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Advances in Human Biology

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1 Advances in Gingival Augmentation Techniques A Literature Review, Hiral Shah, Rupal Mehta, Khushboo Desai, Shilpa Duseja, Santosh Kumar.
Background: In the current practice of periodontics, clinicians are faced with the challenge of not only addressing biological and functional problems present in the periodontium but also providing therapy that results in acceptable aesthetics. The presence of mucogingival problems and gingival recession around anterior, highly visible teeth exemplifies a situation in which a treatment modality that addresses both biological and aesthetic demands is required from the therapist. A variety of soft tissue augmentation procedures directed at root coverage have been documented in the literature utilizing autogenous or allogenic soft tissue grafting or guided tissue regeneration (GTR). The purpose of this review was to assess the effectiveness of newer materials in gingival augmentation procedures.
2 Paving the Way for Implant Placement for an Auricular Prosthesis, Dipti S Shah, Kartik R. Morjaria, Kalpesh C Vaishnav, Pankaj R Patel, Aumkar R. Trivedi.
Background: Ideal placement of bone integrated implants to retain a prosthesis is critical for a successful final prosthetic restoration. Several sources have described the importance and use of surgical templates for the optimal placement of extraoral implants. The literature is replete with information explaining the use of surgical templates for intraoral implant placement. Indeed, correct placement of implants facilitates creating a prosthesis that functions well and looks natural. To ensure proper implant placement, considerable effort should go into pre-surgical planning. It is clear that extraoral surgical templates aid in proper implant placement, yet the literature describing fabrication is limited. This article describes different methods for fabrication of surgical template for placement of implants for an auricular prosthesis.
3 Oral Lichen Planus: An Update on Etiology, Pathogenesis and Management - A Review of Literature, Nilesh Raval, Dhaval Mehta, Chintan Modi, Kanan Vachhrajani, Abhishek Nimavat.
Background: Lichen planus is a chronic inflammatory mucocutaneous disease. Mucosal lesions are classified into six clinical forms and there is malignant potential for Oral Lichen Planus (OLP); therefore, follow-up should be considered. There are many unestablished etiological factors for OLP. A genetic predisposition linked to Th1 cytokine polymorphisms may promote the T cell-mediated immunological response to an induced antigenic change that is supposed to lead to OLP lesions. Some putative etiologic factors, mainly amalgam restorations and hepatitis C virus have been studied in detail. The diagnosis of OLP can be made from the clinical features if they are sufficiently characteristic, but biopsy is recommended to confirm the diagnosis, exclude dysplasia and malignancy and if active treatment is required. The aims of current OLP therapy are to eliminate mucosal erythema and ulceration, alleviate symptoms and reduce the risk of oral cancer. The management of OLP is mainly aimed at controlling the symptoms and topical immunomodulators such as powerful corticosteroids and calcineurin inhibitors have been used. However their long-term effects needs to be better explained and understood.
4 Implant Complications and Failures A Review, Mira Thakkar, Rupal Mehta,Surabhi Joshi, Shefali Sharma.
Background:The goal of modern dentistry is to restore the patients dentition to normal contour, function, comfort, esthetics, speech, health and implant dentistry has the ability to achieve this goal. Although implant is considered to be a safe technique to replace tooth or teeth, certain complications are bound to occur with implants like any other surgical procedures. Implant surgery complications are frequent occurrences in dental practice and knowledge in the management of these cases is essential. The article highlights the complications in implant surgery, which helps to prevent them by proper patient selection, devising proper treatment plan and treating the implant cases in a way to avoid complications and failures associated with implants.
5 Relationship Between Use of Aspirin and Post-Extraction Bleeding Time: A Single Blind Study, Kruti A Shah1* Milind A Patel2 Rohit Tatu3 Vandana Patel
Background: The purpose of the study was to evaluate the effect of low dose aspirin before tooth extraction. Material and Method: The study group consisted of 50 patients who were scheduled to undergo dental extractions. All patients were receiving 75 - 150 milligrams of aspirin daily on a regular basis. The authors randomly divided the patients into two groups: those who stopped the aspirin therapy before the procedure and those who continued the aspirin therapy. One hour before the procedures, all patients underwent a bleeding time test. Results: The mean (Standard Deviation) bleeding time was 1.80.47 minutes for patients who stopped aspirin therapy one week before the procedure. For patients who continued aspirin therapy, the bleeding time was 3.10.65 minutes. However, both groups were within the normal bleeding time range and in both groups, a local hemostatic method was sufficient to control bleeding. No episodes of uncontrolled intra operative or postoperative bleeding were noted. Conclusion: Low-dose aspirin therapy should not be stopped before oral surgery. Local haemostasis is sufficient to control bleeding.
6 Correlation of Mast Cells and Angiogenesis in Oral Squamous Cell Carcinoma and Verrucous Carcinoma, Maruthi Devi K, MS Munisekhar, Charu Suri, Krishna A, G Kiran.
Aim: Presence of Mast cells (MCs) near capillary sprouting sites suggests an association between MCs and anigogenesis. MCs are well recognized as being important in the generation of angiogenic response via the release of heparin and histamine and release and/or activation of extracellular matrix modified enzymes. Thus study was done to histologically evaluate and correlate the number of MCs and angiogenesis in different grades of Oral Squamous Cell Carcinoma (OSCC) and Verrucous Carcinoma (VC). Materials and Methods: A retrospective study was conducted to elaborate upon the correlation between MCs and tumor angiogenesis. Microvessel density (MVD) was detected by immune-histochemical staining using anti CD34 monoclonal antibody and Mast cell density (MCD) was detected by toluidine blue staining. Results: The results showed a significant correlation in the mean MVD and the mean MCD (r= 0.75, p
7 Transgingival Probing and Ultrasonographic Methods for Determination of Gingival Thickness- A Comparative Study, Rakhi Issrani, Sunanda Chavva, Namdeo Prabhu, Vaishali Keluskar, Vasanti Jirge, Vinayak Kumbujkar, Santosh Patil.
Aim: In current era of dentistry attempts are being made to perform several dental procedures quickly and atraumatically as beyond efficacy there is a need for balance and comfort for patients. Measurement of gingival thickness (GTH) has become the matter of significant interest for periodontists, orthodontists and implantologists as well. However, there are relatively few studies investigating the GTH atraumatically and rapidly.The purpose of this study was to assess and compare the two methods of determination of GTH i.e. transgingival probing (TGP) and ultrasonographic method (USG) in association with site, age, gender, tooth wise and dental arch wise in Indian population. Methods: Thirty systemically and periodontally healthy subjects were included in the present study. Gingival thickness was assessed in the maxillary and mandibular anterior teeth by both methods. Results: It was observed that the younger age group had significantly thicker gingiva than older age group. The gingiva was found to be thinner in females than males and in the mandibular arch than the maxilla. Within the limits of the present study it was demonstrated that thickness of gingiva varies with the tooth sites, i.e. midbuccally and interdental papillary region and also with morphology of the crown. Conclusions: In the present study, it was concluded that GTH varies according to site, age, gender tooth and dental arch wise. In comparison to TGP method, USG method assesses GTH more accurately, rapidly and atraumatically.
8 Ridge Augmentation of Posterior Maxilla using Lateral Approach for Sinus Lift: A Case report, Sandeep N, Aarti Saxena, G Siva Prasad Reddy, K Rekha Rani.
Background: Placing implants in the posterior maxilla is challenging at times owing to poor quantity of bone and pneumatization of the maxillary sinus. In a patient desirous of implant related prosthesis, there arises a need to augment the bone height. The maxillary sinus lift technique using a lateral approach is frequently used for bone augmentation. This article reports one such treatment option for augmenting bone to place an implant.
9 Fragment Reattachment: Conservative Approach to a Complicated Case - A Case Report, Mashalkar Shailendra, G Sharaschandra Reddy, Suroopa, Sindhu Reddy.
Background: Fracture of anterior teeth is a common occurrence in young children and adolescents. Due to advancements in adhesive technology reattaching the patients own fragment is gaining popularity. Tooth fragment reattachment not only takes care of original tooth anatomy but also the shade selection part. It is definitely a conservative approach which does not need tooth reduction to the extent of full coverage crowns and a cost effective treatment to a complicated problem. In this article a case is presented where post was used along with flowable resin to reattach the tooth.
10 Going Beyond the Conventional Approach - Liquid Supported Denture: A Case Report, Dipti S Shah, Amit M Nebhani, Kalpesh C Vaishnav, Pankaj R Patel, Dhaara M Rana.
Background: The concept of conditioning oral mucosa has gained momentum over the last few years. Different tissue conditioning materials and soft liners have been used for this purpose. But the limitations of these materials has led to the introduction of liquid-supported dentures, which is a newer alternative to conventional complete denture prosthesis in cases with inflamed tissues, atrophic and severely resorbed edentulous ridges. Liquid supported Denture consists of a base which is covered with a preshaped close fitting flexible foil containing a thin film of high viscosity liquid which cushions the underlying tissues. This case report describes fabrication of liquid-supported dentures for patients with compromised tissues.
11 Double Mesiodentes, Bilateral to Midline: A Report of Two Uncommon Cases, Avina Banari
Background: Spontaneously erupted double mesiodentes, bilateral to midline are extremely rare and can alter both occlusion and appearance by affecting the eruption path, position, inclination and axial rotation of the maxillary permanent incisors. Case Report: Two cases of uncommon occurrence of spontaneously erupted double mesiodentes, bilateral to midline are presented here. The first case report highlights a situation where in treatment has been sought due to esthetic concerns arising, following a spontaneous eruption of bilateral mesiodentes. The second case report highlights a situation wherein there has been disturbances related to increasing diastema, axial rotation and inclination of erupted permanent central incisors caused due to spontaneously erupted double mesiodentes with incidental radiographic finding of congenitally missing permanent maxillary lateral incisors. In both the cases, clinical and radiographic findings clinched the diagnosis and prompt extraction of the mesiodentes was undertaken to reduce the extent of possible future complications and orthodontic treatment. Conclusion: Early diagnosis allows for minimization of the treatment required and prevents development of associated problems. Extraction of the mesiodentes in the early mixed dentition stage may facilitate good alignment of incisors, while minimizing orthodontic intervention for space loss, diastema and midline shift.
12 Cast Metal Occlusals: A Vital Tool for Single Complete Denture: A Case Report, Dipti S Shah, Hirenkumar C Rana, Kalpesh C Vaishnav,Pankaj R Patel,Sareen Duseja.
Background: Occlusal surface of the acrylic teeth of a single complete denture in opposition to natural dentition wears out with its use for a longer period of time, which may lead to decrease in the chewing efficiency, loss of vertical dimension of occlusion, change in centric occlusion, denture instability, temporomandibular joint disturbances etc. Re-fabrication of new denture set over a period of time, inclusion of highly cross linked acrylic teeth, amalgam or metal inserts on occlusal surface, use of composite, gold or metal occlusal surface, etc. are some of the treatment options available to counteract that problem. Several articles have described methods to construct gold and metal occlusal surfaces, some of which are time-consuming, expensive and require many cumbersome steps. This clinical case describes the sequence of steps for construction of metal occlusal surfaces on single complete denture using the lost wax technique.
