DT Pakistan No. 4, 2019

News / Clincal Implantology / Pediatric Dentistry

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PUBLISHED IN PAKISTAN

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Brunch with
the President:
Reunion of ....
Page 4

NEWS

JULY, 2019 - Issue No. 04 Vol.6
Edelweiss PEDIATRIC
CROWNs: A new and
innovative ...

Prevention 0: The best
way to prevent ...

CLINICAL IMPLANTOLOGY

Page 8

PEDIATRIC DENTISTRY

DT Pakistan Report

I

SLAMABAD - Pakistan
Medical and Dental Council
(PMDC) has decided to initiate
annual categorization of all public
and private medical and dental
colleges of Pakistan, based on
quality. According to an official of
PMDC, all medical and dental
colleges will be ranked into five
categories from A+ to D on the basis
of their performance indicators,
facilities and faculty, to help students
in making the right choice along with
improving the quality of the colleges.
The ranking will clearly speak of the
college's functionality and
performance, along with pinpointing
the flaws in the overall system.
To kick off the first phase, the
council has decided to scrutinise all

the existing public and private
medical and dental colleges; this
would be the largest inspection that
has ever taken place in the country.
All 167 colleges will be examined
and new frameworks will be
decided for the coming year.
The PMDC official said that the
inspection system was developed
to facilitate a transparent and open
merit-based system, adding that
these will be carried out on a
periodical basis- an annual or threeyear basis. He added that a new
organogram of the organization was
also developed, which had setup the
needed departments, with each
department being headed by a Head
of Department. This head will be
supervising different sections of the
department and will ensure the best
possible implementation of industry-

Photo: DT Pakistan

Medical & dental colleges
to be annually categorized
on quality by PMDC

related governance practices.
The official said that the council had
also developed a policy to impose a
revalidation requirement upon
doctors in line with the international
practises instead of renewing their
licences after a specific period of
time. This step will help doctors to
keep themselves updated on the
Continued on Page 14

Page 9

Rs 600m allocated
for FJID completion

K

ARACHI - The current
government has allocated Rs
600 million in recent budget
for the long
ignored
project of
Fatima Jinnah
Institute of
Dentistry
( F J I D )
despite the
economic
emergency in the country.
The long struggle of dental
community, associations and media
must be appreciated, as well as the
efforts of Dr Arif Alvi, President of
Pakistan, who finally made it possible
to allocate necessary funds for the
completion of FJID.
He paid a special visit to his alma
mater, and assured that he would fulfil
the commitment made by him at the
special briefings in President House
where he met with a delegation
comprising Principal Prof Waheed Ul
Hamid, Project Director Prof Usman
Akhtar, and Dr Wasif Ali Khan. -PR

PDA honours Dr Inayatullah Padhiar S.I.
By Dr Hira Mustafa Khan

K

ARACHI - Pakistan Dental
Association (PDA) hosted
an iftar dinner to honour the
esteemed Dr Inayatullah Padhiar (SI)
the recipient of Sitara-e-Imtiaz by the
President of Pakistan Dr Arif Alvi.
PDA President Dr Mahmood Shah
presented a shield and an ajrak veil
to Dr Inayat (S.I), on behalf of PDA,
as a gesture of appreciation and
recognition of his dental community
work and selfless contribution to
academic writing and organized
dentistry in Pakistan. Dr Mahmood
Shah said that Dr Inayat had been a
source of learning and guidance for
so many dentists including him.
Former PDA presidents, Dr Saqib
Rashid, Dr Kamran Vasfy and Dr
Mumtaz Khan, also came forward to
pay tribute to Dr Inayat (SI). Dr Baqar

PDA President Dr Mahmood Shah presenting shield to Dr Inayatullah
Padhiar S.I. (Photograph: DT Pakistan)

Askary, Dr Asif Niaz Arain and
Dr Anwar Saeed lauded Dr Inayat
(SI) for his work and effort toward
bettering dentistry in the country.
CEO Dental Tribune Syed Hashim
Hasan acknowledged the outstanding
human being and a mentor for so
many not only in the dental profession
but also for supporting the
establishment of Dental News. It was
his words of encouragement and
constant guidance that made Dental
Tribune what it is today.
A segment based on discussion on
PDA affairs also took place, wherein
the current and former PDA presidents
along with others including Dr Asif
Niaz Arain, Dr Anwar Saeed, Dr
Ghulam Ali Sayyal and Dr Nasir
Khan participated and discussed the
various barriers and solutions, and
ways to improvement.
Continued on Page 14

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NEWS

2 DENTAL TRIBUNE Pakistan Edition July 2019

Brunch with the President:
Reunion of deMontmorency
graduates, class 1966

SLAMABAD - March 10th,
2019, was a day of excitement,
significance, and immense pride
for the dental graduates of class 1966
of de'Montmorency College of
Dentistry, Lahore. This day, the
President of Islamic Republic of
Pakistan Dr Arif-r-Reham Alvi, who
also belongs to the same batch of the
dental college, invited all his former
classmates over
brunch at the
President House
in Islamabad.
The meeting
was scheduled
from 11am to
1pm. President
Arif Alvi and his
wife, Samina
Alvi welcomed
all the arriving
guests with an
open and warm
heart. It was an
afternoon full of reminiscence,
nostalgia and celebration of the prized
memories of these graduates from
their time in dental college.
Dr Munir Ahmed who flew all the
way from Canada for the reunion,
played a primary role in arranging it.
He created a WhatsApp group and put
in relentless effort to reach out to all
his UG batch-mates, 48 years after
graduation, and invited them to the
reunion.
Attendees of the reunion brunch
included Dr Abid Bhaijan and Dr
Tahira Abid (USA); Dr Munir Ahmad

and Mrs. Zohra Munir (Canada); Dr
Javaid Ashraf and Mrs. Shezana
Javaid; Capt Dr Abdul Rasheed
Chaudhry; Brig (R) Dr Raza Ahmed
Khan; Dr Asif Ali and Mrs Musarrat
Ara; Dr Farrukh Mumtaz Rana; Col
Dr M. Alamgir Dar (TIM) and
Mrs.Asmat Yasmeen; Dr Zahoor
Ahmad and Mrs Azra Yasmin; Dr
Muhammad Umar Hayat and Mrs.
Farzana Khanam; Col. Dr Naseer
Ahmad; Col Dr Abdus Sattar

52 years, there was also conversation
on the current status of Dentistry in
Pakistan.
Dr Munir Ahmed said, "It is my
wish that Pakistan has a separate
Dental Council similar to the
regulatory bodies in Canada, UK and
USA; an adequate dental health policy
must also be implemented. I have
researched on it and I offer my services
to Pakistan in this regard, and my
services are dedicated to Dr Arif Alvi
who may be
able to bring
these changes."
The guests also
discussed the
potential for
enhancing and
improving the
dental education
and practice in
Pakistan.
Dr Munir said,
"Since dentists
like me, Dr Abid
and Dr Tahira
have spent years practicing in
countries like Canada and USA, we
have offered the president the
amalgamation of our specialties,
experiences and skills in redesigning
the current dental curriculum of
Pakistan."
Dr Arif Alvi welcomed all
suggestions, and offered his own
insight as well.
After an afternoon of exchanging
professional ideas, and narrating
stories from the time in
deMontmorency, the hosts led
the guests toward brunch arrangement.
Photo: DT Pakistan

