DT Pakistan No. 1, 2019

News / Interview / Clinical Implantology / News

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PUBLISHED IN PAKISTAN

www.dental-tribune.com.pk

Dr Arif Alvi

Page 4

Immediate implantation
with CAD/CAM and
functional ...

Fast, functional
aesthetic solution
for anterior ...

An exlusive
interview with

INTERVIEW

JANUARY, 2019 - Issue No. 01 Vol.6

CONVOCATION

Page 6

CLINICAL IMPLANTOLOGY

Page 8

Hamdan Bin Rashid
inaugurates Dubai Dental
Hospital at Arab Health 2019
DT Pakistan Correspondent

D

UBAI- H.H. Sheikh
Hamdan bin Rashid
Al Maktoum,
Deputy Ruler of Dubai,
Minister of Finance and
President of the Dubai Health
Authority, inaugurated the
Dubai Dental Hospital, the
first and largest dental
hospital in Dubai, on the
opening day of Arab Health.
The hospital, which started
out as Dubai Dental Clinic in
2008, has increased its
capacity by 125 percent with
eight specialties under one
roof with a fully-equipped
dental lab, post-surgery
rooms, and an in-house
sterilisation department.
Accredited by Joint

Commission International, the
Dubai Dental Hospital is
equipped with state-of-the-art
technologies, the hospital has
its own imaging department
with 3D radiology, Computeraided Design/Computer-aided
Manufacturing, CAD/CAM,
an Intra Oral Scanner and a
dental laboratory and digital
teeth scanning.
The revamped hospital
includes 63 dental chairs,
m a k i n g i t t h e l a rg e s t
specialised dental facility in
Dubai. With more than 100
qualified healthcare
professionals, it strives to
provide greater access to
specialised oral treatment for
patients of all ages, meeting
the growing demand for

dental care in the region.
"As an urban healthcare
landmark and the largest
healthcare free zone in the
world, the Dubai Healthcare
City is committed to
advancing healthcare in the
UAE and the wider region.
The launch of the Dubai
Dental Hospital is the latest
initiative that reinforces our
commitment and dedication
in helping to drive and build
world-class healthcare
facilities," Dr Amer Al
Zarooni, CEO, Dubai
Healthcare City Medical.
Under the direction of a
highly-skilled team of oral
healthcare professionals, the
hospital will continue to
deliver patient-specific

Tenure of members
cut to three years:
PMDC ordinance
DT Pakistan Report

I

SLAMABAD - In a
first, the federal
government has decided
to revise the tenures of
members of the country's top
medical education regulator
apart from ending the
representation of elected
lawmakers on the board's
table. This is contained in the
new Pakistan Medical and
Dental Council (PMDC)
Ordinance 2019 which was
approved by President Arif
Alvi recently. According to
the ordinance documents, the
federal government has

reduced the tenure of the
council's members from four
years to just three years.
The membership of federal
and provincial health
ministers, federal secretaries
including senate and national
assembly members, has also
been withdrawn, making the
council free of political
interference.
According to the ordinance,
the new council will now
comprise 17 members; of
these, three members will be
nominated by the prime
minister. These members
shall be prominent members
of civil society.

Image Photo: UrduPoint

healthcare in compliance with
international best practices.
The dental hospital provides
treatment across eight
specialist areas: general
dentistry, dental hygiene,
paediatric dentistry, cosmetic
dentistry, oral surgery,
orthodontics, prosthodontics,
endodontics periodontal
treatment and dental
implantology.
"This day is the culmination
of the hard work and efforts
of everyone at DDH and is a
testament to their
commitment that we can
mark this milestone in our
mission to provide greater
(Image: DT Pakistan)

access to specialised oral
treatment for patients of all
ages, meeting the growing
demand for dental care in the
region," said Dr Khawla
Belhoul, Director, Dubai
Dental Hospital.
In addition to providing
patients unrivalled access to
specialist treatment and
expert advice, the hospital is
the clinical partner of the
Mohammed Bin Rashid
University of Medicine and
Health Sciences, providing
clinical training for the
university's Hamdan Bin
Mohammed College of
Dental Medicine residents.

FMH College
of Dentistry bags
top positions
DT Pakistan Report

Other members of the
council will include a
professor and an associate
professor from each public
medical college as per their
rank and experience. They
will be nominated by their
respective provincial
governments. Two members
of the council will be from
private medical colleges who
will be nominated by the
prime minister. Moreover,
there will be two members
from the clinical faculty of
dental colleges who will be
taken from the four provinces

on a rotation basis. In this
regard, one of these members
will be chosen from either
Punjab or KhyberPakhtunkhwa while the
second member will be
nominated from either Sindh
or Balochistan. Another
member of the council will
be nominated by the surgeon
general of the armed forces
medical services group. The
president of the College of
Physicians and Surgeons of
Pakistan (FCPS) will
nominate one member.
Continued on Page 14

L

AHORE - FMH
College of Dentistry
has achieved first
position among all dental
colleges in Punjab. The
students achieved outstanding
distinctions by bagging first
three positions in the First
Professional BDS Annual
Examination held in
November/December 2018
by the University of Health
Sciences. Names of position
holders are; 1st Position - Mr.
Hassaan Hafeez Sheikh and
M s . I r h a Wa j a h a t , 2 n d
Position - Ms. Neha Feyyaz,
and Ms. Zarish Iqbal, 3rd
Position - Mr. Muhammad
HamizAftab.

[2] => Dt pages.FH10

NEWS

2 DENTAL TRIBUNE Pakistan Edition January 2019

PM Khan stresses over
accessible quality healthcare

Publisher/CEO
Syed Hashim A. Hasan
hashim@dental-tribune.com.pk
Editor Clinical Research
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DT Pakistan Report

I

SLAMABAD - Prime Minister
Imran Khan has asked the
concerned officials to spot the
bottlenecks related to administrative
and legislative matters in reforming
the health sector. He has stressed on
the need to remove those practices
that have resulted in the decay of
health services and have hindered the
provision of quality healthcare to the
ordinary people.
The PM recently chaired a briefing
on health reforms being undertaken
in Islamabad Capital Territory, Punjab
and KP, at the Prime Minister Office
(PMO). He highlighted the
significance of state-of-the-art
laboratories and a comprehensive
mechanism to check for, food
contamination leading to stunted
growth and other health hazards, in
coordination with the concerned
authorities at the federal and
provincial levels.
The meeting was informed
that Islamabad Public Health
Management Authority is being

established according to the
recommendation of Task Force on
Health. The PM observed that health
management has remained a
neglected area in the country, and
said that there was a need to ensure
e ff e c t i v e a n d r o b u s t h e a l t h
management mechanism across the
country and to ensure access to
quality healthcare for citizens.
Federal Minister for Health Aamir
Mehmood Kiani, Adviser to Prime
Minister Muhammad Shahzad Arbab,
Minister for Health Punjab Dr Yasmin
Rashid, Minister for Health KP Dr
Hisham Inamullah Khan, federal &
provincial secretaries from health
department, and other senior
government officials were present
during the meeting.
Federal Secretary Health briefed
the meeting on the National Action
Plan for NHSR&C (2019-23), and
Islamabad Capital Health Strategy
NHSR&C Strategic Plan in the
backdrop of abolition of CADD and
transferred health service delivery in
ICT area to Ministry of NHSR&C.

The main objective of the National
Action Plan is to identify strategic
areas and actions to overcome health
challenges through holistic initiatives
in health governance, financing,
access to essential package of health
services, expansion and capacity
building of human resources for
health, quality of health, adherence
to international health regulations
and ensuring continuous research and
innovation in the healthcare.
For the last 55 years, the hospital
beds capacity in the ICT hospitals
had remained stagnant at 2000 beds
only; under the new Capital Health
Strategy, this capacity is being
doubled to 4000 beds in a span of
five years in the ICT area.
Moreover, a state-of-the-art Cancer
Hospital with 200 beds in ICT, a
General Hospital at Tarlai having 200
beds, three Mother Child Hospitals
with total 120 beds capacity at Bhara
Kahu, Rawat and Tarnol are being
established and upgraded while
refurbishment & upgradation of all
Continued on Page 15

KCD to offer FCPS training in periodontology
DT Pakistan Report

P

ESHAWAR - The Khyber College of Dentistry
has become the first public sector institute of the
country to offer offering training in Periodontology
after securing accreditation from the College of Physicians
and Surgeons Pakistan (CPSP) for FCPS part-II training.
The Periodontology Department of Khyber College
of Dentistry (KCD) has been fully accredited by the
CPSP for Fellow of College of Physicians and Surgeons
(FCPS) part II training. Associate Professor Dr Tariq
Ali Khan has been approved as a supervisor for training
in Periodontology.
The Periodontology Department was established in
KCD around 39 years ago. It has now been equipped Representational Image Photo: REUTERS
with lasers, microsurgical instruments and Cone-beam computed tomographic (CBCT) equipment.
This department provides basic periodontal treatments along with some advanced procedures such as implants,
periodontal plastic surgeries, gummy smile corrections and guided tissue regeneration.
In 2018, after a series of visits of the Pakistan Medical and Dental Council (PMDC) teams to the KCD medical
teaching institute (MTI), its seats were enhanced from 50 to 80.

