Prosthetic stage of anterior maxillary implant- a case study

One of the greatest challenges for implant placement in the maxillary anterior zone is not only the restoration of function but also the esthetics. The reestablishment of a normal alveolar contour after implant placement is a critical step in esthetic success. This important aspect consists of replacing the lost portion of the alveolar process and associated soft tissue. It can be onerous to establish a balance between the tooth and the surrounding apparatus at prosthesis - soft tissue interface. This case presents the implant placement aspect with an in-depth consideration of positional parameters and post implant placement with consideration of soft tissue management and manipulation. Thus, the final restoration fitted precisely and harmoniously with the natural and esthetic contours of the gingiva and provided the esthetic results which both the practitioner and the patient were aiming to achieve. Hence, validating use of this technique for suitable patients

Effectiveness of preoperative alprazolam with IANB in anxious patients of irreversible pulpitis

Patients experiencing irreversible inflammation of the dental pulp tend to have a less anesthetic effect of the Inferior alveolar nerve block. Aim of this study was to assess the role of preoperative administration of alprazolam along with inferior alveolar nerve block in patients experiencing permanent damage to the dental pulp. This study included one hundred patients experiencing severe inflammation of the dental pulp involving the mandibular molars and was a potentially randomized double blinded study. 45 minutes prior to administration of the inferior alveolar nerve block the patients were either given 0.5mg of alprazolam or a placebo drug. An interval of 15 minutes was given between the IAN block injection and the initiation of access cavity preparation. Lack of sensation in the lip area was noted for all patients. A visual analogue scale recording was used for every patient to record any stimuli to pain during cavity preparation and initial instrumentation. No or mild response to pain was recorded as a successful outcome. The information was examined using t test and chi square test. The patients given preoperative alprazolam had 52% rate of success. The success rate was 44% [the P value = 0.402], in the control group, showing no statistically significant difference. Giving preoperative 0.5mg alprazolam did not improve the effectiveness of the IAN block in patients with permanent deterioration of the dental pulp

Reasons for the failure of class i and II amalgam restorations

The purpose of the study was to investigate the reasons for the failure of Class I and II amalgam restorations in patients presenting at the Operative Department of Fatima Jinnah Dental College and Hospital. Sample of 100 patients was clinically evaluated to assess the reasons for the failure of amalgam restorations. Information regarding the patients' age, gender, presenting complaints, and reasons for the failure was collected for conducting this study. Results revealed that the most common reason for the failure and replacement of amalgam restorations was secondary caries, followed by inadequate resistance form. It was concluded that the prevailing reason for the failure of restoration is secondary caries which may be as a result of incomplete caries removal and non-retentive cavity preparations

Antimicrobial solutions used for root canal disinfection

This article discusses the significance of root canal disinfectants and comments on how these can be used professionally. The complex root canal system is inhabited with different microbes in periapical periodontitis. There is no particular disinfectant that alone satisfactorily fulfills the entire functions essential for irrigation. Best possible irrigation is found on the combined use of two or more disinfectant, in a particular sequence. Sodium hypochlorite is the most commonly recommended endodontic irrigant, in spite of some adverse reactions. Chlorhexidine, Iodine and Chelators are successful against several bacteria and viruses, mainly in retreatment cases. Newer root canal irrigants like MTAD [Mixture of Tetracycline, Acid and Detergent], Tetraclean, Photo-activated disinfection, Electronically Activated Water, Ozonated water and lasers have potential to maximize root canal disinfection. Currently these newer irrigants could be used as an adjunct to NaOCl, while investigators are continuously looking for the subtle ideal root canal irrigant

Comparison of conventional glass ionomer cement and compomer in class II restorations in primary molars: six months study

Restorations in primary teeth continue to be an important facet of restorative dentistry. Traditionally, posterior primary teeth have been restored with amalgam. Recently, there has been a range of tooth-colored materials available for restoring primary and young mixed dentitions. These materials are conventional glass ionomer cements and composite resins, resin-modified glass ionomer cements and compomers. To compare the clinical performance of conventional glass ionomer cement with compomer, in class II restorations in primary molars. This was a quasi experimental study conducted at Operative Department of Fatima Jinnah Dental College Hospital, Karachi during period of six months, on 132 patients meeting the inclusion criteria [2 proximally carious primary molars, 264 carious lesions] were included in the study. All 132 patients enrolled in the study were recalled after six months and restorations were clinically examined for marginal adaptation and anatomic form. Out of 264 restorations, 10 teeth were lost because of the normal exfoliation of primary teeth.124 restorations failed during the follow-up period from which 123 [93.2%] were conventional glass ionomer cement and only 1[0.8%] was compomer. In terms of marginal adaptation and anatomic form, compomer performed significantly better than Conventional glass ionomer cement in class II cavity in primary molars

