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Editor - Online Haseeb Uddin 14 DENTAL TRIBUNE Pakistan Edition November 2015 Going (unintentionally) green.... Continued from page 04 CAD/CAM dentistry reduces the number of appointments from two (or possibly more, if the restoration does not fit) to one, it stands to reason that every dentist who incorporates these procedures would positively impact the environment by reducing the number of automobile trips patients make to the practice. This would result in a 50 percent reduction in gasoline and oil product use. With a carbon content of 2,421 grams, one gallon of gasoline produces approximately 19.4 pounds per gallon of carbon dioxide emissions. This is calculated by multiplying the carbon content (2,241) by the amount of carbon that remains unoxidized (0.99) by the ratio of the molecular weight of CO2 (44) to the molecular weight of carbon (12). Using the state of California as an example, where approximately 10 percent of the 100 million laboratory dental restorations are completed in the United States every year, we can calculate an approximate savings. If four gallons of gasoline are used for a round trip to the dentist, a restoration needing two appointments to complete would require eight gallons of gasoline. But if these dental practices adopted same-day in-office CAD/CAM dentistry, that number could be cut in half, saving four gallons of gasoline per restoration. Four gallons of gasoline multiplied by 10 million restorations would equal a savings of 40 million gallons of gasoline for restorative procedures in the state of California alone. This, in turn, would equal a reduction of carbon dioxide emissions by 776 million pounds per gallon each year (assuming the previously calculated 19.4 pounds per gallon measurement). If we extrapolate to the United States as a whole, we can calculate that this would equal 400 million gallons of gasoline saved and 7,760 million pounds per gallon of carbon dioxide emissions eliminated, per year. This would all be due solely to a reduction in patient automobile trips to and from the dentist for restorative procedures. While same- day dental procedures may not save the world, their potential impact, even estimated, is undeniable. Conclusion In-office CAD/CAM systems’ advantages are limitless. In addition to the clear financial and practical benefits they bring, their positive impact on the environment makes the decision to upgrade even better. They remove toxic, wasteful and disposable materials and practices from the equation, replacing them with greener practices that have a tangible influence. While the clinical advantages of CAD/CAM systems and same-day dentistry continue to be rightfully celebrated, their ecological advantages should not be overlooked. This article was published in CAD/CAM the international C.E. magazine of digital dentistry, North America Edition, Vol. 4 Issue 1, 2014. A complete list of references is available from the publisher. Where periodontology has advanced Continued from page 06 health and general well-being was recognised by the US surgeon general in a landmark publication titled Oral Health in America. This document for the very first time articulated the importance of oral health in a holistic approach to medical care. Despite the title, its content had global relevance. From this, the concept of periodontal medicine gained further traction and its central hypothesis stated that periodontal infection and inflammation present a significant chronic inflammatory burden at the systemic level. While there is considerable work still to be done, significant progress has been achieved in the past decade. Diabetes is now well recognised to be a significant risk factor for development of periodontitis and, conversely, periodontitis is considered to be a significant modifying or risk factor for glycaemic control in diabetics. Other conditions for which there is good evidence to support interrelationships with periodontitis include cardiovascular disease, rheumatoid arthritis, obesity and renal disease. It remains to be established whether treatment of periodontitis has any impact on systemic conditions, but there is emerging evidence to indicate that this may be the case for diabetes, cardiovascular disease and rheumatoid arthritis. Unfortunately, this has become an opportunistic field of research and to date some 58 conditions have been claimed to fall within the periodontal disease/systemic disease axis, most of which have little or no biological or clinical plausibility. Understanding that periodontal regeneration is biologically possible Regeneration of damaged periodontal tissue as a result of periodontitis has been considered the ultimate goal of periodontal treatment. Over the decades, many procedures have been advocated, mostly associated with root surface conditioning and implantation of bone substitutes into periodontal defects as a means of obtaining periodontal regeneration. Unfortunately, these