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AEEDC 2011
Volume XVIII, Number I, 2011
Full Maxillary Arch Immediate Implant
2nd Yemen Dental Association meeting
ISSN 1026 261X
22nd Saudi Dental Society conference
Acceleration of orthodontic tooth movement
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CONTENTS Vo l u m e X V I I I , N u m b e r I , 2 0 1 1 EDITORIAL TEAM Alfred Naaman, Nada Naaman, Jihad Fakhoury, Dona Raad, Antoine Saadé, Lina Chamseddine, Tarek Kotob, Mohammed Rifai, Bilal Koleilat, Mohammad H. Al-Jammaz COORDINATOR Vanessa Abdelahad ART DEPARTMENT Krystel Kouyoumdjis SUBSCRIPTION Micheline Assaf, Nariman Nehmeh ADVERTISING Josiane Younes PHOTOGRAPHY Albert Saykali TRANSLATION Gisèle Wakim, Marielle Khoury DIRECTOR Tony Dib ISSN 1026-261X
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Acceleration of orthodontic tooth movement for retraction of upper canine by alveolar corticotomy Dr. Azzam AL-Jundi, Dr. Fadi AL-Naoum
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Factors associated with the utilization of prosthetic dental restoration at Ras-Al-Khaimah dental center, UAE Dr. Israa Hadi, Dr. Raghad Hashim
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Full Maxillary Arch Immediate Implant, Immediate Loading with Final Single Restorations: a 7-Year Follow up Dr. Jihad Abdallah
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5th RIDM – Riyadh International Dental Meeting
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2nd Yemen Dental Association meeting
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22nd Saudi Dental Society conference
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AEEDC Dubai 2011
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Product Review
Pr. 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 l’Unité 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. Dr. Olivier Hue, Faculté de chirurgie dentaire de Paris VII, rue Garancière, Paris, France. Brian J. Millar BDS, FDSRCS, Ph.D. Guy’s, King’s, and St. Thomas’ 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. James L. Gutmann, Professor and Director, Graduate Endodontics, Baylor College of Dentistry, Dallas, Texas, USA. 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.
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INTERNATIONAL CALENDAR March 22 – 26, 2011 IDS 2011 34th International Dental Show The leading trade fair for the dental sector, to be held in Cologne - Germany Website: http://english.ids-cologne.de April 6 – 7, 2011 The 7th Jordanian Orthodontic Congress to be held in Amman. Email: info@jos.org.jo Website: www.jos.org.jo April 9 – 2011 Optimisation des Traitements Prothétiques en Implantolologie Monday, April 9 organized by Lebanese Society of Prosthodontics More Info Dr. Marwan DAAS Email: lsprostho@gmail.com April 9 – 11, 2011 15th Kuwait Dental Association International Scientific Conference Hosted by: Kuwait Dental Association. The event will take place at Kuwait Radisson SAS - Al Hashimi Kuwait. Email: info@kda.org.kw Website: http://www.kda.org.kw April 15 – 16, 2011 1st Iraqi Dental Reunion IDA Annual Conference 2011 Hosted by: Iraqi Dental Association at Erbil Iraq. Tel: +971 50 4243072 Email: info@cappmea.com Website: http://www.cappmea.com/idr2011/sponsorship.html May 6 – 7, 2011 The ITI Middle East The ITI Middle East Section has the pleasure of welcoming you to Beirut for its first Section congress on May 6-7, 2011 at the Palais des Congrès, Dbayeh. Website: http://www.iti.org/ May 9 – 12, 2011 5th Jeddah Dental Esthetic Conference Hosted by: King Faisal Specialist Hospital in Jeddah, KSA. Tel +966 2 667 7777 Email: aal-amoudi@kfshrc.edu.sa Website: http://www.kfshrcj.org
May 12 – 13, 2011 5th CAD/CAM & Computerized Dentistry Int'l Conference At the Address Hotel Dubai Marina, UAE Email: info@cappmea.com Website: www.cappmea.com/cadcam5 May 25 – 26, 2011 1st Aesthetic Dentistry Congress Hosted by: JDA The event will be on 25 and 26 of May. Amman Jordan, +962-795944494 Email: dentist_h@yahoo.com Website: http://www.jda.org.jo June 2 – 4, 2011 12th Lebanese University convention at the Rafic Hariri campus, Hadath, Lebanon entitled “Facing Challenges in Dental Practice” Contact Dr. Elie Maalouf: congresul@ul.edu.lb June 02, 2011 4th Annual Congress Faculty of Dentistry University of Jordan Hosted by: The University of Jordan in Amman Jordan, Email: halahmad@hotmail.com Website: http://www.ju-dentalconference.com September 14 – 17, 2011 FDI Annual World Dental Congress Mexico City 2011 Hosted by: FDI The event will start on: 14 Sep And will end on: 17 Sep At Mexico City Mexico, +41 22 560 81 50 Email: congress@fdiworldental.org Website: http://www.fdiworldental.org September 21 – 24, 2011 21st Lebanese Dental Association Meeting at the Palais des Congres-Dbayeh Email: lda@lda.org.lb Website: http://www.lda.org.lb
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ORTHODONTICS
Acceleration of
orthodontic tooth
by alveolar corticotomy *Azzam Al-Jundi, **Fadi Al-Naoum *Professor of orthodontics department, Albaath university **Master degree in orthodontics, Albaath university Introduction: One method used to accelerate orthodontic tooth movement is the corticotomy-facilitated (CF) technique. Tooth movement and alveolar bone reaction after corticotomies have not been thoroughly examined. In this study, the effects of corticotomies on orthodontic tooth movement were investigated in humans. The purposes of this study were to (1) identify the effect of the CF technique on orthodontic tooth movement compared with the standard technique. (2) evaluate pain and discomfort levels and the levels of satisfaction of the patients about corticotomy, during the treatment. (3) compare between males and females regarding tooth movement velocity on the experimental side. Methods: 30 patients, aged 15 to 24 years, with a mean age (20,04±3,63) years were used in this study. Extraction of the maxillary first premolars. On One side, the corticotomy was performed. The canines were distalized with nickel-titanium coil springs on both sides. Corticotomies were performed on the cortical bone of the maxillary first premolars region in 30 patients (10 male and 20 female). The canines on the experimental side and on the sham side were moved distally with a continuous force of 120g. Results: Tooth movement velocities after the corticotomies were significantly faster on the experimental side than on the sham side.
Conclusions: Orthodontic tooth movement increased after the corticotomies. This might be brought about by rapid alveolar bone reaction in the bone marrow cavities, which leads to less hyalinization of the periodontal ligament on the alveolar wall. Suggested that the acceleration of tooth movement associated with corticotomy is due to increased bone turnover and based on a regional acceleratory phenomenon.
Canine Distalization for extraction cases usually takes 6 to 9 months, contributing to an overall treatment time of 1.5 to 2 years. The duration of orthodontic treatment is one of the issues patients complain about most, especially adult patients. That is why many patients refuse orthodontic treatment. The incidences of caries and periodontal disease also increase when treatment is prolonged.1 To shorten the time for orthodontic tooth movement, various attempts have been made. These attempts fall into 3 categories. The first is local or systemic administration of medicines such as prostaglandins, interleukins, leukotrienes, cyclic adenosine monophosphate, and vitamin D.2-5 The second category is mechanical or physical stimulation such as direct electrical current6 or a samarium-cobalt magnet.7 The last category is oral surgery, including gingival fiberotomy,8 alveolar surgery, and distraction osteogenesis. Distraction osteogenesis is a process of growing DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
13 ACCELERATION OF ORTHODONTIC TOOTH MOVEMENT
movement for retraction of upper canine
14 ACCELERATION OF ORTHODONTIC TOOTH MOVEMENT
ORTHODONTICS new bone by mechanical stretching of the pre-existing bone tissue. In 1998, Liou and Huang demonstrated the rapid canine retraction technique involving distraction of the PDL (PDLD) aided by alveolar surgery undermining the interseptal bone. after extraction of the first premolars.9 Iseri et al and Kisnisci et al. described and clinically used a new technique for rapid retraction of the canines, the DAD.10 In 2001, Wilcko et al.11 reported a revised corticotomy-facilitated (CF) technique that included periodontal alveolar augmentation, called accelerated osteogenic orthodontics; it demonstrated acceleration of treatment to one third of the usual time.12 A corticotomy on the alveolar bone makes orthodontic tooth movement faster than that in conventional orthodontic treatment; this leads to shorter orthodontic treatment times.13-18 According to Hajji,12 the active orthodontic treatment periods in patients with corticotomies were 3 to 4 times more rapid compared with patients without corticotomies. It was believed that a corticotomy makes tooth movement faster because the bone block moves with the tooth.11-16 However, tooth movement after a corticotomy should be considered a combination of the classical orthodontic tooth movement and the movement of bone blocks containing a tooth, because the force applied on a tooth is transmitted into the osteotomy gap through the periodontal ligament (PDL). Bone turnover is well known to be accelerated after bone fracture, osteotomy, or bone grafting.19 This could be explained by a regional acceleratory phenomenon (RAP); i.e., osteoclasts and osteoblasts increase by local multicellular mediator mechanisms containing precursors, supporting cells, blood capillaries, and lymph.20 Similarly, bone turnover is increased by RAP after a corticotomy. The velocity of orthodontic tooth movement is influenced by bone turnover,21,22 bone density,23 and hyalinization of the PDL.1 Wilcko et al.11,15 mentioned, in cases of rapid orthodontics with corticotomies, those corticotomies could increase tooth movement by increasing bone turnover and decreasing bone density. However, the increase of tooth movement after a corticotomy was not always examined in humans. In our study, we intended to elucidate the mechanism of the rapid tooth movement associated with corticotomies by investigating the amount of tooth movement and the alveolar bone reaction on the periodontal tissue of the compression side after corticotomies in humans.
