DT Pakistan No. 3, 2023

News / Orthodontics / News

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Published in Pakistan

pk.dental-tribune.com

INNOVATIVE PROTOCOLS
FOR DIGITALISED CLEFT
TREATMENT

ALL BUTTONED UP!
STYLING YOUR PLASTIC
WITH ELASTICS

To help practitioners adopt best
practices and guide them in
integrating digital technology with
the available treatment.
Page 04

Clear aligners have become a
popular method of orthodontic
treatment in the new millennium,
led by the launch of Invisalign.
Page 08

MAY-JUNE 2023 - Issue No. 03 Vol.10

INTERNAL FIXATION
SURGERY EFFECTIVE IN
IMPROVING PATIENTS
QUALITY OF LIFE
Mandibular prognathism is a
common facial deformity in southern
China.
Page 12

Dr Irfan Qureshi: A Distinguished
Ambassador of Pakistan on the Global Stage
TIU hosts sixth National Conference of Oral Sciences
DT Pakistan Report
The Tishk International University
(TIU) organised the sixth National
Conference of Oral Sciences
(NCOS) on the subject 'Dentistry
Beyond Boundaries', which was
attended by international experts
from all over the world who
shared their knowledge and
experiences in the field.
The experts included assistant
professor Dr Irfan Qureshi
(Pakistan), Chief Consultant and
Owner at Dr Irfan Qureshi`s Team
of Professionals, Prof Dr Edward
A Mclaren (USA), a Prosthodontist
and Master Dental Ceramist, who
has retired from both UCLA and
UAB School of Dentistry, and Prof
Dr Ulrich Wegmann (Germany),
Studies of chemistry and dentistry
at the University of Bonn (1978
to 2014), lecturer at the
Department of Dental Prosthetics,
P re c l i n i c a l E d u c a t i o n a n d
Materials Sciences, Prof Dr Atesh
Parlar (Turkey), Periodontoligist,
Implantologist, Dr Rawand
Mustafa, BDS, PhD, Oral and
Maxillofacial Surgeon.
NCOS is periodically organized
by the Faculty of Dentistry, Tishk
International University, in order
to make the knowledge and
information on various aspects of
dentistry accessible to everyone.

Photos:
@tishkdentalhospital

The conference gathers
researcher s, practitioner s,
dentists, educators, and scholars
with interest in any field of
dentistry from around the world.

The NCOS 2023 is designed
to attract the research
communities to promote
connections between theory and
practice and explore different

perspectives on the application
of research findings into different
dentistry fields.
Seminar
Tishk International University's
International Relations and
Diplomacy Department, Faculty
of Administrative Sciences and
Economics hosted Ms Rosy Cave,
British Consul General, Erbil,
who spoke at a seminar on 'UK's
Foreign Policy, Diplomacy and
Policy in Iraq'.
The varsity President assistant
professor Dr Abdul Samad S
Ahmad presented a welcome
address, followed by the
Continued on Page 6

[2] => Edited - Claudia DTI-May-June'23.FH10

NEWS

2

DENTAL TRIBUNE Pakistan Edition MAY-JUNE 2023

Pakistan has highest diabetes
prevalence in world
DT Pakistan Report
KARACHI: A recent study has revealed that Pakistan
has the highest number of diabetes patients in
the world, closely followed by Kuwait and Egypt.
Diabetes is a global health concern that is
increasing in prevalence. There are two main types:
type 1, which is typically diagnosed in childhood,

This study gathered data from 38 nations, and
Pakistan topped the list, followed by Kuwait with
a diabetes incidence of 24.9%, and Egypt with
20.9%.
Healthcare professionals from around the world
have consistently emphasised the importance of
regular exercise as a preventive measure against
various diseases, including diabetes.

Photo:
dentalnewspk

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and type 2, which can be potentially dangerous
if not managed properly.
The study conducted by World of Statistics, a
group supported by the Georgia State University
Department of Mathematics and Statistics, shows
Pakistan has a diabetes prevalence rate of 30.8%,
the highest in the world.

Engaging in physical activity can not only help
in preventing diabetes, but also in controlling its
progression.
The global medical community strongly advises
individuals to adopt a regular exercise routine as
it plays a crucial role in preventing and managing
diseases such as diabetes.

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Tribune International GmbH.

