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Achieving anesthesia in a hot tooth or tooth with inflamed pulp is challenging, especially during endodontic treatment. In the presence of symptomatic irreversible pulpitis, mainly in mandibular teeth, pose even more challenge to attain profound anesthesia. Tetradoxin resistant channel is a class of sodium channel that is found to be increased in such condition and is found to resist local anesthesia. The pH also determines the success of local anesthesia. In inflammatory conditions, the surrounding area\'s pH, which eventually decreases the amount of base form of local anesthetic penetration into the nerve membrane, thereby causing anesthetic failure. In such conditions, the excitability threshold is reduced, leading to failure in achieving anesthesia. This chapter highlights and discusses the cause of anesthetic failure and its management in obtaining profound anesthesia during endodontic treatment.

Current concept of complete denture rehabilitation is more concentrated on the harmonization between the artificial and natural tissues. In certain cases with sunken cheeks, patients need extra support to the dentures. Sunken cheeks are best restored using cheek plumper or cheek lifting appliances. Conventional cheek plumper appliances have issues such as increased weight, hampering the denture retention and muscle fatigue in patients. So, to overcome all these difficulties, literature reported various modifications in fabrication and designing of a cheek plumper prosthesis. The present case report describes the outcomes of a modified check plumper appliance in a completely edentulous patient with sunken cheeks. Cheeks play a crucial role in facial aesthetics due to their extreme visibility.1 the form of the cheeks is determined by the teeth, ridges and contour of the dentures, especially when restoring a completely edentulous patient. During the due course of life, patients experience concaving and hollowing of the cheeks due to extraction of posterior teeth, thinning of tissues due to ageing or weight loss.1 Prosthodontic rehabilitation should not only aim at restoring and replacing the missing teeth, but also restore the facial support. Conventional procedures fulfill the requirements in most of the cases. But, in cases with sunken cheeks, patients need extra support to the dentures. Sunken cheeks are best restored using cheek plumper or cheek lifting appliances. Use of cheek plumper prosthesis in maxillofacial prosthodontics is well documented in the previous literature.2, 3, and 4 Usually denture flanges provide support to the perioral musculature but they fail to mimic the fullness of the cheeks. So, cheek plumper helps in providing a necessary support to the cheeks and thereby enhancing the aesthetics. Usually, cheek plumpers can be un-detachable or conventional type and detachable cheek plumpers. 5 A conventional one is single unit prosthesis with a supporting extension near premolar or molar region. The major disadvantages with un-detachable cheek plumpers are increased weight hampering the retention, difficulty during denture insertion, muscle fatigue and cannot be used in patients with limited mouth opening.6 To overcome the above mentioned problems, the cheek plumper used in the present case was innovated in two aspects. One was the usage of magnet retained attachments for the flanges and the other was to decrease the overall weight of the denture by hollowing the cheek plumper, increasing the retention. The present case report is innovative as compared to the previous literature. None of the case reports have used the hollowing technique for plumpers which attributes to additional decrease in the weight of the denture. The present case report highlights the outcome of a modified check plumper appliance in a completely edentulous patient with sunken cheeks.

Maxillary sinus pneumatisation pose a grave clinical challenge for implant fixed rehabilitation in posterior maxilla owing to diminished bone volume. This necessitates sinus lift and grafting which increase the duration and cost and possible surgical complications. Pterygoid implant has a greater short term osseointegration and is a proven treatment method for rehabilitation of highly resorbed posterior maxilla. To overcome the limitations of sinus grafting techniques, the current case report describes the use of flapless, tilted and pterygoid implant for restoration of partially edentulous atrophic maxilla eliminating grafting.

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