Detection of Dentinal Microcracks in Radicular Dentin after Shaping with XP-endo Shaper, Neoendo Flex Files, and Hero Shaper Using Scanning Electron Microscope: An In Vitro Study.

The study aimed to compare the extent of dentinal microcracks in the radicular dentin using hand K files and various types of rotary nickel-titanium (NiTi) file systems. Forty mandibular incisor teeth (human) were grouped for the study. The root apices were closed, and the canals were straight (<5°). The samples were divided into four groups (n = 10). Group 1-Hand K file system (SybronEndo, SA), Group 2-XP-endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland), Groups 3-Neoendoflex file (Neoendo, Orikam, India), and Group 4-Hero Shaper files (Micro-Mega, Becacon, France). Sectioning was done at 3, 6, and 9 mm from the apex, perpendicular to the long axis using a diamond disc under water coolant. The cut samples were then observed through a scanning electron microscope at ×50 enlargement. The control group showed no microcracks except one sample in the coronal third, which was less significant. The difference in the amount of crack detected on comparing the different groups was significant. In the experimental groups, XP-endo Shaper group showed significantly less number of cracks than the Neoendo flex, and Hero Shaper groups. Within the limitations of this study, all the system, except hand K files, produced remarkable dentinal microcracks. Least cracks were seen in canals instrumented with XP-endo Shaper. It can also be noted that single file system causes less number of microcracks.

The Effect of Root End Cavity Preparation Using Er,Cr:YSGG Laser, Ultrasonic Retrotip, and Bur on the Apical Microleakage of Retrograde Cavity Filled with MTA Plus.

AIM: The sealing ability of the retrograde material is greatly affected by the technique used for root end preparation. Advances in retrograde preparation techniques such as lasers has shown to provide an efficient outcome. The study was to evaluate and compare the effect of various techniques of retrograde cavity preparation on apical microleakage. MATERIALS AND METHODS: Forty-five single rooted teeth were decoronated. Biomechanical preparation was carried out up to size F2 ProTaper system and obturated. Glass-ionomer cement was used as an access restorative material. The apical root resection was done at 3 mm from the apex at angulation of 90° to the long axis of the root. The allocation of the samples was done into three groups of 15 each. Group A: Retrograde cavities prepared using conventional round bur; Group B: Retrograde cavities prepared using ultrasonic retro preparation diamond tip; and Group C: Retrograde cavities prepared using "Erbium, chromium: yttrium, scandium, gallium, garnet" (Er,Cr:YSGG). The retrograde cavities hence prepared were filled with MTA Plus. Nail varnish was used to coat the samples except at the apical end. Samples were immersed in methylene blue for 24h. Stereomicroscope was used for examination of the sectioned teeth. The data were analyzed using one-way analysis of variance (ANOVA) and post hoc Tukey test. RESULTS: Results showed very highly significant difference between laser and bur (P value = 0.001). CONCLUSION: Retrograde preparation with Er,Cr:YSGG showed significantly less microleakage when compared to the use of ultrasonic retrotip and burs.

Influence of Aerated Drink, Mouthwash, and Simulated Gastric Acid on the Surface Roughness of Dental Ceramics: A Comparative In Vitro Study.

BACKGROUND: Dental ceramics are known for their natural appearance and their durable chemical and optical properties, and their uses mainly reflect their excellent aesthetic properties, biocompatibility and resistance to wear. In addition, dental ceramics are considered to be chemically inert restorative material with large differences in the chemical compositions and microstructures. Although ceramics exhibit excellent physical properties and biocompatibility, the oral environment presents a series of external factors that affect its physical and mechanical properties in its long term function. AIMS AND OBJECTIVES: The aim of this study is to compare and evaluate the surface roughness of 2 dental ceramics (Noritake® & IPS Emax ceram) before and after exposure to an aerated drink, a mouthwash and simulated vomit solution with distilled water. MATERIALS AND METHODS: 128 ceramic discs were made, 16 for each of the 4 groups of 2 ceramics to be tested. It was fabricated in the form of discs of diameter 10 mm × 2 mm thickness. The test specimens were calibrated by grinding, using a medium grit diamond bur. Both the above specimens were divided into 4 groups of 16 each. They were then subjected to test solutions. Each specimen in a group was immersed in the following solutions: Coca-Cola, chlorhexidine mouthwash, simulated vomit solution and distilled water. RESULTS: The results analyzed statistically using one way ANOVA (analysis of variance), paired t test and independent t test. CONCLUSION: Within the limitations of this study, it was concluded that the surface roughness of the evaluated ceramics increased upon exposure to Coca-Cola, chlorhexidine mouthwash and simulated vomit solution. Simulated vomit solution caused the maximum change in surface roughness followed by coca cola and then chlorhexidine mouthwash. No changes were observed after immersion in distilled water. Noritake® showed slightly more resistance to change in surface profile when compared to IPS e.max.

