DENTAL TRIBUNE The World’s Dental Newspaper · South Asia Edition Published in India www.dental-tribune.in 6/19 No Tobacco FDI highlights role of dental practitioners on World No Tobacco Day, 2019 Cleft lip & palate New explanation for the genetic mechanism that triggers cleft lip and palate HIV risk Fears of contaminated equipment use - HIV tests offered to dental patients Stem cells Allogenic stem cells – a faster and cheaper method to treat periodontitis ” Page 02 ” Page 03 ” Page 04 ” Page 06 Interview with Dr. Gerhard Iglhaut, Germany (DDS, PhD) : A pioneer with an experience of more than 30 years in Implantology in Oral the Steinbeis-University Implantology (DGI) as well as its board member from 2004 to 2018 and the President from 2013-2015. Since 2005 he is a university Implantology docent at in Berlin and since 2008 docent at the Georg-August-University in Göttingen. Since 1995 he has lectured internationally on Oral Implantology, Periodontology, Plastic Periodontal Surgery and Periodontal Microsurgery. Since 2005 he is docent in Oral Implantology at the Steinbeis- University in Berlin, and since 2008 docent at the Georg-August- University in Göttingen, where he earned his PhD in 2015. Since 2017 he is docent and scientific researcher at University of Freiburg, Dept. Oral and Maxillofacial Surgery/ Plastic Surgery. as such He holds memberships in numerous dental professional organizations the American Academy of Esthetic Dentistry, American Academy of Restorative Dentistry, American Academy Periodontology, European of German Osseointegration, Academy of Association of Oral Surgery, German Association of Oral Implantology and the German Association of Periodontology. Dr. Iglhaut works from his private practice in Memmingen, Germany since 1987. Below is the excerpt of an interview with Dr. Gerhard Iglhaut, who will be visiting India in the month of August, 2019 to conduct a 5 day workshop on soft tissue management in Bangalore. GI: Multiple systematic reviews have concluded that in augmented alveolar bone after GBR technique with bone substitutes, implants show similarly high survival rates compared to autogenous bone grafts. In my more than 30 years clinical implant work I have observed the same experience. Today GBR technique using bone substitutes in combination with particulated autologous bone grafts is the new gold standard. Dr. Rajeev Chitguppi: What are the recent trends in socket grafting? Dr. Gerhard Iglhaut: There is scientific evidence, that socket grafting minimizes horizontal and vertical bone resorption, but slows down bone formation by using bovine bone minerals. Innovative porcine bone substitutes with 100% carbonate apatite shows faster resorption and newly bone formation, therefore allows stabile implant placement already after 4-5 months. RC: Autogenous bone grafts in oral implantology— still a “gold standard”? in term GI: Our goal RC: What are the newer trends in the choice of bone substitutes? implant dentistry is to build up sufficient peri-implant bone thickness for long tissue stability. To achieve volume steadiness, we used bovine bone substitutes with slow resorption over time. Innovative porcine bone materials show faster resorption and more space for new bone formation. The consequence is faster bone regeneration complete resorption of the bone materials after 12 months and RC: Which alloplasts do you prefer in your practice? GI: My clinical experience with ß- Tricalcium phosphate (TCP) materials has shown limited outcomes in several cases. If the patient asks for alloplastic bone materials I therefore prefer synthetic Hydroxy-Apatite (HA). RC: What are the recent trends and which are the most commonly done tissue procedures in your practice to improve the quality of peri- implant soft tissues? soft GI: To protect alveolar bone tissue we need sufficiently thick and fixed peri-implant soft tissues. In cases of thin alveolar mucosa, we have routinely used free gingival or connective tissue grafts in the past. The palatal donor site, however, increases the patient´s morbidity complications, apart from providing a limited quantity of soft tissue. The use of allogenic or porcine acellular dermal matrices offer us novel minimally invasive options in soft tissue augmentation around teeth and implants. and Ad Dr. Gerhard Iglhaut by Dental Tribune International Dr. Gerhard Iglhaut completed his degree in dentistry in 1982 at the Justus Liebig University of Giessen, Germany. He worked as a scientific assistant in the department of Oral Surgery for three years, and earned a specialist certificate in Oral Surgery at the same university, later a specialist certificate in Oral Implantology (DGI) and Periodontology (EDA) Dr. Iglhaut is a lecturer for the German Association of Oral PRINT EVENTS EDUCATION DIGITAL Dental Tribune International The World's SERVICES Largest Dental Marketplace www.dental-tribune.com