13 A Mandibular Second Premolar with Three Canals and Atypical Orifices, Neha Agarwal, Hardik Mevada, Sagar Bumtaria.
Background: Mandibular second premolars with three canals (Type V, Vertucci) and separate foramina are very rare. The anatomy of the pulp chamber floor in these premolars usually reveals one lingual and two buccal orifices at the same level. This case report describes a second premolar with three canals and an unusual pulpal floor anatomy with one mesiobuccal and one distobuccal orifice at the same level and an orifice on the distolingual wall. Very careful examination of the pulpal space with an optical device and preoperative spiral computed tomography is recommended to locate any unusual orifices.
14 Accidental Ingestion of a Dental Bur Seen in a Paediatric Patient - A Case Report, Rohan Bhatt, Applu Atrey, Ashish Kaur, Lipee Dave.
Background:This article presents a case of accidental ingestion of dental bur by a patient during routine dental treatment. This article also points out the possible barrier techniques to prevent swallowing and ingestion of dental foreign objects by patient. An outline of the complications of swallowing/ingestion of foreign objects as well as the required diagnostic measures to be taken following the accidental swallowing and the different treatment options has been laid in brief.
15 Lasers in Facial Aesthetics- A Review, Dishant Shah, Nimisha Desai, Rahul Dhanak
Background: Lasers and optical technologies play a significant role in aesthetic and reconstructive surgery. The unique ability of optical technologies to target specific structures and layers in tissues to effect chemical, mechanical or thermal changes make them a powerful tool in cutaneous rejuvenation, hair removal, fat removal and treatment of vascular lesions such as port-wine stains, among many other procedures. With the development of adjunct techniques such as epidermal cooling, lasers and optical technologies have become more versatile and safe. The constant improvement of existing applications and the emergence of novel applications such as photodynamic therapy, nanoparticles, spectroscopy and noninvasive imaging continue to revolutionize aesthetic medicine by offering a minimally invasive alternative to traditional surgery. In the future, therapies will be based on individualized, maximum, safe radiant exposure to deliver optimal dosimetry. Lasers and optical technologies are headed toward safer, easier and more quantifiable individualized therapy.
16 Extra Oral Periapical Radiography: A review, Rachna Kaul, Shilpa PS.
Background: Intra oral periapical radiographs remain the backbone of diagnostic assessment of dento-facial pathologies. However, in some clinical situation like in developmentally disabled individuals, those with an exaggerated gag reflex, pediatric dental patients and anxious dental patients, it may be very difficult to obtain an intra-oral periapical radiograph of diagnostic quality. In such situations, extra oral periapical radiographs are very useful. They are obtained by placing a sensor outside the oral cavity and then making the radiographic exposure using a digital X ray machine for intra oral radiographs. The radiation dose in this technique is much lesser as compared to panoramic radiographs. This article reviews the technique, advantages, disadvantages and indications of extra oral periapical radiographs.
17 Treatment of Degree II Furcation Defects Using Autogenous Grafts with and without Alendronate - A Split Mouth Clinical Study, Sujit Kumar, Killi V Prabhakara Rao, Dola Srinivasa Rao, Tanuja Penmatsa.
Aim: This study was conducted to evaluate the efficacy of the combination therapy i.e. inverted periosteal graft (IPG) with autogenous bone used alone and in conjunction with an osteoclast inhibitor - 1% alendronate (ALN) sodium gel, in the treatment of mandibular buccal degree II furcation defects. Materials and Method: A total of 28 buccal degree II furcation defects in 14 patients were selected and randomly divided into Group A and Group B. Experimental sites in Group A were treated using inverted periosteal graft and autogenous bone mixed with 1% alendronate gel and experimental sites in Group B were treated with inverted periosteal graft and autogenous bone only. Results: Both the experimental groups showed significant reduction in probing pocket depth, gain in clinical attachment level and mean percentage of horizontal defect fill (41.82% vs 49.09%) at 6 months. Experimental sites in group B showed a significant loss in mean vertical defect height compared to experimental group A (1.52% Vs -1.59%). Conclusion: It can be suggested that bisphosphonates such as alendronate sodium have the potential to inhibit the surgery induced bone loss.
18 Evaluation of Ornidazole Gel as an Adjunct to the Phase I Therapy, Bhavin Patel, Samir Shah, Santosh Kumar
Aim: Gingivitis is a common periodontal condition affecting most of the population of the world. Beneficial results have been achieved by researchers with use of antibiotics as an adjunct to phase I therapy. This study was done to evaluate the therapeutic effectiveness of Ornidazole containing gel as an adjunct to scaling in comparison with scaling alone. Materials and Method: Total 30 subjects of both the sexes diagnosed with chronic generalized gingivitis were recruited for the study. A split mouth study was conducted where scaling was done on the control site & scaling along with Ornidazole gel application was done on the test site. Modified gingival index and plaque index were recorded at baseline, 2 weeks and 4 weeks. Results: This clinical study showed statistically significant improvement in gingival status of all the patients. For both the groups significant difference in mean score (0.52) of modified gingival index was observed but there was no significant difference in mean plaque score between two sites. Conclusion: The result showed that scaling alone can improve the gingival status; however additional benefits can be obtained when antimicrobial gel is used as an adjunctive therapy.
19 Evaluation of Polymerization Shrinkage of Light Cured Composite Resins, Ravisankar Damineni, Abhilash, Mashalkar Shailendra, G Sharaschandra Reddy.
Aim: The purpose of this study was to evaluate the polymerization shrinkage of four different light cured composite resins used for restorative purposes by measuring shrinkage strain. Materials and Method: Thirty composite samples were divided into three groups of ten each. An experimental design was made to record the shrinkage strain while curing the composite sample. The readings were recorded and statistical analysis was done. Results: Results showed samples in group II (fiber reinforced composite) had least polymerization shrinkage whereas group III (Nano filled composite) had the highest shrinkage. Conclusion: Resin matrix composition, filler volume, type of filler and lot of other factors has to be considered before selecting a composite resin for a successful restoration.
20 Effects of Zinc Oxide Nanoparticles in Combination with Conventional Glass Ionomer Cement: In vitro Study, Pranav Vanajassun P, MS Nivedhitha, NT Nishad, Dona Soman.
Aim: The aim of this study was to evaluate the effect of addition of Zinc oxide nanoparticles (ZnO) to the conventional Glass-Ionomer Cement (GIC) on its antibacterial and selective mechanical properties. Materials and Methods: Conventional posterior glass ionomer restorative cement- Fuji IX was used as the control group (control-GIC). Experimental group was prepared by incorporating zinc oxide nano particles of size
21 Clinical Evaluation of Fixed Dental Prosthesis Failures in Indian Population: An In Vivo Study, Dipti S Shah, Kalpesh Vaishnav, Sareen Duseja, Ravi Joshi.
Aim: The purpose of this study was to evaluate the prevalence of causes of fixed dental prosthesis failures in Indian population. Materials and method: A total of 158 patients were selected for the study who reported to the OPD of the Department of prosthodontics, Karnavati School of Dentistry, with complaints related to fixed dental prosthesis (FDP). Site and condition of the prosthesis and its abutments were evaluated and the cause of failure was classified accordingly by John J. Manappallils classification. Results: Majority of failures (32.27%) were found to be class III failure followed by class VI failure (24.05 %). 13.29 % failures were Class IV, 12.65 % failures were identified as class II, 12.02 % failures as class V and 5.69 % failures were categorized in class I failure. Conclusion: Though earlier literature reported caries as the most common cause of fixed dental prosthesis failure, however present study reported class III failures, which include unserviceable restorations due to defective margins, technical failures or esthetic considerations as the most common cause. Therefore proper design of prosthesis is of utmost importance and should be kept in mind during fabrication of FDP.
22 Association between Chronic Periodontitis and Serum Lipid Levels with its Risk to Atherosclerosis, Kush Pathak, Madhusudan Ashtekar, Rashmi Metgud, Suruchi Tekade, Sandeep Jain, Satyajit Tekade.
Aim: Regarding the high prevalence of hyperlpidaemia, which is one of the major risk factors of cardiovascular disease and uncertain reports about the relation between periodontal disease and serum lipid profile, this study was conducted to assess the relation. Materials and Methods: The cohort study was conducted on 45 cases including 30 persons with chronic periodontitis as case group, and 15 healthy subjects as control group. Both groups had same age and weight ranges, sex and diet, without any periodontal treatment history in the past six months, underlying systemic disease such as diabetes, anti-hyperlipidemic drugs or active tobacco smoking history. Low density lipoprotein (LDL), High density lipoprotein (HDL), Triglyceride (TG) and total cholesterol levels (CHOL) were measured by direct enzymatic assay. Results: TG level was 116.713+/-30.485 mg/dl in control group and 166.197+/-69.332 in case group (P =
23 A Study of Analgesic Efficacy of Ibuprofen and Diclofenac Sodium in Acute Pulpitis Patients, Komali G
Aim: Ibuprofen400mg and Diclofenac Sodium 50mg marketed today inhibit Cox-1 and Cox-2 and have selectivity for Cox-1. Ibuprofen 400mg is an established analgesic in the management of acute dental pain. Diclofenac Sodium 50mg is also used in the management of acute pain, but there are very few studies comparing its analgesic efficacy with Ibuprofen. Materials and Method: A double blind randomized study was carried out to compare the analgesic efficacy, safety and potency of Ibuprofen and Diclofenac Sodium in acute pulpitis patients with moderate to severe pain. 60 patients with acute pulpitis were enrolled in the study and Ibuprofen 400mg and Diclofenac Sodium 50mg were randomly given to them. Self-administered questionnaire was given to the patients and they were asked to note the intensity of initial pain on Visual analogue scale. Results: Time of onset of action of drugs, Time to peak effect, Total analgesic effect and tolerability of the drugs were assessed. From the present study it was found that there were statistically significant differences in the onset of action of drug and Time to peak effect. Onset of action was early in Ibuprofen and Time to peak effect was early in Diclofenac sodium. Patients rated both drugs to be equally good on Global evaluation scales. Conclusion: It was found that Diclofenac Sodium is more potent compared to Ibuprofen.
24 Evaluating Awareness on Dental Pulp Stem Cells and its Applications amongst Graduating Dental Students of Ahmedabad and Gandhinagar District: A Cross-Sectional Survey, Rohan Bhatt, Applu Bhatt, Dhruva Gurjar, Lipee Dave
Aim: The next decade of dentistry is speculated to see unparalled advances in the field of stem cell tissue engineering. The discovery of stem cells in the pulp of deciduous teeth raised intriguing possibility of using dental pulp stem cells for various life threatening disorders. This novel therapy has been proved to be a huge scope in dentistry and currently has large-scale clinical applications. The WHO recommends dentists should encourage following evidence based literature in order to educate patients about the collection, storage and use of stem cells. There is a need to assess graduating dental care professionals, which would help in understanding awareness on this topic. Materials and Methods: Four dental colleges from Ahmedabad and Gandhinagar districts participated in the study. A structured questionnaire containing 13 questions was prepared and distributed to the participants. Data was analyzed after all the participants submitted their questionnaire. Results: Out of 372 students, 231 reverted back for the study. Majority of the graduating interns were ignorant about the canine being the best deciduous tooth for the extraction of stem cells. 24.84 % students believed dental pulp stem cells as best source for therapeutic use whereas almost 30% considered as bone marrow or umbilical cord. Majority of participants had no idea regarding the optimal root length to get the vital stem cells post extraction. Conclusion: Updating ourselves in medical profession is key to clinical success. In recent years due to influence of media, patients have become aware of latest innovations in medical and dental science. Therefore it has become necessary for the dental professionals to keep themselves updated to new world of dentistry.
