Impressions

An Official Publicaton of IDA Volume - 12 Issue - 3 July to September - 2013

Impressions Learning by Sharing Knowledge

Inauguration of IDA Bhavan on 22-09-2013 by Mr. U.T. Khadar Honorable Health Minister of Karnataka

manjushri printers, ujire

Awarded “ Best Local Branch Journal” Na onal Award in 2006. Award “Best Local Branch Journal” State Award in 2005, 2006, 2007, 2008

IMPRESSIONS

The Ofcial Publication of

Indian Dental Association Puttur Branch

Editor :

DR. ASHA RAGHAVENDRA Sri Durga Speciality Dental Clinic & Implant Centre Opp. Bus Stand, Above Udupi Hotel Tal : Belthangady (574214), Dist: Dakshina Kannada Tel (O); 234009 ( R); 232006, Mob.: 9480289190 email : [email protected]

Volume - 12 Issue - 3 July to September - 2013

For Free Private Circula on Only Journal of IDA Puttur Branch ; IMPRESSIONS | July-September 2013 | Vol 12 | Issue 3

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Contents

Editors Message ...........................................................................

3

President Message .......................................................................

4

Secretary Message .......................................................................

5

Reconstruction Of Orbital Floor : Review Of Literature ................

6-9

Intrusion Of Maxillary Anterior With Implant In Periodontally Compromised Patient ......................................

10 - 11

Pulp Vitality Tests: A Concise Review

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12 - 14

Branch Activities ...........................................................................

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Journal of IDA Puttur Branch ; IMPRESSIONS | July-September 2013 | Vol 12 | Issue 3

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Editors Message Dr. ASHA RAGHAVENDRA Sri Durga Speciality Dental Clinic & Implant Centre Opp. Bus Stand, Above Udupi Hotel Tal: Belthangady (574214), Dist: Dakshina Kannada Tel (O); 234009(R) ; 232006, Mob. : 9480289190 email : [email protected]

Dear Friends, Could ignorance ever be blissful? Yes and no.But ,it can ill-afford to replace the discursive range of necessary informa on towards which we endlessly strive,day inday-out,to make the cut in our respec ve areas of interest. There is forever this urge'to know'. For to know is to feel and to feel is to hit upon the realiza on to outgrow and outperform, to overcome the set limits that hold us back. Stepping a head,our journal”IMPRESSION” will serve as a window through which the complete profile and co-curricular ac vi es,achievements and progress made during the s pulated period can be viewed.

With regards Dr Asha Raghavendra


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President Message Dr. Raghavendra Pidamale Asst Prof. Dept. of Pedodon cs, AJIDS, Mangalore Sri Durga Speciality Dental Clinic, Opp. Bus Stand Above Udupi Hotel, Taluk Belthangady (574214) Dist : Dakshina Kannada Tel (O); 234009(R) ; 232006 Mob. : 9448203610, 9886663846 email. : [email protected]

Dear Friends, It is a ma er of great pleasure and sa sfac on that our branch has come up with our new dream home”IDA BHAVAN”. A great family meet/CDE/felicita on along with 'DENTIST DAY' celebra on on 14-7-13 followed by guest speaker Dr. Shruthi Rai and a fabulous snake show headed by Dr. Ravindranath Aithal who gave a very beau ful talk on “SNAKE/ENVIRONMENT AND WE”…. Which entangled our mo o's to:”DARE TO BE FREE,DARE TO GO AS FAR AS YOUR THOUGHT LEADS AND DARE TO CARRY THAT OUT IN YOUR LIFE”. And also trust mee ng and cde program was held at IDA building Pu ur on 1/09/13 followed by our speaker Prof.Dr. Krishna Prasad .k. Our “IDA BHAVAN” started with Ganapathi Havan on sep.18 at 8.30 am and next followed by inaugura on on 22nd sep,which was inaugurated by our honarable health minister of Karnataka state Mr.U.T.Khadar and followed by other respected dignitaries and all our branch members and families. Hope we all step forward with the same support and confidence.

