PUBLISHED IN PAKISTAN www.dental-tribune.com.pk SEPTEMBER, 2018 - Issue No. 05 Vol.5 1st International PSOMP Conference FDI World Dental Congress 2018 Dynamic navigation for reliable and predictable ... NEWS Page 4 NEWS Page 6 CLINICAL IMPLANTOLOGY Page 8 Dr Arif Alvi becomes 13th President of Pakistan FDI WDC 2018 Dr Kell: The absolute meeting point for the oral health profession DT Pakistan Report B U E N O S A I R E S , ARGENTINA - From 5th to 8th September, the capital of Argentina was the m e e t i n g p o i n t f o r d e n t a l professionals from around the world. According to FDI, close to 8000 participants from 130 DT Pakistan Report K ARACHI - Dr. Arif-ur- Rehman Alvi was voted the President of Islamic Republic of Pakistan on September 5th 2018, and assumed office on September 9th. President Dr Arif Avi, a close ally of PM Imran Khan, was one of the founding members of Pakistan Tehreek-e-Insaaf (PTI), the winning political party of General Elections Pakistan 2018. After Fatima Ali Jinnah, he is the first dentist to make a name in Pakistani politics, and the second ever dentist to become the president of a country. President Alvi was born in a well- educated family on August 29th 1949, in Karachi, where his father had settled with family post- partition. He split his time between several locations on account of the different places he travelled to for his education. He received his early education in his home town, in Karachi. For his degree in Bachelor of Dental Surgery, Alvi got enrolled in the University of Punjab, in Lahore. He acquired his Master's degree in Prosthodontics after u n d e r g o i n g t w o y e a r s o f postgraduate training at the University of Michigan Ann Arbor, in 1975. For his second postgraduate programme he earned an Master of Science in Dentistry (MSD) in Orthodontics from the University of Pacific San Francisco, in 1984. Later, he went on to become an acknowledged and esteemed contributor of the global dental community. In 1995, he was awarded Diplomate American Board of Orthodontists and became one of the ten Asians with this level of qualification. His achievements are recognized and appreciated worldwide. On being elected as Pakistan's president, Dr Alvi received congratulatory messages from various dental associations globally, among which were Pakistan Dental Association, Asia Pacific Dental Federation, and Turkish Dental Association. This year, FDI in its annual meeting, World Dental Conference, held in Buenos Aires, Argentina, honoured Dr Arif Alvi for his many contributions to the dental community and on being elected as Pakistan's President. Dr Arif Alvi inherited his passion in dentistry from his father, Dr Habib-ur-Rehman Elahi Alvi, who is known to be the dentist of India's first Prime Minister, Jawaharlal Nehru. After partition, and migration to Pakistan, Dr Elahi established a Dental Clinic in Saddar, Karachi. The Alvi clan claims to be in the profession of Dentistry for over a century, since 1880 to be precise. It does not come across as shocking, given that his father, his uncles and aunts, Alvi Continued on Page 15 countries travelled to South America to make use of the numerous opportunities to learn and network at the 106th World Dental Congress (WDC). Among the highlights were papers by key opinion leaders and the state-of- the-art dental technology on display at the industry exhibition. In total, over 150 speakers held lectures across the four days of congress. In order to facilitate accessibility, most lectures were simultaneously interpreted or available on screen in both English and Spanish. The event officially opened with traditional dances, speeches and a warm welcome by FDI President Dr Kathryn Kell. Vice chairman APDF, Dr Asif Niaz Arain and Professor Dr. Fazal Ghani, Head of Prosthodontics Department, Dean Postgraduate Dental Sciences and Coordinator International, Peshawar Dental College (Pakistan), who was awarded the FDI's Travel Grant'18 was present at the event as the Continued on Page 15
NEWS candidates for the post of central council President. Dr. Sultan Zaib Khan, President KP Council won after a tight competition with Dr Saima Chaudhry, and was elected as the new president of the society. Society also awarded PhD faculty with honorary fellowship at the convocation to Prof. Arshad Malik, Dr. Sultan Zaib Khan, Dr. Saima Chaudhry, Dr. Farhat Kazmi, Dr. Erum Khan, and Dr. Sadia Iqbal, Prof. Dr. Arshad Malik was also awarded as President Emeritus by all regional council presidents. A tribute was given to late Prof. Abdul Qadir Khehro for his services to Sindh council, and to Prof. Dr Arshad Malik for his tireless effort for the society. Dental News was also awarded a gold medal for the services rendered to the profession. The event was well managed and highlighted the fact that Oral pathology is an emerging specialty that has a lot of scope in Pakistan. 4 DENTAL TRIBUNE Pakistan Edition September 2018 1ST INTERNATIONAL PSOMP CONFERENCE Oral pathology an emerging specialty DT Pakistan Report K A R A C H I - T h e f i r s t international conference under the aegis of Pakistan Society of Oral and Maxillofacial Pathology (PSOMP) was held at Ziauddin Hospital, Karachi. The conference attracted a huge response, and people from all over Pakistan attended the event. Both national and international speakers participated in the conference. The event started with recitation from the Holy Quran followed, by presentations from distinguished speakers including Prof. Dr. Mervyn Hosein, Dean Faculty of Dentistry, Prof. Dr. Shahid Pervaiz, HOD Pathology Department, AKUH, and Prof. Dr. Talat Mirza, Prof. of Pathology and Director Research. Dr Mervyn M. Hosein's presentation on 'Oral Cancer; Disease Burden and Challenges' provided a lot of insight into OSF incidence in Pakistan. The conference covered multiple topics including in-depth knowledge on progression of head and neck cancer, its epidemiology, etio- pathogenesis, molecular progression, and latest advancements. Prof. Arshad Malik presented on 'Trigeminal Neuralgia and Related Oro-facial Pain'. Under graduate and post graduate poster competition was held which was won by FJDC and LCMD, 2nd Position went to Ziauddin University, and 3rd position was grabbed by DIDC, DUHS. Pakistan Society of Oral and Maxillofacial Pathology (PSOMP) came into being in 2013 through the efforts of