DT India & South Asia No. 11, 2019

There is much more to Digital Dentistry than owning some digital tools & softwares - Dr Aslam Inamdar / Study outlines the emerging, innovative & most effective training methods in implant dentistry / A Clinical Observation: Relation Between Dental Occlusion & Posture / American Dental Association recommends against the use of antibiotics in most toothache cases

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There is much more to Digital Dentistry than owning some digital tools & softwares - Dr Aslam Inamdar
01 - 02 view
Study outlines the emerging, innovative & most effective training methods in implant dentistry
03 - 03 view
A Clinical Observation: Relation Between Dental Occlusion & Posture
04 - 05 view
American Dental Association recommends against the use of antibiotics in most toothache cases
06 - 06 view

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DENTALTRIBUNE
The World’s Dental Newspaper · South Asia Edition

Published in India

www.dental-tribune.in

Digital Dentistry

Implant Training

There is much
more to Digital
Dentistry than
owning some
digital tools &
softwares - Dr
Aslam Inamdar

Study outlines the
emerging,
innovative & most
effective training
methods in
implant dentistry

” Page 01

11/19

Occlusion and Posture
A Clinical Observation:
Relation Between
Dental Occlusion &
Posture
” Page 03

” Page 04

Antibiotics use
American Dental
Association
recommends against
the use of antibiotics
in most toothache
cases

” Page 06

There is much more to Digital
Dentistry than owning some digital
tools & softwares - Dr Aslam Inamdar
by Rajeev Chitguppi, Dental
Tribune South Asia
Dr Aslam Inamdar, the
orofacial architect and the flagbearer of digital dentistry from
India answers the questions
from the readers and the editor
to give a glimpse of what he
is doing currently and how he
plans to take digital dentistry
forward in India. Dr Aslam
has completed his mastership
in
Clinical
Implantology
from Stony Brooks School of
Medicine, New York. However,
his niche remains Digital
Aesthetic Dentistry and Smile
Design, where he has trained
extensively with Christian
Coachman, Florin Kofar and
Master Paulo Kano. Apart from
being an expert in Digital Smile
Design, Dr Aslam is the first
Diplomat from India in Skin
CAD-CAM and also in Natural
Restorations. Currently, he is the
only dentist from Asia to pursue
Diploma in Digital Dentistry
from JSI Institute, Spain. In the
past few years, Dr Aslam has
made multiple international
visits (USA, Romania, Spain,
Brazil, and South Korea) to
upgrade his knowledge in the
fields of implant dentistry and
digital dentistry. Dr Aslam has
founded Rich Smile education,
digital
planning
solution
and distribution to help the
dental practitioners to raise
the standards of their esthetic
dentistry practice and also to
raise the bar of digital dentistry
in India.
What is Digital Dentistry?
A few digital devices, gadgets
and software added to a dental
clinic or much beyond that?
That is a good question to
start with! In the past decade
or so, dentistry has grown by

There is much more to Digital Dentistry than owning some digital tools & softwares- Dr Aslam Inamdar

leaps and bounds and there has
been a paradigm shift due to
newer advances in technology
and materials. Although digital
dentistry tools to capture patient
data, diagnose, plan as well as
related CAD-CAM tools are
freely available, one needs to
be thorough with their clinical
dentistry protocols. Although
there is no dearth of digital
tools and software available
to a practising dentist, a good
workflow is of utmost importance.
Only then can digital tools
and software aid in delivering
faster, better, predictable and
more importantly repeatable
restorations to the patients.
To conclude, merely amassing
gadgets and software is not
digital dentistry. Rather it is the
clinical application of these tools
and investment of time to learn
how to make optimal use of
these in the best interest of our
patients.
You
have
established
yourself as a flagbearer of
digital dentistry in India,

with so many digital dentistry
concepts being implemented
in your clinic. How did your
journey start?
Thank
you
for
the
compliment. With great power
comes great responsibility, and
I constantly aspire to do justice
to the best of my abilities. I
am well aware of many of my
hardworking colleagues who
work with great passion in
this field and are doing great. I
graduated from Nair Hospital
Dental College in 2001. Coming
from a humble background
I had to work different jobs
as an associate dentist until I
started my own clinic with my
wife in 2003. Since my college
days, I have dreamt of creating
natural smiles for my patients. I
struggled for about 10 years just
like any other dentist in Mumbai
city, but I cherished a dream and
a passion to excel.
In 2012, I came across Dr Rajiv
Verma who introduced DSD
through Dr Christian Coachman
in India. The first DSD course
in Goa 2012 was a mesmerising

