CBCT has also been used to investigate paranasal
sinuses6, 65 and to assess obstructive sleep apnea78, 88.
Fig 1. Impacted teeth in close proximity to vital structures, requiring

evaluation using CBCT.
Because CBCT images are collected as a combination of several

2D slices, the technique is superior in overcoming superimpositions
and calculating surface distances9, 10. This advantage has made
CBCT the technique of choice for the investigation of mid-facial
fractures8, 41, orbital fracture assessment and management128, and
in inter-operative visualization of the facial bones after fracture39, 40.
Furthermore, because CBCT is not a magnetic resonance technique,
it is the best option for intraoperative navigation during procedures involving gun-shot wounds72, 96.
CBCT is largely used in planning orthognathic and facial orthomorphic
surgeries, which require detailed visualization of the interocclusal
relationship to augment the 3D virtual skull model with a
detailed representation of the dental surface. With the aid of
advanced software, CBCT facilitates the visualization of soft tissue to
allow for control of the post-treatment aesthetics7, 111, 112 and permits
the evaluation of lip and palate bony depressions in cases of cleft
palate56, 73, 125.
The ability of CBCT to detect salivary-gland defects is also under
investigation108. In addition, one article has reported a tooth
autotransplant case where CBCT demonstrated high accuracy,
and the information provided allowed the rapid completion of
the transplant operation45.
CLINICAL
APPLICATION IN ENDODONTICS
CBCT is a useful tool in diagnosing apical lesions (Fig. 2a, 2b)13,

17, 19, 20, 23, 25, 31, 64, 83, 84, 92, 115, 120
. A few research studies have shown that
contrast-enhanced CBCT images can be used to differentiate
between apical granulomas and apical cysts by measuring the
lesion density (Fig. 3a, 3b)23, 92, 120, 106. Another article describes the
use of CBCT as a tool to categorize the origin of the lesion as

endodontic or non-endodontic17.
Fig 2a. A periapical lesion in a

periapical radiograph (courtesy of
Dr. Fredrek Barnett).
Fig 2b. The same periapical lesion

in a CBCT image (courtesy of
Dr. Fredrek Barnett).
Fig 3a. An apical cyst in an OPG

radiograph.
Fig 3b. The same apical cyst in a

CBCT image.
The superiority of CBCT in detecting fractured roots compared

to 2D radiographs has been demonstrated by several clinical
case reports focused on detecting vertical root fractures17, 77, 89, 92,
106, 115, 120
. CBCT is considered superior to periapical radiographs in
the detection of fractures in buccolingual or mesiodistal directions35, 36, in the measurement of depth in dentin133 and in the
detection of horizontal root fractures17, 92, 115.
CBCT is able to detect lesions in cases of inflammatory root
resorption, whereas conventional 2D x-rays cannot detect them
in early stages24, 115. In other cases such as external root resorption17, 60, 115, 120, external cervical resorption17, 84, 91, and internal
resorption17, 84, 115, 120, CBCT cannot only detect the presence of
resorption but also its extent.
CBCT can be used to determine root morphology; to measure
the number of roots, canals, and accessory canals; and to establish
their working lengths and angulations6, 17, 70, 77, 92, 98, 115, 119, 120. CBCT
also provides accuracy in the assessment of root canal fillings19, 31,
77, 120
, in the detection of pulpal extensions in talon cusps107 and
in the detection of the position of fractured instruments118.
CBCT is a reliable tool for the presurgical assessment of the proximity
of the tooth to adjacent vital structures, the size and extent of a
lesion, and the anatomy and morphology of roots through very
accurate measurements17, 20, 25, 46, 54, 77, 84, 92, 97, 106, 115, 118, 120. In emergency cases requiring tooth assessment after trauma, CBCT
applications can aid in reaching a proper diagnosis to determine
the most suitable treatment approach15, 16, 17, 92. Due to its reliability
and accuracy, CBCT has recently been used to evaluate canal
preparation in different instrumentation techniques74, 76.
ORAL RADIOLOGY
APPLICATIONS
IN IMPLANT DENTISTRY
The increasing demand for dental implants to replace missing

teeth has necessitated a technique capable of obtaining highly
accurate measurements to avoid any damage to vital structures.
Previously, such measurements were obtained through conventional
CT; however, the ability of CBCT to provide greater accuracy in
measurements at lower radiation doses has made it the preferred
option in implant dentistry (Fig. 4a, 4b)21, 28, 32, 37, 46, 47, 48, 63, 65, 67, 90, 101,
103, 104 114, 116, 121, 126
. Furthermore, the presence of new software to
construct surgical guides has further reduced the possibility of
structural damage2, 21, 30, 85, 86, 101. Another article describes the
interoperative use of CBCT in two cases to guide the insertion of
the implant after microsurgical bone transfer38.
Fig 4a. An OPG radiograph for a full-mouth rehabilitation case. The

