Journal of Dental Specialities

03

Authors: Prof. (Dr.) Hari Parkash

The Journal is aimed to provide a platform for scientific exchange of knowledge by publishing Original Research, Case Reports, Systematic Review and Clinical Tips and Communications for the benefit of Dental Fraternity. The journal is committed to enhance Scientific and Evidenced based Dentistry with clinical Outcomes.

5-15

Authors: Threesuttacheep R, Pothacharoen P, Kongtawelert P, Ongchai S, Jotikasthira D, Chatiketu P, Krisanpra

Purposes: The aims were to monitor remaining interrupted force magnitudes, and to compare chondroitin sulphate (CS) levels in gingival crevicular fluid (GCF) of moved mandibular canines, rates of space closure and patients’ pain and discomfort between interrupted and continuous orthodontic force patterns. Materials and method: Fifteen Class I malocclusion patients (5 males and 10 females; aged 17.00 + 3.18 years) who required orthodontic treatment with first premolar extractions, were recruited. Interrupted force pattern was generated by elastomeric chains, and continuous force pattern by Nickel-Titanium closed coil springs. Initial force magnitude was 120 g. Elastomeric chains were replaced by new ones at the end of fourth week during the loaded periods. During the unloaded and the loaded periods, remaining interrupted force magnitudes were measured, and those of continuous force pattern were calibrated and controlled. GCF samples were collected with Periopaper® strips. CS levels were measured by competitive ELISA with WF6 monoclonal antibody during the 8-week control, the unloaded and the 8-week loaded periods. Rates of space closure were measured, and amount of pain and discomfort was assessed by visual analog scale (VAS) scores. Results: Medians of interrupted force magnitudes were 120.0, 60.0, 50.0, 37.5 and 25.0 g, and after elastomeric chain replacement were 120.0, 62.5, 37.5, 25.0 and 25.0 g respectively. There were no significant differences in the median CS levels between the 8-week control and the unloaded periods, and between right and left mandibular canines. Medians of CS levels during the loaded periods, both interrupted and continuous force patterns, were significantly greater than those during the unloaded period (P=0.008 and P=0.027 respectively). Differences between medians of CS levels of interrupted and continuous force patterns during each 1-week loaded period were not significant. There was no significant difference in the rates of space closure, and the patients’ pain and discomfort between interrupted and continuous force patterns. Conclusion: Both interrupted and continuous force patterns, with 120 g initial force magnitude, cause no difference in biochemically-assessed bone remodeling activity, same rate of space closure and same patients’ pain and discomfort. Initial orthodontic force magnitude, of both interrupted and continuous force patterns, may play an important role for alveolar bone remodeling and clinical outcomes.

22-28

Authors: Prarthna B, Saurabh S, Batra P, Dhillon M

Objective: The aim of this study is to describe shape and measure the size of the sella turcica in subjects with class I and class II skeletal types and to check whether sella can be considered as diagnostic marker for skeletal class II malocclusion. Material and Methods: Lateral cephalometric radiographs of 44 individuals (age; 15–30 years) were taken and classified skeletally; 22 as Class I and 22 as Class II (11 males and 11 females in both groups). The linear dimensions (length, depth and diameter) of sella turcica were measured. Student’s t-test was used to calculate differences in linear dimensions. Results: Results show that the sella turcica presented with normal morphology in the majority of subjects (61 percent). No significant differences were found in linear dimensions between genders. Significant difference was found in the depth of sella between Class I and Class II subjects (p<0.05) with smaller depth measurements in skeletal Class II subjects. Conclusions: Significant difference was found in depth of sella between Class I and Class II subjects with smaller depth measurements in Class II subjects. It is concluded that size of sella turcica can be used to approximate the size of the pituitary gland in skeletal Class II malocclusion. Skeletal class II cases due to mandibular deficiency are associated with smaller depth of pituitary fossa.

