Today, implants are considered as a first treatment option to replace missing teeth due to the considerable advantages over the other available options. The ultimate goal of implant treatment is to restore natural esthetics, function, long term health, and patient comfort. Hence, case selection and treatment planning are very crucial to achieve longevity and predictability of the restoration. This article presents a step-by-step protocol for gathering and analyzing the various factors at the pretreatment evaluation stage to set the groundwork for a dentist to consider implant as a restorative option. Clinical Relevance to Interdisciplinary Dentistry

• To help the restorative dentist to identify the ideal implant receptor site.
• Sound periodontal and restorative status is prerequisite to consider implant treatment as an option.
• Restorative driven implant placement is paramount for overall integrity of the dentition.

As practitioners, thinking critically about how we make clinical decisions is important. As educators, we should evaluate how to teach students to make clinical decisions. To make clinical decisions, and to practice modern dentistry and to educate the dental care professionals, the evidence-based dentistry forms an important asset. The cornerstone of evidence-based healthcare and health technology assessment is critical appraisal of the evidence underpinning a finding. The hierarchy of evidence includes several types of studies used to evaluate treatment effects, starting from case reports, observational studies, and randomized controlled trials (RCTs), the tip of which are systematic reviews, which constitute the highest level of evidence because they attempt to collect, combine, and report the best available evidence using systematic, transparent, and reproducible methodology. Clinicians are interested in the highest quality research report available to determine the "best therapy" for their patients. This article will assist in framing the questions and categorizing the best available evidence. A search was initiated to locate original research articles, review articles, and case reports pertaining to the key words: Evidence-based dentistry, hierarchy of evidence, ladder of evidence, research design hierarchy, strength of evidence. Electronic database was retrieved from PubMed , Google and Google Scholar to search and select keywords related to evidence-based medicine and dentistry. The keywords used were evidence based dentistry, research design hierarchy, evidence based practice, and strength of evidence. This article is the result of a literature study on evidence-based research design hierarchy. Clinical Relevance to Interdisciplinary Dentistry

• Evidence-based practice (EBP) is an interdisciplinary approach gaining ground after 1992; hence, its usefulness in any discipline is worth the attention.
• This article explores links between the state of academic and clinical training regarding interdisciplinary EBP and describes strategies to accelerate the translation of evidence across disciplines.
• This paper examines the concept of hierarchy of research design, barriers and challenges and applying evidence based dentistry in practice.

Aim: The study aimed to evaluate the microleakage of nano-filled resin-modified glass ionomer restorative (nano-filled RMGI) in comparison with that of conventional glass ionomer cement (CGIC), and resin-modified glass ionomer cement (RMGIC). Materials and Methods: Forty-five standardized Class V cavity preparations were prepared on sound extracted human molar teeth. Teeth were randomly assigned to three experimental groups of 15 teeth each and restored as follows: Group 1, CGIC; Group 2, RMGIC; and Group 3, nano-filled RMGI. The specimens were placed in a solution of 2% Rhodamine-B dye for 24 h at room temperature under vacuum. Staining along the tooth restoration interface was recorded. Results were analyzed using Kruskal-Wallis and Wilcoxon tests. Results: There were no statistically significant differences in dye leakage between all the three restorative materials for occlusal margins (P = 0.464). Group 3 showed significantly less microleakage compared to Group 1 (P = 0.007) and Group 2 (P = 0.040) at the gingival margins. The degree of microleakage in the gingival margins of each group was more than that found in occlusal margins. Conclusions: No material was able to completely eliminate microleakage at enamel, dentin, or cementum margin. Nano-filled RMGI showed least microleakage compared to other two cements at gingival margins. Clinical Relevance to Interdisciplinary Dentistry

• Cervical lesions have been a restorative challenge for dentists for many years.
• An interdisciplinary treatment approach is the appropriate choice in cases where there is gingival recession and cervical lesions.
• Glass ionomer cements have been commonly used for restoration of cervical lesions.
• Nano-filled resin-modified glass ionomer cement can be used for the restoration of cervical lesions, as it has a better marginal sealing ability compared to conventional glass ionomer and resin-modified glass ionomer cements.