American orthodontics) were used and TPA (transpalatal arch) was soldered to the first upper molars bands. The maxillary left and right canines were chosen to be the experimental and sham sides with one of the random methods. The maxillary first premolars were extracted on both sides to prepare the space for distal movement of the canines. Healing, by the formation and mineralization of callus, usually requires 4 to 16 weeks after bone injury.19 Therefore, at 12 weeks after extraction, the alveolar bone on the experimental side was corticotomized as follows: the gingival mucoperiosteal flaps were raised to expose cortical bone on both the buccal and the lingual sides of the canine (Fig 1 and 2).
Fig 1. Schematic drawing of incision on palatal side.
MATERIAL AND METHODS A clinical prospective study was performed to evaluate the effects of corticotomy in 30 patients (10 male and 20 female) with a mean age (20,04±3,63) years. After conviction there is indication for retraction of the upper canine after extraction of the first upper premolars. The patients were informed of the risks, advantages, and disadvantages of the experiment and they decided to undergo orthodontic treatment after corticotomy and signed a consent form. All patients were treated with preadjusted Straight Wire fixed appliances, with a 0.0220 x 0.0280 slot brackets (Roth, DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
Fig 2. Schematic drawing of incision on buccal side.
The horizontal cut line of the corticotomy was made above the apices of the canine 2-3 mm on the buccal side and at the level of palatal groove on the palatal side. The vertical cut lines were made 1-2 mm apical to the alveolar crests of the canine to the horizontal cut lines on the buccal and lingual sides. Small corticotomy perforations were drilled in the buccal and palatal
ORTHODONTICS One end of the spring was fixed to the hook of the canine bracket with a ligature wire, and the other side was fixed to the hook of the band of the upper first molar. The length of each spring, which corresponded to a contractile force of 120g, was measured with a caliper and strain gauge, and the activation of the spring was set at that length. The force delivery was measured once a week. The distance between canine bracket and first molar hooks was recorded by using a Boley gauge at the following assessment times: after 1 week of corticotomy (T1), after 2 weeks of corticotomy (T2), after 4 weeks of corticotomy (T3), after 2 months of corticotomy (T4) and after 3 months of corticotomy (T5).
Fig 3. Vertical and horizontal corticotomy cuts and perforations on the buccal corticotomy side.
Fig 5. Measurement of the distance between canine bracket and first molar hooks with the Boley gauge.
Fig 4. Vertical and horizontal corticotomy cuts and perforations on the palatal corticotomy side.
Immediately after the corticotomies, the canines of the experimental and sham sides were moved distally along the orthodontic wire with a continuous force of 120 g by using nickel-titanium closed coil springs. The canines were retracted using closed Sentalloy coil springs (American orthodontics) on 0.0190 x 0.0250 stainless steel arch wires.
To evaluate pain and discomfort levels and the levels of satisfaction of the patients about corticotomy during the treatment two specific questionnaires were given to the treated patients. The first questionnaire was given to the treated patients at the following assessment times: after one day of corticotomy (T1), after 3 days of corticotomy (T2), after 5 days of corticotomy (T3), after 1 week of corticotomy (T4). The Second questionnaire was given to the treated patients at the following assessment times: after 1 month of corticotomy (T1), after 2 months of corticotomy (T2), after 3 months of corticotomy (T3). DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
15 ACCELERATION OF ORTHODONTIC TOOTH MOVEMENT
cortical bone. There were about 20 perforations according to the alveolar process area in each patient. These perforations were made to obtain additional bleeding points. (Fig 3 and 4). The corticotomy process was performed with a fissure bur (width 2 mm), The corticotomy cuts and perforations were made with a round bur (diameter 2 mm), under saline-solution irrigation. The width of bone cuts was approximately 2 mm, and the depth was carefully adjusted to reach the bone marrow by confirming bleeding through the cut lines. The mucoperiosteal flaps were sutured with absorbable surgical sutures.
ORTHODONTICS STATISTICAL ANALYSIS The error of the method was calculated for the distance of tooth movement based on double measurements on 10 randomly selected distances of tooth movement measurements and was estimated as S = √∑(d)2/2n, where n = number of paired measurements and d = deviations between the 2 measurements. The error of the method for measurement of tooth movement was 0.028 mm. Comparison of tooth movement velocity between experimental and sham groups with Mann-Whitney U test.
16 ACCELERATION OF ORTHODONTIC TOOTH MOVEMENT
RESULTS The movement velocity on the experimental side was also faster than that on the sham side throughout the experiment (Fig 6). There was a significant difference between the experimental and sham sides at T0-1 and T1-2; movement was approximately 4 times faster on the experimental side. There was a significant difference between the experimental and sham sides at T2-3 and T4-5; movement was approximately 3 times faster on the experimental side. At T3-4 there was a significant difference between the experimental and sham sides movement was approximately twice faster on the experimental side. The main significant findings of the treatment were: (1) There was a significant difference in tooth movement velocity, about 2-4 times faster on the experimental compared with the sham side. (2) No significant differences were detected between males and females regarding tooth movement velocity on the experimental side. (3) No significant differences were detected between males and females regarding tooth movement velocity on the sham side. The questionnaire showed: (1) the corticotomy has a high levels of pain, swelling and discomfort for the first week only. (2) No significant differences were detected between males and females with regarding pain and discomfort. (3) The degree of discomfort at activating the retracting spring was significantly greater on the sham side than that on the experimental side.
significantly accelerated tooth movement. The rate of tooth movement in the CF group was 2-4 times of that in the S group. Tooth movement velocity on the experimental side was significantly faster than on the sham side at T0-1 and T1-2 approximately 4 times faster on the experimental side. Therefore, it is suggested that orthodontic tooth movement increased especially in the early stage after the corticotomies. These results agree with those of Iino et al.,24 who reported significant acceleration of tooth movement in their animal study. The findings corroborate the clinical observations of Wilcko et al.11,15 and Hajji,12 who reported significant reductions in treatment time with CF orthodontics. In this study, Tooth movement began immediately after corticotomy. On the other hand, Iino et al.24 used both labial and lingual corticotomy cuts near the moving premolar. The acceleration of tooth movement in this study was similar to that reported by Ren et al.,25 who used a surgical technique that depended on undermining the interseptal bone in a premolar-extraction canine experiment. The anchorage loss was not measured in this study. We focused on the influence of corticotomy on tooth movement. After the corticotomies in our study, the alveolar bone reaction increased simultaneously with orthodontic tooth movement near the corticotomy possibly by RAP at an early stage. Clinically, it is generally believed that a heavier orthodontic force is needed for the en-masse movement of the bone block with the tooth after a corticotomy.13,14,16,17 However, our results suggest that conventional orthodontic force would increase the velocity of orthodontic tooth movement, possibly by the acceleration of the bone turnover mechanism at an early stage after a corticotomy. No significant differences were detected between males and females regarding pain and discomfort. This result agrees with this of Ngan et al.26
CONCLUSIONS DISCUSSION This study was undertaken to investigate the influence of corticotomy on tooth movement between the CF and the Standard orthodontic techniques. Our results showed that the CF technique
Fig 6. Comparison of tooth movement velocity between experimental and sham groups with Mann-Whitney U test. DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
This study shows that the alveolar corticotomy procedure increases orthodontic tooth movement with accepted degrees of pain and discomfort.