Photo:
DT Pakistan

Publisher and CEO
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

Pakistani team attends AAO Chicago moot
KARACHI: A Pakistani delegation
comprising esteemed dental
professionals participated in the
recently held American
Association of Orthodontist
(AAO) Conference in Chicago,
USA.
The annual four-day global
event show-cased the latest
orthodontic scanners, aligners

and graphic technology, inviting
renowned international speakers
and holding hands-on workshops.
The Pakistani team attending
the event comprised Prof Dr HR
Sukhia, Principal Dental SSCMS,
Dr Rashna H Sukhia, Assistant
Professor and ProgrammeDirector, Orthodontic Residency
Programmes, Aga Khan University

Hospital Karachi, Dr Zahra Khalid,
Assistant Professor at the Armed
Forces Institute of Dentistry
Rawalpindi, Dr Leelan Kanwal,
AKU and Dr Aneel Bherwani, DDS.
The Pakistani delegation
members were highly appreciated
and warmly welcomed by the
AAO organisers during the
sessions. -PR

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reflect of Dental Tribune Pakistan.

[3] => Edited - Claudia DTI-May-June'23.FH10

[4] => Edited - Claudia DTI-May-June'23.FH10

NEWS

4

DENTAL TRIBUNE Pakistan Edition MAY-JUNE 2023

Innovative protocols for
digitalised cleft treatment
To help practitioners adopt best
practices and guide them in integrating
digital technology with the available

Photo:
DT Pakistan

Photos:
DT Pakistan

ITI Study Club launched in Karachi
KARACHI: The International
Team for Implantology (ITI)
Study Club recently launched
its Karachi chapter, to promote
t h e u n d e r s ta n d i n g a n d
application of implant dentistry
through education, research,
and networking opportunities.
The local chapter of the
professional association is led
by directors Dr Ali Sadiq and
Dr Fahad Umer.
The inaugural event held at
Marriott was moderated by Dr
Taimur Khalid and featured
presentations by two implant
dentistry experts, Dr Syed
Murtaza Raza Kazmi and
Dr Humayun Kaleem Siddiqui.
Dr Kazmi's presentation
focused on the 'ALL ON 4'
protocol, a treatment option
for the patients who have
lost multiple teeth or are
edentulous.

Sharing some of the cases
he handled, to illustrate the
effectiveness of this protocol,
Dr Kazmi provided insights
into the surgical and
prosthetic aspects of the
procedure.
Dr Siddiqui's presentation,
on the other hand, focused
on medical emergencies and
implants.
Discussing various types
of emergencies that can
occur during implant surgery,
such as bleeding, he
emphasised the importance
of pre-treatment planning for
the
patients
with
comorbidities.
Dr Siddiqui provided
insights into appropriate
management of medical
emergencies occurring
during implant surgery and
stressed the need for a well-

equipped emergency kit and
trained staff.
The event was attended
by a diverse group of dental
professionals, including
general practitioners,
specialists and postgraduate
re s i d e n ts , w h o h ad a n
opportunity to put queries,
share their experiences, and
network with their peers.
The club plans to organise
t h r e e e v e n t s a n n u a l l y,
featuring renowned experts,
besides hands-on workshops
for its members.
The event was a great
success, providing an
excellent platform for dental
professionals to expand their
knowledge, connect with
their peers, and stay updated
on the latest trends and
developments in implant
dentistry. -PR

BUDC holds students
presentation competition
KARACHI: Believing that academic competitions
are the most effective way to promote learning
and instilling confidence in the students as
compared to conventional grading, the Bahria
University Dental College's Department of
Operative Dentistry held a presentation contest
amongst the Third and Final years BDS students
posted in the department as part of their
rotational activity at Phantom Head Lab.
The event was organised under the
patronage of the Head of Department of
Operative Dentistry, Prof. Dr Shama Asghar.
Presentations of Third Year students were
supervised by Dr Imtiazul Haq and Dr Umeed
Javaid, while Final Year students were supervised
by Dr Ayesha Zafar and Dr Syed Adeel Ahmed.
The topics of the presentations covered a
wide range of Operative Dentistry and
Endodontic concepts, including anterior
restorations, cross infection control and
sterilisation, restorative and endodontic
instruments, restorative materials, restoration

