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Dental implants offer a predictable solution for the replacement of missing dentition. This report describes the case of a patient who underwent dental implant surgery several years ago but due to negligence on the part of previous dentist, her implant pushed into the maxillary sinus. The patient presented with vague pain and swelling in the right maxillary region. Orthopantomogram (OPG) showed that the implant was lying in the right maxillary sinus which the patient had no clue of. It was decided to retrieve the implant and later restore the missing teeth for definitive function and aesthetics. However, at the time of surgery, the implant in question was missing from the anticipated position as it had migrated to the most posterior-superior compartment of the antrum making its retrieval difficult in the first attempt. Later, a maxillofacial surgeon carried out the retrieval. ---Continue

Objective: To evaluate the position of the root apices of posterior teeth of mandible with inferior alveolar nerve canal and the cortical bone on cone beam computed tomography. Method: The retrospective study was conducted from September to October 2021 at the Aga Khan University Hospital, and comprised cone beam computed tomography scans between November 2017 and October 2021 scans of healthy individuals of either gender aged 18-71 years with healthy, untreated, mandibular posterior teeth bilaterally. Shortest distance from apices of the mandibular posterior teeth to the border of inferior alveolar nerve canal, and to the mandibular buccal cortex were measured on the scans. Data was analysed using SPSS 23. Result: Of the 106 scans, 55(52%) were males and 51(48%) were females. Of the 746 33teeth in the scans, 385(51.6%) were present in the scans of males and 361(48.4%) in those of the females. For all mandibular posterior teeth, the distances in females were shorter than males, but for the distance from root apices to the IAN canal, the difference between genders was significant for the roots of second premolar and second molar only on the left side (p0.05). Regarding the distance from the root apices to the buccal cortex, no significant difference was found between the genders, for each type of tooth, (p>0.05). Correlations between the distance from apex to inferior alveolar nerve (r

Objective: To determine the difference in the marginal accuracy at buccal, lingual, mesial and distal margins of temporary crowns fabricated with bisacryl-based temporary crown material. Method: The in-vitro, experimental, laboratory-based study was conducted at the Aga Khan University, Karachi, from September to December 2019, and comprised two bisacryl-based temporary crown material, Integrity and Protemp 4, which were used to fabricate a sample of 24 temporary crowns. A pre-operative polyvinyl siloxane impression served as a template for temporary crown fabrication. A right mandibular molar tooth on a typodont was prepared to receive a crown. The provisional crown material was syringed onto the template and was allowed to cure. All four surfaces of the crown were observed under a stereomicroscope equipped with digital single-lens reflex camera at 25.6x magnification. An image of each surface was captured and a photographic record was maintained. An image processing software was used for the measurement of marginal discrepancy. Marginal accuracy among the four surfaces was assessed. Data was analysed using SPSS 23. Results: Mean marginal discrepancy for provisional crowns fabricated with Protemp 4 and Integrity was 410±222um and 319±176um, respectively. The marginal discrepancy between the two groups was statistically significant (p=0.027), with buccal margin exhibiting the most discrepancy (p

World is experiencing an unprecedented pandemic of COVID-19 for over a year. This viral infection outbreak originated in December 2019 at Wuhan, China and within three months became a global pandemic. The outbreak has affected over 200 countries and territories of the world. Despite of having well-established health care system, countries such as China, Italy, Iran, Spain, France, Germany and USA have experienced a high death toll in this pandemic. Pakistan although being geographic neighbor of China and Iran, is somehow protected from the otherwise expected high case-fatality of COVID-19. This papers explains what factors have protected Pakistan from a high mortality in this pandemic.

Radicular cyst is the most common type of odontogenic cyst associated with the apex of non-vital teeth. The lining of the radicular cyst usually arises from the epithelial rests of Malassez. These cyst usually persists even after the elimination of microbial load from the root canals. Surgical removal is deemed necessary for the management. For larger lesions extending to the facial or palatal cortical plates, additional regenerative procedures such as bone grafting along with collagen membrane are warranted. This case report describes the surgical and prosthetic management of a giant radicular cyst that was perforating the cortical plates in the anterior maxilla. Key words: cysts, radicular cyst; bone grafting, esthetic management, regeneration.