Dr. Nauman Rauf Khan, who is currently the chairman of the society. Executive council included Dr. Asifa Iqbal and Dr. Joharia Azhar from Lahore and Islamabad, respectively. Dr Nauman Khan nominated Prof. Dr. Arshad Malik as the First President of the council. Later regional councils were constituted in KPK, Federal, Punjab, Baluchistan, and Sindh. Regional Council meetings and seminars are held annually. Karachi got the privilege of holding the first international PSOMP conference, at Ziauddin University (Clifton Campus), Karachi. The event also witnessed central council elections. All five provincial presidents participated in the ballot. Dr. Saima Chaudhry from Punjab, Dr. Sultan Zeb from KPK, Dr. Nabiha Farashat from Baluchistan, Dr. Salik Rasool from Sindh, and Dr. Beenish Zubair from federal council were the One dental surgeon running an entire tertiary care hospital DT Pakistan Report L A R K A N A - T h e largest tertiary-care hospital of rural Sindh, is currently being run by only one Senior Dental Surgeon of BPS-18, which i n d i c a t e s t h e condition of governance in Sindh. t o w a r d s Earlier, it was revealed that, 02 dental surgeons were catering patients with dental ailments of not only the entire district of Larkana, but were also dealing with medico-legal cases; and recently, one of them retired. In this connection, the Medical Superintendent, Chandka Medical College Hospital (CMCH), recently sent an urgent letter to the Director General, Health Services, Sindh, Hyderabad, requesting him to increase posts of Dental Surgeons in the SNE. The letter also shed light upon the issue of handling Medico- Legal cases and Maxillofacial Surgeries, which cannot be dealt with by a single doctor. Due to the immense amount of workload, one dental surgeon cannot well. It must be mentioned here that, a 30-bedded Dental Department was established in CMCH in 2015, costing millions of rupees but uptil now, no patient has been admitted due to scarcity of p r o p e r d o c t o r s . T h e machinery, equipment and i n s t r u m e n t s c o s t i n g approximately Rs 20 million have gone to waste, as nobody is available to use them for the benefit of poor patients. Private clinics of specialist doctors, who work under Benazir Bhutto Medical University are flourishing. OPD operated under and by the dental surgeons of Bibi Aseefa Dental College (BADC) is working, but CMCH 's OPD was closed down arbitrarily after opening of BADC, causing issues for needy patients. At BADC, patients have to pay for various treatments, whereas at CMCH services were provided free of cost. Moving onto the matter of BADC doctors handling Medico-Legal cases, they have refused to examine or operate on such cases, to avoid making frequent appearances in courts. Sources disclosed that, District Hospital, Shikarpur has 09 posts of dentists and dental surgeons, Nawabshah has 07 posts, Jacobabad 06 posts, Liaquat University Hospital has 12 posts and they are demanding creation of 30 more posts due to rush of patients, but CMCH has constantly been ignored for unknown reasons by the Government during their past 10 years rule, despite the fact that indisposed people of more than 12 districts reach out to this particular health facility to get medical treatment and undergo surgeries.
6 DENTAL TRIBUNE Pakistan Edition September 2018 NEWS FDI World Dental Congress 2018 welcomed the world of dentistry to South America B U E N O S A I R E S , ARGENTINA - Thirty years after it was first held in the country, this year the FDI World Dental Congress (WDC) returned to Buenos Aires. Despite the three decades that had passed, FDIs aim to make its annual congress the absolute meeting p o i n t f o r t h e o r a l h e a l t h profession remained unchanged. The event was officially opened with traditional dances, speeches and a most warm welcome by FDI President Dr. Kathryn Kell. After a very busy first day, congress attendees, FDI delegates and industry officials met in the general assembly hall at La Rural to celebrate the official opening. A big round of applause met Kells entering of the stage, where she greeted the audience and thanked everyone for travelling from near and far to take part in the 106th flagship event of FDI. Together we can celebrate At the 2018 World Dental Congress opening, Dr. Kathryn Kell, President of the FDI World Dental Federation, welcomed attendees with a stirring address. (Photograph: Monique Mehler, Dental Tribune International) being part of FDIs rich network and local communities who are committed to improving our overall well-being worldwide. I wish you an excellent congress, and from all of us at FDI thank you for being here, said Kell. In his address, Dr. Guillermo Rivero, President of the Argentine dental association (Confederación Odontológica de la República Argentina), added: We have achieved an excellent scientific program which will provide excellent opportunities to learn new and develop existing skills at this multifaceted congress. He furthermore highlighted the importance and positive influence meetings like the WDC had on the reputation and development of emerging countries such as Argentina. After the speeches, the audience was treated to rich cultural performances, with a spectacular tango, followed by the traditional flag ceremony in which the whole audience passionately engaged, and an entertaining Argentine gaucho dance show. T h o u s a n d s o f d e n t a l professionals from all around the world appeared to attend the four- day WDC, which was organized by Istanbul-based company evronas events and the Argentine dental association. More than 160 lectures and presentations, as well as other events related to oral d i s e a s e p r e v e n t i o n a n d management were planned for the congress. In addition, local and global manufacturers were to showcase their latest products and services at the exhibition in the green a n d y e l l o w p a v i l i o n s . F r o m September 5th until 8th, Buenos Aires was to be the world capital of d e n t i s t r y - D e n t a l T r i b u n e International FDI Women Dentists Worldwide gathers for forum B UENOS AIRES, ARGENTINA - On 7 September, an international group of female dentists and opinion leaders in several specialties met for the FDI Women Dentists Worldwide Forum. The session was titled "Leading technologies-Impact of knowledge to clinical