DENTAL TRIBUNE The World’s Dental Newspaper · South Asia Edition Published in India www.dental-tribune.in 9/19 Dental implant Study revisits early & late dental implant failures & compares various implant removal technique Dr Udatta Kher “Partial Extraction Therapy (PET) will become the default technique in the future.” Dr Udatta Kher Causal link Genetic study suggests a causal link between dental caries and cardiovascular- metabolic factors ” Page 03 ” Page 02 Unica Anterior Developing tight proximal contacts in anterior teeth using Unica Anterior matrix – A case report ” Page 05 ” Page 06 Padma Shri Dr Mahesh Verma appointed as the new VC of Guru Gobind Singh Indraprastha University by Dental Tribune South Asia serving as Padma Shri and B. C. Roy awardee Dr Mahesh Verma, who was the Director-Principal of Maulana Azad Institute of Dental Sciences, New Delhi, has been announced as the new Vice- Chancellor of Guru Gobind Singh Indraprastha University in a notification (GGSIPU), released by the Secretary, Higher Education, Delhi government. The higher education department of Delhi Government has appointed Dr Mahesh Verma, an eminent academician, researcher, as the new VC of Guru Gobind administrator for Singh Indraprastha University (GGSIPU) the next five years. Before this appointment, Dr Mahesh Verma served as the director of Maulana Azad Medical Institute of Dental Sciences (MAIDS). from Dr Verma has received the State Award the Government of Delhi in 2001, the B. C. Roy Award in 2007, and the civilian award of Padma Shri in 2014, when he was included in the Republic Day honours. He is also a fellow of the Royal College of Surgeons & Physicians, Glasgow; Fellow, Royal College of Surgeons, England; Fellow, Royal College of Surgeons, Edinburgh; Fellow, International College of Oral Implantologist; Dr Mahesh Verma Has been appointed as the new VC of Guru Gobind Singh Indraprastha UniversityDigital Dentistry and an honorary member of the American Dental Association. as While Dr Verma will focus on the development of infrastructure, multidisciplinary research, ensuring student and employee welfare— once he takes over as the VC of the university which has over 128 colleges. serving the Director-Principal of Maulana Azad Institute of Dental Sciences (MAIDS), the dental wing of Maulana Azad Medical College, New Delhi, Dr Verma helped MAIDS evolve from a dental school of meagre proportions into a Centre of Excellence with a daily count of over 1200 inpatients. An Outlook - Marketing and Development Research Associates (MDRA) survey of premier Indian dental schools placed MAIDS as the best dental school in India. As (WHO) a World Health Organization fellow, Dr Verma is involved in WHO social and community projects as well as institutional projects of the Council of Scientific and Industrial Research (CSIR), Indian Council of Medical Research (ICMR). One of his projects is the development of indigenous dental implants involving Indian Institute of Technology and the CSIR, funded by the Ministry of Science and Technology. Relax your patients and make them feel more comfortable during dental procedures Ad 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
2 News 9/19 Study revisits early & late dental implant failures & compares various implant removal techniques by Dental Tribune International evidence ZURICH, replace missing Switzerland: has Clinical established dental implants as a great treatment option to teeth. However, even with the high success rates reported, like in every medical technique, there are possibilities of biological complications that may lead to implant failure, necessitating the removal of the implant. A recent study by the University of Zurich has revisited the reasons for implant failure and compared different techniques used for implant removal. A literature search identified 28 studies, conducted up to 2018, that had assessed implant failures, removal techniques and the reinsertion of implants in a previously failed site. The researchers classified the factors for implant failures into different categories. Peri- implantitis and inability to attain or maintain osseointegration were included under biological factors. Mechanical factors included implant fractures. Bone overheating, site contamination and malpositioning etc. were grouped under iatrogenic errors. Prosthesis