Oral and Craniofacial Anomalies of Fraser Syndrome:Prosthetic Management.

Fraser syndrome (FS, MIM 219000) is a rare autosomal disorder characterized by systemic and oro-facial malformation, usually comprising cryptophthalmos, laryngeal malformations, syndactyly, and urogenital defects. We presented a 21-year-old FS case with partial missing teeth seeking aesthetic dental treatment. Clinical examination revealed bilateral cryptophthalmos, extensive syndactyly of hands and feet broad nose with the depressed nasal bridge, and surgically corrected bilateral cleft lip. She presented class III jaw relation and reduced the vertical height of the face. Prosthetic rehabilitation of the patient was done with upper and lower overlay dentures made from acrylic resin (VIPI BLOCK TRILUX®, VIPI Industria, Pirassununga, SP, Brazil) using computer-aided design (CAD) and computer-aided manufacturing (CAM) process. At the follow-up visit, the patient presented improved aesthetics and function. Proper management and rehabilitation of FS patients are challenging, but standard guidelines for oral health management are currently lacking. This article presents a case of Fraser syndrome presenting oral and craniofacial anomalies, and prosthetic rehabilitation was done. We also provided recommendations for the optimal oral health care for the FS patients. Functional adaptation and rehabilitation have significant roles in the various functions, survival, and quality of the life of FS patients. Integrated medicaldental care is needed in such patients with support from family members, friends, and colleagues.

Full Coverage Crowns and Resin-bonded Bridge Combination for Missing Mandibular Anterior Teeth.

Most often the anterior teeth and those that are visible when a patient speaks or smiles are chosen for esthetic restorations. The mandibular anterior fixed bridge often presents problems to the dentist due to the size of the natural teeth and their visibility. In addition, due to high cost factor, many patients are not able to afford fixed partial denture for missing anterior teeth. This article describes a cost effective technique for the restoration of missing mandibular anterior teeth by fabrication of full coverage crowns and resin-bonded fixed bridge combination.

A Survey on Oral Health and Practice of Nepalese in Areas Affected by Earthquake in 2015.

Background Understanding post-earthquake oral health indicators is essential for developing oral health interventions of the victims. Presumably, due to a geographic difficulty, there has been no investigation to reveal the oral health status of individuals after the Gorkha earthquake in Nepal. Objective The main objective was to determine the oral health and practice of Nepalese affected by earthquake in April-May, 2015. Method The epidemiological cross sectional study was done at 5 different districts (Sindhupalchok, Dadhing, Bhaktapur, Kathmandu and Kavre) of Nepal from September till November, 2015. Altogether 500 subjects aged form 16 to 80 years of age living in the transitional shelters community were included in earthquake-affected areas. Different parameters were studied from past and present medical and dental problems, habits, oral hygiene habits. DMFT, gingival index, periodontal index were studied and correlation was studied among them. Result It shows that 98% of the participants had plaque and 96.4% of the participants had calculus. Mean decayed was 9, mean missing was 4 and mean filling was 1. 22.60% of the participants had score 0, 34.8% had score 1, 34% had score 2 and 8.60% had score 3 of mean gingivitis index. 10% of the participants showed score 0, 36% showed score 1, 35% showed score 2, 10.2% showed score 3 and 8.2% showed score 4 of mean periodontal index. Moreover, significant correlation was observed among DMFT index, gingival index and periodontal index (p<0.001). Conclusion The oral health care practice, oral hygiene habits, nutritional intake of the people have been affected in the earthquake affected areas. It showed high caries index, gingival index and periodontal index in earthquake affected people suggesting further efforts are needed for an oral health improvement. Data from this study may be used as basic information for oral health planning and future steps in oral health care preventive and therapeutic programs.

Gender Based Comparison of Gingival Zenith Esthetics.

