Clinical Dentistry - Science topic

Sophy

You have a very interesting research topic. I would suggest a qualitative methodology using a research collaborative with both dentists and patients. The patients and dentists should have an existing professional relationship. Consider interviews separately for the patient and dentist and then an interview with both parties. Alternatively, focus group discussions might be useful.

Good luck with your research.

If indicated, extraction of second molars can be performed. However, it depends on the type of case. If first molar is restored or having a poor prognosis, then it should be extracted. Both first and second molar extraction is relatively less common in orthodontics as compared to premolars.

Usually 6 months after grafting is the wait before the movement of teeth. Consulting with a periodontist is necessary to make sure that the graft has healed properly before tooth movement can be undertaken.

Yes, Invisalign clincheck has an option with which you can see the staging in detail. With this function, you can see the exact movement that is planned for each tooth at each stage.

Skeletal age is more appropriate to formulate the treatment plan for growth modification rather than basing the treatment plan on chronological age. The peak growth occurs around stage CVS 3 which is when the functional appliances would be useful. Functional appliances used at a later age lead to mostly dentoalveolar effects, so should be used only when indicated

sugar fermentation guide

Via in vitro study, it would be sensitive for Staphylococcus aureus which is the most common flora in oral cavity, maybe it's its indication.

If we can use PRF solution mixed hydroxyapatite granules then become gel put into the socket, it maybe better.

Using phosphoric acid etching gel. If the color changes to chalk white under loup with white LED light, it's enamel. If the color almost no change even cannot distinguished by loup and white LED light, it's detin.

I guess maybe its property looks like parafilm seal coat that can replace the dentin structure or infiltrate to seal exposed dentin or pulp capping to inhibit the flow of fluid through the true dentin tubules which is the cause of sensitivity...

Thank you so much.

Few challenges

To visualise periodontal ligament direction

To see cementum from dentin

To estimate pressure of erupting tooth

To see periapical blood vessels

All yours ;)

hello Dr .Anurag Tagare

Somaiya Vidyaviha.

you did not tell us How are you working on animal skulls? ie live animals or dry skull or are you working on human dry skulls .there are many answers for each of these items .also what instruments you have like handpiece ,piezo electric or striker saw

assuming you are working on rats for an experiment then the answer is yes i presume you are talking about dental hand piece or are you talking about one of those motors lab motors we use for the dentures.

certainly we use dental hand piece both contra angle and straight hand piece .The reason is we can sterilize them both .This is totally different than the denture lab motor which is difficult to sterilize ,and of course we use a lot of saline and very good satirizing technique to avoid infection .

We follow here the same techniques used by our colleagues in neuro surgery where we first make a whole with a rose head bur then we connect the dots using either a fissure bur or a cutting stainless steel wheel. We some time even use the famous Penfield periosteal elevator under the area we cut to prevent any damages to the brain tissue this is the same instruments our colleagues in neuro surgery use.. Once we finish the procedure we cover the calvaria by the same piece of bone using titanium plates or stainless steel wire to hold the segments back to the skull

hope that helps

best wishes

Dr.K.A.Galil.Professor of Dentistry

Visit my web page Drgalil.ca DDS.,D.Oral & Maxillofacial Surgery,PH.D,FAGD.,FADI.,Cert.Periodontist(Royal College of Dental Surgeons ) ,Developer of The patented first App in Oral Histology in the world for i Pad,i Phone ,i Pod Touch visit the web site https://itunes.apple.com/us/app/dgohe+/id1015383607?mt=8 and down load a free demo ,look at the bottom of the page . see Dr.Galil listed as #17 on 51 first researchers in the History of Western University since 1878

Due to the different natures of both materials (glass ionomer and composites) a few rules should be observed: glass ionomer adheres better to the root surface, while composites adhere better to enamel. Therefore it is crucial not to remove any healthy enamel at the CEJ and preserve even small amounts that would help to bond the composite to. To combine the advantages of both materials, the sandwich technique is being used. https://www.slideshare.net/mobile/ruhi_kashmiri/sandwich-technique-61386414

Some study here called "Effect of Melamine Sponge on Tooth Stain Removal"  Some "newly developed" method which didn't release formaldehyde excessively is mentioned but not specified... Commercial melamine sponges seemed to have released both formalin and formaldehyde. It'd be interesting to get more studies on this!

this absolutely right I would say

If you were to use a laser you can set the power level below that which removes healthy dentine (ablation threshold around 150mJ with Erbium lasers). Composite that is hit by the laser takes on a frosted look that is very different to dentine and can be reduced in thickness to the point where it can often be flicked off with a scaler or Hollenback.

