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Interstitial lung diseases (ILD) or pulmonary fibrosis is a group of lung conditions that involves inflammation and scarring or fibrosis of lung tissues. In this condition, it becomes difficult for the lungs to get enough oxygen. This condition results in shortness of breath and dry cough. The exact cause of ILD is unknown but several factors such as smoking, radiation treatment, certain drugs and medicines, certain connective tissue or collagen diseases, and sarcoidosis may contribute in its development. The common symptoms of ILD include bleeding in the lungs, extreme tiredness and weakness, loss of appetite, unexplained weight loss, and chest discomfort. The most common diagnostic methods used to determine ILD are pulmonary function tests such as spirometry and peak flow monitoring. Chest X-rays, blood tests, and bronchoscopy are some other tests to measure the ability of lungs to move air in and out. Treatment of ILD involves several forms of medications, oxygen therapy, pulmonary rehabilitation, lung transplant and surgery. This book includes some of the vital pieces of work being conducted across the world, on various topics related to the clinical management of interstitial lung disease. For all those who are interested in this medical condition, this book can prove to be an essential guide.
Osteoarthritis is a degenerative condition in which the cartilage between joints wears away and bones rub against each other without the natural cushioning. It is characterized by pain, stiffness, swelling and restricted ability to move. Osteoarthritis of the knee is a form of arthritis affecting the knee joint which usually occurs in people above the age of 45. However, it can also affect younger individuals. This may be due to genetic mutations that lend a susceptibility to the disease, obesity, inherited abnormalities around the knee joint, repetitive stress injuries and other clinical conditions such as excess growth hormone or iron overload disorders. Knee osteoarthritis can take several years to develop. It progresses in stages with symptoms ranging from minor to severe. An examination of the joints, evaluation of their range of motion, blood tests, fluid scan tests and MRI scans can help establish a diagnosis. The treatment of knee osteoarthritis depends on the stage of progression of the disease. Exercises that build strength and mobility, and acetaminophens can address early osteoarthritis. Physical therapy and the practice of wearing braces are recommended for managing mild symptoms. This book aims to shed light on some of the unexplored aspects of osteoarthritis of the knee joint and the recent researches in this condition. The objective of this book is to give a general view of the different symptoms and effects of this condition, and their management strategies. This book is a vital tool for all researching or studying knee osteoarthritis as it gives incredible insights into emerging trends and concepts.
Arthroplasty is a surgical procedure within the domain of orthopedics. In this procedure, the articular surface of a musculoskeletal joint is replaced, remodeled or realigned by osteotomy. The aim of arthroplasty is to relieve pain and restore function to the joint after damage by arthritis or some other type of trauma. The most successful and common form of arthroplasty is the joint replacement arthroplasty. Other types of arthroplasty include interpositional arthroplasty, excisional arthroplasty, resurfacing arthroplasty, mold arthroplasty, etc. However, arthroplasty can cause various complications, such as deep vein thrombosis, infection, bleeding and periprosthetic fracture. The prosthesis selected in arthroplasty must be non-toxic yet resistant, compatible and durable. The technology has been improved in the recent years with a porous-coated prosthesis which helps in bonding to the body. This book strives to provide a fair idea about this discipline and to help develop a better understanding of the latest advances within this field. It consists of contributions made by international experts. This book is a vital tool for all researching or studying arthroplasty as it gives incredible insights into emerging trends and concepts.
The medical imaging technology that is used for the non-invasive assessment of the function and structure of the cardiovascular system is referred to as cardiovascular magnetic resonance imaging (CMR). This imaging technique is helpful in evidence-based diagnostic and therapeutic pathways in cardiovascular disease. The applications of cardiovascular MRI include the assessment of myocardial ischemia and viability, myocarditis, iron overload, congenital heart disease and vascular disease. CMR study includes a few techniques of imaging such as cine imaging for heart function, 4D flow CMR, adenosine for perfusion, etc. This book presents the complex subject of cardiovascular magnetic resonance imaging in the most comprehensible and easy to understand language. It presents researches and studies performed by experts across the globe. The book will help the readers in keeping pace with the rapid changes in this field.
