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DENTO-MED JOURNAL
VOL I, ISSUE1, April 2014
 DENTO-MED JOURNAL
AN OFFICIAL SCIENTIFIC PUBLICATION OF
Dr. G. D. Pol Foundation

Dr. R. D. Das
Editor, Dental Section

Dr. Deeepa Das

Editor, Dental Section

Dr. Vidya Dharane

Editor, Ayurvedic Section

Dr. Varsha Sharma

Editor, Homeopathic Section

Advisors
Dr. Sharad Kokate
Dr. Sanjeev Yadav
Dr. (Mrs.) P. P. Page

Printed For : Dr. G. D. Pol Foundation

Dental College & Hospital, Kharghar, Navi - Mumbai - 410 210

INFORMATION FOR AUTHORS

MANUSCRIPTS : In general, papers must be written in English, and typed double spaced with wide margins on both sides
and submitted in duplicate. Tables, figures captions and other appended materials must be typed on separate sheets.
Manuscript should also be sent in a CD.
REFERENCES : Should be keyed to the text material and placed at the end of the article. The reference should be indexed as
per the vancover method.
ILLUSTRATIONS : Should be clearly numbered and legends should be typed on separate sheet of paper while each figure
should be referred to in the text. Good colour photographs should be supplied.
TABLES : Each table should be typed on separate sheet with the number and title at the top. Footnotes to tables should
appear directly below the table to which they belong.
ABBREVIATIONS : Should be defined the first time they are used.
COPYRIGHT : Submission of manuscripts implies that the work described has not been published before (except in the form
of an abstract or as part of published lecture, review of thesis) that it is not under consideration for publication elsewhere in the
same form, in the same or another language without the comment of copyright holders. The copy right covers the exclusive
rights of reproduction and distribution, photographic reprints, video cassettes and such other similar things. The editors and
publishers accept no legal responsibility for any errors, omissions or opinions expressed by authors. The publisher makes no
warranty, for expression implied with respect tot the material contained therein. The journal is edited and published under the
directions of the journal committee who reserve the right to reject any material without giving explanations. All communication
should be addressed to the Editor.

GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014

 TITLE InDEX
1 YOU DID IT !...... PERIORAL LESION WITH HYPERPIGMENTATION
AFTER DENTAL EXTRACTION – A CASE REPORT
1
Authors
Dr. Vaishali Das, Dr.Shreyas. H. Gupte, Dr. Sachin.P. Bagade

2 PREVALENCE OF DENTAL CARIES AMONG 10-12 YEAR OLD CHILDREN OF

JAFFARI SCHOOL, MUMBAI : A CROSS - SECTIONAL SURVEY 3
Authors
Dr. Dimple Bajaj , Dr. Suyog Savant

3 BETA ANGLE : IS IT RELIABLE? 7

Authors
Dr. Rajesh B. Kuril, Dr. Anita Karandikar, Dr. Dhiren Gaitonde, Dr. Rajesh B. Kuril

4 AMELOBLASTIC FIBRO-ODONTOMA IN ANTERIOR MAXILLA

Authors 11
Dr. Komal Khot, Dr. Barakha Nayak

5 PHOTODYNAMIC THERAPY 16
Authors
Dr Gopal Sharma, Dr Deepa Das, Dr Bhagyashri Purandare, Dr Jaya Mukherjee

6 INSIDE OUT BLEACHING TECHNIQUE- A TREATMENT FOR 22

DISCOLOURED ENDODONTICALLY TREATED TEETH
Authors
Dr Ashwin Jain, Dr. Ushaina Fanibunda, Dr Sapna Sonkurla, Dr Mrinalini Kunte

7 DIAGNOSTIC WAX UP - A VALUABLE TOOL IN

AESTHETIC TREATMENT PLANNING
27
Authors
Dr Ashwin Jain, Dr. Ushaina Fanibunda, Dr Sapna Sonkurla,
Dr. Omkar Shete, Dr. Aruna G.

8 REHABILITATION OF A PATIENT WITH OVERDENTURE USING

STUD ATTACHMENTS - A CASE REPORT 30
Authors
Dr. Omkar R. Shete, Dr. R. D. Das, Dr. Dhananjay Joshi, Dr. Anuradha Nemane,
Dr. Parmeet Banga

GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014

 Few words from our chairman Dr. G. D. Pol

I am very happy to know that the Dental College is coming out with the
issue of “DENTO -MED” .

Since we started with our Post Graduate studies few years back the
college is buzzing with scientific activities & has grown to new heights .

To compile all these scientific activities by the staff and the students we
decided to print our own scientific magazine and is being published at regular
intervals.

I congratulate the staff, the students and specially the editorial team in
making this journal a great success & to sustain the same, getting it to greater
heights.

Dr. G. D. Pol
Chairman

GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014

 Few words from our Dean Dr. Sharad Kokate

It is gives me immerses pleasure to announce the coming of our scientific

journal “Dentomed”.

As an institute Dean I am proud to announce that all our post graduate

subjects got recognition. this has put a strong foundation for us to march
ahead and achieve great goals in dental education in future Under the
dynamic vision of our Chairman Dr. G. D. Pol, the institution has made
consistent progress year after year.

I thank the editor of the journal prof. (Dr.) R. D. Das and his editorial team
for taking great efforts to comeout with this excellent issue.

Dr. Sharad Kokate

Dean

GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014

 We need to ask ourselves, what is our purpose for scientific writing ? Is it for
merely scoring academic points or to contribute to the scientific field and make a
difference ? if one wants to develop a serious profile in a specific area then that will
determine the journals we write for. Sharing and writing with others, and analyzing your
work carefully, carefully considering reviewer’s feedback, all go a long way in ‘quality’
scientific writing content.

Having this ‘writing strategy’ means you are making sure you have both external
motives, such as scoring points and internal motives, which mean working out why
writing for journal matters to you. This will help you to maintain the motivation you will
need to write and publish over a longer term.

Our commitment to come up with a journal and a platform for scientific writing of
excellence has been applauded; both for our consistency in bringing out the journal on
time and striving to maintain a high level of quality throughout. We, at the editorial
board, are proud to announce the first dental issue, we too hope we continue to achieve
greater heights in genius and quality here at the editorial desk and hope that you as
authors too help to maintain the standards of quality and scientific content contribution!

GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014

 YOU DID IT !...... PERIORAL LESION WITH HYPERPIGMENTATION
AFTER DENTAL EXTRACTION – A CASE REPORT
Dr. Vaishali Das
Reader, Department Of Oral & Maxillofacial Surgery.
YMT's Dental College & Hospital, Navi Mumbai.
Dr. Shreyas.H.Gupte
Reader, Department Of Oral & Maxillofacial Surgery.
YMT's Dental College & Hospital, Navi Mumbai.
ABSTRACT:
In the age of “.com” there is too much of
information but less of knowledge. To much stress
is given to information as a result of which
patients with all the collected information and no
knowledge from medical field knock at the
doctors door accusing them for any untoward
event that occurs after the treatment has been
given whether related or unrelated. This small
case report just highlights a similar situation; but
we as doctors first should look at all possibilities
causing a particular complication either local or
systemic and if need be should do the apt referrals
so as to attend to the patients problem more
rationally and prevent any further complications
either medical or medico legal.
INTRODUCTION:
In modern times with easy access to
general but incomplete information and without
sound medical knowledge many of our patients
get misled and confused and as a result have a
general tendency to blame the doctor for any
complications arising from various surgical
procedures saying . YOU DID IT! This small case
report just highlights a similar situation and
emphasizes on the fact that as a operating
surgeon it is important for us to understand a
problem comprehensively co-relate to the case
history and probe into such problems discretely
so as to give a satisfactory reply to the patients
blame and avoid any medico legal complications.
CASE REPORT:
A 15 yr old girl was referred from Dept of
Orthodontia for extractions of 14,24,34 and 44.
After following the routine departmental protocol
1 GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
Dr. Sachin.P. Bagade
Lecturer, Department Of Oral & Maxillofacial Surgery.
YMT's Dental College & Hospital, Navi Mumbai.
and taking case history it was decided to extract
14 & 44 in one sitting in 24 & 34 at the next
sitting after a gap of a week, Post operatively only
tab. crocin was advised in case of pain .The first
sitting extractions were uneventful .
After the second sitting of extractions were
done, almost after a week the patient reported to
the Dept of Oral And Maxillofacial Surgery with
brownish black discolouration circum orally
subjacent to the upper and lower lips.
On extra-oral examination a band of
brownish black discolouration was evident
circum-orally. The lesion was accentuated
bilaterally at the angle of the mouth with a
fissurated appearance. Intraoral examination
revealed that all the extraction sites were healing
excellently and the mucosa and gingiva was
absolutely healthy there were orthodontic
brackets in situ which were put about two weeks
back.
Since the metallic orthodontic brackets
were in situ since day one the possible contact
allergy to this metal was ruled out. The patient
had already undergone extractions in the
previous week without any complications and no
antibiotics were prescribed, so allergy to the
same was ruled out. It was also confirmed that
no savlon or betadine was painted so possible
contact allergy with the same was ruled out. But
the patients complaint was very much the same I
was fine so far but after the extraction was done I
have developed this lesion on the face. On
further probing the patient and her parents on
whether she had applied any cosmetic ointment,
lipstick, cream etc the patient said that
approximately on the fifth day after the extraction
was done she had applied Vaseline on her lips.
This was of a different brand than what she
usually used, after which she developed a red
lesion initially which was itchy and the it got
discoloured .Further on her father gave us a
history that the patient does have skin allergy
problems in the past she had some allergy
problems with the scalp for which was treated
about 1 year back.

