DENTALTRIBUNE The World’s Dental Newspaper · South Asia Edition

Published in India www.dental-tribune.com 12/21

Dr. Madhav Murthy Dr. Ray Williams Magnification Silver nanoparticles.

Dr. Madhav Dr. Ray Williams – Magnification for Silver nanoparticles
Murthy: “brilliant “great friend, beginners (Part 1) – (Ag NPs) in dentistry
mind & a philosopher, Dr. Ridhima Uppal
wonderful guide”: Tribute
human being” from his two
students
” Page 03 ” Page 04 ” Page 05 ” Page 07

GoI increases OMFS procedure

rates under Ayushman Bharat
By Divyesh Mundra, 1st HBP released by NHA in September 2018 had 1,393 packages but
Dental Tribune South Asia just 9 oral surgical procedures as follows:

National Health Authority
(NHA) has made three revisions
to its national Health Benefit
Package (HBP) master since its
launch in September 2018. The
fourth HBP to be released in
November 2021 has increased
packages for four oral surgical
procedures.
National Health Authority
(NHA), under the aegis of
the Ministry of Health and
Family Welfare (MOHFW), is
India’s official authority for
implementing Govt. India’s
flagship health insurance
scheme, Ayushman Bharat (AB).
Ayushman Bharat has two
components:
1. Health and Wellness
Centres
2. Pradhan Mantri Jan
Arogya Yojana (PMJAY)
Through PMJAY, Govt. of
India is mandated to provide
health cover up to Rs 5.00 lakh
per annum per family for
secondary and tertiary care
hospitalization to ~10.74 crore
families (~50 crores Indians)
belonging to the poor and
vulnerable sections of the
society. It covers up to 3 days of
pre-hospitalization and 15 days
post-hospitalization expenses
such as diagnostics & medicines.
Since the scheme’s launch on
23rd September 2018 in Ranchi,
Jharkhand, by the Hon’ble
Prime Minister of India, it has
issued cards to 16.79 Cr Indians
& covered expenses of 2.27 Cr
hospital admissions.
Health Benefit Packages
(HBP)
Empanelled health
providers (EHCP) are paid based
on specified HBP rates. A package
consists of all the costs associated
with the treatment, including
pre and post-hospitalization
Sr.
Name of Oral Surgical Procedure Package Price (in INR)
No.
Fixation of fracture of 1 jaw with closed
1 Rs 5,000
reduction using wires - under LA
Fixation of fracture of 1 jaw with closed
2 Rs 12,000
reduction using wires- under GA
3 Sequestrectomy Rs 1,500
4 TMJ Joint Ankylosis of both jaws under GA Rs 15,000
Release of fibrous bands & grafting in Oral
5 Rs 3,000
Submucous Fibrosis Rx under GA
6 Extraction of an impacted tooth under LA Rs 500
Senior oral surgeons in India welcome the latest development (Photo:
https://abdm.gov.in/) Cyst & tumor of Maxilla/Mandible by
7 Enucleation/ Excision/Marsupialization Rs 2,500
expenses. The specified surgical Charges, Cost of Surgical under Local Anaesthesia (LA)
packages are paid as bundled Appliances, etc. Mandible Tumor Resection and Recon-
care where a single all-inclusive • Medicines and Drugs 8 Rs 6,000
struction/ Oral Cancer surgery
payment is payable to the EHCP • Cost of Prosthetic
by the insurer/ State Health Devices, implants (unless Rs 15,000 for EACH
9 Cleft Lip and Palate surgery
stage
Authority (SHA). However, the payable separately)
medical packages are payable • Pathology and radio-
to the EHCP at a per-day rate logy tests: radiology to include 2nd HBP 2.0 released by NHA in November 2019 added 671
depending upon the admission but not be limited to X-ray, MRI, procedures, increasing the total to 2,064 packages, but only 9 oral
unit (general ward, HDU, ICU). CT scan, etc. (as applicable) surgical procedures were added, increasing the count to 18, as
Day-care packages are payable • Food to patient follows:
just like surgical packages. • Pre and Post
Hospitalisation expenses: Sr.
