DT Pakistan No. 1, 2018

News / Clinical Implantology / Clinical Endodontics / Oral Care for Prevention of Gum / Periodontal Disease

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PUBLISHED IN PAKISTAN

www.dental-tribune.com.pk

Mastering the implant
digital workflow

GCC public sector
dentists urge ...
Page 2

NEWS

JANUARY, 2018 - Issue No. 01 Vol.5

CLINICAL IMPLANTOLOGY

Page 6

Dentinal defects
after root canal ...

CLINICAL ENDODONTICS

Page 8

$3B worth of
deals signed
at AEEDC
DT Pakistan Report

D

UBAI - With ever
growing visitor and
exhibitor base, more
than $3 billion worth of
business deals were signed at
the 22nd UAE International
Dental Conference & Arab
Dental Exhibition (AEEDC)
in Dubai, which attracted
50,000 visitors and
participants from 133
countries.
Dr Abdul Salam Al Madani,
executive chairman of the
AEEDC Dubai Conference
and Exhibition and the Global
Scientific Dental Alliance,
said: "We are very proud with
the great improvement that
AEEDC Dubai has witnessed
this year, as the value of
business deals has increased
this year, which is expected

for an exhibition like AEEDC
Dubai; this goes in line with
the increase in the number of
hospitals and dental colleges,
in addition to the growth of
the healthcare and educational
sector in the GCC and the
world."
Dr Mohammed Jafar
Abedin, scientific vicechairman of AEEDC Dubai,
said: "At AEEDC Dubai, we
highlight 'evidence-based
dentistry', which uses
scientific evidence to guide
decision-making in dentistry,
that has always played a
pivotal role in raising
awareness about the best
practices in the industry."
"In order to help contribute to
the overall well-being of
patients around the world, we
have committed ourselves to

raising the standards of
healthcare, while at the same
time introduce cutting-edge
tools and technologies to
enhance the quality of dental
education accessible to
everyone attending the event."
On its third day, AEEDC
Dubai featured the subject of
radiography and the effective
techniques of 2D and 3D
radiographic interpretation,
aiming to improve the
diagnostic skills of radiology
specialists, as part of a
symposium held under the
title 'Radiology Symposium:
Radiology in Oro-Dental
Medicine'.
Dr Setareh Lavasani,

director of oral and
maxillofacial radiology and
advanced imaging at
C a l i f o r n i a ' s We s t e r n
University, said: "Dentistry
has witnessed tremendous
advances and with them, the
need for precise diagnostic
tools, specially imaging
methods, have become
mandatory. Radiographic
interpretation in the diagnosis
of 2D dental radiographs is
widely prevalent but recently
with the revolutionary
introduction of cone beam
computed tomography and the
addition of the 'third
dimension' to dental imaging,
dental practitioners are

Government exchequer or public
money: A Conundrum
DT Pakistan Report

I

SLAMABAD - The Drug
Regulatory Authority of
Pakistan paid Rs.280 million
from the public exchequer, senate
committee was informed. The
Senate Standing Committee on
National Health Services and
Regulations (NHSR), met in the
presence of Senator Sajjad
Hussain Turi.
Matters regarding the
implementation status of the
recommendations issued by the
committee in previous 3 years

and mechanism of establishment
of a slaughterhouse in the federal
city were discussed.
DRAP officials informed the
senate committee, that the
department paid 280 million over
the past 3 years as 'rent' for the
building, as the issue of the
allotment of land for constructing
their own building is a distant
dream.
The committee in its earlier
recommendations, had directed
the ministry of NHS to construct

a building for the DRAP to save
a huge amount worth
Rs.4.5million, being paid every
month, on account of rent.
The chair was displeased with
the explanation of DRAP
officials, upon claiming 'public
money' as 'government funds.' "It is not the government's fund,
Continued on Page 15

provided with such
information about the
Maxillofacial structures of
their patients, that was
previously unthinkable."
However, Dr Lavasani warned
"dentists using such 3D
technology need to act
responsibly, as without proper
training and the complexity
of normal anatomical
structures viewed in 3D, there
is an inherent risk of missing
crucial information, which can
result in incorrect diagnosis".
The third day also played host
to the GCC Preventive
Dentistry Session, under the
title "Prevention begins early",
Continued on Page 15

PMDC decides to reform
medical, dental curriculum
DT Pakistan Report

I

ISLAMABAD - The interim
Council of the Pakistan
Medical and Dental Council
(PMDC) decided to bring the medical and dental
curriculum on a par with global standards.
The council, the top decision-making body of
the medical and dental education regulator in
the country, met here with PMDC President
Justice (R) Mian Shakirullah Jan in the chair.
Khyber Medical University Peshawar VC
Professor Arshad Javed, in his presentation,
called for reforms in medical and dental
curriculum.
He said several steps were taken in the past
but the PMDC was not able to revise the
Continued on Page 15

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NEWS

2 DENTAL TRIBUNE Pakistan Edition January 2018

GCC public sector dentists urge
preventive dentistry
DT Pakistan Report

Editor Clinical Research
Dr. Inayatullah Padhiar
Editors Research & Public Health
Prof. Dr. Ayyaz Ali Khan

D

UBAI - Keeping and
maintaining a set of strong
healthy teeth is not all about
aesthetics-about staying beautiful and
being able to flash that beautiful smile
confidently-but staying healthy
throughout life in order to fulfil one's
responsibilities and purpose.
It is against this background that
dentists in the Gulf who have chosen
to be in the public health sector and
academe are for more comprehensive
educational and awareness campaigns
on oral hygiene and dental care.
The campaigns include family trips
and exposures to the dentists and the
dental clinics. Parents must play an
active role, because their ignorance
will cause their children's future.
Future and practising dentists must
be encouraged to specialise in
preventive approaches rather than
concentrate more on treatments,
because the overall health issue is
one's well-being from the cradle to
the tomb.
The aforementioned observations
were made at the lectures and
consequent discussions at the "GCC
Preventive Dentistry SessionPrevention Begins Early" on the last
day of the "22nd UAE International
Dental Conference & Arab Dental
Exhibition" held at the Dubai World
Trade Centre.
The session that tackled research
studies conducted across the region

Publisher/CEO
Syed Hashim A. Hasan
hashim@dental-tribune.com.pk

Editor - Online
Haseeb Uddin
Associate Editor
Dr Amna Nayyar
Designing & Layout
Sh. M. Sadiq Ali

Dental Tribune Pakistan

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Clifton, Karachi, Pakistan.
Tel.: +92 21 35378440-2 | Fax: +92 21 35836940
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responsibility for the validity of product claims or
for typographical errors. The publisher also does
not assume responsibility for product names or
statements made by advertisers. Opinions expressed
by authors are their own and may not reflect of
Dental Tribune Pakistan.

