IDA Maharashtra State Branch Dental Dialogue April-Jun 2012

Vol. XXXVIII No.
2 APRIL - J UNE 2012 Dental Dialogue

Indian Dental Association
Maharashtra State Branch
Vol. XXXVIII No. 2 APRIL - J UNE 2012
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E-mail : rajendrabhasme1959@gmail.com / yahoo.com
Office : 57, 38 Rutu Dent, Pradhan Park,
M. G. Road, Nashik 422 001
Tel. No. (O) 0253-2313512 (R) 0253-2577389
Mob. : 90110 27610, 94222 46871
E-mail : n sanjayvasantbhawsar@yahoo.com
n sanjayvbhawsar@gmail.com
President :
I st Vice President :
II nd Vice President :
III rd Vice President :
President Elect :
Imm. Past President :
Hon. Editor :
Dr. Sanjay Bhawsar
Dr. Manoj Joshi
Dr. Suhas Merchant
Dr. Aruna Bhandari
Dr. Bajrang Shinde
Dr. Arunkumar Chhajed
Dr. Rajendra Bhasme
INDIAN DENTAL ASSOCIATION
MAHARASHTRA STATE BRANCH
Website : www.idamsb.org
Official Journal of IDA MSB
Mobile : 9422419428 Telefax : P. P. 0231-2653906
Dental Dialogue
Dental Dialogue
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Opp. Daulatrao Bhosale School,
Shivaji Peth, Kolhapur - 416 012.
Tel. : 0231-2629331
Edit or ia l Office
249 / 79, J ANAK, 1 / 101,
Near Nagala Park Kaman,
Nagala Park, Kolhapur - 416 003.
Tel : 0231-2653473
Res idence
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WHAT I S I N....
What is in . . . 53
Editorial 55
Presidents Message 57
Dental Dialogue News 79
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Temporomandibular Joint Disorders : A Common Problem Yet 59
Complex To Understand
A Rare Case Of Two Separate Mesial Roots In Mandibular 62
First Molar : A Case Report
Reducing Sensitivity After Composite Restoration: A Study 64
Comparing Amount Of Separation And Discomfort During Tooth 66
Separation Between Two Types Of Separators
Feedback 68
Class II Correction, The Functional Therapy Approach 69
Book Review 70
Guiding Planes - Pathway For Success 71
Nodular Fasciitis : A Rare Case Report 73
Therapeutic Role Of Epsilon-Aminocaproic Acid In The Management Of 76
Dentoalveolar Trauma In Hemophilia A- A Case Report
Periodontal Medicine In Clinical Practice 78
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Don't miss the Scientific Extravaganza and Trade fair of International Standards
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* Bachelor of Dental Surgery
* Master of Journalism&CommunicationScience
Dr. RajendraBhasme,BDS, MJC
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This Issue is released on 19th Sept. 2012 i.e. Ganesh Chaturthi Shake 1934, at Kolhapur
Dear Collegues,
At the outset, we apologi se for delay i n publi shi ng thi s i ssue of Dental
Di alogue. The edi tor was busy i n coveri ng XXX London Olympi cs i n Dai ly Ekmat
ti tled n tlnl+ from 5th July to 15 Aug. 2012.
We are very pleased to release thi s i ssue on the auspi ci ous occasi on of Ganesh
Chaturthi u+ ,. I ti s good to know that the 51st MSDC wi ll be held at Pune on
15th & 16th December 2012 at VI TS Hotel & Orchi d Conventi on Center,
Balewadi , Pune.
We would li ke to Congratulate our presi dent Dr. Sanjay Bhavsar for
arrangi ng the Conference & conducti ng zonal conventi ons i n Maharashtra
wi thout havi ng much support from offi ce of HSS I DA MSB.
All are requested to attend i n large numbers.
The Golden Jubi lee of I DA MSB di d not take place due to reasons beyond our
control. Si mi lar event should not happen i n future. The members of I DA are eager
to meet each other i n EC meeti ngs & Zonal Conventi ons etc.
I t i s very easy to cri ti si ze, but i t i s very di ffi cult to work for the associ ati on.
The book on Geri atri c Denti stry by Dr. P. G. Di wan i s
excellent. We appeal DCI to i nclude the subject of Geri atri c
Denti stry i n the dental curri culum.
Also, the members above age 60 yrs. should be excluded
from collecti ng mandetory CDE poi nts.
JUnVr ~mnm _moa`m
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Dr. Sanjay V. Bhawsar
President, IDA MSB
PRESIDENT'S MESSAGE..
Dear Friends,

It has been seven months in my journey as the President of IDA MSB. I am proud
to inform you all that in these few months we have been successful in organizing
various programmes in different zones of Maharashtra state.
The 3 zonal programmes conducted in places like Mumbai, Aurangabad and
Panchagani were a grand scientific bonanza for IDA members. 6 other zonal
programmes are meticulosely planned with the help of eminient speakers in next 5
months.
IDA student members are the back bone of IDA future. This year 5 student Zonal
conferences will be conducted at Maharashtra level so as to provide a platform to
students to exhibit there hidden talent. Students from Dental colleges in the interiors
of the state will have a opportunity to participate in scientific, sports, cultural
competetions. The final state level round of the Students Conference will be held in
Mumbai, this December. I am very much thankful to IDA Mumbai branch for hosting
the student conference.
For the first time a State level Table Tennis & Badminton Tournaments are
arranged for IDA dentist & student members on 14 -16 th Aug. 2012 by IDA MSB in
association with IDA Mumbai branch .
IDA in association with Government of Maharashtra is planning to organize
Dental Check up of near about 1 lakh Anganwadi Sevika & Children from all over the
Maharashtra. I appeal to all the ida members & dental colleges to help us in making
this Towering task successful.
IDA Maharashtra state will be organizing the 51 st Maharashtra State Dental
Conference at Pune in the month of December 2012. I appeal all the members to
participate in large numbers to make it a grand memorable event.
Recently Pepsodent has also joined hands with IDA to support of our scientific
activities.
With the magic of monsoon is in the air let us enjoy the spirit of the season; the
season of warmth, joy and cheer. Best Wishes to all the IDA Members for the
auspicious Shravan, Ganesh Chaturthi and upcoming Dassera and Diwali.
Ability is nothing without opportunity. I thus take the opportunity to wish all our
members good health and success in this wonderful year ahead. May IDA reach
soaring heights which we all have dream of.
Dr. Sanjay Bhavsar
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Dr. Laxmikant Kishanrao Bichile
Elected Member, Maharashtra State Dental Council, Mumbai
Mahatma Gandhi Mission's Medical College and
Hospital, Aurangabad. Mob:-9422709054 (Off)- 0240-6601100
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Temporomandibular joint disorders :
A common problem yet complex to understand
Dr. Manish Agrawal, MDS, Prof.,
Dr. Anita Shipurkar, MDS, Prof.
Dr. Dayanand Huddar, MDS, Reader
Dr. Banashree Sankeshwari, MDS, Asst. Prof.
Dept. of Prosthodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli
Prosthodontics
Abstract :
Introduction:
Temporomandibular joint:
Temporomandibular disorder is any disorder that
affects or is affected by deformity, disease, misalignment
or dysfunction of the temporomandibular joint and the
associated responses in the musculature. The term
temporomandibular disorder include displacement of
one or both joints, misalignment of the disc, various
diseases that affect bone or articular surfaces and other
pathologic disorders, inflammation or injuries to specific
intracapsular structures. This article highlights the
causes, symptoms, diagnosis and treatment on
temporomandibular joint disorder.
Key words: tempormandibular joint, TMJ disorders,
stabilization splints, night guard.
The temporomandibular joint is susceptible to all the
conditions that affect other joints in the body, including
ankylosis, arthritis, trauma, dislocations, developmental
anomalies and neoplasia. Although treatment is often
similar to other joints in the body, some variations exist.
This article will highlight various causes, symptoms, &
treatment for temperomandibular joint disorder (TMJD).

The temporomandibular joint (TMJ)(fig 1,2) is the
area directly in front of the ear on either side of the head
where the upper jaw (maxilla) and lower jaw (mandible)
meet. Within the TMJ, there are moving parts that allow
the upper jaw to close on the lower jaw. This joint is a
typical sliding "ball and socket" that has a disc
sandwiched between it. The TMJ is used throughout the
day to move the jaw, especially in biting and chewing,
talking, and yawning. It is one of the most frequently used
1,2
joints of the body.
The temporomandibular joints are complex and are
composed of muscles, tendons, and bones. Each
component contributes to the smooth operation of the
TMJ. When the muscles are relaxed and balanced and both
jaw joints open and close comfortably, we are able to talk,
chew, or yawn without pain.
We can locate the TMJ by putting a finger on the
triangular structure in front of the ear. The finger is moved
just slightly forward and pressed firmly while opening the
jaw. The motion felt is from the TMJ. We can also feel the
joint motion if we put a little finger against the inside front
1
part of the ear canal. These maneuvers can cause
considerable discomfort to a person who is experiencing
TMJ difficulty.
Due to the proximity of the ear to the temporo-
mandibular joint, TMJ pain can often be confused with ear
pain. The pain may be referred in around half of all
patients and experienced as otalgia (earache). Conversely,
TMD is an important possible cause of secondary otalgia.
Treatment of TMD may then significantly reduce sympt-
oms of otalgia and tinnitus as well as atypical facial pain.
The dysfunction involved is most often in regards to
the relationship between the condyle of the mandible and
the disc. The sounds produced by this dysfunction are
usually described as a "click" or a "pop" when a single
sound is heard and as "crepitation" or "crepitus" when
there are multiple, rough sounds.
TMJD is a term covering acute or chronic
inflammation of the temporomandibular joint, which
connects the mandible to the skull. The disorder and
resultant dysfunction can result in significant pain and
impairment. Because the disorder transcends the
boundaries between several health-care disciplinesin
particular, dentistry and neurologythere are a variety of
treatment approaches.
The temporomandibular joint is susceptible to many
of the conditions that affect other joints in the body,
including ankylosis, arthritis, trauma, dislocations,
developmental anomalies, and neoplasia.
An older name for the condition is "Costen's
syndrome", after James B. Costen, who partially
characterized it in 1934.
Temporomandibular joint disorder (TMJD or TMD)
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Cause:
There are many external factors that place undue
strain on the TMJ. These include but are not limited to the
following:
Bruxism has been shown to be a contributory factor in
the majority of TMD cases. Over-opening the jaw beyond
its range for the individual or unusually aggressive or
repetitive sliding of the jaw sideways (laterally) or
forward (protrusive). These movements may also be due
to parafunctional habits or a malalignment of the jaw or
dentition. This may be due to:
1. Bruxism (repetitive unconscious clenching or
grinding of teeth, often at night).
2. Trauma
3. Misalignment of the occlusal surfaces of the teeth due
to defective crowns or other restorative procedures.
4. Jaw thrusting (causing unusual speech and chewing
habits).
5. Excessive gum chewing or nail biting.
6. Size of food bites eaten.
7. Degenerative joint disease, such as osteoarthritis or
organic degeneration of the articular surfaces,
recurrent fi brous and/ or bony ankyl osi s,
developmental abnormality, or pathologic lesions
within the TMJ
8. Myofascial pain dysfunction syndrome
9. Lack of overbite
Patients with TMD often experience pain such as
migraines or headaches, and consider this pain TMJ-
related.. The dentist must ensure a correct diagnosis does
not mistake trigeminal neuralgia as a temporomandibular
disorder. The following are behaviors or conditions that
can lead to TMJ disorders.
