The astute clinician strives to create a beautiful smile paying due heed not only to the gleaming white teeth, but also to the health of the surrounding tissues. A sound periodontium provides a firm foundation for an esthetic and functional prosthesis. Conversely, when restorations are designed to be self-cleansing and promote gingival health, the tissues present a harmonious esthetic blend at the restorative -gingival interface. This review paper aims at exploring the potential of an interdisciplinary approach to achieve this end. This involves incorporating a comprehensive treatment plan, paying close attention to both soft and hard tissues around teeth and implants before, during, and after restorative procedure. Key aspects of the restoration and partial denture design that have a direct effect on the periodontium include restoration contour, margin adaptation, margin placement, prosthetic and restorative materials, design of fixed and removable partial dentures, restorative procedures and occlusal function. Special emphasis is paid to the consequences of violation of biologic width, that leads to incessant inflammation, possible recession and unsightly exposure of crown margin. Periodontal considerations include control of periodontal inflammation, correction of the gingival architecture, and periodontal maintenance. A search of articles from "Pubmed" and "Medline" with the keywords restorative-alveolar interface, methods of gingival retraction and biologic width was conducted. A total of 430 abstracts were collected, of which most relevant articles were included in this paper. Clinical Relevance to Interdisciplinary Dentistry

• To promote restoration and pontic designs that promote favorable tissue response.
• To stress the importance of preserving biologic width to all dental practitioners
• To shed light on iatrogenic damage to the periodontium from certain materials and procedures.
• To unveil the potential of periodontal plastic surgery techniques like augmenting attached gingiva and esthetic crown lengthening prior to restorative procedures when indicated.
• To emphasize the need for recall and maintenance therapy.

All the above concepts can be successfully implemented into clinical practice.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Aim: The aim of the study was to check the effectiveness of both Robert Azzi and Han and Takei technique in reconstructing the lost interdental papilla between maxillary central incisors. It also compared the two techniques. Materials and Methods: Fourteen systemically healthy patients fulfilling the inclusion and exclusion criteria were selected for the study. The clinical parameters were evaluated at baseline, 6 months and 12 months postsurgically. Results: The results showed that there was a statistical significant improvement in both papilla presence index score and papillary height in both the groups from baseline but on comparison, no technique was superior to the other. Conclusion: Both the techniques were equally good in reconstructing the interdental papilla. And no technique was superior to the other. Clinical Relevance to Interdisciplinary Dentistry An open gingival embrasure or black triangle occurs as a result of a deficiency of papilla beneath the contact point. The treatment of open embrasures may require restorative, orthodontic and periodontal considerations depending on the underlying etiology. Treatment of open embrasures requires an interdisciplinary approach of orthodontic, periodontic, and restorative treatment. Open gingival embrasures have complex esthetic and functional problems. An interdisciplinary team approach with the general dentist, orthodontist, and periodontist is critical.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Periodontology is a fast evolving field where newer insights into existing concepts are changing the face of the traditional periodontal treatment. However, the protocol of periodontal referrals has undergone little change over the last decade. This emphasizes the need for more research into what has been happening in the field of dental practice with a view of achieving the best prognosis for the patient's ailment. A questionnaire study was carried out in the form of a survey among 102 general dental practitioners to assess the knowledge update and periodontal referral relationship among general practitioners (GPs). Aim: The aim was to assess the knowledge update regarding advanced periodontal procedures among general dental practitioners. Materials and Methods: A survey form was distributed to 102 general dental practitioners having their dental clinics in and around Mangalore city with, qualification of Bachelor of Dental Surgery only. Results: The following trends were noted: (1) 71% of private practitioners referred patients to periodontists for surgical therapy. (2) About 50% GPs refer patients to periodontists for ridge augmentation and implant procedures. (3) 76% of GPs have attended <5 continuing dental education (CDE) programs in the past 1-year. (4) 92% of the GPs performed phase-1 therapy on their own. Conclusion: Majority of the private practitioners perform phase-1 therapy on their own, but the referral relationships have improved. Although almost half the number of private practitioners is aware of the procedures like implants and ridge augmentation, it is important to keep the knowledge updated by attending more CDE programs. Clinical relevance to interdisciplinary dentistry The referral of patients to specialist needs to improve and all dentist must be updated of the current trends in dental practice

