IDA Maharashtra State Branch Dental Dialogue April-Jun 2012

7/28/2019 IDA Maharashtra State Branch Dental Dialogue April-Jun 2012

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Vol. XXXVIII No. 2 APRIL - JUNE 2012Dental Dialogue


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Indian Denta l Associat ion

Maharashtra State Branch

Vol. XXXVIII No. 2APRIL - JUNE 2012

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E-mail : [email protected] / yahoo.com

Office : 57, 38 Rutu Dent, Pradhan Park,M. G. Road, Nashik 422 001

Tel. No. (O) 0253-2313512 (R) 0253-2577389

Mob. : 90110 27610, 94222 46871

E-mail : [email protected]

[email protected]

President :

I st Vice President :

II nd Vice President :

III rd Vice President :

President Elect :

Imm. Past President :

Hon. Editor :

Dr. Sanjay Bhawsar

Dr. Manoj Joshi

Dr. Suhas Merchant

Dr. Aruna Bhandari

Dr. Bajrang Shinde

Dr. Arunkumar Chhajed

Dr. Rajendra Bhasme

INDIAN DENTAL ASSOCIATIONINDIAN DENTAL ASSOCIATIONMAHARASHTRA STATE BRANC H

Website : www.idamsb.org

Official Journal of IDA MSB

Mobile : 9422419428 Telefax : P. P. 0231-2653906

Dental DialogueDental Dialogue

1215 'A' Ground Floor,

Opp. Daulatrao Bhosale School,

Shivaji Peth, Kolhapur - 416 012.

Tel. : 0231-2629331

Editor ia l Office249 / 79, JANAK, 1 / 101,

Near Nagala Park Kaman,

Nagala Park, Kolhapur - 416 003.

Tel : 0231-2653473

Residence


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Indian Dent al Associat ion

Mahara shtra State Branch


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WHAT IS IN....What is in . . . 53

Editorial 55

Presidents Message 57

Dental Dialogue News 79

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Temporomandibular Joint Disorders : A Common Problem Yet 59

Complex To Understand

A Rare Case Of Two Separate Mesial Roots In Mandibular 62

First Molar : A Case Report

Reducing Sensitivity After Composite Restoration: A Study 64

Comparing Amount Of Separation And Discomfort During Tooth 66

Separation Between Two Types Of Separators

Feedback 68

Class II Correction, The Functional Therapy Approach 69

Book Review 70

Guiding Planes - Pathway For Success 71

Nodular Fasciitis : A Rare Case Report 73

Therapeutic Role Of Epsilon-Aminocaproic Acid In The Management Of 76

Dentoalveolar Trauma In Hemophilia A- A Case Report

Periodontal Medicine In Clinical Practice 78


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Don't miss the Scientific Extravaganza and Trade fair of International Standards


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* Bachelor of Dental Surgery

*Master of Journalism& Communication Science

Dr. Rajendra Bhasme,BDS, MJC

ED

ITORIAL

This Issue is released on 19th Sept. 2012 i.e. Ganesh Chaturthi Shake 1934, at Kolhapur

Dear Collegues,

At the outset, we apologise for delay in publishing this issue of Dental

D ialogue. The editor was busy in covering XXX London Olympics in D aily Ekmat

ti tleddoY Am{bqnH$Mofr om 5th July to 15 Aug. 2012.

We are very pleased to release this issue on the auspicious occasion of Ganesh

Chaturthi eHo$ 1934. I tis good to know that the 51st M SDC will be held at Pune on15th & 16th December 2012 at VI T S Hotel & Orchid Convent ion Center,

Balewadi, Pune.

We would li ke to Congratulate our president Dr. Sanjay Bhavsar for

arranging the Conference & conducting zonal convent ions in M aharashtra

without having much support fr om off ice of H SS I DA M SB.

All are requested to attend in large numbers.

T he Golden Jubilee of I DA M SB did not take place due to reasons beyond our

control. Similar event should not happen in future. The members of I DA are eager

to meet each other in EC meetings & Zonal Convent ions etc.

I t is very easy to critisize, but it is very di ff icult to work for the association.

T he book on Geriatr ic Dentistry by Dr. P. G. Diwan is

excellent . We appeal DCI to include the subject of Geriatric

Dentistry in the dental curriculum.

Also, the members above age 60 yrs. should be excluded

fr om collecting mandetory CDE points.

JUnVr ~mnm _ma`mJUnVr ~mnm _moa`m


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E-mail : [email protected]


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Dr. Sanjay V. Bhawsar

President, IDA MSB

Dear Friends,

It has been seven months in my journey as the President of IDA MSB. I am proud

to inform you all that in these few months we have been successful in organizingvarious programmes in different zones of Maharashtra state.

The 3 zonal programmes conducted in places like Mumbai, Aurangabad and

Panchagani were a grand scientific bonanza for IDA members. 6 other zonal

programmes are meticulosely planned with the help of eminient speakers in next 5

months.

IDA student members are the back bone of IDA future. This year 5 student Zonal

conferences will be conducted at Maharashtra level so as to provide a platform to

students to exhibit there hidden talent. Students from Dental colleges in the interiors

of the state will have a opportunity to participate in scientific, sports, culturalcompetetions. The final state level round of the Students Conference will be held in

Mumbai, this December. I am very much thankful to IDA Mumbai branch for hosting

the student conference.

For the first time a State level Table Tennis & Badminton Tournaments are

arranged for IDA dentist & student members on 14 -16 th Aug. 2012 by IDA MSB in

association with IDA Mumbai branch .

IDA in association with Government of Maharashtra is planning to organize

Dental Check up of near about 1 lakh Anganwadi Sevika & Children from all over the

Maharashtra. I appeal to all the ida members & dental colleges to help us in makingthis Towering task successful.

IDA Maharashtra state will be organizing the 51 st Maharashtra State Dental

Conference at Pune in the month of December 2012. I appeal all the members to

participate in large numbers to make it a grand memorable event.

Recently Pepsodent has also joined hands with IDA to support of our scientific

activities.

With the magic of monsoon is in the air let us enjoy the spirit of the season; the

season of warmth, joy and cheer. Best Wishes to all the IDA Members for the

auspicious Shravan, Ganesh Chaturthi and upcoming Dassera and Diwali.

Ability is nothing without opportunity. I thus take the opportunity to wish all our

members good health and success in this wonderful year ahead. May IDA reach

soaring heights which we all have dream of.

Dr. Sanjay Bhavsar


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H. S>m. {dU nmQ>rbAm_Mo ghm`m`rH. S>m. {dU nmQ>rbAm_Mo ghm`m`rDr. Laxmikant Kishanrao BichileElected Member, Maharashtra State Dental Council, Mumbai

Mahatma Gandhi Mission's Medical College andHospital, Aurangabad. Mob:-9422709054 (Off)- 0240-6601100


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Temporomandibular joint disorders :

A common problem yet complex to understand

Dr. Manish Agrawal, MDS, Prof.,Dr. Anita Shipurkar, MDS, Prof.

Dr. Dayanand Huddar, MDS, ReaderDr. Banashree Sankeshwari, MDS, Asst. Prof.

Dept. of Prosthodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli

Prosthodontics

Abstract :

Introduction:

Temporomandibular joint:

Temporomandibular disorder is any disorder thataffects or is affected by deformity, disease, misalignmentor dysfunction of the temporomandibular joint and theassociated responses in the musculature. The termtemporomandibular disorder include displacement ofone or both joints, misalignment of the disc, variousdiseases that affect bone or articular surfaces and other

pathologic disorders, inflammation or injuries to specificintracapsular structures. This article highlights thecauses, symptoms, diagnosis and treatment ontemporomandibular joint disorder.

Key words: tempormandibular joint, TMJ disorders,stabilization splints, night guard.

The temporomandibular joint is susceptible to all theconditions that affect other joints in the body, includingankylosis, arthritis, trauma, dislocations, developmentalanomalies and neoplasia. Although treatment is oftensimilar to other joints in the body, some variations exist.This article will highlight various causes, symptoms, &treatment for temperomandibular joint disorder (TMJD).

The temporomandibular joint (TMJ)(fig 1,2) is thearea directly in front of the ear on either side of the headwhere the upper jaw (maxilla) and lower jaw (mandible)meet. Within the TMJ, there are moving parts that allow

the upper jaw to close on the lower jaw. This joint is atypical sliding "ball and socket" that has a discsandwiched between it. The TMJ is used throughout theday to move the jaw, especially in biting and chewing,talking, and yawning. It is one of the most frequently used

1,2joints of the body.