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responsibility for the validity of product claims or
for typographical errors. The publisher also does
not assume responsibility for product names or
statements made by advertisers. Opinions expressed
by authors are their own and may not reflect of
Dental Tribune Pakistan.

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[3] => Dt pages.FH10

[4] => Dt pages.FH10

INTERVIEW

(Photograph: Arsalan A. Shaikh)

4 DENTAL TRIBUNE Pakistan Edition January 2019

An Exclusive Interview

I thought that I might have to change from
dentistry to some other profession: Dr Arif Alvi
By Syed Hashim Hasan
Dr Arif Alvi was recently interviewed
by Dental Tribune Pakistan, and the
excerpts of the exclusive talk with him
are as under:Syed Hashim Hasan: Let's begin with
a topic that is of interest to the masses,
which is that you have a bullet in your
arm. Why did you decide to keep it?
President Dr Arif Alvi: (laughs) I
didn't decide to keep it. I was injured
in the late 1960's- I think it was 1969.
It was a struggle for democracy against
Ayub Khan. I got shot, and was
transported to the hospital by a cyclist,
who took me to Mayo Hospital from
Mall Road. The doctors there were
more concerned about establishing
broken nerve contact and blood supply,
and therefore, they said that to fish
around for the bullet was not possible.
The damage was so severe that for
about 8 to 9 months I was not able to move
fingers. The motor neurons had not
recovered. Even today, the sensory supply
to two or three of my fingers is relatively
poor. For example, I am not able to count
pages or money. So that is a good point.
I still can't count money with my right
hand. All the bad things come into the left
hand to count. I think that was the reason
why the doctors at that time decided not
to probe for two bullets in the arm, and so
they are still there.
HH: So there are two and not one
bullet in your arm?
AA: Yes, one can be felt but the other
one.
HH: Dentistry is a skill where hands
play a pivotal role so how come it did
not affect your practice?
AA: No, it has not affected my practice.
My motor neuron situation recovered

in about a year. Back then, for about
four to five months I had thought that
I might have to change from dentistry
to some other profession. That was
during the final year of BDS, so it was
very disappointing.
HH: Belonging to a family of dental
surgeons, what exactly led you into
politics?
AA: Actually, I was always interested
in anti-corruption; I was always
interested in the history of Pakistan;
and I was always frustrated when I
looked at the deprived people of our
society. Then there was the fact that
my father was also a politician and a
dentist; he was dentist to Jawaharlal
Nehru. So because he was a politician,
there was good discussion in the family
about politics. The third reason was
that my mother was a very well-read
lady, and she exposed to me a variety
of reading material. In the college days,
on her recommendation and her
insistence, I used to read philosophy,
Marxian theories, and Maulana
Maududi and his Islamic Law and
constitution. This was all at the time
of my intermediate. As she persisted,
my interest in reading increased, and
it still continues. I must pray for her
forgiveness from Allah (SWT).
HH: So along the way what was the
role of your family and friends?
AA: In politics, the family was very
supportive. I think what I am today,
the family has a lot to do with that.
And it's not being said as a cliché. I
believe very strongly that without the
support of the family, I would not have
been where I am. For example, in the
management of my Alvi Dental
Hospital, my wife has played such a
big and tremendous role that I never
knew what was the income of the

hospital, who was being employed,
and all the other decisions that were
made. So I was free in my mind to look
at other things. The family's support is
tremendous.
HH: Was there ever a phase when
you thought you had hit rock bottom
in politics?
AA: Every time I lost an election
I felt that I'd hit rock bottom, but the
struggle continued. Every day I would
open a newspaper, my frustration
would increase, but the recovery was
fast as well. I needed to do something.
My frustration is still there. Every time
I read a newspaper, every day, the
frustration is still there. There are so
many things that have to be done, and
even being the President of Pakistan I
am unable to reach out everywhere and
do it. Therefore, this government has
been, and should be focusing on
systems, rather than reactions to
individual issues. Sometimes, I have
seen and I have disliked the fact- for
example, it appears in the media that
a certain poor man or a poor child was
seen on the streets and because the
pictures made it to the newspapers, the
Chief Minister of the province or the
Prime Minister solved that issue. I
believe that there should be an
institutional response. Maybe, those
who come in the newspapers are
probably 0.001%, and much more
people are there who need an
institutional response. So I think that
is where institutions are important.
HH: Being a very distinguished dentist
and an educationist and now the
President of Pakistan, what kind of
plans should be expected with your
insight about the system and its
loopholes?
AA: I am very sorry to state that I find

my own professional field lacking in
its organizational capabilities. I believe
that they should be dragging themselves
up and functioning better, because
unless the organizations and
associations of the profession think of
improvement in the profession, nothing
can happen. Dentistry as a profession
is not purely related to knowledge and
delivery, it is also related to an
organizational aspect, where, for
example, if you want to handle
quackery or prevention, you have to
look at these things in an organizational
manner. That is what associations are
for. Presently, I am disappointed in the
organizational aspect of dentistry in
Pakistan. Therefore, I feel limited in
my ability to lift them up. It has to
come from the profession, and only
then I can help.
HH: So the professionals need to come
in and suggest things?
AA: Of course, and not only suggest
things you know, the organizational
capabilities should increase. Dentistry
as a profession has a different role than
dentistry in education. Universities and
colleges are there, they impart
education. Dentistry as a profession
can then look at the education
standards. Maybe they can also suggest
to PMDC on how to improve. Dentistry
as an association can look at the aspect
of continuing education, rather than all
continuing education being in the realm
of the industry. Dentistry associations
can play a big part. As an association,
the biggest part that dentistry can play
is in prevention because, sure, the
colleges can teach prevention, but at
the level of society a professional goes
out and says that this is how you brush
your teeth, this is how you wash your
hands, for example, to avoid
Continued on Page 13

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CLINICAL IMPLANTOLOGY

6 DENTAL TRIBUNE Pakistan Edition January 2019

Fast, functional aesthetic solution for
anterior tooth trauma
By Dr. Martin Weber

C

EREC and oral surgery? In
times when patients go to a
practice to receive complete,
aesthetic, state-of-the-art treatment as
quickly as possible, I think they go
together very well. I did not always
think so. Certainly, CEREC was
always interesting; I have used it since
2003, but I did not always find the
results convincing. In 2014, I had a
closer look at an event in Salzburg,
Austria, and learnt two things: the
system had been further developed,
and in particular, the precision had
been improved considerably. It fits
well in my practice; I use it almost

Fig. 1: Single-tooth exposure of
tooth #21 after recurrent marginal
gingivitis. Owing to the initial
diagnosis of extensive resorption,
the tooth could not be preserved.

CAD, Ivoclar Vivadent; and Celtra
Duo, Dentsply Sirona) to treat my
patients. The possibility of using
implants in the premolar and molar
region with screw-retained all-ceramic
crowns is especially interesting.
Sintering or crystallisation in the
CEREC SpeedFire furnace is fast and
fits smoothly into the workflow.
The advantage for my practice,
where I also employ two other dentists,
is obvious. We produce laboratory
tasks right in the practice and have the
entire workflow under control, and our
patients are satisfied. They are still
really impressed by the technology
today. They are treated immediately,

Fig. 2: Single-tooth exposure of tooth #21 after recurrent
marginal gingivitis. Owing to the initial diagnosis of
extensive resorption, the tooth could not be preserved.

Fig. 5: The prosthetic proposal was also used as the basic file
for producing the surgical guide with the gap at position #21.

Fig. 9: Preparing the implant bed according
to the recommended drill sequence, insertion
of the implant using the SICAT surgical guide.

every day because I have many patients
who have busy jobs and do not have
much time. I experience a great
workflow in the practice that gives me
maximum flexibility. Depending on
the indication and the patients wishes,
I can decide whether to make the
restoration myself or outsource it to a
laboratory, which I often do for more
elaborate bridges. Then, I send the
scan directly to my partner laboratory
via Sirona Connectthat is very
reliable.
I mainly use conventional ceramic
materials (VITA ENAMIC, VITA
Zahnfabrik; CEREC Blocs C PC,
Dentsply Sirona; IPS e-max and Telio

Fig. 3: The initial situation in 3-D in the Sidexis 4 imaging
software (Dentsply Sirona) showed good apical bone substance
with the possibility of immediate implantation.