Name of Oral Surgical Procedure Package Price (in INR)
HBP rate (in case of surgical Expenses incurred for No.
or defined day-care benefits) consultation, diagnostic tests, 1 Apicoectomy of a single tooth Rs 1,500
includes: and medicines before the
• Registration charges admission of the patient in the 2 Correction of Oro-antral communication Rs 7,000 – LA
• Bed charges (General same hospital, and up to 15 days Rs 12,000 – GA
Ward) of the discharge from the hospital 3 Intra-oral submandibular sialolithotomy Rs 6,000 – LA
• Nursing and Boarding for the same ailment/ surgery (Soft & Hard Tissue) Rs 9,000 – GA
charges 4 Dentoalveolar trauma- wiring Rs 3,000
• Surgeons, Anaesthe-
tists, Medical Practitioners, 5 Intra-Oral Parotid sialolithotomy Rs 6,000 – LA
Consultants fees, etc. Rs 9,000 – GA
• Anesthesia, Blood 6 Extra-Oral Parotid sialolithotomy under Rs 11,000
GA
Transfusion, Oxygen, OT
NHA has made three revisions to its national HBP master since its 7 Re-implantation of an avulsed tooth with Rs 1,500
wiring
launch in September 2018.
8 Osteo-radio necrosis management by Rs 5,000 – LA
New Changes in excision Rs 9,000 – GA
Sr. Health Benefit
Release Date packages rates of existing
No. Package (HBP 9 Open Reduction and Internal Fixation of Rs 18,000 – Single
added packages Maxilla/Mandible/Zygoma Rs 25,000 – Multiple
care
1 HBP 1.0 Sept 2018 1,393 0
3rd HBP 2.1 released by NHA in November 2020 added 76 NEW
2 HBP 2.0 November 2019 671 450
packages, but none from oral surgery and did not change rates of
3 HBP 2.1 November 2020 76 0 any packages.
4 HBP 2.2 November 2021 1 409
2 News 12/21

Author:
4th HBP 2.2 by NHA to be released in November 2021 has increased tive restorations, gum surgeries tems Studies (SHSS), Tata Ins-
packages for the following four oral surgical procedures: and prosthetic procedures, like titute of Social Sciences (TISS),
dental caries, periodontitis and Mumbai. He is a healthcare ma-
Current Proposed loss of teeth are most common nagement professional having
Package Name Procedure Name
Price price
oral health conditions across the 5 years of diverse experience
Enucleation/ Excision/ world & India bears a high bur- across hospital administration,
Surgery for Cyst & Max- Marsupialization for
2,500 Rs 10,500 den of it.” patient advocacy, public health
illa/Mandible tumor cyst & tumor of Maxilla
& Mandible Let us hope that National He- policy, and implementation of
Submandibular (SM) Excision of SM Salivary
alth Authority (NHA) team also public health programs. Divyesh
9,000 21,600 analyses the state-wise utiliza- actively tweets on challenges
Salivary Gland Gland
Closed Reduction for Inter-maxillary fixation tion of all 18 health benefit packa- confronting the Indian health-
9,200 11,300 ges done under oral and maxillo- care system including medical
Fracture of Maxilla for fracture of Maxilla
Inter-maxillary fixation facial surgery specialty and bro- and dental education.
Closed Reduction for adly dentistry and shares it in
for fracture of Mandible 9,200 18,500 Dr. Divyesh Mundra on Twitter
Fracture of Mandible
& Zygoma the public domain for the public Dr. Divyesh Mundra on LinkedIn
Prof. Department of Oral & (MOHFW) decision regarding health dentistry community to
Maxillofacial Surgery (OMFS), revision of health benefit packa- frame better oral health policies
Dean, Pacific Dental College and ges under Ayushman Bharat, for improving the overall health
Hospital, Udaipur, Rajasthan & which was much needed. Also, I status of the community.
Executive Committee Member do hope they revise the package
Association of Oral and Maxil- of extraction of impacted wis- Reference: Dr. Divyesh Mundra
lofacial Surgeons of India (AI- dom tooth, which is very cur- Official Website of PMJAY
OMSI) Dr. Bhagvandas Rai: rently very low and, if possible, Health Benefit Packages https:// Dr. Divyesh Mundra (BDS)
“I welcome National Health include other essential & most pmjay.gov.in/about/pmjay completed his Masters in Public
Authority (NHA) & Minis- common dental procedures like Health (MPH) Administration
try of Health & Family Welfare simple extraction, conserva- from the School of Health Sys-

Dr. C. P. Boghani – a great academic &

clinician Ad

Dr. Boghani started his clinical practice in 1984 and practiced till the
age of 80. (Photo: boghanidentalclinic.com)

By Dental Tribune South Asia in 1978 and 1980. He was editor

A heartfelt tribute to
Dr. C. P. Boghani, a great
periodontist, clinician,
academic, and editor.
Dr. Boghani completed his
undergraduate dentistry (1958)
and MDS in Periodontics (1961)
from Govt Dental College &
Hospital, Mumbai. He was from
the first batch of PG students in
Periodontology at Bombay Uni-
versity under the able guidance of
Dr. GB Shankawalkar.
