A Journal of Clinical Dentistry-Heal Talk

5-6

Authors: Dr. Manik Saha Dr. Srijon Mukherjee

Cutaneous squamous cell carcinoma (SCC) is the second most common form of skin cancer. Squamous cell carcinoma often appears on top of the nose, forehead, lower lip, and/or hands. Squamous cell carcinoma tumors may also appear in areas of the skin that have been burned, exposed to chemicals, or had x-ray treatments of middle-aged and elderly individuals. SCC is much more common in geographic are as where patients have a high frequency of sun exposure. Most SCCs are readily identified and removed in the physician's office as a minor surgical procedure. Larger and more invasive lesions may require aggressive surgical management, radiation therapy, or both. High-risk SCC carries a significant risk of metastasis and, as such, requires careful evaluation and treatment.

5-6

Authors: Dr. Puneet Kalra Dr. A.S. Rana Dr. Sunil Gupta Dr. Gaurav Jain Dr. Deepak Gupta

Whenever there is a fracture of upper third (cranial part) of the facial skeleton, frontal bone is likely to fracture. Frontal bone can fracture in central or lateral parts. These injuries are in close vicinity with the brain and its menninges [1]. Who should deal with these injuries, is an obvious question to be asked? A maxillofacial surgeon with his expertise can deal with these craniofacial injuries. A case of lateral frontal bone fracture was treated with excellent result at a private Neuro- center, Meerut Institute of Mental health and Neurosciences (MIMHANS), is presented in this article.

6-7

Authors: Dr. Ashutosh Dixit Dr. Seema Dixit Dr. Mohit Sharma

Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing periodontal injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep subgingival caries. Discussed here is a case of deep subgingival caries on the distal surface of a mandibular molar where crown lengthening was done subsquent to which pre-fabricated post was cemented and composite core was made. This was followed by crown preparation and subsquent placement of porcelain fused to metal crown, all leading to a result which was profoundly satisfying for the patient as well as clinician.

7-8

Authors: Dr. Meghna Sharma Dr. Kulbhushan Sharma Dr. Samita Mittal

A patient aged 23 years came to the clinic with chief complaint of mobile retained lower deciduous 2nd molars on both (left & right) side. On oral examination, both deciduous molars where grade I mobile with no other finding. On radiographic examination, where was minimal support of bone of around 2-3mm of root was holded by bone.

8-9

Authors: Dr. Arun Gupta Dr. Varun Saini

A fractured tooth or root is one of the most difficult & challenging cases to manage in a dental clinic : more so when the tooth is fractured below the level of gingiva especially because the treatment options are limited & maintenance of esthetic appearance of the maxillary dentition which is determined by the relationship between the shape, contour, colour, position & arrangement of teeth & healthy gingiva. This clinical report describes the replacement of the infected root stump in upper posterior teeth using dental implant, which has nowadays emerged as the most appropriate means of tooth replacement. Since 1968 when Dr. Brammark first used Titanium as dental implant, it has been the material of choice for being implanted into the oral tissues beneath the mucosal or/and periosteal tissue for fixed or removable prosthesis.

8-9

Authors: Dr. Neeraj Nagpal Dr. K.L. Gupta Dr. Suchi Agarwal

Numerous ocular impression and fitting techniques have been described in the literature. Most can be placed into one of several broad categories: direct impression/external impression, impression with a stock ocular tray or modified stock ocular tray, impression with custom ocular tray, impression using a stock ocular prosthesis, ocular prosthesis modification, and the wax Scleral blank technique, Ocular chosen for a custom ocular prosthesis. An attempt is also made to mimick the shade and colour of the sclera in the wax pattern itself; using white paraffin wax. This gives an accurate registration of the position and alignment of iris disc assembly, giving a natural look.

