Case 1: Stage III, Grade C, Incisor-molar pattern Periodontitis
Case 2: Stage III, Grade C, Generalized Periodontitis
Case 3: Stage III, Grade C, Generalized Periodontitis
Case 4: Stage III, Grade C, Generalized Periodontitis
Case 5: Stage IV, Grade C, Generalized Periodontitis
The European Federation of Periodontology Perio Master Clinic will be held in Asia for the first time!
Please visit the following link for more details:
Peri-implantitis: Prevention and Treatment of Soft and Hard Tissue Defects
March 1-2, 2019
Harbour Grand Kowloon, Hong Kong
Annual General Meeting 2017
Date: 3rd December 2017
Venue: Centenary Room 1, G/F, Marco Polo Hong Kong Hotel,
3 Canton Road, Habour City, Tsim Sha Tsui, Kowloon, Hong Kong.
Registration : 8:30 to 9:00am
Annual General Meeting: 9:00 am to 1:00pm
"Principles of flap design and wound healing. From periodontal plastic surgery to implant management"
Prof. Maurizio S Tonetti
HKSPID Study Group
"Mechanical plaque control - revisit"
Venue: PPDH 7/F Lounge
From left to right: Dr. Chung-Yin Leung, Dr. Becky Woo, Dr. Kelvin Wan, Dr. Wilson Lin, Dr. Annie Chan, Dr. Trustin Choi, Dr. Yuen-Kwan Tse, Dr. Clive Fung, Dr. Vincent Ngai.
Comments and Discussions
There are many well described tooth brushing methods developed since the introduction of modern type of toothbrush around 1930's. However, there is no one particular brushing method found to be superior to the others. In fact, many people habitually use more than one type of brushing technique on different parts of the mouth. In the clinic, it may be advisable to modify and improve patient’s existing brushing method for easy adaptation.
Overall there is insufficient evidence to claimed or refute a benefit for flossing in reducing plaque.
Interdental brush was found to be more effective as compare to flossing. However it's use is restricted to opened interdental space where the brush can pass through easily.
There is no conclusive evidence to claim that woodstick have beneficial effect on visible interdental plaque.
Oral irrigator does not have a beneficial effect in reducing visible plaque. However, there seems to be a trend in favor of oral irrigation in reducing gingival inflammation.
Interdental brush should be used when the interdental space is large enough for it to pass through. Otherwise, flossing is recommended. Despite the lack of evidence for its effectiveness, flossing is considered a logical way to remove plaque in closed interdental space.
Size of a toothbrush head should be appropriate to the size of the oral cavity so that it can be positioned easily on various locations of the mouth.
Emphasis moved to using soft bristle toothbrush as compared to the past when people tend to buy hard bristle toothbrush after we understand more the importance of plaque removal rather calculus removal. Concern about toothbrush trauma is also a factor for this move. There are studies showing medium toothbrush clean better than soft bristle toothbrush. However, the effectiveness of cleaning should not be traded off for the damage to the cervical tissue especially when patient already show signs of toothbrush trauma.
There is no conclusive evidence found to support whether taper on round-end bristle is more effective in plaque removal.
Brush head pattern
Angled bristle design showed a slightly better result in plaque removal than the multi-level and flat-trim design numerically. The possible benefit may be the result of its bristle being able to reach farther into the interdental space.
There are toothbrushes specifically designed to use on implants. However there is not any scientific evidence showing their efficacy on plaque removal.
Manual toothbrush vs electric toothbrush
With regard to gingivitis, there is moderate quality of evidence that powered toothbrushes provide a statistically significant benefit when compared with manual toothbrushes which corresponds to a 6% and 11% reduction in gingivitis in the short term and in the long term respectively (Yaacob et al. 2014)
More evidence was for counter-rotational and oscillating–rotating brushes which demonstrated a statistically significant reduction in plaque and gingivitis.
Publication bias might be expected in the reporting of toothbrush trials as manufacturers would likely want to have scientific support for the effectiveness of their products.
Based on the outcome of this review, the authors concluded that powered toothbrushes reduce plaque and gingivitis (slightly) more than manual tooth brushing in the short and long term. The clinical importance of these findings remains unclear.
