1. Conventional immediate denture
2. Delayed immediate denture
3. Transitional immediate denture

Etiology of malocclusion

Graber’s classification
General factors
1. Heredity
2. Congenital
3. Environment
    a) Prenatal (trauma, maternal diet, German measles, maternal metabolism etc.)
    b) Post natal ( birth injury, cerebral palsy, T.M.J. injury )
4. Pre-disposing metabolic climate and disease
    a) Endocrine imbalance
    b) Metabolic disturbance
    c) Infectious disease
5. Dietary problems ( nutritional deficiency )
6. Abnormal pressure habits and functional aberrations
    a) Abnormal sucking
    b) Thumb and finger sucking
    c) Tongue thrust and tongue sucking
    d) Lip and nail biting
    e) Abnormal swallowing habits
     (Improper deglutition)
    f) Speech defects
    g) Respiratory abnormalities
     (Mouth breathing etc,)
    h) Tonsils and adenoids
    i) Psychogenic tics and bruxim
    j) Posture
    k) Trauma and accidents

1. Anomalies of number : Supernumerary teeth, Missing teeth (congenital absence or loss due to accidents, caries, etc)
2. Anomalies of tooth size
3. Anomalies of tooth shape
4. Abnormal labial frenum : mucosal barriers
5. Premature loss
6. Prolonged retention
7. Delayed eruption of permanent teeth
8. Abnormal eruptive path
9. Ankylosis
10. Dental caries
11. Improper dental restorations

A   fixed or removable orthodontic appliance for preserving the space created by the premature loss of one or more teeth. It can be unilateral or bilateral.

Space maintainers are appliance made of metal or plastic that is custom fit to your child’s mouth.

 Primary teeth can be lost early for several reasons.

1. Accident or knocked out in a fall
2. Extraction because tooth cavity
3. missing at birth
4. some disease or condition can lead to every tooth loss.

Each one also acts as a guide for the permanent tooth that replaces it if deciduous tooth is lost early; the permanent tooth loses its guide. It can drift or erupt incorrectly into the mouth adjacent teeth can move into space. This means the permanent tooth can’t come in so space maintainers may be used.

Classification of mouth breathers
Mouth breathers can be classified into 3 types:

1. Obstructive
2. Habitual
3. Anatomic

1. Deviated nasal septum
2. Nasal polyps
3. Chronic inflammation of nasal mucosa
4. Localized benign tumors 
5. Congenital enlargement of nasal turbinates
6. Allergic reaction of the nasal mucosa
7. Obstructive adenoids

Habitual:  A habitual mouth breather is one who continues to breathe through his mouth even though the nasal obstruction is removed. Thus mouth breathing becomes a deep rooted habit that is performed unconsciously.

Anatomic:  An anatomic mouth breather is one whose lip morphology does not permit complete closure of the mouth, such as a patient having short upper lip.

Causes of mouth breathing

1. Excessive use of pacifier during infancy
2. Recurring allergies
3. Constriction of upper airways
4. Malpositioned of lower jaw
5. nasal polyps
6. deviation of nasal septum
7. tonsil hypertrophy

CAUSES:  According to Fletcher
Genetic factors- Hypertonic orbicularis oris.
Behavior (habit) –Tongue thrust can be acquired as a habit.

INDICATION

1. Inflammation extending beyond coronal pulp
2. Primary teeth with necrotic pulps
3. Roots and surrounding bone free of pathology
4. At least ½ of root length remaining
5. Second primary molar retention for the erupting first permanent molars
6. No permanent successor
7. Internal resorption without any obvious perforation
8. Pulpless primary teeth with sinus tracts

CONTRAINDICATION

1. Teeth with non restorable crowns
2. Periradicular involvement extending to the permanent tooth bud
3. Pathological resorption of at least one third of root with a fistulous sinus tract
4. Excessive internal resorption
5. Extensive pulp floor opening into the bifurcation
6. Systemic disease such as congenital or rheumatic heart disease, hepatitis, leukemia.
7. Primary teeth with underlying dentigerous or follicular cysts

IMAGE

Pit and fissure sealants are marketed in variety of formats; they can be filled, unfilled, tinted, clear or opaque. They may be polymerized in variety of ways.

