IDA MP State Dental journal (4 October to December 2015

Issue - 4, Oct. to Dec. 2015

UG-26, BCM Heights, Vijay Nagar, Indore (M.P.) Ph. : 0731 4084488

C O N T E N T S Message President Elect - Dr. Sunil Gupta

V Review Article Low-level laser therapy used in dentistry Dr. Vinay Jain, Dr. Apurva Rahalkar, Dr. Alisha singh

Laser applications in orthodontics Dr. Satyendra Gupta, Dr. Indira Gupta, Dr. Rajat Dubey, Dr. Heeralal Chokotiya

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Technique Article Getting correct prosthesis in aesthetic zone- a clinical view

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Dr Pankaj Kharade, Dr Geeta Rajput, Dr Swati Sharma

Management of mid root fracture with a biommetic material – A Case Report

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Dr. Saloni Goenka, Dr. Hema.B.S

Prosthetic Rehabilitation By A Custom Made Scleral Shell Prosthesis

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Dr Anshul M Saxena, Dr S.P. Singh, Dr Roma Goswami

Nonsteroidal anti-inflammatory drugs (also called nonsteroidal anti-inflammatory agents/analgesics (NSAIAs) or nonsteroidal anti-inflammatory medicines (NSAIMs) Srushti Jain

Changes in syllabus of public health dentistry to make it Career oriented a discussion Vonica .C. Motiani

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Dr. Vivek Choukse

Dr. Vivek Choukse

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Issue - 4, Oct. to Dec. 2015

Dear Friends, This year was a special year for the history of IDA MP branch. Glory of IDA is reaching at its best. So far as the social and academic aspects are concerned, office bearers of IDA MP branch are doing their job selflessly. In spite of their professional and family commitment, they are involving in social and organizational deeds. Of course they are following footprints of their forerunners, to make dental profession better and better.

In this way this is the time to recognize the selfless work done by Dr. Alok Purohit who is doing social work related with IDA as well as other social cause like “ beti bachao and beti padhao� , producing , directing and financing the films related with public awareness. Now there are 14 branches of IDA MP State , all are creating history in dental awareness campaign in different areas of Madhya Pradesh.

Though IDA is facing many challenges such as number of members are standstill.

We are not able to attract new budding dentist to join IDA. This may be because of increase memberships fees or not providing enough benefits or not able to do proper communication to budding dental professional. Whatever the reason is, like any other organization we also need new members for constant growth and we can get better leaders from them.

Continuous CDE programme and other activities to improve professional skill is useful if it can reach to each and every dentist, to new or experienced , to urban or rural areas.

Ethics and values should be given paramount importance in all programme of IDA. At last with SWOT analysis I found past glory & dedicated team as Strength of IDA, decreasing membership & lake of enthusiasm in new budding dentist towards IDA as Weakness, growing numbers of new dental professionals & technological advancement as Opportunity and bad politics & appeasement to non deserving as biggest Threat to IDA.

Thanks Jai Hind Jai IDA

IDA MP State Branch

Issue - 4, Oct. to Dec. 2015

Issue - 4, Oct. to Dec. 2015

Dear Colleagues, The year just concluded has been an extremely satisfying one in which the association has been able to move past several milestones in service of the community of its member.

I am deeply honoured to be president of IDA. I take this opportunity to thank the IDA members and look forward to our teamwork in creating guidelines to achieve the best standard of care.

IDA has conducted 3 major ground breaking events this year Endo manthan, TII - OCF training programme, state conference at the end of the year under my president ship.

I would like to express my recognition for the excellent work and tireless efforts of our predecessors.

I would like to express my sincere gratitude and sense of appreciation of support and co-operation provided by the state and local branches without which my tenure as head of IDA M.P. State would not` have been fruitful.

Certainly, I must congratulate my predecessors in excellently carrying out all the programmes.

The association has been able to accomplish significant success in several of activities carried out to enhance, oral health scenario in the country by conducting oral hygiene camps, TII - OFC programmes, celebration of oral hygiene day etc.

I would like to thank my family for their constant co-operation which helped me to fulfill my duties as a president with great ease.

Nevertheless I like to thank my wife Dr. Benaiffer Agrawal for helping me in shouldering the responsibilities of profess which made it easier to carry out my duties successfully.

I am completing my president ship; I must thank all office bearers, Secretary Dr. Manish Verma, Dr. Akhilesh Jain, Dr. Sanjeev Bajpai, Dr Nishant Chourasia, Dr Alok Diwan, Dr Saurav Dantre I know, list is unending, hundreds - thousands people are behind my success, because of certain constraints, their names cannot be mentioned.

Therefore, I sincerely thank all the people involved in making my tenure success.

JAI HIND JAI IDA

IDA MP State Branch

Issue - 4, Oct. to Dec. 2015

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President Elect

Dr. Sunil Gupta President Elect IDA M.P. State Branch

Season's Greetings to all my associates & colleagues.

It gives me immense pleasure to take the charge of State President. I am very thankful to all of you for showing faith in me. I am very well aware of a great responsibility; I have taken on my shoulders.An association is a group of capable & efficient people who work in progress of the association.

With the advancing time & technology we people have to focus on the scientific knowledge & awareness among the citizens in relation to Dental Sciences.

Various Scientific Programmes, CDEs & awareness campaigns are being held for a long time but with advancements in our profession we have to work hard to keep ourselves more updated. With changing time, we have to aware the common people in a different way & correct manner.

IDA has always been a platform for upcoming Dental Professionals & we will be now providing good opportunities for PG students as well. It's our responsibility to guide UG students so that they can represent their talent by participating in various activities of IDA. Before I conclude, I want to say that I will try my best to maintain the dignity & respect of the association & will lead IDA to a bright future.

I will need your valuable suggestions & support for accomplishment of activities. “Growth is never a mere chance; it is the result of forces working together.�

Jai Hind, Jai IDA Dr. Sunil Gupta President Elect , IDA M.P. State Branch

IV Issue - 4, Oct. to Dec. 2015

Issue - 4, Oct. to Dec. 2015

Dear colleagues,

Dr Manish Verma Hon state secretary IDA MP State Branch

Festive greetings.

It has been our endeavour to increase the membreship base and expand the ida mp state by forming more number of branches in the peripheral areas. I am happy to inform you that recently we have inducted two more branches betul and seoni.

Recently, we have conduced installation ceremony of betul branch and we are happy to inform that a meticulously planned cde programme is organised along with the state ec meeting. This is very positive sign for the growth of association. It is more important that the members are now united not only to raise the standard of dental practice and are also joining hands for fighting against the quacks and local legal issues. At the same time they are also working to promote the oral health awareness in the public. Its long due that state dental council should take steps against the quacks in madhya pradesh.

In this era of 3g and 4g , with ever increasing use of internet, there is need for all the practitioners to be more cautious and follow the ethical ways of dental practice and maintain the harmony and cohesiveness with their fellow colleagues.

Annual conferences provides a wider platform to interact with colleagues and witness the ever expanding dentistry.

The organising committee of the forthcoming state conference is working hard to make this conference a memorable one. We invite all of you to be the part of this mega event and witness the changes in dentistry.

On the behalf of ida, i wish you all health and happy festival of deepawali. May this festive season brings good health and prosperity everyones lives.

With best wishes for coming year, Jai Hind Jai IDA Dr Manish Verma State Secretary IDA MP State Branch

V Issue - 4, Oct. to Dec. 2015

Review LOW-LEVEL LASER THERAPY USED IN DENTISTRY Dr. Vinay Jain1, Dr. Apurva Rahalkar2, Dr. Alisha singh3 ABSTRACT Despite more than 30 years of experiences with low-level laser therapy (LLLT) or 'biostimulation' in dentistry, concerns remain as to its effectiveness as a treatment modality.

Controlled clinical studies have demonstrated that while LLLT is effective for some specific applications, it is not a panacea.

This paper provides an outline of the biological basis of LLLT and summarizes the findings of controlled clinical studies of the use of LLLT for specific soft tissue applications in dentistry.

Areas of controversy where there is a pressing need for further research are identified.

KEY WORDS :Low-level laser therapy, Dental implant, Fibroblast, Odontoblast, Plasminogen INTRODUCTION LASER stands for Light Amplification by Stimulated Emission of Radiation. The was introduced in dentistry, in the 1960s, by Miaman.1 This is a device which produces light which is inphase (have the same frequency) called coherent light.

Lasers can be classified as hard tissue lasers and soft tissue lasers depending upon the type of interaction between the laser and tissues. This Interaction of laser and tissues depends upon wavelength, power, tissue type and time2. Hard tissue lasers are those where tissue effects are direct and through primary action offer both hard tissue and soft tissue applications, but have limitations due to high costs and thermal injury to the tooth pulp. Soft lasers are those which affect the tissue through indirect and secondary intermittent action. Soft tissue laser, based on the semiconductor diode devices, which are compact, low-cost devices used predominantly for applications, is broadly termed as low-level laser therapy (LLLT) or 'biostimulation' laser3.

Low level -intensity laser radiation for therapy was pioneered

by Endre Master in Hungary in the late 1960s and independently by Fredrich Plog in Canada. It is used in non surgical (primary benefit) and promotes tissue healing, reduces 4 edema, inflammation, and pain . LLLT has been an interesting therapy for more than 30 years, but not well-defined field among the medical, dental, physiotherapy and veterinary professions.