among children and their families on
the impact of the disregard for oral
hygiene and dental care from birth
resulting in failing health, was chaired
by GCC States Health Ministers
Council-Executive Board scientific
adviser Prof. Abdullah Al Shammery
and Dubai Health Authority (DHA)Dental Services director Dr Tariq
Khoory.
On the sidelines of the meet, lecture
presenters DHA-Dental Services
Department-Dubai Primary Health
Care dentist Dr Shiamaa Shihab
Ahmed Al Mashadani and Oman
Ministry of Health-Dental Services
head Dr Huda Al Bahri, and delegate
Princess Noura University-Clinical
Affairs (Saudi Arabia) vice dean Dr
Abeer Al Shami concurred that all
health insurers must give their share

by considering oral hygiene and dental
care, including the preventive
measures in their policies and
packages.
They replied to the question he said
at the open discussions on why some
insurers and some members of the
medical community have seemingly
cast aside oral hygiene and dental care,
taking these as simply aesthetics and
not about one's general health and
well-being. Al Mashadani said it is
critical that insurers are on equal
footing with families and the
educational and health sectors on
preventive dentistry, because neglect
will lead to a grim world of unhealthy
sick individuals.
She wondered how children would
be able to consume their food and eat
Continued on Page 15

International Imprint
Group Editor

Daniel Zimmermann
newsroom@dental-tribune.com
Tel.:+44 161 112 1830

Clinical Editors

Nathalie Schüller
Magda Wojtkiewicz

Editor

Yvonne Bachmann

Editor & Social Media Manager Monique Mehler
DTI Communication Service

Marc Chalupsky
Kasper Mussche

Copy Editors

Ann-Katrin Paulick
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Publisher/President/CEO

Torsten R. Oemus

Chief Financial Officer

Dan Wunderlich

Chief Technology Officer

Serban Veres

Business Development Manager

Claudia Salwiczek-Majonek
Project Manager Online

Tom Carvalho
Junior Project Managers Online Hannes Kuschick

Chao Tong

E-Learning Manager

OPINION

Regulating drug laws

By Muhammad Hamid Zaman

O

n an afternoon of
January 31st in
Lahore, dozens of
academics, physicians,
public health professionals,
hospital administrators and
even
government
professionals took the time
out to come to the Lahore
University of Management
Sciences to discuss the sharp
cliff of infectious diseases
in the country. A cliff, from
where every year, we tend
to throw the people down,
mostly the poor and the
vulnerable, into death, doom
and financial destruction.
Of the topics that were
discussed, none were scarier
than the growing threat of
antibiotic resistance. The
situation where the arsenal
of our best drugs to control
and cure infection is

rendered useless. The
scenario which in many
situations is already playing
out in our urban and rural
areas, means that routine
procedures in surgery that
require infection control are
becoming challenging.
From the birth to post-natal
care, from getting treatment
for typhoid to controlling
the spread of TB, every
procedure and treatment is
becoming more difficult,
more expensive and less
likely to succeed.
While the discussion at
times was heated, and
people expressed frustration
with the government and the
ill-executed 18th
amendment, there was
agreement that the best
solutions are right in front
of us. Whereas there is a

Lars Hoffmann

Education Director Tribune CME

Christiane Ferret
Event Services/Project Manager Sarah Schubert
Tribune CME & CROIXTURE
Marketing Services

Nadine Dehmel

whole list of things that can
and should be done, there
are two straight forward
acts, present squarely within
the governments mandate,
that can save us billions in
cost and improve the lives
of millions of our citizens.
The first is having a
prescription drug law that
separates over-the-counter
drugs from those that
require prescriptions from
bonafide doctors. This is
urgently needed and well
within the scope and
mandate of the government.
Not a single group of
physicians or public health
experts would disagree with
such a law. We need to
protect the drugs, and the
people. Similar laws exist
around the world to protect
citizens and their health.

Sales Services

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Accounting Services

Karen Hamatschek
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Media Sales Managers

Widespread sale, use and
abuse of antibiotics are
responsible for our
antibiotic resistance
apocalypse. People are able
to buy any antibiotic of their
choice, without any
understanding of care or
caution. Pharmacists are
equally to blame, for they
are glad that their sales
continue to scale new
heights. Unaware public
uses antibiotics as an
ordinary pain killer, using
them with every sneeze and
Continued on Page 15

Melissa Brown (International)
Hélène Carpentier (Western Europe)
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Executive Producer

Gernot Meyer

Advertising Disposition

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Dental Tribune International

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©2018, 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 or claims, or statements made by
advertisers. Opinions expressed by authors are their
own and may not reflect those of Dental Tribune
International.

[3] => Dt pages.FH10

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NEWS

4 DENTAL TRIBUNE Pakistan Edition January 2018

Dental health of children
in Germany among the
best globally
DT International

REIFSWALD, Germany According to new research,
nearly 80 per cent of 12-yearold sixth-graders in Germany have
caries-free permanent dentition,
making Germany top internationally,
alongside Denmark, in terms of dental
health in this age group. However,
early childhood caries is still too
common in the country and affects
the healthy development of some
children.
These latest figures come from the
epidemiological accompanying
investigations for group prophylaxis
carried out on behalf of the Deutschen
Arbeitsgemeinschaft für
Jugendzahnpflege (DAJ), a German
organisation dedicated to maintaining
and promoting the oral health of
children and adolescents. For the
study, more than 300,000 children in
the country underwent dental

examinations in the 2015/2016 school
year.
As part of the representative study,
which the DAJ commissioned for the
sixth time since 1994/1995, a dental
team headed by the Greifswald
paediatric dentist Prof. Christian
Splieth determined the childrens oral
health status in three age groups: 12year-old pupils in the sixth grade, 6to 7-year-old first-graders and, for the
first time, 3-year-old kindergarten
children. The examinations were
conducted in ten federal states of
Germany.
The unit of measure used to assess
oral health was the dmf/DMF index.
The study found a DMF score of 0.44
for the 12-year-olds studied, and 78.8
per cent of the children in this age
group had a healthy dentition. Both
values were the best ever achieved in
Germany.
In the 6- to 7-year-old
schoolchildren, however, who still

mainly have primary teeth, the dmf
score was 1.73. In this age group, only
53.8 per cent had a healthy dentition.
This was only a slight improvement
in the national average compared with
the values recorded in the last DAJ
study, conducted in 2010, for some
federal states even had a slight
deterioration. Thus, this age group
was found to still have a higher caries
burden than the group of 12-year-olds.
The epidemiological study found a
dmf score of 0.48 for the 3-year-olds.
This means that 13.7 per cent of this
age group already had dental caries,
while 86.3 per cent had healthy teeth.
The data underpins what has already
been suggested on the basis of
previous regional studies and clinical

Study shows positive influence
on dental caries using a
multilevel approach
DT International

