Background: The behavior of oral health providers toward their own oral health reflects their understanding of the importance of preventive dental procedures and of improving the oral health of their target population. Aim: This study was done with an aim to assess the relationship between oral health behavior, oral hygiene and gingival status of third and final year dental students from a Dental College in Indore City, India. Methods: A total of 137 dental students participated in the study. The students were invited to complete the Hiroshima University-Dental Behavioral Inventory (HU-DBI) questionnaire. The HU-DBI questionnaire consisted of twenty polar responses (agree/disagree) regarding oral health-related behavior. In addition, two further questions about the frequency of brushing and flossing were included. Subsequently, oral health examination was conducted to assess plaque and gingival status. Data were analyzed using Chi-square test, Independent sample t-test, and Pearson's correlation. The significance level was set at P ≤ 0.05. Result: The results showed that about 66.6% of the students checked their teeth in the mirror after brushing. Only 20.1% of the students reported bleeding from gums. The mean oral heath behavior score (HU-DBI) was 6.47 ± 2.0. A negative correlation of HU-DBI scores with plaque (r = −0.501) and gingival scores (r = −0.580) was observed. Conclusion: Thus, it is concluded that there is a significant relationship between the oral health behavior, oral hygiene, and gingival status of dental students. Dental students with better self-reported oral health behavior had lower plaque and gingival scores indicating a better attitude toward oral health.

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Context: Some radicular changes are challenging for clinicians to diagnose, such as of root perforations, external root resorption (ERR), and vertical root fractures (VRFs). This study aims to facilitate it by comparing the diagnostic accuracy of cone-beam computed tomography (CBCT), orthopantomography, and conventional and digital periapical radiography (DPR) in the diagnosis of such problems. Is it worth doing CBCT despite the radiation dose? Aims: To evaluate and compare the diagnostic accuracy of CBCT, panoramic radiography, and conventional and DPR in the diagnosis of root perforation (RP), ERR, and VRF. Materials and Methods: The sample consisted of 40 extracted human teeth and 10 macerated human mandibles. RPs were performed using diamond burs, ERRs using spherical carbide burs, and RFs using a universal machine EMIC-DL 1000. The images were evaluated by 6 dentomaxillofacial radiologists. Results: Receiver operating characteristic (ROC) revealed that CBCT showed the highest area under the ROC curve (Az) values for RP, ERR, and VRF (0.903, 0.950, and 0.849, respectively). The worst Az values for RP, ERR, and VRF (0.718, 0.494, and 0.611, respectively) were for panoramic radiography. Conclusions: CBCT showed the best results in the diagnosis of ERR and VRF. The diagnosis of ERR was the least accurate, panoramic radiography being not appropriate for its diagnosis. CBCT and conventional periapical radiography obtained similar results for the evaluation of RP. So for, RP indicate the conventional periapical radiography because CBCT has a higher radiation dose.

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Context: The platelet rich fibrin (PRF) is second generation platelet concentrate that has been widely used and researched for stimulation and acceleration of soft tissue and osseous healing. Its continuous delivery of growth factors and proteins mimic the need of physiological wound healing and regenerative tissue processes. Aims and Objectives: The aim of this study was to evaluate the efficacy of PRF in osseous regeneration after enucleation of cystic lesions. The objectives of this study were: (1) To evaluate osseous regeneration radiographically with the use of PRF in intrabony defects after cystic enucleation. (2) To evaluate the degree of bone density in intrabony defects with the use of PRF postoperatively after 1 ^st , 3 ^rd , and 6 ^th months. Subjects and Methods: 10 cases of cystic lesions were treated using PRF after cystic enucleation. Follow-up radiographs (orthopantomogram) were taken 1 ^st , 3 ^rd , and 6 ^th months postoperatively. Bone density was measured with grayscale histogram using Adobe Photoshop 7.0 software. Results: The subsequent follow-up examinations revealed progressive, predictable, and significant radiographic osseous regeneration. Conclusion: The use of PRF in management of cystic lesions seems to be a novel therapeutic approach promoting faster osseous regeneration within 6 months postoperatively however further study is required with larger sample size and with a control group.

