DT India (Archived)

Prozone confirms effectiveness of ozone dental therapy / News & Opinions / Does dentine hypersensitivity affect oral health-related qualty of life? / A case report: Unusual anatomy of maxillary second molar / Treating a peri-radicular abscess / Interview with Dr Oliver Hennedige - Singapore / Saddle stool in dentistry / Current concepts in gutta-percha removal for re-treatment (Part 1 of 2) / Case report: Interdisciplinary full mouth rehabilitation / FDI World Dental Communique (Mar/Apr 2010) / Complete maxillary implant prosthodontic rehabilitation with a CAD/CAM-fixed prosthesis / Epulis gravidarum mimicking a neoplasm / Miniscrews—a focal point in practice (Part 4 of 6)

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Table of contents

DENTAL TRIBUNE
The World’s Dental Newspaper  India Edition
PUBLISHED IN INDIA

www.dental-tribune.com

News in brief
Genes control early tooth
development

VOL. 2 NO. 2

Trends & Applications
Does dentine hypersensitivity affect oral
health-related quality
of life?

Interview
“Evolution of miniimplants”

Technology
CAD/CAM-fixed
prosthesis

4Page 4

4Page 12

4Page 22

Several genes affect tooth
development in the first year of
life, according to the study conducted at the Imperial College
London, the University of Bristol, & the University of Oulu
in Finland. The research found
that the babies’ teeth with

Prozone confirms effectiveness of ozone
dental therapy

certain genetic variants tend to

treatment.

appear later & that these chil-

ozone, a reactive three-oxygen

dren have a lower number of

molecule also found in earth’s

teeth by the age of one. In addi-

atmosphere, is a relatively new

tion, those children whose teeth

concept in dentistry. Earlier

develop later have a 35 percent

studies indicate that it only takes

increased likelihood of requir-

a few seconds of therapy to kill

ing orthodontic treatment.

99 percent of bacteria making

Some of the genes identified
have been linked, in previous

Treatment

with

it a thousand times more powerThese pictures shows agar plates with bacterial strain Escherichia coli. The left plate was treated with Prozone for 24 seconds
and shows areas that are visibly bacteria-free. (DTI/Photo courtesy of Salzburg University, Austria)

studies, with the development

ful than other bacteria killing
agents. The new study shows that

Daniel Zimmermann
DTI

2009, samples of Streptococcus

have a low bacterial count also

in order to reach the total poten-

mutans and Escherichia coli

increase.

tial, treatment has to be per-

may lead to innovations in the

LEIPZIG, Germany: Clinical

were gassed immediately and

early treatment and prevention

tests from the Department of

after 1.5 hours with ozone for

of congenital dental and occlu-

Molecular Biology at the Univer-

24 seconds and several times.

sion problem.

sity of Salzburg in Austria have

of the skull, jaws, ears, fingers,
toes, and heart. The discovery

formed immediately. Delayed
W&H’s ozone generator has

treatment also results in reduced

been available to dentists world-

bacteria count but the visible

wide since 2008. Despite it’s

effects are less significant.

confirmed that dental treatment

The results demonstrated

sterilizable ergonomically hand-

with Prozone, a next-generation

that treatments with 24 seconds

piece, it features preset prede-

Devices utilizing ozone tech-

ozone generator by Austrian

ozone had visible effects on the

fined treatment times which

nology such as Prozone expose

manufacturer W&H, is highly

treated area. In all tests immedi-

make it easy to manage, the

filtered air to a highly electrical

effective against bacteria strains

ate treatment was more effective

company states. Prozone is suit-

voltage which is directly applied

that are responsible for oroden-

than treatment after 1.5 hours.

able for a wide range of dental

to the treatment area where

tal infections and the develop-

When the duration of the treat-

applications including cavity

it destroys bacteria and viruses

ment of dental caries. In the

ment was increased, the areas

and surgical disinfection as well

through oxidation. DT

control

which contain no bacteria or

as periodontal and endodontic

study

conducted

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[2] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

News

2

Nano-Bio-Chip detects oral cancer

News in brief
No more dental colleges
in the country

diagnostic NBC had comparable

the past 50 years as most cases

success rate with 97 percent

are diagnosed in the advanced

The Dental Council of India

sensitivity in detecting oral can-

stages.

(DCI) has decided not to sanc-

cer, and 93 percent specificity

tion new dental colleges, any-

in detecting which patients

where in the country for the

had malignant or premalignant

procedure requires just a little

next five years, to regulate

lesions. The device will undergo

brush of the lesion with a tooth-

dental education and the dental

a more extensive clinical trial

brush-like instrument instead

profession. This announce-

involving 500 patients in Hous-

of an invasive, painful biopsy,

ment was made by DCI chief Dr

ton,

the

and can deliver results with

Anil Kohli, who was in Manga-

U.K., which could lead to an

in 15 mins. “One of the key

lore to attend the silver jubilee

application for FDA approval

discoveries in this paper is to

celebration of A B Shetty Memo-

in two to five years.

show that the miniaturized,

rial Institute of Dental Sciences.
“It is imperative to maintain

San

Antonio,

and

This

minimally

invasive

noninvasive approach produces

Photo courtesy of Textbook of Oral Pathlogy by Harsh Mohan.

Oral cancer is among the

about the same result as the

Isha Goel
DT India

a single microfluidic platform:

ten

cell separation/capture on the

worldwide with a high morta-

John

ical sciences assumes far grea-

New Delhi, India: A team of

membrane

biomarker

lity rate. According to a WHO

statement.

ter importance than ever before

scientists at the Bio Science

immunolabeling and cytoche-

survey report, India has the

in this age of change,” he said,

Research Collaborative, at Rice

mical staining, and fluorescent

highest number of oral cancer

The Rice University has

adding that “preserving quality

University, in Houston, US, has

imaging and analysis. According

cases in the world, out of which

received a US $2 million grant

of education is of paramount

developed a nano-bio-chip (NBC)

to this pilot study, published in

90 percent were due to tobacco

from the National Institute for

importance.”

than

sensor technique that analyzes

the Journal Cancer Prevention

related diseases, leading to

Dental & Craniofacial Research

sanctioning new dental col-

specimens from brush biopsies

Research, the researchers com-

2,200 deaths each day. The 5-

Division of the National Insti-

leges, DCI will focus its energy

of lesions to detect oral cancer.

pared results of traditional diag-

year survival rate of 50 percent,

tutes of Health for their work. DT

on ensuring that quality dental

The nano-bio-chip integrates

nostic test, and those obtained

among patients with oral cancer,

education is imparted to stu-

multiple laboratory processes into

with the NBC, to find that the

has remained unchanged for

quality in every sphere of life,”
Dr Kohli said. “The field of med-

“Rather

filter,

most

common

cancers

pathologists do," study leader
McDevitt

said

in

a

dents in existing dental colleges

Indigenous implants will
be a lot cheaper

Brain unable to localise tooth pain
Claudia Salwiczek
DTI

Many brain regions responded

A report, published in The

to top and bottom tooth pain—
Ger-

carried by signals from two

the Maulana Azad Institute

many: The brain is not able to

distinct branches of a fibre

of Dental Sciences (MAIDS),

discriminate between a painful

called the trigeminal nerve—in

under the New Millennium

upper tooth and a painful lower

the same way. The maxillary

Indian Technology Leadership

tooth, researchers found. The re-

branch (V2) carries pain signals

Initiative by the Ministry of

sults of a new imaging study,

from the upper jaw, and the

Science and Technology, has

which will be published in the

mandibular branch (V3) carries

successfully developed a new

journal Pain, may help devise

pain signals from the lower jaw.

indigenous dental implant,

better treatments for acute tooth

which will cost between Rs

pain, such as cavities or infec-

The researchers found that

2,000 and 3000.

tions, and more chronic condi-

regions in the cerebral cortex,

tions like phantom pain of a tooth

including the somatosensory

after it has been removed.

cortex, the insular cortex and

Times

of

India

says

that

Dr Mahesh Verma, principal
investigator of the project, said

ERLANGEN/LEIPZIG,

that a team of doctors, from

the cingulate cortex, all behaved

same,” Forster said, although, he

the brain—and the person—

MAIDS, conceptualized & desi-

The researchers led by Prof

similarly for both toothaches.

added, “their experiments might

couldn’t tell where the pain was

gned the outline for the implant

Clemens Forster of the Univer-

These brain regions are known

have missed subtle differences

coming from. “Dentists should

which has been fabricated by

sity of Erlangen-Nuremberg in

to play important roles in the pain

that could account for why some

be aware that patients aren’t al-

IIT Delhi engineers. “Five

Germany analysed the brain ac-

projection system, yet none

tooth pain can be localised.”

ways able to locate the pain”,

human trials of the indigenous

tivity in healthy volunteers as

showed major differences be-

implant, fabricated in India,

they experienced tooth pain. By

tween the two toothaches. “The

Because the same regions

have been successfully com-

delivering short electrical pul-

activation was more or less the

were active in both toothaches,

pleted,” he added. The micro

ses to either the upper left or the

CT analysis, to assess the per-

lower left canine tooth, a painful

centage and quality of osseoin-

sensation similar to that felt

tegration of implant in the trial,

when biting into an ice cube was

conducted on rabbits was done

triggered. To see how the brain

at Trivandrum-based research

responds to pain emanating from

institute have also

different teeth, the researchers

The World’s Dent al Newspaper  India Ed ition

used functional magnetic reso-

Published by Jaypee Brothers Medical Publishers (P) Ltd., India

The dental implants, impor-

nance imaging (fMRI) to monitor

© 2010, Dental Tribune International GmbH. All rights reserved.

ted from countries like US and

changes in activity when the

Israel, cost up to Rs 20,000.

upper or the lower tooth was

The indigenous implants are

stimulated.

shown

positive results.

expec-ted to provide a cheaper
solution to wider loser implants
in India.

“At the beginning, we expected a good difference, but that
was not the case,” Forster stated.

Forster says. “There are physiological and anatomical reasons
for that.” DT

International Imprint

DENTAL TRIBUNE

Dental Tribune India makes every effort to report clinical
information and manufacturer’s 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 or claims, or
statements made by advertisers. Opinions expressed by
authors are their own and may not reflect those of Dental
Tribune International.

Publisher
Torsten Oemus
t.oemus@dental-tribune.com

Chairman DT India
Jitendar P. Vij
jaypee@jaypeebrothers.com

Editor
Dr. Isha Goel
isha.goel@jaypeebrothers.com
Editorial Consultants
Dr. Gurkeerat Singh
Dr. Amit Garg

Dental Tribune India

Published by : Jaypee Brothers Medical
Director
Publishers (P) Ltd.
P. N. Venkatraman
4838/24, Ansari Road, Daryaganj,
venkatraman@jaypeebrothers.com New Delhi 110002, India
Phone: +91 11 43574357
e-mail:jaypee@jaypeebrothers.com
Chief Editor
Website: www.jaypeebrothers.com
Dr. Naren Aggarwal
naren.aggarwal@jaypeebrothers.com

BDZ/0909/04

in India,” he added.

[3] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

News & Opinion

IDEM confirms role as major APAC meeting
Organiser announces plans for 2012/More variety in the scientific programme
representing

Daniel Zimmermann
DTI

all

sectors

dentistry.

SINGAPORE/LEIPZIG, Germany:
With final participation numbers

Michael Dreyer, Vice-Presi-

having been announced, the

dent Asia Pacific of Koelnmesse

International Dental Exhibition

Pte Ltd, told Dental Tribune

and Meeting (IDEM) confirmed

Asia Pacific that despite organi-

its position as a major dental

sational changes and the eco-

meeting for the Asia Pacific

nomic turndown, IDEM 2010

region. An improved scientific

was in line with IDEM 2008.

programme & a higher number

He said that his company will

of exhibitors again drew more

aim to improve the meeting

than 6,000 dental professionals

further in order to make it

to Singapore. Exhibitors and

available to further professional

the organiser said that they

groups like dental assistants.

were satisfied with the number
Singapore Dental Association

and type of visitors this year.
Singapore’s Health Minister Khaw Boon Wan (third from left) pays a visit to IDEM 2010. (DTI/Photo courtesy of Koelnmesse)

President Dr Lewis Lee said that

IDEM, which is organised

affected by the global financial

exhibition, which saw increa-

For the first time, manufac-

the decision to hold pre-congress

by Koelnmesse Singapore Ltd,

crisis in 2008/09, growth rates

sed numbers of dental surgical

turers from the republics of

courses and master classes this

is held biannually in cooperation

are expected to pick up once

equipment and bone-grafting

Slovenia & Colombia showcased

year was well received by most

with the Singapore Dental Asso-

the economy begins to recover,

tools to aid dental implant

their portfolio in Singapore. The

congress attendees. He announ-

ciation and the FDI World Dental

a May 2009 industry report

procedures on display. Besides

British Dental Trade Association

ced plans to broaden the scien-

Federation.

stated. According to the same

classical equipment like instru-

hosted their first national pavi-

tific programme in 2012, incor-

report, sales figures of dental

ments, units or fillings, digital

lion at the show alongside trade

porating more topics like dental

This year’s scientific progra-

implants in the Asia Pacific

dentistry specialists also pre-

participations from Australia,

materials, orthodontics or oral

mme focused on implantology

region experienced doubledigit

sented 3-D imaging systems

Taiwan,

Korea,

medicine. A larger number of

and aesthetics— two of the most

growth rates back in 2008.

that aim to streamline comm-

France and Switzerland. The

hands on workshop will be

unication between dentists and

US and German dental industry

offered as well, he added.

successful sectors in the Asia

Singapore,

Pacific dental market. Although

Implantology was a signifi-

laboratories, and thus improve

were the most well represented,

sales figures were significantly

cant part of this year’s trade

long-term treatment outcomes.

