5..
IMPLANT RETAINED
MANDIBULAR
CVERDENTU
A

RE

bstract

ll BriefBackground
Th^eoaim,of this clinical report is to describe the use of a low_ protite.aftachment system to accommodate limited tnterarch

space for a mandibular implant-retatned ovefdenture ll Materials and Methods

A 2-implant-retained overdenture whtch js a compreterv edenturous l,,i.oiffS iiHlilJff

well-accepted mandrbre was

llDiscussion
Discussion deals wjth the methodology of implant placement rnctud-ingfabrication of complete deniure whiii,..,"O.r rurgi_ cal gulde template and other treatment mooalitjes. ll Summary and Conclusions supeorted prosthesis provides an exce ent supporr
J1:lTpla]r

;!:::1:}1#":*'dentuf

e

i'rprant'u*""ii'i.' Ji,iv. r,. ll Key Words

ffJil::Tffr

r-diburar

denrure, imptanr supporred
Man-

t.
Indian Joumal of Dental Sciences.
September 2013 lssue:3, Vol.:5
All rights are reserved

wwwijds.in

Indion Journol

of Dentol Sciences
E

Modified Technique For Artificial Saliva
Reservoirs In Maxillary Denture

P ISSN NO.

0976{003

'Varun Kumar
'Amrinder Sjngh Tuti

'Leena Tomar uaorta Abstrac{
Xerostornia is a relalively common complaint lhalcan make the weanng of complete dentures very uncomfortable for affected individuals. to help overcohe this problem,

a number

ol techniques have been proposed for incorporating ,es"rvoi'.i,
5"i"".v
dentures. These have had varying degrees ot siccess. This anicte orEseni"l'"1."?o"n patrent suflering trom Xerostomii wh-o was successfu y rreated w,ff, n"*lo,i-oii'u!".on
", " denlure "

i;ntii;;!

iri"irir,"",t"

Key Words
Artificial, Saliva, Maxillery Xe.ostomia

Irtroduction
Xcrosromia is the dryness ofmouth from

tmotanrotootr

ondehcel oerJ s & tmptantotogy.

MaU'u.a,Uttar Pradesh, India
Email dNarun_smite@yahoo.co l\robile: 09719041000

tndividuals. To help overcome this problem, number of techniques have

In

submisslon i 3"June 2012
Acceptod | 23"Juty 2013

incorporating

for

reservoirs containing salivary substitutcs increased b lood pressurc,
Into dentures uith varying degrees of osteoarthritis, and non-insulin dependent diabetes mellitu$ Patienrs pasi dental history rcvcalcd that shc had many scts ol maxillary ancl mandihular denrurcs mad" in lecent ycaru but was always unable to wear the denture due to constant wearing dentures a com mon irritation. Patient's mouth was nored to be conrplaint.r'l Depending upon the cause, a very dry with cracks at the corner of tne vanety ol rreatlnent options areavailabre mouth.After a number of unsuccessful
!o the clinician. In medication induced adjustments to the existing dentures. rt Xerostomia - discussion with a patient's was decided to conslruct a new set of general medical pracdtioner. In severe maxillary and mandibular dentures.sircc
Xerostomic cases - Saliva substitutes or the patieut was suffering from salivary srimulants, Soft denturc liners Xerostomia a decision was iradc ro can be qiven.r'rl'l In cases where all incorporate a salivaly reservoil in the treatment modalities have oroven new dentures. Durrng this proccss, the unsucccssful, rhc incoryoratio; into patient's physician was also contactcd dentures of resewoirs containing saliva and the mcdicar.ions were reduced to alter subsdrure. has been proposed.r'll',r" This to tryand rcduce rhe hypo s0livation. anrcle presents a case ot a patient suffenng from Xerostomia who was Proccdurc successfully treatcd with a new form of Clinicallv, primary ard secondary res€rvolr in maxrllary denfure rvherc rmpression wasrnade in lhe normar

T}rs modified netv technique resulted in a denturE rhat prof ided good lubrication

I

A lmplanlology,
Kalka Dentat Cottege, Meerut

dentures very unconrfortable for affect€d

o{hcr rreatrnenr modalities had failed.

K.D Dentsl Cotlege. Mathu

'Reader, Dsol, Ot penodonlrca
HimachalDent Co ege.Sundemaoar
'Proress-r. DeD Ot prosrhodonl,cs C tmpta"totog,.
D.J College Ot enta, Soences A Research -

also.lTllsrter

swallowing elc. It also makes wearing ol

for

'Reade( Oept. Of P.osthodonr,cs

ofthe oral tissues. was easily cleaned by the wearer and was produced fronr

oral and oropharyngeal functions AD forty-five year old female was rnc luding eating. speaking and rcfcrred to rhe
Dcpartmcnt o

been proposed

'Saraswati Rana
'Himanshu Shekhawat

'Assrstant P.ofessor

lack of normal secretions. patient routine denture materials s!ffering ftom Xerostomia Dot only has dry mouth but also difficulty In normal Case Report

Ebfur lqrnal

ISSN NO.223r-2293

manner The

nta x

illa

- nr an d

relationship was recorded

ibtr la

with

mandible in retnrded position and

r

thc an ot DentalSciences. (September 2013Issue:3, Vot.:5) All mghts are reserved.