Frequency and duration of toothbrushing
Lang et al. (1973) found that brushing every 48 hours can maintain gingival health and prevent gingivitis
As most individuals do not completely remove plaque at each brushing, higher frequencies of brushing may be beneficial to gingival health. (Addy & Adriaens 1998, Jepsen 1998)
There is no significant gains could be achieved by increasing the frequency to more than two times a day(Frandsen 1986)
A habit of brushing two times a day should optimize the chance of maintaining gingival health and is easy to follow by patients.
There is some evidence showing that increase in brushing time improve plaque removal. But there is no optimal tooth brushing time can be identified. There is recommendation for brushing for 2 minutes or more. (Van der Weijden et al. 2005)
Patients usually believe they spend more time than they actually do in tooth brushing.
Individuals typically brush for about one minute or less but most people significantly overestimate tooth-brushing duration. (Terezhalmy et al. 2005)
Free for HKSPID members
12th Asian Pacific Society of Periodontology Meeting
Please visit apsp2017seoul.org for more details
HKSPID Study Group 2017
Chemical Plaque Control - from evidence to practice
14th June 2017 (Wednesday)
7/F, Prince Philip Dental Hospital
34 Hospital Road, Sai Ying Pun, Hong Kong.
Dr. Ngai Kwai Shing Vincent
To gather a group of clinicians with the relevant expertise or interest to discuss on the issue of concern
Through structured critical discussion on the relevant evidence during the process, to produce clinically useful comments, recommendations, guidelines, or consensus statements on the concerned issue
From left to right: Dr. Clive Fung, Dr. Chung-Yin Leung, Dr. Yuen-Kwan Tse, Dr. Man-Ha Chan, Dr. Douglas Chong, Dr. Sin-Tsoi Ng, Dr. Sui-Cheung Sum, Dr. Annie Chan, Dr. Becky Woo, Dr. Trustin Choi, Dr. Wilson Lin, Dr. Kelvin Wan, Dr. Cheuk-Kuen Cheng, Dr. Hok-Ling Wong, Dr. Henry Liu
lIt was found that many studies on chemical plaque control involve certain amount of bias and heterogeneity.
lIn a comprehensive review “Efﬁcacy of adjunctive anti-plaque chemical agents in managing gingivitis: a systematic review and meta-analysis” by Serrano et al.in 2015, it stated that: “Regarding the independency of the study, in terms of funding and authors, most of the studies were economically supported by private companies with commercial interests in the results, which were clearly stated in the paper (n = 43) or was evident due to the presence of employees of the company in the list of authors (n = 31). Independent researchers (e.g. university staff) were authors in 70 papers, but in 38 of them, they worked together with employees of the funding company (total, n = 53) and/or with staff from a private research company (total, n = 24). Considering as low risk of bias those studies with independent authors and funding, four had low, eight unclear and 75 high risk.”
lHowever, with all the existing available evidence, it was found that chemical plaque control provides statistically signiﬁcant additional benefit over the control groups
lThe clinical benefit varied with different agents and with different indices used in the studies.
The additional effects were statistically significant in terms of Loe & Silness gingival index (46 comparisons, WMD -0.217), modified gingival index (n = 23, -0.415), gingivitis severity index (n = 26, -14.939%) or bleeding index (n = 23, -7.626%), with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies, WMD -0.475), Silness & Loe (n = 26, -0.109), and plaque severity (n = 12, -23.4%) indices, with significant heterogeneity (Serrano et al. 2015).
lWhether this benefit offer any clinical value is subjected to interpretation.
lThe studies didn’t address the cost-effectiveness issue
lNo specific recommendation for target group of patient who will benefit most from chemical plaque control
lIn many studies, participants in the control group were allowed to brush according to their normal regimen without proper oral hygiene instruction.
lAs early as 1965, Lo¨e et al. Showed, in the well-known “Experimental Gingivitis” study, that proper mechanical tooth brushing is effective in treating gingivitis.
lLang et al.(1973) demonstrated that students who thoroughly removed plaque at least every second day, did not develop clinical signs of gingival inflammation over a 6-week period. This included the use of inter-proximal aids (dental floss and toothpicks) as well as the toothbrush.
lIn the well-motivated and properly instructed individuals who are willing to invest the necessary time and effort, mechanical measures using traditional toothbrushes and adjunctive manual (inter-dental) devices are effective in controlling plaque. Although maintaining a dentition close to plaque free is not easy.