experience for me. My dream of
doing some of the best work saw
a light at the end of the tunnel.
You started off with DSD.
What were the other things you
started along the same lines?
Soon after doing my basic
DSD and DSD Residency with
Dr Christian Coachman at Spain
and in Brazil, I realised I needed
to learn more in the field of
CAD-CAM dentistry to be selfdependent in terms of the entire
digital workflow and the journey
still continues. I personally
believe there is much more to
explore.
I learnt the RAW protocol
from Florin Cofar in Romania,
new SKIN and 3D natural
staining from master Paulo
Kano, 3D staining for zirconia
from Changhwan Kim, digital
expert protocols from Jacobo
Somoza, Spain.
You are the only one, I
have seen, who uses the term
Orofacial Architect. How is an
Orofacial Architect different

from a prosthetic or restorative
dentist?
The term Orofacial Architect
was
coined
by
Christian
Coachman. I liked it very much.
I believe dentistry today is more
than just being a dentist fixing
issues related to teeth. We all
have been taught at universities
about the stomatognathic system
related to head, face and neck.
Dental issues can have a
long-lasting effect on the body
as a whole. Every expert focuses
solely on his area of expertise.
Our entire focus so far has been to
get the biological and functional
rehabilitation, mostly giving
least importance to esthetics.
Even though we deliver, we
leave our patients emotionally
handicapped.
An orofacial architect like
any other architect collects
the
necessary
information
in realtime, understands the
client desires, uses technology,
imagination and his expertise
to create 3D miniatures of the
proposed plan. This creates
harmony between aesthetics and
usability of the project.
Similarly, in today‘s times,
the orofacial architect becomes
the pilot of the project who
starts his plan with maximum
aesthetics as a priority and
finding a balance between form,
function and biology.
Once the aesthetic plan is
approved, then the clinical aspect
begins in reverse order. Thus
giving importance to biology,
form, function and completed
with a possible and desired level
of aesthetics by the patient in the
plan.
This way we address the often
neglected aspect of dentistry- the
emotional dentistry!
Tell us how digital dentistry
has
completely
changed

[2] =>

2

News

the
evaluation,
treatment
and patient experience in
your practice. Which is the
commonest treatment modality
that has undergone complete
transformation because of
digital dentistry?
There is no particular digital
treatment modality as such I can
say but it‘s the whole philosophy
of digital dentistry. It begins
with DSD treatment planning in
2D which comes from Christian
Coachman. As and when we look
after chief complaint and basic
hygiene of the patient and we see
slightest opportunity to serve
a patient with better treatment
outcomes we do the photo -video
protocol, intraoral scanning
if required CBCT and convert
all this data to make patients
digital clone. After this DSD 2D
planning is done. This helps us
to find the gaps from patients
current situation to the final
best possible aesthetic outcome
of treatment. Again our team as
per the expertise will look into
possible difficulties and how to
reach for the dream smile with
minimally invasive dentistry
while maintaining Biology and
function. A 3 D printed digital
mock-up based on Natural
Restorations is created to provide
for TEST DRIVE and seek patient
acceptance. This is a somewhat
normal routine we follow.
This method has set us
different from the routine dental
practice and patients love the fact
that before actually committing
for treatment a final look test
is done and a lot of options
regarding choice of materials
and related things is discussed.
This helps them understand
the benefits and the value of
financial investments into dental
health as per their choice. We
believe this is a more ethical,
patient-centric approach while
providing holistic dentistry.
If you want to see how these
tools and devices are used and
integrated with various concepts,
read my article published in an
earlier issue of Dental Tribune
South Asia. Click here to read how
the entire digital workflow has been
simplified into six steps.
What is the difference
between intraoral scanning,
PVS and lab scanning?
Technically, an intraoral
scanner scans up to 5 microns
accuracy and many lab scanners
do scan to similar levels. Most
labs convert PVS impressions
to digital workflow though lab
scanners to create prostheses.
The errors of PVS impression do
get copied by the lab scanners
and then the entire workflow
gets those flaws. An intraoral
scanner gives us a chance to
correct the errors instantly, saves

