DT South Asia No. 3, 2024

CHF technique prevents common endodontic mishaps / AI-powered AR systems will revolutionize implantology / India’s largest dental chain opens milestone 500th clinic / Do our patients know the value of a tooth? / India begins assessing its 400 dental colleges / Periodontal healing may improve overall well-being via improved gut health

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The World‘s Dental Newspaper
South Asia Edition
Published in India
AI TOOLS

www.dental-tribune.com

AI-powered
AR
systems
revolutionize implantology

Vol. 2, No. 3

ORAL HEALTH

PERIODONTITIS

will

Do our patients know the value of
a tooth?

Periodontal healing may improve
overall well-being via improved gut
health

Page 03

Page 05

Page 07

CHF technique prevents common
endodontic mishaps
• How to avoid post-operative
flare-ups
• How to prevent over-instrumentation
• Why there is a sudden loss of
working length (WL)
• How to decide when or at what
file size shaping should end,
both during the initial treatment and during re-treatments

The Conceptual Hybrid Flare (CHF) technique is a novel technique developed to revolutionize the cleaning and shaping of root
canals making the endodontic procedures more predictable, and also preventing and managing the commonest mishaps.
(Image: Canva)

By Dr Sourav Banerjee
The conceptual hybrid flare
(CHF) technique is a novel approach developed to revolutionise
the cleaning and shaping of root
canals, making endodontic procedures more predictable and preventing and managing common
mishaps such as file separation,
canal transportation, ledging, zipping, and perforation. The following editorial by Dr Sourav Banerjee
summarises his original copyrighted research.
One morning, I received a
message on my mobile that read,
“A new amazing file has been
launched.” My eyes lit up with excitement, and I hurried to acquire
it, assuming it was the solution to
all the problems I face during root
canal treatment procedures. This

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happens to many clinicians who
are not satisfied with the endodontic procedures they perform.
What most of us overlook is that
files are there to create space for
the irrigants, shaping the canals so
that subsequent disinfection of
the complex canal system can be
achieved. Thus, the key to predictable endodontics is a biological
goal that is predictably achievable,
alongside mishap-free canal shaping.
Endodontics has evolved considerably over the past few decades. The desire to save natural
teeth has driven researchers to develop materials and techniques
that make root canal treatment
(RCT) more precise and predictable. The gateway to successful
endodontic treatment is adequate
cleaning and shaping of the canals. A well-shaped canal ensures
optimal activated irrigation and
disinfection to achieve the biological goal. The shaping procedure is
one aspect of endodontic treatment that has seen significant
changes, from file design to metallurgy and various shaping techniques. These efforts aim to
achieve mishap-free canal shaping.

CHF focuses on quality patient
care, making the procedure easy
and predictable for the clinician.
The concept:
The CHF technique was conceived to find a solution to various
mishaps that occur during the
shaping of root canals. The technique was developed with the aim
of avoiding these complications in
a predictable manner. Over a decade, through my interactions in
lectures, training programmes,
and workshops, I observed that
the majority of clinicians faced
similar challenges during RCTs and
expressed similar doubts and concerns. I deduced that clinicians
were becoming entangled in multiple variables and that a simple,
straightforward approach could
address the issue.
Here are some of the common concerns I frequently heard:
• When to change the files
• How many times a file can be
reused
• How to determine the canal
size for preparation
• How to shape severely curved
canals
• How to shape calcified canals
• How to prevent canal transportation during shaping

An endodontic procedure demands considering the following
variables pre-operatively:
1. File design
2. File metallurgy
3. Canal curvature on the intraoral
periapical radiograph (IOPAR)
4. Visible patency of the canals
and pulp chamber
5. Calcifications, if present, in the
pulp chamber or encroaching
the canal orifices
6. The periapical area on the
IOPAR
7. The lateral width of the canal
Critical aspects considered in
the development of the CHF
technique:
1. Depth of penetration of the
endodontic irrigation needle,
which is recommended to be
within 1 mm of the end of the
working length
2. The action of hypochlorite
solution (hypo) is time-dependent
3. Hypo needs to be in contact
with the tissues for dissolution
and disinfection, for which better flow, low surface tension,
and adequate space are needed
4. The removal of the smear layer
and disruption of the biofilm is
essential for achieving the endodontic biological goal, and ultrasonic activation is the most
effective method to achieve
this; to allow acoustic streaming, adequate space is required
5. These goals must be achieved
in the critical apical few millimetres that contain the majority of the ramifications and finer
anatomies branching from the
main canal system (the CHF
technique effectively addresses
these five critical aspects while
conserving tooth structure)

