Knowledge and awareness regarding uses of extracted natural tooth in clinical practice.

Restoration of aesthetics is one the major patients' concern in dentistry which may be disrupted due to tooth-loss secondary to trauma, or as part of orthodontic treatment or periodontal problem. A number of treatment options are available for the replacement of teeth, but they may be expensive, and time-consuming, involving artificial teeth. For immediate tooth replacement, patient's own intentionally extracted or unintentionally avulsed tooth maybe used. The current narrative review was planned to discuss various techniques for the use of natural tooth pontic, which preserves the original contours, size and colour of the replaced tooth. Before using these teeth in a prosthesis, they need to be thoroughly disinfected and stored in appropriate medium according to the global guidelines. This reversible option would boost patient's confidence, preserve natural tooth anatomy and improve patient's acceptance.

Oral manifestations of Covid-19-A literature review.

Initially, it was reported that coronavirus 2019 disease (Covid-19) affects respiratory, gastrointestinal and neurological systems, but the oral, olfactory and integumentary systems are also involved. This review discusses various oral manifestations of Covid-19 reported in the literature along with possible underlying mechanisms. The reported manifestations include taste impairment, oral mucosal changes (petechiae, ulcers, plaque-like lesions, reactivation of herpes simplex virus 1(HSV1), geographical tongue and desquamative gingivitis) and dry mouth. The prominent location for mucosal lesions are tongue, palate and labial mucosa. The exact pathogenesis of these oral symptoms is not known. Angiotensin-converting enzyme 2 (ACE2) cell receptors are expressed in abundance on oral mucosa allowing severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) to infect them. Gustatory impairment along with olfactory changes is now listed as a symptom of Covid-19 by the World Health Organization, but further research is needed to confirm a link between reported additional oral symptoms and Covid-19. Dental professionals may encounter individuals with Covid-19 and be called upon to identify various oral manifestations of this disease.

Effect of full sulcular versus papilla-sparing flap on periodontal parameters in periradicular surgeries: A systematic review and meta-analysis.

BACKGROUND: Access to apical root canal system is gained after flap elevation using various incision techniques. Soft-tissue healing after periradicular surgery may include gingival recession, papilla recession, changes in probing depth, and clinical attachment loss. OBJECTIVE: The objective of this study was to compare the effect of full sulcular flap design versus papilla-sparing flap design on the periodontal parameters in periradicular surgeries. MATERIALS AND METHODS: It was a systematic review and meta-analysis. Electronic and manual searches were conducted in multiple databases including PubMed, Dental and Oral Sciences, Cochrane, and CINAHL Plus until May 2019. Initial search yielded 2575 studies with 5 articles meeting the inclusion criteria. The primary outcomes assessed were gingival recession and change in the papilla height. The secondary outcomes evaluated were probing depth, clinical attachment loss, postoperative pain, bleeding, and discomfort. Random-effects model was employed for computation of effect size, and forest plots were made. RESULTS: Out of the five articles that satisfied the inclusion criteria, three were randomized control trials and two were nonrandom trials. No significant differences were found in the gingival recession (P = 0.79), papilla height (P = 0.55), gingival bleeding, and plaque indices. Statistically significant differences in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004) were observed for the two flap designs in probing depth (P = 0.006) and clinical attachment loss (P = 0.0004). CONCLUSIONS: The present systematic review and meta-analysis showed that probing depth and attachment loss are affected by the choice of flap design. On the other hand, gingival recession and papilla height are not influenced by the type of incision. However, finding of the present review may change if more studies on this topic will be included in the future. Therefore, more clinical trials with long-term follow-ups are needed.

Augmented reality in clinical dental training and education.

Dentistry is a profession that requires coordinated motor skills in addition to acquired knowledge for ideal execution of any treatment plan for patients. Learning experiences have been modified over a period of time for students as well as for the healthcare providers. Conventional pre-clinical training employed the use of cadavers, but financial, ethical and supervisory constraints have become a major shortcoming. With the adaptation of technology in dentistry, pre-clinical training has now employed simulation. It provides the opportunity for students to develop psychomotor skills for procedures by practising pre-clinical, standardised learning competencies before they engage in patient-management. Simulation involves computer-aided learning, augmented reality and virtual reality, which are largely taking over pre-clinical teaching. Augmented reality is commonly being employed in maxillofacial, restorative, tooth morphology learning and mastering technique for administering local anaesthesia in dentistry. Virtual reality is being employed particularly in pre-treatment implant planning and dental education for students. Use of haptic technology, like robotics, is also gaining popularity, and facilitates a two-way communication between the user and the environment to better simulate the clinical setting for learning purposes.

Aesthetic rehabilitation in a patient with skeletal mandibular deficiency and open bite: journey from splinted metalloceramic prosthesis to all-ceramic crowns.

