dr haja badrudeen

Feb / Mac / Apr 2013

Note:This newsletter is a publication of the Malaysian Dental Association and opinions expressed herein are that of the authors and do not necessarily re�ect the opinion of the editorial board, the MDA council or the said Association. MDA NEWS shall not, without written consent of the Association, to be hired, lent, given or otherwise disposed of by way of trade or a�xed to or as part of any publication or advertising, literary or pictorial matter whatsover.

Editor : Dr Shalini Kanagasingam Advertising & Classi�eds Chairperson : Dr Eileen Koh Mei Yen Contributing Writers : Dr Yew Hsu Zenn Dr Jolene Lai Dr Hans Prakash Ex-o�cio : Dr Haja Badrudeen Treasurer : Dr Darren Yap

Malaysian Dental Association54-2, 2nd Floor, Medan Setia 2, Plaza Damansara, Bukit Damansara, 50490 Kuala Lumpur, Malaysia.

Tel: 603-2095 1532, 2095 1495 Fax: 603-2094 4670 E-mail: mdaassoca@uni�.my / [email protected]

www.mda.org.my

75th - Diamond Jubilee

Malaysian Dental Association1938 - 2013

Feb / Mac / Apr 2013 • MDA NEWS • 3

Message From The President Of Malaysian Dental AssociationDR HAJA BADRUDEEN

Message From The Honorary General Secretary Of Malaysian Dental AssociationDR NEOH EIN YAU

We have lapsed into another new year with a very successful 20th FDI/MDA Scientific Convention and Trade Exhibition. This event drew world class speakers both regionally and internationally with more than 700 registered delegates attending this prestigious convention. The convention was incomplete without the trade exhibition where the best dental technologies and dental equipments were being showcased at 133 booths.

For the first time, the computerised registration was done in a very efficient way, utilizing bar code to identify and register delegates, thus reducing queue that has long been the bottle neck at the registration counter in all our previous conventions. We hope to expand the usage of this system to all MDA events in the near future. Feedbacks from delegates are utmost importance to further improve the birth of the system. I must thanks all the Organising committee in particular the registration committee members, secretariat staffs and student volunteers for their wonderful effort to learn and blend into this new system.

The number of delegates signing up for the 35th APDC that will be held at Kuala Lumpur Convention Centre is encouraging. We are less than 4 months away from the APDC and the entire local organising committee under the leadership of Professor Dato' A. Ratnanesan is gearing up, pushing to the limit - only with one aim : Bringing world renouwned speakers to our doorstep. Their noble effort, spirit of volunteerism, and selfless commitment to MDA must be applauded.

Lastly, the pursuit of bringing the best CPD to our members is challenging and thus, I wish all of you to attend and support all MDA organised events especially the 35th APDC.

See you at Kuala Lumpur Convention Centre from 7-12 May 2013.

Yours sincerelyNeoh Ein YauHon Gen SecretaryMalaysian Dental Association

Fellow MDA MembersAssalamualaikum dan Salam Sejahtera.

Happy 75th Diamond Jubilee to the Malaysian Dental Association!

I am proud to be serving as President during this momentous year. The year 2013 marks the Diamond Jubilee of our beloved association and it is certainly a time to reflect on how far we have come in our quest to serve the dental profession. MDA has certainly grown from strength to strength and I am inspired to be part of our soon to be 5000 strong family of dental professionals.

I am happy to report that the MDA Council are hard at work in our ongoing mission to represent the views and opinions of Malaysian dental practitioners. A nationwide road show has been organized to keep all MDA members informed regarding the new Dental Bill. This would not have been possible without the full support and collaboration from the Ministry of Health, in particular our esteemed colleagues from the Oral Health Division. As President, I would also like to acknowledge the roles played by the proactive MDA Zones, who constantly provided important input in order to ensure that the new Dental Bill would reflect fairly on the dental community.

At this time of the year, our main goal is to organize a successful 35th Asia Pacific Dental Congress (APDC), to be held at KLCC Convention Centre, from 7th-12th May 2013. . As part of the team, I am happy to report that the registration numbers are increasing steadily and we are all geared for one of the biggest events in the region.

We are less than 4 months away from the APDC and the entire local organizing committee under the leadership of Professor Dato' Dr Ratnanesan are continuing to work tirelessly to bring in the best, world renowned speakers to our doorstep . Their noble efforts, spirit of volunteerism, and selfless commitment to MDA should be applauded. I hope that all MDA members will support our efforts and we look forward to seeing all of you at KLCC Convention Centre in May. It will be an event to remember! Best Regards, Dr Haja Badrudeen Bin Sirajudeen MDA President

4 • MDA NEWS • Feb / Mac / Apr 2013

Building relationshipsDentistry – especially in general practice – is unusual within healthcare in that we spend so much of our time with healthy people who have no presenting problems. When problems do arise we try to fix them and in doing so, we are often capitalising upon any previous relationship we have established with the patient or family concerned.

This is exactly what we do when things go wrong, too. Building strong, caring relationships with our patients not only makes good business sense – it also helps to keep us safe. Those of you who have attended our small group workshops Mastering Your Risk and Mastering Adverse Outcomes, will

understand the underlying logic and compelling evidence for this. While in Hong Kong for the FDI, Dental Protection delivered the special ‘launch’ presentation of the third workshop in this series, Mastering Difficult Interactions, to a specially invited VIP audience that included representatives from many national dental associations, including MDA.

All three workshops (3 hours each) are now available free of charge at various venues in Malaysia to Dental Protection/MPS members, in collaboration with MDA. Contact MDA for further information and registration for these workshops.

Case 1Another Cone Beam CT of a patient with a repaired cleft lip and palate. This scan was taken to identify whether there was adequate native maxillary bone in order to provide implants to support an upper complete denture. The scan shows a highly resorbed maxilla with inadequate bone for implant placement Case

Case 2This case shows a Cone Beam CT of the maxilla. This patient had been considered for implants in the upper

Avoiding surprises

Excerpts from

RiskwiseMalaysia

TrainingWhilst dentists have been trained to interpret intra-oral X-ray images, the same may not be true of computerised axial tomography (CAT scans), or magnetic resonance images (MRIs). Even orthopantomograms (OPGs) and lateral skull radiographs may contain more information than the average dental practitioner needs for their immediate purpose and/or is trained and competent to make a diagnosis from. It is generally accepted that the clinician has a duty not only to limit the amount of radiation to which a patient is exposed, but also to ensure that the diagnostic yield and ultimate clinical value in terms of the care and treatment of the patient, is maximised and commensurate with the level of exposure. The use of limited field cone beam imaging is just one example of how the prudent and responsible clinician can reduce the patient’s exposure to radiation without compromising on the quality of patient care.

Duty of careThis is, of course, part of a clinician’s legal and ethical duty of care, but the duty of care does not stop with safely taking the x-ray. The image which has been ordered or taken provides not only the specific information that the dental practitioner needs for the immediate treatment of the patient, but in many instances a wealth of additional information about other structures in the surrounding area, this raises an important and interesting question - what happens with all the further information contained within that ‘bigger picture’?

left and upper right premolar and molar areas. The scan shows adequate bone for three units in the upper left premolar area but inadequate bone in the upper right jaw. The saggital sections show a very thin bony wall in the highly pneumatised sinus as well as a thin sinus membrane lining that would make bony augmentation difficult


The bigger pictureIn answering this question, one must start from the premise that a dental practitioner is not registered to practice medicine, and must not therefore stray into doing so – however unwitting. At one extreme the dental practitioner might not have sufficient training or expertise to recognise the full significance of what the image reveals, and some vitally important information that could benefit the patient, might not be acted upon. At the other extreme, the maxim ‘a little knowledge is a dangerous thing’ might apply, and the dental practitioner might overlook or misdiagnose something revealed by the image, to the patient’s detriment.

Who owns the image?The fact that a patient may have paid to have an x-ray (or other image) taken, does not alter the fact that the resulting physical or electronic image forms part of the clinical record held by (and owned by) the practitioner in question, rather than being ‘owned’ by the patient in the same way as they might ‘own’ a denture after it is fitted. In situations where the clinician simply works in a practice which is owned and operated by someone else, it is generally the practice owner who owns and is responsible for the clinical records, and this fact is normally reflected in any practice agreement/contract that exists between the parties.

