Madridge Journal of Dentistry and Oral Surgery

ISSN: 2639-0434

2nd International Conference on Dentistry

May 7-9, 2018, Rome, Italy
Accepted Abstracts
DOI: 10.18689/2639-0434.a2.004

Immediate Implant Placement Utilizing the Root Membrane Techniue Socket Shileds

Ahmed Mohammed Shamiyah

Noble Smile Dental Care, Saudi Arabia

The immediate implant placement is a complex surgical procedure mainly because of the cascade of event that follows every tooth extraction.

Alveolar ridge resorption is a physiological process that cannot be entirely prevented based on current evidence. Ridge resorption can be categorized as a multifactorial phenomenon that is partially attributed to the loss of blood supply that is derived from the periodontal ligament PDL prior to tooth extraction.

The buccal plate of the teeth especially in the anterior teeth is most often very thin, leading to significant dimensional alterations during immediate post extraction period.

Theses alterations are three dimensional and lead to apical migration of the soft tissue and concavities on the flat facial surface of the ridge.

Many studies were done to evaluate the possibilities to preserve the buccal resorption, maintain and recreate a mucosal zenith post tooth extraction and immediate implant placement

Preservation of the buccal portion of the root of the tooth may be atraumatic approach that leads to the preservation of the blood supply of the buccal plate and consequent preservation of the dimension of the alveolar ridge.

The rationale behind the intentional retention of the buccal aspect of the root with its periodontal apparatus is that a portion of the blood supply that derives from PDL is maintained.

The evolution of the procedure and technique will be described, advantages and limitations will discuss.

Ahmed Mohammed Shamiyah completed Masters in Implant Dentistry, UCLA-GIDE Fellowship Program, Master in Oral Science New York State University at Buffalo Advanced Education in Prosthodontics, Advanced Fixed Prosthodontics Technique and Seminar University of Illinois at Chicago and Bachelor of Dental Surgery (B.D.S.) Bangalore University India.

Psychological Stress and Burnout Among Dental Staff: A Cross Sectional Survey

Abdullah Alzahem*, M Alaqeel, L Alqudaibi, Y Alhaizan, R Albani and A Aljuraisi

Ministry of National Guard Health Affairs, Saudi Arabia

Professional burnout, a prolonged response to stress, would possibly affect the standards of patient care. Burnout is defined as emotional exhaustion, depersonalization, and diminished personal accomplishment.

Aim: Identify and compare psychological stress and burnout levelsamong different job titles and specialties in dental clinics. Also, determine the effect of marital status, age, and gender on stress and burnout levels.

Methods: Convenient sampling approach is used to distribute the questionnaire among dental staff (n=177, response rate=88.5%). Two validated questionnaires, psychological stress measure-9 (PSM-9) and Maslach Burnout Inventory–Human Services Survey (MBI-HSS), are used.

Results: Mean level (and standard deviation) of stress was 32.60 (11.43), with the highest stress levels seen in consultants and residents (39.17% and 38.33%). Hygienists and technicians scored the highest lack of personal accomplishment (24.53%), consultants scored the highest emotional exhaustion (24.64%), while residents scored the highest impersonal response toward patients (26.67%).

Conclusion: Participants with the job title “consultant” and “resident” are shown to be the most stressed and burnt-out category among the dental department. Specialty, gender, age and marital status are not shown to be risk factors in our study. Stress and burnoutshould be reduced to maintain the standards of patient care.

Abdullah Mohammed Alzahem (BDS, FAGD, MME, PhD) the Assistant Professor of Medical Education graduated 1995 with BDS degree. 1998, completed postgraduate studies in Temporomandibular Joint Disorders and Advanced General Dentistry in USA. 2004, awarded the prestigious Fellowship of General Dentistry Academy (FAGD), and in the same year appointed as Dental Consultant. 2009, completed successfully two-year master program in Medical Education (MME).2015, completed PhD degree in Medical Education at Erasmus University Rotterdam, and was appointed as Director of Quality Assurance in King Saud bin Abdulaziz University for Health Sciences.

Principles of Smile Analysis in Orthodontics

Abu-Hussein Muhamad

University of Athens, Greece

Orthodontics is a branch of dentistry that has been creating attractive and stunning smiles for centuries. Dentofacial appearance is one of the main determinants of physical attractiveness. Esthetic smile design is a multifactorial decision-making process that allows the clinician to treat patients with an individualized, interdisciplinary approach. This review aims to discuss various smile patterns and anatomical parameters for assessing and designing beautiful smiles.

Abu-Hussein Muhamad completed his DDS in 1986, DPD (Drodont) Dentistry for Children1988 International Short-Term Program in Orthodontics1994, 6 WEEKS Aarhus, Denmark Postgraduate taught courses (two-years) in Oral Biology/Pathology, Dental Faculty, University of Athens 1998. He is a Master of Biostatistics, School Mathematics/Medicine, Athens 2001 Postgraduate Bioesthetic Dentistry and OBI, International Faculty. Diploma Roth/Williams Center for Functional Occlusion.

Screw vs Cemented Implant Supported Prosthesis

Ahmad Al Awadhi

Ministry of Health, Kuwait

Fixed Implant supported prosthesis improved patient comfort and functional capabilities. It all started with using fixed detachable casted metal bar with acrylic teeth by Branemark.

Technology in implant supported prosthesis fabrication improved and treatment options have been diversified for the past 40 years. For simple cases, there is a huge controversy in making the choice between cemented and screw retained implant crowns. New objectives and criteria need to be suggested to simplify treatment modalities. Several authors discussed major principles for treatment planning and these principles should serve as a foundation for any treatment options that involve advanced technology. Unfortunately, these principles lack important clinical factors. The purpose of this presentation is to propose more detailed criteria that help in decision making during treatment planning fixed implant supported restorations. These criteria can be used as a guide for clinicians to simplify the process of treatment planning and to expect more predictable and safe outcome in regards to functional and esthetic aspects.

Ahmad Al Awadhi completed BA degree and DDS from the University of Missouri at Kansas City in 2006. Ministry of Health in Kuwait in a one-year rotation program in several specialty centers. MFDS-RCSI fellowship in 2008 from The Royal Colleges of Ireland, Advanced Prosthodontics specialty degree as well as the Master of Academic Medicine degree from the University of Southern California (USC) in 2013. Taught as a volunteer in USC, Worked ministry of health of Kuwait in the prosthodontics department, working in Bayan Dental Center. Part-time faculty in Kuwait University Dental School.

Influence of Attachment Type on Stress Distribution in Mandibular Implant-Retained over Dentures

Ahmed Ibrahim Mahrous

Al-Farabi Medical Colleges, Saudi Arabia

Objective: To evaluate the stresses transmitted to the supporting structures of implant retained mandibular over-denture with different types of attachment.

Materials & methods: An acrylic model resembling the edentulous mandibular arch was manufactured with simulated mucosa covering the residual ridge. Two implants were installed in the canine region one on each side. Complete lower overdenture was constructed on the model. Three different types of attachments were used successively; ball and socket, magnet and bar clip system.

Eight strain gauges were attached to the lingual and labial/buccal aspects of the two implants and first molar area on the right and left side of the model.

Microstrain readings were collected from the digital strain meter and statistically analyzed.

Results: When the load was applied anterioly: there was significant difference between the three types of attachments regarding stress distributions (a) on the implants with the highest stresses produced by the bar/clip attachment, (b) on the first molars with the highest stresses produced by the magnet attachment. When the load was applied posteriorly: there was significant difference between the three types of attachments regarding stress distributions (a) on the implants (loaded and none loaded) with the highest stresses produced by the bar/clip attachment, (b) on the first molars (loaded and non- loaded) with the highest stresses produced by the magnet attachment.

Keywords: Dental implant, Attachment, Stress distribution

Ahmed Ibrahim Mahrous completed his BDS, Msc, PhD. He currently working as Assistant Professor of Prosthodontics & Implantology at Al-Farabi Medical College, School of Dentistry, KSA/ October 6th University faculty of dentistry, Egypt Since 2012 till now. Prosthodontics researcher and specialist related to dental Implantology field since 2004 and have many publications in the scoop and field of implant prosthetics specially those related to implant retained over dentures and the wide use of different implant attachments in complete and partial edentulous cases.

Iatrogenic Effects of Orthodontic Treatment: Decision-Making in Diagnosis, Treatment and Modalities of Prevention

Ahmed Abdulrazzaq

Rutgers University, USA

Introduction: The goal of orthodontic treatment is to develop a well-balanced, functional and esthetic Occlusion however just like any treatment modality or consumption of any medication, there is needs to be a balance between advantages and disadvantages as clinicians, we want to increase the advantages or benefits of treatment and minimize or eliminate the side effects. Iatrogenic Effects of orthodontic treatment are defined as the deleterious effects to the dentition, periodontium or the patient that may occur as a result of the orthodontic treatment performed. The complications due to orthodontic treatment are a result of a multifactorial process including the patientʼs own biology, clinical skills of the orthodontist, orthodontic appliances, orthodontic treatment procedures and length of treatment. If orthodontic treatment is to be beneficial, the advantages it offers should outweigh any possible damage it may cause. It is important to assess the risks of treatment as well as the potential gain and balance these aspects of treatment prior to deciding to treat a malocclusion. In this article we will discuss the possible iatrogenic effects of orthodontic treatment as well as decisionmaking in management and modalities to prevent such possible complications.