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

An abnormal upper labial frenum is one of the most common mucogingival problems that can lead to formation of diastema, limit the lip movement, and may affect the esthetics in case of a high smile line. Frenectomy is a common restorative surgical procedure in the field of dentistry and is the treatment of choice to correct the atypical frenum. Over the last century, this technique has been modified in many ways. This case report highlights a technique of frenectomy that resulted in good esthetics, color match, and patient comfort for treatment of an abnormal frenum. Clinical Relevance to Interdisciplinary Dentistry Present technique was carried out as a preventive measure to avoid post-orthodontic relapse due to existing tension by the labial frenum. Specifically before orthodontic intervention, presented technique also displayed its significance because of the achieved gain in attached gingiva; healing by primary intention and acceptable color match in the esthetic zone.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Unicystic ameloblastoma (UA) derived the name by its macro and microscopic appearance. It is considered to be less aggressive compared with conventional ameloblastoma both in its growth pattern and recurrence rate, however, few of its histopathological types are treated in the same manner as that of conventional ameloblastoma. Therefore, the aggressiveness of this lesion is a dependent factor. Most of these lesions when occur in the mandibular third molar region with impaction, they are usually removed on radiographic diagnosis of dentigerous cyst and then the specimen is subjected to histopathological examination. Hence, the diagnosis of UA is evident only after microscopic evaluation of the specimen. Here, we report one such case of UA treated by enucleating on radiological findings. Clinical Relevance to Interdisciplinary Dentistry

• When a cyst of the jaw is associated with impacted tooth the most common provisional diagnosis is dentigerous cyst, at the same time unicystic ameloblastoma (UA) (dentigerous variant) need to be considered as one of the differential diagnosis along with other cysts of the jaws. Then, it becomes important for the radiologist to carefully examine radiograph to assess the true dentigerous cyst-impacted tooth relationship to narrow down the diagnosis
• On removal of such cyst either in toto or as a cyst wall curettage, it is important for the surgeon and the pathologist to examine both the inner and outer wall of the cyst sac. The presence of several polypoid/exophytic/nodular growths in the inner and/outer surface of the cyst wall may favor the initial diagnosis of UA rather than dentigerous cyst even though lack of these finding does not contradict the diagnosis of UA
• When treatment of such cyst done based on radiographic diagnosis, entire tissue of the cyst after enucleation must be evaluated histopathologically by the pathologist to eliminate possibility of UA and when diagnosed histopathologically as UA, serial sectioning of the entire tissue is mandatory for the pathologist to arrive at the diagnosis of proper subtype of UA, as the recurrence rate changes accordingly
• In our case, the UA was treated conservatively by considering the radiographic diagnosis of a dentigerous cyst. Whereas histopathology revealed UA subtype 1.2.3. Follow-up after 6 months showed good bone remodeling with no sign of recurrence on the radiograph. Since the recurrence of UA is long delayed, regular follow-up for a long period is necessary
• Thus, the collective opinion by the clinician, radiologist, surgeon, and pathologist plays a very important role in the effective management of UAs.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

One of the biggest challenges in management of severe hypodontia cases is the inadequate space for restorations. Increasing the occlusal vertical dimension (OVD) using conventional prosthodontics can be aggressive, technically challenging and accompanied with high maintenance. Application of Dahl's principle to create space is well-documented and is commonly applied in tooth wear patients. To date, there is no evidence to use Dahl's principle in severe hypodontia patients. However, with the signs of dentoalveolar compensation, Dahl's concept should be considered at an earlier stage to increase OVD due to its conservative nature. This article illustrates and provides a detailed description regarding this technique to create the restorative space for implant supported restorations. Clinical Relevance to Interdisciplinary Dentistry

Severe hypodontia is rare and ideally should be managed since young

This full mouth rehabilitation case was carefully planned using conservative prosthodontics approach to achieve optimum outcome

Interdisciplinary management is always needed involving different specialties to contribute their own expertise and working together to achieve an ideal outcome for the patient.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Dental implants are being increasingly used in dentistry. Millions of implants are being placed on a yearly basis around the world by dental surgeons. These implants support restorations ranging from a single crown to a denture. There are significant costs associated with implant supported restorations. The advent of peri-implant diseases threatens the survival and maintenance of implant supported restorations leading to significant impact on the sustainability of such restorations while affecting the patient's functionality. This review article discusses the current concepts, as well as the etiopathological and treatment considerations related to peri-implant diseases. Clinical Relevance to Interdisciplinary Dentistry Peri-implant disease affects implants, the peri-implant tissues and implant supported restorations. This article is relevant to this journal as peri-implant disease and its management is detrimental to the practice of the various disciplines of dentistry including periodontics, prosthodontics, implant dentistry and restorative dentistry

