PDA - Shield & Dental Tribune join hands to reach over 25 - 000 patients / The new model of periodontal disease / Teeth may predict human evolution / Technological innovation in professional home bleaching: The ENA White 2.0 system in only 2 minutes per day without tray / Feline dental implants: New paradigm shift in maxillary cuspid extraction treatment planning
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04 - 04 viewTechnological innovation in professional home bleaching: The ENA White 2.0 system in only 2 minutes per day without tray
06 - 14 viewFeline dental implants: New paradigm shift in maxillary cuspid extraction treatment planning
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PUBLISHED IN PAKISTAN
www.dental-tribune.com.pk
Feline dental implants:
New paradigm shift in
maxillary cuspid extraction
treatment planning
Technological innovation
in professional home
bleaching.....
CLINICAL PRACTICE
MARCH, 2016 - Issue No. 02 Vol.3
Page 6
CLINICAL PRACTICE
Page 10
2016 Customer Service
Award
NATIONAL NEWS
Page 14
WOHD 2016
PDA, Shield &
Dental Tribune join
hands to reach over
25,000 patients
Editor - Online
Haseeb Uddin
Editor Online
Haseeb Uddin
It all starts here
DT Pakistan Report
K
ARACHI - World Oral
Health Day (WOHD) is
celebrated each year on
March 20 to highlight the benefits of
a healthy mouth and to create
worldwide awareness of the issues
concerning oral health and oral
hygiene among all and sundry,
whether old and young.
Though the oral diseases affect 90
per cent of the world's population in
their lifetime, many of them could be
prevented with increased support of
government, health associations and
the society at large, and with the
funding required for prevention,
detection and treatment of such
Healthy mouth. Healthy body
ailments.
"It all starts here, Healthy mouth,
Healthy body" is the theme of 2016
World Oral Health Day. Dental News
a JV partner of Dental Tribune in
Pakistan in collaboration with Pakistan
Dental Association (PDA) launched
a major campaign aimed at
popularizing the WOHD 2016's
current year's theme "It all starts here,
Healthy mouth, Healthy body" so that
people could be apprised about the
importance of oral health. The
campaign is backed by FDI, JPDA,
DTI, FDI partner associations and the
local sponsor, Shield Corporation.
World Oral Health Day is celebrated
throughout the world on March 20
and in Pakistan it would be the 6th
consecutive year that the Shield
Corporation, as part of its CSR
activities, has sponsored the mega
event. Shield Corporation will be
doing 204 schools across Pakistan in
April to create awareness among
schoolchildren as part of its
commitment to serve the community.
In Pakistan, Shield Corporation Ltd.
has been working in the sphere of oral
cancer for over 30 years and like
previous years, Shield® again joined
hands with the internationally
celebrated "World Oral Health Day"
to highlight the importance of oral
hygiene and to offer the dental and
oral health community an action
platform so as to help reduce the global
oral disease burden.
As more than 90 per cent of all
dental diseases go untreated, Pakistan
has a long way to go before it can
truly celebrate `healthy smiles'. Almost
every Pakistani has or will suffer from
oral disease in their lifetime, ranging
Continued on page 04
2,775 DRUGS REGISTERED IN 2015
Drap vows to clear 7,500 pending cases by October
By Our Staff Reporter
ARACHI- Drug Regulatory Authority of
Pakistan’s (Drap) chief executive officer
(CEO) Dr Muhammad Aslam has vowed
that all the 7,500 pending cases of drugs registration
will be cleared during the current year.
The Drap has, however, registered 1,900 medicines
during 2014 and 2,775 medicines in 2015, he added.
Giving details of the pending cases, Drap chief said
that of the total 7,500 drug registration cases, 3,500
cases belonged to the period ranging between 2010
and 2015, while remaining 4,000 cases have been
pending due to some technical reasons such as
incomplete documents or non-payment of
registration fees, etc.
According to a press release, the Drap had fixed
the timeframe of 30 days to clear such cases and
that all these cases would be registered by October
this year.
A mechanism had been evolved to maintain
transparency in registration of drugs and two
meetings will be convened every month to study
K
the cases, the press release quoted Dr Aslam as
saying.
“In fact, drugs registration cases kept on piling up
as previously only few meetings used to be convened
in a year,” he added.
He said that of the 700 pharmaceutical companies
registered with Drap, 24 are multinationals.
He said that under the reforms transformation
strategy, the authority had been focusing on four
aspects which include registration, licensing, quality
control and price control of medicines, besides an
international standard of registration was being
developed in the country to make it on par with the
standard of WHO-specific format, called Committee
on Trade and Development (CTD).
Under the Drap’s new reforms policy, seniorlevel officers such as chairman and secretary would
be the signing authority for registration as against
the past practice when a section officer used to be
the signing authority, he said, adding that there
would be an international standard accredited central
drug-testing laboratory, while laboratories would
also start working at provincial level.
He said these laboratories would be pre-qualified
from the WHO in order to improve the credibility
of these labs.
He said that a federal drug surveillance laboratory
would soon start functioning under WHO
assessment scheme and Drap would observe gaps
and potentials, while its transparency would be
checked by the WHO. Continued on page 14
[2] =>
2 DENTAL TRIBUNE Pakistan Edition March 2016
The new model of periodontal disease
DT International
By Richard H. Nagelberg, DDS
olymicrobial Synergy and Dysbiosis (PSD) is the
word salad that the new model of periodontal disease
is called as revealed by research. Let's consume this
salad.
Polymicrobial is self-explanatory; i.e., a community of
different microbes. Synergy is a term used in many different
settings. In business, it can be defined as the increased
effectiveness that results when two or more people or
businesses work together. The definition in the context of
PSD is actually very similar. Synergy in this case refers
to the coordinated action of oral bacteria promoting
P
inflammation and periodontal disease. A homeostatic
(nondysbiotic) balance of bacteria promotes healthy gums.
In this current model of periodontal disease, bacteria such
as Porphyromonas gingivalis are called perio pathogens.
In the new model of periodontal disease development and
progression, P. gingivalis is called a keystone pathogen.
This is not just a matter of verbiage, as you will see.
It should be borne in mind that the current model of
Publisher/CEO
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hashim@dental-tribune.com.pk
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Haseeb Uddin
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not assume responsibility for product names or
statements made by advertisers. Opinions expressed
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inflammation and bacterial survival. The term further
explains that the coordinated action of the community of
microbes is exponentially greater than it would be if the
individual microbial species were working separately, and
not in a good way. It's all about the increased virulence of
the synergistic oral bacteria, and how damage is ramped
up when they work together.
