History and evolution of implants /certified fixed orthodontic courses by Indian dental academy

4,918 views

Published on

Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable

Published in: Health & Medicine, Business
1 Comment
15 Likes
Statistics
Notes
No Downloads
Views
Total views
4,918
On SlideShare
0
From Embeds
0
Number of Embeds
23
Actions
Shares
0
Downloads
4
Comments
1
Likes
15
Embeds 0
No embeds

No notes for slide

History and evolution of implants /certified fixed orthodontic courses by Indian dental academy

  1. 1. HISTORY AND EVOLUTION OF IMPLANTS www.indiandentalacademy.com
  2. 2. HISTORY AND EVOLUTION OF IMPLANTS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. CONTENTS      Introduction Definitions History and Evolution of implants can be studied as -The ancient era - The Medieval period - The foundational period - The Premodern era - The dawn of the modern era - Contemporary oral implantology Summary and Conclusion References. www.indiandentalacademy.com
  4. 4.  INTRODUCTION www.indiandentalacademy.com
  5. 5.  Def of Implant (GPT 8 )  Any object or material such as an alloplastic substance or other tissue, which is partially or completely inserted or grafted into the body for therapeutic, diagnostic, prosthetic or experimental purposes.  Def of Implantology  Term historically conceived as the study or science of planning and restoring dental implants. www.indiandentalacademy.com
  6. 6.  Def of Dental Implant  A prosthetic device made of alloplastic material implanted into the oral tissues beneath the mucosal or/ & periosteal layer &/or within the bone to provide retention & support for a fixed or removable dental prosthesis ;a substance that is placed into or / & upon the jaw bone to support a fixed or removable dental prosthesis.  Def. Of Osseointegration The apparent direct attachment or connection of osseous tissue to an inert, alloplastic material without intervening connective tissue.  www.indiandentalacademy.com
  7. 7.  ANCIENT ERA - 1000 A.D www.indiandentalacademy.com
  8. 8.  History of dentistry….3000 B.C .  HISTORY TRACED IN MIDDLE EAST  In 1862 Gaillardot discovered a prosthodontic appliance near the ancient city of Sidon. Appliance was dating 400 B.C period .  Carved ivory tooth replacing the two missing incisors. www.indiandentalacademy.com
  9. 9.  HISTORY TRACED IN THE EGYPTIAN DYNASTIES  Evidences have shown the implantation of animal teeth & artificial teeth carved of ivory .  Implantation prior to mummification. www.indiandentalacademy.com
  10. 10.  In 1981 evidences of oldest dental implant was found in the Kalavak Necropolis, near Izmir , Turkey.  The discoveries were dated back to 550 B.C . A canine tooth like object made of two piece of calcite having hardness similar to natural teeth showing wear on the chewing surface & secured with gold wires wrapped around the neck of adjacent teeth. www.indiandentalacademy.com
  11. 11.  Cranin suggested that earliest recorded dental implant specimen was inserted during the PRE COLUMBIAN ERA.  In 1931 Wilson Popenoe discovered a skull in the Ulua river valley of Honduras , dating to the period 600 A.D .  Skull had an artificial tooth replacing lower left lateral incisor, carved of a dark stone . Radiographs showed the evidence of compact bone around the implant.  The Mayans practiced the implantation of alloplastic materials in living persons. www.indiandentalacademy.com
  12. 12. www.indiandentalacademy.com
  13. 13.  MEDIEVAL PERIOD (1000-1799 A.D) www.indiandentalacademy.com
  14. 14.  Allotransplantation (18 -19 Century) mainly in England & Colonial America.  Albucasis de Condue ( 936- 1013 A.D) an Arab surgeon described the transplantation procedures . He attempted to use ox bone to replace missing teeth. www.indiandentalacademy.com
  15. 15.  In Japan in the 15th & 16th C. Wooden dowel & crown prosthesis was designed . The pin inserted into the root canal of non vial teeth.  This was an early ENDODONTIC IMPLANT – SUPPORTED PROSTHESIS. www.indiandentalacademy.com
