Context: Implant design influences the stress distribution in an implant-supported distal cantilever fixed partial denture and supporting bone tissue. Aim: The purpose of this study was to investigate the effect of implant design on the stress distribution in the framework, implant, and surrounding bone, using a three-dimensional finite-element analysis. Materials and Methods: A three-dimensional finite-element model of a mandibular section of bone with implants placed in the first and second premolar region was created to support a distal cantilever fixed partial denture. A one-piece and two-piece implant and its suprastructure were simulated into wire frame models using Pro engineer (Pro E) program. Four models were created in this study. Results: Comparative analysis of all models showed that the maximum stress overall was in the cervical portion of the secondary abutment. When used in combination, the maximum stress was when the two-piece implant was used as secondary abutment. The one-piece implant showed less stress compared to its counterpart when used as secondary abutment. The maximum stress distribution in the bone was around the neck region of the secondary implant. Conclusion: Within the limitations of this study, it can be concluded that stress distribution is better in a one-piece implant design when compared with the two-piece implant design, with stress concentration being more at the junction of the abutment and the implant fixture in the two-piece implant. When implants are used as abutments (either primary or secondary), irrespective of their position and design, the secondary implant shows the maximum amount of stresses.

Background: Dental caries is a multifactorial disease with varying clinical picture and its diagnostic criteria is complicated, when initial lesion is considered. Hence, there is a need for an index which measures cavitated, non-cavitated, and initial lesion in dental caries. So, the purpose of this study was to compare the of def index with Nyvad's new diagnostic criteria. Materials and Methods: A total of 249 school children in the age group of three to six years were selected for the study from Sajjan Rao School at Bangalore city. Children teeth were cleaned and dried with cotton rolls and chip blower. The dental caries examinations were conducted under standardized conditions using plane mouth mirrors and explorers with the help of artificial illumination. The diagnostic criteria used were deft and d, e, and f component of Nyvad's new caries diagnostic criteria. Mann Whitney 'U' test was used to compare the two indexes at five percent significant level. Results: The mean value for deft was 2.48 and the mean for d, e, and f component of Nyvad's new caries diagnostic criteria was 3.18 which shows statistically significant difference with P value of <0.05. Conclusion: The result obtained by Nyvad's new caries diagnostic criteria produces values much higher than those with def caries index system. Hence, Nyvad's new caries diagnostic criteria can be used to diagnose dental caries at the initial stages, which in turn will reflect exact prevalence of caries.

Background: Fracture of provisional fixed partial denture (FPD) may jeopardize the success of provisional prosthodontic treatment phase and cause patient discomfort. Aim: The aim of this study was to compare the fracture toughness of the Polymethyl Methacrylate (PMMA) resin and Bis-Acryl Composite (BAC) resin reinforced with the Polyethylene and Glass fibers. Materials and Methods: Three groups (N=10) of each of the two materials were prepared for the fracture toughness test. Two groups had the different reinforcements and group without reinforcement served as the control. The mean fracture toughness (MPa.m^½ ) was compared by One-way ANOVA, followed by the Scheffe analysis. Fracture toughness between fiber-reinforced PMMA and BAC resin was compared by the independent samples t test. Results: For the controls, the fracture toughness for PMMA resin (0.91) was significantly lower than for the BAC resin (1.19). Glass fiber reinforcement produced significantly higher fracture toughness for both, PMMA (1.48) and BAC (1.82) resin, but the Polyethylene fibers did not (0.95 for PMMA and 1.23 for BAC resin). Among the reinforced groups, Silane impregnated Glass fibers showed highest fracture toughness for the BAC resin (1.82). Conclusion: Of two fiber reinforcement methods evaluated, Glass fiber reinforcement for the PMMA and BAC resin produced highest fracture toughness. Clinical Implications: On the basis of this in--vitro study, the use of Glass and Polyethylene fibers tested may be an effective way to reinforce resins used to fabricate fixed provisional restorations.

Objective: To suggest a custom bar supported overdenture treatment modality for prosthodontic management of patients with severe gag reflex. Background: Some patients have a severe gag reflex and cannot tolerate conventional maxillary complete dentures with maximum palatal coverage and extensions of all borders. The condition further gets complicated in patients suffering from respiratory problems along with severe gag reflex. Severe gagging acts as a barrier to treat such patients with accepted clinical procedures and prevent patients from wearing the prosthesis. By saving some of the remaining natural teeth and fabricating, a horse shoe shape palateless simple tooth or bar supported overdenture can be successfully used for treating such patients. Materials and Methods: The remaining maxillary right and left canines were prepared with the tapered round end diamond bur to receive copings of custom bar after intentional root canal treatment of same teeth. Impression was made with light body and putty of the polyvinyl siloxane elastomer with double step putty wash technique. Impression was poured with die stone. Wax pattern of copings with bar was fabricated with inlay wax which was invested and casted. After retrieving the bar, it was finished and its fit was evaluated. The coping-bar assembly was finally cemented with the glass ionomer cement. Palateless overdenture was fabricated by conventional technique used for the fabrication of complete denture. Conclusion: Palateless custom bar supported overdenture procedure can be successfully used for the management of patients with severe gag reflex with improved denture retention, stability, chewing efficiency and comfort of the patient.

Purpose of the Study: The purpose was to analyze and classify behavioral pattern of complete denture patients and to identify difficult patients. Materials and Methods: Fifty complete denture patients were randomly selected for the study. Their behavioral pattern was categorized using House classification as philosophic, indifferent, exacting and hysterical. The above behavioral classification was based on two methods namely interview and questionnaire and graphoanalysis. Accuracy of the above-mentioned two methods in predicting behavior of complete denture patients was statistically evaluated. Results: On analyzing the data it was found that a significant correlation exists between handwriting pattern and behavior of an individual. Further it was noticed that chances of identifying difficult patients such as hysterical was more effective by employing graphoanalysis than questionnaire and interview method. Conclusion: Graphoanalysis in addition with properly structured interview and questionnaire is useful in evaluation of behavior of an individual especially for recognizing difficult patients.

