The usual pulpal diagnostic instruments have been shown to be unreliable in diagnosing the pulpal status of the teeth following a traumatic injury, especially for teeth with immature root formation and open apex. Compounding the problem with these testing methods is that they all are very subjective, dependant on cooperation and understanding of the situation by the patient, which can lead to a further difficulty in cases involving young children. It is important to note that the usual pulp vitality tests provide information only about the presence or absence of nerve receptors in the pulp and not about the pulpal blood supply. Recent efforts for assessing pulpal circulation have involved the use of laser Doppler flowmetry and pulse oximetry. Though both methods are in their infancy and are not yet ready for general clinical applications, but hopefully before long, these technologies will become part of dentists' diagnostic armamentaria. The PubMed database search revealed that the reference list for Pulse Oximetry featured 2196 articles; in dentistry-121 articles and for Laser Doppler Flowmetry-932 articles and in dentistry-18 articles. A forward search was undertaken on selected articles, author names, and contemporary endodontic texts. A review is presented on the key developments in the arena of these pulp-tests to familiarize the modern dentists with the new advances in endodontic diagnosis.

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The success of a complete denture relies on the principles of retention, stability and support. The prosthodontist's skill lies in applying these principles efficiently in critical situations. Severely resorbed maxillary edentulous ridges that are narrow and constricted with increased inter ridge space provide decreased support, retention and stability. The consequent weight of the processed denture only compromises them further. This article describes a case report of an edentulous patient with resorbed ridges where a simplified technique of fabricating a light weight maxillary complete denture was used for preservation of denture bearing areas.

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The interdisciplinary treatment is becoming an ever-increasing part of modern-day orthodontic practice. Subgingivally fractured incisors pose a true therapeutic dilemma to the dental team. Attempts to expose the fracture line by alveolar re-contouring and periodontal procedures may compromise the functional root length and esthetics. Placing the margin of the restoration in the biologic width frequently leads to chronic gingivitis, the loss of clinical attachment, pockets and gingival recessions. Controlled orthodontic extrusion is considered as the easiest orthodontic tooth movement to expose the fracture line, which can produce excellent results with a good prognosis and a low risk of relapse. This case report describes in detail the chosen treatment for subgingivally fractured permanent incisors and is followed by a discussion of the considerations involved in the choice of treatment.

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The misuse of various chemicals in dentistry may cause damage to gingiva and alveolar bone. In this case report, we describe necrosis of the gingiva and alveolar bone caused by pulp devitalizer. A paraformaldehyde preparation was applied to an inflamed and symptomatic pulp of the maxillary left first molar (tooth #26), in a 20-year-old male. Spillage of the product was responsible for marked necrosis of the gingiva and the alveolar cortical bone, which resulted in great loss of the supporting bone. Surgical intervention was required wherein the necrosed bone was removed and the bone defect was filled with bone graft. The flap was coronally repositioned and sutured securely. After the treatment, the patient's complaints had resolved. Extreme care must be exercised while delivering of such products during treatment.

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This case report presents clenching as one of the etiological factors in the causation of multiple acute periodontal abscesses. Acute inflammatory periodontal diseases often present diagnostic problems for the clinician. These are not numerous, but cannot be glossed over. Acute periodontal abscess is one such condition which requires timely intervention and management. The development of the acute exacerbation occurs from an alteration in the tissues immediately adjacent to the affected teeth. Occlusion of the orifice of the periodontal pocket, diabetes, and clenching or bruxism are factors that can cause such an alteration. Here, we report a rare case of multiple acute periodontal abscesses due to clenching in an adult male. A 19-year-old male patient reported to the Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India, with pain and swelling of left cheek and left lower back teeth region of 2 days duration associated with difficulty in mouth opening. Detailed history revealed forceful clenching of teeth during his sleep. He appeared toxic and febrile. There was a diffuse, tender extraoral swelling in the left cheek. The patient had trismus and intraoral examination revealed multiple periodontal abscesses from 34 to 37. The drainage of the abscesses was obtained through the pocket orifice. The root surface was thoroughly planed to remove the deposits and to enhance further drainage. Subgingival irrigation with 0.1% povidone iodine was done and systemic antibiotics were prescribed. The patient was explained regarding the cause of the disease and motivated to stop clenching again. Subgingival irrigation with povidone iodine was continued for the next 3 days and the area curetted after 1 week to prevent recurrence. The healing was uneventful. Clenching of teeth can be one of the etiological factors for the causation of multiple acute periodontal abscesses which can be managed with proper and timely intervention of periodontal therapy.

