The interrelationship between endodontic and periodontal diseases has been a subject of speculation, confusion and controversy for many years. Pulpal and periodontal problems are responsible for more than 50% of tooth mortality today. An endo-perio lesion can have a varied pathogenesis which ranges from quite simple to relatively complex one. These lesions often present challenges to the clinician as far as diagnosis and prognosis of the involved teeth are concerned. It is very essential to make a correct diagnosis so that the appropriate treatment can be provided. To make a correct diagnosis the clinician should have a thorough understanding and scientific knowledge of these lesions and may need to perform restorative, endoontic or periodontal therapy, either singly or in combination to treat them. Therefore, this presentation will highlight the diagnostic, clinical guidelines and decision-making in the treatment of these lesions from an Endodontist's point of view to achieve the best outcome. Clinical Relevance to Interdisciplinary Dentistry

• Perio-endo lesions are very complex in nature and can have a varied pathogenesis.
• Treatment decision-making and prognosis depend primarily on the diagnosis of the specific endodontic and/or periodontal diseases.
• To have the best prognosis, clinician should refer the case to various areas of specialization, to perform restorative, endodontic or periodontal therapy, either singly or in combination. Therefore, to achieve the best outcome for these lesions, a multi-disciplinary approach should be involved.

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Abutment teeth are called upon to withstand the forces normally directed to the missing teeth, in addition to those usually applied to the abutments. Whenever possible, an abutment should be a vital tooth. Normally, teeth with active periodontal problem should not be used as abutment teeth. The use of multiple splinted abutment teeth, non-rigid connectors or intermediate abutments makes the procedure much more difficult and often the result compromises the long-term prognosis. In cases where tooth preparation cannot solve the problem, the use of various attachments and a telescopic retainer must be considered. Understanding the basic concepts of how to retain various restorative components and how to protect the remaining tooth structure, will enable us to answer the numerous questionable situations that arise during the restorative process will be facilitated. Thus, this will result in final restorations that are based on sound design principles. Clinical Relevance to Interdisciplinary Dentistry

• Fixed prosthetic treatments are always dependent upon the support they receive from abutment teeth. Abutment teeth should have sufficient coronal structure to provide retention to the prosthesis. It might sometimes be necessary to expose or increase the clinical crown by periodontal surgery for support and esthetics. It is also seen that many a times the teeth are supra erupted as a result of absence of opposing dentition which calls for the need of intentional endodontic treatment. By a combination of treatments with interdisciplinary dentistry, we will succeed in providing a functional prosthesis which fulfils esthetic and restorative needs.

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Magnets have been used widely in the field of dentistry for many years with some success, as they can be manufactured in small dimensions as retentive devices in overdenture technique, maxillofacial prosthesis, and obturators. These magnets are attached with remaining root structure or osseointegrated implants which transfer the occlusal load to the bone through the periodontal ligament of the retained roots, thereby prevent resorption of remaining alveolar bone proper and inter-radicular bone present around the roots. In this article, the use of magnetic assembly in fabrication of mandibular overdenture on retained roots and a conventional maxillary removable partial denture is discussed. Magnetic assembly consists of magnet and coping with a keeper on the remaining tooth structure since magnetic attachments can provide support, stability, and retention. Clinical Relevance to Interdisciplinary Dentistry

• The present article demonstrates the rehabilitation of partially edentulous patient with the help of magnetic assembly mandibular overdenture and maxillary conventional removable partial denture. Clinical presentation showed few remaining teeth in relation to the mandibular ridge. A multidisciplinary approach was adopted to retain the remaining teeth in the mandibular arch with the help of endodontic treatment (root canal treatment) followed by prosthetic rehabilitation.

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Rehabilitating patients with maxillofacial defects is one of the most challenging therapies of the stomatognathic system. Maxillomandibular defects being the most common of these defects need to be rehabilitated to restore the lost form, function and speech. Prosthetic reconstruction of these defects may be achieved with the help of varied prosthesis, removable and fixed. The present case report describes a case of CEOT (Calcifying Epithelial Odontogenic Tumor) managed with a treatment obturator which allowed closure of the defect by secondary healing through granulation tissue maturation and associated bone fill. A 19 gauge wire was used for creating the substructure treatment obturator. Wire was adapted to stabilize the appliance, and provide retentive properties. The obturator allowed decrease in size of defect and enhanced comfort and overall well-being of the patient. Clinical Relevance to Interdisciplinary Dentistry

1. Team work involving oral surgeon, oral radiologist and rehabilitation by a prosthodontist lead to the success of the procedure.

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Multiple adjacent recession type defects in the dentition of an individual are routinely encountered in the clinical practice, and hence present a challenge for management. If left untreated or unmonitored, they can be detrimental to periodontal or dental health. Patient esthetic demands have become so stringent that root-coverage procedures carried out should provide soft-tissue anatomy comparable to and indistinguishable from adjacent tissue. A combination of semilunar flap and veneers was used to treat such a kind of defect in a 45-year-old female patient complaining of unsightly and long appearing teeth since 4 years. The present case report demonstrates that the semilunar flap can be an effective treatment for the management of multiple recession defects affecting adjacent teeth. This surgical technique resulted in 100% root coverage of all the anterior teeth except 22 at 10-month post-treatment examination. Further, follow-up is required to evaluate the stability of this treatment. Clinical relevance to interdisciplinary dentistry

1. Biologic width violation is one of the contributing factors for gingival recession.
2. Multiple adjacent recession type defect with altered pink to white ratio in the esthetic zone is a challenge for management.
3. Altered pink to white ratio in such cases may be treated with a combination of semilunar flap and veneers.
4. Team approach needed to decide on the location of the gingival margin and veneer margin to create ideal, stable dentogingival relationships.