Your's Dr Raghavendra Pidamale


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Secretary’s Message Dr. Charan Kaje Asst. prof. MDCRC Edappal Kerala Kaje Dental Care Centre Leelavathi Arcade, Main Road, Vi al Dakshina Kannada -574243, Karnataka Tel(O): 08255- 238238 M- 9448437804, 7795566191 [email protected] Dear members,

A very happy navrathri to all. I wish all the members a very happy and safe deepavali. We have succssesfully completed 9 CDE'S in this year. On 14/7/13 @Rotary th hall,Pu ur, our 8 cde held.Dr.Shruthi Hegde,Asst professor, dept of oral medicine and radiology,A. B Sheety dental college,Deralaka e,Mangalore gave a lecture on Dental Radiograpraphy and Dr.Raveendranath Aithal, Herpatologist and General prac oner, pu ur, gave a lecture on Snake,We and Environment.He also gave live demo of many varie es of snakes to all our members. Same evening Den st day was celebrated. Felicita on to newly married couple of our branch members who joined pg course was conducted. On 01/09/13 Dr Krishna Prasad, Professor &hod,Dept of conserva ve den stry,KVG dental college, sullia, gave lecture on Root canal irrigants and Dr Rithesh K.B,Asst professor,Dept of oral surgery, Ajids mangalore, gave a lecture on Oral surgical procedures ,at our newly built bulding. On 22/09/13 our dream turned to reality…….our own building IDA BHAVANA was inaugarated by the honarable health minister, Karnataka, followed by state EC mee ng and CDE. A very warm welcome to all the members for the state conference to be held in th madikeri on 22-24 november. Dr. Charan Kaje Hon Secretary.


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RECONSTRUCTION OF ORBITAL FLOOR : REVIEW OF LITERATURE Dr. Ashish Shetty *, Dr. Shreyas Sorake **, Dr. Rithesh K.B *, Dr. Pritish Patnaik *** ABSTRACT: A myriad of techniques and materials have been proposed for the surgical reconstruc on of the internal orbit. The restora on of the orbital volume with an adequate material is challenging at mes and is very cri cal for normal func oning and esthe cs. The purpose of this ar cle is to review the commonly used materials for the reconstruc on of the orbital floor. Key words: Orbital defect, Trauma, Reconstruc on Introduc on Each orbit can be compared to a ny jewel box that has very precious contents, all carefully wrapped in fat ssue. Morphologically, each orbit is a four-sided pyramid with a posterior apex, anterior base and a 1 medially lted axis. Floor of the orbit is of par cular interest because of its frequent involvement either in isola on as a so called 'pure' type of blow out fracture or more commonly as an impure fracture in associa on with other fractures in zygoma c area. Its shape is almost triangular with rouded corners being narrow posteriorly. Contrary to the common belief, the floor is not horizontal but slopes upwards & medially at 45° & ascends posteriorly at about 30°, to terminate as the anterior margin of inferior orbital fissure. At this point the bone curves smoothly but abruptly downwards into infratemporal fossa to form posterior wall of maxillary antrum. The floor is formed by three bones: the orbital plate of the maxilla forms the largest part, the orbital surface of the zygoma c forms the antero lateral part and the orbital process of the pala ne bone forms a small 2 area behind the maxilla. Infraorbital margin cannot withstand direct force in the central and medial areas because of the proximity of the underlying maxillary antrum and the closely related infraorbital canal. Infraorbital nerves & vessels are mostly involved either by compression

or contusion or by direct penetra on from spicules of bone. Complete division is uncommon.3 Treatment of trauma c orbital injuries has long been a formidable challenge to the maxillofacial surgeon. Significant complica ons can occur as a result of these injuries, including enophthalmos, persistent diplopia, ver cal dystopia, and restric on of gaze. Over the last several decades, many advances have been made in the surgical treatment of trauma c 4 injuries to the orbital skeleton. The aim of this ar cle is to review various treatment op ons for reconstruc on of orbit floor defects. Commonly used reconstruc on materials: I l a n ko v a n e t a l e x a m i n e d 2 2 2 p a e n t s w h o underwent orbital reconstruc on with split thickness calvarial gra s. A er the first opera on, 86% of the sample a ained sa sfactory aesthe cs on clinical examina on. There were 13 (4.6%) complica ons, most occurring during harves ng full-thickness calvarial gra s. From this study it was seen that orbital reconstruc on can be performed using calvarial bone to obtain sa sfactory aesthe c and func onal results. This can be accomplished with minimal donor site morbidity.5 Castellani et al used conchal car lage in 14 cases to span small orbital floor defects (up to 2 X 2 cm). The incidence of clinical signs during follow-up and the surgical complica ons included 1 case of entropion