In vivo study of antibacterial effect of calcium hydroxide and chlorhexidine as intracanal medicaments in a sample of Pakistani population

The objectives of this study were to evaluate the antibacterial effects of Calcium hydroxide and Chlorhexidene as intra canal medicaments in a sample of Pakistani population. Eighty, single rooted teeth of patients with necrotic pulps and periradicular lesion who presented at Department Of Operative Dentistry, Fatima Jinnah Dental College Hospital, Azam Basti were recruited in the study. At first appointment the root canals were cleaned, shaped and dried. Initial samples for bacteriological examination were taken. Medicaments to be tested were placed in the root canals and access cavities were sealed with temporary filling material. After seven days, samples were taken again from the root canal and inspected for growth of microorganism to determine the efficacy of the medicament used. Data was compared using 'Pearson's Chi-square test' on SPSS version 10 for windows. Twenty three [57.5%] out of 40 cases with Chlorhexidene dressing yielded negative cultures. Whereas Calcium Hydroxide group showed negative cultures in 18 [45%] out of 40. There were no statistically significant differences between the two medicament groups. [p-value is 0.263]. Chlorhexidene has better antibacterial effects than calcium hydroxide clinically. However, there were no statistically significant differences among the medicaments tested

evaluation of association between crown margins and materials with the periodontal health

The objective of this study was to evaluate the association between crown margin and type of restorative material on the periodontal health of the restored teeth. This case control study was conducted on 100 patients [50 metal crowns, 50 porcelain fused to metal crowns] whose prosthesis were fabricated in the department of crown and bridge of Fatima Jinnah Dental College Hospital. Contra-lateral tooth of same patient served as control. Clinical evaluation was performed and periodontal indices including Bleeding index, Plaque index, and Pocket depth measurement were recorded on a proforma. CPITN[Ash] "C"probe was used to record the readings. Data was analyzed with SPSS for windows using chi square test. One hundred patients with either porcelain fused to metal crown [n=50] or metal crown [n=50] with unrestored and healthy contralateral dentition were included in the study. Teeth restored with supra-gingival margins scored better for bleeding index, plaque index and pocket depth as compared to teeth restored with subgingival margins [p value<0.01]. The type of restorative material did not have an effect on recorded scores [p value>0.1]. Supragingival preparations for the crowns were better tolerated by the periodontium as compared to the subgingival preparations. There was no influence of type of restorative material on gingival health

Regenerative pulp therapy

Regenerative Endodontics is a new treatment modality that offers a predictable result in teeth with pulpal necrosis and open apex. This case report describes the treatment of a necrotic immature permanent central incisor with complicated crown fracture, in which a regenerative approach was used. Revascularization procedures may provide a more predicable outcome, while rendering mature root formation at the same time. This article describes an ongoing case of revascularization

Replacement of resin-based composite restorations in permanent teeth

To determine the reasons for replacement of composite resin restorations and evaluate the association between the reasons for replacement of restorations with gender, duration of failure and different class of cavities. Cross-sectional study. Operative Department of Fatima Jinnah Dental Hospital, Karachi, from January to May 2009. Patients were selected randomly who had presented with post restoration complaint after composite filling. Specially designed proformas were used to get the information such as the name of the patient, age, gender, teeth in need for replacement of restorations, age of the replaced restorations, and the reasons for replacement. The criteria for replacement of composite restorations were secondary caries, discoloration, improper proximal contact, fractured restoration and gingival irritation due to overhang. The significance of results was obtained by applying chi-square test. A total of 413 patients ranging in age from 17 to 63 years were examined; 263 were males while 150 were females. Secondary caries [52.3%] was the most frequent reason for replacement of restorations in permanent teeth followed by discoloration [16.9%] and fracture of fillings [12.6%]. Chi-square test shows significant relationship between gender and reasons for replacement [p < 0.001]. Highly significant difference was found between different class of cavities and reasons for replacement of composite fillings [p < 0.001]. The median longevity of the replaced composite restorations was about 3 years. Secondary caries was the most common reason for replacement of composite fillings. The median longevity in this sample was calculated to be 3.0 years