2 News 6/19 FDI highlights role of dental practitioners on World No Tobacco Day, 2019 by FDI World Dental Federation GENEVA, Switzerland: World Health Organization (WHO) and global partners celebrate World No Tobacco Day on May 31 every year. WHO emphasizes on a specific area every year, and this year’s primary focus was on lung health. However, FDI World Dental Federation highlighted the relationship between the use of tobacco and oral health. WHO stated that the annual campaign was an opportunity to raise awareness about the harmful and deadly effects of tobacco use and second-hand smoke exposure. The objective of the campaign was to discourage the use of tobacco in any form. Tobacco use increases the risk of periodontal disease and oral cancer. It also causes staining of teeth, bad breath and premature loss of teeth, and leads to loss of the taste and smell sensations. Moreover, oral diseases and other non-communicable diseases share modifiable risk factors, such as tobacco use, harmful use of alcohol, and high sugar diets. According to FDI, oral health uniquely to help patients professionals positioned reduce or quit tobacco use: are • They are equipped to identify and treat the adverse effects of the oropharyngeal region. tobacco on • They often treat children and their caregivers, which provides opportunities to raise awareness of the dangers of tobacco. • They often treat pregnant women and can teach them that using tobacco during pregnancy increases the risk of health problems for developing babies. • They can contribute to a multidisciplinary approach to help their patients quit; for example, they can be the first to refer their patients to a tobacco cessation programme. • They can motivate their patients who are smokers to quit by showing them the harmful effects of tobacco on the mouth. The global health community agrees one should consider every day as a World No Tobacco Day. By understanding and raising awareness about the harmful effects of tobacco use on oral health and overall health, patients and practitioners can work together to help minimize the tobacco use worldwide. #WorldNoTobaccoDay: FDI highlights the role of practitioners in fight for tobacco control (Image : https://www.fdiworlddental.org) Ad Editorial: Can we rebuild the lost enamel? We knew since the beginning that once the enamel is lost, it is lost forever because it cannot regenerate naturally. However, this could change in the future, all thanks to Professor Janet Moradian-Oldak, Herman Ostrow School of Dentistry. She works out of the Center for Craniofacial Molecular Biology, University of Southern California. Moradian-Oldak has been working on a unique hydrogel based on the chitosan- amelogenin peptide, which can promote the growth of an enamel-like surface on teeth and also remineralize the dentin. Many might question the need to go for an expensive modality like peptides when we already have Fluoride as a cheaper and easier way to strengthen the tooth surface. The answer lies in the limitation of Fluoride, which basically creates calcium-phosphate patches on the tooth surface, sealing the dentinal tubules. This is more about blocking the nerve rather than rebuilding the enamel. Peptides, on the other hand, painted on a tooth surface that is affected by early caries, erosion and in hypersensitivity situations would rebuild the enamel in a biomimetic or life- like fashion. Moradian-Oldak has received three grants for this research. The first grant will help her test the amelogenin-derived peptides in the hydrogel form. The second grant, to understand the structural biology of enamel. The third grant will help her team to explore chemistry and develop newer strategies to synthesize a restorative material that behaves similar to enamel. This brings us to a critical question - Will this innovation reduce the dentist‘s role? Will this research affect the restorative jobs in dentistry? The answer is No. Patients would still need to visit the dentist. The peptides will only prevent deep decay when applied in the early stages of caries, and rebuild the lost enamel naturally. We wish Moradian-Oldak and her team all the luck in this research, and wish to see the peptide product soon in