Dental world APRIL MAY 2010 for email.pdf

Loading ...
Global Do...
News & Politics
Website: www.deltahealth1.com
April-May,2010
Issue-2
Vol -10
Pages-16
Rs 75
dw_2000@rediffmail.com
From the pen of Our Guest 
EDITOR-IN-CHIEF
Prof. (Dr.) N. Sridhar Shetty 
Profession of 
Dentistry in India have 
witnessed remarkable progress 
and occupied important place 
in the health care system. The 
patient care for the health of a 
prime organ of the human 
body stomatognathic system is 
more recent in form. Service 
rendered, the mode of 
treatme
nt and 
care by 
the 
knowle
dgeable 
and 
skillful 
professi
onals 
are update and at international status.  
The profession is supervised and 
guided with vision and policies by the 
governments, universities and in particular 
apex body Dental Council of India (DCI).  
However to maintain and to excel the present 
status, teaching institutions have to focus 
specially:
?
On establishment of teaching clinics of 
the institutions at International protocol by 
providing time to time updated equipments (ergonomics), 
instruments and updated treatment methodologies. 
?
The arrangement of clinical equipments for practice of four 
handed dentistry, judicious cross infection control and hospital waste 
management. 
?
Introduction of interdisciplinary clinical departments for 
managing recent specialized approaches for management of 
patients.(Implantology, Craniofacial Surgery, Esthetic Dentistry, etc)
?
The restorative laboratories should be updated time to time 
for utilization of recent developed restorative materials and 
technology.
?
The research center as a separate department has to be 
established with total support of funds and facilities for research at 
higher standards. 
Statute body (A licensing authority) should guard the interest 
of general public in the oral and dental health care and should 
formulate a legal inspection protocol for control of oral and dental 
health care practice to aid the professionals to meet the requirements 
of ethics and law.  With the co-operation of dental schools they 
should formulate a protocol for the quality treatment and conduct a 
frequent joint supervision and guidance all throughout their practice.
Para dental courses have to be controlled, and conducted 
appropriately at dental teaching institutions only. The curriculum and 
training methods should be updated to the degree level to meet the 
present technology in all restorative procedures. Likewise Dental 
hygienist/Dental Assistants programme should be updated to 
graduate level to meet the present day patient care and clinical 
assisting.  The separate para dental courses to be started either in 
dental colleges/ engineering colleges with association of dental 
equipment manufacturers in training qualified dental equipment 
maintenance engineer.
Policies, Research and progress in last 6 decades has focused 
on producing quality clinicians at graduate, post graduate and at 
doctorate level. Thus it has given a special status to the profession by 
Contd. On page no 2
Editorial Board
          
                
         
