Dr. GANGWANI JAYESH ASHOK

Dr. GANGWANI JAYESH ASHOK

SYNOPSIS

Dr. GANGWANI JAYESH ASHOK

POST GRADUATE STUDENT

DEPARTMENT OF PROSTHODONTICS

INCLUDING CROWN & BRIDGE AND IMPLANTOLOGY

K.V.G. DENTAL COLLEGE & HOSPITAL,

KURUNJIBHAG, SULLIA (D.K.), KARNATAKA –574327.

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / DR. GANGWANI JAYESH ASHOK
POST GRADUATE STUDENT,
DEPARTMENT OF PROSTHODONTICS INCLUDING CROWN & BRIDGE AND IMPLANTOLOGY,
K.V.G.DENTAL COLLEGE & HOSPITAL,
KURUNJIBHAG, SULLIA (D.K.),
KARNATAKA,INDIA-574 327.
2. / NAME OF THE INSTITUTION / K.V.G.DENTAL COLLEGE & HOSPITAL,
KURUNJIBHAG, SULLIA(D.K.)
KARNATAKA,INDIA-574 327.
3. / COURSE OF STUDY AND SUBJECT / MASTER OF DENTAL SURGERY
PROSTHODONTICS
INCLUDING CROWN & BRIDGE AND IMPLANTOLOGY
4. / DATE OF ADMISSION TO COURSE / JUNE 17th, 2013.
5. / TITLE OF THE THESIS / A STUDY TO FIND THE CORRELATION BETWEEN VARIOUS PALATAL RUGAE MEASUREMENTS, INCISIVE PAPILLA MEASUREMENTS AND SIGNIFICANT ANTERIOR MAXILLARY DIMENSIONS AND TOOTH POSITIONS AMONG THE PEOPLE OF DAKSHINA KANNADA POPULATION.
6.
7. / Brief resume of the intended work:
6.1 Need for the study:
Determination of the correct anterior tooth position is an important consideration in fabricating conventional complete dentures or implant-supported prosthesis. Anterior teeth, especially maxillary anterior teeth, play a key role in achieving “improvement in patient esthetic value”. A patient’s existing dentures, pre-extraction radiographs, diagnostic casts and photographs made before the dentition is lost, may be useful in determining tooth position.In the absence of pre-extraction records, various guides have been used to select appropriately sized anterior teeth for edentulous patients.1Among the guides proposed was the relationship between facial measurements and natural tooth dimensions. Facial anatomical landmarks that have been used as guides include the inter-commissural width, inter-pupillary width, inter-alar width, and inner-canthal distance.2-4
The incisive papilla is one of the more stable landmarks remaining unchanged after anterior tooth extraction and subsequent resorption of the maxillary ridge.5 Therefore, in the absence of pre-extraction records, the papilla can serve as an anatomical landmark and as a useful guide for assessing the original positions of certain key teeth.5,6 The anterior part of the incisive papilla may be affected or damaged during extraction of maxillary anterior teeth or due to the resorption that takes place following loss of teeth. The centre and posterior parts of the papilla are more likely to remain constant. The midpoint of the incisive papilla is more commonly used as a reference point, although the posterior part is more stable, as it undergoes the least change after the teeth have been extracted.7
Transverse palatine folds or palatal rugaeare asymmetrical and irregular elevations of the mucosa in the anterior third of the palate, arranged in a transverse direction from the palatine raphe located in the mid-sagittal plane. Palatine rugae can be used as internal dental cast reference points for quantification of tooth migration in cases of orthodontic treatment.8 Their unique individual characteristicsand reasonable stability during growth9,10 makes them suitable reference points from which reference planes necessary for longitudinal cast analysis can be derived. The rugae alsoplay an important role in forensic dentistry, as they are protected from trauma and high temperatures due to their internal position in the oral cavity, surrounded and
protected by lips, cheeks, tongue, teeth and bone. But there is little information concerning the relationship of palatine rugae to natural teeth. Boucher stated that “a study that would search for a relationship between the upper cuspids and the rugae might be worth the effort”.11
So the purpose of this study is to find if any correlation exists between various palatal rugae measurements, incisive papilla measurements and key anterior maxillary dimensions along with maxillary anterior tooth positions among the people of Dakshina Kannada population.
6.2 Review of Literature
A study was done to find the relationship between the maxillary central incisor and the incisive papilla. It was found that the incisal edges of the maxillary central incisors should be 5-8 mm anterior to the papilla.5 A similar study was done and it was found that the average distance between the anterior point of the central incisors and the center ofthe incisive papilla was 7.7 mm.12Another study described 8-10 mm for this measurement.6
A studydescribed that for 92.1% of 507casts, the lineconnecting the tips of the maxillary canines was within an area of 1 mm anterior and posterior to the center of incisive papilla.13
Another study concluded that rugae should not be used as a guide in determining the position of maxillary canines, because in only half the patients did the rugae point towards the maxillary canines. But the incisive papilla can be used as a guide in positioning the central incisors, because in 98% of patients, it was between the central incisors.14
A study was done to find the relationship of central incisors and canines to incisive papilla. It was found that 57.6% of inter-canine lines passed through the centre of the papilla and they also suggested that an average distance of 12-13 mm from the posterior end of the papilla to the labial surface of central incisors, and an inter-canine distance of 33-35 mm can be used as starting points.7
A study was done to find the change in the length of rugaewhich concluded that the length of rugae increased significantly till 10 years of age thereby remaining stable throughout life. This change in length of rugae with age was suggested to be as a result of the underlying palatal growth.15
