Poonam Prakash

Background: Artistic and scientific principles play a vital role in esthetic smile designing. These principles can be established through data collected from patients, diagnostic models, dental research, scientific measurements and basic artistic concepts of beauty in nature. Various proportions have been identified by many authors and attempts have been made to apply those proportions in smile designing to improve the esthetic outcome of rehabilitation. This study aims to ascertain the most prevalent dental proportion existing in natural dentition based on photographic data, to be utilized in clinical application. Objectives: 1. To investigate and compare the existence of Golden proportion, Recurring Esthetic Dental, Preston proportion and Golden Percentage in maxillary anterior teeth in dentate population using digital photographs and software analysis; 2. Correlation of the dental esthetic proportions with dentogenic concept. Materials and Methods: Fifty dentate individuals with full complement of maxillary anterior teeth were selected for the study. Digital photographs (frontal) were taken from a standardized distance. Mesiodistal width of individual tooth was taken at incisal contact with adjacent tooth and readings were tabulated. Ratio of adjacent teeth was calculated for evaluation of dental esthetic proportions. The width of each tooth was used to calculate the golden percentage and results obtained were subjected to statistical analysis. Results: For Golden proportion, distribution of mean delta (difference between observed and reference data) for all parameters differs significantly from the reference standard (p-value0.05 for all). Mean overall absolute delta value for standards such as Golden percentage, RED proportion, Preston proportion and Golden proportion is 1.62, 7.42, 9.00 and 10.54 respectively. Distribution of mean overall delta for either ratios did not differ significantly across three demographic variables studied in the study group (p-value>0.05). Conclusion: Based on results, it was found that golden percentage was most prevalent for all age groups, irrespective of gender and difference in personality types. Other commonly occurring standards (in ascending order) based on delta value after Golden percentage are RED proportion, Preston proportion and Golden proportion respectively.   Keywords: Golden proportion, Recurring Esthetic Dental, Preston proportion, Golden Percentage, Dentogenic

Objective: To evaluate and compare the effect of two approaches of cryotherapy for improving the success rate of Inferior alveolar nerve block and reduction of pain during access opening in mandibular molars with symptomatic irreversible pulpitis. Materials and Methods: Thirty patients diagnosed with symptomatic irreversible pulpitis were selected based on inclusion and exclusion criteria to participate in the study. 3 groups were designed; Group 1(Control group) - inferior alveolar nerve block(IANB) with lignocaine (2%) adrenaline (1:80000), Group 2(IANB+ small ice pack)-inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + small ice packs (wrapped in sterile gauze); Group 3 (IANB+Endo Ice) -inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + Endo Ice application. Patients were randomly allocated to any one of the groups: The level of preoperative pain was recorded using the Numeric visual analogue scale (VAS). Endodontic therapy was done 15 minutes after the IANB injection. The level of intra operative pain during access opening was recorded again using the same scale. If the patients reported moderate or severe pain during the procedure, the IANB was defined as “unsuccessful,” and a supplementary injection was administered. Results: There was statistically significant difference found in pain reduction among 3 groups (p=0.01). Post hoc analysis revealed significant difference between Group 1(Control) and Group 2(IANB+ small ice pack) with (p=0.003). Overall success rate of IANB was found to be 66.66 %. Conclusion: Both the techniques of intraoral cryotherapy exhibited improved pain reduction as well as increased the success rate of IANBs in mandibular molar teeth with SIP. Hence based on the results obtained, it is suggested that cryotherapy can serve as a useful adjunct to anaesthesia during endodontic procedures. Keywords: Anesthesia, Cryotherapy, Ice pack, Endo-Ice, Mandibular molars, Symptomatic irreversible pulpitis.

