DT India & South Asia No. 12, 2019
“Plastic periodontal surgery has evolved a lot in the last decade.” – Markus Hürzeler / Otto Zuhr / New study suggests fillings may not be best treatment for childhood dental caries / News
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DENTALTRIBUNE
The World’s Dental Newspaper · South Asia Edition
Published in India
www.dental-tribune.in
Childhood Dental
Patient Complaint
New study
suggests fillings
may not be best
treatment for
childhood dental
caries
Researchers from
the University of
Toronto conduct
the largest patient
complaint study to
date
” Page 03
12/19
Treatment of Periodontitis Salivary Cytokines
Perio Workshop 2019,
Spain develops new
guidelines for the
treatment of
periodontitis
” Page 04
Prolged consumption
of caffeine, alcohol,
and tobacco alters
the levels of salivary
cytokines.
” Page 05
” Page 07
“Plastic periodontal surgery has
evolved a lot in the last decade.” –
Markus Hürzeler / Otto Zuhr
the lifespan of microsurgical
instruments – How often does
one need to change it?
Provided that we are
talking about high-quality
instruments, this is more
a question of maintenance
than a question of time - wellmaintained instruments don’t
need to be changed for many
many years.
Sudhindra Kulkarni: What
is more critical - vertical soft
tissue thickness or horizontal
bulk of soft tissue in the
periodontal or peri-implant soft
tissue stability and function?
by Rajeev Chitguppi, Dental
Tribune South Asia
Prof. Dr Markus Hürzeler
and Dr Otto Zuhr, popularly
known as Hürzeler/ Zuhr,
have taken clinical excellence,
education, and research in
periodontics,
implantology
and
microsurgeries
to
a
different level. The Hürzeler/
Zuhr academy is one of the
truly world-class centres for
education and training in
dentistry. Drs Hürzeler/ Zuhr
will answer the questions and
share their expertise in this
interview with three PerioImplantologists from India Drs Sudhindra Kulkarni, Neel
Bhatavadekar, and Akshay
Kumarswamy.
Prof. Markus B. Hürzeler
received his dental degree
from the University of Zurich,
his certificate as a specialist in
Periodontics from the Swiss
Society of Periodontology, the
Docent (Associate Professor)
degree from the Department
of Prosthodontics at AlbertLudwigs University in Freiburg,
Germany, and his certificate in
Prosthodontics from the German
Society of Prosthodontics. He is
Clinical Associate Professor at
the Albert-Ludwigs University
of Freiburg, Department of
the Operative Dentistry and
Periodontology and Clinical
Associate Professor at the
University of Texas in Houston,
Texas. Dr Hürzeler has produced
more
than
100
scientific
publications within the field
of implants, periodontology
and tissue regeneration and
is a regular national and
international
lecturer.
He
maintains a private practice
focused on periodontics and
“Plastic periodontal surgery has evolved a lot in the last decade.“ - Markus Hürzeler / Otto Zuhr
implant dentistry in Munich,
Germany.
Dr Otto Zuhr studied
dentistry at the University of
Aachen from 1986 until 1992.
After finishing his studies in
1992, he received his DMD
from the Department of Oral
and Maxillofacial Surgery in
Aachen and started his work
as a dentist in Munich. Several
educational programs led him
to Switzerland, Scandinavia and
the USA during the following two
years. In 1994 he started to work
at the Institute of Periodontology
and Implantology (IPI) with Drs.
Bolz and Wachtel. In 1996 he
opened his own office focusing
on periodontal surgery and
aesthetic dentistry in Munich.
In 1999 he founded a new clinic
together with Drs. Bolz, Wachtel,
and Hürzeler and became
an associate member in the
Institute of Periodontology and
Implantology (IPI) in Munich. In
2001 he received his Specialist in
Periodontology of the German
Society
of
Periodontology
(DGP). Otto Zuhr has written
several articles in the field of
periodontology and aesthetic
dentistry and is lecturing
nationally and internationally.