DT Pakistan Report

Chaudhry and Mrs Bushra Sattar;
Dr Shabab Rizvi; Dr Maqbool Ahmed;
Dr Mirza Sikandar Hayat and
DrGhulam Ali.
At the brunch, speaking on behalf
of the group, MC Dr Munir Ahmed
said, "We are very proud of Dr Arif
Alvi who is the President of our
beloved country." He also went on to
tell everyone that Dr Arif Alvi "was
the most genius student of our class."
Where the reuniting friends indulged
in fun interaction and chatted about
the four years spent together in college
and other events spanning over past

Lecture and workshop on
endodontics and periodontology

Photo: DT Pakistan

ARACHI - A comprehensive and
didactic lecture on endodontics and
periodontology, featuring Fanta Dental
Rotary system (AF F one), was arranged by
Dentsco International at Fatima Jinnah Dental
College (FJDC). The lecture had a grand
attendance of renowned consultants and clinicians.
Professor Saqib Rashid was the guest of honour;
Prof. Yawar Ali Abidi, Prof Zahid Iqbal, Prof
Henna Ahmed, Dr Yasir Raza, Dr Azmat Khan,
Dr Sameer Qureshi, Prof Shoaib Khan, Dr Asjad
Shoukat and Dr Ali Asghar were also present.
Those attending the workshop included dental
students, postgraduates, and general practitioners. There was a remarkable response from sixty five keen participants.
Prof Abu Bakr shared insight of his vast knowledge in his intriguing lecture and workshop. The next lecture was by
Dr Ashar Jamelle; he outlined his surgical cases and the new classification, which had the participants captivated. This
was followed by the workshop on diagnosis and problem solving which was very well received and appreciated. - PR

Publisher/CEO
Syed Hashim A. Hasan
hashim@dental-tribune.com.pk
Editor Clinical Research
Dr. Inayatullah Padhiar
Editors Research & Public Health
Prof. Dr. Ayyaz Ali Khan
Editor - Online
Haseeb Uddin
Designing & Layout
Sh. M. Sadiq Ali

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NEWS

4 DENTAL TRIBUNE Pakistan Edition July 2019

Periodontal disease management workshop by IADSR

K

Photo: DT Pakistan

ARACHI - Institute of Advanced
Dental Sciences and Research
(IADSR) recently held a two-day
workshop on 'Comprehensive Management of
Periodontal disease'. The workshop was a part
of IADSR 8th Professional Diploma in Advanced
General Dentistry (PDAGD). The participants
were facilitated by Dr Muhammad Haseeb, Head
of the Department of Periodontology at
University of Lahore. He explained how to
recognize periodontal disease, its signs and
symptoms and emphasized on the surgical and
non-surgical management in dental practice.
Dr Muhammad Haseeb demonstrated the use
of periodontal surgical instruments accurately
and effectively. The following topics were taught:
surgical and non-surgical management of
periodontal disease including regenerative
therapy, guided tissue regeneration, bone grafting
procedures, gingivectomy, crown lengthening,
splinting, and periodontal flap therapies.
He emphasized a lot on patient's education
related to the disease, and designing of a
comprehensive treatment plan after diagnosing
the disease. The attendees were given two
different case studies to solve with an aim to
disseminate new knowledge regarding problems
which are commonly identified during clinical
practice. Participants diagnosed and designed
comprehensive treatment plans for different
cases and performed surgical procedures on goat
heads and phantom heads.
It was an interactive session and any queries
raised while solving case studies were elaborately
answered by Dr M. Haseeb. An in-depth
discussion cleared doubts and misconceptions
of the participating practitioners. -PR

Dentists in Multan pull out 252
teeth from 14yr olds mouth

M

K

ARACHI - "Our mission is to
produce a reliable, high quality
dental implant system, based on
scientific evidence and proven concepts,
with the goal of making implant treatment
affordable for all patients," said a Turkish
dental implant expert at a training workshop
in Jinnah Sindh Medical University (JSMU).

Institute of Oral Health Sciences (SIOHS)
is providing this service to people at an
economical cost on a no profit basis."
Pro Vice Chancellor Prof Lubna Ansari
Baig told the visitors that it was encouraging
to learn that they shared the university's
goal of making high quality dental care
affordable for people.

Dr Ayesha Gull, Dr Fishan Ali, and Dr
Muzammil who performed stepwise
surgery at Nishtar Hospital, Multan.
The boy was suffering from Complex
Odontoma and had hundreds of teeth in
his maxilla and mandible. In the first
step, surgery was performed on the
maxilla alone, from where 252 teeth
were extracted; mandibular surgery will be done in the next
step after healing of maxilla.
In previous literature, there is record of 232 teeth being
extracted from a 17yr old boy's mouth, in India. -PR

Photo: DT Pakistan

Photo: DT Pakistan

ULTAN - A team of oral and maxillofacial
surgeons of Nishtar Institute of Dentistry, in
Multan, pulled out 252 teeth from the maxilla of
a 14 year old boy. The team was headed by Dr Saima Munir,
Dr Sohail Fareed, Dr Khalil Ahmed, Dr Faizan Virk,

Training workshop on modern
dental implants at JSMU concludes

Vice Chancellor JSMU Prof SM Tariq
Rafi welcomed the guests and described the
vision of the university under which high
quality dental care is being provided to the
masses at nominal cost. "Dental implants
are a very expensive option in the market.
The Out Patients Department at our Sindh

Experts trained 80 participants in using
the dental implant system in the workshop
that lasted two days.
Registrar Prof Saadia Akram, Principal
SIOHS Prof Zubair Abbasi, and organizer
Dr Erum Behroz were also part of the
programme. -PR

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NEWS

6 DENTAL TRIBUNE Pakistan Edition July 2019

Sugar industry exploited dietitians
to influence dentists, study shows

AN FRANCISCO,
U.S./VANCOUVER,
B R I T I S H
COLUMBIA, CANADA - In
1975, the U.S. Sugar
Association (SA) created the
Regional Nutritional
Information Program (RNIP)
in an effort to enlist dietitians
to spread positive messages
about sugar and health. A
recent study has inquired into
the RNIP and evaluated its
impact
on
dental
professionals. The findings
suggest that the sugar industry
used dietitians strategically in
order to influence the dental
community's views on sugar.
Researchers from the
University of California, San
Francisco School of Dentistry
reviewed 304 internal SA
documents dating from 1974
to 1978 related to the RNIP's
operations, regulatory

activities and scientific
research. To further explore
the SA's influence on the
dental community, they
selected 59 documents for an
in-depth analysis and
identified the emerging
themes. They used secondary
sources to contextualize their
findings.
The data revealed that the
RNIP was an integral part of
the SA's public relations
campaign and was designed
to portray the safety and
benefits of sugar in a balanced
diet. The target audiences
included universities, public
schools, professional
associations and the media.
According to the study,
dietitians working for the SA
hosted educational
workshops, incorporated the
association's literature into
libraries and curricula,

monitored professional and
consumer attitudes toward
sugar and made media
appearances. They also
interacted with dental
professionals by documenting
their attitudes toward sugar,
influencing a professional
conference to include prosugar speakers, developing a
media program that
minimized sugar's role in
causing dental caries, and by
monitoring and criticizing
dental researchers who sought
to examine the high-sugar
content of breakfast cereals.
According to the World
Health Organization (WHO),
dental caries is a major public
health problem and is
the most widespread
noncommunicable disease.
WHO states that it can be
prevented by avoiding dietary
free sugars.