11/19

the time of physical transfer.
Another biggest advantage of an
intraoral scanner, in my opinion,
is its ability to scan a bite and
preserve it all through the case
completion phase so that it is
available to be reused whenever
there is a change in the treatment
plan. This possibility itself is
responsible for bringing out a
lot many innovations in digital
dentistry which is not possible
with lab scanners.
How to communicate with a
Digital Lab?
It is necessary to develop a
synergy between clinical digital
tools and laboratory digital
tools. It is easier for those big
practices who invest for in-house
use, but if you are outsourcing
then you should visit the lab
and understand the tools and
software that your technicians
are using. Understand the
requirements and limitations
from a laboratory perspective.
Digital Dentistry is growing by
leaps and bounds so frequent
interactions with each other is
very important.
We have heard about your
Natural Anatomical Shape
Restorations. It simply sounds
like Biomimetic Dentistry to
me. Is it the same?
No, it is not! Biomimetic
dentistry is an attempt at trying
to copy nature, while Natural
Restoration is the exact copy
and recreation of Natural teeth
shape, surface morphology in
monolithic restorations.
The natural shape, and
morphology form the basic
essence of dental white aesthetics!
Thanks to Master Paulo Kano
and his philosophy of New Skin
which got further developed into
100% digital workflow now we
call it as Natural Restorations.
So I don‘t call it Biomimetic
dentistry. I call it Copy-Paste
dentistry because it duplicates
nature precisely.
Coming to the other concept:
what exactly is the Injected
Smile concept?
This is a very fast, repeatable,
predictable and economical way
to restore teeth and smiles. It can
be used as interim restoration or
in certain cases as a long term
solution too.
We use DSD 2D planning
followed by 3D digital wax-up
and print 3D models. Clear
silicone indices are made and
these indices can be used to
build a predictable composite.
At the end inject bulk flowable
composites. This gives exact
natural shape and morphology
without the need for the dentist
to spend unnecessary clinical
time sculpting to mimic nature.

What is the downside of
Digital Dentistry?
I don‘t see any downside of
digital dentistry. As and when
you embrace it and cover the
learning curve, you will feel it‘s
the Golden era of Dentistry. Of
course, you will feel the cost of
investment is higher initially, and
a beginner may be overwhelmed
by the sheer number of tools
available and their workflows.
However, one can find out better
ways to workaround manage
this.
How difficult or easy is
the learning curve in Digital
Dentistry? How was it for you?
It will depend upon one‘s
digital literacy and clinical
experience to implement the
digital workflow in practice.
For me, I was so much digitally
ignorant that I didn‘t know what
powerpoint was and how to use
it when I attempted my first DSD
course in 2012 with Christian
Coachman. Again DSLR camera
was never heard of by me. It
took me an entire one year to
understand DSD philosophy and
do my own treatment planning
using powerpoint software. It
was difficult to find time from
routine busy practice. But I
pursued against all difficulties
and thanks to Dr Rajiv Varma
who pushed hard for me. Next
hurdle after learning to plan 2 D
DSD was to make it understand
the
interdisciplinary
team
which hardly existed in those
years for me. The final analogue
wax-up was again dependent on
technicians understanding and
expertise.
I worked with the DSD
concept with great difficulty
initially due to various obstacles
like technicians having difficulty
implementing it. I learned
computers better and DSLR
photography and kept myself
updated in CAD-CAM dentistry
from many other mentors and
reputed institutes globally. I have
consistently kept myself updated
in learning and implementing
the digital protocols and
invested accordingly in relevant
CAD-CAM tools. My wife and
associate dentists and my teams
at both clinics have been a great
support throughout.
I pursued my answers
in 3D CAD-CAM world and
visited many other countries
and mentors like Florin Cofar,
Paulo Kano, Jacobo Somoza
and likewise many others. The
journey still continues and
I am enjoying every bit of it.
Persistence is the key to get
through.
What advice will you give
to youngsters who are eager to
incorporate Digital Dentistry
in their practice but have cost