Fig. 6: The intraoral CEREC scan superimposed
over 3-D image data for optimal positioning of the
implant in the Galileos Implant planning software.

Fig. 10: Intra-op CEREC scanning
with a ScanPost.

posttraumatic resorption of the root,
and the tooth could therefore not be
preserved (Figs. 1 & 2). The tooth was
to be replaced by an implant with an
all-ceramic crown immediately after
extraction. To plan the procedure, a 3D radiograph (Orthophos XG 3D,
Dentsply Sirona) was taken. It was
important to assess the available
horizontal and vertical bone and
evaluate apical osteolytic processes
after the failure of endodontic treatment
and in the region of the crestal bone
due to progressive dentinal resorption.
The integrity of the vestibular lamina
was preserved, and there was sufficient
apical bone to allow immediate

have no problems thanks to the precise
fit, and feel like they are involved
because they can watch us create the
design and view the planning process
live in CEREC. And yes, patients do
talk about that with their friends and
family. This case study shows how the
digital processes, including implant
planning, with CEREC work.
Treatment of an anterior tooth trauma
with an immediate implant
The female patient, born in 1989,
came to my practice with problems at
tooth #21 caused by a childhood
trauma. The gingival margins were
reddened and bled when probed. The
intraoral radiograph showed

Fig. 4: Tooth #21 was deleted in CEREC to simulate
the initial post-op situation.

Fig. 7: Gentle extraction preserving the
vestibular lamina.

Fig. 11: Augmentation of the
vestibular alveolus.

When extracting tooth #21, it was
important to preserve the vestibular
lamina to allow immediate
implantation. For this reason, the
Sharpeys fibres were carefully severed
with a periotome, and the tooth was
gently removed (Fig. 7). The tooth had
pronounced dentinal resorption,
confirming the previously made
diagnosis (Fig. 8). The SiroLaser Blue
(Dentsply Sirona) with a wavelength
of 970 nm was used to disinfect the
alveolus. An OsseoSpeed EV 4.815
mm implant (Astra Tech Implant
System, Dentsply Sirona) was inserted
immediately using a surgical guide
(SICAT OPTIGUIDE, SICAT; Fig. 9).

Fig. 8: The resorption of tooth #21, external view.
This confirmed the accuracy of the diagnosis from
the imaging procedure.

Fig. 12: The screw-retained
crown as a finished polished
temporary.

implantation with immediate loading
(Fig. 3).
After scanning the upper jaw, tooth
#21 was deleted in CEREC to simulate
the initial postoperative situation. The
prosthetic proposal for tooth #21 was
used to optimise implant planning and
to produce the surgical guide (Figs. 4
& 5). In the implant planning software
(Galileos Implant, Dentsply Sirona),
the prosthetic proposal was
superimposed over the CBCT data for
the optimal positioning of the implant.
In this way, sufficient vestibular
distance was ensured, and the correct
size of the implant for optimal primary
stability could be selected (Fig. 6).

Fig. 13: Sealing the screw channel
with composite.

At > 35 Ncm, sufficient primary
stability was achieved.
After the intraoperative scan with a
ScanPost (Dentsply Sirona) to
complete the temporary restoration,
the vestibular alveolus was filled with
a bone substitute material (Figs. 10 &
11).
Designing the temporary screwretained crown included processing
the composite crown (Telio CAD)
produced with CEREC and extraorally
attaching the TiBase (Telio CAD,
Ivoclar Vivadent on Dentsply Sirona
TiBase). The crown was screwed in
situ, and the screw channel was sealed
Continued on Page 10

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8 DENTAL TRIBUNE Pakistan Edition January 2019

CLINICAL IMPLANTOLOGY

Immediate implantation with CAD/CAM and
functional restoration in the aesthetic zone
By Dr. Martin Weber

he aesthetics are always a
significant challenge during
implant restoration, especially
in the aesthetic zone, in addition to the
full consideration required regarding
function. In this article, we present a
case of multiple tooth fractures due to
trauma. After tooth extraction,
immediate implantation and guided
bone regeneration (GBR) were
performed. During the prosthetic
procedure, the design and transfer of
the emergence profile of the soft tissue,
functional design and occlusal
adjustment, as well as the CAD/CAM
process, were satisfactorily realised to
achieve the aesthetic and functional goals.
Case report
Dental history
A 40-year-old female patient had
sustained trauma to her anterior teeth
caused by accidental syncope three
weeks before. The clinical examination
found that tooth #11 had been luxated;
the crowns of teeth #12 and 21 had
fractured, with the residual margin
extending 35 mm below the gingiva
and the teeth affected by Grade III
mobility; and the crown of tooth #22
had fractured, with the residual margin
at gingival level. There were no
obvious abnormalities in the remaining
teeth (Figs. 14). After excluding major
systemic diseases, it was decided that
she required fixed implant restoration
with high demands regarding aesthetics
and function.

Fig. 1: Pre-op frontal view of the
anterior teeth.

Treatment procedure
Teeth #12, 21 and 22 were extracted.
To o t h # 11 u n d e r w e n t e a r l y
implantation and tooth #22 immediate
implantation with GBR (Figs. 5 & 6).
After three months of healing,
osseointegration had taken place. An
implant level impression was taken
for fabricating a provisional bridge
supported by temporary abutments
for teeth #1222. The technician
modified the shape of the artificial
gingiva on the model in order to form
the proper gingival curve and
emergence profile, then finished the
provisional bridge, while the dentist
modified the gingival shape using an
olive-shaped bur intraorally (Figs.
718).
The aesthetic and functional
outcomes of the provisional restoration
were checked. The tip of tooth #13
was too low to achieve a good smile
line. When checking the intercuspal
position (ICP) and lateral excursion
using 80 µm occluding paper, tooth
#13 was found to be out of contact.
After reshaping the labial contour and
filling the lingual surface with resin,
tooth #13 had good contact and
guidance during ICP and lateral
excursion (Figs. 1923).
Once the aesthetic and functional
outcomes had been confirmed, the
anterior guidance of the provisional
restoration was recorded on an
articulator (Artex, Amann Girrbach)
and its individual incisal guide table

Fig. 2: Pre-op occlusal view of the
anterior teeth.

Fig. 3: Pre-op panoramic radiograph.

(Figs. 2427). Next, the emergence
profile of the provisional restoration
was transferred and the cast model
was made and mounted on the
articulator (Figs. 2833).
The cast model was scanned step
by step to obtain a digital model and
this was integrated with a virtual
articulator. The anterior guidance of
the virtual articulator was set
according to the data from the
provisional restoration. Next, the
design was completed on computer
and the titanium-based zirconia
abutment and fixed zirconia bridge
produced via CAM. After staining and
glazing, the final restoration was
completed (Figs. 3441). The final
restoration demonstrated a good
outcome, both aesthetically and
functionally (Figs. 4250).
Discussion
This patient came to the clinic just
after the trauma, and according to the
intraoral condition, immediate
implantation could have been carried
out. However, owing to the
unexplained accidental syncope,
diseases of the central neural system
were to be excluded first, so delayed
dental treatment was suggested.
Three weeks later, after a general
physical check-up, implantation was
begun. Usually, operation within 48
hours after tooth extraction is
considered as immediate implantation,
while operation within the first six
weeks after tooth extraction is

Fig. 4: Pre-op CT analysis.

Fig. 7: Frontal view of the anterior teeth
three months post-op.

Fig. 8: Occlusal view of the anterior
teeth three months post-op.

Fig. 9: Patient smiling three months
post-op.

Fig. 10: The overjet and overbite between the
implants and the mandibular anterior teeth.

Fig. 13: Reshaping of the artificial gingival contour on
the model in order to obtain a good gingival aesthetic
effect (performed by dental technician Samuel Chou).

Fig. 14: Provisional restoration
on the model.

Fig. 15: Insertion of provisional
abutments.

Fig. 16: Modification of the gingival
contour under the pontic.

Fig. 19: The patient smiling with
the provisional restoration in situ.

Fig. 20: The patient smiling after adjustment Fig. 21: Frontal view of the anterior teeth after
adjustment of the labial contour of tooth #13.
of the labial contour of tooth #13.