Ahmed Abdulrazzaq, completed his BDS and currently working as Orthodontic Fellow in Orthodontic Department Rutgers University, 2017 Program Director in Almagrib Specialized Dental Center, Baghdad (2012-15) Program Director in Numan University Hospital, Baghdad (2007-12).

Association between Oral Tori, Occlusal Biting Force and Mandibular Cortical Index

AlaʼN. F. Al-Daqaq

Jordan University of Science and Technology, UAE

Previous studies evaluated the effects of environmental and genetic factors on occurrence of oral tori. Results of the relationship between presence of tori, occlusal biting forces and mandibular cortical index (MCI) were not conclusive. The objectives of the current study are to assess the relationship between occurrence of oral tori, occlusal biting forces and MCI in a selected sample of Jordanians, to establish the relationship between MCI readings with Klemittiʼs class and to explore the association between different variables.130 Jordanians of both genders who met the inclusion criteria were examined and divided to 65 tori subjects and 65 age and gender matched controls. Examination was performed to confirm the presence/absence of tori. Size, shape and location of tori were recorded from the obtained study casts. Measurements were carried out using digital calipers (0.01mm). Biting force was recorded in Newtonʼs using a portable occlusal force gauge (GM10, Nagano Keiki, Tokyo, Japan). MCIand Klemittiʼs classification was reported by two radiologists on panoramic radiographs. The mean was calculated for continuous variables. Frequency distribution of categorical variables was provided. Weighted Kappa analysis test for inter-observer agreement of MCI and Klemittiʼs classification. Logistic regression to test the adjusted effect of confounders on the outcome. The average Bite force was significantly higher in tori subjects by 100 N compared to control subjects and was higher in males compared to females. Klemetti classes and MCI were both affected by occlusal biting force. An average was used to assess the relation between MCI andKlemetti classes.

Dr. AlaʼAl-Daqaqcompleted her Master in Clinical Dentistry Prosthodontics in Jordan University of Science and Technology 2016 at the age of 29th and she has published two case reports during Post-graduate program in Dental News-December issue 2014. Another publication related to her Master thesis was accepted in Quintessence International in 2017. She also worked in collaboration with British Academy of Implant and Restorative Dentistry. She obtained her degree of Doctor of Dental Surgery in 2010 and her internship in 2011 from Ajman University of Science and Technology. She is currently a licensed dentist registered in Health Authority of Abu Dhabi – United Arab Emirates.

Evaluation of an Innovative Computer-Assisted Sagittal Split Ramus Osteotomy to Reduce Neurosensory Alterations Following Orthognathic Surgery

Alauddin Mohammed Ahmad Hussein, Hazem T Al-Ahmad Mohammed, W M Saleh Alaʼuddin and M Hussein

Istishari Arab Hospital, Palestine

Background Sagittal split ramus osteotomy (SSRO) can be associated with postoperative neurosensory disturbances. This study aimed to evaluate the effectiveness of computer-assisted SSRO in reducing the incidence and severity of neurosensory alterations, using a surgical guide fabricated by computeraided design and rapid prototyping (to guide bone cutting lateral to the inferior alveolar nerve). Methods A prospective double-blind, randomized controlled, clinical trial of computer-assisted SSRO vs conventional SSRO (assigned in a split-mouth design) in eight patients, mean age 23 (range 18–30) years, who participated in one session preoperatively and three sessions at 1 week and 1, 3 and 6 months postoperatively. At each session, subjective oral sensation was scored and quantitative sensory tests were performed. Neurosensory changes were compared between the two sides. Results The results showed that on the computer-assisted SSRO sides, patients had lower postoperative abnormal thresholds for the Semmes–Weinstein monofilaments on lower lip and chin (p < 0.05 at 3 months) and for the two-point discrimination on lower lip (p < 0.05 at 1 week) and chin (p < 0.05 at 6 months), with fewer abnormal self-reported changes in lower lip sensation (p < 0.05 at 1 week) after surgery. Conclusions these findings imply that computer-assisted SSRO is associated with better levels of neurosensory function after surgery

Dr. Alaa Hussein is a Specialist in Oral and Maxillofacial Surgery with over 11 years of experience. He is currently a Specialist and the Head of Oral and Maxillofacial Surgery Department at Istishari Arab Hospital. Prior to joining Istishari Arab Hospital in Ramallah, Dr. Hussein worked at the Arab American University – Jenin as the head of oral and maxillofacial surgery department/faculty of dentistry. Dr. Hussein graduated from the Faculty of Dentistry from the Arab American University - Israel. Then he continued his specialized training in Oral and Maxillofacial Surgery at Jordan University Hospital - Jordan.

Re-Visiting the Decay, Missing, Filled Teeth (DMFT) Index with a Mathematical Modeling Concept

Amar Hassan Khamis

Mohammed Bin Rashid University of Medicine and Health Sciences, UAE

Abstract Background: The well-established DMFT index has been used for over 75 years as a key for measuring dental caries in dentistry. DMFT is applied to permanent dentition and expressed as the total number of teeth decayed (D), missing (M), or filled (F), tooth (T) in an individual. Objectives: The objective of this study is to build a mathematical model for the existing DMFT index and compare its parameters by suggested new mathematical model. Mathematical Models: Fixed Model: Is a mathematical model for the existing DMFT index and will be considered as fixed model; in which all individuals under screening will have the same probability θ, 0 ≤ θ ≤1 of dental caries. In this fixed model the unit of the screening is the individual, and will be evaluated for caries as a dichotomous (0, 1) variable. Random Model: The new suggested model is a random model that suggests a mouth of an individual as an environment and the tooth is a unit of research. In this random model, only the teeth in one mouth have the same probability θ, 0 ≤ θi ≤ 1 where 1, 2, ik = L ; number of screening individuals. Expected Outcome: Mathematically, the fixed model will highlight what the value 1 will hide as information and hence this may explain why the average of DMFT is may be overestimated for any sample studied using fixed model. The random model will yield a cumulative weighed probability on the function of the number of teeth screened per mouth, 0 d, d 1, hence the average DMFT index will be weighed against the number of teeth screened per all subjects. Conclusion: The random model yields an average and more realistic expected value for the population studied. Furthermore, in such model, it is easy to estimate the variance and it is obvious that this model yields the smallest variance.

Keywords: Oral Health, Dental Caries, Epidemiology, DMFT Index

Genetic and Biochemical Changes in the Mandibular Condylar Cartilageas a Function of Administration of Growth Factors and Mandibular Advancement

Amol Patil

Bharati Vidyapeeth Deemed University Dental College and Hospital, India

Since mandibular condyle plays a significant role in the development form and function of oro-facial complex, it has received special attention in orthodontics. Accordingly, besides mandibular advancement, condylar growth modification is induced by growth factors also. Most of the studies in this regard have used either histological, histomorphometric, immuno-histomorphometric, biochemical or auto-radiographic methods as a diagnostic tool to evaluate the growth at the condyle or detected increased expression of some growth factors/biomarkers of mandibular condylar cartilage (MCC) growth. Although, these studies have dealt with condylar growth by providing valuable leads at a cellular level, several questions have remained unanswered and which could be answered only on a genetic level, elucidated by cellular studies, quantified by molecular markers and validated by statistical analysis. Expression of Vascular endothelial growth factor (VEGF), a potent regulator of neo-vascularization, was observed in the condyles and glenoid fossa of the growing rats. Decorin (DCN) plays an essential role in the development, texture, integrity, maintenance and functions of virtually all tissues, including MCC. It is postulated that Matrix-Gla-Protein (MGP) has a regulatory role in chondrocytes, cartilage and mineralization of skeletal as well as dental tissues. Thus the present study has precisely attempted to evaluate the genetic factors i.e. VEGF, SOX-9, MMP-1. MMP-13, DCN and MGP genes as markers of condylar growth in young rabbits as a function of epigenetic factors like mandibular anterior repositioning appliances with and without the administration of growth factors (TGF-β and IGF-1).

Dr. Amol Patil currently working as Professor/Post-graduate Guide and PhD Guide at Bharati Vidyapeeth University Dental College & Hospital, Pune and he have been awarded as “Best Scientist Award” 2016 at Bharati Vidyapeeth University. He is one of the few who has completed his PhD in Orthodontics. He was a Gold Medalist in MDS Orthodontics. He has a keen interest in research because of which he pursued his PhD and has total 34 publications out of which 10 are international with high impact factor (4.586). He is Reviewer in 17 international journals including AJO, EJO, WJO etc and on board of advisors of 4 international journals. He has been an invited speaker to various international conferences related to basic sciences (1st World molecular and cell biology conference, USA, 2012;Cell Biology Conference, China, 2014; Epigenetics and Biotechnology Conference 2014); 50th Indian Orthodontic Conference, Hyderabad and recently presented a research paper at 115th AAO conference, San Fransisco. He has presented various papers in national and international conferences for which he has been awarded the best paper awards too. He has keen interest in growth, genetics and basic research.