During the development of the
technique, the challenge was to incorporate the fundamentals of
shaping root canals while keeping
it simple and safe.
The two most vital aspects
prioritised:
1. Predictable shaping of the canals, offsetting all major potential mishaps
2. Making the technique biologically acceptable and evidence-based
The CHF technique adequately
addresses all the above concerns.
It is designed to achieve the biological goal by enabling the creation of an optimum size in the
critical apical zone, allowing the
placement of irrigation needles to
the required depth and enabling
ultrasonic activation. The technique requires all preparation to
end at size 25.06, creating a 0.31
mm space at D1, which is the optimum size for activated irrigation
while being conservative and safe.
The CHF technique has three
variations:
1. LFS (long file sequence)
2. SFS (short file sequence)
3. USS (ultra-short sequence)
The technique functions in
the following sequence:
1. Orifice shaping
2. Glide path
3. Gradual widening of the glide
path
4. Gradual apical preparations
and widening
5. Gradual mid-root flaring
6. Finishing
LFS technique:
1. Canal location (10.02) – S1
2. Orifice shaping (8% or above)
– S2
3. Establishing the glide path +
SLC (10.02) – S3
4. First complete flare + first apical preparation (13.04/03) – S4
5. Second apical preparation
(15.02) – S5
6. Second complete flare + third
apical preparation (17.04) – S6
7. Fourth apical preparation
(20.02) – S7

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Dental Tribune South Asia Edition | 03/2024

8. First mid-root flaring (20.06) –
S8
9. Apical widening (20.04) – S9
10. Second
mid-root
flaring
(25.06) – S10
11. Fifth apical preparation (25.04)
– S11
12. Final flare / finishing (25.06) –
S12
SFS technique:
*S8 and S9 are missing in the
SFS technique, which is recommended for file systems without
the 20.04 and 20.06 files. This approach increases the stress on the
files and the canal wall, with only
10 steps.
USS technique:
Ultra-short sequence is recommended for file systems without 17.04, 20.04, and 20.06. In this
technique, *S8, S9, and **S6 are
missing.
The technique requires intermittent irrigation and irrigant exchange throughout the process. In
constricted canals, multiple repetitions may be needed in a single
step. A 3% hypo solution is recommended for balancing efficacy and
safety, with EDTA 17% liquid used
intermittently for chelation and removal of the smear layer and accumulated hard tissue debris (AHTD).
Activated chelation with EDTA, followed by 5 ml of hypo per canal, is
recommended, preferably using
continuous negative pressure irri-

gation and evacuation (CNPIE) or
ultrasonic (US) activation. A final
rinse with normal saline or distilled
water follows the final flare.
How the CHF technique
works:
The technique allows each file
to work in a particular area or segment of the canal, thereby reducing the length of engagement
(LoE) of the file at any moment.
This reduces the chance of torsional failure (TF). The technique
accounts for variables to govern
the sequence of the files to be
used. Studies have shown that
stress on files working in a canal is
high when the effective length of
the file in contact with the canal
wall is longer and when the percentage size increase is 50% or
more. The CHF technique solves
these two issues effectively. This is
a prescription technique that remains the same for all clinical situations.
There is often confusion
among clinicians regarding which
shaping technique to use in different clinical conditions. Frequently,
canals have curvature in planes
that are not visible in 2D radiographs. In such scenarios, there is
a high chance of file separation
with even a slight flaw. In such
cases, CHF proves to be a favourable technique as it circumvents
the possible mishaps that could
occur. The technique is like a pre-

scription where the clinician follows the prescribed sequence.
Whether it is a calcified canal or a
curved canal in any plane, it works.
The technique has a mathematical explanation, showing
which files are the most stressed in
the sequence and need frequent
inspection
and
replacement.
Hence, soft metallurgy plays an
important role. The advantage of
soft metallurgy is that the flutes
undergo deformation before separation, which can be easily noticed with keen inspection. During
the development phase, it was
found that even if the file was rotated with only half of the required
torque, there was neither excessive binding with the canal wall nor
auto-reverse while shaping proceeded without obstruction. By
this alone, it can be appreciated
that this technique inflicts minimal
stress on the canal wall, reducing
transportation, crazing, and other
silent mishaps.
Why all shaping needs to
end at 25.06%
This technique follows irrigation-centric shaping. The irrigation needle has a gauge of #30, so
for effective placement to the WL,
the size should be at least #30 or
more. The size prepared by a 25.06
file is #31 at D1. A 25.06 file keeps
the apical size at D0 at 25 but adequately enlarges the canal at D1
to allow placement of a 31G irriga-