with more than 20 companies

Dentists crucial for
detecting mouth
breathing symptoms
Daniel Zimmermann
DTI

Long Face Syndrome, gummy

NEW YORK, USA/LEIPZIG,

Moreover, poor sleeping habits

Germany: Medical and dental

that result from the condition

problems associated with mouth

can adversely affect growth and

breathing often go unnoticed by

academic performance.

smiles or other malocclusions.

health professionals, a new
study from the US suggests. The

Dentists may be the first to

habit, which is caused by abnor-

identify the symptoms of mouth

malities of the upper respiratory

breathing, as they typically

tract, usually occurs in spring

request that their patients return

when many people suffer from

every six months, which means

pollen and seasonal allergies.

that some people see their dentist

Dentist are advised to regularly

more frequently than they see

check for mouth breathing sym-

their physician.

ptoms and swollen tonsils especially in children as young as

Treatment for mouth breath-

5 years of age, the author

ing can be beneficial for chil-

recommends.

dren’s medical and social conditions if caught early. Swollen

If untreated, mouth breath-

tonsils and adenoids can be

ing can cause a wide range of

surgically removed by an ear-

medical issues such as poor

nose-throat specialist & dentists

oxygen concentration in the

can use expansion appliances

blood, high blood pressure or

to help widen the sinuses and

sleep apnoea. In addition, it has

open nasal airway passages

been found to be responsible for

if the face and mouth are

abnormal facial growth prima-

narrow. DT

rily in the upper and lower jaw
shape of children, leading to

 DT page 6

[4] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

trends & applications

Does dentine hypersensitivity affect oral
health-related qualty of life?

as 60 to 98 per cent have been
reported in patients with periodontitis. While many individuals do not seek treatment to

To be able to assess levels of

desensitise their teeth because

OHIP questions are:

OHRQoL in non-English speak-

they do not perceive dentine

of OHRQoL facilitates studying

• Have you had trouble pron-

ing populations, cross-culturally

hypersensitivity to be a severe

oral complaint frequently repor-

the impact of a disease on a

ouncing words because of

adapted translations of the origi-

oral health problem, 10 to 25

ted in clinical dental practice.

person’s total oral health be-

problems with your teeth,

nal English-language version of

per cent of patients experience

While many individuals do not

cause it can be used across

mouth or dentures?

the OHIP into Chinese, Dutch,

discomfort to the extent that

seek treatment to desensitise

conditions. It describes the way

• Have you found it uncomfort-

Hungarian, Italian, Japanese,

it interferes with their eating,

their teeth because they do not

in which oral health affects a

able to eat any foods because

Portuguese, Spanish & Swedish

drinking (hot & cold beverages),

perceive dentine hypersensitiv-

person’s ability to function, his or

of problems with your teeth,

has been achieved in several

oral hygiene habits and some-

ity to be a severe oral health

her psychological status, social

mouth or dentures?

countries. The demand for an

times even breathing. The deg-

problem, a substantial number of

factors and pain or discomfort.

• Have you felt that your sense

internationally comparable Ger-

ree of discomfort depends on

of taste has worsened beca-

man tool led to the development

individual pain perception, pain

use of problems with your

of a German version of the OHIP

tolerance, and emotional and

on oral health and orofacial

handicap. Examples of some

concerns (Fig. 1). The concept

Dentine hypersensitivity is an

Dr Katrin Bekes
Germany

patients experience discomfort
to the extent that it interferes

How to measure OHRQoL

with their eating, drinking, oral

OHRQoL is a multidimensional

teeth, mouth or dentures?

(OHIP-G), which determines the

physical factors. These symp-

hygiene habits and sometimes

construct that cannot be obser-

For each of the 49 OHIP ques-

OHRQoL of German speaking

toms are highly relevant from

even breathing. These symptom

ved directly. It needs to be visua-

tions, subjects are asked how

persons. OHIP-G includes the 49

the patient’s point of view and

often have a considerably adve-

lised by means of suitable indi-

frequently they have experien-

items of the English original, as

often have a considerably adve-

rse impact on their daily quality

cators. In order to comprehend

ced the oral problem. Responses

well as four additional items that

rse effect on daily QoL.

of life (QoL). This article reviews

a construct like this, target per-

are according to a Likert-type

were regarded as important for

the impairments of oral health

sons, that is patients, have to be

scale: 0 = never, 1 = hardly ever,

the German population specifi-

A study was conducted at

related quality of life in patients

asked pertinent questions. For

2 = occasionally, 3 = fairly often,

cally. OHIP-G can be applied to

the Martin Luther University,

seeking care for dentine hyper-

example, some questions focus

and 4 = very often.

patients of 16 years and older.

Halle-Wittenberg, Germany to
describe and evaluate OHR QoL

sensitivity.

in patients with dentine hyperTraditionally, dentists have

sensitivity. Data was collected

been trained to recognise & treat

through a questionnaire as part

oral diseases & to describe them

of a larger study targeting several

by using dental indices. Dental

areas of oral health beyond

indices provide a quantitative

hypersensitive teeth, such as oral

method for measuring, scoring,

hygiene, prevention efforts, and

and analysing dental conditions

oral behaviours and habits.

in individuals and groups. They
describe the status of individu-

Fig. 1. OHRQoL is one dimension of quality of life.

Fig. 2. Hypersensitive cervical dentine surfaces.

There were 724 patients
(mean age: 42.8 ± 13.0 years)

als or groups with respect to

tions, with 5 scoring steps each,

OHRQoL in patients
seeking care for dentine
hypersensitivity

offices because of hypersensi-

social interaction. The Oral

which provides a good impres-

Dentine hypersensitivity is a

tive teeth and reacting positively

disease processes. They give no

Health Impact Profile (OHIP)

sion of the extent to which OHR

common oral complaint that is

to an air stimulus applied by the

indication of the impact of the

is amongst the most widely used

QoL is affected. A score of 0

frequently reported in dental

dentist. Patients with removable

disease process, especially oral

instrument in studies evaluating

indicates the absence of any oral

practice. It is characterised by

partial dentures & patients with

disorder, on function or psycho-

OHRQoL. It attempts to measure

health related problem. Higher

a short and sharp pain arising

missing answers in the OHIP

social well being, and only pro-

both the frequency and severity

scores represent an OHRQoL

from exposed dentine and occu-

questionnaire were excluded.

vide little insight into the impact

of oral problems on functional &

that is more impaired. The

rring in the presence of ther-

After these exclusions, 656

on daily living and QoL.

psychosocial well being. This

most extensive impairment of

mal, chemical, tactile or osmotic

patients remained in the study

tool was developed by Slade and

the OHRQoL is expressed by a

stimuli (Fig. 2). From the rela-

for analysis. These patients were

Spencer in Australia in 1994.

score of 196. This is termed the

tively few studies that investi-

compared with 1,541 subjects

problem index and demonstra-

gate the prevalence of dentine

without removable partial den-

the condition being measured.

on function, some are concerned

A summary score of between

How ever, important as these

with pain and discomfort, and

0 & 196 results from the 49 ques-

objective measures are, they

others evaluate self-image and

only reflect the end-point of the

Therefore, QoL research in
medicine & dentistry has attrac-

who participated in the study,
presenting at 161 German dental

ted increasing attention over

The OHIP is a 49-item meas-

tes that all oral problems are

hypersensitivity, it can be con-

tures from a national, general

the past years. QoL is defined

ure, with statements grouped

frequently encountered. A table

cluded that it is a frequent con-

German

as an individual’s perception

into seven theoretical domains,

of standard values representa-

dition. Studies have reported a

(mean age: 37.7 ± 13.4 years).

of his or her position in life, in

namely functional limitation,

tive of different populations is

prevalence of dentine hypersen-

OHRQoL was assessed using

the context of the culture and

pain, psychological discomfort,

provided, according to which the

sitivity in the adult dentate popu-

OHIP-G. The patients comple-

value systems in which he or

physical disability, psychological

patient’s score can be compared

lation ranging from 4 to 57 per-

ted the OHIP-G questionnaire

she lives and in relation to his or

disability, social disability and

and evaluated.

cent. However, figures as high

in the dental office.

population

sample

her expectations, goals and concerns. QoL has multiple dimensions (such as cultural factors,
social integration, socioeconomic status, quality of environment and personal autonomy).
One dimension of QoL is health.
The real impact of health and
disease on QoL is known as
health related quality of life
(HRQoL). Oral health related
quality of life (OHRQoL) is that
part of HRQoL that focuses

Fig. 3. Differences in OHRQoL measured with the OHIP questionnaire in patients
with dentine hypersensitivity and in a general population sample.

Fig. 4. OHRQoL in patients with dentine hypersensitivity and in a general population
grouped by gender.

[5] => DTAP0109_01-02_TitleNews

[6] => DTAP0109_01-02_TitleNews

6

DeNtal tribuNe | april-June, 2010

trends & applications
The OHIP-G summary score

score of 30 (Fig. 3). Ten percent

women reported more prob-

of treatment. The impact of

on whether or how patients

characterised the OHRQoL con-

of the subjects with the highest

lems with the condition of

oral disorders and interventions

should be treated. The extent

struct as a whole. The OHIP-G

OHI P-G summary scores had

dentine hypersensitivity than

on

oral

of this effect is comparable to

summary score of patients with

scores of 36 (general popula-

men, which is in contrast to the

health status and OHRQoL is

that of other oral diseases and

hypersensitive teeth was 34.5

tion) and 66 (patients).

general population, in which

increasingly recognised as an

conditions, such as temporo-

men had higher OHIP scores

important component of health.

mandibular

than women (Fig. 4).

Dentine hypersensitivity is a

present investigation is the first

frequent problem that can be

study that evaluates the impact

observed in adults of all ages.

of this condition using a widely

(± 22.6), while the general
population sample had a score

Differences

according

to

patients’

perceived

disorders.

The

of 12.2 (± 18.4). The 22.3 differ-

gender were minimal. Although

ence was statistically signifi-

the difference between gender

Conclusions

cant. The general population

of a mean 2.8 points was stati-

QoL has been established as

In this study, patients with

used patient-centred outcome

subjects had an OHIP-G median

stically significant (p < 0.01),

an important outcome for eva-

sensitive teeth reported sub-

measure to characterise the

score of 5, while the patient

it was regarded as negligibl.

luating the impact of a disease

stantial OHR QoL impairment,

broader

group had an OHIP-G median

Amongst the patient group,

and for assessing the efficacy

which may have an influence

condition on patients’ perceived

influence

of

this

oral health. DT
About the author

Dr Katrin Bekes is Assistant
Medical Director at the Department of Operative Dentistry and
Periodontology, University School
of Dental Medicine, Martin Luther
University Halle-wittenberg, Halle
/Saale Germany. She can be contacted at katrin.bekes@medizin.
uni-halle.de.

 DT page 3

Delegates that joined the
first precongress sessions on
Thursday morning confirmed
that the programme was a large
improvement to the offerings
in 2008. Most of the people interviewed said that because of
these changes they were able to
attend most of the sessions held
during the course of the meeting.
“I think the congress was pretty
well organised and there was
less overlapping which made
it easier to get into more sessions,” said one dentist from
Singapore.
According to Mr Dreyer, preparations for the next edition of
IDEM in 2012 have already
begun and the first speakers
have been announced. Amongst
others, there will be sessions on
the management of endodontic
disasters, the biological effects
of current restorative materials
on the pulp-dentine complex
and current concepts on posts
and cores.
The next meeting is scheduled
to be held 20–22 April 2012. DT

[7] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

Case report

7

A case report: Unusual anatomy of maxillary second molar
eral. Libfeld and Rostein also

ograph revealed a large carious

namely mesiobuccal (MB), disto-

well as after completion of

examined 1200 teeth radio-

lesion on buccal surface of #27

buccal (DB), mesiopalatal (MP),

the preparation. Conefit was

graphically, and reported that

involving the pulp (Fig. 1). Based

and distopalatal (DP). Two dis-

carried

four rooted maxillary second

on clinical and radiographical

tinct palatal orifices related to

dardized gutta-percha of med-

The main objectives of an

molars occurred in 0.416% of

evidence, it was diagnosed as

two separate palatal roots were

ium size (Sure-endo, Korea)

endodontic treatment are the

cases.8 The four roots in maxil-

irreversible pulpitis.

identified.

with the help of gutta-percha

elimination of microorganism

lary molar is more frequent in

from the root canal system

second molars, the conclusion

Dr P D Joshi
India

Introduction

gauge

out

with

(Dentsply

non-stan-

Maillefer,

Ballagues) (Fig. 10 & 11).

The careful observation of

The extensive search with

periapical radiograph shows that

Ultrasonic tip #2 of Start X

the second molar has unusual

was carried out for second

Now, the canals were dried

This case report illustrates

root morphology, i.e., it has four

MB, but could not be located.

using paperpoints of size F3 (by

the importance of knowledge

separate roots. The unusual two

They were further straightlined

Dentsply Maillefer, Balla-gues)

about unusual variations in

separated palatal roots are long

with X-Gates of cavity access

and then obturated with selected

This case report presents

morphology of root and canal,

and diverging like horns.

set (by Dentsply Maillefer, Bal-

cone, using down pack with sys-

an unusual maxillary right

proper acess opening, gaining

lagues) (Fig. 5 & 6). The working

tem B and back pack with obtura

second molar with four roots

straight line access, proper

The non-surgical endodontic

length (WL) was determined

II device (Fig. 12). A periapical

(mesiobuccal, distobuccal, mesio-

cleaning and shaping of canals,

therapy was planned for tooth

using Root ZX electronic apex

radiograph (Fig. 13) was taken

palatal, and distopalatal). The

and obturation.

