DT Pakistan No. 5, 2019

News / Interview / Clinical Endodontic / Clinical Implantology

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Use of 3D technology
in the diagnosis and
treatment of ...

Grab any opportunity,
learn, and prove
yourself: Dr Sameer

INTERVIEW

Page 6

SEPTEMBER, 2019 - Issue No. 05 Vol.6

CLINICAL ENDODONTIC

Page 8

Straumann Pro Arch
concept with fully
guided implant ....

CLINICAL IMPLANTOLOGY

1st UHS IDC

UHS unveils game-changing
international dental congress

Page 9

SIOHS introduces
integrated curriculum
By H. Hasan

K

ARACHI - Sindh Institute
of Oral Health Sciences
(SIOHS), Jinnah Sindh
Medical University (JSMU), is
committed to modernizing dental
education in Pakistan and, therefore,
has introduced integrated curriculum,
case-based learning and problem based
Image: DT Pakistan

Photos: DT Pakistan

By Dr Hira M. Khan

L

AHORE - October 5th
marked the final day of the
1st UHS International Dental
Conference (IDC) organized at the
Convention Center, Expo Center
Lahore, under the auspices of
University of Health Sciences. The
congress welcomed over 2,300
participants from all over the
country. 30 international speakers
graced the event. Over 150
companies showcased their products
at the 5th DTMA Trade Exhibition

on UHS's platform.
The opening ceremony was
embellished with the top dignitaries
of the country, as well as the dental
world. The Chief Guest for the
occasion was the honourable
President of the Islamic Republic of
Pakistan, Dr Arif-ur-Rehman Alvi.
Punjab Health Minister and Patron
Conference, Dr Yasmin Rashid, also
graced the event. Foreign delegates
from Turkey, Palestine, Egypt,
Jordan, Saudi Arabia, Sri Lanka,
Canada, UK, China, Thailand,
Brunei Darussalam, and Brazil,

participated in the 1st UHS IDC.
With an announcement, the Master
of Ceremony Dr Saima Chaudhary
commenced day-one's proceedings,
which was marked by recitation from
the Holy Qur'an. Dr Arif Alvi
officially inaugurated the 1st UHS
International Dental Conference.
Later in his address, Dr Arif Alvi
stressed on prevention as the number
one strategy against oral diseases
and, therefore, the need of the hour.
He further said, "90% of oral
diseases are preventable, and so
Continued on Page 15

learning in their institute. These
academic innovations include
structured teaching in all basic and
clinical sciences departments. Active
participation of students in these
programs is also encouraged.
The new changes in the curriculum
is the brainchild of Prof Kefi Iqbal the
Dean of SIOHS and head of the
department.
The curriculum includes the course
topic, further comprising elaborate
lecture topics and learning objectives,
which facilitates in providing better
focus to the learning graduates; there
Continued on Page 15

ADA FDI World Dental
Congress19 concludes in
San Francisco
DT Pakistan Report

T

he 107th edition of FDI World
Dental Congress that
welcomed over 30,000
participants from all over the globe
came to its conclusion on September
10th, 2019, in San Francisco, USA.
The congress was hosted in
collaboration with ADA at the
Moscone Center, where it commenced
on September 4th.
The attendees learned about various
skills, and groundbreaking researches
and innovations in Dentistry through

workshops, seminars and the World
Dental Congress exhibition. They
were also offered the opportunity to
network with leaders of global
dentistry.
Dr Saima Butt, a member of
Pakistan Dental Association (PDA),
as well as FDI National Liaison
Officer in Pakistan, represented the
country on the international platform,
where she also contested for the
science committee.
NLOs of the Asia Pacific Region
participated in the Congress under
the Chairmanship of Dr Awab Alvi,

Photo: DT Pakistan

a renowned dentist in Pakistan and
son of the President of the Islamic
Republic of Pakistan Dr Arif Alvi.
FDI President Dr Katheryn Kell, in
her concluding statement, thanked all
the delegates and members, for
allowing her the opportunity to serve.
Dr Kell acknowledged that the two
years of her presidency had been very
exciting, memorable and rewarding,
not only for her but the FDI
community as a whole.
Dr Gerhard Seeberger, the new

president of the FDI World Dental
Federation (2019-20), said that during
his term as president, he wants to
guarantee dignity: dignity for dentistry
as a medical profession at the service
of the people; dignity for people and
patients; and, finally, dignity for FDI
and its members with the latter will
be conferred to only those dentists if
they tirelessly engaged for the
betterment of the global society. Dr
Seeberger continued that his priorities
Continued on Page 15

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NEWS

2 DENTAL TRIBUNE Pakistan Edition September 2019

SHCC forms IRB to promote research
Image: DT Pakistan

DT Pakistan Report

ARACHI - The
Sindh Healthcare
Commission
(SHCC) has established its
Institutional Research
Board (IRB) with the aim
to review the research
projects for scientific and
ethical values and promote
responsible research culture
for health in the Sindh
province.
The IRB will also
facilitate researchers by
reviewing research projects
and ensuring that the rights
and welfare of human
subjects are being
protected. The IRB
welcomes research projects
of experienced as well as
amateur researchers willing
to initiate research in the
areas of healthcare subjects,
especially in Sindh. The
main emphasis will be

Syed Hashim A. Hasan
hashim@dental-tribune.com.pk
Editor Clinical Research
Dr. Inayatullah Padhiar
Editors Research & Public Health
Prof. Dr. Ayyaz Ali Khan
Editor - Online
Haseeb Uddin
Designing & Layout
Sheikh M. Sadiq Ali

given on issues such as
infection prevention and
control, injection safety,
and other health-related
topics.
The SHCC will utilize
such research projects
focused on creating an
impact on healthcare quality
improvement in Sindh and
presenting solutions for
improvement in areas of

healthcare service delivery.
The SHCC has notified
members of the IRB
including Dr Rafique
Khanani, Chairman, Dr
Faiza Erum Bhutto,
Coordinator, Dr Tasneem
Ahmed, Member, Dr Nazir
Khan, Member, Dr Sharaf
Ali Shah, Member, Justice
Sabir Chippa, Member, Dr
Najia Mansoor, Member,

Dr Ayaz Mustafa, Member,
and Ms Sameen Zaidi,
Member.
The team from the
Directorate of Clinical
Governance and Training
also attended the three-day
workshop (TOT) on Patient
Safety Friendly Health
Initiative organized by the
World Health Organization
(WHO) in Karachi.

Prof Tariq Javed sheds light on the
intricacies of Periodontal Surgery

Photos: DT Pakistan

Prof Ghani wins membership of renowned UK Charity
n recognition of his extraordinary
contributions towards facilitating
the use of evidence based
medicine (EBM), Prof. Dr Fazal
Ghani, Head of Department of
Prosthodontics and Dean Postgraduate
Dental Sciences, Peshawar Dental
College, Peshawar has earned the right
to Cochrane Collaboration
Membership. Cochrane Collaboration
is a UK registered Charity with its
office in Central London. Cochrane
has 11,000 members and over 68,000
supporters coming from more than
130 countries, worldwide. Cochrane
volunteers and contributors are
researchers, health professionals,
patients, care-givers, and people
passionate about improving health

outcomes for everyone, everywhere.
The Cochrane global independent
network gathers and summarizes the
best evidence from research and to
make it easily accessible to help all
including healthcare providers, policy
makers and healthcare consumers
make informed choices about
treatment. Cochrane has been doing
this for 25 years.
The benefits of being a Cochrane
Collaboration Member include;
1.Voting right in Cochrane elections
and helping to shape its future policies
and plans.
2.Tracking and gaining recognition
for his contributions, and using his
particular skills and interests most
effectively.