1. Teeth grinding and teeth clenching (bruxism)
increase the wear on the cartilage lining of the TMJ.
Those who grind or clench their teeth may be
unaware of this behavior unless they are told by
someone observing this pattern while sleeping or by a
dental professional noticing telltale signs of wear and
tear on the teeth. Many patients awaken in the
morning with jaw or ear pain.
2. Habitual gum chewing or fingernail biting
3. Dental problems and misalignment of the teeth
(malocclusion). Patients may complain that it is
difficult to find a comfortable bite or that the way their
teeth fit together has changed. Chewing on only one
side of the jaw can lead to or be a result of TMJ
problems.
4. Trauma to the jaws: Previous fractures in the jaw or
facial bones can lead to TMJ disorders.
Stress frequently leads to unreleased nervous energy.
It is very common for people under stress to release this
nervous energy by either consciously or unconsciously
grinding or clenching their teeth.
Occupational tasks such as holding the telephone
between the head and shoulder may contribute to TMJ
disorders.
Symptoms:
13
Treatment for TMJ disorders:
TMJ pain disorders usually occur because of
unbalanced activity, spasm, or overuse of the jaw muscles.
Symptoms tend to be chronic, and treatment is aimed at
eliminating the precipitating factors. Many symptoms
may not appear related to the TMJ itself.
Signs and symptoms of temporomandibular joint
disorder vary in their presentation and can be very
complex, but are often simple. On average the symptoms
will involve more than one of the numerous TMJ
components: muscles, nerves, tendons, ligaments, bones,
connective tissue, and the teeth. Ear pain associated with
the swelling of proximal tissue is a symptom of
temporomandibular joint disorder.
The following are common Symptoms associated
with TMJ disorders:
l Biting or chewing difficulty or discomfort
l Clicking, popping, or grating sound when opening or
closing the mouth
l Dull, aching pain in the face
l Earache (particularly in the morning)
l Headache (particularly in the morning)
l Hearing loss
l Migraine (particularly in the morning)
l Jaw pain or tenderness of the jaw
l Reduced ability to open or close the mouth
l Tinnitus
l Neck and shoulder pain
l Dizziness
How are patients evaluated and diagnosed when TMJ
problems are suspected?
A complete dental and medical evaluation is often
necessary and recommended to evaluate patients with
suspected TMJ disorders. One or more of the following
diagnostic clues or procedures may be used to establish
the diagnosis. Damaged jaw joints are suspected when
there are popping, clicking, and grating sounds associated
with movement of the jaw. Chewing may become painful,
and the jaw may lock or not open widely. The teeth may be
worn smooth, as well as show a loss of the normal bumps
and ridges on the tooth surface. Ear symptoms are very
common. Infection of the ear, sinuses, and teeth can be
discovered by medical and dental examination. Dental X-
rays and computerized tomography (CT) scanning help to
define the bony detail of the joint, while magnetic
resonance imaging (MRI) is used to analyze soft tissues
,

The mainstay of treatment for acute TMJ pain is heat
and ice, soft diet, and anti-inflammatory medications.
1. Jaw rest: It can be beneficial to keep the teeth apart as
much as possible. It is also important to recognize
when tooth grinding is occurring and devise methods
to cease this activity. Patients are advised to avoid
chewing gum or eating hard, chewy, or crunchy foods
such as raw vegetables, candy, or nuts. Foods that
require opening the mouth widely, such as a big
hamburger, are also not recommended.
Dr. Manish Agrawal, et al
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2. Heat and ice therapy: These assist in reducing muscle
tension and spasm. However, immediately after an
injury to the TMJ, treatment with cold applications is
best. Cold packs can be helpful for relieving pain.
3. Medications: Anti-inflammatory medications such as
aspirin, ibuprofen, naproxen, or steroids can help
control inflammation. Muscle relaxants, such as
diazepam (Valium), aid in decreasing muscle spasms.
In certain situations, local injection of cortisone
preparations (methylprednisolone triamcinolone [,
Celestone) into the TMJ may be helpful.
4. Physical therapy: Passively opening and closing the
jaw, massage, and electrical stimulation help to
decrease pain and increase the range of motion and
strength of the joint.
5. Stress management: Stress support groups,
psychological counseling, and medications can also
assist in reducing muscle tension. Biofeedback helps
people recognize times of increased muscle activity
and spasm and provides methods to help control them.
6. Occlusal therapy: A custom-made acrylic appliance
which fits over the teeth is commonly prescribed for
night but may be required throughout the day. It acts to
balance the bite and reduce or eliminate teeth grinding
or clenching (bruxism).
7. Correction of bite abnormalities: Corrective dental
therapy, such as orthodontics, may be required to
correct an abnormal bite. Dental restorations assist in
creating a more stable bite. Adjustments of bridges or
crowns act to ensure proper alignment of the teeth.
8. Surgery: Surgery is indicated in those situations in
which medical therapy has failed. It is done as a last
resort. TMJ arthroscopy, ligament tightening, joint
restructuring, and joint replacement are considered in
the most severe cases of joint damage or deterioration.
In line with the recommendations treatments for TMJ
should not permanently alter the jaw or teeth, but need to
be reversible. To avoid permanent change, over-the-
counter or prescription pain medications may be
prescribed. Some sufferers may also benefit from gentle
stretching or relaxation exercises for the jaw, which may be
recommended by their healthcare providers.
Other interventions include:
1
l Stabilization splint (biteplate, night guard) is a
common but unproven treatment for TMD. A splint
should be properly fitted to avoid exacerbating the
problem and utilized for brief periods of time. The use
Reversible treatments
Dr. Manish Agrawal, et al
KOLKATTA
Attend in Large Numbers
21st t o 24t h Febr uar y 2013
66th Indian
Dental Conference
51st Maharashtra State
Dental Conference
PUNE
15th & 16th December 2012
of splint should be discontinued if it is painful or
increases existing pain.
3
l Mandibular Repositioning (MORA) Devices can be
worn for a short time to help alleviate symptoms
related to painful clicking when opening the mouth
wide, but 24-hour wear for the long term may lead to
changes in the position of the teeth that can complicate
treatment. A typical long-term permanent treatment
(if the device is proven to work especially well for the
situation) would be to convert the device to a flat-plane
bite plate fully covering either the upper or lower teeth
and to be used only at night.
l Regular exercise such as running for 20 minutes 3
times a week is extremely efficient in alleviating TMD
brought about through stress-induced Bruxism.
Exercise essentially burns away the chemicals like
cortisol and norepinephrine that cause stress so the
unconscious mind no longer feels the need to relieve its
stress through jaw-clenching.
If the occlusal surfaces of the teeth or the supporting
structures have been altered due to inappropriate dental
treatment, periodontal disease, or trauma, the proper
occlusion may need to be restored. Patients with bridges,
crowns, or onlays should be checked for bite discrepancies.
These discrepancies, if present, may cause a person to
make contact with posterior teeth during sideways
chewing motions. These inappropriate contacts are called
interferences, and if present, they can cause a patient to
subconsciously avoid those motions, as they will provoke a
painful response. The result can be excessive strain or even
spasms of the chewing muscles. Treatment could include
adjusting the restorations or replacing them.
Dentist should have detail knowledge of TMJ
disorders its causes, symptoms & treatment options.
Successful treatment of TMJ disorder can be attributed to
doing a comprehensive examination, carefully and
completely collecting all the needed information, & proper
treatment planning.
1. Okeson, Jeffrey P. (2003). Management of temporomandi-
bular disorders and occlusion (5th ed.). St. Louis: Mosby.
th
2. Gray`s Anatomy. 39 edition, Elsevier
3. Peter E. Dawson Functional Occlusion: From TMJ to Smile
rd
Design (3 ed.) Elsevier Health Sciences.
Long-term approach
Restoration of the occlusal surfaces of the teeth
Conclusion:
References:
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Abstract:
Introduction:
Case report:
This paper presents the presence of bifurcated mesial
root of mandibular first permanent molar. A major
anatomic variant of the first mandibular molar tooth -
the presence of an additional distolingual root, also
known as Radix Entomolaris has been well documented.
Very few studies have documented the presence of two
separate mesial roots in mandibular first molar. Hence
this paper presents the report of a case in which
endodontic therapy was performed on mandibular
first molar with rare occurrence of two separate mesial
roots, each having a single canal.
Key Words: Mandibular first molar, Bifurcated Mesial
root, Anatomic variations.
The prime objective of endodontic therapy is
thorough chemo-mechanical debridement of the entire
pulp space & the three dimensional sealing of the root
canal. For this, it is essential for an operator to be familiar
with the tooth morphology & root canal anatomy. Failure
to achieve the above may lead to persistence of infection
& treatment failure. Pucci & Reig (1944) reported that
first molar is the only multi-rooted molar that always
presents with two perfectly differentiated rootsone
mesial & one distal and rarely with an additional
1,2
distolingual root. The major variant of this tooth type,
i.e, the additional disto-lingual root has been mentioned
3
in the literature by Carabelli (1844). This additional
distolingual root was named as Radix Entomolaris by Bolk
in the year 1915. However, there is little documentation
about the two separate mesial roots (mesiobuccal &
mesiolingual). This paper presents the unusual
occurrence of two separate mesial roots in mandibular
first molar.
A female patient aged 18 years reported to the
Department of Conservative Dentistry & Endodontics,
with the chief complaint of dull pain in the left lower back
region of the mandible since 6 months. Extraoral
examination revealed palpable lower left submandibular
lymph nodes & tender to percussion. Intraoral
examination showed deep carious lesion in relation to left
mandibular first molar. Vitality testing was performed
A Rare Case Of Two Separate Mesial Roots In
Mandibular First Molar : A Case Report
Dr. Sunil Saler, MDS Prof. & Head
Dr. Anita Shipurkar, Principal & Prof. Dr. Santosh Hugar, MDS, Asso. Prof.
Dr. Jaykumar Patil, MDS, Prof. Dr. Hemanth Vagarali, MDS, Asso. Prof.
Dr. Samruddhi Metha, BDS Asst. Prof.
Department Of Conservative And Endodontics, Bharti Vidyapeeth Dental College, Sangli
using electric pulp tester and it was found to be non
responsive. Radiographic examination revealed deep
carious lesion (Fig 1) approximating pulp and increased
thickness of the periodontal ligament space suggestive of
periapical periodontitis. On careful examination of the
diagnostic radiograph, two separate mesial roots (Fig 2)
were seen which was again checked with the help of radio-
visiography. After achieving adequate local anesthesia,
caries were excavated & access cavity was prepared.
Complete care was taken during the location of all the root
canal orifices as diagnostic radiograph showed aberrant
root morphology. Working length was measured using
electronic apex locator which was later confirmed by
radiographic method. The presence of two separate
mesial roots without extra canal was confirmed at this
step. Biomechanical preparation was done & obturation
was completed using lateral condensation method (Fig 4).
Access cavity was restored immediately with silver
amalgam and in the consecutive appointments the tooth
was restored with complete cast metal restoration (Fig 5).
The three rooted mandibular molar reported here
had two mesial roots and one distal root with one canal in
each root. Initial evaluation of preoperative radiograph
revealed that distal root may contain two canals but on
careful exploration only one oval distal canal was found
which was connected with narrow isthmus in between.