data that was obtained from this image was limited.
Fig 5a. A clinical image of multiple

implants placed 5 years ago.
Fig 5b. A periapical radiograph for

implants replacing teeth 8 and 9.
The data that was collected from
this image was limited.
Fig 5c. A CBCT image clearly

showing the amount of bone loss.
Fig 5d. A CBCT image showing

evidence of total buccal plate
destruction.
cases that require the placement of tiny screw implants as temporary

anchors, CBCT acts as a useful visual guiding technique for safe
insertion of these anchors52, 53, 95 as well as to assess the bone
density before, during and after treatment (Fig. 6)33, 99.
CBCT incorporates multiple different views of an object in one scan
(e.g., frontal, right lateral, left lateral, 45-degree, and submental
views), which is an additional advantage of the technique58, 124.
CBCT is therefore considered a more accurate option for the clinician
because the images are self-corrected for magnification, producing
orthogonal images with a 1:1 ratio5.
APPLICATIONS
Fig 4b. CBCT images for the same patient. Considerably more data was
obtained from these images with regard to bone quality, implant length
and diameter, implant locations and proximity to vital structures.
CBCT can be used to measure bone quality4, 37, 46, 47, 78, 90, 109, 110 and
quantity37, 103, 109, 116, which has led to a reduction in implant failure
because the reliable information provided by CBCT has led to
improvements in case selection. CBCT is also used to assess the
success of bone grafts and post-treatment evaluations (Fig. 5a to
5d)90, 116.
APPLICATIONS
IN
TMJ
IMAGING
One of the major advantages of CBCT is its ability to define the

true position of the condyle in the fossa, which often reveals the
possibility of dislocation of the disk in the joint90, 117, 120 and the
extent of translation of the condyle in the fossa117. Due to its
accuracy, CBCT facilitates easy measurement of the roof of the
glenoid fossa51, 68 and provides the ability to visualize soft tissue
around the TMJ44, which may reduce the requirement for the use
of MRI in these cases.
Due to these advantages, CBCT has become the imaging device
of choice in cases of trauma, pain and dysfunction, and fibroosseous ankylosis43, 82, 100, 114, as well as in the detection of condylar
IN ORTHODONTICS
The introduction of new software in orthodontic assessment has

enabled the use of CBCT images in cephalometric analysis26, 46, 59,
65, 101
and has led to CBCT becoming the tool of choice for assessing facial growth, age, airway function1, 55, 105, and disturbances in
tooth eruption75.
CBCT is a reliable tool in assessing the proximity of the tooth to vital
structures that may interfere with orthodontic treatment22, 94. In
Fig 6. A CBCT image to assess bone density during treatment.
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ORAL RADIOLOGY
cortical erosion and cysts46. The use of 3D features facilitates the
safe application of the image-guided puncture technique, which
is a treatment modality for TMJ disk adhesion42.
PERIODONTICS
APPLICATIONS
The high measurement accuracy of CBCT with minimal margins

of error allows its use in obtaining a detailed morphologic
description of the bone120, 122, with measurement accuracy equal
to that of direct measurement with a periodontal probe71, 120.
CBCT also aids in assessing furcation involvement68, 115,120.
CBCT can be used in the detection of buccal and lingual
defects49, 120 where conventional 2D radiography shows limitations. CBCT allows accurate measurement of intrabony defects11,
79
as well the ability to assess dehiscence, fenestration defects
and periodontal cysts50, 120. CBCT has also proved its superiority in
evaluating the outcome of regenerative periodontal therapy49.
OPERATIVE
DENTISTRY APPLICATIONS
Based on the data in the available literature, the use of CBCT in

detecting occlusal caries is not yet justified because CBCT delivers a
higher radiation dose to the patient compared to conventional
2D radiographs with no additional benefit. However, CBCT has
proved to be useful in assessing the depth of proximal caries115.
Table 2 shows examples of typical radiation doses received from
various dental radiological procedures in operative dentistry.
Table 2. Typical doses from various dental radiological procedures
Intraoral (F speed, rectangular collimator)

