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  1. 1. EN TAL ASSO Journal of the Indian Dental Association D C IAINDIAN Tamil Nadu State Branch TI O N Journal Office : Vel Dental Home, No.10, Bharathi Street, Pondicherry - 605 001.Volume 5 Issue 16 Knowledge . Service . Love Jan. - Mar. 2013 Advisors President DR. D. SENTHIL KUMAR Dr. S. Thillainayagam Honorary State Secretary DR. C. SIVAKUMAR Dr. C.R. Ramachandran Dr. Gunaseelan Rajan Honorary Treasurer DR. T.S. RANJITH Dr. George Paul President-Elect DR. S. THILLAINAYAGAM Dr. Sivapathasundaram Dr. S.M .Balaji Imm. Past President DR. K. RAJASIGAMANI Dr. N.R. Krishnaswamy Vice Presidents DR. A.P. MAHESWAR Editor in chief DR. RADHA KRISHNAN Dr. A. Thangavelu DR. V. BASKAR Associate Editors Hony. Jt. Secretary DR. M. SETHU ANANDAN Dr. Jayantha Padmanaban Dr. G. Ulaganathan Hon. Asst. Secretary DR. A.L. MEENAKSHISUNDARAM Assistant Editors Convenor C.D.E. DR. J. SELVAKUMAR Dr. J. Selvakumar Dr. V. Arun Prasad Rao Convenor C.D.H DR. S. THIRUNEELAKANDAN Dr. Thamarai Selvi Honorary Editor DR. ANNAMALAI THANGAVELU Dr. R. Madhan Convenor - Care & Concern DR. BALA. SIVA GOVINDAN Sectional Editors Dr. A. Tamizhchelvan Executive Committe Members Dr. G. Mohan Dr. Vijay Vaikunth Dr. Balamurugan .L Dr. Pradeep R. Dr. S. Rajasekar Dr. Benedict .V Dr. Prince Soyus Suresh Dr. R. Sasirekha Dr. Chendil Maran Dr. Rajarajan Immanuvel Dr. A.P. Maheswar Dr. Dhineksh Kumar .N Dr. Rajasekaran .K.G Dr. S. Murugesan Dr. Elango .K Dr. Ravi Shankar .DM Dr. Subramanium Dr. Karthik .K Dr. Samuel Pushparaj Reviewers Dr. Kanna Peruman .J Dr. Saravana Bharathi Dr. S. Ramaswamy Dr. Kalaiselvan .N Dr. Surendra Babu .J Dr. Vijayalakshimi Dr. Kandasamy Ramesh .M Dr. Sudhakar .G Dr. Madhavan Nirmal Dr. Kumar .K Dr. Sudhakaran .B Dr. Vidya Dr. Mohamhed Mustafa .S.T Dr. Sukumaran .D.K Dr. S. Karthikeyani Dr. Murugesan .S Dr. Syed Rafiq Dr. A.L. Meenakshisundaram Dr. Nagaraj .V Dr. Vasantha Raj .R Dr. T.R. Sudharson Dr. Nanda Kumar .G Dr. Vasudevan Dr. J. Johnson Raja Dr. C. Hari Prasath Dr. Prakash .R Dr. Yogananth. R Dr. V. Balakumar Dr. Y.A. Bindhu Central Council Members Dr. A. Arvind Kumar Dr. Senthil Kumar Dr. Aravind Kumar .A Dr. Murali Baskaran .K Dr. J. Kannaperuman Dr. Arun .R Dr. Rajasigamani Dr. M. Ramaswamy Dr. Baby Johm .J Dr. Rajmohan .A Dr. N. Dhineksh Kumar Dr. (Capt) Bellie . R Dr. Senthilkumar D. Dr. Jagdeep Raju Dr. Gokul Raj .T Dr. Surendaran .G.P Theme Editors Dr. George Thomas Dr. Sivakumar .C Dr. Srivatsa Kengasubbiah Dr. Iyyappan shankar .V Dr. Sudharson .T.R Dr. Yoganand Dr. Johnson Raja Dr. Sethumadhavan .U Editorial Manager Dr. Maheswar .A.P Dr. Umashanka .K.K Dr. K. Vasanthakumar Dr. Meenakshi Sundaram .A.L Dr. Vijayakumar .P Publisher Edited by Designed & Printed by IDA TN State Branch Prof . Dr. A. Thangavelu MDS,DNB. Kannan Offset, Pondicherry - 1.
  2. 2. Guidelines for AuthorsSubmit all manuscripts to : Prof. Dr. A. Thangavelu, MDS, DNB., Vel Dental Home, No.10, Bharathi Street, Pondicherry - 605 001. 1. A Covering letter with the following words signed by all the authors should be submitted "The submitted material has not been published earlier and it is not under consideration for publication elsewhere. The copyright of the paper if published will stand transferred to the Journal of Indian Dental Association. We will indemnify and keep indemnified The IDA Tamilnadu State Branch and the Editorial Committee and the Editor of the Journal of the Indian Dental Association Tamilnadu against all claims and expenses including legal costs in case of breach of copyright or other laws arising as a result of publication of our articles" 2. Submit the final version of manuscript in MS Word format in a CD or send it by mail to the Editor 3. Send a Scanned photograph of the author /s 4. Editiorial decisions - all manuscripts submitted are peer reviewed by at least one external peer reviewer. 5. Decisions of the Editorials committee will be final 6. The Editor has the right to alter and modify the articles as per needs and space restrictions Manuscripts, Length and number of references-guidelines Research Articles Case Reports Correspondence 1. Manuscript 1. Title pages 1. Title pages 1. Title pages Text Parts 2. Postal Address/ 2. Postal Address/ 2. Postal Address/ Labelsheet Labelsheet Labelsheet 3. Blind Title Page 3. Blind Title Page 3. Blind Title Page 4. Structured Abstract 4. Case Report/s 4. Letter i. Objectives 5. Comments 5. Acknowledgments i. Materials and Methods 6. Acknowledgments 6. References list i. Results 7. Legends for figures ii. Conclusions 8. References list 5. Introduction 6. Methods 7. Results 8. Discussion 9. Conclusions 10. Acknowledgments 11. Legends for figures 12. References 2. Tables and Total tables + figures = 5 no tables +2/3 figures no table figures 3. Manuscript length 2000 words maximum 6000 words maximum 600 words maximum 4. References Original 20 review 40 3 to 5 3 to 5
  3. 3. From the Presidents desk At the outset I take this opportunity to thank all my IDA members and well wishers for honouring me on takingover as the President of IDA-Tamilnadu for the year 2013. I wish everyone of you to have a very productive and fruitfulNew year 2013. A month has passed and I am happy to inform you that I have already touched the ground and visited a fewbranches. It was a pleasure to meet and interact with several office bearers and members of Marthandam and Madurai. I am happy to see the enthusiasm among several of our members and I hope this spirit continues to prevail allacross the state so that all of us together can make IDA truly a larger and stronger body. I strongly believe that as dentists we have a strong commitment to the community in which we live. The basic aim of IDA is to promote oral health and hygiene in the country and all the efforts of IDA are directedat attaining this cherished goal. At the same time enhancing the image of our members in the public and promoting their professionaladvancements and their family security are matters very close to IDA. Organising lectures and scientific symposia are means of keeping abreast with the changing world of dentalscience and we are working on it. We need your cooperation and support in taking dentistry to higher levels of excellence and without that IDAwould not be able to achieve the goals it has set for itself. Vazhga IDA. Dr. D. Senthil Kumar BDS President, IDA-Tamil nadu C.Doraiswami Nalayini Dental Clinic, 8,Azad Street,Udumalpet.642126. 9842225506,
  4. 4. From the Secretarys deskDear Friends,Wish You All Very Happy Prosperous New Year.Dentist are specialty oriented professional, each and every specialty in dentistry are interrelated and the specialist havegreat relationship with each other The present day development in the Dental field especially the technological advancesin each specialty create a great challenge to update and to put it in our day to day practice for the benefits of our patients.There is a wide range of technological changes in Dental Science- today. In these situations the journal published byState Branch of IDA plays a major role in getting the update information to the clinic desk .I am sure the Tamilnadu Journal (JIDAT) is severing the purpose for more than a year and continues to do so. Each andevery member reading the journal should promote the journal and motivate the other members to subscribe for thejournal. Similarly another field were we should improve is “Service and creation of Awareness among the rural patient.We can improve this by improving our local branch CDH programs. CDE Credit Point is must to renew our councilregistration. I sincerely request all the members to attend all IDA activities, and get the maximum benefit from ourassociation . Do more CDH Activities. Best Wishes. Dr.C. Sivakumar Hon. Sec IDA TN