                        
Prof. (Dr) 
Aruna Bhat               
Professor(Dr) N. Sridhar Shetty
Editor-in-Chief
Prof. (Dr) 
Pushparaj Shetty
Prof. (Dr) 
Deepak Pai  
Prof.(Dr) 
Vinaya Bhat
FIT AND INSERTION OF 
COMPLETE DENTURE  
PROSTHESIS IN ONE 
DAY AT CAMP SITE
A UNIQUE COMMUNITY TREATMENT 
P R O G R A M M E  -   S I N G L E   D AY 
COMPLETE DENTURE 
The Stomatognathic system is a prime organ of the 
human body, with vital functions such as respiration, 
mastication, speech, appearance and psychological 
comfort. Ingestion, mastication, deglutition and nutrition 
formulate the vital chain that is a basis to human 
existence The jaws carrying the teeth in coordination with 
other structures of the Stomatognathic System are 
handicapped by the loss of teeth. The jaws handicapped 
by the loss of teeth, have been rehabilitated successfully 
with the scientific progress with consideration of 
biological, biomechanical, bioeasthetic, biophonetic and 
biopsychosocial factors.  
Decay and periodontal diseases is a prime reason for 
loss of teeth. Majority of the edentulous people are at the 
age over 50 years and elderly. The large populations of 
elderly edentulous people are dependent on their 
meager income or support of their children.
This organ of the human body,Stomatognathic system 
handicapped with loss of teeth can be successfully 
rehabilitated and edentulous persons are thus no more 
considered as handicapped.  
The treatment plan for providing a complete denture 
prosthesis has two phases - a Clinical phase and 
Laboratory phase. This treatment procedure usually 
takes approximately 7 clinical appointments, (an hour's 
duration each) in a regular dental clinics or hospital. For 
the elderly edentulous patients who are mentally, 
physically, and economically compromised these visits 
are tedious, tiresome and time consuming and also may 
involve long distance travelling.
The author, a Prosthodontist, conceptualized and 
implemented in 1987 a project “Institutionalized approach 
total health care for rural and semi urban population at 
door step - free of cost” (Establishment of  Rural Satellite 
Centers, Awareness programs  house to house visit and 
Street Plays, School Health Programmes, Oral and 
Dental awareness Treatment Camps). Under this project 
the qualified manpower, instruments, infrastructure and 
advanced therapeutic facilities are made available by 
facilitating accessibility, availability and affordability for 
the people living in rural areas. (By 2006 over 1,500,000 
rural people are treated and benefitted from this Project).
He envisionedthat under this project,providinga complete 
denture prosthesis in a single day for those edentulous 
patients of the rural population at a camp site. This 
concept of single day denture camp in which an 
edentulous patientis diagnosed and treated with a new 
pair of artificial complete denture 
prosthesisat a treatment camps in a day. 
The patients who are treated and provided 
with complete denture prosthesis are 
followed up after 48 hours by revisiting the 
camp site.
The single day denture camp was 
conducted at Uppinangady (Karnataka) 
for the first time in 1990, with limited 
manpower. There after 45 such single day 
denture camps were conducted (total 
number of complete dentures are 1920). 
The highest number of patients provided 
with complete denture prosthesis in a day 
was 175 at Chintamani, Karnataka. These 
camps are conducted even at outside the 
state in places like Coimbatore in Tamil 
Nadu, Tirupathi in Andhra Pradesh and 
Payannur in Kerala. 
Organizing single day denture treatment 
camp`s. 
By associating and interacting with the local 
village leaders, local voluntary 
organizations, clubs,gramapanchayaths, 
charitable institutions and NGO like 
Rotorian, Lions etc., are taken into 
confidence for dissemination of information 
and broader participation . These agencies 
are requested to facilitate and to provide 
arrangements for clinical and laboratory 
work places,furnishingwith chairs,tables and 
benches. This work place is requested to be 
prepared in advance to simulate a clinical 
environment at the camp site a clinical work 
station for practice in a hygienic and sterile 
Contd. Pg 2
Dental World is honored to have Professor (Dr.) NAILADY SRIDHAR SHETTY 
as our guest EDITOR-IN-CHIEF. Truly a human being who has worn many hats 
in his time. Recipient of the prestigious DR. B.C. ROY  NATIONAL AWARD and 
Ex-President- DENTAL COUNCIL, Dr. N. Sridhar Shetty has come a long way 
from a little boy in a small township to one of the best academicians, able 
administrators and compassionate Prosthodontist of our country. It is not 
without reason that on Teachers Day 2007, the Rajiv Gandhi University of 
Health Sciences, Bangalore should deem it necessary to honour him as one of 
the most distinguished eminent Senior Teacher in the field of health Sciences 
and possibly this country, has ever known. Through his interest, he was able to 
carry out Oral and Dental Health care(rural programme) awareness and 
treatment after care for more than 15,00,000 people at free of cost, truly a 
remarkable job and one of its kind throughout the world. His efforts were even 
highly appreciated by the global icon Dr A. P. J. Abdul Kalam. We thank him 
from the interior of our heart for being our guest EDITOR-IN CHIEF. Let’s look at 
the World of Dentistry through the eyes and heart of Prof.(Dr.) N. Sridhar 
Shetty.                                                                                                   
                                                                                                         Neeraj Kaushik 
2
April-May, 2010          Issue-2   Vol-10
providing knowledgeable, skillful manpower for the 
health care of stomatognathic system. Man power ratio to 
the population is being achieved.
At present qualified manpower, equipments and 
instruments, infrastructure and advanced therapeutic 
facilities are concentrated in big cities and towns, which 
make up only 20% to 30% of the population of the 
country. 70% to 80% of the population is inhabitated in 
the rural areas who are mostly poor and ignorant of 
healthcare facilities. Extension of health care facilities is a 
duty and obligation of the profession. The profession 
needs to create awareness, accessibility, availability and 
affordability for the people in rural areas, by 
implementing newer policies and approaches for 
assessment, prevention, diagnosis, treatment and after 
care to lead a quality life without compromising on 
educational standards in curriculum and duration. 
The Dental graduates who are taking qualification 
have to spend large sum of  money  and time (5 years 
duration) and further Post graduation takes additional 
large sum of money and time(3 years duration). To 
establish their private practice they have to further look 
for large sum of funds approximately for the tune of     
Rs. 300,000 to Rs. 500,000. Since the economy of the 
rural people is poor, their priority for oral and dental 
health care will be the last. Practitioners in the rural areas 
even at economical treatment cost, will not attract patients 
to have sufficient income and would like to settle in 
metropolitan cities, big cities and towns to maintain his or 
her economical status.
This being the situation in our country a policy to 
be formulated and legalized to take the qualified people to 
the rural areas for treatment and after care. Teaching 
institutions have a requirement of manpower of quantity 
and quality, support staff including nurses, hygienist, 
technicians, etc. and students. In addition to the 
infrastructures, instruments, equipments and therapeutic 
facilities which are required for the clinical training of 
graduate, postgraduate students. The teaching institutions 
are probably the best resources for providing economical 
healthcare (Free of cost) for the deprived population.
 A statute can be formulated and changed for all 
teaching institutions. The manpower at the institution 
must spend their learning and teaching and clinical 
practice in and around clusters of rural centers equipped 
with clinical facilities as in the dental institution teaching 
clinics, instead of working under just one roof within a 
campus with metropolitan comforts.
?
The Institution should take the 
responsibilities (by law) of health care for minimum of 
100,000 rural families in the vicinity of 200 to 300 K.M. 
radius of the institution.
?
Teaching institutions should establish a 
separate network of teaching clinical centers (Minimum 
of 5 Satellite centers, with continuous interaction with the 
nucleus institution) where teachers and students along 
with other staff impart care to the patients (learning, 
teaching and treatment).
?
Mobile preventive and treatment teams 
with portable equipments and instruments, to conduct 
treatment camps for these populations in total, frequently 
and perpetually for health awareness, prevention, 
treatment and after care.
?
The curriculum has to be updated, 
modified to include a programme for the students to visit 
house to house (Awareness at the doorstep) to create 
public health, and oral and dental health awareness, as 
well as to conduct epidemiological and demographic 
distribution of target diseases and identification of 
hospital care need of each family. A formulated health 
assessment team comprising of faculty members, 
postgraduate and undergraduate students and interns and 
social workers. 
?
Curriculum to be introduced for the 
awareness of patients, to include street plays, folk dances, 
writing of poems, etc which would enhance the ability of 
the students to communicate with society and create a 
lasting impression for proper healthcare and prevention of 
diseases.
?
The clinical teaching program must be 
conducted by faculty members in each specialty divided 
into smaller groups at different satellite centers to 
facilitate divided groups of students for clinical training 
and learning, and patient management. The students are to 
be taught and trained in smaller groups in each satellite 
centre focusing on prevention, diagnosis, treatment and 
aftercare.
Message
?
With the present technology students can be taught 
via the E-learning process and get exposed to all faculty members for 
lectures, clinical discussions and interactions. 
?
Our resources - Qualified manpower are migrating to 
different nations and ready to work even in hardship since the 
remunerations are very high and free of tax. Hence, it is necessary to 
bring a policy to give certain tax free incentives (rural hardship 
allowances, children education allowances, etc.) to all those who are 
working in the rural areas.
The goal of reaching this target group i.e., the rural 
population for the total healthcare is a must.  We as a professionals 
are proud of its status, qualifications and abilities. We have ethics, 
morals and duties as professionals to take care of this poor ignorant 
rural population of our country for total healthcare to create healthy 
rural India. The profession along with their governing and regulating 
authorities should come forward to meet the requirement of the day  
Awareness, Accessibility, Availability, Affordability to implement 
and provide “total health care for rural population free of cost”. 
Contd from pg 1....Fit & insertion of
environment(cleanliness with disinfectants).Provision for water, 
electricity/generator, toilets and provisions for waste disposal are also 
arranged for. 
These volunteers arerequested to publicize the program and pool the 
edentulous patients at the proposed treatment centers like the village 
centers or schools or community hall etc. They are also requested to 
arrange and provide food and water free of cost for these patients, 
since they have to be present from 8 AM to 6 PM continuously at the 
camp site.
Since each patient has to be attended continuously for treatment 
(approximately 9 hours) the number of patients is restricted to a 
maximum of 100 to proportionate the manpower, equipment etc. The 
treatment is carried out following the protocols for sterilization 
asepsis, infection control and hospital waste management (disposal 
of sharps and non-sharps, biodegradable material etc.is carried out 
by collecting all materials in a disposable bags and carryingthem 
back to the institution for incineration)
Team for single day denture camps:
The team consists of Teaching Faculty, Postgraduate students, 
interns, Nurses, clinical assistants, Dental mechanics, maintenance 
engineers and social workers.
Keeping in mind the importance of cross-infection control, acceptable 
clinical steps and laboratory steps, planning sessions are conducted 
by the team members before the day of treatment camp for co-
ordinated and speedy clinical and laboratory work.It is planned to fit 
and insert complete dentures prosthesis before 6.00 p.m. so as to 
help the patients to reach their home before sunset.
Equipment, Instruments and Materials
Dental Chairs:
As the number of patients would vary from 50 to 100,theregular 
dental chairs and units is not feasible to transport.Hence a concept of 
simple portable dental chair for clinical work station was introduced. 
The patients are made to recline over the cushioned boards placed 
against the back rest of any ordinary chair which would enable the 
patient's head and neck to be stabilized, being pre-requisite for any 
dental treatment. Each station is provided with a small table to 
facilitate placement of required instruments and materials. The 
material cost and expenses for medicine etc., are borne by the 
institution/charitable organizations. 
Cross Infection Control Implements and practice:
1.
Disposable Gloves
2.
Disposable masks
3.
Doctor's Coat(below Knee Length and long sleeved)
4.