Photo:
DT Pakistan

of compromised teeth, esthetic considerations
in restorations etc.
Dr Maleeha (SR Paedodontics) and
Dr Aneeqa (AP Paedodontics), who were judges
of the competition, not only graded the
students, but also gave their valuable insight
and feedback to them on their skills and
encouraged them.
The contest winners were awarded
certificates and the event ended on a note of
encouragement for all participants from Prof
Dr Shama Asghar. -PR

t r e a t m e n t , F D I Wo r l d D e n t a l
Federation, Smile Train, and Dentsply
Sirona have collaborated to develop
the first-ever global standard protocols
for digitalised cleft treatment. These
protocols have been extensively
researched and are expected to
significantly improve the accuracy and
efficacy of existing treatments by
providing dental professionals with a
comprehensive digital clinical approach
across all stages of care.
The protocols cover presurgical
o r t h o p e d i c s , m i xe d d e n t i t i o n ,
permanent dentition, and oral
re h a b i l i ta t i o n , w i t h a re m o t e
monitoring and oral health component
in each field.
Prof. Ihsane Ben Yahya, FDI
President, says these protocols will
bring health and opportunity to
countless children worldwide and
expressed his gratitude to everyone
involved in this landmark achievement.
To make the mass of available
information user-friendly, an interactive
tool was created to display all
information and help the dental
professional navigate through all the
different stages of care.
Susannah Schaefer, President and
CEO of Smile Train, says the new
protocols set the bar for the evolution
of digital cleft care, leveraging
technology that will ensure access to
high-quality care for marginalised
communities, and reduce the burden
of care for the cleft community.
Moreover, Smile Train and FDI, with
support from Dentsply Sirona, have
developed a clinical education course
to provide clef t professionals
worldwide with additional in-depth
training on digital cleft care protocols,
and support them as they integrate
digital technologies into their
treatment plans.
The partnership builds on
an ongoing global collaboration
between Dentsply Sirona and Smile
Train and aims to expand access
to comprehensive cleft care
worldwide. -PR

[5] => Edited - Claudia DTI-May-June'23.FH10

[6] => Edited - Claudia DTI-May-June'23.FH10

NEWS

6

DENTAL TRIBUNE Pakistan Edition MAY-JUNE 2023

FJDC drive stresses early
detection of oral cancer

APDSA holds oral health camp
for kids with special needs

KARACHI: Marking April as
Oral Cancer Awareness
Month, like elsewhere in the
world, the Fatima Jinnah
Dental College (FJDC) ran a
month-long campaign
comprising different
activities, including
educational lectures and
screening camps, to raise
awareness about the disease
that is second most common
cancer in the country as per

TA X I L A : A P D S A - Pa k i s t a n
collaborated with HITEC IMS Dental
College to organise a free dental
camp at Nasheman School for
Special Education and Rehabilitation
in Wah Cantt to celebrate World
Oral Health Day.
APDSA Liaison Off icer
Dr Aniqa Tahir led the event with
the aim of promoting oral hygiene
and educating the caretakers of
special students about basic dental
health and its implementation.
At the camp the volunteers
c o n d u c te d a n o r a l h y g i e n e
awareness session, followed by a
Q&A session for parents and
teachers.
The volunteers examined over
300 children for any oral condition
requiring treatment.
Colgate Pakistan distributed oral
hygiene sample kits among the
students in connection with World
Oral Health Day.
The APDSA team comprised
20 volunteers, along with 2 PGs and
the organizing committee.
The volunteers were given
certificates of participation.

The activity was aimed to
encourage the children to maintain
their oral hygiene and raise
awareness about the importance of
oral health among the community.
Nasheman School is a wellestablished special education
institute for children with hearing
impairments, visual impairments,
and other issues, including autism,
c e re b r a l pa l s y a n d D o w n's
syndrome.
The camp was overseen by
Dr Shahreen Zahid and the
Department of Community Dentistry
of HITEC IMS Dental College, under
the guidance of Dr Mariya Rabbani,
who played a significant role in
organizing and executing the event.
Overall, the dental camp was a
great success in promoting oral
health awareness and education on
World Oral Health Day. -PR

TIU hosts sixth National Conference
of Oral Sciences

president as a token of gratitude
from the university.

Head of the IRD Department,
Dr Mohammad Salih Mustafa, who
read from the biography of the
consul general.
Ms Rosy shared her extensive
experience in foreign policy and
diplomacy, highlighting the
determinants of states foreign
policies in the international
system, and the UK's foreign policy's
motivating factors, such as its
national interest and the sectoral
areas that the British Consulate,
Erbil, intervenes in for the security,
peace and development of the
Kurdistan Region and Iraq. These
sectoral areas include political,
economic, security, education and
human rights fronts.
In the end, a question and
answer session was held where the
par ticipants, including TIU
academics, students, and members
of the public put their queries to
the seasoned diplomat, which were
answered by her.
A certificate of appreciation was
given to Ms Rosy by the TIU

