PUBLISHED IN PAKISTAN www.dental-tribune.com.pk JANUARY, 2019 - Issue No. 01 Vol.6 An exlusive interview with Dr Arif Alvi Fast, functional aesthetic solution for anterior ... Immediate implantation with CAD/CAM and functional ... INTERVIEW Page 4 CONVOCATION Page 6 CLINICAL IMPLANTOLOGY Page 8 Hamdan Bin Rashid inaugurates Dubai Dental Hospital at Arab Health 2019 DT Pakistan Correspondent D UBAI- H.H. Sheikh Hamdan bin Rashid A l M a k t o u m , Deputy Ruler of Dubai, Minister of Finance and President of the Dubai Health Authority, inaugurated the Dubai Dental Hospital, the first and largest dental hospital in Dubai, on the opening day of Arab Health. The hospital, which started out as Dubai Dental Clinic in 2008, has increased its capacity by 125 percent with eight specialties under one roof with a fully-equipped dental lab, post-surgery rooms, and an in-house sterilisation department. A c c r e d i t e d b y J o i n t Commission International, the Dubai Dental Hospital is equipped with state-of-the-art technologies, the hospital has its own imaging department with 3D radiology, Computer- aided Design/Computer-aided Manufacturing, CAD/CAM, an Intra Oral Scanner and a dental laboratory and digital teeth scanning. The revamped hospital includes 63 dental chairs, m a k i n g i t t h e l a rg e s t specialised dental facility in Dubai. With more than 100 q u a l i f i e d h e a l t h c a r e professionals, it strives to provide greater access to specialised oral treatment for patients of all ages, meeting the growing demand for dental care in the region. "As an urban healthcare landmark and the largest healthcare free zone in the world, the Dubai Healthcare C i t y i s c o m m i t t e d t o advancing healthcare in the UAE and the wider region. The launch of the Dubai Dental Hospital is the latest initiative that reinforces our commitment and dedication in helping to drive and build w o r l d - c l a s s h e a l t h c a r e facilities," Dr Amer Al Z a r o o n i , C E O , D u b a i Healthcare City Medical. Under the direction of a highly-skilled team of oral healthcare professionals, the hospital will continue to deliver patient-specific healthcare in compliance with international best practices. The dental hospital provides t r e a t m e n t a c r o s s e i g h t specialist areas: general dentistry, dental hygiene, paediatric dentistry, cosmetic dentistry, oral surgery, orthodontics, prosthodontics, endodontics periodontal t r e a t m e n t a n d d e n t a l implantology. "This day is the culmination of the hard work and efforts of everyone at DDH and is a t e s t a m e n t t h e i r commitment that we can mark this milestone in our mission to provide greater t o (Image: DT Pakistan) Tenure of members cut to three years: PMDC ordinance DT Pakistan Report I SLAMABAD - In a f i r s t , t h e f e d e r a l government has decided to revise the tenures of members of the country's top medical education regulator apart from ending the representation of elected lawmakers on the board's table. This is contained in the new Pakistan Medical and Dental Council (PMDC) Ordinance 2019 which was approved by President Arif Alvi recently. According to the ordinance documents, the federal government has reduced the tenure of the council's members from four years to just three years. The membership of federal a n d p r o v i n c i a l h e a l t h ministers, federal secretaries including senate and national assembly members, has also been withdrawn, making the council free of political interference. According to the ordinance, the new council will now comprise 17 members; of these, three members will be nominated by the prime minister. These members shall be prominent members of civil society. Other members of the council will include a professor and an associate professor from each public medical college as per their rank and experience. They will be nominated by their r e s p e c t i v e p r o v i n c i a l governments. Two members of the council will be from private medical colleges who will be nominated by the prime minister. Moreover, there will be two members from the clinical faculty of dental colleges who will be taken from the four provinces on a rotation basis. In this regard, one of these members will be chosen from either P u n j a b o r K h y b e r - Pakhtunkhwa while the second member will be nominated from either Sindh or Balochistan. Another member of the council will be nominated by the surgeon general of the armed forces medical services group. The president of the College of Physicians and Surgeons of P a k i s t a n ( F C P S ) w i l l nominate one member. Continued on Page 14 Image Photo: UrduPoint access to specialised oral treatment for patients of all ages, meeting the growing demand for dental care in the region," said Dr Khawla Belhoul, Director, Dubai Dental Hospital. In addition to providing patients unrivalled access to specialist treatment and expert advice, the hospital is the clinical partner of the Mohammed Bin Rashid University of Medicine and Health Sciences, providing clinical training for the university's Hamdan Bin Mohammed College of Dental Medicine residents. FMH College of Dentistry bags top positions DT Pakistan Report L A H O R E - F M H College of Dentistry has achieved first position among all dental colleges in Punjab. The students achieved outstanding distinctions by bagging first three positions in the First Professional BDS Annual E x a m i n a t i o n h e l d i n November/December 2018 by the University of Health Sciences. Names of position holders are; 1st Position - Mr. Hassaan Hafeez Sheikh and M s . I r h a Wa j a h a t , 2 n d Position - Ms. Neha Feyyaz, and Ms. Zarish Iqbal, 3rd Position - Mr. Muhammad HamizAftab.
4 DENTAL TRIBUNE Pakistan Edition January 2019 INTERVIEW An Exclusive Interview ) h k i a h S . A n a l a s r A : h p a r g o t o h P ( I thought that I might have to change from dentistry to some other profession: Dr Arif Alvi By Syed Hashim Hasan Dr Arif Alvi was recently interviewed by Dental Tribune Pakistan, and the excerpts of the exclusive talk with him are as under:- in about a year. Back then, for about four to five months I had thought that I might have to change from dentistry to some other profession. That was during the final year of BDS, so it was very disappointing. Syed Hashim Hasan: Let's begin with a topic that is of interest to the masses, which is that you have a bullet in your arm. Why did you decide to keep it? President Dr Arif Alvi: (laughs) I didn't decide to keep it. I was injured in the late 1960's- I think it was 1969. It was a struggle for democracy against Ayub Khan. I got shot, and was transported to the hospital by a cyclist, who took me to Mayo Hospital from Mall Road. The doctors there were more concerned about establishing broken nerve contact and blood supply, and therefore, they said that to fish around for the bullet was not possible. The damage was so severe that for about 8 to 9 months I was not able to move fingers. The motor neurons had not recovered. Even today, the sensory supply to two or three of my fingers is relatively poor. For example, I am not able to count pages or money. So that is a good point. I still can't count money with my right hand. All the bad things come into the left hand to count. I think that was the reason why the doctors at that time decided not to probe for two bullets in the arm, and so they are still there. HH: So there are two and not one bullet in your arm? AA: Yes, one can be felt but the other one. HH: Dentistry is a skill where hands play a pivotal role so how come it did not affect your practice? AA: No, it has not affected my practice. My motor neuron situation recovered HH: Belonging to a family of dental surgeons, what exactly led you into politics? AA: Actually, I was always interested in anti-corruption; I was always interested in the history of Pakistan; and I was always frustrated when I looked at the deprived people of our society. Then there was the fact that my father was also a politician and a dentist; he was dentist to Jawaharlal Nehru. So because he was a politician, there was good discussion in the family about politics. The third reason was that my mother was a very well-read lady, and she exposed to me a variety of reading material. In the college days, on her recommendation and her insistence, I used to read philosophy, Marxian theories, and Maulana Maududi and his Islamic Law and constitution. This was all at the time of my intermediate. As she persisted, my interest in reading increased, and