#27. The treatment was started

locator (EAL), (by Dentaport ZX,

to confirm the quality of obtura-

with administration of local

J. Morita, Japan).

tion. Permanent restoration was

and prevention of subsequent

9

made by Christie, et al.

reinfection of the system.1 Inability to find and properly treat
the canal may cause failure.2

unusual morphology of roots of
the maxillary second molar

Case report

may be a challenge in diagnosis

A 34-year-old female reported

with 1:200000 adrenaline. Caries

Files were placed in the

and treatment execution. 3-5

to the clinic with the chief com-

was removed, and then the

canals (Fig. 7) according to WL

Discussion

plaint of pain in relation to upper

missing buccal surface of the

determined by EAL, and then

Incidence of four rooted maxil-

Diamond, in his textbook

left back tooth region since two

tooth was build up using glass

one more periapical radiograph

lary second molar is very rare.

on dental anatomy, has shown

days, and pain usually occur

ionomer cement fuji type II, to

was taken to confirm the WL

Etienne Deveaux10 presented

two cases of maxillary first

after stimulation with hot and

facilitate the isolation of tooth

(Fig. 8).

a case report in Vol. 25, No. 8,

molars with two distinct palatal

cold liquids. The patient gave the

using Rubber Dam (Hygienic

roots.6

history of pain getting worse on

Corp., USA).

anesthesia using 2% lignocaine

lying down, and waking up

done on the next appointment.

JOE Aug. 1999, and Peter M
The cleaning and shaping

Di Fiore11 presented first molar

of canals were carried out with

in Vol. 25, No. 10, JOE Oct. 1999.

Sabala, et al, in a radiogra-

with pain in the middle of the

A usual triangular access

rotary NiTi Protaper instrum-

Hartwell and Bellizi12 reported

phic survey, found that the most

night. The clinical examination

cavity (Fig. 2) was modified

ents series (by Dentsply Mail-

that 9.6% of maxillary molars,

common aberration of maxillary

showed a large carious lesion

to square-shaped (rhomboidal)

lefer, Ballagues), according to

they examined, had four canals,

molars involved the fusion of

on the buccal surface of the

(Fig. 3) using cavity access set (by

the manufacturer’s instructions.

but had not mentioned about

22 percent of the facial roots

maxillary left second molar

Dentsply Mail-lefer, Ballagues),

The final instrumentation was

any case with four roots.

of second molars.7 They discov-

(#27). Vitality test with cold

and was further refined with tip

carried out with sizes S1 to F3

ered that aberrations occurred

stimulant revealed severe, rapid,

#2 of Start X ultrasonic kit (by

of NiTi Protoper instruments

Christie, et al,9 have proposed

in less than 1 percent of the

and long-lasting pain from

Dentsply Maillefer, Ballagues)

(Fig. 9). For irrigation, 3%

a classification system for four

cases and that of 90 percent

maxillary left second molar.

(Fig. 4). After access opening,

sodium hypochlorite was used

rooted maxillary second molar

of such aberrations were bilat-

Pre-operative periapical radi-

the four orifices were explored,

during instrumentation and as

abnormalities.

Fig. 1: Pre-operative radiograph

Fig. 2: Triangular access opening

Fig. 3: Modified (Rhomboidal) access opening

Fig. 4: Ultrasonic Tip

Fig. 5: X-Gates being used for straight lining of access

Fig. 6: Access after orifice enlargement

Fig. 7: Files in position for WL

Fig. 8: WL radiograph

Fig. 9: WL radiograph for buccal canals

Fig. 10: Shaping with Protaper Instruments

Fig. 11: Conefit

Fig. 12: Conefit Radiograph

[8] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

Case report

Type I with long tortuous diver-

Christie’s classification. Accord-

gent separate palatal roots

ing to literature, it occurs bila-

Type II with short blunt and

terally, but in this patient it

parallel roots

was unilateral.

Type

III

those

with

three

convergent roots and distinctly
divergent fourth distobuccal
root.
The tooth treated in this
case appears to be of Type I
variety

according

the

References
1. De Deus QD. Endodontia,
5th ed. Medsi: Rio de Janerio.
1992.
2. Zeigler PE, Serene TP. Failures
in therapy. In: Cohen S, Burns
RC, eds. Pathways of the pulp.
4th ed. St Louis: CV Mosby 1987:
723-753.

3. Thompson BH. Endodontic
therapy of an unusual maxillary
second molar. J Endodontics
1988; 14: 143-146.
4. Fahid A, Taintor JF. Maxillary
second molar with three buccal
roots. J Endodontics 1988; 14:
181-183.
5. Malagnino V, Gallottni L, Passariello P. Some unusual clinical cases on root anatomy of
permanent maxillary molars.
J Endodontics 1997; 23: 127128.
6. Diamond M. Dental anatomy
including anatomy of the head

and neck. New York: MacMillan
1952: 203-205.
7. Sabala CL, Benenati FW, Neas
BR. Bilateral root or root canal
aberrations in a dental school
patient population. J Endodontics 1994; 20: 38-42.
8. Libfeld H, Rotstein I. Incidence
of four-rooted maxillary second
molars: literature review and
radiographic survey of 1, 200
teeth. J Endodontics 1989; 15:
129-131.

Fig. 13: Post-obturation view

9. Christie WH, Peikoff MD, Fogel
HM. Maxillary molars with
two palatal roots: a retrospec-

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10. Etienne Deveaux: Maxillary
second Molar with Two Palatal
Roots; Vol. 25, No. 8, JOE. 1999
Aug.
11. Peter M.Di. Fiore: A FourRooted Quadrangular Maxillary Molar Vol. 25, No. 10,
JOE. 1999 Oct.
12. Hartwell G, Bellizzi R. Clinical
investigation of in vivo endodontically treated mandibular &
maxillary molars. J Endodontics
1982; 8: 555-557. DT

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conservative dentistry & endodontics. He has a private practice
specializing in endodontics in
Mumbai. In addition, he has taken
specialized training in microscopic
endodontics from the University of
Pennsylvania, USA, and in implant
dentistry from Germany. He is an
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micro-dentistry at Government
Dental College, Mumbai. He lectures & demonstrates extensively
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and micro-dentistry. He can be
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[9] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

Clinical

Treating a peri-radicular abscess
Dentist Nicolai Orsteen presents a clinical case study looking at the treatment of a maxillary left lateral front tooth
The patient is a 24-year old white

referred for examination and

Northern European male. His

treatment of tooth 22.

chief complaint was pain from

Following the investigations,
the diagnosis showed that a peri-

tion was completed mechani-

cussion. The temporary filling

cally using Hedstroms files

was removed and the root canal

(size 90/20 mm/incisal edge).

disinfected again with Irrisafe,

the maxillary left lateral front

Diagnosis

radicular abscess was related to

tooth, with periodic swelling of

The extra-oral examination on

non-vital tooth 22. The problems

Particular care was taken

percen NaOCl, two per cent

the left anterior palatal.

30 January 2008 was within

associated with the diagnosis

during irrigation due to the

CHX and 17 per cent EDTA.

normal limits, shown in Figures

were a wide root canal, and an

open apex, & ultrasonics were

A long-term intra- canal dressing

2 and 3.

open apex with large apical

used for the further cleaning

with Ca(OH)2 was placed, and

lesion.

of the canal. A formula of one

IRM was applied as a temporary

per cent NaOCl, two per cent

filling.

The patient’s dental history
indicated previous problems in
this region, documenting an

However, as is visible in Table

as well as a formula of one

one, the intra-oral examination

The structured treatment

CHX and 17 per cent EDTA were

March 2007 due to pain and

revealed gingival bleeding on

plan involved conventional root

used for chemical root canal

swelling from tooth 22. He was

prodding, no sinus tract and

canal treatment, and to be assess

disinfection. The canal was

Preparing for root
treatment

prescribed a seven-day course of

fluctuant swelling of the palate

for surgery after six months.

dressed with Ca(OH)2 and IRM

The patient missed the follow-

Penicillin V tablets (660mg

mucosa in the area of teeth 21,

was applied as a temporary

ing three appointments, but re-

qds*4) for acute apical periodon-

22 and 23. The periodontal

The treatment plan

filling.

turned on October 14. On this

titis tooth 22. Following this

pockets however, were within

Treatment commenced on 3

appointment, the patient was

normal limits.

April 2008. Following an initial

Five days after the comple-

to percussion and palpation. As

clinical examination, the tooth

tion of the treatment, the patient

there were no real signs of im-

emergency

appointment

Table 1: Clinical findings

date the tooth was still sensitive

was diagnosed with & apical

sought an emergency consulta-

provement, it was decided that

Sensitivity to Cold

Yes

abscess (no sinus present). Ac-

tion because of severe pain and

the tooth should be root filled &

Percussion

Yes

cess was gained under a rubber

swelling from tooth 22. He was

an appointment for apical sur-

Palpation

Yes

dam and the canal was filled

prescribed an eight-day course

gery was made. To ease discom-

Mobility

with exudate.

of clindamycin (500 mg x 3*3)

fort, the root canal was filled

Probing Depth (mm)

to ease the discomfort.

with an 8mm length of white

Restoration

NoneComposite (Pal)

None

Further radiographic investigation in April 2008 revealed that the patient was suffering from a
discontinuation of the lamina dura on tooth 22, as well as a large circumscribed apical radiolucency (Ø 15mm). The radiographic findings in the coronal part of the root were diagnosed as
dens-in-dente (see Figure 4).

Fig. 2: Frontal view

Fig. 1: Frontal view

Fig. 5: Working lenght radiograph Fig. 6: MTA in the canal

Fig. 10: Elevation of surgical flap

Fig. 7: MTA in the canal

Fig. 11: Granulation osteotomy

The root canal length was

MTA, & a wet cotton pellet was

determined both by apex locator

Following the surgery, on

placed over the MTA. On top of

(RootZX) and a periapical radi-

May 29, tooth 22 was asympto-

the cotton pellet, a temporary

ograph. The root canal disinfec-

matic and swill sensitive to per-

filling with IRM was placed.

Fig. 3: Occlusal view

Fig. 4: Pre-operatve periapical radiograph

Fig. 8: MTA, wet cotton pellet and IRM

Fig. 9: White MTA in the canal

Fig. 12: Granulation tissue removed & root-end resection performed

Fig. 13: Flap sutured with 6-0 silk sutures

[10] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

10 Clinical

Fig. 14: Suturing at the junction between the mesial
vertical releasing incision and the horizontal
marginal incision

Fig. 18: Occlusal view after removal of sutures

Fig. 15: Wound healing before removal of sutures

Fig. 16: Wound healing at the junction between the
mesial verical releasing incision and the horizontal
marginal incision before removal of sutures

Fig. 19: Composite filling on the palatal aspect of tooth 22

Fig. 17: Wound healing after removal of sutures

Fig. 20: Post-operative view

Fig. 21: Post-operative periapical radiographs

The re-operative procedure

a root-end resection of about

tablets (qds 660 mg *4) for seven

lined cystic wall with intense

was carried out on November

three millimeters of the root.

days was also given.

chronic to acute inflammation,

6. A marginal incision from

The root end was inspected

The sutures were removed

the mesial aspect of tooth 21

through the operating micro-

on November 13, and there was

and to the distal aspect of tooth

scope, & no fracture was found.

evidence of good soft tissue
healing. The patient experi-

23 was made, followed by

consistent with a radicular cyst.

Result
Prognosis

enced no discomfort from the

The patient’s long-term prog-

surgical site.

nosis is uncertain, due to the

5mm vertical releasing incisions

The adaptation of the white

at the mesial aspect of tooth

MTA to the root canal was judged

21, and a length of 10mm at the

as good and the operation site

distal aspect of tooth 23. The

was inspected and rinsed with

The temporary filling and

mucoperiostal flap was elevated

sterile saline, before being

cotton pellet were removed

(see Figure 10), and a pathologi-

sutured with five 6-0 silk sutures.

during the post-treatment resto-

Follow-up
On November 13 for a twelve-

ration procedure, and replaced

month post-surgery appoint-

by

restoration

ment, the patient was still asy-

cal fenestration of the cortical

About the author

thin root canal walls and risk

a

composite

of fracture.

buccal bone was evident, appro-

The patient was informed

ximately 3mm from the marg-

about the prognosis of the

(35 per cent phosphoric acid,

mptomatic. Teeth 21 and 23

inal bone crest between teeth

tooth and given post-operative

Adper, Scotchbond, Filtek Flow

were sensitive to ice-test, and

22 & 23. An osteotomy was per-

instructions. Six 400mg Ibupro-

(A3) in the apical part, Filtek

there were no periodontal prob-

formed after which the lesion

fen tablets were dispensed, and

Supreme (A3D and A2B) in the

ing depths over four millimetres

was treated by curettage. A bio-

the patient was instructed to

coronal part). Teeth 21 and

around tooth 22.

psy of the lesion was taken.

take one every four hours in

23 maintained vitality. The histo-

The palatal cortical bone also

the first day following surgery.

logical report of the lesion

had a pathological perforation,

A prescription of Penicillin V

showed a partial epithelium

The

radiograph

evidence of healing. DT

showed

Dr Nicolai Orsteen graduated
from the University of Oslo in January 2002, completing his specialist
training in endodontics in June
2009. He then worked in general
practice in Oslo from February 2002
was also a secretary on the regional
dental board in Norway from 2004
to 2006. From August 2008, Nicolai
worked at a specialist practice in
Oslo before joining the specialist
team at Endocare Richmond and
Harley Street. For more information please call 020 7224 0999 email
reception@endocare.co.uk or visit
www.endocare.co.uk .

[11] => DTAP0109_01-02_TitleNews

[12] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

12 interview

“Evolution of mini-implants”
Interview with Dr Oliver Hennedige, Singapore
About 24 years ago, an accom-

coating osseointegration takes

in immediately extracted socket.

growth wherever these are

plished implantologist, Dr Victor

place, I must caution not all

What I do, is measure the length

introduced.

