DT Pakistan No. 5, 2016

IAMRA urges PMDC to improve quality of education or face the music / Mobile app for Annual World Dental Congress / RCPS appoints Prof Ghani as Dental Adviser / News / Value chains being transformed by new digital dental technologies / Interview with Prof Tipu Sultan: Most of hospitals lack anaesthesia facilities / Upper and lower dentures on Rhein83 components / Bioactive materials: A new approach to dental care / Children’s oral health remains of concern in Hong Kong

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PUBLISHED IN PAKISTAN

www.dental-tribune.com.pk
Upper and lower
dentures on...

Career development
opportunities...

NEWS

SEPTEMBER, 2016 - Issue No. 05 Vol.3

Page 2

CLINICAL PRACTICE

Page 11

Implant dentistry
requires...

NATIONAL NEWS

Mobile app for Annual
World Dental Congress
Editor - Online
Haseeb Uddin

DT International

OZNAN (POLAND) - One month ahead of
its Annual World Dental Congress, the FDI
World Dental Federation has introduced a
mobile app exclusively for the event, which will be
held in Poland this year. According to the organisers,
it is a useful and convenient tool that will provide
Editor - Online
participants and exhibition visitors with all ofHaseeb
the Uddin
necessary information about the congress and help
them structure their event experience individually.
The smartphone app will give attendees access to
information about the scientific programme and allow organized a symposia at the FDI Annual World Dental
them create their own schedule, add notes on the Congress, Poznan.
sessions in advance or in real time, and find their way
All lectures to be delivered at the symposia by
around the exhibition area. It is available in several experts in the field provide an invaluable opportunity
languages, including English, Dutch, French, German, to learn from opinion leaders, while earning ADA
Italian, Polish, Portuguese, Spanish and Swedish. CERP C.E. Credits.
The 2016 Annual World Dental Congress will be
In this regard, a programme has been developed that
held at the Miedzynarodowe Targi Poznanskie, the is both diverse and engaging, with every lecture
Poznan International Fair, from September 7 to 10. offering the practical guidance that one seeks to take
SYMPOSIA: Dental Tribune Study Club has
Continued on page 15

Page 14

Don’t seek admission to
unregistered medical &
dental colleges: PMDC
DT Pakistan Report

SLAMABAD - The Pakistan Medical
and Dental Council (PMDC) has
advised students to get admission in
only recognised and registered medical and
dental colleges.
According to an official of the PMDC, all
such students could check the list of
registered and authorised medical and dental
colleges from the PMDC website. He said
that no medical or dental institution was
allowed to train students which was not
registered with the PMDC.
He said that all the institutions which were
advertising admissions of medical and
dental colleges must follow the seat
allocation prescribed by the council in order
to avoid any inconvenience in future.
He added that passed out medical dental
graduates without having students
registration with the PMDC would not be
registered as medical and dental
practitioners.

IAMRA urges PMDC to improve quality
of education or face the music

RCPS appoints Prof
Ghani as Dental Adviser

DT Pakistan Report

ESHAWAR - The
Royal College of
Physicians &
Surgeons, Glasgow (UK)
has appointed Prof. Dr.
Fazal Ghani as its Dental
Adviser from Pakistan for a three-year
term in recognition of his services in dental
education, dental research and dental health.
As such Prof. Ghani has become Dental
representative from Pakistan as a member
of the International Advisers Network of
the prestigious Royal Surgical
College in the United Kingdom.
A short biography of Prof. Ghani has
been posted on the Website of the Royal
Surgical College Glasgow. As an
international adviser to the Royal College,
Prof Ghani will frequently hold online
meetings, besides undertaking visits to the
Royal Surgical College, Glasgow.
Prof Ghani did his BSc and BDS from
Peshawar, M. Sc, PhD (from London) and
FDS & RCPS (from Glasgow). He is
currently working as Professor and Head
Continued on page 15

SLAMABAD - Thousands of
Pakistani doctors face a threat
of a comprehensive ban on
practice and study in the United
States and Europe in the wake of
IAMRA's (International Association
of Medical Regulatory Authorities)
repeated warnings to the PMDC
that it should help improve the
quality of medical education and
close down all illegal medical
colleges in the country.
According to media reports, the
IAMRA had, a few months, back
asked the PMDC to improve the
quality of medical education and
shut all illegal medical colleges.
The IAMRA had reportedly warned
that in case of non-compliance, it
would ask the governments of the
United States and all the European
countries to impose a ban on the
Pakistani doctors' work or study in
their respective countries.

Confirming that that the IAMRA
had issued the warning, PMDC
president Prof Shabbir Lehri said
that the Council fought the case
before the IAMRA and got oneyear relaxation for improving the
quality of medical education in the
country.
Pointing out that the PMDC had
sealed illegal or unauthorised
medical colleges, he deplored
that in the past those medical
colleges were allowed to function,
which brought international
embarrassment to Pakistan.
The IAMRA comprises almost all
the medical regulatory authorities
in the world. Hardly, any country
can entertain the doctors from
another country without the
approval and authorisation of the
IAMRA.
According to sources, the
Pakistani negotiators spoiled the

case before the IAMRA, as they
concealed the fact that the PMDC
was not actually functional since
2012. The PMDC, at that time, was
being run by an ad-hoc committee.
And, therefore, it did not have the
authority to recognise or seal the
medical colleges.
Moreover, taking an undue
advantage of the situation, countries
like India got a maximum number
of its doctors adjusted in the US
and the Europe. The Pakistani
doctors had once been very
influential and instrumental in
IAMRA. Prof Syed Sibitul Hasnain
was member of the management
committee of the authority. Former
PMDC registrar Dr Ahmad Nadeem
Akbar was also the member of
IAMRA and the World Federation
of Medical Education.
Sources said problems surfaced

DT Pakistan Report

[2] =>

NEWS

2 DENTAL TRIBUNE Pakistan Edition September 2016

Career development opportunities
and support in a corporate practice
By Dr Sarah Weston

aving worked for most of my career in the much difference to someone’s quality of life. I am hoping
independent sector, I was aware of the negative to undertake an implant restoration course soon as well,
press surrounding corporate dentistry before I so I will be able to restore the implants placed by colleagues
joined the mydentist group, but I have to say that those at local practices in the group.
Since working for the company, I have become a mentor
rumours were all unfounded. In fact, I feel quite
passionately that new graduates are still being given that too, which has definitely been a highlight for me. It is a
role I really enjoy, as after 20 years
negative message. As a company we
in the job, it is satisfying to pass on
should try to give the next generation
some of my experience to the younger
the facts and engage them directly.
generation. I had a great vocational
It has been 20 years since I qualified
training instructor when I started and
from Guy’s Hospital. Since then, I
I hope I can be as good to new
have worked in Australia, New
associates as he was to me. It is a job
Zealand and the UK and across most
areas of the profession, be it as a house Corporate dentistry is better than its that is mutually beneficial: it is
extremely rewarding to see a mentee
officer in New Zealand, in NHS and
image, says Dr Sarah Weston.
improve and gain in confidence and
private practices, or as a partner and
an associate. At my current practice in the small market it does the same for the mentor.
Within the company, we are fortunate to have a high
town of Woodbridge in Suffolk, we predominately perform
NHS dentistry, but do offer a range of private services. level of support from practice and area managers through
With an interesting demographic of patients, we have to clinical support managers and clinical directors. They
the opportunity to utilise all our skills. We routinely see are there to help prevent small problems from becoming
25–30 patients a day and I am lucky that I work with a larger ones. It is true that the red flags and key performance
really great team and most of us have worked together indicators can feel intrusive at times, but I do feel they
for a while now. It is good to be with other people who are there to help clinicians above everything else. A visit
understand the stress and strains of the job and can have from the clinical support manager should be seen as a
positive thing and I am fortunate to have a great manager
a good laugh together at times.
I work full time, so my days tend to be fairly similar. I in my area. One thing I have learnt is that it can be lonely
start with a coffee then move on to checking day lists, in the independent sector and there is no one looking out
patient records and laboratory work, etc. I hate surprises for you in the same way. I think the support network
available is the real strength of corporate dentistry.
so I like to know what the day will hold.
Furthermore, we are incredibly fortunate to have the
Most of my days are spent performing a mix of
examinations and treatments, with the odd interesting case online academy and the reminder to complete CPD when
thrown in. I also offer facial aesthetic procedures and have it is required. This can be a burden for dentists and if there
recently been on the Denture Excellence course. It is great is any way to make it easier then we should be grateful.
to be able to offer such a wide choice of treatment options My practice manager keeps us up to date on when our
to patients and the denture excellence has really taken off. CPD is due and the opportunity to complete it online is
Continued on page 15
It is an area I really enjoy, as a good denture can make so

Publisher/CEO
Syed Hashim A. Hasan
hashim@dental-tribune.com.pk
Editor Clinical Research:
Dr. Inayatullah Padhiar
Editors Research & Public Health
Prof. Dr. Ayyaz Ali Khan
Editor - Online
Haseeb Uddin
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statements made by advertisers. Opinions expressed
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Dental Tribune Pakistan.

