nov / dec / jan 2013 · nov / dec / jan 2013 note: this newsletter is a publication of the...

Nov / Dec / Jan 2013

Note:This newsletter is a publication of the Malaysian Dental Association and opinions expressed herein are that of the authors and do not necessarily re�ect the opinion of the editorial board, the MDA council or the said Association. MDA NEWS shall not, without written consent of the Association, to be hired, lent, given or otherwise disposed of by way of trade or a�xed to or as part of any publication or advertising, literary or pictorial matter whatsover.

Editor : Dr Shalini Kanagasingam Advertising & Classi�eds Chairperson : Dr Eileen Koh Mei Yen Contributing Writers : Dr Yew Hsu Zenn Dr Jolene Lai Dr Hans Prakash Ex-o�cio : Dr Haja Badrudeen Treasurer : Dr Darren Yap

Malaysian Dental Association54-2, 2nd Floor, Medan Setia 2, Plaza Damansara, Bukit Damansara, 50490 Kuala Lumpur, Malaysia.

Tel: 603-2095 1532, 2095 1495 Fax: 603-2094 4670 E-mail: mdaassoca@uni�.my / [email protected]

MDA President's Thoughts on The Dental Bill 2013 • pg3MDA Meeting with Minister of Health • pg4Message from FDI President • pg5Prefabricated Composite Veneers • pg6Dental Protection Column • pg9Report of Government Liaison Committee • pg12

www.mda.org.my

Nov / Dec 2012 / Jan 2013 • MDA NEWS • 3

Message FromThe President Of Malaysian Dental Association

DR HAJA BADRUDEEN

Fellow MDA Members

Assalamualaikum dan Salam Sejahtera.

This year marks a new period in the history of dentistry in Malaysia - The Dental Bill 2013. We are fully aware of the long process of discussions and consultations both within the profession and with the Ministry of Health Malaysia, and finally after about 12 years the Dental Bill is ready. MDA has recommended detailed amendments to some provisions in the new Dental Bill before it being presented to Parliament for debate. MDA, is optimistic that the changes made to the Dental Act 1971 and provided in the new Dental Bill 2013 will herald a new era of excellence to the dental profession in this country. The new Dental Bill 2013 will bring about some significant changes to our practice of dentistry. Firstly, the new Dental Bill will create a Specialist Dental Register, with specific criteria applicable for registration and credentials. Practitioners may no longer claim to unsuspecting patients that they are specialists without accredited training in a dental specialty as listed by the Specialist Sub-Committee of the National Specialist Register (NSR). What would this mean to the practitioner? For most of us, it would not matter, as procedures within the scope of general dental practice would not be considered as specialist procedures. But for those who are practice procedures that requires accredited training, they, potentially could be in serious trouble if litigation arises from what is justly deemed as specialist procedures. Further, it is likely that Dental protection cover for dental practitioners and dental specialists could be different in future. Next, dentists, like many other learned societies in Malaysia, would have compulsory Continuous Professional Education (CPD) as a professional requirement. A minimum 30 points accumulated in the preceeding year would be necessary for renewal of Annual Practicing Certificate (APC). Compulsory CPD is not new to the dental profession, and has been implemented in UK for more than a decade, as well as by our neighbouring countries. Now, with availability of quality Scientific Conferences organized by MDA, MDA Zones

and Affiliates, there is no reason for dental practitioners to claim difficulty in collecting the required minimum CPD points. CPD should be seen as a lifelong learning process, and it therefore incumbent on dentists to keep themselves updated on new dental procedures and technologies for the benefit of their patients. The Dental Bill will also introduce a register for Dental Therapists. They are of course the trained dental nurses who are currently employed within the Ministry of Health to provide dental care for school going children. Once registered, dental therapists will be eligible to work in private as opposed to government sector only. The new Dental Bill Would enable dentists to employ dental therapists to conduct simple procedures as defined by their scope of work, and spend more of their professional time treating patients with complex treatment needs. We look with pride at 2012 on the successful conduct of dental conferences in Kota Kinabalu, Penang, Malacca and Johor Bahru. These congresses exemplify the excellent progress MDA Zones have made in recent years in organizing regional scientific meetings. Interspaced with these meetings, MDA organized the MDA/FDI event and the 69thAGM in conjunction with the Commonwealth Dental Association Conference in Kuching. Looking back, at conferences for dentists, about a decade ago, there were only the selected few to attend. Now dentists have many choices to choose. Moreover, specialist societies and dental affiliates are conducting many workshops and scientific meetings too. Despite all these events, sadly the number of dentists who actually attend plenary lectures has been dwindling. MDA HQ is very concern about this trend, where participation for scientific meetings has more to do with dental trade rather than exchange of scientific knowledge. Perhaps we need to rethink how annual conferences are conducted between MDA'S Zones and Affiliates to avoid duplication and frequency. On that note, it is also timely to introduce a mechanism to monitor participation of delegates at lectures before verifying CPD points. For a start, the showcase event of 2013, the 35th Asia Pacific Dental Conference 8-12 May in Kuala Lumpur would monitor actual attendance by dentists at lectures on daily basis before verification of CPD points in the conference participation certificates. With MDA'S Election being planned in mid year, on behalf of MDA, I urge more members to come forth to contribute to our professional association by becoming office bearers of MDA. It is easy to criticize the outgoing MDA Council, as we see during the AGM's, but without sufficient talent who would want to volunteer their services, MDA's future can become limited in many ways. Let us all take cognizance of this and better our association in this challenging time. I take this opportunity to wish each one of you a belated Happy New Year 2013 and best wishes in your endeavours.God Bless. Best Regards, Dr Haja Badrudeen Bin Sirajudeen MDA President

4 • MDA NEWS • Nov / Dec 2012 / Jan 2013

The meeting with our esteemed Minister of Health was held on the 8th October 2012 at the Ministry of Health Block E7 in Putrajaya. The MDA was represented by the President, Dr Haja Badrudeen and Dr Chow Kai Foo. Dato’ Dr How Kim Chuan and Dr Thurairatnam were also present. The MPDPA were represented by their President Dr Malliga and Dr Vijendran. The Principal Director of the Oral Health Division, Dr Khairiyah and Dr Elise represented the Oral Health Division. Professor Toh Chooi Gait represented the universities. There were also 2 representatives from the Dental Nurses. The legal advisor to the MOH, Puan Wong was also present.

Dr Elise presented a power point presentation of the Dental Bill. Members present were free to make comments and recommendations. The Minister of Health, Dato’ Sri Liow Tiong Lai had welcomed everyone warmly and was very open, frank and considerate. We were all free to speak up and be heard. The Minister emphasized that his overall sentiment and spirit is to enable the profession to practice freely and responsibly with as few constraints as possible, especially so that the nation can capitalize on the current surge and opportunities in the area of medical and dental tourism. These were the welcome results of the dialogue:

The Dental Bill 2013:MDA Meeting With The Minister Of Health

• The private sector will have at least 50% representation in the Malaysian Dental Council.

• Appointments to the important Dental Evaluation Committee and Dental Specialist Qualifying Committee should be subject to the consent of the Minister for the sake of check and balance.