  16. 16. • • Charles Allen in 1687 gave the first written work on dentistry. He described the replanting of tooth into the same patient. • Allen emphasized on transplantation of tooth using animal tooth. • In European sphere transplantation became the common practice performed by barber surgeons of the Era. • The tooth transplant could lead to transfer of diseases . • Implants made from ivory, shells & bone were used. www.indiandentalacademy.com
  17. 17. • Ambroise Pare, a French physician , a surgeon to four kings of France. • He replaced the missing teeth with implants made up of bone & ivory . • He successfully replaced missing tooth of Princess by transplanting. www.indiandentalacademy.com
  18. 18.  John Hunter in 1728 – 1793 A.D suggested the possibility of transplanting. www.indiandentalacademy.com
  19. 19.  THE FOUNDATION PERIOD (18001910) www.indiandentalacademy.com
  20. 20.  The endosseous oral implantology truly began in the 19 th Century.  Maggilio in 1809 , a dentist at the university of Nancy , France, author of the book called “THE ART OF THE DENTIST”. The first reference to modern style implants.  He has described the implant & placement.  He made the tooth root shaped implant with 18 carat gold with three prongs at the end to hold it in place in the bone . The implant was placed in the freshly extracted socket site retained with the prongs. After the tissues healed the crown was attached with the help of post placed into the hole of root section of the implant.  He placed the single stage gold implant. www.indiandentalacademy.com
  21. 21.  In mid 1800s advancement in the antiseptics & surgical techniques , there were documentation of implanted materials.  W. J . Younger of San Francisco introduced operations in United States. In 1893 he wrote that his operation has successfully entered 8th year of life. www.indiandentalacademy.com
  22. 22.  In 1886 Harris treated a Chinese patient in Grass valley , California . He placed the tooth root shaped platinum post with lead coating, lasted for 27 yrs Reported in Dental Cosmos in 1887.  In 1889 Edmunds of New York reported on March 12 ,1889 to the First District dental society of that city. He implanted the metallic capsule. www.indiandentalacademy.com
  23. 23.  In 1888 Berry reported about the root form implants made up of lead.  In 1890 , a Massachusetts minister had his lower jaw resected & was restored with an extensive system of gold crowns soldered & joined to hinged device attached to the remaining dentition .  Znamenski in 1891 reported on implantation made of Porcelain, gutta-percha & rubber. www.indiandentalacademy.com
  24. 24.  Bonwill in 1895 reported on the implantation of one or two tubes of gold or Iridium as a support for individual teeth or crown.  IN 1898 R. E Payne at the National Dental Association meeting gave the first clinical demonstration by placing the silver capsule in the extracted tooth socket. www.indiandentalacademy.com
  25. 25.  PREMODERN ERA ( 1910-1930) www.indiandentalacademy.com
  26. 26.  The first two decades of 20th C. predominated by the clinicians namely R.E Payne& E. J .Greenfield.  R. E .Payne presented his technique of capsule implantation at the clinics of Third international Dental Congress, reported in the Dental Cosmos in 1901.  Technique- Extracting the root , enlarging the socket with trephine, trial fitting of the capsule. He then placed grooves on both sides of the socket & filled 2/3rds with rubber, fitted the porcelain root into the capsule & set it with gutta-percha.  In 1903 Sholl in Pennsylvania , implanted porcelain tooth with corrugated porcelain root. www.indiandentalacademy.com
  27. 27.  In 1913 Dr. Edward J. Greenfield came up with the surgical method to prepare osteotomy in the healed bone using trephine.  He fabricated the hollow cylindrical basket root of 20 gauge iridioplatinum soldered with 24 carat gold. Precursor of hollow basket design www.indiandentalacademy.com
  28. 28.   GREENFIELD EMPHASIZED ON The importance of intimate contact between bone & implant. Hollow implants facilitated growth of bone into implant body & secure it.  3 months period of unloading.  Implants failures because of infection.  His techniques were similar to present concepts of osteotomy preparation, restoring after healing time www.indiandentalacademy.com
