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RNI No. UPENG/2007/22988 | Vol. 14, Issue 11-12,Oct.-Nov. 2021 | Rs. 80/- | ISSN No.: 0976-2248 GUIDENT

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Dr. P. Sesha Reddy (Joint Secretary)

Dr. V. Anand Kumar (Editor)

Dr. Sanketh Kethi Reddy (Treasurer)

Dr. V. Rangarajan (President)

Dr. Akshay Bhargava (Past President)

Dr. Chethan Hegde (President Elect)

Dr. Sunil Dhaded (Vice President I)

Dr. R. Sridharan (Vice President II)

IPS OFFICE BEARERS

ORGANIZING COMMITTEE

Dr. Mahesh Verma (Chairperson)

Dr.T.V.Padmanabhan (Co Chairperson)

Dr. Mahendernath Reddy (Co Chairperson)

Dr.U.V.Gandhi (Conference Secretary)

Dr. Manesh Lahori (Organizing Secretary)

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GUIDENT | Your Guide on the path of Dentistry4

EditorialEditorial Oct-Nov 2021Editorial

EditorDr. Parvez Alam Khan

Associate EditorDr. Manesh Lahori

Chief Co-ordinatorManzar. A

Assistant EditorsDr. Noorul AnwarDr. Irfanul Haque

Legal AdvisorAdvocate Syed Ahmad Saud

Layout DesignShariq Roomi

Editor’s DeskDear Readers,Greeting from team GUIDENT.In our dental practice, we are surrounded by many occupational hazards. Tuberculosis is one of them. A study concluded that Hospital Dental Practice personnel might be at increased risk for exposure to TB. The risk of transmission of tuberculosis in dental settings is slightly high; the Centers for Disease Control and Prevention (CDC), recommends dental health care personnel include protocols for tuberculosis infection control in their offices’ written infection control program.FDI strongly reaffirms the importance of adherence to current infection control recommendations set forth by the appropriate local and international bodies to minimize the spread of respiratory and other diseases in dentistry. With the incidence of 30 lakh TB patients annually, we should be extra careful and follow all infection control protocols.

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Your Guide on the path of Dentistry | GUIDENT 5

EditorialOct-Nov 2021 EditorialEditorial

The Views expressed in this issue are those of the contributors and not necessarily those of the Magazine. Though every care has been taken to ensure the accuracy and authenticity of information, “GUIDENT” is however not responsible for damages caused by misinterpretation of information expressed and implied within the pages of this issue. All disputes are to be referred to Uttar Pradesh Jurisdiction.

Dr. S. P. Aggarwal, DelhiDr. Porus Turner, MumbaiDr. U. S. Krishna Nayak, MangaloreDr. Usha Mohandas, BangaluruDr. Himanshu Aeran, RishikeshDr. Vivek Hegde, PuneDr. Zahra Hussaini, MumbaiDr. Lanka Mahesh, DelhiDr. N. N. Singh, RanchiDr. Deepak Mehta, BengaluruDr. Mohammad Abbas Khan (USA)Dr. Parvesh Mehra, DelhiDr. S. S. Ahmad, PatnaDr. Edward Lynch, Warwick (UK)Dr. Ajay Sharma, Delhi

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Associate Editor’s DeskVIRTUAL REALITY: DELIVER BETTER CARE TO PATIENTS VR is a dental technology that could help practitioners deliver better care to patients. VR refers to a nonconventional computer graphics system having a virtual sense of reality or surrounding in which display technologies are developed in such a way that human mind perceives it as an absolute reality depending on the methods used which bring human to some other place. In a dental practice setting, virtual or augmented reality (AR) can be in the form of headsets or smart glasses worn by patients to provide digital distractions. In many ways, it’s an extension of function currently filled by ceiling-mounted televisions in dental offices that give patients something else to focus on. According to a recent Cedars-Sinai study, virtual reality also has statistically significant impacts on pain management: VR users reported a consistent drop in perceived pain when using VR. This can also help create empathy between dentist and patient, in turn, leading to improved care. VR is also used in training to allow dentistry students to digitally experience dental procedures. It displays a three-dimensional (3D) model of teeth/whole human head. This is especially useful for emergency issues that rarely occur but require specific experience to treat. Virtual reality is a promising tool which should be used to prepare patients for dental procedures.

Review Board-2021-22

Dr. Manesh LahoriB.D.S, M.D.S, F.I.S.O.I, F.I.C.O.I, Principal, Professor & HOD, Department of Prosthodontics,

K.D. Dental College and Hospital, Mathura (U.P), Email: [email protected]

Dr. A. K. Munshi (Pedodontics)Dr. Kumar Raghav (Pedodontics)Dr. Gopu Kumar Nair (Oral Medicine & Radiology)Dr. Vidya Krishnan (Oral Medicine & Radiology)Dr. Rathika Rai (Prosthodontics)Dr. Rahul Nagrath (Prosthodontics)Dr. Annil Dhingra (Endodontics)Dr. Shashit Shetty (Endodontics)Dr. Sriniwas S.R. (Periodontics)

Dr. Aditya Sinha (Periodontics)Dr. Umesh Chandra Prasad. G (Oral Pathology) Dr. Usha Balan (Oral Pathology)Dr. Shishir Mohan Garg (Oral & Maxillofacial Surgery)Dr. Gagan Sabharwal (Oral & Maxillofacial Surgery)Dr. Shrish M. Bapat (Orthodontics)Dr. Prathapan Parayaruthottam (Orthodontics)Dr. Vincy Antony (Orthodontics)


Contents Oct-Nov 2021Contents

CONTENTSOCTOBER-NOVEMBER

08

11

14

ESTHETIC ORAL REHABILITATION WITH MANDIBULAR TELESCOPIC OVERDENTURE OPPOSING MAXILLARY FIXED DENTAL PROSTHESIS- A CASE REPORTDr. Yashi Garg, Dr. Manesh Lahori

CONTEMPORARY CONCEPT IN GINGIVAL RETRACTION FOR IMPLANT PROSTHESISDr. Krishna Kumar U

APEXIFICATION USING MTA- A CASE SERIESDr. Rishika Luhach,Dr. Ayushi Bangari, Dr. Annil Dhingra

ENDODONTIC MANAGEMENT OF RADIX ENTOMOLARIS INMANDIBULAR FIRST MOLAR- A CASE REPORTDr. Prakriti Kaul, Dr. Ajay Kumar Nagpal, Dr. Sunil Kumar

TALONS CUSP: AN EAGLES EYE FOR AN EAGLES TALON- A CASE REPORT Dr. Deepika N. Chari, Dr. Bhavna Dave, Dr. Bhavana I

REPLANTATION OF AVULSED TOOTH WITH EXTENDED EXTRA ORAL TIME- A CASE REPORTDr. Sowndarya Gunasekaran, Dr. Srinidhi Bhatt, Dr. Shanthala B. M

ORAL MUCOCELE : A CASE REPORTDr. Aakanksha Tiwari, Dr. Reshma Avhad

GIANT COMPOUND ODONTOMA- A CASE REPORTDr. Eldhose K.G., Dr. Paul Steaphen, Dr. Anu Jose

RANULA IN A 7 YEAR OLD CHILD : A CASE REPORT AND REVIEWOF LITERATUREDr. K.T. Magesh, Dr. R. Ramya, Dr. M. Nivedhidha

SEPARATED INSTRUMENTAL RETRIEVAL(S.I.R.):CALL FOR A PROTOCOLDr. Uma Ramana Prakhya, Dr. Pranitha.V, Dr. Saumya.V

TOBACCO CESSATION AND COUNSELINGDr. Nitul Barman, Dr. Navpreet Kaur, Dr. Vivek Sharma

DENTAL DISPOSABLES VS REUSABLE CONSUMABLES

DENTSPLY SIRONA AND 3SHAPE EXPAND THEIR STRATEGIC PARTNERSHIP WITH SEAMLESS CONNECTIVITY FOR DENTISTS AND DENTAL LABS.

THE GOLD STANDARD IN INSTRUMENT DISINFECTION

18

30

32

21

26

34

38

43

46

24 44

COMPRESSED AIR | SUCTION | IMAGING | DENTAL CARE | HYGIENE

I’m merciful when it comes to viruses. I kill them fast.

Hygiene saves lives!

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DUERR DENTAL India Pvt Ltd, Wholly owned subsidiary of DÜRR DENTAL SEDr. Nikhil Saxena, Sales & Marketing Manager, Mobile: +91 93 1184 4642 Tel/Fax: +91 11 4217 5949E-mail: [email protected] or [email protected]

AZ_Hygiene_Flaechen_210x297mm_EN_ohne-Forte_Indien.indd 1AZ_Hygiene_Flaechen_210x297mm_EN_ohne-Forte_Indien.indd 1 04.11.21 11:2304.11.21 11:23

Contents COMPRESSED AIR | SUCTION | IMAGING | DENTAL CARE | HYGIENE

I’m merciful when it comes to viruses. I kill them fast.

Hygiene saves lives!

System-Hygiene from Dürr Dental

duerrdental.com/hygiene-saves-lives

There’s one thing that surface disinfection really must achieve: destruction of viruses, bacteria and fungi as fast as possible. FD quick disinfectant from Dürr Dental works in seconds. It has a particularly high level of material compatibility as well as offering reliable protection for the patient and surgery team. More at www.duerrdental.com

DUERR DENTAL India Pvt Ltd, Wholly owned subsidiary of DÜRR DENTAL SEDr. Nikhil Saxena, Sales & Marketing Manager, Mobile: +91 93 1184 4642 Tel/Fax: +91 11 4217 5949E-mail: [email protected] or [email protected]

AZ_Hygiene_Flaechen_210x297mm_EN_ohne-Forte_Indien.indd 1AZ_Hygiene_Flaechen_210x297mm_EN_ohne-Forte_Indien.indd 1 04.11.21 11:2304.11.21 11:23


ProsthodonticsProsthodontics Oct-Nov 2021ProsthodoNtics ESTHETIC ORAL REHABILITATION WITH MANDIBULAR

TELESCOPIC OVERDENTURE OPPOSING MAXILLARY FIXED DENTAL PROSTHESIS:

Dr. Yashi Garg P.G Student

Dr. Manesh LahoriDean & HOD

The treatment modality for treating a partial edentulous patient is either extracting the remaining natural teeth followed by fabrication of complete denture but the conservative approach is the fabrication of overdenture with remaining natural teeth. Overdenture provides better retention, stability, support and most importantly better proprioception. It is therefore, more acceptable to patient. A telescopic overdenture incorporates two copings which provide retention by frictional fit mechanism. This case report describes the rehabilitation of patient with few remaining teeth in mandible present bilaterally.

INTRODUCTION A telescopic denture also known as overdenture or overlay denture is a removable dental prosthesis that covers and rests on one or more remaining natural teeth, the roots of natural teeth, and/or dental implants.1 These dentures have a full coverage milled primary coping which is cemented to the prepared teeth and a secondary coping which is incorporated into the denture. The secondary coping fits over the primary coping and provide retention by friction fit and interfacial surface tension mechanism.2,3 These two mechanisms are depends on the tapered configuration of the contacting walls. Smaller the degree of taper, greater the frictional retention of prosthesis.4

Overdenture offers many advantages over conventional denture. Overdenture incorporates remaining teeth which enhances retention and support. It reduces the amount of residual ridge resorption as forces are transmitted to the long axis of teeth and provides proprioception by preserving the periodontal membrane.5 Telescopic overdentures can also be given in case of periodontally compromised teeth as it disperses the forces thereby preventing pathologic migration.2

CASE REPORTA 65-year-old male patient reported to the department of Prosthodontics with a chief complaint of missing teeth. History revealed extractions due to caries and periodontal disease around 1 year back. Intraoral examination revealed retroclined anterior maxillary teeth, supraeruption i.r.t. 21,22 and missing all mandibular teeth except 32,33 and 43 (Fig. 1). Grade III mobility was seen. After explaining various treatment options to the patient, a treatment plan was formulated to preserve 33 and 43 and to make a mandibular telescopic overdenture retained by stud attachments against maxillary fixed dental prosthesis.

Extraction was done i.r.t. tooth 32. Root canal treatment of tooth 14, 13, 12, 11, 21, 22, 24, 33 and 43 was done. For the maxillary teeth, tooth preparation was done (Fig. 2) followed by final impression with polyvinyl siloxane elastomeric impression material by double step putty wash technique

Department of Prosthodontics

K.D Dental College & Hospital, Mathura India

A Case Report

Fig. 1: Intraoral preoperative view


ProsthodonticsOct-Nov 2021 ProsthodoNticsProsthodonticsthe abutments, the impression was made by using a polyvinyl siloxane elastomeric impression material by double step putty wash technique. The impression was poured with Type III stone to obtain a cast on which the primary copings were fabricated (Fig. 4). The fit of the primary coping was evaluated in the patient’s mouth, after which they were cemented with glass ionomer cement. Another impression was made by using double step putty wash technique by using a custom acrylic resin tray to obtain a cast on which the secondary copings attached through bar were fabricated (Fig. 5). The fit of the secondary copings over the primary copings was evaluated in the patient’s mouth.

The secondary copings were placed on the master cast, covered with wax (for easy separation during dewaxing) and the trial denture base was fabricated. Occlusion rims were fabricated over the trial denture base. Horizontal and vertical maxillomandibular records were obtained. Mandibular cast was mounted using centric relation record. Teeth arrangement and try-in was done (Fig. 6). Dentures were then processed in a conventional manner, finished, polished and delivered to the patient (Fig. 7 & 8).

Fig. 2: Tooth preparation done

Fig 3: Temporization done on maxillary teeth

Fig 4: Primary copings

Fig 6: Try-in done

Fig 7: Intaglio surface of denture with secondary copings

Fig 5: Secondary copings with retentive bar

and temporization (Fig. 3). After 1 week, metal ceramic crowns were cemented with glass ionomer cement.

Coronal height of the mandibular teeth were reduced 3 mm short of marginal gingiva and shaped like a dome (Fig.2). After the preparation of Fig 8: Pre-treatment and Post-treatment intraoral view

BEFORE

AFTER


Prosthodontics Oct-Nov 2021ProsthodoNtics DISCUSSIONTelescopic dentures offer many advantages over conventional dentures therefore, extraction of all natural teeth and subsequent replacement with a complete mandibular denture is not the most desirable treatment option. Retaining few natural teeth preserve proprioception, prevent ridge resorption and give a psychological comfort to the patient; which ultimately improves the stability and acceptability of the dentures.6,7 Teeth which are unsuitable to support a fixed partial denture and a removable partial denture can be conserved and suitably modified to act as abutments under overdentures.8

The major advantage offered by telescopic overdentures is retrievability. The dentures can be easily repaired or relined without the need of reconstructing a new prosthesis.

The success of overdenture depends on the condition of the underlying abutments and denture. Therefore, patient should be given proper detailed instructions about the denture maintenance, oral hygiene and periodontal health of abutments.

CONCLUSIONRehabilitation of partial edentulous arches with overdentures has become a widely accepted treatment modality as it successfully overcome many of the difficulties associated with conventional denture. Modified design with bar attachment fixed to copings as used in this case provides added retention which improves patient compliance and success. Even though implant supported overdentures are used increasingly but tooth supported telescopic dentures should always be advocated as an alternative treatment plan.

REFERENCES1. The Glossary of Prosthodontic Terms: Ninth Edition. J Prosthet Dent. 2017

May;117(5S):e1-e105.

2. Devi S, Nallaswamy D, Duraisamy R. Oral rehabilitation with telescopic overdenture-A case report. J Res Med Dent Sci, 2021, 9 (1): 210-214.

3. Abraham PA, Koka P, Murugesan K, Vasanthakumar M. Telescopic overdenture supported by a combination of tooth and an implant: A clinical report. J Indian Prosthodont Society 2010; 10:230-233.

4. Singh, K. & Gupta, N. Telescopic denture - A treatment modality for minimizing the conventional removable complete denture problems: A case report. Journal of Clinical and Diagnostic Research 2012; 6(6). 1112-1116.

5. Sharma HK, Padiyar N, Kaurani P, Singh DP, Meena S, Gupta A. Tooth-supported Overdenture using Castable Ball and Socket Attachments. J Mahatma Gandhi Univ Med Sci Tech 2017;2(2):106-108.

6. Satyendra K, Kumar D, Legha VS, Arun Kumar KV. Specially designed tooth supported mandibular overdenture with enhanced retention. Med J Armed Forces India. 2015;71(Suppl 2):S546-S548.