* Asst. Professor **Reader *** Post Graduate

Department of Oral and Mxillofacial Surgery, A. J. Institute of Dental Sciences, Mangalore. Journal of IDA Puttur Branch ; IMPRESSIONS | July-September 2013 | Vol 12 | Issue 3

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and 1 case of palpebral edema. They concluded that conchal gra is easy to harvest providing an op mal support func on for the globe with minimum donorsite morbidity. 6 Bayat et al compared autogenous nasal septal car lage and conchal car lage as gra s for reconstruc on of orbital blowout fractures in 22 pa ents. The pa ents treated with a nasal septal car lage gra had significantly be er correc on of enophthalmos than those treated with conchal car lage a er 10 days and 3–6 months. There was significantly less residual enophthalmos in the nasal septal gra group. They concluded that nasal septal car lage is a be er gra than conchal car lage for reconstruc on of blowout fractures.7 The use of contralateral coronoid process in the reconstruc on of orbital floor was studied by Mintz et al. Eight pa ents who had sustained either an isolated orbital floor blowout fracture or orbital floor compromise with an associated zygoma c b o n e f ra c t u r e w e r e t r e a t e d b y u s i n g t h e i r contralateral coronoid process for repair of the orbital floor. Although minimal trimming of the peripheral bony margins and medial coronoid cor cal plate was needed, none of the gra s required recontouring of their lateral cor cal surface in the eight pa ents. Postopera ve radiographic studies showed a correct anatomic contour of the orbital floor. A l-year follow-up of each pa ent showed no occurrence of diplopia, enophthalmia, muscle entrapment, or infec on. All eight pa ents had transient (1 to 2 weeks) trismus. Hence they summarised that the coronoid process makes an excellent donor gra site for reconstruc on of orbital floor deformi es.8 A retrospec ve study was conducted on 16 pa ents, by Krishnan and Johnson, who had isolated blowout fractures or orbital floor defects reconstructed with mandibular symphyseal bone gra s. Symphyseal bone gra s were used when the defects were less than 2 cm in diameter. During a mean follow-up of 12 months (range, 9 to 36 months), pa ents had no

postopera ve complaints. There were no instances of infec on at the surgical sites, and none of the gra s were extruded or lost.9 Guerra et al retrospec vely analyzed 55 pa ents who had undergone surgical repair of orbital floor fractures with dehydrated human dura mater. A 7% complica on rate was noted. No implant migra on or infec on resulted. One year post surgery, all pa ents showed a complete resolu on of their 10 diplopia. Celikoz et al used lyophilized tensor fascia lata in 12 pa ents. Foley's catheter was placed into maxillary sinus to provide temporary support to fascia. Pa ents were followed for 12 months to 2 years. No cases of infec on, exposure, extrusion, or gra removal were encountered, and enophthalmus, symmetry changes, or restricted movement were not o bs er ved d u rin g t h e fo llow - u p p erio d . T h ey concluded that lyophilized fascia lata is easy to shape and place in the defect. It provides an excellent material for repair of small to moderate-sized orbital 11 floor defects. Rosbe reported a case of a 44 year old who sustained a right tripod fracture, medial and inferior blow out fractures and a temporal bone fracture. Explora on of the orbital floor revealed complete loss of structural support without lateral or medial shelves to fix bone ra s or alloplas c material. A er cannula ng the severed lacrimal system, a 20 ml Foley catheter was placed through the fight nostril, through the inferior meatus, and into the maxillary sinus. Under direct vision from the orbit, the Foley balloon was inflated with 20 ml saline solu on. Immediate post opera vely, the pa ent developed chemosis and lost light percep on. So immediately he deflated the balloon and administered steroid. Then under CT guidance 10 ml of dilute contrast media was placed in balloon. A er 10 days, the balloon was removed. Follow-up ll 3 months showed normal globe posi on. Hence, Foleys catheter for orbital floor 12 support should be used judiciously.


