Oral cancer assuming epidemic proportion: Prof Sirajuddaula / PDA(K)office-bearers administered oath / The importance of brand and own reputation—from real daily life to the web / News / Advanced Restorative Techniques and the Full / Partial Mouth Reconstruction - Part 2 Occlusal Concepts / Clinical Management Approach of Molar Incisor Hypomineralisation. A case report
Oral cancer assuming epidemic proportion: Prof Sirajuddaula
01 - 14 viewPDA(K)office-bearers administered oath
01 - 14 viewThe importance of brand and own reputation—from real daily life to the web
02 - 12 viewNews
04 - 14 viewAdvanced Restorative Techniques and the Full / Partial Mouth Reconstruction - Part 2 Occlusal Concepts
06 - 07 viewClinical Management Approach of Molar Incisor Hypomineralisation. A case report
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[1] =>
PUBLISHED IN PAKISTAN
www.dental-tribune.com.pk
MAY, 2016 - Issue No. 03 Vol.3
Clinical Management
Approach of Molar Incisor
Hypomineralisation ...
The importance of brand
and own reputation ...
PRACTICE MANAGEMENT
Page 2
Editor - Online
Haseeb Uddin
CLINICAL PRACTICE
Page 10
3M expands efficient
bonding procedure...
BUSINESS
Page 12
Editor Online
Haseeb Uddin
PDA(K)office-bearers administered oath
DT Pakistan Report
K
ARACHI -The newlyelected office-bearers
of Pakistan Dental
Association's (PDA) Karachi
chapter were administered oath
at a simple but impressive
ceremony held here on Sunday
(May 29) at the DHA Club.
All the office-bearers of PDA,
Karachi were elected unopposed
and they were administered oath
by Dr Mahmood Shah, the
incumbent President of PDA's
Sindh chapter.
Felicitating the newly-elected
body, Dr Shah exhorted them to
work for the betterment of the
dental profession and community.
He appreciated the efforts of PDA
CC and the Election Commission
for holding free and fair elections.
Speaking on the occasion, PDA
Karachi chapter's president Dr
Abubakar Sheikh vowed to serve
the dental committee with the
assistance of his seniors, saying
guidance of seniors was a must
to make PDA more effective.
"My new panel decided to
contest the election for the
betterment of the profession
against all odds and even against
the wishes of the sitting PDA
(CC) President Prof Saqib
Rashid," he said, adding that the
new body will leave no stone
unturned in initiating educational
and other activities for the benefit
of dentists in Karachi. He then
introduced his team of newlyelected members who were
administered by the PDA Sindh
Chapter President, Dr Mahmood
Shah.
At the outset, he thanked all,
including the PDA CC, Election
Commission and then introduced
the newly-elected office-bearers.
They include Dr Syed Abrar
Ali (Vice President); Dr Shoaib
Khan (General Secretary),
Dr Murtaza Kazmi(Treasurer),
Continued on page 14
CM nominates top
candidate to head DUHS
DT Pakistan Report
K
ARACHI- Sindh Chief Minister Syed
Qaim Ali Shah on tuesday finally
surrendered his discretionary power to
nomainate a candidate os his choice for the position
of Dow University of Health Sciences (DUHS)
vice chancellor by recommending the one who
topped the list of candidates prepared by a search
committee.
The officials said the chief minister sent a
summary to Sindh Governor Dr Ishrat ul Ibad
with the recommendation to appoint Dr saeed
Quraishy as the new vice chancellor of the DUHS.
Dr quraishy had topped the list of 10 candidates
prepaerd by the search committee, the officials
added.
MENACE OF ‘GUTKA’, CHALIA
Oral cancer assuming epidemic proportion: Prof Sirajuddaula
DT Pakistan Report
K
ARACHI- Prominent pathologist Prof
Sirajuddaula Syed said here that oral cancer,
which is directly linked to ‘gutka’, ‘chalia’,
‘mainpuri’,‘panprag’, etc., is almost epidemic in
Karachi and other parts of Sindh.
Talking to Dental News, Prof Sirajuddaula, who
is associated with Ziauddin Medical University as
head of its Pathology department, said that betel
nut (chalia) is a heavily-infested with fungus i.e.
aspergillous flavus and it produces a chemical
known as afltoxin - an established cancer causing
element.
Recalling that in 2003, as many as 300 containers
of fungus-infested ‘chalia’ were imported from
Indonesia, Malaysia and Sri Lanka during the tenure
of former prime minister Shaukat Aziz, was seized
at Karachi Port by the then Collector of Customs,
Abdul Waheed Khan. Later, he (Prof Sirajuddaula)
along with a leader of PMA, Dr Sajjad Qasiser,
who is also a prominent ENT surgeon, visited the
port to check the consignment of a private importer.
They were taken aback when highly obnoxious
fumes came out from one of the containers. Later,
the Aga Khan University Lab and The Lab where
the samples of the imported ‘chalia’ were sent found
them infested with fungus.
Later, it was on the demand of the PMA, Karachi,
the Supreme Court ordered the consignment be sent
back to the country from where it was imported as
it was not fit for human consumption, but most
probably the importer of the ‘chalia’ using his
political clouts managed to get permission from the
then government for exporting the fungus-infested
chalia to Afghanistan via land route, he said. "Who
knows where it (fungus-infested chalia) landed as
it was supposed to be exported to
Afghanistan via land route," he quipped.
Elaborating, Prof Sirajuddaula said that as a matter
of fact even plain 'chalia' in any form is highly
injurious to heath as it contains carcinogen (a
substance that produces cancer) when mixed with
other hazardous item like artificial colour, chemical,
etc., and thus increases the chances of causing
serious diseases like oral cancer (mostly tongue,
cheek and lips), mouth ulcer, maggots in mouth,
submucous fibrosis, etc.
STATISTICS: Oral cancer is the second largest
cancer in Pakistan as around more than 55 per cent
of people are in the habit of chewing `pa'an', 'chalia',
'gutka', 'mainpuri', etc., and approximately 15 to
20pc of teenagers are suffering from oral submucous
fibrosis (OSMF or OSF), which is called precancerous disease.
The most deplorable thing about a patient suffering
from OSF is that he/she cannot open his/her mouth
completely because of loss of elasticity of oral
mucosa, burning of mouth during eating, some
patient only depend on liquid diets.
Talking about the hazards of OSF, he said that
it's a chronic, complex, rarely will it turn (1pc) to
a precancerous condition of the mouth characterized
by juxta-epithelial inflammatory reaction and
progressive progressive fibrosis of submuscosal
tissues (the lamina propria and deeper connective
Continued on page 14
[2] =>
2 DENTAL TRIBUNE Pakistan Edition March 2016
PRACTICE MANAGEMENT
The importance of brand and own reputation—from
real daily life to the web
By Richard H. Nagelberg, DDS
Editor Clinical Research:
Dr. Inayatullah Padhiar
W
e usually associate the term ‘brand’ with a
product that has a unique, consistent and wellrecognised character (i.e. Coca-Cola, BMW).