Dysbiosis is an imbalance in the abundance or influence
of a microbial community. A dysbiotic state promotes
Claudia Duschek
periodontal disease also involves a polymicrobial dysbiotic
bacterial community. The current model indicates that a
predominance of perio pathogens is required for disease
development, which is a dysbiotic state. There are, however,
fundamental and critically important differences in the
current and new, emerging understanding of periodontal
disease. The differences are critically important in a variety
of ways.
Editor
Anne Faulmann
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Serban Veres
Neutrophil and cancer cell ‘crosstalk’
underlies oral cancer metastasis
DT International Canada
n abnormal immune response
or “feedback loop” could very
well be the underlying cause
of metastases in oral cancers, according
to Dr. Marco Magalhaes, assistant
professor at the University of Toronto’s
Faculty of Dentistry and lead
researcher in a study published in the
journal Cancer Immunology Research.
Magalhaes has unearthed a significant
connection between the inflammatory
response of a very specific form of
immune cells, neutrophils, and the
spread of this deadly disease.
“There’s a unique inflammatory
response with oral cancers,” explains
Magalhaes, citing the growing body
of evidence between cellular
inflammation and cancer, “because
the oral cavity is quite unique in the
body. A great many things are
happening at the same time.”
Magalhaes focused attention on
neutrophils, immune cells commonly
found in saliva and the oral cavity but
not widely researched in relation to
oral cancer. Like other immune cells,
neutrophils secrete a group of
molecules, including TNFa, that
regulates how the body responds to
inflammation.
A
The study noted that oral cancer cells
secreted IL8, another inflammatory
mediator, which activates neutrophils,
effectively establishing a massive
immune-response buildup or
“feedback loop.”
Ultimately, the researchers found,
the immune-response loop resulted in
increased invasive structures known
as “invadapodia,” used by the cancer
cells to invade and metastasize.
“If we understand how the immune
system interacts with the cancer, we
can modulate the immune response to
acquire an anti-cancer response instead
of a pro-tumor response,” Magalhaes
argues.
While the study points to the
possibility of one day creating targeted,
personalized immunotherapies for
patients with oral cancer that could
effectively shut down the abnormal
immune response, the team is currently
expanding upon their study of
inflammation and oral cancer.
Approximately 3,600 cases of oral
cancer are diagnosed in Canada every
year, yet the survival rates — 50 to 60
percent over five years — have
remained stagnant for decades while
other cancer survival rates have
dramatically improved.
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Oral squamous cell is shown invading the
extracellular matrix of a healthy cell
About the Faculty of Dentistry,
University of Toronto
Combining the rigours of biological
and clinical research with a
comprehensive educational experience
across a full range of undergraduate
and graduate programs — with and
without advanced specialty training
— the Faculty of Dentistry at the
University of Toronto has earned
international respect for its dental
research and training.
Whether focused on biomaterials
and microbiology, next-generation
nanoparticles, stem-cell therapies or
ground-breaking population and
access-to-care studies, the mission is
to shape the future of dentistry and
promote optimal health by striving for
integrity and excellence in all aspects
of research, education and clinical
practice. You can learn more at
www.dentistry.utoronto.ca.
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[3] =>
[4] =>
04 DENTAL TRIBUNE Pakistan Edition March 2016
Study explores dentists’
views on teledentistry
Teeth may predict human
evolution
Teledentistry, which was first used by the US military to treat troops
stationed far from dental specialists, could provide a means to improve
access at low cost for people in need.
Dr Alistair Evans examines a range of hominin skull casts that were
included in the study
DT International
P
ERTH, Australia: Although
teledentistry has shown to be
a valuable addition to regular
dental services in pilot programmes in
remote and underserved areas, many
dental professionals still have
uncertainties regarding the
implementation of an efficient
teledental system in daily practice, an
Australian study has found.
Teledental programmes hold the
promise of providing underserved and
low-income patients with affordable
dental care and thereby reducing
financial burdens through preventive
care. The concept provides that
specially trained hygienists and
assistants consult via the Internet with
their supervising dentists and might
perform basic treatments that would
normally be outside of their official
scope of practice.
In order to explore dental
practitioners’ perceptions of the
usefulness of teledentistry in improving
dental practice and patient outcomes,
researchers from the University of
Western Australia surveyed 135
Australian dentists in an online
questionnaire.
In the survey, dental practitioners’
perceptions regarding teledental
services were polled in four categories,
namely the usefulness of teledentistry
for patients, the usefulness of
teledentistry for dental practice, the
capability of teledentistry to improve
practice, and perceived concerns about
the use of teledentistry.
More than 80 per cent of the
participants agreed that teledentistry
would improve dental practice through
enhancing communication with peers,
guidance and referral of new patients.
The majority also felt that teledentistry
would be useful in improving patient
management and increasing patient
satisfaction. However, a substantial
proportion of the respondents also
expressed reservations towards
telemedicine in routine practice,
including uncertainty regarding
technical reliability, privacy issues,
practice expenses, as well as medical
issues, such as surgery time and
diagnostic accuracy.
Continued on page 14
PDA, Shield & Dental Tribune....
Continued from front Page
from gum disease and tooth decay to oral cancer. Only
20pc of the country's population enjoys access to oral
healthcare; 50pc of school children have dental carries,
while Oral Cancer is, unfortunately, the second most
common cancer in the country.
Keeping in view the disturbing scenario vis-à-vis
the oral health issues in Pakistan, Shield ® in
collaboration with Dental Tribune, the widely-read
monthly magazine that had been providing instant
coverage to the events taking place in the field of
dentistry and carrying the most revealing stories for
over a decade, reiterate its commitment of bringing
out a positive change in the population's oral health
by actively participating in PDA's activities.
This year's programme that includes 17 cities and
60 locations allover Pakistan - courtesy Shield
Corporation and PDA - is the biggest-ever activity of
its kind undertaken in the country. The sponsors also
arranged free checkup of school children in various
cities of Pakistan, besides launching extensive print
and electronic media campaigns and the sole objective
of all such activities is to create awareness about oral
health among the masses.
DT International
M
ELBOURNE, Australia:
Variation in tooth sizes in
humans has been primarily
attributed to natural selection and
dietary changes over the centuries.
However, the underlying mechanisms
of these changes have not been fully
understood to date. Researchers have
now found that relative tooth size in
mammals follows a simple rule. Using
the rule, scientists can predict the sizes
of teeth missing from human fossils
and extinct hominins, and provide
clues about future evolution of human
dentition.
The study was conducted by an
international team of anthropologists
and developmental biologists from
Finland, Germany, the UK and the
US, and led by Dr Alistair Evans from
Monash University’s School of
Biological Sciences in Australia. In
order to examine the evolution of the
proportions of human teeth, the team
used a new extensive database on fossil
hominins and modern humans
collected over several decades, as well
as high-resolution 3-D imaging
technology.
They found that the inhibitory
The activities in Pakistan began with school
programmes on March 7. It was followed by a press
conference where PDA officials highlighted Pakistan's
oral health issues.