Intraoral (E speed, round collimator)
Full-mouth set (E speed, round collimator)
Lateral ceph (F speed, rare-earth screen)
DPT (F speed, rare-earth screen)
Cone-beam CT both jaws
Hospital CT both jaws
FORENSIC
other keywords and terminology were entered into the PubMed

search engine (e.g., cone beam volumetric scanning, true volumetric
computed tomography, dental CT, dental 3D-CT, and cone beam volumetric imaging), they did not result in additional relevant articles130.
0.001
0.004
0.080
0.002
0.015
0.068
0.600
mSv
mSv
mSv
mSv
mSv
mSv
mSv
APPLICATIONS
Dental age estimation is considered an important factor in the

field of forensic science, and this estimation can be performed
non-invasively using CBCT; an estimate of a subjects age can
then be derived from the subjects pulp/tooth ratio127.
Discussion
CBCT scanners represent a significant advancement in dental
and maxillofacial imaging. Since their introduction for dental use
in the late 1990s129, there has been an increased interest in these
devices. The number of CBCT-related articles published per year
has increased tremendously over the last few years. We have performed a systematic review of the literature related to CBCT imaging
applications in dental practice and summarized the applications of
this new imaging technique in different dental specialties.
CBCT was used as a keyword in this systematic review. Although
The clinical applications of CBCT imaging in dentistry are constantly

increasing. The results of this systematic review showed that of
the 540 articles published in the last 12 years, 130 were clinically
relevant. The most common clinical applications of CBCT were in
OMFS, implant dentistry, and endodontics. CBCT has shown limited
use in operative dentistry because of the high radiation dose compared to conventional 2D radiography without any additional benefit.
The dental literature on CBCT is promising and indicates that
more research is required to explore the benefits of CBCT in forensic
dentistry. Although no literature was found on prosthodontic
applications of CBCT, the improved standard of care seen in
prosthodontic treatment can be attributed to applications of CBCT
found in other dental specialties and related to prosthodontic,
such as bone grafting, soft tissue grafting, prosthetic-driven
implant placement, maxillofacial prosthodontics and
Temporomandibular joint disorders. CBCT images are important
in special cases that require the assessment of restorability of
multiple teeth (Fig. 7a to 7e).
The newest CBCT systems show higher resolution and lower
exposure than previous systems, and the new systems are less
expensive and more specific for dental use than their predecessors.
The flat-panel detectors are less prone to beam hardening artifacts.
CBCT also shows disadvantages such as susceptibility to motion
artifacts, low contrast resolution, and limited internal soft-tissue
visualization capability. Furthermore, due to the distortion of
Hounsfield units, CBCT cannot be used for the estimation of
bone density.
As far as the radiation dose of CBCT imaging is concerned, it is
crucial that a radiation dose as low as reasonably achievable
(alara) is respected. Although CBCT imaging will certainly
improve patient care, dentists must possess the anatomical
knowledge and the experience to interpret the scanned data
accurately. Dentists must evaluate whether these imaging
modalities add to their diagnostic knowledge and raise the standard
of dental care or simply place the patient at a higher risk. Such
evaluation requires continuous training, education for dentists
and thorough research.
One of the most clinically useful aspects of CBCT imaging is the
availability of highly sophisticated software that allows the large
volumes of acquired data to be broken down, processed and
reconstructed131. This ability makes data interpretation much more
user-friendly, particularly if competent technical and educational
training is provided to the dentists and technicians.
ORAL RADIOLOGY
Fig 7a. Multiple endodontically treated

teeth in a patient with a history of periapical surgery.
Fig 7b. A periapical image

showing a compromised
crown-to-root ratio.
Future research should focus on obtaining accurate data regarding

the radiation doses of CBCT systems. These systems have a small
detector size, and the field of view and scanned volume are
somewhat limited. Due to these factors, ideal CBCT systems for
orthodontic and orthognathic surgery are not yet available.
CBCT applications in forensic dentistry and prosthodontics
require further investigation.
For the references listing please refer to the article on
www.dentalnews.com
Table 3. Basic principles on the use of CBCT in dental applications
(from eadmft)
Fig 7c. A CBCT image showing the

absence of the buccal plate and a
compromised palatal plate; this
image indicates the teeth to be
extracted and the grafting site
before implant placement.
Fig 7d. A photograph showing

the location of bone grafting. The
least traumatic extractions were
performed for teeth 7, 8, 9 and
10.
Fig 7e. A photograph shows the in-progress healing of the grafted sites
intended for the future placement of implants.
The increasing popularity of CBCT has resulted in the manufacture

