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FDI Worldental Daily

Science & Practice Wednesday, 28 August 2013 T hemaingoalsinthetreatment ofcleftlipandpalatecasesare to achieve labial, palatal and velopharyngeal closure, as well as a balanced profile, harmonious fa- cial appearance and good occlu- sion. Usually, these goals can be achieved at an early age. In 20 to 25 per cent of patients, however, dentofacial skeletal deformities, and in 4 to 45 per cent oronasal fis- tulae occur, which require second- ary surgical correction. In severe cases with wide oronasal fistulae, the common ap- proach is to cover the gap with buc- cal mucosal or tongue flaps. Unfor- tunately, this approach might not always yield the desired results. An- other difficulty with using conven- tional methods to treat cleft lip and palate patients is achieving ad- vancement in cases of severe maxil- lary deficiency owing to tight scar tissue resulting from prior surgical intervention and the possible pres- ence of a pharyngeal flap. Even though advancement is achieved most of the time, there is a tendency to relapse for reasons similar to those that make surgery difficult. Maxillary distraction, however, al- lows greater advancement of bone and soft tissue, promising higher stability. The latest studies have focused on the distraction of the maxillary segments for preventing velopha- ryngeal insufficiency. A new design has been proposed with the arch wisedistractionappliance,whichal- lows control of the direction of the segments with higher precision.The appliance works on two parallel arches passing through double semicircular hooks and double tubes. The distractor is attached to the gingivally positioned wire and allows repeated reactivation. This ability allows for both sagittal cor- rectionandcleftspaceclosureatthe same time. In addition, it is applica- ble to even the most difficult cases. Another advantage is that it is tooth borne. Unlike other distrac- tion systems, another surgical inter- vention for removing the device is not required. Aesthetically, it is much more acceptable compared with other devices, which generally require extra-oral parts for anchor- age. Therefore, this appliance is a successful tool for reconstructing large gaps in the cleft area and cor- recting the anteroposterior defi- ciencies in cleft lip and palate cases. Itismyhopethattheapplicationwill become an alternative to aggressive surgical intervention. Dr Nejat Erverdi is a visiting profes- sor at the University of Connecticut Health Center in the USA and past president of the European Ortho- dontic Society. Today, he will be pre- senting a paper titled “A novel method for the treatment of cleft palate case: Distraction osteogene- sis” during one of the afternoon ses- sions as part of the 2013 FDI AWDC scientific programme. A novel method for the treatment of cleft palate ByDrNejatErverdi,Turkey 8 www.fdiworldental.org www.fdi2014.org.in www.fdiworldental.org A billion smiles welcome the world of dentistry FDI 2014, New Delhi, India Annual World Dental Congress 11 - 14 September 2014 Greater Noida A billion smiles w ome the welcA billion smiles w 4.org.in1.fdi20www orldental.org.fdiwwww ld of denorome the w 4.org.in orldental.org ytistrld of den AD N owadays, everyone seems to be talking about minimally in- vasive dentistry and many pa- tients now appreciate that only as much hard tissue is removed during dental restoration as needed. How- ever, does minimally invasive den- tistry entail careful preparation only? Certainly not. Current minimally invasive den- tistry is based on four principles: ex- cavation, defect-oriented prepara- tion, longevity and reparability. It is a factthattheoverallsurvivalofteethis higherwhenpulpvitalityispreserved through gentle caries excavation in- stead of risking exposure of the tooth with aggressive excavation meas- ures.When the tooth is subsequently prepared with rotary instruments, preparation can be extremely limited because adhesive dentistry requires no macro-retention. However, the success of minimal invasive dentistry is only successful when restorations survive for a long time. What use is a small filling if it becomes insufficient after a short amount of time? Finally, why should one attempt to completely remove (partially) defective restorations? Es- pecially with perfectly matching tooth-coloured materials this makes no sense at all. When 80 per cent of the restoration is intact, e.g. facing a chipping of the proximal ridge, there isnoreasontocompletelyremoveany restoration. Moreover, the risk of iatrogenic injury to sound tooth hard tissuesduringremovalofresin-based composites or ceramics is irresponsi- bly high. Modern repair strategies help to avoid these mistakes. Only through the combination of these fourprinciples,areweabletoworkre- sponsibly with almost perfect aes- thetic materials. Please think about this for a second. Prof. Roland Frankenberger is Director of the Department of Restorative Dentistry at the Philipp University of Marburg’sSchoolofDentalMedicinein Germany.Today,hewillbepresentinga paper titled “Resin composites—How farwecango?Longevity,indicationand repair” during one of the late morning sessions as part of the 2013 FDI AWDC scientificprogramme. Minimally inva- sive dentistry— What is it? ByProf.RolandFrankenberger,Germany IProf.RolandFrankenberger,Germany “In severe cases with wide oronasal fistulae, the common approach is to cover the gap with buccal mucosal or tongue flaps.” IDrNejatErverdi,Turkey