Dental News December 2011

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Dental News, Volume XVIII, Number IV, 2011

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CONTENTS Volume XVII I , Number IV, 2011

Alfred Naaman, Nada Naaman, Jihad Fakhoury, Dona Raad, Antoine Saadé, Lina Chamseddine, Tarek Kotob, Mohammed Rifai, Bilal Koleilat, Mohammad H. Al-JammazVanessa AbdelahadKrystel KouyoumdjisMicheline Assaf, Nariman NehmehJosiane YounesAlbert SaykaliGisèle Wakim, Marielle KhouryTony Dib1026-261X

DENTAL NEWS – Sami Solh Ave., G. Younis Bldg.POB: 116-5515 Beirut, Lebanon.Tel: 961-3-30 30 48Fax: 961-1-38 46 57Email: [email protected]: www.dentalnews.comwww.facebook.com/dentalnews1

INTERNATIONAL REVIEW BOARDPr. M.A. Bassiouny BDS, DMD, MSc, Ph.D. Director International Program, Temple University, Philadelphia, USA.Pr. N.F. Bissada D.D.S., M.S.D Professor and Chairman, Department of Periodontics, Case Western Reserve University, USA.Pr. Jean-Louis Brouillet D.C.D, D.S.O. Chairman, Department of Restorative Dentistry, Aix-Marseille II, France.Pierre Colon D.C.D., D.S.O. Maître de conférence des universités, Paris, France.Dr. Jean-Claude Franquin, Directeur de lʼUnité de Recherche ER116, Marseille, France.Pr. Gilles Koubi D.C.D., D.S.O. Department of Restorative Dentistry, Aix-Marseille II, France.Pr. Guido Goracci. University LA SAPIENZA, School of Medicine & Dentistry, Roma, Italia.Brian J. Millar BDS, Ph.D. Guyʼs, Kingʼs, and St. Thomasʼ College School of Medecine & Dentistry, London, UK.Pr. Dr. Klaus Ott, Director of the Clinics of Westfälischen Wilhelms-University, Münster, Germany.Wilhelm-Joseph Pertot DEA, Maître de conférence, Aix-Marseille II, France.Pr. Dr. Alfred Renk, Bayerische Julius-Maximilians-University, Würzburg, Germany.Dr. Philippe Roche-Poggi DEA. Maître de conférence des universités, Aix-Marseille II, France. Michel Sixou D.C.D., D.E.A. Department of Priodontology, Toulouse, France.Pr. M. Sharawy B.D.S., Ph.D. Professor and Director, Department of Oral biology, Medical College of Georgia, Augusta, Georgia, USA.V

EDITORIAL TEAM

COORDINATORART DEPARTMENT

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DENTAL NEWS IS A QUARTERLY MAGAZINE DISTRIBUTED MAINLY IN

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THE COUNCIL OF DENTAL SOCIETIES FOR THE GCC.Statements and opinions expressed in the articles

and communications herein are those of the author(s) and not necessarily those of the Editor(s) or publisher. No part of

this magazine may be reproduced in any form, either electronic or mechanical, without the express written permission of the publisher.

Treatment of Angle Class II division II maloc-clusion with deep overbiteDr Kholood Alfoudari Full Arch Implant Reconstruction of patient with Combination Syndrome: A clinical Approach Husain Ghadhanfari, Abdulaziz AlSanousi, Edward Monaco

Should Bio-Oss be used as an onlay bone substitute?Abdullah Al-Harkan

Parental Separation Nourah Al-Maheemid

The 3rd National Guard and 1ST Saudi Endodontic Society

EDA - Cairo EGYPT

DFCIC 2011 - Dubai

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ORTHODONTICS

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AbstractA 13 years old female presented in the late mixed dentition stage with a Class II division 2 incisor relationship on a moderate Class II skeletal base with average vertical proportions. The upper arch presented with mild crowding and retroclined central incisors. The lower arch was also mildly crowded with proclined labial segment. In occlusion, the overbite was deep and complete with scissor bite involving the upper and lower right 1st premolars. The treatment consisted of an initial sectional fixed appliance involving the upper labial segment followed by a Twin Block appliance. A subsequent second phase of upper and lower pre-adjusted edgewise fixed appliances were used on a non-extraction basis for definitive alignment, levelling and occlusal detailing. Retention consisted of removable upper and lower Essix retainers. Introduction A Class II incisor relationship is defined by the British Standards classification as being present when the lower incisor edges oc-clude posterior to the cingulum plateau of the upper incisors1. In Class II division 2 cases, the upper central incisors are retroclined and the overjet usually minimal but may be increased. Treat-ment of class II div 2 cases of growing patients with moderate to severe skeletal discrepancy usually involves proclination of the upper labial segment, converting the incisal relationship to a Class II division I malocclusion. Then the treatment is followed by a functional appliance phase to correct the sagittal discrepancy. The initial phase of proclination of the upper labial segment is achieved by one of the following methods:1- Expansion and Labial Segment Alignment Appliance (ELSAA) is the most commonly used. 2- Sectional fixed appliance treatment to the upper labial seg-ment only.3- Modified twin block appliance as demonstrated by Dyer and colleagues (2001) where they incorporated an anterior screw and torquing spurs in the twin block appliance for the upper

labial segment. This avoids the need for an initial upper labial segment alignment. The success of treating Class II division 2 incisor relationship depends on the correction of the transverse, anterior- posterior and vertical discrepancies. To achieve stability of the corrected malocclusion, it is important to correct the inter-incisal angle and edge centroid relationship3. Houston (1989) stated that it is essen-tial to reduce the inter-incisal angle towards 125 degrees, bringing the lower incisor tip anterior to the upper incisor centroid. The Twin Block was developed by Clark (1982) and has proved a popular and clinically successful appliance. The correction of the sagittal discrepancy is possible in many patients within 6-9 months. However, it requires patient co-operation and increased daily wear. The correction of the malocclusion is achieved by mandibular skeletal and dentoalveolar changes in addition to normal growth.

Case history A 13 year old female presented to the orthodontic department complaining of crooked upper front teeth. She was very motivated and had no medical condition contra-indicating the provision of orthodontic treatment.

Extra oral examination The patient presented with moderate class II skeletal pattern with average Frankfort-mandibular planes angle and lower anterior face height. The lips were competent with slightly high resting lower lip line, with average upper incisor show at rest and full crown show when smiling. The labiomental fold was prominent. Intra-oral examination The poor oral hygiene resulted in generalised gingivitis and de-calcification of the cervical margins of the upper labial segment. She was in the late mixed dentition stage with a Class II division 2 incisor relationship. All the permanent dentition was present except the unerupted lower second premolars and second molars with

Angle Class II division II

Dr. Kholood Al Foudari BDS

[email protected]

Treatment of

malocclusion with deep overbite


14

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retained second deciduous molars. The upper arch presented with mild crowding and retroclined central incisors. The lower arch was also mildly crowded with proclined labial segment. In occlusion, the overbite was deep and traumatic to the upper palatal gingival tissues. There was also a scissor bite involving the upper and lower right 1st premolars. The overjet was 3 mm and upper and lower centre lines were coincident. The buccal segment relationship was class II bilaterally.

Radiographic assessment All the permenant teeth were present including the lower second premolars, lower second molars and all third molars as shown in the Dental Panoramic Tomogram (DPT). The upper standard occlusal view revealed normal morphology of the incisors roots and no supernumerary. The cephalometric analysis supports the clinical finding of a moderate Class II sagittal skeletal relationship

(ANB: 7°). Vertically, the lower face height is in the lower end of the normal range (53%) and the MMPA is increased (32°). Dentally, the upper incisors are retroclined to the maxillary plane (96°) while the lower incisors are proclined to the mandibular plane (105˚). The lower incisor edges lying posteriorly to the up-per root centroid (-1 mm).

Aetiology Mandibular retrognathia is the main aetiological , genetically in-herited, factor. It resulted in moderate Class II skeletal pattern with deep overbite. The lower lip line is slightly resting higher than normal which resulted in the retroclination of the upper central incisors.