it still continues. I must pray for her forgiveness from Allah (SWT). HH: So along the way what was the role of your family and friends? AA: In politics, the family was very supportive. I think what I am today, the family has a lot to do with that. And it's not being said as a cliché. I believe very strongly that without the support of the family, I would not have been where I am. For example, in the management of my Alvi Dental Hospital, my wife has played such a big and tremendous role that I never knew what was the income of the hospital, who was being employed, and all the other decisions that were made. So I was free in my mind to look at other things. The family's support is tremendous. HH: Was there ever a phase when you thought you had hit rock bottom in politics? AA: Every time I lost an election I felt that I'd hit rock bottom, but the struggle continued. Every day I would open a newspaper, my frustration would increase, but the recovery was fast as well. I needed to do something. My frustration is still there. Every time I read a newspaper, every day, the frustration is still there. There are so many things that have to be done, and even being the President of Pakistan I am unable to reach out everywhere and do it. Therefore, this government has been, and should be focusing on systems, rather than reactions to individual issues. Sometimes, I have seen and I have disliked the fact- for example, it appears in the media that a certain poor man or a poor child was seen on the streets and because the pictures made it to the newspapers, the Chief Minister of the province or the Prime Minister solved that issue. I believe that there should be an institutional response. Maybe, those who come in the newspapers are probably 0.001%, and much more people are there who need an institutional response. So I think that is where institutions are important. HH: Being a very distinguished dentist and an educationist and now the President of Pakistan, what kind of plans should be expected with your insight about the system and its loopholes? AA: I am very sorry to state that I find my own professional field lacking in its organizational capabilities. I believe that they should be dragging themselves up and functioning better, because u n l e s s t h e o rg a n i z a t i o n s a n d associations of the profession think of improvement in the profession, nothing can happen. Dentistry as a profession is not purely related to knowledge and delivery, it is also related to an organizational aspect, where, for example, if you want to handle quackery or prevention, you have to look at these things in an organizational manner. That is what associations are for. Presently, I am disappointed in the organizational aspect of dentistry in Pakistan. Therefore, I feel limited in my ability to lift them up. It has to come from the profession, and only then I can help. HH: So the professionals need to come in and suggest things? AA: Of course, and not only suggest things you know, the organizational capabilities should increase. Dentistry as a profession has a different role than dentistry in education. Universities and colleges are there, they impart education. Dentistry as a profession can then look at the education standards. Maybe they can also suggest to PMDC on how to improve. Dentistry as an association can look at the aspect of continuing education, rather than all continuing education being in the realm of the industry. Dentistry associations can play a big part. As an association, the biggest part that dentistry can play is in prevention because, sure, the colleges can teach prevention, but at the level of society a professional goes out and says that this is how you brush your teeth, this is how you wash your hands, for example, to avoid Continued on Page 13
6 DENTAL TRIBUNE Pakistan Edition January 2019 CLINICAL IMPLANTOLOGY Fast, functional aesthetic solution for anterior tooth trauma By Dr. Martin Weber C EREC and oral surgery? In times when patients go to a practice to receive complete, aesthetic, state-of-the-art treatment as quickly as possible, I think they go together very well. I did not always think so. Certainly, CEREC was always interesting; I have used it since 2003, but I did not always find the results convincing. In 2014, I had a closer look at an event in Salzburg, Austria, and learnt two things: the system had been further developed, and in particular, the precision had been improved considerably. It fits well in my practice; I use it almost CAD, Ivoclar Vivadent; and Celtra Duo, Dentsply Sirona) to treat my patients. The possibility of using implants in the premolar and molar region with screw-retained all-ceramic crowns is especially interesting. Sintering or crystallisation in the CEREC SpeedFire furnace is fast and fits smoothly into the workflow. The advantage for my practice, where I also employ two other dentists, is obvious. We produce laboratory tasks right in the practice and have the entire workflow under control, and our patients are satisfied. They are still really impressed by the technology today. They are treated immediately, posttraumatic resorption of the root, and the tooth could therefore not be preserved (Figs. 1 & 2). The tooth was to be replaced by an implant with an all-ceramic crown immediately after extraction. To plan the procedure, a 3- D radiograph (Orthophos XG 3D, Dentsply Sirona) was taken. It was important to assess the available horizontal and vertical bone and evaluate apical osteolytic processes after the failure of endodontic treatment and in the region of the crestal bone due to progressive dentinal resorption. The integrity of the vestibular lamina was preserved, and there was sufficient apical bone to allow immediate t o a l l o w When extracting tooth #21, it was important to preserve the vestibular l a m i n a i m m e d i a t e implantation. For this reason, the Sharpeys fibres were carefully severed with a periotome, and the tooth was gently removed (Fig. 7). The tooth had pronounced dentinal resorption, confirming the previously made diagnosis (Fig. 8). The SiroLaser Blue (Dentsply Sirona) with a wavelength of 970 nm was used to disinfect the alveolus. An OsseoSpeed EV 4.815 mm implant (Astra Tech Implant System, Dentsply Sirona) was inserted immediately using a surgical guide (SICAT OPTIGUIDE, SICAT; Fig. 9). Fig. 1: Single-tooth exposure of tooth #21 after recurrent marginal gingivitis. Owing to the initial diagnosis of extensive resorption, the tooth could not be preserved. Fig. 2: Single-tooth exposure of tooth #21 after recurrent marginal gingivitis. Owing to the initial diagnosis of extensive resorption, the tooth could not be preserved. Fig. 3: The initial situation in 3-D in the Sidexis 4 imaging software (Dentsply Sirona) showed good apical bone substance with the possibility of immediate implantation. Fig. 4: Tooth #21 was deleted in CEREC to simulate the initial post-op situation. Fig. 5: The prosthetic proposal was also used as the basic file for producing the surgical guide with the gap at position #21. Fig. 6: The intraoral CEREC scan superimposed over 3-D image data for optimal positioning of the implant in the Galileos Implant planning software. Fig. 7: Gentle extraction preserving the vestibular lamina. Fig. 8: The resorption of tooth #21, external view. This confirmed the accuracy of the diagnosis from the imaging procedure. Fig. 9: Preparing the implant bed according to the recommended drill sequence, insertion of the implant using the SICAT surgical guide. Fig. 10: Intra-op CEREC scanning with a ScanPost. Fig. 11: Augmentation of the vestibular alveolus. Fig. 12: The screw-retained crown as a finished polished temporary. Fig. 13: Sealing the screw channel with composite. every day because I have many patients who have busy jobs and do not have much time. I experience a great workflow in the practice that gives me maximum flexibility. Depending on the indication and the patients wishes, I can decide whether to make the restoration myself or outsource it to a laboratory, which I often do for more elaborate bridges. Then, I send the scan directly to my partner laboratory via Sirona Connectthat is very reliable. I mainly use conventional ceramic materials (VITA ENAMIC, VITA Zahnfabrik; CEREC Blocs C PC, Dentsply Sirona; IPS e-max and Telio have no problems thanks to the precise fit, and feel like they are involved because they can watch us create the design and view the planning process live in CEREC. And yes, patients do talk about that with their friends and family. This