A walk was organized by Liaquat University of
Medical and Health Sciences in Hyderabad and it was
followed by a well-attended symposium held to create
awareness about oral health issues. At a free checkup
camp organized on March 21, patients were taught
correct brushing techniques and were given a tooth
brush and paste free of any charge.
The participating institutions included Altamash
Institute of Dental Medicine, Bahria University, Baqai
Medical & Dental University, Bibi Asefa Dental
College, Bhitai Dental & Medical College & Hospital,
Dr.Khalid Dental Surgery, Sukkur; Civil Hospital
Hyderabad, Dow International Dental College,
Dr Ishrat-ul-Ebad Khan Institute of Oral Health
Sciences, Dow Dental College, Fatima Jinnah Dental
College, Hamdard University Dental Hospital, Isra
University, Jinnah Medical & Dental College, Jinnah
Sindh Medical University, Karachi Medical & Dental
College, Liaquat College of Medicine & Dentistry,
Liaquat University of Medical & Health Sciences,
Madina Medical Centre, Bin Qasim; Sir Syed Dental
cascade, a mathematical model for
interpreting relative tooth size,
produces the default pattern of tooth
size for all lower primary post-canines
in hominins. “On the basis of the
relationship of inhibitory cascade
patterning with size, we can use the
size at one tooth position to predict
the sizes of the remaining four primary
postcanine teeth in the row for
hominins,” they explained.
The findings of the study can be
used to interpret hominin fossil finds
and look into possible drivers of
human evolution. “Sometimes we find
only a few teeth in a fossil. With our
new insight, we can reliably estimate
how big the missing teeth were. The
early hominin Ardipithecus is a good
example—the second milk molar has
never been found, but we can now
predict how big it was,” Evans said.
“Our new study shows that the
pattern is a lot simpler than we first
thought—human evolution was much
more limited,” he concluded.
The study, titled “A simple rule
governs the evolution and development
of hominin tooth size”, was published
online on 24 February in the Nature
journal.
College, Ziauddin Dental College (ZU), Islamic
International Dental College (Riphah University),
Islamabad Medical & Dental College, Margalla College
of Dentistry, Aziz Fatima Hospital FSD, Allied Hospital
(Punjab Medical College) FSD, CMH Lahore Medical
College, de'Montmorency College of Dentistry, Faryal
Dental College, FMH Medical & Dental College, Islam
Dental College, Lahore Medical & Dental College,
Nishtar Institute of Dentistry, Multan; Multan Medical
& Dental College, Rural Health Centre Laws, District
Chakwal; Sheikh Zayed Hospital, Lahore; Sheikh
Zayed Hospital RYK, The University of Lahore,
University of Faisalabad (Madina University), VIP
Niazi Medical Complex, Sargodha; Ayub Medical &
Dental College, Bacha Khan Medical College, Mardan;
Peshawar Dental College, Sardar Begum Dental
College, Women Dental College/Rehmat Memorial
Hospital, Abbottabad and Bolan Medical College,
Quetta.
Dental Tribune which spearheaded and initiated the
World Oral Health Day in Pakistan with its sponsor Shield Corporation- in 2010, has been working tirelessly
to create oral health awareness across Pakistan and
enjoying continued support from dental institutions in
organizing free OPDs to mark the WOHD 2016.
[5] =>
[6] =>
CLINICAL PRACTICE
6 DENTAL TRIBUNE Pakistan Edition March 2016
Technological innovation in professional home
bleaching: The ENA White 2.0 system in only
2 minutes per day without tray
Editor - Online
Haseeb Uddin
DT International
By Dr Luigi Leonardi, Italia
he desire for whiter teeth has
considerably increased in the
last few years. The demand
for tooth bleaching as a cosmetic
treatment is increasing more and
more, despite the recession, which
only marginally affected aesthetics
and cosmetics.
Nowadays, we live in a world where
appearance is extremely important in
any field; according to independent
studies conducted for the American
Association of Cosmetic Dentistry:
. 99.7 % of Americans are convinced
that a bright smile is an important
social factor;
. 96 % of adults are convinced that
an unpleasant smile may have a
negative influence on career
opportunities;
. 74 % of adults think that an
unpleasant smile may have a negative
influence on career opportunities. We
are also aware that the desire of having
a bright smile with white teeth has
existed for centuries, but the research
in this sector has only stepped notably
forward during the past few decades.
We are also aware that the desire of
having a bright smile with white teeth
has existed for centuries, but the
research in this sector has only stepped
notably forward during the past few
decades.
This happened especially at the end
of ‘80s, thanks to Dr Eyneman and
Dr Aiwood,[1–4] who conceived the
idea of home bleaching treatment with
the use of the well-known bleaching
trays, customized or not, adequately
filled with low-percentage hydrogen
peroxide and worn for some hours a
day or even all night long.
Afterwards, the companies of the
dental field worked hard to improve
these procedures, such as designing
pre-filled trays or changing the flavour
of the gel. The method is substantially
the same, only the percentage of
hydrogen peroxide (also available as
carbamide peroxide) may vary from
10 % to 30 %.[6,7] This influenced
the contact period, which is at least
from a couple of hours a day (for
percentages that are onlyallowed for
cosmetic bleaching) to all night long.
All of them start from a single
assumption: the bleaching action of
peroxide needs a variable contact
period to penetrate through the enamel
prisms and the dentinal tubules,
releasing active oxygen and allowing
the free radicals to attack the
chromophobe particles and reach the
T
Fig. 3a: Unscrew and remove
the cap of the toothbrush.
Fig. 1: Bleaching system ENA White
2.0: toothbrush with dispenser
containing hydrogen peroxide
bleaching gel with special activator
XS 151, which increases its absorption
rate exponentially.
Fig. 2: 30-year-old male patient
with discolouration on the central and
lateral teeth; shade A3 of VITA shade
guide.
Fig. 3b: Unscrew the toothbrush
and remove it from the dispenser.
Fig. 3c: Remove the seal from the
base of the toothbrush with tweezers.
Fig. 3d: Screw the
toothbrush again.
Fig. 3e: Rotate the ring anticlockwise towards the direction
‘UP’ until the gel comes out from
the hole among the bristles.
Fig. 3f: It is necessary to use
a small lentil-sized dose of the
gel.
Fig. 3g: The patient must brush
the teeth to be bleached for about
30 seconds with horizontal
movements, avoiding contact with
the gums as much as possible.
Fig. 3h: Rinse the bristles with
running water.
Fig. 3i: Brush again for further 30
seconds and rinse accurately.
Fig. 4: Check after 4 days.
Fig. 5: Check after 7 days.
Fig. 6: Check after 10 days.
