Purpose: The aim of this study is to investigate the presence and the extent of a possible marginal gap after the interposition of a flowable composite between the composite restoration and the dental structures (enamel and cementum). This technique is also used to eliminate the infiltration in a zone of the cavity preparation that is frequently at a risk of secondary decay. Materials and Methods: Fifteen human premolars extracted for orthodontic reasons were used for the study. A cavity with mesial and distal margin in enamel and cementum was realized in every tooth. The cavities were then restored with an adhesive system (ScotchBond 3MÔ) and composite (Filtek Supreme 3MÔ); and, a fine layer of flowable composite was applied in the distal margin of each cavity. Scanning electron microscopy (SEM) in secondary electron imaging (S.E.I.) modality was used for the study and identifying the marginal gaps in the composite restorations. Data was investigated on the mesial and distal margin of each cavity at the restoration-enamel interface, and at the restoration-cementum interface. The interfaces were divided in four groups: Group A (enamel/composite); Group B (enamel/flow/composite); Group C (cementum/composite); and, Group D (cementum/flow/composite). Results: By the comparison of the gap's average width found in each group, it is evidenced that the average width of the gap increases when the interface moves from the coronal to the radicular end (Group A 0,1 ± 0,4 μm Vs Group C 12,3 ± 11,6 μm; Group B 0,2 ± 0,8 μm Vs Group D 2,8 ± 6,6 μm). Correlating the measurements of the marginal gap's average width among the Group A and Group B, no significant variations were obtained; and instead, on comparing Group C with Group D, the gap's average width decreases. Conclusion: The interposition of a low elastic modulus composite between the adhesive layer and the composite resin allows an improvement of the cementum-restoration interface by the means of a lower shrinkage stress during polymerization.

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Background: Although type 1 diabetes mellitus (T1DM) has a significant impact on oral health, its association with dental caries is yet not clear. Aim: The aim of this study was to evaluate the salivary flow rate and caries in Brazilian youth with type 1 diabetes mellitus. Setting and Design: A Cross-sectional study was performed in a tertiary university hospital. Materials and Methods: Fifty-one age matched subjects suffering from type 1 diabetes mellitus were selected for the study and evaluated for the following: salivary flow rate, number of decayed, missing and filled tooth in permanent dentition (DMF-T) and decayed, extracted, filled tooth index in the deciduous dentition (def-t); visible plaque index (VPI) and gingival bleeding index (GBI). Statistics and analysis: The t test was utilized when the variables showed normal distribution. The Mann-Whitney test was utilized for comparing non-normal variables. Kolmorgorov-Smirnov test was used to assess the normality assumption. The differences were considered significant when P < 0.05. Results: The age and gender distribution of patients and controls was 11.3 ± 3.4 years (56% males) and 11.9 ± 3.4 years (37% males). The mean glycated hemoglobin value in the diabetics was 9.7 ± 1.9%. Salivary flow rate was lower in the diabetic pateints as compared to controls (P = 0.02). No differences were found in the DMF-T/def-t indices of diabetic and non-diabetic patients (P = 0.43/0.14). VPI was similar in both the groups (P = 0.15). GBI was higher in the diabetics (8.1 vs. 5.18; P = 0.11). There were no differences in the dental caries experience and dental plaque in the two groups. Conclusion: The lower salivary flow rate in diabetics could have been related to their higher GBI. The higher GBI in the diabetics is a matter of concern in the diabetics and is a sign for higher chances of developing periodontal problems.

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Introduction: Good oral health is a mirror of overall health and well-being. Oral health is determined by diet, oral hygiene practices, and the pattern of dental visits. Poor oral health has significant social and economic consequences. Outreach programs conducted by dental schools offer an opportunity for early diagnosis and treatment, dental health education, and institution of preventive measures. Objective: To assess the utilization of oral healthcare services among adults attending outreach programs. Materials and Methods: This study included 246 adults aged 18-55 years attending community outreach programs in and around Bangalore. Using a questionnaire we collected data on dental visits, perceived oral health status, reasons for seeking care, and barriers in seeking care. Statistical significance was assessed using the Chi-square test. Results: In this sample, 28% had visited the dentist in the last 12 months. Males visited dentist more frequently than females. The main reason for a dental visit was for tooth extraction (11%), followed by restorative and endodontic treatment 6%. The main barriers to utilization of dental services were high cost (22%), inability to take time off from child care duties (19.5%), and fear of the dentist or dental tools (8.5%). Conclusion: The utilization of dental services in this population was poor. The majority of the dental visits were for treatment of acute symptoms rather than for preventive care. High cost was the main barrier to the utilization of dental services. Policies and programs should focus on these factors to decrease the burden of oral diseases and to improve quality of life among the socioeconomically disadvantaged.

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Background: The present study's objectives were to compare the perceptions of oral health-related quality of life (OHRQoL) among school children presents dental caries with that of caries-free school children, and to evaluate the subjective impact of atraumatic restorative treatment (ART) on the OHRQoL of school children. Design: Exploratory study. Setting: Public school in Piracicaba, Brazil. Materials and Methods: The sample was composed of 30 children in the age-group of 8-10 years. The children were divided into two groups: one with caries and other without caries. The information related to OHRQoL was obtained through the administration of the Child Perceptions Questionnaires (CPQ _8-10 ). To evaluate the impact of ART on the school children's OHRQoL, the CPQ _8-10 was re-administered 4 weeks after the initial treatment. For statistical analysis we used the nonparametric Wilcoxon test for two dependent variables (test and re-test groups) and the nonparametric Mann-Whitney test for independent variables (test and control groups). Results: It was observed that children with dental caries reported larger impact of oral health conditions on the quality of life when compared with the caries-free group, especially in the emotional and social well-being domains ( P≤.05). After the school children who presented with dental caries received ART, there was improvement in the median scores of CPQ _8-10 in all of the domains, but particularly in the functional limitation domain ( P≤.05). Conclusion: Dental caries exerts a strong influence on the OHRQoL of children. ART was shown to be a simple and painless caries management approach that could improve the OHRQoL of school children.

