DENTAL TRIBUNE The World’s Dental Newspaper · South Asia Edition Published in India Childhood Dental New study suggests fillings may not be best treatment for childhood dental caries ” Page 03 Patient Complaint Researchers from the University of Toronto conduct the largest patient complaint study to date www.dental-tribune.in 12/19 Treatment of Periodontitis Perio Workshop 2019, Spain develops new guidelines for the treatment of periodontitis Salivary Cytokines Prolged consumption of caffeine, alcohol, and tobacco alters the levels of salivary cytokines. ” Page 04 ” Page 05 ” Page 07 “Plastic periodontal surgery has evolved a lot in the last decade.” – Markus Hürzeler / Otto Zuhr by Rajeev Chitguppi, Dental Tribune South Asia the lifespan of microsurgical instruments – How often does one need to change it? to Prof. Dr Markus Hürzeler and Dr Otto Zuhr, popularly known as Hürzeler/ Zuhr, have taken clinical excellence, research education, and in implantology periodontics, and microsurgeries a different level. The Hürzeler/ Zuhr academy is one of the truly world-class centres for education and in dentistry. Drs Hürzeler/ Zuhr will answer the questions and share their expertise in this interview with three Perio- Implantologists from India - Drs Sudhindra Kulkarni, Neel Bhatavadekar, and Akshay Kumarswamy. training “Plastic periodontal surgery has evolved a lot in the last decade.“ - Markus Hürzeler / Otto Zuhr from Prof. Markus B. Hürzeler received his dental degree from the University of Zurich, his certificate as a specialist in Periodontics the Swiss Society of Periodontology, the Docent (Associate Professor) degree from the Department of Prosthodontics at Albert- Ludwigs University in Freiburg, Germany, and his certificate in Prosthodontics from the German Society of Prosthodontics. He is Clinical Associate Professor at the Albert-Ludwigs University of Freiburg, Department of the Operative Dentistry and and Clinical Periodontology Associate Professor the University of Texas in Houston, Texas. Dr Hürzeler has produced scientific more 100 publications within the field implants, periodontology of and tissue regeneration and regular national and is a international lecturer. He maintains a private practice focused on periodontics and than at implant dentistry in Munich, Germany. Dr Otto Zuhr studied dentistry at the University of Aachen from 1986 until 1992. After finishing his studies in 1992, he received his DMD from the Department of Oral and Maxillofacial Surgery in Aachen and started his work as a dentist in Munich. Several educational programs led him to Switzerland, Scandinavia and the USA during the following two years. In 1994 he started to work at the Institute of Periodontology and Implantology (IPI) with Drs. Bolz and Wachtel. In 1996 he opened his own office focusing on periodontal surgery and aesthetic dentistry in Munich. In 1999 he founded a new clinic together with Drs. Bolz, Wachtel, and became and Hürzeler an associate member in the Institute of Periodontology and Implantology (IPI) in Munich. In 2001 he received his Specialist in Periodontology of the German Society Periodontology of and (DGP). Otto Zuhr has written several articles in the field of periodontology and aesthetic dentistry lecturing nationally and internationally. In 2012 he published his book “Plastic-Esthetic Periodontal and Implant Surgery” with Quintessence. is Drs Huerzeler/ Zuhr will answer the questions and share their expertise in this interview with three Perio-Implantologists from India - Drs. Sudhindra Kulkarni, Neel Bhatavadekar, and Akshay Kumarswamy. Akshay Kumarswamy: Having pioneered microscopic periodontal plastic surgery (PPS), what according to you is the ideal magnification that one should start with to do periodontal plastic surgery? the The minimal magnification depends on instruments and suturing materials used. For the surgical set that we have developed and brought on the market, a 4.5 to 6 fold magnification would be ideal. Sudhindra Kulkarni: Does Connective Tissue Graft (CTG) function better as a pedicle graft or as a free graft? I don’t know. The additional primary blood supply of the pedicle might improve initial revascularization of the graft. If this is of clinical relevance is a matter of further research. Neel Bhatavadekar: What are your sutures of choice for for mucogingival surgeries? the flap suturing There is no suture of choice. Sutures can have different tasks and must consequently fulfil varying requirements. Whereas polypropylene is used in the vast majority of indications, needle lengths from 12 to 15 mm and threads from 6.0 to 8.0 are selected according to the clinical situation. Akshay According Kumarswamy: is to you, what this Provided that we