  5. 5. From the Editors deskKnowledge, Service, LoveNothing as Empowering as Knowledge,Nothing as Compassionate as Service, &Nothing as Gratifying as Love!!!Dear Pals Wishes for a happy and prosperous new year. Hope this New Year brings all the strength and prosperity to ourprofession. After a long contemplation about 21st Dec 2012 – “The End Of The World “ , in spite of all prophesies ,Mayans calendar, earth changing the axis, comets hitting the earth ,we now see the survival of the human continue toexist towards 2013 and further . Life is like that!...we pass through the difficulties we face , we cross all the hurdles we come across . Its sure thatnothing can stops us from living. The thing is how we live is the questions? We should think and take that path whichlead us to live with morality, ethic and humanity. Each and every individual should try to live for good. All of us shouldtake a task to improve our standards There are lots of things to ponder, to enjoy, to correct , to modify and to change Letthe new year give all that strength to all our members to take a resolution , take a chance ,join hands and fight for ourrights and to stabilize our profession “ Dentistry” . Each one of us have a great role in it , let us not blame each others for the flaws Everyone has a responsibility, ifeach one of us walk towards that good changes I am sure our profession will leap ahead and be an envy to our colleagues,job opportunities, irregularities in dental education, Unethical practices, service to the needy and developing a clearidentity among the health professional are the areas of concern. So Let us arise, join hands to solve our problems, Let us change for the CHANGE and create a history. Prof. Dr. A. Thangavelu, MDS, DNB., Editor-in-Chief, JIDAT
  6. 6. Journal of the Indian Dental Association - Tamil Nadu Vol. 5 Issue. 16 Jan. 2013 ContentsForce Systems in Orthodontics – An Overview of Traditional and Recent Concepts 01Dr. Santhana Krishanan, Dr. K.Rajasigamani, Dr. N. Kurunji kumaran, Dr. V. VenkataramanaCranial Bone Graft for Orbital Floor Reconstruction 04Dr.C. Hari Prasath MDS, MOMS RCPS, Prof. Vinod Narayanan, MDS; FRDRCS; MOMS RCPSComparison of Radicular and Intra Radicular Stud Attachments: Case Reports 10Dr. Bharanija Kalidasan Selvi, Dr. Eazhil Raj, Dr. Jaya KrishnaKumar S, Dr. Azhagarasan N.SAn Insight to Single Visit Endodontics 14Dr. A. Shafie Ahamed, Dr. Deepa Vinoth KumarCommon and Uncommon form of Oral Mucocele 18Dr. Sudhaa Mani MDS , Dr. Eswaramurthy BDSInterim and Esthetic Management of an Avulsed Tooth 22Dr. S. Leena Sankari M.D.SPeriodontal Disease and Respiratory Infection - A Link 25Dr. P.l. Ravishankar, Dr. S. RajsekharMilestones in Periodontics 27Dr. D. Ida Sibylla BDS, M.Sc., (Neuroscience)
  7. 7. Vol. 5 Issue. 16 Jan. 2013Patient-Friendly Approach to the Management of Periodontal Disease 33Dr. M. Vijayalakshmi, Dr. Gayathri. S, Dr. M. G. Krishna Baba, Dr. Sumathi. H. Rao, Dr. T. GeethaPathophysiology of Acute Necrotizing Ulcerative Gingivitis(Anug) / Vincents Infection - A Review 36Dr. K. Sasireka M.D.S, Dr. M. Devi M.D.SA New Concept of Dental Arch of Children in Normal Occlusion 39Abu-Hussein Muhamad DDS, MScD, MSc, DPD, FICD, Sarafianou Aspasia DDS, PhDMobile Dental Clinic – An Outreach Government Programme - An Overview 45Dr. Ramasubramanian .S, BDSNon Pharmacological Management of Dental Anxiety in Adults 48Dr. A.M.Devapriya MDS, Dr.D.Mythireyi MDS
  8. 8. FORCE SYSTEMS IN ORTHODONTICS –AN OVERVIEW OF TRADITIONAL AND RECENT CONCEPTSDr. Santhana Krishanan1, Dr. K.Rajasigamani2, Dr. N. Kurunji kumaran3, Dr. V. Venkataramana 41. Assistant professor, 2. Vice principal, 3. Reader, 4. Reader,Department of Orthodontics, Raja Muthiah Dental College and Hospital, Annamalai University, Chidambaram ABSTRACT: There is little doubt that the prevalence of patients with underlying medical conditions seeking orthodontic care has increased over the past two decades. In this literature we are discussing some major medical problems and precautions to be taken during orthodontic treatment.INTRODUCTION: physiological reaction to the forces applied by mechanical procedures. The physiological process ofMechanotransduction is the field which discusses the resorption by the osteoclastic cells is the basic activitymechanism of biotransformation of force into biological that allows the bone to change and tooth to move. Sincereaction. In orthodontics force is used to correct a given these osteoclastic cells are carried by the blood to the sitemalocclusion, the tooth responds to the applied force and of their activity and resultant bone resorption, the keymove towards the proposed final ideal position. A better factor in the efficiency movement of teeth seems to be theunderstanding of force systems on the basis of physics, blood supply carries cell and sustains their activity. Whenmechanics and biology is a mandatory for proper a generous blood supply can be maintained by applying aunderstanding of orthodontic mechanotherapy. light force, tooth movement is more efficient. When blood supply to the area, the osteoclastic activity of boneIn this context, the present overview emphasizes on the resorption is limited and the teeth do not move or theytraditional and recent concepts of force systems utilizedin orthodontics and their corresponding biological move slowly. Heavy forces that squeeze out the bloodresponse produced by teeth. cells can limit the physiologic response and markedly affect the rate of tooth movement.1. OPTIMUM ORTHODONTIC FORCE 3. STAGES IN TOOTH MOVEMENTThe magnitude of the optimum force will vary dependingon the way it is distributed in the periodontal ligament i.e. Figure 1, explains the stages of tooth movement after anit is different for different types of tooth movement. application of a moderate orthodontic load of 20 to 50g.Smith and Storey1 in their study on tooth movement in 8patients concluded that optimal lower canine movementoccurs with 150 to 250 grams of force. At higher forcelevels of 400 to 600 grams, the anchor unit of the secondpremolar and first molar moved more than the canine.Fortin2 recommends 147 gm as the optimum force forpremolar translation in dogs. Reitan3 advocates 250 gms stages of tooth movementfor retraction of human lower canines. Lee recommends150 gms to 260 gms as optimum canine retraction force. Tooth movement can be differentiated into three phases.Rickctts and associates prescribe 75 gms as optimumforce for canine retraction. 3.1 Initial Phase2. PHYSIOLOGY OF TOOTH MOVEMENT This is characterized by rapid tooth movement. It lasts for 4 a few days normally. The rapid onset of displacementRuel W. Bench et al in 1978 put forth the physiology of immediately after force application suggests that toothtooth movement. The orthodontic movement of teeth movement in the initial phase largely representsoccurs as a result of the biological response and the displacement of the tooth in the periodontal space. 01 JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013
  9. 9. 3.2 Lag Phase tooth movement produced. This center of rotation (which characterizes the type of tooth movement) is determinedTooth does not move or show a relatively low rate of by the M/F parameter for a given tooth.displacement compared to the initial phase. This lag intooth displacement is due to the hyalinization (non 6. WAYS OF INCREASING M/F RATIOvitalization) of the periodontal ligament in maximal stressareas. No tooth movement can occur until the area of non Poul Gjessing6 observed that M/F ratio could be raised byvitalization has been removed by cellular process. I) Increasing the vertical dimension gingival to the bracket 2) Increasing the horizontal dimension in the apical part3.3 Post Lag Phase of the loop 3) Decreasing the interbracket distance 4) Positioning of the loop close to the tooth to be retractedHere, there is sudden increase in rate of tooth movement. 5) Angulating the mesial and distal legs of the springAs the hyalinized zones disappear, force producing 6) Adding more wire gingival to the bracket.frontal resorption on the alveolar bone increases the rateof tooth movement. 