In 2012 he published his book
“Plastic-Esthetic
Periodontal
and Implant Surgery” with
Quintessence.
Drs Huerzeler/ Zuhr will
answer the questions and share
their expertise in this interview
with three Perio-Implantologists
from India - Drs. Sudhindra
Kulkarni, Neel Bhatavadekar,
and Akshay Kumarswamy.
Akshay
Kumarswamy:
Having pioneered microscopic
periodontal plastic surgery
(PPS), what according to you
is the ideal magnification that
one should start with to do
periodontal plastic surgery?
The minimal magnification
depends on the instruments
and suturing materials used.
For the surgical set that we
have developed and brought
on the market, a 4.5 to 6 fold
magnification would be ideal.
Sudhindra Kulkarni: Does
Connective Tissue Graft (CTG)
function better as a pedicle
graft or as a free graft?
I don’t know. The additional
primary blood supply of the
pedicle might improve initial
revascularization of the graft. If
this is of clinical relevance is a
matter of further research.
Neel Bhatavadekar: What
are your sutures of choice
for suturing the flap for
mucogingival surgeries?
There is no suture of choice.
Sutures can have different tasks
and must consequently fulfil
varying requirements. Whereas
polypropylene is used in the
vast majority of indications,
needle lengths from 12 to 15 mm
and threads from 6.0 to 8.0 are
selected according to the clinical
situation.
Akshay
Kumarswamy:
According to you, what is
It is probably not possible
to give a general answer to
this question. From a principle
point of view, it becomes more
and more evident that soft
tissue thickness matters for the
vertical soft tissue position and
soft tissue stability. However,
the thickness can counteract
with quality-esthetic criteria of
success and might be interpreted
with caution having in mind that
teeth, implants, pontics, etc.…
create very different biological
environments.
Neel Bhatavadekar: For
tunnelling
procedures,
sometimes the time required
may be higher than for
conventional
split-thickness
flaps. In this scenario, do you,
in your clinical experience,
see the long term benefit of
tunnelling versus conventional
split-thickness flaps in terms
of % root coverage, or better
esthetics?
Yes, it is true. Tunnelling
procedures
need
specific
microsurgical instrumentation
and take longer. Talking about
research in gingival recession
therapy, there doesn’t seem to
be an advantage related to root
[2] =>
2
News
coverage. The advantage can
be found in the quality-esthetic
outcomes. In principle, it is as
simple as this: if there is no cut,
there cannot be any visible scar
tissue formation. From a broader
scope, avoiding surface incision
also results in maintaining the
best possible vascularisation of
the flaps. This might be important
in particular in surgical sites
with compromised blood supply
like, for instance, around dental
implants or in papilla areas.
These advantages become more
and more evident and are more
12/19
and more addressed in the
literature.
Akshay
Kumarswamy:
For general dentists, who
want to start learning esthetic
Periodontal Plastic Surgery,
which learning model would
you suggest before taking the
plunge on patients?
I truly believe that successful
treatment outcomes in these
types of interventions are
mainly dependent on a profound
biological
understanding
combined with manual dexterity.
Well established textbooks like
for instance, the one from Jan
Lindhe & Klaus Lang can be
recommended to study the basic
wound healing principles in
the oral cavity. For manual skill
development, any exercise can
be recommended that brings
the clinician to the limit of his
or her existing manual abilities.
To exercise specific surgical
interventions, animal models
like for instance pig jaws are til
to this day very suitable.
surgeries from 10 years ago,
what would you change?
Many, many things would
be changed. Plastic periodontal
surgery has evolved a lot in the last
decade. The further development
of incision-free flap elevation
concepts combined with selected
harvesting procedures for soft
tissue autografts at the palate
has coined up to date clinical
conceptions in an incomparable
way.
Neel Bhatavadekar: If you
had to redo your mucogingival
Sudhindra Kulkarni: Do you
think PRF and its ilk have any
significant role in improving
soft tissue biotypes?