Oral and maxillofacial (OMF) surgery is a unique speciality. In many countries, OMFS is a dental speciality but the scope of its practice significantly overlaps with other specialities, including otolaryngology, head and neck surgery, plastic surgery, and orthopaedics. Thus, OMF surgery represents a true amalgamation of medical and dental specialities. There are different requirements of OMF residency training, which include a dental undergraduate training, medical training, or both. The training pathways for this speciality have evolved much in the last three decades and there is still no consensus over a single uniform path of becoming an OMF surgeon. An OMF surgeon deals with trauma, cysts, tumours and other pathologies of the maxilla, mandible, and zygomatic complex that need surgical correction. In addition to being a diverse speciality, the academic and research domains of residency have also changed. In Pakistan, residency training in OMF surgery started in 1994 and since then a lot of growth has taken place. This paper summarises the evolution and scope of OMF surgery and the contribution of this speciality in the overall academia and research in Pakistan's national dental scenario.

Dental extraction of abscessed or infected teeth before cardiac operation is frequently advocated to lower the risk of infections especially infective endocarditis. The scientific evidence that supports dental procedures before cardio-valvular surgery is however limited. The aim of the present paper was to explore whether there are any protocols for patients needing dental treatment before cardiac operations. Moreover, we have discussed the real life challenges encountered in the management of such patients. Continuous....

Objective: To compare one year retention rate of bonded amalgam sealants (BAS) with that of conventional resinbasedsealant (RBS).Methods: It was a parallel group, equivalence, randomised controlled trial done during March 2018 to December2019 at the dental clinics of Dow University of Health Sciences, and the Jinnah Sind Medical University, Karachi,Pakistan on children aged 12-16 years, who were randomly assigned to one of the two treatment groups (BAS vs.RBS). Complete retention of the sealant at one year follow-up was labeled as success. Multi-level mixed effect logisticregression model was employed. Study was registered at www.clinicaltrials.gov # NCT NCT03130725.Results: There were 137 teeth (23 subjects) in the BAS and 128 teeth (15 subjects) in the RBS group that wereevaluated for sealant retention at 12 months follow-up. Among the BAS group, 100/137 (73%) sealants werecompletely retained whereas 110/128 (86%) were fully retained in the RBS group. Nearly, 22/137 (16%) BAS and10/128 (7.8%) RBS were completely dislodged. In multivariable analysis, subject age >15 years and male genderwere found to be significantly associated with the dislodgement of sealants.Conclusions: At 12 months follow-up, the retention of bonded amalgam sealant (BAS) was significantly lower thanthat of the resin-based sealant (RBS).Keywords: Bonded amalgam sealants, Resin-based sealants, Retention, Caries.RCT Registration: www.clinicaltrials.gov with # NCT NCT03130725.

To identify top 30 studies related to dental implant failures based on bibliometric analysis.The bibliometric study was conducted at Aga Khan University, Karachi from April 2021 to June 2021 and comprised database search on Google Scholar used key words "dental implant failures" for studies published between 1990 and 2020. The selected studies were reviewed based on citation count for which the cut-off date was June 1, 2021.The top 30 papers on dental implant failures had median citation count of 153 (range: 41-1583. Most of the studies were retrospective 11(36.7%), followed by literature reviews 6(20%). The top three contributing journals were the 'International Journal of Oral Maxillofacial Implants' 6(20%), the 'Clinical Oral Implants Research' 5(16.7%) and 'Clinical Implant Dentistry and Related Research' 3(10%). Goteborg University, Sweden, contributed the maximum number of most cited papers 8(26.7%).Most of the papers in the top-cited on dental implant failures were retrospective studies, and there was only one clinical trial.

Objective: To radiographically evaluate the proximal marginal fit of the clinically acceptable metal-ceramic crowns.Method: The prospective study was conducted at the dental clinics of Aga Khan University, Karachi, from July toDecember 2018, and comprised metal-ceramic crowns that were evaluated prior to the cementation. Clinicalexaminations were conducted by seating the crown on the tooth preparation and visual assessment was done usingsharp explorer along the margins. Clinically acceptable crowns were then evaluated on the bite-wing radiograph.Any horizontal or vertical inaccuracy of >0.5mm at the proximal margins was recorded as 'discrepancy'. Data wasanalysed using SPSS 22.Results: Of the 230 interproximal margins of 115 crowns evaluated, 113(49.1%) sites had marginal discrepancies;44(19.1%) horizontal discrepancies, 58(25.2%) vertical discrepancies, and 11(4.8%) having both horizontal andvertical discrepancies. Horizontal crown margin discrepancies were most associated with the mesial site of themaxillary crowns, while vertical discrepancies were commonly associated with the distal aspect of all crowns(p