of a large number of CBCT units, numerous presentations at
conferences and a significant increase in published articles.
These factors have led to an uncontrolled and non-evidence-based
reporting of radiation dose values that can be attributed to the
limited technical knowledge of medical imaging devices among
new users. To counter this uncontrolled exchange, the European
Academy of Dental and Maxillofacial Radiology has developed
guidelines outlining the basic principles for the use of CBCT in
dental applications132; these guidelines are shown in Table 3.
Conclusions
The majority of CBCT applications in the practice of dentistry are
found in the specialties of OMFS, endodontics, implant dentistry,
and orthodontics. CBCT examinations must not be performed
unless they are necessary and unless the benefits clearly outweigh
the risks. The images acquired using CBCT must undergo a thorough
clinical evaluation of the entire image dataset (i.e., a radiological
report should be completed) to maximize the clinical data
obtained from these images.
1- CBCT examinations must not be carried out unless a history and clinical examination have been performed
2- CBCT examinations must be justified for each patient to demonstrate that the
benefits outweigh the risks
3- CBCT examinations should potentially add new information to aid the patients
management
4- CBCT should not be repeated routinely on a patient without a new risk/benefit
assessment having been performed
5- When accepting referrals from other dentists for CBCT examinations, the referring dentist must supply sufficient clinical information (results of a history and
examination) to allow the CBCT Practitioner to perform the Justification Process
6- CBCT should only be used when the question for which imaging is required cannot be answered adequately by lower dose conventional (traditional) radiography
7- CBCT images must undergo a thorough clinical evaluation (radiological report)
of the entire image dataset
8- Where it is likely that evaluation of soft tissues will be required as part of the
patients radiological assessment, the appropriate imaging should be conventional
medical CT or MR, rather than CBCT
9- CBCT equipment should offer a choice of volume sizes, and examinations must
use the smallest volume that is compatible with the clinical situation if this provides
less radiation dose to the patient
10- Where CBCT equipment offers a choice of resolution, the resolution compatible
with adequate diagnosis and the lowest achievable radiation dose should be used
11- A quality assurance programme must be established and implemented for each
CBCT facility, including equipment, techniques and quality control procedures
12- Aids to accurate positioning (light beam markers) must always be used
13- All new installations of CBCT equipment should undergo a critical examination
and detailed acceptance tests before use to ensure that radiation protection for
staff, members of the public and patient are optimal
14- CBCT equipment should undergo regular routine tests to ensure that radiation
protection, for both practice/facility users and patients, has not significantly deteriorated
15- For staff protection from CBCT equipment, the guidelines detailed in Section 6
of the European Commission document Radiation Protection 136. European
Guidelines on Radiation Protection in Dental Radiology should be followed
16- All those involved with CBCT must have received adequate theoretical and
practical training for the purpose of radiological practices and relevant competence
in radiation protection
17- Continuing education and training after qualification are required, particularly
when new CBCT equipment or techniques are adopted
18- Dentists responsible for CBCT facilities who have not previously received adequate
theoretical and practical training should undergo a period of additional theoretical
and practical training that has been validated by an academic institution (University or
equivalent). Where national specialist qualifications in DMFR exist, the design and
delivery of CBCT training programmes should involve a DMF Radiologist
19- For dento-alveolar CBCT images of the teeth, their supporting structures, the
mandible and the maxilla up to the floor of the nose (e.g. 8cm x 8cm or smaller
fields of view), clinical evaluation (radiological report) should be made by a specially trained DMF Radiologist or, where this is impracticable, an adequately trained
general dental practitioner
20- For non-dento-alveolar small fields of view (e.g., temporal bone) and all craniofacial CBCT images (fields of view extending beyond the teeth, their supporting
structures, the mandible, including the TMJ, and the maxilla up to the floor of the
nose), clinical evaluation (radiological report) should be made by a specially
trained DMF Radiologist or by a Clinical Radiologist (Medical Radiologist)
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The Egyptian Orthodontic Society

th
celebrates its 25 Anniversary
36 EOS - 2011
The International Congress of the Egyptian Orthodontic Society

was a Joint Meeting with the Cyprus Orthodontic Society, the
Greek Orthodontic Society, the Lebanese Orthodontic Society
and the South African Society of Orthodontists
On January 21 23, 2001, the five Societies joined the
International Orthodontic Congress organized by the Egyptian
Orthodontic Society, in Alexandria, Egypt. A very successful
event organized by Dr. Abbas Zaher, professor in Alexandria
University and treasurer of the Egyptian Orthodontic Society.
240 Participants from Egypt and other Societies took part in this
event. The largest group came from Greece with 36 persons. 24
local and international companies exhibited at the congress.
18 internationally renowned speakers took the podium to share
their clinical and research experiences. Guest speakers for the
congress: Eric Liou, Taiwan, Eustaquio Araujo and Varun Kalra,
USA, Nasib Balut and Juan Carlos Solorio, Mexico, Arturo Vela, Spain,
Drs. Samir Aboul Azm and Edmond Chaptini exchanging plaques from
the Egyptian and the Lebanese Orthodontic Societies
Maja Ovsenik, Slovenia, Bakr Rabie, Hong Kong, Christodoulos