25 A Rare Case of Amyloid Goiter: Ultrasonographic Findings and Thioflavin T Staining, Vipul V Solanki, Digish U Vaghela, Arunkumar Marekar, Shamji R Chauhan, Seema N Baxi.
Background: Clinically significant enlargement of the thyroid gland by amyloid deposition is rare. A case study of 22-year-old lady with gradual enlargement of the thyroid gland has been presented. Routine haemological, biochemical test including thyroid function tests were normal. Ultrasonographic findings were nonspecific. Amyloid goiter has to be differentiated from other types of goitre and malignancy. FNAC was found to be suspicious for the presence of amyloid. Special staining with thioflavin T confirmed amyloid deposition.
26 Socket Preservation: A Foregoing Approach for Future Implant Placement, Nikunj Bhuva, Rupal Mehta, Shilpa Duseja, Khushboo Desai.
Background: Significant changes in bone volume and morphology following tooth extraction can make implant rehabilitation very difficult and these changes increase as the time from extraction to implant placement increases. The extraction socket preservation technique conserves the alveolar architecture and prevents hard and soft tissue collapse that minimizes the necessity for future augmentation procedures. Many techniques have been discovered for socket preservation which allows the dentist to place the implant in extraction sites that were thought to be compromised. Recently, to reinstate alveolar bone loss and to support efficient placement of dental implants many different bone substitute such as autografts, allografts, xenografts, synthetic biomaterials and osteoactive agents have been proposed. The aim of this case report was to evaluate the aptitude of bioactive glass with collagen membrane in the socket preservation for the development of ideal future implant site.
27 Two Dentigerous Cysts in 12 Years Old Children: Report of an Unusual Case, Geeta Mishra Tripathi, Shaji Thomas, NS Gautam, Ajay Pillai.
Background: Dentigerous cysts are common cysts of the jaws. They are associated with the crowns of permanent teeth, most frequently associated with impacted mandibular third molars. The other teeth that are commonly affected are, in order of frequency, the maxillary canines, the maxillary third molars and, rarely, the central incisor. Radiographically, the cyst appears as ovoid well-demarcated unilocular radiolucency with a sclerotic border. The present case reports describes the surgical enucleation of a 2 dentigerous cysts involving the lower permanent canine and upper premolar of maxilla in 12 years old nonsyndromic children.
28 Surgical Management of Iatrogenic Perforations of Maxillary Central Incisors with MTA, Rajasekhar V, Gautam NS, Narsimha Rao VV, Srinivas Kumar CH.
Background: Perforations represent pathologic or iatrogenic communications between the root canal space and the attachment apparatus. Root perforations are significant complications to endodontic treatment and, if not detected and treated properly, the breakdown of the periodontium may ultimately lead to loss of the tooth. Iatrogenic root perforations are the second most common reason for endodontic failure. As a repair material for perforation, MTA is considered to be gold standard. Complete clinical and radiographic examination and adequate knowledge of the morphology of the teeth is necessary for successful clinical outcome.
29 Usual Complication after Radiotherapy of Jaws for Carcinoma: Osteoradionecrosis, Kartik Dholakia, Rahul Dhanak, Tushar Makwana.
Background: Osteoradionecrosis (ORN) is the death of bone due to radiation. The bone dies because of damage to its blood vessels caused by the radiation. Radiation provides high cure rates, but has also called increasing attention to its side effects. Osteoradionecrosis (ORN) is one of the most severe and serious complications of head and neck cancer treatment. A new theory for the pathogenesis of ORN has proposed that damage to bone is caused by radiation-induced fibrosis. Here there is a case which was operated conservatively and after 8 months of follow up no recurrence was observed.
30 Management of Medically Compromised Patient in Periodontal Practice: An Overview (Part 1), Monali Shah, Deepak Dave, Rahul Dave, Ashit Bharwani, Amit Shah.
Background: Periodontal management of the medically compromised patients require acquisition of complete health history as well as dental history of the patient. This should include documentation via questionnaire as well as a verbal history. Preferably an oral history should also be obtained as a review of systems. The dental history should also include questions related to current oral conditions such as periodontal disease or oral ulceration and past dental treatment and potential complications from prior intervention including treatment failure and the delivery of anesthesia or post-treatment medication. The first step in managing the patients with medical problems is acquiring thorough health history of the patients. The second step for the periodontist is to fully understand the significance of the diseases that may have affected the patient. Each identified condition can affect periodontal treatment in a unique manner. The periodontist needs to understand the potential complications that can occur as a consequence of the treatment of a medically compromised patient. Also deciding pre-treatment or post-treatment medication or emergency care is required. This part of review focuses on a number of medical problems that the periodontist might encounter in daily practice that necessitate extra knowledge and care to prevent potential complications causing otherwise unnecessary morbidity and mortality of the patients. These include diabetes, multiple drug interactions and important cardiac diseases.
31 Evaluation and Comparison of Healing of Periodontal Flaps when Closed with Silk Sutures and N-Butyl Cyanoacrylate: A Clinico Histological Study, Chirag Shah, Mayur Parmar, Khushboo Desai, Shilpa Budhiraja, Santosh Kumar.
Background: The periodontal flap is one of the most frequently employed procedures, particularly for moderate to deep pockets. Silk is the most commonly used suture material for approximating the flap margins together after periodontal flap surgery. There are some major disadvantages of silk sutures and to overcome some difficulties with sutures, a need for alternative of sutures is always felt. N-butyl cyanoacrylate is a tissue adhesive, which can be used for the closure of the incised wounds. Objective: The present study was carried out to evaluate and compare accumulation of dental plaque and response of gingival tissue during the healing period after periodontal flap surgery when closed with N butyl cyanoacrylate and silk sutures. Materials and Methods: The study was carried out on 30 patients and divided into three groups, 10 patients per group: Group A, Group B and Group C. In each patient, a split mouth design was employed. The flap surgical procedure was carried out for the pocket therapy and the selection of the site for suture and cyanoacrylate was done randomly. Antibiotics and analgesics were prescribed and the patients were recalled after 1 week, 3 weeks and 6 weeks. Results: It was found that healing with the cyanoacrylate is associated with less amount of inflammation during the first week when compared with silk. However, over a longer period the sites treated with both the materials showed similar healing patterns after 3 weeks and 6 weeks. Conclusion: It can be concluded that healing of periodontal flaps when closed with silk sutures and N butyl cyanoacrylate is normal, uneventful, healed by primary intention and aids in early initial healing compared to silk suture.
32 Community Analysis of Endophytic Fungi In Medicinal Plant Gloriosa Superba, Abhishek Budhiraja, Sanjay Kumar, Kunal Nepali, Sanjna Kaul,Kanaya Lal Dhar.
Aim: All plants are expected to host endophytes, but only 3% of plants have been explored for their fungal communities. Aim of the present study was to isolate the mycoflora of Gloriosa superba, an important medicinal plant of subcontinent. Material and Methods: Different parts of G. superba were surface sterilized and internal tissues were aseptically exposed to the culture media unless the growth of mycelia was observed. Each fungal isolate was cultured separately to get the pure culture for further evaluation and analysis. Each culture was identified on the basis of its morphological characteristics and bioactive isolates were also characterized on the basis of their molecular profiling. Results: 42 isolates belonging to 22 different genera were obtained and were identified. 5 isolates exhibited good antimicrobial and anticancer potential against human pathogenic bacterial strains and human cancer cell lines. These isolates were identified on the basis of their molecular characteristics. PCR was done using Primers for ITS region and PCR products of the isolates were sequenced and their sequences were BLASTED to NCBI. Sequences were also submitted to GenBank. Conclusion: Results of the present study confirmed that plants are associated with microorganisms which are present in their internal tissues. These microorganisms survive in symbiotic relationship with their hosts and may provide assistance to their host to protect them against various pathogens.
33 The Effect of Improved Periodontal Health On Metabolic Control In Type 2 Diabetes Mellitus , Chirag Shah, Darshan Modi, Surbhi Joshi, Khushboo Desai.
Objectives: The aim of the present study was to investigate the effect of improved periodontal health on metabolic control in type 2 diabetes mellitus (DM) patients. Material and Methods: Fifty (50) patients with type 2 DM were selected. Subjects were randomly assigned into two groups. Data collection: Plaque index (PI), gingival index (GI), probing pocket depth (PPD) and bleeding on probing (BOP) were recorded at baseline and after 3 months. Glycosylated haemoglobin (HbA1c), were analysed at baseline, 3 months following the periodontal therapy. The treatment group received full-mouth scaling and root planing whereas the control group received no periodontal treatment. Results: A statistically significant effect could be demonstrated for PI, GI, PPD, CAL and BOP for the treatment group. HbA1c levels in the treatment group decreased significantly whereas the control group showed a slight but insignificant decrease for this parameter. Conclusions: The results of this study showed that non-surgical periodontal treatment is associated with improved glycaemic control in type 2 patients and could be undertaken along with the standard measures for the diabetic patient care.
34 Perception of Smile Esthetics: A comparative Evaluation in Orthodontist and Laypersons, Divyaroop Rai, Anuroop Rai, Vikas Gill, Tripti Rai.
Aims: The purpose of this investigation was to compare the difference in esthetic perception of the professionals and the laypersons in posed/social smile among young adults seeking orthodontic treatment. Materials and Methods: Images of the posed smile were captured with a digital camera from the 60 non-orthodontic treated young adults (30 males, 30 females) and were judged by panels of 10 laypersons and orthodontists each. Visual analog scale was used to measure the pleasantness of smile and Likert scale was used to observe the importance of inciso-gingival display, upper vertical lip thickness, lower vertical lip thickness, buccal corridor and smile arc in smile attractiveness. Pearsons correlation and chi square test was used to identify determinants of the pleasing smile from the results of a Visual analog scale and Likert scale. Results: The esthetic smile judgment of orthodontists disagreed with those of laypersons. Three factors formed significant components of a pleasant smile, for orthodontists (inciso-gingival display, upper lip & buccal corridor) and three for laypersons (upper lip, lower lip & smile arc). Conclusion: Inciso-gingival display, upper lip, lower lip and buccal corridor proved to be the most influential variables in smile esthetics.
35 A Short Term Comparative Clinical Evaluation of Diode Laser and Hand Instruments for Gingival Curettage, Chirag Shah, Bhavesh Modi, Shilpa Budhiraja, Khushboo Desai.