Fig. 7: Check after 12 days.
desired effect.[9]
Materials and methods
After years of attempts and
experimentations used to improve the
current methods and the result, I have
managed to refine a new method,
making it easy and above all reducing
the daily duration of the treatment to
only two minutes instead of 6–8 hours
of the traditional cosmetic home
bleaching: I have optimised the
method in an extreme way.
After several tests, I deduced that
peroxide, if activated by a special
accelerator (XS 151) could penetrate
in a faster way, exploiting the action
of mechanical pressure generated by
a special toothbrush with nozzle-doser
and a dispenser filled with this special
bleaching substance (Fig. 1). This
special bleaching toothbrush has been
designed with a smaller head if
compared to the most common
toothbrushes in order to reduce the
contact with oral mucosa. Soft blunted
bristles activate the accelerator (XS
151) contained in the gel while
brushing and guarantee a faster
absorption of the bleaching gel; it also
improves the procedure by drastically
reducing the application time: from
6–8 hours to two minutes per day!
The advantages are amazing, because
reducing the contact period means
reducing enormously the undesirable
effects[8]: inflammation of soft
tissues, hypersensitivity, risk of
swallowing the gel and so on. There
is also an improvement of some
[7] =>
CLINICAL PRACTICE
Fig. 8: Check after 16 days
Fig. 9: Check after 21 days.
Fig. 10: Check after 28 days.
Fig. 11: Check after 35 days: the
chromaticity at the end of the
treatment corresponds to A1 of VITA
shade guide.
Fig. 12: A 25-year-old female
patient, unsatisfied with a bleaching
treatment with tray; initial colour of
teeth was A3 of the VITA shade guide
Fig. 13: Check after 10 days: the
result corresponds to A2 of the
VITA shade guide.
Fig. 14: Check after 21 days:
she reached shade A1 of the
VITA shade guide.
psychological aspects, due to the
need of wearing the tray for hours
or all night long[5] with interferences
with normal interpersonal
relationships both in private life and
at work.
The new method, as said before,
considers reduced application times
of about two minutes per day; it is
easy to understand how this can
encourage the user to apply tooth
bleaching. The average total contact
period of the whole treatment is less
than one hour (two minutes for 20
days). This corresponds to less than
one-fifth of the time that a single
application with the tray technique
takes, which is currently the most
common mode. Furthermore, this
special toothbrush with dispenser is
extremely easy to carry thanks to its
pocket-size and can be used for one
minute in the morning and one
minute in the evening anywhere, after
one’s usual oral hygiene routine. The
treatment lasts about 15–20 days on
average, and this duration is sufficient
to obtain an excellent result,
achieving a reduction of 1–2 chromes
of the VITA shade guide depending
on the subject with a minimum
commitment. Wherever you want,
whenever you want: you can choose
the place and time of application,
which makes it different from other
methods. The here-analysed method
respects all the recent UE laws about
the use of hydrogen peroxide as a
cosmetic bleaching treatment,
accepting a maximum percentage of
6 %, specifying that the bleaching
kits must be delivered to the user
only by the dentist as a professional
treatment, after an accurate visit and
the evaluation of each single case.
It is also important to underline
that advice and protocols are the
fundamentals of what has been stated
so far. First of all, the dentist must
undertake thorough plaque removal,
advise the patient about correct oral
hygiene use, which means brushing
the teeth with adequate toothpastes
with special characteristics, for
example, the Enamel Plus toothpaste,
which has a low abrasion formula
and desensitizing action: this
enhances and maintains the bleaching
effect reached with this system. It
is also important to limit the
consumption of food with a high acid
pH, such as citrus fruit, tomatoes,
tea, tobacco etc, in order to preserve
the achieved result. We also
recommend to: schedule regular
visits with your dentist in order to
monitor the condition of teeth and
mucosa and point out any irritation
or inflammation of mucosa[10];
repeat the bleaching treatment
regularly to maintain the results,
considering that the repetition of this
method decreases the undesirable
effects thanks to the limited contact
period of 1 hour maximum for the
whole complete treatment of about
15–20 days, in comparison to the
March 2016 Pakistan Edition DENTAL TRIBUNE 7
120–150 hours or more of the
traditional bleaching with tray method.
Comparative analysis with traditional
bleaching systems
We carried out a comparative study
performing 20 bleaching treatments
in the same period: ten cases were
treated according to the traditional
technique with tray and 6 % hydrogen
peroxide, and the other ten patients
with ENA White 2.0. The patients
were aged between 25 and 55, and
were divided into three age groups.
The first group were treated with
bleaching trays and 6 % hydrogen
peroxide:
. Five were satisfied with the result;
. Three were not satisfied with the
treatment and decided not to extend
the treatment of a further 15–20 days;
. Two abandoned the treatment
because they considered the
application times to be too demanding;
they didn’t have time to carry out the
treatment as it clashed with their hours
of working and/or because they felt
discomfort and annoyance wearing
the tray at night.
The inconveniences reported during
the bleaching treatment with tray
include the fact that in some cases, it
was very difficult or even impossible
to keep the tray in the mouth—which
has a recommended time of action of
several hours or all night—due to
illness, for example flu, bronchitis
with coughing fits, also with phlegm
and colds. This was a further
complaint that sometimes contributed
to demotivate the user in such a
decisive way as to suspend the
treatment.
The second group of ten people who
used the new system ENA White 2.0
proposed by me:
We could verify the total satisfaction
in nine subjects, only one of them
was not completely satisfied because
he expected a more evident effect and
did not want to extend the treatment.
With regard to motivation, all of
them showed a huge satisfaction,
especially for how the kit had been
introduced, considering it as very
innovative, handy and with no limits
of use.
Clinical cases
The case report in the pictures
shows a 30-year-old male with an
apparently optimal health condition,
who was unhappy with the
discolouration on the central and
upper- and lower-lateral teeth near
the cervical area. After an objective
examination of the oral cavity, the
subject showed a normal gingival
biotype, good gingival health and
good oral hygiene. For the verification
of the initial and final colour (hue and
croma) I used the VITA shade guide,
starting from A3 (Fig. 2).
After a session of professional
prophylaxis I proposed to the patient
the bleaching treatment Ena White
2.0 and advised him to perform it after
his oral hygiene routine in the morning
and in the evening. When he realised
how easy the system was to use, he
immediately accepted the treatment
that I explained, as shown in the
pictures.