PRINCIPLE OF LOW-LEVEL LASER THERAPY When laser light is applied, the photons penetrate into the mitochondria of the cell and the production of ATP occurs through oxidative processes.4 This increased cellular energy may cause immune system modulation, pain relief, wound healing and nerve regeneration. It may also cause a change in cell membrane permeability to nitric oxide and calcium ions, and stimulate the release of growth factors. This in turn leads to a number of secondary and tertiary clinical effects: t Lymphatic flow increases, which may help in the reduction of swelling (edema) t Increased production of ß-endorphins causing reduction in pain 5

·Increased collateral circulation and microcirculation helps in wound healing5. t · Reduction in the afferent C-fibers depolarization (which carry pulpal pain) causes reduction in dental pain5.

6 7 t · Increased collagen formation and fibroblast stimulation helps in wound healing t · Increased stimulation of osteoblasts and odontoblasts stimulates the production of bone and dentin formation. t · Increased activity of neutrophils and macrophages helps in immune response and growth factors release. t Research has also shown an interesting fact that laser light will have no effect on healthy tissue and will affect only on damaged or sick cells.8 CLINICAL APPLICATIONS OF LOW-LEVEL LASER THERAPY Low-level Laser Therapy has been an essential tool for many treatment modalities and the dental field is no exception.9 It may be used for anything that causes pain or irritation.

Therapeutic lasers are of low power with no significant side effects so the integration of low-level laser therapy in a dental practice is very straightforward. It requires only a modest period of training. Here are some of the applications of lowlevel laser therapy.

ENDODONTICS10 Phototherapy has been shown to reduce post-operative pain and swelling, and lessen the need for analgesics and reduce pulp hyperemia.

DENTIN HYPERSENSITIVITY11,12 Low-level laser therapy has been shown to reduce dentin hypersensitivity. Treatment with low-level laser provides 'melting' of the dentin surface which seals dentinal tubules without damage to the pulp. This may be due to the reduced conduction of C-fibers, which carry pulpal pain, as well as stimulation of ß-endorphins by low-level laser therapy.

SOFT TISSUE LESIONS13,14 (such as herpes, aphthous ulcers, denture sores and angular cheilitis) With the help of LLLT reduction in pain and prevention of lesions from developing can be achieved if the light is applied during the prodromal stage. A decreased recurrence rate has also been reported.

RESTORATIVE DENTISTRY15 LLLT can provide analgesia successfully for primary tooth restorations (by inhibiting the C-fibers, laser therapy can be used in most primary tooth restorations), reduction of postoperative sensitivity and production of secondary dentin in deep restorative procedures.

FACIAL PAIN RELIEF It provides jaw muscle relaxation, especially after long appointments.

IMPLANTS16 LLLT can decrease pain sensations during the implant placement. It also help to speed up the integration of the implant t

1,2,3, PG Student - Department of Periodontics, Sri Aurobindo College of Dentistry, Indore

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into the bone and can improve the quality of the bone around the implant. According to a study which investigated the effect of infrared light on the loading time of dental implants found a significantly greater amount of mature bone, a bone with better distribution and organization after laser irradiation when compared to the control group.

PERIODONTOLOGY LLLT · Stimulates fibroblasts for faster regeneration of soft tissues · Provides analgesia · Modulates the inflammatory chemical mediators that cause pain and discomfort. · Shown improved clinical outcomes when used in conjunction with surgical lasers for treatment such as gingivectomy, periodontitis, and periodontal surgery.

A study conducted by Amorim JCF et al. (2006) showed a statistically significant decrease in pocket depth at 21 and 28 days post surgery17. Ozawa et al. (1997) showed that LLLT significantly inhibits the increase in plasminogen activity induced in human periodontal ligament cells in response to 18 mechanical tensile force.

ORTHODONTICS It reduces the initial tension, pain and can increase the speed of tooth movements by increasing the osteoclastic activity on the pressure side and osteoblastic activity on the tension side.19 Youssef et al (2008) evaluated the effect of the lowlevel (GaAlAs) diode laser (809 nm, 100 mW) on the canine retraction during an orthodontic movement and assess pain levels during this treatment. The pain level was evaluated by a patient questionnaire. The velocity of canine movement was signi? cantly greater in the study group than in the control group. The pain intensity was also at lower levels in the study group than in the control group throughout the retraction period. Their ? ndings suggested that low-level laser therapy can highly accelerate tooth movement during orthodontic treatment and can also effectively reduce the pain level.20 DOSAGE CALCULATION The suggested treatment dosages: · 2 to 3 J/cm2 two or three times a week on gingival tissues; 2 · 6 to 10 J/cm once or twice a week at a temporomandibular joint (TMJ); · 4 to 6 J/cm2 two or three times a week on muscles; and · 2 to 4 J/cm2 directly on the tooth or indirectly above the apex or osseous structure.

BENEFITS OF LOW-LEVEL LASER THERAPY The use of LLLT is great benefit in everyday clinical practice, for the following reasons: · Treatments are covered directly by insurance for many clinical indications. · The reduced use of post-operative medications is important when treating an aging population. · Offering treatment with a low-level laser has proven to be a significant practice builder.

There are fewer postoperative complications and after-hours emergency calls, and there are few, if any adverse side effects of laser treatment.

CONCLUSION Photo-biomodulation is an evolving technology. With every

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passing day, mechanisms of laser therapy, doses, treatment locations and diseases in which it will have an effect are being discovered. Improvements in the design of LLLT equipment are necessary to enable the various techniques to be accomplished within an adequate time period and without breaching cross-infection control requirements. Given the huge benefits of LLLT, its applications are promising. Efforts should be made towards investigating the precise dosimetry required for therapeutic laser effects, in order to achieve standardization of treatment protocols.

REFERENCES 1. Maiman TH. Stimulated optical radiation in ruby lasers. Nature. 1960;187:493 2. Goldman L, Goldman B, Van-Lieu N. Current laser dentistry. Lasers Surg Med.1987;6:559-6 3. Sun G, Tunér J. Low-level laser therapy in dentistry. Dent Clin North Am 2004;48:1061-76 4. Karu T. Low power laser therapy. In: Letokhov VS, Shank CV, Shen 2. YR, Walther H, Editors. Biomedical Photonics handbook. Switzerland: Khorwood Academic Publishers; 2003. p.

48.

5. Enwemeka CS, Parker JC, Dowdy DS, Harkness EE, Sanford LE, Woodruff LD. The efficacy of low-power lasers in tissue repair and pain control: a meta-analysis study. Photomed Laser Surg. 2005 Apr; 23 (2): 177-81.

6. Lam, et al. Laser stimulation of collagen synthesis in human skin, fibroblast cultures.

Lasers life Sci 1986;1:61-77.

7. Hrnjak, et al. Stimulatory effect of low-power density HeNe laser radiation on human fibroblasts in vitro. Vojnosanit Pregl 1995;52:539-546 8. Bjordal, Can LLLT Substitute NSAIDs, Anaglesics and Steroid Injections in Arthritis, tendinopathies and Muscle Pain? A Comparison of Patient Samples, Efficacy and Safety in randomized, Placebo-Controlled Trials (abstract from WALT meeting). Photomedicine and laser Surgery; 2007:25(4): 361 9. J. Tuner, Hode, L. Laser Therapy: Clinical Practice and Scientific Background (Sweden).

Prima Books:2002 page 115-28.

10. Kutvolgyi, I. Low Level Laser as a Diagnostic Tool in Dentistry. Laser Therapy,1998:10:7982.

11. Gerschman JA, Ruben J, Gebart-Eaglemont J: Low- level laser therapy for dentinal tooth hypersensitivity, Aust Dent J,1994: 39:353, 12. Liu, H. C. LAN, W.H. The Combined Effectiveness of the Semiconductor Laser with duraphat in the Treatment of Dentine Hypersensitivity. Journal of Clinical Medicine & Surgery, 1994:12(6): 315-319.

13. Marei, M.K., Meguid, S.H.A. Effect of Low Energy Laser Application in the Treatment of Denture-induced Mucosal Lesions. Journal of Prosthetic Dentistry,1997:7: 256-264.

14. Colvard M, Kuo P. Managing aphthous ulcers: laser treatment applied. 11. J Am Dent Assoc 1991;122:51-3 15. Navratil, L., Dylevsky, I. Mechanisms of the Analgesic Effect of Therapeutic Lasers In Vivo. Laser Therapy 1997, 6: 33-39.

16. Lopes CB, Pinheiro AL, Sathaiah S, Da Silva NS, Salgado MA. Infrared laser photo biomodulation (λ 830nm) on bone tissue around dental implants: a Raman spectroscopy and scanning electron microscopy study in rabbits. Photomed Laser Surg 2007; 25(2):95101.

17. Amorim JCF, de Sousa GR, de Barros Silveira L, Prates RA, Pinotti M, Ribeiro MS. Clinical study of the gingival healing after gingivectomy and low-level laser therapy.

Photomed Laser Surg 2006;24(5):588-594.

18. Ozawa Y, Shimizu N, Abiko Y Low-energy diode laser irradiation reduced plasminogen activator activity in human periodontal ligament cells. Lasers Surg Med 1997: 21(5):456-463 19. Kawasaki K, Shimizu N. Effects of low-energy laser irradiation on bone remodeling during experimental tooth movement in rats. Lasers Surg Med 2000;26:282-9 20. Mohamed Youssef, Sharif Ashkar, Eyad Hamade, Norbert Gutknecht, Friedrich Lampert, Maziar Mir. The effect of low-level laser therapy during orthodontic movement: a preliminary study. Lasers Med Sci 2008:2

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Review LASER APPLICATIONS IN ORTHODONTICS 1

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Dr. Satyendra Gupta , Dr. Indira Gupta , Dr. Rajat Dubey , Dr. Heeralal Chokotiya ABSTRACT: The use of lasers in orthodontics has made it possible for orthodontic clinicians to more easily and ably address the challenges faced on a daily basis in orthodontic practice. Understanding the various uses of lasers is simply to accept the cutting edge of present day orthodontics. From the daily orthodontic procedure of surface preparation, bonding, debonding till the adjunctive procedures of frenectomy, canine exposure, and gingivectomy can be done with lasers. Record maintenance, cast analysis in 3D, holography, spectroscopy, welding, scanning and many more are done with lasers. Future of painless and faster dentistry, in orthodontic practice, can be achieved, to the one that understands the use of lasers in the field of orthodontics. Lasers are our tool of tomorrow, only if we are ready with knowledge of it today.