Alright.   Please  keep me posted.

Thanks again.

The important issue here is that we could not generalized the way of treatment for all open bite cases,either by extrusion of anteriors or intrusion of posteriors or may be both as combination..there are several factors which make  the  decision of treatment.and i think that the most important one is the incisor show at rest and smile,in which if there was a good or enough incisor show,so we cant do further extrusion of anterios at all , in addition to the compromized alveolar bone height as Dr.Jenkins mention3d in the previous comment ..

Regarding to stability in the available evidence. i think there is no evidence to prefer extrusion or intrusion in the literatue ..

Thank you .

Non vital primary teeth certainly needed pulpectomy. But in uncooperative children, non vital teeth will be able to maintain for a shorter period with non vital pulpotomy along with through cleaning of the pulp chamber and disinfect with sodium hypochlorite (until perform the pulpectomy).

I enthusiastically support the prior two comments. Data strongly suggest that the odds of creating problems that did not exist initially go up when asymptomatic third molars are routinely extracted. Dental insurance data for patients treated in the State of Washington support this finding.

Thank you for your Valuable comments and related refereces.

I thnik role of Calcium Hydorxide has been reduced in any type of cavties as it is very brittle in nature. Morevoer,, idea of sealing the caries instead of removing it, further decreases the indication of Cahydroxide use.Sealing the cavity well using glass ionomers to inhibit the ingress of bacteria under the placed restoration ensures the progression of caries..

This is not my area of expertise

A) Deep bite is one of the most common malocclusion seen in children as well as adults that can occur along with other associated malocclusions. ‫It is said to be one of the most deleterious malocclusion when considered from the viewpoint of the future health of the masticatory apparatus and the dental units. There are two types of deep bite: incomplete and complete deep bite.

If not treated, deep bites can result in: TRAUMA to the palatal mucosa, behind the upper incisors or to the labial gingiva of the lower incisors. This can result in painful soft tissue and periodontal defects overbites greater than 40% as excessive, compromising the periodontal tissues and acting as a co-contributing factor in the aetiology of TMD. Excessive ATTRITION of anterior teeth, especially lower incisors, is often associated with a deep anterior overbite and Bruxism.

Orthodontic treatment mechanics to correct a deep bite must be specific for: the TYPE of deep bite and ETIOLOGICAL FACTORS identified in the diagnosis for each individual patient; the amount of GROWTH remaining also affects treatment decisions and modalities. Deep bite corrections achieved during periods of active growth have been found to be more stable than those in adult patients

Treatment modalities include:

1. Intrusion of upper and/or lower incisors

2. Extrusion of upper and/or lower posterior teeth

3. A combination of anterior intrusion and posterior extrusion

4. Proclination of incisors

5. Adult surgery

The successful treatment of deep bite correction depends on an elaborate clinical examination, thorough cephalometric analysis, and judicious treatment planning among the various available options and by- using appropriate mechanotherapy followed by a proper retention protocol.

REMOVABLE APPLIANCES- The anterior bite plane is a modified Hawley’s appliance with a flat ledge of acrylic behind the upper incisors. The anterior bite plane consist of 1) Adam’s clasps on the molars (help in retaining the appliance) 2) A labial bow (counter any forward movement of incisors) 3) Base plate with anterior bite plane (1.5 – 2 mm) - As the posterior teeth erupt the height of the bite plane is gradually increased.

Fixed appliances 1) Use of anchorage bends: given in the arch wire mesial to the molar tubes (the anterior part of the arch wire lies gingival to bracket slot)2) Use of arch wires with reverse curve of Spee. 3) Use of utility arches: Utility arches are arch wires that are bent in such a way that they bypass the buccal segment & are engaged on the incisors (activated by giving a V bend in the buccal segment of the wire.

If we want to achieve the desired rotation of maxillary incisor while correcting the deep bite, we can incorporate Z spring along with the anterior bite plane.

 This kind of behaviour is psychological rather than bilological. Tea and coffee if works no harm in trying.

Dear Arif Mohiddin

The following references could by answer, in adition, to your question

Best wishes

Heber

Valentijn-Benz M, Nazmi K, Brand HS, van't Hof W, Veerman EC. Growth of Candida albicans in human saliva is supported by low-molecular-mass compounds. FEMS Yeast Res. 2015 Dec;15(8). pii: fov088. doi: 10.1093/femsyr/fov088. Epub 2015 Sep 20.