Poster contest
Fifth-grade dental implant course
students presented 13 scientific
posters in different aspects of dental
implantology at a poster contest
held by the varsity's dentistry
department.
Asst Prof. Dr Mehmet Ozdemir,
Vice President for Academic Affairs,
Mr Ercan Sezer, Executive Academic
Advisor, Dr Aliser Babakulyev,
Head of Dentistry Department,
Dr Ranj Nadhim, Chief of Oral and
Maxillofacial Surgery Branch, were
present on the occasion.
The activity aimed to show
students the format of scientific
conferences and teach them how
to prepare and present scientific
posters for international
conferences.
It also focused on implementing
a formative assessment strategy as
part of the dental implant module
assessment criteria.
Formative assessment tools are
highly encouraged in the universities
that apply the Bologna process.

prevention by dedicating the
entire month to it.
For the purpose the FJDC
o rg a n i s e d c a m pa i g n s ,
including educational
lectures, and screening
camps for students, faculty,
and patients, to educate
them on the significance of
oral cancer prevention and
to instill in the students a
sense of obligation to fight
this disease.

Photos:
DT Pakistan

Continued from front page

t h e Pa k i s ta n M e d i c a l
Research Council.
According to the council
approximately 30 percent of
all cancer cases reported in
Pakistan are of oral cancer,
attributing it to common use
of tobacco and betel nuts in
the country, which increases
the risk of developing this
disease.
Despite such high
prevalence, public awareness
of the signs and symptoms
of oral cancer is limited,
resulting in late-stage
diagnosis and poor survival
rates among the patients.
FJDC CEO Dr Hussain
Askary, as an advocate of
preventive dentistry, ensured
that his college and hospital
play an active role in
spreading awareness about
the disease and its

FJDC also conducted free
dental treatment for children
and a School Dental Health
Programme, providing more
than 300 schoolchildren free
screenings and educating
them on the harmful effects
of bad habits like chewing
paan and gutka, which are
c o m m o n i n Pa k i s ta n .
Seminars were also held
on the college and hospital
campuses, where senior
faculty members gave
lectures on oral cancer, and
the students and teaching
staff had lively discussions
on new initiatives to
decrease the prevalence of
oral cancer in the country.
The FJDC awareness drive
especially stressed the need
for an early diagnosis
and prevention of oral
cancer. -PR

Photos:
DT Pakistan

[7] => Edited - Claudia DTI-May-June'23.FH10

[8] => Edited - Claudia DTI-May-June'23.FH10

8

Orthodontics
DENTAL TRIBUNE Pakistan Edition MAY-JUNE 2023

All buttoned up! Styling your plastic with elastics
Dr Chris Cetta, US
Clear aligners have become a
popular method of orthodontic
treatment in the new millennium,
led by the launch of Invisalign by
Align Technology in 1997. While the
initial use of aligners was reserved
for minor tooth movement and
addressing orthodontic relapse,
orthodontists gradually began
treating cases of greater complexity
as patient demand grew for this
more aesthetic option. Pioneering
orthodontists began incorporating
d e n ta l e l a s t i c s t o c o r r e c t
malocclusions starting in the
mid-2000s. This was accomplished
by manually cutting the aligners
chairside or by directing the
technician to lower the simulated
gingiva, thereby altering the trim
line of the aligners. Align Technology
began offering prefabricated hooks
and cut-out windows in its Invisalign
aligners beginning with the G3
1
release in 2010.
Orthodontists cleverly
a p p ro p r i a te d t h e a va i l a b l e
components for fixed orthodontic
appliances to correct malocclusions
with aligners. Lingual buttons,
bondable molar tubes and Caplin
hooks were often utilised in the early
days, with variable success. Because
these parts often had a small surface
area and were designed for the
centre of the clinical crown, there
were frequent bond failures and
frustrating emergency visits for
patients and parents.
Recent innovations in bondable
auxiliaries have made incorporating
elastics into aligner cases much
more predictable. Precision Aligner
Buttons (DynaFlex), for example, are
reimagined bondable buttons
designed specifically for aligners.
These buttons were engineered
to fit within the prefabricated cutouts provided by most major
aligner manufacturers. Precision
Aligner Buttons also have a base
pad that is contoured for the
cervical or gingival third of the
clinical crown and a maximised
surface area for additional bond
strength. The following article
provides a review of clinical
scenarios for which incorporating
elastics into your treatment plan
can be advantageous.
Class II malocclusion
For mild to moderate Class II
cases in which the molar

Fig. 1: The Precision Punch is part of the Clear Collection
by HuFriedyGroup.

cusp, placing the cut-out window
on the distal aspect.
I prefer buttons on the
mandibular first molars for several
reasons. Firstly, although bonding
buttons is an extra step and creates
the potential for bond failure, it is
simply easier for the patients to
fasten elastic bands to outwardprojecting buttons in the back of
the mouth. Ease of use often equals
better compliance. Secondly, the
plastic dovetail created by a hook
can bend outwards and irritate the
cheek. Thirdly, heavier elastic bands
can lift or potentially dislodge
aligners. The only scenarios in

Figs. 2ah: Initial photographs of a case involving an impacted maxillary right canine.

