Endo Tribune Middle East & Africa No. 4, 2024
Final programme announced for Clinical Endodontics Symposium in Dubai / Utilising R-SWEEPS laser-assisted irrigation for the treatment of chronic periapical periodontitis / News
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DTMEA_No.4. Vol.14_ET.indd
PUBLISHED IN DUBAI
www.dental-tribune.me
Vol. 14, No. 4
Final programme announced for Clinical
Endodontics Symposium in Dubai
By CAPP Events & Training
For the first time as a distinct sub-event, the
Clinical Endodontics Symposium (CES) will debut
at the CAD/CAM Digital & Oral Facial Aesthetics
37th Int’l Dental ConfEx, scheduled for 15-16 November 2024. This event will be held at the prestigious Madinat Jumeirah Arena & Conference
Center in Dubai, UAE, and is set to be a cutting-edge exploration of the latest advancements in clinical endodontics.
The CES will gather leading experts, researchers, and practitioners from around the
globe to delve into the newest techniques, technologies, and trends shaping the field of endodontics. Attendees can look forward to a robust
programme featuring insightful presentations
and interactive discussions that cover a wide
spectrum of topics, including innovative root
canal treatments, advancements in diagnostic
tools, and the integration of digital technologies
in endodontic procedures.
Let's take a closer look at some of the prominent speakers who will be sharing their expertise at the symposium:
•
•
•
•
•
•
Prof. Federico Foschi, Ireland - "Modern
Endodontics at a Glance." Prof. Foschi will explore the latest advancements and techniques in modern endodontics, providing a
comprehensive overview of the field.
Dr. Antonis Chaniotis, Greece - "Management of Splitting Root Canal Systems: Instruments and Techniques." Dr. Chaniotis will discuss innovative instruments and techniques
for effectively managing complex root canal
systems, focusing on splitting scenarios.
Prof. Gianluca Gambarini, Italy - "Simplifying Endodontic Procedures While Increasing
Quality of Treatments." Prof. Gambarini will
share methods to streamline endodontic procedures, enhancing treatment quality and efficiency.
Prof. Damiano Pasqualini, Italy - "How to Be
Successful in Modern Surgical Microendodontics." Prof. Pasqualini will provide insights into achieving success in surgical microendodontics, emphasizing modern techniques and best practices.
Dr. Mohamad Zaafrany, Egypt - "The Ultimate Guide for Management of Separated
Files." Dr. Zaafrany will offer a comprehensive
guide on managing separated files, focusing
on strategies to ensure optimal outcomes.
Prof. James Prichard, UK - "Management of
Curved Canals with Heat Treated Alloys." Prof.
Prichard will discuss the management of
curved canals using heat-treated alloys, highlighting their benefits and application in endodontics.
Hands-on courses
•
Dr. Antonis Chaniotis, Greece - "Management of Root Canal Blockage and
Apical Periodontitis".
•
Prof. Damiano Pasqualini, Italy "Modern Surgical Microendodontics".
These sessions will provide participants
with the opportunity to gain practical experience under the guidance of renowned experts, ensuring that they leave with valuable
skills and knowledge applicable to their practices.
Join CAPP at CES 2024
The Clinical Endodontics Symposium
promises to be an exceptional opportunity
for dental professionals to stay at the forefront of endodontic innovation. Whether
you are a seasoned practitioner or new to
the field, CES 2024 offers a unique platform
to enhance your expertise, network with
peers, and discover the latest advancements that are transforming endodontic
care.
Mark your calendars for 15-16 November 2024, and join us at the Madinat Jumeirah Arena & Conference Center in Dubai
for this event. Don’t miss the chance to be
part of the future of endodontics!