case study shows how the digital processes, including implant planning, with CEREC work. Treatment of an anterior tooth trauma with an immediate implant The female patient, born in 1989, came to my practice with problems at tooth #21 caused by a childhood trauma. The gingival margins were reddened and bled when probed. The i n t r a o r a l r a d i o g r a p h s h o w e d implantation with immediate loading (Fig. 3). At > 35 Ncm, sufficient primary stability was achieved. After scanning the upper jaw, tooth #21 was deleted in CEREC to simulate the initial postoperative situation. The prosthetic proposal for tooth #21 was used to optimise implant planning and to produce the surgical guide (Figs. 4 & 5). In the implant planning software (Galileos Implant, Dentsply Sirona), t h e p r o s t h e t i c p r o p o s a l w a s superimposed over the CBCT data for the optimal positioning of the implant. In this way, sufficient vestibular distance was ensured, and the correct size of the implant for optimal primary stability could be selected (Fig. 6). After the intraoperative scan with a ScanPost (Dentsply Sirona) to complete the temporary restoration, the vestibular alveolus was filled with a bone substitute material (Figs. 10 & 11). Designing the temporary screw- retained crown included processing the composite crown (Telio CAD) produced with CEREC and extraorally attaching the TiBase (Telio CAD, Ivoclar Vivadent on Dentsply Sirona TiBase). The crown was screwed in situ, and the screw channel was sealed Continued on Page 10
8 DENTAL TRIBUNE Pakistan Edition January 2019 CLINICAL IMPLANTOLOGY Immediate implantation with CAD/CAM and functional restoration in the aesthetic zone By Dr. Martin Weber T he aesthetics are always a significant challenge during implant restoration, especially in the aesthetic zone, in addition to the full consideration required regarding function. In this article, we present a case of multiple tooth fractures due to trauma. After tooth extraction, immediate implantation and guided bone regeneration (GBR) were performed. During the prosthetic procedure, the design and transfer of the emergence profile of the soft tissue, functional design and occlusal adjustment, as well as the CAD/CAM process, were satisfactorily realised to achieve the aesthetic and functional goals. Case report Dental history A 40-year-old female patient had sustained trauma to her anterior teeth caused by accidental syncope three weeks before. The clinical examination found that tooth #11 had been luxated; the crowns of teeth #12 and 21 had fractured, with the residual margin extending 35 mm below the gingiva and the teeth affected by Grade III mobility; and the crown of tooth #22 had fractured, with the residual margin at gingival level. There were no obvious abnormalities in the remaining teeth (Figs. 14). After excluding major systemic diseases, it was decided that she required fixed implant restoration with high demands regarding aesthetics and function. Treatment procedure Teeth #12, 21 and 22 were extracted. To o t h # 11 u n d e r w e n t e a r l y implantation and tooth #22 immediate implantation with GBR (Figs. 5 & 6). After three months of healing, osseointegration had taken place. An implant level impression was taken for fabricating a provisional bridge supported by temporary abutments for teeth #1222. The technician modified the shape of the artificial gingiva on the model in order to form the proper gingival curve and emergence profile, then finished the provisional bridge, while the dentist modified the gingival shape using an olive-shaped bur intraorally (Figs. 718). The aesthetic and functional outcomes of the provisional restoration were checked. The tip of tooth #13 was too low to achieve a good smile line. When checking the intercuspal position (ICP) and lateral excursion using 80 µm occluding paper, tooth #13 was found to be out of contact. After reshaping the labial contour and filling the lingual surface with resin, tooth #13 had good contact and guidance during ICP and lateral excursion (Figs. 1923). Once the aesthetic and functional outcomes had been confirmed, the anterior guidance of the provisional restoration was recorded on an articulator (Artex, Amann Girrbach) and its individual incisal guide table (Figs. 2427). Next, the emergence profile of the provisional restoration was transferred and the cast model was made and mounted on the articulator (Figs. 2833). The cast model was scanned step by step to obtain a digital model and this was integrated with a virtual articulator. The anterior guidance of the virtual articulator was set according to the data from the provisional restoration. Next, the design was completed on computer and the titanium-based zirconia abutment and fixed zirconia bridge produced via CAM. After staining and glazing, the final restoration was completed (Figs. 3441). The final restoration demonstrated a good outcome, both aesthetically and functionally (Figs. 4250). Discussion This patient came to the clinic just after the trauma, and according to the intraoral condition, immediate implantation could have been carried o u t . H o w e v e r, o w i n g t o t h e unexplained accidental syncope, diseases of the central neural system were to be excluded first, so delayed dental treatment was suggested. Three weeks later, after a general physical check-up, implantation was begun. Usually, operation within 48 hours after tooth extraction is considered as immediate implantation, while operation within the first six weeks after tooth extraction is considered as early implantation. Therefore, in this case, implant #11 was early implantation and implant #22 immediate implantation. The preoperative CT analysis showed that the labial side of the alveolar ridge of teeth #12, 11 and 22 was deficient; thus, GBR was needed in order to obtain sufficient bone quantity. After three months of healing, both hard and soft tissue around the implants had been well maintained, providing a sufficient foundation for the maxillary restoration. In order to form a good gingival shape, either the provisional restoration can be adjusted step by step or the shape of the soft tissue can be designed first, the provisional restoration manufactured to meet the aesthetic demand directly, then the soft tissue intraorally adjusted and reshaped. In this case, we followed the second option. After using an olive-shaped bur to adjust the form of the gingiva under the pontic, making it match the provisional restoration, which had already been well designed and manufactured, a perfect soft-tissue outcome was achieved. By means of regular methods to transfer the emergence profile, it was copied to the final restoration, which is the foundation for the good soft- tissue effect of the final prosthesis. It was also very important to obtain the proper anterior guidance during Continued on Page 14 Fig. 1: Pre-op frontal view of the Fig. 2: Pre-op occlusal view of the Fig. 3: Pre-op panoramic radiograph. Fig. 4: Pre-op CT analysis. anterior teeth. anterior teeth. Fig. 5: Frontal view of the anterior Fig. 6: Occlusal view of the anterior teeth immediately post-op. teeth immediately post-op. Fig. 7: Frontal view of the anterior teeth Fig. 8: Occlusal view of the anterior Fig. 9: Patient smiling three months three months post-op. teeth three months post-op. post-op. Fig. 10: The overjet and overbite between the implants and the mandibular anterior teeth. Fig. 11: The emergence profile three Fig. 12: Two impression copings connected months post-op. for the implant level impression. Fig. 13: Reshaping of the artificial gingival contour on the model in order to obtain a good gingival aesthetic effect (performed by dental technician Samuel Chou). Fig. 14: Provisional restoration Fig. 15: Insertion of provisional Fig. 16: Modification of the gingival on the model. abutments. contour under the pontic. Fig. 17: Finishing of the reshaping of the gingiva. Fig. 18: Frontal view of the provisional restoration just after delivery. Fig. 19: The patient smiling with the provisional restoration in situ. Fig. 20: The patient smiling after adjustment of the labial contour of tooth #13. Fig. 21: Frontal view of the anterior teeth after adjustment of the labial contour of tooth #13. Fig. 22: ICP contact on tooth #13 after reshaping of the lingual surface with resin Fig. 23: Lateral guidance on tooth #13 after reshaping of the lingual surface with resin (12 µm occluding paper, red). (12 µm occluding paper, red). Fig. 24: Facebow transfer of the provisional restoration.
