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Clinical Dentistry - Science topic

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Questions related to Clinical Dentistry
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Any prons & cons ? Long-term outcomes and clinical observations ? How about the chances of proper eruption of third molars ? What is the acceptable clinical justification for these extractions ? Orthodontist opinion from their area of expertise would be highly appreciated.
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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.
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In response to this question, I can only find experience based recommendations in the literature that differed from as early as 3 weeks to as late as 12 weeks. There is a single animal experiment from Japan (Uji, 1996) in cats that compare one week and 8 weeks, but the experimental model does not really mimic that of a cleft. Recently, a couple of studies addressed the issue of moving teeth into the post distraction bone regenerate which may be considered quite similar. Does anybody know any research-based recommendations done on cleft material?
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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.
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I want to evaluate the efficacy of invisalign, but waiting for the patients' finishing day seems too long for me. Is there a way to get the information about the specific distance invisalign moves a particular tooth in one step? That would be a great help
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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.
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I believe age is not really a limiting factor if cooperation is ok
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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
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I plan to conduct an experiment wherein I compare tooth whiteness to general bacterial load (no specific bacteria is targeted for counting, rather as many bacteria as possible are taken into account, with specific colonies of bacteria being noted) of a subject's tooth surface based on the toothpaste they are using. I have found little to no journal with methods that satisfy my experiment. Help is greatly appreciated.
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sugar fermentation guide
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With the new COVID-19 outbreaks and shortages of N95 masks: what are the alternatives for the healthcare workers (doctors, dentists, nurses, RTs) who may be in close contact with potential COVID-19 patients?
Would you recommend putting a regular surgical mask and face shield on top of it?
Suggestions with scientific rationale are welcome...
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First, there is no indication for using respirators for preventing the transmission of corona virus except in situations where there is risk of aerosolization of droplets, e.g., sprays, splashes, coughs, sneezes etc. Therefore, the misuse should stop. Education and training on when, and how to use it could help reduce the demands.
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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.
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I am interested in any studies that involve hydroxyappatite solutions being applied in tray form to improve periodontal and dentoalveolar health.
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If we can use PRF solution mixed hydroxyapatite granules then become gel put into the socket, it maybe better.
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Is it possible for a dentist to use a product that highlights enamel or dentin ? It should have a real interest in the bonding procedures to apply. Of course it should not color the tissues or it should be removed very easily. Thank you for your help.
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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.
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Carbon nanotubes (CNT) has huge potential application in a lot of fields of science. I was wondering if it can be used as a filler by dentists?
Also, can anyone think of any other application of CNT in the field of dentistry?
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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...
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Traumatology
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Thank you so much.
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What is the best laser for gingival and lip depigmentation?
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Biolase by using the turbo HP very good result
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The image processing playing an important role in dentistry also. Today, the impact of dental imaging (DI) in dentistry is essential in detecting dental abnormalities. It helps medical staff to detect and diagnose the disease in proper way. The first dental x-rays taken by Dr. Otto Walkhoff in January 1896. Dr. WAlkhoff used his own mouth for an exposure of x-rays for 25 min after this experimentation the revolution in dentistry started. In the field of dentistry the most important concern is diagnosis of patient.
1) Mindy Cash and Bettina Basrani, “Intraoral Radiographic Principles and Techniques”, pocket dentistry, Fastest Clinical Dentistry Insight Engine, Jan 12, 2015
2) Richard Hogan, Michaela Goodwin, Nicola Boothman, Timothy Iafolla, Iain A. Pretty, “Further opportunities for digital imaging in dental epidemiology”, Journal of Dentistry 74 , S2–S9, 2018
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Few challenges
To visualise periodontal ligament direction
To see cementum from dentin
To estimate pressure of erupting tooth
To see periapical blood vessels
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Intra-Oral Hydrogen-Ion Concentrations Associated With Dental Caries Activity
Thanks!!
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A Dental Lab Micromotor tends to have sufficient torque for tooth cavity removal. How much torque is required for cutting skull during craniotomy ?
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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
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esthetics, fluoride release, tooth bonding, strength
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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
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Are the super high densities of melamine foam strips and PP plastic handles really
eco friendly?
The manufacturers state the following
Main Characteristics:
Innovation: nanotubes technology, need water only, patent products.
Eco-Friendly: no chemical ingredients, 99.9% natural anti-bacteria.
Health: remove dental plaque by physical absorption principle, no hurt enamel.