If Clinician A refers the patient to Clinician B for the purpose of obtaining certain images, the resulting image(s) can reasonably be said to form part of the clinical record of both clinicians. They each have a duty of care to the patient in relation to any such image which is not diminished by the fact that there is a second clinician involved. One clinician cannot (and must not) shelter behind the other nor assume responsibilities on the part of the other. There needs to be a clear and mutually understood delineation of roles and responsibilities. In some cases the referring clinician will get back the required image(s), and nothing beyond that. In other cases the referring clinician will get back the requested image(s) complete with a report from a radiologist. But for the dental practitioner there are risks even in the latter situation, because the level of knowledge of dentistry and dental structures varies widely form one radiologist to another and both the detail of the report and the meaning and significance behind the words used within it, can be open to interpretation.

Back to basicsThe patient, having undergone the radiation exposure, has a right to expect that the maximum diagnostic value is derived from it. In that respect they are (usually) totally reliant upon the health professionals involved. They will not (in the above scenario) thank either clinician if something significant is missed or not acted upon, and they suffer avoidable harm as a

consequence of this. Consent sits at the heart of this – the patient must understand the purpose for which the image is being taken, the balance of risks and benefits and (importantly) how the image will be used for the purposes of the dental care that they are undergoing. However, the prudent dental practitioner will also make it clear to the patient, when taking or ordering images which will contain much more information than (for example) an intra-oral x-ray, that they are not qualified to make any medical diagnosis from any further information that the image(s) might contain. For that reason, the patient may wish either to be referred to a radiologist for the specific purpose of obtaining a report on the totality of the image from an appropriately qualified and experienced person, or to seek advice from their own medical practitioner which may similarly lead to a referral for a radiological report.

Such a response would demonstrate a far more responsible approach than avoiding these new forms of imaging altogether and relying upon traditional, limited field, two-dimensional images. It is a matter for conjecture, how muchlonger it will remain possible to defend the use of two dimensional imaging, when carrying out procedures where the information potentially contained in the ‘missing’ third dimension, may represent the difference between a good and safe outcome, and one where the patient suffers some kind of avoidable harm or has a less favourable treatment outcome than might otherwise have been likely.

SummaryPrevious generations of dentists will have come to the conclusion that they no longer wished to take the risk of attempting the surgical extraction of a lower third molar, or a complex restorative treatment plan without good pre-operative x-ray. Going forward, the profession may well decide that they no longer wish to take the risk of carrying out many other procedures in modern dentistry, using ‘yesterday’s’ technology. Every approach has its risks, inconvenience, logistic and costs hurdles to overcome and as always the challenge is to manage them appropriately, keeping the patient an active participant in the decisionmaking process at all times.

Excerpts from

RiskwiseMalaysia


Excerpts from

RiskwiseMalaysia

Handle with careThe risks arising from sodium hypochlorite irrigation in endodontics

Endodontics continues to be a source of claims against dentists.1 The most frequent cause is the incomplete obturation of the root canal system in the presence of residual infection. Whatever technique is adopted, the disinfection of the canal(s) remains a crucial ingredient of success.

Why use it?Sodium hypochlorite (in concentrations ranging from 1% to 5.25%) is a widely accepted method of disinfecting the root canal system. This commonly used irrigant dissolves organic material in the canal system as well as being an effective antimicrobial agent. Sodium hypochlorite is also readily available and cheap, although the branded varieties widely available and widely used (and widely advocated by specialists and lecturers in the field and in published articles) are not actually licensed for medical use.

DisadvantagesSodium hypochlorite is strongly alkaline, caustic and irritant. It is cytotoxic in concentrations as low as 0.5% - much lower than the strength at which it is commonlyused for endodontic irrigation. Not surprisingly, therefore, it can have disastrous effects outside the confines of the root canal system. Meticulous isolation of the tooth is therefore essential as well as adequate protection of the patient’s eyes and clothing. If sodium hypochlorite comes into contact with vital tissues it can cause severe inflammation and tissue necrosis. The resulting complications can range from minor discomfort to significant tissue necrosis and nerve damage.

Pure hypochlorite, free of the additives found in some domestic bleach is also available. Although intended for endodontic use, it should still be used with caution.

Measuring the riskExtrusion of sodium hypochlorite beyond the root canal system is not commonly reported. Indeed it seems that the percentage of cases involving leakage of bleach is reassuringly small. Nevertheless, it is important that the clinician should reduce the risk and be able to respond to the situation effectively if it should arise.

Potential damageThe general damages (eg. for pain and suffering) in cases involving extensive soft tissue damage from the introduction of sodium hypochlorite solution into the bone and soft tissues can be quite significant. Paraesthesia or a painful, protracted dysaesthesia is quite common and in some cases may interfere with a

patient’s work or social life. Some of these cases have featured amongst the most costly endodontic claim settlements as a result of complications such as these.

Many cases have involved the needle of an irrigation syringe becoming detached as soon as pressure is applied to the syringe, resulting in bleach being sprayedforcefully into the face and eyes of patient, operator and dental nurse alike. This underlines the value of the routine use of well-designed and well-fitting protective eyewear.

Sodium hypochlorite can sometimes be forced out of the tooth into the surrounding tissue through;• A pre-existing open root apex• the apex of a tooth enlarged prior to obturation• the apices of unexpected lateral canals• undetected cracks• iatrogenic perforations created during treatment.

The result of such an accidental flow of the hypochlorite solution is unpredictable with no certain correlation between its concentration and volume, and the severity of the patient’s symptoms. Commonly the patient will experience immediate severe pain, swelling, and haemorrhage from the canal access cavity, although any pain or discomfort may be masked to a greater or lesser extent by the effect of local anaesthesia. There have also been cases of gingival and soft tissue damage from hypochlorite escaping unseen through and beneath a poorly-placed rubber dam.

Responding to problemsIt is important that the clinician recognises the situation and responds quickly with an explanation and reassurance for the patient. An initial palliative treatment using analgesics may be useful whilst considering referral to a local hospital department for further assessment.

In a hospital setting, ‘Steroids are often used to dampen the inflammatory response and antibiotics to reduce secondary infection. Wound debridement is required where there is extensive soft tissue necrosis, which if left, would lead to secondary infection. MRI scanning gives further information on bony involvement’.2

Minimising the risk• Assess the root canal system angulation on X-ray• Assess the possibility of an open apex• Allow for any miscalculation of the angle that an

existing crown can create• Create adequate coronal access• Avoid creating a perforation• If you are at all concerned that a perforation may

have been created, do not use hypochlorite irrigation until you have ascertained the position


• Stop if bleeding occurs from the canal and reassess the possibility of a perforation

• Use an endodontic irrigation syringe with a screw-on needle and side vent to avoid needle detachment and to minimise the risk of apical leakage of irrigant (Luer-Lok™)

• If a screw-on needle is not available, ensure that the irrigation nozzle is tightly secured onto the syringe containing the irrigant solution, and check this before use

• Do not allow the needle to bind in the canal • Stop well short of the working length • Avoid injecting the solution too quickly, or with excessive force. Using the forefinger rather than the thumb to depress the syringe is a useful tip

• Use gentle pressure and watch to see the irrigant flowing back through the access cavity.

Intra-operative view of debridement of hypochlorite injury following endodontic treatment

Malaysian Endodontic SocietyAnnual Scientific Meeting & AGM

24th November 2013 (Sunday)Venue: The Gardens Hotel, MidValley City, Kuala Lumpur

Professor James L. GutmannDDS, Cert Endo, PhD (honoris causa), FACD, FICD, FADI, FAHD

Professor Emeritus in Endodontics/Restorative Sciences, Texas A&M University Baylor College of Dentistry, Dallas, Texas. Past President of the American Association of Endodontists and Vice President of the American Academy of the History of Dentistry. Diplomate of the American Board of Endodontics

Lecture: Clinical & Biologic Realities in the Endodontics Technological Explosion

Dr Meetu Ralli KohliBDS DMD, Diplomate of American Board of EndodonticsDirector – CE & International Program, Department of Endodontics, University of Pennsylvania

Lecture: Endodontic Surgery Intentional Replantation Endodontic versus Implant Prognosis

Please go to www.endodontics.org.my for more information

Jointly organized by: In collaboration with:

These articles are excerpts from Riskwise Malaysia and reprinted with the kind permission of Dental Protection Limited.


