An Aesthetic and Economic Approach of Smile Designing for a Patient With Dentinogenesis Imperfecta: A Rare Case Entity.

This is a case report presenting a female patient in her twenties suffering from severely stained, unaesthetic, and worn-out teeth since her childhood. It was a major aesthetic and functional concern for her. This clinical presentation describes the prosthetic rehabilitation of a patient with generalized discolored and worn-out teeth to have enhanced aesthetics and masticatory function of the patient. This is a referred case of dentinogenesis imperfecta- II (DGI-II) from the Department of Oral Medicine and Radiology and Oral Pathology, as diagnosed by them after a thorough clinical, radiographical, and histopathological examination. DGI is a disorder of teeth characterized by discoloration and rapid wear and belongs to a group of disorders of the development of teeth. Due to the rapid wear and generalized intrinsically stained and discolored teeth, there is a loss of vertical dimension of occlusion (VDO) and an unesthetic look of the patient respectively. Therefore, the main objective of the case report is to re-establish the aesthetic and regain the VDO and functionality of the damaged teeth using the Pankey Mann Schuyler philosophy in which the first anterior teeth were rehabilitated with porcelain fused to metal (PFM) crowns based on aesthetics and phonetics of the patient. This was followed by posterior PFM crowns based on Broadrick's flag analysis for posterior occlusal plane determination and centric occlusion.

Pankey Mann Schuyler Philosophy-Based Prosthetic Rehabilitation for an Amelogenesis Imperfecta Patient: A Case Report.

This clinical case report presents the prosthetic rehabilitation of a 23-year-old male patient with generalized discolored and worn-out teeth, which were of aesthetic and functional concern. In collaboration with the Department of Oral Medicine and Radiology and Oral Pathology, this clinical condition was diagnosed as amelogenesis imperfecta (AGI). AGI is a genetic odontological disorder that is an epithelial derivative of the developed tooth bud with enamel malformation. AGI typically affects both deciduous and permanent teeth. Patients generally have aesthetic complaints and compromised chewing efficiency with loss of vertical dimension. Prosthetically rehabilitating an AGI patient is a multidisciplinary approach to regain aesthetics, phonetics, and mastication. This article describes the full mouth rehabilitation, following the Pankey Mann Schuyler philosophy, of the patient with AGI involving all teeth. Full mouth rehabilitation was planned to restore aesthetics, phonetics, and mastication in four phases. First was prosthetic rehabilitation of the mandibular anterior teeth, followed by the maxillary anterior, mandibular posterior, and, finally, maxillary posterior teeth.

Finger Prosthesis: An Economic and Esthetic Approach.

Fabrication of prosthetic fingers is more of an art than a science. The prosthetic finger must match the missing fingers or digits to such an extent to have a natural aesthetic look for the patient. This would build up the patient's confidence and prevent unwanted attraction by others. A patient, 47 years old, reported the loss of the middle finger of the right hand. The loss of the right middle finger was till the first phalanx, and it was distorted till the second phalanx. The patient wanted to have a natural look at his hand. Alginate impressions of the patient's amputated finger and the donor's relevant matching fingertip were made. A waxed prosthesis pattern was fabricated with the donor's fingertip. A wax trial was done in the patient, and was flasked. A heat cure acrylic was intrinsically painted with acrylic paint color to match the adjacent finger's skin tone, followed by packing these in the dewaxed mold, processed, trimmed, finished, and polished. This case report describes a method of obtaining or enhancing retention of the prosthetic finger by adopting a customized finger ring on the master cast and also customizing the prosthesis in the clinical rest position to have the aesthetic appearance in the resting condition of the palms and fingers. This method is cheaper and very easy to be adopted for affected people.

Evaluation and Comparison of Stress in Divergent and Convergent Collar Designs of Implants With Different Bone Densities: A Finite Element Study.