7. Prakash V.S., Shivaprakash G., Hegde S., Nagarajappa Four and two tooth supported-Conventional over denture: two case reports. Int J Oral Health Sci. 2013;3:61–64.

8. Shruthi CS, Poojya R, Ram S, Anupama. Telescopic Overdenture: A Case Report. Int J Biomed Sci. 2017;13(1):43-47.

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ImplantImplant Oct-Nov 2021Implant CONTEMPORARY CONCEPT IN GINGIVAL RETRACTION FOR

IMPLANT PROSTHESIS

INTRODUCTIONOsseointegrated implants have successfully provided alternative treatment to conventional prosthesis for the patients who have lost one, multiple, or all teeth who are seeking for a prosthetic substitute that can provide adequate masticatory, phonetic, and esthetic function.1 Today, the focus is more on the soft tissue than bony tissue in creating an esthetic restoration.2 In oral implants, fabrication of subgingivally placed abutment’s margin is required, especially in esthetic regions and where minimal interarch space exists which necessitates reduced height of the abutment.3 The goal of soft tissue retraction in implants is to reversibly displace tissues and to expose margins of implant abutments before impression making.4 Inaccuracy in superstructure as a result of improper impression will lead to pathological biological cascades in peri-implant support tissues.This article reviews about present day concept involved in gingival retraction process in implant prosthetic replacement.

SOFT TISSUE HISTOPATHOLOGY MECHANISM IN IMPLANT TREATMENT The junctional epithelium associated with natural teeth has a high rate of cell turnover, which occurs rapidly during the wound healing that takes place after recovering from infection or trauma.5 The rate of junctional epithelium cell turnover is twice that of oral gingival epithelium. At the base of the sulcus, the rate of exfoliation is as much as fifty times that of oral gingival epithelium that hinders bacterial colonization of the sulcus. When the junctional epithelium that surrounds implants is exposed to gingival retraction procedures, it is at greater risk of experiencing penetration damage than is the sulcus of natural teeth. Implant mucosa lacks keratinized epithelium at the base of the sulcus, which forms the junctional epithelium and has a hemidesmosomal attachment and internal basal lamina in the lower regions of the interface.6 It adheres poorly to implant surfaces, is more permeable and has a lower capacity for proliferation and regeneration than does the junctional epithelium around situations. Another consideration that has a

Department of Prosthodontics

Rajarajeshwari Dental College and Hospital, Bangalore

Dr. Krishna Kumar UProfessor

bearing on the ability of epithelial tissues to withstand chemo mechanical manipulative procedures is the influence of the gingival biotype, categorized as thick or thin variety. Thick gingival biotype is more conducive for implant prosthesis.

In peridental tissue, the fiber-rich, highly organized periodontal complex surrounding natural teeth provides support for gingival tissues when they are retracted, mitigating the collapse of the tissues when the retraction agents are removed before making the impression. The periimplantfiber structure, however, does not provide the same level of support and is not able to prevent the collapse of retracted tissues to the same extent, which complicates attempts to successfully make impressions. This is particularly true in situations in which the depth of sulcus is greater than average, such as when an implant has been placed deeply.

GINGIVAL RETRACTION PROBLEMS IN IMPLANT PROSTHETIC PHASESeveral impression techniques are used in implant dentistry, and some require gingival displacement while making impressions. Others, such as the pickup impression technique, do not require any gingival retraction. For screw retained implant restorations, most systems use mechanical components impression copings that can be adapted accurately and directly to the fixture head on the abutment shoulder. With cement-retained prostheses that use customized abutments, the pickup impression technique cannot be used owing to the unique contour of the abutments. Therefore, clinicians must use another technique such as the conventional crown and bridge impression or optical impression. To ensure accuracy with polyvinyl siloxane impression materials, clinicians must maintain a minimum bulk of point two millimeter thickness in the sulcus area, which they can achieve by retracting the gingiva for at least four minutes before making the impression.7 Rapid reclosure of the sulcus requires that clinicians make the impression immediately after removing the retraction material.8


ImplantOct-Nov 2021 ImplantImplant Placement of mechno chemical cords can cause inflammation and rebound hyperemia to the sulcular epithelium and underlying connective tissues. The filaments or fibers of conventional cords also may cause residual contamination of sulcular wounds, creating foreign body reactions and exacerbating inflammation. Healing of the sulcus can take few days time. Use of minimal force is necessary when packing cords to protect sharpe fibers. The use of metal instruments for cord placement in implant impression procedure might cause problem. Few lasers are contraindicated near implant surfaces, because they tend to absorb energy, which causes them to heat up and transmit the heat to bone, fragile subjunctional epithelium at the sulcus base around implants. Electro surgery is not recommended around implants because there is significant risk that the contacting electrode may arc by conducting electric current though the metal implant structure to the bone rather than via the more dispersive gingival tissue pathway. The concentrated electrical current at the tip of electrodes can generate heat, which may cause osseous or mucosal necrosis. Rotary curettage is inappropriate for use around implant restorations because of poor tactile control when cutting soft tissue, which could lead to bur contact damage to the implant surface and over instrumentation. The action of aluminum chloride is similar to that of aluminum sulfate, which is an astringent that causes precipitation of tissue proteins but less vasoconstriction than epinephrine.9 Aluminum chloride is the least irritating of the medicaments used for impregnating retraction cords, but it disturbs the setting of polyvinyl siloxane impression materials.10

Aluminum potassium sulphate and aluminum chloride medicated cords are more effective in keeping the sulcus open after clinicians remove the cord.

VIRTUAL GINGIVAL RETRACTION IN IMPLANT TREATMENTLarger sulcus spaces than necessary for conventional crown and bridge impression techniques are needed when making digital computer aided design/computer-aided manufacturing impressions to ensure accurate recording of finishing lines. Direct optical impressions are limited to line of sight, which is facilitated by performing gingival retraction to expose finish lines. Artifacts caused by retraction cord fibers that remain in the sulcus may affect the accuracy of optical impressions. Fifteen percent aluminum chloride in an inject able kaolin matrix leaves a clean sulcus, reducing the influence of artifact-generated errors. However, the powders used when making optical impressions to reduce reflectivity and make tooth surfaces measurable can influence impression accuracy by increasing tooth surface thickness. Clinicians regard the indirect capture of digitized information as being potentially more accurate; however, the way in which clinicians can acquire data is influenced by the thickness of the impression material in the sulcus area. Significant errors can result from thin impression margins with a radius less than the contacting probe tip.

CONCLUSIONThe use of fifteen percent aluminum chloride in an injectable kaolin matrix is effective. It also is safe, with the reports of no adverse effects. Gingival recession associated with an injection of aluminum chloride into the gingival sulcus is almost undetectable. The injectable matrix is hydrophilic and can be flushed away relatively easily from the gingival crevice. Gcuff which is newly introduced retraction system seems to yield predictable restoration for implant patients.

REFERENCES1. Goldstein, Ronald E. Esthetics in Dentistry. 2nd ed. Hamilton, On: B.C. Decker;

1998.

2. Pad bury A Jr, Eber R, Wang HL. Interactions between the gingival and the margin of restorations. J Clin Periodontol 2003; 30:379-85.

3. Misch CE. Cement retained implant prostheses: Implant protective occlusion. Dental Implant Prosthetics. St. Louis: Mosby; 2005.

4. Bennani V, Schwass D, Chandler N. Gingival retraction techniques for implants versus teeth: Current status. J Am Dent Assoc 2008; 139:1354-63.

5. Shimono M, Ishikawa T, Enokiya Y, et al. Biological characteristics of the junctional epithelium. J Electron Microsc (Tokyo) 2003;52(6):627-639.

6. Glauser R, Schupbach P, Gottlow J, Hammerle CH. Periimplantsoft tissue barrier at experimental one-piece mini-implants with different surface topography in humans: a light-microscopic overview and histometric analysis.Clin Implant Dent Relat Res 2005;7(suppl 1):S44-S51

7. Baharav H, Laufer BZ, Langer Y, Cardash HS. The effect of displacement time on gingival crevice width. Int J Prosthodont 1997; 10(3):248-253

8. Laufer BZ, Baharav H, Langer Y, Cardash HS. The closure of the gingival crevice following gingival retraction for impression making. J Oral Rehabil 1997; 24(9):629-63

9. Kellam SA, Smith JR, Scheffel SJ. Epinephrine absorption from commercial gingival retraction cords in clinical patients. J Prosthet Dent 1992; 68(5):761-765.

10. Dental product spotlight: gingival retraction cord. JADA 2002; 133(5):652-653.


EndodonticsEndodontics Oct-Nov 2021Endodontics

APEXIFICATION USING MTA

INTRODUCTIONTraumatic injuries to young permanent teeth affect 30% of children. These injuries often result in pulpal inflammation or necrosis and subsequent incomplete development of dentinal wall and root apices. The golden rule in the practice of endodontics is to debride and obturate the canals as efficiently and three dimensionally as possible in an amount of time and appointments that are reasonable to the patient.Before 1966 the clinical management of the “Blunder buss” canal usually required a surgical approach for the placement of an apical seal into the often fragile and flaring apex. Apicoectomy further reduces the root length resulting in a very unfavorable crown root ratio.The treatment of choice for necrotic young permanent teeth is apexification.

PURPOSE: The aim of this study is to investigate several cases with different root canal anatomies like in open apex with blunderbuss canals in maxillary central incisors and their management.

Material and methods: Four Cases of maxillary central incisors with immature open apex and blunderbuss canals w.r.t 11 & 21.

CASE SERIESApexification with Mineral Trioxide Aggregate

CASE REPORT 1:A 18-year-old female patient reported with a chief complaint of pain in her upper front tooth region for past two days. Patient gave history of dull throbbing pain for the past 6 months in the same region. Past medical and dental history was non-contributory. Clinical examination showed Ellis Davis Class IV Fracture in upper left central incisor (21). Sensibility test showed no response in 21.Radiographic examination showed blunderbuss canal and a periapical radiolucency in relation to 21. (Figure 1). Based on the clinical examination, sensibility test and radiographic findings, a provisional diagnosis of Ellis Davis Class IV fracture with open apex and periapical pathology was

Department of Conservative Dentistry and Endodontics

Seema Dental College And Hospital, Rishikesh

made. Apexification was planned with MTA (PROROOT Densply).A written consent was taken from the patient after explaining the treatment protocol. In the first visit, access opening was done under isolation using endo access bur #1.Canal patency was checked using a #10 K file and working length was determined using Ingle’s Radiographic method. Biomechanical preparation was done using K files using step back technique. Irrigation was done using 5.25 % NaOCl and saline). Chlorhexidine was used as a final irrigant. Calcium Hydroxide was placed using a Lentulo spiral and tooth was temporized. Patient was recalled after a week. In the second visit, access cavity was re-established, canal was irrigated copiously

Dr. Annil Dhingra Professor & H.O.D.

Dr. Ayushi BangariP.G. Student

Dr. Rishika LuhachP.G. Student

PRE OPERATIVE RADIOGRAPH

WORKING LENGTH ESTABLISHED

INTRA CANAL MEDICAMENT PLACED

FORMATION OF MTA PLUG

OBTURATION DONE POST OPERATIVE RADIOGRAPH

A Case Series


EndodonticsOct-Nov 2021 EndodonticsEndodontics visit, access cavity was re-established, canal was irrigated copiously following the same protocol and dried with sterile paper points. MTA was mixed according to the manufacturer’s protocol and and packed to a thickness of 5 mm in the apical third using a hand plugger. A sterilecotton pellet was placed in the canal andthe tooth was temporized. Patient was recalled after two days. In the subsequent visit, obturation was done using thermoplasticized guttapercha and Composite resin restoration was placed to seal the access cavity. Patient was recalled after a month for follow up.


following the same protocol and dried with sterile paper points.MTA )was mixed according to the manufacturer’s protocol and and packed to a thickness of 5 mm in the apical third using a hand plugger (Figure 1.4). A sterilecotton pellet was placed in the canal and the tooth was temporized. Patient was recalled after two days.

In the subsequent visit, obturation was done using thermoplasticized guttapercha and Composite resin restoration was placed to seal the access cavity.

CASE REPORT 2:A 21-year-old female patient came with a chief complaint of pain in her upper front tooth region for past two days. Patient gave history of dull throbbing pain for the past 6 months in the same region. Past medical and dental history was non-contributory. Clinical examination showed Ellis Davis Class IV Fracture in upper left central incisor (21). Sensibility test showed no response in 21.Radiographic examination showed blunderbuss canal and a periapical radiolucency in relation to 21. Based on the clinical examination, sensibility test and radiographic findings, a provisional diagnosis of Ellis Davis Class IV fracture with open apex and periapical pathology was made. Apexification was planned with MTA (PROROOT Dentsply).A written consent was taken from the patient after explaining the treatment protocol. In the first visit, Access opening was done under isolation using endo access bur #1.



FORMATION OF MTA PLUG

OBTURATION DONE POST OPERATIVE RADIOGRAPH

Canal patency was checked using a #10 K file and working length was determined using Ingle’s Radiographic method. Biomechanical preparation was done using K files usingstep back technique. Irrigation was done using 5.25 % NaOCl and saline). Chlorhexidine was used as a final irrigant. Calcium Hydroxide was placed using a Lentulo spiral) and tooth was temporized. Patient was recalled after a week. In the second




MTA PLUG CREATED MASTER CONE TAKEN OBTURATION DONE

CASE REPORT 3:An 31year old female patient reported with a chief complaint of discolored left maxillary central incisor with a history of trauma 10 year back. The concerned tooth did not respond to both electric and heat test. The periapical radiograph revealed a large blunderbuss canal of the same tooth. On clinical examination, Ellis Class I fracture in permanent left maxillary central incisor was evident. Apexification with MTA was planned. Access opening was prepared and working length was determined ; irrigation was done with saline. Biomechanical preparation was carried out using 70 size k file with circumferential filing motion. Root canal debridement was done using alternative irrigation with 2.5% NaoCl and saline. Calcium hydroxide was placed in the root canal and patient recalled after 5 days. At subsequent appointment, canal was irrigated with 2.5% NaoCl and 2% chlorhexidine. The canal was dried with paper points and MTA placed with pluggers until thickness of 6 mm. A wet cotton pellet was placed in the canal and access cavity was sealed with temporary cement. In next appointment, root canal was obturated with using lateral condensation technique. Access cavity sealed with glass ionomer cement.


EndodonticsEndodontics Oct-Nov 2021Endodontics

CASE REPORT 4:An 17 year old male patient reported with a chief complaint of discolored and broken left maxillary central incisor with a history of trauma 7 year back. The concerned tooth did not respond to both electric and heat test. The periapical radiograph revealed a large blunderbuss canal of the same tooth. On clinical examination, Ellis Class III fracture in permanent left maxillary central incisor was evident. Apexification with MTA was planned. Access opening was prepared and working length was determined ; irrigation was

done with saline. Biomechanical preparation was carried out using 70 size k file with circumferential filing motion. Root canal debridement was done using alternative irrigation with 2.5% NaoCl and saline. Calcium hydroxide was placed in the root canal and patient recalled after 5 days. At subsequent appointment, canal was irrigated with 2.5% NaoCl and 2% chlorhexidine. The canal was dried with paper points and MTA placed with pluggers until thickness of 5 mm . A wet cotton pellet was placed in the canal and access cavity was sealed with temporary cement. In next appointment, root canal was obturated with using lateral condensation technique.

DISCUSSION The goal of apexification is to obtain an apical barrier to prevent the passage of toxins and bacteria into periapical tissues from root canal. In the literature, many materials have been used for apexification, such as calcium hydroxide in combination with sterile water, saline, local anesthetic, CMCP, zinc oxide paste with cresol and iodoform, polyantibiotic paste and tricalcium phosphate. Calcium hydroxide is one of the most important medicaments used in treatments of pulp conditions and apical periodontitis.

MTA as an apexification material represents a primary monoblock. Appetite like interfacial deposits form during the maturation of MTA result in filling the gap induced during material shrinkage phase and improves the frictional resistance of MTA to root canal walls. MTA has superior biocompatibility and it is less cytotoxic due to its alkaline pH and presence of calcium and phosphate ions in its formulation results in capacity to attract blastic cells and promote favorable environment for cementum deposition. A total of 5 mm barrier is significantly stronger and shows less leakage than 2 mm barrier.In the present case, MTA was placed for around 6 mm in the apical region.