  29. 29.  In 1920s Leger- Dorez developed expansible root implant, was comparable to a concrete expansion bolt.  Smolon described the implant as a four part device with the shaft buried in bone with the internal threads to receive a screw , fastening the neck into the shaft. the post for attaching the prosthesis.  The historical basis for the internal screws provided for the retention of prosthetic devices similar to today’s implants.  Tomkin’s 1925 implanted porcelain teeth.  Brill in 1936 inserted rubber pins in artificially prepared sockets. www.indiandentalacademy.com
  30. 30.  THE DAWN OF THE MODERN ERA 1935-1978 A.D www.indiandentalacademy.com
  31. 31.  The modern era of implant dentistry most definitely began in the late1930s with the work of Venable, Strock , Dahl , Gershkoff & Goldberg.  Venable in 1937 developed the cast Co- Chr- Mo alloy known as Vitallium.  In 1939 Alvin & Moses Strock used the Venable screw type implant. www.indiandentalacademy.com
  32. 32.  Adams in 1937 developed a submergible threaded cylindrical implant with round bottom , smooth gingival collar & healing cap. The ball head screwed to the root was used to retain an overdenture.  The components designed to flex vertically or laterally similar to the IMZ intramobile element. www.indiandentalacademy.com
  33. 33.  In 1938 Stock placed the threaded vitallium implant into the extraction socket, the first long term endosseous implant.  It remained firm & asymptomatic for nearly 17 years.  He demonstrated that the Vitallium implants were well tolerated. www.indiandentalacademy.com
  34. 34.  In 1947, Formiggini developed a single helix wire spiral implants made of stainless steel or tantalum. Two ends of the wire were soldered together to form a post or neck.  Chercheve Modified by increasing the length of the neck & double helix out of vitallium.  He developed the co-coordinated system of instrumentation for implant insertion. www.indiandentalacademy.com
  35. 35. www.indiandentalacademy.com
  36. 36.  Marziani’s use of porcelain & acrylic roots to support full dentures.  In 1950 Lee’s Post design i.e central narrow post with extensions. www.indiandentalacademy.com
  37. 37.  In 1943 Dahl in Germany developed Intramucosal or button implants – Mucosal inserts. www.indiandentalacademy.com
  38. 38. www.indiandentalacademy.com
  39. 39.  SUBPERIOSTEAL IMPLANTS  An implant structure that covers the almost entire crestal surface of maxillary & mandibular RAR under the soft tissue to include the periosteum , with the four to six posts protruding out through gingiva and on it the complete denture will be attached.  In 1943 Gustav Dahl placed the SP implant on maxillary RAR later on mandibular.  Dahl & Izikowitz described the frames placed around the teeth in partially edentulous patients termed as SUPERPLANTS. www.indiandentalacademy.com
  40. 40. FABRICATION OF SUB PERIOSTEAL IMPLANT  Goldberg & Gershkoff method  Make an impression of the mucosa covering the RAR  Make model & wire template made for radiography.  Measurements of the soft tissue depth were derived from the radiography and model was carved & casted to produce the multifenestrated Co-Chr-Mo casting with four abutments. www.indiandentalacademy.com
  41. 41.  Berman introduced the Two stage surgical technique for sub periosteal implant.  First step was a direct impression of the surgically exposed bone  Second was implanting the subperiosteal frame generated from the stone cast.  Kleinschmidt developed anterior single sub periosteal implant.  Marziani reported on the fabrication of full upper & lower subperiosteal implant. www.indiandentalacademy.com
  42. 42.  Weinberg sectional subperiosteal implant.  Lew developed modified technique for fitting upper implants by extending the implant frame further to the periphery. www.indiandentalacademy.com
  43. 43.  Linkow developed Sub periosteal implant consisting of three islands www.indiandentalacademy.com
  44. 44.  CT scan imaging technique used to obtain three dimensional replica of the mandible & CAD-CAM models used for fabricating the frame work.  Long term success only 50 to 60%. www.indiandentalacademy.com