36-39

Authors: Lone EA, Utreja AK, Singh SP, Jena AK

Objective: To evaluate the effect of comprehensive orthodontic treatment on frequency and severity of white spot lesions (WSLs). Methods: Total 92 (M=43, F=49) subjects in the age range of 12-35 years seeking comprehensive orthodontic treatment were screened for the study. Among 92 subjects, 46 subjects (M=18, F=28) who fulfilled the selection criteria were included in the study. In 46 subjects, a total of 1026 teeth were examined for the evaluation of WSLs. The frequency and severity of WSLs were recorded on a standard proforma at the beginning (T0) and after completion of orthodontic treatment (T1) by direct visual assessment and by DIAGNOdent. The pre-treatment (T0) and post-treatment (T1) visual and DIAGNOdent scores were compared by using Wilcoxon Signed Rank test. The P-value of 0.05 was considered as the level of significance. Results: The frequency of WSLs among subjects seeking comprehensive orthodontic treatment was increased significantly from the pre-treatment value of 65.2% to post-treatment value of 95.7% (P < 0.001). Of 1026 teeth examined, 107 (10.4%) teeth had white spot lesions at the beginning of orthodontic treatment and 272 (26.5%) teeth had white spot lesions at the end of orthodontic treatment (P<0.001). The mean DIAGNOdent score was comparable between the pre and post-treatment evaluation (P=0.282). Conclusion: Treatment of malocclusion by comprehensive orthodontic treatment had a significant effect on the development and severity of white spot lesions.

43-47

Authors: Sharma A, Shokeen S, Arora R, Dhaginakatti SA

Introduction: Forensic odontology involves application of dental sciences in the identification of deceased individuals through comparison of ante-mortem and post-mortem records. Aim: To study knowledge, attitude and practice of forensic odontology among private dental practitioners in Ghaziabad city. Material and Methods: A questionnaire based cross–sectional survey was conducted on 137 private dental practitioners in their dental clinic at Ghaziabad city. A 20 Item Structured questionnaire was used to assess knowledge of dentist about the significance of dental records, indicators of child abuse, dental age estimation, identification of an individual, bite marks and dentist as a witness in the court for forensic evidence. Questions regarding their attitude and practice about maintenance of dental records and source for update on recent advances in dental practice were assessed. Results In our study only 11% B.D.S and 23% M.D.S dental practitioners maintain dental records in their clinic. 98.4% of B.D.S and 90% of M.D.S dental practitioners said that their knowledge level/ awareness regarding forensic odontology were perceived to be inadequate. 77% of B.D.S and 66% of M.D.S dental practitioners did not know the relevance of maintaining dental records for identification of criminals and dead-bodies. 96.7% of B.D.S and 95.9% M.D.S dental practitioners were not confident in handling forensic dentistry related cases. Conclusion: Our study revealed prevalent inadequate knowledge, poor attitude and lack of practice pertaining to patient’s dental record maintenance and clinical knowledge of forensic odontology among dental practitioners in Ghaziabad.

54-59

Authors: Kumar P, Sharma R, Saroha K, Sharma P, Singh V

Aim and Objective: To assess and compare the shear bond strength of brackets bonded with two different self-adhesive systems with and without contamination (Water, Saliva and Blood) and to evaluate the effect of Salivatact on the shear bond strength obtained with Beauty Ortho Bond. Material and Method: 15 premolars each (a total of 180) were bonded with Transbond XT plus, Beauty Ortho Bond and Beauty Ortho Bond with salivatact under various conditions i.e. dry, water, saliva and blood contamination. The shear bond strength and the ARI values were obtained and evaluated statistically. Results: Transbond plus had the maximum bond strength in dry condition and when contaminated with water or saliva. The bond strength of Beauty Ortho Bond with and without salivatect was similar in dry condition and when contaminated with water or saliva. The shear bond strength was lowest after the blood contamination in all the groups and highest for dry condition. Contamination with water and saliva resulted in similar strengths for all the groups. The bond strength achieved with all the three contaminants (water, saliva, blood) was similar when Salivatact was used. Conclusion: Contamination decreases the bond strength for all the groups and this decrease is maximum in case of blood contamination. Bond strength of Transbond color change adhesive is higher than that of Beauty Ortho Bond under all conditions except when contaminated with blood using Salivatect. Beauty Ortho Bond using Salivatact had higher bond strength when contaminated with blood.