tion needle. Additionally, the tapered shape aids in US activation
with a size #20 tip.
US activation is a proven
method to effectively remove the
smear layer from the critical apical
third. TDA (transverse displacement amplitude) of the US file
needs adequate room (approximately 50-80 microns) to occur.
Hence, a 25.06 file provides the
optimum room needed while
keeping the terminal preparation
as minimal as possible.
Dr Sourav Banerjee graduated
from SDCH under RGUHS Bengaluru with distinction. He pursued a
postgraduate programme in clinical endodontics from the New
York University College of Dentistry (Department of CDE) and
subsequently completed a mastership programme in surgical
endodontics. He also holds an
MSc in medical microbiology and
a postgraduate diploma in hospital administration.
Additionally, he is a fellow of
the Nobel implantology programme in Sweden and a POS
graduate. Dr Banerjee has served
as an RMO at SSG Government
Hospital and as an associate consultant at Max Hospital. With over
21 years of experience, he is currently a consultant in endodontics
and restorative dentistry at Omkarananda Dental Care & Research,
Jamshedpur.

About

Dr. Sourav Banerjee
Dr Banerjee is a pioneer of microscope-enhanced
dentistry,
with live-streaming of cases and
training in eastern India. He is the
founder of the EndoConcept programme and the Microscope and
Endodontic Training Academy
(META). He has conducted over
105 CDE programmes and trained
more than 600 clinicians through
EndoConcept SEP, both in India
and abroad. He holds intellectual
property rights for developing the
CHF technique for shaping endodontic root canals predictably
and safely. He has been a key opinion leader for Kavo Kerr, Coxo,
GSK, Alkem, and other multinational corporations.

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Dental Tribune South Asia Edition | 03/2024

AI-powered AR systems will revolutionize
implantology

The use of AI and AR combination may change how modern guided implant surgeries are performed and may replace conventional software. (Image: Canva)

By Dr Sahithi Kolli
Dentistry is witnessing the
combination of augmented reality
(AR)1 and artificial intelligence
(AI), 2 two disruptive technologies
that promise to revolutionise implant surgery. In today’s dentistry,
new technologies are changing
how procedures are performed.
This digital transformation began
with intraoral scanners, CBCT, 3D
printing, CAD CAM, and diagnostic software. These advancements
have streamlined workflow and
treatment planning with precision.
Now, the field is witnessing the
combination of augmented reality

and artificial intelligence, two disruptive technologies that promise
to revolutionise implant surgery.
The fusion of AI and AR guides
implant surgery with enhanced
precision and clarity. This approach could transform workflows, enabling authentic and accurate 3D planning of dental implants in a holographic environment. AI-powered AR platforms
assist prosthodontists in guided
implant surgery, providing real-time navigation and visualisation of the implant placement process. 3 AI algorithms analyse patient imaging data, such as CBCT

scans and intraoral scans, to precisely plan placement. By identifying anatomical structures and assessing bone quality, AI recommends optimal implant positions
and angles for each patient’s
unique anatomy. During surgery,
AR overlays generated by AI algorithms offer real-time guidance,
indicating planned implant locations and tracking surgical instruments and patient anatomy. This
visualisation ensures precise implant positioning relative to surrounding structures.
The AI-powered AR systems
streamline implant placement, re-

ducing surgical time and enhancing workflow efficiency. Several
software options on the market integrate AI and AR for implant
placement. For instance, Implant
Studio by 3Shape provides tools
for delivering complete or temporary prosthetic solutions to patients on the day of surgery. NobelClinician by Nobel Biocare
plans implant treatment based on
patient anatomy and requirements. A recent article concluded
that the combined use of AI and
AR may change the perspectives
of modern guided implant surgery
for authentic 3D planning that may
replace conventional software. 3

AI-powered AR has the potential to revolutionise patient communication and education in implant dentistry. By integrating AR
visualisation into treatment planning, clinicians create immersive
virtual simulations, allowing patients to visualise proposed treatment outcomes and actively participate in decision-making. This
collaborative approach fosters
greater patient engagement, enhances treatment acceptance, and
empowers patients to make informed choices about their oral
healthcare journey.