Sendax of America, decided to

mini-implants and conventional

of the extracted root, choose

question the protocol and ration-

implants are the same. They

a mini-implant at least 2-3 mm

What are the advantages and

ale in placing large diameter

are not generic products, and

longer than the lenght of the

disadvantages of mini-implants

implants. He developed the

you have to choose your mini-

root, and utilize the same proce-

over conventional implants, and

small diameter implants with a

implant carefully, i.e., the com-

dure of the initial use of a pilot

are there limits for their use?

straightforward protocol, which,

pany that produces it.

drill, I introduce the mini-

in most instances require no

implants into the socket. It is

Really, the advantages of mini-

surgery, and with an initial entry

I utilize Mini Drive-Lock,

firm and I always pack a bone

implants are phenomenal. You

point with only a pilot drill, he

(MDL), coming from the United

augmentation material into the

can even use in medically

Dr Oliver Hennedige is the

proposed a self-tapping (screw-

States of America. It has really

socket and stitch tight the open-

compromised

Secretary General of Asia Pacific

ing) procedure, which not only

good properties which allow

ing. If the opening is large,

controlled diabetes, heart condi-

Dental Federation (APDF) and

delivered the implant into the

easy placement and long-term

e.g., molar extraction, I place a

tion, and for those who are suffer-

is Executive Director, Interna-

bone but also firmly secured it

stability, especially for crowns

membrane over the socket, so as

ing from Alzheimer where there

tional College of Continuing

into its place. It was minimally

and bridges. The Food and

to prevent washing out of the

is very poor control of jaw

Dental Education (ICCDE). He

invasive, incredibly less trau-

Drug

bone augmentation material.

movement, stabilized dentures

runs a very successful group

matic, and painless. It allowed

dental practice in Singapore,

the operator to stabilize dentures

and lectures and demonstrates

and securely fix crowns and

extensively

dental

bridges. Today, it is widely used

implants. DT India editor, Isha

worldwide and will, in my view,

Goel, had a chance to speak with

replace conventional implants.

Dr Oliver during a workshop,

There are very few instances

organized by APDF, ICCDE, and

indeed and mini-implants, once

Indian Dental Association (IDA)

it is understood, will become

recently in New Delhi, India.

standard practice. In fact, there

mini

Administration

from

patients

with

is an exponential growth of

Isha Goel: The dental implants

mini-implants in America and

have been the most influential

worldwide, because of simplic-

change in dentistry and you re-

ity, extremely high success rate,

cently shared your views about

and above all patients talk about

evolution of mini-implants in a

the straightforward procedures

workshop organized by Asia

and good aesthetic results.

Pacific Dental Federation, ICCDE,

and IDA recently in New Delhi,

Mini-implants

growth

Dr Oliver, Dr Anil Kholi, Dr Jeffrey Tsang, and Dr Paramjit Singh (from left to right) during the workshop in New Delhi, India.

India. Can you give our readers

phenomenal and will be a pro-

an overview of the rationale

cedure, which every dentist of

America, which is very stringent

I allow initial healing for

with mini-implants or fixed

for use of mini-implants?

the present and future genera-

in its protocol, has accepted

about 3-4 weeks and then pro-

crowns and bridges have been

tion will need to know. Its growth

MDL for long-term use in the

ceed to do the prosthetic aspect.

a gift to them.

Dr Oliver: Mini dental implants

will be driven by patients’

mouth.

I’ve met with very good results.

evolved because of the draw-

demand.

backs and failures of the larger

Very old and frail patients

I use Perioglas from the USA
My experience having placed

with badly resorbed jaws need

for best results.

diameter conventional implants.

How do mini-implants osseo-

more than 3000 units, is that

Conventional implants, while

integrate and what is your

mini-implants not only work,

An observant selection, appro-

being promoted as the panacea

experience on their long-term

patients love them and these

priate treatment plan, precise

can be really benefited with the

for missing teeth, have a high

stability?

are an excellent practice builder.

surgery, and proper design of

use of mini-implants. I’ve placed

I can safely say that I enjoy at

prosthesis are essential for opti-

mini-implants in such patients

failure rate as these would re-

not undergo invasive procedures
bone

build-up.

They

quire an invasive procedure,

The probability of osseointe-

least a 95 percent success

mal outcome. How will you

in their late seventies and

a very skillful operator, a lot of

grating of mini-implant is much

rate. I see my patients regularly

grade the success rate of mini-

eighties. Some of my patients

understanding, and the use of

greater, as it does not utilize

for all dental procedures on a

implants in comparison with

are still eating well and living

a complex range of specialized

osteotomy (in simple terms,

6 monthly recall and mini-

conventional implants?

quality lives right into their

and specific instruments. The

cutting out large chunks of bone

implants placed in more than

complexity has resulted in strict

in order to introduce the con-

seven years ago (that is when

Frankly

protocols that hoped to minimize

ventional implants). Without the

I embarked on mini-implants)

really no comparison. Mini-

I believe mini-implants will

failures.

trauma of this procedure, which

are still functioning well. It

implants were actually devel-

continue to evolve and a whole

may generate excessive heat,

is truly an advancement that

oped because of the drawbacks

range of uses will come into

While conventional dental

may ultimately result in bone

the dental profession cannot

and failures of conventional

existence, as they are minimally

implants are successful in the

necrosis & failure of the conven-

ignore.

dental implants. They are afford-

invasive, easy to use, operator

hands of an experienced and

tional implants, mini-implants

able and are really revolutioniz-

friendly, patient friendly, and

competent operator, it generally

utilize a self-tapping procedure,

Canmini-implants also be placed

ing the use of dental implants.

will be really a boon to patient

failed in the hands of those with

which allow, intimate and firm

in the socket immediately after

As I predicted, seven years ago

care. Mini-implants are afford-

less experience. It took time, and

contact of mini-implant to bone,

the tooth extraction like we do

in an article, it will bring about

able and cost a fraction of

usually a lot of failures on the

once it is introduced.

with the regular implants?

a paradigm shift in the use of

conventional implants. DT

tional implants.

speaking,

there

dental implants. Mini-implants

way before a dentist or specialist
became adept in placing conven-

nineties.

With the specific design like

In my practice and in my lectures,

are so successful that these

Dr Oliver thank you very much

a typical screw and surface

I teach the use of mini-implants

are experiencing exponential

for the interview.

[13] => DTAP0109_01-02_TitleNews

[14] => DTAP0109_01-02_TitleNews

Issue 2
March 2010

Brushing off

Dentin Hyper
Proper Technique Helps Prevent Potential Oral Problems
There is a growing professional awareness that dentinal hypersensitivity is one of
the top five oral problems which may compel an individual to seek dental care.
Dentinal hypersensitivity is described clinically as a
short, sharp pain due to exposed dentinal tubules
responding to a variety of external stimuli which
includes thermal, osmotic, mechanical, evaporative,
and tactile stimuli.
Common treatment modalities usually involve
prevention of the occurrence of nerve stimulation by
either occluding the dentinal tubules or altering the
nerve stimulation process. Reduction or elimination
of risk factors, which include appropriate behavioral
conditioning among others, is also an integral
component of managing dentinal hypersensitivity.
The exposure of dentinal tubules is generally
attributed to the loss of tooth substance, both
enamel and cementum. One of the factors
contributing to the surface loss is poor tooth
brushing technique. If done injudiciously,
toothbrushing, the very activity designed to protect
Opening of the dentinal tubules
( Scanning Electron Microscope)

the health of the
dentition, may actually
be a significan t factor in
undermining the tooth
structure and, in
consequence, oral
health, itself.
Vigorous and
horizontally directed
strokes particularly on
the gum area can wear a
v-shaped abrasion on the neck of the tooth. This will
render a large number of dentinal tubules exposed
and open to the oral environment and the fluids
inside vulnerable to rapid pressure changes which in
turn elicit nerve response perceived as a painful
sensation by the patient.
Behavioral modification coupled with the use of
“tissue friendly” soft toothbrush and gentle
toothpaste may significantly prevent the
unnecessary exposure of dentinal tubules. Using
soft-bristled tooth brush, the patient may direct
the tufts at a 45-degree angle around the gum
area and apply deliberate but gentle sweeping
strokes along the tooth surface towards the
incisal or cuspal surfaces. The gum area should
also be covered in the gentle brushing to aid in

YOUR P
PARTNER
ARTN
NER IN
N OR
ORAL
RA
AL HE
HEALTH
EA
ALTH

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ÛÃÊ>ÀiÊ>VÌÛiÊÊ\Ê}Ê}ÊUÊ

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>`ÊUÊ* ««iÃÊUÊ>>ÞÃ>ÊUÊ-}>«ÀiÊUÊ6iÌ>ÊUÊ,ÕÃÃ>ÊUÊ1
««iÃÊUÊ>>ÞÃ>ÊUÊ-}>«ÀiÊUÊ6iÌ>ÊUÊ,ÕÃÃ>ÊUÊ1

[15] => DTAP0109_01-02_TitleNews

THE
E DENT
ENTAL
TAL
A PROFESSION
ROFESSION & PA
ATIENT
TIENT PARTNERSHIP
ARTNERSHIP

ORAL
O
RAL CARE LINK
COLGATE
ATE PROFESSIONAL INFORMATION CENTER

rsensitivity

Dr. Arturo De Leon
Dean of Fatima College of Dentistry
Philippines

enhancing tissue stimulation and blood circulation
for a more improved health of the gingiva.
Brushing the teeth correctly, at least
twice a day, with fluoride-containing
toothpaste may help provide the
individual with an acid-resistant
protective layer. And in case of the
onset of symptoms of dentinal
hypersensitivity, one may find relief by
using hypersensitivity relieving paste.
aste. In search of
such appropriate relief, scientific advancements are
directed towards the use of natural existing
ingredients and more natural ways of relieving
dentin hypersensitivity (e.g. sealing or occluding the
dentinal tubules with calcium and phosphate -rich
materials). As reported a more recent
technological breakthrough paved the way
towards the development of a toothpaste which
is clinically proven to provide immediate and
lasting relief from dentin hypersensitivity with
the use of a naturally occurring amino acid found
in saliva.

Cuspal
C
uspal

Colgate® 360°® Sensitive toothbrush

A two-minute brushing is said to be sufficient to
clean the different surfaces of the dentition. It is just
like enjoying your favorite music while doing
something after savoring your favorite dish or meal.
Undoubtedly, it is also like brushing off a potential
problem like dentinal hypersensitivity while enjoying
an after-meal personal hygiene activity towards a
healthy smile.

À>iÊUÊ/ÕÀiÞÊUÊ>â>
À>iÊUÊ/ÕÀiÞÊUÊ>â> ÃÃÌ>ÊUÊiÀ}>ÊUÊÀi>ÊUÊâiÀL>>
Ì>ÊUÊiÀ}>ÊUÊÀi>ÊUÊâiÀL>>

www.colgateprofessional.com
www.colg
gate
eprofes
o ssiona
o al..com
m

[16] => DTAP0109_01-02_TitleNews

[17] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

Product Spotlight 17

Saddle stool in dentistry
Veli-Jussi Jalkanen, specialist in sitting ergonomics discusses a healthy and comfortable way to sit

Dental Events
2010

While some dental professionals

degree angle, tilting the pelvis

For men (who have the pubic

chair. The movements you do

have insufficient knowledge to

to a near neutral position, as

bone much further back than

while using the chair keep your

be able to recognise or manage

when standing. This allows the

women) a divided seat is a safer

muscles active and improve your

sitting disorders, others realise

lower back and upper body to

solution in the long run. Pressure

metabolism.

that back pain and shoulder

find a relaxed, natural posture

on the pudendal nerve & tissues

tension have a lot to do with

without the need for a backrest.

on the pubic bone can lead to

sitting. Poor circulation in the

Feet rest on the floor on both

erectile dysfunction. Loose, light

The Scandinavian
working concept…

lower extremities; shortage of

sides of the body as if you were

and stretching trousers are hig-

…is shown in the pictures. Often-

1st HONG KONG INTERNATIONAL
DENTAL EXPO

oxygen; hip, knee and shoulder

riding a horse. This way it is easy

hly recommended for men when

times, both the dentist and the

Where: Hong Kong

joint problems; sitting fatigue,

to operate pedals with your feet -

sitting on any seats. With women,

assistant utilise a saddle stool.

Hong Kong Dental Association

and genital health problems

they must be placed on the side.

an additional advantage is the

Good posture, easy visibility into

Date: 18-20 June 2010

decreased growth of bacteria

the patient’s mouth, efficient and

Web site: www.hkideas.org

as a result of better ventilation,

free movement can all become

lower humidity and temperature

reality. The saddle stool allows

35th Annual Meeting of American
Academy of Esthetic Dentistry

Good, natural and relaxed

in the genital area. This has a

close proximity to the patient,

Where: Chicago, USA

are affected by these disorders

posture which also keeps im-

positive effect on the Footoper-

leaving more room for the legs

Date: 03-08 August 2010

whether they are aware of them

proving for years

ated height control (accessory)

under the patient. This method of

Less shoulder area tension by

keeps the gloves clean & is very

working dramatically decreases

ICOI World Congress

aware of SDs would usually like

allowing lower positioning of

helpful in maintaining the wel-

problems for both the dentist and

Where: Hamburg, Germany

to improve the situation and look

the patient

fare of your body and accuracy

the assistant, and is becoming the

Date: 26-28 August 2010

eliminating

of your work while you change

most common way to sit and

Web site: www.icoi.org

lower back pain (oftentimes

positions and sitting height in the

work for dentist in Scandinavia.

FDI WORLD DENTAL CONGRESS

it disappears in a week)

middle of a long procedure.

are some examples of the ailgroup of SDs (Sitting Disorders).

General benefits from a
saddle stool in dentistry

All people working in dentistry

•

ments that belong to the large

or not. Many of those who are

for a more healthy, productive

•

•

and comfortable way to work.