Fig. 3: Panoramic image showing an impacted maxillary right canine.

classification is a half cusp or less
off, I recommend incorporating
prefabricated hooks, that is,
notches or slits, on the maxillary
canines and cut-out windows on
the mandibular first molars. I
recommend placing the cut-out
windows in the centre of the clinical
crown, as the square anatomy of
the mandibular first molar almost
always resists rotational forces. If
there is a large posterior open bite,
I will occasionally add a composite
extrusion attachment to the mesial

which I will incorporate hooks in
the posterior are if the patient has
gold or porcelain crown
restorations or if there is a severely
collapsed vertical dimension.
After buttons have been
bonded to the mandibular first
molars, patients are instructed to
start with 1/4 in., 4.5 oz elastics. If
additional Class II correction is
needed, I advance the patient to
1/4 in., 6.5 oz elastics.
There are several clinical
indications for which I prefer

cut-out windows on the maxillary
canines as opposed to hooks. If the
maxillary canines are buccally
ectopic or high, the elastic band will
also provide a vertical force vector
to aid in extrusion. For Class II
division II cases, attaching the elastic
band directly to the canine avoids
any distal force on the aligners,
which would counteract the
proclination of the maxillary central
incisors. A third scenario for cut outs
on the maxillary canines is for more
severe Class II cases in which the
molar relationship is a half to full
cusp off. Anecdotally, I have seen
more effective Class II correction
when bondable buttons are placed
on the maxillary canines, versus
hooks or notches in the aligner.
Regarding aesthetic button
options, clear Precision
Aligner Buttons are made of a
composite-ceramic hybrid. These
buttons also universally fit maxillary
and mandibular canines and
premolars in the cervical or gingival
third of the crown adjacent to the
gingival margin.
Class III malocclusion
For Class III cases, I will design
my cases with hooks on the
mandibular canines and cut-out
windows on the maxillary first
molars. I avoid hooks on the
maxillary first molars for the same
reasons that I avoid them in the
posterior on Class II cases. If more
significant Class III correction is
needed, I have had good success
with buttons bonded directly to the
mandibular canines. This is another
great indication for clear Precision
Aligner Buttons.
As transverse discrepancy and
posterior crossbite are often
associated with Class III
malocclusion, I incorporate a pearl
from Dr Maz Moshiri and prescribe
the cut-out windows on the palatal
aspect of the maxillary first molars.
Placing the buttons on the lingual
aspect introduces an expansive force
vector that can be quite beneficial.
If attempting this technique, I
recommend either a vertical or
optimised attachment on the
buccal surface, as the maxillary first
molars are more susceptible to
rotation around their palatal cusps.
Posterior and lateral open bite
Cut-out windows and bondable
buttons can be incorporated into
aligner treatment plans in several

[9] => Edited - Claudia DTI-May-June'23.FH10

Orthodontics

DENTAL TRIBUNE Pakistan Edition MAY-JUNE 2023

Figs. 4-6: Progress photographs showing a clear Precision Aligner Button which the surgeon attached to the canine. Notches were placed for the bootstrap elastic
on the lingual aspect of the maxillary lateral incisor and first premolar, using the Tear Drop instrument.

ways. In low angle, skeletal deep
bite patients, posterior vertical
elastics can be used to help open
the vertical dimension of occlusion.
Posterior elastics can also be
implemented in the orthodontic
finishing stages to settle a resultant
posterior open bite. In this scenario,
for which button cut-outs may not
have been pre-planned, the
Precision Punch (Fig. 1) and the
Petite Punch (both HuFriedyGroup)
are an excellent option. Another
situation in which posterior vertical
elastics can come in handy is
settling a bite after orthognathic
surgery.
Anterior open bite
Elastics can be incorporated into
anterior open bite cases in either
triangle or anterior box
configurations. For triangle elastics,
clear Precision Aligner Buttons can
be bonded to the maxillary and
mandibular canines, as well as the
mandibular f irs t premolars.
I recommend starting with 1/4 in.,
4.5 oz elastics. For anterior box
e l as t i c s , b u t to n s c o u l d b e
considered for the maxillary lateral
incisors.
The clear Precision Aligner
Buttons have a convex base and are
better suited for the canines. I
recommend selecting an aesthetic
button with a flat base to better
match the anatomical features of
the incisors. When using anterior
box elastics, a 5/16 in., 4.5 oz elastic
is recommended. Because these
elastics can inhibit speech, I ask my
patients to wear them at night only.
Extraction cases
While each extraction case
should be considered on an
individual basis, bondable buttons
may be advantageous in setting up
your anchorage system for space
closure mechanics. Buttons will
provide a more direct force to
specific teeth, as opposed to hooks,
which will distribute those forces to
multiple teeth through the aligner.