Provisions of wash basin at work stations containing 
dettol/betadine solutions for necessary hand disinfection. 
5.
Individual Spittoons (buckets) containing small quantity of 
dettol solution.
6.
Separate bags for collecting waste (cotton, gauze, material 
etc.)
7.
All the instruments including linen (for patient's cover and 
wrapping of instruments), gauze, and cotton are carried in individual 
sterilized kits.
Emergency Drugs: Oxygen cylinders and emergency drugs (cardiac 
and allergic etc conditions)
Material: modeling wax and boxing wax, Acrylic teeth sets (300 
assorted in size, shape color), dental plaster, dental stone, 
impression materials  alginate, green stick compound, zinc oxide 
eugenol, self cure acrylic resin (tray material), heat cured acrylic 
resin, separating media, pumice, whitening powder, polishing cakes, 
cellophane sheets for trial packing, articulating papers. Closed 
Porcelain jars for mixing heat cured acrylic resin powder and liquid.
Equipment and Instruments:
Model Trimmers (5), Gas Lines with cylinders for 25 stations with 
Bunsen burners, spirit lamps (100), laboratory micro-motors(Heavy 
duty) with straight hand pieces (30) , polishing and trimming lathes 
(5), Bench Presses (5), are transported from the institution. 10 HP 
portable generators are carried to the camp site from the institution or 
arranged by the volunteers.
For curing of the acrylic dentures, the requisite of acrylizer cannot be 
transported and utilized for want of 
electricity. Three large containers (capacity 
to hold 100 pairs of flasks) are requested to 
be  arranged from by the volunteers where 
cooking gas or firewood is used to warm 
and boil the water. One vessel which is 
smaller in height is utilized for the dewaxing 
to facilitate retrieval of artificial teeth in the 
event of loss from the flask. (for easy 
visualization and access). The second 
vessel is used for initial curing where in 
temperature is controlled to be within 65-70 
degrees centigrade (to be checked with 
finger) for half an hour. The third vessel is 
for boiling the water where the flasked 
denture is cured at 100 degrees for one 
hour.
Set of Instruments for each work station 
(both clinical and laboratory): Mouth 
Mirrors, Tweezers, Stock Impression Trays 
(Edentulous), indelible pencils, Wax Knife, 
Plaster knife, wax spatulas, lecron Carvers, 
Rubber Bowls, Flasks and Clamps, Flask 
Carriers for dewaxing, Plastic or wooden 
hammers, frit saws (small carpenter's saw), 
brushes and wooden spatulas, Long Metal 
Hooks to attach to the flasks to remove 
from curing, Metal Number Tags for 
identification of the individual pairs of flasks. 
During curing, Lathe stone, polishing cones, 
wool buffs, wheel brushes, sandpaper rolls, 
Trimming stones (acrylic trimmings burs, 
assorted shaped stones, fissure burs, sand 
paper mandrels.
S.S. Kolakebail, Adocate, Ex MLA, Kundapur, 
Date 16.9.1992
My Dear Siri,
Three months are over since you made me a 
new man, My people here though they loved 
me so much, they only established that I am 
82 years old by celebrating my age, whereas 
yours was the simple direct miracle. With a 
day you reversed the order of the age and 
made me 28 years young man…
… You may be rather surprised that I am a 
living advertisement that everyone sees me 
young, see your miracle. The denture speaks 
to your extra-ordinary ability and merit in your 
vocation……………
With love 
Sd/-
To:Prof. (Dr) N. Sridhar Shetty
Dean, A.B.Shetty Memorial Instt. Of Dental 
Sciences, Deralakatte, Mangalore
Procedure:
Each patient is treated by one 
Postgraduate student/Doctor who is 
assisted by one intern or a senior student. 
Five working stations (group of 5 patients) 
will be supervised and guided by the one 
faculty member to facilitate for a speedy 
work. . One technician is designated for five 
work stations. (Five students  one faculty  
one technician).
8:00 AM - Patients are seated at clinical 
work station and examined to see the 
overall status of the edentulous ridges and 
associated structures.Patients attitude, 
adaptability and expectations are 
assessed. The patient is informed in 
advance about the treatment plan , duration 
, initial difficulties in learning and wearing 
dentures. The expected retention, stability, 
esthetics and comforts.
8:10 AM  8:30AM: Primary Impression  the 
stock tray is selected and modified to fit 
approximately maxillary and mandibular 
alveolar ridges in patients mouth for making 
the primary impressions. The doctor / 
postgraduate student with assistance of the 
intern/student will make the maxillary 
primary impression by using alginate 
impression material. The impression is 
carried to the lab immediately by intern to 
pour the cast and to prepare the special 
tray quickly. In the mean time the 
mandibular alginate primary impression is 
made and carried by the doctor to pour the 
cast for preparation of special tray.
8:30AM  9:00AM - Thestudent/intern and 
technician will pour the cast and separate 
Contd pg 4
April-May, 2010          Issue-2   Vol-10
3
4
April-May, 2010          Issue-2   Vol-10
Contd from pg 2....Fit & insertion of
the impression from the set cast , custom made acrylic 
resin tray is fabricated  with spacer  and stops and made 
ready for making the final impression. The maxillary 
custom tray will be prepared first (8:45 AM) followed by 
the preparation of mandibular custom tray. Thus 
prepared trays are placed in warm water for 10 minutes 
before being checked in the patient's mouth.
9:00 AM  9:20 AM - The maxillary custom tray which is 
made ready is immediately carried to the work station, 
checked in the patient's mouth and adjusted for its fit 
and extension .The peripheral moldingis carried out by 
low fusing modeling plastic (green stick compound) and 
impression is made by using zinc oxide eugenol paste 
and sent (with intern) for pouring in dental stone to make 
the master cast and to prepare temporary denture base 
carrying occlusion rims (Technician and Intern). (9:20-
10:00AM)
9:20 AM  9-40 AM - The mandibular custom tray which is 
made ready is quickly taken to the clinical work station 
and checked in the patient's mouth and adjusted for its 
fit and extension.The  peripheral molding is carried out  
by low fusing modeling plastic (green stick compound) 
and impression is made by using zinc oxide eugenol 
paste and sent for pouring in dental stone and to make 
the master castand to prepare temporary denture base 
carrying occlusion rims (technician and intern). (9:40-
10:20AM)
10:00 A.M  Maxillary Occlusal Rims are adjusted in the 
patients mouth for facial fullness, anterior and posterior 
occlusal plane, lip lines (high and low),smile line,midline 
and canine lines.
10:20A.M  10:30A.M  Mandibular Occlusal Rims are 
inserted in the patients mouth to occlude and adjusted 
for establishment of vertical clearance of occlusion(VD). 
The patient is trained to capture centric relation and 
relevant canine line, midline are marked. The maxillary 
and mandibular occlusalrims occluded in centric relation 
is sealed and centric relation is registered. Selection of 
teeth is done for arrangement of artificial teeth.
10:30 A.M  11:00 A.M  Mounting of sealed occlusal rims 
on free plane mean value articulator. (non-adjustable)
11:00 A.M  12 Noon  Arrangement of teeth, waxing and 
contouring 
12 Noon  12.20P.M  Try in of waxed up denture
12:20 P.M  1:20 P.M  Flasking of maxillary and maxillary 
waxed up dentures. (Alongwith assistance of intern and 
technician)
1:20 P.M  1:30 P.M  Working lunch 
1:30 P.M  1:45 P.M  Dewaxing of maxillary and 
mandibular flasked waxed up denture and application of 
separating media.
1:45 P.M 2:15P.M.  Mixing of acrylic resin powder and 
liquid, packing, trial packing and keeping under the 
bench press.
2:15 PM  2:25 P.M.  Bench Curing of clamped flasks. 
The flasks are hooked together and designated number 
is tagged.
2:25P.M  2:55P.M  Curing in warm water for half an hour 
(60  70 degree centigrade to avoid porosity)
2:55P.M  3:55P.M  Clamped Flasks are transferred to the 
vessel containing boiling water and kept for one hour for 
curing.
3:55 P.M. 4:05 P.M  Bench Cooling
4:05  5:00P.M  Deflasking, Trimming and Polishing of 
Acrylized Denture
5:00 PM  5:30 PM  Fit, Insertion and Post Insertion 
Instructions.
Patients are recalled to the camp site after 48 hours for 
review by team of four doctors.
The faculty and students continue to practice 
providing a complete denture prosthesis in a day 
at the institution for those who are travelling from 
long distance.
PROFESSOR (DR)NAILADY SRIDHAR SHETTY 
is Founder Dean and DIRECTOR, CADSS(Centre 
for Advanced Dentofacial stomatognathic 
Sciences), A.B.SHETTY MEMORIAL INSTITUTE 
OF DENTAL SCIENCES. 
Professor Shetty has above 45 years of teaching 
experience, record 21years as a principal/Dean of 
one of India’s best  Dental College. Through this 
project study, Dr Shetty has set up a benchmark 
for other dental institutions on How to provide 
specialised dental treatment even to the remote 
areas.
February-March, 2010      Issue-1   Vol-10
5
Ruby Dental Pvt Ltd
1085, Bazar Paiwalan, Near Jama Masjid, Delhi-6 Phone No: 011-23285001, 23266400 
Fax: 91-11-23278569, Cell: 09811144220  E Mail: rubydentalpvtltd@yahoo.co.in 
www.rubydental.net
April-May, 2010        Issue-2   Vol-10
6
Full Mouth Rehabilitation- A case report
Prof. (Dr.) Chethan Hegde, Prof.(DR) N. Sridhar Shetty,  Prof. (Dr.) Manoj Shetty, Prof. (Dr.) Krishna Prasad D.
One of the most challenging treatment procedures 
in restorative dentistry is to restore completely 
mutilated dentition. This involves not only the 
restoration of teeth but also the rehabilitation of 
entire stomatognathic system. Of the many, one of 
the most accepted techniques in full mouth 
rehabilitation is the modified Pankey-Mann-
Schuyler technique. This article describes the 
systematic approach to be followed to achieve this 
goal, namely
1.
Static coordinated occlusal contact of the 
maximum number of teeth when the mandible is in 
centric relation.
2.
An anterior guidance that is in harmony 
with function in lateral eccentric positions on the 
working side.
3.
Disclusion by the anterior guidance of all 
posterior teeth in protrusion.
4.
Disclusion of all non-working side inclines 
in lateral excursions.
5.
Disclusion of all the working side inclines 
in lateral excursions.
Pre-operative examination and assessment 
involves not only assessment of teeth and its 
surrounding structures but also of entire 
stomatognathic system involving the centric 
relation, vertical dimension, neutral zone, 
components of smile, existing centric and 
eccentric occlusion and cause for mutilation of 
dentition. This case report describes various steps 
described in modified Pankey-Mann-Schuyler 
technique incorporated in the rehabilitation of a 
completely mutilated dentition due to 
Amelogenesis Imperfecta (Figure1).
Fig. 1
Fig. 2
Stage I: Preparation of mandibular anteriors 
and restoration
This is the starting point where all lower anteriors 
were prepared and restored (figure 2). Various 
guidelines were followed to reestablish lower 
incisal plane (a) lower incisal edges were placed 
at the level of lower lip during rest, (b) lower 
canines were placed at the level of corner of 
mouth, (c) lower incisal edge were barely made 
to touch the upper incisal edge when the patient 
pronounced the alphabet 's', (d) incisal edges 
were made to slant labially with linguo-incisal 
edge 0.5mm higher than the labio incisal edge 
like a incisal wear facet (figure 3).
Fig. 3
Fig. 4
Stage II: Preparation of mandibular 
posteriors
To start with, the lower occlusal plane 
was assessed. In order to achieve 
disocclusion, it was necessary to 
incorporate anteroposterior curve of 
Spee. It was done using Broadrick 
Occlusal Plane Analyser [1] by 
drawing a four inch arc on flag post 
from anterior most part of condyle and 
another arc from end of distal slope of 
canine. From point of intersection of 
these two arcs, referred to as survey 
centre, a four inch arc is drawn on all 
posterior teeth which represented 
posterior occlusal plane (figure 4). A 
wax template was prepared along a 
line 1 to 1.5mm below the established 
occlusal plane which was used as 
template for occlusal reduction of 
posterior tooth preparation. At this 
stage lower posterior teeth were not 
restored.
Fig 5
Fig. 6
Stage III: Preparation and 
restoration of maxillary anteriors
All maxillary teeth were prepared, both 
maxillary and mandibular impressions 
and subsequently casts were 
procured. Maxillary cast was mounted 
using facebow to facilitate transfer of 
orientation relation. At this stage 
centric relation record was made by 
guiding mandible to centric relation 
according to Dawsons bimanual 
manipulation technique [2] at an 
established vertical dimension. 
Since all posterior teeth were kept out 
of occlusion in the earlier stage there 
were no occlusal interference, this 
facilitated easy and precise recording 
of centric relation.
 Palatal contours of maxillary incisors 
were built in such a way that lower 
incisal edges barely touched the upper 
lingual fossae which directed forces 
along the long axis of maxillary 
anteriors. Anterior guidance was 
established using customized anterior 
guide table prepared preoperatively 
keeping disocclusion of posterior teeth 
in mind [3]. Phonetic and esthetic 
guidelines were considered to 
establish height of maxillary teeth. By 
pronouncing labio-dental sound 'f' 
incisal edge of maxillary teeth were 
made to touch the vermilion border of 
lower lip thereafter upper and lower 
teeth were barely made to touch while 
pronouncing dental sound 's'. Incisal 
edges of maxillary teeth were made to 
follow lower lip line during smile. 
Stage IV: Restoring the 
mandibular posterior teeth
 