The gland in the body which produces the hormones that regulate the utilization of energy by the body is known as the thyroid gland. The disorders related to this gland may lead to the production of too less of this hormone or too much, which can result in hypothyroidism or hyperthyroidism respectively. This in turn can cause symptoms such as weight loss, weight gain, irritability and fatigue. Some of the other disorders of the thyroid gland are goiter, thyroid cancer and thyroiditis. Different approaches, evaluations and case studies on thyroid disorders have been included in this book. Those in search of information to further their knowledge will be greatly assisted by it.
Fungal infections are diseases that are caused by fungus. They can affect the skin, nails, and lungs. Various types of fungal infections have been divided into three categories, namely superficial, subcutaneous, and systemic fungal infections. Subcutaneous fungal infections usually affect tissues beneath the skin, whereas systemic fungal infections can affect organs such as the lungs, eyes, liver, and brain. Some of the major fungal infections include athlete's foot, jock itch, pityriasis versicolor, ringworm, and thrush. The common symptoms of fungal infections vary widely and can include blisters, irritation, itching, redness, scaly skin, swelling, and difficulty in breathing. Immunocompromised people are at an increased risk of fungal infections. The diagnosis of fungal infections can be done using a combination of physical examination and laboratory tests, such as skin or blood cultures. After the type of fungal infection has been diagnosed, the medical practitioners usually prescribe a treatment involving antifungal medications, which may be administered orally or topically. The most common anti-fungal medications include azoles, polyenes, echinocandins, and allylamines. The patients should complete the full course of medicine prescribed to them to prevent the development of drug-resistant strains of the fungus. The topics covered in this extensive book deal with the core subject of fungal infections. It will provide comprehensive knowledge to the readers.
Urology is a medical specialty that focuses on the diagnosis and treatment of diseases and disorders related to the urinary tract and the male reproductive system. It encompasses the surgical as well as non-surgical treatment of urological diseases. The various diseases and diagnostic procedures which fall within this field are urinary tract infections, kidney stones and benign prostatic hyperplasia. Urinary tract infections are bacterial infections that can affect any part of the urinary system, including the bladder, urethra, ureters and kidneys. Kidney stones are hard deposits that form in the kidneys and can cause severe pain and other urinary symptoms. The book aims to shed light on some of the unexplored aspects of urology and the recent researches in this field. It includes contributions of medical experts which will provide innovative insights into this field. This book is a resource guide for experts as well as students.
Stroke is a medical emergency that occurs when blood flow to the brain is disrupted, resulting in damage to brain cells. Rapid diagnosis and treatment are essential to minimize brain damage and improve outcomes. Strokes are broadly divided into ischemic strokes and hemorrhagic strokes. The strokes which are caused due to the blockage of an artery are known as ischemic strokes. Hemorrhagic strokes are caused by the rupturing and bleeding of a blood vessel which supplies blood to the brain. The diagnosis of a stroke can be done by studying the medical history and conducting a physical examination. It can also be done through imaging tests such as CT scan, MRI scan and angiography. From theories to research to practical applications, case studies related to all contemporary topics of relevance to strokes have been included in this book. It will serve as a valuable source of reference for graduate and postgraduate students
Dentistry is an important branch of healthcare that focuses on the diagnosis, prevention and treatment of issues related to oral health. One of the primary aspects of dentistry is preventive care. Regular dental check-ups, cleanings, and oral examinations help in detecting early signs of dental problems such as tooth decay, gum disease and oral cancer. Restorative dentistry is another fundamental aspect of the field. It involves repairing and restoring damaged or missing teeth. Dental fillings, crowns, bridges, and dentures are some of the common restorative treatments which are offered within dentistry. It also encompasses specialized fields such as orthodontics, which corrects misaligned teeth and bite irregularities, and endodontics, which involves root canal treatments to save infected teeth. This book contains some path-breaking studies in the field of dentistry. It will serve as a reference to a broad spectrum of readers.