are about high-quality talking instruments, is more a question of maintenance than a question of time - well- maintained instruments don’t need to be changed for many many years. Sudhindra Kulkarni: What is more critical - vertical soft tissue thickness or horizontal bulk of soft tissue in the periodontal or peri-implant soft tissue stability and function? It is probably not possible to give a general answer to this question. From a principle point of view, it becomes more and more evident that soft tissue thickness matters for the vertical soft tissue position and soft tissue stability. However, the thickness can counteract with quality-esthetic criteria of success and might be interpreted with caution having in mind that teeth, implants, pontics, etc.… create very different biological environments. than Neel Bhatavadekar: For procedures, tunnelling sometimes the time required may be higher for conventional split-thickness flaps. In this scenario, do you, in your clinical experience, see the long term benefit of tunnelling versus conventional split-thickness flaps in terms of % root coverage, or better esthetics? Yes, it is true. Tunnelling specific need procedures microsurgical instrumentation and take longer. Talking about research in gingival recession therapy, there doesn’t seem to be an advantage related to root
2 News coverage. The advantage can be found in the quality-esthetic outcomes. In principle, it is as simple as this: if there is no cut, there cannot be any visible scar tissue formation. From a broader scope, avoiding surface incision also results in maintaining the best possible vascularisation of the flaps. This might be important in particular in surgical sites with compromised blood supply like, for instance, around dental implants or in papilla areas. These advantages become more and more evident and are more and more addressed literature. in the Akshay Kumarswamy: For general dentists, who want to start learning esthetic Periodontal Plastic Surgery, which learning model would you suggest before taking the plunge on patients? in interventions I truly believe that successful these treatment outcomes are types of mainly dependent on a profound biological understanding combined with manual dexterity. Well established textbooks like for instance, the one from Jan Lindhe & Klaus Lang can be recommended to study the basic wound healing principles in the oral cavity. For manual skill development, any exercise can be recommended that brings the clinician to the limit of his or her existing manual abilities. To exercise specific surgical interventions, animal models like for instance pig jaws are til to this day very suitable. surgeries from 10 years ago, what would you change? Many, many things would be changed. Plastic periodontal surgery has evolved a lot in the last decade. The further development of incision-free flap elevation concepts combined with selected harvesting procedures for soft tissue autografts at the palate has coined up to date clinical conceptions in an incomparable way. Neel Bhatavadekar: If you had to redo your mucogingival 12/19 We have been working on the socket-shield technique for more than ten years now. We truly believe that before a new clinical procedure can fully be recommended, we need to have enough external evidence to support the new approach. Therefore, we are working for many years on creating the necessary data. Finally, we started our Randomized Controlled Trials about two years ago. The preliminary data look promising. Since the benefits for the patient are tremendously high, and there are clinical situations two (i.e. missing teeth beside each other in the esthetic zone) where we do not have concepts yet which allow a predictable outcome we decided to offer in the year 2020 our first master class on socket-shield- technique in our Huerzeler/Zuhr Academy. We think it is now time to discuss this new technique at a much greater depth. sincere gratitude We would like to extend our and appreciation to Drs. Sudhindra Kulkarni, Neel Bhatavadekar and Akshay Kumarswamy for interviewing Drs. Hürzeler/ Zuhr and adding a great value to this article. Sudhindra Kulkarni: Do you think PRF and its ilk have any significant role in improving soft tissue biotypes? There is no doubt that there is great potential in many indications. If LPRF will one day be actually able to replace soft tissue replacement grafts for soft tissue volume augmentation will most probably be dependent on finding carrier or stabilization materials. A thrilling field of research - we will see... suitable Editor‘s question: Although you were the earliest to come up with the Socket Shield technique, you didn‘t promote it as aggressively as others did. What‘s the