Experience of early childhood caries [ECC] in children at Fatima Jinnah dental college hospital, Karachi and its relationship with feeding practices

The aim of the study was to find the experience of early childhood caries [ECC] in children at Fatima Jinnah dental college hospital, Karachi in the period of six months and its relationship with feeding practices. A total of 521 children 2- 6 years of age were screened for the present study who came to Fatima Jinnah dental college hospital Karachi in the period of Sept-Dec 2008 and June- July 2009. Examination and detection of the caries was solely based on visualization. A parent or a caregiver was asked to complete a questionnaire regarding information about the child, their oral hygiene, social class and feeding practices. The modification of Kuppuswami scale was used to classify the socioeconomic status. The rate and pattern of caries were analyzed and each child was classified as mild, moderate or severe ECC. There is a strong and significant relationship between the presence of early childhood caries and the degree of feeding abuse. Children from low socioeconomic status have increased early childhood caries. The experience of early childhood caries was 50.1% in the children attending dental opd of Fatima Jinnah Dental College Hospital in the period of six months. Early childhood caries were more in children who were always taking a feeding bottle especially to bed at night and those who consume cariogenic snacks and were increasingly seen in lower socioeconomic groups

Effect of accidental periapical extrusion of calcium hydroxide paste [A case report]

Calcium hydroxide is an effective biocompatible substance that has been widely studied in scientific research, and is regarded as the material of choice for treating intracanal infections. The paper discusses a case of a non vital central incisor with a large periapical lesion, in which calcium hydroxide paste containing iodoform as a radiopacifier was used. There was an un-intentional extrusion of calcium hydroxide during application. The patient was seen at a regular periodic recall for one year. The followup revealed that the accidental extrusion of calcium hydroxide did not have any detrimental effect on periapical healing

Critical evaluation of material and procedures used for the functional peripheral moulding of special trays

Border molding is done to record the peripheral margins of the denture and to ensure their extension to the sulcus reflection and in the post dam area in the maxilla. With the use of green stick compound for border moulding it is possible to record the border details accurately but it tends to be messy and it is difficult to determine the consistency and proper temperature. Therefore, the use of thermoplastic compound has been examined and recommended to be kept to a minimum due to the availability of simpler techniques and easy to handle and accurate materials. Students may now be introduced to the various techniques and materials for border moulding along with the concept behind the procedure. This will enable them to decide on their own which technique to employ and master. In this paper, a critical evaluation of the various materials and techniques used for border moulding of the special tray is given. It is not the authors' intention to criticize the current methods of teaching in our dental schools but to encourage the readers to broaden their vision of the often complex but fascinating craft of complete denture construction

Acquaintance of dental professionals in relation to emergency management of tooth avulsion in Karachi

Avulsion of permanent tooth is the most serious of all dental injuries. The prognosis depends on the measures taken at the place of accident or the time immediately after the avulsion. An appropriate emergency management and treatment plan is important for a good prognosis. The objective of the present study was to evaluate and investigate the knowledge of dental professionals about the emergency management of tooth avulsion in Karachi. Two hundred questionnaires were distributed amongst General dental practitioner, Postgraduate trainees and house officers, the questions were related to knowledge of how to treat and manage the traumatic avulsion of teeth. Out of 200 dentists targeted 50% were involved in Continuing Education Programme 25% updated their knowledge through journals and books. While rest had only information they got during their education at dental schools. The data suggested that the level of knowledge on the management of dental avulsion among dental professional in city of Karachi is adequate

Apical barrier therapies in traumatized immature teeth - a case report

This case report reviews the rationale and techniques for treatment of non vital immature tooth. The importance of careful case assessment through clinical examination and investigation, and accurate pulpal diagnosis in the treatment of immature teeth with pulpal injury cannot be overemphasized. The treatment of choice for necrotic teeth is apexification, which is induction of apical closure to produce more favourable conditions for conventional root canal filling. The most commonly adovacated medicament is calcium hydroxide, although recently considerable interest has been expressed in the use of mineral trioxide aggregate

