Background: Diabetes mellitus (DM) is an endocrine disease characterized by hyperglycemia, the pathogenic mechanisms by which hyperglycemia arises differ widely. Monitoring people with diabetes involve repeated estimations of plasma glucose either by finger pricks or by intravenous blood sampling. Hence, a noninvasive procedure for glucose measurements would be most precious under the circumstances. Aims: (1) To evaluate salivary glucose, total protein and albumin in type 1 DM (T1DM) patients and to compare with healthy nondiabetic control group. (2) To compare and correlate serum and salivary glucose levels in patients with T1DM. Study Design: This study consisted of 30 T1DM patients and 30 controls. All subjects were subjected to the serum glucose, salivary glucose, and total protein and albumin estimations. Materials and Methods: Glucose estimations were done by glucose oxidase-peroxidase method, total protein estimations were done by Biuret method, end point and albumin estimations were done by bromocresol green dye method, end point. All the estimations were performed using an autoanalyzer. Statistical Analysis: Mean and standard deviation, Student's t-test and Karl Pearson correlation co-efficient were calculated. All these statistical analyses were performed by using SPSS 11.5 software. Results: The results showed elevated levels of salivary glucose, total protein and albumin in T1DM group compared to healthy controls. Further the levels of serum and salivary glucose in T1DM patients were significantly correlated. Conclusion: There are definite changes in salivary composition with increased levels of salivary glucose, total protein and albumin in T1DM patients compared with healthy controls. Salivary glucose could be used for monitoring of DM.

Background and Aim: Teeth are excellent material for anthropological, genetic and odontologic investigations in both living and dead population. Canines are the ideal teeth for identification of sex, due to its sexual dimorphism and durability in the oral cavity. This study tests the effectiveness of the canine tooth in predicting sex of an individual. Materials and Methods: This study involved 60 males and 60 females between the age group of 20-30 years. Mesio-distal (MD) widths of maxillary and mandibular right and left canines and inter-canine distance of both arches were measured clinically and on cast for all patients. Standard canine indices were derived from these dimensions and tested for sexual dimorphism and reliability of canine teeth in gender determination by comparison with the known gender of the population under investigation. Results: All measurements showed significant sexual dimorphism. Standard mandibular canine index (CI) was found to be more reliable in gender estimation than the MD width of canine and CI values. Interpretation and Conclusion: Use of the standard mandibular CI in gender determination is recommended for forensic procedures as it was found to have an acceptable accuracy. MD width of canine may be used in a setup when only the single tooth or a fragment of a jaw is available for analysis, with due consideration to its relatively low accuracy.

Background: In recent years, evidence has come forth supporting the notion that localized infectious diseases such as periodontal disease may indeed influence a number of systemic diseases. Erectile dysfunction (ED) and chronic periodontitis have common risk factors such as diabetes mellitus, cardiac diseases and smoking etc. Aim: The aim was to evaluate the periodontal status of the subjects suffering from ED and to find association between vasculogenic ED and chronic periodontitis, if any. Study Design: A total of 53 subjects suffering from vasculogenic ED were enrolled for the study and were divided into three groups on the basis of severity of ED. Materials and Methods: The clinical (probing pocket depth) and radiographic parameters (alveolar bone loss) were recorded and periodontal status of three groups was evaluated, compared and an attempt was made to find an association between ED and chronic periodontitis. Karl Pearson's correlation was used to assess an association between the two conditions. Statistical Analysis: One-way ANOVA and Scheffe's test were used to find the significant difference of chronic periodontitis with severity of ED. Karl Pearson's correlation was used to find an association between chronic periodontitis and ED. Results: Statistically significant mean differences of 1.73 mm, 0.56 mm and 1.17 mm were recorded when comparison was made among Group I and III, Group I and II and Group II and III, respectively. Mean differences in bone loss among three groups were also statistically significant. Both the diseases were positively correlated to each other. Conclusion: It may be concluded that chronic periodontitis and ED are associated with each other. However, further large scale studies with confounder analysis and longitudinal follow-up are warranted to explore the link between these two diseases.