Dental Tribune Pakistan
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Tel.: +92 21 35378440-2
Fax: +92 21 35836940
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Dental Tribune Pakistan cannot assume
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.
International Office/Headquarters

ARACHI - In its effort
to promote dental
education, the
Altamash Institute of Dental
Medicine recently organized a
lecture on periodontal surgery.
The renowned Prof Tariq Javed,
Professor of Periodontics from
the Carolina Institute, USA,
conducted the lecture in which
he discussed various
periodontium related surgeries
that support restorative and prosthodontic treatments such as prosthodontics ridge augmentation and smile
enhancement. He also performed surgery during the session as part of a live demonstration.
At the end of the session, house officers, students, and faculty members engaged in a question and answer session
with the Professor. Dr Hasnain gave his vote of thanks and appreciated Prof Javed's efforts towards providing awareness
concerning healthy practices. He also thanked the students and faculty for being a part of the session. -PR

Publisher/CEO

3.Continuing to
build his skills
and expertise as
an
active
contributor to
Cochrane's
work.
4.R e c e i v i n g
information and updates targeted to
his skills, interests, and training needs.
As an active Cochrane
Collaboration Member, Dr Ghani will
commit to adhering to Cochrane's
principles, as well as confirming that
he is not currently employed by a
medical device manufacturer or
pharmaceutical company. Cochrane's
strength lies in the people who make
up their community. -PR

Publisher/Chief Executive Officer
Torsten R. Oemus
Director of Content
Claudia Duschek
Dental Tribune International GmbH
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48 474 302
Fax: +49 341 48 474 173
General requests:
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Editorial material translated and reprinted
in this issue from Dental Tribune
International, Germany is copyrighted by
Dental Tribune International GmbH. All
rights are reserved. Published with the
permission of Dental Tribune International
GmbH, Holbeinstr. 29, 04229 Leipzig,
Germany. Reproduction in any manner in
any language, in whole or in part, without
the prior written permission of Dental
Tribune International GmbH is expressly
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of Dental Tribune International GmbH.
©2019, Dental Tribune International GmbH.
All rights reserved. Dental Tribune
International GmbH makes every effort to
report clinical information and
manufacturers' product news accurately, but
cannot assume responsibility for the validity
of product claims, or for typographical errors.
The publishers also do not assume
responsibility for product names, claims, or
statements made by advertisers. Opinions
expressed by authors are their own and may
not reflect those of Dental Tribune
International GmbH.

[3] => Dt pages.FH10

[4] => Dt pages.FH10

NEWS
Career counseling workshop at IADSR

4 DENTAL TRIBUNE Pakistan Edition September 2019

Dr Irfan Qureshis
Comprehensive
Implantology Course

K

ARACHI - Renowned Implantologist
Dr Irfan Qureshi recently conducted a
two-day course on Comprehensive
Implantology. The course was designed for general
dental practitioners and dental students that desired
to enhance their clinical knowledge and skills in
Implant Dentistry.
The course outlined the basics of implantology,
applied anatomy, diagnosis and treatment planning,
bone physiology, sinus augmentation, socket
management, and digital workflow, all followed by
live surgical demonstration and hands-on workshop.
Day 1 of the course started off with the participants
introducing themselves, followed by a detailed and
in-depth lecture delivered by Dr Qureshi. Before
diving into the course outline, he acquainted himself
with all the candidates by having candid conversations
and speaking on motivational subjects, expertly
easing the students into the educational aspect of
class.
The highlights of Day 2 comprised several case
presentations, live dental implant demonstration and
a hands-on workshop, all guided and supervised by
Dr Irfan Qureshi and his associates. -PR

Lecture on Laser
Dentistry at AIDM

K

ARACHI - Altamash Institute of Dental
Medicine (AIDM) recently organized a
lecture on Laser Dentistry in an effort to
promote continuing dental education. Renowned
dentist Dr Talat Qadri, from the Karolinska Institute,
conducted the lecture. He
discussed the topics of dental
pain and practice of laser
dentistry in detail. He also
presented some of his past cases.
At the end of the session, final
year students and faculty of
AIDM were invited to raise

Pediatric dentistry hands-on

A

two-day workshop on pediatric
dentistry was recently conducted at
the Institute of Advanced Dental
Sciences and Research (IADSR). It was held
as a part of the IADSR's 8th Professional
Diploma in Advanced General Dentistry
(PDAGD). The workshop was unique and
distinctive in such a way that for the first time
a dedicated two-day workshop was held on
pediatric dentistry to provide an opportunity
for the participants to learn under the
supervision of highly professional and esteemed
facilitators.
Professor Dr Amjad H Wyne, Professor of
Pediatric Dentistry at the King Saud University
College of Dentistry, Riyadh, and Dr Arham
Nawaz Chohan, Professor of Pediatric Dentistry
at CMH, Lahore, facilitated the workshop. Prof
Wyne discussed examination and treatment
planning in pediatric dental patients in detail,
along with the advantages and disadvantages
of working without a plan. He also taught the
principles and factors that are to be considered
in treatment planning, the role of antibiotics in
children, as well as behavioral management
techniques. Pulp therapy in the primary dentition
from clinical diagnosis to the treatment
procedures were discussed with the students as
well.
Posterior stainless steel crown and anterior
strip crown was performed by the participants
Photo: DT Pakistan

Photo:
DT Pakistan

questions, which were expertly answered by Dr Talat.
Dr Hasnain also gave his vote of thanks to Dr Talat
and appreciated his efforts for providing awareness
for better
practices. He also thanked the students and dental
faculty for being a part of the session. -PR

Photo: DT Pakistan

Photo: DT Pakistan

Photo: DT Pakistan

L

AHORE - Keeping in
Photo: DT Pakistan
view the importance of
making the right career
choice, a workshop was held at
the Institute of Advanced Dental
Sciences and Research (IADSR).
The event was facilitated by
National Coordinator of IADSR
and Dean of Dentistry at Azra
Naheed Medical & Dental
College Prof Ayaz Ali Khan, Dr
M Sohaib Nawaz, Dr M Haseeb,
and Dr M Ahmad Javaid.
The participants were counseled
on postgraduate degrees after BDS and how to set
up your local qualification at an international level.
Facilitators also guided participants on the opening
of private practices and answered their queries as well.
Particular emphasis was given to those who wish to
pursue dentistry in Canada. The session concluded
with an aim to continue such endeavors in the future
as well. -PR

on typodont under the supervision of Professors.
The facilitators solved queries concerning the
common complications that were faced by the
participants during procedures.
Prof Arham Chohan further explained pulp
therapy in young permanent teeth and trauma
to primary and permanent teeth in the interactive
session. He also discussed the iatrogenic cases
in pediatric dentistry and elaborated the role of
radiography in the primary dentition. Prof
Arham taught apexogenesis, apexification, and
space management in children, complications
of pulpotomy in primary molars, reattachment
of fractured tooth fragment, MTA pulpotomy,
and local anesthesia in children. The workshop
was concluded by notching its desired learning
outcomes. -PR

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6 DENTAL TRIBUNE Pakistan Edition September 2019