According to the historical review of literature for all the articles published during the last 100 years on the topic of different methods used to select artificial anterior teeth for the edentulous patient, it was concluded that till date no reliable, universally acceptable method of determining tooth size has been found.16
A study reported that no two palates are alike in their configuration. Even between twins, the patterns are not identical. Comparing the palatal rugae patterns in certain individuals before and after various dental treatment modalities like removable prosthesis, orthodontic treatment with and without extraction of teeth, and healing of any lesion or pathology in the palatal rugae area; there were no changes observed in the palatal rugae pattern in terms of number, shape and size of the palatal rugae. Hence, various dental treatment modalities do not have any effect on the palatal rugae patterns.17
A studyshowed that the third ruga, the farthest from the incisors, can be used as a reliable reference to assess longitudinal dental changes mainly when growth changes are less prominent.18
A study was done to relate various palatal rugae measurements to determine anterior maxillary dimensions and they concluded that significant correlations were found between measurements in anterior dental segment and palatal rugae measurements. Those correlations were, however, low. Although some correlation values obtained were statistically significant, they are not likely to have significant clinical predictive value.19
6.3 Aims and Objectives of the study:
  1. To find the relationship between palatal rugae, incisive papilla and maxillary anterior dental segment to provide a reliable and a reproducible guide for arrangement of anterior teeth.
  2. To measure the length of third palatal ruga and the width of the maxillary anterior dental segment and to find the relationship between them.
  3. To find the correlation between various palatal rugae measurements and key anterior maxillary dimensions along with various maxillary anterior tooth positions.
  4. To find the correlation between various incisive papilla measurements and key anterior maxillary dimensions along with various maxillary anterior tooth positions.
Materials and Methods:
7.1 Source of the data:
Study population:
A total of 120 individuals who are native of Dakshina Kannada region with an age ranging from 21 - 30 years old will be taken for this study. This study will be done in the Department of Prosthodontics including crown & bridge and implantology, K.V.G. Dental College & Hospital, Sullia.
Inclusion criteria for the subject:
  1. Angle’sclass I skeletal & occlusal relationship (minimal tooth rotation or compression can be allowed).
  2. Good oral hygiene.
  3. All individuals should have a subjectively pleasing smile and objectively radiant symmetry in the arrangement of their maxillary anterior teeth.
  4. All individuals should have intact teeth.
  5. Should be native of Dakshina Kannada region.
Exclusion criteria for the subject:
  1. Previous orthodontic treatment.
  2. Extensive prosthodontic treatment.
  3. Presence of any visible spacing or any diastemma.
  4. Presence of any restorations.
  5. More than one missing tooth excluding 3rd molars.
  6. Visible tooth attrition on anterior teeth.
  7. Patient with any tooth size or shape deformity.
  8. Periodontally compromised dentition such as localized or generalized periodontitis, pathologic migration.
  9. Patients with congenital and acquired orofacial deformities.
7.2.Methods of Collecting Data:
Instruments and materials that will be used during the course of the study:
1) Instruments:
  1. Dentulous rimlock perforated stock tray (S. S. WHITE).
  2. Digital vernier caliper (with 0.01mm accuracy).
  3. Flexible and stiff rubber bowls.
  4. Curved and straight stainless steel spatulas.
  5. Water and Powder measuring apparatus for alginate (supplied by the manufacturer).
  6. Base former.
  7. Graphite pencil.
  8. Protractor and compass.
  9. Graph paper.
  10. Stainless steel measuring scale.
  • 2) Materials:
  1. Alginate impression material (Tropicalgin ISO 1563-ADA spec. 18, Zhermack, Italy).
  2. ADA Type III Dental stone (Kalstone, Kalabhai Karsons Pvt. Ltd, India).
  3. ADA Type II Dental plaster (Kaldent, Kalabhai Karsons Pvt. Ltd, India).
  4. Utility/Beading wax (Surana, India).
3) Methodology:
After selecting the subjects suitable for the study, procedure will be explained to them & after obtaining their consent; they will be seated on a dental chair in an upright position & draped. Impression & cast making procedures: After doing a brief oral examination, proper sized perforated rim lock stock tray(S. S. WHITE) will be selected; utility/beading wax will be used if customization of tray is required in any specific area. Alginate impression powder will be mixed with water according to the manufacturer’s instructions in a flexible rubber bowl with curved
stainless steel spatula. Impression tray will be loaded and maxillary impression will be made. The cast will be poured immediately with hard setting dental stone (TYPE III). After one hour, cast will be recovered and a base will be made for the cast in a base former with hard setting dental plaster (TYPE II).
The measurements on the dentulous cast will be made in the following way: Digital vernier caliper (with 0.01 mm accuracy) will be used for the vertical and sagittal cast measurements.
  1. Anterior maxillary arch width: It will be measured from the central point of the first premolar to the central point of the contralateral side first premolar with a vernier caliper by keeping the arms of the caliper in contact with the central point.
  2. Mesio-distal width of the maxillary incisors: It will be measured with the caliper by drawing a line perpendicular to long axis of the tooth at the maximum coronal width of the tooth. The four individual tooth width measurements from each cast will be added to give a total width for the four maxillary incisors.
