DT Pakistan No. 3, 2018

News / Clinical Endodontics / Clinical Orthodontics

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PUBLISHED IN PAKISTAN

NEWS

www.dental-tribune.com.pk

Over Rs. 96 Billion
Earmarked for
Health Sector

Page 2

MAY, 2018 - Issue No. 03 Vol.5

The effect of partial
vacuum on the
chemical ...

CLINICAL ENDODONTICS

Page 6

3D Endo Software,
glide path
management and ...

CLINICAL ENDODONTICS

40th APDC held in Manila

PDA President
Elected in Manila
DT Pakistan Report

DT Pakistan Report

ANILA - The 40th Asia
Pacific Dental Congress
(APDC) was held at the
SMX Convention Center in Manila,
Philippines, from 7-11 May. It was
held concurrently with the 109th
Philippine Dental Association Annual
Convention & Scientific Meeting,
gathering the region's dental
practitioners, researchers and allied
health professionals.
Pakistan delegation led by Dr
Mahmood Shah President (PDA)
included Dr Asif Arain and Dr Anwar
Saeed. Dr Asif Arain was elected for
the 6th time as Vice President APDF
a real honour for him and Pakistan.
Dr Mahmood Shah also won his
chairmanship of oral diseases
commission while Dr Anwar Saeed
could not retain his slot.
Pakistan Dental Association was
given a rare honour of presenting the
awards with the host country. The
PDA delegation also presented life
time achievement awards to the

Page 8

distinguished members of APDF who
have served the association over the
years for the services rendered.
The congress has dental science and
technology at the forefront in line
with the the rapid advances in dental
materials and technology are
benefiting patients, as well as
practices, with the knowledge and
technology required to offer advanced
treatment options such as laser,
aesthetic, digital and implant dentistry.

The theme "Intensifying
professionalism in synergy with dental
science and technology" compliments
the fact that participants will be able
to discuss the scientific and technical
breakthroughs that are changing the
landscape of dentistry, and fulfill their
continuing education and professional
development requirements.
"Our theme for this year aptly
describes, how we as dental
Continued on Page 15

ANILA
Dr
Mahmood Shah, PDA
President, was elected
as Chairman of
Oral Diseases
Commission,
Asia Pacific
D e n t a l
Federation
(APDF) at
APDF Elections held during 40th
APDC in Manila, Philippines.
13 Countries voted in favour of
Dr Mahmood Shah, whereas his
rival Dr Chow Kaifoo (from
Malaysia) could only get 7 votes.
This is Dr Mahmood Shah's
third consecutive victory as
elected Chairman of Oral
Diseases Commission, APDF.
Previously, he had defeated
candidates from Sri Lanka and
Philippines.
Dr Asif Niaz Arain was also
re-elected as Vice President,
APDF.

PDA (CC) invited to
Sindh Assembly
DT Pakistan Report

ARACHI - A delegation of Pakistan Dental Association
(CC) office bearers and council members was invited
to the Sindh Assembly by the honourable speaker Agha
Siraj Durrani. The delegation led by Dr Mahmood Shah Presdient
PDA (CC) and accompanied by all the office bearers and council
members.
Dr Mahmood Shah was presented with Sindh Assembly Shield
and the entire delegation was accorded a VIP Protocol. The

delegation was given cultural gifts including Ajrak and Topi. The delegation on the
invitation of the speaker witnessed the assembly session as well.
During this high profile visit, matters related to promotion of Oral Health were discussed.
It was also discussed that a Sindh Dental Act should be enacted for which PDA has
started working.
This is the first time that PDA members were invited to the Sindh Assembly as a
delegation.

[2] => Dt pages.FH10

NEWS

2 DENTAL TRIBUNE Pakistan Edition May 2018
SINDH BUDGET 2018-19

Over Rs. 96 Billion Earmarked
for Health Sector
DT Pakistan Report

K

ARACHI
Sindh
Government has allocated Rs
96.38 billion for the Health
Sector in the budget for financial year
2018-19.
"Apart from rupees 12.2 billion for
non-development side, rupees 12.50
billion have been allocated in the head
of development," Sindh Chief Minister
Syed Murad Ali Shah, said at the Sindh
Assembly, while presenting the budget.
He further said that, new schemes
within the health sector would be
accommodated under the provision of
Rs 50 billion.
Shah also elaborated his
government's performance in 201718, highlighting 68 new uplift schemes
of Rs 5.12 billion, including RHCs,
Trauma-Emergency Centers and
construction of warehouses at all

divisional HQRs for cold storage
facility; four schemes of up-gradation
of RHC, to THQ Hospitals and
establishment of Cancer Ward at
NIMRA, Jamshoro at the cost of Rs
1.086 billion.
EPI operational budget under Sindh
Immunization Support Program
increased from Rs 100 million to Rs
1.80 billion while expansion of 2160
LHWs at a cost of Rs 982.31 million
in addition to 1063 LHWs under Thar
Package.
He acknowledged the services
rendered by National Institute of
Cardiovascular Diseases (NICVD)
which is the biggest center for the
treatment of heart attack and primary
angioplasty in the world. Currently, 6
chest pain units are functional in
Karachi and 60 more such chest pain
units will be installed in different areas

Publisher/CEO
Syed Hashim A. Hasan
hashim@dental-tribune.com.pk
Editor Clinical Research
Dr. Inayatullah Padhiar

of the province. NICVD satellite
centers are present in Tando
Muhammad Khan, Larkana,
Hyderabad and Sehwan, in
collaboration with the Government of
Sindh. Soon, 3 more NICVD centers
will be made functional at Nawabshah,
Khairpur and Mithi in the year 2018.
Grant for NICVD has been enhanced
from Rs 5.769 billion to Rs 8.094
billion for next financial year.
Initiatives under PPP: Murad Shah
said that 1,213 health facilities have
been outsourced on performance based
management contract, which include
1,049 facilities to PPHI and 158
facilities outsourced to some other
NGOs (108 Integrated Health Services,
35 HANDS, 01 Indus Hospital, 13
Medical Emergency Relief
Foundation, 01 Poverty Eradication
Continued on Page 15
Initiative.)