AN FRANCISCO, U.S. - According
to a new study, a multilevel approach
that includes a dental caries risk
assessment, aggressive preventive measures
and conservative restorations can dramatically
reduce caries incidence. The findings, which
support earlier research demonstrating
positive results of the assessment and
treatment method in a university setting, show
that the protocol has the potential to transform
dental care for high-risk patients.
We put the 2012 UCSF [Caries
Management by Risk Assessment] clinical
study into the real world and showed it
works, said lead author Dr. Peter Rechmann,
Professor of Preventive and Restorative
Dental Sciences at the University of
California, San Francisco (UCSF) School of
Dentistry. The patients at high caries risk
who used prescription products went down
significantly over time in their risk level.
Those in the control group also reduced their
risk to a lesser degree, simply by using overthe-counter products that also protect teeth
and affect the bacteria.
Caries Management by Risk Assessment
(CAMBRA) is a method that was originally
developed in 2003 by a team led by then
Dean of the UCSF School of Dentistry Prof.
John Featherstone. The method adopts a
multilevel approach in which dentists collect
patients dental and medical histories, conduct

clinical examinations to assess caries, and
utilize behavioral approaches and chemical
treatments to optimize protective factors.
For their two-year study, Rechmann and
his colleagues recruited 30 dentists to take
part, 18 from private practices and three from
community clinics. The study involved 460
patients aged between 12 and 65, split into
two groups: the CAMBRA group and control
group, with 239 and 221 participants,
respectively. In the CAMBRA group, highrisk patients received prescription fluoride
toothpaste, a chlorhexidine antibacterial rinse,
xylitol mints and a fluoride varnish. The
control group received regular fluoride
toothpaste, an assumed inactive mouthrinse,
sorbitol candies and a nonfluoride varnish.
In follow-up visits at six, 12, 18 and 24
months, new carious lesions or changes in
caries risk level were recorded. According to
the results, a significantly greater percentage
of high-risk participants were classified as
Continued on Page 14

experience: caries of the primary
dentition occurs very early in some
cases. A relatively small group of
children had severe caries (3.57 dmf),
which is very difficult to treat and
often only under anaesthesia.
The findings show that there is
social polarisation of caries already
at a very early stage; however, they
also suggest that the implementation
of the DAJ recommendations
published in 2016 for the prevention
of early childhood caries for day care
centres and parents was a step in the
right direction and must be further
expanded. The new findings will be
evaluated in the coming months for
further possibilities for prevention.
- DT Europe

Australian senate support
for medical device
reforms welcomed
DT International

ANBERRA, Australia - A senate committee report
recommending the passage of legislation that
changes the way the Therapeutic Goods
Administration (TGA)
regulates medicines and
medical devices has been
welcomed by the Australian
Dental Industry Association
(ADIA). It delivers a longstanding legislative reform that
ADIA has been lobbying politicians of all political
persuasions to deliver on for nearly a decade.
This bill contains important reforms that will cut the
red tape associated with introducing into the Australian
market new and innovative patient treatment and diagnostic
options, said ADIA CEO Troy Williams.
The bill will reportedly also make changes that support
amendments to the Therapeutic Goods Act 1989 made
in 2017. The reforms will allow the TGA to authorise
Australian companies to undertake conformity
assessments, a significant departure from past practice
where only the TGA could perform such evaluations.
This legislation, combined with the legislative changes
made last year that ADIA also secured, creates a far more
efficient system for dental product manufacturers to
introduce new products to the Australian market. Whereas
previously the TGA was the sole source of authority, the
increasing use of overseas regulators and third-party
Australian conformity assessment bodies will provide
alternatives without compromising patient safety, said
Williams.
Williams went on to say that ADIA has been pushing
Continued on Page 15

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6 DENTAL TRIBUNE Pakistan Edition January 2018

CLINICAL IMPLANTOLOGY

Mastering the implant
digital workflow
By Ross Cutts

hether we like it or not, we
are embracing the digital
era in our brave new world.
Many dental practices are now
becoming paper-freea digital
innovationand even using tablet
computers to record patient details
and medical histories. We are
continually surprised by the rising age
of the technologically savvy patient,
particularly those of a certain
generation who perhaps we assume
would be less so than the perceived
iPhone generation.
This change in the patient
demographic and attitude towards
technology is filtering through to us
in the dental profession. The nuts and
bolts of implant dentistry tends to lend
itself more readily to the digital
revolution of dentistry in the UK and
now globally. Many practitioners
opposed to or reluctant to embrace it
are actually being influenced by it
through shifting workflows in dental
laboratories, even where more
traditional clinical practices are
followed chairside. Quite often, wet
impressions are poured and stone
models are scanned to produce STL
files for laboratories to process during
crown and bridge unit manufacturing.
As an implant clinician, one does
not have to invest in a CT scanner or
chairside intra-oral scannerthere are
ways that other centres and
laboratories can provide these services.
However, having these tools at ones
disposal greatly increases ones
efficiency and means one is not reliant
on external services for ones patients.
If you fail to planthen you plan
to failBenjamin Franklin
So how do we begin the implant
digital workflow? Successful implant
treatment begins with thorough case
assessment and planning of the
proposed restoration. This is important
for all cases, not just what we deem
the complex ones. Even the most
experienced implant clinician can miss
a potential treatment planning hazard,
especially during a busy day. Accurate
study model casts are an essential part
of this; however, we can now use intraoral scans preoperatively to begin the
digital workflow. We take a scan rather
than impressions to form digital
models. Our laboratory can then use
these to create digital wax-ups of
proposed treatment outcomes.
We are routinely used to 2-D
radiographic imaging techniques in
dentistry, but with the availability and
access to CBCT scanning devices now,
we are able to assess bone quantity
and quality of proposed implant
surgical sites. With ever-reducing
doses of 3-D imaging and improving

accuracy, we are able to use CBCT
scans, combined with clever software
packages such as coDiagnostiX
(Dental Wings), to plan safe and
accurate implant placement and
r e s t o r a t i o n . We a r e a b l e t o
preoperatively plan precise implant
placement with safe surgical margins
away from important anatomical
structures, such as the inferior alveolar
nerve or maxillary sinus. From this,
we are then able to design and either
mill or print a surgical guide to use
for precise implant placement.
Even with assisted surgery or guided
surgery, there are sometimes certain
restrictions that prevent us from
achieving the most ideal implant
placement, such as this case shown
where posterior access in the second
molar region was reduced, so
achieving the perfect parallel was
extremely difficult.
There are fully guided systems
available that allow for absolutely
precise implant placement, but these
are fraught with complexities and
should be reserved for experienced
clinicians. The accuracy of surgical
guides should not be used to make up
for a lack of surgical competency
however.
There are many factors to be
considered when using surgical guides,
including whether the guide is tooth, soft tissue- or bone-supported. Toothsupported allows the greatest degree
of accuracy.
If tooth-supported,
. are there windows in the guide that
direct full seating of the guide?
. are the teeth that support exact
positioning of the guide mobile? Any
mobility adds a degree of inaccuracy.
. is the guide made from a direct intraoral scan or a scan of a study model?
If scanning a study model, is this an
accurate stone model representation?
Otherwise, there is the risk of poor
seating and inaccuracy of the guide.
If soft tissue-supported, mobility
completely negates any accuracy of
the guide, so it should only be used
for a pilot drill and then a more
conventional surgical protocol
adopted.
If bone-supported,
. raising of a very large surgical flap
is likely.
. it is very difficult to ensure accurate
full seating of a bone-supported guide
in the precise planned position and
this relies upon external fixation.
Once the implants are placed in situ
and fully integrated, we then have a
choice of conventional wet impression
techniques versus digital intra-oral
scanning. For the majority of cases,
intra-oral scanning is extremely
predictable and reliablemore so than
conventional techniqueswith milled