  3. Length of third palatal ruga: The lateral most ends of the third palatal ruga (or the 2nd primary ruga) will be identified on each stone cast and marked with graphite pencil. The distance between the two lateral points will be measured on a straight line using a vernier caliper. If branching of ruga is present, the anterior branch will be taken into consideration. The arms of the caliper will be adjusted so that they remain in contact with the graphite marks.
  4. Length of first palatal ruga: The lateral most ends of the first palatal ruga (1stprimary ruga) will be identified on each stone cast and marked with graphite pencil. The distance between the two lateral points will be measured on a straight line using a vernier caliper.
If branching of ruga is present, the anterior branch will be taken into consideration. The arms of the caliper will be adjusted so that they remain in contact with the graphite marks.
  1. Distance between third and first palatal rugae (right & left sides): The lateral most ends of the first palatal ruga (1stprimary ruga) and third palatal ruga will be identified on each stone cast & marked with graphite pencil. The distance between the two lateral points of ipsilateral first and third rugae on each side will be measured on a straight line using a vernier caliper. If branching of ruga is present, the anterior branch will be taken
into consideration. The arms of the caliper will be adjusted so that they remain in contact with the graphite marks.
  1. Distance between first palatal ruga and the tip of canine (right & left sides): The lateral most ends of the first palatal ruga(1stprimary ruga) and the tips of canines on each side will be identified on each stone cast and marked with graphite pencil. The distance between the twoipsilateral points on each side will be measured on a straight line using a vernier caliper. If branching of ruga is present, the anterior branch will be taken into consideration.The arms of caliper will be adjusted so that they remain in contact with the graphite marks.
  2. Distance between incisive papilla and central incisor (right & left sides): The posterior-most point of incisive papilla and the midpoint of the incisal surface of both the right and left central incisors will be identified on each stone cast and marked with graphite pencil. The distance between the two points on each side will be measured on a straight line using a vernier caliper. The arms of the caliper will be adjusted so that they remain in contact with the graphite marks.
  3. Perpendicular distance from incisive papilla to a line connecting the first premolars:The posterior-most point of incisive papilla and the central point of the first premolars on both sides will be identified on each stone cast and marked with graphite pencil. The following distances between the 2 points will be measured on a straight line using a vernier caliper-
a)Central point of the first premolars.
b)Central point of first premolar (right side) to the posterior-most point of incisive papilla.
c)Central point of first premolar (left side) to the posterior-most point of incisive papilla.
With all these measurements, a triangle will be constructed on a graph paper (using a compass) taking posterior-most point of incisive papilla as the apex and the line connecting the premolars as the base. A perpendicular(using a protractor) from the apex to the base gives the distance from the incisive papilla to the premolars.
  1. Perpendicular distance from central incisor to a line connecting the first premolars: The midpoint of incisal surface of right central incisor & the central point of first premolars on both sides will be identified on each stone cast and marked with graphite pencil.The following distances between the 2 points will be measured on a straight line using a vernier caliper-
a)Central point of the first premolars.
b)Central point of first premolar (right side) to the midpoint of incisal surface of right central incisor.
c)Central point of first premolar (left side)to the midpoint of incisal surface of right central incisor.
With all these measurements, a triangle will be constructed on a graph paper(using a compass) taking the midpoint of incisal surface of right central incisor as the apex and the line connecting the premolars as the base. A perpendicular(using a protractor) from the apex to the base gives the distance from the central incisor to the premolars.
  1. Perpendicular distance from incisive papilla to third palatal ruga: The posterior-most point of incisive papilla & the lateral ends of third palatal ruga on both sides will be identified on each stone cast and marked with graphite pencil.The following distances between the 2 points will be measured on a straight line using a vernier caliper-
a)The lateral ends of third palatal rugae.
b)The lateral end of third palatal ruga to the posterior-most point of incisive papilla(right side).
c)The lateral end of third palatal ruga to the posterior-most point of incisive papilla(left side).
With all these measurements, a triangle will be constructed on a graph paper(using a compass)taking the posterior-most point of incisive papilla as the apex & the line connecting the lateral ends of the third ruga as the base. A perpendicular(using a protractor) from the apex to the base gives the distance from the incisive papilla to the third ruga.
4) Collection of Data:
  1. All the measurements will be obtained from the dentulous cast in millimeters.
  2. Five consecutive readings of each measurement will be taken by the same operator and the mean will be recorded. This is done to achieve acceptable accuracy and reliability.
  3. Mean value and standard deviations will be obtained and the data analyzed statistically.
5) Statistical Analysis:
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