Editors Research & Public Health
Prof. Dr. Ayyaz Ali Khan
Editor - Online
Haseeb Uddin
Designing & Layout
Sh. M. Sadiq Ali

Dental Tribune Pakistan

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Tel.: +92 21 35378440-2 | Fax: +92 21 35836940
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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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Publisher/President/CEO

Torsten R. Oemus

Chief Financial Officer

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Yvonne Bachmann

Clinical Editors

Nathalie Schüller
Magda Wojtkiewicz

Editor & Social Media Manager Monique Mehler

PDA Plaque to APDF Secretary General,
Dr Oliver Hennedige

PDA Plaque to APDC Chairman,
PDA Plaque to APDF President,
PDA Plaque to ICCDE President,
Dr Villareal (Philippines)
Dr Fernando Fernandez (Philippines) Dr Jeffrey Tsang (Hong Kong)

PDA Gives International Awards
in Manila APDC

DT Pakistan Report

P

akistan Dental Association was given a unique honour at the 40th APDC in
Manila where Asia-Pacific Dental Federation and Philippines Dental Association
accepted PDA President Dr Mahmood Shah's request of giving PDA Life Time
Achievement Awards to International Dental Stalwarts, at the Gala Night of 40th
APDC. Dr Mahmood Shah, PDA President, gave 05 Life Time Achievement Awards
to FDI, APDF, ICCDE Presidents, APDF Secretary General and APDC Chairman.
A special Humanity Award was presented to Prof Dr S.M. Balaji in recognition of

Kasper Mussche
Brendan Day

Junior Editors

Franziska Beier
Luke Gribble

Copy Editors

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Junior Business Development
& Marketing

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PDA Plaque to
Prof Dr S.M. BalajI (India)
his outstanding contributions
in Cranio-Facial Surgery. Prof
Dr Balaji provided free
treatment, airfare, boarding and
lodging for poor patients from
Pakistan seeking treatment in
Chennai, India.

PDA Plaque to FDI President, Dr Kathryn Kell (USA)

Editors

Executive Producer

Gernot Meyer

Advertising Disposition

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©2018, Dental Tribune International GmbH.
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publishers also do not assume responsibility for
product names or claims, or statements made by
advertisers. Opinions expressed by authors are their
own and may not reflect those of Dental Tribune
International.

[3] => Dt pages.FH10

[4] => Dt pages.FH10

NEWS

4 DENTAL TRIBUNE Pakistan Edition May 2018

ICDHonouring the worlds
leading dentists since 1920
By Nathalie Schüller

T

he International College of
Dentists (ICD) will celebrate
its centennial in 2020. The ICD
is the oldest and largest honour society
for dentists in the world and was
conceived by Drs Louis Ottofy and
Tsurukichi Okumura with the vision to
start an organisation of outstanding
dentists to maintain professional
collegiality and friendship, monitor and
evaluate the progress of dentistry
internationally, and disseminate such
information to dentists worldwide.
Today, the ICD has 12,000 fellows
in 122 affiliated countries, from a
diversity of cultures and social
backgrounds and with different
professional experiences. It aims to
recognise their outstanding
contributions to the dental profession
in upholding the college core values of
leadership,
recognition,
humanitarianism, education and
professional relations. On behalf of
Dental Tribune Online, I had the
pleasure of speaking with Dr Dov
Sydney, the International Editor and
Director of Communications, as well
as the Chair of the College Centennial
Committee.
Dr Sydney, tell me how and why you
became involved in the ICD.
It was in a manner very typical of the
ICD. I had a patient who was a dentist
and told me about the voluntary work
he was doing for an ICD clinic for blind
people. I had no idea then what the
ICD was about. He told me more about
the ICD and asked whether I would
like to become involved in the clinic
to help the patients, and based on my
background and CV, said he would like
to nominate me to become a fellow.
That was in 1996 and I was proud to
agree. I was active in the Israel District
and then moved to the European
Section board as regent, editor and
website manager. Later, I was asked to
serve on the worldwide executive of
the organisation as the International
Editor and Director of Communications
for the ICD.
While our organisation is focused on
improving access and quality of oral
health, we are also a professional
society of shared interests and values,
so there is also the meaningful
fellowship and camaraderie aspect: we
meet at regional and international levels
for both serious discussions and social
events. This is a unique group in which
there is the absence of an atmosphere
of competition and the need to show
how successful one is or how many
papers one has published. This is
uncommon in many professional
associations. I feel everybody is aware
of and appreciates this unique aspect
of the ICD. The ICD promotes a
collaborative, sharing relationship
guided by the universal principle that
all members are equals regardless of

their national origin, culture or
language.
Are all potential members nominated
by fellows?
Yes, one has to be nominated by two
fellows in good standing. Lets say a
candidate lives in Germany. Two
members of the college would have to
recommend the person to the German
District committee, who, following the
recommendation from the credential
review committee, would pass the
recommendation on to the full European
Section board (consisting of all 35
European member countries) for a vote
on the nomination. The decision would
then passed on to the ICD world
headquarters for completion of the
process and preparation of certificates.
So, the process does take time, but that
is to ensure thorough scrutiny of
requirements and documentation
inherent in the peer-review procedures.
What is the basic requirement to be
nominated? Are accomplishments in
dentistry, humanitarian work or both
required?
Nominees have to have made major
contributions to dentistry in more than
one of the following areas:
academia/teaching, research,
humanitarian programmes, leadership
or service projects. In other words, they
must have had a significant impact on
dentistry and society.
What is your major joy, your main
motivation, in being part of the ICD?
As the International Editor and
Director of Communications, I see all
of the reports and images of ICD events
and projects that take place around the
world.
I have to select the ones that will appear
online and in our journal. That is why
I sent you a photo of the 2015 issue of
The Globe, the ICD journal. In this
photo, one can truly see the kind of
impact so many of our projects have
on the people who are the recipients of
ICD compassion and dedication. It is
evident in their eyesa palpable image
of someones unselfishness, caring for
another human being, some receiving
care for the very first time in their lives.
Is dental care the main thing we
should worry about in parts of the
world that are so destitute?
Oral disease is usually treatable, often
preventable, and yet if one has a bad
toothache, one cannot function; if one
loses ones teeth, one cannot eat. In
many parts of the world where nutrition
is poor, without functional teeth to eat
properly and digest food, overall health
is affected. Furthermore, there are
places in the world where dental
infections are so neglected and serious
that they can lead to major disease states
and even death.
Another strength of the ICD is that
we look at the overall impact of our
projects on the community. I recall
reporting on a group that went to Nepal