IOS Scanner

Printed Models

3-D Radiograph

2-D Radiograph

CoDiagnostiX Screenshot

CoDiagnostiX screenshot of
guide production

Printed Surgical Guide

Post-op radiograph of
implant placement

Surgical placement of
LL67 implants

Tissue level implants

Scan Bodies

Crowns on model

Composite flow material used to Composite flow material used to
increase scanning reference points increase scanning reference points

Verification jig locked in situ to Createch framework showing the
verify passive implant positioning
fit surface
(and lately printed) models having
excellent properties and less
accumulation of processing errors.
However, deeply placed implants
relative to adjacent teeth with deep
contact points are very difficult to scan
and pick up. Straumann tissue level
implants offer a very straightforward
restorative platform to scan from.
With greater numbers of implants
and fewer teeth to act as reference
points, intra-oral scanning becomes
less reliableparticularly across the
archso we need to exercise caution
and be aware of its limitations. We
have used composite flow stuck to the
soft tissue to increase reference points
for our scanners, increasing their
ability to stitch images more accurately
together. With this in mind, we cannot
assume the scan is accurate and any
framework fabricated would be nonpassive; therefore, we must use other

Final metal-ceramic bridge
in situ

methods to verify the scans accuracy.
We have found locking temporary
abutments within a composite
framework intra-orally the easiest and
most reproducible way to do this. It
then allows us to design and mill a
truly passive framework by Createch
and a temporary acrylic bridge.
Conclusion
There are many opportunities to opt
in and out of using technology
regarding the digital implant workflow.
For anyone considering capital
investment, the most important
question to ask is, how will or can this
improve the outcomes I provide to my
patients, and then determine whether
that warrants the expenditure. Too
often are we subjected to sales pitches
of the next biggest thing by company
sales representatives and gadgets and
gizmos end up by the wayside.
Continued on page 14

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8 DENTAL TRIBUNE Pakistan Edition January 2018

CLINICAL ENDODONTICS

Dentinal defects after root
canal preparation
By Dr Taha Özyürek

V

ertical root fractures are one
of the most frequent
complications seen on teeth
having endodontic treatment, and
generally result in the extraction of
tooth (Haueisen et al. 2013). The root
canal treatment procedures may cause
dentinal stress and consequently
dentinal cracks. The emerging dentinal
fractures may transform into vertical
root fractures under functional loads
(Barreto et al. 2012).
The physical and mechanical
properties of nickel titanium (NiTi)
rotary file systems my affect the
incidence of cracks on dentinal surface
(Adorno et al. 2011). Moreover, the
type of movement used in shaping the
root canals may also influence the
incidence of dentinal defects. Liu et
al. (2013) have reported that a
continuous rotational movement
causes more dentinal defects than
reciprocation movement, while
Bürklein et al. (2013) have reported
that reciprocation movement causes
more dentinal defects.
WaveOne (WO; Dentsply Maillefer)
NiTi singlefile system was recently
modified to WaveOne Gold (WOG;
Dentsply Maillefer). While
maintaining the reciprocation
movement of the file, its cross-section,
dimensions and geometry were
changed. The cross-section of the file
was altered to a parallelogram, having
two cutting edges. Moreover, the offcentre design that ProTaper Next
(Dentsply Maillefer) files have is used
in WOG files too. The most significant
change in files is the Gold heat
treatment method. Gold heat treatment
is based on reversing the M-Wire
technology employing the preproduction heat treatment, and by
heating the file after production and
then slowly cooling it. The
manufacturer company claims that
this new heat treatment increases the
flexibility of files (WaveOne Gold
Brochure).
Another NiTi rotary file system
made using the Gold heat treatment
procedure is the recently introduced
ProTaper GOLD (PTG; Dentsply
Maillefer) system. Similar to ProTaper
Universal (PTU; Dentsply Maillefer)
system, this model consists of three
shaping (SX, S1 and S2) and five
finishing (F1, F2, F3, F4 and F5) files.
PTG uses the continuous rotation
movement at the same torque and
speed settings with PTU, but the
manufacturer claims that PTG files
are two times more resistant to the
cyclic fatigue under favour of
flexibility offered by the Gold alloy
(ProTaper Gold Brochure). From the
aspect of metallurgical character, PTG

NiTi files have not only the 2-stage
specific transformation feature but
also high Af temperature similar to
controlled memory (Shen et al. 2011).
Recently, the patented treatments
have been involved in the innovative
production of new HyFlex EDM files
(HEDM; Coltène/Whaledent,
Altstätten, Switzerland). The main
feature of these files is that they are
manufactured via an electro-discharge
machining (EDM) process. The EDM
is a non-contact machining procedure
used in engineering for manufacturing
the parts that would be difficult to
machine with conventional techniques.
The removal of material is performed
by pulsating electric current discharges
that flow between an electrode and
the work piece are immersed in a
dielectric medium. The electric current
partially melts and evaporates small
portions of the material in a wellcontrolled and repeatable manner. The
material is therefore superficially
removed, leaving an isotropic surface,
characterised by regularly distributed
craters (Pirani et al. 2015).
In our comprehensive literature
review, no study examining the
dentinal defects caused by HEDM
NiTi files during root canal shaping
procedure was found. For this purpose,
the aim of this in vitro study was to
compare the incidences of dentinal
defects that HEDM, WOG and PTG
NiTi files create during shaping the
mesial canals of mandibular molar
teeth. The null hypothesis of present
study was that there would be no
difference between the dentinal defect
formation incidences of HEDM, WOG
and PTG NiTi files.
Material and methods
Specimen selection
After obtaining the ethical
committee approval, 80 mandibular
molar teeth that were extracted due to
periodontal reasons and had < 20° of
canal curvature (Schneider 1971) and
two separate mesial canals were
involved in this study. The soft and
hard tissues around the teeth were
mechanically removed using a
periodontal curette. Moreover, the
distal roots of teeth were removed
under water-cooling. The crowns of
teeth were removed from the enamelcement junction under water-cooling,
allowing 16 mm of root length. The
radiographic images of teeth were
taken in mesio-distal and bucco-lingual
directions. Teeth that were found to
have calcification, history of previous
root canal treatment, involving internal
and/or external resorption, or were
fractured and/or had immature roots
were excluded. The selected teeth were
kept in distilled water at 4 °C for the
experimental procedures.
The roots of teeth were wrapped