Thus an apt referral to a Dermatologist

was made who diagnosed it as contact dermatitis
with fungal infection and suitable treatment was Photograph showing circum-oral hyperpigmentation
given.

DISCUSSION:
Though we are professionally trained
dentists we are doctors first, hence we should
look at all possibilities causing a particular
complication may be local or systemic and if need
arises apt referrals should be done to attend to
the patients problem more rationally and prevent
any further complications either medical or
medico legal.

GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014 2

 Prevalence of Dental Caries among 10-12 year old children of
Jaffari school , Mumbai: A Cross –sectional survey
Dr. Dimple Bajaj , Dr. Suyog Savant
Department of Public Health Dentistry
YMT Dental College & Hospital, Kharghar , Mumbai
Abstract:
Objective:
To assess the prevalence of dental caries
and treatment needs among 10-12 year old
children of Jaffari school, Mumbai, India.
Methods:
Study population comprised of children
aged 10-12 years who were attending the Jaffari
school in Govandi. The children were examined
in their school seated on an ordinary chair, in
broad day light using WHO (1997) criteria. All the
children requiring treatment were referred to the
Department of Pedodontics and Public Health
dentistry, Y.M.T. Dental College and Hospital,
Kharghar.
Results:
The overall prevalence of dental caries in
the sample was 86.59%. Prevalence of dental
caries in females(94.67%) was higher for all age
groups as compared to males(80.12%). The
DMFT+deft was 3.98, 3.83 and 2.53 for 10, 11
and 12 years respectively.
Conclusion:
This study is a pointer to the fact that there
still exist a large segment of the population who
continue to remain ignorant about the detriment
effect of poor oral health and the multiple
benefits enjoyed from good oral health.
Key Words: Dental Caries, Treatment
Needs, Prevalence
3 GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
INTRODUCTION
Dental caries can be traced to be as old as
1
civilization with its evidence seen even in skeletal
remnants of prehistoric human. It is a
multifactorial disease, caused by a web of factors
like micro-organisms, substrate, host factors
2
related to the teeth and time.
Dental caries is the most common chronic
disease of childhood that interferes with normal
nutrition intake, speech, self-esteem and daily
routine activities, because the caries pain
adversely affects the normal food intake.
Hence, an attempt is made to provide baseline
data of dental caries prevalence and treatment
needs among 10-12 year old children of Jaffari
school, Mumbai, India.
AIMS AND OBJECTIVES
1. To assess the prevalence of dental caries
and treatment needs among 10-12 year
old children of Jaffari school, Mumbai,
India.
2. To provide a baseline data and
information about dental caries
experience.
3. To provide information to the health
authorities for planning appropriate
preventive and curative programs for
schools.
MATERIALS AND METHODS
The present study was carried out in Jaffari
th th
school , Govandi between 10 October to 14
November 2011. The study population
comprised of children aged 10-12 years who
were attending the Jaffari school in Govandi.
Before starting the study official permission was
obtained from all the concerned authorities. An
initial training and calibration exercise was
conducted to provide practical experience in the
study methodology and the coding system for the
dental examiners prior to the main survey. Visit to
the school was made on predecided dates and all
the students present on the scheduled dates were
examined.
The children were examined in their school
seated on an ordinary chair, in broad day light
using WHO (1997) criteria. The children were
asked to rinse mouth thoroughly before
examination, then the teeth were dried with
cotton swab and the dental caries were recorded
using DMFT and deft.
All the children requiring treatment were
referred to the Department of Pedodontics and
Public Health dentistry, Y.M.T. Dental College and
Hospital, Kharghar. Survey findings were
reported to respective school authorities on the
spot. The data gathered was analyzed using
statistical package SPSS and the results were
tabulated.
RESULTS
Epidemiological survey was conducted for
261 school children; belong to the age group of
10-12 years. Out of the study population
186(71.26%) comprised of males and
75(28.74%) comprised of females [Table-1].
The overall prevalence of dental caries in the
sample was 86.59%. It was found that 10 years
had 94% spread of dental caries as compared to
85.42% and 76.92% in 11 and 12 years age
group [Table-2].
Further, it was observed that prevalence of dental
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
caries in females (94.67%) was higher for all age
groups as compared to males (80.12%) as shown
in Table-3.
The DMFT+deft was 3.98, 3.83 and 2.53 for 10 ,
11 and 12 years respectively [Table-4].
DISCUSSION
This study documented 86.59%
prevalence of dental caries among school
children aged 10-12 years in Jaffari school ,
Govandi, Mumbai, indicating a widespread
neglect of oral health in the children.
It was observed that the caries prevalence of 12
years age group was lower as compared to the
10 and 11 years. This show as age advances the
prevalence of dental caries decreases. This
finding corresponds with the studies conducted
by Joyson Moses (2011)3, Peterson PE et al
(1991)4, Retna Kumari N (1999)5 and Dash JK
6
(2002) .
In the present study, we find slightly high number
of caries cases among females (94.67%) in
comparison to males (80.12%). This can be
attributed to number of facts, including early
teeth eruption in girls in comparison to boys, fear
of dentist among male and female and also to
differences in dietary patterns7, 8.
Higher DMFT scores in the age group of 12 years
appears to be due to increased exposure of the
susceptible tooth to poor oral hygiene
conditions, because dental caries is a continuous
and cumulative process.
CONCLUSION
The result of this study is a pointer to the fact that
there still exist a large segment of the population
who continue to remain ignorant about the
detriment effect of poor oral health and the
multiple benefits enjoyed from good oral health.
4
Table 1: Distribution of sample on the basis of age and sex

Table 2: Prevalence of dental caries

Table 3: Prevalence of dental caries on the basis of gender

5 GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014

 Table 4: Intra-analysis of deft+DMFT
REFERENCES
1. National Oral Health Policy; JIDA 1986;
58:397-401.
2. Fejerskov O. changing paradigms in
concepts on dental caries:consequences for
oral health care. Caries Res. 2004;
38(3):182-91.
3. Joyson Moses, BN Rangeeth, Deepa G :
Prevalence of dental caries , Socio-
Economic status and treatment needs
among 5 to 15 year old school going
children of Chidambaram. Journal of
Clinical and Diagnostic Res. 2011; 5(1):
146-151.
4. Peterson PE, PulsenVJ, Ramalhaleo J and
Ratsifaritara C: Dental caries and dental
health behavior situation among 6 and 12
year urban school children in Madagascar.
Afr Dent J. 1991;5:1-7.
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
5. Retna kumara N: Prevalence of dental
caries and risk assessment among primary
school children of 6-12 year old in the
Varkala municipal area of Kerala. J Indian
Soc Pedo Prev Dent. 1999; 17(4):135-142.
6. Dash JK ,Sahoo PK, and Bhuyan SK:
Prevalence of dental caries and treatment
needs among children of cuttack(Orissa). J
Ind Soc Pedo Prev Dent. 2002;20(4):134-
144.
7. Nanda A, Ingle NA: Study of fear in
dentistry. J Ind Dent Assoc. 2002; 73:104-
110.
8. Kutesa A, Mwanika A, Wandera M. Pattern
of dental caries in mulago dental school
clinic, Uganda. African Health Sci.
2005;5:65-68.
6
 BETA ANGLE : IS IT RELIABLE?
DR. RAJESH B. KURIL, DR. ANITA KARANDIKAR, DR.DHIREN GAITONDE,
M.D.S. ORTHODONTICS, READER M.D.S. ORTHODONTICS, (PROFESSOR) READER
DEPARTMENT OF ORTHODONTICS, ADDRESS: DEPARTMENT OF ORTHODONTICS, DEPARTMENT OF ORTHODONTICS,
Y.M.T. DENTAL COLLEGE, KHARGHAR, Y.M.T. DENTAL COLLEGE, KHARGHAR, Y.M.T. DENTAL COLLEGE, KHARGHAR,
Email id: rajeshlibran3@yahoo.com Email.id: drkarandikarymt@gmail.com Email.id: dhirengaitonde@rediffmail.com
DR. SANUBER SACNIDINIA,
Postgraduate Student
DEPARTMENT OF ORTHODONTICS,
Y.M.T. DENTAL COLLEGE, KHARGHAR,

Abstract:
Purpose:
1) This study was done to assess reliability of Beta
Angle in sagittal skeletal discrepancy and effect
of jaw rotations on the measurement of Beta
Angle.
2)To compare the values of Beta Angle and ANB
angle in sagittal skeletal discrepancy cases.
Material and Method:
Total 60 patients cephalograms (aged 15 to 25
years) were selected for the study. The mean and
SD were calculated for ANB angle and Beta
Angle. After using Analysis of Variance, we
obtained results that showed stastically significant
difference between the values of ANB and Beta
angle in different sagittal skeletal growth
patterns.
Conclusion:
1) From the present study, it can be concluded
that ANB angle remains more reliable as
compared to Beta Angle in non-growing
individuals.
2) Jaw rotations affect Beta Angle to a large
extent and can often be misleading.
Key words: Beta Angle, ANB angle, jaw rotations,
sagittal skeletal growth pattern.
Introduction:
One of the major concerns in orthodontics
is the accurate evaluation of sagittal jaw
relationship between maxilla and mandible.
Rotations of jaws during growth,vertical
relationships between jaws,lack of validity of
landmark location and inter-examiner variability
makes diagnosis even more critical. (1-3)
Since Wylie's first attempt to describe A- P
jaw relationship, various other cephalometric
parameters have been proposed.4 Downs(1948)
introduced the A-B plane angle.5A few years later
Riedel in 1952 introduced ANB angle. Although
some authors have questioned the reliability of
ANB angle depending upon changing position of
nasion during growth, till date it is the most
commonly used measurement to assess the
sagittal discrepancy.6-8 Recently, few researchers
have proposed new angular measurements to
assess the anteroposterior jaw discrepancy
between maxilla and mandible.9
Alex Jacobson in 1975 introduced
Wits appraisal. It relates point A and Point B to the
functional occlusal plane. The distance between
the points of intersection AO and BO is measured
to describe antero-posterior relationship.In
females AO should coincide BO, whereas in