Grab any opportunity,
learn, and prove yourself:
Dr Sameer Qureshi

D

r Sameer Qureshi graduated from Fatimah Jinnah
Dental College (FJDC), Karachi, in 2001. Following
his graduation, Dr Sameer went on to pursue his
Masters in Prosthodontics from the University of Manchester.
After returning from England, Dr Sameer returned to his
alma mater, FJDC, as an educator. He has been associated
with the institute ever since. Dr Sameer also runs his own
private practice in DHA, Karachi. He also teaches various
courses in Prosthodontics and Restorative Dentistry to sustain
his passion for teaching.
By Dr Hira M. Khan
Dental Tribune Pakistan: Which
higher education option would you
recommend to young graduates after
BDS: Masters from abroad, FCPS,
or MDS?
Sameer Qureshi: No education is
useless because you are always
learning something new. FCPS,
however, being a fellowship program,
has a lot of weightage. It is a good
option if you plan to stay in Pakistan.
MDS is rising to prominence with
each passing day; however, it is going
to take some time to prove itself.
Regardless, it is a good degree for
both clinical and non-clinical fields.
As far as Masters from abroad is
concerned, if you have the opportunity
and means of going abroad, I would
always suggest that you should. That
way, the horizon opens up, and you
get many opportunities to learn about
new aspects of the field. It is good to
go abroad and achieve something
besides doing your basic degree from
Pakistan.
DTP: Benefits and drawbacks of MSc
from abroad and FCPS from
Pakistan on a local and global scale?
SQ: Both are good education
platforms, and if you can gather both
that would be a huge plus. Having
international exposure is always
important for any human being. I
always push my students to go abroad,
if they can, to get some basic
understanding of what is happening
outside Pakistan.
Both options come with their own
set of perks. No education option
comes with an inherent disadvantage;
it is up to the acquirer how they use
the acquired knowledge. If there is
bad luck or lack of hard work, things
might not work out then, but education
itself does not carry any disadvantage.
Anything that you have learnt is going
to prove beneficial if applied properly.
Regarding the fact that you plan on
staying in the country and practicing

or/and teaching dentistry, I would say
FCPS is the goal at the moment. MDS
is also an excellent major degree that
you could pursue. Then again, if you
want to learn good clinical dentistry,
I would say that you acquire basics
from here and then go abroad to learn
skills from the masters who have
written the books.
DTP: What was the time of
completion of your degree?
SQ: I did my Masters in Fixed and
Removable Prosthodontics from the
University of Manchester. It was a
one-year degree. I got an excellent
opportunity to learn from incredible
teachers. Alhamdullilah, life has been
good to me in prosthodontics so far.
DTP: What is the expected time of
completion of your suggested degree?
SQ: I would say that any four-year
degree would do the job. Whether it
is Masters or FCPS, you should go
for a four-year clinical program if you
want to become a clinician. However,

For higher studies in
Dentistry, England is the
easiest to get in.
if non-clinical subjects have good
opportunities, then any program with
a three to four-year duration would
do well for your learning and
contribute to the credibility of your
degree.
DTP: What would you recommend
out of the two: join the workforce or
pursue higher education after BDS?
SQ: I would suggest that one should
start studying during their house job
if there is a plan to do post-graduation
immediately after. So you can
complete your education in one go
because once you start working it
creates a lag between you and further
education. Therefore, it is better to
finish with post-graduation to
maintain the flow of studying. It is
easier to do it when you have peers

INTERVIEW
RAPID FIRE
1. Why dentistry and not medicine?
SQ: It was my father's wish. I
wanted to be a pilot like him.
2. Why Masters and not FCPS?
SQ: I wanted to go abroad.
3. MSc, MDS, or Fellowship?
SQ: Whichever opportunity you
get, take it, grab it, learn from it,
and prove yourself.
4. Priority after graduation (BDS)?
SQ: Post-graduation. If not, then
private practice and courses.
Continuing education is essential.
5. Is prevention still better than
cure?
SQ: Always was and always will
be, in every aspect.

MDS is becoming more
prominent day by day; it is
going to take some time
to prove itself.
along with you, which creates a
'college environment' that facilitates
better learning.
So I would say, go with the flow.
Complete your education, whether it
is FCPS or MDS.
Along with education, you must also
find time for clinical attachments/
observerships. It would prove to be
very helpful in polishing your clinical
knowledge. If you get a good job
opportunity, and you are able to divide
your time between your two
commitments effectively, then that is
great too. In any case, it is advisable
to pursue higher education, which is
easier to manage if you are not
working alongside.
DTP: For those joining the workforce
after BDS, which one is the better
choice: private practice or getting a
job at an institute or a clinic?
SQ: Opening a clinic is a very good
idea but it is essential to have some
prior experience, because managing
a clinic is a completely different
ballgame. It is about marketing,
dealing with all kinds of people, etc.
It is not only about seating your patient
and starting to drill their teeth. You

Go with the flow.
Complete your education,
whether it is FCPS or MDS.
have to manage the clinic, manage
your staff, and so you have to learn
those basics. I opened my own clinic
5-6 years after my graduation. I got
my basic training from my seniors,
for which I took on observership with
great dentists. If presented with
opportunities, do take up clinical
attachments and observerships. It helps

6. How importance is sterilization?
SQ: It is as essential for the doctor
as it is for the patient.
7. Can enamel structure really
be restored with a toothpaste?
SQ: We have great modern fillings
for that purpose.
8. Patient history, important or just
a formality?
SQ: Extremely important. Cannot
move forward without it.
a lot in setting up a private practice.
DTP: What are your recommended
destinations and institutes for those
wanting to pursue a foreign degree?
SQ: There are a lot of options to
choose from. I would suggest
researching thoroughly regarding the
various programmes being offered,
the standing of the university, and
their faculty while going through the
process of applying to foreign
universities. England has a lot of good
universities; I would name the
University of Manchester because I
had a great experience there.
The city was beautiful as well. To
name a few other options, there is
Kings College, Eastman, Edinburgh,
and Sheffield.
There are three different countries
for you to deal with: UK, USA, and
Australia. England is the easiest to get
in. The US and Australia would be a
difficult path to pursue.
DTP: Reflect on your experience of
learning abroad?
SQ: Personally, I feel that while
studying there, I was able to groom
myself. It was a great experience,
learning from some of the most
prominent names in dentistry. I found
it to be a morale-boosting experience.
The learning environment there is
fantastic. We as a nation are
hardworking people when presented
with a good opportunity in a foreign
country; we are capable of achieving
a lot.

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CLINICAL ENDODONTIC

8 DENTAL TRIBUNE Pakistan Edition September 2019

Use of 3D technology in the diagnosis and
treatment of endodontic disease
trium technology, with extremely
satisfactory results. The imaging is
very accurate and highly detailed, and
above all, the user friendliness of the
ACTEON Imaging Suite makes it
possible to identify even slight
differences between the different
radiographic slices, differences that
are of paramount importance for
making a correct endodontic diagnosis
and for the therapeutic decisionmaking process itself. Clinician
experience alone is not sufficient for
establishing the correct approach to
be adopted in the case of endodontic
disease, and very often clinical cases
that were initially scheduled for

By Dr. Fabio Gorni

I

n recent years, the technology
associated with endodontic
therapy has undergone a veritable
revolution. For years, intraoral
radiographs were used as the basis
for diagnosis and for planning root
canal therapy, despite the fact that
these images did not provide a faithful
reproduction of the endodontic
anatomy. This created a series of
technical problems, which, although
they could be partly overcome by the
operators personal experience, to
some extent remained unresolved,
especially in the field of diagnosis.

Fig. 1

Fig. 7

Fig. 2

Fig. 3

Fig. 8

Fig. 14,15

I personally started using cone beam
computed tomography (CBCT) for
endodontic purposes more than ten
years ago. Although the machines that
I used then were far from ideal for
this specific purpose, the possibilities
offered today by increasingly
sophisticated technologies have
greatly improved my diagnostic and
interventional capabilities. In order
to make an accurate diagnosis, an
endodontist needs to perform a highly
detailed assessment of the canal and
pulpal anatomy, which requires highdefinition examination techniques and
software that enables the endodontist
to rotate the tooth accurately and
easily. This may seem obvious and
trivial, but is not. Indeed, over the
past ten years, I have had the
opportunity to work with a large
number of devices and dozens of
software programmes, but only very
few have proven to be suitable for
endodontic purposes. For a few years
now, I have been using ACTEONs

Fig. 4

Fig. 9

Fig. 16

root of this molar to the furcation,
while the axial slices allow us to
conduct a precise analysis of the
endodontic anatomy and, in particular,
the shape of the mesial root, which
in this case was fused with the palatine
root. A full overview of the case can,
therefore, guide the decision-making
process and direct the treatment plan
towards a specific type of treatment
(Figs. 14).
In the maxillary premolar shown in
Figures 5 and 6, the fistulogram
revealed the presence of an apical
lesion that extended coronally to
approximately the middle third of the
root. The clinical decision could,