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Objectives: The aim of this study is to compare the masseter muscle thickness in different vertical dentofacial patterns and identify the possible sexual dimorphism and also to correlate masseter muscle thickness with craniofacial morphology using cephalometric parameters. Materials and Methods: The masseter muscle thickness was measured using ultrasonography in 60 subjects (30 females and 30 males). Standardized lateral and posteroanterior cephalograms were taken to determine the facial morphology. The subjects were divided into three vertical pattern groups (I, II, and III) according to their Jarabak ratio: hypodivergent ( n = 20), normodivergent (n = 20), and hyperdivergent (n = 20). The sample was further subdivided into males and female subgroups. Results: Masseter muscle thickness relaxed (MMTR) in hypodivergent group was 13.94 ± 1.51. Mean value of MMTR in normodivergent group was 12.53 ± 1.21 and the MMTR in hyperdivergent group was 11.13 ± 1.18. The mean value of masseter muscle thickness contracted (MMTC) in hypodivergent group was 15.46 ± 1.33. Mean value of MMTC in normodivergent group was 13.81 ± 1.38 and the mean value of MMTC in hyperdivergent group was 12.27 ± 1.26. MMTC showed a significant, negative correlation with mandibular plane angle and gonial angle. Posterior facial height, symphysis width, intermolar width of maxillary first molars, maxillary width, and facial width (bizygomatic width) showed significant ( P < 0.05 or P < 0.01) positive correlation. Conclusion: The masseter muscle thickness varied among the three vertical dentofacial patterns and sexual dimorphism also existed except in the hyperdivergent group. Masseter muscle thickness was found to be negatively correlated to vertical facial pattern and positively associated with transverse craniofacial morphology.

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Oral complications from radiation to the head and neck or chemotherapy for any malignancy can compromise patients' health and quality of life and affect their ability to complete planned cancer treatment. For some patients the complications can be so debilitating that they may tolerate only lower doses of therapy, postpone scheduled treatments, or discontinue treatment entirely. Oral complications can also lead to serious systemic infections. Medically necessary oral care before, during, and after cancer treatment can prevent or reduce the incidence and severity of oral complications, enhancing both patient survival and quality of life. In the present article we present an overview of oral complications, and their possible management, after radiation therapy in the head-and-neck region.

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Context: A step-by-step approach to harvesting stem cells from the pulp of permanent and deciduous teeth, the problems faced during culture, and the differences in the growth properties and morphology of cells obtained from both the sources has been discussed as a precursor to the use of these cells in therapy. Aims: To isolate, culture, and study the morphology and growth characteristics of mesenchymal stem cells from the dental pulp of permanent teeth (dental pulp stem cells; DPSC) and exfoliated deciduous teeth (stem cells from human exfoliated deciduous; SHED). Settings and Design : Cell culture study carried out at the Department of Oral and Maxillofacial Pathology, Ragas Dental College and Hospital, Chennai. Materials and Methods: Fifteen permanent teeth and thirteen deciduous teeth from ten subjects were used. The growth characteristics and phenotype of cultured DPSCs and SHED were studied from the fourth passage on 24-well plates. Statistical analysis used : Data analysis was done using SPSS ^® version 10.05. Linear regression analysis was performed to derive the slope from growth curves and Mann-Whitney U test was performed to compare the fibroblastoid: epithelioid cell ratio between permanent and deciduous tooth pulp groups. Results: Protocol for the culture of DPSC and SHED was standardized. DPSC and SHED populations were morphologically distinct. The cells from permanent tooth pulp showed a higher proportion of spindle-shaped fibroblastoid cells, whereas deciduous pulp culture showed a higher proportion of epithelioid cells. The seeding efficiency of DPSC - 88.9% (14 ^th permanent tooth pulp) and 91.7% (15 ^th permanent tooth pulp) was higher as compared to SHED - 84.25% (10 ^th deciduous tooth pulp). Conclusions: Permanent and deciduous teeth are both viable sources of stem cells. The permanent teeth were easier to culture because of a lower chance of contamination with oral microflora. The growth characteristics of the cells obtained from both these sources were similar. However, there was a difference in the ratio of fibroblastoid cells to epithelioid cells between the cultures obtained from the permanent and deciduous teeth.

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Objective: To compare four different surface treatment methods and determine which produces adequate bond strength between ceramic brackets and facets of porcelain (feldspathic), and evaluate the Adhesive Remnant Index (ARI) scores. Materials and Methods: Ten facets of porcelain specimens with glazed surfaces were used for each group. The specimens were randomly assigned to one of the following treatment conditions of the porcelain surface: (1) no surface treatment (control group), (2) fine diamond bur + orthophosphoric acid gel 37%, (3) hydrofluoric acid (HFL) 10%, and (4) HFL 10% + silane. Ceramic brackets were bonded with the adhesive cement Transbond XT. The shear bond strength values were measured on a universal testing machine at a crosshead speed of 0.5 mm/min. Results: There was a significant difference (P<0.05) between the control group and all other groups. There was no significant difference (P<0.05) between treated porcelain surface with diamond bur + orthophosphoric acid gel 37% (4.8 MPa) and HFL 10% (6.1 MPa), but the group treated with HFL 10% had clinically acceptable bond strength values. The group treated with HFL 10% + silane (17.5 MPa) resulted in a statistically significant higher tensile bond strength (P<0.05). In group 4, 20% of the porcelain facets displayed damage. Conclusion: Etching of the surface with HFL increased the bond strength values. Silane application was recommended to bond a ceramic bracket to the porcelain surface in order to achieve bond strengths that are clinically acceptable.

