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p-ISSN No. 2348-1870
e-ISSN No. 2321-1849
www.jdpeers.asia
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Journal of Dental Peers A Dental Journal for All j. Dent. Peers Vol.2, Issue 2, April-June 2014
Open Access, Double Blind, Peer Reviewed Journal
Indexed with Copernicus International, Open J-Gate,
Google Scholar & Indian Science Abstracts
Journal of Dental Peers. All rights reserved.
Journal of Dental Peers 2013. All Rights Reserved.
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pISSN NO. 2348-1870 eISSN NO. 2321-1849 Journal of Dental peers is aimed at providing a platform to researchers, clinicians and academicians in the field of Dentistry to expand their knowledge and share their ideas. Papers will include reports on unusual and interesting case presentations and review papers on significant topics. Journal of dental peers will be published quarterly.
Journal of Dental peers will encourage scientific research to enhance the standards of Dental practice and education. It has been initiated with the purpose of bringing scientific research, interesting case reports, newer techniques and opinions to raise the dental practice and to reach the general practitioner.
EDITORIAL BOARD Editor-in-Chief Dr.Amit Kalra Editors Dr.Amandeep Bhullar Dr.Manmohit Singh Co-Editors Dr. Smriti Bhanot Dr. Neeraj Mittal Dr. Deepika Associate Editors Dr. RamanPreet Kaur Dr. Gurpreet Kaur Executive Board Dr. Manish Kinra Dr. Rafey Fahim Dr. Kavita Gupta Advisory Board
Dr Swatantra Aggarwal Dr Vinod Sachdeva Dr Shrinivas Vanaki Dr Vikas Jindal Dr Anil Singla Dr Jaidev Dhillon Dr B K Singh Dr Sharad Kamat
Dr Gaurav Gupta Dr R.S. Puranik Dr Vikas Kamble Dr Raviraj Desai Dr Dev Datta Das Dr Ajay Bibra Dr Nidhi Gupta Dr Surekha Puranik Dr Manoj Shetty
International Reviewer's Dr Md. Abid Hussain Dr Jaspreet Kaur Dr C V Raghunath Dr Pankaj Gulati Dr Gaurav Puri Dr Amit Gaba Dr Kanwalpreet Singh
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Ownership/Distrtibution Rights While the information in this journal is believed to be accurate at the date of this publication, neither the authors, the editors or the publishers, will not accept any legal responsibility for any errors or omissions that may have been made. The publisher makes no warranty, expressed or implied, with respect to the material contained herein. All articles published in this journal are protected by copyright, which covers the exclusive right to reproduce and distribute the article, as well as all translation rights. No material published in this journal may be reproduced photographically or stored on microfilm, in electronic data bases, on video disks etc. without first obtaining written permission from the publisher (respective the copyright owner if other than Journal of Dental Peers). The use of general descriptive names, trade names, trademarks etc. in this publication, even if not specifically identified, does not imply that the relevant laws and regulations do not protect these names. The Publisher may store your names and email addresses entered in this journal site in electronic format in order to correspond with you about the publication of your article in the journal, but will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party. Electronic Distribution E-article can be obtained from www.jdpeers.asia. Further more information can also be obtained from [email protected]. For ad related enquires, proposals can be sent to [email protected].
JOURNAL OF DENTAL PEERS July 2014 w Vol.2w Issue 2
Table of Contents
ORIGINAL RESEARCH
37 Evaluation of the Extent of Facial Asymmetry in Aesthetically Symmetric Faces of Bilaspur Population
Abhay Prem Prakash Agarwal1, Thilagrani P.R.2, Ashok Kumar Dhanyasi3, Jaiprakash Mongia4
43 Assessment of Dental Aesthetic Index Among School Children of Bilaspur (CG), India Hemlata Rajmani1, Thilagrani P.R.2, Ashok Kumar Dhanyasi3, Jaiprakash Mongia4
CASE REPORT
48 Resin Retained Prosthesis for anterior Tooth Replacement-Maryland Bridge- A Case Report Manoj Upadhayay1, Sudhanshu Srivastava2, Sakshi Chopra3, Mansi Rajput4, Pratim Talukdar5, Rashi Singh6
52 Bar & Clip Retained Overdenture- A Case Report Sahil Sekhri1, Shivali Goyal2, Sanjeev Mittal3
55 Management of Failed Implant using Platelet Rich Fibrin (PRF)- A Case Report Amarnath1, Pratim Talukdar2, Nitika Sachan3, Mukut Seal4, Meghali Langthasa5
59 Management of Partial Edentulism with Flexible Dentures- A Case Series Reeta Jain1, Gyan Chand2, Deepika3
LITERATURE REVIEW
62 Changing Perception and Attitude of Pediatric Dentistry Neetika Singh1, Rohit Thakur2, Nagender Chauhan3, Marisha Kaul4
ORIGINAL RESEARCH
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 37
Evaluation of the Extent of Facial Asymmetry in Aesthetically Symmetric
Faces of Bilaspur Population *Abhay Prem Prakash Agarwal1, Thilagrani P.R.2, Ashok Kumar Dhanyasi3, Jaiprakash Mongia4
Abstract Background: Although minor asymmetries are rarely evident, but the asymmetries which affects function, aesthetics or social
acceptance of an individual need complete evaluation.
Aims: To evaluate the extent of facial asymmetry in aesthetically symmetric faces of the Bilaspur population.
Materials and methods: Simple random sampling was executed to select 500 Adult subjects (250 males and 250 females) aged 12-25
years from the daily out patients of the Department of orthodontics and Dentofacial Orthopedics, New Horizon Dental College,
Bilaspur, Chhattisgarh. A Poster anterior (PA) cephalogram was obtained with each subject in centric occlusion. Skeletal asymmetry
was determined using Grummon's analysis.
Results: The results indicate less asymmetry and more dimensional stability as the cranium is approached and mandibular region
shows the asymmetries of higher magnitude. A tendency toward right side dominance was statistically significant.
Conclusion: Asymmetries are common finding in the present group of population, with males showing higher rate of asymmetry then
the females.
Keywords: Facial asymmetry, Symmetry, aesthetics.
Introduction Asymmetry is defined as being present when one or
more of the facial or cranial bilateral components (bone or soft
tissues) are not equidistant from the midline or that the center
of each of the unpaired structures does not lie on that line[1].
Asymmetry of the face is one of the more difficult problems
with which orthodontists have to contend and which often
present serious diagnostic difficulties [2]. The recognition of
the actual site of asymmetry is essential for correct treatment
planning.
Gross asymmetries occur in developmentally
acquired as well as in congenital abnormalities, usually
involve both soft and hard tissues.
*1Post-Graduate Student, 2Professor & Head, 3Reader, 4Reader, Dept. Orthodontics & Dentofacial Orthopedics, New Horizon Dental College, Sakri, Bilaspur(CG), India. E-mail:[email protected] * Corresponding Author
Minor asymmetries of the face are a common finding
in normal individuals [1,3] although they are rarely evident
and generally pass unnoticed [2,4]. Asymmetry becomes
important when it affects function, aesthetics or social
acceptance of an individual. A more precise method to
measure asymmetry is to use radiographs of the subjects.
Asymmetry of the craniofacial bones can be quantified only
through X-ray techniques. In the lateral cephalometric film,
vertical asymmetries are often recognized by the failure of
bilaterally symmetric objects to superimpose, as they normally
will. An additional dimension can be added to the radiographic
examination by panoramic films, which are useful when the
sections of mandible are deformed. Sub-mental vertex view is
also useful when the mandibular ramus is severely deformed.
Computed tomography (CT) also allows the three
dimensional viewing but significantly more radiation is
required. Thus the most common view used is the Postero-
Anterior on which researchers have used different reference
points for construction of the midline of the face, which is
essential in the study of asymmetries [5]. So for, Postero-
ORIGINAL RESEARCH
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 38
Anterior (PA) view remains most widely used tool for the
research on asymmetries. The present article aims to assess the
nature of asymmetry in aesthetically pleasing faces in
Bilaspur, Chhattisgarh population using Postero-Anterior (PA)
films.
Materials And Methods A cross-sectional study was conducted on a sample of
500 adult subjects (250 male and 250 female). Simple random
sampling was executed for the sample selection. All the
subjects were taken from the daily out patients of the
Department of Oral Medicine and Radiology, and the
Department of Orthodontics and Dentofacial Orthopedics,
New Horizon Dental College and Hospital, Bilaspur,
Chhattisgarh, India. All the subjects selected had clinically
acceptable facial harmony and symmetry with full
complement of teeth. They had no history of orthodontic
treatment and mandibular displacement during opening and
closing.
To minimize the subjective error in selection, a panel
of three orthodontists examined each person and the subjects
were selected when all the three agreed. Ethical clearance was
obtained from the ethical committee of New Horizon Dental
College and Hospital, Bilaspur, Chhattisgarh. The purpose of
the study was explained to the subjects and the written consent
was obtained before exposing them to X-ray.
The single examiner on the acetate tracing paper
traced all the P-A Cephalometric X-rays. The intra examiner
variability was determined by randomly selecting a sample of
10 PA cephalograms for retracing within period of two
months. The error was found to be 0.5 mm, which was within
normal limits.