The temporomandibular joints are complex and arecomposed of muscles, tendons, and bones. Eachcomponent contributes to the smooth operation of theTMJ. When the muscles are relaxed and balanced and both

jaw joints open and close comfortably, we are able to talk,

chew, or yawn without pain.We can locate the TMJ by putting a finger on the

triangular structure in front of the ear. The finger is movedjust slightly forward and pressed firmly while opening thejaw. The motion felt is from the TMJ. We can also feel thejoint motion if we put a little finger against the inside front

1part of the ear canal. These maneuvers can causeconsiderable discomfort to a person who is experiencingTMJ difficulty.

Due to the proximity of the ear to the temporo-mandibular joint, TMJ pain can often be confused with earpain. The pain may be referred in around half of allpatients and experienced as otalgia (earache). Conversely,TMD is an important possible cause of secondary otalgia.

Treatment of TMD may then significantly reduce sympt-oms of otalgia and tinnitus as well as atypical facial pain.

The dysfunction involved is most often in regards tothe relationship between the condyle of the mandible andthe disc. The sounds produced by this dysfunction areusually described as a "click" or a "pop" when a singlesound is heard and as "crepitation" or "crepitus" whenthere are multiple, rough sounds.

TMJD is a term covering acute or chronicinflammation of the temporomandibular joint, whichconnects the mandible to the skull. The disorder andresultant dysfunction can result in significant pain andimpairment. Because the disorder transcends the

boundaries between several health-care disciplinesinparticular, dentistry and neurologythere are a variety oftreatment approaches.

The temporomandibular joint is susceptible to manyof the conditions that affect other joints in the body,including ankylosis, arthritis, trauma, dislocations,developmental anomalies, and neoplasia.

An older name for the condition is "Costen'ssyndrome", after James B. Costen, who partiallycharacterized it in 1934.

Temporomandibular joint disorder (TMJD or TMD)


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Cause:

There are many external factors that place unduestrain on the TMJ. These include but are not limited to thefollowing:

Bruxism has been shown to be a contributory factor inthe majority of TMD cases. Over-opening the jaw beyondits range for the individual or unusually aggressive or

repetitive sliding of the jaw sideways (laterally) orforward (protrusive). These movements may also be dueto parafunctional habits or a malalignment of the jaw ordentition. This may be due to:

1. Bruxism (repetitive unconscious clenching orgrinding of teeth, often at night).

2. Trauma

3. Misalignment of the occlusal surfaces of the teeth dueto defective crowns or other restorative procedures.

4. Jaw thrusting (causing unusual speech and chewinghabits).

5. Excessive gum chewing or nail biting.

6. Size of food bites eaten.

7. Degenerative joint disease, such as osteoarthritis ororganic degeneration of the articular surfaces,recurrent fibrous and/or bony ankylosis,developmental abnormality, or pathologic lesionswithin the TMJ

8. Myofascial pain dysfunction syndrome

9. Lack of overbite

Patients with TMD often experience pain such asmigraines or headaches, and consider this pain TMJ-related.. The dentist must ensure a correct diagnosis doesnot mistake trigeminal neuralgia as a temporomandibulardisorder. The following are behaviors or conditions thatcan lead to TMJ disorders.

1. Teeth grinding and teeth clenching (bruxism)

increase the wear on the cartilage lining of the TMJ.Those who grind or clench their teeth may beunaware of this behavior unless they are told bysomeone observing this pattern while sleeping or by adental professional noticing telltale signs of wear andtear on the teeth. Many patients awaken in themorning with jaw or ear pain.

2. Habitual gum chewing or fingernail biting

3. Dental problems and misalignment of the teeth(malocclusion). Patients may complain that it isdifficult to find a comfortable bite or that the way theirteeth fit together has changed. Chewing on only oneside of the jaw can lead to or be a result of TMJproblems.

4. Trauma to the jaws: Previous fractures in the jaw orfacial bones can lead to TMJ disorders.

Stress frequently leads to unreleased nervous energy.It is very common for people under stress to release thisnervous energy by either consciously or unconsciouslygrinding or clenching their teeth.

Occupational tasks such as holding the telephonebetween the head and shoulder may contribute to TMJdisorders.

Symptoms:

1 3Treatment for TMJ disorders:

TMJ pain disorders usually occur because ounbalanced activity, spasm, or overuse of the jaw musclesSymptoms tend to be chronic, and treatment is aimed aeliminating the precipitating factors. Many symptommay not appear related to the TMJ itself.

Signs and symptoms of temporomandibular join

disorder vary in their presentation and can be verycomplex, but are often simple. On average the symptomwill involve more than one of the numerous TMcomponents: muscles, nerves, tendons, ligaments, bonesconnective tissue, and the teeth. Ear pain associated withthe swelling of proximal tissue is a symptom otemporomandibular joint disorder.

The following are common Symptoms associatedwith TMJ disorders:

l Biting or chewing difficulty or discomfort

l Clicking, popping, or grating sound when opening oclosing the mouth

l Dull, aching pain in the face

l Earache (particularly in the morning)

l Headache (particularly in the morning)

l Hearing loss

l Migraine (particularly in the morning)

l Jaw pain or tenderness of the jaw

l Reduced ability to open or close the mouth

l Tinnitus

l Neck and shoulder pain

l Dizziness

How are patients evaluated and diagnosed when TMproblems are suspected?

A complete dental and medical evaluation is oftennecessary and recommended to evaluate patients with

suspected TMJ disorders. One or more of the followingdiagnostic clues or procedures may be used to establishthe diagnosis. Damaged jaw joints are suspected whenthere are popping, clicking, and grating sounds associatedwith movement of the jaw. Chewing may become painfuand the jaw may lock or not open widely. The teeth may bworn smooth, as well as show a loss of the normal bumpsand ridges on the tooth surface. Ear symptoms are verycommon. Infection of the ear, sinuses, and teeth can bdiscovered by medical and dental examination. Dental Xrays and computerized tomography (CT) scanning help todefine the bony detail of the joint, while magnetiresonance imaging (MRI) is used to analyze soft tissues

,

The mainstay of treatment for acute TMJ pain is heaand ice, soft diet, and anti-inflammatory medications.

1. Jaw rest: It can be beneficial to keep the teeth apart amuch as possible. It is also important to recognizwhen tooth grinding is occurring and devise methodsto cease this activity. Patients are advised to avoidchewing gum or eating hard, chewy, or crunchy foodsuch as raw vegetables, candy, or nuts. Foods tharequire opening the mouth widely, such as a bighamburger, are also not recommended.

Dr. Manish Agrawal, et al


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2. Heat and ice therapy: These assist in reducing muscletension and spasm. However, immediately after aninjury to the TMJ, treatment with cold applications isbest. Cold packs can be helpful for relieving pain.

3. Medications: Anti-inflammatory medications such asaspirin, ibuprofen, naproxen, or steroids can helpcontrol inflammation. Muscle relaxants, such as

diazepam (Valium), aid in decreasing muscle spasms.In certain situations, local injection of cortisonepreparations (methylprednisolone triamcinolone [,Celestone) into the TMJ may be helpful.

4. Physical therapy: Passively opening and closing thejaw, massage, and electrical stimulation help todecrease pain and increase the range of motion andstrength of the joint.

5. Stress management: Stress support groups,psychological counseling, and medications can alsoassist in reducing muscle tension. Biofeedback helpspeople recognize times of increased muscle activityand spasm and provides methods to help control them.

6. Occlusal therapy: A custom-made acrylic appliance

which fits over the teeth is commonly prescribed fornight but may be required throughout the day. It acts tobalance the bite and reduce or eliminate teeth grindingor clenching (bruxism).

7. Correction of bite abnormalities: Corrective dentaltherapy, such as orthodontics, may be required tocorrect an abnormal bite. Dental restorations assist increating a more stable bite. Adjustments of bridges orcrowns act to ensure proper alignment of the teeth.

8. Surgery: Surgery is indicated in those situations inwhich medical therapy has failed. It is done as a lastresort. TMJ arthroscopy, ligament tightening, jointrestructuring, and joint replacement are considered inthe most severe cases of joint damage or deterioration.

In line with the recommendations treatments for TMJshould not permanently alter the jaw or teeth, but need tobe reversible. To avoid permanent change, over-the-counter or prescription pain medications may beprescribed. Some sufferers may also benefit from gentlestretching or relaxation exercises for the jaw, which may berecommended by their healthcare providers.