7. FORCE DECAY4. DESIGN FACTORS IN ORTHODONTIC The force magnitude of springs or loops graduallyAPPLIANCES declines as the tooth moves. This decline is force decay. Only in theory, it is possible to make a perfect spring, oneIn order to achieve the desired tooth movements, the that would deliver the same force day after day, no matterproper force system is a critical requirement. Few terms how much of how little the tooth moved in response tomust be borne in mind before determining the design that force. With many orthodontic device the force mayfactors. even fall to zero.A force is a load applied to an object that will tend to Based on force decay, force duration is classified asmove it to a different position in space. (figure 2)The moment of a force is equal to the magnitude of theforce multiplied by the perpendicular distance from itsline of action to the centre of resistance.The only force system that can produce pure rotation(i.e. a moment with no net force) is a couple which is twoequal and opposite, non-collinear but parallel forces.The point around which rotation actually occurs when anobject is being moved is center of rotation.Center of resistance is that point at which a free object orbody can be perfectly balanced. At this point, resistanceto movement is concentrated for mathematical analysis.5. FACTORS DETERMINING CENTRE OF RESISTANCERoot lengths, Marginal bone level, characteristic ofperiodontal ligament are some factors5 that has to beconsidered while determining center of resistance. Inorder to produce movement other than uncontrolledtipping by applying a force system only at the bracket, asingle force alone is insufficient [movements such as Types of forcesbodily translation as required in space closure using Continuousedgewise and preadjusted edgewise appliances]. In these Interruptedcases, a rotational tendency (moment) must also be Intermittentapplied to the bracket. In order to attain a desirable tooth movement, anThe proportion of the rotational tendency (moment) to optimum and a constant force is required. This is possiblethe force applied at the bracket will determine the type of only with a proper load deflection rate.JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013 02
  10. 10. 8. LOAD DEFLECTION RATE Light, intermittent forces during closing spaces allows the resorbed cementum to heal and prevent furtherRefers to the amount of force produced for every unit of resorption8. Mc Fadden et al9 found no difference in theactivation of an orthodontic wire or spring. If the rate is extent of root resorption in patients treated with orlower, the force is more constant as the tooth moves. without extractions.8.1. Wire Cross Section CONCLUSIONThe load deflection rate in a round wire is directly Till date force is the only medicine available in the handdependent on the fourth, power of wire diameter. For by orthodontists to cure malocclusion. Various methodsexample, if the cross-sectional diameter of a spring is of force generations have been attempted using elastics,reduced from 0.016 inch to 0.014 inch (Only 0.002 coil springs, alloy materials, magnets, and screws.inch), the load deflection rate is nearly halved. The load Irrespective of the utilized methods the applied forcedeflection rate of a rectangular wire is directly dependent should be optional in Biological nature to overcome theon the third power of the diameter. The rate is dependent iatrogenic root resorption and non vitality of tooth duringon the orientation of the rectangular dimensions. or after orthodontic treatment. A sound knowledge for biological response for an8.2. Wire Length applied force is the key to success in orthodontic treatment.The wire length changes the load deflection rate inverselyas the third power. For example, if the length of the spring REFERENCESis tripled, the load-deflection rate is dramatically reduced 1. Story E and Smith R. Force in orthodontics and itsby one twenty seventh its initial rate. Therefore, small relation to tooth movement. Aust dent j. 1952:56;11-increase in the length of the wire dramatically reduces the 18load deflection rate. 2. Fortin JM: Translation of premolars in dogs by8.3. Wire Material controlling the moment to force ratio on the crown. American Journal of Orthodontics and DentofacialAltering the material affects the spring rate in direct Orthopedics; 1971; 59; 541- 551.proportion to its modulus of elasticity. Stainless steel 3. Reitan K: Some factors determining the evaluation ofalloys have replaced the lower strength gold alloys many forces in orthodontics. American Journal ofyears ago. In order to improve the characteristics of Orthodontics and Dentofacial Orthopedics;stainless steel arch wire, multistrand wires with greater 1957;43:1;32-45.flexibility (i.e.) reduced load deflection rates have beenintroduced. 4. Ruel W. Bench, Carl F. Gugino, James J. Hilgers - Bioprogressive therapy part - 6. Journal of ClinicalROOT RESORPTION Orthodontics 1978:12;2;123-139Reitan has shown that external root resorption is weakly 5. Kazuo Tanne, Koenig, Charles J. Burstone - Momentrelated to force magnitude and closely related to the type to force ratios and center of rotation. Americanof tooth movement, specifically intrusion and tipping. Journal of Orthodontics and DentofacialExternal root resorption (ERR) is initiated 14 to 20 days Orthopedics 1988; 94: 426 -431.after force onset and the process of ERR continues even 6. Poul Gjessing - Biomechanical design and clinicalduring retention periods of up to 1 year. It is a product of evaluation of new canine retraction spring. Americanaverage force and the time during which it acts. Journal of orthodontics and dentofacial orthopedics 1985;87:5;353-362.Dougherty made a clinical observation that in the cases,in which maximum anchorage preparation was 7. Reitan. K. Biomechanical principles and reaction: In:necessary and extreme tip back bends placed, there was a Graber TM. Swain BT. Orthodontics-currentgreater resorption of mandibular 1st molars especially the principles and techniques: St. Louis CV Mosby.distal roots. 8. Steadman Sr. Resume of the literature on root resorption. Angle Orthodontist 1942:12;1;28-38Root resorption is the same, irrespective of the treatmentmodality. Be it Begg or edgewise, it is accepted that 9. Mcfadden et al. a study of the relationship betweenextensive tooth displacement, torque movements and incisor intrusion and root shortening. Americanjiggling forces are responsible for resorption7. Journal of orthodontics and dentofacial Orthopedics 1989; 96:5;390-396 03 JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013 resorption8
  11. 11. CRANIAL BONE GRAFT FOR ORBITAL FLOOR RECONSTRUCTIONDr.C. Hari Prasath MDS, MOMS RCPS1, Prof. VinodNarayanan, MDS; FRDRCS; MOMS RCPS21. Senior Lecturer, Division of Oral and Maxillofacial Surgery, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamilnadu.2. Division of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital, Saveetha University, Chennai. Purpose : The study was to evaluate use of cranial bone grafts in orbital floor reconstruction. Patients and Methods : 12 patients with unilateral orbital floor fracture underwent cranial bone graft for correction of enophthalmos, hypopthalmos and diplopia. The inclusion criteria were pure blowout fracture of the orbit or impure blowout fracture of the orbit. Preoperative and postoperative CT scans, Radiographs and measurements were recorded. Results : Reconstruction of the orbital floor was done in twelve patients. The period of follow-up and evaluation for the cranial bone graft was 1 week, 3 months and 6 months. These patients underwent CT scans at six months period for evaluation of graft position, uptake. The pre operative enophthalmos in twelve orbital floor fractures varied from 3-6 mm. In this series of twelve orbital floor fracture the post operative enophthalmos score was =2 mm. Five out of twelve patients in the series had preoperative diplopia and none had postoperative diplopia at the time of follow-up and improvement of the eye position and gaze was also found during the checkups. Conclusion : Cranial bone is an accessible autogenous tissue which should be considered when an autogenous graft is needed for orbital floor fracture reconstructions.INTRODUCTION: the deformity of the bony structures, and this predisposes to entrapment of the soft tissues by the bony fragments.Fractures in and around the orbit are common. Theimportant aspect of orbital injuries is their intimate Surgical correction mandates replacement of the bonyrelationship with the globe, periorbital soft tissue, and soft tissues into anatomic position and if necessary,eyelids, sinuses, brain