Implant dentistry has changed significantly in the past several decades. Since the early investigations of branemark that led to the dental application of osseointegration,1 the field of dental implantology has evolved rapidly. Although technology has improved greatly over the past several years, and some conventional implant systems allow for early loading, most conventional endosseous fixtures require up to 4 to 6 months or longer before prosthetic restoration can be completed.2 In addition, often times these larger-diameter implants requires sinus lift procedures and bone augmentation. Using mini dental implants that enable immediate denture stabilization, or single and multiple-tooth replacement in as little as one visit,3 is clearly desirable to patients. The relatively lower cost of mini dental implants allows fro a large patient-selection base. Christensen described these implants as simple, predictable, minimally invasive, and relatively inexpensive.4 Additionally, the osseointegration period required for mini dental implants can be significantly shorter than that for conventional implants because of a less aggressive insertion procedure (ie, minimized disruption of the periosteum).

Mini dental implants were initially designed for the temporary stabilization of a prosthesis during the healing period of conventional implants. 5 Recently they have

AbstractMini dental implants are becoming increasingly popular in dental care today. Because of their smaller size they are often used in cases of limited bone anatomy. Mini dental implants have diameters ranging from 1.8mm to 3mm and are suitable for long-term use. This article describes a retrospective analysis of 5640 mini dental implants placed into 1260 patients over a 12 years period. The mean length of follow-up was 3.5 years. The implants placed supported removable (2319) and fixed prostheses (3321), with placement in the maxilla (3134) and mandible (2506), The overall implant survival was 92.1%. Failures of implants (445) were attributed to mobility of the implant; the mean time to failure for these implants was 14.4 months. The small size of these implants has led to the development of techniques that enable placement and use in a short amount of time for both the doctor and patient. The high rates of success show that mini dental implants are suitable for use in supporting fixed and removable prosthetics.

Todd Ellis Shatkin, DDS and Christopher Anthony Petrotto

Mini Dental Implants:A Retrospective Analysis of 5640 Implants Placed Over a 12-years Period

become popular in use for orthodontic anchorage,6-8 periodontal therapy,9 fixed prosthetics, and complete denture stabilization,10 Because mini implant insertion requires minimal disruption area.2 Mini dental implants and their function in immediate loading for denture stabilization and fixed restorations have become increasingly prevalent in the literature. Ahn and colleagues reported reported 26 of 27 mini dental implants were stable in the mandible at 21 weeks of follow-up.11 A previous study by the primary author of 2514 mini dental implants place in mandile and maxilla reported and average overall implants survival of 94.1%.3 In a multi-clinic evaluation of mini dental implant use in denture stabilization, Bulard and Vance reported similar results with approximately 90% success rates.2 This article describes a retrospective analysis of 5640 mini dental implants used in various treatment modalities in 1260 patients, showing an overall implant survival rate of 92.1%.

SURGICAL PROCEDUREA panoramic roentgenogram or cone beam computed tomography scan was completed to assess bone parameters and plan implant placement sites. Consider the example of the stabilization of a maxillary and mandibular denture (figure1). The placement sites were marked on the radiography between the canine and first bicuspid anterior to the mental foramen as well as in the region of lateral incisors anteriorly (Figure 2). Next, depending on the size and type of prosthesis, the quantity of mini implants to use was determined. The primary author recommends the placement of four mini implants for the stabilization of a full mandibular denture. While four mini implants may also be sufficient for a maxillary denture stabilization procedure, six are recommended if a palateless denture is being considered. For single tooth replacement one mini implants is used for anterior and bicuspid teeth, while for molars, often two mini implants are used.12,13 In this context, occlusal and masticatory forces are distributed over an augmented implants interface; the relative strain on any implant is reduced.13 Furthemore, the bridgework in these case acts as a splint, anchoring adjacent implants and reducing micro-movement.13 Similarly, adjacent missing teeth replaced using mini dental implants should be splinted together.

The next step was to determined the appropriate mini dental implant size. The longest mini dental implants possible for the available bone should always be used.14

Mini implants do not utilize deep bone osteotomies like conventional implant system require, the minimally invasive nature of using a small 1.2-mm pilot drill to a depth of only


a portion of the mini implants length avoids the possibility of osteonecrosis from oval-drilling bone. In this study or otherwise, the primary author has not encountered any cases of odteonecrosis with mini implants, even in patients who are immunocompromised or taking multiple medications. For a detailed study on implant size selection, see the noted references.15

Next, the surgical stent was placed in the patient's mouth and marks were placed through the stent openings using a marking stick (Figure a and Figure 4). These marks were used to confirm planned implant placement positions. Infiltration anesthesia was then used between the periosteum and bone. Local anesthetic was injected on the mark, lingual to the mark, and buccal to the mark, at each location. Though a local anesthesia block of the inferior alveolar nerve is used in many dental procedure, it is not recommended for mini dental implant placement.16 This is because using infiltration affords the patient continued sensation of the inferior alveolar nerve, which allows the patient to offer feedback during the procedure, thus reducing the risk of nerve damage.

The pilot hole for the mini implants was then made using a 1.2-mm pilot drill ( approximately half the diameter of the mini implants). Using sterile srgiacl techniques17 the dentist drilled to the appropriate depth based on bone dentistry evaluation and implant type selected. For very dense bone, a pilot hole was drilled to be 80% of the length of the implant. For moderately dense bone, the pilot hole depth was 60% of the length of the implant. For low-density bone (maxillary bone or soft mandibular spongy bone) the pilot hole was created at 50% the length of the mini implant. Because of the flapless surgical technique most often utilized with mini implants, a surgical stent (Figure 5) designed from preoperative dental models, x-rays, and/or cone beam CT scans provides for proper angulation in the bone. A pilot drill guide (Figure 6) was used to position the pilot hole in the center of the surgical stent sleeve and maintain correct trajectory of the drill.18,19 The pilot drill was used to puncture the tissue down to the bone, and after locating the bone surface the pilot hole was made with a tapping motion.

FIG 1. Upper palateless denture and lower denture with surgical stents. FIG 2. Panoramic x-ray with prospective implant locations and mental foramen marked. FIG 3 AND FIG 4. Marks placed through stent openings using marking stick (Fig 3): marks on gingiva (Fig 4).

FIG 5 AND FIG 6. Surgical stent in place pilot drill guide and surgical handpiece (Fig 6). FIG 7. Implants placed in maxilla (immediate postoperative view). FIG 8. O-ring housing abutments on O-balls of mini implants. FIG 9. Upper and lower dentures with O-ring housings in place. FIG 10. Postoperative radiograph with upper and lower mini implants in place.5


The Implant was first removed from its package using either the finger driver or a contra angle adapter. This prevented the sterile surface of the implant from being contaminated. The implant was then inserted into the pilot opening through the surgical stent and gingiva, and into the bone. The implant was slowly rotated clockwise (with a drill or hand instrumentation) using downward pressure until firm, bony resistance was detected. The implant was inserted until all threads were subgingival and the top of the polished collars was flush with the top of the gingiva. At this point the clinical knows that the implant is seated to the proper depth of placement (Figure 7). If extremely dense bone was present, as is often the case in the anterior mandible, a ratchet wrench was used for the final rotations of implant insertion. The ratchet wrenching was done using very slow incremental turns, which allowed full insertion of the implant without implant fracture or stripping of bone. If very heavy resistance was noticed, the implant was removed by rotation in the reverse direction and the pilot hole was made deeper, or a shorter implant was used. Through the entire rotation procedure, pressure was constantly applied on the head of the ratchet in the direction of desired insertion.

The mini dental implants used in this study were inserted such that the square neck portion of the implant was supra-gingival. O-ring housing abutments were then placed on the O-balls of the mini implants (Figure 8). With a pear-shaped loboratory bur, holes were placed in the patient's denture at the previously marked locations. The denture was tried in the patient's mouth for full seating. The holes in the denture were then filled with a housing resin or cold-cure acrylic. Before these materials set, the denture was placed on the O-ring housings and seated firmly. The patients was instructed to bite down for 3 to 5 minutes. The denture was then removed and the firmness of the housings was assessed. If housings were loose, the appropriate acrylic was applied. The denture with housings was then smoothed and adjusted to avoid patient discomfort and sore spot development (Figure 9). A postoperative radiograph can seen in Figure 10.