These brands conjure up images in the minds of consumers.
Large organisations work hard to raise the power and status
of their brands and guard them carefully against unlicensed
use or unfair imitation.
The American Marketing Association (AMA) defines a
brand as a “name, term, sign, symbol or design, or a
combination of them intended to identify the goods and
services of one seller or group of sellers and to differentiate
them from those of other sellers”.
Therefore, it makes sense to understand that branding is
not about getting your target market to choose you over
the competition, but it is about getting your prospects to
see you as the only one that provides a solution to their
problem. Looking out into the world today, it is easy to
see why brands are more important now than at any time
in the past 100 years. Brands are psychology and science
brought together as a promise mark, as opposed to a
trademark. Products have life cycles. Brands outlive
products. Brands convey a uniform quality, credibility and
experience. Brands are valuable. Many companies put the
value of their brand on their balance sheet.
Why? Well you do not have to look very far. In today’s
world, branding is more important than ever. But you
cannot simply build a brand like they did in the old days.
You need a cultural movement strategy to achieve kinetic
growth for your brand. With that, only the sky’s the limit.
What sells Chanel when it produces a cosmetic? A cream
or a dream of beauty? What does the Perugina brand sell
when it produces the ‘Bacio’? A chocolate or a feeling?
What sells Ferrari when it produces the 458: car or social
status? What sells Starbucks when opening its stores? A
coffee or a third place between home and work? The list
goes on with many examples. Branding is fundamental.
Branding is basic. Branding is essential. Building brands
builds incredible value for companies and corporations.
If you are still not convinced, let me give you another
example. The dollar is a world brand. In essence it is
simply a piece of paper. But branding has made it valuable.
All the tools of marketing and brand building have been
used to create its value. On the front you will find the
owner of the brand: the Federal Reserve. There is a
testimonial from the first President of the United States,
George Washington. There is a simple user’s guide: “This
note is legal tender for debts public and private”. And if
you are still not convinced, the owner has added the allimportant emotional message: “In God We Trust”. The
dollar is a world brand. It confers a uniform value globally.
But, as I said, it is really just a piece of paper. Branding
has made it worth something.
I mentioned earlier that brands are more important today
than in the past. There are a few reasons for this. Firstly,
the world has come online and there are many new markets
and a growing middle class in places such as India, China,
Brazil, Russia, South Africa, Nigeria, Indonesia and in
many more places. These consumers buy brands. They
buy premium brands. The best branding today is based on
a strong idea. The best brands have remarkable creativity
in advertising to help them break through people’s wall of
indifference to create brand heat and product lust. A case
in point is the recent turnaround of Chrysler and its reliance
on marketing and advertising. Or look at the reinvention
of Levis. A final example is a campaign by my own agency,
which has helped reenergise one of America’s great iconic
brands—Jim Beam.
Developing a corporate brand is important because a
positive brand image will give consumers, and other
interested stakeholders, confidence about the full range of
products and activities associated with a particular company.
Publisher/CEO
Syed Hashim A. Hasan
hashim@dental-tribune.com.pk
Editors Research & Public Health
Prof. Dr. Ayyaz Ali Khan
Editor - Online
Haseeb Uddin
Designing & Layouting
Sh. M. Sadiq Ali
Dental Tribune Pakistan
• Essence: A single, energising central idea; it is the
heartbeat of the organisation.
• Values: What the organisation believes in and stands
for.
• Personality: The traits and qualities that distinguish
your organisation as being different.
Behaviour: The actions associated with values and
personality.
• Relationships: The internal and external rules of
engagement.
• Value Proposition: The offer that is made to customers,
the point of difference and why it matters.
The sophisticated strategy is a cultural movement strategy.
I believe that building brands now requires a cultural
movement strategy as opposed to simply a brand building
strategy. A cultural movement strategy can accelerate your
brand’s rise to dominance. Once you have cultural
movement, you can do anything in a fragmenting media
environment, maximising the power of social media and
technology. The world has changed. We are now living in
the age of uprisings and movements. I have written about
how to build a brand in this new age in my new book
Uprising. These days, building brands has become a lot
less expensive and smart brands can take advantage of
new tools and rocket up there globally, very fast. A common
interpretation is that a brand is the promise that is made
to customers. Or, the brand is not what you say it is, but
what your customers say it is. While these views are
legitimate ways of helping to understand a brand, anactively-managed approach makes a brand more tangible
and provides it with structure. Company branding is the
most efficient way to show potential customers what your
business is about. It is reflected visually via the logo and
company design elements, as well as through verbiage in
marketing materials, slogans and informational copy.
According to Fast Company magazine, “The brand is a
promise of the value you’ll receive”.
In the face of the current economic challenges, it is worth
noting that brands do better in tough times compared to
unbranded products. Brands outlive product cycles. And
in these challenging times, there are still great brands being
built. Brand owners still recognise opportunity and their
brands will thrive in the years ahead.
No branding, no differentiation. No differentiation, no
long-term profitability. People do not have relationships
with products, they are loyal to brands. In a movement
strategy, brands have a purpose that people can get behind.
Brands can inspire millions of people to join a community.
Brands can rally people for or against something. Products
are one dimensional in a social media enabled world,
brands are Russian dolls, with many layers, tenents and
beliefs that can create great followings of people who find
them relevant. Brands can activate a passionate group of
people to do something like changing the world. Products
cannot really do that.
Brands have to contain:
• Uniqueness: utilise your branding to set yourself apart
from your competitors. To do this, analyse what you do
best and consider you target demographic. Use graphics
and word choices that clearly reflect your business to your
target audience, hence your brand. Use your branding to
deliver clear messages.
Continued on page 12
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Dental Tribune Pakistan cannot assume
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.
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[3] =>
[4] =>
NEWS
04 DENTAL TRIBUNE Pakistan Edition May 2016
Symptoms of sleep-disordered breathing, such as frequent snoring, apnoea and
choking, may lead to health problems if untreated, the researchers said
Dental lasers are predicted to grow at an accelerated pace over the next years
Parents not aware of risks associated Dental tourism and lasers to fuel
with persistent snoring in children growth of dental equipment market
G
OTHENBURG, SWEDEN:
Occasional snoring in
children is common and
often harmless. However, persistent
breathing disturbances during sleep
can result in an increased risk of
trouble concentrating, learning
difficulties and delayed growth,
experts say. A new study from the
Sahlgrenska Academy in Sweden has
now found that many parents
underestimate the negative effects that
the condition can have on their
children’s quality of sleep and life.
Examining the prevalence of snoring
and sleep apnoea in 754 children aged
11 and under, the researchers found
that 4.8 per cent experienced sleepdisordered breathing symptoms
several times a week. Despite
pronounced snoring, only 31 per cent
of these children had been in contact
with a health care provider regarding
their symptoms, the survey
established.