7 GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014

males BO should be 1mm ahead of AO. Though
Wits appraisal avoids point N, accurate
identification of functional occlusal plane is not
easy or accurately reproducible, especially in
mixed dentition patients. Secondly, any change in
the angulation of functional occlusal plane,
caused either by tooth eruption and dental
development or orthodontic intervention can
10
profoundly influence Wits appraisal.
Baik and Ververidou (2004) introduced
an approach for assessing sagittal discrepancy,
called as Beta Angle. The authors have
specifically mentioned that the beta angle
remains relatively stable even when the jaws are
11
rotated. Few studies have also shown that Beta
Angle in highly reliable to assess anteroposterior
12
sagittal discrepancy.
However, based on this study, few things
need to be considered before implementing the
Beta Angle for analysis of anteroposterior sagittal
jaw discrepancy.
i) It uses point A and Point B, which can be
remodeled by orthodontic treatment and
growth
ii) Minor changes in jaw rotations, reflects as
high variability in the values of Beta angle.
iii) Reproducibility of condylion on closed
13
mouth lateral films is limited.
0
iv) Nearly, 1 error is there in approximation
11
of centre of condyle.
iv) There is high sensitivity in discrimination of
Skeletal Class II group from Skeletal Class
I group.
Materials and Methods:
The present study was done at Department
of Orthodontics, Y.M.T. Dental College,
KHARGHAR. The sample consisted of non-
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
orthodontically treated individuals. After
screening many files from the department record
files, total 60 pretreatment cephalograms were
selected for the study. The age group was 15 to 25
years old individuals and samples were retraced
after initial selection for accuracy of selection.
Group1 : Skeletal Class I
(Male: 10 and Female: 10)
Group2 : Skeletal Class II
(Male 10 and Female:10)
Group3 : Skeletal Class III
(Male 10 and Female: 10)
All the lateral cephalograms were exposed with
jaws in centric relation, lips relaxed and head in
natural head position. The radiographs were
exposed under the standard condition in
Department of Oral Medicine and Radiology.
Selection Criteria for the Samples:
Skeletal Class I: ANB angle 10 to 30
Skeletal Class II: ANB angle above 4
0
Skeletal Class III : ANB angle less than or equal to
1
0
Statistical Analysis :
Data collected was entered to Excel(
Microsoft, Redmand, Washington,USA).All data
were visually screened for any missing data or
outliers and for validity of distribution
assumptions. The mean, Standard Deviation and
p values were calculated for each parameter.
Analysis of variance (ANOVA) was performed
and highly significant differences were found in
ANB angle and Beta angle values. No statistically
significant difference in the mean value of ANB
angle within the groups was observed. In
between the genders, no statistically significant
difference was observed. (Table-I)
8

Discussion:
In orthodontics diagnosis and treatment
planning is an indispensible step and
anteroposterior relation of the jaws is generally
determined by cephalometric analysis.
9
Clinicians with increasing frequency are treating
malocclusions in conjunction with orthognathic
surgery. A method of maxillomandibular
assessment that provides accurate data on this
relation at an early age would be highly
desirable.11To evaluate this relationship, various
angular and linear measurements have been
suggested, but these can be erroneous as
angular measurements are affected by the
inclinations of reference line.
So, one must consider Bjorks opinion
that the human body constitutes a functional
entity, no part of which can be varied without
entailing some changes in other parts. Similarly,
the facial skeleton and the dentition are
functional parts of the skull as a whole. It follows,
therefore, that variations in the bite will be
largely related to cranial and facial structures.
14
Baik and Ververidou suggested that,
Beta angle enables better diagnosis and
treatment planning for patients. But in the
present study it is observed that the complex
geometry in the craniofacial region makes this
9 GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
measurement unreliable. This can be explained
with the help of following figure. (fig.1)
Authors have mentioned that the Beta
Angle remains relatively stable even when the
jaws are rotated. They suggest that as B-Point
rotated either backward or downward, then the
C-B line is also rotated in the same direction,
carrying the perpendicular from point A with it.
Because the A-B line is also rotating in the same
direction, the Beta Angle remains relatively
stable. But, on the contrary when actually, it is
measured on cephalograms, there is substantial
variation in Beta Angle measurement .This factor
of jaw rotations can often be misleading and
makes the interpretation of this angle much
more complex. H o w e v e r, ANB angle
measurements did not show so much variation in
measurements in the same cephalograms.
This variability in measurements can
make this angle more unreliable during
consecutive comparisons, throughout
orthodontic treatment.
The present study is in contradiction to
previously done study by Sachdeva et al. who
showed that Beta Angle is significant to asses
sagittal jaw relations between maxilla and
10
mandible as compared to ANB angle. One more
study by Doshi et al. has also mentioned that the
Beta Angle is highly reliable to assess
12
anteroposterior sagittal discrepancy.
From this study we suggest that
clinicians should not totally rely on Beta Angle for
diagnosis and treatment planning of skeletal
sagittal discrepancy. A clinician should be aware
of as much cephalometric analysis as possible but
use them cautiously and appropriately. A
cephalometric analysis in the form of ANB angle,
which was developed years ago, still remains
more reliable as compared to Beta Angle
REFERENCES :  roentgenograms. Am J Orthod 1955; 41: 658-73.
1. Jacobson A: The "Wits appraisal ofjaw disharmony.
Am J Orthod 1975; 67: 125-138.
2. Moyers RE, Bookstein FL, Guire KE:The concept of
pattern in craniofacialgrowth. Am J Orthod 1979;
76: 136-148
3. Nanda R , Me r r i l l RM : Cephalometric
assessment of sagittal relationship between
maxilla andmandible: Am J Orthod Dentofac
Orthop 994;105:328-44
4. Wylie W L 1947 : The assessment of anteroposterior
dysplasia. Angle orthodontist 17: 97–109
5. Downs WB: Variations in facialrelationships: Their
significance in treatment and prognosis: Am J
Orthod 1948;34:812-823
6. Moyers RE, Bookstein FL, Guire KE. The concept of
pattern in craniofacial growth. Am J Orthod
1979;76:136-48.
7. Moore AW. Observations on facial growth and its
clinical significance. Am J Orthod 1959;45:399-
423.
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
especially in the non-growing individuals.
Cephalometrics is not an exact science.9
This study proves an effort to overcome
shortcomings of previous analysis can have its
own limitations too.
Conclusion:
1) From the present study, it can be
concluded that ANB angle remains more
reliable as compared to Beta Angle in
non-growing individuals.
2) Jaw rotations affect Beta Angle to a large
extent and can often be misleading.
8. Nanda RS. The rates of growth of several facial
components measured from serial cephalometric
9. Bhad WA, Nayak S and Doshi UH: A new approach
of assessing sagittal dysplasia : the W angle :
European Journal of Orthodontic 2011:1-5.
10. Kavita Sachdeva,,Anil Singla, Vivek Mahajan, H.S.
Jaj, et al: Comparison of Different Angular
Measurements to Assess Sagittal Skeletal
Discrepancy - A Cephalometric Study:Indian
Journal of Dental Sciences;June 2012 Issue:2, vol
4:027-029
11. Baik CY, Ververidou M: A new approach of
assessing sagittal discrepancies: the Beta angle.
Am J Orthod Dentofac Orthop 2004;126:100-
105.
12. J R Doshi, Kalyani Trivedi, Tarulatha Shyagali:
Assessment of Anteroposterior apical jaw base
relationship using MountVernon Index (MVI):Jr. of
Oral Health Research,Issue1, vol 2:28-32
13. Adenwalla S T, Kronman J H, Attarzadeh F 1988
Porion and condyle as cephalometric landmarks:
an error study. American Journal of Orthodontics
and Dentofacial Orthopedics;94: 411–415
10
 Ameloblastic fibro-odontoma in anterior maxilla- A case report
Dr. Komal Khot1 Dr. Barakha Nayak, 2
Department of Oral Pathology & Microbiology ,
Y.M.T Dental College Navi Mumbai
Abstract-
Ameloblastic fibro-odontoma (AFO) is a
rare benign mixed odontogenic tumor. It is a
slow-growing, generally asymptomatic lesion
and more prevalent in children and adolescents.
Here is a report of an interesting case of AFO
involving anterior maxilla in a fifteen year-old
male patient. Occlusal radiograph showed a
large, well-demarcated radiolucency with radio-
opaque areas & miniature teeth like structures.
Histologically, the lesion was diagnosed as AFO
associated with compound odontoma .This paper
discusses the clinical, radio graphical and
histopathological aspect of AFO with review of
literature. The patient has been monitored for
eight months, and the lesion has not recurred till
date.
Introduction-
Odontogenic tumors are a heterogeneous
group of diseases ranging from hamartomas to
benign and malignant neoplasms. Odontogenic
tumors arise from odontogenic epithelium,
ectomesenchyme and mesenchymal tissue.
Recent studies assessing large numbers of cases
have shown that these tumors constitute 0.84% to
1.78% of the histopathological findings of
renowned Oral Pathology departments.2
According to the World Health Organization ,
ameloblastic fibro-odontoma (AFO) is a tumor
with histological features similar to those of
ameloblastic fibroma (AF), but with inductive
changes that lead to the formation of dentin or
11
enamel.1Among the odontogenic tumors, the
incidence of AFO varies from 0.3% to 1.7%,
reaching 4.6% when only the cases in children
are considered. Most cases are diagnosed in the
first two decades of life, between the ages of nine
and eleven years on average.1,2 There is a slightly
higher incidence of AFO in males, as well as in
the posterior mandible area7. AFO is generally
an asymptomatic, slow-growing tumor,
commonly associated with an unerupted tooth.
Radiographically, ameloblastic fibro-odontoma
presents as a well-demarcated radiolucency
containing radiopaque areas.8 Conservative
surgical excision is the treatment of choice and
the lesion does not tend to recur. 1
Histopathologically, it shows islands, strands &
cords of odontogenic epithelium immersed in
embryonic connective tissue that mimics
primitive dental pulp with formation of
osteodentin & enamel .8
Case report -
A 15 yr old male patient reported to
Y.M.T. dental college with the chief complaint of
missing upper front teeth & swelling that had
appeared two months before. Patient gave
history of trauma nine years back in the same
region & his medical history was unremarkable.
Extraoral examination revealed mild facial
asymmetry, with swelling on the left side of the
maxilla which was asymptomatic and covered
with healthy skin of normal color.(fig-1) Intraoral
examination revealed a swelling in anterior
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
maxilla, extending from the left deciduous lateral
incisor to right permanent central incisor covered
with normal mucosa,3x 4cm in size. Over-
retained deciduous lateral incisor & transposition
of permanent left lateral incisor were seen;
swelling was non-tender & hard to palpation.(fig-
2) In occlusal radiograph, a circumscribed
radiolucent lesion containing radio -opaque
masses of varying size and shape were seen
along with impacted 21, 23 & over-retained 62.
(fig-3) A provisional diagnosis of compound
odontoma was made. The differential diagnosis
would include lesions with mixed radiographic
patterns, such as calcifying epithelial
odontogenic tumor, calcifying odontogenic cyst,
immature complex odontoma and possibly
adenomatoid odontogenic tumor. under general
anesthesia enucleation and curettage of the
lesion & extraction of 62 was done .The surgical
specimen was fixed in neutral buffered formalin &
subjected to pathological analysis. The
macroscopic examination showed a mixed lesion
presenting some areas made up of soft tissue &
some calcified materials; rudimentary teeth like
structures were also seen.(fig-4,5)
Histopathological examination revealed
immature connective tissue stroma with young
fibroblasts & delicate collagen fibers containing
cords, strands & islands of pre-ameloblast like
odontogenic epithelium. At places, these islands
had a peripheral halo of hyalinization which was
suggestive of inductive changes. At places
abundant dentin like tissue enclosing pulp like
tissue, resembling rudimentary teeth like
structures was seen.(fig-6,7,8)
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
The present case was histologically
diagnosed as Ameloblastic fibro -odontoma
associated with compound odontoma .After one
month of follow-up, the clinical and radiological
appearance of the bone and surrounding soft
tissue was normal.
Discussion
Hooker in 1967 suggested the present
lesion Ameloblastic fibro-odontoma as a distinct
entity. Until then, many similar odontogenic
tumors were categorized as ameloblastic
fibroma, ameloblastic odontoma and cyst
adenoma. AFO is a rare, benign mixed
odontogenic tumor composed of ameloblastic
fibroma on one hand & complex odontoma on
the other. Controversy exists regarding the
histogenesis of mixed odontogenic tumors.
Cahn and Blum (1952) postulated that
ameloblastic fibroma, the histologically least
differentiated tumor, develops first into a
moderately differentiated form, ameloblastic
fibro-odontoma, and eventually into complex
odontoma. However, the concept that these
lesions represent a continuum of differentiation
is not widely accepted, and others feel that they
1,7
are separate pathologic entities.
There has been a lot of discussion in the
literature regarding whether AFO is a neoplasm
or hamartoma. H.P.Philipsen & Reichart (1997)
suggested a hypothesis regarding the
pathogenesis and relationship between the
“mixed odontogenic tumors” and the
odontomas. Most mixed odontogenic tumors are
considered to be hamartomatous and are part of
a developing complex odontoma . AF or AFD is
12
the first step in the development of a complex
odontoma. These tumors can develop further into
the second stage called AFO. The final stage is the
fully mineralized complex odontoma. The
compound odontoma is not an alternative final
stage of the complex odontoma but rather a
malformation with a high degree of
histomorphological differentiation ,
pathogenetically closely related to the process
producing hyperodontia, “multiple schizodontia”
or locally conditioned hyperactivity of the dental
3
lamina. The diagnosis of present case
Ameloblastic fibro-odontoma associated with
compound odontoma was supported by this
theory.
A c c o r d i n g t o t h e Wo r l d H e a l t h
Organization, the distinction between complex
and compound odontomas is based on the
arrangement of the dental hard tissues found in
the lesions. In complex odontomas, these tissues
are found in a more or less disorderly pattern.
However, some authors have suggested that both
types of odontoma are pathogenetically different.
A complex odontoma, more commonly found in
the posterior mandible, like AFO, could be the
end-stage of a hamartomatous lesion. On the
other hand, a compound odontoma seldom has
any clinical relation with AFO and its occurrence
could be the result of local hyperactivity of the
dental lamina. According to Chen et al, the
13
presence of disorganized odontogenic
epithelium and ectomesenchyme, associated
with irregular formation of dentin and enamel
make it unlikely that structures similar to teeth be
4
formed in AFO. Nevertheless, in the present case
reported here, rudimentary teeth like structures
were quite apparent.
All AFO’s should not be considered as
hamartomas because of possible recurrence &
malignant transformation seen after surgical
excision. Recurrence of AFO was seen in cases
reported by Frissell et al(1953) ,Tsagaris (1972),
Pindborg (1974), Furst I & Pharoah M, (1999),
Friedrich RE(2001), Chen et al(2005) & Oghli
(2007). Cases of malignant transformation were
seen by Howell and associates (1977) ,Herzog
and co-workers (1991) Bregni et al (2001) till
date.
Conclusion
This unique case of ameloblastic fibro-
odontoma associated with compound odontoma
was reported in accordance with the literature.
There was no recurrence noted clinically &
radiographically during eight months of follow-
up, The teeth which were left behind have not
caused any recurrence till date.Long term follow-
up with short intervals should be maintained in
management of ameloblastic fibro-odontoma .
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
 FIG-1 Extra oral picture showing mild Fig-2 Missing maxillary anterior teeth.
facial asymmetry.

