tooth extraction followed by immidiate implant

Happy Diwali

Avulsion of tooth

Simple tips for every patient or parent to follow in case of Avulsion of tooth. Follow these steps and seek dental help as soon as possible with the tooth. 

Detailed description of Avulsion of Tooth for Dentists and patient

Definition: Displacement of tooth totally out of the socket.

Some Facts about Avulsion:

• Ranges from 0.5 -16% of injuries in the permanent dentition
• 7-13% in the primary dentition
• Occurs most often in 7-9 yrs of age.

Etiology:

•  Fights
• Sports injuries
• Falls against hard objects
• Accidents

Most Frequently Affected areas:

• Max. CI – Most affected.
• Lower jaw – seldom affected.
• Usually involves single tooth.
• Associated with lip lacerations and fracture of alveolar socket wall.

Treatment:

This is a true dental emergency because the treatment and prognosis are extremely time dependent.

The main Aim of Treatment Plan is Reimplantation.

Success of Reimplantation depends on:

• The success of reimplantation is inversely related to the storage material and the time the tooth is out of the mouth.
• Teeth reimplanted within 30 min have a good chance of surviving, whereas those reimplanted after 2 or more hours have a more limited survival.

The goals of reimplanting teeth:

• To maintain the viability of periodontal ligament cells
• The avulsed tooth should be without periodontal problems.
• To return the cells as close to normal condition as possible.
• Impede resorption of the tooth.
• Alveolar socket should be reasonably intact
• Extra-alveolar period should be considered.

Time within which the teeth should be Reimplanted:

• After avulsion, the pdl cells are cut off from their blood supply and their stored cell metabolites are depleted.
• So should be replanted within 60-120 mins.   (Blanoff ,1981)
• After this time, pdl cells undergo necrosis & root resorption begins.
• Since teeth are rarely replanted within this time, biologic storage and protection from crushing of pdl cells is of paramount importance.

Save a Tooth - Emergency tooth preserving system

Storage Media (For Storing Avusled tooth before reimplantation )

1. Saline
2. Milk – Low fat milk preserved pdl cells better than whole milk.
3. Saliva
4. Oral vestibule
5. Hank’s balanced salt solution
6. Viaspan
7. Propolis
8. Tender coconut water
9. Contact lens solution

Note: Storage of avulsed teeth in water and saliva has been shown to be damaging to the periodontal ligament cells, thus causing increased root resorption. (Andreason. Effect of extra-alveolar period and storage media upon periodontal and pulpal healing after replantation of mature permanent incisors. Int J Oral Surg,1981)

Steps to Follow before Reimplantation of Tooth into socket:

1. If dirty, the tooth should be grasped by the crown and rinsed gently in saline, tap water or milk at the scene of the injury.
2. Do not scrub off, brush the tooth or handle the root.
3. Immediately place the tooth back in the socket and hold in place with light pressure en route to the treating facility.
4. There is no need to physically debride the socket prior to replacement.
5. Gentle saline irrigation will remove debris.
6. If the tooth cannot be replaced at the scene, it should be stored in the buccal vestibule or floor of the mouth for transport.
7. If this is not possible, the tooth should be stored in a cup with the Hanks Balanced Salt Solution (HBSS), the patient’s saliva, milk, saline or water. Do not wrap tooth in tissue, towel or foil or allowed to dry out.

Reimplantation n splinting - delayed reimplantation

Steps for Immediate Reimplantation Procedure:

1. Preservation of the avulsed tooth.
2. Cleansing of the avulsed tooth
3. Cleansing of the alveolus
4. Replantation & Splinting
5. Endodontic treatment
6. Splinting removal and final RCT
7. Bleaching or Restorative treatment

Post Reimplantation measures to be taken:

• Once the tooth is reimplanted in a gently saline-irrigated socket, splint it to the adjacent teeth with a non-rigid or semi-rigid splint for 7–10 days.
• If a concomitant alveolar fracture is present, maintain the splint for 2–8 weeks.
• Longer splinting periods are required for more extensive fractures.

In a permanent tooth with an open apex that has been replanted 2hrs after avulsion:

• Radiographs and clinical exam should be performed in 3–4 weeks to look for evidence of pulpal pathology versus revitalization.If pathosis is noted, root canal therapy should be instituted immediately.
• The canal should be cleaned and filled with CaOH2 until apexification has occurred (usually 6–24 months).
• Then obturation with gutta percha is indicated.

For a permanent tooth with a partially to completely closed apex and less than 2 h dry time:

• The pulp should be removed in 7–14 days.
• The canal is cleaned and CaOH2 is placed.
• The new American Association of Endodontics guidelines recommend only 7–14 days of CaOH2 treatment and immediate obturation of the canal with gutta percha and sealer.