Postoperative instructions were given to the patient, and an appointment was scheduled for 24 hours after placement. Patients were told to wear their dentures continuously for the first 24 hours to allow the tissue surrounding the implants to heal without advancing up around the neck and O-balls of the implants. It is important that any dentist considering using mini dental implants be adequately educated in the surgical aspects of implant placement.

The primary author developed the Fabricated Implant Restoration and Surgical Technique (F.I.R.S.T) (Patent: USPTO #7,108,511 B; September 2006), which enable the placement of mini dental implants and permanent crows to be cemented in a single visit (Figure 11 through Figure 15).

With the growing demand from patients for fewer office visits, lower cost procedures with immediate results, and shorter recovery time, dental rehabilitation techniques have been developed for minimally invasive, single-stage implant placement.

MATERIALS AND METHODSFrom January 10, 2000, to February 8, 2012, 5640 implants were placed in 1260 patients. All patients received treatment in a private office setting. Most patients were selected for implant placement based on subjective complaints such as concern about denture reliability social in social settings, difficulty wearing an upper or lower denture, cosmetic concerns from missing teeth, and the desire to feel more confident. Objective reasons for mini dental implant placement included dentures stabilization on a narrow alveolar ridge, single missing teeth, and partial or complete edentulism. There were minimal exclusion criteria; severely atrophic or poor quality bone was considered.

Twelve years and 1 month after the first mini dental implant in this study was placed, a review of patient charts was performed to assess implant survival. Success criteria included some of those described by Buseretal 20:1) absence of continual subjective complaints such as pain or foreign body sensation:2) absence of mobility;3) absence of recurrent peri-implant infection with suppuration; and 4) absence of continuous radiolucency around the implant.

When mobility of a fixed prosthetic was present, it was removed and implants were individually assessed. If a fixed prosthesis was stable, and the above success criteria observed in this study were met, it was assumed that all underlying implant were stable.

FIG 11. Preoperative view. FIG 12. Surgical stent in place. FIG 13. Implant placement using a finger driver. FIG 14. MIni implants in place FIG 15. Cemented crowns in place (immediate postoperative view)


Patient variables were obtained from the dental record, These included age, sex, date of birth, implant placement date, type of prosthesis (upper or lower partial denture, upper or lower full denture, fixed upper or lower prosthesis, or single tooth restoration), implant size (diameter and length), anatomical location (anterior or posterior, maxillary or mandibular), smoking status, and date of previous implant failure (if applicable). The date of most recent follow-up was also recorded. Overall implant survival was then determined along with survival rates based on some of the above listed patient variables.

RESULTSThe mean duration of follow-up was 3.5 years. Of the 5640 implants placed, 445 failures were recorded, giving an overall survival rate of 92.1%. The mean time to failure for this series was 14.4 months.

The distribution of implants used for each treatment modality is shown in Table 1. There were 2506 implants placed into the mandible and 3134 placed into the maxilla. Analysis of implant survival in the mandible and maxilla revealed similar survival rates of 93.1% and 91.3%, respectively. Survival based on each modality revealed that implants supporting partial lower dentures fared the best, with a survival rate of 95.6%, while those supporting full upper dentures fared the worst, with 85,2% survival (Figure 16).

PartialLower

FixedUpper

FullLower

FullUpper

FixedLower

PartialUpper

95.6%94.5%

90.0%

85.2%

95.0%95.3%

98

96

94

92

90

88

86

84

82

80

Surv

ival

(%)

FIG 16. Implant Survival Based on Treatment Modality

Implants supporting fixed prostheses were considerably more successful than those supporting removable prostheses, having success rates of 94.7% and 88.4%, respectively. Further analysis of location of placement revealed a lower mini implant success rate in the maxilla (90.3% anterior; 92.5% posterior) relative to the mandible (92.3% anterior; 94.1% posterior). The reduced implant success rate in the maxilla was likely due to its poorer bone quality relative to the mandible. Though there exists greater occlusion in the posterior regions of the month, higher implant success rates in those areas may be attributed to the use of multiple implants to support a prosthesis, mimicking the natural root anatomy. Often, two implants were used to replace single morals and multiple implants were used for posterior restorations involving more than one tooth.

Gender also played a role in the survival of implants. Of the 3378 implants placed in females, the overall success was 93.0%, while the success rate of the 2262 implants placed in male was only 90.8%.

Implants were placed in patients aged 13 years old to 95 years old. The distribution of implant by patient's age is shown in Figure 17. Patients 21 to 30 years of age had the highest rate of success at 95.8%.


There were 445 implant failures observed. Implants considered as failed presented as being mobile or fractured. Of those implants that failed, the majority did so in the first 6 months following implantation. Implants not failing in this time following insertion likely attained osseintegration. This correlates with Branemark's classical definition of osseointegration of 3 to 6 months in the mandible and 6 to 9 month in the maxilla.21

CONCLUSIONWith the growing demand from patients for fewer office visits, lower cost procedures with immediate results, and shorter recovery time, dental rehabilitation techniques have been developed for minimally invasive, single-stage implant placement. the mini dental implants used in these procedures have been demonstrated to have high success rates. Over a 12-year period, 5640 mini dental implants were placed with an overall survival of 92.1%. With the proper training.22 consideration for prosthetic subtype, implant location, size, and patient variables, mini dental implants can provided exceptional outcomes. These results are rewarding for the dentist, minimally invasive and affordable to the patient, and have long-term success for both fixed and removable prosthetics.

REFERENCE1. Taylor TD, Agar JR. Twenty years of progress in implant

prosthodontics. J Prosthet Dent. 2002;88(1):89-95.2. Bulard RA, Vance JB. Multi-clinic evaluation using mini

dental implants for long-term denture stabilization: a preliminary biometric evaluation. Compend Contin Educ Dent. 2005;26(12):892-897.

3. Shatkin TE, Shatkin S, Oppenheime BD, Oppenheimer AJ. Mini dental implants for long-term fixed and removable prosthetics: a retrospective analysis of 2514 implants placed over-year period. Compend Contin Educ Dent.2007:28(2):92-99.

4. Christensen GJ. The increased use of small-diameter implants. J Am Dent Assoc. 2009;140(6):709-712.

5. Sendax VI. Mini-implants as adjuncts for transitional prostheses. Dent Implantol Update. 1996;7(2):12-15.

6. Baumgaertel S, Razavi MR, Hans MG. Mini-implant anchorage for the orthodontic practitioner. Am J Orthod Dentofacial Orthop.2008;133(4):621-627.

7. Chen Y, Kyug HM, Zhao WT, Yu WJ. Critical factors for the success of orthodontic mini-implants: a systematis review. Am J Orthod Dentofacial Orthop. 2009;135(3):284-291.

8. Ren Y. Mini-implants for direct or indirect orthodontic anchorage. Evid Based Dent.2009;10(4):113.

9. Nagata M, Nagaoka S. Preservation of the natural teeth and arch integrity by the use of transitional mini-implants. J

TABLE 1 IMPLANT DISTRIBUTION BY PROSTHETIC SUBTYPE_____________________________________________________________Prosthetic Subtype Percent of Implant TotalFixed upper bridge 34%Fixed lower bridge 25%Full upper denture 20%Full lower denture 19%Partial upper denture 1%partial lower denture 1%

Periodontol.2000;719120:1910.10. Hoos JC. An overview of mini-impalnts and their role in

complete denture treatment. Dent Econ.2011:101(4):2-16.

11. Ahn MR, An KN, Cho JH, Sohn DS. Immediate loading with mini dental implants in the fully edentulous mandible. Implant Dent. 2004;13(4):367-372.

12. Henry PJ. Tooth loss and implant replacement. Aust Dent J.2004;45(3):150-172.

13. Weiss CM, Weiss A. Principles and Practice of Implant Dentistry. St Louis, Mo: Mosby Inc.; 2001.

14. Olate S, Lyrio MC, de Moreses M. Influence of diameter and length of implant on early dental failure.J Oral Maxillafac Surg. 2010;68(2):414-419.

15. Callan DP. Current concepts in selecting dental implant diameter size. Dent Implantol Update. 2004;15(3):17-23.

16. Heller AA, Shankland WEII. Alternative to the inferior alveolar nerve block anesthesia when placing mandibular dental implants posterior to the mental foremen.J Oral Implantol.2001;27(3):127-133.