The analysis for assessment of transverse frontal
facial asymmetry was done by using parts of the frontal
asymmetry analysis suggested by Grummons [6]Fig.1. To
check the linear transverse asymmetry, the distance between
each landmark, left and right, and the MSR line was recorded
in millimeters. The difference between each pair of
measurements was also recorded in millimeters as left side
minus right side; in this way sidedness in facial asymmetry
could be evaluated. The total width between the bilateral
landmarks (sum of left and right side) was calculated.
The absolute value of the left and right difference was
used to compute the mean absolute asymmetry for each of the
dimensions studied. Separate computation was made to test for
left or right side dominance within the sample. Positive (+)
sign for the left side and negative (-) sign for the right side
were used to indicate sidedness. The data collected from the
tracing was fed into the computer and the SPSS 17 was used to
perform the statistical analysis. Mean absolute value, Standard
Deviation (SD) and absolute value of the left and right
difference (d) was calculated. To find the differences between
male and female for different measurements Independentt
test was applied.
Results All the subjects examined showed asymmetries in
one or more of the measured dimensions. Table 1 shows the
vertical asymmetry in between male, female and in the whole
group (including male and female) for the four planes
investigated. The comparison of the value depicted no
significant difference between the males and females. Mean
absolute value and sidedness (in degree and millimeter) for the
Mandibular morphology is depicted in Table 2A. In all the
linear measurements of mandibular morphology males showed
higher rate of asymmetry compare to females, and at Go-Me
length (5.10 mm) males have almost double the asymmetry in
comparison to females (2.65 mm), which is statistically
significant. In the sidedness, males showed left sidedness at
Co-Go, whereas at Go-Me and Co-Me they showed right
sidedness, which is statistically significant. In females all the
lengths showed right sidedness, but only Go-Me and Co-Me
are statistically significant (Table 2A). Table 3A gives the
description of skeleto-facial asymmetry in transverse direction.
ORIGINAL RESEARCH
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 39
Table 1: Mean absolute value for the vertical asymmetries (in degree).
Angle Male (n=250) Female (n=250) Total(n=500) Mean
SD Mean
SD Mean
SD
Z - plane 89.920 1.550 89.90 1.090 89.910 1.330 ZA - plane 90.10 1.570 90.320 0.760 90.210 1.220 Occlusion -plane 90.220 1.740 90.160 1.490 90.190 1.600 Ag - plane 90.320 1.710 90.720 1.320 90.520 1.530
= Mean Table 2A: Gender wise mean absolute value and sidedness (in degree and millimeter) for the mandibular morphology
Absolute values ( |d|) Sidedness ( d ) Male
(N=250) Female (N=250)
P value
Male (N=250) Female (N=250) P value
|d| SD |d| SD |d| SD P value
|d| SD P value
Go - Angle
2.92 2.48 1.98 1.53 0.11 -1.08 3.71 0.15 0.22o 2.52o 0.66 0.34
Co-Go Length
2.76 2.42 1.70 1.25 0.05 1.80 3.23 0.01* -0.10 2.13 0.81 0.01*
Go-Me Length
5.10 3.25 2.82 2.65 0.009* -4.02 4.56 0.000*
-2.06 3.30 0.005* 0.08
Co-Me Length
2.94 2.61 2.18 1.74 0.23 -1.82 3.51 0.01* -1.58 2.32 0.002* 0.77
* = Significant, p
ORIGINAL RESEARCH
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 40
Table 4A : Gender wise Mandibular deviation: mean absolute value and sidedness (in millimeters)
DIMENSIONS Absolute values ( |d|) Sidedness ( d ) Male (N=250) Female
(N=250) P value
Male (N=250) Female (N=250) P value
|d| SD |d| SD |d| SD P value |d| SD P value
Mandibular offset at mention
2.56 1.59 1.82 1.51 0.099 1.20 2.80 0.043* 1.18 2.07 0.009* 0.97
* = Significant, p
ORIGINAL RESEARCH
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 41
statistically significant. All the transverse parameters used for
assessment of skeleto-facial asymmetry were measured from
MSR line and recorded individually for left and right side. The
asymmetry at Ag and Co distance is higher compare to Z, NC
and J distance. Peck et al., (1991)[9] found the asymmetry in
the upper facial region to be 0.87 mm.
In their study, Peck et al., (1991)[9] have used lateral
orbital (LO) point to check the asymmetry in upper facial
region, whereas in the present study as well as in the study of
Sumant Goel[8] zygomatico frontal suture (Z) point was used
for the same. The asymmetry observed for Z distance in our
study is 1.07 mm, which is higher in comparison to earlier
results[9].
When we considered the asymmetries from hairline
to chin, we found that the asymmetries decrease in magnitude
as we approach higher in craniofacial region and mandibular
region showed the asymmetries of higher magnitude. This
finding is in agreement with the results of earlier studies[8,9].
Zygomatic (ZA) point showed right sidedness and is
statistically significant, which is in accordance with the results
of the previous study [9]. Certain habits like sleeping only at
one side with pillow, during growing period may make
difference between left and right side at lateral zygomatic
(ZA) point.
Less asymmetry was seen in mandibular region (at
Ag) in comparison to the previous studies [8,9]. Mandibular
region shows left sidedness, which is opposite to the study
done by Peck et al., (1991)[9] but in agreement with the results
of Sumant Goel (2003)[8]. In both the studies, authors have
used gonial point (Go) to check the asymmetry in mandibular
region, whereas in the present study antigonial notch (Ag) was
used as suggested by Grummons[6] for the same.
The asymmetry for condylar distance indicates that
the mandibulo-facial region exhibit the highest asymmetries in
patients with malocclusion. Similar findings were reported by
Farkas and Cheung (1987)[10] and Sumant Goel (2003)[8].
Sleeping habits and other environmental influences may play a
role in the difference between left and right of Co, but
Lear[10] described a method for graphic and metric appraisal
of arch and palate form. He concluded that there was a marked
asymmetry in the arch form where the subject spent equal
positions at night with the right and the left cheeks pillowed.
Mandibular deviations showed asymmetry of 2.19 mm, which
is less compared to the study done by Sumant Goel (2003)[8].
This is in agreement with Severt and Proffit (1997)[11] who
found an incidence of 74% of chin deviations. This high
incidence of chin deviation may be due to the asymmetries of
mandibular length, which also showed high incidence.
Various parameters that showed right sidedness in the
present study are: Go angle, Go-Me and Co-Me in mandibular
morphology, ZA and Co in transverse skeletofacial
asymmetry, in which except Go angle all parameters are
statistically significant. Which is similar to the study done by
Shah and Joshi (1978)[3], Farkas and Cheuing (1981)[10],
Peck et al., (1991)[9], Ferrario et al. (1994)[13] and Sumant
Goel (2003)[8].
Conclusion Following conclusion can be drawn from the present study;
1. Asymmetries are common finding in the present
group of population.
2. The asymmetries decrease in magnitude as we
approach higher in craniofacial regions and
mandibular region shows the asymmetries of higher
magnitude.
3. Males show higher rates of asymmetries compare to
females.
4. There is a right side dominance of facial asymmetry.
Source of Interest/ Conflict: None Declared.
References 1. Sutton PRN. Lateral facial asymmetry. Angle Orthod
1968;38:82-93.
2. Mulick JF. An investigation of craniofacial asymmetry
using the serial twin study method. Am J Orthod
1965;5:112-29.
ORIGINAL RESEARCH
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 42
3. Shah SM, Joshi MR. An assessment of asymmetry in the
normal craniofacial complex. Angle Orthod 1978;48:141-
48.
4. Plint DA, Ellisdon PS. Facial asymmetries and
mandibular displacements. Br J Orthod 1971;1:227-35.
5. Marmary Y, Zilberman Y, Mirsky Y. Use of foramina
Spinosa to determine Skull Midlines. Angle Orthod 1979;
49:263-68.
6. Grummons DC, Kappeyne MA. A frontal asymmetry
analysis. J ClinOrthod 1987; 21:448- 65.
7. Scott JH. The analysis of facial growth in the anterior and
vertical dimension. Am J Orthod 1958;44:507-13.
8. Goel S, Ambedkar A, Darda M, Sonar S. An assessment
of facial asymmetry in Karnataka population. Journal of
Indian orthodontic society : 2003;36:30-38.
9. Peck S, Peck L, Kataja M. Skeletal asymmetry in
esthetically pleasing faces. Angle Orthod 1991;61:43-48.
10. Farkas LG, Cheung G. Facial asymmetry in Healthy
North American Caucasians. - Angle Orthod 1981;51:76-
78.
11. Lear CSC. Symmetry analysis of the palate and maxillary
dental arch. Angle Orthod 1968;38:56-62.
12. Severt, Proffit. The prevalence of facial asymmetry in the
dentofacial deformities population at the University of
North Carolina. Am J Orthod. Orthognath. Surg
1997;12:171-76.
13. Ferrario VF, Sforza C, Carlo EP, Tartaglia G. Distance
from symmetry: A three dimensional evaluation of facial
asymmetry. American association of oral and maxillo-
facial surgeons 1994; 52: 1126-32.
How to cite this Article; Abhay Prem Prakash Agarwal, Thilagrani P.R., Ashok Kumar Dhanyasi, Jaiprakash Mongia. Evaluation of the Extent of Facial Asymmetry in Aesthetically Symmetric Faces of Bilaspur Population. J. Dent. Peers 2014;2(2):37-42.