There is no doubt that there
is great potential in many
indications. If LPRF will one
day be actually able to replace
soft tissue replacement grafts for
soft tissue volume augmentation
will most probably be dependent
on finding suitable carrier
or stabilization materials. A
thrilling field of research - we
will see...
Dr Sudhindra Kulkarni
Dr Neel Bhatavadekar
Dr Akshay Kumarswamy
Dr Sudhindra Kulkarni
(MDS,
Periodontics).
Fellow and Diplomate of
International Congress of
Oral Implantologists (ICOI,
USA). Professor and Head,
Department of Implantology
at SDM Dental College,
Dharwad.
Dr Neel Bhatavadekar
(MS, Perio- US) is the
first U.S Board Certified
Periodontist in India. First
ITI Fellow (International
Team for Implantology).
Diplomate
of
American
Board of Periodontology. He
is a visiting faculty at Univ. of
Texas Health Science Center
(US), and Univ. of North
Carolina at Chapel Hill (US).
Dr Akshay Kumarswamy
(BDS, CAGS, MS-Perio, USA )
is a Diplomate of the American
Board of Periodontology and
Diplomate of International
Congress
of
Oral
Implantologists (ICOI).
Editor‘s question: Although
you were the earliest to come
up with the Socket Shield
technique, you didn‘t promote
it as aggressively as others did.
What‘s the reason? Are others
missing out on something that
you have observed and realized?
We have been working on
the socket-shield technique for
more than ten years now. We
truly believe that before a new
clinical procedure can fully
be recommended, we need to
have enough external evidence
to support the new approach.
Therefore, we are working
for many years on creating
the necessary data. Finally,
we started our Randomized
Controlled Trials about two years
ago. The preliminary data look
promising. Since the benefits
for the patient are tremendously
high, and there are clinical
situations (i.e. missing two
teeth beside each other in the
esthetic zone) where we do not
have concepts yet which allow a
predictable outcome we decided
to offer in the year 2020 our first
master class on socket-shieldtechnique in our Huerzeler/Zuhr
Academy. We think it is now time
to discuss this new technique at a
much greater depth.
We would like to extend
our sincere gratitude and
appreciation to Drs. Sudhindra
Kulkarni, Neel Bhatavadekar
and Akshay Kumarswamy for
interviewing Drs. Hürzeler/
Zuhr and adding a great value to
this article.
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[3] =>
3
News
12/19
New study suggests fillings may not be
best treatment for childhood dental caries
by Dental Tribune International
LEEDS, UK: Though the
role of dental fillings in the
treatment of dental caries in
permanent dentition is well
established, the same cannot be
said about primary dentition,
as their usefulness is still
debatable. A new study has
cast further doubt on their
role, suggesting that there is
no evidence that conventional
fillings are more effective in
stopping the progress of caries
in children.
The multicenter randomized
controlled trial compared the
clinical effectiveness of three
treatment strategies for a length
of over 3 years for managing
dental caries in primary teeth.
Participants aged 3 to 7 years
with at least one primary molar
with dentinal carious lesion were
randomly allocated across the
three treatment groups.
This study called the
FiCTION (Filling Children’s
Teeth: Indicated or Not) trial
A new study has suggested that fillings are no more effective in preventing further caries and/or pain in
children than other treatments are. (Image: Evgeniy Kalinovskiy/Shutterstock)
studied 1,144 children residing
in the UK by assigning each
participant randomly to one of
the three treatment options: the
standard “drill and fill” approach,
which involves drilling out the
decayed tissue; a minimally
invasive approach of sealing the
caries under a metal crown or
filling; and the avoidance of any
fillings being placed while also
emphasising a reduction in sugar
intake and the necessity of taking
greater care of the child’s oral
health. The duration of the trial
lasted up to three years for some
children. On comparison, there
were no significant differences
in the outcomes between the
three treatment groups. 450
participants reported that they
continued to experience further
caries and pain.