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Twenty eight pa ents having orbital floor fractures with persistent diplopia, enophthalmos, and/or infraorbital nerve paraesthesia were operated at Turku University Central Hospital. Reconstruc on was either with bioac ve glass (study group) or autogenous car lage implants (control group). Postopera ve tomograms showed adequate maintenance of orbital and maxillary sinus volume without any evidence of resorp on in either group. None of 14 pa ents in the study group had any evidence of dystopia or complica ons rela ng to implants follow-up. One had infraorbital nerve paraesthesia and another had entropion postopera vely. Among the 14 control subjects there were three cases of persistent diplopia, two of i n f ra o r b i ta l n e r ve p a ra e st h e s i a a n d o n e o f enophthalmos.13 Gabrielli et al evaluated the the efficacy and safety of trauma c orbital floor defect reconstruc on with tanium mesh in 14 pa ents and concluded that tanium mesh is a reliable op on for orbital 14 reconstruc on, despite some complica ons. Edward Ellis and Yinghui Tan assessed 38 pa ents with orbital floor fractures who underwent internal orbital reconstruc on with either cranial bone gra s or tanium mesh implants. They found that orbits reconstructed with tanium mesh were more 15 accurate than those reconstructed with bone. Baumann et al reviewed thirty one pa ents who underwent reconstruc on of internal orbital wall fractures with a resorbable 0.25 mm or 0.5 mm-thick polydioxanone implant. Fracture size was graded as small, moderate or large by CT scans and opera ng records. Two of the 25 pa ents with small or moderate defects showed an enophthalmos of 2–3 mm. Five of the six pa ents with large defects had enophthalmos. The scar that formed a er implant resorp on was too weak to provide adequate support of the globe in large defects. Hence, blowout and midfacial fractures with small to moderate 2 defects in the orbital floor (up to a size of 2.5 cm ) can

be reconstructed by polydioxanone sheet to avoidenophthalmos. Polydioxanone implants should only be used in cases without massive orbital fat hernia on. The scar formed a er implant resorp on influences func onal outcome.16 Lieger retrospec vely analyzed forty-six pa ents who had orbital blowout fractures with at least 1.5-cm2 bone defects in 1 or 2 walls. Each defect was reconstructed within 2 weeks of injury using a triangle form plate of polylac de. None of the pa ents showed clinical foreignbody reac ons. There was no evidence of infec on. Diplopia was seen in 6 pa ents 3 months postopera vely but n o r m a l i ze d i n 5 p a e n t s a t 6 m o n t h s . M i l d enophthalmos was seen in 2 pa ents postopera vely at 1 year. No sagging of the reconstructed area was f o u n d o n C T. H e n c e i t w a s c o n c l u d e d t h a t bioresorbable poly-l/dl-lac de plates are well tolerated, reliable material in orbital repair of rela velylarge defects. The bioresorbable plate leaves a stable bridge of healed bone or so ssue a er complete degrada on.17 Yasumura et al treated 18 cases of blow out fracture of orbital floor with transzygoma c Kirschner wire. This technique does not require a subciliary approach, only an intraoral transantral approach and a stab incision in the cheek. The wire was used to directly support the fracture segment in five cases and used together with a maxillary sinus anterior wall bone gra in 13 cases. The wire is inserted from the stab incision into the maxillary sinus through the zygoma c body and run close to the roof of the sinus. 18 The stab incision was only 2 to 3 mm in length. If muscle entrapment was present then an addi onal orbital incision may be placed in this technique. Conclusion From the above review, it is clear that many op ons exist to correct or treat this defect. This proves that the ideal material is yet to be found. A struggle s ll remains between closed versus open approach and use of ar ficial materials versus autologous bone.