Dr. Boghani later went on to
receive his DPD (Eng.) in 1970.
Dr. Boghani worked as the
Professor and Head, Dept of
Periodontics, GDC Ahemdabad
(1963-1984) and then joined
Bagalkot and Yenopoya
Dental College, Mangalore as
a PG teacher. He was a great
academician, a Prof. Emeritus,
who went as an examiner to
almost all the dental colleges in
India.
Dr. Boghani was the President
of the Indian Dental Association,
Ahemdabad. He was also the
President of the Indian Society
of Periodontology (ISP) twice
of ISP bulletin since 1990 which
was later upgraded to Journal of
Indian Society of Periodontology
(JISP) in 1999. (Dr. Aswatha
Kumarswamy, Mumbai took
over as the editor of the Journal of
Indian Society of Periodontology
in 1999. Incidentally, Dr. Boghani
was Dr. Kumarswamy‘s examiner
in BDS).
Dr. Boghani was a Senate
member and the Faculty Dean
of Gujarat University. He was
also elected as the President of
Gujarat Dental Council for two
terms.
Dr. Boghani started his clinical
practice in 1984 and practiced
till the age of 80, after which he
continued work on diagnosis and
treatment planning.
Dr. Boghani, a great academic
who made many contributions
to Indian periodontics, was
conferred with the “LIFETIME
ACHIEVEMENT AWARD“ in
2015.
3 News
Dr. Madhav Murthy: “brilliant mind &
a wonderful human being”
By Dental Tribune South Asia
The dental fraternity has
lost an outstanding individual
who gave so much to the dental
industry in terms of creative
thinking, quality education, and
much more. His contribution
to our field will always be
recognized at the highest
level. Three people who knew
Dr. Madhav Murthy well pay
their tribute.
Dr. Paresh Kale, Prostho-
dontist, Pune:
Dr. Madhav Murthy was a
close friend despite the difference
in age and being in different
cities. Our alma matter of
GDC & H Mumbai was a
common thread that brought
us close. Our passion for
dentistry, teaching, and learning
strengthened the bond between
us. I have come across very few
General Dentists with his acute
academic inclination. He was an
outstanding teacher and a great
mentor, helping me enhance my
public speaking and presentation
skills.
He adapted very well to
his Corporate Role in 3M after
a short stint as a lecturer at
a private dental school. A
meticulous, organized, and
highly disciplined man - Madhav
had a massive role in bringing in
the work culture and ethics that
3M Dental is known for.
Madhav was always
enthusiastic about and receptive
to new ideas, which resulted in
us doing many projects together.
It was frequently out-of-the-box
thinking but was eventually
highly appreciated. He had the
unique ability to find talent and
made sure the person used it to
his maximum potential. He had
the foresight to take on such
people and pursue novel projects.
A teacher at heart, which was the
early part of his career, continued
being one after taking on the role
of professional services manager
at 3M Dental.
Dr. Madhav left a mark on
many young and upcoming
dentists, sharing his passion
for dentistry with them and
motivating them to do better
dentistry, adapting to new
techniques and technologies.
Madhav had varied
interests, including music and
Tributes pour in for Dr. Madhav Murthy a well known clinician and educator in Indian dentistry
photography. It‘s worth
mentioning his keen interest in
learning different branches of
sciences, especially Astrophysics.
For a dentist, his knowledge
of Astrophysics was extremely
impressive.
Madhav was a family man
who cared for and loved his
wife, Anita, and son Bharat and
extended the same care and love
to his extended family. He was a
true friend who could be relied
on at any time. He was always
warm and welcoming, and his
hospitality knew no bounds.
He always gave generously and
selflessly.
Madhav, a very kind and
generous person, will be missed
by family and close friends, and
all whose lives he touched.
Oswald Miranda: (Worked
with Dr. Murthy in 3M)
The GENTLE GIANT – this
is how I will always fondly
remember my close friend and
colleague of 16 years (we worked
together at 3M ESPE), Dr. Madhav
Murthy.
My association with Madhav
dates back almost three decades.
A vibrant personality, always
smiling, exuding warmth, and
looking at the lighter side of
things.
Professionally he was easily
one of the most accomplished
academicians, literally an
authority on all aspects of
dentistry. A brilliant and
riveting speaker, Madhav had an
exceptional capacity for reading
and learning.
I will never forget one of our
innumerable long flights where
Dr. Madhav was completely
engrossed in a nuclear physics
book for more than 3 hours.
When I asked him if I could
look at the book‘s contents, he
was most happy to share it with
me. It was then that I realized
his tremendous capacity for
academics as I could not
understand a single sentence in
the complex book.