The first generation of fissure sealants is ultraviolet light cure, the second generation is chemically cured (autopolymerised) and third generation is visible light cure. The fourth generation fissure sealants are those containing fluorides.

TYPE OF FISSURE SEALANTS

A)
   1. Three different kinds of plastics have been used as occlusal sealants:
          a)  Polyurethanes
          b) Cyanoacrylates
          c) Bisphenol a glycidyl methacrylate (BIS-GMA)
   2. Resin based sealants
   3. Glass ionomer sealants
   4. Fluoride containing sealants
B)
   1. Filled and unfilled
   2. Light cured and chemically (self) cured
   3. Clear and tinted.

Gold alloys contain gold, copper and other metals that results in a strong effective filling, crown or bridge.

Gold alloys are primarily used for inlays, onlays, crowns and fixed bridges.

There are two form of gold fillings, cast gold fillings(gold inlay and onlay) made with 14 or 18 kt gold and gold foil made with pure 24 kt gold.

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TYPES:
1.GOLD INLAY
Gold inlay is basically gold filling which fits within the contours of tooth. The gold inlay involves the occlusal and proximal surface of posterior tooth and may cap one or more but not all of the cusps.

Gold inlay is custom crafted in dental laboratory to precisely fit tooth so it takes two appointments to restore tooth with an inlay.

INDICATION:
    1. Replace over amalgam restoration.
    2. When proximal surface caries is extensive.
    3. Gold inlay restorations for class-1, class-4, class-5, and class-6 cavity.

2. GOLD ONLAY
Gold onlay involves the proximal surface of a posterior tooth and caps all of the cusps.

A gold onlay covers and protects the biting surface of a tooth that is severely damaged and not possible with dental filling.

INDICATION:
    1. In posterior teeth after root canal treatment.
    2. As a splinting to improve stability of the teeth.
    3. Partial coverage of posterior teeth where significant loss of coronal dentine.

ADVANTAGE:
    1. Strength (can withstand occlusal forces)
    2. Long lasting life (at least 10 to 15 years)
    3. Naturally beautiful
    4. Gold is pliable.
    5. Gold is versatile.

DISADVANTAGES:
    1. Expensive
    2. Galvanic shock
    3. More visit

TYPES:
Glass ionomer are classified into five types.
    1. Conventional glass ionomer cements.
    2. Resin modified glass ionomer cements.
    3. Hybrid ionomer cements. (Also known as dual cured glass ionomer cement).
    4. Tri-cure glass ionomer cements.
    5. Metal reinforced glass ionomer cements.

INDICATION:
    1. Type-2 glass ionomer for restorations.
    2. Type-3 glass ionomer for liners and bases.
    3. Type-4 glass ionomer for fissure sealants.
    4. Type-5 glass ionomer for core build up.
    5. Intermediate Restorations.
    6. Restorations for decidious teeth.
    7. Adhesive cavity liners(sandwich technique)

IMAGES:

Before

After

ADVANTAGE:

1. Inherent adhesion to tooth structure
2. High retention rate
3. Little shrinkage and good marginal seal
4. Fluoride release and caries inhibition
5. Biocompatible
6. Minimal cavity preparation

DISADVANTAGE:

1. Brittle
2. Soluble
3. Abrasive
4. Water sensitive during setting phase
5. Less aesthetic than composite

CONTRAINDICATION:

1. Aesthetic requirement
2. Area of high abrasion
3. Area of high occlusal load

Dental composite resins are types of synthetic resins which are used in dentistry as restorative material or adhesives.

Composite resins are most commonly composed of BISGMA (Bisphenol Glycidyl Methacrylate).
Now UDMA (urethane dimethacrylate) and TEGDMA (Triethylene glycol dimethacrylate) are also being used.

Fillers used are quartz, silica, tricalcium phosphate, zirconium dioxide. They provide strength, hardness, rigidity to the material.

Coupling agent binds the resin matrix to the filler particles. Organic salines are commonly used coupling agents.

Coloring agents used are aluminium oxide, titanium dioxide.

Composite are divided into types depending upon the size, amount and composition of the inorganic filler.

TYPES:

1. Conventional
2. Microfilled
3. Nanofilled

More advance composite

• Flowable composite
• Laser curing composite
• Packable composite
• Antibacterial composite

Placement of composite requires an etchant and bonding agent.
-On the bases of how they can be used the composite fillings are divided into two types

Direct dental composite
Direct dental composite placed by dentist in clinical one visit.

