Journal of Dental Specialities

Page No. 105-107

Authors: Mahesh Verma

Introduction I, came across an interview by the legendary cricketer Sachin Tendulkar, considered “child prodigy” in his teenage years and definitely the best amongst the best in the world of cricket till date. To my surprise he revealed the “early days” of his childhood were well spent on “training hard” with the ball and the bat and not really with learning trigonometry and Shakespeare plays. Well, we all know what really helped him earn his bouquet of roses and rise through the ranks (when I say this I have no intention to belittle trigonometry or Shakespeare plays!). But, why do I talk about this? Somewhere in the interview, the words “early days” and “training hard” got imprinted in my mind and arose my inquisitiveness and also the topic of this editorial. I dug deeper into the content of “training methods (in sports)” and came across two whipsaw methods- “Early Specialization” and “Late Diversification”. 1 The common base for both the schemes is the “exposure to general events” and “exposure to specialised events” (analogous to graduate training and post graduate training respectively). What makes them distinct is the variation in ‘length and density’ of the event exposures by tuning the time point to separate the events.

Page No. 113-118

Authors: Kritika Saxena, Manisha Lakhanpal Sharma, Bhuvana Vijay, Manu Dhillon

Introduction: Diabetes and its acute complications have become a significant health hazard worldwide, particularly in the Indian subcontinent. To date, there is no data on the awareness of dental professionals regarding the management of diabetic patients. Aim: The aim of the study was to assess the knowledge, attitude and practice of dental professionals in India regarding the clinical manifestations and management of diabetic patients. Material and Methods: The study was cross – sectional, comprising of 100 dental professionals, including dental graduates, post graduates, faculty members of dental colleges and private practitioners from the Delhi NCR region. Data was obtained by a self completion questionnaire which was pretested by conducting a pilot study, comprising of a fourteen item questionnaire aimed at assessing the knowledge, attitude and practice of dental fraternity regarding the manifestations and management of diabetic patients. In the questionnaire, nine questions aimed at assessing the knowledge, two questions assessed the attitude and three were for practice assessment. Results: The results showed a clear cut knowledge deficit amongst dental fraternity regarding the manifestations and management of diabetics in dental practice. Conclusion: The present study showed low level of awareness of dental fraternity regarding diabetes. Therefore, designing strong curriculum resources for oral health care providers, in order to enhance their awareness towards diabetes is the need of the hour.

Page No. 124-130

Authors: Akshay Rathore, Suma GN, Sharad Sahai, Manisha Lakhanpal Sharma, Siddharth Srivastava

Aim: Age estimation is an important aspect of forensic odontology. Calculation of pulp volume using CBCT and its correlation with age could be an effective, non destructive method. The aim of this pilot study was to verify and calibrate the proposed method of calculating pulp and tooth volume using CBCT. Materials and Method: The study was conducted on six extracted monoradicular teeth which were scanned by Cone Beam CT (CS9300-C 3D.Carestream Health, Inc. Rochester, NY) after endodontic preparation. The tooth (TV2) and pulp volumes (PV 2) were then calculated using imaging software (Xelis Dental software (INFINITT Inc., Seoul, South Korea). Then actual tooth (TV1) and pulp volumes (PV1) were calculated based on the Archimedes principle. The pulp and tooth volume ratios R1 and R2 were also calculated. The estimated and actual values were compared and percentage error was calculated. Results: The percentage error was also calculated to evaluate the accuracy which was found to be 8.84%, 2.6% and 12.7% for TV1 and TV2, PV1 and PV2 and R1 and R2 respectively. Conclusion: These were in accordance with the results by Yang et al. 7 who obtained a percentage error of ±7.8% while the estimated error was quite less than that reported by Star et al8 who reported the maximum percentage error to be 21% and 16% for pulp and tooth volumes respectively.