9-12

Authors: Dr. Sumidha Rohatgi Dr. Pankaj Bansal

Patient's desire to maintain his own dentition and advancements in the field of dentistry have led to a more conservative rather than radical approach. Presence of significant furcation involvement means a 'questionable' long term prognosis for the tooth1. A combination of endodontic, restorative and periodontal techniques can be used to retain a tooth in whole or in part which may be useful either as independent units or abutments for fixed bridges. A case of conserving a part of a periodontally involved multirooted tooth with grade III furcation by using all the three disciplines has been presented.

10

Authors: Dr. Geeta Paul Dr. Rahul Paul

Fixed prosthodontic treatment improves patients comfort and masticatory ablity ,maintains the health and integrity of dental arches and elevates patients self image .But all patients who desire fixed partial denture are not candidates for conventional fixed teeth,. e.g. in mandibular anterior region, where conventional fixed prosthesis can not be given. The imaginative approach to deal with such situations is by composite resin bonded metal retainers or a fibre reinforced composite bridge.

13-14

Authors: Dr. Kapil Mohan Dr. Jaihans Agarwal

India, a country rich in beauty, culture and heritage has emerged as a strong contender for medical tourism, given its historical reputation of providing the world with highly skilled man-power including doctors, engineers and computer professionals etc. Advanced medical treatment needs are available in India as per international standards of care at nearly one tenth of their costs in developed nations.

13

Authors: Prof. (Dr.) U.S. Krishna Nayak Dr. Varun Goyal Prof. (Dr.) Giridhar Reddy

In dentistry, much of your success depends on what you do the quality of your treatment, how well you accommodate patients or how many services you offer. But what many dentists fail to realize is that there is also significant power in what you say. When it comes to their dental care, human beings are hesitant, skeptical, lazy and sometimes flat out irrational. That means that choosing the right words to describe your practice and your treatment is crucial if you want to keep them from slipping into avoidance and procrastination.

14-15

Authors: Dr. Rahul Paul Dr. Geeta Paul

Health care personnel refer to all paid/unpaid persons working in health care settings who have the potential for exposure to infectious materials [e.g. blood, tissue, specific body fluids and medical supplies, equipment or environmental surfaces contaminated with the infectious substances]. Rationale for infection control is to control iatrogenic nasocomial infections among patients and potential occupational exposure of care providers to disease causing microbes during provision of care. The term Disease Control or Infection Control does not mean total prevention of iatrogenic nasocomial infections or occupational exposure to blood and other potentially infectious materials, it only means reducing the risks of disease.

15-20

Authors: Dr. Binita Srivastava, Dr. Hind P. Bhatia Dr. Ashish Singh, Dr. Nidhi Gupta Dr. Neeraj Solanki

Objective -The aim of this study is to present a review of the reported literature on (i) Computer controlled local anaesthesia delivery system-WAND (ii) Its clinical applications in the practice of Paediatric Dentistry. Method Electronic literature of scientific papers up to year 2009 was reviewed on the MEDLINE, Embase, Enteez Pubmed, and various other journals using specific key words. The search yielded 100 papers, out of which 45 were identified as conforming to the applied criteria. These papers formed the basis of the review and clinical scenarios presented which demonstrate the application of WAND in the practice of Paediatric Dentistry. Conclusion This paper illustrates applicability of Wand to various dental procedures & how the Wand will likely affect Pedodontist and their Pediatric patients. The cost/benefits must be weighed by each Pedodontist, but it appears that the Wand can deliver proper anaesthesia & significantly reduce the likelihood of disruptive behaviours during the initial moments of injections.

16-17

Authors: Dr. Anurag Gurtu Dr. Chandrawati Guha Dr. Kanishka Dua

Variations in dental anatomy are found in all teeth. Knowledge of these variations, particularly concerning the location and treatment of all canals, is very important for the success of endodontic therapy, because the inability to find and properly treat the root canals may cause failures. Variations in canal morphology, such as extra canals, apical ramifications, apical deltas, or lateral canals, are commonly encountered, and their incidence and significance have been well documented. Vertucci's classification is a standardized method for categorizing known root canal anatomical variations .However, the clinician should also be aware of the possibility of the existence of fewer root and/or canal numbers. The present report describes the root canal treatment in a maxillary first molar with single root canal.