To compare the effect of OneShape and ProTaper Next file on the change in canal width and angle of curvature in simulated curved canal in resin blocks.The quasi-experimental study was conducted at the Aga Khan University, Karachi, from January to March 2018, and comprised endodontic resin blocks that had inbuilt curved canals. These were randomly divided into 2 equal groups and were subsequently prepared using OneShape in group A, and ProTaper Next rotary instrument in group B followed by staining with red and blue ink for comparison of pre- and post operative images of canals. Standardised photographs were taken along with reference measuring scale. Independent sample t-test and Paired sample t-test were used to compare the angle of curvature and canal width changes and pre and post instrumentation changes in resin block after using both the instruments, respectively. Intra class correlation was used to determine inter-examiner reliability. The level of significance was kept at p value0.01. SPSS 22 was used for data analysis.Of the 60 blocks, 30(50%) were in each of the two groups. The mean pre-instrumentation angle of curvature was 32.3±2.13 and 31.0±3.28 degrees for groups A and B. The mean degree of canal straightening post-intervention was 1.5±0.5 and 3.6±1.38 degrees in groups A and B (p0.001). In terms of canal width changes, OneShape file removed more resin material from the canal walls compared to the ProTaper Next system (p0.001).ProTaper Next file significantly altered the angle of curvature in the resin block compared to OneShape file, but the amount of material removed from the canal space was significantly higher with the OneShape file compared to ProTaper Next.

This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high smile line and maintenance of an adequate biological width. After periodontal healing, all-ceramic individual crowns were placed on the maxillary anterior teeth along with a three-unit all-ceramic bridge for the replacement of the left upper maxillary first premolar. The final results were aesthetically pleasing with good marginal fit. The patient was extremely satisfied with the outcome as all her concerns were addressed. It is, therefore, advisable to consider placing individual crowns rather than multiunit splinted prosthesis whenever possible.

To compare the surface defects created on the ProTaper Next files versus HyFlex Electrical Discharge Machining files after single clinical use in molars.The cross-sectional study was conducted in the dental department of the Aga Khan University Hospital, Karachi, from December 2018 to June 2019, and comprised Nickel-Titanium files belonging to HyFlex Electrical Discharge Machining and ProTaper Next to perform complete root canal treatment of molar teeth. The files were first visually examined and then analysed under 25.6x magnification using a stereomicroscope for the evaluation of surface defects. A photographic record was maintained and studied. Data was analysed using SPSS 23.0.Of the 114 files, 38(33.3%) each were ProTaper Next X1, ProTaper Next X2 and HyFlex Electrical Discharge Machining. The number of files showing defects under microscopic evaluation were 17(14.9%). Deformation of the cutting edge was the most frequently seen defect type, found in 9(7.9%) files. The frequency of fractured files was 4(3.5%). The odds of microscopic defects in HyFlex Electrical Discharge Machining files was 2.64 times that of ProTaper Next files.Even after single clinical use, HyFlex Electrical Discharge Machining files were more likely to get microscopic defects on their surface compared to ProTaper files.

Background and Objectives: Owing to high proliferation rate, multipotency and self-renewal capability, dental pulp stem cells (DPSC) and stem cells from human exfoliated teeth (SHED) have become stem cell source of choice for cell based regenerative therapies. We aimed to compare DPSC and SHED as stem cell sources with a future use in regeneration of calcified tissue. Methods: Explant derived human DPSC (n=9) and SHED (n=1) were cryopreserved, thawed and expanded for analysis of population doubling time, colony forming unit assay and efficiency. A growth curve was plotted to determine population doubling time, while colony forming numbers and efficiency was determined at plating cell densities of 5.6, 11.1 and 22.2 / cm2. The isolated cells were characterized for the presence of stem cell markers by immunophenotyping and immunofluorescence staining, and tri-lineage differentiation. Statistical analysis was performed by Pearson correlation, Exponential regression and two way Anova with Tukey test at p

Maxillofacial Prosthodontics (MFP) is a super-specialty of prosthodontics that involves around rehabilitation of patients presenting with congenital maxillofacial defects or craniofacial disabilities acquired due to disease such as cancer or trauma. (1) There are several types of prostheses that can be designed and fabricated by a maxillofacial prosthesis to improve the quality of life of patients. A simple classification is shown in figure 1. Continuous...