There is increasing popularity with one visit apexification technique using Mineral Trioxide Aggregate (MTA) as osteoconductive apical barrier. MTA is relatively non cytotoxic and stimulates cementogenesis. This Portland cement based material generates a highly alkaline aqueous environment by leaching of calcium and hydroxyl ions, rendering it bioactive by forming hydroxyappatite in presence of phosphate containing fluids. Unlike the extended use of Ca(OH)2 in immature roots, prolonged filling of these roots with MTA did not reduce their fracture resistance.3

Periapical radiograph showing wide open

apex in relation to 21 (arrow)

Periapical radiograph showing working

length in relation to 21

Periapical radiograph showing intracanal

medicament

Radiograph showing placement of mineral

trioxide aggregate

Radiograph showing complete obturation

of 21

Periapical radiograph showing wide open

apex in relation to 21 (arrow)

Periapical radiograph showing working

length in relation to 21

Periapical radiograph showing intracanal

medicament

Radiograph showing placement of mineral

trioxide aggregate

Radiograph showing complete obturation

of 21


EndodonticsOct-Nov 2021 EndodonticsEndodontics Torabinejad reported the ingredients in MTA as tri calcium silicate, tricalcium aluminate, tricalcium oxide and silicate oxide with some other mineral oxides that were responsible for the chemical and physical properties of aggregate. The powder consists of fine hydrophilic particles that set in the presence of moisture. The hydration of the powder results in a colloidal gel with a pH of 12.5 that will set in approximately 3 hours. MTA has a compressive strength equal to intermediate restorative material and Super - EBA but less than that of amalgam. It is commercially available as ProRoot MTA ,and has been advocated for use in the immediate obturation of open root apex.

CONCLUSIONThe apexification by Ca(OH)2 has been applied for many years back to the present as a valid therapy to perform an apexification treatment.

The MTA barrier as a treatment of apexification is a technique that is applied as a substitution to Ca(OH)2 apexification; this technique does not require several appointments, and the conformation of the barrier does not need an external factor to develop, as in the case of the apexification with Ca(OH)2, as well as in the regeneration of the pulp.

REFERENCES1. SeltzerS.Endodontology; Biologic Considerationsin Endodontic Procedures,

1988, 2nd edn. Philadelphia; Lea and Febiger.

2. Lee SJ, Monset M, Torabinejad M. Sealing ability of a mineral trioxideaggregate for repair of lateral root perforations. J. Endod 1993; 19 : 541-4.

3. Rebecca L, Martin BS, Francesca M et al.Sealing properties of mineral trioxide aggregate orthograde apical plugs and root fillings in an in vitro apexification model. J Endod 2007;33:272-275

4. Torabinejad M, ChivianN.Clinical applications of mineral trioxide aggregate.JEndod 1999;25:197-205

5. Shabahang S, TorabinejadM.Treatment of teeth with open apices using mineral trioxide aggregate. Pract Periodont Aesthet Dent 2000;12:315-20




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Endodontics Endodontics Oct-Nov 2021Endodontics ENDODONTIC MANAGEMENT OF RADIX ENTOMOLARIS IN

MANDIBULAR FIRST MOLAR

Dr. Sunil KumarProfessor

Dr. Prakriti KaulP.G. Student

INTRODUCTIONThe main purpose of endodontic therapy is the elimination of bacteria from the infected root canals and prevention of risk of further reinfection which is mainly achieved by thorough cleaning and shaping of root canals followed by three dimensional obturation with a coronal fluid tight seal. For this the clinicians must have a thorough knowledge of the diversity of morphology of root canal systems and its variations that may complicate the procedure. The majority of mandibular first molars have two roots, mesial and distal with two mesial and one distal canal. Many variations in root canal systems have been described. Fabra-Campos reported the presence of three mesial canals while Stroner reported three distal canals.1-4

A major but rare variant is the presence of three roots in mandibular first molar, first mentioned in the literature by Carabelli in 1844; known as radix entomolaris located in distolingual position.5 When located on mesiobuccal surface, the anomaly is known as radix paramolaris. The external morphology of this anomaly having additional lingual or buccal root, are described by Carlsen and Alexandersen. The Latin term Radix Entomolaris (RE) was coined by Mihaly Lenhossek in 1922.6

The main etiological factor behind this variant can be attributed to racial, genetic and external factors during odontogenesis7 or penetrance of an atavistic gene or polygenetic system (appearance of a trait belonging to a distant ancestor that has been dormant in recent generations).

The occurrence of third root varies in different ethnic groups, with the incidence of less than 5 percent. The maximum frequency occurs in African populations and is 3% .It appears to be 3.4-4.2% in Europeans, less than 5% in Eurasians and Indians , 5% to 40% in Mongoloid traits, such as Chinese, Eskimo and American Indians and 8.2% in Malaysian Borneos.8

Radiographic diagnosis plays an unparalleled role in successful endodontic treatment of almost every case, and when taken at different angulations gives information about extra canals or roots and aids in the better understanding

Department of Conservative Dentistry & Endodontics

K.D. Dental College & Hospital, Mathura

of the anatomy of the root canal system and the treatment approach with sufficient `knowledge and absolute clinical thoroughness for successful root canal treatment.

This case report is about the detection and management of radix entomolaris (RE) in a mandibular first molar during its root canal treatment in a patient who came to the Department of Conservative Dentistry and Endodontics with a chief complaint of pain in right lower back molar region which aggravated during mastication and was spontaneous in nature indicating signs of irreversible pulpitis.

CASE REPORT A 58 year old male patient was referred to Department of Conservative dentistry & Endodontics, K.D. Dental College Mathura, with spontaneous pain in his mandibular right first molar for the past four days. On clinical examination of the patient his mandibular right first molar had a deep carious lesion. Tooth was moderately tender on percussion. Intra Oral Periapical (IOPA) Radiograph of tooth showed a coronal radiolucent area on the distal

Dr. Ajay Kumar NagpalProfessor & HOD

Usually mandibular first molar have three roots typically that is mesiolingual, mesiobuccal and distal canal. But sometimes the clinician encounters a fourth canal in the same buccolingual plane as the distobuccal root and superimposition of both roots can appear on the preoperative radiograph, resulting in an inaccurate diagnosis. In this case report we did the endodontic management of radix entomolaris of a 58 year old male which came with the chief complaint of spontaneous pain. Understanding such variant of root canal anatomy helps in the crucial approach toward working

with such cases.

A Case Report


Endodontics Oct-Nov 2021 Endodontics Endodontics Patient was recalled after a week for check up, he was completely asymptomatic and then he was scheduled for permanent restoration with a PFM crown.

aspect of the tooth which approached the pulp. Radiograph also revealed the presence of an extra distal root with accompanying apical radiolucency. From patient history and clinical examination a diagnosis of acute apical periodontitis was established and endodontic treatment was initiated after the informed consent from the patient. Buccal object rule (SLOB technique) confirmed the additional root as distolingual root [RADIX ENTOMOLARIS].

CLINICAL MANAGEMENTRadiographic evaluation of the involved teeth revealed two completely formed roots with no indication of any variation in the root canal anatomy in 46. The teeth were anesthetized using lignocaine. After rubber dam isolation, caries excavation and access cavity was done on the tooth. On inspection with a DG 16 endodontic explorer initially, the pulp chamber floor revealed three canals – mesiobuccal, mesiolingual, and the distal. A search for the second distal canal was made by further exploration of the pulpal floor with a DG 16 endodontic explorer. A catch disto lingually unveiled the second distal orifice, and the access cavity was modified from a triangular form to a trapezoidal shape to include the distolingual canal. Negotiation of the canals was carried out with ISO size 6, 8, and 10 K files. Working length was determined using the Woodpecker apex locator with 15 No. K files and was verified using periapical radiograph. The working length radiograph taken with different horizontal angulations revealed the presence of a third root located distolingually. The additional root was narrow, short and tapers towards the apex. Thus, care should be taken to avoid overpreparation and any inadvertent perforation of the root during root canal treatment. A mild perforation site was restored using Glass Ionomer Cement at the chamber floor. The coronal access was defined with Gates Glidden burs (Dentsply, Maillefer) and canals were shaped with Hyflex CM files under copious irrigation with 2.5% sodium hypochlorite and lubrication with RCPrep. All canals were enlarged to 25/4 by crown down preparation to the working length to minimise the risk of strip perforation and also because of the age factor of patient that may have calcified the canal a bit. Two calcium hydroxide medicament dressings were placed at a week interval to aid in the healing process. At the fourth appointment, the patient was completely asymptomatic and canals were dry. The root canal system was then obturated with Gutta percha using single cone technique (25/4) and Zinc Oxide Eugenol sealer.

NEGOTIATING RADIX ACCESS OPENING

WORKING LENGTH MASTER CONE

OBTURATION PERFORATION

NEGOTIATING PERFORATION PERFORATION REPAIR

POST OPERATIVE

DISCUSSIONThe presence of RE or a radix paramolaris has clinical implications in endodontics, oral surgery and orthodontics and an accurate diagnosis of these supernumerary roots can avoid complications or a “missed canal” during root canal treatment. RE is mostly situated in the same buccolingual plane as the distobuccal root, a superimposition of both roots can appear on the preoperative radiograph, resulting in an inaccurate diagnosis. Some particular marks or characteristics, such as an unclear view or outline of the distal root contour or the root canal, can indicate the presence of a “hidden” RE. To reveal the RE, a second radiograph should be taken from a more mesial or distal angle (30°).9,10

CLASSIFICATION: CARLSEN & ALEXANDERSEN (1990)Classified radix entomolaris (RE) into four different types based on the location of its cervical part11:

1. Type A: the RE is located lingually to the distal root complex which has two cone-shaped macrostructures.

2. Type B: the RE is located lingually to the distal root complex which has one cone-shaped macrostructures.

3. Type C: the RE is located lingually to the mesial root complex.

4. Type AC: the RE is located lingually between the mesial and distal root complexes.


Endodontics Oct-Nov 2021Endodontics 5. Carabelli G (Editor). Systematisches Handbuch der Zahn heilkunde (2nd edn.).

Vienna: Braumuller and Seidel. 1844: 114.

6. I. Stamfelj. Who coined the term radix entomolaris? International Endodontic Journal. 2014; 47: 810–811.

7. Sperber GH, Moreau JL. Study of the number of roots and canals in Senegalese first permanent mandibular molars. Int Endod J. 1998; 31(2):117–22.

8. Shekhar Bhatia S , Kohli S, Parolia A , Lim YN , Tung L , Hean T Prevalence of Radix Molar in Mandibular Permanent Molars: An Observational Study in Malaysian Population. Oral Health and Dental Management • January 2015

9. Reichart PA, Metah D (1981) Three-rooted permanent mandibular first molars in the Thai. Community Dent Oral Epidemiol 9: 191-192. 23.

10. Gu Y1, Zhou P, Ding Y, Wang P, Ni L (2011) Root canal morphology of permanent three-rooted mandibular first molars: Part III--An odontometric analysis. J Endod 37: 485-490.

11. Carlsen O, Alexandersen V (1990) Radix entomolaris: identification and morphology. Scand J Dent Res 98: 363-373.

12. De Moor RJ, Deroose CA, Calberson FL (2004) The radix entomolaris in mandibular first molars: an endodontic challenge. Int Endod J 37: 789-799.

13. Song JS, Choi HJ, Jung IY, Jung HS, Kim SO (2010) The prevalence and morphologic classification of distolingual roots in the mandibular molars in a Korean population. J Endod 36: 653-657.

14. Reichart PA, Metah D (1981) Three-rooted permanent mandibular first molars in the Thai. Community Dent Oral Epidemiol 9: 191-192. .

15. Gu Y1, Zhou P, Ding Y, Wang P, Ni L (2011) Root canal morphology of permanent three-rooted mandibular first molars: Part III--An odontometric analysis. J Endod 37: 485-490.

16. Walker RT, Quackenbush LE (1985) Three-rooted lower first permanent molars in Hong Kong Chinese. Br Dent J 159: 298-299. 25..

17. Ingle JI, Heithersay, GS, Hatwell GR (2002) Endodontic Diagnostic Procedures. BC Decker, London, UK.

18. Gopikrishna V, Reuben, J., Kandaswamy, D (2008) Endodontic management of a maxillary first molar with two palatal roots and a single fused buccal root diagnosed with spiral computed tomography-a case report. Oral Surgery Oral Medicine, Oral Pathology, Oral Radiology and Endodontology 105: e74-e8.

19. Aggarwal V, Singla M, Logani A, Shah N (2009) Endodontic management of a maxillary first molar with two palatal canals with the aid of spiral computed tomography: a case report. J Endod 35: 137-139.

De Moor et al. (2004) classified radix entomolaris based on the curvature of the root or root canal12:

1. Type 1: a straight root or root canal.

2. Type 2: a curved coronal third which becomes straighter in the middle and apical third.

3. Type 3: an initial curve in the coronal third with a second buccally oriented curve which begins in the middle or apical third.

Song JS et al. (2010) further added two more newly defined variants of RE13:

1. Small type: length shorter than half of the length of the distobuccal root.

2. Conical type: smaller than the small type and having no root canal within it.

MorphologyThe radix entomolaris is located distolingually ranging from short, conical extension to a normal mature root length with its coronal third partially or completely fixed to distal root.14 Externally, the distal furcation is slightly lower (1 mm.) than the furcation between mesial and distal roots.15 Clinically, tooth with additional distolingual root may present a more bulbous crown outline, an additional cusp, a prominent distolingual lobe or cervical prominence. These features can indicate the presence of additional root. Radiographically, third root is visible in 90% of cases.16,17 In addition to this, magnifying loupes, dental microscope or intraoral camera may also be useful. Recently, cone-beam computed tomography (CBCT) has emerged as a useful tool to aid in the diagnosis of teeth with complex root anatomies. However, cost and accessibility are the main limiting factors till now.18,19

CLINICAL IMPLICATIONSOral surgical procedures: Radix entomolaris may pose great difficulty during extraction and orthodontic procedure. Tooth should be thoroughly luxated during extraction, as distolingual root might fracture as it is smaller than mesial and distobuccal roots.

Orthodontic procedures: During orthodontic procedure, presence of distolingual root and its curvature makes tooth movement difficult.

CONCLUSION Dental practitioners should be aware of this variation in anatomy of permanent mandibular first molars. The morphological variations of the RE in terms of root inclination and root canal curvature demand a careful and focused clinical approach to avoid or overcome procedural errors during endodontic therapy.

REFERENCES 1. Vertucci FJ (1984) Root canal anatomy of the human permanent teeth. Oral

Surg Oral Med Oral Pathol 58: 589-599.

2. Barker BC, Parsons KC, Mills PR, Williams GL (1974) Anatomy of root canals. III. Permanent mandibular molars. Aust Dent J 19: 408-413.

3. Fabra-Campos H (1989) Three canals in the mesial root of mandibular first permanent molars: a clinical study. Int Endod J 22: 39-43.

4. Stroner WF, Remeikis NA, Carr GB (1984) Mandibular first molar with three distal canals. Oral Surg Oral Med Oral Pathol 57: 554-557.


Pedodontics Oct-Nov 2021 Pedodontics

TALONS CUSP: AN EAGLES EYE FOR AN EAGLES TALON

Dr. Deepika N. ChariP.G. Student

Dr. Bhavana IP.G. Student

Dr. Bhavna DaveDean, Professor & H.O.D

Introduction: A dental anomaly that results in cusp like projection resembling an eagles claw is the talons cusp which is very rare and unusual. Right from the small- asymptomatic one to a cusp that could lead to obvious occlusal interference, talons cusps vary in different sizes and based on that the treatment plan varies. Case report: This paper is about the conservative management of a palatally present talon cusp of upper central incisor. MTA with several benefits including biocompatibility, sealing ability, prevention of bacterial infiltration, osteogeneic and dentinogenic potential has been selected as the material of choice for the mechanical accidental pin- point exposure.Key words: Talons cusp, direct pulp capping, MTA, dental anomaly..