INTRODUCTION: LASER is the acronym for 'Light Amplification by Stimulated Emission of Radiation' that dates back to approximately 50 years ago1. The application of lasers in the field of medicine and surgery has gained wide popularity following the discovery of the “Rubby Laser” by Maiman2.

Since then, research has been directed to introduce laser technology in the field of dentistry. Lasers can be applied to many fields in dental research and basic research offers new possibilities by advancing laser technology3. Now, lasers find numerous applications in orthodontics as an important field of dentistry. The purpose of this article is to review some of the major applications of laser in the field of orthodontics.

Historical perspective: As early as 1917, American physicist Albert Einstein first proposed the theory of 'stimulated emission', the process which made lasers possible. In 1954, Charles Townes at Columbia University demonstrated a working device using ammonia gas as the active medium that produced microwave amplification and the first generation of electromagnetic radiation by stimulated emissions. This device was called the 'maser' which is an acronym for microwave amplification by stimulated emission of radiation. In 1960, the first laser to use visible light (using a ruby medium) was developed by physicist Theodor H Maiman, following the theoretical work of Einstein, Townes, and Schawlow. The first laser specifically for dental use was a neodymium-yttriumaluminum-garnet (Nd:YAG) laser, developed in 1987 and approved by the food and drug administration in 1990.4 Laser versus scalpel: A laser offers numerous advantages compared with conventional scalpel surgery. The most significant advantage is that a laser coagulates capillaries, seals lymphatics, and sterilizes the surgical field during ablation (Sarver and Yanosky, 2005)5. Separation of tissue is more precise with a laser than a scalpel (Rossman and Cobb, 1995)6.

Additionally, minor aphthous and herpetic ulcerations – which commonly occur during the early stages of treatment as the patients get accustomed to their orthodontic appliances – can be vaporized.

Laser surgery is routinely performed using only light local anesthetic or compound topical anesthetic.Furthermore, there is markedly less bleeding with laser surgery, particularly for

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frenal surgery, as well as minimal edema, & no need for sutures or unsightly periodontal dressing (Haytac and Ozcelik, 2006)7.

Applications of Lasers in Orthodontics: In orthodontic practice, lasers have many common applications, including acceleration of tooth movement, bone remodeling, enamel etching prior to bonding, debonding of ceramic brackets and pain reduction after orthodontic force and prevention of enamel demineralization. Soft-tissue applications such as frenectomies, gingival contouring and crown lengthening can also be achieved using the dental lasers.

1. Establishing Tooth Proportionality before Bracket Placement: In smile design, our concepts of set formulas for bracket placement depend on the final incisor placement in the dynamic smile, determined by both the incisal edge and the gingival margin. It is therefore important to be able to visualize the crown in ideal proportion before bracket placement. The disproportion could be due to lack of incisor height (gingival encroachment or delayed or incomplete passive eruption requiring gingival reshaping) or incisors that are morphologically wider than ideal. To improve tooth proportion laser gingivectomy could be performed before bracket placement so that we could maximize our chances of positioning the incisors in their ideal vertical position. Because the soft-tissue laser seals the incision as it is made, brackets can be placed immediately after the procedure, and healing of the tissue follows.8 2. Gingivectomy and gingivoplasty: (Recommend laser settings: diode laser: 1.0–1.5 W; erbium-doped solid-state laser: 1.5–2.5 W) Gingivectomy is the surgical removal of a portion of gingival tissue for improved oral health, functional contour or esthetic appearance.

Gingivoplasty is the surgical reshaping and re-contouringof the outer surface of gingival tissue for cosmetic, physiological, or functional purposes, usually done in combination with gingivectomy( fig.1). With conventional scalpel surgery, gingivoplasty corrected the thick, unnatural gingival margins left after the gingivectomy procedure. With soft tissue laser surgery, gingivectomy and gingivoplasty are almost always used simultaneously to improve gingival health and enhance smile esthetics.

When the first premolar is in the canine position, its crown height looks too short. An option is to lengthen the premolar crown by laser gingivectomy or simplified osseous crown lengthening9

Fig.1 (a).pre operative photograph with gingival enlargement

1. MDS Student Department of Orthodontics, 2 Professor & HOD Department of concervetiv,3. Senior Lecture- Department of Periodontics, 4. Senior Lecturer - Department of Orthodontics, Mansarover Dental College Bhopal

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Fig. 1(b) Removal of excess gingival enlargement by laser gingivectomy.

Fig.3 (b) Frenectomy procedure during laser surgery

Fig.3(c) Immediately after Frenectomy surgery Fig.1(c). Post operative after laser gingivectomy 3. Contouring of Gingival and Interdental Margins: Hypertrophic gingival margins are often seen in orthodontic treatment secondary to marginal gingival inflammation, both acute and chronic. The hypertrophic papillae could be ablated and the rolled gingival margins beveled to sharpen their contour adjacent to the crown of the tooth. Four weeks after the procedure, the gingival margin greatly improved.10

Fig.2 (a) Preoperative photograph of hypertrophic gingival margins

Fig. 2 (b) The dramatic improvement in gingival esthetics after laser surgery 4. Frenectomy: (Recommend laser settings: diode laser: 1.0â&#x20AC;&#x201C;1.5 W, erbium doped solid-state laser: 1.5â&#x20AC;&#x201C;2.5 W followed by coagulation at <1.0 W with no water) A frenectomy or frenulectomy is the surgical removal of a small band of muscle tissue known as the frenum or frenulum from its attachment into the mucoperiosteal covering of the alveolar process.

Fig.3 (a) midline diastema before Frenectomy

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5. Laser Etching of Enamel for Orthodontic Bonding: Various commercially available laser systems have been introduced for dental use. Enamel and dentin surfaces etched with erbium, chromium-doped: yttrium scandium gallium garnet (Er, Cr:YSGG) lasers show microirregularities and no smear layer. Laser etching inhibits caries, and this could be of great importance in orthodontics. Because water sprays and air drying are not needed with laser etching, procedural errors can be reduced and time saved. Therefore, Er, Cr:YSGG laser irradiation could be a suitable technique to etch enamel for orthodontic bonding (Fig. 4)11.

Fig .4. Laser Etching of Enamel for Orthodontic Bonding 6.Laser Bonding: Argon laser are used as light curing adhesives. The enamel surface was etched with 37% phosphoric acid for 15 seconds. The surface is treated with Megabond. Adhesive precoated brackets were placed on enamel surface. Laser tip is held 0.5 mm from the bracket and the light curing wand is kept touching the bracket. No enamel damage caused by argon lasers at energy levels of 1.6 to 6 watts.12 7.Laser Debonding of Ceramic Orthodontic Brackets : Recently, ceramic brackets have been increasingly used in orthodontic treatment of adult patients. Ceramic brackets provide superior esthetics compared to metal brackets which makes them very desirable for patients. However, the major drawback of these brackets is their brittleness which makes bracket removal process very difficult. While metal brackets are ductile and thus can be easily peeled from the tooth surface, ceramic brackets might cause serious problems such as enamel tear outs or pain at the time of removal.13 Different laser devices have also been introduced as an adjunct in the removal of brackets. It has been stated that carbon dioxide (CO2), neodymium-doped yttrium aluminum garnet (Nd-YAG) or erbium-doped yttrium aluminum garnet (Er-YAG) lasers can cause degradation in the adhesive resin that holds the bracket in

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Fig .4. Laser Etching of Enamel for Orthodontic Bonding 6.Laser Bonding: Argon laser are used as light curing adhesives. The enamel surface was etched with 37% phosphoric acid for 15 seconds. The surface is treated with Megabond. Adhesive precoated brackets were placed on enamel surface. Laser tip is held 0.5 mm from the bracket and the light curing wand is kept touching the bracket. No enamel damage caused by argon lasers at energy levels of 1.6 to 6 watts.12 7.Laser Debonding of Ceramic Orthodontic Brackets : Recently, ceramic brackets have been increasingly used in orthodontic treatment of adult patients. Ceramic brackets provide superior esthetics compared to metal brackets which makes them very desirable for patients. However, the major drawback of these brackets is their brittleness which makes bracket removal process very difficult. While metal brackets are ductile and thus can be easily peeled from the tooth surface, ceramic brackets might cause serious problems such as enamel tear outs or pain at the time of removal.13 Different laser devices have also been introduced as an adjunct in the removal of brackets. It has been stated that carbon dioxide (CO2), neodymium-doped yttrium aluminum garnet (Nd-YAG) or erbium-doped yttrium aluminum garnet (Er-YAG) lasers can cause degradation in the adhesive resin that holds the bracket in place, thereby facilitating the debonding process.13 8. Three-dimensional Laser Scanning System: Our understanding of the growth of craniofacial features is improving with the development of accurate, low-cost, threedimensional (3D) imaging systems. The laser scanner can be used as a soft-tissue scanner and is a valuable tool for its ease of application and creation of 3D images. Images have been created to establish databases for normative populations and cross sectional growth changes, and also to assess clinical outcomes in surgical and nonsurgical treatments in the head and neck regions.14

attend continuing education courses, and recognize the inherent risks associated with laser surgery. As an orthodontist committed to providing the best possible service, adjunctive procedures such as soft tissue surgery can dramatically enhance the overall treatment experience in your office.