Page No. 135-138

Authors: Geetika Gupta, Noopur Gupta, Radhika Chopra, Vinod Sachdev

Background/Aim: The purpose of this study was to assess the level of awareness towards management and prevention of dental injuries among sports instructors in Delhi, India, by a self-administered questionnaire. Material and Methods: A total of 100 questionnaires were distributed to sports instructors from different sports academies of Delhi, India. The questionnaire surveyed the basic details of the sports instructors, their knowledge in management of dental trauma and awareness regarding use of mouth guards to prevent dental trauma.Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16.0. Results: 96 out of 100 teachers responded to the questionnaires, who had a mean experience of 6.9 years, out of which 23% gave training for basketball, 20.8% for cricket, 13% for tennis and rest 43.2% for other contact sports. 28% stated that they would preserve a fractured fragment or avulsed tooth, while the remaining 72% won’t. The medium which they preferred was ice (35%), handkerchief (22%), any liquid (20%), in child’s mouth (9%), cotton (8%) and in child’s hand (2%). Amongst ones who preferred other liquid as transportation medium, 57% preferred tap water, 28% fresh milk, 8% spirit while 3% normal saline. Though, 67% of these teachers were aware of the use of mouth guards, 51% of these stated that they wouldn’t advice its use. Conclusion: Hence, the present study indicates that there is lack of awareness among the sports instructors regarding the management and prevention of dental injuries in Delhi, India.

Page No. 142-146

Authors: Shubhra Vaish, Vidya Dodwad, Aakriti Mahajan, Sonakshi Gupta

Abstract Introduction: Various chemotherapeutic agents can be administered subgingivally to enhance the efficacy of non-surgical therapy mechanical treatment. Chlorhexidine (CHX) is an effective antimicrobial agent and has been used as a topical antiseptic for over 30 years. The aim of the study was to evaluate and compare the clinical efficacy of various forms of local delivery of Chlorhexidine (CHX) i.e. 0.2% CHX irrigation, 1.5% CHX gel and 2.5mg biodegradable CHX chip as an adjunct to scaling and root planning in the management of Chronic Periodontitis. Materials and Method: Forty sites from patients with Chronic Periodontitis and probing depth 5 to 7 mm were randomly divided into 4 groups. Group I (10 Sites): scaling and root planing (SRP) + subgingival irrigation with 0.2% Chlorhexidine; Group II (10 Sites): SRP + subgingival application of 1.5% Chlorhexidine gel (Chlo-Site); Group III (10 Sites): SRP + intrapocket administration of Chlorhexidine chip (Periocol-CG); Group IV (10 Sites): scaling and root planing only (control group). Improvement in periodontal health was assessed by the gingival index of Loe and Silness and plaque was assessed using the Turesky et al. modification of Quigley Hein Index at baseline, 1 month and 3 months. Pocket probing depth and clinical attachment level were also measured using customized acrylic stents. Results: Significant clinical improvement was seen in all the groups from baseline to 3 months. Subgingival irrigation with 0.2% CHX xdid not provide any additional benefit over SRP alone in the improvement of clinical indices. Adjunctive use of 1.5% xanthan based CHX gel and CHX chip along with conventional nonsurgical therapy provided clinically favorable results in terms of reduction of pocket probing depth and clinical attachment level than SRP alone. Conclusion: Based on the findings, it was concluded that 1.5% CHX gel and CHX chip provide significant results as compared to SRP alone. Subgingival irrigation with 0.2% CHX provides similar clinical benefits as mechanical debridement alone.

Page No. 152-156

Authors: Arushi Pandey, Nirmala N Rao, Gurkiran Kaur

Introduction: Langerhans cells are dendritic bone marrow derived cells situated suprabasally in most stratified squamous epithelia and behave as very potent antigen presenting cells. Routine Hematoxylin and Eosin staining cannot localize them in the epithelium, thus immunofluorescence or immunohistochemical techniques are employed. Aim and Objectives: To develop a technique for staining Langerhans cells in tissues which is equally specific and sensitive while being relatively inexpensive in comparison to the contemporary techniques. Materials and Method: The study was carried out in the oral pathology laboratory with post graduate teaching requirements. It mainly included a cryostat other than the routine set up equipment. The study included twenty histopathologically confirmed cases of Oral Lichen Planus (OLP). Four serial sections of each tissue were stained with Hematoxylin & Eosin (H&E) stain, ATP-lead substrate, control (absence of Adenosine triphosphate salt) and Masson’s Fontana stain and observed under the microscope for presence of Langerhans cells. A modified method for staining, to observe Langerhans cells, given by Juhlin L and Shelly WB was used. Results: All twenty cases showed positive staining using the modified technique. The cells which were typified as Langerhans cells, were those with round/ovoid brown stained cells showing the presence of minimum of 2-3 dendritic processes from the cell surface. ATPase activity was found more localized in the cell membrane and dendrites. Conclusion: The modified histochemistry technique for identifying Langerhans cells was found to be highly sensitive and specific, as well as, very cost effective.