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Consistent knowledge of developmental anomalies along with careful clinical and radiographic interpretation is essential pre-requisites for successful management. This case describes a 2-year follow-up of a case with carious mandibular right first premolar with two roots, three root canals and a deep periodontal probing depth along with an early Grade II furcation involvement. The tooth was endodontically treated followed by periodontal surgery, to eliminate the pocket and promote bone fill in the osseous and furcation defect. Hydroxyapatite graft composited with bioactive glass was utilized for enhancing bone formation. Clinical Relevance to Interdisciplinary Dentistry

1. Detailed knowledge of root anomalies in mandibular premolars is a pre-requisite for successful management of combined endo-perio lesions.
2. Periodontal regenerative procedure using hydroxyapatite graft can be performed to enhance bone formation.
3. Use of radiographs and advanced diagnostic aids are recommended for clinical evaluation of tooth anomalies.

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Teeth may be lost because of trauma, caries, periodontal disease, congenital defects and iatrogenic treatment. Tooth loss has a negative impact on masticatory function, esthetics and self-image. Fixed partial dentures, removable partial dentures, complete dentures and implant-supported dentures can replace missing teeth comfortably and esthetically, but it is not known whether they differ in their ability to reconstruct the masticatory function, phonetics and esthetics and preserve the residual bone ridge. Despite recent developments in dental implantology, the conservative approach to root preservation is still valid. In view of increased root caries rate in the elderly arid lax oral hygiene habits of the most overdenture wearers, placing protective copings on root abutments, when economically feasible, is the preferred method of treatment. Retention of overdentures is increased by including stud attachments in the abutments. Incorporation of cast metal frameworks is recommended to prevent base fractures. Clinical Relevance to Interdisciplinary Dentistry With some patients, the operating dentist alone cannot accomplish the correction, but may require the assistance of other dental disciplines. This case report describes an interdisciplinary approach for the coordinated treatment of a patient with badly broken down and missing teeth. The patient's functional and esthetic expectations were successfully met with interdisciplinary treatments, including

• Oral prophylaxis followed by treatment for benign migratory glossitis.
• Endodontic treatment for two grossly carious teeth.
• Cast partial dentures for the maxilla and mandible.

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Objectives: The purpose of this cross-sectional survey was to evaluate the utilization of dental services by pregnant women due to dental pain and also to evaluate the role of their educational qualification on utilization. Materials and Methods: The research tool was a semi-structured questionnaire, which was completed by 175 pregnant women attending various primary health centers, private clinics and nursing homes in Mangalore. The women were divided into two groups namely, Group 1: Who have not been graduated and Group 2: Who have been graduated. Comparisons were made between Group 1 and Group 2. The data collected was analyzed using descriptive statistics, Chi-square test and odds ratio (OR). Results: Decayed teeth were found to be the predominant factor of pain as reported by women in both groups. However, the number of women who utilized dental services during this period was almost identical in both the groups, with 23.5% women in Group 1 and 24.7% women in Group 2. However, the association between utilization of dental care among pregnant women in both groups who did not report dental pain during pregnancy and those who did report showed statistical significance (OR = 13.63; 95% confidence interval = 3.81, 48.75). Conclusion: The present study showed that despite the presence of pain due to dental causes, utilization of dental services by pregnant women was poor. It was also revealed that those with a graduate qualification were more likely to visit a dentist for preventive treatment during pregnancy Clinical Relevance to Interdisciplinary Dentistry

1. Utilization of oral health-care services will provide insight to dental clinicians about treatment planning and also to educate about the treatment option to patients.
2. Pregnant women being one of the target groups for oral health services, oral health professionals must know in detail about their utilization history.
3. Pain is an important factor for utilization of the dental services, which may be due to pulpal, periodontal and oral lesions. Etiology and treatment planning requires an interdisciplinary approach.

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Introduction: One of the reasons for persistent endodontic infection is the retention of microorganism on root canal walls. Studies on endodontic prognosis have demonstrated that the addition of antibiotics to the root canal sealer is proven to be beneficial to prevent re-infection and impart antimicrobial property for a longer time. Aims and Objectives: The primary aim of this study is to determine and the secondary aim is to compare the sealing ability of Kerr Pulp Canal Sealer (extended working time) (PCS [EWT]) when used with or without various antibiotic additives viz.; amoxycillin, doxycycline and metronidazole using apical dye leakage method. Materials and Methods: An in vitro study was performed on extracted human teeth, obturated with sealer-antibiotic combinations and sealers alone. Rhodamine-B dye penetration was done for 10 days and the teeth were sectioned and viewed under light microscope; then linear dye penetration was measured and statistically analyzed. Results: Kerr PCS (EWT) showed mean apical leakage of 3.475 mm (P = 0.655, Z = 0.447), whereas PCS (EWT) combined with amoxycillin showed a mean apical leakage of 0.997 mm (P = 0.084, Z = 1.727) showing its clinical significance. PCS (EWT) + amoxycillin showed the best sealing ability with least apical leakage. Conclusion: Addition of antibiotics such as amoxycillin, doxycycline and metronidazole to Kerr PCS (EWT) sealer is recommended as it helps to improve the antibacterial property and the apical sealing ability. Clinical Relevance to Interdisciplinary Dentistry

1. Bacteria and by-products in the dentinal tubules can cause reinfection of root canal treated teeth.
2. The continuous release of antibacterial agent is desirable to prevent reinfection in root canal treated teeth.
3. This original research hopes to prevent reinfection under the restorations of endodontically treated teeth by the action of additives in root canal sealers and by controlling the microleakage.

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