Comparative Study of Single Needle Versus Double Needles Arthrocentesis using Research Diagnostic Criteria for Temporomandibular Joint Disorders (RDC/TMD)

Diaa E Mostafa

Minia University School of dentistry, Egypt

Introduction: The aim of this study was to compare the clinical outcome of single needle approach versus double needles in treating patients suffering temporomandibular disorders (TMD) using the research diagnostic criteria (RDC/TMD). Methods. twelve patients (9 females and 3 males, mean age 31.16 years) were included to the study. TMJs were divided into 2 groups randomly: double needle arthrocentesis(group A) and single needle arthrocentesis (group B). The study was carried on a double blind fashion, every patient received a full axis I RDC examination prior to the arthrocentesis procedure and in the follow up periods The data were collected and statistically compared using SPSS package for windows. Results. Three months after the arthrocentesis procedures, regarding mouth opening, excursive movements, joint sound and pain score there was no statistically significant difference between 2 groups; while for protrusive movements there was statistically significant difference between the two groups at period of 1 month (P-value 0.034), at 2 months (P-value 0.022) and at 3 months (P-value 0.021)Conclusion. From this study, it is concluded that adequate results for treatment of internal derangement of TMJ were achieved with single and double needle arthrocentesis in the form of improved function and pain reduction. The adoption of a single-needle injection technique might have some advantages over the traditional 2-needle technique yet it remains a fertile ground for further trials and investigations. Arthrocentesis is an effective technique for eliminating the studied cytokines from the TMJ synovial fluid.

Diaa Mostafa is an assistant lecturer in the oral & maxillofacial surgery department of faculty of dentistry at the University of Minia - Egypt where he has been a faculty member since 2007. He completed his MSc and undergraduate studies at Minia University. My research interests lie in the area of temporomandibular joint disorders. In recent years & for my PhD research, he has focused on better techniques for arthroscopic management of TMJ. He has served on roughly plenty conference and workshop program committees. He is instructor for a clinical part of oral surgery for undergraduate topics in my department & Vice director of cranio- maxillofacial surgery unit at Minia university dental hospital

Microleakage of Sonic Activated Nanohybrid Composite Restorations as Affected by Cavity Configuration and Placement Technique Ebaa I Al-Agha Alfarabi Private College, Saudi Arabia

Objective: This study was conducted to evaluate the effect of different cervical cavity configurations (Dish, U and Wedge shape) and placement techniques (Bulk and Incremental packing) and Inlay fabrication of class V composite resin restorations on microleakage.

Material and Method: A total of 90 upper single rooted premolar teeth were randomly divided into three main groups of 30 teeth each, according to the cavity shapes (Dish, U and Wedge shape) prepared in the cervical area of the teeth. Each group was further subdivided into three subgroups of 10 teeth each, according to the placement technique of the composite resin, Bulkfill (SonicFill), Incremental packing (TetricEvoCeram) and Inlay fabrication. Teeth were immersed in a freshly prepared aqueous methylene blue solution for 4 hours at room temperature, and then they were vertically sectioned through the centre of the restoration in a buccolingual direction. The sectioned specimens were examined under stereomicroscope at 45 x magnification interface.

Results: Regardless to cavity design, totally it was found that SonicFillgroup recorded statistically significant highest leakage % mean value followed by TetricEvoCeramgroup mean while Inlay group recorded statistically significant lowest leakage % mean value.

Regardless to restorative material, totally it was found that Wedge design group recorded statistically significant highest leakage % mean value followed by U shape design group meanwhile Dish design group recorded statistically significant lowest leakage % mean value.

Conclusions: Cavity configuration is a crucial factor in microleakage formation being more pronounced in wedge shaped cavities and microleakage varied with the placement technique of the resin composite restoration and the sonication did not improve microleakage while the inlay placement seemed beneficial.

Keywords: class V cavities, microleakage, nanohybrid composite, placement technique

Dr. Ebaa I Alagha currently working as Ass. Professor of Operative dentistry at Alfarabi private college- Jeddah- Saudi Arabia and worked previously as Lecturer of Operative dentistry, October 6th Univ-Egypt, Ass. Lecturer of Operative dentistry, October 6th University-Egypt, General practitioner at Misr University for Science & Technology in the Restorative clinic for the MFDS & MRD programs (Royal College of Surgeons of Edinburgh). She completed a PhD degree in Operative dentistry. Al-Azhar - University in Cairo 2016 and Master Degree in Operative dentistry. Al-Azhar University in Cairo 2013-Diploma in Total Quality Management for Healthcare Reform (TQMHC) in American University in Cairo2013-Bachelor in oral and Dental Medicine, October 6th University 2003 Very Good with honor.

3-D Laser Assisted Endodontics Diagnosing and Treatment

Brian P Trava

University of Medicine and Dentistry of New Jersey, USA

The integration of CBCT imaging and laser treatment are becoming a standard in in the dental office. The lecture demonstrates the importance of an interdisciplinary approach to diagnosis the etiology of oral maxillary symptoms that present by a patient. The integration of Er;Cr:YSGG laser with CBCT imaging on non-surgical, surgical, and regenerative endodontics is shown in case studies also presented the importance of 3D imaging in diagnosing odontogenic and non-odontogenic lesions.

Dr. Brian Trava earned his B.A. from Lycoming College (1984). His DMD at UMDNJ in 1988, finishing with his postgraduate degree in endodontics at UMDNJ in 1990 Dr. Trava has been in active practice since 1990. He maintains four (4) endodontic practices in North Jersey. Dr. Trava served as assistant clinical professor of postgraduate endodontics at UMDNJ. He has conducted research in dentin bridge formation and PMN inflammatory research at Merck. Dr. Trava lectures throughout the country on CBCT for Planmeca USA and the use of laser assisted endodontics. Dr. Trava has multiple publications in his field. He is a member of the American Dental Association, New Jersey Dental Association, AAE, International Association of Traumatology, Academy of Laser Dentistry Academy for Sports Dentistry. He has contributed his time in Africa for Basketball Without Borders with the National Basketball Association. Dr. Trava holds a U.S. patent for the first dental child identification system.

Evaluation of the Osteoconductive Property of Localy Synthetic Hydroxyapatite from Egg Shell as a Novel Bone Substitute – An Experimental Study in Rat

Fouad Hussain Al-Bayaty, Anissa Lokman, Suhaila Yazid and Omar Emad

Universiti Teknologi MARA (UiTM), Malaysia

Objectives: To evaluate the osteoconductive property and healing of locally synthetic hydroxyapatite from egg shell in extracted tooth socket.

Materials and Methods: Toxicity of hydroxyapatite from egg shell was tested on fibroblast and osteoblast cells line. Upper central incisors of thirty six adult male Sprague Dawley rats were extracted. Animals were divided into four groups; sockets of group 1(control) were left empty, group 2 filled with commercially available hydroxyapatite, group 3 with locally synthetic hydroxyapatite from egg shell, while group 4 with locally synthetic hydroxyapatite from egg shell and growth factor platelet rich plasma. All sockets were sutured with resorbable dental suture. Animals were scarified, two, three and four weeks after the extractions. Serial sections were obtained and stained with hematoxylin and eosin, immunohistochemistry and Massonʼs Trichom staining. Blood samples were taken before and after experiment for biochemical analysis. All statistical analysis were done using SPSS version 20.

Results: Hydroxyapatite from egg shell showed no toxicity on fibroblasts and osteoblasts. There were no changes in biochemical blood parameters of experimental group compared to control group. Histological examination of haematoxylin and eosin, immunohistochamical and Mason Trichom demonstrated that sockets treated with locally synthetic hydroxyapatite from egg shell and growth factor were completely filled with newly generated bone tissue with a thickness comparable to native bone and were significantly better than the control group. Fibroblast and collagen fibres were more predominant in experimental groups than the control.

Conclusion: Locally synthetic hydroxyapatite from egg shell promoted bone healing by osteoconductive property and increased with combination of growth factor.

Fouad Hussain Al-Bayaty Currently, Professor at the Faculty of Dentistry Universiti Teknologi MARA-UiTM. External Examiners for PhD and M.Sc. Postgraduate students, Supervising thesis of 35 PhD and M. Sc. Students in Malaysia and Iraq, published more than 120 research in ISI and non ISI scientific journals and five books, obtained 79 medals (gold, silver and bronze) in the international and national level.

Bio Rejuvenation Dentistry: Minimally Invasive Full Mouth Rehabilitation

Hal Stewart

The Texas Center for Occlusal Studies, USA

The disease of malocclusion related enamel/tooth structure attrition is rampant. The coordination between a stable temporomandibular joint, optimally functioning chewing muscle, biologic tooth morphology, and the proper inter-arch relationship is paramount in establishing a healthy, stable, optimally function occlusion.

Biorejuvenation dentistry is not only a technique, but it is a philosophy. The premise is that a biologically sound occlusal rehabilitation cannot be accomplished without addressing all the above mentioned components: Joint, Tooth Morphology, Inter arch relationship, and Muscle coordination. When all of these are coordinated then full mouth rehabilitation can be accomplished predictably and optimally with the use of minimally invasive composite resins. The author has been practicing biorejuvenation since 2001 with hundreds of long-term successful cases.

Dr. Hal Stewart is founder and clinical instructor for The Texas Center for Occlusal Studies and Minimally Invasive Dentistry, located in Flower Mound, Texas. He is also a key opinion leader for Ultradent, GC American, and Align Technologies. Dr. Stewart maintains a private practice in Flower Mound, TX where he specializes in biorejuvenation dentistry.