He had a true passion for
teaching and loved to travel
and meet people. Indeed a rare
blend of a brilliant mind and a
wonderful human being.
Dr. Madhav will be fondly
remembered by his numerous
friends and colleagues for a long
time to come for the fantastic
memories that he has left behind.
Aman Kapoor: (General
Manager: Digital Care at
Madhavbaug, worked with Dr.
Murthy in 3M)
I‘m saddened and shocked by
the loss of an amazing person,
guide, and mentor, Dr. Madhav
Murthy - one of the rare and
unique people with that kind of
all-round persona, a gem of a
person who left an indelible mark
on the lives of so many. A clinical
magician, possessor of immense
in-depth knowledge, a person
who went and created tracks and
pathways which many would
follow. As deep was his clinical
expertise, equally great was his
people connect.
He built bonds easily with
everyone he came across,
a genuine person with an
incredible sense of humor,
always caring—a teacher to the
core, and so much more.
I was lucky to have worked
under him, learned from him, and
been mentored by sir. He was one
person who molded a lot of me
and my skills. Sir was a person I
knowingly or unknowingly keep
quoting frequently, a person who
braved to go on many unknown
paths and laid a track for many
to follow.
Person of such a warm
heart and nature. A gem who
possessed so much and yet was
so humble and down to earth.
I have learned so so so much
from you sir, have so many
incredible memories shared with
you. We will all miss you, so will
so many whose life you have
touched and molded.
May your soul get eternal
rest, and may you beautify the
smiles of the heavens, build
bonds with the Gods and walk
12/21
over the bridges of eternal peace
and tranquility. I am sure they
are already impressed with
you as much as a long-lasting
impression you left in our hearts.
About:
Dr. Madhav Murthy had a
clinical practice in Bangalore,
mainly focused on Restorative &
Esthetic Dentistry. He completed
his BDS from Govt Dental
College, Mumbai (Bombay
University) in 1983.
He was in academics as the
Head, Dept. of Material Sciences
in Dentistry & Conservative
Dentistry at Bangalore for 10
years.
Authored and published
many clinical articles on
Restorative Dentistry and
Minimal Intervention dentistry.
Dr. Murthy was a certified Six
Sigma Black Belt.
He worked as the Regional
Professional Services Manager
for 3M ESPE Dental - South East
Asia region.
4 News
Dr. Ray Williams – “great friend,
philosopher, guide”: Tribute from his
two students
By Dr. Neel Bhatavadekar &
Dr. Akshay Kumarswamy
A luminary in the field
of periodontics, Dr. Ray
Williams - the former chair of
periodontology, and Straumann
Distinguished Professor at the
University of North Carolina at
Chapel Hill Adams School of
Dentistry, passed away on October
28, 2021. Drs. Neel Bhatavadekar
& Akshay Kumarswamy - two of
his students, now well-known
periodontists in India pay their
tribute to their revered guide and
mentor.
Dr. Akshay Kumarswamy:
Dr. Ray Williams or Dr.
Williams or just Ray was a giant
among men - both literally and
figuratively. The world knew him
as an outstanding periodontal
educator, researcher, and
teacher. We, his students in the
Periodontology Department of
the University of North Carolina
at Chapel Hill, knew him as our
Department chair, a humorist, a
lover of good scotch, and someone
who wanted his residents to enjoy
life while doing their residency.
His late wife Joan and he used to
open up their lovely home to us
every Christmas. It was a pleasure
sitting by the fireside while he used
to regale us with funny anecdotes
from his illustrious life. His slow,
Dr. Ray Williams was a well known name in periodontics. (Photo: dentistry.unc.edu)
The attached picture was taken
on a cruise on Lake Geneva in
Switzerland - we were there for
the ITI World Symposium in 2010
measured speech added to the
crescendo of his jokes.
Dr. Williams would participate
in our case discussions and journal
article discussions. He used to
bring a unique perspective based
on his years of experience as an
academician. We were blessed to
have him there - someone who was
later conferred with the highest
award by the American Academy
of Periodontology - The AAP Gold
Medal. Not often does one get to
sit and interact with someone of
his personality and stature. He
had a vast library at home and
introduced a non-dental book club
amongst us residents. He would
pick a book and give it to us, and
there would be a discussion after
everyone had read it.
Personally, he was a father
figure to me. I knew of him through
his close friendship with my
father but did not meet him until
I joined UNC. He left UNC during
my second year of residency to
become the Dean of the Stony
Brook University Dental School,
but his personal touch came to the
fore when I received a handwritten
letter from him following up on
my progress. I was deeply touched
when he sent a copy of the kid’s
book “Dr. DeSoto” as a gift to my
newborn son Atharva. I am glad I
shared a glass of the finest scotch
whiskey with him in what would
be our last meeting in 2016. Here
was a man who touched lives
across three generations.
