Context: This study evaluated and compared the shaping ability of ProTaper Gold (PG) (PG; Dentsply, Tulsa Dental Specialties, Tulsa, OK, USA) system with ProTaper Universal (PU) (PU; Dentsply Maillefer, Ballaigues, Switzerland) using cone-beam computed tomography (CBCT) imaging. Materials and Methods: Forty mesiobuccal canals of mandibular first molars with curvatures of 25−30° were divided into two experimental groups (n = 20) according to the rotary nickel-titanium (NiTi) file system used in canal instrumentation as follows: Group PG and group PU. Canals were scanned before and after instrumentation using CBCT scanner to evaluate root canal transportation and centering ratio at 3, 5, and 7 mm from the apex and volumetric changes. Data were statistically analyzed using independent t-tests and the significance level was set at P < 0.05. Results: There was no significant difference between PG and PU systems in the mean volume of removed dentine, canal transportation, and centering ratio (P > 0.05). Conclusions: The PG and PU NiTi rotary systems showed similar root canal shaping abilities in the preparation of mesial canals of mandibular first molars.

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Context: Adhesive dentistry has been progressing with rapid pace over the past decade. Composite resin is the most esthetic restorative material currently available for restoring teeth. In spite of it being in use since a decade, still failure cases are seen which are mainly due to polymerization shrinkage and subsequent inadequate adhesion to cavity walls, leading to microleakage. Various generations of dentin bonding agents have been introduced to overcome the shortcoming of composite resin. Aims: To determine the microleakage of the 6 ^th , 7 ^th , and 8 ^th generation dentin bonding agents. Materials and Methods: Forty-five extracted human premolars were taken for the study. Standardized Class V cavities were prepared on all the teeth. The samples were divided into three groups according to the generation of bonding agent used. Group I was bonded with the 6 ^th generation, Group II with the 7 ^th generation, and Group III with the 8 ^th generation dentin bonding agent. All the Class V preparations were restored with a nano-ceramic composite restorative (Ceram X). The samples were then thermocycled between 5 and 55 ± 2°C for 100 cycles and immersed in 2% methylene blue for 48 h for evaluation of microleakage under a stereomicroscope. Statistical Analysis Used: The data was statistically analyzed using Kruskal-Wallis nonparametric analysis, and Mann-Whitney U-test was applied to compare the various groups. Results: The microleakage value was the highest in Group II (7 ^th generation bonding agent) followed by Group I (6 ^th generation bonding agent) and least in Group III (8 ^th generation bonding agent). Conclusions: The 8 ^th generation dentin bonding showed statistically significant results in terms of lesser microleakage as compared to the 6 ^th and 7 ^th generation dentin bonding agents.

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Introduction: Anti-microbial therapy is essential along with conventional therapy in the management of periodontal disease. Instead of systemic chemical agents, herbal products could be used as antimicrobial agents. Herbal local drug delivery systems are effective alternative for systemic therapy in managing the chronic periodontal disease. In this study, 10% neem oil chip was used as a local drug delivery system to evaluate the efficacy in the periodontal disease management. Materials and Methods: Twenty otherwise healthy patients with the bilateral periodontal probing depth of 5-6 mm were included in the study. After scaling and root planning (SRP), 10% nonabsorbable neem chip was placed in the pocket in one side of the arch. Other side was done with SRP only. Clinical parameters were recorded on the baseline, 7^th day, and 21^st day. Plaque samples were obtained for a microbiological study on the baseline and 21^st day. Porphyromonas gingivalis strains were seen using quantitative and qualitative polymerase chain reaction assay. All results were statistically evaluated. Results: Clinical parameters showed statistically improved on the neem chip sites and presence of P. gingivalis strains were significantly reduced on the neem chip sites. Conclusion: Hence, 10% neem oil local delivery system delivers desired effects on P. gingivalis. Further research is needed to evaluate the neem oil efficacy on other periodontal pathogens.

