DT India & South Asia No. 10, 2019

AIIMS & Union Health Ministry launch ‘eDantSeva’ web & app to reach out to over 1 billion people / News / Slow Dentistry- a concept to empower dental patients and also reduce work stress among dentists

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AIIMS & Union Health Ministry launch ‘eDantSeva’ web & app to reach out to over 1 billion people
01 - 01 view
News
02 - 05 view
Slow Dentistry- a concept to empower dental patients and also reduce work stress among dentists
06 - 07 view

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DENTALTRIBUNE
The World’s Dental Newspaper · South Asia Edition

Published in India

www.dental-tribune.in

Digital Aesthetic

Robotic implant

Digital Aesthetic
Dentistry: 6-Step
Workflow
Integrates
Multiple Systems,
Gadgets, and
Tools

Boston University
Dental School- the
first US dental
school to
implement robotic
implant surgeries

” Page 02

10/19

Gingival cells

Slow Dentistry

Study identifies gingival
cells that can protect
against periodontitis

” Page 04

” Page 05

Slow Dentistry- a
concept to empower
dental patients and
also reduce work
stress among
dentists

” Page 06

AIIMS & Union Health Ministry
launch ‘eDantSeva’ web & app to
reach out to over 1 billion people
by Dental Tribune South Asia
New Delhi, India: The All
India Institute of Medical
Sciences (AIIMS), and Union
Health ministry have launched
‘eDantSeva‘ website and mobile
application - that will reach out
to more than one billion people
with just one click.
On the 7th of October 2019,
the All India Institute of Medical
Sciences, in collaboration with the
Union Health Ministry launched
a unique digital platform
‘e-DantSeva‘ - the first-ever
website and mobile application
on oral health awareness.
Union
Health
Minister
Harsh Vardhan said the digital
platform will provide oral health
information
gathered
from
authentic scientific resources
and help people to get timely
advice for managing their dental
emergencies and various oral
health problems. The ‘eDantSeva‘
website and mobile application
will reach out to more than one
billion people with just one click,
he added.
‘e-DantSeva‘
contains
information about the National
Oral Health Programme, a
detailed list of all the dental
facility and colleges, Information,
Education and Communication
(IEC) material and a unique
feature called the ‘Symptom
Checker‘.
eDantSeva aims to sensitize
people about the significance
of maintaining optimum oral
health and equips them with
the tools and knowledge to
do so, including awareness on
the nearest oral health service
facility (contains GPRS and
satellite images of the facility for
easier access to the people).
Dr Harsh Vardhan also
released a Braille booklet
and voice-over on oral health

AIIMS & Union Health Ministry launch ‚eDantSeva‘ Website & App to reach out to over 1 billion people (Photo: National Portal of India (india.
gov.in); Wikimedia/Magnus Maske; Flickr/ Russavia)

education for visually impaired.
“Oral health is indispensable for
the wellbeing and good quality
of life. Poor oral health affects
growth negatively in all aspects
of human development,“ he said
The objectives of e-DantSeva
include:
•
Improvement in the
determinants of oral health
e.g. healthy diet, oral hygiene
improvement
etc.
and
to
reduce disparity in oral health
accessibility in rural & urban
population.
•
Reduce morbidity from
oral diseases by strengthening
oral health services at Sub
district/district hospital to start
with.
•
Integrate oral health
promotion
and
preventive
services with general health

care system and other sectors
that influence oral health;
namely various National Health
Programs.
•
Promotion of Public
Private Partnerships (PPP) for
achieving public health goals.
Email : nohpindia@gmail.
com – is available for any questions
people may have about their
dental health and the choices that
are available to address specific
conditions.
The current initiatives in the
domain of Oral Health include:
•
Initiation of the Pit and
Fissure Sealant Pilot Project in
2017 in collaboration with 12
dental colleges and institutes
with a target to seal 53,750
permanent molars in children
6-14 years of age to prevent dental
caries.