Quick Response Code

acceptable frecway spacc. Thc nrodels

were then articulated rn the normal way and the teelh sel up for tty in. After try in ot the setup the reservoir was conslructed 2mm rhick Inodelljng wax

was adapted over rhe entire palatal surface of the nraxillaly denture
(Fig,l).The center. of palatal wax

wasthen removed. A rrnr ofwax rvas left on thc pcliphcry to lotm thc lescrvorr

(Fig.2). The asscmbly was processed w(h heat cured acrylic resi|l (Fig..l).
Alicl lhc deflasking and polishing procedures were completed, wax was

poured inro thc reservorr space (Fig.4). rnc scparattng mcdrum was applicd on the wax. another layer

ofwax wis added

on the previous layer and a lid

was

made(Fig.s) This second layer ofwax

DR BABITA MEENA- DR PALVI KAPOOR* DR HIMANSHU SHEKHAWAT*-

ABSTRACT
Naturalmicronora in the oralcavity become establlshed du.ing chlldhood and th6h changolhroughoutthestagas oflife und€r the infuonco ofvanous envhontnental and behevioral factors. lflhe prolile of microbial communities is altered, pathogenicactivity lr|ay be exhibited, resulting in dentalcaries or periodontal disease Furthemore, recent sludies havg demonslrated lhat microorganisms in clental plaques can play an etiologrcal role in syslem|c diseases such as diabetes and atherosclerosis. Oental plaque is now recognjzed as a cohptex mrcrobial biofitm consisting of over 600 djflerenl baclerial species in the human oralc€vity, Previous microbiological studtes based on tradrtional culture melhods did not accuratelyeslimate microbial conlenl ofbiofilms due to the exrstence ofmany uhcultivatable microorganislns Recentadvahces in molecular microbiological techhiques havethus demonstrated that oralmrqollora are moroComplexand diverse than hltherto envisaged This anicle presents an Overvie\N of oral microllora, with an esp€clalfocus on roles in oraland syslemicheallh,
Key words ; Microllord, biolilms

INTRODUCTION

rhrcroorganisms and some ol these witl become established as pad of

The mouth harbours many microorganjsms is an ecosystem of considerable cohplexity, lhal has not been fully investigated yet and is
{ar

tom completely understood Recenlly the mouth was regarded

as a

single habitant for microorganisms but it is how reatized that the teeth,

grngval crevice, tongu€, olher mucosal surfaces ahd saliva all frcm drnerdnl hebitral or sires when microorgenisms multipty Each habitat contains rts characteristc population with many difte.ent microbial species Bacteria are the most predominant type of microorganrsms presenl h

h

uman o.al cavily Mo.e lhan 30 gene.a of bacteria have been

delected In human mouth 25 ofwhich are regular members olthe oral nora These belong Io both aerobic and anaerobic groups of bacteria

Baclena present in lhe oralcavity are both gram +ve and gram

avc€ge 750 million microorganjsms are presenl

in each

-v€

mlotsaliva

On

",

DEVELOPMENT OF THE ORAL FLORA
The dMtded inlo

1
2
3. tl '1.

4categaies

toteeth and changes jn the dtel the overalt properlres otorganisms jn lhe moulh will change. Actinomycetes, tactobeci i and Rothia are tuned regulady" 3.Adolescence
The greatesl increase in number of organisms in lhe mouth occurswhen

the permanent teeth erupl These teeth have deep tssues in their surlaces interproximal spaces are much larger in lh€se In d€ciduous denlilion The gingival c.evice is deeper than in deciduous teeth and allows for'a greal increase in anaerobtc organisms, Bacleroids spp

in targe nu.nb€r as we as leplofrichia spp, lusobaclerium spp and spirocheies The lesion of denlat caries wtll creale a new involvernent for organisms especially streplococci will become eslablished

lurnish

4.Adulthood
Inlancyand early child hood
Varying amount of dentat plaque may be presenl and the degree of

Adolescence

chronrc periodonrat disease atso govern the numb€r and typBs ol microorganisms found, Carious lesron and unsalsfactory restoralion

Adullhood

ginh: the mouth of ihe futt term foetus is usually gterite although

may be rsolaled eitherwith colitumns tactobaci i, bacillus spp, neisseria spp anC yeasts Streptococcus salivarious is the most common isolate riom the mouth olyoung babies and togetherwith staphytococcus albus
Occ€sionallycandida albicans muttiply.apidtyin the mouth and in tow pH rl p.evenls lhe noamal groMh ol other commensals and overorowth of yeasLs produceswhat is known

asoralthrush',

Infancy and early child hood

]e

lhe appearance of streplococcus sanguis and mulants Wilh increasing

Arbirrh

organisms lltt|ch areonly transientmay be aquiredfrom molherand atso frorn envrronment Several streptococcal end staphylococcal species

2.

commensal llora of the individuatThe eruption ot deciduous teerh provdes a different surface lor microbial attachment characlerized by

infants comes rnto contactwilh an everincreasing rangeof

provide environm ent for bacteria.