17. Friberg B. Sterile operating conditions for the placement of intraoral implants. J Oral Maxillofac Surg. 1996;54(11):1334-1336.

18. Choi M, Romberg E, Driscoll CF. Effects of varied dimensions of surgical guides on implant angulations. J Prosthet Dent. 2004;92(5):463-469.

19. Lewis S, Avera S, Engleman M, Beumer J III. The restoration of improperly inclined osseointegrated implants. Int J Oral Maxillofac Implants. 1989:4(2):147-152.

20. Buser D, Meriscke-Stern R, Bernard JP, etal. Long-term evaluation of non-submerged ITI implants. Part 1:8-years life table analysis of a prospective multi-center study with2359 implants. Clin Oral Implants Res 1997;8(3):161-172.

21. Branemark PI. The Osseointegration Book: from Calvarium to Cacaneous. Berlin, Germany: Quintessence Publishing;2005:215-225.

22. Christensen GJ. The "mini"-implant has arrived. J Am Dent Assoc. 2006;137(3):387-390.

This article was originallypublished by AEGIS Communications. Permission to reprint sought by Secretary General of Asia Pacific Dental Congress.


QUICK TECHNIQUEThe TiLOS SystemRenato de Toledo Leonardo,DDS,MSc., PhD; Richard D. Tuttle, DDS; Ida Baghoomian, M.Sc.

Endodontics is a science that embodies etiology, agnosis, prevention, and treatment of apical periodontitis and its repercussion in the organism1. Unfortunately, if the levels of success are evaluated, it is clear that after 2 to 4 years of treatment, approximately 30% of root canal treatments must be performed again2. This may be due to the fact that many clinicians base their practice of endodontics on opinions, personal history, and empirical deductions. “Responsible Endodontics” must be constructed under the guise of scientific, clinical, radiographic, and histopathological evidence. The practice of endodontics should be addressed with a sense of responsibility and consideration of different options. One must give serious consideration to technologicalresources available for diagnosis, for root canal negotiation,and for cleaning, shaping, and filling techniques that will increase post-treatment success.

During the last 2 decades, several new technologies appearedon the market. Technologies for anesthesia3, electronic apex locators4, radiovisiograph5, cone-beam computed tomography scans6, ultrasound units7, lasers8, operating microscopes9, monoblock concepts of obturation10, and resinbased root canal sealers11 are some examples, but the most relevant change observed during this period has been the use of new alloys and new oscillatory kinematics for root canal preparation. Ni-Ti rotary instrumentation personifies this revolution12, but even with the industry’s commitmentto offering the widest range of instruments and design ofNi-

Ti, no one has mastered the avoidance of instrument fracture or separation. The continued need for K-files associated with rotary Ni-Ti instrumentation confirms the inability of these files to create a safe preparation. Unfortunately, there is no reliable evidence to predict and prevent such occurrences13.It is routine to hear even from the advocates of the use of Ni-Ti rotary instruments that despite the advantages of rotary systems, file separation is both frequent and frustrating. Moreover, some manufacturers recommend the single use of Ni-Ti rotary instruments, whether it’s one canal or a tooth with 5 canals. Most manufacturers caution against the use of Ni-Ti rotary instruments in more than one tooth. When the literature for this subject is taken into account, findings suggest that clinicians (general dentists and specialists)

Figure 1

Figure 2

use this instrument more then they should14. This contributes to the high number of fracture occurrences. A technology designed to avoid the incidence of fractures is the TiLOS system. It is a continuation of Ultradent Products’ AnatomicEndodontic Technology (AET) system that utilizes the most current technology for addressing the biological considerations of a root canal while cleaning and shaping. By accounting for the anatomical variations and pathological conditions of the tooth, clinicians using TiLOS have found

that in most cases, the TiLOS/AET system is easy to use, safe, reliable, and cost-effective, with better results and fewer risks. The concept of hybridizing a system with different metal alloy instruments offers the best attributes of cleaning and shaping with less likelihood of problems during the biomechanical preparation.


Developed by Ultradent, the TiLOS System (Figure 1) brings all these developments together - or in other words, the right metal in the right area of the root canal at the right time. The system consists of (a) 1 stainless steel shaping file, with a respective diameter of .13mm (tip diameter) and taper .030mm/mm (taper), (b) 2 hand K-type stainless steel files, Nos. 15 and 20, supplemented by 2 Ni-Ti files with an active portion diameter of .25mm and tapers of .08 and .04mm/mm. The following sequence (Figure 2) indicates the use of the hand instrument K-file No. 15 for the catheterization, negotiation of the root canal, and determination of tooth length (with an x-ray or electronic apex locator). Instrumentation is initiated once the length of the tooth is reached. Sometimes, in canals with extreme atresia or curves, this step must be performed with hand instruments of smaller diameter, such as K-type files No. 10, .08. In large root canals, this task can be performed with instruments of larger diameter, such as K-type files Nos. 20 or 25.

An important step is to observe and record the first hand instrument to reach the tooth length, the anatomic diameter which meets resistance. This instrument is called the Apical Instrument (AI). When the case in question is a tooth with pulp necrosis, the catheterization and negotiation should be made by thirds, always thoroughly irrigating the root canal with sodium hypochlorite solution. Following the first step, mechanical oscillating instrumentation proceeds with the use of the Endo-Eze handpiece and shaping files .13 mm, .03 mm/mm to 3 mm short of the tooth length. The kinematics of this file is the circular and perimetral motion, brushing with force against the entire length of the walls. Following the change of each instrument, irrigation must be performed with 5ml of irrigant solution. By carrying out this initial preparation, all the interferences of coronary and middle thirds are eliminated to easily reach the apex. In order for this to happen safely, we recommend the use of precurved stainless steel hand files that with catheterization will reach the tooth length and promote the instrumentation of the root canal. This is followed by using the yellow file .02 to the working length to maintain the glide path. This justifies the interference removal and the transformation of the troubled “V Zones” (middle third interferences) in safe “U Zones,” entirely cleaning the path toward the apical third and diminishing the risk of fracture (not to mention using Ni- Ti instruments with a smaller risk to prepare the apical area). At this point, the same oscillating handpiece is used to instrument the root canal with No. 25 Ni-Ti files and tapers .08mm and .04mm, respectively, in the cinematic crown-apex pressure less motion until the tooth length is reached. Depending on the anatomy, this will result with file .08 or .04in atresia and curved canals with the No. 25 Ni-Ti file .02. Now the apical instrument is used as a reference because the apical preparation may be enlarged with Ni-Ti hand files up to 5 numbers beyond the apical instrument. For example,

if the apical instrument is a No. 15 instrument, the apical portion should be instrumented with Ni-Ti hand files until No. 40. In this case, apical instruments manufactured by Ultradent in Ni-TI can be used, available from Nos. 25 to 80.

References1. Leonardo RT, Palo RM, Tuttle RD. Tilos System Chapter XXVI

in: Leonardo M.R. and Leonardo R.T. Endodontics Biological Concepts and Technological Resources. Artes Médicas: São Paulo; 2010. 629 p.

2. Chevigny C, Dao TT, Basrani BR, Marquis V, Farzaneh M, Abitbol S, Friedman S. Treatment outcome in endodontics: The Toronto Study—Phase 4. J Endod. 2008; 34 (3): 258-63.

3. Matthews R, Drum M, Reader A, Nusstein J, Beck M. Articaine for supplemental buccal mandibular infiltration anesthesia in patients with irreversible pulpitis when the inferior alveolar nerve block fails. J Endod. 2009; 35 (3) :343-6.

4. Pascon EA, Marrelli M, Congi O, Ciancio R, Miceli F, Versiani MA. An in vivo comparison of working length determination of two frequencybased electronic apex locators. Int Endod J. 2009; 42 (11): 1026-31.

5. Radel RT, Goodell GG, McClanahan SB, Cohen ME. In vitro radiographic determination of distances from working length files to root ends comparing Kodak RVG 6000, Schick CDR, and Kodak insight film. J Endod. 2006; 32 (6): 566-8. Epub 2006. Apr 4.

6. Garcia de Paula-Silva FW, Hassan B, Bezerra da Silva LA, Leonardo MR, Wu MK. Outcome of root canal treatment in dogs determined by periapical radiography and cone-beam computed tomography scans. J Endod. 2009;35 (5): 723-6.