Treatment aims and objectives 1- Improve the oral hygiene

Table 1: Cephalometric analysis pre-treatment

SNASNBANBUpper incisors to maxillary plane angle Lower incisor to mandibular plane angleInterincisal angle Maxillary mandibular planes angle Lower facial height %Lower incisor edge to upper root centroid

Pre-treatmentVariable Normal (SD)

79˚72˚7˚

96˚

105˚

126˚32˚

53%-1 mm

81 ± 378 ± 33 ± 2

108 ± 6

93 ± 6

133 ± 10 27 ± 3

55 ± 20-2mm

Fig. 2: Pre-treatment radiographs

Fig. 1: Pre-treatment extra oral and intra oral photographs


15

2- Decompensate upper incisors by proclination 3- Improve the facial profile by orthopaedic therapy 4- Align and level the arches5- Overbite correction6- Overjet reduction7- Arch coordination and occlusal detailing8- Achieve a Class I molar relationship9- Retention10- Monitor eruption of the unerupted teeth

Treatment plan1- Patient referral to school of hygiene for prevention advice

and oral hygiene instruction.2- Sectional fixed Preadjusted Edgewise appliance to procline

the upper labial segment3- Twin Block appliance4- Upper and lower Preadjusted Edgewise appliances with

an MBT prescription and an 0.022” x 0.030” slot 5- Retainers

Treatment rationaleUpper fixed sectional 3/3 and functional appliance therapy:To improve dento-facial aesthetics and occlusal relationships, the initial aim was to improve the sagittal skeletal discrepancy. The sectional fixed appliance encourages proclination of the upper labial segment. The principal advantage of the Twin block was to allow incisor and molar correction and upper arch expansion.

Fixed appliance therapy:A second phase of fixed appliance therapy was used to reduce the remaining overbite and to detail the occlusion. Bonding the lower second molars and the use of Class II inter-maxillary elas-tics were employed to facilitate overbite reduction. The increased lower incisor labial root torque of the MBT prescription will also help resist excessive proclination.

Treatment progress After the functional appliance stage, Cephalometric analysis shows that the sagittal skeletal relationship has improved slightly

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Fig. 3: Clark Twin Block

Fig. 4: Photographs Post function-al appliance phase with sectional fixed appliance

Fig. 6: Fixed appliances stage

Table 2: Cephalometric analysis post functional applaince phase

SNASNBANBUpper incisors to maxillary plane angle Lower incisor to mandibular plane angleInterincisal angle Maxillary mandibular planes angle Lower facial height %Lower incisor edge to upper root centroid

During treatment

Variable Change during treatment

78˚74˚4˚

107˚

108˚

113˚32˚

53%+2 mm

-1+2-3

+11

+3

-13 0

0+3

Fig.5: Cephalomtric radiograph Post functioanl appliance phase superimposed with the initial cephalometric view. Note the resulted favourable mandibular growth (green tracing line)


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ORTHODONTICS

(ANB: 4). Vertically, there has been no change in the skeletal relationships. There has been significant dento-alveolar changes; the upper incisor teeth have proclined (+11°) to a normal inclina-tion while the lower incisors have proclined but to a lesser extent (+3°; A-Po +2mm).

Treatment result The patient completed the treatment aged 14 years and 7 months. The malocclusion was treated satisfactory and the treat-ment aims were achieved. The functional appliance phase was successful in the improvement of the facial profile, reduction of the OJ, OB and the correction of the molar relationship.

Discussion The sectional fixed appliances allowed for the decompensation of the upper labial segment by proclination which facilitated the functional appliance phase.

The patient had a favourable growth pattern which contributed to the majority of the corrected malocclusion. The fixed appli-ance phase was indicated to detail the occlusion and to close the remaining lateral open bite post functional.

The lower labial segment was proclined at initial presentation. This happened naturally as an attempt to compensate for the underlying moderate Class II skeletal base. The inclination of the lower labial segment was maintained at the end of the treatment and that was achieved with the use of the fixed appliances with an MBT prescription (-6° torque for the lower labial segment).

The patient was provided with upper and lower Essix retainers for full time wear initially. The patient was advised about the late lower labial segment crowding and the importance of the long-term retention.

Conclusion The success of treatment of Class II div II cases with functional appliances depends on:1- Patients co-operation with appliance wear.2- Favourable mandibular growth. 3- Correction of the inter-incisal angle and edge centroid

relationship3,4

1- British Standard Institute. Glossary of Dental Terms 1983. BS9942; BSI London. 2- Dyer, F.M, Mckeown and H.F, Sandler, P.J. (2001) Journal of Orthodontics. 28: 271-2803- Houston, W. and Tulley, J. (1993) A textbook of orthodontics, Wright, Bristol 4- Houston, W. (1989) Incisor edge centroid relationship and overbite depth, Eu-ropean Journal of Orthodontics, 11: 139-1435- Clark, W.J. (1982) The Twin Bock traction technique, European Journal of Orthodontics, 4: 129-138

REFERENCES

Fig. 7: Post treatment extra oral and intra oral clinical photographs

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Full Arch Implant Reconstruction of patient with Combination Syndrome:

A clinical Approach

Lack of equilibrium between opposite arches in edentulous patient leads sometimes to major problems related to occlusal planes. They can be left untreated or improperly treated. This article re-views one such problem known as Combination Syndrome. The treatment method described involves using a fixed mandibular prosthesis over implants that have been placed immediately after extraction.Rewarding outcomes depend on thorough evaluation and proper diagnosis of a patient’s oral condition. Once the starting point has been determined and the final outcome is designed, the treatment plan merely becomes the method of reaching the desired result.Kelly first described Combination Syndrome in 1972 as destructive changes in hard and soft tissues of patients with complete maxil-lary denture opposing an unstable bilateral free-end mandibular partial denture.1, 2 In different words, Combination Syndrome is a description of a dental condition that is the result of long term use of a few, usually6 remaining lower anterior teeth, #22-27 and a complete upper denture with no other natural remaining teeth and a lower free end Kennedy class I removable partial denture. The normal biting pressure or forces are directed from the remaining lowfrocks teeth and transmitted through the upper anterior denture, with resulting resorption of bone and slow auto-rotation & tilting of the denture upward and backward, with the upper anterior teeth becoming less visible and the upper posterior

teeth becoming more visible as the denture is rotated from func-tion with bone loss of the premaxilla.There may be seven characteristics associated with this syn-drome: 1. Bone loss in the premaxilla. 2. Dropping of the pos-terior maxilla (tuberosities). 3. Extrusion of the lower anterior teeth. 4. Posterior bone loss in the mandible under the RPD. and 5. Papillary hyperplasia of the maxilla. 6. Decreased Oc-clusal Vertical Dimension. and 7. Facial aesthetics often altered dramatically.If not corrected, the unstable occlusion can result in progressive posterior mandibular atrophy leading to greenstick fractures. The method of reestablishing a proper occlusal relationship is discussed in this article using a conventional maxillary denture and fixed mandibular implant restoration to correct the occlusal issues.

CASE REPORTSA healthy 54 year-old female patient presented with a complete maxillary conventional denture and class I Kennedy lower partial denture (Fig. 1). The mandibular residual ridge was shaped in the form of a knife edge and the tissue covering the edentulous ridge appeared loose. The buccal shelf areas were inadequate in size to provide the denture with support. The mandible showed extrusion of both the alveolar process and remaining dentition (Fig. 2). The maxilla showed enlarged tuberosity, atrophic pre maxilla, and Papillary hyperplasia on her hard palate (Fig. 3). A

Husain Ghadhanfari DDS, MS, Abdulaziz AlSanousi, Edward Monaco

[email protected]

Fig 2Fig 1

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limited interarch space was evident at the approximate occlusal vertical dimension (Fig. 4). The patient desired restoration of her teeth within her budgetary limits, with a preference for a non-removable prosthesis of lower arch and more stable maxillary prosthesis, if possible. The treatment plan that was developed included a new upper denture opposing a fixed mandibular prosthesis.

Preoperative PlanningInitial treatment planning began with mounted study casts, pan-oramic radiographic film, cephalometric radiographic film, and intraoral photographs. The mandibular cast was duplicated and a diagnostic wax-up was fabricated to identify ideal implant sites. Two surgical templates were fabricated, one involving occlusal window to indicate approximate implant sites and another outlining the buccal limitations3 (Fig. 5, and 6). The mandibular cast was also used to fabricate an immediate complete lower denture.

