Himanshu Aeran

In edentulous patient, restoring labial fullness is a delicate technique. To achieve our clinical aim, proper communication between the dentist and the laboratory technician is required. In some completely edentulous cases, the prominent enlarged labial flange of a complete denture contributes to poor facial aesthetics. To solve this problem, the complete denture was adjusted and a gum-fit or flangless denture was prescribed. This case reports presents a simple, cost-effective, conservative and non-surgical option for fabricating dentures in a patient with a large maxillary ridge in order to improve the patient's facial aesthetics.   Keywords: Flangless denture, Edentulous

Background: Periodontitis is an inflammatory disease which results by the interaction between bacteria leading to inflammation and destruction of the connective tissue attachment apparatus. Flap surgeries are most frequently employed treatment modality for deep periodontal pockets. Over the decades, many suture materials like silk and nylonare being used for the approximation of the flaps. In the present scenario of periodontal advancements, fibrin glue manifests to be a great alternative to flap approximation with better clinical and histological results. Aim & Objectives: This randomized clinico-histological study aims to compare the healing of modified flap operation when approximated with Silk suture and N-butyl cyanoacrylate bioadhesive. Materials and Methods: Thirty patients were recruited in this clinico-histological study. In Group A, surgical site was approximated by 3-0 black braided silk sutures (@TRUSILK) and in Group B, N-butyl cyanoacrylate bioadhesive (@EPICLOS) was used by driplets for flap approximation. Patients were recalled for removal of sutures and any cyanoacrylate present after 1 week of surgery. All the parameters (clinical and histological) were taken at baseline and at 7 day. Results: On intra and inter group comparison all the clinical parameters i.e., Gingival index (GI), Papillary Marginal Attachment (PMA) Index, Turesky-Gilmore-Glickman modification of Quigley Hein Plaque Index (TQHPI), Wound healing index (WHI) and histological parameters i.e., inflammatory cells and vascularity shows significant reduction at 7 day in group B (N-butyl-cyanoacrylate). Conclusion: N-butyl-cyanoacrylate (Group B) is more effective in reducing the clinical and histological parameters than Silk sutures (Group A).   Keywords: Modified flap operation, Silk sutures, N-butyl cyanoacrylate, Healing, Excisional biopsy.

A pier abutment is the lone standing abutment tooth between two critically situated edentulous spaces, in a frequently seen clinical situation, a missing first premolar and first molar is seen, which leads to a design where canine and the second molar acts as a terminal abutments and second premolar acts as a pier abutment. This pier abutment acts as a fulcrum which may lead to debonding of the less retentive terminal abutment during function, to overcome this situation a non rigid connector is advised. This paper presents a clinical case report which describes the incorporation of non rigid connector to rehabilitate the pier abutment case in unilateral maxillary and mandibular region.   Keywords: Stress breaker, Pier abutment, Non rigid connector, Key­keyway.

Context: One of the most commonly faced clinical problems is dentinal hypersensitivity (DH). It's a "enigma" that's "often met yet seldom comprehended." It is defined as a sensation of discomfort caused by exposed dentine in response to heat, chemical, tactile, or osmotic stimulation. It appears to be a common ailment, with estimates ranging from 4% to 74 percent of the population. Aim: The study aimed in evaluating the efficacy of sodium fluoride varnish, dentine bonding agent and diode laser in treating dentine hypersensitivity in vitro and in vivo. Materials and Methods: The research was split into two parts: in vitro and in vivo. In the in vitro study, 40 anterior teeth were extracted and separated into four groups: control, group A (fluoride varnish), group B (dentine bonding agent), and group C (laser), all of which were studied under a scanning electron microscope. For the in vivo part 30 patients aged 20-50 years with the chief complaint of sensitivity to hot and cold were selected from the outpatient department (OPD) of Seema Dental college and Hospital. The patients were divided into 3 groups, group A(fluoride varnish), group B (dentine bonding agent) group C (laser). At the end of 3 months, there was a statistically significant difference seen in mean VAS and VRS scores between Group A, Group B, and Group C; additionally, the mean of dentinal tubules in the SEM study (In vitro) was seen to be significantly higher in the Control group compared to Group A and Group B, and significantly higher than Group C. Conclusion: According to the findings of this study, all three treatment methods, sodium fluoride varnish, dentine bonding agent and laser are efficient in reducing dentine hypersensitivity in both in vivo and vitro studies, with laser showing better outcomes.   Keywords: Dentine hypersensitivity, Sodium fluoride varnish, Dentine bonding agent, Diode laser, Scanning electron microscope.