Family characteristics influence
periodontal diseases in children

R I S B A N E ,
AUSTRALIA Numerous studies
have been published on the
association between dental
caries and various family
contextual factors. However,
similar research with regard
to periodontal disease is
limited. Thus, the aim of a
recent systematic review was
to assess the influence of
family characteristics on According to a recent systematic review, the socio-economic
status of parents influences the prevalence of periodontal diseases
periodontal diseases in in their children. (Photograph: MilanMarkovic78/Shutterstock)
children.
For the review of the
"Similar to dental caries, psychosocial variables on
relevant literature, 32 studies t h r e e c o m m o n l y u s e d periodontal diseases in
from a number of countries indicators of parent's socio- children," he continued.
were included. Factors economic status namely
"It is important to understand
considered varied in the income, education and which parental characteristics
different studies but included occupation are significantly influence periodontal disease
family income, parents' socio- associated with periodontal in children to plan health
economic status, educational diseases in children with better promotion or prevention
status and occupation, and periodontal status being programmes for preventing
parental knowledge, practices observed in children of parents periodontal diseases in
and clinical status.
with higher socio-economic c h i l d r e n , " c o n c l u d e d
The review found that status than those children Tadakamadla.
parents' socio-economic status whose parents are of lower
The study, titled "Effect of
is significantly associated with socio-economic status," said family characteristics on
periodontal diseases in lead author Dr Santosh Kumar periodontal diseases in
c h i l d r e n . F u r t h e r m o r e , Tadakamadla, Senior Research children and adolescents-A
children who are exposed to Fellow at the School of systematic review", was
passive smoking and have Dentistry and Oral Health at published online in the
parents with periodontal G r i ff i t h U n i v e r s i t y i n International Journal of Dental
diseases are more likely to Brisbane. "However, there was Hygiene on 2 April 2019,
have periodontal diseases as not much research done to ahead of inclusion in an issue.
well.
explore the effect of parental - Dental Tribune International

The findings of a recent study have suggested that the U.S.
Sugar Association used dietitians to refute dentists antisugar messages at professional meetings and in the media.
(Photograph: Kagai19927/Shutterstock)
The researchers caution the
public health community to
consider corporate
relationships in the dietetic
profession as potentially
detrimental to oral health.
The findings were presented
at the 97th General Session
and Exhibition of the
International Association for
Dental Research, held in
conjunction with the 48th
Annual Meeting of the
American Association for
Dental Research and the 43rd

Annual Meeting of the
Canadian Association for
Dental Research. The event
took place on June 19-22 in
the West Building of the
Va n c o u v e r C o n v e n t i o n
Centre.
An oral presentation of the
findings of the study, titled
"Sugar industry's use of
dietitians to influence
dental professionals, 19741978," was held on June 19,
2019. - Dental Tribune
International

Scottish professor wins
international dental
research award

U N D E E , U K / VA N C O U V E R , B r i t i s h
Columbia, Canada: In recognition of his
prominence in the world of dental academia,
Prof. Graham Ogden of the University of Dundee has
been awarded the 2019 International Association for
Dental Research (IADR) Distinguished Scientist Award
in Oral Medicine and Pathology Research. Ogden was
presented with this accolade at the recent 97th General
Session and Exhibition of the IADR held in Vancouver
in Canada.

Prof. Graham Ogden is currently Professor of Oral
Surgery at the University of Dundee, as well as Vice
President of the Dental Faculty of the Royal College
of Physicians and Surgeons in Glasgow. (Photograph:
The University of Dundee)
The award is one of the highest honours bestowed
by the IADR and recognises Ogden's outstanding and
sustained body of peer-reviewed research that has
contributed to an understanding of the mechanisms
governing the health and diseases of the oral cavity
and associated structures, which principally encompass
skin, bone and the oral soft tissue. The award consists
of a monetary prize and a plaque.
Continued on page 15

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CLINICAL IMPLANTOLOGY

8 DENTAL TRIBUNE Pakistan Edition July 2019

Prevention 0: The best way to prevent peri-implant disease?
By Prof. Magda Mensi, T. Ives &
Dr G.Garzetti

he philosophy of prevention in
all medical professions is
increasing from a global
perspective. In fact, prevention of
chronic non-communicable diseases,
the major burden of illness and
disability in almost all countries in the
world, has been strengthened in recent
years. The motivation is to ensure a
better quality of life for people and to
reduce public health expenditures. In
dentistry, periodontitis is one of the
major chronic non-communicable
diseases. World experts in periodontics
and science have published several
principles regarding the prevention of
periodontal diseases.
Peri-implantitis is a twenty-firstcentury version of periodontitis and

Fig. 1a: Implant in position #14 affected by peri-implantitis:
periimplant probing a) with the prosthetic crown in situ and
b) after prosthetic crown removal

Fig. 4b: Peri-implant home care
with a) AirFloss (Philips),
b) X-Floss (ROEN) and c)
interdental brush (TePe)

to patients if consideration is given
from the beginning to the entire
situation. Implants may not always be
in the best interest of the patient.
For these reasons, every clinician,
before placing an implant, should
consider not only patient- and sitespecific aspects, but also surgeon,
prosthodontist, dental hygienist and
dental technician skills in order to
minimise the possibility of periimplantitis in the future.
The following should be considered
before primary and secondary
prevention, and it is the proposal of
the authors that this approach be called
"Prevention 0".
Patient-specific considerations
When deciding to rehabilitate a
patient with dental implants, before
surgical planning, we have to carefully
inform the patient about the

Fig. 1b: Implant in position #14 affected by periimplantitis: periimplant probing a) with the prosthetic
crown in situ and b) after prosthetic crown removal

Fig. 4c: Peri-implant home care with a) AirFloss (Philips),
b) X-Floss (ROEN) and c) interdental brush (TePe)

increasing in occurrence as implant
placement is increasing (Figs. 1-3).
Like periodontitis, it is a biofilmassociated pathological condition, but
instead of affecting periodontal
ligaments and bone, it is characterised
by inflammation in the peri-implant
mucosa and subsequent progressive
loss of supporting bone.The main
reasons for concerns in this area are
an aetiology in which several risk
factors can play a determining role
and a lack of a gold standard therapy.
Primary and secondary preventative
measures are really important to
prevent mucositis and peri-implantitis
and to avoid recurrences, but there are
many details to consider before placing
implants to mitigate iatrogenic
problems. There are many different
prosthetic solutions besides implants
that dental professionals could propose

alveolar process, inducing hard- and
soft-tissue deficiencies. The clinician
must evaluate carefully all sites
exposed to the following factors,
because they have the potential for
major healing deficiencies: loss of
periodontal support, endodontic
infections, longitudinal root fractures,
thin buccal bone plates, buccal/lingual
tooth position in relation to the arch,
extraction with additional trauma to
the tissue, injury, pneumatisation of
the maxillary sinus, medications and
systemic diseases reducing the amount
of naturally formed bone, agenesis of
teeth and pressure from soft-tissuesupported removable prostheses.
Other site considerations relate to
anatomical knowledge and in respect
to the suitable anatomical structure of
the area (maxillary sinus, inferior
alveolar nerve), endodontic and