Objective To evaluate the parallelism of natural maxillary occlusal plane with inter-pupillary line and ala-tragus line, and to evaluate the anatomic relationship of natural mandibular occlusal plane with retromolar pad among dentate subjects. Methods The cross-sectional study was conducted from September 2017 to February 2018 at Fatima Jinnah Dental College, Karachi, and comprised front and profile photographs of subjects aged 20-28 years while holding the camper's plane against the maxillary occlusal plane. The photographs were imported in a software and an interpupillary line was drawn and the angle with Camper's plane was measured. On both profile pictures, lines were drawn from base of the ala to the superior, middle and inferior points on the tragus. The angle between ala-tragus line and Camper's plane were measured. Intra-orally, height of the mandibular occlusal plane in relation to the retromolar pad was evaluated using a stainless steel scale. Data was analysed using SPSS 23. Results Of the 109 subjects with a mean age of 23.03±1.36 years, 76(69.72%) were females. Horizontal parallelism of occlusal plane with inter-pupillary line was observed with a mean angle of 1.17±1.27 degrees. The angle between the occlusal plane and the inferior ala-tragus line was 4.25 degrees on the right side, and 4.50 degrees on the left. Intraorally, mandibular occlusal plane coincided with the inferior 48(44%) and the middle third 48(44%) of the retromolar pad. Conclusions Inter-pupillary line and retromolar pad area should be used as a guide in the determination of plane of occlusion. The ala-tragus line was not found to be a reliable guide.

Objective: To compare the microleakage around resin modified glass ionomer cement (RMGIC) based sealants and flowable resin based sealants placed with or without ameloplasty in extracted human teeth. Methods: This in-vitro experimental study was conducted at the Operative Dentistry Department, Dow University of Health Sciences, Karachi, Pakistan from June 2017 to December 2018. Sixty extracted human molars and premolars were assigned to four groups (n=15) each, according to the type of fissure sealant (flowable resin based sealant or resin modified glass ionomer based sealant) used and either placed with or without ameloplasty. Specimens were thermocycled and then immersed in 1% methylene blue for 24 hours. Specimens were then sectioned and examined using stereo-microscope (50X) for microleakage that was scored on an ordinal scale. Mann-Whitney U test and Ordinal regression were applied. Level of significance kept at 0.05. Results: There was a statistically significant difference (p-value

OBJECTIVE To compare apical microleakage of extracted, single-rooted teeth obturated with thermoplasticized injectable gutta-percha using two different endodontic sealers (calcium-hydroxide and resin based). STUDY DESIGN An experimental study. PLACE AND DURATION OF STUDY The Aga Khan University Hospital (AKUH), Dental Clinics and Laboratory from June to September 2015. METHODOLOGY The study was conducted using extracted teeth. After access cavities were made, cleaning and shaping of root canals was done in 70 teeth. Teeth were randomly allocated into two groups and obturated with thermoplasticized injectable gutta-percha (Obtura II) using two sealers (Sealapex vs. AH plus). After immersing the teeth in 2.0% methylene blue, they were split longitudinally, viewed under light microscope (magnification X4) and images were taken by a camera connected to microscope. The extent of dye penetration was assessed from apex to its coronal part and recorded in millimeters. Independent sample t-test was used to compare microleakage in the two groups. Pearson correlation coefficient was used for inter-examiner reliability of dye penetration measurements. A p-value of

To determine if low birth weight is associated with hypovitaminosis D and periodontal disease among a sample of Pakistani women residing in district Jhelum, Punjab.Cross-sectional study nested in a large community-based longitudinal study.Tehsil Pind Dadan Khan, District Jhelum, Pakistan from August 2012 to October 2015.Women during 12-16th week of pregnancy were selected. Dental examination was performed. Probing depth3 mm was labeled as periodontal disease, whereas serum level20.0 ng/mL was taken as hypovitaminosis D. Mothers of low birth weight babies (2500 g) were compared to mothers who gave birth to normal weight (2500 g) babies. Odds ratio was applied to measure the strength of association of low birth weight with maternal hypovitaminosis D and also for maternal periodontal disease.There were 62 participants in the study. The mean age of mothers was 26.7 ±4.5 years. It was alarming to observe that 53 (85%) participants had vitamin D deficiency. However, periodontal disease was only seen in four participants (6%). Out of the 62 mothers, eighteen (29%) gave birth to low birth weight babies. None of the variables were found to be associated with the low birth weight.The present study did not find any significant association of low birth weight with hypovitaminosis D or maternal periodontal disease in the studied sample.