References 1. Nalcaci R, Cokakoglu S. Laser in orthodontics. Eur J Dent 2013;7:119-125 2. Maiman TH. Stimulated optical radiation in ruby. Nature.1960; 187: 493-7.

3. Convissar RA. Principles and practice of laser dentistry. 1st ed. St. Louis: Mosby Elsevier; 2011 4. AAPD Reference Manual. Policy on the use of lasers for pediatric dental patients 2013;35:13-16.

5. Sarver DM, Yanosky M (2005) Principles of cosmetic dentistry in orthodontics: part 2. Soft tissue laser technology and cosmetic gingival contouring. American Journal of Orthodontics and Dentofacial Orthopedics 127: 85â&#x20AC;&#x201C;90.

6. Rossman JA, Cobb CM (1995) Lasers in periodontal therapy.

Periodontology 2000 9: 150â&#x20AC;&#x201C;64.

7. Haytac MC, Ozcelik O (2006) Evaluation of patient perceptions: a comparison of carbon dioxide laser and scalpel techniques.

Journal of Periodontology 77: 1815â&#x20AC;&#x201C;19.

8. Gupta VK, Jena AK, Singh SP, Utreja A. Applications of Lasers in modern orthodontic practice: a review of literature. Orthod CYBER J 2009 9. Phadnis PS, et al. Lasers: a contemporary tool in orthodontics.

JIOH 2011;3:351-358.

10. Seth V, et al. Lasers: boon for orthodontics. Ind J Dent Sci 2012;4:50-57.

11. Hossain M, Nakamura Y, Yamada Y, Kimura Y, Matsumoto N, Matsumoto K. Effects of Er, Cr:YSGG laser irradiation in human enamel and dentin: ablation and morphological studies. J Clin Laser Med Surg 1999;17:155-159.

12. Raj Vikram N, Vanathi P, John NT, Kumar NV. Laser in orthodontics: a review. Int J Contem Dent 2011;2: 100-108 13. Heidari S, Torkan S. Laser applications in orthodontics. J Lasers Med Sci 2013;4:151-158.

14. Yamada T, Mori Y, Katsuhiro M, Katsuaki M, Tsukamoto Y. Three-dimensional analysis of facial morphology in normal Japanese children as control data for cleft surgery. Cleft Palate Craniofac J 2002;39:517-526.

Fig. 5(a). Removal of a mucocele in the lower lip with a diode laser

Fig. 5. (b) Same day final results 30 minutes after surgery Conclusion The use of soft tissue lasers offers many advantages such as improved oral hygiene, practice efficiencies, and esthetic finishing. Clinicians interested in incorporating soft tissue lasers into their practice should obtain proficiency certification,

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Technique Article GETTING CORRECT PROSTHESIS IN AESTHETIC ZONE- A CLINICAL VIEW Dr Pankaj Kharade1, Dr Geeta Rajput2, Dr Swati Sharma3 Introduction- Nowadays various types of prostheses are available to replace missing teeth in aesthetic zone. There are several factors affecting the final treatment decision regarding the replacement of a missing tooth in esthetic zone, these factors are case dependant. In many cases if more than one treatment option is possible, the definitive replacement depends on patient's decision/financial status or influenced by the patient's gender, age, public awareness and patient's knowledge. Nevertheless, it still remains imperative to recognize a positive need to restore a space in esthetic zone and to undertake a cost-benefit analysis for any proposed restoration not only in economic terms but also in biological price to tooth structure and the supporting tissues. When you come across a compromised tooth in the esthetic zone which is impossible to restore (Fig. 1), you need to execute a treatment plan which is most suitable for that particular clinical situation

Fig. 1- A compromised tooth in the esthetic zone which is impossible to restore Resin-bonded Fixed Prosthesis- In the patients who are interested in replacing missing tooth with fixed prosthesis other than the conventional fixed partial denture and in young patients where implant and conventional FPD's are contraindicated, the resin bonded FPD's or the fiber reinforced composite resin FPD are viable treatment options. A major advantage of resin-bonded prostheses is that minimal tooth preparation is required and so they can usually be considered a reversible procedure (Fig. 2).

Fig. 2- Resin bonded prosthesis Fiber reinforced composite resin Fixed Partial Denture- In recent years, fiber-reinforced composite resins (FRCs) have gained increasing acceptance in mainstream prosthodontics as viable alternatives to alloy-based restorations.

Fig. 3- Fiber reinforced composite resin Fixed Partial Denture This method of tooth replacement is viewed as a fast, simple, cost-effective means of replacing anterior teeth. The restoration remains intact, with no discoloration or deterioration at the recall visits. The clinician has complete control over the shade and shape of the pontic, and because the prosthesis contains no metal, there are no concerns about metal showing through thin abutment teeth.

Modified fixed removable partial dentures- They were developed by Andrew, hence they are also known as Andrew's bridge system. These dentures are indicated for edentulous ridges with severe vertical deficit. The prosthesis consists of a fixed component and a removable component.

Fig. 4- Andrew's bridge Drawbacks of this prosthesis are as following, tooth preparation is required. Teeth with large and vital pulp are often at risk because of large amount of tooth structure that has to be removed. Crowns with short height are usually unfavorable.

Their problems in free end saddle cases because of complexity of movement and their so-called stress breaking action, which is often theoretically unsound. Cost and time high and technical expertise required is considerable.

Conventional fixed prosthesis or Bridge- Advantages of conventional bridgework are that it provides a predictable and aesthetic result. It is completed in relatively short time. It has many disadvantages such as significant tooth preparation necessary, which can lead to problems with the endodontic status of abutment teeth. To achieve better aesthetics, the facial margin of an anterior restoration is often placed subgingivally, this increases the potential for gingival destruction. Brittle fracture can occur due to failure at the metal ceramic junction. It is more expensive. Conventional FPD is also contraindicated owing to large pulp chambers and horns which may result in pulp exposure during tooth preparation.

1. (Corresponding author) Assistant Professor, Department of Prosthodontics, Dr. Z. A Dental College and Hospital, Aligarh Muslim University, Aligarh, 2. Professor, Department of Prosthodontics, Dr. Z. A. Dental College and Hospital, Aligarh Muslim University, Aligarh, 3. Senior Resident. Department of Conservative & Endodontics, Dr. Z. A .Dental College and Hospital, Aligarh muslim university, Aligarh

6 Issue - 4, Oct. to Dec. 2015

Removable Partial Denture- Clinicians rarely advocate removable partial prosthesis as a substitute for a single missing tooth especially anterior tooth. The usual indication for the removable option is economics. However, it still represents the easiest temporary treatment modality during submerged implant healing period. Dissatisfaction is related to mastication, esthetics, number of missing teeth and maintenance of oral hygiene.

Implants- Nowadays, implant placement followed by prosthetic rehabilitation to replace single or multiple teeth in the esthetic zone is the most conservative and most superior treatment modality from esthetic point of view provided the soft and hard tissues are not distorted. In many respects the prosthodontic treatment for a single tooth is straightforward if the planning and placement of the implant is correct. They have many advantages and are placed independently of potential abutment teeth. An implant-supported fixed bridge may be indicated where the length of the span is too great for resinbonded or fixed bridgework, or there are no suitable abutment teeth.

Developments in the field of implantology include the use of immediate implants that are placed into a prepared extraction socket following tooth removal. They have the advantages that the number of surgical sessions is reduced, the waiting period for socket healing is eliminated, the alveolar ridge height and width is preserved and overall costs are reduced. The main disadvantages of this technique are that it is more demanding both surgically and prosthetically.

Immediate loading is also increasing in popularity. This involves fitting a provisional restoration immediately after implant placement in order to restore function and appearance, as well as improving the final soft tissue contour by allowing the gingiva to heal around a restoration with similar contours to the final prosthesis. The driving force behind the desire to immediately load implants has been reducing treatment time and providing patients with a stable interim prosthesis. There are many patients who are losing teeth and have never worn a removable prosthesis, these individuals can experience significant psychologic and functional difficulties throughout the submerged healing time when they have to wear an interim removable prosthesis. Immediate loading has many advantages such as the implant and crown/prosthesis are placed the same day, thereby providing the patient with an esthetic and stable replacement for the missing tooth/teeth in one appointment.

The number of surgical procedures is reduced. When the success data was published by Schnitman PA et ai & Chiapasco M et al and guidelines were established for implants that would be immediately loaded, immediate loaded implant prosthesis has become an conservative and time saving treatment option for the patients .

Discussion- Treatment decisions cannot be performed depending on the basis of clinical examination or a dentist's opinion alone, but should be discussed in close consultation with patients. On one hand, gender was found to be a patient factor that might influence treatment options. It was found that when females chose to replace the missing tooth in esthetic zone, they usually favor fixed or implant treatment option more

than removable treatment modality and this could be due to the fact that females are more apprehensive about their appearance and removable prosthesis makes them more conscious. The level of education and patient's awareness towards different treatment modalities to replace single missing tooth have significant effect on the treatment choice. Attention of others to the patients' missing tooth and that might affect their relationship with others are important factors in execution of treatment.

Conclusion- Whichever treatment modality is finally selected, it should suit the needs of the patient, be carefully planned and skilfully executed. The choice between several treatment options for replacing a single missing tooth in esthetic zone is influenced by clinical, dentist- and patient-immanent factors.

References1. Albrektsson T, Brånemark PI, Hawnsson HA, Lindstrom J. Osseointegrated titanium implants; Requirements for ensuring a long-lasting direct bone-toimplant anchorage in man. Acta Orthop Scand 1981;52:155-170.