BACKGROUND: The failure and the success rate of an implant depends on biomechanical factors, esthetics and painless sterile implant surgery conditions, out of which stresses applied to the bone and its surrounding, bone-implant interface, material characteristics of the implant used and the strength of the bone and its surrounding are the important factors. This study aimed to evaluate the stress distribution of divergent collar design (DCD) and convergent collar design (CCD) implants placing them in four different densities of the bone (D1, D2, D3 and D4). The evaluation of the stress distribution of DCD and CCD was performed using the 3D finite element method (FEM), by placing them in four different bone densities. In addition to this, a comparison of the effect of DCD and CCD in terms of stress distribution in the bone was also done. MATERIALS AND METHODS: The software used to process the geometric characteristics of the missing first molar in the mandibular section were Ansys, version 19.2, CATIA, version 5, and Solidworks (Dassault Systèmes). Using these software, three models were designed and successfully restored using an all-ceramic crown implant. The first model was a geometric model of the first molar mandibular bone section, the second model was a cylindrical implant (4x10 mm) with a DCD and CCD, and the third model had titanium alloy (Ti-6Al-4V) properties incorporated into the implant. RESULTS: The D1 bone model showed the lowest stress concentration compared to D2, D3, D4. The DCD showed the lower stress and strain concentrations as compared to the CCD in the contiguous crestal bone in all the densities of the bone in both vertical and lateral or oblique loadings. The DCD with the D1 bone showed the least stress concentration around the crestal bone region. The results of this study also showed that the maximum von Mises stress was observed in the crestal region or the neck of the implant for both the convergent and divergent collar implant designs in all the four densities of the bone. CONCLUSION: Before a patient trial of a new implant design or a new implant material, finite element analysis (FEA) gives us a clear picture of what will be the patient bone response when an implant will be placed and loaded. FEA also gives us an opportunity to test a new implant material without putting a patient at risk. In this study, four different types of bone were incorporated with two different implant collar designs. Each implant assembly was subjected to vertical as well as oblique forces. The response of each bone type for the titanium alloy implant was recorded. A color-coded response for the magnitude and the location of the maximum stress received by the bone was observed. Maximum stresses were seen in the crestal region. As this is a computer-based model, dynamic loading was not possible. This study provided us with the possible outcome in patients under a static load. Further studies can be conducted in vivo to record dynamic loading responses as well as long-time loading responses.

Evaluation and Comparison of the Geometrical Relationship of Tooth and Lip Arcs and Their Correlation to Smile Arcs Between Males and Females in a North Indian Population.

Background With the increasing influence of social media, millennials and the generations that follow have increasingly pressing aesthetic concerns. Following this, there has been a sea change in treatment plans and procedures as well as the choice of material. Dentistry nowadays is dependent on digital data to compute and design prostheses; these technologies are often not readily available all over the world. The purpose of this research article is to measure the tooth arc (TA) and lip arc (LA) and their correlation to the smile arcs with a cohort consisting of males and females from a single center in northern India. The SA measurement, evaluation, and comparison of smile aesthetics in this young population may be used as a threshold to these smile variables so that prosthodontists can easily prevent or modify aesthetically displeasing features. This research article will be useful for cases requiring restorations and replacements of maxillary anterior teeth. Materials and methods In this research work, photographic analysis was used and photographs of hundred subjects were taken. The camera was fixed using a tripod, at an 11-inch distance from the face, so that a clear picture of the face could be taken from the tip of the nose to the chin. A digital single-lens reflex (DSLR) camera (Nikon D-60, with the Nikon DX AF-S Nikkor 18- 135mm lens, Tokyo, Japan) was used to take the facial photographs. As the posed smile is more predictable than the natural smile, subjects were asked to smile while keeping their natural head position (NHP). Parabolas were made with Math-GV software () and superimposed on the photographs to calculate the value. Results The mean LA shows greater curvature in the female population. There was no significant (p=0.92) relationship between TA curvature in the male (0.07±0.03) and female populations (0.08 ± 0.03), whereas the LA in males (0.10±0.03) and LA in females (0.12±0.04) showed a significant relationship (p=0.03) between both groups. The LA of the female population was found to be steeper than that of the male population. This study signifies that there is no significant difference (p=0.92) between the skeletal makeup of the male and female populations but the muscular activity and muscle function differ in the male and female populations. Regarding arc-wise comparisons in both male and female populations, the male population showed a statistically insignificant (p=0.27) correlation in lip and tooth arcs. But in the female population, the correlation between these arcs was statistically significant (p=0.01). Conclusion These study results provide useful guidance for evaluating anterior teeth and planning treatment for aesthetic restorative care. Clinicians should consider not only racial and gender differences when developing an aesthetic treatment plan but also the symmetry of the facial structure which should be in harmony with the dental arc. The harmony of each determinant of aesthetics, with each other, aids in promoting beauty as a whole.