practice" and consisted of papers presented by three women dentists who are all part of Women Dentists Worldwide. Moderator of the session and Women Dentists Worldwide Chair Dr. Vesna Barac-Furtinger led the audience, which consisted of men and women alike, through the program. She explained that FDI Women Dentists Worldwide exists to coordinate the activities of the national groups, promote the collection of information about women dentists and their pattern of working, and address inequalities where they exist. Furthermore, it aims to facilitate contacts between women and enhance their full participation in all branches of the profession on a worldwide basis. Before introducing the first speaker of the morning, Barac-Furtinger welcomed honorary guest FDI President Dr. Kathryn Kell, who joined the forum for the lectures and networking opportunities. As a dentist, Kell has been a longtime member and Women Dentists Worldwide Forum attendees got together for a group photo with FDI President Dr. Kathryn Kell. (Photograph: Monique Mehler, Dental Tribune International) supporter of Women Dentists Worldwide. Dr. Nermin Yamalik, who is a periodontist and professor at Hacettepe University in Ankara, Turkey, gave the first lecture, titled "Evidence based dentistry (EBD) and critical thinking." She pointed out that EBD and critical thinking are crucial from both a scientific and dental practice viewpoint. This is due to their potential impact on the outcome of dental treatment and the success of the dental practice, she said. The second speaker was orthodontist Dr. Simona Dianiskova from Bratislava, Slovakia, where besides working in her own practice, she teaches at the Slovak Medical University. Her lecture "Digitalisation in orthodontic practice" addressed how modern technology has simplified her everyday work. At the end of her lecture, Dianiskova thanked FDI for providing women from all over the world with a platform for learning, sharing and networking. Lastly, American board-certified orthodontist Dr. Jina Lee Linton presented her paper, "3D digital- CCO System, scale up in orthodontics." Linton lives and works in Seoul, South Korea. During her lecture, she introduced 3-D biodigital diagnosis and treatment planning. Furthermore, she explained what the Complete Clinical Orthodontics System is, and how to accomplish speedy, efficient, predictable, and stable outcomes using it. - Dental Tribune International
8 DENTAL TRIBUNE Pakistan Edition September 2018 CLINICAL IMPLANTOLOGY Dynamic navigation for reliable and predictable flapless implant placement By Dr David Burgess A 52-year-old female patient was concerned about the appearance of her smile. Her upper right first molar and second premolar had been missing for several years (Figs. 1 and 2). She was otherwise a fit and healthy non-smoker. The patient was unwilling to consider a denture and was not keen for the symptomless adjacent teeth to be prepared for bridgework, particularly the upper right first premolar, which was unfilled. She did not wish to have any form of removable prosthesis. She chose to have implant-supported crowns, as she wanted the final restoration to be as close as possible to having natural teeth. Clinical examination and planning before implant surgery. A NaviStent was fabricated and a fiducial marker attached, prior to the CBCT scan. Fabrication of the NaviStent is quick, easy and takes place chairside, using a unique thermo-plastic material which is moulded directly onto the patient's existing dentition. The NaviStent is designed and fabricated to ensure a high level of stability, while providing unrestricted access to the planned implant sites. The scan was taken with a Morita 3-D CBCT system, which provides high definition, distortion-free images for accurate diagnosis and planning. Radiographic and CBCT examination revealed approximately 9 mm of bone depth, from the crest of the ridge to the floor of the maxillary antrum, in the upper right second premolar site, crowns were planned prior to treatment and the consequent position of the implants determined, so that the optimum restoration could be achieved. Due to the limited bone depth in the first molar site, augmentation of the ridge was planned by utilising the internal sinus lift (or Summer's) technique. The minimally invasive procedure allowed placement of dental implants in a site with reduced bone depth, without causing iatrogenic sequelae through damaging an intact Schneiderian membrane. Flapless procedure Treatment was carried out under local anaesthesia. The flapless procedure resulted in minimal trauma to the gingival tissue overlying the ridge. The previously constructed the sinus lift. Navident provided visual confirmation of the position of the drill tip to accurately gauge the correct depth (Fig. 8). Preparation continued using a 3.5 mm drill bit, which, again, was calibrated and verified before use (Figs. 9 and 10). A 3.5 mm diameter and 8 mm length Dentsply Ankylos C/X implant was placed 1 mm subcrestally in the upper right second premolar site. A guide pin was placed in the upper right first molar site to check the depth and alignment (Fig. 11). The NaviStent was removed and the site was prepared for the sinus lift osteotome (Figs. 12 and 13). The osteotome was tapped gently with a surgical mallet until the remaining thin layer of bone infractured and was elevated (Fig. 14). The Schneiderian Fig:1 Fig:2 Fig: 3 Fig: 4 Fig: 5 Fig: 6 Fig: 7 Fig: 8 Fig: 9 Fig: 10 Fig: 11 Fig: 12 Clinical examination suggested that the bucco-palatal width of the maxillary ridge was wide enough to consider flapless surgery. This had added appeal, as the patient was travelling a great distance for the treatment, so wished to minimise the number of appointments and the p o t e n t i a l f o r p o s t o p e r a t i v e complications. C o m p u t e r - g u i d e d d y n a m i c navigation with Navident by ClaroNav was used in the preparation of this case. Scanning and planning took place during the assessment visit, 48 hours and no more than 5 mm bone depth in the first molar site. Planning took place immediately after the scan, with the patient present, so she could see the proposed treatment on the Navident software. She felt reassured by the care being taken to achieve optimum implant positioning, with minimal risk of potential complications, and was extremely impressed with