NEWS Nanodiamonds might January 2019 Pakistan Edition DENTAL TRIBUNE 9 aid recovery from root canal treatment L surfaces-similar to actual diamonds-that enable the particles to deliver a wide range of drugs and imaging agents. OS ANGELES, U.S.- C a l i f o r n i a - b a s e d r e s e a r c h e r s h a v e recently been working on a tiny, but powerful ally that could help prevent infection after root canal treatment. In a clinical trial it was found that nanodiamonds protected disinfected root canals after the nerve and pulp were removed, thereby improving the likelihood of a full recovery. The findings are considered a milestone for the use of nanodiamonds in humans. Nanodiamonds are particles made of carbon and are so small that millions of them could fit on the head of a pin. The particles resemble soccer balls, but have faceted N EW YORK, U.S. - Recent papers on opioids and their use within the dental industry have drawn increased attention. In response to research related to opioid prescriptions for some d e n t a l p r o c e d u r e s , t h e American Dental Association (ADA) has recently released a statement clarifying their position on the broader issue. In the statement, the ADA said: "In order to combat opioid abuse among adolescents, and across all ages, the ADA has urged all 161,000 member dentists to double down on their efforts to prevent opioids from harming patients and their families." According to the ADA, the growing body of research supports their policy that dentists should prescribe non- steroidal anti-inflammatory drugs (NSAIDs) alone or in c o m b i n a t i o n w i t h acetaminophen over opioids as first-line therapy. Stating that the ADA is "dedicated to raising awareness and taking action on the opioid public health crisis." In March 2018, the ADA adopted a policy related to opioid prescription by dentists for acute pain. The policy supports mandatory continuing "Harnessing the unique properties of nanodiamonds in the clinic may help scientists, doctors and dentists overcome key challenges that confront several areas of h e a l t h c a r e , i n c l u d i n g improving lesion healing in oral health," said Dr. Dean Ho, professor of oral biology at the UCLA School of Dentistry and co-corresponding author of the study. The researchers tested nanodiamond-embedded gutta percha (NDGP) in three patients who were undergoing root canal procedures. Tests In a clinical trial, a UCLA-led team used biomaterials embedded with nanodiamonds tiny gems to help tissue heal. (Image: designleo/Shutterstock) of the implanted material confirmed that the NDGP was more resistant to buckling and breaking than conventional gutta percha. All three patients healed properly, without any unusual pain and without infection. "This trial confirms the immense promise of using nanodiamonds to overcome barriers for a range of procedures, from particularly challenging endodontics cases t o o r t h o p e d i c s , t i s s u e engineering, and others," said Prof. Mo Kang, co-author and endodontics professor at UCLA. The study, titled "Clinical validation of a nanodiamond- embedded thermoplastic biomaterial," was published in Proceedings of the National Academy of Sciences on Oct. 23, 2018 ahead of print. - Dental Tribune International ADA releases statement regarding research on opioid prescriptions German report shows the frequency of dental check-ups has increased B ERLIN, GERMANY - In a new study, researchers from the Robert Koch Institut (RKI) have examined, among other subjects, the prevalence, determinants and trends of tooth brushing frequency and utilisation of dental check-ups in children and adolescents in Germany. The reports are based on Instead of prescribing opioids, the American Dental Association believes that dentists should consider non-steroidal anti- inflammatory drugs as the first-line of therapy for acute pain management. (Photograph: KieferPix/Shutterstock) education regarding the prescription of opioids and other controlled substances, imposes statutory limits on opioid dosage and a duration of no more than seven days for the treatment of acute pain. The guidelines are consistent with the Centers for Disease Control and Prevention's evidence- based guidelines and requires dentists to register with and use Prescription Drug Monitoring Programs to promote the appropriate use of opioids to deter misuse and abuse. In further support of the ADA's position, in April researchers from the ADA Science Institute, Case Western Reserve University and the University of Pittsburgh published a scientific review of studies in the Journal of the American Dental Association. The study concluded that N S A I D s a l o n e o r i n c o m b i n a t i o n w i t h acetaminophen are generally m o r e e ff e c t i v e a n d a r e associated with fewer side effects than opioids. "Working together with p h y s i c i a n s , p h a r m a c i e s , policymakers and the public, the ADA believes it is possible t o e n d t h i s t r a g i c a n d preventable public health crisis that has been devastating our families and communities," the statement concluded. - Dental Tr i b u n e I n t e r n a t i o n a l . In a recent study, researchers in Germany have found, since a previous 2003-2006 report, the frequency of dental check-ups has increased. (Photograph: Pressmaster/Shutterstock) the data collected from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). According to the study, around 80 per cent of children and adolescents meet the recommended tooth brushing frequency and dental check-ups. However, around one- fifth of children and adolescents do not, with 14- to 17- year-old adolescents, as well as those with low socio- economic status and or migrant backgrounds being particularly at risk. Additionally, the results also showed that the utilisation of dental check-ups has increased compared to the Continued on Page 14
10 DENTAL TRIBUNE Pakistan Edition January 2019 Dental hygiene may be key for lupus NEWS e x p e c t t h a t a seemingly small c h a n g e , l i k e b r u s h i n g a n d flossing regularly, c o u l d b e n e f i t patients who are already on a host o f p o w e r f u l medications by allowing them to m o d i f y t h e i r treatment with fewer drugs or less powerful dosages." O KLAHOMA CITY, U.S. - Good oral hygiene can obviate many diseases, including gingivitis, diabetes and hypotension. Now, new research suggests it may also make a difference in the prevention and management of lupus. In the study, the scientists focused on bacteria commonly found in the mouth that have previously been associated with gum disease. Oklahoma Medical Research Foundation scientists, Drs. Umesh Deshmukh and Harini Bagavant have found a link between gum disease and lupus, an auto-immune disease that affects an estimated 1.5 million Americans. "Our findings suggest a simple message, if there is good dental care, patients have a good chance of experiencing less severe disease," said Bagavant. "With further research, we might be able to tell if proper oral health has the potential to help prevent these diseases altogether." She added: "Our study shows that patients who might have been exposed to gum disease-causing bacteria show higher lupus activity. Therefore, we Oklahoma Medical Research Foundation husband-and-wife research team Drs. Umesh Deshmukh (left) and Harini Bagavant have found a link between dental hygiene and auto-immune diseases, such as lupus. (Photograph: Oklahoma Medical Research Foundation) Deshmukh said the new findings provide a strong rationale for improving dental care in lupus patients as an addition to traditional therapy. The research could also lead to new methods of early disease detection. He emphasized that the findings could also have implications beyond lupus. "Poor oral health can contribute to a number of diseases," said Deshmukh. "Taking care of your teeth now could help you avoid Type 1 diabetes, cardiovascular disease and rheumatoid arthritis, among others." The study, titled "Antibodies to periodontogenic bacteria are associated with higher disease activity in lupus patients," was published in a Clinical and Experimental Rheumatology epub edition ahead of print on June 25, 2018. - Dental Tribune International Fast, functional aesthetic ... Continued from page 8 with composite (Figs. 12 & 13). The situation after the temporary restoration (Fig. 14) was aesthetic and free of inflammation. The temporary was positioned 0.5 mm short of occlusion. The patient came for a follow-up after one week. At this visit, we used the soft laser (SiroLaser Blue, wavelength of 660 nm) to activate wound healing (Fig. 15). Four months after this treatment, the patient came to the practice for the final restoration. We had previously sent the scan to the partner laboratory via the Sirona Connect portal. There, the abutment was designed with the inLab software (Dentsply Sirona), milled and attached with a titanium base. The temporary was then removed, and the abutment was inserted using a transfer key. The vestibular contour was completely preserved (Figs. 16 & 17). After sealing the screw channel with a PTFE strip, an all-ceramic, custom-veneered crown was inserted for a perfect aesthetic outcome of the anterior tooth (Fig. 18). Coordinated system supports the workflow For this case, I used the digital workflow from Dentsply Sirona. After having tested different systems, it proved to be especially efficient and easy. The individual steps, from imaging and diagnosis using the scan, ordering the surgical guide and planning surgery up to producing the temporary restoration and the final prosthesis, are very well