Objectives: This randomized split-mouth clinical trial was designed to evaluate the effect of gingival curettage with diode laser to gingival curettage with hand instruments. Materials and methods: A total of 34 chronic periodontitis subjects, of both genders, were selected. 5 mm or deep periodontal pockets (up to 7mm), indicated for curettage procedures were chosen from each subject. In all patients contralateral sides were randomly divided into experimental and control site. The patients had undergone scaling and root planing before curettage procedure. On the experimental site curettage was done with diode laser (980 nm) and on control site curettage was done with hand instruments (gracey curettes). Clinical data were collected at baseline, 1 week, 6 weeks and 3 months after therapy. Results: There was a significant improvement of all the clinical parameters - relative attachment level (RAL), probing pocket depth (PPD), plaque index (PI), modified gingival index (MGI) for both groups (P
36 Nitric Oxides in Periodontics, Rupang Parekh, Monali Shah, Neeraj Deshpande, Sonam Mufti.
Background: Nitric oxide (NO) is a free radical, that is, an uncharged molecule with an unpaired electron. NO is a molecule, involved in vascular regulation, homeostasis, bone formation and resorption, neuro-transmission, and immune function. It also has antimicrobial activity and is considered to be an important molecule against infectious diseases, such as periodontitis. NO works as an effector of host-induced tissue damage mediated by the production of proinflammatory cytokines, prostaglandins and by the production of reactive nitrogen species. It might play a role in the pathogenesis of periodontitis and subsequent bone loss, either directly or indirectly by modulating the production of other pro-inflammatory cytokines. Although little has been published on its role in oral diseases, it certainly has important actions in periodontal diseases. Hence, this review will throw a light on the role of nitric oxide in periodontal disease based on recent evidences.
37 Era of Smart Toothbrushes, Kuldeep Sharma
Background: Toothbrushes are an adjunct part of daily life being oldest and simplest method for maintaining oral hygiene. Explaining correct way of brushing and to keep a check on it, was a challenging task for the dentists in the past. This problem led to dental as well as periodontal problems. Now the new smart technology is used in toothbrushes that not only offer different brushing modes for polishing, massaging and cleaning but can also wirelessly connect to a mirror-mounted LCD display which monitors for regular brushing with timer and pressure measuring sensor. New Ionic toothbrushes have also been introduced which are helpful in removing plaque more effectively. The purpose of this paper is to discuss how the technological advancements have entered in dentistry and to show the future of oral hygiene maintenance in patients for keeping a record of every patient for better patient compliance and to prevent periodontal problem and hence delivering better treatment.
38 Sealing Ability of Four Root End Filling Materials: A Glucose Penetration Leakage Study, Sindhu S Reddy, Sujatha V, S Mahalaxmi.
Background: The aim of this study was to determine the sealing ability of four root end filling materials- Intermediate Restorative Material (IRM), Mineral Trioxide Aggregate, Geristore and Retroplast using a glucose leakage model. Material and Method: 100 extracted teeth were used for this study. The teeth were divided into 6 groups 4 experimental groups of 20 teeth each and 2 control groups of 10 teeth each. In the positive control, no root end filling was done and in the negative control, the teeth were completely coated with nail varnish. All the teeth were instrumented, their apices were resected. 3mm deep root end preparations were prepared with retrotips. The root end cavities of the experimental groups were filled with the retrograde filling materials. The materials were manipulated according to the manufacturers instructions. Each tooth was mounted in a glucose leakage device as described by Xu and coworkers.6 The amount of glucose was determined by a UV-VIS recording spectrophotometer at 500-nm wavelength. The results were analyzed using One way ANOVA followed by Tukey- HSD procedure and Students paired t-test. Results: The results showed that Mineral Trioxide Aggregate showed the least leakage compared to other three experimental groups. Conclusion: According to the results of this study, MTA showed the least leakage at both 7th and 14th days and hence can be considered as the material of choice for root end filling.
39 Teething Beliefs and Practices among a Sub-Urban Population in India-A Cross Sectional Study, Shoba Fernandes, Siddana Goud. R, Shrudha Potdar, Sidhartha Ram Pujari.
Background: Beliefs related to teething and practices regarding its management have varied cross culturally in various parts of the world. A paucity of specific studies related to teething in contemporary literature in India lead to this cross sectional study, to investigate the knowledge and practices about teething among the population in the central Indian region. Materials and Method: Cross sectional survey of 150 mothers with the youngest child of less than 24 months of age was performed. A structured questionnaire which consisted of 21 questions was utilized. The numerically coded data was entered using SPSS version 16 and chi square test applied to analyze variables. Results: The results showed that only 26.3% of interviewed mothers had good knowledge levels of teething problems. Majority of the mothers had good knowledge regarding irritability, biting fingers/objects and drooling. The remaining depicted inaccurate attribution to symptoms like fever (75%), diaper rash (77%) and diarrhoea (42%). 79% hesitated to consult dentists or health professionals. Conclusions: Poor knowledge levels among mothers shown in this study confirmed our belief that extensive parental education is necessary with regard to teething problems. The erroneous beliefs and practices demonstrated a need for further investigation.
40 Frenectomy Using Electrocautery: A Case Series., Sneha Shah, Vandana Rathwa, Monali Shah, Deepak Dave.
Background: While performing frenectomy, conventional scalpel techniques have their own traditional drawbacks. To overcome them, we have novel techniques like electrocautery and lasers, which are increasingly being used in routine periodontal practice. However, there isnt sufficient evidence supporting the use of electrocautery in frenectomy. Aim of the study is to compare the conventional scalpel technique and the electrocautery technique for frenectomy procedure. Material & Method: Two cases were selected. For the 1st case, electrocautery was used, while for the 2nd case, conventional scalpel technique was used for frenectomy. For both the patients, similar clinical parameters were assessed at baseline, 1 week and 1 month. Result: Clinically, both the cases showed similar improvement post 1 week as well as post 1 month. Conclusion: This case series shows equivalent results for both the techniques, with slight benefit of the electrocautery over the other, in terms of patient comfort.
41 Modern Day Endodontics with Root Canal Treatment and Fibre Reinforced Composite Core Built up as a Means of Avoiding Crown Placement in a Single Appointment A Case Report, Chintan Joshi, Hardik Mewada, Mahendra Patel, Pathik Patel.
Single visit root canal treatment option is recently considered to be best for irreversible pulpitis and aymptomatic apical periodontitis cases. Also when gross coronal tooth structure has been destroyed by caries, post enodontically it is important to give a restoration which would reinforce the remaining tooth structure and resist fracture against heavy occlusal loading. So, in this particular case, single visit root canal treatment was opted and fibre reinforced nanohybrid composite system was used for reinforcing the coronal tooth portion. Follow up of 2 years showed no signs of any fracture of the crown portion without any symptom related to the root canal treatment.
42 Two Alternatives for Impression Making of Mandibular Flabby Ridge: Case Reports, Khyati Shah, Pooja Parikh, Naveen YG, Tamanna Chhabra.
With the increase in life expectancy, there is increase in number of edentulous individuals requiring rehabilitation with complete dentures. Flabby ridge is a commonly encountered condition in clinical practice which affects the retention and stability of the mandibular denture. Two patients reported in K.M. Shah dental college with flabby mandibular ridges. Two different secondary impressions were employed for the two patients, one was 'Window technique using Hub of needle' and other was 'Window technique using Magnets'. These techniques resulted in a stable and retentive mandibular denture.
43 Oral Health and Adolescence Pregnancy: A Social Oblivion in India, Rohan Bhatt, Gautami Shah
Background: India remains a country, in which adolescent marriage remains extremely likely in addition to a high incidence rate of deplorable events and lack of education, which accounts for adolescent pregnancy. The oblivion towards the repercussions associated with adolescent pregnancy has led to a series of complications: both oral and systemic.
44 Obturator for Cleft Palate A Case Report, Nalam Sai Gautam, M Sridhar.
Background: Cleft lip and palate is associated constellation of problems that need to be solved for successful habilitation. Neonates with a cleft palate have difficulty in eating which may lead to failure to thrive. One of the immediate problems to be addressed in newborn is difficulty in feeding. Obturators are fabricated to overcome such problems in infants. The obturator prevents the tongue from entering the defect and interfering with the spontaneous growth of palatal shelves towards the midline. It also helps to position the tongue in correct position to perform its functional role in the development of jaws and contributes to speech development. A case of 1month old infant with cleft palate for whom obturator was made is presented here.
45 Reduced Proportion of Children Aged 3-5 Years who have Dental Caries Experience in their Primary Teeth in India, Applu Atrey, Rohan Bhatt, Jay Dave.
Background: Early childhood caries (ECC) is a serious public health concern especially for socially disadvantaged groups, in both developed and developing worlds. Yet, it remains relatively unexplored and poorly defined in many developing countries. The presence of high levels of ECC, despite a reduction in permanent-dentition caries through fluoridation of water and use of fluoridated tooth- pastes, begs for a broader look at social and behavioral factors that correlate with this form of the disease. All untreated Dental Carious lesions may not be detrimental to the general health; however, it significantly influences the QoL and dietary intake of children. Patterns of behavior learnt in early childhood are deeply ingrained and resistant to change and mother has an important role in this respect. Interventions found effective in preventing ECC in other populations has shown no demonstrable long- term or sustainable benefit in most communities.
46 Gardners Syndrome - A Case Report, Jay C Shah, Navin S Shah, Parshwa N.Shah.
Background: Gardners syndrome, a hereditary dominant condition, comprises of multiple osteomas, cutaneous and soft tissue tumors and polyposis coli. In 1951, Gardner reported the association between surface tumors and colonic polyps that are prone to malignant degeneration. It follows dominant hereditary pattern of multiple osteoma associated with colonic polyposis. The most commonly affected bones are the mandible and maxilla, followed by the frontal, sphenoid and ethmoid bones. The most common cutaneous finding in patients with Gardners syndrome is epidermoid cysts, which tend to be numerous and are present in the multiple forms in 50 65% of the patients.
47 Maxillary Supernumerary Premolars A Rare Case Report, Nalam Sai Gautam, Nalam Radhika Gautham.
Background: Supernumerary tooth (ST) is a developmental anomaly and has been argued to arise from multiple etiologies. These teeth may remain embedded in the alveolar bone or can erupt into the oral cavity. When it remains embedded, it may cause disturbance to the developing teeth. Hyperdontia is the condition of having supernumerary teeth, or teeth that appear in addition to the regular number of teeth. The prevalence of supernumerary teeth varies between 0.1 and 3.8% and is more common in the permanent dentition. These are more common in the mandible than in the maxilla. Presented here is a rare case of patient who was diagnosed with supernumerary premolar in both quadrants of maxilla discovered on routine radiographic examination.
48 Azithromycin in Periodontics, Chirayu Shah, Monali Shah, Deepak Dave, Prasad Nadig, Amit Shah.
Azithromycin is an azalide, a subclass of macrolide antibiotics. Azithromycin is used to treat many different infections, including acute otitis media, nonstreptococcal bacterial pharyngitis, gastrointestinal infections such as traveler's diarrhea, respiratory tract infections such as pneumonia, cellulitis, babesiosis, bartonella infection, chancroid cholera, donovanosis, leptospirosis, lyme disease, malaria, mycobacterium avium complex disease, neisseria meningitis, pelvic inflammatory disease, pertussis, scrub typhus, toxoplasmosis, and salmonellosis. It is used to prevent bacterial endocarditis and some sexually transmitted infections including those from unprotected sex or sexual assault. Azithromycin could have a triple role in the treatment and resolution of periodontal diseases: suppressing periodontopathogens, anti-inflammatory activity and healing through persistence at low levels in macrophages and fibroblasts in periodontal tissues, even after a single course of three tablets. If future periodontal research confirms these properties, it could become a valuable host-modulator in periodontal treatment.