Aim: To compare the shear bond strength of resin-modified glass ionomer and nano-filled flowable composite liners to nanocomposite restorative material. Materials and Methods: In this in vitro study, 24 specimens were prepared in acrylic blocks for the study with 12 in each group. Group I consisted of resin-modified glass ionomer liner (GC Fuji II LC Improved) bonded to a cylinder of nanocomposite (Z350 Universal Restorative) whereas in Group II flowable composite liner (Filtek Z350 Flowable Restorative) was bonded to a cylinder of nanocomposite (Z350 Universal Restorative). Shear bond strength was determined using Instron Universal testing machine. Student's independent sample t test was used for analysis. Results: The mean shear bond strength value of Group I was greater than Group II and the difference was statistically significant (P = 0.001). Conclusion: Resin-modified glass ionomer appears to be a more compatible liner under nanocomposite restoration than flowable composite as it exhibited significantly higher shear bond strength. Clinical Relevance to Interdisciplinary Dentistry

• Resin-modified glass ionomer and flowable composites have been used as liners under resin composite restorations in both primary and permanent teeth to compensate for their polymerization shrinkage.
• Adequate bonding of liners to composites is as important as bonding to dentin for the success of this technique.
• Bonding of resin-modified glass ionomer liner to nanocomposite restorative material is better than flowable composite liner and hence should be preferred over flowable composite as a liner.

Aims: In this study, a sample of 28 patients followed the clinical functionality and durability of inlay fiber-reniforced composite (FRC) bridge restorations, laboratory fabricated, for a period of 7 years. Materials and Methods: Patients with the loss of a first molar in the posterior region were selected for the study. Fabrications of FRC structures were made of longitudinal and woven fibers and ceramic optimized polymer material was used for veneering. Statistical Analysis Used: The restorations were evaluated using the modified United States Public Health Service (USPHS) parameters system for the clinical evaluation of dental restorative materials. Kaplan-Meier survival test was used for analyzing the data. Results: During the evaluation period, no fracture of the FRC construction was found. At all tested restorations, significant color change of the Ceromer veneering material was observed. During the investigation time, the color of the restorations became slightly lighter, with loss of gloss. In two patients, a chip off from the veneered material was noticed after 4 years, in three patients over 5 years and in three patients after 6 years. Conclusions: FRC-Ceromer inlay fixed prosthetic restorations for a period of 7 years showed acceptable clinical durability and functionality. Clinical Relevance to Interdisciplinary Dentistry Fiber reinforced composite inlay restorations for a period of seven years showed exceptional durability and functionality with minimal preparation of the abutment teeth. FRC restorations present an acceptable alternative to the classical construction of the metal ceramic or full ceramic bridge which needs to make preparation with extensive reduction of the abutment teeth.

Modifying the balance between resorption and apposition through selectively injuring the cortical plate of the alveolus has been an approach to accelerate tooth movement and is referred to as periodontally accelerated osteogenic orthodontics. It has gradually gained popularity as an adjunct treatment option for adults, as routine orthodontic tooth movement is difficult and time consuming once the mineralization and maturation of the maxilla and mandible are complete. Case selection is a very important step in which both the orthodontist and the periodontist should agree upon the need for corticotomy. The periodontally accelerated osteogenic orthodontic technique described by Wilcko (2001) involves full thickness flap reflection labially and lingually. Selective alveolar decortications are performed in the form of vertical decortications cuts up to 0.5 mm in depth, interdentally as well as horizontal cuts beyond the apex connecting the vertical decortications cuts. Adequate bio-absorbable grafting material is placed over the decortications site and sutured. Orthodontic tooth movement should start 1 or 2 weeks after the surgery. The present article reviews on contemporary clinical techniques in accelerated osteogenic orthodontics and a case report in which this technique has been implicated. Clinical Relevance to Interdisciplinary Dentistry

• The term interdisciplinary dentistry depicts the importance of team work.
• The combined effort of the specialists of the various branches of dentistry will help to deliver the best treatment to the patient by providing a well functioning dentition in a healthy periodontal environment.
• The present article highlights the importance of an interdisciplinary approach for the purpose of periodontally accelerated osteogenic orthodontics, in the treatment of adult orthodontic patients.

Congenital and developmental disorders such as Amelogenesis imperfecta play a vital role in the overall development of a growing adult. The extensive destruction and unsightly appearance of the teeth often have a detrimental effect on the social skills and self-confidence of these patients. Prosthetic and restorative treatment in these patients aims at restoring function of the masticatory apparatus as well as enhancing its esthetic and visual appeal. A multidisciplinary approach is imperative for the successful rehabilitation and overall psychosocial wellbeing of the patient. This case report highlights the various stages of treatment for the complete rehabilitation of a young adult with Amelogenesis imperfecta. Clinical Relevance to Interdisciplinary Dentistry A multidisciplinary approach facilitates the complete functional, esthetic and psychological management of a patient with Amelogenesis imperfecta.

• Intentional endodontic treatment was carried out on the posterior teeth due to severe attrition on the occlusal surfaces.
• Crown lengthening procedures were undertaken in the maxillary and mandibular posterior regions to allow for sufficient crown height for restorations.
• Full-coverage lithium disilicate crowns for the anterior teeth and ceramo-metal crowns for the posterior teeth were indicated to fulfill the esthetic and functional demands of the patient.