Heart diseases refer to conditions that affect the heart, its vessels, muscles, valves, or internal electric pathways responsible for muscular contraction. Coronary artery disease is the most common type of heart disease and it may lead to chest pain, stroke, or heart attack. Other major heart diseases include irregular heartbeats (arrhythmias), endocarditis, congestive heart failure, and congenital heart disease. High blood pressure, poor diet, obesity, smoking, high cholesterol, and lack of exercise can all increase the risk of developing various heart diseases. Stress tests, chest X-rays, cardiac CT scans, and electrocardiograms (EKGs/ECGs) can be used to diagnose heart diseases. The treatment of heart diseases is usually based on the type and cause of heart damage. Healthy lifestyle choices such as quitting smoking, exercising regularly, eating a low-fat and low-salt diet, and catching on enough sleep are crucial components of its treatment. This book provides significant information to help develop a good understanding of heart diseases. The extensive content of this book provides the readers with a thorough understanding of the condition. For all readers who are interested in the study of heart diseases, the case studies included in this book will serve as an excellent guide to develop a comprehensive understanding.
Nephrology is an area of medical science that focuses on the diagnosis, treatment and management of various kidney diseases and disorders. Some common kidney diseases and conditions treated under nephrology include chronic kidney disease, acute kidney injury and kidney stones. Chronic kidney disease is a progressive condition characterized by the gradual loss of kidney function over time. Acute kidney injury refers to the sudden and temporary loss of kidney function, often caused by conditions such as severe infections, dehydration, medications, or reduced blood flow to the kidneys. Kidney stones are hard deposits formed in the kidneys. They can be treated through medications, dietary changes and lifestyle modifications. This book unfolds the innovative aspects of nephrology which will be crucial for the progress of this field in the future. Those in search of information to further their knowledge will be greatly assisted by it.
Pediatric dentistry, also known as pedodontics, is a branch of dentistry that focuses on the dental care and oral health of infants, children and adolescents. One of the major aspects of pediatric dentistry is the monitoring of the growth and development of the teeth and jaws of children. This involves the evaluation of the eruption of primary teeth and the development of permanent teeth, as well as the identification of any orthodontic abnormalities. It is also involves the administration of preventative dental care which helps in the promotion of good oral health from an early age. This encompasses dental cleanings, dental sealants, and dental check-ups. This book contains some path-breaking studies in the field of pediatric dentistry. The various studies that are constantly contributing towards advancing treatment modalities and evolution of this field are examined in detail. This book is a resource guide for experts as well as students.
Periodontology, also known as periodontics, is a dental specialty that focuses on the prevention, diagnosis, and treatment of diseases and conditions that affect the supporting structures of the teeth, including the gums, periodontal ligament and the alveolar bone. Some of the key aspects of periodontology and periodontics include the diagnosis and treatment of periodontal diseases, periodontal surgery and treatment of gum recession. A few of the gum diseases treated within this field are gingivitis and periodontitis. There are also numerous surgical procedures carried out within this field of dentistry such as flap surgery, dental implant placement and bone grafts. This book unfolds the innovative aspects of periodontology, which will be crucial for the progress of this field in the future. It will also provide interesting topics for research which interested readers can take up. Periodontists and students actively engaged in this field will find this book full of crucial and unexplored concepts.
Ophthalmology is a medical specialty focused on the diagnosis and treatment of diseases and disorders related to the eyes and visual system. It seeks to provide medical and surgical care for a wide range of eye conditions such as glaucoma, age-related macular degeneration and retinal detachment. Glaucoma refers to a group of eye conditions which are characterized by damage to the optic nerve, and it is often associated with increased intraocular pressure. It can be treated through medications, laser therapy and surgical interventions. Age-related macular degeneration is a progressive degenerative disease which affects the central portion of the retina. It can lead to central vision loss and can be treated through injections, medications and laser therapy, depending on the type and stage of the disease. Different approaches, evaluations and advanced studies on ophthalmology have been included in this book. Researchers and students in this field will be assisted by it.
Oral and maxillofacial surgery is a specialized branch of dentistry that focuses on the diagnosis and surgical management of conditions affecting the face, jaws, mouth and neck. Some of the key procedures which are undertaken within this area of medicine are orthognathic surgery, management of facial trauma and the extraction of impacted teeth. Orthognathic surgery aims to correct severe abnormalities of the jaw and facial structures, including problems with biting, chewing, speech and facial balance. The management of facial trauma involves treating facial injuries resulting from accidents, sports-related incidents or assaults. Treatment of oral and facial infections also takes place within this field of medicine. In this book, using case studies and examples, constant effort has been made to make the understanding of the difficult concepts of oral and maxillofacial surgery as easy and informative as possible, for the readers. It will help new researchers by foregrounding their knowledge in this area of study.