coordinated. The interface to SICAT is included in the planning software and enables one- click ordering. Even if I do not use a surgical guide for every implantation, I find it to be very useful depending on the indication. I also use laser in my practice depending on the indication. In the case of this patient, there was an inflammatory process at the tooth (granuloma). With the laser, I can achieve thorough disinfection of the alveolus and also activate wound healing. I found that the CEREC Software 4.5.2 has brought another major advance in the accuracy of fit compared with the preceding versions. In addition, it is fast and reliable. The optimised processes proved to be especially advantageous for implants, as in this case. I particularly appreciate the option of implementing screw-retained solutions with CEREC. In my practice, I place more than 100 implants a year with CEREC I generally use screw- retained crowns. They considerably reduce the risk of peri-implantitis owing to the absence of cement. For implants in the anterior tooth region, I produce long-term temporaries with CEREC. They have the significant advantage in that they do not look like temporaries, do not feel like temporaries to patients, and thus ensure better quality of life. The patients are also convinced of this. The follow-up radiograph (Fig. 19) before the final restoration with a custom-veneered c e r a m i c c r o w n s h o w e d g o o d osseointegration of the implant. The gingivae were externally completely free of inflammation. Discussion Given the great aesthetic demands and the need for rapid results, thorough consideration must be given to the options available for treating anterior teeth. In my view, conservation by means of conventional techniques was Fig. 14: Situation immediately after Fig. 15: Situation after one week: activation of wound insertion of the crown. healing with a soft laser of 660 nm. Fig. 16: Inserting the abutment with the transfer key. Fig. 17: Complete preservation of the vestibular contour. Fig. 19: Ideal osseointegration four months post-op. Fig. 18: Final image immediately after inserting the crown with an ideal red-white aesthetic. not possible in this case owing to the comprehensive and advanced internal resorption of tooth #21 due to previous trauma. Upon extracting this tooth, it was particularly evident that it was not worthy of conservation (Fig. 8). The young age of the female patient and the integrity of the adjacent teeth meant that a bridge was ruled out as an alternative. In light of the favourable anatomical situation with fully conserved vestibular bone lamella, immediate implantation was the optimal treatment option for improved conservation of the bundle bone and, along with it, the hard and soft tissue. The fixed provisional crown supported the soft tissue, was aesthetically pleasing and offered the patient a highly satisfactory solution. Moreover, the digital workflow offered the patient additional comfort (impression without a tray). Editorial note: A list of references is available from the publisher. This article was published in CAD/CAM international magazine of digital dentistry No. 03/2018. - Dental Tribune International
12 DENTAL TRIBUNE Pakistan Edition January 2019 Study of medieval plaque shows how oral microbiomes have changed C O P E N H A G E N , D E N M A R K - A number of recent studies have shown that d e n t a l c a l c u l u s f r o m archaeological samples could be a rich source for better understanding the dental health of our ancestors. Similarly, a new study of the calculus of remains buried in a Danish cemetery has shed light on the oral microbiomes of certain groups of medieval humans in the area. Calculus samples taken from medieval remains in Denmark were found to be far more heterogeneous than samples taken from modern Danish individuals. (Photograph: University of Copenhagen) A team from the University of Copenhagen led the study and sampled calculus from the remains of 21 humans buried circa 1100-1450 CE in the medieval cemetery of the village Tjærby, Denmark. A total of 3,671 proteins from 220 different protein groups were identified from the calculus, with approximately 85 to 95 per cent produced by bacteria from the oral microbiome. Although all of the studied samples showed traces of bacteria associated with periodontal disease and dental caries, the team was able to divide the samples into two groups: one that was health- predisposed and the other more susceptible to oral disease. In the former group, there was just one case of periodontitis, whereas seven members of the latter group displayed signs of severe tooth decay. Since the two groups were more than likely to have had similar diets and oral health habits, the difference in oral health outcomes is likely to be attributed to differences in p r o t e i n s , a s Streptococcus sanguinis, a relatively harmless bacteria that was far more prevalent in the former group's oral microbiomes. s u c h Despite these differences, the calculus samples that were used were found to be far more heterogeneous than samples gathered from modern Danish individuals. The study's authors argued that the increased diversity of modern diets, combined with environmental and lifestyle factors, genetics, h y g i e n e p r a c t i c e s a n d different personal histories of antibiotics use were likely to be the main causes of the variety in modern oral microbiomes. T h e s t u d y , t i t l e d "Quantitative metaproteomics of medieval dental calculus reveals individual oral health status", was published online in Nature Communications on 20 November 2018. - D e n t a l T r i b u n e International NEWS Osteology Foundation: Hand in abstracts by mid-January The Osteology Foundation encourages dentists to hand in their research abstracts by 15 January 2019. The winners of the best abstracts will have the opportunity to present their findings at the foundations symposium in Barcelona in April 2019. (Image: Osteology Foundation) B UCERNE, SWITZERLAND - Researchers in the field of regenerative dentistry and oral tissue engineering have the opportunity to present their findings at the International Osteology Symposiums Poster Presentation and Research Forum. The deadline to submit abstracts of original research is 15 January 2019. The symposium will take place from 25 to 27 April 2019 at the Barcelona International Convention Centre and will address the latest developments of techniques and technologies in oral tissue regeneration. For the upcoming event, the Osteology Foundation encourages dental professionals to submit their abstracts in order to get the chance to present their research live on stage or during a poster session. The authors of the six best abstracts that are submitted for consideration in the Osteology Research Forum in each of the two categoriesbasic and clinical researchwill be invited to present by 28 February 2019. These investigators will have the opportunity to present the content of their posters during an oral presentation at the Osteology Research Forum on Friday, 26 April 2019. Furthermore, the Continued on page 14 nodes removed during surgery. About 9 percent of these lymph nodes were positive for cancer. This means that some patients had an LNR above 10 per cent, while others had especially low or even zero LNR. The study found that patients with an LNR greater than 10 per cent had about two and a half times a greater risk of cancer recurrence and 2.7 times greater risk of death than patients with an LNR below 10 percent. Lymph node ratio may predict graveness of oral cavity cancer A URORA, Colo., U.S. : Since oral cavity cancer is often only discovered late in its development, patients with this advanced form of disease have a 5-year survival rate of only 40 percent. Researchers from the University of Colorado Denver (CU Denver) now found that the lymph node ratio (LNR) provides an indication for the seriousness of oral cavity cancer. This knowledge could not only help patients better predict the course of their disease, but could also help doctors choose the most appropriate post-surgical treatment. Researchers from CU Denver's Cancer Center collected information from 149 patients treated at UCHealth University of Colorado Hospital with surgery and or post-surgical treatments for locally- advanced oral cavity cancer from 2000 to 2015, in order to look for patterns in the collected data. "We wanted to know if features of these patients, their tumors or their treatment could predict survival," said first author Ding Ding, a medical student at the Department of Radiation Oncology at CU Denver. As a first step in the study, researchers confirmed a handful of the expected risk factors-based on findings of previous studies-such as being non- white, uninsured or insured by Medicaid, having a larger primary tumor, having "margins" around the tumor that tested positive for cancer even after surgery, or having tumors that had already invaded surrounding tissues, all predicted shorter overall A recent U.S. study found that lymph node ratio may indicate the risk of recurrence of oral cavity cancer and event of death. (Photograph: Photographee.eu/Shutterstock) survival rates. Another factor that is commonly used in models predicting cancer risk is the extent of lymph node involvement. "The current nodal staging system for oral cavity cancer is based on the size, number, laterality and spread of the tumor outside the wall of the involved lymph nodes," Ding explained. "In other types of cancers, such as breast cancer, researchers have been exploring another measure of lymph node involvement, namely whether the ratio of surgically removed lymph nodes that are positive for cancer can predict treatment outcomes. We wondered if LNR, could be a predictor of survival in oral cavity cancer, as well." All the study participants had a median of 29 lymph "In our study, LNR appeared to be more predictive of patient outcomes than the traditional method of lymph node staging. Larger scale studies are needed to verify these findings and it might be worth exploring ways to incorporate LNR into the current model for evaluating recurrence risks," added Ding. Patients with aggressive disease should receive more intensive chemotherapy and radiation after surgery, whereas others with less aggressive disease often forgo the full extent of these treatments. Thus, the study adds to a growing body of evidence supporting the use of LNR to identify patients at a higher risk for recurrence and death from locally-advanced oral cavity cancer. The study, titled "Association between lymph node ratio and recurrence and survival outcomes in patients with oral cavity cancer," was published online on Nov. 15, 2018 in JAMA Otolaryngology- Head & Neck Surgery. - Dental Tribune International