ORIGINAL RESEARCH
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 43
Assessment of Dental Aesthetic Index Among School Children of Bilaspur
(CG), India *Hemlata Rajmani1, Thilagrani P.R.2, Ashok Kumar Dhanyasi3, Jaiprakash Mongia4
Abstract Introduction-Malocclusion is one of the most widespread oral health problems that the society is facing. There is increased concern
for dental appearance during adolescents to early adulthood. Most of the malocclusion can be corrected if detected early by
correctional methods.
Objectives-This study is to know the prevalence of malocclusion and orthodontic treatment needs among 12-15yr old school children
of Bilaspur.
Materials and Methods-A total of 351 study subjects were selected based on convenience sampling and examination was carried out
under natural light and data was recorded using WHO Proforma 1997. The collected data was subjected to statistical analysis using
SPSS16.
Results-Out of the 351 children examined, 46.2% were boys & 53.8% were girls and their mean age was 13.89yrs. One and two
segment crowding was seen in 24.5% & 11.4% respectively. Normal molar relation was seen in 80.3% of children. Definite, severe
and very severe or handicapping malocclusion was seen in 9.7%, 4.3% & 3.4% of children respectively. There is no statistically
significant difference in malocclusion status between boys and girls.
Conclusion-Only 4.3% and 3.4% of children required highly desirable and mandatory orthodontic treatment needs.
Keywords- Malocclusion, Dental Aesthetic Index, Orthodontic Treatment needs.
Introduction Dento-facial appearance has a lot to do with the way
the people are perceived in the society.[1] People equate good
dental appearance with success in many aspects.[2] Social
interactions that have a negative effect on self-image, career
advancement and a peer group acceptance have been
associated with an unacceptable dental appearance.[3] The
prevalence of malocclusion varies from country to country and
among different races.[1] The reasons to develop malocclusion
could be genetic or environmental and/or combination of both
the factors along with various local factors such as adverse
oral habits, tooth anomalies, form and developmental posit ion
of teeth can cause malocclusion.
*1Post-Graduate Student, 2Professor & Head, 3Reader, 4Reader, Dept. Orthodontics & Dentofacial Orthopedics, New Horizon Dental College, Sakri, Bilaspur(CG), India. E-mail: [email protected] * Corresponding Author
Orthodontics has traditionally focussed on children
and adolescents.[4] There is an increases concern for dental
appearance during adolescents to early childhood has been
observed.[2] Malocclusions are 3rd in the ranking of priorities
among the problems of dental public health worldwide,
surpassed only by dental cavity and periodontal diseases.[5]
The benefits of taking orthodontic treatment are to prevention
of tissue damage and correction of aesthetic component,
improve the physical function[2]. A variety of indices have
been developed to assist professionals in categorizing
malocclusion according to the treatment needs[6]. Dental
Aesthetic Index (DAI) introduced by Cons et al(1986), which
links clinical and aesthetic components. It was developed
originally based on North American Caucasian sample.[7] The
World Health Organization concerning to acknowledge the
real malocclusions conditions in different countries, adopted it
as a cross cultural index and advocated it in the 4th Edition of
ORIGINAL RESEARCH
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 44
the Manual of Basic Oral Health Survey, so there would be a
suitable instrument to gather epidemiological data collection
and assessment of orthodontic treatment needs [5,7-9]. DAI is
proven to be reliable, valid, versatile, simple and easily
applied index[7,9]. Most of the malocclusion can be corrected
if detected early by correctional methods.[1] This study was
intended to evaluate the prevalence of malocclusion, its
severity and the orthodontic treatment needs using DAI,
among 12-15yr old school children of Bilaspur, Chattishgarh.
Materials and Methods The present study was conducted among 12-15yr old
school children of Bilaspur, Chattishgarh. The schools were
selected based on convenience sampling. A total of 351 school
children of both sexes were selected for the study based on
convenience sampling. Approval was obtained from the
concerned authorities before the start of the study. All
examinations were performed at schools while children were
seated on chair under normal illumination. The examiners
were trained and intra-examiner calibration was done. Kappa
statistics showed a good agreement. Sufficient number of
autoclaved instruments was taken to the examination site. The
WHO Proforma (1997) was used to assess the malocclusion.
Data collected was coded, processed and subjected to
statistical analysis using SPSS version 16.
Results The study population consisted of about 351 school
children aged 12-15years in Bilaspur city, out of which 46.2%
were males and 53.8% were females (Table 1). Table 2 shows
the distribution of DAI components. Out of 351 school
children, 24.5% had one segment crowding and 11.4% had
two segments crowding. One and two segment spacing was
seen in 8.5% and 1.7% school children respectively. Diastema
of 1-3mm was seen among 5.7% of the study subjects. Largest
maxillary irregularity of 0, 1-3 and >3mm was seen among
80.9%, 17.1% and 2% of school children respectively. Largest
mandibular irregularity of 0, 1-3 and >3mm was seen among
72.1%, 27.6% and 0.3% of school children respectively.
Maxillary over-jet of 0-3mm is considered normal and was
seen among 76.4% of school children and >3mm was seen
among 23.6%of school children. Mandibular overjet of 0-3mm
was among 99.4% of school children and 0.6% of them had
>3mm of overjet. Open bite of >3mm was seen among 0.9%
of study subjects. Molar relation was normal among 80.3% of
school children whereas half cusp and full cusp molar relation
was seen among 14.8% and 4.8% of school children. There
was no statistically significant difference between the DAI
scores and the gender. Table 3 shows the distribution of
according to DAI score, severity of malocclusion, treatment
indicated and gender. 4.3% and 3.4% of the study subjects had
severe and very severe malocclusion respectively and required
highly desirable and mandatory orthodontic treatment needs.
Discussion Many epidemiological studies have been conducted
worldwide utilizing various indices for quantifying the extent
of malocclusion.[1] Crowding of incisal segment affects half
of all children in mixed dentitions and it worsens in adolescent
years as the permanent teeth erupt and continues to increases
as the age progresses.[2] In the current study, 35.9% of the
study population had incisal crowding. The results of the
current study are in correlation with the study conducted by
Shivakumar et al[2] and in contrast with a study conducted by
Bhardwaj et al[1].
Both the upper and lower incisal segments were
examined for spacing. In the present study, 10.2% had incisal
segment spacing either in one or both the arches which school
children and this result was in correlation to the study
conducted by Artenio Jose IsperGarbin et al[5].
Diastema>1mm was seen among 5.7% of school children and
this result was in correlation to the study conducted by Artenio
Jose IsperGarbin et al5. Irregularity may occur with or without
crowding. In the current study, 19.1% of the children had
maxillary anterior irregularity of >1mm, and the results are in
ORIGINAL RESEARCH
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 45
TABLE 1. Age Wise Distribution of Study Population
AGE FREQUENCY PERCENTAGE 12 13 3.7 13 95 27.1 14 133 37.9 15 110 31.3
TOTAL 351 100
TABLE 2. Distribution of Dai Component
DAI COMPONENTS PERCENTAGE (%) CROWDING 0
0NE SEGMENT TWO SEGMENT
64.1 24.5 11.4
SPACING 0 0NE SEGMENT TWO SEGMENT
89.7 8.5 1.7
DIASTEMA 0 1-3
94.3 5.7
LARGEST MAXILLARY IRREGULARITY(mm)
0 0-3 >3
80.9 17.1 2
LARGEST MANDIBULAR IRREGULARITY(mm)
0 0-3 >3
72.1 27.6 0.3
MAXILLARY OVERJET (mm) 0-3 >3
76.4 23.6
MANDIBULAR OVERJET(mm) 0 >3
99.4 0.6
OPEN BITE(mm) 0 >3
99.1 0.9
MOLAR RELATION NORMAL HALF CUSP FULL CUSP
80.3 14.8 4.8
TABLE 3. Distribution of the Subjects According to Dai Scores, Severity of Malocclusion, Treatment Needs and Gender (P=3.946).
DAI SCORE
Severity Of Malocclusion
Treatment Indicated
MALE (%)
FEMALE (%)
TOTAL (%)
35 Very severe or handicapping malocclusion
Mandatory 4.9 2.1 3.4
TOTAL 100 100 100
ORIGINAL RESEARCH
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 46
correlation with the study conducted by Shivakumar et al[2]
and Artenio Jose IsperGarbin et al[5]. 27.9% had mandibular
anterior irregularity >1mm and the result were in contrast with
the study conducted by Bhardwaj et al[1], DS Rwakatema et
al[8], B. Eduardo and F.M Carlos[9].
In the present study, maxillary overjet of >3mm was
seen in 23.6% and it was similar to the study conducted by B.
Eduardo and F.M Carlos9 and Bhardwaj et al1 and in contrast
to a study conducted by Matilda Mtaya et al10.
Mandibular overjet of >3mm was seen in 0.6% of
school children and it was in correlation with studies
conducted by Shivakumar et al2, DS Rwakatema et al8 ,
Bhardwaj et al1 and Artenio Jose IsperGarbin et al5.