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Taking brushing selfies could
help improve oral health

International PR & Project Manager

Marc Chalupsky
Marketing & Sales Services

Nicole Andrä
Event Services

Esther Wodarski
Accounting Services

DT International

HIO, USA/CHENNAI,
INDIA - Smartphone video
selfies are a popular means
of communication today and they are
increasingly being used in the medical
field to assess, monitor and determine
the progression of disease. For the
first time, the findings of a new study
have suggested that recording video
selfies while brushing could help
patients improve their oral health care
techniques, even within a short period.
In the study, four dental student
interns recorded five video selfies
each while brushing at home over a
period of 14 days using smartphones
mounted on stands.
At baseline, several surfaces within
sextants were not being brushed—
notably the lingual surfaces of
maxillary and mandibular anterior
teeth and the palatal aspect of the right
maxillary posterior sextant. After the
intervention, all four participants had

developed toothbrushing strokes that
covered all their tooth surfaces.
Overall, the researchers saw an
increase in the accuracy of
brushstrokes, an increase in number
of strokes and an overall 8 percent
improvement in toothbrushing skills.
“Often, toothbrushing is learned and
practiced without proper supervision,”
said Dr. Lance T. Vernon, a senior
instructor at the Case Western Reserve
University School of Dental Medicine
and co-author of the study. “Changing
toothbrushing behaviors—which are
ingrained habits tied to muscle
memory—can take a lot of time and
guidance.”
“Our study suggests that, in the
future, recording these selfies can help
shift some of this time investment in
improving brushing to technology,”
Vernon added. “Patients can then
receive feedback from dental
professionals.”

Recording video selfies while brushing
could help improve toothbrushing skills.

The researchers concluded,
however, that further investigation
using a larger sample size is needed
to thoroughly assess the effectiveness
of this approach in order to improve
toothbrushing skills and better
understand the role of proactive
interference (when learning a new
behavior is hindered by knowledge
and habits associated with an old
behavior).
The study, titled “Using smartphone
video ‘selfies’ to monitor change in
toothbrushing behavior after a brief
intervention: A pilot study,” was
published in the May/June issue of
the Indian Journal of Dental Research.
It was conducted at the Case Western
Reserve University School of Dental
Medicine in Ohio in collaboration
with the Ragas Dental College and
Hospital in Chennai.

Karen Hamatschek
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Media Sales Managers

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[3] =>

[4] =>

NEWS

04 DENTAL TRIBUNE Pakistan Edition September 2016

To floss or to brush—that is the
(interdental) question
By Marc Chalupsky

L

EIPZIG, GERMANY - Should dental floss
still be used as a tool to combat plaque, caries
and periodontal disease? After almost 40
years, the US Department of Health and Human
Services and Department of Agriculture have
removed their recommendation to use dental floss
from their latest Dietary Guidelines for Americans.
And the dental world discussed a recent report which
made worldwide headlines and concluded that no
scientific evidence has proven the effectiveness of
flossing. So: What are alternatives for dental
professionals? Dental Tribune Online posed these
questions to three dental hygienists.
For a long time, dental professionals have
recommended daily flossing as a necessary part of
health care. However, the Associated Press reviewed
25 prominent studies that compared the combination
of toothbrushes and floss and their effectiveness in
plaque removal. As Dental Tribune Online reported
earlier, the investigation found only weak and
unreliable evidence. According to the article, some
studies were not valid since they included very few
participants and had a short duration of only a couple
of weeks. When asked for a statement, dental floss
manufacturers were not able to provide scientific
evidence even though many of the previously
mentioned studies were funded by this industry. In
the meanwhile, manufacturers have already
announced new funding for comprehensive research
to determine the effects of flossing on oral health.
As periodontal disease and caries develop over
months and years, future research will have to focus
on a larger study population over a longer period in
order to measure periodontal health effectively. In
the meantime, how should dental professionals deal
with this issue? Do they have an alternative to dental
floss?
Are interdental brushes another solution?
According to Swiss oral health care provider
Curaden, not cleaning interdentally would be going
too far. Choosing a suitable interdental cleaner and
using the proper technique are always important.
Floss is appropriate for anterior teeth, where long,
flat approximal surfaces and narrow spaces make
access with an interdental brush difficult. Ideally,
one should use dental floss for the narrow interdental
spaces between the anterior teeth and interdental
brushes for the posterior teeth. According to the
Swiss company, interdental brushes are very effective
and extremely easy to use compared to dental floss,
but must be used gently in order not to injure the
gums. Interdental brushes help prevent build-up of
plaque between teeth and that causes bleeding gums,
gingivitis and periodontitis and dental caries. In
addition to interdental brushes, the company
produces toothbrushes and toothpastes under its
CURAPROX brand and supports educational
prophylaxis training called iTOP for dental
professionals.
CEO and owner of Curaden Ueli Breitschmid
said, “Since 1972, our company has been the
pacesetter for interdental brushes, which remove
both food residue between the teeth and—more
importantly—dental plaque. Since they do not
damage tissue, our interdental brushes are not only
recommended by the dental professionals globally,
but are also prescribed to their patients and their
use taught to each patient individually.” According
to Curaden, the advantages of interdental brushes
over flossing have been demonstrated in numerous

Review challenges
dental health
recommendation to
avoid dried fruits
DT International

B
Despite the recent dental floss discussion, patients
should not conclude that less thorough dental care is
advised. But what interdental cleaners should dental
professionals recommend?

studies. For example, in a study titled “Comparison
of different approaches of interdental oral hygiene:
Interdental brushes versus dental floss”, patients
with periodontitis used dental floss and interdental
brushes to reduce plaque over a six-week period.
Interdental brushes were found to remove
significantly more plaque than dental floss did.
Furthermore, patient acceptance seemed to be higher
with interdental brushes.
“Everyone knows dental floss, but only few like
to do it—because they do not know how,” according
to Edith Maurer, a Swiss-based dental hygienist
with 40 years of experience. She added: “A very
short thread should be kept between the fingers,
moving up and down the sides of the teeth. But most
of the time, it slips away, cuts into the gums and so
constantly injures the structure of the gingivae.
Dental floss should be used if something is stuck
between your teeth but not for cleaning below your
gums. After all, it has been a razor-sharp tool for
over 200 years and is quite dangerous if you do not
use it correctly. Imagine cutting a pudding with
floss. It will work perfectly, nothing will be attached
to the floss. But if you use a fine interdental brush,
it will take away more of the pudding. Interdental
brushes should be the preferred tool if you want to
clean your gums at least in the posterior region.”
Individually trained oral prophylaxis is the key
According to dental hygienist Catherine Schubert,
the space below the contact area should be the focus.
“We need to carefully differentiate between gum
disease and dental caries. Interdental brushes are
more effective for the prevention of gum disease
owing to their space-filling properties. However, a
thin shaft and longer bristles are necessary to reach
below the interdental contact point where caries
mostly develops. Interdental brushes can prevent
interdental caries if applied correctly, which is below
the interdental contact point. Of course, floss also
cleans below the contact point. However, using floss
just because it is normal, without thinking about the
right technique, will not lead to the prevention of
caries. At the same time, using an interdental brush
without proper instruction will not lead to the
prevention of gum disease. After all, it is not a
government or institution that should decide about
one’s oral hygiene, but the dental professional needs
to choose which cleaning technique is most efficient
for each of his patients. Individually trained oral
prophylaxis has always been the key to one’s health."
Elizabeth van der Ham, a South African dental
hygienist, agrees that one has to choose carefully
between flossing and interdental brushing: “Dental
floss throughout the years has been a saving grace
for many patients overcoming oral health issues.
Continued on page 15