“The study shows that awareness is
low regarding the negative effects of
breathing disturbances during sleep
on children’s health and that most
parents are not aware that this is
something that should be investigated.
An obvious result of the study is that
we must consider how parents are
given information about the condition
and where they can seek help,” said
Dr Gunnhildur Gudnadottir from the
Department of Otorhinolaryngology
at the academy.
“Children with persistent snoring
often have a reduced quality of life.
In particular, this applies to children
who have sleep apnoea,” Gudnadottir
said. This is mainly due to the
condition affecting sleep quality,
which in turn can lead to daytime
tiredness, concentration and learning
difficulties, bedwetting and delayed
growth.
Since many parents do not seem to
be aware of the risks associated with
habitual snoring, the researchers
advised parents with children suffering
from severe recurrent snoring and
sleep apnoea to seek medical
evaluation.
The most common reason for
snoring in children is enlarged tonsils
or adenoids. In these cases, snoring
can often be resolved or reduced with
surgery. Other common causes are
anatomical, such as a small jaw or a
small airway that the child was born
with, or poorly integrated breathing
muscles that do not open the airway
enough during sleep.
The results of the study, titled
“Healthcare provider contact for
children with symptoms of sleepdisordered breathing: A population
survey”, was published in the March
issue of the Journal of Laryngology
and Otology. DT Sweden
A
LBANY, USA: Market
research company
Tr a n s p a r e n c y M a r k e t
Research has reported that the global
dental equipment market is expected
to reach US$7.6 billion by 2018, from
US$5.5 billion in 2011, growing at a
compound annual rate of 4.7 percent
from 2012 to 2018. Technological
innovations and increasing awareness
of dental hygiene are contributors to
the segment’s growth, but high initial
costs for dental equipment remain.
The report analyzes different types
of dental equipment, including dental
radiology equipment, systems and
parts, laboratory machines and
hygiene maintenance devices.
An earlier report by business
consulting firm Grand View Research
forecast that the market would reach
US$8.45 billion by 2020, equaling a
compound annual growth rate of 8.2
percent. Both reports linked the
demand for dental equipment with
surging dental tourism, increasing
popularity of cosmetic dental
treatment, and advancements in
diagnostic and treatment technologies.
Systems and parts remain the largest
product segment, followed by dental
radiology equipment. According to
both reports, dental lasers are
predicted to grow at an accelerated
pace owing to the increasing adoption
of minimally invasive surgical
procedures that remove dental decay
without harming the soft and hard
tissue. The growing ageing population
and the baby boomers are additional
factors for the rising demand for
dental procedures.
North America has traditionally led
the market for dental equipment,
while Asia Pacific has grown at a
faster rate. Increased demand for
dental instruments and technologies,
in combination with improving health
care infrastructure, will affect this
trend in the coming years. The growth
in patients travelling to Asia Pacific
and eastern Europe for cheaper dental
surgeries and implants will also affect
sales of dental equipment in these
regions.
The Transparency Market Research
report covers the financial figures,
business strategies, product portfolios
and recent developments of the major
companies operating in the global
dental equipment market, including
Carestream Dental, GC Corporation,
Henry Schein, Danaher Corporation,
DENTSPLY Sirona, Planmeca,
BIOLASE, Ivoclar Vivadent and Adec.
The full report is available for
purchase at www.transparencymarket
research.com/dental-devicesmarket.html.
The Grand View Research report
can be bought at www.grandviewre
search.com/industry-analysis/dentalequipment-market. DT USA
New X-ray imaging technique visualises teeth’s nanostructures
M
UNICH, GERMANY: With the help of a new computed tomography
(CT) method that is based on the scattering of X-rays, a team of
international researchers has been able to visualise nanostructures
in objects measuring just a few millimetres for the first time. To demonstrate
the potential of the technique, the researchers reconstructed the precise 3-D
orientation of collagen fibres in a piece of human tooth.
The new method, which was developed by a team of researchers from
Technische Universität München (TUM), the Charité hospital in Berlin, Lund
University and the Paul Scherrer Institute in Switzerland, utilises the scattering
of X-rays rather than their absorption.
Conventional CT methods calculate exactly one value, known as a voxel,
for each 3-D image point within an object. The advantage of the new technique
is that it assigns multiple values to each voxel, as the scattered light arrives
from various directions.
“Thanks to this additional information, we’re able to learn a great deal more
about the nanostructure of an
object than with conventional
CT methods. By indirectly
measuring scattered X-rays,
we can now visualise minute
structures that are too small for
direct spatial resolution,”
explained Prof. Franz Pfeiffer,
Representation of the orientation of collagen
fibres within a tooth sample. The new method
head of the Institute of
Biomedical Physics at TUM. makes it possible to visualise structures in the
nanometre range in millimetre-sized objects at
By combining 3-D
a high level of precisio
information from scattered Xrays with CT, the researchers were able to view clearly the 3-D orientation
of collagen fibres in a piece of human tooth measuring around 3 mm. In order
Continued on page 14
[5] =>
[6] =>
CLINICAL PRACTICE
6 DENTAL TRIBUNE Pakistan Edition May 2016
Advanced Restorative Techniques and the Full / Partial
Mouth Reconstruction - Part 2 Occlusal Concepts
By Prof. Paul Tipton, UK
Editor - Online
M
ThisUddin
has evolved into the five
of locating the transverse horizontal Haseeb
axis and transferring the recording principles of occlusion I embrace
to an articulator using a facebow. today:
Stuart became associated with the 1. RCP = ICP around RAP
Gnathological Society early and 2. Mutually protected occlusion
published the classic ‘Research 3. Anterior guidance
Report’ with McCollum in 1955. 4. No non-working side interferences
Their observations led to the 5. Posterior stability
The early gnathologists studied the
development of the principles of
mandibular movements, transverse recorded tracings made during
ost advanced restorative
dentistry techniques have
changed little over the last
20-30 years, including that of the full
mouth reconstruction. However, the
impact of new dental materials, such
as titanium and zirconia, has had a
major influence on aesthetic dentistry
and implantology during this time
period. As a result, the profession
Fig 1: Full face
pre-op view
Fig 2: ICP
Fig 3: Upper arch
pre-op
Fig 4: Facebow
recording
be discussions between groups as to
the exact definition of RAP, it is
generally accepted as a muscular
relaxed, reproducible and braced
position that is an area not a pinpoint
and can only be achieved with relaxed
musculature.