Hearing Assessment of Dental Personnel: A Cross-sectional Exploratory Study.

AIM: Dental professionals are prone to have hearing impairment due to prolonged exposure of noise in dental college. The aim of the study was to assess the hearing ability of dental personnel working in Yenepoya Deemed to be University, Mangaluru, Karnataka, India. MATERIALS AND METHODS: A cross-sectional exploratory study was conducted on 60 subjects (30 male and 30 female). Audiometric analysis was carried out using pure-tone audiometry (PTA) and otoacoustic emission test (OAE). STATISTICAL ANALYSIS: Data were calculated and analyzed using two-way analysis of variance and Tukey's honestly significant difference test. RESULTS: No statistically significant difference was observed between hearing loss and its association with age, gender, working experience, mean daily working time, and specialization. PTA results showed a statistically significant hearing loss in the left ear, showing a dip at frequency of 4000 Hz among working experience group of 11-15 years and at 6000 Hz for 21-25 years. Also, a statistically significant hearing loss was observed in the left ear at 6000 and 8000 Hz for the age-group of 51-55 years. OAE results were consistent with PTA findings. CONCLUSION: Dentists and dental personnel are at a higher risk of noise-induced hearing loss. As the working experience increases, the threshold shift is seen to shift from 4000 to 6000 Hz, which is indicative of sensorineural hearing loss due to noise-induced dental environment.

A Novel Design Modification to Improve Flexural Strength of Zirconia Framework: A Comparative Experimental In Vitro Study.

AIM: Zirconia-based restoration is successfully replacing metal ceramic restorations in posterior areas. Although higher mechanical properties of zirconia, their use in compromised situation is questionable. Hence, there is a need to modify the design which to strengthen the framework. The aim of this in vitro study was to evaluate the influence of lingual collar design on the flexural strength of CAD/CAM-fabricated posterior three-unit zirconia framework. MATERIALS AND METHODS: A mandibular metallic stainless steel master mold is designed for a three-unit fixed partial denture framework. All CAD-milled 20 samples are divided into two groups based on the design. Group A--with collar (10 samples) and Group B--without collar (10 samples), tested using universal testing machine to calculate the mean fracture load and flexural strength. STATISTICAL ANALYSIS USED: Descriptive statistics and independent sample t test were used to find the difference between the groups, and simple linear regression was used to find the relationship between load and displacement between the groups. RESULTS: The result of the mean flexural strength for Group A was 11328.06 ± 3770MPa and for Group B was 7633.95 ± 3196MPa; the mean fracture strength observed for Group A was 1274.04 ± 424MPa and for Group B was 858.80 ± 359MPa. A statistically significant difference was observed in flexural strength between Groups A and B (P < 0.05). CONCLUSION: Zirconia framework with connector dimension of 7 mm2 with lingual collar design can be successfully incorporated in compromised situation where an ideal connector dimension of 9 mm2 cannot be placed.

A Study to Assess the Bond Strength of Acrylic Teeth With Different Retentive Features.

BACKGROUND AND AIM: Flexible denture base has been gaining attention as a denture base material because of its toxicological safety, comfort, and enhanced aesthetics. Debonding of acrylic teeth from the flexible denture base material has posed a great problem to the clinician and patient. This study aimed at comparing the bond strength between flexible denture base with acrylic teeth having different mechanical modifications. MATERIALS AND METHODS: Forty mandibular molar teeth (Combination Acry Rock, Badia Polesine (Ro), Italy) were used in four groups for mechanical modifications on the ridge lap area. The groups were group 1 (no mechanical modifications), group 2 (round groove 2 mm in diameter and 2 mm deep on the ridge lap surface), group 3 (horizontal slot 2 mm deep, 2 mm wide, and 4 mm long prepared on the ridge lap surface of the teeth), and group 4 (T-shaped groove 2 mm deep, 2 mm wide, and length of 4 mm mesiodistally and 2 mm buccolingually prepared with a straight fissure bur). The acrylic teeth were attached to a wax block of dimension 1.2 cm × 1.2 cm × 2.5 cm. These were flasked and dewaxed, followed by injection molding with Valplast flexible denture base material. The bond strength was assessed by attaching the specimens to universal testing machine tested under a tensile load at a cross-head speed of 1 mm/min till it fractured. Data obtained were statistically evaluated by one-way analysis of variance and post hoc test. RESULTS: There was significant increase in mean bond strength after various mechanical modifications. Group with T-shaped diatoric hole showed greatest bond strength value compared to other groups. CONCLUSION: Incorporating mechanical retentive features with increased surface area and undercut can improve the bonding of acrylic teeth to flexible denture base.