Department of Pediatric and Preventive Dentistry

K.M. Shah Dental College and Hospital, Sumandeep Vidhyapeeth Deemed To Be University, Piparia, Waghodia (T), Vadodara (D), Gujarat

A Case Report

INTRODUCTIONBelieved to occur due to layering of the internal enamel epithelium and dental papilla in excess into the stellate reticulum which mostly occurs in the morphological differentiation stage of tooth development, talons cusp is a rare dental anamoly.1

It is a cusp like projection on an anterior tooth which can otherwise be denoted as hyperplasia of the cingulum of an anterior tooth. Described by Mitchell (1982) and name coined by Ripa, Talons cusp was catagorised into 3 types by Hattab et al- Type I, Type II and Type III.2

This three pronged appearance3 is mostly located on the lingual aspect, rarely on the facial aspect. It mostly shows unilateral prevalence with majority in the permanent dentition and rarely in the primary dentition. Right from small talons cusp with no symptoms to very large cusps which may either interfere with the occlusion, irritate the soft tissues and tongue, can cause cusp fracture or the deep grooves present may lead to accumulation of dental plaque and eventually which are susceptible to dental caries.1

Various treatment options based on the severity needs of the Talons cusp can vary right from sealing the fissures, restore with composite restoration, reducing the cusp till there is no occlusal interference, pulpotomy, endodontic treatment and in worst cases can even lead to extraction of the concerned tooth.4.

Grinding the cusp till the patient shows any signs of pain/ sensitivity is a minimal intervention approach. This grinding of the cusp is followed by the application of the remineralizing paste to prevent it from further damage to the remaining tooth structure. On mechanical accidental pin- point exposure, a biocompatible radiopaque base such as MTA or calcium hydroxide is placed in contact with the exposed pulp tissue5. MTA with various advantages is a single- sitting option for direct pulp therapy.

CASE REPORTA 9-year- old female patient reported to the department of Pediatric and Preventive Dentistry with a complaint of presence of an extra tooth behind the upper front tooth. The patient had no relevant medical or dental history and no such family history. The patient was non- syndronic.

On clinical examination, presence of a pyramid shaped additional cusp like projection was seen on the palatal aspect of right maxillary central incisor. It was extending from the cervical margin of the tooth towards the incisal edge. 11 was palatally displaced due to the premature contact of the talons cusp with the opposing lower right incisor (41) (Image 1)

Image1(a-c): a) Pre- operative front view b) Pre- operative maxillary arch occlusal view c) Pre- operative right occlusion view

Radiographically, there was V- shaped radiopaque structure that seemed to arise from cingulam of 11 superimposed over the image of 11 with no periapical pathology. (Image 2 (e-f))


Pedodontics Pedodontics Oct-Nov 2021Pedodontics All these findings indicated that there was presence of Type I Talons cusp in relation to 11.

Treatment was planned based on the conservative approach. As it was patients first dental visit, the oral prophylaxis was done followed by the reduction of the most prominent part of the talons cusp till midway. The patient was asked to apply remineralizing agent on the reduced part. The patient was then asked to come for a follow up after 1 week. With no complaint of sensitivity, further grinding of the tooth palatally till any signs of discomfort for the patient was carried out. There was a pin point exposure on grinding and immediately the procedure was discontinued. The patient showed no signs of pain. Direct pulp capping procedure was carried out using MTA which was then followed with placement of GIC restoration. The patient was recalled after 3 months, 6 months and 1 year. There were no signs of pain clinically or any presence of abnormal radiographic findings.

PROCEDURE

Fig- 1a,b & c

Fig- 2 e &f

Image2 (e,f): e) Pre- operative IOPA f) Pre-operative maxillary arch occlusal radiograph

There was positive pulp tests with both electric as well as thermal(cold) test which were performed.

Image 3: Initial grinding of the Talon cusp irt 11 till cingulum

Image 4: Mechanical accidental pin- point irt 11

Image 5: MTA direct pulp capping irt 11 Image 6: GIC restoration post MTA placement irt 11

Image 7: IOPA irt 11

Image 8: IOPA irt 11 with 1 year follow up. No periapical pathology can be seen.

DISCUSSIONTalons cusp is a rare odontogenic anomaly with a prevalence between 0.06% and 7.7% most commonly occurs in the maxillary arch and seen in permanent


Pedodontics Oct-Nov 2021 PedodonticsPedodontics 3. Neville BW; Chi AC; Damm DD; Allen CA (13May 2015). Oral and Maxillofacial

Pathology. Head and Neck Pathology. 1. Elsevier Health Sciences. Pp. 80-81.

4. Oredugba, Folakemi. (2005). Mandibular facial talon cusp: Case report. BMC oral health. 5. 9. 10.1186/1472-6831-5-9.

5. AAPD guidelines- Reference Manual: Guideline on Pulp Therapy for Primary and Immature Permanent Teeth, 2018.

6. Mallineni SK,Panampally GK,Chen Y , et al Mandibular talon cusps: a systematic review and data analysis. J Clin Exp Dent 2014;6:e408–13

7. Talon cusp in permanent dentition associated with other dental anomalies: review of literature and reports of seven cases.Hattab FN, Yassin OM, al-Nimri KSASDC J Dent Child. 1996 Sep-Oct; 63(5):368-76.

8. Abbott PV, Labial and palatal “talon cusps” on the same tooth: a case report, Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998, 85(6):726–730.

9. Dens evaginatus (evaginated odontome). Its structure and responses to external stimuli.Oehlers FA, Lee KW, Lee EC Dent Pract Dent Rec. 1967 Mar; 17(7):239-44.

10. Prophylactic treatment of dens evaginatus using mineral trioxide aggregate. Koh ET, Ford TR, Kariyawasam SP, Chen NN, Torabinejad M J Endod. 2001 Aug; 27(8):540-2.

11. Long term clinical assessment of direct pulp capping.Baume LJ, Holz J Int Dent J. 1981 Dec; 31(4):251-60.

12. Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study. Barthel CR, Rosenkranz B, Leuenberg A, Roulet JFJ Endod. 2000 Sep; 26(9):525-8.)

dentition6 as can be observed in the above case. It is elicited as an additional cusp- like projection giving a three prong appearance.

According to Hattab et al, Talons cusp is classified into Type I- True talon, Type II- Semi Talon and Type III- Trace Talon. As in this case, it is a true talon which suggests a Well- delineated additional cusp that prominently projects from palatal surface of tooth and that extends at least half the distance from cemento- enamel junction to the incisal edge.7

Talons cusp is usually misinterpreted as a supernumerary tooth and hence proper knowledge regarding the dental anomalies is must for the clinician. Along with the knowledge the art of clinical and radiographic interpretation plays a major role is early detection of the Talons cusp and subsequently resulting in the prompt management preventing the tooth from becoming carious or eventually preserving the vitality of the tooth.

Talons cusp varies in size, shape and location so accordingly the treatment plan depends. From a very small cusp to a cusp that can cause occlusal interference can be observed8. In the above case a separate conical cusp can be appreciated.

The occlusal interference of the Talons cusp with the opposing arch can slowly result in the palatal displacement of the affected tooth as in this case and can lead to gingival problems. The tooth with immature apices, desensitizing agent is usually followed after selective grinding of the cusp. Due to location of the odontoblasts along the length of the cusp, grinding of the cusp initiates the deposition of the reparative dentine.9

Grinding is done based on patients compliance and clinical outcome. Due to superimposition in IOPA, the exact extension of the pulp in the Talons cusp cannot be accurately. Hence, while grinding, if there is accidental exposure, immediate sealing of the exposure site with MTA shows positive results with the formation of reparative dentine and maintainence of vitality of the pulp. MTA direct pulp capping is a single sitting procedure that provides a quick dentin bridge formation at the junction.10 Both clinical and radiographic regular follow ups of the treated tooth at specific intervals are must to check for any signs of pathology.11 The final restoration is crucial for a better clinical success.12

Hence, an eagle’s eye approach i.e following up carefully of the eagles talon ie the Talons cusp is the key factor in such cases.

CONCLUSIONMistaking a Talons cusp to a supernumerary tooth is very common. Hence, a proper clinical and radiographic knowledge coupled with proper diagnosis will help prevent the tooth from caries and eventually preserve its vitality. MTA single sitting direct pulp capping showed successful management of mechanically exposed pulp during the conservative grinding of the Talon’s cusp.

REFERENCES1. Özçelik, Bahar & Atila Pektas, Burcu. (2011). Bilateral Palatal Talon Cusps

on Permanent Maxillary Lateral Incisors: A Case Report. European journal of dentistry. 5. 113-6. 10.1055/s-0039-1698866.

2. “Presentation and Management of Talon Cusp” www.jpma.org.pk. Retrieved 2015-11-02.


Pedodontics Pedodontics Oct-Nov 2021Pedodontics REPLANTATION OF AVULSED TOOTH WITH EXTENDED EXTRA

ORAL TIME

Dr. Srinidhi BhattSenior Lecturer

Dr. Shanthala B. MProfessor & Head

Dr. Sowndarya GunasekaranP.G. Student

Treatment of the avulsed tooth include replantation of the tooth, which can restore the function and aesthetic appearance at an early stage after injury. The prognosis of replanted avulsed tooth depends on viability of the remaining periodontal ligament cells on the root surface of a replanted tooth. This is a case report which describes the management of an avulsed maxillary central incisor by replantation after 16 hours of extraoral time, tooth stored in milk in a 10-year-old girl. Keywords: avulsed tooth, Storage media, Reimplantation, Dental trauma.


Coorg Institute of Dental Sciences, Virajpet, Kodagu, Karnataka, India

A Case Report

INTRODUCTIONTooth avulsion is defined as total displacement of the tooth out of its alveolar socket.1 Avulsion is result a of traumatic injuries in the oro-facial region, and is classified as an injury of periodontal tissues, as well as extrusive, lateral, or intrusive luxation.2,3 Traumatic injuries to newly erupted permanent anterior teeth are common during childhood and 0.5-16% of the 7-70 year-old group experience tooth avulsion.1,2,4 Degeneration of the periodontal ligament depends on several factors, such as trauma, extra-alveolar period, management of the root and storage medium.2,4 But if appropriately managed, avulsed teeth with viable periodontal ligament which is re-planted or re-implanted can have an excellent prognosis.1,2,5

The factor to be focused from the child patient or care giver is the awareness of replantation of avulsed tooth, time of report for the dental office care and storage media of the avulsed tooth. Storage media suggested for avulsed tooth.5

The extra oral time of avulsed tooth is a crucial factor for the viabilty of the periodontal ligament cells.5

Milk has a unique combination of nutrients, capable of maintaining PDL cell viability, and with its physiological pH of 6.5-7.2, it can be considered as the best storage medium in most situations. The PDL cells have been shown to survive for 2-6 hours when immersed in milk

CASE REPORTA 10-year-old girl reported to the department of Pediatric and Preventive Dentistry with a chief complaint of trauma to the upper anterior teeth, due to fall at school. Extra-oral examination showed bruises on the chin. Intra-oral examination revealed avulsion of 21 (fig 1). The attendant (father) of the patient collected the avulsed tooth and stored in milk after the accident for 16 hours. No soft tissue injury was examined intra orally

Fig 1 – Avulsed tooth kept in saline


Pedodontics Oct-Nov 2021 PedodonticsPedodontics Replantation of avulsed tooth was considered despite the extended extra oral time of as the patient was young and to relieve her from psychological, cosmetic and functional trauma. Since the extra-oral time was more than 2 hours, root canal therapy was initiated extra-orally by holding the avulsed tooth by grasping only at the neck of the crown using forceps and to protect the viability of the periodontal ligament.

Under local Anaesthesia the socket was irrigated with normal saline solution to remove the debris and the blood clots. The tooth was then placed in position inside the socket. Composite splint was given, (Fig -2). Followed by oral medication, Amoxicillin 500mg and metronidazole 400mg TDS and a combination of Ibuprofen 400mg and paracetamol 500mg TDS.

DISCUSSION Tooth avulsion is the most serious of all dental injuries. The maxillary central incisors are the most prone teeth for avulsion either due to trauma during sports or automobile accidents. The prognosis of replantation of avulsedtooth depends on the measures taken at the place of injury or the time lapsed immediately after the avulsion rather than treatment procedure followed in the clinics.5 As sstandard protocols are followed in the management of traumatic injuries, i.e., examination of the avulsed tooth, cleaning of the region and the tooth, replantation of the tooth, splinting of the tooth, appropriate medication and follow-up.

In the literature there are extensive reports on storage media and awareness of the replantation of avulsed tooth than on the time elapsed and replantation of avulsed tooth on extended extra oral time. Most important factors for successful healing of the Periodontal membrane of a replanted tooth is the length of the extra alveolar time.7,8 and maintaining the avulsed tooth in an appropriate storage media until reimplantation.7

The teeth replanted from 6 hrs to 48 hrs after avulsion and treated endodontically are shown to be clinically functional for a number of years.(8) The ideal extra-oral time is 20 mins, and the maximum extra-oral time, as reported in literature, is 48 hours.8 In this case, since the extra oral time was more than 16 hrs, it was possible that the tooth had lost its vitality, hence root canal treatment was initiated prior to the replacement of tooth in the socket. In such cases of delayed replantation, the use of adequate media for storage and transportation of the avulsed teeth might improve the prognosis considerably.9 Prognosis improved in this case, as the tooth was stored in milk soon after the accident.

The presence of mind of patient’s father in preserving the avulsed tooth in milk is commendable and reflects increased awareness towards dental practices. Milk has a physiologic osmolality and contains markedly fewer bacteria than does saliva.7 Milk, saliva, saline, HBSS, propolis, Viaspan, and recently coconut water are being used as storage media, and all of these agents were investigated for their ability to maintain cell viability.10,11 Favourable outcome of the tooth implies, asymptomatic, normal mobility, normal percussion sound, no radiographic evidence of resorption or periradicular osteitis and normal lamina dura. An appropriate treatment plan after an injury is of utmost important for a good prognosis.12 We have achieved successfully objectives like acceptable esthetic appearance, occlusal function, and favorable healing. Patient was asymptomatic and fully satisfied with the treatment with a follow up of one year.

CONCLUSION In cases of avulsed tooth with extended extra oral time, although the risk of progressive replacement resorption and subsequent tooth loss is quite high, Replantation can be tried, as the technique seems to have advantage of maintaining aesthetic appearance and occlusal function.

Intentional reimplantation in extended extra oral time to be preferred to extraction as this would reduce the unnecessary elaborate prosthetic rehabilitation later.

A Long term follow up with regular recall visits may confirm the success of the treatment. The one year follow up, in this case, has shown favourable healing and successful outcome of the treatment.

Fig 2 – reimplantation and composite splinting of 21

The splint was removed after a period of 6 weeks (fig 3) and follow up photographs (fig 4) and radiograph were taken for one year, which revealed normal root configuration, intact periodontal ligament and without any periapical pathology.

Fig 3 – one week follow up

Fig 4 – One year follow upReferences are available on request


PeriodonticsPeriodontics Oct-Nov 2021Periodontics

ORAL MUCOCELE : A CASE REPORT

The mucocele is one of the most common benign tissue masses that occur in oral cavity. It is basically of two types : mucous retention and mucous extravasation type. Clinical observation gives the provisional diagnosis which is confirmed histopathologically. Treatment is surgical removal of the lesion.

INTRODUCTION Mucocele is a benign, mucous containing cystic lesion of minor salivary gland.The term is derived from a Latin word, mucous and coele means cavity.1 It is caused as a result of accumulation of mucous and alteration of minor salivary glands which results in a limited swelling. It is the 17th most common salivary gland lesion in oral cavity.2

Department of Periodontology and Oral Implantology

Dr. Rajesh Ramdasji Kambe Dental College And Hospital, Akola

Dr. Reshma Avhad Assistant Professor

Dr. Aakanksha Tiwari Intern

dome shaped approximately 1-2 mm to several cms in size. History of trauma to lower lip due to either lip biting or piercing repeatedly. Superficial lesion is bluish in colour and is transluscent, while deeper lesion is normal in colour same as that of surrounding mucosa due to the thickness of mucosa overlying the lesion.

Oral Mucocele

Variants There are two variants of mucocele : mucous retention cyst and mucous extravasation cyst. Mucous retention cyst is caused because of accumulation of mucous in minor salivary gland due to obstruction of ducts of these glands.3 Mucous extravasation cyst is caused due to rupture of duct of minor salivary gland and alteration of minor salivary gland which results in a limited swelling.3 It can also be: Superficial or deep. Superficial is located directly under the mucosa and deeper is located in the lower cornium.

Superficial Deep

Clinical FeaturesMucocele is more prevalent in children and young adults. Its common location is on lower lip lateral to the midline. Clinically it is a raised vesicle usually of

Normal Histologic Appearance

DiagnosisDiagnosis is clinical. Fluctuation in the lesion helps to come to proper diagnosis. FNAC and Histopathology further confirms the diagnosis.