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Background: Sequential aligners (SAs) introduced about a decade ago, changed the practice of orthodontics as we knew it but the adverse events and reactions (AER) associated with SA is not known. The Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database is a reliable database that has AERs reported. The manuscript attempts to review the AER associated with SA using the MAUDE database. Materials and Methods: The authors downloaded and reviewed the SA-related AER from MAUDE for a period of 5 years. In-depth analysis of the site and nature of intraoral and extraoral AERs were performed. We attempted to calculate the probability of pathologies being directly related to SA use, using Bayes' theorem. Results: In the study period of 5 years, 175 cases of AER registered with MAUDE database owing to use of SA. Of the 175 cases, 129 (73.71%) instances were mandatory reports filed by the manufacturer. Of all AERs, 32 (18.29%) cases had been diagnosed/suspected to have an allergic reaction, 20 (11.43%) of them with anaphylactic reaction and 4 (2.29%) of them with angioedema. Lesions involving tongue, throat, and lip such as soreness, inflammation, and hives were more commonly reported. In addition, 12 cases (6.86%) reported of nausea, 11 (6.29%) of gastrointestinal issues (stomach upset, diarrhea, and vomiting), 13 (7.43%) of neuromuscular issues (muscle cramps, spasm, and pain), 13 (7.43%) of cough, 10 (5.71%) of persistent headache, 3 (1.71%) of fever, and 12 (6.86%) of cardiac-related issues were identified. Conclusions: The AERs associated with SA has been described. Though the MAUDE database is not an exact, wholesome and reliable source to identify the potential AER, currently, it is the only available source of AERs associated with SA use. The nature of AERs with the use of SA and its potential pathogenesis and implications has been discussed.

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Background: The present study was conducted to determine the frequency and type of adverse events (AEs) associated with ultrasonic scaler reported to the Food and Drug Administration manufacturer and user facility device experience (MAUDE) database. Materials and Methods: The authors reviewed the ultrasonic scaler units (USU) related AEs reported to MAUDE from October 1, 1995, to September 31, 2015. Analyses of details collected are presented. Results: MAUDE received a total of 667 unique USU-related AE reports. Of 667 cases, MAUDE classified 628 instances (94.2%) as malfunction 27 (4%) as injurious, 10 (1.5%) as others, and 2 (0.3%) claiming the use of USU as cause of death. Of the 667 cases, 511 (76.6%) were used for endodontic application, and 147 (22%) as scaler applications. In 512 (76.8%) instances, there was separation of the tips, posing danger to patients or users, and 112 (16.8%) instances of overheating, 12 (1.8%) instances of breakage, and electrical issues in 8 (1.2%) instances. These AE resulted in 19 instances of thermal injury, 2 suspicious deaths, and hearing loss in 3 cases. In 4 cases, patient swallowed broken parts requiring additional medical care. Conclusions: Use of USU, a Class 2 device without exemption, carries a degree of risk to patient's safety, if not properly used. As of today, MAUDE data is the only reliable source of AE until another database or such study is carried out. Certain AE that has been largely anecdotal, such as hearing loss has been reported in this study. The findings from study reiterate that more in-depth analysis of AE of USU is needed. Until then operator needs to take all precautions to avoid AE when using USU.

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Verrucous hemangioma (VH) is an uncommon, congenital, vascular malformation that involves dermis and subcutaneous connective tissue of skin. VH lesions are initially present at birth, and therefore, the diagnosis in the elderly may be difficult. Review of literature reveals that VH lesions are commonly located unilaterally on the lower extremities. VH may clinically present as keratotic, papular, nodular, or plaque-like lesions that are reddish-blue in color. VH does not resolve spontaneously and has a tendency to relapse. The diagnosis of VH is generally done on the basis of histopathology. Early diagnosis is important to get a better cosmetic result. VH requires a large, deep excision to avoid recurrence because of frequent extension into subcutaneous fat planes. Intra-oral lesions of VH have rarely been reported in the literature. We present an extremely rare case of VH occurring in the retromolar triangle area of oral cavity.