technique. If prefabricated hooks or
notches were not requested in the
aligner, the Tear Drop plier
(HuFriedyGroup) can be used to
incorporate the necessary notches
in the aligner. I recommend placing
the slits on the two adjacent teeth
to avoid aligner cracking, since the
plastic is often thin where the
eruption compensation or virtual
geometry is present. I recommend
a 3/16 in. elastic (Figs. 48).
If a closed exposure technique
is warranted, consider using
Dr Jay Bowmans Monkey hook
(American Orthodontics) to attach
to the terminal end of the gold
chain. This will also allow the patient
to attach an elastic band from the
impacted tooth to the aligner.
Figs. 7ah: Progress photographs showing the maxillary right canine fully erupted. The patient was scanned for an
additional series of aligners (refinement) to address the Class II occlusion on the right side.

Fig. 8: Panoramic image showing the maxillary right canine fully erupted.

Impacted maxillary canines
Orthodontists have traditionally
recommended fixed appliances
when surgical exposure of impacted
maxillary canines is necessary, owing
to the obvious anchorage need for
the orthodontic traction (Figs. 2 & 3).
The recent popularity of aligners
has forced me to think creatively
regarding extrusion of these
impacted teeth. My first cases
incorporated either banded transpalatal arches with cantilever arms
or bondable cantilever arms that
could receive an elastic thread.
While every impaction scenario
is unique, I have moved away from

the ancillary fixed appliances. For
mild to moderate impaction,
particularly when the impacted
tooth is mid-alveolar ridge or on
the buccal aspect, I employ an elastic
band that is fastened by the patient
directly to the aligner in a bootstrap
fashion.
When an open exposure
technique is indicated, consider
requesting that the surgeon attach
a bondable button to the impacted
canine, as opposed to the traditional
gold chain. The patient is then
instructed on how to fasten an
elastic band from the button to the
aligner using the boot strap

Moderate to severe tooth
rotation
For rotated premolars and
canines, consider incorporating
auxiliaries such as bondable buttons
into the treatment plan. Certainly,
rotations can be corrected with
plastic and composite attachments;
however, the rate is typically
2
limited to 2° per aligner stage.
Incorporating auxiliaries such as
bondable buttons could effect
correction two to three times faster
3
than using aligners alone. This is
particularly advantageous when
correction of the rotated tooth is
the rate-limiting step in terms of
the number of aligners.
Regarding selection criteria, this
technique is ideal for conical shaped
premolars or canines that are
rotated by more than 30°. If the
premolars have a boxy morphology,
I suggest sticking with the
composite attachment. The reason
is that the premolar will not spin as
easily within the confines of the
aligner. For more severe rotations,
consider creating space mesial and
distal to the tooth with the aligner
movement. Certainly, bondable
buttons can be employed on the
lingual or palatal aspect to create a
biomechanical force couple, though
Continued on Page 10

[10] => Edited - Claudia DTI-May-June'23.FH10

Orthodontics

DENTAL TRIBUNE Pakistan Edition MAY-JUNE 2023

Fig. 9: A mandibular left premolar exhibiting a 76° rotation
according to Invisaligns ClinCheck software.

Continued from page 9

the bonded buttons on the internal surface may
be irritating or bothersome to the patient.
To incorporate this technique, a prefabricated
cut-out window is placed on the affected premolar
or canine, as well as on an anchor tooth. If cutouts were not planned during the design phase,
the Precision and Petite punches are great options
for making these windows for the buttons. First
molars are recommended as anchor teeth, as the
square anatomy helps resist rotational moments
of force. An elastic power chain is connected
between the bondable buttons. It is
recommended to see the patient every four
weeks to change the elastic chain owing to force
decay and to monitor the progress of the rotation
(Figs. 913).

Figs. 12-13: Correction of the rotated premolar occurred in 12 weeks. Had
the same tooth been rotated with just a composite attachment, it would have
taken 38 weeks at the programmed 2° of rotation per aligner.