Treatment Surgical excision of the cyst along with associated salivary acini. Excision can be done by following methods: Cryosurgery, Conventional surgical removal, Electrosurgery, Laser.4

Marsupialisation, micromarsupialization can also be done.


PeriodonticsOct-Nov 2021 PeriodonticsPeriodontics THE CASE REPORT

Clinical examinationA 30 year old female patient reported to the department of Periodontics, Dr R R Kambe Dental College, Akola with chief complaint of swelling in lower lip since a month and difficulty in chewing. The patient was apparently alright one month back when she noticed a small swelling in lower lip lateral to midline on left side which was initially small in size and has gradually increased to the present size. Patient

gave history of habit of lip biting. There was no pain associated with the swelling. Patient’s past medical and dental history were not significant and no significant family history was observed.

Extraoral ExaminationFace appeared bilaterally symmetrical, Temperomndibular joint movements were synchronous and lips were competent. Lymph nodes were non palpable.

Intraoral examinationswelling present on lower lip lateral to midline on left side in relation with 34. Approximate size of the lesion is 10mm by 5mm. Shape is elliptical to ovoid. Colour is reddish blue.

Consistency is soft and is non tender, non reducible lesion, fixed to underlying tissue.

Phase II therapy included Surgical Excision using Laser. The lesion was removed along with associated glandular acini. The excised lesion was sent for histopathologic examination. Post operative instructions were given and patient was recalled after a week for follow up and to examine healing. Analgesics were prescribed.

InvestigationsThe tentative diagnosis is made from clinical history, clinical presentation, and palpation. Routine hematological examinations were found to be normal including haemogram & Bleeding time & Clotting time.

Histopathological examination to confirm the provisional diagnosis was done.

Provisional DiagnosisMucous extravasation cyst

Differential DiagnosisXX Salivary gland tumour

XX Traumatic lesion (Traumatic fibroma)

XX Vesiculobullous lesion (mucous membrane pemphigoid)

Treatment Phase I therapy included thorough scaling and root planing and oral hygiene instructions were given. Proper brushing technique was demonstrated. 0.2% chlorhexidine mouthwash was advised 10ml 1:1 dilution, twice daily for 15 days.

DISCUSSIONMost common location of mucocele is in lower labial mucosa about 70% of total cases.

A rate of recurrence from 2.43% to 8.8% has been reported. Literature shows equal incidence in males and females but there are reports suggesting a slightly higher incidence in females 1.3:15 Lip biting is found to be common causative factor for mucocele to occur.6 If the vesicle is un roofed by suction pressure by any individual, they may report a chronic and recurrent history.7

The key point in avoiding recurrence is to eliminate adjacent surrounding glandular acini and to remove the lesion upto the muscle layer.

A localized and terminal paresthesia of labial mucosa close to surgical site in 10.58% of total patients 3 months after surgery.

Laser – total treatment within 3 to 5 min whereas scalpel technique is meticulous and need to perform suturing at end of operation.8

ADVANTAGES OF CO2 LASER VERSUS COLD SCALPEL1. Minimal damage to neighboring tissues

2. Bloodless and highly decontaminated surgical bed.

3. Lessened swelling and pain during post operative period.

4. Appearance of fewer myofibroblasts resulting in comparatively lesser wound contraction.9

The Lesion Demarcation around lesion with laser

Demarcated lesion Lesion held with holding forcep

Excision of the Lesion Excised tissue sent for histopathologic examination


Periodontics Oct-Nov 2021Periodontics CO2 laser have excellent aesthetic outcome without any fibrosis or scarring while scalpel leaves small residual unesthetic defect after the healing period in 5 of 25 lower lip mucoceles treated with surgical treatment.

Healing of wound caused by CO2 laser results inAppearance of fibro osseous membrane after 72 hrs that replaces superficial necrotic layer of irradiated tissues.

Epithelial covering occurs after 2 weeks.Thinner and parakeratotic epithelium is seen in comparision with epithelium that appears after surgical resection.

REFERENCES1. Baurmash HD. Mucoceles and Ranulas. J Oral Maxillofac surg 2003; 61:369-78

2. Flaitz CM,Hicks JM. Mucocele and Ranula.eMedicine;2015

3. J Ata-Ali, C Carrillo2 , C Bonet Oral Mucocele: review of literature J Clin Exp Dent. 2010;2(1):e18-21.

4. Huang IY, Chen CM, Kao YH, Worthington P. Treatment of mucocele of lower lip with carbon dioxide laser. J Oral Maxillofac Surg 2007;65:855-8

5. Rao PK, Hegde D, Shetty SR, Chatra L, Shenai P. Oral mucocele-diagnosis and management. J Dent Med Sci 2012;2:26-30.

6. Jha M, Jogani V. Oral mucocele: Reviwe and case report. J Contemporary Dent 2012;2:119-24.

7. Shafer’s Textbook of Oral Pathology. 2009. Sixth edition: 541-542

8. Subramaniam Ramkumar, Lakshmi Ramkumar, Narasimha Malathi, Ramlingam Suganya. Case Report- Exision of Mucocele Using Diode Laser in Lower Lip, Case Report in Dentistry, 2016, Article ID 1746316

9. Raffetto, Lasers for initial periodontal therapy, Dental Clin N Am 2004;48:923-936


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Periodontics


Oral SurgeryOral Surgery Oct-Nov 2021Oral Surgery

GIANT COMPOUND ODONTOMA

Dr. Eldhose K.G. Professor

Dr. Paul SteaphenSenior Lecturer

Odontomes are common benign tumors which arise from odontogenic tissues. They are classified into two types – Compound odotomes and Complex Odontomes absed on its morphology. Usually they are asymptomatic, but at later stages can present as a swelling or may become infected and cause pain. They are usually associated with unerupted permanent or primary teeth. Radiographic evaluation is diagnostic. Early surgical treatment is of paramount importance to minimize complications and further interventions. In this, we present a case report of a 19 years old male with Giant compound odontome in anterior maxilla.

Key Words: Odontoma; Compound odontome; radioopaque lesion

INTRODUCTIONBroca first coined the term Odontoma in 1866.1 Odontomas are less aggressive, most prevalent benign tumors.1 They are developmental in origin and arise from odontogenic tissues.5 Morphologically they are subdivided into Complex and Compound odontomas.2 They are usually asymptomatic and are diagnosed on routine dental/radiographic examination as small, solitary, multiple radio-opaque lesions.1,3 Rarely this lesions attain a larger size.5 They are radiographically and histologically characterized by the production of mature enamel, dentin, cementum as well as pulp.5 Early diagnosis and prompt treatment is adviced to prevent lengthy and expensive corrective procedures.4 Here we present a case of Giant Compound Odontoma in maxillary anterior region of a 19 years old male patient.

CASE REPORTA 19-year-old male reported to the department of Oral and Maxillofacial Surgery, Annoor Dental College and Hospital, Muvattupuzha with Chief complaint of missing teeth and gap in upper left front tooth region. Patient gives no history of pain or swelling. There were no complaints in other facial issues, no history of trauma, and other health conditions were well-adjusted. On Extraoral examination, no abnormalities were detected. However on Intraoral examination, Permanent Maxillary left canine(23) was missing with a mild swelling above permanent maxillary first premolar (24) region .

An orthopantamogram(OPG) was taken which shows multiple radio-opaque tooth like structures in the left maxilla. Also an impacted tooth was present above the lesion and associated mesiodens in relation to upper maxillary incisors.

It was provisionally diagnosed as Compound odontoma and was surgically removed under general anesthesia. The tumor was surgically removed using crestal incision extending from 21 to 25 region and a full thickness mucoperiosteal flap was elevated. Surgical site was exposed and 51 odontomes were removed along with the impacted left maxillary canine(23).

Department of Oral and Maxillofacial Surgery

Annoor Dental College and Hospital, Muvattupuzha India

A CASE REPORT

Dr. Anu Jose Senior Lecturer


Oral SurgeryOct-Nov 2021 Oral Surgery Oral Surgery Closure was done with 3-0 vicryl. Specimen sent for histopathological examination.

age of 20 years and may be associated with a retained primary tooth or an unerupted primary/permanent tooth.3,9

Diagnosis is usually fone with the help of radiographic evaluation using orthopantomogram.8

The literature defines two treatment modalities one in which the impacted teeth is removed, the second option where the impacted teeth is orthodontically extruded into occlusion following removal of interference caused by odontome.8 In the case, we have removed the impacted tooth along with the lesion.

Surgical removal is the choice of treatment for this condition as its presence can cause problems like root resorptions of the neighboring teeth.10 Small, localized odontomas are easier to manage, but large odontomas require a more complex treatment approach which include osteoplasty, reconstruction of soft tissue and dental prosthesis.7

CONCLUSIONThe present case report is of compound odontome of anterior maxilla associated with an impacted canine. As odontomes are encountered earlier in life mostly not after 2nd decade, clinical and radiographic evaluation of younger age group with missing permanent teeth is of paramount importance to minimize interventions as well as complications following enucleation.

REFERENCES1. Van HA, Nguyen TT, Vo NQ, Vo TH, Chansomphou V, Pham NT, Trinh CT, Aiuto

R. Giant compound odontoma of the mandible in an adolescent. Journal of Pediatric Surgery Case Reports. 2021 Feb 1;65:101755.

2. Rana V, Srivastava N, Kaushik N, Sharma V, Panthri P, Niranjan MM. Compound odontome: A case report. International journal of clinical pediatric dentistry. 2019 Jan;12(1):64.

3. Eswara UM. Compound odontoma in anterior mandible—a case report. The Malaysian journal of medical sciences: MJMS. 2017 May;24(3):92.

4. de Oliveira BH, Campos V, Marçal S. Compound odontoma-diagnosis and treatment: three case reports. Pediatric dentistry. 2001 Mar 1;23(2):151-7.

5. Akerzoul N, Chbicheb S, El Wady W. Giant Complex Odontoma of Mandible: A Spectacular Case Report. Open Dent J 2017; 11: 413–9.

6. Salgado H, Mesquita P. Odontoma Composto: Caso Clínico.

7. Kunusoth R, Sahu V, Fathima A, Prakash R, Kumar S, Pala KN. Compound odontoma in the anterior maxilla. Oncology and Radiotherapy. 2019;1(46):43-5.

8. Meneses-Santos D, Góis AS, de Souza Amorim K, Junior RL, de Almeida Souza LM. Compound odontoma associated to permanent teeth impaction in jaw: case report. Journal of Oral Diagnosis. 2018;3(1):1-6.

9. Raval N, Mehta D, Vachhrajani K, Nimavat A. Erupted odontoma: a case report. Journal of clinical and diagnostic research: JCDR. 2014 Jul;8(7):ZD10.

10. Souza EQ, Ganzaroli VF, de Almeida IR, Freire JD, de Abreu Costa L, Toro LF, Guiati IZ, Ponzoni D, Ervolino E, do Couto Filho CE. Compound odontoma in the anterior region of the mandible: clinical case report. Research, Society and Development. 2021 Oct 4;10(13):e50101320987-.

The histological examination was also done which revealed that the lesion was encapsulated with evidence of cementum and dentine like structures along with pulpal tissue and epithelial remnants.

Postoperatively follow up done after 1 week, 2 weeks, 1 month and 3 months clinically and radiographically(OPG). Healing is satisfactory and no evidence of recurrence noted.

DISCUSSIONOdontome’s are relatively common,hamartomous malformation usually associated with an impacted tooth.2 In 2005, WHO classified Odontomes into two types – Complex odontome and Compound Odontome.5

Compound odontoma usually contains multiple radiopaque, miniature tooth-like structures known as denticles of varying size and shape surrounded by a narrow radiolucent zone whereas complex odontoma consist of an irregular mass of hard and soft dental tissues surrounded by a narrow radiolucent band with a smooth outer periphery.1,6

Compound odontomas are usually asymptomatic swelling which cause bony expansion.7 It may occur anywhere in the jaws but is commonly seen in maxillary canine/premolar region.5 They are usually detected before the


Oral PathologyOral Pathology Oct-Nov 2021Oral PathOlOgy RANULA IN A 7 YEAR OLD CHILD : A CASE REPORT AND REVIEW

OF LITERATURE

INTRODUCTIONThe name “ranula” is used to describe an extravasation cyst which is found in the floor of the mouth. This lesion resembles the bulging underbelly of a frog and is derived from the Latin word “rana” meaning “underbelly of frog”. The other names for Ranula are Mucous Extravasation Cyst/ Retention Phenomenon/Sublingual Cyst/Cervical or Plunging Ranula/Mucocele. The most usual type which appears in the oral cavity is the mucous cyst.

Based on their site of occurrence, they can be classified into three groups namely , Sublingual, Sublingual-submandibular and Submandibular.1 Ranula is a mucus filled cavity, specifically occurring in the floor of the mouth that is related to the functioning of the ducts of the sublingual salivary gland or rarely the submandibular gland. The pathogenesis of Ranula is mainly due to blockage of salivary gland duct after trauma.2

CASE REPORTA seven year old female child reported to my hospital with a complaint of swelling in the floor of the mouth for the past 1 month. Patient was apparently alright one month back since then she noticed swelling that started as a small one in the beginning and gradually increased to the present size. On examination, swelling was firm, non-tender with a bluish hue on the left side ventral aspect tongue and not associated with pain. The swelling has extended diffusely to the left submandibular region and is tender and fluctuant. Intra orally the floor of the mouth is raised from 41 to 36 region, surface mucosa. A provisional diagnosis of cyst was given.

The differential diagnosis includes Ranula, thyroglossal duct cyst, Sialolithiasis, cystic hygroma. MRI imaging was done which revealed a large multiseptated cystic lesion in the left sublingual space measuring about 43 mm x 33 mm x 34 mm extending up to the midline displacing the left side of the tongue and hilum of the submandibular gland. Based on the clinic-radiologic correlation, a diagnosis of Ranula was given. Patient was advised to do a biopsy for further confirmation.

Department of Oral Pathology and Microbiology,

SRM Kattankulathur Dental College and Hospital, Potheri

Dr. R. Ramya Tutor

Dr. K.T. Magesh Vice Principal & HOD

Ranula is a mucus filled cavity, specifically occurring in the floor of the mouth that is related to the functioning of the ducts of the sublingual salivary gland or rarely the submandibular gland. The pathogenesis of ranula is mainly due to blockage of salivary gland duct after trauma. A variety of treatments for ranula has been suggested that includes aspiration of cystic fluid, sclerotherapy, marsupialisation, incision and drainage, and excision of the sublingual gland with or without ranula. These various treatments have shown diversified results. Most surgeons agree that removal of the sublingual gland is necessary in oral and plunging ranula. Herewith, we discuss a case of ranula with review of literature and emphasis on management of the lesion. Keywords: Ranula, Sublingual gland, Plunging ranula

Dr. M. Nivedhidha Tutor

Figure 1 : The clinical picture shows a bluish hue with swelling in

the floor of the mouth which is smooth and soft in consistency.


Oral PathologyOct-Nov 2021 Oral PathOlOgyOral Pathology

Under General Anaesthesia, the cystic lesion along with sublingual gland is excised and sent for Histopathological examination. Excised soft tissue specimen received in formalin, measured about 3.5 x 3.0 cm brown in colour, firm in consistency with surface corrugations. Specimen was cut into 3 longitudinal sections. All the pieces were submitted for processing.

The histopathological examination of the soft tissue specimen shows several large collapsed empty spaces of presumed mucin accumulation surrounded by compressed connective tissue stroma predominantly thrown into folds and papillary projections. The compressed connective tissue appears edematous in few areas along with fibroblasts, chronic inflammatory cells, foamy macrophages, numerous engorged thin-walled blood vessels and several areas of haemorrhage. Several lobules of mucous gland acini and ductal elements along with a dilated feeder duct are also seen. Small nerve bundles along with an area showing neurovascular bundles are also evident.

Based on the correlation with clinical findings, imaging and histopathology, a final diagnosis of mucous retention cyst was given.