49 Dental Stem Cells and their Applications in Regenerative Medicine-A Review, Neelampari Parikh, Zankhana Vyas, Gunjan Dave.
Among the types of adult stem cells, those derived from tooth structures have been receiving the attention of researchers over the past decade and inspiring hope for practical applications in the future. Dental stem cells are a valuable source of stem cells and are found in teeth with healthy pulp Till date five different human dental stem cells have been isolated and characterized: Dental Pulp Stem Cells (DPSCs), Stem Cells From Exfoliated Deciduous Teeth (SHED), Periodontal Ligament Stem Cells (PDLSCs), Stem Cells From Apical Papilla (SCAP) and Dental Follicle Progenitor Cells (DFPCs). The discovery of dental stem cells and recent advances in cellular and molecular biology have led to the development of novel therapeutic strategies that aim at the regeneration of oral tissues that were injured by disease or trauma. Dental Stem cells research has given newer conceptual approach to therapy of various diseases named regenerative dentistry and it will have its place in the clinical practice of dentistry in the future. This review, discusses the types of dental stem cells, their banking and their possible application in treatment of diseases in future.
50 Pattern of Malocclusion and Treatment need in Orthodontic Patients in Rural Population: An Institution Based Study, Tanvi Bihani
Objective: The aim of the study was to assess the prevalence and pattern of malocclusion among patients who visited Department of Orthodontics of Rajasthan Dental College and Hospital, Jaipur (Rajasthan) through a awareness program, being conducted at Bagru as a baseline data for proper treatment planning, teaching, and further research. Materials & Method: This study was conducted on 125 patients who attended the Orthodontic Department from November 2011 to November 2012. Information regarding age, sex, type of malocclusion, dentofacial patterns and dentofacial characteristics was obtained from patient records. Orthodontic treatment need was assessed using DHC component of IOTN. Results: The results of the study showed that the patients age ranged from 9 to 32 years. There were 63(50.4%) males and 62(49.6%) females. Chief complaints of majority of patients were forwardly placed upper teeth and irregularly placed teeth. The commonest type of malocclusion was Angles class II which was seen in 77 (61.6%) of patients. There was an increased overjet in 70.4% of subjects. Assessment of need for orthodontic treatment using the DHC component of IOTN showed that 46 (36.8%) were in great need of orthodontic treatment and 36(28.8%) had definite need of treatment. Conclusion: The results give a detailed pattern of malocclusion in orthodontic patients of rural area and may provide a baseline data for research and planning orthodontic services.
51 To Assess the Influence of Nanofilled and Nanoceramic Composite Restorative Systems on the Fracture Resistance of Maxillary Premolars with Class II Mesio-Occlusodistal Cavities, Manish Shah, Pranav Kharod, Aesha Amin, Mahendra Patel.
Objective: To assess the influence of nanofilled, and nanoceramic, composite restorative systems on the fracture resistance of maxillary premolars with Class II mesio-occlusodistal (MOD) cavities. Materials and Method: 30 sound maxillary human premolars were divided into 3 groups of 10 teeth each. Teeth in the first group were left intact and tested as unprepared positive controls. Teeth in the remaining two groups were prepared with MOD cavities and were restored with a nanofilled composite (Ice, SDI), a nanoceramic composite (CeramX mono). The specimens were loaded occlusally in a universal testing machine using a metal sphere that contacted only the teeth on the cuspal inclines until fracture occurred. The results were analysed by Kruskal-Wallis and Mann-Whitney U tests. The level of significance was set at 0.05. Results: No statistically significant difference in cuspal fracture resistance was found between the unprepared positive control teeth and those teeth restored with nano filled and nanoceramic composite (P > .05). Conclusion: Under compressive load testing, teeth with nanofilled and nanoceramic filled composite restorations had similar cuspal fracture resistance which was not statistically different form intact unprepared teeth.
52 Management of Gingival Hyperpigmentation Using Surgical Blade and Diode Laser Therapy: A Case Report, Sujal Shah, Vandana Rathwa, Monali Shah, Deepak Dave.
Gingival hyperpigmentation has been a major concern for a large number of patients visiting the dentist. Clinicians are challenged for attending to and correcting this biologic, esthetic and functional problem. Melanin, a non-hemoglobin derived brown pigment, is often abnormally deposited in the basal and suprabasal cell layers of gingival epithelium due to which the gums appear black particularly in patients having a high smile line. Several depigmentation procedures like scalpel surgery, gingivectomy with free gingival autograft, electrosurgery, cryosurgery, laser therapy using Nd:YAG, diode or CO2, abrasion with diamond bur, chemical agents like 90% phenol and 95% alcohol have been employed for removal of melanin pigmentation. The present case report describes two distinct surgical depigmentation procedures: scalpel blade surgery and semiconductor diode laser for complete removal of gingival pigmentation, tissue healing following the surgery and fulfillment of patient centered outcomes like satisfaction, pain intensity assessment and adverse events. Diode is a solid state semiconductor laser that combines Gallium (Ga), Arsenide (Ar) and other elements like aluminum (Al) and Indium (In), converting electric energy into light energy. In this report both the surgical techniques have shown excellent results, however scalpel blade surgery showed marginally better results in terms of tissue healing and esthetics.
53 Pregnancy Tumor of Gingiva: A Case Report with Review of Literature , Nilesh Raval, Hiren H Patadiya, Chintan Modi, Abhishek Nimavat, Suhani Khamar, Kanan Vachhrajani.
Pyogenic granuloma or granuloma pyogenicum or pregnancy tumor is a well-known oral lesion which is a fast growing reactive proliferation of endothelial cells mainly seen on the gingiva. It usually arises in response to various stimuli such as traumatic injury, local irritation, hormonal factors, or certain kinds of drugs. This article presents a detailed case history with complete investigation and thorough review of pregnancy tumor.
54 Dermal Fillers - Role in Post Orthognathic Surgery and Orthodontics A Review, MR Haranadha Reddy, Vimala Manne, Ranjit Manne, NVS Sekhar Reddy, John Koshy, Sri Harsha Konuru.
Background: Patients seeking correction of dental or dentofacial deformities also present with concomitant soft tissue deformities like decreased lip length, increased or decreased lip thickness, inadequate vermillion show etc. Correction of skeletal or dental deformities alone may not achieve appreciable results unless a focus is made on the correction of soft tissue deformities during the treatment planning. Soft tissue deformities that exist with the skeletal or dental deformities may be self-corrected by Orthognathic surgery/Orthodontics or combination of both. But in many situations adjuvant procedures to the perioral structures may need to be performed to get the optimal overall results. This can be accomplished by dermal fillers, Botulinum Toxin A injections or by surgical soft tissues procedures.
55 To Evaluate the Effect of Steel Strengtheners on Fracture Resistance of Heat Cured Methyl Methacrylic Resin An in Vitro Study, Anantha Reddy, Vijay Prasad Koganti, Parth Satwalekar, Sudharshan Reddy, Ramaswamy Reddy, N Sandeep.
Aim: The acrylic resin material is an indispensable material in removable prosthodontics. There has been continuous search to reduce processing time and enhance physical properties such as strength deformation. Fracture of acrylic resin is an unresolved problem in removable prosthodontics. Numerous attempts have been made to determine its causes. The present study was done to compare the fracture resistance of acrylic resin denture base reinforced with steel strengtheners. Materials and Methods: To measure the fracture resistance of heat cure acrylic resin, a total of 45 specimens were prepared and divided into 3 categories: Group1: No strengtheners, Group 2: Thin gauge strengtheners and Group 3: Thick gauge (0.6 mm X 7 mm). All the samples prepared were of specific dimensions i.e. 55 mm in length, 22 mm in width and 3 mm in thickness as a means for standardization. The flexural strength of the samples was recorded using a universal testing machine and the data obtained was statistically analysed. The statistical analysis was done by calculating the average and standard deviation for each parameter used in the study. To find out the significant difference between different concentrations and different time intervals unpaired t test was performed. Here p andt value is used to evaluate the fracture resistance. Results: Acrylic samples with steel strengtheners fared better when compared to those without steel strengtheners. Thick gauge strengtheners were found to be more resistant to fracture. The difference was statistically significant. Conclusion: The incorporation of thick steel strengtheners few millimetres apart and perpendicular to anticipated line of fracture will produce significant resistance to flexure and reduce the likelihood of fracture of the acrylic resin denture base.
56 A Clinical Comparison of Three Techniques of Mandibular Local Anaesthesia , Sthitaprajna Lenka, Nikil Jain, Rajat Mohanty, Dhirendra Kumar Singh, Minkle Gulati.
Aim: Inferior dental anaesthesia via the direct intraoral approach, mandibular conduction anaesthesia via extraoral landmarks (Gow-Gates) and mandibular conduction anaesthesia via the tuberosity approach (Akinosi) were evaluated using pain during injection, aspiration test, pinprick, depth and frequency of anaesthesia, onset and duration of anaesthesia. Materials and Methods: 120 patients of both sexes, aged from 16 years to 50 years undergoing mandibular molar tooth extraction were included. They were randomly designated into 3 groups with regards to the applied technique of mandibular anaesthesia. Each patient was given injection of 2 ml of 2% lignocaine with adrenaline (1:80,000) using 2ml disposable syringes and a 25 gauge, 1.5 inch needle. Results: Classical inferior nerve block showed greater incidence of pain among the applied techniques. Positive aspiration was most frequently observed with classical inferior nerve block. The onset of anaesthesia was found to be slower with Gow-Gates technique while duration of anaesthesia was longer. Mandibular conduction anaesthesia via the tuberosity approach did not show any particular advantage over the other two techniques in this study. Conclusions: After using Gow-Gates method, it was found that the Gow-Gates technique is a highly successful alternative to the conventional inferior nerve block with regards to increased success rate, constancy of landmarks, decreased positive aspiration rate, decreased incidence of complications such as trismus, the advantage of one injection to anaesthetize a greater area supplied by the mandibular nerve, longer duration of anaesthesia and less amount of pain experienced during injection.
57 Comparison of Shear Bond Strength and Surface Structure Between Acid Etching and Air-Abrasion Techniques, A Radhika Reddy, Vijay Prasad Koganti.
Aim: To compare shear bond strength and surface structure between acid etching and air-abrasion techniques Materials and Methods: Sixty three extracted human premolar teeth were taken, divided into three groups and mounted with color codings. Group l was acid etched with 37% phosphoric acid. Group ll and lll air abrasion was done with 50 & 90 Al2O3 particles respectively. After enamel preparation, from each group one tooth was selected for surface roughness study by scanning electron microscope (SEM). The other sixty teeth were selected to evaluate shear bond strength by Instron universal testing machine. Results: Group I showed significantly higher shear bond strength (10.1 3.6 Mpa) than Group II and Group III. In SEM study Group l etching pattern showed peripheral dissolution of the prisms. The enamel removal of Group ll was more regular, uniform and less as compared to Group lll. Adhesive remnant index showed that no adhesive material was left on the tooth surface of Group ll & lll as compared to Group l after debonding. Conclusion: From the present study it was concluded that air abrasion can be used as an adjunct to acid etching but by itself it is not a potent enamel preparation agent.