design and functional overload were categorised as functional reasons. The study failure showed implant that an early is typically caused by deficient osseointegration - either the lack of attaining it or maintaining it, or by bone overheating or site contamination. Late implant failures are caused by implant fractures, malpositioned implants and progressive peri- implantitis. To date, peri implantitis remains the main reason for late implant failures implant failure (81.9%). Early results that are generally mobile and easy to implant failure remove. Late implants in means the implants can be at least partially osseointegrated in the apical region. Most late failing implants are not mobile and, therefore, are more difficult to remove. the For implant piezo-surgery, removal techniques, the study compared tooth extraction set, trephine burs, laser surgery, counter-torque ratchet technique (CTRT) and electrosurgery. The study found trephine burs to be the best- known method implant removal. However, the study recommended that the CTRT method, alone or combined, should be the first choice for the removal of implants because of its low invasiveness. for the survival implants placed Furthermore, the researchers rates studied of the previously failed sites, which was, irrespective of early or late failure, in the range of 71–100% over five years. in A recent study has shown peri-implantitis to be the main reason for dental implant failure. (Photograph: Kasama Kanpittaya/Shutterstock) Little data is zirconia available regarding implant removal. The unique physical properties of Zirconia make it necessary to use a different approach for the removal of zirconia implants as compared to titanium implants. is required, interventions should be based regarding on minimally access and management as well as considerations invasive removal “If healing. (Post) predictable Operative considerations should primarily depend on the defect type and the consecutive implantation plans,” concluded the authors in their paper. The study, titled “Removal of failed dental implants revisited: Questions and answers”, was published online in Clinical and Experimental Dental Research on 21 August 2019, ahead of inclusion in an issue. Ad Ad THE FIRST AND UNIQUE DENTAL IMPLANT IN THE WORLD MANUFACTURED THROUGH DIRECT LASER METAL FORMING TECHNIQUE BY MICROFUSION OF TITANIUM PARTICLES SURFACE l SPONGY l TRIDIMENSIONAL l ISOELASTIC CAVITIES l INTERCONNECTED l 2-200 µm Cleared! ACTIVE POROUS SURFACE l THICKNESS TO 250 µm l DESIGNED TO PROMOTE BONE GROWTH MORE THAN 15 YEARS OF EXPERIENCE BY DOCTORS ALL AROUND THE WORLD OVER 250.000 UNITS SOLD WORLDWIDE References available upon request ONE STEP BEYOND LifeCare Devices Private Limited 210 Udyog Mandir 1, 2nd Floor, 7-C Bhagoji Keer Marg, Mahim West, Mumbai - 400 016 Phone: +91 22 6146 4725 / 27 E-mail: email@example.com
3 News 9/19 “Partial Extraction Therapy (PET) will become the default technique in the future.” Dr Udatta Kher 4. How did your journey of Partial Extraction Therapy (PET), and more specifically, Socket Shield (SS) begin? I was introduced to the socket shield procedure by my dear friend Dr T.V.Narayan in 2013. It sounded absurd to me back then. I was truly inspired by the cases presented by Maurice Salama and Jorge Campos Aliaga on Dental XP and that led me to learn more about the procedure. I was astonished at the beautiful outcome of my very first case of socket shield. I waited for 1 year to see the follow-up before I performed the procedure again and I haven’t looked back! I am so convinced in my mind that the Partial Extraction Therapy/ Socket shield will become the default technique of placing implants in the future. 5. You were a part of the 1st international PET consensus #JTI2017 in Madrid? Can you share a few insights about the consensus meeting? The first PET consensus saw a group of like-minded clinicians who were early adopters, getting together to brainstorm about indications the technique, and nuances of the socket shield procedure. Clinicians like Maurice Salama, Howard Gluckman, Micheal Pikos, Mitsias Miltiadis, Snjezana Pohl and others were a part of this unique event. I am privileged to be a part of the PET research group which will assemble again in 2020 for the next PET consensus meeting. The objective will be to provide more specific guidelines for case selection, design of the shield, and management of complications. The interest in the field has grown exponentially and there is a need for clinicians to share their experiences. 