Th

ere is increase in bacteroids spp and

spfochetes superfaoal plaque contains many sreptococci moslly slreplococcus mutans, mitior and sanguis Aclinomyceles are atso regularly isolated Edentutous patients harbour few spirochetes or bacleriods bul their caniage ot yeasts increases yeasts are hormally found in lhe dorsum

oflongue Oenlure provide proveo envronmenl

In

which yeasts can multipty"

Benefits of oral mlcroflora
The benellcial aspecls of residenr microbial llora ot orat cavily tor the hostincludes 1 Supplyof cerlain nutients

.SENIOR RESIDENT *SENIOR
LECTURER *POST GMDUATE STUDENT
D€PTT. Of COIISERVATIVE, FACULTY OF OENTALSCIENCES, CSMMU, LUCKNOW U,P.'DEPTT.
OF ORAL & MAXILLOFACIAL SURGERYh
DASIESII IXIiTITUTE OF RESEARCH AND DENTAL SCIEIICES. FARIDKOT, DEPTT. OF PROSTHODONTICS,
DJ DEI{TAL COLLEGE , MODINAGAR-

ll.
Volume'1. lssue

DR PALVI KAPOOR' DR BABITA MEENA* DR HIMANSHU SHEKHAWAT*- DR. HARMEET
DR
KAPOOR-

SINGH*"

ABSTRACT
Osseoinlegralion is becoming increasingty routine inthe rehabililation ofpartially orfully edenlulouspatients. However, the surrounding tissues may besubjecl to infammatory conditions simi16r toperiodontal

d

isease and so roquire maintenance

This arlicle discusses the background, aetiologydiagnosis ofperi-implanl diseases! and lhemaintenance, care and trealment of peri-imptantinteclion in osseointegrated implants.

KQyleolds. Osseointegration, peri-implant mucositis, periimplantitis.

INTRODUCTION
The provisron of implant retarnecl prostheses is becomrng more and more common In lhe lasl 30 years over 700 000 palents have be€n

increasing number of sludies suggest thal anaerobic plaque bacteria may have an adverse eflecl on pen-rmplant ttssue h ealth 'As soon as an rmplanl rs exposed lo lh€ oral cavtty plaque wrlt form on rts surtace The

treated using lhe Br6nemalk system alone (Nobel Biocare, persoral

process may be identical lo that seen on leeth, wilh

cornmunicalion, 2003).The hrgh survival rateof osseointegrated den!al

pellrcle and subsequent m/crobtal colonizatton In edentulous pa ents

implants is well documented, but it is becoming increasingty clear that

colonizalron of the peri-implant sulcus originar€s from the microflora lound in saliva 5The organisms associatedwilh mucosilis are verystmilar

successfully Integraled implants are susceplible lo disease condilions

lhat may lead ro the loss of lhe implant Alrhough placement and restoralion are usuallV lhe field ofthe Deriodontal. oraland maxillofacial surgery or prostheticspecralist, given the increasing numbers ol patients

treated wilh osseointegrated fixtures

il

he

formation ol

lo thal of gingivilis and,unsurprisingly thai of perrrmplantitis is very similartolhal seen in pe.iodontilis

Expernlenlally induced peri-inrplanlrt s was induced in palients

srx

rs increasingly likely thal

monlhsafterabutrnenl conneclion in lwostage imptants byasking these

mainlenance ofth€se rmplants wrllbecome much more common by the generaldentist lmplantconrplicalions can be due to a numberofcauses

subjecls lo refraintrom oral hygiene procedures for th.ee weeks "rAs a

including prosthesis instability, implant mobllity, occtusat tBuma

lncreased 6rou nd the implants and alsolhe le€ th in a similar way

lraclured conrponenls, parn, Inflammation, infection

and

lhe accumulalion of plaque around implants can lead to pea-rmplanl

neuropathy.rFailure olimplants may be described as eadyor late Earty failure follows shorlly after placemont and osseolntegration is never

mucosils lJsing dark-field mrcroscopy lo analyze plaque safiples

result of plaque accumLrlation gingival Indices

a d probing

deplhs
H

ence

collected, the percentage ofcoccoid cells, motile rods and spirochaetes

really achieved Late failure occurs In a successtully Integrared rmptant

kom the pen mplantmucositis srtes was very srmrbr ro that from the

lime afler placement and subsequenl restoration. The causes of late failure may be marginal inlection/disease or biomechanical

gingivilis sites-r

ovedoad However, an analysts of the clinical trials ot lhe lTl system

was sludied in a beagle dog model' Comparisons of successful and failing rmplants have shown differences In the composition ol the

some

reveals Lhal avery smallproportion oflailuresseem lo be associated wilh

In

terestingly, lhe innammatory Infiltra te wes ot equat srze

to adjacent conlrolleelh and to implanls when de noyo plaque formation

occlusal ovedoad 'From this analysis lhe maior cause of late failures could be altribuled to pei-implant inleclons tt was noted that palienrs

associated

wilh good oral hygiene tended lo keep implants longer The aim of this

numbersof Gram negative anaerobes'!

paper is lo discuss the implant associared diseases

maintenanceandtrealrnenlolosseointegrated

their

diagnosis,

lixtures

AETIOLOGY

Acli

no b ac illu s act ino

mycele tnco mi

I

a n

s.

Potphyrcmonasgingivalis Fusobacterium

P

rc vo

I

e

I

la

i

D

te. n

e d

t

a

spectes Campylobactel

all been assodated with failing implants ' These oeanisms and Treponemadenlicolahaw been foLrnd al pen-implanlitis siles 'lnsummary, ilappears thalthe perirmptanl trssue is colonrzed by fecl{rs have