Samples of slices obtained at different distance from the apex presenting
dentinal defects. (a) Control Group, (b) HyFlex EDM, (c) WaveOne Gold,
and (d) ProTaper Gold.
with aluminium foil and then
embedded into acrylic resin (Imicryl,
Konya, Turkey) (Capar et al. 2014).
After the acrylic set, the teeth were
taken out from the resin, and the foils
were removed. To simulate the
periodontal ligament, the resin blocks
were filled with viscous silicon
impression material (Express XT Light
Body Quick; 3M ESPE, Neuss,
Germany) and the specimens were
then placed into the resin blocks again.
Root canal preparation
The canals of teeth were penetrated
using a #10 K-file (Dentsply Maillefer)
until the tip of file was seen from the
apex. The working length was set to
1 mm shorter than this length. For all
of the specimens, the glide path was
created ensuring the apical diameter
of 0.20 mm. For every specimen, 20
ml 1 % sodium hypochlorite (NaOCl)
was used during the preparation. The
entire procedure was executed by the
same endodontist, having 5 years of
experience. The teeth were randomly
divided into 4 groups, 20 teeth in each.
And then, the following procedures
were performed.
Group 1: HyFlex EDM
Using the torque-controlled
endodontic motor (X-Smart; Dentsply
Maillefer), the root preparation of the
specimens in this group was performed
by using a HEDM 25/.~ NiTi singlefile system according to the
manufacturers instructions at 500 rpm
and 2.5 Ncm torque.
Group 2: WaveOne GOLD
Using the torque-controlled
endodontic motor (VDW Reciproc
GOLD; VDW, Munich, Germany),
the root preparation of the specimens
in this group was performed by using
a WOG Primary (25/.07) NiTi singlefile system according to the
manufacturer s instructions in
WaveOne ALL programme.
Group 3: ProTaper GOLD
Using the torque-controlled
endodontic motor (X-Smart; Dentsply
Maillefer), the root preparation of the
specimens in this group was performed
by using a PTG NiTi rotary file
systems S1 (18/.02), S2 (20/.04), F1
(20/.07) and F2 (25/.08) files according
to the manufacturers instructions at
300 rpm and 3 Ncm torque.

Group 4: Negative control
No intervention was made to this
group and they were assigned to the
negative control group.
Assessment of dentinal defects
Under water-cooling (Isomet;
Buehler Ltd, Lake Bluff, IL, USA),
the roots of 80 specimens were cut
perpendicular to the tooth axis at 3, 6,
and 9 mm distant from the apex, and
3 slices were obtained from each
specimen. Trans-illumination was
applied to the slices from 1 mm
distance in mesial, distal, buccal, and
lingual directions using a LED (LED
Light; Denshine Technology, China)
device. The digital images (4 images
from each slice) were taken under x25
magnification using a digital camera
connected to stereomicroscope
(Olympus BX43, Olympus Co, Tokyo,
Japan). In order to eliminate the bias
of observers, the canals on digital
images were masked using a circular
drawing. A total of 960 digital
images240 from each groupwere
examined to determine if any cracks
were present. The images obtained
were then randomly assigned to two
experienced endodontists, who were
not involved in the preparation of the
specimens, in order to determine the
presence or absence of dentinal
defects. To define crack formation,
two different categories were made
(i.e. no crack and crack) to avoid
the confusing description of root
cracks. No crack was defined as the
root dentine without cracks or craze
lines either at the internal surface of
the root canal wall or the external
surface of the root. Crack was defined
as all lines observed on the slice that
either extended from the root canal
lumen to the dentine or from the outer
root surface into the dentine (Shemesh
et al. 2009) (Fig. 1).
Statistical analyses
In examining the intergroup
incidence of dentinal defects, a ChiSquare test was used. The level of
statistical significance was set to 5 %.
The statistical analyses were
performed using SPSS 21 (IBM-SPSS
Inc., Chicago, IL, USA) software.
Results
In the present study, 960 images
Continued on page 14

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[10] => Dt pages.FH10

10 DENTAL TRIBUNE Pakistan Edition January 2018

Oral Care for Prevention of Gum/Periodontal Disease
A Dentists Guide
By Dr Ayesha Iqbal
Overview
Maintaining good oral health is essential to one's
overall health. In general, the goals of proper oral
hygiene are to remove or prevent plaque and tartar
formation and buildup, prevent dental caries and
periodontal disease, and decrease the incidence of
halitosis. Results from various clinical studies have
concluded that poor oral hygiene is linked directly
to an increased incidence of dental caries, periodontal
disease, halitosis, oral pain, and discomfort for
denture wearers. Some clinical studies suggest that
gum disease may also increase an individual's risk
for developing cardiovascular disease or stroke and
may contribute to other health issues. As a dentist
majority of the patients are seen either with halitosis,
bleeding gums or with tenderness in gums.
What is Periodontal Disease?
Periodontal disease, commonly known as gum
disease, is caused by bacteria in plaque. If not
consistently removed, these bacteria builds up,
infecting your teeth, gums, and eventually the bone
that supports your teeth - a common cause of tooth
loss. Gingivitis, or inflammation of the gums, is
the mildest form of periodontal disease. If left

untreated, gingivitis can lead to a more serious and
irreversible form of gum disease called periodontitis
This disease has three stages of progression:
gingivitis, periodontitis, and advanced periodontitis;
the longer the disease has to advance, the more
damage it causes. With advancements in detection
and treatment, we can discover periodontal disease
early and begin treatment before complicated issues
arise.
Signs and Symptoms
While signs and symptoms of periodontal disease
vary from person to person, the following are

Periodontal Disease

Diseased Gums

to periodontal disease:
. Poor oral hygiene habits
. Genetic predisposition to dental issues
. Hormonal changes during puberty, pregnancy,
menstruation, and menopause
. Smoking
. Misaligned or crowded teeth
. Use of certain medications, such as phenytoin,
nifedipine, or cyclosporine
. Certain medical conditions, such as diabetes,
cancer, and HIV
. Poor nutrition
Tests and Diagnosis
Your dentist will examine the condition of your
teeth and gums to determine whether you have
periodontal disease. He or she will also look for
plaque and tartar buildup on your teeth. If
periodontal disease is found, your dentist may take
x-rays to determine whether it has spread to the
supporting bone structures of your teeth.
How Can I Prevent Gum Disease Before it Starts?
Simple, everyday steps can also be taken to avoid
gum disease growth, including:
. Brushing and flossing consistently at least twice
a day
. Using an antimicrobial mouth rinse daily to help
control plaque
. Scheduling regular checkups
If you are experiencing the symptoms of gum
disease, it's essential that you begin treatment.
Besides tooth loss, studies have linked untreated
periodontal disease to the development of severe

Management
Gingivitis can be managed and even reversed
with daily brushing, flossing, and routine dental
cleanings. In addition to maintaining proper oral
hygiene, you can use a mouth rinse that prevents
plaque and tartar buildup. Electric toothbrushes are
helpful because they are more effective at removing
plaque and tartar than manual toothbrushes. If the
gum disease has progressed to periodontitis, you
should adhere to the treatment plan your dentist
has recommended, maintain a daily oral care routine,
and get regular professional dental care.
Treatment and Care
The goals in treating periodontal disease are to
decrease inflammation and prevent further dental
issues. Treatment is based on the severity and form
of gum disease. Antibiotics are sometimes
prescribed, and periodontal surgery may be needed.
Your doctor will determine the best treatment for
your individual needs.
Alternative Remedies
Although clinical data on the effectiveness of
alternative therapies in treating periodontal disease
are limited, some individuals elect to use alternative
therapies. Your health care provider may recommend
the following alternative therapies:
. Natural herbal supplements or teas, such as
rosemary, ginger, turmeric, and cumin
. Vitamin/mineral supplements, such as zinc, folic
acid, and vitamins C and D
. Proper oral hygiene
Self-Care
A host of nonprescription dental care products
are marketed for the prevention of common oral
health problems. These products are available in
various formulations of dentifrices, including anti-

