Category: Management

Prosthodontic Management of Ectodermal Dysplasia with Iliac bone graft and endosseou

Management

Illica crest bone graft Ectodermal DysplasiaProsthodontic Management of Ectodermal Dysplasia with Iliac bone graft and endosseous implants : A case report

Dr Neeraj Nagpal , Dr K L Gupta, Dr Ruchi Nagpal, Dr Dhruv Sharma

ABSTRACT : Ectodermal dysplasia is a rare congenital disease that affects several ectodermal structures . Persons suffering from ectodermal dysplasia may have various manifestations of the disease that differ in severity and may or may not involve teeth, skin, nails , seat and sebaceous glands. The most common form of ectodermal dysplasia syndrome is hypohidrotic ectodermal dysplasia and is usually inherited as an X- linked recessive trait .Female carriers have a variable degree of clinical manifestations . This case report discusses prosthodontic management of an 18 year old female suffering from ectodermal dysplasia . Clinical management consisted of iliac crest autogenous bone graft to augment premaxilla . Later 2 endosseous implants placed in premaxilla and 2 endosseous implants placed in parasymphysis region of the mandible. After Osseointegration of the implants a four unit fixed partial denture placed in maxilla and an implant supported over denture fabricated for mandibular arch. Keywords : Ectodermal dysplasia , Christ Siemens syndrome ,Hypohidrosis , Hypotrichosis , Hypodontia . Introduction : Ectodermal dysplasia is a hereditary disorder manifested as dysplasia of tissues of ectodermal origin primarily nail, teeth skin and occasionally dysplasia of mesoderm derived tissues . As defined by Freire – Maia the nosologic group of Ectodermal dysplasia is any syndrome that exhibits at least 2 of the features ,that is ,abnormal hair (trichodysplasia ) , abnormal dentition , abnormal nails (onchodysplasia ) and abnormal or missing seat glands (dyshidrosis ) [1]. More than 150 different variants of Ectodermal dysplasia have been described [2]. Hidrotic and hypohidrotic are the 2 forms of Ectodermal dysplasia . In both types teeth and hair are similarly affected , but manifestations in nails and s eat glands and the hereditary pattern tend to differ [3] . The X- linked hypohidrotic form or Christ Siemens syndrome is characterized by clinical triad of hypohidrosis , hypotrichosis and hypodontia . Hidrotic form is inherited as an autosomal dominant trait and affects teeth , hair , and nails but usually spares the s eat glands .Prosthodontic rehabilitation is of paramount importance in patients suffering from Ectodermal dysplasia for functional , physiologic and psychologic reasons [1]. Case Report : An 18 year old female named Reena reported with multiple missing teeth since birth. Her parents reported in difficulty in getting her married due to poor look resulting from several congenitally missing teeth. After clinical and radiographic examination the case diagnosed as Anhidrotic Ectodermal Dysplasia . Family history of Ectodermal dysplasia as negative . The young lady as moderately built with hypotrichosis , scarce eyebrows and scarce eyelashes , dry anhidrotic skin , depressed nasal bridge , thin lips ,dark pigmented skin around periorbital area and nose , facial height as reduced ( fig . 1 ) She reported absence of eat and that her lips and tongue remain dry in all climates . There was no relevant effect on the nails . Intraoral examination revealed presence of partially erupted four teeth in the region of 13, 16, 23 and 26 ( fig 2, 3 ). The edentulous ridge as atrophic with decreased height . the palate as shallow , oral mucosa as normal and dry due to less saliva , the tongue as relatively large . OPG X ray depicted poorly developed premaxilla and completely edentulous mandible .( fig 4 ) Surgical and Prosthodontic Management Initially the impacted canine in the mandibular arch as surgically removed ( seen in the OPG fig 1 ). The ridge augumentation of the premaxilla was done with the help of an autogenious bone graft taken from the patients iliac crest( fig 2 ). Hence, the residual alveolar ridge made suitable for the implant placement .Three implants were placed in the mandibular arch in C,B and D positions , followed by the fabrication of an implant supported mandibular overdenture .