Are there any studies to back this up?
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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!
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Antibiotic resistant endodontic infection is a common finding in failed root canal treated tooth with history of long term medication. 
As a part of a research proposal to the Indo-Norwegian collaborative research, we would like to have a norwegian team to do a part of this project.
Interested Norwegian researchers kindly contact. 
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this absolutely right I would say
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Any composite detector available in the market that one can use to avoid unnecessary removal of healthy tooth structure especially when shade matching was done when placing the restoration?
Should carving anatomy be avoided in the posterior teeth to ease the replacement? 
Thanks
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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.
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My center is in need of dental units. Can your center be of help???
Thanks!!
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Alright.   Please  keep me posted.
Thanks again.
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The patient I treated has both skeletal and dental component to his open bite, but it was argued that molar intrusion is far more stable than anterior teeth extrusion . As far as I know is that the elimination of the causative factor of the open bite is what makes the best results in terms of stability .
The full details of the case are listed in my questions.
Thanks for your help
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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 .
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Pedodontist, Pulpototmy, nonvital, primary tooth
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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).
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The partial impacted or fully impacted third molar significantly increase the incidence of mandibular angle fractures and decrease the incidence of condylar fractures. Due to the potentially challenges to the surgeons also more serious complications associated with condylar fracture, should the clinicians carefully consider the decision of mandibular third molar extraction?
How about the opinion that said, "the early removal of 3M is suggested to prevent the risks inherent in maintaining these impacted teeth as well as to limit future surgical risk and difficulties"?
How can we calculate the benefits and risks?
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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.
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Intracapsular mandibular condylar fracture displaced more than 5 mm and more than 30 angulation.Is it always necessary to open TMJ capsule? Please give your idea. The patient may visit early, or it may be delayed case.Thank you.
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Thank you for your Valuable comments and related refereces.
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Managing deep Carious is Challenging when it comes for better prognosis. Although we have MTA, Bio-dentin. But when it  comes for calcium Hydroxide, There is always  a question for the clinician whether to choose light cure or conventional ( mixing and putting  into the cavity and wait for proper setting.
Please Cite any Authentic Research paper.
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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..
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I will be very grateful for anyone who wants to donate personal used equipment to our periodontology practice. I am interested in equipment like the halimeter machine, diode laser machine, electrocautery machine, gas chromatography machine, periodontal endoscopy machine etc.
Thank you!
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This is not my area of expertise
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Present is a 6 mm overbite with one top incisor rotated due to overcrowding.  Bottom incisors are also overcrowded.  The mandibular arch has a deep curve of Spee.  No cross bite.  Currently using Damon III braces top an bottom with class iii elastic.
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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.
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Some clinicians recommend and even practice administering tea or hot chocolate to patients before procedures under local anaesthesia. Does it actually work? Is there any evidence? 
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 This kind of behaviour is psychological rather than bilological. Tea and coffee if works no harm in trying.
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To perform study 
Please send related article or explanation.
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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.
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Looking for evidence of clinically recognised condition
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  1. Thank you for these studies. I wonder why this clinical observation has never been studied?. I have found mention of Indo-Pakistan differences but not ethnic Chinese .
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Polymerisation shrinkage, adequate curing, c-factor reduction
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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.
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1. Epinephrine may cause acute hypertensive crisis (dangerously high blood pressure)
2. Interaction of epinephrine and some antihypertensive medications may cause acute hypertensive or hypotensive crisis.
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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
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Normally BOP is the first sign that tells you the activity of the disease. Similarly PPD and Recession suggests severity of the disease. Based on these clinical parameters how would you diagnose if the situation is healthy or diseased. Lets suppose if a patient is having a pocket depth of 3mm and recession of 3mm (that makes attachment loss of 6mm) but there is no bleeding on probing and no signs of inflammation and radiographically u have observed 30% bone loss associated with few teeth. Would you consider this case as diseased situation and treat for periodontal issues? 
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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 
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Heat causes thermal insult to pulp & brings Hg to surface of restoration( increased corrosion susceptibility)
Rotary instruments, intermittent pressure, medium speed, wet abrasives, use of pumice or tin oxide
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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.
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i am writing a research preposal for university and i am looking for information for literature reviews and more gerneral inforamtion and the method about how to measure the common red fox (vulpes vulpes) dental structure. 