•
Approval of AIIMS,
New Delhi for the set up of the
National Referral and Research
Institute for Higher Dental
Studies (NaRRIDS), an apex
Institute for oral health research
and tertiary care.
•
Conduction of Regional
and National Review Meetings
and Workshops for the purpose
of training and capacity building
of State Nodal Officers
•
Development
of
training manuals on oral health
for para-dental staff, including
oral health manuals for school
teachers and healthcare workers
•
Set up of Tobacco
Cessation Centers in dental
colleges across the country
through a collaboration with the
Dental Council of India.

•
Development of IEC/
BCC materials to generate
awareness on oral health,
including posters, pamphlets,
television commercial, radio
jingle and games for children.
•
Celebration of World
Oral Health Day on 20th March
across the country.
•
Initiation of a Pilot
Project on Oral Health Care of
Pregnant Women in collaboration
with the Dental Department at
VMMC &Safdarjung Hospital
•
Drafting of a National
Oral Health Policy for India
•
Engagement
of
stakeholders for phasing down
on dental amalgam in India
under the Minamata Convention

[2] =>

News

10/19

Digital Aesthetic Dentistry:
6-Step Workflow Integrates
Multiple Systems, Gadgets, and
Tools
The second step is to collect
the intraoral data using a 3Shape
Trios intraoral scanner. (Fig 8)
Use the scanned data and
design a digital wax-up using the
new SKIN concept, introduced
by Paulo Kano. (As mentioned
earlier, this process has been
completely digitized by Florin
Cofar et al through the ‘RAW’
concept.)
Use the 3Shape Software to
create two sets of digital wax-ups
– one for the upper 6 anteriors
and another for the upper 10
teeth till the second premolars
using the tooth shapes available
in the 3Shape library. (Fig 9- 12).
The 3 D wax-up can also be done
using the Exocad software.

Digital Aesthetic Dentistry: 6-Step Workflow Integrates Multiple Systems - DSD, New SKIN and RAW. (Photograph: Dr Aslam Inamdar)

by Dr Aslam Inamdar
With so many new tools and
systems populating the digital
dentistry and smile design
space, a beginner often finds
himself confused about the
different terminologies and the
clinical steps used. Dr Aslam
Inamdar simplifies the digital
workflow and the clinical
procedures into 6 easy steps for
anybody to understand.
Introduction:
One of the biggest challenges
we have in clinical dentistry
is to meet the expectations of
esthetically demanding patients,
for which it becomes imperative
for the aesthetic dentist to
understand his patient’s needs
as well as desires. Also, we need
tools that enhance our diagnostic
vision and make it easier for us to
communicate the treatment steps
with our team objectively and
clearly. The need is to employ
user-friendly systems & create
standardized workflows that
can guide the team through the
aesthetic rehabilitation process.
The ultimate aim is to address
the functional and biological
issues
therapeutically
and

generate aesthetic outcomes that
are predictable & consistent.
Digital Smile Design (DSD),
a novel concept designed by Dr
Christian Coachman, collects
digital images of the patient’s
smile and provides essential
tools to create a 3D diagnostic
wax-up. High-quality digital
images - static and dynamic,
make
the
foundation
of
DSD for the documentation,
communication and analysis
of data - the most critical
components of contemporary
esthetic rehabilitation. Moreover,
they create a set of standardised
templates
and
guidelines
for diagnosis and treatment
planning. We also need good
videos documenting the patient‘s
phonetics.
The DSD protocol is also a
fantastic communication tool
to enable the patients to see the
treatment outcomes beforehand.
Test drive – a powerful DSD tool
enables the patients not only to
see and compare the end result
with the pre-op situation but also
experience it in real life. A test
drive adds transparency, builds
trust and increases the treatment
acceptance rate.