17

Authors: Dr. Dinesh Agarwal, Dr. A. Mitra Dr. S.P. Sondhi, Dr. T.R. Sirohi Dr. Aron

The prevalence of primary Antitubercular drug resistance was found to be quite high in Meerut. The resistance to individual drugs was Pyrazinamide 20% , Inh 15.6%, Rifampicin18.5%, Streptomycin10%, Ehtambutol 0% . MDR was found to be 18.5% which is much higher than reported earlier.

18-20

Authors: Dr. K.L. Gupta Dr. Jameel A. Saib

An endless number of denture wearers and the dentists who fabricate them are using the denture adhesives, just to improve the patient acceptance of comfort with dentures. Then to prosthodontists have a negative attitude towards denture adhesives and assume that to advocate their use is a means of compensating deficiencies in clinical and technical procedures. Adhesives increase denture retention and hence lead to improve chewing ability, reduces denture wobble, improves comfort and reduces amount of food particles collecting under the dentures. Therefore, denture patients should use adhesives on the advice of their dentists and should be instructed in its proper use and cautioned against misuse. All denture patients should be advised to consult their dentists for periodic examinations of their dentures and the health of the oral cavity

19-20

Authors: Dr. Jayashree Sen, Dr. Manik Saha Dr. Srijan Mukherjee

In maxillofacial trauma , as there is anatomical distortion, oral or nasal intubation, for securing airway is avoided. Tracheostomy has its complications. So airway maintenance can be challanged with a technique called sub mental intubation practically it is an orosubmental procedure. It gives a safe and the least adverse post operative outcome.

21-22

Authors: Dr. Sunil Kumar Gupta, Dr. A.S. Rana Dr. Deepak Gupta, Dr. Gaurav Jain Dr. Puneet Kalra

Various odontogenic anomalies can occur that result in joining or tuning defects. These include fusion, germination and concrescence. This paper presents an unexpected case of concrescence with a review of the literature.

21-26

Authors: Dr. Jinendra Jain, Dr. Gokkulakrishnan Dr. Sridhar Kannan, Dr. Ashish Kumar Shahi

Jaw defect can develop as result of surgery, trauma, infection or congenital malformation. The aim of replacing osseous structure are preservation of morphologic contour, restoration of mechanical strength function, & elimination of dead space and thus promote healing and prevent in-growth of soft tissue. The surgical removal of impacted mandibular third molar is one of the most frequently performed minor oral surgical procedure. The defect caused by such surgery often results in dry socket, infection and periodontal problems. The wound also undergoes secondary healing. To overcome these adverse effect, various implant material like antibiotics supplemented bone allografts (ASBA), and antibiotics with hydroxyapatite (drug delivery system) have been used to fill the above defect, with encouraging result. In the present study, natural hydroxyapatite in granular form was mixed with plaster of paris to fill in bony defects resulting from surgical removal of impacted third molar.. The plaster serves as a binder that holds the hydroxyapatite granules together and provides an effective delivery system.

24-26

Authors: Dr. Aswini Y.B., Dr. Varun Sardana

Background : Various disinfecting solutions have been indicated for decontamination of toothbrush. Objects : To know the acceptability of 3% neem, 2% triclosan, 0.2% chlorhexidine gluconate and 1% sodium hypochlorite as toothbrush disinfectants. Setting and Design : This was a double bliond, randomized, linear cross over, in vivo comparative trial conducted among 40 children aged 12-15 years. Method & Material : The study was divided into 5 phases (Phase 1-distilled water, phase 2-3% neem, phase 3-2% triclosan, phase 4-0.2% Chlorhexidine gluconate and phase 5-1% Sodium hypochlorite). The toothbrushes were soaked for 12 hours in antimicrobial solutions of respective phases (with a wash out period of one week in between each phase) after which the children brushed and asked for acceptability regarding taste by an open and closed ended questionnaire. Results : 80.6% of subjects accepted the toothbrushes and 19.4% did not (Chi-square,2=7.16, p=0.07, NS). The acceptance being high for phase 5 (36 subjects). Conclusion : It can be concluded that, all solutions were acceptable for toothbrush decontamination. The preference of taste perception was high for sodium hypochlorite followed by triclosan, neem and then chlorhexidine solution.

