Recalibrating Dental Education: Passion for Profession and Compassion for Patients – An Interview with Prof (Dr.) Ghanta Sunil

In this exclusive interview, we sat down with Prof (Dr.) Ghanta Sunil — a passionate academician and curriculum reform advocate — to talk about the urgent need to upgrade the dental curriculum. With decades of experience, an eye on the future, and feet firmly grounded in educational values, Dr. Ghanta Sunil breaks down what’s missing, what must change, and how the next generation of dentists can be better prepared for a complex and compassionate future.

Q1: Why do you think there should be a upgradation of curriculum in the field of dentistry?

The contemporary curriculum is a synergetic contribution of many teachers and thinkers through their unwavering commitment and radiant receptivity towards dentistry. We are grateful for the intuitive insights and inspirational wisdom that is evident through their incisive, instructive and informative teaching that will be respected, remembered and revered for days to come and years to go.

However, it is important that we accept, analyze and acknowledge the compounding pace of changing trends in the field of science, technology, research, development, innovation and entrepreneurship, along with the professional paradigm shift in the areas of patient expectation, parent aspirations, public perceptions, pupils transformation, human and moral values, ethical consideration and legal implications in the field of medical and allied sciences.

Considering the above it is important and inevitable that we should involve, evolve, adapt and integrate new methods and methodologies, newer modes and modalities, latest techniques and technologies, thus recalibrating dentistry as an enduring classic with a rarified stature.

Q2: What do you mean by pupils transformation in your list of paradigm shift and can you explain its relevance in your recalibration concept?

The transgenerational transformative transition driven by the man-machine complex has transcended from biologic and organic evolution (biceps to neurons) to mechanical and inorganic revolution (hardware-software) leading to Transhumanisation. This mechanical and inorganic revolution is going to be a million times faster than its predecessor for which we need to plan and prepare our students for a complex interconnected future while nurturing their holistic growth.

Q3: What are the guides and constructs that you think that the comprehensive standardized syllabus should be based on?

The constructs of the course and curriculum should be both descriptive in its content and prescriptive in application within the analytical and dialectical framework of the regulatory body. It should be patient centered, and student mentored in spheres of personal, personality and professional development. The comprehensive standardized syllabus should be guided by a holistic integrated set of principles that are priceless and techniques that are tested and timeless. It is important to balance the magical dialect of preserving the core principles, but at the same time stimulating progress by enriching faculty teaching skills and enhancing student learning cognitive abilities that are patient centered. The importance of human touch, humility, empathy and patience should be inculcated as an interwoven fabric while designing, developing, creating and curating the course and curriculum which makes it less materialistic and more humanistic/alluristic.  By weaving these constructs we can create a robust, adaptable and compassionate educational framework that prepares students for complexities of modern practices.

Q4: Who do you think should be involved in the curriculum development to bring out a comprehensive standardized syllabus?

A curriculum is a culmination of subject content, educational strategies and environment, learning outcomes and opportunities along with assessments. Hence to ensure its effectiveness and relevance it is essential to involve stakeholders to contribute their insights and inputs at different levels of the system based on their areas of experience and expertise. The collaborative approach should take into account the future needs of both community and the profession. The stakeholders are:

  • Policy makers – Government, University, Institution
  • Professors
  • Pupils
  • Parents
  • Private practitioner
  • Public innovators and entrepreneurs

Q5: What are the core areas that should be addressed in developing a comprehensive standardized syllabus?

The core of the curriculum design should be conceptualized on “entrustable professional activity” which is a culmination of several competences that the student/clinician should achieve to transcend this therapeutical proficiency (preclinical) into clinical procedural proficiency, transforming them from a novice into an expert.

  • Establishing gap analysis in the existing system.
  • Deciphering and Deconstructing the gap analysis.
  • Curriculum redesign based on the analyzed and assimilated gap analysis.
  • Implementation of training protocols based on the designed curriculum.
  • Inculcating multi model elements (Faculty Development Program, Continuing Dental Education) in order to increase the familiarity between the trainee- trainer-technique-technology-method-methodology-mode and modality complex interface, thus helping to translate the true therapeutic proficiency of the student/clinician into procedural performance (preclinical to clinical skills).
  • Assessment methods and Validation tools.
  • Feedback and sustainability.
  • The curriculum can effectively bridge the gap between theoretical knowledge and practical skills, fostering the development of competent healthcare professions.