Objective: The objective of this study is to assess the utility of facebow transfer in the fabrication of occlusal splints, complete dentures and full arch fixed dental prosthesis. Materials and Methods: A systematic review protocol was registered at PROSPERO registry, University of York, UK (CRD42016041919). Following databases were explored: PubMed, CINAHL, Cochrane, and Web of knowledge. The PICO model included participants who received occlusal splint or complete denture or full arch fixed dental prosthesis at the centric relation position. The intervention was the use of facebow transfer. Comparators were prosthesis made without using a facebow. Outcomes were the patient satisfaction of the prosthesis and the need for laboratory adjustments. Only randomized clinical trials were included in the present review. A customized data extraction pro forma was used to extract the data and assess its quality. Results: A total of 505 articles were retrieved. On excluding duplicates, protocols, case reports, case series, narrative reviews, etc., only eight studies were selected for review. Six clinical trials on 249 complete dentures and two clinical trials on 65 occlusal splints were reviewed. No study on full arch crown and bridge work satisfied the inclusion criteria. Conclusions: The use of facebow did not yield a superior fit or comfort of the complete dentures or occlusal splints. Therefore, there is no evidence of the utility facebow transfer for these prostheses. However, no inference could be drawn for its utility in full arch fixed dental prosthesis as there were no studies to draw an inference.

The present report is comprised of five patients of panfacial fractures in which initially oral intubation was done that was later moved to retromolar area. This modification is an improvised approach that appears beneficial in surgeries requiring maxillo-mandibular fixation. Owing to low morbidity, the retromolar intubation should be considered as a preferred method to avoid tracheostomy.

Objective: To isolate dental pulp mesenchymal stem cells (MSCs) from non-infected human permanent and deciduous teeth. Methods: It was an in-vitro experimental study. Human teeth were collected from 13 apparently healthy subjects including nine adults and four children. After decoronation dental pulps were extirpated from teeth and cultured via explant method in a stem cell defined media. Data was analyzed by descriptive statistics. Results: As above MSCs emerged exhibiting fibroblast-like morphology. In vitro culture was positive for 100% (9/9) and 75% (3/4) of the permanent and deciduous teeth respectively. First cell appeared from deciduous teeth pulp in 10±6.2 days while permanent teeth pulp took 12.4±3.7 days. Together, 26.6±3.6 and 24.5±3.5 days were required for permanent and deciduous tooth pulp stem cells to be ready for further assays. Conclusions: The protocol we developed is easy and consistent and can be used to generate reliable source of MScs for engineering of calcified and non-calcified tissue for regenerative medicine approaches. doi: https://doi.org/10.12669/pjms.35.4.540 How to cite this:Naz S, Khan FR, Zohra RR, Lakhundi SS, Khan MS, Mohammed N, et al. Isolation and culture of dental pulp stem cells from permanent and deciduous teeth. Pak J Med Sci. 2019;35(4):997-1002. doi: https://doi.org/10.12669/pjms.35.4.540 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Patients undergoing surgical resection and ionizing radiations for the treatment of head and cancer may lead a challenging life even after the cure of the disease; because these procedures can adversely affect the oral mucosa, salivary gland, bone, masticatory musculature, and the dentition. Especially, if major salivary glands are exposed to high dose radiation, an irreversible xerostomia may occur that can lead to rampant dental caries. Treatment of these complications demands high cost and time; and is often unaffordable for the patients in the resource constraint setting rendering them to compromise on their quality of life. The healthcare providers should work together in a team to prevent or manage these complications and improve the lives of the patients. This review paper focuses on the significance of low cost fluoride treatment for salvaging the dentition among patients who have had developed head and neck carcinoma and later got subjected to surgical resection and radiation therapy.