Fig. 2: Radiographic examination
of the implant

Fig. 3: Excess resin cement around the implant

Fig. 5a: Professional peri-implant biofilm removal by a) AIRFLOW
with erythritol powder (PLUS powder, EMS), b) PERIOFLOW with
PLUS powder and c) with PEEK tip (PI, EMS)

characteristics of this procedure. It is
important to underline that personal
daily maintenance at home and
appropriate compliance regarding
follow-up controls and dental hygiene
therapies are effective preventative
measures. Procedure awareness and
compliance are the foundation for
success, but the clinician must also
inform the patient about the impact of
systemic disorders (osteogenesis
imperfecta, ectodermal dysplasia,
diabetes), medications (bisphosphonates), therapies (radiotherapy in
the jawbone), habits (smoking, poor
biofilm control) and a history of
aggressive periodontitis as being
relevant risk factors for peri-implant
disease.
Site-specific considerations
The healing process after tooth loss
leads to a variable reduction of the

dental coach or personal oral trainer,
motivating patients not only in dental
habits but also in lifestyle, for example
regarding smoking cessation and diet.
This is a friendly expert who
strengthens patient fidelity to the
dental office, even in fearful patients,
and maintains restorative work and
rehabilitations undertaken by the
dentist.
To perform professional care in a
minimally invasive way, wearing
loupes and using plaque disclosing
agents and appropriate devices are
mandatory, especially if prosthetic
rehabilitation is difficult for the patient
to maintain. Correct and periodic
biofilm removal should be considered
the standard of care for prevention
and management of peri-implant
disease. For this reason, patients
should be motivated and instructed in

Fig. 4a: Peri-implant home care with
a) AirFloss (Philips), b) X-Floss (ROEN)
and c) interdental brush (TePe)

Fig. 5b: Professional peri-implant biofilm removal by a) AIRFLOW
with erythritol powder (PLUS powder, EMS), b) PERIOFLOW with
PLUS powder and c) with PEEK tip (PI, EMS)

periodontal health of adjacent teeth,
and patient phenotype. According to
Linkevicius et al. there is significant
evidence that thin soft tissue leads to
increased marginal bone loss
compared with thick soft tissue around
implants.[3, 8] Lack of bone has led
to the development of various
alternative surgical techniques to avoid
large bone regenerations or grafts,
such as short implants, tilted implants,
pterygoid implants and palatal implant
mesh, with questionable results, but
definitely decreasing the cleanability
and maintainability of implants and
prostheses.
Dental hygienist skills and devices
This professional figure plays a key
role in disease prevention and oral
health promotion.[9] Dental hygienists
should not limit their activities to being
an oral cleaner, but act as the patient's

daily implant maintenance, which
should begin before implant placement
and be continued after treatment within
a regular, personalised recall regime
(Figs. 4 & 5).
Surgeon skills
Nowadays, especially in Italy, a new
professional figure has appeared: the
implantologist, who is a graduate
dentist, generally a co-worker, and
goes to different dental offices or
clinics and mainly places implants,
often without sufficient expertise in
periodontal and prosthetic fields. That
means, in some cases, implant
mispositioning, resulting in
reconstructive and maintenance
problems. In order to avoid fabrication
of specific prosthetic parts, unrestored
implants and surgical interventions to
remove or reposition them in
Continued on page 15

[9] => Dt pages.FH10

PEDIATRIC DENTISTRY

July 2019 Pakistan Edition DENTAL TRIBUNE 9

Edelweiss PEDIATRIC CROWNs: A new and
innovative approach to restoring primary teeth
By Dr Desigar Moodley, Dr Kunal
Gupta, Dr Stephan Lampl

T

he management of dental
caries in children is necessary
because caries is a progressive
disease which can eventually damage
the tooth and can be detrimental to
the permanent teeth and the childs
general well-being. As outlined in this
clinical case, edelweiss PEDIATRIC
CROWNs are a simple solution which
is aesthetic but also functional in
providing an effective treatment
option for the restoration of decayed
primary teeth.
Introduction
The main objective of restorative
treatment in the paediatric patient is
to repair or limit the damage from
caries, protect and preserve the tooth
structure, and maintain pulp vitality
whenever possible. Although stainlesssteel crowns have proved to be
successful in clinical treatment, the
views of dental practitioners on the
use of these crowns differ. The
majority of general dental practitioners
consider these crowns to be an
impractical restorative technique for
a busy daily practice and unsuitable
for most children. Guidelines on the
use of stainless-steel crowns as set out
by the British Society of Paediatric
Dentistry have largely been ignored,
as they do not reflect the views of the
majority of general dental
practitioners. In recent years, because
of increased demand for aesthetics,
prefabricated zirconia crowns have
become increasingly popular. Zirconia
paediatric crowns, however, require
a more aggressive approach with
subgingival preparation margins to
restore primary teeth, which can often
lead to pulpal exposure because of the
large pulpal chambers and high pulpal
horns in primary teeth. Because
zirconia crowns cannot be crimped,
the clinician must prepare the teeth to
fit the zirconia crowns. Therefore, an
increase in preparation and fitting time
is necessary. Furthermore, preparation
of subgingival margins can often result
in gingival haemorrhage, which can
compromise the retention of zirconia
crowns.
To overcome the shortcomings of
the above-mentioned treatment
options, a minimally invasive, highly
aesthetic paediatric crown was recently
introduced to the market that is
produced from a laser-sintered and vitrified composite. This process
improves the flexural strength of the
crown to 550 MPa and produces a
highly aesthetic glossy surface.
Edelweiss PEDIATRIC CROWNs are
prefabricated crowns that are
contoured to mimic the anatomy of