7. Desai P, Himel V. Comparative safety of various intracanal irrigation systems. J Endod. 2009;35 (4): 545-9.

8. Moura-Netto C, Pinto T, Davidowicz H, de Moura AA. Apical leakage of three resin-based endodontic sealers after 810-nm-diode laser irradiation. Photomed laser surg. 2009;27 (6): 891-4.

9. de Mello Junior JE, Cunha RS, Bueno CE, Zuolo ML. Retreatment efficacy of gutta-percha removal using a clinical microscope and ultrasonic instruments: part I - an ex vivo study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108 (1): e59-62.

10. Tay FR, Pashley DH. Monoblocks in root canals: a hypothetical or a tangible goal. J Endod. 2007; 33 (4): 391-8. Epub 2007 Feb 20.

11. Zmener O, Pameijer CH. Clinical and radiographical evaluation of a resinbased root canal sealer: a 5-year follow-up. J. Endod. 2007; 33 (6): 676-9.

12. McSpadden J, Mounce R. Rotary instrumentation: asking the right questions, part 1. Dent Today. 2004; 23 (7): 88, 90-1.

13. Musikant BL. One good system beats two bad. Ind Dent Res Rev. 2009: 18-21.

14. Bird DC, Chambers D, Peters OAl. Usage parameters of nickeltitanium rotary instruments: a survey of Rev. 2009: 18-21.

14. Bird DC, Chambers D, Peters OAl. Usage parameters of nickeltitanium rotary instruments: a survey of endodontists in the united states. J Endod. 2009; 35: 1193-7.

About the AuthorDr. Renato Leonardo graduated from Araraquara Dental School-UNESP (Brazil) with a Masters in Endodontics and a PhD in Pathology. He is currently the head and chairman MS of the Department of Endodontics and PhD programs there, as well as a member of the Regional Board of Endodontics (Brazil) and vice president of the Brazilian Academy of Endodontic Professors. An invited professor at UTHSCSA (Texas) and the International University of Catalunya (Spain), he has published 63 articles and authored 43 chapters in endodontic books. Fluent in four languages, Leonardo lectures internationally and, when not speaking, resides in Brazil with his family.


3RD BORNEO DENTAL CONGRESS 2013 SCIENTIFIC CONVENTION AND TRADE EXHIBITION CUM 4th MDAEZ AGM.

Report by DrAbd Rashid HassanOrganizing Chairman

The 3RD Borneo Dental Congress 2013 (3rd BDC 2O13) cum 4th Malaysian Dental Association Eastern Zone (MDA EZ) Annual General Meeting was held at 1 Borneo Grand Ballroom, Kota Kinabalu , Sabah from 25-27 January 2013. This year’s event was themed “Practising The Pragmatic Elements In The Dental Profession” and covered two and a half days of robust discussions, knowledge exchange and networking. A total of 360 global dental practitioners and professionals congregated at 1 Borneo Grand Ballroom for the 3rd BDC 2013, an increase of close to 92 percent from 2012. The annual dental Trade Fair and conference provided an excellent opportunity for the MDA EZ delegation to interact with established leaders in the field, new entrants in the arena, industry experts and dental trade professionals.

The congress was officiated by The Right Honourable Chief Minister of Sabah. In his speech, he hoped that the congress be an annual event in Sabah and the State Government of Sabah will give full support in Eastern Zone activities. His speech text was read by The Honourable Deputy Chief Minister, YB Datuk Dr Yee Moh Chai. The 3rd Borneo Dental Congress 2013 Trade Exhibition kicked-off with The Ribbon Cutting Ceremony and this trade fair provided an expanded showcase of the latest dental equipment from across the globe, with a 20% increase in exhibition floor space. A total of 25 exhibitors from 20 companies presented exhibits ranging from preventive and restorative treatment procedures to surgical equipment and laboratory tools. As such, we were pleased to receive many visitors from the dental trade fraternity and dentists from all over the world.

The hands – on workshop started earlier on Friday the 25th of January, with Dr Eduardo Mahn showing the handling of IPS Empress Composite system to it’s maximum benefits, followed by Dr Murino Sutedjo: Reciproc Endo System and Prof. Dr. Deepak Mehta: Edelweiss Kit Pre Fabricated Veneer the next day.

The Traditional Night had showcased the colourful local Sabahan cultural costumes during the Informal Dinner. The delegates were exposed to local performances and had a chance to dance along to commemoratte the event. The dinner was sponsored by The Deputy Health Minister of Malaysia YB Datuk Rosnah binti Abdul Rashid Shirlin. Most of the overseas delegate remembered the dinner as an “unforgetable night”.

The AGM was held on Sunday afternoon and the new office bearers elected were as follows: • Chairman: Dr Leong Kei Joe, • Hon. Secretary: Dr Nurshaline Pauline, • Hon. Treasurer: Dr Abd Rashid, • Exco members: Dr Alex Lo Shen En, Dr James Chhoa Jau

Min, Dr Edric Chik-Eurn Kho and Dr Lawrence Lau. • Auditor: Dr John Ting Sii Ong , • Immediate Past Chairman: Dr Hu Chang and • Advisor: Dr Roland Chia Ming Shen.

Opening Ceremony of 3rd Borneo Dental Congress

Busy exhibtion trade booths

Memento presentation to YB Datuk Dr Yee Moh Chai by Organizing Chairperson, Dr Abd Rashid

Hands on workshops during the event

Ribbon cutting ceremony

Informal dinner


Memento presented to YB Datuk Rosnah, represented and received by Dr Khairiyah Abdul Muttalib.

Lecture hall packed with eager participant

Photo opportunity with Murut dancers Scientific programme lectures

The congress also promoted the 35th APDC in May to all the participating exhibitors of 3rd Borneo Dental Congress 2013, at least 80 delegates signed up for the upcoming event. It was indeed a productive convention . 3rd BDC 2013 provided an all –round experience with a good mix of Trade Fair, Scientific Conference and hands-on workshop . The knowledge, insights and networking gained by the MDA delegation will help accelerate the progress of the industry as a whole, resulting in a more sophisticated dental profession and in turn, a more robust dental market. This will go far in ensuring the success of the upcoming 4th BDC 2014 next year.

The MDA EZ delegates also took the opportunity to network with other dental associations during the 3RD BDC opening ceremony and informal night including our Singaporean, Indonesian, Brunei Darus-Salam, Dubai, Indian, Chile, USA, Hong Kong and Chinese counterparts. Some of the noted colleagues who had attended were the Principal Director Of Oral Health Division, Ministry Of Health Malaysia, Director of Sabah State Health Department Dr Christina Rundi, President Of MDA Dr Haja Badrudeen and 35th APDC Organizing Chairman Dato’ Dr. Ratnanesan and the council members.

The Malaysian Dental Association: Our Story...The year 2013 marks MDA’s 75th Diamond Jubilee celebrations. In conjunction with this, the editorial board of the MDA Newsletter would like to highlight the colourful history of our beloved association.

President:Prof. E.K.Tratman

The history of the Malaysian Dental Association (MDA) began on the 2nd of September 1938, as the Malayan Dental Association. The association was officially inaugurated at a special meeting held in the Dental Clinic, General Hospital Singapore. Dr E K Tratman, who was appointed as Professor of Dental Surgery and Head of the Dental School of the King Edward VII College of Medicine in 1929, became its first President while Tan Sri Dr Tay Teck Eng took on the duties of Honorary General Secretary.

In the early years when there were few dentists, activities were limited. In fact, the association’s operations came to a standstill during the World War II period. After the defeat of the Axis powers, the Medical College resumed teaching

in mid-1946 and slowly the association was revived. At that time, most of the activities were organized in conjunction with and in the dental school.

The visionary leaders of MDA set out objectives for the association which are still relevant to us today, namely to maintain the honour and interest of the association, to foster a feeling of friendship among its members and to hold periodical meetings for the discussion of scientific subjects and of professional matters.

The first logo for the Malayan Dental Association


On the 4th of March 1939 the first Annual General Meeting held at Dental Clinic, Singapore Central Hospital.