FIG-3 Oclusal radiograph showing radiolucency

containing varying radio-opaque masses.

FIG-4 & FIG-5 Surgical specimen showing soft tissue along with small rudimentary teeth like structures .

FIG-6 H&E stain (10X) small islands and chords

of odontogenic epithelium in a primitive
mesenchymal stroma.

GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014 14

 FIG-7 H&E stain (40X)
Decalcified sections showing inductive changes and dentin like structures resembling
rudimentary teeth.
References
1. Barnes L, Eveson J, Reichart P, Sidransky D.
World Health Organization classification
of tumours. Pathology and genetics head
and neck tumours.Lyon: IARC Press; 2005.
2. Guerrisi M, Piloni M, Keszler A.
Odontogenic tumors in children and
adolescents. A 15-year retrospective study
in Argentina. Med Oral Patol Oral Cir
Bucal 2007;12:E180-5.
3. H.P. Philipsen, R.A. Reichart and F.
Pratorius, Mixed odontogenic tumors and
odontomas:considerations on
interrelationship: review of the literature
and presentation of 134 new cases of
odontoma, Oral Oncol 33 (1997), pp.
86–90.
4. Chen Y, Tie/Jun L, Yan G, Shi-Feng Y.
Ameloblastic fibroma and related lesions:
aclinicopathologic study with reference to
their nature and interrelationship. J Oral
Pathol Med 2005;34:588-95.
15
FIG-8 H&E stain (40X)
5. Howell RM, Burkes EJ. Malignant
transformation of ameloblastic fibro-
odontoma to ameloblastic fibrosarcoma.
Oral Surg Oral Med Oral Pathol
1977;43:391-401.
6. Bregni RC, Taylor AM, Garcia AM.
Ameloblastic fibrosarcoma of the mandible:
report of two cases and review of the
literature. J Oral Pathol Med 2001;30:316-
20.
7. Slootweg PJ. Analysis of the interrelationship
of mixed odontogenic tumors – ameloblastic
fibroma, ameloblastic fibro odontoma, and
the odontomas. Oral Surg 1981;51:266.
8. Shafer WG, Hine MK, Levy BM. A textbook of
Oral pathology, 5th edn. Philadelphia: WB
Sauders, 2005; 30.
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
 PHOTODYNAMIC THERAPY
AUTHOR
Dr Gopal Sharma
Head of department,
Oral Medicine and Radiology.
YMT Dental college and Hospital
Dr Jaya Mukherjee
Postgraduate student,
Dept of Oral medicine and Radiology,
YMT Dental college
ABSTRACT
Cancer is the one of the leading causes of
death today. We cannot as of now prevent cancer,
hence early detection and early treatment is the
only way to reduce cancer mortality rates. But,
cancer therapies are not without their
disadvantages and the patient has to pay a heavy
cost in the form of adverse effects. Cancer
treatment using photosensitizing agents is a new
and novel approach. It is especially useful in the
effective treatment of precancerous lesions and
early carcinomas. Treatment using photodynamic
therapy is easy, time-saving and more often than
not painless. It is efficient and convenient;
hospitalization is not required as opposed to other
modes of treatment. Its added and biggest
advantage is that it can be repeated, if needed.
The aim of the article is to bring to light another
treatment modality which is effective against
cancer as well as cost-effective.
Keywords: Photodynamic therapy, cancer,
Photofrin, Levulan.
Premalignant changes in the mouth, which
are often widespread, are frequently excised or
vaporized, whereas cancers are treated by
excision or radiotherapy, both of which have
1 11
cumulative morbidity . In spite of the combination
therapy, the overall survival rates have not
2
improved substantially in the last two decades .
Moreover, these aggressive treatments often
cause difficulties in chewing, swallowing, speech,
and even loss of the aesthetics. Therefore, an
effective therapeutic tool without the
disadvantages of conventional modality is
required in order to improve the treatment results
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
Dr Deepa Das
Associate professor,
Dept of Oral medicine and Radiology,
YMT Dental college
Dr Bhagyashri Purandare
Postgraduate student,
Dept of Oral medicine and Radiology,
YMT Dental college
of oral cancers. 3. Photodynamic therapy (PDT) is
4
a new method of treating various tumours.
Photodynamic therapy (PDT) is another option
that produces local tissue necrosis with light after
prior administration of a photosensitizing agent.
This heals with remarkably little scarring and no
1
cumulative toxicity. It relies upon a unique
interaction between light and special chemicals
(photosensitizers) to produce free radicals of
. 5
oxygen at an intracellular level In PDT, in-situ
photosensitization of a non-toxic sensitizer
generates cytotoxic reactive oxygen species
(ROS) that cause cell death and necrosis of tumor
components, with minimal damage to the
surrounding tissue. 6 - 9 PDT involves two
individually non-toxic components, light and
photo sensitizer, that work together to induce
cellular and tissue destruction in an oxygen-
dependent manner. This technique is based on
the administration of an exogenous photo
sensitizer to render tumor tissue sensitive to light
of a specific wavelength. The photosensitizers are
normally inert and have a selective affinity to
tumor tissue10.
When a photo sensitizer in tissues is
activated by a light of specific wavelength, it
transfers energy from light to molecular oxygen,
resulting in generation of reactive oxygen species
(ROS) . This results either in the production of
oxygen free radicals [type I mechanism], or the
formation of intracellular singlet oxygen [type
mechanism] , which causes tumour cell death by
intracellular oxygenation and vascular shutdown
6,12
mechanisms . The cause of cell death is similar
to apoptosis 13. There are three main mechanisms
by which PDT mediates tumor destruction. Firstly,
the ROS can kill tumor cells directly. Secondly,
16
PDT can damage the tumor associated
vasculature, leading to thrombus formation and
subsequent tumor infarction. Thirdly, PDT can
also activate an immune response against tumor
cells 11 .
The selective uptake and retention of a
local or systemically administered photo
sensitizer in tumour tissue is an important factor
in PDT 14. Of potential advantage is the fact that
cancer cells appear to have more photo sensitizer
inside them than surrounding non cancer tissue
after a specified amount of time has passed (the
drug-light interval). 15 The exact mechanisms of
this is unknown, but it is quite common to find
tumour to normal tissue ratios of drug up to 4:1 in
the head and neck region. When tumour: normal
tissue differentiation has reached an optimum,
the photo sensitizer is activated by non-thermal
15
light of appropriate wavelength . Thus there
can be a degree of selectivity regarding
treatment. 16
Healing is rapid, as the extracellular matrix
is left relatively intact, allowing migration and
seeding of normal cells into the spaces previously
17
occupied by malignant disease This means that
post-operative inpatient stay can be minimized;
often treatments can be performed on a day-stay
basis. Previous studies using first and second-
generation photosensitizers have shown very
promising results when PDT has been used as a
primary treatment modality for HNMSC 18.The use
of photodynamic therapy for the treatment of
malignant and non-malignant conditions is
.5
increasing
PHOTOSENSITIZING AGENTS:
PORFIMER SODIUM 19
Porfimer sodium was the first drug to
receive approval for PDT. The drug has been
approved for use in advanced and early-stage
lung cancers, superficial gastric cancer,
oesophageal adenocarcinoma, cervical cancer,
and bladder cancer. The advantages of Porfimer
sodium are that it: destroys tumours effectively, is
non-toxic in the absence of light, and can be
easily formulated in a water-soluble preparation
for intravenous administration. The drug induces
17
protracted skin photosensitivity14, the time
between administration of Porfimer sodium and
light is typically 48–72 h, during which the
patient must be protected from light.
FOSCAN®
Foscan® is the trade name of meta-tetra
(hydroxyphenyl) chlorin, or mTHPC. It is a second
generation photosensitizing drug. Foscan®
powder is made up into a solution for injection by
reconstitution with its solvent (1g ethanol and 1g
polyethylene glycol 400) made up to 5.ml with
sterile water for injection. It has a red peak of
activation at 652 nanometres (nm); treatment
times are usually around 200 seconds
depending on the power of the laser and the
area to be treated. The drug – light interval is 96
hours for the treatment of HNMSCC.
5-AMINO LEVULINIC ACID
ALA itself is not a photo sensitizer but
serves as the biological precursor of a photo
sensitizer, protoporphyrin IX (PpIX), in the heme
biosynthesis pathway 10. The main advantage of
PPIX relative to other photosensitizing agents is
the short half-life of its photosensitizing effects,
which do not last longer than 48 h (Kennedy et
al, 1990; Fukuda et al, 1993) 20,21 .PDT has been
applied to treat a number of oncological
diseases. To date, it has mainly been used to
treat superficial malignant or premalignant skin