2. Roberts EW, Poon LC, Smith RK. Interface histology of rigid endosseous implants. J Oral Implantol 1986;12:406-416.

3. Schnitman PA, Wöhrle PS, Rubenstein JE. Immediate fixed interim prostheses supported by two-stage threaded implants: Methodology and results. J Oral Implantol 1990;16:96-105.

4. Tarnow DP, Entiaz S, Cassi A. Immediate loading of threaded implants at one-stage surgery in edentulous arches: 10 consecutive case reports with 1 to 5 year data. Int J Oral Maxillofac Implants 1997;12:319-324.

5. Schnitman PA, Wöhrle PS, Rubenstein JE, DaSilva JD, Wang NH. Ten-year results for Brånemark implants immediately loaded with fixed prostheses at implant placement. Int J Oral Maxillofac Implant 1997 Jul Aug;12(4):495503.

6. Chiapasco M, Abati S, Romeo E, Vogel G. Implant-retained mandibular overdentures with Branemark System MKII implants: A prospective comparative study between delayed and immediate loading. Int J Oral Maxillofac Implants 2001;16:537-546.

7. Cooper LF, Scurria MS, Lang LA, Guckes AD, Moriarty JD, Felton DA. Treatment of edentulism using Astra Tech implants and ball abutments to retain mandibular overdentures. Int J Oral Maxillofac Implants 1999;14:646-653.

8. Arnbjerg D, Soderfeldt B, Palmqvist S: Factors determining satisfaction with dental care. Community Dent Health 1992, 9:295-300.

9. Balshi TJ, Wolfinger GJ. A new protocol for immediate loading of dental implants. Dentistry Today 2001;20:60-65.

10. Brånemark P-I, Engstrand P, Öhrnell L-O, et al. Brånemark Novum: A new treatment concept for rehabilitation of the edentulous mandible.

Preliminary results from a prospective clinicial follow-up study. Clin Implant Dent Rel Res 1999;1:2-16.

11. Babbush CA, Kent JN, Misiek DJ. Titanium plasma-sprayed (TPS) screw implants for the reconstruction of the edentulous mandible. J Oral Maxillofac Surg 1986;44:274-282.

12. Piattelli A, Trisi P, Romasco N, Emanuelli M. Histologic analysis of a screw implant retrieved from man: Influence of early loading and primary stability. J Oral Implantol 1993;19:303-306.

13. Sagara M, Akagawa Y, Nikai H, Tsuru H. The effects of early occlusal loading on one-stage titanium alloy implants in beagle dogs: A pilot study. J Prosthet Dent 1993;69:281-288.

14. Balshi TJ, Wolfinger GJ. Immediate loading of Brånemark implants in edentulous mandibles: A preliminary report. Implant Dent 1997;6:83-88.

15. Randow K, Ericsson I, Nilner K, Petersson A, Glantz P-O. Immediate functional loading of Brånemark dental implants. An 18-month study. Clin Oral Implants Res 1999;10:8-15.

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Case Report MANAGEMENT OF MID ROOT FRACTURE WITH A BIOMMETIC MATERIAL â&#x20AC;&#x201C; A CASE REPORT Dr. Saloni Goenka1, Dr. Hema.B.S2 Abstract :Traumatic injuries to the teeth accounts for approximately 25% of dental condition where patients seeks for emergency treatment. Radicular fractures are one such entity which is challenging to address due to various complications like periodontal communication, increased mobility, and continued pulpal infection leading to necrosis. Radicular fractures in the middle third of the root have long been considered teeth of salvage due to unfavourable fracture pattern. Diagnosis and management of such fracture pose a unique challenge to clinician. Emergency management to the tooth to normalcy at the earliest is very much essential in our routine clinical practice. Present case report highlights about the management of radicular fracture in the middle third of the root with a biomimetic material which has opened new horizons to save such teeth.

Key words:-Radicular fracture , Middle root fracture, MTA (Mineral Trioxide Aggregate) .

Introduction : Trauma to the oral region occur frequently and comprises 5% of all injuries for which people seek treatment.1 Root fractures of permanent teeth are relatively rare form of injury, occurring in 0.5 -7.0% of cases. They are considered to occur most commonly in the 11 â&#x20AC;&#x201C; 20 years of age group and are often associated with the fracture of alveolar process.Root fractures are usually classified as involving the apical,middle or the coronal third of the root.2 Middle third fractures are generally transverse to oblique and may be single or multiple, complete or incomplete.3 It occurs in the maxillary central and maxillary laterals mainly due to frontal impact with a rare involvement of only 5%in mandibular incisors. Treatment approaches for these fractures is complex involving prognostic consideration like degree of displacement of fracture fragment, patient's age, stage of root development, mobility of the coronal fragment, and diastatsis of the fragments.Endodontic treatment is required in these situations as they lead to pulp necrosis.3 Case Report A 22 years old male patient reported to the department of Conservative Dentistry and Endodontics, Rishi Raj College of Dental Sciences and Research Centre, Bhopal, India, with a chief complaint of pain in upper front tooth region since 2 months. Patient gives a history of trauma due to road traffic accident two months back. Intra oral examination revealed dislocation of right maxillary central incisor with grade II mobility and tenderness on percussion. (Fig:1) The intra oral periapical radiograph reveals an oblique fracture line in cervical and middle third of the root and with minimum displacement of the fractured segments, and widening of the periodontal ligament space was seen till the middle third of the root with 11 ( Fig:2). The tooth showed no response to thermal and Electric Pulp Test and it was diagnosed as Ellis class VI fracture.

Immediatetreatment was planned as repositioning and splinting of the fractured tooth under profound local anaesthesiabecause of the force necessary to reposition the coronal fragment. Firm finger pressure was applied and splinting was done by acid etch technique. The labial surface of the tooth were etched using 37%phosphoric acid for 20 seconds, washed with water then dried.The bonding agent was applied and light cured for 20 seconds. The ligature was placed on the middle third of the tooth surface and splinting was done using flowablecomposite resin (Ivoclarvivadent) (Fig:3).All the treatment options were explained to the patient and it was decided to go with the conservative endodontic management with MTA (Angelus)as an intraradicular splint. Access opening was done,canal was irrigated with 5.25% sodium hypochlorite and Saline. The working length was determined with stainless steel 20 K fileusing radiograph (Fig:4). Biomechanical preparation was done with crown down technique and calcium hydroxide(Apexcal, Ivoclarvivadent) was placed as an intracanalmedicament. It was changed at weeks interval repeatedly for four weeks to control bleeding from fracture site. The canal was dried with paper points and obturated with guttapercha using zinc oxide eugenol sealer(Ammdent, mohali, India) by lateral condensation technique (fig:5). Guttapercha was condensed back below the fracture line (Fig:6) and MTA (Mineral Trioxide Aggregate) was placed at the fracture site by using hand plugger(Fig:7)and access cavity was restored with composite (Fig:8). At the end of three months, mobility had subsided and splint was removed and tooth was checked both clinically and radio graphically (Fig:9&10).

Discussion:Management of horizontal middle third root fracture is challenging to an endodontist due to association of pulpal and periodontal components. Hence the ultimate goal is to preserve the natural dentition encourages the possibilitiesof new horizon to manage these critical situations.4 The following are the treatment options carried out with varied level of success: 1. Root canal therapy of both the segments. This may be indicated in fracture cases when segments are not separated, but leakage from the fracture line can lead to failure.

2. Root canal treatment of the coronal segment only, if this segment shows no mobility. This is the current recommendation, particularly with the view that the apical segment may contain vital , healthy pulp tissue.

3. The use of an intra radicular splint has been recommended

by Weine et al 1971.

4. Root extrusion is a solution for teeth with root fractures at or near the alveolar crest.

5. Placement of endodontic implant with or without periapical surgery or the last resort where the natural tooth cannot be saved would be ; 5 6. Extraction and subsequent replacement of prosthesis.

1. 2nd year PG Student Rishiraj College of Dental Science And Research Centre Bhopal Madhya Pradesh. India., 2. M.D.S. Professor, Dept of Conservative Dentistry & Endodontics. Rishiraj College of Dental Sciences & Research Centre. Bhopal. Madhya Pradesh. India

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Healing in teeth with horizontal fracture can be either : healing with hard tissue; interposition of connective tissue; interposition of bone and connective tissue; and interposition of granulation tissue. Various treatment techniques for managing fractured teeth with necrotic pulp have been suggested. The initial treatment consists of repositioning and stabilising the coronal fragment to allow healing of the periodontal ligament surrounding the coronal segment to occur. 6, 7Intraradicular splinting is indicated in cases in which the fracture line is in the middle or coronal segment.

Recently MTA is gaining more acceptancein alternative approaches.7The use of MTA has expanded to many clinical application. Its excellent biocompatibility has been evidenced in several favourable biologic processes such as minimal toxicity and pulpal irritation, mild periapical inflammation, nonmutagenecity, cell adherence and growth. The increased level of alkaline phosphatase and osteocalcin , interleukin production, enhances periodontal ligament attachment, cementum growth and dentinal bridge formation.Thus the use of MTA as an intra radicular splint has gained acceptance due to its osteoconductive ,osteoinductive and cementogenic potential.8 Conclusion:The treatment prognosis of such cases depends upon patient and professional relation. The treatment of radicular fractures especially in cervical and middle third have long been considered to have a poor prognosis because of lack of understanding of the newer materials like MTA. The innovation of biomimetic material has brought thenew horizon in treatment modalities so that we can save the natural dentition, and preserve the tooth as much as possible.