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References : 1. Mar ns et al. Microsurgical Anatomy of the Orbit: The Rule of Seven. Anatomy Research

Interna onal 2011;1-14. 2. Patnaik V.V.G., Bala Sanju, Singla Rajan K. Anatomy of the bony orbit-some applied aspects. J Anat. Soc.

India 2001;50(1):59-67. 3. Williams, J. L. : Rowe & Williams Maxillo facial Injuries In :Fractures of the zygoma c complex & orbit.

2nd Edn. Vol.I, Churchill Livingestons Edinburgh, London : pp: 475-9.(1994). 4. Po er, Ellis. Biomaterials for Reconstruc on of the Internal Orbit. J Oral Maxillofac Surg 2004;62:1280-

97. 5. V. Ilankovan , I.T. Jackson . Experience in the use of calvarial bone gra s in orbital reconstruc on.

Br J Oral Maxillofac Surg 1992;30(2):92-6. 6. Castellani et al. Treatment of orbital floor blowout fractures with conchal auricular car lage gra :

a report on 14 cases. J Oral Maxillofac Surg 2002;60:1413-7. 7. Bayat et al. Comparison of conchal car lage gra with nasal septal car lage gra for reconstruc on of

orbital floor blowout fractures. Br J Oral Maxillofac Surg 2010;48:617-20. 8. Mintz et al. Contralateral coronoid process bone gra s for orbital floor reconstruc on:an anatomic and

clinical study. J Oral Maxillofac Surg 1998;56: 1140-4. 9. Krishnan, Johnson. Orbital floor reconstruc on with autogenous mandibular symphyseal bone gra s.

J Oral Maxillofac Surg 1997;55:327-30. 10. Guerra et al. Reconstruc on of orbital fractures with dehydrated human dura mater. J Oral Maxillofac

Surg 2000;58:1361-6. 11. Celikoz, Duman, Selmanpakoglu. Reconstruc on of the orbital floor with lyophilized tensor fascia lata.

J Oral Maxillofac Surg 1997;55:240-4. 12. Rosbe, Meredith, Holmes. Complica on of maxillary sinus Foley balloon placement for orbital floor

support. Otolaryngol Head Neck Surg 1997;117:148-50. 13. Kinnunen et al. Reconstruc on of orbital floor fractures using bioac ve glass. J Cranio-Maxillofac Surg

2000;28:229-34. 14. Gabrielli et al. Orbital wall reconstruc on with tanium mesh: retrospec ve study of 24 pa ents.

Craniomaxillofac Trauma Reconstruc on 2011;4:151–6. 15. Edward Ellis, Yinghui Tan. Assessment of internal orbital reconstruc ons for pure blowout fractures:

cranial bone gra s versus tanium mesh. J Oral Maxillofac Surg 2003;61:442-53. 16. Baumann, G. Burggasser, N. Gauss, R. Ewers: Orbital floor reconstruc on with an

alloplas c resorbable polydioxanone sheet. Int. J. Oral Maxillofac. Surg. 2002;31:367–73. 17. Lieger et al. Repair of orbital floor fractures using bioresorbable poly-l/dl-lac de plates. Arch Facial

Plast Surg. 2010;12(6):399-404. 18. Yasumura et al. Transzygoma c Kirschner wire fixa on for the treatment of blowout fracture. J Plast

Reconstr Aesthet Surg 2012;65, 875-82.


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INTRUSION OF MAXILLARY ANTERIOR WITH IMPLANT IN PERIODONTALLY COMPROMISED PATIENT Dr. Kiran Raj *, Dr. Ashith M. V **, Dr. Salman Khan *** ABSTRACT This case report demonstrates the treatment of an adult periodontally compromised pa ent, an aesthe c smile was achieved with proper occlusion, orthodon c mini implant was used for intrusion of the maxillary anterior & bonding was carried out in a new innova ve way to reduce the chair side me. Chronic periodontal condi on, pa ent's apprehension, oral habits, me and cost constraints were c onsidered in the best of pa ent's interests for the treatment. INTRODUCTION In a periodontally compromised case, it is most important not to extrude teeth as the bone support would decrease further. In the process of trying to intrude an anterior tooth the posteriors usually tend to extrude. Even in the process of

Alignment This Untoward Movement Does Occur.