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Background: Children with hearing impairment (CHI) have special accessibility issues to meet their health care needs. Their oral health status is deprived and has wide ranging treatment needs to attend. Aim: The aim of this study was to evaluate the oral health status and treatment needs of CHI attending a special school in Bhimavaram Town, India. Study Design: The study design was a descriptive cross-sectional study. Materials and Methods: This study was conducted in November 2012 at SVS special school for deaf, Bhimavaram, India. This study involved 180 CHI of both genders, aged 6-16 years, divided into Group-I (6-8 years), Group-II (9-12 years), and Group-III (13-16 years). Oral health status and treatment needs were recorded using methods and standards recommended by the WHO for Oral Health Surveys, 1997. Dental caries prevalence (decayed, missing, and filled teeth [DMFT/dmft]), gingivitis levels (Lφe, Silness Gingival Index), plaque levels (Silness, Lφe Plaque index), and treatment needs were the parameters recorded and analyzed. Statistical Analysis: Z-test for proportion, one-way analysis of variance, and Chi-square test were used to analyze the data. Results: Prevalence of dental caries in the sample was found to be 65% with a mean level of caries prevalence (DMFT) of 1.6 ± 1.3 in Group-I, 1.9 ± 1.2 in Group-II, and 2.2 ± 1.2 in Group-III. About 91.7% of the total children examined needs treatment. The mean plaque and gingivitis scores of the sample were 1.70 ± 0.61 and 1.59 ± 0.58, respectively. Conclusion: These findings imply the overwhelming situation of CHI in oral health perspective. Hence, prevention-based educational and motivational programs should be targeted to this vital group to achieve adequate oral hygiene levels.

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Aim: The present study evaluated the influence of the working length and foraminal enlargement on the sealing ability and anatomy of the apical region of the root. Materials and Methods: Fifty-five roots were divided into three groups: G1, instrumentation 1 mm short of the major foramen; G2, instrumentation in the limit of the apical foramen; and G3, instrumentation 1 mm beyond the foramen. All groups were prepared using nickel-titanium rotary files and obturated with AH Plus and Gutta-percha. Photomicrographs were taken using a scanning electron microscopy (SEM) before instrumentation, after instrumentation with each file, and after root canal filling. Moreover, bacterial microleakage with Enterococcus faecalis was performed. Results: The results were analyzed using Mann-Whitney, Friedman, Kruskal-Wallis and Kaplan-Meier tests at a significance level of 5%. The cemental canal was uninstrumented in G1. No statistical differences regarding foramen deviation was observed when compared G2 and G3 (P > 0.05). SEM analysis showed that G2 and G3 resulted in good apical foramen obturation. Microleakage showed no statistically significant differences between all of the groups tested. Conclusions: Under the conditions of this study, it can be concluded that foramen enlargement resulted in more apical deviation; however, no differences in bacterial microleakage was observed among the experimental groups.

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Aim: This article reviews the issue of dental unit waterline (DUWL) contamination which affects all the clinical and hospital settings. The contaminating microorganisms commonly isolated from these settings and the most pathogenic among them have serious consequences. Over the years several measures are inculcated for decontamination of water, their advantages and shortcomings have been addressed. Options using nanotechnology which are available in the market are described briefly. Materials and Methods: A manual and electronic search was conducted. Google and PubMed were searched for relevant material from studies up to 2013. Medical Subject Headings words looked for were "Nanotechnology," "Water purification," and "Biofilms." Reviewed findings were summarized by topic, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement for reporting. Seventy articles were shortlisted for articles pertaining to our topic of discussion. A systematic approach was followed by two independent reviewers and included eligibility criteria for study inclusion, data extraction, data synthesis, and drawing of conclusion. Results: Dental waterline contamination is widespread in any type of dental setting having serious implications on clinicians and patients alike, especially elderly and immune-compromised. Hence, international bodies like center for disease and control and American Dental Association have come up with stringent measures for maintenance of water quality. A gamut of procedures has been tried to overcome this problem ranging from chlorinated products, water filters to the usage of distilled water. The use of nanoemulsions, nanofilters, nanomembranes, etc., and their applicability for routine usage is discussed. Conclusions: Biofilm formation in DUWLs is inevitable with the subsequent release of part of microbiota into the otherwise sterile dental settings. These consequences can be quite serious on clinicians and dental patients. Though conventional measures in water decontamination have been partly successful, the quest for more foolproof methods has led to the use of latest technology, i.e., nanotechnology. The most practical option has to be chosen based on the ease of their usage.