Presence of extra root or extra root canals has also been
Discussion:
Endodondotics
APPEAL
To,
All branch Secretaries & Members
- Typewritten or well written with the spacing without
spelling mistakes.
- On one side of page only (keep back page empty)
- Reach before the 10th of Every Quarter i.e. March, June,
September & December month.
- Colour photograph shall be sharp, Well contrast with full
light effect.
- Caption should be written on the back of photograph
Names of the persons from Right to Left.
- Photographs with action are most preferable (As lighting
the lamp, / opening ceremony etc.)
- News matter if published in the local news paper please
send the photo copy of the page.
- Photographs & Newsmatter will not be returned back (it
would not be possible)
- News matter which will be sent should be signed by
office bearer of the branch.
- Any special extra-curricular activity of member should
be sent for DD. which all our members should know.
- Poems, Dental Unfortgetable experience, jokes subject
which should be discussed all over the state & practical
tips to the treatment of patients should be sent.
- Editorial board's decision will be final.
- Address - 249/79 JANAK - 1 / 101,
NAGALA PARK, KOLHAPUR.
Ph. : 0231-2653473, Mobile 9422419428
email - rajendrabhasme1959@gmail.com / yahoo.com
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related to the aberrant
morphology of the crown,
i.e., presence of extra cusp or
abnormally sized tooth.
However in this case the
occlusal portion of the
crown was grossly decayed
hence, it was difficult to
associate root anatomy with
crown morphology. Presence of extra canals is fairly
common, but occurrence of extra mesial root is not.
Several reports have discussed about the presence of
additional distolingual root also known as Radix
Entomolaris. The available literature does not document
much about the occurrence of two mesial roots in
mandibular first molar. Only few cases have been reported

with such kind of anomaly.
Previous studies document the presence of more than
two root canals in the mesial root with an incidence of
5, 6
2.07% up to 13.3% of the examined cases . A third root
has been reported in some cases either mesially or distally
7
(5.3%). Ingle documents the 2.2% occurrence of three
roots in mandibular first molar; however, he has not
8
differentiated it in extra mesial or distal root. In this case
no extra canal was found in spite of the presence of
additional root. To locate all the canals deroofing of the
pulp chamber becomes extremely important and
immense care has to be taken to accomplish the above
goal.
Additional third root is commonly present on the
lingual aspect of the distal root. Only Sperber & Moreau
(1998) have reported an additional root on the buccal
9
aspect. The nature of this additional root is also variable,
ranging from a short conical extension to full length, with
pulp extending into the root even if short. (Reichart &
10
Metah, 1981). Very few cases report the presence of four
roots with four canals but such rare variations of
mandibular first molar are more common in Asians &
11
Caucasians. The preoperative radiographs play an
important role in the diagnosis and treatment plan of any
case. During reimplantation knowledge of anatomy is the
key to success. Partial removal of the tooth during
extraction procedure, may lead to clinical failure.
This anomaly is genetically oriented developmental
defect during the maturation of the tooth as this was
present bilaterally. Previous studies report the
occurrence of extra root specific to the race & geographic
location. This paper opens the door for further studies on
the abnormalities in the mesial root anatomy of the
mandibular first molars.
Dr. Sunil Saler, et al
References:
1. Pucci FM, Reig R. Conductos Radiculares. Buenos Aires,
Editorial Medico-Quirurgica 1944.
2. Philip AA, Shetty Harish, Varma Ravi. Madibular first molar
with an unusual root morphology A case report.Ker Stat
Dent J 2006:33-34.
3. Moor RJG, Deroose AJG & Calberson FLG. Int Endod J
2004;37:789-799.
4. Burns R, Herbranson EJ. Tooth morphology and cavity
preparation. In Cohen S, Burns RC, editors: Pathways of pulp,
ed 8, St Louis, 2002, Mosby:211.
5. Goel NK, Gill KS, Taneja JR. Study of root canals configuration
in mandibular first permanent molar. J Indian Soc Pedod Prev
Dent. 1991 Mar;8(1):12-4.
6. Fabra-Campos H. Unusual root anatomy of mandibular first
molars. J Endod. 1985 Dec;11(12):568-72. No abstract
available.
th
7. Grossman LI. Endodontic practice, 10 edition, Philadelphia,
1981:170
th
8. Ingle JI, Bakland LK. Ontario, B.C. decker Co.Endodontics 5
edition:151
9. Sperber GH, Moreau JL. Study of the number of roots and the
canals in Senegalese first permanent molars. Int Endod J
1998;31:112-116.
10. Reichart PA, Metah D. Three rooted permanent mandibular
first molars in Thai. Commu Dent & Oral Bio 1981;9:191-192.
th
11. Weine FS. Endodontic therapy, St Louis, Mosby Co, 6 edition:
150.
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Abstract
Introduction
Objective
Methods
It is usual problem to face tooth-sensitivity after resin
composite restoration. A Sensitivity analysis was carried
out depending upon the cavities of different depths and
use of various liners and base materials. Factors
responsible for post-operative sensitivity in general
dentistry and measures to avoid them same were listed.
The results were obtained accordingly
(Keywords: Resi n composi te restorati on,
postoperative sensitivity, pulpal protection, dentine
bonding system, cavity depth, cavity class, survey in
private dental clinics.)
The use of tooth coloured restorative materials for
posterior teeth began with earliest generation of
bondable composite restorative material in early 1970s.
For forty years industry continues to search for bulk full
composite that can be used with ease and predictability of
dental amalgam. Despite improvements in composite
treatment over past decades, postoperative sensitivity
still remains a problem.
Caries profunda showed a fourteen times higher risk of
failure in cavities with pulp exposure compared to
restorations that were localized in dentin. Regard to type
of sensitivity no patients reported sensitivity to sweet or
sour, most of them described their sensitivity sharp or
dull.
Incidence of postoperative sensitivity was evaluated in
resine based posterior restorations.
To analyze the relationship between cavity depth and
liners with postoperative sensitivity of resin composite
restorations.
A clinical follow up was conducted on 152 resin
composite restorations made in two private dental clinics
over 2 months period. A total 73 class I and 79 class II
restorations (MO/ DO and MOD) were placed in patients
ranging in age from 20 to 50 years. After cavity
preparations were completed, rubber dam was placed
and preparations were restored using total etch system
(prime and bond NT) and resin based restorative
material. Patients were contacted after 24 hours and 7, 30
and 9 days postoperatively and questioned regarding the
presence of sensitivity and stimuli that triggered that
sensitivity.
Reducing Sensitivity after Composite
Restoration: A Study
Dr. Manjiri Vartak
Govt. Dental College and Hospital, Mumbai
Results
Concluding Remarks
Group 1: 39% of restorations had no protective layer. As
depth of prepared cavities increased restoration received
one of three pulpal protection methods.
Group 2: Calcium hydroxide base.
Group 3: Glass inomer cement.
Group 4: Protection with calcium hydroxide base in
combination with glass inomer cement. Incidence of
postoperative sensitivity showed significant difference
among groups 1, 2 and 3 but was significantly lower in
group 1 when cavity was limited to enamel than in group 4
with deep cavity. Restorations made in shallow and
medium depth cavities demonstrated significantly less
postoperative sensitivity than those made in deep cavities.
In restorations with approximately same length, group 2
and group 3 restorations showed less or nil sensitivity
compared to group 1 or 2.
The newer generation dentin bonding agents showed
significantly lower incidence of postoperative sensitivity
than early generation group.
Postoperative sensitivity in resin composite
restorations was related to absence of protective layer at a
same time it increased with depth of cavities restored with
resin composite. Type of dentine bonding agent could also
be responsible for postoperative sensitivity.
Though postoperative sensitivity has been vexing issue
for most dentists, fortunately there are simple solutions to
this irritating problem. Listed below are causes and
solutions.
1. Poor dentine penetration by bonding agent.
Application of 2 or 3 layers of bonding agent with air
thinning and curing separately for each one.
Or
Use of 1 bottle self-etch resin.
2. Bad C factor and boxy conventional preparations: Bad C
factor in responsible for postoperative pain in tooth
with simple conservative class 1 preparation on the
same patient where deep restoration has no
postoperative sensitivity. Tooth reduction for cavity
preparation should be confined to elimination of
carious tooth structure and cavity design to withstand
intraoral environment. Bevel enamel margins to
conceal the margins. Roughed margins of enamel also
enhance bond strength. Internal line angles of cavity
Restorative Dentistry
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design should be rounded to improve stress
distribution after placement of restorative material
through Micro-mechanical adhesive approach.
Isolation is key feature in the success of the composite
restorations for proper moisture control, to prevent
bacterial or salivary contamination and reduce
airborne debris.
3. Replacing old GV Black style:
a. Dentine should be built by layering process in
increments. Cusps should be built in increments
followed by cross linking. Cavity should not be
filled horizontally.
b. Bulk filled cavity preparations result in
photopolymerization induced stress resulting
from volumetric shrinkage, reaction kinetics and
viscoelastic properties of composite resins.
c. Recommended techniques to fill the cavity by
composite restoration are,
* Oblique incremental technique.
* Modified incremental technique
* Centripetal incremental insertion technique.
d. Use RMGIC as a liner to replace missing dentine.
e. Use of 1 bottle self-etch resin.
4. Flowable base: Glass inomer cement bonds directly
with tooth structure, biocompatible and considering
ease with which it can be used; it acts as an excellent
base before placement of composite restoration.
a. Glass inomer can be placed in small disposable
syringe and introduced into floor of cavity. It can be
very easily shaped using condenser to provide
Leveled floor for composite restoration.
b. An alternative technique is almost fill the cavity floor
with glass inomer cement And then use high speed
rotary instrument to reshpe cavity preparation.
5. Acid etching or Rinse etching: Acid etching the
dentine before use of self-etch bonding agent.This
additional etching creates over-etch situation which
has deep demineralization zone for subsequently
placed primer to completely penetrate.
6. Shaking of bottle containing bonding agent: As
multiple components in bonding agent tend to settle
or separate during storage, it is necessary to
thoroughly shake the bottle prior to despensing.
7. Air bubble entrapment at bonding interphase of
composite and dentine. Sensitivity in this case
occurred because bubble shrinks during biting and
applies pressure. Solution-Remove restoration and
replace it with correct one. Use air thinning technique
along with curing of each layer separately while
application of bonding agent.
8. Type of polymerization protocol: Soft start
polymerization protocol reduces final stress of
restoration by producing modest decrease in
conversio of composite as compared to pulse protocol
or conventional full intensity care technique.
9. Not following manufacturers' protocol. Agitate the
bonding agent for time prescribed by manufacturer.
Use of air thinning technique after application of
bottle bonding agent.
10. No heavy chewing for 24 hours:Tooth coloured
composite filling is 80% hard at a time of placement
and continues to harden for additional 24 hours
before reaching its full strength. Heavy chewing can
cause microfractures in restoration reducing its life
span.
Black, G. V. 1917. A Work on Operative Dentistry, 2
Volums. 3rd edition, Chicago: Medico- Dental Publishing.
Hickel, R. and J. Manhart. 2001. Longevity of
restorations in Posterior Teeth and Reasons for Failure.
Journal of Adhesive Dentistry, 3(1): 4564.