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This case report describes the treatment of two pulpless immature maxillary central incisors. Conventional apexification techniques were not used. A regenerative technique based on literature to achieve revascularization was followed. This treatment approach involves disinfection of the canal space with topical antibiotics followed by blood clot induction from the periapical tissues. At the one year follow-up, significant root growth was achieved.

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The challenge to our profession today is to improve the quality of oral health while overcoming both extrinsic and intrinsic factors which may adversely affect our progress toward achieving this goal. Nanotechnology which is fast developing, its name reverberating in almost every field, is also making and is set to transform dentistry in a huge way. This article tries to give an insight of the application of nanotechnology in dentistry using both top down and bottom up approach, recent development of nano products with superior quality, helical rosette nanotubes as a bone substitute, surface treatment of implant, dentifrobot, improved diagnostic instruments, (biomarkers, stem cell imaging in MRI) precise drug delivery system, controlled radiation therapy and bio nano sensors for cancer treatment, the near to achieve future ground breaking realities of development of bionic mandible, nanorobots, respirocytes, microbiovore, cytorobots, karyorobots, their effect on dentistry and medicine, and the possible risk factors and the ethical concerns to be looked into for application of nanotechnology in dentistry.

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Porcelain is known to be the most aesthetic material for dental restorations. Dental porcelains have had to be reinforced with metal substructures in the past due to their unpredictable strength. However, clinicians have often faced an aesthetic challenge when restoring anterior teeth with porcelain-fused to metal restorations. A demand for a more aesthetic alternative has led to the evolution of metal-free restorations. This article discusses the various metal-free ceramic systems available, their applications, including their margin configurations and cementation protocols and specific indications and advantages of each system. Clinical evidence and experimental studies have been reviewed to provide an evidence-based application of these materials in different situations.

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Tremendous progress has been made in procedures for making fixed prosthodontic impressions over the past few decades. A common objective for impressions and interim crowns or fixed dental prostheses is to register the prepared abutments and finish lines accurately. For all impression procedures, the gingival tissue must be displaced to allow the subgingival finish lines to be registered. Retraction is the temporary displacement of the gingival tissue away from the prepared teeth. This article discusses the current methods that are applied for displacement of gingival tissues so that adequate amount of unprepared tooth structure can be recorded with least distortion of impression material as well as minimal damage to attachment apparatus of the tooth. In addition to this, gingival displacement techniques around implants and for computer aided design/computer added manufacturing (CAD/CAM) based restorations have been discussed. PubMed and Google Scholar were used to search any studies involving gingival retraction techniques. The keywords used were gingival retraction, gingival displacement, gingival retraction in implants and retraction cord. Gingival retraction holds an indispensable place during soft tissue management before an impression is made. Swift increase in research work in the recent past leaves no option for a clinician, but to be updated and to possess optimum knowledge to rationalize the use of materials and techniques that are employed for gingival displacement in proximity to both teeth as well as implants.