Tooth agenesis is a common developmental anomaly that appears in 2.2-10% of the general population (excluding agenesis of third molars). Congenital tooth agenesis can be either hypodontia (agenesis of fewer than six teeth excluding third molars) or oligodontia (agenesis of more than six teeth excluding third molars). Oligodontia can occur either as an isolated condition (nonsyndromic oligodontia) or it can be associated with cleft lip or palate and other genetic syndromes (syndromic oligodontia). The exact aetiology of oligodontia is unknown. The management includes various procedures such as restorative, surgical, and orthodontic to improve the aesthetics and function. This article reports rare three cases of congenitally missing permanent teeth with over-retained deciduous dentition and review the literature citing its etiology, clinical implications, and management. Clinical relevance to interdisciplinary dentistry

• The timing of diagnosis is not only important for choosing an appropriate treatment plan, but also for obtaining successful treatment results.
• The missing teeth, abnormal occlusion, or altered facial appearance may cause psychological distress in some or all patients.
• Treatment includes multidisciplinary team approach of pedodontists, orthodontists, oral and maxillofacial surgeons, and prosthodontists to restore aesthetics, functional, and psychological reasons depending on the severity of the condition and patient's perceived need for care
• The treatment not only improves speech and masticatory function, but also has psychological implications that may greatly help in regaining self-confidence.

Gingival pigmentation is a major concern for a large number of patients visiting the dentist. The patients with excessive gingival display and pigmentation are more concerned esthetically. Most pigmentation is caused by five primary pigments out of which melanin shows the maximum incidence rate. Melanin hyper pigmentation usually does not present as a medical problem, but patients may complain about their unesthetic black gums. The gingiva is the most frequently pigmented intraoral tissue, with the highest rate observed in the area of the incisors Esthetic periodontal plastic surgery is a boon in patients having "dark gums" and "gummy smile." This article offers a retrospective case series of gingival depigmentation by epithelial excision using scalpel. Out of the several techniques employed for depigmentation, the surgical technique using scalpel is still the first and most popular technique. Experience of 4 years is put forward with critical analysis of the surgical technique including the various advantages and disadvantages. This is a case report representing a simple surgical technique of de-epithelization which has been successfully used to treat gingival hyperpigmentation caused by excessive melanin deposition and highlights the relevance of an esthetically pleasing smile especially in smile conscious individuals. Clinical Relevance to Interdisciplinary Dentistry

• Gingival hyper pigmentation is a very common esthetic complaint reported by patients in various fields of dentistry. Through this case series the dentists can ascertain the various types of techniques mentioned in the following article for treating pigmented gums with pleasing esthetics &acceptable patients satisfaction

Implant rehabilitation involving patients with facial deformities and temporomandibular joint (TMJ) ankylosis requires competence and expertise. It is important to understand that such patients present with minimal or restricted mouth opening, severe joint and facial pain, mandibular deviation, and facial deformities. The case reported here involved two-stage implant rehabilitation for a 54-year-old female patient who had undergone custom-made TMJ condyle and fossa reconstructive prosthesis due to severe facial deformity and ankylosis of the right TMJ following previous unsuccessful surgeries. Following the reflection of a mucoperiostel flap three implants corresponding to the missing maxillary canine, first and second premolars were placed. To achieve better distribution of occlusal load and optimal esthetics, the prosthesis was restored with 3-unit porcelain fused to metal crown and bridge. Clinical Relevance to Interdisciplinary Dentistry

• This case report signifies the multidisciplinary approach to complex implant dentistry through surgical and prosthodontic functional rehabilitation.
• It also highlights the importance of restoring the dentition in situations of facial and mandibular reconstruction, whereby we achieve optimal and adequate function and esthetics.
• This unique case report also will conclude the need for future rehabilitation of patients with TMJ condylar reconstruction, and the special care needed to improve occlusal balance.

The objective of full mouth rehabilitation must be the reconstruction, restoration and maintenance of the health of the entire oral mechanism. It demands rehabilitation within the physiological and functional harmony of the stomatoganthic system. One of the most demanding aspects essential to long-term success of such cases involves the development of sufficient restorative space, while simultaneously fulfilling aesthetic, occlusal and functional parameters. Different philosophies have been documented for rehabilitation of such cases and the choice of the treatment plan depends on the skill and experience of the clinician. Pankeymann- Schuyler philosophy is followed for the prosthetic rehabilitation because it is a well organized, logical procedure where anterior guidance is first established followed by restoration of the posterior teeth. Clinical Relevance to Interdisciplinary Dentistry

• Patient with severely attrited teeth have decreased vertical dimension which causes decrease in vertical dimension.
• Prosthetic rehabilitation is not possible without restoring the dentition to optimal health.
• Treatment approach requires and interdisciplinary approach with periodontal and endodontic proceduresfor an aesthetically and functionally acceptable results.