Other interventions include:1

l Stabilization splint (biteplate, night guard) is acommon but unproven treatment for TMD. A splintshould be properly fitted to avoid exacerbating theproblem and utilized for brief periods of time. The use

Reversible treatments

Dr. Manish Agrawal, et al

KOLKATTAKOLKATTAAttend in Large Numbers

21st to 24th February 2013

66th IndianDental Conference

51st Maharashtra StateDental Conference

PUNE15th & 16th December 2012

of splint should be discontinued if it is painful orincreases existing pain.

3l Mandibular Repositioning (MORA) Devices can be

worn for a short time to help alleviate symptomsrelated to painful clicking when opening the mouthwide, but 24-hour wear for the long term may lead tochanges in the position of the teeth that can complicate

treatment. A typical long-term permanent treatment(if the device is proven to work especially well for thesituation) would be to convert the device to a flat-planebite plate fully covering either the upper or lower teethand to be used only at night.

l Regular exercise such as running for 20 minutes 3times a week is extremely efficient in alleviating TMDbrought about through stress-induced Bruxism.Exercise essentially burns away the chemicals likecortisol and norepinephrine that cause stress so theunconscious mind no longer feels the need to relieve itsstress through jaw-clenching.

If the occlusal surfaces of the teeth or the supportingstructures have been altered due to inappropriate dentaltreatment, periodontal disease, or trauma, the properocclusion may need to be restored. Patients with bridges,crowns, or onlays should be checked for bite discrepancies.These discrepancies, if present, may cause a person tomake contact with posterior teeth during sidewayschewing motions. These inappropriate contacts are calledinterferences, and if present, they can cause a patient tosubconsciously avoid those motions, as they will provoke apainful response. The result can be excessive strain or evenspasms of the chewing muscles. Treatment could includeadjusting the restorations or replacing them.

Dentist should have detail knowledge of TMJdisorders its causes, symptoms & treatment options.Successful treatment of TMJ disorder can be attributed todoing a comprehensive examination, carefully andcompletely collecting all the needed information, & propertreatment planning.

1. Okeson, Jeffrey P. (2003). Management of temporomandi-bular disorders and occlusion (5th ed.). St. Louis: Mosby.

th2. Gray`s Anatomy. 39 edition, Elsevier

3. Peter E. Dawson Functional Occlusion: From TMJ to Smilerd

Design (3 ed.) Elsevier Health Sciences.

Long-term approach

Restoration of the occlusal surfaces of the teeth

Conclusion:

References:


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Abstract:

Introduction:

Case report:

This paper presents the presence of bifurcated mesialroot of mandibular first permanent molar. A majoranatomic variant of the first mandibular molar tooth -the presence of an additional distolingual root, alsoknown as Radix Entomolaris has been well documented.

Very few studies have documented the presence of twoseparate mesial roots in mandibular first molar. Hencethis paper presents the report of a case in whichendodontic therapy was performed on mandibularfirst molar with rare occurrence of two separate mesialroots, each having a single canal.

Key Words: Mandibular first molar, Bifurcated Mesialroot, Anatomic variations.

The prime objective of endodontic therapy isthorough chemo-mechanical debridement of the entirepulp space & the three dimensional sealing of the rootcanal. For this, it is essential for an operator to be familiar

with the tooth morphology & root canal anatomy. Failureto achieve the above may lead to persistence of infection& treatment failure. Pucci & Reig (1944) reported thatfirst molar is the only multi-rooted molar that alwayspresents with two perfectly differentiated rootsonemesial & one distal and rarely with an additional

1,2distolingual root. The major variant of this tooth type,i.e, the additional disto-lingual root has been mentioned

3in the literature by Carabelli (1844). This additionaldistolingual root was named as Radix Entomolaris by Bolkin the year 1915. However, there is little documentationabout the two separate mesial roots (mesiobuccal &mesiolingual). This paper presents the unusualoccurrence of two separate mesial roots in mandibular

first molar.

A female patient aged 18 years reported to theDepartment of Conservative Dentistry & Endodontics,with the chief complaint of dull pain in the left lower backregion of the mandible since 6 months. Extraoralexamination revealed palpable lower left submandibularlymph nodes & tender to percussion. Intraoralexamination showed deep carious lesion in relation to leftmandibular first molar. Vitality testing was performed

A Rare Case Of Two Separate Mesial Roots In

Mandibular First Molar : A Case Report

Dr. Sunil Saler, MDS Prof. & Head

Dr. Anita Shipurkar, Principal & Prof. Dr. Santosh Hugar, MDS, Asso. Prof.Dr. Jaykumar Patil, MDS, Prof. Dr. Hemanth Vagarali, MDS, Asso. Prof.

Dr. Samruddhi Metha, BDS Asst. Prof.

Department Of Conservative And Endodontics, Bharti Vidyapeeth Dental College, Sangli

using electric pulp tester and it was found to be noresponsive. Radiographic examination revealed deecarious lesion (Fig 1) approximating pulp and increase

thickness of the periodontal ligament space suggestive operiapical periodontitis. On careful examination of thdiagnostic radiograph, two separate mesial roots (Fig 2were seen which was again checked with the help of radiovisiography. After achieving adequate local anesthesiacaries were excavated & access cavity was preparedComplete care was taken during the location of all the roocanal orifices as diagnostic radiograph showed aberranroot morphology. Working length was measured usinelectronic apex locator which was later confirmed bradiographic method. The presence of two separatmesial roots without extra canal was confirmed at thistep. Biomechanical preparation was done & obturatiowas completed using lateral condensation method (Fig 4

Access cavity was restored immediately with silveamalgam and in the consecutive appointments the tootwas restored with complete cast metal restoration (Fig 5)

The three rooted mandibular molar reported herhad two mesial roots and one distal root with one canal ieach root. Initial evaluation of preoperative radiograprevealed that distal root may contain two canals but ocareful exploration only one oval distal canal was founwhich was connected with narrow isthmus in betweenPresence of extra root or extra root canals has also been

Discussion:

Endodondotics


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APPEALTo,

All branch Secretaries & Members

- Typewritten or well written with the spacing withoutspelling mistakes.

- On one side of page only (keep back page empty)

- Reach before the 10th of Every Quarter i.e. March, June,September & December month.

- Colour photograph shall be sharp, Well contrast with fulllight effect.

- Caption should be written on the back of photographNames of the persons from Right to Left.

- Photographs with action are most preferable (As lightingthe lamp, / opening ceremony etc.)

- News matter if published in the local news paper pleasesend the photo copy of the page.

- Photographs & Newsmatter will not be returned back (itwould not be possible)

- News matter which will be sent should be signed by

office bearer of the branch.- Any special extra-curricular activity of member shouldbe sent for DD. which all our members should know.

- Poems, Dental Unfortgetable experience, jokes subjectwhich should be discussed all over the state & practicaltips to the treatment of patients should be sent.

- Editorial board's decision will be final.

- Address - 249/79 JANAK - 1 / 101,

NAGALA PARK, KOLHAPUR.

Ph. : 0231-2653473, Mobile 9422419428

email - [email protected] / yahoo.com

Copys for the news matter should be

Photographs should be

Wor ld Dental ShowMUMBAIMUMBAI5th, 6th, 7th October 2012

at BKC

www.wds.org.in




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related to the aberrantmorphology of the crown,i.e., presence of extra cusp orabnormally sized tooth.However in this case theocclusal portion of thecrown was grossly decayed

hence, it was difficult toassociate root anatomy withcrown morphology. Presence of extra canals is fairlycommon, but occurrence of extra mesial root is not.Several reports have discussed about the presence ofadditional distolingual root also known as RadixEntomolaris. The available literature does not documentmuch about the occurrence of two mesial roots inmandibular first molar. Only few cases have been reportedwith such kind of anomaly.

Previous studies document the presence of more thantwo root canals in the mesial root with an incidence of

5, 62.07% up to 13.3% of the examined cases . A third roothas been reported in some cases either mesially or distally

7(5.3%). Ingle documents the 2.2% occurrence of threeroots in mandibular first molar; however, he has not

8differentiated it in extra mesial or distal root. In this caseno extra canal was found in spite of the presence ofadditional root. To locate all the canals deroofing of thepulp chamber becomes extremely important andimmense care has to be taken to accomplish the abovegoal.

Additional third root is commonly present on thelingual aspect of the distal root. Only Sperber & Moreau(1998) have reported an additional root on the buccal

9aspect. The nature of this additional root is also variable,ranging from a short conical extension to full length, withpulp extending into the root even if short. (Reichart &

10Metah, 1981). Very few cases report the presence of four

roots with four canals but such rare variations ofmandibular first molar are more common in Asians &

11Caucasians. The preoperative radiographs play animportant role in the diagnosis and treatment plan of anycase. During reimplantation knowledge of anatomy is thekey to success. Partial removal of the tooth duringextraction procedure, may lead to clinical failure.