the technology. The Navident planning software allowed the placement of the implants to be restoratively driven. The size, shape and position of the intended NaviStent, and the drill tag and jaw tag supplied by ClaroNav, were prepared immediately prior to surgery (Fig. 3). In accordance with the Navident protocol, the axis of the drill and tip of the pilot drill were calibrated (Figs. 4 and 5) and verified before site preparation commenced (Fig. 6). Using computer-guided surgery, the pathway of the drill could be followed clearly on the computer screen positioned in front of the patient (Fig. 7). Approximately 1 mm of bone was left intact in the upper right first molar site ready for membrane was carefully raised through manipulation with the osteotome and a heterogeneous bovine bone graft material (Bio-Oss, Geistlich) was introduced into the implant site (Fig. 15). A 4.5 mm diameter and 6.6 mm length Ankylos C/X implant was then placed 1 mm subcrestally (Figs. 16 and 17). Both implants had good primary stability on placement. Ankylos Balance posterior sulcus formers were fitted, without the need for additional closure with sutures (Fig. 18). Continued on page 12
10 DENTAL TRIBUNE Pakistan Edition September 2018 Interview: I truly believe in the effect of preventative measures By Monique Mehler, Dental Tribune International D espite being one of the most easily preventable diseases, dental caries still poses a major health concern across all age groups around the world. Very young children especially are affected for many reasons, which are the focus of investigation by clinicians such as Prof. Ece Eden. In 1988, Eden graduated from Ege University in Izmir in Turkey, where she has been practising dentistry and conducting research to this day. At the Department of Pedodontics, Eden lectures and supervises dental and medical students, in addition to directing numerous scientific projects and speaking at international congresses. To learn more about her motivation, Dental Tribune Online spoke to her about her work in the field of paediatric dentistry and the lectures she has given in Buenos Aires. Prof. Eden, at the World Dental Congress this week, you gave three lectures. Two of them focused on controlling and preventing dental caries. Why did you pick this topic as your main issue of discussion? Dental caries is the most highly prevalent disease of all ages, with symptoms of the process causing carious lesions. Dentists all around the world are mostly dealing with consequences of dental caries rather than treating the disease itself and are educated more on restorative work as the most important part of oral rehabilitation. However, as dentists, we need to understand the aetiology of the disease of dental caries and we need to use this knowledge to provide necessary care for our patients for better oral health. On the other side, today, we are well aware that oral health is one of the major determinants of well- being and overall health. Although the current scientific evidence has shown the importance of oral health, we are still dealing with caries as the most prominent oral disease today. Thus, we, as today's generation of dentists, should educate our patients and especially seek to gain patient compliance for success in our daily routine. This way, our aim to provide health with functioning and good-looking dentition for a lifetime can be achieved. With all of this in mind, I spoke about how we can manage this challenging caries prevention task in young children in my first lecture and in different situations in my second presentation. Focusing on your first lecture, "Early childhood caries: Problems of the very young and role of the family". What are the main risk factors for early childhood caries? The condition we call early childhood caries (ECC) today was formerly known as nursing bottle caries or nursing caries, ascribing it to inappropriate feeding practices. However, multiple aetiological factors are involved in this early-stage disease. In addition to dietary factors, lack of oral hygiene, lack of fluoride exposure, and enamel defects are some of the major factors. The oral health of a caregiver with a high cariogenic bacterial load causes an early transmission of cariogenic bacteria, which is important in its aetiology. Immigrants and children from socially disadvantaged and low socio-economic backgrounds, who tend to have inappropriate feeding practices, have a higher risk of developing ECC and its severe form. It is very clear that there are many different determinants and factors of the elevated risk status of our children. We need to outline all these factors in order to develop either individual or public prevention programmes to address the global caries problem. For many years now, you have been working in and conducting research on paediatric dentistry. Have you observed any growing trends? For example, does caries affect more newborns these days than, say, ten years ago? Unfortunately, as an active clinician working in the university's paediatric dentistry clinic in the third-biggest city of a developing country for more than 20 years, I have to admit that there is still high caries prevalence among children. Socio-economic pressures have forced more mothers to work, changing the family structure and causing grandparents or nannies to take over the responsibility of caring for children at home. These generations consumed more sugar-added cariogenic food without any improvements in oral hygiene practices. Neither grandparents nor mothers are adequately aware of the importance of oral hygiene practices right after the eruption of the first tooth. All these have contributed to the high prevalence of the disease in children. The difference I have observed today is that I have younger patients with severe ECC being treated then I had ten years ago. In recent years, more children with the severe form have been brought to clinics at younger ages soon after the start of the disease for proper care. This early encounter with the dentist at the onset of the disease is beneficial for preserving more healthy tooth tissue and the possibility of controlling the disease, but treatment is difficult and costly as well as it is late. This was the primary reason we conducted the study on pregnant women that I spoke about in my lecture. I believe our study, which began Prof. Eden has, among