An anterior openbite of >3mm was seen in 0.9% of
school children which was similar to studies conducted by
Bhardwaj et al1 and B. Eduardo and F.M Carlos9. Normal
molar relation was seen in 80.3% of the school children and
which was similar to the study conducted by Bhardwaj et al1
and was in contrast with the study conducted by Artenio Jose
IsperGarbin et al5. Definite malocclusion was seen in 9.7% of
the school children, severe malocclusion was seen in 4.3% of
school children and very severe or handicapping malocclusion
was seen in 3.4% of children. Similar results were found in the
study conducted by Vijaya Hedge and RekhaShenoy11,
Bhardwaj et al1 and Shivakumar et al2, whereas it was in
contrast with the study conducted by B. Eduardo and F.M
Carlos9 and D.S Rwakatema et al8.
Conclusion Thus the present study concluded that out of 351
study subjects, 4.3% and 3.4% of school children required
highly desirable and mandatory type of orthodontic treatment
needs respectively. The information from this study forms a
part of the basis not only for further research, but also for
planning orthodontic care.
Source of Interest/ Conflict: None Declared.
References 1. VK Bhardwaj, KL Veeresha and KR Sharma.
Prevalence of malocclusion and orthodontic needs
among 16 and 17year old school going children in
Shimla city, Himachal Pradesh. Indian Journal of
Dental Research 2011;22(4): 556-560.
2. Shivakumar KM, Chandu GN, Subba Reddy VV, et
al. Prevalence of malocclusion and orthodontic
treatment needs among middle and high school
children of Davangere city, India by Dental Aesthetic
Index. J India SocPedodPrev Dent 2009; 27:211-218.
3. H. Nihal, B. Guvenc and U. Ersin.Dental Aesthetic
Index scores and perception of personal dental
appearance among Turkish university students.
European Journal of Orthodontics 2009; 31: 168-
173.
4. B.A Carlos, M.C Jose-Maria, M.P David, et al.
Orthodontic treatment need in Spanish young adult
population. Med Oral Patol Oral Cir Bucal 2012;
17(4):638-643.
5. I.G Artenio Jose , P.P Paulo Cesar, S.G CleaAdas, et
al. Malocclusion prevalence and comparison between
the Angle classification and the Dental Aesthetic
Index in scholars in the interior of Sao Paulo state-
Brazil. Dental Press J Orthod 2010; 15(4):94-102.
6. Poonacha KS, Deshpande SD, Shigli AL. Dental
Aesthetic Index, applicability in Indian population: a
retrospective study. J Indian Pedod Prev Debt 2010;
28: 13-17.
7. B. Venkatesh, Gopu H. Assessment of Orthodontic
treatment needs according to Dental Aesthetic Index.
Journal of Dental Sciences and Research 2011;
2(2):9-13.
8. D.S Rwakatema, P.M. Ng'ang'a and A.M. Kemoli.
Orthodontic treatment needs among 12-15 year olds
in Moshi, Tanzania. East African Medical Journal
2007; 84(5): 226-232.
ORIGINAL RESEARCH
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 47
9. B. Eduardo and F.M Carlos. Orthdontic treatment
need in Peruvian young adults evaluated through
Dental Aesthetic Index. Angle Orthodontist 2006;
76(3): 417- 421.
10. M Matilda, B. Pongsri and A. Anne Nordrehaug.
Prevalence of malocclusion and its relationship with
socio-demographic factors, dental caries and oral
hygiene in 12 to 14 year old Tanzanian school
children. European Journal of Orthodontics 2009;
31: 467-476.
11. H. Vijaya and S. Rekha.Dentition status, treatment
needs and malocclusion status among 15-year-old
school children of Mangalore- a pilot study. JIDA
2010; 4 (12): 568-569.
How to cite this Article; Hemlata Rajmani, Thilagrani P.R., Ashok Kumar
Dhanyasi, Jaiprakash Mongia. Assessment of Dental
Aesthetic Index Among School Children of Bilaspur (CG),
India. J. Dent. Peers 2014;2(2):43-47.
CASE REPORT
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 1
Resin Retained Prosthesis for anterior Tooth Replacement-Maryland Bridge- A
Case Report. Manoj Upadhayay1, Sudhanshu Srivastava2, Sakshi Chopra3, Mansi Rajput4, *Pratim Talukdar5, Rashi Singh6 Abstract Restoring a missing single central incisor is one of the most difficult esthetic procedures in dentistry. A space in the anterior region of
the dental arch either due to trauma, congenital missing tooth, tooth lost to decay, trauma, root fracture, failed root canal treatment, or
pathology can produce a huge amount of psychological impact on the patient. The various treatment option like implant, removable
partial denture and fixed partial denture are available. However these treatment options are not applicable in every case due to various
reasons like growth of the jaws, cost, amount of tooth reduction, and chair side time for the procedure. In some of such situation, a
resin- bonded fixed partial denture (RBFPD) such as Maryland Bridge fulfills all the requirements of an ideal interim solution.
Keywords- Missing single central incisor, Resin- bonded fixed partial denture, Maryland Bridge.
Introduction Over the last several decades, dentistry has focused
on more conservative treatment modalities and preventive
techniques. This has been possible not only because of
improved techniques and materials, but also because of the
understanding that tooth preparation, regardless of how
conservative it may be, is an irreversible procedure.
It is said that restoring a missing single central incisor
is one of the most difficult esthetic procedures in dentistry. A
number of dental concerns need to be considered when
treating an anterior tooth such as shade, morphology, gingival
contours, bone levels, and occlusion. Additionally, a choice
between a fixed prosthesis, removable prosthesis, and an
implant needs to be determined. Finally, in present era patient
is more demanding in terms of esthetics, they opt for more
conservative and less invasive procedures [1].
A missing tooth in the anterior region is not only a
physical loss, but also has a physcological impact on the
patient.
1Reader, 2,3,4PG Student, Department of Prosthodontics,
Babu Banarsi Das University, Lucknow, Uttar Pradesh, India. *5,6Private Dental Practitioner.
E-mail:[email protected]
* Corresponding Author
To remove healthy tooth structure of adjacent teeth to
replace a congenitally missing tooth or a tooth lost to decay,
trauma, root fracture, failed root canal treatment, or pathology
is a very aggressive treatment option for both patients and
dentists. Infection in any of these situations creates an
environment in the hard and soft tissues that makes
regeneration procedures more difficult, thereby complicating
the ability to create a natural appearance in the definitive
restoration
Today techniques and materials are available that
provide the typical clinician a number of options which are
both professionally satisfying to the dentist and aesthetically
and functionally appropriate to the patient.
1. FlipperThe only advantage for the flipper was the
cost factor. A few of the disadvantages were the lack
of mastication ability, and the possibility of problems
during speaking.
2. ImplantThe implant option had the advantage of
long-term stability. The disadvantages were the cost
and the time factor before a final restoration could be
completed.
3. Three-unit bridgeThe advantages for this option
included excellent stability and function. The major
CASE REPORT
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 49
disadvantage was the necessity of reducing viable
tooth structure.
4. Maryland BridgeThe advantage for this type of
bridge was in the minimal reduction on the lingual of
the abutment teeth. The given disadvantage for this
option was the possible debonding of the bridge.
While a conventional three-unit fixed partial denture
is a predictable technique to replace a missing tooth, the
invasive nature of the treatment can lead to other
complications throughout the life of the restoration.
Complications may include mechanical overload of the
abutment teeth with weakening or fracture, risk of endodontic
treatment, periodontal problems, decay, and cement failure. If
any of these complications occurs on one of the abutment
teeth, the entire prosthesis will fail.
This case report describes the use of resin bonded
fixed partial denture as a valuable treatment plan in restoring
smile and oral functions with minimal biological cost.
Case Report
A male patient, aged 31 years presented with a
missing upper left maxillary central incisor (21). Patient gave
a history of tooth lost due to trauma 2 years back. On
examination it was revealed that the entire tooth was missing
with an edentulous area with no space loss (Fig.1). An intra
oral periapical radiograph was taken and the radiography
revealed complete root formation of the adjacent teeth (12 &
21).
After considering the patients wish and the clinical
situation, other treatment options like removable partial
denture, fixed partial denture and implant were eliminated and
it was decided to replace it with a Maryland bridge as an
interim solution. Tooth preparation for both 12 and 21 was
done following the standard technique. Lingual preparation
ended 1mm from the incisal edge and a light chamfer finish
line was prepared 1 mm supra-gingivally (Fig.2, 3) an
impression was made in polyether impression material and
sent to the laboratory.
After the metal try-in was successful (Fig.4) shade
selection was done using a shade guide. The trial fitting of the
prosthesis was done. Esthetics, mastication and speech were
evaluated. The laboratory technician was instructed to keep the
metal wings of the prosthesis off the incisal third to prevent
darkening of the tooth because of the inhibition of light
transmission. In addition, care was taken to make sure metal
would not be visible interproximally or at the embrasure areas.
After isolation, the Maryland Bridge was cemented (Fig. 5,6,
7) using conventional composite resin cement. A 12-month
follow-up was advised until the patient is ready to replace the
bridge with a more permanent solution.
Discussion For more than 50 years, dentistry has sought amore
conservative approach to replacing a single missing tooth with
a conventional fixed prosthesis, which involves the cutting of
sound tooth structure. Treatment possibilities have evolved
from bonding a natural extracted tooth or composite resin
restoration to the adjacent teeth, [2-4] to the Rochette bridge,
[5,6] to the maryland bridge,[79] and currently to the single-
implantsupported crown. It is debatable which technique is
the most conservative, and in many instances the patients
preference tells the restoration of choice. The clinician must
also evaluate the advantages and disadvantages of such
techniques in order to provide the patient with the best clinical
result since not all patients should be treated with the same
restoration type or design.