the market for clinical application in patients. Hope you like all the articles published in this issue. Happy reading. Dr. Rajeev Chitguppi Executive Editor, Dental Tribune (South Asia) LifeCare Devices Private Limited210 Udyog Mandir 1, 7-C Bhagoji Keer Marg, Mahim West, Mumbai – 400 016.Phone: +91 22 6146 4725 / 27 | E-mail email@example.comYour distributor:INDICATIONS:► Oral surgery► Implantology► Plastic surgery► Bone grafts► Sinus lifts► Wound closure► Soft tissue surgery► Socket preservation► Regenerative medicine► Dermatology► Orthopedics► AestheticsDuo Quattro Centrifuge‘’Strictly physiologic!and6 Protocols:Position 1: A-PRF + : 1300 rpm / 14 min Position 2 : i-PRF : 700 rpm / 3 minPosition 3 : i-PRF M : 700 rpm / 4 minPosition 4 : i-PRF + : 700 rpm / 5 minPosition 5 : A-PRF Liquid : 1300 rpm / 5 minPosition 6 : Custom : 1300 rpm / 3 minPosition 7 : Manual : Free settings+tubes(Red) 10ml To Obtain: - PRF Clots - PRF Membranes - PRF Plugstubes(Purple / Lavindine) 13mlFor injectable PRF, only for:- Aesthetics- OrthopaedicsBlood CollectorsBlood collectors are used to draw blood.tubes(Green) 10mlFor Liquid PRF, for:- Sticky Bone- Large Membranes- Intra oral Injections(Pre-Op. Flap Injection / Papilla / TMG / Endo)S-« PRF Box » allow you to get the membranes always hydrated and of constant thickness, but also to recover the exsudate rich in proteins: Vitronectin and Fibronectin. You can also produce ‘‘plugs’’ of PRF.PRF box with a crusher in Teflon, with compartments of differentsizes to easily create large membranes and sticky bone.
3 News 6/19 New explanation for the genetic mechanism that triggers cleft lip and palate several thousand locations in our genome in this way,” said co- author Dr Julia Welzenbach from the University of Bonn. “Among them are 17 which, as we already know from large genetic studies, are involved in the formation of scissures and a large number of other regions whose involvement was previously unknown.” The observation that TP63 activates a large number of regions shows the importance of this gene in humans. A mutation that affects its function severely, would automatically affect a large number of organs as well. This was the reason why TP63 was originally associated with only the syndromic form of cleft lip and palate. “In the case of the non-syndromic form, however, its disturbing activity is limited to developing facial cells,” said Ludwig. The newly established cell system provides a tool that enables the researchers to investigate this disorder in greater detail and identify its biological causes. “For example, we could test the effect of different environmental factors on TP63 activity in facial cells,” stated Ludwig. Environmental influences are known to increase the risk Oral clefts occur in about one in 700 live births worldwide, but researchers have only recently learnt how this process works. (Photograph: King97tut/ Wikimedia Commons) of facial malformation. Scientists can apply such tests to families that are known to have a genetic predisposition and provide them with recommendations for better individual prophylaxis. The titled study, “p63 establishes epithelial enhancers at critical craniofacial development genes”, was published in the May 2019 issue of Science Advances. Ad by Dental Tribune International BONN, Germany/ PHILADELPHIA, US: For long it has been known that the TP63 gene can contribute to the development of cleft lip and palate, but the exact process has been unclear. A recent joint study by the universities of Bonn and Pennsylvania has clarified this mechanism of action. About one in 500 births in Europe and one is 700 births worldwide are known to be affected by cleft lip and palate. They occur due to a developmental anomaly that appears in the early weeks of embryonic development, which causes parts of the face or palate remain unfused. For quite some time, it has been known that mutations of TP63 gene can trigger the severe forms of cleft lip and palate. Clinically, the features are not only limited to the formation of gaps in the facial area, but also involve the malformations of the extremities and diseases in the skin, hair and tooth area. Generally whenever such features are combined together, a term known as ‘syndrome’ is assigned to the overall condition. Originally TP63 was thought to be playing a role only in the development of this „syndromal“ form of the cleft lip and palate. However, in the last two years, there are increasing indications to suggest that this is not true. Dr. Kerstin Ludwig from the Institute of Human Genetics of the University Hospital Bonn says „In our work, we were able to show for the first time that TP63 is indeed a link between the syndromal and the isolated form, and how it intervenes in facial development.