concerns? How can they start
small and cut costs?
Haha...
This
question
suddenly makes me wonder am
I so old..!
Ok, then let‘s change the
word from youngsters to
beginners. What would be your
advice to them?
I consider myself still a
novice in the game of dentistry!!
For dentists who have a stable
dental practice, my advice is
digital dentistry is here to stay.
Whenever you feel you are ready,
start investing slowly in digital
equipment, but spend more time
on gaining knowledge on digital
workflows and the clinical
integration. Start with digital
documentation of your work
which doesn‘t cost much. Move
out of comfort zone and develop
a new (digital) culture in your
practice.
What would be your
advice to the ambitious fresh
graduates who are looking for
quality higher education, not
only digital dentistry but any
type of higher education?
My advice to the beginners
would be not to look for quick
returns as soon as you graduate.
The focus for early 3 to 5
years should be on gathering
experience. For this one needs
to associate with good clinicians
and practices, and also help them
grow as associates. While doing
this, you will automatically learn
many things. Keep attending
continued dental educations on
a timely basis. There are many
and it is natural that one gets
confused. Follow your subject
of passion and gut feeling. Most
of the time when I attend such
workshops I may learn only one
thing but that could drastically
change many things for me.
Keep changing your mentors as
soon as you learned enough from
them. No cost-cutting when you
have to get an education first.
Earn, survive and keep investing
back in the profession at least for
10 years. Follow your passion
and money follows you at the
right time.
So you have followed your
passion in digital dentistry.
What are the various digital
tools and gadgets that you are
using in your clinic to apply the
concepts and philosophies of
digital dentistry?
The most basic thing is
documentation for which I have
a DSLR camera and related
flashlights. Coming to clinical
execution, I have 3Shape intraoral
scanner, 3Shape dental designer,
implant planning software,
photon 3D printer, and of course
the laptops that support the 3D

workflow. Milling is currently
outsourced.
If you want to see how these
tools and devices are used and
integrated with various concepts,
read my article published in an
earlier issue of Dental Tribune
South Asia.
What is a typical digital
dentistry day in your clinic
Dental studio?
At the moment, in my day to
practice with every new patient
we collect photos, videos and
intraoral scans. After completion
of routine dental treatment by the
associate dentists, we schedule a
test drive. After the test drive if
the patient consents, we begin the
treatment. In between patients, I
practice my learning on software
and teach my upcoming team at
Rich Smile.
You said Rich Smile. What
is it?
Rich Smile is my dream
project which will have various
verticals mainly clinics, digital
design services and digital lab
services. The idea is to establish
a premium dental practice
with all the digital gadgets and
workflows under one umbrella
providing world-class dentistry.
How is Rich Smile going to
raise the standards of dental care
in India? How can practitioners
become a part of this?
There are a lot of practitioners
who do not wish to invest heavily
financially or in infrastructure
but wish to provide great
dentistry to their patients. Rich
Smile will provide the digital
design, workflows and the lab
services to them. As of now,
Rich Smile provides consultants
to various practices so that they
can deliver custom made natural
smiles to their patients. Rich
Smile education will provide
continuing education to the
upcoming talent of the country
to take the mantle forward.
We at Rich Smile education
wish to introduce some methods
for ease of planning in terms of
esthetic as well as 3D implant
planning. To become a part of
this, practitioners can click here:
http://bit.ly/richsmile and take
this survey and tell us their exact
requirements.

[3] =>

3

News

11/19

Study outlines the emerging, innovative
& most effective training methods in
implant dentistry
by Dental Tribune International
LISBON,
Portugal:
Technological progress is not
only helping the development
of newer implant treatment
techniques but also creating a
need to update the education
methods and models in implant
dentistry. Recent research from
Portugal, the UK and the US on
the trends in implant dentistry
education has summarised the
most effective training methods
in implantology. The publication
discusses
innovative,
nontraditional
methods
and
encourages dentists to seek
professional education after
their university training has
ended.
Nowadays,
traditional
teaching methods are being