This anomaly is genetically oriented developmentaldefect during the maturation of the tooth as this waspresent bilaterally. Previous studies report theoccurrence of extra root specific to the race & geographiclocation. This paper opens the door for further studies onthe abnormalities in the mesial root anatomy of themandibular first molars.

Dr. Sunil Saler, et al

References:

1. Pucci FM, Reig R. Conductos Radiculares. Buenos Aires,Editorial Medico-Quirurgica 1944.

2. Philip AA, Shetty Harish, Varma Ravi. Madibular first molarwith an unusual root morphology A case report.Ker StatDent J 2006:33-34.

3. Moor RJG, Deroose AJG & Calberson FLG. Int Endod J

2004;37:789-799.4. Burns R, Herbranson EJ. Tooth morphology and cavity

preparation. In Cohen S, Burns RC, editors: Pathways of pulp,ed 8, St Louis, 2002, Mosby:211.

5. Goel NK, Gill KS, Taneja JR. Study of root canals configurationin mandibular first permanent molar. J Indian Soc Pedod PrevDent. 1991 Mar;8(1):12-4.

6. Fabra-Campos H. Unusual root anatomy of mandibular firstmolars. J Endod. 1985 Dec;11(12):568-72. No abstractavailable.

th7. Grossman LI. Endodontic practice, 10 edition, Philadelphia,

1981:170th

8. Ingle JI, Bakland LK. Ontario, B.C. decker Co.Endodontics 5edition:151

9. Sperber GH, Moreau JL. Study of the number of roots and thecanals in Senegalese first permanent molars. Int Endod J1998;31:112-116.

10. Reichart PA, Metah D. Three rooted permanent mandibularfirst molars in Thai. Commu Dent & Oral Bio 1981;9:191-192.

th11. Weine FS. Endodontic therapy, St Louis, Mosby Co, 6 edition:

150.


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Abstract

Introduction

Objective

Methods

It is usual problem to face tooth-sensitivity after resincomposite restoration. A Sensitivity analysis was carriedout depending upon the cavities of different depths anduse of various liners and base materials. Factorsresponsible for post-operative sensitivity in generaldentistry and measures to avoid them same were listed.The results were obtained accordingly

(Keywords: Resin composite restoration,postoperative sensitivity, pulpal protection, dentine

bonding system, cavity depth, cavity class, survey inprivate dental clinics.)

The use of tooth coloured restorative materials forposterior teeth began with earliest generation ofbondable composite restorative material in early 1970s.For forty years industry continues to search for bulk fullcomposite that can be used with ease and predictability ofdental amalgam. Despite improvements in compositetreatment over past decades, postoperative sensitivitystill remains a problem.

Caries profunda showed a fourteen times higher risk offailure in cavities with pulp exposure compared to

restorations that were localized in dentin. Regard to typeof sensitivity no patients reported sensitivity to sweet orsour, most of them described their sensitivity sharp ordull.

Incidence of postoperative sensitivity was evaluated inresine based posterior restorations.

To analyze the relationship between cavity depth andliners with postoperative sensitivity of resin compositerestorations.

A clinical follow up was conducted on 152 resincomposite restorations made in two private dental clinics

over 2 months period. A total 73 class I and 79 class IIrestorations (MO/DO and MOD) were placed in patientsranging in age from 20 to 50 years. After cavitypreparations were completed, rubber dam was placedand preparations were restored using total etch system(prime and bond NT) and resin based restorativematerial. Patients were contacted after 24 hours and 7, 30and 9 days postoperatively and questioned regarding thepresence of sensitivity and stimuli that triggered thatsensitivity.

Reducing Sensitivity after Composite

Restoration: A Study

Dr. Manjiri Vartak

Govt. Dental College and Hospital, Mumbai

Results

Concluding Remarks

Group 1: 39% of restorations had no protective layer. Adepth of prepared cavities increased restoration receiveone of three pulpal protection methods.

Group 2: Calcium hydroxide base.

Group 3: Glass inomer cement.

Group 4: Protection with calcium hydroxide base icombination with glass inomer cement. Incidence opostoperative sensitivity showed significant differencamong groups 1, 2 and 3 but was significantly lower igroup 1 when cavity was limited to enamel than in group with deep cavity. Restorations made in shallow anmedium depth cavities demonstrated significantly lespostoperative sensitivity than those made in deep cavitieIn restorations with approximately same length, group and group 3 restorations showed less or nil sensitivitcompared to group 1 or 2.

The newer generation dentin bonding agents showesignificantly lower incidence of postoperative sensitivitthan early generation group.

Postoperative sensitivity in resin compositrestorations was related to absence of protective layer at

same time it increased with depth of cavities restored witresin composite. Type of dentine bonding agent could alsbe responsible for postoperative sensitivity.

Though postoperative sensitivity has been vexing issufor most dentists, fortunately there are simple solutions tthis irritating problem. Listed below are causes ansolutions.

1. Poor dentine penetration by bonding agenApplication of 2 or 3 layers of bonding agent with aithinning and curing separately for each one.

Or

Use of 1 bottle self-etch resin.

2. Bad C factor and boxy conventional preparations: Bad factor in responsible for postoperative pain in tootwith simple conservative class 1 preparation on thsame patient where deep restoration has npostoperative sensitivity. Tooth reduction for cavitpreparation should be confined to elimination ocarious tooth structure and cavity design to withstanintraoral environment. Bevel enamel margins tconceal the margins. Roughed margins of enamel alsenhance bond strength. Internal line angles of cavit

Restorative Dentistry


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design should be rounded to improve stressdistribution after placement of restorative materialthrough Micro-mechanical adhesive approach.Isolation is key feature in the success of the compositerestorations for proper moisture control, to preventbacterial or salivary contamination and reduceairborne debris.

3. Replacing old GV Black style:a. Dentine should be built by layering process in

increments. Cusps should be built in incrementsfollowed by cross linking. Cavity should not befilled horizontally.

b. Bulk filled cavity preparations result inphotopolymerization induced stress resultingfrom volumetric shrinkage, reaction kinetics andviscoelastic properties of composite resins.

c. Recommended techniques to fill the cavity bycomposite restoration are,

* Oblique incremental technique.

* Modified incremental technique

* Centripetal incremental insertion technique.

d. Use RMGIC as a liner to replace missing dentine.

e. Use of 1 bottle self-etch resin.

4. Flowable base: Glass inomer cement bonds directlywith tooth structure, biocompatible and consideringease with which it can be used; it acts as an excellentbase before placement of composite restoration.

a. Glass inomer can be placed in small disposablesyringe and introduced into floor of cavity. It can bevery easily shaped using condenser to provideLeveled floor for composite restoration.

b. An alternative technique is almost fill the cavity floor

with glass inomer cement And then use high speedrotary instrument to reshpe cavity preparation.

5. Acid etching or Rinse etching: Acid etching thedentine before use of self-etch bonding agent.Thisadditional etching creates over-etch situation whichhas deep demineralization zone for subsequentlyplaced primer to completely penetrate.

6. Shaking of bottle containing bonding agent: Asmultiple components in bonding agent tend to settleor separate during storage, it is necessary tothoroughly shake the bottle prior to despensing.

7. Air bubble entrapment at bonding interphase ofcomposite and dentine. Sensitivity in this case

occurred because bubble shrinks during biting andapplies pressure. Solution-Remove restoration andreplace it with correct one. Use air thinning techniquealong with curing of each layer separately whileapplication of bonding agent.

8. Type of polymerization protocol: Soft startpolymerization protocol reduces final stress ofrestoration by producing modest decrease inconversio of composite as compared to pulse protocolor conventional full intensity care technique.

9. Not following manufacturers' protocol. Agitate thebonding agent for time prescribed by manufacturer.Use of air thinning technique after application ofbottle bonding agent.

10. No heavy chewing for 24 hours:Tooth colouredcomposite filling is 80% hard at a time of placementand continues to harden for additional 24 hours

before reaching its full strength. Heavy chewing cancause microfractures in restoration reducing its lifespan.

Black, G. V. 1917. A Work on Operative Dentistry, 2Volums. 3rd edition, Chicago: Medico- Dental Publishing.

Hickel, R. and J. Manhart. 2001. Longevity ofrestorations in Posterior Teeth and Reasons for Failure.Journal of Adhesive Dentistry, 3(1): 4564.