Assessment of Oral Mucosal Lesions (OML), Periodontal Health Conditions, and Unmet Dental Treatment Needs in the Rural Adult Population of Jharkhand, North India.

Background Dental diseases like caries, periodontal diseases, and oral mucosal lesions (OML) are common findings in rural adult populations that greatly impact their quality of life. Aim To assess OML, periodontal health conditions, and unmet dental treatment needs in the rural adult population in Jharkhand. Methodology A total of 700 permanent residents of Bero Block, Jharkhand, North India, in the age group of 35-44 years, participated in this cross-sectional study. Both men and women were equally represented. Their socio-demographic characteristics and previous dental visits were collected using standardized proforma. An assessment of periodontal health conditions, OML, and unmet dental treatment needs was done using the World Health Organization (WHO) Oral Health Assessment Proforma of 1997. Results It was found that over half (54.3%) of the study population had the adverse habit of smoking and chewing paan. Males were more likely to experience leukoplakia (18.87%), whereas females were more likely to experience abscesses (9.43%). The majority of males and females had a community periodontal index (CPI) score and loss of attachment (LOA) score greater than two, which indicated poor periodontal health as assessed by the periodontal index. Both males and females needed extraction of the diseased teeth as their primary treatment. Conclusion The rural adult population residing in the Bero block of Jharkhand showed poor periodontal health and high unmet dental treatment needs. These people need effective oral health promotion policies and dental health education to improve their oral health.

Assessment of Anterior Loop of Inferior Alveolar Nerve and Its Anatomic Variations with Age, Gender, and Dentition Status in Indian Population: A CBCT Study.

BACKGROUND: The posterior region of the mandible is more often related to iatrogenic errors, but the interforaminal region is also not spared for neurovascular complications. This study aimed to use CBCT images to evaluate the prevalence of anterior nerve looping and its variations with age, gender, and dentition status. METHODS: This retrospective study was carried out by studying 600 CBCT scans retrieved from archival records of a CBCT center in Lucknow. The scans were inspected by two trained investigators. The length of the anterior loop was measured using the measuring tool of Carestream 3D imaging software. Descriptive and analytical tests were performed. RESULTS: The prevalence of the anterior loop of the inferior alveolar nerve was found to be 56%. The prevalence was found to be more on the right side (29.0%) compared to the left side (27.0%). The most common anterior looping of the inferior alveolar nerve was type 3 followed by type 1. Males were found to have significantly higher loops compared to females. The number of loops was found to decrease significantly with age. The mean length of the loop was found to vary from 1.14 to 1.61 mm. CONCLUSION: The anterior looping of IAN is very much prevalent in the Lucknow population. The use of the CBCT technique and appropriate preplanning prior to surgery or implant placement should be performed to prevent nerve injury.

Assessment of the Relationship between Oral Health Behavior, Oral Hygiene, and Gingival Status of Adolescent Tobacco Consumers in Ranchi, Jharkhand: A Comparative Study.