replaced by modern techniques
that involve awe-inspiring images,
dynamic videos and interactive
exercises in lectures, and quizzes
or anonymous question sessions,
for on-site learning, to engage
participants who would usually
be too shy to ask questions.
The researchers of this study
evaluated two main learning
models: action learning and
blended learning, and also
reviewed - augmented reality,
artificial intelligence, haptics and
mixed reality and also analyzed
the experiences and opinions of
expert authors. They stated: “One
challenge in implant dentistry
education is that professional
learners who wish to learn are still,
too often, taught in traditional
ways of knowledge sharing rather
than involving students directly

in the application of knowledge
to solve, or better still prevent,
clinical problems.”
Action learning is a learning
approach where people are
committed to solving reallife problems through action.
Research highlights hands-on
exercises as an essential tool
in implant dentistry training.
Standardised plastic models
which mimic patients’ real
situations are a good way of
simulating implant placement.
Digital planning, customised
3D-printed models, animal and
human cadaver models, and
dynamic navigation systems
simulate real-life situations and
allow surgeons to practise in an
interactive way.
Different studies have shown
how hands-on exercises promote

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A recent review has summarised the most effective training methods
for implant dentistry. (Image: Photographee.eu/Shutterstock)

students’ learning by building
on their intrinsic motivation. A
survey conducted among 372
undergraduate students who
experienced both passive and
active learning showed that active
instruction had more positive
effects on their psychological and
behavioural outcomes.
However,
this
method
has limitations too. Action
learning models are expensive
as they require more resources facilitators, equipment and space,
which are not needed in the case
of a single instructor giving a
lecture in a lecture hall. An action
learning environment, owing to
unfamiliarity, can create a sense
of discomfort among participants,
who are taking on new processes.
Not all learners are comfortable
revealing what they do not know
to other participants, who may be
strangers.
The publication also covers
blended learning - a term that has
caused much confusion. However,
a popular definition states that this
learning model blends online and
face-to-face interaction to enhance
meaningful interaction between
students, teachers, and resources.
Many studies have demonstrated
that the blended learning model
provides superior outcomes when
compared with more traditional
teaching methods. However,
even with all the evidence and all
the technological advancements
that can help us overcome the
obstacles of different time zones
and geographical location, the
process of integration of blended
learning programmes within
mainstream
dental
implant
education has been slow.
Artificial intelligence (AI)
and machine learning (ML) are
two significant technological
contributors to blended learning,
as they incorporate significant
advances in computing power.
Furthermore, augmented reality

(AR) and virtual reality (VR) are
considered innovative advances
in implant dentistry education.
AR allows the user to feel as
though he or she is connected to
an enhanced environment. VR
brings together a combination of
multiple technologies, allowing
users to interact with virtual
entities in real-time.
Blended learning has its own
challenges and limitations. The
construction of sufficiently “real”
environments requires expensive
and
sometimes
technically
challenging interface design.
Another critical issue is data and
user privacy.
The researchers recommended
online interactive learning in
small working groups via social
media as this method allows
dentists to share their clinical
cases and also the day-to-day
clinical challenges that they face
in their daily practice. Webinars,
due to their flexibility of location
and their ability to promote
interaction via Q & A, are also
considered to be a good learning
method.
“Education
in
implant
dentistry will evolve quickly over
the next decade as technologies
already being used in other
industries are incorporated into
new and innovative learning
models. […] Going forward,
instead of traditional models of
education being used to achieve
all educational objectives, now
traditional formats that will be
ineffective with today’s learner will
be replaced, where appropriate,
with online education, AR, ML,
VR, and MR [mixed reality],”
stated the authors.
The study, titled “Innovative
trends in implant dentistry
training and education: A
narrative review”, was published
in the October 2019 issue of the
Journal of Clinical Medicine.