CAPP Events & Training
Web: www.cappmea.com/confex2024
Mob: +971502793711
E-mail: events@cappmea.com
[2] =>
DTMEA_No.4. Vol.14_ET.indd
CASE REPORT
A4
Endo Tribune Middle East & Africa Edition | 04/2024
Utilising R-SWEEPS laser-assisted
irrigation for the treatment of
chronic periapical periodontitis
By Dr Hui Jing Phang,
Singapore
Case report
A 48-year-old female patient
was referred to our clinic owing to a
defective amalgam restoration on
tooth #46. She had spontaneous
acute pain in the area of tooth #46
when eating, and the pain had increasingly become unbearable at
night, causing her to lose sleep. The
patient was healthy, had no known
allergies and good oral health.
Tooth #46 was tender to percussion, non-tender to palpation and
had no response to the electric pulp
test and cold test. Analysis of the
dental
panoramic
tomogram
showed a large mesio-occlusal amalgam restoration with recurrent caries, reaching close to the mesial pulp
horn of the tooth (Fig. 1). Two roots
could be observed and no visible
root resorption. Slight periodontal
ligament widening was evident and a
periapical lesion. She was diagnosed
with irreversible pulpitis of tooth #46
and chronic periapical periodontitis.
We decided to use laser-assisted
irrigation with a 2,940 nm Er:YAG
laser and Fotona R-SWEEPS (resonant shock wave-enhanced emission
photoacoustic streaming) mode at
settings suitable for treating a mandibular molar. In the first session, 4%
articaine
hydrochloride
with
1:100,000 adrenaline (citocartin,
Molteni Dental) was administered to
1
Fig. 1: Initial dental panoramic tomograph.
anaesthetise the area. The patient
was properly draped with a waterproof gown to protect her clothing.
The tooth was isolated with a dental
dam. The old amalgam and carious
tissue were removed, an access cavity was prepared and the root canal
was negotiated to the apex with a #8
hand K-file. There was no spontaneous bleeding upon opening of the
pulp chamber, and there was necrotic tissue present. Hence, the decision was made to complete the
root canal treatment in two sessions.
A total of four canals were identified (Fig. 2). The treatment started
with continuous delivery of sodium
hypochlorite (NaClO) solution (3 ml)
by syringe and simultaneous activa-
tion by Er:YAG laser. Laser-assisted irrigation was performed with a LightWalker AT S (Fotona) and an Er:YAG
H14 handpiece with a flat SWEEPS
400/9 fibre tip positioned safely at the
entrance to the pulp orifice (Table 1).
For the shaping of the root canal system, the ProTaper Gold rotary file
system (Dentsply Sirona) was used.
Minimally invasive root canal preparation began with the 19/0.04 SX file
to relocate the coronal aspect of the
canals. Cleaning and shaping of the
canals were subsequently performed
with the 18/.02 S1 file and 20/.07 F1
file to the working length. The
R-SWEEPS final irrigation protocol
was performed at the end of instrumentation and consisted of two cy-
cles of 17% EDTA activated by
R-SWEEPS for 30 seconds for each
activation period with 30 seconds of
resting time in between, rinsing with
distilled water activated by R-SWEEPS
for 30 seconds, and then three cycles
of 5% NaClO activated by R-SWEEPS
for 30 seconds for each activation
period and a resting time of at least
30 seconds in between. After drying
the canals (Fig. 3), Odontopaste
(Australian Dental Manufacturing), a
zinc oxide-based root canal paste
with 5% clindamycin hydrochloride
and 1% triamcinolone acetonide,
was placed, followed by a temporary
filling (Fig. 4).
There was no pain or discomfort
during or after the clinical treatment,
Parameter
Energy (mJ)
Power (W)
Frequency (Hz)
Water
Air
2
Value
10
0.3
15
0
0
3
Fig. 2: Access to the pulp chamber showing four canals. Fig. 3: Pulp chamber after irrigation with R-SWEEPS.
Table 1: Laser parameters used for root
canal irrigation with R-SWEEPS activation.
4
6
5
Fig. 4: Post-op radiograph showing the temporary filling. Fig. 5: Three-month follow-up radiograph showing no inflammation in the area of tooth #46.
