Background: There are several treatment approaches for mandibular condyle fractures. Type of fracture, clinical experience, and preference of the operating surgeon dictate the approach. Given this highly varied outcome, this manuscript intends to document the treatment experience of 75 patients with extracapsular condyle fractures using author's modification of the traditional endaural approach in the region. Materials and Methods: A retrospective chart review was performed on patients with mandibular condylar fractures who visited the author's center between 2004 and 2014. For the surgical reduction and fixation, an endaural (ear) approach via the author's modification of Al-Kayat Bramley's incision in the superficial temporal region was used. Postoperative clinical parameters were evaluated which include the degree of mouth opening, chin deviation during mouth opening, occlusal relationship, temporomandibular joint function, radiographic stability, and other postoperative complications of condylar fractures such as infection, plate fracture, and permanent paralysis of facial nerve. Adolescence/adult patients with unilateral/bilateral condylar fracture who underwent open reduction with the follow-up of at least 1 year were included in the study. Edentulous and patients <15 years who underwent closed treatment were excluded from the study. Results: The study group consisted of 75 cases of mandibular condyle fractures, of which 55 cases were of unilateral condyle fractures and 20 cases were of bilateral condylar fractures. Postoperative follow-up of patients ranged from 1 to 10 years with the mean of 3.04 ± 1.93 years. The occlusal relationships were excellent in all with the mean degree of mouth opening of 40.11 mm (maximum 4.5 cm and minimum 2.9 cm), of which four patients reported restricted mouth opening. Orthopantomogram and computed tomography showed complete anatomical reduction of the condyle fracture in all patients. Nine out of 75 patients developed transient facial weakness, with no other postoperative complications of condylar fractures such as infections, plate fracture, and permanent paralysis of facial nerve were noted. The overall success rate was 92%. Conclusion: Surgery for mandibular condyle fractures with modified approach allows direct vision of the fracture and reduces surgical trauma to the site while avoiding permanent facial nerve injury. Hence, the author's modified Al-Kayat Bramley incision via endaural approach could be considered as the best approach for open reduction and internal fixation of condylar neck and subcondylar mandibular fractures.

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Objective: The objective of this study was to compare the sorption and solubility of heat-cure and self-cure acrylic resins in different solutions. Materials and Methods: One heat-cure acrylic resin (Trevalon) and one self-cure acrylic resin (Rapid Repair) were studied. Five groups of square-shaped specimens (20 mm × 20 mm × 2 mm) were prepared for each acrylic resin and then immersed in five solutions: distilled water, artificial saliva, denture cleansing solution, distilled water, and denture cleaning solution for 12 h alternatively, artificial saliva and denture cleaning solution for 12 h alternatively at 37 ± 2°C, and tested sorption and solubility by weight gain/loss method, respectively, after 1, 6, and 11 weeks. The data were analyzed by one-way analysis of variance followed by post hoc Tukey's test. Results: Water sorption mean values varied from 17.5 ± 0.88 to 27.25 ± 1.04 μg/mm ³ for heat cure and from 12.75 ± 0.55 to 19.75 ± 1.04 μg/mm ³ for self-cure in the different solutions after different interval periods of 1, 6, and 11 weeks. These values were statistically significant (P< 0.001). Water solubility mean values varied from 0.25 ± 0.55 to 1.5 ± 0.55 μg/mm ³ for heat cure and from 1.5 ± 0.55 to 6.5 ± 0.55 μg/mm ³ for self-cure in the different solutions after different interval periods of 1, 6, and 11 weeks. These values were statistically not significant (P > 0.05). There was no linear correlation between sorption and solubility values. Overall, analysis of results showed the maximum sorption value in denture cleansing solution followed by alternative soaking in distilled water and artificial saliva. Least sorption was observed with artificial saliva followed by distilled water. Conclusion: Both heat-cure and self-cure acrylic resins showed varying water sorption and solubility. The results of both water sorption and solubility showed compliance with the International Standards Organization specification. No correlation was found between water sorption and solubility. Artificial saliva solution is a better storage medium than distilled water and denture cleansing solution for both heat-cure and self-cure acrylic resins.

