clinical case album by Dr Harshavardhan Patwal

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Dr Harshavardhan Patwal

this is short uncompleted vertion my a case album . it was part of a clinical curricullum of mds .

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CLINICAL CASE ALBUM
PRESENTATION
Harshavardhan Patwal

clinical case album by Dr Harshavardhan Patwal

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Risk assessment is the determination of quantitative or qualitative estimate of risk related to a well-defined situation and a recognized threat (also called hazard). Quantitative risk assessment requires calculations of two components of risk (R): the magnitude of the potential loss (L), and the probability (p) that the loss will occur. An acceptable risk is a risk that is understood and tolerated usually because the cost or difficulty of implementing an effective countermeasure for the associated vulnerability exceeds the expectation of loss."Health risk assessment" includes variations, such as risk as the type and severity of response, with or without a probabilistic context.

Clinical Risk Assesment - Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Dental Implants have changed the face of dentistry over the last 25 years. What are dental implants? What is the history of dental implants? And how are they used to replace missing teeth? This section will give you an overview of the topic of dental implants, to be followed by more detail in additional sections. As with most treatment procedures in dentistry today, dental implants not only involve scientific discovery, research and understanding, but also application in clinical practice. The practice of implant dentistry requires expertise in planning, surgery and tooth restoration; it is as much about art and experience as it is about science. This site will help provide you with the knowledge you need to make informed choices in consultation with your dental health professionals. Dental Implants Dental illustration by Dear Doctor Let’s start from the beginning: A dental implant is actually a replacement for the root or roots of a tooth. Like tooth roots, dental implants are secured in the jawbone and are not visible once surgically placed. They are used to secure crowns (the parts of teeth seen in the mouth), bridgework or dentures by a variety of means. They are made of titanium, which is lightweight, strong and biocompatible, which means that it is not rejected by the body. Titanium and titanium alloys are the most widely used metals in both dental and other bone implants, such as orthopedic joint replacements. Dental implants have the highest success rate of any implanted surgical device. Titanium’s special property of fusing to bone, called osseointegration (“osseo” – bone; “integration” – fusion or joining with), is the biological basis of dental implant success. That’s because when teeth are lost, the bone that supported those teeth is lost too. Placing dental implants stabilizes bone, preventing its loss. Along with replacing lost teeth, implants help maintain the jawbone’s shape and density. This means they also support the facial skeleton and, indirectly, the soft tissue structures — gum tissues, cheeks and lips. Dental implants help you eat, chew, smile, talk and look completely natural. This functionality imparts social, psychological and physical well-being.

Basics Of Implantology - Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

There is no question that given the current state of the art in dentistry, that dental implants are pretty much the best way to replace teeth; they are stand alone tooth replacement systems that look and function just like natural teeth. They do not attach to adjacent teeth like a fixed bridge and don't have to be taken in and out like removable partial dentures. A dental implant is a tooth root replacement made of titanium, which has the unique property of being osteophilic (osteo-bone, philic-loving) and actually fuses to bone. A crown, the part of the tooth that you see in your mouth, is attached to the implant. And the great thing about implants is they are not susceptible to decay or periodontal (gum) disease in the same way that teeth are. Now here are a few important pointers, which hold for implants generally and are especially important in your case when replacing a front tooth for an imminent event . Dr Harshavardhan Patwal

Immediate implants - Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Treatment of gingival recession has become an important therapeutic issue due to the increasing number of cosmetic requests from patients. The dual goals of mucogingival treatment include complete root coverage, up to the cemento-enamel junction, and blending of tissue color between the treated area and non-treated adjacent tissues. Even though the connective tissue graft is commonly considered the “gold standard” for treatment of recession defects, it may not always be the best surgical option for every case. Dr Harshavardhan Patwal , Under non-experimental conditions, all root coverage procedures may be effective in terms of complete root coverage and excellent esthetics. Careful analyses of patient- and defect-related factors, however, are key considerations prior to selecting an appropriate surgical technique.

Non surgical management of gingival recession- Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest. Malocclusion is the misalignment of teeth and jaws, or more simply, a "bad bite". Malocclusion can cause a number of health and dental problems. Static occlusion refers to contact between teeth when the jaw is closed and stationary, while dynamic occlusion refers to occlusal contacts made when the jaw is moving. Dynamic occlusion is also termed as articulation. During chewing, there is no tooth contact between the teeth on the chewing side of the mouth. Centric occlusion is the occlusion of opposing teeth when the mandible is in centric relation. Centric occlusion is the first tooth contact and may or may not coincide with maximum intercuspation. It is also referred to as a person's habitual bite, bite of convenience, or intercuspation position (ICP). Centric relation, not to be confused with centric occlusion, is a relationship between the maxilla and mandible. Dr Harshavardhan Patwal , Malocclusion is the result of the body trying to optimize its function in a dysfunctional environment. It can be associated with a number of problems, including crooked teeth, gum problems, the temporomandibular joint (TMJ), and jaw muscles. Teeth, fillings, and crowns may wear, break, or loosen, and teeth may be tender or ache. Receding gums can be exacerbated by a faulty bite. If the jaw is mispositioned, jaw muscles may have to work harder, which can lead to fatigue and or muscle spasms. This in turn can lead to headaches or migraines, eye or sinus pain, and pain in the neck, shoulder, or even back. Malocclusion can be a contributing factor to sleep disordered breathing which may include snoring, upper airway resistance syndrome, and / or sleep apnea (apnea means without breath). Untreated damaging malocclusion can lead to occlusal trauma. Some of the treatments for different occlusal problems include protecting the teeth with dental splints (orthotics), tooth adjustments, replacement of teeth, medication (usually temporary), a diet of softer foods, TENS to relax tensed muscles, and relaxation therapy for stress-related clenching. Removable dental appliances may be used to alter the development of the jaws. Fixed appliances such as braces may be used to move the teeth in the jaws. Jaw surgery is also used to correct malocclusion.