Healthy posture for long
term sitting:

•

•

supports
2. Thighs 90° apart and pointing
down enough to keep the

•

upper body in balance
3. Close to 135° angles in hips

•

and knees
•

5. No pressure on the genitals
and under the hip (especially
for men)

•

This ideal position can be
obtained with a saddle stool.

Sitting on a saddle stool
is based…
…on the sitting bones that are
located under the hip. They

•

Where: Beijing (China National Convention Center)
Date: 09-12 June 2010
Web site: www.sinodent.com.cn

Web site: www.estheticacademy.org

Where: Salvador de Bahia, Brazil

Shoulder joint problems…

Adapting to a saddle
chair takes some effort…

Web site: www.fdiworldental.org

deeper breathing

…often come from elevated

…because almost everything

IDEM INDIA, 2010

Preventing shoulder, hip and

shoulder positions, which stress

changes. The body needs time to

Where: Mumbai, India

knee joint problems, angles

the joints. A riding-like sitting

adjust. Learning to use the saddle

Date: 09-11 September 2010

are more natural

position allows lower positioning

chair takes a few days and the

Web site: www.idem-india.com

Easier movements and good

of the patient, which allows you

“saddle soreness” in the buttocks

DENTAL EXPO

working positions

to relax your shoulders.

and inner thighs as well as

Where: Moscow

fatigue of the back muscles last

Dental Expo Ltd.

two-14 days.

Date: 20-23 September 2010

Preventing fatigue & impro-

Improved circulation in lower

Date: 02-05 September 2010

cose veins + cellulite built up

Sitting down & standing
up…

Easy visibility into the mouth

…is easy because on a saddle

It is worth it, but…

by leaning forward with a

stool you are half way up already.

…nothing comes for free. Finan-

Where: Rome, Italy

straight back

Sitting down could not be any

cially, the change is cheap. But

Date: 07-09 October 2010

Working at a close distance

more fluent since the backrest is

most importantly, you need

Web site: www.expodental.it

(also the assistant) with legs

never in the way. You just lift your

to learn about sitting physiology

ADA Annual Session

under the hoisted chair

leg over the seat from the back

to be motivated to make the

American Dental Association

Easy rolling & turning makes

and sit down. This kind of mount-

change, alter your working

Where: Orlando, United States

picking materials fast and

ing puts you instantly into the

movements and positions and

Date: 09-12 October 2010

effortless

right kind of relaxed sitting

tolerate temporary discomfort.

Web site: www.ada.org

position with good posture.

As a return you may achieve a

BDTA Dental Showcase

extremities prevents vari-

4. Weight on the sitting bones,
not the muscles

or

ving productivity through

1. Good, relaxed posture, balanced and without harmful

Relieving

SINODENTAL

A divided seat is helpful…

Web site: www.dental-expo.com
International Expo Dental

healthier body, better posture,

Where: Excel, London

higher

Date: 14-16 October 2010

keep the buttocks and thighs

… because the free space allows

Data entering…

from being pressed against the

proper pelvis/hip position with-

…is more fluent and time-saving

patients with the same energy),

Web site: www.bdta.org.uk

seat if they have a firm support.

out pressure or discomfort in

when you can roll back and forth

improved quality of work and

World Dental Show

Thighs point down at a 45

the soft tissues on the pubic bone.

fast and easily with your saddle

more satisfying years at work. DT

Where: Mumbai, India

productivity

(more

Date: 29-31 October 2010
Web site: www.wds.org.in
Dentech China 2010
Where: Shanghai, China
Date: 02-05 November 2010
Web site: www.dentech.com.cn
54th AMIC Dental Expo
Where: Mexico City, Mexico
Date: 03-07 November 2010
Web site: www.amicdental.com.mx
FAMDENT SHOW 2010
Where: Hyderabad, India
Date: 26-28 November 2010
Email: famdentresponse@gmail.com
The Great New York Dental Meeting
Where: New York, USA
Date: 26 Nov-01 Dec 2010
Web site: www.gnydm.com DT

[18] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

18 trends

Current concepts in gutta-percha removal for re-treatment
Two-part series by Dr Roheet Khatavkar & Dr Vivek Hegde—Part I
Common reasons for an endo-

3. Combination of paper points

dontic failure include missed

and gutta-percha solvent

canals, ledge formation, perfo-

are available usually in amber-

remnants.3,4 Paper points can

the gutta-percha by frictional

colored bottles.

also be used for retrieving sludge

heat and facilitates its removal

of soft-ened gutta-percha for-

from the root canal by its H-file

med on the reaction of solvent

like flute design. These stainless

with gutta-percha.

steel drills are more effective

4. Rotary instruments

rations, separated instruments,

Chloroform has been proven

a. Gates Glidden drill/Peeso

inadequately filled canals, coro-

to be most successful in plastic-

reamer

nal leakage, and error in post

b. GPX gutta-percha remover

izing gutta-percha points, and

placement.

c. NiTi rotary instruments

thus facilitating its removal from

The ‘wicking technique’ is

portion of the root canals. These

5. Specialized rotary instruments

root canals during retreatment.

used, i.e., flushing the root canal

drills are available in various

designed for retreatment

The reported adverse effects

with solvent followed by drying

sizes, ranging from ISO 25–50,

a. ProTaper Universal retreat-

on the health, from exposure to

it with paper points, which helps

and more recently introduced

For a successful orthograde
retreatment, the removal of the

in the coronal and middle –third

endodontic filling material, such

ment instruments

chloroform, have necessitated

in removing the softened gutta-

NiTi GPX removers that can be

as gutta-percha, is essential to

b. Mtwo retreatment files

the use of a less hazardous

percha along with paper points.

used in curved canals as well

1, 2

This technique is very useful in

(Fig. 3).

allow access to the canals for

c. R-Endo retreatment files

a successful debridement and

6. Heat transfer devices

re-obturation of the root canal

a. Heat carrier tips

system. This article deals with

b. Ultrasonic tips

the removal of gutta-percha

narrow canals or the canals with
The use of solvent softens

a greater degree of curvature.

the gutta-percha, and then soft-

4. Rotary Instruments

ened gutta-percha can be easily

7. Soft tissue laser.

based obturating material, as

solvent replacing chloroform.

removed from the canals by

C. NiTi Rotary Instruments
The use of NiTi Rotary instruments have the advantage of
removing gutta-percha as well

an essential step in a successful

1. K-files or H-files

placing the file into the canals

A. Gates Glidden Drill and Peeso
Reamer

endodontic retreatment.

K-files or H-files are the basic

and applying firm pressure

The use of Gates Glidden drill

under-prepared tooth, simulta-

instruments in an endodontist’s

against the canal walls.

or Peeso reamer (Figs 2a & b)

neously. The number of studies

is a well-known technique to

carried out for comparing the

as shaping the root canals in an

The first step in planning for

armamentarium, which can be

a tooth requiring retreatment

used to engage the mass of gutta-

Micro-debriders and openers

remove gutta-percha from the

gutta-percha removal efficacy

is – ‘Coronal disassembly’. This

percha, and by applying an

(Dentsply Maillefer) are small

coronal and middle portion of

of rotary with the hand instru-

involves removal of the coronal

outward firm-pressure mass can

files having 90-degree bend at

the root canal.5 The non-flexible

mentation, have shown both

restoration including full cover-

be removed. This technique,

the working end and an attac-

head and lateral cutting design

techniques to be almost equally

age restoration, core build-up

however, allows for a gross

hed handle (Fig. 1). It may also

of these instruments do not

effective.6 It has been advocated

material, and post placed into

removal of gutta-percha espe-

be used to substitute standard

allow instrumentation in the

that the use of rotary devices in

the canal. After gaining access

cially from large canals, which

K-files and H-files.

curved portion of the root canal.

endodontic retreatment should

into the pulp chamber, it is a

are poorly compacted allowing

Therefore, the additional use

be followed by hand instru-

prerequisite for the clinician to

files to bypass the obturating

inspect the chamber floor for

material and ‘bite’ into the mass.

3. Combination of Paper
Points and Gutta-percha
Solvents:

of hand instrument is often

mentation to achieve optimal

necessary. Due to their stiffness

cleanliness of root canal walls.

2. Gutta-percha Solvents

and predisposition to fracture,

The rotary instruments reach

Most of the literature shows that

they are safer in the straight

the whole working length easily,

A wide array of chemicals are

gutta-percha filling material

portions of the canal of anterior

plasticize gutta-percha through

available today as gutta-percha

cannot be removed completely

and posterior teeth.

frictional heat, & remove gutta-

solvents, such as eucalyptus oil,

from the root canals. In such

The clinician can use various

turpentine,

chloroform, xylol,

cases, a solvent is flushed into

options for the removal of

methylene chloride, orange-

the root canals upto the level

The GPX gutta-percha remover

plete the removal.6 These instru-

obturating material:

wood oil, methyl chloroform,

of pulp chamber, in an effort

(Prestige Dental) is a specially

ments are recommended to be

1. K-files or H-files

endosolv E, endosolv R, and

to maximize the interaction of

designed file used in a slow-

used at rotational speed of three-

2. Gutta-percha solvent

tetrahydrofuran. These solvents

the solvent and gutta-percha

speed handpiece. It plasticizes

four times more than that of the

any missed canals, which can
also be a cause of failure.

Techniques for Guttapercha Removal

B. GPX Gutta-percha Remover

percha quickly. Later, hand
instruments can refine and com-

rotational speed which is recomA

mended for routine cleaning

and shaping procedures. The
rotary instruments also have
increased chances of fracture
in case they are forced through
the mass of gutta-percha. DT

Editorial note: The references
will be published with part II
Fig. 2a: Gates Glidden drills nos. 1-6 can be identified by the head-design and
rings on the latch-type attachment
Fig. 2b: Peeso reamers nos. 1-6 can be identified by the longer length of flutes
on the head-design and the rings on latch-type attachment

Fig.1: Micro-debriders and Micro-openers from Dentsply Maiellefer

GPXTM · Stainless Steel

Packaging unit

Color code

Size

DØ 1/100 mm

025

030

035

040

045

050

Size

DØ 1/100 mm

025

030

035

040

045

050

L=21

270.....

2001

2002

2003

2004

2005

2006

L=21

270.....

1901

1902

1903

1904

1905

1906

2000

of Dental Tribune India.

About the authors

Niti GPXTM · Nickel Titanium

Packaging unit

Assortment

of this article in the next edition

Assortment

1900

CPXTM features a spiraled vent through which gutta-percha is extruded as it is plasterized

A latch-type nickel titanium alloy instrument for use on low speed hand pieces. CPXTM

from frictional heat.

features a spiraled vent through which gutta-percha is extruded as it is plasterized from
frictional heat.

Fig. 3: GPX Stainless Steel & NiTi instruments available for removal of gutta-percha in straight and curved canals respectively

Dr Roheet Khatavkar is a postgraduate student in the department of conservative dentistry
and endodontics at M A Rangoonwala Dental College, Pune, India.
Dr Roheet can be contacted at
drkhatavkar @gmail.com.
Dr Vivek Hegde is professor and
head of the department of conservative dentistry and endodontics at
M A Rangoonwala Dental College,
Pune, India. He can be contacted
at drvivekhegde@rediffmail.com.

[19] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

Clinical 19

Case report: Interdisciplinary full mouth rehabilitation
By Dr Ratnadeep Patil, Dr Kripa Shetty, and Dr Kavita Mahesh, India
Introduction

missing teeth, mobile and mig-

Material options were given

right (UR) 1, 2, 4, 5, and 6, and

base impression material, and

The success of functional and

rated teeth. Diagnostic periapi-

to the patient and a metal

Upper left (UL) 1, 2, 4, and 6

working casts were prepared

esthetic restorations in a case

cal radiograph revealed hori-

ceramic prosthesis was chosen.

followed by immediate extrac-

to make abutments. The work-

requiring full mouth rehabilita-

zontal bone loss and missing

ing casts were then mounted

tion is often dependant on

teeth. Based on the clinical

Treatment Sequencing

tion implants (Xive/Frialit by
Friadent, GmBH) on UR 2

on a non-arcon, semi-adjust-

our understanding of inter-

and radiographical evidence,

Treatment was carried out in

(3.4 x 11), 4(3.8 x 13), 5(3.8 x 11),

able articulator using facebow

disciplinary concepts. With every

it was diagnosed that the patient

the mandibular arch followed

6(4.5 x 9.5); UL 1(3.8 x 11),

records. The centric relation

patient being unique and repre-

was suffering from generalized

by the maxillary arch in the

2(3.4 x 11), 4(3.8 x 13), 6(4.5

and vertical dimension were

senting a special blend of age,

moderate

following phases:

x 8) was done. Prefabricated

also transferred to the articu-

personality characteristics as

trauma from occlusion. The

provisional acrylic fixed pros-

lator from the patient, using

well as expectations, our know-

treatment plan was made keep-

theses were given after bite

polyvinyl siloxane putty bite.

ledge of interdisciplinary con-

ing in mind the end-result,

Subgingival curettage of the

adjustment. During the follow-

During metal trial, fit of the

cepts can open a whole range

harmonious

biological

lower arch along with the

ing visit, intentional root canal

castings and occlusal clearance

of treatment options and out-

and functional aspects. The

extraction of lower right (LR)

treatment was performed in

were checked. A Bisque trial

comes.1 Today, every dental

treatment plan involved:

1 and 2, and lower left (LL)

LR 3, 4, 5, 7, and LL 3, 4, 5, 6

was, done to confirm fit, shade

1, 2, and 7, followed by place-

teeth.

and occlusal parameters.

periodontitis

with

with

practitioner must have a thorough knowledge of the roles

-

of these disciplines in producing

Phase 1

Periodontal therapy invol-

ment of immediate extraction

ving subgingival curettage.

implants (Xive/Frialit by Fria-

Phase 2

Later, the final metal ceramic

an esthetic makeover, with the

-

Extraction of hopeless teeth.

dent, GmBH) on LR 6(4.5 x 13),

The loading of abutment in the

prosthesis was constructed. The

most conservative and biolo-

-

Crowns and bridges on

2(3.4 x13) and LL 2(3.4 x 13),

upper and lower arch implants

final prosthesis, after all occl-

gically-sound interdisciplinary

remaining teeth, along with

7(5.5 x 8) was done. Prefabri-

was performed six months after

usal adjustment, was cemented

treatment plan.2,3

implant-supported prosthe-

cated provisional acrylic fixed

the stage 1 surgery. UL 3 was,

using Glass Ionomer Cement.

sis for missing teeth. Reha-

prostheses were given in the

also extracted due to persisting

Recall appointments were given

bilitation of occlusion is the

same sitting resting on the

mobility, hence, poor long-term

for cleaning and maintenance

A 57-year-old female patient

crucial phase to ensure long-

remaining natural teeth. Occ-

prognosis. Intentional root canal

of the prostheses at every 6

reported with the complaint of

term oral health.

lusal adjustments were made

treatment was performed in UR

months.