lesions and mucosal lesions accessible via
endoscope or bare fibers such as carcinoma in
situ of the urinary bladder, endoluminal tumors
of the esophagus or the bronchus, or tumors in
the head and neck region. 22 Gaullier et al (1997)
found that long-chained ALA esters reduced
30–150-fold the amount of ALA needed to reach
the same level of PPIX accumulation as that
obtained by non-esterified ALA in a human cell
line, whereas short-chained pro-ALAs were less
efficient than ALA. 23 ALA-PDT at least has the
following advantages over conventional
treatments: it is non-invasive; it produces
excellent cosmetic results; it is well tolerated by
patients; it can be applied to patients who refuse
surgery or have pacemakers and bleeding
tendency; and it can be applied repeatedly
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
without cumulative toxicity.24Previous studies by
Leunig and his colleagues 25-27 demonstrated that
topically applied ALA can be selective for oral
premalignant and malignant tissues.
METHYL ALA
Methyl aminolevulinate is applied as a
cream for 3–4 h, during which photosensitivity is
generated. The licence given by the US Food and
Drug Administration for use of aminolevulinic
acid requires use of blue light. Methyl
aminolevulinate is always used with red light.
The site of the lesion is usually irradiated for 5–20
min. During the initial period of irradiation, the
patient might feel some discomfort or pain at the
site. This discomfort does not usually need
intervention, but local anaesthetic can be given if
. 19
required
NEW PHOTOSENSITIZERS
The search for new, third-generation
photosensitizers is still ongoing, especially for
drugs that can be activated with light of a longer
wavelength, which provoke shorter generalized
photosensitivity and have better tumor specificity.
New photosensitizers already in clinical trials
include tin ethyl etiopurpurin (SnET2), mono-L-
aspartyl chlorin e6 (Npe6), benzoporphyrin
derivative (BPD), and lutetium texaphyrin (Lu-
Tex), which all have absorption bands at
relatively high wavelengths (660, 664, 690, and
732 nm, respectively) and provoke only mild,
30
transient skin photosensitivity.
APPLICATIONS IN VARIOUS SYSTEMS
PDT using ALA for dysplasia of the mouth
produces consistent epithelial necrosis with
excellent healing and is a simple and effective
way to manage these patients. 1. Kubler et al,
2001, found PDT with Foscan to be as effective as
other standard techniques such as surgery or
radiation therapy for treatment of carcinoma of
the lip 14. PDT has been clinically applied to
superficial tumors directly accessible to
illumination, such as cutaneous basal cell
carcinoma, head and neck tumors, oesophageal
carcinoma and lung carcinoma.
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
LIGHT SOURCES
PDT requires a source of light that activates
the photosensitizer by exposure to low-power
visible light at a specific wavelength. Human
tissue transmits red light efficiently, and the
longer activation wavelength of the
photosensitizer results in deeper light
p e n e t r a t i o n . C o n s e q u e n t l y, m o s t
photosensitizers are activated by red light
between 630 and 700 nm, corresponding to a
light penetration depth from 0.5 cm (at 630 nm)
to 1.5 cm (at ~ 700 nm) . This limits the depth of
necrosis and/or apoptosis and defines the
therapeutic effect. As a result, larger solid tumors
cannot be uniformly illuminated, because of the
limited depth of light penetration. The total light
dose, the dose rates, and the depth of destruction
vary with each tissue treated and with each
28
photosensitizer.
ADVANTAGES
It has no long-term side effects when used
properly. It is less invasive than surgery. It usually
takes only a short time and is most often done as
an outpatient. It can be targeted very precisely.
Unlike radiation, PDT can be repeated many
times at the same site if needed. There is little or
no scarring after the site heals. It often costs less
than other cancer treatments.(American Cancer
Society)
PHOTODYNAMIC ANTIMICROBIAL
CHEMOTHERAPY OF DENTAL AND MUCOSAL
INFECTIONS
In recent years, the emergence of
antibioticresistant strains, such as
methicillinresistant Staphylococcus aureus and
vancomycin-resistant Enterococcus faecalis,
stimulated a search for alternative treatments.
PACT has the potential to be such an alternative,
especially for the treatment of localized infections
of the skin and the oral cavity. Micro-organisms
that are killed by PACT include bacteria, fungi,
viruses, and protozoa. The development of
resistance to PACT appears to be unlikely, since,
in microbial cells, singlet oxygen and free radicals
18
interact with several cell structures and different
metabolic pathways. PACT is equally effective
against antibiotic-resistant and antibiotic-
susceptible bacteria, and repeated
photosensitization has not induced the selection
of resistant strains (Wainwright and Crossley,
29
2004)
LIMITATIONS:
The major general adverse effect of
porfimer sodium PDT is prolonged
photosensitivity, which makes strict avoidance of
direct sunlight imperative. Incidences of mild to
moderate skin phototoxic reactions in this study
were frequent despite intensive patient
education, with severe phototoxic reaction due
to noncompliance. Another PDT sequela was
moderate to severe pain if the treatment field was
in the oral cavity. Transient hoarseness was
experienced by all patients who received
laryngeal PDT. However, there were no long-term
complications, such as xerostomia, chronic dental
decay, dysphagia, and worsening of preexisting
osteoradionecrosis. Voice quality improved in all
patients with laryngeal lesions compared with
31
their pretreatment status. All other potential
side-effects, such as allergic reaction, change of
liver parameters, etc., occur infrequently and are
specific for each photosensitizer and each
32
patient .
CONCLUSION
Recurrent head and neck cancers are
difficult to treat because of the complex regional
anatomy and close proximity to vital
structuresThe most important advantage of PDT is
its ability to target malignant tissue selectively
without adverse effects on other organs and is
safe enough to apply even in elderly patients
without risk of carcinogenicity. For further
progress in the clinical practice of PDT in head
and neck cancer, it is necessary to develop a laser
beam that can penetrate tissue more deeply.33 It is
minimally invasive, effective for carcinomas and
sarcomas and can be used in patients who are
unfit for further radiotherapy or surgery. It is a
therapeutic option that is likely to become a
19
useful addition to the armamentarium of the
integrated head and neck oncology team for
late-stage disease34.
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21. Fukuda H, Casas A, Chueke F, Paredes S
and Batlle A (1993) Photodynamic action
of endogenously syntesized porphyrins
from aminolevulinic acid, using a new
model for assaying the effectiveness of
tumoral cell killing. Int J Biochem
25:1395–1398
22. Thomas J. Vogl, ,Katrin Eichler, Martin G.
Mack, Stephan Zangos, Christopher
Herzog, axel Thalhammer, Kerstin
Engelmann. Interstitial photodynamic
laser therapy in interventional oncology.
Eur Radiol (2004) 14:1063–1073 .
23. Gaullier J, Berg C, Peng Q, Anholt H,
Selbo P, Ma L and Moan J (1997) Use of 5-
aminolevulinic acid esters to improve
photodynamic therapy on cells in
culture.Cancer Res 57: 1481–1486
24. Peng Q, Warloe T, Berg K, Moan J,
Kongshaug M, Giercksky KE, et al. 5-
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 Aminolevulinic acid-based photodynamic
Merrill A. Biel, MD; Barbara Henderson,
therapy. Cancer 1997;79(12):2282–308.
PhD Arch Otolaryngol Head Neck Surg.
2 0 0 9 ; 1 3 5 ( 8 ) : 7 8 4 - 7 8 8 .
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doi:10.1001/archoto.2009.98.
Alwin G, Baumgartner R, et al.
Fluorescence imaging and spectroscopy
32. Vrouenraets MB, Visser GW, Snow GB, van
of 5-aminolevulinic acid induced
Dongen GA (2003). Basic principles,
protoporphyrin IX for the detection of
applications in oncology and improved
neoplastic lesions in the oral cavity. Am J
selectivity of photodynamic therapy.
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Anticancer Res 23:505-522.
26. Leunig A, Betz CS, Mehlmann M, Stepp H,
33. Photodynamic Therapy for Head and
Arbogast S,Grevers G, et al. Detection of
Neck Cancer Tomoyuki Yoshida*,
squamous cell carcinoma of the oral cavity
Harubumi Kato, Tetsuya Okunaka, Tetsuo
by imaging 5-aminolevulinic acid-induced
Saeki, Shinya Ohashi, Tadao Okudaira, A.
protoporphyrin IX fluorescence.
Masaji Lee, Hikari Yoshida, Hidehiro
Laryngoscope 2000;110(1):78–83.
Maruoka, Hiroyuki Ito And Sotaro
Funasaka Diagnostic And Therapeutic
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Endoscopy, Vol. 3, Pp. 41-51
Arbogast S, Grevers G, et al. Fluorescence
staining of oral cancer using a topical
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31. Photodynamic Therapy for Head and Neck