Context: Although, incidence of complete edentulism has decreased, partial edentulism is still prevalent in the country. This study aims to establish a relationship between socio-demographic variables, etiological factors, and partial edentulism. It also evaluates the prevalence of different classes of partial edentulism according to Kennedy's classification. Materials and Methods: An institution-based, cross-sectional study was conducted on a randomly selected population in the state of Goa, India. The study group included patients who attended the Outpatient Department (OPD) of Prosthodontics during September to October, 2009. Data were acquired based on a pre-formed pro-forma (inclusive of a structured questionnaire and clinical examination) and was statistically analysed using the chi-square test. Results: A total of 423 participants were enrolled for this study. Three hundred and twenty-two individuals were partially edentulous indicating a prevalence rate of 76.12%. 54.97% were females. The peak was recorded in the age group of 24-34 years, 51.24% were un-employed, 54.97% belonged to the medium income group, 58.07% resided in urban areas, 48.45% belonged to the basic educational group and 54.35% had a fair oral hygiene status. Kennedy's class III group (50.30%) was the most frequent type of partial edentulism. An association between the aforementioned characteristics and partial edentulism was recorded with a statistically significant association between partial edentulism and two characteristics, namely monthly family income and education. Conclusion: Partial edentulism is dependent on a combination of socio-demographic factors and the present study reveals a high prevalence rate of partial edentulism in the studied population.

Background: In general, people speak and swallow frequently in their daily lives rather than making exaggerated tongue movements. Aim: The aim was to compare the effect of tongue movements on lingual sulcus depth, during the border molding process of impression making of mandibular complete dentures. Settings and Design: In total, 32 double master impressions were made. One of these pairs was obtained by allowing the patient to swallow and the other by enabling the tongue to make excessive movements. Materials and Methods: Measurements were taken from different regions of the lingual sulcus by determining the length of the parallel lines drawn from fixed points marked on the residual ridge crest to the deepest point of the alveolingual sulcus. These measurements were performed using a RMI three-dimensional measurement system. Statistical Analysis Used: Data were compared using the paired t-test (alpha = 0.05). Results and Conclusion: The high value found in casts with border molding, while swallowing was statistically significant in vertical and horizontal directions of the anterior lingual sulcus region (<0.001), vertical direction of the middle lingual sulcus region (MLSR) (<0.05) and horizontal direction of the retromylohyoid and MLSR (<0.05). According to the paired t-test, the mean differences between the 32 casts were statistically significant (<0.001). Within the limitations of this study, the swallowing in the vertical and horizontal directions provided higher values compared to the excessive movement of the tongue.

Background: Patient wanted to restore her lost teeth with implants in the lower left first molar and second premolar region. Cone beam computerized tomography (CBCT) revealed inadequate bone width and height around future implant sites. The extraction socket of second premolar area revealed inadequate socket healing with sparse bone fill after 4 months of extraction. Aim: To evaluate the clinical feasibility of using a collagen physical resorbable barrier made of human pericardium (HP) to augment localized alveolar ridge defects for the subsequent placement of dental implants. Materials and Methods: Ridge augmentation was done in the compromised area using Puros^® demineralized bone matrix (DBM) Putty with chips and an HP allograft membrane. Horizontal (width) and vertical hard tissue measurements with CBCT were recorded on the day of ridge augmentation surgery, 4 month and 7 months follow-up. Intra oral periapical taken 1 year after implant installation showed minimal crestal bone loss. Results: Bone volume achieved through guided bone regeneration was a gain of 4.8 mm horizontally (width) and 6.8 mm vertically in the deficient ridge within a period of 7 months following the procedure. Conclusion and Clinical Implications: The results suggested that HP Allograft membrane may be a suitable component for augmentation of localized alveolar ridge defects in conjunction with DBM with bone chips.