64-67

Authors: Yadav S, Agarwal A, Singh S, Kumar S, Anand KR, Chhabra V

Purpose: The aim of this follow up clinical study was to evaluate the effectiveness of 2mm, 3-dimentional locking titanium miniplates. Patients and Method: A prospective randomized clinical trial was carried out on 10 patients with mandibular fractures. The patients were evaluated for the operating time, clinical assessment of mobility after fixation, occlusion, adequacy of reduction on post-operative radiograph and any surgical complications. The statistical analysis was carried out in SPSS software. Results: In 10 patients, 9(90%) were males and 1(10%) were females with a mean age of 28.75 years. Road traffic accident (RTA) was the etiological factor in 7(70%), inter-personal violence in 2 (20%) and fall in 1(10%) patient. The average intra-operative time was 40.10 min locking plates. This was found to be statistically significant when compared to the intra-operative time of non-locking plates in the literature. Bite force was measured in kilogram/cm2 using indigenously designed bite force measurement device. All the measurements were compared to the control group who did not sustain mandible fracture. At third month it was found that there was no significant difference in the bite between locking plates and control group. On examination satisfactory postoperative functional occlusion was found to be 100% in locking plates. Conclusions: The results obtained suggest that 3-D locking plate/screw system fulfill the treatment goals of adequate reduction, fixation and stabilization of fracture of mandible. 3-D locking plating system adequately reduces the fracture without much need for adaptation and hence reduces the intra-operative time.

76-80

Authors: Choudhury R, Kukreja P, Kumar S, Bhatnagar A, Anand KR, Chhabra V

Purpose: The aim of this study was to investigate the effects of a new flap design, the pedicle flap used for the removal of mandibular third molars on postoperative morbidity. Materials and Method: 10 patients with partially erupted mandibular third molar were studied. Swelling, pain, trismus, dry socket and wound dehiscence measures were recorded on days 2 and 7. Data were analysed using the t-independent test and Fischer’s exact test. Results: Facial swelling, pain, restricted mouth opening was seen in the postoperative period. Wound dehiscence was seen in only 1 patient and no incidence of dry socket was noted. Conclusion: Pedicle flap design has led to better wound healing and lesser incidence of dry socket.

86-88

Authors: Nagda SJ

Current training in dental education in India is mostly traditional. The method followed all over is predominantly didactic i.e. lectures and laboratories for skills and clinical training. It is time to introspect and analyze the reasons our graduates are appearing for entrance examinations and repeating their graduation in various parts of the world. We need to assess our training program and see if it meets the needs of students and community; to see how it matches to the various dental training programs globally. Our fraternity has to be aware of the global changes that have occurred in the field of education. This will enable them to improve, innovate and strengthen their skills and the program. There are many challenges facing us. They range from teaching learning methods, curriculum innovations, assessment techniques and improving attitudes and communication skills. This article will be a preliminary article on dental education in India and a series of articles will follow to address some important and pressing issues.

92-95

Authors: Gupta S, Kumar K, Raviprakash SM, Arunkumar KV

Oral verrucous carcinoma was first recognized by Ackerman in 1948 as a distinct entity. Although it occurs at various anatomic sites, most intraoral cases involve buccal mucosa, alveolar mucosa and gingiva. The purpose of this article is to describe four cases of verrucous hyperplasia and carcinoma with special emphasis on various clinical presentation and the most predilection sites. Verrucous hyperplasia and verrucous carcinoma may not be distinguished clinically or may coexist, resulting in diagnostic difficulties. It should be born in mind that leukoplakic lesions may transform into verrucous carcinoma or squamous cell carcinoma, so all such pre-cancerous lesions should be scrutinized conscientiously. Thus, it is amenability of both the oral physicians and histopathologists to be scrupulous about warty and exophytic lesions.

102-108

Authors: Kumar S, Jayan B, Bansal AK

The interest in studying the upper airway has always been there in orthodontics. Acoustic Pharyngometry is a relatively new technique in this field which measures the upper airway precisely. The technique is based on acoustic reflection technology. Sound waves are projected down the airway and reflected back out in such a way that the Pharyngometry software can analyze and quantify changes in the airway cross sectional area. It is an easy and quick technique that measures patient’s pharyngeal airway size and patency from the oropharyngeal junction to the glottis. The technique is useful in screening of patients having higher risk for sleep disordered breathing, establishing candidacy for mandibular advancement device and accurate bite recording/ titration of the appliance and also for planning surgical intervention. The aim of this article is to sensitize orthodontic professionals about this technique and to discuss the basic procedural methodology along with its clinical usefulness.