MATERIAL & METHODS Pretreatment Photographs A 0.019 x 0.025 stainless steel wire was bent to the malocclusion and fixed. The bonding and placement of the wire was carried out in a new innova ve method. Ini ally the wire was bent segmentally on the le and right sides on the study models to the malocclusion and later the brackets were a ached to the wire with elas c ligatures. The brackets along with the wire were then bonded on to the teeth together. * Asst. Professor **Asst. Professor *** Post Graduate Department of Pedodontics and Orthodontics A.B. Shetty Dental College Manglore / Yenepoya Dental College, Manglore


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This procedure decreases chair side me and makes it much easier.

A mini screw implant (1.3mm x 6mm) was used, inserted on the anterior palate to a ain a lingually directed force along with a labial force from a sec onal 0.014 Ni-Ti wire. The Ni-Ti wire was anchored onto the le and right segmental stainless steel wires. A lingual bu on was bonded onto the extruded central incisor and a pre-calibrated force of 15gms was given with an E- chain a ached to the implant. An intrusion of 2mm was achieved in 3 months period.

The treatment was focused on improving the aesthe cs & func onality of the maxillary central incisor which was extruding. RESULT The overall result for this pa ent was good, a significant amount of intrusion was achieved, improved aesthe cs was established, the pa ent was sa sfied with the result obtained accommoda ng his personal constraints. CONCLUSION A periodontally compromised situa on involves an interdisciplinary approach, it is important to sure the pa ent achieves treatment at the earliest in such cases as theres a risk of trauma or avulsion to the already extruding anteriors. To be able to preserve the anteriors, maintaining aesthe c harmony doesn't always require an extensive line of treatment especially in the above scenario. Therefore a simple innova ve method, me and again should be developed to render services to such pa ents. REFERENCES

MID-TREATMENT PHOTOGRAPHS

POST-TREATMENT PHOTOGRAPHS

1.

Levi HL. Intrusion of anterior and posterior teeth. In: Marks MH, Corn H, editors. Atlas of adult orthodon cs. Philadelphia: Lea and Febiger; 1989. p.448- 56.

2.

Melsen B, Agerbaek N, Markenstam G. Intrusion of incisors in adult pa ents with marginal bone loss. Am J Orthod 1989; 96:232-41.

3.

Melsen B, Kragskov J. Tissue reac on to intrusion of periodontally involved teeth. In: Davidovitch Z, editor. Biological mech anism of tooth movement and craniofacial adapta on. Colum bus: Ohio State University College of Den stry; 1992. p. 423-30.

DISCUSSION

Conven onal orthodon cs for intrusion would cause further bone loss on the compromised labial cor cal plates as the forces are delivered from the labial. For this reason it was decided to use a mini screw implant, besides the pa ent had me & cost restraints, for which the new method of bonding was carried out. Journal of IDA Puttur Branch ; IMPRESSIONS | July-September 2013 | Vol 12 | Issue 3