Fig. 5

Fig. 10

Fig. 17

orthograde treatment, after CBCT
assessment, turn into cases for
endodontic surgery or vice versa. We
can therefore state that the capability
we have now of performing these
studies in a quick and easy manner
has drastically reduced the number
of incorrect diagnoses and,
consequently, the number of clinical
errors.
The case with which I would like
to start my clinical review is a perfect
example of how difficult it is to
establish the origin of the patients
symptoms on the basis of an intraoral
radiograph alone. Not only does the
2D study fail to establish with
certainty the presence of a lesion, but
more importantly, it is impossible to
establish the size, morphology and
type of the lesion. An analysis of the
3D imaging, however, provides a clear
picture of the clinical situation: the
coronal and sagittal slices revealed
the presence of a large lesion
extending from the apex of the mesial

Fig. 6

Fig. 11

Fig. 18

diagnosis, thus, made it possible to
perform selective intervention on the
remaining pulp, leading to successful
treatment of the untreated canal.
Undeniably, one of the most
complex conditions to treat is external
invasive root resorption, where the
extent of the defect affects the
treatment options. It therefore
becomes sensible to perform a
preoperative evaluation of the location
and extent of the resorption, and the
potential for recovery, thus, depends
on correct 3D planning of the
procedure, which can only be
achieved after examination of the
CBCT images. It is very important to

Fig. 12,13

Fig. 19

therefore, propend towards orthograde
retreatment; however, CBCT gave us
a very different view of the situation
compared with the radiograph, as it
indicated that a prior treatment had
irreversibly damaged the tooth, which
would therefore have to be extracted.
The situation was entirely different
for the mandibular premolar shown
in Figures 7 to 9, where, in the absence
of any radiological signs of a lesion
and despite the apparently correct
endodontic approach adopted by
another colleague, the patient
complained of persistent pain which
was both spontaneous and triggered
by percussion of the tooth. In this
case, the previous excellent root canal
therapy would suggest an endodontic
surgery approach, which could
guarantee a higher success rate than
retreatment. Given this diagnostic
doubt, it was decided to perform a
3D study, which revealed an
endodontic lesion caused by an
untreated lingual canal. This correct

Fig. 20

be able to view the slices of the tooth
correctly in all three planes, focusing
in particular on the axial slices, which
will prove to be strategic from an
endodontic diagnosis point of view.
Comparing the two teeth shown in
Figures 10 to 22 demonstrates just
how important it is to analyse all the
slices of the CBCT study correctly.
We can see that, in the maxillary
molar, the lesion penetrates into the
pulp chamber, starting from the roots
distal surface, but remains within the
coronal third of the tooth, without
significantly affecting the integrity of
the pulp chamber floor (Figs. 1015).
The clinical images illustrate the
operative treatment phases, from
resorption debridement through to
repair using bioceramic cement (Figs.
1619). The final radiographic images
confirm the validity of the
conservative and endodontic treatment
of the tooth. The situation is
completely different for the
Continued on page 14

[9] => Dt pages.FH10

CLINICAL IMPLANTOLOGY

September 2019 Pakistan Edition DENTAL TRIBUNE 9

Straumann Pro Arch concept with fully guided
implant and abutment placement
By Dr Nikolay Makarov

I

n cases of severe posterior bone
atrophy, Straumann Pro Arch is
a solution that helps achieve fixed
restoration for the patient. Straumann
Guided Surgery and the coDiagnostiX
planning software (Dental Wings) can
produce predictable results in cases
of complex bone anatomy or when
implants are placed such to obtain
planned multi-unit angulation. With
CARES Visual (Straumann), we can
obtain a precise framework fit on the
original components, which is
fundamental for the final restoration.
Initial situation
A 70-year-old female patient in good
general health presented to a private
practice with an edentulous maxilla
and partially edentulous mandible
seeking a fullmouth rehabilitation.
Conditions in the maxilla allowed
satisfactory retention of a new
complete denture, which was accepted
by the patient, while the mandible
exhibited severe atrophy of the hardand soft-tissue in the posterior region
and hopeless teeth in the frontal area,
as observed clinically and confirmed
by a CT scan (Fig. 1).
Treatment planning
Bone quality in the mandible
allowed placement of four implants
in the anterior region, with both lateral
implants tilted, and did not allow for
any implants to be placed in the distal
area. For these reasons, the Pro Arch
concept was chosen as a treatment
modality. As bone conditions in the
mandible were very difficult in terms
of correct implant placement, it was
decided to place them with the help
of a surgical guide.
The planning included several steps.
First, the hopeless teeth in the
mandible were to be extracted,
followed by delivery of a complete
immediate denture, as they did not
offer any stable support for a surgical
guide. Six weeks later, owing to the
lack of keratinised tissue in the
premolar regions, apical repositioning
and a free gingival graft were
performed (Fig. 2). After 1.5 months,
the denture was relined with a mixture
of barium sulphate and resin,
transforming the denture into a
radiographic stent (Fig. 3). Another
CT scan was recorded with the stent
in the mouth (Fig. 4). The stone cast
of the stent was poured (Fig. 5), giving
us the actual clinical picture of the
mucosa, and both cast and stent were
scanned to obtain their STL files.
Using the coDiagnostiX planning
software, the radiopaque saddle of the
stent and the STL scan were matched,
which also allowed the stent to be
matched with the cast as positive and

Fig. 1

Fig. 2

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 11

Fig. 12

Fig. 13

Fig. 14

Fig. 15

Fig. 16

Fig. 17

Fig. 18

Fig. 19

Fig. 20

Fig. 21

Fig. 22

Fig. 23

Fig. 24

Fig. 25

Fig. 27

Fig. 31

Fig. 26

Fig. 28

Fig. 32

Fig. 29

Fig. 33

Fig. 30

Fig. 34

negative, thus, giving us the soft-tissue
volume. Implants were planned in a
prosthetically driven manner at sites
#34, 32, 42 and 44, with corresponding
screw-retained abutments (Fig. 6).
Because of an open-flap procedure
owing to the lack of keratinised tissue
and the placement of long implants
(all Straumann BLT Roxolid, SLA
implants; 4.1 × 12.0 mm), it was
decided to make two surgical guides:
first, a mucosa-supported guide only
for drilling the template fixation pins
(Straumann; Fig. 7); and second, a
pin-supported guide for fully guided
implant placement (Fig. 8).
The software can be used to choose
a screw-retained abutment in implant
planning. Also, we can plan abutment
placement with the engraving of
implant rotation markers on the guide.
This planning helps us stop at the right
moment in terms of rotation at the
very end of implant placement. We
planned to convert the denture into an
immediate temporary fixed restoration
and deliver the final restoration three
months after implant placement.
Surgical procedure
On the day of surgery, two
impressions were taken: first with the
guide for the pins for stable drilling
(Fig. 9), then with the existing
prosthesis (Fig. 10) for its correct
conversion into an immediate
restoration. The first mucosasupported guide was used for drilling
the sites for template fixation pins
(Fig. 11). Next, the guide was
removed, the flap was raised and the
second guide was fixed with the pins
at the corresponding sites (Fig. 12).
Implant beds were prepared (Figs.
13 & 14) and Straumann BLT implants
placed with a torque setting of more
than 35 Ncm, following the protocol
to allow correct subsequent screw
retained abutment placement (Figs.
15 & 16). Bone around the implants
was prepared with bone profilers
(Straumann) for the same reason (Fig.
17). The crest was flattened (Figs. 18
& 19), screw-retained abutments were
screwed to 35 Ncm (Fig. 20) and
covered with healing caps, and the
wound was sutured (Fig. 21).
Prosthetic procedure
Provisional restoration
On the same day of the surgery, the
existing denture was converted into
an immediate temporary fixed
restoration by adjusting it on
temporary abutments directly in the
mouth (Fig. 22), and an impression
was taken as a double- check. The
restoration was tightened to 15 Ncm
(Fig. 23). Ten days later, the sutures
were removed, the control CT scan
was recorded (Fig. 24) and the results
Continued on Page 15