other things, discussed the topic of caries prevention at the FDI World Dental Congress 2018. (Photograph: Monique Mehler, Dental Tribune International monitoring at pregnancy with three-year follow-up, is a good example that demonstrates the role of the family and the importance of education as effective primary prevention. Do you think there is more that can be done by the government, such as a sugar tax or health labels on sugary drinks, to guide caregivers and therefore prevent caries? Or do you think that the main responsibility to educate themselves and their kids on the causes of caries lies with parents? I think all parties should work hand in hand to prevent and control ECC. The outcome of the disease causes losses for the community, besides affecting the quality of life of the affected children and their families. The situation is capable of generating social and behavioural disorders, and low self-esteem, and has a financial impact. Targeted strategies should include various stakeholder groups, such as dental practitioners and policymakers. A common risk factor approach for non-communicable diseases to link caries prevention with hygiene and control of obesity and diabetes is a good opportunity to seize. Educating expectant mothers, parents, educators and healthcare professionals will help to prevent the disease. Society-based precautions should include health labelling on potentially cariogenic drinks and food. Governments may control hazardous products by taxation and can establish prevention programmes, starting with social awareness and education. What was the take-home message for your audience? Risk of carious lesion development should be carefully monitored by the dentist and the balance between demineralisation and remineralisation should be controlled. Educating mothers, who play a very important role in providing oral hygiene and proper diet for children, is mandatory. Dentists should be educated on strategies to modify behaviour in mothers so that they take action regarding their children's oral health, and dentists need to help them to overcome the burden of ECC in the community. Although there are many barriers in relation to the Continued on page 14 Observational study determines risk factors for Noma S OKOTO, NIGERIA - Noma, a rare disease found predominantly in underserved areas, causes rapid progressive destruction, or gangrene, of the tissue of the face and jaw. Now, members of international humanitarian medical organisation Médecins Sans Frontières have analysed 74 cases of noma in north-west Nigeria and pinpointed risk factors for developing the disease. Noma mostly affects children under the age of 5 years old, and it is estimated that up to 90 per cent of noma-affected people die. Those who survive are left with severe facial disfigurements and multiple health problems, resulting in difficulty eating and breathing, as well as social isolation. Noma is most prevalent along the "noma belt", stretching from Senegal to Ethiopia, Continued on page 14 A child with Noma disease cries in the health centre of the NGO Sentinelles in Zinder, southern Niger. AFP
12 DENTAL TRIBUNE Pakistan Edition September 2018 CLINICAL IMPLANTOLOGY New method could prevent failure of dental implants C AMBRIDGE, MASS., U.S. - Hydrogen embrittlement causes sudden, costly failures of metal components across a wide range of industries. Researchers from the Massachusetts Institute of Technology (MIT) have now made a discovery that could help prevent failure of metal devices such as dental implants. "Hydrogen gets into the metal and causes it to fracture unexpectedly in a process called hydrogen embrittlement," said lead author Dr. John P. Hanson, who conducted the research as a PhD student at MIT. Scientists have studied hydrogen embrittlement for over 150 years, but it remains difficult to predict. "That's largely because we don't have a complete understanding of the mechanisms behind it," explained Hanson. In order to analyze the microscopic structure of a crack in a superalloy of nickel, the researchers employed two different synchrotron tools, high-energy diffraction microscopy and X-ray tomography, at the Argonne National Laboratory's. Advanced Photon Source, Illinois, U.S. A new study has offered a way to predict fractures in metal, which could help prevent the failure of dental implants. (Photograph: Texas A&M University) Metals are composed of microscopic crystals or grains. In nickel superalloys, the fractures brought on by hydrogen embrittlement travel along the boundaries between those grains. According to Hanson, the unique tools allowed scientists for the first time to look at not only the grain orientations around a crack in progress, but also the grain boundaries. From those observations, the team identified ten grain boundaries that are more resistant to cracks. "We were able to show not only which grain boundaries are stronger, but exactly what it is about them that improves their performance," concluded Hanson. This could ultimately allow engineers to build stronger metals by designing them with these characteristics. The study, titled "Crystallographic character of grain boundaries resistant to hydrogen-assisted fracture in Ni-base alloy 725," was published online in Nature Communications on Aug. 23, 2018. It was conducted in collaboration with Carnegie Mellon University, Pittsburgh, and Texas A&M University, College Station, U.S. -Dental Tribune International Dynamic navigation for ... Continued from page 8 Implant placement in optimum bone Navident was used to guide the implant site preparation dynamically, to ensure implants were placed in the their alignment made future impression taking and restoration straightforward. The ability to watch the drill virtually on the CBCT scan, as the implant sites were prepared, allowed the exact point at which to cease vertical drilling to be achieved in one visit. least trauma possible. Computer-guided navigation enabled the implants to be placed reliably and predictably within optimum bone, without the need to reflect a flap (Fig. 19). Consequently, the patient The implants were restored four months after placement, with custom- made Dentsply Atlantis titanium abutments and Lava zirconia crowns (3M ESPE; Figs. 20-25). Fig: 13 Fig: 14 Fig: 15 Fig: 16 Fig: 17 Fig: 18 Fig: 19 Fig: 20 Fig: 21 Fig: 22 Fig: 23 Fig: 24 Fig: 25 pre-determined position without the need for a static drilling guide. This facilitated placement of the implants in the optimum amount of bone without inadvertent damage to the maxillary sinus membrane. It also ensured that be judged visually. Assessment, planning and placement were carried out within 48 hours, due to the patient's limited ability to attend for appointments. Using Navident, there is no reason why this could not experienced no postoperative swelling or bruising and she reported very little discomfort after treatment. This outcome satisfied the primary objective of aiming for clinical perfection, whilst ensuring the patient experienced the Editorial note: A list of references is available from the publisher. This article was published in CAD/CAM international magazine of digital dentistry No. 04/2017. - Dental Tribune International