References
1. Pellegrino, G., Mangano, C.,
Mangano, R. et al. Augmented reality for dental implantology: a
pilot clinical report of two cases.
BMC Oral Health 19, 158 (2019).
https://doi.org/10.1186/s12903019-0853-y
2. Alqutaibi AY, Algabri RS, Elawady D, Ibrahim WI. Advancements in artificial intelligence algorithms for dental implant identification: A systematic review with
meta-analysis. J Prosthet Dent.
2023 Dec 28(23)00783-7. doi:
10.1016/j.prosdent.2023.11.027.
Epub ahead of print. PMID:
38158266
3. Mangano, F. G., Admakin, O.,
Lerner, H., & Mangano, C. (2023).
Artificial intelligence and augmented reality for guided implant
surgery planning: A proof of concept. Journal of Dentistry, 133,
104485

Surgical guide by 3Shape Software for implant placement

Kapanu’s software helps patients and dentists to visualize treatment outcomes
before surgery.

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Dental Tribune South Asia Edition | 03/2024

India’s largest dental chain opens
th
milestone 500 clinic
in this vertical with the best of
technology and experts.”

The opening of Clove Dental’s 500 clinic in India promises to improve oral health
among a population with high rates of periodontal disease. (Image: WESTOCK
PRODUCTIONS/Shutterstock)
th

By Dental Tribune International
NEW DELHI, India: After opening 12 new clinics in a single day,
Clove Dental, India’s largest dental
chain, has attained an even more
impressive milestone. On 3 May, it
opened its 500 th clinic in the country. The significant achievement
crowns a period of sustained
growth fuelled by foreign capital
investment.

Speaking on this recent triumph in the company’s press release, founder and CEO Amarinder
Singh stated, “Over the past 13
years, we have taken dental care to
newer heights by opening clinics
in almost 26 cities across the country. Our 500th clinic is a testament
to our motto of providing quality
dental care, adhering to global
standards, and making India excel

Commenting on the factors
underlying the company’s success,
Dr Vimal Arora, Clove Dental’s
chief clinical officer, explained in
the same press release that “with a
focus on building technology inhouse, along with robust training
of doctors and dental assistants,
Clove Dental clinics have set outstanding benchmarks. Our unique
standardised processes of peerto-peer reviews, 10× safety protocols, four-step sterilisation and
open-all-days-of-the-week policy
have made Clove Dental the undisputed leader”.
The continued expansion of
Clove comes on the back of a
US$50.0 million (€45.5 million*) investment in its parent company,
Global Dental Services, by the
Qatar Investment Authority (QIA),
in November last year. According
to the QIA website, “The equity injection from QIA will unlock signif-

icant growth opportunities for the
group as it seeks to expand across
India, ensuring that more Indians
have access to reliable, high-quality, and affordable dental care.”
In a country where it is estimated that half of adults suffer
from periodontal disease and
where there is a widespread lack of
awareness about the importance
of oral health, Clove’s expansion is
not only a significant accomplishment for the company but also
stands to contribute importantly
to overall health standards across
the country.
Last year, Dental Tribune India
reported on the rise of Clove to
become a major provider in the Indian dental care market. In that interview, Singh outlined his company’s vision to establish 1,000 clinics
in the next five years, indicating
that there is likely much more to
come from Clove.

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DENTAL TRIBUNE SOUTH ASIA
EDITION

PUBLISHER
Ruumi J. DARUWALLA
CHIEF EDITOR
Dr. Meera VERMA

CLINICAL EDITOR
Dr. Dilip DESHPANDE

RESEARCH EDITOR
Dr. Shobha DESHPANDE

ASSOCIATE EDITOR
Dr. GN ANANDAKRISHNA
EXECUTIVE EDITOR
Dr. Rajeev CHITGUPPI

ASSISTANT EXECUTIVE EDITOR
Dr. Riddhi D. TELISARA
DESIGNER
Anil LAHANE

PRINTER
Mehernosh MISTRY
Burzin MISTRY
Ampersand, Mumbai, India

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Dental Tribune South Asia Edition | 03/2024

Do our patients know the value of a tooth?
By Dr Bianca Nazareth-Arya
Even teeth deemed hopeless
have been salvaged through thorough periodontal care and diligent supportive treatment. Patients treated for aggressive periodontitis have sustained their
teeth for up to 15 years post-treatment. This editorial by Dr Bianca
Nazareth-Arya emphasises how
long-term follow-up can be a
game-changer in maintaining
teeth, implants and the surrounding tissue healthy.
What really is the value of a
tooth? How do we determine its
worth? We have often encountered patients in pain who will tell
us, “Just extract the tooth, doctor,”
while we are intent on weaving
magical tales of root canals and
flap surgeries. Now imagine a man
in severe pain from a myocardial
infarction saying a version of the
same thing: “Just remove the
heart, doctor.” Leave aside the fact
that it is a life-and-death situation
for a minute—could it also be that,
really, the value of one tooth is in
question when there are 31 more
to spare?
But when faced with the imminent loss of all teeth, the dynamics
change. Patients show both willingness and commitment to save
teeth. This is where our decision-making regarding options
and treatment modalities plays a
significant role.
Periodontal disease, unlike
caries, does not have severe pain
or symptoms that a patient notices
until it is advanced, leading to delayed treatment, diagnosis, and
often insufficient care. By the time
the patient becomes aware of their
condition, it is often too late for
the periodontist to save the tooth,
and the implantologist must step
in.
Periodontal treatment, both
surgical and non-surgical, plays a
significant role in saving teeth.