With improvements in the field of adhesive dentistry,
resin-bonded bridgework has become a viable option for the
long-term replacement of missing teeth. One study reported a
median survival time of 7 years 10 months [10]. Possible
designs include: cantilever, fixed-fixed and hybrid where one
of the retainers is conventional. A major advantage of resin-
bonded prostheses is that minimal tooth preparation is required
and so they can usually be considered a reversible procedure.
As dentine preparation is not involved, the integrity of a young
pulp is maintained. Other advantages include the fact that
anaesthesia is not normally required, soft tissues are not
CASE REPORT
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 50
disturbed which simplifies impression procedures, and
margins are supragingival, facilitating plaque removal.
Fig. 1. Intra oral view of missing tooth.
Fig.2 & 3. Palatal view of prepared tooth surfaces.
Fig.4. Metal Try In.
Fig.5 & 6. Cemented Restoratin Frontal and Palatal View.
Fig.7. Extra oral view of Cemented restoration.
The Rochette bridge replaces the missing tooth
without any tooth preparation, it was, at best, considered a
temporary solution, and its framework was designed with a
gold substructure and hence resulted in a thick metal
framework. Such restorations were designed with macro-
mechanical retentions to lock the composite into the gold and
through the bonded lingual surface. This technique met the
patients conservative requirements of replacing the missing
tooth, even though it required the patients compliance not to
overload the prosthesis during masticatory function and
necessitated a modified flossing technique because of the
splinted prosthesis. Resin-bonded prosthesis continued to
improve, and their evolution led to the development of the
Maryland Bridge.
In this technique, the tooth required a conservative
preparation in the enamel only with a gingival rest to create a
definite seat. The preparation design included an interproximal
wraparound to help prevent lingual displacement and to
increase stability on a bondable surface area (enamel) with a
solid, non-perforated, metal substructure that could be as thin
as 0.2 mm. Use of a non-noble metal alloy significantly
increases the mechanical retention of the etched framework
and more easily prevents degradation of the luting resin in the
oral cavity. Care must be exercised so the framework does not
involve the incisal third of the abutment teeth, since this could
block translucency and result in a graying effect. While use of
a resin-bonded retainer involves a very conservative technique
and preparation of the enamel is minimal care must be
exercised to prevent occlusal overload during function
Conclusion
Resin bonded bridges can be highly effective in
replacing missing teeth, restoring oral function and aesthetics
and result in high levels of patient satisfaction. They represent
a minimally invasive, cost effective and long lasting treatment
modality. Reference
1. Parker RM. An Ultraconservative Technique for
Restoring a Missing Central Incisor. Contemporary
Esthetics 2007: 30-34.
2. Ibsen RL. One-appointment technic using an
adhesive composite. Dent Surv 1973;49:3032.
3. Ibsen RL. Fixed prosthetics with a natural crown
pontic using an adhesive composite: Case history. J
South Cal Dent Assoc1973;41:100102.
CASE REPORT
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 51
4. Jordan RE, Suzuki M, Sills PS, Gratton DR,
Gwinnett JA. Temporary fixed partial dentures
fabricated by means of the acid-etch resin technique:
A report of 86 cases followed for up to three years. J
Am Dent Assoc1978;96:9941001.
5. Rochette AL. Attachment of a splint to enamel of
lower anterior teeth. J Prosthet Dent 1973;30:418
423.
6. Howe DF, Denehy GE. Anterior fixed partial
dentures utilizing the acid-etch technique and a cast
metal framework. J Prosthet Dent 1977;37:2831.
7. Livaditis GJ, Thompson VP. Etched castings: An
improved retentive mechanism for resin-bonded
retainers. J Prosthet Dent 1982;47:5258.
8. Simonsen R, Thompson V, Barrack G. Etched Cast
Restorations: Clinical and Laboratory Techniques.
Chicago: Quintessence, 1983.
9. Rubinstein S, Jekkals V. Preparation for anterior
resin-bonded retainers. Compend Cont Educ Dent
1986;7:631632.
10. Djemal S, Setchell D, King P, Wickens J. Long-term
survival characteristics of 832 resin-retained bridges
and splints provided in a post-graduate teaching
hospital between 1978 and 1993. J Oral Rehab
1999;26: 302320.
How to cite this Article; Manoj Upadhayay, Sudhanshu Srivastava, Sakshi Chopra,
Mansi Rajput, Pratim Talukdar, Rashi Singh. Resin
Retained Prosthesis for anterior Tooth Replacement-Maryland
Bridge- A Case Report. J. Dent. Peers 2014;2(2):48-51.
CASE REPORT
Journal of Dental Peers, Vol. 2 Issue 2, July 2014 52
Bar & Clip Retained Overdenture- A Case Report
*Sahil Sekhri1, Shivali Goyal2, Sanjeev Mittal3 Abstract It is more important to preserve what already exists than to replace what is missing as stated by MM De Van has never been questioned or disagreed. Considering this the preservation of one or more teeth/roots to facilitate an overdenture has many advantages, including preservation of alveolar bone overtime. Overdentures provide better function than conventional complete dentures through a variety of factors, such as improved biting force chewing efficiency, and increased speed of controlled mandibular movement. In addition, they minimize the downward and forward setting of a denture, which otherwise occurs with alveolar bone resorption. This article presents a case report in which bar and clip retained overdenture was constructed for the patient. Keywords overdenture, bar, clip, ridge preservation.
Introduction It is more important to preserve what already exists than to replace what is missing as stated by MM De Van has never been questioned or disagreed. Considering this the preservation of one or more teeth/roots to facilitate an overdenture has many advantages, including preservation of alveolar bone overtime[1]. Retaining teeth for an overdenture is an old concept and a viable treatment modality[2-5]. Through a reduction of crown to root ratio, it is distinctly possible that retained roots could support retentive elements that would be used to secure a dental prosthesis. Overdenture can be defined as a complete or partial removable denture supported by retained roots or teeth to provide improved support, stability, and tactile and proprioceptive sensation and to reduce bone resorption. The clinician must face a number of decisions when planning for over denture. Overdentures provide better function than conventional complete dentures through a variety of factors, such as improved biting force chewing efficiency, and increased speed of controlled mandibular movement[5]. In addition, they minimize the downward and forward setting of a denture, which otherwise occurs with alveolar bone resorption[6].
With increasing stress on preventive prosthodontics, the use of over dentures has reached a point where it is now a feasible alternative to most treatment plan outlines in the construction of prosthesis for patients with remaining teeth.
*1P.G. Student, 2P.G. Student, 3Professor, Department of Prosthodontics, M.M. College of Dental Sciences & Research, Mullana, Ambala, India. E-mail: [email protected]
*House No.427, Sec-46-A,Chandigarh-160047
The overdenture, a complete or partial denture prosthesis constructed over existing teeth or root structure, is not a new concept in a technical approach to a prosthodontic problem. Indeed its use dates back to 100 years. Overdenture is also known as Overlay dentures, Onlay dentures, Hybrid dentures, Superimposed dentures, Telescoped dentures, Biologic dentures, Coping prosthesis [5-7].
Advantages
Preservation of alveolar bone. Preservation of proprioceptive response. A simple approach to a problem patient. Simplicity of construction ease of obtaining accurate
records and superior denture stability Support Periodontal maintenance Retention Open palate possible Cost effective Ideal occlusion Superior patient acceptance Less trauma to supporting tissues Conversion to complete denture
Indications Patients with poor prognosis for complete dentures In maxilla in cases with excessive vertical overlap
of anterior teeth Unilateral overdenture with bone loss is excessive on
one side of the arch Contraindications
Lack of patient acceptance Lack of proper oral hygiene and periodontal tissue
maintenance When other treatment modalities promise superior
results. Cost considerations
CASE REPORT
Journal of Dental Peers, Vol. 2 Issue 2, July 2014 53
Denture stability is believed widely to be related to resistance against other forces like oblique and anterior-posterior forces. The patient's satisfaction is directly influenced by the amount of denture retention as it has been shown through several studies. The need for correcting the patients problems with faulty denture is an inevitable consequence of retention failure and residual ridge resorption. Various methods to connect overdentures have been described. Industrial balls and cast round or oval (e.g. Dolder bar) bar attachments are frequently used. Following clinical case report describes the procedure of fabricating bar retained mandibular overdenture with a superior retention and stability as compared to conventional complete denture. Case report An 80 year old male patient reported to Department of Prosthodontics, M. M. college of Dental Sciences & Research, Mullana, Ambala for replacement of missing teeth. The patient with lower partial edentulism with intact canines, thorough intra- oral examination presented periodontally sound mandibular canines and patient wanted to preserve his teeth. So keeping in consideration patients needs and oral findings it was planned to fabricate a mandibular overdenture for the patient. An OPG (Orthopantomogram) along with IOPAR (intra oral periapical radiograph) i.e. 33 and 43 were taken to rule out any underlying pathology. Thorough oral prophylaxis was performed on both upper and lower arches before impression procedures. Diagnostic impressions were made and tentative jaw relation record was made to carefully evaluate the interarch space and for occlusal considerations to aid in further treatment planning. Considering the close proximity of abutments and clinical condition of abutments it was decided to provide a bar splinted mandibular overdenture. Intentional RCTs were performed on both the canines. Clinical Steps
1. Tooth preparation was done on abutments (33,43). Crowns were reduced to approx. 4mm length with uniform axial taper.
Fig. 1 Final Impression of lower ridge
Fig.2 Wax pattern prepared on to the cast
Fig.3 Casting tried on to the patients mouth
Fig.4 Denture with metallic clip
Fig.5 Nylon rider in place
Fig.6 Post-operative
2. For additional retention of copings radicular means of retention was opted and post space was prepared upto depth of 5mm.