Fig. 6: Final restoration in situ.
and thus the patient did not need to
take any medication to relieve the
pain. Two weeks later at the second
appointment, the Odontopaste was
washed out with one 30-second
EDTA cycle, followed by rinsing the
canal with distilled water and three
cycles of 30-second R-SWEEPS irrigation with 5% NaClO. The final obturation was done with iRoot SP bioceramic sealant (Innovative BioCeramix) and thermoplastic gutta-percha
Thermafil (Dentsply Sirona).
The three-month follow-up
showed healthy periapical bone
structure and no clinical symptoms
(Fig. 5). The tooth had been restored
using a complete monolithic zirconia
crown (Fig. 6). The gingiva was completely healthy and had a normal
pocket probing depth.
Conclusion
R-SWEEPS laser-assisted irrigation supports minimally invasive
endodontics and superior decontamination, enabling a paradigm
shift in the practice of endodontics.
R-SWEEPS may be utilised to increase the efficacy of laser-assisted
root canal therapy.
Editorial note: This article was first
published in roots international magazine of endodontics, Vol. 20, Issue
1/2024.
Dr Hui
Jing Phang
graduated
as valedictorian from the National
University of Singapore, won the
University Silver Medal, Terrell Medal,
Tratman Medal and Singapore Dental Association Book Prize and was
placed on the dean’s list. She started
her career as a dental surgeon in
a public hospital, treating patients
requiring complex, multidisciplinary medical and dental care. After
hospital practice, Dr Phang joined a
leading family dental care practice
with a strong emphasis on advanced
dental technology and aesthetic
dentistry. She is the founder and clinical director of the Toothbar Dental
in Singapore. Dr Phang has a keen
interest in cosmetic and restorative
dentistry involving dental lasers,
tooth whitening, CAD/CAM ceramic
dental restorations, clear aligners,
dental implants, root canal treatment
and dental splints for managing
temporomandibular joint pain from
bruxism.
[3] =>
DTMEA_No.4. Vol.14_ET.indd
NEWS
A3
Endo Tribune Middle East & Africa Edition | 04/2024
Study identifies gaps in Turkish
dentists’ knowledge of oral cancer
and mucosal lesions
By Dental Tribune International
According to the American Cancer Society, 58,450 new oropharyngeal cancer cases and 12,230 deaths
are expected in the US alone in 2024.
The World Health Organization’s
Global Cancer Observatory reported
2,246 new cases of lip and oral cavity
cancer and 551 deaths in Turkey in
2022. These figures highlight the importance of early diagnosis and the
appropriate referral of patients, for
which dentists are well placed. To
that end, a recent study has assessed
the oral cancer knowledge and experience of dentists in Turkey and
found gaps in their clinical and theoretical knowledge, pointing to the
need for improved training.
“Our article informs about dentists’ knowledge of oral cancer and
oral mucosal lesions and recommends measures to eliminate possible knowledge deficiencies. Considering that dentists can play an active
role in the early diagnosis of oral can-
cers, we aimed to contribute to dental education in Turkey,” senior author Dr Mert Karabağ, a researcher in
the Department of Oral and Maxillofacial Surgery at Recep Tayyip Erdoğan University in Rize, told Dental
Tribune International (DTI).
The study involved 361 dentists
who were actively practising in Turkey between January 2020 and January 2023. Participants received a
16-question survey sent via email
enquiring about their self-reported
experience and knowledge of oral
cancer lesions and their biopsy and
testing their knowledge of identification, diagnosis and biopsy of cancerous and non-cancerous lesions.
Most participants identified
smoking, alcohol consumption, UV
radiation exposure and viral infections such as human papillomavirus
as predisposing factors for oral cancer. Similar studies have also found
that dentists generally have good
knowledge of these risk factors.
However, 64.5% of the participants
incorrectly believed that advanced
age increased oral cancer risk, unlike
the findings in studies in other countries.
Although 62.3% reported that
they were unsure of whether they
had sufficient knowledge and experience of oral cancer lesions,
33.0% of the participants stated
that they had previously diagnosed
a cancerous lesion. Only 21.3%
considered their knowledge and
experience to be sufficient, and
70.8% of them had previously diagnosed a cancerous lesion. Furthermore, only 36.0% of the respondents accurately stated that the
tongue is the most common site for
oral cancers.