PRE-TREATMENT

Healthy Gums

common among many affected patients:
. Bleeding gums during and after brushing teeth
. Tender, red, swollen gums
. Mouth sores
. Persistent halitosis
. Pain when chewing
. Loose or shifting teeth
. Receding gums
. Formation of deep pockets between teeth and
gums
. Changes in the way dentures fit
Cause/Common Triggers
Periodontal disease is caused by bacteria in dental
plaque. A number of factors can cause or contribute

POST-TREATMENT

health issues such as heart disease, strokes, diabetes
and pre-term low birth-weight babies.
To prevent periodontal disease, it is recommended
establishing a good oral hygiene routine, which
includes brushing at least twice a day, flossing daily,
and receiving professional dental care at least twice
a year.

plaque/anti-gingivitis, tartar control, and sensitivity
toothpastes, whitening products, flossing products,
topical fluoride products, and cosmetic and
therapeutic antiseptic mouth rinses. Various products
are also marketed to meet the dental needs of
children; these products encourage and aid in
improving brushing techniques. In addition, plaque
removal devices, such as manual and electric
toothbrushes, dental flossers, and oral irrigating
devices, are commonly used and recommended for
plaque removal.

[11] => Dt pages.FH10

[12] => Dt pages.FH10

[13] => Dt pages.FH10

[14] => Dt pages.FH10

14 DENTAL TRIBUNE Pakistan Edition January 2018

Study shows positive ...
Continued from page 4

lower risk after receiving CAMBRA
preventive therapies. Dental caries
was low in both groups.
Among 242 patients (137
intervention, 105 control) initially
identified as high risk for caries, only
a quarter of the patients remained at
high risk in the CAMBRA group at
24 months, and just over half (54
percent) in the control group. Of the
192 low-risk participants (93
intervention, 99 control), most
participants remained low risk. The
researchers believe this points to the
assessment correctly identifying those
at risk for caries.

Study shows positive ...
Continued from page 6

Acknowledgements
Andy Morton and Ian Murch, the
fantastic laboratory technicians at
Borough Crown and Bridge that I
work closely with. -DT UK

Dentinal defects after root ...
Continued from page 8

taken from 240 tooth slices were
examined. The distribution of dentinal
defects caused by the tested NiTi file
systems between apical, medial, and
coronal regions is presented in Table
1. In the present study, no statistically
significant difference was found
among the NiTi files tested and
between them and control group in
terms of the total number of dentinal
defects (P > 0.05).
Discussion
In this study, the dentinal defects
created by HEDM, WOG and PTG
NiTi file systems on mandibular molar
teeths mesial canals were evaluated.
The Number and Percentage of Slices
with Defects at Each Level (n = 20)
Total of specimens
of
presenting defects
n (%)

3mm

6mm

9mm

n(%)

n(%)

n(%)

Control

4 (20 %)

8 (40 %)

6 (30 %)

11 (55 %)

Pro Taper GOLD

8 (40 %)

10 (50 %) 8 (40 %)

14 (70 %)

WaveONE GOLD

6 (30 %)

9 (45 %)

8 (40 %)

12 (60 %)

HyFlex EDM

5 (25 %)

10 (50 %) 7 (35 %)

11 (55 %)

Group

According to the results of the present
study, it was determined that all of the
tested NiTi files created dentinal
defects but no statistically significant
difference was found when compared
to thecontrol group. For this reason,
the null hypothesis of the present study
was accepted.
In many in vitro studies, the dentinal
defects created by the NiTi file systems
during root canal preparation were
investigated using single- and
straightrooted teeth (Karata et al.
2015b, Kfir et al. 2017). However, the
increasing root canal curvature would
increase the stress on the files, which
were used in preparation, and
consequently on the dentine. An
increase in the stress on dentine would
cause increasing irregularities
(transportation, straightening, etc.)
within the canal and lead to thinner
dentinal structure in certain regions.
Thinner dentine would weaken the
root structure and prepare the ground

for vertical root fracture formation
(Kim et al. 2013). In previous studies,
it has been reported that the highest
level of stress occurred on the curved
root canals during the root canal
preparation by NiTi rotary files (Kim
et al. 2013, Medha et al. 2014). For
this reason, the mesial canals of
mandibular molar teeth were used in
present study.
NiTi file manufacturers generally
recommend using the files on single.
Based on four-canal maxillary first
molar tooth in present study, the files
were discarded after use in four canals
(two specimens) in order to prevent
the deformation from influencing the
results (Hin et al. 2013).
It has been reported that use of larger
files in shaping the root canals increase
the incidence of dentinal defect
formation (Capar et al. 2015). For this
reason, in the present study, the apical
diameter of files was determined to
be 0.25 mm, and no larger file was
used. Moreover, in order to protect
the dentine microstructure, 1 % NaOCl
was used as an irrigation solution.
Thus, it was ensured that most of the
dentinal defects to be related with the
mechanic preparation.
It has been reported that the forces
applied while extracting the teeth, and
the stress during storing the teeth and
obtaining the slices might cause
dentinal defects (De-Deus et al. 2014).
This may explain the formation of
dentinal defects in the negative control
group, where no intervention was
made. Studies using conventional
methods of sectioning have failed in
determining these defects in negative
control groups (Capar et al. 2014,
Karata et al. 2015b, Li et al. 2015).
When illumination was applied on the
obtained dentine slices, the light
moved along the dentine, but stopped
at the point of any crack on dentine
and thus the presence of crack and/or
fracture could be determined
(American Association of
Endodontists, 2008). In Coelho and
colleagues study (2016a, 2016b),
dentinal defects could be determined
in many specimens in negative control
groups by employing light-emitting
diode (LED) trans-illumination.
Moreover, Arslan et al. (2014) have
also used methylene blue in order to
determine dentinal defects, and they
reported non-significant differences
between the experimental group and
negative control group in terms of
dentinal defects.
Arias et al. (2014) reported in their
study that masking is important for
eliminating observer bias because of
observing which of the specimens had
been shaped or not. For this reason,
the canal-masking method was used
in the present study in order to
eliminate any bias. The movement
kinematic of NiTi files may affect the
amount of dentinal defects during
canal root shaping by files. Under
favour of the reciprocation movement
in clockwise and counterclockwise