• The clause to set up a privileging committee will be deleted. 47. (2) now changed to 45. (2) should be deleted because it will limit the right of the general practitioner to practice dentistry. This will result in a monopoly by dental specialists, drive up the prices for the public and furthermore discourage general dentists from pursuing continuing professional development and upgrading of their knowledge and skills. Even in advanced countries like the United States and the UK, general practitioners can practise all procedures in the field of dentistry provided they consider themselves having had the necessary training and are fully aware that they are legally responsible for themselves.

• The Annual Practicing Certificate needs only to be paid for once a year and carry one principal address. After all, dental officers in the government have one address which is the Ministry of Health and they can be sent to practice anywhere in the country. We should not burden the dental practitioner with unnecessary requirements. One address is sufficient. The medical doctor need only provide one address and they can practice anywhere in the country. Why should we be any different? What is the justification if any?

Due appreciation should be extended to the President Dr Haja for speaking up strongly against the privileging clause together with representatives from the MPDPA. Dr Chow raised up the request for only one principal address for the APC, whereupon with strong supporting comments from Dato’ How and Dr Thurai, the Minister consented to it. Dato’ How and Dr Chow spoke out strongly against the severe penalties in the Bill especially when compared to the Medical Act Malaysia and best international practices and also natural justice. The Minister readily directed the legal advisor to the Ministry of Health to streamline the penalties to the Medical Act so that the penalties in the Dental Act will not seem so incongruous when compared to the Medical Act.We gained most of the vital concessions that we had hoped for. The Minister of Health has assured all members of the dental profession that he is always open to feedback from them.

Reported by Dr Chow Kai Foo

• All penalties should be streamlined to the Medical Act Malaysia which lists only 5 offences with the maximum fine of RM100,000 or a jail term of 3 years. Dentistry, being a much less risky profession than medicine should correspondingly carry lighter penalties.

YB Dato' Sri Liow Tiong Lai


Message from the

FDI PresidentDear members, dear colleagues

Oral diseases are among the most common chronic diseases. Worldwide, 90% of the population is at risk from some form of oral disorder, ranging from caries,

periodontal diseases and tooth decay to oral cancer. At the same time, our profession and the dental team is able to offer quality services to an increased proportion of the population, with orthodontics, implants and aesthetics contributing adequate dentition and a longer life to a healthier population. However, despite the progress made, the burden of oral disease is still underestimated in many countries, as is the high and devastating cost to families and societies.

The good news is that World Oral Health Day, on 20 March 2013, provides us with the opportunity to raise awareness and encourage individuals, families, communities and governments to take action to reduce the burden of oral disease. We are therefore delighted to provide you with the World Oral Health Day 2013 campaign toolkit.

The decision to create World Oral Health Day was taken at the FDI Annual World Dental Congress (AWDC) in Dubai in 2007. The original date, 12 September, corresponded to the birthday of FDI founder Charles Godon and thus seemed a logical choice.

However, the September date also fell either during, or in the immediate aftermath of, the FDI World Congress. This left little time for the FDI, engaged in the planning of the AWDC, or its national dental associations, to prepare what should be a major event in the world oral health calendar, on a par with the AWDC itself. The FDI General Assembly and its member associations decided to move the date of World Oral Health Day to 20 March. The month of March falls exactly half way between AWDCs and was therefore deemed suitable by FDI General Assembly delegates.

This year our efforts will focus on protecting the teeth and mouths of the population throughout life, from young children to the increasing elderly population. The theme we have chosen is “Healthy teeth for healthy life”.

This is now more significant than ever before. The 2011 United Nations Political Declaration on Noncommunicable Diseases recognised that oral health shares the same risk factors as the main lethal chronic diseases and that a common approach should be used to address the challenges our populations are facing in the coming years.

World Oral Health Day offers the dental and oral health community a platform to take action and help reduce the global disease burden. By working together, we can unite

our efforts to prevent the epidemic of caries, gum diseases and tooth loss and help our communities to maintain proper dentition for life. For the first time in history, we can offer thorough preventive measures, good brushing habits, and, when required, sophisticated technologies and support to guarantee chewing throughout the life course.

Within the following pages, you will find a range of documents to support you with your activities this year, from organising your World Oral Health Day events and liaising with the media, to guidance on how you can use World Oral Health Day in your advocacy efforts. This toolkit contains guidance documents with an appendix of supporting materials: please refer to the table of contents for further information on the resources and how to use them.

We hope you find this toolkit useful and that it helps and inspires you to organise World Oral Health Day activities in your region.

If you require any further information, please contact [email protected].

Meanwhile, thank you for your dedication and support; with your continuous commitment we will advance the fight against oral diseases together, and help to protect the valuable lives of the population.

We wish you all the best for your efforts in 2013, and look forward to hearing your success stories.

Best wishes,

Orlando Monteiro da Silva Jean-Luc EiseléFDI President FDI Executive Director


Prefabricated composite veneers:historical perspectives, indications and clinical application

“the prefabricated composite veneer is likely to establish itself as the modern and improved version for direct composite veneers...”

While the “invention” of veneering anterior teeth by Dr Pincus1 was first presented in 1937, it became more popular in the midseventies, using 3 different approaches: direct bonding using resin composites, prefabricated composite veneers and indirect, custom-made porcelain veneers.2-4

The pre-fabricated composite veneer (Mastique®, Caulk) was then explored about 35 years ago, using a methyl-methacrylate matrix and large glass fillers, such as used in resin composites3,4 but with limited success due to technological limitations and poor surface qualities. 5 The breakthrough in porcelain veneering technique happened with the development of ceramic etching and true adhesive cementation as developed by Rochette (1975)6 and thereafter improved by Calamia and Simonsen (1983).7 From there, this technique underwent considerable successand development over the following years and continues today. The rapid loss of surface gloss and surface degradation of prefabricated resin veneers associated with interfacial defects, which led to the demise of the system and replacement by porcelain veneers, which also had the advantage of an individual fabrication process.

More recently, an innovative shade guide was used in the context of the “natural layering concept”, 8 based on a 2-layer incremental technique mimicking the anatomy of natural teeth.9,10 The shade guide consists of enamel shells into which the dentin samples are inserted and then allow the practitioner to foresee the result produced by the combination of any selected dentin and enamel shades. When a proper match between the shade guide and contra-lateral or reference tooth is obtained, a predictable aesthetic result and restoration optical integration is ensured. Based on a technology comparable to the one used to produce the enamel shells, the concept of prefabricated composite veneers was recently revitalized.11 Using high pressure molding and heat curing processes, followed by laser surface vitrification, the Direct Veneer® (Edelweiss-dentistry, Hoerbranz, Austria) was launched and is based on high pressure molding and heat curing processes, followed by laser surface vitrification.This enables the veneers to exhibit a hard and glossy surface, with slight texture to fit the majority of dentitions. The system is actually aimed at facilitating the aesthetic restoration of decayed or discoloured single and multiple anterior teeth (Figure 1).

