An Improvised Approach For Regaining Mouth Opening And Managing Tooth Wear In Oral Sub-Mucous Fibrosis.

This case report demonstrates the full mouth prosthetic rehabilitation of a patient with generalised compensated tooth wear and oral sub-mucous fibrosis (OSMF). A 50- year-old female with advanced tooth wear and concomitant OSMF presented to the clinic. She was managed in a sequential manner using an occlusal splint, extractions of hopeless teeth, root canal treatment of strategically important teeth, surgical crown lengthening of abutment teeth, and dental implants to replace missing dentition, followed by crown and bridgework to rehabilitate the dentition. All procedures were done on the principles of re-organised occlusal intervention. The outcome was a functional dentition with an aesthetic smile and a satisfied patient. The regaining of mouth opening among OSMF subjects is a challenge. The usual management is prescribing muscle stretching exercises, drugs, or surgery. In the present case, we managed to achieve significant improvement in mouth opening with occlusal splints. The use of such occlusal orthotics has never been reported.

Full mouth functional and aesthetic rehabilitation of a patient affected with hypoplastic type of amelogenesis imperfecta.

The management of Amelogenesis imperfecta often poses a challenge for the dentists. It not only includes aesthetic and functional rehabilitation of the patient, but also requires a positive rapport building with the patient due to psychosocial issues. The treatment plan is driven by patient demands, age, cost-affordability, severity of the disease and the presenting condition. The present case report elucidates step by step management of a 20 year-old female who presented with generalized hypersensitivity, intermittent pain associated with multiple decayed posterior teeth, poor dental aesthetics and anterior deep bite. The management consisted of endodontic treatments in all teeth, crown lengthening to gain ferrule in some teeth, provision of provisional bridges at an increased vertical dimension for six weeks followed by full mouth all ceramic crowns on all teeth. The prosthetic management aimed at reorganized occlusal scheme. There was a significant improvement in the aesthetics, deep bite, and along with correction of the vertical dimension of occlusion. Key words:Amelogenesis imperfecta, hypoplastic enamel, mouth rehabilitation, dental esthetics.

Success of pulpotomy in mature permanent teeth with irreversible pulpitis: A systematic review.

The objective of the present systematic review is to evaluate the success of pulpotomy in mature permanent teeth presented with irreversible pulpitis. The following databases were searched: PubMed, Oral and Dentistry Database, Cochrane, and CINAHL plus. We included studies published in the English language only. However, narrative reviews and case reports/series were excluded. The first electronic and hand search yielded a total of 2851 articles. After going through extensive screening and eligibility process, only six articles were finally selected for the review. The follow-up period ranged from 1 to 10 years. Randomized controlled trial compared pulpotomy with the root canal treatment and reported comparable and even better success of the pulpotomy (78% success). All the other studies have also shown better clinical and radiographic success of pulpotomy (68%-100%). Pulpotomy can be considered an alternative option for mature permanent teeth with irreversible pulpitis.

Interdisciplinary management of gingival recession and pathologic teeth migration-Revisiting dental aesthetics.

Poor aesthetics due to gingival recession can be a common concern among patients, specifically in individuals with gummy or high smile line. Various factors including patient related, site specific and technical factors need to be considered while treating gingival recession, as they all have a significant bearing on treatment success. Patients having aesthetic problems due to exposed root surfaces should have surgical root coverage procedures. Pathologic migration of anterior teeth is another aesthetic and functional problem that may be associated with advanced or chronic periodontal disease. Literature suggests the destruction of periodontal supporting structures to be the most commonly associated factor responsible for pathologic tooth migration. This case report is about the management of dental aesthetics of a middle-aged lady who was concerned about recession and pathologic tooth migration secondary to chronic periodontal disease. Employing multidisciplinary approach that included surgery, periodontics, endodontic and prosthodontics, the lady was provided with an aesthetically pleasing dentition.

Evaluation of the root and canal morphology of mandibular first permanent molars in a sample of Pakistani population by cone-beam computed tomography.

OBJECTIVE: To evaluate the root canal morphology of permanent mandibular first molars using Cone Beam Computed Tomography. METHODS: The retrospective study was done at Aga Khan University Hospital, Karachi, and comprised medical records of patients who visited the dental clinics from December 2016 to March 2017. Mandibular first permanent molars were evaluated on Cone Beam Computed Tomography images. Frequency distribution of Vertucci's classification was determined, and so was the association between Vertucci's classifications and gender. SPSS 20 was used for data analysis. RESULTS: A total of 142 mandibular first permanent molars were evaluated on 78 Cone Beam Computed Tomography images. The most common Vertucci's classification was Type IV for mesial root 86(60.56%) and Type I for distal root 63(44%). There was no difference in the two genders for root canal morphology (p>0.05). CONCLUSIONS: Type IV Vertucci's were prevalent in the mesial root and Type I were common in the distal root of permanent mandibular first molars.

Most effective method for the management of physiologic gingival hyperpigmentation: A systematic review and meta-analysis.

