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Ortho Tribune Middle East & Africa No.1, 2018

E2 ◊Page E1 here on, it is solely a matter of pref- erence, as the patient might enjoy the beach, a VR video of Honolulu, or maybe even climbing a mountain. Any VR video is acceptable, as long as it achieves its purpose: calming the patient during a treatment session. Thus, everything becomes less tense, and the patient is relaxed. This might also be convenient for the dentist, as he can then execute whatever treat- ment is necessary as quickly and ef- ficiently as possible. Convincing the patient to undertake an orthodontic treatment is one thing, convincing him to follow the relevant recommendations is an- other. Obtaining patient compliance is not easy, especially in the case of younger patients. Furthermore, den- tists have an unfortunate notorious association with pain and suffering, which might induce anxiety in a pa- tient. Again, VR can be applied here to divert the attention of the most dynamic patients. Another aspect worthy of mention regarding the benefits is the intellectual retention of instructions on hygiene proce- dures, for example, which might be dependent on support. It is plausible to assume that verbal instructions on hygiene may be forgotten once the patient has left the clinic. Most orthodontic practices provide only leaflets, but few patients retain these or follow their recommendations. A VR video featuring the practitioner or team members might have a much greater impact on follow-up care at home. The message could be ORTHO TRIBUNE Dental Tribune Middle East & Africa Edition | 1/2018 Fig. 4: Nikon KeyMission Utility. Fig. 5: Operatory room in VR. pre-recorded and viewed on demand by the patient. The aims of this for- mat is that it can provide different intellectual integration between information, which is connected to a stream of visual and auditory stimuli. The clinician might wish to promote the patient retaining the provided information in an easier way to achieve greater clinical suc- cess. For example, youngsters might remember their favourite movie line by heart, as opposed to information provided by their dentist. This is be- cause it demands less of youngsters to remember words that are con- nected with pictures. For the health practitioner, VR may yield an unexpected, but welcome, advantage in terms of professional education (Fig. 6). Many of us have not been able to attend a confer- ence on the other side of the world for logistical reasons. In the near fu- ture, it will be possible to attend an orthodontic congress and listen to international speakers while sitting comfortably at home. Similarly, the demonstration of a new therapeu- tic technique will be easier with a VR video rather than plunging into a detailed explanation in an article without any illustration. The trainer can record his or her procedures with a 360° camera to allow the student to learn through immersion the techni- cal movements and ergonomics of the technique being taught. It would be an understatement to claim that VR provides an alternative to conventional styles of learning. Al- though it is far from perfect, it allows a wider spread of knowledge and a totally immersive pedagogy. VR is changing the way we work, learn and treat our patients. We have seen over time an evolution of orthodontic care by improving patient comfort. We are not just dealing with a set of teeth fixed into a bone mass append- ed to a skull, but with a person whose positive experience will inevitably lead to clinical success. Similarly, orthodontic education has evolved over time, since the transmission of knowledge is no longer done with a Kodak Carousel slide projector, but with sophisticated presentation soft- ware, incorporating photographs and clinical videos. VR is paving the way to a higher degree of evolution regarding how to understand our environment, whether it is an en- vironment of care or work. As with tourism or cinema, VR offers many opportunities in the field of health. Orthodontics is entering into a 360° revolution focused on the patient experience. Acknowledgements The author reports no conflicting interests. He would like to thank Dr Eren Cicek for the proofreading and kind support. Dr Yassine Harichane graduated from Paris Descartes University in France and completed his MSc and PhD on dental pulp stem cells. He maintains a private practice in Canada and can be contacted at Use of diode laser in the treatment of gingival enlargement during orthodontic treatment Case report By Prof. Carlo Fornaini, Drs Aldo Op- pici, Luigi Cella & Elisabetta Merigo, Italy Introduction In recent decades, we have witnessed the substantial development and expansion of the use of fixed ortho- dontic appliances. While their appli- cation has many advantages, several problems related to the health of the soft tissue may sometimes appear during treatment. In fact, the use of fixed orthodontic appliances may provoke labial desquamation,1 ery- thema multiforme,2 gingivitis3 and gingival enlargement.4 Gingival enlargement is a very com- mon complication during ortho- dontic treatment,5 but fortunately, it seems to be transitory and generally resolves after orthodontic therapy, even if sometimes incompletely. Gingival overgrowth induced by or- thodontic treatment shows a specific fibrous and thickened gingival ap- pearance, different from fragile gin- giva with marginal gingival redness common in allergic or inflammatory gingival lesions.6 Several clinical studies suggest that orthodontic treatment may be asso- ciated with a decrease in periodontal health, causing a hypertrophic form of gingivitis. However, the actual pathogenesis of gingival enlarge- ment is not yet completely under- stood, although probably involves increased production by fibroblasts of amorphous ground substance with a high level of glycosaminogly- cans. Increases in mRNA expression of Type I collagen and up-regulation of keratinocyte growth factor recep- tor could play an important role in excessive proliferation of epithelial cells and increased development of ÿPage E3 Fig. 1: Clinical view, showing gingival enlargement, just before the debond- ing procedure. Fig. 2: Application of a topical anaesthetic. Fig. 3: Surgical laser-assisted treatment via laser gingivectomy. Fig. 4: Clinical view just after surgery. Fig. 5: Healing five days after surgery. Fig. 6: One month follow-up.

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