and the lacrimal apparatus. correction of the deficit in volume 4,5,6Blowout fractures of the orbit most commonly involve thefloor and/or medial wall. The displacement of the walls Despite the general good results of orbital reconstruction,can have serious sequelae regarding function and there are cases in which the cosmetic outcomes may beappearance of the eye 1. It can cause a number of different than those noted immediately after surgery. It isproblems, including diplopia, ocular muscle entrapment, suspected that the implant/graft and soft tissue undergoesand enophthalmos. From the functional standpoint, resorption, which also affects the position and possiblydisplacement of a bony wall disturbs the position of the function of the globe. However it is agreed that thesoft tissues, causing problems of eye movement and reconstruction of the orbital walls is essential to maintaindiplopia. Additionally, direct damage to the soft tissue shape and function of the orbit 7,8,9 . Autogenous cranialcan lead to scar contracture, globe dystopia, and bone grafts have been the preferred material fordysmotility. If the globe is injured, there can be a loss of reconstruction of the orbital walls for many years10,11 . Thevision 2. purpose of the study was to evaluate use of cranial bone grafts in orbital floor reconstruction.Several theories have been proposed to explain the effectof trauma to the orbit. In the hydraulic theory 2, a hard MATERIALS AND METHODS:object strikes the soft tissues of the orbit and transferspressures from these tissues to one of the orbital walls. The study consists of twelve patients who had orbitalThe inner wall then opens like a trap door in to the floor fracture during the period April 2006 to Marchadjacent sinus, and the soft tissues are pushed through the 2007. The inclusion criteria were patient with puredefect. In another theory, called buckling theory3, a force blowout fracture of the orbit, impure blowout fracture ofto the orbital rim causes the orbital walls to buckle, the orbit. The exclusion criteria were orbital fracture withdeforming them and the soft tissues. The deformity of the neurological complications, associated skull basesoft tissues of the orbit recovers much more slowly than fracture, direct trauma to the orbit.JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013 04
  12. 12. These patients had a previous history of blunt trauma or fracture site. Donor defect is packed with surgicalroad traffic accident to the facial skeleton or orbit. (oxidized cellulose). The harvested cranial graft isOpthalmological and neurological evaluation 12 was prepared and ends are smoothened. Osteotomy cuts areobtained for all the patients. Routine radiographs 13 and placed if needed to gain the shape of the floor. The cranialcomputer tomography scans taken to identify the site and graft is inserted in the defect site and globe position andsize of the fracture. Patients underwent orbital floor level is compared clinically with the opposite normalreconstruction with cranial bone graft for enophthalmos side.and impairment in the range of ocular movements. RESULTSPre operative and post operative enophthalmos weremeasured by corneal projection using a Hertel Reconstruction of the orbital floor was done in twelveExopthalometer. More than 2mm difference was needed patients. The time from initial injury to surgery variedto show clinically evident enophthalmos. The eye from one week to twelve weeks with a median of sixposition on one side could also be used as a control for weeks. The period of follow-up and evaluation for thethe other in the absence of orbital rim displacement. cranial bone graft was 1 week, 3 months and 6 months.Ocular motility was tested in the field of gaze for any The most common preoperative clinical findings in thismuscle entrapment. The purpose of the surgery was to series were limited ocular motility, paresthesia, diplopiareduce the enophthalmos to as close to zero as possible and enophthalmos. The indication for surgery in thewhen comparing the pre operative values. patients was orbital floor defect with herniation of orbitalReconstruction with cranial bone graft was done in tissue or orbital floor defects associated with othertwelve patients. In this series the cause of injury were midface fractures with significant enophthalmos.blunt trauma in 4 patients and road traffic accident in 8patients. The age ranged from 24 yrs to 39 yrs with a mean Out of twelve patients, one had developed post operativeof 30.25 years. infection in the surgical site after one month and ectropion of the lower eyelid was present. Plate removalThe post operative follow up was scheduled for One was done for that patient after six months since theweek, Three months and Six months after surgery and fixation was found to be loose on re-exploration. Scarpost operative CT scans and radiographs were taken to revision was done for the ectropion of the lower eye lid.evaluate the graft position, uptake. These post operative In these twelve patients graft was left in situ with outfollow ups were used for determining resolution of plating or other kind of fixation. In this series one patientenophthalmos and diplopia. had a breach of inner cortex of the calvarium with a duralOPERATIVE TECHNIQUE: tear and venous bleed. The adjacent temporalis muscle was taken, crushed, and used as a plug to close the defectLower mid lid- crease incision is placed on the skin or the and to stop bleeding. The patient was evaluated for signsdissection is carried through the existing wound. of neurologic changes which were found to beUnfortunately, there are limitation to dissect within the completely absent.orbit and are described as “Safe distances”5. Thesubcutaneous dissection is carried out in inferior These patients underwent computer tomography scans atdirection to the orbicularis muscle fibers and stopping six months period for evaluation of graft position, uptake.when the orbital septum is encountered. Once the They were also evaluated as to whether theseptum is encountered, the preseptal approach is then enophthalmos became clinically insignificant orcarried out inferiorly to the orbital rim. The periosteum is reduced. The pre operative enophthalmos in twelveincised just below it and subperiosteal dissection is orbital floor fractures varied from 3-6 mm. The postcarried out from orbital rim to the fracture site. operative enophthalmos was analyzed at three and six months, a time when swelling was believed to haveCranial bone graft is harvested by placing approximately subsided. The patients out come were recorded as either6cm skin incision on the mid portion of the parietal bone successful (a post score of =2 mm) or unsuccessful (a postand dissection is carried till the periosteum. Once the score of >2 mm). In this series of twelve orbital floorperiosteum is incised, bony marks are placed on the fracture the post operative enophthalmos score was =2cranial bone. Cuts are deepened and limited to the outer mm. Five out of twelve patients had preoperativedipole. The ends are beveled in 45° angulations and the diplopia and none had postoperative diplopia at the timechisel and mallet is used for harvesting of the graft. The of follow-up and improvement of the eye position andbony graft harvested is usually exceeding the size of the gaze was also found during the check ups. 05 JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013