Composites are available in many shades so according to color of tooth shade is selected to give best esthetic results through single shade, dual shade and multilayering technique.

Before putting the resin in the cavity the area treated with an agent that is called as the etching process.

After etching and bond is applied which is cured by light then composite is placed and is cured with light.

Direct dental composites can be used for

1. Filling gaps (diastemas) between teeth using a shell-like veneer.
2. Minor reshaping of teeth.
3. Partial crowns on single teeth.

INDIRECT DENTAL COMPOSITE
This type of composite is cured outside the mouth.
Indirect composites can have higher filler levels and are cured for longer times
As result they have higher levels and depths of cure then direct composite.

Indirect dental composites can be used for 

1. Filling cavities in teeth as fillings, inlays and onlays.
2. Filling gaps between teeth using a shell-like veneer.
3. Reshaping of teeth.
4. Full or partial crowns on single teeth.
5. Bridges.

Before

After

Dental amalgam is the most commonly used dental restorative material used for dental fillings.

Fillings made with amalgam are also known as silver fillings.

Amalgam consists of combination of metals, these include silver, mercury, tin, copper and small amounts of zinc, iridium or palladium with development of tooth colored materials to restore teeth, amalgam is used less often than in the past.

INDICATION:
Amalgum restorations for class-1 cavity, class-2 cavity, class-3 cavity, class-4 cavity and class-5 cavity.

IMAGE:


ADVANTAGE:

1. Long lasting and strong, with stand the forces of chewing.
2. Less costly than the other material

DISADVANTAGE:

1. amalgam doesn’t match with natural color of tooth.
2. amalgam doesn’t bond with natural tooth.
3. Requirement of cavity preparation to keep filling in place.

1. bluish red
2. thickened marginal gingival
3. bluish red vertical zone from the gingival margin to alveolar mucosa.
4. gingival bleeding and suppuration
5. tooth mobility
6. distema formation

There are four basic modalities of pocket elimination:
Repair, resection, regeneration and extraction.

TREATMENT:
1.Maintain good oral hygiene
2.Scaling & Root planning
3.Laser deep pocket cleaning
4.Gingival curettage
5.Gingivectomy
6.periodontal flap surgery
    a) Papilla preservation flap
    b) Sulcular incision flap
    c) Modified widman flap
    d) Undisplaced flap
    e) Apically displaced flap with bone contouring
7.Resective osseous surgery
8.Reconstructive osseous surgery
9.tooth extraction or partial tooth extraction
(hemisection or root resection)

1. Continued irritation by calculus, food debris, deposition of foreign body in the interdental spaces
2. lateral periodontal abscess is commonly associated to supra and infra bony pockets as they are very hard to clean.
3. External root resorption
4. cracked tooth
5. perforation of lateral wall of tooth during root canal therapy possible cause.

1. mild, moderate to severe pain
2. Gums are reddened, swollen and pus may come out an application of pressure
3. tooth may show mobility, tenderness and slight elevation
4. fever
5. lymph node tenderness is common
6. mouth opening may be difficult

1. Incision and drainage
2. Analgesic for eliminate pain
3. Antibiotics for eliminate infection
4. maintain oral hygiene
5. scaling, gingivectomy if necessary
6. examination if needed

Definition:  periodontitis is the most common type of periodontal disease and results from extention of the inflammatory process initiated in the gingival to supporting periodontal tissues.

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Etiology of periodontitis

1. dental plaque
2. Material Alba
3. Dental calculus
4. Microorganisms
5. food debris
6. poor oral hygiene
7. dental stains
8. Iatrogenic factors
9. Faulty fixed or Removable prosthesis
10. Food impaction
11. Unreplaced missing teeth
12. Malocclusion
13. Mouth breathing
14. Tobacco chewing
15. Thumb sucking
16. Cigarette smoking
17. Toothbrush trauma  
18. chemical irritation
19. bruxism

RISK FACTOR

1. vit-c
2. gingivitis
3. Heredity
4. poor oral health habits
5. Tobacco use
6. Diabetes
7. older age
8. Decreased immunity such as that occurring with leukemia or HIV-AIDS
9. Poor nutrition
10. certain medication
11. Hormonal changes such as related to pregnancy
12. ill fitting dental restorations. 