BACKGROUND: Tobacco consumption is very prevalent in India and associated with a number of oral health problems. Good oral health behavior plays a significant role in improving oral hygiene status. OBJECTIVES: To assess the relationship between the oral health behavior, oral hygiene, and gingival status of adolescent tobacco consumers (smoke/smokeless form) and to compare it with that of the nonconsumers of tobacco in the same age group, who were selected from the OPD of Dental Institute, RIMS. METHODS: This was a cross-sectional study carried out in Ranchi. The study included a total of 400 adolescents who were reported to be consumers of tobacco and 400 adolescents who were nonconsumers of tobacco. The oral health behavior was assessed using HU-DBI. The plaque and gingival scores were assessed using standardized indices. Data were analyzed using the Chi-square test, independent sample t-test, and Pearson's correlation. The significance level was set at p ≤ 0.05. RESULTS: The majority of tobacco consumers were found to have poor plaque scores as assessed using the plaque index. As assessed by the gingival index, the majority of the tobacco consumers were found to have a severe form of gingivitis. The mean plaque score (2.38 ± 0.51, p value <0.001) and the mean gingival score (2.6 ± 0.63, p value <0.001) were significantly higher in tobacco consumers. The mean HU-DBI score was significantly higher in non-tobacco consumers (8.3 ± 1.60, p value <0.001). It was observed that the gingival and plaque scores have a significant negative correlation with the HU-DBI score. The majority of tobacco consumers were worried about the staining of teeth and bleeding from gums. A dental visit for a routine preventive check-up was reported to be rare in both groups. CONCLUSION: The oral hygiene and gingival status were significantly poor in tobacco consumers compared to non-tobacco consumers. As the oral health behavior of the participants improved, the plaque and gingival scores reduced significantly.

Assessment of basal implants in compromised ridges.

AIM: The aim of the present study was to evaluate clinically, radiographically, and functionally the outcomes of immediately loaded basal implants when placed in patients with compromised bone/alveolar ridges. MATERIALS AND METHODS: A total of 18 systemically healthy (9 male and 9 female) subjects with compromised bone with poor quantity or quality were included in the study. A total number of 57 implants was placed, out of which 26 implants were placed in maxilla and 31 implants in mandible. There were 6 patients in which single implants were placed and in rest of the 12 patients, multiple implants were placed, out of which full mouth rehabilitation was done in one patient. In 10 patients, implants were placed immediately in fresh extraction socket and in 7 patients, implants were placed in healed edentulous site. In all the patients, loading was done immediately within 72 h of implant placement. All patients were evaluated for primary and secondary stability, pain, periimplant bone levels using IOPA with grid and CBCT, bleeding, suppuration, sulcular bleeding index, prosthetic complications, and patient satisfaction at specified time intervals. RESULT: All the values obtained during the study were expressed in the form of mean, standard deviation, and standard error of the mean. The parameters were compared between groups using Paired t-test for intragroup comparison at a similar time, i.e., baseline, 1 month, and 3 months. The data collected was comprehensively analyzed using SPSS software. All implants were successful, with no incidence of infection, nil mobility at the end of the study period of 6 months. CONCLUSION: Thus, it can be concluded from the present study, that Basal implants can play a vital role in the rehabilitation of patients, where compromised quality and/or quantity of bone is present and additional augmentation procedures would be required for the placement of conventional root form implants.

A randomized controlled trial comparing the radiographic evaluation of crestal bone resorption in single implant versus two implant-retained overdentures.

AIM: The aim of this study was to evaluate and compare radiographically the amount of crestal bone resorption during healing and loading period in single implant versus two implant-retained mandibular overdentures in totally edentulous patients. MATERIALS AND METHODS: A total of 20 edentulous patients (12 male and 8 female) with age range of 58.6 years were included in this clinical trial which was completed in four phases (clinical and radiographic diagnosis, surgical phase, implant loading phase, and bone level measurement phase). The eligible patients were randomly allocated in two equivalent groups of 10 participants each per group. The allocation was in 1:1 ratio via randomized chit method. Group I included the case group, that is, single implant, and Group II included the control group, that is, two implants located in mandible. A total of 30 implants were placed in Group I and 20 implants in Group II. Digital intraoral peri-apical radiographs (RVG 5100) were used for measuring the bone level immediately after implant surgery, 1 month, 3 months, 4 months, and 6 months. RESULT: This study showed that there was a mean crestal bone loss of 0.7 mm between the tip of the implant and alveolar crest at the end of 6 months after implant placement in single implant Group I while 0.67 mm in case of Group II two-implant-retained mandibular overdentures. The percentage of crestal bone loss after 6 months follow-up was 6.45% in Group I which was statistically insignificant compared with Group II where 6.25% of bone loss was recorded. CONCLUSION: Single implant-retained mandibular overdentures could be used as another alternative treatment option for completely edentulous elderly patients with severely resorbed ridges and financially and systemically compromised conditions.