Background: Traditionally, inlay casting waxes have been used to fabricate patterns for castings. Newer resin pattern materials offer greater rigidity and strength, allowing easier laboratory and intraoral adjustment without the fear of pattern damage. They also claim to possess a greater dimensional stability when compared to inlay wax. Aims: This study attempted to determine and compare the marginal accuracy of patterns fabricated from an inlay casting wax, an autopolymerized pattern resin and a light polymerized pattern resin on storage off the die for varying time intervals. Materials and Methods: Ten patterns each were fabricated from an inlay casting wax (GC Corp., Tokyo, Japan), an autopolymerized resin pattern material (Pattern resin, GC Corp, Tokyo, Japan) and a light-cured resin pattern material (Palavit GLC, Hereaus Kulzer GmbH, Germany). The completed patterns were stored off the die at room temperature. Marginal gaps were evaluated by reseating the patterns on their respective dies and observing it under a stereomicroscope at 1, 12, and 24 h intervals after pattern fabrication. Results: The results revealed that the inlay wax showed a significantly greater marginal discrepancy at the 12 and 24 h intervals. The autopolymerized resin showed an initial (at 1 h) marginal discrepancy slightly greater than inlay wax, but showed a significantly less marginal gap (as compared to inlay wax) at the other two time intervals. The light-cured resin proved to be significantly more dimensionally stable, and showed minimal change during the storage period. Conclusion: The resin pattern materials studied, undergo a significantly less dimensional change than the inlay waxes on prolonged storage. They would possibly be a better alternative to inlay wax in situations requiring high precision or when delayed investment (more than 1 h) of patterns can be expected.

Aim: To evaluate the remineralization potential of Amorphous Calcium Phosphate (ACP) and Fluoride containing pit and Fissure Sealants using Scanning Electron Microscopy. Materials and Methods: Thirty maxillary first premolars were divided into three groups of ten each and were randomly selected for ACP containing (Aegis- Opaque White, Bosworth Co. Ltd.), Fluoride containing (Teethmate F1 Natural Clear, Kuraray Co. Ltd.), resin based (Concise- Opaque White, 3M ESPE Co. Ltd.) pit and fissure sealant applications. The Concise group served as a control. The teeth weresubjected to the pH-cycling regimen for a period of two weeks. After two weeks, the teeth were sectioned bucco-lingually into 4mm sections and were observed under Scanning Electron Microscope at 50X, 250X, 500X, 1000X and 1500X magnifications. The qualitative changes at the tooth surface and sealant interface were examined and presence of white zone at the interface was considered positive for remineralization. Results: Both ACP containing (Aegis) and Fluoride containing (Teethmate F1) group showed white zone at the tooth surface-sealant interface. The resin based group (Concise) showed regular interface between the sealant and the tooth structure, but no clear cut white zone was observed. Conclusion: Both, Aegis and Teethmate F1 have the potential to remineralize. Release of Amorphous Calcium Phosphate molecules in Aegis group and formation of Fluoroapetite in Teethmate F1 group, were probably responsible for the remineralization.

Background: The commonly accepted idea concerning root planing is that excessive removal of cementum is not necessary for removal of endotoxins. The ideal instrument should enable the removal of all extraneous substances from the root surfaces, without causing any iatrogenic effects. Aim: To compare the remaining calculus, loss of tooth substance, and roughness of root surface after root planing with Gracey curette, ultrasonic instrument (Slimline^® insert FSI-SLI-10S), and DesmoClean^® rotary bur. Materials and Methods: The efficiency of calculus removal, the amount of lost tooth substance, and root surface roughness resulting from the use of hand curette, ultrasonic instrument, and rotary bur on 36 extracted mandibular incisors were examined by SEM. We used three indices to measure the changes: Remaining calculus index (RCI), Loss of tooth substance index (LTSI), and Roughness loss of tooth substance index (RLTSI). Twelve samples were treated with each instrument. The time required for instrumentation was also noted. Statistical Analysis: Kruskal-Wallis ANOVA was used for multiple group comparisons and the Mann-Whitney test for group-wise comparisons. Analysis was carried out with SPSS^® software (version 13). Results and Conclusion: The RCI and LTSI showed nonsignificant differences between the three groups. RLTSI showed a significant difference between Slimline™ and hand curette as well as Slimline™ and Desmo-Clean™. Slimline™ showed the least mean scores for RCI, LTSI, and RLTSI. Thus, even though the difference was not statistically significant, Slimline™ insert was shown to be better than the other methods as assessed by the indices scores and the instrumentation time.

Background: Provision of oral health care in India, especially for the underprivileged is limited due to inadequate finances and manpower. Resources of dental colleges in such a scenario can be utilized to provide prevention oriented oral health care. Aim: To improve the oral health status of children at an institute in Nellore district of Andhra Pradesh, India, through prevention based comprehensive dental health care program (CDHP). Design and Setting: A longitudinal institution based interventional study conducted among the primary grade children (n=162). Materials and Methods: Baseline data collection included (i) basic demographic data (ii) body mass index (BMI) (iii) assessment of the dentition status and treatment needs according to WHO 1997 criteria. The CDHP included group based dental health education, professional oral prophylaxis, weekly (0.2%) sodium fluoride mouth rinse program, biannual application of topical fluoride (1.23% APF), pit and fissure sealants for all first permanent molars and provision of all necessary curative services. Results: Mean treatment requirements per child decreased at 18 months. New caries lesions developed among four children. BMI of children with decay was seen to improve significantly after instituting the CDHP. Conclusion: CDHP is effective in overall improvement of general and oral health. In resource limited countries like India, such programs organized by dental schools can improve oral health.