By prioritizing maintenance and hygiene, patients can significantly improve their chances of enjoying healthy and functional teeth
and implants for years to come. (Image: Bianca Nazareth-Arya)

However, the success of the treatment ultimately depends on the
patient. The maintenance phase of
periodontal treatment is more tedious, requiring the patient to be
more conscientious than with any
other dental treatment. Unlike
treatments that only require periodic check-ups and simple daily
care routines, periodontal maintenance often involves more frequent dental visits, diligent oral
hygiene at home, and specialised
treatments such as deep cleanings
or surgeries. Lifestyle changes, like
quitting smoking and managing
stress, may also be necessary to
support gingival health.
Keeping all the above in mind,
the argument could be made that
similar maintenance routines are
required for dental implants. Unfortunately, patients are often unaware of this and mistakenly believe that implants will resolve
their problems with little or no
maintenance in the future.
The critical stage of treatment
planning is determining a tooth’s
prognosis. There are several methods to assist in this decision-mak-

ing—some quite detailed, taking
into consideration factors like patient willingness, finances, and
clinical factors such as pocket
depth.1 Unfortunately, decisions
are often based on bone loss,
pocket depth, and mobility, but
the reality is that the same teeth
with the same conditions in different patients can have a different
prognosis depending on hygiene,
maintenance, follow-up, masticatory loads, and the unpredictability of the variables in a patient’s
mouth. A clinician’s expertise in diagnosis and treatment will also influence the outcome. Therefore,
following a rigid flowchart is not
enough—clinicians must use experience, intuition, and patient
knowledge to make the best decisions.
Even so-called hopeless teeth
have been preserved successfully
with adequate periodontal treatment followed by strict supportive
periodontal treatment (SPT). 2. 3 Patients with treated aggressive
periodontitis have shown survival
of teeth for as long as 15 years
after treatment.4 This indicates

that even patients with seemingly
hopeless dentition should be offered the option to keep their
teeth, with the understanding that
they must take responsibility for
their condition and follow the
treatment plan and maintenance
protocol. At such times, we should
avoid glorifying the alternative of
implants, falsely implying that
they require less care or will last indefinitely.
It stands to reason that, if presented in such a manner, 100% of
patients who can afford implants
would choose them. As soon as
implants are offered as an option,
a bias is introduced into treatment
planning.5 An implant success rate
of 98% or higher is misleading, as
this refers only to the implant’s
survival in the mouth, not the
peri-implant disease, inflammation, or bone loss that affects
many surviving implants.6
Therefore, it is crucial to present dental implants responsibly,
explaining their benefits but also
clarifying that they are not a “setit-and-forget-it” solution.

Fig. 1a: Pre-op OPG of patient showing bone loss, intra bony defects.

Fig. 2a: Patient detected with aggressive perdontitis in 2016.

Fig. 1b: 10 year follow-up.

Fig. 2b: Same patient in 2023 with severe deterioration of perious condition and no
follo up or SPT.

For patients who choose to
save their teeth, the maintenance
phase is vital—not only to ensure
the survival of their teeth but also
to prevent further deterioration
that could jeopardise future implant treatment. In our experience,
we have often found patients stable for four to six years with regular SPT, only to lose track of them
until they return ten years later, at
which point there is no longer
enough bone for conventional implants, forcing us to resort to extreme bone augmentation or zygomatic and pterygoid implants.
Hence, the delicate balance
between saving teeth and opting
for implants must be revisited regularly with each patient to ensure
that the maintenance of their teeth
does not risk the loss of residual
bone.

Conclusion

In conclusion, the long-term
survival of teeth and implants after
periodontal disease treatment depends on the partnership between
patients and dental professionals.
By prioritising maintenance and
hygiene, patients can significantly
improve their chances of enjoying
healthy and functional teeth and
implants for years to come. The
choice to save teeth must always
come first, with consideration
given to age, health, hygiene, and
other factors.