Lower posterior teeth were waxed 
up arbitrarily. Using Broadrick 
occlusal analyser, a four inch 
radius arc was marked from 
survey centre over waxed up 
posterior teeth. This line denotes 
level of posterior occlusal plane 
thus established height of posterior 
teeth as well as curve of Spee. 
Lower lingual cusps were 
established at a level 1mm lower 
to level of buccal cusp height; this 
establishes the curve of Wilson 
which helps in easy transfer of 
food bolus from tongue to occlusal 
table and vice versa. Curve of 
Wilson also helps in disocclusion 
of posterior teeth during 
laterotrusive movements. The 
inner inclines of lower posterior 
teeth were determined using 
Fossa Guide [2], which is a arrow 
shaped guide which is established 
based on lateral border of 
envelope of movement determined 
by canine guidance (figure 5). The 
buccal and lingual inner inclines of 
lower posterior teeth were made to 
be wider than the inclines of fossa 
guide which would help in 
elimination of any interference of 
posterior teeth inclines during 
lateral movements. These crowns 
were cemented in place. 
Fig. 7 (Post-operative)
Pre-operative
Stage V: Preparation and 
restoration of maxillary 
posterior teeth     
Maxillary posterior teeth were 
prepared, impression was made 
and cast was poured. Using hard 
base plate wax a firm base 
extending from prepared teeth on 
left side to right side was prepared 
and was mounted with soft mouth 
temperature wax to record 
functionally generated path [4]. 
This wax mount was placed inside 
patients mouth, patient was made 
to close by guiding the mandible to 
centric relation. Next patient was 
guided to right, left and protrusive 
mandibular movements. Patient 
was allowed to make all 
intermediate and functional 
movements himself and record the 
path travelled by all lower posterior 
teeth on functional wax. A stone 
core (figure 6) was poured on this 
functional generated path which 
was used to make maxillary crown wax 
pattern [5] which would disocclude during all 
eccentric movements. These completed 
crowns were tried in patient's mouth for 
uniform contact of all posterior teeth in 
centric relation and for mutually protected 
occlusion and cemented (Figure 7). 
Conclusion:
Modified Pankey-Mann-Schuyler technique 
provides step by step procedure to be 
followed in full mouth rehabilitation and 
helps in achieving defined goals and 
objectives. Even though procedures 
involved are very elaborate, they are easy to 
follow and gives a sense of security to the 
restorative dentist, specially to those who 
are attempting full mouth rehabilitation 
cases for the first time.
References:
1.
Christopher D. Lynch, Robert J. 
McConnell. Prosthodontic management of the 
curve of Spee: Use of the Broadrick flag. J 
Prosthet Dent 2002;87:593-7.
2.
Dawson, P. E.: Functional Occlusion: 
From TMJ to Smile Design, Elsevier, 2007, pp 
75-83, 214-220.
3.
Dawson, P. E.: Evaluation, Diagnosis, 
and Treatment of Occlusal Problems. St. Louis, 
1974, The C: V Moshy Co..p 161.
4.
Pankey LD, Mann AW: Oral 
rehabilitation. Part II. Reconstruction of the upper 
teeth using a functionally generated path 
technique. J Prosthet Dent 1960; 10:151-162.
5.
Meyer FS: The generated path 
technique in reconstruction dentistry. Part II. 
Fixed partial dentures. J Prosthet Dent 
1959;9:432-440.
Authors
Prof. (Dr.) Chethan Hegde
Prof.(Dr) N. Sridhar Shetty
Prof. (Dr.) Manoj Shetty
Prof. (Dr.) Krishna Prasad D.
Professor, Department of 
Prosthodontics, A B 
Shetty Memorial Institute 
of Dental Sciences, 
Mangalore.
Director, CADSS, 
A.B.Shetty Memorial 
Institute of Dental 
Sciences, Mangalore
Professor, Department of 
Prosthodontics, A B 
Shetty Memorial Institute 
of Dental Sciences, 
Mangalore.
Professor and Head of 
Department, Department 
of Prosthodontics, A B 
Shetty Memorial Institute 
of Dental Sciences, 
Mangalore.
April-May, 2010          Issue-2   Vol-10
7
Welcome to the World of  dentomed
Dentomed is specializing in 
developing, innovating and 
importing complete range of 
dental equipments to offer 
you customised solutions 
for your clinical and 
institutional needs. 
“QUALITY FIRST, SERVICE 
UPMOST,  AFFORDABILITY 
FOR ALL” is our service 
tenet. 
We are working ourselves 
to supply many kinds of 
products, such as DENTAL 
CHAIRS & UNITS, LED 
CURING LIGHTS, 
HANDPIECES, 
AUTOCLAVES, 
AIRCOMPRESSORS, X-RAY 
UNITS and others a lot 
more. We constantly work 
hard to ensure superior 
quality, dependable 
performance, attractive 
designs, sophisticated 
technology and reasonable 
price products to suit your 
clinical and institutional 
needs. 
OUR MISSION:
“Deliver dependable and 
reliable dental products and 
services for better dentistry 
that benefit practitioners 
and patients everywhere 
with focus on INNOVATION, 
QUALITY, SERVICE AND 
AFFORDABILITY”. 
Passion, Vision, Innovation, Affordability and Service. These five words 
manifests   our corporate philosophy, our beliefs and values and in the 
products and services provided by Dentomed. These words establish the 
focus and direction of our work and express our commitment to our 
customers. Our company is built on product leadership, scientific 
innovations, and customer orientation. Our journey builds on our 
commitment to innovate by providing world class solutions and services 
for all your clinical and institutional needs. Today our ability to uniquely 
combine our product portfolio puts us in a leading position in the 
industry.  We are able to offer full range of solutions for all your clinical 
needs. Our biggest strength today is that we deliver on our promises and 
will never be satisfied until you are satisfied with our products and 
services. You have my word on it.
Sincerely,
Vivek Tangri (09654350641), vivektangri8@gmail.com
Managing Director
We deliver on our promises
Reasons  why you should 
buy dentomed products
- AFFORDABILITY
- PRODUCT QUALITY
- INNOVATIVE 
TECHNOLOGIES TO 
FULFILL EVERCHANGING 
CLINICAL NEEDS.
- ALL BUDGET CLINICAL 
SOLUTIONS
- COMPLETE RANGE OF 
DENTAL CLINICAL 
EQUIPMENTS UNDER ONE 
ROOF.
- ADEQUATE INVENTORY 
TO ENSURE QUICK 
DELIVERY.
- ALL SPARE PARTS 
AVAILABLE AT ANY GIVEN 
POINT, SO NO WAITING. 
- ALL INDIA SERVICE 
NETWORK. NO 
MATTER WHERE EVER 
YOU ARE, OUR 
SERVICE ENGINEERS 
ARE ALWAYS NEAR 
YOU.
- 24 HOURS IN YOUR 
SERVICE.
- OUR RESEARCH 
TEAM TO CONSTANTLY 
MONITOR NEW 
INNOVATIONS 
THROUGHOUT THE 
WORLD SO AS TO 
CONSTANTLY 
UPDATING PRODUCT 
PORTFOLIO.
- A BIG LIST Of OUR 
SATISFIED AND HAPPY 
CUSTOMERS. 
Happy Patient
Bechara Patient
Of dentist 
who uses 
high quality 
& service 
reliable 
dentomed 
products.
Of dentist 
who uses 
other 
products
Refinement of Cleft Care for 
Developing Countries is the Theme of 
INDOCLEFTCON-2010 
Department of 
Orthodontics and 
Dentofacial Orthopedics, 
Centre of Dental 
Education and 
Research, All India 
Institute of Medical 
Sciences organises 9th 
Annual Conference of 
Indian Society of Cleft 
Lip Palate and 
Craniofacial Anomalies 
(ISCLP &CA). This 
annual conference was 
organised from 23rd to 
25th of April, 2010 in 
AIIMS, New Delhi. 
INDOCLEFTCON 2010 
would provide a platform 
to workout  strategies  in 
the prevention and 
management of 
congenital deformities of 
face including cleft Lip 
and Palate with special reference to the  developing countries 
including  India where social, economic and educational constraints 
have a direct impact on this problem, says Prof. (Dr.) O. P. 
Kharbanda, President- ISCLP and CA And Organising 
Chairman, INDOCLEFTCON-2010. 
Prof. (Dr.) O.P.Kharbanda, 
President-ISCLP & CA and 
Chairman-INDOCLEFTCON 2010
April-May, 2010        Issue-2   Vol-10
8
My Students who 
made me Proud
Prof. (Dr.) N. Sridhar Shetty
Prof. (Dr.) S.Ramananda Shetty 
Vice chancellor 
P r o f e s s o r  
R a m a n a n d  
S h e t t y  ,  A  
Prosthodont is t  
who has occupied 
the highest seat of 
the Rajiv Gandhi 
U n i v e r s i t y  o f  
Health Sciences, 
Bangalore. He 
was my student at 
G o v t .  D e n t a l  
C o l l e g e  ,  
Bangalore who 
r o s e   i n  t h e   
profession today 
he is a consultant 
, Professor and 
administrator and 
is a robust live fish 
in a stream of professional education that has been intricately 
knitted with Health care service. I am proud of my beloved 
student , Vice Chancellor Ramananda Shetty.
Presently, he is Vice-Chancellor of Rajiv Gandhi University of 
Health Sciences in Karnataka, the largest Health Sciences 
University in India. He has brought metamorphic changes in 
administration, governance, academic standards; secured 
academic excellence in teaching that will have a permanent 
improvement in Health Care Delivery.
The University did not inherit any International linkages in the 
past ten years of its existence. Dr.Shetty initiated discussion 
with several Universities of repute abroad and even visited 
some of them. His efforts yielded in signing the MOU with Gulf 
Medical University, Minnesota, USA etc. The intention is to 
start bilateral exchange programs for students and faculty in 
affiliated colleges and also to offer dual degrees jointly. 
 His dynamism crossed the state and attracted attention of Her 
Excellency President of India, Smt. Pratibha Patil. She 
appointed Dr S. Ramananda Shetty as nominee of the 
President to the Banaras Hindu University to serve till 
December 2012.
 ”A complete administrative system that towers above scores 
of professional Health scientists, teachers, distinct 
administrators, educationists and professionals all traits  rolled 
into one  is the name Dr S. Ramananda shetty”. 
Vice Chancellor, Rajiv Gandhi University of 
Health Sciences, A largest Medical University, 
Bangalore
Dr. B. Subhashchandra Shetty
Dr.  Subhaschandra  
Shetty an endodontist  
who is a Managing 
D i rec tor  o f  lead ing 
manufacturing company 
C o n f i d e n t  D e n t a l  
Equipment Ltd., 
 The 
warmth of my affection to 
him stems from the fact 
that Dr. Subhaschandra 
Shetty is my student. I 
was a faculty at Govt. 
D e n t a l  c o l l e g e  ,  
Bangalore where he he 
persued his BDS and 
M D S  d e g r e e .  D r .  
Subhaschandra Shetty is 
a dynamic, diligent , 
sportsman . He was 
friendly humane  and had leadership qualities. He was loved 
by his fellow students and the faculty. He is the personality to 
take the challenge . He was the first professional dental 
surgeon who has entered inot manufacturing dental 
Managing Director, Confident Dental 
Equipments Ltd.
equipments . He established a company 
“Confident  Dental Equipment Company 
Lit. wherein he was instrumental for 
bringing high tech equipment to the 
country. He made available for the Indian 
dental surgeons , a international standard 
equipments at a competitive and 
economical  prices and made practitioner 
professional life easy. 
Confident today is largest Producer of 
Dental Equipment in Asia, Developed 
entire ranges of Clinical and Laboratory 
equipment, saving great amount of 
foreign exchange and also made the 
technology available to everyone.  This is 
the Proud Company which has 
developed equipment on par with any of 
the world class equipment. 
He had held several prestigious positions 
including President-Indian Dental 
Association. As IDA President formulated 
a single Constitution. Earlier every 
branch use to hold a constitution giving 
room to lot of litigation.  Single 
constitution helped greatly to discipline of 
Association.
Dr. Vimi S.
Dr. Vimi S. , BDS, MDS.,Senior 
Lecturer in the  department of 
Oral Pathology of SINHGAD 
DENTAL COLLEGE, PUNE
As a teacher 
for the last 
45 years 
thousand of 
students 
passed out 
from the 
institutions 
where I was 
a faculty. 
During my 
carrier at 
Govt. Dental 
College 
Bangalore as 
a faculty , 
there were many dynamic students who are 
intelligent  with highest ranks in academics 
and professional capabilities there were 
many students who are  sportsmen of 
repute , and excellent in extracurricular 
activities. I remember there was a brilliant a 
student a rank holder and state basket ball 
player, Dr. Sudhindra with whom I played 
basket ball and also associated with his as 
a junior faculty member There are many 
such brilliant personality who where my 
students and occupied highest positions in 
academics , administration, research and 
industries at international and national level. 
With above memories I would like to 
present the most recent star  students is Dr. 
Vimi S. a pleasing personality , sportsmen 
and the university rank holder . She was 
most familiar and friend to fellow students 
and her teachers.
Dr. Vimi  joined as first BDS student at 
A.B.Shetty Memorial Institt. Of dental; 
Sciences in the year 2000. She impressed 
every faculty member as a best student in 
the class and the best  in sports and games  
and most  capable person in extracurricular 
activities. She is the rank holder in the 
university from first year to final year and all 
rounder sportsmen and a leader at the 
institution when she was a student at this 
college. She was loved and recognized by 
one and all as one of the most brilliant and 
lovable student of the college . She persued 
her post graduation MDS in Oral Pathology 
and joined as faculty which is the right 
choice for her carrier . I wish her to become 
great teacher and researcher. I wish her all 
the best in her future endeavor to be a icon 
of the profession of dentistry. 
Prof. (Dr.) N. Rajiv Shetty - 
my teacher & source of inspiration
Prof. (Dr.) N. Sridhar Shetty
Prof. (Dr.) N. Rajiv Shetty 
The dream begins with a teacher 
who believes in you, who tugs and 
pushes and leads you to the next 
plateau, sometimes poking you 
with a sharp stick called "truth." 
These words of Dan Rather reminds 
me of my teacher Prof. Rajiv Shetty. 
Whatever I have achieved in life is 
because of my teachers, as a great 
teacher is like a candle - it consumes 
itself to light the way for others. My 
writing as Editor-in-Chief  would 
never complete without the mention 
of  Prof. N. Rajiv Shetty. Prof. Rajiv 
Shetty needs no introduction for 
being at the helm of affairs for over 5 
decades in the field of dentistry, a 
renowned endodontist , most respected dental surgeon , dedicated 
teacher , disciplined and upright administrator and a role model. He 
has a reputed professional carrier and most seeking consultant 
dental surgeon in the profession for the last 5 decades. He is in the 
profession as a teacher, principal, and director of medical education. 