Aim: Thermal analysis of the temperature and stress distribution of parallel sided, threaded and non-threaded dowels and core materials under thermal loading within a maxillary central incisor using a three dimensional finite element study. Materials and Methods: 3D models of endodontically treated maxillary central incisor with parallel sided, threaded and non- threaded post and core materials were simulated using the ANSYS software. Materials simulated were parallel sided cast gold post and core, parallel sided fibre reinforced composite (FRC) post and core, and parallel sided, threaded, prefabricated stainless steel post and amalgam core. Thermal loads simulating hot (60 degree C/ 333K) and cold (15 degree C/288K) liquid were applied for 15 seconds at the incisal edge. The temperature changes at the selected nodes were obtained on the various post and core materials, interface between post and dentin, interface between core and dentin, within the dentin and within the cement layer. Results: Temperature and stress distribution pattern were represented in numerical and color coding and results interpreted. Thermal stresses arises as a result of temperature changes. A decreased temperature gradient of the metallic dowels and core (T1 hot - 0.002K, T3 hot - 1.071K, T1 cold -0.99K, T3 cold - 0K) were obtained than that of the FRC dowel and core of 1.982K(hot) and1.55K(cold) respectively due to the higher thermal conductivity of the metals. Higher thermal stress values of 3.567 Mpa(hot) and 3.092 Mpa(cold) respectively were obtained for the FRC dowels and higher stress values of 39.679 Mpa(hot) and 57.855 Mpa(cold) respectively were also obtained for the FRC cores. These values indicated that thermal stresses of the FRC dowel and core were greater than that of cast gold dowel and core and prefabricated stainless steel dowel and amalgam core due to its high coefficient of thermal expansion. Maximum stress values of the FRC dowel and core of 1.87 Mpa(hot) and 2.57 Mpa(cold) respectively were also generated in the cement layer, core and metal ceramic crown. The junction of the metal ceramic crown and dentin demonstrated the maximum stress. Higher thermal stress values of 59.162 ± 10 Mpa were obtained in the restoration and the coronal portion of the dentin than the stress levels of .0039 ± 10Mpa in the supporting bone due to an increased thermal expansion. Conclusion: Non-metallic dowel and core materials such as fibre reinforced composite dowels (FRC) generate greater stress than metallic dowel and core materials. This emphasized the preferable use of the metallic dowel and core materials in the oral environment.

Objective: The present study was to evaluate and compare anchorage loss in sagittal, vertical dimension in incisal, molar segments and distal tipping of upper canine after first phase of orthodontic mechanotherapy utilizing MBT and ROTH philosophies. Materials and Methods: Thirty patients with class I dentoalveolar malocclusion requiring extraction of all first premolars were randomly assigned into group I and group II. Set of two lateral cephalograms (T1) and (T2) were obtained with appliance in place and after sufficient leveling and aligning respectively. Linear measurements were recorded on the tracings using Pancherz analysis. A Wilcoxon t-test was use to assess the linear changes. Results: In group I sample, upper and lower incisors retroclined during T1 - T2; by mean (SD) value of 2.267 (1.0032) mm, 2.4 (0.98) mm, respectively. Group II sample showed upper incisor proclination by -0.4 (1.404) and lower incisal retroclination by 0.06 (1.48). Upper and lower molars in group I remained stationary and group II upper and lower molars moved mesially by -1.133 (0.351) and -0.002 (0.005). In group I, upper and lower incisors extruded by -0.867 (0.611) and -0.67 (0.703), respectively, and group II the upper and lower incisors extruded by -0.9 (0.507) and -0.133 (0.639). Upper canine tipped distally during T1 - T2 in group I by -0.33° (2.609) and group II there was a change in distal tip of upper canine by -3° (3.184). Conclusion: Results from this random clinical trial showed that MBT technique effectively addressed perceived inadequacies of ROTH philosophy.

Purpose: This study was designed to evaluate the buccal corridor in smile esthetics and to correlate it with underlying hard tissues. Materials and Methods: Posed smiling frontal photographs, digital posterior-anterior (PA) cephalograms, and study models of 25 males and 25 females in age range of 18-25 years were taken. Photographs were evaluated for smile esthetics by eight orthodontists, eight plastic surgeons, eight beauticians and eight lay people to group them into three groups with least attractive, average and attractive smile and buccal corridor width was measured. Digital PA cephalograms were transferred on Nemo-tech software for frontal facial analysis. Intercanine and intermolar widths were measured on upper study model with the help of a digital calliper. Results: The buccal corridor width was least in attractive smile group and maximum in least attractive smile group. The buccal corridor width had a negligible correlation with hard tissues and a mild to moderate inverse correlation with intercanine and intermolar widths within the groups. Conclusion: As the amount of buccal corridor display was increased, smiling images were scored less attractive by the evaluators. The buccal corridor is not influenced by underlying skeletal hard tissues but have mild to moderate inverse correlation with the intercanine and intermolar width.

Background: There has been no study to date comparing the effectiveness and predictability of transpositional flap (TF) with that of the gold standard connective tissue graft (CTG) for root coverage. This study was performed during 2001-2002 at Government Dental College and Hospital, Mumbai India. Objectives: To evaluate the effectiveness and predictability of TF vs CTG for coverage of Miller's class I and class II facial marginal tissue recession defects. Materials and Methods: Twenty cases fulfilling the selection criteria were identified and randomly allotted to two groups: group I (TF, 10 cases) and group II (CTG, 10 cases). Registered parameters included plaque index (PI), defect-specific plaque index (DPI), gingival index (GI), defect-specific gingival index (DGI), recession depth (RD), recession width (RW), probing depth (PD), attachment level (AL), width of keratinized tissue (KT), percentage defect coverage (DC), and percentage root coverage (RC). Results: For group I: preoperative PI, DPI, GI, DGI, RD, PD, KT, and RC were 0.38±0.14, 1.1±0.57, 0.02±0.02, 0.36±0.29, 4.45±2.0, 1.5±0.71, 1.45±1.30, and 68.57±14.36, respectively; the corresponding postoperative values were 0.38±0.11, 0.36±0.29, 0.01±0.01, 0.10±0.16, 3.2±2.44, 1.1±0.32, 2.65±1.03, and 77.40±17.23. For group II the preoperative PI, DPI, GI, DGI, RD, PD, KT, and RC were 0.77±0.5, 1.53±0.63, 0.12±0.18, 0.59±0.62, 4.95±1.59, 1.9±0.74, 0.50±1.08, and 65.05±11.22, respectively, and the corresponding postoperative values were 0.49±0.32, 0.8±0.50, 0.03±0.53, 0.03±0.10, 0.90±0.88, 1.2±0.42, 4.4±1.07, and 93.65±6.18, respectively. Conclusion: The TF technique for coverage of single tooth buccal recession defects of Miller's class I and class II types in mandibular anterior teeth was neither effective nor predictable in defect coverage and defect elimination.