Disclosures
Dr Cetta is the co-inventor of Precision Aligner
Buttons by DynaFlex and the Precision Punch
by HuFriedyGroup and receives royalties
in exchange for licensing the designs.
Dr Chris Cetta is a boardcertified orthodontist practising
at Blue Wave Orthodontics in
Tampa and Bradenton in Florida
in the US. He is the coinventor,
along with Dr Richard Kaye, of
Precision Aligner Buttons and the Precision Punch.
Dr Cetta also hosts the Illuminate Orthodontic
Podcast, seeking to shine a light on the innovators
and inventors of the orthodontic profession.

Figs. 10-11: Invisalign aligners with a metal Precision Aligner Button bonded to the mandibular left first molar and a clear Precision Aligner Button to the rotated
premolar. A clear elastic power chain connected the two teeth and was changed every four weeks.

Editorial note: This article was first published
in alignersinternational magazine of aligner
orthodontics, vol. 2, issue 1/2023.
References
1 Align Technology. Align Technology
introduces Invisalign G3. 2010 Aug 16
[cited 2023 Feb 11].
Available from: https://investor.aligntech.com/
newsreleases/ news-release-details/alignte c h n o l o g y - i n t ro d u c e s - i n v i s a l i g n - g 3 .

2 Simon M, Keilig L, Schwarze J, Jung BA,
Bourauel C.Treatment outcome and efficacy
of an aligner techniqueregarding incisor
torque, premolar derotation and molar
distalization. BMC Oral Health. 2014
Jun 11;14:68. doi: 10.1186/1472-6831-14-68.
3 Cetta C. Do the twist: incorporating button
auxiliaries with aligner s for severe
rotations. Orthodontic Products. 2022
AprMay:301.

[11] => Edited - Claudia DTI-May-June'23.FH10

NEWS

DENTAL TRIBUNE Pakistan Edition MAY-JUNE 2023

Background music found to enhance
dental students clinical competence
By Iveta Ramonaite,
Dental Tribune International
KUOPIO, Finland: In a recent study carried out
at the University of Eastern Finland, researchers
have investigated the effect of slow background
music on dental students preclinical manual
skills training. They found that background music
can effectively reduce dental students stress

The data suggested that more than 50%
of the dental undergraduates felt that slow
background music helped to relieve stress
while preparing the teeth, and 68% of the
students thought it helped with stress
reduction while doing cavity restorations.
Students reported enhanced relaxation and
reduced feelings of stress during complex
procedures and higher levels of positive

performance during their preclinical simulation
training.
The researchers found that the majority of
the students were satisfied with listening to
background music during practice. Music was
found to reduce stress while increasing the
motivation to learn and practise. According
to the students, background music did not
disrupt communication in the classroom.

A recent study has investigated whether slow background music has an impact on dental students anxiety, satisfaction and performance during preclinical exercises.
(Image: Vladimir Sukhachev/Shutterstock)

and improve their motivation and performance
during preclinical tooth preparation exercises.
Dental students often experience great stress
during their studies, which may have serious
repercussions on their mental health. Various
studies have previously reported that music can
have a positive impact on emotions and
well-being. It has also been shown that
background music can promote education and
learning and can increase student satisfaction
and productivity.
Adding to the existing literature, researchers
from Finland examined whether background
music can influence preclinical dental students
anxiety levels or performance during preclinical
practice. The study included 36 third-year dental
students who filled in a questionnaire that
measured their subjective evaluation of the
effects of slow background music on the stress
or anxiety levels experienced during a preclinical
cariology course.

feelings when practising while listening to
slow background music.
Additionally, 24 out of the 36 students
participated in a cross-over study on the
impact of slow background music on the
quality of cavity preparation and on the time
taken for this procedure. These students were
split into two groups. The first group listened
to background music such as classical, jazz or
slow pop music while working, whereas the
second group worked in the normal ambient
noise of the simulation laborator y.
Using music for cavity preparation
For the purpose of the study, the
researchers used a virtual reality haptic dental
trainer and monitored the students basic
manual skills. Using ImageJ software and
macrophotographs of the prepared teeth, they
also examined how slow background music
can improve students cavity preparation

Additionally, it was found that background
music enhanced the students use of time
during cavity preparation and improved the
quality of the procedure.
In line with the findings, the researchers
believe that dental educators should be aware
of students learning obstacles and take steps
to improve their emotional well-being. To that
end, the study has shown that playing soothing
background music during preclinical training
sessions might benefit students education.
Finally, the researchers believe that music
intervention could also be an effective tool to
reduce stress in other dental education
environments.
The study, titled Influence of background
music on stress reduction and impact on
performances during students simulation
exercises, was published online on 9 May
2023 in the Journal of Dental Education, ahead
of inclusion in an issue.