Only 18.0% of the participants
said they had sufficient knowledge
and experience of oral biopsy techniques, and 70.8% of those participants had previously diagnosed a
cancerous lesion. For the question
testing biopsy knowledge, 27.4% of
participants who answered correctly stated that they had suffi-
cient knowledge and experience in
this regard.
Of participants who stated that
they had sufficient knowledge and
experience of oral cancer lesions,
34.4% had received training on oral
cancer, whereas 55.7% of the participants overall had not. Among
the respondents who had previously received training on oral cancer, the rate of having diagnosed a
cancerous lesion was 42.5%, compared with 25.4% among those
who had not received training.
Commenting on the findings,
Dr Karabağ told DTI that he was
surprised to learn that the results
were similar between participants
who reported having sufficient
knowledge of and experience with
oral cancer and those who did not
feel their knowledge and experience were sufficient. The study
highlights the need to increase
dentists’ knowledge about oral
cancer through undergraduate and
continuing education. Further
studies with larger samples are
needed to better identify the gaps
in dentists’ knowledge on the subject.
The vast majority of the participants were general dentists, followed by oral and maxillofacial surgeons. The researchers reported
that oral and maxillofacial surgeons had the highest rate of correct responses demonstrating their
knowledge, experience and clinical
practices, whereas prosthodontists
showed the least knowledge of oral
cancer. More oral and maxillofacial
surgeons also had received specific
training on oral cancer.
“The findings will contribute to
early diagnosis and survival rates of
oral cancer and will help improve
dental professionals’ knowledge
and experience with oral cancer lesions,” Dr Karabağ concluded.
The study, titled “Evaluation of
Turkish dentists’ knowledge about
oral cancer and oral mucosal lesions”,
was published online on 29 June 2024
in BMC Oral Health.
Review offers evidence of link
between oral microbiome and cancer
By Iveta Ramonaite, Dental
Tribune International
The oral cavity represents a complex microenvironment where a diverse microbial community flourishes. A recent review study, carried
out by researchers at Karolinska Institutet in collaboration with researchers in South Korea, Sri Lanka
and Australia, has recently taken a
deeper look at oral microbes and
their potential impact on oral pathologies, including oral cancer. The data
gathered in the review may help improve the diagnosis and management of oral disease.
“The topic of the association between cancer and the microbiome,
including in the oral cavity, is a very
timely one,” lead author Prof. Georgios Belibasakis, professor of clinical
oral infection biology and head of
the Division of Oral Health and Periodontology in the Department of
Dental Medicine at Karolinska Institutet, told Dental Tribune International.
Discussing the most interesting
findings, he commented: “There
are documented associations between oral dysplastic conditions,
including oral cancer, and the oral
microbiome. The associations do
not necessarily imply a cause–effect relationship, but there can be a
vicious circle between the establishment of a dysbiotic microbiome
and the progression of oral pathologies. An important aspect is that
the two major components of the
oral microbiome, the bacteriome
and the mycobiome, tend to act
synergistically in the deterioration
of oral pathologies. Moreover, the
tumour microenvironment, depending also on the specific type,
can favour the colonisation and invasion of certain microbial species
that are clinically proven to be associated with a given neoplastic
condition.”
The study has diagnostic and
prognostic implications for oral
medicine, and the researchers believe that the findings could help
explain the complex interplay between bacteria and fungi in the oral
cavity, thus leading to improved
prevention and management of
oral cancer. Additionally, Prof. Belibasakis noted that screening for alterations in the bacterial and/or
fungal make-up of suspected sites
could provide early indications or
reveal the progression patterns of
oral mucosal conditions such as
oral cancer.
“Variations in the core microbiome of an individual may serve as
predictive markers for any oral
condition, including carcinogenesis. The available data enhances our
understanding of the ecology of
oral niches and their dysbiotic
changes during oral mucosal dysplasia and oral cancer,” he commented. “This knowledge could
support early diagnostic and prognostic tools as well as innovative
treatments, making a quantum
leap in oral medicine,” he concluded.