25-28

Authors: Dr. Imran Khan

Fracture of the mandible occurs more frequently than any other fracture of the facial skeleton due to its prominent position. Its one of the serious facial injuries that an average practicing dental surgeon may expect to encounter, though rarely. Management of mandibular fractures has evolved as early as 1650 BC, when an Egyptian Papyrus described the examination, diagnosis, and treatment of mandible fractures. Many patients either were not treated properly or received no treatment and subsequently died.

26-27

Authors: Dr. Chandrawati Guha Dr. Anurag Gurtu Dr. Payal Singhal

An inlay may be defined as a restoration which has been constructed out of mouth from gold, porcelain or other material and then cemented into the prepared cavity of a tooth. A composite inlay may be defined as a solid mass of resin composite that is cemented into a dental cavity. The form of the inlay is established by either a direct or an indirect technique. A major advantage of composite inlay systems is their ability to reduce the adverse consequences of polymerization shrinkage and stresses of directly placed posterior composites, as only the resin lute remains to be polymerized at cementation.

27-28

Authors: Dr. Vineeta Gupta, Dr. Ashish Gupta Dr. Shamindra Sengupta Dr. Hitesh Vij, Dr. Ruchieka Vij

Leukoplakia is strictly a clinical term indicating a white patch or plaque on the oral mucosa that cannot be rubbed off and cannot be characterized clinically as any other disease. This excludes lesions like lichen planus, candidiasis, leukoedma and frictional keratosis. Most cases of leukoplakia are etiologically related to the use of tobacco in smoked or smokeless forms and may regress after discontinuation of tobacco use.1 Oral Lichen Planus (OLP) is a common mucocutaneous disease thought to be affecting 0.5-1 % of the worlds population.2 The exact cause of OLP is unknown and it is generally considered to be an immunologically mediated process that microscopically resembles a hypersensitivity reaction.3 Through this article we wish to discuss a case which based on the clinical examination and the history provided by the patient, was diagnosed as leukoplakia. But which after the histopathological examination was confirmed to be a case of OLP. As both of these lesions are commonly seen and both have different treatment plans and prognosis it is important to distinguish both form each other

29-31

Authors: Dr. Pradeep Tandon

For many dental surgeons; “the number one cause of stress in their clinic” is not the clinical work problems; But rather staff related issues. Little or no emphasisemphasis is placed one business and staff management in dental colleges and our dental graduates/Post-Graduates are not prepared for their roles as business-persons persons and employers. Each clinic is a business center with dentist as its leader and a staff-team to serve and patients as target consumers. So, it’s a challenging task to create and maintain a dental team. With a wider view of dental practice in mind, we observe three type of set-ups.

29

Authors: Dr. Chander Shekhar Joshi Dr. Anamika Sharma

Triclosan (5 chloro 2 (2, 4 dichlorophenoxy) phenol also known as Irgasan or Microban is a chlorinated compound which has functional groups representative of both ether and phenols. It is a potent wide spectrum antibacterial and antifungal agent. It was recently shown to target a specific bacterial fatty acid biosynthetic enzyme, enoyl[acyl carrier protein] reductase, in Gram negative and Gram positive bacteria, as well as in the Mycobacteria. Triclosan is used in many common household products including Clearsil Daily face wash, Dentyl face wash, Dentyl mouth wash, Colgate total range, Sensodyne total care etc. Reports have suggested that Triclosan reacts with the free chlorine in tap water to produce lesser compounds like 2,4 dichlorophenol which converts into Dioxins upon exposure to UV radiation and these dioxins are extremely toxic and are very potent endocrine disruptor in the North American bullfrog. However at this stage, further research may be needed before we arrive at a final conclusion.