Digitization in removable Prosthodontics offers multiple advantages such as digital surveying, designing the framework with components and obtaining a 3D printed resin framework which can be tried intraorally and cast using conventional techniques, teeth arrangement. This technology is time-saving, highly accurate, also allows digital archiving of casts. This case report presents utilization of digital techniques and conventional protocols in rehabilitation of a bilateral posterior edentulous mandibular arch with an attachment retained cast partial denture.   Keywords: Partially edentulous, Digitisation, Functionally generated path, Altered cast

Background: Maxillofacial surgeons and Prosthodontist deal with rehabilitation of defects of orofacial region but understanding the mental attitude of patients is often ignored or neglected. Success of any prosthesis relies on patient’s compliance and motivation to adjust and cope up with irreversible loss. Evaluation of psychological distress and management of the same is of utmost importance. Literature is deficit with an elaborate systematic classification system to evaluate the impact of maxillofacial defect on the psychological status of patients and role of therapy on improvement post-rehabilitation. Aims & Objective: Am of this study is to propose a customized comprehensive protocol for evaluation of psychological status using ICD-11 classification system before and after maxillofacial prosthetic intervention and impact of psychological management tools on the same. Materials and Methods: Ten patients with maxillofacial defects reporting for prosthetic rehabilitation were selected. Psychological evaluation tool, ICD-11 classification system was applied pre and post rehabilitation by two independent observers. Customized psychological management protocol was formulated and implemented to note the impact on overall improvement in psychological status of the patient. Results: Patients with severe personality trait showed varied levels of improvement ranging from no change to mild. Five patients with moderate personality trait showed improvement and change in personality trait to mild on implementation of psychological tools. Statistical evaluation could not be done due to multitude of subjective variables. Conclusion: ICD-11 can be used as a successful tool for psychological evaluation of patients. Necessary intervention at every level in form of family support, support groups, psychological therapeutic modalities and therapies can improve status of the patient. A well-structured management protocol helps in early recognition of psychological distress and systematic management of the same to improve clinical outcome of the rehabilitation procedure. Clinical Implications: Patients with maxillofacial defects experience a progressive cycle of loss and grief. This diminishes their ability to adjust to stress and acceptability towards maxillofacial prosthetic rehabilitation procedure. Assessment of psychological alteration using a standardized classification system and utilization of therapeutic modalities to deal with the same helps in successful rehabilitation and restoration of patient in the society as a whole.   Keywords: Customized protocol, Psychological evaluation, maxillofacial, ICD­11

Achieving primary stability in dental implants is crucial factor for accomplishing successful osteointegration with bone. Micro-motions higher than the threshold of 50 to 100 ?m can lead to formation of fibrous tissue at the bone-to-implant interface. Therefore, osteointegration may be vitiated due to insufficient primary stability. Osseointegration is defined as a direct and functional connection between the implant biomaterial and the surrounding bone tissue. Osseointegration development requires an initial rigid implant fixation into the bone at the time of surgery and a secondary stage of new bone apposition directly onto the implant surface. Dental implants function to transfer the load to the surrounding biological tissues. Due to the absence of a periodontal ligament, its firm anchorage to bone, various forces acting on it and the presence of prosthetic components, they share a complex biomechanical relationship. The longevity of these osseointegrated implants depend on optimizing these complex interactions. Hence, the knowledge of forces acting on implant, design considerations of implant and bone mechanics is essential to fabricate an optimized implant supported prosthesis.   Keywords: Dental Implant, Biomechanics, Bone­implant interface, Osseointegration, stability

Ameloblastoma is a rare, benign tumor of odontogenic epithelium that was recognized in 1827 by Cusack and renamed ameloblastoma in 1930 by Ivey and Churchill. Ameloblastomas can be found both in the maxilla and mandible with a greater predilection of about 80% in the mandible with the posterior ramus area being the most frequent site. While chemotherapy, radiation therapy, curettage and liquid nitrogen have been effective in some cases of ameloblastoma, surgical resection remains the most definitive treatment for this condition. Rehabilitation of residual mandibular defect post resection is a challenge due to long span compromised ridge condition and the absence of dentition. In such scenario, a fixed-removable prosthesis allows rapid return to excellent function by providing favorable biomechanical stress distribution along with restoration of esthetics, phonetics and ease of postoperative care and maintenance. This paper presents successful Prosthodontic rehabilitation of a patient with a large residual mandibular defect secondary to surgical resection for ameloblastoma using fixed-removable hybrid prosthesis. Keywords: Ameloblastoma, Mandibular defects, Hybrid prosthesis, Fixedremovable partial denture.