  45. 45. ONE STAGE ENDOSTEAL PINS, SCREWS, & CYLINDERS  The early 1960s marked the beginning of an active developmental era in implant design.  Scialom developed a tantalum tripodal pin .  Three intersecting pins were joined by acrylic to support the crown. Difficulty in maintaining the trifurcation limited the comfortable survival. www.indiandentalacademy.com
  46. 46.  In 1960 Onlay developed Virilium posts placed into endodonticaly treated teeth extending beyond the apex. www.indiandentalacademy.com
  47. 47. SCREW TYPE IMPLANT  Tramonte introduced a stress resistant drive screw implant.  Meglan & Lehman reported on the expandable implants.  Lew introduced a self tapping Vitallium screw implant with conventional threads & square post.  Muratori & Pasquallini introduced hollow cores along with the screw threads.  The majority of these screw shaped implants were one piece & were not submerged , did not osseointegrate .It was emphasized that the fibrous peri implant membrane with its shock absorbing feature preferred than bone fusing to implant. www.indiandentalacademy.com
  48. 48.  In 1963 Dr. Linkow , American Dentist developed first screw type of implant – Vent Plant.  This was the first self tapping , self threading implant . It had an open cage like design that went into bone first , with a few threads on solid body at the top. He used Vitallium first latter on titanium. www.indiandentalacademy.com
  49. 49. BLADE IMPLANTS  Linkow blade implants invented in 1967.  Long thin blade that will be surgically inserted into the groove in the bone .  Abutment projecting out from the blade to this crown or attachment for denture can be placed.  It required the shared support of natural teeth also.  Restored within month so became most widely used in united states.  Linkow modified the design configuration for broad applicability in maxilla & mandible, narrow ridges. www.indiandentalacademy.com
  50. 50. www.indiandentalacademy.com
  51. 51. www.indiandentalacademy.com
  52. 52. www.indiandentalacademy.com
  53. 53.  In 1970 Roberts & Roberts developed Ramus blade implants .  It was to be positioned by anchoring distally between the cortical plates in the ramus of the mandible www.indiandentalacademy.com
  54. 54. www.indiandentalacademy.com
  55. 55.  RAMUS FRAME IMPLANT developed Roberts & Roberts in 1970 .  The endosseous implant received stabilization from its anchorage in ramus area bilaterally & in the symphyseal region. www.indiandentalacademy.com
  56. 56. www.indiandentalacademy.com
  57. 57. www.indiandentalacademy.com
  58. 58. TRANSOSTEAL IMPLANTS  In 1975 Small introduced the transosteal mandibullar staple & bone plate, a reconstructive device placed through a submental incision & attached to the mandible with multiple fixation & two transosteal screws to support a full arch prosthesis.  He presented 16 yrs evaluation,  Cranin developed single transosteal implant. www.indiandentalacademy.com
  59. 59. www.indiandentalacademy.com
  60. 60.    In 1970 Kawahara was developing a ceramic implant in Japan . first Aluminium oxide implant placed. In 1970 Grenoble placed Vitreous Carbon implant . www.indiandentalacademy.com
  61. 61.  CONTEMPORARY ORAL IMPLANTOLOGY 1978 to present www.indiandentalacademy.com
  62. 62.   In 1978 conference held at Harward , co- sponsored by NIH. This was the milestone for further research. www.indiandentalacademy.com
  63. 63.  In 1976 Dr. Andre Schroeder in Switzerland reported the bone growth into titanium plasma sprayed hollow endosseous implants.  At the same time , Prof. Willischulte in Germany reported the success with immediate placement of Vitreous Carbon implant after dental extraction & invented Frialit-2 implant. www.indiandentalacademy.com
  64. 64.  Per-Ingvar Branemark developed the two stage threaded titanium endosseous root form implant in North America.  “ Vital microscopy”…  In 1960 at Gothenburg…  Branemark noticed that there was no inflammatory reaction to the titanium. www.indiandentalacademy.com
  65. 65.  He started thinking about the potential of titanium to act as an anchorage point, so the spur for the next experiment whether titanium can be used as a bridge in bone healing application.  Concept of Osseo integration developed  The first clinical trail was done in 1965.  In 1971 surgical equipments.  In May 1982 Dr. George Zarb organized the Toronto conference on osseointegration. Branemark presented Two stage threaded root form implant along with the 15 yrs research work & clinical trail. www.indiandentalacademy.com