For permanent teeth with partially to completely closed apices and greater than 2 h extraoral time:

• Root canal therapy can be performed immediately.
• These teeth will eventually be lost to resorption but may be retained short term and are likely to ankylose.
• The tooth, once the canal has been extirpated extra-orally can be soaked in sodium fluoride solution to discourage resorption once reimplanted.

Do not replant primary teeth.

Antibiotic Prpphylaxis:

Consider tetanus prophylaxis and antibiotics (penicillin VK 500 mg QID, clindamycin 150–300 mg QID or erythromycin 250 mg QID) for 7–10 days and place the patient on a soft diet.

In Case of Delayed Reimplantation:

1. Cleansing  & conditioning of the avulsed tooth

Cleaning n conditioning of Avulsed tooth in delayed reimplantation

2. Extraoral  endodontic treatment

Extraoral RCT for delayed Reimplantation

3. Cleansing of the alveolar socket

4. Replantation and splinting

Reimplantation n splinting - delayed reimplantation

5. Treatment of resorbed replanted tooth

NEET Vs State government's

Supreme Court takes over 23 cases against PG medical entrance test

The Supreme Court on Friday transferred to itself 23 cases from various High Courts across the country relating to petitions challenging the National Eligibility & Entrance

 Test (NEET) for admission to post-graduate medical courses from 2013-14.






As per the regulations announced by the Medical Council of India, seats will be allotted from the National list and State-wise merit list prepared by the MCI. Further, 50 per cent of all PG courses will be filled by candidates selected by the State Government.

Andhra Pradesh and Tamil Nadu, several associations of private medical colleges, D.D. Medical College & Hospital, Tamil Nadu, and various individual colleges had filed petitions in the respective High Courts and obtained an interim stay against the applicability of NEET to them.

Aggrieved by these orders, the MCI filed petitions seeking transfer of these cases to the Supreme Court to avoid multiplicity of proceedings.

NEET – MDS Entrance Detailed information 2012-2013

NEET – National Eligibility cum Entrance Examination is the national entrance examination being conducted by AIIMS for admissions into MDS seats all over India for the year 2013.

NEET MDS Examination dates 2013: The suspected dates for NEET 2013 are January. Although there has been no notification by DCI or NBE or AIIMS regarding the date. This is a tentative date.

NEET Examination Pattern: NEET for MDS is being conducted by AIIMS. The examination pattern details have not been notified yet but looking at the Medical Entrance Examination exam pattern, MDS NEET examination pattern will also be the same.

1. Number of questions: 200
2. No negative markings
3. Time: 3 hours
4. Examination Type: Online / Physical (Should wait for notifications for conformation)
5. Examinations Centers: Will be updated after the release of official notification

Reservations for Eligibility in NEET MDS Exmaination Seat Allocations/Counselling: 

The marks will be sorted out into Percentile and for qualifying into counselling the following minimum percentiles should be obtained by each category of Students:

1. General Students: 50 Percentile
2. Backward Casts- SC/ST – 40 Percentile
3. Locomotory Disability of Lower Limbs: 45 Percentile

Dentists who have worked under State and Central Government Service in Villages will be given 10%-30% additional marks based on the location of their work.

50% of PG Diploma courses shall be reserved for students who have served the State/Central Government for 3 years or more in remote areas.

3% seats will be allotted to students with locomotion disability of 50-70% of lower limbs. In case the allotted 3% seats are not filled by students with 50-70% disability these seats will be filled by students with 40-50% disability

What is Percentile ? How is Percentile calculation done in NEET MDS Entrance ?

The highest marks obtained by a student will be termed as 100 Percentile and the next highest number of marks will be termed as 99% percentile and so on.

Seat Allocations in All India Merit Entrance NEET – MDS 2013:

• 50% (Fifty Percent) of Total seats shall be allotted by counselling by the concerned State or National authority in Non- Government Dental Colleges.
• 50% (Fifty Percent) of total seats shall be allotted by the respective colleges based on the merit list prepared by the National Eligibility-cum-Entrance Test
• 50% of PG Diploma courses shall be reserved for students who have served the State/Central Government for 3 years or more in remote areas.
• 3% seats will be allotted to students with 50-70% locomotory disability.

How will the Ranks be allotted:

• All India Merit List/Rank: It is the rank which will be allotted to you on the National ranking system. It is the National rank. Which will be used to take seats in National level in States other than your Native State.
• State wise Merit List/Rank: It is the rank allotted to you based on the competition in your native state. It is the State Rank.