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Context: This study evaluates the antimicrobial efficacy of commercially available chlorhexidine (CHX) mouthrinses of different concentrations. Aims: To evaluate and compare the antimicrobial efficacy of commercially available CHX mouthrinses of different concentrations (0.2%, 0.12%, and 0.1%) against specific standard strains of oral microflora at full strength (FS) and 1:1 dilution at 24 h. Settings and Design: Ten commercially available 0.2% (Rexidine, Hexidine, Smilehex, Chlorhex, Hexidale, Hex, Everfresh, and Gargwell), 0.12% (Periogard), and 0.1% (Eludril) CHX mouthrinses were selected to evaluate the efficacy against specific oral microflora using agar well diffusion Method. Materials and Methods: The standard strains of Streptococcus mutans American Type Culture Collection (ATCC 21293), Streptococcus sanguis Microbial Type Culture Collection (MTCC 442), Actinomyces viscosus (ATCC 3268), Staphylococcus aureus (ATCC 25923), Streptococcus pyogenes (MTCC 442), and Candida albicans (MTCC 183) were selected. The antimicrobial efficacy was calculated by measuring mean inhibitory zones formed on agar media. Statistical Analysis Used: Independent t-test, one-way ANOVA, Kruskal-Wallis tests, and Tukey's Post hoc analysis were used. Results: Among 0.2% of CHX mouthrinses at FS and 1:1 dilution, hexidine was effective against most of the microorganisms except with S. pyogenes and C. albicans, where Hex and Hexidale were effective, respectively. When the concentration of 0.1% and 0.12% CHX was considered, Eludril was more effective at FS against all except with S. aureus and S. pyogenes which were more sensitive to Periogard at both FS and 1:1 dilution. Conclusions: 0.12% and 0.1% of CHX mouthrinses showed comparable efficacy with 0.2% CHX mouthrinses irrespective of their formulations.

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Purpose: Human teeth are the most stable and durable tissues in the body. Teeth can be identified even after complete decomposition, thus making them invaluable for identification of sex and age from fragmentary adult skeleton. This study aimed to compare the morphological and radiological measurements of canine and investigate its accuracy in sex determination. Materials and Methods: This study involved 60 males and 60 females between the age group of 20 and 30 years. Mesiodistal (MD) widths of mandibular left canines and mandibular inter-canine distance (ICD) were measured and compared both clinically and on digital intraoral periapical and occlusal radiographs. Discriminant function analysis was carried out for gender determination. Discriminant equation and cutoff point were used in determining the gender and the percentage accuracy. Kappa statistics were carried out to assess intra-observer agreement. Results: A definite statistically significant difference in the MD width and ICD was found between males and females. Clinical and radiological measurements were almost equally efficacious in gender determination with an accuracy of 55-75% in both males and females. When all the variables were used, the accuracy of gender determination increased substantially to 94%. k-values suggested a high intra-observer agreement. Conclusion: It can be concluded that both the clinical and radiographic measurements of MD width of canine and ICD are quick and easy methods for determining sex and in identification of an unknown individual with a substantial accuracy.

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Aim: This study aimed to investigate the existence of the golden proportion, recurring esthetic dental (RED) proportion and golden percentage between the frontal view widths of the maxillary anterior natural dentition among students of Indian origin by the aid of digital photography. Materials and Methods: This study was conducted with 80 dental students (41 female and 39 male), with ages ranging from 20 to 23 years. Students whose natural smile did not develop any visual tension with regard to the study's and their own criteria were selected as having an esthetic smile. Photographs were taken, and the mesiodistal widths of six maxillary anterior teeth were measured digitally using software. Once the measurements were recorded three different theories of proportion were applied and statistical analysis was done. Results: The golden proportion, i.e., 62% RED proportion and golden percentage were not observed in the subjects. According to the subjects evaluated, the average width of the maxillary lateral incisor was 72% of the frontal view width of the central incisor. The average width of the canine was 84% of the frontal view width of the lateral incisor. Conclusion: The golden proportion and RED proportion were not observed in the natural smiles of subjects who were deemed to have an esthetic smile. The values proposed for the golden percentage theory were not observed in subjects with an esthetic smile. Average frontal view percentage widths of the maxillary anterior dentition exist and can be useful in predicting naturally occurring widths in smiles deemed to be esthetic in a specific population.