Background: Smile is the defining element of the face, its impact holding utmost importance in the perception of feelings. Lip is an integral part for a perfectly perceived smile. The aim of the present manuscript is to present an innovative approach to smile improvement by lip design in Indian context. Materials and Methods: Thirty-five patients who had undergone smile design (lip) in the institute were taken up for retrospective analysis. The technique of using fillers for lip augmentation was assessed, and the final result evaluated. Results: Demographic details are presented . We observed that the upliftment of the lips was more visible, and the fillers enhanced the volume resulting in an attractive smile. Conclusion: Smile reconstruction has been revolutionized by the new filler materials for volume augmentation of lips. We advocate this novel approach of lip design using fillers to generate a gorgeous smile.

Introduction: Research is important in medical and dental sciences to improve healthcare. Faculties play an important role in research productivity and student motivation in research. Aim: The aim of this paper was to assess the attitude and experiences of dental post-graduate teachers toward article writing and reading and to discuss the barriers faced by them. Materials and Methods: A total of 150 dental post-graduate teachers from various Dental Colleges in South India participated as the study group. A questionnaire relating to publishing practices was distributed, and the results were analyzed. Result: Majority of the study group (82%) were involved in the publication with many (48.4%) doing so for career progression. Journal prestige was the main reason for selection of journals. Lack of time was the main reason for those not involved in the publication. Conclusion: This study revealed the positive attitude of teachers toward scientific reading and writing. They only require motivation and time.

Context: To improve the flexural strength of polymethylmethacrylate (PMMA). Aim: To evaluate whether the incorporation of titanium dioxide nanoparticles in polymethylmethacrylate (PMMA) increases the flexural strength and to compare the different concentrations of titanium dioxide nanoparticles and its relation to flexural strength. Settings and Design: Study was conducted in Sri Ramachandra University utilizing 40 specimens manufactured from clear heat polymerizing acrylic resin. Materials and Methods: Forty specimens of clear heat polymerizing acrylic resin of dimensions 65 Χ 10 Χ 3 mm as per ISO 1,567 standardization were fabricated and were grouped into A (CONTROL) with no titanium dioxide (TiO2) nanoparticles, B with 0.5 gms of TiO ₂ nanoparticles, C with 1 gm of TiO ₂ nanoparticles and D with 2.5 gms of TiO ₂ nanoparticles added.The concentrations of titanium dioxide in each group were 1 wt%, 2 wt% and 5 wt%. Universal testing machine INSTRON was used to load at the center of the specimen with a cross head speed of 1.50 mm/min and a span length of 40.00 mm. Statistical Analysis Used: ANOVA and multiple comparisons are carried out using the independent t-test. Results: The ANOVA result shows that there is a significant difference between the groups with respect to the mean flexural strength. Highest mean flexural strength is observed in Group D, while the lowest is seen in Group A. Independent t-test revealed that there was a statistical significance between Group A and Group D (0.041) and between Group B and Group D (0.028). Conclusions: The results concluded that polymethylmethacrylate reinforced with different concentrations of titanium dioxide nanoparticles showed superior flexural strength than those of normal PMMA.

Aim: The aim of this study was to evaluate the effectiveness of dentifrices containing high concentrations of sodium fluoride (NaF) and casein phosphopeptide-amorphous calcium phosphate cream plus fluoride (CPP-ACPF) in prevention of the erosion in a simulated oral environment study model. Subjects and Methods: Fifteen flat human enamel specimens were polished and half of the surfaces were protected with adhesive tape. Initial Knoop microhardness (KHN) and surface roughness (SR) were measured, and specimens were assigned to four groups: Control (placebo toothpaste - G1); CPP-ACPF (G2), NaF 1450 ppm (G3), and NaF 5000 ppm (G4). Enamel surfaces were brushed 3 times daily in association with demineralization-remineralization cycles (5s in cola drink + 5s in artificial saliva/10 cycles/twice daily) and the specimens were maintained in a salivary flow simulator apparatus. After 14 days, KHN and SR were measured again, and the enamel surfaces were analyzed by scanning electronic microscopy (SEM). Statistical Analysis Used: Data were analyzed using the two-way ANOVA and Student-Newman-Keuls multiple range test (α =0.05). Results: All the tested groups presented a decrease in KHN after 14 days (P < 0.05). There was no statistical significance among materials tested. Significant increase in SR was observed for all groups. SEM analysis showed morphological alterations with honeycomb structures in enamel surfaces in the four experimental groups. Conclusions: It was concluded that tooth brushing with dentifrices with high concentration of NaF and CPP-ACPF cream was not able to prevent enamel erosion in simulated oral environment.