Dr. Williams - I know you are
in a better place and are happy
to join Joan. I hope you get the
finest aged scotch wherever you
are. Cheers to your life and I will
always be thankful that you were
a part of my family and our lives.
Dr. Neel Bhatavadekar:
Yesterday the world of
Periodontics lost a star.
Ray Williams has left his
legacy with many of his students,
currently Deans, Chairs, and
leaders in our specialty. Ray was
a terrific mentor, philosopher,
friend, and guide for me, right
from the time of my residency at
UNC-Chapel Hill (2004- 2007) to
a few months ago, when we had
our last chat. I am still coming to
terms with it, but I remind myself
to celebrate his life, ethics, and a
quest for excellence.
Prof Ray Williams was known
for his charismatic ability to cut
through communication barriers
and relate to his peers and students
2-3 decades younger than him. He
had a striking impact on the career
development of all his students.
He helped us readily connect
with leaders in our specialty and
industry, based on each student‘s
area of interest.
I particularly remember him
asking me to drive Prof Jan Lindhe
home after a late dinner at Ray‘s
home to ensure that I got enough
face time with Dr. Lindhe. This
ability of his to intertwine people
led to a sense of a ‘larger family‘
that one was part of.
Another attribute that I vividly
remember was his approach to
holistic education. He insisted that
in addition to classical literature
reviews, we also review non-
12/21
dental novels like, ‘Complications‘
by Atul Gawande, or similar books
where students would understand
the need to become compassionate
with patients.
It is very rare to find teachers of
his caliber, and more importantly,
teachers who become so positively
influential to so many. Ray, you
will be sorely missed, but heaven
just became a better place with you
there!
About:
In 2004, Dr. Williams received
the American Academy of
Periodontology’s Outstanding
Educator Award and William J.
Gies Award. In 2008 he received
the University of North Carolina’s
Distinguished Teaching Award
and the American Academy of
Periodontology’s Gold Medal
Award. In 2013 he received the
Paul Goldhaber Award from
the Harvard School of Dental
Medicine.
His major research interests
were clinical and translational
research in both pharmacological
modifications of the host response
and in anti-infective approaches to
treat periodontal disease. He also
worked in the area of oral health-
general health relationships.
5 News
Magnification for beginners
(Part 1) – Dr. Ridhima Uppal
Magnification systems increase clinician‘s precision, improve ergonomics, and increase work efficiency (Photo: Canva)
By Dr. Ridhima Uppal
State of the art dentistry is
all about providing atraumatic
and minimally invasive dental
treatments to the patients
while improving the clinician‘s
precision and efficiency. The first
article of this 2-part series by
Dr. Ridhima Uppal outlines the
most essential concepts needed
for beginners who are planning
to incorporate magnification
systems in their practice.
Upgrading our daily practice
with a magnification system helps
increase the clinician‘s precision
Figure 1a: Improved
ergonomics using magnifying
loupes
Figure 1b: Improved
ergonomics using Dental
Operating Microscope
Figure 2a: Magnification
Loupes
Figure 2b: Dental Operating
Microscope
in work as it not only provides a
corrective and a magnified vision
but also improves the ergonomics,
thus increasing the work efficiency
(Figure 1a & 1b).
Two types of magnification
systems (Figure 2) are in use-
a) Magnification loupes- most
commonly used
b) Dental operating
microscope.
Magnification loupes work at
a magnification of 2.5x-4x, where
two monocular microscopes with
side-by-side lenses are angled
to focus on an object (Keplerian
optics, Figure 3).
Figure 3: Keplerian Optics
Figure 4: Galilean Optics
Being portable in nature, the
loupes have an added advantage
over a surgical operating
microscope but at the same
time, loupes could result in eye
fatigue as they cause converging
of the eyes to view an image. The
surgical microscope is however
a complicated system of lenses
that allows binocular viewing
(Galilean optics, Figure 4) at a
magnification of approximately
5x to 40x. Microscopes offer a
powerful co-axial illumination
with a higher magnification
power over telescopic loupes.
Adapting to a magnification
system is a steep learning curve
and one should start with a pair
of magnifying loupes thereupon
strengthening the clinical skills.
Having an aided visual
guidance gives an edge to enhance
one’s fine motor skills that
translate into minimal surgical
trauma and smaller surgical
field allowing better primary
wound closure and consequently
a rapid, comfortable, less painful,
and non-inflammatory healing
phase are some of the many
advantages provided while using
a magnification system.
The clinicians having been
exposed to binoculars and cameras
understand magnification as only
a means of enhanced vision. But
there is much more to what the
eyes can see!