6. What‘s your take on socket grafting? How many of your socket grafted cases need In this interview Dr Udatta Kher provides answers to all the clinically relevant topics in implantology. by Rajeev Chitguppi, Dental Tribune South Asia Dr Udatta Kher has made significant contributions to the field of implant dentistry. He has developed a wealth of clinical evidence on Socket Shield. He has also developed MITSA - an innovative technique that has simplified the sinus lift procedure and made it user- friendly for the beginners. He is a well-known educator in implant dentistry, providing quality training through his academy ‚Impart Education.‘ In this interview, Dr Udatta Kher provides answers to all the clinically relevant topics in implantology. Dr Udatta Kher graduated from Govt. Dental College and Hospital, Mumbai in 1991 and completed his post-graduation in Oral Surgery from the same institute in 1995. He practices in Mumbai and specializes in Implant Dentistry. He is the Director of ‘Impart Education’ an academy for training dentists in the field of Implant Dentistry and Full Mouth Rehabilitation. Dr Udatta is an Xpert on Dental XP, the largest portal in the world for Continuing Dental Education. He is also a registered ITI speaker. He is the Consultant Oral Surgeon and Implantologist to the Hon Governor of Maharashtra. He has the unique distinction of having lectured in all the continents of the world in the field of Oral Implantology. An avid traveller, trekker, and photographer, Dr Udatta knows how to maintain work-life balance. He can be contacted at www.drkher.com to prevent recommend implants 1. For the esthetic areas, ITI guidelines that immediate should be reserved only for the ‚most ideal‘ cases the buccal tissue loss. Else, one should simply go for an‚ early‘ placement. We know that you have been a strong proponent of‚ So, nowadays, how many of your anterior implant esthetic cases, percentage-wise, go for socket shield vs immediate implants vs early implants? Shield.‘ Socket Adjacent socket shields in esthetic zone The socket shield technique is the only procedure that can prevent the inevitable labial bone loss after extractions of teeth. In my practice, I perform a socket shield procedure for every tooth indicated for an extraction in the esthetic zone, provided the labial plate is intact. In case the preoperative scan shows an absence of the labial bone, I choose the ‘Early Implant Placement’ strategy as per the ITI guidelines. I see very few indications for the conventional extraction and Dual Zone Grafting protocol in my practice. 2. What were the challenges you faced in your early days of implantology regarding implant placement and restoration in the anterior esthetic zone? a The biggest challenge I used to face, was getting an esthetic restoration from the laboratory. It was frustrating to build up peri-implant tissue, and still end up with an unaesthetic outcome because of sub-standard restoration. Over the years the lab work in India has improved to such an extent that it matches the highest international standards. It was also disappointing to see the results of some of the grafting procedures I performed in the initial days of my practice. Also, I didn’t pay much attention to building soft tissue around implants in the esthetic zone due to which I landed up with unsatisfactory results. 3. A lot of youngsters seek your advice. What‘s the most common mistake that you see in the implants restored in the esthetic zone nowadays? If there is one single important piece of advice you wish to give the youngsters regarding implants in the esthetic zone, what would that be? The team of clinicians at #JTI2017 - 1st PET consensus, Madrid. If is, there is one key to success in the esthetic zone, it is the ‘3-D implant positioning’. Most errors in the aesthetic zone occur due to malposed implants. Hence my advice for youngsters irrespective of what surgical procedure is being executed, like post-extraction immediate placement, socket shield procedure, ridge-split procedure, ridge expansion of conventional placement, the ideal prosthetically-driven implant placement is sacrosanct.