Fig. 22: ICP contact on tooth #13 after
reshaping of the lingual surface with resin
(12 µm occluding paper, red).

considered as early implantation.
Therefore, in this case, implant #11
was early implantation and implant
#22 immediate implantation. The
preoperative CT analysis showed that
the labial side of the alveolar ridge of
teeth #12, 11 and 22 was deficient;
thus, GBR was needed in order to
obtain sufficient bone quantity.
After three months of healing, both
hard and soft tissue around the
implants had been well maintained,
providing a sufficient foundation for
the maxillary restoration. In order to
form a good gingival shape, either the
provisional restoration can be adjusted
step by step or the shape of the soft
tissue can be designed first, the
provisional restoration manufactured
to meet the aesthetic demand directly,
then the soft tissue intraorally adjusted
and reshaped.
In this case, we followed the second
option. After using an olive-shaped
bur to adjust the form of the gingiva
under the pontic, making it match the
provisional restoration, which had
already been well designed and
manufactured, a perfect soft-tissue
outcome was achieved.
By means of regular methods to
transfer the emergence profile, it was
copied to the final restoration, which
is the foundation for the good softtissue effect of the final prosthesis.
It was also very important to obtain
the proper anterior guidance during
Continued on Page 14

Fig. 5: Frontal view of the anterior
teeth immediately post-op.

Fig. 6: Occlusal view of the anterior
teeth immediately post-op.

Fig. 11: The emergence profile three
months post-op.

Fig. 12: Two impression copings connected
for the implant level impression.

Fig. 17: Finishing of the
reshaping of the gingiva.

Fig. 18: Frontal view of the provisional
restoration just after delivery.

Fig. 23: Lateral guidance on tooth #13 after
reshaping of the lingual surface with resin
(12 µm occluding paper, red).

Fig. 24: Facebow transfer of the
provisional restoration.

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NEWS

January 2019 Pakistan Edition DENTAL TRIBUNE 9

Nanodiamonds might
aid recovery from
root canal treatment

OS ANGELES, U.S.California-based
researchers have
recently been working on a
tiny, but powerful ally that
could help prevent infection
after root canal treatment. In
a clinical trial it was found
that nanodiamonds protected
disinfected root canals after
the nerve and pulp were
removed, thereby improving
the likelihood of a full
recovery. The findings are
considered a milestone for the
use of nanodiamonds in
humans.
Nanodiamonds are particles
made of carbon and are so
small that millions of them
could fit on the head of a pin.
The particles resemble soccer
balls, but have faceted

surfaces-similar to actual
diamonds-that enable the
particles to deliver a wide
range of drugs and imaging
agents.
"Harnessing the unique
properties of nanodiamonds
in the clinic may help
scientists, doctors and dentists
overcome key challenges that
confront several areas of
health care, including
improving lesion healing in
oral health," said Dr. Dean Ho,
professor of oral biology at
the UCLA School of Dentistry
and co-corresponding author
of the study.
The researchers tested
nanodiamond-embedded gutta
percha (NDGP) in three
patients who were undergoing
root canal procedures. Tests

In a clinical trial, a UCLA-led team used biomaterials embedded with nanodiamonds
tiny gems to help tissue heal. (Image: designleo/Shutterstock)
of the implanted material
confirmed that the NDGP was
more resistant to buckling and
breaking than conventional
gutta percha. All three patients
healed properly, without any
unusual pain and without
infection.
"This trial confirms the

immense promise of using
nanodiamonds to overcome
barriers for a range of
procedures, from particularly
challenging endodontics cases
to orthopedics, tissue
engineering, and others," said
Prof. Mo Kang, co-author and
endodontics professor at

ADA releases statement regarding
research on opioid prescriptions

EW YORK, U.S. Recent papers on
opioids and their use
within the dental industry have
drawn increased attention. In
response to research related to
opioid prescriptions for some
dental procedures, the
American Dental Association
(ADA) has recently released a
statement clarifying their
position on the broader issue.
In the statement, the ADA
said: "In order to combat opioid
abuse among adolescents, and
across all ages, the ADA has
urged all 161,000 member
dentists to double down on their
efforts to prevent opioids from
harming patients and their
families."
According to the ADA, the
growing body of research
supports their policy that
dentists should prescribe nonsteroidal anti-inflammatory
drugs (NSAIDs) alone or in
combination
with
acetaminophen over opioids as
first-line therapy. Stating that
the ADA is "dedicated to raising
awareness and taking action on
the opioid public health crisis."
In March 2018, the ADA
adopted a policy related to
opioid prescription by dentists
for acute pain. The policy
supports mandatory continuing

UCLA.
The study, titled "Clinical
validation of a nanodiamondembedded thermoplastic
biomaterial," was published
in Proceedings of the National
Academy of Sciences on Oct.
23, 2018 ahead of print.
- Dental Tribune International

German report shows the
frequency of dental
check-ups has increased

ERLIN, GERMANY - In a new study,
researchers from the Robert Koch Institut (RKI)
have examined, among other subjects, the
prevalence, determinants and trends of tooth brushing
frequency and utilisation of dental check-ups in children
and adolescents in Germany. The reports are based on

Instead of prescribing opioids, the American Dental Association
believes that dentists should consider non-steroidal antiinflammatory drugs as the first-line of therapy for acute pain
management. (Photograph: KieferPix/Shutterstock)
education regarding the
prescription of opioids and
other controlled substances,
imposes statutory limits on
opioid dosage and a duration
of no more than seven days for
the treatment of acute pain. The
guidelines are consistent with
the Centers for Disease Control
and Prevention's evidencebased guidelines and requires
dentists to register with and use
Prescription Drug Monitoring
Programs to promote the
appropriate use of opioids to
deter misuse and abuse.
In further support of the
ADA's position, in April
researchers from the ADA
Science Institute, Case Western
Reserve University and the

University of Pittsburgh
published a scientific review of
studies in the Journal of the
American Dental Association.
The study concluded that
NSAIDs alone or in
combination
with
acetaminophen are generally
more effective and are
associated with fewer side
effects than opioids.
"Working together with
physicians, pharmacies,
policymakers and the public,
the ADA believes it is possible
to end this tragic and
preventable public health crisis
that has been devastating our
families and communities," the
statement concluded. - Dental
Tr i b u n e I n t e r n a t i o n a l .

In a recent study, researchers in Germany have
found, since a previous 2003-2006 report, the
frequency of dental check-ups has increased.
(Photograph: Pressmaster/Shutterstock)
the data collected from the second wave of the German
Health Interview and Examination Survey for Children
and Adolescents (KiGGS Wave 2, 2014-2017).
According to the study, around 80 per cent of children
and adolescents meet the recommended tooth brushing
frequency and dental check-ups. However, around onefifth of children and adolescents do not, with 14- to 17year-old adolescents, as well as those with low socioeconomic status and or migrant backgrounds being
particularly at risk.
Additionally, the results also showed that the utilisation
of dental check-ups has increased compared to the
Continued on Page 14

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NEWS

10 DENTAL TRIBUNE Pakistan Edition January 2019

Dental hygiene may be
key for lupus

KLAHOMA CITY, U.S. - Good oral
hygiene can obviate many diseases,
including gingivitis, diabetes and
hypotension. Now, new research suggests it may
also make a difference in the prevention and
management of lupus. In the study, the scientists
focused on bacteria commonly found in the mouth
that have previously been associated with gum
disease.
Oklahoma Medical Research Foundation scientists,
Drs. Umesh Deshmukh and Harini Bagavant have
found a link between gum disease and lupus, an
auto-immune disease that affects an estimated 1.5
million Americans.
"Our findings suggest a simple message, if there
is good dental care, patients have a good chance
of experiencing less severe disease," said Bagavant.
"With further research, we might be able to tell if
proper oral health has the potential to help prevent
these diseases altogether."
She added: "Our study shows that patients who
might have been exposed to gum disease-causing
bacteria show higher lupus activity. Therefore, we