The perception of improved
hand skills with the use of
magnification has not yet been
appreciated. The improved
ergonomics benefit the clinician
in avoiding musculoskeletal
problems and reduced eye fatigue.
Adding to all these benefits, a
magnification system is a strong
tool for patient education and
motivation and for self-evaluation
of one‘s own work thus helping in
improving the quality of day-to-
day practice.
‘‘ I can do better; if I can see
better; but I can do the best if I
can see even better‘‘
12/21
IMPRINT
PUBLISHER & CHIEF EXECUTIVE
OFFICER
Torsten R. OEMUS
CHIEF CONTENT OFFICER
Claudia DUSCHEK
DENTAL TRIBUNE SOUTH ASIA
EDITION
PUBLISHER
Ruumi J. DARUWALLA
CHIEF EDITOR
Dr. Meera VERMA
CLINICAL EDITOR
Dr. Dilip DESHPANDE
RESEARCH EDITOR
Dr. Shobha DESHPANDE
ASSOCIATE EDITOR
Dr. GN ANANDAKRISHNA
EXECUTIVE EDITOR
Dr. Rajeev CHITGUPPI
ASSISTANT EXECUTIVE EDITOR
Dr. Amisha PAREKH
DESIGNER
Anil LAHANE
PRINTER
Mehernosh & Burzin MISTRY
Ampersand, Mumbai, India
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6 News
How to choose a magnification system
(Part 2) - Dr. Ridhima Uppal
By Dr. Ridhima Uppal
The second part of the series
gives simple guidelines to
beginners on how to choose a
magnification system.
As discussed in part-1 of this
series, two types of magnification
systems exist
a) Magnifying Surgical
Loupes (Figure 1a)
b) Dental Operating
Microscope (Figure 1b)
Figure 1a:
Magnifying Surgical Loupes
Figure 1b:
Dental Operating Microscope
The magnification systems
work upon four specifications:
1. Magnification Strength-
2.5x, 3.5x, 4x, 5.4x, 10x...
2. Working Distance-
Distance between the lens and
the patient.
3. Field of View- The area
in focus.
4. Depth of Field- How
far, above and below the sample
plane the objective lens and the
specimen can be while remaining
in perfect focus.
The selection process of the
magnification tool should be
carried out correctly towards
achieving the maximum
benefits of magnified vision and
improved ergonomics.
This article pens down the key
features to keep in mind during
the decision-making process.
A. Decision making while
buying magnification loupes
Loupes work with the eyes
to create what the user perceives
(Galilean Optics).
The clarity of the image
dictated by loupes is directly
Simple, easy to understand article to help beginners choose the right
magnification system. (Photo: Dr. Ridhima Uppal)
proportional to the loupes‘
resolution.
1. Magnification level and
Working Distance
a. The right magnification
strength provides an optimal
working distance, leading to an
ergonomic balance (Figure 2a and
2b).
b. 2.5x - 3.5x is appropriate
for most microsurgical procedures.
c. For intricate procedures,
higher magnification levels
provided by the microscope are
more helpful.
d. The lowest magnification
settings allow a wide field of view.
Anyone who is a beginner
should go with the lowest
possible magnification.
Figure 2a:
Optimal Working distance
Figure 2b:
Ergonomic Balance
2. Weight
Lightweight loupes are more
comfortable. Clinicians should
carefully test the frames; the
weight of the loupes should dis-
tribute evenly around the bridge
of the nose and ears.
3. Design
There are two key designs:
a. Through the lens
(TTL) loupes (Figure 3a)- With
optics inbuilt into the lens of the
frame. These are prescription,
customized loupes.
b. Flip-Up loupes (Figure
3b) - With the adjustable
mechanism of optics. These
Figure 3a:
TTL Loupes
Figure 3b:
Flip-Up loupes
are non-prescription, easily
adjustable loupes.
4. Adjustment settings
a. Inter-pupillary distance
(Figure 4)
b. Depth of field
c. Width of field
One can also get his/her own
loupes customized according to
these adjustment settings
5. Illumination
a. Additional illumination
is imperative (Figure 5).
b. Supplementary lights
should be of appropriate
intensity and color. It is available
as halogen, LED, Xenon.
c. Xenon is the best, its
wavelength being equivalent to
natural light.
Figure 4: Blue line depicts the
interpupillary distance-IPD
Figure 5: LED light attached to
the loupes
6. Warranty and repair
considerations when making
the purchase.
7. Price range
a. TTL loupes are more
expensive than flip-up loupes.
b. Before you buy your
own pair of surgical loupes,
make sure you do your research.