ETHERSDEN, UK - Dental health
associations worldwide, including the
British Oral Health Foundation,
usually advise against snacking on dried fruits.
Owing to their stickiness, they adhere to the
teeth and are thus considered to be detrimental
to dental health. By reviewing scientific
literature on this topic, a nutrition expert from

A new study has cast doubt on the common perception
that eating dried fruit can cause dental problems

the UK has now found that this assumption
might not be founded on scientific evidence.
The review was undertaken by Dr Michèle
Sadler, a registered nutritionist. “There is a
lack of good quality scientific data to support
restrictive advice for dried fruit intake on the
basis of dental health parameters and further
research is required,” she concluded.
However, she found that there are a number
of potential benefits of consuming dried fruits
for dental health. For instance, eating dried
fruits requires substantial chewing, which
encourages salivary flow. In addition, they
contain antimicrobial compounds and sorbitol.
Furthermore, Sadler pointed out that advice

Student develops
artificial dental plaque
DT International

W

ITTEN, GERMANY - As part of
a research project, a dentistry
student from Germany has
developed a new formula to synthesise dental
plaque, which could help facilitate research
on oral biofilm significantly in the future. As
the first dental student ever to speak at the
congress, she presented her findings at the

From left: Dr Tomas Lang, CEO ORMED - Institute
for Oral Medicine at the University of Witten/ Herdecke,
Ann-Kathrin Flad and Prof. emeritus Peter Gängler

94th General Session and Exhibition of the
International Association for Dental Research,
which took place from 22 to 25 June in Seoul
in South Korea.
“These results are important for the
development of toothbrushes and other devices
because their effectiveness has to be tested,”
Continued on page 15

[5] =>

[6] =>

CLINICAL PRACTICE
Value chains being transformed by new digital dental technologies

6 DENTAL TRIBUNE Pakistan Edition September 2016

By Friedhelm Klingenburg, CEO Merz
Dental GmbH

he definition of ‘value chain’
depicts the stages of
production as an ordered
series of activities. These activities
create values, consume resources and
are linked to one another in Processes.
According to the approach taken by
Michael E. Porter[1], ‘Every firm is
a collection of activities that are
performed to design, produce, market,
deliver, and support its product. All
of these activities can be represented
using a value chain’. Another
definition describes the value (adding)
chain as ‘the stages of the
transformation process that a product
or service passes through, from
starting materials to final use’.[2]
Value added is the difference between
the income that the product generates

dentist generated his value added by surgery and the insertion of a dental
Online
r e s t -oUddin
ration (conservative or
rendering services for patients. The Editor
Haseeb
chain has changed more and more prosthetic). The other activities will
over the past 20–30 years, mainly due be replaced by digital work processes.
There would probably have not been
to the introduction of digital
technologies. The following outline any change in the value chain that had
presents selected developments based applied for decades (see Fig. 1) if
on use of digital technologies, plus a companies like Sirona had not
future-oriented project for the introduced the first digital technologies
integration of total prosthetics into to dental practices and dental labs in
the 1980s. And even though the
digital technology.
Analogue meets digital (change in concept of the shift in value added
was already an integral part of the
occupation profiles)
The whole field of digital system, initially only work steps and
technologies in dentistry has now work processes in the dental lab were
become so extensive that not all facilitated, speeded up and thus made
aspects can be covered in this article. more efficient in implementation at
For example, digital technology has the beginning of this digital evolution,
an impact on the following. by using scanners and CAD/CAM
. The profile of a dental technician's milling machines. Only in a
occupation, which is no longer a subsequent step were other market
‘plaster room’ job but rather a participants included, e.g. milling
computer workstation position. As a centres in Germany and abroad or also
Role of market participants in the value adding process, NOT INCLUDING
digital steps taking a precious metal-based crown as an example

Human resources
Technology development
Procurement

Inbound
logistics

Operations Marketing
and sales

Out bound
logistics

Customer
service

D E N TA L L A B

D E B TA L L A B
Diagnosis
Preparation
Shade taking
Impression taking

Plaster model
Jaw relation recording
(articulator)
Modeling: wax sprue
Investment
Processing: metal
framework
Veneering plioshing

Manufacture and supply
of precious metal alloy

DENTIST

Primary activities

Scan for conventional
impression
Design preparation
limits

I N D U S T RY

Manufacture/
supply of materials

Digital scan
Data transmission

Diagnosis
Preparation
Shade taking
Impression
taking
Temporary
restoration

Fig 1: Basic model of Porter’s value chain.

Role of market participants in the value adding process, NOT INCLUDING digital
technology taking a ceramic crown as an example

DENTIST

I N D U S T RY

Pro
fit m
arg
in

Supporting
activites

in
arg
fit m
Pro

Corporate infrastructure

had in the dental lab? The fact is that
there has been a shift in the focuses
of activity in in-house production
towards more services in the digital
planning and coordination process and
the process chain has been minimised.
In terms of quality not much has
changed, even though it may have
been expected. Without doubt,
material quality is perceived by the
patient only in terms of shade (from
gold to white) and the fit/security of
a dental restoration is still dependent
on the job instructions that have been
received from the dental practice.
Process quantity has seen a major
change—nowadays only half of the
original dental lab processes are
necessary in the lab in order to produce
a functional, highly aesthetic dental
restoration. Although in economic
terms it means high capital investment
costs for the dental lab owner, it also

Milling centre
Range of services
identical to those
of an external
milling centre

Fig 2: Basic model of market participants in the value
adding process, not including digital dental technology.

Milling
Veneering /finishing

MILLING
CENTRE

Optional:
Purchasing from
milling
centre/industry

Checking the dataset
Design preparation
limits
Milling
Dispatch to dental lab
Optional:
Completion and
dispatch to dentist

Fig 3: Basic model of market participants in the value
adding process, not including digital dental technology.

THE CONVENTIONAL PRODUCTION PROCESS FOR A FULL DENTURE
IS HIGHLY COMPLEX AND TIME TIME-CONSUMING
Production of a full denture becomes aconomically viable by using Merz Dental’s innovative
Baltic Denture System (BDS) with a considerably reducted process flow

STEP 1

DENTAL LAB

Impression taking

DENTAL OFFICE

STEP 2

STEP 1

Model casting
Making the impression tray

STEP 3

Functional impression taking

DENTAL LAB

Functional impression
taking and transfer

STEP 4
STEP 2

Making the bite rim

Computerised design
Milling

Occlusal registration
STEP 6

Model analysis
and model casting

STEP 7

Incorporation
STEP 8

Corrections and finalisation
STEP 1

Incorporation

Try-in

Fig 4: Mandibular BDLoad, after milling process.

STEP 3

Scanning the impression

STEP 5

Fig 6: Innovative digital method of
treatment and production.

Fig 5: Illustration of the conventional method of
production and treatment.

and the resources employed.
To be specific, this means that the
value chain is represented by the sum
of all values added (margin) of each
individual market participant. All
market participants who wish to
participate in a value chain together
make up the value chain system of an
industry. If this is applied to our
industry, we must consider the specific
situation of the market participants,
‘industry, dental lab, dental practice
and patient’. All those involved are
part of the value chain. In the past,
industry generated its value added by
manufacturing consumables or
equipment for the dental technician
or dentist, the dental technician
generated his value added by making
traditional dental restorations and the

result, however, the requirements
change for candidates because the
modern-day ‘skilled trade’ calls for
future applicants to be interested in
computer aided design (CAD) for
crowns, bridges, telescopes,
abutments, etc and the programming
of milling strategies for transforming
the CAD design into an end product
that is made by subtractive or additive
processes. It is advisable and essential
to integrate such requirements into
dental technician training at an early
stage.
. The rendering of dentistry services
is calling for increasing use of stateof-the-art digital instruments and
methods. In future, a dentist will not
only make a diagnosis but chiefly
focus on treatment preparation,

industrial companies that want to
participate in the value added (Figs.
2 & 3).
Digitisation—an opportunity for the
dental lab?
For a long time now, innovative and
marketing- oriented dental labs have
recognised the advantages of
digitisation and been benefiting from
their timely entry to the world of
CAD/CAM. Their wide range of
services covers the entire dental
technology portfolio with modern,
stateof-the-art framework materials
and veneering materials. Standard
restorations in particular, such as
crowns and bridges are made by
CAD/CAM—nowadays that is
already state of the art. But what
impact have these change processes

means that, depending on the
amortisation period and the quantities
to be made, he is able to make
competitive prices when faced with
market participants who attempt to
penetrate the market by price
dumping.
These days, the dental lab is—more
than ever—a service provider for the
dental practice and less and less a
skilled trade. That naturally involves
risks for the skilled occupation, but it
also offers substantial opportunities.
A dental lab owner can highlight his
locational advantage and provide his
special services and cooperation in a
spirit of partnership.
What type of dental lab are you?
Do you rank among the dental labs
that are still highly characterised by