Treating TMD can Fix a World of Problems

Jeffrey L. Brown

Sleep & TMJ Therapy, USA

It is the belief of the author that when the articular discs of the temporomandibular joints are displaced, this can cause pressure on the blood vessels and nerves throughout the area. This is referred to as TMD (Temporomandibular Joint Disorder). The co morbidities of TMD can include head and neck pain, breathing difficulties, and even such disorders as Touretteʼs Syndrome, Parkinsonʼs, along with essential tremors. The authors have noted that the key to success in treating the TMD, and the associated co morbidities, involve successful diagnosis using MRI technology, muscle palpation, and a careful selection of proper appliances to level the glenoid fossaʼs while decompressing the articular discs. Unfortunately, too many patients end up suffering at the hands of a practitioner who does not understand the need to properly analyze and diagnose the true underlying condition. The authors, over the years, have each met countless patients who have been to dozens of doctors, only to discover there was an underlying TMJ problem. Dr. Brown recently met one patient who had been to 85 doctors prior to meeting him and in just a few months of treatment did extremely well.

In this presentation, it will be shown that not only is a great MRI needed, but there must be the ability to palpate the various muscles and cranial bones to determine any underlying cranial distortions. In addition, proper x-rays are used to confirm the suspected condition. Once the condition has been identified, then a treatment plan can begin. Dr. Brown and Dr. Stack are able to re-align the cranial bones and decompress the jaw joints at the same time. The goal with patients who have movement disorders is to take the pressure off the auriculotemporal nerve and reduce the noxious signals to the brain that cause the movement, or the ‘tic’ as it is called. This treatment is extremely effective and in only a small number of cases is any type of surgery considered. Dr. Brown is one of a small handful of practitioners in the world who treats his patients using the ‘ALF’ appliance. This is a specialty appliance designed to expand the upper and lower jaws, increase nasal patency, and make more room for the tongue which will decrease obstructive sleep apneas and improve sleep disordered breathing. All of this is tied into TMD treatment.

Dr. Jeffrey Brown is a dentist in Falls Church, Virginia, whose practice is limited to the treatment of TMJ disorders. Dr. Brown sees patients who suffer from displaced articular discs in the jaw joint which cause whole body problems. In addition, his training in cranial bone distortion allows him to better diagnose the problems and how to treat accordingly. He is one of the few practitioners in the world who have trained for over 400 hours just on the ALF appliance alone. His focus is on TMJ disorders, cranial bone distortions, and their tie in to sleep disordered breathing. He has found that by looking at the patient as a ‘whole personʼ and not just the teeth, that higher success are achieved.

Digital Approach to Immediate Implantology: The Solution for Com-Plex Cases with Bone Atrophy

Alessandro Palumbo

Studio Odontoiatrico Dott Alessandro Palumbo, Italy

Complex cases of bone atrophy of the jaws are difficult to treat for any Implantologist. Lack of resi-dual bone and the difficulty of getting new bone live and stable over time is a problem for the den-tist. Bone regeneration techniques are long, invasive, and with low successful success rates in short and especially long-term. Computer-assisted Implantology is a valuable help as it allows sub-millimeter accuracy to maximize the residual bone of the patient. We speak of the inter foramina area of the jaw, the sects and walls of the maxillary sinus, the Pterigoid area, etc. The three-dimen-sional analysis of the amount of residual alveolar and basal bone obtained from CBCT examination and digital navigation techniques allow us to locate all the little bone available. In addition to this fundamental aspect, it is also possible to have a virtual planning of the intervention keeping in mind the position of future prosthetic teeth. Navigation software allows you to locate the inclination leng-th and position of the implant using the maximum bone and keeping in mind the prosthetic emer-gency profile. The virtual project can be faithfully reported to the patient on the day of surgery th-rough a stereolithographic surgical guide. This guide, if the steps are correctly performed, allows to position the implant in the patientʼs mouth exactly in the residual bone.

Getting that same position by working with a free hand would not be possible for the same sur-geon. Furthermore C.A.I. allows these interventions to be minimally invasive quick and very well accepted by the patients. Almost always it is possible to load the fixtures immediately, allowing the immediate function of the prosthesis.

In this report, the author, who uses these methods since 2000, will exhibit atrophic cases of partial and total jaw with immediate loading of implants successfully treated with digital implantology. 15-year follow-up cases will also be shown.

Show the surgeon and prosthetist how complex cases of atrophies of the jaw can be solved using Computer Aided Implantology. C.A.I. : The simple solution for complex cases. Show clinical daily work of 15 with real clinical cases of unselected patients.

Dr. Palumbo Alessandro was among the first in the world, thanks to the University of Louvain Bel-gium, to clinically use the computer-assisted Implantology technique on his private patients. He lo-ves innovations and minimal invasiveness for the patientʼs ultimate) well-being, he is one of the founders of the CAI Academy and has been tutor and speaker in courses and congresses in Italy and abroad. His first Dubai lesson on the subject was in 2015. Mentor of the CAI Academy of the Implant Academy and Mentor of the Nobel Biocare Program Free Professionals loving innovations in Pesca-ra Italy.

Digital Implantology

Konstantinos Tokmakidis

Adligenswil Zahnärztliche Gemeinschaftspraxis AG, Switzerland

Tooth loss leads through complex biochemical channels to both hard- and soft-tissue loss. Nowadays implant therapy is in many cases the preferred treatment. For many years implant insertion was bone-guided. Today we have many tools for full restorational guidance during planning and execution of our treatment protocols.

For a very long time backwards planning was propagated, unfortunately limited just to the planning of the reconstruction. Nowadays we are capable of also planning the needing grafting procedures.

This lecture aims in presenting the possibilities that are given with today available tools, associatedtreatment protocols, the optimization of existing protocols, their advantages and limitations. Thus, an overview will be given for adequate methods and materials with respect to different indications.

The lecture is targeting both beginners and experienced clinicians, giving guidelines for everyday practice.

Dr. Konstantinos Tokmakidis graduated from the University of Greifswald (GER), School of Dentistry in 2003. Shortly after he entered a 3-years Prosthodontics Program at the University of Aachen (GER). At the same time, he attended a post-graduate program for implantology from the German Association of Implantology. In 2014, he gained his Masters in Periodontology and Implant Therapy. His practice is limited ever since in prosthodontics, implantology and periodontology. Dr. Tokmakidis carries a board certification in Prosthodontics as well as Implant Dentistry. He is a multinational speaker since 2004 for Implantology and Implant Prosthetics as well as Digital Dentistry. His main fields of study are implantology, CAD-CAM and its implementation into everyday recostructionaland implant dentistry.

Management and Healing of Oral Wounds using Plasma Rich Fibrin

Kristina Rebić* and Bojan Gacic

University of Belgrade, Serbia

Oral wounds occur most commonly after teeth extraction, surgical procedures or as a result of injuries. Wounds resulting from surgical interventions are primary closed. Open wounds are more often and they heal per secundam intentionem. Specificity of oral wounds is their exposure in oral cavity and absence of scab, good vascular and innervation network, where many local factors (saliva, bacteria, smoking, immunodeficiency, etc.) can slow the healing process. Wound healing is very complex and has four phases where various growth factors and proteins are included. Healing of these wounds is slow, and during that period some complications can occur (alveolitis, infections, etc.).

Plasma rich fibrin is biological, autologous material gained from patientʼs blood. It consists of dense fibrin mesh infiltrated with white blood cells, platelets, and growth factors. Growth factors have angiotrophic and osseoconductive role, and also influence on differentiating mesenchyme cells. In degranulation process, platelets release cytokines that have multiple mechanism of improving healing by stimulating reparation and production of collagen. Also cytokines have a key role in regulation of cell apoptosis and cicatrisation. In comparison to any other material, biological response to platelet rich fibrin is superior. Placing this material in extraction sockets or oral wounds accelerates healing process, prevents and diminish occurred complications and modifies soft and hard tissue management where is necessary.

Kristina Rebić has started her postdoctoral studies 4 years ago on Belgrade University, School of Dental Medicine, on thesis: Closing oroantral communications using plasma rich fibrin ( prf ). She is research assistant and Oral surgery resident in Belgrade University, School of Dental Medicine, Clinic of Oral surgery. She is the director of her own private practice. She has published several papers and presentations on domestic conferences.

Differences between Adult Patients with Cerebral Palsy and Control Group Regarding Electromyographic Activity of the Masticatory Muscles

Miriam Yumi Matsui

Sao Paulo State University, Brazil

Objective: To compare the masticatory behavior of patients with cerebral palsy with different degrees of oral motor impairment and control group, at rest and function.

Methods: 30 adult patients with cerebral palsy and 30 subjects without any neuromotordisorders, were enrolled in this study. Oral motor function impairment was classified for each subject according to the Orofacial Motor Function Assessment Scale. Surface electromyography was bilaterally recorded from masseter and anterior temporalis at rest, maximal voluntary clench and mouth opening. Comparison between the groups was statistically assessed by means of Mann-Whitney test.

Results: At rest and open mouth, electromyographic values were greater in patients with cerebral palsy when compared to control group. During maximal voluntary clench, the opposite occurred.

Conclusion: In cerebral palsy, jaw muscles are tensioned when they should not and are not efficient when they should.

Significance: To improve their masticatory function, muscle therapy should approach rest, mouth opening and clenching differently.

Miriam Yumi Matsui completed in 2005-2009 Graduation, School of Dentistry, USP – Universidade de São Paulo, São Paulo, Brazil. In 2010-2012: Master Science Degree in Biosciences and Oral Diagnosis, School of Dentistry, UNESP – Universidade Estadual Paulista, São José DOS Campos, Brazil.

Questionable or Hopeless.. Thinking Outside the Box

Ahmad Imam

King Abdulaziz University, Saudi Arabia

When to extract a tooth and place an implant? Assuming a patient has adequate financial ability to do either treatment, when should a questionable tooth be extracted, and when should it be retained?