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Objectives: The aim of the study is to evaluate the connective tissue changes in different grades of Oral Squamous Cell Carcinoma (OSCC's) and the influence of these changes in predicting the biological behavior of these tumors. Materials and Methods: A total of 39 cases of OSCC's and 6 sections of controls were examined using seven connective tissue special histochemical stains. Results: Staining intensity of collagen, reticulin, acid mucins, fibrin, glycoproteins, sulfated mucins, elastic fibers around the tumor islands and within the connective tissue was observed. Conclusions: Tumor cells which grow progressively in the host stroma have the capacity to pre-empt and subvert the response of host, which is essential for their growth and spread. Clinical Relevance: The reactive changes in the tumor stroma may alter the biological aggressiveness of oral cancer, and by incorporating this concept into a prognostic system, we may help to reflect the biologic diversity of oral cancer and predict its clinical outcomes.

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Introduction: Surgical extraction of lower 3 ^rd molar is the most frequent intervention in oral surgery. This procedure is often associated with significant post operative swelling that may have both biological and social implications. Various studies have been done using different anti inflammatory drugs to study their impact on inflammation. Material and Methods: This study was conducted on 110 patients who had undergone surgical removal of mandibular third molar. The subjects were divided into two groups by double blind method. In addition to post operative swelling and pain , trismus was evaluated using two different groups of drugs. Results: One group was administered 1 mg of dexamethazone every 8 hours for 3 days post operatively. The other group was administered 10 mg of serratiopaptidase every 8 hours for 3 days post operatively. Swelling, pain and trismus were assessed on the 1 ^st , 3 ^rd , 5 ^th and 7 ^th post operative days. The results of the studies were statistically analysed. Conclusion: The results showed dexamethazone was more effective in reduction of swelling and pain in comparison with serratiopaptidase. Both dexamethazone and serratiopaptidase had the same effect on trismus.

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Objective: The objective of the study was to compare the effect of two different desensitizers on shear bond strength of two different fifth-generation single-bottle adhesive agents on dentin surface. Materials and methods: Sixty human premolars were taken and divided into six groups of 10 samples each. The first two groups were the control groups and were not pretreated with any desensitizer; the remaining four groups were the experimental groups and were pretreated with either Denshield™ or Sensodent-K™ desensitizer. The specimens in each group were subjected to acid etching, application of adhesive (Single Bond or Prime and Bond NT), and application of hybrid composite resin (Z-100) according to the standard protocol. The specimens were subjected to shear bond strength testing, using a Lloyds universal testing machine (EZ20), followed by stereomicroscopic evaluation of the fracture mode at the debonded interface. Results: Statistically significant difference existed between the two bonding agents in the control groups (group 1 and 2), with Prime and Bond NT showing higher bond strength than Single Bond. No statistically significant difference existed between either control or pretreated with any desensitizer when either of the adhesive systems was used. Prime and Bond NT showed statistically higher bond strength value when teeth were pretreated with Sensodent-K™ (groups 5 and 6). No statistically significant difference in bond strength values were observed between the bonding agents when pretreated with Denshield™ desensitizer.

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Context: The mandible is inevitably affected by radiation during radiotherapy of head and neck cancers. Surveys have shown that most of the emphasis has been on osteoradionecrosis (ORN), while the other bony changes occurring in this area have been largely ignored. Aims: In this study we examine the radiologic changes in the mandible of irradiated patients using panoramic radiography and compare it with the mandible in non-irradiated cases. Materials and Methods: Mandibular bone changes of 48 patients who had received therapeutic radiation for head and neck cancer were assessed. We measured the width of the cortex and the width of the mandibular canal on panoramic radiographs and assessed the changes by comparison with the mandibular bones of non-irradiated subjects. Clinical evaluations were performed for assessing maximum jaw opening, masticatory muscle tenderness, and presence of mucosal ulcers and/or exposed bone in the oral cavity. Statistical analysis: Paired t-test, Chi-square test, and Mann-Whitney test were used for statistical analysis. P < 0.05 was taken to indicate statistical significance. Results: There was no evidence of mucosal ulceration or exposed bone in irradiated patients. There was significant relationship between the number of years after radiotherapy and the degree of limitation of mouth opening (P = 0.000). Receipt of concurrent chemotherapy did not seem to have any additive effect on the width of mandibular canal or the thickness of the mandibular cortex. Conclusion: Reduction in the width of the mandibular cortex and dimensions of the inferior alveolar canal could be considered as one of the effects of head and neck radiotherapy.