Context: Bonding procedures are time consuming and debonding of brackets is a common problem encountered in orthodontics. Aims: The purpose of this in vitro study was to evaluate the shear bond strength (SBS) with different enamel pretreatment (acid etching, air abrasion, and bur abrasion) to enhance the bonding performance. Subjects and Methods: A total of 60 extracted premolars for orthodontic purposes were randomly assigned to three groups based on conditioning method: Group I - conventional etching with 37% phosphoric acid; Group II - air abrasion with 50 μm aluminum oxide; and Group III - bur abrasion with diamond fissure (#330, MANI, Dia-Burs, New Jersey, USA). After storing the specimens for 24 h in distilled water at 37°C, SBS was measured with Universal testing machine (Lloyd Universal testing machine-Model No. L.R 100K, UK). The shear force at a crosshead speed of 1 mm/min was transmitted to brackets. The adhesive remnant index (ARIs) scores were recorded after bracket failure. Statistical Analysis Used: Descriptive statistics, multiple comparisons of the SBS of different groups, were performed by analysis of variance. The Tukey's test was used to evaluate differences in ARI scores between groups. All statistical evaluations were calculated using the Statistical Package for Social Sciences Windows, release 10.0.0 (SPSS Inc., Chicago, Illinois, USA). Results: The analysis of SBS variance (P < 0.01) and Chi-square test of ARIs scores (P < 0.01) revealed significant differences among three groups tested. The SBS in Group I (mean: 8.822 ± 0.92 MPa) and Group III (mean: 6.015 ± 0.87 MPa) was significantly higher than Group II (mean: 3.824 ± 0.57 MPa). The ARI was used to evaluate the residual adhesive on the enamel after bracket removal. The Tukey's test was used to evaluate differences in the ARI scores among the groups. Conclusions: The current findings indicate that enamel surface preparation using bur abrasion results in a significant higher than air abrasion; within the limitations of this study recommend bur abrasion as a viable alternative to acid etching.

Background: Streptococcus mutans is one of the most important cariogenic species of the human oral microbial flora. Biofilm style of microbial growth thought to resist the actions of antimicrobials. Aim: The purpose of this study was to evaluate the antimicrobial efficacy of Triphala, and 0.2% chlorhexidine against S. mutans biofilm formed on tooth substrate. Settings and Design: Randomized control trial. Methods: Extracted human mandibular premolars sectioned below the cemento-enamel junction were placed in the tissue culture wells exposing the crown surface to S. mutans to form a biofilm. At the end of 3 ^rd and 7 ^th day, all groups were treated for 10 min with the test solutions and control and were analyzed qualitatively and quantitatively. Statistical Analysis Used: One-way ANOVA. Results: Qualitative assay with 3 days biofilm showed complete inhibition of bacterial growth with Triphala, but 0.2% chlorhexidine and saline showed the presence of bacterial growth. In quantitative analysis, 0.2% chlorhexidine and Saline treated tooth samples have shown 1052 Χ 10 ⁴ ± 15.1 Χ 10 ⁴ CFU/ml, 141.3 Χ 10 ⁹ ± 2.1Χ10 ⁹ CFU/ml, respectively. Qualitative assay with 7 days biofilm on crown portion showed dense growth when treated with 0.2% chlorhexidine and saline, whereas Triphala has shown minimal growth. In Quantitative analysis, Triphala showed statistically significant result when compared with 0.2% chlorhexidine and saline. Conclusion: Triphala showed statistically significant antibacterial activity against S. mutans biofilm formed on tooth substrate. The incorporation of Triphala in mouth rinse could prove to be effective in reducing S. mutans count in the oral cavity.