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you might be interested in a new intraoral scanner
Optics and Lasers in Engineering
Volume 54, March 2014, Pages 187-196
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The current imaging method of choice is conventional dental radiography. Needed information regarding impacted teeth cannot be obtained adequately by lower dose conventional (traditional) radiography. Should the indication to use cbct be emphasized?
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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.
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I am planning to conduct a study regarding the bite force of patients undergoing orthodontic treatment. For this study, I require a digital bite force gauge. Which is the most reliable gauge for measuring bite force? I look forward to your suggestions.
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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
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The latest RCT state that treatment should start before age 10, but they did not mention the lowest age.
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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.
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Our patient ingested a dental instrument of K-file during the treatment;and we hope to share this case with some others.However,the number of paper relevant was quite low.So I hope someone could answer my question.As a matter of fact,there were two pieces of paper which were discribing similar cases,they were published in 2007 and 2008.And the IF of the journal involved is high.I am doubtful that our cases would be rejected by the editor.Thank you so much.
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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.
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So I'm doing a list of indications to include the second permanent molars to treatment plan. So far, the only two indications I can think of are:
1- when posterior anchorage needs reinforcement.
2- when additional lower face height increases are required to reduce the overbite.
Share additional uses for the second permanent molars if you could.
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CDC-AAP NCHS and European case definitions for periodontal disease.
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Uncontrolled post extraction bleeding is encountered by many dental practitioners and literature has numerous methods to control such bleeding like use of pressure pack, bone wax,suturing etc. But which local haemostatic agent is best and simple to use with limited/no post operative complications?
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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
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We often encounter lingual rolling (tipping) of molar during its protraction. It is especially true when the first molar is missing and the second molar has to be protracted into that space. To avoid this, I try using rectangular wire with offset bend. What are other possible ways of doing it?
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Please see the attached article. the authors have used similar techniques, My be useful 
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It is always done on STAINLESS STEEL ARCHWIRE.
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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.
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please provide the links in support of your answer
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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.  
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Please support your answer with evidence
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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)
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How can you provide dental treatment to the patients with severe gag reflex. Specially recording the impressions become a serious problem for such patients .... how do we deal with this.
Please share your experience ?
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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.
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1.Root planning/Curettage/Flap surgey
2.Root conditioning/Local irrigation?
3. RCT
4. Crown
5. Extraction of hopeless tooth
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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 !
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While checking for the efficacy of  intra canal medicaments, how do we standardise the depth of penetration of any antimicrobial agent into the dentinal tubules?
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  1. Usually the dentinal tubule disinfection is studied at two different depths i.e 200 and 400 micrometers.... To standardise Gates Glidden drills no. 4&5 are used; where 4 corresponds to 200 micrometers and number 5 to 400 micrometers.... Also peezo reamers can be used for standardisation. For further understanding u can refer to articles like Vaghela et al. 2011; Journal of conservative Dentistry and Krithika datta et al Journal of Endodontics 2007.
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Do we have any research in the solutions of the following problems?
1. The data registration and utilization into pre-CAD and in-CAD data or workflow of the in-streamline dental CAD/CAM systems:
1.1. - The condylar movement registration (non-CAD data format).
1.2. - The occlusion stress on bite plane (non-CAD data format).
1.3. - The relative movement of jaws in the biting (non-CAD data format).
1.4. - The facial & smile design capturing, in both 2D and 3D (non-CAD and CAD data format).
2. The open library for specific objects for special restorations:
2.1. - Wax-up morphology of dentitions or teeth by nationalities, genders and ages. 
2.2. - On-implant customizable restorations.
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Wax up and double scanning work very well on smile creation.
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Several referrals are done seeking intentional RCT from Prosthodontist for Fixed partial denture when they anticipate pain and/or hypersensitivity in the vital abutment. There seem to be no any criteria in the literature to support it. It is being done only on the basis of the intellectual guess. Thus, several teeth are losing pulp and vitality. In the healthy teeth following tooth preparation pain or hypersensitivity may be the transient problem, in an absence of infection and after proper coverage of cut tooth structure it may subside. So what do you think? Not all cases but the majority of cases can be prevented from losing the health of pulp. Cement the tooth with temporary cement and wait for symptoms to relieve.
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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)
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In case of dental trauma when there is a displacement of a permanent tooth (axially or laterally), the recommendations (international association of dental traumatology) are to reposition the tooth as soon as possible. But these recommendations are for dentists. What about patients? Do dentists, as for avulsed tooth, have to encourage the patient / parent to reposition the tooth themselves (before consulting a dentist of course) ? This is not indicated in The dental Trauma Guide. Some authors asserts that patient must not touch displaced tooth while others affirms that, in case of mobility of the tooth, patients have to try to reposition it.