14 DENTAL TRIBUNE Pakistan Edition September 2018 New study links low-level vitamin D, periodontitis and Type 2 diabetes T O R O N T O , C A N A D A - F o r multiple reasons, vitamin D3 is an essential vitamin. In a new study that may add to its importance, r e s e a r c h e r s f r o m t h e University of Toronto have identified how the vitamin and periodontitis together influence Type 2 diabetes. With the prevalence of prediabetes and Type 2 diabetes reportedly on the rise, the study may help discover the role periodontal disease plays. Lead author of the study A l e k s a n d r a Z u k f o u n d increased odds of developing Type 2 diabetes among people with periodontal disease who are also lacking in vitamin D3. "We know that vitamin D is not only helpful for bone health, but is also shown to have antimicrobial and anti- i n f l a m m a t o r y e f f e c t s . Sufficient vitamin D levels can potentially decrease inflammation and affect oral microbes related to gum disease," said Zuk, a Ph.D. candidate in epidemiology at the Dalla Lana School of Public Health and a trainee at the Population Health A n a l y t i c s L a b o r a t o r y. According to the study, half of American adults have some form of periodontitis and vitamin D insufficiency. Zuk hopes that, by better understanding exposures, targeted treatment can be developed as an additional line of defense against diabetes. For example, by changing the vitamin D status from low to high among adults with periodontitis could affect glucose levels in people living with Type 2 diabetes. With the role of periodontal disease still unclear when it comes to Type 2 diabetes, Researchers believe the study might impact further research into periodontal disease and the role it plays in Type 2 diabetes. (Photograph: zlikovec /Shutterstock) Zuk believes that exploring the impact of novel factors associated with disease risk is critical to finding some answers. "Because it's the first study, we really need to look at these two exposures again in other studies and population. It might impact further diabetes research," noted Zuk. The study, titled "Joint effects of serum vitamin D insufficiency and periodontitis on insulin resistance, pre- diabetes, and Type 2 diabetes: Results from the National H e a l t h a n d N u t r i t i o n E x a m i n a t i o n S u r v e y (NHANES) 2009-2010," was published in BMJ Open Diabetes Research and Care on July 23, 2018. -Dental Tr i b u n e I n t e r n a t i o n a l 38th Intl Dental Show... Continued from front page be twofold; addressing the medical as well as the technical aspects. In other words, the demands of a dentist and that of a dental technician are appreciated in a manner that the ultimate benefit goes to all the involved parties. However, often times the use of a certain technique is influenced by variables from the patient's end. For instance, a patient short on time will opt for simpler chairside techniques, which the dentist has to provide. High speed digital systems with the capability to simplify and improve chairside procedures are possible solutions to such issues. Various specialties are brilliant candidates for digitalized dentistry. In orthodontics and prosthodontics, model scanning, and virtual designing have a promising scope. Similarly, in implantology laboratory support in terms of obtaining drilling templates and virtual designs can further simplify the procedure and ameliorate the aesthetic results, as well as improve the lifespan of the fixed prosthetic. In endodontics remotely motorized instruments with precise values entered in the system can give a much more accurate result, with little chance of failure. How a treatment pans out is, of course, the result of treatment planning and implementation, which includes the expertise of the dental and technical experts, and the ease of the patient. During these discussions variables like patient's choice o f m a t e r i a l a n d t r e a t m e n t option, dentist's opinion on the m o s t p r o m i s i n g m a t e r i a l / t r e a t m e n t / t e c h n i q u e , a n d t h e availability of technology with the dental technician and the feasibility of its usage must all be considered. H e i b a c h s t a t e d t h a t " T h e International Dental Show (ID) from 1 2 t o 1 6 M a r c h 2 0 1 9 , w i l l comprehensively present the current development status of materials and processing methods as well as the new opportunities of how the dentist and dental technician can optimally pass the ball to each other." He encouraged individuals from the dental community to attend the event as a team, promising that there was ample to learn. He claimed that the way forward was through knowledge and acceptance of the progressing technology, and teamwork. I truly believe in the effect ... Continued from page 10 community and culture that end up with dental caries, educating mothers is effective in reducing ECC, but we need to transform the whole community and integrate oral health into general health for greater success. Is there anything else you would like to add? I truly believe in the effect of preventative measures, and with the evidence on caries prevention and basic understanding of the cariogenic process, dentists all around the world should practise caries management according to the needs of their patients. Moreover, as dental professionals, we should raise a unified voice globally to promote awareness particularly of the early prevention of caries and thus oral health. -Dental Tribune International Observational