Fast, functional aesthetic ...
Continued from page 8

with composite (Figs. 12 & 13).
The situation after the temporary
restoration (Fig. 14) was aesthetic and
free of inflammation. The temporary
was positioned 0.5 mm short of
occlusion. The patient came for a
follow-up after one week. At this visit,
we used the soft laser (SiroLaser Blue,
wavelength of 660 nm) to activate
wound healing (Fig. 15).
Four months after this treatment, the
patient came to the practice for the
final restoration. We had previously
sent the scan to the partner laboratory
via the Sirona Connect portal. There,
the abutment was designed with the
inLab software (Dentsply Sirona),
milled and attached with a titanium
base.
The temporary was then removed,
and the abutment was inserted using a
transfer key. The vestibular contour
was completely preserved (Figs. 16 &
17). After sealing the screw channel
with a PTFE strip, an all-ceramic,
custom-veneered crown was inserted
for a perfect aesthetic outcome
of the anterior tooth (Fig. 18).
Coordinated system supports the
workflow
For this case, I used the digital
workflow from Dentsply Sirona. After
having tested different systems, it
proved to be especially efficient and
easy. The individual steps, from
imaging and diagnosis using the scan,
ordering the surgical guide and
planning surgery up to producing the
temporary restoration and the final
prosthesis, are very well coordinated.
The interface to SICAT is included in
the planning software and enables oneclick ordering. Even if I do not use a
surgical guide for every implantation,

expect that a
seemingly small
change, like
brushing and
flossing regularly,
could benefit
patients who are
already on a host
of powerful
Oklahoma Medical Research Foundation husband-and-wife research team Drs.
medications by
Umesh Deshmukh (left) and Harini Bagavant have found a link between dental
allowing them to
m o d i f y t h e i r hygiene and auto-immune diseases, such as lupus. (Photograph: Oklahoma Medical
Research Foundation)
treatment with
fewer drugs or
"Taking care of your teeth now could help you
less powerful dosages."
Deshmukh said the new findings provide a strong avoid Type 1 diabetes, cardiovascular disease and
rationale for improving dental care in lupus patients rheumatoid arthritis, among others."
as an addition to traditional therapy. The research
The study, titled "Antibodies to periodontogenic
could also lead to new methods of early disease bacteria are associated with higher disease activity
detection.
in lupus patients," was published in a Clinical and
He emphasized that the findings could also have Experimental Rheumatology epub edition ahead
implications beyond lupus. "Poor oral health can of print on June 25, 2018. - Dental Tribune
contribute to a number of diseases," said Deshmukh. International

I find it to be very useful depending
on the indication.
I also use laser in my practice
depending on the indication. In the case
of this patient, there was an
inflammatory process at the tooth
(granuloma). With the laser, I can
achieve thorough disinfection of the
alveolus and also activate wound
healing.
I found that the CEREC Software
4.5.2 has brought another major
advance in the accuracy of fit compared
with the preceding versions. In addition,
it is fast and reliable. The optimised
processes proved to be especially
advantageous for implants, as in this
case. I particularly appreciate the option
of implementing screw-retained
solutions with CEREC. In my practice,
I place more than 100 implants a year
with CEREC I generally use screwretained crowns. They considerably
reduce the risk of peri-implantitis owing
to the absence of cement.
For implants in the anterior tooth
region, I produce long-term temporaries
with CEREC. They have the significant
advantage in that they do not look like
temporaries, do not feel like
temporaries to patients, and thus ensure
better quality of life. The patients are
also convinced of this. The follow-up
radiograph (Fig. 19) before the final
restoration with a custom-veneered
ceramic crown showed good
osseointegration of the implant. The
gingivae were externally completely
free of inflammation.
Discussion
Given the great aesthetic demands
and the need for rapid results, thorough
consideration must be given to the
options available for treating anterior
teeth. In my view, conservation by
means of conventional techniques was

Fig. 14: Situation immediately after
insertion of the crown.

Fig. 15: Situation after one week: activation of wound
healing with a soft laser of 660 nm.

Fig. 16: Inserting the abutment with
the transfer key.

Fig. 17: Complete preservation
of the vestibular contour.

Fig. 19: Ideal
osseointegration
four months
post-op.

Fig. 18: Final image immediately after inserting
the crown with an ideal red-white aesthetic.

not possible in this case owing to the
comprehensive and advanced internal
resorption of tooth #21 due to previous
trauma. Upon extracting this tooth, it
was particularly evident that it was not
worthy of conservation (Fig. 8). The
young age of the female patient and
the integrity of the adjacent teeth meant
that a bridge was ruled out as an
alternative. In light of the favourable
anatomical situation with fully
conserved vestibular bone lamella,
immediate implantation was the
optimal treatment option for improved

conservation of the bundle bone and,
along with it, the hard and soft tissue.
The fixed provisional crown supported
the soft tissue, was aesthetically
pleasing and offered the patient a highly
satisfactory solution. Moreover, the
digital workflow offered the patient
additional comfort (impression without
a tray).
Editorial note: A list of references is
available from the publisher. This article
was published in CAD/CAM international
magazine of digital dentistry No. 03/2018.

- Dental Tribune International

[11] => Dt pages.FH10

[12] => Dt pages.FH10

NEWS

12 DENTAL TRIBUNE Pakistan Edition January 2019

Study of medieval plaque shows
how oral microbiomes have changed

Osteology Foundation: Hand
in abstracts by mid-January

OPENHAGEN,
DENMARK - A
number of recent
studies have shown that
dental calculus from
archaeological samples could
be a rich source for better
understanding the dental
health of our ancestors.
Similarly, a new study of the
calculus of remains buried in
a Danish cemetery has shed
light on the oral microbiomes
of certain groups of medieval
humans in the area.
A team from the University
of Copenhagen led the study
and sampled calculus from
the remains of 21 humans
buried circa 1100-1450 CE
in the medieval cemetery of
the village Tjærby, Denmark.
A total of 3,671 proteins from
220 different protein groups
were identified from the
calculus, with approximately
85 to 95 per cent produced
by bacteria from the oral
microbiome.
Although all of the studied
samples showed traces of
bacteria associated with
periodontal disease and dental
caries, the team was able to
divide the samples into two
groups: one that was healthpredisposed and the other
more susceptible to oral

Calculus samples taken from medieval remains in Denmark
were found to be far more heterogeneous than samples taken
from modern Danish individuals. (Photograph: University
of Copenhagen)
disease. In the former group,
there was just one case of
periodontitis, whereas seven
members of the latter group
displayed signs of severe
tooth decay. Since the two
groups were more than likely
to have had similar diets and
oral health habits, the
difference in oral health
outcomes is likely to be
attributed to differences in
proteins, such as
Streptococcus sanguinis, a
relatively harmless bacteria
that was far more prevalent
in the former group's oral
microbiomes.
Despite these differences,
the calculus samples that
were used were found to be
far more heterogeneous than

samples gathered from
modern Danish individuals.
The study's authors argued
that the increased diversity
of modern diets, combined
with environmental and
lifestyle factors, genetics,
hygiene practices and
different personal histories of
antibiotics use were likely to
be the main causes of the
variety in modern oral
microbiomes.
T h e s t u d y, t i t l e d
"Quantitative metaproteomics
of medieval dental calculus
reveals individual oral health
status", was published online
in Nature Communications
on 20 November 2018.
- Dental Tribune
International

The Osteology Foundation encourages dentists to hand
in their research abstracts by 15 January 2019. The
winners of the best abstracts will have the opportunity to
present their findings at the foundations symposium in
Barcelona in April 2019. (Image: Osteology Foundation)

UCERNE, SWITZERLAND - Researchers in the
field of regenerative dentistry and oral tissue
engineering have the opportunity to present their
findings at the International Osteology Symposiums Poster
Presentation and Research Forum. The deadline to submit
abstracts of original research is 15 January 2019.
The symposium will take place from 25 to 27 April 2019
at the Barcelona International Convention Centre and will
address the latest developments of techniques and
technologies in oral tissue regeneration. For the upcoming
event, the Osteology Foundation encourages dental
professionals to submit their abstracts in order to get the
chance to present their research live on stage or during a
poster session.
The authors of the six best abstracts that are submitted
for consideration in the Osteology Research Forum in each
of the two categoriesbasic and clinical researchwill be
invited to present by 28 February 2019. These investigators
will have the opportunity to present the content of their
posters during an oral presentation at the Osteology Research
Forum on Friday, 26 April 2019. Furthermore, the
Continued on page 14

Lymph node ratio may predict graveness of oral cavity cancer

URORA, Colo., U.S. : Since oral cavity
cancer is often only discovered late in its
development, patients with this advanced
form of disease have a 5-year survival rate of only
40 percent. Researchers from the University of
Colorado Denver (CU Denver) now found that the
lymph node ratio (LNR) provides an indication for
the seriousness of oral cavity cancer. This knowledge
could not only help patients better predict the course
of their disease, but could also help doctors choose
the most appropriate post-surgical treatment.
Researchers from CU Denver's Cancer Center
collected information from 149 patients treated at
UCHealth University of Colorado Hospital with
surgery and or post-surgical treatments for locallyadvanced oral cavity cancer from 2000 to 2015, in
order to look for patterns in the collected data.
"We wanted to know if features of these patients,
their tumors or their treatment could predict survival,"
said first author Ding Ding, a medical student at the
Department of Radiation Oncology at CU Denver.
As a first step in the study, researchers confirmed
a handful of the expected risk factors-based on
findings of previous studies-such as being nonwhite, uninsured or insured by Medicaid, having a
larger primary tumor, having "margins" around the
tumor that tested positive for cancer even after
surgery, or having tumors that had already invaded
surrounding tissues, all predicted shorter overall