Laspos, Cyprus, Edmond Chaptini, Lebanon, Athanasios E
Athanasiou and Michael Kalavritinos, Greece, Phumzile Hlongwa
and Rashid Chamda, South Africa, joined by Walid El Kenany,
Yehia Mostafa, Amr Abol Ezz and Abbas Zaher from Egypt.
On Thursday January 20, an opening reception was organized to
welcome the attendees and the presidents of the joining societies gave short welcome speeches. Drs. Christodoulos Laspos
the president of the Cyprus Orthodontic Society, Dr. Paul
Karvelas the president of the Greek Orthodontic Society, Dr.
Dayalan Sundrum the president of the South African Society of
Orthodontists and Dr. Samir Aboul Azm, the president of the
Egyptian Orthodontic Society addressed the congress guests. In
addition, Dr. Athanasios E. Athanasiou the immediate past president of the World Federation of Orthodontists and Dr. Maja
Ovsenik, the immediate past-president of the European
Orthodontic Society were among the guest speakers.
Dr. Eric Liou during his presentation
Dr. Edmond Chaptini delivering his lecture
The Exhibition floor
Dr. Abbas Zaher delivering his presentation in the congress
Drs. Bakr Rabie, Yehia Mostafa, Walid El Kenany and Khaled Aboul Azm
Exclusive
W&H
innovation
preview
As in other IDS years, W&H presented many new products
and innovations to the special guests from around the
world during the weekend prior to the IDS.
40 W&H INNOVATION PREVIEW
Mr. Peter Malata addressing the guests during the gala dinner
In small groups, the visitors had the opportunity to see the latest
product such as the class-B Lina sterilizer and the new water
treatment system Multidem. Also to see the actual brightness of LED+
in reality, understanding the new instruments and technologies,
watch how to use professional new treatment techniques and
the use of digital media as well as hands on use - W&H staff was
proud to guide customers through the world of W&H.
Unprecedented levels of success

Also captivating was the unique and passionate lecture during
the lunch break by Thomas Bubendorfer - alpine extreme athlete.
He showed that achieving unprecedented levels of success
through passion, joy, self-motivation, responsibility and learning
is for both parties a philosophy - for professional climbers as well
as W&H. Because People have Priority.
Distributors from around the world during the presentation
Emotional evening
In the evening, the guests went to a wonderful gala dinner with
a show and an upbeat video on W&H journey through the 120year history since 1890 in Berlin right up to the present day. The
evening was also full of emotion due to the retirement of
Dr. Bernd Rippel and Michel Paten, who took leave of our partners and were surprised to be presented with gifts.
Dr. Rippel again officially passed over the sales portfolio to his
successor - Rudolf Flieger and Dr Rippel, thanked all the partners for
their loyalty and cooperation, which he hopes will continue for W&H.
Mr. Khaled Al Turki Receiving a trophy for his company achievement
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Biggest IDS ever
Visitors, exhibitors and area

all up significantly
Once again, IDS offered a whole range of new products and

excellent opportunities to exchange information, communicate
with partners and place orders. That's why exhibitors, visitors and
media representatives alike were all delighted with the trade fair.
Highly satisfied trade visitors

Not only the exhibitors but also trade visitors report that the
trade fair was a great success. This is confirmed by initial
responses to the visitor survey. Altogether 95 per cent of respondents indicated that they were satisfied or very satisfied with IDS.
In addition, 93 per cent would recommend a visit to IDS to a
close business associate.
Feedback from exhibitors:

Klaus Rbesamen, Managing Director, Komet/Gebr. Brasseler
"As far as Komet is concerned, IDS 2011 was a great event. In
fact it even exceeded our expectations. Once again, we were
able to present ourselves to a broad specialist public as an innovation leader when it comes to dental instruments and tools. The
many customers we met from Germany and abroad were very
positive about our innovations. As a result, we are optimistic
about the future."
Jost C. Fischer, Chairman & Chief Executive Officer, Sirona
Dental Systems
"The trade fair was very successful as far as we're concerned.
The number of visitors was amazing. In fact, all of our employees were involved in discussions around the clock. You could
clearly see that the economy had picked up again. As a result,
the atmosphere at the fair was extremely positive. In my opinion,
it was the best IDS ever."
In my opinion,
it was the
best IDS
ever
43 IDS - 2011
The world's leading dental trade fair IDS came to a close with an
extremely upbeat mood and outstanding results after five days
in Cologne. "We've succeeded in making the International
Dental Show even more attractive, both domestically and internationally. The strong increase in international participants especially shows that IDS is the world's leading dental trade show,"
says Dr. Martin Rickert, Chairman of the Association of German
Dental Manufacturers (VDDI).
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44 IDS - 2011
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46 IDS - 2011
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48 IDS - 2011
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50 IDS - 2011
MetaFix
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The 15th Kuwait Dental Association International Scientific Conference

Kuwait Radisson SAS 9 - 11 April 2011
52 15TH KUWAIT DENTAL ASSOCIATION CONFERENCE
Honorable guests,
I am pleased to welcome you all, to this scientific event which takes place in the State of
Kuwait the land of friendship and peace under the patronage of the Minister of Health
H. E. Dr. Hilal M. Al-Sayer. My dear colleagues, conducting such an event habitually and
continuously is a pride and credit for the dental association. Today, in this conference, we
have adopted a new slogan Invitation to the World of Dentistry which intended to
reflect the KDAs Board of Directors extent and the keenness towards the importance of
developing the scientific and professional training for dentists. We consider this is to be a
turning point that thrust our brothers and sisters professional standard by means of the
scientific and educational vision that sustained through scientific and interdependence
exchange among the dentists in the State of Kuwait and other countries as well. We deem
that this will motivate all our colleagues to work together and strive to provide all that is new
in dentistry for a better future of this beloved country. In the meantime, we also take this
opportunity to congratulate all of you and us on the occasions of celebrating the 50th
anniversary of the independence of the State of Kuwait, the 20th anniversary of the
Liberation and the 5 years of the succession of his Highness the Amir of Kuwait Sheikh
Sabah Al Ahmed al Jaber Al Sabah. Finally, I wish for my all doctor brothers and sisters
and participants from outside the State of Kuwait, a pleasant stay in their second home.
Dr. Ebrahim Esmail Taqi, President of the Kuwait Dental Association
Dr. Youssef Al Duweiri giving his speech

Picture from the audience during the opening ceremony
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TROPHY DISTRIBUTION
to Dr. Ghassan Yared President of the Lebanese Dental Association
to Dr. Hani Ounsi from Lebanon
to Dr. Ahmed Kahtani President of the SDS
to Dr. Hamad Al Harthy President of the Omani Dental Society
to Dr. Mohamed Darwish President of Qatar Dental Society
to Dr. Mohamed Ben Hafidh President of the Yemen Dental Society
to Mr. Ghassan Mamlouk CEO of ATC
to Pr. Youssef Talic from the KSA
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Picture of the Lebanese delegation from the closing ceremony
EXHIBITION FLOOR
La Droguerie Tamer membre de G. Tamer Holding

rae trois trophes l International Dental Show (IDS).
Wael Houry, Diaa Khreish, Eiichi Nakanishi

Prsident de NSK, Gaby Tamer, Tarek Skaff, Hiroki Kano
Stephen Lawry, Tarek Skaff, Gaby Tamer

et Scott Parrish (Prsident de A-Dec)
Lquipe de la Droguerie Tamer membre de G.Tamer Holding sest rendue lInternational Dental Show (IDS)
qui sest tenu Cologne. Cette exposition internationale la plus importante dans le domaine dentaire attire
chaque anne plus de 120.000 visiteurs des quatre coins du globe et prsente les technologies rcentes
des marques les plus connues.
Droguerie Tamer qui reprsente sur le march libanais et rgional des marques importantes (comme A-Dec, NSK,
Septodont, Bego, Biomet 3i, Discus Dental et Ivoclar Vivadent, Dentsply, Coltne Whaledent, Sunstar-Gum,
Waterpik), fut reprsente par Tarek Skaff (directeur gnral), Diaa Khreich (directeur Tamer Levant),
Carlos Abillama (directeur 3i Mena) et Wael Houry
(directeur des ventes),pour recueillir trois trophes:
le premier trophe fut dcern par la socit Adec
en commmoration de son 20e anniversaire de
partenariat et en reconnaissance de son soutien aux
ventes et services des produits dentaires Adec. Les
deux autres trophes furent dcerns respectivement
par les socits NSK et Bego en apprciation du
rsultat remarquable des ventes accompli par le
Tarek Skaff, Gaby Tamer, David Halimi
Lquipe Tamer: Carlos Abillama,
groupe en 2010.
Diaa Khreish, Gaby Tamer, Tarek Skaff,