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Purpose of the Study: The study was designed to evaluate and compare stress distribution in transcortical section of bone with normal abutment and platform switched abutment under vertical and oblique forces in posterior mandible region. Materials and Methods: A three-dimensional finite element model was designed using ANSYS 13.0 software. The type of bone selection for the model was made of type II mandibular bone, having cortical bone thickness ranging from 0.595 mm to 1.515 mm with the crestal region measuring 1.5 mm surrounding dense trabecular bone. The implant will be modulated at 5 mm restorative platform and tapering down to 4.5 mm wide at the threads, 13 mm long with an abutment 3 mm in height. The models will be designed for two situations: (1) An implant with a 5 mm diameter abutment representing a standard platform in the posterior mandible region. (2) An implant with a 4.5 mm diameter abutment representing platform switching in the posterior mandible region. Force application was performed in both oblique and vertical conditions using 100 N as a representative masticatory force. For oblique loading, a force of 100 N was applied at 15° from the vertical axis. von Mises stress analysis was evaluated. Results: The results of the study showed cortical stress in the conventional and platform switching model under oblique forces were 59.329 MPa and 39.952 MPa, respectively. Cortical stress in the conventional and platform switching model under vertical forces was 13.914 MPa and 12.793 MPa, respectively. Conclusion: Results from this study showed the platform switched abutment led to relative decrease in von Mises stress in transcortical section of bone compared to normal abutment under vertical and oblique forces in posterior mandible region.

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Agenesis of corpus callosum (ACC) can have various development abnormalities spectrum. These include delay in milestones to complex neuropsychiatric manifestations. Following case report highlights the case of a young infant presenting with associated features including bilateral cleft lip and palate and hypertelorism. The kid was refused treatment at several centers owing to the central nervous system abnormality. This case reports highlight the ACC as a comorbid diagnosis in cleft lip and palate patient with hypertelorism perhaps owing to ignorance and fear of this apparently innocuous congenital malformation.

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Aim: This study was conducted to estimate and correlate salivary thiocyanate (SCN) levels in periodontally healthy subjects, smokers, nonsmokers, and gutka-chewers with chronic periodontitis. Methodology: The study population consisted of 40 systemically healthy subjects in the age group of 18-55 years that was further divided into four groups: Control, smokers, nonsmokers, and gutka-chewers with chronic periodontitis. Gingival index (GI) (Loe and Silness-1963), probing depth (PD), clinical attachment loss was assessed. Estimation of SCN was performed by ultraviolet spectrophotometer at 447 nm wavelength. Statistical analysis was performed using the one-way ANOVAs Welch test and Pearson's correlation test using SPSS version 17 software. Results: Results showed statistically significant increase in SCN levels in smokers as compared to gutka-chewers with chronic periodontitis, control, and nonsmokers with chronic periodontitis subjects. Significantly higher PD and loss of attachment were seen in smokers group compared with other groups. A negative correlation observed between the GI and thiocyanate levels. Conclusion: The present study revealed a significant increase in SCN levels in smokers with periodontitis as compared to nonsmokers.