Page No. 162-166

Authors: SK Agarwal, Rutuparna Sasane

Introduction: Accurate impressions are of utmost importance for a well fitting prosthesis. Use of custom tray and application of tray adhesives have been shown to provide best accuracy. But, there is a dearth of studies on cohesive and adhesive bond strength of tray adhesive to the light polymerizing and autopolymerising custom tray materials. Aim & Objectives: Comparative evaluation of the tensile bond strength of addition silicone impression material to different tray materials using different adhesive systems. Materials & Method: Addition silicone impression material was used along with universal paint on tray adhesive. 20 samples of auto polymerizing tray material were made. In 10 samples adhesive was not applied (AM GROUP 1) and in the remaining 10 samples adhesive was applied (AMC GROUP 2). Similarly, 20 samples of light polymerizing tray material were made. In 10 samples adhesive was not applied (LM GROUP 3) and in remaining 10 samples adhesive was applied (LMC GROUP 4). The samples were placed in Universal Testing Machine to evaluate the tensile strength. The values obtained were tabulated & pair t test statistical analysis was performed to obtain the results. Results: The mean tensile bond strength was highest in Group 4 Light cure acrylic resin mechanical + chemical [ LMC] (0.2694 MPa), followed by Group 2 Auto polymerizing acrylic resin mechanical + chemical [AMC] (0.179 MPa), Group 3 Light cure acrylic resin mechanical [LM] (0.1302 MPa), & lowest in Group 1 Auto polymerizing acrylic resin mechanical [AM] (0.101 MPa) respectively. Conclusion: Application of tray adhesive increased the tensile bond strength between the tray and addition silicone impression material. Light polymerizing tray material with perforations and adhesive application showed highest tensile bond strength. The use of tray adhesive is highly recommended for making accurate impressions.

Page No. 174-177

Authors: Preethi Purushothama, Neethi H, Indu M, N. Chaitanya Babu, Saurabh Juneja

Introduction: Oral malignancy has a very high incident rate in India as a result of habitual tobacco chewing and its products. Microscopic examination of the tissue specimen following a biopsy, which is an invasive procedure, forms the gold standard for diagnosing these lesions. Autofluorescence spectroscopy (AF) of blood plasma promises to be a sensitive and non-invasive method for screening and monitoring such cases. Aim and Objectives: To evaluate and compare the spectral emission range of cases from oral squamous cell carcinoma, leukoplakia and control subjects in the visible spectral region. Materials and Method: Blood samples from 5 cases each of oral squamous cell carcinoma, leukoplakia and normal individual were taken and subjected to excitation wavelengths at 405 and 420 nm using autofluorescence spectrometer and emission wavelength were noted. Results: Fluorescent emission spectra of blood plasma of oral malignant lesions exhibited characteristic spectral difference with a shift towards the red spectrum with reference to normal subjects indicating alteration in the internal fluorophore concentration owing to malignant changes. Conclusion: Autofluorescence spectroscopic analysis of blood plasma promises to be a valuable non invasive tool in the diagnosis of oral malignancy from clinically appearing normal tissue.

Page No. 183-186

Authors: Shweta Singh, Amit Kumar Singh, Anmol Agarwal, Payal Agarwal

Christ Siemen Touraine (C.S.T) syndrome is characterised by classical triad of hypohidrosis, hypotrichosis and hypodontia. The oral manifestations are characteristic for this particular syndrome. It is necessary to identify this disease at its early stage in order to render prompt treatment. This article, presents a case report of a one year six month old boy, with C.S.T syndrome with various investigations like radiographic, dermatoglyphics, sweat pore count and treatment plan.

Page No. 190-193

Authors: Rahul Sharma, Jay Vikram, Dhruv Anand, Anurag Hasti, Pradeep Sharma

It is well documented that restoration of posterior atrophied maxilla with implants is a complex entity in itself. Since, implant placement in this area is often accompanied by sinus lift which itself is a morbid procedure with questionable success rate, a new approach of placement of implants in Pterygo maxillary area was explored. The purpose of this article is to present a case report in which Pterygo-maxillary implant has been successfully placed to restore atrophied posterior maxilla without the sinus lift using 3D imaging technique - Cone Beam Computerised Tomography (CBCT). Thus, making it an easy procedure for placement of implants in the areas previously considered to be unapproachable.