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Background: Distraction osteogenesis (DO) emerges to be a promising alternative to the traditional method of bone lengthening, by which a significant skeletal and soft tissue enlargement can be obtained in the hypoplastic area in a short period. Manipulations of the newly created callus (regenerate), during DO or as a single step molding procedure at the end of the distraction process, may be necessary to correct the mandibular position. Aim: To report the efficacy of callus molding (CM) - floating bone concept in the vertical lengthening of ramus by DO and creating a gonial angle in the difficult case of vector selection or surgically induced asymmetry. Materials and Methods: Retrospective analysis of patients who underwent DO of mandible followed by CM for correction of mandibular asymmetry at authors centers from 2008 to 2014 formed the study group. Only the mandibular distraction cases were included in the study. After the 5 days of latency period, the mandible was distracted at the rate of 1 mm/day. At the end of DO, CM was completed in the 1-3 weeks before consolidation. CM was done either by removing the lower screws with distractor in place or after removal of distractor based on case selection. Secondary maxillary correction by Le Fort I osteotomy using bone graft and further occlusion is corrected by postorthodontics if necessary. Splints were used during CM for predetermined occlusion. In all the cases, postoperative intermaxillary fixation was maintained for 8 weeks for stable ossification of the callus. Results: The study group consist of four and five cases of external and internal distraction, respectively. Of the 9 patients who underwent DO, 6 were females and 3 were males. The mean age of the population ranged from 10 to 21 years with a mean age of 18 years. The average distracted length of the mandible was 23.55 mm ranging from 20 to 26 mm with the standard deviation of 1.95. The mean deviation of the mandible (crossbite) at the end of distraction was around 8.23 mm ranging from 5 to 12 mm with the standard deviation of 2.17. Of the total 9 cases, only in 3 cases CM is done during DO and the rest 6 cases the CM is done after removal of the distractor. Secondary maxillary correction by Le Fort I osteotomy was done for 4 cases, and postorthodontic correction was done in 3 cases. In all the 9 cases, 100% results (as assessed clinically and radiographically) achieved with the creation of perfect gonial angle. Conclusions: CM plays a crucial role in those cases where proper vector orientation is hindered because of anatomical difficulty for osteotomy cuts and parallel fixation of the distractor to ramus resulting in cross-bite with deviation toward the undistracted side. Manipulation of the regenerates would provide a precise achievement of gonial angle, minimizing the need for secondary corrections, and diminishing treatment duration and costs.

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Background: Gingival recession (GR) is one of the most common esthetic and functional concerns associated with periodontal disease. A variety of surgical procedures has been introduced to the field of cosmetic periodontology for the treatment of GR. Aim: To evaluate and compare the clinical outcome of semilunar coronally advanced flap (SCAF) with and without button technique in the treatment of Miller's Class I and II GRs. Study Design: A total of 12 subjects with bilateral single Miller's Class I and II recession were selected for the study. Split mouth design was used. Materials and Methods: Surgical sites were randomly divided into test and control groups. In control sites, SCAF alone was done whereas in test site, a combination of SCAF and button technique was performed. The clinical parameters including GR, periodontal pocket depth, clinical attachment level (CAL), and width of keratinized gingiva were recorded at baseline and 6 months postsurgery. Data so collected were put to statistical analysis. Statistical Analysis: Student's t-test was used to find significance of parameters between baseline and 6 months. For inter-group comparisons paired t-test was performed. Results: Statistically significant improvements were recorded in both groups from baseline to 6 months. Inter-group comparison yielded statistically significant differences in GR and CAL in favor of test group. Conclusion: Combination of SCAF and button technique resulted in statistically significant improvements in clinical parameters as compared to SCAF alone. Future clinical studies with much larger sample size and longer follow-up periods are warranted.

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Ameloblastoma is a benign, locally aggressive tumor originating from the odontogenic epithelium. It manifests as a slow growing swelling, causing expansion of the jaw bones. Radiologically, it presents as a unilocular or multilocular radiolucency exhibiting a characteristic soap bubble or honeycomb appearance. Ameloblastoma exhibits several histologic patterns of which basal cell variant is a rare entity. The present case report is that of a maxillary ameloblastoma exhibiting a basaloid differentiation that may put one in the mind of a basaloid squamous cell carcinoma or a basal cell carcinoma. Confirmation of such rare variants should be done not only based on histopathology but with the help of supplemental immunohistochemical analysis. The present case report helps in exposing a rare variant of ameloblastoma and emphasizes the role of advanced diagnostic aids such as immunohistochemistry in establishing the diagnosis.

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Context: p53 and survivin are involved in cell cycle progression and inhibition of apoptosis, respectively. Survivin is a unique protein which functions in progression of cell division and inhibits apoptosis leading to cell proliferation and cell survival. According to the literature, mutation of p53 leads to promotion of survivin function. Thus, the importance of cell cycle aberration and uncontrolled proliferation resulting from mutation of p53 and up-regulation of survivin is discussed. Aims: To assess the role of p53 and survivin in ameloblastoma and adenomatoid odontogenic tumor (AOT). Settings and Design: The percentages of positive tumor cells were considered for statistical evaluation. Nuclear labeling index for p53 and nuclear, cytoplasmic and combined labeling index for survivin was obtained from the stained slides. Materials and Methods: Immunohistochemical expression of p53 and survivin was done qualitatively and quantitatively in 25 cases each of ameloblastoma and AOT. Statistical Analysis Used: Mann-Whitney U-test, Wilcoxon signed ranks test and Pearson's correlation test. Results: Quantitatively, p53 and survivin expression was statistically significant in AOT (P = 0.003) and qualitatively, in ameloblastoma (P = 0.004). Survivin expression was significant (P = 0.002) between the study groups unlike that of p53 (P = 0.554). Conclusions: There was no much difference in p53 expression in ameloblastoma and AOT suggestive of cell cycle aberration in both the odontogenic tumors, but significant difference in survivin expression in ameloblastoma and AOT with higher percentage of positive cells in ameloblastoma may be indicative of an aggressive behavior of ameloblastoma.