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10 DENTAL TRIBUNE Pakistan Edition September 2019

Torsional resistance of two nickel-titanium
rotary instruments: A comparative study
By Prof. Gianluca Gambarini, Italy

his study explores how heat treatment less
significantly influences (increasing or
decreasing) torsional resistance when
compared to the high increase in flexibility and
fatigue resistance reported in many published
articles. Moreover, torsional fracture occurs
extremely rapidly when an instruments tip becomes
blocked.
Introduction
The main mechanisms of nickel-titanium (NiTi)
endodontic instrument fracture have been revealed
as two modes of failure, one being torsional failure
and the other cyclic fatigue. The former contributes
to a significant proportion of failures. Cyclic fatigue
fracture is caused by repetitive compressive and
tensile stresses on the outermost fibres of a file
rotating in a curved root canal, and torsional failure
occurs when the tip of the instrument binds to the
canal wall, even in a straight root canal.
Cyclic fatigue resistance of NiTi instruments has
been assessed extensively. In contrast, there is less
information available on torsional fracture resistance
tests. The main method of testing for static rotational
fracture is the comparison of the torsional resistance
of the instruments as described by ISO 3630-1.
According to this specification, the 3 mm file tip
must be fixed with brass and a rotational speed of
2 rpm applied to create a continuous torsional load
until fracture occurs.
Torsional load can be limited during intra-canal
rotary instrumentation by the torque-controlled
endodontic motor: torque settings can be selected

to prevent excessive torsional load on the
instruments. It has been shown that the correct
preset torque value for each instrument is very
difficult to determine. If it is too high, safety
becomes dependent on the clinicians skill in
avoiding over-engagement and/or blockage of the
file. If it is too low, the rotary instrument will be
loaded by repeated locking and release through use
of the torque-controlled motor or auto-reverse
function. However, in narrow canals, where
instruments are subject to higher torsional stresses
than in wider canals, the chance of experiencing
these repetitive torsional loads is increased.
To this point, torque value at failure according
to the ISO test has not been commonly used to
determine torque settings in torque-controlled
motors. In most cases, values are higher than torque
at failure. As a consequence, the concept that the
use of a preset torque value that is considered safe
(i.e. capable of preventing shear fracture of the
instrument) is not completely accurate. Therefore,
NiTi rotary instruments should ideally exhibit a
good resistance to torsion in all cases and in curved
canals should also be flexible and resistant to cyclic
fatigue.
Many factors can affect resistance to torsion,
including design, dimensions, manufacturing
process and motion. In the present study, two NiTi
rotary instruments, similar in dimensions and design,
were tested to compare torque at failure. The null
hypothesis was that any differences found would
be related to different manufacturing processes.
Methodology
The following instruments from two different

NEWS

systems were tested
and compared:
Prof. Gianluca Gambarini.
P r o T a p e r N e x t (Photograph: Gianluca Gambarini)
(Dentsply Maillefer)
and EdgeFile X7 (EdgeEndo). For each brand, ten
17/0.04 instruments were subjected to a repetitive
torsional test. The test was performed using a
torque-controlled endodontic motor (MASTERsurg,
KaVo). The motor allowed for precise recording
of torque values during the instruments use. The
accuracy and reliability of the device had been
validated in a previous study. To perform the test,
the apical 3 mm of each file was firmly secured,
embedded in a resin block produced with a mixed
autopolymerising resin (DuraLay, Reliance Dental
Manufacturing). Each file was then rotated
clockwise at a speed of 300 rpm until fracture
occurred. The torque limit was set at 5.5 N cm, to
ensure recording measurements ranging from 0.1
to 5.5 N cm. The torque values at failure were
recorded by the integrated software of the motor
and analysed using spreadsheet software. The data
was analysed using one-way analysis of variance
and a Tukey test with a significance level of
a = 5%.
Results
Table 1 shows
the results from
the present study.
T h e P r o Ta p e r
Next
files
demonstrated no
significantly
different levels of
Continued on page 15

Study determines reasons
for dental implant failure
and removal techniques

URICH, Switzerland: Dental
implants have become a great
treatment option to replace
missing teeth, and various treatment
concepts have reported high success
rates. Nevertheless, like in every
medical procedure, biological
complications can occur which may
lead to complete implant failure and,
consequently, in the worst-case
scenario, to the removal of the
implant. A recent study by researchers
from the University of Zurich has
revisited the reasons for implant
failure and compared different
removal techniques.
A literature search included 28
studies which had been conducted up
to 2018. The studies assessed titanium
implant failure, removal techniques
and the reinsertion of implants in a
previously failed site.
The research team identified
different categories of factors causing
implant failure. Biological factors
include peri-implantitis and failure to
attain or to maintain osseointegration.

Implant fracture is an example of a
mechanical factor. Medical errors
causing implant failure include bone
overheating, site contamination and
malpositioning. Functional reasons
for implant failure include design of
prosthesis and functional overload.
The researchers found that early According to a recent study, peri-implantitis is currently the main reason for
dental implant failure. (Photograph: Kasama Kanpittaya/Shutterstock)
implant failure is normally caused by
the lack of attaining or maintaining
osseointegration, or bone overheating Even though trephine burs seem to
"If removal is required,
or site contamination. Late implant be the best-known method for implant interventions should be based on
failure is triggered by implant removal, the CTRT method, alone or considerations regarding minimally
fractures, malpositioned implants and combined, should be the first choice invasive access and management as
progressive peri-implantitis. The last for the clinician because of its low well as predictable healing.
causes 81.9% of late implant failures. invasiveness.
(Post)Operative considerations should
Early implant failure results in
Furthermore, the research team primarily depend on the defect type
implants that are normally mobile and found that implantation in previously and the consecutive implantation
easy to remove. Late implant failure failed sites, irrespective of early or plans," concluded the authors in their
means the implants can be at least late failure, results in a 71-100% paper.
partly osseointegrated and, therefore, survival rate over five years. The study, titled Removal of failed
more difficult to remove.
Regarding zirconia implant removal, dental implants revisited: Questions
As options for implant removal, the little data is available. Because of and answers, was published online
study determined tooth extraction, zirconia's physical properties, it is in Clinical and Experimental Dental
trephine burs, piezo-surgery, laser supposed that these implants require Research on 21 August 2019, ahead
surgery, the counter-torque ratchet a different approach to removal of inclusion in an issue. - Dental
technique (CTRT) and electrosurgery. compared with titanium implants. Tribune International

[11] => Dt pages.FH10

September 2019 Pakistan Edition DENTAL TRIBUNE 11
NEWS
Researchers to develop
biodegradable strip and gel to
prevent bone loss in periodontitis

EW YORK, U.S.: In a step
that may help redefine the
treatment of periodontitis,
researchers at New York University
College of Dentistry (NYU Dentistry)
startup company Periomics Care have
been awarded a one-year grant to
develop an oral strip and gel to treat
the disease. The grant, which began
Aug. 1, 2019, and totals $224,000,
was provided by the National Institute
of Dental and Craniofacial Research
and will be used specifically to help
prevent bone loss in people with Type
2 diabetes.
With periodontitis five times more
likely in patients with Type 2 diabetes
than in those without, researchers
hope that they can develop a treatment
that not only improves outcomes but
also reduces pain. "There is a major
void in therapeutic products for

periodontal disease that target the
underlying mechanism of disease-and
are easy for dentists and patients to
use," said Dr. Angela Kamer,
Associate Professor of Periodontology
and Implant Dentistry at NYU
Dentistry and a consultant on the
project.
In a previous study by researchers at
Periomics Care, scientists found that
a metabolite called succinate is
elevated in people with diabetes and
activates succinate receptor 1
(SUCNR1). The study demonstrated
that blocking SUCNR1 activation
controls inflammation and periodontal
bone loss, suggesting that SUCNR1
would be a useful target for
developing therapies to prevent
periodontal bone loss. With this in
mind, a new team of researchers aim
to develop a sustained-release oral