Intentional root canal treat-

to achieve proper function,

3, 7 and UL 5, 7 to improve

dentition, missing bridge, and

ment was performed for

comfort, and esthetics.

their prognosis and prepared

desire to restore her smile.

remaining teeth in order

During clinical examination,

to alleviate post-periodontal

it was noted that the patient

therapy hypersensitivity.

curettage of the upper arch

After a week, final impres-

Maintenance and recall.

along with extraction of upper

sions were made using rubber

Case Report

mobile teeth, spacing in anterior

had deep periodontal pockets,

-

-

1a

1b

to receive crowns.
After a week, subgingival

1c

Restorative and Occlusal
Consideraions
The final occlusion given to
the patient was Class II with
anterior

guidance,

which

1d

Figs. 1a-d: Pre-operative intra oral view
1e

1f

2a

Fig. 1e: Pre-operative smile

Fig. 1f : Pre-operative OPG

Fig. 2a: Maxillary occlusal view after final preparation

2b

2c

3a

Fig. 2b: Mandibular occlusal view after final preparation

Fig. 2c: Post-loading OPG

Fig. 3a:Post-operative intraoral view

3b

3c

Figs. 3b-d: Post-operative intraoral view

3d

3e

Fig. 3e: Post-operative smile

[20] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

20 Clinical

Discussion

Dental

problems

are

often

multi-factorial, and may not be
satisfactorily resolved by the
restorative treatment alone.5
Creating the perfect smile
along with health is a challenging procedure that requires
Fig. 4: Anterior excursive view

Fig. 3f: Post-operative OPG

a multidisciplinary approach,

allowed direct axial forces and

excursive movements was given

laced with an implant supported

side, canine-guided occlusion

and meticulous treatment plan-

had minimized off axial forces

attention. Since, upper left can-

bridge, a group functions was

was given, since natural canines

ning. Emphasis was given on

on the implant. Disclusion in

ine was missing and was rep-

advisable,4 whereas on the right

were present.

occlusal adjustments in both
temporary and final restoration, since occlusal rehabilitation is the key to long-term

FDI Annual World Dental Congress

success

the

restorations

and the oral health.

References

2-5 September 2010
Salvador da Bahia, Brazil

1. Spear F, Kokich V, Mathews D.
Interdisciplinary management
of anterior dental esthetics.
JADA 2006, Vol.137; 160-170.
2. F. Dennis. Complete artificial
dentition supported by endosseous implants: a case report
of total in-office treatment.
JOI 91-97.
3. R Patil. Textbook of Esthetic
Dentistry: An Artists Science.
4. I Ahmad. Anterior dental esthetics: A gingival perspective.
British Dental Journal 2005;
199: 195–202. doi: 10.1038/
sj. bdj.4812611.
5. I Ahmad. Geometric considerations in anterior dental
esthetics: Restorative principles. PPAD 1998; 10(7):
813-22. DT

About the authors
Dr Ratnadeep Patil has maintained a successful private practice specializing in aesthetic and
implant dentistry in Mumbai,
since 1988. He is a diplomate of
the International College of Oral
Implantologists and is an active
member of International Association of Dental Research. He has
authored a clinical textbook
on aesthetic dentistry (Esthetic
Dentistry: An Artist’s Science)
and been actively involved in
conducting continuing dental
education programmes.
Dr Kripa Shetty has graduated
from A B Shetty Dental College.
She is an associate dental surgeon
at Smile Care®, with special focus
on restorative & esthetic dentistry.
She is an active member in
research and publication division
of Smile Care®.

congress@fdiworldental.org

www.fdiworldental.org

Dr Kavita Mahesh has been in
clinical practice since she graduated from the Government Dental
College and Hospital, Mumbai
in 2002. She completed her postgraduate certificate in implant
dentistry at New York. She is actively involved in clinical research
and continuing dental education
programs with the Smile Care®
team.

[21] => DTAP0109_01-02_TitleNews

FDI explores preventive dentistry at 2010 AEEDC Dubai
FDI World Dental Federation introduces the Global Caries Initiative to the Gulf Region as part of a global consultation process
Representatives from FDI World

Caries Initiative to key opinion

the 2010 AEEDC Conference

an address to attendees of the

associations to further preven-

Dental Federation, including Dr

leaders of the Gulf Region.

Program: Dr Julian Fisher, FDI

Gulf Cooperation Council Pre-

tion at the national level.” FDI

Asso ciate Director of Education

ventive Dentistry Conference,

Roberto Vianna, FDI President,
were recently in Dubai for the

The Global Caries Initiative

and Scientific Affairs, described

paying a special thank you to

2010 UAE International Dental

(GCI) was first conceived during

the context of GCI in a presenta-

Professor Abdullah Al Sham-

Conference and Arab Dental

the Rio Caries Conference in July

tion entitled, “The Global Caries

mery, Dean of Riyadh Colleges

Exhibition

Dubai),

2009, where conference attend-

Initiative: A Profession-Led Call-

of Dentistry and Pharmacy and

where they participated in the

ees—including leading experts

to-Action” and Dr Nigel Pitts, of

AEEDC International Scientific

AEEDC

Conference Program,

in epidemiology, cariology, den-

the University of Dundee (Scot-

Advisory Board Member. Dr Via-

the Gulf

Cooperation Council

tal education,

land), presented

nna said, that FDI World Dental

Preventive

Dentistry Confer-

change management conceded

related to “A New Approach to

Federation

ence and the 7th Annual Arab

there is a need to establish a

Caries Classification, Detection

participate in this Conference

Asian Scientific Dental Alliance,

broad alliance of key influenc-

and Assessment: The Experien-

and looks forward to working

introducing the FDI Global

ers and decision-makers to effect

ces of ICDAS”, which addresses

together with the Gulf Coopera-

across

an underlying theme identified

tion Council and FDI member

health systems and in individual

early in the GCI consultation

behaviour in order to eradicate

process; that is, the need for

caries worldwide by 2020.

the profession to establish a

(AEEDC

fundamental

prevention and

change

his research

common language for caries.
Departing from this objec-

Dr Pitts has been working with

“is delighted to

Dr Julian Fisher, FDI Education and
Scientific Affairs Manager

FDI Corporate Partners
meeting in Chicago

FDI World Dental Fede-

FDI World Dental Federation to

ration embarked upon a global

explore an international caries

The annual FDI Corporate Partn-

importance of partnership betw-

consultation process to assess

classification system within the

ers meeting took place at the

een FDI World Dental Federation

the potential challenges and im-

context of GCI.

end of February during the 145th

and the dental industry, encour-

Chicago Dental Society Mid-

aging an “open dialogue, which

tive,

pact of introducing a preventive
model to existing systems for

Dr Roberto Vianna reinforced

Winter Meeting. FDI President

strengthens our relationship and

caries management. The most

the FDI World Dental Federation

Dr Roberto Vianna opened the

brings mutual benefits to both

recent seminar took place at

commitment to oral health in

meeting, welcoming & thanking

parties.” The presentations por-

FDI Corporate Partners for their

tion of the meeting included a

un wavering support, particularly

financial review by Jerome Esti-

in view of the economic chall-

gnard, FDI Director of Finance &

enges still affecting businesses

Operations, who summarised the

worldwide. Joining the FDI Pre-

2009 year-end results and budget

sident at the meeting were FDI

forecasts for 2010 and beyond.

FDI teams up with OSAP to improve
global patient safety standards
FDI World Dental Federation

ing recognition of the harms

President-Elect, Dr Orlando Mon-

is participating in an official

caused by health care, the WHO

teiro da Silva; Councillor, Dr

The annual FDI Corporate

review of the WHO Patient Safety

initiated a review of the Guide

Kathryn Kell; Executive Director,

Partners meeting is held in the

Curriculum

together

and invited FDI World Dental

Dr David Alexander; and other

first quarter of each year, alternat-

with the Organization for Safety

Federation to participate as a

full-time FDI professional staff

ing venues between the Chicago

and Asepsis Procedures (OSAP),

primary partner in the project,

from the Finance, Communica-

Dental Society Mid-winter Meet-

International

of

together with the International

tions and Congress departments.

ing and the International Dental

Dental Educators and Associa-

Council of Midwives and other

tions (IFDEA), and other lead-

members of the World Health

Dr David Alexander presen-

ing global medical profession

Professions Alliance (WHPA);

ted a detailed report of ongoing

associations.

International Council of Nurses,

FDI activities & achievements in

International Pharmaceutical

2009, including the introduction of

Federation and World Medical

a new FDI website, preparations

Association. Professors Takashi

for the 2010 Annual World Dental

Guide,

Federation

Patient safety is an emerging

unsafe medical care every year.

discipline, aiming to reduce

Show in Cologne, Germany. FDI

harm to patient caused by health

The multi-professional WHO

Inoue and Nermin Yamalik, of

Congress in Salvador da Bahia,

care and to identify opportunities

Patient Safety Curriculum Guide

the FDI Education Committee,

Brazil, future congress venues,

for improving patient out comes.

was first published in 2009 to

will be contributing to the re-

progress on the Global Caries Ini-

According to the WHO Research

provide medical schools with

view. Details are expected to be

tiative and a summary of internal

Priority Setting Working Group

guidelines for teaching patient

finalised during a consensus

process improvements across the

on Patient Safety, tens of millions

safety, and has since been down-

meeting at the 2010 OSAP Ann-

organisation. Dr Alexander rem-

of patients worldwide suffer
disabling injuries or death due to

loaded by more than 1000 institutions in 100 countries. In grow-

ual Symposium in June. FDI

inded participants of the critical

About the publisher
Publisher
FDI World Dental Federation
Tour de Cointrin, Avenue Louis Casai 84,
Case Postale 3
1216 Cointrin – Genève, Switzerland
Phone: +41 22 560 81 50
Fax: +41 22 560 81 40
E-mail: media@fdiworldental.org
Web site: www.fdiworldental.org

FDI Communications Manager
Aimée DuBrûle
FDI Worldental Communiqué is published by
the FDI World Dental Federation. The newsletter and all articles and illustrations therein are
protected by copyright. Any utilisation without
prior consent from the editor or publisher is
inadmissible and liable to prosecution.

[22] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

22 technology

Complete maxillary implant prosthodontic rehabilitation
with a CAD/CAM-fixed prosthesis
By Neo Tee-Khin, Ansgar C. Cheng, Helena Lee and Ben Lim, Specialist Dental Group, Singapore
Endosseous implant treatment

careful consideration of the

Traditional implant prosthe-

has been widely reported as a

risks and benefits of various

ses are commonly fabricated

highly predictable treatment

treatment options are essential

using acrylic resin teeth sup-

modality with a low percentage

for the treatment planning and

ported by a metal framework.

However, application of this

Conventional porcelain-fus-

of clinical complications. Pru-

long-term success of prostho-

Significant space is designed at

prosthetic design in the maxil-

ed-to-metal restorations require

the tissue surface of the pros-

lary arch is occa-sionally esthe-

the placement of labial restora-

dent clinical judgement and

1

dontic treatment.

thesis to enhance oral hygiene

tically inadequate and speech

maintenance.

may be compromised.

tion margins below the free
gingival margin in order to mask
the hue and value transition be-

World
W
orld Dental Show

tween the sub-gingival implant
sub-structures and the supragingival crown restorations.

29 - 31 October 2010, Mumbai

From a periodontal point of
view, sub-gingival placement of

More
professionals
Mor
e than 30000 dental pr
ofessionals
expected in 2010

restoration margins is related
to adverse periodontal tissue
response.2–5 As a result, restoration margins are best placed
coronally from the free gingival
margin.4,5
Porcelain-fused-to-metal restorations are commonly used
in the posterior teeth because
of their well-documented longterm clinical track record.6–13
CAD/CAM ceramic-based materials are prescribed nowadays,

Be in the Forefront
Forefront
of Dental
ental
e than 500 Booths
More

o Largest Exhibition in Asia in 2009
o Scientific Confer
ence in association with
Conference
California,
University of Califor
nia, San Francisco

promising physical properties
14,15

and clinical longevity.16
This article describes the

clinical application of highstrength zirconium oxide resto-

Exhibition
in India
o 10 Highly specialized courses

owing to their demonstrated

rations in the prosthodontic
management of an edentulous
maxilla with a failing implant
prosthesis.

