ISSUE NO. 2
THE DENTAL SCOPE THE FIRST DSSA MIU MAGAZINE THINK FAST AND ACT FASTER IN ANAPHYLACTIC SHOCK EXPLORE ORAL MAXILLOFACIAL SURGERY WITH PROFSSOR KATAMISH AND LECTURER DR. NASR
ROBOTS VS SURGEONS. A STEP TOWARDS THE FUTURE SINGLE VISIT REHABILITATION BY DR. OMAR NABIL EDITOR-IN-CHIEF: ESRAA YOUSEF
SENIOR EDITOR: AHMED AMR MERGHNY
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D S S A
M I U
B O A R D
2 0 1 7 / 1 8
ABOUT DSSA MIU Dental Students' Scientific Association of Misr International University (DSSA MIU) is an NGO local association under the IADS. The International Association of Dental
The dental students’ educational needs go beyond
Students (IADS) is a non-governmental
the dental curriculum and clinical practice within
organization that represents dental students in
the Faculty. Students need to taste extracurricular
60 countries worldwide. It was founded in
activities such as being engaged into abroad
September 1951, during the first IADS General
internships, prophylaxis campaigns, scientific
Assembly that took place in Copenhagen,
events, training sessions and voluntary activities.
Denmark.
Only through these activities they can become leaders of their dental student communities.
IADS Headquarters is based at the FDI World Dental Federation headquarters in Geneva. IADS
DSSA-MIU is a student based association
represents the interests of more than 200,000
empowering MIU students, especially dentistry
dental students in around 60 countries
students, aspires to be recognized as a highly
worldwide including Egypt under the name
competitive academic and research association,
"Dental Students' Scientific Association" (DSSA)
enriching our Egyptian community with it's
founded in 1970.
excellency.
Photography by Mohanad Tarek and Omar El Hambouly
THE DENTAL SCOPE PAGE 03 / ISSUE 02
CONTENTS 07
Single Visit Rehabilitation. A case by Dr. Omar Nabil.
09
Medical Emergency: Anaphylactic Shock.
13
Life of an Oral Maxillofacial Surgeon with Lecturer Dr. Tamer Nasr and Professor Mohamed Katamish.
18
65th Annual IADS Congress in Taiwan.
13 13
18
07 THINK F.A.S.T 09 04 Robotics in Surgery? 05 Prevent Hepatitis: know the facts 06 3D Printing in Surgery 15 T-Spine Mobility Exercises 16 The March to Dentistry 19 Can you diagnose this month's case?
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Robotics in Surgery? Surgical robotics scored the world’s first successful implant surgery performed entirely by a robot with absolutely no human intervention. On Saturday, September the 16th, 2017; Xi’an, China witnessed the success of a dental robot that implanted two 3D-printed implants into a female patient's mouth during a one-hour long procedure. The robot was developed by the collaboration of the Fourth Military Medical University and Beihang University in Beijing. The initiation of this invention was in response to the lack of dentists present which were required to provide a large number of patients with dental implants, in addition to the poor quality of surgery performed to those who previously received implants. Prior to the operation, data of the patient’s skull and jaw was obtained through a CT; a special marking system was used to store the acquired data. The robot was pre-programmed to adjust to the patient’s movements during the operation. With no further human role, The robot autonomously inserted the implants into the patient’s sockets within an error margin of 0.2 to 0.3 mm. The high precision of the robot surgeon offers another advantage within the limited accessibility of the surgical field which often presents difficulty to the human surgeon.
Could robots takeover the practice? *To read more on this subject please use the QR code provided
Summarized by Hadeer Ayman
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Courtesy of The World Hepatitis Alliance
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3D PRINTING IN SURGERY THE INNOVATIVE USE OF PRINTERS WHICH CREATE 3-D PATIENT MODELS
Beth Israel Deaconess Medical Center in Boston won a grant of $40,000 from Wiliam F.Milton fund of Harvard Medical School, in order to use 3D printers to recreate the patient's anatomy, for the purpose of patient education, along with explanation of the proposed treatment plan to be carried out.
DR/Daniel B Jones,MD. Surgery. Beth Israel Deaconess Medical Center.