112-116

Authors: Rathi P, Sood R, Dodwad V, Vaish S

Introduction: Enlarged Gingiva is one of the prime concerns for both dentists and patients causing esthetic and functional problems. The treatment is based on the understanding of cause and underlying pathologic changes, be it inflammatory, pharmacologically induced, associated with systemic diseases, neoplastic, iatrogenic or idiopathic. Objective: To provide minimally invasive periodontal therapy to patients presenting with gingival overgrowth of five different etiological backgrounds. Materials and Methods: Patients with gingival overgrowths reported to the Department of Periodontology and Oral Implantology, ITS-CDSR, Muradnagar, Ghaziabad. Based on the individual history, the patients were categorized under five sections. First was inflammatory due to local deposits, Second was drug induced (phenytoin and amlodipine), Third was iatrogenic in patient undergoing orthodontic treatment, Fourth idiopathic and Fifth Miscellaneous in which patient himself wanted gingival correction because of esthetic concerns. Different treatment strategies were advocated depending upon the history, clinical examination and medical consent. Results: All patients were successfully treated with full mouth scaling, root planing and surgical therapy. Full mouth gingivectomy and gingivoplasty was conducted one week apart, one quadrant each week with scalpel, electro cautery and LASER depending upon the patient’s requirement. Conclusion: This case series emphasizes on the different types of gingival enlargement based on the etiology and highlights different treatment modalities advocated to manage such cases.

120-122

Authors: Konwar SK, Saxena A, Singla A, Chandna AK

Anterior crossbite is an abnormal labiolingual relation in which maxillary anterior teeth are locked behind the mandibular anterior teeth. Many methods are used to raise the bite to correct anterior crossbite. Here, a new method is described which will retain the bite blocks in place for easier correction of anterior crossbite.

123-124

Authors: Prof. (Dr.) Hari Parkash

The Journal is aimed to provide a platform for scientific exchange of knowledge by publishing Original Research, Case Reports, Systematic Review and Clinical Tips and Communications for the benefit of Dental Fraternity. The journal is committed to enhance Scientific and Evidenced based Dentistry with clinical Outcomes.

126-129

Authors: Apala Baduni, Bharat M. Mody, Shivanand Bagewadi, Manisha Lakhanpal Sharma, Bhuvana Vijay, Aanchal G

Introduction: Oral submucous fibrosis and leukoplakia are highly prevalent in India Lipids are the chief cell membrane components which are essential for various biological functions like cell growth and division of normal as well as malignant tissues. Lipids can be helpful for studying the variation in the cholesterol levels for diagnosing and treating the diseases. Aim: The present study evaluated the plasma lipid profiles in patients with Oral submucous fibrosis and leukoplakia and controls. Methodology: 21 patients were selected for the study out of which 7 had OSMF 7 had oral leukoplakia and 7 were included in control group. Patients with cardiovascular diseases, uncontrolled diabetes, acute hepatitis, thyroid dysfunction, and any drug history were excluded from the study. 5ml blood sample was taken and the serum was tested for triglycride levels(TG) , total cholesterol (TC), LDL, HDL, LDL VLDL level were analyzed using triglycerides were analyzed by auto-analyzer used for the analysis of the results is a fully automated biochemistry analyzer. Results: In this study TC, HDL, LDL level analysis showed lower levels in oral leukoplakia and OSMF patients than that of the controls. Conclusion: The alterations in the plasma lipid profile patterns were considerable and recommend a still in-depth study with larger sample size in this aspect for early diagnosis and management of oral leukoplakia to prevent malignant transformation.

140-145

Authors: Ritu Duggal, Neeta Singh

Aim: To compare distribution of apoptotic cells in the Periodontium following Orthodontic force application, to study the apoptotic index and co-relate with different phases of tooth movement. Material and methods: 100 patients, age 12-20 years, of class II div 1 malocclusion, were randomly divided into Groups I to V, requiring first premolars extraction with fixed Mechanotherapy. After leveling, canine was retracted using closed coil spring (100 gm forces). Surgical extraction of premolar was performed on 0, 3,7,14 & 21 days. Periodontium tissue was processed and apoptosis was evaluated by TUNEL assay. Apoptotic cells were counted from 4 different fields per slide and compared with the basal group. Results: The mean Apoptotic Index increased from day3 and peaked at day7 for both compression and tension sides. On tension side, at days 14 & 21 apoptosis wasn’t significant indicating earlier recovery. On compression side, there is more gradual decrease in apoptosis with lowest mean values at day 21, though not same as the basal level, indicating that the periodontal tissues require more than 21 days for complete recovery. The overall difference in apoptotic rate was statistically significant for both compression and tension sides. Conclusion: Tissue response is a time-dependant normal physiological process where periodontal cells are cleared by apoptosis. The correlation coefficient value indicates the apoptotic activity increased with force on compression side & increased significantly on tension side too, signaling towards force-dependant direct relation between the two. Cells on tension side showed a more rapid rate of recovery as compared to compression side.