4 News grafting again at the time of implant placement? routinely I do not perform socket grafting in my practice. Actually, I am against the procedure because of its inconsistencies. There is no assurance of volume maintenance after socket grafting and very often there is a need for a second round of grafting during implant placement. My preference is to enter the site early at 6-8 weeks post-extraction the collapse has set in and perform the grafting at the time of implant placement. The only 2 occasions that I have performed a socket grafting procedure in my practice is on adolescent patients for whom an implant placement had to be delayed. before 7. Coming to sinus lift, Invasive the Minimally Sinus Transcrestal Augmentation technique, popularly known as MITSA, is a great technique developed by you. People feel it‘s a real game- changer. How did you come up with this technique? How many of your own sinus lift cases have moved from the lateral window approach to MITSA? Something close to my heart. I chanced upon the technique when I discovered that the 3mm diameter an osteotome coincides with the diameter of the Novabone (Calcium Phosphosilicate) cartridge nozzle. The hydraulic pressure exerted by the viscous putty provided the right amount of sinus elevation through a minimally crestal approach. invasive The original technique was developed for the osteotome, but over the years it has been used with crestal drills and Densah drills. However, I feel for a country like India, where the cost of equipment and drills is prohibitive, the original osteotome technique still has a place in many practices. It is the most economical and effective technique of doing a crestal sinus grafting. In my practice, any case with a residual bone height of over 2.5mm is managed with the MITSA protocol. Hence the number of lateral window sinus lifts has dropped drastically. 8. Where do you see a place for cortical - basal implants? where I see a place for this treatment modality is highly resorbed jaws conventional treatment modalities are not easily possible without extensive grafting. However, the prosthetic management of the cases is to sharing clinical work and ideas, with a large population across the globe. It is a great tool to inspire young clinicians improve their knowledge and clinical work. Needless to say, it does not substitute the need for attending continuing education programs to upgrade one‘s skillsets. It acts as an adjunct to old and time tested methods of learning. Never before have we seen so many wonderful clinicians from India, showcasing their work on an international platform. I believe social media has a big role to play in this transition. 11. What‘s your take on mushrooming of academies and courses in dentistry and Implantology? I see that as a healthy sign of progress. Every aspiring educator needs to sharpen his/ her skills if he/she has to start teaching. As more clinicians choose to share their knowledge and start teaching, they need to enhance their own skills if they are to remain relevant. This has a positive impact on the number of clinicians who rise above the rest and inspire others to do excel in their craft. There will always be a few academies and courses which are below par. But the clinician is smart enough 9/19 to recognise that, due to social media exposure. Such academies and courses will cease to exist very soon. 12. What are your new areas of interest that you are working upon currently? Prosthodontics I am currently working on techniques for simplifying Implant for clinicians. That has remained a challenge for many practices. The Fast Tracking technique that we recently published in The Compendium is an example. There are a few more concepts in the pipeline. I am also working on some protocols to amalgamate MITSA and Densah. Since the osteotome is not a very elegant tool for surgeries, clinicians have moved towards drills for improving the patient experience. I am working at further refining those protocols. Also in the pipeline are some publications on PET. This is a golden era for Implant dentistry in India and I feel privileged to be a part of these exciting times! Ad way below what we see in conventional implant dentistry. For that reason, I don’t fancy that option in my practice. However, for like post-cancer resections and reconstructions, this can be a good tool to improve the quality of life for patients. cases 9. What is your take on All-on-4 and All-on-6? indications. Very good options for the I routinely right perform All-on-4 procedures for geriatric patients who are edentulous. In patients who are rendered edentulous at a younger age, I opt for the All-on-6 option. In very young