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PULP VITALITY TESTS: A CONCISE REVIEW Dr. Ganesh Prasad B *, Dr. Raghavendra P *, Dr. Nitin Gonsalves ** Pradeep Pasiari ***, Nikhil I Malgaonkar **** Over the years many techniques and devices for tes ng the vitality of the pulp have been in use. The assessment of pulp vitality is an important factor for the establishment of the treatment plan. This ar cle aims at reviewing the methods of tes ng pulp vitality that have been developed over the me. Pulp vitality tests related to the Neurophysiology of the pulp: Electric Pulp tester: This is a widely used device to test the pulp vitality, by delivering an electric current to s mulate the myelinated A-delta fibres.1,2 A non liquid-based interface medium, such as k-Y lubrica ng gel and Crest baking soda, is necessary to conduct electrical impulse to the tooth.3,4,5 This device determines the presence of vital nerve fibres, but does not address the health or integrity of the pulp. Various reports indicate the possibility of both false-posi ve and false-nega ve results. 6,7,8 Applica on of Cold and Heat (Thermal Tests) The use of hot water bath or heated gu a-percha to the tooth surface is commonly to deliver heat to the pulp. 9,10 It is important to use heat carefully to avoid pulpal damage. The methods of applying cold include the use of ice s cks, ethyl chloride, CO2 s cks and dichlorodifluoromethane (DDM), out of which CO2 and DDM are more 11,12 effec ve. Limita ons of Neurophysiology-related pulp tests: 13 The response to these tests indicates only the vitality of sensory fibres. 10-16% of the results has been found 8 to be false. The nervous system is highly resistant to inflamma on and hence may remain reac ve even 14 though all surrounding ssues have degenerated. These tests may also cause unpleasant sensa on to the pa ent.15 Therefore the vitality of the pulp is best determined according to the health of the vascular supply, not of the neural system. Methods to assess the Vascularity of the Pulp: Dual-wavelength Spectrophotometry (DWS) It is carried out with a non-invasive portable instrument. It is used to test pulpal blood flow. Oximetry by spectrophotometer determines the level of oxygen satura on in the pulpal blood supply. This instrument is 16,17 useful for determining pulp necrosis and the inflammatory status of the pulp. Pulse Oximetry Pulse oximetry is based on DWS. It is widely used in medical field to measure oxygen levels during administra on of intravenous anesthesia. 18 Pulse oxymetry is atrauma c and non-invasive, so its use is valuable to den stry. The technology is based on a modifica on of Beer's law: “ the absorp on of light by a solute is related to its concentra on at a given wavelength.19 * Senior lecturer **Senior lecturer ** Reader *** Consultant maxillofacial surgeon **** Senior lecturer ** Department of Oral Pathology A. J. Institute of Dental Sciences, Mangalore. *** Wynad Institute of Medical Sciences, Wynad, Kerala. **** Department of Oral Pathology, Yogitha Dental College, Khed, Maharashtra.


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Gopikrishna and group compared a custom-made pulse-oximeter dental probe with thermal and electrical tests for the assessment of pulp vitality. They found that the sensi vity of the pulse oximeter is 100%; the cold test, 81%; and the electrical pulp tester, 71%. 53 Laser Doppler Flowmetry Laser Doppler flowmetry (LDF) is an accurate, noninvasive, reproducible, reliable method of assessing blood flow in microvascular systems with a diode that projects an infrared light beam through the crown and pulp 21-24 chamber . The LDF technique takes about an hour to produce recordings, making it imprac cal for dental prac ces unless its me frame can be shortened to a few minutes. Conclusions There are many types of techniques and devices available in the market test the pulp vitality. Most of the commonly used techniques rely on the neurophysiology of the pulp, resul ng some mes in false-nega ve or false-posi ve results. The techniques that assess the pulpal blood flow have been reported to be more reliable, and are likely to be more popular means of pulp vitality tes ng in the future. Reference 1.

ooleyC RL, S lley J, Lubow RM. Evalua on of a digital pulp tester. Oral Surg Oral Med Oral Pathol 1984; 58(4):437–42.

2.

Narhi M, Virtanen A, Kuhta J, Huopaniemi T. Electrical s mula on of teeth with a pulp tester in the cat. Scand J Dent Res 1979; 87(1):32–8.

3.

Cooley RL, Robison SF. Variables associated with electric pulp tes ng. Oral Surg Oral Med Oral Pathol 1980; 50(1):66–73.

4.

Mickel AK, Lindquist KA, Chogle S, Jones JJ, Curd F. Electric pulp tester conductance through various interface media. J Endod 2006; 32(12):1178–80

5.

Michaelson RE, Seidberg BH, Gu uso J. An in vivo evalua on of interface media used with the electric pulp tester. J Am Dent Assoc 1975; 91(1):118–21.

6.

Bhaskar SN, Rappaport HM. Dental vitality tests and pulp status. J Am Dent Assoc 1973; 86(2):409–11.

7.