Editorial note: The study, titled
“Bacteriome and mycobiome dysbiosis in oral mucosal dysplasia and oral
cancer”, was published online on 19
March 2024 in Periodontology 2000.
Prof. Georgios Belibasakis.
[4] =>
DTMEA_No.4. Vol.14_ET.indd
NEWS
A2
Endo Tribune Middle East & Africa Edition | 04/2024
Piezoceramic stack actuator
speeds up root canal treatment
By Franziska Beier, Dental
Tribune International
A common challenge faced
during root canal treatment is the
frequent jamming of the rotating file,
necessitating regular cleaning. Addressing this issue, researchers from
the Fraunhofer Institute for Ceramic
Technologies and Systems (IKTS) in
Dresden and the Department of
Dentistry at the Rostock University
Medical Center have developed a
piezoceramic stack actuator that allows for quicker and more efficient
patient procedures.
In Germany, approximately
seven million root canal treatments
are performed annually. Despite
dental files being made from a superelastic nickel-titanium alloy, there
is a high risk of these files breaking
under stress, necessitating their frequent removal and thorough cleaning. The newly developed device
overlays the file’s rotation with axial
vibration in the ultrasonic frequency
range. The aim is to reduce the risk of
file breakage and improve the efficiency of root canal treatments.
Advantages of the piezoceramic stack actuator
Dr Holger Neubert, head of the
Department of Smart Materials and
Systems at Fraunhofer IKTS, said in a
press release: “By overlaying the rotation with axial vibration, the file
gets clogged less quickly, meaning
that it doesn’t need to be cleaned so
often. Dentists are then able to concentrate much more on their complex work in the root canal. The risk
of the file breaking is also reduced.”
He added: “The core idea of
combining the two motions of the
dental file came from the specialists
at the Department of Dentistry at the
Rostock University Medical Center.
We used piezoceramic stack actuators as the drive element because
they are most able to meet the special requirements for vibration amplitude and frequency, size as well as
supply voltage.”
(Image: luckystep/Freepick)
Piezoceramic-based actuators
bring numerous benefits. Their compact size and rapid, precise operation make them highly efficient and
offer ease of control and minimal
heat loss. These actuators are composed of multiple layered segments
that collectively enhance displacement, allowing for a design that is
sufficiently small to navigate the
tightest spaces in a patient’s mouth.
Additionally, the research team constructed the stack actuator from
lead-free materials, adhering to the
future requirements of the European
directive on the restriction of hazard-
ous substances in electrical and electronic equipment.
Dentists at Rostock University
Medical Center conducted trials of
the new technology on artificial
teeth and obtained positive results.
Additional medical engineering applications
The newly developed technology holds promise for a range of
medical applications beyond dentistry, including applications in diagnostic imaging and cancer treatment. Researchers are exploring its
use in low-frequency ultrasonic
transducers, which offer high penetration depth for tomography. Advances in piezoceramic transducers
have led to their miniaturisation, allowing as many as 2,000 units to be
incorporated into a standard-sized
tomography system. This facilitates
the high-resolution 3D imaging crucial for medical diagnostics.
In addition, high-frequency ultrasound transducers are becoming
increasingly valuable in fields like
dermatology for their ability to provide precise images at shallow
depths. Further potential lies in
high-performance ultrasonic trans-
ducers designed to target and destroy specific tissue areas with focused sonic waves, a technique particularly relevant in cancer therapy.
“Piezoceramic components can
be used in a wide array of applications and, thanks to their compactness and performance, are ideal for
medical engineering. We are able to
develop custom solutions to suit the
needs of individual clients,” emphasised Dr Neubert.
“The newly developed technology holds
promise for a range of medical applications
beyond dentistry, including applications in
diagnostic imaging and cancer treatment.”
Dental file with integrated piezoceramic stack actuator.
(Image: © Fraunhofer IKTS)
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