Background The size, proportion and gingival zenith position of maxillary anterior teeth plays in the anterior teeth esthetics. Objective To compare the gingival zenith positions and levels between male and female in right and left side as an esthetic parameter. Method Impression of the maxillary arch was made in each participant with irreversible hydrocolloid, and dental cast was made with dental stone type IV. Two clinical parameters were evaluated: (1) the gingival zenith position (GZP) from the vertical bisected midline along the long axis of each individual maxillary anterior tooth; and (2) the gingival zenith level (GZL) of the lateral incisors in an apical-coronal direction relative to the gingival line joining the tangents of the GZP of the adjacent central incisor and canine teeth under healthy conditions. Statistical analyses were conducted using SPSS with the level of significance (α) = 0.05. Descriptive statistics was done and Independent t-test was used to compare the GZP and GZL between male and female. Result In male, the gingival zenith position for right side central, lateral and canine were 1.05 mm, 0.57 mm and 0.14 mm, and in left side were 1.02 mm, 0.53 mm, 0.15 mm. In female, the gingival zenith position for right side central, lateral and canine were 0.99 mm, 0.48 mm and 0.15 mm, and in left side were 0.94 mm, 0.44 mm and 0.14 mm. The gingival zenith position was significantly different between male and female for both lateral incisors. In addition, significantly different was found for the lateral incisor between right and left side. In male, the gingival zenith level of right and left lateral incisors 0.74 mm and 0.71 mm. In female, the gingival zenith level of right and left lateral incisors 0.76 mm and 0.72 mm. No significant difference was found between male and female for the gingival zenith level of right and left lateral incisors. Conclusion The GZP and GZL obtained from this study can be clinically applied to reestablish the GZP of the maxillary anterior teeth during periodontal surgery; crown lengthening or root coverage procedures.

Nepalese Esthetic Dental (NED) Proportion in Nepalese Population.

Background Lots of studies on maxillary anterior teeth proportions have been studied in different populations in various countries, but no studies have been conducted in Nepal on the esthetic maxillary anterior teeth proportions. Objective The study was done to investigate the maxillary anterior teeth proportions in a Nepalese population. Teeth proportions in the total population were compared with golden proportion (GP) and golden standard (GS). Method A total of 150 Nepalese subjects were divided in three facial types; broad, average and narrow group. Maxillary anterior teeth were measured from dental casts using digital calipers. The perceived width ratios of lateral to central incisor (LI/CI) and canine to lateral incisor (CN/LI), ratios of mean central incisor length to 2 central incisor widths (CIL/2CIW), and actual width to length ratios (WLRs) (%) were calculated in each facial type and compared. Mean LI/CI, CN/LI and CIL/2CIW in total population were calculated and compared with GP (0.618), and mean WLRs in the total population were compared with GS (80%). All teeth proportions were compared among three facial types. One-sample t-test and one-way ANOVA were performed to analyze the data (α = 0.05). Result The LI/CI, CN/LI, CIL/2CIW and WLRs in three facial types showed no significant difference. The LI/CI, CN/LI and CIL/2CIW in the total population were 66%, 70% and 55% respectively, and were significantly different from GP. The WLRs for CI, LI and CN in the total population were 90%, 86% and 89% respectively and significantly differed from GS. These values were considered to constitute the Nepalese Esthetic Dental (NED) proportion. Conclusion No significant difference of maxillary anterior teeth proportions were observed among three facial types. Teeth proportions in the total population significantly differed from GP and GS. We propose the NED proportion as a guideline for dental treatment in the maxillary anterior region in Nepalese populations.

Knowledge of emergency management of avulsed teeth among general dentists in Kathmandu.

BACKGROUND: An avulsed permanent tooth is one of the most emergency situations in dentistry. Dentists handling the situation should have adequate knowledge in this field. OBJECTIVE: To assess the level of knowledge of emergency management of avulsed teeth among general dentists in Kathmandu. METHODS: A questionnaire containing 10 close ended questions about emergency management of avulsed teeth was distributed among 102 general dental practitioners working in different private dental hospitals and clinics of Kathmandu. The dental hospital and clinics were randomly selected. This cross sectional study was conducted between January 2012 to February 2012. RESULTS: Among the studied group, almost all of the participants, 98(96.1%) said that an avulsed permanent tooth cannot be replanted in all cases. Majority of them, 63 (61.8%) said that the critical time for the replantation is within 20 minutes. General dentists of Kathmandu did not have adequate knowledge about emergency management of avulsed teeth. CONCLUSION: An education program should be conducted to increase the knowledge of general dentists in the management of traumatic injuries to teeth.