Oral cancer ranks among the top three in the country and is major health problem. In India, people affected generally belong to the low-income groups due to a prevalence of habits such as tobacco chewing and lack of awareness and capability to afford the diagnostic and treatment modalities Oral cancer is defined as the cancer of lips, mouth and tongue. The management of cancerous lesions in maxilla and mandible is difficult due to their proximity to vital structures, especially in cases of maxilla wherein due to its strategic anatomic location, comprising of the skull base and its related structures, any radical treatment is deferred. Moreover, the anatomic complexities and the cancellous nature of the bone make it very difficult to achieve wide and clear surgical margins resulting in poor prognosis. The comprehensive management comprises of multidisciplinary team effort comprising of surgical resection of the tumour along with the prosthetic rehabilitation to restore the lost form and function. It may also include chemotherapy or radiation therapy. Keywords: Oral cancer, Maxillectomy, Surgical resection, Weber Ferguson, Prosthetic rehabilitation.

Segmental or marginal resection of mandible leads to defects altering the physiological position and movements of mandible. This occurs due to altered muscular action and contracture of scar tissue. Guide flange is a conventional prosthesis that helps to guide the mandible and restores repeated positioning of mandible to improve mastication and to provide support to remaining structures. Immediate rehabilitation helps in maintaining the balance and counteracts unilateral action of muscles to provide stability. It is difficult to achieve favorable outcome with guide flange alone, if deviation is more and the muscular forces are strong. Adjunctive therapies like physiotherapy, maxillomandibular fixation with elastics, prosthesis anchored to natural teeth or forceful manipulation within physiological limits may be used to correct long standing deviation post surgery. This case report highlights use of (Maxillomandibular Fixation) MMF screws with orthodontic elastics to aid in proper functioning of guide flange prosthesis to restore masticatory efficiency. Keywords: Mandibulectomy, Mandibular deviation, Guidance flange prosthesis.

Mucormycosis is a rapidly progressing and invasive form of fungal infection involving the nose and paranasal sinuses of head and neck region with high mortality and morbidity. Compromised immunological conditions like uncontrolled diabetics mellitus, Leukaemia, prolonged use of steroids are the most common predisposing factors for this disease. Aggressive surgical debridement including resection of involved maxillofacial structures like orbit, maxilla and/or nose is the commonly used treatment protocol in such conditions. Rehabilitation of such large maxillofacial defects is a Prosthodontic challenge and many problems are encountered in  rehabilitation like lack of retention due to dislodging forces exerted by scarred post surgical soft tissues, lack of bony base, lost structures of the posterior palatal seal area, multiple defect sites and compromised medical status due to comorbidities that also affects healing rate of the defect. This clinical report describes prosthetic rehabilitation of a patient with residual maxillary and orbital defects secondary to surgical management of sinoorbital mucormycosis with a combination prosthesis comprising of orbital and obturator using an innovative method of achieving retention between the two, thereby providing complete functional and esthetic rehabilitation of the patient. Keywords: Sinoorbital Mucormycosis, Maxillectomy, Orbital Exenteration, Retention, Obturator, Orbital Prosthesis.

The long successful history of Cast metal post-core systems is due to their superior physical properties. However, the high elastic modulus of metal can cause stress concentrations within the radicular dentin, leading to root fractures. Increased awareness for more esthetic restorations has led to the development of tooth-coloured, translucent, metal-free post-core systems. Notably, the introduction of Zirconia ceramic post and core systems satisfies this trend of a heightened awareness of esthetics, wherein the translucency of all-ceramic crowns is not hampered giving lifelike esthetics. Here, presented is a case report wherein an endodontically treated anterior tooth with loss of crown structure has been rehabilitated using a zirconia post and an all ceramic full coverage restoration. Keywords: Coronoradicular, CAD-CAM.

Maxillary defects may be due to trauma, congenital defects or secondary to surgical correction of benign and malignant tumours. Surgical management leads to loss of maxilla, soft palate and contiguous structures leading to a communication between the oral and nasal regions that causes difficulty in speech, deglutition, mastication, respiration and loss of facial support. The goal of rehabilitation is to bring about improvement in basic functions of mastication, deglutition, speech, esthetics thereby boosting the psychological status of the patient. An obturator acts as a framework over which tissues may be shaped by the surgeon, holds the surgical dressing, serves as a temporary prosthesis during the period of surgical correction and helps to restore a patient’s cosmetic appearance soon after after surgery.  The basic principles of retention and stability are difficult to achieve due to increased weight of the prosthesis. Obturator is generally made in two parts i.e. the palatal portion and the hollow bulb .However in this case, a novel technique was utilized to fabricate the prosthesis in three parts i.e. the palatal portion, the hollow bulb and the hollow occlusal rim. Since there was sufficient volume in the area of occlusal rim, it was made hollow as well to further reduce the weight of the prosthesis. Using the method described, the stability and retention of the obturator were improved, speech intelligibility increased, and food and liquid leakage to the nasal cavity were reduced. Keywords: Maxillectomy, Retention, Three piece hollow bulb obturator.