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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, 
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Can we discuss the real scenario of medical treatment vis-a-vis efficacy of different drugs with their merits & demerits over one another as well as a practical comparison with surgical modalities. Personal experiences are more than welcomed over papers as I am highly skeptical of the results.
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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. 
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Does someone know the relationship of Temporomandibular Joint disorders and oxidative stress?
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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.
My reply
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 
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Hello everyone, Do you know about the in-vivo model for dental pulp stem cell aging? I would like to know if there is any documented materials about the inducing factors for dental pulp stem cells aging in the in vivo model using mice. I would be very much happy to know about.
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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.
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Severe ECC with damage to the maxillary anterior teeth and some posterior teeth WITHOUT a habit of night time feeding practices ( means child consumes milk at the beginning of sleep or in between sleep before the child wakes up from the bed.....use of breast milk or bottle milk or both) ?
On demand or at will breast feeding or bottle milk with or without sugar, frequency while sleeping could be once or more than once
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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.
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Cantilever FPDs, especially distal cantilevers, are discouraged in the texts and are prescribed with many precautions. What type of FAILURES are associated with them? Are the Forces and Biomechanics (and hence, the design considerations) similar for the lower and upper arches?
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When considering relatively classical dental literature the names of Laurell  and Lundgren  come to mind. These authors used long cantilevers in the natural dentition with  excellent long-term success which was most likely secondary to careful management of occlusion and the beneficial effect of tooth mobility as a "stress relief" mechanism. Not long after these authors we started to see more common descriptions of cantilever usage with implant retained dental prostheses were the implants, by necessity, were placed between the mental foramen and the cantilever was extended distally and bilaterally. Perhaps with the implant prosthetic approach the situation benefited from the fact that many of those early prostheses were opposed by complete dentures which then created the, thought to be, relief system. Over time however cantilever usage in the combination with implant supported bilateral prostheses has been quite efficacious  and eventually effective.
I mentioned previously, perhaps in response to another similar question, that there are number of critical factors and need to be considered when cantilevers are used in combination with implant retained prostheses. The situation must be curvilinear relative to the placement of the implants, there must be an appropriate relationship between the distance from the fulcrum to the anterior most abutment and its relationship to the length of the cantilever, there must be an appreciation of the type of material that is used for the framework that supports the cantilever, occlusion must be managed very carefully, the anticipated forces exerted by the patient must be considered, etc. it is not as simple situation where we can simply state that cantilevers work or that cantilevers don't work. When the myriad of considerations are managed appropriately cantilevers indeed do work but ignorance of or disregard to some of the critical factors will doom the treatment.
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The material of choice being rip-bond.
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maybe you can't see the images, so I try to upload in this way :)
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Some article shows that tooth contacting habit have a correlation with TMD. Most of them using a questionnaire to investigate the evidence. I would like to know, Is there any information about the duration of tooth contacting habit? The duration might be shorter than clenching/tonic.
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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.
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I'm trying to make a compendium of many concepts of "dental caries" with different projections.
Thank you in advance and best regards.
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Thank you both of you.... was very helpful all... best regards
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There are numerous software applications for dental implant planning. There are significant differences in the workflow. Is there any study comparing these workflows. Is there any study if there is a difference in the treatment outcome?
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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.
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Could application of LASER in root canal system has any beneficial effect on the disinfection protocol
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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.
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Try in of dental bridge
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Menat, it is important to consider:
  • General fit and stability (check for rocking) - often defects on the fitting surface can prevent full seating. Silicone can be useful here to line the prosthesis and identify areas of close contact. Powder sprays can also be used by I would be careful not to contaminate the surface excessively
  • Marginal fit should be checked, and shouldn't be larger than a straight probe tip
  • The occlusion should be checked with shimstock and GHM articulating paper
  • Aesthetics should be checked
  • Wider tooth parameters should be confirmed such as periodontal status, exclusion of periapical pathology and occlusal scheme
Hope this helps!
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In case of accidental exposure during routine dental procedure, the contacts such as accidental prick or eyes.