Aim of the study: The aim of this study was to consider friction in buccal segment attachments during overjet reduction by means of sliding mechanics. Friction was compared in Stainless Steel, Titanium and Cobalt Chromium brackets, using Stainless Steel and Beta Titanium wires. Materials and Methods: This in-vitro study comprised 18 samples (6 x 3 brackets of different materials-stainless steel, titanium and cobalt chromium). Each jig comprised of a buccal segment model of two premolar brackets and a molar tube simulating the upper posterior buccal segment. Each jig was coupled with the wire of 0.019 x 0.025 inch dimension and was tested with a Universal Testing Machine. Ligation was achieved using low friction elastomeric modules (Slide ^TM , Leone, Italy), a non-conventional elastomeric module. Results: All three bracket systems showed significantly higher frictional forces for the beta titanium wire than for the stainless steel wire. When coupled with the stainless steel wire, the titanium bracket showed the least friction, followed by stainless steel and cobalt chromium brackets. When coupled with the beta titanium wire, the titanium brackets again showed the least friction; while the difference in frictional levels between the stainless steel and cobalt chromium brackets was not statistically significant. The titanium brackets showed the least friction among all the groups tested for both wires. Conclusion: Titanium bracket with Beta Titanium wires could and probably should be the alternative metal bracket used in the nickel sensitive patient.

Addition silicone impression materials have been used as impression material for more than 20 years. Although they are among the most expensive impression materials, they became popular during the past decade as they have excellent physical properties. Prevention of infection is an important aspect in dental treatment since dental professionals are routinely exposed to the wide variety of microorganisms present in saliva. Gloves are the most common protective measure used during dental treatment. The gloves are mostly made of latex. In this study, we examine how the setting time of three types polyvinyl putty materials were affected by the use of five different brands of latex gloves and one brand of vinyl gloves. Each material was first mixed without wearing gloves according to the manufacturer's instructions. After the stipulated mixing time, the setting time was measured using the Vicat needle. The setting time is measured from the time of mixing till the time that the needle does not produce any indentation on the surface of the material. The putty material was then mixed with gloved hands (using the five different brands of latex gloves in turn) and the setting time was measured. Then the material was mixed with washed gloved hands, and the setting time was measured again. Finally, the material was mixed with vinyl gloved hands and the setting time was measured. The following conclusions were drawn from the study:

• Reprosil™ and Express™ showed significant variation in the setting time with the latex gloved hands.
• There was no significant variation in the setting time when material was mixed with unwashed vs washed gloved hands.
• Vinyl gloves did not significantly affect the setting time of any of the putty impression materials.

Context: During fixed orthodontic therapy, when the stress levels in the periodontal ligament (PDL) exceedsan optimum level, it could lead to root resorption. Aims: To determine an apical stress incident on the maxillary central incisor during tooth movement with varying cemental and periodontal ligament thickness by Finite Element Method (FEM) modeling. Settings and Design: A three dimensional finite element model of a maxillary central incisor along with enamel, dentin, cementum, PDL and alveolar bone was recreated using EZIDCOM and AUTOCAD software. ALTAIR Hyper mesh 7.0 version was used to create the Finite Element meshwork of the tooth. This virtual model was transferred to Finite Element Analysis software, ANSYS where different tooth movements were performed. Materials and Methods: Cemental thickness at the root apex was varied from 200 μm to 1000 μm in increments of 200 μm. PDL thickness was varied as 0.24 mm and 0.15 mm. Intrusive, Extrusive, Rotation and Tipping forces were delivered to determine an apical stress for each set of parameters. Results: Results indicated that an apical stress induced in the cementum and PDL, increased with an increase in cementum and PDL thickness respectively. Apical stress induced in the cementum remained the same or decreased with an increase in the PDL thickness. Apical stress induced in the PDL decreased with an increase in the cementum thickness. Conclusion: The study concluded that the clinical delivery of an orthodontic forces will cause stress in the cementum and PDL. Hence, it is necessary to limit the orthodontic force to prevent root resorption.

Context: The result of the studies concerning the bonding of self-adhesive resin cements to dentin is controversial. Aims: To assess in vitro shear bond strength (SBS) of three self-adhesive dual-cured resin cements to dentin compared to a currently used dual-cured resin cement, using SBS test. Settings and Design: The extant study is an experimental in vitro one on extracted human third molars dentin. Material and Methods: 40 intact human third molars were selected and randomly divided into 4 groups of 10. Buccal dentin surfaces were exposed perpendicular to the long axis and prepared with SiC papers. A translucent plastic ring, was placed over the dentin surfaces. Group I (Control group): After 15 s of etching and application of Excite DSC Bond (Ex), Variolink II (Var II) resin cement was injected into the plastic ring and was light cured for 40 s. Group II: RelyX Unicem (RX) was injected into the plastic ring and after 30 s, was light cured for 40 s. Group III: Maxcem (Mc) was injected into the plastic ring and after 30 s, was light cured for 40 s. Group IV: Multilink Sprint (MS) was injected into the plastic ring and after 30 s, was light cured for 40 s. After thermal cycling, SBS were measured with a universal testing machine. Statistical Analysis Used: Statistical computations were conducted according to Student's t-test. Results: The mean SBS and standard deviations (in parentheses) for groups I, II, III, and IV were 12.95 (2.64), 6.73 (0.79), 3.01 (0.90), 4.60 (0.75) MPa, respectively. Statistical analysis, revealed that: (1) the mean SBS of Var II were significantly higher than the other groups (P<0.05). (2) The mean SBS of Mc and MS were significantly lower than RX (P<0.05). (3) The mean SBS of Mc and MS did not show significant difference (P>0.05). Conclusion: Bond strength of three self-adhesive resin cements was significantly lower than the conventional total-etch resin cement. RX significantly performed better SBS than Mc and MS to dentin.