IndicationsThe aforementioned direct composite veneer system does not aim to replace the well-established individualized porcelain veneer technique but rather offers an alternative to the delicate and time consuming direct (or free hand) built up composite veneers technique. (Figures 2-4).

Prefabricated composite veneers present an obvious potential in the following indications:

Figure 1. Section of an Edelweiss veneer showing the inorganic vitrified restoration surface, providing optimal surface gloss.

Figure 2. Preoperative view of a patient showing moderate tosevere front tooth wear; despite the significant tissue destruction, a micro-invasive treatment approach was selected using prefabricated composite veneers.

Figure 3. Set of prefabricated composite veneers featuring a vitrified inorganic surface with high gloss.

Figure 4. Post-operative view showing the good aesthetic andfunctional integration of cemented restorations.


1. Single facial restorations:• large restorations/decay with loss of natural tooth

buccal anatomy/colour;• non-vital, discoloured teeth;• traumatized, discoloured teeth (without endodontic

treatment);• severe/extended tooth fracture; or• extended tooth dysplasia or hypoplasia.

2. Full smile facial rehabilitations:• moderate to severe discolourations (i.e. tetracycline

staining and fluorosis);• generalized enamel hypoplasia/dysplasia (i.e:

amelogenis imperfecta IIIA, ...);• large serial restorations/decays with loss of natural

tooth buccal anatomy/colour;• attrition of incisal edges (after proper occlusal and

functional management);• financial limitations; or• young patients with an immature gingival profile. In

fact, the aforementioned indications cover both the accepted and some controversial cosmetic application of “classical” veneers, while other mere cosmetic indications are to be considered really controversial also with this technique. Based on the whole spectrum of restorative procedures (Table 1), such veneering technique lies also in the micro-invasive group, which makes it part of modern treatment strategies and a viable alternative to direct veneers.

Clinical protocol and treatment sequence The case preparation for prefabricated composite veneers does not differ from other functional and aesthetic treatments. The treatment approach and sequence as depicted in Chart1 may follow as soon as the initial

Figure 5. View of the transition area, from enamel to dentin. The composite-composite interface is also visible and shows that this interface is stable and resisted perfectly to occlusal loading.

Treatment approach Usual procedures

Non-invasive Bleaching, microabrasion,orthodontics

Minimally-invasive Direct composites,enamel recountouring

Micro-invasive Veneers, inlays and onlaysMacro-invasive Crowns and bridges

therapy and proper prophylactic measures are completed. Apart from the need to individualize the cervical profile and possibly the proximal and incisal edges, the overall preparation and cementation procedures are for the most part very similar to those applied for indirect porcelain veneers, which keeps the learning curve for this technique to a minimum. Another advantage for both the patient and the dental team is of course the fact that no temporaries are needed. In regards to the internal surface treatment, these restorations are handled identically to composite inlays and onlays, which eliminate the need to acquire additional material or products, which is also of practical interest.

Fatigue testing simulating about 4 years of clinical service12,13 have shown overall an excellent performance of the restorations. Almost no defect was observed either before or after loading at both enamel and dentin margins. The most relevant demonstration of the satisfactory behaviour of tested prefabricated veneers was obtained with the evaluation of restoration internal adaptation. There was no defect found at the interface with enamel or in-between luting cement and the veneer, which confirmed the excellent bond strength at either composite-enamel or composite- composite interfaces.


ConclusionsThe concept for prefabricated composites veneers was introduced in dentistry about 35 years ago with rather limited success due to former technological limitations. As a result, this interesting treatment option was replaced by an increase in the porcelain veneering technique. This “old” idea has been recently revisited by taking advantage of modern technology via the introduction of surface laser vitrification, enabling for the first time the production of a resistant, inorganic glossy surface. However, this rejuvenated technique shall not replace conventional “custom-made” ceramic veneers, but rather offers the clinician a one-visit, cost-effective alternative to directly (or free hand) built up composite veneers. This system may also allow us to fill in gaps within our treatment armamentarium with obvious and interesting application potential, such as the treatment of young patients with localized or generalized hypoplasia/dysplasia, discolouration and in general, when a long-term temporary and highly-aesthetic solution is needed.

In conclusion, the prefabricated composite veneer is likely toestablish itself as the modern and improved version for direct composite veneers.

References1. Pincus CL.”Building mouth personality” A paper

presented at: California State Dental Association; 1937:San Jose, California.

2. Faunce FR, Myers DR. Laminate veneer restoration of permanent incisors. JADA 1976;93:790-792.

3. Helpin LM, Fleming JE. Laboratory technique for the laminate veneer restoration. Pediatric Dentistry 1982;4:48-50.

4. Haas BR. Mastique veneers: a cosmetic and financial alternative in post-periodontal care. J N J Dent Assoc 1982;53:25-27.

5. Jensen O.E., Soltys, J.L. “Six month clinical evaluation of prefabricated veneer restorations after partial enamel removal.” J Oral Rehab. 1986;13: 49-55.

6. Rochette AL. A ceramic restoration bonded by etched enamel and resin for fractured incisors. J Prosthet Dent 1975;33: 287-293.

7. Calamia JR. Etched porcelain facial veneers: a new treatment modality based on scientific and clinical evidence. N Y J Dent 1983;53:255-259.

8. Patent No US2002/0064749 A1, May 30, 2002.9. Dietschi D, Ardu S, Krejci I. A new shading concept based

on natural tooth colour applied to direct composites restorations. Quintessence Int 2006;37:91-102

10. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative procedures. Eur J Esthet Dent 2008;3:14-29.

11. Patent No A1124/2010 July 2, 201012. Krejci I, Reich T, Lutz F, Albertoni M. In-vitro Testverfahren

zur Evaluation dentaler Restaurationssysteme. Schweiz Monatsschr Zahnmed 1990; 100: 953-959.

13. Krejci I, Heinzmann JL, Lutz F. Verschleiss von Schmelz, Amalgam und ihrer Schmelz-Antagonisten im computer gesteuerten Kausimulator. Schweiz Monatschr Zahmed 1990; 100: 1285-1291.

About the authorDr Didier Dietschi was licensed in 1984 and received his doctoral and Privat Docent degrees in 1988 and 2003, respectively, at the University of Geneva, Switzerland. He also received a PhD in 2003 at the University of ACTA, Netherlands. Following

a 6- year period of full time teaching and research activity in Operative Dentistry and Periodontology, he started a part-time private practice in Geneva dedicated to aesthetic restorative dentistry. He now holds positions of adjunct Professor at CASE Western University (USA) and senior lecturer at the University of Geneva. Dr Dietschi has published more than 75 clinical and scientific papers and book chapters on adhesive and aesthetic restorations and co-authored the book “Adhesive Metal-free Restorations”, edited in 1987 by Quintessence and translated into 7 languages. Dr Dietschi lectures internationally on adhesive and aesthetic restorations.

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VeneersThere seems to be an increasing appetite for cosmetic improvements to the human physiognomy and we are deluged with air-brushed images of idealised facial features, which feed a heightened awareness of selfFew of us can escape this pressure to ‘make the best of ourselves’ and dentists are exploiting the business opportunities offered by the current fashion for enhancement.

