DT Pakistan No. 6, 2014

News / Contribution of CAD/CAM technology to implant-supported screw-retained restorations - Use of a full-arch bridge in the maxillae: A case report / International News

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Editor - Online
Haseeb Uddin

PUBLISHED IN PAKISTAN

New research ties
tobacco use to
higher risk of
oral HPV infection

www.dental-tribune.com.pk

Contribution of CAD/
CAM technology
in dental
implantology
Page 2

CLINICAL PRACTICE

NOVEMBER, 2014 - Issue No. 06 Vol.1

Karachi first ever
Style Italiano
Restorative
Workshop
Page 4

Page 8

Karachi first ever Style
Italiano Restorative Workshop

President
PDA
encourages
students
to attend the
forthcoming
Symposium

Editor - Online
Haseeb Uddin

DT Pakistan Report

K

ARACHI: Keeping up with its tradition of
bringing the dental fraternity together with
outstanding symposiums, seminars and
other related events, the very first Style Italiano
Restorative Workshop was organized on the 19th
of October at Pearl Continental Hotel, Karachi, in
collaboration with Pakistan Dental Association.
Amidst countless uncertainties pertaining to the
political scenario and law and order situation of the

city, the workshop received an overwhelming
response and was attended by house officers, trainee
residents, private practitioners and students from
leading institutes of Karachi and Hyderabad.
The Expert Symposium started with the recitation
from the Holy Quran followed by the National
Anthem. The programme started on time with the
lecture of Dr Arshad Hasan, Head of the
Continued to page 08
New Delhi to discuss and
exchange information on
the newest methods and
concepts in dentistry, as
well as the latest issues
and developments
concerning oral health.
From India alone, the
organisers expected more
than 10,000 participants
to attend the event, which
was held at the India Expo
Centre and Mart in
Greater Noida, a satellite
town with a population of
100,000 outside the Indian
capital. They were joined
by hundreds of dental
professionals came to India from all over the globe.
It is the second time that India hosted the prestigious
dental event since 2004. While the country has made
large strides since then in the improvement of health
and now boasts the world’s largest dental workforce,
Continued to page 11

FDI Annual World Dental
Congress held in India

DT International Report

N

EW DELHI, India: After a decade, the
Annual World Dental Congress of the FDI
World Dental Federation made its first return
to India. Over a period of four days, dental
professionals, public health stakeholders and the
dental industry came together in Greater Noida near

DT Pakistan Report

K

ARACHI: Dr Saqib Rashid,
President Pakistan Dental
Association (PDA) addressed the
participants of the Style Italiano Restorative
Workshop, and encouraged them to attend
similar events and workshops arranged in
the future as they offer an excellent learning
platform for all aspiring dental practitioners.
He invited them to attend the forthcoming
PDA Symposium to be held on the 30th of
November. The event was previously
postponed owing to the uncertain political,
and law and order situation of the city,
keeping the safety of participants in mind.
Upon its initial announcement, the
Symposium had received an overwhelming
response. Distinguished professionals of
Pakistan’s dental community will be
presenting their lectures at the event and
hand-on workshops will also be organized.
He stated that the Pakistan Dental
Association has organized the Symposium
aiming to equip young minds with new
skills, techniques and knowledge and that
all students must register for it.

[2] =>

2 DENTAL TRIBUNE Pakistan Edition November 2014

New research ties tobacco use to
higher risk of oral HPV infection

Publisher/CEO
Editor
- Online
Syed
Hashim A. Hasan
Haseeb
Uddin
hashim.hasan@dental-tribune.com.pk
Editor Clinical Research:
Dr. Inayatullah Padhiar
Editors Research & Public Health
Prof. Dr. Ayyaz Ali Khan
Editorial Executive
Dr. Tehmina Khan
Editor - Online
Haseeb Uddin
Graphics Designer
Sh. M. Sadiq Ali

Dental Tribune Pakistan
DT International Report

B

ALTIMORE, USA: A recently
published study has shown that
infection with the oral human
papillomavirus Type 16 (HPV 16), which is
also thought to cause oropharyngeal cancer,
is more common among people who have
recently used or been exposed to tobacco. The
researchers found that even modest tobacco
use, like three cigarettes per day, is associated
with higher oral HPV prevalence.
The study included 6,887 participants, who
were originally enrolled in the National Health
and Nutrition Examination Survey, a program
of studies designed to assess the health and
nutritional status of adults and children in the
U.S. Current tobacco users accounted for 28.6
percent (2,012) of the study population and 1
percent (63) were infected with HPV 16.
Examination of blood and urine, as well as
oral rinsing and gargling to collect mouth and
throat cells, found that participants with higher
levels of tobacco-related biomarkers in their
blood and urine, which can come from any
tobacco source-even secondhand smoke-were
more likely to have oral HPV 16 DNA
compared with those who had no detectable
levels of the compounds, explained Dr. Carole

F a k h r y, a n a s s i s t a n t p r o f e s s o r o f
otolaryngology–head and neck surgery at the
Johns Hopkins University School of Medicine,
where the study was conducted. According to
the study, oral HPV 16 prevalence was greater
in current tobacco users (2.0 percent) than in
former tobacco users or those who had never
consumed tobacco (0.6 percent).
In addition, a dose-response relation was
found. The equivalent of three cigarettes per
day increased the risk of HPV 16 by 31 percent,
and the equivalent of four cigarettes per day
increased the risk by 68 percent.
HPV 16 is primarily transmitted through
oral sex, and current tobacco users in the study
were more likely to have a higher number of
lifetime oral sexual partners compared with
nonusers. Thus, although the study found an
independent relationship between tobacco use
and HPV 16 infection, it cannot be ruled out
that participants who used more tobacco might
also have had more oral sex and were therefore
at higher risk of infection.
The study, titled “Tobacco Use and Oral
HPV-16 Infection,” was published in the Oct.
8 issue of the Journal of the American Medical
Association.