Dysplasia and Cancer Nestor R. Rigual,
MD; Krishnakumar Thankappan, MMBS,
MCh; Michele Cooper, RN; Maureen A.
Sullivan, DDS; Thomas Dougherty, PhD;
Saurin R. Popat, MD; Thom R. Loree, MD;

21 GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014

 Inside out bleaching technique- A treatment for
discoloured endodontically treated teeth
Dr Ashwin Jain, Dr Sapna Sonkurla,
Reader, Dep. of Conservative dentistry, Lecturer, Dep. of Conservative dentistry,
YMT dental college, Navi Mumbai YMT dental college, Navi Mumbai

Dr Ushaina Fanibunda, Dr Mrinalini Kunte,

Reader, Department of Conservative dentistry, Lecturer, Dep. of Conservative dentistry,
YMT dental college, Navi Mumbai YMT dental college, Navi Mumbai

Abstract erythrocyte destruction.

2
Other causes of
Discolouration of a permanent incisor may discolouration in endodontically treated teeth
have a significant social impact on people. include obturation materials, remnants of pulp
Intervention should be minimally destructive of tissue in the pulp horns, intracanal
tooth tissue and should not compromise future medicaments and coronal
restorative options. This paper reviews the restorations.1Noticeable discolouration of teeth
technique of inside/outside bleaching, and can impact on a person’s self-image, self-
proposes it as an efficient, effective and confidence, physical attractiveness and
acceptable method for use in the compliant employability.
3

patient with an unaesthetic non-vital tooth.
Introduction
Permanent incisors may discolour
following trauma, loss of vitality, endodontic
1
treatment and restorative procedures. The blood
pigment haematin is responsible for enamel and
dentine staining following trauma-induced
Over the years, a number of bleaching and
restorative techniques have been proposed for
managing discoloured non-vital incisors(Table
1)
All of them have their own advantages and
disadvantages.So proper case selection and
techniques are to be customized for each
individual case.

Treatment options for dicoloured permanent incisor

Bleaching techniques ■ Inside/outside bleaching

■ Non-vital power bleaching
■ Walking bleach technique
■ External night-guard bleaching