Background: A bidirectional relationship is seen between periodontal disease and diabetes mellitus. Adipokines like resistin and chemerin act as a proinflammatory molecule. Their action is mediated by the generation of pro-inflammatory cytokines and the stimulation of inflammatory cell chemotaxis to the site of inflammation. Aim and Objectives: This study aimed to compare the levels of resistin and chemerin in saliva in diabetes mellitus type 2 and chronic periodontitis after non-surgical periodontal therapy (NSPT). Materials and Methods: Forty-five subjects were recruited and divided into three groups – healthy controls (Group A), chronic periodontitis (Group B) and diabetes mellitus type 2 with chronic periodontitis (Group C). Group B and C received NSPT. The parameters included were gingival index, plaque index, clinical attachment loss and probing pocket depth which were evaluated at baseline and end of three months. Levels of resistin and chemerin in saliva were evaluated using resistin and chemerin enzyme linked immunosorbent assay (ELISA) kit. Result: At 3 months, PI, GI, PPD and CAL was reduced statistically significant in B and C groups as compared PI and GI of group A. Salivary resistin and chemerin levels were also reduced significantly in all three groups except chemerin in group A. Mean salivary resistin and chemerin levels at baseline were highest in group C followed by group B and least in group A. Conclusion: Non-surgical periodontal therapy reduces all clinical variables, resistin and chemerin levels. Salivary resistin and chemerin levels can be used as a likely biomarker to assess the outcome following NSPT.   Keywords: Combined oral contraception, Hormonal contraceptives, Progestin-only, Hypothalamic-pituitary-ovarian.

Aim: This case report aims to analyze the treatment outcome of receding gums with coronally advanced flap (CAF) with/without an autologous platelet rich fibrin (PRF). Materials and Methods: Two patients with localized Miller’s class I gingival recession reported to the department of Periodontology, Seema Dental College and Hospital, Rishikesh, were selected for coronally advanced flap with/without autologous platelet rich fibrin for aesthetic purpose. At baseline, 1 and 3-month treatment outcome was assessed by following clinical parameters such as recession depth (RD), recession width (RW), clinical attachment level (CAL), keratinized tissue width (WKT). Results: Recession depth (RD), Recession width (RW), Clinical attachment level (CAL), Width of keratinized tissue (WKT) shows significant improvement in patient with platelet rich fibrin at 1 month & 3 months. Conclusion: Coronally advanced flap along with PRF shows that it is a predictable treatment modality for localized Miller's class I recession defects. Keywords: Gingival recession, Coronally, Platelet rich fibrin.

Aim: The study was done to analyse parent’s understanding about their child's dental health in the first dentist visit, with a particular focus on the internet's impact on parents of preschool children. Materials and Methods: This survey was conducted among 800 parents of pre-school children enrolled in various schools from Rishikesh. A pre-validated questionnaire was distributed among participants. Participants were given questionnaires written in English and the local Hindi language before and after the educational intervention to assess oral health-related awareness of the parents regarding their child's oral health. Conclusion: From the total sample, 35% had poor knowledge score before the educational intervention and 100% had good knowledge score after the educational intervention. The current study concluded that higher levels of oral health education and awareness would lead to better oral health status in children. When the parental KAP score was compared before and after educational intervention, there was a statistically significant difference seen. Health care providers/dentists should organise activities such as parental guidance, lectures, and mass education in home wellness centres to develop knowledge to promote good oral health.   Keywords: Educational intervention, Pre-educational intervention, Poor knowledge.

Conventional implants cannot be placed in patients with severe atrophied maxilla resulting in insufficient amount of bone remaining for anchorage. Routinely, grafts were the preferred technique. But the drawbacks associated with this procedure, Branemark proposed surgical /prosthetic rehabilitation with zygomatic implants to overcome them. This review aims to address the criteria for placement, surgical and prosthodontics procedure, outcome evaluation and complications arising with zygomatic implants.   Keywords: Maxilla, Implants, Prosthetic, Surgical, Rehabilitation