Letzel, H. 1989. Survival Rates and Reasons for Failure
of Posterior Composite Restorations in Multi-centre
Clinical Trial. Journal of Dentistry, 17: S10S17.
U. S. Natinal Library of Medicine, National Institute of
Health. PMID19192831. PuMed-indexed for MEDICINE.
Wendt, S. L. and K. F. Leinfelder. 1992. Clinical
Evaluation of Clearfill Photo Posterior: 3 Year Results.
American Journal of Dentistry. 6: 121125.
Select References
Dr. Manjiri Vartak
EDITOR,
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ABSTRACT:
INTRODUCTION
Introduction:- For treatment with a fixed orthodontic
appliance, different types of separators have been used in
orthodontics. Separation of the molars is necessary to
create enough space for bands that anchor the appliance.
Materials & Methods:-The separators tested were spring-
type and elastomeric separators. Fourteen patients are
taken. Two spring-type and two elastomeric separators
were placed alternately in the left or the right quadrant.
After a separation period of 5days, the amount of
separation was measured with a leaf gauge. A questionn-
aire will be used to register the patient discomfort. Results:
The mean separation was 0.3 mm for the spring-type and
0.4 mm for the elastomeric separators. The springs were
considered less painful than the elastomerics, For both
separators, the pain was worst at day 2 and subsided
almost completely by day 5. Discussion:- The difference in
separation effect between springs and elastomerics are
small. Although bands for a fixed appliance is
approximately 0.25 mm, the amount of separation is
0.3mm & 0.4mm respectively. It was found that mild to
moderate pain is associated with orthodontic separators.
Conclusions: The separation effect of the two separators
was considered clinically equivalent and since pain of
moderate intensity occurs during the separation period.
Treatment with a fixed orthodontic appliance,
separation of molars are necessary to create space for
bands that anchors the appliance. Ideal Requirements Of
Separators includes rapid & Good separation, no patient
discomfort or pain, it should be easily cleaned &
1
radiopaque and not to be lost . Different types of
separators are used in orthodontics. Angle discussed the
need for separation in 1907, and his method is still popular
today. Angle explained the use of a brass wire ligature
passed under the contact, then carried on over the contact,
after which the ends were tightly twisted together. In 1921
Calvin Case advocated the use of a separating tape, which
was wax wrapped tape wrapped around the contact. He
Comparing Amount Of Separation And
Discomfort During Tooth Separation Between
Two Types Of Separators
Dr. Bidarkar Mayur, PG Student
Dr. Swaroop Savanur, Prof. & HOD
Dr. Basavraj, Reader
Dept. Of Orthodontics, PDU Dental College, Solapur
Dr. Jayasudha K., Reader
Dept. Of Pedodontia, PDU Dental College, Solapur
Orthodondotics
said that the tape should left on for only 24 hours. The
changed in separation was not sufficient. Rubber
separators were mentioned by Thurow and Dickson.
2
Anderson and Begg describes about separating springs .
(a) Brass wire separators (b) Latex elastic separators
\
(c) E lastomeric separators (d) Spring type steel separators
2
l Hoffman - separation effect of four types of
separators was examined, but subjective experience
was not investigated.
3,4
l Ngan et al - perception of pain & discomfort in
patients undergoing treatment for 7 days of
separation. It was found that separators caused high
levels of discomfort at 4 and 24 hours after
placement. No systematic studies had been
performed on separating effect and perception of
pain and discomfort after placement of separators.
AIM:-Comparing Amount Of Separation And
Discomfort During Tooth Separation Between Two Types
Of Separators

1) To measure Amount of separation
2) Pain and discomfort associated with separation
AIM AND OBJECTIVES
OBJECTIVES:-
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2) Pain & discomfort:-
All 14 patients completed the study and the response
rate was excellent. The patients noted that elastomeric
are more painful than the springs, but the difference was
not statically significant. Two patients complained of pain
during chewing. The pain gradually increased with both
separators and peaked at day 2.
Measurement of separation distance with
thickness gauge of distance 0.4mm
Lateral View Occlusal View
Dr. Bidarkar Mayur, et al
MATERIAL AND METHODS
STATISTICAL ANALYSIS
RESULTS
l Fourteen patients, 7 girls and 7 boys with age
range of 17 to 21 years. (mean age of 20 years )
participated in study. Informed consent was taken.
Separators were placed mesial and distal point contact of
st
maxillary 1 molar which had bilateral approximal
contacts. The separators used were spring-type steel
separators and elastomeric separators. The springs
applied with light wire pliers and the elastomerics with
separator placing forceps. Two springs and two
elastomeric Separators were placed alternatively in the
left and right quadrant of maxilla. The separators had
been place for 4 days. Elastomeric and springs were
removed with a curved probe and light wire plier
respectively.
After air spray drying of the maxillary molars,
amount of separation of each maxillary molar was
measured mesially and distally with a thickness gauge.(0-
1mm with difference gauge 0.05 gradings) The patients
perception of pain/ discomfort was recorded by
questionnaires.
To detect the
difference between
q u a n t i t a t i v e
variables, paired t test
was used. Whether
t her e was any
significant difference
in the amount of pain
r epor ted due to
separators ,wilcoxon's signed rank test is used.
Difference of probabilities of less than 5% were
considered statistically significant.
1) Separation Effect:-
As the results obtained did not differ significantly
between the genders or between separation mesial or
distal to maxillary molars. The mean separating effect was
0.3mm for the springs and 0.4 mm for the elastomerics.
Difference in effect was significant p
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DISCUSSION
The difference in separation effect between springs and
elastomeric was small and statistically not significant. The
space needed for fitting bands for a fixed appliance is
approx.0.25 mm. So, the amount of separation 0.3 and 0.4
mm for springs and elastomerics. Which concludes twice
the thickness of bands. It was found that mild to moderate
5
pain was associated with orthodontic separators . So, the
springs are considered less painful than the elastomerics.
The pain was perceived as worst during day 2 and
th
subsides at day 4 and subsides almost on 5 day. So, we
advice that to perform molar band fitting at least 5 days
after inserting the separators. No significant difference
found between boys and girls pain/ discomfort experience
during the separation. Although some studies report more
patient discomfort for girls than boys. More girls than boys
used analgesics in this study. It has been reported that
orthodontic patients use analgesics often.
Eating was most affected during the separation period.
Most patients preferred soft foods. So, it should be in mind
that pain may occur during eating.
The influence on regular activities as well as day today
work was considered negligible. Hence, in this study the
patient had no problem in discriminating between pain &
discomfort in right and left posterior teeth when two types
of separators were placed on right and left side respectively.
As there is high scope of this study, we advice to use
recent elastomeric materials, and also requirement of good
sample size.
CONCLUSION
REFERENCES
The difference in separation effect between
springs and elastomeric was small and statistically not
significant.
The separation effect of the two types of
separators was considered clinically significant.
Both types of Separators caused pain of mild to
moderate intensity with springs considered less painful
than elastomeric.
The pain was worst at day 2 and had subsided
completely at day 4. Therefore, molar banding should be
done at least 4 days after inserting the separator.
1) Separation effect and Perception of Pain and Discomfort
from two types of Orthodontic Separators World J Orthod
2004;5:172-176
2) Hoffman WE. A study of four types of orthodontic
separators. Am J Orthod 1972; 62; 67-73.
3) Ngan P, Wilson S, Shanfeld J. The effect of ibuprofen on the
level of discomfort in patients undergoing orthodontic
treatment AJODO 1994; 106;88-95
4) Scheurer P, Firestone A. Perception of pain as a result of
orthodontic treatment with fixed appliance. Eur J Orthod
1996,18:349-357
5) Ngan P, Kess B, Wilson S. Perception of discomfort by
patients undergoing orthodontic treatment . AJODO
1989;96;47-53
6) Proffit WR. Contemporary Orthodontics(ed.4)
Dr. Bidarkar Mayur, et al
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Very nice issue of Dental Dialogue of J an. to Mar. 2012 this shows that MSB is functining.
, Pune (1st J une 2012)
Beautiful Photo of Koyna Lake Tapping on Dental Dialogue.
, Pune (1st J une 2012)
Beautiful Photo of Koyna Lake Tapping on Dental Dialogue.
, Principal, PDUDC, Solapur (2nd J une 2012)
Its excellent issue thank you.
, Solapur (19th May 2012)
Read & informative Dental Dialogue.
, Akola (2012)
Congratulations Dr. Bhasme for coming out with a timely issue inspite of all that is happening IDA
MSB. It has really assured common members like me that we still have our beloved association in
existence. In Greek Mythology the earth is supported on shoulders of ATLAS. I am happy you have
become ATLAS for IDA MSB.
, Aurangabad (2nd J une 2012)
Respected Sir,
Thanks again for adding a new era of knowledge in Dental Dialogue. I feel your work is totally
justifiable inspite of all odds which is going in IDA MSB. Keep the same enthusiasm.
, Chopada-J algaon (5th J une 2012)
Once again congratulations for publishing very nice issue of Dental Dialogue.
, Amravati (5th J une 2012)
Received Dental Dialogue J ournal congratulations for receiving award. Very informative issue.
Continue same good work in future.
, Solapur (23rd J uly 2012)
Dr. Nitin Barve
Dr. Mansing Chavan
Dr. R. S. Birngane
Dr. Vikas Kamble
Dr. Tushar Vora
Dr. Shivkumar Ranjalkar
Dr. Rahul Patil
Dr. Sandeep Patil
Dr. Sanjay Sakkarshetti
By Sms
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Pre Treatment
Front Profile Lateral Profile Front Smile
Front Occlusion
Left Buccal Occlusion
Right Buccal Occlusion
Mid treatment with Twin Block
Frontal view Right buccal view
Introduction
Case Details
TREATMENT PROGRESS :
Conventi onal orthodonti c appl i ances use
mechanical forces to alter the position of the teeth into a
more favourable position. However the scope of these
appliances is restricted by the aberrations in the
1
developmental process or the neuromuscular capsule.
About 40% of the malocclusions treated belong to
Class-II category. Abundant research has shown that most
of the Class-II problem occurs because of retrognathic
mandible which can be corrected by the use of functional
appliances if the patient reports to the orthodontist when
some percentage of growth is still left in the patient ( ie in
2
and around puberty).
The following case report shows in detail how a case
of Cl-II malocclusion was treated using Twin Block
followed by finishing the case with fixed mechanotherapy.
CHIEF COMPLAIN : Patient by the name of Shantanu
Goswami, aged 11 years reported with a chief complain of
protruding upper front teeth.
DIAGNOSIS : After clinical examination and
cephalometric analysis the case was diagnosed to be of
Class-II malocclusion with retrognathic mandible and
normal maxilla. Molar relation and canine relation were
Class- II with overjet of 7 mm and overbite of 4mm.
TREATMENT PLAN : As the patient had about 60 to
70 percentage of grwth left according to the CVMI status,
the treatment was planned in two phases. In phase-1 Twin
Block was planned to -treat the retrognathic mandible
and in phase -2 fixed appliances were planned to finish of
the case with minor dental corrections treated.
Phase 1 : Twin Block was fabricated with 5 mm
sagittal advancement and 5mm vertical opening.
Expansion screw was placed in the maxillary arch to
correct maxillary constriction.The Twin Block was
cemented to achieve 24hr wear. Patient wore the
appliance for 6 months after which trimming was started
to achieve proper vertical erruption of posterior
th
dentition. At the end of 12 month after achieving Class-I
molar relation Twin Block was discontinued.