Prof. Shetty with his vast experience was also  Director of Medical 
Education for the Government  of Karnataka, and has to his credit 
being the first ever dental surgeon in the country to occupy this 
prestigious post . He happens to be one among the few pioneers and 
renowned  specialist in the field of dentistry. He was the member of 
Dental Council of India , Karnataka Dental Council , Indian Dental 
Association, Federation of Operative Dentistry in India, Fellow of 
International college of Dentists , he occupied coveted post of 
President Federation of Operative dentistry in India. He was honored 
at the silver jubilee  of International college of Dentists for the 
outstanding achievement in the field of dentistry, at the Asia pacific 
Dental Federation for sincere and dedicated services rendered 
towards operative dentistry in India , he was honored by the 
Federation of Operative Dentistry in India for his excellent service 
and enhancement of the profession . He was presented with the 
plaque of honor by the Rajiv Gandhi University of the Health 
Sciences, on teachers day he as was honored by the Indian Dental 
Association , Bangalore  Life time achievement award for his 
dedicated and outstanding service to the cause of dentistry in 
Karnataka for more than 40 years. He was also honored by Bunt 
sanga association for outstanding achievement in public life. 
He has been honored with several awards including the Rajyotsava 
award, the highest honor in the state by Government of Karnataka 
for his outstanding achievements in the field of dentistry. He has also 
been presented with the certificate of merit for distinguished 
contributions to dentistry by the “Pierre Fauchord Academy” United 
States of America”.
Brief News
Courtesy-Dibya Industries
April-May, 2010          Issue-2   Vol-10
9
Carat Biopaque
Carat Ecoline
highest quality dental ceramics
Carat Biopaque
Ready-to-use Opaque Porcelain
Carat Ecoline
The Economic Ceramic System
Marketed in India by:
Call our Toll Free No.
1 8 0 0  11  7 8  7 8
Mob:      98100-57251
Email: anilberi@stimbrushes.com
Global Dent Pvt. Ltd.
F-91, Sector-8, Noida, UP-201301
April-May, 2010       Issue-2   Vol-10
10
 Prof. N. Sridhar Shetty’s
10 Principles of a successful 
 professional life
1.
To be a Raja vaidhya (Kings Physician) is a great opportunity. 
Be concern and kind to serve (30%of service) the rural population of 
India who are void of awareness , availability, accessibility and 
affordability for their oral and dental care (health care) 
2.
Discipline is the gate way of learning. Professional education 
is to experience knowledge and progress our mind for better social 
leaving. 
3.
Practice the profession of dentistry with moral and ethics. Be 
disciplined, regular, punctual , kind and humane.
4.
One cannot become millionaire in a day, sapling cannot bare 
fruits, and it needs to grow into a tree. Grow as a tree to bear fruit 
and be the successful leader of the profession of dentistry. Acquire 
knowledge, skill and ability to elevate pain and sufferings of people 
to provide quality life. 
5.
It is not important to be a leader or a millionaire to make quick 
money. Be kind and concern to the health care of rural people of 
India; render your knowledge, skill to serve all those rural people 
who are ignorant about oral and dental health care. 
6.
Learning is a continuous process. Be acquainted with 
progress of science of dentistry continuously and perpetually. 
7.
Be in contact with your alma mater to update your knowledge, 
clinical skills and practice.
8.
Associate with your professional colleagues, exchange and 
share your professional experience.
9.
Make habit to read scientific news matters, journals, and 
progress of the science to know and understand this scientific world. 
10.
Associate with nongovernment. organization and professional 
association render your service and experience for the better cause 
of human beings and your social living.  
Now grow your tooth by stem cell, a new 
technology :Stem cell banking in india
Author: Prof. (Dr.) Sanjay Agarwal  , Co-author: Dr Priti Agarwal
Stem cells are cells found in all multi cellular organisms. They are characterized by the ability to 
renew themselves through mitotic cell division and differentiate into a diverse range of 
specialized cell types. Research in the stem cell field grew out findings by Canadian scientists 
Ernest A. McCulloh and James E. Till in the 1960. The two broad types of mammalian stem cells 
are: embryonic stem cells that are isolated from the inner cell mass of blastocysts, and adult 
stem cells that are found in adult tissues. In a developing embryo, stem cells can differentiate 
into all  of the specialized embryonic tissues. In adult organisms, stem cells and progenitor cells 
acts as a repair system for the body, replenishing specialized cells, but also maintain the normal 
turnover of regenerative organs, such as blood, skin, or intestinal tissues.
Stem cell can now be grown and transformed into specialized cells with characteristics 
consistent with cells of various tissues such as muscles or nerves through cell culture. 
Highly plastic adult stem cells from a variety of sources, including umbilical cord blood and bone 
marrow, are routinely used in medical therapies. Embryonic cell lines and autologous embryonic 
stem cells generated through therapeutic cloning have also been proposed as promising 
candidates for future therapies.
The classical definition of a stem cell requires that is posses two properties:
?
Self renewal- the ability to go through numerous cycles of cell division while 
maintaining the undifferentiated state.
?
Potency- the capacity to differentiate into specialized cell types. In the strictest sense, 
this requires stem cells to be either totipotent or pluripotent- to be able to give rise to any mature 
cell type, although multipotent or unipotent progenitor cells are sometimes referred to as stem 
cells.
Potency specifies the differentiation potential (the potential to differentiate into different cell 
types) of the stem cell.
?
Totipotent (a.k.a. omnipotent) stem cells can differentiate into embryonic and 
extraembryonic cell types. Such cells can construct a complete, viable, organism. These cells 
are produced from the fusion of egg and sperm cell. Cells produced by the first few divisions of 
the fertilized egg are also totopotent.
?
Pluripotent stem cells are the descendents of totipotent cells and can differentiate into 
nearly all cells, i.e. cells derived from any of the three germ layers.
?
Multipotent stem cells can differentiate into a number of cells, but only those of a 
closely related family of cells.
?
Unipotent cells can produce only one cell type, their own, but have the property of self-
renewal which distinguishes them from non-stem cells (e.g. muscle stem cells).
Identification
The practical definition of a stem cell is the functional definition- a cell that has the potential to 
regenerate tissue over a lifetime. For example, the gold standard test for a bone marrow or 
hematopoitic stem cell (HSC) is the ability to transplant one cell and save an individual without 
HSCs. In this case, a stem cell must be able to produce new blood cells and immune cells over 
a long term, demonstrating potency. It should also be possible to isolate stem cells from the 
translanted individual, which can themselves be transplanted into another individual without 
HSCs, demonstrating that the stem cell was able to self-renew.
Properties of stem cells can be illustrated in vitro, using methods such as clonogenic assays. 
Where single cells are characterized by their ability to differentiate and self- renew . as well, 
stem cells can be isolated based on a distinctive set of cell surface markers. However, in vitro 
culture conditions can alter the behavior of cells, making it unclear whether the cells will behave 
in a similar manner in vivi. Considerable debate exists whether some proposed adult cell 
populations are truly stem cells.
Fetal Stem Cells
Fetal stem cells are primitive cells types found in the organs of fetuses. The classification of fetal 
stem cells remains unclear and this type of stem cell is currently often grouped into an adult 
stem cell. However, a more clear distinction between the two cell types appears necessary.
Stem cell division and differentiation.-A- stem cell; B- progenitor; C- differentiated cell; 1- 
symmetric stem cell division; 2- asymmetric stem cell division; 3- progenitor division;4- terminal 
differentiation.
The term adult stem cell refers to any cell which is found in a developed organism that has two 
properties: the abilty to divede and create another cell like itself and also divide and create a cell 
more differentiated than itself. Also known as somatic stem cells and germline (giving rise to 
gamets) stem cells, they can be found in children, as well as adults.
Pluripotent adult stem cells are rare and generally small in number but can be found in a number 
of tissues including umbilical cord blood. A great deal of adult cell research has focused on 
clarifying their capacity to divide or self-renew indefinitely and their differentiation potential.
Most adult stem cells are lineage restricted (mulipotent) and are generally refferd to by their 
tissue cells origin (mesenchymal stem cell, adipose derived stem cell, endothelial stem cell, etc.)
Adult stem cell treatments have been successfully used for many years to treat leukemia and 
related bome/ blood cancers through bone maroow transplants. Adult stem cells are also used in 
veterinary medicine to treat tendon and ligament injuries in horses.
The use of adult stem cells in research and therapy is not as controversial as embryonic stem 
cells, because the production of adult stem cells does not require the destruction of an emnryo. 
Additionally, because in some instances adult stem cells can be obtained from the intended 
recipient, (an autograft) the risk of rejection is essentially non-existent in these situations.
Amniotic
Multipotent stem cells are also found in amniotic fluid. These stem cells are very active, expand 
extensively without feeders and are not tumorogenic. Amniotic stem cells are multipotent and 
can differentiate in cells of adipogenic, osteogenic, mypgenic, endothelial, hepatic and also 
neuronal lines.
From an ethical point of view, stem cells from amniotic fluid can solve a lot of problems, because 
it's possible to catch amniotic stem cells without destrying enbroyes. For example, the Vatican 
newspaper “ Osservatore Romano” called amniotic stem cell “ the future of medicine”.
It's possible to collect amniotic stem cells for donors or for autologous use: the first US amniotic 
stem cell bank opened in Medford, MA, by Biocell Corporation and collaborates with various 
hospitals and universities all over the world.
Treatments
Diseases and conditions where stem cell treatment is promising or emerging. Bone marrow 
transplantation is, as of 2009, the only established use of stem cells.
Medical researchers believe that stem cell therapy has the potential to dramatically change the 
treatment of human disease. A number of adult stem cell therapies already exist, particulary 
bone marrow transplants  that are used to treat leukemia. In the future, medical researchers 
anticipate being able to use technologies derived from stem cell research to treat a wider variety 
of diseases including cancer, Parkinson's disease, spinal cord injuries, Amyotrophic lateral 
sclerosis, multiple sclerosis, and muscle damage, amongst a number of other impairment and 
conditions. However, there still exists a great deal of social and scientific uncertainty surrounding 
stem cell research, which could possibly be overcome through public debate and future 
research, and further education of the public.
Research Patents
The patents covering a lot of work on human embryonic stem cells are owned by the Wisconsin 
Alumni Research Foundation (W A R F). W A R F does not charge academics to study human 
stem cells but does charge commercial users.
Embryonic Stem Cells.
Advantages-
?
Because they have the potential to become any cell in the human body, embryonic 
stem cells are commonly considered to hold the most promise for treating disease and replacing 
tissue and cells.
?
Large numbers can be easily grown in the laboratory.
Disadvantages-
?
Safely and effectiveness in human has not yet been determined.
?
Because they have the potential to become any cell in the human body, they are 
difficult  for scientist to control.
?
They can change into unintended types of cells in the body. E.g- cells intended to 
become liver cells may become pancreatic cells.
Ethical issues-
Many people oppose embryonic stem cell research because they believe that once 
termed, the embryo is a human life that showed not be destroyed. This is an very significant 
political moral and religious issues for many.
Adult stem cells-
Advantages-
?
Have been safely used in humans for over 30 yrs.
?
No danger of immune system rejection with cells from the patient's own body.
?
Extremely low risk of tumor growth
?
Easier to control than embryonic cells.
Disadvantages-
?
Present in the body in very small numbers
?
More limited in what they can become than fetal or embryonic cells.
?
More difficult to grow in the laboratory.
Ethical issues-
?
No significant ethical issues.
                               Stemade in the first private cell bank in India which introduces the innovative 
concept of Dental Stem Cell Banking. Stemade has taken this innovative approach by accessing 
the patented technology of extracting viable stem cells from the human tooth. Stemade aims to 
gain repute in the new era of regenerative medicine through dental stem cell banking.
            Stemade is a subsidiary of Geneoval, which has a unique Philosphy of being a long term 
value generating companion for its stakeholders.
Author
Prof. (Dr.) Sanjay Agarwal,   
Professor and Head of 
Department Conservative 
Dentistry & Endodontics, 
I.P. DENTAL COLLEGE & 
HOSPITAL
GHAZIABAD  (U.P)
Mob: 9811262920
Co-Author
Dr. Priti Agarwal, 
She is in private 
practice in New Delhi
Dental World Mumbai Helpline
         9021729911
IMMEDIATE LOADING OF IMPLANTS USING SYNCONE 
ABUTMENTS FOR A COMPLETE DENTURE PROSTHESIS
Dr. Rakshith Hegde, Prof. N. Sridhar Shetty , Prof. Chethan Hegde 
In a completely mucosa supported complete 
denture prosthesis, retention is a major problem. 
Anchoring such prosthesis with endosteal 