Clinical report
A 62-year-old female with an

World
Dental
D
ental
a
Show

Mumbai
Approved By

implant-supported

maxillary

prosthesis was evaluated at the
Specialist Dental Group in Singapore. She presented clinically

Indian T
Trade
rade Promotion Organisation
Ministry of Health & Family Welfare
W

with a maxillary fixed complete

Ministry of Home Af
Affairs
fairs
Ministry of External Af
Affairs
fairs

denture supported by six endos-

Approved By

Media Partners
Partners

seous implants (Nobel Replace,
Tapered Groovy, Nobel Biocare).
The prosthesis had acrylic

Organiser
Indian Dental Association
Bombay Mutual T
Terrace,
errace, 2nd Floor,
Floor
534 Sandhurst Bridge, Opera House,
Mumbai - 400 007
Tel
Tel : +91 (22) 43434545, 23671515,
+91 (22) 23696655
Fax: (22) 23685613
Email : info@wds.org.in
Website
Website : www
www.ida.org.in
.ida.org.in
www.wds.org.in
www.wds.org.in

THE

Mumbai, December-2009, V

Voice
The National V
oice of the Dental Profession

Affiliate Members

World
W
orld Dental Federation

$VLD3DFL¿F'HQWDO)HGHUDWLRQ

Commonwealth Dental association

International Association
of Dental Research

Society for Research on
Tobacco
Nicotine & T
obacco

resin teeth supported by a gold
alloy metal framework. The
implant at the patient’s maxillary
right canine area was exposed.
The patient reported no symptoms (Fig. 1). An occlusal examination revealed a stable maximal

intercuspation

position

with insignificant centric relation to maximal inter-cuspation
slide at the teeth level. A canine-

Venue
V
enue - MMRDA,
MMRDA , Opp. Citi Bank, Bandra - Kurla
Kurla Complex Bandra ( E ) Mumbai 400051, Maharashtra

guided occlusal scheme was
noted. No parafunc-tional habits

[23] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

technology 23

Fig. 1: Pre-treatment intra-oral frontal view: A large space was
noted between the intaglio surface of the prosthesis and the
maxillary tissue, and there was significant tissue resorption on
the labial surface of the implant over the maxillary right canine
area. The patient was asymptomatic.

Fig. 4: Completed maxillary prosthesis with gingival-colored porcelain applied to provide adequate
lip support; excessive crown height was reduced.

were

reported.

Fig. 2: Full-thickness flap revealed the advanced bone loss on the
labial surface of the implant. In spite of the tissue damage, this
implant was clinically firm.

Fig. 5: Anterior view showing the CAD/CAM-fabricated full-ceramic implant abutments at the
approximated vertical dimension of occlusion.

Fig. 3: Maxillary prosthesis before the application of tooth-colored
porcelain; excessive crown length was noted at this stage.

Fig. 6: Occlusal view of the maxillary arch before insertion of the maxillary prosthesis; favorable anterior-posterior spread allowed the replacement of
posterior teeth with distal cantilevering.

Sub-optimal

loxane material (Aquasil Ultra

to the manufacturer’s recom-

maxillary lip support was noted.

Heavy, DENTSPLY DeTrey) was

mendations.

carefully injected around all

Fig. 7: Completed maxillary implant-supported
prosthesis; note the placement of the supra-gingival
margins.

In this clinical report, the

be informed of the potential

failure of one implant at a

financial and time implications

crucial location indicated the

should the need for refabrication

need for re-fabrication of the

of the restorations arise.

A significant amount of dead

the impression copings. A stock

Subsequently, overlaying low

space was identified between

tray loaded with putty material

-fusing, tooth-colored porcelain

the intaglio surface of the pros-

(Aquasil Putty, DENTSPLY De

material (IPS e.max, Ivoclar

thesis & the maxillary soft tissue.

Trey) was seated over the

Vivadent) was manually applied

As the patient desired a high

The functional management of

entire maxillary arch to make

onto the exterior to create pro-

level of esthetics, full-ceramic

an edentulous maxilla using a

the definitive impression.

per anatomic form (Fig. 3).

restorations were selected. By

full-ceramic implant-supported

Low-fusing,

gingival-colored

prescribing tooth-colored ce-

maxillary prosthesis has been-

Upon removal of the maxillary prosthesis, all the maxillary

entire implant prosthesis.

Conclusion

implants were found to be osseo-

A jaw-relation record at the

porcelain material (IPS e.max)

ramic abutments & full-ceramic

reported. New CAD/CAM-based

in-tegrated. The patient desired

treatment vertical dimension

was applied to create proper

restorations, prosthesis margins

restorative materials were used

to correct the failing implant,

was made with a vinyl poly-

lip support (Fig. 4).

were made at the gingival level

in treating this case.

restore lip support, masticatory

siloxane material (Regisil PB,

function and facial esthetics.

DENTSPLY DeTrey).

The overall treatment plan-

and gingival retraction proceDuring the delivery clinical

The maxillary and mandi-

dures were eliminated during

session, the old prosthesis was

impression

removed and the new custom

insertion.

and

prosthesis

The use of high-strength
full-ceramic restorations enhances overall esthetic predictability and long-term functional

included removal of the implant

bular

at the maxillary right canine

mounted

area, replacement of a new

center of a semi-adjustable

implant at the maxillary right

articulator (Hanau Wide-vue,

The new prosthesis was tried

theses usually requires longer-

A complete list of references

canine region and fabrication

Teledyne Waterpik) using aver-

in to verify color, occlusion, lip

term provisional restoration in

is available from the publisher. DT

of a full-arch, zirconium oxide-

age settings.17,18

support, teeth form and comfort.

order to facilitate a predictable

definitive

casts

arbitrarily

were
the

abutments were torqued to 32
Ncm (Fig. 5).

Full-arch prosthodontic rehabilitation using fixed pros-

treatment outcome.

based ceramic restoration in
The custom zirconium oxide

Upon confirmation of the

abutments with gold-alloy fitting

patient’s acceptance, the implant

In this patient, the existing

Under local anaesthesia, the

surface (Procera, Nobel Bio-

abutments were sealed in gutta-

maxillary prosthesis served as

implant at the maxillary right

care) were CAD/CAM fabricated

percha (Fig. 6) and the pros-

a long-term provisional resto-

canine area was removed surgi-

according to the prosthesis

thesis was cemented in resin-

ration for verifying her adapt-

cally (Fig. 2) and a new 13 mm

design.

modified glass-ionomer luting

ability, & multiple professional

agent (RelyX Unicem, 3M ESPE).

clinical adjustments of provi-

the maxilla.

outcome.

long regular platform implant

sional restorations were not

was placed (NobelReplace, Ta-

The development of the

pered Groovy). The new implant

planned definitive maxillary

The patient was evaluated 2

was submerged and primary

restoration was carried out

weeks postoperatively. Anterior

wound closure achieved. The

using a CAD/CAM process. The

guided occlusal schemes were

This treatment sequence

existing prosthesis was reinser-

maxillary definitive cast with the

verified intra-orally before and-

increased the margin of safety

ted during the healing period to

custom full-ceramic abutments

after prosthesis cementation

in the execution of the definitive

serve as a provisional prosthesis.

were scanned (Zeno Scan, Wie-

(Fig. 7). The patient reported

full-ceramic restoration.

land Dental+Technik), and the

no discomfort and she had

Once osseointegration was

prosthesis framework was desi-

been functioning well with the

Intra-oral verification of the

achieved a few months later, the

gned using a software program

new resto-rations. No abnormal

new treatment occlusal scheme

new implant was exposed and

(D700, 3Shape).

clinical signs were noted.

and detailed in situ clinical

the maxilla was ready for pros-

About the author

Discussion

required.

adjustment of the restorations
on the day of prostheses inser-

thodontic rehabilitation after a

The framework was milled in

few weeks of soft-tissue healing.

zirconium-base-material (Zeno

Osseointegration is a well-

tion still formed the essential

Zr Bridge, Wieland Dental +

documented and predictable

foundation for proper treatment

Six implant-level impression

Technik) with a milling machine

clinical treatment option. On

execution.

copings (NobelReplace) were

(Zeno 4030 M1, Wieland Dental+

the other hand, management

placed onto the maxillary implants. High-viscosity vinyl polysi-

Technik). The prosthesis framework was sintered according

of implant-failure is also a
clinical reality.

In any major prosthodontic
treatment, the patient should

Dr. Ansgar C. Cheng is a prosthodontist with Specialist Dental
Group™, Mount Elizabeth Hospital, Singapore, and an adjunct
associate professor at the National University of Singapore.
Dr. Ansgar C. Cheng
3 Mount Elizabeth #08-10
Singapore 228510
Republic of Singapore
E-mail: drcheng@specialist
dentalgroup.com

[24] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

24 Case report

Epulis gravidarum mimicking a neoplasm
A case report by Dr Deepak Chopra, Dr Mayur Kaushik, Dr Deepak Kochar, and Dr Sidharath Malik, India
Introduction
aled granulation tissue with
Pregnancy is a delicate condi-

non-neoplastic proliferation of

tion, involving complex physi-

endothelial cells, suggestive of

cal and physiological changes.1

epulis gravidarum.

Modification of metabolism,
immunology, and high level of

Case Description

hormones make it possible for

A 26-year-old female was refer-

fetus to grow & develop, ending

red with the chief complaint of an

up with labor. Variations of these

extensive gingival enlargement

hormones cause some changes

on the lower right anterior tooth

on skin and oral mucosa.2

region. The lesion was of negligi-

The changes progress due to

ble size when the patient first

increased level of sex hormones

noticed it three weeks ago, but

in blood and saliva. These hor-

had grown rapidly over the past

mones are thought to be the

twenty days to attain the present

reasons for occurrence of infla-

size. The patient’s medical

mmatory process and the epulis

history revealed that she was

gravidarum.3

at five months of gestation with

Fig. 1: Pre-operative view

Fig. 2: Excised lesion

Fig. 3: Sutured with 6-0 silk sutures

Fig. 4: Post-operative view

no systemic disease.
The progesterone & estrogen
receptors are situated in basal

Clinical examination reve-

and spinous stratum of the ep-

aled

ithelium, and in the connective

pedunclated lesion on the man-

tissue. That is why those cells

dibular right buccal side bet-

are influenced by a high level of

ween the interdental gingival of

pregnancy hormones.4 Proges-

lateral incisor and canine. It

terone dilates blood vessels,

measured approximately 2.5

makes them more permeable,

cm in diameter with some areas

and increases proliferation of

of erythema. The lesion was

in that the lesion is not pus

sarcoma, kaposi’s sarcoma and

capillary vessels. Estrogen reg-

rough and firm in consistency

producing as “pyogenic” implies.

non-hodgkins lymphoma.10

ulates the proliferation, differ-

on palpation that bled minimally

It is however, a tumor of gra-

entiation, and keratinization of

(Fig. 1). The swelling also inter-

nulation tissue, as granuloma

Conclusion

the gingival tissue. These hor-

fered with eating and speech.

implies.1 It has been called an

Epulis gravidarum represents

mones increase gingival bleed-

On examination, patient’s oral

epulis, because it is located

an important differential diag-

ing, cause gingival growth, and

hygiene was found good.

more frequently in the gingiva.

nosis of oral masses and can

Some other terms used are

behave in a very aggressive

Excisional biopsy of the

“granuloma telangiectaticum”

fashion, mimicking a malignant

swelling with a wide margin

and “pregnancy tumor”. The

tumor.

Epulis gravidarum is a quite

was performed (Figs. 2 & 3). The

term “hemangiomatous granu-

should be sent for histopatho-

rare gingival disorder occurring

histopathological examination

loma” was suggested by An-

logical reports to exclude malig-

in 1.8 to 5% of pregnant women,

revealed

granulation

gelopoulos to accurately reflect

nancy. It is acceptable practice

and it affects more commonly

tissue with non-neoplastic pro-

the characteristic histopatho-

to excise aggressive variants

the anterior region of the upper

liferation of endothelial cells

logic picture (hemangioma-like)

of this lesion during pregnancy

jaw.6 It is a smooth or lobulated

and the enlargement of blood

and the inflammatory nature

to avoid distressing side effects.

exophytic lesion and manifests

capillaries. Infiltration of acute

(granuloma) of the lesion.8

as a pink, red, or purple erythe-

and chronic inflammatory cells

matous papule with peduncu-

in a collagenous matrix was also

Clinically it presents as a

lated or sessile base.1 It usually

present. Surface of the lesion

lesion that is pedunculated or

arises in the 2nd trimester, grows

showed hyperplastic parakera-

broad based, highly vascular-

gradually over a few months

tinised stratified squamous epi-

ized, smooth, edematous, hem-

time, and it also tends to bleed.

thelium with areas of atrophy

orrhagic, soft, red with glossy

After delivery of the child, it may

and ulcer. These findings were

surface and hardened when it

regress and disappear entirely.7

consistent with a histopatho-

had been longstanding. It could

logical

be a single or multiple well

isolated

exophytic,

lead to deepening of periodontal
5

pockets as well.

The purpose of this article is

young

diagnosis

epulis

gravidarum.

localized outgrowth, painless
or with dull pain. It usually

to describe a gingival swelling
in a five months pregnant 26-

After three weeks of post-

year-old woman, which grew

operative

very rapidly unlike for this kind

appearance of normal gingiva

of tumor mimicking a malignant

was present at the site of the

neoplasm.

lesion (Fig. 4).