Stem Cells and Their Application in Dentistry: A Review.

The use of the term "stem cells" dates back to the 1800s; however, the application of the same is still not completely understood. Recent advances have indicated the harvesting of postnatal stem cells from sources such as the dental pulp and fat. The pluripotent nature of these cells allows for use in various aspects of treatment and patient care such as organ and tissue transplantation, bony defects repair, distraction osteogenesis, cell therapies, gene therapy, and toxicology testing of new drugs. This article explores the various aspects involved, the current status, and future challenges of stem cell therapy in patient care and management.

Assessment of Periodontal Disease Among the Dental Prosthetic and Nonprosthetic Wearers in an Adult Rural Population in Mangalore Taluk, South India.

BACKGROUND: Oral health as an integral part of general health. Rural population neglect oral health as they lack awareness on oral diseases and also due to inadequate availability of dental services. There is a very high prevalence of chronic inflammatory periodontal disease in the rural Indian population, which is left untreated. Hence, this cross-sectional survey was taken up in the rural area of Mangalore taluk, Karnataka, India. MATERIALS AND METHODS: A cross-sectional survey was carried out on 1312 participants aged 18 years and older. The prevalence of periodontal disease among the dental prosthetic and nonprosthetic wearers was assessed. The World Health Organization format was used to record the periodontal status and loss of attachment. Data collected were analyzed using chi-square test. P < 0.05 was considered as significant. RESULT: Of the 1312 included subjects, 520 were males (39.6%) and 792 were females (60.3%). Periodontal status showed that calculus was found to be high among all age groups. When the prevalence of periodontal disease was assessed among the prosthetic wearers, it was found that subjects wearing removable partial denture showed increased prevalence of periodontal pocket depth and attachment loss irrespective of age group, gender, and educational qualification. CONCLUSION: Lack of awareness among the individuals regarding periodontal diseases has been associated with consistently higher prevalence of periodontal diseases and treatment needs. Demographical studies need to be carried out at regular intervals, thus helping in planning the treatment needs nationwide for better oral health care in rural population.

Evaluation of Patient and Parent Satisfaction After Orthodontic Treatment/Orthognathic Surgery for Cleft Lip and Palate Deformity.

OBJECTIVES: The objectives of this study were to evaluate the satisfaction of patients, parents, and individuals other than health professionals (neighbors or relatives), regarding the quality of care, and to evaluate the patients general care, facial appearance, dental changes, and psychological assessment by social outlook and emotional quotient. MATERIALS AND METHODS: Sixty patients with cleft lip and palate reporting to a dental institution were divided into two age groups, 0-15 years (G1) and 15-30 years (G2), their parents (P1 and P2) and a group comprising their neighbour's or relatives (T1 and T2) were also divided according to G1 and G2. To evaluate their satisfaction toward the treatment received, three separate questionnaires were given to the three groups and their responses were subjected to statistical analysis. RESULTS: The results showed that majority of patients (74%) and their parents (60%) were satisfied with the orthodontic treatment they received to align the teeth. But they were not satisfied with the appearance of lip (61.6% and 56.6%), nose (60% and 53.3%), and speech (62%). This study showed that cleft-affected individuals were teased mainly for speech (60%) followed by lip and teeth. Sixty percent of the patients admitted that their self-confidence was quite affected because of cleft and 36.6% expressed that their school/college results have been affected. CONCLUSION: Majority of cleft lip and palate patients as well as their parents were satisfied with their child's dental appearance; they were unsatisfied with the appearance of nose, lip, smile, and speech.

An In vitro Comparison of Coconut Water, Milk, and Saline in Maintaining Periodontal Ligament Cell Viability.