Aims: Comparing the calcium concentration and pH levels of Ca(OH) ₂ medicament placing in pulp chamber and root canal. Materials and Methods: Ninety-nine extracted human mandibular second premolars were instrumented to size #40 k file. Nine teeth served as the control group and the remaining teeth were assigned into two groups. Group 1-Ca(OH) ₂ was placed in the dried pulp chamber, while root canals remained wet with normal saline; group 2-Ca(OH) ₂ was placed in dried root canals. In control group, canals remained wet without medication. Each group was divided into 3 sub-groups of 15 teeth in which pH and calcium concentration were measured in three intervals of 2 days, 1 week, and 2 weeks by pH meter and atomic absorption spectrometer system, respectively. Findings were assessed using Kruskal-Wallis and t-test. Results: At 1 and 2 weeks, the calcium concentration had increased without being significantly different from Ca(OH) ₂ placed either in the root canal or in the pulp chamber. Ca(OH) ₂ placed in the pulp chamber or root canal provided similar pH values (P=0.362). Conclusions: Placing Ca(OH) ₂ in pulp chamber is as effective as placing it in the root canal.

Background: Bonding brackets to fluorosed enamel remains a clinical challenge and bracket failure at the compromised enamel interface is common. Objective: To check the effect of air abrasion on the retention of metallic brackets bonded to fluorosed enamel surface. Materials and Methods: Sixty freshly extracted human premolar teeth having moderate to severe dental fluorosis as per Dean's criteria were collected and divided into three groups of 20 each. The groups were treated as follows: In group I, acid etching was followed by bonding with Transbond XT^® ; in group II, sandblasting and acid etching was followed by bonding with Transbond XT^® ; and in group III, sandblasting and acid etching was followed by bonding with Enlight LC^® . An Instron™ universal testing machine was used for determining the debonding force, and from this the shear bond strength was computed. The sample with highest shear bond strength from each group was selected for the scanning electron microscopy (SEM) study. The prepared specimens were examined under a JSM-840A scanning electron microscope (JEOL Ltd, Tokyo, Japan) operated at 20 kV. Photographs were taken at progressively higher magnifications of ×50, ×100, ×500, and ×1000 to view the enamel surface and the adhesive remaining on the enamel surface after debonding. The shear bond strengths of the groups were compared using the one-way ANOVA (analysis of variance) and Tukey post hoc test. The distribution of adhesive remnant index (ARI) score was compared using the Chi-square test. Results: The mean shear bond strength in group I was 10.36 MPa, with a standard deviation of 0.225. The corresponding values in group II and group III were 11.41±0.237 MPa and 11.39±0.201 Mpa, respectively. There was a statistically significant difference between the three groups in the mean shear bond strength values. Conclusion: Sandblasting followed by acid etching provides significantly higher bond strength values compared to acid etching alone, irrespective of the bonding material employed.

Introduction: Tooth eruption, recognized as an aspect of human growth and development, could possibly be influenced by a number of factors. It may reflect the general body development. Aim: The aim of the present research is to investigate the relationship of deciduous teeth emergence with physical growth (weight/height indices). Materials and Methods: A study was conducted among a sample of 1132 Egyptian infants whose ages range from 4 to 36 months. The sample was collected from some randomly selected health centers affiliated to the ministry of health where various socioeconomic strata from different geographic localities were recruited. The children visit there regularly for vaccination at definite ages. Weight and height were evaluated as factors that might have influence on the time of deciduous teeth emergence. Results: The results showed a certain degree of correlation between the number of deciduous teeth emerged and the studied anthropometric measurements which differed by sex and age. Conclusion: All anthropometric parameters showed relationship with the number of teeth at different levels. Although weight showed influence on the number of teeth emerged, it was less significant than height.

Background: Full-coverage porcelain fused to metal crowns is commonly recommended for restoration of extensively damaged teeth. Ability of the dentist to adequately prepare teeth is fundamental to success and longevity of these restorations. Aims: This study was designed to compare recommended convergence angle and taper values of tooth preparation with clinically practiced values and to assess the factors such as tooth position, operator experience, vitality, and restorative status on convergence angle of prepared teeth. Setting and Design: It was a descriptive, cross-sectional study design and held at The Aga Khan University Hospital, Dental Section, for a period of 1 year. Materials and Methods: A minimum of 197 crown preparation models of molar and premolar teeth prepared by residents and specialists were collected in order to achieve the objectives of the study on the basis of convenient sampling technique. Statistical Analysis: One sample t-test used to compare the mean practiced convergence angle values with its recommended values. Independent sample t-test and one-way ANOVA was used to see difference in the convergence angle values of the teeth prepared by different operators, tooth type, vitality status, and restorative status of teeth. Results: Mean reported convergence angle and axial wall taper values were 23.7°±8.9° and 11.3°±7.8°, respectively, which is significantly greater (P<0.001) than the recommended values. Convergence angle values were greater for molars as compared to premolars. Conclusion: There was a considerable disparity between the convergent angles values recorded in this study and the recommended guidelines and are affected by tooth type, vitality, and restorative status of tooth.