Study... Continued from page 10 but cases have also been reported elsewhere. The World Health Organization estimates that 140,000 children contract noma each year. The research team studied 74 children with noma and 222 controls matched by village of residence, current age and sex. The patients were admitted to the Noma Children's Hospital in Sokoto between May 2015 and June 2016 and were all under the age of 15 at the time of onset. Each participant's parents or caregiver answered questis about household s o c i o - d e m o g r a p h i c s , l i v i n g conditions, vaccination history, breastfeeding and other nutrition- related practices. While many factors were similar between cases and controls-including low vaccination rates-some stood out as risk factors for noma. Children who were fed pap, a corn porridge, every day were at a higher risk of contracting noma. The researchers hypothesise that eating pap is a proxy for overall poor variation in diet. Children whose mother was their primary caregiver, whose caregiver was married, and who were fed colostrum, the earliest breastmilk after birth, were less likely to get noma. "Noma is a neglected disease, and current risk factors suggest that intervention efforts could be more effective by focussing on access to h e a l t h c a r e , t h e b e n e f i t s o f breastfeeding and a varied diet," said l e a d - a u t h o r E l i s e F a r l e y , epidemiologist at Médecins Sans Frontières, on behalf of her research team. "However, more research is needed to better understand the pathogenesis of this disease in order to improve prevention, early detection and treatment." The study, titled "Risk factors for diagnosed noma in northwest Nigeria: A case-control study, 2017", was published online in the August 2018 issue of PLOS Neglected Tropical Diseases. -Dental Tribune International
Dr Arif Alvi Becomes ... Continued from front page himself along with all his siblings, and children are dentists. It is an interesting fact indeed! Despite the dedicated interest in dentistry, his persona decidedly remained political. Pres. Alvi has had an extensive career in politics, which only recently reached its peak. Alvi started off in the field some five decades ago; as the President of student union at de'Montmorency College of Dentistry, an affiliate of University of Punjab in Lahore, he was an active member of the students' wing of Jamaat- i-Islami. During the military regime of Gen Ayub Khan, Alvi, then a student, played a notable role by standing up for democracy in the country by taking part in various student rallies. An interesting fact about Alvi from those days is that he was shot during one of the demonstrations at The Mall, in Lahore; and to date he carries the bullet embedded in his right arm, as an insignia of pride on contributing to the struggle for democracy in Pakistan. He was the Jamaat-e-Islami candidate for Provincial Assembly in Karachi in 1979. However, the elections were not held. In his younger days, Alvi also engaged in playing sports, like squash, cricket, and hockey. His fervour for politics was boundless, yet he remained loyal to his profession of dentistry. He chaired the 1st Pakistan International Dental Conference in the year 1981. In 1987, he again chaired the 3rd Pakistan International Dental Conference, which was inaugurated by PM Junejo. Dr Alvi served as the Editor in Chief for the Journal of Pakistan Dental Association from 1985 to 1988, and was elected as the President of Pakistan and Dental Association in 1997, where he served for over 4 years. Currently, he is the Dean of the Faculty of Orthodontics of the College of Physicians and Surgeons Pakistan. His benefitting work in dentistry went beyond the border, and established his name and label on the international horizon. Based on his exceptional feats in academic and clinical fields, Dr Alvi was awarded Fellowships of The Pierre Fauchard Academy, International College of Dentists, The American College of Dentists, and International College of Continuing Dental Education. He was elected as the President of Asia Pacific Dental Federation, in the year 2006. The same year, he was the chairman at the Asia Pacific Dental Congress. Dr Alvi did his country proud by forming the first ever Pakistani representation at the Fédération Dentaire Internationale (FDI) forum; after being elected by 103 countries, he served on the FDI council from 2007-2010. A dentist by profession, one of the co-founders of PTI, and a co-author of PTI's constitution, Dr Arif Alvi contested in General Elections Pakistan for Sindh Assembly seats, in 1997, but remained unsuccessful. The 2002 Elections did not reap much for him 2018 Pakistan Edition DENTAL TRIBUNE 15 September either, but he remained on the journey, refusing to label mere stumbles as failures. Being a resolute and committed PTI member, he steadily ascended within the party. From being on the party's executive council in 1996, he became the party's President in Sindh, in 1997. In 2001, he was promoted to the post of PTI's Vice President, following which he was designated the position of party's secretary general in 2006, to which he remained dedicated to until 2013. By the time of General Elections 2013, Pakistan Tehreek-e-Insaaf (PTI) had established itself as a renowned political party dedicated to make the much desired flip; to bring about the change that would free the society from a corrupt, oppressive system. That year, PTI could not win the mandate, but several PTI leaders made the cut to General and Provincial Assemblies. Among these was Dr Alvi who won from the NA-250 constituency of Karachi. During his term, Alvi made it his purpose to make improvements in education, and the living standards of his people. He targeted many schools, hospitals, and other civil structures. The highlights include dental education and health awareness programmes, renovation of several educational institutions, improving security conditions, alleviating poverty, ration distribution among the less privileged. Correction of civil administration was his area of focus wherein he undertook the issues of security, water supply and conservation, tanker Mafia, street/traffic Lights, encroachments, garbage disposal, playgrounds, schools etc. Being a healthcare provider, and a public's man, welfare remained his strong suit. Dr Alvi is involved in several philanthropic