3. Border moulding of the lower ridge was done. Impression of both the space created and the lower ridge was taken with light body impression material (indirect technique)(Fig 1).
CASE REPORT
Journal of Dental Peers, Vol. 2 Issue 2, July 2014 54
4. The cast was poured in die stone. 5. Inlay wax copings were fabricated on cast which
were connected by pre-fabricated bar; as it is known that the splinting of two or more teeth with a bar produces stability similar to that obtained with rigid stud-type attachment when the overdenture is in place.The design was similar to that of a dolder bar. The Dolder bar is the one most often mentioned in discussions of the bar system. (Fig 2).
6. The sprues were attached over copings as well over the bar and casting was done in Ni-Cr using conventional technique, it was finished and polished.
7. The casting was tried on cast and then intraorally to check for passive fit. (Fig 3).
8. Jaw relation recording was done in conventional way and a tooth set up was done which was tried in patients mouth.
9. The metal rider and the spacer were placed and the cast was blocked with type IV die stone.
10. Rest of the acrylization procedure is similar to conventional complete denture, after dewaxing stage, the metal rider clip was snapped onto the bar and packing is done.
11. After curing was complete, the denture was retrieved with metal clip picked up in denture, the denture was finished and polished. (Fig 4).
12. Seating tool was used to place the nylon rider in the metal clip which will be attached to the bar. (Fig 5).
13. The copings with bar attachment are cemented in patients mouth, and the denture was delivered to patient after checking the fit in patient. The patient was given placement and home care instructions. Patient was recalled for examination after 24 hrs and was advised to get check up done every 6 months. (Fig 6).
Discussion It is well known fact that the residual ridge resorption is an inevitable pathophysiological phenomenon. The mandibular residual ridge resorbs almost 4 times faster than the maxillary ridge according to the literature. It is also proven that the bone/supporting structures around the retained teeth or implants are maintained for a longer duration of time. It is thus essential and well required that a clinician endeavors to preserve the last tooth/root. For this type of patient, mandibular overdenture are less expensive than implant prosthodontics, have a better
prognosis than would a replacement fixed partial denture, and are more retentive stable, and functional than complete dentures, the mandibular bar retained overdenture provides a sense of proprioception. It also reduces torquing of the remaining root structures because crown-root ratio is decreased. The bar affords adequate retention without unduly torquing the bar and canine abutments. Further, the patient can more easily perform plaque-control procedures because access is unimpeded. Last, the abutments are less susceptible to caries because the cast coping covers the exposed tooth structure[6].
Conclusion The use of teeth as over denture abutments is beneficial to the patients. The patients strict compliance with oral hygiene procedures and maintenance instructions will greatly increase the long-range prognosis of the denture tooth complex.
Source of Interest/ Conflict: None Declared References
1. Crum AJ, Rooney GE, Jr. Alveolar bone loss in overdentures: a 5 year study. J Prosthet Dent 1978; 40:610-3.
2. Tallgren A. Changes in adult face height due to aging, wear, loss of teeth and prosthetic treatment. Acta Odontol Scand. 1957;15:24.
3. Brill N. Adaptation and the hybrid prosthesis. J Prosthet Dent. 1955;5:811823.
4. Miller PA. Complete dentures supported by natural teeth. J Prosthet Dent.1958;8:924928.
5. Prince JB. Conservation of the supportive mechanism. J Prosthet Dent.1965;19:327338.
6. Williamson RT. Retentive bar overdenture fabrication with preformed castable components: A case report. Quintessence Int 1994;25:389-94.
7. Dole VR, Marathe SS, Singh GS, Dable RA. Cost effective pre-fabricated semi-precision attached overdenture- a case report. J Evo Med Dent Sci 2012;1(6):1263-6.
How to cite this Article; Sahil Sekhri, Shivali Goyal and Sanjeev Mittal. Bar & Clip Retained Overdenture- A Case Report. J. Dent. Peers 2014;2(2):51-53.
CASE REPORT
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 55
Management of failed implant using platelet rich fibrin (PRF)- A case report
Amarnath1, *Pratim Talukdar2, Nitika Sachan3, Mukut Seal4, Meghali Langthasa5
Abstract Implant-supported restoration offers a predictable treatment for tooth replacement. Reported success rates for dental
implants are high. Nevertheless, failures that mandate immediate implant removal do occur. The consequences of implant removal
jeopardize the clinicians efforts to accomplish satisfactory function and esthetics. Appropriate use of the contemporary techniques
like PRF will enable the successful treatment of almost any complicated case with bone deficient regions of the jaw. This case
reports the step-by-step procedures in a case of failed maxillary right central incisor implant which was removed and restored by
placement of implant simultaneous with the use of bone grafting and PRF for the re-establishing predictable bone volume to
support the new implant.
Key words: Implant failure, PRF, centrifuge, predictable bone volume.
Introduction Dental surgeons are constantly looking for
maximizing the healing response of the patient during
reconstructive procedures. The search for predictable
outcomes in terms of volume of bone and implant
osseointegration had lead to development of many bioactive
surgical additives [1]. In 1974, platelets regenerative
potentiality was introduced, and Ross et al., [2] were first to
describe a growth factor from platelets. After activation of
the platelets which are trapped within fibrin matrix, growth
factors are released and stimulate the mitogenic response in
the bone periosteum during normal wound healing for repair
of the bone.[3] Better understanding of physiologic
properties of platelets in wound healing since last two
decades led to increase its therapeutic applications in the
various forms showing varying results.
Platelet-rich plasma (PRP) was proposed as a
method of introducing concentrated growth factors PDGF,
TGF-, and IGF-1 to the surgical site, enriching the natural
blood clot in order to expedite wound healing and stimulate
bone regeneration.[4]
1M.D.S. Orthodontics, *2M.D.S. Prosthodontics, 3M.D.S. Prosthodontics, 4M.D.S. Endodontics, 5M.D.S. Pedodontics. Email: [email protected]
*Dr. Pratim Talukdar, House No. 13, Bye Lane-2, Swahid Dilip Huzuri Path, Sarumotoria, Dispur, Guwahati-781016, Assam, India.
Platelet-rich fibrin (PRF), developed in France by
Choukroun et al (2001), is a second-generation platelet
concentrate widely used to accelerate soft and hard tissue
healing. PRF is a strictly autologous fibrin matrix containing
a large quantity of platelet and leukocyte cytokines. Platelet-
rich fibrin (PRF) represents a new step in the platelet gel
therapeutic concept with simplified processing minus
artificial biochemical modification[5]. Unlike other platelet
concentrates, this technique requires neither anticoagulants
nor bovine thrombin (nor any other gellation agent), making
it no more than centrifuged natural blood without
additives.[6,7]
Case report
A 21 year old male reported to the dental clinic
with chief complaint of loosening of implant and unesthetic
appearance. On clinical examination, implant placed in
region of 11 was found to be mobile and showed signs of
peri-implantitis (Fig 1). Due to implant failure, the length of
the offending prosthesis was visibly longer compared to the
contra-lateral tooth. Radiograph showed considerable bone
loss around the implant (Fig 2). History revealed that
implant had been placed 3 years back which progressively
became loose over the period of last six months. After
examination and history, decision was taken to remove the
existing implant and restore the surgical site with bone graft
mixed with platelet rich fibrin and place a new implant at the
same visit.
CASE REPORT
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 56
Procedure Before starting the surgical procedure, patient was
prepared to draw 3 vials of blood to prepare PRF. It required
a 24 gauge butterfly needle and 9 ml blood collection tubes.
For PRF preparation, whole blood was drawn into the tubes
without anticoagulant and immediately centrifuged using
laboratory centrifuge(R-8C, SRL Diagnostics) (Fig 3).
Within a few minutes, the absence of anticoagulant
allows activation of the majority of platelets contained in the
sample to trigger a coagulation cascade. Fibrinogen is at first
concentrated in the upper part of the tube, until the effect of
the circulating thrombin transforms it into a fibrin network.
The result is a fibrin clot containing the platelets located in
the middle of the tube, just between the red blood cell layer
at the bottom and acellular plasma at the top (Fig 4).
The platelet rich fibrin also called as the snot clot
was removed from the tubes and the RBC portion was
carefully seperated. (Fig 5) PRF from one tube was kept to
be mixed with bone graft (Nova bone, bioactive synthetic
bone graft) , while the other two were placed into a PRF box
which flattens the PRF into a membrane with 1mm
thickness. (Fig 6)
Patient was then prepared for surgery. The failed
implant that had a diameter of 3mm was removed (Fig 7);
use of trephine drill was not necessary due to extreme
mobility of implant. Incisions were made to expose the
surgical site (Fig 8). The socket left by the extracted implant
was curetted and all granulation tissue and socket debris
were removed. A new implant was placed in the surgical site
(Nobel Active , 3.0*11.5mm). The defect around the implant
was filled with bone graft mixed with PRF. After
condensing the graft around implant the PRF membrane was
delicately placed over the implant (Fig 9) and the surgical
site, followed by flap replacement and sutures (Fig 10).
