Coltene Holding Ag · SIX:CLTN
Coltene — Investor Presentation (February 2021)
68 slides from Coltene's investor presentation, February 2021
Slide 1: Endodontic Retreatments: Why, When, How?
ENDODONTIC RETREATMENTS WHY, WHE N, HOW? Please look at the references at the end of the presentation. POWERPOINT_MM_REMOVER_DEALERS_EN_V3 1
Slide 2: Revision
REVISION Rev Date Author Changes V1 2020-03-09 MKT MM Creation V2 2020-04-01 FAAR Only MicroMega V3 2021-02-10 DOCA S21/22 Percentage correction S34/60 Graphic and organisational changes, additions of information to improve understanding and reformulation POWERPOINT_MM_REMOVER_DEALERS_EN_V3 2
Slide 3: Endodontic Retreatment Why & When, Coltene File for Retreatment
ENDODONTIC RETREATMENT WHY & WHEN COLTENE FILE FOR RETREATMENT A N I N CREA SI N G P OTEN TI A L D EFI N I TI ON COM P ETI TI V E L A N D SCA P E CA U SES FOR FAI L U RES SU CCESS RATES POWERPOINT_MM_REMOVER_DEALERS_EN_V3 3
Slide 4: Endodontic Retreatment Why & When?
ENDODONTIC RETREATMENT WHY & WHEN? Please look at the references at the end of the presentation. POWERPOINT_MM_REMOVER_DEALERS_EN_V3 4
Slide 5: Endodontic Retreatment Definitions
ENDODONTIC RETREATMENT DEFINITIONS A procedure to remove root canal filling materials from the tooth, followed by cleaning, shaping and obturation of the canals (American Association of Endodontists) Non-surgical retreatment is an endodontic procedure whose goals are "to remove materials from the ro
Slide 6: Why Retreat a Tooth?
ENDODONTIC RETREATMENT WHY RETREAT A TOOTH? 1. In case of failure of the initial Root Canal Treatment (RCT) 2. The initial treatment was successful but a new problem appears (new decay, broken crown, tooth fracture…) 3. In case of a new restoration (technical retreatment) POWERPOINT_MM_REMOVER_DEALE
Slide 7: Causes for Failures of Initial RCT
ENDODONTIC RETREATMENT CAUSES FOR FAILURES OF INITIAL RCT Improper selection of the treatment strategy Incorrect oral examination Misinterpretation of radiographs Operative causes POWERPOINT_MM_REMOVER_DEALERS_EN_V3 7
Slide 8: Causes for Failures of RCT
CAUSES FOR FAILURES OF RCT 01 Operative causes : failure to attain biomechanics and biological objectives CANAL ACCESS PREPARATION PREPARATION IRRIGATION Perforation Under or overextended preparation OBTURATION Source : aae.org OTHER CAUSES OF FAILURES POWERPOINT_MM_REMOVER_DEALERS_EN_V3 8
Slide 9: Causes for Failures of RCT: Canal Preparation
CAUSES FOR FAILURES OF RCT ACCESS PREPARATIO 02 Operative causes : failure to attain N biomechanics and biological CANAL objectives PREPARATION Perforations IRRIGATION Ledge formation Canal blockage / Untreated calcified canal Missed canal OBTURATION Instrument separation Source : aae.org OTHER CAUS
Slide 10: Causes for Failures of RCT: Irrigation
CAUSES FOR FAILURES OF RCT ACCESS PREPARATIO 03 Operative causes : failure to attain N biomechanics and biological objectives CANAL IRRIGATION PREPARATION Incorrect irrigants Not enough disinfection of the root canal OBTURATIO N OTHER CAUSES POWERPOINT_MM_REMOVER_DEALERS_EN_V3 10
Slide 11: Causes for Failures of RCT: Obturation
CAUSES FOR FAILURES OF RCT ACCESS PREPARATIO 04 Operative causes : failure to attain N biomechanics and biological OBTURATION objectives CANAL PREPARATIO N Overextended filling IRRIGATION Underextended filling Periodontal involvement – lateral and accessory canals OTHER CAUSES POWERPOINT_MM_REMOVER_
Slide 12: Causes for Failures of RCT: Other Causes
CAUSES FOR FAILURES OF RCT ACCESS PREPARATIO 05 Operative causes : failure to attain N biomechanics and biological objectives CANAL OTHER CAUSES PREPARATIO OF FAILURES N Poor coronal restoration IRRIGATION Resistant bacteria Economic constraints Inadequate sterilization of OBTURATION instruments POW