Background Tooth extraction is a common oral surgery procedure carried out mainly on outpatient basis. It is important to evaluate the risk factors which can lead to various complications after extraction of teeth. Normal healing of an extraction socket may be impaired by the presence of one or more factors. The objective of this study was to find out the effect of the medical conditions such diabetes, hypertension and smoking habit on the process of normal healing following dental extractions. Methodology Patients reported for dental extraction in oral and maxillofacial surgery department at Baqai Dental College were divided into two groups. A control group and a disease group with systemic conditions like diabetes mellitus, hypertension and habit of smoking. All the extractions were performed under local anesthesia by the dental officers. SPSS version 17 was used to perform statistical analysis to identify the risk factors and possible relationships with the healing in extraction sockets. Results In this study 88 females, 152 males participated. In healthy group there were 93 patients enrolled. In the healthy subjects (n = 93) 39.7% reported complications whereas in the diseased group (n = 147) the reported complications were 61.2% (Table 1). The percentages and number of patients are charted below according to complications. Table 2 is showing different complications and their percentages. Table 3 is showing disease patterns in both the groups and odds ratio which is greater than 4 in our study. Conclusions The odds of complications among subjects with co-morbidities are four times that of same in the healthy subjects.

Objective To determine the frequency of complications in crowns cemented over a 5-year period in a tertiary care hospital and also to report the survival of these crowns. Methods The retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from March 2017 to March 2018 and comprised porcelain fused-to-metal crowns placed on the anterior or posterior teeth that were fabricated at the institutional laboratory and were placed in institutional dental clinics in the preceding 5 years. Porcelain-fused to-metal The crowns were clinically and radio-graphically evaluated in a duration of two months for presence/absence of complications. Factors associated with the failure of the crowns, their survival and the impact of covariates, like gender, flossing and bruxism, on the survival time were determined. Data was analysed using SPSS 22. Results There were 150 crowns related to 107 patients who had a mean age of 45.0±11.4 years. The most common complication observed was open proximal contacts 9(6%) followed by de-cementation 8(5.3%), porcelain chipping 9(6%) and abutment fracture 2(1.3%). The 5-year survival rate of the crowns was 127(84.7%). The mean follow-up time was 57.2±1.0 months. Overall, year-wise survival of PFM crowns for one year till five years was 147 (98%), 144 (96%), 135 (90%), 130 (86%) and 119 (79%) respectively. Conclusions The porcelain-fused-to-metal crowns had a high 5-year survival rate. Open proximal contacts represented the most common complication.

Dental education and training in Pakistan and India are largely influenced by the British system of education. However, there are some differences in the mode of postgraduate training in these countries. In Pakistan, hospital-based residency training is the mainstay, culminating in a fellowship diploma awarded by the College of Physicians and Surgeons of Pakistan. Whereas, in Indian students of dentistry pursue university-based MDS programme as the primary pathway to specialist training. From the beginning the Indian dental academia has remained vigilant in adopting a correct nomenclature for the specialty concerned with the dental conservation. They named it Conservative Dentistry & Endodontics while in Pakistan the same specialty termed Operative Dentistry has become an obsolete term and does not represent the scope of work practiced by specialists in this discipline. A simple addition of the term "Endodontics" to the present nomenclature of "Operative Dentistry" will resolve the matter of a missing identity in a clinical specialty in Pakistan. The present paper suggests the need for advocacy to change the term used for this particular dental specialty.

Dental fluorosis is defined as hypomineralisation of enamel resulting from excessive ingestion of fluoride (more than 1emsp14;ppm) during tooth development. Mild-to-moderate forms of dental fluorosis are often unnoticed by the patients whereas severe fluorosis presents with dark brown-to-black discolouration of teeth along with enamel pitting and hypoplasia. Such discolouration results in an unpleasing appearance as well as psychological distress to the affected individual. Dental fluorosis can be managed by bleaching, micro/macroabrasion, veneering or crowning. The choice between different treatment options depends on the severity of fluorosis and patients' aesthetic demands. The aim of this case report was to describe the stepwise oral rehabilitation of an adult with severe fluorosis along with multiple carious teeth. After restoration of carious teeth and extraction of unsalvageable teeth, bleaching and full-coverage restorations were used for the management of fluorosis.