Another concept that we
describe here is called the ‘New
SKIN’ designed by Paulo Kano.
The New SKIN concept uses
natural anatomical shapes of the
teeth to give a natural appearance.
Originally it was a combination
of digital and manual workflows.
Later it was completely digitized
by Florin Cofar et al through
the ‘RAW’ concept. Now, all
these workflows are clinically
known as Natural Restoration
workflows.
This case shows how we
create two test drives (mockups), both of which have DSD
planning in common, but differ
in their morphology based on the
tooth shapes selected from the
3Shape digital library.
Case presentation:
A 27-year-old male presented
with a short and small upper
right lateral incisor (12), and
worn-out central incisors (11/21).
Below is a 6- step workflow that
covers the digital planning and
clinical execution until he gets a
test drive to wear.

Step 1: Photographs and
Treatment Planning using the
DSD Software (Fig 1 - 6).
First, we need a full set of
high-resolution photographs to
analyse and diagnose the smile.
Also, good videos documenting
the patient‘s phonetics.
We use these images to
plan the treatment and also to
guide the team through all the
subsequent steps of smile design
and esthetic rehabilitation.
Next, we start with the
Digital Smile Design process
to create a treatment plan. Out
of all the images taken above,
three photographs viz. frontal,
12 o‘clock position, and occlusal
– are essential for this step. We
have to verify the harmony
among these three images as
shown in Fig. 7.
We do the DSD 2D planning
using the keynote on a Mac/
powerpoint/ DSD app or any
similar app. This 2D planning
creates the foundation for the
subsequent 3D steps.
Step 2: Intraoral Scanner
and Digital Wax-ups using the
New SKIN / RAW concepts

Step 3: 3D Printing of the
Digital Wax-up.
Next, we 3-D print the digital
wax-ups (Anycubic Photon 3D
Printer). (Fig 13-14)
3 D printing can be done,
besides Photon, in any DLP /SLA
printer.
Step 4: Create a Silicone
Index using 3D printed models.
Next, you create a silicone
index - an impression of a
wax-up. If you have created a
digital wax-up, as done in this
case, then 3D print the digital
wax-up first and then take its
impression. A silicone index is
designed for transferring the
information of a wax-up into the
mouth during treatment.
The
silicone
index
prepared from the 3D printed
models (Fig 14- 15) carries the
provisionalization
material
(Luxatemp) into the patient’s
mouth to create two sets of mockups.
Step
5:
Carry
a
provisionalization
material
intraorally in the Silicone Index.
One silicone index carries the
provisionalization (Luxatemp)
material (A2 shade) for the
upper 6 anterior teeth, whereas
the other carries Luxatemp (A1
shade) for the upper 10 teeth till
the second premolars.
We create two mock-ups (Fig
16-17) and the patient gets to

[3] =>

3

News

compare them with the baseline
situation (pre-op images).

10/19

Step 6: Test-drive the
mockup in the patient’s mouth
Allow the patient to wear
and experience the test-drive.
Evaluate his satisfaction with the
new appearance, function, and
speech with the intraoral testdrive. (Fig 18- 23)
Take your patient‘s approval
for the subsequent steps of smile
design.

Conclusion: What after the
patient approval?
Next, as per DSD planning,
we carry out the necessary
orthodontic,
periodontic,
implant procedures or any other
treatment. This is followed by
restorative treatment where
we create final restorations in
monolithic materials using the
same teeth shape and morphology
as approved by the patient in the
test drive. This leaves no room

Fig-1

Fig-6

Fig-2

for surprises in the end, as we
begin the procedure with the end
in mind !!
In Digital Aesthetic Dentistry,
the right mix and the optimum
use of advanced technologies –
DSD, New SKIN concept, RAW,
Intraoral scanner, Digital library,
3D wax-up software, 3D printer
- can give excellent results in
esthetic rehabilitations.