the primary tooth and are supplied
in various sizes for both anterior and
posterior teeth for different clinical
situations.
Clinical case report
A 4-year-old girl was referred to
the Childrens Dental Center in
Gurgaon in India with the complaint
of painful teeth when eating and the
presence of unsightly maxillary
anterior teeth. Clinical examination
showed large carious lesions in the
maxillary anterior teeth (Fig. 1). A
radiographic examination showed
pulpal involvement of caries in teeth
#51 and 61 (Fig. 2).
The objectives of the treatment plan
were first to alleviate pain and remove
any pathology and then restore
function and aesthetics. After rubber
dam placement, routine endodontic
treatment was performed on teeth
#51 and 61 and the root canals were
filled with Vitapex (Neo Dental), a
resorbable calcium hydroxide-based
paste with iodoform. Since aesthetics
was a priority, edelweiss PEDIATRIC
CROWNs were used to restore the
four anterior teeth. Using a sizing
gauge (supplied by the manufacturer)
to determine the size, the
appropriately sized crowns were
selected (Fig. 3).
All caries was removed using a
round diamond bur, and mesial and
distal reduction were achieved with
a fine tapered diamond bur to open
the interproximal contacts and to
begin circumferential reduction.
Buccal and lingual reduction were
achieved with a round-ended straight
fissure diamond point. All margins
and the extent of reduction were
dictated by the caries and kept to a
minimum in order to preserve as
much tooth structure as possible. The
margins were kept supragingival
(Fig. 4).
The crowns were then checked for
fit and prepared for the bonding
procedure. The inside surfaces of the
crowns were lightly roughened using
a diamond football bur (RA 379),
rinsed off and air-dried. Edelweiss
VENEER Bond (Fig. 5) was applied
to the inside of the crown and lightcured for 20 seconds.
The prepared tooth surface was
etched with 37 per cent phosphoric
acid for 10 seconds, and bonding
agent was applied and light-cured for
20 seconds (Figs. 6 & 7). Edelweiss
composite in Shade A0 was added
to the inside of the crown and placed
over the prepared tooth, the crown
was seated firmly and excess
composite was removed from the
margins (Fig. 8). Incisal edges and
labial inclination were then assessed,
Continued on page 15

Fig. 1: Caries associated with the four front teeth

Fig. 3: Edelweiss Sizing Guide in small, medium
and large size for crown size selection

Fig. 2: Radiographic examination revealed
pulpal involvement of caries in 51 and 61.

Fig. 4: Crown preparations with margins kept supra-gingival

Fig. 5: Edelweiss Veneer Bond applied to inner surface
of the pediatric crown, air dried and light cured

Fig. 7: Bonding agent applied and light cured for 20 seconds

Fig. 6: Tooth surfaces prepared with 37%
phosphoric acid for 10 seconds.

Fig. 8: Excess cement removed from
margins prior to final cure.

Fig. 9: Front teeth restored with edelweiss pediatric crowns

Fig. 10: Four month follow up showed good gingival
health and no discoloration of the crowns.

Fig. 11: Preoperative situation

Fig. 12: Postoperative situation

[10] => Dt pages.FH10

NEWS

10 DENTAL TRIBUNE Pakistan Edition July 2019

Technology may help clinicians
see a patients real-time pain

NN ARBOR, MICH.,
U.S. - Management of a
patient's pain during even
the simplest of procedures can be
difficult. In a development that
may one day simplify the task, a
team of scientists from the
University of Michigan (UM) have
created a technology to help
clinicians "see" and map patient
pain in real time, through special
augmented reality glasses.
Although it is still some years away
from being integrated into dental
Dr. Hassan Jassar (seated) tests out the new technology that helps a clinician
offices, the researchers believe the better understand a patients pain. (Photograph: University of Michigan)
technology is a good first step in
t h e a d v a n c e m e n t o f p a i n The technology was tested on 21 researchers, they used brain pain
management technology.
volunteer dental patients, and the data to develop algorithms that,
"It's very hard for us to measure researchers hope to include other when coupled with new software
and express our pain, including its types of pain and different and neuroimaging hardware,
expectation and associated conditions in the future.
predicted pain or the absence of it
anxiety," said Dr. Alex DaSilva,
Patients wore caps fitted with about 70% of the time.
associate professor at the UM sensors to detect changes to blood
With CLARAi, practitioners
School of Dentistry and Director flow and oxygenation. Their could begin to understand a
of the Headache and Orofacial Pain reaction to cold when applied to patient's pain better while still
Effort Laboratory.
their teeth was then measured. remaining focused on the
A portable clinical augmented While seated in the dental chair, procedure at hand. "Right now, we
reality and artificial intelligence patients wore augmented reality have a one to ten rating system,
(CLARAi) platform combines glasses that allowed the researchers but that's far from a reliable and
visualization with brain data using to view the subject's brain activity objective pain measurement,"
neuroimaging to navigate through in real time on a reconstructed brain noted DaSilva. - Dental Tribune
a patient's brain while in the chair. template. According to the International

Salivary microbiomes
of children show sexspecific differences

ANCOUVER, BRITISH
COLUMBIA, CANADA Dental caries represents one of
the most common chronic diseases in
young children and is a multifactorial
disease. Women exhibit higher caries
incidence than men, but it remains unclear

According to a recent study, boys and
girls show significant differences in their
oral microbiota. (Photograph: Yuliia
D/Shutterstock)
whether the same disparity is found in
children. A poster presentation on the
topic of sex-specific differences in the
microorganisms associated with dental
caries found in children's saliva was given
by Stephanie Ortiz of the Oregon Health
and Science University, Portland, U.S.,
at the 97th General Session and
Exhibition of the International Association
for Dental Research (IADR).
Continued on page 15

FEFU scientists may have
found way to grow new
teeth for patients

LADIVOSTOK, RUSSIA A group of histologists and
dentists from the Far Eastern
Federal University (FEFU) have
collaborated with Russian and
Japanese colleagues and discovered
cells that may be responsible for the
formation of human dental tissue. The
findings could provide a basis for the
development of bioengineering
techniques in dentistry aimed at
growing new dental tissue.
The scientists used human prenatal
tissue to study the early stage of
development of the embryonic oral
cavity during the fifth and the sixth
week of tooth formation. They
recognised several types of cells that
are involved in the formation of one
of the tooth rudiments, namely the
enamel organ. Additionally, they
identified the chromophobe cells
responsible for the development of
human teeth in the first weeks of
embryo growth.
"Numerous attempts to grow teeth
from only the stem cells involved in
the development of enamel, dentin
and pulp, i.e. ameloblasts and

odontoblasts, were not successful:
there was no enamel on the samples,
teeth were covered only by defective
dentin. The absence of an easily
accessible source of cells for growing
dental tissue seriously restricts the
development of a bioengineering
approach to dental treatment. To
In a recent study, scientists have identified cells that may help advance tissue
develop technologies of tissue
engineering and regenerative medicine and aid in developing novel treatments
engineering and regenerative
in dentistry. (Photograph: Pressmaster/Shutterstock)
medicine, promising methods of
treatment in dentistry, the cells
identified by us may become the clue
The scientist noted that large development, different types and
to the new level of quality dental chromophobe cells do not reside forms of teeth develop from the
treatment," said Dr Ivan Reva, senior only where the teeth of the embryo seemingly homogeneous and
researcher in the Laboratory for Cell form. They also exist at the border multilayered ectoderm which is
and Molecular Neurobiology at the where the multilayered squamous located in the forming oral cavity.
FEFU's School of Biomedicine. epithelium of the oral cavity passes However, it is already clear that more
"Natural implants that are into the cylindrical epithelium of kinds of cells are engaged in the
completely identical to human teeth the developing digestive tube. This earliest stages of human tooth
will no doubt be better than titanium means that the new bioengineering formation than were previously
ones, and their lifespan can be longer approach is relevant not only for supposed.
than that of artificial ones, which are growing new dental tissue but also
The study, titled "Embryonic
guaranteed for 10-15 years. Although for growing organs for subsequent development of human teeth", was
for a successful experiment, we still transplantation and will probably published in the March 2019 issue
have a lack of knowledge about be applied in gastroenterology. of the International Journal of Applied
intercellular signalling interactions
The scientists have yet to and Fundamental Research and is
during the teeth development," he understand how, in the earliest only available in Russian. - Dental
added.
s t a g e s o f h u m a n e m b r y o Tribune International

