Re: partial pulpotomy VS full pulpotomy

[Guest guest]

hi ayhamclinically speaking if it was contaminated 5adays i will do partial pulptomy if the bleeding stops then i just restore the tooth if the bleeding still proceeds then iwill go for full pulptomy . thats just what i think , i thought it might help if share it :)kind regards Khalil Raziq From: ayhamsbahi@...Date: Sun, 13 May 2012 10:27:53 +0100Subject: partial pulpotomy VS full pulpotomy

Hi Guys Is there anymore exact indication regarding the exposure time of the pulp to chose between the 2 techniques for the treatment?in pink book is written (more than 24 hours it can be 1 week as an indication to partial pulpotomy) i mean if the patient had complicated tooth fracture on a tooth with open apex and the esposure was for 5 days (contaminated pulp) would you go for partial pulpotomy or full pulpotomy? which one is the treatment of choice? I guess it was a question in the last April exam Your help will be appreciated Ayham Sbahi

[Guest guest]

Thank you Khalil for your point,clinically there is noproblem everything depends on the pulp state and on the syptoms(pain on hot,TTP,X-ray)etc... but the prblem was if this question will appear on the exam with always insufficient information of the question as you know ( just to give you less clues to answer the question), anyway the only clue i found is from the success rate 72% for the full pulpotomy and 96% for the partial pulpotomy, so i will choose the partial one. More opinions on this are welcome Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 11:59 Subject: RE: partial pulpotomy VS full pulpotomy

hi ayhamclinically speaking if it was contaminated 5adays i will do partial pulptomy if the bleeding stops then i just restore the tooth if the bleeding still proceeds then iwill go for full pulptomy . thats just what i think , i thought it might help if share it :)kind regards Khalil Raziq From: ayhamsbahi@...Date: Sun, 13 May 2012 10:27:53 +0100Subject: partial pulpotomy VS full pulpotomy

Hi Guys Is there anymore exact indication regarding the exposure time of the pulp to chose between the 2 techniques for the treatment?in pink book is written (more than 24 hours it can be 1 week as an indication to partial pulpotomy) i mean if the patient had complicated tooth fracture on a tooth with open apex and the esposure was for 5 days (contaminated pulp) would you go for partial pulpotomy or full pulpotomy? which one is the treatment of choice? I guess it was a question in the last April exam Your help will be appreciated Ayham Sbahi

[Guest guest]

okay ayham i brought this info from my old lecture notes:regarding cvek pulptomy (partial pulptomy) in 1978 cveck showed that in exposed pulp ( from 1hr to 90 days!!!) inflammation dose not extend beyond 2mm removal of 2mm of pulpal tissue +dressing with ca(OH) = success rate of 96 % .... hope it helps From: ayhamsbahi@...Date: Sun, 13 May 2012 12:25:08 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you Khalil for your point,clinically there is noproblem everything depends on the pulp state and on the syptoms(pain on hot,TTP,X-ray)etc... but the prblem was if this question will appear on the exam with always insufficient information of the question as you know ( just to give you less clues to answer the question), anyway the only clue i found is from the success rate 72% for the full pulpotomy and 96% for the partial pulpotomy, so i will choose the partial one. More opinions on this are welcome Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 11:59 Subject: RE: partial pulpotomy VS full pulpotomy

hi ayhamclinically speaking if it was contaminated 5adays i will do partial pulptomy if the bleeding stops then i just restore the tooth if the bleeding still proceeds then iwill go for full pulptomy . thats just what i think , i thought it might help if share it :)kind regards Khalil Raziq From: ayhamsbahi@...Date: Sun, 13 May 2012 10:27:53 +0100Subject: partial pulpotomy VS full pulpotomy