Fig 7. Comparison of tooth movement velocity between males and females groups in experimental side.
REFERENCES
1. Bohl MV, Maltha JC, Von den Hoff JW, Kuijpers-Jagtman AM. Focal hyalinization during experimental tooth movement in beagle dogs. Am J Orthod Dentofacial Orthop 2004;125: 615-23. 2. Lee W. Experimental study of the effect of prostaglandin administration on tooth movement with particular emphasis on the relationship to the method of PGEI administration. Am J Orthod Dentofacial Orthop 1990;98:231-41. 3. Mohammed AH, Tatakis DN, Dziak R. Leukotrienes in orthodontic movement. Am J Orthod Dentofacial Orthop 1989;95:231-7. 4. Yamasaki K. The role of cyclic AMP, calcium and prostaglandins in the induction of osteoclastic bone resorption associated with experimental tooth movement. J Dent Res 1983;62:877-81. 5. Collins MK, Sinclair PM. The local use of vitamin D to increase the rate of orthodontic tooth movement. Am J Orthod Dentofacial Orthop 1998;94:278-84. 6. Davidovitch Z, Finkelson MD, Steigman S, Shanfeld JL, Montgomery PC, Korostoff E. Electric currents, bone remodeling, and orthodontic tooth movement. II. Increase in rate of tooth movement and periodontal cyclic neucleotide levels by combined force and electric current. Am J Orthod 1980;77:33-47. 7. Darendeliler MA, Sinlcair PM, Kusy RP. The effect of samariumcobalt magnets and pulsed electromagnetic fields on tooth movement. Am J Orthod Dentofacial Orthop 1995;107:578-88. 8. Tuncay OC, Killiany DM. The effect of gingival fiberotomy on the rate of tooth movement. Am J Orthod 1986;89:212-5. 9. Liou EJW, Huang CS. Rapid canine retraction through distraction of the periodontal ligament. Am J Orthod Dentofacial Orthop. 1998; 114:372–382. 10. Iseri H, Kisnisci R, Bzizi N, Tuz H. Rapid canine retraction and orthodontic treatment with dentoalveolar distraction osteogenesis. Am J Orthod Dentofacial Orthop. 2005; 127:533–541. 11. Wilcko MH,Wilcko MT, Bouquot JE, Ferguson DJ. Rapid orthodontics with alveolar reshaping: two case reports of decrowding. Int J Periodontics Restorative Dent 2001;21:9-19. 12. Hajji SS. The influence of accelerated osteogenic response on mandibular decrowding [thesis]. St Louis: St Louis University; 2000. 13. Köle H. Surgical operation on the alveolar ridge to correct occlusal abnormalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1959;12:515-29. 14. Converse JM, Horwitz SL. The surgical orthodontic approach to the treatment of dentofacial deformities. Am J Orthod 1969;55: 217-43. 15. Wilcko WM, Ferguson DJ, Bouquot JE, Wilcko MT. Rapid orthodontic decrowding with alveolar augmentation: case report. World J Orthod 2003;4:197-205. 16. Chung KR, Oh MY, Ko SJ. Corticotomy-assisted orthodontics. J Clin Orthod 2001;35:331-9. 17. Hwang HS, Lee KH. Intrusion of overerupted molars by corticotomy and magnets. Am J Orthod Dentofacial Orthop 2001; 120:209-15. 18. Suya H. Corticotomy in orthodontics. In: Hosl E, Baldauf A, editors. 19. Frost HM. The biology of fracture healing. An overview for clinicians. Part I. Clin Orthop Related Res 1989;248:283-93. 20. Yaffe A, Fine N, Binderman I. Regional accelerated phenomenon in the mandible following mucoperiosteal flap surgery. J Periodontol 1994;65:79-83. 21. Verna C, Dalstra M, Melsen B. The rate and the type of orthodontic tooth movement is influenced by bone turnover in a rat model. Eur J Orthod 2000;22:343-52. 22. Verna C, Melsen B. Tissue reaction to orthodontic tooth movement in different bone turnover conditions. Orthod Craniofac Res 2003;6:155-63. 23. Goldie RS, King GJ. Root resorption and tooth movement in orthodontically treated, calcium-deficient, and lactating rats. Am J Orthod 1984;85:424-30. 24. Iino S, Sakoda S, Ito G, Nishimori T, Ikeda T, Miyawaki S. Acceleration of orthodontic tooth movement by alveolar corticotomy in the dog. Am J Orthod Dentofacial Orthop 2007;131:448.e1-8. 25. Ren A, Lv T, Kang N, Zhao B, Chen Y, Bai D. Rapid orthodontic tooth movement aided by alveolar surgery in beagles. Am J Orthod Dentofacial Orthop 2007;131:160.e1-10. 26. Ngan P, Kess B, Wilson S. Perception of discomfort by patients undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:47-53.
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PROSTHETIC DENTISTRY
Factors associated with the utilization of at Ras-Al-Khaimah dental center, UAE *Dr. Israa Hadi, **Dr. Raghad Hashim *RAK dental center, UAE **Ajman University, Ajman, UAE
Introduction Ras-Al-Khaimah (RAK) is located on the Arabian Gulf. It borders Umm Al Quwain, Sharjah, and Fujairah and has long borders with the Sultanate of Oman. The total area of the Emirate of Ras-Al-Khaimah is 2478 km2 according to the survey administration of municipality department. In 2007 the total Population of Ras-Al-Khaimah was officially estimated at 214.000, 132.000 Male and 82.000 Female.1 During 2006 the number of attendants to the Dental Clinics in Ras-Al-Khaimah was 45.519 patients, 8.712 were citizen of whom 2.088 were new cases & 6.624 were follow up cases. Prosthetic treatments are provided by RAK dental center only (where only UAE nationals entitled to receive treatment free of charges). Cases treated are referred from the all dental clinics in Ras-Al-Khaimah. It is well known that total or partial edentulism is a good indicator of the oral health of population.2, 3 Edentulism can substantially affect oral and general health as well as the overall quality of life 4, 5. Teeth play an important role in the maintenance of a positive self-image. Therefore, loss of teeth results in significant disabilities, which can profoundly disrupt social activities. Tooth loss is very traumatic and upsetting and is regarded as a serious life event that requires significant social and psychological readjustment.6, 7 Whilst specific diseases like dental caries and periodontal disease are the major cause of tooth loss,8, 9, 10 several non-disease factors such as attitude, behavior, dental attendance, and characteristics of the health care system tend to influence in the decision to become edentulous 11. Significant relationship between socio-demographic
variables and edentulism, with age and socio-economic status playing vital roles in edentulism and denture demand.12 Many studies reported that the incidence of edentulism correlated with educational levels and income status, with those in the lower levels exhibiting higher risks of becoming totally edentulous.13, 14 Furthermore, inadequate diet contributed to widespread premature and heavy losses of permanent teeth 15. Tobacco use is a risk factor in tooth loss particularly in people having a high consumption over several years 16. Recent surveys have shown higher frequency of tooth loss among adults in the industrialized countries than among their counterparts in developing countries, where access to dental care is limited.17, 18 In some circumstances stress and other psychological factors may greatly impact health status,19, 20 including oral health. In order to improve the quality of life that is compromised because of the loss of teeth, dentists often recommend removable or fixed prostheses for patients with missing teeth. Epidemiological data on health and its related issues are very important in order to plan for future health care provision. To our knowledge, there is no epidemiological study on edentulousness or prosthetic dental restoration in Ras-Al-Khaimah. The aim of the current study is to determine the prevalence of various types of prosthetic dental restorations among patients who have been treated in the prosthetic department of RAK dental center (the only government dental center which provides this service in RAK) and to investigate its association with some of the socio-demographic characteristics and general health status. DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
19 FACTORS ASSOCIATED WITH THE UTILIZATION OF PROSTHETIC DENTAL RESTORATION
prosthetic dental restoration
PROSTHETIC DENTISTRY Table 1. Participants’ characteristics by age, gender
NUMBER AGE 25 – 34 35 – 44 45 – 54 55 – 64 ≥ 65 GENDER Male Female
years years years years
PERCENTAGE
231 136 235 232 174
22.9 13.5 23.3 23.0 17.2
358 651
35.5% 64.5%
20 FACTORS ASSOCIATED WITH THE UTILIZATION OF PROSTHETIC DENTAL RESTORATION
Method
% % % % %