[11] => Dt pages.FH10

[12] => Dt pages.FH10

NEWS

12 DENTAL TRIBUNE Pakistan Edition July 2019

A shift in biofilm management
By Dr Klaus-Dieter Bastendorf

C

enturies ago, dentistry
identified mineral deposits,
such as calculus, as the main
cause of dental disease. Further
research then recognised bacterial
infections in the roots and the
periodontium as the cause of
periodontitis. So, what was the logical
solution? To remove calculus
completely. Today, we know that
calculus has a porous surface that
provides a niche environment
for bacteria and endotoxins.
Endotoxins are not absorbed into the
calculus, and they can be easily
removed. However, extensive
removal of calculus is contraindicated and counterproductive.
When I started out as a dentist over
40 years ago, prophylaxis was still in
its infancy. At my university, there
was minimal literature on everyday
oral hygiene. An eye-opening moment
for me was during a visit to Prof. Jan
Lindhe in Gothenburg in Sweden.
There, we studied cases of
periodontitis for which almost
everyone recommended complete
dentures. We then saw images of the
same patients ten years laterthey
still had their natural teeth, solely
thanks to prophylaxis. The thing that
made me opt for prophylaxis in
dentistry was the birth of my first
daughter. I would never have been
able to forgive myself if she had
developed a dental disease. This
private passion for preventative
dentistry and the vision of Prof. Per
Axelsson and Lindhe have stayed
with me to this day. Although my
childrens and grandchildrens teeth
are healthy, I do see many unhealthy
teeth in people in my own generation.
Forty years ago, there was a limited
understanding of biofilm, individual
diagnostics and individual
prophylaxis. We removed calculus
twice a year, but only introduced
individual diagnostics and treatment
in 1994. Today, we know the value
of prophylaxis. One major reason is
that we have a greater understanding
of the causes of the most prevalent
dental diseases. The trigger for
cavities, gingivitis, periodontitis, periimplant mucositis and peri-implantitis
is always biofilm and not calculus.
However, the amount of biofilm is
not the determining factor; rather, it
is the biofilms ecological make-up,
type and balance.
Biofilm is a microbial, organised
collection of microorganisms. The
microorganisms are embedded in a
matrix of extracellular polymer
substances that the microorganisms
produce themselves. Microorganisms
in biofilm show a different phenotype
regarding growth rate and gene
expression compared with suspended

living cells. Dental plaque is a kind
of biofilm, and since biofilm forms
an adhesive layer, special effort is
required to disrupt and remove it.
Classic
Currently, there are two avenues
available for the manual destruction
of oral biofilm, everyday manual
biofilm management and professional
manual biofilm management. In
professional manual biofilm
management, we have a range of tools
available, including manual
debridement with handheld
instruments and classic surface
polishing, as well as debridement with
sonic and ultrasonic instruments, such
as air polishing systems. Most dental
practices still clean the surface of the
teeth with manual tools. In initial
therapy, after the use of the PIEZON,
we sometimes still use manual tools,
though never for maintenance therapy.
The correct use of these manual tools
is technically challenging and requires
good tactile ability and extensive
training. The treatment itself is very
time-consuming and tiring for the
practitioner, but indispensable for
non-surgical treatment of deep
pockets caused by periodontitis. The
procedure often leads to oversensitive
roots and aesthetically displeasing
and noticeable recessions. Manual
tools are not well received by patients
either and often cause dental
practitioners hand and arm ligaments
to tire. These reasons have led to the
need for new tools to be used at
regular intervals.
or contemporary?
Axelsson and Lindhe began to use
ultrasonic tools in their maintenance
therapy. This technology broke
through in the 1980s as bulky
ultrasonic tips, which were replaced
with fine tips based on periodontal
probes. I can still remember the
introduction of gentler piezoceramic
ultrasonic devicesa true scientific
and technological innovation. Only
this ultrasonic technology allowed
linear, low-pain movements. A
consensus paper on this topic,
published during the EuroPerio7
congress in Vienna in Austria in 2012,
can be summarised as follows:
. Piezoceramic technologies have
proven effective for manually
removing build-up.
. They can be used universally (both
sub- and supragingivally) to remove
mineralised build-up and bacterial
biofilm.
. They are gentle on soft tissue.
. They allow for shorter treatment
times.
. They are less painful for the patient.
. They can be used after a short
training period.
Today, we know even more. Powder
jet devices can be used to remove
sub- and supragingival biofilm and

Dr Klaus-Dieter Bastendorf, scientific adviser to the Swiss Dental Academy,
explains dental prophylaxis and Guided Biofilm Therapy from Swiss company,
Electro Medical Systems (EMS). (Photograph: EMS)
staining more efficiently and quickly.
Low-abrasion powder based on
glycine or erythritol and new
subgingival nozzles perform
exceptionally well. The literature on
powder and water jet technology with
low-abrasion powders in biofilm
management, compared with manual
and ultrasonic tools, highlights the
benefits of this new technology.
Furthermore, air polishing with lowabrasion powder removes more
bacteria than manual and ultrasonic
tools do. Many studies have shown
that air polishing can remove
supragingival build-up and stains
much more effectively than classic
polishing methods can. This applies
to soft tissue, hard tissue and
restorative materials. Therefore,
subgingival air polishing with lowabrasion powder is sufficiently gentle
to be suitable for use on all dental
tissue.
A short guide to powder
The most commonly used powders
are sodium bicarbonate, glycine and
erythritol. Sodium bicarbonate is a
white crystalline powder with a range
of applications in food and medicine,
and it breaks down at temperatures
above 56 °C. In wet conditions,
sodium bicarbonate, a hydrogen
carbonate anion, can neutralise acids.
This property explains its central role
as the most important blood buffer,
since it can regulate the acid-alkali
balance in the human body.
Glycine is the simplest stable amino
acid that can be made by the human
body, where it acts as a radical catcher
and neurotransmitter. Glycine is found
in almost all foods that contain
protein, as it is a common building
block of almost all types of protein.
Glycine is also found in collagen, an
important component of tendons,
bone, skin and teeth. Glycine is an
approved dietary supplement with no
maximum dose, as it supports various
bodily functions. In the food industry,
it is often used as a flavour enhancer
or humectant. Studies from 2008
onwards have shown that air polishing
with glycine powder does not irritate
the gingivae.
Since 2012, we have almost
exclusively used erythritol, a white