First of all you show the patient
how to open the toothbrush by
unscrewing the cap (Fig. 3a). Then
the head of the brush must be
unscrewed too (Fig. 3b) to remove
the seal from the base of the
toothbrush (Fig. 3c). After screwing
the final part of the toothbrush on the
dispenser again (Fig. 13d), you must
rotate the ring on the base of the
toothbrush anti-clockwise towards the
direction ‘UP’ until the bleaching gel
comes out (Fig. 13e). For the first
application, a couple of rotations are
required, until the tube is filled up to
the bristles. Explain to the patient that
for the following applications it will
be sufficient to rotate the ring of 2–3
marks to obtain the needed quantity
of gel, like a small lentil, as shown in
the picture (Fig. 13f). Show the patient
how to proceed with brushing: make
a horizontal movement for about 30
seconds (Fig. 13g), avoiding brushing
the gums as much as possible; the
blunted shape of the bristles helps the
patient to avoid this contact, which
does not cause irritations anyway,
considering the short application
period. At this point it is necessary to
rinse the toothbrush with water (Fig.
13h) and brush the teeth again for a
further 30 seconds (Fig. 13i). In this
way the residual gel on the teeth is
diluted before the final rinse.
You can notice the evolution of the
bleaching action in pictures from Fig.
4 to Fig. 11, where you can appreciate
the final result of the treatment after
35 days with a shade corresponding
to A1 of VITA shade guide. Halfway
through treatment, a lighter
chromaticity, almost equal to A2 of
VITA shade guide, had been achieved,
as shown in Fig. 9.
The second case (No 15 of the
statistic table) shows a 25-year-old
female patient who was not satisfied
with a bleaching treatment performed
with a tray six months before, which
irritated her gums. With the new
treatment, she reported no discomfort
and appreciated the result, as you can
see in the pictures she changed from
shade A3 of VITA shade guide
(Fig. 12) to shade A1 (Fig. 14) in
about 20 days (after 10 days, the result
was already equal to A2 (Fig. 13).
Conclusion
Dental discolouration is an
important factor of psychological
discomfort for the patient, which leads
to an increase in cosmetic bleaching
requests. The new method explained
here makes the bleaching procedure
easier, considerably reducing the side
effects that can appear with other
techniques, thanks to the shorter
contact period between gel and tooth.
This method allows to reach very
satisfying results and produces a
growth in the request of bleaching
Continued on page 14
[8] =>
AL
N
O
I
AT
N
R
L
A
TE
N
N
I
O
2
TI
A
N
6
RS
E
K
SPEA
6 CDE HOURS
&
24 th APRIL 2016
REGENT PLAZA , KARACHI
SPEAKERS
Dr Abid Faqir (UK)
(Implantologist)
Dr Irfan Qureshi
(Prosthodontist /
Implantologist)
Dr Khurram Ataullah
(Periodontist/
Implantologist)
Dr Bilal Shaikh
(Implantologist)
Dr Sameer Qureshi
(Prosthodontist)
Dr Adnan Aslam
(Oral & Maxillofacial
Surgeon)
SIDDIQIS
EXCEUTIVE CLINICS
OROFACIAL
PROFESSIONALS
‘D’Care
The
Dr Puria Parvini (Germany)
(Periodontist /
Implantologist
DR.TALAL & ASSOCIATES
Implant gets a new, multidisciplinary outlook.
Join our dynamic speakers as they enlighten us on
the importance of saving the bone, leading to a more
successful outcome after implant placement.
The world of implant dentistry has just broadened its horizons.
Pre Conference Hands-On Workshop
By Dr Abid Faquir (UK)
(Immediate Implant placement in Extraction Socket)
Venue: Regent Plaza
Date: 22nd-23rd April 2016
(12 CDE HOURS)
(Rs 25,000/-)
Post Conference Hands-On Workshop
By Dr Puria Parvini (Germany)
(Soft Tissue Management)
Venue: Regent Plaza
Date: 25th-26th April 2016
(12 CDE HOURS)
(Rs 25,000/-)
Dr Mansoor Ahmed
(Oral & Maxillofacial
Surgeon)
VALUE ADDED FEATURES
Poster Competition
Lucky Draws
ISC’16 Idol
(Singing Competition)
REGISTRATION FEE
HOUSE OFFICER / PG TRAINEE STUDENT (Rs 3000/-)
GENERAL PRACTITIONER (PKR 4000/-)
ON-SITE (PKR 4500/-)
Official Media Partners
Platinum sponsor
Dental
Tribune
Pakistan
I N T E R N A T I O N A L
I M P L A N T
S U R G I C O N
2 0 1 6
[9] =>
[10] =>
CLINICAL PRACTICE
10 DENTAL TRIBUNE Pakistan Edition March 2016
Editor Online
Feline dental implants: New paradigm shift in
maxillary cuspid extraction treatment planning
DT International USA
Haseeb By Rocco E. Mele, DVM, Anthony Caiafa, BVSc
Uddin
BDSc, & Gregori M. Kurtzman, DDS, MAGD,
DICOI
F
elines (cats) are by nature carnivores and,
as such, their diet reflects that. It is accepted
that diet affects health, and ability to eat
(or lack thereof) can have negative effects on the
diet, and thus, general health. Implants have become
Fig. 1: Radiograph
demonstrating alveolar fracture
adjacent to mobile maxillary
right canine.
Fig. 5:
Completed and
luted abutmentcrown intraorally.
owner of the pet. These included: stabilization of
the luxated tooth followed by endodontic treatment
in two or three months; extraction of the canine
and no replacement; or extraction with immediate
implant placement, providing the alveolar process
and vault were intact and primary stability of the
implant could be attained. After discussion with
the feline's owner reviewing the pros/cons of the
different treatment options, the owner chose to
have the canine extracted and implant placed.
Fig. 2: Implant placed into osteotomy
at immediate extraction site at the right
maxillary canine with buccal flap (left
and middle) and primary closure of
the site (right).
an option for replacement of lost canines in these
animals.
This allows the animal to maintain the level of
mastication found in those felines who have normal
oral health and permit better nutrient uptake as
well as psychological maintenance of the animal.
We will discuss two cases of lost maxillary canines
and implant treatment to replace the lost teeth.
Case report 1
A 4.5-year-old male neutered Russian Blue cat
weighing 11.5 pounds was referred for multiple
bite wound evaluation and a luxated R maxillary
canine tooth (#104) of three-day duration. On initial
examination, there were multiple bite wounds with
deep penrose drains in place, bruising and abrasions
in the inguinal areas. The sites were stable. Also,
the R maxillary cuspid was luxated with a slight
mesial deviation, mobility and painful.
All treatment options were considered with the
Fig. 3: Closed tray impression coping
placed into the implant (left), radiograph
to verify part mating (center) and healing
abutment placed (right).
Fig. 4: Soft-tissue model
with analog and completed
cast abutment-crown ready
for cementation into the
implant intraorally.
Fig. 7: Radiograph at 26-months postinsertion demonstrating maintenance
of bone at the same level as at insertion
with no evidence of periimplantitis.
Fig. 8: RClinical examination with
endodontic file in the right maxillary canine
(left) and radiograph demonstrating apical
pathology at the mobile tooth (right).