In the past, when implants were not available, the decision was easier. However, now that placement of an implant in a healthy patient with adequate bone is relatively easy, the decision is more difficult and complicated by a second question: When to decide that a questionable tooth is a hopeless one?

More importantly, once the decision to save a tooth is made, how could we, as successful service providers, achieve a reliable result consistently every time we decide to save a tooth? Especially those heroic attempts to maintain teeth with questionable prognosis are currently being doubted.

This presentation aims to answer these questions from several angles. The reasons of why goes the extra mile to save a questionable tooth are explored. The patient role in making that decision is highlighted. Factors influencing the joint patient/dentist decision are discussed. These include; patient age, the general health of the patient, the strategic value of the tooth, the amount of tooth structure remaining, occlusion, financial limitations in relation to long-term prognosis, patient desire to keep the natural tooth, and patient acceptance of other needed procedures to retain the tooth.

Moreover, a discussion of potential reported success rate, longevity, survival, given the conflicting evidence-based dental literature with its varying definitions of ‘success/failureʼ is included.

Questions and doubts abound in the decision making process in regards to the prognosis of an individual tooth. In dentistry, as in all biologic sciences, there are no straightforward answers to questions. This presentation will attempt to aid the practitioner in the decision making process and clinical management of compromised questionable tooth.

Dr. Ahmad Imam is a prosthodontist, Assistant Professor and Clinical Director of the 6th year Comprehensive Care Clinic, Prosthodontics Division, Department of Oral & Maxillofacial Rehabilitation, Faculty of Dentistry, King Abdulaziz University and previously his holding the position of Assistant Professor and Chairman of the Intern Clinical Training, Prosthodontics Division, Department of Oral & Maxillofacial Rehabilitation, Faculty of Dentistry, King Abdulaziz University.
Ahmad is also a prosthodontics instructor at King Abdul Aziz Universityʼs Faculty of Dentistry (KAUFD) at both the undergraduate and graduate levels. In addition to his academic and teaching roles, Ahmad works in private practice as a Consulting Prosthodontist in Jeddah, Saudi Arabia.

Clinical Assessment and Joint Tensile Strength of Chair Side Band and Loop Space Maintainers

Mohamed El Raiyes

Tanta University School of Dentistry, Egypt

Survival of space maintainers has the interest from researchers in pediatric dentistry, due to their clinical importance in developing dentition in pediatric population. Chairside space maintainers are single setting technique which saves practice time. The aim of the study was to assess clinical performance, mean survival time, gingival condition and caries status and joint tensile strength of chairside band and loop space maintainers compared to conventional band and loop space maintainer. Clinical trial conducted on thirty healthy children between ages four to seven years old with premature loss of bilateral mandibular primary first molars were selected from Pedodontic clinic, Faculty of Dentistry, Tanta University and laboratory trial done at National Research Centre, Cairo. For each candidate, chairside space maintainer was inserted in one side, whiles the conventional type on the other side and evaluated every 3 months for nine months. 83.33% success rate in chairside group with (8.56 months) mean survival time and 73.33% in conventional type with 7.5 months mean survival time. No statistical significant difference (P>0.05) between both groups regarding success rate, survival time, caries assessment and joint tensile strength, only gingival index increased during study period. In

Conclusion: Chairside space maintainer is considered a successful appliance.

Mohamed El-Raiyes has completed his MDS in Pediatric Dentistry at the age of 28 years from Tanta University and BDS from Minia University School of Dentistry (Egypt). El-Raiyes is also a registered specialist in Infection Control and Healthcare quality management, with a PGPD from Arab Medical Union, as well as PGPD in Health Care Quality Management, from the American University in Cairo. He published his first paper in the Egypt Dental Journal, based on his dissertation evaluating the efficiency of new techniques involving preventive orthodontics.

Considerations for Successful Implant Treatment in Diabetic Patients

Mohamed A Hassan

October 6 University, Egypt

Literature review study aims to evaluate the effectiveness of glycaemic control, preoperative antibiotic and CHX mouth rinse and patient motivation on implant success in diabetic patients.

Discussion and Results: Hyperglycaemia have been shown to alter normal process of ossiointegration by inhibition of osteoblastic cell proliferation and collagen production, Prolonged hyperglycaemia may result in delayed wound healing around dental implant and osseointegration due to altered metabolic rate While, the time required to achieve 100% level of healing, patients with high level of HbA1c ≥ 8.1% required about twice the time to return to baseline levels compared controlled and non-diabetic patients. Some articles shows better success rates of dental implant treatment regardless diabetic control level. By following a restricted protocol includes antibiotic course and CHX (0.12) mouthwash. Preoperative antibiotic usage showed a favourable improvement in implant survival (Table1)

Also the improved implant success by using CHX persists from implant insertion till prosthesis construction phase and extend post-loading.

Conclusions: Pre-operative antibiotic regimens and CHX mouth rinse must be kept in consideration to enhance wound healing and reduce possibility of infection. Always consider delayed loading, Patient motivation and restriction to good glycaemic control must be noticed and recorded in patientʼs file through follow up visits Careless patients that show insufficient oral health care and lack of motivation. In such cases dental implants doesnʼt consider a treatment of choice

Mohamed is a demonstrator in oral medicine, Periodontology and oral diagnosis, faculty of dentistry, October 6 University. He has completed his Msc of Implantology from international medical college-Germany. He is a member of the German board of oral Implantology. Also He is the director of Hayah implant Education Center, his current research interest include implant in patients with low bone quality and implant in diabetic patients.

Erbium Family Laser: Silent Revolution in Dentistry

Nagy Abdulsamee

Modern University for Technology & Information, Egypt

Erbium laser systems quickly began establishing themselves as compact and versatile additions to the dentistʼs repertoire, predominantly for performing hard tissue dental applications. Research has shown that their wavelengths are ideally suited for both soft and hard tissue procedures due to their high absorption in water and hydroxyapatite. Therefore these lasers are considered one of the most versatile with regard to the number of possible treatment options, as their wavelength can be effectively used in the field of soft and hard tissue surgery, periodontics, endodontics, implantology, cavity preparation, and tooth whitening. The versatility of the instrument, combined with the latest achievements in laser technology, compact design and affordability, should appeal to dental professionals seeking to optimize the procedures they currently perform and expand the number of services they offer which is the main aim of the current lecture.

Nagy Abdul-Samee Abdul-Hameed is a Formerly, Vice Dean for Graduate Studies and Rsearches, College of Oral and Dental Medicine, Misr University for Science & Technology, Egypt. Currently, he works as a Professor and Head of Dental Biomaterials, Faculty of Dentistry, Modern University for Technology & Information (MTI), Egypt from 1/9/2016 till now and also Member in the editorial board of many International Dental Journals. He made a lot of work shops about laser use in dentistry at many colleges of dentistry in Egypt and Lebanon. He is a Speaker in many national and international conferences.

Caries Experience among Ukrainian School Children

N Chukhray* and N Smolyar

Danylo Halytsky Lviv National Medical University, Ukraine

Aims: The prevalence of dental caries among children in Ukraine has increased dramatically during the last few decades and reached 60% - 90 %. Physical, functional, social, psychological and emotional impacts of dental caries have been well documented to diminish the quality of life. The aim of this paper was to investigate the prevalence of dental caries, carious, filled permanent and missed permanent teeth.

Methods: For this purpose 1301 5-16-year-old children from Lviv (Ukraine) were examined (612 girls (52, 44%) and 555 boys (47, 56%) by trained dentist examiners. Dental caries was assessed according to the guidelines given by WHO (1997) under natural day light using mouth mirror sand probes. Decayed, missing and filled permanent teeth (DMFT) due to caries were recorded and summarized as DMFT by a calibrated investigator. All examinations were performed by the same person, in standard conditions. Ethical approval and parental consent was obtained for this study. Data for the various groups were compared using Studentʼs t-test.

Results: It is established that prevalence of dental caries of the permanent teeth for the examined children, is, in the average, 72, 15±1, 31% and caries intensity (DMF index) - 2, 86±0, 21. The detailed analysis depending on sex, showed that for girls, prevalence of dental caries of the permanent teeth, in the average, it is higher (78, 92±1, 65%) comparing with boys (64, 14±2, 04%), (p<0, 001). The analysis of index DMF structure showed that, in the average, on one child was 0, 98±0, 14decayed tooth, 1, 84±0, 18filled tooth, and 0, 04±0, 01 missed tooth. Analysis of caries intensity of the permanent teeth depending on age showed that from six to sixteen years the index of decayed teeth - “D” grows from a 0, 27±0, 07 tooth to 1, 43±0, 18 tooth, (p<0, 001) (in five times). Untreated dental caries in children may lead to infection, pain, and lost school productivity–both in terms of lost school day sand reduced concentrationin school. From six to eight years percentage of decayed teeth is higher from percentage of the filled teeth, on the contrary, from nine years, percentage of the filled teeth prevails and in sixteen years the correlation of percentage of indexes “D” and “F” makes 25, 04±3, 95% and 73, 56±4, 03%. As a result of comparison of caries intensity of the permanent teeth depending on sex, it was found out, that, on the average, for girls it insignificantly differs in comparing to the boys and makes a 3, 41±0, 37 tooth against a 3, 39±0, 34 tooth. Analysis of caries intensity depending on age showed that in all age-dependent groups caries intensity of permanent teeth is more higher for girls.