crystalline powder with a pleasantly
sweet taste. Erythritol is found in
small amounts in nature, for example
in honey, wine grapes, melons and
mushrooms, and it is produced by the
fermentation of natural sugar. Owing
to its sweet taste, erythritol is used as
a sweetener to replace sugar. It has
almost no calories when absorbed by
the human body and is suitable for
people with diabetes. Oral bacteria
are not able to metabolise erythritol,
so it is not cariogenic. Various studies
have shown that only glycine and
erythritol powders do not change the
surface structure of composite fillings
and that erythritol powder produces
no changes on glass ionomer surfaces.
Guided Biofilm Therapy
Guided Biofilm Therapy (GBT)
perfectly combines air polishing
devices and low-abrasion powders.
Developed in collaboration with
universities and dental practices,
GBT is a concept designed for
contemporary prophylaxis. Based on
decades of scientific knowledge and
evidence, GBT is the next step in
prophylaxis. The eight steps that
comprise GBT can be adapted to suit
the treatment and patient, from
patients in initial therapy to patients
in maintenance therapy. It is for
healthy patients and for patients with
dental caries (especially in the initial
stages), gingivitis, periodontitis, periimplant mucositis or peri-implantitis.
The GBT concept ensures a
systematic, quality-orientated
approach, covering greeting of the
patient, diagnostic data collection,
everyday oral hygiene advice,
professional tooth cleaning, the
dentists final diagnosis and checkups, and chemically supported plaque
removal, as well as recalls. Alongside
the disclosing of the supragingival
biofilm, the process of professional
tooth cleaning has changed
considerably. The contemporary
approach begins with sub- and
supragingival biofilm removal using
air polishing technology with
AIRFLOW POWDER PLUS. This
erythritol-based powder guarantees
targeted, gentle, risk-orientated
removal of the biofilm to support the
Continued on page 14

[13] => Dt pages.FH10

[14] => Dt pages.FH10

14 DENTAL TRIBUNE Pakistan Edition July 2019

Study examines mothers
perception of her childs
oral health status

P

ITTSBURGH, U.S. - Mothers
play a primary role in the health
of their children. This function
may be particularly important for
children in Appalachia, a region in the
eastern U.S., who have increased
dental caries relative to children in
other areas of the U.S. In a recent
study on families in the region,
scientists have examined the degree
to which a childs caries experience
is in concordance with the mothers
perception of the health of her childs
teeth, and how this agreement varies
by socio-demographic factors. The
finding was that the majority of
mothers in the study were well aware
of their childrens oral health status.
The data obtained could help in
developing novel caries prevention
and treatment strategies.

The study was carried out by
researchers from the University of
Pittsburgh School of Dental Medicine.
The researchers obtained crosssectional data on mothers and their
children younger than 6 years old
through the Center for Oral Health
Research in Appalachia study. They
interviewed and clinically examined
a community-based sample of 815
motherchild dyads from
Pennsylvania and West Virginia. They
then statistically estimated the
association between a mothers
perception of her childs oral health
status and her childs actual caries
status, and compared the sociodemographic factors between
concordant and nonconcordant
motherchild pairs.
The finding was that the mothers

A recent study has highlighted the role mothers play in the health of their
children. (Photograph: Yuganov Konstantin/Shutterstock)
perception of her childs oral health
status was strongly linked with the
childs caries experience. In total, twothirds of motherchild dyads showed
concordance between the mothers
perception of her childs oral health
status and the childs caries experience.
Concordance was associated with
younger child age and the child having
dental insurance coverage.
The mothers awareness of her
childs oral health status could be used

to develop effective prevention and
treatment strategies, particularly for
young children who are more
susceptible to developing caries.
The study, titled Association
between a childs caries experience
and the mothers perception of her
childs oral health status, was
published online in the June 2019 issue
of the Journal of the American Dental
Association. - Dental Tribune
International

technician and the patient. With GBT,
we can finally carry out professional
biofilm management effectively,
gently, safely, quickly and without
pain.
For the best results, it is especially
important to use the correct devices
and tools, such as GBT. Currently,
there are a few new products on the
powder market. However, in addition
to the powders properties and
scientific evidence that these powders
are biocompatible and do not cause
damage, it has become increasingly
important for powders to be
compatible with dental devices. This
requirement has been addressed by
Switzerland-based EMS, who has not
only significantly contributed to the
development of GBT but also
provided suitable devices and tools
(including the AIRFLOW
PROPHYLAXIS MASTER,
AIRFLOW POWDER PLUS,
AIRFLOW handpiece, PERIOFLOW

handpiece, PERIOFLOW nozzle and
PIEZON NO PAIN).
The scientific knowledge and
technological progress for a paradigm
change in professional prophylaxis
have now been established. Now is
the time to integrate these
developments into our everyday
practice for the well-being of our
patients and ourselves. - Dental
Tribune International

Photo: DT Pakistan

PDA honours Dr Inayatullah
Continued from front page

Other prominent names among
those who attended the event include
Prof Mahmood Haider, Dr Rafiq
Moosa, Dr Hasnain Sakrani, Dr
Nadeem, Dr Wahab Qadri, Dr Awab
Alvi, Dr Arshad Hassan, Dr Masood
Zakai, Dr Farhan, Dr Mahmood
Hussain, Dr Hassan Askari, Dr
Murtaza Kazmi, Dr Saima Akram
Butt and Dr Amir Akbar Shaikh.
It was heartening to see the initiative
of Pakistan Dental Association for
acknowledging one of its most humble
and extraordinary member.

Medical & Dental Colleges ...
Continued from front page

and lateral borders of themodern
medical developments and techniques
to provide the best quality treatment
to their patients.
The council has also planned to
introduce major IT-based reforms, as
digital enablement was absent at the
PMDC. Steps are being taken on an
urgent basis to further enhance the
efficacy of the council by employing
a policy of automation and
digitisation of resources. A digital
portal was being designed to assist
the masses in verifying doctor
credentials such as their field of
specialisation through a mobile app.
This portal will also assist the public
in submitting their complaints as well
as reviewing the disciplinary actions
taken in regards to their complaint,
the official added.
Furthermore, the council will also

install proprietary software for
digitisation and electronic access to
the registration processes initiated or
undertaken by the council. These
systems will enable students and
doctors to renew as well as apply for
their licences, along with obtaining
different certification through a digital
system. A proactive policy was also
being developed to deal with the
pending litigation, which included
numerous court cases in a bid to
resolve those disputes that could be
easily dealt with by the PMDC itself,
the official said.

A shift in biofilm ...
Continued from page 12

initial diagnosis. This is followed by
the targeted and minimally invasive
removal of mineralised build-up with
PIEZON NO PAIN. This approach
has many additional benefits,
including short treatment times and
maximum comfort for both the

I always wanted to
be a dentist! I
thought I was going
to be fixing teeth
and making
beautiful smiles.
~Tori Bowie

[15] => Dt pages.FH10

July 2019 Pakistan Edition DENTAL TRIBUNE 15

Prevention 0: The best ...
Continued from page 8

favourable prosthetic positions, this
surgical intervention should only be
performed by an elite clinician. This
is an expert dentist with the necessary

and requirements and which has to be
planned before surgical intervention.
After data collection and decision
planning regarding the numbers of
implants requested, Toronto versus
overdenture, cemented versus screwed