implants is the best method of achieving 
maximum retention even under load. If the 
patient opts for an implant supported prosthesis, 
a “fixed” denture can often be delivered 
immediately after implant placement.
About 30 years ago, in 1979 Dr. Philippe 
Ledermann demonstrated that four implants 
primarily splinted on a bar can be immediately 
loaded. The resilience between the die and 
matrices(bar-joint denture) has the effect of 
distributing the chewing forces through the 
implants and also through the base of the 
denture to the mucosa and the alveolar ridge. 
The disadvantage of the Ledermann method and 
other comparable concepts and current systems 
is the large amount of work in the laboratory that 
is required. This means higher costs and 
significantly longer treatment time. The generally 
older, edentulous patient (Fig. 1) with a poorly 
fitted total mandibular denture is primarily 
interested in having a denture that remains firmly 
seated while chewing and talking. This should be 
accomplished as quickly as possible i.e. in one 
session  and without a complex procedure. The 
Ankylos SynCone Concept offers this option. The 
denture is fitted onto the abutments immediately 
after placement of the implants while the patient 
is still anesthetized. The patient can leave the 
clinic with a functionally and esthetically 
satisfactory restoration. The immediately placed 
prosthesis acts simultaneously as a healing plate. 
It covers the wound and helps to reduce 
postoperative swelling.
The treatment method described here, is based 
on immediate loading of four inter foraminal 
ANKYLOS® implants without the use of a bar 
retainer. The denture is retained by prefabricated 
conical crowns (degunorms), which are inserted 
into the existing denture base by direct intraoral 
polymerization immediately after surgery and 
supported by the corresponding conical primary 
implant abutments (Syncone Abutments). This 
method facilitates secondary splinting by way of 
the inserted mandibular complete denture. The 
progressive thread design of ankylos ensures the 
primary stability that is essential for immediate 
loading in all bone qualities There are 5 factors 
influencing initial and lasting tissue stability, 1-No 
micromovement, 2-Bacteria-proof connection, 3-
Platform-Switching, 4-Subcrestal placement, 5-
Microroughness to the interface.
Morse taper connection  -  No gap below 
gingival ,No micromovement ,Strength, Low 
risk of fracture, Antirotational
Ankylos Progressive Thread design  and 
micro-roughened implant surface with 
with increased wettable properties for 
initial and final bone healing and 
anchorage  for initial and final stability. 
Thread design to reduce load transfer to 
the crestal cortical bone and greater 
transfer to the elastic cancellous region. 
Thread geometry and thread depth to 
reduce the concentration of tension in 
the emergence region of the implant 
through the bone(where load transfer is 
greatest in threaded region in threaded 
implants
Platform Switching -ANKYLOS® CONVINCES 
THROUGH BETTER BONE PRESERVATION. 
The dense crestal apposition of peri-implant 
hard and soft tissue at the implant is a 
decisive factor for a successful, fast, and 
stable osseointegration of the implant  and it 
guarantees a harmonic design of the soft 
tissue contour.
Microbacteri
a in 
microgap at 
abutment 
connection 
leading to 
crestal bone 
resorption 
An initial point is definitely the implant-abutment 
connection. Micromovements between implant 
and abutment can irritate the tissue. And the 
irritation causes bone resorption in the region of 
the implant shoulder. The first requirement for an 
implant system in esthetically critical cases is 
therefore one that can establish a mechanically 
stable and bacteriaproof connection between 
implant and abutment that is proof against 
micromovements. Some implant systems manage 
this by using an internal, friction locked and keyed 
tapered connection. This connection forms a 
virtual single component implant-abutment 
combination, which ensures stable tissue and 
prosthetic reliability right from the start. The single 
piece implant system has an axis at the implant-
crestal bone junction at the crestal bone and 
results in crestal bone resorption. By platform 
switching with morse tapered connection , the 
axis on loading shifts away from the crestal bone 
and no micromovements, thereby crestal bone 
resorption is prevented. This gives the 
implantologist prosthetic reliability and the virtual 
single unit has many advantages for the 
prosthetic restoration. The fixed implant-abutment 
connection enables transgingival healing with no 
esthetic compromises and as a result optimum 
soft tissue regeneration. An implant with morse 
taper connection does not have it: the microgap, 
micromovement. It is automatically sealed to 
prevent ingress of bacteria. Chewing loads cause 
relative movement between implant and 
abutment, resulting in a pumping effect. The 
result is infection in the tissue at the interface 
level because of the ingress of endotoxins. The 
bone responds with resorption below the implant-
abutment. The potential for infection is reduced 
without the microgap  and without 
micromovement it simply does not occur. Without 
microbial leakage in the implant lumen there is no 
microbial colonization and without endotoxins no 
potential for infection. The implantologist should 
consider the most bacteria-proof, gap-free 
connection possible when selecting the implant 
system for cases with reduced bone volume, thin 
gingiva or particularly high esthetic demands. 
This will keep the peri-implant hard and soft 
tissue stable. Platform switching is an important 
factor for tissue stability  but only in conjunction 
with a connection design that eliminates 
micromovements and is proof against the ingress 
of bacteria, referred to as platform shifting. The 
smaller diameter of the abutment means that 
there is more space for peri-implant soft tissue, 
which improves the red esthetics. To keep it 
natural looking, cylindrical implants should be 
placed below the bone margin, which means 
subcrestal placement. The subcrestal placement 
of microstructured at implant shoulder and  with 
platform shifting allows the bone to grow which 
helps in support for the gingival tissue to establish 
tissue stability for esthetics. (Biological width) 
However, subcrestal placement is the real bone 
killer if the implants have a connection that allows 
micromovement and a microgap. The bone only 
remains stable in spite of
subcrestal placement if there is 
absolutely no irritation at all, which 
requires a bacteria-proof and rigid 
connection design that also prevents 
irritation by platform switching. This 
results in a natural emergence profile 
that leaves space for thick, stable soft 
tissue above the implant shoulder. The 
deposition of bone above the level of the
connection was formerly considered 
impossible because the microroughness 
of the implant surface always ended 
below the level of the implant shoulder. 
Implant concepts that make use of tissue 
deposition in the shoulder region of the 
implant simply extend the growth-
activating implant surface over the 
shoulder region of the implant. Both bone 
and connective tissue cells are deposited 
on a microroughened implant shoulder 
and spread faster and extend more than 
on a machined surface. In combination 
with platform switching, subcrestal 
placement and a morse tapper  
connection design that eliminates 
micromovements and bone can grow on 
the horizontal shoulder surface and on 
the abutment. 
This provides support for the overlying 
soft tissue and for patients means long-
term stability of good esthetic results. In 
general  the following factors are taken 
into account when selecting the implant 
system:
1. No micromovement (morse taper 
connection) 
2. Bacteria-proof connection(morse taper 
connection) 
3. Platform switching with 
microroughness on the platform 
4. Option of subcrestal placement and 
5. Microroughness to the interface (surface 
area increase with increased wettability)
6. progressive thread design.
The ANKYLOS®  SynCone system offers this 
option. The denture is delivered immediately 
after placement of the implants while the 
patient is still anesthetized. The patient can 
leave the clinic with a functionally and 
esthetically satisfactory restoration. The 
treatment concept takes advantage of the 
telescopic system. The splinting of the 
implants, which is absolutely essential for 
immediate loading in all cases, is achieved 
via the prosthesis as a secondary factor. The 
industrially prefabricated, milled retention 
elements with a tapered design guarantee 
excellent fit with optimum friction. The indirect 
splinting with the four tapered crowns 
stabilizes the prosthesis and prevents it from 
moving. The implants are immobilized in 
three dimensions. The chewing loads with a 
solely implant-supported prosthesis are no 
longer distributed over the entire mucosa but 
are transmitted directly to the implants. The 
immediately placed prosthesis acts 
simultaneously as a healing plate. It covers 
the wound and helps to reduce postoperative 
swelling. We can quite rightly speak of 
significantly improved comfort during 
treatment for the patient under such 
conditions. The confirmed long-term stability 
of Ankylos implants  combined with 
immediate restoration is derived from the 
following properties of the implant: the thread 
design, the morse tapered connection 
between implant and abutment, the cell plus 
surface and the resulting platform switching. 
The microstructure of the cell plus surface 
accelerates the bone reaction and supports 
adhesion of bone-inducing cells on the bone-
implant interface. The result is a fast bone to 
implant contact and successful 
osseointegration. The progressive thread 
MAINTENANCE FREE
EASY TO USE
April- May, 2010          Issue 2   Vol 10
11
ensures the primary stability that is essential for 
immediate loading in all bone qualities. The 
stability is retained under functional loading and 
also when the dentures are removed. The 
exposed implant shoulder allows the Ankylos 
implant to be positioned up to more than 1 mm 
subcrestally. The load is transferred to the 
cancellous bone (particularly to the apex). Lateral 
forces are transferred to the bone via the profiled 
elbows of the threads. This reduces the load on 
the cortical bone and the crestal bone. An 
immediate implant placement reduces the bone-
free, sickle-shaped space of the alveolar cavity. 
The implant axes should be aligned as parallel as 
possible. The minimum distances to the 
emergence openings of the mental foramen and 
the course of the nerve must also be considered. 
Implants from 3.5 mm diameter and 11 mm length 
are the minimum requirement. The previously 
prepared existing complete denture prosthesis 
can ideally be used for assessment of bone height 
by x-ray and can also be used as a surgical 
template. The final prosthesis is  ground for 
accommodation of degunorm and should be as 
little as possible to reduce shrinkage during 
polymerization. The denture is placed in the exact 
position. When prepared in this way the SynCone 
caps(degunorm) can be polymerized intra orally to 
fit accurately in the final occlusal position without 
tension. Immediately on polymarization of the 
added selfcure resin, the denture is trimmed and 
delivered. This imposes an immediate functional 
load on the implants. 
There are four important considerations for 
placement of implants  and restoration using 
syncone abutments :
1. Subcrestal positioning of implants
2. Tension-free, intraoral polymerization of the 
secondary structures
3. Secondary splinting of the implants using the 
prosthesis
4. A solely implant-borne denture
The exact fit between secondary structure 
(SynCone abutments) and tertiary structure 
(matrices in the denture) prevents excessive 
horizontal force on the implants. The 
micromovements transferred to the implants by 
chewing, swallowing and talking are reduced to a 
minimum. To prevent excessive vertical forces as 
the cause of a functional overload, the patient is 
advised to eat only soft food for the first two 
weeks. The duration of the treatment is reduced to 
one session of about two hours and the 
prefabricated components allow accurate fitting at 
chairside. Once the osseointegration phase has 
been completed, a new tapered denture with a 
metal framework should be planned with the 
patient. The patient will then have a restoration 
that is very comfortable and esthetic with a 
significantly reduced denture base or a design 
similar to a bridge in the interforaminal region. The 
Ankylos SynCone concept can also be used in the 
maxilla but 6 implants have to be used and 
instead of 4degree tapered abutments as in the 
mandible, a 6degree tapered abutments have to 
be used. Also angulated syncone abutments can 
be used to achieve parallelism. 
Conclusion : immediate loading of ankylos 
implants for complete denture prosthesis 
facilitates patients treatment with implant 
supported prosthesis . the cost and time are 
reduced , and patient leaves the clinic with 
comfort confidence. Ankylos implants is 
selected for the evidence of success of  
longevity. The following factors enhances  
initial and lasting tissue stability 1. No 
micromovement (morse taper connection)  2. 
Bacteria-proof connection(morse taper 
connection)  3. Platform switching with 
microroughness on the platform 4. Option of 
subcrestal placement and 5. Microroughness 
to the interface (surface area increase with 
increased wettability) 6. Progressive thread 
design 
Radiological Assessment of bone 
height 
Subcrestal placement of 4 ankylos fixtures
Ankylos fixtures , syncone abutments and 
diganomes 
Syncone abutments placed immediately 
over the fixtures and sutured 
Placement of rubberdam for prevention of 
flow of acrylic resin below the abutment
Attaching dugunorms using self cure to the 
Prefabricated denture 
Dugunorm transferred on to the 
prosthesis 
Authors
Dr. Rakshith Hegde, 
Reader, Dept. Of 
Prosthodontics
A.B.Shetty Memorial 
Institute of Dental 
Sciences
Prof.(Dr) N. 
Sridhar Shetty, 
Director, CADSS, 
A.B.Shetty 
Memorial Institute 
of Dental 
Sciences, 
Mangalore
Prof. (Dr.) Chethan 
Hegde
Professor, Department 
of Prosthodontics, A B 
Shetty Memorial 
Institute of Dental 
Sciences, Mangalore
Behind a beautiful smile like
hers
is a quality lab like 
ours
i
 