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Aims: A randomized clinical trail was designed to compare the efficacy of two commercially available desensitizing agents (fluoride varnish containing 6% sodium fluoride and 6% calcium fluoride and a gel containing 6% potassium nitrate and 0.11% fluoride ions) in the treatment of dentinal hypersensitivity. Settings and Design: Randomized clinical trial. Materials and Methods: Twenty-one patients were selected. Subjects were evaluated using three different stimuli, i.e., tactile test, air blast test and cold water test. They were then randomly divided into two groups. Patients in group I were treated with fluoride varnish and group II patients were treated with gel containing 6% potassium nitrate and 0.11% fluoride ions. The patients were examined at baseline, immediately after application of the agent, at 1 week, 1 month and 3 months interval. Statistical Analysis: Statistical analysis was done using unpaired "t" test, paired "t" test and Chi-square test with Yate's correction. Results: The results were analyzed; it was seen that patients treated in group I showed significantly better results compared to group II patients at 1 month and 3 months interval. Teeth which required repeat dose and those which did not require repeat dose were comparable in number. Conclusions: Both the agents showed significant reduction in sensitivity at all time intervals compared to baseline. A comparatively significant reduction in sensitivity score was seen in patients treated with fluoride varnish and it appeared to be more effective in providing long-term relief against all the three test stimuli. Teeth with initial high sensitivity score required repeat doses, which was comparable for both the groups.

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Langerhan cell histiocytosis, formerly known as histiocytosis X, traditionally denotes a group of diseases that stem from proliferative reticuloendothelial disturbances.The etiology and pathogenesis of the disease remain debatable. In this paper we report a case of Langerhan cell histiocytosis in a 3 ¹ / ₂ -year-old child who reported to the department of oral pathology with gingival enlargements. The radiological features and histopathological features are also discussed.

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Context: The effect of different curing units on bond strength of orthodontic brackets is still unclear when utilizing nanofilled composites in comparison with traditional Transbond-XT. Aim: To evaluate the influence of two adhesive promoters and two curing-light units on the shear bond strength (SBS) of orthodontic brackets. Settings and Design: The factors under study were adhesive promoters (nanofilled composite - Filtek-Z350 flowable restorative and conventional orthodontic adhesive - Transbond XT) and curing-light units (halogen lamp - Ultralux and LED device - Radii-Call). Material and Methods: Forty lower bovine incisors were utilized. The teeth were distributed in four groups (n = 10) according to the combination between adhesive promoters and curing-light units. Scotchbond Multipurpose-Plus and Transbond-XT primer were used to bond Filtek-Z350 Flowable Restorative and Transbond-XT, respectively. After storage in distilled water for 24 h, the brackets were subjected to SBS test at a speed of 0.5 mm/min until bracket debonding. The Adhesive Remnant Index (ARI) was assigned at fractured specimens. Statistical analysis used: Analysis of variance and Tukey test were utilized. The Kruskal-Wallis test was used to compare ARI scores between the groups (p<0.05). Results: There was statistically significant difference between the adhesive promoters tested. Transbond-XT showed higher SBS means than Filtek-Z350. There was no statistically significant difference between both curing-light units tested in this study, neither between ARI scores. Conclusions: The conventional orthodontic adhesive presented higher bond strength than the nanofilled composite, although both materials interacted similarly to the teeth. The curing-light devices tested did not influence on bond strength of orthodontic brackets.

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Metastatic tumors are of great significance since few cases may represent the only symptom of an undiscovered underlying malignancy. Metastatic tumors rarely metastasize to the oral region despite the fact that many common primary neoplasms frequently metastasize to bone. The true incidence of metastatic tumors in the bones of the jaw is unknown, as jaws are not always included in radiographic skeletal surveys for metastasis. Sometimes oral metastasis may be the first evidence of metastasis from its primary site. A case of metastatic follicular thyroid carcinoma to the mandible is presented here, along with the discussion of clinical and histological features. The present case not only emphasizes the importance of considering metastasis in the differential diagnosis of a radiolucent lesion in the mandible, but also emphasizes in the improvement of the overall survival rate and treatment results by an early detection of metastatic disease.

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Background: Establishment of a proper occlusal plane is needed for developing an occlusion that is compatible with the biomechanics of a stomatognathic system. There has been a great deal of controversy regarding the anatomic reference point/s taken for identifying the Camper's plane (Ala-Tragus) to which the occlusal plane is oriented parallel in regular complete denture Prosthodontic practice. There has been no study in literature to correlate the occlusal plane to the Camper's plane in various skeletal malocclusions using landmarks on a lateral Cephalogram. Aim : The aim of the study isto determine the relative parallelism of the occlusal plane to ala- tragal lines in various malocclusions. Methodology: A total of sixty subjects belonging to Class I, Class II and class III malocclusions were selected for the study. Markings with radiopaque marker of 1 mm diameter were adhered against the superior, middle and inferior border of the tragus and against the lower borer of ala of the nose. Lateral cephalograms were obtained for all of the pateints. Tracing was performed for all of these radiographs. Statistical Analysis Used: Analysis of Variance (ANOVA) test and Post-Hoc test of Bonferroni were used to compare the angles formed at the superior, middle and inferior borders with the occlusal plane. Results: The result from the present study showed that in Class I and Class III malocclusion, the line drawn from the lower border of ala of the nose to the inferior position of the tragus (Camper' plane C) was relatively parallel to occlusal plane; and, in Class II malocclusion, the line drawn from the lower border of ala of nose to middle border of tragus (Camper's plane B) was relatively parallel to occlusal plane.

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Aim of the study : The aim of the study was to check the stress absorbed by the bone around mini over-denture dental implant with and without acrylonitrile O-ring under two different loading conditions. The initial stress absorbed by the implant plays a significant role in the success of the immediate loading implants. Materials and Methods: A three-dimensional finite element analysis using Pro-E mechanica finite element software was used to check the stress absorbed by the bone with and without acrylonitrile O-ring. The implant and the mandible where modeled from the data obtained from C.T. scan and optical projector using reverse engineering process. Two different loading conditions of 80 N and 220 N were determined and the analysis was done. Results: The result showed at lower loads (80 N), there was not much difference in the stress absorbed by the cancellous bone with or without acrylonitrile O-ring, but at higher loads (220), there was difference in the stress absorbed by the cancellous bone with (0.03508 Mpa) and without acrylonitrile O-ring (3.874 Mpa) which showed that significant stress was absorbed by the acrylonitrile O- ring. Conclusion: This study proves that higher loads during parafunctional movement were absorbed by the acrylonitrile O-ring increasing the success of the implants.