B. Decision-making while
buying dental operating
microscope
1. Optical Quality (Figure 6):
a. There should be no
compromise with the optical
quality.
b. Only superior optics
with excellent clarity offering
high resolution, large depth
of field and, maximum light
transmission should be looked
for at the first.
2. Illumination
Illumination light (Xenon/
LED/Halogen) present within
the microscope system dictates
the brightness and color of the
image.
Figure 6: Objective Lens
(Microscope)
3. Ergonomic Design
The microscope design
should help the dentist maintain
a neutral, upright working
position (Figure 7).
12/21
Figure 7: Neutral, upright
working ergonomic position
maintained while working on
microscope
Various ergonomic accessories
like varioscope are also available.
4. Workflow Integration
The functionality of the
microscope‘s design (Floor
Mount, Wall Mount, Ceiling
mount design) should improve
the workflow.
5. Documentation
With the use of a dental
operating microscope, live
onscreen video play is possible,
which is useful for patient
motivation and training
purposes.
6. Hygiene
a. Maintenance of
adequate standards of cleanliness
is a prerequisite with the use of a
microscope.
b. A streamlined
design with the cables routed
internally makes it easier to
maintain cleanliness and also
helps avoid any accidental
cable damage. Every action
has an impact. Choose wisely
the impact you want to have.
About:
Dr. Ridhima Uppal
Dr. Ridhima is pursuing
her Master of Dental surgery
in Periodontology from SGT
University, Gurugram, Haryana.
(05/2019 - 05/2022)
She has done her Fellowship
in Contemporary Endodontics
from DY Patil University, Navi
Mumbai, Maharashtra.
She completed her BDS from
Bhojia Dental College & Hospital,
Shimla, after which she was into
private practice for a while before
starting her higher education in
Endodontics & Periodontics.
7 News
Silver nanoparticles (Ag NPs) in
dentistry
By Dr. Aditya K. S.
Silver nanoparticles (Ag
NPs) are one of the most unique
nanotechnology-based products
among all metallic nanoparticles.
This article by Dr. Aditya K. S.
summarizes the evolving
significance and application of
Ag NPs in dentistry.
Silver nanoparticles in
endodontics and dentistry make it
more viable and exciting because
of their excellent properties such
as good conductivity, catalytic,
chemical stability, and most
significant anti-inflammatory and
antiviral activities.
Silver Nanoparticles and
silver integrated compounds are
very lethal to microbes such as
16 bacteria species, fungi and
viruses. The release of silver ions
is accountable for the antibacterial
activity, which later results in
bacterial mortality. The bacterial
constituents that Ag NPs destroy
are DNA, proteins, and lipids.
Also, it induces oxidative stress
response by killing the bacterial
cells. The efficacy of nanoparticles
has a contrary connection with
their size. In addition, charged
nanoparticles do not scatter across
the biofilm because of the carboxyl
and phosphoryl groups on the
bacteria‘s cell surface, which gives
electronegative character.
Dental composite resin from rice husk
By Amisha Parekh
Dental Tribune South Asia.
Increased esthetic demands,
good mechanical properties, and
ease of application have increased
the use of composite resins
in preventive and restorative
dentistry. The incorporation of
natural products in composite
resins, thereby making them
eco-friendly, has recently gained
popularity. Some of the benefits
include lower cost, lower
toxicity, higher sustainability,
lightweight, etc.
Rice husk, a natural sheath that
forms around rice grains during
their growth, can be obtained as a
natural fiber from agro-industrial
waste and can be used as filler in
composites materials in various
polymer matrices.
Dental composite made of
rice husk:
Rice husk is a biomass
waste from rice having high
silica content. It also has high
strength, resistance to bacterial
decomposition, hard surface,
The silver nanoparticles have
effective antimicrobial ingredients
in adhesives, prosthetics,
implants, osteogenic induction,
and inhibition of biofilm
development. Nanoparticles can
be incorporated in intracanal
medicament, irrigation materials,
and sealers. Antimicrobial action
can also be seen in Streptococcus
mutans, E. coli, E. faecalis, Candida
albicans and Actinomyces when
mineral trioxide aggregate (MTA)
and calcium-based cement were
added with Silver Nanoparticles.
Synthesis of Ag NPs involves
physical, chemical, biological, and
two other methods, bottom-up
and top-down. Antimicrobial
properties of silver nanoparticles
include adhesion to the cell
membrane, penetration inside
the cell and nucleus, cell toxicity,
and modulation of cell signaling.
