Objective: The objective of this study was to determine the most suitable material for indirect pulp treatment (IPT) clinically and to determine the thickness (in mm) and type of tissue in terms of radiodensity (in Hounsfield units [HU]) formed after pulp capping using cone-beam computed tomography (CBCT) scan. Materials and Methods: A longitudinal interventional single-blind randomized clinical trial was conducted on 94 children (7–12 years) with a deep carious lesion in one or more primary second molar and permanent first molar without the history of spontaneous pain indicated for indirect pulp capping (IPC) procedure. About 109 teeth were treated using three materials, namely, calcium hydroxide (setting type), glass ionomer cement (Type VII), and mineral trioxide aggregate randomly. The teeth were followed up at an interval of 8 weeks, 6 months, and 1 year for success of IPT as per the American Academy of Pediatric Dentistry clinical criteria. For determining the thickness and type of dentin tissue formed, a CBCT scan was done immediately postoperative and another scan at an interval of 6 months. The scans were compared to evaluate the average thickness of the dentin bridge formed. Results and Conclusions: Success rate for IPC was 96.85%. A significant difference was obtained in the average thickness of reparative dentin at immediate postoperative and 6-month postoperative values in all three groups suggesting distinct barrier formation. Similar significant findings were obtained in radiodensity of barrier formed (in HU). All three materials were found to be equally suitable as IPC agents suggesting mineral gain.

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Context: In India, teeth cleaning with tooth powder is common in rural and semi-urban areas. These dentifrices may contain low-quality abrasives, which may have a deleterious effect on dental hard tissues. Aims: This study aims to evaluate the tooth substance loss caused by different dentifrices and to correlate it with chemical composition, size, and shape of abrasives used. Settings and Design: An indigenously made automated machine was used for brushing the specimens. Materials and Methods: Sixty-four freshly extracted premolars were allocated to eight groups (n = 8). Colgate toothpaste was used as the control group. Each specimen was brushed in a vertical motion for 2½ h at 200 strokes/min with a constant applied load of 200 g corresponding to 6-month brushing. The difference in weight (pre- and post-brushing) was determined by an analytical weighing machine. Chemical analysis was done to determine the presence of iron oxide by Inductively Coupled Plasma Mass Spectrometry method. Shape and size of the abrasive particles was evaluated under scanning electron microscopy (SEM). Statistical Analysis Used: One-way analysis of variance and Paired t-test were used to analyze the data. Results: Tooth substance loss was maximum in the group brushed with red tooth powder, which was shown to contain the highest amount of iron oxide and also exhibited large, irregularly shaped abrasive particles under SEM. Conclusions: Tooth substance loss was documented to be correlated with chemical composition (iron oxide) and the size and shape of abrasive particles used in dentifrices.

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Fibrous ankylosis is a common complication of trauma to the temporomandibular joint (TMJ) in children. Proper treatment and regular follow-up is necessary for its successful management. This report highlights a case of posttraumatic fibrous ankylosis successfully managed with brisement force-gradual tractional forces applied to the TMJ under local anesthesia without any associated complications. Mouth opening increased significantly from 15 to 35 mm. The patient was advised to perform rigorous physiotherapy at home, to maintain interincisal opening of 35 mm. The case was followed up for 6 months with no decrease in mouth opening.

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Objective: The aim of this study was to assess the effect of adjunctive photodynamic therapy (PDT) (using 810 nm diode laser and Indocyanine green as photosensitizer) in chronic periodontitis. Materials and Methods: Patients with untreated chronic periodontitis were included. Treatment was done according to a split mouth design. All sites received periodontal treatment comprising scaling and root-planing (SRP). Test group were additionally treated with PDT. Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD) and Relative Attachment Level (RAL) were evaluated at baseline, 1 month and 3 months. Results: Mean baseline values for PI, GI, PPD and RAL were not different in the test group and control group. Statistical significant difference in PPD and RAL, 3 months after treatment was seen in test group as compared to the control group. Conclusions: In patients with chronic periodontitis, clinical outcomes of conventional SRP can be improved by adjunctive PDT.

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Context: A better understanding of the relation between traumatic dental occlusion and periodontal changes is needed. Aims: This study aimed to evaluate the pattern of osteoclastic activity in the periodontal bone in front of the traumatic dental occlusion in rat molars. Patients and Methods: Traumatic dental occlusion (TO) was induced in twenty rats, which were sacrificed after periods of 2, 5, 7, and 14 days. Transversal histological sections of both jaws were stained with tartrate-resistant acid phosphatase and hematoxylin and eosin. Mann–Whitney U-test was used for group comparison, and Pearson's correlation test was applied for the number of osteoclasts and bone area (BA). Results: Traumatic dental occlusion caused an increase in the number of osteoclasts in the bone of the upper and lower right first molar from days 2–5 to 2–14, respectively. In the TO groups, the number of osteoclasts on the lamina dura and in the center of the alveolar bone septum, respectively, increased almost 4-fold and 9-fold in the lower jaw; and 3-fold and 5-fold in the upper jaw, during all periods. In the TO groups, the BA of the alveolar bone septum was substantially reduced. There was a negative correlation between the number of osteoclasts and BA in both jaws during all experimental periods. Conclusions: Traumatic dental occlusion increases osteoclast activity in the alveolar lamina dura and in the center of alveolar bone and stimulates a higher degradation in the center of the alveolar bone septum.