What is the Native State, How do i know which state i should be writing from in NEET MDS entrance:

• There are many students who are native of one state and completed BDS from another state. Remember this point:
• You should write your Entrance examination from the State where your family has been residing for the past 5-7 years. Even if you have studied in a different state for the past 5 years the residential address of your parents will be considered.
• Some states allow Domicile Criteria: Where some students who have domicile for a particular state inspite of having their graduation degree from another state will be allowed to take up PG in the respective state colleges.

LINK TO NATIVITY NOTICE STATE/NATIONAL MERIT LIST:

http://www.nbe.gov.in/neetpg/pdoofs/Public%20Notice.pdf

Egyptian-style

Dentistry, ancient Egyptian-style: Mummy found with teeth stuffed with linen in attempt to cure agonizing tooth-ache

• 
  
• 1)Experts believe man from Thebes died in excruciating pain.
• 
  
• 2)Researchers found linen 'filling' dipped in medicine inside infected tooth
• Say find could prove that dental experts were constantly trying new techniques.

Scientists performing CT scans on the head of an Egyptian mummy say they have found one of the worst cases of dental problems ever seen - an a unique treatment to try and treat it.

Researchers CT scanning a 2,100 year old mummy were stunned to find evidence of a sinus infection caused by a mouthful of cavities and other tooth problems.

The also came across a unique find - a cavity filled with linen.

Researchers used a CT scanner to see inside the man's mouth, and created a 3D reconstruction showing the worn incisors

Using a piece of linen, which may have first been dipped in a medicine such as fig juice or cedar oil, a form of 'packing' in the biggest and most painful cavity, located on the left side of his jaw between the first and second molars, was inserted.

This acted as a barrier to prevent food particles from getting into the cavity, with any medicine on the linen helping to ease the pain, the study researchers said. 

The man, whose name is unknown, was in his 20s or early 30s, and lived at a time when Egypt was ruled by a dynasty of Greek kings.

 

Andrew Wade, at the University of Western Ontario, used new high-resolution CT scans of his teeth and body, according to the International Journal of Paleopathology. 

Researchers said this is the first known case of such packing treatment done on an ancient Egyptian. 

'The dental treatment, filling a large inter-proximal cavity [a cavity between two teeth] with a protective, likely medicine-laden, barrier is a unique example of dental intervention in ancient Egypt,' the team writes in their journal article.

'The dental packing described here is unique among ancient Egyptian mummies studied to date, and represents one of only a few recorded dental interventions in ancient Egypt.

CT scans of the entire mouth were carried out to allow the researchers to recreate a 3D version. The linen filling can be be seen on the right of the mouth

DENTISTRY IN EGYPT

Dentistry was relatively commonplace in Egypt, and records indicate that it was being practiced at least as far back as when the Great Pyramids were built. 

However, this finding has led researchers to believe experts may have practiced advanced techniques.

Dental problems were not unusual, as the coarsely ground grain ancient Egyptians consumed was not good for the teeth.

The team say the find add weight to the theory that dentists were commonplace in Egypt.

'Such a finding lends further support for the existence of a group of dental specialists practicing interventional medicine in ancient Egypt. 

'While the physical evidence, to date for other interventions, may be scarce, the findings presented here should underline the need to continue to look for evidence of dental packing as well as other therapeutic dental interventions in the ancient world.'

The small linen mass was initially found during a scan in the mid-1990s, but the scanning resolution of the time was too low to allow a full analysis. 

The high-resolution scanner his team used for their latest study was six times as powerful.

The young wealthy man from Thebes was nearing the end of his life when his dental problem hit, researchers believe.

The man, whose name is unknown, was in his 20s or early 30s, and had 'numerous' abscesses and cavities, conditions that appear to have resulted, at some point, in a sinus infection, something potentially deadly, the study researchers said, although they could not pinpoint his cause of death.

THE MUMMY WITH NO NAME

The 3D reconstruction was made from data collected during high resolution CT scans of the mummy.

When he died he was mummified, his brain and many of his organs taken out, resin put in and his body wrapped. 

Embalmers left his heart inside the body, a sign perhaps of his elite status, researchers say.

After being mummified he was likely put in a coffin and given funerary rites befitting someone of his wealth and stature. 

Where he was laid to rest in Thebes isn't known, as his body was not seen again until 1859 when James Ferrier, a businessman and politician, brought the mummified body (the whereabouts of the coffin is unknown) to Montreal, where today it lies in the Redpath Museum at McGill University.

Experts say the pain the young man suffered would have been excruciating, and say his problems would have been a 'serious health risk' for modern dentists.