Conclusions: Our study reported that the prevalence of dental caries of the permanent teeth for the examined children, is, in the average, 72, 15±1, 31% and caries intensity (DMF index) - 2, 86±0, 21. The analysis of index DMF structure showed that, in the average, it was revealed 0, 98±0, 14 carious tooth, 1, 84±0, 18 filled tooth, and 0, 04±0, 01 missed tooth.

Chukhray Natalya, working in Danylo Halytskiy Lviv National Medical University, Ukraine as a Assoc Prof. of Orthodontics Department Topics of research: epidemiology of dental caries and malocclusions, resistance of tooth enamel to dental caries. Author of more than 140 scientific issues.

Orthodontic Diagnosis and Treatment Planning

Omar Yousry

Cairo University, Egypt

The comprehensive orthodontic diagnosis is considered the most important step in planning the orthodontic treatment. Accurate diagnosis and identification of all dento-facial abnormalities along with proper estimation of the patient chief concern, motivation and expectations is mandatory before starting the orthodontic treatment plan. Planning the orthodontic treatment always start with series of questions in which each question leads to another. And the answers for these questions would be the main items of the treatment plan. For every question to be answered there are many factors to be considered and many variables to be evaluated. Any pathological problems (systemic or local) must be outlined clearly before starting planning for treatment of any developmental problems. Pathological problems may necessitate consultation from the physician or other dental specialist; this may alter the orthodontic treatment plan, modify, postpone or even contraindicate it. The first question must be: should I treat this patient? To answer this question the need, demand for treatment and also the benefits and risks of orthodontic treatment for this specific patient should be thoroughly investigated. The second question about the perfect timing for treatment and to answer this question the clinician should be totally aware about the essentials of growth and development of dento-facial complex and dental occlusion and the etiology and sequel of different malocclusions. Other questions considering the path of treatment (Interceptive treatment - growth modification – orthodontic camouflage – orthognathic surgery ), the need for extraction or not, the choice of teeth to be extracted, anchorage demand, type of orthodontic appliances and the mechanics to be used should be properly selected. Also the retention protocol and appliances should be addressed from the first day.

Omar Yousry Mostafa completed Bds, Msc Orthodontics in Cairo university. He currently works as an Assistant Lecturer at orthodontic department, Cairo University and Owner of multi-branch orthodontic clinic in Cairo.

Use of Autogenous Symphyseal Bone Graft for Ridge Augmentation: Clinico-Radiographic Study

Prashant A Punde

School of Dental Sciences, India

Context: Reconstruction of the lost bone has always thrown a challenge to maxillofacial surgeons. Various attempts have been made in pursuit of gaining maximum quantitative and qualitative bone fill with attempts of minimizing the morbidity.

Aims: Study is done to evaluate clinical & radiological efficacy of autogenous graft from mandibular symphysis with platelet rich plasma in correction of bony defects of jaws.

Settings and Design: This prospective study includes 25 patients. Follow up period was 12 months. The outcome was evaluated according to Berglandʼs scale & Cooleʼs method.

Methods & Materials: All patients had undergone autogenous symphysis grafting with simultaneous placement of platelet rich plasma. All surgeries were conducted under local anaesthetia.

Statistical Analysis Used: Chi-square test & student‘tʼtests were used for significance. Results were found statistically significant. Comparison between the two radiographic techniques was found insignificant.

Results: The amount of available bone at recipient site before grafting was found to be in the range of 7% - 60.8% & 10%-70% according to different methods of measurement. The bone bridge height obtained after bone grafting, at the end of 12 months was in the range of 60% - 100% & 66% - 100% respectively.

Conclusion: For repair of most localized bone defects onlay block bone, from the mandibular symphysis with platelet rich plasma, provide certain advantages with excellent quality of autogenous bone. Along with this we have also utilized the opportunity to evaluate two different radiographic scales to compare the bone fill. Limited amount of graft precludes its use for extensive bony defects.

Keywords: autogenous graft; onlay block graft; mandibular symphysis; platelet rich plasma.

Dr. Prashant A. Punde has completed his BDS from esteemed Government Dental College Nagpur in the year 2007. He has achieved success in national level postgraduate entrance exam & completed MDS in subject of Oral & Maxillofacial Surgery from Krishnadevaraya College of Dental Sciences, Bangalore in the year 2011. He had contributed his work on LASERs in asiaʼs highest selling Textbook of Oral & Maxillofacial Surgery by Dr. Neelima Malik. He has presented 12 scientific papers and has 14 scientific articles in various Journals. He has guided undergraduate scientific projects and papers in various conferences with notable success. He has worked as reviewer for International Journal of Health & Allied Sciences, Ethiopian Journal of Health Sciences & Dental Research Journal. His work expertise includes Orthognathic surgery, traumatology & Temporomandibular joint surgery.

An ex vivo Evaluation of the Efficacy of Andrographolide in Modulating Differential Expression of Transcription Factors and Target Genes in Periodontal Cells and its Role in the Treatment of Periodontal Disease

Presanthila Janam

PMS College of Dental Sciences & Research, India

Andrographolide is a herbal extract traditionally used in South Asian countries for treating inflammatory diseases. A study was done to evaluate the efficacy of andrographolide in the management of periodontal disease. Periodontal ligament fibroblasts (PDLF) were cultured from healthy and diseased periodontium using explant culture methods. The safe dose of Andrographolide was determined using MTT assay LPS (Lipopoly Saccharide) of the most important periodontopathogen. Pgingivalis was used to activate NFkB and STAT 3 in PDLF. The efficacy of AG in inhibiting NFkB and STAT 3 was analysed using immunofluorescence. Down regulation of expression of target genes of these transcription factors related to inflammation and bone resorption were analysed using real time PCR. Andrographolideupto the concentration of 25µM was found to be safe as determined by MTT assay. Statistically significant activation of NFkB and STAT 3 and down regulated expression of inflammatory and bone resorptive genes in cultural PDLF were obtained. The adjuctive use of a novel herbal drug andrographolide is a promising host modulation agent in periodontal therapy.

Dr. Presanthila Janam former Principal, Govt. Dental College, Trivandrum, currently serving as Director of CDE, Associate Dean Research &Professor, Dept. of Periodontics, PMS College of Dental Science & Research, Trivandrum. Earned BDS from Govt. Dental College Trivandrum and MDS Periodontics from Kerala University 1986 Presented 30 scientific papers and was a presenter for the annual world congress FDI New Delhi and an invited speaker, 8th International Conference in Dentistry, Dubai. She has authored numerous peer reviewed scientific papers and has 60 international, national and state publications. She is the recipient of Best Scientific paper awards of the IDA, Kerala State Conference 2006, 2007 and 2009. She is the recipient of the State Best Doctor Award in Dentistry in 2010 and also the recipient of the Best Dentist Award 2017 by the Kerala Dental Council.

The Three-Dimensional Skeletal Proportional Equation, is it Applicable?

Ahmed H Harara*, Amr R Al-Bialy and Sanaa Abu Zaid

Cairo University, Egypt

The aim of this study was to establish anindividualized 3D proportionalcephalometric analysis for 37 Egyptian adult subjects (18-25 y) having balanced facial proportions andAngle`s class I molar & canine relationship. The inter-and intra-observer reliability was confirmed after the 3D landmarks identification for randomly selected 10% of the sampleby two observers, the researcher (observer1) and a colleague (observer2), and only for the researcher to do it twice with a gap of 7 days between them. Seventeen cranial, maxillary and mandibular base landmarks were located on each CBCT image in-order to perform fifteen length, height and width linear measurements between the different anatomical landmarks which were projected to the main reference system, also eleven length, height and width ratios were calculated for each sex.

Results: The intra-observer, inter-observer reliability for landmarks showed high concordance with identical ICC and CCC. As for length, height and linear measurement, there was a significant statistical sex difference. However, for length, height and width ratios, a non-significant statistical sex difference was found. The data would lead us to sum-up the result that in average facial proportion subjects, the maxillary basal width, maxillary basal length, mandibular corpal width and mandibular corpal length are nearly equal (1:1). The inter-orbital width equals the sum of the maxillary and mandibular basal widths (1:1), while the some of the posterior and anterior lower facial height nearly equals the inter-orbital width (1:1), and the posterior lower facial height nearly half the anterior lower facial height (0.5:1).

Hence, the previously mentioned craniofacial relationships in the Egyptian adults with average facial proportions could be summarized into the newly introduced the three-dimensional skeletal proportional equation provided a statistical fitness within the Egyptian adults of average facial proportions. Which assesses the degree of harmony between each measurement within the same element, as well as the degree of harmony between the four elements of the equation regardless the gender or skull size of the subject?

Ahmed Hussien Zaher Harara, Masterʼs degree in Orthodontics, Faculty of dentistry, Cairo University, 2016. Private practitioner at Saudi Modern Dental Complex and Kingdom of Saudi Arabia

Instrumentation of Irregularly Shaped Root Canals: Evidence Based Update

Ajinkya M Pawar

Nair Hospital Dental College, India

One of the main objectives of endodontic treatment is the thorough preparation of the root canal system and proper obturation for obtaining a three-dimensional seal. To achieve this goal, clinicians must have a comprehensive knowledge of the normal anatomy of the relevant root canal system and its common variations. Cross-sectional root canal configurations have been classified as round, oval, long oval, flattened, or irregular. The irregularly shaped canals should have a different approach regarding management compared with normal root canal configurations. The recognition of these canals determines that a different approach be applied in cleaning, shaping and obturation. It is difficult to prepare such root canals since their irregular shape make steady contact of the instruments with the canal walls a challenge. Circumferential filing movements allow improved contact with the canal wall, although this method does not always guarantee the preparation of the entire root canal. The aim of this presentation is to address the definition, prevalence, and treatment protocols for irregularly shaped canals.