directions, the file is protected from
being stuck within the canal while
shaping the root canals (Yared 2008).
Some of the studies have reported
WaveOne files to cause less dentinal
defects than ProTaper Universal files
(Kansal et al. 2014, Li et al. 2015),
while some other studies have reported
that reciprocation systems create more
dentinal defects (Bürklein et al. 2013).
Besides that, in some studies, no
statistically significant difference
between the reciprocation systems and
rotary systems has been reported
(Arias et al. 2014, Karata et al. 2015a,
Coelho et al. 2016b). Li et al. (2015)
have examined the dentinal defect
formation incidences of ProTaper
Universal, ProTaper Next and
WaveOne files in curved root canals
of molar teeth. The researchers have
reported that ProTaper Next file system
created less dentinal defects than other
files. El Nasr and El Kader (2014)
have reported ProTaper Universal F2
files operating based on the same
movement kinematic with WaveOne
system to cause less dentinal defects.
Similar to the results of other studies
(Capar et al. 2014, Li et al. 2015), the
researchers attributed these results to
the heat treatment, to which WaveOne
files are exposed. Karata et al. (2015a)
have examined the dentinal cracks
created by ProTaper Universal, ProFile
Vortex (Dentsply Maillefer), ProTaper
GOLD, Reciproc (VDW, Munich,
Germany), and F360 (Komet
Brasseler, Lemgo, Germany) files
systems in mandibular incisor teeth,
and reported that there was no
statistically significant difference
between ProTaper Universal, ProFile
Vortex, ProTaper GOLD and Reciproc
groups in terms of dentinal defect
formation. It is believed that the reason
for the difference in the present study
originates from the differences in
methodologies used. Similar to the
present study, Coelho et al. (2016b)
have used LED in investigating the
dentinal defects created by ProFile
(Dentsply Maillefer), TRUShape
(Dentsply Maillefer) and WaveOne
GOLD systems on mandibular molar
teeths mesial canals, and reported
statistically non-significant differences
between the negative control group
and experimental groups in terms of
dentinal defects.
Capar et al. (2014) have examined
the dentinal defects created by HyFlex
CM, ProTaper Universal and ProTaper
Next NiTi file systems on mandibular
premolar teeth during preparation
procedure. The researchers have
reported ProTaper Next and HyFlex
CM files to cause less dentinal defects
than the ProTaper Universal files.
Ashraf et al. (2016) have examined
the dentinal defects created by
ProTaper Universal, ProTaper Next
and HyFlex CM NiTi file systems in
mandibular premolar teeth by using
sectioning method. Researchers have
reported that HyFlex CM files caused
less cracks than ProTaper Universal

and ProTaper Next files did. In our
literature review, it was determined
that HEDM files dentinal defect
incidence had not been studied before.
For this reason, it is not possible to
directly compare the results of the
present study to those of others. In a
finite elements analysis, it has been
shown that increasing the taper of files
also increased the stress on root canals
during shaping procedure (Kim et al.
2010). Bier et al. (2009) reported that
the taper of files might influence
dentinal defects on roots during the
shaping procedure. Yolda et al. (2012)
have alleged that the tip design, crosssection, constant or variable taper, and
groove and pitch structure of NiTi files
might be related with the formation
of dentinal defects. However, it is not
exactly known how the taper of files
affected the results of present study,
because the taper of files used were
not same and the taper of HEDM file
was not known. The similar results
obtained are thought to originate from
the fact that the files were made of
alloys having no shape memory (Gold
and CM).
Versluis et al. (2006) have reported
that the level of stress on coronal and
medial third during root canal shaping
was three times more than that on the
apical third. Despite that, Kim et al.
(2010) have reported the stress on the
apical third during shaping of the
curved root canals to be more than
that on the middle and coronal third.
According to the results of the present
study, there was statistically nonsignificant differences between the
dentinal defects created by NiTi file
systems on the apical, middle, and
coronal third, and this finding is
believed to originate from the fact that
the files were made of alloys having
no shape memory (Gold and CM).
Even though it was important to
simulate the clinic conditions in a
laboratory environment in the present
study, especially in the studies on
examining the mechanical properties
of teeth, many external factors such
as storing the teeth after extraction
and until the sectioning procedure
affected the results of study (Bürklein
et al. 2013). For this reason, as stated
by Coelho et al. (2016b) in their study,
the use of teeth extracted using
periodontal reasons, which require
very low level of force during
extraction, and the careful storage of
these teeth until the sectioning
procedures would allow for more
successful outcomes. Another
limitation of present study is the
difficulty of standardisation of apical
pressure applied by the operator during
root canal shaping procedure and that
this may influence the results.
Conclusion
Within the limitations of the present
study, no statistically significant
difference was found among the
HEDM, WOG, PTG and the control
group in terms of the total number of
dentinal defects.

[15] => Dt pages.FH10

January 2018 Pakistan Edition DENTAL TRIBUNE 15

$3B worth of deals ...
Continued from front page

which aimed to raise awareness and
understanding on school-based
approaches to preventive dentistry and
the establishment of diet counseling in
schools across the GCC states. The
session highlighted many practical
solutions and strategies to educate
children about the importance of
maintaining oral and dental hygiene
while also discussing the
implementation of simple dental care
techniques in schools across the GCC.
AEEDC Dubai 2018 concluded with
a Press conference to highlight the
preventive dental care strategies in the
GCC states, implement the right
solutions to combat dental diseases
among children, learn from similar
experiences in preventive dental care
abroad and make evidence-based
recommendations for establishing
foolproof and effective preventive
dental care programmes in the GCC.
AEEDC Dubai Night was also held
to recognise the efforts of those who
contributed to the oral and dental health
industry. The ceremony was honoured
with the presence of Abdul Rahman
Ghanim Al Mutaiwee, director of the
Office of the Ministry of Foreign Affairs
and International Cooperation in Dubai;
Dr Mansour Al Awar, chancellor of
Hamdan bin Mohammed Smart
University; Prof Abdullah Al
Shammery, scientific chairman of the
Global Scientific Dental Alliance; and
Dr Al Madani.
During the ceremony, Al Mutaiwee
was given the AEEDC Dubai Special
Award 2018 for his invaluable support
during the inception of the AEEDC
Dubai conference and exhibition, while
Prof Hezekiah Adeyemi Mosadomi,
director of the research centre at Riyadh
Colleges of Dentistry and Pharmacy,
was awarded the AEEDC Dubai
Personality of the Year Award 2018 for
his outstanding contribution to the oral
health profession, among others.