Results A total of 1009 patients were included in this study, 358 (35.5%) male and 651 (64.5%) female. The age range of the participants was 25-70 years with the mean age of 44.8 (sd=14.0) years. The utilization of complete dentures, single complete dentures (with or without other prosthetic restoration) and removable partial denture (one or more) were (17.4%), (7.8%), and (39.3%) respectively while, the utilization of the fixed restorations (bridges or implant), crowns were (20.4%), (15.0%) respectively (data not presented). The association between various type of prosthetic dental restoration used and other variables (age, gender,employment status and medical history) are presented in Table 2. The use of the removable dental prostheses (RPDs) was the highest 397 (39.4%). There was statistically significant association between wearing complete denture in both jaws or single complete denture (with or without other prosthetic restoration), and age. The uses of RPD were significantly higher in patients younger than 65 years. Similarly the use of fixed restoration was significantly higher in patients younger than 65 years. Crowns were used more often in patients aged from 25-34 years. There was a significant assosiation between gender and the demand for prosthetic dental restoration, 64.5% of the female used it, while only 35.5% were male (Figure 1). Complete dentures in both jaws were significantly more common among female 103 (10.2%) than among male 73 (7.2%). While, the rate of single complete denture (with or without other prosthetic restoration) almost the same among both male and female patients. Compared with 230 females, only 167 males had one or more removable partial denture. Females utilization of fixed restorations
Data has been collected from the patient’s files that have been treated in RAK dental center between February 2005 December 2007 (patients who came for consultation only or did not finish their treatment were not included in this study). Ethical approval for the study was obtained from the ministry of health – RAK medical district. The collected data included the age, gender, employment status and the general health condition of the participants, in addition to types of prosthetic restoration used. According to the type of the prosthetic restoration used, nine categories were included: (1) complete denture (fully edentulous), (2) single complete denture, (3) single complete denture with partial (removable or fixed), (4) single removable partial denture, (5) more than one removable partial denture, (6) Removable partial denture with Fixed partial denture (one or more), (7) single fixed partial denture (bridge or implant), (8) more than one fixed partial denture (bridge or implant), (9) crown or crowns. Regrouping had been made as follow: (1) “complete denture” (fully edentulous), (2) “single Table 2. The association between prosthetic dental restorations used and other variables. complete denture” and/ or single CD SINGLE CD FIXED RPD complete denture with partial, (3) RESTORATION /+ RPD “removable partial denture” representing AGE 60 77 3 1 single removable partial denture, or 25 – 34 years 47 54 3 1 more than one removable partial denture, 35 – 44 years 115 49 29 17 or removable partial denture with 45 – 54 years 116 23 54 35 fixed partial denture (one or more), (4) 55 – 64 years ≥ 65 59 3 87 25 “fixed partial denture”, representing single fixed partial denture (bridge or GENDER implant), or more than one fixed Male 167 50 73 38 partial denture (bridge or implant). (5) Female 230 156 103 41 for “Crowns”. Unfortunately patients’ level of education EMPLOYMENT STATUS 116 57 38 18 was not mentioned in the patient’s file Employed 281 149 138 61 so we choose employment status as an Unemployed alternative. General health condition included four categories: Healthy, Diabetics, Hypertension, and other illness. Data were analyzed using SPSS program version 13.0. DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
MEDICAL HISTORY Healthy Diabetics Hypertension Other illness
86 23 29 5
46 5 17 2
261 37 45 8
173 7 13 5
CROWN
90 a 31 25 4 —
30 a 121
31 120
135 a 4 2 5
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PROSTHETIC DENTISTRY were three times more than male, similarly the utilization of crowns were four times higher among female. With regard to the employment status and the utilization of various types of prosthetic dental restoration, it was quite clear that the unemployed participants were the group of highest demand for all types of prosthetic dental restoration. Considering the health status, healthy patients (69.5%) tended to use prosthetic dental restoration more often than those with medical conditions.
22 FACTORS ASSOCIATED WITH THE UTILIZATION OF PROSTHETIC DENTAL RESTORATION
Discussion In the past, tooth loss in adults has been mainly attributed to periodontal disease and caries, moreover, apart from oral disease various non-disease indicators such as socio-demographic factors, dental utilization behaviors have shown to be associated with tooth mortality. Therefore, knowledge of factors that influence the uses of prosthetic dental prosthesis will be important for effective planning and provision of oral health services. While in developed countries the need for removable partial denture or complete dentures declines, in less developed countries the need for removable partial or complete dentures is still increasing 21, 22. As expected and consistent with the findings of other studies 23, 24 , the results revealed a significant association between the use of various dental prosthesis and age. It is believed that with increasing age, oral and dental problems increase. Although with increasing age, there is a decline in taste and smell 25, which can influence the status of oral health and function; age alone is not responsible for the deterioration of oral health. There may be several other factors such as multiple chronic diseases, intake of several medications and their side effects, socio-economic factors and psychological factors such as depression and isolation (because of gradual loss of spouse and friends and feeling of being unwanted by family members), leading to neglect of personal hygiene and health 26,27. In a multivariate analysis of oral health survey conducted on the elderly in the UK, it was found that age and educational level had the largest effect on level of edentulousness, persons over 75 years of age were 144 times more likely to have lost all their teeth compared with persons of 16-44 years of age. Similarly persons with no qualifications were nine times and people with qualification below degree level were four times more likely than persons with higher qualifications to be edentulous 28. Our findings showed that unemployed individuals experienced significantly more tooth loss than the employed participants that might be a reflection of either being retired or having no qualifications. In a study reported from Germany on older adults, it was found that educational level had a direct impact on level of edendulousness 29. Low education level was associated with increased level of edentulousness. Thus, the findings of the present study are in conformity with the German study Whereas lots of studies 30, 31 revealed a significant association between uses of dental prosthesis and age, our study showed that DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
uses of removable and fixed partial denture were significantly higher in patients younger than 65 years, in contrast, complete denture utilization was significantly higher among those who aged 65 and above. In conformity with the findings of other studies 32, 33 the present study showed that females were more likely to wear dentures than males. the demand for prosthetic dental restoration were 64% among females while only 35% males. This probably is a reflection of the gender-related differences in the use of dental services. Older women tend to use dental services more often than older men 32. Moreover for older women, oral health can have impact on their feeling of attractiveness 34. This could have contributed to a higher level of denture wearers among women than men. In the present study employment status also emerged as a factor that influenced denture status, the utilization of all dental prosthesis were higher among unemployed patients, being unemployed might reflect the level of educational attainment this is consistent with finding of Shah et al. study 25, where he reported that the prevalence of wearing of dentures increased with the increase in the level of literacy.
Conclusion This study reveals that the prevalence of wearing RPDs was high among the prosthetic departments` patients in RAK dental center. The highest frequency of fixed and RPDs among unemployed may reveal an association between tooth loss and education attainment or due to low level dental health care awearness. Further research is required to identify factors contributing to tooth loss among those patients. Efforts are needed to increase dental health care awareness among such group of patients by implementing some educational program. This study might be considered as a base line for further study to be conducted in the future. Acknowledgements: The authors would like to thank the staff of RAK dental center for their assistance in this study .