In the maxillary arch ridge the ridge augumentation was done with the help of a iliac crest graft Henceforth , a tooth supported fixed prosthesis i.r.t 24,25,26 as fabricated . Followed by the placement of 2 implants in the premaxillary segment .After three months of osseointegration , a four unit implant supported fixed prosthesis replacing 11 ,12 ,21 and 22 as fabricated .

An iliac crest bone graft as harvested ( fig 3 ) and stabilized to augment the premaxilla ( fig 5 ) .The iliac crest is preferentially selected because it is an autogenous cancellous bone graft and is easily harvested and has predictable acceptance and biointegration . After 2 months of bone augmentation 2 endosseous implants were placed in the augmented premaxilla( fig 6 ). Osseointegration of the implants as allowed for four months , followed by fabrication of four unit fixed partial denture prosthesis in 11, 12, 21and 22 regions. Impression as made using elastomeric impression material by putty ash technique .Abutment analogues and implant analogues were placed in the impression . The impression as poured in die stone by split cast technique. Later three endosseous double stage implants were placed in the mandibular arch ( fig 7 ). After four months of Osseointegration , the implants were uncovered , the abutments ere attached and a customized impression as made , after border molding , in rubber base impression material. The mandibular arch rehabilitated with implant supported overdenture ( fig 8 ) due to economical constraints and ease of rehabilitation .The denture as fabricated from heat cured P.M.M.A. (Trevalon powder and liquid , Dentsply ) .The intaglio surface of the denture as relieved and the female housings of the implant attached using autopolymerising acrylic resin P.M.M.A. (Dentsply ) There as marked improvement in speech and the facial esthetics . Discussion The treatment for a patient of Ectodermal dysplasia varies and generally depends on the persons age , dental agenesis , degree of malformation of teeth , the growth and development of the stomatognathic system of the patient and patient’s motivation . According to Nowak [1] treating the ectodermal dysplasia patient requires the clinician to be knowledgeable in growth and development , behavioral management , techniques in fabrication of prosthesis , the ability to motivate the patient in the use of the prosthesis and the long term follow -up for the modification and/ or replacement of the prosthesis . Prosthodontic treatment for ectodermal dysplasia includes removable partial denture or complete denture , overdenture and implants .These approaches may be used either individually or in combination to provide optimal results . Early prosthodontic treatment is generally recommended from the age of 5 years . This early restoration of facial appearance is essential for normal psychological development . [1] . Rapid growth in early life dictates the use of removable partial or complete dentures for these patients. When full growth is reached, treatment planning may include dental implants to retain, support, and stabilize prostheses. Osseointegrated implants offer an alternative that will provide major improvement in the long-term prognosis for oral rehabilitation. In treatment planning for implant dentistry in these patients, extra care must be taken to determine whether adequate bone level to receive the implants is present and whether there is adequate vertical dimension of bone to support the implants. Diminished bone volume may limit the success of implants, especially in the maxilla . The problems associated with complete denture placement in an ectodermal dysplasia case are mainly associated with periodic adjustment due to growth changes and difficulties in achieving good retention and stability [5] .Difficulties in achieving adequate resistance to lateral and anteroposterior displacement of the denture in hypohidrotic ectodermal dysplasia patient are due to dryness of oral mucosa and underdevelopment of maxillary tuberosities and alveolar ridges .[6] If few teeth are present in the mouth, overdentures are the most desirable treatment options [1,3].Overdentures help in preservation of the alveolar bone . Due to decreased number of abutments conventional fixed prosthodontic treatment needs to be altered . Dental implants may be placed in specific areas of the alveolar ridge to gain support for the FPD . For adult patients with ectodermal dysplasia , dental implants are the treatment of choice because growth has stabilized and implants may be used to support , retain and stabilize the prosthesis [1]. In this case of an 21 year old female and the premaxilla being poorly developed . Hence, an iliac crest autogenous bone graft used to augment the premaxilla followed by placement of 2 endosseous implants . The implants were later rehabilitated with a four unit porcelain fused to metal fixed partial denture . The treatment not only improved the patient- s functional and esthetic status (fig 7 ) but also improved the psychological wellbeing and the social life. Conclusion The study discusses the management of a young lady with Anhidrotic Ectodermal Dysplasia having multiple missing teeth and atrophic partially edentulous maxilla and edentulous mandibular ridge . A prosthodontic rehabilitation consisted of bone augmentation of premaxilla with iliac crest autogenous bone graft . Subsequently , 2 endosseous implants were placed to support a four unit fixed partial denture . An implant supported overdenture fabricated for completely edentulous mandibular arch . Hence , physical , physiological and psychological status of the patient as optimally restored . References 1.Pigno MA , Blackman RB ,Cronin RJ ,Cavazos E (1996 ) Prosthodontic management of ectodermal dysplasia :a review of literature . J Prosthet Dent 2.Pinheiro M ,Freire-Maia N (1994 ) Ectodermal dysplasias : a clinical classification and a casual review . Am J Med Genet 53 : 153- 162 3.Bonilla ED , Guerra L , Luna O (1997 ) Overdenture prosthesis for oral rehabilitation of hypohidrotic ectodermal dysplasia : a case report . Quintessence Int 28 (10): 657-661 Tarjan I , Gabrir K , Rozsa N (2005 ) Early prosthetic treatment of patient with ectodermal dysplasia : a clinical report J Prosthetic Dent 93 : 419-424 REFRENCES