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Dental Tribune Pakistan.

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Group Editor

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Tel.:+49 341 48 474 107

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Chicago Crash claims the lives of three
gifted Pakistani doctors

Magda Wojtkiewicz
Yvonne Bachmann
Claudia Duschek
Sabrina Raaff
Hans Motschmann
Torsten Oemus
Dan Wunderlich
Claudia Salwiczek
Lars Hoffmann
Matthias Diessner
(Key Accounts)
Melissa Brown
(International)
Peter Witteczek
(Asia Pacific)
Maria Kaiser
(North America)
Weridiana Mageswki
(Latin America)

Hélène Carpentier
(Europe)

DT Pakistan Report

C

HICAGO: According to the NTSB
investigators, an airplane headed
towards Lawrence disappeared off
radar and later crashed near a suburban area
of Chicago on the eve of Sunday. The
investigators confirmed that three passengers
killed in the crash were identified as Dr Tausif
Rehman M.D., Dr Ali A. Kanchwala M.D.
and Dr Maria Javaid Kanchwala M.D. Dr
Rehman was an esteemed neurosurgeon at
Cotton-O’Neil Topeka, Dr Ali was a
pulmonologist at the same clinic, and Dr Maria
was an interventional cardiologist at the
Kansas City Providence Medical Center.
The plane reportedly crashed in the Palos

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Dental Tribune International
Hills area on an empty lot, and therefore did
not cause any casualties on the ground.
According to the reporters, the three
passengers on board were flying to Chicago
for a shopping trip. Only five minutes after it
had left the Midway Airport in Chicago, the
plane crashed after it was lost on the radar.
Based on the debris scatter and damage at
the scene, the investigators have assumed that
the six-seat plane had made a ‘nosedive’ crash
landing. John Brennan, a National
Transportation Safety Board air safety
investigator, explained that the aircraft had
impacted at an almost vertical position.
Continued to page 11

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[3] =>

[4] =>

4 DENTAL TRIBUNE Pakistan Edition November 2014

Contribution of CAD/CAM technology to
implant-supported screw-retained restorations
Use of a full-arch bridge in the maxillae: A case report
Author Dr Richard Marcelat, France

n dental implantology, the optimal and truly
passive fit of the framework is essential for the
longterm success of a restoration owing to the
physiology of bone tissue around implants. For a
multiple-unit implant-supported restoration, the
traditional pouring technique is rather complex and
challenging. The difficulty of achieving a passive
fit is directly correlated to the number of components
used and the volume of the framework. CAD/CAM
technology provides such a high level of accuracy
that it has revolutionised the field of restorative
dentistry.
Today, many implant manufacturers collaborate
with industrial companies to develop state-of-theart machining solutions for their implant-supported
frameworks. In that regard, the concept developed
by Simeda (Anthogyr) is innovative and supported
by many years of proven success in the fabrication
of CAD/CAM dental restorations. The major
advantage of CAD/CAM technology is that it
guarantees a highly accurate and predictable fit
(< 10 m). This clinical case report demonstrates the
high potential of this novel digital solution.
Patient presentation
The male patient was a former smoker and 51
years old when the treatment was initiated. He
presented with high blood pressure and took Tahor
(pFizer) on a daily basis. In addition, he had been
on Kardegic (Sanofi) therapy since a heart attack
in 2005. For functional and aesthetic reasons, he
wanted a fixed
prosthesis in his maxillary arch (Figs. 1a & b).
Debridement and pre-implant surgery
Owing to the periodontal condition of his
remaining maxillary teeth, all of them were
atraumatically removed. Then, mechanical
debridement was performed through alveolar
curettage and copious irrigation with Betadine. A
maxillary complete overdenture was fabricated
and placed on the same day of the extractions.
After a healing period of four months,
DentaScan images (GE Healthcare) were obtained
to evaluate the bone height. The scans showed
significant bone resorption in the posterior sections
of the maxillae (Figs. 2a–c): SA-4, according to
Misch’s classification, since the residual ridge
height was less than 5 mm. Sinus grafting was
deemed necessary and implant placement had to
be delayed by five to six months, until complete
healing and good initial stability had been
achieved.
Bilateral sinus lift was performed under local
anaesthesia from a lateral approach using the
technique described by Tatum. The Schneiderian
membrane was lifted gently. As there were no
perforations, platelet-rich fibrin was used for
coverage of the sinus floor. Maxgraft (botiss
biomaterials) allografts were placed to elevate the
maxillary sinus floor, and then covered with a
Bio-Gide (Geistlich) collagen membrane and
platelet-rich fibrin.
After a healing period of five months, the
patient underwent a CT scan wearing a scan
prosthesis of acrylic resin and commercially
available teeth for visibility of the desired tooth
location in the CT images. The CT examination
showed adequate bone volume in the grafted
posterior regions and an even sinus floor with
homogeneous allografted areas. The dome-like
shape of the vestibulo-lingual crosssections was
indicative of the absence of material leakage into

CLINICAL PRACTICE
Fig. 1a
Initial status.
Fig. 1b
Pre-op panoramic
radiograph.