Background: Heat cured Polymethylmethacrylate (PMMA) and Lucitone are the most commonly used denture base resins but their discoloration results in esthetic problems. There is evidence that these resins get discolored on contact with coloring solutions due to sorption but very few studies report on the effect with food colorants. Hence, this study was conducted to evaluate and measure the effect of these food colorants on the denture base resins. Purpose: The color stability of two commercially available denture base acrylic resins (Trevalon & Lucitone) was studied in vitro. Materials and Methods : The specimens were exposed to solution of artificial saliva (control), mixture of artificial saliva and coffee solution and mixture of artificial saliva and turmeric solution. The color measurements were made at baseline (before immersion) and after 30 and 60 days of exposure to staining solutions and color characteristics compared with a white standard using a computer controlled spectrophotometer. Finally, the color stability was quantitatively measured again and color differences (?E) were calculated. Results: The results of discoloration were analyzed with ANOVA, and it indicated that all factors (time, material, and staining solution), and all possible interactions among them, were found to be statistically significant (p 3 solutions were slight and at trace level. Conclusions: All materials tested were acceptable from the standpoint of color stability for long term exposure to these food colorants. Trevalon® (PMMA), demonstrated maximum color stability as compared to Lucitone FRS and discoloration increased proportionally with immersion period. Keywords: Denture base, Color stability, Foodcolorant.  

With the improved health care facilities and nutritional levels, the average life expectancy of Indian population has been on a steady rise over the years. Geriatrics, or geriatric medicine, is a specialty that focuses on health care of elderly people. It aims to promote the health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of elderly people. Rather, this decision is determined by the individual patient’s needs, and the availability of a specialist. It is important to note the difference between geriatrics, the care of aged people, and gerontology, which is the study of the ageing process itself. The term geriatrics comes from the Greek ????? geron meaning "old man", and ????o? iatros meaning "healer". However, geriatrics is sometimes called medical gerontology. It is also defined as the branch of medical science dealing with old age & its disease. The increased life expectancy demands an improved quality of life for the elderly thereby making geriatric medicine and dentistry an important aspect of the healthcare system. This paper covers the overall demographics of the elderly population along with the various physical, dental and psychological changes that occur in them. Keywords: Geriatrics, Ageing, Quality of life.

The goal of health care services (Medical& Dental) around the world is to provide safe and effective health care to people when they are unwell. Accessible and safe primary care is essential to achieving universal health coverage and to supporting the United Nations Sustainable Development Goals, which prioritize healthy lives and promote well-being for all. Health services work hard to provide safe and high quality care, but sometimes people are inadvertently harmed. Unsafe health care in the form of under or over prescription of medicines has been recognized as a global challenge and research and clinical trials are in progress to understand the causes, consequences and potential solutions to this problem. Understanding the magnitude and nature of harm along with measures to reduce the harm is important because, every day, millions of people across the world utilise these health care services. Medications are offered by health services throughout the world that helps in increasing the quality of life and the overall life span of the individuals. However, with the prescription, comes a growing risk of harm especially with ageing population with increasingly complex medical needs and the introduction of many new medications.  Rationalised use of medications goes a long way in prompt and effective management, but unsafe usage can cause avoidable illness and injury, leading to unnecessary hospitalizations, and in some cases, disability and even death. In many cases, prescriptions are given in the initial stages of management protocol. A substantial amount of literature about medication errors exists, but there are differences in the type of clinical problems encountered, classes of medications used and the organization of services in primary care. So the emphasis in health care settings should be towards institution of definitive treatment rather than the prophylactic medications unless the systemic status really warrants its use. The field of dentistry is one such area in which the medications are used as an adjunct for improving the prognosis of the therapy instituted. So there is a dire need of clear guidelines to provide definitive dental treatment to cure the problem rather than prophylactic medications per se. There are numerous guidelines issued by WHO & ADA for the same but the judicious utilisation and implementation of the same remains the treating surgeon’s prerogative and totally depends on his judgement and experience. The aim of this technical review is to provide an overview on key issues that can impact safety in the provision of medications. It negates the “one-size-fits-all” approach, and focuses on customised treatment protocol and medication regimen based on the clinical diagnosis giving due consideration to other variables such as age, gender and systemic status of an individual. The approach to improving safety in health care, therefore, needs to consider applicability in each country and care setting. Keywords: Antibiotics, Symptomatic irreversible pulpitis, Symptomatic apical periodontitis pulp necrosis, Localized acute apical abscess, Antibiotic resistance.