Restorative techniques ■ Direct composite restoration

■ Indirect or direct composite veneer
■ Porcelain veneer
■ Full coverage crown

GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014 22

The inside/outside bleaching technique-
This technique was first described by Settembrini
et al. (Settembrini et al. 1997) and was later
modified (Liebenberg 1997). As the name
implies, the idea is to apply bleaching agent both
on the external and internal surfaces of the tooth.
The access cavity remains open during the entire
treatment process. Bleaching gel is placed on the
internal and external aspects of a non-vital,
root filled, discoloured tooth and refreshed
regularly
10% carbamide peroxide gel is the most
commonly used concentration and the most
researched.6 Gel is usually available in a user-
Advantages
Conservative, safe and effective
Rapid bleaching result
No sensitivity (non-vital tooth)
Bleach accesses internal aspect of the tooth.
Lower concentration than walking bleach or
power bleach technique.
Discolouration is easier to mask with
restoration if necessary
Preserves tooth structure
No compromise of future options.
Cost-effective alternative to crowns and
veneers and their subsequent replacement.
Case selection
Case selection is paramount to the successful use
of the inside/outside bleaching technique. A
thorough assessment must be made to ensure
suitability of the patient and the endodontically
treated tooth.
23
friendly pre-loaded syringe. A variety of products
are commercially available including
Opalescence, NiteWhite and Polanight. The
literature confirms that the carbamide peroxide
in 10% concentration is safe and effective in
terms of toxicity and carcinogenesis, when used
under the supervision of a dentist.3,7
The inside/outside technique has evolved as an
excellent option for young patients. It holds many
advantages over more historic management
options such as lower bleach concentration and
minimal tooth destruction; it does, however,
require careful patient and tooth selection to
ensure a successful result (Table 2).
Disadvantages
Requires compliant patient
Risk of bacterial contamination if the patient
does not return for access closure
Risk of food impaction in open access cavities
Risk of sensitivity of adjacent teeth
Requires manual dexterity by the patient
Additional cost of tray fabrication
Patient selection
Assess patient compliance, and that the patient
has the necessary manual dexterity required for
bleach administration. It is important that the
patient understands the unfavourable
consequences of delayed coronal seal
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
replacement. In the three- to seven-day
treatment course, the coronal access is open but
unlikely to develop problems, especially given the
antibacterial nature of urea. A longer time frame
will predispose the vulnerable tooth to bacterial
invasion, possible endodontic failure and caries.
The patient’s medical history should be reviewed
to highlight any medical conditions that may
contraindicate bleaching, e.g., enzymatic
disorders and any known allergies to H2O2 and
plastics.15
Tooth selection
A comprehensive clinical and radiographic
examination must be carried out, including
trauma history, existing restorations and quality
of endodontic treatment. Some oral conditions
that need to be resolved prior to bleaching or may
contraindicate the use of bleaching products
include poor oral hygiene, dry mouth, unrestored
caries and severe enamel erosion.15 It is
important to diagnose the cause and type of tooth
discolouration. Grey-brown intrinsic
discolouration of pulpal origin is most amenable
to the inside/outside bleaching technique.
The adequacy of the endodontic obturation
should be reviewed and have a well-condensed
appearance on a periapical radiograph (Figure
1). It is imperative to ensure that there is no
evidence of periapical radioluscency.
Steps in inside/outside bleaching technique
A) Pre operative visit
B) Tooth preparation
C) Bleaching homework by patient
D) Closure of access
A) Pre operative visit
Step 1: Obtain written informed consent.
Step 2: Ensure quality of endodontic restoration
and vitality of adjacent teeth
Step 3: Record pre-operative shade clinically and
photographically (Figure 2A).
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
Step 4: Construct plastic bleaching tray from an
alginate impression (Figure 2B). The tray should
extend to at least two teeth on either side with a
reservoir on the tooth to be bleached.
B)Tooth preparation
Step 1: Remove necessary restoration.
Remove restorative material from the external
facial surface of the tooth requiring contact with
the bleaching gel, e.g. composite veneer.
Step 2: Access the pulp chamber and thoroughly
clean off any debris.
Step 3: Remove gutta percha 2-3mm below
cementoenamel junction using endodontic burs,
Gates Glidden or a heated plugger. Confirm
measurement using periodontal probe or
endodontic files with a stop.
Step 4: Seal the gutta percha, Place >2mm glass
ionomer cement (resin modified or conventional)
or zinc phosphate cement as a protective seal
over the GP to prevent leakage (Figure 4).
Placing the base at the CEJ reduces bleach
permeability through the cervical dentine.
Step 5: Etch the internal aspect of the tooth with
30% phosphoric acid for one minute; this
removes the smear layer and opens the tubules.
Step 6: Deliver 10% carbamide peroxide bleach,
tray and clear instructions.
C: BLEACHING HOMEWORK
Step 1: Instruct the patient to inject bleaching gel
into the canal orifice.
Step 2: Load the tray reservoir with a pea sized
amount of gel.It may be useful to mark the
correct tooth on the tray with an alcohol pen.
Step 3: Insert the tray over the teeth and remove
any excess gel using finger, cotton wool, tissue.
Step 4: Change bleach gel every two to four
hours during the daytime and before bed.
Remove for tooth cleaning only. Avoid contact
sports.
24
Step 5: Clean the access cavity between
bleaching sessions using tufted brush, or a
syringe with water.
D: CLOSURE
Step 1: Review after three to five days.
Assess the degree of lightening. Continue for a
further three to four days if necessary. It is
recommended to slightly over- bleach the tooth
(see Cases 1 and 4). When the desired colour
has been achieved, clean the pulp chamber
thoroughly with an ultrasonic scaler.
Step 2: Provisionally restore the access cavity for
at least two weeks.
This allows the shade to stabilise and oxygen to
dissipate from the tooth, ensuring that the enamel
is free of residual oxygen, which may inhibit the
composite bond. Place cotton pellet and brightest
shade of glass ionomer cement (resin modified or
conventional).
Step 3: Definitive composite. It is useful to restore
the access cavity with a bright shade of composite
to allow easier retrieval. White GP may be placed
Figure no 1 Preoperative Shade recording
25
in the access cavity prior to composite restoration
to aid re-entry for further bleaching in the
future.23
Step 4: Review the patient clinically and
radiographically as indicated.
Conclusion
The inside/outside bleaching technique
clinical technique is highly effective in producing
successful and predictable cosmetic results in
patients. The use of lower concentration H2O2
minimises the risk of root resorption that exists
with walking and power bleaching techniques.
Inside/outside bleaching provides a less
destructive and cost-effective alternative to
veneers and their subsequent replacement.
Although increased patient co-operation and
commitment is required, results are more
rapid and reliable than the walking bleach
technique The clinical success and reduction of
potential harmful sequelae invite the
inside/outside bleaching technique to be
recommended as the treatment of choice for
non-vital discoloured incisors in compliant
patients.
Figure no 2 Pre operative radiograph
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014

Figure no 3 Bleaching tray
Figure no 5 Inserting the bleaching gel inside the tooth and on the tray
References
1. Walton, R.E., Torabinejad, M. Principles
and Practice of Endodontics (3rd ed.). USA,
Saunders, 2002.
2. Marin, P.D., Bartold, P.M., Heithersay, G.S.
Tooth discoloration by blood: an in vitro
histochemical study. Endod Dent
Traumatol 1997; 13 (3):132-138.
3. Kelleher, M.G., Roe, F.J. The safety-in-use
of 10% carbamide peroxide(Opalescence)
for bleaching teeth under the supervision
of a dentist. Br Dent J 1999; 187 (4): 190-
194.
4. Fearon, J. Tooth whitening: concepts and
controversies. J Ir Dent Assoc 2007; 53 (3):
132-140.
5. Settembrini, L., Gultz, J., Kaim, J., Scherer,
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
Figure no 4 Glass ionomer seal in situ
overlying gutta percha at CEJ
W. A technique for bleaching non-vital
teeth: inside/outside bleaching. J Am
Dent Assoc 1997;128 (9): 1283-1284.
6. Nixon, P.J., Gahan, M., Robinson, S.,
Chan, M.F. Conservative aesthetic
techniques for discoloured teeth: 1. The
use of bleaching. Dent Update 2007; 34
(2): 98-100, 103-4, 107.
7. Poyser, N.J., Kelleher, M.G., Briggs, P.F.
Managing discoloured non-vital teeth:
the inside/outside bleaching technique.
Dent Update 2004; 31(4): 204-10, 213-
214.
8. Sulieman, M. An overview of bleaching
techniques. I. History, chemistry, safety
and legal aspects. Dent Update 2004; 31
(10): 608-10, 612-614, 616.
26
 Diagnostic wax up –A valuable tool in aesthetic treatment planning
Dr Ashwin Jain, Reader,
Department of Conservative dentistry,
YMT dental college, Navi Mumbai
Dr Ushaina Fanibunda Reader,
Department of Conservative dentistry,
YMT dental college, Navi Mumbai
Abstract
Diagnostic wax up is a dental diagnostic
procedure in which planned restorations are
developed in wax on a diagnostic cast to
determine optimal clinical and laboratory
procedures necessary to achieve the desired
esthetics and function. A Diagnostic Wax-up
provides the patient with a three-dimensional
example of the final case. Thus allowing for test
drive of the new smile. It helps in increasing
patient acceptance and also allows better
communication between the three – Patient,
Dentist and lab technician
Key words- Diagnostic wax up, Case
acceptance, Communication tool, preparation
requirements
Success in aesthetic dentistry relies largely
on the ability to understand clearly the patient's
chief complaint and expectations in seeking
dental treatment to correct an aesthetic concern
and to address them as fully as possible. Patients
are increasingly demanding and may have
expectations that exceed what can be achieved in
reality. Esthetic and functional treatment
outcomes should be known prior to placement of
a definitive restoration. Respecting this principle
27
Dr Sapna Sonkurla, Lecturer,
Department of Conservative dentistry,
YMT dental college, Navi Mumbai
Dr Omkar Shete, Lecturer,
Department of Prosthodontics
YMT dental college, Navi Mumbai
Dr Aruna G., Lecturer,
Department of Periodontology
J.S.S. dental college & hospital, mysore
will prevent major disappointments and
unnecessary remakes. Hence Diagnostic waxup
is recommended to enhance predictability of the
treatment.
A diagnostic wax-up is defined by the
Glossary of Prosthodontic Terms as” a dental
diagnostic procedure in which planned
restorations are developed in wax on a
diagnostic cast to determine optimal clinical and
laboratory procedures necessary to achieve the
desired esthetics and function.”
A Diagnostic Wax-up provides the patient
with a three-dimensional example of the final
case. Their current situation and how a more
esthetic solution can be achieved are clearly
illustrated. The shape and contour of the teeth
are easily discussed, all dramatically increasing
case acceptance.
Features and Benefits
1. Natural looking three-dimensional
representation of the final case.
2. Illustrates current situation and how more
esthetic smile can be achieved.
3. For esthetic cases of all types, not just
Advanced Cosmetics!
4. Dramatically increases case acceptance
rates.
5. Can see tooth preparation requirements,
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
 dramatically reducing preparation time in
the operatory.
6. Assists in creating smile design.
7. Allows careful evaluation of function,
anterior guidance and cuspid rise.
8. Create good quality temporaries in
minutes using temporary Stent based on
the Wax-up.
Indications:
All cases of Esthetic Dentistry require better
visualization of end result
Anterior Crowns
Veneers.
Posterior Crowns.
Anterior or posterior bridges.
Implants.
Advanced cosmetic cases.
Requirements for Diagnostic Wax-up There
should be Detailed Prescription and Notes for
effective communication with the laboratory
· Detailed Case Design for Wax-up
o Include occlusal concerns, esthetic
concerns, soft tissue problems or changes,
materials to be used and incisal edge length of
the centrals (i.e. measure from the gingival
margin to incisal edge of the central to create
“Golden Proportions”).
o Indicate on prescription whether soft tissue
recontouring will be done.
· Photographs
o Shoot full series of pre-operative
photographs depicting different views for design
of case(e.g., the AACD “12 Series” photos).
o Be sure to include photos of any midline or
canting problems with a stick bite.
o Other useful views include a full-face shot
of the patient and un-retracted smile shots to
show lip contour.
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
· Complete and Accurate Upper and Lower
Master Impressions
o Ensure technician can see all 360º of the
margins including the labial/buccal vestibules
and hamular notches
o Include the vestibules in impressions.
o Full arch polyvinyl siloxane impressions
preferred if more than four teeth being prepared.
· Use full arch trays.
· Bite Registrations
o Verify that the incisal edge of the centrals is
parallel with the interpupilary line.
o Use plastic stick, not wood, as wood
distorts when being disinfected.
The diagnostic wax-up is created by
modifying the shape of teeth on a patient's
diagnostic cast with the application of wax and by
reducing the stone as needed. The diagnostic
wax-up often reveals additional necessary
treatment that was not evident during the clinical
exam and is a dynamic visual and functional aid
in achieving predictable results.The fabrication of
the provisional, based on the treatment wax-up,
is the crucial step where we allow the patient to
“test drive” the treatment plan. This gives the
patient the opportunity to have the dentist make
any modifications to the provisionals. Once the
patient is satisfied with the provisionals, new
models are made and these new models are then
used to guide the fabrication of the final
restoration.
In this age of “instant everything” we must
resist the temptation to go directly to a final
restoration which we hope the patient can adapt
to. The inclusion of this provisional tryout phase
will dramatically improve the long-term success
of cases where significant changes are planned.
28
Conclusion
The diagnostic wax-up brings the treatment plan
from the intangible to a full-scale visual model,
resulting in an effective communication tool for
all of the treatment partners: Patient, Dentist and
Technician.