Placing the condyles with the correct
position and having immediate
disclusion (canine guidance and
Fig 5: Upper cast
front view
Fig 6: Upper cast
right-hand view
Fig 7: Upper cast
left-hand view
Fig 8: Lower study cast
Fig 9: Diagnostic waxing
front view
Fig 10: Diagnostic waxing
right-hand view
Fig 11: Diagnostic waxing
left-hand view
Fig 12: Lower wax-up
Fig 13: Prototypes types
upper arch
Fig 14: Prototypes lower arch
Fig 15: Upper prep guide
Fig 16: Lower prep guide
may have an over-reliance on new
materials rather than tried and tested
techniques.
Some fundamental techniques are
just as relevant today as they were
when I started my Master’s degree
in conservative dentistry at the
Eastman Dental Hospital in 1987.
During the course of this series of
articles on advanced restorative
techniques, some old techniques will
be revisited in light of today’s
aesthetic and restorative requirements
and some newer concepts will be
discussed in greater detail whilst
dealing with the overall topic of full
mouth reconstruction. This article
discusses the topic of occlusion and
occlusal concepts.
Gnathology
Stallard first coined the term
gnathology in 1924, defining it as the
science that relates to the anatomy,
histology, physiology and pathology
of the masticatory system. McCollum
formed the Gnathological Society in
1926 and is credited with the
discovery of the first positive method
horizontal axis, maxillomandibular
relationships, and an arcon-style
articulator that was designed to accept
the transfer of these occlusal records.
The goal was to truly capture
maxillomandibular relationships that
accurately reproduced border jaw
movements and which would then
allow the technician to produce the
most stable, functional and aesthetic
occlusal form for indirect cast
restorations. The registration of the
horizontal and sagittal movements of
patients was believed to allow the
maximum cusp height-fossae depth
with proper placement of ridges and
grooves to enhance stability, function
and aesthetics.
Fundamentals of gnathology
The fundamentals of gnathology
include the concepts of retruded axis
position (centric relation), anterior
guidance, occlusal vertical dimension,
the intercuspal design, and the
relationship of the determinants of
mandibular movements recorded
using complex instrumentation to the
occlusion in fixed prosthodontics.
mandibular movements. When the
mandible travels forward along the
sagittal plane it is considered a
protrusive excursion or protrusion.
Therefore, retrusion is the movement
toward the posterior; and it is the
most retruded physiologic relation of
the mandible to the maxilla to and
from which the individual can make
lateral movements that initially
defined retruded axis position (RAP)
or centric relation (CR) to the
gnathologist. Further investigations
led the gnathologists to believe that
mandibular (condylar) movements
are governed by the three axes of
rotation.
The concept of retruded axis
position evolved into a threedimensional position, resulting in its
description as the rearmost,
uppermost, and midmost (RUM)
position of the condyles in the glenoid
fossa. More recently, with the input
of anatomists and physiologists, the
concept has also included a bone
braced position slightly anterior to
the RUM position. Whilst there can
incisor guidance) upon movement
away from that position, with no
vertical or horizontal deflective
contacts is fundamental to
gnathology. Tooth wear is considered
pathological in gnathology and one
of its fundamental concepts is trying
to advance a dentition with minimal
wear.
Alternative occlusal concepts:
Pankey Mann Schuyler
As gnathology was evolving,
several competing occlusal concepts
and permutations were theorised,
such as the Pankey Mann Schuyler
(PMS) theory of occlusion. The
Pankey Mann Schuyler concepts
evolved out of an initial study group
headed by LD Pankey on the east
coast of America. Nomenclature was
different and included centre relation
(CR) instead of retruded axis position
(RAP); centre related occlusion
(CRO) instead of retruded contact
position (RCP) and centric occlusion
(CO) instead of inter-cuspal position
(ICP). Beyron, following his
observations on Australian Aborgines,
[7] =>
CLINICAL PRACTICE
suggested that uniform tooth contact
and resultant wear on several teeth
in lateral occlusion was a positive
and inevitable outcome. As a
modification of canine guidance, the
Pankey Mann Schuyler philosophy
in complete full mouth reconstruction
was to have simultaneous contacts
of the canine and posterior teeth in
the laterotrusive (working) excursion,
known as group function, and only
anterior teeth contact in the protrusive
excursive movement.
Schuyler further suggested that
incisal guidance without freedom of
movement from a centric related
May 2016 Pakistan Edition DENTAL TRIBUNE 7
related occlusion to centric occlusion,
should be incorporated into a
restoration by means of a post
restorative occlusal adjustment.
Dawson illustrates the ‘freedom in
centric’ concept within the lingual
concavity of the maxillary anterior
teeth. He redefines long centric as
‘freedom to close the mandible either
into centric relation or slightly
anterior to it without varying the
vertical dimension at the anterior
teeth’. Additionally, long centric
accommodated changes in head
position and postural closure (Mohl
position).
to adapt to various influences and
though, in the author’s opinion, the
concept of gnathology will produce
stable long-term results, some
patients may require more freedom
in their occlusion and the PMS
concepts are not to be dismissed in
these patients. Indeed, some PMS
concepts such as waxing-up the curve
of Spee and Monson prior to occlusal
rehabilitation are incorporated into
every day occlusal practice.
Case study
Patient A was referred to me for a
full mouth reconstruction and
aesthetic improvements to her smile
‘freedom in centric’ style approach
where initial guidance in both left
and right lateral excursions came
from posterior teeth until such time
as the canines contacted and then
took over as canine guidance. In
protrusion, a similar long centric was
established on posterior teeth so that
in protrusive movements the initial
guidance was from the posterior teeth
until such time as the incisors touched
and then took over the further smooth
protrusive movements. This was
achieved by using a fully adjustable
articulator to complete the
restorations (Figures 17 and 18).
Fig 17: Upper right restoration on
fully adjustable articulator
Fig 18: Upper left restoration on
fully adjustable articulator
Fig 19: Anterior crowns front view
Fig 20: Anterior crowns
right hand view
Fig 21: Anterior crowns
left hand view
Fig 22: Upper arch occlusal view
Fig 23: Upper right quadrant with
palatal ramps
Fig 24: Upper left quadrant
with palatal ramps
Fig 25: Intercuspal position
with no anterior contacts
Fig 26: Upper anteriors
occlusion (CRO) to a more anterior
tooth intercuspation (CO) will ‘lockin’ the posterior occlusion (long
centric).
The incisal guidance, along with
‘long centric’, is determined by the
distance from transverse horizontal
axis-centric relation and the normal
freedom of movement in the envelope
of function. This method requires
that the incisal guidance be
established and the mandibular
posterior buccal cusps be placed to
a height measured along the occlusal
plane as dictated by the curve of
Monson. The maxillary posterior
teeth are developed after the
completion of the mandibular
restorations as dictated by a wax
functionally generated path record.
The definitive restorations are
equilibrated into a centric relation
position with mandibular buccal
cusps onto a flattened fossae-marginal
ridge contact with ‘freedom in
centric’ anterior guidance and group
function in laterotrusive (working)
excursion.