Objective : The purpose of this in vitro study was to evaluate the effect of different techniques of surface preparation on the microleakage of a sealant applied with traditional acid etching and self-etched bonding agent. Study Design : A total of 60 extracted third molars were randomly assigned into six groups (n = 10/each). The occlusal surfaces were sealed with a sealant (Clinpro) after one of the following pretreatments: (1) phosphoric acid etching; (2) Prompt L-Pop; (3) laser + etching; (4) laser + Prompt L-Pop; (5) air abrasion + etching; (6) air abrasion + Prompt L-Pop. The specimens were immersed in a 0.5% basic fuchsin solution. Buccolingual cuts parallel to the long axis of the tooth were made. The surfaces were scored 0--2 for extent of microleakage using a microscope and the data were analyzed statistically. Results : The poorest results were obtained with laser + Prompt L-Pop which showed a greater number of specimens with microleakage (80%). Air abrasion surface preparation + phosphoric acid etching showed less microleakage than the other groups (40%). Kruskal--Wallis and t-tests revealed no significant difference in microleakage between six groups. Conclusion : The self-etching adhesive studied seems an attractive alternative to the acid-etch technique for sealant application in young children where simplifications in the clinical procedure are warranted. No significant difference was noted between the different types of enamel preparation before fissure sealant.

Background: Nucleolar organizer regions (NOR) are associated with proliferative activity and represent a diagnostic and prognostic marker. Materials and Methods: Smears were taken from smokers, tobacco chewers, oral squamous cell carcinoma patients, and normal subjects and evaluated by 2 silver-staining nucleolar organizer region (AgNOR) counting methods: (1) mean number of AgNORs per nucleus (mAgNOR); and (2) percentage of nuclei with >3 and >5 AgNORs (pAgNOR). Results: A statistically significant difference was observed between normal subjects, smokers, tobacco chewers, and oral cancer patients and between tobacco chewers with and without lesion. No significant difference was observed between tobacco chewers and smokers except in the percentage of >5 criteria. Conclusions: AgNOR enumeration using noninvasive methods, such as the cytobrush appears to be useful technique in distinguishing between normal mucosa, mucosa with and without lesions exposed to carcinogens, such as tobacco and frank oral carcinoma.

The success of dental implants has long been established through various studies with a particular emphasis laid on an implant design. Crest module is that portion of a two-piece metal dental implant, designed to hold the prosthetic components in place and to create a transition zone to the load bearing implant body. Its design, position in relation to the alveolar crest, and an abutment implant interface makes us believe that, it has a major role in integration to both hard and soft tissues. Unfortunately, in most clinical conditions, early tissue breakdown leading to soft tissue and hard tissue loss begins at this region. Early crestal bone loss is usually highest during the first year after placement ranging from 0.9 to 1.6mm and averaged 0.05-0.13mm in the subsequent years ^. Various hypotheses have been stated to reason it however, none has been proved convincingly. In light of this, various attempts have been made to overcome this undesirable bone loss, by varying an implant design, the position, surgical protocol, and the prosthetic options. Irrespective of an implant system and designs that are used, crestal bone loss of up to the first thread is often observed. The purpose of this review is to look into the various designs and treatment modalities, which have been introduced into the crest module of an implant body to achieve the best biomechanical and esthetic result.

Hypoglossia is a rare entity which is reported sporadically. Hypoglossia has often occurred in an association with limb anomalies and, therefore, these cases have been grouped together as hypoglossia-hypodactylia within oromandibular limb hypogenesis syndromes. The literature on this condition is reviewed, and a case of hypoglossia has also been presented. An investigative protocol to aid in the treatment planning of a patient with hypoglossia has also been suggested.

Angiolymphoid hyperplasia with an eosinophilia (ALHE) is a rare benign entity whose etiology and pathogenesis is under debate. Clinically, it is characterised by cutaneous papules or nodules on the head and neck. Literature reveals very few cases of this entity in the oral mucosa. Here, we report a case of ALHE in a 25 year-old woman, who presented with a painless, 5mm x 5mm, sub mucosal erythematous nodule on left angle of mouth at lower lip. Histological examination of lip biopsy specimens revealed an increase in small vessels. The vascular walls consist of prominent endothelial cells with a histiocytoid appearance, which protruded into the lumen. Many eosinophils and lymphocytes were also seen around the vessels. The diagnosis of ALHE was made from the above findings.

The anterolateral thigh flap is a highly versatile and reliable flap for use in the reconstruction of various soft-tissue defects of the head and neck. This flap has gained great popularity due to its versatility, ability for a two-team approach, and minimal donor site morbidity. However, it has not met the same enthusiasm in the armamentarium of Maxillofacial Surgeons due to its relative difficulty in perforator dissection, reported variations of the vascular anatomy, and the presumed increased thickness of the anterolateral thigh tissue. These obstacles may be overcome by increased surgical experience and by the ability to create a thinner suprafacial flap or thinning the flap after it has been obtained. We have described the versatility of this flap for the reconstruction of the through and through defect of cheek following cancer ablation along with difficulties in raising flap.

Acrylic resin denture teeth often exhibit rapid occlusal wear, which may lead to decrease in the chewing efficiency, loss of vertical dimension of occlusion, denture instability, temporomandibular joint disturbances, etc. There are various treatment options available like, use of highly cross linked acrylic teeth, amalgam or metal inserts on occlusal surface, use of composite, gold or metal occlusal surface, etc. Several articles have described methods to construct gold and metal occlusal surfaces, however, these methods are time-consuming, expensive and requires many cumbersome steps. These methods also requires the patient to be without the prosthesis for the time during which the laboratory procedures are performed. This article presents a quick, simple and relatively inexpensive procedure for construction of metal occlusal surfaces on complete dentures.