An exclusive interview with Dr Arif Alvi ... Continued from page 4 communicable diseases. There is so much which the profession can do, therefore, in that realm I am disappointed, that they should put their houses in order and try and pick up these issues. HH: Being one of the architects of the Dental Act yourself, do you think it will see light of the day? AA: I think Dental Act was written with the help of other acts, and other people. It was written by me in the mid-1980s. A copy of it is still with me, which was signed by the Prime Minister Muhammad Khan Junejo. It was presented to him in the 1980s. Every time I lost an election I felt that I'd hit rock bottom, but the struggle continued. Again, it is disappointing; today I feel that I would like the Dental Act to be implemented and brought out, but I believe that the profession is not ready to take charge. Therefore, personally my opinion today is, and I would like to have a discourse with the associations or dentists in this regard, that presently I feel that everything can be worked out under the umbrella of Pakistan Medical and Dental Council (PMDC). The dental profession is not managing itself well, now imagine that we have a separate Pakistan Dental Council; there is no confidence in me for that, when they cannot take care of their own associations right now, how will they take care of the profession at large. So therefore, because of lack of confidence, I believe that the best thing for dentistry is that it may continue along with the Pakistan Medical and Dental Council. Soon, an ordinance will be coming through me, in which I have made a lot of suggestions, like increasing the number of dentists being represented in it, as well as having a standing committee of the dentists so that the issues of dentistry go to that standing committee, and the decisions made then come to the main PMDC. Dentists have communicated to me over the last decades that the PMDC does not have the time to look at dental issues. So rather than debating on it in the full house, they should develop their own recommendations, where maybe the issues are going to be handled better. I am suggesting a sub- registrar also, for dentistry separately, so those issues can be handled. HH: Like in other countries, these dental councils or medical councils are handled by professionals rather than people from the same profession. There could be lawyers, there could be people from other disciplines. Is it possible that similar thing can happen in Pakistan? At this point in time a judge is heading PMDC, but something on a permanent basis. AA: I think the new ordinance when it will come as an ordinance, and then go to parliament as a bill, I think the structure will be well-defined. In the organization, not only the judiciary, but other people from other professions would also be involved; somebody who has management skills should be there; where issues of education are concerned, somebody with merit in that area should be there. So I think it would be a comprehensive act when it comes. HH: Will it be doing something for the curriculum as well? AA: Why not? I think that is primary. I think it is very important that the curriculum should be looked at, the goals should be looked at. I wrote a treatise on the competencies which we expect from the dentists in the Asia Pacific region. I think part of that could be adopted, or may have already been adopted that decision of what you want a dentist to be like, that the final product should be in mind. Then after that, there should be flexibility between institutions on how to achieve the same goal throughout Pakistan. HH: Being a brilliant dentist, an accomplished politician, how important do you think it is to not feel limited by your degree? How important is it to pursue your dreams beyond your profession? AA: Must be important. It was very important to me, and I think it should be important to everybody. I pursued my dreams in dentistry first; politics went side by side. But I pursued my dreams in dentistry. I tried to excel, tried to go abroad. When I came back with my first Masters in Prosthodontics, I thought I had achieved everything. Within six, seven years I realized that I needed to do something in Orthodontics, so I went back. Did that. Then further achievement was that I worked hard for achieving Diplomate status in the American Boards. So every decade, I tried to improve my excellence in my own field. Starting in the 1960s, my own BDS; 1970s, the first Master's (degree); 1980s, the second Master's (degree); 1990s, the Diplomate status. In the 1970s, when I had excelled in dentistry, then in 1970s and 1980s I looked at improving my management and my clinic. So that was a big change, relocating from Abdullah Haroon Road to a run-of-the- mill dental office, I developed my hospital in Sindhi Muslim Society, which I still love in the sense that it is a beautiful piece of art and architecture. So those were the struggles in dentistry, but at the same time my frustration regarding what was happening in Pakistan was also simultaneously getting important, in the 1980s and 1990s. I have worked in politics in the 1970's also, and in the 1960's also. But in the 1980's and 1990's, it pushed me more to try and achieve things on the 2019 Pakistan Edition DENTAL TRIBUNE 13 January political side. I was given the permission to establish a medical and dental university. We wanted to set up a charitable medical and dental college, charitable in the sense that we did not want to make money from it. So that was the intent. The first permission given in 1988 was to me. Dr Tariq Sohail was the Health Secretary. I had applied for this in the 1970s-so issue was that when I got the permission, I had to make a big decision, and that decision was that I thought that if I went into teaching, I would have to devote my life to it, and I thought there that were so many issue that were important beyond my dentistry that I could not devote my life only to dental teaching. So I made that decision. The second grantee of that era was the Baqai I encourage girls that dentistry is a good profession, even if they take it up as part-time practice Medical & Dental University. So they set it up, and I did not. So I kept myself open to be able to contribute more in a field where I have more access. But all through my periods, I was always looking for going out to the people and to address them. You remember that we started the oral, public dental education programme with the help of a c o m m e r c i a l t o o t h p a s t e manufacturing company when I was the President of Pakistan Dental Association, and we went out and educated about 900,000 children about how to brush. So the issue still is that we must improve the dental health, the oral health of the people of Pakistan. That cannot happen only by curative dentistry, it has to be prevention at a massive scale. The orientation of the dentist coming out of medical and dental colleges, or doctors, should be geared towards prevention because a dollar spent in prevention, saves a hundred dollars in curative care. And Pakistan is a poor country, therefore, the consensus and the commitment should be to look at issues of prevention easily done. HH: Yes, prevention is better than cure? AA: Yes, in dentistry it is also much easily done. HH: You played a major role in World Oral Health Day (WOHD) with FDI, and then had it passed in the Assembly here in Pakistan? AA: These things I have done simultaneously, like I said. In the first decade of 2000s, there was a conference in Pakistan, which was in 2006- the Asia Pacific Congress, which we held. I was the Chairman of that conference. It was a big struggle, with the local situation getting bad with violence. There was a group of dentists who wanted that the conference should be cancelled. But wherever the issue of Pakistan came in, I insisted that the conference should be held. So we held the congress, and from that congress on I started working in the international arena, which I did not want to. My colleagues kept on telling me that I should be taking lectures abroad etc. etc. I did not want to. But from that conference I started working in the After my first Masters, I thought I had achieved everything. Asia Pacific Dental Federation (APDF), and from there I jumped into the FDI, which is the World Dental Federation. Even there I started looking at Prevention and World Oral Health Day. The date was decided by my push for