“ This study international collaborative involved researchers from the University of Pennsylvania, who were able to „program“ human cells in culture into facial cells. This facilitated the evaluation of the effect of TP63 gene on this particular cell type. This data was then blended with genetic data of large patient cohorts by the Bonn researchers. „We were able to show that TP63 increases the activity of a whole series of genes that play a role in the development of isolated forms of cleft lip and palate,“ says Ludwig. is a complex of DNA and various proteins present inside the cell nucleus. It is a long thread bundled into a compact ball. TP63 attaches to this chromatin thread and loosens the compact ball, which along with other modifications, causes a particular gene in this region to be read more frequently. current regulates to TP63 knowledge, “According Chromatin
3 News 6/19 Review study compares machined and sandblasted dental implant surfaces by Dental Tribune International of to degree BUDAPEST, Hungary: Earlier studies have shown that surface roughness is plays a critical role influence the biological integration and success rates of dental implants. In recent times, the focus has shifted from machined to sandblasted surfaces. However, clinicians have been still looking for strong scientific evidence that supports the use of sandblasted implants over machined ones in clinical practice. Looking at this need, the team of researchers from Semmelweis University in Budapest, carried out a comparative evaluation of implant failure and marginal bone loss between the two types of surfaces. the roughness Ever since it emerged that surface greatly influences the degree of biological integration and success rates of dental implants, various surface modifications such as sandblasting, acid-etching, anodization, plasma-spraying, coating with different bioactive surfaces and the combination of these have come into practice. be introduced, Among all these methods, sandblasting was the earliest to during which, ceramic particles such as titanium oxide, aluminium oxide or silica are blasted on to the implant surface. Two factors - the sand particle size and the speed with which they hit the implant surface – play a key role in influencing the implant surface roughness. Compared to the machined implants that have smoother surfaces with shallow grooves, the sandblasted ones demonstrate rough surfaces. irregular, Studies have shown different results while demonstrating effects of the sandblasting on osseointegration, While several in vitro studies have positive demonstrated effects on osseointegration, some preclinical and clinical studies have shown that moderately rough surfaces may not perform better. sandblasting the of A recent study showed that there is a difference in the survival rates between sandblasted and machined surfaces of dental implants. (Photograph: volodymyr007 /Pixabay) These studies bring in a newer perspective to osseointegration by shifting the focus to the formation of biofilm. They suggest that a rougher surface may influence the process of biofilm formation, making it easier for the bacteria to attach to the implant surface. The bacterial biofilm renders implants vulnerable to peri-implantitis, resulting in marginal bone loss around the rough surfaces. the current seven 362 The systematic study was a review, which included studies, comparing sandblasted surfaces with 360 machined ones. The results showed that after one year of use, the risk of failure among sandblasted surfaces was 80 per cent lower when compared to machined implants. When the effect of sandblasting was evaluated after five years, the risk of failure was 74 per cent lower in the sandblasted implant surfaces. However, when marginal bone loss was assessed, there was no significant difference between the two implant surfaces after one and five years of use. in The researchers concluded: “This meta-analysis reveals that sandblasting is superior over machined surface implant failure but not in marginal bone level in healthy subjects. It also points out the need for further randomised clinical trials with large sample size for objective the clinical determination of benefits of certain implant surface modifications.” The study was conducted in collaboration with the University of Pécs and the University of