  66. 66. www.indiandentalacademy.com
  67. 67. BRANEMARK SYSTEM COMPONENTS  FIXTURE –  pure titanium with machined threads .  The top of the fixture has hexagonal design & threads ..  The apical portion tapered with four vertical notches.  COVER SCREW- seals the coronal potion of fixture during the interim period. www.indiandentalacademy.com
  68. 68.  ABUTMENT- -made of titanium in a cylinder shape. the apical portion has hexagonal shape to fit the coronal portion of fixture. www.indiandentalacademy.com
  69. 69.  ABUTMENT SCREW – insert through the abutment & threads into the fixture to connect the two components .  GOLD CYLINDER- made of lAu , Pl, Pd. It is machined to fit the coronal portion of the abutment. It becomes integral part of final prosthesis.  GOLD SCREW –inserted through the gold cylinder & threads into the abutment screw to connect the gold cylinder & abutment. www.indiandentalacademy.com
  70. 70. www.indiandentalacademy.com
  71. 71. IMZ IMPLANT SYSTEM      Kirsch developed the IMZ implant system in 1974. Since 1978 in clinical use. Intramobile cylinder endosseous two stage osseointegrated implant. The polyoxymethylene & polyacetal used as IME. Available in 3.5 to 4mm diameter and 8,10,13,15mm length. Surface coating may be titanium plasma spray or plasma sprayed HA coated surface. www.indiandentalacademy.com
  72. 72. IMZ IMPLANT SYSTEM  Kirsch developed the IMZ implant system in 1974. Since 1978 in clinical use.  Intramobile cylinder endosseous two stage osseointegrated implant.  The polyoxymethylene & polyacetal used as IME.  Available in 3.5 to 4mm diameter and 8,10,13,15mm length.  Surface coating may be titanium plasma spray or plasma sprayed HA coated surface. www.indiandentalacademy.com
  73. 73. www.indiandentalacademy.com
  74. 74. LEDERMAN SCREW IMPLANT  In 1977 Dr. Philippe Lederman in collaboration with strauman co. developed the Titanium plasma spraed screw type implant.  In 1989 Lederman developed the New Ledreman screw implant Surface roughened by sand blasting & acid etching. www.indiandentalacademy.com
  75. 75. ITI BONE FIT IMPLANT SYSTEM     Developed by ‘International Team for Implantology’. Three different types Single stage & two stage. Transgingivally placed in healing phase so second surgical procedure for uncovering the implant is avoided. www.indiandentalacademy.com
  76. 76. THE HAND-TITANIUM IMPLANT SYSTEM     Clinical use since 1985 at Switzerland & now in use world wide ( Lederman 1986). A conical, step- screw, pure Ti implant with self thread. Length- 10 to 20mm. Diameter – 3.5 to 7mm. www.indiandentalacademy.com
  77. 77.  In early 1980s Tantum introduced Omni R implant A Ti root form implant with horizontal fins.  Omni S implant – for placing into bone grafted maxillary sinus. www.indiandentalacademy.com
  78. 78.  In 1983 EL Blasty & Kamel introduced the new endosseous implant material i.e Poly acrylic acid reinforced with ceramic alumina particles 0.3 microns.  The hydrophilic matrix swells in contact with aqueous solution.  The gradual pressure on the surrounding bone stimulates osseous activity.  Implanted in canine, premolar sites with promising results. www.indiandentalacademy.com
  79. 79. MINI DENTAL IMPLANT   In 1985 Victor Sendax developed MDI. Ultra – small diameter 1.8 mm, biocompatible Ti alloy implant screws.  Bulard added single one piece `O- ball’ design . www.indiandentalacademy.com
  80. 80. www.indiandentalacademy.com
  81. 81. CORE VENT  Developed by Dr. Gerald Niznick in 1986.  Hollow basket design made of Ti alloy.  Different fixture designs Screw –Vent, Micro-Vent, Bio –Vent. www.indiandentalacademy.com
  82. 82. www.indiandentalacademy.com
  83. 83. ENDOPORE  A root form dental implant developed by Doughlas et.al in 1996 made of Ti alloy & sintered with same alloy producing porous surface.  Biological & clinical advantages. www.indiandentalacademy.com