31-32

Authors: Dr Jayashree Sen

On 10th december1844, Horace Wells, a dentist of Hartford, Connecticut attended a 'lecture exhibition' by an itinerant scientist Gardner Quincy Colton1 and recognized the anaesthetic property of (N2O) Nitrous oxide2 .The following day, Wells requested Colton to extract one of his teeth by administering N2O on him by an inhaler in front of another dentist William Riggs, a witness3. But Wells' success and overconfidence led him to failure. In January 1845 while he was demonstrating an amputation publicly in Harvard Medical School Boston, under N2O analgesia, the patient cried out in pain because his technique probably was not correct . The pioneer Dentist Wells, who was the first one to recognize the anaesthetic qualities of N2O, became insane out of frustration. He was arrested for throwing acid at two women in Newyork city and committed suicide in 1848

31-34

Authors: Dr. Imran Khan Dr. Mohd. Irfan Ansari Dr. Rizwan Khan

The purpose of this article is to update oral surgeons & our fellow dental surgeons on approaches for perioperative management of the pregnant patient. Knowledge of the physiologic changes from a non gravid to a gravid (Pregnant) woman is of utmost importance to the dentist or the oral & maxillofacial surgeon in his/her ability to manage patient population. To understand the management of these patients one should know the ethical principles that apply in this situation, followed by their relevant physiologic changes & their treatment implications, the risk of various medications to mother & fetus, the management of concomitant medical problems in the pregnant patient appropriate timing in oral surgery during pregnancy & management of emergencies during pregnancy.

32-33

Authors: Dr. Manik Saha Dr. Srijon Mukherjee

Squamous Cell Carcinoma (SCC) is the most common oral malignancy and represents approximately 90% to 95% of all malignant tumors that occurs in the mouth. The cancer of the tongue comprises between 25 % to 50% of all intra oral cancer. The classic ulcerative SCC is described as a crater like lesion having a velvety red base rolled indurated border. Large and more invasive lesions may require aggressive surgical management, radiation / chemotherapy, or both. High risk SCC carries a significant risk of metastasis and as such requires a careful evaluation & treatment.

33-38

Authors: Dr. S. Varun Dr. Y.B. Aswini

As dentists we must know the concept of dental negligence and relevant provisions of various laws enacted in this area which is of great concern to us. Various laws for medical and dental practitioners have been based on negligence. Again the carelessness and recklessness has been identified as two different entities. Various case reports international and Indian has been discussed in this article.

34-35

Authors: Dr. Ravi Prakash S.M., Dr. M. Srinivasa Raju Dr. Om Prakash Dwarkadas Toshniwal Dr. Navneet Gill

Treacher Collins syndrome is a rare autosomal dominant disorder of craniofacial development. The fully expressed phenotype exhibits characteristic dysmorphic features involving the face, eyes, mandible and ears. We report a case of a 17 year old female presenting with the typical orofacial implications of this syndrome.

35-38

Authors: Dr. Mukhatar Ahmed Javali Dr. S. Bhudevamma Dr. Arjumand Fathima Dr. Humera Ayesha

Periodontal disease is a general term encompassing several pathological conditions such as chronic periodontitis, aggressive periodontitis, and necrotizing periodontitis. The primary etiology of periodontal disease is bacterial plaque however environment,behavioral and genetic factors acts as a risk, which influence host response and disease progresion.Most periodontal therapy remains focused on eradication of bacterial plaque and modification of risk factors. Chemotherapy may be directed at subgingival plaque, using antimicrobials, or at the host response using anti-inflammatory agents. Antimicrobials can be locally or systemically delivered; however in most cases antimicrobial chemotherapy should be considered adjunctive to mechanical debridement. Local delivery means introduction of materials into the periodontal pocket designed to positively affect the treatment of periodontal diseases. These systems have provided the profession with a new tool which,in clinical trials, has shown to alter the subgingival flora and influence the healing of the marginal attachment appartus. This review article evaluates the efficacy, limitation and future perspectives of local drug delivery of antimicrobials in Periodontics.