BACKGROUND AND OBJECTIVES: Two of the most critical factors affecting the prognosis of an avulsed tooth after replantation are extraoral dry time and the storage media in which the tooth is placed before treatment is rendered. The present study is undertaken to evaluate the periodontal ligament (PDL) cell viability after storage of teeth in different storage media, namely, coconut water, milk, and saline. MATERIALS AND METHODS: Forty sound human premolars undergoing extraction for orthodontic purpose were selected. The teeth were allowed to lie dry on sand/mud for 30 min followed by which they were randomly divided and stored in three different media, i.e., coconut water, milk, and saline. After 45-min storage in their respective media, the root surface was then scraped for PDL tissue. RESULTS: The ANOVA and Newman-Keuls post hoc procedure for statistical analysis of viable cell count under a light microscope using hemocytometer demonstrated that coconut water preserved significantly more PDL cells viable (P < 0.05) compared with milk and saline. CONCLUSION: Storage media help in preserving the viability of PDL cells when immediate replantation is not possible. This study evaluated the posttraumatic PDL cells' viability following storage in three different storage media. Within the parameters of this study, it was found that coconut water is the most effective media for maintaining the viability of PDL.

Smoking Cessation Advice: Knowledge, Attitude, and Practice among Clinical Dental Students'.

BACKGROUND: Smoking is the single most important public health challenge facing the National Health Service. The detrimental effects on the general health of tobacco smoking are well documented. Smoking is a primary risk factor for oral cancer and many oral diseases. Dental professional scan plays an important role in preventing adverse health effects by promoting smoking cessation. OBJECTIVE: To assess the knowledge, attitude, and practice among clinical dental students in giving smoking cessation advice and to explore the barriers to this activity. MATERIALS AND METHODS: A total of 262 clinical dental trainee of two dental colleges (College of Dental Sciences and Bapuji Dental College) of Davangere city were included in the survey. A self-administered questionnaire was administered to assess the knowledge, attitude, and practice toward Tobacco Cessation Advise. RESULTS: Among the 262 participants in the study, around 51% said they know about Nicotine Replacement Therapy, and among them, only 4.6% were aware of the options available in the market. When asked about 5A's of tobacco cessation, only 35.5% were aware of it. Similarly, when asked about 5R's of tobacco cessation, 48.5% were unaware of it. CONCLUSIONS: The respondents did not have sufficient knowledge regarding tobacco cessation advice. With patient's disinterest and lack of time being quoted as the important barriers in providing tobacco cessation advice, it is highly recommended that there is need to incorporate few chapters on tobacco, its effect and cessation of habit in the undergraduate dental curriculum with simultaneous application of the same in clinical practice.

Effect of Fluoride Varnish and Dentifrices and Its Combination on Deciduous Enamel Demineralization: An In vitro Study.

INTRODUCTION: Dental caries remains the most important dental health problem in developing countries. Application of varnish on tooth surfaces is shown to promote the uptake of firmly bound fluoride by enamel, which is considered important. Along with the incorporation of fluoride into the crystalline lattice, there is formation of calcium fluoride compounds on enamel. METHODOLOGY: Seventy deciduous canines were covered with nail polish. A window measuring 4 mm × 4 mm was left on their buccal surface, These were randomly assigned to seven groups (n = 6): S: sound enamel not subjected to any regimen or treatment; N: negative control, subjected to the pH-cycling regimen without any treatment; D1 and D2: subjected to the pH-cycling regimen and treated two times daily with 1100 and 500 ppm F dentifrice, respectively; VF: fluoride varnish (subjected to F-varnish before and in the middle of the pH-cycling regimen); and VF + D1 and VF + D2. After a period of 10 days, sectioning of teeth was done, and enamel demineralization was measured. RESULTS: The combination of dentifrice and varnish (groups VF + D1 and VF + D2) significantly reduced demineralization compared with the N group at all distances evaluated (P < 0.05), but the combination did not differ from the dentifrice groups at most distances from the surface (P > 0.05). CONCLUSION: The results of this study suggest that the combination of F-varnish with dentifrices containing 500 or 1100 ppm F is not more effective in reducing demineralization in primary teeth than the isolated effect of dentifrice containing 1100 ppm.

An In Vivo Study to Compare and Evaluate the Correlation of the Facial Measurements with the Combined Mesiodistal Width of the Maxillary Anterior Teeth between Males and Females.