[4] =>

4 News

11/19

A Clinical Observation: Relation
Between Dental Occlusion & Posture
by Dr. Rinku Jain
The relationship between
stomatognathic and postural
system has been investigated by
many health care professionals.
Posture and the mandibular
function are strongly influenced
by the position of the teeth. We
know any missing tooth if not
replaced for long period of time
may lead to change in the bite,
because of the change in the
position of the adjacent and/ or
opposing teeth, especially in
pateints with poor oral hygiene.
A successful clinical outcome
of any dental restorative work
depends on proper occlusal
harmony.
With
advanced
digitization, we can measure
dynamic occlusal forces and
achieve occlusal stability with
T-Scan. Here is a case report
with treatment of traumatic bite
and its influence on posture,
before and after achieving the
occlusal harmony using T-Scan.
Introduction:
“The relation between dental
occlusion, body posture and
temporomandibular disorder is
a controversial topic in dentistry,
though the role of dental occlusion
in the development of TMDs
cannot be overruled”(2). “During
the routine oral examination,
the signs and symptoms of
dental occlusal disease must be
noted, and the patient should
be educated about the further
diagnosis and treatment” (2).
This is a case report showing
how occlusal changes can lead
to postural changes. This case
report details the correction of
traumatic bite with restorative
work and measurement of
occlusal forces with T-Scan.
It shows the importance of
correction of the traumatic bite
at the earliest to prevent TMD
and postural changes. It was
observed that minimal changes
in occlusion can affect the
posture.
Case report:
Patient aged 38, reported to
our office to get her missing teeth
fixed. She informed of habitual

Fig 1

spine (Fig 13 a,b,c & d). A year
later the temporary crown with
26 replaced with E-max layered
zirconia crown, and again
finished the occlusal analysis
with T-Scan.
Change in posture:
After completion of the
treatment, there was a drastic
change in the posture of the
patient which can be compared in
the before and after photographs.
(Fig 13)

Occlusal correction and restorative treatment resulted in a remarkable improvement in the posture of the
patient, pertaining to the head position and curvature of the spine. (Photograph: by Dr. Rinku Jain)

chewing of food only on the right
side of the jaw.

Treatment plan:
Oral prophylaxis followed by
treatment of carious teeth with

Discussion:
The patient had fair oral
hygiene. The extracted teeth were
not replaced hence there was
supra eruption of the opposing
molar on the left side and mesial
inclination of 47, leading to
traumatic bite, thus leading to
incisal attrition of upper and
lower anterior teeth and abrasion
with 23, 34 & 44. Pre-treatment
and post-treatment postural
photographs were taken to see
if the correction of occlusion had
any effect on posture.
After explaining to the
patient, about the intraoral
findings and the importance of
occlusal correction not only for
the prognosis of the implant but
also for the health of the teeth
and mouth, the patient agreed to
the planned treatment.
Firstly oral prophylaxis was
done followed by treating all the
carious lesions with biomimetic
restorations. The incisal build-up
was done with stress-reduced
direct composite restorations on

all the attrited teeth (Fig 7, 8),
to achieve canine guidance in
lateral excursive movements of
the jaw.
Indirect Sinus lift was
performed with 26 because the
residual alveolar bone height
was 5 mm. Nova bone putty was
used as a grafting material and
GenXt implant 4.2 x 8 was placed.
Immediate Bis-acrylic temporary
crown was placed, the temporary
crown was kept out of occlusion
and splinted to the proximal
surfaces of 25 & 27 with flowable
composite. 46 was not replaced
because of reduced mesiodistal
space between 45 & 47. Other
alternative treatment to replace
46 would have been orthodontic
tooth movement of 47 and then
place an implant to restore 46.
As the patient was from another
country, looking at the amount of
time it would require he denied
the option.
Occlusal force analysis was
done using T-scan (Fig 11 & 12).
Enameloplasty was done on
36 & 27 and occlusal stability
achieved. After the completion
of the treatment postural
photographs were taken. There
was a remarkable difference
noted in the posture of the
patient, pertaining to the head
position and curvature of the

Fig 2

Fig 3

Fig 4

Medical History:
Chronic sinusitis & headaches
2-3 times in a week.
No other relevant medical
history.
Dental History:
Extraction of upper left molar
a year back and extraction of a
lower right molar 2 years back.
Intra oral examination:
Intraoral photographs.
Incisal attrition with 12, 11,
21, 22, 31, 32, 41, 42, 43 (Fig 1, 2,
3, 4)
Missing tooth no 26 & 46
Reduced mesio-distal space
between 45 & 47 (Fig 3)
Mesialy tilted 47 (Fig 5), Supra
erupted 36 (Fig 6),
Cervical abrasion with 23, 34,
44
Caries with 11, 12, 16, 17, 21,
22, 24, 25, 27, 45, 47, 48
Extraoral examination:
No relevant signs related to
TMJ, and other facial structures
Investigations: CBCT.
Postural photographs.

biomimetic restorations. An
incisal build-up for all the anterior
teeth with stress-reduced direct
composite restoration, Indirect
Sinus Lift & implant placement
with 26. Occlusal force analysis
with T-Scan.