Page No. 197-200

Authors: Nitin Tomar, Divya Dureja, Mayur Kaushik, Amit Wadhawan

Introduction: Gingival hyperplasia (GH) not only predisposes to the functional but also to esthetic concerns of the patients. For rendering a possible treatment a periodontist should recognize the underlying pathology, be it inflammatory, neoplastic, iatrogenic, idiopathic or in association with any underlying systemic disease. Materials and Methods: A thorough individual history was obtained with clinical presentation of GH, according to which they were grouped under six sections. First, was drug induced (phenytoin), second was unilateral idiopathic enlargement, third was inflammatory, fourth demonstrated GH due to orthodontic treatment, fifth was stated as inappropriate gum to tooth ratio due to altered passive eruption and lastly was pregnancy induced GH. Results: The cases presented were treated with full mouth oral prophylaxis following which, surgical intervention was done if indicated. Conclusion: The present case series highlights different types of gingival enlargement, their underlying etiology and emphasizes on various treatment modalities that can be employed.

2-3

Authors: Prof. (Dr.) Hari Parkash.

Presently the Dental World is experiencing a revolution in terms of digitization, computerization, subtractive and additive technologies being influenced to a large extent with the world of virtual reality. Wikipedia defines Virtual Reality as, immersive multimedia or computer-simulated reality, replicating an environment that simulates a physical presence in places in the real world or an imagined world, allowing the user to interact in that world1 . Virtual realities artificially create sensory experiences, which can include sight, touch, hearing, and smell. The Virtual World has shown its strong presence in the field of implant planning, surgical guides, CAD CAM prosthesis, maxillofacial prosthodontics and many other areas. Milled prosthesis and surgical guides for implant placement have established themselves in a strong way. The newer vistas added in the field of Virtual Reality are the Virtual Face Bow, Virtual Articulators and Virtual Reality Haptic System

5-9

Authors: Okeigbemen Sunny Ajimen.

Introduction: Community- based dental training and service is the new direction in dental education. It offers a variety of positive learning experiences for dental students, providing the needed dental services for rural and the underserved areas. A case study of University of Benin dental school was carried out to evaluate the historical development of community-based services, challenges and prospects. Materials and methods: Data was obtained using the historical method through qualitative oral interviews, documents and training brochures and retrospective method from records of outreaches to rural community dental clinic, special needs, school oral health and adult/ geriatric centre using oral health outreach summary form. The qualitative research methodology of health service evaluation was used to obtain information on historical background from library documents including school brochures and records and analyzed with Micro Soft Excel and SPSS software. Results: The development of the community dentistry in the University of Benin as a specialty began under framework granting it departmental status. The learning methods until recently were essentially lecture and clinic based with curriculum structure designed to provide newly admitted students with the understanding of their chosen profession, its development, responsibilities and ethical obligations. These improved community- based programs beginning from 2011 include oral health awareness and screening for school children, community dental services for rural dwellers, special needs and orphanage programmes, and adult/geriatric client screening services. At the Community Dental Clinic in an outpost of the University of Benin Teaching Hospital, 164 patients have been seen, a total of 3479 school children were screened and 872 (25%) referred for dental treatment. Similarly 169 persons with special needs and orphans were screened with 58 (34.3%) referrals to the dental clinics. At the Oral health screening component of the Centre for Disease Control at the University of Benin Teaching (CDC-UBTH) 2609 clients seen with 1855 (71%) referrals to the dental centre. Conclusion: The provision of oral health education, comprehensive and preventive services to school children, the elderly, underserved and disadvantaged persons as a regular and sustainable program is faced with challenges.

14-20

Authors: Archana Rai, Ipseeta Menon, Aruna DS, Avnish Singh.