A recent U.S. study found that lymph node ratio
may indicate the risk of recurrence of oral cavity
cancer and event of death. (Photograph:
Photographee.eu/Shutterstock)
survival rates.
Another factor that is commonly used in models
predicting cancer risk is the extent of lymph node
involvement. "The current nodal staging system for
oral cavity cancer is based on the size, number,
laterality and spread of the tumor outside the wall
of the involved lymph nodes," Ding explained. "In
other types of cancers, such as breast cancer,
researchers have been exploring another measure
of lymph node involvement, namely whether the
ratio of surgically removed lymph nodes that are
positive for cancer can predict treatment outcomes.
We wondered if LNR, could be a predictor of
survival in oral cavity cancer, as well."
All the study participants had a median of 29 lymph

nodes removed during surgery. About 9 percent of
these lymph nodes were positive for cancer. This
means that some patients had an LNR above 10 per
cent, while others had especially low or even zero
LNR. The study found that patients with an LNR
greater than 10 per cent had about two and a half
times a greater risk of cancer recurrence and 2.7
times greater risk of death than patients with an
LNR below 10 percent.
"In our study, LNR appeared to be more predictive
of patient outcomes than the traditional method of
lymph node staging. Larger scale studies are needed
to verify these findings and it might be worth
exploring ways to incorporate LNR into the current
model for evaluating recurrence risks," added Ding.
Patients with aggressive disease should receive more
intensive chemotherapy and radiation after surgery,
whereas others with less aggressive disease often
forgo the full extent of these treatments. Thus, the
study adds to a growing body of evidence supporting
the use of LNR to identify patients at a higher risk
for recurrence and death from locally-advanced oral
cavity cancer.
The study, titled "Association between lymph
node ratio and recurrence and survival outcomes in
patients with oral cavity cancer," was published
online on Nov. 15, 2018 in JAMA OtolaryngologyHead & Neck Surgery. - Dental Tribune
International

[13] => Dt pages.FH10

January 2019 Pakistan Edition DENTAL TRIBUNE 13
An exclusive interview with

Dr Arif Alvi ...

Continued from page 4

communicable diseases. There is so
much which the profession can do,
therefore, in that realm I am
disappointed, that they should put their
houses in order and try and pick up
these issues.
HH: Being one of the architects of
the Dental Act yourself, do you think
it will see light of the day?
AA: I think Dental Act was written
with the help of other acts, and other
people. It was written by me in the
mid-1980s. A copy of it is still with
me, which was signed by the Prime
Minister Muhammad Khan Junejo. It
was presented to him in the 1980s.

Every time I lost an
election I felt that I'd hit
rock bottom, but the
struggle continued.
Again, it is disappointing; today I feel
that I would like the Dental Act to be
implemented and brought out, but I
believe that the profession is not ready
to take charge. Therefore, personally
my opinion today is, and I would like
to have a discourse with the
associations or dentists in this regard,
that presently I feel that everything can
be worked out under the umbrella of
Pakistan Medical and Dental Council
(PMDC). The dental profession is not
managing itself well, now imagine that
we have a separate Pakistan Dental
Council; there is no confidence in me
for that, when they cannot take care of
their own associations right now, how
will they take care of the profession at
large. So therefore, because of lack of
confidence, I believe that the best thing
for dentistry is that it may continue
along with the Pakistan Medical and
Dental Council. Soon, an ordinance
will be coming through me, in which
I have made a lot of suggestions, like
increasing the number of dentists being
represented in it, as well as having a
standing committee of the dentists so
that the issues of dentistry go to that
standing committee, and the decisions
made then come to the main PMDC.
Dentists have communicated to me
over the last decades that the PMDC
does not have the time to look at dental
issues. So rather than debating on it in
the full house, they should develop
their own recommendations, where
maybe the issues are going to be
handled better. I am suggesting a subregistrar also, for dentistry separately,
so those issues can be handled.
HH: Like in other countries, these
dental councils or medical councils
are handled by professionals rather
than people from the same profession.
There could be lawyers, there could
be people from other disciplines. Is it
possible that similar thing can happen
in Pakistan? At this point in time a

judge is heading PMDC, but
something on a permanent basis.
AA: I think the new ordinance when
it will come as an ordinance, and then
go to parliament as a bill, I think the
structure will be well-defined. In the
organization, not only the judiciary,
but other people from other professions
would also be involved; somebody who
has management skills should be there;
where issues of education are
concerned, somebody with merit in
that area should be there. So I think it
would be a comprehensive act when it
comes.
HH: Will it be doing something for
the curriculum as well?
AA: Why not? I think that is primary.
I think it is very important that the
curriculum should be looked at, the
goals should be looked at. I wrote a
treatise on the competencies which we
expect from the dentists in the Asia
Pacific region. I think part of that could
be adopted, or may have already been
adopted that decision of what you want
a dentist to be like, that the final product
should be in mind. Then after that,
there should be flexibility between
institutions on how to achieve the same
goal throughout Pakistan.
HH: Being a brilliant dentist, an
accomplished politician, how
important do you think it is to not feel
limited by your degree? How
important is it to pursue your dreams
beyond your profession?
AA: Must be important. It was very
important to me, and I think it should
be important to everybody. I pursued
my dreams in dentistry first; politics
went side by side. But I pursued my
dreams in dentistry. I tried to excel,
tried to go abroad. When I came back
with my first Masters in Prosthodontics,
I thought I had achieved everything.
Within six, seven years I realized that
I needed to do something in
Orthodontics, so I went back. Did that.
Then further achievement was that I
worked hard for achieving Diplomate
status in the American Boards. So every
decade, I tried to improve my
excellence in my own field. Starting
in the 1960s, my own BDS; 1970s, the
first Master's (degree); 1980s, the
second Master's (degree); 1990s, the
Diplomate status. In the 1970s, when
I had excelled in dentistry, then in
1970s and 1980s I looked at improving
my management and my clinic. So that
was a big change, relocating from
Abdullah Haroon Road to a run-of-themill dental office, I developed my
hospital in Sindhi Muslim Society,
which I still love in the sense that it is
a beautiful piece of art and architecture.
So those were the struggles in dentistry,
but at the same time my frustration
regarding what was happening in
Pakistan was also simultaneously
getting important, in the 1980s and
1990s. I have worked in politics in the
1970's also, and in the 1960's also. But
in the 1980's and 1990's, it pushed me
more to try and achieve things on the

political side. I was given the
permission to establish a medical and
dental university. We wanted to set up
a charitable medical and dental college,
charitable in the sense that we did not
want to make money from it. So that
was the intent. The first permission
given in 1988 was to me. Dr Tariq
Sohail was the Health Secretary. I had
applied for this in the 1970s-so issue
was that when I got the permission, I
had to make a big decision, and that
decision was that I thought that if I
went into teaching, I would have to
devote my life to it, and I thought there
that were so many issue that were
important beyond my dentistry that I
could not devote my life only to dental
teaching. So I made that decision. The
second grantee of that era was the Baqai

I encourage girls
that dentistry is a good
profession, even if they
take it up as part-time
practice
Medical & Dental University. So they
set it up, and I did not. So I kept myself
open to be able to contribute more in
a field where I have more access. But
all through my periods, I was always
looking for going out to the people
and to address them. You remember
that we started the oral, public dental
education programme with the help of
a commercial toothpaste
manufacturing company when I was
the President of Pakistan Dental
Association, and we went out and
educated about 900,000 children about
how to brush. So the issue still is that
we must improve the dental health,
the oral health of the people of
Pakistan. That cannot happen only by
curative dentistry, it has to be
prevention at a massive scale. The
orientation of the dentist coming out
of medical and dental colleges, or
doctors, should be geared towards
prevention because a dollar spent in
prevention, saves a hundred dollars in
curative care. And Pakistan is a poor
country, therefore, the consensus and
the commitment should be to look at
issues of prevention easily done.
HH: Yes, prevention is better than
cure?
AA: Yes, in dentistry it is also much
easily done.
HH: You played a major role in World
Oral Health Day (WOHD) with FDI,
and then had it passed in the Assembly
here in Pakistan?
AA: These things I have done
simultaneously, like I said. In the first
decade of 2000s, there was a
conference in Pakistan, which was in
2006- the Asia Pacific Congress, which
we held. I was the Chairman of that
conference. It was a big struggle, with
the local situation getting bad with
violence. There was a group of dentists
who wanted that the conference should

be cancelled. But wherever the issue
of Pakistan came in, I insisted that the
conference should be held. So we held
the congress, and from that congress
on I started working in the international
arena, which I did not want to. My
colleagues kept on telling me that I
should be taking lectures abroad etc.
etc. I did not want to. But from that
conference I started working in the