reason? Are others missing out on something that you have observed and realized? Dr Sudhindra Kulkarni Dr Neel Bhatavadekar Dr Akshay Kumarswamy Dr Sudhindra Kulkarni (MDS, Periodontics). Fellow and Diplomate of International Congress of Oral Implantologists (ICOI, USA). Professor and Head, Department of Implantology at SDM Dental College, Dharwad. is Dr Neel Bhatavadekar (MS, Perio- US) the first U.S Board Certified Periodontist in India. First (International ITI Fellow for Team Implantology). Diplomate of American Board of Periodontology. He is a visiting faculty at Univ. of Texas Health Science Center (US), and Univ. of North Carolina at Chapel Hill (US). Dr Akshay Kumarswamy (BDS, CAGS, MS-Perio, USA ) is a Diplomate of the American Board of Periodontology and Diplomate of International Congress Oral Implantologists (ICOI). of 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: email@example.com www.lifecare.in
3 News 12/19 New study suggests fillings may not be best treatment for childhood dental caries by Dental Tribune International their usefulness LEEDS, UK: Though the role of dental fillings in the treatment of dental caries in permanent dentition is well established, the same cannot be said about primary dentition, as is still debatable. A new study has cast further doubt on their role, suggesting that there is no evidence that conventional fillings are more effective in stopping the progress of caries in children. The multicenter randomized controlled trial compared the clinical effectiveness of three treatment strategies for a length of over 3 years for managing dental caries in primary teeth. Participants aged 3 to 7 years with at least one primary molar with dentinal carious lesion were randomly allocated across the three treatment groups. This study the FiCTION (Filling Children’s Teeth: Indicated or Not) trial called continued to experience further caries and pain. level but “Our study shows that each way of treating decay worked to a similar that children who get tooth decay at a young age have a high chance of experiencing toothache and abscesses regardless of the way the dentist manages the decay,” said Prof. Nicola Innes, chair of paediatric dentistry at the University of Dundee School of Dentistry and lead author of the study. “What is absolutely clear from our trial is that the best way to manage tooth decay is not by drilling it out or sealing it in— it’s by preventing it in the first place,” Innes added. The study, titled “Child caries randomized management: A controlled dental in trial practice”, was published online on 26 November 2019 in the Journal of Dental Research, ahead of inclusion in an issue. Ad A new study has suggested that fillings are no more effective in preventing further caries and/or pain in children than other treatments are. (Image: Evgeniy Kalinovskiy/Shutterstock) studied 1,144 children residing in the UK by assigning each participant randomly to one of the three treatment options: the standard “drill and fill” approach, which involves drilling out the decayed tissue; a minimally invasive approach of sealing the caries under a metal crown or filling; and the avoidance of any fillings being placed while also emphasising a reduction in sugar intake and the necessity of taking greater care of the child’s oral health. The duration of the trial lasted up to three years for some children. On comparison, there were no significant differences in the outcomes between the three treatment groups. 450 participants reported that they PRINT EVENTS EDUCATION DIGITAL SERVICES Dental Tribune International The World's Dental Marketplace www.dental-tribune.com
4 News 12/19 Researchers from the University of Toronto conduct the largest patient complaint study to date by Dental Tribune International complaints TORONTO, Canada: A team of researchers from the University of Toronto have recently published the largest longitudinal study conducted on patient to date. The study analyzed the complaints made over a period of eleven years to the Royal College of Dental Surgeons of Ontario the regulatory and licensing body governing Ontario’s dentists and their standards of practice. The study has provided insights into perceptions surrounding oral health care professionals and their standards of care and highlighted the importance of high-quality clinical care and treatment. (RCDSO), The nurses team of researchers from the University of Toronto examined, over the course of nearly two years, about 2,199 out of 4,627 complaints submitted to the college. Since the majority of complaints originated with patients, the researchers also collected complaints from family members, dentists, hygienists, and pharmacists. sample “This is a unique study of its kind