Surgical phaseThe patient was required to have no food or fluids from midnight before surgery (NPO). The patient was given 0.5 mg sublingual triazolam 1 hour before surgery for sedative purposes. In addi-tion, amoxillin (antibiotic to prevent infections), dexamethasone (corticosteroid used to minimize postoperative swelling) and ibuprofen (nonsteroidal anti-inflammatory drug used to assist in preventing swelling as well as analgesia) were also adminis-tered 1 hour before surgery. The patient’s mouth and face were

scrubbed with chlorhexidine (0.12%). Bilateral inferior alveolar nerve blocks were given with 2% articaine (1:100,000 epinephrine) and local infiltration with 2% lidocaine (1:50,000 epinephrine) to assist with hemostasis. A midcrestal incision was made from the right distal first molar area to the left distal first molar area with midline vertical releasing incision. A full-thickness buccal flap was reflected and tied back to the vestibule using 2-0 silk suture material. The surgical template was inserted to mark the locations on the alveolar crest. The remaining teeth were extracted, and an alveoplasty was performed on the anterior undercuts of the buccal aspect of the ridge to level the extruded segment (Fig. 7). The template was inserted again to prepare the osteot-omy within the buccal confines of the template. Teeth # 34(21), 33(22), 41(25), 43(27) and 44(28) sites were prepared for a 3.5 mm X 10.0 mm (Nobel Direct Groovy, Nobel Biocare) endosteal root form implant and inserted. Healing caps were placed. An Amalgam tattoo at Site no. 4327 was removed using a round bur. The resulting defect was filled with a demineralized freeze-dried bone allograft (DFDBA) (Puros, Zimmer Dental, CA, USA) and covered with a collagen membrane (BioMend, Zimmer Dental, CA, USA).Flap margins were trimmed with scissors to allow primary closure with no redundant tissue. Flaps were reapproximated using 3-0 Vicryl (Johnson & Johnson, Somerville, NJ) in an interrupted and continuous manner. The immediate complete lower denture was relined using CoeSoft tissue conditioner (GC America, Alsip, IL). Ice packs were given to the patient and postoperative toons

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were reviewed.Sutures were removed 2 weeks postsurgically, and the immediate lower denture was once again relined using soft chairside liner (GC America, Alsip, IL).

Prosthetic phaseThe patient was instructed not to wear the upper denture for 24 hours before this appointment to permit tissue relaxation.4-6 A final impression of the maxilla using a custom tray and polyvinyl-siloxane was made. Two months later, the patient received a final impression of the implants using impression pick up technique, a custom tray, and polyvinylsiloxane. The midline, incisal edge position, occlusal plane, buccal lip support, and anterior segment were indicated on the acrylic maxillary base and wax rim. Mandibular record base and wax rim was used with the aid of modified temporary abutment to secure the acrylic base for vertical dimension and bite registration record.Temporary Abutments were used on the master cast to wax up the mandibular framework (Fig. 8). Completed framework wax up was sent to be scanned and a milled titanium framework to be fabricated. The milled titanium framework (NobelProcera Implant titanium bridge, Nobel Biocare, NJ) tried in the patient mouth for passive fitness (Fig. 9). Final try-in of the maxillary denture with teeth set in wax was made against mandibular denture teeth try-in set over the tita-nium framework. The occlusal plane (Curve of Spee and Curve

of Wilson) was developed on the mandibular try-in hybrid den-ture using a Circular setup template. This plate is set against the occlusal surfaces of the mandibular teeth and is based on a 3-inch Sphere.Denture teeth were set in a medial-positioned lingualized occlusion. Misch proposed this occlusal design, which is a modification of the occlusal scheme first developed by Payne and Pound. Only the lingual cusps of the maxillary posterior teeth are in contact with the central fossa during centric occlusion. The mandibular molar cusps are positioned medial to a line drawn from the mesial of the canine to the lingual aspect of the retromolar pad.7 The mandibular prosthesis was created in 1 piece with Procera milled titanium framework. The mandibular implants were placed with-in mental foramen area to accommodate mandibular flexure and limit torsion on the implants.8, 9

After esthetics, occlusion, phonetics, and comfort were evalu-ated both dentures were processed in heat-cured acrylic and delivered at the same appointment (Fig. 10).10 Verification of abutments being seated required periapical films. The implant abutments were then torque to 30 Ncm. Cotton was placed over the abutment screws and sealed with Fermit-N (Vivadent, Schaan, Liechtenstein).Final panoramic (Fig. 11) was taken to verify baseline crestal bone levels.The patient was recalled two weeks post delivery to evaluate the occlusion, oral hygiene, and soft tissue.

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Discussion Combination Syndrome is an aggressive occlusal problem that slowly develops over time. Once detected, treatment options are evaluated. Different treatment approaches should be suggested for a patient with Combination Syndrome. The choice of treat-ment ultimately depends on the patient, the amount of time and money she is willing to spend for the treatment, her oral condition and her desire for fixed or removable prosthesis. These options must resolve the problems of function, esthetics, and patient desires, as well as economics. To fulfill these requirements, 2 types of prostheses are available: conventional denture or an implant-retained prosthesis. The use of a conventional denture in restoring the mandibular dentition provides the least patient satisfaction as compared with a fixed prosthesis. For this reason, the patient elected to have the mandibular rehabilitation with an

implant-retained prosthesis. The maxillary dentition was restored with a conventional denture because the patient had been wear-ing, had tolerated, and had accepted a complete denture. Also, both esthetics and economics were easily managed with this prosthesis.Post treatment maintenance recalls appointments are essential to assure denture stability, proper occlusal scheme, and mainte-nance of posterior support and vertical dimension of occlusion. The patient should be recalled on 3 months, 6 months, and 12 months intervals during the first year to observe any changes in posterior support. If acrylic tooth wear and support are lost in the posterior regions, accelerated premaxilla atrophy will develop from excessive forces. Bilateral balanced occlusion is essential for long-term success.This case study deals with treatment of Combination Syndrome. Understanding the cause can assist the practitioner in preventing further residual ridge deterioration.

Conclusion The assessment of the risk of developing the combination syndrome depends on past dental history, the condition of the remaining mandibular anterior teeth, and posterior lack of occlusal support. The dentist should study the case carefully in order to assure the irreversibility of this syndrome. Implants provide a predictable method of tooth replacement offering excellent functional and esthetic benefits. Like with any complicated treatment, thorough diagnosis, planning, and implementation of treatment will result in an outstanding outcome for both the patient and dentist.

Fig 5

1. Kelly E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. J Prosthet Dent. 1972;27:140–150.2. Saunders TR, Gillis RE, Desjardins RP. The maxillary complete denture oppos-ing the mandibular bilateral distal extension partial denture. Treatment consider-ations. J Prosthet Dent. 1979;41:124–128.3. Cabianca M. Surgical template fabrication and utilization involving steel tubes. Int Magazine Oral Implantology. 2001;2: 31–35.4. Zarb GA, et al. Boucher’s Prosthodontic Treatment for Edentulous Patients,10th ed. St. Louis: Mosby; 1990: 174.5. Lytle RB. Management of abused oral tissues in complete denture construction. J Prosthet Dent. 1957;7:27–42.

6. Kydd WL, Colin HD. The biological and mechanical effects of stress on oral mucosa. J Prosthet Dent. 1982;47:317–329.7. Misch CE. Maxillary denture opposing an implant prosthesis. In: Misch CE, ed. Contemporary Implant Dentistry, 2nd ed. St. Louis: Mosby; 1999:639–644.8. Misch CE. Diagnostic casts, preimplant prosthodontics, treatment prostheses, and surgical templates. In: Misch CE, ed. Contemporary Implant Dentistry, 2nd ed. St. Louis: Mosby; 1999:143–144.9. Goodkind RJ, Heringlake CB. Mandibular flexure in opening and closure move-ments. J Prosthet Dent. 1973;30: 134–138.10. Zarb GA, et al. Boucher’s Prosthodontic Treatment for Edentulous Patients, 10th ed. St. Louis: Mosby; 1990: 400–405.