DISCUSSIONRanula is an extravasation cyst and develops from extravasation of mucus after trauma to the sublingual gland and rarely submandibular gland or obstruction of the salivary ducts. Many theories for the origin and pathogenesis of these cysts have been postulated by Hippocrates, who described that ranulas are the effect of local inflammation of sublingual salivary gland.3 Ranulas can be classified into three groups. Oral ranulas present with intraoral swelling only, while a plunging ranula exhibits cervical swelling without swelling of the mouth floor. A mixed ranula has both intraoral and cervical swelling.4 Trauma, obstruction, or inflammation can damage one or more ducts, causing leakage of salivary contents into the surrounding tissue, inducing a fibroblastic reaction that seals the mucus in a connective tissue sac, referred to as an extravasation pseudocyst. This is the most common type of ranula. In less than 10% of all ranulas, congenital obstruction, by either an imperforate salivary duct or an ostial adhesion, leads to the formation of a retention cyst.5 The pathogenesis of plunging ranula may be as extension of a simple

ranula, congenital in origin via ectopic cell rests or iatrogenic in nature due to transposition of tissue during surgery involving the salivary structures. Extensive extension has been reported in rare occurrences, producing pressure symptoms like dysphagia and airway obstruction. The current consensus is that submandibular glands are involved by extension of a plunging ranula into it and engulfing it, rather than being an intrinsic pathology of the gland.6 The typical clinical manifestation of a ranula is a slow-growing (usually unilateral but can be bilateral), pliable, painless mass in the floor of the mouth.5 Ranulas account for 6% of all salivary gland cysts.7 Clinically, it appears round or oval in shape, bluish in color, mobile and soft in consistency, and fluctuant upon palpation opposed to lymphomas and tumors of the salivary glands. Further enlargement of the swelling might lead to dysphagia, difficulty in speech, or even airway blockage.8There seems to be a higher frequency among young adults in their second and third decades as well as in children younger than 10 years, with a slight female preponderance.5

The most common technique for the management of ranula in earlier days was marsupialisation. Though marsupialisation was done, the cyst had a high recurrence rate of 61%-89% as the cyst is not completely removed. In some instances, it served as a precursor for plunging ranula. However, the packing of the ranula cavity with gauze after marsupialisation was found to be effective in reducing the recurrence rate which is generally recommended for cyst less than 2 cm in diameter.Ogita S et al., introduced OK-432 (lyophilized streptococcal preparation) for lymphangioma which was considered as an alternative method to surgical management.1

CONCLUSIONRanula is an extravasation cyst and may develop from extravasation of mucus after trauma to the sublingual gland and rarely submandibular gland or obstruction of salivary ducts. Many theories for the origin and pathogenesis of these cysts have been postulated by Hippocrates, who described that ranulas are the effect of local inflammation of sublingual salivary glands .

REFERENCES1. Saraniya Packiri, Deepa Gurunathan, and Kathiravan Selvarasu. Management

of Paediatric Oral Ranula: A Systematic Review. J Clin Diagn Res. 2017 Sep; 11(9): ZE06–ZE09.

2. Tanay Chaubal, Ranjeet Bapat. Ranula : Frog’s Belly.The American Journal of medicine 2021;23-03.

3. Nikolaos Kolomvos , Evangelos Kalfarentzos, Nikolaos Papadogeorgakis. Surgical treatment of plunging ranula: Report of three cases and review of literature.2019; 2214-5419

4. Moon-Gi Choi. Case report of the management of the ranula. (J Korean Assoc Oral Maxillofac Surg 2019;45:357-363).

5. Elizabeth Ayers, MS, RDMS, RVT- Journal of Diagnostic Medical Sonography. Plunging Ranula: A Case Report . 2018, Vol. 34(4) 285–290

6. Ramji AN. Int J Otorhinolaryngol Head Neck Surg. Sequestered plunging ranula: a case report and literature review.2019 Sep;5(5):1411-1415

7. Arunkumar Kamalakaran ,Balaji Jayaraman , Saravanan Balasubramaniam ,Rohini Thirunavukkarasu ,Bharathi Ramakrishnan. Plunging Ranula in a 78- year- old Male – a Rare Case Report. 2018;10(1):e92-5.

Figure 2 : The histopathological picture shows several large collapsed empty spaces of presumed mucin accumulation surrounded by compressed connective tissue stroma

predominantly thrown into folds and papillary projections.


Research Research Oct-Nov 2021ReseaRch SEPARATED INSTRUMENTAL RETRIEVAL(S.I.R.):

CALL FOR A PROTOCOL

Dr. Pranitha.VProfessor

Dr. Saumya.VP.G Student

Dr. Uma Ramana PrakhyaEx P.G. Student

AIM: To evaluate the knowledge about instrument separation and retrieval treatment options among postgraduate students and practising dentists MATERIALS AND METHODS: A self-administered questionnaire was given to dentists and postgraduate students.RESULTS: There exists difference in knowledge and practices among postgraduate students and practitioners.CONCLUSION: Prevention is the best antidote for a separated file in the canal. Adhering to proven concepts with combining the best strategies and making safe techniques during preparation, will eliminate the separated instrument procedural mishaps.KEYWORDS: Files, root canal treatment, separated endodontic instrument, causes, management, retrieval


MNR DENTAL COLLEGE AND HOSPITAL, SANGAREEDY INDIA

INTRODUCTIONEndodontic instrument separation within the root canal is an untoward occurrence that will interfere with cleaning and shaping procedures affecting long-term prognosis of the tooth.1 It’s been reported that the prevalence of separated instrument ranges from 2 to 6% by Tronstad et al2 and 0.5 to 5% by Iqbal et al.3

MATERIALS & METHODSA cross sectional study was conducted in 125 dental fraternity. Out of 125, a self-administered questionnaire (Table 1) was given to 67 postgraduate students and 58 dental practitioners.

S. No Questions1 What is your current professional status?

a) Post-graduateb) Dental Practitioner

2 How many years have you been practicing dentistry?a) Less than 3 yearsb) 5 – 10 yearsc) More than 10 years

3 If you break an instrument do you think it is required to inform your patient?a) Yesb) no

4 Which types of files frequently break with you?a) Rotary filesb) Hand files

5 Which alloy of manufacture is frequently broken?a) S.Sb) NiTi

6 Which sizes are more broken?a) Smallb) Large

7 In which part of root canal, instruments separate?a) Apicalb) Middlec) Coronal

8 In which stage of RCT, instruments separated?a) While negotiating the canalb) During cleaning and shapingc) After cleaning and shaping

9 Causes of breakage according to your preparation.a) Root canal anatomyb) Improper usec) Wrong file motiond) Over usage of the filee) Dentist experience


Research Oct-Nov 2021 ReseaRchResearch 10 If file breakage is related to root canal anatomy, what is the most

common cause?a) Narrow canalb) Curved canalc) Calcified canal

11 In which teeth instruments break more?a) Incisorsb) Caninesc) Premolarsd) Molars

12 If it is molars, in which root canal is more instrument breakage?a) MB canalb) MB2 canalc) ML canald) DB canale) Palatal canalf) Distal canal

13 What you will do to deal with this separated instrument?a) Leave itb) Bypassc) Extraction of the toothd) Refer to endodontist

14 Which method will help you more in removing the separating file?a) Masserann kitb) Ultra-sonicsc) Conventional methodd) IRS

15 While attempting to bypass separated file, which procedure error result?a) Over enlargement of canalb) Ledge formationc) Canal irregularitiesd) Apical transportatione) Perforation

16 In follow up- what results do you find?a) Poor prognosis with treatment failureb) Good prognosisc) It depends on multiple factors.

Table 1: S.I.R. Questionnaire

The collected data were entered into Microsoft Excel sheets and statistically analysed using SPSS version 22 (IBM corporation, Washington DC, United States). The data was expressed as percentages.

RESULTSResults of demographic data, current professional status and practising were presented in Table 2.

62% of broken files were rotary files, 74% stainless steel files, and regarding size in 52% of cases smaller size files most separated in the canal. (Figure 1).

Professional status Postgraduate 67 54%Dental Practitioner 58 46%

Experience Less than 3 years 75 60%5-10 years 46 37%More than 10 years 4 3%

TABLE 2: BASELINE DEMOGRAPHICS

FIGURE 1: MOST FREQUENT FILES, ALLOY OF MANUFACTURE, FILE SIZE SEPARATED IN THE CANAL

FIGURE 2: Which part and stage of root canal instrument commonly separate

FIGURE 3: CAUSES OF BREAKAGE


Research Research Oct-Nov 2021ReseaRch Concerning the site, higher percentage was separated in apical third (68%). With 72% of them broken during cleaning and shaping. [Fig-2]. With regard to different opinions concerning causes are as follows, 41% of breakage due to over usage of the file [Fig-3], most commonly were in molars by 95% [Fig-4] especially in mesiobuccal canal 32% followed by MB2 canal (26%), mesiolingual canal (21%), distobuccal canal (12%), palatal (5%) and distal canal (4%). [Fig 4].

Regarding dealing with the management, 50 % opted to bypass whereas 40 % preferred to refer to endodontist.

Concerning removal methods, 34% of dentists removed separated instrument using Masserann kit, while 28% used ultrasonics and conventional method and 10% IRS.

DISCUSSIONThis is a cross-sectional study aimed to compare the incidence, factors contributing for separated endodontic files between dentists and postgraduates along with treatment options, management mishaps and methods used to retrieve endodontic files during endodontic treatment among dentists in Sangareddy.

FIGURE 4: MOST COMMON TEETH AND MOST COMMON ROOT CANAL IN MOLARS

FIGURE 5: MANAGEMENT OPTIONS

FIGURE 6: METHODS USED TO REMOVE SEPARATED FILE

Different methods for retrieval of instruments4 are: Conventional method; Tweezers, endodontic forceps, mosquito, dental pliers; Micro-tube, Injection needle, Tube like systems, Ultra sonics-Dental operating microscope, Laser, Electrolysis

Tube like systems: Aggressive, risk of root weakening, perforation; Cannot be applied to narrow and curved canals

XX Endoextractor system

XX Masserann kit

XX Instrument removal system (IRS)

XX Separated instrument removal system

XX Canceliar instrument

XX Mounce extractor

Ultrasonics-Dental operating microscope: Can be inserted in depth into the root canal, allows working under bright illumination and magnification, limits the risk of excessive removal of dentin and possible perforation and can be used without water increasing the visibility.


Research Oct-Nov 2021 ReseaRchResearch It causes increased temperature in outer surface of root and secondary separation of the fragment which can be prevented by air spray, low power and not using for longer period.

FACTS FROM LITERATURE4

XX Rotary instrument separation frequency- 0% to 13%

XX Manual instrument separation frequency- 0.25% to 6%

XX Highest frequency of instrument separation in molars (more in mesiobuccal canal)- 77% to 89%

XX Higher rate of separation is in apical third-41% to 82.7%

XX Most common site separation site-2mm from tip of the instrument

XX Most common sizes of instruments undergoing separation–NO 15-40(ISO); taper-4% and 9%.

XX Clinical success rate for treatment of separated instrument- 53% to 95%

XX Rate of successful fragment removal (44%-95%) is higher than instrument bypass (9%-47.7%)

XX Stainless steel instruments are easily retrieved than NiTi

XX Longer fragments are easily removed than shorter ones

Rotary files (62%) were more separated than hand files (38%) contrast to study by Samah et al5 where hand files (53%) were more separated than rotary (47%).

Stainless steel files (74%) were more separated than NiTi (26%) corresponds to study by Samah et al5 (68%).

Small size files are more separated (52%) that corresponds with Choksi et al6

who reported that they are more prone to distortion as a result of stressing on their small cross sections.

Concerning the site, higher percentage was separated in apical third (68%) corresponds to study by Samah et al5 (72%).

While 72% significantly broke during cleaning and shaping -corresponds to study by Samah et al 5 (78%) and Madarati et al,2008.5

41% of causes of breakage were over usage of the file in contrast to this, root canal anatomy (45%) was the major cause as reported by Madarati et al7where 28% of the cause of breakage is due to root canal anatomy.

95% of instruments separated in molars, 32% in mesiobuccal canal (26% MB2 canal) followed by 21% mesiolingual canal corresponding with Madarati et al7.

50% of the sample successfully bypassed which was in contrast to the study by Gandevivala et al8 where majority of them referred to the endodontist.

34% of dentists could successfully remove using masseran kit which was in contrast to the study by Gencoglu and Helvacioglu9 which confirmed that ultrasonics with the aid of an operating dental microscope is more successful in removing fractured instruments.

CONCLUSION“SIR “presents a call for a protocol to handle these endodontic mishaps as a fearless challenge.

REFERENCES1. Sokhi R, Sumanthini MV, Shenoy V. Retrieval of Separated Instrument using

Ultrasonics in a Permanent Mandibular Second Molar: A Case Report. J Contemp Dent. 2014;4(1).

2. Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique. J Endodon. 1979;5(3): 83-90.

3. Iqbal MK, Kohli MR, Kim JS. A retrospective clinical study of incidence of root canal instrument separation in an endodontics graduate program: a PennEndo database study. J Endod. 2006;32: 1048-1052.

4. Triantafyllia Vouzara, Maryam el Chares, Kleoniki Lyroudia. Separated Instrument in Endodontics: Frequency, Treatment and Prognosis. Balk J Dent Med. 2018;123-132.

5. Samah et al. Evaluation of the Factors and Treatment Options of Separated Endodontic Files. Journal of Clinical and Diagnostic Research. 2016;10(3): ZC18-ZC23.

6. ChoksiD,IdnaniB,KalariaD,Patel RN. Management of an Intracanal Separated Instrument: A CaseReport. IranEndodJ. 2013;8(4):205-7.

7. Abmad A.Madarati,Mark J.Hunter,Paul M.H. Dummer. Management of Intracanal separated instruments, JOE. 2013;39(5).

8. Gandevivala A, Parekh B, Poplai G, Sayed A. Surgical removal of fractured endodontic instrument in the periapex of mandibular first molar. J Int Oral Health. 2014;6(4):85-88.

9. Nimet Gencoglua, Dilek Helvacioglub. Comparison of the Different Techniques to Remove Fractured Endodontic Instruments from Root Canal Systems. Eur J Dent. 2009;3:90-95.


GeneralGeneral Oct-Nov 2021General

TOBACCO CESSATION AND COUNSELING

INTRODUCTIONThe tobacco epidemic is one of the biggest public health threats the world is currently facing, killing more than 8 million people per year around the world. More than 7 million had died due to direct tobacco use while around 1.2 million non- smoker died because of exposure to second-hand smoke. Over 80% of the 1.3 billion tobacco users worldwide live developing countries, where the burden of tobacco-related illness and death is highest. Tobacco use contributes to poverty by diverting household spending from basic and fundamental needs such as food and shelter to tobacco.1

India is the second largest consumer of tobacco. According to GATS-2 reports, 28.6% of the population consume tobacco in any form, 10.7% smoke, and 21.4% use smokeless tobacco. Khaini (a form of smokeless tobacco) and beedis are the dominant forms of tobacco consumed in India, at 11% and 8%, respectively. By comparing GATS 2010, there has been a 6% decrease in the tobacco consumption recorded in GATS 2017 and also the NFHS-4 has shown decrease in the graph of prevalence rate as compared with NFHS-3. There has been increase in 1 year in the initiation of tobacco use in GATS-2 compared with the previous survey. However, between NFHS-3 and NFHS-2, during the gap of 7 years, all forms of tobacco consumption had increased; greatest numbers were seen in between 15 to 24 years. The annual growth rate of tobacco consumption is 2% to 3%.2

Smoked form was consumed by 14% of the population. On an average, Indians smoked about 6.2 cigarettes per day; this is the lowest of all countries, but among women, although the prevalence of cigarette smoking was less, the mean cigarettes per day were quite high, about 7, higher than the average of men, which was 6.1.In India, beedis accounted for the largest proportion of smoked tobacco consumed, especially among the lower socio-economic group, they consume beedis 8 to 10 times more than cigarette smoking. A study that assessed trends in beedi and cigarette smoking in India from 1998 to 2015 showed that beedis had been replaced by cigarettes among men due to rising income and increased affordability; that was significantly noticed among the lower socio-economic status groups.3

Department of Public Health Dentistry

K. D Dental College & Hospital Mathura

Dr. Vivek SharmaReader

Dr. Navpreet KaurProfessor & HOD

Dr. Nitul BarmanP.G. Student

Regarding smokeless tobacco, India has the largest number of smokeless tobacco users in the world. Out of the 346 million global consumers, India alone has 80.8 million smokeless tobacco consumers, and there has been definite increase in smokeless tobacco across all age groups. Trends in age-specific standardized prevalence of smokeless tobacco use in India showed that consumption of smokeless tobacco increased with age for both the sexes. Moreover, smokeless tobacco use is considered as a common smoking cessation method and a study showed that 34.4% of smokers switched to smokeless tobacco from smoking tobacco use as a cessation method.4

Secondhand smoke (SHS) exposure is a significant problem in India, at both indoor and outdoor. A study has shown that 70% to 80% of the male smokers regularly smoked in home; 3 in every 10 adults working indoor are exposed to SHS. In home, SHS exposure has been seen especially high among children.4

Tobacco is also seen to be the leading cause for non-communicable diseases (NCDs); mortality due to NCDs accounts to approximately 63% of total tobacco users out of which approximately 80% of the deaths occur due to NCDs occur in low and middle income countries (LMICs) and 50% of these deaths occur in the age group of 30 to 69 years accounting 12% of the total tobacco users death in people who are above 30 years (WHO).5

Among smokers who are aware of the adverse effects of smoking, 3 out of 4 individuals are interested in quitting. One of the most important responsibilities of a countries health care system is to treat nicotine dependence. This effort contains different methods such as individual behavioural counseling, group behavioural counselling, pharmacotherapy/ medications and quit lines/telephone counseling. The cost of these methods varies, however these methods are not equally effective. So, it is important to match the treatment method to the local and cultural context as well as to client’s current needs.6

So, it has become very essential for integration of tobacco cessation programmes with health and development programmes which can be very helpful in overcoming the barriers in tobacco control and decreasing the tobacco-associated burden.