Peri-implant Inleclrons are generally classiiied as peri-implant rh!cositis and perirmplantitis depending on lhe severity 'Peri-rmpla nt mucositis is

intlammatory reaction in lhe sofl lissues sufiounding an implanr rPeri'implantitis is an inflam matory reaction wilh

delined

llora Successful implants were sparsely colonized bycram

positrve cocci, compared to failing implants siles, whrch contained large

as afeversible

thesame flora as lhe periodontium and lhsl disease ofthislissue

is

similar to gingivilis or periodonlilrs

lossofsupporting bone in the lissues sunounding an iniplant An
LECTURER HSENIOR RESIDENT *POST GRADUATE STUDENT '"LECTURER
OEPTT. OF ORAL & MAXILLOFACIAL SURGERY, DASMESH INSTITUTE OF RESEARCH AND DENTAL SCIENCES.
DEPTT. OF CONSERVATIVE, FACULry OF DENTAL SCIENCES, CS.,MU, LUCKNOW U.P.*
DEPTT. OF PROSTHODONTICS, DJ DENTAL COLLEGE. MODINAGAR
.SENIOR

FARIDKOT"""

very

l\tBFLIDJ. Volume

2

Number

2

160

October' 2011

KAPOOR DHEERAJ.
GUPTA ARUN,
MEENA BABITA'
SHEKHAWAT HIMANSHU"

MAXILLOFACIAL PROSTHETIC
MATERIALS - THEN, NOW BEYOND

'Senior Lecluref
' Direclor PG Sludres,
Professor & Head
' Senror Residenl

' Post Graduate St!denl

AASTRACT

Itatenals used in maxillafacial proslhelics encompass a wide mnge

of

chemical stuclures Phystcal

Add re s s for

-..ofenenrs loward

.+ lFe

rs and

the tdeal

elaslomerc

Key Words; Maxlllofacial

w

resull from molecular

[,4atenal, p otyetherurclhanas.

C

oft e sqoncle n c e :

Dr. DHEERAJ KAPOOR

modilicalions

seniorLecturer
Deperlment of Proslhodonlics

vutcanu"

P""ffih

-

Institute of Research & Denlal sciences'

nineteenth century, vulcanite was used an artillcial nose made from gold
INTRODUCTION:
Forgetand r:he early part of the 20^ century. introduced in prosthodontics and to replace his own nose. Dr a sectional
Verschuylen fabncated dunng and shortlY after maxillofacial prosthetics and replaced l\.4r. mask in silver for a soldter who
=specrally I, prosthetic restoralions most of the earlier materials. Gelatin Facial

,',olo War third of face in war. Pierre nere made through collabration of gelatin glycerin compound (by hennig) lost lower (1678-1761) the father of was developed and was widely used to Fauchard aen'!s:s and plastrc surgeons. Even during and after the llrst world war The modern scientificdentistryfabricated
'jrtc '953. proslhetic reconstruction of most common materials currently in maxillofacial prostheses in heac and neck defects was largely of intra and papier-mache and silverDr. William
^e! ected by the dental professions. use tor the fabrication polymerlc in Morton (1819-1868), who rs famous for year when a group of extraoral prostheses are
]'-a: was the nature. These include vinyl chloride developing anesthetics, fabricated a
: e.lrsl s founded the American out of porcelain and lvlaxillof cial polymers, acrylic copolymersheaF nasal prosthesisthe exact color of and
A:ademy of the enameled it to t'os:hetics With the contlnous frnally silicone rubbers. both rubber was type and the of maxillofacial vulcanizingvulcanization (RTV)room patient's face. VulcanizedGoodyea|n ac!a.cement Charles type :'.s:Fetics. the American Denta temperature describes the matenals discovered by , Upham, a Boston
In 1901
1851 .
\ssaiation s has now recognlzed this This arlicle dentrst described lhe use of s:e.alry. Today almost all Pahents used in constructing maxillofacial vulcanized rubber to fabricate facial prosthetic devices for special clinical
,., :- oralorfacialdefecls are referred to prostheses Following the use of
:e!-: s:s for the construction of situation.' prevulcanized latex in 1930s, acrylic
-rax ilcfacial prostheses. Having H'STORY
The flrst historical report of facia resin became available to the dental
-':9'Jone sorre evolutionary change, profession in the early 1940s. In 1960
:.e p4.ciples concepts and practlces prostheses appeared during the fourth silicone was developed by Dow corning prosthodonlic lreatment Egyptian dynasty (2613 BC -24948C). a:r aable to s:i :f,nsitLrte the fundamental basls Excavation of tombs from this period company. George Barnhart, a tecnniLian Introduced
'l!' souncj maxrllofacial prosthetic revealed evidence o[ ocular, nasal, maxillofacralthe field of Maxillofacial prostheses. silicones to orbital and a auricular
!.e.a9Y
r.ta.)' recent developments in polymer During the Greek & Roman Pefiod Prosthodonlics. In 1970, Gonzalez the use of Polyurelhane
'esea.ch and in the fabrication of (1000 BC) facial masks were described1990- Lontz - modilied have Permitted the constructed in a gold and silver. .1970 to accliances Polysiloxane elastomers. Lewis &
(15'10-ax 3'3c'al crosthodontist to restore Ambrose Parethe firsl 1590) appears to Castleberry introduced Siphenylenes to tabrlcation of
:.:e ^r'.:ers of such People to have been and Udagama & Dlane used Silastic sa: e:-, :'mlve 'nan used slone. nasal and auricular prosthesis using medrcal adhesive 1990 to
Presentglued
n::: :-- cclon- to obturate the gold. srlver. paper and Inen cloth
Antonocci & Stansberry- new
-:Ae':s:^e e!'a ci:he together. Tycho Brahe (1 546- 1601 )
::'=::
:

l?.
BFUDJ, Volume

2

Nwnber

2

Octobea

20ll

133

DENTAL IMPLANT
MATERIALS

KAPOOR PALVI
MEENA BABITA'
SINGH S.V.3
SHEKHAWAT HIMANSHU'

' Senior Lecturer

'Senior Resident
J

Prot. & Head

ABSIRACT

AddrEss

Io r

Cor€sqondenc e :

Dr. PALVI KAPOOR
Keywotds.'