High generation of aerosols, and the presence of SARS-CoV-2 in saliva have suggested oral cavity as a reservoir for COVID-19 transmission. COVID-19 can penetrate the human body. The transmission can occur during coughing, sneezing, talking and even during dental care. SARS-CoV-2 is an enveloped virus, characterized by an outer lipid membrane. It has been seen that preprocedural rinses with mouthwash reduces the viral load. Chlorhexidine gluconate has been used in the clinical practice since ages. It is a broad spectrum antimicrobial agent, causing distruction of cellular membranes. It acts against gram positive and gram negative bacteria, aerobes, facultative anaerobes and fungus. It is also seen to be effective against viruses. Therefore, this review focuses on the role of chlorhexidine in COVID-19.   Keywords: Chlorhexidine, Covid- 19, Mouthwashes

Pulp necrosis with incomplete root formation in permanent teeth leads to open apex of the particular tooth which leads to the formation of the periapical pathology. The management of such cases poses a great endodontic challenge. Apexification is the process of induction of calcific barrier across the open apex or the continued apical development in an immature tooth with infected necrotic pulp. The aim of this case report is to share a successful apexification of maxillary central incisors with by using Biodentine without complications. Result: Biodentine is a material of choice for single visit apexification. Keywords: Apexification, Apical barrier, Biodentine, Immature teeth.

A simple estimation of the proportion of the partial edentulous persons is a rough indication of dental diseases and also the success or failure of dental care. The epidemiological features of partial edentulousness of one community or one village can be evaluated on the basis of a cross-sectional houseto-house survey. In this study a cross-sectional house-to-house survey was carried out at lower Garhwal region of Uttarakhand, India. The objective of this study was to determine the prevalence of the level of edentulism and its relevance to other co-factors such as age, gender and socioeconomic status. Keywords: Partially edentulism, Socioeconomic status, Kennedy’s classes, Survey, Garhwal.

Missing teeth can be substituted by the use of the dental implants. This treatment modality has been proven to be a gold standard for replacement of the missing tooth in the past decade. The most widely used implants in the current scenario are the osseointegrated implants with various shortcomings and the most prominent one is the lack of the periodontal ligament. To overcome this, implants with periodontal ligaments can be procured and this can be possible by the application of the tissue engineering concept along with suitable implant material. Tissue engineering has become an integral part of the periodontal therapy and its use has opened various gates in the field of dentistry. A tissue engineered periodontal ligament around the dental implant has been introduced in the past few years and is called as ligaplant. These ligaplants has become a promising option that can provide good biological performance leading to an increased life of the prosthesis. This review article highlights the advantages of the periodontal ligament combined dental implants in comparison to the conventional implants and also the process of their procurement has been discussed. Keywords: Ligaplants, Implants, Tissue engineering, Periodontal ligament, Osteointegration.

Aim: To compare the effectiveness of a Single Tuft Toothbrush (STB) with Conventional Toothbrush (CT) for the control of dental plaque. Materials and Methods: Chronic generalized gingivitis patients (n=25) were selected and received professional oral prophylaxis. All the subjects were reevaluated after 7 days and based on the periodontal evaluation (probing pocket depth and clinical attachment level), only periodontally healthy subjects (n=20) were included in the study. Subjects were randomly divided into 2 groups: STB group (n=20); CT group (n=20). Subjects were instructed to use only the assigned toothbrush for 72 hours with a 3-day washout period. The evaluated parameters were Gingival index (Loe and Silness,1963), disclosed plaque index and modified sulcular bleeding index (Momblli,1987) at baseline (T=0) and at the end of each experimental period (T=72). Results: On intragroup comparison there was statistically significant difference in all the parameters in both groups at 72 hours (p Conclusion: Single tuft brushes are more effective for control of dental plaque as compared to conventional toothbrush. Keywords: Periodontally, Conventional toothbrush.