39-40

Authors: Dr. Vikas Verma, Dr. Amit Goel Dr. Ritu Bishnoi, Dr. Nidhi Raheja Dr. Poonam Gupta

The current concept concerning the etiology of periodontitis consider 3 groups of factors which determine whether active periodontitis will occurs in a subject- 1. Susceptible host. 2.The presence of pathogenic species. 3. Absence of so called beneficial bacteria.

39-40

Authors: Dr. Rahul Paul Dr. Geeta Paul

Today in our country, all age groups put together have an incidence of 5.7million HIV cases. Several factors put India in danger of experiencing a rapid spread, if effective prevention and control measures are not scaled up and expanded throughout the country. Medical professionals especially dentists are at high risk of being infected by HIV mostly because large number of cases still remain undocumented firstly because of social stigma attached to it and secondly the people being unaware about the cause, nature and spread of disease . We will discuss about the etiology, mode of transmission, management protocol and universal precautions to be followed for AIDS.

40-43

Authors: Dr. Rochna Rai, Dr. Pravin Kumar Dr. Dax Abraham

Introduction The term 'hand hygiene' not only refers to the process of keeping the hands clean; it includes the attitudes that arise from a deep understanding of the importance of preventing the transmission of bacteria. On a practical level, hand hygiene is aimed at reducing the bacterial contamination of the hands and, by extension, that of the objects into which they come in contact. This includes hand washing with soap or cleanser and the use of antimicrobials. Handwashing is emphasized as the single most important measure to prevent cross transmission of micro-organisms and thus to prevent nosocomial infections.1 However, under routine hospital practice compliance with this measure is still unacceptably low, less than 50% in most studies published in the past 20 years. This constant finding is worrying because recent studies have shown that this level of compliance will not reduce the risk of transmission of multiresistant bacteria in hospital.

41

Authors: Dr. Hitesh Vij Dr. Ruchieka Vij Dr. Vineeta Gupta Dr. Shamindra Sengupta

Oral cavity can be affected by numerous pathological conditions. These pathologies may have varied appearances like a swelling, an ulcer, a fistula etc., while some of these are common, others are rare. Ulcerative lesions are quite frequently encountered in the dental patients. Though ulcers have similar appearances, their etiologies encompass numerous disorders which may be reactive, infectious, immunologic, neoplastic or traumatic.1 Traumatic ulcers are generally caused by mechanical trauma and a cause and effect relationship is usually obvious. These ulcers are quite common in areas which easily come between teeth, such as lower lip, tongue and buccal mucosa. These may even arise due to masochistic habits, ill fitting prosthesis or sometimes may be iatrogenic. Even the use of a very strong mouth rinse or consumption of extremely hot food can cause ulcerations on oral mucosa. Traumatic ulcers can be acute or chronic. Acute ulcers are generally painful have a yellow base with surrounding red halo. The patient generally gives a history of trauma and the lesion heals in a week to 10 days, if the cause is eliminated. In case of chronic ulcers there is little or no pain, they have a yellow base with elevated margins. The patient may not remember history of trauma due to the long standing nature of the lesion. These ulcers do not heal easily, unless the cause and any other irritant are removed. Their clinical appearance and long standing presence may mimic carcinoma or infectious ulcers.1 In this article we present a case which was clinically thought to be a non-healing ulcer but after biopsy and proper correlation with clinical history was diagnosed as an ulcer caused by the presence of a foreign body.