Figure 1- Pre Operative Smile

Figure 2 –Diagnostic cast prior to wax up

Figure 3- Wax up after addition of

White wax and proper contouring
References
1. Chiche GJ, Pinault A, Esthetics of anterior
fixed prosthodontics. Chicago,
Quintessence Publishing Co., 1994.
2. Magne P, Belser U, Bonded porcelain
restorations in the anterior dentition a
biomimetic approach, first ed. Carol
Stream,Ill., Quintessence Publishing Co.,
2002.
3. Rufenacht CR, Fundamentals of esthetics.
Chicago: Quintessence Publishing Co.,
1990
4. The glossary of prosthodontic terms. J
Prosthet Dent 94(1):10-92, 2005
5. Magne P, Magne M, Belser U, The
diagnostic template: a key element to the
comprehensive esthetic t r e a t m e n t
concept. Int J Periodontics Restorative
Dent 16(6):560 9, 1996.
6. Magne P, Magne M, Use of additive wax-
up and direct intraoral mock-up for
enamel preservation with porcelain
laminate veneers. Eur J Esthet Dent
1(1):10-9, 2006.

29 GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014

 Rehabilitation of a patient with overdenture using stud attachments – A case report
Author
Dr. Omkar R. Shete,
MDS,
Lecturer, Dep. of Prosthodontics,
Y. M. T. Dental College, Kharghar, New Mumbai
Dr.Dhananjay Joshi,
MDS
Professor, Department of Prosthodontics,
Y. M. T. Dental College, Kharghar, New Mumbai,
Abstract:
The use of teeth as overdenture abutments is
a common form of treatment. However, most
roots are used only for support. Simple stud
Dr. R. D. Das,
MDS,
Professor, Dep. of Prosthodontics,
Y. M. T. Dental College, Kharghar, New Mumbai,
Dr. Anuradha Nemane,
MDS
Reader, Dep. of Prosthodontics,
Y. M. T. Dental College, Kharghar, New Mumbai,
Dr. Parmeet Banga
MDS,
Lecturer, Dep. of Prosthodontics,
Y. M. T. Dental College, Kharghar, New Mumbai,
overdentures could be fabricated with passive
retention using abutments with coping or with
active abutments like an attachment
overdenture. 4

precision attachments will also aid the retention

CASE REPORT:
of the prosthesis. This article presents a case
A healthy, 65 year old female reported with a
where studs have been used to help retain
chief complaint pertained to the lack of function
removable prostheses.
and esthetic deficiency due to loss of the teeth. A
detailed medical, dental and social history was
In the past, when patients used to visit the
obtained.
dentist with few badly broken remaining teeth,
Intra oral examination showed completely
the treatment modality was extraction of the
edentulous maxillary arch and partially
remaining teeth followed by a complete denture.
edentulous mandibular arch [fig. 1and 2]. The
These complete dentures were satisfactory in the
patient related the history of tooth loss as a result
beginning but with each subsequent year of use,
of unavailability of dental care earlier in life
patient became more intolerant due to
leading to caries and periodontal problems. The
continuous resorption of the alveolar bone. 1, 2

teeth present were #35 and #45 which were

Shakespeare has said about the old age, “It is
periodontally compromised. These teeth had
the last scene of all, that ends strange eventful
grade I mobility and grade I recession with sound
history, is the second childishness, and near
tooth structure. Radiological examination
oblivion. Sans teeth, sans eyes, sans taste, sans
included IOPA’s of #35 and #45 and ortho-
everything”. It is the responsibility of the dentist to
pentomograph (OPG) to exclude any radiological
prevent tooth loss whenever possible. The
pathology.
residual ridge resorption is inevitable after
Treatment plan was developed with the
extraction of teeth. However, the extent of this
following objectives: reduce the loss of the teeth,
process varies depending on individual
restore masticatory function and improve the
anatomic, biologic and mechanical factors.
esthetics. On the basis of diagnostic findings, it
Retention of teeth or roots in the alveolar bone
was concluded that after oral prophylaxis and
can improve bone maintenance around and
improving crown root ratio, #35 and #45 can
between these structures. Bone maintenance is
serve as abutments for overdenture. Diagnostic
the most significant advantage of a tooth-borne
mounting revealed adequate inter-arch space for
complete over-denture which further improves
the necessary components of stud attachment
retention and stability. Tooth supported
3

[fig. 3] and functional placement of acrylic teeth

GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014 30

without compromising esthetics.
Intentional endodontic treatments were
carried out for #35 and #45. The compromised
crown root ratio was improved by sectioning the
crown at gingival level. The exposed portion of
the dentin was then subjected to topical fluoride
application. Post space preparation was done
using two standard size burs viz. access
preparation bur and counter sink bur provided in
the kit. The male component of an attachment
(stud) was then cemented in the post space using
type I glass ionomer cement [fig. 4].
Peripheral molding was done and secondary
impressions were made. While making
mandibular secondary impression female
components were placed on the stud intra-orally
so as to record space required. Face bow transfer
was made and the cast mounted on a semi-
adjustable articulator (Hanau wide view).
Interocclusal records were made in bite
registration wax. The horizontal and lateral
condylar guidances were set, maxillary and
mandibular anterior teeth arranged and the
incisal guidance was adjusted. The posterior
teeth were set in a bilateral balanced occlusion.
The trial dentures were then tried in the mouth,
vertical dimension verified, centric and eccentric
contacts were evaluated. The facial and
functional harmony was studied and patient’s
approval obtained. The dentures were then
waxed and processed. After curing was
completed, laboratory remount and occlusal
adjustment was done. Finally, the dentures were
finished and polished.
The female component (nylon cap) of an
attachment was then attached to the intaglio
surface of the mandibular denture using
autopolymerizing acrylic resin. For this purpose, a
rubber band was used to cover the undercut area
of stud (to avoid locking) and the nylon cap was
placed on the ball of the post. Once the nylon
caps were picked up, rubber bands were
removed and flash trimmed. The denture was
adjusted and equilibrated [fig. 5 and 6]. Post
insertion instructions were given along with a
recall appointment. The following day, the mouth
was observed for sore areas and final occlusal
31
adjustments were made.
DISCUSSION
According to De Van’s Dictum, preservation
of whatever remains in patients mouth is more
important than meticulous replacement of the
missing. Thus preventive prosthodontics
emphasizes the importance of any procedure
that can improve prognosis.. Crum and Runey 5
(1975) in a 5-year study found that retention of
mandibular canines for overdentures led to
preservation of alveolar bone. Further,
Roumanas et al. concluded that anterior
6
mandible height resorbed four times faster than
maxillary arch with conventional dentures. He
also found that overdenture patients had a
chewing efficiency which was one-third higher
than that of complete denture wearers.
The success of the overdentures depends upon
the proper attachment selection for the particular
case. Attachment selection is based on available
interarch space, amount of bone support
opposing dentition, clinical experience, personal
preferences, maintenance of oral hygiene and
cost. Accessposts are stud attachments that work
7
well with overdentures, as they are the simplest
of all. They occupy a small vertical space and the
male units on the different roots do not require
parallelism. Resiliency of female component
relieves stress being directly transferred to the
abutment. The nylon cap provides 3-5 pounds of
retention. The technical work required is minimal
and can be carried out at chairside, thus making
it cost effective.
CONCLUSION
The concept of overdentures provides a
positive means of delaying the process of
resorption of alveolar bone. Although it is a
feasible alternative, it is not often used to its full
potential. Careful case selections, abutment
preparation, maintainance of oral hygiene as
well as periodic recall are keys to successful
overdenture rehabilitation.
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
 Figure 1: Pre-operative Mandibular arch
Figure 3: Stud Attachments
Figure 5: Maxillary and Mandibular
Dentures in place
REFERENCES
1. Brewer AA, Morrow RM: Overdentures, ed 2. St
Louis, CV Mosby, 1980.
2. Thayer HH, Caputo AA: Effects of overdentures
upon the remaining oral structures. J Prosthet
Dent 1977; 37:374-381.
3. Wayne R Frantz: The use of natural teeth in
overdentures. J Prosthet Dent 1975;34:135-140
4. Mensor MC Jr: Attachment fixation of the
overdenture: Part II. J Prosthet Dent 1978;39:16- 20.
5. Crum, R. J. and Rooney, G. E. Alveolar bone loss
GDPF-DMJ, VOL-I, ISSUE 1, APRIL 2014
Figure 2: Pre-operativeMaxillary arch
Figure 4: Stud attachments in place
Figure 6: Mandibular denture with
female component
in overdentures - 5 year study. J Prosthet Dent
40:610-613, 1978
6. Roumanas E., N. Garret, M. Hamada and K.
Kapur,.Comparisons of chewing difficulty of
consumed foods with mandibular conventional
dentures and implant-supported overdentures in
diabetic denture wearers. Int. J. Prosthodont.,
2003;16: 609-614
7. Toolson, L. B. and Smith, D. E. A five-year
longitudinal study of patients treated with
overdentures. J Prosthet Dent 49:749-756,
1983.
32
 Dr. Sharad Kokate

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