With World War II looming, the last recorded meeting was held at the Institute of Medical Research Kuala Lumpur, 4th October 1941

2nd Annual General Meeting, 1940

With the surrender of the Axis powers at the end of the war, the revival of the MDA was initiated. The Ordinary Meeting was held on Saturday 9th February 1946 at the Dental Clinic, Kandang Kerbau Hospital, Singapore.

The 2nd president Mr. C. F. Mummery proposed the professional of dental care for the masses. By then, 82% of the qualified dentists were members of the association.

The first Malayan Dental Bulletin made its appearance in 1947 with Mr. M. Subramaniam as the editor.

In 1948 Dr Ong Kee Yeam tookover the Presidency.

In 1961 the Malayan Dental Journal is launched with Mr. J. A. Jansen as the editor. A code of Ethics was formulated and adopted in 1961 stressing the responsibilities of dentists of their patients, colleagues and the dental profession.

After Malaya gained independence in 1957, Malayan Dental Association continued to represent the dental professions both in Malaysia and Singapore. In 1963, Singapore together with Sarawak and Sabah, merged with Malaya to become Malaysia. The following year, at the conclusion of the 4th Asia Pacific Dental Congress (APDC), the name was changed to Malaysian Dental Association.The MDA celebrated its Silver Jubilee in 1963.

By 1949 the MDA had 3 branches


The Malayan Dental Association underwent a metamorphosis and become the Malaysian Dental Association.

Upon Malaysia and Singapore going their separate ways, the Singapore Dental Association was born on the 24th of March 1967.

The 29th AGM was held on the 19th of April 1972. Dr. Lim Chee Shin assumed the Presidency and for the first time the MDA had Secretariat with a paid employee.

1975 AGM Scientific Convention.

President Dr. De Silva installed Yang Amat Berhormat Tun Abdul Razak, first Prime Minister as Patron of the Malaysian Dental Association on 19th April 1974.

MDA made history in 1974 being the first foreign dental mission to visit China.

The Association was honoured to play host to the 4th Asian Pacific Dental Federation Congress in Singapore.

In 1965, Singapore separated from Malaysia and became an independent nation and thus, in 1966, an agreement was reached to dichotomize the association into the Malaysian Dental Association and the Singapore Dental Association. The 24th Annual General Meeting was held in Singapore on 25th March 1967, 'the first and last time' it was to be held 'away'.


In 1979 the MDA foundation was incorporated and it purchased a 3-storey shop lot in Jalan Klang Lama.

On the 1st of March 1987 the MDA acquired a floor in Plaza Damansara to house the present secretariat.

In April MDA was then given the privilege to host the 9th APDC and the FICD

induction ceremony.

9th APDC Kuala Lumpur

The first MDA/SDA Joint Scientific Congress & Dental Trade Exhibition

was held in 1982.

In April 1991 the inaugural meeting of the Commonwealth Dental Association was held in Kuala Lumpur and Dr. A. Ratnanesan was elected President-Elect.

The 49th AGM was held inKuching, Sarawak.

In 1994 the 50th AGM saw the reintroduction of the President-Elect system. On the 24th of March the MDA celebrated its Golden Jubilee with the charity dinner and launched the MDA history book. In that year the first FDI/MDA/SDA Joint Convention in Kuala Lumpur and the 51st AGM held at Langkawi.

In 1994 the 50th AGM saw the reintroduction of the President-Elect system.On the 24th of March the MDA celebrated its Golden Jubilee with the charity dinner and launched the MDA history book.In that year the first FDI/MDA/SDA Joint Convention in Kuala Lumpur and the 51st AGM held at Langkawi

In May 1995 the 52nd MDA AGM was held in Kuala Terengganu. The same year, MDA's bid to host the 89th FDI World Dental Congress was officially accepted.

In 1997 the MDA organised the 4th FDI/MDA Scientific Convention and the 54th MDA AGM/BSGDS Scientific Convention. The MDA's home page was officially launched that year. This year saw the inaugural diplomates presentation ceremony with the DGDP examination, which was followed by a formal dinner.

In 1998 the 5th FDI/MDA Scientific Convention and the Kongsi Raya dinner were organised. The 55th MDA AGM and Scientific Convention was held at the Awana Kijal Beach and Golf Resort from 14th to 17th May 1998.

Adapted from the Malaysian Dental Association website.


The Asia Pacific Academy of Implant Dentistry (APAID) is an organization founded by 17 countries around the Asia Pacific region. The objectives and vision of APAID are to promote implant education and exchange knowledge about implant treatment as well as researches around this area.

The 1st Asia Pacific Academy of Implant Dentistry (APAID) International Congress was held in Manila, Philippines in 2009 where two Members of the Board of Directors representing Malaysia were elected, namely Dr Michael Ong Ah Hup and Datuk Dr Teo Choo Kum. The 2nd APAID Congress was then held in Bangkok in 2010 together with Bangkok Implant Symposium.

In 2013, the 3rd APAID International Congress was held in Taipei, Taiwan from March 8 to 10 where the following Dental Surgeons and Specialists from Malaysia received their professional APAID Credential Certificates:

Diplomate of APAID:- 1. Dr Michael Ong Ah Hup (Malaysia) 2. Datuk Dr Teo Choo Kum (Malaysia)

Fellowship of APAID:- 1. Dr Beh Wee Ren (Malaysia) 2. Dr Lee Wayn Juen (Malaysia) 3. Dr Loh Kok Heng (Malaysia) 4. Dr Naresh Yedthare Shetty (India)

During these conferences, experts and specialists from Asia-Pacific region, Middle East, Europe and USA shared their latest researches, technology and knowledge to improve the outcome of dental implant treatment for patients in these member nations. Dr Michael Ong Ah Hup, the Former Professor of Oral and Maxillofacial Surgery of University of Malaya and Founding President of Malaysian Oral Implant Association (MOIA) was invited to be an Examiner for the Poster Competition and a Guest Speaker for the 3rd APAID Congress.

Congratulations to all the recipients who had satisfied the requirements and were conferred the honours by the Board of Directors of APAID.

For further information, kindly visit the APAID website: www.apaid.asia

Malaysian Dentists gained Honours at the 3rd APAID Congress

Celebrating With Colleagues In 3Rd APAID Congress

Receiving The Diplomate Of Apaid During 3rd APAID International Congress In Taipei Taiwan

Greetings From Taiwan With President Of APDC/APRO, Dr James Chih-Chien Lee

With Members Of The Board Of Directors Of APAID

APAID Opening Ceremony

Invited Guest Speaker Of 3Rd APAID International Congress In Taipei Taiwan From Malaysia, Dr Michael Ong


Northern Zone Report 11th Penang Dental Congress

In recent years the Malaysian Dental Association Northern Zone (MDA NZ) have organized an enlightening and illuminating event; the Penang Dental Congress held annually in the island of Penang. This year was no exception and the 11th Penang Dental Congress was held from 19th to 21st October 2012 in Equatorial Hotel, with two pre-congress workshops on 18th October 2012 at MDA NZ’s office and Equatorial Hotel. For the second time in history, this year’s Congress was held for 3 days, bringing it to an international level, where renowned speakers from Malaysia, India, Japan, Singapore, Thailand and Taiwan were invited to share their expertise and knowledge with dentists from various parts of the world.

On the 19th October 2012, the opening ceremony of the 11th PDC was officiated by the Principal Director of Oral Health Division, Ministry of Health Malaysia, Dr Khairiyah bt Abdul Muttalib. She mentioned about the status of the Dental Bill and Dental Act 2012 in her speech. She also talked about decisions on autonomous liberalization and the status of Malaysia in ASEAN in the opening ceremony.

The 11th PDC has attracted more than 400 participants and has created an excellent platform for participants to gain knowledge and to explore the prospective of novel advances in dentistry.

The opening ceremony of 11th PDC was officiated by Principal Director of Oral Health Division, Ministry of Health Malaysia, Dr Khairiyah bt Abdul Muttalib (center); together with the TPKN(G)Pulau Pinang, Dr Abdul Razak bin Osman; President MDA year 2012/2013, Dr Haja Bahrudeen; Chairman of Malaysian Dental Association, Dr Goon Yong Por; President Elect MDA year 2012/2013, Dr Neoh Gim Bok; organizing chairman of the 11th PDC, Dr Ang Lai Choon; and Pengarah of PPKK & KLPM. (From right)

Staff from GSK was explaining the latest GSK product to Dr Khairiyah bt Abdul Muttalib.