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Background: Work-related musculoskeletal disorders (WMSDs) are responsible for morbidity in many working populations, which are of multifactorial in origin and of global concern due to industrialization. Dentists as one of the health-care professionals are prone to develop these WMSDs. The study aims to determine the prevalence of WMSDs among dentists in Bhopal region and explores the various risk factors for the development of MSDs and WMSDs. Materials and Methods: This proposed study is a cross-sectional study conducted among dentists of two randomly selected dental colleges of Bhopal, India. A structured questionnaire was used to collect the demographic information, occupational history, risk factors, and ergonomic awareness with job task details. Prevalidated standardized tools such as quick exposure check list, rapid entire body assessment score sheet, and Nordic Musculoskeletal Questionnaire were also used. Data were entered in MS-Excel and analyzed through SPSS version 18. Results: More than 92% of the participants reported pain and discomfort in at least one part of their body. The major affected body part is neck, followed by the lower back and wrist. More than half of the orthodontists and oral surgeons reported that their MSDs are work-related origin. Pearson's correlation test indicated that there is a positive correlation between the current exposure and risk (r = 0.613). Multivariate regression analysis found that younger participants, male (OR = 4.1), involved physical activity (OR = 1.04), dentists not taught about ergonomics in their dental school (OR = 1.69) or never attended any workshops (OR = 1.38), who reported task involving sustained muscle contraction (OR = 1.12) or task with repetitive movements (OR = 1.11) are the major risk factors for the development of MSDs among the dentists. Conclusion: This risk assessment study found that there is a high prevalence of MSDs and WMSDs among dentists. Ergonomic awareness and health promotion need to be integrated with the professional practice for dentists.

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Context: Topical corticosteroids are the treatment of choice for oral lichen planus (OLP) due to its potential anti-inflammatory effect. However, chronic nature of OLP often requires long-term and frequent applications, exposing patients to local and systemic side effects. Aim: To detect the systemic absorption of 0.1% triamcinolone acetonide (TAC) through the oral mucosa of patients with OLP. Subjects and Methods: This was a pilot pharmacokinetic study carried out in the Department of Oral Medicine and Radiology in collaboration with the Department of Toxicology, over 10 months. A total of twenty patients with OLP were included and advised to apply 0.1% TAC 3 times/day for 2 weeks and 2 times/day for next 2 weeks. Blood samples were obtained on the first and second visits and analyzed for triamcinolone using High pressure liquid chromatography (HPLC). Statistical Analysis Used: Paired t-test was done to compare visual analog scale (VAS) score for burning sensation at the first and second visits, statistically significant if P < 0.05. The baseline demographic data were analyzed using descriptive statistics. Results: Paired t-test was done to compare VAS score for burning sensation at the first and second visits, which turned to being statistically significant (P = 0.001). Although HPLC is an established method for the detection of TAC, none of the study populations showed evidence of steroid (TAC) in the blood sample during 4 weeks of treatment duration. Conclusions: 0.1% triamcinolone is a relatively safe drug to be used with no systemic absorption in the standard dose regimen for oral lichen palnus.

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Background: Attempts to refine toothbrushing (TB) technique, an ingrained habit in adults, can meet with some challenges. Recently, the role of proactive interference as a barrier to improving the learning of proper brushing has been proposed. This pilot feasibility study was designed to investigate TB behavior and to see how it changes after training. Smartphone video “selfies” (SPVSs) are increasingly being used in the medical field to assess, monitor, and determine the progression of diseases. Materials and Methods: We used SPVS to study TB skills in a small sample of volunteers. Over a period of 14 days, after a one-time group training session, we observed TB behavior of volunteers using self-captured SPVS. Results: Following the brief intervention, we observed an 8% of improvement in TB skills. Discussion: To the best of our knowledge, this is the first report using SPVS to study TB behavior. We demonstrated initial feasibility of using SPVS in the dental setting. We observed modest improvements in toothbrushing accuracy and quality, and we generated important experiences about the use of Selfies for TB monitoring and intervention, and some interesting insights about where in the toothbrushing is more or less effective. Conclusion: Further investigation using a larger sample size is needed to thoroughly assess the effectiveness of this approach to improve TB skills and better understand the role of proactive interference.

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Context: Platelet concentrates have been extensively used in a variety of medical fields to promote soft- and hard-tissue regeneration. The significance behind their use lies in the abundance of growth factors (GFs) in platelets α-granules that promote wound healing. Other than releasing a pool of GFs upon activation, platelets also have many features that indicate their role in the anti-infective host defense. Aim: The aim of this study is to evaluate the antimicrobial activities of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) against periodontal disease-associated bacteria. Subjects and Methods: Blood samples were obtained from ten adult male patients. PRP and PRF were procured using centrifugation. The antimicrobial activity of PRP and PRF was evaluated by microbial culturing using bacterial strains of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Results: P. gingivalis and A. actinomycetemcomitans were inhibited by PRP but not by PRF. Conclusions: PRP is a potentially useful substance in the fight against periodontal pathogens. This might represent a valuable property in adjunct to the enhancement of tissue regeneration.