internationally,” said lead author Dr. Carlos Quiñonez, associate professor and director of the graduate program in dental public health in the Faculty of Dentistry at the University of Toronto. “People have conducted similar studies in hospital and other health care settings, using questionnaires patient and A recent study found that besides excellent clinical care and patient safety, communication and interpersonal skills are nearly equally integral to oral health care. (Image: Diego Cervo/Shutterstock) competency,” enough on communication, on relational said Quiñonez. “We can do better from the point of view of social competence in dentistry.” The study, titled Analyzing Complaints Made by the Public to the Royal College of Dental Surgeons of Ontario, was published by the RCDSO and the University of Toronto, Faculty of Dentistry. The article is available on the RCDSO website. Ad satisfaction surveys, or case files of regulatory findings once the regulator has weighed in. But no one has taken this volume of complaints to a regulator and quantified them,” he noted. complaints To maintain objectivity and avoid bias, the researchers piloted a framework that turned qualitative into quantitative data by coding them and then organizing them into various domains and subdomains. “One’s experience when so subjective, so how that translates into the letters themselves is very unique,” explained co- author Monika Roerig, research coordinator at the university. receiving care is The findings indicated that 59% of all complaints made to the RCDSO related to clinical care and treatment, and that 56% interpersonal conduct relationships and informed consent. Additionally, 42% of the complaints involved issues with management and access to care. and issues around involved some “I think this study really revealed valuable information from all members of the public,” Roerig said. “The study shows us that it’s important to have excellent clinical care and safety, but communication and interpersonal skills were extremely important. The two work hand in hand.” The researchers believe that the findings could help improve patient experience in the dental office and impact continuing education trends and practice standards. “I don’t think we do
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7 News 12/19 Prolonged consumption of caffeine, alcohol, and tobacco alters the levels of salivary cytokines. by Dental Tribune International VALENCIA, Spain: Various studies have shown that long term consumption of alcohol, tobacco and caffeine affect the biological and microbiological status of the oral cavity. The first pilot study of its kind has investigated whether the alterations occur to the levels of cytokines in the saliva of patients who consume these three stimulating substances frequently. interleukin-1 Dr Verónica Veses from the CEU Cardenal Herrera in Valencia and University investigated her team the cytokines levels of three viz. alpha, tumour necrosis factor-alpha and interferon-gamma. The research team took saliva swabs from 50 patients from the CEU dental clinic and divided the participants different groups based on their self- into In the first study of its kind, researchers have investigated whether regular consumption of alcohol, tobacco and caffeine can affect certain cytokines in saliva. (Image: Evgeny Karandaev/Shutterstock) reported levels of consumption of caffeine, alcohol or tobacco. “In our results, we detected that frequent consumers of large amounts of alcohol and tobacco show a greater presence of the three studied cytokines in their saliva, which predisposes them to suffer chronic inflammatory, periodontal tumoural diseases in their oral cavity. Specifically, we detected that or interleukin-1 alpha was the highest in alcohol consumers, interferon-gamma was and higher smokers,” explained Veses. among Ad interferon-gamma The study also revealed that the patients who consumed caffeine through coffee and/or soft drinks had higher levels of and tumour necrosis factor-alpha compared to the participants who did not. “Only their levels of interleukin-1 alpha are lower than those registered among non-consumers,” noted Veses. correlation between A previous study by the same research team had found the a consumption of stimulants and oral microflora alteration. Now, the current study is the first to show that prolonged consumption of three stimulants alters the levels of salivary cytokines. the in The study, of response titled “Modulation salivary cytokines to alcohol, tobacco and caffeine consumption: A pilot study”, was published on 12 November 2018 in Scientific Reports. 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
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