Dr. Robert Andrews, Dr. Daniel B Jones and Dr. Justin W. King, initiated the idea with the aim to better doctor-patient communication, in addition to fully insuring the informed consent of the patient before proceeding with the Surgery. With the patient 3-D models being readily available for use, this will in turn facilitate efficient training of surgeons students; moreover , they can be used for pre-surgical mock ups in order to prevent complications during the final procedure. Finally, in the case of a cancerous lesion, the CT scan can be printed, for the purpose of guiding the surgeon to it's least traumatic removal. The models are created out of polymers using 3-D printers made by Object Geometries Ltd. These printers work by taking a 3-D computer file and forming a series of cross-sectional slices from it. Each slice is then printed, one on top of the other, to create the 3-D model. Despite their benefits they are very expensive and take a lot of time as each model takes about 15 man hours of work to create. The current use of these 3D models are for training and pre-surgical mock ups and so have not yet been used for patient care to this date.
DR/Justin W. Kung,MD. Diagnostic Radiology. Beth Israel Deaconess Medical Center. Beth Israel Deaconess Hospital-Needham.
Summarized by Doaa Reda
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SINGLE VISIT REHABILITATION Case by Dr Omar Nabil*
Introduction In this edition’s case, Dr. Nabil received a male patient who was complaining of the appearance of his upper right lateral incisor. Upon clinical examination, Dr. Nabil observed that the gingival tissues were not attached to the tooth. upon further investigation, it was noted that the gingiva of the offending tooth, which had an old discolored composite restoration, was hyperplastic, unattached, overlying caries and differed in contour to the gingival margin of the right side. Moreover, the adjacent canine and central were also affected in the same manner. Due to the patient's tight schedule, the full treatment plan was limited to just a single visit.
* Teaching Assistant, Operative department at British University of Egypt. Undertaking Restorative Masters degree at Suez Canal University, Course coordinator of "Fill with Skill".
Case Presentation
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Before The first step in Dr. Nabil’s treatment plan was gingivectomy of the tissues covering the central incisor, lateral incisor and canine. This was done to even out the contours of the gingiva between the left and right sides of the mouth, remove the flabby tissue and expose the decayed tooth structure for proper treatment. This procedure was carried out with the use of a scalpel under local anesthesia. Hemostasis was achieved through firm pressure with a cotton soaked in anesthetic.
Dr. Nabil then proceeded to remove all of the carious lesion. Indirect pulp capping was carried out with Theracal (Resin modified calcium silicate) which serves to improve and stimulate the healing of the pulp to counteract the inflammation caused by the caries.
Due to the poor oral hygiene of the patient, restoration of the teeth was carried out with resin modified glass ionomer, with replacement by composite only after improval of oral hygiene. After which, finishing and polishing was done,
After Written by Youssef Galal
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MEDICAL EMERGENCIES
THINK F.A.S.T ACT FASTER. FACE
AIRWAY
STOMACH TOTAL BODY
By Dr. Hassan Mahmoud*
ANAPHYLACTIC SHOCK Anaphylactic shock is the term used to describe a sudden and acute allergic reaction, due to ingested or injected allergen such as anesthesia or penicillin, that affects multiple organs simultaneously. It is a life-threatening condition that ends by loss of consciousness, cyanosis and death. Because of the severity of such a case, it is of great importance for the dental practitioner to know what to do if ever faced with this emergency. *Misr International University clinics complex manager. American Heart Association instructor for basic life support and first aid courses.
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LOOK OUT FOR THE SIGNS CNS Signs:
Light headedness Loss of consciousness Confusion Headache Anxiety
Angioedema
Respiratory Signs:
Shortness of breath Laryngeal edema Wheezing Cough
Urticaria
Cardiovascular Signs:
Weak and rapid pulse Hypotension Cyanosis
Gastrointestinal Signs:
Abdominal pain Diarrhea Vomiting Pelvic Pain
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DON'T PANIC
Treatment of Anaphylactic shock is simple as long as you act F.A.S.T.
Place Patient in Shock Position to increase venous return.
Administer 0.2 mg/kg of body weight of Epinepherine.
Administer 100% oxygen to compensate for breathing difficulty.
After controlling the Life threatening phase, Administer the following drugs if needed: Diphenhydramine IV to block H1 histamine receptors (Benadryl). Ranitidine IV to block H2 histamine receptors (Zantac). Hydrocortisone every 6 hours as needed. Salbutamol inhilation to relief bronchospasm. IV fluids to counteract fluid imbalance.