Deflective contacts
Though 90% of natural dentitions
have a deflective occlusal contact or
an occlusal ‘prematurity’ between
centric related occlusion (CRO) and
centric occlusion (CO), it is usually
in the form of a slide that has both a
vertical and horizontal component
occurring in all three planes.
According to Ash and Ramfjord, the
horizontal ‘long centric’, from centric
Fig 27: Upper anteriors
final view
Gnathology versus PMS
Gnathologists believe that once the
condyles are positioned in retruded
axis position (centric relation), any
movement out of this position should
disocclude the posterior segment,
thus nullifying any horizontal cuspfossae area contact.
This belief, combined with the
immediate anterior disocclusion,
forms the basis of a mutually
protected occlusion and limits tooth
wear. The PMS occlusal scheme,
however, encourages multiple
occlusal contacts during lateral
movements (group function or wide
centre) and during protrusive
movements (long centric). This may
have the effect of increasing tooth
wear. It is, therefore, logical that the
PMS occlusal scheme recommends
that occlusal wear is physiological,
not pathological as suggested by
gnathologists. The task of adjusting
maximum intercuspation contacts in
two different positions on an
articulator may result in a lack of
precision in both positions. However,
the masticatory system has the ability
Fig 28: Lower anteriors
final view
Fig 29: Full face
final view
(Figures 1-3). Initial impressions,
facebow and jaw registration were
taken for mounted study models
(Figure 4). The study models showed
the degree of over-eruption of her
anterior segments and disturbances
to the occlusal plane (Figures 5-8).
Initial diagnostic waxing (Figures
9-12), prototypes (Figures 13 and 14)
and prep guides (Figures 15 and 16)
were completed using a lower curve
of Spee of a 4” radius (anatomical
average as recommended by the PMS
techniques).
Initial prototypes were placed with
large palatal ramps on the upper
anterior teeth to allow anterior tooth
contacts and thus an immediate
disclusion style of occlusal scheme
as recommended in the gnathological
approach.
During the course of the initial
preparation and prototypes and after
a period of stabilisation, the patient
was struggling to come to terms with
the palatal ramps from a speech and
comfort point of view.
The decision was made to change
the occlusal scheme to a PMS
Conclusions
The definitive anterior crowns were
made of Procera all ceramic (Nobel
Biocare) (Figures 19-21). The
posteriors were constructed of
traditional porcelain fused to metal
with large flat areas on the palatal
cusps for the establishment of both
‘long and wide centric’ (Figures 2224) as in the new intercuspal position
there were no anterior contacts
(Figure 25) due to loss of the palatal
ramps. The final aesthetic result can
be seen in Figures 26 to 29.
Occlusion and the various occlusal
concepts have caused – and continue
to cause – debate. Whilst the author
has been trained throughout his career
in the concepts of gnathology, there
is the recognition that other occlusal
concepts, such as PMS and bilateral
balance, may have a part to play in
treatment of some patients.
During the rest of this series, the
principles of gnathology will be used
in the treatment of the partial or full
mouth reconstruction.
Acknowledgements
For the writing of this article on
advanced restorative techniques, the
author would like to thank the
following people for their help:
Dr Ibrahim Hussain, BDS,
M.Med.Sci.Implantology – implant
surgeon Dr Andrew Watson, BDS,
MSc, specialist in endodontics
Mr Bradley Moore – dental
technician, ADS Laboratory,
Harrogate. DT UK
[8] =>
[9] =>
[10] =>
10 DENTAL TRIBUNE Pakistan Edition May 2016
Editor Online
CLINICAL PRACTICE
Clinical Management Approach of Molar Incisor
Hypomineralisation. A case report
Haseeb
Uddin
Fig. 1 (a, b, c, d & e). Showing a dislodged filling of 36. 16 yellowish brown hypomineralised lesions.
36 and46 large composite fillings.
By Dr. Shaikha Alraeesi, UAE & Dr. Manal Al
Halabi, UAE
Abstract
Molar incisor hypomineralisation (MIH) is a
relatively common dental defect that appears in first
permanent molars and incisors and varies in clinical
severity. The specific etiological factors remain
unclear. Inappropriate diagnosis can result in
mismanagement of the condition and results in early
loss of first permanent molars (FPM) in particular.
Therefore, the early identification of such condition
will allow early intervention including monitoring
and preventive interventions that might help in
remineralisation of the hypomineralised tooth
structure. These preventive measures can be
instituted as soon as affected surfaces are accessible
Clinical relevance statement
Failure of early diagnosis and dental management
in cases of Molar Incisor Hypomineralisation (MIH)
leads to rapid development of dental caries, increased
pulpal inflammation and continuous enamel as well
as restoration breakdown.
Objective statement
The reader should understand the Molar Incisor
Hypomineralisation (MIH) condition and the
availability of different management options of this
condition.
Introduction
Molar Incisor hypomineralisation (MIH) is a
developmentally derived dental defect that involves
hypomineralisation of 1 to 4 first permanent molars
(FPM), frequently associated with similarly affected
permanent incisors. The pattern of enamel defects
consists of asymmetric, well-demarcated defects
affecting the enamel of the FPMs and is associated
with similar defects in permanent incisors and
canines tips.1
~ Prevalence
Available modern clinical prevalence data for
MIH, mostly from Northern Europe, ranges from
3.6% to 25% and seems to differ between countries
and birth cohorts.2
~ An etiology
An etiology of this condition is poorly understood,
with many associated factors (including
environmental changes, breast feeding, respiratory
diseases, oxygen shortage of ameloblasts and high
fever diseases) but few proven causative agents.3
~ Clinical Features
Fairly large demarcated opacities, whitish-yellow
or yellowish-brown in colour that may or may not
be associated with post eruptive enamel breakdown.
Hypomineralised enamel can be soft, porous and
look like discoloured chalk or Old Dutch cheese.
Subsurface porosity leads to breakdown after
eruption, especially under occlusal forces, resulting
in exposed dentine and sensitivity.4
~ Management
Permanent molars affected by hypomineralisation
are prone to rapid development of dental caries and
repeated breakdown of restorations.
Fig. 2 (a, b & c). OPT radiograph showing: normal alveolar bone levels, a normally developing dentition, except
lower left third molar, E’s are near physiological exfoliation, more than 2/3 of the roots of 7’s are calcified, 46 RC
Fig. 3 (a, b, c, d & e). Immediate post- treatment completion images. All first permanents molar were restored with
SSCs. Good gingival health and oral hygiene were noted.
Fig. 4 (a & b). Bitewing radiographs taken 6 months post treatment completion .Radiographic finding, fully seated
crowns of all first permant molars with no progression of any pathological lesion underneath the SSC.
Therefore, careful planning is required, taking into
account patient’s age (behaviour management
issues), degree of crowding and co-operation.
Sensitivity of affected teeth plays a major role in
difficulty of achieving anaesthesia and thus
behavioural issues.