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Context: The position of mandibular foramen (MF) is an important anatomical landmark for effective anesthesia in dentistry for many procedures, including dental extraction from the lower jaw and putting mandibular implants. Several causes have been examined in this context, and the uncertainty in the location of the MF has been examined to be a major factor for the high failure rate of anesthesia and complications of the orthodontic procedure. Aims: The purpose of this study was to examine and analyze the position of the MF relative to six bony landmarks on the ramus in the population of Jharkhand. Subjects and Methods: The different parameters were measured in 30 dry adult's mandibles that were obtained from the Department of Anatomy. The data were tabulated and statistically analyzed. Statistical Analysis Used: Paired t-test. Results: The mean distance between the MF and the respective landmarks was noted as 16.00 ± 3.50 mm for the anterior border, 10.21 ± 2.34 mm for the posterior border, 20.48 ± 3.89 mm for the superior border, 24.15 ± 4.97 mm for the inferior border, 33.46 ± 6.08 mm for the condyle, and 12.31 ± 4.88 mm for the internal oblique ridge for the right side. On the left side, these distances were 16.27 ± 3.9 for the anterior border, 10.28 ± 5.24 for the posterior border, 20.15 ± 3.8 for superior border, 24.86 ± 4.04 for inferior border 32.48 ± 4.73 for condyle, and 10.93 ± 4.06 for the inferior oblique ridge. Statistically, there was no significant difference in the distance to either side from selected 5 landmarks, the only exception being the condyle. Conclusions: Condyle and internal oblique ridge have been shown to be two new landmarks that may be used to find MF. Bilateral symmetry has been shown for all landmarks except for condyle.

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Aim: The present study evaluated the antimicrobial efficacy of Chlorhexidine, Nisin and Linezolid and a control group (Normal saline ) against Enterococcus faecalis (EF). Methods: Human single rooted premolars with type I canal anatomy were instrumented with ProTaper using NaOCl as an irrigant. Supension of EF was inoculated into each root specimen and incubated. The medicaments were syringed into each root and incubated. After 24 hours, 8 samples per group (among the 4 groups) were retrieved. A hole was drilled on each root, and the dentinal shavings obtained were allowed to fall in brain-heart infusion (BHI) broth. Dilutions from the broth were plated and spread over blood agar. Colony-forming units (CFU) of EF was counted. The procedure was repeated after 72 hrs and 1 week. Results: In group Nisin, the mean CFU was 10.6250 at 24 hrs, 6.6250 at 72 hrs and 6.2500 after 1 week respectively (statistically significant). In group Chlorhexidine, mean CFU was found to be the lowest of 10.5000 at 24 hrs, with further gradual increase to 13.7500 at 72 hrs and further increase to 15.8750 by 1 week. Similarly, in group linezolid , the mean CFU was found to decrease from 49.0000 at 24 hrs to 29.8750 at 72hrs and then increase to 34.8750 in 1 week

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Dual arch impressions have been in use for many years. Five in-office techniques for fabrication of the tray have been suggested, in case the manufactured (stock) tray is not available to the clinician. The design consists of two parts of the tray (the plastic frame and lattice). Five types of materials for the lattice have been described. The indications, advantages, and disadvantages of the techniques together with an appraisal of the five different lattice materials have been described. Overall the techniques are simple and require materials that are easily available. It does not take much time and can be used to attain efficient results in case the stock tray is not available in the operatory.

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Context: Gender determination is considered an important step in reconstructing the biological profile of unknown individuals from the forensic context. Assessment of sex differences from human remains will be of immense help as it would narrow down fields of search to 50 %. Aims: To evaluate the accuracy of various dental parameters used for the gender determination. Settings and Design: The aim of the present study was to investigate the accuracy of various methods employed in gender determination or personal identification such as mesiodistal width of molars, mesiodistal width of canine, mandibular and maxillary canine index in age group of 15 to 65 years. Methods and Material: A total of 200 patients were selected comprising of both the genders in the age group of 15-65 years belonging to various parts of Nagpur. The mesiodistal crown width of mandibular and maxillary permanent molar and canine teeth and the intercanine distance was measured and the values were noted. Statistical analysis used: the data was analysed using SPSS 18 software. Results: The mean of mesio distal width of maxillary and mandibular molar in males and females is suggestive of gender dimorphism in maxillary molars which was statistically significant.The maxillary inter-canine distance was greater in males and was statistically significant. Conclusions: The dental parameters can be used as a tool for accurate gender determination in forensic investigations.

