Now a day?s dentistry has progressed that even a person at the age of 90 years can have full compliment of teeth. The branch of dentistry dealing with artificial teeth and any missing facial parts such as eye, ear, nose or lips is called as Prosthodontics. Your missing teeth can be replaced by an artificial removable or a fixed prosthesis. Well, both these prosthesis are made as per your own personal, aesthetic and functional preference.

Why a Prosthodontist?
They provides an extremely high level of care for patients who have missing teeth or have significant damage to their existing teeth. Training includes crowns, bridges, dentures, cosmetics, tempromandibular joint dysfunction, maxillofacial prosthesis and Dental implants. They also deal with congenital defects as well as problems arising from trauma and cancer. Dental Implants are in fact replica of tooth root, which is placed in your jaw during a small surgery. These are inert metal screws made of a special metal called as Titanium. These screw shaped titanium are placed at a pre-determined location for the tooth inside the bone. Later on once the bone anchors this metal screw, artificial tooth is placed on this screw. This kind of implant-supported tooth is completely similar to original tooth in terms of structure, esthetics and function. Titanium is a well-known metal for its biocompatibility. It is being used for more than a century now for orthopedic purposes. This kind of implant can also be used for supporting multiple teeth or complete denture. Implants have an edge over the conventional fixed prosthesis that in this procedure, preparation of adjacent teeth is not required. The only disadvantage is that the implant is costing little above twenty thousand per teeth and which is out of reach for most of our population. There is good news that the efforts are on to devise indigenous implants in India. Once this project is over, the cost will reduce significantly and common man will be able to afford it.

The most striking advancement in this branch is related to Maxillo-facial Prosthesis. In which we can replace missing facial parts and reduce or hide the disfigurement. We commonly see the patients of trauma and cancer of head and neck area with significant disfiguration and visible defects on face. With the recent advances, implants are now being used for supporting other devices and maxillo-facial prosthesis. Now with these advancements it will be possible to hide such deformities and defects. In this technique, missing part of the face is fabricated with the help of acrylic resin and over this a covering resembling skin is given, which is made of a special material called as silicone. This gives resemblance to remaining skin and the defect is repaired.
Patients contemplating dental implants or major changes in their appearances with the use of crown, bridges, smile designing and ceramic laminates should consult with a Prosthodontist to assure that they are gaining the best possible care for their dentition.
Dr. Vinod Chandel MDS. (Prosthodontics) AIIMS New Delhi
Advanced Dental Care,Prosthodontic and Implant Centre
SCO 157/1 Sector 37-C, Chandigarh
Phone no. 2691001, 09815131898

INTRODUCTION:
Intrusion of extruded maxillary second molar has always been a challenging situation in orthodontics. Extrusion of second molar/s is commonly seen when the opposing tooth is missing due to extraction or congenital absence. It leads to occlusal plane problems and occasionally buccal tilting of second molars. Sometimes it is also seenin cases of a complete ope bite, with occlusal contacts in second molar region only.
An attempt to level the extruded maxillary second molars by using fixed orthodontic appliance involving the second molars with a continuous arch wire leads to extrusion of teeth anterior to the second molars rather than its intrusion. It results in opening of mandibular plane angle, and downward and backward rotation of mandible. It is detrimental esp in cases of vertical growth pattern and skeletal class II cases.
Some clinicians tend to equilibrate the occlusal surface of extruded maxillary second molar to level it. It may be a method of choice in mild extrusion cases, but in other cases, the tooth may require intentional root canal treatment, reduction of crown and then placing jacket crown, thus jeopardising the long life of the tooth.
To solve this problem, we have successfully used a modified form of transpalatal arch (M-TPA) to apply isolated intrusive forces on the extruded maxillary second molar only. The anchorage is obtained by M-TPA and involving the other teeth in a continuous arch wire from first permanent molar of one side to other side.
FABRICATION OF M-TPA:
A double buccal tube having a headgear tube is used on the maxillary first molar bands and the bands are then taken in a pick-up impression, and a working cast is made in plaster of paris. M-TPA is made in 0.9 – 1.0 mm hard stainless steel round wire. Its distal ends are bent in the form of hooks adapted along the palatal curvature; approx 2 mm away from the palatal tissues, and extending around 6 – 8 mm from the free gingival margins. It is then soldered on thefirst molar bands taken in the pick-up impression, (FIGS.). Another hook of the same wire is made extending approx. 4 - 6 mm from free gingival margin avoiding the active vestibular depth on buccal side, which is adapted in relation to the extruded maxillary second molar on buccal side. It is inserted in the headgear tube from the distal opening and soldered there. It may be done for both the sides if required. This assembly is now cemented in place on the maxillary first molars with light cured glass ionomer cement.
These two hooks on M-TPA can now be used for engaging elastic or E-chain, crossing over the occlusal surface of extruded maxillary second molar, (FIGS.). The forces are now concentrated on extruded maxillary second molar only. The forces required can be achieved by adjusting the length of E-chain or size of the elastics. A lingual button or a Beggs’ bracket or other bracket can be bonded on the occlusal surface of extruded maxillary second molar to avoid slippage of the E-chain, which otherwise may lead to gingival trauma if it gets slipped in the proximal side of the extruded maxillary second molar. Elastics are to be changed everyday which require patient’s cooperation, so E-chain is a better option.
Adequate intrusion of extruded maxillary second molar can be achieved within 3 – 4 months. A palatally – directed force from the E-chain may also lead to correction of buccal inclination of the second molar. After intrusion ,the second molars can now be incorporated in the continuous arch wire with other teeth, by placing buccal tube in proper position. It will help in prevention of the relapse of the intrusion. However, a light intrusiove force must be continued on the corrected maxillary second molar with the help of E-chain as before to avoid relapse for at least 3 -4 months more.
CONCLUSION:
M-TPA is an inexpensive and effective appliance for intrusion of extruded maxillary second molars. It helps to apply isolated forces on the extruded maxillary second molar, without disturbing anchorage teeth and causing any ill – effects on the dentition.