Slide 13: Causes for Failures of RCT
CAUSES FOR FAILURES OF RCT In other cases, a new problem can jeopardize a tooth that was successfully treated. For example: New decay can expose the root canal filling material to bacteria, causing a new infection in the tooth A loose, cracked or broken crown or filling can expose the tooth to a new
Slide 14: Success Rate
SUCCESS RATE Figures on the outcome of initial Root Canal Treatment (RCT) Success rate of initial RCT varies from 74.7% (1) to 94% (2) Most studies report an average success rate of 90% between 1 and 5 years (2), dropping to 73% after 20 years (3) Even with evolution of technique and materials (swit
Slide 15: Success Rate
SUCCESS RATE Figures on the outcome of initial Root Canal Treatment (RCT) The success rate is influenced by the type of Operator Tooth Obturation Coronal restoration Patient POWERPOINT_MM_REMOVER_DEALERS_EN_V3 15
Slide 16: Success Rate
SUCCESS RATE Figures on the outcome of initial Root Canal Treatment (RCT) Type of Operator Better success rate at 5 years is achieved for RCT performed by endodontists (98.1%) than GDPs (89.7%) (5) 4 times more chance for good outcome if treatment is performed by a graduate dentist rather than a stu
Slide 17: Success Rate
SUCCESS RATE Figures on the outcome of initial Root Canal Treatment (RCT) Type of tooth Multi-rooted teeth, and particularly molars, have the lowest success rate (7, 11) due to a more complex anatomy and less accessibility thus the treatment is more difficult The success rate of infected teeth (peri
Slide 18: Success Rate
SUCCESS RATE Figures on the outcome of initial Root Canal Treatment (RCT) Type of obturation, tooth and patient Vertical compaction would have better outcome according to Chevigny et al. (2008) compared to lateral condensation (12) For tooth with coronal leakage of the restoration, the success rate
Slide 19: Success Rate: Figures of Retreatment
SUCCESS RATE Figures of retreatment Success rate of retreatments between 92% and 98% if there is no apical pathology (16) If apical pathology = 64-70% (16) Example of a case addressed to an endo-specialist POWERPOINT_MM_REMOVER_DEALERS_EN_V3 19
Slide 20: Success Rate: Figures of Retreatment
SUCCESS RATE Figures of retreatment Other factors that may affect the success rate of retreatments: Quality of the overall initial RCT According to Chevigny et al. (2008) (14) and Farzaneh et al. (2004) (15), poor initial RCT will allow retreatment with an increased success rate POWERPOINT_MM_REMOVE
Slide 21: Success Rate: Figures of Retreatment
0,9 0,675 87% SUCCESS RATE 0,45 68% 0,225 0 Good Quality Bad Quality Figures of retreatment -22% Other factors that may affect the success rate of retreatments: Quality of the overall initial RCT Quality of the first root canal obturation (17) POWERPOINT_MM_REMOVER_DEALERS_EN_V3 21 Example of a case
Slide 22: Success Rate: Figures of Retreatment
0,9 SUCCESS RATE 0,675 86% 0,45 0,225 48% 0 Figures of retreatment Original anatomy Original anatomy altered respected Other factors that may affect the success rate of retreatments: -44% Quality of the overall initial RCT Quality of the first root canal obturation (17) If altered anatomies: zipping
Slide 23: Success Rate: Conclusion
SUCCESS RATE As a conclusion… No apical pathology = 92 – 98% Apical pathology = 64 – 70% Poor initial obturation = 87% Good initial obturation = 68% Original anatomy respected = 86% Altered anatomy = 48% POWERPOINT_MM_REMOVER_DEALERS_EN_V3 23
Slide 24: Coltene File for Retreatment