58 Antimicrobial Efficacy of Emblica Officinalis Fruit Extracts on S.Mutans, E.Faecalis and C.Albicans, Shrudha Potdar, Nagesh Lakshminarayan, Siddana Goud R.
Objective: Emblica officinalis fruit is used in Indian traditional medicine since ages as an antimicrobial agent. Review of literature yielded a paucity of studies related to the effect of Emblica officinalis fruit extract against Streptococcus mutans, Enterococcus faecalis and Candida albicans, so the present study was designed. Our aim was to determine the antimicrobial efficacy of ethanol, acetone and distilled water extracts of Emblica officinalis against Streptococcus mutans, Enterococcus faecalis and Candida albicans. Materials and Method: Extract of Emblica officinalis in ethanol, acetone and distilled water were obtained by cold maceration. The crude residue was obtained by evaporation at room temperature. The antimicrobial efficacy of Emblica officinalis in all extracts were assessed against oral microorganisms by finding out zone of inhibition and minimal inhibitory concentration. Results: Emblica officinalis in ethanol, acetone and distilled water were found to be effective against Streptococcus mutans, Enterococcus faecalis and Candida albicans by highest zone of inhibition being 38 mm for acetonic extract of emblica officinalis against Enterococcus faecalis. Minimum inhibitory concentration of ethanolic and acetonic emblica officinalis extracts for Candida albicans was established at 0.09% and distilled water extract at 1.56%. Minimum inhibitory concentration for ethanolic extract of emblica officinalis for Enterococcus faecalis was 3.12%, acetonic extract of Emblica officinalis was established at 0.39% and distilled water extract of emblica officinalis was established at 12.5%. Conclusion: Emblica officinalis could be considered as an effective antimicrobial agent. The antimicrobial activities can be enhanced if the phytoactive components are purified and adequate dosage determined for proper administration.
59 All Zirconia: A New Material for Posteriors with Minimal Tooth Preparation, Asha M Rathod, Omkar K Shetty, Sameer R Gharat, Raina Dsouza.
Background: Planning and executing the restorative rehabilitation of a decimated dentition is probably one of the most intellectually and technically demanding tasks being faced by a dentist. Full mouth rehabilitation involves restoring the dentate or a partially dentate mouth to provide an orderly pattern of occlusal contact and articulation that will optimize oral function, occlusal stability and esthetics. This case report demonstrates a full mouth rehabilitation of a patient for esthetically and functionally compromised dentition by a recently introduced metal-free restoration. The final prosthesis ensured a restoration resulting in predictable posterior disclusion and anterior guidance in harmony with the condylar path.
60 Two Rooted Mandibular First Molar with Three Distal Canals A Case Report, LR Surendra, Y NarendraNath Reddy, E Sivaprasad Reddy, D Ramaraju, T Yehoshuva Reddy.
Background: The Mandibular first molar is the tooth that requires root canal treatment most often. It usually has two roots with two canals mesially and one or two canals distally. A mandibular first molar with more than four canals represents a rare anatomical variation, especially when the three canals are found in distal root. With increasing reports of aberrant canal morphology, the clinician needs to be aware of this varied anatomy. This case report discusses endodontic management of 2 rooted mandibular molar with 3 distal canals (disto-buccal, middle- distal, disto-lingual) and 2 mesial canals.
61 An Unusual Case of All Impacted Mandibular Anterior Teeth, GV Reddy, GS Prasada Reddy, CN Sreenivas, I Venkata Krishna, K Dinesh Sharma.
Background: Multiple impacted teeth by itself is a rare condition and often found in association with syndromes. A rare case of multiple impacted mandibular anterior teeth in which no syndrome or systemic conditions are associated is being reported.
62 A Case Report of Ridge Augmentation using Onlay Interpositional Graft: An Approach to Improve Prosthetic Prognosis of a Deficit Ridge, Devanand Shetty, Suyog Dharmadhikari, Arvind Shetty, Ranjeet Bapat.
Background: Periodontal therapy has developed beyond the scope of the treatment of periodontal pathoses. Periodontal plastic surgery consists of the reconstructive procedures designed to enhance the both function and esthetics. Deficient ridges pose a severe problem to the restorative dentist in restoring the natural form, function and esthetics of the prosthesis replacing the natural dentition. Depending upon the severity, location of these defects and the prosthetic option chosen, hard and soft tissue ridge augmentation or non-surgical approach or a combination may help to address them. The present clinical report describes a soft tissue ridge augmentation of a localized ridge defect in maxillary aesthetic region using onlay interpositional graft followed by fixed partial denture.
63 Idiopathic Gingival Enlargement A Case Report, Sanyuktha Shetty, Arvind Shetty, Devanand Shetty, Suyog Dharmadikari.
Background: Idiopathic gingival fibromatosis is a rare hereditary condition that has no definite cause. The pathogenesis of gingival fibromatosis is still unknown but an increase in proliferation of the gingival fibroblasts as well as increased collagen synthesis may be involved. In modern times, a mutation in the son of sevenless-1 (SOS-1) gene has been suggested as a possible cause of isolated (non-syndromic) gingival fibromatosis, but no definite linkage has been established. A twenty four year old patient presented with gingival enlargement since one year. Based on clinical and radiographic examination, laboratory tests, and thorough oral hygiene instructions, an external bevel gingivectomy was performed to remove excess gingival tissue. There was recurrence within two months following the surgery. The exact cause of the gingival enlargement was not identified, although amelioration of the fibrotic, enlarged gingiva was observed which recurred within two month after performing conventional gingivectomy. Recurrence of gingival fibromatosis in such patients can also be attributed to genetic predisposition.
64 Crouzon Syndrome A Rare Case Report, Ramesh Pandey, Shefali Sharma, Mastan Mukarrab, Santosh Kumar.
Background: A 13 year old boy presented with gradual poor grade in his school performance. Parents of the boy were worried because of his deteriorating academic performance and physical appearance. Patient was subjected to thorough clinical examination and Radiological examination and was found to be having features and findings consistent with Crouzon Syndrome. The patient was properly counselled and was lost to follow up after 6 months due to his social and economical constraints.
65 Accuracy of Different Elastomeric Impression Materials Using Dual Arch Impression Trays: An In Vitro Study, Sareen Duseja, Dipti Shah, Kalpesh Vaishnav, Shilpa Duseja, Santosh Kumar, Khushboo Desai.
Aim: This study was done to evaluate the accuracy of dies obtained after pouring different elastomeric impression materials in different viscosities using dual arch/ triple trays. Materials and Method: Tooth preparation was done on mandibular left first molar in a typodont. Fifty impressions each of condensation silicon (putty and light body), vinyl polysiloxane (putty and light body), monophase vinyl polysiloxane and monophase polyether were made in dual arch/triple trays. These impressions were poured in Type IV gypsum. The buccolingual width of the prepared tooth was calculated and was compared with the dies prepared using stereomicroscope. The data was subjected to ANOVA test. Results: The dies obtained from impressions made with monophase vinyl polysiloxane in triple trays were most accurate followed by monophase polyether, condensation silicon (putty and light body) and vinyl polysiloxane (putty and light body). Conclusion: Triple trays when used in conjunction with proper impression material and technique may prove to be a simplified yet accurate method of impression making.
66 Comparative Evaluation of the Tensile Bond Strength of Custom and Pre-Fabricated Posts An in Vitro Study, Heena Fuletra, Kamal Bagda, Suman Makam, Kruti Patel, Niket Kachhi.
Aim: To evaluate the effect of cyclic loading on the tensile bond strength and retention of custom?fabricated cast posts, prefabricated metal posts and glass fiber posts. Materials and Method: Thirty extracted human maxillary central incisors were decoronated at the cementoenamel junction (CEJ) and randomly divided into three groups (n=10). Specimens were instrumented and obturated. Twenty four hours after obturation, post space was prepared upto no. 5 Peeso Reamer. Groups A, B and C were restored using custom cast post and core, Para Post (Whale dent) and Reforpost (Angelus) respectively thereafter. Five specimens from each group were subjected to cyclic loading. Tensile bond strength (TBS) of teeth before and after cyclic loading was evaluated. Results: For both, with and without loading, Groups A and B were not significantly different from each other but Group C was significantly different from Groups A and B. The results indicated that cyclic loading reduces retention potential of all three types of post, but it was minimum in group C. Conclusions: Cyclic loading reduced the retention of all posts but was comparatively lesser for the glass fiber post. This system provides sufficient retention required for clinical success.
67 Comparative Analysis of Fracture Resistance of Maxillary Premolars with Class II MOD Cavities Restored with Novel Nanocomposites Including Fibre Reinforced Composite Restorative System: A Step Ahead in Composite Dentistry, Chintan Joshi, Mahendra Patel, Parth Desai, Pathik Patel.
Aim: To determine the influence of nanocomposites such as nanofilled, nanoceramic and fibre reinforced composite restorative systems on the fracture resistance of maxillary premolars with Class II mesio-occlusodistal (MOD) cavities. Materials and Method: Eighty sound maxillary human premolars were divided into four groups of 20 teeth each. Teeth in the first group were left intact (unprepared) and tested as positive controls. Teeth in the remaining three groups were prepared with MOD cavities and were restored with a nanofilled composite (Ice), a nanoceramic composite (CeramX mono) and a fibre reinforced composite (Tetric N Flow & CeramX mono). All groups were stored in water at 37C for 24 hours and thermocycled and then tested in universal testing machine. Statistical analysis was done by Kruskal-Wallis and Mann-Whitney U tests. The level of significance was set at 0.05. Results: Results between each group were statistically significant (P> 0.05) except between nanoceramic and fibre reinforced composite system. Conclusion: Under compressive load testing, all restored teeth had lower cuspal fracture resistance than unprepared control teeth. Nanoceramic showed the highest mean cuspal fracture resistance while nanofilled showed the least and fibre reinforced composite proved to be a true tooth reinforcing agent.
68 A Comparative Evaluation of Stress Distribution at the Implant Abutment Interface between Platforms Switched Morse Taper and Pseudo Platform Switched Internal Hex Connection Implant A 3D Finite Element Analysis, Anuradha Borse, Rubina Tabassum, Omkar Shetty.
Aim: The purpose of the study was to evaluate and compare the stress distribution at the implant abutment interface in a platform switched Morse taper and pseudo platform switched internal hex connection implant system under simulated load using a 3D finite element analysis. Materials and Method: In the study ANKYLOS which is a Morse taper platform switching implant system (Group A) and XiVE having an internal hex connection which forms a pseudo platform switched implant system (Group B) were used. The geometric properties of implant systems were modeled using 3D finite element analysis. The masticatory forces of 200 N, 500 N and 1000 N were applied axially to both the implant systems with the abutment screw tightening torque of 110 Nm2, 320 Nm2 and 550 Nm2. Von Mises stress distribution pattern was analyzed considering the objectives of the study. In order to interpret the result, the data generated by finite element analysis (FEA) were statistically analyzed. Results: There was better stress distribution for Group B at the neck of implant as compared to Group A but on screw Group A showed more decrease in force concentration and therefore better stress distribution. Conclusion: Stress concentration on connecting screw of pseudo platform switch implant was more and may lead to fracture or loosing of screw than platform switched Morse taper implant.