Barbot V, Migeot V, Rodier MH, Deborde M, Imbert C. Saliva promotes survival and even proliferation of Candida species in tap water. FEMS Microbiol Lett. 2011 Nov;324(1):17-20. doi: 10.1111/j.1574-6968.2011.02379.x. Epub 2011 Sep 8.

First off for those who don't look back but for 5-10 years in the dental literature you are doomed to repeat the newest philosophies without considering the history and outcomes.  Back in the early 1980's we researched the curing abilities of composite resins penetrating the light from the facial and lingual aspects and measuring cure by hardness and bonding to enamel.  Then by bonding to dentin.  The long and short was that we could cure through 7+ mm of tooth from the facial, say through a maxillary cuspid to use a light cured composite resin, Silux, to bond metal phalanges of acid-etched resin bonded fixed partial dentures.  The bond were the same as composite resin to enamel and the the hardness below the brackets when debonded was the same as buttons of  the composite resin discs 1X20 mm used to test water sorption.  We then took it to a Pedo grad thesis and to orthodontic brackets for 6X6 and now today this is the way Fast Braces bonds their brackets.  Dentin microleakage of bulk placed restorations cured through the facial and lingual interproximal areas were measured and were actually slightly better than horizontal placement techniques.  I have just retired from 40 years of private practice, military practice, teaching and Biomaterial and Clinical research (having received a MS in Biomaterials and Clinical Research in 1988).  I used this technique in my private practice for over the last 20 years and my composite resin placed from my records have lasted an average of 14.5 yrs for all composite resins, Classes 1, 2, 3, 4, 5, all bulk filled and cured through the enamel facial and then lingual surfaces of the tooth and interproximal spaces.  None of the classes stick out in statistical significance, that is to say just as many Class 2 failed as did the other classes.  So I have seen that incremental, horizontal and vertical, and by the way several papers find no real significance to leakage placing either horizontal or obliquely, is no better and much slower than bulk placement and additionally curing for 20 sec through the facial and lingual surfaces.  And for the skeptics, I did not have patients reporting sensitivity after placement of composite resins.

Anesthetic agents whether it is Lidocaine, Prilocaine, Mepivacaine solution with vasoconstrictor can be used safely in hypertensive patients attending dental clinic. However It is of utmost importance that dental clinicians need to select anesthetic solution in hypertensive patients considering their cardiovascular effect in order to provide comfort to the patients and knowing safety

Dear Maaz Assad,

I will answer your question based on academic background, but with more emphasis on daily practice, results and patient satisfaction. 

The decision on the approach to the case you briefly described, will be not only based on the clinical records you just provided, but on the patient's expectations. If we are purely talking about the teeth periodontal condition ( the disease) then I would not consider that case for periodontal treatment as there is not sign of active disease. The patient, though, is still a periodontal patient and may be enrolled in a maintenance protocol that allows you to keep a closer look, in case the disease progresses and you want to intervene earlier.

On the other hand, patient's complaint might be the recession you mentioned, or sensivity due to root exposure. This would not need your intervention because of the periodontal condition, but rather because of the consequences of precious disease installation, that 

Today the use of amalgam is reduced, but when you need to polish, use a water cooling, succion and reduce the time of contact between the modeling instruments and the restoration.

you might be interested in a new intraoral scanner

Optics and Lasers in Engineering

Volume 54, March 2014, Pages 187-196

If 3D information is needed for the management of the impacted tooth CBCT is indicated (This conclusion can be drawn on conventional X-ray imaging and clinical examination (palpation)).

If a 4cmx4cm volume is made with 90kV, low tubecurrent (2 to 3 mA) and limited arch rotation (180 degrees 9 seconds) this exposure can be made safely in children (dose aruond 10 micro Sievert).

This volume will not be crisp and sharp but it will give you the information at the lowest dose (ALADA as low as diagnostically acceptable).

If on the other hand the exposure is made with a large volume and custom parameters the dose can be 10 to 40 times higher.

Dr. Giri,

Dr. Samuel Roldan,a Colombian researcher at CES University in Medellin Colombia has done extensive work with bite force measurement. I understand he has developed and validated a bite force measuring device. You might want to check with him.

This is his e-mail: sirr1965@gmail.com

I do agree with Dr. Giri as it could be treated as early as in the deciduous dentition example with the use of YC III shield.