[7] =>

CLINICAL PRACTICE
craftsmanship? Are you extremely
uncertain and waiting to see what
happens or do you lack the required
knowledge of economics or marketing
to also embark on the path of
digitisation? The fact is that anyone
who fails to have an open mind about
digital technology will no longer have
a major player role among the dental
labs. The more dental practices invest
in digital workflow and exchange
relevant data, the more dental labs
have to adapt and serve it
technologically. It is still the
responsibility of dental labs to support
the dentist, and hence the patient, by
providing optimal process chains. That
is why dental labs should regard
digitisation as an opportunity.
From stand-alone solutions to value
chains
At the beginning of the digital dental
world there were stand-alone solutions,
single work steps, but nowadays there
is more and more consideration of
complex dental lab processes that can
be implemented on a totally digital
basis. It all started with implant
navigation, digital function
diagnostics, and the production of
aesthetic dental restorations in the
form of crowns and bridges, and
nowadays these have already become
mainstream, so to speak, in an
innovative, modern-day dental lab.
The next step in a dental world that is
becoming increasingly digital is
advancement towards the
consideration of entire value chains—
including the process of making full
dentures.
Backward planning for full
dentures—the digital value adding
process in reverse!
While in the past the introduction of
digital technologies chiefly aimed at
indication-related solutions for
individual work steps, the focus of
digital dental technologies is now on
entire value adding processes. One of
the last groups of topics and areas of
indications, which, in digital terms,
has so far only been dealt with in
passing, is total prosthetics. Here in
particular, though, there are innovative
digital approaches that will simplify
and speed up production. This is where
pioneering digital revolutions are
accounting for yet another milestone
in digital dental technology. The future
scenario is depicted in Figure 6.
After all, total prosthetics does not
merit the reputation of being an
‘unloved child’. For dentists and dental
technicians it still does not have the
same level of importance as other
prosthetic restorations. But why? It is
certainly not due to the fact that
patients are so difficult, or total
prosthetics generally is so unattractive
to dentists and dental technicians. On
the contrary. Production of a precisionfit, functional and aesthetic prosthesis
is often a major challenge to dentists
and dental technicians. Especially
because with edentulous patients
important information is frequently
missing to be able to achieve an

optimal reconstruction of the jaw and
mouth. The main reason is rather that
the dentist’s and dental technician’s
services to be rendered for a full
denture are both extensive and
elaborate and the fee chargeable for
the service cannot cover the costs
incurred. In Germany, between
300,000 and 400,000 full dentures are
still being made every year.
And according to expert opinion,
the figure will tend to remain constant
in years to come owing to a longer
life expectancy and sociodemographic
change. With an average total fee rate
of approx. €1,000–1,400 per full
denture this market segment has a
volume of over €300 million—and
that only applies to Germany.
Consequently, total prosthetics still
ranks as one of the most important
areas of prosthetics.
The complexity of today's
production process for a full denture
is illustrated by the following flow
chart.
Production of a conventional
prosthesis is currently based on
complex interaction between the
dentist, dental technician and patient.
In an idealised process flow, there are
at least five appointments for the
patient and dentist, which can take
several days or even a few weeks.
From the very first appointment the
work starts to be dispatched, from the
first impression, functional impression
and occlusal record to the first wax
model, until, after much to and fro
between the dental practice and the
dental lab, the final denture can be
fitted in the last appointment. The
dentist's net treatment time in the chair
can then total about 2.5 hours. Quite
often another one to two more
appointments are required. Per
appointment there is a calculated
preparation and follow-up time of at
least 5 minutes so if there are five
appointments another 25 minutes have
to be added on. Consequently, dental
practice time soon totals 3 hours or
more for a full denture.
At the dental lab end, the level of
complexity is even higher. From initial
model impression taking to final
completion the dental lab can expect
to have dental lab work amounting to
6–8 hours. This does not include pickup and delivery times for commuting
between the dental lab and the dental
practice. Even after denture
incorporation there is often rework,
which is time-consuming and not
included in the service fee.
The conventional workflow (Fig. 5)
for making a full denture therefore
positively cries out for an approach to
address the last bulwark of the
conventional dental process chain and
make a digital solution available.
The future of the full denture is digital
That is definite. Although nowadays
there are ways of simplifying
individual work steps with a scanner
and a CAD/CAM milling machine
(prosthesis baseplate or basing arches
made from industrially prefabricated

September 2016 Pakistan Edition DENTAL TRIBUNE 7
blanks), consideration of the process
chain as a whole has so far been
missing. This is the approach adopted
in the following illustrated solution
with a full denture based on completely
digital development and production.
The entire solution concept is based
on the principle of backward planning.
In real terms this means that a full
denture completed by a master
craftsman is customised to suit the
patient's oral situation, with just one
appointment! Very soon the production
of a full denture will take place in a
fully digital process—from digital
impression taking to production,
completely devoid of dust and plaster.
Unfortunately the digital scanning
systems available at present are not
yet able to provide the option of
comprehensive collection of oral
situation information in a single
appointment, but it is definitely only
a matter of time. Until then the jaw
relation, palate, centric relation and
aesthetics will be recorded by analogue
means and then transferred to the
digital system. By this method, all the
data for making the prosthesis later is
collected in just one appointment.
The process is followed by
comparing the digital data with a
prosthesis database, selecting the
appropriate milling blanks with
previously polymerized dental arches,
and the modelling of the gums, which
vary from patient to patient. After
transferring it to the CAM module all
that has to be done is mill the
respective maxillary/mandibular pair.
That is followed by finalisation in the
dental lab and a second appointment
at the dentist's for the purpose of
incorporation. The finished product is
a functional, precision-fit, highly
aesthetic dental restoration of master
craftsmanship quality, made in
Germany!
This new future-oriented method
called Baltic Denture System uses
digital technologies to make the
production of a full denture
economically profitable again for the
dental practice and the dental lab, for
the first time in years. Despite
digitisation, market participants remain
the same and the value adding process
takes place within the familiar,
implemented structures.
Digital technology as an option for
additional business
With the aforementioned method of
production and by focusing on a small
number of analogue processes in the
dental lab there is more scope for new
lines of business for dental labs. The
dental lab of the future will no doubt
regard itself increasingly as a partner
and service unit for its dentist and be
capable of taking ‘troublesome’ issues
off his hands. In addition, the dental
lab can manage the data stream for its
client to ensure optimal results.
Another field of activity that presents
itself as a result of digital techniques
is that of dental aesthetics! One
example is the concept of lächeln2go
(smile to go), which, with its

Fig 7: BDLoad (maxillary and mandibular
milling blank in occlusion, available in
various sizes) before milling process.

Fig 8: BDLoad (maxillary and mandibular
milling blank in occlusion, available in
various sizes) before milling process.

Fig 9: Process-integrated BDCreator
CAD Software.

Fig 10: BDLoad, during milling process.

Fig 11: BDLoad, after milling process.