Phase 2 : Fixed mechanotherapy was started by
bonding MBT 0.022 prescription. Finishing and detailing
Class II Correction, The Functional Therapy Approach
Dr Rishi A Joshi
Sr Lect. Dept of Orthodontics. Hithkarini Dental College, Jabalpur, Madhya Pradesh.
Dr Parikshit Rao
Sr Lect, Dept Of Orthodontics, K..M.Shah Dental College, Pipariya, Vadodara, Gujrat.
was achieved and case was ready for debonding after 4
months.
PHOTOGRAPHS :
Orthodontics
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Left buccal view
End treatment
Front profile Lateral Profile Front Smile
Front occlusion Left Buccal occlusion
Right Buccal Occclusion
Conclusion :
References :
Skeletal Class-I I malocclusion if treated by
combination of functional appliance and fixed
mechanotherapy can give good and stable results. Twin
block is a very good appliance of choice as it has good
patient compliance and is a full time wear appliance.
1 Woodside DG, Metaxas A, Altuna G. The influence offunctional
appliance on glenoid fossa remodelling . Am J Orthod
Dentofacial Orthop. 1987;92:181-98.
2 Bishara SE, Ziaja RR. Functional Appliances: A review, Am J
Orthod Dentofac Orthop 1989;95:250-6
Dr. P. G. Diwan needs to be complemented for his
great contribution to Dentistry in India by
authoring the book titled Geriatric Dentistry in
India. This is a unique book of its kind on the very
important topic of Geriatric Dentistry that has
been written with 50 plus years of Clinical
Experience.
He has covered most of the topics pertaining to
the practice of dentistry for elderly people (age 60
years of above) who contribute almost 8%of the
Indian Population. i.e. about 100 million people.
Ironically, Geriatric Dentistry has not been
included in the curriculum in the Dental
Institutions in India that should have been.
This book will be a great guide for the
undergraduate students to learn the geriatric
changes in the oral cavity. Also the changes
occuring in the oral cavity as a result of systemic
diseases that are prevalent in elderly population
have been discussed in details.
The knowledge about dental treatment for
medically compromised people & also the
emergencies in geriatric dental practice will be
very useful for the practising Dental Surgeons in
India.
Book Review
Dr. Rishi A. Joshi et al
Price j: 450/-
Dr. Anil Kapadia
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Abstract :
Introduction:
Functions of guiding planes surface:-
Guiding planes play as very vital role in removable
prosthodontics but unfortunately it is least considered.
Guiding planes provide easy path of placement and
removal and also helps in designing other components of
RPD Guiding planes not only essential in removable
prosthesis but are equally important in fixed restorations,
over denture and implant denture.
Although the term 'guide plane' is used more widely in
partial denture design but the significance of planes and
the concept of guide plane denture is perhaps not fully
appreciated.
A brief introduction to the concept of guiding planes
and how to achieve then in various situations is discussed
in this presentation.
The glossary defines the guiding planes as "two or
more vertically parallel surfaces of abutment teeth so
oriented as to direct the path of placement and removal of
removable partial denture"
This definition makes the point that guide planes
establish a single and direct path of insertion as a basis on
which denture may be designed.
Guiding planes presents in natural crown contour or
formed by selective grinding of natural crown contour or
contouring of surveyed crown. Guiding planes may be
contacted by various components of removal partial
denture.
1) To provide one path of placement and removal.
2) The more vertical walls they are prepared
parallel, fewer the possibilities for dislodgement of
prosthesis
3) Guiding plane retention has less potential for
causing supporting structure damage
4) Guiding planes have horizontal bracing
capabilities.
5) To ensure the intended actions of reciprocal
stabilizing and retentive components.
6) To minimize deep undercut zones.
GUIDING PLANES - PATHWAY FOR SUCCESS
Dr. Vaishali Bondekar, Prof.
Dr. Pranab Kumar Sanyal, Prof., HOD, Dean
Dr. Pravin Badwaik, Reader
Dr. Guruprasad Handal, Lecturer
Dept. of Prosthodontics:Y.C.M.M & R.D.F Dental Collage, Ahmednagar
Prosthodontics
7) To minimize food traps between abutment teeth
and components and possibility for improved esthetics.
Guiding planes 2 to 3 mm in length is sufficient to
achieve during insertion any plane prepared to a much
greater length interfere with health of the gingival
cervices.
(1) Place the analyzing rod in the surveyor spindle.
(2) Move the tilt-top table, with the cast in position
slightly anteroposteriorly until the spindle contacts the
occlusal one third of the proximal surfaces of the
proposed abutment teeth. when anterior teeth are
missing, guide planes on either side of the edentulous
space must be given precedence.
Guiding planes should be prepared to be parallel to
one another and to the path of insertion as determined by
the surveying stylus. these surfaces very seldom occur
naturally and need to be prepared directly on enamel or
on cast or composite restorations.
Mount the diagnostic cast on a tilt table; Position the
adjustable table so that occlusal surfaces of the teeth are
parallel to the platform Select most desirable tilt to attain
parallelism for future guiding planes. Record the surface
which needs reduction and relation of the cast to the
surveyor.
Length of the guide plane:-
Locating the guiding planes:-
Preparing guiding planes for removable partial
denture:
Procedure:-
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Determine the relative parallelism of the tooth surface
by contacting proximal tooth surfaces with surveyor
blade.
Alter the cast position anteroposteriorly until
proximal surfaces are in a parallel relation to one another
( Fig A and B )
Selecting suitable anteroposterior tilt should to
provide parallel proximal surfaces that may act as guiding
planes.
Differentiation between tooth borne and distal
extension removable partial denture as they affect
the choice of guiding plane location:-
Many competent dentists mistakenly believe that
guiding planes are advantageous for every type of
removal partial denture. Distal extension removable
partial denture present different set of circumstances
than a total tooth supported removable partial denture.

Tooth borne removable partial dentures are
supported on both ends of the edentulous area by rest
located on prepared tooth surfaces. These rests direct the
forces during mastication down the long axis of teeth
deriving support from the tension on the periodontal
ligaments. The guiding planes need to be considered in
relation to the forces or actions cause during
dislodgement. The larger the numbers of vertical walls
that can be made parallel to each other, the more retentive
the removable partial denture. All the forces of
dislodgement will be non destructive in fact these guiding
planes will provide horizontal bracing of teeth involved. A
precision partial denture is prime example of retention
and bracing that can be provided by guiding planes.
Distal extension removable partial denture should be
considered different than tooth borne removable partial
dentures to the design of prosthesis and associated
preparation of abutment teeth one end of the denture
base moves more than the other because resiliency of the
soft tissues overlying the bone. This movement can cause
rapid destruction of periodontal support of the abutment
teeth and dictates a different design of both claps
assembly and the guiding planes.
Guiding planes must be considered with respect to
center of rotation of the removable partial denture and
consequent movement of denture during function, many
of the tooth surfaces used for guiding planes on a tooth
born removable partial denture should not be contacted
with distal extension removable partial denture because
of potential damage to the teeth. This damage can be
caused by guiding plates which can in combination with
clasp assembly act as levers to lift the teeth occlusally and
distally.
Tooth born removable partial denture:-
Distal extension removable partial dentures:-
Dr. Vaishali Bondekar, et al
With clasp type removable partial denture the contact
of distal surface of guiding plates against guiding planes
will move the fulcrums or rotation centers to these points
thus placing the retentive clasp on the opposite side of the
fulcrum line and causing possible extrusion of abutment
teeth during function. Any part of the distal surface of an
abutment tooth must be free of contact by removable
partial denture during functionally movement. This can
be accomplished by placing a short vertical guiding plane
on occlusal one third of the tooth and then constructing
guiding plate of the removable partial denture so that its
occlusal edge is at the same level as the gingival limit of the
prepared guiding plate, because of the convexity of teeth
mesiodistally guiding plate should not wrap around the
distal surface. The only buccolingual surfaces of an
abutment teeth supporting distal extension partial
denture that should have guiding planes are those
surfaces they are mesial to greatest mesiodistal convexity
unless the guiding plates are constructed to immediately
disengage the tooth during functional compression of the
base.
Guiding planes they are contacted by guiding plates
are an important aspect of removable partial denture
design principal complete vertical contact is beneficial for
tooth born removable partial dentures. When distal
extension ridges are present complete contact is
detrimental. The design should be modified to take into
account the different resiliencies of the supporting
structures.
1. Arthur M.L, Angelo L.F
A simplified procedure for survey and design of diagnostic
casts. J Prosthetic Dent 1977;37;681
2. MC, crackens: - Removable partial prosthodontics eighth
edition, 1989
3. O.L Bezzon, M.G.C Mattos, R.F Ribero.
Surveying removable partial dentures: the importance of
guiding planes and path of insertion for stability J Prosthetic
Dent 1997:78:413
4. Stewart, Rudd, kuebker
Clinical removable partial prosthodontics 1983 .
Summary:-
References:-
66th Indian Dental Conference
KOLKATTA
21st to 24th February 2013
www.idc2013.org.in
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ABSTRACT
INTRODUCTION :
CASE HISTORY :
Nodular fasciitis (NF) a soft tissue lesion mainly
composed of myofibroblastic cells, is well documented in
various body locations however, in the oral cavity it is rare.
Accurate diagnosis of such lesion is very important as
some of these lesions resemble a sarcoma and this
presents a diagnostic challange for the pathologists. Also,
clinician should avoid unnecessary and often mutilating
surgery for the same. Hence, the rare case of nodular
fasciitis in the right cheek is reported together with a
differential diagnosis.
Nodular fasciitis is a single, rapidly growing and firm
subcutaneous nodule most commonly over the arm and
trunk and may be characterized as benign reactive
proliferation of fibroblasts.
I ni ti al l y nodul ar fasci i ti s i s defi ned as
pesudosarcomatous fibromatosis. It was first reported by
KONWALER. KEASBY and KAPLAN in 1955.
Nodular fasciitis is most common in third decade, but
may occur at all age groups.
Males and females are equally affected. It usually
presents as a rapidly growing soft tissue mass, some what
tender and fixed structure but with freely movable
overlying skin.
Although cause is unknown, trauma is believed to be
important. Clinically the lesion present as a rapidly
growing soft tissue mass, usually of short duration 2-4
weeks on average.
The histopathological diagnosis is not so easy because
it's histopathologic finding having bizarre appearance
and show considerable variations. Because of this nature,
nodular fasciitis was infrequently diagnosed as
fibrosarcoma and other malignancies in the past.
Therefore, in a view of this aggressive clinical
behaviour of this lesion accurate histopathological
investigation is essential to prevent unnecessary over
radical and mutilating surgery.
A 25 years old young female reported to Dept. of Oral
Diagnosis and Radiology, Government Dental College and
Hospital Aurangabad, with a complaint of swelling on the
right side of the cheek since 2 months.