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Objective: The aim of this study was to determine the prevalence of malocclusion and orthodontic treatment need in 13–18-year-old schoolchildren of Nalagarh, Himachal Pradesh, India using the Index of Orthodontic Treatment need (IOTN) and to analyze the treatment needs between males and females and correlation between the esthetic component (AC) and dental health component (DHC) of IOTN. Subjects and Methods: The sample comprised 2000 school children (1125 females and 875 males) who had not undergone orthodontic treatment. No radiographs, study casts, were used; IOTN was calculated from clinical examination. Results: DHC results showed that little need for orthodontic treatment was found in 31.6% and moderate need in 30.85%. A great need was estimated at 37.55%. Severe contact point displacement of more than 4 mm was the most common occlusal feature in the definite treatment need group, followed by increased overjet, impeded eruption of teeth, and anterior or posterior cross bite. AC results showed that little need for orthodontic treatment was in 86.15%, moderate need in 8.90%, and great need in 4.95%. Limitations: Index does not consider midline discrepancy, soft tissue abnormalities, and AC does not include Class III and Class II div 2 malocclusion photographs. Conclusions: There seems a discrepancy in the proportion of children needing orthodontic treatment on esthetic and dental health grounds. This study provides baseline data on the need and demand for orthodontic treatment among the sample which is important for planning public orthodontic and dental services.

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Objectives: Morphologic detection of connective tissue fiber changes in oral squamous cell carcinoma (OSCC) using special stains remains less documented. The aims of the present study were to study the collagen and elastic fibers in different stages of OSCC and to correlate these changes with two grading systems - Broder's and Bryne's. Study Design: Forty-eight cases of OSCC were studied using hematoxylin and eosin, Verhoeff's - Van Gieson stain for elastic fibers and picrosirius red stain for collagen fibers. The changes were compared with all the grades of carcinoma. Normal mucosa was taken as control. Results: Statistical analysis using Chi-square and ANOVA, showed significant association between the grades of carcinoma and extracellular matrix changes. Greenish-yellow collagen fibers were found to be significantly increased in the poorly differentiated/Grade 3 cases (P< 0.0001) where as well-differentiated/Grade 1 cases showed predominantly reddish-orange and yellowish-orange birefringence of collagen fibers. Chi-square analysis showed a significant amount of fragmented pattern of elastic fibers in poorly differentiated OSCC (χ² = 104.45, P = 0.009)/Grade 3 OSCC (χ² = 94.81, P = 0.016). Conclusion: The study of the connective tissue stromal changes can be used as an adjunct to histological grading and thereby helping the surgeon to determine the amount of marginal clearance.

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Context: The substantial knowledge concerning ergonomics and its practical application is vital for forestalling musculoskeletal disorders. The role of equipment ergonomics (EE) in preventing these work-related ailments is significantly noteworthy. Aim: The aim of the study was to assess the prevailing perception of postgraduates (PGs) and interns regarding EE and preparing the Indian dental workforce for the challenges of India's growing economy and population. Settings and Design: Authors conducted a cross-sectional survey between December 2013 and February 2014 amidst the interns and PG dental students of Davangere city, Karnataka, India. Subjects and Methods: The data were collected using 21-item custom designed proforma, comprising of questions evaluating student's basic knowledge about EE. Statistical Analysis Used: Statistical analysis was done using Chi-square test in each group (PGs and interns) and Mann–Whitney test was implemented for comparison between both groups. Results: Of 358 subjects surveyed, 48% PGs and 52% interns affirmed that they came across EE only through this survey. In addition, 91.18% of PGs and 90.59% interns believed that the accentuation on EE is less in the current dental curriculum. Conclusions: Comprehensive understanding and practical application of EE among the participants was found to be lacking. The importance of microbreaks and chair side exercises should be emphasized and training should be initiated at an early stage before improper postural habits develop.