Fig. 10: Patient at initiation of restorative phase
showing lack of inflammation at previously placed
implant (a), tissue punch being used to expose the
implant (b) and uncovery of the cover screw (c).
Fig. 11: Radiograph of the implant at
initiation of the restorative phase (top and
bottom right) and after placement of healing
abutment (bottom left).
Fig. 6: Case 26-months post-insertion
of the abutment-crown demonstrating
good gingival health with a lack of
inflammation.
Fig. 9: Diamond being used on the residual root (a)
to atraumatically extract the root, implant being inserted
into the osteotomy (b), implant placed subcrestally (c)
and site closed by primary intention (d).
being attempted in two to three months, a very
good possibility of root resorption complication
exists.[1] Additionally, extraction and immediate
implant placement can also be problematic. But
it's less problematic than attempting to stabilize
the luxated canine with subsequent endodontic
treatment.
At the time surgery was performed, all past
immediate implants in cats have integrated, and no
integration failures have been observed during
The authors believe all three options have their
own inherent complications. The owner did not
desire having a cat without prominent anterior
teeth. The owner, a well-educated engineer,
analyzed all of the options and made an informed
decision.
The lead author has performed numerous
stabilization and endodontic treatment cases with
luxated canines in dogs with relatively good results.
In his experience a Figure 8 wire around the canines
and use of acrylic or spot cure with some flowable
composite has not been a positive experience for
cats with luxated canines. They typically don't
tolerate the procedure very well. With a fracture
as it presented in this case, the maxillary right
cuspid (tooth #104) is not very stable and can be
a challenge maintaining proper occlusion. Even
with the best intentions, possible periodontal
ligament devitalization and endodontic treatment
long-term follow-up on these patients. If the
implants are not restored (put to sleep), the buccal
osseous morphology is well-maintained, preventing
a traumatic episode with the ipsilateral canine.
Implant placement in these situations are becoming
more predictable with happy owners and patients.[2]
Surgical phase
The patient was pre-medicated with Atropine
Sulphate (1/120 grain; 1 ml/20#; subcutaneously:
VetOne; Boise, Idaho) and Acepromazine (10
mg/ml; .02-.05/#; subcutaneously; VetOne).
Atropine is given before anesthesia to decrease
mucus secretions orally and has the added benefit
of regulating heartbeat during sedation.
Acepromazine is a common tranquilizer and central
nervous system depressant given to pets. It is also
used to prevent anxiety associated with thunder,
fireworks and vet or groomer visits.
Continued on page 12
[11] =>
[12] =>
12 DENTAL TRIBUNE Pakistan Edition March 2016
Feline dental implants: New
paradigm shift in maxillary....
Continued from page 04
General anesthesia was induced by
mask with Sevoflurane (vaporizer #7,
O2 @ 4L per minute; VetOne). Oral
tracheal intubation was completed and
anesthesia was maintained at vaporizer
The crestal gap between the implant
and socket was filled with Fusion
Bone Putty (Veterinary Transplant
Services (VTS), Kent, Wa.) to assist
in socket regeneration and to minimize
bone resorption.[3,4,5] A cover screw
was placed and the flap repositioned
to achieve primary closure with 5-0
Fig. 12: Closed tray impression
head placed onto implant to take
impression (bottom left) and healing
abutment in place (top right).
Fig. 13: Virtual cast with analog
created using digital scanning of
the soft-tissue model ready for
virtual design of the restoration.
Fig. 14: Completed CAD/CAM metal
abutment and zirconia crown (top) and
the abutment on the soft-tissue model
(bottom left) and with crown inserted
over the abutment (bottom right).
Fig. 15: Radiographs at abutment
placement.
Fig. 16: Completed restoration
seven months post-insertion
demonstrating a lack of soft-tissue
inflammation.
Fig. 17: Completed restoration
10 months post-insertion
demonstrating a lack of soft-tissue
inflammation.
setting #3, O2 1L/minute following
Feline Anesthetic Protocol (FAP).
A complete oral exam and digital PA
radiographs were obtained. A luxation
of tooth #104 and some mobility was
noted. Additionally, a widening of the
periodontal ligament space with a
vertical fracture of the incisive bone
at the diastema of teeth #s 103/104
was observed (Fig. 1).
A sulcular full thickness MP flap
was elevated to evaluate the alveolar
process of the maxillary bone. The
canine tooth (#104) was atraumatically
extracted to avoid any further damage
to the alveolar socket and surrounding
bone. Socket debridement was
performed and copious levage was
complete with 0.9 percent NaCl
(VetOne). The site was prepared to
accept a 5.0 x10 mm Engage implant
(OCO Biomedical, Albuquerque,
N.M.), which was subsequently placed
into the osteotomy and positioned
subcrestally with a final insertion
torque of 45 Ncm.
resorbable monofilament sutures
(Securos Surgical, Fiskdale, Mass.)
(Fig. 2). Recovery was uneventful and
the patient was discharged with postsurgical instructions the same day.
Clavimox (62.5 mg/ml @ 1ml bid)
(Zoetis, Florham Park, N.J.), a broadspectrum antibiotic, and
Buprenorphine (0.1 ml bid orally for
3-5 days) (Reckitt Benckiser
Healthcare, Parsippany, N.J.), an
opioid pain reliever, were dispensed
to the owner.
Uncovering and restoration phase
At six months post-insertion, the
patient was re-evaluated for soft-tissue
healing and osseointegration. FAP was
again utilized as in the surgical phase.
Dental radiographs were evaluated
and implant stability and integration
were determined to be adequate.
A tissue punch was used to expose
the implant head, preserving adequate
attached gingiva on the buccal. The
cover screw was removed and closed
tray implant impression abutment was
CLINICAL PRACTICE
placed (OCO Biomedical) and a
radiograph taken to verify proper
mating of the impression head to the
implant (Figs. 3a, 3b). Impressions
were fabricated with a fast set VPS
hand mix putty and a fast set light
body VPS impression material (Benco
Dental Supply, Tucson, Ariz.).
A transmucosal healing abutment
(OCO Biomedical) was placed to
insure proper emergence profile to
support the future prosthetic
components[6, 7] (Fig. 3c). The
impression was sent to the dental lab
(Doks Dental, Tucson, Ariz.), and a
soft-tissue stone model was fabricated
with analogs embedded within. The
planned prosthetic was waxed up for
a palladium implant restoration, which
would be luted into the implant
(Fig. 4).
At one-month post impressions, the
patient returned for delivery of the
implant restoration. FAP was again
utilized and the prostheses was tried
in and then was cemented into the
integrated implant utilizing a selfadhesive resin cement (BisCem, Bisco
Inc., Schaumburg, Ill.) (Fig. 5).