movements. His contributions to this cause include the trusteeship of Safiya Azimuddin Charitable Trust and ShirinBai Jinnah Charitable Trust, of ShirinBai Jinnah Charitable Trust and of ShirinBai Jinnah Charitable Trust which was established by Shirinbai Jinnah (Quaid-e-Azam's siter) to which she gifted all her material possessions, including the Mohatta Palace in Karachi. Dr Alvi is also involved in the running of Alvia Trust. In the general election of July 25 2018, Dr Arif Alvi won a National Assembly seat, after over 91,000 people who stood for change voted for him. The presidential elections were held on September 5th 2018, in which Dr Arif Alvi defeated Pakistan Peoples Party Parliamentarian's candidate Aitzaz Ahsan, and Pakistan Muslim League- N's nominee Maulana Fazal-ur-Rehman, to assume the position of the 13th President of Islamic Republic of Pakistan. Pres. Dr Arif Alvi is happily married to Samina Alvi. Together, they have four children, all of which are married, and settled with their families. Dr Alvi is deeply attached his grandchildren, tremendously enjoys their company. He considers them as one of the greatest joys and pleasures of his life. Dr Alvi is involved in the running of two major dental clinics, both of which are located in Karachi. FDI WDC 2018 Continued from front page representative of PDA, Pakistan. Dental Tribune, the Media Partner of FDI set up its booth at the event, where its publications were showcased. The DN stall had several distinguished visitors on all four days. Many Pakistani faces were also seen in attendance, at the congress. Prior to and during the main congress, several meetings of the FDI delegates were held including the FDI Open Fora, FDI Membership Liaison and Support Committee (MLSC) meeting, meetings of the various Regional Dental Federations including the Asia Pacific Dental Federations (APDF / APDC, meeting of the Women Dentists Worldwide Forum (WDWF), meeting of the World Oral Health Day (WOHD) Launch. Two General Assemblies of the FDI were held to take key decisions on various issues and guidelines governing and influencing the science, education and practice related to dental healthcare services. The General Assembly (GA) is the FDI's supreme legislative and governing body. Notable outcomes of the proceedings in Buenos Aires also included the welcoming of new FDI member associations. The FDI Council leads the FDI in line with its vision mission; it is comprised of the FDI President, President-elect, Treasurer, and 10 Councillors. In this year's congress, the GA adopted 10 policy statements: 1.(Deep) dentine caries and restorative care 2.Continuing dental medical education in dentistry 3.Dental amalgam phase down 4.Dentistry and oral health related apps 5.Dentistry and sleep-related breathing disorders 6.Global periodontal health 7.Nanoparticles in dental practice 8.Providing basic oral healthcare for displaced persons 9.National health policy with the inclusion of oral health 10. Promoting oral health through fluoride toothpaste The new and revised policy statements will be soon available for consultation through the FDI website. It is to note that the FDI policy statements, which detail FDI's position on issues of interest within the oral health community, are put together through consultation, discussion and consensus among leading dental experts from around the world. A key publication that was launched during the Congress was the Second edition of the Dental Ethics Manual with its full version available on the FDI website. DAY 1- Among the many speakers to speak were Prof. Papa Ibrahima Ngom from Senegal who discussed the 'Orthodontic Management of a Missing Tooth in Developing Countries'; Dr Paulo Kano from Brazil who talked about 'Aesthetic Dentistry, and Use of CAD/CAM'; Prof Ece Eden from Turkey lectures on 'Early Childhood Caries: Problems of the very Young and Role of the Family'. The subjects that were touched during the Hot Topic Session were 'Future of Dental Materials, Minamata and the Impact on Dental,' 'New Material & New Challenges in Reconstructive Dentistry', and 'Bioactive Dental Materials'. Two Meet the Expert sessions were held by Dr Daniel Paesani from Argentina and Dr U?ur Ergin from Turkey, respectively. The topics were 'All You Want to Know about Bruxism' and 'Update on Cement'. DAY 2- The two Meet the Expert sessions were directed by Dr Lars Christensen and Prof. Marco Ferrari, their subjects being 'Are we Ready to Go Digital in Orthodontics?', and 'Adhesive Dentistry', respectively. An important highlight of the day was the session held by Women Dentists Worldwide Forum. It covered subjects like 'Breastfeeding and laser in Odontopediatry', 'Dental Care and Oral Health for Achieving Healthy Longevity in An Aging Society', 'Tooth Bleaching and Its Undesirable Effects', 'Treatment Care of 21st Century with Implants', and 'The Usefulness of Plasma Rich Fibrin (i-PRF) in the Treatment of TMD Painful Conditions'. DAY 3- The Ninth Annual Alliance for a Cavity-Free Future Global Summit was also held on the third day, where in subjects like 'Catalyzing Change in Education, Policy and Practice', 'Towards Paying for Health in Dentistry: Policy Lab Update-The Next Steps', and 'Towards Paying for Health in Dentistry: Policy Lab Update-The Process This Year', were addressed. F I N A L D A Y - S y m p o s i u m 'Contemporary Treatment of Caries Lesions' was held on the fourth day of the conference, where Prof. Jo Frencken from Netherlands, Prof. Soraya Coelho Leal from Brazil, Dr Edward Lo from China, and Dr Nicola Innes from UK spoke on the subjects of caries detection methods, caries preventative measures, carious tissue removal techniques, and treatments for carious lesions, respectively. After congress hours, WDC attendees w e r e o ff e r e d a r i c h c u l t u r a l entertainment program, starting with the engaging and welcoming opening ceremony. At Buenos Aires Night, participants experienced the delights of Argentine beef, so essential to traditional cuisine, regional wine and the sensual tango. On the last evening of the congress, a glamorous gala dinner was hosted at the architecturally beautiful Palacio San Miguel. The 2019 WDC will take place from 5 to 8 September at the Moscone Convention Center in San Francisco, U.S. The American Dental Association, which will host the event in cooperation with FDI.