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The use of dental implants to support either fixed crowns and bridges or removable dentures has made it possible for many patients to experience an artificial dentition that is as esthetic and functional as their natural teeth were. Dental implant treatment has evolved over the years. Progress in implantology has been focused at increasing patient's comfort by reducing the treatment time and achieving esthetic and functional rehabilitation as early as possible. Although this has been achieved to a large extent by the use of immediate loading concepts, the same cannot be applied to all clinical situations. There are still many clinical situations wherein the patient would have to go through a waiting period after a surgical procedure (it could be the surgery to place a dental implant or bone grafting surgery, or even extraction of some teeth). During such a waiting period, the patient needs to function on a fixed temporary restoration till the final restoration can be placed. This has been made possible today by the advent of transitional implants which have been designed for and are placed along with the conventional implants for the replacement of the patient's missing dentition and enabling the patient to experience the benefits of implantology immediately. This paper presents an overview of transitional implants and its clinical application.

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This review of literature is an attempt to summarize different modalities of ozone application in dentistry. Ozone gas has a high oxidation potential and is effective against bacteria, viruses, fungi, and protozoa. It also has the capacity to stimulate blood circulation, platelets, and immune response. Ozone is used in dentistry in gaseous, ozonated water and as ozonated oils. Ozone was shown to be biocompatible and is used in all aspects of dentistry. It has been shown to stimulate remineralization of recent caries-affected teeth and is used as a preventive therapy in caries, root caries, and intracanal irrigants in endodontic treatment. It has been used in treatment of alveolitis, avascular osteonecrosis of the jaw, and herpes virus infection. It also inhibits plaque formation and can be used as an adjuvant in periodontal surgical and maintenance phase. Ozone has also been used in dental unit water line to disinfect water. Advantage of ozone therapy is it is an atraumatic, biologically based treatment. While laboratory studies suggest a promising potential of ozone in dentistry, less number of clinical studies were documented. More number of randomized, controlled trials need to be conducted to determine the precise indications and guidelines to treat various dental pathologies with this promising medical agent.

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Dental literature supports the concept that vertical dimension of occlusion is normally not lost in severely worn dentition, and the bite should generally not be opened to facilitate dental reconstruction. Many of us think that an excessive worn dentition results in loss of vertical dimension of occlusion, and that this loss should be regained during reconstruction. However, restoration of a periodontally sound but severely worn dentition, at existing vertical dimension, frequently presents unique challenges in patient management, diagnosis, treatment planning, and restorative methodology. This report reviews and demonstrates a planned approach to this complex treatment situation that can lead to a favourable and predictable prognosis i.e. restoration of a functional occlusion and esthetics along with endodontic treatment, at existing vertical dimension of occlusion.

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The challenging concept of "reconstructive esthetic implant dentistry," and its prime goal of achieving a functional and esthetically pleasing rehabilitation of the mouth, has finally reached where the nature could be mimicked. Commonly confronted issues of insufficient bone volume and thread exposure warrant bone augmentative procedures. Bone reconstruction should restore bone volume in both horizontal and vertical directions. Besides autogenous grafts being the golden standard of augmentation, various bone substitutes have been used with promising results. The main rationale in guided bone regeneration (GBR) techniques is the creation of space for matrix producing cells if significant volumes of bone are to be achieved. This case report highlights the technique of using allograft and alloderm on the principles of GBR technique with satisfactory clinical results.

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Endodontic-periodontal combined lesion is a clinical dilemma because making a differential diagnosis and deciding a prognosis are difficult. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. Periradicular bone loss secondary to endodontic pathosis is typically seen in teeth with necrotic pulps. The ultimate goal of periodontal therapy is not only to maintain the natural dentition, but also to restore lost periodontium. Combined periodontal and endodontic diseases involve the periodontal attachment apparatus. The treatment of endodontic-periodontal combined lesions requires both endodontic therapy and periodontal regenerative procedures. With advancements in new techniques and materials different treatment choices are available, providing a superior prognosis. This article includes case reports of combined endo-perio lesions which were first treated with conventional endodontic therapy and then followed by periodontal surgery. This combined treatment resulted in a radiographical evidence of alveolar bone gain. This case report demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function to the teeth with severe attachment loss caused by an endo-perio lesion.