References:
1.
The Anatomical Shell
Technique:
An
Approach
to
Improve
the
Esthetic
Predictability of CAD/CAM
Restorations. Paulo Kano et
al. Quintessence of Dental
Technology 2013: Vol 362.
2. Improving aesthetics in
CAD/CAM dentistry – Anatomic
Shell Technique (AST) Paulo
Kano, Cristiano Xavier, Jonathan
Ferencz et al. Cosmetic Dentistry

Fig-10

International, 2013 Issue 4,
Volume 7: 18- 21.
3. Coachman C, Calamita
MA,
Sesma
N.
Dynamic
Documentation of the Smile
and the 2D/3D Digital Smile
Design Process. Int J Periodontics
Restorative Dent. 2017; 37 (2):183193.
4. The Anatomical Shell
Technique: Mimicking Nature—
Paulo Kano; Luiz Narciso
Baratieri et al. Quintessence of
Dental Technology 2014: Vol 37

Fig-19

Fig-11

Fig-15

Fig-20

Fig-3

Fig-7

Fig-12

Fig-16

Fig-21

Fig-4

Fig-8

Fig-13

Fig-17

Fig-22

Fig-5

Fig-9

Fig-14

Fig-18

Fig-23

Dr.
Aslam
Inamdar’s
professional
journey
and
his state of the art practice
in Mumbai is a rich blend of
the most contemporary and
advanced domains of dentistry
in the right mix.
After
graduating
from
Nair Hospital Dental College,
Mumbai he started with Dr.
Inamdar’s Dental Studio – his

award winning dental clinic
located in South Mumbai.
First, he took training in
Digital Smile Design (DSD)
from Dr. Christian Coachman,
and then worked as a cotrainer for DSD with Dr. Rajiv
Verma. Next, Dr. Aslam
completed his Mastership in
Clinical Implantology from
Stony Brooks School of Dental

Medicine (New York, USA)
along with Online Externship
in Dental Implantology from
Dentalxp, Atlanta, USA. He is
a consulting implantologist to
many clinics in Mumbai. Dr.
Aslam continued his journey
in digital dentistry by getting
extensively trained in CADCAM dentistry from Florin
Cofar and master Paulo Kano.

Very recently, Dr. Aslam
received his Diplomat in New
SKIN & Magic Make Up from
Romania. Dr. Aslam is known
as the Digital Dentist of India
with his state of the art practice
focusing on Digital Smile
Design, extensive use of Intraoral scanner, 3D Printer and
CAD CAM Technology.

Author:

Dr Aslam Inamdar

[4] =>

4 News

10/19

Boston University Dental School- the first
US dental school to implement robotic
implant surgeries
by Dental Tribune South Asia
The Henry M. Goldman
School of Dental Medicine
(GSDM) at Boston University
has become the first U.S. dental
school to use surgical robotic
devices for dental implant
surgeries.
Yomi, the robot-assisted
surgical device, developed by
Miami-based healthcare start-up
Neocis is the first (and to date,
only) dental implant surgery
device to have received the
clearance from the U.S. Food and
Drug Administration; and now,
the Henry M. Goldman School
of Dental Medicine (GSDM)
has become the first U.S. dental
school to acquire and install the
Yomi surgical robotic devices for
dental implant surgeries.
Yomi will provide an excellent
opportunity for the predoctoral
students and the postdoctoral
residents of the dental school
to learn how the accuracy and
precision of this state-of-the-art
robotic technology can impact

Goldman School of Dental Medicine, Boston becomes the first US Dental School to acquire and implement
Yomi Robotic System for dental implant surgery by Neocis (Photo: www.neocis.com)

and significantly improve dental
implant surgical outcomes and
patient care.
Dr Alexander Bendayan,
GSDM’s assistant dean of
digital development & clinical
training, believes that Yomi is
truly revolutionary and will
significantly improve the way
dental implant surgeries are
done at the Henry M. Goldman
School of Dental Medicine, and
also that it will help to establish