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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
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According to CDC guidelines, before any surgery on which a graft, prosthese, or implant is placed in the body antimicrobial prophylaxis is indicated. Implant surgery is an indication for prescribing antimicrobial agents. In dental literature per-operative and post operative prescription of chlorhexidine mouthwash and antibiotics are mentioned. But there is not a common regimen for this purpose. Each author use a personal regimen in his or her research. All of them are acceptable and useful. I want to gather the ideas of the Research Gate community regarding this topic.
What is your regimen before and after implant surgery? 
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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
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Most of the time we come across patients suffering from HIV, HCV, HBV and many more. In our dental set up what all are the standard protocol to treat those patients.
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The golden rule is to consider and hence treat all patients as potential carriers. Wear gloves, face masks and avoid sterss.
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There is need for effective diagnostic criteria and functional tests in order to detect those individuals with oral dryness who may require oral treatment, such as alleviation of discomfort and/or prevention of disease (Lofgen et al., 2012).
Examples:
- Xerostomia Inventory schort form (SXI-D)
- Index for symptoms of xerostomia (bother index)
- Clinical oral dryness score for clinical signs (CODS)
- Sialometry, the measurement of whole salivary flow rates
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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
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Would you use Carbopol® ETD2050 for simulation of caries lesions rather than classic remin/miner solutions applied with cycle methods?
What is your opinion on the benefits and limitations of this method?
Thanks a lot.
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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 
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Vertical integration is combining knowledge of basic medical/ dental sciences with clinical sciences. Dental students go to clinics in 3rd year of their education. How can clinical knowledge be imparted to preclinical dental students?
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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.
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In the treatment of gingival recession around lower incisors by applying free connective tissue graft along the area of recession, how it is possible to pull the alveolar mucosal flap from the vestibule and inner mucosa of lower lip with the purpose of covering the connective tissue graft over the gingival recession?
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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!
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It has become clear to me that the indication to place a crown or inlay restoration rather then a direct composite (or amalgam) restoration is not based on sufficient scientific evidence. As a result, especially among different countries great differences in treatment choices may exist.
Therefore: would anyone make a crown in a caries risk patient in case of a large defect where the alternative would be a large, probably deep subgingival restoration.
In the Netherlands we tend not to do that as we only place indirect restorations in patients with a stable mouth condition (low caries risk). I know that in other countries that may be different. So please tell me what is the indication for crowns in risk patients in your university or practice.
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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. 
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For dental abfractions, the theory suggests that the high occlusal loads cause large cervical stress concentrations, resulting in a disruption of the bonds between the hydroxyapatite crystals and the eventual loss of cervical enamel.
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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? 
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Teledentistry is a new science with little initiatives around the world. I want to know the thinking of professionals and professors about this possible support.
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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.
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Setting time of sealer have any effect on immediate permanent access restorative material.
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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.
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(Saturation)
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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.
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The chicken eggshell and its membranes are an inexpensive and abundant waste material which exhibit interesting characteristics for many potential applications. The eggshell is formed mainly of calcium carbonate (CaCO3) and is used widely as an animal feed, lime (Ca(OH)2) substitute or a fertilizer. Moreover, the associated eggshell membranes have a high content of bioactive components, as well as properties of moisture retention and biodegradability which have potential use for clinical, cosmetic, nutraceutical and nanotechnology applications. The eggshell membranes have been also used for biosorption of heavy metals and dyes and as a template to synthesize metal nanoparticles. The combination of nanosized calcium phosphate (Ca3(PO4)2) biomaterials synthesized from eggshell and eggshell membrane show promise to develop drug delivery system and nanowires for electronic devices. In addition, a derived product, the soluble eggshell membrane protein (SEP) has applications in tissue engineering.
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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.
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I have a 12 years old patient with a traumatized upper lateral and canine, incomplete root formation, open apex in both of them in X-ray, no mobility for both, pain upon percussion related only to lateral. Access opening was done and there was a relief of pain. Could the protocol of that be in the form of Pulpotec Pulpotomy until root growth completion? And then re-entry and complete RCT can be done?
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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.
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What accounts for the decrease of the distance measured on the dental arch, between the mesial surfaces of first permanent molars, when changing from mixed dentition to the permanent dentition?
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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.
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Could you recommend any books or articles on the morphology of the roots of teeth? It is an important topic regarding periodontology and I do not seem to be able to find much. Thank you.
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Can any one support me with some articles about types, clinical application, and side effect of anti-fungal and anti-viral medication in oral and maxillofacial surgery.
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And the second file.