AIM: The aim of this study was to compare and evaluate the correlation of the facial measurements (interalar, intercommissural, intercanthal, and interpupillary distance) with the combined mesiodistal width of the maxillary anterior teeth between males and females. OBJECTIVES: The objectives of this study were: (a) To evaluate the correlation of the facial measurements (interalar, intercommissural, intercanthal, and interpupillary distance) and combined mesiodistal width of maxillary anterior teeth. (b) To compare the correlation of the facial measurements (interalar, intercommissural, intercanthal, and interpupillary distance) with the combined mesiodistal width of maxillary anterior teeth between males and females. MATERIALS AND METHODS: This study was carried out on 120 dentate Subjects selected from Yenepoya Dental College, Mangalore. The vernier caliper was used to measure the interalar, intercommissural, intercanthal, and interpupillary distance. The mesiodistal width of maxillary anterior teeth was measured on the cast. For accuracy, every distance was measured three times and the mean taken. RESULTS: Comparison of parameters between males and females was calculated using independent sample t-test. The values obtained for each variables are interalar distance: for males 38.89 ± 2.19 and for females 35.58 ± 2.33. Intercommissural distance: for males 50.96 ± 2.99 and for females 47.15 ± 2.97. Intercanthal distance: for males 31.92 ± 1.46 and for females 30.46 ± 2.07. Interpupillary distance: for males 65.15 ± 2.82 and for females 61.78 ± 3.18. Mesiodistal width of maxillary anterior teeth: for males 52.55 ± 1.82 and for females 51.33 ± 2.50. CONCLUSION: Within the limitations of this study, the study concluded there is a significant correlation between interalar, intercommissural, intercanthal, interpupillary distance, and mesiodistal width of maxillary anterior teeth in total subjects. In females, there is a significant correlation between interalar, intercanthal, interpupillary distance, and mesiodistal width of maxillary anterior teeth.

An Evaluation of the Effect of Various Gloves on Polymerization Inhibition of Elastomeric Impression Materials: An In vitro Study.

BACKGROUND: Latex protective barriers such as gloves and rubber dam material have been used widely in restorative procedures for crown and bridge. However, the chemical used during latex glove fabrication is thought to inhibit the polymerization of elastomeric impression materials used for impression making which has a detrimental effect on the dimensional accuracy and surface definition of resultant casts used for restorative procedures. The objectives of the study were to examine the surface of different elastomeric impressions on contact with various gloves. MATERIALS AND METHODS: This clinical study included a total of eighty specimens of two types of the putty elastomeric impression material were hand manipulated by wearing three different gloves materials and is placed on a marked area of a clean and alcohol-treated glass slab at room temperature. The specimens examined for any signs of polymerization inhibition. The specimen will be rated as being "inhibited" if any residue remains on the glass slab and absence of the above will result as "no inhibition." RESULTS: The results showed no interference with the polymerization inhibition of the selected elastomers followed by the nitrile glove. The latex gloves showed inhibited set of the elastomeric impression material but set after sometime confirming time-dependent inhibition of the impression material. CONCLUSION: This study shows that the use of latex and sometime nitrile gloves during crown and bridge procedures should be contraindicated and the use of vinyl gloves should be stressed when working with elastomeric impression materials.

Efficacy of Denture Cleansers on Impact Strength of Heat polymerized Acrylic Resins.

PURPOSE: The study was aimed to compare and evaluate the changes in the impact strength of heat cure denture base resins when treated using denture cleansers. METHODOLOGY: Study was conducted with sample size of 40 and dimesion 65 mm length, 10 mm width, and 3 mm thickness as per the ISO 1567. Distilled water has been used as control group, in which 10 samples were immersed of 40 samples. Of remaining 30 samples, 10 were treated with Clinsodent, 10 were treated with VI-Clean, and 10 were treated with Clanden denture cleansers. The impact strength of these specimens from each group was tested with the help of Charpy-type pendulum impact strength tester. The energy absorbed to fracture the specimens was recorded, and impact strength was calculated and was analyzed using Kruskal-Wallis ANOVA and Mann-Whitney test. RESULTS: Impact strength of samples was significantly reduced after immersion in denture cleansers Clinsodent, VI-Clean, and Clanden solutions when compared to control group. CONCLUSION: Clinsodent, VI-Clean, and Clanden denture cleansers decrease the impact strength of heat cure denture base resin after immersion. Hence, the study concludes that denture cleansers should be used with caution and advised to follow manufacturer's instructions.

Variations in Flexural Strength of Heat-polymerized Acrylic Resin after the Usage of Denture Cleansers.