to help children in great need of dental
care. When the team arrived, they
encountered unexpected problems. The
community was suffering from mass
diarrhoea, a major disease in the Third
World. People can become extremely
ill and die from not having access to
clean running water. The water used to
brush the childrens teeth was
contaminated. The team developed a
programme to bring running water into
the village for toilets and sinks for
toothbrushing. The rate of diarrhoea
went from 75 per cent to 5 per cent.
Children were able to go back to school.
The adults could work. This is a good
example of how ICD dental projects
can have a major impact on a
community and the overall health of
the project sites population.
How are ICD projects initiated?
There are many kinds of projects.
Some are directly funded through the
ICDs Global Visionary Fund. Also,
there are 15 sections of the college and
they have their own foundations or
funds to initiate their own projects.
Many fellows are also involved in
individual ICD projects. Soon, we will
be introducing an interactive map of
hundreds of projects on our website
where a visitor can see educational
projects, student exchange programmes,
humanitarian missions and more. We
currently have a major programme on
antibiotic resistance owing to the fact
that antibiotics today are becoming less
and less effective. We work with the
Centers for Disease Control and
Prevention in Atlanta in the US and the
World Health Organization to put on
programmes teaching dentists how to
deal with antibiotic resistance. We also
provide programmes on sepsis and
sterilisation.
2020 will mark the 100-year
anniversary of the ICD. What are the
changes, progress and developments
you are the happiest about today?
The fact that we grew from a concept
first established by a Japanese dentist
and an American dentist meeting a 100
years ago endeavouring to have an
international organisation to today, with
the largest footprint of any dental
honour society in the world, says a
great deal. The integrity of the
organisation throughout our 100 years
in recognising those dentists who truly
demonstrate having made major
contributions to dentistry and society
has been consistent. We are not a very
well-known organisation; in fact, many
dentists are unaware of the ICD. We
realise that, in order to honour our motto
of recognizing service as well as the
opportunity to serve and to be true to
the vision of our founding fathers, we
do have to make ourselves better known
in order to ensure that deserving dentists
are recognised by the college.
The centennial is a watershed
moment for the college and validates

FDI President Dr Kathryn Kell and Philips CEO of Business Group
Health and Wellness Taiwans Minister of Health Chen
Shih-Chung (left), with Dr Dov Sydney (right), at the kick off
to the Centennial campaign. Sinéad Kwant

that the ICD core values are sustainable
and worthy. The projects, the
organisation and the dedication of our
members to improving oral health care
are only possible because our fellows
deeply believe in what they are doing;
had they not, the ICD would have
disappeared long ago.
I remember a dentist who once told
me he needed to do what he wanted
and stay true to himself. Therefore,
he did not want sponsors because he
wanted to stay objective and not want
to feel he had to promote a company
or a product and in doing so lose a
bit of his independence, not be able
to give the message he wanted to give.
In financing all these projects, your
collaborations with companies, can
you still stay independent and choose
what is the best in keeping with the
ICDs values?
We have various levels of
sponsorship. We collaborate with
companies like Henry Schein, Modern
Dental Group, Dentsply Sirona,
Spident, Hu-Friedy and EMS, as well
as organisations like the International
Congress of Oral Implantologists, that
provide us with their generous support.
When we take on a sponsor, it is not as
an advertiser, but as a partner in a
strategic alliance of shared values. That
alliance has various parameters and
mutual responsibilities that create a
unique symbiotic relationship between
the college and our corporate sponsors.
What do you think are the major
challenges facing the college today?
All major organisations in dentistry
are seeking new members. Some have
little or no oversight or require little, if
any, performance evidence as a
prerequisite to membership, unlike the
ICD, whose requirements are
considered of the most stringent of all
recognition-based international dental
honour societies. Quite frankly, some
try to imitate how the ICD operates,
and why not? The ICD is in the enviable
and unique position of having recorded
sustained membership growth for the
last ten years. We have a strong and
consistent contact relationship with our
members by focusing on meeting
fellows needs, staying relevant and
consistently seeking out new and
innovative methods to enhance our
communications and connection with
them.
But, with the constant bombardment
of information via the Internet and emails, there are many challenges and
media competition for our members
attention. We are meeting those
challenges with innovative
communication packaging, but its a
constant and unending endeavour.
Continued on page 15

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CLINICAL ENDODONTICS

6 DENTAL TRIBUNE Pakistan Edition May 2018

The effect of partial vacuum on the chemical
preparation of the root canal system
By Dr. Philippe Sleiman

F

rom the early 20th century,
when Walter Hess and Ernest
Zürcher demonstrated root
canal anatomy with an unprecedented
visual clarity, its complexity has
fascinated researchers armed with ever
better imaging toolsfrom blue dyes
to CT, from CBCT to confocal
microscopy, from clear tooth
preparations to micro-CT , to name
just a few. Thanks to rigorous research
and discussion, the diverse intricacy
of root canal morphology is well
understood and accepted today.
However, the question of how to best
prepare this space to restore
homeostasis remains open to debate,
which is conducted both in the
scientific and, unfortunately,
commercial domains. Our task as
scholars and clinicians is to investigate
which approaches would be practical
and applicable to bring teeth and
periodontium back to health in

a standardised sequence of irrigation.
While various tools for irrigation and
activation of solutions were studied
extensively, the first sequence was
suggested only in 2005, and it made
clinicians aware that alternating
solutions could be as beneficial as the
use of negative pressure in order to
achieve a clean root canal space and
diminish postoperative pain.
Below you will find descriptions
and outcomes of several studies that
led to a suggested protocol of irrigation
that is presented in the conclusion of
the present publication.
Investigating irrigation today
The fact that during root canal
shaping the system may get blocked
by debris led to the question of how
to best conduct the chemical
preparation so that the dentinal tubules
remain open to allow for a better
cleaning and, consequently, sealing
of the system. Drawing from clinical
experience and improved outcomes,
Jaramillo et al. have formulated an

Fig:1a

Fig: 3

Fig:1b

Fig: 4

accordance with evidence-based
endodontics and principles of
minimally-invasive dentistry.
As yet another array of new file
systems are launched in the market,
we seem to share an understanding
that files do not have the ability to
clean root canal space, only preparing,
i.e. shaping it, while it is the irrigation
process that provides a level of
cleanliness that can, hopefully, create
conditions for the body to heal. Thus,
given that the shaping is acceptable
(i.e. the files used remove the bulk of
the pulp and/or infected dentine
without blocking the system with
debris as well as maintain the original
shape of the canal without any microcrack formation), it is the chemical
preparation that is responsible for
treating the system in all its
complexity.
For a long time, irrigation remained
a somewhat mystical part of the
process, with a general agreement that
a good rinse is necessary, but without