41-42

Authors: Dr. C.S. Baiju Dr. Smriti Manchanda

Periodontal diseases are considered as infections of periodontium with a bacterial etiology, an immune response and subsequent tissue destruction .Non surgical and surgical pocket therapy as well as periodontal plastic surgeries are the two important branches of treatment modalities available in this field. This article is an appraisal of new materials used in periodontal therapy procedures which aid us in non-surgical techniques.

43-44

Authors: Dr. Binita Srivastava, Dr. Hind P. Bhatia Dr. Archana Agarwal, Dr. Ashish Singh Dr. Nidhi Gupta, Dr. Paramjeet S. Chopra

Sugar substitutes can play an important role in shifting the caries process in favor of maintaining dental health, and they should be recommended as part of an overall preventive treatment plan for patients at high risk of developing caries. The role of sucrose and other fermentable carbohydrates in the etiology of dental caries has been well established. Since it is known that sugared chewing gums may increase the risk of dental caries, it has been proposed that the replacement of sucrose in chewing gum or candies with a sugar substitute such as xylitol, may contribute to caries prevention.

43-44

Authors: Dr. Prashant Bhasin Dr. Meenu Taneja Dr. Binita Srivastava

Endodontic surgery constitutes the last clinical resort for maintaining the tooth in oral cavity. Endodontic surgery is performed to resolve inflammatory processes that cannot be successfully treated by conventional techniques, which may be due to complex canal and/or apical anatomy and external inflammatory processes (1). Surgical procedures may also be indicated for the resolution of procedural misadventures, to include root perforation that may occur either during canal instrumentation or post-space preparation(1,2).

45-50

Authors: Dr. Salil Pawah Dr. Niraj Rampal Dr. Amit Gupta

When faced with a clinical situation requiring intervention, Prosthodontists differ in their choice of treatment. In view of its ever-broadening scope, brought about by many new and improved materials and techniques, Prosthodontic decision-making is becoming increasingly challenging. Even thoug dental education is based on scientific knowledge and acquired clinical experience, it is possible that variations in clinical decision making are also influenced by individual preferences and styles. Decision making of different diverse clinical therapies should include two important aspects of therapy the efficacy and effectiveness. There are three ways in which a clinician can choose a specific treatment induction, deduction and seduction. The process is undoubtedly very complex, involving many influential factors, which may be both patient and dentist related, the mechanisms involved in the selectionæ evaluation and application of information remain unclear. Most of the cases are compromised by other conditions orally or systemically that require the Prosthodontist to apply a lot of effort in deciding what the best treatment for each case.

45-46

Authors: Dr. G.D. Singhal Dr. Devvrat Singh Dr. Mohit Sharma

This case report presents a 23 year old male with an oblique fractured maxillary right central incisor & lateral incisor. The treatment of the fracture included removal of coronal segment followed by an endodontic treatment. Flap surgery with an crevicular incision & ostectomy was performed to access fracture line. Then fragments were bonded with dual cure resin luting cement using a prefabricated post. After six months, clinical examinations showed a stable reattachment of the fragments, good aesthetics and periodontal health.

45-46

Authors: Dr. Puneet Ajwani Dr. Nalini Saini Dr. Parul Bansal

Aim : To present two case reports in which smile enhancement was achieved using a professional tooth whitening system (Colgate visible white containing 9% H2O2). Summary : Two female patients reported to the department of Conservative Dentistry & Endodontics with the same chief complaint of yellowish discoloration of teeth. They requested for whitening of teeth as they were not very happy with their smile. They were treated with a professional tooth whitening system (extracoronal office bleach) three times with a gap of two days between each appointment. The treatment resulted in significant tooth whitening & overall smile enhancement.