Dental fluorosis and associated risk factors in early adolescents in India.

Background Dental fluorosis has a negative impact on the facial esthetics of adolescents and is a worldwide oral health concern. Objective To assess the prevalence and associated risk factors for dental fluorosis in early adolescents in India. Methods This was a cross-sectional study carried out on 800 adolescent school children selected from the Jhabua and Dhar districts of Madhya Pradesh, India. The children were in the of 12-15-year age group. A total of eight schools from both Jhabua and Dhar districts were included in the study. A self-administered questionnaire collected information on demographic characteristics, oral hygiene practices and various risk factors for dental fluorosis. Water samples were collected from each zone and sent to a laboratory for water fluoride estimation. Dental fluorosis was assessed using the Dean index. Chi-squared (χ2) and logistic regression analysis were performed. Results The overall prevalence of dental fluorosis was found to be 40.5% in early adolescents. The prevalence of dental fluorosis was found to be 45% in the Jhabua district and 36% in the Dhar district. The water fluoride content was found to be the strongest predictor for dental fluorosis followed by the method of water storage. Conclusion Dental fluorosis affects a large number of adolescents in both the Jhabua and Dhar districts of Madhya Pradesh. Effective policies focusing on oral health education and prevention of dental fluorosis need to be drafted.

Oral health impact, dental caries experience, and associated factors in 12-15-year-old school children in India.

BACKGROUND: Dental caries affects quality of life and has a negative impact on daily performance. OBJECTIVE: The study was conducted to assess the impact of oral health and its associated factors in schoolchildren in the age group 12-15 years in Indore, Madhya Pradesh. METHODS: A cross-sectional survey was conducted in schoolchildren in the age group 12-15 years. Sociodemographic and oral health related behaviors of schoolchildren were collected using a self-administered questionnaire. Child oral impact on daily performance (OIDP) questionnaire was used to assess the oral impacts. Oral examination was performed to check the presence of caries using decayed, missing and filled teeth (DMFT) index. RESULTS: A total of 690 schoolchildren participated in the survey. The mean age of the children was 13.58 years. The overall prevalence of dental caries was found to be 47.2%. The prevalence of one or more impact in the study population was 36.5%. The most prevalent impact was difficulty in eating and cleaning of teeth and the least prevalent impact were emotion and studying. Results of logistic regression analysis showed that the type of school that a child goes to, socioeconomic status, material used, dental visit, and dental caries were significantly associated with the Child-OIDP affected score. CONCLUSION: Oral health had a significant effect on the quality of life of schoolchildren. The prevalence of dental caries was found to be high. Effective policies need to be drafted for oral health promotion in this age group.

Mandibular canine index: A reliable predictor for gender identification using study cast in Indian population.

CONTEXT: Various methods are used for gender identification in anthropologic and forensic investigations. The canine tooth is widely used for gender determination because of its sexual dimorphism and durability in the oral cavity. Mandibular canine index (MCI) is one of the most reliable and valid predictor for gender identification. AIM: To assess the reliability of MCI in gender determination in Indian population. SETTINGS AND DESIGN: This was an experimental study involving the preparation of plaster models of 100 individuals residing in Udaipur, Rajasthan, India. Of these 45 were males and 55 were females. Both sexes were in the age group of 20-30 years. Study casts were prepared for all individuals and the measurements of mandibular canine teeth were taken. The MCI was calculated using standardized equation. In addition, the percentage of sexual dimorphism was calculated. STATISTICAL ANALYSIS USED: Independent sample t-test was used. P < 0.05 was considered statistically significant. RESULTS: There was a significant difference (P < 0.05) observed between inter-canine distance, right and left canine width and right and left MCI between males and females. Sexual dimorphism is more on left permanent mandibular canine teeth than right permanent mandibular canine teeth. The overall percentage of accuracy observed was 85.5%. CONCLUSIONS: Study findings reveal that MCI can be used a reliable predictor for gender determination in Indian population and can form the basis of anthropologic and forensic investigations.