Fig: 5

experimental irrigation sequence based
on Sleimans 2005 suggestions, and
added a negative pressure device to
see if it may have added benefits.
Scanning electron microscopy used
to evaluate the cleanliness of dentinal
tubules at three different levels of the
canals demonstrated that our
experimental sequencealternating
the use of 6 percent NaOCl and 17
percent EDTA with water in
betweenhad shown a significantly
better ability to keep the entrances of
dentinal tubules open and avoid the
blockage of dentinal tubules by the
smear layer and debris during the
cleaning and shaping procedure
compared with the use of 6 percent
NaOCl or 17 percent EDTA alone.
The results emphasised the importance
of the early use of 17 percent EDTA
and not only as a final rinse.
This sequence allows us to use the
standard endodontic irrigants during
chemical root canal preparation and
prevents any chemical interaction

between them thanks to the use of
distilled water at strategic times.
Depending on the pH levels and the
nature of the solutions, such chemical
interactions may have a variety
consequences, from brown (and in
some instances, carcinogenic)
precipitation to dentine modification,
potentially affecting general health
and/or quality of the dentine inside
the root canal system, which, in turn,
may influence the longevity of the
link between the sealer and the dentine,
thus changing the outcome of the root
canal treatment in general.
Another finding of the study that
echoed positive clinical outcomes
related to the use of negative pressure
in combination with the experimental
irrigation sequence; the irrigation
protocol that included both the
Sleiman sequence (alternating between
sodium hypochlorite, water, and
EDTA) and a negative pressure
irrigation device was proven to be the
most efficient in opening dentinal

content of the root canal space inside
the main canalmainly in the apical
partas well as inside lateral canals
and dentinal tubules and preventing
the irrigants from reaching these areas
and performing their best (Figs. 1a
and b). Secondly, once the airlock is
eliminated, the partial vacuum force
helps in distributing irrigants into the
totality of the root canal system,
including the depth of the dentinal
tubules. Thirdly, negative pressure
irrigation allows for introducing a
significantly larger volume of
irrigating solutions over a shorter
period of time, increasing the
efficiency and decreasing the length
of the procedure. These unique
properties result in a faster and better
chemical preparation of the entire
internal space.
Sleiman-Iandolo testing used freshly
extracted premolars, removed due to
periodontal pathology, impregnated
with methylene blue dye in a
centrifuge; this resulted in pushing the

Fig: 2a

Fig: 2b

Fig: 2c

Fig: 6

Fig: 7

Fig: 8

tubules and maintaining them open.
It may be posited that the negative
pressure allows for a formation of a
temporary partial vacuum force, which
first draws the liquids from the access
cavity into the root canal system and
then suctions them out of the system.
Using the macro- and the microcannulas of the negative pressure
irrigation unit in, correspondingly, the
coronal-middle and apical parts of the
root canal system, leads to the creation
of a vacuum, or a partial vacuum, to
be more specific, inside the root canal
space. Though its main role is to attract
solutions deeper and deeper into the
system and safely remove them from
within, the partial vacuum created by
the negative pressure has a number of
other important benefits as SleimanIandolo testing has shown.
First of all, it can eliminate the
airlock (better known in endodontics
as vapor lock) inevitably resulting
from bubbly chemical reactions
between irrigating solutions and the

dye deeply into the dentinal tubules
(Fig. 2a). To compare commonly used
irrigant delivery techniques, a negative
pressure irrigation unit was used
(EndoVac) as well as a lateral-vented
needle, manual activation of the
solution, and passive ultrasonic
irrigation in combination with the
Sleiman irrigation sequence. EndoVac
+ Sleiman sequence was shown to be
the only approach that allowed for a
complete removal of the methylene
blue dye from the entire root canal
system and dentinal tubules over the
total time of 25 minutes, while the
other approaches failed to achieve a
completely clean system (Figs. 2b &
c).
The Sleiman sequence goes beyond
using water as an intermediate between
the two alternating solutions and as
the final irrigant (water cooled to
between 2.5°C and 4°C and used for
postoperative pain control or in a
cryotherapy modality also suggested
Continued on page 10

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CLINICAL ENDODONTICS
3D Endo Software, glide path management and WaveOne Gold

8 DENTAL TRIBUNE Pakistan Edition May 2018

By Peet J. van der Vyver and
Farzana Paleker

R

adiographic imaging forms an
essential part of the diagnosis,
treatment planning and followup, in modern endodontics. Cone beam
computer tomography (CBCT) allows
for the visualisation of root canal
systems in three dimensions without
the superimposition of anatomic
structures that occurs with conventional
radiographs. CBCT units reconstruct
the projection data to produce
interrelational images in the axial,
sagittal and coronal planes. Due to the
higher resolution of limited field of
view CBCT units (Fig. 1) their
application in endodontics has been
expanded. High-resolution CBCT

Fig:1

Fig: 6

Fig: 13

Fig: 20

procedure.
In addition, the software also allows
one to choose (from a preloaded
database of endodontic file systems),
a file or system that will most likely
result in optimal canal preparation for
that specific shape or diameter of a canal.
The purpose of this article is to
demonstrate the benefit of the 3D Endo
Software in a complex clinical case that
required endodontic treatment. In
addition, a different approach to glide
path management and root canal
preparation for canals that present with
multi-planar anatomy will be discussed.
Case report
Preoperative evaluation
The patient, a 25-year-old female,
reported with irreversible pulpitis on

Fig: 2

Fig: 3

Fig: 7

Fig: 8

Fig: 14

Fig: 21

Fig: 4a

Fig: 15

Fig: 22

images are ideal for diagnosis of
periapical lesions, identification of root
fractures and resorption lesions and for
the evaluation of root canal
morphology, root length and root
curvatures.
Dentsply Sirona recently launched
3D Endo Software that allows the
clinician to perform pre-endodontic
treatment planning of simple and
complex endodontic cases, using
DICOM (Digital Imaging and
Communications in Medicine) data
from a CBCT scan. The innovative
software allows for the identification
of anatomical complexities, design of
access cavities, working length
measurement, and identification of
canal curvatures before the actual

Fig: 23

Fig: 24

in the axial plane; and in the sagittal
plane, evidence of severe root
curvatures were present in the
mesiobuccal and distobuccal root canal
systems. It was decided to do a more
in-depth investigation as a result of this
complex anatomy, using the 3D Endo
Software (Dentsply Sirona).
3D Endo Software
The data of the limited field of view
CBCT scan was exported as a DICOM
file and imported into the 3D Endo
Software. The 3-D planning of the case
was then completed in five easy steps.
In the first step, Diagnosis and
Pathology, the imported scan was
reviewed in the axial, sagittal and
coronal planes. The software has the
ability to present a 3-D reconstructed

Fig: 4b

Fig: 9

Fig: 16

Fig: 25

Fig: 26

Fig: 27

her maxillary second left molar. The
tooth was temporarily restored with
Intermediate Restorative Material
(IRM, Dentsply Sirona) and the patient
complained about continuous food
impaction between her maxillary left,
first and second molar teeth (Fig. 2).
A periapical radiograph revealed that
the temporary restoration was not
sealing at the gingival margin (Fig. 3).
Also, visible on the periapical
radiograph was evidence of possible
curvatures in the mesiobuccal and
distobuccal roots. It was decided, with
the consent of the patient, to take a
limited field of view CBCT scan to
explore the anatomy of this tooth. The
CBCT scan revealed the presence of
three root canal systems when viewed

Fig: 4c

Fig: 5b
5b
Fig:

Fig: 5a

Fig: 10

Fig: 17

Fig: 28

in the software. Figures 8 to 10 show
the mapping of the palatal, mesiobuccal,
and distobuccal root canal systems.
During the fifth step, Treatment
Plan, the software projected ISO size
06 instruments into the canals (Fig. 11),
which allowed the operator to visualise
the internal anatomy of the canals,
check straight line access, and modify
the proposed access if necessary. A
rubber stop on the files can then be
digitally adjusted to a coronal reference
point of choice that will then indicate
the proposed working length for each
root canal system. This view can also
be rotated in 3-D to alert the operator
of the angle and direction of curvatures
in the root canal systems (Fig. 12). The
step after treatment plan is to select

Fig: 11

Fig: 12

Fig: 18

Fig: 29

view where the transparency of the
teeth can be changed (Figs. 4ad).
The second step, 3D Tooth
Anatomy, involved selecting the tooth
to be examined and the entire volume
was cropped to only leave the data of
interest behind (Fig. 5). In the third
step, Canal System, the number of
root canals were identified and each
root canal was then mapped separately
by identifying the orifice and
radiographic apical foramen of each
root canal (Fig. 6).
With the fourth step, 3D Canal
Anatomy, the software made a
proposal of the canal anatomy (Fig. 7),
but the operator can make corrections
according to the canal configuration
that can be viewed in different planes

Fig: 19

Fig: 30
a master file from a preloaded database
of endodontic file systems that will
most likely result in optimal canal
preparation for that specific shape or
diameter of a canal. Considering the sshaped curvatures in all three root canal
systems as well as the sharp curvatures
in different planes, it was decided to
use the Primary WaveOne Gold file
(25/07) in the palatal canal and the
Small WaveOne Gold file (20/07) for
root canal preparation in the twochallenging buccal root canal systems
(Fig. 13). The selected instruments
were then displayed in the root canal
systems and the operator again
digitally rotated and visualised the
root canal anatomy in 3-D (Fig. 14).
Continued on page 14

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10 DENTAL TRIBUNE Pakistan Edition May 2018

CLINICAL ORTHODONTICS

Use of diode laser in the treatment
of gingival enlargement during
orthodontic treatment
By Dr Carlo Fornaini

n recent decades, we have
witnessed the substantial
development and expansion of the
use of fixed orthodontic appliances.
While their application has many
advantages, several problems related
to the health of the soft tissue may
sometimes appear during treatment. In
fact, the use of fixed orthodontic
appliances may provoke labial
desquamation, erythema multiforme,
gingivitis and gingival enlargement.
Gingival enlargement is a very
common complication during
orthodontic treatment, but fortunately,
it seems to be transitory and generally
resolves after orthodontic therapy, even
if sometimes incompletely. Gingival
overgrowth induced by orthodontic
treatment shows a specific fibrous and
thickened gingival appearance,
different from fragile gingiva with
marginal gingival redness common in
allergic or inflammatory gingival
lesions.
Several clinical studies suggest that
orthodontic treatment may be
associated with a decrease in
periodontal health, causing a
hypertrophic form of gingivitis.
However, the actual pathogenesis of
gingival enlargement is not yet
completely understood, although
probably involves increased production
by fibroblasts of amorphous ground
substance with a high level of
glycosaminoglycans. Increases in
mRNA expression of Type I collagen
and up-regulation of keratinocyte
growth factor receptor could play an
important role in excessive proliferation

of epithelial cells and increased
development of gingival enlargement,
on the basis of some studies, in cases
of poor oral hygiene status. However,
there is no clear definition on its
aetiology, although it is probably
associated with the inflammatory
response induced by the corrosion of
orthodontic appliances, particularly
those of nickel, linked to an
inflammatory response considered a
Type IV hypersensitivity and
manifested as nickel-induced allergic
contact stomatitis, even if its aetiology
has not yet clearly been defined.
The treatment of these conditions is
surgical. Histological and histochemical
studies have demonstrated that the
removal of the gingival papilla can
promote the formation of normal
connective tissue. Because the classic
intervention performed by scalpel has
some disadvantages, mainly linked to
the discomfort for the patient (e.g.
anaesthesia by injection and sutures),
there has been great interest in the
utilisation of laser technology.
Case report
A 14-year-old female patient was
referred to our department by the
orthodontics unit because, at the end
of fixed orthodontic treatment, she had
developed gingival enlargement in the
upper arch (Fig. 1), probably related
to the fast closure of the spaces
associated with very poor oral hygiene
due to bleeding during toothbrushing.
Just after the removal of the appliance,
a topical anaesthetic (EMLA,
AstraZeneca) was applied to the
gingivae (Fig. 2) and a gingivectomy
was performed using a diode laser

The effect of partial vacuum on ...
Continued from page 6

by Sleiman and investigated by Vera et al. it also
stipulates that when using the macro- or the microcannula of the negative pressure irrigation unit for
chemical preparation, every five seconds a two-tothree-second pause should be made when no irrigant
is added. It is during this pause that the partial
vacuum is created by the cannula, which will draw
out all the fluids, residues and gases from all the
root canal system. Once the system has been drained,
the partial vacuum established inside the root canal
system in its entirety can attract a fresh portion of
irrigant for a faster and cleaner preparation of the
root canal system.
Clinical cases
In the images above, we present some of the
typical cases demonstrating the cleanliness of the
root canal system achieved as shown by the lateral
and/or accessory canals visualised upon 3-D warm
vertical condensation (Figs. 36).
The case of a failing root canal treatment with
apical infection and an internal resorption in the

(XD-2, Fotona) according to the
technique of removal of the inter dental
papillae (Fig. 3). The parameters used
were as follows: a wavelength of 808
nm, 3 W in continuous wave, a 320
µm fibre in contact mode. The
intervention had a duration of 375
seconds, and the patient did not feel
any pain (Fig. 4). After the intervention,
the patient did not take any kind of
pain medication, and the healing
process was completed in five days
(Fig. 5).
Discussion
The first laser appliance was built
by Maiman in 1960, and some years
later, it was successfully employed in
medicine and in oral surgery with
several advantages. It may provide
excellent incision performance with
sealing of small blood and lymphatic
vessels, resulting in haemostasis and
reduced postoperative oedema.
Furthermore, target tissues are
disinfected as a result of local heating
and production of an eschar layer,
which results in a decreased amount
of scarring owing to decreased postoperative tissue shrinkage, allowing
one to avoid the use of sutures.
Diodes, the last generation of laser
used in dentistry, have several
advantages, such as reduced cost and
size, and ofer the operator the
possibility to work both in continuous
and chopped mode. Based on our
experience, we can confirm that this
technology may represent a new
approach to the resolution of gingival
enlargement during orthodontic
treatment, with better comfort for the
patient during and after surgery. -DT

apical area was referred to us (Fig. 7). After removing
the previous filling, chemical preparation was
performed, with the help of the partial vacuum
inside the system the chemicals were able to clean
the resorption area without an aggressive effect on
the periodontal ligament; this has led to a truly
three-dimensional obturation. The 4-month followup image (Fig. 8) confirms a fast healing of both
the apical area and the area of the resorption lesion.
Conclusions
Realising that a 100 percent disinfection of the
root canal space remains unattainable, we continue
to strive for perfection in our attempts to develop
viable clinical protocols that would allow lowering
the inflammatory and/or bacterial load so that our
patients bodies can heal. Based on the supporting
research and testing as well as on a history of
sustainably high treatment outcomes for both primary
endodontic treatment and retreatment of vital and
non-vital teeth, we would like to propose our
irrigation protocol as a fast, safe, and, most
importantly, evidence-based technique of chemical
preparation.