REFERENCES

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30

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Often times, dental implant placement is complicated by inad-equacy of bone volume due to tooth loss, periodontal disease, pathology, or trauma. However, more challenging implant cases are being performed due to the advancement in bone augmen-tation procedures and materials to augment deficient alveolar bone.1

Autogenous bone is considered to be the “gold standard”, for alveolar ridge regeneration, due to its osteogenicity.1,2 Howev-er, autogenous bone grafts are associated with rapid rate of resorption3 and donor site morbidity.1 This has led scientists to investigate allogenic and xenogenic bone grafts, as well as allo-plastic materials, such as Hydroxyapatite and Calcium Phosphate Compounds.4

An alternative to autogenous bone is xenograft. Although xeno-grafts have provided acceptable results, they are considered to be inferior in bone generation potential when compared to au-tografts. However, the supply of xenograft is unlimited. Xenografts are usually derived from bovine origin.5

Bio-Oss® (Geistlich Pharmaceutical, Walhusen, Switzerland) is a natural bovine bone derivative that lacks the organic component.6 Bio-Oss® and mineralized human bone are similar in their chemi-cal and morphological structures.2 Bio-Oss® granules are 0.25 to 1.00 mm in diameter.6 Due to its porous structure, Bio-Oss® occupies 25-30% of the defect space initially.7 This facilitates angiogenesis (penetration of the bone augmentation material by blood vessels) and osteoblast migration.8

Along with all of its potential properties, the osteoconductive nature of Bio-Oss® when used as an onlay graft is not well established. The Osteoconductivity of Bio-Oss® has been a topic of debate in the literature.

It is well known that an onlay bone graft is more challenging to maintain clinically than an inlay bone graft. Rosenthal et al. dem-onstrated that onlay bone grafts showed resorption with time,

while inlay bone grafts showed increased volumes overtime.9 In-creased bone to bone contact between the inlay bone graft and the native bone is one explanation to this difference. Another explanation is the fact that inlay bone grafts are surrounded by biological boundaries. This shields them from recoil forces of the surrounding soft tissue. In addition, inlay bone grafts receive identical physical stresses to those received by the surrounding bone.9

Some studies described Bio-Oss® as having osteoconductive properties. In an experiment involving the skull of the rabbit, us-ing histomorphometric analysis, Slotte et al. examined the bone formation in titanium cylinders filled with either autogenous bone or Bio-Oss® as compared to empty titanium cylinders as controls. Significantly more bone tissue was found in the two test groups than the control group.10

Other studies claimed that Bio-Oss® is not osteoconductive when used as an onlay. In an experiment involving the skull of the rat, Slotte and Lundgren studied, histomorphometrically, the bone generation potential of silicone domes grafted with Bio-Oss® compared to empty ones.11 The study demonstrated that Bio-Oss® arrested bone formation.

In two different studies using the mandible of the rat, Stavro-poulos et al. studied the amount of bone generation in Teflon capsules grafted with Bio-Oss® as compared to empty (control) capsules. The capsules were fixed to the mandible using suture material. In both experiments, it was shown that Bio-Oss® had an inhibitory effect on bone formation.12,13

Such results and the results of other studies have led some authors to suggest that dental implant survival in grafted sites may be owed mainly to the function of the native bone rather than the bone graft itself.14

SHOULD BIO-OSS BE USED AS AN ONLAY BONE SUBSTITUTE?Abdullah Al-Harkan DMD, MSc, FRCD (C)

Department of Oral and Maxillofacial Surgery, Farwaniya Hospital, Ministry of Health, Kuwait - [email protected]

IMPLANT DENTISTRY

Araújo et al. found that Bio-Oss® resulted in less bone generation than autogenous bone when used as an onlay in dogs’ mandibles.15 However, they found that Bio-Oss® maintained more volume than autogenous bone did. Due to this fact, some authors sug-gested the use of Bio-Oss® mainly to preserve the architecture of the soft tissue.16

From the discussion above, in my opinion, the use of Bio-Oss® an onlay bone substitute may not have a significant value in bone generation potential, but it may add some value to the way it supports the soft tissue profile. This feature may give the implant a better esthetic outcome.

1- Norton M, Odell EW, Thompson ID, Cook RJ. Efficacy of bovine bone mineral for alveolar augmentation: a human histologic study. Clinical Oral Implant Re-search. 2003; 14: 775-7832- Ewers R, Goriwoda W, Schopper C, Moser D, Spassova E. Histologic findings at augmented bone areas supplied with different bone substitute materials com-bined with sinus floor lifting. Report of one case. Clinical Implant Research. 2004; 15: 96-100.3- Johansson, B., Grepe, A., Wannfors, K. & Hirsch, J-M. (2001) A clinical study of changes in the volume of bone grafts in the atrophic maxilla. Dentomaxillofacial Radiology 30: 157-161.4- Hämmerle, C.H., Chiantella, G.C., Karring, T. & Lang, N.P. (1998) The effect of a deproteinized bovine bone mineral on bone regeneration around titanium dental implants. Clinical Oral Implants Research 3: 151-162.5- Tuominen, T., Jäsmä, T., Tuukkanen, J., Marttinen, A., Lindholm, T.S. & Jalovaara, P. (2001) Bovine bone implant with bovine bone morphogenetic protein in healing a canine ulnar defect. International Orthopaedics 25(1): 5-8.6- Hising, P., Bolin, A. & Branting, C. (2001) Reconstruction of severely resorbed alveolar ridge crests with dental implants using a bovine bone mineral for augmen-tation. The International Journal of Oral & Maxillofacial Implants 16(1): 90-97. 7- Peetz, M (1997) Characterization of xenogenic bone material. In: Boyne, P.J., ed. Osseous reconstruction of the maxilla and the mandible – surgical techniques using titanium mesh and bone mineral, 87-100. Chicago, Berlin: Quintessence.8- Yildirim M, Spiekermann H, Biesterfeld S, Edelhoff D. Maxillary sinus augmen-tation using xenogenic bone substitute material Bio-Oss® in combination with venous blood. A histologic and histomorphometric study in humans. Clinical Oral Implant Research 2000: 11:217-229

9- Rosenthal, A.H. and S.R. Buchman, Volume maintenance of inlay bone grafts in the craniofacial skeleton. Plastic and reconstructiove surgey, 2003. 112(3) p.802811.10- Slotte C, Lundgren D, Burgos PM. Placement of autogenic bone chips or bo-vine bone mineral in guided bone augmentation: A rabbit skull study. The Interna-tional Journal of Oral & Maxillofacial implants, 2003; 18: 795-80611- Slotte C, Lundgren D. Augmentation of calvarial tissue using non-permeable silicone domes and bovine bone mineral. An experimental study in the rat. Clinical Oral Implant Research 1999: 10: 468-47612- Stavropoulos A, Kostopoulos L, Mardas N, Nyengaard JR, Karring T. Depro-teinized bovine bone used as an adjunct to guided bone augmentation (GBA) An experimental study in the rat. Clinical Implant Dentistry and Related Research, 2001a; 3: 156-16513- Stavropoulos A, Kostopoulos L, Nyengaard J R, Karring T. Deproteinized bo-vine bone (Bio-Oss®) and bioactive glass (Biogran®) arrest bone formation when used as an adjunct to guided tissue regeneration (GTR). An experimental study in the rat. Journal of Clinical Periodontology 2003; 30: 636-64314- Aghaloo TL, Moy PK, Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement? Int J Oral Max-illofac Implants. 2007; 22 Suppl:49-70.15- Araújo MG, Sonohara M, Hayacibara R, Cardaropoli G, Lindhe J, Lateral ridge augmentation by the use of grafts comprised of autologous bone or a biomate-rial. An experiment in the dog. J Clin Periodontol. 2002 Dec; 29(12):1122-31.16- Schlee M, Esposito M, Aesthetic and patient preference using a bone substi-tute to preserve extraction sockets under pontics. A cross-sectional survey. Eur J Oral Implantol. 2009 Autumn; 2(3):209-17.

REFERENCES

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Key Words: Parental separation. Behavior management. Pediatric dentists.