new standards of care for the
profession.
In the Yomi protocol, the
implant surgeon first creates
a virtual plan for the implant
placement using 3D scans taken
of the patient’s mouth. The
system then guides the surgeon
in the precise implementation
of that plan, giving real-time
feedback via haptic technology to
guide him through the process.
Yomi is flexible enough to adjust
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dynamically to accommodate
any mid-procedure changes.
The implant surgeon controls
the handpiece at all times, and
Yomi augments his ‚feel‘. So,
essentially, Yomi complements,
rather than overriding your
clinical expertise.
Dr Alon Mozes, co-founder
and CEO of Neocis, and a member
of the Dean’s Advisory Board
at GSDM said that embedding
this advanced technology at the

dental-school level will help in
building comfort and skill from
the ground up and that Yomi
may become a new standard of
care for dental implants.
GSDM, with assistance from
Neocis technicians, completed
installing and calibrating the
robotic devices in September
2019. GSDM faculty members
underwent rigorous two-day
training in the last week of
September 2019, with additional
two-day
training
sessions
planned in the next few months.
Once the training is complete, the
GSDM faculty members will not
only implement the Yomi system
on their patients but will also
start instructing the predoctoral
students
and
postdoctoral
residents on this technology.
All predoctoral students
at GSDM currently have the
opportunity to place dental
implants using guided surgery,
and soon they will be able to use
the first robot-assisted dental
surgical system in the U.S.
Ad

[5] =>

News

10/19

Study identifies gingival
cells that can protect against
periodontitis.

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A new study has indicated that molecular pathways in periodontal solitary chemosensory cells are involved in the regulation of oral
microbiota. (Image: Monell Chemical Senses Center (CC BY 4.0) creativecommons.org)

by Dental Tribune International
PHILADELPHIA,
U.S./
CHENGDU, China: Periodontitis
remains the sixth most prevalent
infectious disease worldwide,
and the most common cause of
tooth loss despite significant
advancements in oral health care.
A new cell type discovered in the
gingival epithelium that helps
protect against harmful bacteria
has renewed the interest in the
immunological regulation of
periodontal diseases.
Periodontitis is a chronic
inflammation
of
the
toothsupporting tissues induced by a
bacterial infection. Recent studies
have shown that periodontitis
results from a condition known
as polymicrobial dysbiosis, which
disturbs the ecologically balanced
oral
microbiota
needed
for
maintaining normal periodontal
homeostasis. The host innate immune
system remains highly active in
order to maintain the homeostasis in
healthy periodontal tissue; however,

an imbalance or disruption in innate
immunity also contributes to the
destruction of periodontal tissue.
The host-microbiota interactions that
determine periodontal homeostasis
are complex and remain poorly
defined. We have very limited
knowledge of the specific host
receptors that detect pathogenic oral
bacteria.
However, this study appears
to have taken us closer to the point
of understanding the receptors
and molecules that can influence
the onset of periodontitis and its
management.
Researchers
from
Monell
Chemical Senses Center, a nonprofit
independent scientific institute,
collaborated with the scientists from
Sichuan University in Chengdu in
China and examined the gingivae
of mice, where they found a cell
type called solitary chemosensory
cells (SCCs) that expressed different
types of taste receptors as well as
the protein gustducin. SCCs, which
have previously been found in the
urinary tract, the gut and the nasal

cavities, function by sensing irritants
and bacteria.
The study showed that when
the researchers genetically removed
gustducin and/or SCCs from the
mice’s gingivae, often pathogenic
oral bacteria quickly grew in
numbers, resulting in periodontitis.
In contrast, when they stimulated
the bitter taste receptors in SCCs,
it promoted the production of
antimicrobial molecules.
Overall, mice without gustducin
in their SCCs harboured more
potentially harmful oral microbiome
than those with gustducin present
in their SCCs. Most importantly,
the researchers identified these
differences in oral flora compositions
much before any periodontal bone
loss occurred, which implies that
the presence or absence of gustducin
in SCCs could be regarded as a
forerunner to periodontitis and help
us in the early identification of the
disease.
“Our study adds to a growing
list of tissues we now know contain
SCCs and indicates that the common