Fig: 1

Fig: 2

Fig: 3

Fig: 4

Fig: 5

Fig: 6

The Sleiman irrigation protocol requires 6 percent
(or 5.25 percent , if the 6 percent concentration is
not available) NaOCl, 17 percent EDTA, distilled
water or normal saline. For the best results it is
recommended to use a negative pressure irrigation
unit to introduce and remove the solutions in order
to benefit from the partial vacuum force; however,
it must be said that using other introduction
techniques in combination with the Sleiman sequence
of irrigants will also improve chemical preparation
results and lead to a cleaner root canal space.
. Access cavity; manual files to locate orifices;
manual files for initial scoutingNaOCl
. H2O
. Machine files for root canal preparationEDTA
. H2O
. In between machine filesNaOCl
. H2O (cold for cryotherapy)
. Drying the root canal systemEndoVac
The whole irrigation procedure should follow
the 5 sec introducing solution + 3 sec pause
guideline to achieve the best effect of the partial
vacuum. -DT

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[12] => Dt pages.FH10

[13] => Dt pages.FH10

[14] => Dt pages.FH10

14 DENTAL TRIBUNE Pakistan Edition May 2018

3D Endo Software, glide ...
Continued from page 8

Pre-endodontic restoration
At the following visit, the tooth was
anaesthetised, and a rubber dam placed.
The temporary filling material was
removed, revealing evidence of caries
as indicated by caries indicator solution
(Fig. 15). The caries was removed and
the pulp was exposed (Fig. 16). A preendodontic restoration was performed
using the Palodent V3 matrix system
(Dentsply Sirona; Fig. 17) in
combination with SDR bulk fill
flowable resin (Dentsply Sirona) and
ceram.x SphereTEC one composite
resin (Dentsply Sirona; Fig. 18). After
the pre-endodontic restoration, an
access cavity was prepared and the
canals were located under
magnification.
Canal negotiation and glide path
preparation
The pulp chamber was filled with
Glyde (Dentsply Sirona) before the
canals were carefully negotiated to full
working using pre-curved size 08 KFiles (Fig. 19). Working length
measurements obtained from an
electronic apex locator reading
corresponded with the lengths obtained
from the 3D Endo Software. These
measurements were also confirmed
radiographically (Fig. 20). A
reproducible glide path was prepared
in each root canal system with the size
08 K-File in an M4 Reciprocating
handpiece (Sybron Endo; Fig. 21),
followed by making a size 10 K-File
super loose (Fig. 22). A ProGlider
(Dentsply Sirona) was used in a rotary
motion to expand the glide path in the
palatal root canal (Fig. 23). Considering
the sharp and severe curvatures in the
two buccal canals, it was decided to
convert the ProGlider instrument into
a manual file to expand the glide path
in these tortuous canals with more
safety (Fig. 24). The manually adapted
ProGlider was used in a balanced force
motion up to working length. In
addition, to create more safety during
the canal preparation of the two
challenging buccal root canals, it was
also decided to use the reciprocating
WaveOne Gold Glider (Dentsply
Sirona; Fig. 25), after the ProGlider
instrument to further expand the glide
paths. The WaveOne Gold Glider was
used in 48 backstroke brushing
motions from working length, in the
two buccal root canal systems.
Root canal preparation, irrigation,
and obturation
As mentioned before, WaveOne Gold
files (Dentsply Sirona) were selected
for root canal preparation. The palatal
canal was prepared with the
reciprocating, Primary WaveOne Gold
instrument (Fig. 26), and the two buccal
root canals with the Small WaveOne
Gold file up to working length (Fig.
27).
After canal preparation, the canals
were flooded with 17 % EDTA solution
(Ultradent) and the solution activated
for 1 minute with the EDDY Endo

Irrigation Tip (VDW) driven by an air
scaler (SONICflex LUX 2000L,
KaVo). Thereafter, final disinfection
was achieved by activating 3.5 %,
heated sodium hypochlorite for three
minutes, again activated with the
EDDY Endo Irrigation Tip.
The canals were dried with paper
points and obturated using matching
gutta-percha points, Pulp Canal Sealer
(Kerr) and the Calamus Dual
Obturation Unit (Dentsply Sirona).
Figure 28 shows the final result after
obturation.
Discussion
According to the European Society
of Endodontologys position statement,
the use of CBCT in endodontics should
only be considered if additional
information from the reconstructed
three-dimensional images will
potentially aid in the diagnosis and/or
enhance the management of the tooth
with an endodontic problem. A limited
field of view CBCT scan should be
considered as the imaging modality of
choice for teeth with the potential for
extra canals and suspected complex
root canal morphology.
The 3D Endo Software that was used
in this case report not only allowed the
operator to scroll through the
tomographic slices in the coronal, axial
and sagittal planes, but facilitated a 3D image of the root canal anatomy
prior to treatment. Only after
visualising the severe curvatures and
their projection in the buccal palatal
direction was the complexity of this
case realised. This information was
vital for the treatment-planning phase
of this case. According to the
information obtained from the 3D Endo
Software, the authors could select the
ideal instruments for canal negotiation,
glide path and canal preparation,
irrigation and obturation. According
to Tchorz (2017), the option to plan
endodontic cases in 3-D before
treatment is a significant gain for
modern endodontics, and can help to
prevent procedural errors, especially
in complex cases. It is important to
note that in this case report the working
length measurements obtained from
the 3D Endo Software and the apex
locator correlated with each other.
However, it always advised to verify
the software readings with an apex
locator, as several parameters such as
the access cavity design and position,
the amount of coronal preflaring and
the choice of reference point can have
an influence on the working length
measurement.
The most challenging clinical aspect
of this case was to negotiate the canals
to patency, to create reproducible micro
glide paths, and to expand the glide
paths to a level where the maximum
safety could be secured before
introducing the root canal preparation
instruments. The glide path
preparations were managed with
manual K-Files, K-Files in the
reciprocating M4 handpiece followed
by expanding the glide paths with the