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Objectives: The study was conducted to emphasize the sensitivity and specificity of dental pulp in identifying the ABO Blood group, Rhesus factor and also to emphasize the role of dental pulp in forensic odontology to identify the deceased individual. Materials and Methods: The study was conducted on 60 patients. The samples obtained from finger-prick method from those 60 patients were considered as control and the samples obtained from the pulp were considered as case. The blood grouping, Rhesus typing for capillary blood drawn by finger prick was done by slide-agglutination method and the blood grouping, Rhesus typing for extracted dental pulp was done by absorption-elution method. Results: Fifty seven teeth out of sixty showed positive results. Blood group elicited from capillary blood done by slide-agglutination method matched with that of the pulpal blood group elicited by absorption-elution method. Three showed negative results. Conclusion: As the teeth are the hardest, most stable biological material, resist adverse environmental conditions and the pulpal tissue inside the teeth is well protected, the blood group antigen from pulp remains stable for long. Thus, the high potential value of dental pulp tissue is highlighted in this study.

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Background: Barrier membrane helps in periodontal regeneration by preventing the migration of epithelial cells and cells from the gingival connective tissue onto the root surface. Different types of membranes have been used to regenerate periodontal tissues. There are very few documented reports where rubber dam has been used as a barrier membrane for regeneration of periodontal defects. Case Description: A female patient aged 20 years with localized aggressive periodontal disease participated in this clinical report. Infrabony defect in the lower anterior region was selected for surgical treatment. Rubber dam was trimmed to cover the defect. Orthodontic treatment was done for the realignment of malpositioned teeth 1 year after the surgery and patient was followed up for a period of 3 years after surgery. Results: Rubber barrier membrane did not result in any untoward side effects. Patient did not show any sign of inflammation or recurrence of probing depth at 3-year follow-up period. Clinical Implications: Rubber dam as barrier membrane yields good results.

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Aims and Objectives: To minimize the deleterious effects of contaminated enamel on bonding, some authors have advocated the use of adhesive systems under the sealant. The aim of this study was to compare the microleakage of two self-etch and the one-bottle adhesive used in pit and fissure sealant with or without saliva contamination. Materials and Methods: Sixty extracted premolar teeth were assigned to the six groups. Group 1: Acid +saliva +single bond +sealant, Group 2: Acid +single bond +sealant, Group 3: Saliva +S ³ bond +sealant, Group 4: S ³ bond +sealant, Group 5: Saliva +protect bond +sealant, Group 6: Protect bond +sealant. The teeth were thermocycled and immersed in 2% basic fuchsine dye for 24 h, then sectioned and examined with a stereomicroscope under ×40 magnification. The results were evaluated with Kruskal-Wallis and Dunn tests. Results: Group 2 has the lower microleakage scores than Groups 4 and 6. Also, Group 6 has the lower microleakage scores than Group 4, and generally an increase in microleakage was observed in each group related to contamination. Conclusion: The best technique of sealant therapy in saliva contaminated and non- contaminated condition is the use of acid-etching and bonding agent.

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Background: It remains important to have a thorough knowledge of the micro-flora harboring the white coats of doctors to minimize cross-contamination and improve patient safety by reducing the risk of nosocomial infections. This study presents the microbiological analysis of the white coats in clinical departments of a dental college and hospital. Materials and Methods: The swabs for the study were taken from the white coats of undergraduate students posted in various clinical departments, interns, and the post-graduate students. The microbial contamination was studied by observing and recording the colony morphology on the culture plates, Gram's staining with light microscopic screening of the slides, and the biochemical characterization of the isolates using standard microbiology protocols. Results: Microbiological analysis of swabs taken from the white coats in the dental operatory showed that 100% coats had bacterial contamination. Out of 30 swabs collected, 46 cultures were obtained. 50% cultures showed Gram-positive cocci, making it the major microbial group contaminating the white coats in the dental operatory. Conclusion: The presented study highlights the fact that the white coats are a potential source of cross infection. The results of this study mandate a strict audit process and protocols to be set in place for preventing cross-contamination from the white coats in a dental operatory.

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Introduction: Surgical removal of impacted mandibular third molar is one of the most commonly performed procedures in oral and maxillofacial surgical practice. The role of preoperative and postoperative medications for management of postoperative complications has been extensively evaluated. Aim: To assess the therapeutic effect of a single dose of 40 mg sublingual piroxicam (study group) vs 150 mg oral diclofenac (50 mg thrice a day) (control group) in patients undergoing surgical removal of impacted mandibular third molar. Materials and Methods: A total of 100 patients with asymptomatic impacted mandibular third molars were randomized into two groups. One group received two 20-mg tablets of piroxicam once daily on the first and second postoperative days, followed by one 20-mg tablet on the third post-operative day. The other group received one tablet of diclofenac 50 mg orally thrice daily on the first, second, and third post-operative days. Repeated extraoral examinations were done for continuous assessment of swelling, trismus, and reduction in pain. Ovearall impression of the treating physician and the patient regarding efficacy of study drugs were recorded at the end of the study. Results: In the piroxicam group there was >50% reduction in pain on all three days postoperatively. The incidence of swelling and trismus was found to be higher in the control group as compared to the study group. Adverse events, such as gastrointestinal (GI) disturbances, were significantly higher in the diclofenac group (11%) as compared to the piroxicam group (0%). Conclusion: Two sublingual piroxicam 20 mg tablets once daily has better efficacy and tolerability profile than diclofenac 50 mg one tablet thrice daily in the management of pain after surgical removal of impacted mandibular third molar. Study Title: A Comparative Study to Evaluate Clinical Efficacy and Safety of Sublingual Piroxicam and Diclofenac in the Management of Pain after Surgical Removal of Impacted Mandibular Third Molar.