early concepts were naive owing to a poor understanding of the requirements for periodontal regeneration, namely the encouragement of new cementum, bone and periodontal ligament. Filling a periodontal defect with a substance that had no relevance to the next functional stage of reconstruction is irrational. Nonetheless, as a profession, we had become obsessed with filling holes in bone rather than studying the natural healing processes required to regenerate the periodontal attachment apparatus. Ignorance of the contribution of the various tissue components to periodontal wound healing explained the widespread misuse of bone transplantation in the treatment of intra-bony pockets, which unfortunately still pervades some areas of periodontology. It is now recognised that regenerative treatment of periodontal defects with an agent or procedure requires that each functional stage of reconstruction be grounded in a biologically directed process. With such concepts in mind, the seminal studies of Karring, Nyman and co-workers from Gothenburg in Sweden led to the development of guided tissue regeneration (GTR) as a treatment modality.Although this was a significant advance, it became evident that while periodontal regeneration was biologically possible it was clinically very difficult to achieve on a reliable basis owing to a vast range of patient and operator variables. More recently, we have seen the development of biological agents and preparations that, when applied on to root surfaces, can result in significant regeneration of damaged periodontal tissue. The use of such agents offers a simpler approach to periodontal regeneration with equivalent, and sometimes superior, results compared with GTR procedures. However, as has been noted for GTR, the clinical outcomes using biological agents can be variable and further work is needed to improve their clinical utility. Moreover, the use of mesenchymal stem cells and genetic modulation of periodontal cells have been explored for the purposes of achieving periodontal regeneration. The future looks promising, but no doubt there is a considerable amount of work to be done before reliable and predictable periodontal regeneration becomes a reality. Photoacoustic shockwave with irrigant debrides.... Continued from page 12 demonstrated its ability to decontaminate and debride areas that files and instrumentation cannot reach - success rates rise and retreatment for past failures is possible.7 PIPS is also helpful in locating and helping negoti- ate calcified canals. PIPS is a valuable additional tool in the treatment of endodontics regradless of the shiping and obturation system used. Laser technology used in endodontics during the past 20 years has undergone an im- portant evolution. Research in recent years has been directed toward producing laser tech- nologies (such as impulses of reduced length, radial-firing and stripped tips) and tech- niques (such as LAI and PIPS) that are able to simplify laser use in endodontics and mini- mize the undesirable thermal effects on the dentinal walls, using lower energies in the presence of chemical irri- gants. EDTA has proved to be the best solu- tion for the LAI technique that activates the liquid and enhances its cleaning of the smear layer. The use of a laser (PIPS) to activate sodium hypochlorite increases its antimicrobial activity. Finally, using the correct protocol, the PIPS techniquereducesthethermal effects and exerts both a stronger cleaning and bactericidal action, because of its stream- ing of fluids initiated by the photonic energy of the laser. Further studies are cur- rently underway to validate LAI and PIPS technique as innovative technologies in modern endodontics. DR. ENRICO DIVITO prac- tices in Scottsdale, Ariz. In 2004, heformed theArizona Center for Laser Dentistry. He is the founder and direc- tor of the state-accredited Arizona School of Dental Assisting (ASDA). In addition to teaching at ASDA, DiVito is also a clinical professor at the Arizona School of Dentistry and Oral Health. He is a graduate of the University of the Pacific, Arthur A. Dugoni School of Dentistry with honors. He can be reached at edivito@azcld.com. List of references is available from the publisher onrequest. Extract with confidence LM Dental's extraction instruments uniquely combine ergonomics, Scandinavian design and functionality for atraumatic tooth extraction. They feature comfortable, non-slip ErgoTouch handles and are well-balanced and lightweight, according to the company. LM extraction instruments are supplied in convenient autoclaveable cassettes that protect both the instrument and the handler during the maintenance cycles. DT International DentaPure® DP365B is an in-line attachment dental water purifier designed for bottled water and should be changed after one year. The constant presence of iodinated water in the dental unit cartridge is EPA labeled to purify incoming water to 200 cfu/ml bacteria DentaPure Waterline Purification Cartridge