Refrences:1. Flores MT et al. Guidelines for the management of traumatic dental injuries. I. Fractures and luxation of permanent teeth.

Issue - 4, Oct. to Dec. 2015

Dent Traumatol 2007; 23: 66-71.

2. Yates JA. Root fractures in permanent teeth: a clinical review.

IntEndod J 1992; 25: 150-157.

3. Rangareddy M.S, Daga A, Vardhan Y.V, Daneswari M. Management of Root Fracture: A Novel, Noninvasive Treatment Approach. Case Reports in Dentistry. 2013.

4. Bakland KL, Andreasen JO. Dental Traumatology: essential diagnosis and treatment planning. Endodontic topics.2004; 7: 14-34.

5. Parekh J.D, Sathyanararyanan R, Manjunath M T. Clinical management of mid root fracture in maxillary central incisors : case report. Int J Oral Sci. 2010; 2(4): 215-221.

6. Cantore S, Ballini A, Crinocoli V, Grassi FR. Treatment of horizontal root fracture:- a case report. Cases Journal 2009; 2:8101.

7. Agrawal V, Patil D. A novel approach in treating horizontally fractures canine using RIBBOND splint and MTA as an obturating material and intra radicular splint: A case report.

IJDR. 2014; 25(1): 95-98.

8. Sarkar NK, Caicedo R, Ritwik P, Moiseyeva R, Kawashima I. Physicomechanical basis of the biologic properties of Mineral Trioxde Aggregate. J Endod 2005; 31(2): 97-100.

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Case Report

PROSTHETIC REHABILITATION BY A CUSTOM MADE SCLERAL SHELL PROSTHESIS Dr Anshul M Saxena1, Dr S.P. Singh2, Dr Roma Goswami3 Abstract The psychological trauma suffered by the patient due to loss of an eye requires a prosthetic rehabilitation to provide cosmetic and functional result. There are different treatment modalities present for the prosthetic rehabilitation depending upon the size, type of defect and the surgical approach being adopted, namely evisceration, enucleation and exenteration. The case report described here presents the prosthetic rehabilitation of evisceration by a scleral shell prosthesis.

Keywords: enucleation, evisceration, exenteration and scleral shell Introduction Malignancy, trauma and congenital defect results to the loss of an eye and subsequent deformity. These defects can be ocular or orbital depending upon the surgical approach used. The ocular defect involves only the eyeball, whereas orbital defects include the periorbital tissue[1]. Surgical procedures adopted for the removal of an eye were classified by Peymanetal, into three general categories evisceration ( removal of intraocular content of eyeglobe), enucleation ( removal of globe and parts of the optic nerve) or exenteration ( removal of the entire orbital content [2].

After surgical resection there is loss of orbital volume which can be rehabilitated either by surgical reconstruction of soft tissue or prosthetic rehabilitation. This prosthesis is retained by utilizing the undercuts present in the orbit or with the help of osseointegrated implants [3]. This article describes a case which is been rehabilitated using a scleral shell prosthesis.

Case report A 65 year old male patient reported to the department of prosthodontics. He gave a history of some disease in childhood which lead to loss of an eye. On referral to the ophthalmic department it was confirmed that the entire globe was removed but the sclera was intact. [ Figure 1 ].“Evisceration is a form of mutilating surgery involving removal of intraocular contents through an incision in the cornea or sclera. The remaining tissues containing optic nerve, sclera, extraocular muscle, and periorbita are left undisturbed.”[3] The procedure provides a superior final cosmetic outcome minimally affecting the orbital contents.[4] Prosthesis fabrication (1) Patient was explained about the procedure andpetroleum jelly was applied to the eyebrows for theeasy removal of the impression material after it sets.

(2) An impression was made of the ocular defect using adisposable syringe; a non-irritating impression material i.e. light body elasto-meric impression material.

(3) During the procedure, the patient was seated in anupright position with the head supported by the headrest. This position allows the natural positioning ofthe palpebrae and

surrounding tissue relative to theforce of gravity.

(4) Elastomeric impression material of light bodyconsistency was mixed and loaded in thesyringe, and sufficient material was injected to fillthe concavity of the tray slowly to avoid incorpo-ration of air bubble. The tray was then reinsertedand reoriented in the defect; sufficient material wasinjected to elevate the lid contour similar to thenormal side.

(5) After the material had set, the assembly was removedand the impression was examined for defects andvoids.[ Figure 2] (6) After obtaining an acceptable impression, the cast was poured in 3 piece. To it was attached the sprue. Through this sprue the wax was flown inside to obtain the wax pattern.[ Figure 3] (7) The three piece cast was opened and the wax pattern was obtained. Smoothening of the edges of the wax pattern was done.

(8) After this fit of wax pattern was observed by gentlylifting the lids and observing the extensions into thefornices. Areas of under extension were correctedby adding wax.[Figure 4] (9) The support and soft tissue contours afforded by the wax pattern was compared visually with thepatient's eye open and by bimanual palpation withthe eyes closed.

(10) It wasreproduced in auto polymerizing clear acrylic resin,The acrylic scleral pattern should behighly polished and free from dust, debris andirritating monomer before placing it in the oculardefect.

(11) A protective blepharospasm occurred when the acrylic shell was first placed in the socket.Patient was asked to relax for several minutes till theirritation subsides.[Figure 5] (12) After asking the patient to do all the movements the overextended acrylic shell was trimmed and if underextended, wax was added.

(13) Iris positioning was decided similar to contra lateral eye by positioning the graph paper and marking the position of the iris. [Figure 6] (14) Staining was done on the scleral shell, than it was kept in the flask a thin layer of processed clear acrylic resin was applied over thesurface of the painted sclera to seal in pigments andvascular fibrils as well as to replace any adjustments [Fig 7] (15) Final prosthesis was inserted in ocular defect and patient was asked to relax for at least 10 min to allow orbicular muscles to relax, so as to evaluate the final prosthesis [Fig 8] (16) Patient was instructed on removal and placement of the prosthesis and was asked to take out the prosthesis at night.

(17) Patient was followed up at 3rd day, 7th day, 1 month, 3 months and thereafter yearly.

1. JR – 3, Department of Prosthodontics, Crown & Bridge Subharti Dental College, Meerut, 2. Professor & Head, Department of Prosthodontics, Crown & Bridge, Subharti Dental College, Meerut, 3. Professor, Department of Prosthodontics, Crown & Bridge, Subharti Dental College, Meerut

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Discussion Scleral shell prosthesis is a artificial replacement of an eye after enucleation. It is in the hands of the prosthodontist to apply the optimum technique for it's rehabilitation. A properly contoured and fabricated prosthesis maintains it's orientation when patient performs various eye movements.[5] with the advent of newer materials it is possible to fabricate a prosthesis with life like appearance. A custom made ocular prosthesis provide better results esthetically and functionally. It fills the space of the socket and retains in the undercut of the eye, providing muscular function of the lids and gives the gaze similar to that of natural eye.[5].

Conclusion The present case report describes the prosthetic rehabilitation of evisceration. Custom made scleral shell prosthesis was fabricated. For such patients a multidisciplinary approach should be applied to get a better functional and esthetic outcome.

Figure 1

Figure 2

Figure 3

References 1. Ben Simon GJ, Schwarcz RM, Douglas R, Fiaschetti D, McCann JD, Goldberg RA. Orbital exenteration: One size does not fit all. Am J Ophthalmol 2005;139:11-7.

2. Peyman GA, Sanders DR, Goldberg MF. Principles and Practice of Ophthalmology. Vol. 3. 1st Indian Ed. New Delhi: Jaypee Bros; 1987. p. 2.

3. Levine MR, Fagien S. Enucleation and evisceration. In: Stewart WB, editor. Surgery of the Eyelids, Orbit and Lacrimal System. Ophthalmology Monographs. Vol. 3.

American Academy of Ophthalmology; 1995. p. 8.

4. Shore JW. Evisceration. In: Levine MR, editor. Manual of Oculoplastic Surgery. New York: Churchill Livingstone; 1988. p. 189-94.

5. P. J. Doshi and B. Aruna, “Prosthetic Management of Patient with ocular defect,” The Journal of Indian Prosthodontic Society, vol. 5, no. 1, pp. 37–38, 2005.

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Student Section NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (ALSO CALLED NONSTEROIDAL ANTI-INFLAMMATORY AGENTS/ANALGESICS (NSAIAS) OR NONSTEROIDAL ANTI-INFLAMMATORY MEDICINES (NSAIMS)

Srushti Jain1 ABSTRACT Acute pain is the most common complaint that causes patients to seek help from healthcare professionals. Pain management remains an important consideration in dental care. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is not a single entity, it is a part of the entire inflammatory process and one of the clinical signs of inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs commonly prescribed in dental practice for the management of pain and swelling. Since analgesics are widely used in dentistry their pharmacological study is important for their optimal effect. This article reviews these drug including mechanism of action, indications, contraindication and drug interaction.

INTRODUCTION Nonsteroidal anti-inflammatory drugs (also called nonsteroidal anti-inflammatory agents/analgesics (NSAIAs) or nonsteroidal anti-inflammatory medicines (NSAIMs), are a drug class that groups together drugs that provides analgesic (pain-killing) and antipyretic (feverreducing) effects, and, in higher doses, anti-inflammatory effects. As analgesics, NSAIDs are unusual in that they are non-narcotic and thus are used as a non-addictive alternative to narcotics.

The most common NSAIDs are aspirin, ibuprofen and naproxen - probably because they are available over-thecounter (OTC, no prescription required).