Fig 12: BDLoad, after milling process.

volunteers, first developed the concept
of dental aesthetics as a new line of
business. What is impressive is the
use of a two-dimensional aesthetics
check that makes it easy to record
dental status and aesthetic deficits.
Conclusion
It remains to be seen who the
winners and losers of increasing
digitisation will be. The fact is that
we are not yet at the end of optimal
digital workflow. It is still important
to modernise and develop digital
processes. However, the opportunities
are quite clearly in the majority, and
due to optimisation in the process
chain the resulting work has a higher
Continued on page 15

[8] =>

[9] =>

INTERVIEW

September 2016 Pakistan Edition DENTAL TRIBUNE 09

Most of hospitals lack anaesthesia
facilities: Prof Tipu Sultan
Criticises CPSP for
compromising quality of
trainers and trainees
By Azizullah Sharif

R

ENOWNED anaesthetist, Prof Tipu Sultan
said that it was an irony that although
owners of most of hospitals across the
country are doctors, majority of them have
compromised the quality in their healthcare
facilities, whether it is their surgical, gynaecology,
anaesthesiology or any other ward or department.
He was also critical of College of Physicians
and Surgeons of Pakistan (CPSP), saying that the
college controlling 64 disciplines of postgraduation by conducting examinations and
overviewing their training programmes which are
supposed to be structured throughout the country,
yet the quality of both the trainers and trainees in
most of the disciplines have been compromised.
"In fact, there is an internal management crisis in
the CPSP," he deplored.
Prof Tipu Sultan, who was unanimously elected
as the maiden chairperson of Sindh Healthcare
Commission at its meeting held recently, expressed
these views in an interview with the Dental Tribune.
Prof Tipu Sultan, who is commonly known as
‘Baba-e-Anaesthesia’ in the medical profession,
did his MBBS from Dow Medical College,
received D.A. (Diploma in Anaesthesia) in 1973,
got training in anaesthesia from England's Charing
Cross Hospital and fellowship from Royal College
of Anaesthesia in early 1976, joined his alma mater
(DMC) as assistant professor in 1976 where he
established anaesthesia department and later
converted it into a post-graduation centre which
has, so far, produced 300 anaesthetists. Of them,
he has the singular honour of producing as many
as 218 anaesthetists which is highest in Pakistan
under one person and under one department.
It means that of around total 1,250 anaesthetists
available in the country, about one-fourth of them
have been trained and produced by Prof Tipu
Sultan alone, and it for this very reason that he
is known in the medical profession as
‘Baba-e-Anaesthesia’. Half of the anaesthetists
produced by him are working in Karachi while
remaining are serving in different parts of Sindh,
Balochistan, Saudi Arabia, Muscat, Dubai, etc.
He had also served as medical superintendent
of Civil Hospital, Karachi, elected councilor of
CPSP from Sindh and the founding principal of
Bahria Medical and Dental College. During his
association with the Bahria Medical College, he
was also instrumental in establishing its faculty
and getting the college's building shifted to Defence
Housing Authority's Phase-II from its previous
location which was near Dalmia Cement Factory.

The most interesting, rather cherished
aspect of Prof Tipu Sultan's life was that
when he entered into the premises of
DMC in 1962, the premier medical
college of the country, to do his MBBS,
his mother Dr Atia Saheba was already

there to greet him as a final-year student
of the same institution.
Asked what measures he intends to take in his
capacity as chairperson of Sindh Healthcare
Commission against the specialists who are
charging exorbitant fees from patients, Prof Tipu
said that he will, definitely, like to rationalize their
fee so that people belonging to low-income group
could also benefit from their expertise.
To another query, whether the provincial
healthcare commission would ensure that all
medical practitioners must display their PMDC's
(Pakistan Medical and Dental Council) registration
numbers conspicuously on their clinics' boards as
well as on their letterheads used as prescriptions,
he said that though it was already mandatory under
the PMDC's rules, the provincial healthcare
commission would ensure that the council's rules
are implemented in letter and spirit.

Asked when the healthcare commission
would start implementing its terms of
r e f e r e n c e ( To R ) w h i c h i n c l u d e
accreditation and registration of all
healthcare centres (both private and
public), all medical stores, laboratories
and bringing an end to the menace of
quackery, etc., he said that it will start
functioning as soon as its chief executive
officer is appointed from amongst grade
20 officers and its head office and
regional offices are set up. Both the
provincial health minister and secretary
health are making their endeavours in
this regard, he added.
DUHS: About the DUHS which is without vice
chancellor for the last 10 months or so, Prof Tipu
Sultan remarked: "Law of the land has become a
mockery as in the case of appointment of DUHS
vice chancellor rules and regulations of PMDC,
HEC, Sindh and federal governments' are being
openly flouted."
Replying to a question, he said that it was
mandatory upon anaesthetists to remain present
at hospitals as long as the patients whom they
administer anaesthetic recover from the effects of
anaesthesia and become stable.
ILL-EQUIPPED: Asked if all the hospitals of
the country are equipped with necessary
anaesthesia monitors, gadgets and proper recovery
rooms, he replied in the negative, saying that
except for a few major hospitals, rest of healthcare
facilities are without such facilities. He also
admitted that portable anaesthesia machines that
an anaesthetist carry to a hospitals lacking
necessary anaesthesia equipments usually did not
work properly and as such their results cannot be
relied upon.
Asked that why a huge number of doctors used
to prefer to become anaesthetists under his
supervision, he replied that since there is no
glamour and no money in the field of
anaesthesiology as compared to surgery and other

Prof Tipu Sultan
specialties only the `dropouts' used to become
anaesthetists as well as due his open door policy
of accepting graduates from any college of Sindh.
Talking proudly about his students, he said that
they still come to him for doing refresher courses
which he organizes twice a year for them at his
family's farm, located in Koohi Goth, Malir, Deh
Landhi.

Prof Tipu Sultan in whose family there
are 42 doctors, starting from her mother
Dr Atia, her children and their children.
His two brothers - Prof Sirajudaula Syed,
Dr Shershah Syed - are prominent
pathologist and gynaecologist,
respectively, while his five sisters - Chand
Bibi, Shaheen Zafar are gynacologists
at Malir's Atia Hospital and Liaquat
National Hospital (LNH); Afia Zafar is
the head of Aga Khan University's
Pathology department; Safia Zafar
(Professor of Anaesthesia at Dow
University of Health Sciences) and
Ghausia is housewife and whose husband
is an assistant professor at LNH. Besides,
Prof Tipu's two sons are also doctors one of them is an anaesthetist and the
other is an orthopaedic surgeon.
Son of late Syed Abu Zafar, who in 1948
established Ghazi Mohammad Bin Qasim School
in Lyari's Agra Taj Colony for imparting free
education to the children of the poor locality, Prof
Tipu Sultan and his family members have now set
up Malir University of Science and Technology
(MUST) at Koohi Goth, Malir-Landhi.
The university of which he is chancellor will
kick off in September and despite being in private
sector its fee structure will be at par with Karachi
University's evening programme's fees.

Happiness is your dentist
telling you it won’t hurt and
then having him catch his
hand in the drill.
~ Johnny Carson

[10] =>

[11] =>

CLINICAL PRACTICE

September 2016 Pakistan Edition DENTAL TRIBUNE 11

Upper and lower dentures on Rhein83 components
By Marco De Angelis, DDS, and Luigi
Ciccarelli, dental technician

I

n this clinical case are illustrated
in a very schematic way some
stages of the realization of an upper
and lower overdenture on eight
implants, four on the upper and four
on the lower jaw (Fig. 1). This solution
will provide greater stability to the
prosthesis during the phonation and the
chewing functions, allowing the patient
to relate in their social sphere with
safety and confidence.
This technique uses the spherical
attachments that allow the clinician to
reduce the final costs of the article
compared to a solution with a bar.
The presence of the retention given
by the implants do not exclude that the
prosthesis must have the same

requirements of a traditional one,
namely it must have an appropriate
extension of the edges, a correct vertical
dimension, a centric relationship
repetable and a correct assembly of the
teeth (Figs. 3-5). The prosthesis thus
conceived will not have only an implant
support but will also have a mucous
support.
If the prosthesis doesn’t meet the
above-mentioned requirements, it may
occur a failure of the device and the
implants loss.
We illustrate only the steps related
to the finalization of the work.
After the esthetic and functional tests
and the approval of clinical and patient,
the prosthesis will be completed.
In the presence of reduced vertical
dimensions and a high number of
implants it is preferred the use of a

Fig 1: Attachments Ot Equator screwed into the implants.