March 20th. People in Geneva, where the FDI has an office- primary office- they would tell me that there is no money in it. "Why do you want to do this?" And I told them that within the first few years we would start generating money because there will be cooperation with toothpaste manufacturers. The World Oral Health Day is now totally established. When I was one of the elected councillors, the task was given entirely to me. I worked in FDI for six years. From the first year, I started insisting for this. I think, by the fourth or fifth year, I was s u c c e s s f u l i n c o n v i n c i n g m y colleagues. So Pakistan takes the credit for that. HH: You would be happy to know that on a nation-wide level, Dental News was the first to organize the World Oral Health Day, and with your blessings, we have been observing the day since 2011? AA: Yeah, that I know. I am aware of it. HH: The most intense lesson that you have learnt during your years studying, practicing, or in politics? AA: I think it is very easy to say it has been difficult for me. People easily say, "Stay by the truth and serve the people." Staying by the truth by itself is a difficult thing. Then serving the people, is again not an easy task. So I think the most testing time, and the most difficult times was facing violence in this whole struggle; from getting shot in the first decade of my political awareness, and then being shot at while standing up against the violence and bad state of Karachi. You know the history, how much we sacrificed. People thought that I will not live in those testing times. But Allah Ta'ala is greatest. When God's hand is on you, no one can touch you. HH: We know you as a brave politician? AA: It is not bravery. Sometimes when I was struggling against corruption, for example when I was a dental Continued on Page 15
14 DENTAL TRIBUNE Pakistan Edition January 2019 Immediate implantation ... Continued from page 14 the maxillary incisal implant restoration procedure. We carried out the adjustment of the anterior guidance during model and used the same data to form the anterior guidance of the final restoration. When manufacturing the final restoration, a CAD/CAM system was used. Digital models, ICP relationship and In this case, a titanium- based zirconia abutment and zirconia bridge were used. The zirconia material used on the titanium base was a special zirconia with extremely high strength, which can guarantee 3-D multilayer colour. Without any ceramic veneer, only with a little staining and glazing, an excellent colour and translucent effect can be achieved. This was a difficult implant- Miaozhen Wang and the prosthodontists were Drs Feng Liu and Xiaorui Shi. T h e r e s t o r a t i o n w a s c o m p l e t e d b y d e n t a l technicians Samuel Chou and Chunyu Duan. Fig. 25: Mounting of the provisional Fig. 26: Mounting of the mandibular restoration. model according to ICP bite registration. Fig. 28: Emergence profile after shaping Fig. 29: Individual impression coping. Fig. 30: Implant level impression. by the provisional restoration. Fig. 27: According to the anterior guidance of the provisional restoration, the individual incisal guide table was set. Fig. 31: Insertion of 5 mm healing abutments to obtain sufficient retention for the bite registration material. The same posterior ICP bite registration was used as for the provisional restoration in order to ensure the ICP was stable. Fig. 32: ICP bite registration on Fig. 33: Cross-mounting of the Fig. 34: Step-by-step model the healing abutments. maxillary cast model. scanning. Fig. 35: The provisional digital model was matched with the cast digital model. Fig. 36: The incisal guide table was set in the virtual articulator. Fig. 37: Design of the abutment. Fig. 38: Design of the bridge. Fig. 39: Manufacture of the restoration with multilayer zirconia. Fig. 40: Final restoration (performed by dental technician Chunyu Duan). Fig. 41: The zirconia bridge without Fig. 42: The titanium-based Fig. 43: Frontal view of the any ceramic veneer. zirconia abutment. anterior teeth just after delivery. Fig. 44: ICP occlusal contact (12 µm occluding paper, red). Fig. 45: Protrusive contact just after Fig. 46: After occlusal adjustment, the delivery; only tooth #11 achieved contact protrusive contact was even on the (12 µm occluding paper, black). restoration (12 µm occluding paper, black). Fig. 47: Protrusion just after Fig. 48: Frontal view of the anterior delivery. teeth after two weeks. Fig. 49: Patient smiling two weeks after delivery of the final restoration. Fig. 50: CT analysis post-op. the provisional restoration procedure. Once the patient had adapted, we set the individual incisal guide table according to the provisional restoration, cross-mounted the cast model with the provisional restoration data on anterior guidance were integrated into the virtual articulation system. In the process of CAD, the precise design of both aesthetic and functional aspects could be realised. e x c e l l e n t s t r e n g t h a n d durability of the restoration even if very thinly applied. The zirconia material used for the bridge restoration was a kind of CAD/CAM zirconia with a high translucency and supported aesthetic restoration case. With the great efforts of the surgeons, prosthodontists and technicians, a satisfactory result was achieved. The surgeons in this case were Drs Feng Liu and Editorial note: A list of references is available from the publisher. This article was published in CAD/CAM international magazine of digital dentistry No. 02/2018. - Dental Tribune International Tenure of members cut to ... Continued from front page As per the amended ordinance, the first meeting of the health council will be held within 15 days of the issuance of notification for council members. This meeting will elect the new president and vice president of PMDC from amongst the council members. A quorum of 11 members will be mandatory for the election while the presence of 10 members will be mandatory to call a general meeting of the council. As per the amended ordinance, no one will be allowed to join the council until they submit an affidavit declaring that they stand to gain no personal benefit from being on the council. Hence, any member whose spouse or child is a direct or indirect owner of the medical or dental college will not be allowed to join the council. The new ordinance further states that if any council member misses three consecutive meetings of the council or remain outside of Pakistan for more than a year, they will not be able to continue as a member of the council and any other suitable candidate will be included in the council in their stead for the remainder of the tenure. As per the amended ordinance, the health ministry can remove the president and vice president of the council on five occasions: if two-thirds of the council decides to remove the president and vice president; in case their names are removed from the doctors' registry due to any inquiry; they are declared mentally unstable; they are sentenced in a criminal case; or if they are found to be affiliated with any private institution. The amended law states that the council will meet at least once every three months. The PMDC Registrar will serve as the secretary of the meeting. The council will continue its responsibility of regulating medical and dental institutions, educational establishments across the country. The amended ordinance was introduced after it was run on an ad-hoc basis for the past 11 months after the Supreme Court of Pakistan (SC) dissolved the former council and replaced it with a nine-member council headed by a former SC judge. The Pakistan Medical Association (PMA) has already rejected the ordinance stating that it was created without taking them on board apart from introducing a nomination system, instead of the election system for members. German report shows the ... Continued from page 9 KiGGS baseline study in 2003-2006. However, with more work still to be done, the researchers noted that effective caries prevention requires interdisciplinary cooperation between dentistry, paediatrics and other medical disciplines. Emphasising that target group appropriate measures, such as for children and adolescents with low s o c i a l s t a t u s a n d o r m i g r a n t backgrounds have delivered promising results. i s T h e K i G G S t h e o n l y comprehensive study on the health of children and adolescents in Germany and an important database for evidence-based policy decisions. KiGGS Wave 2 was carried out between 2014 and 2017. As well as oral health, the study also focused on the utilisation of physical therapy, speech therapy and occupational therapy and the association between the utilisation of medical services and social status. The report, titled "Utilization of medical services by children and adolescents in Germany", was published on 4 December in the Robert Koch Institut's Journal of Health Monitoring. - Dental Tribune International Osteology Foundation ... Continued from page 12 investigators presenting at the event will have their registration fee reimbursed. The three best presentations in each of the two categories will be announced during the symposium and will be awarded prize money of 1000, 750 and 500 for first, second and third place, respectively. Abstracts can be submitted online at www.box.osteology.org and more information and specific guidelines can be found at www.osteology- barcelona.org. - Dental Tribune International