1.Hickey A, Vergo JR TJ: Prosthetic treatments for patients with ectodermal dysplasia. J Prosthet Dent 2001;86:364- 368. 2.Guckes AD, Scurria MS, King TS, et al: Prospective clinical trial of dental implants in persons with ectodermal dysplasia. J Prosthet Dent 2002;88:21-25. 3.Dhanrajani PJ, Jiffry AO: Management of ectodermal dysplasia: a literature review. Dent Update 1998;25:73-75 4.NaBadalung DP: Prosthodontic rehabilitation of an anhidrotic ectodermal dysplasia patient: a clinical report. J Prosthet Dent 1999;81:499-502 5.Pigno MA, Blackman RB, Cronin RJ, et al: Prosthodontic management of ectodermal dysplasia: a review of the literature. J Prosthet Dent 1996;76:541-545 6.Blattner RJ: Hereditary ectodermal dysplasia. J Pediatr 1968;73:444-447 7.Davarpanah M, Moon JW, Yang LR, et al: Dental implants in the oral rehabilitation of a teenager with hypohidrotic ectodermal dysplasia: report of a case. Int J Oral Maxillofac Implants 1997;12:252-258 8.Bolender CL, Law DB, Austin LB: Prosthodontic treatment of ectodermal dysplasia. A case report. J Prosthet Dent 1964;14:317-325 9.Snawder KD: Considerations in dental treatment of children with ectodermal dysplasia. J Am Dent Assoc 1976;93:1177-1179 10.Guckes AD, Brahim JS, McCarthy GR, et al: Using endosseous implants for patients with ectodermal dysplasia. J Am Dent Assoc 1991;122:59-62 4. Sha RM (1990 ) Prosthetic management of hypohidrotic ectodermal dysplasia with anadontia : case report . Aust Dent J 35 : 113-166

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Right Payroll Software Delhi and Its Merits for Business Management

Management

Payroll management is an integral function which cannot be overlooked yet the traditional system of accounting did not serve the purpose in error free manner. Thus, buying payroll software from Delhi is a decision to be taken after analyzing its worth.