ENEVA, SWITZERLAND/NEW YORK,
US - Orofacial clefts are the most common
birth defects in the US. Children with
orofacial clefts can be at an increased risk of caries,
periodontal disease and other oral health issues
even after undergoing surgery. FDI World Dental
Federation (FDI) and Smile Train are working to
address the issue and have recently launched a twoyear project to improve oral healthcare guidance
and treatment for children with clefts.
The project is funded by GlaxoSmithKline (GSK)
Consumer Healthcare and is aimed at developing
oral health education resources for dentists and
other healthcare professionals. The project team
will create educational materials for cleft patients
and their families, raise awareness of the oral
healthcare challenges that may occur after the cleft
surgery, and provide oral healthcare instructions.
"Clefts affect one in 700 children worldwide," said
Dr Kathryn Kell, immediate past President of FDI.
"In India alone, we estimate that 100 babies with
clefts are born every day, and many of these children

Researchers at New York University College of Dentistry startup company
Periomics Care will spend the next year working on a biodegradable strip
and gel to help reduce the effects of bone loss in periodontitis.
(Photograph: trailak amtim/Shutterstock)
strip and gel formulation to target the
protein.
According to researchers, the oral
strip and gel will use biodegradable
material filled with a SUCNR1
antagonist, a method protected by a
provisional U.S. patent. The strip
would be implanted by a dentist, while
patients would apply the topical gel
to their gingivae themselves. "The
development of a biodegradable oral

Children with clefts
to receive improved
oral healthcare

FDI World Dental Federation and Smile Train
have launched a project to address the oral health
challenges of children with clefts. (Photograph:
Chaikom/Shutterstock)
do not survive. In the US, a baby with a cleft is
born every 75 minutes. FDI is committed to
supporting this vulnerable patient group."
Postoperative care for patients with clefts may

strip or gel formulation that could be
administered through less invasive
approaches to augment or replace
conventional treatment could prove
to be a major step forward in the
treatment of periodontal disease," said
Dr. Deepak Saxena, Associate
Professor of Basic Science and
Craniofacial Biology at NYU
Dentistry and Director of Periomics
Care. - Dental Tribune International

require various specialists who have thorough
knowledge in nursing, plastic surgery, paediatric
dentistry, speech therapy and orthodontics. As most
of these services are unavailable in low- and middleincome countries, many patients with clefts are
unable to receive the required comprehensive
treatment and care.
"We aim to highlight the important role of dentists
within the cleft care team," said Susannah Schaefer,
President and CEO at Smile Train. "Regular dental
care for children with clefts is essential to help
manage their increased risk for oral diseases. It's
important for oral health professionals to guide
cleft patients and their families in their oral hygiene
and help them maintain healthy mouths and the
highest possible quality of life."
"Comprehensive cleft care is a key area of focus
for our partnership with Smile Train and the general
dental practitioner role is vital in this," said Jayant
Singh, Head of Global Oral and Skin Health at
GSK Consumer Healthcare. - Dental Tribune
International

Poor water quality may be factor in high
consumption of sugary drinks

A N B E R R A ,
AUSTRALIA - The
poor state of
Australians' oral health has
received much needed
attention over recent years.
For some Aboriginal and
Torres Strait Islander people,
particularly those living in
remote communities, their
oral health is being severely
compromised owing to the
consumption of sugary
drinks, according to a recent
study by researchers from the
Australian National
University (ANU).
According to Rethink

Sugary Drink, some male
Australians aged between 12
and 24 consume 1.5 litres of
soft drinks, sports drinks or
energy drinks a day. High
consumption of such
beverages has had a huge
impact on the oral health of
many people, and calls for
better labelling and sugar tax
have been made to help
mitigate the situation.
However, for Aboriginal and
Torres Strait Islander people
in remote communities, it is
not only that they are
consuming these drinks, but
also, according to this recent

study, many of them feel that
they have no healthier option,
owing to the poor quality of
drinking water. "Families
living in regional and remote
settings have expressed
concern about the safety and
quality of drinking water,"
said lead author Dr Katherine
Thurber.
What is perhaps more
concerning is that the habit
of high consumption of
sugary drinks is introduced
at a very young age. In the
study, researchers focused
their attention on infants and
toddlers aged 0-3 years. Data

Study finds poor-quality drinking water in remote parts of
Australia may be one reason for high consumption of sugary
drinks from a young age. (Photograph: Elizaveta
Galitckaia/Shutterstock)
was gathered from 900
participants, and the results
showed that 50% had
consumed some form of
sugary drink. Cordial was the
beverage most commonly
consumed at 47%, followed

by soft drinks at 19% and
sweetened tea and coffee at
13%. The remaining 50% of
the participants had not
consumed any form of sugary
drink in their first three years
Continued on page 15

[12] => Dt pages.FH10

NEWS

12 DENTAL TRIBUNE Pakistan Edition September 2019

Study examines oral
health behaviours in elite

ONDON, UK - Various studies
have found that poor oral health
may impair training and
athletic performance. A recent study
has examined oral health behaviours
and risks in athletes and the potential
for oral health intervention. The
findings showed that the athletes had
considerably high rates of oral disease
regardless of healthy brushing habits.
This disparity might be explained by
their heavy consumption of sports
drinks. However, the athletes showed
great interest in changing their oral
hygiene habits and were quite prepared
to improve their oral health.
In the cross-sectional study
conducted by University College
London (UCL), the researchers
surveyed 352 Olympic and
professional athletes. All of the
participants had undergone oral health
screenings, and 344 athletes had also
completed a questionnaire. The
researchers assessed oral health
conditions such as dental caries,

gingival health and tooth erosion. They
also considered self-reported oral
hygiene habits.
Nearly the entire study population
(94%) reported brushing their teeth
twice daily, while 44% flossed their
teeth on a regular basis. With regard
to the oral health risks, the data
revealed that approximately half of
A recent study has highlighted a mismatch between athletes' healthy oral
the athletes had untreated dental caries.
health behaviours and the prevalence of oral diseases. (Photograph: Suzanne
Moreover, an overwhelming majority
Tucker/Shutterstock)
showed the first signs of gingivitis,
and almost a third of the athletes smoke and have a healthy general promote their oral health through oral
admitted that poor oral health affected diet," said co-author of the study Dr health interventions such as fluoride
their training and athletic performance. Julie Gallagher, a researcher in the rinses, prophylactic dental visits and
A vast majority of the athletes (87%) Centre for Oral Health and reduced intake of sports drinks, the
were found to regularly consume Performance at UCL Eastman Dental researchers have been working on
sports drinks, while 59% often used Institute, in an article published on designing an oral health intervention
energy bars and 70% ate energy gels the university's website. "However, study and are hoping to publish the
containing excessive amounts of sugar they use sports drinks, energy gels results shortly.
The study, titled Oral health-related
in order to boost their endurance. and bars frequently during training
"We found that a majority of the and competition. The sugar in these behaviours reported by elite and
athletes in our survey already have products increases the risk of tooth professional athletes, was published
good oral health-related habits in as decay and the acidity of them increases on 23 August 2019 in the British
Dental Journal. - Dental Tribune
much as they brush their teeth twice the risk of erosion."
Since the athletes were willing to International
a day, visit the dentist regularly, don't