Government exchequer or ...
Continued from front page

but public money, which is collected
from the taxes of people and is being
utilized carelessly." -Committee
Chairman Senator Sajjad Hussain Turi,
remarked.
DRAP officials responded that the
matter of allotment of 50 canal land
has already been taken up with the
National Institute of Health
Management and they have agreed to
provide appropriate land for
construction of the building.
Furthermore, they added, that the Public
Works Department has refused to
initiate work and DARP is mulling to
award the contract to a private firm,
after obtaining an approval letter from
NIH.
Senator Ashok Kumar expressed
concerns over the matter as to why
DARP requires such a vast area for
their building, to which DARP officials
responded that they plan to set up
testing labs and other facilities. Officials

also informed the Senate Body that a
number of drug manufacturing
companies have shut down their
businesses and fled the country due to
the new drug policies, while 16 licenses
were cancelled during the last 3 years.
They added that the Drug Pricing Policy
2015 is currently being implemented
and uniform generic prices for new
registrations are being fixed under the
policy.
However, variation in prices of
generic products of different companies
is a global phenomenon and many
companies sell drugs below the
maximum retail prices, fixed by the
federal government.
Points were raised by Senator Ashok
Kumar, regarding the shortage of
medicines in the market, along with
financial corruption in the departments,
followed by mismanagement.
The Senate Committee was told by
DARP officials, that efforts are
continued to resolve all issues till June.
The officials of Capital Development
Authority (CDA) also briefed the
committee on the establishment of a
slaughterhouse in the city, with land
being allocated already: and the Senate
Committee then recommended
constituting a separate committee,
comprising members from CDA,
Capital Administration and
Development Division (CADD), NHS
and National Food Security, to handle
this issue.
The committee in the last 3 years
gave 30 recommendations regarding
DARP issues, 15 on Pakistan Medical
and Dental Council and 10 on NIH.

PMDC decides to reform ...
Continued from front page

curriculum. The council unanimously
decided that assistance would be sought
from noted medical educationists of
the country to design national
curriculum to produce quality doctors
to meet the country's health
requirements.
The PMDC president said the new
integrated modular curriculum would
be student-centered and would help
undergraduate students to upgrade their
existing knowledge and clinical skills.
He added that the new curriculum
would help produce better professional
doctors and dentists.
The participants pointed out that there
was a dire need for the revision of
inspection performas for medical and
dental colleges in the country. They
decided that the council would
introduce improved and revised
inspection performa for future
inspections and recognition of medical
and dental colleges.
The council considered the need of
students and faculty feedback of
respective colleges in the new performa
saying they practically witness the
quality of education. It decided that the
revised performas would be precise,
transparent and in line with the current
Gazette regulations. The inspections
carried out at the moment will however
be in line with the current performa.

The council said once the performa
was formulated in accordance with
Gazette rules and approved by it,
training of inspectors would be
conducted in collaboration with the
federal government.
The meeting was attended by
Attorney General of Pakistan Ashtar
Ausaf Ali, National University of
Medical Sciences Vice-Chancellor LtGen Dr Syed Mohammad Imran
Majeed, Vice Chancellor of the
University of Health Sciences, Lahore,
Prof Faisal Masud, KMU principal Prof
Arshad Javed, Bolan Medical College,
Quetta, principal Prof Shabir Ahmed
Lehri, nominee of the Attorney General
for Pakistan Chaudhry Amir Rehan,
Jinnah Sindh Medical University,
Karachi, principal Prof Tariq Rafi and
national health services DG Dr Asad
Hafeez.

Al Bahri said: "Breastmilk is the first
food of babies. Preventive dentistry
must start (at home with the mothers)."
In answer to the question he himself
floated among the panelists and the
audience, some of whom were Dentistry
students, regarding the need for all
dentists to seriously consider preventive
dentistry in their practice, Al Shammery
said: "Preventive dentistry in private
practice can generate money. We are
not against money but we have to
become responsible for our children's
health."
Khoory supported Al Mashadani's
recommendation that the renewal of
the dentists' licenses be connected with
the number of preventive dentistry cases
they have been into.

Regulating drug laws
Continued from page 2

every time someone has a headache.

GCC public sector dentists ... This is putting all of us at risk, and
Continued from page 2

well with decaying or rotten teeth; how
children would attend school, get
educated and fully develop their
potentials if they go through periodic
toothaches and other dental worries.
Asked on the diseases which various
research works have discovered to have
links with poor oral hygiene and lack
of dental care, Al Mashadani not only
mentioned diabetes, cardiovascular
diseases and asthma, but she also
pointed to a study conducted among
children and adults in Finland which
had revealed that oral cancer is the
consequence of the bacterial growth
due to gum diseases.
Her lecture was on the DHA study
"My Smile: Tooth Brushing Schemes
in Dubai Schools, A Step Forward in
Oral Health" for which she highlighted
three elements.
One, expatriate families or parents
admitted are in a bind, because of the
limited insurers that offer oral hygiene
and dental care in their policies and
packages.
Two, routine oral hygiene and dental
check-ups must be mandatory from
birth just as immunisations are, and be
a part of the annual school enrollment
procedures.
Three, all dentists must be obliged to
do preventive dentistry with their annual
assessments and license renewals
anchored on this.
"It is not all about aesthetics. It is all
about over-all health," Al Mashadani
said.
Oman's Al Bahri and Saudi Arabia's
Al Shami said having insurers
understand their significance in one's
general health through preventive
dentistry would in the long-run redound
in a win-win situation for public health,
general welfare and the industry.
According to Al Shami, one effective
way to teach parents is the UK
experience wherein mothers, for their
own good, advantage and awareness,
are expected to routinely take their
children from age one to the dental
clinic and to the dentist-even only for
mere exposure.

must stop immediately.
The second act is controlling the use
of antibiotics for animal growth.
Pakistani animal farmers, like their
counterparts in other countries, have
figured that antibiotics are a powerful
growth promoter in animals. Antibiotics
help fatten the chicken and the cattle,
thereby helping farmers achieve
slaughter weight in a much smaller time
period, which helps them significantly
increase their productivity and requiring
less feed. Farmers in Pakistan are using
antibiotics with a free hand, with no
law to stop them. This is not a zero sum
game. The cost of this is unhealthy
animals, widespread use of antibiotics
and the resistance that passes from
animals to humans. This passing of
antibiotics from animals to humans
means that even without actually getting
a prescription of antibiotics, we are
consuming a high dose and that too
without our knowledge or consent. This
act, once again squarely within the
control of the government, is just as
essential as the first one on prescription
to safeguard our health.
New antibiotics are not coming to
the market and there is a broad
agreement that without better awareness
and better laws, new drugs wouldnt
be particularly useful. The real solution
will come from control of what we
already have. This governance, called
antibiotic stewardship, is not just better
health policy, it is also better fiscal
policy. It will save billions spent in
treatment of preventable infections and
save the valuable labour and effort lost
due to prolonged health challenges of
antibiotic resistance.

Regulating drug laws
Continued from page 2

for the changes because they create a
regulatory framework for dental
products that is based on a risk
management approach designed to
ensure public health and safety. He
added that the reforms will
simultaneously free the dental industry
from any unnecessary regulatory
burden. -DT Asia Pacific

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[cover] => DT Pakistan No. 1, 2018

[toc] => Array ( [0] => Array ( [title] => News [page] => 1 ) [1] => Array ( [title] => Clinical Implantology [page] => 6 ) [2] => Array ( [title] => Clinical Endodontics [page] => 8 ) [3] => Array ( [title] => Oral Care for Prevention of Gum / Periodontal Disease [page] => 10 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

News / Clinical Implantology / Clinical Endodontics / Oral Care for Prevention of Gum / Periodontal Disease

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