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Prosthetic rehabilitation of edentulous sites with concomitant alveolar deficiency is always an esthetic and functional challenge. In the current case, the advantages of distraction osteogenesis and hybrid prosthesis with a cast metal framework were used to restore esthetics and function. The surgical elegance of distraction osteogenesis combined with the variety of features of hybrid prosthesis ensured successful rehabilitation, patient comfort and ease of maintenance. This case report highlights the need for meticulous preoperative planning and selection of the right options, both surgical and prosthetic to effectively restore complex oral defects using implants. Traumatic defects are mostly accompanied by hard and soft tissue loss. This report describes the surgical and prosthetic treatment of a patient with a traumatic mandibular defect. The trauma resulted in the loss of numerous mandibular teeth and extensive loss of bone particularly in the anterior mandible. In order to restore the lost hard and soft tissues, the treatment plan comprised of alveolar distraction osteogenesis in the anterior mandible followed by an implant supported screw-retained FP-3 prosthesis. This article also describes a technique to ensure a passive well-fitting cast metal framework for the fixed removable screw-retained hybrid prosthesis. Clinical Relevance to Interdisciplinary Dentistry

• Placement of implants in compromised edentulous ridges often results in a compromised final prosthetic outcome.
• This case report describes an interdisciplinary approach to manage hard and soft tissue ridge defects using alveolar distraction osteogenesis, followed by implant placement and prosthetic rehabilitation using a hybrid denture. The integration of the faculties of prosthodontics, oral and maxillofacial surgery, and oral and maxillofacial radiology was the key factor that determined the successful completion of this complex and technically demanding case.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Objectives: The purpose of this study is to evaluate the effect of occlusal equilibration using immediate complete anterior guidance development (ICAGD) technique by Kerstein. This technique is the most advanced verifiable and measurable way of digitally analysing the occlusion using T-scan technology and muscle activity using electromyography. Materials and Methods: This study is to assess the subjective symptoms of 75 patients diagnosed as myofascial pain patients and who were treated by ICAGD technique as described by Kerstein. The common complaints of the patients were pain in the masseter and temporal muscles, jaw tiredness in the mornings, night bruxing and difficulty in chewing. This technique involves occlusal equilibration to remove all posterior interferences and establish anterior guidance. The patients were treated over three visits 1-week apart and followed for 3 years. The symptoms reduction occurred for all the patients after the first correction in about 5-10 days. In about a period of 3 years review, no recurrence was seen of the chronic myofascial symptoms. Results: Regardless of the chronic nature of the patient's symptoms, symptom reduction occurred in a week's time. This agrees with the studies of Kerstein and others. Discussion: If free excursive mandibular movements are not established, may lead to muscle dysfunction at later years. Thus, equilibration should be done to establish good and free functional movements without any interference. Clinical relevance to interdisciplinary dentistry Using biometric tools like T scan helps dentists to 100% accurate diagnosis of TMD/ occlusion problems and to treat the case objectively. In the area of interdisciplinary practices, these gadgets help us to identify the issues precisely. Thus, a clinician will be at an advantage to locate the causative factor immediately with accuracy and treat the patient.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Gingivoplasty, gingivectomy, and crown lengthening procedures are routinely carried out in dental practices to correct irregular gingival contours, remove excess gingival tissue, gingival overgrowths, and to expose the finish lines for restorative purposes, respectively. These soft tissue excision procedures are routinely performed either with gingivectomy knives, bard parker blades and electrosurgery. However, in the recent past, with the advances in the technology the use of lasers for the soft tissue treatment has emerged. Moreover, the increased postoperative discomfort and bleeding that have been associated with conventional methods has always weighed on the minds of the practitioners, as well as the patients. This paper describes a case where the gingival margins were stable even after 3 years of follow-up with the laser method. Clinical Relevance to Interdisciplinary Dentistry

• Full mouth rehabilitation requires a multidisciplinary approach. In this present case LASER has been used for gingival contouring, and has been compared with scalpel.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Palatal radicular grooves (PRGs) are developmental anomalies of maxillary incisors, when present can act as a site for plaque accumulation and periodontal infection. They are easily overlooked as etiologic factors, as these grooves are covered by periodontal tissues. The clinician has to be alert and check for variations in the anatomy of the tooth as a cause of pulp necrosis in the anterior segment of the tooth when other causes are ruled out. It is often associated with incorrect diagnosis, and subsequent treatment failure. This case report describes the diagnosis and management of two cases of Type II PRG of a maxillary lateral incisor with periapical and periodontal regeneration. Clinical Relevance to Interdisciplinary Dentistry

PRG presents with myriad symptoms.

Accurate diagnosis requires careful clinical and radiographic examination and advanced imaging, in doubt.

Early detection and an interdisciplinary approachs are required to improve the prognosis of the involved tooth.

Platelet-rich-fibrin acts as the promising material of choice for regeneration of lost structures and faster soft tissue wound healing.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]