GeneralOct-Nov 2021 GeneralGeneral THE PROBLEM OF NICOTINE ADDICTION: ITS DEPENDENCE AND WITHDRAWALAddiction to nicotine does not happen quickly, it develops gradually. Most smokers go through a series of steps from experimentation or trial to regular use on their way to be addicted. Particularly in the industrialized countries, most people get addiction to nicotine by smoking during their adolescent time. Evidence shows that around 50% of those who initially start smoking in the adolescent years continue to smoke for 15 to 20 years.7

Smoking is a highly efficient form of administration of drug. Inhaled nicotine enters through the lungs and moves into the brain within seconds through blood circulation. Due to rapid rates of absorption and entry into the brain, a strong feeling of “rush” occur and thus reinforcing the effects of the drug. In addition, nicotine accumulates in the body over the course of 6 to 9 hours of continuity of smoking and results in 24 hours of exposure. Arteriovenous differences in nicotine concentrations during cigarette smoking are substantial, with arterial levels up to 10 times as high as venous levels. The persistence of nicotine in the brain throughout the day and night lead to change in the structure and function of nicotinic receptors, thus stimulates the intracellular processes of neuroadaptation.8

Withdrawal produces a series of symptoms that tobacco users may experience when they stop tobacco use suddenly. Withdrawal symptoms may vary but include a craving for nicotine, irritability, frustration or anger, anxiety, depression, diversion from concentrating, restlessness, and increased appetite (which can lead to weight gain). Most symptoms reach to maximum threshold post 24 to 48 hours after cessation and then gradually diminish over a period of few weeks. Some withdrawal symptoms may persist for months such as dysphoria, mild depression, anhedonia and increased appetite.9

Dependence is a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

1. Tolerance

2. Withdrawal

3. Taking larger amounts of the substance or over a longer period than was intended.

4. A persistent desire for or unsuccessful efforts to cut down on substance use.

5. A great deal of time being spent in activities necessary to obtain or use a substance.

6. Abandonment or reduction of important social, occupational, or recreational activities because of substance abuse.

Withdrawal symptoms are also related to the degree of dependence, and they may increase temptations to smoke and alleviate the withdrawal, especially within the first 30 days after cessation. Withdrawal symptoms can be present, persist in a milder form, when a smoker reduces the number of cigarettes smoked or switches to a low-nicotine cigarette. Cravings can persist for months, especially if triggered by situational cues.10, 11

UNDERSTANDING THE CHALLENGES AND OPPORTUNITY OF TOBACCO CESSATION

Studies from India have shown that health education and community awareness has significantly helped in tobacco cessation. The existing TCCs are not sufficiently equipped to take care of any population-based cessation scale-up programme. In low-resource settings, with limited access to pharmacotherapy, there is also a need to evaluate cost-effective behavioural interventions, particularly for smokeless forms of tobacco use, for further expansion of tobacco cessation activities.12

Thus, tobacco cessation activities clearly need to be up-scaled, and the public better informed of the availability and relevance of such interventions. Younger persons using tobacco, women users, rural populations and the economically under privileged need to be more actively targeted. The integration of tobacco cessation with existing national health programmes is a cost-effective strategy to widen the cessation services for effective outreach at the community level. The use of innovative technologies like mobile phones and setting up quit-lines can give a major challenge to the current efforts of the Government of India for providing cessation facilities to a greater population, especially in the remote and rural areas. Thus, integration of these services into the health care delivery system still remains a challenge.13

APPROACHES TOWARDS TOBACCO CESSATION

Tobacco cessation methods can be broadly classified into:

1. Cognitive Behavioral Therapy (CBT)1.1 Brief advice/interventions:-

A variety of behavior therapies, ranging in complexity from simple advice offered by a physician or other health care provider or much more extensive therapy offered by counselors, have been shown to be efficacious for tobacco cessation.

One of the most effective non-pharmacological interventions for smokers strongly motivated to quit is by providing behavior support beyond scheduled clinical care by appropriately trained counselors.

The 5A’s approach assists initially in identifying smokers by encouraging health professionals to ‘ask’ patients/clients whether they smoke/use tobacco. If they smoke, then ‘assess’ –whether willingness to stop smoking, then should ‘advise’ on the importance of quitting, should offer ‘assistance’ in the form of pharmacotherapy and/or referral for behavioural support, and finally should ‘arrange’ a follow-up appointment, if possible, with those patients who wish to stop smoking advice works primarily by triggering a cessation attempt.14

Strategies for Tobacco Cessation – Clinical Practice Guidelines: The 5-A’s and 5-R’s:

The five A‘s: Ask, Advise, Assess, Assist and Arrange and five R‘s: Relevance, Risk, Rewards, Repetition, Roadblocks is a five to fifteen minute approach that has proven global success.


GeneralGeneral Oct-Nov 2021General 1.2 Individual behavioral counseling:-

This type of counseling involves scheduled face-to-face appointments with a trained smoking cessation counselor. In addition to other behavior change techniques, motivational interviewing is generally incorporated into this form of behavioral intervention and is designed to enhance a person‘s impetus to change their behavior. This patient-centered approach enhances an individual‘s motivation for change through self-examination and identification of ambivalence to change and the subsequent resolution leading to sustained positive behavior change.

1.3 Group behaviour therapy programs:-

This form of therapy is offered to small groups of clients, and information, advice and, in most cases, behavioural intervention is provided. Group support allows individuals to learn behavioral techniques, and group participants provide peer support. The chances of quitting are doubled for those who attend group behavioral programs compared with those who receive self-help material but no face- to-face behavioral support. It is currently unclear whether groups are more effective than individual counseling.15

1.4 Telephone counseling/ quitlines :-

Quitlines are telephone-based tobacco cessation services. Since the late 1980‘s, quitlines have been established in many countries, states and provinces. Most are accessed through a toll-free telephone number and provide a combination of services including educational materials, referral to local programs, and individualized telephone counseling. Counselors answer callers‘ questions about the cessation process and help them develop an effective plan for quitting. Reactive quitlines only respond to incoming calls. Proactive quitlines handle incoming calls and also follow up the initial contact with additional outbound calls, to help initiate a quit attempt or to help prevent relapse.

2. Intensive clinical interventionBrief advice from a heath care provider is recognized as an important motivator for a quit attempt. However, the 5A‘s approaches to minimal intervention stress the importance of assisting clients to make a cessation attempt. This may include more intensive behavioural therapy. A range of more intensive behavioural methods has been used in clinical settings to support patient attempts at smoking cessation

These include:

a) Individual counseling

b) Supportive group sessions

c) Aversion therapy

3. Pharmacotherapy:-Types of available pharmacological interventions for smoking cessation have been demonstrated with behavioral support.

3.1. First Line of Drugs

3.1.1. NRT (Nicotine Replacement Therapy):-

NRT increases abstinence rates by 2 to 3 times that of placebo. All pharmacotherapy treatments approximately double the cessation rates.

Therefore, patient preference and prior experience is the basis for treatment choice.

NRT is not advised for patients in immediate post myocardial infarction (within 4 weeks), patients with serious arrhythmias, worsening angina pectoris, or pregnant and lactating women. NRT works by supplanting nicotine from cigarettes and relieving or preventing nicotine withdrawal symptoms. Non-NRT alters or alleviates withdrawal symptoms as well.

Nicotine gumNicotine gum (Nicotine Polacrilex, Nicorette) has been available by prescription since 1985 and over the counter since 1996. Appropriate patient education is required for optimal use of the nicotine gum. Chew the gum until a pepperyl taste or tingling sensation occurs, then park the gum between cheek and gum, to facilitate nicotine absorption through the oral mucosa. Repeat the process of intermittently chewing and parking for about 30 minutes. Daily, patients may chew up to 30 pieces (2 mg) or 20 pieces (4 mg) of the gum. Over-the-counter gum labels recommend chewing 1 to 2 pieces per hour. Start most smokers on 2 mg gum. General guidelines are: use the 2 mg dosage for smokers who smoke fewer than 25 cigarettes per day, and the 4 mg dosage for smokers who smoke at least 25 cigarettes per day.16

Nicotine patchThe nicotine patch is available in several formulations that vary in strength and duration of action. Patches are worn for 16 or 24 hours per day. The 24-hour patch has the advantage of controlling morning smoking urges by producing higher blood nicotine levels upon awakening. The 24-hour patch may be associated with sleep disturbances, but the 16-hour patch is not.17

Starting doses are 21 to 22 mg (24-hour patch) and 15 mg (16-hour patch). Treat most light smokers with a standard dose patch, 21 to 22 mg/24 hours. A new patch is applied each morning on a hairless location between the neck and waist. After 4 to 6 weeks the dose is tapered to half of previous dose i.e.14 mg/24-hour. Following an additional 2 to 4 weeks, apply the lowest dose 7 mg/24 hour to complete the taper. The duration of patch use ranges from 6 to 12 weeks, depending on specific patient characteristics (e.g., prior experience with the patch, amount smoked and amount of nicotine dependence).17

Nicotine nasal sprayNicotine nasal spray (Nicotrol NS) was approved in March 1996 for prescription use. The nasal spray delivers nicotine more rapidly than gum, patch or inhaler, and mimics the nicotine bolus from cigarettes. Smokers use 1 to 2 puffs per hour for 3 months. One spray of 0.5 mg into each nostril equals one dose of 1 mg. Patients may use 1 or 2 doses per hour, not to exceed 5 doses per hour or 40 doses per day. An average smoker uses 15 doses per day, decreasing the dosage over time. The medication is sprayed against lower nasal mucosa. It should not to be sniffed, swallowed, or inhaled.18

Nicotine inhalerThe nicotine inhaler (Nicotrol Inhaler) has been available in prescription form since 1998. The inhaler may be the best choice for smokers that need a substitute for the hand to mouth behaviour, and the tactile/sensory stimulation


GeneralOct-Nov 2021 GeneralGeneral Acupuncture as an aid to smoking cessation has been the subject of a number of controlled studies. Two meta-analyses have reviewed the results of controlled studies (While et al, 1990, Flore et al, 2000). There was no significant difference between active acupuncture and inactive acupuncture procedures.22

4.2. Hypnotherapy

Hypnotherapy as an aid to smoking cessation has been the subject of a number of studies, including some controlled trials but the Cochrane systematic review (Abbott et al, 2002) concluded that there was such heterogeneity between methods and results that a meta-analysis of the literature was not possible at that time. The review concluded that hypnotherapy does not show a greater effect on six month quit rates than other interventions or no treatment.22

4.3. Yoga therapy

Tobacco smoking remains the leading preventable cause of death across the world. Exercise has shown promise as an aid to smoking cessation because it reduces weight gain and weight concerns, improves affect, and reduces nicotine withdrawal symptoms and cigarette craving. Studies have shown that the practice of yoga improves weight control, and reduces perceived stress and negative affect. Yoga practice also includes regulation of breathing and focused attention, both of which may enhance stress reduction and improve mood and well-being and may improve cessation outcomes.22

ROLE OF DENTAL HEALTH PROFESSIONALS IN TOBACCO CESSATIONAs health professionals, the role of dentist specifically the public health dentist is constantly expanding and can be as far reaching as a professional’s imagination, sense of responsibility and efforts. This is attributed to their expertise in dental and oral matter; they are highly respected, trusted and influential community leaders in any society. Their voices are heard across a vast range of social, economic and political arenas. Thus, they constitute a “teachable moment” to the community and can perform a unique role in tobacco use cessation activities.23

At the individual level This is approached at chair side, where the dentists see the harmful effects of tobacco use and they spend more time with the patient than other physicians. They should use this time to counsel the patient by promoting the oral health and healthy lifestyles. This can be achieved through few minutes of focused talk during oral examination and make the patient aware and conscious of the harmful effects of tobacco use. 24

For those willing to quit the 5 “A” method should be implemented

1) Ask - about tobacco use at every visit,

2) Advise - non-users to never use tobacco and users to quit,

3) Assess - the patient’s readiness to quit and the level of dependence,

4) Assist - with quitting,

5) Arrange - follow-up visits.

that cigarettes provide. It is also effective as a combination therapy with other NRT agents and bupropion. The -inhaler‖ designation is a misnomer. The device does not deliver nicotine to the lungs. Each puff on the inhaler delivers 13 mg. To receive levels similar to most cigarettes, over 20 minutes, 80 puffs are needed to get 2 mg of nicotine.

Nicotine VaccineXX A novel approach to assist in smoking cessation is the development of a

nicotine-specific vaccine.

XX Attaching nicotine to a suitable antigenic protein stimulates formation of antibodies (Nic-IgG) that has a high affinity and specificity for nicotine.

3.1.2. Non-NRTs:-Bupropion Hydrochloride:-

Since 1998, bupropion hydrochloride (Zyban) has been available as an aid to smoking cessation by prescription. Bupropion is an aminoketone antidepressant that weakly inhibits both noradrenergic and dopaminergic uptake. It is believed to work based on the dopaminergic activity affecting the mesolimbic system and nucleus accumbens, which is the pleasure reinforcing area of the brain for addictive drugs. It also affects the noradrenergic activity in the locus caeruleus, which activates higher cortical functions such as alertness, concentration and memory. Lack of norepinephrine stimulation with nicotine withdrawal may account for withdrawal symptoms.19

Varenicline:-

Varenicline is the most recent drug developed for specific use in smoking cessation. It has a different mechanism of action to the other available smoking cessation products and appears to be an improvement on existing treatments for tobacco dependence. It is designed to work on the same receptor in the brain as nicotine to help relieve the craving and withdrawal symptoms associated with giving up smoking, while at the same time block the satisfying effects of nicotine. A total treatment duration of 12 weeks is usually recommended. If a patient who has managed to stop smoking at the end of the treatment period lacks confidence about remaining abstinent, it is worth considering treatment continuation, bearing in mind the high smoking relapse rates. Results of a long-term safety study indicate that varenicline is well tolerated and has a favorable safety profile for administration of up to 1 year.20

3.2. Second Line of Drugs

Clonidine & NortriptylineClonidine is a centrally acting α2-adrenergic agonist that dampens sympathetic nervous system activity. A small number of trials have shown that clonidine may be effective in promoting smoking cessation, but prominent side effects limit its usefulness for this purpose.

Nortriptyline is a tricyclic antidepressant that blocks reuptake of norepinephrine and serotonin. Dose :- 0.15mg – 0.75mg per day for 3-10 weeks.21

4. Other forms of therapy4.1. Acupuncture


GeneralGeneral Oct-Nov 2021General In the community level.