Conclusion:
It was observed that there
was a remarkable change in the
posture on creating an occlusal
harmony both in MIP and
achieving canine guidance and
DTR (disclusion time reduction)
treatment by measuring of
occlusal forces with T-Scan.
T-Scan overcomes the known
limitations of articulating paper.
This shows dental occlusion
influences posture. This also
shows there needs to be a holistic
dental treatment approach and
not mere symptomatic treatment.
“Patients presenting with any
signs of occlusal disease should
be thoroughly examined and
the cause should be determined
while treating. The occlusal
disease may have a detrimental
effect on the general well-being
of the patient in the long run.
Conservative treatment approach
with high success rate should be
practised” (2). Further studies
having a sufficient number of
cases are required to establish
the relationship between dental
occlusion and cranio-cervical
posture.
References:
1. Pacella E, Dari M,
Giovannoni D, Mezio M, Caterini
L, Costantini A, et al. The
relationship between occlusion
and posture: a systematic
review.
WebmedCentral
O R T H O D O N T I C S
2017;8(11):WMC005374
2. Khan MT, Verma SK,
Maheshwari S, Zahid SN,
Chaudhary PK. Neuromuscular
dentistry: Occlusal diseases and
posture. J Oral Biol Craniofac Res.

Fig 5

[5] =>

5

News

11/19

IMPRINT
INTERNATIONAL OFFICE/
HEADQUARTERS
PUBLISHER/CHIEF EXECUTIVE
OFFICER				
Torsten R. OEMUS

Fig 6

Fig 7

Fig 8

DIRECTOR OF CONTENT
Claudia DUSCHEK

Fig 9

DENTAL TRIBUNE SOUTH ASIA
EDITION
PUBLISHER
Ruumi J. DARUWALLA
CHIEF EDITOR
Dr. Meera VERMA
ASSOCIATE EDITOR
Dr. GN ANANDAKRISHNA

Fig 10

Fig 11

Fig 12

Fig 12

2013;3(3):146–150. DOI:10.1016/j.
jobcr.2013.03.003
3. Bracco P, Deregibus A,
Piscetta R. Effects of different jaw
relations on postural stability in
human
subjects.
Neurosci
Lett.
2004;356:228–30.
4.
Atsushi
Yamashita,
Yasuhiro
Kondo
&Junro
Yamashita Thirty-year follow-up
of a TMD case treated based on

the neuromuscular concept: a
case report Journal Cranio, 24 Jan
2014: 224-234
5. Westersund CD, Scholten
J, Turner RJ. Relationship
between
craniocervical
orientation and center of force
of occlusion in adults. Cranio.
2017
Sep;35(5):283-289.
doi:
10.1080/08869634.2016.1235254.
Epub 2016 Oct 20. PubMed PMID:
27760504.

6. Baldini A, Nota A, Tripodi
D, Longoni S, Cozza P. Evaluation
of the correlation between
dental occlusion and posture
using a force platform. Clinics
(Sao Paulo). 2013;68(1):45–49.
doi:10.6061/clinics/2013(01)oa07
7. Michelotti A, Buonocore G,
Manzo P, Pellegrino G, Farella
M. Dental occlusion and posture:
an overview. Prog Orthod.
2011;12(1):53-8. DOI: 10.1016/j.

pio.2010.09.010. Epub 2011 Jan
20. Review. PubMed PMID:
21515232.
8. Carini F, Mazzola M, Fici C,
Palmeri S, Messina M, Damiani
P, Tomasello G. Posture and
posturology, anatomical and
physiological profiles: overview
and current state of art. Acta
Biomed. 2017 Apr 28;88(1): 11-16

Author:

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PRINTER
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Dr Rinku Jain