69 Percutaneous Injuries Amongst Dentists of Ahmedabad City: A Questionnaire Survey, Akash Azad, Niraj Kinariwala, Rupal Vaidya, Shraddha Chokshi.
Aims: To investigate amongst endodontists the incidence of percutaneous injuries, the circumstances associated with them, the therapeutic measures taken after the injuries and their compliance with infection control measures. Materials and Method: Information on percutaneous injuries and infection control practices were gathered from one hundred and forty endodontists through a questionnaire form. Data was analysed using independent samples t-test. The level of significance was set at p?0.05. Results: Endodontic files were associated with 66% of the injuries and fingers were injured in 75% of the most recent cases. Medical assistance was sought in 36% of the most recent injuries. Endodontists, who always or usually practiced 4-handed endodontics (p?0.007) as well as those not performing surgical endodontics (p?0.007) reported significantly fewer injuries. In 91% of the participants, a complete hepatitis B virus vaccination was reported. Gloves, Double gloves, Long sleeve labcoat and puncture-resistant containers for disposal of sharp instruments were always used by 92.6%, 58%, 19% and 63.4% of the respondents respectively. Conclusion: The practice of four-handed endodontics was associated with reduced number of percutaneous injuries but the performance of surgical endodontics increased their incidence. Also the endodontists showed a high level of compliance with infection control measures.
70 Comparison of Palatal Rugae Pattern among North Indian, South Indian and Chinese Students of Manipal University40, S Venu M Reddy, N S Gautam, T Hanumanth Rao, N Radhika Gautam, Ravichandra Koganti, Rohit Agarwal.
Aims: To compare the palatal rugae pattern for possible differences between North Indian, South Indian and Chinese students of Manipal University, Manipal. To determine the rugae length, shape, direction, unification and number of the primary rugae. Materials and Method: The study sample consisted of 50 diagnostic study models of 25 males and 25 females within the age group of 15-23 years that were available in the department and were free from palatal defects. These cases were further segregated into 10 cases of each of North Indian, South Indian and Chinese groups and their dental casts were analyzed. Results: There were no significant differences in any parameter when compared between the sexes in the three groups. The difference in length among 3 groups was not statistically significant. The most common rugae shapes observed were wavy and curved. The North Indian group had a predominantly curved rugae shape while the South Indian and Chinese groups had wavy rugae. The rugae direction observed was mostly forward. Most of North Indians and South Indians had forward rugae and Chinese group had both types. Conclusion: The present study indicated that the rugae patterns of the Chinese group are significantly different from the two Indian groups and can hence be used for group identity.
71 Clinical and Histopathological Evaluation of Healing After Excision of Leukoplakia with Diode Laser, Kruti A Shah, Hemal R Brahmkshatriya, Rushit J Patel, Mansi H Brahmkshatriya.
Aim: Oral Leukoplakia is considered commonest precancerous white lesion affecting oral mucosa. There are several medicinal and surgical options available to treat the lesion. Scalpel removal of the lesion leads to scar formation and pain along with bleeding at the time of surgery. Removal with Laser is another option for managing leukoplakia. There are very few studies present with removal of leukoplakia using Diode Laser. This study was undertaken to clinically and histopathologically evaluate the efficacy of Diode Laser in leukoplakia. Materials and Method: Six patients, 5 male (84%) and 1 female (16%) with leukoplakia were treated with Diode laser (980nm) at 3 - 4 watts. Patients on steroid therapy or immune-suppressants and suffering from any other chronic debilitating diseases were excluded from the study. Wilcoxon Signed Ranks Test was applied for assessing the p-Value for statistical analysis. Result: After one month, the patients were examined for normal clinical healing of the site. For more confirmation, re-biopsy was done and result showed normal tissue healing except in one patient (16%). Only one patient (16%) developed pain, swelling, fibrosis and recurrence. Conclusion: It was concluded that laser provides good coagulation, healing, reduces surgical time and prevents high-grade infection.
72 Correlation of the Condylar Guidance Obtained by Protrusive Interocclusal Record and Panoramic Radiographs in Completely Edentulous Patients: An in Vivo Study, Khyati Shah, JR Patel, Tamanna Chhabra, Pathik Patel.
Aim: The purpose of this study was to evaluate the reliability of programming the articulator using the radiographs and the interocclusal records made during Jaw relation (Arrow point tracing). Materials and Method: The study comprised of 15 edentulous subjects with well formed maxillary and mandibular ridges, with no signs and symptoms of temporomandibular joint disorders and neuromuscular disorders. Digital Orthopantomograph was taken for all the subjects. The condylar guidance angles were traced on Orthopantomograph for right and left sides and the values were recorded. The protrusive interocclusal records were made at jaw relation stage and at try-in stage using bite registration paste for all subjects. These interocclusal records were used to programme the Semi-adjustable articulator (Hanau Wide Vue) and the condylar guidance values on the right and left sides were recorded. The condylar guidance values so obtained were compared with the values obtained by Orthopantomograph. The condylar guidance values obtained by the various procedures were subjected to independent t-test and Pearson correlation test. Results: The results showed statistically significant difference between the condylar guidance values obtained from Orthopantomograph (Radiograph) and the condylar guidance values obtained at the stage of jaw relation. Conclusion: Within the limitations of the study, it can be concluded that the condylar guidance values obtained from the Radiographs were higher than those obtained at the stage of jaw relation recording stage.
73 A Comparison of Clinical Efficacy of Dentifrices Containing Calcium Sodium Phosphosilicate, Nanoparticle Hydroxyapatite and a Dentifrice Containing Casein Phosphopeptide Amorphous Calcium Phosphate on Dentinal Hypersensitivity- A Comparative Triple Blind Randomized Study, Pinojj, Arvind Shetty, Devanand Shetty, Sanyuktha Shetty.
Aim: A considerable number of agents are effective in the treatment of dentin hypersensitivity. This3 month randomized clinical trial compares a dentifrice containing Calcium Sodium Phosphosilicate, Nanoparticle Hydroxyapatite and Casein Phosphopeptide-Amorphous Calicium Phosphate. Materials and Method: Eighty teeth were selected in each group. The volunteers selected at baseline had a history of dentin hypersensitivity caused by gingival recession or after scaling and root planing. Patients were evaluated for dentin hypersensitivity using visual analog score and Schiff test. Patients were required to have a visual analog scale score of 2 to be included in the study. After sensitivity scores for controlled air stimulus and cold water at baseline were recorded, subjects were given toothpastes randomly and sensitivity scores were measured again at 2nd week, 4th week, 2nd month and 3rd month. Results: All three groups showed reduction in sensitivity scores at 2weeks, 4 weeks and at 3 months for air stimulus and cold water. The nanoparticle hydroxyapatite group was found to be significantly better in reducing the visual analog scale score as well as Schiff test score and at any time point for both measures of sensitivity. Conclusion: The Nanoparticle Hydroxyapatite group showed comparable reduction in the symptoms of dentin hypersensitivity.
74 Successful Management of Tubal Ectopic Pregnancy with Transvaginal Sonography Guided Intracardiac KCL Injection and Systemic Methotrexate A Case Report, Sumesh Choudhary, Vineet V Mishra.
Background: Methotrexate (Mtx) is an accepted modality for conservative treatment of ectopic pregnancy. However, there is no consensus regarding its use in live ectopic pregnancy and high serum beta-human chorionic gonadotrophin (?-hCG) titres. Concurrent use of intra-sac hypertonic KCl, to produce cardiac asystole with systemic Mtx potentially improve outcome in live ectopic gestations with very high serum ?-hCG titres. Here a successful management of live ectopic pregnancy in a 25-year-old nulliparous woman, with very high ?-hCG titres (29502.04mIU/mL), using ultrasound-guided intra-cardiac potassium chloride (KCl) injection and systemic Mtx is reported. No treatment related complications were encountered. However, individualized treatment with a stringent follow-up regime is mandatory in such cases.
75 Rehabilitation of a Partial Rhinectomy Patient with Eyeglass Supported Provisional Nasal Prosthesis A Case Report, Dipti Shah, Kalpesh Vaishnav, Sareen Duseja, Saloni Naik.
Background: Acquired facial defects caused by extirpation of neoplasms, congenital malformations or traumatic injury results in a huge functional, cosmetic and psychological handicap in those patients. These defects can be restored by facial prosthesis using different materials and retention methods to achieve a life-like appearance and function. This clinical report describes a treatment schedule using mechanically retained poly methyl methacrylate (PMMA) resin nasal prosthesis for a patient who has undergone a partial rhinectomy due to squamous cell carcinoma of the nose. The prosthesis was made to restore the esthetic appearance of patient with mechanically retained spectacle glass frame prosthesis without any prosthetic adhesives so that the patient is more comfortable and confident to resume daily activities.
76 Inverted and Impacted Third Molars Report of Two Rare Cases with Literature, Rushit Patel, Jayanti Patel, Vandana Shah, Rakesh Shah, Vikas Bhakhar.
Background: Teeth start to erupt during infancy and again when the primary teeth are replaced by the permanent teeth. If a tooth fails to erupt or emerges only partially, it is considered to be impacted. This most commonly happens with the wisdom teeth as they are the last teeth to erupt in the oral cavity between 17 to 21 years. An impacted tooth remains stuck in gum tissue or bone for various reasons as in overcrowded regions were there could be no room for them to emerge or if the jaw is too small to fit the wisdom teeth. Teeth may also become twisted, tilted or displaced as they try to emerge resulting in impaction.
77 Sturge Weber Syndrome - A Rare Cause of Childhood Epilepsy, Parthvi Patel, Prasad Muley.
Background: The Sturge Weber syndrome (SWS) or Encephalotrigeminal Angiomatosis is a congenital, non-hereditary rare condition of unknown etiology. The classic pathognomonic features of disease include angioma of the leptomeninges extending to cerebral cortex with ipsilateral angiomatous lesions, unilateral facial nevus usually affecting one division of trigeminal nerve and convulsions. Here, a case of 4 year old male child who presented with congenital skin lesions, convulsions and glaucoma that was diagnosed as type I SWS is being reported.
78 Natal Teeth Report of Two Cases, Nalam Sai Gautam1, N. Radhika Gautham.
Background: Presence of Natal and neonatal teeth are a rare event in the oral cavity, which may interfere with breast feeding & may lead to numerous complications. The decision to keep or to extract these teeth should be evaluated in each case, keeping in mind the scientific knowledge, clinical common sense and parental opinion. A case of immature natal maxillary anterior teeth and a case of natal mandibular anterior tooth are reported.
79 Evaluation of Recurring Esthetic Dental Proportion in Natural Mandibular Anterior Dentition, Dipti S Shah, Kalpesh Vaishnav, Sareen Duseja, Rima S Sheth.
Aim: The concept of the Recurring esthetic dental (RED) proportion is useful in diagnosing and developing symmetry, dominance and proportion for esthetically pleasing smiles. This study was undertaken to evaluate validity of RED proportion in mandibular anterior teeth. Materials and Method: One hundred and three subjects in age group of 50 yrs. and more were selected for the study. Photographs of subjects were taken using Nikon D200 camera with 135mm lens and analyzed using Adobe Photoshop CS4 extended software. The widths of mandibular central incisor, lateral incisor and canine were measured with this software and their successive proportions were calculated. Results: After calculating proportions in mandibular anterior teeth, P value was found to be statistically insignificant (P>0.05). Conclusion: Within the limitations of the study, RED proportion was not seen in mandibular natural dentition.