CLINICAL ENDODONTICS
ProGlider and the WaveOne Gold
Glider instruments.
In 2006, West recommended using
K-Files with an initial watch winding
motion to remove restricted dentine in
very narrow canals, followed by a
vertical in and out motion with a 1 mm
amplitude and gradually increasing the
amplitude as the dentine wall wears
away and the file advances apically.
[11] Several authors have described
the use of a small K-Files driven by a
reciprocating handpiece for initial glide
path preparation, especially in very
constricted or curved canals. The main
advantages of using the reciprocating
M4 handpiece is to reduce the glide
path preparation time, hand fatigue,
and to secure the canal in narrow, multiplanar root canals faster compared to
the conventional manual technique.
Securing the two multi-planar buccal
root canal systems in this case, with a
size 08 K-File in the M4 reciprocating
handpiece, facilitated further glide path
enlargement.
The ProGlider, a single file rotary
glide path instrument was the first
instrument used to expand the glide
paths. This file is manufactured from
M-wire NiTi alloy that shows more
flexibility and resistance to cyclic
fatigue compared to conventional NiTi
alloy. It has a semi-active tip, size ISO
016 (D0) with a 2 % taper that
progressively increases up to 8 % (D14;
Fig. 29). The cross section of the
ProGlider instrument is square and the
file is used in a continuous rotary
motion at 300 rpm and a torque setting
of 24 Ncm. Considering the severe
curvatures in different planes of the
buccal root canal systems, the
ProGlider instrument was first used in
a manual mode up to working length
in these two canals. It was also then
decided to further expand the glide
path in these canals by using the
WaveOne Gold Glider, also a single,
reciprocating glide path file designed
for glide path enlargement. Here, a
second glide path instrument was used
because the cutting envelope of the
WaveOne Gold Glider is more than
the ProGlider instrument (Fig. 30). The
rationale for this double file approach
for glide path expansion was to
enhance safety for the preparation files
that followed.
The file tip of the WaveOne Gold
Glider at D0 has a ISO 015 tip size
with a 2 % taper, and the taper
progressively increases up to 6 % (D16;
Fig. 29). The file has a semi-active tip
and a parallelogram-shaped crosssection. The WaveOne Gold Glider is
manufactured using NiTi wire
subjected to a post-manufacturing
thermal process, whereby a new phasetransition point between martensite
and austenite is identified to produce
a file with super-elastic NiTi metal
properties. This process gives the file
a gold finish with enhanced flexibility
and resistance to cyclic fatigue
compared to conventional NiTi and
M-wire alloys. The WaveOne Gold

Glider was driven by the X-Smart
motor, on the WaveOne setting. The
file was taken up to working length in
the already secured and expanded glide
path and the glide path was further
expanded by using a 48 backstroke
brushing motions, until the file felt
completely loose in the challenging
canal systems.
The WaveOne Gold Primary and
Small files were selected for root canal
preparation in this case. These files are
manufactured with the same technique
as described above for the WaveOne
Gold Glider, to produce a file with
super-elastic NiTi metal properties.
The WaveOne Gold Primary file
(Dentsply Sirona) is 50 % more
resistant to cyclic fatigue, 80 % more
flexible, and 23 % more efficient than
the conventional
WaveOne Primary instrument. This
unequal clockwise (CW) and counterclockwise (CCW) reciprocating motion
of the WaveOne Gold system has the
following advantages over continuous
rotation systems:
. Binding of the instruments into the
root canal dentine walls is less frequent,
reducing torsional stress.
. Reduction of the number of cycles
within the root canal during preparation
results in less flexural stress on the
instrument.
. Improved safety, as the CCW
disengaging angle is designed to be
less than the elastic limit of the
instrument.
. There is decreased risk of instrument
fracture.
. It allows the file to easily progress
towards working length without using
potentially dangerous inward pressure.
Wa v e O n e G o l d f i l e s a r e
characterised by a parallelogram (with
two 85 degree cutting edges), offcentred, cross-section.According to
Ruddle, this design limits the
engagement between the file and the
dentine to only one or two contact
points at any given cross section. This
will subsequently reduce taper lock
and the screw-in effect, improve safety,
and cutting efficiency. The newly
designed files is also manufactured
with an ogival, roundly tapered and
semi-active guiding tip to ensure that
the files progress safely along canals
with a secured and confirmed
reproducible glide path.
Conclusion
The preoperative planning stage using
the 3D Endo Software provided the
authors with vital information
regarding the complex root canal
anatomy that influenced the choice of
materials and techniques in this case
report. Because the root canal anatomy
could be visualised in 3-D
preoperatively, the authors realised that
there would be a high risk of either
losing working length or instrument
fracture during canal preparation. It
was therefore very important to secure
the canals by means of glide path
preparation and enlargement prior to
root canal preparation. -DT

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May 2018 Pakistan Edition DENTAL TRIBUNE 15

Genetic mutation from last ice age linked
to shovel-shaped incisors
DT International

ERKELEY, Calif., U.S. Scientists have been puzzled
by the evolutionary
adaptation behind a common tooth
trait of northeastern Asians and Native
Americans: shovel-shaped incisors.
An analysis of archeological
specimens carried out by researchers
from the University of California,
Berkeley has shown that nearly all
early Native Americans had shoveled
incisors, and genetic evidence
pinpoints the selection to a long period
of isolation in the far north 20,000
years ago.
The critical role that breastfeeding
plays in infant survival may have led,
during the last ice age, to common
genetic changes in East Asians and
Native Americans that also affect the
shape of their teeth. According to the
researchers, this genetic mutation,
which probably arose 20,000 years
ago during a period referred to as the

Beringian standstill, increases the
branching density of mammary ducts
in the breasts, potentially providing
more fat and vitamin D to infants living
in the far north, where the scarcity of
ultraviolet radiation makes it difficult
to produce vitamin D in the skin. It
just so happens that the gene
controlling mammary duct growth also
affects the shape of human incisors.
Consequently, as the genetic
mutation was selected for in an
ancestral population living in the far
north during the last ice age, shovelshaped incisors became more frequent
too. Incisors are called shovel-shaped
when the lingual and palatal surfaces
of the incisors have ridges along the
sides and incisal edge.
For the study, Dr. Leslea Hlusko, an
associate professor in the Department
of Integrative Biology at the university,
and her colleagues assessed the
occurrence of shovel-shaped incisors
in archeological populations in order

40th APDC held in Manila
Continued from front page

professionals, continually strive for excellence in
whatever field of specialty we may be into. Featured
in this convention are renowned local and foreign
speakers from every specialty field, who will bring
in their expertise through noteworthy lectures that
are relevant and timely to our dental practice."
Dr Arleen R. Reyes, Philippine Dental Association
President-Elect
The conference had a distinguished lineup of
speakers including Regional and international experts
coming together to lead a dynamic scientific
programme, plenary sessions, lunch symposia, and
hands-on workshops specifically tailored to the
region's dental practitioners at all career stages.
The state-of-the art scientific programme, along with
over 500 dental trade booths provided the participants
with an opportunity to hear firsthand from the world's
leading experts in dentistry and to inspire the
advancement of the profession in their home
countries.
Manila, known as the 'Pearl of the Orient', is center
of the country's government and commerce and is
filled with important architectural and cultural
landmarks. An elaborate social programme was
organized for which the attendees were recommended
to register beforehand.