Department ot Maxittofacial Suroerv
'
Dashesh Institule of Research
& Oontal Sciences, Faridkol

-

tmpt€nfl ilanium

INTRODUCTION:

METALSANDALLOYS

Materials used for the fabrication of Titanium and Titanium.6 Aluminumdental implants can be categorized in 2 4Vanadium (Ti-6Al-4V) different ways. From a fundamental
Titanium Metallic element, Ti. Atomic chemical point of view dental implants number 22, atomic mass 47.90, density fall into 1 of the following 3 primary 4.54 g/cm3 and melting point 1,668.C. groups: ( 1 ) metals, (2) ceramics, and
Similar colour steel. Relativelv
(3)polymers. Inaddition, biomaterials common in the earth's crust. In alloyei can be classified based on the type of form, tiianium is being used biologic response theyelicit when increasingly in the ceramic, aircrafr and implanted and the long-term interaction aerospace industries. lts

lo

that develops with the host tissue. biocompatjblepropertiesenableittobe used in prostheses inserted during

Three majortypes of biodynamic aclivity have been reported:
(1 ) biotolerant, (2) bioinert, and
(3) bioactive (Table 1).
Biotolerant materials are those that are not necessarily rejecled when

surgery. The ability oftitanium to establish direct contact with bone tissue iswell-documented.
This reactive group of metals and

is one important property consideration

related to the use of titanium tor dental implants.Titanium is the the material of choice because ofits inert and biocompatible nature Daired with excellent resistance to corrosion. lltanium shows a relativelylow modulus ofelasticity and tensile strength when compared with most other alloys. The modulus of elasticltv of titanium is 5 times greater than thai of compact bone, and this property places emphasis on the importance of

design in the proper distribution of mechanical stress transfers."T

TITANIUM.ALUMINUM
UANADIUM.

alloys (with primary elements from It is the most commonly used alloy of implanted into living tissue, but are reactive group metallic substances) titanium The wrought alloy condition is sunounded by a fibrous layer in the formtenacious oxides in airor approximately 6 times stronger than form of a capsule. Bioinen materjals oxygenated solutions. Itanium (I)

allow close apposition of bone on therr oxidizes (passivates) upon contact sudace, leading to contact with room temperature air and normal osleogenesis. Bioactive materials also tissue fluids. This reactivity is favorable allow the formation of new bone onto for dental implant devices. In the theirsurface, but ion exchange with absence of interfacial motion or host Ussue leads to the formation of a adverse environmental conditions, this chemical bond along the interface passivated (oxidized) surface condition
(bonding osteogenesis). Bioinert and minimizes biocorrosion phenomena. In bioactive materials are also called situations where the implant would be

compact bone and therebyaffords more opportunities for designs with

thinner sections (e.9., plateaus. thin

interconnecting regions implant-toabutment connection screw housing, irregular scaffolds, porosites). The

modulus of elasticity of the alloy is slightly greater than that of titaniun being about 5.6 times lhat of comDacr

bone. The alloy and the primary osteoconductive, meaning that they placed within a closely fihing receptor element (li) both have titanium oxide can actas scaffolds allowing bone site in bone,

groMh on their surfaces,''

areasscratched or

abraded during placement would repassivate in vlvo. This characteristic

(passivated) surfaces. The possible influences of aluminum and vanadium biodegradation products on local and

2q
Int Poster J Dent Oral Med 2012, Vol 14 No 4, Poster 629

Prosthetic Reincarnation
Restoring t€Gth in god's own way
Languag€: English
Authors:
Mukesh Hasija, MDS,
King George Medical University, Faculty of Dental Sciences, New Delhi, India
Assist. Prof. Himanshu Shekhawat, MDS,
Kalka Dental College, Meerut, Uttar Pradesh, India
Prof. K. K. Wadhwani, MDS,
King George Medical College, Lucknow, Uttar Pradesh, India
Assist. Prof. Babita Meena, MDS,
Jamia Milia Islamia University, New Delhi, india
Deepri Wadhwa, pg student,
Dr. Ziauddin Ahmad Dental College, Aligarh Muslim University, Allgarh, India

Date/Event,/venue:
9- 12 december 2010

2sthFODI & 18th IES natinal conference, chennnai
India

lst table top presentatlon

lntrodu€tion
Fragment reattachment using natural teeth is a technique known as "Blologlcal Restoration" and provldes excellent results regarding surface smoothness, esthetics. Several authors have suggested the use of natural teeth fragments as an efflcient method for restoring fractured anterior teeth. The combination of dental fraqments, adhesives, and restorative materials that are commercially available today provides a good functional and esthetic result, connecting these properties within an alternative treatment in the restoration of extensively damaged fractured teeth.