Despite the help, he succumbed shortly after, perhaps in just a matter of weeks.

Dentistry was nothing new in Egypt, ancient records indicate that it was being practiced at least as far back as when the Great Pyramids were built.

Dental problems were also not unusual, the coarsely ground grain ancient Egyptians consumed was not good for the teeth.

CT scans allowed the team to examine the filling in far greater detail than ever before.

CT slices showing the wear of the left first (left) and second right (right) incisors of the mummy

NEET FOR MDS!!!

FAQS ON NEET MDS ENTRANCE EXAM .... 

 LATEST UPDATE :

   NEET MADE OFFICIAL BY DCI FOR THE MDS SEAT ENTRANCE ON ALL INDIA BASIS . DOWNLOAD THE OFFICIAL NOTIFICATION HERE : 

http://www.dciindia.org/dciregulation_2006_pages/pdf_files/Revised%20MDS%20Course%20(2nd%20Amendment)%20Regulations,%202007.pdf

 For all Dental Students : NEET for MDS Entrance MDS Entrance Exam for MDS Seats Admission 2013.Entrance Exam for MDS seats admission session 2013, on All India Basis shall be conducted by AIIMS.

 Announcement in this regard shall be made by AIIMS, New Delhi.

 The Official Site of NEET has given the rules of Exam mostly in relation to MS/MD . Its being said that the rules for MDS Exams will be same .

 But We should see for the final Notification by AIIMS for the NEET MDS Entrance . See this Note that will be constantly updated Official NEET Website : http://www.nbe.gov.in/neetpg/

PLEASE NOTE : 

MDS Entrance Exam for MDS Seats Admission 2013 Entrance Exam for MDS seats admission session 2013, on All India Basis shall be conducted by AIIMS. Announcement in this regard shall be made by AIIMS, New Delhi. 

Q Is there a single common exam for MDS henceforth ?A Yes , There will be a single common entrance exam for the year 2013-14 . It is called NEET - National Eligibility cum entrance test for admission to postgraduate course .

Q What is the eligibility basis for admission through NEET ? A In order to be eligible for admission in any postgraduate course through NEET , the candidate must obtain a minimum of marks at 50th percentile . For SC, ST and other backward tribes the eligibility would be a minimum of 40th percentile . For physically disabled candidates it would be 45th percentile .

Q Does it mean there is no COMED or CET etc ??A There has been no mention of non existence of private bodies for councelling , as per the gazette and its notification , there will be a single entrance exam NEET . In private colleges , 50 % of the seats shall be filled in by the state or the authority appointed by them and the remaining 50 % of the seats to be filled on the basis of merit list prepared as per the marks obtained in NEET .

Q What is the last date for admissions ?A According to the notification , the classes for the postgraduate courses should begin by 2nd May and all admission procedure should end before 2nd may.

Q How many seats will be available this year ?A There is no notification on the number of seats that will be available .

Q Will there be a single councelling for admissions ?A Again , there is no notification on the pattern of councelling , although it has been mentioned in the gazette that there will two types of merit list , one on nation wide basis based on the marks obtained through NEET and state wise merit list . So this means that the marks obtained through the single NEET exam will be used in multiple ways like state wise or college wise .

Q Is there any increase in fees or is there a common fees too ?A No special mention on the fees , will have to wait for a notification on the fees .

Q Im from Maharashtra , can I take up a seat in karnataka ?A As there is a state wise list , so a residency rule may apply , that only that state residents can take up a seat through the state wise merit list , although for a nation wise list , one can take up seat anywhere .

Q What about the syllabus and exam pattern?

A There is no specific information on syllabus, but it can be assumed that syllabus will not change. Although pattern or marks distribution may change but there is no official update on that yet.

NEET UPDATE ON THE MERIT LIST OF ENTRANCE EXAM :*All the PG seats will be filled by NEET Entrance marks .
*Ranks will be published in 2 ways STATE WISE MERIT LIST & NATIONAL MERIT LIST . We will discuss both . Read below .
State wise Rank : 50% of total seats in that state .
These will be filled by the merit list drawn from NEET. For eg if U are from Rajasthan , A separate list will be prepared as per the marks in NEET of all students from Rajasthan . And from that state list 50 % state seats will be filled as per the ranking .
*Remaining 50% of the seats will be filled from the national merit list.
So from the last example , if U r from Rajasthan & u couldn't get a seat in Rajasthan in the state merit list .U still have a chance to get a seat in the national merit list . But u may have to join another college in another state as per ur rank .
N.B : To be eligible for seat selection a candidate need to score 50 percentile or above .