Protection of wages by managing it and its components proves to be an obligation for every business owner to ensure just payroll. To begin with, salary structure of all the staff members varies depending on their designation. Nevertheless, missing out any allowance or deduction while ruling out payroll, the glitches pertaining to calculations can prove to be major interruption in the mechanism of accounting officials! On the other hand, if these issues get neglected due to miscellaneous reasons, then, the entire episode can leave a negative impact on employees. Well, this can be avoided if ERP solution has been purchased by the company owner which compiles necessary modules those in totality make payroll management simplified.

Moreover, this software which is specifically developed for monitoring payroll and its constituents has absolute automated functioning. This in turn is a basic feature which lessens the burden of officials to a greater extent enabling them to make salary slips in most convenient way. In fact, payroll software Delhi has undergone improvisation several times and the best version which is available at present delivers advanced solution. The best part to be mentioned over here is the customization of software which can allow entrepreneurs to make the most out of its mechanism. Before actually proceeding with the finalization of best service provider based in Delhi, it will be ideal to take a look at points of significance those can influence your decision by and large:

USP of the solution has to be determined initially: Ever since payroll solutions powered by high-end technologies have emerged as resourceful yet when it comes to invest on highly advanced payroll management system Delhi, one has to check for its USPs. In other words, the whole idea is to select the solution of managing salary and its components after checking its promising nature that makes it superior as compared to others.

Chalk out your priorities to get tailored services: In case, pre-designed software of payroll available in Delhi does not meet your business targets effectually, then, you should identify the unique needs. After maintaining this checklist, you will be able to request for HR payroll software on the basis of the same rightly. However, you have to make sure your all the requisites have been presented forth the service providers appropriate so that they can offer profitable solution.

Ask the expert to avoid goofing up: In case, you are unable to take a final call with respect to finalization of payroll software Delhi, then, it is ideal to involve consultants. These experts will not just offer free demo of their software of payroll instead they even suggest the potential output. To cut it short, due to their immense experience in dealing with distinct business types, the consultants can recommend which variation of modules within the interface of payroll software will be beneficial for you.

On a whole, it can be affirmed that buying best payroll management system becomes quicker process, if all the aspects are borne in mind beforehand.

Payroll Software Delhi developed by HR Software Solutions is regarded as one of the best and easy to use software comprising of Payroll management system Delhi of both windows and web based modules.

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Pay Per Click Campaign Management The Best If You Want A Lot Of Traffic

Management

Website can be called as the mirror of work that you do. It is really nice and gives the way to have the best website. It also defines the work being done by you. Apart from giving you revenue it can be called as the primary way of advertising on the internet. Many of the important website is benefited by Pay-per-click Campaign Management. It is also called as the largest players in the market.

It can be called as the campaign that let you know that who comes to your website and who have the recent visit. This is the best way to know about the trafficking and the hitting that your website gets in general this way one can make sure that the website is working. It will le you know that the website is looking attractive or not. So, one can choose of yours and go for the best option that will give you an idea of popularity on the internet. A PPC campaign is exactly the type of click on the site that will let you know that the website is going nicely or not. So if you have the idea of it then takes the help of it to make the website a hot. If you have no idea then one can go through the internet and can take the idea of it. It is helpful in many ways. The first and the foremost thing is that, you will get the idea of the website hit and the revenue that determines the development of the site.This is the way where you only pay for clicks to your site. This way if a person clicks on the site than it can get performance advertising.

There is attractive way that a person go and see the website but do not give a click. This is called as the impression. It can be called as the tracking system where the number of promotion can be seen. This is helpful in converting visitors into customers. This is the important to know that this the way one can make a good impression on the website. So if you have a website then go for it as it will give you the idea and good promotion. Many of the company will be interested in investing in your website. So, have the plans and make the use of it as the best. It is made for you and will help you.

About Author

Karan Mehra is an expert author in writing on different topics of online marketing including ppc services india. Get more details from here about how to choose best SEO Services India.

Table Management Software – Making Catering Business Efficient And Systematic

Management

The time gone by when there was no systematic process for running a catering business except the fact that catering industries had to rely on their traditional way of entertaining customers by employing people as a worker. The time changed because of the introduction of many innovative technologies, including table management software.