Purpose: To study taboos in dentistry and their effect on adult oral health behavior in Ghaziabad. Materials and Methods: Cross-sectional community based questionnaire survey was conducted on sample of 350 adults aged 20years and above from Ghaziabad urban and rural areas. Multistage random sampling technique was used. Single field trained and calibrated investigator collected data by interviewing study subjects using pretested structured, close ended questionnaire consisting of self-designed questions seeking on taboos related to dentistry and oral health behavior besides socio-demographic variables. Kappa co-efficient of questionnaire content was 0.80. Data was entered and analyzed using SPSS software version 21.0. Chi square analysis showed intergroup comparisons. Results: Taboos related to dentistry were prevalent in urban and rural areas. Significant gender difference among subjects who believed that there was no need to visit dentist until all permanent teeth erupt and better not to brush teeth when gums bleed were highly prevalent among females (p<0.05) from both urban and rural areas. Significant association between prevalent taboos and Dental visit variables were reported. Conclusion: Taboos related to dentistry has negative effect on adult oral health behavior.

26-30

Authors: Rabinder Kaur, Piush Kumar, Payal Sharma, Shalaj Bhatnagar.

Objective: To evaluate frictional forces generated in retrieved aesthetic archwires with different ligation methods. Materials and Method: A total of 40(20 new and 20 retrieved from the patient’s mouth) Teflon coated 019X025 Stainless steel archwires and 40(20 new and 20 retrieved from the patient’s mouth) conventional 019X025 Stainless steel archwires were used for the study. The retrieved archwires were cleaned in ultrasonic cleaner for 15 minutes and placed in glutaraldehyde solution for one hour. A jig was formed using ceramic brackets without metal slot and a molar tube for the purpose of evaluation of friction forces. The wires were ligated with either stainless steel ligatures or elastomeric modules. The values obtained were subjected to Mann Whitney and Wilcoxon Sign rank test for statistical analysis. Results: The frictional values for conventional Stainless steel wires was less than Teflon coated wires in case of new wires. In case of retrieved archwires there was no difference between conventional or Teflon coated wires. The amount of friction for both Teflon coated and conventional wires decreased on retrieved from the patient. In case of Teflon coated wires the friction was greater with ligatures as compared to modules while in case of conventional Stainless steel wires it was vice-versa. Conclusion: Teflon coated wires when cleaned in ultrasonic cleaner showed reduction in frictional forces with no significant difference in friction generated by both methods of ligation.

36-38

Authors: Pankaj Kukreja, Mohit Mangla, Lily Rajput, Kumar Rakshak Anand, Sanjeev Kumar, Heena Agarwal.

Aim: To evaluate the effect of different percentage elongations on the ultimate tensile strength of 24 and 26 gauge stainless steel wires. Materials and Methods: 5 sets of wires were taken from a single spool of 26 gauge and 24 gauge obtained from a single manufacturer. They were pre-stretched to different percentages of 0%, 2.5%, 5%, 7.5%, 10% and 12.5%. The wires were cut to a standard length of 20 cm each and were subjected to tensile stretching forces at a uniform rate of 20mm/minute in Universal Testing Machine (UTM). The ultimate load was evaluated in each of the wires. Results: The mean ultimate load for 24 gauge wire was noted to be the highest (62.84± 0.38) in 10% elongation and the least (57.44± 0.32) in 12.5%. Whereas in 26 gauge, mean ultimate load was noted to be highest (62.64 ± 0.16) in 5 % elongation and least (58.39 ± 0.26) in 10% elongation. Conclusion: We can do pre-stretching of 24 gauge wire upto 10 % for maximum ultimate strength and for 26 gauge upto 5% for maximum ultimate strength.

46-51

Authors: Cheshta Yadav, Ashok Kumar Utreja, Satinder Pal Singh, Ashok Kumar Jena.

Objective: To test the null hypothesis that premolar extraction had no favorable effect on the angulation of developing third molar among subjects undergoing comprehensive orthodontic treatment. Materials and Methods: Pre- and post-treatment orthopantomograms of 73 subjects in the age range of 13-24 years were divided into three groups to evaluate the effect of premolar extraction on the improvement of developing third molar angulation. Group-I (n=26) included subjects in whom all first premolars were extracted, Group-II (n=20) included subjects in whom all second premolars were extracted and Group-III (n=27) included subjects in whom non-extraction orthodontic treatment was carried out for the correction of their malocclusion. Descriptive statistics, paired t-test were used for the statistical analysis. The P-value of 0.05 was considered as level of significant. Results: The mean angulations of maxillary third molars were increased significantly following first and second premolars extraction treatment (P<0.01). The mean angulations of mandibular third molars were increased marginally following first premolars extraction treatment, however the mean angulations of the mandibular third molars were increased significantly following second premolars extraction treatment (P<0.05). The changes in the angulations of maxillary and mandibular third molars after non-extraction orthodontic treatment were very modest and statistically not-significant. Conclusions: Extraction of first and second premolars had favorable effect on the angulation of developing third molars. The favorable changes were more following the second premolars extraction as compared to the all first premolars extraction.