OBJECTIVE: The objective of this study was to evaluate and compare changes in the flexural strength of heat-cured denture base resins when treated using denture cleansers. STUDY DESIGN: A total of 40 specimens with dimension 65 mm length, 10 mm width, and 3 mm thickness were prepared as per ISO 1567 specification. A total of 10 specimens were immersed in distilled water to be used as control. Of the remaining 30 samples, 10 were treated with Clinsodent, 10 with VI-Clean, and 10 with Clanden denture cleansers. Specimens in each group were subjected to three-point flexural load in universal testing machine at a cross-head speed of 5 mm/min. The peak load (N) was recorded and flexural strength was calculated. The findings were analyzed using Kruskal-Wallis analysis of variance and Mann-Whitney test. RESULTS: Heat-cured denture base resin selected for this study showed significant difference in flexural strength after immersion in denture cleansers Clinsodent, VI-Clean, and Clanden solutions, when compared with the control group. CONCLUSION: Findings of this study showed that denture cleansers altered the flexural strength of heat polymerized acrylic resins that endured soaking cycles which simulated 180 days of use. Hence, denture cleansers should be used with caution, once a day after brushing the dentures. It is advisable for patients to follow the manufacturer's instructions.

Marginal Accuracy of Castings Fabricated with Ringless Casting Investment System and Metal Ring Casting Investment System: A Comparative Study.

BACKGROUND: The thermal expansion of the investment can be restricted by the metal casting ring because the thermal expansion of the ring is less than that of the investment. The ringless casting procedure is in use in clinical dentistry, though there is little scientific data to support its use in fixed partial dentures. In this study, marginal discrepancy of castings produced with the ringless casting technique and the conventional technique using the metal rings were compared. MATERIALS AND METHODS: A total of 30 wax patterns were fabricated directly on a metal die. Optical stereomicroscope was used to measure the marginal discrepancy between the metal die and wax patterns. A total of 15 castings were invested using Bellavest T phosphate-bonded investment with the ringless technique and 15 were invested with the same investment with a metal ring; 30 castings were produced using a nickel-chromium ceramo-metal alloy. The internal surface of the castings was not modified and seated with finger pressure. The vertical marginal discrepancy was measured using an optical stereomicroscope at a magnification of 100x. The data obtained were statistically analyzed using students t-test (paired t-test and unpaired t-test). RESULTS: The castings of the ringless technique provided less vertical marginal discrepancy (240.56 ± 45.81 µ) than the castings produced with the conventional metal ring technique (281.98± 53.05 µ). The difference was statistically significant. CONCLUSION: The ringless casting technique had produced better marginal accuracy compared with conventional casting technique. Ringless casting system can be used routinely for clinical purpose.

Posturedontics: How does dentistry fit you?

Dentists are at high risk for musculoskeletal disorders (MSD's) due to their work. MSD's is an umbrella term for number of injuries affecting different parts of the body, including joints, muscles, tendons, nerves that can arise from sudden exertion or making the same motions repeatedly. These injuries can develop over time and can lead to long-term disability. Dental professional often develop musculoskeletal problems due to bad working habits, uncomfortable physical posture causing unnecessary musculoskeletal loading, discomfort and fatigue. Ergonomic principles when it is applied, it will help to reduce stress and eliminate many potential injuries and disorders associated with the overuse of muscles, bad posture, and repeated tasks. This can be accomplished by using a proper dental chair, lighting and the selection of ergonomically-friendly equipment to fit the dental professionals physical capabilities and limitations. This review addresses about the basics of ergonomics, positioning, viewing, handling, and prevention of MSD's.

India's baby boomers: In driving need for dental care.

The present paper aims to review the literature on increasing health care challenges and needs of a growing Indian geriatric population. It also focuses on the need to overcome the shortfalls in its current oral health status in elderly. This review is based on a PubMed database search engine published in the period from 1990 to 2010 in various dental journals. Different strategies are designed to provide better facilities and easy access of these facilities not only to elderly living in the city but to the one's in rural areas. It is emphasized that geriatric dentistry should be included in the educational systems to help resolve problems of oral health care for the elderly in India.

Prosthetic management of malpositioned implant using custom cast abutment.

Two cases are reported with malpositioned implants. Both the implants were placed 6-7 months back. They had osseointegrated well with the surrounding bone. However, they presented severe facial inclination. Case I was restored with custom cast abutment with an auto polymerizing acrylic gingival veneer. Case II was restored with custom cast UCLA type plastic implant abutment. Ceramic was directly fired on the custom cast abutments. The dual treatment strategy resulted in functional and esthetic restorations despite facial malposition of the implants.