After my first
Masters, I thought I had
achieved everything.
Asia Pacific Dental Federation
(APDF), and from there I jumped into
the FDI, which is the World Dental
Federation. Even there I started looking
at Prevention and World Oral Health
Day. The date was decided by my push
for March 20th. People in Geneva,
where the FDI has an office- primary
office- they would tell me that there
is no money in it. "Why do you want
to do this?" And I told them that within
the first few years we would start
generating money because there will
be cooperation with toothpaste
manufacturers. The World Oral Health
Day is now totally established. When
I was one of the elected councillors,
the task was given entirely to me. I
worked in FDI for six years. From the
first year, I started insisting for this. I
think, by the fourth or fifth year, I was
successful in convincing my
colleagues. So Pakistan takes the credit
for that.
HH: You would be happy to know
that on a nation-wide level, Dental
News was the first to organize the
World Oral Health Day, and with your
blessings, we have been observing the
day since 2011?
AA: Yeah, that I know. I am aware of
it.
HH: The most intense lesson that you
have learnt during your years
studying, practicing, or in politics?
AA: I think it is very easy to say it has
been difficult for me. People easily
say, "Stay by the truth and serve the
people." Staying by the truth by itself
is a difficult thing. Then serving the
people, is again not an easy task. So I
think the most testing time, and the
most difficult times was facing
violence in this whole struggle; from
getting shot in the first decade of my
political awareness, and then being
shot at while standing up against the
violence and bad state of Karachi. You
know the history, how much we
sacrificed. People thought that I will
not live in those testing times. But
Allah Ta'ala is greatest. When God's
hand is on you, no one can touch you.
HH: We know you as a brave
politician?
AA: It is not bravery. Sometimes when
I was struggling against corruption,
for example when I was a dental
Continued on Page 15

[14] => Dt pages.FH10

14 DENTAL TRIBUNE Pakistan Edition January 2019

Immediate implantation ...
Continued from page 14

the maxillary incisal implant
restoration procedure. We
carried out the adjustment of
the anterior guidance during

model and used the same data
to form the anterior guidance
of the final restoration.
When manufacturing the
final restoration, a CAD/CAM
system was used. Digital
models, ICP relationship and

Fig. 25: Mounting of the provisional
restoration.

Fig. 26: Mounting of the mandibular
model according to ICP bite registration.

Fig. 31: Insertion of 5 mm healing abutments to obtain sufficient retention for
the bite registration material. The same posterior ICP bite registration was
used as for the provisional restoration in order to ensure the ICP was stable.

Fig. 32: ICP bite registration on
the healing abutments.

Fig. 37: Design of the abutment.

Fig. 44: ICP occlusal contact
(12 µm occluding paper, red).

Fig. 38: Design of the bridge.

In this case, a titaniumbased zirconia abutment and
zirconia bridge were used. The
zirconia material used on the
titanium base was a special
zirconia with extremely high
strength, which can guarantee
Fig. 27:
According to
the anterior
guidance of the
provisional
restoration, the
individual
incisal guide
table was set.

Fig. 33: Cross-mounting of the
maxillary cast model.

Fig. 39: Manufacture of the
restoration with multilayer zirconia.

Fig. 45: Protrusive contact just after
Fig. 46: After occlusal adjustment, the
delivery; only tooth #11 achieved contact
protrusive contact was even on the
(12 µm occluding paper, black).
restoration (12 µm occluding paper, black).

the provisional restoration
procedure. Once the patient had
adapted, we set the individual
incisal guide table according
to the provisional restoration,
cross-mounted the cast model
with the provisional restoration

data on anterior guidance were
integrated into the virtual
articulation system. In the
process of CAD, the precise
design of both aesthetic and
functional aspects could be
realised.

Tenure of members cut to ...
Continued from front page

As per the amended ordinance, the
first meeting of the health council will
be held within 15 days of the issuance
of notification for council members.
This meeting will elect the new
president and vice president of PMDC
from amongst the council members. A
quorum of 11 members will be
mandatory for the election while the
presence of 10 members will be
mandatory to call a general meeting of
the council.
As per the amended ordinance, no
one will be allowed to join the council
until they submit an affidavit declaring
that they stand to gain no personal
benefit from being on the council.
Hence, any member whose spouse or
child is a direct or indirect owner of
the medical or dental college will not
be allowed to join the council.
The new ordinance further states that
if any council member misses three
consecutive meetings of the council or
remain outside of Pakistan for more
than a year, they will not be able to
continue as a member of the council
and any other suitable candidate will

3-D multilayer colour.
Without any ceramic veneer,
only with a little staining and
glazing, an excellent colour
and translucent effect can be
achieved.
This was a difficult implant-

Fig. 28: Emergence profile after shaping
by the provisional restoration.

Fig. 29: Individual impression coping.

Fig. 30: Implant level impression.

Fig. 34: Step-by-step model
scanning.

Fig. 35: The provisional digital model
was matched with the cast digital model.

Fig. 36: The incisal guide table was set
in the virtual articulator.

Fig. 40: Final restoration (performed Fig. 41: The zirconia bridge without
by dental technician Chunyu Duan).
any ceramic veneer.

Fig. 47: Protrusion just after
delivery.

Fig. 48: Frontal view of the anterior
teeth after two weeks.

excellent strength and
durability of the restoration
even if very thinly applied.
The zirconia material used for
the bridge restoration was a
kind of CAD/CAM zirconia
with a high translucency and

be included in the council in their stead
for the remainder of the tenure.
As per the amended ordinance, the
health ministry can remove the
president and vice president of the
council on five occasions: if two-thirds
of the council decides to remove the
president and vice president; in case
their names are removed from the
doctors' registry due to any inquiry;
they are declared mentally unstable;
they are sentenced in a criminal case;
or if they are found to be affiliated with
any private institution.
The amended law states that the
council will meet at least once every
three months.
The PMDC Registrar will serve as
the secretary of the meeting.
The council will continue its
responsibility of regulating medical
and dental institutions, educational
establishments across the country.
The amended ordinance was introduced
after it was run on an ad-hoc basis for
the past 11 months after the Supreme
Court of Pakistan (SC) dissolved the
former council and replaced it with a
nine-member council headed by a
former SC judge.

Miaozhen Wang and the
prosthodontists were Drs
Feng Liu and Xiaorui Shi.
The restoration was
completed by dental
technicians Samuel Chou and
Chunyu Duan.

Fig. 42: The titanium-based
zirconia abutment.

Fig. 43: Frontal view of the
anterior teeth just after delivery.

Fig. 49: Patient smiling two weeks
after delivery of the final restoration.

Fig. 50: CT analysis post-op.

supported aesthetic restoration
case. With the great efforts of
the surgeons, prosthodontists
and technicians, a satisfactory
result was achieved.
The surgeons in this case
were Drs Feng Liu and

The Pakistan Medical Association
(PMA) has already rejected the
ordinance stating that it was created
without taking them on board apart
from introducing a nomination system,
instead of the election system for
members.

German report shows the ...
Continued from page 9

KiGGS baseline study in 2003-2006.
However, with more work still to be
done, the researchers noted that
effective caries prevention requires
interdisciplinary cooperation between
dentistry, paediatrics and other medical
disciplines. Emphasising that target
group appropriate measures, such as
for children and adolescents with low
social status and or migrant
backgrounds have delivered promising
results.
The KiGGS is the only
comprehensive study on the health of
children and adolescents in Germany
and an important database for
evidence-based policy decisions.
KiGGS Wave 2 was carried out
between 2014 and 2017. As well as
oral health, the study also focused on

Editorial note: A list of
references is available from
the publisher. This article was
published in CAD/CAM 
international magazine of
digital dentistry No. 02/2018.
- Dental Tribune International

the utilisation of physical therapy,
speech therapy and occupational
therapy and the association between
the utilisation of medical services and
social status.
The report, titled "Utilization of
medical services by children and
adolescents in Germany", was
published on 4 December in the Robert
Koch Institut's Journal of Health
Monitoring. - Dental Tribune
International

Osteology Foundation ...
Continued from page 12

investigators presenting at the event
will have their registration fee
reimbursed.
The three best presentations in each
of the two categories will be
announced during the symposium and
will be awarded prize money of 1000,
750 and 500 for first, second and
third place, respectively.
Abstracts can be submitted online
at www.box.osteology.org and more
information and specific guidelines
can be found at www.osteologybarcelona.org. - Dental Tribune
International