Forensic is any term related to court of jurisdiction. Forensic medicine relates the application of knowledge of principles with practitioners of medical and para medical sciences for the purpose of administration of law. It includes various disciplines such as forensic toxicology, forensic engineering, forensic anthropology and forensic odontology. Forensic dentistry includes various odontological parameters such as DNA fingerprinting, bite mark identification, rugoscopy and cheiloscopy but these markers are of little use in completely edentulous patients. Dental records of edentulous patients are often sparse due to in frequent follow up of the patients and lack of record keeping by the dental practitioners. Therefore, the provision of some form of permanent denture labeling or marking can serve as a solution to these problems. Keywords: Forensic identification, Barcode, Micro SD card, Ante mortem records.

Lennox-Gastaut syndrome (LGS) is a severe pediatric epilepsy syndrome characterized by mixed seizures, cognitive decline, and generalized slow (Seizures are often resistant to therapy. Atonic seizures result in dangerous drop attacks with risks of injury and impairment of the quality of life. The seizures are frequently resistant to multiple antiepileptic (AED) drugs. The non pharmacological treatments such as the ketogenic diet, vagus nerve stimulation, and epilepsy surgery should be considered when multidrug therapy is of  limited  help. This paper aims to present a case report along with an updated comprehensive outline of LGS and the available medical, surgical and dental treatments. Further long term randomized controlled trials are required to compare efficacy of different therapeutic interventions. Keywords: Lennox Gataut syndrome, Pediatric epilepsy, Ketogenic diet.

The disability associated with the loss of an eye can cause significant physical, psychological and emotional disturbances. A maxillofacial Prosthodontist can boost the physical and psychological well being of such patients by restoration of functional and esthetic requirements. A 30 year old male serving soldier who sustained a blast injury to the left eye during a counter insurgency operation in the northern sector of the country was referred to Department of Prosthodontics for prosthetic rehabilitation of missing left eye. A custom made heat polymerized polymethyl methaacrylate ocular prosthesis was fabricated for the patient which restored normal opening of the eye, some degree of movements and esthetically pleasing appearance. Keywords: Ocular defect, Custom ocular prosthesis.

Background: Accurate recording of occlusal vertical dimension in edentulous patients is always a prime consideration for an operator but subjective in nature and depends on esthetics and phonetics. Although there are many techniques used for recording vertical dimension at occlusion; still, there is no objective reference point against which, the recorded OVD can be verified. Aim: The aim of this study was to correlate the vertical dimension of occlusion with accepted anatomical facial landmarks and digit measurements in dentulous subjects. Objectives: To derive a correlation between OVD and demographics (Age and gender); to validate specific facial and digit measurements which can be used to verify the recorded OVD. Study design : Cross sectional study Materials and Methods: 51 adult dentulous volunteers were selected for the study. Various facial and digit measurements were recorded and the correlation between OVD and these measurements was checked using independent sample t test. The correlation was analysed using Pearson’s method Null hypothesis: There is no correlation between Vertical dimension of occlusion (OVD) and facial or digit measurements. Results: The Pearson’s product moment correlation coefficient was determined. Among the digit measurements, OVD was significantly (p-value Among the facial measurements, OVD was significantly (p-value Conclusion: Various facial and finger measurements can be utilised as adjuncts for the estimation and verification of occlusal vertical dimension.   Keywords: Occlusal Vertical Dimension, Facial measurements, Finger measurements, Correlation, Dentulous