2019 Pakistan Edition DENTAL TRIBUNE 15 January Gel fillings may enhance root canal treatment, study shows S It was found that the nitric oxide-releasing gel had antibacterial effects. Also, nitric oxide helps wound healing and blood vessel growth by preventing death of blood vessel cells (vascular endothelial cells) and by regulating vascular endothelial growth factor. This allows the interior of the treated tooth to regenerate. EOUL, South Korea/BIRMINGHAM, Ala., U.S.: Root canal treatments currently rely on clotted blood to fill the empty tooth canal. In order to find a more reliable, biodegradable filling that promotes healing and the regeneration of the tooth, scientists have developed a gel filling to use in the root canal treatment that releases nitric oxide and antibiotics inside the treated tooth. The pilot study, conducted by Dr Choi from Kyung Hee University and Dr Cheon from the University of Alabama at Birmingham and their colleagues, showed that this new canal filling material has the potential to boost the regeneration of the impaired tooth. The gel is made from peptide amphiphiles- molecules that self-assemble into gel-like structures depending on their charge. In order to add the nitric oxide, the researchers reacted the amphiphiles Authors Dr Kyounga Cheon (left) and Dr Sungchul Choi (right) and their colleagues designed a novel gel to fill teeth, enabling a better root canal treatment. (Photograph: Dr Kyounga Cheon and Dr Sungchul Choi) with poly-lysine as a nitric oxide donor before heat-induced polymerisation took place. The antibiotics ciprofloxacin and metronidazole were then encapsulated in the gel during the polymerisation process. The antibacterial effect of nitric oxide that the authors observed in their study might actually allow them to omit the conventional antibiotics completely in the future. Additionally, Choi and Cheon want to supplement the gel with growth factors in order to support the growth factors that are naturally present in the treated tooth. The study, titled "Effects of the nitric oxide releasing biomimetic nanomatrix gel on pulp- dentin regeneration: Pilot study," was published in PLOS ONE on 11 October 2018. - Dental Tribune International PM Khan stresses over ... Continued from page 2 Rural Health Centres and Basic Health Units will be done by June 2020, the meeting was further informed. Federal Secretary Health also briefed that in order to address the issue of shortage of health workforce, particularly the nursing staff; recruitment was in process in all hospitals along with establishment of nursing & associated medical sciences university in ICT. Minister for Health KP Dr Hisham Inamullah Khan briefed the meeting on the reforms introduced by the provincial Health Ministry during the last 100 days in terms of expansion of Sehat Insaf Cards, assessment of inputs in all health facilities according to new services package, preparation to establish HR Unit in the Health Department & Strengthening of HCC, achievement of 95% measles immunisation coverage in the province, inception of community based complaints and grievance management system & media cell, procurement of MIS & inventory management system, release of GBP 3.2 million for achieving 100% targets set by DFID and an additional GBP 3.2 million for drafting KP Health Policy, amendment of MTI Act, policies on quality of medicines and initiation of Public Private Partnerships with pharmaceutical companies to provide free care to around 0.5 million patients for four non-communicable diseases. Minister for Health Punjab Dr Yasmin Rashid briefed the meeting that the Punjab Health Department was going to issue Sehat Insaf Cards in four districts namely DG Khan, Rajanpur, Lodhran and Multan. The minister further informed the meeting that five Mother & Child hospitals are being established in the province along with a nursing college. Dr Yasmin Rashid further informed the meeting about the steps being taken for strengthening and capacity building of human resource and measures for prioritising healthcare projects across the province according to the needs of the ordinary people. An exclusive interview with Dr Arif Alvi ... Continued from page 13 student, I remember doing a protest in de'Montmorency College of Dentistry, because there was corruption. The best part was that a weekly used to come out by the name of "Zindagi". A journalist by the name of Sajjad Mir, a talk show host, wrote an article on me and my struggle against corruption in Zindagi, and it ran for two or three pages. This was in 1969. HH: During one of your campaigns, you also did something on 'Save Water'. For example, using a mug to brush your teeth. You still believe that that is the way forward? AA: I think that is definitely the way forward. The scarcity of water, global warming, the environment, the lack of trees in Pakistan, we are conscious of all these things. What we did was, we did a 'Million trees Tsunami' in Karachi, we went to schools, we educated children to make their flat balconies green, we started this 'beej wali pencil' concept (pencils with seeds). We worked in that area. And even today I believe that conservation of water is very important. Make people guilty. I feel so guilty when I open the tap and I feel that the water is being wasted, so it is a daily guilt. I want to reduce the consumption of water, and of course, electricity as well. The new generation should be learning conservation, and it should be practicing conservation. In Pakistan, which has a very major religious ethos, I give examples from the Prophet Muhammad's (PBUH) life; he used to do miswak so many times a day. There are twenty or twenty two ahaadith describing how frequently he did that. The Prophet (PBUH) said to conserve water, the Prophet (PBUH) talked about cleaning, the importance of trees. He called it sadqa-e-jaria (ceaseless charity). Cleanliness of water is sadqa-e-jaria too. In my constituency, I have put up 12 filtration plants to give clean water to people because all this is related to general health. Prophet (PBUH) used to do wuzu (ablution) so many times a day. Washing of hands prevents communicable diseases. There is so much treasure in our history, which can motivate people in this direction. So I think, conservation of water and frequent brushing is the way to go. I practice brushing almost 4-5 times a day now. It just makes me feel good. Mouth odours are kept away, and the spirit of sunnah is taken up again. The Prophet practiced of brushing- doing miswak- with every wuzu, and every time when he went out to meet people. It is tremendous guidance for me. I can assure people, it significantly improves oral health. HH: Is that your message for the World Oral Health Day also? AA: Absolutely. Brush as many times as you can. 90%-95% of oral diseases are because of poor brushing. HH: Do you thing quackery is an issue in dentistry? AA: I am sure it is. In Pakistan, in education, there was a Supreme Court decision, whereby admissions are now being given on merit. What has happened now is that there are 80% girls and 20% boys. That is very good because it is on merit. But what happens is, you expect all lady dentists, who come out to be able to practice. The figures that I get say that about 50% of the women do not practice at all. They give it up forever. Recently I spoke at a convocation ceremony for a medical and dental college, and I encouraged the girls there that dentistry was such a good profession. Even as a part-time practice, you should do it, because there is so much investment in those people by the government and by the people of Pakistan. You are learning and practicing on the people of Pakistan. So the lack of dentists is also because although we are producing dentists, but a large number of those dentists never go out and work. Otherwise it is a waste of educational resources, and it is unfortunate that the country would not have enough curative care. That is where quackery comes in. If people have a problem and they do not find a dentist, they will take an Aspirin, they will do totka (hacks). Anybody will advise them, and they will put a clove in the mouth and try to dissolve it. There are so many ways, but they cannot just ignore the pain. And if they do not find a dentist, they will resort to hacks, and they will go to a quack. They will go to somebody who can fix it in whichever way. So it is the need of the people to get some attention. How can you handle it? I think by producing more dentists who practice. The need for quacks then evaporates. It is not purely a law and order situation. HH: Do you think that besides Karachi, Lahore and Islamabad, the dentists need to go in the periphery as well? AA: Yes. I think that should be a commercial incentive for a dentist to go into the periphery, because you cannot force anybody to go there. So there must be some incentives. HH: I am sure you are familiar with a made-in-Pakistan smartphone application, Authentik that can curb quackery? AA: Authentik can be of help in putting an end to quackery. Definitely. HH: What is your message to the people of Pakistan for New Years? AA: My message would be to work harder, to work with care, and help the people of Pakistan. There are around 20 million children out of school, help in that context. Do look at prevention in health, for both communicable and non- communicable diseases. Improve your diet, and exercise regularly. There are so many things that people can do without the state's help; care for nutrition, encourage breastfeeding by mothers, increase the nutrition level, look for safe water, keep clean. So the message is comprehensive, not one single thing, but if you want a Naya Pakistan, you will have to work very hard. HH: So Naya Pakistan is hard work? AA: Absolutely.