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Background: Ladakh has less than optimal oral health care services and a poor transport and connectivity with other areas of the country during most part of the year. Therefore, immediate address to any dental pain is not possible. This study aims to determine the prevalence of dental pain among 12-15-year-old schoolchildren of Leh, Ladakh after the commutation impairing time of the year. Materials and Methods: A cross-sectional study was conducted in May 2014 to determine the prevalence and impact of dental pain among adolescents residing in Leh, Ladakh. A total of 264 students in the age group of 12-15 years participated in the study. The data were obtained using a pretested questionnaire that elicited information on past experience (6 months) of dental pain and the resultant impact on their daily lives. Statistical Analysis Used: Descriptive statistics was used for distribution of frequencies. Results: The response rate was 75.7%. Seventy-seven percent of the students reported dental pain in the past 6 months. About 89% of the students reported, at least, one impact due to dental pain. Females reported more than their male counterpart. Difficulty in eating was found to be commonly reported impact followed by difficulty in sleeping. Conclusions: The prevalence of dental pain and its impact was found to be high. There is a need for a paradigm shift in focus of oral health services from urban areas to remote and rural areas. Knowledge about the magnitude of dental pain can be used to evaluate and plan preventive and curative services in remote and rural areas.

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Aim: The present study was undertaken to evaluate and compare the impact strength and transverse strength of the high-impact denture base materials. A conventional heat polymerized acrylic resin was used as a control. Materials and Methods: The entire experiment was divided into four main groups with twenty specimens each according to denture base material selected Trevalon, Trevalon Hi, DPI Tuff and Metrocryl Hi. These groups were further subgrouped into the two parameters selected, impact strength and flexural strength with ten specimens each. These specimens were then subjected to transverse bend tests with the help of Lloyds instrument using a three point bend principle. Impact tests were undertaken using an Izod-Charpy digital impact tester. Results: This study was analyzed with one-way analysis of variance using Fisher f-test and Bonferroni t-test. There was a significant improvement in the impact strength of high-impact denture base resins as compared to control (Trevalon). However, in terms of transverse bend tests, only DPI Tuff showed higher transverse strength in comparison to control. Trevalon Hi and Metrocryl Hi showed a decrease in transverse strength. Conclusions: Within the limits of this in vitro study, (1) There is a definite increase in impact strength due to the incorporation of butadiene styrene rubber in this high strength denture base materials as compared to Trevalon used as a control. (2) Further investigations are required to prevent the unduly decrease of transverse strength. (3) It was the limitation of the study that the exact composition of the high-impact resins was not disclosed by the manufacturer that would have helped in better understanding of their behavior.

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Objective: This clinical study compared the effects of an antibacterial regimen, comprising a triclosan toothpaste and a 0.075% cetylpyridinium chloride (CPC) mouthrinse, on malodor, self-reported malodor, and oral hygiene measures such as dental plaque, gingivitis, and bleeding relative to brushing with a fluoride toothpaste. Materials and Methods: At baseline, 36 subjects were evaluated for malodor (9-point organoleptic scale [OLT]), dental plaque (Turesky modification of Quigley-Hein; PI), gingivitis (Lφe-Silness; GI) and bleeding (Ainamo and Bay; BI) and randomized to (1) tooth brushing with fluoride toothpaste, or (2) a regimen comprising tooth brushing with a triclosan toothpaste and mouth rinsing with CPC mouthrinse. After the first use of assigned treatments, subjects were evaluated for malodor 2 h after breakfast (OLT-2 h) and used provided treatments for the next 14 days. On the 7 ^th and 14 ^th days, subjects refrained from oral hygiene for 12 h before evaluations (OLT, PI, GI, and BI) and then performed oral hygiene at the dental clinic. Subjects were evaluated for malodor 2 h after breakfast (OLT-2 h) and self-assessed their malodor on a 100 mm visual analog scale (VAS). Results: Treatment groups demonstrated no significant differences in OLT, PI, GI, BI at baseline (P > 0.05). OLT-2 h scores after the first use of regimen and after tooth brushing alone were 5.94 and 6.21, respectively, and were statistically significantly different (P < 0.05). Correspondingly, the regimen demonstrated progressive reductions in OLT and OLT-2 h on the 7 ^th and 14 ^th day evaluations (5.81, 4.88, and 5.09, 4.20, respectively) and were significantly lower than after tooth brushing alone (6.49, 6.18, and 6.35, 5.99, respectively) (P < 0.05). From the 7 ^th to 14 ^th days, the regimen also demonstrated progressively lower PI, GI, BI, and self-reported malodor (VAS scores) which were significantly lower than tooth brushing alone (P < 0.05). Conclusions: Results from this study demonstrated that a regimen comprising a triclosan toothpaste and CPC mouthrinse demonstrated significant malodor reductions 2 h after the first use and progressively increasing reductions in malodor, dental plaque, gingivitis, bleeding and self-reported malodor from the 7 ^th to 14 ^th days than tooth brushing alone.