Dr Rinku Jain is the
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as a Biomimetic Dentist by the
Alleman-Deliperi Center for
Biomimetic Dentistry USA,
focusing on reproducing the
biomechanics and esthetic
properties of intact healthy
teeth using the latest techniques
and materials. Dr Rinku is
a member of the American
Academy
Of
Biomimetic
Dentistry. She can be contacted
at 

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International GmbH.
All rights reserved. Dental Tribune
International makes every effort
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product claims, or for typographical
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DENTAL TRIBUNE
The World’s Dental Newspaper · United Kingdom Edition

[6] =>

6 Clinical

11/19

American Dental Association
recommends against the use of
antibiotics in most toothache cases

American Dental Association (ADA) has issued a new set of guidelines recommending that antibiotics are
not needed in most toothache cases. (Photograph: pxhere/Creative Commons CC0)

by Rajeev Chitguppi, Dental
Tribune South Asia
CHICAGO, U.S.: To combat
the menace of antibiotic
overprescription of antibiotics
that results in the development of
antibiotic-resistant bacteria, the
American Dental Association
(ADA) has issued a new set of
guidelines recommending that
antibiotics are not needed in
most toothache cases.

Various reports published
recently (2017 -2019) suggest
that 30- 85% of dental antibiotic
prescriptions
are
either
suboptimal or not indicated,
raising the cost-related and
public health concerns, which
has made the appropriate use of
antibiotics a critical issue in the
health care agenda.
The new guidelines published
in the Journal of American Dental
Association recommend against
the use of antibiotics for most

pulpal and periapical conditions.
Instead, they recommend, if
needed, over-the-counter pain
relievers such as acetaminophen
and ibuprofen.
Definitive,
Conservative
Dental Treatment (DCDT) refers
to
pulpotomy,
pulpectomy,
nonsurgical root canal treatment,
or incision for drainage abscess.
Only those clinicians, who are
authorized or trained to perform
the specified treatment, should do
so. The new report has developed

an algorithm to identify where
and how to prescribe antibiotics
as an adjunct to DCDT.
With likely negligible benefits
and potentially large harms, the
panel recommended against
using antibiotics in most clinical
scenarios, irrespective of DCDT
availability.
A vital pulp with symptomatic
irreversible pulpitis or a necrotic
pulp with symptomatic apical
periodontitis does not warrant
antibiotic prescription if there is
only pain and no swelling. The
report quotes enough evidence
that suggests that nonsteroidal
anti-inflammatory drugs may
be effective in managing dental
pain. Dentists should consider
antibiotics only in cases of pain
with swelling, and that too when
an acute apical abscess leads
to systemic involvement (fever,
swollen lymph nodes etc).
The expert panel recommends
both amoxicillin and penicillin as
first-line treatments but prefers
amoxicillin
over
penicillin
because of two reasons. First,
amoxicillin is more effective
against a range of gram-negative
anaerobes, and second, it is
associated with a lower incidence

of
gastrointestinal
adverse
effects.
Dentists should reevaluate
the clinical condition within 3
days. Also, they should instruct
their patients to discontinue
antibiotics 24 hours after their
symptoms resolve, irrespective
of reevaluation after 3 days.
Due to a higher bacterial
resistance demonstrated by
azithromycin
compared
to
other
antibiotics,
patients
on azithromycin should be
instructed to closely monitor
their symptoms and call their
dentist if their infection worsens
while on therapy.
The
guideline,
titled
“Evidence-based clinical practice
guideline on antibiotic use for the
urgent management of pulpaland periapical-related dental
pain and intraoral swelling: A
report from the American Dental
Association,” was published in
the November 2019 issue of the
Journal of the American Dental
Association.

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5/7/19 11:42 AM

[7] =>

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7 News

7/19

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[cover] => DT India & South Asia No. 11, 2019

[toc] => Array ( [0] => Array ( [title] => There is much more to Digital Dentistry than owning some digital tools & softwares - Dr Aslam Inamdar [page] => 01 ) [1] => Array ( [title] => Study outlines the emerging, innovative & most effective training methods in implant dentistry [page] => 03 ) [2] => Array ( [title] => A Clinical Observation: Relation Between Dental Occlusion & Posture [page] => 04 ) [3] => Array ( [title] => American Dental Association recommends against the use of antibiotics in most toothache cases [page] => 06 ) ) [toc_html] =>

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