COLTENE FILE FOR RETREATMENT Please look at the references at the end of the presentation. POWERPOINT_MM_REMOVER_DEALERS_EN_V3 24
Slide 25: Trends & Statistics on Retreatment
COLTENE FILE FOR RETREATMENT TRENDS & STATISTICS ON RETREATMENT Globally, the trend is moving to retreatments On average 30% retreatments (growing) and 70% RCT with GDPs On average 80% retreatments and 20% RCT with endo-specialists POWERPOINT_MM_REMOVER_DEALERS_EN_V3 25
Slide 26: Product Portfolio Evolution
COLTENE FILE FOR RETREATMENT PRODUCT PORTFOLIO EVOLUTION In the process of MM range rationalization, R-ENDO has been discontinued and replaced by MicroMega REMOVER with the lat est manufacturing benefits. MicroMega REMOVER is a file dedicated to the removal of the obturation material. POWERPOINT_MM_
Slide 27: The Various Techniques of Retreatment
COLTENE FILE FOR RETREATMENT THE VARIOUS TECHNIQUES OF RETREATMENT Hand files: time consuming, risk of breakage Ultrasound tips: mostly used for broken file removal, help the retreatment but not for the whole procedure Rotary NiTi files: no significant innovation since 2010 Reciprocating NiTi files
Slide 28: The Various Techniques of Retreatment
COLTENE FILE FOR RETREATMENT THE VARIOUS TECHNIQUES OF RETREATMENT Rotary NiTi files and reciprocating NiTi files from competition POWERPOINT_MM_REMOVER_DEALERS_EN_V3 28
Slide 29: Competition Analysis
COMPETITION ANALYSIS MICROMEGA DENTSPLY SIRONA REMOVER PROTAPER UNIVERSAL RETREATMENT D1 D2 D3 NUMBER OF FILES TO REMOVE THE OBTURATION MATERIAL 1 3 SINGLE USE MULTIPLE USE NUMBER OF USES (3 CANALS) (2 TO 8 CANALS) ACTIVE TIP ? 30. 07 DIMENSIONS 30. 09 25 .08 20 .07 L19 OR L23 GUTTA PERCHA POINTS, O
Slide 30: Competition Analysis
COMPETITION ANALYSIS VDW MICROMEGA RECIPROC, REMOVER RECIPROC BLUE NUMBER OF FILES TO REMOVE THE 1 ≃1 OBTURATION MATERIAL SINGLE USE SINGLE USE NUMBER OF USES (3 CANALS) (ONE MOLAR) ACTIVE TIP ? 30. 07 25 .08 40 .06 50 .05 DIMENSIONS L19 OR L23 L 21, 25 OR 31 GUTTA-PERCHA AND CARRIER- OBTURATION MAT
Slide 31: Competition Analysis
COMPETITION ANALYSIS FKG MICROMEGA D-RACE REMOVER DR1 DR2 NUMBER OF FILES TO REMOVE THE 1 2 OBTURATION MATERIAL SINGLE USE DR1: MULTIPLE USE NUMBER OF USES (3 CANALS) DR2: SINGLE USE ACTIVE TIP ? 30. 07 30 .10 L15 25 .04 L25 DIMENSIONS L19 OR L23 800-100 RPM 400-600 RPM GUTTA PERCHA, OBTURATORS, OBT
Slide 32: Competition Analysis
COMPETITION ANALYSIS FKG MICROMEGA XP ENDO RETREATMENT REMOVER DR1 XP-ENDO SHAPER XP-ENDO FINISHER R NUMBER OF FILES TO REMOVE THE 1 2 OBTURATION MATERIAL DR1: MULTIPLE USE SINGLE USE XP-ENDO SHAPER: SINGLE USE NUMBER OF USES (3 CANALS) XP-ENDO FINISHER R: SINGLE USE ACTIVE TIP ? SEMI ACTIVE 30. 07
Slide 33: Competition Analysis
COMPETITION ANALYSIS MicroMega MICROMEGA R-ENDO REMOVER R1 R2 R3 NUMBER OF FILES TO REMOVE THE 3 OBTURATION MATERIAL 1 SINGLE USE MULTIPLE USE NUMBER OF USES (3 CANALS) ACTIVE TIP ? R1 25 .08 L15 30. 07 DIMENSIONS R2 25 .06 L19 L19 OR L23 R3 25 .04 L23 GUTTA PERCHA GUTTA PERCHA, OBTURATION MATERIAL
Slide 34: MicroMega REMOVER
MicroMega REMOVER REMOVE GUTTA PERCHA POWERPOINT_MM_REMOVER_DEALERS_EN_V3 34
Slide 35: POWERPOINT_MM_REMOVER_DEALERS_EN_V3
POWERPOINT_MM_REMOVER_DEALERS_EN_V3 35
Slide 36: End User Pains
END USER PAINS Complexity of retreatment procedures, especially removing the old filling material Learning a new instrumental technique Using excessive solvant, dangerous for patients POWERPOINT_MM_REMOVER_DEALERS_EN_V3 36
Slide 37: Removing the Obturation Material
RETREATMENT AFTER AN INITIAL TREATMENT FAILURE REMOVING THE 3 MADE BY GUTTA PERCHA OBTURATION OBTURATION MATERIAL MicroMega REMOVER IF A NEW PROBLEM OCCURS AFTER A SUCCESSFUL TREATMENT (NEW DECAY, BROKEN CROWN, TOOTH FRACTURE…) IN CASE OF A NEW RESTORATION (TECHNICAL RETREATMENT) POWERPOINT_MM_REMOV