Occlusion in periodontal practice - Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Since the initial observations of oral bacteria within dental plaque by van Leeuwenhoek using his primitive microscopes in 1680, an event that is generally recognized as the advent of oral microbiological investigation, oral microbiology has gone through phases of “reductionism” and “holism”. From the small beginnings of the Miller and Black period, in which microbiologists followed Koch’s postulates, took the reductionist approach to try to study the complex oral microbial community by analyzing individual species; to the modern era when oral researchers embrace “holism” or “system thinking”, adopt new concepts such as interspecies interaction, microbial community, biofilms, poly-microbial diseases, oral microbiological knowledge has burgeoned and our ability to identify the resident organisms in dental plaque and decipher the interactions between key components has rapidly increased, such knowledge has greatly changed our view of the oral microbial flora, provided invaluable insight into the etiology of dental and periodontal diseases, opened the door to new approaches and techniques for developing new therapeutic and preventive tools for combating oral polymicrobial diseases. Dr Harshavardhan Patwal Like many other biological sciences, the study of microbiology has gone through phases of “reductionism” and “holism”. For a long time, microbiologists took the reductionist approach to study complex microbial communities by analyzing individual bacterial species. The strategy was to understand the whole by examining smaller components, and has been the hallmark of much of the industrial and scientific revolutions for the past 150 years. While reductionism has greatly advanced microbiology, it was recognized that assembly of smaller pieces cannot explain the whole! Modern microbiologists are learning “system thinking” and “holism.” From global gene regulation to “metagenomics” to “biofilms”, microbiology is entering an exciting new era with emphasis on revealing and decoding the interactions of different elements within a microbial community. The knowledge obtained from “system thinking” is changing our understanding of microbial physiology and our ability to diagnose/treat microbial infections, and will have great impact on oral microbiology as well.

Oral microbiology- Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage. Disturbances in the normal redox state of cells can cause toxic effects through the production of peroxides and free radicals that damage all components of the cell, including proteins, lipids, and DNA. Oxidative stress from oxidative metabolism causes base damage, as well as strand breaks in DNA. Base damage is mostly indirect and caused by reactive oxygen species (ROS) generated, e.g. O2− (superoxide radical), OH (hydroxyl radical) and H2O2 (hydrogen peroxide).Further, some reactive oxidative species act as cellular messengers in redox signaling. Thus, oxidative stress can cause disruptions in normal mechanisms of cellular signaling. Dr Harshavardhan Patwal , Chemically, oxidative stress is associated with increased production of oxidizing species or a significant decrease in the effectiveness of antioxidant defenses, such as glutathione.The effects of oxidative stress depend upon the size of these changes, with a cell being able to overcome small perturbations and regain its original state. However, more severe oxidative stress can cause cell death and even moderate oxidation can trigger apoptosis, while more intense stresses may cause necrosis. Production of reactive oxygen species is a particularly destructive aspect of oxidative* stress. Such species include free radicals and peroxides. Some of the less reactive of these species (such as superoxide) can be converted by oxidoreduction reactions with transition metals or other redox cycling compounds (including quinones) into more aggressive radical species that can cause extensive cellular damage.Most long-term effects are caused by damage to DNA

Oxidative stress and periodontal disease- Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

The periodontium is the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. The word comes from the Greek terms περί peri-, meaning "around" and -odont, meaning "tooth". Literally taken, it means that which is "around the tooth". Periodontics is the dental specialty that relates specifically to the care and maintenance of these tissues. It provides the support necessary to maintain teeth in function. It consists of four principal components, namely: Gingiva Periodontal ligament (PDL) Cementum Alveolar bone proper Dr Harshavardhan Patwal explains the diffrent cell matrix interactions with emphasis on each components is distinct in location, architecture, and biochemical properties, which adapt during the life of the structure. For example, as teeth respond to forces or migrate medially, bone resorbs on the pressure side and is added on the tension side. Cementum similarly adapts to wear on the occlusal surfaces of the teeth by apical deposition. The periodontal ligament in itself is an area of high turnover that allows the tooth not only to be suspended in the alveolar bone but also to respond to the forces. Thus, although seemingly static and having functions of their own, all of these components function as a single unit .