Fluoride exposure during pregnancy
linked with low IQ in children

U E B E C C I T Y,
CANADA - Various
studies
have
investigated the effectiveness
of fluoridated water in the
prevention of dental caries. A
recent study has taken a step
further and examined the
association between a
mother's fluoride intake
during pregnancy and a child's
IQ score. The findings
A recent study found that fluoride intake during pregnancy
indicate that fluoride exposure
may affect a child's IQ score. (Photograph: wavebreakmedia/
in pregnancy may affect a
Shutterstock)
child's intellectual
development and should, with fluoridated municipal mg fluoride in mothers was
t h e r e f o r e , b e r e d u c e d . water at the time of the study. linked with a 3.66 lower IQ
According to the study, The researchers examined the score for both boys and girls.
water fluoridation is supplied children's IQ scores at 3 and
Although the study raises
to approximately 66% of U.S. 4 years old.
considerable concerns over
residents, 38% of Canadian
The data showed that community water fluoridation,
residents and 3% of European mothers who lived in areas many researchers have
residents, mostly owing to its with fluoride added to tap dismissed the findings on the
perceived advantages to oral w a t e r
had
h i g h e r grounds that it lacks sufficient
health.
concentrations of the mineral proof. Therefore, more studies
The study used data from in their urine compared with need to be conducted on the
the Maternal-Infant Research those who lived in areas with topic to validate the findings.
on Environmental Chemicals nonfluoridated water. A 1
T h e s t u d y, t i t l e d
cohort study and assessed m g / L h i g h e r f l u o r i d e " A s s o c i a t i o n b e t w e e n
maternal urinary fluoride concentration in a mother's maternal fluoride exposure
concentration, self-reported urine was associated with a during pregnancy and IQ
daily fluoride intake and the 4.5 lower IQ score in boys. s c o r e s i n o ff s p r i n g i n
children's IQ test scores in 601 However, the researchers Canada," was published
mother-child pairs from six found no link between a online on Aug. 19, 2019, in
major cities in Canada. More mother's urinary fluoride level JAMA Pediatrics, ahead of
than 40% of the participants and a daughter's IQ score. inclusion in an issue. - Dental
lived in communities supplied Finally, a daily increase of 1 Tribune International

Reflux associated with
temporomandibular
disorder, study finds

IAN, CHINA - Reflux is an uncomfortable
condition that can have negative effects on a
patient's oral health. In a recent study, researchers
have established that temporomandibular disorder (TMD)
is associated with gastro-oesophageal reflux (GERD).
Other factors such as anxiety and poor sleep contribute
to this correlation. The authors of the study have noted
that physicians need to be aware of the association and
consider instituting multidisciplinary management
programmes to help patients.

An international team of researchers from China and
the US have found that gastro-oesophageal reflux is
associated with temporomandibular disorder.
(Photograph: GBALLGIGGSPHOTO/Shutterstock)
An international team of researchers looked at data
from two separate hospitals in China on 1,522 patients
aged between 18 and 70 years old with chronic TMD.
They set out to understand the connection between the
disorder and GERD and to determine whether anxiety,
somatisation and depression influence the association.
In the study, co-author Dr Jihua Chen, from the Air
Force Military Medical University in Xian, noted that
the relationship between chronic musculoskeletal diseases,
Continued on page 15

[13] => Dt pages.FH10

[14] => Dt pages.FH10

14 DENTAL TRIBUNE Pakistan Edition September 2019

Good oral health as a positive
part of ageing process
By FDI World Dental Federation

ENEVA, SWITZERLAND The world's population is
ageing, and experts predict
that, by 2050, 25% of the world's
population-two billion people-will be
over 60 years old. A fifth of these-400
million-will be over 80 years old.
Thus, FDI World Dental Federation
recently released three practical guides
that highlight advisory measures to
maintain good oral health even into
old age.
Epidemiological studies show that
older people are particularly affected
by poor oral health, which has negative
consequences for their general health.
Oral conditions such as dental caries,
periodontal disease, tooth loss, dry
mouth or oral cancer affect their
chewing function and nutritional intake

as well as their ability to interact
socially.
FDI's Oral Health for an Ageing
Population project was launched in
2015 to strengthen the role of the oral
health community in helping patients
to achieve healthy longevity. The
project pushes for oral health
challenges to be addressed as part of
broader disease policies and health
promotion strategies for ageing
populations.
FDI prioritises raising awareness of
effective strategies and actions to
manage the oral health needs of older
adults. It details options for assessing
and treating frail and dependent
patients and promotes the importance
of an interprofessional team in caring
for them.
Global population ageing has a direct
impact on daily dental practice

Use of 3D technology in ...
Continued from page 8

mandibular molar, where the evaluation of the
CBCT scan clearly reveals the extent of the
resorption, which invades the pulp chamber floor
until the furcation, a situation that cannot be
determined from observing the preoperative
radiograph alone (Figs. 2022).

Fig. 21

Fig. 27

Fig. 33

Preoperative CBCT evaluation is useful in cases
requiring a surgical approach, not only in order to
confirm the presence of a lesion but also to plan
the procedure and, in particular, identify the type
of surgical incision to be used, based on its size and
location (Figs. 2325). This specific case is
characteristic of this situation. The intraoral
radiograph did not make it possible to ascertain the
extent of the lesion, which involved not only the

FDI recently released three practical
guides that highlight a series of steps
that dentists, elderly patients and their
carers can follow in order to make
good oral health a positive part of the
ageing process. The guide for dentists
outlines the tools needed to assess
patients and their oral health levels in
the context of their dependency. The

apical region of the premolar but also a distal
edentulous segment. This region would need to be
treated with regenerative therapy in order to
guarantee correct healing of the area, with
subsequent insertion of a membrane, the flap must
be protected using a totally different approach to
that required for endodontic surgery. The
intraoperative images illustrate the various stages

Fig. 22

Fig. 26

FDI's Oral Health for an Ageing Population project aims to improve oral
disease prevention and treatment strategies for elderly patients and advocates
that oral health be included in broader health policies for ageing populations.
(Image: FDI)

Fig. 23

Fig. 28

Fig. 34

guides for patients and carers provide
tailored guidelines to help older
patients take care of their oral health
based on their level of dependency.
The practical guides are Oral Health
in Older Adults, Oral Health: Caring
for Older Adults, and Managing Older
Adults: Chairside Guide. - Dental
Tribune International

the two canal systems of the canine and the decay
involves the portion of tooth where the dens in dente
is present. The treatment plan therefore involved
root canal therapy for just one portion of the pulp,
while the other was to be kept vital. The image
sequence of the treatment shows how it was possible,
using CBCT and a surgical microscope, to perform
a minimally invasive access, which spared much

Fig. 24

Fig. 29

Fig. 25

Fig. 30

Fig. 35

of the procedure (Figs. 2628). The CBCT scan
performed 12 months later confirmed complete
healing of the apical lesion and perfect graft
integration (Figs. 2931).
Another compelling advantage of this 3D
technology is the possibility of using a minimally
invasive approach for performing cavity access.
For demonstration, the next case involves a dens in
dente. The CBCT scan shows a separation between

Fig. 31

Fig. 36

Fig. 32

Fig. 37

of the canines clinical crown and kept the diseasefree portion of the tooth vital. The radiographic
follow-up confirmed complete healing of the lesion
and the vital part of the canine did not present any
signs of disease six years later (Figs. 3237).
Editorial note: This article was published in
CAD/CAM - international magazine of digital
dentistry No. 02/2019. - Dental Tribune
International