Hi Guys Is there anymore exact indication regarding the exposure time of the pulp to chose between the 2 techniques for the treatment?in pink book is written (more than 24 hours it can be 1 week as an indication to partial pulpotomy) i mean if the patient had complicated tooth fracture on a tooth with open apex and the esposure was for 5 days (contaminated pulp) would you go for partial pulpotomy or full pulpotomy? which one is the treatment of choice? I guess it was a question in the last April exam Your help will be appreciated Ayham Sbahi

[Guest guest]

Thank you so much Khalil know there is no doubt about it,but if they will ask regarding the partial Cvek pulpotomy how many mm to remove from the pulpal tissue and there an options 2 mm or 4 mm or till bleeding seen? Sorry i don't want make it complicated,but i can expect from them anything.so should we go for till bleeding seen or 2 mm? Regard's Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 12:42 Subject: RE: partial pulpotomy VS full pulpotomy

okay ayham i brought this info from my old lecture notes:regarding cvek pulptomy (partial pulptomy) in 1978 cveck showed that in exposed pulp ( from 1hr to 90 days!!!) inflammation dose not extend beyond 2mm removal of 2mm of pulpal tissue +dressing with ca(OH) = success rate of 96 % .... hope it helps From: ayhamsbahi@...Date: Sun, 13 May 2012 12:25:08 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you Khalil for your point,clinically there is noproblem everything depends on the pulp state and on the syptoms(pain on hot,TTP,X-ray)etc... but the prblem was if this question will appear on the exam with always insufficient information of the question as you know ( just to give you less clues to answer the question), anyway the only clue i found is from the success rate 72% for the full pulpotomy and 96% for the partial pulpotomy, so i will choose the partial one. More opinions on this are welcome Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 11:59 Subject: RE: partial pulpotomy VS full pulpotomy

hi ayhamclinically speaking if it was contaminated 5adays i will do partial pulptomy if the bleeding stops then i just restore the tooth if the bleeding still proceeds then iwill go for full pulptomy . thats just what i think , i thought it might help if share it :)kind regards Khalil Raziq From: ayhamsbahi@...Date: Sun, 13 May 2012 10:27:53 +0100Subject: partial pulpotomy VS full pulpotomy

Hi Guys Is there anymore exact indication regarding the exposure time of the pulp to chose between the 2 techniques for the treatment?in pink book is written (more than 24 hours it can be 1 week as an indication to partial pulpotomy) i mean if the patient had complicated tooth fracture on a tooth with open apex and the esposure was for 5 days (contaminated pulp) would you go for partial pulpotomy or full pulpotomy? which one is the treatment of choice? I guess it was a question in the last April exam Your help will be appreciated Ayham Sbahi

[Guest guest]

ummm ur right thats became quiet complicating lool, okay iwould go for when bleeding stops because bleeding is the factor which determines the extent of the inflammation ,, so if i had acase like that i would remove 2mm and then gently rinse the chamber with isotonic saline until bleeding stops , and i will not proceed untill the bleeding is completely stopped (so i think its the most reliable diagnostic aid in this case ) but then its hard to talk logic with these people lool From: ayhamsbahi@...Date: Sun, 13 May 2012 12:57:10 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you so much Khalil know there is no doubt about it,but if they will ask regarding the partial Cvek pulpotomy how many mm to remove from the pulpal tissue and there an options 2 mm or 4 mm or till bleeding seen? Sorry i don't want make it complicated,but i can expect from them anything.so should we go for till bleeding seen or 2 mm? Regard's Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 12:42 Subject: RE: partial pulpotomy VS full pulpotomy

okay ayham i brought this info from my old lecture notes:regarding cvek pulptomy (partial pulptomy) in 1978 cveck showed that in exposed pulp ( from 1hr to 90 days!!!) inflammation dose not extend beyond 2mm removal of 2mm of pulpal tissue +dressing with ca(OH) = success rate of 96 % .... hope it helps From: ayhamsbahi@...Date: Sun, 13 May 2012 12:25:08 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you Khalil for your point,clinically there is noproblem everything depends on the pulp state and on the syptoms(pain on hot,TTP,X-ray)etc... but the prblem was if this question will appear on the exam with always insufficient information of the question as you know ( just to give you less clues to answer the question), anyway the only clue i found is from the success rate 72% for the full pulpotomy and 96% for the partial pulpotomy, so i will choose the partial one. More opinions on this are welcome Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 11:59 Subject: RE: partial pulpotomy VS full pulpotomy