Introduction: Morphological deviations of the cervical vertebral column have been described in relation to craniofacial aberrations and syndromes. Furthermore, it has recently been shown that abnormal morphology of upper cervical vertebrae is associated with malformation of the jaws and occlusion. Accordingly, it is relevant to focus on similar associations in patients with skeletal malocclusions. Therefore, the objectives of this study are to:

1. Identify the anomalies of the cervical column in patients with skeletal malocclusions
2. Determine the association between cervical vertebral anomalies and skeletal malocclusions.

Materials and Methods: This cross-sectional study was conducted on a total of 90 subjects at the Aga Khan University Hospital, Pakistan. The inclusion criteria were: (1) Pakistani origin; (2) standardized pretreatment profile radiograph with first six cervical vertebrae visible; and (3) accessibility of the second-profile radiograph (mid- or posttreatment). The exclusion criteria were: (1) A prior history of orthodontic treatment; (2) any craniofacial anomaly; and (3) systemic muscle or joint disorder. Lateral cephalograms of all subjects (n = 90) were traced by the principal investigator and sagittal jaw relationship was assessed. A total of 30 subjects each with skeletal Class I, Class II, and Class III malocclusions were selected and the cervical vertebral anomalies were observed on their cephalometric radiographs. The frequencies of cervical vertebral anomalies according to skeletal malocclusion categories and gender were analyzed with the Chi-square test, whereas association of cervical vertebral anomalies with skeletal malocclusions was assessed with logistic regression analysis. The level of significance (P ≤ 0.05) was used for the statistical tests. Results: Most common anomaly observed in the three groups was fusion between C2 and C3 (P = 0.006). This anomaly was found in 20% of subjects with skeletal Class I, 50% of subjects with skeletal Class II and 53.3% with skeletal Class III malocclusions. The highest frequencies of partial cleft at the level of C1 and occipitalization were observed in subjects with skeletal Class II and III malocclusions, respectively. However, none of the subjects showed fusion between C1 and C2 or dehiscence. No statistically significant gender difference was found in the occurrence of morphological deviations of the cervical column. The association of cervical vertebral anomaly was found to be the highest with skeletal Class III and lowest with skeletal Class I malocclusions. Conclusion: Fusion between C2 and C3 seems to be the most commonly occurring anomaly. This anomaly seems to be more often associated with skeletal Class III than skeletal Class I or Class II malocclusions.

Background: Antimicrobial agents serve as an effective adjunct with mechanical means in plaque control. Chlorhexidine has been the gold standard in the field of dentistry, but these days a growing number of dentists are embracing the philosophy that natural agents are better for children's oral health, and the focus is shifted toward biogenic agents for oral hygiene maintenance in children. Aim: The aim was to evaluate antimicrobial and plaque inhibitory potential of herbal and probiotic rinses against Streptococcus viridans with commonly used antimicrobial agent like 0.2% chlorhexidine digluconate. Materials and Methods: A randomized clinical trial was conducted on 60 subjects aged between 6 and 14 years and were divided into three groups comprising 20 subjects in each group. Three oral rinses were administered twice daily for a period of 1 week. Estimation of plaque scores and S. viridans counts was done before and after intervention, and the results were statistically analyzed. Results: The change in mean plaque index in Groups A, B, and C was 0.28 ± 0.16, 1.37 ± 0.43, and 0.60 ± 0.35 respectively. Furthermore, change in mean log ₁₀ colony forming unit (CFU)/ml of S. viridans in Groups A, B, and C was 0.13 ± 0.06, 0.53 ± 0.17, and 0.22 ± 0.06 CFU/ml, respectively. Conclusion: Based on observations done during the course of study herbal rinse proved equally effective as 0.2% chlorhexidine digluconate in reducing S. viridans counts and plaque accumulation after 1 week of intervention, whereas probiotic rinse was least effective. However, long-term clinical trial with larger sample size needs to be undertaken, especially to evaluate beneficial effects of biogenic agents such as herbal and probiotic rinses.