Hi, Wang,

After going through your question,I understand that the instrument was ingested not inhaled. First of all there are fairly good number of case reports in the literature reporting the ingestion/inhalation of dental instruments. But that can not be a sole reason for the editor to reject your case report. To increase the chances of your manuscript published, you must have complete documentation of what measures taken immediately to retrieve the instrument. What led the instrument slippage in to esophagus, and followup documentation. If rubber dam was not used you have to substantiate the reason why rubber dam was not used etc, We have a similar case report published, hope that may help you out to some extent.

Dear Adel Zakhary

pls check the link.

None! The real disadvantage is in not using them! These has resulted in dozens of arbitrary case definitions! Pls see my review of this here https://www.google.com.ng/url?sa=t&source=web&rct=j&url=https://www.researchgate.net/publication/256476083_Confusion_in_Periodontitis_Diagnostic_criteria&ved=0ahUKEwiW0Oz-m57MAhUIM8AKHW6XBIYQFggZMAA&usg=AFQjCNEPWN2PV4bSoFBFdeM4k8y5DEk8PQ

Dear Jamal Giri ,

please check the article .

Topical use of Tranexamic acid (TXA an antifibrinolytic agent) is often used by dentists who perform procedures on patients on anticoagulant treatment (Patatanian E, Fugate SE: Hemostatic mouthwashes in anticoagulated patients undergoing dental extraction, 2006). It seems effective and safe, easy to use and well accepted by patients.

Furthermore, it has been shown to reduce bleeding in orthognatic surgery (Olsen JJ, Skov et al: Prevention of Bleeding in Orthognathic Surgery-A Systematic Review and Meta-Analysis of Randomized Controlled Trials, 2015). There is also a recent Cochrane review evaluating the topical use of surgery in general.

I am not a dentist, therefore this suggestion is not based on practical knowledge but my Work on anticoagulant treatement

Q: Have you experienced or have evidence on retracting the canine on NI-TI archwire?

The 'roller coaster' effect is observed when a wire of low strength such as Niti is used for canine retraction. Niti does not have the strength to remain rigid when a retracting force such as an elastic chain is stretched from the molar to the canine. The molar and premolar crowns tend to tip mesially and extrude distally. The flexible Niti then bends gingivally and as a result tends to tip the canine crown distally. The orientation of the canine bracket when the crown tips distally tend to extrude the incisors and deepen the bite. In short, the entire occlusal plane goes for a toss and when we follow the occlusal plane from the right molar to the left molar it resembles a roller coaster and hence the term is used. To prevent this roller coaster effect, as a rule, try to avoid use of elastic chains with round Niti archwire for canine retraction.

You can read the following article for further clarification:

Kulshrestha RS, Tandon R, Chandra P. Canine retraction: A systematic review of different methods used. J Orthod Sci. 2015 Jan-Mar;4(1):1-8. doi: 10.4103/2278-0203.149608.

For a reliable answer when comparing two intervention, the best way is to check if there are any randomised clinical trials that have been done or better still systematic reviews. Unfortunately you will have to wait several years to gain a more reliable answer to your question. Current knowledge is based on a week evidence.  

Both of the above materials have shown promise and articles have shown them to be equally efficacious in preserving pdl viability. Kindly refer to M Goswami et al JCD 2011 Jul-Sep 14(3)

First start with the ABCs of dealing with this issue: The choice of trays that don't extend excessively; the choice of impression materials that don't easily flow backwards; and the choice of the right amount of this material so you dont end up with excess flowing backwards.

Then we move to the tricks that could be used, and I could mention a couple here: EITHER have the patient suck a candy made with the medical topical anesthetic tetracaine 1% until it begins to coat both the hard and soft palates, OR have the patient massage their hands with a chemical ice bag. The idea here is to keep the hypothalamus distracted and busy. As you know, the hypothalamus is the part of the brain that, besides other things, controls the gag reflex. So if you can keep this part busy with those "other things", then it will temporarily "forget" about the gag reflex.

Morning appointments are typically given for those anxious patients. To minimize the gag reflex, patients anxiety needs to be at a minimum. So anything that can be done to decrease the anxiety should be tried. Having a chair with heat and vibrating modes that the patient can control during the procedure also helps, since it provides a pleasing vibration meanwhile.

Nitrous oxide is a good way to calm the patient and their reactions to sensations during dental procedures.And finally, antianxiety elixir could be used.