Wael Houry
Gaby Tamer, Alex Al Dahi, Tarek Skaff sur le stand Bego
(V.P. Septodont) Diaa Khreish, Wael Houry
Stand Biomet 3i
With the same spirit of G. Tamer Holding in the MENA region,

and since day one in Iraq, Tamer Levant decided to take the
level of dentistry in Iraq to a higher position by listening closely
to the dental community needs and investing more in the
education and support of the Iraqi dentists and above all
believing in them.
With top international brand names in dental industry Tamer
Levant was among the first gold sponsors of the 1st Iraqi
Dental Reunion IDR meeting held in Erbil last April. More than
1200 participants from the different provinces of Iraq, Ministers
of Health, Deans, Professors, Dentists and Dental Technicians
had the opportunity to reunite and see closely the latest in
dentistry. Tamer Levant through its supplier DENTSPLY,
offered 2 lectures followed by a workshop presented by a
highly professional lecturer from the Saint Joseph and the
Lebanese University in Beirut Dr Karim Corbani who lectured
on: "Direct Posterior Restorations" and "Achieving Consistent
Results with Direct Anterior Composite". And Dr. Edward Rizk,
lectured on "Winning the Challenge of Mechanical Shaping of
Narrow and Curved Canals". While the workshops were
prepared to receive a maximum of 20, 250 dentists were
striving to get these places.
The Exhibition was a great success. It gave us the opportunity
to be at the service of the Iraqi dentist in both Governmental
and private sector said Diaa Khreish Managing Director of
Tamer Levant in Iraq.
In addition to the presence of the President and CEO of
G.Tamer Holding Mr Gaby Tamer, and the General Manager,
Mr Tarek Skaff, Technical Manager Mr Antoine Eid, and the
Managing Director of Tamer Levant Mr Diaa Khreish, top
supplier were among the attendee from A-dec Mr Steven
Lawry Territory Manager, from Dentsply Dr Harika Gokcesu
Regional Director of Dentsply UK export, Dr Ghada Bassil
Sales and Professional Services Manager in addition to the
team of Tamer Levant in Iraq.
Tamer Levant will keep on investing into education, training
and will continue to provide the finest products and services
for all the dental communities in Iraq through its direct offices
in Erbil and Baghdad and its chain of distributors in the rest
of the cities of Iraq.
Tamer Levant represents the following leading brands in Iraq:
Dentsply , Dentsply Maillefer, A-dec, NSK, Biomet 3i,Tecnogaz,
MGF, BlueX , Nordent.
Endo hands-on by Dr. Edward Rizk
Tamer Levant Stand
Dr. Karim Corbani
Dr. Edward Rizk, Wissam Shedid, Dr. Ghada Bassil, Diaa Khreish,
Gaby Tamer, Steve Lawry, Dr. Karim Corbani, Dr. Harika Gokcesu,
Tony Eid, Tarek Skaff
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Picture from the opening ceremony
Pr. Roberto JUSTUS,

President of the World
Federation of Orthodontists
Its our pleasure and honor to welcome you to our 10th scientific
Meeting and we are deeply grateful to your presence today in
the opening ceremony.
We thank the Lebanese Dental Association for its continuous
support, the world Federation of Orthodontics for its invaluable
help and the Luxembourg Orthodontic Society for having made
this event a real success.
We have tried to focus through this meeting on basics as well as
on recent advancements and new developments in orthodontics in
order to bring to our colleague Orthodontics after year 2000.
The main objectives were:
First: To honor our teacher, our friend, our colleague Professor
Pierre Rizkallah who passed away. Multi-talented man, honest and
passionate who left a major print on the field of orthodontics in
Lebanon.
Second: To bring the latest developments in orthodontics
through pre- and post-congress Courses dealing with 3D
Imaging and Lingual Orthodontics.
and Third: To open the door for multidisciplinary interaction with
Oral Radiology and Human Anthropology. All this, without forgetting the basic clinical teaching as well as Evidence Based
Orthodontics. Topics which will be developed by different
experts in their fields.
The success of the event is due to a highly motivated group of
people who worked hard as a solid team, I would like to thank
every one of them from the bottom of my heart.
We hope that this meeting will be remembered and this occasion will
be an annual appointment to see and learn from each other.
Dr. Odile HUTEREAU, President of the