Fig. 1a

Editor - Online

the maxillary
sinuses
(Fig. 5a).
Haseeb
Uddin
Osteogenic activation
I performed osteogenic activation of the processed
maxgraft bone used for sinus lift using the technique
described by Scortecci.
A trans-parietal approach was used for insertion
of the Bone Matrix Osteotensor (Victory) after a
minimally invasive flapless protocol. Endosteal
stimulation results in osteogenic activation and
allows evaluation of the mechanical strength of the
grafted areas by probing. Owing to this simple and
minimally invasive technique, the initial quality of
the future recipient bone site is easily assessed.
These techniques have been successfully used
in orthopaedics for ten years. In view of the excellent
response to osteogenic activation, it was decided
that implants would be placed 45 days later.
Treatment planning
The case was planned in the SIMPLANT
(DENTSPLY Implants) treatment planning software.
The scan prosthesis is critical for determination of
the correct position and axial alignment of the
implants; visualisation of the emergence profile;
and determination of the size, position and axial
alignment of the abutments. Furthermore, it allows
optimal use of the available bone height. At this
stage, special attention should be paid to 3-D
positioning of the implants and particularly to the
emergence profile in order to facilitate the fabrication
process of the final restoration. Straight or angled
conical abutments are now clearly visible on the
vestibulo-lingual cross-sections. Ten Axiom PX
implants (Anthogyr) were planned for a maxillary
screw-retained bridge restoration (Figs.5a-c).
Implant placement
Implant placement was performed under local
anaesthesia using the case-specific surgical guide.
For this patient, I used a specific implant design
(Axiom PX, Anthogyr) with symmetrical doublelead threads (selfdrilling and self-tapping) and a
reverse conical neck. Its unique design, combined
with a special drilling protocol, promotes bone
conden sation even in soft bone, ensuring excellent
initial fixation. The BCP (biphasiccalcium
phosphate) sandblasting technique yields an implant
surface with superior osteoconductive properties
that positively influence the development of
osteoblastic cells in the early stage of
osseointegration. A flapless technique was used for
implant placement. The flapless technique has
definite advantages: preservation of the subperiosteal
blood vessels, and improved patient comfort owing
to a shorter operating time and simple post-operative
care.
Temporary bridge and immediate loading
It was agreed with the patient that the implants
would be immediately loaded, provided that good
initial stability was obtained. The temporary
removable prosthesis would be worn for a limited
period. Fortunately, adequate stability was achieved,
allowing for immediate loading. Each implant
(except #27) was torqued to 35 Ncm or more. On
the same day, an impression was made using the
pick-up technique, with a previously prepared
impression tray. First, the final straight conical
abutments were hand tightened into the implants
using a torque of 15 Ncm. They were intended to
accommodate the screwretained provisional and
then the final screwretained prosthesis.
The Axiom PX implant system offers two major

Fig. 1b

Fig. 2a

Figs. 2a–c
DentaScan
images.

Fig. 2b

Fig. 2c

Fig. 5a
Fig. 5a Implant placement planning in SIMPLANT (DENTSPLY
Implants) software.
Fig. 5b Implant placement planning in SIMPLANT (DENTSPLY
Implants) software.
Figs. 5c–d CT cross-sections.

Fig. 5d

Fig. 5b

Fig. 5c

Fig. 7a
Panoramic radiograph
showing the temporary bridge
placed 48 hours earlier.
Figs. 7b The high-rigidity
temporary bridge made
of cobalt–chromium and resin.

Fig. 7a

Fig. 7b

Fig. 8

Fig. 9a

Fig. 9b
Fig. 8 Healing status
at six months post-op.
Fig. 9a The impression.
Fig. 9b The interconnected
pick-up transfer copings.
Fig. 9c The wax bite block.
Fig. 9d The master model.

Fig. 9c

Fig. 9d

[5] =>

CLINICAL PRACTICE

Fig. 10

Fig. 11b

Fig. 11c

Fig. 11d
Fig. 10 A wax-up of the framework.
Figs. 11a–d CAD of the model.
Fig. 12a

Fig. 12b

Fig. 12c
Figs. 12a–c Machining from a titanium block.

Fig. 13a

Fig. 13b

Fig. 13c

Fig. 13d

Fig. 13e

Fig. 13f

Figs. 13a & b The machined titanium framework.
Figs. 13c–f The final bridge.

Fig. 13g The patient’s new
smile.
Fig. 13f
Fig. 13h A post-op panoramic
radiograph with the bridge
in place.
Fig. 13g