Hello there Alok, hope you are well. This question has a lot of divisions and we could see a long debate. lets hope the followers give their valuable comments and share their knowledge.

In my personal experience and as far as my knowledge is concerned regarding the subject, endo-perio or perio-endo whichever the case, we must perform endodontic therapy of a tooth. Curretage or root surface debridement is for sure recommended in case there is severe periodontal condition. Local irrigation would be a part of our overall treatment planning and maybe done. As far as crown fabrication is concerned, that would depend on the size of the access we make for endodontic therapy. and well extraction would be of course the BEST option for a tooth which is hopeless. 

I am attaching a link for you to have a look. Its an old article in dental update but quite sound and simple. Please share if you have something new,

Best wishes !

Wax up and double scanning work very well on smile creation.

Consensus Conference Subcommittee 2

was charged with the identification and definition of

all diagnostic terms for pulpal health and disease states

by using a systematic review of the literature. Methods:

Eight databases were searched, and numerous widely

recognized endodontic texts were consulted. For each

reference the level of evidence was determined, and

the findings were summarized by members of the

subcommittee. Highest levels of evidence were always

included when available. Areas of inquiry included

quantification of pulpal pain, the designation of conditions

that can be identified in the dental pulp, diagnostic

terms that can best represent pulpal health and disease,

and metrics used to arrive at such designations. Results

and Conclusions: On the basis of the findings of this

inquiry, specific diagnostic terms for pulpal health and

disease are suggested. In addition, numerous areas for

further study were identified. (J Endod 2009;35:1645–

1657)

If the displaced tooth is aprimary tooth yes, patient or parent has to reposiition the tooth asap, if it is a permanent tooth, also I encouraged patient to reposition the tooth, BUT, as a temporary move, patients must to go to a certified Dentist in order to position the tooth in the correct postion and to do all necessary means to keep the area clean and secure for some time until the tooth stays firm in the correct position, 

A very important question. The condition is very common in our sub-continent and difficult to manage especially when prosthodontic rehabilitation is required in such patients.

Well evidence based treatment should be followed i believe. There is no single treatment and there are variations seen in the literature also. I find this one as a good read .... hope it helps. 

Hello Dr José Manuel Valdés Reyes ·

The authors say

the aim of this investigation is to evaluate the suitability and flexibility of the bio-active containing designer materials to act as an “in vitro” probe to gain insights into molecular origin of TMJ.

In this investigation we prepared and evaluated bioactive materials containing Chitosan/Hydroxyapatite, which have proven to be suitability and flexibility of the designer materials to act as an “in vitro” probe to gain insights into molecular origin of TMJ and more specifically excessive damage caused by oxygen centered radicals and the defense “build in” free radical defense mechanism of the functionalized bio-scaffolds on the molecular level and apply the newly developed materials for the development of new therapeutic treatment modalities in the TMJ therapy.

This is obviously not the so called western treatment where we treat TMJ with anti inflammatory drugs  or as I do we do  arthroscopic lavage of the TMJ .this treatment depends on having a scaffold material chitosan loaded with natural herbs or oils  and applied to the tmJ to detect  the so called molecular origin of TMJ .this is different what I would call molecular origin if TMJ to me molecular origin will be looking for signaling molecules like this

Various signalling pathways, as FGF, WNT and TGF-β pathways, regulate the processes involved in embryogenesis. FGF (Fibroblast Growth Factor) ligands bind toreceptors tyrosine kinase, FGFR (Fibroblast Growth Factor Receptors), and form a stable complex with co-receptors HSPG (Heparan Sulphate Proteoglycans) that will promote autophosphorylation of the intracellular domain of FGFR and consequent activation of four main pathways: MAPK/ERK, PI3K, PLCγ and JAK/STAT.

·        MAPK/ERK (Mitogen-Activated Protein Kinase/Extracellular Signal-Regulated Kinase) regulates gene transcription through successive kinase phosphorylation and in human embryonic stem cells it helps maintaining pluripotency. However, in the presence of Activin A, a TGF-β ligand, it causes the formation of mesoderm andneuroectoderm.

·        Phosphorylation of membrane phospholipids by PI3K (Phosphatidylinositol 3-Kinase) results in activation of AKT/PKB (Protein Kinase B). This kinase is involved in cell survival and inhibition of apoptosis, cellular growth and maintenance of pluripotency, in embryonic stem cells.