  13. 13. GRAFT PRE OP PRE OP POST OP POST OP DISCUSSION NO ENAOPTAHM DIPLOPIA ENAOPTAHM DIPLOPIA 1 4 _ 0 _ The use of bone grafts has played an important role in oral 2 5 + 2 _ and maxillofacial surgery with relative disagreement _ _ among surgeons on the different grafting methods 3 3 0 _ _ existing. The important criteria’s to be considered when 4 4 1 _ _ evaluating grafting materials include biocompatibility, 5 4 0 availability, osteogenesis, ability to act as a matrix, and 6 5 + 2 _ mechanical stability14,15 7 6 + 2 _ 8 3 _ 0 _ The standard regenerative bone grafting material used is 9 4 _ 2 _ autogenous bone for its capability to support 10 3 _ 1 _ osteogenesis, osteoinductive and osteoconductive 11 5 + 2 _ properties. Three forms of free bone grafts include _ cortical, cancellous, and corticocancellous 16. Cortical 12 6 + 2 grafts are able to withstand early mechanical forces; < 2mm –Successful, > 2mm - unsuccessful however, they require more time to revascularize. Common donor sites for bone grafting are cranial vault, iliac crest, ribs, mandibular symphysis, and external oblique ridge 7,16. Particularly the calvarial bone is more permanent than bone from other donor sites 14. Variable rates of resorption are seen, if iliac bone is used. But an appropriate graft selection should be based upon the goals of reconstruction. Different materials are used for orbital floor fractures reconstructions are autogenous and allogenous grafts 2,7 (cranial bone, iliac, rib, symphysis, septal and auricular cartilage) or synthetic material (alloplastic materials- Preoperative CT titanium mesh). When alloplastic materials are used complications such as extrusion, foreign body reaction, infection, displacements are possible sequelae 7 . The ideal management of orbital floor fractures continues to be debated. Cranial bone grafts are widely used for numerous maxillofacial reconstructive surgical procedures. We sought to illustrate the usefulness of cranial bone grafts in orbital floor fracture reconstruction mainly because of the histomorphological similarities of the bone, curvature of the bone to the recipient site and it is particular integration with the facial bone structure. An ideal Intra operative graft Harvest material should closely replicate the tissue it replaces 16. Advantages with calvarial bone grafting are minimal postoperative pain, scar is hidden in the hair line, propensity to maintain original graft volume, local availability, low infection rate and less donor site morbidity 10,11. Disadvantages with calvarial bone grafting can be difficulty to run two surgical teams simultaneously, may not yield sufficient cancellous bone (<30cc), neurologic sequelae may arise with other potential complications10. Possible Complication rate were 5.6-7.6%. Reported complications are, hematoma/seroma, infection, dural tear with possible Postoperative CT CSF leakage, leptomeningeal cyst, laceration of superiorJIDAT, Vol.5, Iss.16, Jan.-Mar.-2013 06
  14. 14. sagittal sinus. Voska P et al used cranial bone grafts for ocular examination is necessary; in particular, specialtreating posttraumatic defects, defects originated after attention is required to check vision and pupillarytumor removal and cranial anomalies in 95 patients. No response for optic neuropathy and to assess extraocularserious postoperative complications appeared in any of motility and forced ductions/generations for extraocularthe 95 patients. In 10% of the cases, when bone grafts muscle entrapment, ischemia, hemorrhage, or orbitalwere used like onlays, he reported resorption was up to compartment syndrome22. Following the findings, a20% of the volume. Author in conclusion added that rigid carefully planned surgical treatment of blow-out fracturesmethod of fixation of the graft will reduce the resorption is proposed in correlation with the clinical symptoms andrate 11. Smolka et al states that calvarial split bone grafts radiological evidence and proper history.shows low rate of bone resorption after extensive alveolarridge reconstruction 17. CT scans are the method for evaluation of orbital floor fractures 4. Axial and coronal CT scans is the standardStanislaw B.Bartkowski et al evaluates 90 patients with diagnostic imaging technique for assessing orbitalblow-out fracture of the orbit and states that in cases with trauma, and careful analysis of CT slices can contributea defect of the orbital floor fracture reconstruction, the toward improved planning of treatment 23,24,25, material is autogenous bone graft18. V. Ilankovan et al Calculations of blow-out fractures of the orbital floor byin 1992 states that orbital reconstruction can be 3D-CT and 2D-CT method are accurate for assessing theperformed using with cranial bone graft in 222 patients area of fracture and the volume of herniated tissue 23.with 279 calvarial grafts. There were 13 (4.6%)complications, most occurring during harvesting full- In our clinical study, twelve patients with orbital floorthickness calvarial grafts. fracture were analyzed from 2006 to 2007 at the department of Oral and Maxillo-Facial Surgery. AgeThe main aim of surgical treatment is the anatomical ranged from 24 to 39 yrs. The reconstruction was madecorrection of the bony defect by restoring the anatomy by calvarial bone grafts taken only from the outer table ofand volume of the orbit to avoid any complications. the calvarium. The size of the graft was approximatelyOrbital floor morphology differs with age and gender. from 2cm to 2.5cm. In this study we analyze the pro andThe inclination of the orbital floor is steeper in children vs of calvarial bone grafting. Today alloplastic materialsthan in adults and in males than in females. Also the merit certain circumstances only when bone autogenouslowest point shifts lower and more posteriorly as patient graft is contraindicated or when the surgeon dont want toages 19 use it and is also cost effective. At the end of six monthsIn case of orbital blowout fractures the most commonly we found that the graft position, uptake was excellentfractured area is the orbital floor; where intrusion and with less resorption rate and no donor site morbidity.entrapment of the orbital content, and more specifically, Orbital surgery is not risk free. The decision to proceedof the inferior rectus and the inferior oblique muscles or with surgery must consider potential surgicaltheir facial attachments into the fracture lines and toward complications, which can include blindness, subsequentthe maxillary sinus . They account to approximately 11% infection of implanted material, orbital implantof fractures involving the orbit 20. The indications and migration, postoperative mydriasis, epiphora, andtiming for fracture repair are still controversial5,6. Lester M worsening diplopia 27,28.Cramer1 study shows that the earlier the surgery isperformed the easier it is to accomplish successful We are in the conclusion that on the basis of ouranatomic reductions and to ensure uniform excellent investigations early surgical treatment leads toresults. The “ideal” time to intervene after fracture satisfactory long-term results. As a result of favorableoccurrence cannot be precisely defined. Ultimately, the biological response in our study with no surgicaldecision to proceed with surgery should be based on the complications, cranial bone graft was considered to be apatient’s symptoms, clinical findings, and thorough promising autogenous material for orbital floor fractureinformed consent about the risks and benefits of surgical reconstructions with advantages of minimalintervention 8. postoperative pain, scar hidden in the hair line,Symptoms of orbital floor fractures include orbital pain, propensity to maintain original graft volume and lessenophthalmos, hypesthesia in the V2 distribution donor site morbidity. This, together with our favorable(infraorbital: cheek and teeth), and diplopia. Eyelid experience, encourages us to continue to use cranialecchymosis, subcutaneous emphysema, ptosis, epistaxis, bone graft in the future. Thus we conclude by saying thatlacrimal system injuries, and pupillary dilation may be cranial bone graft is an ideal autogenous material forassociated with orbital floor fractures 6,21. Thorough orbital floor fracture reconstruction. 07 JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013