Letzel, H. 1989. Survival Rates and Reasons for Failureof Posterior Composite Restorations in Multi-centreClinical Trial. Journal of Dentistry, 17: S10S17.

U. S. Natinal Library of Medicine, National Institute ofHealth. PMID19192831. PuMed-indexed for MEDICINE.

Wendt, S. L. and K. F. Leinfelder. 1992. ClinicalEvaluation of Clearfill Photo Posterior: 3 Year Results.

American Journal of Dentistry. 6: 121125.

Select References

Dr. Manjiri Vartak

EDITOR,

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9. Beautiful photographs for cover page are also invited.

Send your articles to :


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ABSTRACT:

INTRODUCTION

Introduction:- For treatment with a fixed orthodonticappliance, different types of separators have been used inorthodontics. Separation of the molars is necessary tocreate enough space for bands that anchor the appliance.Materials & Methods:-The separators tested were spring-type and elastomeric separators. Fourteen patients aretaken. Two spring-type and two elastomeric separatorswere placed alternately in the left or the right quadrant.

After a separation period of 5days, the amount ofseparation was measured with a leaf gauge. A questionn-aire will be used to register the patient discomfort. Results:The mean separation was 0.3 mm for the spring-type and0.4 mm for the elastomeric separators. The springs wereconsidered less painful than the elastomerics, For bothseparators, the pain was worst at day 2 and subsidedalmost completely by day 5. Discussion:- The difference in

separation effect between springs and elastomerics aresmall. Although bands for a fixed appliance isapproximately 0.25 mm, the amount of separation is0.3mm & 0.4mm respectively. It was found that mild tomoderate pain is associated with orthodontic separators.Conclusions: The separation effect of the two separatorswas considered clinically equivalent and since pain ofmoderate intensity occurs during the separation period.

Treatment with a fixed orthodontic appliance,separation of molars are necessary to create space forbands that anchors the appliance. Ideal Requirements Of

Separators includes rapid & Good separation, no patientdiscomfort or pain, it should be easily cleaned &1

radiopaque and not to be lost . Different types ofseparators are used in orthodontics. Angle discussed theneed for separation in 1907, and his method is still populartoday. Angle explained the use of a brass wire ligaturepassed under the contact, then carried on over the contact,after which the ends were tightly twisted together. In 1921Calvin Case advocated the use of a separating tape, whichwas wax wrapped tape wrapped around the contact. He

Comparing Amount Of Separation And

Discomfort During Tooth Separation Between

Two Types Of Separators

Dr. Bidarkar Mayur, PG Student

Dr. Swaroop Savanur, Prof. & HOD

Dr. Basavraj, Reader

Dept. Of Orthodontics, PDU Dental College, Solapur

Dr. Jayasudha K., Reader

Dept. Of Pedodontia, PDU Dental College, Solapur

Orthodondotics

said that the tape should left on for only 24 hours. Thchanged in separation was not sufficient. Rubbeseparators were mentioned by Thurow and Dickso

2Anderson and Begg describes about separating springs .

(a) Brass wire separators (b) Latex elastic separato\

(c) E lastomeric separators (d) Spring type steel separator2

l Hoffman - separation effect of four types separators was examined, but subjective experiencwas not investigated.

3,4l Ngan et al - perception of pain & discomfort

patients undergoing treatment for 7 days oseparation. It was found that separators caused higlevels of discomfort at 4 and 24 hours afteplacement. No systematic studies had bee

performed on separating effect and perception pain and discomfort after placement of separators.

AIM:-Comparing Amount Of Separation AnDiscomfort During Tooth Separation Between Two TypeOf Separators

1) To measure Amount of separation

2) Pain and discomfort associated with separation

AIM AND OBJECTIVES

OBJECTIVES:-


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2) Pain & discomfort:-

All 14 patients completed the study and the responserate was excellent. The patients noted that elastomericare more painful than the springs, but the difference wasnot statically significant. Two patients complained of pain

during chewing. The pain gradually increased with bothseparators and peaked at day 2.

Measurement of separation distance withthickness gauge of distance 0.4mm

Lateral ViewOcclusal View

Dr. Bidarkar Mayur, et al

MATERIAL AND METHODS

STATISTICAL ANALYSIS

RESULTS

l Fourteen patients, 7 girls and 7 boys with agerange of 17 to 21 years. (mean age of 20 years )participated in study. Informed consent was taken.Separators were placed mesial and distal point contact of

stmaxillary 1 molar which had bilateral approximal

contacts. The separators used were spring-type steelseparators and elastomeric separators. The springsapplied with light wire pliers and the elastomerics withseparator placing forceps. Two springs and twoelastomeric Separators were placed alternatively in theleft and right quadrant of maxilla. The separators hadbeen place for 4 days. Elastomeric and springs wereremoved with a curved probe and light wire plierrespectively.

After air spray drying of the maxillary molars,amount of separation of each maxillary molar wasmeasured mesially and distally with a thickness gauge.(0-1mm with difference gauge 0.05 gradings) The patients

perception of pain/discomfort was recorded byquestionnaires.

To detect thedifference betweenq u a n t i t a t i v evariables, paired t testwas used. Whethert h e r e w a s a n ysignificant differencein the amount of painreported due to

separators ,wilcoxon's signed rank test is used.Difference of probabilities of less than 5% were

considered statistically significant.

1) Separation Effect:-

As the results obtained did not differ significantlybetween the genders or between separation mesial ordistal to maxillary molars. The mean separating effect was0.3mm for the springs and 0.4 mm for the elastomerics.Difference in effect was significant p


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DISCUSSION

The difference in separation effect between springs andelastomeric was small and statistically not significant. Thespace needed for fitting bands for a fixed appliance isapprox.0.25 mm. So, the amount of separation 0.3 and 0.4mm for springs and elastomerics. Which concludes twice

the thickness of bands. It was found that mild to moderate5pain was associated with orthodontic separators . So, thesprings are considered less painful than the elastomerics.

The pain was perceived as worst during day 2 andth

subsides at day 4 and subsides almost on 5 day. So, weadvice that to perform molar band fitting at least 5 daysafter inserting the separators. No significant differencefound between boys and girls pain/discomfort experienceduring the separation. Although some studies report morepatient discomfort for girls than boys. More girls than boysused analgesics in this study. It has been reported thatorthodontic patients use analgesics often.

Eating was most affected during the separation period.

Most patients preferred soft foods. So, it should be in mindthat pain may occur during eating.

The influence on regular activities as well as day todaywork was considered negligible. Hence, in this study thepatient had no problem in discriminating between pain &discomfort in right and left posterior teeth when two typesof separators were placed on right and left side respectively.

As there is high scope of this study, we advice to userecent elastomeric materials, and also requirement of goodsample size.

CONCLUSION

REFERENCES

The difference in separation effect betweensprings and elastomeric was small and statistically nosignificant.

The separation effect of the two types oseparators was considered clinically significant.

Both types of Separators caused pain of mild tmoderate intensity with springs considered less painfuthan elastomeric.

The pain was worst at day 2 and had subsidedcompletely at day 4. Therefore, molar banding should bedone at least 4 days after inserting the separator.

1) Separation effect and Perception of Pain and Discomforfrom two types of Orthodontic Separators World J Orthod2004;5:172-176

2) Hoffman WE. A study of four types of orthodontiseparators.Am J Orthod 1972; 62; 67-73.

3) Ngan P, Wilson S, Shanfeld J. The effect of ibuprofen on thlevel of discomfort in patients undergoing orthodontictreatmentAJODO 1994; 106;88-95

4) Scheurer P, Firestone A. Perception of pain as a result oorthodontic treatment with fixed appliance. Eur J Orthod1996,18:349-357

5) Ngan P, Kess B, Wilson S. Perception of discomfort bpatients undergoing orthodontic treatment . AJODO1989;96;47-53

6) Proffit WR. Contemporary Orthodontics(ed.4)

Dr. Bidarkar Mayur, et a

Feedback

Very nice issue of Dental Dialogue of J an. to Mar. 2012 this shows that MSB is functining., Pune (1st June 2012)

Beautiful Photo of Koyna Lake Tapping on Dental Dialogue., Pune (1st June 2012)

Beautiful Photo of Koyna Lake Tapping on Dental Dialogue., Principal, PDUDC, Solapur (2nd June 2012)

Its excellent issue thank you., Solapur (19th May 2012)

Read & informative Dental Dialogue., Akola (2012)

Congratulations Dr. Bhasme for coming out with a timely issue inspite of all that is happening IDAMSB. It has really assured common members like me that we still have our beloved association inexistence. In Greek Mythology the earth is supported on shoulders ofATLAS. I am happy you havebecome ATLAS for IDA MSB.