“Our study shows that each
way of treating decay worked
to a similar level but that
children who get tooth decay at
a young age have a high chance
of experiencing toothache and
abscesses regardless of the way
the dentist manages the decay,”
said Prof. Nicola Innes, chair
of paediatric dentistry at the
University of Dundee School of
Dentistry and lead author of the
study.
“What is absolutely clear
from our trial is that the best way
to manage tooth decay is not by
drilling it out or sealing it in—
it’s by preventing it in the first
place,” Innes added.
The study, titled “Child caries
management: A randomized
controlled trial in dental
practice”, was published online
on 26 November 2019 in the
Journal of Dental Research,
ahead of inclusion in an issue.
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[4] =>
4 News
12/19
Researchers from the University of
Toronto conduct the largest patient
complaint study to date
by Dental Tribune International
TORONTO, Canada: A
team of researchers from the
University of Toronto have
recently published the largest
longitudinal study conducted
on patient complaints to
date. The study analyzed the
complaints made over a period
of eleven years to the Royal
College of Dental Surgeons
of Ontario (RCDSO), the
regulatory and licensing body
governing Ontario’s dentists
and their standards of practice.
The study has provided insights
into perceptions surrounding
oral health care professionals
and their standards of care and
highlighted the importance of
high-quality clinical care and
treatment.
The team of researchers
from the University of Toronto
examined, over the course of
nearly two years, about 2,199 out
of 4,627 complaints submitted to
the college. Since the majority
of complaints originated with
patients, the researchers also
collected sample complaints
from family members, dentists,
hygienists,
nurses
and
pharmacists.
“This is a unique study of its
kind internationally,” said lead
author Dr. Carlos Quiñonez,
associate professor and director
of the graduate program in dental
public health in the Faculty of
Dentistry at the University of
Toronto. “People have conducted
similar studies in hospital and
other health care settings, using
questionnaires
and
patient
A recent study found that besides excellent clinical care and patient safety, communication and
interpersonal skills are nearly equally integral to oral health care. (Image: Diego Cervo/Shutterstock)
Ad
satisfaction surveys, or case files
of regulatory findings once the
regulator has weighed in. But
no one has taken this volume of
complaints to a regulator and
quantified them,” he noted.
To
maintain
objectivity
and avoid bias, the researchers
piloted a framework that turned
qualitative
complaints
into
quantitative data by coding
them and then organizing
them into various domains and
subdomains. “One’s experience
when receiving care is so
subjective, so how that translates
into the letters themselves is
very unique,” explained coauthor Monika Roerig, research
coordinator at the university.
The findings indicated that
59% of all complaints made to
the RCDSO related to clinical
care and treatment, and that
56% involved interpersonal
relationships
and
conduct
and issues around informed
consent. Additionally, 42% of the
complaints involved issues with
management and access to care.
“I think this study really
revealed
some
valuable
information from all members
of the public,” Roerig said. “The
study shows us that it’s important
to have excellent clinical care
and safety, but communication
and interpersonal skills were
extremely important. The two
work hand in hand.”
The researchers believe that
the findings could help improve
patient experience in the dental
office and impact continuing
education trends and practice
standards. “I don’t think we do
enough on communication, on
relational competency,” said
Quiñonez. “We can do better
from the point of view of social
competence in dentistry.”
The study, titled Analyzing
Complaints Made by the Public
to the Royal College of Dental
Surgeons of Ontario, was
published by the RCDSO and the
University of Toronto, Faculty of
Dentistry. The article is available
on the RCDSO website.