  15. 15. REFERENCES: 13. Stephen H. Miller and William J. MorrisCurrent. Current concepts in the diagnosis and management1. Lester M. Cramer, Frank M. Tooze and Sidney of fractures of the orbital floor, The Am J Surg, 1972, Lerman. Blowout fractures of the orbit, Br J of Plast 123(5); 560-563. Surg, 1965, 18; 171-179. 14. Edward Ellis III, Elias Messo. Use of nonresorbable2. Dongmei He, Preston H. Blomquist and Edward alloplastic implants for internal orbital Ellis III. Association between Ocular Injuries and reconstruction, J Oral Maxillofac Surg, 2004, 62(3); Internal Orbital Fractures, J Oral Maxillofac Surg, 873-81. 2007, 65(4); 713-720. 15. Mario F. Muoz Guerra, Jesus sastre Terez et al.3. Shoab A. Siddique and Robert H. Mathog. Reconstruction of orbital fractures with dehydrated Comparison of parietal and iliac crest bone grafts for human duramater, J oral maxillofac surg, 2000, orbital reconstruction, J Oral Maxillofac Surg, 58(12): 1361-1366. 2002, 60(1); 44-50. 16. Risto Kontio. Treatment of orbital fractures: The case for reconstruction with autogenous bone, J Oral4. Oliver Ploder, Clemens Klug, Werner Backfrieder, Maxillofac Surg, 2004, 62(1); 863-68. Martin Voracek, Christian Czerny and Manfred Tschabitscher. 2D- and 3D-based measurements of 17. Smolka W, Eggensperger N , Carollo V, Ozdoba C, orbital floor fractures from CT scans, J Cranio- Lizuka T. Changes in the volume and dentistry of Maxillofac Surg, 2002, 30(2); 153-159 calvarial split bone grafts after alveolar ridge augmentation. Clin Oral Impl Res. 2006, 17; 149-5. B.T. Evans and A.A.C. Webb. Post-traumatic orbital 55. reconstruction: Anatomical landmarks and the concept of the deep orbit, Brit J Oral Maxillofac 18. Bartkowski SB, Krzystkowa KM: Blow-out fracture of Surg, 2007, 45(3); 183-189. the orbit. Diagnostic and therapeutic considerations, and results in 90 patients treated, J6. Hartstein ME, Roper-Hall G. Update on orbital floor Oral Maxillofac Surg, 1982, 10; 155-164. fractures: indications and timing for repair, Facial Plast Surg. 2000, 16(2); 95-106. 19. Tomohisa Nagasao, Makoto Hikosaka, Tadaaki Morotomi, Maki Nagasao, Kaoru Ogawa and Tatsuo7. Mordechai Kraus, Albert Gatot and Dan M. Fliss. Nakajima. Analysis of the orbital floor morphology, J Repair of traumatic inferior orbital wall defects with Cranio-Maxillofac Surg, 2007, 35(2); 112-119. nasoseptal cartilage, J Oral Maxillofac Surg, 2001, 59(12); 1397-1400. 20. Chen JM, Zingg M, Laedrach K, Raveh J. Early surgical intervention for orbital floor fractures, J Oral8. Lena Folkestad and Gösta Granström. A Maxillofac Surg, 1992, 52; 935-41. prospective study of orbital fracture sequelae after 21. Michael A. Burnstine, Clinical Recommendations change of surgical routines, J Oral Maxillofac Surg, for Repair of Isolated Orbital Floor Fractures An 2003, 61(9); 1038-1044. Evidence-based Analysis, Ophthalmol 2002, 109; 1207–1213.9. M. Marasco and F.S. De Ponte. Reconstruction of orbital floor fractures. A current surgical 22. K. de Man, R. Wijngaarde, J. Hes and P.T. de Jong. management, J Cranio-Maxillofac Surg, 2006, Influence of age on the management of blow-out 34(1);11. fractures of the orbital floor, Int J Oral Maxillofac Surg, 1991, 20(6); 330-336.10. V. Ilankovan and I.T. Jackson. Experince in the use of calvarial bone grafts in orbital reconstruction, Brit 23. Harris GJ, Garcia GH, Logani SC, MurphyML, Sheth J Oral Maxillofac Surg, 1992, 30(2); 92-96. BP, Seth AK: Orbital blow-out fractures: correlation of preoperative computed tomography and11. Koz~k J., Voska P. Long-term experiences with postoperative ocular motility. Trans Am calvarial bone grafts in cranio- maxillo-facial Ophthalmol Soc 1998 96: 329–347. surgery, J Cranio-Maxillofac Surg, 1996, 24(1); 65. 24. Edward Ellis and Yinghui Tan. Assessment of12. Thomas H. OHare. Blow-out fractures: A review, J internal orbital reconstructions for pure blowout Emerg Med, 1991, 9(4); 253-263. fractures: Cranial bone grafts versus titanium mesh, J Oral Maxillofac Surg, 2003, 61(4); 442-453.JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013 08
  16. 16. 25. Stewart MG, Patrinely JR, Appling WD: Late proptosis following orbital floor fracture repair. Arch Otolaryngol Head Neck Surg, 1995, 121:649.26. Sachs ME: Orbital floor fractures: The maxillary approach. Adv Ophthalmic Plast Reconstr Surg 6:387, 198727. Lena Fol kestad and Thomas Westin: Long-term sequelae after surgery for orbital floor fractures, Otolaryngol Head Neck Surg 1999;120:914-21.28. H. Popat and Liu D. Blindness after blow-out fracture repair. Ophthal Plast Reconstr Surg 2007;10:206–10. Corresponding author : Dr C. Hariprasath, Senior Lecturer, Division of Oral and Maxillofacial Surgery, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamil Nadu – 608002, INDIA + 91 9487474246 09 JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013
  17. 17. COMPARISON OF RADICULAR AND INTRA RADICULARSTUD ATTACHMENTS: CASE REPORTSDr. Bharaniraja Kalidasan Selvi1, Dr. Eazhil Raj2, Dr. Jaya KrishnaKumar S3, Dr. Azhagarasan N.S41. Senior lecturer, Department of Prosthodontics, SRM Dental College, Bharathi salai, Ramapuram, Chennai-89.2. Reader, Department of Prosthodontics, Chettinad Dental college and Research Institute, OMR, Padur, Chennai- 603103.3. Professor, Department of Prosthodontics, Ragas Dental College & Hospital, 2/102, East Coast Road, Uthandi, Chennai-119. .4. Professor & H.O.D, Department of Prosthodontics, Ragas Dental College & Hospital, 2/102, East Coast Road, Uthandi, Chennai-119. Key words: Tooth supported overdenture, stud attachments, radicular attachments, intra radicular attachments. ABSTRACT: Complete dentures present many problems that may be avoided by the retention of roots of selected key teeth. Retention of these roots makes possible to fabricate a denture that provides support, retention, stability and comfort, superior to that of a conventional complete denture. Alveolar bone is preserved, and the occlusal vertical dimension and centric relation are maintained. Facial and lip changes are minimized, while the ability to masticate is maximized. The patient experiences a sense of security and feels that he has his teeth and he looks his best. Despite recent developments in dental implantology, the conservative approach to root preservation is still valid. Placement of attachments in the abutments further increases retention of overdentures. Though many attachments such as stud and bar attachments are available, proper selection to meet patient’s needs is essential.Short running title: Clinical report on usage of stud retention of the denture, thereby helps in betterattachments. mastication9,10,11. The overdentures render maximum support and improve compromised esthetic appearanceARTICLE PROPER in patients with congenital anomalies such as cleft palate, ectodermal dysplasia, hypodontia, those with sequelae ofINTRODUCTION: maxillofacial trauma and tumor1. Other patients who may benefit from tooth-supported dentures are those withEdentulousness was once considered to be a normal part malrelated ridges, those facing the loss of teeth in oneof aging and the conventional way of treating edentulous dental arch while the other arch is dentulous, those withpatients was by means of complete dentures. However, unfavourable tongue positions, muscle attachments, orlimitations such as residual ridge resorption, loss of residual ridges and those who encounter difficulty withocclusal stability, undermined esthetic appearance & stability or retention of conventional complete denture2.decrease in neuromuscular skills in manipulating thedentures as age progresses has detracted the quality of life The tooth supported overdentures are of two types,of such patients1. Considerable clinical experience and conventional and with attachments1,12. The notion ofdocumented research have underscored the merits of underscoring the use of attachments shifts theretained natural teeth or substitution by dental implants to conventional overdenture design which providesserve as abutments under complete dentures and partial stability and retardation of RRR, to major emphasis ondenture2-6. In this regards overdentures have found prosthesis retention. Overdenture attachments areincreased application in prosthodontics. available for chair side procedure or requiring a laboratory casting. The attachments are of bar and studPeriodontally compromised teeth are often too weak to types1,12. Stud type attachments may be positioned oversupport a partial denture for long term. The larger crown the root/ implant (radicular) or in the root/ implantroot ratio created by periodontal disease results in forces abutment (intra radicular). In intra radicular stud typethat can gradually extract the remaining teeth. Reduction attachments, a prefabricated component is placed withinof the clinical crown creates a more favorable crown to the center of the teeth root and the male component isroot ratio to compensate for progressive bone loss, to incorporated in the impression surface of overdenture.increase the longevity of remaining natural teeth and The radicular attachment is incorporated on or into a postprovides adequate place for the overlying artificial and coping type casting. The crown root ratio is alsodenture tooth and denture base4,7,8. They also provide enhanced with the low profile of the stud typepsychological benefit to the patient, tactile attachments12.discrimination, better load transmission of the prosthesisto the underlying structures and improve stability &JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013 10