superstructure of cobalt chromium that
will prevent any breakage in
correspondence of the metal housings
containing the retentive caps (Figs. 6,
6a).
Before the construction of the
structures the silicone keys of the teeth
assembly are made that will allow you
later, to reposition the teeth and to check
the available spaces. The structures will
be opacified to prevent the metal shine
through the resin (Figs. 7, 7a).
Once polymerized the prosthesis (in
this case in a traditional muffle with
the coloring of the prosthetic flanges),
finished and polished, the completed
devices is then send the in the studio
for the final delivery (Figs. 8-10).
The clinician before fixing the
retentive caps (Figs. 2, 2a, 2b) will
check the insertion paths of the

Fig 2: Ot Equator attachment.

prosthesis eliminating residual areas
of compressions with a special pasta
and the centric contacts.
The fixing of the retentive caps with
liquid resin will be facilitated by the
use of protective disks that prevent the
resin from invading the undercuts of
the attachments allowing an easy
removal of the prosthesis once cured
(Fig. 11).
After the curing, the excess of resin
will be finished with a bur (Fig. 12).
Before the final delivery, the patient
will be instructed to store and clean
properly the prosthesis and implants.
The prosthesis in situ, with the clear
satisfaction of the patient (Figs. 1318). Thanks to Mr. Vincenzo Liberati
for the construction of the
superstructure (Lab.DentaLine).
DT USA

Fig 2a: Ot Equator attachment.

Fig 2b: Ot Equator attachment.

Fig 3: Lower prosthesis with
stainless-steel housings cured.

Fig 4: Mounting of the teeth.

Fig 5: Mounting of the teeth.

Fig 6: Superstructures.

Fig 6a: Superstructures.

Fig 7: Structure opacified.

Fig 7a: Structure opacified.

Fig 8: Denture completed.

Fig 9: Denture completed.

Fig 14: Prosthetics completed
and delivered to the patient.

Fig 10: Denture completed.

Fig 15: Prosthetics completed
and delivered to the patient.

Fig 11: Definitive fixation
of the retentive caps.

Fig 13: Prosthetics completed
and delivered to the patient.

Fig 16: Prosthetics completed
and delivered to the patient.

Fig 12: Definitive fixation
of the retentive caps.

Fig 17: Prosthetics
completed and
delivered to the patient.

Fig 18: Prosthetics
completed and
delivered to the patient.

[12] =>

[13] =>

September 2016 Pakistan Edition DENTAL TRIBUNE 13

Bioactive materials: A new approach to dental care
By Larry Clark, FIADFE, CAED, and
Fredrick M. Berk, BA, FIADFE,
Pulpdent Corp.

T

oday’s new and innovative
technologies hold a great
potential to improve oral
health and advance dental care. One
of those budding technologies is
evident in the ACTIVA BioACTIVE
product range (Pulpdent, USA). As
part of a new class of esthetic,
bioactive restorative dental materials,
it offers an alternative to traditional
composite restoratives and delivers
direct benefits to dentists and patients.
Bioactive materials are “smart,”
moisture-friendly and dynamic. By
responding to ambient conditions in
the mouth, they play an active role in
the oral environment[1] and stimulate
formation of a layer of protective,
apatite-like crystal deposits at the
material-tooth interface[2] that forms
a natural bond between the material
and living tissue.[3] This natural
protective remineralization process
knits the restoration and the tooth
together. A crystalized connective
layer penetrates and fills micro-gaps,
seals margins, guards against recurrent
caries and prevents the staining
associated with microleakage and
failure.
ACTIVA BioACTIVE materials are
the first dental restoratives with a
bioactive resin matrix, shockabsorbing resin component and
reactive glass fillers designed to mimic
the physical and chemical properties
of natural teeth. ACTIVA responds to
pH cycles in the mouth with release
and recharge of calcium, phosphate
and fluoride.
ACTIVA BioACTIVE products
resist fracture and chipping at the

margins[4–6] while maintaining the
high compressive and tensile
strength[7] and wear resistance[8,9]
required of an esthetic restorative
resin. It can be used for all patients
and contains no Bisphenol A, no BisGMA and no BPA derivatives.
Over a period of five to seven years,
failure may become visible at the
marginal interface between the cement
or restorative material and the tooth.
Some materials are soluble and wash
out at the margins, others are brittle
and chip, and still others do not adapt
intimately to tooth structure and form
gaps, allowing microleakage to
undermine the integrity of the
restoration. These problems are
compounded by constant acid attacks,
the solubility and degradation of
bonding agents and the
incompatibility of the materials with
the soft tissues, all leading to a
proliferation of restoration
failure[10–14] (Figs. 1, 2).
A C T I VA
BioACTIVERESTORATIVE solves the problem
of microleakage as the primary cause
of restoration failure.[15–17] As
flowable/injectable materials, they
easily adapt to irregular tooth surfaces
and exhibit wear resistance
comparable to traditional composites.
The Mixpac Colibri mixing tip
(Sulzer Mixpac, Switzerland) mixes
the base and catalyst of the twocomponent material, prevents air
bubbles with the 360-degree fully
turnable and bendable needle and
allows for precise placement of
material, even in post holes and hardto-reach areas. Placing the Mixpac
Colibri mixing tip along the wall at
the floor of the cavity, allowing the
restorative material to flow ahead of
the needle, and keeping it submerged

Fig 1: Recurrent caries and wash
out of cement on three-unit bridge.

Fig 2: Repair with ACTIVA
BioACTIVE-RESTORATIVE.

Fig 3: Top, Colibri metal cannula
and, bottom, easy access to cavity
floors with the Colibri mix tip.

Fig 4: Top, Colibri metal cannula
and, bottom, easy access to cavity
floors with the Colibri mix tip.

in the material at all times ensures
intimate adaptation with tooth
structure and a gap-free restoration
(Fig. 3).
ACTIVA BioACTIVE-CEMENT
stimulates continuous formation of
calcium and phosphate crystals that
strengthen the surrounding dentition
and ensure marginal integrity (Fig.
4). This crystalline seal is virtually
insoluble and friendly to surrounding
tissues. These unique chemical and
physical properties provide a durable,
long-lasting seal for crown and bridge
placements fabricated with both
traditional and newer materials.
ACTIVA BioACTIVE-CEMENT
has self-etching, self-adhesive
properties and is both light-curing and
self-curing. Its syringe delivery system

in combination with the Mixpac
Colibri mixing tip provides an easy
and simplified cementation procedure.
After more than three years of
clinical use and more than 25
p u b l i s h e d s t u d i e s , A C T I VA
BioACTIVE materials have been
validated and proven successful. A
one-year Clinical Performance Report
from The Dental Advisor awarded
ACTIVA its highest 5-plus rating
(+++++) and a 98 percent approval
rating.[20]
A 36-month recall visit of an early
ACTIVA placement looked like newly
placed. This provides further clinical
proof of the material’s ability to
penetrate and integrate with tooth
structure and form a positive seal
against microleakage. DT, USA

Children’s oral health remains of concern in Hong Kong
DT International

H

ONG KONG - Over the past 50 years,
dental public health measures and policies
have been implemented by the government
in Hong Kong to help improve the oral health of
the population and children in particular. A historical
analysis has now shown that these efforts have led
to a general improvement in the oral health of
schoolchildren. However, dental disease is still
prevalent among children, especially preschoolers,
in the country.
In order to provide a historical and epidemiological
overview of the oral health of Hong Kong children,
dental researchers at the University of Hong Kong
reviewed all available oral health epidemiological
data and information from published literature
before 2014 through electronic database searches,
supplemented with information obtained from
government-archived oral health reports.
In 1961, water fluoridation was implemented in
Hong Kong and remarkably reduced the prevalence
of dental caries. The researchers found that caries
experience and severity among schoolchildren and