Sindh Budget 2018-19
Continued from page 2

2 Regional Blood Transfusion Centers at Sukkur
and Jamshoro have been outsourced to Sukkur Blood
Bank and Indus Hospital, respectively.
Grants: Sindh Government is granting Rs 5.59 billion
to SIUT within the next financial year (2018-19). It
includes
establishment of SIUT at Larkana with an allocation
of Rs 497.5 million. SIUT Sukkur chapter has been
established at the cost of Rs 552.27 million. This
institute has been functionalized to provide affordable
OPD, Diagnostic, Dialysis and other specialized
services. Bone Marrow Transplantation Unit in SIUT
established at the cost of Rs 692.779 million, which

to estimate the time and place of
evolutionary selection for the trait.
They found that nearly 100 percent of
Native Americans prior to European
colonization had shoveled incisors, as
do approximately 40 percent of East
Asians today.
The genetic mutation responsible for
shoveling and ductal branching in
mammary glands is also involved in
determining the density of sweat glands
in the skin and the thickness of hair
shafts. As a consequence, selection on
one trait leads to coordinated evolution
of the others.
The Beringian standstill describes
the several thousand-year period of
isolation of ancestral Native Americans
in an area known as Beringiatoday
consisting of the Bering Strait and
adjacent parts of Siberia and Alaska
that resulted in genetic differentiation
from other Asian groups. Genetic
studies of animals and plants from the
Beringia region suggest an isolated

is equipped with state-of-the-art infrastructure and
facilities, benefiting 50-100 patients. Child Life
Foundation is managing children emergency rooms
in 3 Government Hospitals under PPP agreement
which includes, Dr. Ruth Pfau Civil Hospital Karachi,
National Institute of Child Health and Sindh
Government Hospital Korangi No.5.
By May 2018, Child Life Foundation would start
operation at 2 more emergency service centers in
Abbasi Shaheed Hospital and Lyari General Hospital
in Karachi. By June 2018, Child Life would begin
ER operations in 2 more facilities: Peoples Medical
College, Nawabshah and Chandka Medical College,
Larkana. Lastly by the end of 2018, Children ERs
would also become functional at Ghulam Muhammad
Mahar Medical College, Sukkur and Liaquat
University of Medical and Health Sciences, Jamshoro.
Furthermore, he added that, Sindh is facing
challenges of malnutrition, as 48 percent children in
Sindh are undernourished and stunted. Sindh
Government, in collaboration with World Bank, has
begun a multi-sectorial program to reduce the rate
of stunting in children with the aim to reduce it by
30% within the next 5 years.
Rs 2.4 billion are allocated for the non-development
side, in the year 2017-18. CM proposed an allocation
of Rs 5.1 billion in the next year. The major
departments responsible for this program are Health,
Agriculture, Livestock and Fisheries, Local Govt.
Social Welfare.
A new allocation was proposed in the budget, for
International Centre for Chemical and Biological
Sciences for strengthening Jamil-ur-Rehman Centre
for Genome Research at the University of Karachi
to establish a DNA Lab.
Funds were allocated in the budget to improve
Cardiology Department at Lyari General Hospital
Karachi; to strengthen Sindh Institute of
Ophthalmology & Visual Sciences Hyderabad; to
construct 200-bed Surgical Block at Liaquat
University Hospital; to construct 200-bed Urology,
Nephrology, Gastroenterology, Endoscopy, Suite,
Dermatology, endocrinology and Diabetes Block,
LUH, Jamshoro; to establish NICVD Satellite Centre

area during that time where species
with locally adaptive traits arose. Such
isolation is suitable for selection on
genetic variants that make it easier for
plants, animals and humans to survive.
People have long thought that this
shoveling pattern is so strong that there
must have been evolutionary selection
favoring the trait. This Beringian
population is one example of what has
happened thousands of times, over
millions of years: Human populations
form, exist for a little while and then
disperse to form new populations,
mixing with other groups of people,
all of them leaving traces on modern
human variation today. An important
take-home message is that human
variation today reflects this dynamic
process of ephemeral populations,
rather than the traditional concept of
geographic races with distinct
differences between them, said
Hlusko.

at Shaheed Benazirabad. To rehabilitate and
strengthen Nursing Hostel, Obstetrics & Gynecology
Department, O.T., External Development and Missing
Facilities at Sheikh Zayed Campus, CMCH, Larkana;
to construct Building of Nursing School & Hostel
Mirpurkhas; to up-grade Rural Health Centre to the
level of Taluka Hospital Khanpur in District
Shikarpur; to strengthen Development wing including
Capacity Building of officers/officials of Health
Department.
Indus Hospital Badin: The initiatives brought about
remarkable improvement in the provision of public
health service, including OPDs, IPDS, surgeries, etc.
The management of DHQ Badin was handed over
to Indus Hospital, under the PPP mode in March,
2016 and very soon, people of Badin will see a new
250-bedded health facility.

ICD-Honouring the worlds ...
Continued from page 4

We have already touched on the ideas of friendship
and passion of ICD Fellows. What is the main
ingredient of the ICDs success to you?
Dedication and commitment to ICD core values
is the common denominator; ICD Fellows are driven
as individuals and as a group to improving dentistry
and the life of those being underserved. One sees
that everywhere we have an ICD presence.
The celebration of the 100-year anniversary is
planned to be a worldwide event; every section,
district and region will be holding events. Can you
tell us a bit more about what we can expect before
the grand finale in Nagoya in Japan in 2020?
As mentioned earlier, we have 15 sections, 70
districts and 15 regions worldwide, and they will be
participating in different ways to acknowledge the
100-year anniversary. Every ICD jurisdiction will
have an event during 2020 that will memorialise that
special year and will lead up to the very special
finale in Nagoya in November 2020. There will be
a ceremony in Nagoya in which new inductees from
all over the world will participate in an Olympicstyle event, in addition to a gala banquet, special
entertainment and many surprises! - DT

[16] => Dt pages.FH10

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[cover] => DT Pakistan No. 3, 2018

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News / Clinical Endodontics / Clinical Orthodontics

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