On clinical examination, medium built young patient
having a swelling on the right side of the cheek. Extraoral
NODULAR FASCIITIS :
A RARE CASE REPORT
Dr. ,
,
Dr.Vaishali Anil Nandkhedkar Dental Surgeon, Oral Pathology & Microbiology
Dr. Jaishri Sanjay Pagare Assit. Prof., Oral Medicine & Radiology
Dept. of Oral Medicine & Radiology Govt.Dental College & Hospital, Aurangabad
examination revealed, a small, oval shape swelling about
size (2x2 Cm) on the right cheek. The swelling was fixed to
underlying skin; and consistency of the swelling was firm
to hard. Skin over the swelling was normal. There was no
sign of any inflammation or sinus tract. In past medical
history, patient gave history of trauma to the right cheek 3
weeks back. After that lesion gradually increased in size to
attempt present size.
On intraoral examination, there was no relevant
clinical finding. The associated teeth with swelling were
vital and non tender. Radiological examination revealed
the teeth and supporting tissue showed no abnormality.
Routine Haematological examination was normal.
Ultrasonography of the lesion was advised to the patient.
High frequency probe ultrasonography was done. USG
reports suggestive of nodular hypoechoic lesion on the
right cheek, just superior to right mandibular ramus. No
obvious bony erosion.
No definitive diagnosis was made until an incisional
biopsy was performed under local anaesthesia. The
hi stopathol ogi cal exami nati on reveal ed as a
neurofibroma. But second opinion was taken from
Bombay Hospital and Medical Research Center.
Histopathological examination, suggests that fragments
of a spindle cell lesion composed of short spindle cells
arranged in intersecting fascicl and whorls with focal stori
Oral Pathology
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form pattern. The cells posses, oval, bland appearing,
palestaining nudei fair number of mitoses are detected. The
intervening stroma is loose textured and myoxid with
microcysts containing extravasated RBCs and nucleated
giant cells. There was no malignancy. Diagnosis was
NODULAR FASCIITIS.
Nodular fasciitis, a soft tissue lesion mainly composed
of myofibroblastic cells, is well documented in various body
locations however in the oral cavity it is rare. Nodular
fasciitis is relatively rare and recognized as occuring in the
sub-cutaneous tissues of the expremities and trunk6. In
Japan, IWASKI and Enjoji, reported that the percentage of
orofacial lesion was 7% of all cases of nodular fasciitis.
Thus, it was uncommon in the orofacial region.
Trauma is often cited as a possible aetiology, but the
true pathogenesis is still unknown2. If trauma is an
important cause then one should expect to see the lesion
more commonly in the oral cavity. Most authors, believe
that the lesion represents a reactive or inflammatory
process of fibrous connective tissue13.
Nodular fasciitis in the oral cavity, occurs at all ages. A
peak incidence occurs between 30 and 40 years1. The
most common location of oral nodular fasciitis was the
buccal mucosa3.
The tumour is usually a discrete soft tissue mass, some
what tender and fixed to the subjacent structure but with a
freely movable overlying skin. Size varies from 4mm to 4 cm
in size. On clinical presentation, the lesion clinically
simulate anything from an abscess to a neurofibroma1.
Histologically, the appearance of the lesion is
characteristic and striking, it shows hapazard arrangement
of irregular bundles or single fibroblastis in a mucoid
matrix1.
Prince et al, have divided nodular fasciitis into three
DISCUSSION :
histological subtypes. Type-I nodules are moderately
cellular with an abundant interestitial ground substance
giving the lesion a distinctly myoxid appearance. This
ground substance is most abundant in the pari Cellular
Center with increasing cellularity of periphery of the
lesion. Vascularity is prominent, and multinucleated giant
cells are commonely seen. Type II nodules manifests less
ground substance and tendency toward greater
cellularity with less haphazard arrangements of the cells.
Type III nodules are biologically more mature. There is
increased collagen production with small amount of
ground substance1.
Histologically features of nodular fasciitis may vary
considerbly, but four features are commonly observed.
I] Spindle shaped fibroblasts that tend to be arranged in
long fascicles which are slightly curved, whorled or 's'
shaped.
II] Small clett or slit like space that often separate
fibroblasts.
III] Few extravasated erythrocytes.
IV] Mucoid interstitial ground substance1.
Nodular fasciitis should be differentiated from
fi brosar coma / sarcoma. Because of wi de
histopathological diversity in nodular fasciitis
approxametly 50% cases were misdiagnosed as sarcoma
or other malignant neoplasm. Another lesion considered
for differential diagnosis is neurofibroma. As both lesions
are unencapsulated lesions composed of spindle cells.
However, neurofibroma lacks an inflammatory
component and extravasated blood cells frequently
encounter in nodular fasciitis.
Fibrous Histiocytoma and Nodular fasciitis are some
time impossible to distinguish, only differentiating point
is histocyte like cells with abudant cytoplasm which may
be prominent in many fibrous histiocytama but absent in
nodular fasciitis. Presence of foam cells also another point
which favour a diagnosis of fibrous histiocytoma.
Fibromatosis is another group of lesion taking for
consideration as a differential diagnosis. Fibromatosis
usually clinically infiltrate into the surrounding tissue.
Fibromatosis is lacking the myoxid tissue and granulation
tissue like appearance frequently found in Nodular
fasccitis3.
Schawanoma, myofibroma should be distinguished
from nodular fasciitis mainly n the basis of it's biphasic
zoing phenomenon that refers to the presence of light
staining collagenous hyalinized areas, schawanoma
presents as a mixture of Antoni Type A & Type B structure
which is not feature of nodular fasciitis. In addition,
proliferating capillaries, extravasated red blood cells and
inflammatory cells are not typically found is schawanoma.
Immuno histochemical study of S-100 exclude neural
tumor.
In summary, nodular fasciitis is a soft tissue lesion
mainly composed of myofibroblastic cells. In the oral
cavity it is very rare. Because of it's histological variation's
Dr. Vaishali Nandkhedkar, et al
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EDITOR, Dent al Di al ogue
in the past it is misdiagnosed as sarcoma or other
malignancies. Accurate diagnosis is important to avoid
unnecessary and often mutilating surgery.
It is hoped that this publication will aid in
identification of a reactive lesion, in an already
diagnostically challening group, which can be mistaken
for low grade malignancy.
1] Tumour's of Head and Neck - John Batsakis, 2nd edition,
William and Wilkins, Batimocel London Page 259-262.
2] Oral Nodular fasciitis - A Case Report -
- D.M.Badia, L.Rossi, A.R.Sorci and M.Riminucei
- Oral Oncology Eur. J. Cancer, 1994.
- Vol. 30 B, No.3, P.P. 221-222.
3] Clinico pathologic correalations of myofibroblastic tumours
of the oral cavity. 1. Nodular fasciitis.
- Dan Dayan, Varda Nasrallah, Marillena Vered
- Journal of oral pathology and medicine vol.34 issue - 7 Page
426-435 Agusut - 2005.
4] Oral Nodular Fasciitis
- H.T.Davies, N.Bradley and J.E. Bowerman.
- British Journal of Oral and Maxillofacial Surgery (1989),
Vol.27, Page No.147-151.
5] Nodular Fasciitis and Solitary Fibrous tumour of the oral
region - Tumours of fibroblast heterogeneity.
- Lewis R. Eversole, Russel Christene, Ginseeppe Ficarra,
Lucina Pierleoni et al.
- Oral surgery, oral medicine, oral pathology oral Radiology
Endodontic 1999
6] Soft tissue tumours.
- Enzinger - Weis SW
- 3rd edition, St.Louis, Mosby, 1995.
7] Nodular fasciitis In : Fletcher CDM Unni KK Mertens, F, eds,
Pathology and genetics, Tumours of Soft Tissue and bone
(WHO Classification of Tumours). Evan's H., Bridge J.A.
8] Intravascular fasciites : a case report in an intraoral location
- M.A.Kahn, D.R.Weathers and D.M.Johnson
- Vol.16, No.6, July 1987.
- Journal of Oral Pathogy - Page No.303 - 306.
9] Connective tissue lesions in oral pathology. Clinical
pathologic corelations.
- Regezi J.A., Sclubba J.J., Jordan RCK eds.
- 4th edition, St.Louis : skounders 2003 Page No.164-166.
10] Burket's - Oral Medicine 'Benign Lesions of the oral cavity' -
A. ROSS KERR.
- John A. Phelam, 11th edition, chapter No.6 Page No.134-
REFERENCES :
135.
11] Nodular fasciitis of the upper labial fascia:cytometric and
ultrastructural studies.
- Authors :- Tomonori Kawana, Hijrotsugu yamato, Akira
Deguli, Testuo Oikawa and Hirotusugu
- Int.Journal Oral Maxillofacial Surgery 1986, Vol.15, 464-
468.
12] Shater's Text book of oral pathology, Rajendran and
Shivpath Sundnaram, Elsevier, 6th edition 2009.
13] Lucas's Pathology of Tumour of the oral tissues
- Roderik A. Cawson et al.
- Edition - 5th
- Churchill Livingstone London.
Dr. Vaishali Nandkhedkar, et al
51st Maharashtra State
Dental Conference
PUNE
15th & 16th December 2012
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ABSTRACT:
INTRODUCTION:
CASE REPORT:
The dental treatment of patients with inherited
bleeding disorders has been widely discussed in the
literature with the aim of developing guidelines for
common procedures.
A factor VIII level of 6% to 50% of normal factor activity
(mild hemophilia) is associated with bleeding during
surgery or trauma, 1% to 5% with bleeding after mild
injury and <1% (severe hemophilia) with spontaneous
bleeding.
In patients with hemophilia, transfusion of appropriate
factor to 50-100% of normal levels is recommended when a
single bolus infusion is used in an outpatient setting.
Considering usage of an antifibrinolytic agent like epsilon
aminocaproic acid (EACA) may be helpful. We are
presenting a case of dentoalveolar trauma treated in a
patient with hemophilia A.
Key words: Hemophilia A, Epsilon-aminocaproic acid
Hemophilia A is the most common type of hemophilia.
It is largely an inherited disorder in which one of the
proteins needed to form blood clots is missing or reduced.
The use of EACA has proved to be an efficient and practical
method for treating hemophiliacs who require dental
treatment. In the past, patients required prolonged
hospitalisation and received replacement infusions every
12 hours during their stay. This resulted in a large expense
because of the cost of the material and hospitalization, not
to mention the trauma sustained by the patient both
physically and psychologically. By decreasing the number
of factor infusions, the risk of complications such as the
transmission of hepatitis, allergic reaction and inhibitor
formation decreases.
A 48 year old male patient reported to our unit with
complaining of mobile upper anterior teeth. He gave a
history of assault with a blow on his face. He also gave a
family history of hemophilia A .
On examination, the upper central & lateral incisors
were significantly mobile with continuous mild bleeding
from that site. No other soft tissue injuries were noticed on
the face. Since the involved teeth required immobilization if
they were to be retained and as the patient also insisted on
the same, it was planned to immobilize them with an arch
Therapeutic Role Of Epsilon-aminocaproic
Acid In The Management Of Dentoalveolar Trauma
In Hemophilia A- A Case Report
Dr. Vivek Gurjar, Prof., Dept. of Oral and Maxillofacial Surgery
Dr. Minal Gurjar, Reader, Dept. of Periodontics
BVDU Dental College & Hospital, Sangli
Oral Surgery
bar. Based on the family history, routine laboratory
investigations for hemophilia were carried out. The local
hemophilia unit was contacted , who would be responsible
for arranging the administration and monitoring of
treatment products. The administration of clotting factor
concentrates both before and after the procedure along
with the use of an antifibrinolytic agent namely EACA (50
mg/ kg four times a day) was considered. It was decided to
continue the drug for a further period of 4 days post
treatment.