Slide 38: MicroMega REMOVER Technical Features & Benefits
MicroMega REMOVER TECHNICAL FEATURES & BENEFITS POWERPOINT_MM_REMOVER_DEALERS_EN_V3 38
Slide 39: Features & Benefits: Cross Section
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL ➢ Approved features ➢ Cross section: ✓ Improve debris removal(22) o Triple helix with open flute o Asymetrical in the coronal section Watch the video on the following slide… POWERPOINT_MM_REMOVER_DEALERS_EN_V3 39
Slide 40: Features & Benefits (video)
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL POWERPOINT_MM_REMOVER_DEALERS_EN_V3 40 Dr. BALTHAZARD & Dr. VINCENT
Slide 41: Features & Benefits: Non-active Tip
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL ➢ Approved features ➢ Non-active tip ✓ Decreased the risk of ledges(22) ✓ Safe endo file(22) ✓ Respect the anatomy(22) ° ✓ Cutting efficiency thanks to active edges(22) POWERPOINT_MM_REMOVER_DEALERS_EN_V3 41
Slide 42: Features & Benefits: Heat Treatment
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL ➢ Gaining efficiency without compromising safety ➢ Heat treatment ✓ Flexibility(23) ✓ Cyclic fatigue resistance(23) ✓ Respect the original anatomy(22) POWERPOINT_MM_REMOVER_DEALERS_EN_V3 42
Slide 43: Features & Benefits: 1 mm Diameter Wire
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL ➢ Minimally invasive approach to keep the tooth integrity Ø1mm ➢ 1 mm diameter wire ✓ Flexibility ✓ Preservation of the dentine(24) ✓ Protection of the peri-cervical area (24) ✓ Formation of micro-cracks reduced (
Slide 44: Features & Benefits: Size 30
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL ➢ Unique features specially adapted for removing the obturation material ➢ 30 .07 ✓ Improve cleaning while increasing the shaping size (compared to a 25.04 standard preparation) Please see the figure on the follow
Slide 45: Features & Benefits
INSTRUMENT MicroMega REMOVER INSTRUMENT 25 .04 30 .07 L19 25 .06 FEATURES & BENEFITS POWERPOINT_MM_REMOVER_DEALERS_EN_V3 45
Slide 46: Features & Benefits: Taper .07
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL ➢ Unique features specially adapted for removing the obturation material ➢ Taper .07 ✓ This taper increases friction, consequently the heating process that plasticizes the GP, creating small beads as well as remov
Slide 47: Features & Benefits (video)
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL 47 Dr. MALLET POWERPOINT_MM_REMOVER_DEALERS_EN_V3
Slide 48: Features & Benefits: Single File, Single Use
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL ➢ Gaining efficiency without compromising safety ➢ Single file ✓ Just ONE file to perform the removal the ➢ Single use gutta-percha ➢ 1 patient ✓ Time-saving ➢ 3 canals ✓ Safety optimization (reduces cross- contam
Slide 49: Features & Benefits: No Use of Solvent
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL ➢ NO USE of solvant ✓ Friction and heating will allow to remove GP in one piece(19)(20) ✓ Solvant on GP would not dissolve it but soften it into a solvo-percha mass, difficult to remove as sticked and stuck into t
Slide 50: Features & Benefits (video)
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL 50 Dr. MALLET POWERPOINT_MM_REMOVER_DEALERS_EN_V3
Slide 51: Features & Benefits: Length and Protocol
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL ➢ Unique features specially adapted for removing the obturation MicroMega REMOVER Ø0,30 material INSTRUMENT 25.06 Ø0,43 ➢ L19 or 23mm MicroMega REMOVER INSTRUMENT 30 .07 L19 25 .06 📖 Protocol WL*-3mm ✓ Keeps the…
Slide 52: Features & Benefits: Application Settings