- Preventive
• Diet advice
• Higher fluoride toothpaste (at least 1450ppm F)
• Topical fluoride varnish
• Casein phopshpeptide-amorphous calcium
phosphate (CPP-ACP)
- Restorative:
• A small lesion can be treated with localized
composite, where the enamel is soft, or fissure
sealants, where the hardness of the enamel appears
no different from the unaffected enamel.
• GIC is recommended as dentine replacement or
as an interim restoration due the ease of placement,
fluoride release and chemical bonding.
• For extensive lesions with post-eruptive breakdown
especially if the cusps are involved, preformed
stainless steel crowns (SSCs) are preferred as
an effective medium-term restoration. SSCs can
preserve the FPM until cast restorations are
feasible. 5,6
- To save the tooth or not?
• The first decision in the management of the MIH
FPM is whether the tooth should be saved or not.
The decision to extract or restore will depend upon
a number of different factors, some of these being
the degree/extent of hypomineralisation, posteruptive breakdown, sensitivity, age and co-operation
of the patient, any developmentally absent teeth.
Consultation with an orthodontist is advised.
According to the Royal College of Surgeons of
England Guidelines for the Extraction of First
Permanent Molars in Children, the ideal timing of
first permanent molar extraction is between 8-10
years of age after the eruption of the lateral incisors
but before the eruption of the second permanent
molars and second premolars. Traditionally, for the
most optimum mesial movement of the second
permanent molar to occupy the place of the extracted
FPM and produce the best occlusal position, t it has
been suggested that the second permanent molar is
demonstrating radiographic evidence of calcification
in the root bifurcation.7
Case report
A ten-year-old patient (S.S) with no significant
medical history or allergies presented to the
Department of Paediatric Dentistry at Hamdan Bin
Mohammed College of Dental Medicine
(HBMCDM) in Dubai Healthcare City, Dubai
(UAE). Complaining of slight pain due to a
dislodged filling in her upper left region. Presently
the tooth is asymptomatic. The pain is described as
intermittent during the day, lasts for a while (hour
or less), does not stop her playing or affect her
sleep.
Detailed history was taken from the father. The
father reported that (S.S) had a significant number
of upper respiratory tract infections and tonsillitis
during early years of life.
Clinical and radiographic examination of (S.S)
revealed yellowish discoloration of the enamel on
the occlusal surfaces of 16 and 26. 26 presented
with a dislodged filling, 36 and 46 had big composite
fillings. The presentation of the FPM is consistent
with the diagnosis of molar incisor
hypomineralisation (MIH) without incisor
Continued on page 14
[11] =>
[12] =>
12 DENTAL TRIBUNE Pakistan Edition May 2016
BUSINESS
3M expands efficient bonding procedure
across bracket lines
S
aving time and simplifying procedures is
key to maintaining a profitable practice.
With the introduction of the APC Flash-Free
Adhesive Coated Appliance System in 2013,
orthodontists have seen the elimination of the flash
removal step from bracket bonding, saving
significant time without compromising bond
strength. When orthodontists said they wanted more
brackets available with this adhesive system, 3M
listened.
At the AAO’s 2016 Annual Session, 3M is
introducing Victory Series Low Profile Brackets
with APC Flash-Free Adhesive (available in
August), enabling this 3M line of best-selling
brackets to now offer best-in-class bonding
efficiency.
Victory Series Low Profile brackets with APC
Flash-Free Adhesive will join Clarity ADVANCED
Ceramic Brackets, the SmartClip SL3 and Clarity
SL Self-Ligating Appliance Systems and Victory
Series Superior Fit Buccal Tubes in offering
orthodontists advanced adhesive technology that
allows them to move directly from bracket
placement to bracket cure without removing
adhesive flash, according to the company.
Patients treated with 3M brackets that include
APC Flash-Free Adhesive also benefit from added
protection for tooth enamel and a quicker and easier
debonding appointment, the company said.
Further positioning orthodontists for productivity
and patient satisfaction, 3M will also introduce
enhancements to the SmartClip SL3 Self-Ligating
Appliance System, resulting in improved rotational
control and reduction in engagement and
disengagement forces, the company said.
By continuously incorporating user feedback,
3M is perfecting an arsenal of products that enhance
efficiency, improve the patient experience and
simplify procedures, according to the company.
“3M Oral Care offers unique and efficient
products that help orthodontists differentiate their
practices, grow case starts and enjoy clinical,
professional and personal success,” said James
Ingebrand, vice president and general manager, 3M
Oral Care. “Brilliant esthetics, expanded availability
of APC Flash-Free Adhesive and enhancements to
SmartClip SL3 Self-Ligating Brackets are just three
of the exciting reasons to visit the 3M exhibit at
the 2016 AAO Annual Session.”
At the AAO meeting, industry experts were
discussing their experience with 3M products, along
with tips and tricks for use, at the 3M booth. Topics
included Class II correction, esthetics, digital
orthodontics and lingual orthodontics, with experts
such as Dr. Lisa Alvetro, Dr. Moe Razavi, Dr. Shane
Langley, Dr. Adam Schulhof, Dr. Anoop Sondhi,
Dr. Bill Vogt, Dr. Neil Warshawsky and Dr. Robert
Waugh.
Orthodontists were encouraged to visit the booth
to experience the benefits of APC Flash-Free
Adhesive first hand and to try out 3M’s
patient-facing Paint Your Smile web app on a big
screen. DT USA
The importance of brand ...
Continued from Page 02
• Target Audience: done correctly, your brand
can assist you in getting a stronger foothold in
your niche market. Define your unique selling
position and consider methods to communicate
key messages to your desired audience. Use
specific images or phrases to encourage the feel
of inclusivity. Let them know the reason your
company exists and how it can fulfil their needs.
This can connect you to your target audience,
engage them and motivate them to buy.
• Emotional Connections: according to a 2010
study conducted by the world’s largest public
relations firm, Edelman, the Y Generation, also
known as the Millennials, consider brand
identification almost as important as religious
preference and ethnic background when defining
themselves online. The power of branding has
successfully melded into that of personal
identification and emotional connection.
• Message Delivery: having strong branding can
evoke trust from your niche market. This can
translate to your newsletters, emails and
advertisements garnering a greater response, hence
increasing sales. As people will already be vested
in your brand, they will be confident that they will
receive value for time spent reading your messages
or researching your product.
• Consistency: focus on your long-term branding
efforts to keep your business consistent. This
consistency should transcend messages, product
lines and audience appeal. It should enhance your
business, adding depth to your company’s presence.
This should allow you to grow and keep a loyal
following.
Many small organisations and start-ups neglect
spending necessary time thinking about their brand
in this broad sense and the impact it has on their
business. Let’s look at 10 reasons why digging
into your brand is important:
• Branding promotes recognition. People tend
to do business with companies they are familiar
with. If your branding is consistent and easy to
recognise, it can help people feel more at east
purchasing your products or services.