  18. 18. CASE REPORTS:Case 1: A 74 year old female patient presented with thecomplaint of inability to retain partial denture in thelower arch. Her dental history revealed that the patienthad been completely edentulous in upper arch andpartially edentulous in lower arch for past five years andhad been wearing dentures. Clinical examinationrevealed ill fitting lower denture with the presence of Intaglio surface of the denture with33,35,41 and 43. Patient had been a known diabetic for resilient female element.past 10 years and has neuromuscular inco-ordination andunder medication the same. Radiographic investigationsrevealed generalized bone loss.Taking into consideration patient’s age, medical andpsychological status, overdentures with stud attachmentswere planned with 33 and 43 as abutments. The heightand width of the abutments were evaluatedradiographically and clinically and intra radicular studtype attachment was selected (zest standard, zest anchorsattachment system, CA). Sprue former attached to wax patterns with castable male component. Abutment teeth adequately prepared after elective endodontic procedure. Metal female element oriented over cemented male components. Metal female element luted in prepared root recess. Orientation of male component analog in reline impression. Resilient male element placed in position. Intaglio surface of denture with female components. 11 JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013
  19. 19. Endodontic procedures for the abutment teeth were bone, the health of the individual, and the amount ofcompleted and adequately prepared for overdenture trauma to which the structures are subjected4.procedures (fig 1). The complete denture was fabricated.The abutment was clinically reduced to the height of The concept of overdentures developed as a simple andabout 1mm above the gingival tissue level and a pilot economic alternative to prolong the retention andhole made in canal orifice with No 700 carbide bur of a function of the last few remaining teeth in a compromiseddepth of 7mm. The drill was aligned parallel to path of dentition. The biological maintenance of ainsertion of the denture. The pilot hole was enlarged neuromuscular mechanism, the temporomandibularusing No 6 round carbide bur to a depth of 4mm. The articulation and a better medium for support and stabilitydiamond sizing bur was used to create a full 360 degree for a denture can be accomplished better by retainedrecessed seat in the occlusal surface. The metal female natural teeth than by the mucoperiosteum4. The area thatelement was tried in the prepared root recesses for proper is most critical for maintaining teeth to retain alveolarfit and then cemented using glass ionomer cement (fig 2). bone is the anterior region of the mandible. PreservationThe resilient male element was attached to female of atleast two roots in the anterior mandible to avoid theelement (fig 3). The lower denture was tried in to check advanced resorption of the anterior edentulous mandiblefor clearance to accept resilient males. A small vent hole has been the primary application of the overdenture7.was made on the lingual surface of the denture. Self cureacrylic resin of thin consistency was placed in the denture Natural roots may prevent or retard residual alveolarrecess and also painted around the male elements. bone loss. The threshold of minimal perceived pressureDenture was seated in the patient’s mouth and was asked was significantly lower with overdentures supported byto occlude. Excess material was expressed through the tooth roots than by implants due to presence of receptorsvent hole and sufficient time was allowed for the resin in periodontal ligament10,14,15.material to set. The overdenture was removed, finishedand polished. (fig 4). Stud attachments are simple and versatile in connecting complete denture to remaining natural teeth / implants. ACase 2: A 63yr old patient presented with complaint of solid attachment as that used in case 2, allows noinability to eat and speak properly due to missing teeth. movement between the male and female elements. ThisHe gave history of partial edentulousm for past two years. feature transfers stress towards the roots / implants andClinical and radiographic examination revealed presence away from the ridge. The intra radicular resilient stud typeof 33 and 44 with adequate bone support. Various attachments allow movement in any plane and transferstreatment options were explained to patient and stress away from the root/ implants and towards theremovable prosthesis was considered. The inter ridge tissues. For this reason, resilient attachments are selecteddistance was found to be adequate for placement of much more frequently than solid attachments. Retentionradicular attachments. The adequate tooth preparation achieved is satisfactory and they promote better oralwas performed and denture construction was done till the hygiene. The intra radicular attachment requires lesstrial denture stage. Root preparation was done and the space than other attachments and doesn’t requirecastable male component was attached to the post additional precious metal casting. Any significantpattern and parallelism checked. After investing (fig 5), divergence between the roots or between roots and pathcasting, finishing and polishing, the post was cemented. of insertion of the denture results in rapid wear of maleThe metallic female was oriented over the male components and requires frequent replacement12.component (fig 6) and a reline impression was madeusing trial denture. The analog of male component was Disadvantages of overdenture include fracture of dentureoriented to the female component in the impression (fig base resin, fracture of teeth, need for changes of7) and denture was processed. The retention rings were prosthetic design followed by fabrication of newplaced in the female component incorporated in the final prosthesis. Prosthesis related adjustments include soredenture (fig 8). Denture was seated intraorally and spots, relining of overdenture, occlusal adjustments,evaluated. changes of tooth arrangement for esthetic reasons, excessive wear of teeth10.DISCUSSION: SUMMARY:Extraction of entire dentitions with complete denturereplacements was used to be promoted as an inexpensive Now a days numerous attachments are available suitableand permanent solution for oral health care in the past. for various clinical scenario. With proper case selection,The structure of maxillae and mandible was designed to treatment plan considering biological and prosthodontichold the natural teeth roots, but not to act as a supporting aspects and post insertion maintainence, overdenturesfactor for artificial dentures. So it is certain that resorption with attachments can be used with great success tooccurs if this structure is disturbed4,13. The rate of improve retention and esthetics.resorption depends on three factors; the character of theJIDAT, Vol.5, Iss.16, Jan.-Mar.-2013 12
