Anaphylaxis is among the emergency clinical events specifi cally related to local anaesthesia, leading to morbidity and mortality. Hence, our aim is to update knowledge of dental professionals about management of this entity with appropriate emergency management, by giving proper pharmacotherapy to prevent further auto immune reaction thus, saving their lives.

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Dental implants require different biomechanical considerations from natural teeth. Also, with one of the criteria for long-term implant success being “occlusion,” it becomes imperative for the clinician to be well versed with the different concepts when rehabilitating with an implant prosthesis. All endeavors must be made to reduce the overload and noxious forces on implants during mandibular movements. The occlusal rehabilitation schemes for implant-supported prostheses are derivatives of the occlusal scheme for natural dentition. The implant-protected occlusion (IPO) scheme has been designed to ensure the longevity of both prosthesis and implant. The article reviews the concepts of IPO and their applicability in different clinical scenarios.

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The relationship between periodontal health and the restoration of teeth is intimate and inseparable. Human teeth are designed in such a way that the individual tooth contributes significantly to their own support as well as collectively the teeth in the arch. Decay on the proximal surfaces occurs mainly due to the faulty interrelationship between the contact area, marginal ridge, the embrasures and the gingiva. An adequate understanding of the relationship between periodontal tissues and restorative dentistry is paramount to ensure an adequate form, function, aesthetics and comfort of the dentition. For long-term survival of restoration, both functionally and esthetically, certain biological considerations are very critical to preserve the health of the periodontium and thus must be given due importance in clinical practice. While most clinicians are aware of this important relationship, uncertainly remains regarding specific concept such as biologic width and its maintainces.

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The histopathological analysis of the tissue includes a detailed study of cellular and nuclear structures and their altered presentation in a given pathology. This is carried out by using a large spectrum of staining procedures and a variety of microscopic techniques. One of the specific and interesting features is the observation of various histopathological bodies seen in different pathologies. The presence of histopathological bodies is often an important diagnostic-aid in identifying the underlying disease. Hence, the present article is an attempt to compile different histopathological bodies seen in various diseases with special emphasis on pathogenesis, microscopic and ultramicroscopic features of the same

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The purpose of this review is to highlight the current etiological and therapeutic concepts of aggressive periodontitis which is rapidly progressing and aggressive in nature. It leads to destruction of periodontal tissues and loss of teeth. We need advanced diagnostic techniques to learn about current disease activity and rate of progression. We also require strategies to keep the disease under control with proper maintenance regime and prevent tooth loss, because it can result into complicated prosthetic rehabilitation in a very young patient. The evidence suggests that aggressive periodontitis is influenced by microbiological, genetic, and host factors. This paper reviews clinical, microbiological, immunological, and genetic aspects of pathogenesis of aggressive periodontitis, as well as diagnostic criteria of the disease and appropriate nonsurgical and surgical treatment options.

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Placing dental implants in the maxillary posterior region can be both challenging and un-nerving for a regular implant dentist who is not well versed with advanced surgical procedures. It is vital for a general dentist to understand the fundamentals of bone grafting the maxillary sinus if he/she is really committed to providing the best health care for their patients. The dental practice is seeing an increasing group of patients who are living longer, and this group of older baby boomers often has an edentulous posterior maxilla either unilateral or bilateral. When edentulous, the posterior maxilla more likely has diminished bone height, which does not allow for the placement of dental implants without creating additional bone. Through grafting the maxillary sinus, bone of ideal quality can be created (allowing for placement of dental implants), which offer many advantages over other tooth replacement modalities. The sinus graft offers the dental patient a predictable procedure of regenerating lost osseous structure in the posterior maxilla. This offers the patient many advantages for long-term success. If dentists understand these concepts, they can better educate their patients and guide them to have the procedure performed. This article outlines bone grafting of the maxillary sinus for the purpose of placing dental implants. This review will help the readers to understand the intricacies of sinus augmentation. They can relate their patient's condition with the available literature and chalk out the best treatment plan for the patient, especially by using indirect sinus augmentation procedures which are less invasive and highly successful if done using prescribed technique.

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Dimensional changes in the alveolar ridge after extraction often compromises on achieving optimal implant stability and placement of implants in the right prosthodontic positions. These situations demand augmentation of the residual ridge to achieve successful implant placement and long-term survival. Although the available literature speaks of an overabundance of techniques and agents for ridge augmentation, there is a relative paucity of quality evidence to guide the selection of suitable techniques and material. Henceforth, this paper is an endeavor to develop and describe an evidence-based decision pathway for the selection of suitable techniques for various clinical situations. Additionally, a descriptive overview of various techniques and materials is presented.