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Context: Temporomandibular joint disorders (TMDs) have been recognized as one of the most common causes of nondental orofacial pain. Various studies have been reported in literature regarding the relationship between prevalence of signs and symptoms of TMDs and gender, suggestive of female predilection; however, none of the studies have yet been reported to suggest the relationship between knowledge about temporomandibular joint (TMJ) and TMDs and self-awareness of its signs and symptoms. Aim: To find a relationship between the level of knowledge about TMJ and TMDs and self-awareness of its signs and symptoms. Settings and Design: This study was designed as an institutional survey. The study sample comprised 491 undergraduate and postgraduate (PG) students, consisting of 90 males and 401 females with age ranging between 18 and 32 years. Subjects and Methods: Two sets of questionnaire were distributed among the students. Statistical Analysis Used: Statistical analysis was performed with the help of Epi Info (TM) 3.5.3, descriptive statistical analysis, test of proportion, Chi-square test, one-way analysis of variance, Tukey's test, and knowledge index. Results: It was observed that there was a gradual increase in the level of knowledge about TMJ and TMDs and self-awareness of its signs and symptoms from the 1^st year to PG students. Conclusions: A direct relationship exists between the level of knowledge about TMJ and TMDs and self-awareness of its signs and symptoms.

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Context: A study was done to assess the average distances of root apices of mandibular first molar, second molar, and second premolar to inferior alveolar nerve canal (IANC), among males and females in central India. Materials and Methods: High-resolution full-volume cone-beam computed tomography (CBCT) scans were obtained from the radiology database at the Sri Aurobindo College of Dentistry, Indore. After scrutinizing the database, CBCT of 40 males and 40 females that conformed to the inclusion and exclusion criteria were selected for the study. Results: All the data were analyzed using SPSS, Version 16. Descriptive statistics of the variables and measurements are presented using Students t-test (paired and unpaired), and correlation between age was tabled by Karl Pearson's correlation coefficient method. Conclusion: For the second premolar, the average distance to the IANC was 0.88–13.03 mm for males and 0.00–5.49 mm for females. The average distance of IANC to the mesial root apex of first molar was 1.46–13.23 mm for males and 0.93–8.03 mm for females. For the second molar, the average distance was 1.31–14.71 mm for males and 0.00–6.91 mm for females (values on left side were shorter as compared to right side). In the overall population, only second molar exhibited significant difference in the distance from root apex to IANC when compared bilaterally. In addition to gender differences, age-related differences were found to be significant for the first molar on left side and second molar on the right side of the population (P< 0.05).

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Objective: The objective of this study is to compare the cyclic fatigue resistance of nine types of endodontic instruments of nickel–titanium. Materials and Methods: Five files of 25 mm of length of each group: Reciproc (RC) R25; WaveOne (WO) Primary; Unicone (UC) L25 25/0.06; K3XF 25/0.06; ProTaper Universal F2 (PTF2); ProTaper Next X2 (PTX2); Mtwo 25/0.06; BioRaCe 25/0.06; One Shape L25 25/0.06 were subjected to a cyclic fatigue resistance test on a mechanical apparatus. The mean fracture time was analyzed statistically by one-way analysis of variance and Tukey's honest significant difference post hoc test, with significance set at P< 0.05. Conclusion: It was observed that the groups PTX2, RC, R25, UC L25 25/0.06, and WO Primary presented greater cyclic fracture resistance than the other groups (P< 0.001).

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Background: Periodontal attachment loss could be an earlier indicator or a possible risk factor of dentine hypersensitivity (DH). Thus, there is a need for diagnosing this condition both by questionnaire and by clinical examination before rendering both home care and in-office treatment modalities. Aims: To investigate the relationship between various demographic factors and DH and to detect the percentage of patients using desensitizing agents. Materials and Methods: In this cross-sectional study, 2051 patients were evaluated till the required sample size of 1000 patients was achieved who were evaluated both by questionnaire and clinical test. Association between DH clinical attachment level and apparent recession was established. Results: This study found that the prevalence of dentine hypersensitivity in chronic periodontitis patients was 37.2% according to questionnaire and 47.8% according to the results of clinical test. Various demographic factors were found to affect dentine hypersensitivity such as age, gender, education, diet, and locality. Conclusion: The prevalence of dentine hypersensitivity in chronic periodontitis patients was 37.2% according to questionnaire and 47.8% according to the results of clinical test. Periodontal attachment loss could be an earlier indicator or a possible risk factor of DH. Only 14.36% of the patients with sensitive teeth used desensitizing paste. This could be due to the fact that either the patients did not consider the condition bad enough to warrant treatment or it was not being diagnosed.