AgNPs can be added into
different restorative materials
such as Composites – as filler
particles and Glass Ionomer - by
diffusion. These nanoparticles
can be used in root canal irrigant,
intracanal medicament, Gutta-
percha, and root canal sealer in
endodontics. With the growth of
silver nanoparticles in the market,
so does the toxic effects of the
surroundings and the health of
human beings.
low density, and is inexpensive.
Some researchers have recently
explored its use as a filler in dental
composite resin to minimize
environmental pollution and
reduce composite material costs.
Packable and flowable composite
resins were manufactured using
rice husk silica as a filler. This
process involved the extraction
of silica from rice husk and
precipitation of silica.
A systematic review and meta-
analysis found that the rice-husk
composites had inferior physical
and mechanical strengths and
lower surface roughness than
commercially available composite
resins. This meta-analysis,
conducted on eleven articles and
one book section, suggested that
the reason for inferior mechanical
properties could be the low
filler loading. However, it did
demonstrate comparable color
stability with other commercially
available composite resins.
Flowable rice husk composites
showed lower compressive
Ongoing research is trying to explore more applications of Silver
Nanoparticles in dentistry. (Photo: Wikimedia Commons/ Theivasanthi)
Use of nanomaterials in
dentistry:
• Endodontics: silver
and chitosan NPs in endodontic
sealers for antimicrobial uses.
• Periodontics: Perio-
dontitis can be treated with
tetracycline loaded periodontal
patch.
• Restorative dentistry:
incorporation of nanoparticles to
enhance mechanical properties.
• Prosthodontics: metal
alloy combination for making
dentures.
• Oral medicine: organic
and inorganic nanoparticles can
be used in therapeutics.
• Oral surgery: repair
bone defects and treat oral cancer
with nanoparticles.
• Orthodontics: coating
of archwires and orthodontic
bracket by nanoparticles.
strength than hybrid flowable
composites, although their
hardness values were superior to
commercially available flowable
composites.
Future scope:
This study recommends using
rice husk dental composite with
increased filler loading for future
approaches. Some studies have
also suggested the incorporation
of zirconia nano-powder to
improve the compressive strength,
fracture strength, and hardness
values and reduce polymerization
shrinkage of the rice husk
composite. Methods such as
reinforcing rice husk dental
composites with solid elements
like alumina and zirconia,
incorporating resin monomers
like ormocers, using coupling
agents like zirconate, and adding
antibacterial agents have also been
used been suggested to improve
the properties of rice husk dental
composites and prevent secondary
caries.
Conclusion: Ag NPs can
be adapted to improve their
antibacterial stability, specificity,
biosafety and biocompatibility
for therapeutic assistance and
compressed possible toxicity. These
silver nanoparticles are one of the
most remarkable nanomaterials
used in manufacturing and
commercial applications. There
are some limitations for Ag NPs;
therefore, research should be done
to overcome and explore more
possibilities for applications in
dentistry.
Reference:
Lakshmi Thangavelu,
Abdul Adil, Arshad, Devaraj,
Sreekanth Mallineni, Rishitha
Sajja, Anil Chakradhar, and
Mohmed Karobari. Antimicrobial
Properties of Silver Nitrate
Nanoparticle and Its Application
in Endodontics and Dentistry: A
Rice husk can be used as filler in composites materials. (Photo: Flickr/
Aaron May)
Conclusion:
Rice husk is an inexpensive
source of silica for use as filler
particles in dental composites.
These composites have been
found to have acceptable
clinical performance in terms of
physical, mechanical, and optical
properties. Hence, rice husk
dental composites are considered
a potential emerging biomaterial
in dentistry and more strategies
must be explored to improve their
properties.
12/21
Review of Literature. Hindawi,
Journal of Nanomaterials.
2021, 12 pages https://doi.
org/10.1155/2021/9132714. Link:
h t t p s://w w w. h i n d aw i . c o m/
journals/jnm/2021/9132714/
About:
Dr. Aditya K.S.
Dr. Aditya completed his BDS
from Government Dental College
and Hospital, Kadapa. Currently,
he is working as an Associate
Dentist. When the second wave
of COVID-19 was at its peak,
he joined the State General
Government Hospital, Kadapa as
a Medical officer, and managed
a large number of patients in the
general ward and the ICU.
Aditya has cleared his National
Board Dental Examinations
(NBDE) by JCNDE, USA. He is
interested in studying dental
biomaterials, and aspiring to
become a Biomaterials Research
scientist.
Reference:
1. Lin, GSS, Cher, CY,
Cheah, KK, Noorani, TY, Ismail,
NH, Ghani, NRNA. Novel dental
composite resin derived from rice
husk natural biowaste: A systematic
review and recommendation for
future advancement. J Esthet
Restor Dent. 2021; 1- 9. doi:10.1111/
jerd.12831
7 News 7/19

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