Objectives: The purpose of this study was to evaluate the surface micromorphological changes of conventional glass ionomer cement (GIC) (Fuji II, GC Corporation, Tokyo, Japan) and high strength, high viscosity GIC (Fuji IX GP, GC Corporation) subjected to 1.23% acidulated phosphate fluoride (APF) gel for 4 min. It also evaluated the surface micromorphological changes that occurred in these materials when they were coated with a layer of glass ionomer varnish prior to the application of 1.23% APF gel. Materials and Methods: A total of 60 uniform glass ionomer cylinders were prepared (30 of each Fuji II and Fuji IX) and stored in distilled water for 48 h, following which they were divided into six groups depending on the surface treatment. Group 1: Fuji II alone, Group 2: Fuji IX alone, Group 3: Fuji II + 1.23% APF gel for 4 min, Group 4: Fuji IX + 1.23% APF gel for 4 min, Group 5: Fuji II + varnish + 1.23% APF gel for 4 min, and Group 6: Fuji IX + varnish + 1.23% APF gel for 4 min. After the required surface treatment had been done, the specimens were mounted, coated, and evaluated under scanning electron microscope. Statistical Analysis: Kruskal-Wallis test applied to compare the level of degradation among the groups subjected to treatment was highly significant (P < 0.001). Mann-Whitney test was applied to test the association between glass ionomer varnish and level of surface degradation and was also statistically significant (P = 0.001). Results: The results indicated that APF gel etched the surface of both Fuji II and Fuji IX. However, Fuji IX showed to possess better resistance to the erosive effect of APF than Fuji II. It was also observed that application of glass ionomer varnish prior to APF gel application protected the glass ionomer from the erosive effect of APF gel. Conclusion: APF gel caused erosive wear of the GICs esp. Fuji II. Hence, it is advisable to avoid the use of APF containing preparations for regular home use especially in children having glass ionomer restoration. If APF gel is indicated or preferred for professional application, it is recommended to apply glass ionomer varnish on the restored teeth prior to the APF gel application.

Context: Antioxidant properties and Vitamin C. Background: Vitamin C is a naturally occurring organic compound and a potent antioxidant preventing oxidative damage to lipids and other macromolecules. It can also exhibit bimodal activity as a pro-oxidant at a higher concentration. Vitamin C has a switch over role from being an antioxidant in physiologic conditions to a pro-oxidant under pathologic conditions. A systematic review of this role would help to elucidate whether it is an antioxidant or a pro-oxidant in the oral environment. Objective: To review studies reported in the literature elucidating the activity of Vitamin C and determine whether it is an antioxidant or a pro-oxidant. Materials and Methods: Articles were searched in PubMed, MEDLINE using appropriate key words like "Vitamin C," "antioxidant activity," "pro-oxidant activity," "oral health" "oral disease." Hand search of journals was also performed. Articles were reviewed and analyzed. Results: Search strategy reviewed 10 relevant articles which studied the dual role of Vitamin C. 65% of authors analyzed antioxidant action of ascorbic acid compared to 35% of the pro-oxidant potential. Vitamin C acts as an antioxidant and a pro-oxidant by a plethora of mechanisms. Factors determining its bimodal activity were studied, and the frequencies of their occurrence in the literature were depicted in percentage. Conclusion: The data validates the role of Vitamin C as an antioxidant under physiologic conditions exhibiting a cross over role as a pro-oxidant in pathological conditions. Further studies are required to substantiate its pro-oxidant activity to draw concrete conclusions.