[5] =>
5
News
12/19
Perio Workshop 2019, Spain
develops new guidelines for
the treatment of periodontitis
IMPRINT
INTERNATIONAL OFFICE/
HEADQUARTERS
PUBLISHER/CHIEF EXECUTIVE
OFFICER
Torsten R. OEMUS
DIRECTOR OF CONTENT
Claudia DUSCHEK
DENTAL TRIBUNE SOUTH ASIA
EDITION
PUBLISHER
Ruumi J. DARUWALLA
CHIEF EDITOR
Dr. Meera VERMA
ASSOCIATE EDITOR
Dr. GN ANANDAKRISHNA
EXECUTIVE EDITOR
Dr. Rajeev CHITGUPPI
DESIGNER
Anil LAHANE
PRINTER
Ampersand
Editorial material translated and
reprinted in this issue from Dental
Tribune International, Germany
is copyrighted by Dental Tribune
International GmbH. All rights
are reserved. Published with the
permission of Dental Tribune
International GmbH, Holbeinstr.
29, 04229 Leipzig, Germany.
Reproduction in any manner in
any language, in whole or in part,
without the prior written permission
of Dental Tribune International
GmbH is expressly prohibited.
Dental Tribune is a trademark of
Dental Tribune International GmbH.
Ninety experts attended this year’s Perio Workshop, an event that is organised annually by the European Federation of Periodontology. (Image: EFP)
by Dental Tribune International
BRUSSELS, Belgium: Perio
Workshop 2019 has put forth an
evidence-based, more effective
approach towards the treatment
of Stage I, II and III periodontitis.
More than 90 leading periodontists,
dental experts and specialists from
across the world attended this
meeting organized by the European
Federation of Periodontology (EFP)
to develop the treatment guidelines.
A large group of specialists from
the field of periodontics gathered in
La Granja de San Ildefonso in Spain
in November 2019 to reach a new
consensus and develop guidelines
on the optimal management of
periodontitis, the most serious
periodontal disease and one of the
most widespread chronic conditions
in the world.
Chaired
by
renowned
periodontist Prof. Mariano Sanz
from Spain, the Perio Workshop 2019
was held under the theme “Evidencebased guidelines for periodontal
therapy”. The expert attendees
identified
precise
therapeutic
pathways based on the patient’s
diagnosis and came up with a set of
recommendations detailing specific
interventions.
A unique approach introduced
in the guidelines was stepped care.
Instead of a fixed order of steps
when treating a patient, the stepped
care approach allows overlapping of
several steps as it delivers the least
complex and least resource-intensive
therapy initially, and only moves to
more complex or intensive therapies
if monitoring of the patient shows
that they are clinically indispensable.
The specialists at the Perio
Workshop 2019 were divided into
four working groups of experts who
analyzed 15 systematic reviews and
a position paper on different aspects
of periodontal therapy for Stages
I, II and III of periodontitis and the
maintenance of the successfully
treated periodontitis patients. The
workshop did not cover Stage IV
periodontitis, as the guidelines for
this stage will be drawn up during
the Perio Workshop to be held in
November 2020.
Besides focusing on the
scientific evidence supporting the
different interventions, the scientists
considered their consistency and
value, the clinical relevance of the
outcomes, the balance of benefits
and harms, patient preferences, and
ethical, legal, economic and practical
considerations.
The workshop benefited from
the input of top-level specialists, not
only from the European Federation
of Periodontology (EFP) but also
from eight other European scientific
societies and organisations: the
European Federation of Conservative
Dentistry, the European Association
of Dental Public Health, the
European Society of Endodontology,
the
European
Prosthodontic
Association, the Council of European
Dentists, the European Dental
Hygienists Federation, the European
Dental Students’ Association and the
Platform for Better Oral Health in
Europe.
The clinical guideline document
drawn up by Perio Workshop 2019
will be published next year, along
with other related papers, in a special
open-access supplement to the
Journal of Clinical Periodontology,
the official publication of the EFP.
“Perio Workshop 2019 was an
important step forward both for
periodontitis patients and for oral
healthcare professionals,” said
Sanz. “In the coming years, it will
have a major impact on improving
patient care by having identified the
evidence supporting the different
periodontal interventions, together
with the adequate step-by-step
approach to treatment approach,” he
continued.