Obstetrics and gynecology is a medical specialty that seeks to provide medical care and support to women throughout the different stages of their reproductive lives. It focuses on two primary areas, obstetrics and gynecology. Obstetrics deals with pregnancy, childbirth, and postpartum issues. It encompasses prenatal care, monitoring the health of the mother and the developing fetus, managing and addressing any complications that may arise during pregnancy. It also provides support during labor and delivery. Gynecology focuses on the health of the female reproductive system outside of pregnancy. It deals with the diagnosis, treatment and prevention of conditions related to the female reproductive system, such as menstrual disorders, fertility issues, sexually transmitted infections (STIs), uterine fibroids, ovarian cysts, endometriosis, and gynecological cancers. This book strives to provide a fair idea about this discipline and to help develop a better understanding of the latest advances within this field. Those in search of information to further their knowledge will be greatly assisted by it.
The medical specialty that deals with the diagnosis and treatment of eye diseases is known as ophthalmology. The surgical sub-specialty within this field is known as ophthalmic surgery. It involves the surgical procedures performed on the eyes or its surrounding structures to correct various eye conditions and improve visual function. Some of the common types of ophthalmic surgeries are cataract surgery, refractive surgery and retinal surgery. Cataract surgery involves the removal of a cloudy lens, known as the cataract, from the eye and replacing it with an artificial intraocular lens in order to restore clear vision. Refractive surgeries, such as LASIK, photorefractive keratectomy and small incision lenticule extraction, aim to correct vision problems such as nearsightedness, farsightedness, astigmatism and presbyopia. This book is compiled in such a manner, that it will provide in-depth knowledge about the ophthalmic surgery. It includes contributions of experts and scientists which will provide innovative insights into this field of medicine.
The branch of medicine which deals with the causes, diagnosis and treatment of various kidney diseases and disorders is known as nephrology. Some of the prominent causes of kidney diseases are kidney stones, diabetes, hypertension, glomerulonephritis and polycystic kidney disease. There are various treatment approaches which are used within this field such as medications, dialysis and kidney transplantation. Medications can be used to manage the underlying causes and symptoms of kidney diseases. They are also used to control blood pressure, manage diabetes, reduce inflammation and treat infections. Dialysis is a treatment that performs the functions of the kidneys artificially when they are unable to do so effectively. It involves removing waste products and excess fluids from the blood using a machine. This book provides comprehensive insights into the field of nephrology. It is appropriate for students seeking detailed information in this area of medicine as well as for experts.
Neurology is a medical specialty that focuses on the diagnosis and treatment of diseases and disorders of the nervous system. Some of the diagnostic approaches which are used within this field are neuroimaging, electrophysiological tests and genetic testing. Neuroimaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) scans help in visualizing the structure and function of the brain and spinal cord. Electrophysiological tests include tests such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS), and they measure the electrical activity of the brain, nerves, and muscles. Some of the common treatment approaches which are used within this field are rehabilitation therapies, interventional procedures and surgical interventions. This book includes some of the vital pieces of work being conducted across the world, on various topics related to neurology. It will serve as a valuable source of reference for graduate and postgraduate students.
Dental implants refer to artificial tooth roots which are made of a biocompatible material such as titanium. These are surgically placed into the jawbone and are used to support a dental prosthesis. Implant dentistry is a specialized field of dentistry that aims to replace missing teeth or stabilize dentures using dental implants. They offer a wide variety of benefits for restoring appearance and improving the quality of life of patients. It also helps in promoting the health of the surrounding bone and gums, and preventing the shrinkage of the jawbone which may be caused by bone loss. Most of the topics introduced in this book cover new techniques and the applications of implant dentistry. From theories to research to practical applications, case studies related to all contemporary topics of relevance to this field have been included herein. This book is a vital tool for all researching and studying this field.