We had the patient rinse the mouth with chlorhexidine
mouthwash two mi nutes
before the administration of
the local anesthetic. The teeth
involved were immobilized
wi t h an ar ch bar as
atraumatically as possible and
occlusion checked. (fig.1)
The patient was given detailed postoperative
instructions like no mouth rinsing for 24 hours, no smoking
for 24 hours, soft diet for 24 hours and prescribed
medication to be taken as instructed. Antibiotics were used
following the procedure considering that their use may
prevent a late bleed due to infection. An antibacterial
mouthwash was prescribed. Emergency contact details
were given to the patient in case of a problem.
The patient was followed up every 24 hours for the next
5 days and no bleeding episode was encountered. After a
period of 4 weeks, at the time of arch bar removal, the same
p r o ced u r e o f f act o r
concentr ates and EACA
administration was followed
and the pr ocedur e was
completed uneventfully. (fig.2)
The patient was followed up for
a further period of 5 days.
Dental surgeons must be aware of the impact of
bleeding disorders on the management of patients. Patient
evaluation and history should begin with standard medical
questionnaires. For the purpose of history-taking, a
(1)
clinically significant bleeding episode is one that
continues beyond 12 hours, causes the patient to call or
return to the dental practitioner or to seek medical
treatment or emergency care, results in the development of
DISCUSSION:
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hematoma or ecchymosis within the soft tissues or
requires blood product support.
When a bleeding disorder is suspected, laboratory
investigations, including blood counts and clotting studies
should be carried out. Preoperative laboratory
(2)
tests include bleeding time to determine platelet function,
activated partial thromboplastin time to evaluate the
intrinsic coagulation pathway, international normalized
ratio to measure the extrinsic pathway and platelet count to
quantify platelet function.
Hemophilia A is an X-linked hereditary disorder with a
deficiency of factor VIII. In about 30% of cases, there is no
family history of the disorder and the condition is the result
of a spontaneous gene mutation. All races and economic
groups are affected equally.
Hemophilia is considered severe when plasma activity
is <1 IU/ dL (normal range 50-100), moderate if it ranges
between 2 and 5 IU/ dL and mild if it is between 6 and 40
IU/ dL. When a person with hemophilia is injured, he does
not bleed harder or faster than a person without
hemophilia. Rather, he bleeds longer.
The treatment of patients with hemophilia A involves
the replacement of the deficient clotting factors by
intravenous infusion to either control or prevent bleeding.
Historically, international guidelines for oral surgery
recommended the administration of clotting factor
concentrates both before and after surgery. Doses are
calculated to increase the level of factor VIII to 50-100
(3) (4)
IU/ dL for a period of at least seven days . Ublansky et al.
advised an increase of factor VIII to 50% for either regional
or infiltration local anesthesia. The literature describes
many successful dental treatment protocols that provide a
remarkable reduction in the number of bleeding episodes
following oral procedures using oral antifibrinolytic
agents, systemic hemostatic replacement therapy, and local
(5-7)
hemostatic agents . The patient's hematologist should be
consulted before planning, and patients with severe
disease should be treated in specialty centres.
Options for factor VIII replacement are factor VIII
concentrates, fresh frozen plasma and cryoprecipitate.
Highly purified forms of factor VIII concentrates,
manufactured using recombinant or monoclonal antibody
purification techniques, are preferred because of their
(8)
greater viral safety. New generations of recombinant
factor VIII are being developed that are free from human
and animal proteins, in an attempt to further improve their
(9)
safety. A further potential complication of factor
replacement therapy is the development of antibodies or
inhibitors to factor VIII . Inhibitors usually develop early in
a person's treatment . Antibodies to factor VIII have been
found in 8 to 20% of the patients with severe hemophilia
(10)
A . In such patients, a focus on local measures is critical.
Antifibrinolytic therapy can be used pre & postoperatively
to protect the formed blood clot. EACA is the common agent
used.
EACA is a derivative and analogue of the amino acid
lysine, which makes it an effective inhibitor for enzymes
that bind that particular residue. Such enzymes include
proteolytic enzymes like plasmin, the enzyme responsible
for fibrinolysis. For this reason it is effective in treatment of
bleeding disorders. Effective blood levels of the drug are
readily obtainable with either oral or intravenous
administration, with very high levels of the drug being
found in the urine since the drug is greatly concentrated
during excretion. Major side effects from EACA include
hypotension, cardiac arrhythmias, rhabdomyolysis, and
generation of thrombi. The incidence of thrombotic events
secondary to the inhibition of the fibrinolytic system by
EACA is unknown, but may be particularly increased in
those patients who have some underlying predisposition to
develop thrombosis. The potential benefit from the use of
EACA must be weighed against the possible complications.
The management of patients with bleeding disorders
depends on the severity of the condition and the
invasiveness of the planned dental procedure. If the
procedure has limited invasiveness and the patient has a
mild bleeding disorder, only slight or no modification will
be required. In patients with severe bleeding disorders, the
goal is to minimize the challenge to the patient by restoring
the hemostatic system to acceptable levels and maintaining
hemostasis by local and adjunctive methods. Careful pre-
operative planning and the use of antifibrinolytic agents
will prevent many postoperative problems. EACA in
conjunction with a single infusion of cryoprecipitate can
insure hemostasis in most patients with haemophilia A.
1. Lockhart PB, Gibson J, Pond SH, Leitch J. Dental management
considerations for the patient with an acquired coagulopathy.
Part 1: Coagulopathies from systemic disease. Br Dent J 2003;
195(8):43945.
2. Meechan JG, Greenwood M. General medicine and surgery for
dental practitioners Part 9: haematology and patients with
bleeding problems. Br Dent J 2003; 195(6):30510.
3. Mulkey TF. Outpatient treatment of hemophiliacs for dental
extractions. J Oral Surg 1976; 34:428-34.
4. Ublansky JH. Comprehensive dental care for
CONCLUSION:
References:
children with
bleeding disorders a dentist's perspective. J Can Dent Assoc
1992, 58(2);111-14.
5. Larsen PE. Dental Management of the Patient with
Hemophilia. (Letter) Oral Surg Oral Med Oral Pathol 1989;
67(5):632-33.
6. Sindet-Pedersen S; Gram J, and Jespersen J. The possible role
of oral epithelial cells in tissue-type plasminogen activator-
related fibrinolysis in human saliva. J Dent Res 1990;
69(6):1283-86.
7. Sindet-Pedersen S; Stenbjerg S, Ingerslev J and Karring T.
Surgical treatment of severe periodontitis in a haemophiliac
patient with inhibitors to factor VIII. Report of a case. J Clin
Periodontol 1988; 15:636-38.
8. Lusher JM, Roth DA. The safety and efficacy of B-domain
deleted recombinant factor VIII concentrates in patients with
severe haemophilia A: an update. Haemophilia 2005;
11(3):2923.
9. Manno CS. The promise of third-generation recombinant
therapy and gene therapy. Semin Hematol 2003; 40(3 Suppl
3):238
10. Sultan Y, the French Hemophilia Study Group. Prevalence of
inhibitors in a population of 3435 hemophilia patients in
France. Thromb Haemost 1992; 67:600-2.
Dr. Vivek Gurjar, et al
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l The concept of Periodontal disease as localized entities
affecting only teeth & supporting apparatus is over
simplified and is in need of revision rather than being
confined to the periodontium , periodontal diseases may
have wide ranging systemic effects.
l In susceptible individuals periodontal infection may act
as an independent risk factor for systemic disease and
may be involved in the basic pathogenic mechanisms of
these conditions
l Furthermore periodontal infection may exacerbate
existing systemic disorders
l Organ Systems And Conditions Possibly Influenced By
Periodontal Infection
l Cardiovascular / Cerebrovascular System.
n Atherosclerosis n Angina
n Myocardial Infraction MI n Coronary Heart Disease
l Cerebrovascular Accident (stroke)
n Endocrine system n Diabetes Mellitus
l Reproductive System
n Preterm Low Birth Weight (LBW) Infants
n Pre-eclampsia
l Respiratory system
n Chronic Obstructive Pulmonary Disease(COPD) -Acute
Bacterial Pneumonia
Proper use of knowledge of potential relationship
between periodontal disease and systemic health requires
the dental professional to expand his or her horizons, to step
back from the technically demanding aspects of the dental art
& to recognize the oral cavity as one of the many interrelated
organ systems.
An infection the size of ones palm on the leg of a pregnant
woman would be a major concern to the patient and her
health care provider, given the potential negative
consequences of this localized infection on the fetal and
maternal health.
A similar suppurating infection on the foot of a person
with diabetes would be a cause for immediate evaluation and
aggressive treatment, knowing the effects of such infection on
metabolic control of diabetes. Periodontal infection must be
viewed in a similar manner.
Periodontitis is a gram negative infection resulting in
severe inflammation with potential intravascular
dissemination of microorganisms and their products
throughout the body.
The sub gingival micro biota in patients with
periodontitis provides a significant and persistent gram -ve
bacterial challenge to the host.
These organisms and their products such as
lipopolysaccharide have ready access to the periodontal
tissues and to the circulation via the sulcular epithelium
which is frequently ulcerated and discontinuous.
Periodontal Disease and Systemic Health
Sub gingival Environment as a Reservoir of Bacteria :
Just as periodontal tissues mount an immuno-
inflammatory response to bacteria and their products
systemic challenge with these agents also induces a major
vascular response.
This host response may offer explanatory mechanisms
for interaction between periodontal infections and a
variety of systemic disorders. However periodontitis tends
to be a "silent" disease until destruction results in acute
symptoms. Most patients as well as many medical
professionals do not recognize the potential infection that
may exit within the oral cavity.
Patient education is a priority. Only 30 years ago the
factors involved in CHD were unclear. At present however it
would be difficult to find an individual who was unfamiliar
with the link between cholesterol and heart disease.
This change was precipitated by research clearly
demonstrating the increased risk for heart disease in
individuals with high cholesterol levels followed by
intensive education efforts to spread the message from the
scientific community to the public at large.
It is important to recognize that high cholesterol levels
have not been shown to cause heart disease in all
individuals but rather significantly increase the risk of the
disease. Cholesterol has also been demonstrated to have a
biologically plausible role in the pathogenesis of CHD.
Similarly patient education efforts in the realm of
periodontal medicine must emphasize the nature of
periodontal infections, the increased risk for systemic
disease associated with the infection and biologically
plausible role periodontal infection may play in systemic
disorders.
Few individuals had their cholesterol levels evaluated
until the knowledge of the link between cholesterol and
heart disease became widespread, likewise increased
appreciation of the potential effects of periodontal
infection on systemic health may result in increased patient
demand for evaluation.
The pregnant woman usually knows that infections
may adversely affect her pregnancy, patients with diabetes
generally know that infections impair glycemic control,
however many of these patients do not know that occult
periodontal infections can have the same effect as clinically
evident infections.
The dentist is responsible for diagnosing the
periodontal infections, providing appropriate treatment
and preventing disease recurrence and progression.