Q6. How do you envisage the final success of a new comprehensive standardized syllabus for the dental profession?

  • Patient centric
  • Student centric
  • Teacher centric

Patient centric: The patient centric success of the new curriculum can be reflected in improvised evaluation and outcomes in patient care and enhanced safety due to

  • Precision in the procedural planning
  • Perfection in execution of professional procedures
  • Accuracy and predictability in treatment outcomes
  • Reduced treatment time
  • Reduced scope of procedural errors
  • Safer and faster post-operative recovery

Student centric: The student centric parameter to assess the success of the comprehensive standardized syllabus should be based on the evaluation of their Intellect, attitude and skills in different spheres of overall student development. Bringing an insight into students: –

  • Personal development
  • Personality development
  • Professional development

Giving an insight to the students that it is “better to make mistakes than fake perfection” thus making them revered doctors, responsible citizens and respectable humans.

Teacher centric:

  • Professional enrichment through Faculty development programs.
  • To demarcate the role of the teachers, responsibilities of the parents and duties of the students.
  • To make the students themselves involved in the internal self-assessment process through professional assessment and validation tools.
  • To enhance and create a platform to promote Implementation Research, Innovation and Entrepreneurship abilities through multiple incentivized opportunities making them role models for their peer group and the students alike.

Q7: Do you think the present system is not good?

Although remembering, respecting and revering our teachers for their incisive, instructive, informative and memorable teachings, we need to accept, analyze and acknowledge the changing trends and times making it inevitable and important to let the conventional methods take guiding roles.

Any curriculum should have its basics very strong for which we need to preserve the core and stimulate progress keeping in pace with the advances in science, technology, research, development, innovation.

While welcoming the transgenerational transformation transition involving interface of that will help the man-machine complex bring about innovative, productive and sustainable solutions in the area.

Thank you for reading our interview with Dr. Ghanta Sunil. We’re excited to continue the conversation live soon, where we’ll delve even deeper into the topics discussed and share fresh insights. Be sure to stay tuned for the upcoming installment — you won’t want to miss what’s next.

Understanding the Quad-Helix Appliance for Maxillary Expansion

Palatal expansion has been a cornerstone of orthodontic treatment for over a century. Despite its proven efficacy, this technique has sparked debates within the orthodontic community. Is rapid expansion the best approach, or do slower methods offer greater stability? Let’s dive into the history, mechanics, and clinical applications of maxillary expansion, with a special focus on the quad-helix appliance.

The primary goal of palatal expansion is to coordinate the maxillary and mandibular denture bases, addressing narrow or collapsed arches. This can be achieved through:

  1. Orthodontic Movement (tooth-focused)
  2. Orthopedic Movement (bone-focused)
  3. Combination Therapy

A variety of appliances—fixed, semi-fixed, and removable—are employed to achieve these goals.

MethodAdvantagesChallenges
Rapid Palatal ExpansionQuick skeletal changesPotential for relapse and sutural strain
Slow ExpansionGreater histologic integrity of suturesRequires longer treatment time

HISTORY

Coffin Loop Appliance:

  • Incorporated in a vulcanite plate for upper arch expansion.
  • Produces continuous force due to the configuration of the palatal compound loop.

Martin Schwarz Appliance:

  • Popular in Europe.
  • Utilizes tissue-borne anchorage with wire components for tooth movement.
  • Expansion force is intermittent due to the jackscrew mechanism.

Haas and Wertz Fixed Appliance:

  • Designed for rapid expansion of the midpalatal suture in narrow maxillary arches.
  • Cemented to maxillary first premolars and first permanent molars.
  • Includes a palatal jackscrew and acrylic extensions.
  • Produces lateral orthopedic movement of the maxilla due to high force magnitude.