AbstractObjective: The aim of this study was to explore the preference of parents and dentists as regards parental presence/absence in a dental clinic during a child’s dental treatment in Kuwait. Methods: Two hundred and twenty seven subjects were includ-ed in this prospective study. The subjects comprised two groups, Group I included parents of 152 child-patients, and Group II, 75 dental care providers (pediatric dentists and general practitioners). The data was collected on a pre-designed questionnaire, which included demographic variables on child-patients and parents, as well as their preference to remain inside or outside the clinic. The dentist’s opinion on this matter was also obtained. Results: Results showed a general preference of parents for being with the child during treatment, a decline was observed with the increasing birth order of child (p<0.046), as well as increasing parental age (p<0.022). This preference was found to be the same between mothers and fathers (p 0.923). Logistic regression anal-ysis revealed that only dental specialty was a significant factor (p<0.013) among dentists. Pediatric dentists’ preference on pa-rental presence was seven times higher than general practitioners (OR = 7.2, CI=1.5-34.8). Also, 115 (76%) parents preferred to be with their child during treatment, as compared to 28 (37%) dentists favoring parental presence (p<0.001; OR=5.2, CI=2.9-9.5). Conclusion: A statistically significant relation was found in terms of parents’ preference, whether to be inside or outside the clinic during their child’s dental treatment, child’s birth order, and age of the parent. Pediatric dentists showed an overall pref-erence towards a parent’s presence inside the clinic during the child’s dental treatment. A majority of general dentists did not prefer parental presence in the clinic.

IntroductionFor children’s treatment, it is essential to have good behav-ioral management techniques, and one of these techniques is to separate the parents from the child(1,2,3). Unfortunately, separation anxiety is a common problem in pediatric dentistry, especially with younger children(4). Many studies tend to sup-port the presence of parents in dental clinic due to the reported augmentation of negative behavior of children when separated from their parents(5-11). Also, an overall increasing preference was observed among pediatric dentists towards parental participation in the clinic during child’s treatment(4). A majority of parents stated that they themselves would feel better if they stayed in the clinic with their child, as this practice would increase the child’s cooperation(9,12,13). However, some studies have reported that a majority of dentists do not prefer parental presence in the dental clinic during their child’s treatment(5,6). Traditionaly, dentists in Kuwait excluded parents from the dental clinic, to help in the elimination of many of the child’s behavior problems. Some dental clinics in Kuwait have this practice as a matter of policy. Kamp had noted that parents’ exclusion from the den-tal clinic was part of the routine pediatric treatment by many practitioners(12). Excluding parents from the clinic was favored by many dentists as they thought that this technique would re-duce conflicts of authority and a child’s negative behaviors(5,12,14). Another reason, reportedly preferring the separation technique, was that some dentists felt uncomfortable using a number of behavior management techniques, especially more advanced behavior management techniques, in parents presence(4,14). Also documented is the parent’s anxiety having a big effect on child’s behavior during dental visit(1,15). While parents have been shown to be more anxious, their presence reportedly resulted in a more apprehensive behavior from their children(16,17). However, there are many reports that found no statistically significant difference

Preference of Parents and Dentists in Using

Parental Separation Techniqueduring Dental Care for Children in KuwaitNourah S. Al-Maheemid, BDS - Mohammad A. Hasan, BA/DDS. MS - Prem N. Sharma, Abdulaziz A. Hasan, BA/DDS. MS.

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between the behavior of children who are separated from their parents, as compared to the behavior of children who are not separated(5,8,15,18,19).Two factors are important and should be considered in the deci-sion concerning inclusion or exclusion of parents during dental treatment: (1) Parental preference, and (2) Dentist preference/office policy(6).A cross-sectional study was designed to study parental and den-tists’ preferences in this regard, in the context of dental clinics in Kuwait. The objective of this study was to explore the preferences of parents and dentists concerning parental presence in a dental clinic during a child’s dental treatment in Kuwait.

Subjects and MethodsThe study was conducted at the: (1) Faculty of Dentistry, Kuwait University, (2) Specialty dental centers at Ministry of Health (Al-Amiri, Benaid Al-Gar, Al-Farwaniya, Al-Jahra), which included multiple pediatric, orthodontic and emergency clinics, and (3) four polyclinics (general dentistry) in the same residential areas as the specialty dental centers. The study was conducted in two groups. Group 1, comprised of 152 children and their parents. These subjects included all parents who accompanied their children to the dental clinic at the specialty dental centers or polyclinics, from 9 a.m. to 10 a.m., during a period of one week. Group 2 consisted of 75 dentists, including 26 pediatric dentists (total number of pediatric dentists in Kuwait at the time of the study), and 49 general dentists (total number of general dentists in the dental centers, where the study was conducted). A pre-designed, close-ended questionnaire was used for data collection. Demographic data on the subjects in Group 1, included child’s age, gender and his/her birth order in the family. Information obtained from the accompanying parent were; age, gender, education level, and their preference to remain inside or outside the clinic, during a child’s dental treatment in normal situations (routine dental visit during normal working hours). Subjects in Group 2, were the dentists, who completed a different

closed-ended questionnaire, that consisted information on their clinic, specialty, age, gender, year of graduation, as well as their preference regarding parent’s presence or absence in the clinic during a child’s dental treatment. All dentists responded to the questions in the survey. For the purpose of this study, all subjects, in both groups (parents and dentists) participated in this blind cross-sectional survey.Statistical software, Statistical Package for Social Sciences (SPSS) version 15.0 was used for data management, analysis and pre-sentation of results. Descriptive statistics have been presented as number, percentages, mean ±standard deviation (SD), and range. Normality of data distribution was ascertained with Kolmogorov-Smirnov test. The association of different characteristics with parents’ or dentists’ preferences was assessed with Chi-square or Fisher’s test. Mean ages were compared with Mann-Whitney nonparametric test. Logistic regression was applied to find the factors influencing the preference of parents being inside the clinic during a child’s treatment. Odds ratio (OR) and 95% confidence interval (CI) were computed. A probability value (p < 0.05) was considered significant at two-tailed level.

ResultsAll 227 subjects, 152 parents and 75 dentists, included in the study, completed the questionnaire with a response rate of 100 percent. In Group I, the mean age of child-patients was 4.7 years, ranging between 2 to 10 years, with male to female ratio of 1.2 :1 (Table1). No significant difference was observed between mean ages of male and female child-patients (4.68±1.42 vs 4.73±1.89, p=0.454). Parents, whether mother or father, in almost equal number, accompanied the children. Parents mean age was 35.2 years, ranging between 21 to 56 years, though fathers had significantly higher mean age (37 years) as compared to mothers, (33 years); ( 37.2±6.4 vs 33.0±5.9; p<0.001). More than half of the parents, 87 (57.2%) had university education, followed by secondary (30.3%) and primary (12.5%).Three-quarters, 115 (75.7%) of parents preferred to remain inside the dental clinic during their child’s treatment, while re-maining 37 (24.3%) either preferred to remain outside (6.6%), with their preference depending on treatment (9.2%), or did not have any preference of being inside or outside the clinic (8.5%)

Table 1 Demographic characteristics of child-patients and their accom-panying parents to the dental clinic (N=152)

Fig 1 Parents’ preference to be inside or outside the dental clinic dur-ing their child’s treatment (N=152)

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PEDIATRIC DENTISTRY

Majority of children 118 (77.6%) were in the age-group (4-6) years, while 20 (13.2%) were three years and below, and 14 (9.2%) were above 6 years (Table 2). A declining trend was observed as regards parents preference for being inside with re-spect to a child’s increasing age, though this was not significant (p<0.558). No significant difference was observed with regard to child’s gender. Chi-square for trend showed a significant declining trend in parent’s preference to remain inside with in-creasing child’s birth order (p<0.045). Similar trend was noticed with regard to increasing age of parents (p<0.022). However, parental preference was found to be same between mothers (76%) and fathers (75.3%), (p=0.923). Parental education did not show any difference in their preferences to be inside the clinic (p<0.882) In Group II, 75 dentists (49 general and 26 pediatric dentists) recorded their opinion about the presence or absence of parents during dental treatment of children (Table 3). More than half of the dentists, 41 (54.7%) were in the age-group (20-29) years, with mean age 32.2 (± 9.4) years ranging between 22 to 54 years. The mean age for pediatric dentists was significantly higher than general practitioners (40.2±8.4 vs 28.0±7.0, p<0.001). Gender-wise, there were 46 females (61.3%) with a mean age of 30.9 (± 9.7) years, and 29 males (38.7%) with mean age 34.3 (± 8.8); p<0.049. Fifty-six percent of the dentists graduated in the year 2000, or after. As regards dentist’s opinion on parents being inside or outside the clinic, 69.2% pediatric dentists preferred parents presence in the clinic as compared to general

practitioners (20.4%), p<0.001. All pediatric dentists were in fa-vor of parents’ presence during a child’s first visit. There was a significant association with dentists increasing age and parent’s presence in the clinic (p<0.01). Also, significantly higher prefer-ence for parental participation was observed among dentists, who graduated before the year 2000 (p< 0.005). However, on logistic regression analysis, only specialty was found to be a sig-nificant factor (p<0.013), where pediatric dentists’ preference on parental presence was seven times higher than general prac-titioners (OR = 7.2, CI=1.5-34.8).In Group I and Group II, 115 (76%) parents preferred to be with their child during treatment as compared to 28 (37%) dentists (pediatric dentists and general practitioners), who favored parental presence (p<0.001; OR=5.2, CI=2.9-9.5).