An interdisciplinary approach towards full mouth re-restoration of severely compromised dentition requires; complete understanding of the patient's problem through history and examination of the dentition. The treatment approach should begin with an appropriate diagnosis and predictable prognosis sequencing it with specialty treatment to obtain a successful result. This clinical case report describes the implementation of a diagnostically based treatment plan for treating the maxillary arch with flap surgery and intrusion, partially edentulous mandibular arch treated by extracting the hopeless teeth and replacing the missing with an over-denture. During follow-up esthetic management of the gingival recession with respect to upper right central incisor was done using a sub-epithelial connective tissue graft procedure and paramount importance was placed on supportive periodontal therapy during the follow-up period of 2 years. Clinical Relevance to Interdisciplinary Dentistry

• The article describes an interdisciplinary approach for a successful implementation of interdisciplinary treatment to resolve dental problems for an individual requiring full-mouth re-restoration.
• Describes an unique way of restoring lost aesthetics and function.

Frenum is a fold of tissue or muscle connecting the lips, cheek, or tongue to the jawbone. It is also known as frenulum, frenulums, frenula, frenums, or frena. Ankyloglossia, commonly known as tongue tie, is a congenital anomaly characterized by an abnormally short/tight lingual frenulum, which restricts mobility of the tongue tip. Though the ankyloglossia or tongue tie is not a serious manifestation, it may lead to a host of problems including infant feeding difficulties, speech disorders, and various mechanical and social issues related to the inability of the tongue to protrude. Lingual frenectomy is advised for the management of ankyloglossia. The present paper discusses one case of successful management of ankyloglossia or tongue tie with diode laser. Clinical Relevance to Interdisciplinary Dentistry

• Ankyloglossia is commonly associated with speech problems.
• Tongue tie can be corrected by lingual frenectomy
• The common problem during scalpel frenectomy is excessive bleeding.
• To reduce bleeding during surgery and improve postoperative healing, laser-assisted frenectomy is preferred.

Capillary hemangioma is benign proliferation of blood vessels that primarily occurs during childhood. Pyogenic granuloma is a common benign lesion often found in oral cavity. Pyogenic granuloma is known to show a striking predilection for the gingiva and capillary hemangioma frequently occurs in the lips, cheek, and tongue. The gingival occurrence of capillary hemangioma is considered relatively rare. The purpose of this article is to report two unusual cases of benign tumor occurring on the gingiva which was clinically diagnosed as pyogenic granuloma and histopathologically as capillary hemangioma. Clinical Relevance to Interdisciplinary Dentistry

• The clinical diagnosis of such an uncommon occurrence can be quite challenging as they sometimes may mimic benign as pyogenic granuloma
• In reality, it could be a more serious lesion such as malignancies.

Dentists should therefore be aware of these lesions when making diagnosis and attempts at excision of apparently innocent lesions may result in serious bleeding.

The present study reports a case of coronoradicular fracture with the biological width invasion that was successfully managed by orthodontic root extrusion. Clinically, the patient presented with a subgingival fracture of the first maxillary premolar, with a tooth fragment 5.0 mm below the enamel-cementum junction. The initial examination suggested a poor prognosis for the clinical case; however, we decided to employ an orthodontic root extrusion over 5 months. After 1 year, a satisfactory prosthetic rehabilitation, associated with the periodontal health, could be observed and it can be concluded that orthodontic root extrusion is an essential tool for the management of extensive subgingival fractures. Clinical Relevance to Interdisciplinary Dentistry

• Extrusion root is a conservative treatment.
• Root or coronal fractures can be treated with root extrusion.
• Prognosis of this type of treatment is extremely favorable.

Odontomes represent a hamartomatous malformation rather than a neoplasm. Compound odontome bear same superficial anatomical similarity to normal teeth. The presence of the odontomes is the common cause of failure of eruption of the teeth present adjoining them. In the cases where impacted teeth are present in favorable position, these teeth can be made to erupt at a suitable position in dental arch. This is a case report of interdisciplinary management of compound odontoma. Clinical Relevance to Interdisciplinary Dentistry

• This case shows the importance of multidisciplinary management of impacted incisor associated with odontomes.
• Each specialist is important at various stages of treatment, everyone needs to be consulted to prevent any irreversible damage to patient
• Orthodontist and periodontist need to be in continuous touch throughout the treatment in order to maintain the periodontal integrity of such cases.
• Root resorption may ensue in the teeth that are moved from an ectopic position; endodontist must be consulted whenever it is suspected.