References

1. Avila G, Galindo-Moreno P,
Soehren S, Misch CE, Morelli T, Wang
HL. A novel decision-making process
for tooth retention or extraction. J Periodontol. 2009 Mar;80(3):476-91. doi:
10.1902/jop.2009.080454.
PMID:
19254132.
2. Faggion CM Jr, Petersilka G,
Lange DE, Gerss J, Flemmig TF. Prognostic model for tooth survival in patients treated for periodontitis. J Clin
Periodontol 2007;34(3):226-231.
3. Hirschfeld L, Wasserman B. A
long-term survey of tooth loss in 600
treated periodontal patients. J Periodontol 1978;49(5):225-237.
4. Graetz C, Dörfer CE, Kahl M,
Kocher T, Fawzy El-Sayed K, Wiebe JF,
Gomer K, Rühling A. Retention of questionable and hopeless teeth in compliant patients treated for aggressive
periodontitis. J Clin Periodontol. 2011
Aug;38(8):707-14.
5. Clark D, Levin L. In the dental implant era, why do we still bother saving
teeth?
Dent
Traumatol.
2019
Dec;35(6):368-375.
doi:
10.1111/
edt.12492. Epub 2019 Oct 14. PMID:
31132200.
6. Berglundh T, Armitage G, Araujo
MG, Avila-Ortiz G, Blanco J, Camargo
PM, Chen S, Cochran D, Derks J, Figuero
E, Hämmerle CHF, Heitz-Mayfield LJA,
Huynh-Ba G, Iacono V, Koo KT, Lambert
F, McCauley L, Quirynen M, Renvert S,
Salvi GE, Schwarz F, Tarnow D, Tomasi C,
Wang HL, Zitzmann N. Peri-implant
diseases and conditions: Consensus report of workgroup 4 of the 2017 World
Workshop on the Classification of Periodontal and Peri-Implant Diseases and
Conditions. J Clin Periodontol. 2018
Jun;45 Suppl 20:S286-S291.

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6

Dental Tribune South Asia Edition | 03/2024

India begins assessing its 400 dental colleges

Health authorities in India are laying the groundwork for nationwide accreditation of the country’s dental colleges. (Image: Maneesh Agnihotri/Shutterstock)

By Dental Tribune International
NAGPUR, India: The sheer
number of dental colleges in India
makes the country a global powerhouse in dental education, and efforts are underway to ensure that
the quality of the country’s thousands of dental graduates remains
high. Representatives from the
Dental Council of India (DCI) and
National Accreditation Board for
Education and Training (NABET)
visited the Government Dental
College and Hospital in Nagpur
this week in what marks the beginning of a nationwide quality assessment of all dental schools operating in the country.

The college in Nagpur is one of
ten throughout India that were selected for the pilot assessment
programme, the results of which
will contribute to the drafting of a
standardised format for appraising India’s dental schools. The
Times of India reported that the
pilot programme assessments by
NABET and DCI representatives
were focusing on ten key parameters, including the curriculum,
human resources, students’ practical and clinical exposure, teaching technique and innovative
teaching approaches, admission
processes, research output and
community
outreach
programmes.

Dr Abhay Datarkar, dean of
Government Dental College and
Hospital, told the newspaper that
the visit represented “a landmark
achievement that will pave the way
for a nationwide system of rating
dental colleges using NABET accreditation”, which has already
been tested and applied at India’s
medical and homeopathic colleges. “Experienced faculty members from our college proposed
valuable modifications to the assessment pro forma specifically
designed for dental colleges.
These suggestions are expected to
receive due consideration during
formulating the national assessment criteria,” Dr Datarkar added.

Dr Vaibhav Karemore, an assistant professor at the college in
Nagpur, said: “By establishing a robust assessment and rating system, aspiring dental professionals
can be assured of pursuing their
education at institutions that meet
the highest standards.”
According to DCI figures, India
has 323 colleges offering Bachelor
of Dental Surgery degrees, 279 offering Master of Dental Surgery
degrees, nine offering postgraduate diplomas in orthodontics and
dentofacial orthopaedics, conservative dentistry and endodontics,
prosthodontics, paediatric and
preventive dentistry, oral and
maxillofacial surgery, and peri-

odontics and 111 offering qualifications in the areas of dental hygiene and dental mechanics. Dental Tribune International reported
in August last year that the National Dental Commission Bill 2023
proposed major changes to dental
education in India, including introducing the National Exit Test that
all dental graduates would have to
pass to obtain licensure to practise
and the replacement of the DCI
with the yet-to-be-formed National Dental Commission as India’s top regulatory body for dental education.