Patient was recalled after 24hrs and 1 week to
assess healing and then after 3months for radiographic and
clinical examination. Adequate bone was found surrounding
the implant and signs of osseointegration could be
appreciated on the radiograph. (Fig 11) A healing period of
3 months was found to be sufficient to resist a torque of 25
N.cm applied during abutment tightening.
Discussion Dentists are often faced with implant failure that
may occur due to multiple reasons. It is important to manage
such cases with techniques that will give predictable
outcomes and which are considerably less technique
sensitive and economical. Removal of failed implants often
leads to large bone defects due to use of trephines. This
necessitates placement of larger dimension implant which
might not be feasible due to limited available bone. Such
cases require use of bone graft to restore the defect. To
maximise the benefits of grafting and to ensure good bone
volume, PRF membranes are used.
PRF is easy to obtain, less costly, and a possibly
very beneficial ingredient to add to the regenerative mix.
The easily applied PRF membrane acts much like a fibrin
bandage,[8] serving as a matrix to accelerate the healing of
wound edges. [9] It also provides a significant postoperative
protection of the surgical site and seems to accelerate the
integration and remodeling of the grafted biomaterial. [10-
12]
Release of growth factors from PRF through in
vitro studies and good results from in vivo studies has led to
increased clinical application of PRF. It was shown that
there are better results of PRF over PRP. Dohanet al.,[13]
proved a slower release of growth factors from PRF than
PRP and observed better healing properties with PRF. It was
observed and shown that the cells are able to migrate from
fibrin scaffold; while some authors demonstrated the PRF as
a supportive matrix for bone morphogenetic protein as well.
There are several advantages of PRF over PRP like
no biochemical handling of blood, simple and cost-effective
process, use of bovine thrombin and anticoagulants not
required, favorable healing due to slow polymerization,
more efficient cell migration and proliferation. PRF has
supportive effect on immune system and also helps in
hemostasis.[14,15]
Conclusion Although PRF belongs to a new generation of
platelet concentrates, the biologic activity of fibrin molecule
is enough in itself to account for significant cicatricial
capacity of the PRF. The slow polymerization mode confers
CASE REPORT
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 57
to PRF membrane as a particularly favorable physiologic
architecture to support the healing process. This case report
demonstrates the clinically predictable outcomes obtained in
management of failed implant using PRF.
Fig. 1 & 2: Pre-operative intra-oral photograph showing failed implant which is considerably longer than its counterpart and Radiographic view showing severe bone loss around the failed implant in the region of 11.
Fig. 3 & 4: Vials of blood collected from the patient are centrifuged and Fibrinogen concentrated in the upper part of the tube resulting in a fibrin clot.
Fig. 5 & 6: Plasma rich fibrin removed from the tubes with RBC portion removed and PRF box, which flattens the PRF into a membrane with 1mm thickness.
Fig. 7 & 8: Failed implant was removed and Incisions made to expose the surgical site. A new implant was placed in the surgical site.
Fig. 9 & 10: After condensing the graft around implant the PRF membrane was delicately place over the implant and closed surgical site with sutures.
Fig. 11: 3-months post-operative radiograph showing osseointegrated implant with adequate surrounding bone.
Source of Interest/ Conflict: None Declared.
References 1. Dohan DM, Choukroun J, Diss A, Dohan SL,
Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin
(PRF): A second-generation platelet concentrate.
Part I: Technological concepts and evolution. Oral
Surg Oral Med Oral Pathol Oral Radiol
Endod. 2006;101:e3744.
2. Ross R, Glomset J, Kariya B, Harker L. A platelet-
dependent serum factor that stimulates the
proliferation of arterial smooth muscle cells in
vitro. Proc Natl Acad Sci U S A. 1974;71:120710.
3. Gassling V, Douglas T, Warnke PH, Ail Y,
Wiltfang J, Becker ST. Platelet-rich fibrin
membranes as scaffolds for periosteal tissue
engineering. Clin Oral Implants Res. 2010;21:543
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4. Soffer E, Ouhayoun JP, Anagnostou F. Fibrin
sealants and platelet preparations in bone and
periodontal healing. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2003; 95:521-528.
5. Dohan DM, Choukroun J, Diss A, Dohan SL,
Dohan AJ, Mouhyi J, Gogly B. Platelet-rich fibrin
(PRF): a second-generation platelet concentrate.
Part I: technological concepts and evolution. Oral
CASE REPORT
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Surg Oral Med Oral Pathol Oral Radiol Endod
2006; 101:e37-44.
6. Marx RE, Carlson ER, Eichstaedt RM, Schimmele
SR, Strauss JE, Georgeff KR. Platelet-rich plasma:
Growth factor enhancement for bone grafts. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod
1998; 85(6):638-646.
7. Weibrich G, Kleis WK, Buch R, Hitzler WE,
Hafner G. The Harvest Smart PReP system versus
the Friadent-Schutze platelet-rich plasma kit. Clin
Oral Implants Res 2003; 14:233-239.
8. Vence BS, Mandelaris GA, Forbes DP.
Management of dentoalveolar ridge defects for
implant site development: An interdisciplinary
approach. Compend Cont Ed Dent 2009; 30(5):250-
262.
9. Gabling VLW, Ail,Y, Springer IN, Hubert N,
Wiltfang J. Platelet-rich Plasma and Platelet-rich
fibrin in human cell culture. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2009; 108:48-55.
10. Choukroun J, Adda F, Schoeffler C, Vervelle A.
Une opportunit en paro-implantologie: le PRF.
Implantodontie 2001; 42:55-62.
11. Dohan DM, Choukroun J, Diss A, Dohan SL,
Dohan AJ, Mouhyi J, Gogly B. Platelet-rich fibrin
(PRF): a second-generation platelet concentrate.
Part II: platelet-related biologic features. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod 2006;
10145-50.
12. Dohan DM, Choukroun J, Diss A, Dohan SL,
Dohan AJJ, Mouhyi J, Gogly B. Platelet-rich fibrin
(PRF): A second generation platelet concentrate.
III. Leukocyte activation: A new feature for platelet
concentrates? Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2006; 101:51- 55.
13. Dohan DM, Choukroun J, Diss A, Dohan SL,
Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin
(PRF): A second-generation platelet concentrate.
Part II: Platelet-related biologic features. Oral Surg
Oral Med Oral Pathol Oral Radiol
Endod. 2006;101:e4550.
14. He L, Lin Y, Hu X, Zhang Y, Wu H. A
comparative study of platelet-rich fibrin (PRF) and
platelet-rich plasma (PRP) on the effect of
proliferation and differentiation of rat osteoblasts in
vitro. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod. 2009;108:70713.
15. Vinazzer H. Fibrin sealing: Physiologic and
biochemical background. Fac Plast
Surg. 1985;2:2915.
How to cite this Article; Amarnath, Pratim Talukdar, Nitika Sachan, Mukut Seal, Meghali Langthasa. Management of failed implant using platelet rich fibrin (PRF)- A case report. J. Dent. Peers 2014;2(2):54-58.
CASE REPORT
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 59
Management of Partial Edentulism with Flexible Dentures- A Case Series *Reeta Jain1, Gyan Chand2, Deepika3 Abstract The fabrication of prosthesis for partially edentulous arches creates a challenge when soft tissue and bony undercuts, interferences,
multiple paths of placement, tilted teeth and deranged occlusion are present to complicate the treatment plan. Flexible dentures are the
best treatment options to treat partial edentulous conditions. These case reports describe the management of partially edentulous
conditions with flexible partial dentures rather than with cast partial dentures.
Key words: Thermoplastic Resin FRS Lucitone, Injection System, Flexible Denture, Acrylic clasps.
Introduction Restoration of esthetics is an important factor to
consider in the fabrication of a removable partial denture
(RPD). Several types of polymers and metal alloys have been
used in RPD construction. Frequently, RPD clasps made from
the same alloy as the metal framework. The most common
alloys used for clasps are cobalt-chromium (Co-Cr) alloy and
gold and titanium alloys; although these may be unaesthetic
[1]. Thermoplastic materials for dental prostheses were first
introduced to dentistry in the 1950s. These materials were
similar grades of Polyamides (nylon plastics). It is reported
that these materials have a sufficiently high resilience and
modulus of elasticity to allow its use in the manufacture of
retentive clasps, connectors, and support elements for
removable partial dentures [2, 3].
FRS Lucitone is a pressure injected, flexible denture
base resin that is ideal for partial dentures and unilateral
restorations.
*1Professor and Head, Department of Prosthodontics,
Crown and Bridge Including Implantology, 2Sr. lecturer,
Department of Oral and Maxillofacial surgery, 3Sr. lecturer,
Department of Prosthodontics, Crown and Bridge Including
Implantology, Genesis Institute of Dental Sciences and
Research, Ferozepur, (Punjab).