Because many medical professionals are unfamiliar with
the oral cavity and oral health research the dentist must
reach out to the medical community to improve the patient
care through education and communication. The emerging
field of periodontal medicine offers new insights into the
concept of oral cavity as one system inter connected with
the whole human body.
th
1) Text Book Clinical Periodontology Carranzza - 10 Edition
Patient Education
References:
PERIODONTAL MEDICINE IN CLINICAL PRACTICE
Dr. Alka Waghmare,
Prof. & Head, Dept of Periodontolog ACPM Dental College, Dhule
Periodontics
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N E W S
Dental Dialogue
IDA MSB
J oin Social
Security Scheme
Contact
Dr. Narendra Paralkar
Cl i ni c : 022 27823658, 27823757
KOLKATTA
Attend in Large Numbers
21st t o 24t h Febr uar y 2013
66th Indian
Dental Conference
OFFICE BEARERS WORKSHOP
AWARDS OF IDA MSB FOR 2010-11
Local branch journal award to
Dr. Ashish Mahajan of Jalgaon Branch
Best branch award to
Dombivali Branch
Best Branch award
to Jalana Branch
Panchgani 1st April : Officer Bearers workshop was organised here at Blue Country Resort, thing ar
road Pachgani of IDAMSB for two days. There were five presentation on various subjects for the
offfice bearers of local branches
Publication by local branches : Dr. Rajendra Bhasme
Duties of President : Dr. Mohan Gokhale Local Branch f unction ing : Dr. Jayant Deshpande
Social Security Scheme of IDAMSB : Dr. Subhash Sane
On Sunday there was presentation on progress of IDAby HSG Dr. Ashok Dhobale. Dr. Anand
Godsay President IDAwas felicitated. Also Dr. Pramod Gurav president elect of IDA was felicitated
by his native branch by Dr. Bajarang Shinde . The first EC of IDAMSB also took place in the same
place.. Near about 100 office bearers were present fromlocal branches of Maharashtra.
l
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l
Duites of Treasurer : Dr. Nitin Barve l
FELICITATIONOF GUEST SPEAKERS
Best Local Branch
President Award
Dr. Rajendra Bhasme Dr. Nitin Barve Dr. Mohan Gokhale Dr. Jayant Deshpande Dr. Subhash Sane
Dignitories on the dias from left Dr. Suresh Meshram, Editor JIDA, Dr.
Bajarang Shinde, President Elect, Dr. Sanjay Bhawsar, President IDA
MSB, Dr. Anand Godshay, President IDA, Dr. Ashok Dhoble, HSG, Dr.
Pramod Gurav, President Elect IDA& Dr. Suhas Merchant, V. P. IDAMSB
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JALGAON BR.
IDA Jalgaon branch conducted 4th CDE
programme on 25 may 2012 at Hotel Silver
Palace, Jalgaon. 40 ida members attended
the CDE programme. Speaker- Dr. Vaijayanti
Padhye. Topic- Glimpses of Australia
Dr. Ashish Mahajan
2ND EC OF
IDA MSB AT NASHIK
CHANDRAPUR BR.
Chandrap
ur I DA
Hosti ng
Z o n a l
Scientific
Program
Away
from head
office Mumbai, In vidarbha region chandrapur
IDA branch is one of the active branch doing
various activities in their zone like scientific,
people awareness in remote areas. Oral checkup
campaign.
rd
On 3 of June 2012 Sunday Chandrapur IDA
branch conducted scientific session on prostho-
perio approach by prosthodontist Dr. K. S.
Lahoti and periodontist Dr. Abhishek Soni in
presence of ChairPerson Dr. Sushil Mundhada,
president Dr. Vijay Giri, hon. Secretory Dr. Pravin
Ghode and about 50 delegates from various
places.
IDA Jalgaon Branch conducted 5th CDE of Jalgaon Branch at Hotel
Silver Palace on 22nd June 2012. Guest Speaker for the programme
is Dr. Rahul Bhosari, MDS (Perio) from CDE Jalgaon.
Nashik : 17th June 2012 second EC of IDA
MSB is held here at Hotel Sai Palace, Mumbai
Agra road, Nashik, First issue of Dental
Dialogue for the year 2012i.e. JAN.-
MAR.2012 was released here at the hands of
Dr. Sanjay Bhavsar President IDA MSB.
KOLHAPUR BR.
Release of Dental Dialogue
Morning of 20 April was made one of the most valuable one by guest
speaker Dr. Hemant Umaraji who is HOD of Oral Medicine & Radiology in
GDC, Mumbai. The lecture held under heading of ''Differential Diagnosis of
oral lesions''. The topic discussed was important by point of view of day to
day clinical practice.
Started discussion with basic differences in physiologic white conditions
& pathological white conditions, Linea alba. Fordy's granules &
leukoplakia. As Dr. Das said ''Diagnosis of rare disease you are rarely
correct !'' So one must start from common lesion possible in particular
region of oral cavity. Other cases shown like traumatic ulcer on lateral
border of tongue as a result of sharp cusp of tooth, lingual varicosities
illustrated with help of clinical photographs. For lingual Thyroid use of I
dye & scientography might be useful in diagnosis.
Dr. Pravin Ghode
Dr. Shailesh Joshi
Dr. Shirgopikar felicitating Dr. Hemant Umraji
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IDA Dhule branch had conducted rd4thscientific programme at IDA Dhule branch on
Sunday1st July 2012. Details are as follow:-
Speaker :- Dr Abhay Datarkar, MDS (Oral Surgery)
Topic : -1) Day to Day Orak
SurgicalPractise :-
#COMPLICATED EXODONTIA
#WISDOM TOOTH SURGERY WHEN,
WHY, & HOW ? ; IMPACTED CANINE &
SUPERNUMERARY TEETH
#TIME :- 10:00-11:00AM.
2) PERIAPICAL PROCEDURES & OTHER MINOR ORAL SURGICAL PROCEDURE.
#TIME :- 11:00-12:30PM.
Day &Date :- 01 JULY SUNDAY 2012.
Venue :-Hotel Residency Park.
Dr. Sujit Pardeshi selected as Assistant
Governor of Rotary District 3030 for
the year 2012-13. He has taken charge
of the same from 1st July 2012 for Zone
5. A Rotarian since 10 years, he has
served on many important posts at
district level after being served as
President of Rotary club of Pachora-
Bhadgaon during the centennial year of
Rotary in 2004-05. Rotary district 3030
consists of 13 revenue districts from
Nashik to Nagpur. Interestingly, Dr. Sujit
was also selected to go to the
Netherlands in Rotary's Group Study
Exchange Program as a team member &
goodwill ambassador of India.
KHARGHAR BR.
DHULE BR.
We ida Kharghar branch proud for our founder president Dr Sudarshan G
Ranpise,Prof.& Head Dept OF OMDR,Bharati Vidyapeeth Deemed University Dental
College & Hospital Navi Mumbai,has been felicitated by Bharati Vidyapeeth
Management on the auspicious 48th Foundation Day st Bharati Vidyapeeth
education complex Dhankavadi, Puneon 10th May Thursday 2012 at hands of
Hon.Higher and Technical Education Minister Mr Rajesh Tope Govt.of Maharashtra
on the highest acievement of Philosophy of Doctorate (PhD) in the subject of Modern
Criminal Investigation:A Critical Analysis under the guidance of Prof.Dr P. Daniel
(Guide), Dr. Vijay Chitnis (Co-Guide)PhD teachersat Mumbai University. Dr S. G.
Ranpise has completed his PhD from OpenIntenational Complementary Medicine
Colombo. He has honored with shawl, floral bouque and momento Bharati
Vidyaoeeth. Dignitaries on the dias from left to right Dr Vishwajeet Kadam President
Maharashtra Youth cCongress and Secretary Bharati Vidyapeeth, Hon. Min.Mr.
Rajesh Tope, Hon.Min.Dr Patangrao Kadam Founder and Chancellor of Bharati
Vidyapeeth, Hon. Min.Mr Rajendra Darda,Dr Shivajirao Kadam Vice Chancellor
Bharati Vidyapeeth and others.
Secretory, IDA Kharghar Branch, Navi Mumbai
Dr.Rajiv Kulkarni
IDA Kharghar Branch President Prof. Dr
Rahul Hegde who has been elected
second time as an Executive member of
Dental Council of India on 14th May
2012 Chandigarh during general body
meeting of DCI. He is already a Senet
member of Maharashtra University of
Health Sciences.
EC Member DCI
ConferenceSecretary
Dr. Girish Nagarkar from Pune Br. elected
as Conference Secretary for 52nd
Maharashtra State Dental Conference to
be held at Nashik in DEC. 2013.
Asst, Governor of Rotary
Dr. Parag Targe
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ACHI EVER SP ORTS CLUB
VENUE
VASANTRAO NAIK COLLEGE,
JALNA ROAD AURANGABAD
MR NITIN RATHOD
(SECRETARY)
9422206608
PRAVIN BHUJBAL
(COACH)
9881521216
MANOJ KANODAJE
(COACH)
9923597467
GAMES
TABLE TENNIS, CRICKET, BADMINTON ,
BASKET BALL, VOLLEY BALL.
With Best Compliments from
RNI No. 27841/75
Editorial Committee
Members :
Editor : DR. RAJENDRA BHASME
Assistant Editor : Dr. Shailesh Yadav
Contributory Editors :
Dr. R. S. Sathwane Dr. Abhay Kolte
Dr. Vivek Pakhmode
Business Managers :
Dr. Vikas N. Patil, Dr. Ashish Khasbage
Dr. Arun Khalikar
Public Relations : Dr. Bajrang Shinde
Dr. Chandrashekhar Tambade
Dr. Naveen Hantodkar Dr. Sujit Pardeshi
Co-ordinators : Dr. Harish Kulkarni
Dr. Deepak Matani,
Dr. Shrinivas Ashtekar
Advisors : Dr. Ashok Dhoble, HSG
Dr. S. G. Damle Dr. Dilip Pol
Dr. Suresh Meshram Dr. Vijay Pethe
Dr. Abhay Kamra Dr. Sabita M. Ram
International Advisor : Dr. Chhad Gehani (U.S.A.)
CopyRight Readressal Committee :
Printed & Published by on behalf of the Indian Dental Association,
Maharashtra State Branch and Printed at , Bhausingji Road, Nagala Park, Kolhapur 416 002. and published
at 1215 'A', Ground Floor, Opp. Daulatrao Bhosale School, Shivaji Peth, Kolhapur 416 012.
Dr. Rajendra Bhasme
Rajhuns Printing Press
Dr. Rajendra Bhasme Editor
Opnions expressed in the articles and advertisements are those of the authors and not necessarily those of the Editor or Publisher.
The Editor and Publisher disclaim any responsibility or liability for such material, views, statements of claims. The material
(text, illustrations, slides, tables, etc.) supplied for articles is the sole responsibility of the author and / or Advertiser.
Dental Dialogue is not responsible for verifying or authenticating the source of such material.
Circulation free to all members of IDA Maharashtra State Branch Non Members : Rs. 15/- Inland
Pre. : Dr. Sanjay Bhawsar
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Copy right : All the rights are assigned by the author (s) to the Dental Dialogue & are reserved. No part of the article (s) should be
reproduced or copied in any form or by any means i.e. graphic, electronic, or mechanical without written permission of the Editor.
Vol. XXXVIII No. 2 APRIL - J UNE 2012 Dental Dialogue
Vol. XXXVIII No. 2 APRIL - J UNE 2012 Dental Dialogue
RNI Reg. No. 27841 / 75

IDA Maharashtra State Branch Dental Dialogue April-Jun 2012

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