·        PLCγ (Phosphoinositide Phospholipase C γ) hydrolyzes membrane phospholipids to form IP3 (Inositoltriphosphate) and DAG (Diacylglycerol), leading to activation of kinases and regulating morphogenic movements during gastrulation and neurulation.

·        STAT (Signal Trandsducer and Activator of Transcription) is phosphorylated by JAK (Janus Kinase) and regulates gene transcription, determining cell fates. In mouse embryonic stem cells, this pathway helps maintaining pluripotency.

The WNT pathway allows β-catenin function in gene transcription, once the interaction between WNT ligand and G protein-coupled receptor Frizzled inhibits GSK-3(Glycogen Synthase Kinase-3) and thus formation of β-catenin destruction complex.Although there is some controversy about the effects of this pathway in embryogenesis, it is thought that WNT signalling induces primitive streak, mesoderm and endoderm formation.[100] In TGF-β (Transforming Growth Factor β) pathway, BMP(Bone Morphogenic Protein), Activin and Nodal ligands bind to their receptors and activate Smads that bind to DNA and promote gene transcription.Activin is necessary for mesoderm and specially endoderm differentiation, and Nodal and BMP are involved in embryo patterning. BMP is also responsible for formation of extra-embryonic tissues before and during gastrulation, and for early mesoderm differentiation, when Activin and FGF pathways are activated.

The only thing I can relate to that paper is chitosan where one of my colleagues use it and hopes to use in periodontal research as barrier

This paper has nothing to do with molecular biology of TMJ it has to do with delivering substance on a substrate (chitosan ) and detecting what comes out on the substrate

this paper is not in my specialty.

my research with molecular biology and what i call molequar  biology could be seen in the review i wrote in a paper i entitled

Molecular Biology of Orthodontic Tooth Movement

i have attached the paper for your  enjoyment 

best wishes

Professor K.galil.DDS.,D.Oral&max fac Surg.,Ph.D.,FAGD.,FADI.,Cert.Periodntist (Royal College of Dental Surgeons)

visit DGOHE +itune to see the new Oral histology App fr the I phone,Ipad &I Pod touch 

Dear José,

Thank you very much. I had went through that report already before. They have checked the features of DPSCs from different ages. I am looking for any model using the young mice. There are some reports which say that oxidative stress by glucose or irradiation can cause stem cell senescence, but most of the works are focused on hematopoietic  stem cells or other cells. I think the similar principle may work. So, liked to take some references from already available literature.

There was another patient of severe ECC (24 months old) who was epileptic and on valproate syrup since he was 9 months old. may be that is the reason why he has got multiple caries.

The best, easiest, and fastest is the 810nm diode laser. 

I refer to my paper on the topic:

Dogus et al JPros 2011

This describes implant cantilever-teeth maxillary laterals can routinely be cantilevered from natural canines with full coverage or they can be cantilevered from minimally prepared teeth see Hussey et al & Kern et al as these are conservative resin bonded solutions in both metal ceramic or all ceramic resin bonded FPDs (Maryland Bridges)

maybe you can't see the images, so I try to upload in this way :)

DTR is very fast!  about 30% of the patients begin feeling relief on visit one BEFORE THEY LEAVE THE OFFICE!  I do nothing to the muscles other than measure them.  Many times you can see the exact correction that reduces muscle activity.  I no longer build splints or night guards.  I will make a fixed orthotic if I am making an increase in VDO.  In my experience once the structural issue is corrected (the teeth) the functional (muscles) issues take care of themselves.  Correcting an unbalanced bite does help, but timing trumps the balance of force issues almost every time.

Thank you both of you.... was very helpful all... best regards

Hi Alexandros, thank you for your answer. There are plenty of studies measuring the precision of io-scanners, since that is as easy as it is important to measure. The exactness of any relevant system on the market is (no longer) of any conercen, IMHO. BUT there are huge differences in the handling and workflow. And these differences matter to me as a clinician.

Photothermal lasers (diode and Nd:YAG) have shown promise in bactericidal effects.  However, these days, there is much more emphasis on the photoacoustic nature of laser energy in root canals, especially with erbium lasers, which have been shown to create shockwaves, pressure waves and cavitation within the endodontic canal system.  This powerful combination is highly effective in removing bacteria and biofilm from the canal.  See Gordon's study published in JADA which demonstrates 99.7% reduction in intracanal pathogens using only erbium laser.  I suspect effect is greater now, with conical laser fibers which direct energy laterally far more than ever before.  Walsh has shown similar cavitation effects using diode lasers, however, because of the greatly reduced peak power compared to erbium lasers, the cavitation cannot be as significant.  In the end, although disinfection is very significant, no one has shown complete eradication or sterility, which was your original question.