BACKGROUND AND AIM: Gingival hyperpigmentation is an esthetic problem. The aim of the present study was to identify most effective treatment modality for managing generalized physiological gingival pigmentation. MATERIALS AND METHODS: A systematic review and meta-analysis were done (1919 to October 2018) using PubMed, CINHAL, Dental and Oral Science, and manual searches. Twenty-five articles were finally reviewed. Only human clinical trials were considered with physiological gingival pigmentation treated with different depigmentation methods and compared with surgical stripping. The outcome was the achievement of gingival depigmentation and its recurrence. RevMan software was used for data analysis. RESULTS: Of 26,132 articles, 25 met the inclusion criteria. Seventeen were randomized control trials and 8 were nonrandomized control trials. Most of the studies were on laser. The control group was scalpel surgery. Majority of studies showed no difference in compared treatment modality. A meta-analysis compared laser ablation with surgical stripping revealed a nonsignificance difference regarding recurrence (P = 0.75) and depigmentation (P = 0.23) and a statistically significant difference regarding postoperative pain favoring laser ablation (P ≤ 0.05). CONCLUSIONS: Surgical stripping has been the conventional treatment of choice, but our review showed that new techniques are equally effective or even better. Laser especially diode laser was the most frequently used technique and showed better esthetic outcomes, less pain, faster healing, and patients' preference and satisfaction after treatment. However, laser showed more regimentation at 6-month evaluation. More good quality randomized controlled trials with different depigmentation methods are needed to draw strong conclusions.

Prosthetic rehabilitation of edentulous mandible with two-implant retained fixed hybrid prosthesis: A case report.

Removable complete dentures have been the most costeffective treatment option for edentulous jaws since decades. However, certain problems are encountered by the patients such as stability of the lower dentures resulting in poor masticatory efficiency. Ridge resorption and inadequate bony support are the long-term complications comprising the stability of the denture and patient finding it difficult to control denture movement during speaking and eating reducing patient compliance. Mandibular implant retained over dentures or hybrid dentures have shown to be better alternatives in terms of retention, stability and patient satisfaction. Two implants provide cost-effective, stabilized and comfortable treatment options. The present case report discusses the management of the patient with compromised dentition in which all teeth were extracted followed by conventional upper complete denture and lower two implant supported fixed hybrid dentures with splinted bar attachment.

Evaluation of root morphology and canal configuration of Maxillary Premolars in a sample of Pakistani population by using Cone Beam Computed Tomography.

OBJECTIVE: To evaluate the root canal morphology of maxillary premolars. METHODS: his retrospective study was conducted from November 2016 to January 2017 at Aga Khan University Hospital, Karachi, and reviewed Cone Beam Computed Tomography images of maxillary first and second premolars done from November 2014 to October 2016. Frequency distribution of Vertucci's classification was determined. Chi square test was applied to determine any association between Vertucci's type and gender. SPSS 19 was used for data analysis. RESULTS: Of the 114 first premolars, 74(68.6%) were bi-rooted and 36(31.5%) were single-rooted. The mean lengths of buccal and palatal roots were 20.6 ±1.7mm and 19.5±2.0 mm, respectively. The most common canal morphology reported for maxillary first premolars was type I 127(68%) followed by type II 24(12.9%). Of the 115 maxillary second premolars, 97(84%) were single-rooted. The mean lengths of buccal and palatal root were 20.7±1.6mm and 19.0±1.45mm, respectively. The most common canal morphology reported for second premolars was type I 71(53.4%) followed by type II 18(13.5%). CONCLUSIONS: Vertucci's type I was the most common canal configuration for maxillary first and second premolars and there was no gender-based difference for root canal morphology of maxillary premolars.

In vitro assessment of the accuracy of extraoral periapical radiography in root length determination.

OBJECTIVE: To determine the accuracy of extra oral periapical radiography in obtaining root length by comparing it with the radiographs obtained from standard intraoral approach and extended distance intraoral approach. MATERIALS AND METHODS: It was an in vitro, comparative study conducted at the dental clinics of Aga Khan University Hospital. ERC exemption was obtained for this work, ref number 3407Sur-ERC-14. We included premolars and molars of a standard phantom head mounted with metal and radiopaque teeth. Radiation was exposed using three radiographic approaches: Standard intraoral, extended length intraoral and extraoral. Since, the unit of analysis was individual root, thus, we had a total of 24 images. The images were stored in VixWin software. The length of the roots was determined using the scale function of the measuring tool inbuilt in the software. Data were analyzed using SPSS version 19.0 and GraphPad software. Pearson correlation coefficient and Bland-Altman test was applied to determine whether the tooth length readings obtained from three different approaches were correlated. P = 0.05 was taken as statistically significant. RESULTS: The correlation between standard intraoral and extended intraoral was 0.97; the correlation between standard intraoral and extraoral method was 0.82 while the correlation between extended intraoral and extraoral was 0.76. The results of Bland-Altman test showed that the average discrepancy between these methods is not large enough to be considered as significant. CONCLUSIONS: It appears that the extraoral radiographic method can be used in root length determination in subjects where intraoral radiography is not possible.