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The presence of foreign objects in the pulp chamber of fractured permanent teeth is a rare phenomenon and often diagnosed accidently .These foreign bodies are most commonly self inflicted by young patients and remain impacted within the pulp canal thereby acting as potential source of infection and painful conditions1. In the present case report, we present successful endodontic management of stapler pin lodged in fractured maxillary central incisor with challenge of open apex in young patient using biodentine as a novel apical matrix.

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Context: This study was carried out on the assumption that calcium hydroxide [Ca(OH) ₂ ] dressing and irrigants may influence the obturation of lateral canals. Aims: To evaluate the influence of 2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) gel and Ca(OH) ₂ on the filling of artificial lateral canals. Settings and Design: Ex vivo quantitative laboratory study. Materials and Methods: Forty-two human mandibular premolars were selected. After cavity access, six lateral canals were performed, two in each root section, one mesial and one on the distal root surface. After preparation, the specimens were randomly divided into four groups: Group I: Under irrigation with 2% CHX and saline solution and with intracanal dressing Ca(OH) ₂ paste; Group II: The same preparation as Group I, but without Ca(OH) ₂ ; Group III: Under irrigation with 2.5% NaOCl without Ca(OH) ₂ ; and Group IV: The same preparation as Group III, but with Ca(OH) ₂ . Two teeth without intracanal dressing were used as negative controls. Lateral condensation technique was performed. Then, digital radiographic images were obtained. Statistical Analysis Used: Data were analyzed using SPSS 17.0, submitted to Kappa (reliability between examiners) and Kruskal-Wallis test. Results: No statistical difference was registered between Groups II and III in all root sections (P > 0.05), but it was observed between Groups I and IV (P < 0.05), except on the apical section (P > 0.05). In all sections, the Group I filled more artificial lateral canals than in Group IV. Conclusions: The irrigants tested had no influence on the filling of artificial lateral canals. Nevertheless, intracanal dressing of Ca(OH) ₂ influenced this filling.

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This is a very rare case report of a multiple odontome involving the upper jaws, lower jaws and an extragnathic site. A thirty seven year-old male complained of missing teeth in his left upper and lower jaw since childhood. Radiographic examination revealed multiple calcified teeth like structures in the left side of the patient's maxilla, mandible and mastoid region of skull base. We arrived at the diagnosis of compound odontome. Patient was otherwise systemically normal and with good health. He underwent surgical enucleation of the jaw odontome while the extragnathic odontome was left under observation. This rare case report proves that the embryonic dental cells might migrate to the primordium of the Rathke's pouch and further might be carried towards the site of the developing cranial base region.

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Background: Several substances have been researched to act as vehicles associated with calcium hydroxide. The specific type of vehicle is directly related to the effectiveness of the ionic dissociation, antimicrobial action, and biocompatibility of this medication. Aim: To make a histological evaluation of the biocompatibility of calcium hydroxide associated with a new vehicle (triethanolamine), compared with polyethylene glycol, saline solution, and olive oil. Materials and Methods: Fifty mice of guinea pig species were randomly divided into five groups (n = 10) according to each vehicle used - Group 1: calcium hydroxide, Group 2: triethanolamine, Group 3: polyethylene glycol, Group 4: saline solution, and Group 5: olive oil - and further divided into subgroups according to the two analysis periods - (a) 30 and (b) 90 days. Teflon carriers filled with the evaluated substances were placed in standardized bone cavities in the anterior mandible region. The animals were euthanized to perform a histological analysis after the time periods analyzed. Results: In 30 days, specimens from Groups 1, 3, and 5 showed a very pronounced inflammatory response. Specimens from Group 2 showed an inflammatory reaction ranging from mild to severe, with rapid resorption of the material and progressive advancement of osteoid tissue into the teflon carriers. Specimens from Group 4 showed a moderate inflammatory reaction. In 90 days, specimens from Group 1 showed a very pronounced fibrous replacement. In regard to Group 2 specimens, the tested material was solubilized and replaced by newly formed bone tissue. For Groups 3 and 5 specimens, the inflammatory reaction went from acute to moderate. In relation to Group 4 specimens, an organized bone formation process was observed. Conclusions: Specimens from Group 2 showed higher biocompatibility, especially as compared with the specimens from Groups 3 and 5.

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