80 Importance and Calculation of Pharyngeal Spaces and Hyoid Position Before and After Orthognathic Surgery, Dhruv Yadav, Divyaroop Rai, Vikas Gill, Akrati Dosi, Abhilasha Choudhary.
Aim: The purpose of the study was to examine the changes in dimension of pharyngeal airway spaces (PAS) and hyoid bone position after surgery in class II and class III skeletal malocclusion. Methods: This study included 50 patients of class II and class III skeletal and dental malocclusion who had undergone orthognathic surgery. The pre and post treatment lateral cephalograms were taken to calculate upper and lower air way spaces and position of hyoid bone was also measured before and after the surgery. Results: Changes in upper and lower airway spaces and alteration in the location of hyoid bone was seen in Class II cases only. Conclusion: Maintaining of lower air way spaces in surgical class III cases of mandibular set back and position of hyoid bone is very important.
81 Evaluation of Preformed Stainless Steel Crowns Crazing by Various Sterilization Methods of Steam Autoclave: A Pilot Study, Shital DP Kiran, Megha C Patel, Rohan Bhatt, Kuntal Bhatt.
Aim: To evaluate the crazing of preformed stainless steel crowns by two different temperatures of autoclave sterilization. Materials and Method: 15 stainless steel crowns (3M ESP) were divided into 3 groups namely Group 1(G1) which was taken as control, Group 2(G2) which underwent Steam autoclaving at 121c, 15psi pressure for 20 minutes and Group 3(G3) which underwent Steam autoclaving at 132c, 30psi pressure for 8 min. The changes on the vestibular surface were then scored for presence or absence of crazing by using stereomicroscopy. The data was then analysed. Results: In control group the surface was relatively smooth when observed under stereomicroscope. However, in Group 2 cracks involving one-third to one-half of the surface were seen under stereomicroscope. Similar results were obtained in Group 3. Conclusion: Technique of steam autoclaving of sterilization has harmful effect on the surface of stainless steel crowns.
82 Comparative Evaluation of Two in Office Bleaching Systems and the Effect of Light on Their Bleaching Efficiency An in Vivo Study, Sameer V Savaliya, Manish B Shah, Pooja N Patel, Margi R. Patel.
Aim: In office bleaching has gained popularity in recent times as one of the most efficient and cost effective technique for treatment of discoloured teeth. Aim of this study was to evaluate the bleaching efficiency of two different In office bleaching materials and the efficacy of light on the shade change. Materials and Methods: 24 patients were randomly assigned to 4 treatment groups. Treatment involved application of 40% H2O2 (Opalescence Boost, Ultradent, US), 35% H2O2 (Whiteness HP Maxx, FGM Dental Products, Brasil) with and without using LED Bleaching light. Evaluation of shade change was done subjectively (Vita Classical shade guide) as well as using spectrophotometer (Vita Easy shade). Results: Statistical analysis of data revealed that there was no significant difference among the two bleaching materials with or without the use of light, but a significant difference was observed when bleaching with light was compared to bleaching without light. Conclusion: The use of light enhances the bleaching efficiency of in office beaching gels irrespective of the concentration.
83 Single Puncture Arthrocentesis for the Inflammatory Temporomandibular Joint Disorders, Naveen Rao, Prithish Patnayak, Shreyas Sorake, Ashish Shetty, Chethan M Koteswara, Vikram Bhat.
Aim: Arthrocentesis of the temporomandibular joint traditionally involves irrigation of the upper joint space and manipulation of the joint, using 2 needles inserted through two separate puncture sites. The blind insertion of the second needle is often challenging. The surgeon may lose the right place during the procedure. So it may need manipulation and sometimes even multiple punctures. This often leads to extra-articular leak of the lavage solution which decreases the intra-articular pressure required for lysis. To overcome this unwanted clinical situation, a simple technique of introducing both the needles through a single puncture to accomplish the procedure of arthrocentesis more effectively has been followed in this study. Materials and Method: This study was conducted on 20 patients diagnosed with inflammatory conditions of the temporomandibular joint. Patient underwent arthrocentesis using a modified dual needle device with Ringers lactate as a lavage solution. Pre-op and post-op data were recorded over three months and analyzed statistically. Results: Mouth opening and visual analogue score for pain which were analyzed by student paired t test revealed that mouth opening increased and pain decreased significantly (p
84 Evaluation of the Efficacy of Commercially Available Nano-Hydroxyapatite Paste as a Desensitizing Agent, Meghna Amin, Rupal Mehta, Shilpa Duseja, Khushboo Desai.
Aim: To evaluate the efficacy of commercially available nano-hydroxyapaptite paste as a desensitizing agent. Materials & Methods: The study included 30 subjects complaining of dentinal hypersensitivity. After prophylactic scaling & root planing, patients were instructed to brush with the given commercially available nano-hydroxyapatite paste twice a day. A numeric rating scale was used to measure the parameter of pain related to the stimuli at the baseline and after the application of gel at the intervals of 24 hours, 1 month, 3 months and 6 months. Results: There was remarkable decrease in the dentinal hypersensitivity at the end of 6 months. Intragroup comparisons at various time intervals were significant (p
85 Pattern and Knowledge of Wrights Modification of Frankls Behavior Rating Scale Followed among Postgraduate Students of Pediatric Dentistry in Ahmedabad City A Survey, Shital Kiran, Rohan Bhatt, Megha Patel, Nilay Shah.
Aim: To check the knowledge and technique of Wrights modification of Frankls behavior rating scale among postgraduate students of pediatric dentistry in Ahmedabad city. Materials and Method: 21 postgraduate students studying in pediatric dentistry of different colleges from Ahmedabad city were selected. A questionnaire containing various questions regarding Wrights modification of Frankls behavior rating scale was asked to fill. Result: The results suggested that they use this scale routinely and rate it properly but there are differences in timing of the rating. Conclusion: All Post Graduate students in pediatric dentistry from Ahmedabad city colleges use Wrights modification of Frankl behavior rating scale routinely and correctly.
86 Integrated Surgical and Orthodontic Treatment: A Twinned Teeth Dilemma , Seema D Bargale, Shital Kiran DP.
Background: Twinned or geminated teeth may cause spacing, caries, aesthetic and periodontal problems which are usually seen in the anterior region. Various treatment methods can be used for correction of double teeth according to the demands of the condition. This article reports bilateral fused maxillary incisor teeth. The fused right side incisor was separated by hemisection and remaining mesial incisal margin was built using composite. Further, comprehensive orthodontic treatment was done to align the anterior maxillary teeth.
87 Sub Mental Intubation in Facio-Maxillary Injury, Palak Chudasama, Milan Mehta, Parv Doshi, Gyanendra Mishra, Dushyant Baraiya.
Background: Airway management in patient with Facio-Maxillary injury is challenging due to disruption of components of upper airway, and anesthesiologist has to share the airway with the surgeons. Submental Endotracheal Intubation is safe, simple and useful technique, where oral and nasal Endotracheal Intubation cannot be performed. It avoids tracheostomy and its consequent morbidity. Here is described a case of Submental endotracheal Intubation in a 52 years old patient with panfacial trauma (FMI). He was schedule for surgical reconstruction involving Maxilo-Mandibular Fixation. Intermittent intra-operative, dental occlusion was needed to check alignment of fractured segment. Patient had nasal bone fracture and crush injury to tongue and its challenging task for an anesthesiologist to manage such airway without further damage to upper airway. Several techniques have been proposed. In this case Submental endotracheal Intubation technique for surgery with the help of surgeon was used and intra operative and post-operative period was uneventful.
88 Riga-Fede Disease: Report of a Case with Literature Review, Rohan Bhatt, Bhavna Dave, Megha Sheth.
Background: The term Riga-Fede disease has been used historically to describe traumatic ulceration that occurs on the ventral surface of tongue in neonates and infants. It is most often associated with natal and neonatal teeth in newborns. A case of Riga-Fede disease is presented here.
89 Multinucleated Giant Cells in Unicystic Ameloblastoma: A Very Rare Case Report and Review of the Literature, MS Muni Sekhar, Kiran G, KV Ramana Reddy, Krishna A, Charu Suri.
Background: Occurrence of giant cells has been reported in malignancies of pancreas, breast and thyroid but rarely in benign tumors. However, giant cells were observed in some benign odontogenic neoplasms like solid multicystic ameloblastoma. Studies were carried out in the past to establish the origin and nature of these giant cells and the results were quite variable. Here, a very rare case of unicystic ameloblastoma (UA) is presented which revealed focal multinucleated giant cells in close proximity to the calcifications seen in the connective tissue. An attempt was made to identify the nature and origin of these giant cells by immunohistochemical staining, the cells were negative for cytokeratin and positive for CD68. This suggests that the giant cells were non-epithelial in origin and probably were of foreign body type and stromal in origin.
90 Multiple Pyogenic Granulomas: A Case Report, Arvind K Shetty, Pooja Wadkar.
Background: Pyogenic granuloma is primarily a reactive tumour like overgrowth seen in the oral cavity caused due to irritation, physical trauma or hormonal factors. Pyogenic granuloma is not an infectious but a reactive lesion, and causes functional and esthetic challenges. This case report describes the occurrence of multiple pyogenic granulomas; a rare entity; in the oral cavity of a 35 year old female patient. Diagnosis and treatment of pyogenic granuloma is important to prevent its recurrence. Based on clinical findings and histopathological reports a proper diagnosis was achieved and the multiple lesions were treated using a minimally invasive technique of excision using a diode laser.
91 Unpredictable Root Canal Morphology: Expect the Unexpected, Sohez J. Makani, Kiran Vachhani, Kailash Attur, Shoba Fernandes.
Background: A maxillary first molar with more than four canals is an interesting example of anatomic variations, especially when two of these canals are detected, with separate apical foramen in the distal root. The inability to locate the unexpected canals of various anatomical configuration and subsequently treat them, may lead to therapeutic failures. Endodontic retreatment is usually the modality of choice in such cases. This report describes a case of a maxillary first molar with five canals (two mesial canals in mesial root, two distal canals in two distal roots and a palatal canal in palatal root). Additionally it shows a rare anatomic configuration and emphasizes the importance of identifying additional canals.
92 Prosthetic Rehabilitation by Palatal Hollow Bulb Obturator with Cast Metal Denture Base: A Case Report, George Francis, Paul Kariyatty, Joseph lijo, Mathew M Alani, Pramod PS, Donny Philip Varughese.
Background: Prosthetic reconstruction of partial maxillectomy defects is a challenging procedure that requires multidisciplinary expertise to achieve an acceptable function, speech and esthetics. This procedure improves the quality of life for the patient as a normal individual. Obturation of the defect depends on its volume and position of remaining hard and soft tissues which determine the retention, stability and support for the prosthesis. The prosthesis should be simple to handle, easy to maintain, biocompatible, light in weight and convenient for future adjustments. This case report describes a clinical case of partial maxillectomy which was successfully rehabilitated with a definitive closed hollow bulb obturator and cast metal denture base.