FEATURES & BENEFITS MicroMega REMOVER: JUST ONE FILE TO REMOVE THE OBTURATION MATERIAL ➢ Application - Settings 📖 Continuous rotation 📖 Speed 400-800 rpm (highest efficiency achieved with a speed between 600-800 rpm)(22) 📖 Recommended torque: 2.5 N.cm POWERPOINT_MM_REMOVER_DEALERS_EN_V3 52
Slide 53: MicroMega REMOVER Application
MicroMega REMOVER APPLICATION POWERPOINT_MM_REMOVER_DEALERS_EN_V3 53
Slide 54: Overall Protocol
MicroMega REMOVER APPLICATION OVERALL PROTOCOL Access to the canal One Flare Any orifice opener entrances Removing the filling MicroMega MicroMega material REMOVER REMOVER MicroMega 2Shape Re-Shaping Any shaping method MicroMega One Curve POWERPOINT_MM_REMOVER_DEALERS_EN_V3 54
Slide 55: Protocol
MicroMega REMOVER MicroMega APPLICATION Irrigation Irrigation PROTOCOL MicroMega REMOVER MicroMega SHAPING FILES WL*-3mm Area with obturation 3 canals Single use * Working Length POWERPOINT_MM_REMOVER_DEALERS_EN_V3 55
Slide 56: Retreatment Procedure: REMOVER & 2Shape
MicroMega REMOVER APPLICATION MicroMega Irrigatio Irrigatio Irrigatio n n n RETREATMENT PROCEDURE MicroMega REMOVER & 2Shape WL*-3mm Area with obturation 3 canals Single use The choice of the shaping instruments to be used after MicroMega REMOVER is subject to the practitioner’s own decision, depend
Slide 57: Retreatment Procedure: REMOVER & One Curve
MicroMega REMOVER APPLICATION MicroMega Irrigatio Irrigatio n n RETREATMENT PROCEDURE MicroMega REMOVER & One Curve WL*-3mm Area with obturation 3 canals Single use The choice of the shaping instruments to be used after MicroMega REMOVER is subject to the practitioner’s own decision, depending on th
Slide 58: Settings
MicroMega REMOVER APPLICATION SETTINGS Continuous rotation Speed 400-800 rpm Maximum recommended torque: 2.5 N.cm Compatible with any endo-motor in continuous rotation POWERPOINT_MM_REMOVER_DEALERS_EN_V3 58
Slide 59: Situation and Bonus
MicroMega REMOVER APPLICATION SITUATION AND BONUS Gutta percha Only for gutta percha obturation material (+sealer) Most of retreatments Target: Endo-specialists & general practitioners POWERPOINT_MM_REMOVER_DEALERS_EN_V3 59
Slide 60: MicroMega REMOVER Price
MicroMega REMOVER APPLICATION MicroMega REMOVER PRICE Recommended retail price 52.5€ blister of 5References Designation B5 MICROMEGA REMOVER L19 N30 7% 20952301 Suitable price to enter the market CLASSICS B5 MICROMEGA REMOVER L23 N30 7% Less expensive than competition 20952311 CLASSICS POWERPOINT_MM
Slide 61: The Essential Piece of Your Retreatment
MicroMega REMOVER TH E ESSEN TIAL PIEC E O F Y O U R R ETR EATMENT POWERPOINT_MM_REMOVER_DEALERS_EN_V3 61
Slide 62: MicroMega REMOVER Regulatory Information
MicroMega REMOVER Year of CE marking: 2019 - medical device class IIa according to Directive 93/42/EEC - notified body: GMED (CE0459) Medical device for dental care, meant for professional dental use only. See product labelling and instructions for use. Legal manufacturer: Micro-Mega SA 12, rue du t
Slide 63: References
REFERENCES M icroMega R E MOV ER POWERPOINT_MM_REMOVER_DEALERS_EN_V3 63
Slide 64: References
REFERENCES POWERPOINT_MM_REMOVER_DEALERS_EN_V3 64
Slide 65: References
REFERENCES POWERPOINT_MM_REMOVER_DEALERS_EN_V3 65
Slide 66: References
REFERENCES POWERPOINT_MM_REMOVER_DEALERS_EN_V3 66
Slide 67: References
REFERENCES POWERPOINT_MM_REMOVER_DEALERS_EN_V3 67
Slide 68: References
REFERENCES (19) Betti L. V. & Bramante C. M. (2001). Quantec SC rotary instruments versus hand files for gutta-percha removal in root canal retreatment. International Endodontic Journal, 34, 514-519. (20) Bramante C.M., Siquira fidelis N., Santos assumpçao T., Bernardineli N., Brandao garcia R., Sil