PROSTHETIC DENTISTRY REFERENCES
31:403-11. 19. Angelilo IF, Sagliocco G, Hendricks SJ, Villari P. Tooth loss and dental caries in institutionalized elderly in Italy. Community Dentistry Oral Epidemiology 1990; 18:216-218. 20. Pallegedara C and Ekanayake L. Tooth loss, the wearing of dentures and associated factors in Sri Lankan older individuals. Gerodontology 2005; 22: 193-199. 21. Moskona D, Kaplan I. Oral health and treatment needs in a non-institutionalized elderly population: experience of a dental school associated geriatric clinic. Gerodontology 1995; 12:95-98. 22. Dolan TA, Gilbert GH, Duncan RP, Foerster U. Twenty-four month incidence of root caries among a diverse group of adults. Community Dentistry Oral Epidemiology. 2001; 29:329-340. 23.Slade G, Spencer J, Gorkic E, Andrews G. Oral health status and treatment needs of non-institutionalized persons aged 60+ in Adelaide, South Australia. Australian Dental Journal. 1993; 38:373-380. 24.Shah N, Parkash H, Sunderam R. Edentulousness denture wear and denture needs of Indian elderly, a community based study. Journal Oral Rehabilitation 2004; 31:467-476. 25. Shah N. Geriatric oral health issues in India. International Dental Journal 2001; 51:212-218. 26. Ship JA. The influence of aging on oral health and consequences for taste and smell. Physiology behavior 1999; 66:209-215. 27. Ganguli M, Dude S, Johnston JM, Pandav R, Chandra V, Dodge HH. Depressive symptoms, cognitive impairment and function impairment in a rural elderly population in India: a Hindi version of the geriatric depression scale. International Journal of Geriatric Psychiatry. 1999; 14:807-820. 28.Treasure E, Kelly M, Nuttal N, Nunn J, Bradnock G, White D. Factors associated with oral health: a multivariate analysis of results from the 1998 Adult Dental Health survey. British Dental Journal 2001; 190:60-67. 29. Nitschke I. Geriatric oral health issues in Germany. International dental Journal 2001; 51:207-211. 30. Al-Shammery A, El-Backly M, Gutle EE. Permanent tooth loss among adults and children in Saudi Arabia .Community Dental Health 1998; 15: 277-280. 31. Klein BE, Klein R, Knudston MD. Life style correlates of tooth loss in an adult Midwestern population. Journal of Public Health Dentistry 2004; 64:145-150. 32. McGrath C, Bedi R. Sever tooth loss among UK adult --who goes for oral rehabilitation. Journal Oral Rehabilitation 2002; 29:240-244. 33.Ettinger RL, Worren JJ, Levy SM, et al. Oral health: Perceptions of need in a rural Iowa county. Special Care in Dentistry 2004; 24:13-21. 34. Trulsson U, Engstrand P, Berggren U et al. Edentulousness and oral rehabilitation: experiences from patients’ perspective. European journal Oral Sciences 2002; 110: 417424.
ar
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te e
1. The Studies and Statistics Administration Department. Economic Development Statistical Year Book 2007. 2. Marcus PA, Joshi A, Judith AJ, Morgano SM. Complete edentulism and denture use for elders in New England. Journal Prosthetic Dentistry 1996; 79:260-266. 3. Brodeeur JM, Benigeri M, Naccache H, Olivier M, Payette M. Trends in the level of edentulism in Quebec between 1980 and 1993. Journal of the Canadian Dental Association 1996; 62:159-160. 4. Lacopino AM, Wathen WF. Geriatric prosthodontics: an overview, Part I. Pretreatment consideration. Quintessence International 1993; 24:259-266. 5. Lacopino AM. Wathen WF. Geriatric prosthodontics: an overview. Part II. Treatment consideration. Quintessence International 1993; 24:353-361. 6. Omar R, Tashkand E, Abduljabbar T, Abdullah MA, Akeel RF. Sentiments expressed in relation to tooth loss: a qualitative study among edentulous Saudis. International Journal of Prosthodontics 2003; 16:515–20. 7. Fiske J, Davis DM, Frances C, Gelbier S. The emotional effects of tooth loss in edentulous people. Br Dent J 1998; 184:90–93. 8. Kaimenyi JT, Sachdera P, Patel S. Causes of tooth mortality at the Dental Hospital Unit of Kenyatta National Hospital of Nairobi, Kenya. Odonto-Stomatologie Tropicale 1988; 1:17-20 9. Brekhus PJ. Dental disease and its relation to the loss of human teeth. Journal of American Dental Association 1929; 2237-2247. 10. MacGregor IDM: Pattern of tooth loss in a selected population of Nigerians. Archive Oral Biology 1972; 17:1573-1582. 11. Bouma J. On becoming edentulous. An investigation into the dental and behaviour reason for full mouth extraction. Thesis Ryksuniversteit te Grmingh 1984. 12. Esan TA, Olusile AO, Akeredolu PA, Esan AO. Socio-demographic factors and edentulism: the Nigerian experience. BMC Oral Health 2004; 4:3. 13. Eklund SA, Burt BA: Risk factor for total tooth loss in the United States: Longitudinal analysis of national data. Journal of Public Health Dentistry 1994; 51(1):5-14. 14. Caplan DJ, Weintraub JA. The oral health burden in the United States: a summary of recent epidemiologic studies. Journal of Dental Education 1993; 57(12):853-862. 15. Hunter JM, Arbona ST. The tooth as a marker of developing world quality of life: a field study in Guatemala. Social Science Medicine 1995; 41(9):1217-1240. 16. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dentistry Oral Epidemiology 2005; 33(2):81-92. 17. Manji F, Baelum V, Fejerskov O. Tooth mortality in an adult rural population in Kenya. Journal Dental Research 1988; 67(2):496-500. 18. Henriksen BM, Axell T, Laake K. Geographic differences in tooth loss and denture wearing among the elderly in Norway. Community Dentistry Oral Epidemiology 2003;
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IMPLANT DENTISTRY
Full Maxillary Arch Immediate Implant Immediate Loading with Final Single Restorations: A 7-Year Follow up 26 FULL MAXILLARY ARCH IMMEDIATE IMPLANT
Jihad Abdallah BDS, MScD, FAAID, FICD, ABOI/ID *Teaching Staff and Implant Program Coordinator – Beirut Arab University (B.A.U) implant@cyberia.net.lb
Successful implant placement immediately after tooth extraction has been well reported in the literature. In this case report, the immediate implant placement and immediate loading of a full maxillary arch is described. Although the temporary restoration was a fixed bridge connecting the twelve implants; the final restoration was twelve single crowns and followed up for 87 months in function. Key Words: dental implants, immediate implant placement, immediate implant loading, locking tapper
osseointegration 3. Since the implant abutment connection, in this implant system that we are using (BiconTM), is a locking taper; single implant restorations could be safely used. Certain implant abutment connections (some screw type) are not secure enough to have single molar restorations, it is recommended to splint 2-3 implants together to prevent the micromotion that might lead to prosthetic failure especially at the weakest point which is the connecting screw 4,5.The only concern that remains is to place an un-splinted implant of enough size to hold masticatory forces especially at the molar area.
Introduction Recent advances in implant surgery have made it the standard of care and it now provides a simplicity that is demanded by our patients. Loading directly after implant insertion is of clinical interest since this considerably shortens treatment time. However, early excessive micromotion after implantation interferes with local bone healing and predisposes a fibrous tissue interface instead of osseointegration 1. As the patient was asking for simple implant restorations, this large number of implants connected in one bridge during healing made the procedure more predictable. It is the macromovement of the implants during healing that leads to fibrous encapsulation of the implants due to scar formation instead of regeneration of bone around implants 2. So properly splinted implants prevents destructive lateral forces on solitary implants and will provide the healing environment needed for DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
Surgical Procedure A 56-year-old healthy patient came in to the Beirut Implant Dentistry center. The patient presented with failing teeth and mobile fixed restorations in the maxillary arch indicating clearance of remaining tooth structure (figure 1). The patient was missing teeth number 1, 2, 3, 4, 12, 15, 16, 17, 18, 31 and 32, and had chronic marginal periodontitis with class I occlusal Angle’s classification. After signing the informed consent, the patient underwent a maxillary arch restoration with 12 immediately placed and loaded implants, under local anesthesia. After trial of the vacupress stent and its proper support on the palatal and labial tissues, the patient was draped and local anesthesia was applied. Periotomes were used to luxate remaining teeth to remove them atraumatically. This was followed by the extraction
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28 FULL MAXILLARY ARCH IMMEDIATE IMPLANT
IMPLANT DENTISTRY of teeth number 5, 6, 8, 9, 10, 11, 13, 14. Proper curettage of the sockets ensured that no granulation tissue was left behind (figure 1). Tissue punch was used to expose crestal bone and sites of implants 3, 4, and 12. After placing the implants in their osteotomies, the shouldered stealth abutments were connected with finger pressure only. The vacupress was placed in the patient’s mouth to check the proper selection of abutment size and angulation. The snap-on abutment covers were then connected to their corresponding abutments (figure 2). The vacupress stent was placed again on top of the connected snap-on acrylic sleeves to make sure that we still have enough space for injecting BIS-GMA around abutments and inside the stent to fabricate the temporary bridge (figure 2). Before the acrylic had set, the stent and temporary bridge were removed, all excess was properly trimmed, and embrasures opened and then balanced occlusion verified with no premature occlusal contact. The patient was given post-operative instructions and dismissed. The patient was instructed to immediately report to the clinic if and as soon as acrylic bridge instability was detected in order to avoid permanent damage. Ice packs were applied during the first 24 hours following surgery. Warm saline water baths followed this for the next week. The amoxicillin regimen (2 grams, 1 hour before surgery then 1 gram before bed for 1 week) was maintained for 7 days. Post-operative care also included 600 mg of Ibuprofen until the pain and swelling stopped. Regular check-ups were performed to check for stability and integrity of the temporary acrylic bridge. Check-ups also screened for any fractures that needed immediate repair.