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We report the use of video laryngoscope for the exchange of orotracheal tube to nasotracheal tube needed for mandibular repair in a case of oromaxillofacial injury.

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Context: India has the third-highest number of people living with human immunodeficiency virus (HIV) in the world. Early diagnosis can prevent HIV transmission and since a large proportion of the Indian population are likely to be seen in a dental setting, it may serve as an important site for early HIV diagnosis. Aims: The aim of this study was to investigate the knowledge of HIV, attitudes, and willingness to conduct HIV testing among Indian dentists. Settings: A cross-sectional survey of 503 Indian dentists was conducted in Delhi, Gandhinagar, Bhubaneswar, and Hyderabad (representing low, moderate, and high HIV prevalence areas). Subjects and Methods: HIV knowledge was measured using the HIV-KQ-18, and attitudes and willingness were examined. Statistical Analysis Used: Descriptive analysis and Chi-square test were performed using SPSS version 21. Results: A third of the respondents had a high HIV knowledge score. High knowledge scores were positively associated with age group, level of education, and dental specialty. Over 73% were willing to deliver HIV-positive test results. Almost 80% of the respondents felt that rapid HIV testing was needed in a dental setting. Attitudes and willingness were found to be significantly related to the survey site suggesting cultural difference as an important factor in taking up HIV testing. Conclusions: General awareness of HIV among this sample of Indian dentists appears to be low. The findings from this study however suggest that Indian dentists have expressed a need for rapid HIV testing in dental setting with a strong emphasis on the need for further education on HIV testing.

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Distomolars are supernumerary teeth present distal to third molars. Although many cases of bilateral fourth molars are reported, very few cases having bilateral fifth molars are described in literature. Here, we present a case having bilateral impacted maxillary fourth and fifth molars with the fifth molar on the left side having an unusually small appearance.

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Aims and Objectives: To use antibacterial agents with two conventional bonding systems and evaluate the shear bond strength (SBS) of bracket to enamel. Materials and Methods: Overall, 120 human-extracted first premolars were used. The specimens were equally divided into six sub-groups of 20 samples. Control groups were bonded with Transbond XT^™ light cure (Group I, after etching with 37% phosphoric acid, 3M Unitek^™ ) and Unite^™ self-cure adhesive (Group II, after etching with 37% phosphoric acid, 3M Unitek^™ ). Experimental groups included teeth surface first coated with Clearfil Protect Bond^™ (Kuraray, Osaka, Japan) (and then bonded with Transbond XT^™ [Group III] or Unite^™ [Group IV]) or bonded with Uni-Etch^™ antibacterial self-etchant (and then bonded with Transbond XT^™ [Group V] or Unite^™ [Group VI]). The third generation MBT bracket bonding system with 0.022 slots was used for bonding. All specimens were tested on Instron machine 5567 (SIES Institute of packaging, Nerul, Navi Mumbai, India) to evaluate the SBS. The sheared surfaces were also investigated with a stereomicroscope to assess adhesive remnants index (ARI scores) on the specimen surfaces. Results: Mean SBS in Group I-Group VI was 10.53 (2.91), 9.12 (2.56), 9.86 (1.98), 6.96 (2.92), 9.57 (2.02), and 7.65 (2.34) megapascals, respectively. Significant differences were only seen between Group III and IV and between Group II and IV. With respect to ARI scores, significant differences were seen only for comparison between Groups II, IV, and VI. Conclusion: Newly developed antibacterial agent could be used with conventional bonding systems effectively to decrease white spots; when used with Transbond XT^™ light cure, the original SBS did not get affected, but when used with Unite^™ self-cure bonding system, it led to reduced SBS significantly.

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