DiscussionThis study demonstrated that a majority of parents (75.7%) pre-ferred to stay inside the dental clinic during their child’s treatment. Although, the data showed that this preference increased especially when children were 5 years of age or younger, the association be-tween the parental preference and the age of the child was not statistically significant (p<0.558). This suggests that the age of the child patient was not the most important factor that deter-mined the decision of parents to be inside or outside the clinic, as suggested by other studies(4,6). Another finding of this study was the statistically significant relation concerning the parents’ preference, whether to be inside or outside the clinic during their child’s dental treatment, child’s birth order, and age of the parent. Parents’ preference to remain inside the clinic with their child decreased with increasing child’s birth order (p<0.045).

Table 2 General characteristics of child-patients and their accompany-ing parents to the dental clinic according to parental preference on remaining inside or outside the clinic duting child’s treatment

Table 3 Dentist’s characteristics and their perception on parent’s presence inside or outside the clinic during child’s treatment

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Also, this preference decreased with increasing age of parents (p<0.022). Parents who preferred to stay inside the dental clinic with their children reported that the reasons behind this choice were to reduce parental and children’s anxiety and increase the comfort level. This tended to increase parents’ satisfaction, and improved the overall child’s dental experience. There was no significant effect of parents’ gender or level of education.The only statistically significant relation in Group II was found between the opinions of dentists’ for having the parents inside or outside the dental clinic during a child’s treatment and the dental specialty. Most pediatric dentists (69%) showed an over-all preference towards parental presence inside the clinic during the child’s dental treatment, regardless of the child’s age, gender, or behavior. Pediatric dentists felt more comfortable having the parents inside the clinic for many reasons, but mainly, as indicated by most pediatric dentists in this study, was to allow the parents to observe the management techniques utilized by dentists. This was especially true for pediatric dentist; if it was the child’s first visit to the dentist (100% of pediatric dentists preferred the parents to stay inside the clinic during the child’s first dental visit). Many parents in other studies also preferred to be with their children in the dental clinic during the initial visit(12,14).On the other hand, most general practitioners (79.6%), in this study, preferred to exclude the parents from the clinic during the dental treatment of their children. The reason, as indicated by the general practitioners, was to eliminate many of the child’s

behavioral problems, a reason reportedly given by other dentists in some other studies(12,20).The authors of this study recognize that future studies are needed, giving consideration to parental preference concerning the type of dental procedure (initial, follow-up, restorative, surgical or emergency). Also, considerations need to be given to whether the parents remain in or out of the operatory, while collecting the data for future studies.

ConclusionThis study demonstrated that parental preference to stay inside or outside the dental clinic during their child’s treatment signifi-cantly depended on the child’s birth order and the parent’s age. Pediatric dentists’ preference on parental presence was seven times higher than general practitioners. This preference by pe-diatric dentists increased especially if it was the child’s first visit. Based on the findings of the study, it is recommended that the dentists may need to include parents in making the decision of using the parental separation technique. Pediatric dentists also need to report to general practitioners about the rationale be-hind their preference to include the parents in the dental clinic during their child’s treatment.

AcknowledgmentThe authors would like to thank Dr. Muawia Qudiemat for his help and support during this study.

1. Crossley M, Joshi G. An investigation of paediatric dentists’ attitudes towards parental accompaniment and behavioral management techniques in the UK. BDJ 2002; 192:517-21.2. Harrell S. Managing slightly uncooperative pediatric patients. JADA 2003; 134:1613-4. 3. Havelka C, McTigue D, Wilson S, Odom J. The influence of social status and prior explanation on parental attitudes toward behavior management techniques. Pediatr Dent 1992; 14:376-81.4. Guthrie A. Separation anxiety: an overview. Pediatr Dent 1997; 19:486-90.5. Crowley E, Whelton H, O’Mullane D, Cronin M, Kelleher V, Flannery E. Parent’s preference as to whether they would like to accompany their child when receiv-ing dental treatment – results from a national survey. J Irish Dent Assoc 2005; 51:23-4.6. Arathi R, Ashwini R, Mangalore. Parental presence in the dental operatory – parent’s point of view. J Indian Soc Pedo Prev Dent 1999; 17:150-5.7. Frankl S, Shiere R, Fogels H. Should the parent remain with the child in the dental operatory. J Dent Child 1962; 29: 150-63.8. Fenlon W, Dabbs A, Curzon M. Parental presence during treatment of the child patient: a study with British parents. Br Dent J 1993; 174:23-8.9. Peretz B, Zadik D. Parent’s attitudes toward behavior management techniques during dental treatment. Ped Dent 1999; 21:201-4.10. Molinari G, DeYoug A. Parental Presence and Absence as a Behavior Manage-ment Technique. J Michigan Dent. Assoc 2004; 86:30-3.

11. Marzo G, Campanella V, Albani F, Gallusi G. Psychological aspects in paediat-ric dentistry: parental presence. E J Ped. dent 2003; 4:177-80.12. Kamp A. Parent child separation during dental care: a survey of parent’s pref-erence. Pediatr Dent 1992; 14:231-5.13. Certo M, Bernat J, Creighton P. Parental views aboutaccompanying their child into the operatory. J Dent Res 1992;71:236-8 14. Marcum B, Turner C, Frank J. Courts. Pediatric dentists’ attitudes regarding parental presence during dental procedures. Pediatric Dentistry 1995; 17:432-6.15. Certo M, Bernat J. Parents in the Operatory. NYSCJ 1995; 79: 16-1916. Himes M, Munyer K, Henly S. Parental presence during pediatric anesthetic inductions. AANA J 2003; 71:293-8.17. Bevan J, Johnston C, Haig M, et al. Preoperative parental anxiety predicts behavioral and emotional responses to induction of anaesthesia in children. Can J Anaesth 1990; 37:177-182.18. Venham L, Bengston D, Ciphes M. Parental presence and the child’s response to dental stress. J Dent Child 1978; 45: 37-41.19. Plefferle J, Machen J, Fields H, Posnick V, Child behavior in the dental sitting relative to parental presence. Ped Dent 1982; 4: 311-316.20. Wright G, Starkey P, Gardner D. Parent-child separation, in Managing Chil-dren’s Behavior in the Dental Office, GZ Wright, PE Starkey, DE Gardner eds. St. Louis: CV Mosby Co. 1983; pp57-74.

REFERENCES

OPERATIVE DENTISTRY

Dentin hypersensitivity is growing in incidence and can be a major concern for patients. The pain associated with dentin hypersensi-tivity is usually brought on by an external stimulus, and the intensity can differ from patient to patient. The diagnosis of dentin hyper-sensitivity often poses a challenge for the dental professional. The cause and description of the pain reported by the patient can vary and is often not adequate to make a definitive diagno-sis. The dental professional often needs to perform a thorough examination, as well as additional tests, to determine why the pain is occurring. The examination and tests can help develop a definitive diagnosis, which allows the dental professional to rule out other possible causes of the pain (periodontal disease, caries, etc) and then implement an appropriate treatment plan to ad-dress the problem.

Dentin is normally covered by enamel or cementum. As a result of any number of factors, including abrasion or periodontal disease causing gingival recession, or erosion removing the surface of tooth enamel, the underlying dentin and dentin tubules can be-come exposed (Figure 1). An external stimulus such as a change in external temperature, air movement, or physical stimulus can cause discomfort for the patient. The external stimulus is usually transitory, and the discomfort subsides shortly after the stimulus is removed.An accepted theory of how dentin hypersensitivity pain is trans-mitted suggests that pressure or ionic changes in the fluid flow that exists in the dentin tubules stimulates the pain experienced by the patient. This is often referred to as the “hydrodynamic theory.” Inside the dentin tubule, a change in pressure causes a

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change in fluid movement, and this is transmitted to the odonto-blastic process and fires the afferent nerve ending in the dentin tubule (Figure 2). It is, therefore, understandable that the pain caused by this change is transient once the stimulus is removed or it dissipates, the pressure within the tubule returns to normal and the pain subsides.