in their original positions. The same procedure was performed on the left side with the right side acting as a reference for Vertical Dimension of occlusion. The cast of the mandibular impression was duplicated by the lab technician so two separate cases could be mounted (left and right). The lab technician also prepared abutments and new temporaries on the final abutments. After transferring the abutments from the cast to the patient’s mouth using the Duralay® resin guide, the final abutments were permanently tapped in place (figure 3). The new acrylic single temporary restorations were tried and occlusion was verified. Any corrections on occlusion or margins were done using cold cure white acrylic at that stage. Again, two impressions were taken for the right and left while keeping the cross arch abutments in thereby maintaining the VDO. The lab technician finalized the single PFM restorations and the main issue at try-in was checking contact points and occlusion.
Figure 2 Intra-oral clinical pictures of the implants in place, the stealth abutments, the acrylic snap on stealth abutments and the temporary restoration.
Figure 1 Preoperative intra-oral picture, preoperative panoramic x-ray, and intra-oral clinical picture after removal of the failing restorations and intra-oral clinical picture after extraction.
Prosthetic Restoration During prosthetic restoration, the acrylic bridge was divided into two sections at the midline between the two central incisors. The right acrylic bridge was removed, as were the stealth abutments. Implant level impression was taken of implants 3, 4, 5, 6, 7, 8 as well as a bite registration all that while keeping the left bridge in place. The stealth abutments and acrylic bridge were placed back DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
As proper margins and embrasures with proper occlusion were respected during the fabrication of the prosthesis, the main concern following prosthetic restoration was proper home care, including brushing and flossing. As such, the patient received proper instruction in plaque control and management (chlorhexidine mouthwash, dental brushing with anti-plaque toothpaste, interdental brushes and dental floss when appropriate). The importance of proxy-brush was explained to the patient after helping him choose the proper size of proxy brush. The patient was asked to visit the office regularly (every 4 months) for scaling and cleaning. A panoramic X-ray was taken every year. Following prosthetic completion, two implants (# 13 and 14) became a little mobile but did not present with pain or any other complications. The percentage of bone to implant may have been insufficient. Both implants were replaced. The replacements remain functioning and in excellent condition as confirmed by the panoramic radiograph and clinical photographs which were taken every year for the past 7 years.
IMPLANT DENTISTRY
Figure 5 Panoramic radiograph taken right after ceramic restoration placement and the figure on the right is the panoramic radiograph taken 7 years later.
Conclusion
Figure 3 Clinical intra-oral pictures of the stealth abutments after healing, temporary restorations on the final abutments, metal try in, and the final ceramic restorations.
Extraction, immediate placement and loading of dental implants is a successful treatment plan that is well tolerated by patients. Follow up for 7 years shows the stability of the dental implants, bone and restorations, which was evident by the panoramic radiograph and clinical pictures (figure 4). Placement of single restorations did not affect the longevity of these implant restorations. It should be noted that this treatment option should not be offered to every single patient. Patients with high esthetic demands in the anterior region should be given the option of surgical rehabilitation of the implant site prior to placement of an implant.
REFERENCES
Figure 4 Panoramic radiographs with the Stealth abutments after healing, the final abutments in place, final PFM single crown restorations, clinical intraoral picture with the ceramic restoration 7 years after placement
1- Brunski JB: In vivo Bone Response to Biomechanical Loading at the Bone/Dental Implant Interface. Adv Dent Res 1999; 13:99-119. 2- Szmukler-Moncler S, Salama H, Reingewirtz Y, Dubruille JH: Timing of loading and effect of micromotion on bone-implant interface: A review of experimental literature. J Biomed Mater Res 1998; 43:192-203. 3- Bergkvist G, Sahlholm S, Karlsson U, Nilner K, Lindh C: Immediately loaded implants supporting fixed prostheses in the edentulous maxilla: a preliminary clinical and radiologic report :Int J Oral Maxillofac Implants. 2005 May-Jun; 20(3): 399-405. 4- Isidor F: Loss of osseointegration caused by occlusal load of oral implants. Clin Oral Implant Res 7:143, 1996 5- 5-Rangert B, Jemt T, Jorneus L: Forces and moments on Branemark implants. Int Oral Maxillofac Implants 4:241, 1998
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ø««fÉæÑ∏dG ∫ÉØW’CG ¿Éæ°S’C á«LÓY áeóN ºjó≤Jh ™ªàéªdG áeóN QÉWGE »a á©eÉéH ¿Éæ°S’CG ÖW á«∏c ∫ÉØW’CG ¿Éæ°S’CG ÖW º°ù≤H ø«HóàæªdG AÉÑW’CG ΩÉb ¢ù«FQ ¬∏dG óÑY óªMG âMóe QƒàcódG PÉà°S’CG ±Gô°TGE âëJ á«Hô©dG ähô«H øe ájÉbƒdG á«Ø«c øY ähô«H QOÉ«ÑdG á°SQóe ÜÓ£d Iô°VÉëe ºjó≤àH º°ù≤dG IÉ°Tôa ΩGóîà°SG á«Ø«ch ¿Éæ°S’CÉH ájÉæ©dG ¥ôWh ¿Éæ°S’CGh ºØdG ¢VGôeGC .¿Éæ°S’CG ∞«¶æàd »Ñ£dG §«îdGh ¿Éæ°S’CG ø«àYƒªée ≈dGE º¡ª«°ù≤J ºJh QOÉ«ÑdG á°SQóe øe áÑdÉW h ÖdÉW 80 ô°†M óbh á«fÉãdGh ≈dh’CG ø«àYƒªéªd Iô°VÉëªdG ¢Vô©H É«∏©dG äÉ°SGQódG AÉÑWGC ΩÉbh .ÜÓ£dG øe ºJh á«∏μdG äGOÉ«Y »a É«μ«æ«∏cGE ÜÓ£dG ™«ªL ¢üëØH AÉÑW’CG ΩÉb ∂dP ó©Hh ºJh ¿Éæ°S’CGh ºØ∏d á«ë°üdG ádÉëdG øY ÜÓ£dG øe ÖdÉW πμd ôjô≤J ºjó≤J .á«∏μdÉH ôjô≤àdG Gòg øe áî°ùæH ®ÉØàM’G ( É«∏©dG äÉ°SGQódG ÜÓW óMG É¡H ´ôÑJ ) ¿Éæ°SGC IÉ°Tôa ÖdÉW πμd ºjó≤J ºJh IQƒ°üe äGQƒ°ûæe É°†jGCh (äÉæ«©c äÉcô°ûdG ióMGE É¡àeób) ¿Éæ°SGC ¿ƒé©e h §˘«˘î˘dG ΩGó˘î˘à˘°SG ᢫˘Ø˘«˘ch ɢ¡˘Ø˘«˘¶˘æ˘Jh ¿É˘æ˘°S’CɢH á˘jÉ˘æ˘©˘dG ¥ô˘W ø˘Y Iô˘°üà˘î˘e .»Ñ£dG
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On behalf of Riyadh Colleges of Dentistry and Pharmacy (RCDP), the sponsor of this conference and the Organizing Committee, it is my distinct pleasure and honor to welcome you all to the two-day conference of the 5th Riyadh International Dental Meeting & Exhibition (RIDME) with the theme: "New Era in Esthetic Dentistry". This conference is the 5th of ten annual meetings on Dentistry and Pharmacy that have been officially approved to be held between 2005 (1426) and September 2015 (1436). The approval is an obvious mark of the recognition and importance attached by the Kingdom of Saudi Arabia to Dentistry and Pharmacy. The conference features a Pre-Conference Symposium on "What are the Attributes of an Ideal Dentist in 2020", IADR-Saudi Section Scientific Meeting, Clinical general and specialized dental practice and Continuing education courses. The great cooperation and interest of the leading dental companies in the Kingdom of Saudi Arabia also enhances the learning content of the 2-day conference.