E-Mail:- [email protected]
*55/6, Gandhi Nagar, Jind (Haryana)
This material generally replaces the metal, and the
pink acrylic denture material used to build the framework for
standard removable partial dentures. Flexible partials blend in
well with the natural appearance of your gums, making the
partial virtually invisible. The plastic has almost a chameleon
effect; it is so strong that the partial dentures can be made very
thin and also picks up the characteristics of the underlying
tissue. This article presents cases of partially edentulous
patients who are successfully treated with pressure injected
FRS Lucitone flexible removable partial dentures.
Case Report- 1
A healthy 58-year-old man was reported in
department of prosthodontics, with chief complaints of
difficulty of eating food and poor appearance. Clinical
Examination of the patient revealed 5 missing maxillary teeth
11, 16, 17, 26, 27 and 4 missing mandibular teeth 34, 37, 46,
47 (Fig.1, 2). As the maxillary and mandibular teeth were
periodontally sound and caries free, they were retained. The
planned treatment was placement of a maxillary and a
mandibular flexible removable partial denture (RPD).
With the aim of maximizing the border seal to ensure
retention, the decision was made to incorporate flexible
flanges in the undercut region using resilient FRS lucitone
material to allow optimal height (extension) and thickness
(width) of the denture flange. The denture flange was designed
to fill the entire available vestibular space. Preliminary
impressions were made in alginate, the model poured.
CASE REPORT
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 60
Secondary impressions were made with dual impression
technique. Bite registration and try-in was done. FRS Lucitone
uses the Retento Grip tissue bearing technique for retention.
No tooth or tissue preparation is needed. After designing the
case on the master model, placing all necessary relief and
blocking in wax, sprue was attached as straight as possible.
After investing and washing out, the teeth were prepared for
mechanical retention. The FRS lucitone resin was injected into
a closed flask using success injection system (Dentsply).
After the case is deflasked, it is finished and fit on the
master model, polished, and placed in water. The partials were
left in the hot water for about one minute. The hot water
treatment permits a very smooth initial insertion and a good
adaptation with the natural tissues in the mouth. If the patient
senses any discomfort because of tightness of a clasp, the clasp
may be loosened slightly by immersing that area of the partial
in hot water and bending the clasp outward. Like any
removable prosthesis, the patient was instructed to utilize good
hygienic practices to maintain the appearance and cleanliness
of the FRS Lucitone restoration (Fig. 3, 4, 5).
Fig. 1 & 2. Front and Intraoral pre-operative view
Fig. 3. Flexible maxillary and mandibular prosthesis
Fig. 4 & 5. Front and Intraoral post-operative view
Case Report- 2
A healthy 53-year-old man was referred to
department of prosthodontics from oral medicine department.
Intraoral examination of the patient revealed 7 remaining
maxillary and 7 mandibular teeth (Fig. 6, 7). Missing teeth
were 11, 14, 16, 17, 21, 22, 25, 26, 34, 35, 36, 37, 45, 46, 47.
As the maxillary and mandibular teeth were periodontally
sound and caries free, they were retained. The planned
treatment was placement of a maxillary and a mandibular
flexible removable partial denture (RPD). Similar procedure
was followed as in Case 1 (Fig. 8, 9, 10).
Fig. 6 & 7. Front and Intraoral pre-operative
Fig. 8: Flexible maxillary and mandibular prosthesis
Fig. 9 & 10. Front and Intraoral post-operative view
Discussion Thermoplastic resins have been used in dentistry for
over 50 years. During that time the applications have
continued to grow, and the interest in these materials of both
the profession and the public has increased. The materials
CASE REPORT
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 61
have superior properties and characteristics and provide
excellent esthetic and biocompatible treatment options. With
the development of new properties, elastomers and copolymer
alloys, there are certain to be additional new applications for
thermoplastic resins in the future, to help patients with
damaged or missing teeth [4].
Retentive clasp arms must be capable of flexing and
returning to their original form and should retain an RPD
satisfactorily. The tooth should not be unduly stressed or
permanently distorted during service and should provide
esthetic results [5]. The clinical experience of loss of retention
of the RPD after the prosthesis is worn for some time raises
the question of whether constant deflection of the clasp during
insertion and removal of the denture fatigues the clasp. The
rationale for using flexible flanges and clasp was to aid
retention by ensuring seal around the entire border of the
denture.
Flexible dentures absorb small amounts of water to
make the denture softer and tissue compatible. They do not
warp or become brittle. These dentures stand aesthetically
superior removable dentures with full functionality and
comfort [6]. Complete biocompatibility is also achieved
because the material is free of monomer and metal, these being
the principle causes of allergic reactions in conventional
denture materials [7].
Conclusion Due to their ability of excellent mould ability,
lightweight to density ratio and high thermal strength,
thermoplastic materials have occupied an envious place for
making complete and partial dentures. However careful case
selection and clinical judgment is required to use flexible
dentures in appropriate situations in order to obtain a
successful treatment outcome.
Source of Interest/ Conflict: None Declared.
References 1. Vallittu PK, Kekkonen M. Deflection fatigue of
cobalt chromium, titanium, and gold alloy cast
denture clasp. J Prosthet Dent 1995;74:412-21.
2. Turner JW, Radford DR, Sherriff M. Flexural
properties and surface finishing of acetal resin
denture clasps. J Prosthodont 1999;8:188-95.
3. Fitton JS, Davies EH, Howlett JA, Pearson GJ. The
physical properties of a polyacetal denture resin. Clin
Mater 1994;17:125-9.
4. Chittaranjan B, Aswini Kumar Kar. Management of a
case of partial edentulism with esthetic flexible
dentures. Indian Journal Of Dental Advancements
2009;1(1):60-2.
5. Kotake M, Wakabayashi N, Ai M, Yoneyama T,
Hamanaka H. Fatigue resistance of titanium-nickel
alloy cast clasps. Int J Prosthodont 1997;10:547-52.
6. Prashanti E, Jain N, Shenoy VK. Flexible denture - A
flexible option to treat edentulous patient. J of Nepal
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7. Shamnur SN, Jagdish KN, Kalavathi K. Flexible
Dentures - An alternate for rigid dentures? Journal of
Dental Sciences and Research 2010;1(1):74-9.
How to cite this Article; Reeta Jain, Gyan Chand and Deepika. Management of Partial Edentulism with Flexible Dentures- A Case Series. J. Dent. Peers 2014;2(2):59-61.
REVIEW
Journal of Dental Peers, Vol. 2. Issue 2, July 2014 62
Lasers - Changing Perception and Attitude of Pediatric Dentistry *Neetika Singh1, Rohit Thakur2, Nagender Chauhan3, Marisha Kaul4
Abstract Past several years have witnessed emergence of lasers entering the field of dentistry. Some of the first reports of their use
invitro date to late 1960s. With laser technology, clinical experience has become beneficial for treatment of children than with
conventional methods, as it eliminates need of high-speed drill along with its noise and vibration, prevents hemorrhage by sealing
blood vessels, providing excellent visibility and reducing operating time. Children and adolescents are best candidates as they are
bothered by pain, bleeding, incapacitation and need for office visits for extensive post-operative activities. Although presently the use
of lasers in dentistry is not as widespread, its use will continue to gain support as more knowledge is gained about its advantages over
the drill. It will only be a matter of time before it becomes the new standard of care in dentistry. There is no doubt that fear of the
infection and pain keeps most patients dreading the dentist. Therefore this is a valuable instrument to provide patients with a satisfying
experience, thus changing the perception and attitude many have of dentistry.
Key words: Lasers, Micro dentistry, Children, Pediatric Dentistry
Introduction Over the years, the use of medical lasers have
become so wide spread that it has grown to be the standard of
care for a vast variety of medical procedures that were once
performed with scalpels. Similarly with the advent of new
technological advances in dentistry the drill can also now be
replaced by the laser, introducing a new philosophy in
dentistry called microdentistry[1]. This development in
laser dentistry has led to an increasing acceptance of this
technology by both practitioners and general public[2].
Review of Literature Taylor R (1965)[3] stated that with 55 joules beam,
pulp tissue of incisors were destroyed, cavitation was
produced in enamel and dentine, and enamel adjacent to
cavitation appeared to be fused so that rod structure was no
longer apparent as compared to 35 joules beam. Adrian JC
*1Senior Lecturer, Institute of Dental Studies and Technology, Meerut, Uttar Pradesh, India., 2Dental Officer, Military Dental Centre (MDC), Meerut., 3M.D.S., Prosthodontics and Crown & Bridge., 4M.D.S., Orthodontics and Dentofacial Orthopedics. E-mail: [email protected]
*H.No 634, Sector 37, Noida, Uttar Pradesh, India.
(1977)[4] suggested that pulp was more resistant to injury by
Nd laser than by the ruby laser. Wigdor H et al (1993)[5]
concluded that Er:YAG laser has lesser thermal effect as
compared to CO2 and Er:YAG lasers. Moshonov J et al
(1995)[6] stated mean cleanliness in non-lased specimens was
approximately 9% and in laser treated it reduced to 2%.Visuri
SR et al (1996)[7] concluded that laser preparation leaves a
suitable surface for strong bond than the standard dental bur.
Baggett FJ et al (1999)[8] stated that Nd:YAG laser removes
soft tissue by photoablative reaction with resultant coagulation
and haemostasis. Medeiros F et al (2005)[9] evaluated
performance of DIAGNOdent for detection and quantification
of smooth surface caries in primary teeth. Radatti D et