In addition, the Dental Nurse & Dental Surgery Assistant Symposium Program was held concurrently with the scientific convention on Friday. Prominent local speakers were invited to talk about new perspectives on caries management in children, working ergonomics in the dental setting and the effective ways of allaying fear and anxiety in children during dental treatment.

On Saturday, the organizing committee scaled even greater heights by organizing the Oral and Poster Presentation. The main aim of the Oral and Poster presentation was to provide opportunity for dental profession to present their research and to share the innovative and ingenious scientific work in dentistry.

With a wide exhibition area in Equatorial Hotel, the Congress Traders’ Exhibition attracted more than 55 exhibitors this year, with hundreds of delegates visiting the booths,

listening to the introduction of latest technology in dental instruments and material provided by various suppliers. It provided a comfortable and convenient environment for dentists to move around and try out all the new dental materials available in the market.

All participants, VIPs and speakers were invited to attend the exciting and wonderful social event, Gala Night on Saturday at 8pm. During the banquet, there were terrific stage performances by students from AIMST Dental Institute as well as slide show presentations of the 2012 year events by MDA NZ members. The participants were expected to let their hair down and enjoy the memories of their friendship, as some meet only during events like these.


Stage performances by students from AIMST Dental Institute

Undoubtedly, the 11th Penang Dental Congress not only helps MDA members to sharpen their clinical acumen, but also helps to foster closer ties among dental professions. It was indeed a fruitful event and members of MDA are undoubtedly looking forward to the merrier and more successful 12th Penang Dental Congress.

Pahang CPD lecture organized by MDA Northern ZoneThe MDA Northern Zone has shown its support for continuous professional learning by organizing Pahang CPD Talk at the Shahzan Inn Hotel, Kuantan, Pahang on the 8th July 2012 (Sunday) from 9am to 12pm)

The event witnessed a turnout of 26 participants and started off with a welcoming note from Dr. Chan Cheng Hoong, the local organizing committee of Pahang state.

Our guest speaker of the day was Dr. Azillah bt. Mohd Ali (Senior Consultant and Head of Department of Paediatric Dentistry, Hospital Sultanah Bahiyah (Alor Setar), who delivered 2 lectures on "Behaviour management: the practical way!" and "Management of first permanent molar:What's new?” .

The lecture was a fantastic journey through minimal invasive dentistry, where Dr. Azillah assimilated her enriching experiences with her passion for high-quality dentistry. This program took the clinicians through detailed “step-by-step” guides for management on paediatric patients. It was indeed a good opportunity for the participants to update their knowledge in the field of paedodontics, especially in non-pharmacological approach in behavioural management and management of permanent first molars, as Dr. Azillah was generous and gracious in sharing her valuable experience and extensive information with the audience.

We would like to thank the local organizing committee (led by Dr. Chan Cheng Hoong), for their cooperation and energy spent in organizing this event. We look forward to seeing everyone again in Kuantan next year!

DENTAL CAREERS

AT A GREAT HOSPITAL

Penang Adventist Hospital, a Malaysian Society for Quality in Health (MSQH) accredited hospital, is the first hospital in Malaysia to be accredited by the Joint Commission International (JCI). Established in 1924, the pioneer not-for-profit private hospital in Malaysia, has grown from a community mission hospital to a tertiary regional medical centre. We are part of an international network of more than 500 hospitals and healthcare facilities within the Adventist Health system. We are looking for dentists who are caring and have a great passion and must be committed to our mission of providing wholistic comprehensive, competent and excellent healthcare Requirements :

• Possess bachelor degree in Dental Surgery • Registered or registerable with the Malaysian Dental Council • At least 3 years post graduate experience • Well-equipped in restorative dentistry, prosthodontics, endodontics, general surgery

and cosmetic dentistry Interested candidates are invited to send resumes to : - Director of Human Resources Penang Adventist Hospital 465 Jalan Burma 10350 Penang Or by email to [email protected] Website : www.pah.com.my

DENTAL CAREERSAT A GREAT HOSPITALPenang Adventist Hospital, a Malaysian Society for Quality in Health (MSQH) accredited hospital, is the first hospital in Malaysia to be accredited by the Joint Commission International (JCI). Established in 1924, the pioneer not-for-profit private hospital in Malaysia, has grown from a community mission hospital to a tertiary regional medical centre. We are part of an international network of more than 500 hospitals and healthcare facilities within the Adventist Health system. We are looking for dentists who are caring and have a great passion and must be committed to our mission of providing wholistic comprehensive, competent and excellent healthcare

Requirements :• Possess bachelor degree in Dental Surgery• Registered or registerable with the Malaysian Dental

Council• At least 3 years post graduate experience• Well-equipped in restorative dentistry, prosthodontics,

endodontics, general surgery and cosmetic dentistry

Interested candidates are invited to send resumes to : -

Director of Human ResourcesPenang Adventist Hospital465 Jalan Burma10350 Penang

Or by email to [email protected] : www.pah.com.my

DENTAL CAREERS

AT A GREAT HOSPITAL

Penang Adventist Hospital, a Malaysian Society for Quality in Health (MSQH) accredited hospital, is the first hospital in Malaysia to be accredited by the Joint Commission International (JCI). Established in 1924, the pioneer not-for-profit private hospital in Malaysia, has grown from a community mission hospital to a tertiary regional medical centre. We are part of an international network of more than 500 hospitals and healthcare facilities within the Adventist Health system. We are looking for dentists who are caring and have a great passion and must be committed to our mission of providing wholistic comprehensive, competent and excellent healthcare Requirements :

• Possess bachelor degree in Dental Surgery • Registered or registerable with the Malaysian Dental Council • At least 3 years post graduate experience • Well-equipped in restorative dentistry, prosthodontics, endodontics, general surgery

and cosmetic dentistry Interested candidates are invited to send resumes to : - Director of Human Resources Penang Adventist Hospital 465 Jalan Burma 10350 Penang Or by email to [email protected] Website : www.pah.com.my

www.lottemalaysia.com

A product of Japan, available in major retail outlets.Contact [email protected] for more information.


ClassifiedPosition Vacant:Dental Surgery Associate Wanted (Part / Full Time)Dental Surgeon Assistant Wanted (Part / Full Time) Working Venue: Kuala Lumpur & Klang Valley Interested candidates please call us now at +603-6201 0111 or kindly drop your resume to [email protected]

Universiti Kebangsaan Malaysia (UKM) Postgraduate Programmes 2013/14Doctor of Philosophy (Oral Biology / Community Dentistry / Paediatric Dentistry)Doctor of Clinical Dentistry (Pediatric Dentistry / Orthodontics / Endodontology / Oral and Maxillofacial Surgery)Master of Dental Science (Oral Biology)Apply before 31st May 2013 - online via http://guest.ukm.my or contact:Tel : 03-8921 4445 Fax : 03-8925 2699 E-mail : [email protected]

Dental surgeon(Full time/part time,registered with MDC) wanted in busy dental practice in K.L. Good working environment,Chinese speaking,replacing dentist with high income & stable clientele.Tel: 012-6618341 , 016-3209502

Dental Associate WantedA busy dental clinic practicing high end dentistry in Kuching city is seeking a dental associate, preferably female. Work hours similar to office hours. Attractive remuneration with housing and transport allowance for outstation candidate. Interested, please email resume to :[email protected] or ring 019-8788718

LOCUM dentist needed at Petaling Jaya on weekend basis.Call:012-2078015.

2 Full time Dental Surgeons wanted to work in established clinics in KL.Must possess APC and good attitude.Senior doctors willing to share knowledge and guide successful candidates.Young doctors sharing same goals and vision can request for partnership after reasonable period of working together. Call Ms Mandy 0162224765.

Sentral Dental ClinicDENTIST VACANCY

Looking for a quali�ed dentist to work in a soon to be opened dental clinic in Bintulu.

• Very good remuneration, yearly increment % pro�t sharing and expansion opportunity.

• Good command of multiple languages/ local dialects is an added advantage.

• Must have good personalities and willing to commit to long term employment.

• Will be appointed as person in charge (PIC). Must not be PIC for another center.

• Interested candidates please email CV, expected salary, face photo to: Felicia - [email protected]

Total care mag ad FA OL.pdf 12/23/10 4:47:59 PM

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