Fig. 13h

November 2014 Pakistan Edition DENTAL TRIBUNE 5
advantages: platform switching and indexing trilobe
morse taper connection. The latter greatly facilitates
abutment placement. A tight stable connection
guarantees integrity of the soft tissue (Fig. 8).
In the laboratory, the master model with the
embedded analogue was used to fabricate a master
plaster cast. A high-rigidity cobalt-chromium and
resin temporary bridge was fabricated, tried in, and
transferred to the patient’s mouth 48 hours after the
implants had been placed. This provisional device
would serve as an external fixator during osseointegration of the implants.
A control radiograph was taken to confirm the
passive fit of the framework. The temporary bridge
was hand tightened to a torque of 10 Ncm. The
occlusion was accurately adjusted (Figs. 7a-b). The
patient wore the temporary bridge for six months.
During that period, a number of parameters were
evaluated, including occlusion, osseointegration
status, oral hygiene, mastication, phonetics,
aesthetics and lip support. The temporary bridge
should be rigid (framework) and easily removable
(screw fixation). Site #27 healed uneventfully,
protected as it was from mechanical stress.
Final bridge
At the end of the six-month healing period,
preparation for the final restoration began. Wearing
the temporary bridge had allowed adjustment of
the abovementioned parameters (e.g. aesthetics,
phonetics and lip support) and validation of the
vertical dimension and intermaxillary relationship.
The temporary bridge was removed, an implant
stability percussion test was performed, and control
radiographs were taken. The straight conical
abutments that had been placed concomitant with
the implants were tightened to 25 Ncm (as
recommended by the manufacturer), except
abutment #23, which was angled (Fig. 8).
An impression of the final bridge was taken with
the same impression tray used for the temporary
bridge.
Pick-up transfer copings were interconnected
using LuxaBite resin (DMG), and the impression
was made using Impregum (3M ESPE). The master
model, including the conical abutment analogues
and silicone soft tissue (representing the patient’s
gingiva), was fabricated and then validated in the
dentist’s office via a wax bite block (into which
extra-hard plaster material was poured). The wax
bite block was then tried in (Figs. 9a–d).
Using silicone indices (vestibular, occlusal and
palatal) from the temporary bridge, a wax-up was
fabricated in the laboratory (Fig. 10). The wax-up
had to meet the aesthetic demands of the patient
and be an exact replica of the temporary bridge
(both anatomically and aesthetically). The validated
master modeland wax-up were sent to the SIMEDA
machining centre, where the master model was
scanned and a CAD model was designed (Figs.
11a–d). A PDF 3-D file is used to validate the
design, after which the manufacturing process can
be initiated. All pieces are machined from titanium
blocks using high-precision five-axis milling
machines (Figs. 12a–c).
Titanium is a lightweight material and, more
importantly, it is highly biocompatible and has
superior mechanical properties. It is four times
lighter than commonly used semiprecious alloys.
Actually, it is the lightest metal used in dentistry.
Furthermore, titanium is a self-passivating metal:
it readily reacts with oxygen in air to form a tough
layer of oxide, which protects against corrosion.
Titanium is known to resist corrosion and chemical
attacks extremely well. Furthermore, it is
bactericidal, a key advantage for dental implants.
Material density is a crucial factor in
implantology. We believe that the weight of a
maxillary implantsupported prosthesis is the most
important factor for the outcome of the restoration.
A few days later, we received the framework for
try-in. It had a perfect passive fit and was returned

to the laboratory for veneering. The metal
preparation in the laboratory entailed sandblasting,
titanium etching and the application of opaque
porcelain to conceal the metal core. The bisquebaked restoration was then tried in to allow the
patient to validate the aesthetics of the restoration.
This step is necessary to assess static and dynamic
occlusion and perform minor adjustments (Figs.
13a–g). The bisque-baked restoration was then
returned to the laboratory for fine tuning and
glazing.
CAD/CAM benefits
Although conventional casting techniques have
evolved, they are still fraught with inaccuracies
owing to the nature of the materials and to their
handling. This includes the risk of errors during
investment processing, risk of metal deformation
and poor metal homogeneity. The CAD/CAM
technologies used for producing metal frameworks
are essential to the quality of the final restoration.
The CT scan data is converted into a format that
allows the 3-D images to be utilised by the selected
treatment planning software. The case is then
planned in the software.
The CAD software has databases that allow the
creation of virtual models for the desired restoration
using different materials, including zirconia,
titanium, cobalt–chromium, IPS e-max and PMMA.
If the dental laboratory has its own scanner, an
STL file is sent directly to the production centre
by e-mail. Otherwise, both the model and the waxup are forwarded to the production centre by courier.
If the computer settings are correct, one is
ensured of perfect reproducibility in the
manufacturing process and consistency in the result
(i.e. a truly passive framework fit). Optimal setting
of the coping thickness parameter or the pontic
connection parameter may prevent torsion or
deformation of the framework during firing of the
ceramic. Subtractive manufacturing, combined with
digital modelling, eliminates the risk of alteration
of the material structure. The resulting metal
framework will have optimal homogeneity and
density.
As regards fabrication of implant superstructures,
machining is the technique of choice for achieving
high precision and near passive fit. Practitioners
can expect consistent and reproducible results,
excellent framework fit, and regular, accurate
prosthetic seals.
Conclusion
Today, dental laboratories are using high-tech
scanning equipment, which allows digitisation of
the master model (to determine the implant index)
and the wax-up. CAD/CAM offers a level of quality
and accuracy unsurpassed by any of the traditional
techniques. Passive fit, which is critical to the
outcome of an implant-supported prosthesis, is a
determinant of the long-term success of a
restoration. Passive fit of the framework for a longspan restoration is much easier to achieve and
reproduce with CAD/CAM than with the traditional
pouring techniques.
The use of CAD/CAM machining for
implantsupported restorations guarantees a highly
accurate and predictable framework fit (< 10 m).
In addition, machining centres can produce
restorations using fully biocompatible materials,
such as titanium and zirconia. In order to take
advantage of the accuracy of CAD/CAM, using
safe and reliable implant systems with superior
biological and biomechanical characteristics is
required.
CAD/CAM will soon be essential. Current
CAD/CAM solutions are easily accessible to any
dentist and do not require fundamental changes to
his or her work habits.
Acknowledgement: Special thanks to G. Nauzes
and J. Bellany, laboratory technicians at Socalab.