[12] => Edited - Claudia DTI-May-June'23.FH10

NEWS

DENTAL TRIBUNE Pakistan Edition MAY-JUNE 2023

Internal fixation surgery effective in
improving patients quality of life
By Iveta Ramonaite,
Dental Tribune International
HONG KONG: Mandibular
prognathism is a common facial
deformity in southern China. Besides
causing temporomandibular joint
pain, the condition affects
patients masticatory function,
facial aesthetics and self-esteem.
A recent study by researchers
from Hong Kong compared the
changes in patients quality of life
after receiving intra-oral vertical
ramus osteotomy (IVRO) or
sagittal split ramus osteotomy
(SSRO) to set back the elongated
mandible. They found that both
surgical techniques can improve
patients physical and mental
health in the long term.
IVRO and SSRO are common
surgical techniques for
mandibular setback and are
widely used in East Asia to treat
pa t i e n ts w i t h m a n d i b u l a r
prognathism. Whereas IVRO
requires a six-week intermaxillary
fixation to achieve bone fixation,
SSRO allows for internal fixation
using titanium plates and screws,
thus enabling immediate jaw
function after the surger y.
According to the researchers,
previous studies showed that IVRO
reduces the risk of injury to the
inferior alveolar nerve compared
with SSRO, which may require a
second operation to remove the
titanium plates and screws if they

Researchers from Hong Kong have recently compared changes in the quality of life of patients receiving sagittal split ramus osteotomy or
intra-oral vertical ramus osteotomy for treating mandibular prognathism. (Image: Beate Panosch/Shutterstock)

It is important to understand
how different surgical procedures
for treating mandibular
prognathism affect the patients
f r o m t h e i r p e r s p e c t i v e ,
commented co-researcher Natalie
Sui Miu Wong, who is a doctoral
candidate in the Faculty of
Dentistry at the University of
Hong Kong. On top of knowing
the clinical outcomes like stability
and possible risks of the two
procedures, this study reflected
how the surgical procedures may

12 months and 24 months. Using
this data, the researchers analysed
the longitudinal changes in the
patients quality of life up to two
years af ter the operation.
The study found that the oral
health-related quality of life in
patients in both IVRO and SSRO
groups was significantly better
three months postoperatively and
continued to improve steadily.
Additionally, it was found that
patients who underwent the
surgery at a younger age had a

A patient with mandibular prognathism. (Image: University of Hong Kong)

University of Hong Kong oral and maxillofacial
surgery researchers Dr Mike Yiu Yan Leung
(left) and Natalie Sui Miu Wong.
(Image: University of Hong Kong)

are exposed or infected. However,
undergoing intermaxillary fixation
had not previously been considered
from the viewpoint of the patient
a gap that was filled by the present
study.

impact their quality of life from
different dimensions, she added.
The study included 98
patients, of which half received
IVRO
and the other half received
SSRO. Their quality of life was
assessed by two self-administered
questionnaires preoperatively and
postoperatively at two weeks, six
weeks, three months, six months,

better oral health-related quality
of life during the postoperative
period.
The study also reported that
both groups experienced a
greater physical impact of the
inter ventions in the early
postoperative period. Social
functioning, emotion and mental
health specifically negatively
affected patients in the IVRO

group. Both physical and mental
health-related quality of life of
patients in both groups had
returned to baseline or improved
by two years after the surgery.
When comparing the two
procedures, it was found that the
patients in the SSRO group
experienced earlier improvement
in their oral, physical and mental
health-related quality of life,
already showing signs of
improvement two weeks after
the surgery. The researchers
suggested that this could be
related to earlier mobilisation and
function of the jaw and not
having to undergo intermaxillary
fixation.
It is encouraging to see that
the correction of mandibular
prognathism improves the
patients quality of life, said lead
researcher Dr Mike Yiu Yan Leung,
a clinical associate professor in
the facultys Division of Oral and
Maxillofacial Surgery. The study
confirms that SSRO appears to
offer earlier improvement of the
patients quality of life after
orthognathic surgery because of
better function, he added.
The study, titled Comparison
of the quality of life changes of
patients receiving sagittal split
ramus osteotomy or intraoral
vertical subsigmoid osteotomy
for mandibular prognathism, was
published in the April 2023 issue
of Clinical Oral Investigations.

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