Dental materials have developed to an extent that a whole new business involving elective procedures has emerged. In the absence of any diagnosed pathology, these procedures are used solely for the purpose of improving the patient’s appearance, and the inherent dento-legal risks are significant.

Using cases involving the provision of veneers as a proxy, it has been possible to analyse the many cases that Dental rotection (DPL) sees and which relate to ‘smile makeovers’. In his article, the graphs provide an indication of the currenttrends and are not intended as anything other than a broad brushstroke of the situation.

Excellent communicationAt the outset, sufficient time needs to be spent establishing why the patient desires cosmetic treatment (is it for professional or social reasons?). The clinician should also understand the motivation that has caused the patient to seek an enhancement to their appearance and why they haveselected you to provide that treatment. De Young et al haveestimated that among patients seeking cosmetic treatments,up to 15% suffer from Body Dysmorphic Disorder1.1 Jongh A, Oosterink FMD, van Rood YR, Aartman IHA. Br Dent J. 2008 Jun 28; 204:691-695

Patient expectations need to be established2 and assessed todetermine if they can realistically be met, bearing in mind the difference between a patient’s and a dentist’s perception of appearance. What may look natural to a dentist may seem entirely wrong to a patient. Any patient who feels their wishes have not been met will not be persuaded to think otherwise3. If the patient does not consider that the clinician has delivered what was promised, they could potentially sue for breach of contract even if there is little or no prospect of the claim succeeding. 2 Maglad AS, Wassell RW, Barclay SC, Walls AWG. Risk management in clinical practice. Part 3. Crowns and bridges. Br Dent J.2010 Aug 14; 209:115-1223 Mehl CJ, Harder S, Kern M. Patients’ and dentists perception of dental appearance. Clin Oral Invest March 2010

Is it reversible?A distinction has to be made between elective treatment4 that is reversible and that which is irreversible; the latter carries a much greater risk. The popularity of ‘smile makeovers’ creates the risk of clinicians ‘selling’ the benefits of cosmetic enhancement whilst skating lightly over the risksin order to ‘close the deal’.

4 DPL. Elective treatment. Risk Management Module 34 2nd edition: (2009)

Patients may attend for the first appointment having alreadydecided what enhancement they are seeking, based on information they have seen in the popular media. Care must be taken to temper such enthusiasm so that the patient can fully understand the risks, rather than the clinician allowing themselves to be carried away by the patient’s own plan for the ‘perfect smile’.

The fact that the patient is keen to go ahead does not relieve the clinician of the obligation to ensure every stage of the consent process has been followed. Indeed, the patient’s focus on a particular treatment option makes it all the more necessary to make them aware of the alternatives.

If I only knew then what I know now...Such heartfelt statements apply equally to the dentist who wished they had known the type of patient they were dealingwith, as it does to the patient whose demands resulted in anappearance that they now find to be unacceptable.

After preparing the teeth for veneers, patients will frequentlyallege that they did not appreciate that tooth enamel had to be removed, believing misleading text in the literature that compared veneers to false nails. This misunderstanding often includes a failure to realise that veneers require lifelongmaintenance. Other misunderstandings have included:

• The potential for lost pulpal vitality that requires endodontic therapy

• fractured or debonded veneer(s)• the length of time to achieve the desired result• periodontal problems created by less-than-ideal margins

Figures 1–3 demonstrate an analysis of cases opened over the past five years at DPL concerning cosmetic procedures and how problems present.

Excerpts from

RiskwiseMalaysia


DPL has seen an increase in the number of veneer cases in the last five years. Without knowing the number of cases involving veneers and the total number of veneers provided annually by members, it is not possible to draw sweeping conclusions from this increase – there may have been a 47%increase in the overall provision of veneers, for example – but the scale and speed of the increase is certainly of concern and this may be a trend that is likely to continue to rise especially in the present economic downturn.

Common problems• Wrong diagnosis/poor case election or assessment – e.g.

failure to diagnose parafunction at the outset, failure to recognise the complexity of the case and refer elsewhere, lack of radiographs, no vitality testing, no periodontal assessment, insufficient tooth structure;

• Debonding of veneers, single or multiple – poor bonding technique, over-preparation, occlusal problems;

• Poor outcome – problems with aesthetics, too bulky, wrong colour, size, insufficient translucency, poor fit;

• Consent – no treatment planning, options not explained, failure to warn of risks, failure to explain removal of tooth structure necessary and irreversible;

• Lack of information about the longevity of restorations and need for maintenance or replacement;

• Loss of vitality, pain and sensitivity;• Secondary caries and periodontal problems developing

around ill-fitting veneers;• Poor or inadequate records, non-contemporaneous or

altered;• Collateral damage;• Failure to communicate relevant information and to deal

with dissatisfaction.

Dealing with problemsAn ‘in house’ complaints procedure is essential for every practice and DPL offers detailed downloadable guidance on this subject in the risk management section of the website. Aproportion of patients may ignore the process and instruct solicitors to pursue a claim in negligence or for breach of contract. Damages awarded in veneer cases can include significant sums for psychiatric/emotional damage if previously sound, intact teeth have been damaged. Once such UK claim of this nature (a smile makeover case) was finally settled for the equivalent of 301,042 Ringgit - not including the defence legal costs.

Typical concerns investigated by national registration bodies• Poor appearance of veneers• A failure to refer due to the complexity of the case• A failure to give treatment options• A failure to provide written treatment plans and cost

estimates• A failure to deal with complaints satisfactorily• Poor communication• Poor or altered, noncontemporaneous dental records.

Reducing the riskConsentWhen elective, irreversible cosmetic treatment is being contemplated, the standard of information that must be given to enable a patient to make an informed decision is now that of the ‘prudent patient’ (what each particular individual needs to know) and not simply what the dentist thinks s/he should explain, or what the reasonable patient would need to know 5.

Excerpts from

RiskwiseMalaysia


This reflects the position established in the landmark Australian case of Rogers v Whitaker 6.5 DPL. Patient autonomy and consent, Dental Ethics Module 8.6 Rogers v Whitaker (1992) 175 CLR479

‘One size fits all’ warnings should be replaced with explanations that are specifically tailored to the individual patient and clinical situation. The procedure being contemplated and inherent risks need to be described in plain language and offered to the patient both verbally and in writing. Alternative options should be explored, including that of doing nothing, particularly if the patient’s expectations areunrealistic. Possibly even consider a reversible approach.

The use of adhesive techniques without removal of tooth tissue, and tooth whitening, are good examples of reversible elective treatment, which have the benefits of avoiding aggressive tooth preparation and fit with the ethical imperative of trying to meet the principle of ‘doing no harm’. Patients need to be told that there are alternatives and a cooling-off period should be factored in to allow patients to go away and spend time weighing up the risks and benefits of the treatment options.

RecordsGood records are the key to being able to demonstrate that the patient was fully informed about all the relevant treatment choices, including the risks, was given time to think about them and the opportunity to return to ask questions before the final decision to proceed was taken. In addition to recording all clinical information, critical discussions such as who initiated the discussion for treatment must also be recorded and a note made of any information sheets or audiovisual aids used to educate the patient. Record all aspects of the discussions. It is not enough just to write the words ‘treatment discussed as normal’.