Menat, it is important to consider:

Hope this helps!

The recommended/standard antiretroviral regimen depend on National guideline for HIV/AIDS in each country

You could also refer to WHO guidelines. Key word: HIV exposure, antiretroviral regimen, WHO

Dental Implants still follow concepts put forth by Branemark. Interesting thing about Branemark is that he was an Orthopaedic surgeon and the protocols that he instituted were based on the same principles of open joint surgeries and implants done in orthopaedics including the scrubbing, draping and isolation. While this is still important for oral environment, no matter how careful we are, contamination of the surgical site with saliva and the bacteria from saliva is inevitable.

Regarding the antibiotic prophylaxis prior to implant surgery or in the post procedure period, it is highly controversial. A few studies done in this regard concluded that post operative antibiotics would not be required. And that the standard surgical prophylaxis prior to surgery is all that is required. But interestingly some have questioned even the administration of pre procedure antibiotics. (more on this later).

For all practical purposes, I wish to state that while I have routinely seen antibiotics being administered after minor oral surgery by most dentists and even oral surgeons, I have not seen high level evidence supporting the same. Infact, most studies in this regard question the routine use of antibiotics after minor oral surgery. Any patient who is being planned for dental implant is being prepared for the procedure with oral prophylaxis and elimination of active periodontal disease before the procedure itself. In this regard, the oral cavity is presumably in pristine health. We do not use antibiotics even for placement of bone implants (post trauma) and haven't encountered any significant increase in infection rates. Post procedure antibiotics cannot and should not be considered a replacement for sound surgical technique and it cannot protect the patient against failure if the technique is erroneous.

Quoting from the article (1) attached :

"The use of prophylactic antibiotics prior to implant placement is controversial. A systematic review supports the use of 2 g amoxicillin as presurgical prophylaxis while a few other studies conclude that there is no added benefit. There is no evidence that implant failure is prevented by antibiotic usage"

The relevant references are also cited for your references. Though this is not exhaustive, the general recommendation will be that for a single site single implant placement, antibiotic prophylaxis would not be required considering that the entire surgical duration will be short and uncomplicated. For longer durations when the bone is expected to be exposed for longer durations or if combined with graft placements, prophylaxis may be considered but stress must be towards following all sterile precautions to prevent contamination of the surface of the implant for best osseointegration and for meticulous surgical technique with slow drilling combined with copious irrigation to prevent bone damage around the implant placed. These are far more important factors for implant success than antibiotics.

Irrational use of antibiotics should be avoided.

Regards,

Dr. Akilesh. R

India

The golden rule is to consider and hence treat all patients as potential carriers. Wear gloves, face masks and avoid sterss.

Probably should not discount the importance of a thorough medical history. There are currently over 100 medications that can cause hyposalivation, as well as a number of medical conditions. A simple test is the retraction of the lower lip for 30 seconds and tamping with small piece of blotting paper. You are looking for evidence of wet dots to indicate function of the minor salivary glands

Dear Dr. Robert Shellis,

this is a very good observation and very helpful to understand possible uses of Carbopol in dental research.

Thank you so much for sharing with us your opinion

All the best and happy new year.

Rgards

Tore 

In our institution, Integrated teaching is not for graduate or postgraduate ,but we have integrated teaching ,in which teacher from various department according to the topic specific present their presentation, and after this question answer session is arranged to clarify the query of the other faculty staff members and Postgraduates students. Topics are chosen according to their importance in the current situation.But In thinking integrated teaching require a lot of efforts to evaluate the level of knowledge and skills of the students.For this effective planning,implementation and evaluation should be planned.

Beautiful suggestions! From my experience, your dilemma seems to have arisen from insufficient keratinized gingiva. In such instances, I have found a two- stage procedure useful. Stage 1 will be to increase the zone of keratinized gingiva achievable with a free gingival graft. Allow a few weeks to heal then proceed to stage two. Harvest your CTG and suture to the prepared recipient site.Complete the process with an immediate coronally-advanced flap. Alternatively, place the CTG using the tunnelling technique. Cheers!