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Periodontitis is a chronic infectious inflammatory disease characterized by the destruction of tooth. The contribution of bacteria to the disease progression is poorly understood probably due to the multifactorial background of this disease. Aggregatibacter actinomycetemcomitans is part of the normal flora in many healthy individuals, but is also a major etiologic agent in some aggressive forms of periodontitis. The genetic diversity among different isolates of Aggregatibacter actinomycetemcomitans is great and its ability to express and release virulence factors varies. Aggregatibacter actinomycetemcomitans, a pathogen not only in periodontal but also in some nonoral infections, possesses several virulence determinants which contribute to its ability to colonize the oral cavity, persist in the periodontal pocket, resist and evade host defenses, cause destruction of soft and hard tooth-supporting tissues, and interfere with host tissue repair after infection. Authors conducted a comprehensive search through PubMed/Medline databases to compile the available literature till June 2014, for the purpose of detailed insight into the bacteria. The search was designed to identify appropriate articles related to virulence factors of Aggregatibacter actinomycetemcomitans, and the articles were independently screened for eligibility.

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Perforations as a possible complication during a root canal treatment may increase the risk of failure for the affected tooth. The influencing factors include the location and the size of the perforation, potential microbial colonization of the endodontic system, the time lapse between the occurrence of the perforation and repair, and the filling material. For the long-term success of the root canal system, it is essential to emphasize on disinfection and sterilization at the perforation site and in the remaining root canal system. Nonsurgical management is possible with predictable prognosis is possible if correct treatment is planned and executed.

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Peripheral giant cell granuloma (PGCG) is a non-neoplastic, tumor-like reactive lesion occurring exclusively on gingiva/alveolar crest. It is thought to arise from the periodontal ligament or the periosteum. Clinically, it bears resemblance to pyogenic granuloma, peripheral ossifying fibroma and many other peripheral lesions seen in the oral cavity, thereby histopathology is mandatory for the diagnosis of this lesion. The lesion although being relatively common, but still carries a lot of ambiguity. The ambiguity is in terms of its etiology, growth potential, biological behavior (recurrence), histogenesis of its cells and its treatment. The entity further holds significance because of its notorious behavior and its high tendency to recur. The present paper describes recurrent PGCG with a comprehensive insight of the literature on its etiology, clinical, radiological, histological, ultrastructural and molecular aspects. Special attention is given on the histogenesis of cells and their types as also on the differential diagnosis and treatment of this lesion.

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Dental health care workers are increasingly called upon to provide quality dental care to individuals whose bleeding and clotting mechanisms have been altered by inherited or acquired diseases. This provides an opportunity for the dentist who is trained in the recognition of oral and systemic signs of altered hemostasis to assist in the diagnosis of the underlying condition. A number of dental procedures result in the risk of bleeding that can have serious consequences, such as severe hemorrhage or possibly death, for the patient with a bleeding disorder. Oral care providers must be aware of the impact of bleeding disorders on the management of their patients. These disorders must be recognized from history, clinical examinations, and laboratory investigations, if indicated, prior to surgical procedures including those in dental surgery to prevent bleeding related complications. Safe dental care may require consultation with the patient's physician, systemic management, and dental treatment modifications. The purpose of this article is how to identify these patients with bleeding disorders.

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The health of the peri – implant tissues play an important in the long term outcome of dental implants. The absence of keratinized gingiva (KG) may be a risk factor for developing recession or peri –implantitis. However there is still ambiguity in the need for keratinized gingiva around dental implants. The preservation and reconstruction of soft tissue around dental implants is an integral component of dental Implantology. There is no long-term evidence whether augmented soft tissues can be maintained over time and are able to influence the peri-implant bone levels. Among the various soft tissue augmentation techniques Apically positioned flap with vestibuloplasty , Free gingival grafts and Connective tissue grafts are documented as the most predictable methods to increase the width of KG. Autogenous grafts increase the soft tissue thickness and improve aesthetics compared to non-grafted sites. The aim of this review is to critically discuss the need for KG around implants and the techniques to preserve and augment KG. It is difficult to arrive at a definitive conclusion due to scarcity of well designed studies in literature. Reliable evidence is lacking to suggest the ideal soft tissue augmentation/preservation techniques. Long term randomized controlled clinical trials are needed to provide a clearer image.

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The dental clinician frequently comes across lesions that involve the hard and soft tissues of the oral cavity. Most of these conditions do not pose a diagnostic problem for the dental surgeon. However, the clinical dentist is sometimes accosted with a lesion, the diagnosis of which is not only challenging, but influencing the choice of treatment. This review article provides a systematic and logical approach for diagnosing common lesions encountered in the dental practice.