  84. 84. STERI OSS SYSTEM  Introduced by Denar  Made up of 99.9% Ti, tapered apex thread design & the coronal 3rd highly polished surface.  Available in 3.5 to 4mm diameter, length 12 mm,16mm,20mm,& miniseries8mm,10mm,12mm length. www.indiandentalacademy.com
  85. 85. NOVUM CONCEPT  Branemark developed the concept of providing a new set of teeth for the mandible in a single day.  Clinically implicated in 1996.  Three titanium fixtures inserted , mucosa is closed & base plate is placed over the fixtures & then the prosthesis is placed. www.indiandentalacademy.com
  86. 86. www.indiandentalacademy.com
  87. 87. ZYGOMATICUS FIXTURES  Branemark.  The long fixture can be anchored in zygoma by approaching through the sinus .  Severely resorbed maxilla. www.indiandentalacademy.com
  88. 88.  1984 – CT scan.  Bone augmentation techniques.  1986 Tatum reported about Sinus lift / Bone graft antroplasty.  1988 Nerve transposition  1989 Pterygoid implants .  1991 Guided tissue regeneration using Gore-Tex or resorbable Vicryl-Mesh used to augment narrow & shallow ridges .  1995 Distraction osteotomies & split ridge technique. www.indiandentalacademy.com
  89. 89.  The screw type implants fabricated by Hydroxy appatite based composites by mixing HA with Al oxide coated Zr oxide powder & compared with Cp.Ti implants.  HA based composites showed better mechanical properties & bioactivity.  (Young Min Kong et.al 2002). www.indiandentalacademy.com
  90. 90.  Development of implants coated with Bioactive Alumina –based composite by electrophoretic deposition method.  Alumina is excellent biomaterial ,good biocompatibility , highly corrosion resistance, high wear resistance & strength.  Wollastonite has (CaO. SiO2) high apatite forming ability deposited into the pores of foamed Alumina by Electrophoretic deposition. www.indiandentalacademy.com
  91. 91. BICORTICAL SCREW IMPLANT  Self tapping type  Diameter 2.5, 3.5 ,4.5,5.5mm  Length 21 -30mm  Post extraction insertion for single tooth replacement. www.indiandentalacademy.com
  92. 92. OSTEOPLATE 2000  Atrophic RAR  The conical plate with shoulder width 1.3 mm & base 0.9 mm. www.indiandentalacademy.com
  93. 93.  Historically dental restorations supported by Osseointegrated implants evolved as  Fully ed. Mandibular arch -1980  Fully ed. Maxillary arch  Short span ed. Segment -1990  Missing single tooth – 1990  1980s restorations were screw retained , 1990s cemented. www.indiandentalacademy.com
  94. 94. Summary       Before 1000 A.D tooth carved of stones , calcite, ivory were implanted. In the 1000 -1799 A.D mainly allotransplantation. In the 1800-1910 period beginning of root form endosseous implant of Au, Pt . In the 1910-1935 Greenfeild designed hollow basket implant. In 1935- 1978 Root form implants of the pin & screw type, Sub periosteal , Ramus blade, Ramus frame, Transosteal. In 1978 Branemark developed the Titanium implants, latter on different surface treated Ti implants developed. www.indiandentalacademy.com
  95. 95.  CONCLUSSION www.indiandentalacademy.com
  96. 96. REFERENCES  Block & Kent’s Endosseous Implants For Maxillofacial Reconstruction.  Elaine Mc Clarence ’s Close to the edge.  Hubertus Spikerman’s Color atlas of Dental medicine (Implantology).  Malvin E. Ring’s Dentistry An Illustrated History.  Sumiya Hobo’s oseointegration and occlusal rehabilitation.  Ralph V. McKinney, Jr’s endosteal dental implants.  ADA council on scientific affairs Dental endosseous implants. An update. JADA, Vol. 135, January 2004. www.indiandentalacademy.com
  97. 97.  Richard M. Sullivan, Implant Dentistry and the Concept of Osseointegration: A Historical Perspective .(2001) Journal of the California Dental Association.  Douglas A. Deporter “simplifying the treatment of edentulousness” JADA 121sept 1996:1343  Young-Min Kong, Hydroxyapatite-Based Composite for Dental Implants: an In Vivo Removal Torque Experiment. J Biomed Mater Res (Appl Biomater) 63: 714– 721, 2003  M. A. EL BASTY and I. L. KAMEL.The Development of a Novel Tooth-root Implant Material. J Dent Res 62(6):733-737, June 1983  Management of atrophic mandibular ridges with Mini dental implant systems- A case report J.IPS;2005;5;158. www.indiandentalacademy.com Vol
  98. 98. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

×