Prevalence and Risk Factors for Oral Potentially Malignant Disorders in Indian Population.

Objective. To assess the prevalence of oral potentially malignant disorders and to determine the potential risk factors for its development in Indian population. Materials and Methods. This cross-sectional study was carried out on 1241 individuals in Indore, Madhya Pradesh. A questionnaire was designed to record information about sociodemographic characteristics, oral hygiene practices, dietary habits, and risk factors for oral potentially malignant disorders. Oral mucosal lesions were examined by a skilled person. Results. The overall prevalence of oral potentially malignant disorders was found to be 13.7% with oral submucous fibrosis (8.06%) found to be more common and erythroplakia (0.24%) found to be least prevalent. Results of Logistic Regression analysis showed that males (OR = 2.09, P value < 0.0001) who were ever consumers of tobacco (OR = 2.06, P value = 0.030) and areca nut chewing (OR = 2.64, P value = 0.004) were more likely to develop oral potentially malignant disorders compared to never consumers. Diabetic (OR = 2.21, P value = 0.014) and underweight individuals (OR = 2.23, P value = 0.007) were more likely to suffer from oral potentially malignant disorders. Conclusion. The study reinforces the association of tobacco and areca nut consumption with oral potentially malignant disorders. An association of oral potentially malignant disorders with diabetes and BMI was confirmed by this study.

Occupational Hepatitis B Exposure: A Peek into Indian Dental Students' Knowledge, Opinion, and Preventive Practices.

Objective. To determine the level of knowledge, opinions, and preventive practices followed by dental students against Hepatitis B. The study also explored if any correlation existed between knowledge, opinion, and preventive practices score. Materials and Methods. A cross-sectional study was conducted in a dental teaching institution. The subjects comprised 216 dental students. The study was conducted using a pretested, self-administered questionnaire. The questionnaire was prepared to assess knowledge, opinion, and preventive practices against Hepatitis B. Kruskal-Wallis and Kendall Tau test were performed. Results. The study found that only 44.4% of the students were vaccinated with Hepatitis B vaccine. 59.3% of the students reported washing their hands after contact with patient's body fluids. 63.9% used personal protective measures like facemask, aprons, head cap, eye shields, and so forth, while treating patients. Median knowledge, opinion, and practice scores were found to be 5.00, 3.00, and 3.00, respectively. Significant correlation was obtained between knowledge and preventive practices score (r = 0.385, p value <0.0001). Conclusion. Effective measures need to be taken to improve preventive practices of the students to prevent them from risk of Hepatitis transmission. Mandatory vaccination against Hepatitis B needs to be implemented.

Prevalence and risk factors for non-carious cervical lesions in children attending special needs schools in India.

We assessed the prevalence and risk factors for development of non-carious cervical lesions (NCCLs) in children attending special needs schools in India. The participants were 395 children aged 12-15 years with disabilities in learning, communication, physical function, and/or development. A questionnaire was designed in order to collect information on sociodemographic characteristics, oral hygiene practices, dietary habits, and risk factors for NCCLs. The chi-square test, bivariate analysis, and logistic regression analysis were used to analyze the data. Presence of NCCLs was associated with use of toothpowder or other materials for teeth cleaning, use of harder toothbrushes, use of a horizontal scrub technique for toothbrushing, consumption of a vegetarian diet, and greater consumption of lemon. The overall prevalence of NCCLs was 22.7%. Most lesions involved minimal loss of contour or defects <1 mm in depth. The prevalence of non-carious cervical lesions was slightly higher than the global average. Effective policies should be developed for oral health care among children attending special needs schools.