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Periodontal surgical procedures could present challenges to the body's clotting mechanism. One such challenge is the uncontrolled hemorrhage that can lead to a life-threatening complication. This case report describes the case of a 20-year-old systemically healthy male patient who reported with an unusual condition of the formation of a “liver clot,” also known as “currant jelly clot,” after 6 days following a semilunar coronally repositioned flap for root coverage. The clot was removed, and the area was irrigated. The patient was recalled after 1 week, wherein the healing was uneventful with no other complication. Uncontrolled bleeding can delay wound healing and activate infection. The liver clot formed, was part of the secondary hemorrhage following 24 h, which interfered with the organization of the physiologic blood clot. Patients should be instructed to undergo blood investigations prior to surgical procedures and should be informed about the possible postsurgical complications that may occur.

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To improve the long-term prognosis of teeth, the treatment of periodontal diseases has evolved from resection to regeneration. Regeneration of the supporting structures of the teeth involves the use of a variety of materials of natural and synthetic origins. The ultimate aim of a true connective tissue attachment to the cementum, however, is difficult to achieve and a few of the materials have shown promising results. Autogenous bone graft obtained from the same individual has always been considered the gold standard because of its high osteogenic potential and virtually nil side effects. The present paper describes the use of autogenous grafts in the periodontal practice. The compilation of the data was done by PubMed search since the first use of the graft in periodontics.

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Open interdental spaces caused by papillary gingival recession are one of the most common problems faced in dentistry. Surgical and nonsurgical periodontal treatments for regeneration of lost papillary height have been reported with limited success. The present study reports effectiveness of autologous cultured fibroblast injections, a tissue engineering technique for papillary regeneration. A black triangle caused by Tarnow's and Nordland's class I papillary gingival loss was reported in maxillary anterior region of a young male patient. An autologous gingival biopsy was cultured in a biotechnology lab for the growth and expansion of fibroblasts. Cultured fibroblast suspension was injected into the receded papilla twice at an interval of 5 days. Follow-ups were recorded on the 6th day, 15 ^th day, at 1 month and at 2 months. Complete fill of black triangle was noted at the end of 2 months. No inflammatory or immune reactions were noted at the site of injection. Autologous cultured fibroblast injections are safe, efficacious, and an acceptable treatment option for the regeneration of lost papillary height.

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Genetics is the study and understanding of the phenomena of heredity and variation. A large number of genes are associated with many systemic conditions. Periodontitis is inflammatory condition of periodontium. Periodontium consists of gingiva, periodontal ligament, cementum, and alveolar bone. It is considered being a multifactorial disease. Studies of animals and humans support the concept that a large number of genes' factor may be associated with periodontitis and clearly play a role in the predisposition and progression of periodontal diseases. It has been proven that genetic factors impair inflammatory and immune responses during periodontal diseases. Research on identifying specific genes causing periodontitis may improve and prevent the disease progression. The aim of this article is to focus on genetic risk factors and its influence for the various forms of periodontal disease.

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Gingival enlargement is a commonly encountered problem in clinical practice. The treatment of choice is gingivectomy. The wound healing takes place by secondary intention and is associated with significant patient morbidity during the healing period. Newer techniques like the use of laser can be employed to enhance patient comfort during procedure and better healing of the gingivectomy sites. Laser use is beneficial as it requires minimal anaesthesia, lesser surgical time and good post-operative healing.

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The clinical practice of yesterday's endodontics becomes the heresy of today, and today's endodontic practice becomes the heresy of tomorrow. The history of endodontics begins in the 17 ^th century. Since then, there have been numerous advances and developments, and research has proceeded continuously without pause. The manufacture of the first instruments for endodontic use dates back to 1875. These early instruments were made by hand from thin steel wires, and they performed the function of modern barbed broaches. In 1955, Ingle was the first to express the need for standardization of canal instruments. In 1965, the American Association of Endodontists adopted the terminology and nomenclature of the proposed standardized system. For many years, the standard cutting instruments have been the reamer, the K-type file, and the Hedstroem file. Recent changes in both metallurgy and endodontic concepts have led to the introduction of a wide range of new instruments. An effort has been made here to present the journey of endodontic instruments from the past to the present.