molecular pathways in gum SCCs
are involved in the regulation of oral
microbiota,” said Dr Marco Tizzano,
a researcher & the co-author of
this study at Monell Chemical
Senses Center. “In the absence of
taste signalling in the gums, the
oral microbiome changed in mice
without gustducin.”
Topical treatment with bittertasting denatonium could increase
the expression of antimicrobial
peptides against ligature-induced
periodontitis in gustducin positive
mice, and not in others.
The research team, based on this
study and other unpublished work
relating to humans, has suggested
that periodontal SCCs in humans
may play a similar regulatory role in
regard to our own oral microbiomes.
The study, titled “Gingival
solitary chemosensory cells are
immune sentinels for periodontitis,”
was published online on Oct. 3, 2019,
in Nature Communications.

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[6] =>

6 Clinical

10/19

Slow Dentistry- a concept to empower dental
patients and also reduce work stress among
dentists

Slow Dentistry has encouraged dental professionals to adopt a slower pace in their dental practices to
ensure patient safety and to reduce work-related stress. (Photo: Joseph Shohmelian from Pixabay)

by Dental Tribune International
LUCERNE,
Switzerland:
A group of international
clinicians have developed this
concept of Slow Dentistry to
overcome the work pressure
or stress seen among dental
professionals to perform and
achieve instant results. The
concept of slow dentistry is
built upon four universal key
principles designed to empower
the patients to be confident
about their safety, well-being
and comfort, and also help

them understand the dental
treatments better.
The nature of work and
working conditions in dental
surgery have turned dentistry
into a stressful profession. With
the dramatic changes that have
taken place in the profession in
recent years, and the changes
that are expected to happen in
the coming years, it has become
critical that we establish the
impact this would have on
on the well-being of dental
professionals.

A study was conducted to
determine the levels of stress
and burnout among dental
professionals in the UK and how
this relates to their well-being.
The study also made an attempt
to identify the sources of workrelated stress that the dentists
self-reported in their practice.
An online survey that
covered the work stress, burnout
and well-being among dentists
- was administered to the
members of the British Dental
Association (BDA), and also the
non-members.

A total of 2503 respondents
gave valid responses, which
showed that dental professionals
working in the UK exhibit high
levels of stress and burnout and
low well-being. General dental
practitioners (GDPs) seem to be
the most affected group. Issues
relating to regulation and fear
of litigation appear to be the
most stressful aspects of being a
dentist.
The findings from this
online survey build upon the
existing research findings and
show that dentistry is, indeed,
a stressful profession. The
changing landscape of dentistry,
over the years, seem to have
shifted the sources of this stress.
The researchers felt that the
interventions should address
these stressors and make changes
in the working conditions of
dentists.
The paper recommended
that instead of solely focusing
on individual solutions (e.g.
stress management), future
interventions should also seek
global solutions (e.g. modifying
the working environment). The
concept of Slow Dentistry aims
to bring in a shift towards a
slower pace of care, which would
not only ensure patient safety
but also minimise the triggers

that create stress among the
practitioners.
“The four cornerstones are
easily identifiable and are a means
to allow patients to influence
their safety and well-being at the
dentist. We encourage everyone
to insist on having the time to
explain and understand, the
time to ensure that anaesthetic
is effective and to take note of
all aspects of hygiene,” said Dr
Miguel Stanley, a co-founder of
Slow Dentistry. “While we may
assume this is all happening—
and, in many cases, it is—the
cornerstones of Slow Dentistry
encourage patients to take some
control over their appointments,”
he commented.
“Having created a large
client base through my passion
and love for dentistry, I found
myself overwhelmed and unable
to cope with the growing patient
list. It soon became evident to
me that time was what I needed,
and what is essential to provide
the best care for my patients,”
said Dr Rhona Eskander, one of
the global ambassadors for Slow
Dentistry.
The study A survey of stress,
burnout and well-being in UK
dentists was published in the
British Dental Journal on 11th
January 2019.
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5/7/19 11:42 AM

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[8] =>

7 News

7/19

and

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[cover] => DT India & South Asia No. 10, 2019

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