Luxembourg Orthodontic Society
62 LOS - SCIENTIFIC MEETING - 2011
Professor Joseph Bouserhal during his opening speech
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Dr. Edmond Chaptini
64 LOS - SCIENTIFIC MEETING - 2011
Left to right : Dr. Athanassiou from Greece, Dr. Massoud form

Saudi Arabia, Dr. Zaher From Egypt, Dr. Justus From Mexico,
Dr. Becker from Luxembourg
left to right - Dr. Elie Khoury, Dr. Nayla Bassil Nassif, Dr. Alain Taouk, Ms.
Faten, Dr. Fady Dahboul from the Lebanese Orthodontic Society
10 LOS
Scientific
Meeting
Left to right : Dr. Justus From Mexico, Dr. Zaher From
Egypt, Dr. Sheib from Lebanon
thth
10 LOS
Scientific
Meeting
left to right - Pr. Antoine Berbery, Dr. Jean Moussa, Dr. Said Halabi,
Dr. Edgard Irani
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Planmeca is first to introduce an integrated 3D unit producing a realistic
3D face photo in addition to traditional digital maxillofacial radiography.
One single scan generates both a 3D photo and a CBVT volume.
Alternatively, the 3D photo can be acquired separately in a completely
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The 3D photo visualises soft tissue in relation to dentin and facial bones,
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www.dentalnews.com
ISSN 1026 261X
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ISSN 1026 261X

Volume XVIII, Number II, 2011

KaVo ESTETICA E50

The best things in life

The new KaVo ESTETICA E50. Simply top of its class.

Experience the feel of perfection and allow

The range of second-generation furnaces is now complete. All G2 furnaces are

Orthodontic Camouflage Treatment of a

Unilateral Subperiosteal Implant

Application of CBCT in Dental Practice

25th Anniversary, International Meeting

120 Years W&H, Pre-IDS Meeting

International Dental Show 2011

15th Kuwait Dental Association

1st Iraqi Dental Reunion

10th Lebanese Orthodontic Society

ITI First Middle East Congress Beirut,

INTERNATIONAL REVIEW BOARD

THE COUNCIL OF DENTAL SOCIETIES FOR THE GCC.

GET YOUR ISSUE ONLINE

Volume XVIII, Number II, 2011

Class II division 1 malocclusion is described as the incisal edges

15.7 years old male presented complaining of prominent upper

13 ORTHODONTIC CAMOUFLAGE TREATMENT OF A CLASS II MALOCCLUSION

Fig 3. A pre-treatment OPG (above) and upper standard occlusal radiographs.

14 ORTHODONTIC CAMOUFLAGE TREATMENT OF A CLASS II MALOCCLUSION

Fig 1. Pre-treatment extra-oral clinical photographs. Note the lip trap

and causing trauma to the palatal mucosa. The centrelines were

radiograph revealed that the upper right central incisor had an

The Dental Panoramic Tomogram (DPT) confirmed the presence

This patient presented with a Class II division 1 malocclusion on

Fig 4. The pre-treatment cephalometric radiograph (up) and the values

Fig 6. TheTrans-Palatal Arch in situ just before the extraction of the

Alternative treatment plan

This was a case of camouflaging the underlying Class II skeletal

15 ORTHODONTIC CAMOUFLAGE TREATMENT OF A CLASS II MALOCCLUSION

16 ORTHODONTIC CAMOUFLAGE TREATMENT OF A CLASS II MALOCCLUSION

Fig 8. Post-treatment extra-oral clinical photographs.

with the treatment option adopted that involved the extraction

The next phase of treatment involved the fitting of the Trans-Palatal

Fig 9. Post-treatment intra-oral clinical photographs.

consider in treatment planning such cases. In this particular case,

1. British Standards Institutes. Glossary of Dental Terms 1983. BS4492; BSI

Keywords: Unilateral subperiosteal implant - Insufficient bone Bone impression

DIVISIONS OF AVAILABLE BONE According to misch(5)

DENTAL NEWS, VOLUME XVIII, NUMBER II, 2011

19 UNILATERAL SUBPERIOSTEAL IMPLANT

When the volume of the residual alveolar ridge is insufficient to

preoperative right side

preoperative left side

fixed dental appliance to restore the bilateral edentulous posterior

20 UNILATERAL SUBPERIOSTEAL IMPLANT

Mode of tissue integration

Soft tissue reflection

Evaluation of the crest

Making the Impression

22 UNILATERAL SUBPERIOSTEAL IMPLANT

Implants and screws in place

Implant insertion (second surgery):

Right side after healing

Left side after healing

Try in right side