Purpose: Decimated dentitions may require raising the vertical dimension in some conditions while performing a full mouth rehabilitation treatment. Increase in a vertical dimension should be diagnosed by reversible methods prior to performing any irreversible methods for a minimum time period. Reversible methods like splints and overlay dentures are often used for this purpose. These methods however cannot be used in some conditions like in cases of brittle teeth. Method: An alternative technique based on adhesive technology has been described which is reversible and yet minimally traumatic to teeth. Conclusions: The technique has two basic aims. The first is to accurately implement the occlusal scheme as planned in the diagnostic wax-up in the reversible method of altering the vertical dimension. The second aim is to increase the vertical dimension with minimal damage to the teeth.

The vital steps in any endodontic treatment are thorough mechanical shaping and chemical cleaning followed by obtaining a fluid tight impervious seal by an inert obturating material. For the past two decades, introduction and use of rotary nickel-titanium (Ni-Ti) files have changed our concepts of endodontic treatment from conventional to contemporary. They have reported good success rates, but still have many drawbacks. The Self-Adjusting File (SAF) introduces a new era in endodontics by performing the vital steps of shaping and cleaning simultaneously. The SAF is a hollow file in design that adapts itself three-dimensionally to the root canal and is a single file system, made up of Ni-Ti lattice. The case series presented in the paper report the clinical experience, while treating primary endodontic cases with the SAF system in India.

Aim: Endodontic management of open apex using Biodentine as an apical matrix. Summary : An immature tooth with pulpal necrosis and periapical pathology imposes a great difficulty to the endodontist. Endodontic treatment options for such teeth consist of conventional apexification procedure with and without apical barriers. Biodentine™ is new calcium silicate based cement that exhibits physical and chemical properties similar to those described for certain Portland cement derivatives. This article demonstrates the use of the newer material, Biodentine as an apical matrix barrier in root end apexification procedure. This case reports present apexification and successful healing with the use of Biodentine as an apical barrier matrix. Conclusion : Apexification in one step using an apical plug of Biodentine can be considered a predictable treatment and may be an alternative to mineral trioxide aggregate apexification.

Periapical surgery is required when periradicular pathosis associated with endodontically treated teeth cannot be resolved by nonsurgical root canal therapy (retreatment), or when retreatment was unsuccessful, not feasible or contraindicated. Endodontic failures can occur when irritants remain within the confines of the root canal, or when an extraradicular infection cannot be eradicated by orthograde root canal treatment. Foreign-body responses toward filling materials, toward cholesterol crystals or radicular cysts, might prevent complete periapical healing. We present here a case report wherein, combination of platelet-rich fibrin (PRF) and the hydroxyapatite graft was used to achieve faster healing of the large periapical lesion. Healing was observed within 8 months, which were confirmed by computed tomography, following improved bone density. PRF has many advantages over platelet-rich plasma. It provides a physiologic architecture that is very favorable to the healing process, which is obtained due to the slow polymerization process.

Background: Image superimposition is a part and parcel of two-dimensional radiography. However, some overlappings are a result of radiographic technique itself. The technique induced superimposition of zygomatic buttress on apices of maxillary molars is common in bisecting angle technique (BAT), which affects the endodontic performance. Certain alterations were carried out in BAT to remove these undiagnostic shadows. The aim of this study was to compare two techniques of periapical radiography namely, BAT and modified BAT (MBAT) in preventing zygomatic superimposition over apices of maxillary molars. Materials and Methods: A total of 62 patients requiring endodontic treatment for at least one maxillary molar were recruited in this cross-sectional study. One tooth from every patient was subjected for two periapical radiographs, one with each BAT and MBAT respectively giving a total of 124 radiographs. Each radiograph was recorded as acceptable or unacceptable, based on zygomatic superimposition and different technical aspects. Chi-square test was used for data analysis. The kappa statistic was used to test intra-observer reliability. Results: With MBAT, the acceptability was 82.3% (n = 51) compared with 43.5% (n = 27) when BAT was employed. The statistically significant difference was found between these two techniques (P = 0.000). The level of agreement between two oral radiologists in their interpretation was high (kappa index = 0.897). Conclusion: Modified BAT was more accurate for periapical radiography of maxillary molars in preventing zygomatic superimposition and related technical errors than BAT.