Fig. 1: Fractured extracted central incisor

Fig. 2: Mesio-distal sections of ext.acted teeth for biological post and core p.eparation

21 lnlr|n{riot|:rl lorr|nal ol l nhirnccd l.lercarch in }lcdrcincs c\. I)cnlrrt( l|r(.. lss\: 2.1-l() ligrt
Vol. I lssue 5, July-2014, pp: (l-8), Available online at: www.erpublications.com

igh-dose intrar,enolls

vitallin C as an

Anticancer Agenl - A Literature Revicu,
Dr. Shikha Nandalr, Dr. Panka.i Ghalaurr. Dr. Himanshu Shekharvat3. Dr. prila Nagara
l)r. Ilagini Ghalauti. Dr. Babita 4cena,'

lbstr4ct: Ascorbate (vitrmin C) is a cofactor for a number of meaabolic enzymes rnd is an indisputable ritlmin c for humans. Howcver, the potential ofascorbate as an anticarccr sgert hrs

essential be€n a topic ofcontroversy, A

rumbcr ofprevious reports have addressed_boah positive rspects and tirnitati-ons ofascorbate ln tbb r'vi€8, w€ briefly summsrize the potential antitumor efficts ofoscorbat€ and its prospccts

irr"r"py. rn

for""n* use. clinical Kcpords: Ascorbate, rscorbic acid, vitamin C, cancer, inaravenous, cytotoxicity, antioxidrnt,

INTRODUCTION
Vitamin

c

is also kno$n as L-ascorbic acid or as sodium L-ascorbate. The richest natural sources ol-\ ilamin C are fiuits

r D_glucose or

D_

uircd fbr ascorbic

I supptemenl in

a

J:T::ffitJil;:l-

lled thrcugh intestinat absorprion.,' stration is used to achieve pharmacologic doses.

n eineirar. buccar mucosa. rabiar mucosa. and hard

prate.

l'cancer. l hc) arc located in are sometimcs preceded by ral squanrous ccll carcinoma accounls lor around 40olo of y occur on the posterior-lateral border and ventral surf-accs

common intraoral location Less common sites include the

In the e-onrerr oicancer- high-dose inrrarenous vitamin C (> tissue. b)

+1.ro\icir) lbr carcer cells. bul not lbr normal

i'r.en d t-or renal disease and glucose 6-phosphate dehyd iarerul nrcniroring ofthe parienr. Vitamin C might reduce
Vitamin C is sell knorr n for its antio\idanr activit), although it is only one of a large variety ol.dierarv antioxioanrs.
\iEmin c hai been \\ell documentcd to reduce the incidenie ofmost malignancies i-" rr".u"t 1 wh"r ir";;;;; h"11,' jctra:ed is rrhether \itamin c has an) therapeutic effect in thc treatment ol'cancer. In the 1950s. vitamin

c

"", ".igi"iiij
Page

|

|

.

>,*
VOLUME

2 ISSUf, I.

JANI AR} - MARCH 2OI4

-AREVIEW
*Dr. Shikha Nandal **Dn Himamhu Shekhbwat ***Dr. Pankaj Ghalaut ****Dr. Babita Me€na

***** Dr

Shamim Anjum

Prosthodontics, Senior Lecturer' P.oslhodontics, Senior l-€cturer
Depaftment ofConservarive Dentistry and Endodontics,Jamia

'1

Proslhodonlid, Asst Professo( PGIDS Rohtok*1a

M[ia blamia,Delhi"'*

Department ofConservative Dentisty

and Endodontic6, Govenunent Dental College,Jaammu.

ABSTRACT
Peri-implantitis is defined as an inflammatory reaction with loss of supponing bone in the tissues surrounding a

functioning implant. Ditrerent iechniques have b€en used for the treatment of peri-implant defects. The infection around an implant is Eeated during mechanical instrumentation wher hard and soft deposits on the surfaces are removed. Recently, several studies implicate that conventional mechanical treatment fails to completely remove the bacteria and calculus deposits, Due to the insufficiency

of

mechanical treatment, laser has b€€n introduc€d as an

altemative or adjunctive treatment. This article presents a literature review ofthe use of lasers: - diode laser, Er:YAG laser, Nd:YAG las€r and CO2 laserin the management ofperi-implantitis

KEYWORDS:

Laser.

Nd:YAG. Er:YAG. Diode. CO2. Per-imDlantitis.

INTRODUCTION:
Peri-implantitis is an infectious inflammatory diseasc associated with bleeding, suppuration and the loss of

supporting bone around n[ctioning oss€ointegratedimplants. The etiopathogenesis of peri-implantitis is complex and related to a variety of factors that affect the peri-implant environment. Peri-implantitis c€n be influenced by three factors:

l.

Patient-related factors including systemic diseases (e.g, diabtes, osteoporosis) and prior dental history (periodontitis)

2.

Social factors such as inadequate oral hygiene, smoking and drug abuse

3.

Parafunctional habits (bruxism and malocclusion

In addition to the above, iatrogenic factors such as faulty restorations, cement left following restoration delivery, and,/or loose components can also play a

significant role

in the development of

peri-

implantitis.
The presence of gram-negative anaerobic biofilm on

the implant surface has been implicated in etiology of

peri-implantitis. Implants

with

the

p€ri-

implantitis reveal complex micro-biota encompassing conventional periodontal pathogansr. In addition to

the dark pigmented, gram-negative anaerobic rods,

other bacterial species are associated with peri-

implant infections e.g Bacteroides fors)4hus,
Fusobactrium nucleatum, Campylobacter,
Peptostreptococcus

micros and

Prevotella

intermediar.