Paracetamol (acetaminophen) is generally not considered an NSAID because it has only little anti-inflammatory activity. It treats pain mainly by blocking COX-2 mostly in the central nervous system, but not much in the rest of the body. Nsaids can be takek: a)Orally b)Intravenously c) Rectally as suppository d)As eye drops e) Topically (creams and gels).

Although the NSAIDs show clear differences in biochemical structure and origin, they present a similar mechanism of action; as a result, their side effects are also similar. This situation is known as a “group effect”.

Classification of NSAIDs NONSELECTIVE COX INHIBITORS (TRADITIONAL NSIADS)

1.Salicylates 2.Propionic acid derivatives 3.Anthranilic acid derivatives 4.Aryl-acetic acid derivatives 5.Oxicam derivatives 6.Pyrrolo-pyrrole derivatives 7.Indole derivative 8.Pyrazolone derivatives

Aspirin Ibuprofen, Naproxen, Ketoprofen Mephenamic acid Diclofenac, aceclofenac Piroxicam, tenoxicam Ketorolac Indomethacin Phenylbutazone

PREFERENTIAL COX-2 INHIBITORS Nimesulide,Meloxicam,Nabumetone

SELECTIVE COX-2 INHIBITORS Celecoxib,Etoricoxib,Parecoxib ANALGESIC ANTIPYRETICS WITH POOR ANTIINFLAMMATORY ACTION

1.Paraaminophenol derivative 2.Pyrazolone derivatives 3.Benzoxazocine derivatives

Paracetamol Metamizol Nefopam

Table 1 Mechanism of action NSAIDs work by reducing the production of prostaglandins.

Prostaglandins are chemicals that promote inflammation, pain, and fever. They also protect the lining of the stomach and intestines from the damaging effects of acid, promote blood clotting by activating blood platelets, and promote normal function of the kidneys.

The enzymes that produce prostaglandins are called cyclooxygenases (COX). There are two types of COX enzymes, COX-1 and COX-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever; however, only COX-1 produces prostaglandins that activate platelets and protect the stomach and intestinal lining. stimuli (physical, chemical or mechanical) Release of arachidonic acid found in cell membrane Cyclooxegenase (COX)

Prostaglandins and thromboxanes

NSAIDS

inflammation pain fever

Fig.1

Pharmacokinetics NSAIDs are well absorbed from the gastrointestinal tract, with the exception of aspirin which undergoes presystemic hydrolysis to form salicylic acid. Concomitant administration of NSAIDs with food or antacids may in some cases lead to delayed or even reduced absorption. The elimination of these drugs depends largely on hepatic biotransformation; renal excretion of unchanged drugs is usually small.

Pharmacological actions A. Analgesia Prostaglandins induce hyperalgesia (increased sensitivity to pain) by affecting the transducing property of free endings .NSAIDs do not affect tenderness induced by direct application PGs,but block the pain sensitizing mechanism induced by bradykinin, TNFα, interleukins and other algesic substances.

They are therefore more effective against inflammation associated pain, including acute dental/postextraction pain.

B. Antipyresis Reduce body temperature and fever but do not cause hypothermia in normal individuals.Fever during infection is produced through generation of pyogens, ILs, interferons, TNFα which induce PG production in hypothalamus which raise its temperature set point.

NSAIDs block the action of pyogen.

1. BDS Final Year Sri Aurobindo College of Dentistry and PG Institute Indore (MP)

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C. Anti inflammatory Pgs are one of the mediators of inflammation. The most important mechanism of anti-inflammatory action of NSAIDs is considered to be inhibition of PG synthesis at the site of injury.

D. Anti platelet action Therapeutic doses of most NSAIDs inhibit platelet aggregation and increase bleeding time.Risk of post-extraction bleeding is enhanced.

E. Ductus arteriosus closure NSAIDs in late pregnancy has been found to promote premature closure of ductus in some cases so NSIADs should be avoided in third trimester of pregnancy.

Therapeutic uses

Analgesic Tooth ache,headache,dysmenorrhoea,all integumentry system pain conditions

Antipyretic Fever rheumatoid fever

Anti-inflammatory Rheumatoid artheritis , osteoartheritis,ankylosos spondilitis

Antiplateletic drug Post MI and post stroke patients

Side effects Gastric irritation,erosion/peptic ulceration,

GASTROINTESTINAL gastric bleeding/perforation,esophagitis RENAL HEPATIC

Sodium and water retention,chronic renal failure,interstitial nephritis, Raised transaminase, hepatic failure(rare)

CNS

Headache,mental confusion,behavioral disturbances,seizure precipitation

HAEMATOLOGICAL

Bleeding,thrombocytopenia,haemolytic anemia,agranulocytosis

RESPIRATORY

Aspirin induced asthma(AERD-aspirin exacerbated respiratory disease/NERD- NSAIDS exacerbated respiratory disease)

OTHERS

Nasal polyposis,skin rashes,pruritis,angioedema

DRUG INTERACTIONS Some commonly used medications known to interact with NSAIDs are: 1) Low dose aspirin: Low-dose aspirin is given as a preventive treatment to thin the blood in people thought to be at risk of blood clot which could trigger a heart attack and stroke.

NSAIDs are usually not recommended for people taking lowdose aspirin because: ¡ NSAIDs can make aspirin less effective in thinning of

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blood. ¡ Combination of these two drug can increase risk of gastric ulcer formation.

2) Diuretics(eg:chlorothiazide-DIURIL,ethacrynicEDECRIN,eplerenone-INSPRA) Diuretics are group of drug that help remove fluid from the body and are used in treatment of high blood pressure.

Diuretics are generally safe to take in combination with NSAIDs but monitoring is needed as occasionally cause kidney damage and high blood pressure.

3) Warfarin Warfarin is a medication used to treat people with history of blood clots. Use of NSAIDs in combination with warfarin is not recommended as NSAIDs enhance the effect of medication and makes patient prone to excessive bleeding.

4) Alcohol Heavy drinkers should not take NSAIDs as it may increase the chances of bleeding in stomach because both alcohol and NSAIDs are gastric irritants.

5) NSAIDs increase negative effect of cyclosporine on kidney function.

CONTRAINDICATIONS NSAIDs is contraindicated in people having following conditions: 1) Children and teenager with viral infectionwith or without fever should not receive aspirin or aspirin containing products due to risk of REYE'S SYNDROME (Reye's syndrome is a rare disorder that causes brain and liver damage.)

2) Those having upcoming surgeries 3) Diabetes that is difficult to control 4) Kidney disease 5) Liver disease 6) Active peptic ulcer disease 7) Bleeding disorder 8) Hypertension 9) Asthma 10) Pregnancy in third trimester Conclusion The management of acute dental pain due to inflammation is a common clinical problem but the use of NSAIDS for the same should be monitored carefully due to its side effects ranging frommild(nausea,vomiting)to serious (gastric bleeding and perforations, kidney damage) .

Contraindications of NSAIDS should be kept in mind before prescribing the same. In cases where NSAIDs are contraindicated acetaminophen is the choice of drug.

For moderate pain that is not relieved by NSAIDs, opioid analgesics are generally agent of choice, opioids alter the patient's perception of the pain in brain. But opioid alone are not prescribed for the management of acute pain because too high dose would be needed and the adverse side effects would not be acceptable(respiratory depression, tolerance, physical dependence, sedation/drowsiness).The combined use of a NSAID with an opioid produces a synergistic effect so that a lower dose of opioid can be used.

Although NSAIDs and short acting opioid are helpful in relieving acute pain, they should not be used on daily basis for chronic pain. The chronic use of NSAIDs may be associated with significant side effects, including renal diseases.

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Student Section CHANGES IN SYLLABUS OF PUBLIC HEALTH DENTISTRY TO MAKE IT CAREER ORIENTED : A DISCUSSION Vonica .C. Motianii1 In this fast changing era of technology and awareness, the needs of community have changed, with enhanced supply of amenities and facilities. 'Public Health' is witnessing a similar change in Indian scenario not only because of remotely generated systemic problems, secondary malignancies, complications and mortality, but also emerging epidemic of oral health problems.

Public Health Dentistry is the most responsible branch of Dental Sciences in order to survey, analyze, plan and make continuous efforts to reduce oral disease burden in the community. Our National Health System too has recognized importance of 'Oral and Dental Health' by including it into National Health Policy and Five Year Plans recently. This is high time that syllabus of Public Health Dentistry should pin up its priorities and be prepared to utilize what our National GDP, Community resources and NGOs at large wish to deliver into the society.

Generation of basic data for Public Health Dentistry and linking it with Community Health Planning and Treatment has to be done at grass root level by primary health care delivery units. Hence, basics of Research Methodology is the first need of syllabi at UG level. Although it is taught in theory, Rationalization of the significance of research and its community relevance should be explained with practical exercises.

At CHCs & District Hospitals (Secondary Care Units), Dental Surgeons (BDS graduates) are the major resource persons for implementing plans for Community based Dentistry. Ironically the basics of Strategic Decision Making do not appear in our syllabi of BDS. ?A graduate in Dental Sciences should be competent to make decisions (provided the basics are taught), resourceful and able to utilize the given resources rationally. But in order to understand the availability of resources from within the community and to put them to good use by rational allocation, students need practical learning of management issues. Examples taken from case studies of Dental Surgeons working with Global Organizations, Public Health agencies, Social Organizations, NGOs and Trust etc. should be mandatory to know the basics of Finance management, Project Management, Operations Management, System Analysis and Design, ?etc. Hence including these topics in the syllabus of Public Health Dentistry will enable us to make and conduct viable programs for Prevention, Surveillance, Research and Clinical Management using allocated funds properly.