Treatment and Prevention MethodsThe treatment and prevention of dentin hypersensitivity has focused on eliminating the ability of the causative agent to stim-ulate discomfort. This has resulted in the development of two major classes of products agents that occlude dentin tubules and desensitizing agents that interfere with the transmission of nerve impulses.

Occluding agents act by physically covering or “plugging” the open, exposed dentin tubules, thus preventing the effect of

thermal changes or physical stimuli caused by the movement of dentin fluid resulting from pressure changes. Some of these agents require professional application in the dental office, while others are incorporated in products that are used by the patient at home.

Desensitizing agents work by altering the levels of charged molecules in the dentin fluid. The most commonly used agent is potassium nitrate, usually delivered in a dentifrice that is applied daily by the patient during regular toothbrushing. The potassium ions must pass from the external dentin surface, through the dentin tubule, and into the pulp in order to reduce the excitation caused by the movement of fluid in the dentin tubules. Most products require continued use over a 4 to 8 week period before the patient realizes significant relief. In addition, use of the prod-uct often needs to be continued in order to maintain the relief afforded by the potassium ions/salts.

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The pain associated with dentin hypersensitivity is usually brought on by an external stimulus, and the intensity can differ from patient to patient.

Use of Pro-Argin™

Technology to Treat Dentin HypersensitivityAlthough the traditional methods of treating dentin hypersen-sitivity have been found to be somewhat effective in providing relief to patients, dental professionals continue to look for better, more effective, fast acting, and lasting treatments. In 2009, the Colgate-Palmolive Company introduced a new in-office treatment for dentin hypersensitivity called Colgate® Sensitive Pro-Relief™ desensitizing paste, based on the Pro-Argin™ technology. The Pro-Argin™ technology consists of arginine, a naturally occurring amino acid, and an insoluble calcium compound in the form of calcium carbonate. These ingredients are delivered in a prophy paste containing a mild abrasive, and can be applied with a pro-phylaxis cup to teeth that exhibit dentin hypersensitivity. Mechanism of action studies have shown that this technology physically seals dentin tubules with a plug that contains arginine, calcium, car-bonate, and phosphate. This plug, which is resistant to normal pulpal pressures and to acid challenge, effectively reduces dentin fluid flow, and thereby reduces sensitivity (Figure 3).A number of studies have been published recently supporting the launch of this new product. Laboratory tests demonstrating the product’s mode of action, as well as clinical trials demonstrating relief of dentin hypersensitivity immediately and 4 weeks after a single application, have been presented to the dental profession as evidence that the Pro-Argin™ technology provides instant and lasting relief of dentin hypersensitivity.The full range of research studies can be accessed on the Colgate dental professional website, www.colgateprofessional.com.Treatment with Colgate® Sensitive Pro-Relief™ desensitizing paste is simple and easy to incorporate into everyday practice. The paste is gentle to gingival tissues, does not elicit pain when applied, and has a pleasant mint flavor. The dental professional applies a small amount of paste to sensitive tooth surfaces with a slowly rotating, soft prophy cup. The dental professional should carefully burnish Colgate® Sensitive Pro-Relief ™ desensitizing paste into all sensitive areas, focusing on the cemento-enamel junction and exposed dentin. Application of Colgate® Sensitive Pro-Relief™ desensitizing paste results in immediate relief that lasts for 4 weeks after a single application.1

Clinicians encounter patients with dentin hypersensitivity on a regular basis. While every patient is different, dentin hypersensi-tivity is an indication that can be managed.

1. Schiff T, Delgado E, Zhang YP, et al. Clinical evaluation of the efficacy of an in-office desensitizing paste containing 8% arginine and calcium carbonate in providing instant and lasting relief of dentin hypersensitivity.Am J Dent. 2009;22(Special Issue A):8A-15A.

REFERENCES


In conjunction with the 3rd Meeting of Saudi National Guard and the 1st Meeting of the Saudi Endodontic Society “New Dental Era”, the ICD Middle East Section Meeting was held in Riyadh, KSA at the Marriott Hotel.

All seven lecturers at the continuing education program were ICD fellows or inductees:

Nasser Al Nooh - Stability of Mandibular Bilateral Osteotomy: screws versus plateNassir Hamlan - Back to the Future with Self Ligating BracketsRiad Bacho - STA Computer Controlled Injection Technology in Pediatric DentistryNadim AbouJaoude - Tooth Preparation fo Zirconia-based RestorationsKhali Al Fouzan - Tooth Preparation for Zirconia-Based Restorations Essam Tashkandi - Dental Shade Matching: a guessing Game?Munir Silwadi - Ceramic Veneers: Clinical Bonding Protocol

In the Induction Ceremony that followed, five nominees from Saudi Arabia received the honor of fellowship into the College:Othman Bakkar, Abdulaziz BinAhmed, Abdullah Al Kraidis, Saad AbdulAziz Al Nazhan, and Abdullah Al Shammery.The new fellows were handed their certificates and gold pins by Section President Roy Sabri, Vice President Youssef Talic and President Elect Riad Bacho. Registrar Nadim AbouJaoude, Councilor Cedric Haddad and Regent District 2 Ali AlEhaideb were the other officers taking part in the ceremony.A dinner followed at the traditional Saudi Al Qarya Al Najdah restaurant.

MORE PICTURES AVAILABLE ONwww.facebook.com/dentalnews1

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Officers and newly inducted fellows: seated from left: Regent Ali Alehaideb, President Elect Riad Bacho, President Roy Sabri, Vice President Youssef Talic. Registrar Nadim AbouJaoude, Councilor Cedric HaddadStanding from left: Abdulaziz BinAhmed, Abdullah Al Shammery, Othman Bakkar, Saad Abdul Aziz Al Nazhan, Abdullah Al Keraidis

Professor Dany Buser lecturing on the latest in implant dentistry


Pr. Gabriele Pecora with Dr. Khaled Al Fouzan Head of the Saudi Endo SocietyPr. Gabriele Pecora with Dr. Khaled Al Fouzan Head of the Saudi Endo Society

With the collaboration of the Iraqi Dental Association IDA,

and the support of the Iraqi Ministry of Health and DENTSPLY,

Tamer Levant Ltd, the official dealer of DENTSPLY in Iraq has

held in Erbil Rotana the “train of trainer” course, for a

group of Endodontists from the different provinces of Iraq,

focusing on the latest techniques of using rotary

instruments for more reliable endodontic treatment.

During this course, the participants were given the title of

“DENTSPLY Maillefer official Trainer” in order to be able to

do their own lectures and workshops in their cities.

It’s been a great privilege to Tamer Levant to invite Professor

Edmond Koyess, Maillefer Opinion Leader and chairman of

endodontics department at the Lebanese University who

animated the two days by delivering lectures and conducting

workshops. It was also honored by the presence of Dr Ghada

Bassil, DENTSPLY Continuous Education Manager, and Mr Diaa

Khreish Managing Director of Tamer Levant in Iraq who

confirmed that Tamer Levant is committed to developing the

dental profession through the latest technology adopted

worldwide and to investing more into the education of the

dentists all over Iraq.

Mr Khreish also revealed that the company contracted with

the Iraqi Dental Association to provide all necessary

equipments and materials for the continuous education

courses, free of charge, and added:

“we are now studying the possibility of investing in larger

dental sectors” Also the company held a lecture and

workshop at the Dental Faculty in Hawler University for the

educational cadre of the faculty with the presence of

Dr Ziwar Kassab, the dean of the faculty.

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Professor Koyess During the lecture

Professor Koyess during the workshop day

with Tamer Levant Team (right to left)

Dr Ghada Bassil, Prof Koyess, Diaa Khreish,

Elie Bou Dargham, Alan Ibrahim, Fady Farjo

photo of the group with Prof Koyess

lecture at Hawler Dental college- Erbil

workshop at Hawler University – Erbil

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Saudi Endodontic Society officers

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Smart VibrationsCompothixo™ is a unique generation in compositeplacing and modelling instrument suitable for allclass restorations.