Today the catering industries have a very distinctive nature of method for promulgating their business by adoption the novelty of table management software by maximizing its potentiality and preloaded features.

How will it affect the catering business?

We are quite aware of the fact that unsystematic process of handling guests accounts for tremendous loss for the catering industry in long term period. If the industry doesn’t show willingness of adopting innovative kind of software technique such as this, then there is high probability that it won’t flourish in the business. Tough competition is order of the day and this is because of the reason that companies need to have a thought for this software.

The software has proven track record of benefiting your catering industry in quite a significant way. One of the notable features of it is that it gives your guests about an empty seat thus reducing your effort of doing the same for them. Other feature of is includes giving you a systematic organization of your guest’s preferences and other key things related to your catering industry.

Now think for a while – employing manpower is good to boost up the performance of a catering industry but when it comes to the technology especially the part of it being used to systematically organize things which would otherwise be time consuming if your employ workforce for that.

The beauty of the technology is that it is one of the most reliable ways of helping mankind experience comfort and convenience at the same time of giving them a very systematic approach of handling things. Hence, software technology for catering industry lends credibility of removing discomfort caused by too much interference of hindrances like inefficient workforce and others.

So, if you are frustrated out of them, it is high time you prioritized this innovative technique to make your catering industry flourishing. Table Management Software extends you convenience and comfort in the blending segment of systematic approach of how to make your catering business easy and technically efficient. You can purchase one of the best services related to this from any renowned company. In this context, always prioritize the company with good market reputation.

for more information please visit here: Event Management Software.

Different Functions of Field Service Management Software

Management

The software developed for field services management is an unbelievable invention of advanced technology. The services management software is designed to handle all kind of basic works engrossed throughout field services. From the origin to present world, software has come through several faces of development. As a result, almost all the field service managers around the world prefer it for managing their task accurately.

Nowadays, there are several vendors available, who offer required field service management software solutions for particular business. These solutions are fit for all kind of technological devices such as mobile phones and computers. The company that utilise such kind of software can manage its schedule and track of outside operations in an effective way. Moreover, the representatives of the company can get customer information, routes, schedules and information about regular supplies and parts with these. And the company manager can create outside resources and agents’ schedule, follow clients as well as employs’ history and ultimately manages the work order properly.

Additional function include repair centre, order management, trouble resolving, dispatching, route planning, partner management, customer appointment reminders, voice-generated and whole project management. The user can install it in his customer support systems as well as in a help desk, according to own comfort. Help desk installed software can resolve problems directly but unable to provide field-related functionality, and on the other side, customer support installation can manage scheduling and inventory management or may integrate to a complete system. Various field service management software also focus on entirely on one function.

Those companies which are requiring more advanced management system with feature including preventive maintenance and unique equipment need to consider given below information:

Firstly, these will have to recognise what kind of buyer these are, as there are several kinds of categories available such as:

1.Contract Buyers: such kinds of buyers work for companies that contract the field work. These are required for tracking request fulfilment, passing work requests as well as tracking client satisfaction.

2.Direct Buyers: These buyers include the companies that maintain their own field. These have clear-cut needs which are attended to by a wide range of clients.

3.Small Business Buyers: These buyers own small businesses moving beyond spreadsheets, Microsoft Outlook and even whiteboards or sticky notes. They want to add field service management capabilities for scheduling orders and tracking clients’ satisfaction.

After analyse the categories it is also essential to know about its various benefits:

The software is very beneficial to users as it reduces the scheduling cost. Traditional system requires more time as well as money for this task. This software can plan field appointments without consuming much time. It helps to increase the clients’ satisfaction as the users are able to manage their work more quickly and accurately. It is able to cover all the demerits of traditional management system and the multi- functionality make the manager adding efficiency in his work. This software is recommendable for all kind of business management.

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