hi ayhamclinically speaking if it was contaminated 5adays i will do partial pulptomy if the bleeding stops then i just restore the tooth if the bleeding still proceeds then iwill go for full pulptomy . thats just what i think , i thought it might help if share it :)kind regards Khalil Raziq From: ayhamsbahi@...Date: Sun, 13 May 2012 10:27:53 +0100Subject: partial pulpotomy VS full pulpotomy

Hi Guys Is there anymore exact indication regarding the exposure time of the pulp to chose between the 2 techniques for the treatment?in pink book is written (more than 24 hours it can be 1 week as an indication to partial pulpotomy) i mean if the patient had complicated tooth fracture on a tooth with open apex and the esposure was for 5 days (contaminated pulp) would you go for partial pulpotomy or full pulpotomy? which one is the treatment of choice? I guess it was a question in the last April exam Your help will be appreciated Ayham Sbahi

[Guest guest]

Nice one )) thank you so much Khalid for your help Regard'sAyham Sbahi From: k-lil raziq <k-lilraziq@...> Sent:

Sunday, 13 May 2012, 13:07 Subject: RE: partial pulpotomy VS full pulpotomy

ummm ur right thats became quiet complicating lool, okay iwould go for when bleeding stops because bleeding is the factor which determines the extent of the inflammation ,, so if i had acase like that i would remove 2mm and then gently rinse the chamber with isotonic saline until bleeding stops , and i will not proceed untill the bleeding is completely stopped (so i think its the most reliable diagnostic aid in this case ) but then its hard to talk logic with these people lool From: ayhamsbahi@...Date: Sun, 13 May 2012 12:57:10 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you so much Khalil know there is no doubt about it,but if they will ask regarding the partial Cvek pulpotomy how many mm to remove from the pulpal tissue and there an options 2 mm or 4 mm or till bleeding seen? Sorry i don't want make it complicated,but i can expect from them anything.so should we go for till bleeding seen or 2 mm? Regard's Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 12:42 Subject: RE: partial pulpotomy VS full pulpotomy

okay ayham i brought this info from my old lecture notes:regarding cvek pulptomy (partial pulptomy) in 1978 cveck showed that in exposed pulp ( from 1hr to 90 days!!!) inflammation dose not extend beyond 2mm removal of 2mm of pulpal tissue +dressing with ca(OH) = success rate of 96 % .... hope it helps From: ayhamsbahi@...Date: Sun, 13 May 2012 12:25:08 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you Khalil for your point,clinically there is noproblem everything depends on the pulp state and on the syptoms(pain on hot,TTP,X-ray)etc... but the prblem was if this question will appear on the exam with always insufficient information of the question as you know ( just to give you less clues to answer the question), anyway the only clue i found is from the success rate 72% for the full pulpotomy and 96% for the partial pulpotomy, so i will choose the partial one. More opinions on this are welcome Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 11:59 Subject: RE: partial pulpotomy VS full pulpotomy

hi ayhamclinically speaking if it was contaminated 5adays i will do partial pulptomy if the bleeding stops then i just restore the tooth if the bleeding still proceeds then iwill go for full pulptomy . thats just what i think , i thought it might help if share it :)kind regards Khalil Raziq From: ayhamsbahi@...Date: Sun, 13 May 2012 10:27:53 +0100Subject: partial pulpotomy VS full pulpotomy