patients, I prefer to graft and place more implants to provide a long term solution. So the decision for me based on the age of the patient. and functional needs. However, I am very selective while performing immediate full arches. Many of these cases receive loading protocols conventional loading for 10. What‘s your take on social media dentistry? How is it influencing the dental practitioners? In my opinion, it is the best thing that has happened to Indian dentistry. I am a big proponent of social media as a means of Ad NOW OFFERING SPECIAL 20% DISCOUNT Belmont leads the way with totally new generation of dental treatment centre. (*Exclusive of Taxes. Terms and Conditions apply.) Exclusive Distributor in India: LifeCare Devices Private Limited T: (022) 6146 4725, 6146 4727. E: firstname.lastname@example.org l Mumbai l Delhi l Bangalore l Kolkatta l Chennai l Pune l Ahmedabad l Madurai l Hyderabad l Chandigarh l Lucknow l Jaipur l Vijayawada
6 Clinical 9/19 Developing tight proximal contacts in anterior teeth using Unica Anterior matrix – A case report characterisation of the adjacent tooth. The final enamel layer was contoured to match the mesial transitional line angle of 21 using a Mylar Pull Through method against the cured mesial wall with good contact already established with the Unica. Finishing was carried out with finishing discs (Shofu Snap-on Discs) and Soflex Spirals (3M ESPE). Polishing was done with Prisma Gloss polishing paste (Dentsply) and a rubber. Conclusion: With their excellent aesthetic and mechanical properties, composite resins have emerged as the most minimally invasive alternatives to restoring anterior teeth. It is now possible to achieve life-like restorations, which are also extremely biomimetic. Establishing good contacts and contours in the anterior region is of paramount importance not just from an aesthetic but also a functional point of view. Understanding the limitations of the material in every situation and adapting newer techniques should be our focus to make our restorations more predictable and durable. References 1. S h e r w o o d IA, Rathakrishnan M, Savadamaoorthi KS, Bhargavi P, Vignesh Kumar V. Modified putty index matrix technique with mylar strip and a new classification selecting the type of matrix in anterior proximal/incisal composite restorations. Clin Case Rep. 2017;5(7):1141-1146. Published 2017 Jun 1. doi:10.1002/ccr3.1006 for 2. Ayush Goyal, Vineeta Nikhil, and Ritu Singh, “Diastema Closure in Anterior Teeth Using a Posterior Matrix,” Case Reports in Dentistry, vol. 2016, Article ID 2538526, 6 pages, 2016. https:// doi.org/10.1155/2016/2538526. 3. Fellippe L. A., Monteiro S. Jr, De Andrada C. A., Di Cerqueira A. D., and Ritter A. V.. 2005. Clinical strategies for success in proximo-incisal restorations. Part composite II. application technique. J. Esthet. Restor. Dent. 17:11–21. [PubMed] Composite 4. Manauta J, Salat A . LAYERS An atlas of composite resin stratification. Quintessence books 2012 Developing tight proximal contacts in anterior teeth using Unica Anterior matrix – A case report (Dr. Nisha Deshpande) by Dr Nisha Deshpande, Dental Tribune South Asia This article is a case report of a direct composite restoration of a fractured central incisor where the proximal contact was developed using the Unica Anterior Matrix. Composites are one of the most widely used materials for the restoration of anterior teeth defects. Modern composites, with their excellent physical and optical properties combined with newer generations of bonding agents, provide clinicians with the ability to deliver predictable lifelike biomimetic restorations. When finished and polished well using the correct protocol, these restorations can survive for a long time in the patient‘s mouth, eliminating or at least reducing the need for more expensive and indirect restorations. lab- dependent Even though the handling characteristics of modern composites are far superior, one of the major problems faced by the clinician while restoring anterior teeth is the development of good interproximal contacts and contours. Matrix application is a critical step in achieving this objective in anterior composite restorations. Matrix systems used in the anterior region can be broadly classified into flexible and rigid. Flexible matrices include the popular transparent mylar strip and soft splint templates, and the rigid matrices include putty index matrix and pre-contoured sectional matrix (posterior). of The Mylar strip can be used with a pull-through method in cases where the adjacent tooth has a flat contact area. The disadvantage this matrix, when used alone, is its flexibility making it challenging to