Dr. Ajinkya Pawar is a dedicated researcher and enthusiastic adopter of new technologies, which can improve treatment results both for doctors and patients. He has decided to dedicate his work life to broaden and expand his knowledge for Endodontics. In his young age he has already published 33 scientific studies in both National and International Journals indexed in PubMed, and a few more in press and under preparation, together with high ranked international researchers. He is passionate about learning new developments in Endodontics and he has travelled around the world pursuing this passion. For his excellence as a clinician and a researcher he has been acknowledged as the Best Endodontist in the year 2016, and Indiaʼs Young Dental Researcher in 2017, respectively. He has completed his B.D.S from Padmashree Dr. D. Y. Patil Deemed University, Nerul, Navi-Mumbai and M.D.S was completed from Maharashtra University of Health Sciences, Nashik. He is currently working as an Assistant Professor in the Department of Conservative Dentistry and Endodontics, at the Nair Hospital Dental College, Mumbai.

Caries of Human Dental Tissues Studied Using X-Ray and Electron Correlative Microscopy

Alexander M Korsunsky

University of Oxford, United Kingdom

Hydrated biological mineral composites of hydroxyapatite crystallites within organic matrix form the hardest tissue in the human body, the dental enamel, as well as other parts of the tooth (dentine, cementum, etc.). These tissues possess a hierarchical structure that delivers their versatile mechanical properties. These composites have excellent thermo-mechanical stability under severe exposure conditions in the oral cavity, but are subject to biological and chemical degradation (decay) due to human dental caries, a disease that affects a vast proportion of the worldʼs population as a consequence of the modern sugar-rich diet, causing dental erosion due to the activity of acid-producing bacteria residing in the biofilm (plaque).

A strong and durable bond between dentine and enamel is formed by the dentine enamel junction (DEJ), an important biological interface that resists failure under long-term harsh thermal and mechanical conditions in the mouth. Understanding the underlying reasons for this remarkable combination of strength and toughness remains an important challenge, both in the context of dentistry, and from the point of view of pursuing biomimetic advanced materials engineering. Residual strain develops in the vicinity of the DEJ during Odontogenesis (tooth formation). The experimental and interpretational challenges that could not be overcome until recently presented an obstacle to the evaluation of residual stress in the vicinity of the DEJ at the appropriate spatial resolution. The recently developed FIB-DIC micro-ring-core method was used to determine the residual elastic strain at micron resolution. The residual strain profiling across the transition from dentine to enamel was correlated with the study of internal architecture using X-ray scattering (SAXS/WAXS), providing insight into the origins of the remarkable performance of the DEJ, and also the degradation of enamel during early caries.

Professor Alexander M. Korsunsky (AMK) is a world-leader in engineering microscopy of materials systems and structures for optimization of design, durability and performance. He leads MBLEM lab at the University of Oxford, and the Centre for In situ Processing Science (CIPS) at Research Complex at Harwell. He consults Rolls-Royce plc on matters of residual stress and structural integrity, and is Editor-in-Chief of Materials & Design, a major Elsevier journal (2017 impact factor 4.364). AMK leads a major EPSRC research project on nanoscale analysis and modelling of human dental caries.

Fabrication of Indirect Tooth Colored Restorations with Protocol Compliance Using CAD/CAM Technology

Angela M De Bartolo

New York University College of Dentistry, USA

Incorporating Computer Aided Design/Computer Aided Manufacture, CAD/CAM, technology has become a critical part of our dental schoolʼs curriculum.

In the esthetic department at New York University College of Dentistry (NYUCD) CAD/CAM technology has been in used for over 20 years. To date, the pre-doctoral students have been given the opportunity to fabricate tooth colored, indirect restorations and ceramic crowns using CAD/CAM technology. The protocol requires that students be given lectures on the methodology and criteria of fabricating restorations using digital impressions. Incorporating CAD/CAM technology in fabricating indirect restorations into the core curriculum enhances clinical growth and development of high-tech capabilities that will enable our students to succeed in the future of dentistry.

CAD/CAM technology can be used to fabricate restorations in one patient visit, however, as part of the learning process, the student will follow school protocol which involves diagnosis, wax-up, preparation on stone model prior to performing the digital impression on the patient. The educational program at NYUCD is designed to credential facultydoctors on teaching the students as well as students learning to fabricate restorations using this innovative technology. Faculty doctors, once credentialed, will guide student dentists in taking digital impressions, design restorations, mill and fire restorations using CAD/CAM technology.

The goal of the training program is to standardize faculty doctors and students to become proficient in CAD/CAM technology and deliver state-of-the art dentistry to the patients.

Dr. Angela M. De Bartolo is a Clinical Assistant Professor and Group Practice Director at New York University, College of Dentistry. Dr. De Bartolo graduated from Fordham University, Rose Hill in 1983 receiving a Bachelor of Science degree in Biology with a minor in Italian Studies. She received her DDS degree from New York University, College of Dentistry in 1987 and continued to pursue a General Practice Residency Program at Lutheran Medical Center in New York for one year. Dr. De Bartolo was in private practice for 25 years and has been in academia for the past 7 years at New York University, College of Dentistry Dr. De Bartolo is a Fellow in the International College of Dentists.
Dr. De Bartolo is an active member of the American Dental Association. Her affiliation with the Oral Health Committee at the Second District Dental Society has enabled her to promote the importance of oral health in children from ages 5 through 18. Dr. De Bartolo has been able to learn and teach the CAD/CAM technology to students. This has enabled her to enrich colleagues and students with CAD/CAM technologypresentations at ADEA meetings as well as publish abstracts in the Journal of Dental Education.

Intelligent Software Solutions from Implant Planning to the Final Restoration

Antonio Corradini

Zirkonzahn SRL – Italy

Dental technology is becoming more and more digital. Especially in the field of dental software engineering, there has been enormous progress over the last years. Virtual planning and designing of dental prosthesis has become an indispensable factor in modern dentistry and dental technology. These new technologies have the capacity to result in greater accuracy, speed and efficiencies leading to improvement in patient care. Furthermore, computer-based guided implant surgery is minimally invasive and requires a shorter chair time and fewer appointments than traditional methods.

There are a lot of CAD-software programmes available on the market. The difficulty of choosing the right one lies in the fact that the programmes work well on their own, but not in combination with other software components. Therefore, the dental technician has well-working single software components, but the linking elements that allow a combination of individual software packages and thus a continuous digital workflow are missing.

In his lecture, MDT Antonio Corradini from the South Tyrolean company Zirkonzahn, will explain and demonstrate Zirkonzahnʼs recently upgraded CAD-software. The software has been developed with the aim to put together a software package in which all the existing software programmes are linked together to provide the user with a complete solution within a single software.

By demonstrating the single software modules and their distinctive features, he will describe new possibilities in treatment planning that allow not onlyto bring the patient data from the analogue into the digital environment but they result also in a better cooperation with the dentist. Taking the example of the implant planning software this means that the implants can now be placed on the basis of the modelled teeth (known as backward planning) and the patient receives an immediate restoration (immediate loading). It is the dentistʼs job to plan the implants while the dental technician produces the drilling template, the custom impression tray, the models as well as the provisional.

In this context, he will also mention the PlaneSystem® for capturing and identifying the patient individual occlusal plane and any associated natural asymmetries with the aid of the Natural Head Position (NHP) and the ala-tragus plane. Together with the Face Hunter 3D facial scanner used for photo-realistic 3D digitisation of patient faces, it guarantees a planning reliability for the dental technician and the patient, as the tooth restoration can be realised based on the patientʼs physiognomy, taking into account bone asymmetries and resulting muscular compensation.

Antonio Corradini will present innovative solutions achieved by modern CAD/CAM technology, show different patient cases and different material options and explain eventual encountered difficulties during the realisation of the cases.

Furthermore, he will speak about Zirkonzahnʼs broad training programme and about the importance of continuing education.

Corticotomy Assisted Orthodontic Treatment

Basma A S Al Maghlouth

Dammam Specialized Dental Center, Saudi Arabia

Dentistry always comes up with wonders when different specialties works hand in hand. Periodontally accelerated osteogenic orthodontics or corticotomy assisted orthodontics is one such wonderful treatment modality which helps in reducing the treatment time by relieving patients of their tedious orthodontic appointments. The technique combines buccal and lingual flap decortications of the bone together with particulate bone grafting and fixed orthodontic treatment. The desired result is obtained within about one third the time needed for conventional technique. The chances of root resorption and relapse had also been found to be reduced with this novel technique. The lecture highlights the importance of the underlying Regionally Accelerated Phenomenon and the Periodontal Surgical technique as well as various indications, contraindications, merits and demerits of the technique in an evidence-based context.

Basma Al Maglouth is a Consultant in Orthodontics, Head of Orthodontic Department at the Dammam Specialized Dental Center, Dammam Medical Tower, Ministry of Health, Dammam, Kingdom of Saudi Arabia. She is a Bachelor of Dental Surgery graduate from the College of Dentistry, King Saud University, Riyadh, Saudi Arabia. She also obtained a Masterʼs Degree in Dentistry and Clinical Certificate in Orthodontics in the same university. She is the Head of the Curriculum Committee of the Saudi Board of Orthodontics of theSaudi Commission for Health Specialties. She is also the Program Director of the Saudi Orthodontic Program in the Eastern Province, a member of the Consultant Evaluation Committee and Accreditation Committee also under the Saudi Board of Orthodontics.