My practice is in geriatric dentistry so lot of my patients are high caries risk patients. I definitely prefer a full crown better than a big indirect restoration, porcelain retain less biofilm than composites or even the enamel do. 25% of posterior class I and II indirect composite restorations fail during the first five years after placement, and failures increase in high caries risk patients. 

This is a good discussion from all. Dr. Price in the early 1900's found abfractions in the isolated tribes of South America...no tooth brushes or even use of sticks were found. Ancient skulls and even pre-industrial skulls tend to not have abfractions - was this due to short longevity or something else? Industrialized nations have a higher incidence of abfractions...yet their diet is softer. Does this mean the toothbrush is the culprit? Studies have found that the tooth structure in an abfraction is lost faster with a harder brush. Is this because when the tooth structure is weakened the hard brush can abrade an otherwise hard surface? 

So, in an industrialized country it seems there are more orthodontic problems from allergies, collapsed arches from mouth breathing/lack of nursing/sleep disorders/etc. Perhaps in an unbalanced dentition the occlusal forces are at pathological vectors of force? If the teeth are only straightened to "appear" cosmetically appropriate the vectors of force may still be pathological. Finding that appropriate physiological position for the teeth and their supporting structures may be the answer? 

Certainly useful in  reasonable limits.Usually the treatment of dental patients need immediate intervention of the doctor. Teledentistry can be used for consultations between other doctors.

Certainly, always place the Cavit while the dam is in place. I also like to use IRM over the Cavit as a temporary, because the geographical nature of my practice means I often have to leave them in place for some time.

Remember this thread was about a permanent restoration, and I assume talking about anterior teeth. Posteriors really need a crown, and therefore a temporary restoration is required until the crown is provided.

The main problem with Cavit alone, is that as it wears, the patient feels the temporary has been lost because they can feel the rim of the access cavity with their tongue.

Ratio of dentist serving to population is still lacking it is 1:2.5 lakh in rural. it is true as stated by Akilesh Ramasamy. Many factors are responsible. 1. Why Dental colleges are more near big cities not in rural areas ? (4-5 Dental colleges with 30 km area in Chandigarh). 2. lack of awareness about oral health and paying capacity of the patients in rural area(Extractions and denture fabrication is the most common treatment given, not by dentists but by the quacks due to the cost factor and non availability of dentists.) To solve this problem, the government should set clinics in rural areas rather than opening vacancies in urban civil hospitals. Punjab government recruited 148 vacancies after 13 years 2 years back.

An interesting and logical idea. Some herbal medical experts recommend ground egg-shell as a dietary supplement for the excellent bone minerals and other proteins required for healthy cell function and bone physiology. They, do however, insist on utilising eggs produced by organic-bred chickens to avoid some of the antibiotics and synthetic supplements given to farmed/caged chickens, and to boil them first prior to use.

Chemically the mineral of human bone is a composite of (essentially) calcium phosphate whereas the main component of egg shell is calcium carbonate. There, will, of course be structural, chemical and mineral phase differences between the two, but I see no reason why egg-shell proper and it's associated proteins from membranes should not be considered for synthesising artificial tooth or bone composite materials for tissue repair/regeneration.

The main purpose in these cases is the maintaining of the pulp vitality, so if in your case ,pulp is vital, partial or cervical pulpotomy must be did and placed MTA on the remainder of the pulp tissue. After setting of the MTA, permanent restoration of the crown can be performed (this technique is named maturegenesis). If the pulp is nonvital revascolarization using triple antibiotic paste is suitable choice.

This refers to the so-called late mesial shift (Baume~1958). The second primary molar's mesial-distal dimension is greater than the premolar that replaces it. This residual space is loss with the mesial migration of the first permanent molar, thus a decrease in arch length between the permanent molars.

Hi Blake,

Quite interesting to me to find a Periodontist interested in root morphology. I recommend you a book by O. Carlsen named "tooth morphology". This book is great, though not famous as others. Carlsen has other valid contribution in the external morphological features of roots in human dentition. Indeed, I usually cite his work in my related publications.

- If you are interested, please refer to:

*https://www.researchgate.net/publication/224763235_Accessory_roots_and_root_canals_in_maxillary_premolar_teeth_a_review_of_a_critical_endodontic_challenge?ev=prf_pub

*https://www.researchgate.net/publication/225060019_Accessory_roots_in_maxillary_molar_teeth_a_review_and_endodontic_considerations?ev=prf_pub

*https://www.researchgate.net/publication/229408649_Different_perspectives_in_under