A 42-year-old man who had been having otalgia and facial and neck pain for 6 months presented for a routine dental examination. He had suffered two head traumas, the first 20 years ago and the second 4 years ago. A panoramic radiograph (PR) was taken as a screening film after the clinical examination. Bilateral styloid process elongation (SPE) was detected, and the patient was diagnosed as having Eagle syndrome. The styloid process (SP) length was 78 mm on the right and 74 mm on the left on multislice computed tomography (MSCT). Bone scan of the cranium showed normal uptake of radiotracer in the cranial bones and some little activity was detected as a silhouette in the localization of SPE in planar and SPECT images. To the best of our knowledge, this is the first case investigating SPE by bone scintigraphy in a patient with Eagle syndrome.

A case of peripheral squamous odontogenic tumor is described in a 60-year-old female who presented with a sessile growth in the right posterior mandible. Radiographic examination revealed no evidence of a central lesion in bone. With the characteristic histopathological picture of benign-appearing islands of squamous epithelium scattered randomly against a background of mature fibrous connective tissue, the tumor was diagnosed as peripheral squamous odontogenic tumor (PSOT). The epithelial islands showed peripheral cuboidal or flattened cells, microcyst formation, individual cell keratinization, and keratin pearl formation.

The traditional technique for correcting class II malocclusion - involving the use of class II elastics and headgear - has been problematic due to its dependence on patient compliance. Functional orthopedic treatment seeks to correct malocclusions and harmonize the shape of the dental arch and orofacial functions. Removable functional appliances are normally very large in size, have unstable fixation, cause discomfort, exert pressure on the mucosa, reduce space for the tongue, cause difficulties in deglutition and speech, and very often affect esthetic appearance. With a fixed appliance like the Forsus™ fatigue-resistant device (FRD), as the appliance is fixed, there is less dependence on patient compliance and the remaining growth after the pubertal growth spurt can be harbored effectively. The Forsus™ FRD is not as rigid as the previous fixed functional appliances and hence is comfortable for the patients. In this case report we describe a patient at the end of the growth stage who had mandibular retrognathia and was successfully treated with the Forsus™ FRD.

Oral health is fundamental to general health and well being. Schools can provide a supportive environment for promoting oral health. School policies and education on health-related matters are imperative for the attainment of good oral health and control of related risk behaviors. Aim: This study was conducted to assess oral health-related knowledge, attitude, and practices among 12-year-old schoolchildren studying in rural areas of Panchkula, India. The ultimate goal was to implement an oral health-promotion program in this area. Materials and Methods: A total of 440 children (216 males and 224 females) from 12 schools were included in this study. All the participants were requested to complete a 13-question closed-ended questionnaire. The statistical significance of any difference between the two genders was determined using the Chi-square test. Results: Only 25% of the participants said that they cleaned their teeth more than once in a day. Thirty-two percent did not clean their teeth daily. Over the preceding 1 year, 45.5% of the childern had had some problem with their teeth and/or gums, but only 35.9% visited the dentist. Among these children, 8.2% used tobacco in some form. Oral health-related knowledge of girls was significantly better than that of boys. Conclusion: Based upon the findings of the present study, the knowledge, attitude, and practices of the surveyed children with regard to oral health is poor. Hence, there is a need for regular oral health education of the children, as well as their parents and school teachers.

Background: A sustained program of research is an integral part of human-kind's efforts to improve oral health. In addition, dental research is a vital part of the development of a strong and prosperous dental education system and has been one of the three pillars of the higher education sector (Research, Education and Service) for a very long time. Aim: This study aims to examine the last 30 years of peer review published dental literature in both, Australia and India, and to define the trends in publication over that time. Materials and Methods: This study used the Pubmed database using a set of core dental words for the years 1980 to 2009. Detailed analysis of the year-by-year rates of publication was done using Microsoft Excel. Results: India is on a near exponential upward growth while Australia through the latter half of the last decade has been more stable in output. State-wise breakdown in both countries shows that the proportions are more consistent for Australia, but for India, a major number of publications can be traced to three states. Conclusion: It is expected that dental research in Australia will grow in the coming decade as the new dental schools embed their educational programs and mature to develop strong research profiles. However, India is becoming a significant force in the published peer review dental research literature, and is growing at a very rapid rate.

Objective: This study was conducted to evaluate by clinical and microbiological parameters the effect of subgingival irrigation with propolis extract. Materials and Methods: Twenty patients diagnosed with chronic periodontitis, each presenting three non-adjacent teeth with deep pockets, were selected. Subgingival plaque sampling and clinical recording (at baseline) and scaling and root planing was performed. Two weeks later the selected periodontal sites were submitted to one of the following treatments: Irrigation with a hydroalcoholic solution of propolis extract twice a week for 2 weeks (group A); irrigation with a placebo twice a week for 2 weeks (group B); or no additional treatment (group C). Clinical and microbiological data was collected at baseline and after 4, 6, and 8 weeks. Results: A decrease in the total viable counts of anaerobic bacteria (P=.007), an increase in the proportion of sites with low levels (≤10 ⁵ cfu/mL) of Porphyromonas gingivalis (P=.044), and an increase in the number of sites negative for bleeding on probing was observed in group A sites as compared to group B and C sites. Conclusion: Subgingival irrigation with propolis extract as an adjuvant to periodontal treatment was more effective than scaling and root planing as assessed by clinical and microbiological parameters.