Irritable bowel syndrome (IBS) refers to a condition that causes abdominal pain and bowel changes. The common symptoms of IBS include changes in bowel movements, bloating, stomach cramps, and frequent diarrhea or constipation. In menstruating women, IBS symptoms may be even worsen. People with IBS usually have a lower pain tolerance. The precise cause of IBS is unknown. Some of the factors that seem to play a role include severe infections, intestine muscle spasms, changes in gut microbiota, and early life stress. IBS can be diagnosed by performing a physical examination along with a review of the symptoms, family history, and medical history. The IBS treatment aims to alleviate the symptoms with the help of probiotics, dietary changes, counseling, and medicine. This book contains a detailed explanation of the various diagnostic and therapeutic techniques associated with irritable bowel syndrome. It aims to shed light on some of the unexplored aspects of this condition. A number of latest researches have been included to keep the readers up-to-date with the latest concepts with respect to this medical condition.
Hematology and oncology are closely related medical specialties that deal with the diagnosis, treatment, and management of blood disorders and cancer respectively. They are separate specialties, and they are combined for the treatment of hematologic malignancies. These malignancies refer to the cancers which originate in the blood forming tissue. Hematological malignancies are classified into three types, namely, multiple myeloma, leukemia and lymphoma. The cancer which develops in the bone marrow and affects plasma cells is known as multiple myeloma. Leukemia refers to a cancer that begins in the bone marrow or blood. On the other hand, lymphoma is a type of hematological malignancy which begins in a part of the immune system known as the lymphatic system. This book includes some of the vital pieces of works being conducted across the world, on various topics related to hematology and oncology. It presents researches and studies performed by experts across the globe. The book is appropriate for students seeking detailed information in this area of medicine as well as for experts.
Hemato-oncology, also known as hematologic oncology, is a medical specialty that focuses on the diagnosis, treatment, and management of cancers affecting the blood, bone marrow, and lymphatic system. It is an interdisciplinary field that combines aspects of hematology (the study of blood disorders) and oncology (the study of cancer). Hemato-oncology deals with hematologic malignancies, which include various types of leukemia, lymphoma and myeloma. Some of the major aspects of hemato-oncology are diagnosis, chemotherapy and stem cell transplantation. There are numerous procedures which are used for the diagnosis of blood related cancers such as bone marrow biopsies, blood tests, genetic testing, imaging studies, and lymph node biopsies. They can be treated through chemotherapy, radiation therapy, targeted therapy, immunotherapy, bone marrow transplantation, or a combination of these approaches. This book includes some of the vital pieces of works being conducted across the world, on various topics related to hemato-oncology. It will also provide interesting topics for research which interested readers can take up. The book will serve as a valuable source of reference for graduate and postgraduate students.
Heart diseases, also called cardiac diseases, refer to conditions that affect the heart. The most common types of heart diseases include atherosclerosis, congenital heart defects, heart infections, arrhythmia, coronary artery disease (CAD), and cardiomyopathy. The major causes of heart disease include genetics, medications, lifestyle, infections, and other diseases. Lifestyle habits like smoking, and medical conditions like high blood pressure and high cholesterol are the major risk factors for heart diseases. Depending on the type of heart disease that a patient has, several treatment options may be used. However, some common strategies for managing heart conditions include lifestyle changes, surgery, and medications. Exercising regularly, avoiding or quitting smoking, eating a balanced diet, limiting alcohol intake, maintaining a moderate body weight, and managing the underlying conditions are few examples of lifestyle changes that can help reduce the risk of developing heart diseases. This book provides comprehensive insights into the field of cardiology. For all readers who are interested in cardiology, the case studies included in this book will serve as an excellent guide to develop a comprehensive understanding.
The set of conditions that affect the cardiovascular system are referred to as heart diseases. Congenital heart defects, dilated cardiomyopathy, heart failure, mitral valve regurgitation, aortic stenosis, coronary artery disease, arrhythmia, myocardial infarction, hypertrophic cardiomyopathy and mitral valve prolapse, are the common types of heart diseases. There are several risk factors of heart diseases such as family history, high blood pressure, diabetes, unhealthy diet, high cholesterol, and smoking. Heart diseases may lead to potentially fatal conditions or diseases such as heart attack, peripheral artery disease, and sudden cardiac arrest. Heart diseases can be diagnosed by examining the medical history of a person and by performing test such as heart tests and blood tests. Heart diseases are not curable or reversible, but they can be managed with the help of medications, surgery or invasive procedures, and lifestyle changes. This book contains case studies related to all the contemporary topics relevant for studying heart diseases. It will help new researchers by foregrounding their knowledge in these conditions.