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Aim: The purpose of this study was to determine the closest matching shade for primary maxillary anterior teeth from the most widely used Vitapan classical shade guide available for permanent teeth. Materials and Methods: A total of 313 children aged between 3 and 5 years were evaluated. Vitapan classical shade guide was used to determine the shade of six primary maxillary anterior teeth. Scores obtained were noted down in a scoring sheet and values were tabulated. Data collected were tabulated and statistically analyzed using Pearson Chi-square test. Results: A1 was found to be the closest matching shade for primary maxillary anterior teeth. D3 was found to be the least prevalent shade for primary maxillary anterior teeth. There was no statistical significant difference in the shades among teeth of same quadrant (p > 0.05) and also between teeth of right and left quadrants (p > 0.05), respectively. Conclusion: A1 shade of Vitapan classical shade guide is the most prevalent shade for primary maxillary anterior teeth and can be satisfactorily reproduced to all primary maxillary anterior teeth in general.

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Background: Cone-beam computed tomography (CBCT) is an upcoming imaging modality in field of dentistry with promising outcomes. Aim of the Study: To assess the dental student's knowledge and attitude regarding CBCT in K. M. Shah Dental College and Hospital as they are future practitioners. Methodology: An anonymous questionnaire consisting of 11 questions was distributed among 320 dental students which included final BDS students, interns, and postgraduate students. Descriptive statistics was used to analyze the responses of the participants, and Chi-square test was applied to statistically evaluate the differences in the responses according to the education level. Results: Totally, 96.9% response rate was achieved. All the students had heard of CBCT used for dental practice. The majority of them gained knowledge about CBCT through faculty lessons. Lower radiation dose was given as the most important advantage of CBCT over medical computed tomography. Many of the students thought that CBCT should be taught during clinical phase of their education, and there is necessary for CBCT unit at dental faculties. More than half of the students believed that the use of CBCT would become more widespread in the near future, and they aspire to use CBCT technology in their future careers. Conclusion: Seeing the positive attitude, it was concluded that the students' should be provided with thorough practical knowledge and efforts should be made to improve their concepts regarding CBCT.

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Introduction: Esthetics is one of the major concerns among people seeking orthodontic treatment, and its perception varies from person to person. Our objective was to determine the differences in the perception of smile esthetics among orthodontists, general dentists, and laypersons with respect to alteration in the maxillary canine gingival margin in close-up smile analyses. Materials and Methods: Close-up photograph of an ideal Indian female smile was selected. The images were digitally altered to create symmetrical images with the gingival margin levels of maxillary canine matching the central incisors. Twelve alterations were created in the gingival margin of the canine with discrepancies of 1, 2, and 3 mm in relation to the most superior point on the labial gingival margin of patient's central incisor and divided under four groups. Finally, close-up images of the smile were assessed by orthodontist, general dentist, and layperson who indicated the level of attractiveness of each smile on a visual analogue score. The data collected were then statistically analyzed by one-way analysis of variance followed by Newman–Keul's range test. Results: Most evaluators considered all the three components, i.e., lips, teeth, and gingiva while assessing the smile's attractiveness. Statistically significant differences were observed between different evaluator groups when considering bilateral increase in crown height by 2 and 3 mm. The perceptions of asymmetries in the gingival margin levels of the maxillary canines were 1.0 mm for orthodontists and 2.0 mm for laypersons. Conclusion: The result of this study suggested that the orthodontists were more critical than dentist and layperson in evaluating smile esthetics.

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Background: Many pathogenic fungi fluoresce in hematoxylin and eosin stained sections, and Papanicolaou (PAP)-stained smears under ultraviolet illumination. In theory, this phenomenon could aid in the diagnosis of common fungal infections without the delay which is usually associated with special stains. Objective: To evaluate the role of fluorescence as a rapid screening technique for oral infections caused by Candida organisms in exfoliative smears of oral candidiasis. Materials and Methods: Two smears and one swab were collected from each of 62 clinically diagnosed cases of oral candidiasis. Smears were stained with (PAP) and periodic acid–Schiff stain (PAS). Both smears were evaluated under light microscopy (LM). Later, PAP smears were observed under fluorescent microscopy (PAP-FM). The swab was inoculated on Sabouraud's agar plate. Each technique was evaluated for sensitivity and specificity. Results: It was found that the PAS-stained smears were more reliable for detection of Candida species than other methods (sensitivity = 100%; specificity = 66.7%). The PAP-LM and PAP-FM showed less sensitivity (67.9% and 85.7%) and specificity (66.7% and 33.3%), respectively. Combined results of both light and fluorescent microscopy of PAP (LM + FM) showed increased sensitivity (89.3%) but reduced specificity (16.7%). Conclusion: PAP autofluorescence is less sensitive than PAS, still it accentuates the distinct morphological features of Candida.