47-48

Authors: Dr. Inderpreet Singh Narula, Dr. K.K. Chaubey Dr. V.K. Arora, Dr. Rajesh K. Thakur Dr. Zeba Jafri, Dr. Shailabh Mehrotra

Pyogenic Granuloma (PG) is an “inflammatory hyperplasia” of the oral mucosa that histologically describes inflamed fibrous and granulation tissue. Some other terms used are “granuloma teleangiectaticum”, "pregnancy tumor" and “epulis gravidarum”. PG has a high incidence especially in pregnant females. The lesions tend to occur more often during the second and third trimester of pregnancy and such lesions are referred to as 'pregnancy tumours'. Increased prevalence of pregnancy epulis towards the end of pregnancy and its tendency to shrink after delivery indicate a definitive role of hormones in the etiology ofthe lesion. Sex hormonal changes observed during pregnancy are said to play an important role in its formation and development. Maintaining a good oral hygiene and use of plaque control measures can avoid the occurrence of Pyogenic Granuloma

48-49

Authors: Dr. Preeti Verma

Oral Submucous fibrosis (OSF) is a slowly, progressive , chronic fibrotic disease of oral cavity & oropharynx characterized by fibroelastic changes & inflammation of the mucosa , leading to progressive inability to open the mouth, swallow or speak. OSF is characterized as a Pre-cancerous condition which is defined as -A generalized pathological state of the oral mucosa associated with a significantly increased risk of cancer, according to WHO. OSF is a chronic & potentially malignant condition of oral cavity. This condition is first described by Schwartz (1952) as the term " Atrophia Idiopathica Mucosae Oris" . Later in 1953, described as OSF by Dr Joshi from Mumbai on the basis of its histological nature. The inflammatory response release cytokines and growth factors that promote fibrosis by inducing the proliferation of fibroblasts , upregulating collegen synthesis & down regulating collagenase production. OSF is a chronic and potentially malignant condition of oral cavity.

48-49

Authors: Dr. Hemanta Bansal Dr. Simarpreet Virk Sandhu Dr. Jagpreet Singh Sandhu

This case report presents a rare and an unusual combination of a talon cusp with fused mandibular permanent incisors. These developmental disturbances cause clinical problems including compromised aesthetics, occlusal interference, displacement of the affected tooth, attrition, periodontopathy, irritation of the tongue, loss of space and malocclusion. Clinical and radiographic characteristics of these anomalies are presented. Recognition and early diagnosis are important to avoid complications.

50-51

Authors: Dr. Ruchieka Vij Dr. Hitesh Vij Dr. Shamindra Sengupta Dr. Vineeta Gupta

Oral cancer is one of the commonest malignancies worldwide. This pathology has a high morbidity and mortality, mainly due to the delayed diagnosis of the lesion. The cause of delayed diagnosis of this lesion can be attributed to the myriad of alterations which can affect the oral mucosa.1 Oral cancer, though is a dreaded condition, it is assumed that if a premalignant lesion is detected and treated, the lesion may not progress to cancer. Oral health professionals can play a important role in early detection of malignant and premalignant conditions and hence can make a considerable contribution to decrease the incidence of oral cancer by identifying high risk patients and educating them in healthy habits.

50-51

Authors: Dr. Harish Rai Chandra Dr. Abikshyeet Panda Dr. Adesh Manchanda

The paradental cyst is an odontogenic cyst of inflammatory origin, which occurs on either the buccal, distal, or (rarely) mesial aspects of partially erupted mandibular third molars. In most cases there is an associated history of recurrent pericoronitis. We present the case of a 23 year old male patient who complained of pain and swelling in the left mandibular region. Radiograph showed a partially impacted left mandibular third molar and whose histopathological picture revealed the diagnosis of paradental cyst.

53-54

Authors: Dr. Anubha Nirawal Dr. V.K. Arora Dr. Zaiba Jafri

The long tooth effect with interdental spaces appearing as “ black triangles” or “ black holes ” is associated with cases of multiple gingival recession having periodontitis and horizontal bone loss hence the esthetics is compromised, to improve the smile line of the patient various periodontal surgeries were thought of but finally it was concluded that the smile line of the patient could only be improved by a prosthetic means that is gingival veneer,which snaps into the interdental spaces thus covering the “black triangles” or the “black holes” and in turn improving the confidence in the patient and making him socially more acceptable.