The Minimal Invasive Smart Smile Design and the Complete Digital Workflow

Cagdas Kislaoglu

Beykent University, Turkey

We live in a era where high technology is a part of our daily lives and at a time where Patients are becoming more specific and demanding about how they would like their anterior teeth to be restored. Not only are they requesting an esthetic solution to their dental problems, but also seeking procedures that require “no touching” or “minimally touching”of remaining tooth structures. As we all know beauty is in the eye of the beholder. There are smile design principles and rules but patients donʼt always want their smile design to be done by rules. Technology is improving at a fast rate, adapting this technology to our dental practices makes our lives easier and more enjoyable. In this lecture we will understand how to customise the smile in a smart way to make the patient and the dentist satisfied and happy. I will include strategies for communicating with the patient and ways of presenting the design to the patient in 3D before the treatment even starts. In this lecture we will go through the complete digital workflow of smile design and CAD/CAM dentistry. Photographs and videos will be shown from all the stages. I am looking forward to see you in my lecture and future smart smile design courses.

Learning Objectives

- Learn the Cornerstones of Smart Smile Design:Evaluation, Design, Provisionalisation.
- Managing esthetic challenges of smile design
- Treatment planning; Philosophy, Strategy, Reality, Problems, Pitfalls, and Possibilities
- Learning the fully digital workflow on smart smile design
- Minimal invasive veneer prep technique

Dr. Cagdas Kislaoglu graduated from Piedmont high school in Piedmont California. Studied dentistry at the University of Marmara Dental School from 1995-2000 and received his DDS degree. After graduating he joined the department of Prosthodontics. He received his Ph.D. Degree in 2005 on the subject of fracture resistance and margin adaptation of zirconium bridges. After the year 2000 he started a private practice focusing on Cosmetic Dentistry. His field of attentions are CAD\CAM dental treatments and smart smile design. Since 2009 he is doing several makeover shows on different national and international television shows focusing on smile design makeovers. Since 2011 he is a part time Associate Professor in the Department of Oral Health Sciences and Technologies in Beykent University.

Going Beyond the Students Boundaries: Using CEREC, Certifying Them in the Fabrication, Milling and Crystallization of E-max Indirect Restorations

Denise Estafan

New York University College of Dentistry, USA

Objective: To train and certify dental students in fabricating indirect tooth colored restorations with CAD/CAM technology.

Introduction: Tooth colored restoration using digital dentistry is growing worldwide. CAD/CAM technology in fabricating tooth colored restorations, including, crowns, inlay/onlays, veneers, three-unit FPDs and implant crowns are used in most of the dental schools in the United States.

Method: At New York University College of Dentistry, the second-year students are trained in the simulation laboratory on how to make digital impressions. Additionally, they use the software to view their work at 12X and improve their own preparations.

As third-year dental students, they design and fabricate two indirect composite restorations and two ceramic restorations using the CAD/CAM. A group of four student doctors practice together using the acquisition unit underthe supervision of a qualified instructor. They are trained to make a digital impression of the prepared tooth and the adjacent teeth, the opposing quadrant and in maximum intercuspation.

Student doctors learn how to digitally design and mill the restorations. In addition, they learn how to operate a high-tech digital crystallization furnace used for staining and glazing ceramic. The student doctors are certified to use CAD/CAM and also the furnace to crystalize their restoration. In fourth year, they have the training and lab experience to deliver CAD/CAM restorations to patients.

Conclusion: Certification of the dental student doctors gives them confidence and self-motivation toexcel in the new world of digital dentistry.

Dr. Denise Estafan graduated from Cairo University College of Dentistry in 1969. After graduation, Dr. Estafan practiced dentistry in a private general dentistry practice for two years. In 1978, Dr. Estafan was appointed instructor at Riyadh University and worked in the outpatient clinics in Ryiadh, Saudi Arabia until 1980. In 1984, Dr Estafan was appointed Assistant Clinical Professor to the Department of Operative Dentistry at New York University College of Dentistry. In 1993, Dr Estafan was appointed to the Division and Prosthodontic Sciences. Dr. Estafan is the author of over 100 publications/abstracts that have focused on dental materials relating to restorative dentistry, aesthetics and CAD/CAM technology. She has lectured nationally and internationally on these topics Dr. Estafan presently holds the rank of Associate Professor and is the Director of Aesthetics Dentistry in the Division of Caries Diagnosis, Management and Aestheticsʼ at New York University College of Dentistry.

Neuromuscular Dentistry: Transcutaneous Electrical Nerve Stimulation and Orthotic Solutions in Full Mouth Reconstruction

Mario F Guiang

Guiang Dental Clinic, Philippines

Temporomandibular disorders (TMD) happen as a result of problems with the jaw, jaw joint, and surrounding facial nerves and muscles that that control jaw movement. The main cause of this is injury to the jaw, the joint, or the nerves and muscles of the head and neck. This could also be due to the patientʼs occlusion not being in the proper position. Transcutaneous electrical nerve stimulation (TENS) currently is a form of electro-analgesia. Hundreds of clinical reports exist concerning the use of TENS for various types of conditions, including myofascial and arthritic pain. It uses electrical currents to stimulate muscle contractions that relieves pain and stiffness while Improving jaw movement.

Orthoses is an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system. They are used to control, guide, and limit joints or body segments for to otherwise correct the shape and/or function of the body, to provide easier movement capacity or reduce pain. Orthoses are also used in denstistry to adjust the patientʼs occlusion to a more optimum position, which allows the temporomandibular joint and the surrounding neuromusculatures to be relieved.

This Lecture will present two full mouth reconstruction cases which utilized TENS and orthotics in their treatments. In the first case, TENS and Orthosiswas used to increased the occlusion of a patient with severe overbite. While in the second case, TENS and orthosis was used to recapture the occlusion of the patient with posterior open bite. Orthoses used on these patients are tooth-colored to preserve the esthetic value of the smile. This Lecture presents to the dental practioners the importance of restoring a balanced occlusal relationship, and encourages them to incorporate the use of TENS and orthotics in their treatment planning.

An Analysis of Dental Implant Materials with an Exclusive Focus on Zirconia vs Titanium

Saurabh Gupta

Axiss Dental Pvt Ltd, India

The key aim of this study is to present a comprehensive review of literatures on dental implant materials. The study focuses on titanium implants in a conventional manner and the newly introduced and highly popular zirconia implants. Some of the major areas covered under this study are clinical considerations and material science which includes implant materials as well as the impacts of its physical properties on outcomes of the treatment.

Titanium is the gold standard for oral implants fabrication in spite of the sensitivity and despite having unclear clinical relevance. The Zirconia implants are highly promising but further clinical studies are required. Also, there is a need of further technical experience and considerations for zirconia implants to lower the mechanical failure incidence.

Dr. Saurabh Gupta holds Masters Degree in Oral & Maxillofacial Surgery and has been in surgical practice since 2014. He is also trained in multiple allied surgical disciplines including Implantology and Laser dentistry. He is involved in cosmetic dentistry including smile design (Certified in ClearPath, botox & fillers).
He has published his papers in various National and International journals, magazines and also writing a chapter for a book on Implantology.
Also, he is an Editorial Board Member for many national and international journals. He is member of International Academy of Ceramic Implantology (IAOCI) and Academy of Laser Dentistry (ALD). Presently he is doing lot of research studies on Ceramic Implantology.

Understandable Occlusion for Everyday Dental Practice Including Implantology

Stuart Orton-Jones

Director Harpole Centre, UK

An understanding of Occlusion is essential whether treating simple cases or highly involved reconstructions casesas well as in the treatment of headaches and temporomandibular joint problems. For all new patient and recall patient examinations an assessment of each patients occlusions should be routine. The barrier to understanding occlusion is often caused by confusing terminology instead of simple every day terminology This helps to clear away the mysteries of occlusion and clarify the place of occlusion in all aspects of dentistry. Special attention will be given to the occlusal schemes required for all types of implant cases. Teeth move in their socket to varying degrees due to the presence of the periodontal ligament Successful Implants are attached directly to bone and move only slightly Special consideration must be made to ensure that implants are not overloaded in excursive movements as the teeth move a little. A thorough occlusal examination system is required in all cases. In complex cases, study models should be mounted in Centric Relation on semi-adjustable articulators. The models may be equilibrated and waxed up as necessary allowing thorough planning to be performed. The overall objective in all occlusion considerations is to produce as stress free dentition as possible.

Stuart Orton-Jones completed B.D.S. L.D.S. R.C.S. Although Stuart Orton-Jones lectures and teaches around the world he believes that truly effective teaching involves participants doing the procedures not just listening to lectures about the procedures. The presentations he has developed are easily understood and make relatively complex subjects easily understandable. All his presentations are available to view and download at no cost on his website. He believes that true teaching should be participant orientated not presenter orientated. His practical teaching sessions are highly appreciated by those attending them because they are involved in doing practical exercises not just listening to lectures. He currently teaches on the American Academy of Dental Implantology Year courses in the US in Oregon and Las Vegas, Saudi Arabia, Kuwait, Abu Dhabi, Iran, India, and Malaysia. He also lectures at several international conferences including Jordan, Egypt, India and the United States. Stuart Orton-Jones has a comprehensive knowledge and experience of dentistry and has attended numerous courses and conferences in Europe, North America the Middle East and Asia. He has lectured extensively at home and abroad.