Comments and recommendations
1.One should not rely on chemical plaque control to solve gingivitis problem. On the other hand, good mechanical plaque control can prevent and successfully treat gingivitis.
2.Mouth rinse should not be recommended as the first line of management strategy for gingivitis.
3.We recommend improving patients’ oral hygiene by mechanical tooth bushing and interdental cleaning.
4.Toothpaste with antiplaque agent may be used as it does not involve extra procedure.
5.Routine use of mouth rinse for everyone is not recommended.
6.Mouth rinse may be used in certain clinical situations: (Whenever patient is unable to perform proper mechanical plaque control).
a.Temporary use after oral surgery.
b.Inability to clean at certain areas.
c.Patient with reduced manual dexterity.
d.When patients, due to various reasons, cannot achieve sufficient oral cleanliness after repeated exhaustive effort of oral hygiene instruction.
When prescribing mouth rinse, clinician should also take into account of the possible side effects and cost-effectiveness of its use.
In the Oral Health Survey 2011, 15.4% Hong Kong people believe mouth rinse can prevent gum disease but only 47.9% think that tooth brushing can prevent gum disease.
One should be careful when people over enthusiastically promote the effect of chemical plaque control, there is a risk that the public may misinterpret chemical plaque control agent as a powerful and essential agent that they can rely on, hence compromise the desire to improve their own tooth brushing.
12th Asian Pacific Society of Periodontology Meeting
The 12th APSP Meeting will be held in Seoul on September 22-24, 2017.
The theme of this meeting is "Contemporary concepts in periodontology and implant dentistry" and the scientific program will showcase the cutting edge advances in the specialty and highlight best researches from member countries.New basic and clinical research findings presented will invigorate you and help you better the health of all your patients.
For more information, please visit the following webpage for more details:
Hong Kong Society of Periodontology and implant Dentistry Ltd.
Prof Maurizio S Tonetti, Clinical Professor and discipline co-ordinator in Periodontology at the Faculty of Dentistry, The University of Hong Kong and Executive Director, European Research Group on Periodontology (ERGOPerio). Formerly: Professor and Head, Department of Periodontology, School of Dental Medicine, University of Connecticut Health Science Centre. Professor and Head, Department of Periodontology at University College London – UK. Adjunct Professor, University of Berne – Switzerland, and University of North Carolina at Chapel Hill – USA. He serves as Editor in Chief of the Journal of Clinical Periodontology.
How to fully capture the benefits of periodontal regeneration to change prognosis of compromised teeth. State of the art practice.
Winning the challenge of periodontitis: integrated preventive and therapeutic care pathway in primary and specialist practice.
Lecture 1 + AGM
Lecture 2 and Periodontal Experts Panel Discussion
Common head and neck pain that you would encounter in a dental clinic
Date: 11 November 2016 (Friday)
Speaker: Dr Sunny Lee (Specialist in Pain Medicine)
Venue: 7/F Lounge, PPDH
Course fee: $500 (Free for members)
Light refreshment provided before and after the seminar
Dr Lee graduated from the Chinese University of Hong Kong. After finished his training in Anaesthesiology and Pain Medicine in Hong Kong, he went to Australia to pursuit further training in pain medicine. After practicing in Australia for some time, he went back to Hong Kong and became the first registered pain medicine specialist here. Currently, he runs his private practices in both Hong Kong and Australia. He is the pioneer in many areas in the field. For example, he is the only private practitioner providing services for spinal cord stimulation at present.
Pain is a commonly encountered problem in clinical practice. It is considered as the fifth vital sign in modern medicine. Researches show chronic pain affects about 20% of population.
In the talk, the speaker would share with the audiences different aspects of pain medicine. He would explore some basic science of pain, principles of pain treatment, types and nature of analgesics and some commonly encountered chronic pain problems that may encountered by dentists.