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Background and Aim: The use of chewing sticks has been well documented since ancient times in India. Chewing sticks are a good alternative to the toothbrush for maintaining oral hygiene. The present study was designed and conducted to compare and evaluate the antimicrobial effects of the aqueous extracts of neem, miswak, mango, and banyan chewing sticks against two bacterial species considered the most important in the initiation and progression of dental caries, namely Streptococcus mutans and Lactobacillus acidophilus, respectively. Materials and Methods: Twigs of the above mentioned chewing sticks were sun dried and powdered, and sterile aqueous solutions of 10%, 25% and 50% concentrations were prepared. Culture plates for S mutans and L acidophilus were prepared and the growth was transferred to nutrient agar and Mueller-Hinton agar; antimicrobial activity of the extracts was tested after 72 h, using the disc diffusion method. Normal saline was used as control. Results: The antimicrobial activity of neem, miswak, and mango extracts increased as their concentrations increased. Both banyan extract and saline showed no antimicrobial activity against the organisms tested. Conclusion and Recommendations: Based on the zones of inhibition, aqueous extracts of neem showed the most antimicrobial activity against S mutans, while miswak extracts showed superior antimicrobial activity against L acidophilus. We recommend further phytochemical and pharmacological studies to discover newer nonsynthetic tooth pastes and mouthwashes.

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Accurate staging and timely assessment is critical in head-and-neck cancer patients for formulating the appropriate treatment strategy. Therefore, optimizing pretreatment imaging for diagnosis is of great importance. Computerized tomography (CT), introduced in the early 70s, followed by magnetic resonance imaging (MRI) and positron emission tomography (PET), refinements in ultrasonography (USG), advances in nuclear medicine, and applications such as sentinel node lymphoscintigraphy have greatly added to diagnostic accuracy. Post-treatment CT or MRI is of value when a recurrent tumor is suspected. It can confirm the presence of such a lesion and determine its extent. This is important information for determining the possibility of salvage therapy.

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Background: The final esthetic outcome of a metal-ceramic restoration is influenced by several factors including the type of the underlying metal as well as the brand of the ceramic. Settings and Design: An in vitro study. Aims: The purpose of the in vitro study was to investigate the influence of four types of metal-ceramic alloys and two porcelain systems on the color co-ordinates of the metal-ceramic complex. It also aimed at establishing a color index which correlated the color of the metal-ceramic combination to the yellow-blue axis. Materials and Methods: Twenty-four disc-shaped metal specimens of 12 mm × 1 mm were cast from base metal alloys, nickel-chromium (Ni-Cr) (Wiron 99), cobalt-chromium (Co-Cr) (Wirobond C), a palladium (Pd)-rich noble metal alloy (Spartan Plus), and a high noble gold (Au) alloy (Pontostar). These discs were covered with two commercially available feldspathic porcelains (Vita Omega and Shofu Vintage) of A3 shade to a total thickness of 1.2 mm. Each group had six specimens, of which three were coated with Vita Omega and the remaining with Shofu Vintage. Opaque and dentin layers were applied to a standardized thickness of 0.2 mm ± 0.05 mm and 1 mm ± 0.05 mm, respectively onto the metal surface after air abrasion with 50 μm alumina particles. The reflectance spectra were measured with a spectrophotometer and data were recorded in L*, a* and b* coordinates in the CIE Lab Color Order System. Statistical Analysis: Analysis of variance (ANOVA) and path analysis were the statistical tools employed to analyze the data. A critical difference (CD) value was calculated for each color co-ordinate to make comparisons between each metal-ceramic combination. A color index for each metal-ceramic complex was also calculated from the color co-ordinates obtained. Results: ANOVA revealed that significant differences existed between the metal-porcelain combination at 0.01 ( P < 0.01) level. The L* value was significantly higher for Au and Co-Cr alloys with Vita Omega porcelain. The a* value was highest for Ni-Cr alloy when combined with Shofu Vintage ceramic. The b* value of Au alloy with Vita Omega porcelain was significantly higher than any other metal-ceramic combination. The color co-ordinates of Pd alloy with both porcelain systems did not show any significant differences. Gold alloy with Vita Omega showed the highest color index value. Conclusion: The variations in metal-ceramic alloy and porcelain can influence the shade of a metal-ceramic restoration. Color index value was the highest for gold alloy.

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Background and Objectives: This study was done with the objectives to determine the range of functional zone between the intercuspal positions and edge to edge position, the range of incomplete and complete disclusion of posterior teeth in canine-guided occlusion, and to have a gender comparison and comparison between right and left sides of the obtained values. Materials and Methods: Thirty-five subjects showing canine-guided occlusion and Angle's class I canine and molar relation were chosen for the study. Maxillary midline and a corresponding line on the mandible were marked in maximum intercuspation with marker pen in the patient's mouth. Lines from 1 to 5 mm were marked on maxillary central incisor with marker pen. A dental floss was looped around the distal surface of mandibular last molar and the subject was asked to make left lateral movement (working side) at 1-mm intervals. The point at which floss was freed posteriorly was considered as initial disclusion and the point at which edges of maxillary and mandibular canines contacted was considered as complete disclusion. Results: Most of the male and female subjects in the study showed progressive disclusion on right side and delayed disclusion on left side. The range of complete disclusion was 3-4 mm in males and 2-3 mm in females irrespective of the side. The range of functional zone was 1-4 mm irrespective of side or gender. Interpretation and Conclusion: There is a need to redefine canine guidance in terms of immediate disclusion, delayed disclusion, and progressive disclusion.