, Aurangabad (2nd J une 2012)

Respected Sir,Thanks again for adding a new era of knowledge in Dental Dialogue. I feel your work is totallyjustifiable inspite of all odds which is going in IDA MSB. Keep the same enthusiasm.

, Chopada-J algaon (5th J une 2012)

Once again congratulations for publishing very nice issue of Dental Dialogue., Amravati (5th J une 2012)

Received Dental Dialogue J ournal congratulations for receiving award. Very informative issue.Continue same good work in future.

, Solapur (23rd July 2012)

Dr. Nitin Barve

Dr. Mansing Chavan

Dr. R. S. Birngane

Dr. Vikas Kamble

Dr. Tushar Vora

Dr. Shivkumar Ranjalkar

Dr. Rahul Patil

Dr. Sandeep Pati l

Dr. Sanjay Sakkarshett i

By Sms


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Pre Treatment

Front Profile Lateral Profile Front Smile

Front Occlusion

Left Buccal Occlusion

Right Buccal Occlusion

Mid treatment with Twin Block

Frontal view Right buccal view

Introduction

Case Details

TREATMENT PROGRESS :

Conventional orthodontic appliances usemechanical forces to alter the position of the teeth into amore favourable position. However the scope of theseappliances is restricted by the aberrations in the

1developmental process or the neuromuscular capsule.

About 40% of the malocclusions treated belong toClass-II category. Abundant research has shown that mostof the Class-II problem occurs because of retrognathic

mandible which can be corrected by the use of functionalappliances if the patient reports to the orthodontist whensome percentage of growth is still left in the patient ( ie in

2and around puberty).

The following case report shows in detail how a caseof Cl-II malocclusion was treated using Twin Blockfollowed by finishing the case with fixed mechanotherapy.

CHIEF COMPLAIN : Patient by the name of ShantanuGoswami, aged 11 years reported with a chief complain ofprotruding upper front teeth.

DIAGNOSIS : After clinical examination and

cephalometric analysis the case was diagnosed to be ofClass-II malocclusion with retrognathic mandible andnormal maxilla. Molar relation and canine relation wereClass- II with overjet of 7 mm and overbite of 4mm.

TREATMENT PLAN : As the patient had about 60 to70 percentage of grwth left according to the CVMI status,the treatment was planned in two phases. In phase-1 TwinBlock was planned to -treat the retrognathic mandibleand in phase -2 fixed appliances were planned to finish ofthe case with minor dental corrections treated.

Phase 1 : Twin Block was fabricated with 5 mmsagittal advancement and 5mm vertical opening.Expansion screw was placed in the maxillary arch tocorrect maxillary constriction.The Twin Block wascemented to achieve 24hr wear. Patient wore theappliance for 6 months after which trimming was startedto achieve proper vertical erruption of posterior

thdentition. At the end of 12 month after achieving Class-Imolar relation Twin Block was discontinued.

Phase 2 : Fixed mechanotherapy was started bybonding MBT 0.022 prescription. Finishing and detailing

Class II Correction, The Functional Therapy Approach

Dr Rishi A Joshi

Sr Lect. Dept of Orthodontics. Hithkarini Dental College, Jabalpur, Madhya Pradesh.

Dr Parikshit Rao

Sr Lect, Dept Of Orthodontics, K..M.Shah Dental College, Pipariya, Vadodara, Gujrat.

was achieved and case was ready for debonding after 4months.

PHOTOGRAPHS :

Orthodontics


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Left buccal view

End treatment

Front profile Lateral Profile Front Smile

Front occlusion Left Buccal occlusion

Right Buccal Occclusion

Conclusion :

References :

Skeletal Class-II malocclusion if treated bycombination of functional appliance and fixedmechanotherapy can give good and stable results. Twinblock is a very good appliance of choice as it has goodpatient compliance and is a full time wear appliance.

1 Woodside DG, Metaxas A, Altuna G. The influence offunctionalappliance on glenoid fossa remodelling . Am J OrthodDentofacial Orthop. 1987;92:181-98.

2 Bishara SE, Ziaja RR. Functional Appliances: A review, Am JOrthod Dentofac Orthop 1989;95:250-6

Dr. P. G. Diwan needs to be complemented for his

great contribution to Dentistry in India by

authoring the book titled Geriatric Dentistry in

India. This is a unique book of its kind on the very

important topic of Geriatric Dentistry that has

been written with 50 plus years of Clinical

Experience.

He has covered most of the topics pertaining to

the practice of dentistry for elderly people (age 60

years of above) who contribute almost 8% of the

Indian Population. i.e. about 100 million people.

Ironically, Geriatric Dentistry has not been

included in the curriculum in the Dental

Institutions in India that should have been.

This book will be a great guide for the

undergraduate students to learn the geriatric

changes in the oral cavity. Also the changes

occuring in the oral cavity as a result of systemic

diseases that are prevalent in elderly population

have been discussed in details.

The knowledge about dental treatment for

medically compromised people & also the

emergencies in geriatric dental practice will be

very useful for the practising Dental Surgeons in

India.

Book ReviewBook ReviewDr. Rishi A. Joshi et al

Pricej: 450/-

Dr. Anil Kapadia


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Abstract :

Introduction:

Functions of guiding planes surface:-

Guiding planes play as very vital role in removableprosthodontics but unfortunately it is least considered.Guiding planes provide easy path of placement andremoval and also helps in designing other components ofRPD Guiding planes not only essential in removableprosthesis but are equally important in fixed restorations,over denture and implant denture.

Although the term 'guide plane' is used more widely inpartial denture design but the significance of planes andthe concept of guide plane denture is perhaps not fullyappreciated.

A brief introduction to the concept of guiding planesand how to achieve then in various situations is discussedin this presentation.

The glossary defines the guiding planes as "two ormore vertically parallel surfaces of abutment teeth sooriented as to direct the path of placement and removal ofremovable partial denture"

This definition makes the point that guide planesestablish a single and direct path of insertion as a basis onwhich denture may be designed.

Guiding planes presents in natural crown contour orformed by selective grinding of natural crown contour orcontouring of surveyed crown. Guiding planes may becontacted by various components of removal partialdenture.

1) To provide one path of placement and removal.

2) The more vertical walls they are preparedparallel, fewer the possibilities for dislodgement ofprosthesis

3) Guiding plane retention has less potential forcausing supporting structure damage

4) Guiding planes have horizontal bracingcapabilities.

5) To ensure the intended actions of reciprocalstabilizing and retentive components.

6) To minimize deep undercut zones.

GUIDING PLANES - PATHWAY FOR SUCCESS

Dr. Vaishali Bondekar, Prof.Dr. Pranab Kumar Sanyal, Prof., HOD, Dean

Dr. Pravin Badwaik, Reader

Dr. Guruprasad Handal, LecturerDept. of Prosthodontics:Y.C.M.M & R.D.F Dental Collage, Ahmednagar

Prosthodontics

7) To minimize food traps between abutment teethand components and possibility for improved esthetics.

Guiding planes 2 to 3 mm in length is sufficient toachieve during insertion any plane prepared to a muchgreater length interfere with health of the gingivalcervices.

(1) Place the analyzing rod in the surveyor spindle.

(2) Move the tilt-top table, with the cast in positionslightly anteroposteriorly until the spindle contacts theocclusal one third of the proximal surfaces of theproposed abutment teeth. when anterior teeth aremissing, guide planes on either side of the edentulousspace must be given precedence.

Guiding planes should be prepared to be parallel toone another and to the path of insertion as determined bythe surveying stylus. these surfaces very seldom occur

naturally and need to be prepared directly on enamel oron cast or composite restorations.

Mount the diagnostic cast on a tilt table; Position theadjustable table so that occlusal surfaces of the teeth areparallel to the platform Select most desirable tilt to attainparallelism for future guiding planes. Record the surfacewhich needs reduction and relation of the cast to thesurveyor.

Length of the guide plane:-

Locating the guiding planes:-

Preparing guiding planes for removable partial

denture:

Procedure:-


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Determine the relative parallelism of the tooth surfaceby contacting proximal tooth surfaces with surveyorblade.

Alter the cast position anteroposteriorly untilproximal surfaces are in a parallel relation to one another(Fig A and B )

Selecting suitable anteroposterior tilt should toprovide parallel proximal surfaces that may act as guidingplanes.