The prime objective of this article is to introduce the newer methods to access, search and process MEDLINE citations. It also aims to provide a brief overview of each service's salient features. A targeted search was conducted in MEDLINE through the OVID gateway. This was followed with a search in Google Scholar as well as Google and Bing. Ninety-two web-based services that can be used to search MEDLINE were identified. The list was shortened to 24 by applying a set of relevancy criteria to select those services more relevant to general medical and dental users. Salient features of the selected services are outlined and a use case based classification of the system has been proposed to help dental practitioners and researchers select the appropriate service for a given purpose.

Context: Teeth with periapical lesion usually present external root resorption around the apical foramen. These areas facilitate adhesion and co-aggregation of microorganisms developing biofilms. Up to the present moment, there is no methodology in the literature that enables the in vitro evaluation of endodontic irrigants and intracanal dressings on biofilms located in apical external root resorptions of human teeth. Aims: This study aimed to describe a new in vitro methodology for Enterococcus faecalis biofilm development in external apical reportion areas of human extracted teeth in different periods of time. Settings and Design: In vitro qualitative laboratory study. Subjects and Methods: Thirty roots from human extracted teeth presenting external apical resorption had their root canal diameters standardized by means of instrumentation. Next, the roots were randomly divided into three groups (n = 30) according to E. faecalis strains (ATCC 29212) exposure time as follows: Group T5, with 5-day exposure; Group T10, with 10-day exposure, and Group T15, with 15-day exposure. The roots were attached to 24-well culture plates so that only their apices could be in contact with bacteria for induction of biofilm formation. At the end of these exposure times, the roots were qualitatively evaluated with scanning electron microscope to observe the presence of biofilm in external resorptions around the apical foramen. Results: It was found that microorganisms were present in all exposure times, although structures suggesting the presence of biofilm with great conglomerate of bacteria showing structures similar to polysaccharide extensions were observed at the 10 ^th day of exposure. Conclusions: By means of this new methodology, it was possible to observe biofilm formation in the areas of external apical resorption after 10 days of exposure.

In routine dental radiography, one may encounter numerous radiographic errors, one of which may be partial images or cone cuts. These cones cut errors although may appear as simple problems, but often persistent cone cuts may be frustrating to the dental practitioner. In this study, our main aim was to find and solve the origin of the problem. This study was conducted with two different intraoral X-ray machines with 12 inch length position indicating devices (PIDs) with four No. 2 intraoral films. If the problem is originated in the X-ray machine, it can be solved by either tapping the collimator or by repositioning the PID.

Objectives: The purpose of this paper is to develop a simple and cost-effective suturing training model. Materials and Methods: A simplified suturing model is developed for preclinical training purpose. The training model requires only three easily available materials, which include synthetic foam sponge, elastomeric impression material and putty impression material. Construction of this model requires only 15 min. Results: The training model thus developed resembles a realistic human tissue with a skin analog, deeper connective tissues and a bony base. This enables the students to practice various suturing technique at different tissue planes. Such practice helps the students to perform a live procedure in a more skilled and less traumatic way. Conclusion: The easy availability and cost-effective nature of the materials, in concert with fast construction time, makes this suturing model appropriate when an affordable alternative is desired.

Dermatillomania is a disorder in which a person habitually picks their skin, and this is a form of self-injury. It can involve any part of the body, but usually involves the face, neck, arms and shoulders. Symptoms often follow an event that has caused severe emotional distress. A dermatillomania or compulsive skin picking episode may be a conscious response to anxiety or depression but is frequently done as an unconscious habit. In this case report, a patient undergoing orthodontic treatment was found to be suffering from dermatillomania and was treated using psychological counseling.