 
i
 
i
 i
i  
 
i
 
 i
 
20 years of lab experience
For complete lab requirement
please call our Chief Technicians:
Manoj Sharma             Mahesh Karmakar
9871801111                   9810946654
9711670777                   9212756545
 
l t  l
 
i
t
l
 
ll 
 
i f 
i i
:
j 
             
 
                   
                   
E mail: swastikamdenatlab@gmail.com
4th International Congress of Oral 
Implantology
New Delhi is going to witness 4th International Congress of Oral Implantology which is 
going to be held from 21st -23rd, May, 2010 in hotel Lalit, New Delhi. This congress will 
be organised by the Academy of Oral implantology. Our aim would be to attract larger 
number of delegates and also encourage all old and new Implant Manufacturers in the 
country to participate in this gala event, says Dr Ajay Sharma, Organising Secretary. 
With the theme, "Implantology- myths and reality " this congress will witness a wealth of 
information about dental implants that will equip all participants with the necessary skills 
and know-how to help millions of toothless people with one of the fastest evolving 
disciplines in Dentistry today. This is in line with the main thrust of AOI's mission of 
providing quality implant education and research. AOI website :www.aoi-india.org
 DR.MEIYANG CHANG joins AB Shetty Silver 
Jubilee Celebrations
 The SILVER JUBILEE 
COLLEGE DAY 
CELEBRATIONS of 
A.B.Shetty Memorial Institute 
of Dental Sciences  was held 
20th April 2010 .
The CHIEF GUEST of the 
function was DR.MEIYANG 
CHANG (CHANG) of INDIAN 
IDOL, IPL AND 
BOLLYWOOD FAME. 
DR.CHANG is a DENTAL 
SURGEON by qualification 
who passed out from V.S 
Dental College, Bangalore in 
2006.
 PROF (DR.) U.S.KRISHNA NAYAK, Dean welcomed the gathering. PROF. (DR.) B. 
RAJENDRA PRASAD, Principal also addressed the gathering. MR.ARJUN NAYAK, 
Student Body President conveyed the Vote of Thanks. PROF. (DR.) PRIYADARSHINI 
HEGDE, Dean Student welfare also attended the function along with all the Head of 
departments, Faculty's and Students. 
Brief News
12
April-May, 2010          Issue 2     Vol 10
Crouzan syndrome 
-Aesthetic correction
Dr. Vikram Shetty
Abstract : 
Crouzan syndrome is a rare disorder characterized 
primarily by sutural synostosis which follows 
autosomal dominant mode of transmission. The first 
description seems to have been made by Crouzon in 
1912. We report a 18-year-old girl with Crouzon 
syndrome, presenting oro-facial characteristics and 
describe the treatment modalities. An 
interdisciplinary approach including Craniofacial 
Surgeon, Neurosurgeon, Anesthesiologist, 
Paediatrician, Orthodontist, Dental Surgeon, 
Psychologist, Radiologist, Speech pathologist, and 
social worker is required for managing these patients
Introduction :
Crouzan syndrome is a form of craniofacial 
dysostosis with an autosomal dominance inheritance 
pattern. The cranial vault presentation is premature 
synostosis of both coronal sutures with a resultant 
brachycephalic shape to the skull. Cranial vault 
suture involvement other than coronal may include 
saggital, metopic or lambdoidal, either in isolation or 
in any combination. The cranial base and upper face 
sutures are variably involved resulting in a degree of 
midface hypoplasia with an angle class III 
malocclusion. The orbits are hypoplastic resulting in 
varied degree of proptosis with additional orbital 
dystopia that may produce a mild to moderate orbital 
hypertelorism. 
Children with Crouzon syndrome have hypoplasia of 
the midface with diminished nasal and 
nasopharyngeal spaces. This increases nasal airway 
resistance. Occurrence of conductive hearing deficit 
is common secondary to stenosis of the external 
auditory canals and this results in frequent middle 
ear infections.
There is a lack of consensus on the timing and 
techniques of reconstruction.
Lannelongue in 1890 and Lane in 1892 performed 
the first recorded surgical approach to 
craniosynostosis, who completed strip 
craniectomies. In 1950 Gillis and Harrison reported 
experience with an extra-cranial Lefort III; later this 
technique was discouraged because of relapse. 
Tessier developed an innovative basic surgical 
approach that included new locations for the Lefort 
III osteotomy: a combined intracranial and 
extracranial approach, use of a coronal skin incision 
to expose the upper facial bones and use of 
autogeneous bone graft. In current practice the use 
of internal miniplate and microplate and screw 
fixation is the preferred form of fixation when stability 
and three dimensional reconstruction of multiple 
osteotomized bone segments and grafts are 
required.
Current staging of reconstruction for Crouzon's 
syndrome include primary cranio-orbital 
decompression and reshaping in infancy, repeating 
the craniotomy for additional cranial vault 
decompression and reshaping in young children, 
management of total midface deformity in childhood 
, management of jaw deformity and malocclusion in 
adolescents.
A 18-year-old female was referred to our hospital in 
2008. She was the Third child of clinically healthy 
parents. The Girl had craniofacial deformities, such 
as Plageocephaly, eye proptosis, maxillary 
hypoplasia with angle class III malocclusion, 
hypertelorism and was diagnosed with Crouzon 
syndrome. 
A routine blood work-up was carried out and the 
results were found to be normal. The patient was 
investigated with a 3-D CT scan along with saggital 
brain and bone cuts. Lateral and anterio-posterior 
cephalometric x-rays and an orthopantomograph 
(OPG) were taken. Radiographs of the skull 
revealed obliteration of sagittal and coronal suture 
lines with obvious bony continuity. CT revealed 
Craniosynostosis with premature closure of sutures, 
hollow orbits with proptosis, hypoplastic maxilla and 
zygoma, moderate degree of hydrocephalus with 
diffuse indentation of inner table of skull and 
narrowing of diploic space and prominent 
convolutional margins.
A detailed neurological and cardiology work up was 
undertaken. Counseling of the family members was 
carried out in view of the risks of the surgery. Cross-
matched whole blood, packed cells and Fresh 
Frozen Plasma was arranged in adequate quantity. 
Detailed photographs were made.
A team headed by the Craniofacial Surgeon and 
comprising a neurosurgeon, an anaesthesiologist, 
an orthodontist and a paediatrician was instituted. 
Planning included prelimnary cuts on dry skull to 
assess the type of results required post surgery and 
to simulate the surgical procedure. 
Intra-operatively preparation involved shaving of the 
head and setting up of central venous access, an 
arterial line and urinary catheterization. A body 
warmer was placed and the patient was placed in a 
Case Report :
slightly head elevated position.
We carried out a craniotomy of the vault for access 
and performed the cranial cuts such that the supra 
orbital rims and a central bando were removed. The 
osteotomised segments were cut by use of additional 
segmental orbital ostectomies for re-shaping. The 
bones were repositioned in an advanced position 
and plated using stainless steel plates. 
Post-operatively the patient developed a CSF leak 
which stopped on the 3rd post-operative day by 
conservative measures. The sutures were removed 
on the 10th day and she was discharged. The 
proptosis has reduced. The patient is on routine 
follow-up. 
She is being prepared for orthognathic surgery for a 
Le Fort III, Le Fort I advancement and mandibular 
rotation.
Fig 1
Fig 2
Fig 3
Figure 1,2 & 3 : Frontal 
and lateral views and  
inter-canthal width 
measurements 
showing the typical 
features of Crouzon's 
syndrome
Fig4  
Fig 5
Fig 6
Fig 7
Fig 8
Fig 9
Fig 10
Fig 11
Fig 12
Fig. 4 through 12 : Intra-operative 
photographs.
Figure 13 & 14 : Frontal and lateral 
views in early post-operative period
Fig 13
Fig 14
Figure 15 & 16 : Frontal and lateral views 
in 6 months post-operative period
Fig 15
Fig 16
References : 
1.Cohen MM Jr. Craniosynostosis and syndromes with craniosynostosis: Incidence, genetics, 
penetrance, variability and new syndrome updating. Birth Defects Orig Artic Ser 1979;15:13-
63       
2. Cohen MM Jr. Craniosynostosis: Diagnosis, evaluation and management. Raven Press: 
New York; 1986       
3. Syndromes of the head and neck. In : Gorlin RJ, Cohen MM, Levin LS, editors. 3 rd ed. 
Oxford University Press: 1990. p. 516-26       
4. Cohen MM Jr. Craniosynostosis update 1987. Am J Med Genet Suppl 1988;4:99-148       
Author:
Dr. Vikram Shetty, MBBS, MDS, DNB Director, Nitte 
Meenakshi Hegde Craniofacial centre , A.B.Shetty 
Memorial Institute of dental Sciences, Mangalore
AWARENESS OF ADVERSE EFFECTS 
OF TOBACCO RELATED HABITS AMONG 
THE NURSING STUDENTS IN MANGALORE
Dr.Uzma Belgaumi1, Prof.(Dr.) Pushparaja Shetty2, Dr. Sreelatha S.V.3, 
Prof (Dr.) Pratima S. Rao4, Lal  P. Madathil5
About 8090% of human cancers may be attributable to 
environmental and lifestyle factors such as tobacco, 
alcohol and dietary habits.1 Tobacco use is the leading 
preventable cause of premature death worldwide. It is 
estimated that 4.9 million people died of tobacco related 
illness in the year 2000 and by the 2020 the number will 
rise to 10 million /year, 70% of which will be in the 
developing countries. 2
Despite improvements in the management of diagnosed 
cases, delay in diagnosis undoubtedly increases the 
morbidity, mortality and the burden on the economy for 
providing health care.3 And health personnel could play 
a fundamental role in preventing Oral Cancer.4,5 The 
nursing community comprises a large pool of the health 
care system and hence can play a very vital role in oral 
cancer prevention and screening 6 and with this in mind 
a survey was conducted to evaluate the awareness of 
tobacco related habits among the nursing students in 
Mangalore.
MATERIALS AND METHOD
The study group consisted of 500 nursing students of 
Usha Institute of Nursing, a Unit of Nitte education trust. 
A survey questionnaire was prepared aimed at 
evaluation the students awareness regarding the 
prevalence of common regional tobacco habits, 
consequences of tobacco usage, signs and symptoms 
of precancer and cancer, study of related topics in the 
curriculum and interest in participation in tobacco 
control programmes. The questionnaire was distributed 
among the students and the results evaluated. 
RESULTS & DISCUSSION 