periodontal ligament turnover - Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Porphyromonas gingivalis belongs to the phylum Bacteroidetes and is a nonmotile, Gram-negative, rod-shaped, anaerobic, pathogenic bacterium. It forms black colonies on blood agar. It is found in the oral cavity, where it is implicated in certain forms of periodontal disease, as well as in the upper gastrointestinal tract, the respiratory tract, and the colon. It has also been isolated from women with bacterial vaginosis. Collagen degradation observed in chronic periodontal disease results in part from the collagenase enzymes of this species. It has been shown in an in vitro study that P. gingivalis can invade human gingival fibroblasts and can survive in them in the presence of considerable concentrations of antibiotics.P. gingivalis also invades gingival epithelial cells in high numbers, in which cases both bacteria and epithelial cells survive for extended periods of time. High levels of specific antibodies can be detected in patients harboring P. gingivalis. Dr Harshavardhan Patwal , explains the various enzymes enzyme peptidyl-arginine deiminase, which is involved in citrullination.[4] Patients with rheumatoid arthritis have an increased incidence of periodontal disease, and antibodies against the bacterium are significantly more common in these patients. P. gingivalis is divided into K-serotypes based upon capsular antigenicity of the various types.

Porphyromonas gingivalis - Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Influence of systemic disorders on periodontal diseases is well established. However, of growing interest is the effect of periodontal diseases on numerous systemic diseases or conditions like cardiovascular disease, cerebrovascular disease, diabetes, pre-term low birth weight babies, preeclampsia, respiratory infections and others including osteoporosis, cancer, rheumatoid arthritis, erectile dysfunction, Alzheimer's disease, gastrointestinal disease, prostatitis, renal diseases, which has also been scientifically validated. This side of the oral-systemic link has been termed Periodontal Medicine and is potentially of great public health significance, as periodontal disease is largely preventable and in many instances readily treatable, hence, providing many new opportunities for preventing and improving prognosis of several systemic pathologic conditions. in this power point Dr Harshavardhan Patwal , highlights the importance of prevention and treatment of periodontal diseases as an essential part of preventive medicine to circumvent its deleterious effects on general health.

Periodontal medicine - Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

ggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) is a Gram-negative, facultative nonmotile, rod-shaped oral commensal often found in association with localized aggressive periodontitis, a severe infection of the periodontium, although it is also associated with nonoral infections. Its role in periodontitis was first discovered by Danish-born periodontist Jørgen Slots, a professor of dentistry and microbiology at the University of Southern California School of Dentistry. 'Bacterium actinomycetem comitans' was described by Klinger (1912) as coccobacillary bacteria isolated together with Actinomyces from actinomycotic lesions of man. It was reclassified as Actinobacillus actinomycetemcomitans by Topley & Wilson (1929) and as Haemophilus actinomycetemcomitans by Potts et al. (1985). The species has attracted attention because of its association with localized aggressive periodontitis. is explained here by Dr Harshavardhan Patwal

Actinomyces Actinomycetemcomitans - Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Treatment planning in periodontics- Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

T lymphocytes in chronic periodontitis- Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Saliva in periodontal diseases - Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Saliva - A diagnostic marker ; Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Corelation between microscopic and macroscopic features of gingiva- Dr Harsha...

Dr Harshavardhan Patwal

Acute gingival infections- Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Bone loss and patterns of bone destruction- Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Genetics,study designs- Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

Cementum - By Dr Harshavardhan Patwal

Dr Harshavardhan Patwal

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Clinical Risk Assesment - Dr Harshavardhan Patwal

Basics Of Implantology - Dr Harshavardhan Patwal

Immediate implants - Dr Harshavardhan Patwal

Non surgical management of gingival recession- Dr Harshavardhan Patwal

Occlusion in periodontal practice - Dr Harshavardhan Patwal

Oral microbiology- Dr Harshavardhan Patwal

Oxidative stress and periodontal disease- Dr Harshavardhan Patwal

periodontal ligament turnover - Dr Harshavardhan Patwal

Porphyromonas gingivalis - Dr Harshavardhan Patwal

Periodontal medicine - Dr Harshavardhan Patwal

Actinomyces Actinomycetemcomitans - Dr Harshavardhan Patwal

Treatment planning in periodontics- Dr Harshavardhan Patwal

T lymphocytes in chronic periodontitis- Dr Harshavardhan Patwal

Saliva in periodontal diseases - Dr Harshavardhan Patwal

Saliva - A diagnostic marker ; Dr Harshavardhan Patwal

Corelation between microscopic and macroscopic features of gingiva- Dr Harsha...

Acute gingival infections- Dr Harshavardhan Patwal

Bone loss and patterns of bone destruction- Dr Harshavardhan Patwal

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Cementum - By Dr Harshavardhan Patwal

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