If the steps taken to communicate information and the efforts made to secure understanding in the case of the specific patient in question are not recorded in the clinical notes, this makes it far easier for a third party to say that the usual full explanation simply did not happen on this occasion and this in turn weakens the defence.

The accessibility and relative simplicity of digital photography has improved the quality of records in cosmetic dentistry and coupled with study models, can significantly improve the quality of the clinical records as well as patient communication and understanding.

ConclusionThe provision of cosmetic treatment can be very rewarding professionally, and patients continue

Prevention is better than cureDPL’s role is in education and helping members to prevent and avoid problems, and that is why we invest so much time and effort in risk management. Yet another purpose is to help members to minimise problems when they do arise, and it is in this context that part of the subscriptions you pay have been deployed to help the MDA to fund a mediation-based complaints resolution system, through the Patients Complaints Bureau Committee (PCBC).

There have been many early successes, as well as the ‘teething’ problems that you will always encounter when embarking upon an ambitious new project such as this. But the real value of a mediation and conciliation service such as that offered by the PCBC lies in the fact that it allows patients to have their concerns and complaints resolved much more quickly, and in a less confrontational way, than would be the case with the obvious alternatives such as civil litigation (a malpractice claim) or a complaint to the Dental Council. It is also better for the practitioner, enables valuable lessons to be learned and applied so that similar problems can be avoided for other patients. And above all, it is less stressful for all concerned.

Dental Protection strongly endorses the work of the PCBC. We urge members to make full use of this service, provided by MDA with the support of Dental Protection and MPS.

Asia Pacific Dental Congress 2013Dental Protection/MPS is delighted to be supporting the MDA and the APDC due to be held in Kuala Lumpur next May, at which our Chairman, Professor Trevor Burke is to be one of the international guest speakers. He recently spoke in both Australia and at the New Zealand Dental Conference and received an enthusiastic reception – so prepare yourself for a treat!

Excerpts from

RiskwiseMalaysia

to drive the continuing demand. Good technical skills can lead to a very low mechanical failure rate of veneers. However, patients’ high expectations, together with differing perceptions of appearance, mean that smile makeovers remain a risky business, with cases reported to DPL having risen by nearly 50% over five years.

A dentist can decrease the risk of dento-legal problems by ensuring that consent procedures are robust and the clinical records are detailed. Whilst the glamour of smile makeovers is alluring, this area of work can be deceptively hazardous. Excellent clinical or soft skills alone will not be sufficient – the full skill set is required to succeed in this demanding area of dentistry.


Report OfGovernment Liaison Committee

1. Draft Dental ActFollowing online engagement on the Dental Act, a lot of feedback has been received regarding the proposed new Act. In particular, much concern has been raised about privileging of general dental practitioners to undertake specialist procedures. In addition, the procedures allowed for dental therapists have also been much debated. Issues raised will be discussed with the Hon. Minister of Health. Presently, there is as yet no indication when the Act will be tabled at Parliament.

2. Autonomous LiberalisationThe letter from MDA to the Hon. Minister of Health objecting to foreign dental specialists setting up standalone clinics has been noted by Bhg Dasar and Perhubungan Antarabangsa of the Ministry.

3. National Blue Ocean Strategy (NBOS)The Ministry of Health has been undertaking efforts towards implementation of NBOS. Currently NBOS 7 is being implemented with theme of “1Malaysia Family Care”. The target groups for implementation include the elderly (including Ministry of Defence veterans), persons with special needs and single mothers. The oral health programme of the Ministry needs to also ensure these groups are targeted in activities undertaken. Corporate social responsibility (CSR) activities with other organisations are encouraged.

4. Rural Transformation Centres (RTC) and Urban Transformation Centres (UTC)

Several RTCs (in Gopeng, Perak; Kota Bharu, Kelantan; Kuala Kedah, Kedah; Pekan Nenas, Johor; Tanjung Manis, Sarawak; and Kuala Linggi, Melaka) and UTCs (Bangunan Dunia Melayu Dunia Islam, Melaka; and Pudu Sentral, FTKL) have been set up with dental clinic as a component. The delivery of oral healthcare at these centres are mainly for relief of pain, and management of conditions requiring immediate treatment.

5. Amendments to the Regulations on the Private Healthcare Facilities and Services Act 1998

A forum was held with the profession on the amendments to the above Act (Act 586) in September, where private dental practitioners have agreed that the Professional Fees shall remain as is in the current 13th Schedule. However, the quantum of charges shall be changed, and this has been submitted to the Medical Practice Division of the Ministry of Health.

6. Moratorium on Establishment of New Dental Faculties

A proposal paper on the above shall be discussed at the next Malaysian Dental Council meeting.

Report submitted by:Datin Dr. Nooral Zeila Junid

MMA Annual And Installation DinnerDate : 14th. JULY 2012 ( Saturday )Time : 7.30 pmVenue : KSL Resort

THE EVENT :The MMA annual and installation night was held in conjunction with the 3rd Johor Medical Conference in Primary Care. The organizing committee had put together a sumptuous dinnerand an interesting event for the night. Heartiest congratulations to Dr Maria Teresa Fernandez on being installed as the new chairman of MMA Johor State.

Photo (From left) : Dr Roshaimi - Director Hosp.Sultanah Aminah JB, Dr Khadijah - Deputy director HSA, Dr Maria Fernandez - MMA Johor State chairman, Dato' Dr N.K.S. Tharmaseelan - MMA president elect, Dr Kamarudin Ahmad - Vice Chairman MMA Johor State, Dr Angie Wong - MDASZ Chairman, Mr. S.Gunasegaran - Johor Bar Council Chairman, Ir Mohd.Khir Muhammad - The Institution of Engineers Southern Branch Chairman.

Specialist in dentine hypersensitivity management


Southern Zone Report

5th SDA MDA SZ Joint Scientific Convention and Trade Exhibition

The 5th SDAMDASZ Joint Scientific Convention and Trade Exhibition themed “Dentistry at the Forefront” was successfully held in KSL Resort, Johor Bahru, from 10th to 11th November 2012. This event saw the enthusiastic participation of dentists from the private as well as the public sectors from Malaysia and Singapore. This year we have about fifty nurses from both side of the causeway participating in a separate half day nurses seminar held in conjunction with the convention. Also held in conjunction with the convention was the poster competition which opened to both doctors and nurses.

Two fully subscripted pre-congress workshops pave the way for the main convention on the 9th November 2012. The half day endodontic workshop was conducted by Assistant Prof. Dr Saisawart Thonguphan from Thailand, a renowned speaker in this region. Running concurrently was the full day implant workshop, conducted by Dr. Cho Yong–Seok from Korea.