Fig. 5c: Professional peri-implant biofilm removal by a)
AIRFLOW with erythritol powder (PLUS powder, EMS), b)
PERIOFLOW with PLUS powder and c) with PEEK tip (PI, EMS)

surgical skills to manage both soft and
hard tissue (before and after implant
placement) perfectly and with adequate
expertise in the prosthetic field to allow
a prothesis-guided implant surgery
and, subsequently, a functioning, not
overloaded, patient-tailored, cleanable
and aesthetically pleasant
rehabilitation.
Prosthodontist skills
Skilled clinicians know that there is
no such thing as a gold standard
prosthesis, but every patient needs a
tailored rehabilitation, which takes
into consideration his or her resources

Fig. 6: Improper planning led to poor performance

work, with a motivated and aware
patient, the surgical and prosthetic
work with careful load management
can start. Only careful and considerate
planning can prevent poor outcomes
(Fig. 6).
Prosthesis fabrication and
cementation
Dental technicians should work in
direct contact with prosthodontists in
order to create aesthetically pleasant,
patient-tailored and comfortable
cleaning spaces. After dental hygienist
instruction and training, patients
should be able to clean their prostheses

Scottish professor wins ...
Continued from page 6

Ogden is currently Professor of Oral Surgery at
the University of Dundee, as well as Vice President
of the Dental Faculty of the Royal College of
Physicians and Surgeons in Glasgow. Since
completing his PhD at the University of Dundee, he
has published more than 100 peer-reviewed works
on the topic of oral cancer ranging from basic science
to chairside management. For raising public
awareness about oral cancer and for his contribution
to professional education on the subject, Ogden
previously received the 2012 Ian Stevenson Award
for Excellence in Public Engagement with Research.
"I am deeply honoured to have received this award
from the IADR, which represents colleagues from
around the world," said Ogden. "It is obviously very
nice to be the focus of such recognition from one's
peers. It also shows the impact Dundee has made in
dental research and the international reputation we
hold." - Dental Tribune International
and final curing was achieved with 20 seconds of

Edelweiss PEDIATRIC CROWNs ...
Continued from page 9

light curing (Fig. 9). A recall visit four months later
showed no staining of the crowns and good gingival
health (Fig. 10)
Discussion
Dental aesthetics and retention of the anterior teeth
may influence proper psychological development in
childhood at an increasingly younger age, particularly
through interaction with other children. This is
evidenced by an increase in the demand for aesthetics,
rather than function, in primary tooth restorations.
To satisfy this demand, the market has recently seen
a shift away from stainless-steel crowns. Prefabricated
zirconia crownssuch as NuSmile, Cheng Crowns
and Kinder Krownsare made of yttrium-stabilised
zirconia, which is either milled or injection moulded.

daily with minimal effort to maintain
healthy mouths. Another important
factor associated with clinical signs
of peri-implant disease is excess
cement. To avoid excess cement,
restoration margins should be located

Fig. 7: Careful removal of excess
cement after prosthesis
cementation using a PEEK tip (PI)

Fig. 8: Careful removal of excess cement with dental floss
after prosthesis cementation

at or above the peri-implant mucosal
margin; otherwise, excess cement must
to be removed.
Despite world literature
demonstrating an increased interest in
excess cement as one of the key factors
in aetio-pathogenesis of peri-implant
disease, a standard protocol guiding
clinicians in this delicate removal
procedure is still needed. From the
authors' point of view, the cementation
procedure requires time, attention,
loupes and meticulousness. For these
reasons, an accurate protocol,
dependent on cement composition,

Zirconia crowns offer superior aesthetics compared
with stainless-steel crowns. However, in vitro fracture
load studies, such as by Townsend et al., showed
variation in crown thickness and fracture between
the zirconia crowns: statistically significant
differences were found between the forces required
to fracture zirconia crowns by the three different
manufacturers, and the increase in force correlated
with crown thickness. The forces required to fracture
the pre-veneered stainless-steel crowns were found
to be greater than those required to fracture zirconia
crowns made by any manufacturer. With a flexural
modulus of 20 GPa, the behaviour of edelweiss
PEDIATRIC CROWNs is similar to that of the
natural tooth structure.
The edelweiss PEDIATRIC CROWNs imitate the
form of natural primary teeth well and mimic the
anatomy of the primary tooth. The mesial and distal
margins of the edelweiss PEDIATRIC CROWNs
follow the natural gingival margin of the primary
teeth, minimising excessive tooth reduction and
removing the need to take margins subgingival unless
caries dictates extension. Furthermore, because of
the minimal preparation needed, there is no risk of
iatrogenic damage to pulp tissue of the primary tooth.
These prefabricated crowns permit quick and safe
treatment with maximum aesthetic results. Should
retreatment be required, edelweiss PEDIATRIC
CROWNs offer the advantage of being easy to
remove, as they can be cut in a way similar to dentine.
The morphology of the edelweiss PEDIATRIC
CROWN has similar cuspal features to that of a
primary tooth, hence very little occlusal adjustment
is needed. If it is needed, it can be done on the
paediatric crown itself and not on the opposing tooth,
thus preserving the natural tooth structure, unlike
zirconia crowns, for which any occlusal adjustment
has to be done on the opposing tooth, causing
unnecessary damage to the opposing tooth.
Furthermore, the natural abrasion of edelweiss crowns

should be published (Figs. 7 & 8).
Conclusion
Implant rehabilitation provides a
therapeutic alternative that is more
similar to natural teeth than other
alternatives. Nevertheless, while an

implant-supported prosthesis can be a
permanent successful solution, it lasts
only if carefully planned with the
patient, properly surgically performed,
correctly loaded, and constantly
maintained by the patient and the dental
professionals. Successful results can
be achieved only by an expert, patientcentred dental team.
Editorial note: A list of references is
available from the publisher. This
article was published in implants international magazine of oral
implantology No. 04/2018. - Dental
Tribune International

and the flexural modulussimilar to that of a natural
toothmay make these crowns more tolerable in
t h e c h i l d s m o u t h a n d k i n d e r t o t h e
temporomandibular joints.
Conclusion
The edelweiss PEDIATRIC CROWN provides a
simple and effective treatment option for the
restoration of decayed primary teeth that is aesthetic
but also functional, making it a superior alternative
to both stainless-steel and zirconia crowns. - Dental
Tribune International

Salivary microbiomes of ...
Continued from page 10

Saliva specimens were collected from 85 children41 boys and 44 girls-between the ages of 2 and 14
years. Microbial DNA was isolated using an isolation
robot and then subjected to polymerase chain reaction
amplification.
Significant differences in oral microbiota were
found between caries-active boys and girls. The
primary microbial genera associated with caries in
young children include Actinobaculum, Atopobium,
Aggregatibacter and Streptococcus. Actinobaculum,
Veillonella parvula and the acid-generating
Lactococcus lactis, all microorganisms associated
with dental caries, were found in much higher
prevalence in caries-active girls than boys, indicating
that these microorganisms may play a more
significant role in girls to shape their cariogenic
microbial environment.
The poster presentation, titled "Gender-specific
differences in the salivary microbiome of cariesactive children," was given on June 21, 2019. The
IADR General Session and Exhibition was held in
Vancouver in conjunction with the 48th Annual
Meeting of the American Association for Dental
Research and the 43rdAnnual Meeting of the
Canadian Association for Dental Research.
- Dental Tribune International

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[cover] => DT Pakistan No. 4, 2019

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News / Clincal Implantology / Pediatric Dentistry

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