How The Tooth Pierces The Heart!!!



Heart Attacks:

The most common strain of bacteria in dental plaque
can cause blood clots that induce heart attacks when
they escape into the bloodstream.

Studies have found the incidences of heart disease are
about twice as high in people with periodontal (gum)
disease.

Periodontal disease is an infection that destroys the
gum surrounding your teeth and also destroys the
supporting bone that holds your teeth in place.



Incidence of Periodontal Disease: Unlike most diseases
that give us early warning signs, gum disease
progresses silently, often without pain. It may
develop slowly or progress quite rapidly. More than
half of all people over 18 have at least the early
stages of periodontal disease. Even more frightening,
after the age of 35, three out of four people are
affected to some degree.



Determining Periodontal Disease:

Early Warning Signs of Periodontal Disease are

The Gums bleed when you brush your teeth.
Gums become red, swollen, or tender.
Gums are pulled away from the teeth.
Pus oozes between teeth and gums when gums are
pressed.
Permanent teeth get loose or separate.
Persistent bad breathe.


Your dentist can help you better understand
periodontal disease and how you can prevent it. He can
quickly and painlessly check and monitor the condition
of your gums during your recare appointments.

Evidence is mounting relating gum disease to a
variety of health concerns, some that are life
threatening

Plaque bacteria threatens your teeth, gums,
restorative and cosmetic work; possibly even your life


By keeping regular re-care appointments with your
dentist, you help increase your chances for a long and
happy life.


Dr. Amjadali.Y. Budguzar
camp, pune.
+91-9822000805

Case Of Total Oral Rehabilitation

Attended By

Dr. Kirit A. Bharwada
Dr. Tushar K. Bharwada

Bharwada Dental Clinic
3, “Prabhuta”, Sarela Wadi, Ghod-Dod Road, Surat – 395001
Tele : +91-261-2668752


Surgical Phase Taken Care By

Dr. Jigish D. Shah

Prosthetics Prepared By

Span Dental Lab - Surat

Case History

• Mrs. Sushilaben Patel
• Female
• Age : 54
• Systemic Condition – NAD
• Oral Hygiene – Good

On Examination

• In Maxilla – Bilateral posterior Missing 16, 17, 18, 25, 26, 27, 28
• Root Remaining 15
• Cavity With Pulp Involvement in 14,13
• In Mandible – Unilateral Posterior Missing 35,36,37,38
• Deeply Carious With RCT & Supra Eruption 46
• Mobile & Supra Erupted 48





Treatment Plan

1. Extration of 15, 46,48
2. Placement of Implant at 15, 17, 25, 27, 35, 37, 45, 47
3. SV RCT in 13,14
4. Porcelain JC on 13,14
5. 3 Unite Porcelain Bridge at 15, 16, 17
6. 3 Unite Porcelain Bridge at 25, 26, 27
7. 3 Unite Porcelain Bridge at 35, 36, 37
8. 3 Unite Porcelain Bridge at 45, 46, 47

Execution of Treatment Plan

Phase I – Surgical

• Extration of 15, 46,48
• Placement of Implant at 15, 17, 25, 27, 35, 37, 45, 47

Phase II – Clinical

• SV RCT in 13,14
• Tooth Preparation of 13 For Porcelain JC
• Tooth Preparation of 14 For Porcelain FCC
• Rubber Base Impression For Final Prosthesis
• Alginate Impression For Temp on 13,14 & Special Tray

Phase III – Laboratory

• Temp Acrylic JC Preparation on 13,14
• Acrylic Special Tray Preparation with holes for implant Heads

Phase IV – Clinical

• Fixation of Temp JC & FCC on 13,14
• Vertical Height Registration With Special Tray & Wax
Bite Blocks

Phase V – Laboratory

• Preparation of All The prosthesis – JC 13 / FCC 14
• 3 Unite Bridge At – 15, 16, 17 / 25, 26, 27
35, 36, 37 / 45, 46, 470

MAKE SURE THAT LAB WILL MAKE ALL THE PROSTHESIS OF PREMOLAR SIZE AND ASK FOR THE BISC TRYAL

Phase VI – Clinical

• Try In For All Prosthesis & If Necessary Please Do The
Occlusal Adjustment By Use Of Articulating Paper





Phase VII – Laboratory

• Final Preparation of All The prosthesis – JC 13 / FCC 14
• 3 Unite Bridge At – 15, 16, 17 / 25, 26, 27
35, 36, 37 / 45, 46, 470

MAKE SURE THAT LAB WILL NOT MAKE ANY CHANGES IN VERTICAL HIGHT

Phase VIII – Clinical

• Fixation of All Prosthesis One By One
• If Necessary Please Do The Occlusal Adjustment By
Use Of Articulating Paper
• Explaining The Use of Interdental Brush For Proper
Oral Hygiene care
• Instructions
After Implant Placenent


Open Bite Due to Implant Head touching So Implant Head has to be Reduced according to Requirements

Implants In Position

Heads For All The Implants Are Of 15 Degree Angulated For Easy Path Of Incrustation With Head Angulated Towards The Natural Teeth

Post Operative Orthopentomogram




Impression






Working Cast With Acrylic Special Tray

Hole For Implants

Working Cast With Bite Registration







All Prosthesis on Final Cast




All Prosthesis in Mouth



Post Treatment Facial Profile