[15] => Dt pages.FH10

January 2019 Pakistan Edition DENTAL TRIBUNE 15

Gel fillings may enhance root canal treatment, study shows

EOUL, South Korea/BIRMINGHAM, Ala.,
U.S.: Root canal treatments currently rely
on clotted blood to fill the empty tooth
canal. In order to find a more reliable,
biodegradable filling that promotes healing and
the regeneration of the tooth, scientists have
developed a gel filling to use in the root canal
treatment that releases nitric oxide and antibiotics
inside the treated tooth.
The pilot study, conducted by Dr Choi from
Kyung Hee University and Dr Cheon from the
University of Alabama at Birmingham and their
colleagues, showed that this new canal filling
material has the potential to boost the regeneration
of the impaired tooth.
The gel is made from peptide amphiphilesmolecules that self-assemble into gel-like structures
depending on their charge. In order to add the
nitric oxide, the researchers reacted the amphiphiles

PM Khan stresses over ...
Continued from page 2

Rural Health Centres and Basic Health
Units will be done by June 2020, the
meeting was further informed.
Federal Secretary Health also briefed
that in order to address the issue of
shortage of health workforce,
particularly the nursing staff; recruitment
was in process in all hospitals along
with establishment of nursing &
associated medical sciences university
in ICT.
Minister for Health KP Dr Hisham
Inamullah Khan briefed the meeting on
the reforms introduced by the provincial
Health Ministry during the last 100 days
in terms of expansion of Sehat Insaf
Cards, assessment of inputs in all health
facilities according to new services
package, preparation to establish HR
Unit in the Health Department &
Strengthening of HCC, achievement of
95% measles immunisation coverage in
the province, inception of community
based complaints and grievance
management system & media cell,
procurement of MIS & inventory
management system, release of GBP
3.2 million for achieving 100% targets
set by DFID and an additional GBP 3.2
million for drafting KP Health Policy,
amendment of MTI Act, policies on
quality of medicines and initiation of
Public Private Partnerships with
pharmaceutical companies to provide
free care to around 0.5 million patients
for four non-communicable diseases.
Minister for Health Punjab Dr Yasmin
Rashid briefed the meeting that the
Punjab Health Department was going
to issue Sehat Insaf Cards in four districts
namely DG Khan, Rajanpur, Lodhran
and Multan. The minister further
informed the meeting that five Mother
& Child hospitals are being established
in the province along with a nursing
college. Dr Yasmin Rashid further
informed the meeting about the steps
being taken for strengthening and
capacity building of human resource
and measures for prioritising healthcare
projects across the province according
to the needs of the ordinary people.

Authors Dr Kyounga Cheon (left) and Dr
Sungchul Choi (right) and their colleagues
designed a novel gel to fill teeth, enabling a better
root canal treatment. (Photograph: Dr Kyounga
Cheon and Dr Sungchul Choi)
with poly-lysine as a nitric oxide donor before
heat-induced polymerisation took place. The
antibiotics ciprofloxacin and metronidazole were
then encapsulated in the gel during the
polymerisation process.

An exclusive interview with

Dr Arif Alvi ...

Continued from page 13

student, I remember doing a protest in
de'Montmorency College of Dentistry,
because there was corruption. The best
part was that a weekly used to come out
by the name of "Zindagi". A journalist
by the name of Sajjad Mir, a talk show
host, wrote an article on me and my
struggle against corruption in Zindagi,
and it ran for two or three pages. This
was in 1969.
HH: During one of your campaigns,
you also did something on 'Save Water'.
For example, using a mug to brush
your teeth. You still believe that that is
the way forward?
AA: I think that is definitely the way
forward. The scarcity of water, global
warming, the environment, the lack of
trees in Pakistan, we are conscious of
all these things. What we did was, we
did a 'Million trees Tsunami' in Karachi,
we went to schools, we educated
children to make their flat balconies
green, we started this 'beej wali pencil'
concept (pencils with seeds). We worked
in that area. And even today I believe
that conservation of water is very
important. Make people guilty. I feel so
guilty when I open the tap and I feel
that the water is being wasted, so it is a
daily guilt. I want to reduce the
consumption of water, and of course,
electricity as well. The new generation
should be learning conservation, and it
should be practicing conservation. In
Pakistan, which has a very major
religious ethos, I give examples from
the Prophet Muhammad's (PBUH) life;
he used to do miswak so many times a
day. There are twenty or twenty two
ahaadith describing how frequently he
did that. The Prophet (PBUH) said to
conserve water, the Prophet (PBUH)
talked about cleaning, the importance
of trees. He called it sadqa-e-jaria
(ceaseless charity). Cleanliness of water
is sadqa-e-jaria too.
In my constituency, I have put up 12
filtration plants to give clean water to
people because all this is related to

It was found that the nitric oxide-releasing gel
had antibacterial effects. Also, nitric oxide helps
wound healing and blood vessel growth by
preventing death of blood vessel cells (vascular
endothelial cells) and by regulating vascular
endothelial growth factor. This allows the interior
of the treated tooth to regenerate.
The antibacterial effect of nitric oxide that the
authors observed in their study might actually
allow them to omit the conventional antibiotics
completely in the future. Additionally, Choi and
Cheon want to supplement the gel with growth
factors in order to support the growth factors that
are naturally present in the treated tooth.
The study, titled "Effects of the nitric oxide
releasing biomimetic nanomatrix gel on pulpdentin regeneration: Pilot study," was published
in PLOS ONE on 11 October 2018. - Dental
Tribune International

general health. Prophet (PBUH) used
to do wuzu (ablution) so many times a
day. Washing of hands prevents
communicable diseases. There is so
much treasure in our history, which can
motivate people in this direction.
So I think, conservation of water and
frequent brushing is the way to go. I
practice brushing almost 4-5 times a
day now. It just makes me feel good.
Mouth odours are kept away, and the
spirit of sunnah is taken up again. The
Prophet practiced of brushing- doing
miswak- with every wuzu, and every
time when he went out to meet people.
It is tremendous guidance for me. I can
assure people, it significantly improves
oral health.
HH: Is that your message for the World
Oral Health Day also?
AA: Absolutely. Brush as many times
as you can. 90%-95% of oral diseases
are because of poor brushing.
HH: Do you thing quackery is an issue
in dentistry?
AA: I am sure it is. In Pakistan, in
education, there was a Supreme Court
decision, whereby admissions are now
being given on merit. What has
happened now is that there are 80% girls
and 20% boys. That is very good
because it is on merit. But what happens
is, you expect all lady dentists, who
come out to be able to practice. The
figures that I get say that about 50% of
the women do not practice at all. They
give it up forever. Recently I spoke at
a convocation ceremony for a medical
and dental college, and I encouraged
the girls there that dentistry was such a
good profession. Even as a part-time
practice, you should do it, because there
is so much investment in those people
by the government and by the people of
Pakistan. You are learning and practicing
on the people of Pakistan. So the lack
of dentists is also because although we
are producing dentists, but a large
number of those dentists never go out
and work. Otherwise it is a waste of
educational resources, and it is
unfortunate that the country would not
have enough curative care. That is where

quackery comes in. If people have a
problem and they do not find a dentist,
they will take an Aspirin, they will do
totka (hacks). Anybody will advise them,
and they will put a clove in the mouth
and try to dissolve it. There are so many
ways, but they cannot just ignore the
pain. And if they do not find a dentist,
they will resort to hacks, and they will
go to a quack. They will go to somebody
who can fix it in whichever way. So it
is the need of the people to get some
attention. How can you handle it? I think
by producing more dentists who practice.
The need for quacks then evaporates. It
is not purely a law and order situation.
HH: Do you think that besides Karachi,
Lahore and Islamabad, the dentists
need to go in the periphery as well?
AA: Yes. I think that should be a
commercial incentive for a dentist to go
into the periphery, because you cannot
force anybody to go there. So there must
be some incentives.
HH: I am sure you are familiar with
a made-in-Pakistan smartphone
application, Authentik that can curb
quackery?
AA: Authentik can be of help in putting
an end to quackery. Definitely.
HH: What is your message to the
people of Pakistan for New Years?
AA: My message would be to work
harder, to work with care, and help the
people of Pakistan. There are around 20
million children out of school, help in
that context. Do look at prevention in
health, for both communicable and noncommunicable diseases. Improve your
diet, and exercise regularly. There are
so many things that people can do
without the state's help; care for
nutrition, encourage breastfeeding by
mothers, increase the nutrition level,
look for safe water, keep clean. So the
message is comprehensive, not one
single thing, but if you want a Naya
Pakistan, you will have to work very
hard.
HH: So Naya Pakistan is hard work?
AA: Absolutely.

[16] => Dt pages.FH10

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[cover] => DT Pakistan No. 1, 2019

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Table of contents

[toc_titles] =>

News / Interview / Clinical Implantology / News

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