In past few decades requirement of qualified Dental Surgeons has increased multifold. Today modern aseptic procedures, conservation of dentition as against extraction of

painful or mobile tooth, Cosmetic and Aesthetic dentistry etc., are well accepted in modern, literate and internet smart society.

Yet, most of this awareness is confined to population which belongs to Upper and Upper-middle-class. Awareness has not yet percolated to the lower and lower-middleclass, possibly because of their existing beliefs, ignorance for oral hygiene, low levels of literacy, hectic life schedules etc.

Most of the lower and lower middle class does not avail of modern dental treatment services due to non affordability also. A positive change in the community mindset can be created by highlighting the health problems arising out of pathogenic Oral Conditions and their burden on Human and National Productivity. Syllabus should provide practical training in Oral Health promotion techniques that are simple and patient friendly. Thus we require training in Information, Education and Communication (IEC) programs including a complete session of Health Care Informatics and it's Utility.

In this era of almost complete automation and e-governance, extensive use of Computers and Management of Databases (DBMS) not only for informatics and statistics but for Decision Support System (DSS) ?are the need of hour. DBMS for prevention of re-iteration of data profiles and data redundancy has also become a 'must learn' entity.

Telemedicine is again a new avenue (Buzz word) in social circles, and needs to be addressed where expert opinions are electronically sought and e-payments are enabled.

Communication basics should be elaborated.

Education of beneficiaries & stakeholders in the society through planning their visits to best clinical setups can generate a supply induced demand in social corridors. We need to revise the communication syllabi in favor of demand generation from within the community.

Exercises for reduction in mortality, morbidity and rehabilitation, specifically for tobacco related oral health should be separately undertaken.

Today, Doctors of Modern era are not only pill prescribers. They have to become social counselors dealing with Promptness and Humanitarian attitudes towards their patients. Thus, the chapter on psychological and behavioral patterns of human beings should to be linked with the basics of Motivation, Leadership and Change Management (Soft Skills) to make us effective modern day consultants.

Teaching of Health Economics is another major topic which should be included for UG students to make them capable of understanding the economic limitations of patients (Value for Money) vis-a-vis the National and Community investment and outcomes of Public Health Dentistry programs.

1. BDS Final Year Sri Aurobindo College of Dentistry and PG Institute Indore (MP)

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Other topics of interest are 'Geriatric Dentistry' to understand complications pertaining to life style related diseases with advancing age and how they can be prevented.

Similarly hands on training on Special Care Dentistry, e.g. in Mentally Compromised Individuals, should be included in UG education.

Preservation of Dental health in case of mass Disasters and Sports Medicine also needs recognition.

In conclusion, the changes in syllabi of Public Health Dentistry will generate more career options and lead the budding dental surgeons to be more community oriented and responsibly prepared for the bright future of Dentistry across

the globe.

The simple mathematic between science and humanities does not seem to exist today only because one finds that making money is the sole objective of the profession without understanding that Community Satisfaction is the true hallmark of achievement. The spectrum of Curative Dentistry is too narrow to reveal the realistic situation of Oral health or to plan the future. Hence in order to bridge the gaps between clinicians and ever changing needs and demands of the society, these new topics should be taught under “Public Health Dentistry” syllabi to bring about a paradigm shift in community orientation towards Dental Sciences.

"This article was awarded first prize in national level essay competition under UG category of IAPHD for year 2015"

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Issue - 4, Oct. to Dec. 2015

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IDA BHOPAL BRANCH ACTIVITY Report of the International symposium on

“Tobacco Control- Globally, Nationally, At State and by you” The Department of Public Health Dentistry, People's College of Dental Sciences and Research Centre, Bhopal organized an international symposium on “Tobacco Control- Globally, Nationally, At State and by you” on the 21st and 22nd of December 2015. A total of 654 delegates had registered, including students and faculty from dental/medical colleges of Bhopal, Indore, Jabalpur, Gwalior of MP and Sawangi- Wardha of Maharashtra. The Madhya Pradesh State Dental Council awarded 9 CDE points for the program.

There were 136 exhibits on display for a competition on posters/models/ paintings/Slogans based on theme of the symposium on day one. Guest speakers for the symposium were Dr Vinayak Mohan Prasad, Project Manager, Prevention of Non Communicable Diseases, WHO, Switzerland, Col Dr Rajesh Kumar Yadav, Commanding Officer of the 21 Corps Dental Unit, Bhopal and Dr. Dilip Kumar Acharya, Surgical Specialist-G.B.Pant District Hospital, Indore -Govt. of M.P. Organizing secretaries for the program were Dr Amith HV, Reader and Dr Garima Bhambhani, Sr Lecturer, Dept of Public Health Dentistry, PCDS & RC, Bhopal.

IDA KATNI BRANCH ACTIVITY On 14th November, Representing IDA Katni, Dr. Akshay Gupta along with group pharma organised a painting competition for children.

Sweets were distributed and best paintings were awarded.

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IDA INDORE BRANCH ACTIVITY CDH ACTIVITY

The Indian Dental Association (IDA) Indore branch in collaboration with Sri Aurobindo College of Dentistry actively participated in Bright Smile Bright Future dental health programme launched by Colgate-Palmolive. The initiative taken under this programme helped us to render our services to a large number of school children. In the year 2015, we conducted approximately 55 camps including those in rural and urban areas. We covered primary schools from both the areas. A total of approximately 10,000 children were screened out of which the program covered a distribution of 3500 oral hygiene packages to all children from private, public and special schools.

The services were delivered to both public and private schools ensuring mass distribution of oral hygiene package provided by Colgate.

The campaign started with the initial oral health education and promotional activity among primary school children followed by the distribution of toothbrushes and toothpastes. The dental health programs were supported and conducted under the guidance of Dr. Prashant Mishra, Reader, Dept. of Public Health Dentistry and Vice President IDA (Indore branch). Dental educative models were also used along with vocational training on oral hygiene.

We moved one step ahead providing the oral hygiene packages and educational programme to the children with special needs. The series of oral health program covered the institutes for visually impaired individuals also.

CONFERENCE:

IDA Indore branch hosted 35thIDA M.P State Dental Conference at hotel Sayaji from 18th-20th December, 2015. The conference was conducted under the able guidance of Dr. Manish Verma, Hon. State Secretary and Dr. Surendra Agarwal, President, IDA M.P State. The conference achieved huge success under flagship of Dr. Sumeet Jain , Organizing Secretary and Dr. Sandhya Jain, Organizing Chairperson.

Dr. Ashok Dhoble, Hon. Secretary General, Head Office inaugurated the scientific session and trade fare.

The chief guest for the inauguration of conference was Sushri Uma Bhartiji, Union Minister of Water Resources, Government of India and Shrimati Maliniji Goud, Mayor and MLA, Indore was guest of honor. Shri Jayawardhan Singh, MLA, Radhogarh and Dr. Ramananda Shetty, Vice-chancellor ,Nitte University, Manglore were the special guests for the same.

The conference achieved huge success with participation of over a 1000 delegates. The conference had an exhaustive scientific schedule designed meticulously by Dr. Rajeev Srivastava, Convenor, Scientific Committee. The conference had 8 keynote lectures, 16 guest speakers, 5 Pre-conference courses and 110 free papers.

IDA Indore branch also celebrated 70 years of its inception. To commemorate this occasion all the past presidents and secretaries of the branch were felicitated. A musical night was also organized and singer Ms Akansha Chanchak, world record holder for nonstop continuous singing graced the occasion.

The Trade fare organized in the conference had over 50 stalls with exciting offers for delegates. Cultural night 'Colors' was organized along with banquet with huge participation by students, staff and practitioners. A rock band consisting of various dentists named 'LAVA' performed during the cultural night. The band members included Dr. Shaleen Vyas, Dr. Jatin Agrawal and Dr. Upendra Singh Bhadauria.

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IDA JABALPUR BRANCH ACTIVITY IDA Dental Checkup Camp at Medical Govt School on 24 November 2015

Dental Checkup Camp at Govt. MLV School

IDA UJJAIN BRANCH ACTIVITY Dr Anurag bhargava MDS (ORAL AND MAXILLOFACIAL SURGERY)delivered lecture on IMPLANTS.

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IDA VINDHYA BRANCH ACTIVITY Activity of IDA Tinciliranch Rewa October 15 Oct. â&#x20AC;&#x201D; Checkup tamp organized at Shemford futurestic school Rewa. 300 Students were examined. 31. Oct â&#x20AC;&#x201D; Hands On course and demonstration On indirect laminates was done by Dr. Rajeev shrivastava and Dr. Vivek Chaukse sir at Hotel Landmark, Rewa Dentists from Rewa and sidhi has participated in the event, The inauguration ceremony was done by mayor of Rewa Smt. Mamta Gupta. Session was huge success as 58 dentist attended the workshop. Later on same day.

A CDE and live Demonstration was held on Hotel Landmark, Rewa by Dr. 910 thomas Dean, Peoples Dental college. He gave his lecture on dissimpaction techniques for 3rd molar dissimpaction, He also gave demonstration of extra oral and intra oral blocks on skull.58 participants had attended the programme.

November 26 Nov. - Dental and Health checkup was organized at Purva Village, Tehsil- Semariya. Camp was organized by MLA Smt. Neelam Mishra. Around 1000 villagers were benefitted.

December 18 dec. Orientation programme and Health checkup was done at Central Academy School on 18 December 500 students participated.

30 dec. Election was conducted and formation of new executive committee was done,

IDA SATNA BRANCH ACTIVITY IDA Satna Conducted CDE Programme Date -5.12.15 Venue - Hotel OM Palace Speaker -Dr. Prateek Mishra ( MDS Prostho) Topic- Full Mouth oral rehabilitation step by step approach 25 member were present

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