Hi Guys Is there anymore exact indication regarding the exposure time of the pulp to chose between the 2 techniques for the treatment?in pink book is written (more than 24 hours it can be 1 week as an indication to partial pulpotomy) i mean if the patient had complicated tooth fracture on a tooth with open apex and the esposure was for 5 days (contaminated pulp) would you go for partial pulpotomy or full pulpotomy? which one is the treatment of choice? I guess it was a question in the last April exam Your help will be appreciated Ayham Sbahi

[Guest guest]

my pleasure ayaham From: ayhamsbahi@...Date: Sun, 13 May 2012 13:35:00 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Nice one )) thank you so much Khalid for your help Regard'sAyham Sbahi From: k-lil raziq <k-lilraziq@...> Sent:

Sunday, 13 May 2012, 13:07 Subject: RE: partial pulpotomy VS full pulpotomy

ummm ur right thats became quiet complicating lool, okay iwould go for when bleeding stops because bleeding is the factor which determines the extent of the inflammation ,, so if i had acase like that i would remove 2mm and then gently rinse the chamber with isotonic saline until bleeding stops , and i will not proceed untill the bleeding is completely stopped (so i think its the most reliable diagnostic aid in this case ) but then its hard to talk logic with these people lool From: ayhamsbahi@...Date: Sun, 13 May 2012 12:57:10 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you so much Khalil know there is no doubt about it,but if they will ask regarding the partial Cvek pulpotomy how many mm to remove from the pulpal tissue and there an options 2 mm or 4 mm or till bleeding seen? Sorry i don't want make it complicated,but i can expect from them anything.so should we go for till bleeding seen or 2 mm? Regard's Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 12:42 Subject: RE: partial pulpotomy VS full pulpotomy

okay ayham i brought this info from my old lecture notes:regarding cvek pulptomy (partial pulptomy) in 1978 cveck showed that in exposed pulp ( from 1hr to 90 days!!!) inflammation dose not extend beyond 2mm removal of 2mm of pulpal tissue +dressing with ca(OH) = success rate of 96 % .... hope it helps From: ayhamsbahi@...Date: Sun, 13 May 2012 12:25:08 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you Khalil for your point,clinically there is noproblem everything depends on the pulp state and on the syptoms(pain on hot,TTP,X-ray)etc... but the prblem was if this question will appear on the exam with always insufficient information of the question as you know ( just to give you less clues to answer the question), anyway the only clue i found is from the success rate 72% for the full pulpotomy and 96% for the partial pulpotomy, so i will choose the partial one. More opinions on this are welcome Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 11:59 Subject: RE: partial pulpotomy VS full pulpotomy

hi ayhamclinically speaking if it was contaminated 5adays i will do partial pulptomy if the bleeding stops then i just restore the tooth if the bleeding still proceeds then iwill go for full pulptomy . thats just what i think , i thought it might help if share it :)kind regards Khalil Raziq From: ayhamsbahi@...Date: Sun, 13 May 2012 10:27:53 +0100Subject: partial pulpotomy VS full pulpotomy

Hi Guys Is there anymore exact indication regarding the exposure time of the pulp to chose between the 2 techniques for the treatment?in pink book is written (more than 24 hours it can be 1 week as an indication to partial pulpotomy) i mean if the patient had complicated tooth fracture on a tooth with open apex and the esposure was for 5 days (contaminated pulp) would you go for partial pulpotomy or full pulpotomy? which one is the treatment of choice? I guess it was a question in the last April exam Your help will be appreciated Ayham Sbahi

[Guest guest]

Would love to hear your opinion :)From April 2012 feedback,Pulpal response to caries at DEJ? normal, dentine involved, peritubular dentin. traumatic pulp exposure of a child, comes for treatment 5 days later? superficial pulpotomy, pulpectomy, coronal pulpotomy.Caries diagnosis :Approximal caries in postApprox caries antOcclusal caries in EnamelOcclusal caries at DEJOcclusal caries in dentin Options,TRANSILLUMINATION ,direct vision,wet tooth ,dry tooth ,BITEWING thanks MokaOn 13 May 2012, at 13:41, k-lil raziq <k-lilraziq@...> wrote:

my pleasure ayaham From: ayhamsbahi@...Date: Sun, 13 May 2012 13:35:00 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Nice one )) thank you so much Khalid for your help Regard'sAyham Sbahi From: k-lil raziq <k-lilraziq@...> Sent:

Sunday, 13 May 2012, 13:07 Subject: RE: partial pulpotomy VS full pulpotomy

ummm ur right thats became quiet complicating lool, okay iwould go for when bleeding stops because bleeding is the factor which determines the extent of the inflammation ,, so if i had acase like that i would remove 2mm and then gently rinse the chamber with isotonic saline until bleeding stops , and i will not proceed untill the bleeding is completely stopped (so i think its the most reliable diagnostic aid in this case ) but then its hard to talk logic with these people lool From: ayhamsbahi@...Date: Sun, 13 May 2012 12:57:10 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you so much Khalil know there is no doubt about it,but if they will ask regarding the partial Cvek pulpotomy how many mm to remove from the pulpal tissue and there an options 2 mm or 4 mm or till bleeding seen? Sorry i don't want make it complicated,but i can expect from them anything.so should we go for till bleeding seen or 2 mm? Regard's Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 12:42 Subject: RE: partial pulpotomy VS full pulpotomy

okay ayham i brought this info from my old lecture notes:regarding cvek pulptomy (partial pulptomy) in 1978 cveck showed that in exposed pulp ( from 1hr to 90 days!!!) inflammation dose not extend beyond 2mm removal of 2mm of pulpal tissue +dressing with ca(OH) = success rate of 96 % .... hope it helps From: ayhamsbahi@...Date: Sun, 13 May 2012 12:25:08 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you Khalil for your point,clinically there is noproblem everything depends on the pulp state and on the syptoms(pain on hot,TTP,X-ray)etc... but the prblem was if this question will appear on the exam with always insufficient information of the question as you know ( just to give you less clues to answer the question), anyway the only clue i found is from the success rate 72% for the full pulpotomy and 96% for the partial pulpotomy, so i will choose the partial one. More opinions on this are welcome Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 11:59 Subject: RE: partial pulpotomy VS full pulpotomy

hi ayhamclinically speaking if it was contaminated 5adays i will do partial pulptomy if the bleeding stops then i just restore the tooth if the bleeding still proceeds then iwill go for full pulptomy . thats just what i think , i thought it might help if share it :)kind regards Khalil Raziq From: ayhamsbahi@...Date: Sun, 13 May 2012 10:27:53 +0100Subject: partial pulpotomy VS full pulpotomy

Hi Guys Is there anymore exact indication regarding the exposure time of the pulp to chose between the 2 techniques for the treatment?in pink book is written (more than 24 hours it can be 1 week as an indication to partial pulpotomy) i mean if the patient had complicated tooth fracture on a tooth with open apex and the esposure was for 5 days (contaminated pulp) would you go for partial pulpotomy or full pulpotomy? which one is the treatment of choice? I guess it was a question in the last April exam Your help will be appreciated Ayham Sbahi

[Guest guest]