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To tackle a large midline diastema and generalized spacing existing before extraction often poses a challenge to the treating prosthodontist. The situation becomes even more complicated if the patient is a teenager, with multiple missing teeth, associated deep bite and where the jaw bone growth has not yet been completed. Possible treatment options would include a removable prosthesis, a fixed partial denture or an implant supported prosthesis. Treating such cases with a simple removable prosthesis cannot be justified if a deep bite existed which would result in posterior disocclusion. Also a conventional fixed partial denture or closure of the diastema with light cure composite (LCC), would result in a seemingly large tooth, which would be unaesthetic in appearance. Implant supported prosthesis is a possibility, if the patient's jaw bone growth has been completed. Another simple non-invasive solution to this problem would be to fabricate a non-rigid connector using loops. This presentation describes the procedure for fabrication of an interim loop connector for a 16 year old female patient who had lost one of her maxillary central incisors as a result of trauma. Patient also had multiple spacing in the maxillary anterior teeth and an associated deep bite. Her cephalogram revealed that she had a Class III skeletal pattern. A permanent treatment at this stage was not possible due to ontoward mandibular growth pattern as revealed on the cephalogram. Hence to dodge all these problems, a simple and non-invasive treatment using loop connectors was chosen till the growth period was completed.

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Purpose: The purpose of this research was to compare stress distribution on the bone between single implant-retained and two-implant-retained mandibular overdentures using three-dimensional (3D) finite element analysis. Materials and Methods: Two 3D finite element models were designed. The first model included single implant-supported mandibular overdenture placed in the midline of the mandible while the second model included two-implant-supported mandibular overdenture placed in the intra-foramen region, retained by ball attachment of the same diameter. The bone was modeled on the D2 bone depending on the classification given by Misch. A computed tomography scan of the mandible was used to model the bone by plotting the key points on the graph and generating the identical key points on the ANSYS Software (ANSYS, Inc., USA). The implant was modeled using appropriate dimensions as provided by the manufacturer. Stresses were calculated based on the von Mises criteria. Results: Stresses produced in the hard bone (HB) and soft bone (SB) were higher in single implant-retained mandibular overdenture while stresses produced around the denture as well as implant were higher in two-implant-retained mandibular overdenture. Conclusion: Within the limitations of the study, it had been seen that stresses produced were the highest on HB and SB in single implant-retained mandibular overdenture while stresses produced across the denture as well as implant were the highest in two-implant-retained mandibular overdenture.

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Statement of Problem: Salivary and serum lactate dehydrogenase (LDH) levels have been correlated with potentially malignant lesions. Salivary LDH levels require special testing and can be expensive. The need for a simple and cost-effective analysis tool is essential to detect the oral malignant lesions to benefit rural populations. Aim: The aim of this study is to estimate the serum LDH in patients with oral lesions due to the consumption of smokeless tobacco. Materials and Methods: Thirty-five patients with lesions were selected for this study while twenty patients served as a control. Levels of serum LDH were assessed. Age- and sex-matched controls (n = 10) with no smokeless consumption habit and with the habit but without lesion (n = 10) also had their blood drawn to assess the basal level of LDH. The results were then analyzed through the two-tailed t-test and Chi-square analysis using the SPSS statistics software. Results: The mean LDH value of patients with habit and lesion is 446.8 U/L; the mean LDH value for patients with habit but without the presence of a lesion is 421.2 U/L, and the mean LDH value for patients without a habit or lesion is 269.4 U/L. The patients having the habit of using smokeless tobacco had higher LDH values compared to the other two groups, and it is found to be statistically significant (p < 0.05). Conclusion: Serum LDH values increased in patients with the habit of chewing smokeless tobacco.

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Osteopetrosis is a rare genetic bone disorder arising due to a defect in the differentiation or function of osteoclast which results in a generalized increase in bone mass. Osteomyelitis is one of the most common complications because of decreased bone marrow function and compromised blood supply. Radiologist plays a vital role in diagnosing osteopetrosis. Here, we present two cases of autosomal dominant osteopetrosis Type II (ADO II) with secondary osteomyelitis changes which were reported to our department. One of these two cases presented with secondary osteomyelitis in both maxilla and mandible and features of rickets, which is very rarely seen in ADO II. To the best of our knowledge, the presentation of rickets with ADO is the first of its kind to be reported. In this paper, we describe the clinical and radiological features leading to the diagnosis of ADO in these two patients. Further, a review of the literature regarding ADO is discussed.