Advertisement

[7] =>

NEWS

Dental Tribune South Asia Edition | 03/2024

Periodontal healing may improve overall
well-being via improved gut health
maintaining a healthy periodontal
state. Moreover, optimizing our
comprehension of the impact of
periodontitis on the gut microbiota depends on understanding
the process behind the transfer of
salivary bacteria to the gut. Significantly, treating periodontitis may
offer a fresh approach to managing systemic illnesses linked to the
resistant gut microbiota. 2

Conclusion

Recent findings suggest that restoring periodontal health may influence gut microbiota composition and systemic inflammation. (Image: Canva)

By Dr Geetpriya Kaur

Periodontal health extends far
beyond the confines of the mouth,
reaching into the intricate ecosystem of the gut. Recent research
suggests a fascinating interplay
between periodontal healing and
gut health, shedding light on potential avenues for improving
overall well-being through periodontal treatments and healing.
Periodontal disease is a prolonged inflammatory ailment that
impacts the periodontium, which
consists of the gingiva, ligaments,
and bones that structurally support the teeth. The pathogenesis
of periodontitis is substantially influenced by dysbiosis, an imbalance of the oral microbiome. The
community of bacteria, viruses,
fungi, and protozoa that are present in the oral mucosa is known as
the oral microbiota. Pathogenic
bacteria are the most dominant
microbiota. In periodontal disease, the ratio of pathogenic to
commensal bacteria is altered. An
association exists between periodontitis and the gut microbiome.1
Periodontal disease is related
to numerous systemic health complications such as cardiovascular
disease, diabetes, as well as negative pregnancy outcomes. More
recently, attention has turned to
the potential correlation between
gut health and periodontal health.
The alterations in the gut microbiota can perform a key function in
the growth of dysbiosis and subsequently periodontal disease.1
There is a bidirectional hypothesis
that periodontitis can also influence gut health via salivary microbiota. 2
Gut microflora and periodontal disease
Several recent investigations
have determined that the gut microbiota holds a potential involve-

ment in the pathogenesis of periodontitis and oral microbiome
dysbiosis. Recent research has
suggested that variations in the
constitution of the gut microbiota
can influence the immune system
as well as inflammation, consequently affecting the oral microbiota and contributing to the onset
of periodontitis. Furthermore, because saliva is consumed, which
may aid in the transfer of oral microbes to the gut, recent investigations have indicated a feasible
relationship between the microbiota of the gastrointestinal tract
and the mouth cavity. It is conceivable that gut microbiota will reciprocally enter the mouth cavity. According to several studies, certain
gut bacteria may protect against
periodontitis, while other microbiota may make the condition more
likely to occur.1
According to the study, there
was a noteworthy distinction in
the quantity of some gut bacteria,
specifically Lachnospiraceae and
Ruminococcaceae, between those
who had periodontitis and those
who were deemed healthy. Therefore, maintaining a balanced microbiome in the mouth and gastrointestinal system may be important for both preventing and
treating periodontal disease. Probiotics and prebiotics, along with a
healthy diet and consistent brushing and flossing, can assist in
achieving a balanced oral and gut
microbiota.1
Several recent studies have investigated this connection, aiming
to elucidate the mechanisms
through which periodontal disease may influence the gut microbiota and overall gastrointestinal
function. The gut microbiota, a
varied group of microorganisms
living in the gastrointestinal tract,
is essential for digestion, immune
system control, and metabolic
functions. Dysbiosis, which refers
to the gut microbiota imbalance, is

associated with health ailments
like inflammatory bowel disease,
irritable bowel syndrome, as well
as metabolic disorders. 3
In the latest research, stool
samples have been gathered from
patients presenting healthy periodontium, gingivitis, and chronic
periodontitis. The composition of
intestinal microbiota was assessed
by Illumina MiSeq sequencing. A
less diverse gut microbiome was
observed in patients with periodontal diseases. Many oral bacteria correlated with periodontal
damage as well as inflammation
had been discovered in the gut microbiota of individuals, irrespective of their periodontal status.4
Another study in 2020 investigated the impacts of periodontal
therapy on gut microbiota composition in patients with chronic periodontitis. Following periodontal
treatment, which involved scaling
and root planing to remove dental
plaque and calculus, the researchers observed significant changes
in the treated individuals’ gut microbiota. Specifically, they noted
an increase in microbial diversity
and a shift towards a more favourable microbial profile resembling
that of healthy individuals. These
findings suggest that improving
periodontal health may have beneficial effects on gut microbiota
composition.5
Beyond microbial changes,
periodontal healing may also influence systemic inflammation,
which can impact gut health. Periodontal disease is characterised
by chronic inflammation in the oral
tissues, which releases pro-inflammatory mediators into the bloodstream. This systemic inflammation has been implicated in the
pathogenesis of various gastrointestinal disorders, including inflammatory bowel disease and irritable bowel syndrome. By reducing oral inflammation through
periodontal therapy, it is possible

to mitigate systemic inflammation
and potentially alleviate symptoms of gut-related conditions.6