[15] => Dt pages.FH10

September 2019 Pakistan Edition DENTAL TRIBUNE 15

UHS unveils game ...
Continued from front page

creating awareness regarding oral
diseases and hygiene must be done on
a war footing."
Dr Yasmin Rashid, in her address at
the occasion, informed everyone about
the necessary efforts the government
was making for the development of
healthcare in Punjab.
A special session-SuXess Factors in
Dentistry- was also conducted on the
first day. It was aimed at young dental
graduates to counsel them with their
future career goals, personal plan
developments, and kick-starting
successful strategies for future
endeavours.
The UHS, through the vision of the
Vice-Chancellor Prof Javed Akram,
also took the initiative of setting up a
forensic odontology registry at the
Jinnah Campus of the University at
Kala Shah Kaku. This registry will
pave the way for the easy identification
of any criminal or disaster victims
through floods, air crash injuries, or
fire accidents. Dr Humayoun spoke
about the registry's significance and
its objectives.
VC UHS Prof Javed Akram
presented a detailed overview of the
conference and its long-term goals.
He said, "Dentistry will reach new
heights after this conference, which is
all about collaboration and innovation
for the ultimate benefit of the patients."
On the second day of the Conference,
along with the main scientific program
UHS planned two exclusive sessions.
The first special session was on "Orosystemic connection" and was
organized by the Pakistan Society of
Internal Medicine.
The second exclusive session was
held by Drug Regulatory Authority of
Pakistan (DRAP) on "Regulatory
Affairs Concerning Dentistry& Dental
Suppliers". The topics touched
included regulatory requirements for
dental and medical devices and an
overview of regulatory affairs in
biomedical and dental devices, and
materials, from DRAP.
The DRAP presentations were
sandwiched between two Oral
Presentation sessions delivered by
postgraduate students exclusively.
Poster presentations were also done
by postgraduate students,
undergraduate students and house
officers, and faculty members,
respectively.
The concluding day housed two
more plenary sessions where national
and international speakers touched on
innovative topics in dentistry. The 3day conference came to an end with a
grand closing ceremony.
The 1st UHS IDC proved to be one
of the largest and most-attended
international dental conferences held
in Pakistan. It witnessed several
collaborations and innovative launches,
and most importantly the historic rise
of globalized and organized dentistry

in Pakistan. Around 20 pre-conference
workshops were taught by foreign
speakers in colleges throughout the
country. Among many others, an MoU
was also signed between Al Quds
University, Jerusalem, Palestine and
UHS; UHS took Al Quds's Dental
Faculty as its adjunct faculty.
Conference Secretary, Dr Sarah
Ghafoor, in her speech presented a
token of thanks to all the sponsors and
her team for making the event
successful.

SIOHS introduces ...
Continued from front page

is improvement in their theoretical
knowledge as well as clinical skills,
enabling them to become self-learners
and thinkers with an ethical orientation.
Teaching methods and assessment are
also part of the curriculum.
All faculty members of the five
affiliated dental colleges and
constituent colleges of JSMU,
including the medical educationists,
have contributed to this milestone.
This curriculum entirely meets the
criteria designed according to the new
regulations of PM&DC, and has also
been approved by the Dental Board of
Studies of JSMU.

ADA FDI World Dental ...
Continued from front page

are guided by FDI's 2018- 2020
Strategic Plan and its three strategic
focus areas: membership, advocacy

and knowledge transfer with his
favorite as the advocacy, as there is a
fundamental need for it.
Professor Ihsane Ben Yahya of the
Dental University in Casablanca,
Morocco was appointed the
FDI President-Elect during the
elections held at the FDI General
Assembly.

Straumann Pro Arch ...
Continued from page 9

were assessed with the coDiagnostiX
evaluation tool.
Final restoration
Two months after the implant
placement, impressions were taken
and the precision was checked with a
verification jig (Figs. 25 & 26). The
vertical dimension of the provisional
prosthesis was followed when
mounting the casts in the articulator
(Figs. 27 & 28). The analogue set-up
was tried in (Fig. 29), then scanned by
the Straumann CARES 7 series
scanner together with the model. The
framework on Straumann Variobase
screwretained abutments was designed
in CARES Visual following the setup anatomy (Fig. 30), then milled from

titanium (Fig. 31). The passive fit of
the framework was checked, and it
was then veneered with resin with the
denture teeth in place (Figs. 32 & 33).
Variobase abutments were cemented
into the prosthesis, and the final
restoration was tightened to 15 Ncm
(Fig. 34). Screw holes were closed
with PTFE tape and composite.
Treatment outcomes
This case shows how digital
technologies help achieve good results
in complex surgical conditions and
facilitate immediate predictable
temporisation. It demonstrates that
correct prosthetically driven implant
planning results in a satisfactory final
restoration.
Acknowledgements
Alexandr Dolgolaptev (framework)
and Vyacheslav Bakaev (veneering)
for performing the laboratory
procedures.
Editorial note: This article was
published in CAD/CAM - international
magazine of digital dentistry No.
0 2 / 2 0 1 9 .- D e n ta l Tr i b u n e
International

Torsional resistance of ...
Continued from page 10

resistance in terms of maximum torque
at failure compared with the EdgeFile
X7 instruments (p < 0.05). Similarly,
no statistically significant differences
were found between the two
instruments in terms of time to failure
(p < 0.05).
Discussion
The ISO torsional resistance static
test was developed more than 50 years
ago to test manual stainless-steel
instruments and is probably not ideal
for testing rotary instruments that rotate
at speeds much higher than 2 rpm or
for the specific motors with torque
control and auto-reverse mode.7
Therefore, in the present study,
torsional resistance was assessed by
using a different speed: the clinical
speed (300 rpm).
The tested instruments were similar
in dimension and design but had been
produced through different
manufacturing processes (alloys and
heat treatments). According to the
manufacturers website, EdgeFile X7
files exhibit a higher flexibility and a
greater resistance to cyclic fatigue than
competitors instruments do. In
stainless-steel instruments, flexibility
and torsional resistance are usually
inversely proportional, which is mainly
due to the mass and/or dimensions of
the instruments. The greater the mass,
the more rigid and resistant to static
torsion the instrument is.8 In the
present case, mass and dimensions
were very similar, and torsional
resistance was similar, showing no
statistically significant difference
between the two instruments. The null
hypothesis was therefore rejected.
Hence, the present study showed
that heat treatment does not
significantly influence torsional

resistance in contrast to the high
increase in flexibility and fatigue
resistance derived from heat treatment
as reported in many published articles.
- Dental Tribune International

Poor water quality may ...
Continued from page 11

of life, which researchers noted as a
positive in the otherwise concerning
results.
Speaking about what could be done
to make improvements, Thurber said,
"Families need relevant advice from
health professionals, but improving
information and knowledge is only
one part of the solution. We also need
programmes and policies to improve
the social determinants of health if we
want to improve nutrition."
The gap between the oral health of
Aboriginal and non-Aboriginal
Australians is closing, which indicates
that the national focus on the issue
may be having an impact. As reported
by the researchers at ANU, babies and
toddlers living in cities and regional
centres were significantly less likely
to consume sugary drinks than were
children in remote areas. However, as
reported recently by Dental Tribune
International, 90% of Australian adults
experience caries in their permanent
teeth, and therefore, there is still plenty
of work to be done.
The study, titled "Sugar-sweetened
beverage consumption among
Indigenous Australian children aged
0-3 years and association with
sociodemographic, life circumstances
and health factors", was published on
28 August 2019 in Public Health
Nutrition, ahead of inclusion in an
issue. - Dental Tribune International

Reflux associated with ...
Continued from page 12

gastro-intestinal diseases, mental
disorders and sleep problems is
complicated. "There is evidence to
support the bidirectional nature of the
associations among these
comorbidities," Chen said. He
explained that patients may be stuck
in a cycle that undermines sleep.
Somatization and anxiety exacerbate
the pain, and this pain can lead to sleep
problems and mental disorders.
According to the results of the study,
symptomatic GERD is a risk factor
for TMD, and people with a longer
history of GERD have a higher risk
of TMD than those with a shorter
history. "Patients with both chronic
TMD and reflux symptoms may be
underdiagnosed, resulting in deferred
effective treatment and a prolonged
disease course," said Chen.
The study, titled "Associations among
gastroesophageal reflux disease,
mental disorders, sleep and chronic
temporomandibular disorder: A casecontrol study", was published on 19
August 2019 in the Canadian Medical
Association Journal. - Dental Tribune
International

[16] => Dt pages.FH10

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[cover] => DT Pakistan No. 5, 2019

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Table of contents

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News / Interview / Clinical Endodontic / Clinical Implantology

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