The organs involved in digestion, such as the esophagus, stomach, small intestine, large intestine, liver, gallbladder and pancreas together make up the gastrointestinal tract. The diagnosis and treatment of disorders related to the gastrointestinal tract are conducted within a medical specialty known as gastroenterology. Some of the diseases and disorders which are treated within this field are peptic ulcer disease, irritable bowel syndrome and gastrointestinal bleeding. The open sores which may form on the upper portion of the small intestine or the inside lining of the stomach are known as peptic ulcers. Irritable bowel syndrome refers to a functional disorder which is characterized by abdominal pain, bloating, and changes in bowel habits without any evidence of structural abnormalities. Gastroenterology also deals with the management of medical conditions that cause bleeding in the digestive tract. These conditions may include diverticulosis, gastrointestinal tumors and varices. This book unravels the recent studies in the field of gastroenterology. It will provide comprehensive knowledge to the readers.
Geriatric dentistry, also known as geriodontics or geriatric oral health, is a specialized field of dentistry that focuses on providing dental care to older adults. It focuses on addressing the unique oral health challenges and dental conditions which affect people as they grow older. Some important aspects of geriatric dentistry are oral health assessment, denture care and treatment of dental diseases. Oral health assessment involves the examination of the teeth, gums, oral tissues, and evaluation of the overall oral hygiene. Dentures refer to prosthetic devices which are used to replace missing teeth. They are used by a large number of older adults and their care encompasses fitting, adjustments, repairs, and maintenance to ensure optimal fit and function. This book unfolds the innovative aspects of geriatric dentistry which will be crucial for the progress of this field in the future. For all those who are interested in this field, it can prove to be an essential guide.
Endocrinology is an area of medical science that focuses on the study and treatment of disorders related to the endocrine system. The endocrine system consists of glands that produce hormones, which are essential for regulating various bodily functions. There can be several causes of endocrine disorders. They can arise from hormone-producing glands, such as the thyroid, adrenal glands, pituitary gland, pancreas, or the ovaries and testes. The symptoms of endocrine disorders vary depending on the specific gland and hormones involved. A few of the common symptoms include fatigue, weight changes, mood swings, abnormal growth patterns, changes in sexual function, excessive thirst or urination, and changes in appetite. Diagnosing endocrine disorders involves a thorough review of medical history, physical examination, and laboratory tests. Imaging techniques such as ultrasounds, CT scans, or MRIs may also be used to visualize the affected glands or detect tumors. This book is a compilation of case studies that discuss the most vital concepts and emerging trends in the field of endocrinology. Those in search of information to further their knowledge will be greatly assisted by it.
Pediatric and geriatric endocrinology are two specialized branches of endocrinology that focus on the unique hormonal challenges and disorders experienced by children and older adults. Pediatric endocrinology primarily deals with hormonal disorders in children and adolescents. Hormonal imbalances during growth and development can have a significant impact on a child's overall health, growth and sexual development. Some of the conditions which are studied and treated under pediatric endocrinology are growth disorders, childhood diabetes (Type 1 and Type 2), thyroid disorders, puberty disorders, adrenal gland disorders and disorders of sexual development. Geriatric endocrinology, on the other hand, focuses on the hormonal changes and disorders that occur in older adults. It involves managing conditions such as menopause and osteoporosis. It also involves diabetes management in older adults, thyroid disorders, adrenal disorders, and hormone-related issues affecting cognitive function and mood. This book provides comprehensive insights into the field of pediatric and geriatric endocrinology. It will serve as a valuable source of reference for graduate and postgraduate students.
Dentistry is a vital branch of healthcare that focuses on the diagnosis, prevention, and treatment of oral health conditions. It plays a crucial role in maintaining overall well-being by promoting good oral hygiene and preventing dental diseases. One of the key aspects of dentistry is preventive care. It includes regular check-ups to detect and address oral health issues at an early stage. Restorative and cosmetic dentistry are other important aspects of dentistry. Restorative dentistry includes use of various techniques to restore damaged teeth and improve their functionality. This may involve treatments such as fillings, crowns, bridges, or dental implants to replace missing teeth and restore oral health and aesthetics. Cosmetic dentistry focuses on enhancing the appearance of the teeth and smile. The book aims to shed light on some of the unexplored aspects of dentistry and the recent researches in this field. It will provide comprehensive knowledge to the readers.
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