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Background and Objectives: Traditionally, there are two treatment modalities for vital primary teeth with deep carious lesion, which include indirect pulp therapy (IPT) and pulpotomy. Enormous research and review in vital pulp therapy gave rise to a question, if primary tooth pulpotomy is obsolete, and should IPT replace pulpotomy? IPT has shown higher long-term success rates than any pulpotomy procedures other than mineral trioxide aggregate (MTA). Hence, the objectives of this study were to evaluate the success rates of IPT using calcium hydroxide and MTA pulpotomy clinically and radiographically. Materials and Methods: Eighty primary second molars were selected and randomly divided into two therapeutic groups of 40 each. Group 1 were treated with IPT using calcium hydroxide paste and Group 2 were treated with conventional pulpotomy using MTA paste followed by stainless steel crown. Follow-up evaluation was done at an interval of 6 weeks, 3 months, and 6 months. Results: The follow-up evaluation revealed 100% clinical success in teeth treated with MTA pulpotomy and one radiographic failure of internal resorption detected at 3 months. There was 100% clinical and radiographic success with teeth treated with IPT. Though there was one radiographic failure with MTA pulpotomy, it was not statistically significant (P > 0.05). Conclusion: Indications being the same for both the procedures why not opt for IPT which offers several advantages over pulpotomy like fewer potential side effects, non-invasive, decreased chair time, child cooperation, and cost-effectiveness.

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Background: Dexketoprofen is the pharmacologically active enantiomer ofracemic Ketoprofen, and is indicated for the treatment of acute pain. Objective: To record the efficacy and safety of Dexketoprofen 25 mg Tablet in treatment of acute dental pain. Material and Methods: This was an observational, prescription event monitoring study in clinical setting. Indian male or female patients between 18-65 years of age who would be undergoing oral surgery consisting of extraction of the impacted or semi-impacted third molars or have acute dental pain and willing to comply with study were included. Patients were treated with Dexketoprofen Tablet 25 mg (Infen-25) every 8 hours preferably 30 min before meal. Efficacy was analyzed by decrease in pain on VAS (Visual Analogue Scale) and investigator's overall assessment of efficacy of therapy. Adverse events, if any, were noted. Results: Data of 3318 patients were analyzed. Mean baseline pain intensity on VAS decreased from 7.74 to 7.02, 5.48, 4 22, 3.31 and 2.52 at 10, 20, 30, 45 and 60 minutes, respectively, after drug administration. Investigators' overall assessment for efficacy was good to excellent in 96.5% patients, while investigators'Dexketoprofen was very well tolerated. Conclusion: Dexketoprofen Tablet provided rapid onset of action, with good tolerability and very high patient and investigator satisfaction.

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Implant-based prosthetic rehabilitation requires an understanding of associated anatomical structures. The ultimate predictability of an implant site is determined by the existing anatomy as related to dentition and the associated hard and soft tissues. Meticulous clinical assessment helps in determining the suitability of the potential site for implant placement. The purpose of this article is to present the clinical assessment for dental implants' placement to modulate peri-implant tissue characteristics in individual clinical need.

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Introduction: Hemisection involves sectioning of a periodontally involved mandibular molar so as to remove the involved root and save the remaining tooth. This procedure helps in saving a tooth which otherwise would have been deemed for extraction. Hemisection refers to removal or separation of root with its accompanying crown portion of two-rooted teeth, most commonly mandibular molars. Method: In this case report, an advanced Endo-Perio lesion on a left mandibular first molar was successfully treated by root-canal treatment and hemisection. This procedure helps preserve the tooth structure, alveolar bone and promote cost savings over other treatment options. Conclusion: Hemisection is a treatment option for saving a mandibular molar which is in advanced stage of periodontal disease of one root. Removal of the affected root will help in retaining the remaining tooth structure.

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Background: The microbial florae in adult periodontitis lesions are comprised of anaerobic rods with Porphyromonas gingivalis as one of the major components (Slots 1976; Slots 1979; and Tanner et al., 1979). P. gingivalis is a black-pigmented gram-negative anaerobic rod and a secondary colonizer of dental plaque requiring antecedent organisms. The presence of this organism either alone or as a mixed infection with other bacteria and with the absence of beneficial species appears to be essential for disease activity. It is a predominant member of the subgingival microbiota in disease. It possesses and "excretes" numerous potentially toxic virulence factors. Aim of this study is to perform a systematic review of studies on P. gingivalis and its virulence factors with a special focus on its vaccine. Materials and Methods: An electronic and manual search based on agreed search phrases between the primary investigator and a secondary investigator was performed for the literature review till January 2014. The articles that were identified by this systematic review (total of 190) were analyzed in detail, which included the study of inference and conclusion. Conclusions: Within the limits of this systematic review, it can be concluded that P. gingivalis induce immune inflammatory response in periodontitis subjects. Therapeutic vaccines need to be developed and studied for their efficacy in controlling periodontitis.

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Pre-prosthetic surgery is an integral part of Complete denture Prosthodontics. The ultimate goal of pre-prosthetic surgery is to prepare a mouth to receive a dental prosthesis by redesigning and smoothening bony edges which would otherwise cause hindrance in restoration of optimum health and function. This case report discusses how reduction of severe bony prominences and smoothening of irregular ridges resulted in achieving a better denture foundation which if left untreated otherwise would have resulted in sore spots and immense discomfort to the patient.

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