A public health dentist specifically can make an immense contribution in tobacco use cessation at the community level by various ways such as the following:

1. by acting as a role model by not using tobacco or by quitting successfully,

2. by performing individual or group meetings periodically about the importance of tobacco use cessation,

3. by developing and implementing school intervention models for tobacco cessation,

4. by displaying educational material during the out-reach programs or in the urban and rural health centers where most of the population visit to seek health care,

5. by writing articles about benefits of tobacco control policies and participating in talk shows,

6. by linking with NGOs to spread health awareness, bringing into limelight the success stories of tobacco use cessation which can help in enlightening the community perception about tobacco use. 25

ROLE OF DCI, GOVT. OF INDIA & MOHFWIn order to tackle the epidemic of tobacco in India the Government of India has taken proactive steps including adjusting and adapting the Framework Convention of Tobacco Control (FCTC) and enacted the “Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce Production, Supply and Distribution)” Act as a multi measure law from May 1st 2004.26

In the pilot phase, tobacco control units were established in 18 districts in 9 states, in 2007-08 which was to be expanded to 12 more states. In 2002, the World Health Organization (WHO) in collaboration with Ministry of Health and Family Welfare, Government of India initially opened 13 Tobacco Cessation Clinics later expanded to 19 across the country. The fourteen tobacco cessation clinics (TCC) were set up in various departments like psychiatry (3), cancer (5), surgical (2), cardiology (1), chest diseases (1) as well as in a general hospital setting (1) and nongovernment organizational setting (1). Later the TCCs were subsequently expanded to five more Regional Cancer Centres (RCC) in 2005. NOHP and NTCP have joined hands to expand the reach of tobacco cessation services in the country in collaboration with the Dental Council of India.27,28

The DCI established Tobacco Cessation Centres (TCC) in all the dental institutes in India in order to encourage and create interdisciplinary clinics in dental institutes across the country that contribute in tobacco control and protecting patients from public health problems. The Tobacco Cessation Centers helps patients who want to stop using tobacco or patients interested in learning more about tobacco cessation. Certified tobacco cessation counsellors provide one-on-one counselling for all patients interested in quitting tobacco. Complimentary materials and cessation tools, such as nicotine patches, lozenges, and/or gum are provided to qualifying patients at no cost.29

The TCC should be under the department of public health dentistry/department of oral medicine and radiology. Strong built-in referral system would be established with other dental and medical departments.29

1. 1st chain of referral: - strong protocol for the referral chain would be developed amongst various departments in the dental college mainly oral medicine and radiology, department of public health dentistry, department of periodontology and department of oral surgery.

a. Clear, short and simple guidelines should be developed for referring a patient along with information of the location and timing of the centre.

b. TCC posters should be the displayed in all areas that clearly mention location and timing of the center.

c. Staff, post graduate students and interns should be oriented regularly.

2. 2nd chain of referral: - All dental colleges in India affiliated either to medical colleges or medical hospitals where various departments like community medicine, pulmonary medicine, preventive cardiology, psychiatry and ENT should be linked to TCC.

3. 3rd chain of referral:- All TCC should display the mCessation Programme- quit tobacco for life 011-229901701 and National Quitline Number 1800-11-2356.

There should be adequate space along with comfortable sitting arrangements, free from external sounds and distractions with adequate storage space for maintaining medical records. The TCC should have sufficient space for display of posters and other materials and provisions for electric supply, telephone and internet facility as well as common access for toilet and drinking water facilities.29

Thus dental institutions can be instrumental in rendering behavioural and pharmacological interventions along with dental care to facilitate changes in tobacco user’s behaviour. It will also strengthen the role and strategies of the DCI and National Tobacco Control Programme, Ministry of Health and Family Welfare and Govt. of India in promoting tobacco control and rendering tobacco cessation services in India.

Finally, tobacco control efforts are more likely to be bolstered when incorporated into existing national-level, state-level and district-level health structures linked with current positions and accountability processes. The attempt to do so under the National Tobacco Control Program must be sustained and strengthened.

REFERENCES1. Tobacco - WHO (World Health Organization). Fact-Sheet. www.who.int;

accessed on 11/2/2021.

2. National Family Health Survey (NFHS) 4. Ministry of Health and Family Welfare, Govt. of India, National Family Health Survey 4, Fact Sheets| India 2017. www.rchiip.org; accessed on 11/2/2021.

3. Gender, Women, and the Tobacco Epidemic: 7. Addiction to Nicotine; www.who.int; accessed on 11/2/2021.

4. Mistry R, Dasika A. Antenatal tobacco use and secondhand smoke exposure in the home in India. Nicotine Tob Res. 2017; 20 (2):258–261.

5. WHO. Code of practice on tobacco control for health professionals organization, Geneva; 2004. www.who.int; accessed on 17/2/2021.

6. Gholamreza Heydari, Mohammadreza Masjedi, Arezoo Ebn Ahmady, Scott J. Leischow, Harry A. Lando, Mohammad Behgam Shadmehr, et.al. A comparative study on tobacco cessation methods: a quantitative systematic review. International journal of preventive medicine; 2014; 5(6): 673–678.

More References Are Available on Request

GeneralOct-Nov 2021 General


DENTAL DISPOSABLES VS REUSABLE CONSUMABLES

The trend for disposable medical devices every day is expanding, more healthcare experts are changing from reusable medical devices to disposable medical devices. Disposable medical devices play a significant part in the healthcare services industry and furthermore represents a consistent development.

Currently the dental industry does not seem to be aligned completely with overall healthcare as the disposables are still a resistant topic of discussion. The factors can be many for this cost, inventory management, acceptance etc. But with Pandemic the scenario is taking a turn around and arise in awareness is much evident.

To give an overview & perspective about the disposables & reusable consumables let us dig the aspects deeper.

A disposable device is one that that is designed to be used on only one patient and then disposed of. The device may be one that is not heat tolerant, such as disposable mouth mirrors, prophy angles, plastic evacuation tips or air/water syringe tips.

A reusable consumable can be used multiple times and that are appropriate for reprocessing and can be safely used on another patient frequently.

Benefits of Disposable Medical Supplies Versus Reusable1. Patient Safety: utilizing reusable medical supplies opens more risks towards

patients of infections caused by cross-contamination if proper sterilization practices are not followed. While the strict cleaning procedures required for these types of supplies can minimize the risk, it’s always important to account for human error which is unavoidable in every industry. Compared to single-use supplies, most of which are pre-packed or sterilized, reusable devices carry a much higher risk of causing infections. When it comes to protecting the health and safety of your patients, choosing between disposable and reusable is simple: Disposable medical supplies win almost every time.

2. Environmental Impact: The most prominent drawback of utilizing single-use supplies is that it contributes to the growing supply of biomedical waste. When you purchase medical disposables, you can rest easy knowing that in addition to keeping your patients safe, you’re protecting the earth.

3. Time: In order to ensure that reusable medical devices are safe to use with other patients, they must be cleaned after every use. Most single-use medical devices are ready to use upon opening, saving medical professionals a significant amount of time. Single-use devices, also, eliminate the need for medical staff to clean, disinfect, and sterilize reusable devices.

4. Reduced risk of cross contamination: According to the CDC (Centres for Disease Control and Prevention), disposable items improve patient safety by eliminating the risk of patient-to-patient contamination because the item is discarded, and therefore not used on another patient. Contaminated consumables spread infection, create health issues, and can complicate surgical recovery. When consumables are used once, there is no risk of cross-contamination between patients.

5. Waste: While many argue the amount of waste disposables create, but on the contrary the amount of energy, water, detergent, steam, and electricity used to decontaminate reusable consumables is more detrimental to the environment than disposable tools.

6. Decontamination: Disposable medical tools ensure a contamination free instrument before each surgery. When a tool comes to the healthcare centre pre-sterilized, the decontamination or lengthy sterilization process isn’t needed, therefore making it easier to use.

7. Traceability: Once a tool is used, disinfected, and put into storage, its cleanliness isn’t traceable. Disposable, one-time-use tools ensure the ability to account for all pieces of inventory and full traceability. The lot number that each piece has is able to be traced back to the medical manufacturing plant to prevent inconsistencies and issues.

Media ReleaseMedia Release Oct-Nov 2021Media Release


DENTSPLY SIRONA AND 3SHAPE EXPAND THEIR STRATEGIC PARTNERSHIP WITH SEAMLESS CONNECTIVITY FOR DENTISTS AND

DENTAL LABS

Dentsply Sirona’s intraoral Primescan and Omnicam scanners now integrate directly with 3Shape’s lab software, delivering better workflows and patient outcomes.

Charlotte, N.C./Copenhagen, Denmark, December 8, 2021. Dentsply Sirona and 3Shape have taken the next step according to their agreement and now provide a seamless and secure integration of Dentsply Sirona’s Connect Case Center with 3Shape’s Dental System software. Dentists using Primescan or Omnicam intraoral scanners for digital impression-taking can now give dental labs secure access to the data through the Connect Case Center Portal. That makes it easy and efficient for dental technicians using 3Shape’s software to work more closely with their dental practice partners.

The new interfaces are available to dental laboratories that use 3Shape’s Dental System and have upgraded to Version 2021.2.

“Digital impressions facilitate communication. After scanning I can discuss the digital model directly with my patient. And because I now can communicate with the lab technician seamlessly, I can share the planned outcome with my patient much quicker – and that is a benefit to the patient that matters,” said Dr. Sabrina Hoffmann, a dentist in Buerstadt, Germany. “What we are experiencing today is truly the dentistry of the future.”

Last June, both companies announced an agreement between the two companies designed to improve digital dentistry and oral health. The goal is to support the dental community through the evolution of efficient, simplified, and digitally oriented workflows for dentists and dental technicians. As a first step, users of 3Shape’s TRIOS intraoral scanner gained validated and seamless access to Dentsply Sirona’s SureSmile Clear Aligners platform, which makes

Fig. 3: 3Shape’s lab software users are future proofing their business by joining the digital revolution in dentistry. 3Shape dental labs can now more easily communicate and exchange

data with their customers using Dentsply Sirona’s Primescan.

Fig. 1: The partnership between Dentsply Sirona and 3Shape has become even more beneficial for customers thanks to a seamless connection between Primescan, Omnicam and 3Shape Labs.

Fig 2: Primescan is a gateway to many digital lab workflows. Users now benefit from a seamless connection to 3Shape lab software.

“I always want to give a patient the treatment I feel is best for them. When companies like Dentsply Sirona and 3Shape choose to work together, it gives all dentists and lab owners more opportunities, and that means better outcomes for our patients,” said Dr. Alan Jurim, owner of integrated DENTAL (Woodbury, NY).

With integrated hardware and software, even highly complex treatments can be efficiently planned and executed. Simplifying digital workflows results in a closer working relationship between labs and their dentist partners.

Fig. 4: Dr. Alan Jurim: “This collaboration gives all dentists and lab owners more opportunities, and that means better

outcomes for our patients.”

Fig. 5: Dr. Sabrina Hoffmann: “Being able to communicate with the lab technician seamlessly makes it possible for me to share the planned

outcome with my patient much quicker.”

Media ReleaseOct-Nov 2021 Media ReleaseMedia Release


it much easier for 3Shape’s customers to offer patients a leading solution for treating malocclusions.

Both companies are now focusing on expanding customer access to an even wider range of technology choices.

About Dentsply Sirona:

Dentsply Sirona is the world’s largest manufacturer of professional dental products and technologies, with over a century of innovation and service to the dental industry and patients worldwide. Dentsply Sirona develops, manufactures, and markets a comprehensive solutions offering including dental and oral health products as well as other consumable medical devices under a strong portfolio of world class brands.

Dentsply Sirona’s products provide innovative, high-quality and effective solutions to advance patient care and deliver better and safer dental care.

Dentsply Sirona’s headquarter is located in Charlotte, North Carolina. The company’s shares are listed in the United States on NASDAQ under the symbol XRAY.

Visit www.dentsplysirona.com for more information about Dentsply Sirona and its products.

About 3Shape:

3Shape is changing dentistry together with dental professionals across the world by developing innovations that provide superior dental care for patients. We partner with industry leaders to give dental professionals open choices for their patient care as well as supporting professionals’ continued education. 3Shape’s solution portfolio includes the 3Shape TRIOS® intraoral scanner, dental lab scanners, design services, and market-leading scanning and design software solutions for both dental practices and labs. Our 1700 employees serve customers in over 100 countries from 3Shape offices around the world. 3Shape’s products and innovations continue to challenge traditional methods, enabling dental professionals to treat more patients more effectively. www.3shape.com

PRESS CONTACT

Marion Par-Weixlberger

Vice President Public Relations & Corporate Communications

Sirona Straße 1, 5071 Wals bei Salzburg, Austria

T +43 (0) 662 2450-588, F +43 (0) 662 2450-540

[email protected]

Bruce Frederic Mendel

3Shape Director Corporate Communications

Holmens Kanal 7, 1060 Copenhagen Denmark

T: +45 7027 2620

[email protected]




01126941512, +91 9990922853

DOWNLOAD APP HERE

Media ReleaseMedia Release Oct-Nov 2021Media Release


THE GOLD STANDARD IN INSTRUMENT DISINFECTION DÜRR DENTAL’S SYSTEM HYGIENE MAKES INSTRUMENT HYGIENE EVEN SAFER AND EASIER.

This is based on the revised version of the recommendations of the Robert Koch Institute’s Commission for Hospital Hygiene and Infectious Disease Prevention, dated Autumn 2012 (hygiene requirements for the treatment of medical instruments). The RKI assesses medical instruments using risk classes A, B, and C, classifying them into non-critical, semi-critical, and critical medical products. For each group of medical products, the institute recommends a suitable treatment procedure. This might be manual, machine-based, or both. For example, for instruments in the class “Semi-critical A+B”, a manual and a machine-based treatment procedure is possible. For “Critical A”, treatment can again be either machine-based or manual. However, in this case manual treatment must be followed by damp heat sterilization in a sterilizer. In the case of “Critical B” instruments, a machine-based treatment procedure is required.

Machine-based treatment is indeed better standardized, easy to reproduce, and less labour-intensive. However, the RKI also states that the manual or partially manual treatment of medical products is still permitted, sensible, and safe. For example, semi-critical instruments in the group A+B, which do not penetrate the skin, do not necessarily need to be sterile when used. However, the aim is to clean and disinfect them so that the germs are reliably eradicated. In the case of a final disinfection of semi-critical medical instruments, the RKI recommends the use of a product with a fully virucidal scope of action (Federal Health Gazette 10-2012, p. 1254). This is only possible in the case of high-quality products, which are also gentle on materials. Dürr Dental supplies products from its System Hygiene range, colour code “blue” especially for this area. This includes fully virucidal products, which are effective against all enveloped and non-enveloped viruses, such as instrument disinfectant ID 213 and drill solution ID 220.

A defined hygiene protocol helps standardize instrument disinfection. There are four work stages:

1. Pre-treatment, collection, pre-cleaning, and dismantling

2. Pre-disinfection, cleaning, disinfection, rinsing, and drying

3. Check for cleanliness and integrity

4. Care and maintenance

The people responsible for instrument treatment are ultimately responsible for deciding whether treatment should always be machine-based or whether a manual procedure is sufficient. This depends on the preceding use of the instrument in question as well as its planned usage in the future. This also

applies when deciding into which risk class an instrument belongs. If in doubt, you should always choose the higher risk classification to be on the safe side. Naturally, another key factor for the success of the hygiene plan is well-trained personnel. Furthermore, you should only use cleaning agents and disinfectants with clear manufacturer specifications whose effectiveness has been proven for the area in question, as is the case for products from Dürr Dental. One quality indicator is certification by Verbund für Angewandte Hygiene e.V. (VAH), which also lists Dürr Dental’s System Hygiene Products.

Instrument disinfection is a really important part of surgery hygiene. Contaminated instruments pose a significant infection risk for patients and the surgery team. The proper disinfection of medical instruments therefore has to be a top priority for dental surgeries.

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1. Most Proactive Dental College of the Year

2. Most Proactive Sr. Academ

ician of the Year (For All Depts.)

3. Most Proactive Jr. Academ

ician of the Year (For All Depts.)

4. Best Dept. of Prosthodontics

5. Best Dept. of Orthodontics

6. Best Dept of Endodontics

7. Best Dept of Periodontics

8. Best Dept of Oral & Max. Surgery

9. Best Dept. of Oral Pathology

10. Best Dept. Oral Medicine & Radiology

11. Best Dept. of Pedodontics

12. Best Dept. of Comm

unity Dentistry

13. Best Student PG Category (Prosthodontics)

14. Best Student PG Category (Orthodontics)

15. Best Student PG Category (Pedodontics)

16. Best Student PG Category (Endodontics)

17. Best Student PG Category (Periodontics)

18. Best Student PG Category (Oral & Max. Surgery)

19. Best Student PG Category (Comm

unity Dentistry)

20. Best Student PG Category (Oral Pathology)

21. Best Student PG Category (Oral Med. & Radiology)

22. Best Student INTERN Category

23. Best Student UG Category 1st year

24. Best Student UG Category 2nd year

25. Best Student UG Category 3rd year

26. Best Student UG Category 4th year

27. T h e Most Prom

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