DISCUSSION Prosthodontic 'Decision Making'The prosthodontist is daily confronted with making decisions to replace missing teeth or defective restorations, to retain or extract periodontally compromised potential abutment teeth, or to prescribe a specific occlusal scheme for a restored dentition. This process is an extension of the clinician's opinion based on his knowledge and clinical experience and strongly influences the treatment modality chosen for a particular patient. Tooth Loss-'Functional Loss'A healthy occlusion is characterized by absence of pathology, satisfactory function and adaptive capacity. Loss of one or more teeth disturbs the functional balance of the remaining teeth and may result in migration, widening of proximal contacts and food impaction, bone resorption, occlusal interferences, loss of vertical dimension, altered mastication, anterior overloading, temporomandibular dysfunction with para-functional activities, altered phonetics, and aesthetics and psychological problems such as affected self-esteem and confidence. 1 A partially edentulous dentition can be practically classified into two groups: 1. Uncomplicated impaired dentition where tooth loss is the only anomaly. 2. Complicated impaired dentition, which is characterized by presence of complicating factors such as poor oral hygiene, caries, periodontal disease, and migration due to tooth loss. Clinically, the uncomplicated impaired dentition can be treated immediately. However, in complicated cases, the causative factors should be identified and treated first and only then should the prosthetic rehabilitation be started. Current Treatment Options for Patients with Missing Single or Multiple TeethIn cases of a missing single tooth the options are interim removable partial denture, cast partial denture, resin bonded prosthesis, fixed partial denture, and implant retained prosthesis.In cases of missing multiple teeth the options are interim removable partial denture, cast partial dentures, resin bonded prosthesis (restricted by length of edentulous span and residual ridge morphology), fixed partial denture (FPD), cast partial/ FPD combinations or implant supported prosthesis. Rehabilitation strategies for partially edentulousprosthodontic principles and current trends

Cases of severe attrition are a common finding in daily clinical practice. Attrition leads to loss of vertical dimension, chewing inefficiency and poor esthetics. These cases require complete oral rehabilitation which can be successfully achieved by a systematic approach integrating various concepts of prosthodontics. The primary aim of such complex treatment modalities is to regain the lost function, esthetics, comfort and confidence for the patient. The following case report describes the complete oral rehabilitation of a patient diagnosed of mutilated dentition and reduced vertical dimensions due to severe attrition. A detailed treatment plan was chalked out which included institution of proper oral hygiene measures, extraction of teeth with poor prognosis, restoration of carious teeth, endodontic treatment for carious teeth with periapical involvement. This was followed by foundation restorations of teeth that were crucial for the final prostheses. Patient was given transitional restorations for about 6 weeks with the aim of regaining the lost vertical dimensions. Final rehabilitation was done by fixed dental prostheses.

Aim: The aim of this study was to evaluate the clinical behavior of prefabricated componeers and direct composite veneering. The objective of the study was to compare the changes in color, surface texture, marginal integrity, and gingival response for componeers and direct composite veneers. Settings and Study Design: This was an in vivo , comparative study. Materials and Methods: Ten patients indicated for anterior veneers were selected and divided into Groups A and B of five patients each. Group A was restored with componeers and Group B with direct composite veneers. Both the groups were compared for color changes, surface textural changes, marginal integrity, and gingival response, starting immediately post veneering and at 3, 6, 9, and 12 months subsequently. Statistical Analysis Used: Friedman's two-way analysis of variance and Mann–Whitney test were used for statistical analysis. Results: Results for color ranged from excellent to good with minimal color changes post veneering. Overall, “gingival response,” in both the groups, showed statistically significant differences in mean rank scores ( P ≤ 0.05). The data depicted an improvement in gingival response for all patients during the period of the study. Surface textural changes were significant only for maxillary right canine and maxillary left lateral incisor ( P = 0.024 and 0.039, respectively) in both the groups. Maxillary right canine in both the groups showed significant changes in marginal integrity. Intergroup comparison of gingival response, surface texture, and marginal integrity depicted no significant difference between the groups ( P > 0.05). Conclusions: This study concluded that the intergroup comparison of componeers and direct composite veneers for the parameters, gingival response, surface texture, and marginal integrity did not depict any significant differences. Both the groups displayed minimal changes in color, surface texture, and marginal integrity and improved gingival response.