• Your brand helps set you apart from the
competition. In today’s global market, it is critical
to stand apart from the crowd. You are no longer
competing on a local stage, your organization now
competes in the global economy. How do you
stand out from the thousands or millions of similar
organisations around the world?
• Your brand tells people about your business
DNA. Your full brand experience, from the visual
elements like the logo to the way that your phones
are answered, tell your customer about the kind
of company that you are. Are all of these points
of entry telling the right story?
• Your brand provides motivation and direction
for your staff. A clear brand strategy provides
the clarity that your staff needs to be successful.
It tells them how to act, how to win, and how to
meet the organisation's goals.
• A strong brand generates referrals. People
love to tell others about the brands they like.
People wear brands, eat brands, listen to brands,
and they are constantly telling others about the
brands they love. On the flip side, you cannot tell
someone about a brand you cannot remember. A
strong brand is critical to generating referrals or
viral traffic.
A strong brand helps customers know what to
expect. A brand that is consistent and clear puts
the customer at ease, because they know exactly
what to expect each and every time they experience
the brand.
• Your brand represents you and your promise
to your customer. It is important to remember that
your brand represents you: you are the brand, your
staff is the brand, your marketing materials are
the brand. What do they say about you, and what
do they say about what you are going to deliver
(promise) to the customer?
• Your brand helps you create clarity and stay
focused. It is very easy to wonder around from
idea to idea with nothing to guide you—it does
not take long to be a long way from your original
goals or plans. A clear brand strategy helps you
stay focused on your mission and vision as an
organisation. Your brand can help you be strategic
and will guide your marketing efforts saving time
and money.
• Your brand helps you connect with your
customers emotionally. A good brand connects
with people at an emotional level, they feel good
when they buy the brand. Purchasing is an
emotional experience and having a strong brand
helps people feel good at an emotional level when
they engage with the company.
• A strong brand provides your business value.
A strong brand will provide value to your
organization well beyond your physical assets.
Think about the brands that you purchase from
(Coca-Cola, Wrangler, Apple, Perugina, Ferrari)—
are these companies really worth their equipment,
their products, their warehouses, or factories? No,
these companies are worth much more than their
physical assets; their brand has created a value
that far exceeds their physical value.
• Wrapping it up. The best branding is built on
a strong idea, an idea that you and your staff can
hold on to, can commit to, and can deliver upon.
Your brand needs to permeate your entire
organisation. When your organisation is clear on
the brand and can deliver on the promise of the
brand, you will see tremendous fruit while building
brand loyalty among your customer base.
But what does a dentist actually sell? Therapies
or trust? Improve the management of the dental
office by increasing the management control, the
Perceived Quality and Value Added, optimizing
costs, acquiring new patients and increasing the
strategic positioning of professional success.
Particular attention was dedicated to finding value
in being able to offer new therapeutic solutions,
especially in this economic, social and cultural
‘time of crisis’.
There are opportunities for growth in the dental
business through increased perception of quality
in presenting and managing the range of services
in the sphere of performance, even aesthetic, not
to mention the more traditional therapies. The
professionalism of the team of front office and
back office generate word of mouth and optimise
all investments in communication. To transfer the
Perceived Quality, needs new tools of
communication personal and professional. Climate
Analysis, Applied neuroscience, Web-Marketing
and motivational communication, are just some
of the methods. DT Italy
The APC Flash-Free Adhesive Coated
Appliance System
[13] =>
[14] =>
14 DENTAL TRIBUNE Pakistan Edition May 2016
PDA(K)office-bearers administered oath
Continued from front page
Dr Mohammad Ali (Joint Secretary), Dr Hassan
Mehdi (CME Chairman) and Dr Noorul
Wahab(President-Elect).
Executive Members are: Dr Atta-ur-Rehman, Dr
Mohammad Amin, Dr Rizwan Jouharand Dr Haroon
Ashraf.
Dr Rafia Burhan was also elected as executive
member of the PDA (Karachi) but later she tendered
her resignation due to some personal reasons.
Meanwhile, Dr Haroon Ashraf has been nominated
as media relations manager.
In his speech, President PDA Central Council Prof
Saqib Rashid commended the role of the election
commission in conducting the PDA (Karachi) polls
in a transparent manner despite facing challenges.
He congratulated the newly-elected office-bearers
of PDA Karachi and hoped that they will work hard
to bring positive changes for the betterment of the
profession.
Prominent, among those, who attended the ceremony
includedDr Kamran Vasfy, Dr Mumtaz Khan, Dr
Baqar Askary, Dr Shah Faisal, Dr Azfarand many
others.
The proceedings began with the recitation of the
Holy Quran by Dr Abbas Mehdi while Dr Shahper
Shahryar was master of the ceremony.
Later, the newly-elected body named Dental News
as its official media partner and announced that the
PDA, Karachi, will soon form a Women's Wing as
an initiative of its new president.
Sponsors were acknowledged on the occasion.
Oral cancer assuming epidemic proportion ...
Continued from front page
tissues). As the disease progresses, the jaws become
rigid to the point that the person is unable to open
the mouth. The condition is remotely linked to oral
cancers and is associated with areca nut or betel
quid chewing, a habit similar to tobacco chewing,
is practiced predominantly in Pakistan and some
other South Asian countries.
"Exposure to areca nut (Arecacatechu) containing
products with or without tobacco (ANCP/T) is
currently believed to lead to OSF in individuals with
genetic immunologic or nutritional predisposition
to the disease.
SYMPTOMS: In the initial phase of the disease,
the mucosa feels leathery with palpable fibrotic
bands. In the advanced stage the oral mucosa loses
its resiliency and becomes blanched and stiff. The
disease is believed to begin in the posterior part of
the oral cavity and gradually spread outward.
Other features of the disease include xerostomia,
recurrent ulceration, pain in the ear or deafness,
nasal intonation of voice, restriction of the movement
of the soft palate, a budlike shrunken uvula, thinning
and stiffening of the lips, pigmentation of the oral
mucosa, dryness of the mouth and burning sensation.
CAUSES: Dried products such as gutka, pa'an
masala have higher concentrations of areca nut and
appear to cause the disease. Other causes are
immunological diseases, extreme climatic conditions,
prolonged deficiency to iron and vitamins in the
diet.
TRETAMENT: Although biopsy screening is
necessary, it is not mandatory because most dentists
could visually examine the area and proceed with
the proper course of treatment.
New X-ray imaging technique ...
Continued from page 04
to do so, 1.4 million scatter images were taken and
then processed using a specially developed algorithm
that builds up a complete reconstruction.
“A sophisticated CT method is still more suitable
for examining large objects. However, our new checked for any discrepancy in each visit.