Differentiation between tooth borne and distalextension removable partial denture as they affect

the choice of guiding plane location:-

Many competent dentists mistakenly believe thatguiding planes are advantageous for every type ofremoval partial denture. Distal extension removablepartial denture present different set of circumstancesthan a total tooth supported removable partial denture.

Tooth borne removable partial dentures aresupported on both ends of the edentulous area by restlocated on prepared tooth surfaces. These rests direct theforces during mastication down the long axis of teethderiving support from the tension on the periodontalligaments. The guiding planes need to be considered inrelation to the forces or actions cause duringdislodgement. The larger the numbers of vertical wallsthat can be made parallel to each other, the more retentivethe removable partial denture. All the forces ofdislodgement will be non destructive in fact these guidingplanes will provide horizontal bracing of teeth involved. Aprecision partial denture is prime example of retention

and bracing that can be provided by guiding planes.

Distal extension removable partial denture should beconsidered different than tooth borne removable partialdentures to the design of prosthesis and associatedpreparation of abutment teeth one end of the denturebase moves more than the other because resiliency of thesoft tissues overlying the bone. This movement can causerapid destruction of periodontal support of the abutmentteeth and dictates a different design of both clapsassembly and the guiding planes.

Guiding planes must be considered with respect to

center of rotation of the removable partial denture andconsequent movement of denture during function, manyof the tooth surfaces used for guiding planes on a toothborn removable partial denture should not be contactedwith distal extension removable partial denture becauseof potential damage to the teeth. This damage can becaused by guiding plates which can in combination withclasp assembly act as levers to lift the teeth occlusally anddistally.

Tooth born removable partial denture:-

Distal extension removable partial dentures:-

Dr. Vaishali Bondekar, et al

With clasp type removable partial denture the contacof distal surface of guiding plates against guiding planeswill move the fulcrums or rotation centers to these pointthus placing the retentive clasp on the opposite side of thefulcrum line and causing possible extrusion of abutmenteeth during function. Any part of the distal surface of anabutment tooth must be free of contact by removable

partial denture during functionally movement. This canbe accomplished by placing a short vertical guiding planon occlusal one third of the tooth and then constructingguiding plate of the removable partial denture so that itsocclusal edge is at the same level as the gingival limit of theprepared guiding plate, because of the convexity of teethmesiodistally guiding plate should not wrap around thedistal surface. The only buccolingual surfaces of anabutment teeth supporting distal extension partiadenture that should have guiding planes are thosesurfaces they are mesial to greatest mesiodistal convexityunless the guiding plates are constructed to immediatelydisengage the tooth during functional compression of th

base.

Guiding planes they are contacted by guiding plateare an important aspect of removable partial denturedesign principal complete vertical contact is beneficial fotooth born removable partial dentures. When distaextension ridges are present complete contact idetrimental. The design should be modified to take intoaccount the different resiliencies of the supportingstructures.

1. Arthur M.L, Angelo L.F

A simplified procedure for survey and design of diagnosticasts. J Prosthetic Dent 1977;37;681

2. MC, crackens: - Removable partial prosthodontics eightedition, 1989

3. O.L Bezzon, M.G.C Mattos, R.F Ribero.Surveying removable partial dentures: the importance oguiding planes and path of insertion for stability J ProsthetiDent 1997:78:413

4. Stewart, Rudd, kuebkerClinical removable partial prosthodontics 1983 .

Summary:-

References:-

66th Indian Dental Conference

KOLKATTAKOLKATTA21st to 24th February 2013

www.idc2013.org.in


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ABSTRACT

INTRODUCTION :

CASE HISTORY :

Nodular fasciitis (NF) a soft tissue lesion mainlycomposed of myofibroblastic cells, is well documented invarious body locations however, in the oral cavity it is rare.

Accurate diagnosis of such lesion is very important assome of these lesions resemble a sarcoma and thispresents a diagnostic challange for the pathologists. Also,clinician should avoid unnecessary and often mutilatingsurgery for the same. Hence, the rare case of nodularfasciitis in the right cheek is reported together with adifferential diagnosis.

Nodular fasciitis is a single, rapidly growing and firmsubcutaneous nodule most commonly over the arm andtrunk and may be characterized as benign reactiveproliferation of fibroblasts.

Initially nodular fasciitis is defined aspesudosarcomatous fibromatosis. It was first reported byKONWALER. KEASBY and KAPLAN in 1955.

Nodular fasciitis is most common in third decade, butmay occur at all age groups.

Males and females are equally affected. It usually

presents as a rapidly growing soft tissue mass, some whattender and fixed structure but with freely movableoverlying skin.

Although cause is unknown, trauma is believed to beimportant. Clinically the lesion present as a rapidlygrowing soft tissue mass, usually of short duration 2-4weeks on average.

The histopathological diagnosis is not so easy becauseit's histopathologic finding having bizarre appearanceand show considerable variations. Because of this nature,nodular fasciitis was infrequently diagnosed asfibrosarcoma and other malignancies in the past.

Therefore, in a view of this aggressive clinical

behaviour of this lesion accurate histopathologicalinvestigation is essential to prevent unnecessary overradical and mutilating surgery.

A 25 years old young female reported to Dept. of OralDiagnosis and Radiology, Government Dental College andHospital Aurangabad, with a complaint of swelling on theright side of the cheek since 2 months.

On clinical examination, medium built young patienthaving a swelling on the right side of the cheek. Extraoral

NODULAR FASCIITIS :

A RARE CASE REPORT

Dr. ,

,

Dr.Vaishali Anil Nandkhedkar Dental Surgeon, Oral Pathology & Microbiology

Dr. Jaishri Sanjay Pagare Assit. Prof., Oral Medicine & RadiologyDept. of Oral Medicine & Radiology Govt.Dental College & Hospital, Aurangabad

examination revealed, a small, oval shape swelling aboutsize (2x2 Cm) on the right cheek. The swelling was fixed tounderlying skin; and consistency of the swelling was firmto hard. Skin over the swelling was normal. There was nosign of any inflammation or sinus tract. In past medicalhistory, patient gave history of trauma to the right cheek 3weeks back. After that lesion gradually increased in size toattempt present size.

On intraoral examination, there was no relevantclinical finding. The associated teeth with swelling werevital and non tender. Radiological examination revealedthe teeth and supporting tissue showed no abnormality.

Routine Haematological examination was normal.Ultrasonography of the lesion was advised to the patient.High frequency probe ultrasonography was done. USGreports suggestive of nodular hypoechoic lesion on the

right cheek, just superior to right mandibular ramus. Noobvious bony erosion.

No definitive diagnosis was made until an incisionalbiopsy was performed under local anaesthesia. Thehistopathological examination revealed as aneurofibroma. But second opinion was taken fromBombay Hospital and Medical Research Center.Histopathological examination, suggests that fragmentsof a spindle cell lesion composed of short spindle cellsarranged in intersecting fascicl and whorls with focal stori

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form pattern. The cells posses, oval, bland appearing,palestaining nudei fair number of mitoses are detected. Theintervening stroma is loose textured and myoxid withmicrocysts containing extravasated RBCs and nucleatedgiant cells. There was no malignancy. Diagnosis wasNODULAR FASCIITIS.

Nodular fasciitis, a soft tissue lesion mainly composedof myofibroblastic cells, is well documented in various bodylocations however in the oral cavity it is rare. Nodularfasciitis is relatively rare and recognized as occuring in thesub-cutaneous tissues of the expremities and trunk6. In

Japan, IWASKI and Enjoji, reported that the percentage oforofacial lesion was 7% of all cases of nodular fasciitis.Thus, it was uncommon in the orofacial region.

Trauma is often cited as a possible aetiology, but thetrue pathogenesis is still unknown2. If trauma is animportant cause then one should expect to see the lesionmore commonly in the oral cavity. Most authors, believethat the lesion represents a reactive or inflammatoryprocess of fibrous connective tissue13.

Nodular fasciitis in the oral cavity, occurs at all ages. Apeak incidence occurs between 30 and 40 years1. Themost common location of oral nodular fasciitis was thebuccal mucosa3.

The tumour is usually a discrete soft tissue mass, somewhat tender and fixed to the subjacent structure but with afreely movable overlying skin. Size varies from 4mm to 4 cmin size. On clinical presentation, the lesion clinicallysimulate anything from an abscess to a neurofibroma1.

Histologically, the appearance of the lesion ischaracteristic and striking, it shows hapazard arrangementof irregular bundles or single fibroblastis in a mucoidmatrix1.