Periodontal diseases are a heterogeneous group of diseases characterized by inflammation and the subsequent destruction of the tooth supporting tissue. Conventional periodontal regenerative procedures involving periodontal flaps for access are employed to improve short- and long-term clinical outcomes of periodontally compromised teeth. Minimally invasive therapeutic approaches with minimized incisions and trauma to the soft tissue have proven to be advantageous over the conventional therapy. This review focuses on four such techniques – PerioProtect, Tri-Immuno Phasic Periodontal Therapy, Subperiosteal Minimally Invasive Aesthetic Ridge Augmentation Technique (SMART) and Flapless technique for Bone Graft. PerioProtect is a non-invasive chemical debriding therapy that involves a customized tray for patients to help manage biofilms, growing in the spaces or pockets between teeth and gum tissue. Tri-immuno phasic therapy is minimally invasive technique, by William Hoisington, which allows clinician to go under the gum line and destroy anaerobic bacteria non-surgically. SMART was suggested by Kent et al. in which a small vertical incision is made in the alveolar ridge and bone graft injected under the periodontium. Flapless technique for bone graft is a non-invasive technique which involves scaling and root planing, and insertion of single grains of bone mineral through the crevicular space into the pocket until it is completely filled. These minimally invasive procedures offer an efficient, safe less traumatic alternative in the treatment of periodontitis. Keywords: PerioProtect, Tri-Immuno, Occlusal forces.

Botox i.e botulinum toxin (BTX), is a neurotoxin protein which is produced by the bacteria clostridium botulium and the other bacteria’s of same species. It has been used in various treatment modalities in medical science. Botox has been approved by FDA for its use in medical industry. Apart from medical application it has also been found useful in various dental treatments, which includes treatment for temporo-mandibula disorders, its use in patients with habit of bruxism and clenching. Botox has also been found useful in enhancing facial aesthetic by removing wrinkle line, treating gummy smiles and also in treating black triangles. Botox is becoming a popular noninvasive treatment modality for various aesthetic and functional problems with minimum trauma and discomfort to the patient. Keywords: Black triangles, Botulinum toxin A, Bruxism, Gummy smile.  

Background: Chronic periodontitis is a condition that causes inflammation in the tissues that support teeth, gradual attachment loss, and bone loss. Stress is the body's feedback towards detrimental forces, diseases, and additional atypical circumstances that are determined to distress its routine physiological equilibrium. On the other hand, the most prevalent psychological problems connected to periodontitis are anxiety and sadness. Aims & Objective: This study intends to assess the relationship between stress, depression, and anxiety with indices of periodontal health. Materials & Methods: A total of 171 patients were assessed & divided into 2 groups. Gingival index, modified sulcus bleeding index, community periodontal index for treatment needs, probing pocket depth, and clinical attachment level were evaluated. The Depression Anxiety Stress Scale–21 questionnaire used as the basis for the psychometric evaluation. Results: The statistical analysis made use of the student 't' test and Pearson's correlation coefficient. When compared between the two groups, Group A had significantly higher values for each metric. The psychometric parameters and the periodontal parameters had a weakly positive connection (p Conclusion: According to the current study, people who are stressed, depressed, or anxious are more likely to develop periodontal disease. Therefore, stress, depression & anxiety could be viewed as a significant periodontal disease risk factor.   Keywords: Periodontitis, Stress, Depression, Anxiety, Neuroendocrine.

Objective: to compare the aligning efficiency, pain experienced by the patient during alignment and the post alignment third order values of anterior teeth in I arch (study) group and conventional NiTi (control) wire group. Design : A prospective clinical study. Materials and Methods: A total of 40 dental arches (maxilla/mandible) were divided into 2 study groups with 20 dental arches (maxilla/mandible) in each group based on the selection criteria. Group I. Twenty dental arches (maxillary/mandibular) having 0.018” preadjusted appliance (MBT) brackets (ORMCO), aligned with I –arch 0.016”x0.014” copper NiTi wires. Group II Twenty dental arches (maxillary/mandibular) having 0.018” preadjusted appliance (MBT) brackets by ORMCO aligned with round super elastic NiTi archwires. Results: I -arch copper NiTi (study group) was more efficient in alignment compared to the superelastic NiTi (control group) in the lower arch and the values are statistically significant. There was torque expression in the I-arch group as compared to the superelastic NiTi group. The subjects in the I-arch (study group) experienced lesser pain compared to the superelastic NiTi (control group) and the pain values are statistically significant.   Keywords: Orthodontic pain, Alignment, NiTi wires, CuNiTi, Torque.

Treating patients using tooth supported overdentures can help in preservation of the remaining natural teeth which can provide psychological, functional and anatomical benefits. Retaining roots can provide preserving proprioceptive receptors and increase the stability of dentures, hence it is the favoured treatment for elderly patients with a few remaining teeth. This case report describes a tooth supported mandibular denture retained using a custom made coping to enhance the retention of the prosthesis.   Keywords: Overdenture, Tooth Supported, Mandibular, Retention, Stability.