[6] =>

6 DENTAL TRIBUNE Pakistan Edition November 2014

World’s Best Goalkeeper
sits for dental impression
for Madame Tussauds

INTERNATIONAL NEWS

Barts study on severe periodontitis
reveals looming crisis

Editor - Online
Haseeb
Uddin

DT International Report

ERLIN, Germany: Manuel Neuer, currently the World’s
Best Goalkeeper, has attended a sitting to be measured
for the creation of his wax twin, which is soon to be
exhibited in Madame Tussauds wax sculpture museum in Berlin.
In addition to body size, and eye and hair colour, the experts
from London needed a dental cast to create a true-to-life smile
for the wax figure.
The 28-year-old goalkeeper, who together with his team
won this year’s World Cup, has achieved many football
successes: World’s Best Goalkeeper in 2013, German footballer
of the year in 2011 and 2014, Golden Glove Award in 2014,
UEFA Champions League winner in 2013 (FC Bayern
München).
“Manuel Neuer is one of the most popular football players
and since the World Cup the most desired football figure of our
visitors,” said Sandra Schmalzried, General Manager of Madame
Tussauds Berlin. “We would love to show the whole world
champion team; however, unfortunately, at a cost of
approximately €200,000 per figure that is not possible.” Thus,
Neuer’s wax figure will represent the entire national team.
For the sitting, during which all of the necessary
measurements were captured, a Madame Tussauds team of
three travelled all the way from London with several boxes of
equipment. With a tape measure and callipers, they took 226
measurements and more than 150 photographs of Neuer’s head
and body from different angles. Using colour scales, his skin,
hair and eye colour were determined.
Dentures produced by external dental laboratory
Even though a small part of the body, the wax figure’s teeth
require precise work and collaboration with a dental laboratory.
“When we meet the celebrity for a sitting, we create a dental
impression, like a dental cast, which we cast out of silicone or
putty. We then send this straight to the dental laboratory to
replicate and create a denture,” a Madame Tussauds wax artist
explained to Dental Tribune ONLINE.
“When we receive the teeth, the gingivae are made out of
wax and the teeth from acrylics. We analyse them, look at them
and check measurements. We try them in the wax head by
inserting them through the neck. If they are signed off by the
senior sculptor, we send them back to the same dental laboratory
for processing. The wax gingivae are replaced with hard acrylic,
a type of resin used for manufacturing dentures. When we
receive the final set, we reinsert them through the neck to be
fitted properly into the wax figure’s head.”
For historical figures, or when the wax figure creators are
not able to meet with a celebrity and take a dental impression,
they create a research file of information about that person’s
teeth, containing photographs of him or her smiling and
photographs that show his or her gingival colour. They blow
up the photographs to be life-size and then the dental laboratory
produces a set of dentures based on the information they have
collated, including measurements, and tooth and gingival shadesalways working from an anatomical standpoint to ensure that
the teeth would function in theory in an actual head.
Wax figure reflects personality and character
During his sitting, Neuer was also closely observed by the
wax artists to establish every detail, including the way he
Continued to page 11

ONDON, UK: Figures by the National Health Service indicate that at least one
in 15 adults in the UK currently suffers from the most severe form of periodontal
disease. Worldwide, the situation looks even more devastating with the condition
to be found in roughly 11 per cent of the earth’s population. An international review
published by researchers from Barts and The London School of Medicine and Dentistry
and dental institutions in Australia and US in the Journal for Dental Research has recently
provided the first insights into the global dynamics of the disease and where it is most
prevelant.
According to the paper, prevalence as well as incidence of severe periodontitis was
reportedly highest in East Sub-Saharan Africa and most parts of South America. Several
countries including Australia, Indonesia or Greece, among others, also ranked below the
global average.
Regions with low occurrence were North America, followed by developed countries
in the Asia Pacific region, as well as Oceania and Western Europe.
While no statistically relevant difference could be found between genders, the researchers
said the condition seemed to increase with age throughout all surveyed countries. Hence,
people at age 38 and beyond are most at risk for developing severe periodontitis.
Overall, the study found that more than 700 million new cases of severe periodontitis
worldwide add to the already large burden every year, which makes the condition rank
among the six most prevalent diseases worldwide. If untreated, it can lead not only to
physical pain and psychological discomfort, but also to functional limitation, as well as
physical and psychological disabilities, according to the author, Director of Research at
Barts Health NHS Trust Prof. Wagner Marcenes, who headed the study.
“The number of severe periodontitis cases has increased dramatically between 1990
and 2010. Since we did not include other types of periodontitis such as its mild and
moderate forms, we are facing an even more serious problem in the population’s oral
health,” he commented on the results.
He said that the data are currently being evaluated further to find out what might cause
this high prevalence including socio-economic indicators and other risk factors.
One of the largest assessment ever conducted on the disease, the review was looking
at epidemiological data from more than 70 studies involving 300,000 patients from 37
countries. While it provides insight into the realities of the disease, according to the
researchers, the results will have to be treated with caution owing to the problem on how
to actually measure periodontal disease. A new standard introduced by the American
Academy of Periodontology and the US Centres for Disease Control and Prevention in
2007, for example, made it difficult to compare any data collected prior.
In the report, the researchers indicated any site with Community Periodontal Index of
Treatment Needs 4, clinical attachment of larger than 6mm and pocket depth of 5 as
periodontitis.