Prince et al, have divided nodular fasciitis into three

DISCUSSION :

histological subtypes. Type-I nodules are moderatecellular with an abundant interestitial ground substancgiving the lesion a distinctly myoxid appearance. Thground substance is most abundant in the pari CellulaCenter with increasing cellularity of periphery of thlesion. Vascularity is prominent, and multinucleated giacells are commonely seen. Type II nodules manifests le

ground substance and tendency toward greatecellularity with less haphazard arrangements of the cellType III nodules are biologically more mature. There increased collagen production with small amount ground substance1.

Histologically features of nodular fasciitis may varconsiderbly, but four features are commonly observed.

I] Spindle shaped fibroblasts that tend to be arranged long fascicles which are slightly curved, whorled or 'shaped.

II] Small clett or slit like space that often separafibroblasts.

III] Few extravasated erythrocytes.

IV] Mucoid interstitial ground substance1.

Nodular fasciitis should be differentiated frofibrosar coma / sarcoma. Because of widhistopathological diversity in nodular fasciitapproxametly 50% cases were misdiagnosed as sarcomor other malignant neoplasm. Another lesion considerefor differential diagnosis is neurofibroma. As both lesionare unencapsulated lesions composed of spindle cellHowever, neurofibroma lacks an inflammatorcomponent and extravasated blood cells frequentencounter in nodular fasciitis.

Fibrous Histiocytoma and Nodular fasciitis are somtime impossible to distinguish, only differentiating poin

is histocyte like cells with abudant cytoplasm which mabe prominent in many fibrous histiocytama but absent nodular fasciitis. Presence of foam cells also another poinwhich favour a diagnosis of fibrous histiocytoma.

Fibromatosis is another group of lesion taking foconsideration as a differential diagnosis. Fibromatosusually clinically infiltrate into the surrounding tissuFibromatosis is lacking the myoxid tissue and granulatiotissue like appearance frequently found in Nodulafasccitis3.

Schawanoma, myofibroma should be distinguishefrom nodular fasciitis mainly n the basis of it's biphaszoing phenomenon that refers to the presence of ligh

staining collagenous hyalinized areas, schawanompresents as a mixture of Antoni Type A & Type B structurwhich is not feature of nodular fasciitis. In additioproliferating capillaries, extravasated red blood cells aninflammatory cells are not typically found is schawanomImmuno histochemical study of S-100 exclude neurtumor.

In summary, nodular fasciitis is a soft tissue lesiomainly composed of myofibroblastic cells. In the orcavity it is very rare. Because of it's histological variation

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in the past it is misdiagnosed as sarcoma or othermalignancies. Accurate diagnosis is important to avoidunnecessary and often mutilating surgery.

It is hoped that this publication will aid inidentification of a reactive lesion, in an alreadydiagnostically challening group, which can be mistakenfor low grade malignancy.

1] Tumour's of Head and Neck - John Batsakis, 2nd edition,William and Wilkins, Batimocel London Page 259-262.

2] Oral Nodular fasciitis - A Case Report -

- D.M.Badia, L.Rossi, A.R.Sorci and M.Riminucei

- Oral Oncology Eur. J. Cancer, 1994.

- Vol. 30 B, No.3, P.P. 221-222.

3] Clinico pathologic correalations of myofibroblastic tumoursof the oral cavity. 1. Nodular fasciitis.

- Dan Dayan, Varda Nasrallah, Marillena Vered

- Journal of oral pathology and medicine vol.34 issue - 7 Page426-435 Agusut - 2005.

4] Oral Nodular Fasciitis

- H.T.Davies, N.Bradley and J.E. Bowerman.

- British Journal of Oral and Maxillofacial Surgery (1989),Vol.27, Page No.147-151.

5] Nodular Fasciitis and Solitary Fibrous tumour of the oralregion - Tumours of fibroblast heterogeneity.

- Lewis R. Eversole, Russel Christene, Ginseeppe Ficarra,Lucina Pierleoni et al.

- Oral surgery, oral medicine, oral pathology oral RadiologyEndodontic 1999

6] Soft tissue tumours.

- Enzinger - Weis SW

- 3rd edition, St.Louis, Mosby, 1995.

7] Nodular fasciitis In : Fletcher CDM Unni KK Mertens, F, eds,

Pathology and genetics, Tumours of Soft Tissue and bone(WHO Classification of Tumours). Evan's H., Bridge J.A.

8] Intravascular fasciites : a case report in an intraoral location

- M.A.Kahn, D.R.Weathers and D.M.Johnson

- Vol.16, No.6, July 1987.

- Journal of Oral Pathogy - Page No.303 - 306.

9] Connective tissue lesions in oral pathology. Clinicalpathologic corelations.

- Regezi J.A., Sclubba J.J., Jordan RCK eds.

- 4th edition, St.Louis : skounders 2003 Page No.164-166.

10] Burket's - Oral Medicine 'Benign Lesions of the oral cavity' -A. ROSS KERR.

- John A. Phelam, 11th edition, chapter No.6 Page No.134-

REFERENCES :

135.

11] Nodular fasciitis of the upper labial fascia:cytometric andultrastructural studies.

- Authors :- Tomonori Kawana, Hijrotsugu yamato, AkiraDeguli, Testuo Oikawa and Hirotusugu

- Int.Journal Oral Maxillofacial Surgery 1986, Vol.15, 464-468.

12] Shater's Text book of oral pathology, Rajendran andShivpath Sundnaram, Elsevier, 6th edition 2009.

13] Lucas's Pathology of Tumour of the oral tissues

- Roderik A. Cawson et al.

- Edition - 5th

- Churchill Livingstone London.

Dr. Vaishali Nandkhedkar, et al

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ABSTRACT:

INTRODUCTION:

CASE REPORT:

The dental treatment of patients with inheritedbleeding disorders has been widely discussed in theliterature with the aim of developing guidelines forcommon procedures.

A factor VIII level of 6% to 50% of normal factor activity(mild hemophilia) is associated with bleeding during

surgery or trauma, 1% to 5% with bleeding after mildinjury and < 1% (severe hemophilia) with spontaneousbleeding.

In patients with hemophilia, transfusion of appropriatefactor to 50-100% of normal levels is recommended when asingle bolus infusion is used in an outpatient setting.Considering usage of an antifibrinolytic agent like epsilonaminocaproic acid (EACA) may be helpful. We arepresenting a case of dentoalveolar trauma treated in apatient with hemophilia A.

Key words: Hemophilia A, Epsilon-aminocaproic acid

Hemophilia A is the most common type of hemophilia.

It is largely an inherited disorder in which one of theproteins needed to form blood clots is missing or reduced.The use of EACA has proved to be an efficient and practicalmethod for treating hemophiliacs who require dentaltreatment. In the past, patients required prolongedhospitalisation and received replacement infusions every12 hours during their stay. This resulted in a large expensebecause of the cost of the material and hospitalization, notto mention the trauma sustained by the patient bothphysically and psychologically. By decreasing the numberof factor infusions, the risk of complications such as thetransmission of hepatitis, allergic reaction and inhibitorformation decreases.

A 48 year old male patient reported to our unit withcomplaining of mobile upper anterior teeth. He gave ahistory of assault with a blow on his face. He also gave afamily history of hemophilia A .

On examination, the upper central & lateral incisorswere significantly mobile with continuous mild bleedingfrom that site. No other soft tissue injuries were noticed onthe face. Since the involved teeth required immobilization ifthey were to be retained and as the patient also insisted onthe same, it was planned to immobilize them with an arch

Therapeutic Role Of Epsilon-aminocaproic

Acid In The Management Of Dentoalveolar Trauma

In Hemophilia A- A Case Report

Dr. Vivek Gurjar, Prof., Dept. of Oral and Maxillofacial SurgeryDr. Minal Gurjar, Reader, Dept. of Periodontics

BVDU Dental College & Hospital, Sangli

Oral Surgery

bar. Based on the family history, routine laboratoryinvestigations for hemophilia were carried out. The locahemophilia unit was contacted , who would be responsiblefor arranging the administration and monitoring otreatment products. The administration of clotting factoconcentrates both before and after the procedure alongwith the use of an antifibrinolytic agent namely EACA (50mg/kg four times a day) was considered. It was decided to

continue the drug for a further period of 4 days postreatment.

We had the patient rinse the mouth with chlorhexidinemouthwash two minutesbefore the administration ofthe local anesthetic. The teethinvolved were immobilizedw i t h a n a r c h b a r a satraumatically as possible andocclusion checked. (fig.1)

The patient was given detailed postoperativinstructions like no mouth rinsing for 24 hours, no smokingfor 24 hours, soft diet f

IDA Maharashtra State Branch Dental Dialogue April-Jun 2012

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