The convention was declared opened on the 10th November by the guest of honor Dr. Neoh Gim Bok who is the president elect of MDA. During the opening ceremony the “Friends of MDASZ Award” was presented to Dr. Philip Goh. In the following two days, participants were captivated by renowned speakers from Singapore and Malaysia as well as from Thailand. Latest innovation and technique were presented to the participants while the trade exhibition, showcasing some of the latest products, complimented the lectures by providing the participants with hands on experience. The poster competition provided the enthusiastic and innovative practitioners a platform to showcase their new findings and in the same time comment from the judges providing them some invaluable learning experience. The first day ended with an interactive dialog session with Dr Elise Monerasinghe from Minister of Health on the Dental Bill 2013. Speakers and members of the organizing committee had a quiet dinner together in Infusion Café in KSL Resort Hotel. The last day of the convention went smoothly. Winners of the various categories of the poster competition were rewarded with prizes and certificates.


Delegates during opening ceremony

Guest of honor with the organizing committee Participants of the nurses seminar


The Exhibition hall

Endodontic Workshop

Implant Workshop

Sentral Dental ClinicDENTIST VACANCY

Looking for a quali�ed dentist to work in a soon to be opened dental clinic in Bintulu.

• Very good remuneration, yearly increment % pro�t sharing and expansion opportunity.

• Good command of multiple languages/ local dialects is an added advantage.

• Must have good personalities and willing to commit to long term employment.

• Will be appointed as person in charge (PIC). Must not be PIC for another center.

• Interested candidates please email CV, expected salary, face photo to: Felicia - [email protected]

Date : 7-12 May 2013Venue : Kuala Lumpur Convention Centre, Kuala Lumpur, Malaysia

LOG ONwww.35thAPDC2013.comfor updates WORKSHOP & LIMITED ATTENDANCE LECTURE

EARLY BIRD EXTENDED TO 30TH MARCH 2013NO

W1

Minimally Invasive Techniques for Difficult Porcelain Laminate Veneer Cases7 MAY 2013, TUESDAY | Half Day: 9am - 12.30pmVenue: Faculty Of Dentistry UKM, KL Campus.

EARLY BIRD FEE(BEFORE 30TH MARCH 2013)

LATEREGISTRATION

RM 1200 RM 1500

Prof Dr Francesco Mannocci (UK) Workshop synopsis: Fibre posts and dentine adhesion: the true story Fibre post restorations and in general adhesive restorations of endodontically treated teeth have been used for almost 20 years. In this lapse of time, fibre posts together with dentine bonding systems and composite resins have widely replaced cast posts and amalgam as core materials. Very few subjects in restorative dentistry have been so thoroughly investigated; the amount of clinical and laboratory research available on this type of restoration is abundant.

Systematic reviews and randomized clinical trials on fibre post restored teeth are available. Clinical trials proved that the compared to cast post restorations, fibre post restorations show less root fractures over the years whereas post core decementation was found to be the most frequent failure mode.In this presentation the scientific evidences on fibre post restorations will be used to offer to endodontists and general practitioners some tips to solve the clinical challenges encountered in daily practice. Indications for fibre post restorations will be discussed in relation to the amount of residual tooth tissue structure available at the end of the endodontic treatment and also in relation to the adhesive techniques used for their cementation. The choice of the adhesive system to be used in combination with fibre posts will be addressed the advantages of operative microscopes and ultrasonics in fibre post removal will be discussed.

Programme:1:30-2.00pm : Registration (UKM)2.00-2.45pm : Lecture: Fibre posts versus cast/metal posts 2.45-3.45pm : Lecture, Demo & Hands-on:"Clinical Tips on Placement of fibre posts technique"3.45-4.15pm : Teabreak4.15-5.30pm : Lecture, Demo & Hands-on: "Clinical Tips on Removal of fibre posts technique"5.30-5.45pm : Q&A, discussion.

Limited to 20 paxSponsors:

Dr Galip Gurel (Turkey) In order to achieve a very precise and predictable tooth preparation, wax-up, silicon indexes and related techniques such as APR (Aesthetic Pre Recontouring), APT (Aesthetic Pre-evaluative Temporaries) and preparation through the APTs are extremely crucial. This eliminates all the possible mistakes and destruction of the depth cutters that could have been done if the tooth was to be prepared without realizing the aging affects on the enamel (volumetric enamel loss) or their unappropriate teeth positions on the dental arch.

* This workshop will include a demonstration by Dr Galip Gurel and hands-on practice by participants. Special models will be provided for participants to optimal clinical experience.

NO

W2

Practical Solutions for Fibre Post & Core Build Up: Mastering successfulplacement and removal7 MAY 2013, TUESDAY | Half Day: 2pm - 5.30pmVenue: Faculty Of Dentistry UKM, KL Campus.


LATEREGISTRATION

RM 350 RM 500

Limited to 30 paxSponsor:

Full Day Workshop Half Day Workshop

6 CPDpoints

CPDpoints4

Dr Fadi Barrak (UK), Prof St John Crean (UK) & Dr Lee Soon Boon (Malaysia)Program8.30 – 9.00 am : Registration9.00 – 10.00 am : Principle of Bone Biology for Dental Implantology (Professor St John Crean, England)10.00– 10.20 am : Coffee break10.20 – 11.20 am : The Effective Use of Osstem CAS-KIT Crestal Approach Sinus augmentation for Dental Implant (Dr Lee Soon Boon, Malaysia)11.20 – 12.30 am : The Safe and Predictable Window Approach Maxillary Sinus Augmentation with Osstem LASK-kit System & Osstem SMART BUILDER bone regeneration technology ( Dr Fadi Barrak, England )12.30 -12.45 pm : Q & A 12.45 – 2.00 pm : LUNCH2.00 – 4.00 pm : (i) Hands on session on Osstem CAS-Kit, (ii) Hands on session on Osstem LASK-kit, (iii) SMART BUILDER bone regeneration hands on session4.00 – 5.15 pm : Two (2) Live Dental Implant Surgeries5.15 – 5.30 pm : Q & A

Dr Todd Shatkins (USA) Success with Mini Dental Implants – a Twelve Year Perspective

With the growing demand from patients for fewer office visits, lower cost procedure with immediate results and shorter recovery time, dental rehabilitation techniques have been developed for minimally invasive, single stage mini implant placement. This workshop will provide a retrospective analysis of 5640 mini dental implants placed over a 12 Year period that was done by Dr. Shatkin.

To be included in this workshop will be the surgical procedure, the materials and methods, the results and the conclusion.

NO

W4

Mini Dental Implant Workshop Includes Live Surgery7 MAY 2013, TUESDAY | Full Day: 9am - 5.00pmVenue: MAHSA University, Jalan Dang Wangi KL.


LATEREGISTRATION

RM 650 RM 800


NO

W10

MDA-Osstem-UCLAN Dental Implantology Hands On Course & Live Surgery7 MAY 2013, TUESDAY | Full Day: 9am - 5.30pmVenue: Faculty Of Dentistry UKM, KL Campus.