Little progress recorded in historical
cleft lip and palate treatment
DT International Report

EW YORK, N.Y.,
USA: The Cleft
Palate–Craniofacial
Journal recently presented a
historical review of what
We s t e r n d o c t o r s a n d
scientists knew about defects
known as cleft lip and palate. The authors
of the review sought to verify that treatment
and surgical techniques for these
malformations were largely esthetic and
unchanged until the 19th century.
When the printing press was invented in

the mid-1400s, it had an unexpected effect
on the practice of Western medicine. With
the creation of moveable type, works by
ancient and medieval doctors could be
preserved, and contemporary surgeons were
Continued to page 11

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[8] =>

8 DENTAL TRIBUNE Pakistan Edition November 2014

Health authorities offer
Ebola guidance for
dentists
DT International Report
TLANTA & CHICAGO, USA: In close
collaboration with the Centers for Disease
Control and Prevention (CDC) and the
Organization for Safety, Asepsis and Prevention,
the American Dental Association (ADA) has
released information for dental professionals on
Ebola virus disease, which is epidemic in West
Africa. Among other recommendations, it provides
advice on the treatment of patients recently
returned from the region.
CDC and its partners are currently working to
help prevent Ebola and other infectious diseases
from being introduced into and spread in the
U.S. As of Oct. 17, the ADA advises dental
professionals of the following:
A person infected with Ebola is not considered
contagious until symptoms appear. Owing to the
virulent nature of the disease, it is highly unlikely
that someone with Ebola symptoms will seek
dental care when he or she is severely ill. However,
according to CDC and the ADA Division of
Science, dental professionals are advised to take
a medical history, including a travel history, from
their patients with symptoms in whom a viral

A

infection is suspected.
As recommended by the ADA Division of
Science, any person within 21 days of returning
from the West African countries Liberia, Sierra
Leone and Guinea may be at risk of having
contacted persons infected with Ebola and may
not exhibit symptoms. If this is the case, dental
professionals are advised to delay routine dental
care of the patient until 21 days have elapsed
from their trip. Palliative care for serious oral
health conditions, dental infections and dental
pain can be provided if necessary after consulting
with the patient’s physician and conforming to
standard precautions and physical barriers.
In general, providers of dental health care
services should continue to follow standard
infection control procedures in the clinical setting
as described in CDC's 2003 Guidelines for
Infection Control in Dental Health-Care Settings,
the organization stated.
Signs and symptoms of Ebola include fever
greater than 38.6 C or 101.5 F and severe
headache, muscle pain, vomiting, diarrhea,
stomach pain, or unexplained bleeding or bruising.

CDC emphasized, “The virus is spread through
direct contact with blood and body fluids of an
infected person, or with objects, like needles, that
have been contaminated with the virus. Ebola is
not spread through the air or by water or, in
general, by food.”
The 2014 Ebola epidemic is the largest in
history, affecting multiple countries in West Africa,
including Guinea, Liberia, Nigeria and Sierra
Leone. Its outbreak was first officially recognized
in March this year. According to estimates by the
World Health Organization (WHO), about 9,000
people have been infected with the disease and
about 4,500 have died.
The first Ebola case to be diagnosed in the
U.S. in a person who had travelled to Dallas from
West Africa was confirmed on Sept. 30.
On Oct. 17, WHO officially declared the Ebola
outbreak in Senegal over and commended the
country on its diligence in ending the transmission
of the virus. Three days later, WHO officially
declared that Nigeria is now free of Ebola virus
transmission.

Karachi first ever Style Italiano
Restorative Workshop

their dental restorations. Dr Salman also presented
an additional lecture on the measures that must
be taken in medical and dental operatories for
patients suffering from osteo-radio necrosis.
Dr Saqib Rasheed also addressed the gathering,
appreciating the commendable efforts put in by
the organizers for the event. He also invited the
participants for the PDA symposium which is to
be held on the 30th of November, and encouraged
the participants to attend future events and
seminars.
Dr Mumtaz Khan expressed his gratitude and
shared his words of wisdom with the young minds.
The three then presented shields to the guests, Dr
Arshad Hasan, Dr Salman Ashraf and Dr Urooj
Mumtaz. Sumptuous lunch was served at the TaiPan restaurant at PC before the hands on
workshop.
During the workshop, the participants were
divided into two groups that were supervised by
Dr Arshad Hasan and Dr Salman Ashraf. Both
the mentors diligently taught the youngsters how
to master the Style Italiano technique. All material
for the workshop was supplied by 3M Pakistan.
Dr Urooj Mumtaz guided the participants as they
proceeded with their work.
3M Pakistan, AusPak International and DIO
Implants were the key sponsors of the event, and
IADSR offered its support in the form of 5
international credit hours to all participants of the
workshop.
Towards the end of the event, the attendees
received certificates of participation. All attendees
were encouraged to share their views, experiences
and pictures online.
The prominent amongst those who attended
the event were Prof Saqib Rashid President
Pakistan Dental Association, Dr Mumtaz Khan,
Dr Azmat Mumtaz and Brigadier Shoaib
representing AIDM.

The next workshop would soon be announced
on orthodontics with aim to equip the participants
with new techniques and expertise.