Up to half of preschool children in Hong Kong
suffer from dental caries.
adolescents decreased significantly, from more than
90 per cent in the 1960s to approximately 50 per
cent in the 1980s and 90s and to less than 25 per
cent currently. However, in the past two decades,
no substantial changes in the caries status among
preschool children have been observed. The caries
incidence in preschool children remains similar,
with a reported prevalence of 35–51 per cent, they
stated.
In 1979, the School Dental Care Service was
introduced to provide prevention and dental
treatment and oral health education to primary

schoolchildren in Hong Kong. The programme
contributed to raising awareness of oral health
among schoolchildren and overcoming many social
barriers to dental care access. Education changed
children’s lifestyles and improved their self-care
practices and use of fluoride oral health care
products, which have become increasingly available
in the country.
Despite these favourable results, the dental caries
experience has remained unchanged for preschool
children, the researchers highlighted. This might
mainly be due to the fact that preschool children in
Hong Kong are not routinely eligible for the schoolbased dental care programme.
Moreover, the researchers observed that the overall
periodontal health of Hong Kong children remains
unsatisfactory, although there is evidence of
improvement. In addition, a decrease in the
prevalence and severity of enamel defects among
Hong Kong children was observed, but there has
recently been a slight increase.
Continued on page 15

[14] =>

14 DENTAL TRIBUNE Pakistan Edition September 2016

Int'l seminar on Dental Research & Periodontology ends
DT Pakistan Report

AHORE - University of Health
Sciences Lahore recently
celebrated its first dental week,
titled as "International Seminars in
Dental Research & Periodontology".
Dr Sarah Ghafoor from the
Department of Oral Biology
University of Health Sciences
organised the event in collaboration
with Pak Association for Dental
Research (IADR Pakistan Section)
and Dental Tribune.
The week included lecture and
workshop seminar.
The seminar which was attended by
more than 500 participants was aimed
at apprising about the recent research
and clinical updates, besides giving
expert advice on the subject
Periodontology to researchers,
scientists, general dentists, clinicians,
students and community, at large.
Guest speakers of the seminar
included Prof Dr Khalid Almas,
Dr Maher Almasri and Dr Kashif
Hafeez from the United Kingdom.
The guests' visit was funded by the
President's Programme for Care of
Highly Qualified Overseas Pakistanis
(National Talent Pool) under the
Ministry of Federal Education and
Professional Training, Islamabad.
The lectures and workshop were kept

Editor - Online

free of registration not only in the
UHS, but also in two other institutes
- Fatima Memorial Hospital College
of Medicine & Dentistry and
Interdisciplinary Research Center for
Biomedical Materials (IRCBM)
COMSATS, Lahore. CME/CDE
activities were also arranged during
the dental week.
The opening session of the event
was chaired by vice chancellor
University of Health Sciences, Major-

interactive session
on career
Haseeb
Uddin guidance,
respectively.
Those who spoke on the second day
of the week included Dean Dental
Sciences and Principal FMH College
of Dentistry Prof Dr NaziaYazdani,
Prof Khalid Almas lecture on, "Oral
Malodor (a social stigma): Etiology,
Diagnosis and Management" and
research interactive session on
Periodontology & Implantitis by
FCPS post graduate residents, faculty

General (Retd) Prof Muhammad
Aslam.
Later, Dr Maher Almasri and Prof
Khalid Almas delivered lectures on
t h e t o p i c s o f " H a r d Ti s s u e
Management in Implant Dentistry Respecting the Biology of Bone" and
"Think Outside the Mouth-The Oral
Systemic Link: An Update" and

of Periodontology, Maxillofacial
Surgery and Prosthodontics. Third
day of the week included session on,
"Guided Tissue Regeneration in
Periodontal Practice" at IRCBM
COMSATS Lahore which was
conducted by Dr Aqif Anwar
Chaudhry who emphasized on the
significance of Dental Materials

Implant dentistry requires expertise: DrJaffer
DT Pakistan Report

IAMRA urges PMDC to improve ...
Continued from front page

when the former PPP government appointed a
Rawalpindi-based doctor as registrar of the PMDC.
The performance of the PMDC massively
deteriorated. The recognition of several illegal
medical colleges brewed an international
controversy, prompting the government to form a
commission of inquiry, headed by Justice Shabbar

PDA (K) forms
women wing
DT Pakistan Report

ARACHI - The Academy of Aesthetic, as
a part of continuous dental initiative,
organized a workshop on implant at its
office here recently.
Delivering his lecture on the subject, Dr. M. Amin
Jaffer, who did his doctorate in dental surgery (DDS)
from the University of Michigan, said that the
practice of implant dentistry requires expertise in
planning, surgery and tooth restoration.
Dr Amin, who is doing his private practice in Ann
Arbor, Michigan and is associated with Mish Implant
Institute since 2012, also presented interesting
clinical implant cases, besides sharing his clinical
experience in depth with the participants of the
workshop.
He alsogave detailed presentation on Atraumatic
Extraction with immediate placement.
"Today, most of the treatment procedures in
dentistry are as much about art and experience as
it is about science," he remarked.

research and clinical integration,
which was continued with dental
biomaterials and Guided Tissue
Regeneration session with Researcher
and Scientists at IRCBM who are
working on indigenous-sourced dental
materials and biomaterials.
The closing session was chaired by
Registrar of the University of Health
Sciences Dr Asad Zaheer.
Speaking on the occasion, he
thanked Prof Khalid and Dr Kashif
Hafeez for being part of Dental Week
UHS and also highlighted the
importance of the National Talent Pool
program in bridging the link between
overseas and local Pakistanis in
academia, research and clinics. This
was followed by Prof Khalid lecture
on, "Tissue engineering and cell
c u l t u r e - b a s e d Te c h n i q u e s i n
Dentistry", presentation on "Scientific
writing and Selection of a research
Project" and clinical case scenario
talk on "Foundations for Soft Tissue
in Dental Implantology" by Dr Kashif
Hafeez. The Post-Seminar Workshop
on, "Using internet effectively for
Evidence-based Dentistry Learning
Purpose" was conducted by Prof
Almas.
The event was concluded with vote
of thanks.

K
The workshop was followed by a lively questionanswer session in which participants posed a variety
of questions to the speaker who answered all such
queries in detail.
Participantsof the workshop were highly
appreciative of Dr Amin Jaffer's talk on the topic
of implant dentistry, saying what they learned during
the workshop was quite useful.
At the outset, DrJaffer expressed his gratitude to
the CEO of the Academy of Aesthetic, Ghazanfar
Rauf, for providing him an opportunity to share his
clinical experience with the participants of workshop.

Raza Rizvi. The commission concluded that most
members of the PMDC's caretaker setup and the
Ministry of Health were responsible for such
irregularities. The authorities tried to hush the
matter up, but the report could not escape the world
attention. The National Assembly Standing
Committee on Health repeatedly pointed out
seriousness of the matter and held the PMDC adhoc committee and the Ministry of Health
responsible for the situation. The committee had

ARACHI Pakistan Dental
Association's
(PDA) Karachi chapter
with a view to promoting
the art and science of
dentistry has formed its
women wing.
According to a press
release of the association, the first four
members of the women wing are:
Dr Maimoona Mushtaq Khan, Dr Sidra Khan,
Dr Tahira Haider and Dr Shahper Shahryar.
The aim behind the move is to encourage,
guide and help members of the profession in
the establishment of their career.
Meanwhile, PDA-Karachi has planned an
endodontic symposium in mid-August, the
release added.

demanded immediate removal of the ad-hoc
members, but it took the PML-N government more
than two years to make the decision. By that time,
the damage was already done.
PMDC former registrar Dr Akbar advised the
PMDC and the Ministry of Health to fight their
case before the IAMRA by providing evidence that
the illegal medical colleges had been sealed and
would never be allowed to operate under any
circumstances.

[15] =>

September 2016 Pakistan Edition DENTAL TRIBUNE 15

Mobile app for ...
Continued from front page

back to the practice and put to
immediate use.
OHO: The aim of the Oral Health
Observatory (OHO) is to understand
current needs in dental care related to
patients and dental professionals at
different levels: local (country-wise),
regional and global. It focuses on three
main areas of interest: behaviour,
clinical and dental practice and the
FDI, in this context, acts as global
convener in oral health.
The information collected will allow
analysis of current needs in dental
care, according to demand, guidance,
policy and funding. This will help
shape the medium-term planning of
professional resources and oral health
systems.
Behavioural and clinical data in
addition to information from the dental
practices are collected directly from
a network of local dentists. National
Dental Associations are responsible
for the recruitment of participating
dentists. This network of general dental
practitioners is responsible for
interviewing and "observing" adults
and children in their country. Data is
collected in a systematic manner using
the same core indicators guaranteeing
its comparability across different
levels.
A pilot project was carried out by
three National Dental Associations in
three countries: Germany, Mexico and
the Netherlands from April to July,
2015. During the pilot, the project
"know how" was evaluated and finetuned for its future implementation.