Periodontal disease induces
gut microflora dysbiosis via salivary microbiota
In a recent clinical study,2 periodontitis can lead to an imbalance
in gut microbiota as well as inflammation in the intestines through
the movement of salivary bacteria.
Fecal and salivary samples were
obtained from 16 individuals without periodontal issues as well as
21 individuals with severe periodontitis and analysed using 16S
rRNA sequencing. Major variations had been noted in both
groups. Significantly, a higher
presence of microbes originating
from saliva was spotted in the severe periodontitis group’s fecal
samples. Following the transplantation of the residual salivary microbes into the control groups of
mice, it had been discovered that
the composition of gut microbiota
of the severe periodontitis group
differed substantially from that of
the control group, with Porphyromonadaceae and Fusobacterium
found to be notably more abundant in the severe periodontitis
group. The severe periodontitis
group exhibited substantially lowered crypt depth as well as expression of zonula occludens-1 in the
colon. In the severe periodontitis
group, there was a considerable
surge in the expression levels of
mRNA of tight junction proteins,
chemokines, and pro-inflammatory cytokines. Salivary microbiota
had been tagged and then transferred to mice to investigate if
bacteria from saliva could endure
in the intestine. It had been discovered that salivary microorganisms
from the severe periodontitis and
healthy groups.
The current study’s findings
reinforced the significance of

Periodontal healing may benefit gut health by modulating gut
microbiota composition and reducing systemic inflammation.
These results highlight the need
for regular dental check-ups and
oral hygiene for both preserving
oral health and enhancing general
well-being. To fully understand
the intricate interactions between
the gut and oral microbiomes and
to investigate potential treatment
approaches that target both systems, more research is required.1

References
1. Anurag Satpathy: Periodontal healing by improving gut
health. HTAJOCD 2023 MarchApril (4): 10-13.
2. Bao J, Li L, Zhang Y, Wang M,
Chen F, Ge S, Chen B, Yan F. Periodontitis may induce gut microbiota dysbiosis via salivary microbiota. International Journal of Oral
Science 2022; 14: 32.
3. Elzayat, H.; Mesto, G.;
Al-Marzooq, F. Unraveling the impact of gut and oral microbiome
on gut health in inflammatory
bowel diseases. Nutrients 2023,
15, 3377. https://doi.org/10.3390/
nu15153377
4. Talita Gomes Baeta Lourenço, Sarah J. Spencer, Eric John
Alm, Ana Paula Vieira Colombo.
Defining the gut microbiota in individuals with periodontal diseases: an exploratory study. Journal of Oral Microbiology 2018; 10:
1487741.
5. Huang Y, Liao Y, Luo B, Li L,
Zhang Y, Yan F. Non-surgical periodontal treatment restored the
gut microbiota and intestinal barrier in apolipoprotein E−/− mice
with periodontitis. Frontiers in Cellular and Infection Microbiology
2020; 10: 498. doi: 10.3389/
fcimb.2020.00498
6. Di Stefano, M.; Santonocito,
S.; Polizzi, A.; Mauceri, R.; Troiano,
G.; Lo Giudice, A.; Romano, A.;
Mascitti, M.; Isola, G. A reciprocal
link between oral and gut microbiota during periodontitis: the potential role of probiotics in reducing dysbiosis-induced inflammation. International Journal of Molecular Sciences 2023; 24, 1084.
h t t p s : //d o i . o r g / 10 . 3 3 9 0 /
ijms24021084

[8] =>

For more informaon or to order any of the products in this brochure, please contact:
LifeCare Devices Private Limited
New Jubilee Building, Office no. 1, Laxmiben Chheda Road, Nalasopara West, Palghar 401 203.
Mumbai Metropolitan Region, Maharashtra, INDIA. | E: info@lifecare.in
| Customer Service : +91 99304 50170 | Customer Service WhatsApp : +91 99304 50169
| Management WhatsApp : +91 99304 50163/+91 99997 86275

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[cover] => DT South Asia No. 3, 2024

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