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Objective: This study evaluated the influence of the instrumentation technique and apical preparation size on the filling capacity of a calcium hydroxide (CH)-based paste. Materials and Methods: Fifty simulated curved canals were prepared in acrylic blocks (five groups; n = 10 each). In three groups, the canals were preflared with Gates-Glidden drills and the apical stop was prepared with #25, 30 or 35 Flexofile files. In the other two groups, the canals were prepared with ProTaper rotary instruments and the apical stop was prepared with F1 and F2. A CH paste was injected into the canals using a special syringe. The four sides of the blocks were scanned with the root curvature to the mesial, buccal, distal and palatal faces. The amount (%) of filling in the total canal area and in the apical 5 mm was obtained [analysis of variance (ANOVA); Tukey's test; α = 0.05]. Qualitative analysis of apical filling was done (absence vs. presence of filling deficiencies) (chi-square test; α = 0.05). Results: There was no significant difference in canal filling among the groups at any block side. Presence of voids was associated with the simulated mesial and distal faces. Conclusions: An effective canal filling with the CH paste was not achieved in all cases. Canal filling failure occurred mostly in the apical third. Filling deficiencies can be better visualized in canals with mesial and distal root curvatures.

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Context: Active white spot lesions (WSLs) are a great concern to clinicians. Aims: This in vitro experiment analyzed cross-sectional microhardness (CSMH) values of occlusal artificially induced active WSLs (control groups D/A, D/B and D/C) along with experimental groups where these lesions were: Exposed to an artificial high risk cariogenic challenge (HRCC) using pH cycling; treated with a glass ionomer cement (GIC) and then exposed to artificial HRCC; or a fluoride varnish (FV) and afterwards submitted to the same artificial HRCC. Materials and Methods: Sixty unerupted human third molars were sectioned buccolingually on the occlusal surface and demineralized for 42 days. One half of each tooth was allocated to control groups (D/A, D/B, and D/C) and the other were used as test groups: A (pH cycling); B (GIC + pH cycling); and C (FV + pH cycling). CSMH test was performed for sound, demineralized, and treated specimens. Statistical Analysis Used: Different depths for CSMH values did not have a normal distribution (Kolmogrov–Smirnov test) and for that matter Wilcoxon and T Test were applied (significance level of 5%). Results: Mean depth of the lesion was 120 μm. A number of samples both in the test groups (n = 37) as in control groups (n = 47) had a lower Knoo p value (softening) or surface erosion. Comparisons between control and test groups only showed statistical difference at a depth 140 μm (P = 0.010) in control group D/A and for test group B at 20 μm (P = 0.004) and at 40 μm (P = 0.007). Conclusions: This in vitro study demonstrated that the use of GIC over an artificial active WSLs and exposed to an artificially HRCC setting tend to express some effect in increased surface KHN values.

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Objectives: To determine the fluorescence property of Vitapan 3D-Master shade guide tabs with a spectrophotometer. Materials and Methods: Fluorescence property of 29 shade tabs, in both of original and ground-to-flat forms, was determined by a reflection spectrophotometer. Color difference (ΔE*_ab-FL) by the inclusion and exclusion of the UV component of a standard daylight simulator (CIE standard illuminant D65) was calculated to determine the fluorescence color change. Fluorescence peak was expressed as the difference in spectral reflectance values by the UV component. Results and Conclusion: ΔE *_ab-FL values were in the range of 0.2 to 2.7 (mean: 1.2±0.6) for the original and 0.5 to 1.6 (mean: 0.9±0.1) for the ground-to-flat tabs, which was significantly different based on paired t-test (p<0.05); however, fluorescence peak was not detected in all the shade tabs. Therefore, fluorescence property of Vitapan 3D-Master shade guide should be modified to have similarfluorescence property of natural teeth and corresponding restorative materials.

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Dentigerous cyst is the most commonly occurring odontogenic cyst after radicular cyst and accounts for 15% of all true cysts in the jaws. The cyst is more common in mandible than in maxilla. The dentigerous cyst is commonly associated with impacted mandibular third molars. In maxilla, the incidence is rare. Dentigerous cyst in maxillary sinus in association with an impacted third molar is an uncommon entity. We present a case of dentigerous cyst associated with an impacted third molar, completely obliterating the maxillary sinus in a 28-year-old female.

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Context: Periodontitis is a potential risk factor for adverse pregnancy outcomes due to the presence of a subgingival load of pathogenic bacteria. Instrumentation of periodontal pockets during treatment may result in bacteremia and/or endotoxemia. Aims: The aim of this pilot clinical trial was to determine the immediate post-scaling and root planing (SRP) level of circulating endotoxin in females presenting with chronic periodontitis. Settings and Design: A before-and-after pilot clinical trial among rural women of low socioeconomic status attending the outpatient department (OPD) for periodontitis. Materials and Methods: Twenty-four women aged 25-35 years, with at least five teeth having probing depth (PD) ≥5 mm, were selected for the study. The clinical trial was divided into three phases: phase 0 (screening), phase I (just before scaling), and phase II (15 min after scaling). Phase 0, one day prior to SRP, was used to assess the eligibility of the patients and record the periodontal status. Endotoxin levels were assessed by a semiquantitiative gel-clot assay, the limulus amoebocyte lysate (Lonza^®), at phase I and phase II. Statistical analysis used: The Chi-square test was used for statistical analysis. Results: There was significant increase of endotoxins levels (P<.05) immediately after scaling (15 min). Conclusions: SRP can lead to endotoxemia, possibly by release of endotoxins by bacteria of periodontal origin, into the systemic circulation.