The new Compothixo™ technology optimizes thethixotropic properties of composites by changingviscosity only, without altering the chemical andmechanical characteristics of the material.

• Better wettability

• Superior adaptation of compositeto cavity walls

• Reduction of air bubbles

• Precise application

• Layer thickness control

• Improved sculptability

• Reduced stickiness

Your practice is our inspiration.™ KerrHawe SA P.O. Box 272 6934 Bioggio Switzerland Freephone: 00800 41 05 05 05 Fax: ++41 91 610 05 14 www.kerrdental.eu

Planmeca ProMax 3DUnique product family

1971 - 2011

More informationwww.planmeca.com

Planmeca OyAsentajankatu 6, 00880 Helsinki, Finland tel. +358 20 7795 500, fax +358 20 7795 [email protected]

Perfect sizes for all needs

Romexis • PlanScan • ProMax 3D • ProFace

Romexxxiiisss • Pllan 3D • PProoFFace

Unique 3D combination for open CAD/CAM

3D X-ray • 3D photo • panoramic • cephalometricRomexis software completes 3D perfection

المؤتمر السعودي العالمي الرابع عشر لجامعة الملك سعود لطب األسنانالثالث والعشرون للجمعية السعودية لطب األسنان

King Saud University 14th International Dental Conferencethe 23rd for the Saudi Dental Society

4677763 / 4677743 / 4677764 / 4677534www.sds.org.sa

Venue Riyadh International Exhibition Center14 – 16 Rabi’ 1 1433H . 6 – 8 February 2012

مركز معارض الرياض الدولي خالل الفترة من ١٤-١٦ ربيع األول ١٤٣٣هـ - الموافق ٦ – ٨ فبراير ٢٠١٢م

BisCem®

Dual-Cured Self-Adhesive Resin Cement

Bonds to a multitude of substrates, including metals, composites,

porcelain and amalgam

DUO-LINK�

Dual-Cured Composite Luting Cement

A universal cement ideal for all-ceramic/porcelain, metal and

composites restorations (inlays,onlays, crowns, bridges), as well

as fiber and metal posts

CHOICE� 2Light-Cured

Veneer CementA multitude of shades ensures

the restoration blends well and isnatural looking for any patient

For more information email [email protected] or visit www.bisco.comThe perfect restoration begins with a solid foundation!

BISCO offers the latest technology in cementation and keeps it simple for the clinician byproviding a cement line which covers every Dentist�s indirect restorative needs!

MetaFix™

All·in·One Matrix System

The easiest solution for creating a perfect contact point

• Integrated tensioning and opening device

• Easy creation of contact point

• No additional tools needed

Your practice is our inspiration.™ KerrHawe SA P.O. Box 268 6934 Bioggio Switzerland Freephone: 00800 41 05 05 05 Fax: ++41 91 610 05 14 www.KerrHawe.com


It is indeed a source of great pleasure to welcome all our esteemed guests in the Egyptian Dental Association’s 15th International Dental Congress.The present Congress is the first Congress to be held after our January 25th revolution and in a new era that is witnessing great democratic upheavals in many Arab nations, but with great turmoil still raging in some other nations.It is, however, through such human interaction such as this Congress that people of different backgrounds are brought together and made to better understand each other, which we are sure will ultimately lead to better understanding between us all, as well as to better relations among all our nations. It is indeed one of the major benefits of scientific exchange to bring different people from all over the world together where they may share common goals and objectives.May we wish all our guests a pleasant and enjoyable stay among us, and we sincerely hope that you may fully enjoy the scientific and social programs we have prepared for you.Professor Tarek Abbas HassanPresident of the EDA and the Congress


Prof T. Abbas’ speech during the opening ceremony

Lebanese delegation with the Egyptian Dental Assosiation Board

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Audience during the lecture



EDA

2011

70

EXHIBITION

FLOOR

Dubai gathered for the third time the world experts of Dental - Facial Cosmetic on the 28th - 29th October 2011. An international conference, at the Jumeirah Beach Hotel, open to all aspects and specialists working in the field of aesthetic dentistry.With the excellent ambiance and cozy atmosphere the conference again makes exceptional net-working and connecting the leaders in the field of Aesthetic Dentistry – practitioners, researchers and industry players.

Bringing together industrial leaders and professional practitioners, the conference not only delivered extensive scientific knowledge from across the globe but gave way for an excellent opportunity to present the latest advancements and developments within the Facial Cosmetics practice.The 3rd dental Facial opened the door to open discussion and learning for this knowledge hungry region and allowed the participants to build their skills and use the opportunity for networking and sharing experiences in the application of technology throughout the learning cycle - from primary and secondary education through to professional development and lifelong learning.


Dr. Aisha Sultan with the organizing committee


Mr. Jamal El Hage President of the Lebanese Dental Technicians Order

Mr. Jean Chiha CMDT receiving the trophy from Dr. Mounir Silwadi

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Thank you for subscribing atdentalnews.comThe winner of the W&H LED Contra - Angle Handpiece(ALEGRA WE - 56 LED G)is Dr. Mayssa Adhami from Lebanon

Dr. Mayssa Adhami Winner of the W&H Hand Piece

The Result were also posted on the Dental News Facebook Page (www.facebook.com/dentalnews1)

®

Dr. Wild’s Mideast Regional Office: Actco, P.O. Box 40746, Larnaca 6306, Cyprus, Tel.: (24) 623515 / 654252, Fax: (24) 623844. E-Mail: [email protected]

• Free from chemical bleaching substances, preservatives and enzymes

• Eliminates easily plaque and stains of tea, nicotine, coffee and fruits

• Contains the natural active ingredient pumice

• For professional and home use

DEPURDENT® cleaning and polishing paste for a brilliant smile

DEPURDENT® Mouthrinse - The perfect supplement to DEPURDENT® cleaning and polishing paste!

• Its special formula prevents the formation of plaque and stains and helps to retain the natural white color of the teeth.

• Fluoride protects against caries.• Refreshing taste for long-lasting fresh breath.

, Fax: (244)4) 62338448448444 . . E-ME-ME-M-ME-M- ailailailaiaila ::::: jojojojojooeiseiseiseiseissa@sa@sa@sa@[email protected] ccommc

New

Dr. Wild & Co. AG www.wild-pharma.com

Bahrain: Awal Pharmacy, East Riffa, Bahrain. Egypt: Sesic, Alexandria. Kuwait: Al-Maseela Pharmaceutical Co., Safat. Lebanon: A.M.G. Medical.Jdeideh-Azur Center Oman: Ibn Sina Pharmacy L.L.C., Muscat. Qatar: Ahmed Khalil Al Baker & Sons, Doha. Saudi Arabia: Depot Pharmaceutique du Moyen Ori-ent, Jeddah. Sudan: Pharma Care Co, Khartoum. United Arab Emirates: Al Hayat Pharmaceuticals, Sharjah. Yemen: Al Rawdha Trading Group, Sana’a.

Swiss professional oral care

new

Welcome to the new science of Sensodyne Repair & Protect

Redefining the science of dentine hypersensitivity

Announcing the arrival of Sensodyne® Repair

& Protect, which brings the unique potential

of NovaMin® calcium phosphate technology

to a daily fluoride toothpaste. NovaMin®

builds a reparative hydroxyapatite-like layer

over exposed dentine and within the tubules1-5

to continually help protect your patients

against the pain of dentine hypersensitivity6-8

Now there’s a major advance

to help you meet the challenge

of dentine hypersensitivity

Specialist in dentine hypersensitivity management

References: 1. Burwell A et al. J Clin Dent 2010; 21(Spec Iss): 66–71. 2. LaTorre G, Greenspan DC. J Clin Dent 2010; in press. 3. Efflant SE et al. J Mater Sci Mater Med 2002; 26(6):557−565. 4. Clark AE et al. J Dent Res 2002; 81 (Spec Iss A): 2182. 5. GSK data on file. 6. Du MQ et al. Am J Dent 2008; 21(4): 210−214. 7. Pradeep AR et al. J Periodontol 2010; 81(8): 1167−1113. 8. Salian S et al. J Clin Dent 2010; in press. SENSODYNE® and the rings device are registered trademarks of the GlaxoSmithKline group of companies. Prepared November 2010. Z-10-175.

VARIOLINK® NThe ESTHETIC dual-/light-curing luting composite system

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Dental News December 2011

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Transcript of Dental News December 2011