The lesion was not painful

followup,

clinical

Discussion

is not bigger than 2 cm in the
diameter.9
Differential diagnosis includes peripheral giant cell granuloma, epulis, peripheral ossifying fibroma, metastatic cancer,

and grew very rapidly over a

Epulis gravidarum is also known

hemangioma, conventional gra-

three week period. The histo-

as “Pyogenic granuloma”. The

nulation tissue, hyperplastic

pathological examination reve-

term is somewhat a misnomer

gingival inflammation, angio-

Excised

specimens

References

7. Ababneh K, Khateeb T. Aggressive pregnancy tumor mimicking a malignant neoplasm:
a case report. J Contemp Dent
Pract. 2009 Nov 1; 10(6): E072-8.
8. Angelopoulos AP. Pyogenic
granuloma of the oral cavity:
Statistical analysis and its clinical feature. J Oral Surg. 1971;
29, 84-9.
9. Daley TD, Nartey NO, Wysocki
GP. Pregnancy tumor: an analysis. Oral Surg Oral Med Oral
Pathol. 1991; 72(2): 196-99.
10. Czerninski R et al. Comparison
of clinical and histological diagnosis in lesions of oral mucosa.
Oral Surg Oral Med Oral Pathol
Oral Radiol Endond. 2007; 103
(4): e20. DT

1. Jafarzadeh H, Sanatkhani M,
Mohtasham N. Oral pyogenic
granuloma: a review. J Oral
Sci. 2006; 48: 167-75.
2. Erickson CV, Matus NR. Skin
disorders of pregnancy. Am
Fam Physic. 1994; 3: 602-10.
3. Laine MA. Effect of pregnancy
on periodontal and dental
health. Acta Odontol Scand.
2002; 60: 257-64.
4. Zeeman GG, Veth O, Dennison
D. Focus on primary care on
periodontal disease. Implications on women’s care. Obst
Gynecol Survey. 2001; 56: 43-9.
5. Henry F, et al. Blood vessel
changes during pregnancy: a
review. Am J Clin Dermatol.
2006; 7: 65-9.
6. Paradowska A, Slawecki K,
Chojak EG. Pregnancy tumor:
review of literature. Dent Med
Probl. 2008; 45(1): 51-4.

About the authors
Dr Deepak Chopra is a reader in
the department of periodontology
at Inderprastha Dental College
at Ghaziabad, India. He can be
contacted at deepakchopra2010
@gmail.com.
Dr Mayur Kaushik is a reader in
the department of periodontology
at Subharati Dental College at
Meerut, India.
Dr Deepak Kochar is an assistant
professor in the department of
periodontology at Inderprastha
Dental College at Ghaziabad,
India.
Dr Sidharath Malik is an assistant
professor in the department of
periodontology at Inderprastha
Dental College at Ghaziabad,
India.

[25] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

trends & applications 25

Miniscrews—a focal point in practice
Six-part series by Dr Björn Ludwig, Dr Bettina Glasl, Dr Thomas Lietz, & Prof. Jörg A. Lisson—Part IV

Figs. 1a–c: Figs. 1a–d: The uprighting of a second molar with simultaneous reshaping of the dental arch. The problem is clearly visible in the X-ray. The uprighting spring is fixed to a miniscrew (a, b). Status
after five months without reactivation of the arch section (c, d).

Clinical examples (2)

for example, to reshape the

occurs when only an uprighting

Repositioning individual teeth

entire dental arch (Figs. 1a–d)

spring is fixed to the multi-

or just upright the tipped tooth.

bracket appliance (Fig. 2). The

If miniscrews with bracket

straightening of an individual

heads are used, it is possible to

tooth may become necessary

tipped (2 ) molars in a full denti-

employ a special NiTi uprigh-

for periodontological, prosthetic

tion represents a therapeutic

ting spring (such as the Memory

or orthodontic reasons. This is a

challenge. The treatment is fur-

Titanol spring, FORESTADENT).

very simple procedure if a mini-

ther complicated if the tooth is

A standard multi-bracket appli-

screw and uprighting spring

not only tipped but also partly

ance can be used to reshape

are used, and the appliance re-

impacted. The presence of a non-

the dental arch. At the same time,

mains invisible to the observer.

erupted third molar does not

a second force element can be

The tooth need only be fitted

simplify the process (Fig. 1a).

applied with the aid of a minis-

with an appropriate attachment

When planning the required

crew and an uprighting spring

system that makes it possible to

appliance, it is important to con-

(Figs. 1b–d). This avoids the loss

fix this to the uprighting spring.

sider whether it is necessary,

of anchorage that inevitably

Depending on how the spring is

The uprighting of molars
The straightening of mesially
nd

Fig. 2: The uprighting spring fixed to the main arch not only affects the molars, but
also causes displacement of the premolars (loss of anchorage). (Photo: Prof.
Dominguez, São Paulo, Brasil).

nents tend to move towards each
other. In the worst-case scenario, only the group providing
anchorage is displaced from its
original position. This can occur
if there is ankylosis of the retinated tooth, something that is
difficult to evaluate during initial
examination. If an attempt is
made to move an ankylosed
Figs. 3a–c: The alignment of a displaced canine using a miniscrew. After the canines have been exposed, they are attached to a bracket by means of a miniscrew
(a). After removal of the screw, the dental arch can be reshaped using a conventional technique (b, c).

canine towards insufficient dental anchorage, the result will be

Figs. 4a–e: Obtaining additional transverse space by means of ‘hybrid RPE’. The initial diagnosis is an asymmetrical narrow jaw with insufficient space for tooth 13 (a). After fixture of the brackets,
two miniscrews (OrthoEasy) were inserted during the same session (b). The hybrid RPE appliance was attached to the miniscrews and molar bands using laboratory abutments (FORESTADENT; c). The
diastema shows the effect of the appliance after ten days’ use (d). Status after transverse expansion and concurrent reshaping of the dental arch (e).

set, it is even possible to achieve

ous appliances are available—

the worst-case scenario. This

intrusion/extrusion of the tooth.

rubber bands, springs, ortho-

can lead to an open bite in the

This form of treatment is inexp-

dontic chains—that are effective

region of the anterior teeth and

ensive for the patient and the

to a greater or lesser extent.

premolars. Miniscrews provide

orthodontist will find it highly

All these mechanisms have

the definitive form of anchorage

effective.

the same underlying problem:

for the alignment of displaced

the neighbouring teeth must be

teeth (Figs. 3a–c). If sufficient

used—directly or indirectly—to

space is available, brackets will

provide an anchorage, so that

not be needed in the initial phase

The alignment of retained or

the required traction forces can

of treatment.

displaced teeth, particularly in

be applied. Ideally, the neigh-

the case of canines, is one of

bouring teeth will offer the

Skeletal adjustments

the most common forms of sur-

greater resistance so that only

Palatine suture expansion

gical intervention in the field of
orthodontic techniques. Numer-

the retained tooth moves. Realistically, however, both compo-

Rapid palatal expansion (RPE) is
one of the most effective and

Alignment of retinated
teeth

Fig. 5: The hybrid RPE appliance with adjuvant anterior hooks for the attachment
of a Delaire mask.

[26] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

26 trends & applications

Figs. 6a–d: Bilateral cross-bite in a seven-year-old boy (a). X-ray of the hybrid RPE appliance in situ (b). Status after ten days’ use: cross-bite has disappeared and vertical bite has remained stable (c, d).

Figs. 7a–d: Anchorage of the canine using a miniscrew avoids protrusion of the anterior teeth when using a fixed Class II correction appliance (here: Williams appliance, FORESTADENT).

verse line connecting the canine/
premolar contact points paramedially. Distraction is achieved
using the same method as in
standard techniques. There are
several advantages to hybrid
RPE. Preparation of the apparatus

much

simpler

and

cheaper, whilst the dental arch,
including the premolars, is
accessible for additional tooth
correction measures.
Figs. 8a & b: The miniscrew stabilises the position of the molars to which the Kinzinger FMA is attached. This counteracts any protrusion of the premolars and
anterior teeth (a). Class I dental status on completion of treatment (b).

Class II corrections
In the case of patients with
Class II malocclusion who have

stable methods of acquiring

upper jaw. The targeted screw

0.2 to 0.6 mm/day. As a rule,

force over more than one tooth.

completed or are near com-

more transverse space in the

rate should be in the range of

the appliance is fixed by means

A further problem is apparent

pleting their growth phase,

of bands to the molars & premo-

here: as it is necessary to leave

simple techniques for the for-

lars. The desired transverse

the appliance in place for a

ward positioning of the lower

width can generally be achieved

longer period after the active

jaw are usually ineffective.

within 10 to 20 days. There

phase, it is only possible to

Following a thorough initial

after, a three-month stabilisation

commence further corrective

examination

phase should be observed, in

treatment for teeth in the ante-

there are three possible thera-

order to allow ossification of

rior region. It is possible to

peutic approaches: camouflage,

the ruptured palatine suture.

overcome these problems by

fixed Cass II correctional appli-

The standard anchorage tech-

using the ‘hybrid RPE’ (Figs.

ances (Herbst splint, Sabbagh

nique

support

4–6). Bands are employed as

Universal Spring, FMA, Jasper

only has several disadvantages.

usual in the molar region.

Jumper etc.) or orthognathic

The most significant is the risk

In the anterior region, the RPE

surgery. The patient must be

of tipping the anchor teeth.

appliance is fixed using two

informed of the advantages

Many appliances have been

miniscrews.

and

described that distribute the

be placed on a notional trans-

Fig. 9: The use of miniscrews to attach intermaxillary rubber traction bands
means that no other attachments to the teeth are necessary.

with

dental

These

should

and

disadvantages

diagnosis,

each

approach. All fixed Class II

Figs. 10a–d: Missing tooth 12 is to be replaced by an implant-based crown. The initial phase of treatment involves widening the gap (a). The head of the vertically inserted OrthoEasy screw (b) is used to
anchor a provisional crown (including bracket), which serves to widen the gap further (c).

[27] => DTAP0109_01-02_TitleNews

DeNtal tribuNe | april-June, 2010

trends & applications 27

correctional appliances—irre-

the dental ridge (Fig. 10b).

Outlook

spective of whether these use

There

least

The clinical use of miniscrews

screws offer, in addition to

the Herbst splint or canted

1 mm of bone to the mesial

supports a wide range of tasks.

screws and insertion tools, a

plane principle—have the same

and distal sides of the mini-

Dental repositioning that was

number of devices that facili-

problem and the same undesir-

screw. The hole for the insertion

previously deemed impossible

tate the use of miniscrews. The

able side effects. There is a

of a miniscrew (1.6 mm) should

becomes

achievable,

whilst

fifth part of this series will

risk of protrusion of the lower

thus be at least 2.6 mm. A provi-

possible

repositioning

tech-

focus on the wide range of

frontal teeth and/or distalisation

sional

niques are improved and sup-

useful

of the upper molars. By means

mounted onto the head of the

ported. In order to achieve

available. DT

of passive stabilisation with

miniscrew.

this, miniscrews alone are not

of Dental Tribune India will

the aid of two miniscrews

bracket can be fixed to this

sufficient; an appropriate range

feature part V of this article.

(Figs. 7 and 8), these effects

crown (Fig. 10c).

of equipment is also necessary.

can be readily avoided.

Orthognathic surgery
After

surgical

intervention

to relocate or reposition the
jaw (for orthodontic or traumatological reasons), it is important to maintain a stable correlation between bone fragments
and the jaw in the postoperative
phase. This promotes healing
and

prevents

relapse.

The

occlusion appliance is fixed
intraorally, using intermaxilliary elastic or wire ligatures,
depending on the situation.
It is essential to use the appropriate fixing options, whether
this is a splint (Schuchardt
splint) or a multi-bracket appliance. Where these are really
only needed in one jaw or jaw
section, the question arises
of whether, in the era of
the miniscrew, it is necessary
to involve the other jaw in
the stabilisation of the surgical
effect. If miniscrews are used
in the opposing jaw (Fig. 9),
the same effect is achieved—
but

with

restriction

considerably

less

from

point

the

of view of the patient.

Pre-prosthetics
It is the aim of pre-prosthetic
orthodontics to position the
teeth optimally for the subsequent

prosthesis.

This

can

include intrusion, uprighting,
and the opening or closing
of gaps, amongst other techniques. As this series and many
other publications have already
shown, miniscrews are particularly useful in this context.
Miniscrews can also be used
as

anchoring

elements

for

a provisional prosthesis. Where
teeth are missing (particularly
the second canines, Fig. 10a)
and the growth phase is not
yet

completed,

the

fitting

of an intermediate prosthesis
is problematic. As an alternative, particularly where additional anchorage is required,
miniscrews can be used. A
longer screw (8 or 10 mm) can
be inserted in the centre of

should

crown
If

can

then

necessary,

Several suppliers of mini-

auxiliaries

that

are

About the author
Dr. Björn Ludwig
Am Bahnhof 54
56841 Traben-Trarbach,
Germany
Tel.: +49 65 41 81 83 81
Fax: +49 65 41 81 83 94
E-mail: bludwig@
kieferorthopaedie-mosel.de

Editorial Note: The next edition

[28] => DTAP0109_01-02_TitleNews

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[toc] => Array ( [0] => Array ( [title] => Prozone confirms effectiveness of ozone dental therapy [page] => 01 ) [1] => Array ( [title] => News & Opinions [page] => 02 ) [2] => Array ( [title] => Does dentine hypersensitivity affect oral health-related qualty of life? [page] => 04 ) [3] => Array ( [title] => A case report: Unusual anatomy of maxillary second molar [page] => 07 ) [4] => Array ( [title] => Treating a peri-radicular abscess [page] => 09 ) [5] => Array ( [title] => Interview with Dr Oliver Hennedige - Singapore [page] => 12 ) [6] => Array ( [title] => Saddle stool in dentistry [page] => 17 ) [7] => Array ( [title] => Current concepts in gutta-percha removal for re-treatment (Part 1 of 2) [page] => 18 ) [8] => Array ( [title] => Case report: Interdisciplinary full mouth rehabilitation [page] => 19 ) [9] => Array ( [title] => FDI World Dental Communique (Mar/Apr 2010) [page] => 21 ) [10] => Array ( [title] => Complete maxillary implant prosthodontic rehabilitation with a CAD/CAM-fixed prosthesis [page] => 22 ) [11] => Array ( [title] => Epulis gravidarum mimicking a neoplasm [page] => 24 ) [12] => Array ( [title] => Miniscrews—a focal point in practice (Part 4 of 6) [page] => 25 ) ) [toc_html] =>

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