Background: The growing demands for esthetic restorations have stimulated intensive research in the field of adhesive dentistry. Dental adhesive systems are used to promote adhesion between composite resins and dental structure. In the fundamental principles of adhesion, the primary mechanism contributing to the formation of adhesion is micromechanical bonding between the restoration and the tooth. The bond strength of self-etching adhesives to dentin was found to be almost equal to that of total-etch adhesives. The aim of the present prospective, double-blind, randomized controlled clinical trial was to evaluate and compare the clinical performance of two self-etch adhesive systems with total-etch adhesive system in noncarious cervical lesions (NCCLs). Materials and Methods: In each patient, three teeth were randomly assigned according to the adhesive system used to Group A (total-etch adhesive system), Group B (two-bottle self-etch adhesive system), and Group C (one-bottle self-etch adhesive system). The clinical efficacy of these adhesive systems was determined by evaluating the retention rate, marginal integrity, and postoperative sensitivity at the following three levels: baseline, 6 months, and 18 months by following the Modified USPHS criteria introduced by Vanherle et al. Results: In the present study, the retention rate at 18 month in Group A, Group B, and Group C of 96%, 92%, and 92% was observed, respectively. A marginal integrity at 18 months was 88%, 80%, and 84% for Group A, Group B, and Group C, respectively. Postoperative sensitivity at 18 months was 16%, 12%, and 12% for Group A, Group B, and Group C, respectively. Conclusion: The clinical performance of total-etch and self-etch adhesive systems in NCCLs did not differ significantly with regard to the evaluated parameters – retention, marginal integrity, and postoperative sensitivity.

Aesthetics Dental fluorosis a b s t r a c t Porcelain laminate restorations are one of the most successful treatment modalities for cosmetic improvement of unsightly anterior teeth. Porcelain veneers within reason allow for the alteration of tooth position, shape, size and color. They require a minimal amount of tooth preparation. This case report describes the management of a case of dental fluorosis and unaesthetic gingival contours by gingival reshaping and final esthetic rehabilitation with porcelain laminates.

Introduction: Use of autopolymerising resin for direct provisionalization is one of the commonest methods employed by clinicians. However, these materials exhibit an exothermic reaction and are prone to cause pulpal damage. Thus, a combination of cooling technique and matrix material to reduce the quantum of heat transferred to a healthy vital pulpal tissue may be employed for minimal tissue damage. An ex-vivo study was thus envisaged to compare the efficacy of various matrix materials and cooling techniques on time related temperature changes in the pulp chamber during the fabrication of provisional FPD restorations using direct technique. Material and Methods: A total of 100 provisional restorations were fabricated and were grouped on the basis of three different matrices: Vacuum template, Putty index and Alginate index and further subgrouped on the basis of various cooling techniques employed. Thermal changes in the pulp chamber was evaluated using Cr/ Al thermocouple placed in the pulp chamber of a prepared tooth and connected to a digital thermometer. Intrapulpal temperature variations were recorded, tabulated and statistically analysed. Results: The inter-group and intra-group statistical comparisons of continuous variables were done using analysis of variance with Bonferroni's correction for multiple group comparisons considering the independent study groups. The underlying normality assumption was tested before subjecting each variable to t test and ANOVA. In the entire study, the p-values less than 0.05 were considered to be statistically significant. All the hypotheses were formulated using two tailed alternatives against each null hypothesis (hypothesis of no difference). The entire data was statistically analysed using Statistical Package for Social Sciences (SPSS ver 21.0, IBM Corporation, USA) for MS Windows. Conclusion: The order of heat dissipation for the different matrices used is as follows: Irreversible hydrocolloid matrix > PVS putty matrix > vacuum form template. It was concluded that intrapulpal temperature rise during the direct fabrication of provisional restorations can be limited by employing different cooling techniques. "Cooling" of PVS putty and alginate impression index for 2 minutes in refrigerator (Ambient temperature 10-12 0 C) was found to be most effective "cooling" method for preventing temperature rise in pulp.

Large defects of the skull leading to neurological defects and facial disfigurement can be traumatizing for the patient. Such defects can be rehabilitated using various biomaterials, polymethyl methacrylate being the most commonly used.

With the advancing digital technology and introduction of newer biocompatible materials with properties similar to biological tissues, CAD CAM fabricated restorations are gaining wide popularity. Introduction of Zirconia and BioHPP (High Performance Polymer) Polyether-ether-ketone (PEEK) has widened the horizons of clinical prosthodontics. Its use has been successfully demonstrated in implantology for fabrication of frameworks and as substructures for replacement of missing teeth. Literature evidence and clinical reports highlighting their usage for long span FDPs is however scanty. This article aims to highlight a combination of digital-analogue procedure for successful rehabilitation of mutilated and missing anterior teeth in a young adult using virtual articulator, modified Bio-HPP PEEK restorations and manufacturer recommended Visio.lign system.