Gingival Zenith - A Critical Factor in Smile Design and Fixed Prosthodontics.

Background & objectives: Knowledge of the gingival zenith (GZ) of the maxillary anterior teeth can be clinically applied to re-establish the proper gingival contour of the maxillary anterior teeth during esthetic anterior oral rehabilitation and smile designing. The purpose of this study was to evaluate gingival zenith (GZ) of each individual maxillary anterior tooth and their relative gingival zenith level. Method: A digital caliper was used to measure the gingival zenith of the maxillary anterior teeth from left canine to right canine on casts made from 30 young individuals without any dental deformity. The highest point on gingival margin of all maxillary anterior teeth was marked. Distance of this gingival zenith from the respective vertical bisector of each tooth was calculated. Also, the digital caliper was used to measure the distance of gingival zenith of the lateral incisors from a line connecting gingival zenith of maxillary central incisor and canine. Results: Significant difference exists between the gingival zenith of maxillary central incisors, lateral incisors and canines. Conclusion: Gingival zenith of maxillary incisors is distally placed whereas for canine it coincides with vertical bisector. Gingival zenith of lateral incisor is incisal to that of central incisor and canine.

“Ovate Pontic”- Esthetic Enhancement of the Anterior Restorations.

Esthetics is of prime concern when replacing any anterior tooth. The prosthesis should resemble the adjacent natural tooth closely. Out of many types of pontic designs, ovate pontic may serve the purpose of providing good esthetics and phonetics. It will maintain interdental papilla and help to maintain good gingival health. In addition to it ovate pontic has an advantage of immediately replacing the missing anterior tooth.

Immunologic response among HIV-infected patients enrolled in a graduated cost-recovery programme of antiretroviral therapy delivery in Chennai, India.

Background & objectives: Sustainability of free antiretroviral therapy (ART) roll out programmes in resource-limited settings is challenging given the need for lifelong therapy and lack of effective vaccine. This study was undertaken to compare treatment outcomes among HIV-infected patients enrolled in a graduated cost-recovery programme of ART delivery in Chennai, India. Methods: Financial status of patients accessing care at a tertiary care centre, YRGCARE, Chennai, was assessed using an economic survey; patients were distributed into tiers 1- 4 requiring them to pay 0, 50, 75 or 100 per cent of their medication costs, respectively. A total of 1754 participants (ART naïve = 244) were enrolled from February 2005-January 2008 with the following distribution: tier 1=371; tier 2=338; tier 3=693; tier 4=352. Linear regression models with generalized estimating equations were used to examine immunological response among patients across the four tiers. Results: Median age was 34; 73 per cent were male, and the majority were on nevirapine-based regimens. Median follow up was 11.1 months. The mean increase in CD4 cell count within the 1st three months of HAART was 50.3 cells/μl per month in tier 1. Compared to those in tier 1, persons in tiers 2, 3 and 4 had comparable increases (49.7, 57.0, and 50.9 cells/μl per month, respectively). Increases in subsequent periods (3-18 and >18 months) were also comparable across tiers. No differential CD4 gains across tiers were observed when the analysis was restricted to patients initiating ART under the GCR programme. Interpretation & conclusions: This ART delivery model was associated with significant CD4 gains with no observable difference by how much patients paid. Importantly, gains were comparable to those in other free rollout programmes. Additional cost-effectiveness analyses and mathematical modelling would be needed to determine whether such a delivery programme is a sustainable alternative to free ART programmes.

Prosthodontic rehabilitation of hemimaxillectomy patient with hollow bulb obturator.

Abstracts: One of the most rapidly growing areas of dentistry from the standpoint of both interest and need is maxillofacial prosthetics. The research on cancer has made understanding and treatment of this dreadful disease a possibility, still the rehabilitation of these patients is a daunting job, and is more so in post-surgical cases. With the advent of new materials and techniques, vast improvement in rehabilitation of maxillofacial patients has been realized. The objective of this case report was to obturate acquired palatal defects and allowing the restoration of functions such as esthetics, mastication, deglutition and speech. This report throws light on the simplified technique to prepare hollow bulb obturator using shim fabrication. This technique results in a prosthesis which is light in weight and aids in better retention and patient’s comfort.

Epidemiology of hepatitis C virus infection & liver disease among injection drug users (IDUs) in Chennai, India.

Background & Objectives: We characterized HCV antibody prevalence, viral persistence, genotype and liver disease prevalence among IDUs in Chennai, India as the study of the association of HIV with each of these states is important and there are no data available. Methods: Between 2005-2006, 1158 IDUs were recruited and followed semi-annually. All were tested for HCV antibodies at baseline; a random sample of 400 antibody positives (200 HIV-positive and 200 HIV-negative) were tested for HCV RNA; 13 of these were sequenced. Assessment of asparate amino transferase (AST)-to-platelet ratio index (APRI) was done on 557 IDUs. Prevalence ratios of each outcome were examined. Results: Median age was 35 yr; 99 per cent were male. HCV antibody prevalence was 55 per cent and was associated with older age, being unmarried, longer injection history, tattoo and injecting at a dealer’s place. Of the 400 HCV antibody positive IDUs, 281 (70.3%) had persistent infection which was less common among hepatitis B-infected persons but not associated with HIV. Of the 13 samples sequenced, 11 (85%) were HCV genotype 3a. Fibrosis prevalence according to APRI was: HIV/HCV-uninfected, 4 per cent; HIV mono-infected, 3 per cent; HCV mono-infected, 11 per cent; HIV/HCV co-infected, 12 per cent (P<0.001). In addition to being associated with HCV and HIV/HCV, fibrosis prevalence was higher among those drinking alcohol frequently; daily marijuana use was protective. Interpretation & Conclusions: Our findings show that IDUs in Chennai have high HCV prevalence and associated disease burden. The burden will increase as access to antiretroviral therapy improves particularly given the high prevalence of HIV, HCV and alcohol use.