Introduction : Patients' perceptions and expectations regarding their appearance play a significant role in treatment planning. The purpose of this study was to compare the perceptions of orthodontists, general dentists, and laypersons regarding smile esthetics after symmetrical and asymmetrical alterations in anterior teeth and their supporting tissues. Materials and Methods: Alterations were made in the crown length, crown width, midline diastema, and gingiva-to-lip relationship of the maxillary anterior teeth in the close-up photograph of a woman's smile. The attractiveness of the smile in the original image and in each of the modified images were assessed by orthodontists (n=40), dentists (n=40), and laypersons (n=40) and scored using a visual analog scale (VAS). The mean VAS scores were calculated for each photograph. ANOVA was used for comparisons between photographs and between groups. To determine threshold levels at which each group discriminated between esthetic and less esthetic dental features were determined by one-way ANOVA (F-test) followed by Newman-Keul's range test. Results : Orthodontists were found to be more critical when evaluating smile images compared to general dentists and laypersons. Symmetrical or asymmetrical alterations in the mesio-distal width of the lateral incisor of up to 2 mm was not perceived as unesthetic by general dentists and laypersons. Conclusion: Laypersons are more accepting of minor variations in anterior tooth size and alignment than orthodontists.

Purpose: To assess the clinical efficacy of a combination of oral midazolam plus low-dose ketamine for reducing anxiety during surgery and in preventing postoperative pain and swelling after the surgical extraction of third molars. Materials and Methods: Thirty patients requiring bilateral surgical extraction of mandibular third molars were included in this study. Prior to extraction of the tooth on the right side, a combination of oral midazolam and low-dose ketamine was given to the patient, while this protocol was not followed for extraction of the tooth on the left side. Anxiety levels were checked before surgery. The postoperative pain and swelling and patient's comfort with and without the premedication were compared. Results: Facial swelling on the postoperative days was lower on the right side than on the left. Pain scores at 30 minutes and 24 hours after surgery were significantly higher on the left side. Also, anxiety during the surgery was less and comfort levels were higher postoperatively when the combination of oral midazolam plus low-dose ketamine was used. Conclusions: Premedication with midazolam plus low-dose ketamine prior to surgical extraction of third molars can provide the patient with a comfortable procedure and good postoperative analgesia, with less swelling and significantly less pain.

Objective: To determine the effect of delayed light polymerization of a dual-cured composite base material on the marginal adaptation of class II composite restoration. Materials and Methods: 35 extracted human molar teeth were used to prepare class II mesio-occlusal or disto-occlusal slot preparations with gingival margins at the CEJ. The teeth were restored using an open-sandwich technique with a 2mm base increment of dual-cured composite, and divided into 5 groups based on the mode of the polymerization of the dual-cured composite base: Group A - self-cured after placement (5 mins), Group B - light-cured immediately after placement, Group C - light-cured 30 seconds after placement, Group D - light-cured 60 seconds after placement, Group E - light-cured 120 seconds after placement. Then a top layer of a light-cured composite resin is placed to complete the restoration. The teeth were thermocycled and immersed in 1% aqueous solution of methylene blue for 24 hours. Sectioning of the teeth and scoring under stereomicroscope was done. Data will be statistically evaluated using the kruskal wallis 1-way ANOVA. Results: Statistical analysis using kruskal wallis 1-way ANOVA showed that the dual-cured composite light polymerized 1 minute after placement exhibited the least microleakage. Conclusion: Delayed light polymerization of the dual-cured composite base reduced the microleakage in class II open-sandwich restorations.

Purpose: To present results of a survey on the status of an implantology amongst implant-practicing dentist across the world in 2009. Materials and Methods: A questionnaire was sent to the members of EAO (European Association of Osseointegration), ICOI (International Congress of Osseointegrated Implants), ISOI (Indian Society of Oral Implantologists), Asian Academy of Osseointegration (AAO), Deutsche Gasellschaft Fur Orale Implantologie (DGOI), Philippines Implant Organization, Korean Society of Oral Implantologist, Japanese Association of OralIimplantologists, Chinese Dental Association, Pakistan Dental Association, asking for the personal (anonymous) background data and their implantology concepts. Specific questions dealt with level of recognition of implants, use of implants, superstructures, techniques followed, and materials used. Results: A total of 1500 (63.6%) of the 2358 questionnaires were answered. Dental implants were the most preferred treatment modality for restoring the missing teeth. Threaded implants were the most preferred. Cement retained implant prosthesis was the most preferred restoration procedure. Dentists believe that the general dentist should practice dental implant treatment modality, preferably teamwork. Immediate loading was the much-accepted concept among the dentists of the developed nations. Conclusion: Dental implants were much accepted treatment modality for the replacement of missing teeth. Most the dentists follow the well documented technique and proven materials, which have been documented in the literature, an evidenced based practice, thus, delivering the best to their patients. Dentists from the developing nations agreed to have standardization in implants.

Cryosurgery is a therapeutical method that uses freezing to obtain a tissue inflammatory and/or a destructive response. It has been successfully used for many cutaneous conditions. Its use is increasing for several conditions in the oral cavity. The oral mucosa, because of its characteristics of humidity and smoothness, is an ideal site for this technique. It shows a very good esthetic result and it may be either the first choice or an alternative option to conventional surgery. This article strives to review the modus operandi of cryosurgical instruments, the various indications, limitations and advantages of cryosurgery in the treatment of oral lesions.

In dental practice, impacted third molar teeth are a common finding. The dentists usually remove them if they are associated with some radiographic finding suggestive of a cyst or a tumor or if they cause pain or resorption of the adjacent teeth. It has been found that, in many cases, even the radiographically and clinically asymptomatic impacted mandibular third molars are associated with some pathology. This paper brings into the light two cases with clinically and radiographically normal impacted third molar teeth associated with dentigerous cyst, thus highlighting that the radiographic appearance is not a reliable indicator of the absence or presence of pathology associated with the impacted third molars.

Oral bisphosphonates are routinely prescribed to post menopausal women. These have shown to increase the risk of osteonecrosis. However, this action may be augmented by local factors. A case report is presented showing an early implant failure in a patient taking oral bisphosphonates. Two implants were placed in left maxillary incisor area. Central incisor was associated with a previous endodontic failure and extraction. Lateral incisor was avulsed 3 years back. After 4 weeks of an implant placement, necrotic bone was evident along with the failing implant in central incisor area. This case report emphasizes on the incidence and an increased risk of implant failure in patients taking oral bisphosphonates.