150-155

Authors: Nidhi Mangtani, Rajath S Pillai, Dinesh Babu B, Veena Jain

Objectives: To assess the effect of resilient lined denture on patient masticatory efficiency, general patient satisfaction and denture quality as compare to conventional complete denture over a period of one year. Material and methodology: A total of 28 completely edentulous patients (14 males and 14 females) aged 45 to 60 years, having well-formed ridges were selected following iclusion exclusion criteria. These were divided into two equal groups, i.e. control (provided conventional mandibular complete denture –group 1) and experimental (provided mandibular denture lined with acrylic soft denture liner – group 2). All patients were clinically evaluated to assess the denture quality, and administered questionnaires for masticatory efficiency and patients general satisfaction level at three intervals i.e. one month (T0), 6 months (T1) and 1 year post-insertion (T2). Results: Statistical analysis for individual question for masticatory efficiency showed significantly higher score (P<.05) at baseline for experimental group as compared to control. While at six and twelve months time interval, significant differences (P<.05) were noted for some questions only. Intra-group analysis showed masticatory efficiency improved significantly over time in controls, while in experimental group masticatory efficiency remained the same (p>.05) for almost all the questions. Patient general satisfaction score at different time intervals for each question showed no significant difference (P>.05) on inter-group comparison. Time dependant intra-group comparison for patient general satisfaction score also showed no significant difference in scores for almost all the questions for both the groups. Statistical analysis for denture quality showed dentures in experimental group have significantly higher (P<.05) scores for denture retention and condition of supporting tissue as compared to control group, while with time denture quality decreased significantly in both the groups. Conclusion: Dentures with soft liner provided better masticatory efficiency while it had no effect on patient’s general satisfaction. Denture quality is better for one with soft liners as compare to one without soft liner.

159-163

Authors: Anand Mangalgi, Aafreen Aftab, Santosh Mathpathi, PavanTenglikar, Swati Devani, Nagesh Ingleshwar

Background and purpose: Aspirin is the most frequently used preventive and therapeutic drug for patients with cardiovascular diseases because of its antiplatelet property, which might lead to the risk of excessive bleeding during the surgery. The purpose of the study is to analyze if there is a need to discontinue low dose antiplatelet therapy before dental extraction. Methodology: The study samples consisted of 25 patients receiving 100 milligrams of aspirin daily and were scheduled to undergo dental extractions. Each patient acted as a control for himself, wherein an extraction was performed on a patient when aspirin was not discontinued and a second extraction after discontinuing aspirin for 72 hours prior the procedure.The bleeding time, clotting time, platelet count and INR were measured preoperatively at both the appointments and the amount of blood loss during the procedure was assessed. Results: The mean blood loss at the first appointment for the patients was 5.78 ml while it was 1.18 ml at the second appointment. The difference was statistically significant with a t – value of 3.2. However, the blood loss in patients during the first appointment was easily managed using local hemostatic measures which prevent any grave bleeding complication. Conclusion: From the observation in this study it can be stated that the low dose aspirin therapy can be continued prior to extraction procedure in the oral cavity without the fear of excessive intra-operative and post operative bleeding.

170-175

Authors: Nitu S S Mishra, Sangeeta P Wanjari, Rajkumar N Parwani, Panjab V Wanjari, Sumedha P Kaothalker

Background: Oral Submucous Fibrosis (OSMF) is a collagen related disorder seen in habitual betel-quid chewers. This is a high risk precancerous condition which clinically presents vertical palpable fibrous bands in buccal mucosa, generalized fibrosis of oral soft tissues with restricted mouth opening. Present study was undertaken to ascertain the changes occurring in collagen type I &III and elastic fibres in OSMF in relation to orientation, density and thickness. Study Methods: The study was performed on 15 cases in each group such as Stage I OSMF, Stage II OSMF, Stage III OSMF and normal oral mucosa (NOM). The biopsied samples were routinely processed for paraffin embedding; stained with Hematoxylin and Eosin as well as special stains like Masson's Trichrome (MT), Verhoeff Van Gieson (VVG) and Picrosirius red (PSR) and examined under light and polarized microscope respectively. MT stain demonstrated all types of collagen fibers collectively while PSR stain under polarized microscopy demonstrated collagen type I and type III separately with enhanced birefringence. VVG stain demonstrated very fine black colored elastic fibers, thus changes taken place could be accurately ascertained with progression of the disease. Results: Change in the orientation of collagen type I has been observed in stage II and stage III of OSMF from haphazard to parallel in relation to surface epithelium, while no change was noted in type III collagen fibres as well as elastic fibres in any stage of OSMF, and remained haphazardly arranged. Increased density of type I collagen was observed with increasing stage of OSMF from moderately dense to dense, while decrease in density of type III collagen was noticed in stage III than in stage II OSMF from moderately dense to sparse. The density of elastic fibres was decreasing from dense in stage I to sparse in stage III. Thickness of collagen type I was increasing with increasing grades while type III collagen and elastic fibres remained unchanged. Conclusion: The alterations in orientation, density and thickness of collagen fibres and density of elastic fibres in various grades of OSMF contribute to the clinical presentation of trismus with progression of the disease.