Continued from front page
Operative Department at DOW Dental.
In his very enlightening presentation Dr Arshad
Hasan shared comprehensive details about hue,
chroma and value of restorations, the importance
of maintaining a graduated difference between
dentin and enamel shades to ensure excellent
aesthetics, an introduction to the Style Italiano
technique, and how to make it successful in clinical
practice. The presentation also included patient
cases with tooth re-creations done using the
layering technique.
This was followed by Dr Urooj Mumtaz Khan’s
highly interactive lecture, who is currently the
Consultant Aesthetics Specialist at Khan’s Dental
Institute. The Sheffield graduate used outstanding
everyday examples to explain the Style Italiano
technique and how students can achieve excellent
results using simple guidelines. ‘It isn’t always
possible to purchase the Style Italiano kit, which
is rather expensive,’ she said ‘but in my clinical
practice, I find that I can achieve almost the same
results with my regular instruments like probes
and plastic instruments. I also used the common
plumbing tape; it offers excellent isolation for a
fraction of the cost’. Dr Urooj’s presentation too
included her own patient cases with excellent
before and after restoration photographs.
Dr Salman Ashraf, Head of the Operative
Department at University of Lahore and visiting
consultant at Shaukat Khanum Memorial Hospital,
Lahore for the dental rehabilitation of cancer
patients was the last speaker. His presentation not
only highlighted the salient features and techniques
of Style Italiano, but also included pictures of
patients from Shaukat Khanum before and after

[9] =>

[10] =>

10 DENTAL TRIBUNE Pakistan Edition November 2014

The growth of
international dental
trade and factors
leading to it

Editor - Online
Haseeb Uddin

A new concept in
dental purchasing
Online retail purchasing may be the
answer to cost cutting challenges for
dentists
DT Pakistan Report

K

DT Pakistan Report

K

ARACHI: The growth of international dental trade and profession
in general is evident by its growth in revenues and standing in
international stocks. Predictions are that global dental supplies
market will be worth more than US $19 million by the year 2017. The
dental equipment market has grown by 5% in 2013, a trend which will
continue. The North American market alone grew by roughly 3% last year,
with pricing as the key determinant of the equation. This year’s predictions
for US also point towards an increase towards the last quarter of 2014.
Similarly, the Asia-Pacific region is set to grow at an annual rate of 8.9%
per annum.
Many factors drive this trend. A significant and steady increase and
spending on dental of treatments has led this major market shift, particularly
in the orthodontics section. Aging population, increased awareness about
oral health and technological developments all contribute towards this
shift. On the dental surgeon’s front, this buying trend is based on the growth
of the dental surgeon’s practice. It has been noticed that should the practice
witness smooth sailing, the buying spree for dental supplies and equipment
usually takes place after one or two quarters.
The 2019 projection for the global dental market is estimated at $7,138.9
million. Current estimates stand at $5,416.3 million, with growth rate at
5.7% in the next five years. Market players at this point in time continue
to be 3M, A-dec, BIOLASE technology, Carestream Health, Danaher
Corporation, Dentsply International and Ivoclar Vivadent among others.
The same trend however, cannot be seen in European countries. Much
of this may be due to the fact that European countries have government
systems supporting and reimbursing dental treatments. This means that the
supply and demand are fairly constant. Current major markets in the
European region are Germany, France and UK.
The dental implant market remains the most lucrative area of investment.
This area has an expected growth rate of 3.5% globally. Other reports have
stated this growth rate to be as high as 10.6% per annum. Straunman
remains the leader in dental implant sector at 18% share worldwide,
followed by Nobel Biocare at 17%.
So what are the implications? The rise in the quick and bulk ordering
may be related to a somewhat new trend in the business: online dental
purchasing. Around three years ago, dentists considered it skeptically.
However, the opinions are changing. This reflects in the sales volumes as
well where a steady growth in bulk ordering behavior is becoming common
among dental surgeons.
Online purchasing options are not only convenient for the dentists who
can buy supplies from the comfort of their office, but also been extremely
cost effective for suppliers looking to cut costs in their supply chain.
Selecting the best online supplier may be the best long term investment
for a dental surgeon.

ARACHI: There are numerous statistics and indicators to
show that dental industry is growing. However the rise in the
costs are forcing dentists to think up of creative solutions to
save money while continuing to provide quality dental care.
The 2013 Dental Trade Alliance meeting revealed some startling
facts about dental services usage around the world, particularly in US
and UK. The trade statistics revealed that despite overall growth in
purchases of the dental industry, the actual consumption of dental
services among younger adults is of decreasing. The state budgets are
still putting restraints on the quality and number of dental services
being provided, thereby leading to a shift towards financing outcomes
as opposed to financing procedures. The direct result is that many of
the dental practices are not practicing active dentistry, but moving
towards integration, efficiency and cost cutting. Contradicting the trend
is increased consumerism in healthcare and demand for dental aesthetic
restorative procedures.
The implications are many for both the dentists and the suppliers
to dentists. Dental surgeons need to find more creative ways to cut
costs while ensuring highest standards of care. This may mean creating
bulk ordering systems or use online buying channels to save time and
costs.

The market is ripe and ready to be explored. Market research by
Federation of the European Dental Industry or FIDE shows that
European sales value excluding metal implants alone stands at €5,897
million, with the UK market standing at €427 million. Interestingly
19% of these suppliers are direct suppliers to the dentists. This is
supported by the statistics showing that over 46% of current UK dentists
are now doing retail purchasing online.
This in order to survive this trend, industry gurus recommend for
suppliers in becoming more focused and picky about choosing target
prospects to reduce marketing costs. Suppliers are now offering dentists
the option of reviewing multiple products offered by different vendors
at the same platform, thus saving time. The same helps dentists make
quicker purchasing decisions, again saving time and effort. Online
shopping trend in other industries have shown huge promise and the
same is now being directed in the dental industry, where it is more
convenient, effective and cost cutting.
The future retail trade in dentistry stands to benefit immensely from
these online platforms and create a new dimension to dental retail
delivery altogether.