66.75% students thought that smoking was more 
commonly practiced than smokeless tobacco 
consumption. 67% students were aware that use of 
tobacco could lead to both oral and lung cancer and 
that oral cancer was common among tobacco users 
with betel quid chewing being rated most common 
cause of  cancer (52%).
However there was some confusion among the 
students regarding the common features of early 
cancer. Though 38.5% of them recognized red and 
white lesions and decreased mouth opening as the 
common features, a large group (35.5%) stated that 
dental caries, tooth ache and pus discharge and 26% of 
them thought bleeding swollen gums and loose teeth 
are signs of early cancer. And hence adequate steps 
need to be taken to educate the students in correct 
identification of early lesions.
68% of the students said that they could recognize the 
signs and symptoms of oral cancer and 64.5 % 
students were able to recognize all the signs and 
symptoms correctly but the remaining students would 
need to be trained.
The reasons for tobacco dependence according to the 
students were varied. 33.25% thought it was due to peer 
pressure, 26.25%  thought it was  a social practice , 25% 
thought  it was due to lack of awareness and the 
remaining 15% thought it was due to stress at work.
When asked how often they came across cancer 
patients, 56.5% said they did so rarely and 24.5% 
frequently. 25% students had participated in tobacco 
control/awareness programmes and 35.25% would like 
to participate in future programmes. This data is 
encouraging and the willingness to provide such services 
by the nursing community is reflected in the values 
obtained and this valuable resource can be appropriately 
channelized for cancer prevention. To strengthen the 
above observation an exuberant 85.5% students said 
that they have educated patients against its adverse 
effects and tried convincing patients to stop the habit. 
And impressive 67.25% students said that they would 
participate in future programmes and 23.25% of them 
were definite about doing so.
57.5% students were aware of the government policies 
on tobacco control and 80% of them thought use of 
tobacco should be banned. The remaining 20% did not 
want a ban on tobacco consumption, and this seems to 
be a large proportion for a community of health care 
personnel. It may also represent a hidden pool of the 
population who could possibly use tobacco products but 
do not acknowledge the habit due to various reasons. 
This would decrease the efficacy of patient management 
and hence steps need to be taken to reinforce positive 
attitude among this group.
In another important question pertaining to the 
curriculum containing related education, 48% said that 
the curriculum did cover the related aspects but a large 
43.25% said that it should be included in the curriculum.
All the students surveyed said that as health care 
personnel they can prevent oral cancer and help 
promote awareness about the adverse effects of tobacco 
consumption. And 74.25% of the students added a 
comment that they would provide health education to 
their patients and examine the patients more thoroughly 
for early changes of precancer and cancer.
Next page
13
April-May, 2010    Issue 2   Vol 10
Contd from previous page.......................
CONCLUSION :With the increasing burden of tobacco induced cancer, we as health professionals have a significant role in 
prevention and treatment of this lifestyle related disease. The nursing community forms a large pool of the health care fraternity. 
Their close association and frequency with dealing with patients and their families along with their knowledge about the disease 
process makes them indispensible in prevention and early detection of tobacco induced oral cancers. 
In conclusion most nursing students surveyed were aware about the adverse effects of tobacco but adequate training needs to be 
given in screening for oral cancer if early lesions are not to be missed. We suggest that oral cancer prevention and screening be an 
essential part of the nursing curriculum with both theoretical and practical demonstrations and active participation in tobacco 
cessation and cancer prevention programmes. With the combined efforts of the health care providers the menace of increasing oral 
cancer can definitely be controlled and the role of nursing community seems indispensible in prevention and early detection oral 
cancers.
BIBLIOGRAPHY
Reddy S, Gupta P. Report on Tobacco control in India  executive summary 
Bobba R, Khan Y. Cancer in India  An Overview. GOR Vol.5 No.4 ; 2003:93 -96. 
Murthy.N, Mathew. A. Cancer epidemiology, prevention and control. Current Science, Vol. 86 ; 2004:518-527
G.L. Lodi, A. Sardella and A. Carrassi. Oral Cancer Prevention and Dentists' Attitude towards Smoking. Oral Oncology, European 
Journal of Cancer, Vol. 318; 153: 1995 
Comment. Oral cancer screening: 5 minutes to save a life. The Lancet. Vol 365; 2005:1905-06
R.Shankarnaryanan. Health care auxiliaries in the detection and prevention of oral cancer. Oral Oncology; 1997 :149- 154
Authors: Dr.Uzma Belgaumi1, Prof.(Dr.) Pushparaja Shetty2, Dr. Sreelatha S.V.3, Prof (Dr.) Pratima S. Rao4, Lal  P. Madathil5
1Post Graduate,2Head of the Department and Professor,3Reader,4Professor,5Professor.Department of Oral Pathology  and 
Microbiology, A.B. Shetty Memorial  Institute Of Dental Sciences, Mangalore, Karnataka.
Dentsply India announce CME Program 
on Endodontics and Implantology 
Dentsply India is honoured and extremely pleased  to announce an International Speaker 
Program on Endodontics and Implantology from 10th to 13th May in Delhi, Bangalore and 
Mumbai. We would be fortunate to have with us Internationally renowned Endodontist 
Dr.Julian Weber, and famous Implantologist Dr.Weigl and Dr.Nentwig, who would be sharing 
the latest developments in their respective field of work. 
News brief
14
April- May 2010, Issue 2  Vol10
The SMILE that you always has dreamed
now at your reach
Before
After
LLis-Universal Composite
Opallis Syringes
Whiteness HP Maxx Bleach
Whiteness Perfect
i
i
l 
i
S-201-204, IInd Floor, Vardhman Plaza, O & P Pocket, Dilshad Garden,
Delhi - 110095 (INDIA) Phone No. +91 11-22131600, Tele-Fax . +91 11-43029499 
Mobile: 09871077633                             Email; jaishreesurgident@gmail.com    
JAISHREE SURGIDENT (INDIA) PVT. LTD.
For membership & subscription details of 
Dental World, please send request at: 
dw_2000@rediffmail.com
MAGNETISM IN ORTHODONTICS 
PROF. (DR.) U. S. KRISHNA NAYAK, DR. AZHAR MOHAMMED, 
DR. YATISH JOSHI, Dr. MANDAVA PRASAD, 
INTRODUCTION:
The first known magnets were the 
lodestones, which were stones that 
were magnetized naturally. The 
Greeks and the Chinese were amused 
by the stones' ability to attract metal 
over a short distance, as if by magic. 
Later they learnt to use lodestones in 
compasses to determine direction. 
Today magnets are used extensively. 
E.g. in VCR's, audio cassettes, ATM 
and credit cards, and the electronics 
industry. The most commonly 
encountered magnet in our lives is the 
planet Earth itself.
HISTORY:
Magnet was originally discovered from 
a place called Magnesia in Greece 
when a shepherd named Magnes 
accidentally came across a stone 
which attracted iron nails in his shoes. 
According to Matasa, the first person 
to write a book on magnets was 
William Gilbert in 1600. It was William 
Gilbert who first realized that the Earth 
was a giant magnet. Serious use of 
magnets in medicine was reported in 
early 19th century. The first use of 
magnets in Dentistry was by Behran 
and Egan in 1953 who used it as 
implants for denture retention. The use 
of magnets for orthodontic tooth 
movement was first described by 
Blechman and Smiley who bonded 
earth magnets made of Aluminum- 
Nickel - Cobalt to the teeth of 
adolescent cats to produce tooth 
movement. Other rare earth magnets, 
Samarium. - Cobalt, introduced by 
Becker in 1970.
PROPERTIES:
1)
COULOMB'S LAW
All magnets obey this law which states 
that the force between two magnetic 
poles is proportional to their 
magnitudes and inversely proportional 
to the square of the distance between 
them.
F α m1 X m2 
        d2
2)
CURIE POINT
Rare earth magnets tend to loss their 
magnetism at room temperature. Pierre 
Currie observed that magnets tend to 
lose their properties if subjected to a 
specific temperature which causes their 
domain to return to random distribution. 
This point of temperature is called 
Currie Point. In Orthodontics, this has 
been overcome by using magnets 
which are combined with other 
elements so that they can be 
incorporated in appliances and also be 
heat sterilized.
3)
ANISOTROPY
This property allows single crystals to 
be preferentially aligned in one    
direction, thus increasing the 
magnetism. This resulted in magnets 
capable of producing high forces 
relative to their sizes.
For rest of the article 
see next issue
April-May, 2010        Issue-2   Vol-10
15
April-May, 2010          Issue-2   Vol-10
16
Published Printed Edited & Owned by Neeraj Kaushik. Published at 1001, 2nd floor, Kucha Natwan, Chandni Chowk, Delhi-110006. Printed at Sandhu Printing Press 3840, Kanhya 
Nagar, Tri Nagar, Delhi-110035. Reproduction of any part is prohibited. Dental World does not guarantee the quality & efficacy of commercial advertisements. The views expressed in 
the articles are of the authors and does not reflect the official view of Dental World.
 Slim X-ray Viewer-LED Based
Regd off: 13, Shreshta Vihar, Vikas Marg Extn. Delhi-92  
Works: 53A, Dilshad Garden, Opp. SBI, Delhi-95 Ph: 22597763, 22597767, Mobile: 9811330727, 9711118436
E mail: gdpdental@gmail.com Website: gdpdentalindia.com 
With 4 Vacuum Cycle
Compact
Simple to Use 
Newly launched
X-Ray Magnifier
Enclave-V 22
Please note that we have shifted 
our works and office at the below 
mentioned address.
Ultraslim, thickness is  only 
19 mm.
LED based with uniform light 
all over.
Very low power conversion.
Table top model with slide 
for holding the X-Ray film.
(Magnification 2.5 X)
Power consumption 5 watt.
UNIKLAVE MINI
UNIKLAVE PLUS
UNIKLAVE SUPER
GLASS BEADS STERILIZER
Digital OPG X-ray Table Top
Can be placed on the wall
Overall Size:
Length 320x Height 270x Depth 75
Screen Size:290mmx230mm
Power Consumption 27 watt
Capacity: 
12 Ltr, 16 Ltr & 22 Ltr
Enclave-V12/V16