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Background and Objective: Endothelin-1 (ET-1) is a 21-amino acid peptide and is a potent vasoconstrictor produced by endothelial cells. It plays a role in the development of diseases such as hypertension and atherosclerosis. Previous studies have identified ET-1 in gingival tissues obtained from patients affected by chronic periodontitis or gingival overgrowth. Thus, there is a need to appraise the role of ET-1 in periodontal disease. Materials and Methods: The electronic search strategy included the databases such as PubMed, PubMed Central, LILACS, MEDLINE, ScienceDirect, MeSH, Cochrane database of systematic reviews, and EMBASE databases. Hand search of relevant journals was also carried out until September 2013. The included studies were both cross-sectional and longitudinal performed in vivo/in vitro, which measures the expression of ET-1 from various cells of the periodontium and in periodontal disease. Further, studies assessing the factors which influence ET-1 expression were included in the study. Results: A total of 15 articles were found relevant and fulfilled the inclusion criteria posed in this review. Ten studies discussed the concentration of ET-1 in periodontal disease, whereas eight studies investigated the cells expressing ET-1. Nine studies assessed the factors influencing ET-1 expression and two studies evaluated the influence of ET-1 on inflammatory mediators and other cytokines. The results suggested that ET-1 is elevated in periodontal diseases and is influenced by inflammatory cytokines and periodontal pathogens. Conclusion: ET-1 was found to have a role in periodontal disease, but further research will be required to substantiate its use as a biomarker.

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Context: Two of the problems of the placement of posts in teeth with short roots are to determine the minimum length of the canal obturation material at the apical third of the root canal and removal of all the canal obturation material from the root canal during post space preparation. Aim: The aim of the present study was to compare the coronal microleakage of mineral trioxide aggregate (MTA) plug and gutta-percha in short roots prepared for post placement using the bacterial penetration technique. Materials and Methods: In the presentin vitro study, 40 extracted single-rooted anterior teeth measuring 13 mm in root length were selected. Since the roots were short, 3 mm of the root length was allocated to the root canal obturation material and 10 mm of the root length was allocated to post placement. After preparation of the root canals, post spaces were prepared and the samples were randomly divided into two groups of gutta-percha and MTA. Fifteen root canals were obturated with gutta-percha and the post space was immediately prepared, with 3 mm of gutta-percha remaining in the apical end of the root canal. In 15 teeth, MTA plugs were placed, which measured 3 mm in length. The samples were placed in the Enterococcus faecalis bacterial microleakage system for 120 days. The time for the turbidity of each sample was recorded. Data were analyzed with Fisher's exact test. Results: During the study period, turbidity was observed in all the gutta-percha samples and in only four MTA samples, with statistically significant differences between the two groups (P< 0.001). Conclusion: Based on the results, MTA exhibited much better sealing ability compared to gutta-percha as a root canal obturation material in teeth with short roots.

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Plasmablastic Lymphoma of oral cavity is an aggressive rare form of Non Hodgkin's Lymphoma which is an Acquired Immuno Deficiency Syndrome defining condition. Head and neck region is the second most common area for extranodal NHL's primarily involving gingiva and palate, which often presents as a diagnostic problem. We report a case of PBL in a 19 year old female patient later diagnosed as Human Immunodeficiency Virus (HIV) positive. She presented with expanding painful ulceroproliferative lesion involving left mandible and gingiva of 20 days duration. Histopathological examination and immunohistochemical analysis confirmed the diagnosis. Uncommon discovery of multiple bony lesions in whole body CT and hypercalcemia raise a question about Multiple Myeloma (MM). Literature showed very few cases with osteolytic lesions and none of the cases reported multiple bone lesions in skull. Our case report stresses the importance of differentiating this extremely rare case of PBL with skull lesions from MM.

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Aim: The aim of this study was to analyze the expression level and localization of Toll-like receptor (TLR) 4 in gingival samples of healthy and chronic periodontitis subjects by indirect immunofluorescence technique (IFT). Materials and Methods: In this study, gingival tissue samples were obtained from 25 healthy and 25 periodontitis individuals. The tissues were processed and the initial characterization was done by hematoxylin and eosin staining. The expression and localization of the TLR4 receptor were determined in the epithelial and connective layer cells of the gingival tissue using the indirect IFT. Immunofluorescence images were acquired and quantitative expression of TLRs was analyzed by calculating the percentage of cells showing positive results. Results: We found that the healthy control group exhibited significantly lower values of TLR4 expression in comparison with the periodontitis patients. We also found that in patients with periodontitis the concentration of TLR4 was higher in the epithelium as compared to their expression in connective tissue cells. Conclusions: These data suggested a definite involvement of TLR4 in initiating and progression of an inflammatory response in periodontitis.

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