[11] =>

November 2014 Pakistan Edition DENTAL TRIBUNE 11

FDI Annual World Dental Congress held in
India
Continued from front page
its population of one billion is plagued by a
number of oral diseases, including caries and
periodontal disease. There has also been a
steep increase in oral cancer cases in the country
in recent years.
In addition to these issues, oral health-related
topics were discussed within a global context.
“During the congress, we will be highlighting
some of the major issues facing dental
practitioners in particular and health services
in general. One of these is improving access
to oral health care, within the context of oral
health as a fundamental right. The other is oral
health care for ageing populations, which will
be the subject of this year’s World Oral Health
Forum under the title ‘Challenges of oral health

care in an ageing society’,” FDI President Dr
Tin Chun Wong said.
She added that congress participants can
look forward to a well-thought-out scientific
programme that covers more than 25 key topics
in dentistry, including endodontics, oral
medicine, preventive dentistry, practice
management, and the latest innovations in
imaging and digital dentistry. Papers will be
presented by more than 30 distinguished
speakers from abroad, as well as 70 outstanding
Indian experts.
Dental innovations were on display during
the FDI World Dental Exhibition, which
received over 200 dealers and manufacturers
from India and abroad showcasing their latest
devices and products on the ground floor.

Chicago Crash claims the lives
of three gifted Pakistani doctors
Continued from page 2
The NTSB confirmed that no distress call was made by the pilot,
and that the aircraft was registered to Dr Tausif Rehman’s Lawrence
Company known as ARC Aviation. Investigations probing into the
cause of the crash are still underway.
Randy Peterson, the CEO and President of Stormont-Vail Healthcare
said, ‘Dr. Rehman and Dr. Kanchwala were extremely valued, highly
skilled and beloved members of our staff. We are heartbroken. Our
thoughts and prayers are with the families of these individuals and the
staff who worked closely with them.’
According to some of the residents near the site, the plane crashed
on the one only empty plot in the area; had it landed anywhere else,
it may have resulted in casualties.
Dr Tausif Rehman was an officially trained, licensed pilot and has
flown numerous times. He graduated from the Aga Khan University,
after which he joined the University of New Mexico to specialize in
Neurosurgery.
Dr Ali Kanchwala graduated from the DOW University of Health
Sciences and later joined the East Carolina University for fellowship.
His wife, Dr Maria Javaid was also a graduate of the DOW University
of Health Sciences who later specialized in the field of interventional
cardiology at the Providence Medical Centre. The two university friends
had tied the knot in Kansas.
Close friends, colleagues and family members describe the trio as
highly dedicated, talented, adventurous and kind hearted individuals.
Their memorial services were held in Kansas earlier this week.

World’s Best Goalkeeper sits for
dental impression for Madame
Tussauds
Continued from page 6
expresses himself and moves, which later helps them in the production
of the wax figure. The artists aim to capture Neuer’s personality and
character accurately in wax. During the meeting, they also discussed
the figure’s pose with the footballer.
For four months, up to 20 artists will be working on the figure at
Madame Tussauds’ studios in London. Once finished, the wax Neuer
will be exhibited in Berlin alongside famous German football icons
Oliver Kahn, Jürgen Klinsmann and Mesut Özil.

Little progress recorded in
historical cleft lip and palate
treatment
Continued from page 8
able to share details about
their methods. The authors
of this review went back to
these early medical,
surgical, and dental records
to find those that mentioned
the harelip, or cleft lip, and
cleft palate.
They found that cleft lips
and palates were recorded
in ancient texts and art in all
cultures reviewed. It appears
that some form of cleft lip
treatment was being
undertaken in the Middle
Ages. The technique mainly
involved sewing the edges
of the defect together to Credits: Government Dental College and Hospital, Ahmedabad, India.
reconstruct the lip. Cleft
palate “surgery” consisted of merely covering up the defect, possibly
because it was seen as impossible to treat.
Despite the increase in published medical texts from the 16th
to the 18th century, Western doctors corrected functional and
esthetic lip defects in much the same way as their predecessors in
the Middle Ages. Surgeons generally did not want to operate on
the mouth because they could not control the pain and feared
hemorrhaging. They also did not appear to understand the origins
and development of these malformations. Infections set in easily,
and medical practitioners had few options for fighting them.
Cleft palate surgery was not possible until the 19th century.
Along with the technical advances of this era, surgeons had more
ways to limit infection and pain in their patients. Not until this
time were fundamental changes recorded in the treatment of cleft
lip and cleft palate.
The Cleft Palate-Craniofacial Journal is an international,
interdisciplinary journal reporting on clinical and research activities
in cleft lip/palate and other craniofacial anomalies, together with
research in related laboratory sciences. It is the official publication
of the American Cleft Palate–Craniofacial Association (ACPA).

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[cover] => DT Pakistan No. 6, 2014

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Table of contents

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News / Contribution of CAD/CAM technology to implant-supported screw-retained restorations - Use of a full-arch bridge in the maxillae: A case report / International News

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