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LIFE OF AN ORAL MAXILLOFACIAL SURGEON WITH PROFESSOR MOHAMED KATAMISH AND LECTURER, DR. TAMER NASR
MOTORCYCLE ACCIDENT? FACE TRAUMA AND A BROKEN MAXILLA? A PATIENT WITH A SKELETALLY DEFORMED MANDIBLE? THAT IS PRETTY MUCH ANOTHER DAY IN THE OFFICE OF AN ORAL MAXILLOFACIAL SURGEON AND TO MANY THAT IS THE ULTIMATE DREAM. HOWEVER, TO MANY OF US, THIS DREAM SEEMS UNACHIEVABLE, DISTANT AND JUST NOT POSSIBLE. SO IN THIS EDITION, WE DECIDED TO GET DOWN TO THE FACTS. IS MAXILLOFACIAL SURGERY REALLY ACHIEVABLE? FIND OUT THE ANSWER TO ALL THE QUESTIONS THAT ARE SURROUNDING THIS FIELD WITH PROFESSOR MOHAMED KATAMISH AND LECTURER, DR. TAMER NASR.
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PROFESSOR MOHAMED KATAMISH HEAD OF ORAL AND MAXILLOFACIAL SURGERY DEPARTMENT MISR INTERNATIONAL UNIVERSITY
" AFTER RETIREMENT I MIGHT WORK ON RESEARCHES, AS I CAN’T IMAGINE MYSELF NOT BEING ACTIVELY WORKING AND BEING PRODUCTIVE "* Did you always aspire to be a surgeon?
No, my main aim was prosthesis, as back then, it was the most flourishing branch of dentistry money wise. However, I was designated as deputy surgeon and if i turned back time, i will choose surgery once more.
What was the topic you discussed for your PhD? It focused on the effect of mandibular resection and retrusion on the tempromandibular joint and muscles, during the orthognathic treatment of skeletal class III.
There are many girls that wish they could enter the OMFS path but a lot have told them not to. What is your opinion on that?
Weak anddorapid pulse For those who not know, can you explain Hypotension what Orthognathic Surgery is? Cyanosis
Orthognathic surgery is performed to I am against this concept but to be honest correct a wide range of minor and this path is difficult and will require a lot major skeletal and dental irregularities, including the of work and effort and compromising at the beginning to succeed in it as it is very misalignment of jaws and teeth. Although the patient's appearance challenging and also because the maxillofacial surgeon has to be on call all may be dramatically enhanced as a result of the patient's surgery, time so she have to find the perfect orthognathic surgeries are performed balance between her personal life and to correct functional problems. work.
In your career, what was the most difficult case you faced?
It was Bimaxillary surgery. These are cases in which the maxilla is retruded, the mandible is protruded, with chin deviation present. Orthognathic surgeries are very challenging and only few specialists can handle them.
"SKILL IS AN ADDED BENEFIT TO EXPERIENCE AND KNOWLEDGE" *
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LECTURER, DR. TAMER NASR ORAL AND MAXILLOFACIAL SURGEON
Concerning girls who want to become maxillofacial surgeons, can they handle such cases?
"UNFORTUNATELY DUE TO OUR CULTURE, SOME PEOPLE BELIEVE THAT IF THEY TEACH STUDENTS PROPERLY THEY MAY BECOME COMPETITION AND BE THE REASON WHY THEY LOSE CASES" * Did you always want to become a maxillofacial surgeon? Yes, because my father -god have mercy on his soul- was a surgeon and head of oral maxillo-facial surgery in a specialized military hospital. So I was raised in a house where I used to play with radiographs instead of playing with puzzles. I used to take the radiographs, look at them and ask questions about them. During the days where he had surgeries I used to ask him to tell me everything that happened. So many years later, here I am.
The problem isn’t with girls and boys. It has to do with the fact that , to reach the level that you want, you will have to cancel everything else out including family, marriage and social life. The problem isn’t with the gender; there are females in the department and we have females surgeons that are very capable. The problem is that parents wish to see their daughters get married and have a family which will not be possible with surgery between emergencies and nights on call in the hospital. But there are female surgeons that I still learn from up to this day. So, if your priority isn’t your social life and family and you are willing to spend years learning then go ahead.
Did you meet any cancerous patients in your career?