36 Riyadh International Dental Meeting - 2010
The Goals of this meeting as envisioned by the College organizing committee include: - disseminating and exchanging information on the most current advancements in _ different aspects of Dentistry - education, care and research. - disseminating this information to dental researchers, clinicians, trainees, students _ and others who attend the meeting. - bringing the original and latest dental instruments and equipment that will be _ show-cased in the exhibition. - bringing the original and latest dental research that will be presented in the _ IADR-Saudi Section Scientific Meeting. - highlighting the role of Riyadh Colleges, a private higher institution of learning, _ as a committed contributor to the advancement of Dentistry in Saudi Arabia. We are particularly delighted that in this year's conference, dental interns who graduated from our College of Dentistry are participating in oral and poster presentations. Prof. Abdullah R. Al Shammery Rector, Riyadh Colleges of Dentistry & Pharmacy Chairman of Organizing Committee
Ribbon cutting of the scientific exhibit following the opening ceremony DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
Picture from the audience during the closing ceremony
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Dr. Ahmad Kahtani president of the SDS
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Picture from the symposium
38 Riyadh International Dental Meeting - 2010
Pr. Mounir Doumit Dean of the Lebanese University Dental School
Picture of the Bahrain delegation
Pr. Al Shammery during his “Attributes of the Ideal Dentist” presentation
Picture of the Lebanese delegation
Picture from the Riyadh College Dental Students
DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
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TROPHY DISTRIBUTION
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Dr. Omar Zidan from Minnesota, USA who tackled CAD/CAM applications
Dr. Elie Ferneini from Connecticut, USA who lectured on Facial Rejuvenation receiving the trophy from Dr. Mohamad Al Awhali
Pr. Magid Amin from Egypt
Dr. Mohamed Saadeh president of the Lebanese Dental Society-Tripoli
Pr. Essam Osman Dean of the Beirut Arab University Dental School
Dr. Ahmed Halim Ayoub from Alexandria, Egypt receiving his trophy
From Left to Right, Dr. Tony Dib, Dr. Zaki Fakiha, Dr Basalaum, Dr F. Bannan, Dr. Bassam Al-Linjawi DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
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42 Riyadh International Dental Meeting - 2010
Dr. Saleh Al Shamrani, Dean of the College of Dentistry, RCDP
DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
HemCon® – Stops bleeding. HemCon Dental Dressing is self-adhesive and self-dissolving. After one minute – the bleeding has stopped. After 48 hours – dressing has dissolved*.
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* The dressing usually dissolves within 48 hours. In some cases this may take up to seven days. ** Malmquist JP, Clemens SC, Oien HJ, Wilson SL. Hemostasis of oral surgery wounds with HemCon Dental Dressing. Journal of Maxillofacial Surg. 2008:66:1177-1183. ©2010 Zimmer Dental Inc. 2346, Rev. 7/10. HemCon is a registered trademark of HemCon Medical Technologies, Inc. HemCon Dental Dressing is manufactured by HemCon Medical Technologies and distributed by Zimmer Dental Inc. Please note that not all products and regenerative materials are registered or available in every country. Please check with a Zimmer Dental representative for availability and additional information.
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Picture of Dr. Mohammed Ben Hafeedh during the opening ceremony DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
Picture from the Audience during the opening ceremony
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Dr. Mohammed Ben Hafeedh president of the Yemeni Dental Association in the middle of Delegates from the Arab Countries
Dr. Rolf Volmer from the German Association of Dental Implantology
Picture from the commercial exhibit
Picture from the commercial exhibit
Picture from an outing in the old city of Sana’a
Picture of delegates from Bahrain, Lebanon, and Palestine
Picture during the dinner at a traditional restaurant
Picture of the Egyptian and Bahraini delegation during the closing ceremony
DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
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48 YEMEN DENTAL ASSOCIATION - 2011
Picture of delegates from the Arab Countries at the Movenpick hotel
Dr. Barakat Al Jaabari President of the Jordanian Dental Association
Picture with Al Hajara Village in backdrop
Dr. Ibrahim Ghannam president of Jerusalem Dental Association receiving the trophy from Dr. Ben Hafeedh
Dr. Yasser Malaeb from Lebanon receiving the trophy from Dr. Ben Hafeedh
DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
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Pr. Noor Habib Dean of the Cairo University Dental School
Dr. Ibrahim Taki president of the Kuwait Dental Association
Dr. Rajaí Kadhem president of the Bahrain Dental Association
50 YEMEN DENTAL ASSOCIATION - 2011
Dr. Tarek Abbas from the Egyptian Dental Association receiving the trophy from Dr. Ben Hafeedh
Picture of the Lebanese Delegation with the Local Organizers (Dr. Nasr Al Qudaimi in the middle) DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
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52 SAUDI DENTAL SOCIETY - 2011
Dr. Ahmed Al Kahtani president of the Saudi Dental Society delivering the opening ceremony speech
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¿Éæ°S’ C G Ö£d ájOƒ©°ùdG á«©ªédG ¢ù«FQ »fÉ£ë≤dG óªMGC QƒàcódG Picture from the audience during the opening ceremony DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
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Dr. Abdullah Al-Othman Rector of the KSU giving his speech
Dr. Abdullah Al-Othman and Dr. Ahmed Al Kahtani
Dr. Arwa Ali AlSayed receiving the King Abdulaziz distinction
left to right; Dr. Halawani, Pr. Wazzan-Dean of the Dental School at KSU, Dr. Kahtani
Dr. Mohamad al Obaida receiving the trophy of the Saudi patent for an anesthetic device
Dr. Dimashkieh during the trophy distribution ceremony
Picture of the social activity from the Rest House near Riyadh
Traditional music and dance during the social activity at the Rest House
DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
Pictures from the dinner taken in front of Burj Al Mamlaka
FROM THE EXHIBITION FLOOR
56 SAUDI DENTAL SOCIETY - 2011
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Hamdan Bin Rashid inaugurates the 15th edition of the UAE International Dental Conference and Arab Dental Exhibition H.H Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai, Minister of Finance and President of Dubai Health Authority inaugurated in February the 1st, the fifteenth edition of the UAE International Dental Conference and Arab Dental Exhibition (AEEDC Dubai 2011), at the Dubai International Convention and Exhibition Centre. Following the traditional ribbon-cutting ceremony, H.H. Sheikh Hamdan Bin Rashid took a tour in the exhibition area, and explored the latest medical devices, technologies and equipment displayed by over 850 specialized companies from 70 countries. The scientific committee has organized an outstanding scientific program supporting universities and scientific institutions in the region, and providing the latest researches and findings in the field of dentistry.
62 AEEDC - 2011
With over 27,000 participants and visitors, this year's growth in both the number of exhibitors and the space of the exhibition area of AEEDC reflects the strategic position and credibility
DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
that Dubai possesses, in addition to AEEDC's capability of presenting the latest research in this field. The overall space of AEEDC exhibition is 28,000 Square meters, and the number of companies participating in AEEDC this year had reached 850 companies from 70 countries. The outcome of the business deals from AEEDC is expected to reach millions of dollars." Said Al Madani. AEEDC Conference and Exhibition represent an exceptional opportunity for all dentists and decision makers from the private and public sectors, to purchase their necessities of devices and equipment, displayed by major international companies. Moreover, AEEDC Exhibition featured 15 national pavilions primarily from; Brazil, China, Finland, France, Germany, Iran, Italy, Japan, Korea, Russia, Spain, Sweden, Switzerland, United States of America and the United Arab Emirates.