Load-Activation Characteristics:

  • Chaconas and Caputo found differences in stress transmission through craniofacial bones with various fixed expansion appliances.
  • Impact on craniofacial sutures varies depending on the appliance.

Rickett’s “W” Expansion Appliance:

  • Initially used for cleft palate conditions with collapsed dental arches.
  • Acts continuously over time until activation force dissipates.

What Makes the Quad-Helix Appliance Unique?

Helical Loops for Increased Flexibility:

  • Initially added to the posterior segment of the palatal arch
  • Further modification introduced four loops (two anterior and two posterior), creating the quad-helix appliance.

Construction Details:

  • Made of 0.038-inch (0.975 mm) wire.
  • Soldered to bands cemented to maxillary first permanent molars or deciduous second molars, depending on the patient’s age.

Initial Activation and Effects:

  • Appliance is activated before cementation.
  • Results in expansion of buccal segments and rotation of banded teeth 

Force Magnitude:

  • Chaconas and Caputo reported that 8 mm of expansion before cementation generates approximately 14 ounces of force 

Effectiveness in Different Age Groups:

Effective in orthopedically widening the maxilla in children, helping to establish a normal maxillomandibular relationship.

Force is sufficient for tooth movement but insufficient for orthopedic effects in adults with closed midpalatal sutures.

In children, particularly in the deciduous or early mixed dentition stages, the resistance of the patent suture is lower than the dentoalveolar area.

Clinical Case: A Pediatric Success Story

  • Patient History: Prolonged thumb-sucking led to a narrow maxilla due to lowered tongue position and buccinator muscle forces.
  • Treatment: Quad-helix appliance activated ~8 mm, sufficient for maxillary expansion.
  • Outcome: Successful expansion and resolution of thumb-sucking habit. The appliance’s palatal position ensured comfort and minimal impact on speech.
AdvantagesImpact
Acts as a habit-breaking deviceAddresses prolonged thumb-sucking habits
Comfortable for the patientMinimal impact on speech
Effective in pediatric casesAchieves orthopedic widening of the maxilla

Insights from Cephalometric and Cast Analysis

Orthodontic Changes (T₁ to Tₚ)

  1. Maxillary Molar Width: Increased by an average of 5.88 mm, reflecting significant dental expansion.
  2. Average Frontal Molar Relation: Improved by 2.95 mm, indicating better occlusal alignment.
  3. Maxillary Intercanine Width: Expanded by 2.74 mm, enhancing anterior dental arch form.

Orthopedic Changes (T₁ to Tₚ)

  1. Maxillary Width: Increased by 0.92 mm, with five cases showing expansions exceeding 2.7 mm.
  2. Maxillomandibular Width: Increased by 0.89 mm, with notable cases surpassing 1.4 mm.
  3. Palatal Changes: The anterior palate moved downward, increasing maxillary height.

Relapse and Stability (Tₚ to T₂)

  1. Minimal Relapse: Dental expansions remained stable over 42 months.
  2. Orthopedic Effects: Demonstrated high stability, contrasting with the relapse often seen in rapid palatal expansion.
  3. Palatal Plane and Maxillary Height: Slight decreases observed, indicating no net parallel downward movement.

Slow vs. Rapid Expansion

  • Slow expansion using the quad-helix appliance demonstrated superior stability and less relapse compared to rapid palatal expansion. The gradual physiologic movement allowed the facial skeleton to adapt, ensuring long-term stability.

Bite Opening

  1. Active Expansion (T₁ to Tₚ): Slight bite opening occurred due to occlusal interferences.
  2. Post-Expansion (Tₚ to T₂): Additional bite opening was attributed to orthodontic treatment rather than the expansion appliance.

Facial Skeletal Considerations

  • Stability was influenced by initial nasal and maxillary widths:
    • Narrow Maxilla + Normal/Wide Nasal Width: High stability.
    • Narrow Nasal Width + Normal Maxilla: Lower stability.

Facial Type

  • The sample skewed toward brachyfacial types, limiting conclusions about expansion outcomes across facial types.