The 26-month follow-up demonstrated
excellent emergence profile and
implant stability with no evidence of
periimplantitis or soft-tissue
inflammation surrounding the implant
restoration (Figs. 6, 7).
Case report 2
A 14.3-year-old male neutered DLH
cat weighing 16.2 pounds presented
for an oral examination. Generalized
calculus and gingivitis was noted, as
well as multiple Feline Oral
Resorptive Lesions (FORL) and a
complicated crown fracture of the
right maxillary canine (#104).
Initial treatment options were
discussed with the owner, which
included scaling and root planing to
treat the generalized periodontal
condition and selective extractions
determined by the initial probing and
dental radiographs. The fractured
canine treatment would be discussed
after a complete oral examination and
radiographs were completed under a
general anesthesia. The right maxillary
canine (#104) fracture appeared to
have been present for a long period
with some definite buccal bone
changes related to the fracture.
Surgical phase
Patient was pre-medicated with
Atropine Sulphate (1/120 grain; .2 ml
subcutaneously) (VetOne) and
Acepromazine (10 mg/ml; .05 ml
subqutaneously) (VetOne). General
anesthesia was induced by mask with
Sevoflurane (Vaporizer #7 / O2 at
4L/minute) (VetOne). Oral tracheal
intubation was completed and
anesthesia was maintained at vaporizer
setting #3 / O2 at 1L/minute following
Feline Anesthetic Protocol (FAP).
A complete oral exam and dental
radiographs were obtained. Multiple
FORL were noted and charted. FORL
are common in cats and are similar to
cervical external resportive lesions in
humans. These teeth typically have a
poor prognosis and require extraction
to treat them. Selective surgical
extractions were successfully
completed while tension-free tissue
flaps were placed at the extraction
sites to achieve primary closure.
The right maxillary canine (#104)
had sustained a prior traumatic fracture
with pulp exposure. Definite buccal
enlargement consistent with alveolar
inflammation (osteitis) was present.
Radiographs confirmed the diagnosis
with secondary root changes evident
(Fig. 8). Endodontic treatment would
have been an option; however, the
root morphology and sclerotic canal
would be problematic.
As in Case 1, the owner elected to
extract the tooth and place an
immediate endosseous implant, if
possible, and wait four-to-six months
before a final restoration could be
placed. In many cases, the author is
placing immediate implants with the
future option of restoration utilizing
digital treatment planning. Using these
advanced computer-aided techniques
(extra-oral scanning and CAD/CAM
design and milling), final results have
proven to be exceptional compared to
the traditional methods of VPS
impression taking and wax-cast
restorations.
A coronectomy was made on the
right maxillary canine (#104) for easy
access of the tooth root. It is imperative
to remove the remaining root while
maintaining the buccal eminence. A
mini envelope flap was utilized to
maintain a good blood supply to the
crestal bone. A fine diamond burr
(#FG 703) (Benco Dental) in a highspeed water cooled drill was used to
detach the periodontal ligament,
making luxating and extraction a
simpler process with less risk of
alveolar fracture (Fig. 9a).
Examination of the socket was
performed and removal of any
inflammatory granulation tissue was
accomplished with a curette and
fissure burr. Socket measurements
(probing and radiograph) were
obtained and the site was prepared to
accept a 5.0 x10 mm Engage implant
(OCO Biomedical), which was
inserted subcrestally with a final
insertion torque of 50 Ncm (Figs. 9b,
9c). The crestal gaps between the
implant and osteotomy were
augmented with feline periomix, a
D F D B A p r o d u c t ( Ve t e r i n a r y
Transplant Service, Kent, Wa.), which
was rehydrated with 2 percent
Xylocaine with 1:50.000 epinephrine
(Dentsply, York, Pa.). Flap apposition
was made to achieve primary closure
with a combination of simple
interrupted and cruciate suture
patterns. Suture material was 5-0
Securocryl with a reverse cutting P3
needle (Securos Surgical, Fiskdale,
Mass.) (Fig. 9d).
Recovery was uneventful, and the
patient was discharged with
Continued on page 14
[13] =>
[14] =>
14 DENTAL TRIBUNE Pakistan Edition March 2016
Dental Science
WORKBOOK
launched
DT Pakistan Report
A R A C H I Preclinical, Dental
Sciences Workbook
has been introduced for dental
students in all JSMU affiliated
colleges.
The book is authored by the Dean, Faculty
of Dentistry & Head Department of Dental
Materials Science, Dr. Kefi Iqbal (PhD)
Sindh Institute of Oral Health Sciences,
Jinnah Sindh Medical University, Karachi.
K
2016 Customer
Service Award
K
ARACHIAlvi Dental
recently has been
awarded with 2016
Customer Service Award by
WhatClinic for excellence in
customer service.
WhatClinic is a healthcare
search engine which directs
patients across the globe in helping them
select their best healthcare provider. On
other hand Alvi Dental is one of the
healthcare unit that has been actively
providing full range of private, cosmetic
and specialist dental treatments in a relaxed
atmosphere and to the highest standards,
using the latest technology.
This award came after years of pleasant
interaction with patients to be appreciated
for best service in terms of treatment and
doctor patient relation.
Drap vows to clear 7,500 pending
cases by October
Continued from front page
With this achievement of
international standard on which the
DRAP was working, Pakistani
companies would be able to get
membership of Pharmaceuticals
Inspection Cooperation Scheme
(PICS) and the move would facilitate
such companies to easily acquire
registration in all the countries of
the world.
Moreover, this step would also
help increase figure of the country's
medicines’ export which, at present,
stood at Rs167 million against India's
Rs20 billion and Bangladesh’s Rs1.8
billion.
He said that after joining PICS not
only country's export would touch
the highest figure in export of
medicines, but local pharmaceutical
exporters, who were looking to
export their products to less explored
countries, would get success. He
said that PICS would endorse
Pakistani pharma companies as
reliable exporters of quality
medicine.
He said that under the 2015 drugs
pricing policy, the government had
strictly controlled the prices of drugs
with regard to hardship cases. Under
the policy, it was the prerogative of
the government to fix the prices of
those medicines that fall under
hardship regime.
He said there was a set procedure
to increase prices like submission
of request (certified data) with the
government by pharmaceutical
companies to raise prices as fixed
at ratio of 4 per cent to 6pc and up
to 8pc in accordance with Consumer
Price Index (CPI).
H o w e v e r, p h a r m a c e u t i c a l
companies, instead of waiting for
government's decision on their
submitted submissions, moved to
the court and got stay order, he
deplored.
at the University of Melbourne’s
Institute for a Broadband-Enabled
Society (now the Melbourne
Networked Society Institute) found
- Online
that more Editor
than half
of the participants
Haseeb Uddin
who had a visual examination over
the Internet were saved the trouble
of a trip to see a specialist face to
face.