Mechanical versus chemical retention in complex restoration

The aims of this study were: [a] to investigate, by questionnaires, the selection and use of materials and techniques to restore complex restorations in vital teeth. [b] Can adhesive resin liners provide retention that is the same as dentinal pins and slots when restoring complex restorations in vital teeth? A self administered questionnaire was developed. Four hundred questionnaires were distributed to senior and junior general dental practitioners employed in hospitals and private sectors of Karachi city. A total of 359 questionnaires were returned, giving a response rate of 89.75%. Amalgam was the most popular material used by general dental practitioners to restore complex restorations in vital teeth followed by glass ionomer plus composite. In vital teeth retentive slots were used the most and retentive pins were the least popular. ways of mechanical retention. The results also showed respondents were using adhesive resin liners exclusively when restoring complex restorations. This study showed that adhesive resin liners may he used as an alternative or adjunct to mechanical retention. Because of the improvements of bonding strength of adhesive resin liners, dentinal pins and slots should not be the only methods considered to restore complex restorations

Pattern of traumatic injuries to maxillary permanent incisors related to age and incisal overjet

To determine the pattern of dental trauma to maxillary permanent incisors with relation to age and overjet. A complete history and examination findings of 100 patients, aged between 7 and 17 years, presenting with trauma to permanent anterior teeth were recorded on a specifically designed proforma. Extraoral and intraoral examinations were performed and radiographs were taken when indicated. Andreasen and Andreasen's Classification [1993] was applied for the classification of dental injury, Overjet of the subjects were also recorded and classified accordingly. Hundred patients with one hundred and twenty nine traumatized teeth were observed and recorded. The average age considered was 12 years. It was noted that boys [62%], were more often involved with trauma as compared to girls [38%]. The maxillary central incisors were found to be the most affected teeth [84%], The most common cause of injuries was fall [59%]. Uncomplicated crown fracture cases were more frequently observed [31%]. Compared to patients with normal overjet, trauma was significantly higher in patients with increased overjet [P = 0.001]. Boys suffered more trauma than girls with a ratio of about 1.6:1. Children with increase overjet were two times more prone to dental trauma with normal overjet

comparison of thermomechanical compaction and cold lateral condensation obturation techniques on the basis of density measurements, using digital radiographs

To compare the cold lateral condensation and the thermomechnical condensation obturation techniques by measuring the radiographic density of the obturation. Digital radiographs were used as an aid for the comparison. A total of 100 single rooted teeth mainly central incisors were divided into two groups. Group A comprised of teeth that were obturated using cold lateral condensation and Group B comprised of teeth that were obturated using thermomechanical technique. The canals of all the teeth were prepared with rotary endodontics [Protaper System] with a working distance of 21mm. During the sample preparations irrigation with EDTA was used to remove the smear layer. One group of teeth was obturated with ISO standardized gutta percha points using cold lateral condensation and the other group was obturated using thermomechanical technique [Gutta Condensors-Dentsply]. Digital radiographs were taken processed in Digora System for both the techniques. The apical area was zoomed to 4x and density measurement readings for both the techniques were recorded and compared using Digora Optime. The mean for Group A was found to be 140 while for Group B the value was 136. The difference was statistically significant [p < 0.005]. The study concluded that both the techniques are acceptable clinically. However the cold lateral condensation technique was found to be superior to thermomechanical compaction in terms of radiographic density

Pit and fissure sealants: an update

Fissure sealants are well-established components in preventive dental care, both for individual patients and in public health programs. Resin pit-and-fissure sealants are considered an important adjunct to oral health care strategies and fluoride therapy in preventing occlusal carious lesions, Occlusal caries accounts for 56% to 70% of the lesions in children aged 5 to 17 years. Fissure sealing is an established and effective approach for caries management on occlusal surfaces. The effectiveness of sealants hinges on their ability to isolate pits and fissures from a combination of bacteria, their nutrients, and acidic metabolic products Consequently, poor sealing ability may cause secondary caries and interfere in long term success of this technique

Incidence of three canals in maxillary first premolar-a case report

This paper reports successful endodontic treatment of a maxillary first premolar with three canals. Maxillary premolars have highly variable root canal morphology, but it is rare, especially in the first premolar, to find three canals. However, in everyday endodontic practice, clinicians have to treat teeth with atypical configurations. Extra roots or root canals if not detected are a major reason for failure. Systematic examination of preoperative X-rays and correct access. Ni-Ti rotary instrumentation technique was chosen for root canal preparation, and Canals were obturated with gutta percha cones [Sure-Endo, Seoul, Korea] and Sealapex [Ken, Sybron, USA] root canal sealer using cold lateral condensation filling technique This methology led to efficient preparation and suitable definitive root canal obturation