This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high smile line and maintenance of an adequate biological width. After periodontal healing, all-ceramic individual crowns were placed on the maxillary anterior teeth along with a three-unit all-ceramic bridge for the replacement of the left upper maxillary first premolar. The final results were aesthetically pleasing with good marginal fit. The patient was extremely satisfied with the outcome as all her concerns were addressed. It is, therefore, advisable to consider placing individual crowns rather than multiunit splinted prosthesis whenever possible.

Five year evaluation of the complications observed in porcelain fused to metal (PFM) crowns placed at a university hospital.

OBJECTIVE: To determine the frequency of complications in crowns cemented over a 5-year period in a tertiary care hospital and also to report the survival of these crowns. METHODS: The retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from March 2017 to March 2018 and comprised porcelain fused-to-metal crowns placed on the anterior or posterior teeth that were fabricated at the institutional laboratory and were placed in institutional dental clinics in the preceding 5 years. Porcelain-fused to-metal The crowns were clinically and radio-graphically evaluated in a duration of two months for presence/absence of complications. Factors associated with the failure of the crowns, their survival and the impact of covariates, like gender, flossing and bruxism, on the survival time were determined. Data was analysed using SPSS 22. RESULTS: There were 150 crowns related to 107 patients who had a mean age of 45.0±11.4 years. The most common complication observed was open proximal contacts 9(6%) followed by de-cementation 8(5.3%), porcelain chipping 9(6%) and abutment fracture 2(1.3%). The 5-year survival rate of the crowns was 127(84.7%). The mean follow-up time was 57.2±1.0 months. Overall, year-wise survival of PFM crowns for one year till five years was 147 (98%), 144 (96%), 135 (90%), 130 (86%) and 119 (79%) respectively. CONCLUSIONS: The porcelain-fused-to-metal crowns had a high 5-year survival rate. Open proximal contacts represented the most common complication.

Bio-active cements-Mineral Trioxide Aggregate based calcium silicate materials: a narrative review.

Recent advances in the field of endodontics have greatly improved the outcome and success rate of dental materials. For last three decades, there has been great interest in the development of bioactive dental material with the ability to interact and induce surrounding dental tissues to promote regeneration of pulpal and periradicular tissues. As these bioactive materials are mainly based on calcium silicates, they are also referred to as Calcium Silicate materials. The first material introduced was Mineral Tri-oxide Aggregate, which, due to its favourable biological properties, gained importance initially. However, later, due to its drawbacks, liked is colouration, long setting time and difficult manipulation, several modifications were done and newer bioactive materials, such as Biodentine, BioAggregate, Endosequence, Calcium-Enriched Mixture etc., were developed. The main applications of these materials are for pulp capping (direc t/indirec t), pulpotomy, perforation repair, resorption defects, apexogenesis and as retrograde filling materials, apexification and endodontic sealers. This review discusses the various types of bioactive materials, their composition, setting mechanism, and literature evidence for current applications.

Conventional and contemporary approaches of splinting traumatized teeth: A review article.

Trauma moves a tooth from its original position which needs to be repositioned for optimum healing and better outcomes. To stabilize the traumatically displaced teeth, splinting is specified as the gold standard. In this article we have discussed about various old and modern techniques based on the type of material to splint teeth with dentoalveolar trauma. As per recommendation of IADT, providing flexible splint is beneficial for good healing. A biologically favourable splint should not just be user friendly but also should be convenient in terms of removal. Every technique has its merits and demerits. Iatrogenic trauma to the teeth due to forceful removal of material should be avoided as it may result in post-operative sensitivity but sometimes it is inevitable. Metallic or wire based splints either secured with ligature wire or resin based material may show directly or through the cemented material and compromise aesthetics. This worsens the physiological impact which the patient is already facing after trauma. Recent advancement in splinting material with fiber reinforced material has brought a dramatic change in terms of strength and aesthetics, specifically after traumatic dental injuries. There are various other techniques discussed here which can be used for splinting teeth when the dentist has limited time in emergency or limited resources. The type and timing of the splinting span should be in accordance with the type of injury and as per IADT recommendation to follow standard of care.

Orthograde apical plug in a traumatized tooth with necrotic pulp and immature apex using calcium silicate cement: A case report.

This case report describes dental management of a 15- year-old boy, undergoing treatment for Thalassaemia Major and Acute Myeloid Leukaemia with bone marrow transplant and immuno-suppressants. During the course of his treatment the patient developed a swelling in anterior maxilla and therefore was referred by the primary physician for evaluation. This case report highlights the management of medically compromised patients in a tertiary care hospital in which apexification was carried out in a permanent immature tooth utilizing MTA as an immediate apical plug.