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Objective: Stereophotogrammetry (SPT) is a method in which three-dimensional coordinates are calculated from multiple two-dimensional projections. The purpose of this study was to compare the surface area changes between the secondary healing and grafting vestibuloplasty techniques in the mandible by using a stereophotogrammetric technique (SPT). Patients and Methods: Thirteen patients were included in this study: six patients were managed by using full-thickness skin or palatal mucosa grafts (two full-thickness palatal mucosal grafts and four full-thickness skin grafts); the remaining seven patients, who did not accept a second surgery for graft harvesting, underwent secondary epithelization vestibuloplasties. Postoperative changes of surgical areas were measured by using SPT. Statistical Analyses: The Wilcoxon (intragroup comparisons) and Mann-Whitney U (intergroup comparisons) tests were used for analysis of data. Results: In the grafting vestibuloplasty group, the surface area gain was statistically significant (P < 0.05). In the secondary epithelization vestibuloplasty group, there was no significant difference (P > 0.05), with even decrease of surface area being noted in some cases. Conclusion: SPT is a valid method for measurement of intraoral soft tissue changes.

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Background: Oral implants are widely used in partially and fully edentulous patients; however, the integration of an implant can be endangered by factors such as intraoral bacteria or inflammatory reactions. The purpose of this study was to evaluate the microbial flora present in the sulcus around dental implants and to assess the relationship between gingival health and microbial flora present. Materials and Methods: Twenty patients who had received oral implants with no complications were followed for a period of 9 months. Assessment of probing depth, the presence of bleeding on probing and microbial sampling from the peri-implant sulcus were performed at three different time points- 4 weeks after surgery, 1 month and 6 months after loading. The samples were taken by paper points and transferred to the microbiology lab in thioglyocolate cultures. In order to do a colony count and isolate the aerobic capnophilic and anerobic bacteria the samples were cultured and incubated on laboratory media. The colonies were also identified using various diagnostic tests. Alterations in the presence of various bacterial species over time and gum health were tested using analysis of variance (ANOVA) with Tukey's test post hoc. Results: The average pocket depth for each patient ranged from 1.37 ±0.39 mm to 2.55 ± 0.72 mm. The bacteria isolated from the cultured samples included aerobic, facultative anerobic, obligate anerobic and capnophilic bacteria. Conclusion: The anerobic conditions created in the peri-implant sulcus might with time enhance the number of anerobic bacteria present following dental implant loading.

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In this study, we have reported a case of the replantation of a maxillary incisor with an extended extraoral period following a traumatic avulsion. After storage in normal saline, the root surface of the avulsed tooth was conditioned with citric acid and treated with a triple antibiotic solution. The tooth socket was filled with Emdogain before replantation. A 12 month, 18 month and a 5 year follow-up clinical examination revealed the patient to be asymptomatic, and the tooth was functional. The recall radiograph showed no evidence of renewed periradicular breakdown and apical root resorption.

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Background: Curved roots of teeth might cause difficulty in root canal treatment and removal. Beside genetic factors, root morphology of the third molars is affected by environmental factors such as mesial migration. However no studies examine the relation between the amount of third molars' movement and their root angles. The purpose of this study was to evaluate the relation between the amount of third molar movement during orthodontic treatment and the angulation of third molar roots. Materials and Methods: The records of 39 patients who had apical closure after orthodontic treatment were evaluated. Root curvature was measured on panoramics using the angle between an occlusal reference line and central line of the most apical ninth of the root. The amount of tooth movement of third molars was measured on the pre- and post- treatment lateral cephalometric radiographs by measuring tooth distance from a perpendicular line. Pearson correlation analysis was preformed to obtain relation of the amount of third molar's movement and its root angulation. Results: In maxillary arch the correlation between tooth movement and root angulation was positive and not significant relation but in mandibular arch this relation was negative and not significant. ( P > 0.05) Conclusion: The relation between the amount of third molar movement and its root angulation was not statistically significant. Therefore movement of third molars during orthodontic treatment should not be assumed as an etiologic factor of root angulations.

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Aim: To investigate the association between gender and type of cleft with hypodontia and to verify if the presence of the cleft interferes with hypodontia of one or more type of teeth in patients with ectodermal dysplasia attending the Hospital for Rehabilitation of Craniofacial Anomalies (HRCA), University of Sγo Paulo (USP). Materials and Methods: Panoramic radiographs of 54 patients of both genders (29 males, 25 females), from the files of the oral radiology sector of HRCA/USP, presenting with ectodermal dysplasia and cleft lip and/or palate were evaluated by radiographic observation of hypodontia of one or more types of teeth. Statistical Analysis: We performed descriptive statistics and statistical analysis by Fisher test. Results: Hypodontia was observed in 50% of females and 50.88% of males; 50% for cleft palate and 50.59% for complete cleft lip and palate. Only 22.22% of patients with cleft palate and 6.67% with complete cleft lip and palate presented with hypodontia of one type of teeth, whereas 77.78% of cases with cleft palate and 93.33% with complete cleft lip and palate displayed hypodontia of more than one type of teeth. Conclusion: Based on the present methodology, there were no statistically significant differences in hypodontia of one or more types of teeth between genders or types of cleft.

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