LATEREGISTRATION

RM 450 RM 600


Dr Paulo Monteiro (Portugal) Workshop synopsis: Fibre posts and dentine adhesion: the true story COMPONEER are polymerised, prefabricated nano-hybrid- composite enamel shells that combine the advantages of direct composite restoration with the advantages of prefabricated veneers. Until now the dentist could only choose between a freehand technique with composite or lab made indirect veneer technology. Especially in the freehand technique the most problems are to perform a correct anatomical shape and the fact that we have air inclusion in

the material, that can lead to discoloration at the surface. The Direct Composite Veneer System adds a new and interesting dimension to existing treatment options. Time- consuming forming of the anatomical shape and surface and elaborate trimming are no longer required. Componeer substitutes the last enamel Layer in the freehand technique. The extremely thin composite shells from 0.3 mm allow a high level of conservation of hard tooth substance during preparation compared to classical veneer preparation. The novel micro-retentive inner surface increases wettability and ensures a lasting bond. Special conditioning of the veneer is not necessary and with an minimal amount of composite between componeer and tooth surface also marginal adaptation is increased. After seating the surface, texture and form can be individualized without loosing surface quality.Whether for incisor extensions, the covering of massive discolouration or the closing of diastemas, aesthetic corrections can be carried out and opens a wide variety of indications. A well-thought-out range of instruments are additionally developed to make the work easier and more efficient. The presentation shows all properties of the system and goes thru the clinical part step by step to show a new challenge in restorative dentistry to make a new aesthetic composition with componeer.

NO

W3

Componeer TM : The New Direct Composite Veneering System 7 MAY 2013, TUESDAY | Half Day: 9am - 12.30pmVenue: Faculty of Dentistry, USIM, Pandan Indah Campus, KL


LATEREGISTRATION

RM 500 RM 650


* complementary kit provided

* Complimentary hands on materials by Osstem Dental Implant System** CPD 6 points

The objectives of this Symposium are to provide an overview of the current evidence-based clinical laser dentistry, over a wide spectrum of laser wavelengths; to provide relevant and reliable information about laser science and laser-tissue interactions in addition to mastering the procedural skills. Delegate will interact with laser dentistry experts and see lasers in action with opportunities for hands-on practice. So that dentists must make informed decisions about the best type of laser for the practice.(Refer 35th APDC website for detailed programme).

NO

W5

WFLD - APDC LASER SYMPOSIUM8-9 MAY 2013, WEDNESDAY & THURSDAY | 2 Days: 8.30am - 5.30pmVenue: MAHSA University, Pusat Bandar Damansara.


LATEREGISTRATION

RM 600 RM 750


Dr Shanon Patel (UK) Cone Beam Computed Tomography (CBCT) is an exciting new technology which has been embraced by all the dental specialties. This presentation will assess the limitations of intra oral radiography in endodontics, and how CBCT may used to overcome some of these limitations. Pertinent endodontic literature will be critically reviewed. Clinical cases will be shown to demonstrate howCBCT may aid useful in the diagnosis and management of a variety of endodontic problems; including assessing periapical lesions, root canal

anatomy, root resorption, dental trauma, retreatments and root fractures.The workshop will cover • cone beam software applications and diagnostic interpretation relevant to restorative dentistry

and endodontics. Using images acquired by a J Morita Veraviewepocs 3D Cone Beam CT (CBCT) unit, you will

be guided in:• the use of CBCT software to explore areas of interest on a 3-dimensional scan using multiple

planes.• How to identify both normal and abnormal anatomy and pathology in teeth and

periodontium.• How to incorporate CBCT data into your treatment plans.This workshop will incorporate illustrated lectures, discussion, case presentations, demonstration and interactive CT scan interpretation. You will have access to an individual computer with CBCT software but are encouraged to bring your own PC laptop and a mouse with you to this program.

NO

W6

New Dimensions in 3-D Cone Beam CT Applications and Interpretation9 MAY 2013, THURSDAY | Full Day: 9am - 5.00pmVenue: Faculty Of Dentistry UKM, KL Campus.


LATEREGISTRATION

RM 500 RM 650


NO

W11

The treatment of C-shaped root canal system9 MAY 2013, THURSDAY | Half Day: 9am - 12.30amVenue: Faculty Of Dentistry UKM, KL Campus.


LATEREGISTRATION

RM 350 RM 500


Professor Dr Fan Bing Mandibular second molars with fused root will be selected and the existence of C-shaped canal system will be confirmed by radiography. After access opening, the canal orifices will be observed and probed under microscope. C-shaped canal negotiation, instrumentation and obturation will be performed.

*Complimentary Reciproc files provided

From left to right: A / prof Sajee Sattayut (Thailand), Prof Loh Hong Sai (Singapore), A / Prof Akira Aoki (Japan) Dr Ambrose Chan (Australia), A / Prof Reza Fekrazad (Iran), Dr Kalhori Katayoun (Iran)

From left to right: Dr Phillip F.F.Tsui (Hong Kong), Prof Kenji Yoshida (Japan), A / Prof Hisashi Watanabe (Japan) Dr Shigeyuki Nagai (Japan), Dato’ Dr How Kim Chuan (Malaysia)

Prof Jean Marc Retrouvey• Orthodontic Aligner therapy has come under the mainstream of orthodontic treatment over

the past few years. The ever-increasing demand for AESTHETIC & COMFORTABLE orthodontic treatment and BROAD SPECTRUM OF FEASIBLE CASES has seen plastic aligner therapy completing more than 2 million cases globally by various systems.

• This 2 day workshop enables you build your practice by adopting and mastering the ClearPath 3D ALIGNER PROPRIETARY TECHNOLOGY to give your patients the aesthetics, comfort, convenience & predictability in their orthodontic treatment.

• In this era of rapidly evolving technology, the 3D orthodontic aligner technology has made it possible for a general dentist too to execute orthodontic treatment effectively for most of his patients.

DAY 1:1. Opening / Introductory proceedings and registration formalities2. Company profile & introduction – ClearPath Orthodontics3. Origin and Evolution of Aligner technology4. Biomechanics and principle of aligners5. Force delivery with aligners6. Types of Aligner systema7. Advantages & Limitations of Aligners8. Case selection parameters for ClearPath aligners9. Clinical cases, Q&A and discussion10. The ClearPath System a. How to submit a case with ClearPath d. Bite taking technique b. Elastomeric impression taking technique e. ClearPath prescription form c. Identifying faulty impressions11. ClearPath virtual setup – how to access & tips for reviewing 12. Inter Proximal Reduction (IPR) in aligner cases13. Monitoring aligner patients & patient care instructions14. ClearPath products, pricing and delivery timelines15. Closing ceremony, Photo session and Certificate Distribution

DAY 2:1. Revision & Refresher of DAY 1 2. HANDLING SKELETAL CASES - Use of auxiliaries / attachments with aligners a. Class II and Class III Elastics c. Micro-implants and Expansion devices b. Extrusive attachments 3. Clinical Case discussions 4. HANDLING MIXED DENTITION CASES5. Perfect 10 finish with aligners6. Difficult tooth movements with Aligners7. HANDS ON DEMONSTRATION a. Impression technique d. Class II and Class III Elastics b. Bite registration e. Intraoral Photography for Aligners c. Extrusive attachments8. Inter Proximal Reduction (IPR) in aligner cases9. Monitoring aligner patients & patient care instructions10. ClearPath products, pricing and delivery timelines11. Closing ceremony, Photo session and Certificate Distribution

Dr Renato Leonardo (Brazil) Dr.Leonardo will teach current procedures in endodontic cleaning and obturation. Step-by-step technique to broaden their scope of the ease in use of Endo-EZE TiLOS system, an ideal new technique for the general practitioner who wants to learn a minimal invasive technique, anatomically guided cleansing technique that preserve root dentin while giving predictable obturation success. Along with the hands-on program, attendees can expect information about vital and non-vital pulp therapy, root canal microbial, access preparation, canal

system morphology, canal disinfection, various obturation techniques and benefits of hand/rotary/alternative technique for canal instrumentation. It will guide you through a complete endodontic procedure where you can experience stress free instrumentation and obturation of the canals.

