a b s t r a c tBackground: Dental implant insertion torque is crucial for the success of the implant and the prosthesis. This in-vivo study was undertaken to determine the average insertion torque being applied to the dental implant while surgically placing it with a non-calibrated manual ratchet.Methods: Three dental surgeons placed a total of 45 dental implants (Touareg, ADIN, Afula, Israel) in 42 selected patients. Each surgeon placed 15 implants. Standardised protocols were followed to prepare the site to place the dental implant. Each implant was placed using a manual non-calibrated implant ratchet first. Once the implant was nearly placed, a manual calibrated torque gauge ratchet was used to place the implant in its final position and at that instance, the maximum final torque applied was noted on the torque gauge scale.

A beautiful smile has a tremendous impact on the perception of one's attractiveness and personality. A smile is a window through which people perceive the personality of an individual. The goal of enhancing patient's appearance requires knowledge of the fundamental concepts of art and beauty. Although ideal occlusion should certainly remain the primary functional goal of orthodontics, the esthetic outcome is also critical for patient satisfaction and therefore essential to the overall treatment objectives. The importance of an attractive smile is unquestionable. A pleasant smile is a composite outcome of structural & harmonious balance between various elements of face including harmonious relationship between teeth, gingival scaffold & the lip framework. The importance of physical and facial attractiveness has been related to initial impressions, social interactions, etc. The subject of smile should greatly interest orthodontists as it forms a key aspect of communication & expression of emotions. There shou ld be established criteria that identifies and quantifies elements of a smile that need correction and/or enhancement. Smile, Gingival scaffold, Lip framework.

Severely worn out dentition needs to be given definite attention as it not only affects aesthetics and can cause psychological distress to the affected individual. The basic goal of rehabilitative dentistry is to increase the life span of the functioning dentition, just as the goal of medicine is to increase the life span of the functioning individual. Management of patients with a badly mutilated dentition is a complex situation and a challenge to dentist's skills. The mutilated dentition due to grossly decayed, tilted, drifted and rotated teeth results in an unaesthetic appearance, alteration in phonetics and difficulty in mastication. This article presents a multidisciplinary approach in rehabilitating mutilated dentition with multiple crowns, fixed partial dentures and a removable partial denture with ceka attachments to enhance retention and stability.