  20. 20. REFERENCES 14. Mericske-Stern R, Hofmann J, Wedig A, Geering AH. In vivo measurements of maximal occlusal force and1. Zarb GA, Bolender CL, Carlsson G,editors. minimal pressure threshold on overdentures Boucher’s prosthodontic treatment for edentulous supported by implants or natural roots: A patients. 11th ed. St Louis: Mosby-Year Book; 1997. comparative study, Part I. Int J Oral Maxillofac2. Morrow RM, Feldmann EE, Rudd KD, Trovillin Implants 1994; 9: 63-70. HM.Tooth-supported complete dentures:An 15. Crum J, Loiselle RJ. Oral perfection and approach to preventive prosthodontics J Prosthet proprioceptions. A review of the literature and its Dent. 1969;21(5):513-22. significance to Prosthodontics. J Prosthet Dent 1972;3. Lord JL, Teel S. The overdenture. Dent Clin North Am 28: 215-30. 1969;13:871-81.4. Miller PA,Complete dentures supported by natural Corresponding author : teeth J Prosthet Dent. 1958: 8(6):924-928. Dr.K.S.Bharaniraja, M.D.S. Senior lecturer, Department of Prosthodontics, SRM Dental College,5. Fenton AH, Hahn N. Tissue response to overdenture Bharathi salai, Ramapuram, Chennai-89. therapy. J Prosthet Dent 1978; 40: 492-8. Tamil Nadu, India. Email id: bharanija@gmail.com6. Toolson LB, Taylor TD. A 10- year report of a Mobile number: 919841228066, longitudinal recall of overdenture patients. J Prosthet Fax number: 044- 22492429. Dent 1989; 62:179-81.7. Fenton AH. The decade of overdenture: 1970-1980. J Prosthet Dent 1998;79(1):31-6.8. Crum RJ, Rooney GE. Alveolar bone loss in overdentures; a 5year study. J Prosthet Dent 1978; 40:610-3.9. Bassi F. Comparing overdenture therapies with teeth and implant abutments. Int J Prosthodont 2009; 22(5): 527-28.10. Hug S, Mantokondis D, Mericske-Stern R. Clinical evaluation of 3 overdenture concepts with tooth roots and implants: 2-year results. Int J Prosthodont 2006; 19(3): 236-243.11. Rissin L, House JE, Manly RS, Kapur KK.Clinical comparison of the masticatory performance and electromyographic activity of patients with complete dentures, overdentures, and natural teeth. J Prosthet Dent 1978; 39:508-11.12. Prieskel H. Overdentures may easy. Berlin: Quintessence; 1996.13. Atwood DA, Coy WA. Clinical, cephalometric, and densitometric study of reduction of residual ridges. J Prosthet Dent 1971; 26: 280-5. 13 JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013
  21. 21. AN INSIGHT TO SINGLE VISIT ENDODONTICSDr. A. Shafie Ahamed1, Dr. Deepa Vinoth Kumar21. Professor, Dept of Conservative Dentistry and Endodontics,Rajah Muthiah Dental College, Annamalai University, Chidambaram. Tamil nadu. Key words: Periapical lesions, calcium hydroxide, nonsurgical endodontic therapyINTRODUCTION: INDICATIONS FOR SVE : • Uncomplicated vital teeth.Single visit endodontics (SVE) is gaining popularity thesedays as compared to multiple visits. SVE implies • Physically compromised patients who have to make‘Conservative non-surgical treatment of an an effort to come to the dental clinic.endodontically involved tooth consisting of completebiomechanical preparation and obturation of the root • Medically compromised patients who requirecanal system in one visit’.The concept of single visit antibiotic prophylaxis and sometimes alteration inendodontics started at least 100 years old. In the recent the medication they take.years single visit endodontics has gained increased • Fractured anterior where esthetics is a concern.acceptance as the best treatment for many cases. Recentstudies have also shown that there is no difference in • Apprehensive but cooperative patientquality of treatment and incidence of post treatment • Patients who require sedation or operation room.complication or success rates between single visit andmultiple visit root canal treatment (Albashaireh and • Uncomplicated non vital teeth with sinus tract.Alnegrish, 1998;Weiger et al.,2000;Sathorn etal.,2005;Field et al.,2004). Many dentists nowadays CONTRA INDICATIONS FOR SVE :prefer single visit endodontic treatment because of many • Acute alveolar abscess cases with pus discharge.advantages. Perhaps, the most important advantage is theprevention of root canal contamination and bacterial re- • Patients who have acute apical periodontitis withgrowth that can occur when the treatment is prolonged severe pain on percussionover an extended period due to leakage of temporary seal(Trope et al., 1999; Soltanoff and Montclair, 1978; • Painful non vital tooth with no sinus tract.Pekruhn, 1981; Rudner and Oliet, 1981; Lin et al.,2007 ). • Asymptomatic teeth with apical lesion and no sinus tract.REASONS FOR NOT DOING SVE • Cases with procedural difficulties like calcified1) Fear of post-op pain. canals, curvatures, extra canals, etc....2) Fear of failure. • Patients with TMJ disorders and inability to open the3) Lack of time. mouth.4) Lack of clinical experience. • Teeth with limited access.5) Lack of equipment. • Non surgical retreatment cases.6) Fear of being “unconventional”. OLIET’S CRITERIA FOR CASE SELECTION7) Fear of patient not accepting SVE • Positive patient’s acceptance.8) Discomfort to the patient. • Sufficient available time to complete the procedureGUIDELINES FOR SVE properly.1. Accurate diagnosis • Absence of any acute symptoms requiring drainage via the canal and of persistent continuous flow of2. Proper case selection exudates or blood.3. Skilled operator • Absence of anatomical obstacles like calcification4. Working time not more than 60 minutes in the canals and procedural difficulties (ledge formation, blockage, perforation).JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013 14
  22. 22. ADVANTAGES Studies evaluating healing of single visit and multiple visit• Intimate awareness of the canal anatomy root canal treatment immediately following instrumentation. Trope et al (1999) 64 Vs 74 %• No risk of losing important landmarks. Weiger et al (2000) 83 Vs 71 %• Canal is never cleaner than immediately after Peters and Wesselink (2002) 81 Vs 71 % proper instrumentation.• No risk of flare-up induced by leakage of temporary The success of endodontic treatment is directly seal. associated with infection control. The literature indicates that rotary, hand or hybrid instrumentation, even when• Teeth are ready for final restoration, diminishing the risk of a fracture necessitating extraction. performed correctly, is inadequate to clear all organic and inorganic debris from the root canal system. For this• Patient’s pre appointment anxiety and post- and other reasons, irrigating solutions play an important operative discomfort are limited to one episode. role making up for the shortcomings of instrumentation• Time is saved for the patient and for practitioner and complementing endodontic disinfection procedures since the treatment is completed in one visit. (Almeida et al., 2012; Bashetty and Hegde, 2010). Post instrumentation sampling showed reductions ofDISADVANTAGES cultivable microbiota. However bacteria still found in• Inability to dry the canals completely. 62% of teeth in one visit group and 64% in two visit group• Insufficient time to complete the procedure. (Kvist et al., 2004). Mechanical debridement with antibacterial irrigation (0.5% NaOCl) can render 40-60%• Possible stress of TMJ musculature or increased of treated teeth bacteria negative (Bystrom and Sundqvist, psychological stress on patients or clinicians because of longer appointment time or both. 1983, Sjogren et al.,1997). Intraradicular microbes surviving root canal treatment- entomed by obturation• Flare-ups cannot be easily treated by opening the and die as a result of inadequate nutrients. Kronfeld’s tooth for drainage. theory, bacterial count decreases –suitable environmentIS THE PROGNOSIS? for healing.Compromised by performing RCT in One appointment POST-OPERATIVE PAIN AND FLARE-UP IN SVE----NO There are numerous studies focusing on post operativeIn Humans, over whelming evidence shows the healing is pain and flare up in SVE and MVE. Most of the studiessame for both single or multiple visits regardless of pulp result showed that there is not much significant differencevitality (Trope et al., 1999; Weiger et al., 2000; Peters and in the post operative pain between SVE and MVE.Wesselink, 2002). Post operative pain Flare up • Pekruhn-1981,1986 • Eleazer and Eleazer-1998 • Almeida et al-2012 • Oginni and Udoye-2004 • Bashetty and Hegde -2010 • Trope-1991 • El Mubarak et al-2010 • Imura and Zuolo-1995 • Siqueira and Barnett-2004 • Walton and Fouad-1992 • Di Renzo et al-2002 • Albashaireh and Alnegrish -1998 • Fava-1995 • Oliet-1983 • Roane et al-1983 • Soltanoff and Montclair-1978 • Fox et al-1970 • Al-Jabreen and Tarik -2002 15 JIDAT, Vol.5, Iss.16, Jan.-Mar.-2013