Dentislry has changed tremendously over the pas decade to the benefit

of both the clinician and

the

VOLUME 2 ISSUE I, JANUARY. MARCH 2OI4

FLABBY RJDGES: A CASE REPORT
*Dr. Shikha Nandal **Dr. Babita Meena ***Dr. Himanshu Shekhawat
****Dr. Pankaj Ghalaut
Depanment of Prosthodontics, Senior Lecturer, PCIDS Rohtak+ Assistant Professor, Department ofconservative

Mllia Islamia,Delhiri Department of Prosthodontics, Senior Lectuerir* Department

deDlistry and endodontics,Jamra o f Prosthodontics, Asst. professor. pGIDS Rohtak+rr1

ABSTRACT
The presence of displaceable denture-bearing tissues often presents a difficulty when making complete dentures. unless managed appropriately, such'flabby ridges' adversely affect the support, retention and

stability of complete dentures. Many impression techniques have been proposed to help overcome thts ditliculty. while these vary in approach, they are similar in their complexity, are often quite timeconsuming to perfbrm, and rely on materials not commonly in use in contemporary general dental

3:

practice. This article describes an impression technique for flabby ridges.

KEYWORDS:

Flabby Ridges, window Techn ique, tmpression ptasrer.

INTRODUCTION

; 3c
; gE
; E:
5*

I

A "tlabby'

Lissue

is an excessively mobile

tissue,I

Published studies indicate that the prevalence

of

maxillary complete denture, He suggested the term
'combination syndrome for this condition.

flabby ridges can vary, occurring in up to 24o/o of

A

edentate maxillae and in

circumvent the difliculty of making a denture to rest

5olo

ofedentate mandibles2.r.

in maxilla were a feature of the
Historically, flabby ridges found

the

anterior

combination

variety

of

techniques have been suggested to

on a flabby ridge. It has been stated that while the

flabby ridge may provide poor retention

for

a

syndrome.a's

denturg it is berter than no ridge

The performance of a complete denture is often a

following surgical excision ofthe flabby tissues.t0

reflection of its support and retention.6 Displaceable,

the flabby tissuc is compressed during conventional

or'flabby ridges', present a particular difiiculty

impression making,

may give rise to complaints

of pain or

and

looseness

relating to a complete denture that rests on them.7

described

as could occur

it will later tend to recoil

If

and

dislodge the resulting overlying denture.T Clearly, an impression teohnique is required which will compress

in

1970, and

an impression technique fbr

maxillary

Watsonr discussed this phenomenon

-

the non-flabby tissues to obtain optimal support, and, at the same time, will not displace the flabby tissues.

tibrous ridges. Further discussion was reported by

Liddlelowrr described

Kellye in 1972, when he described changes caused by

separate impression materials are used in a custom

a mandibular removable partial denture opposing

tray (using'plaster of Paris' over the flabbv tissues-

a

a

technique wh€reby two

E:/Baba Farid University/Dental Journal/2014/REVIEW/Dr. Dheeraj.cdr 28.03.14

BFUDJ, Volume 5, Number 1, Feb., 2014

81

REVIEW
A REVIEW OF OCCLUSAL CONSIDERATION IN
IMPLANT SUPPORTED PROSTHESIS

1

KAPOOR DHEERAJ
2
SHEKHAWAT HIMANSHU
3
MEENA BABITA
NANDAL SHIKHA4
ANJUM SHAMIM5
1

Reader
Demonstrator
Assistant Professor
4
Demonstrator
5
Registrar
2
3

Address for Correspondence :

DR. DHEERAJ KAPOOR
Reader, Department of Prosthodontics and
Implantology, National Dental College,
Derabassi, Punjab, India.
E-mail: drdheerajk@gmail.com

INTRODUCTION
In addressing the subject of oral implantology our must consider not only the surgical phase of placing the implant but also the prosthodontic rehabilitative, procedures.
The choice of an occlusal schema for implant-supported prosthesis is broad and controversial. Whether the selected implant is endosseous, subperiosteal or transosseous, proper understanding and application of sound prosthodontic principles in the selection, placement and restorative phases are prerequisite to successful implant therapy. Thus long-term success depend on several factors like proper selection of patient and implant, aseptic and a traumatic surgical procedures, adequate no load healing period, correct prosthodontic reconstruction and proper follow up care.
So accurate occlusion is essential to the long-term success of implant treatment, thus.1
“Implants cannot bail out our faulty occlusion”
Occlusion must be considered in three major areas, it
1. Occlusal determinants
2. Occlusal forces and their transmission to supporting tissues. 3. Occlusal design and materials.
1. Occlusal determinants:
Occlusion must be viewed as a dynamic function of the stomatognathic system rather than as a static intercuspal position. - Gradual reduction in face height (WO),
- Changes in the maxillomandibular relation,
The presence of temperomandibular dysfunction are important occlusal deviations seen in implant candidates. There problems must be properly diagnosed and addressed in the treatment and laying phase.
The occlusal determinants may be classified as denture occlusion, TMJ's and the neuromuscular mechanism.
Established dental occlusion
Temperomandibular Joints Neuromuscular mechanism. In order to provide physiologic occlusion for implant patients, the dentist should perform occlusal assessment and diagnosis prior to the restorative phase of treatment, and even prior to implant selection and placement.
2. Occlusal forces and their transmission to supporting tissues :