As S.S’s is considered to be of high caries risk
method makes it possible to visualise structures in
the nanometer range in millimeter-sized objects at status .She was kept on regular recall programme
this level of precision for the first time,” said Florian including recall visits and fluoride varnish application
Editor
- Online
every 3 months, radiographs every 6 months. See
Schaff, a PhD student at the institute and lead
author
Haseeb Uddin
Figures 3 (a, b, c, d & e).
of the paper.
The new imaging technique could be of interest Long Term Treatment Plan and Future
for the characterisation of not only biomaterials Considerations
such as bone and teeth, but also functional materials • Regular long-term diet monitoring and
such as fuel cell and battery components, the reinforcement of oral hygiene practices.
• Periodic review of the restorations with
researchers believe.
The results of the study were published online on radiographic assessment.
19 November in the Nature journal in an article • Review the first permanent molars status.
titled “Six-dimensional real and reciprocal space • Monitor eruption and development of dentition.
small-angle X-ray scattering tomography”. DT • Educate patient and parents about the poor longterm prognosis of first permanent molars these teeth
Germany
and available future treatment options.
Discussion
Clinical Management Approach ...
Children with MIH have higher treatment needs
Continued from page 10
involvement. The oral soft tissue appeared healthy and significant challenges in behaviour management
with fair oral hygiene, microdontia of upper lateral than other children. S.S was a quiet girl who was
incisors (peg shaped), with Stained fissures of lower apprehensive in the beginning of the dental treatment
but willing to have the treatment. S.S was diagnosed
primary molars.
Radiographic investigations were done including as MIH in first permanent molars. Using non(OPT and PA radiographs) to assess the proximity pharmacological behaviour management techniques
of the coronal defect to the pulp and to evaluate the including tell-show-do, distraction helped to
periapical region and to ascertain the presence and acclimatize S.S to dental treatment. These techniques
stage of development of remaining permanent are widely used in children’s dentistry and well
dentition (especially lower 7s, 5s and 8s). accepted by parents. The technique works well
MIH was diagnosed based on clinical appearance. combined with behaviour shaping. S.S was rewarded
See Figures 1 (a, b, c, d & e) for clinical features. with a gift after each appointment as positive
Figures 2 (a, b & c) for radiographic findings. reinforcement for her good behaviour and
A diagnostic list and treatment plan was formulated cooperation.
26 was temporized with glass ionomer to relief
by a specialist of Paediatric dentist as well as
orthodontist and explained in detailed to the father. discomfort, stabilize the situation and to reduce
bacterial count present in the oral cavity.
Diagnostic Summary
Failure of achieving complete anaesthesia of first
A fit and healthy 10-year-old girl in the late mixed
dentition with molar incisor hypomineralisation permanent molars was related to the nature of MIH.
(MIH). MIH was diagnosed based on clinical S.S received supplemental intralegmental infiltration.
The innervations density in the pulp of
appearance.
hypomineralised molars is significantly greater than
Aims and objectives of treatment
of normal molars. This can explain why lower left
• To alleviate the pain and sensitivity.
• To preserve the structure of the weakened FPMs. 6 was hard to be anaesthetised.
Due to poor quality of the FPM teeth of S.S and
• To formulate an individualized realistic preventive
significant tooth break down full coverage by
scheme and reinforce it regularly.
• To monitor the occlusion of developing dentition preformed metal crowns was done. Preformed metal
crowns prevent further tooth loss, control sensitivity,
and treat as necessary.
• Maintain good oral health in the long term. establish correct interproximal and proper occlusal
contacts, are not costly and require little time to
Treatment Plan
prepare and insert.
Short /medium term
Conclusions
• Emergency phase
• The presence of MIH molars not only requires the
o Sedative filling of 26
dentist to identify problems at the earliest
• Preventive care phase
opportunity, but also to clarify the problem
o Oral hygiene instructions
thoroughly and explain the treatment options to the
o Diet analysis and advice
parents and child.
o Plaque score
• It is advisable to consider children with a poor
o Fluoride advice
general health in the first four years after birth at
• Restorative treatment phase
o Stainless steel crowns for all permanent first molars risk for MIH. These children should be monitored
more frequently during eruption of the first
• Recall and reviews
o Regular recall 3 months, radiographs every 6 permanent molars.
months and fluoride varnish application every 3 • Whilst many potential approaches exist for the
restorative management of molar incisor
months
hypomineralisation, few are yet supported by good
Medium / long term
• Monitor the eruption of permanent dentition quality clinical research data. Preformed Metal
crowns have been recommended as the prosthesis
• Interdisciplinary management
of choice in MIH afflicted posterior teeth with postTreatment
The treatment plan was set in two phases including eruptive enamel breakdown in majority of the
Short/Medium term and long term. The short term literature available.
will start with Emergency phase for restoring the • The use of nitrous oxide inhalation sedation can
26 with GI as a temporary filling. An extensive be a useful adjunct in obtaining satisfactory analgesia
preventive programme was implemented to improve in MIH patients. Nitrous oxide was not used in the
SS’s oral hygiene in addition to diet assessment, case of S.S. due to parental refusal because of limited
analysis, and advice and fluoride application. In financial resources.
several visit crown preparation was done under local • Had this patient presented earlier, consideration
anesthesia for 36, 46, 16, and 26 followed by stainless for enforced extraction of FPM would have been
steel crown placement. Patient’s occlusion was considered. DT UAE
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[cover] => ![DT Pakistan No. 3, 2016]()
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[title] => Oral cancer assuming epidemic proportion: Prof Sirajuddaula
[page] => 01
)
[1] => Array
(
[title] => PDA(K)office-bearers administered oath
[page] => 01
)
[2] => Array
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[title] => The importance of brand and own reputation—from real daily life to the web
[page] => 02
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[3] => Array
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[title] => News
[page] => 04
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[4] => Array
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[title] => Advanced Restorative Techniques and the Full / Partial Mouth Reconstruction - Part 2 Occlusal Concepts
[page] => 06
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[title] => Clinical Management Approach of Molar Incisor Hypomineralisation. A case report
[page] => 10
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Table of contents
-
Oral cancer assuming epidemic proportion: Prof Sirajuddaula
01 - 14
view
-
PDA(K)office-bearers administered oath
01 - 14
view
-
The importance of brand and own reputation—from real daily life to the web
02 - 12
view
-
News
04 - 14
view
-
Advanced Restorative Techniques and the Full / Partial Mouth Reconstruction - Part 2 Occlusal Concepts
06 - 07
view
-
Clinical Management Approach of Molar Incisor Hypomineralisation. A case report
10 - 14
view
[toc_titles] => Oral cancer assuming epidemic proportion: Prof Sirajuddaula
/ PDA(K)office-bearers administered oath
/ The importance of brand and own reputation—from real daily life to the web
/ News
/ Advanced Restorative Techniques and the Full / Partial Mouth Reconstruction - Part 2 Occlusal Concepts
/ Clinical Management Approach of Molar Incisor Hypomineralisation. A case report
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