61-64

Authors: Mamatha NS, Madhumathi Singh, Beena Roopak, Shilpa Rani MN, Sowmini.

Sialocele is a collection of saliva in the subcutaneous tissue or in the glandular tissues. When this communicates with the skin and drains it is known as parotid fistula. The causes are sharp penetrating trauma, infectious drainage, TMJ surgery, parotidectomy, condylar fracture reduction. We report a case of parotid fistula is due to sharp penetrating object and a case of parotid sialocele following open reduction of condylar fracture. There are numerous methods of treatment of parotid fistula and sialocele. Here we followed repeated aspiration, pressure dressing and oral administration of hyoscine. The excellent result was achieved with conservative therapy.

66-69

Authors: Rohit Kochhar, Ruchika Dewan, Sonal Soi, Mansi Punjabi.

Aim and Objectives: The aim of the present in-vitro study was to evaluate and compare the effect of five commercially available mouthrinses i.e. Listerine, Benzydamine, Rexidine, Proflo, Hiora on the microhardness of the hybrid composite restorative material. Materials and Method: Fifty specimens were prepared withHybrid Composite Restorative Material (Te-Econom Plus) and immersed in Saleve (artificial saliva; supplied by the manufacturer) for 24hr. The baseline microhardness of specimens was recorded using Vicker’s microhardness tester.The pH of mouthrinses was recorded with digital pH meter. All 50 specimens were divided into five groups of 10 samples each and immersed into20 ml of - Group I - Listerine (alcohol based) mouthrinse, Group II - Benzydamine (HCl based) mouthrinse,Group III- Rexidin (Chlorhex based) mouthrinse, Group IV-Proflo (fluoride containing) mouthrinse, and Group V -Hiora (alcohol free, herbal) mouthrinse and incubated for 24hr at 37ºC. After immersion the microhardness values of the specimens were recorded again and the data was tabulated for statistical analysis. Kruskal–Wallis test was used for inter group comparison followed by pairwise comparison of groups using Mann–Whitney U test. Results: All mouthrinses tested showed decreased microhardness of the Te-Econom Plus (hybrid composite restorative material) (P<0.001). Group I-(Listerine) showed highest reduction while Group II-(Benzydamine) showed the lowest reduction in the microhardnessof the hybrid composite restorative material respectively. Conclusion: All the five groups decreased the microhardness of the Hybrid Composite Restorative Material. The highest reduction in microhardness was found in alcohol-containing mouthrinse (Listerine).

74-81

Authors: Ashish Chopra, Sameer Patil, Puneet Batra, Gaurav Singh.

Case report of 19 year old female patient with dentoalveolar excess treated with combined orthodontics and anterior maxillary osteotomy.

87-89

Authors: Shubhra Gill, Rekha Gupta, Mahesh Verma.

Retinoblastoma is one of the commonest malignant intraocular tumors in pediatric population, resulting in evisceration, enucleation or exenteration of orbital contents. An ocular prosthesis can boost the psychological wellbeing of a patient with an anophthalmic socket. Though the stock prosthesis for ocular defects can be used as an interim prosthesis but customized prosthesis is required for better fit, function, esthetics and tissue health of anophthalmic socket. The present case report describes the prosthetic rehabilitation of a surgically treated case of retinoblastoma.

95-98

Authors: Shaily Tyagi, Divya Ratan Dahiya, Praful Mehra, Gaurav Issar.

Implant placement in esthetic zone is a challenge in implant dentistry because of the interplay of multiple factors like adjacent restoration, bone, mucosa, and lip line that result in a serviceable prosthesis complementing the natural dentition. The philosophy behind implant/restorative protocols is preservation. If bone loss occurs gingival architecture will collape, which will lead to aesthetic compromise and inadequate bone for implant placement. This case report aims to describe important aspects of implant placed immediately into fresh extraction sockets, by evaluating the changes that takes place in hard and soft tissues occuring upto 2 years following the implant placement.