180-182

Authors: Pallavi Vashisth, Vatsala V, Sathyajith Naik, Mousumi Goswami Singh

The traditional techniques of chemo-mechanical instrumentation and disinfection of the root canal system used in mature teeth are limited by the immature tooth’s anatomy. The open apex is difficult or impossible to seal with conventional root filling methods because of the absence of an apical stop. Furthermore, the arrested development of the dentinal walls at the time of pulp necrosis leaves a weak tooth with thin dentinal walls that are susceptible to fracture. The purpose of the paper is to present the case of a patient wherein revascularization of the necrotic infected pulp space of an immature permanent mandibular molar was induced by stimulation of a blood clot from the periapical tissues into the canal space. The treatment approach can help rescue infected immature teeth by physiologically strengthening the root walls.

188-191

Authors: Anshdeep Singh, Himanshu Aeran, Seema Dixit, Saurabh Arora, Ashish Chaoudhary

Preservation of tooth is one of the major goals of an Endodontist. This goal can be acquired either by non surgical or surgical approach. Root resection is one of the surgical approaches for preservation of molars with furcation involvement. This procedure results in a unique environment which is dictated by the contours of the remaining roots and the residual furcation between them. Root resorption is a viable treatment option to salvage and retain a part of multirooted teeth. This case report illustrates prognosis of root resection after completion of endodontic therapy for managing a case of root resorption. This case shows external root resorption of the distobuccal root of right maxillary first molar. Due to strategic value of maxillary first molar, it was decided to employ root resection. After completion of endodontic therapy root resection was carried out. After 6 months, the absence of periradicular radiolucent lesions, periodontal pocket, pain, and swelling indicated a successful outcome of root resection.

195-198

Authors: Shaveta Garg, M.K Sunil, Ashwarya Trivedi, Neetu Singla

The Odontogenic Keratocyst (OKC), first described by Phillipsen in 1956, has been reclassified as odontogenic neoplasm and has been renamed as Keratocystic Odontogenic Tumor (KCOT) as reported in WHO classification of head and neck tumors in 2005. Odontogenic keratocysts are benign intraosseous tumors of odontogenic origin that occur most commonly in the jaw. In particular, they have a predilection for the angle and ascending ramus of the mandible. The recurrent rate of odontogenic keratocyst is 25 – 30 percent. A case of odontogenic keratocyst in 60 years old patient is presented involving mandibular third molar ramus area which was recurred after 3 years.

202-206

Authors: Chandrashekhar R. Bande, Dinesh Mohale, Manjiri Thakur, Pravin Lambade

Verrucous Carcinoma is a rare type of low grade, well differentiated squamous cell carcinoma. The author herein reports a case of squamous cell carcinoma arising within verrucous carcinoma of mandible. A 65-year old women reported to hospital with the history of swelling over the gums of lower jaw since 1yr. Her swelling was painless and gradually had spread to the whole mandible. Incisional biopsy and histopathologic examination revealed verrucous carcinoma which was treated with total Mandibulectomy.

211-216

Authors: Ashutosh Shetty, Priyanka Basu, Vivek Bhaskar, U.S. Krishna Nayak

Often many patients cannot be treated by orthodontics alone, and need the combined efforts of orthodontics and orthognathic surgery. Such patients are treated in three phases- a phase of pre surgical orthodontics that involves basically decompensating the dentition, followed by the surgery, which is then finished with final detailing of the occlusion. This article is a case report of a skeletal bimaxillary protrusion patient, who was treated with bi- jaw surgery.