RCPS appoints ...
Continued from front page

of Department of Prosthodontics,
Dean Postgraduate Dental Studies and
as Coordinator International Relations
at Peshawar Dental College,
Peshawar. Earlier, he has worked as
Professor and Head of the Department
of Prosthodontics, Khyber College of
Dentistry Peshawar.
Hailing from village Shewa, District
Swabi, Prof Ghani did his BDS from
the Department of Dentistry, Khyber
Medical College, Peshawar in 1981,
received postgraduate dental training
and education and work experience
from the world-famous dental
institutions, including Eastman Dental
Institute London, University College
& Middlesex School of Dentistry
London, The Dental Institute, London
Hospital Medical College London,
Royal College of Physicians &
Surgeons of Glasgow (UK),
University of Tohoku, Sendai, Japan
and Wonk Wong University, South
Korea.
Prof. Ghani is the pioneer training
supervisor and examiner for the
fellowship in prosthodontics of the
College of Physicians & Surgeons,
Pakistan. He has supervised and
examined many candidates and

scholars sitting for Fellowship, Master
of Science, M. Phil and PhD in the
basic and clinical dental disciplines.
He has delivered lectures and
presented research papers at both
national and international conferences
and meetings. He has also published
over 100 articles and reviewed over
200 articles for publications in various
national and international journals.
Prof Ghani is chairman and member
of different committees of several
o rg a n i z a t i o n s , c o l l e g e s a n d
universities in Pakistan and abroad
and these include Pakistan Medical
& Dental Council, Higher Education
Commission of Pakistan, College of
Physicians & Surgeons Pakistan,
Pakistan Health Research Council,
Royal College of Physicians &
Surgeons, Glasgow and the Saudi
Commission for Health Specialties.
Prof Ghani had earlier served as
president of the Pakistan
Prosthodontics Association (PPA) in
2012-13 and also as chairman
International Conference of Pakistan
Prosthodontics Association held in
Peshawar in 2013. He was also
president of Pakistan Forum for
Restorative Dentistry, besides being
the founding Editor-in-Chief of the
Journal of the Pakistan Prosthodontics
Association (JPPA).

Career development ...
Continued from page 02
a great help, especially when I am
busy in the practice five days a week.
Overall, I feel that my move to
mydentist was the best thing I could
have done for my career. The
opportunities are there to further my
career in ways that I did not feel
existed in the independent sector.
While I enjoy my job enormously,
I would relish the opportunity to move
out of the surgery environment a little
in the coming years and expand on
my mentoring role and continue with
more training and support of new
dentists. I hope I can achieve this
within the company. DT UK &
Ireland

To floss or to brush ...
Continued from page 04
Clinical observations over many years
of floss usage in patients is strong
evidence that floss indeed does have
a place in the oral hygiene regime.
Discarding the use of it totally would
be irresponsible to say the least. In
1965, Prof. Harald Löe and others did
the famous ‘Experimental gingivitis
in man’ study. The outcome was that
gingivitis disappears within two weeks
if the tooth structure is sufficiently
cleaned. Therefore, there are three
criteria we as dental professionals
need to adhere to when selecting a
treatment option for our patients: the
regime needs to be acceptable to the
patient, it has to be atraumatic to the
soft and hard tissue of the oral cavity,
and it should be effective in removing

biofilm and plaque to establish a
healthy status quo in the oral cavity.”
However, no matter what interdental
cleaner one chooses, almost every
tooth has to be treated uniquely.
“Flossing is more acceptable in the
anterior and difficult crowded areas
of the mouth. The interdental brush
has easier access in the posterior
regions that are more difficult to reach.
Flossing is not as effective in the molar
regions because of the concave-shape
of the root structures. Flossing is also
more technique-sensitive and greater
dexterity needs to be applied when
doing it effectively and without
damage. Interdental brushes need to
be selected with careful consideration
of the tooth and interdental shape and
size,” stated Van der Ham. “Most
importantly, patients need to be
constantly educated and their oral
hygiene regime adjusted to their
individual needs and preferences.”
DTI

Review challenges ...
Continued from page 04
on dried fruit consumption should take
into account the nutritional benefits
of dried fruit, which are high in fibre,
low in fat and contain useful levels of
micronutrients.
Sadler has been an independent
nutrition consultant since 2000. In her
work, she focuses on the application
of nutrition science within the food
industry, including nutritional strategy,
new product development and product
positioning, particularly in the area of
health claims, and provides advice on
product composition.
The study, titled “Dried fruit and
dental health”, was published online
on 14 July in the International Journal
of Food Sciences and Nutrition ahead
of print.

Student develops ...
Continued from page 04
explained Ann-Kathrin Flad, who is
an eighth-semester dental student at
Witten/Herdecke University in
Germany and has been involved in
the project for three years already.
“Currently, researchers have to find
study participants who are not allowed
to brush their teeth for days. With the
new formula for artificial dental
plaque, however, this can be avoided,
as it adheres to teeth like natural dental
biofilm. It can be coloured in order to
measure how much is being removed
using manual and electric
toothbrushes, as well as other oral
hygiene tools.”
Alongside her studies, Flad works
at the ORMED—Institute for Oral
Medicine at the university, a research
and development organisation for
scientific services in the field of
experimental and clinical dentistry
with the focus on oral hygiene, robotic
simulation of toothbrushing and
medical plaque control.
Flad’s trip to Seoul was funded by

the Fördergemeinschaft Zahnmedizin,
a non-profit association of dentists
established in 1985 at the university’s
dental school that aims to promote the
link between research and practice. In
pursuing its goals, the association
supports research projects and
congress participation by young dental
professionals.

Value chains being ...
Continued from page 07
level of precision achieved in a shorter
amount of time. This means firstly
that thanks to the declining proportion
of expenditure accounted for by
staff costs per prosthesis it is also
becoming possible to increasingly
internationalise German dental
restoration work. Secondly, scope is
being created for new lines of business
such as dental aesthetics. The patient
too benefits from digital production,
which also saves time for him or her.
Owing to the use of digital
technologies and optimisation of value
chains the profitability of hitherto
unattractive work is increasing again
for the dentist and dental technician.
What is more, in this way scope is
created for additional service
offerings, which in turn creates
potential for additional business and
income.
In spite of all the digitisation and
value chain optimization one must
not forget that, despite everything,
direct contact between the dentist,
dental technician and patient is still
crucial and important for the outcome:
aesthetic and functional dental
restoration about which the patient is
not only satisfied but also enthusiastic
in everyday life. DT Germany

Children’s oral health ...
Continued from page 13
The researchers concluded that new
policies have to be drafted on dental
care protocols to ensure evidencebased standards of care and to promote
regular access to dental care and
preventative services, especially to
improve the oral health of preschool
children in Hong Kong.
The review article, titled “Oral health
of Hong Kong children: A historical
and epidemiological perspective”, was
published in the August issue of the
Hong Kong Medical Journal.

Now, most dentist's
chairs go up and down,
don't they? The one I
was in went back and
forwards. I thought
'This is unusual'. And
the dentist said to me
'Mr Vine, get out of the
filing cabinet.

~ Tim Vine

[16] =>

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[cover] => DT Pakistan No. 5, 2016

[toc] => Array ( [0] => Array ( [title] => IAMRA urges PMDC to improve quality of education or face the music [page] => 01 ) [1] => Array ( [title] => Mobile app for Annual World Dental Congress [page] => 01 ) [2] => Array ( [title] => RCPS appoints Prof Ghani as Dental Adviser [page] => 01 ) [3] => Array ( [title] => News [page] => 02 ) [4] => Array ( [title] => Value chains being transformed by new digital dental technologies [page] => 06 ) [5] => Array ( [title] => Interview with Prof Tipu Sultan: Most of hospitals lack anaesthesia facilities [page] => 09 ) [6] => Array ( [title] => Upper and lower dentures on Rhein83 components [page] => 11 ) [7] => Array ( [title] => Bioactive materials: A new approach to dental care [page] => 13 ) [8] => Array ( [title] => Children’s oral health remains of concern in Hong Kong [page] => 13 ) ) [toc_html] =>

Table of contents

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