Szeged, both in Hungary. The study, titled “Sandblasting reduces dental implant failure rate but not marginal bone level loss: A systematic review and meta-analysis”, was published online on 3 May 2019 in PLOS ONE. Ad Relax your patients and make them feel more comfortable during dental procedures Matrx Nitrous Oxide and Oxygen Conscious Sedation Systems There are many good reasons to use nitrous oxide sedation in your dental practice: • Safe - N2O/O2 has been used globally for over 100 years • Relieves patient anxiety and discomfort • Patients remain awake, yet more relaxed, making it an excellent patient management tool • Improves patient experience, resulting in return visits Matrx is made in the USA 210 Udyog Mandir 1 7-C Bhagoji Keer Road Mahim West, Mumbai 400016 India Phone: +91 22 61 46 47 48 Email: firstname.lastname@example.org www.lifecare.in
6 Clinical 6/19 Allogenic stem cells – a faster and cheaper method to treat periodontitis Researchers in Japan have developed a new method to treat periodontitis that they believe will be faster, cheaper and more effective than anything available today. (Photograph: DRosenbach/Wikipedia) and as such it explores the potential use of allogeneic MSCs for tissue regeneration. The study is a powerful first step towards further development of stem cell- based therapy for the treatment of periodontal disease,” he added. The study, titled “Periodontal regeneration allogeneic transplantation of adipose tissue derived multi-lineage progenitor by stem cells in vivo”, was published on 29 January 2019 in Scientific Reports. Ad by Dental Tribune Asia Pacific SENDAI, Japan: Periodontitis is a common oral disease that affects the oral health of many people with serious effects. A new research from Japan proposes a novel cell-based regenerative approach, which promises to address & overcome some of the shortcomings and limitations of the regenerative therapies, currently being used for the treatment of periodontitis. Various treatment approaches, such as guided tissue regeneration (GTR), platelet-rich plasma (PRP), and enamel matrix derivatives (EMD), have been in use for long with success rates that are variable in their ability to regenerate the lost periodontal tissues. A variety of recombinant human cytokines too have been investigated for their ability to stimulate the regeneration of periodontal tissues. However, the above-mentioned regenerative therapies have shown predictable outcomes only in the three- wall periodontal defects. They still remain unpredictable in advanced periodontal defects, where the resident progenitor cells are reduced or destroyed. that works on Therefore, in order to improve the outcomes and predictability of these regenerative therapies, one should focus on stem cell biology the differentiation of stem cells into PDL, cementum and alveolar bone. For these reasons, the use of stem cell therapy combined with tissue engineering principles has become the focus of research in periodontal regeneration therapies. Although cell-based therapy using autologous stem cells has been a preferred strategy for the regeneration of periodontal tissues in severe defects, it has its own limitations, to overcome which, the use of allogeneic stem cells has been considered as an alternative strategy for the regeneration of large periodontal defects. In this study, conducted in collaboration with researchers from Osaka University in Osaka and Fujita Health University in Toyoake, the researchers from Tohoku University in Sendai took stem cells from the adipose tissue of healthy mini pigs and transplanted them into those that had periodontal defects. The mini pig periodontal defect model showed that allogeneic adipose-derived mesenchymal progenitor stem cells (ADMPCs) are safe and effective for the treatment of periodontitis. The researchers believe that this new approach involving the allogenic stem cell therapy will be faster and cheaper. “The use of cell-based therapies is a promising approach to treat human disease. This kind of treatment paradigm is important because commercially available stem cells that represent a cell- based specifically developed to treat periodontal tissue regeneration will reduce time and cost while improving quality assurance,” said lead author Prof. Masahiro Saito, from the Department of Restorative Dentistry at Tohoku University Graduate School of Dentistry. therapy “Our study demonstrates that ADMPCs appear to be safe and not triggering an immune response in allogeneic settings,
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