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Aims : To evaluate the effect of two fibers (polyethylene or glass) and a flowable resin liner on microleakage in Class II adhesive restorations. Materials and Methods : Class II cavities were prepared on mesial and distal surfaces of 40 extracted sound human molars. The cavity margins were below the CEJ on one side and above the CEJ on the other. The teeth were randomly divided into four groups according to the restoration technique: group 1: restored with a resin composite in bulk after SE Bond application; group 2: flowable resin liner was used before composite restoration; group 3: polyethylene fibre and in group 4: glass fiber was placed into the bed of flowable resin before composite restoration. Samples were finished, stored in distilled water and then thermocycled. Apices were sealed and tooth surfaces were coated with nail polish within 1 mm of the margins and placed in basic fuschin dye for 24 h at 37ºC. Teeth were rinsed and sectioned longitudinally through the restorations. Microleakage was evaluated and scored. Statistical Analysis Used : Kruskal-Wallis, Mann-Whitney U-test. Results : Flowable resin, everStick NET, and Ribbond THM used in combination with flowable resin significantly reduced leakage at occlusal enamel margins (P<0.05). Conclusions : Use of flowable composite alone or in combination with polyethylene or glass fibers reduces occlusal leakage in Class II adhesive cavities with enamel margins.

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Vertical root fractures, or VRFs, usually are characterized by an incomplete or complete fracture line that extends through the long axis of the root toward the apex. The cause of VRFs is mainly trauma and iatrogenic reasons. Complete or incomplete VRFs constitute an ongoing problem in dentistry because they are difficult to be diagnosed in the early stages. In most cases, tooth extraction is the only reasonable treatment when the VRF is finally diagnosed. Other options have been put forward such as bonding the two fractured segments and reimplanting the tooth. A similar case has been described here.

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Traumatic injuries of the teeth and their structures are complex and require comprehensive, accurate diagnosis and a multidisciplinary approach for successful treatment outcome. The article emphasizes the need for a planned multidisciplinary approach to treat subgingival crown fracture, keeping into consideration the biological, functional, esthetic and patient demands. The fractured tooth was endodontically treated with post and core placement, orthodontically extruded and soft tissue contours corrected for crown placement.

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Platelet rich fibrin is a novel treatment option available for various mucogingival defects with varied outcome. Although it is as its infancy, the best part of platelet-rich fibrin is acquirement of optimal esthetic results with excellent soft tissue contour and texture. This case reports highlights the usage of platelet rich fibrin membrane for the treatment of mucogingival defects such as gingival recession.

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Accurate diagnosis will be prime aspect in any clinical pathology which helps in effective treatment plan. Improper diagnosis could drastically alter the treatment outcome. Dental developmental anomalies in various forms are often unrevealed things in clinical diagnosis. Unrevealed anomalies could be the hindrance in treatment and may lead into loss of structures. One such most often missed developmental anomaly in periodontal aspect is radicular lingual groove. This article is dealing with a salvaging of radicular lingual groove in 22 with inter disciplinary approach using bone grafts and platelet- rich plasma.

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Implant dentistry is the fastest evolving field in dentistry. The ability to treat a wide range of tissueswith a laser has been a fact of life for a long time. What is new, are the potential applications (new indications) and the refinement of techniques. A case series has been presented with laser being used for tissue management in various implant systems.

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Mini dental implants (MDI) are ultra-small diameter (l.8 mm width), biocompatible titanium alloy implant screws, conceived and designed over 20 years ago by a board-certified Manhattan dentist, Victor I. Sendax, DDS. Dr. R.A. Bulard added a single one piece 'O-ball' design to Dr. Sandax`s concept. These implants can be used in atrophic ridges, flabby ridges or in other cases where there is denture instability or lack of retention due to poor availability of residual bone. In this article, we discuss a case report of a 59-year-old female patient with a severely atrophic mandibular ridge that was managed by the MDI system with an overdenture.

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