“The development of an EFP, S3
level, and clinical practice guideline
is a very important accomplishment
for European periodontology,”
added Dr David Herrera, who will
chair Perio Workshop 2020. “We
will now have a solid basis when
designing the treatment plan in the
management of patients with Stage
I, II and III periodontitis. For Stage
IV periodontitis, we will need to wait
another year, and the EFP Workshop
Committee is already working on
the preparations for the generation
of a guideline for such a significant
condition.”
DENTAL TRIBUNE
INTERNATIONAL GMBH
Holbeinstr. 29, 04229, Leipzig,
Germany
Tel.: +49 341 48 474-302
Fax: +49 341 48 474-173
info@dental-tribune.com
www.dental-tribune.com
© 2019, Dental Tribune
International GmbH.
All rights reserved. Dental Tribune
International 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, claims, or statements made
by advertisers. Opinions expressed
by authors are their own and may
not reflect those of Dental Tribune
International.
DENTAL TRIBUNE
The World’s Dental Newspaper · United Kingdom Edition
[6] =>
6 Clinical
EdgeEndo
11/19
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[7] =>
7
News
12/19
Prolonged consumption of caffeine, alcohol,
and tobacco alters the levels of salivary
cytokines.
by Dental Tribune International
VALENCIA, Spain: Various
studies have shown that long
term consumption of alcohol,
tobacco and caffeine affect the
biological and microbiological
status of the oral cavity. The
first pilot study of its kind
has investigated whether the
alterations occur to the levels
of cytokines in the saliva of
patients who consume these
three stimulating substances
frequently.
Dr Verónica Veses from
the CEU Cardenal Herrera
University in Valencia and
her team investigated the
levels of three cytokines
viz.
interleukin-1
alpha,
tumour necrosis factor-alpha
and interferon-gamma. The
research team took saliva swabs
from 50 patients from the CEU
dental clinic and divided the
participants into different
groups based on their self-
In the first study of its kind, researchers have investigated whether regular consumption of alcohol, tobacco
and caffeine can affect certain cytokines in saliva. (Image: Evgeny Karandaev/Shutterstock)
reported levels of consumption
of caffeine, alcohol or tobacco.
“In our results, we detected
that frequent consumers of large
amounts of alcohol and tobacco
show a greater presence of the
three studied cytokines in their
saliva, which predisposes them
to suffer chronic inflammatory,
periodontal
or
tumoural
diseases in their oral cavity.
Specifically, we detected that
interleukin-1 alpha was the
highest in alcohol consumers,
and interferon-gamma was
higher
among
smokers,”
explained Veses.
The study also revealed that
the patients who consumed
caffeine through coffee and/or
soft drinks had higher levels
of
interferon-gamma
and
tumour necrosis factor-alpha
compared to the participants
who did not. “Only their levels
of interleukin-1 alpha are lower
than those registered among
non-consumers,” noted Veses.
A previous study by the
same research team had found
a correlation between the
consumption of stimulants
and oral microflora alteration.
Now, the current study is the
first to show that prolonged
consumption of the three
stimulants alters the levels of
salivary cytokines.
The
study,
titled
“Modulation
of
salivary
cytokines in response to
alcohol, tobacco and caffeine
consumption: A pilot study”,
was published on 12 November
2018 in Scientific Reports.
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[8] =>
7 News
7/19
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Strictly physiologic!
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+ tubes S« PRF Box » allow you to get the membranes always hydrated and of
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)
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[title] => “Plastic periodontal surgery has evolved a lot in the last decade.” – Markus Hürzeler / Otto Zuhr
[page] => 01
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[title] => New study suggests fillings may not be best treatment for childhood dental caries
[page] => 03
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[page] => 04
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[toc_titles] => “Plastic periodontal surgery has evolved a lot in the last decade.” – Markus Hürzeler / Otto Zuhr
/ New study suggests fillings may not be best treatment for childhood dental caries
/ News
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