Bernick S, Nedelman C. Effect of aging on the human pulp. J Endod 19751(3):88–94.

8.

Petersson K, Soderstrom C, Kiani-Anaraki M, Levy G. Evalua on of the ability of thermal and electrical tests to register pulp vitality. Endod DentTraumatol 1999; 15(3):127–31.

9.

Zach L, Cohen G. Pulp response to externally applied heat. Oral Surg Oral Med Oral Pathol 1965; 19:515–30.

10.

Baldissara P, Catapano S, Sco R. Clinical and histological evalua on of thermal injury thresholds in human teeth: a preliminary study. J Oral Rehabil 1997; 24(11):791–801.

11.

Fleury A, Regan JD. Endodon c diagnosis: clinical aspects. J Ir Dent Assoc 2006; 52(1):28–38.

12.

Fuss Z, Trowbridge H, Bender IB, Rickoff B, Sorin S. Assessment of reliability of electrical and thermal pulp tes ng agents. J Endod 1986; 12(7):301–5.


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13.

Cohen S, Burns RC, editors. Pathways of the pulp. 8th ed. St. Louis: Mosby; 2002.

14.

Radhakrishnan S, Munshi AK, Hegde AM. Pulse oximetry: a diagnos c instrument in pulpal vitality tes ng. J Clin Pediatr Dent 2002; 26(2):141–5.

15.

Noble WC, Wilcox LR, Scamman F, Johnson WT, Diaz-Arnold A. Detec on of pulpal circula on in vitro by pulse oximetry. J Endod 1996; 22(1):1–5.

16.

Sigurdsson A. Pulpal diagnosis. Endodon c Topics 2003; 5:12–25.

17.

Nissan R, Trope M, Zhang CD, Chance B. Dual wavelength spectrophotometry as a diagnos c test of the pulp chamber contents. Oral Surg Oral Med Oral Pathol 1992; 74(4):508–14.

18.

Samraj R, Indira R, Srinivasan MR, Kumar A. Recent advances in pulp vitality tes ng. Endodontology 2003; 15:14–7.

19.

Schnapp LM, Cohen NH. Pulse oximetry. Uses and abuses. Chest 1990; 98(5):1244–50.

20.

Gopikrishna V, Tinagupta K, Kandaswamy D. Evalua on of efficacy of a new custom-made pulse oximeter dental probe in comparison with the electrical and thermal tests for assessing pulp vitality. J Endod 2007; 33(4):411–4.

21.

Gazelius B, Olgart L, Edwall B, Edwall L. Non-invasive recording of blood flow in human dental pulp. Endod Dent Traumatol 1986; 2(5):219–21.

22.

Olgart L, Gazelius B, Lindh-Stromberg U. Laser Doppler flowmetry in assessing vitality in luxated permanent teeth. Int Endod J 1988; 21(5):300–6.

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Ingolfsson AE, Tronstad L, Riva CE. Reliability of laser Doppler flowmetry in tes ng vitality of human teeth. Endod Dent Traumatol 1994; 10(4):185–7.

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IDA PUTTUR BRANCH ACTIVITY th

On 14/7/13 @Rotary hall,Pu ur, our 8 CDE held. Dr. Shruthi Hegde, Asst professor, dept of oral medicine and radiology, A. B Sheety Dental College, Deralaka e, Mangalore gave a lecture on Dental Radiograpraphy and Dr. Raveendranath Aithal, Herpatologist and General prac oner, pu ur, gave a lecture on Snake, We and Environment.He also gave live demo of many varie es of snakes to all our members.

On 01/09/13 Dr Krishna Prasad, Professor & HOD, Dept of conserva ve den stry, KVG Dental College, Sullia, gave lecture on Root canal irrigants a at our newly built building.


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IDA PUTTUR BRANCH ACTIVITY On 22/09/13 our dream turned to reality…….our own building IDA BHAVANA was inaugurated by the honorable health minister Mr U T Khadar, Karnataka, followed by state EC mee ng and CDE. Gurst speakers were Prof (Dr) Rajendra Prasad, Prof (Dr) Akther Husain, & Dr Rakshith Hegde


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