NO

W7

Minimally invasive technique - Endo-EZE TiLOS system(A Hybrid StainlessSteel and Nickel Titanium File system)9 MAY 2013, THURSDAY | Half Day: 2pm - 5.30pmVenue: Faculty of Dentistry USIM Pandan Indah Campus, KL.


LATEREGISTRATION

RM 350 RM 500


NO

W8

Clearpath Orthodontics Workshop *complementary starter kit CD provided10-11 MAY 2013, FRIDAY & SATURDAY | 2 Days: 9pm - 5.00pmVenue: MAHSA University, Pusat Bandar Damansara.


LATEREGISTRATION

10 May 2013(Beginner)RM 400

11 May 2013(Advance)

RM 400

Both DayRM 650

10 May 2013(Beginner)RM 550

11 May 2013(Advance)

RM 550

Both DayRM 800


Dr Michael Mandikos • Attendees will be guided through the correct preparation designs for

all-ceramic crowns for anterior and posterior teeth, with reference to difference between preparations for Zirconia or for pressed ceramics.

• Attendees will then learn to make a highly aesthetic provisional restoration for their prepared tooth, as well as learn tricks to improve the fit of their provisional. There will also be a cementation exercise to demonstrate the correct technique for seating and bonding in an all-ceramic crown, as well as a ceramic or fibre post.

At the completion of this workshop, attendees should be able to properly prepare an incisor or molar for an all-ceramic crown, fabricate a well-fitting provisional restoration, and correctly cement an all-ceramic crown as well as a post.

NO

W9

All Ceramic Workshop11 MAY 2013, SATURDAY | Half Day: 2pm - 5.30pmVenue: Faculty of Dentistry USIM Pandan Indah Campus, KL.


LATEREGISTRATION

RM 500 RM 650


Speker: Prof Dr Dennis Tarnow (USA)

Immediate vs. Delayed Socket Placement:What We Know, What We Think WeKnow and What We Don’t Know?

ABSTRACTImmediate placements of implants into extraction sockets is an exciting

treatment alternative for our patients. However, there are many potential short and particularly long term risks which the practitioner must be fully aware of. This presentation will focus on the potential problems and benefits both clinically and biologically when the choice of immediate socket placement is made for single and multiple sites. Upon completion of this presentation, participants should be able to understand:• Identify what type of healing takes place against the implant in immediate socket placement• Know how to minimize recession with immediate provisionalization?• Know the proper crown contour for immediate provisionals?• Know if the gap distance really matters?• Know if primary closure should be attempted or should it be left open?• Know if membranes should be utilized?• Know what type of graft material, if any, should be utilized?• Identify what are the potential short and long term risks involved with immediate placement of implants?

The Interdental Papilla DilemmaWhat We Know, What We Don’tKnow and Where We Have To Go From Here?

ABSTRACTThe key problem with implants today is deciding the proper treatment plan when two adjacent teeth need to be replaced in the esthetic zone. The research has shown that the papilla betweentwo adjacent implants is shorter than the papilla between two adjacent teeth. This program will discuss the proper treatment plan when confronted with having to replace two adjacent teeth. The biologic reasons for this problem will be discussed as well as possible solutions that can be used now and in the future.Upon completion of this presentation, participants should be able to understand:• Know how to treatment plan single teeth in the esthetic zone?• Know how to treatment plan multiple adjacent teeth in the esthetic zone?• Learn how to use orthodontics, prosthodontics and periodontics to maximize success in the esthetic zone

NO

1

LIMITED ATTENDANCE LECTURE/ MASTERCLASS10 MAY 2013, FRIDAY | Full Day: 9pm - 5.00pmVenue: KLCC


LATEREGISTRATION

RM 600 RM 750


Total care mag ad FA OL.pdf 12/23/10 4:47:59 PM

24 • MDA NEWS • Nov / Dec 2012 / Jan 2013 Aug / Sep / Oct 2012 • mda news • 24

Classi�ed

KUALA LUMPUR

INTERNATIONAL DENTAL CENTRE

• Full time dental surgeon / orthodontist

• High ow of patients from overseas

& local market

• Good working environment

• Latest technology available

• Flexible working hour

• Attractive remuneration

Interested Applicants

Please call Faye Puan at 012-2929 081

ONG DENTAL &ORTHODONTIC SPECIALIST CENTREASSOCIATE DENTAL SURGEON (Full Time) required:

- Attractive Remuneration- Centre equipped with latest equipment- Centre provides General and Specialist dental care (Orthodontics & Implants) Please email resume to [email protected] call Miss Ong 012 5770822

FULL TIME DENTAL SURGEON positions available at Johor Bahru's fastest growing dental group. Interested applicants please contact Ms. Zoe at 0127815576.

Applicants must have valid APC.

LOCUM DENTAL SURGEON wanted on weekend basis at Tmn Megah, PJ.

Contact: 012-2078015

please.

DENTAL SURGEON(Full time /part time,registered with MDC)wanted in busy dental practice in KL.

Good working environment, Chinese speaking, replacing dentist with high income and stableclientele.Tel: 016-6981390 ; 012-6616487

Established clinic along Jalan Semabok, Melaka, for sale. Interested parties may kindly contact +6019 6266049. Serious inquiries only please.

FULL TIME FEMALE MALAYSIAN DENTIST REQUIRED IN KL.PLS CALL 0193032040 IF INTERESTED

FEM

DENTAL SURGEON / ASSOCIATE WANTED IN KOTA DAMANSARA- An established dental clinic in Dataran Sunway, Kota Damansara, PJ- Flexible working hour 5/6 days a week- Mandarin / Cantonese speaking prefered- Please send you application and resume to [email protected] Enquiries please contact 03-61485208 / www.malaysiasmile.com

FACULTY JOBS AVAILABLE AT UNIVERSITY OF DAMMAM,

SAUDI ARABIA

The College of Dentistry at the University of Dammam is seeking full

time faculty in the following specialties:

Endodontics, Pedodontics,

Restorative Dentistry, Periodontics,

Oral and Maxillofacial Surgery, Prosthodontics,

Dental Public Health, and Basic Oral Sciences

The Candidate should be a PhD holder (or equivalent) or at least a

holder of a Master degree with a postgraduate training. The

candidate should possess solid interpersonal and communication

skills.

Please direct your electronic responses to:

Recruitment Committee

Email: [email protected]

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nov / dec / jan 2013 · nov / dec / jan 2013 note: this newsletter is a publication of the...

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