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DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
Planmeca sets new standards with world’s first dental unit integrated intraoral scanner for open connectivity to various CAD/CAM systems.
Planmeca Oy, Asentajankatu 6, 00880 Helsinki, Finland tel. +358 20 7795 500, fax +358 20 7795 555, sales@planmeca.com, www.planmeca.com
11
We would like to invite you to explore the dentistry in new dimensions – see the perfect combination of digital intraoral scan, CBVT and 3D facial photo datasets in one 3D image. This digital perfection enables you to study patient’s complete anatomy in detail, plan and utilise open interface with modern CAD/CAM systems according to your needs. Now you can be one of the pioneering specialists, whether you are an implantologist, endodontist, periodontist, orthodontist or maxillofacial surgeon. The new era of dentistry is reality. It’s your decision.
1971 - 2 0
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DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
60stst Anniversary Anniversary of the60Lebanese University of the Lebanese University
iversity Dental Me ese Un Lebaan iversity Dental Meeting n U nese b eting e L 12 th 12th
2011 2011
June 2-4 June 2-4
CHALLEN ISTRY CHALLENGES IN DENT T GES IN DEN ISTRY Lebanese University School of Dentistry 5DÀF +DULUL &DPSXV -XQH FRQJUHVXO#XO HGX OE
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DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
If you like DuraShield®, you’ll love these Sultan products…
Topex® Fluoride Foam Easy, 60-second application. Dense enough to provide excellent coverage, yet stays in the tray under bite pressure for a more pleasant patient experience. Five delicious flavors!
Topex® Dual Arch Fluoride Trays Its natural arch and more defined occlusal anatomy helps force fluoride onto all biting and interproximal tooth surfaces. Locking handles allow for easy placement and removal. Available in four sizes.
You missed a spot...
Topex® APF Fluoride Gel Thixotropic formulation remains in the tray, reducing fluoride ingestion. Fast, 60-second application. Available in five great Topex flavors.
It’s easy to do if you use a white fluoride varnish. DuraShield® is easy to see and apply—every time. Why take a risk and waste time? DuraShield® is an incredibly effective, fluoride treatment that’s effortless to apply. Its light amber color lets you know the tooth surface is completely covered, yet is almost undetectable to your patient. Each .40 ml unit dose pack can be mixed prior to application, guaranteeing a consistent fluoride level. And with the handy UltraBrush™ 2.0 bristle brush, DuraShield is a total application system… just pop it open, and you’re ready to go. But most important, DuraShield works. As a powerful desensitizing agent, DuraShield relieves hypersensitivity where dentin or cementum are exposed. Its 5% sodium fluoride formula sets on contact with saliva and releases fluoride for up to eight hours. That means enhanced fluoride uptake, with minimal food or drink restrictions for your UNIT DOSE MIXING LIGHT AMBER COLOR patients. You can be confident your patients are protected. And the Bubble Fun® Flavor is great for patients of all ages. Easy… fast… effective. When it comes to doing the job right on fluoride Pre-application Light amber color means treatments, you can’t miss with DuraShield. mixing ensures full coverage without fluoride content. compromise of esthetics.
Topex® Topical Anesthetic Quick onset delivers maximum strength 20% benzocaine for fast, temporary relief of pain. Reduces salivation, keeping gel active longer. Seven great flavors!
Estimated 14 CME Hours
20 % Discount for the Readers of the Magazine
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Smart Vibrations Compothixo™ is a unique generation in composite placing and modelling instrument suitable for all class restorations. The new Compothixo™ technology optimizes the thixotropic properties of composites by changing viscosity only, without altering the chemical and mechanical characteristics of the material.
• Better wettability • Superior adaptation of composite to cavity walls • Reduction of air bubbles • Precise application • Layer thickness control • Improved sculptability • Reduced stickiness
KerrHawe SA P.O. Box 272 6934 Bioggio Switzerland Freephone: 00800 41 05 05 05 Fax: ++41 91 610 05 14 www.kerrdental.eu
Your practice is our inspiration.™
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DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
EXCOM
Central Suction EXCOM hybrid A2-ECO II EXCOM Z-ECO Light
EXCOM hybrid 2
from 1 up to 15 dental units u Reliable function, even with large amounts of water u High, constant suction power u For 1 up to 15 dental units u Optional amalgam separation module
METASYS Medizintechnik GmbH Florianistrasse 3 A-6063 Rum bei Innsbruck
www.metasys.com
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76 AEEDC - 2011
THE DENTAL NEWS
DENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
STAND AT
AEEDC 2011
VITA VMK Master Brand new, yet still a classic! ®
The new VITA metal ceramic with the familiar layering you’re accustomed to.
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Av ail an able d V in ITA VI cla TA S ss YS ica TE lA M 1– 3D D 4 -M sh AS ad TE es R ® !
1968: The world is in motion and VITA revolutionizes the world of
Master is especially well suited for the veneering of non-precious
dentistry with its VMK 68 metal ceramic. In 1995, VITA inspires the
metal alloy frameworks. Furthermore, the traditional layering con-
world of dentistry again – with the original VMK 95. And in 2009?
cept continues to provide simple handling. Equally simple and
VITA goes one step further: VITA VMK Master. Thanks to its firing
highly aesthetic is being able to choose between the two VITA
temperature, chemical and physical characteristics, VITA VMK
original shade systems. www.vita-zahnfabrik.com
PRODUCT NEWS
Cavex LC Dental Tray light-curing tray material
78 PRODUCT NEWS
The Cavex LC Dental Tray is a light-curing resin for the production of individual or functional impression trays. Other application areas include the production of bite impression templates. The Cavex LC Dental Tray distinguishes itself from other brands among other things through the extra wide fit. No more fuss and bother with pasting on bits and pieces. The material has excellent malleability. The standard model is suitable for upper jaw models. However, by cutting out the palate part it is also suitable for modelling the lower jaw. The Cavex LC Dental Tray can be cured with both UV and halogen equipment. For more information, please visit www.cavex.nl
Zimmer Tapered Screw-Vent Implant Zimmer Dental Inc., is pleased to celebrate the 10th Anniversary of its renowned Tapered Screw-Vent® Implant by offering special cost-saving opportunities to new and existing customers. With more than two million units sold worldwide, the flagship product has built a solid reputation of trust and performance. Seven prospective studies on Tapered Screw-Vent Implants have reported cumulative success rates of more than 99 percent. Available in 3.7mm, 4.1mm, 4.7mm, and 6.0mm sizes, the Tapered Screw-Vent Implant’s proprietary, friction-fit, internal hex platform reduces stress on crestal bone and resists abutment screw loosening. With triple-lead threads, MTX™ and MP-1® HA surfaces, and a tapered implant body, the versatile Tapered Screw-Vent Implant is the platform of choice for thousands of clinicians. And because of its initial implant staDENTAL NEWS, VOLUME XVIII, NUMBER I, 2011
Turns 10
bility, it also enables immediate restorations and immediate loading where clinically appropriate. Visit www.zimmerdental.com for more information.
Cavex ColorChange chrom atic d e nt a l a l g i na t e
5 years shelf life
superior tear resistance
5
D lity ime
days ns
D lity ime bi
ional Sta
bi
ns
snap set
ional Sta
CAVEXYOUR IMPRESSION IS OUR CONCERN Cavex has been producing alginate impression materials for more than 55 years. As a result all our alginates have been developed to perfection. In September 2007 Cavex ColorChange has been awarded the highest rating “excellent” by THE DENTAL ADVISOR. Cavex ColorChange was used by 27 consultants and received a 96% clinical rating. 71% of consultants would switch, and 76% would recommend Cavex ColorChange to colleagues. Cavex Holland BV, P.O. Box 852, 2003 RW Haarlem, The Netherlands. Tel +31 23 530 77 00 Fax +31 23 535 64 82 dental@cavex.nl www.cavex.nl
“THAT’S ALL I NEED!”
Galip Gürel, Dentist, Turkey.
Many different indications and many different materials to choose from – this scenario is a thing of the past. The IPS e.max system allows you to solve all your all-ceramic cases, from thin veneers to 12-unit bridges. Dental professionals all over the world are delighted.
amic r e c l l a need u o y l al
www.ivoclarvivadent.com Ivoclar Vivadent AG
Bendererstr. 2 | FL-9494 Schaan | Principality of Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60