Transmission and distribution of stresses to implant supporting structures depend on the magnitude, direction and duration of the applied occlusal loads.
One of the principle objectives in implant prosthodontics is reduction of occlusal loads and accordingly reduction of transmitted stresses to the supporting osseous structure.
The initial reversible signs and symptoms of trauma on natural teeth do not occur with endosteal implants.
An absence of soft tissue interface between the implant body and bone results with greatest magnitude of force localized around the implant bone region, leading to loss of crestal bone around the implant which results in loss of support to implant increased sulcus pocket depth.
So unless the density of bone increases or the amount or duration of force decreases, the condition will progress and even accelerate until implant less occurs. Thus elements to decreased crestal bone forces are implemented in occlusal design of the prosthesis.
The primary forces of occlusion should be directed to the long axis of the implant body, not the abutment post.
Wherever possible implant bodies should be primarily submitted to the vertical component of the occlusal load.
Horizontal or lateral forces magnify the amount of compressive and tensile stress at the implant crestal site and should be reduced or eliminated.2,3,4
a. Offset load:
OFF set usually are facial or lingual occlusal contacts not those in the long axis of the implant body.
In screw-retained restoration, occlusal contact rarely is placed over an access hole. Therefore offset loads are common when occlusal screws are used. But when cement refined prosthesis is used, the occlusal load in directly placed over the long axis of the implant body.
In case of anterior implants, the screw retained prosthesis is placed lingual to the incisal edge on the access hole in the cingulum region, compared to cement retained prosthesis.
In order to decrease the offset load in screw-retained prosthesis during lateral excursion, natural truth when present the greatest load.
In summary, the general principles regarding direction of load to the implant body are.
a. Axial loads to the implant body produce less compressive and tensile stress.

ENDODONTOLOGY Volume: 26 Issue 2 December 2014

ORIGINAL RESEARCH

Papilla Base Incision: An Evaluation of Post-Operative Healing of
Interdental Papilla after Endodontic Surgery
Himanshu Shekhawat1, Babita Meena2, Sanjay Miglani3, Mukesh Hasija4,
Irfan Ansari5, Sarita Kohli6
____________________________________________________________________________________________
1Tutor,

ESIC Dental Hospital, Rohini, New delhi, India. professor, 3,5Associate professor, 6Professor & Incharge, Department of Conservative Dentistry and Endodontics,
Faculty of Dentistry, Jamia Millia Islamia University, Delhi, India.
2,4Assistant

E-mail: babita14meena@rediffmail.com

Abstract:
Aims and objectives: The purpose of this study was to describe and evaluate a novel marginal incision technique –the papilla base incision, which preserves the integrity of the interdental papilla during and after endodontic surgery in cases where there is no evidence of marginal periodontitis.
Methodology: Fifteen patients in general good health referred to the department of endodontics with periradicular pathology where endodontic surgery was indicated were selected for the study irrespective of age, sex and socioeconomic status.
Results: The visual observation of the incisions at one month recall demonstrated one site with visible defects (grade 1), five sites with partially detectable incision defect (grade 2) and nine sites with perfect healing (grade 3) .
Conclusion: Papilla based incision is an excellent method of elevating the mucoperiosteal flap with excellent esthetics and without any postoperative loss of papilla height or gingival recession.
Keywords: Papilla Preservation, Interdental Papilla

Background:
Surgical endodontic therapy is the treatment of choice to remove disease and prevent recurrence when teeth have responded poorly to conventional treatment or non-surgical means of treatment to ultimately facilitate the healing so that the tooth returns to function.1 As surgical procedure has some inevitable complications like loss of interdental papilla height, gingival recession;
Once the practitioner is certain that no better result can be achieved by using nonsurgical treatment, then and only then should the surgical option be considered.2, 3, 4, 5
The two major components of surgical access are visual and manipulative. Visual access enables the endodontist to view the entire surgical field and manipulative access helps to carry out all the surgical steps without hinderance. Flaps for endodontic surgery require a horizontal and a vertical component. It is the site of the horizontal component that determines the type of flap.6, 7 Loss of the interproximal dental papillae may cause functional, phonetic and aesthetic problems.
Complete and predictable restoration of lost interdental papillae remains one of the biggest challenges in endodontic and periodontal reconstructive surgery.8 The interdental papilla is the portion of the gingiva between two adjacent teeth, functioning as a biologic barrier to protect periodontal ligament, cementum and alveolar bone from the oral environment.9 To achieve access for endodontic surgery, a full thickness flap must be raised, which consists of gingival and mucosal tissue as well as periosteum. To mobilize the flap, various modes of incisions can be selected including horizontal incisions
(sulcular and submarginal) and vertical releasing
272

incisions.10, 11 There are two basic types of flap sulcular and mucogingival. Though sulcular flaps remain most frequently used in endodontic surgery, it has disadvantages like recession and unpredictable shrinkage of papilla during healing.12 A triangular/rectangular flap with a sulcular incision provides the best access of all flaps. Of utmost concern when utilizing this design is the health of the gingival tissues. If the tissues that comprise the attachment apparatus are handled with skill during incision and elevation, healing by primary intention will occur, provided no other surgical principle is violated.11
To prevent the post-surgical complications a new incision for the marginal mucoperiosteal flap was designed to prevent loss of interdental papilla height, which involves the preservation of the entire papilla, thus eliminating any potential loss of height as a result of the surgical or healing process.13 The purpose of this study was to describe and evaluate a novel marginal incision technique – the papilla base incision, which preserves the integrity of the interdental papilla during and after endodontic surgery in cases where there is no evidence of marginal periodontitis.
Methodology:
Fifteen patients in general good health referred to the department of endodontics with peri-radicular pathology where endodontic surgery was indicated were selected for the study irrespective of age, sex and socioeconomic status. The age of the patients ranged between 15 and 60 years, with a mean age of 29.6 years.
The teeth consisted of maxillary anteriors and premolars.
All teeth had persisting symptoms and peri-apical