Currently, Victoria has two other
teledentistry projects underway,
including one for paediatric patients
living in rural and remote areas, and
the other to test whether nurseadministered teledentistry
examinations would prove
acceptable to patients in residential
aged care facilities.
In the US, the American Dental
Association’s House of Delegates
issued a comprehensive policy
statement on teledentistry in
November 2015. The resolution
states that dental benefit plans and
other third-party payers should cover
services provided through
teledentistry at the same level as
services delivered in a traditional inperson encounter.
generally reported optimism and
support regarding the concept and
its integration into current dental
practices, more information on how
teledentistry could be of benefit
regarding specific practice issues is
needed in order to encourage dentists
to apply telemedicine in routine
practice, the researchers concluded.
The study, titled “Perceptions of
Australian dental practitioners about
using telemedicine in dental
practice”, was published online on
15 January in the British Dental
Journal.
Over the past several years, various
projects have tested the potential of
teledentistry services in Australia.
In 2015, a trial conducted by
researchers and technology experts
paradigm shift in maxillary....
Continued from page 12
postsurgical instructions the same
day. Clavimox (62.5 mg/ml for 1 ml
bid) (Zoetis) and Buprenorphine
(0.1ml bid orally for 3-5 days)
(Reckitt Benckiser Health Care)
were dispensed.
Uncovering and restoration phase
At five-months post-implant
placement, the patient returned for
the start of the restorative phase (Fig
10a). FAP was administered and
radiographs were obtained to verify
osseous integration (Fig. 11). A tissue
punch was utilized to expose the
cover screw, and it was removed
from the implant (Figs. 10b, 10c).
It is crucial to develop and maintain
healthy keratinized tissue at the
Technological innovation in
professional home bleaching....
Continued from page 07
from the patient: this is attributable
to both the time which is reduced
(two minutes a day) thanks to the
special accelerator XS 151 contained
in the hydrogen peroxide gel, which
activates while brushing, and its
portability, which means it can be
performed anywhere and not
exclusively at home, thanks to the
new pre-filled brush.
Acknowledgements
I would like to thank Micerium
S.p.A. for the kind collaboration and
for the material that was provided,
in particular Dr Eugenio Miceli for
his attention and availability.
I also thank my son Marco for
supporting me during my work with
his knowledge in the chemical and
pharmaceutical field, acquired with
his degree in CFT and the doctorate
at Madrid Conplutense University.
Assignment Book
explores dentists’ views on
for Community Study
teledentistry
Continued from page 04
Dentistry
Although dental practitioners Feline dental implants: New
ARACHI- Fatima
Jinnah Dental College
has introduced 1st
ever assignment book for
community dentistry.
The assignment book consists
of interactive charts and tables which not
only encourage students to put their efforts
in improving their knowledge but also
provide an insight for the lecturers to cover
important topics in their lectures.
The Assignment book is being produced
and compiled by Dr. Zubia Waqar, a
graduate of Fatima Jinnah Dental College
and Masters in Public Health from Anglia
Ruskin University. She is presently working
as an Assistant Professor in the Department
of Community & Preventive Dentistry at
Fatima Jinnah Dental College. -PR
K
healing abutment site. This KT will
minimize bone resorption and
inflammatory reaction around the
prosthetics.6, 7 A closed tray
impression coping was secured to
the implant (Fig. 12, bottom), and
VPS impressions were obtained. The
impression coping was removed
intraorally, and a healing abutment
was placed (OCO Biomedical) to
develop the tissue emergence profile
(Fig. 12, top).
The impressions were sent to the
dental lab (Precision Ceramics,
Montclair, Calif.), and a soft-tissue
stone model was created with the
implant analogs within the model.
The final restoration would be a
custom anodized abutment and solid
zirconia crown to be luted to the
abutment. The soft-tissue model was
digitally scanned and designed
virtually (Fig. 13). The abutment
was CAD/CAM milled, and then the
zirconia crown was milled to fit the
abutment (Fig. 14).
One month post-impressions, the
patient again returned for delivery
of the final components. Patient was
anesthetized with the same protocol
utilized at the prior appointments.
Radiographs were obtained to verify
the proper seating of the abutment
into the implant (Fig. 15). After
verification, the abutment screw was
hand tightened and checked with the
torque wrench for the manufacturer
recommended 30 Ncm. The zirconia
crown was cemented to the abutment
utilizing BisCem (Bisco Inc.), and
the prosthetics were complete.
The patient was seen for several
post-operative appointments. At 7and 10-month visits, photos
demonstrate exceptional results with
this paradigm shift in the treatment
of non-repairable fractured maxillary
cuspids in this cat (Figs. 16, 17).
Conclusion
Replacement of lost canines in
felines allows the animals to
maintain a better diet by helping
them to better masticate food. This
allows the animals to gain proper
nutrients from food, which helps
maximize overall health and
lifespan. Additionally, as the animals
are able to chew normally, the
authors believe they have a better
psychological well-being, leading
to a happier animal and overall better
quality, and ultimately, quantity of
life.
Digital treatment planning has
made a dramatic change in the way
dental implants can be incorporated
into our canine and our feline
patients. This provides easier
treatment by the practitioner yielding
a superior product as compared to
traditional methods previously
utilized as discussed in Case 1. As
with human patients, treatment
options need to be provided with the
animal's owner making the final,
informed decision on care to be
rendered.
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[title] => PDA - Shield & Dental Tribune join hands to reach over 25 - 000 patients
[page] => 01
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[1] => Array
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[title] => The new model of periodontal disease
[page] => 02
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[2] => Array
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[title] => Teeth may predict human evolution
[page] => 04
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[3] => Array
(
[title] => Technological innovation in professional home bleaching: The ENA White 2.0 system in only 2 minutes per day without tray
[page] => 06
)
[4] => Array
(
[title] => Feline dental implants: New paradigm shift in maxillary cuspid extraction treatment planning
[page] => 10
)
)
[toc_html] =>
Table of contents
-
PDA - Shield & Dental Tribune join hands to reach over 25 - 000 patients
01 - 04
view
-
The new model of periodontal disease
02 - 01
view
-
Teeth may predict human evolution
04 - 04
view
-
Technological innovation in professional home bleaching: The ENA White 2.0 system in only 2 minutes per day without tray
06 - 14
view
-
Feline dental implants: New paradigm shift in maxillary cuspid extraction treatment planning
10 - 14
view
[toc_titles] => PDA - Shield & Dental Tribune join hands to reach over 25 - 000 patients
/ The new model of periodontal disease
/ Teeth may predict human evolution
/ Technological innovation in professional home bleaching: The ENA White 2.0 system in only 2 minutes per day without tray
/ Feline dental implants: New paradigm shift in maxillary cuspid extraction treatment planning
[cached] => true
)