Not many, but I was put in the situation where I had to tell patients that they had a lesion that was probably cancerous. One time in the clinics, there was a case that no one wanted to handle and they did not want to tell her; but you are not supposed to lie to the patient or over-simplify or over-glorify the case. Ethically, you should tell the patient that his tumor or hyperplasia is not benign and that, if he is treated properly, the chances of death due to that particular lesion should decrease dramatically if God wills it. So you try to give him the complete story without giving him a heart-attack.
Photography by Omar El Hambouly Interviewed by Amr El Husseiny and Reem Ismail Written by Karim Ashraf *quoted by Proffessor Katamish and Lecturer, Dr. Nasr.
Can robots replace surgeons in the future?
In some places, yes. The logic behind using robots is that you either want a remotely controlled operator in the case of military medicine for example or you need a superior amount of precision such as neurosurgery which requires precision within less than a millimeter of space. But in our speciality, for example, the most recent occurrence was that a robot placed an implant without very strict supervision. Despite this, you will always need a surgeon to program the robot, control it and to create a treatment plan. You need the surgeons mind. Robots cannot accommodate the risk of complications, they need straightforward cases.
*tinu latned eht no detaes gnieb fo sdoirep gnol rof tcefrep sesicrexE
T-Spine Mobility Exercises
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1
2
While seated, extend the arms and grab your shins, knees or touch your shoulders
Look up and push your chest forward.
3
Look down and round your back. Repeat.
*Exercises by Coach Mohamed Ihab. Current senior manager at Gold's Gym Avenue. Certified Fitness Trainer, ISSA. Exercise Therapy certification, ISSA.
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THE MARCH TO DENTISTRY AN ARTICLE BASED ON THE REAL EXPERIENCES OF DENTISTRY GRADUATES.
The Dental Student Scientific Association of Misr International University, carried out a survey on 6o graduates with the aim of highlighting issues faced post-graduation. After reviewing the results, three main problems were stated; lack of awareness of dental materials, inability to prescribe the correct medication and the robotic nature of education. The first problem is concerned with Misr International University graduates. The availability of all the materials and instruments in the clinic, makes it harder on the graduate to be aware of the; type, cost and availability in the dental market. The second problem manifests in the form of inability to prescribe correct medications by fresh graduates. This is a result from ignorance on the infinite brand names available in the market and the ideal therapeutic doses needed. The third problem is, as a dental student, the education system in Egypt is highly dependent on; information cramming, sleep deprivation and spoon-feeding.
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65% of postgraduates state that the clinical training they underwent at university was insufficient.
Although the discussed problems are very critical, Albert Einstein once said “The only source of knowledge is experience.”. Thus, to become a skillful, all rounded dentist, you should never allow yourself to be limited by the walls of a lecture room or spoon-fed all the information as this will prevent you from widening your scope of the dental field. Here are the most valuable advice provided by the postgraduates: 1. Try to organise yourself a clinical attachment. 2. Try to get your internship in a teaching hospital. 3. Partake in as many courses as possible. 4. Read continuously to stay updated with the latest research papers and technology. 5. Don't confine yourself to one school of treatment. 6. Make sure you're aware of all the possible medical emergencies. 7. Always refer your patient and never ignore your conscience. Written by Aya Ahmed
77% of postgraduates affirm they were unprepared to prescribe medications.
74% claim they were unaware of the dental market after graduation.
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PROBLEM BASED LEARNING
courtesy of dental.washington
Can you diagnose this month's case? This is a 63-year-old male who presented to his dentist with the chief complaint of a palatal lesion that was of about one month’s duration. The patient stated that about a month prior, he had started to notice roughness in his palate. He consulted with his dentist, who noted a diffuse discolored flat and nodular mass on the palate. The patient was referred for a biopsy. The patient’s health is otherwise stable with no symptoms related to swallowing or speech difficulty. There are no neck nodes or any other symptoms. The patient’s past medical history is significant for rhinoplasty in 1980, malignant melanoma of the skin in 2004 successfully treated with surgery. The patient also had cataract surgery in 2009 and surgery on his right foot in 2008. Histologic examination of the H & E section revealed surface epithelium with atypical melanocytes present within the surface and the deep lamina propria.
*Diagnosis to previous issue's case: Squamous Cell Carcinoma. Wait for the diagnosis in our next issue!
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Dedicated to
"Special thanks to the Scientific committee for their dedication in making this magazine possible. Your persistence and determination is an inspiration to remain as professional and diligent as possible."- Ahmed Khalifa, President of Dental Students'Â Scientific Association 17/18.
Scientific Committee
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