hello moka:okay lets see: FIRST QUESTION:pupal response to caries at DEJ is pertubular dentin reference : essentials of dental caries the disease and its managment THird edition by .A.M.Kidd (beautiful book)second question:superficial pulptomy (according to cveck findings) you have upt to 90 days!!Refrence:lecture notesThird question:1.approximal caries in post teeth : BITWING2. approximal caries in anterior teeth : transilliumination3.occlusal enamel caries: direct vision4.occlusal caries in dentin:not sure!5. occlusal caries at DEJ :not sure!(i dont know how they come up with these questions lool)Refrence: same as the first questionhope it helps , show me what you think please From: mokaamr@...Date: Sun, 13 May 2012 18:54:07 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Would love to hear your opinion :)From April 2012 feedback,Pulpal response to caries at DEJ? normal, dentine involved, peritubular dentin. traumatic pulp exposure of a child, comes for treatment 5 days later? superficial pulpotomy, pulpectomy, coronal pulpotomy.Caries diagnosis :Approximal caries in postApprox caries antOcclusal caries in EnamelOcclusal caries at DEJOcclusal caries in dentin Options,TRANSILLUMINATION ,direct vision,wet tooth ,dry tooth ,BITEWING thanks MokaOn 13 May 2012, at 13:41, k-lil raziq <k-lilraziq@...> wrote:

my pleasure ayaham From: ayhamsbahi@...Date: Sun, 13 May 2012 13:35:00 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Nice one )) thank you so much Khalid for your help Regard'sAyham Sbahi From: k-lil raziq <k-lilraziq@...> Sent:

Sunday, 13 May 2012, 13:07 Subject: RE: partial pulpotomy VS full pulpotomy

ummm ur right thats became quiet complicating lool, okay iwould go for when bleeding stops because bleeding is the factor which determines the extent of the inflammation ,, so if i had acase like that i would remove 2mm and then gently rinse the chamber with isotonic saline until bleeding stops , and i will not proceed untill the bleeding is completely stopped (so i think its the most reliable diagnostic aid in this case ) but then its hard to talk logic with these people lool From: ayhamsbahi@...Date: Sun, 13 May 2012 12:57:10 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you so much Khalil know there is no doubt about it,but if they will ask regarding the partial Cvek pulpotomy how many mm to remove from the pulpal tissue and there an options 2 mm or 4 mm or till bleeding seen? Sorry i don't want make it complicated,but i can expect from them anything.so should we go for till bleeding seen or 2 mm? Regard's Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 12:42 Subject: RE: partial pulpotomy VS full pulpotomy

okay ayham i brought this info from my old lecture notes:regarding cvek pulptomy (partial pulptomy) in 1978 cveck showed that in exposed pulp ( from 1hr to 90 days!!!) inflammation dose not extend beyond 2mm removal of 2mm of pulpal tissue +dressing with ca(OH) = success rate of 96 % .... hope it helps From: ayhamsbahi@...Date: Sun, 13 May 2012 12:25:08 +0100Subject: Re: partial pulpotomy VS full pulpotomy

Thank you Khalil for your point,clinically there is noproblem everything depends on the pulp state and on the syptoms(pain on hot,TTP,X-ray)etc... but the prblem was if this question will appear on the exam with always insufficient information of the question as you know ( just to give you less clues to answer the question), anyway the only clue i found is from the success rate 72% for the full pulpotomy and 96% for the partial pulpotomy, so i will choose the partial one. More opinions on this are welcome Ayham Sbahi From: k-lil raziq <k-lilraziq@...> Sent: Sunday, 13 May 2012, 11:59 Subject: RE: partial pulpotomy VS full pulpotomy

hi ayhamclinically speaking if it was contaminated 5adays i will do partial pulptomy if the bleeding stops then i just restore the tooth if the bleeding still proceeds then iwill go for full pulptomy . thats just what i think , i thought it might help if share it :)kind regards Khalil Raziq From: ayhamsbahi@...Date: Sun, 13 May 2012 10:27:53 +0100Subject: partial pulpotomy VS full pulpotomy

Hi Guys Is there anymore exact indication regarding the exposure time of the pulp to chose between the 2 techniques for the treatment?in pink book is written (more than 24 hours it can be 1 week as an indication to partial pulpotomy) i mean if the patient had complicated tooth fracture on a tooth with open apex and the esposure was for 5 days (contaminated pulp) would you go for partial pulpotomy or full pulpotomy? which one is the treatment of choice? I guess it was a question in the last April exam Your help will be appreciated Ayham Sbahi