contour large areas leading to irregular contours and contacts. Posterior contoured sectional matrices have often been used for this purpose but have their limitations when restoring teeth where the adjacent tooth has a flat contact area. Another problem commonly faced is the stabilisation of the matrix when restoring adjacent lesions. It also becomes cumbersome to restore multiple surfaces of the same tooth and multiple adjacent lesions as it is extremely time- consuming. In cases where a Class V cervical defect also needs to be addressed, none of these matrices can be adequately used. these limitations, the Style Italiano group has developed a new matrix for anterior teeth called the Unica Anterior. overcome all To developed Unica is a simple matrix specifically for anterior restorations such as class III, IV, V, direct stratification composite veneers, and shape modifications. The placement wings allow the operator to place and adapt the matrix quickly and efficiently. Its contoured shape and adapts correctly to the different morphologies of anterior teeth and makes it possible to restore interproximal cervical margins at once, even in the presence of rubber-dam or gingival retraction cords, thus reducing chair-time significantly. Furthermore, Unica anterior matrix, once positioned, allows visualising the final shape of the restoration easily. This article is a case report of a direct composite restoration of a fractured central incisor where the proximal contact was developed using the Unica Anterior Matrix. Case Report A 32-year-old man walks into our dental office with the chief complain of a broken front tooth. On examination, a Class IV fracture is seen involving the enamel and dentin of 11. The IOPA did not show any significant findings, and the tooth reacted positively to vitality testing. It was decided to restore the tooth with Direct Composite Resin. Preoperative photographic records were taken. Small buttons of different shades (dentin, body and enamel shades of A1 and A2) of composite resin were placed on the adjacent teeth and photographs were taken with different settings to ascertain the correct value and chroma of the material to be used (button technique). Rubber dam isolation with floss tie ligature was carried for the out to provide absolute isolation required bonding protocol. A 2mm wide bevel was given with a diamond point and finished with finishing discs involving the enamel and dentin on the buccal surface of the fractured tooth. The palatal portion of the fracture line was only smoothened to remove any overhanging enamel. The tooth was etched with 37% Phosphoric Acid (D tech) for 20 seconds. After thorough rinsing with water and light air- drying, two coats of Universal Bonding Agent (Single Bond Universal, 3M ESPE) was applied, air thinned and photocured for 20 seconds. Palatal shell was made with A2 Enamel (Filtek Z350XT) using a mylar strip and index finger held palatally for support. At this stage, the Unica Anterior Matrix (Polydentia) was adapted and secured by pulling the palatal wings and placing an interdental wedge. A2 Enamel was then applied and compacted against the matrix mesially to form the mesial surface of the restoration. Once we have an adequate ‘box’ with tight interproximal contact, it becomes relatively easy to finish the final layering. In this case, A2 Dentin, A2 Body, and A2 Enamel shades were used to complete the restoration. White opaque tints were also added before the final enamel layer to mirror the white spot
7 Clinical 9/19 Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 Fig 6 Fig 7 Fig 8 Fig 9 Fig 10 Fig 11 Fig 12 Fig 13 Author: Dr Nisha Deshpande ZDr Nisha Deshpande graduated from Government Dental College and Hospital, in 2007. She was Mumbai the the Vice- Chancellor‘s Gold Medal for scoring highest marks in her recipient of Sciences final BDS examination from Maharashtra University of Health (MUHS) having topped the University in 2006. She has received the Post Graduate Certificate in Aesthetic Dentistry from State University of New York at Buffalo, USA in 2011. She is a member of the European Society of Cosmetic Dentistry (ESCD) Indian Academy of Aesthetic and Cosmetic Dentistry (IAACD). and the She is currently pursuing the International Certification In Aesthetic and Restorative Dentistry from Egas Moniz University, Caparica, Portugal. She contacted at email@example.com. can be Ad PRINT EVENTS EDUCATION DIGITAL SERVICES Dental Tribune International The World's Dental Marketplace www.dental-tribune.com
7 News 7/19 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 firstname.lastname@example.orgYour 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.