PERIODONTITIS
Classified according to rate of progression
1) slowly progressive periodontitis
2)Rapidly progressive periodontitis
   -Classified according to age at onset
1)Adult onset periodontitis
2)early onset periodontitis
    a) Prepubertal periodontitis.
    b) Juvenile periodontitis.

OTHER FORMS OF PERIODONTITIS
1) Aggressive periodontitis
2) Necrotizing ulcerative periodontitis
3) Refractory periodontitis
4) Periodontitis as manifestation of systemic disease
   A) Associated with hematological disorders
     1. Acquired neutropenia
     2. Leukaemias
     3. Others
   B) Associated with genetic disorders
     1. Familial and cyclic neutropenia
     2. Down-syndrome
     3. Leukocyte adhesion deficiency syndromes.
     4.papillon lefevres syndrome
     5. chediak-Higashisyndrome
     6. Histocytosis syndrome
     7. Glycogen storage disease
     8. Infantile genetic agranulocytosis
     9. Cohen syndrome
    10.Ehlers-Danlos syndrome(type 4 and type 8)
    11.Hypophosphatasia
    12.Other

5)Combined periodontic endodontic lesion
6)Abscess of periodontitis
 a)Gingival abscess.
 b)Periodontal abscess.
 c)peri coronal abscess.

SYMPTOMS OF PERIODONTITIS

1. Red swollen or tender gums
2. Bleeding gums during tooth brushing
3. Halitosis or bad breath
4. Gums that have palled always from teeth or gingival recession
5. pus formation between teeth and gums
6. Loosening or separating teeth
7. Deep pockets between teeth and gums.

Periodontitis has been linked to increased inflammation in body such as indicated by raised levels of c-reactive protein and interleukin 6. It is through this linked to increased risk of stroke, myocardial infarction and atherosclerosis.

Diagnosis of periodontitis.

1. Oral examination by dentist or dental hygienist.
2. By x-rays
3. Periodontal probing procedure
4. Examination of periodontal pocket

Radiographic changes in periodontitis
Normally interdental septa

1. The interdental septum normally presents a thin radio opaque border adjacent to and at the crest of periodontal ligament this border is referred to as laminadura
2. Radiographically continuous white line but really it is perforated by numerous small foramina and traversed by blood vessels, lymphatic’s and nerve pass between periodontal ligament and bone.
3. changes in angulations of x-rays beam produce considerable variations in its appearance.

AFTER PERIODONTITIS RADIOGRAPHIC CHANGES

1. Fuzziness and break in the continuity of laminadura at the mesial and distal aspect of crest of interdental septum.
2. Wedge shaped radiolucent area is formed at the mesial or distal aspect of crest of septal bone.
3. Finger like radiolucent projections extend from crest into the septum & height is reduced.
4. Height of interdental septum is progressively reduced by extention of inflammation and resorption of bone.
5. Radioopaque horizontal line across the roots.

# TREATMENT PLAN OF PERIODONTITIS
There are several ways to treat periodontitis depending on its severity, etiology, symptoms and risk factors.

NONSURGICAL TREATMENTS
if periodontitis is not in advanced treatment can include less invasive procedure including

SCALING
Scaling removes plaque and food debris from tooth surfaces and beneath gums. It performed by ultrasonic scaler device.

ROOTPLANNING
Root planning smoothes the root surfaces and present further develop of plaque and calculus.

ANTIBIOTICS:
Topical or oral antibiotics to help control bacterial infection

NSAIDS : To reduce inflammation.

SURGICAL TREATMENTS:
If periodontitis may in advanced then surgical procedure may require such as

FLAP SURGERY
-In this procedure makes small incision in gums so that section of gum tissue is pull back exposing root surface for scaling and rootplaning.periodontitis may be causes bone loss, the underlying bone may be recontoured before the gum tissue
Is sutured back in place. The procedure is under local anesthesia.

SOFTT TISSUE GRAFTS:
If gum tissue lose in periodontal disease, and gumline recedes, making teeth appear longer than normal, then damaged tissue replaced by removing small
This procedure reduces gum recession, cover exposure of root surface, and give aesthetically pleasing appearance.

1. Flossing daily
2. Brushing after meals every day.
3. Balanced and healthy diet.