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Background: The purpose of this study was to compare the frontal lip cant changes in common facial asymmetry (FA) cases after simultaneous maxillomandibular distraction osteogenesis (DO) and mandibular DO with maxillary orthognathic surgery. Materials and Methods: Retrospective analysis of FA cases at tertiary craniofacial referral was performed. Patients of either gender with all medical imaging records and pre- and post-operative (1 year) facial photographs in natural head position were included in the study. The lip cant change was assessed by the ratio of the linear dimension between affected and unaffected side labial commissures and the bi-pupillary reference line. Difference between the pre- and post-operative ratio was analyzed. Statistical analysis was performed for the outcome. P ≤0.05 was taken as significant. Results: The mean preoperative measured value of the affected side was 0.845 ± 0.036 while the postoperative value was 0.95 ± 0.032. The effective change was 0.11 ± 0.044. The postoperative ratio compared with simultaneous DO case was 0.98 ± 0.06 while that of mandibular distraction with orthognathic surgery was 0.92 ± 0.08 (P = 0.048). The mean change of the simultaneous DO case was measured as 0.114 ± 0.041 while the same for the mandibular distraction with orthognathic surgery was 0.069 ± 0.035 (P = 0.013). Discussion and Conclusion: The results indicate that the simultaneous DO yields more better frontal lip cant change between both halves than the mono-DO with orthognathic surgery. The mean change is much higher in the simultaneous DO cases indicating a more effective correction and desired result. The biological reason and lip musculature mechanism behind the response in both conditions are discussed.

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Separation of the endodontic instrument within the root canal system and sharp injuries to the dentist is not an uncommon event in endodontic practice. Although root canal instruments can fracture at any stage of endodontic treatment, its fracture within the dentist's hand is a very rare event. An unusual case of accidental separation and lodgment of rotary endodontic file in the dentist's thumb is presented along with its management. A 33-year-old dentist reported with an accidental lodgment of rotary endodontic file into his thumb. The fractured instrument was removed successfully by a surgeon. The present case describes a rare event of occupational risk in endodontic practice.

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Aim: The aim of this study was to comparatively assess the gelatinolytic activity of matrix metalloproteinases(MMPs) and Cysteine Cathepsins (CCs) in the adhesive interface using etch and rinse adhesive at different time intervals using zymographic technique. Methodology: Twenty freshly extracted non-carious human third molars were used in this study. Occlusal surfaces were ground flat and 1mm thick horizontal dentin slabs were obtained from each tooth using a diamond disc. The dentin surface was polished with 600-grit silicon-carbide paper. Five out of 20 samples were directly pulverized. In the remaining fifteen samples, the dentin was etched and adhesive was applied and light cured according to the manufacturer's instructions. A 1mm thick flowable composite was build up and light cured. Bonded specimens were cut vertically into 3 to 4 dentin slabs by means of diamond disc to expose the adhesive/dentin interfaces. These were then ground down to 500 µm thick resin-dentin interface using a hard tissue microtome. These sections were then pulverised into powder. Following this, every five samples were subjected to zymographic analysis after 1 day, 7 days and 21 days. Results: Zymograms showed clear, thicker bands on all three isoforms in the etched samples compared to control samples at 1^st and 7^th day intervals and became inactive at 21^st day for all three isoforms. MMP 9 activity was relatively higher when compared to CCs and MMP 2. Conclusion: Etch and rinse adhesive activated MMPs and CCs within the hybrid layer that remained active till 7^th day and no gelatinolytic activity was found on 21^st day and MMPs are more active compared to CCs and MMP-2.

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Aims: To evaluate the levels of salivary thiocyanate and its relation with the occurrence of micronuclei (MN) using exfoliative cytology in smokers and nonsmokers. Materials and Methods: One hundred and twenty patients were divided into 3 groups: nonsmoker group 1 (control), smokers group 2, and smokers group 3. Their saliva was collected and analyzed for thiocyanate levels, and exfoliative cytology was evaluated for the presence of MN. Statistical Analysis Used: Fisher's exact test and ANOVA test were used. Results: It was seen that as the grade of smoking increased, the levels of salivary thiocyanate and occurrence of MN increased. Conclusions: Detection and quantification of “biomarkers” such as salivary thiocyanate and MN in noninvasive and painless procedures such as oral exfoliative cytology can be an upcoming research domain in the field of cancer prevention and therapeutics.

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Background: The Government of India is increasingly emphasizing the provisioning of dental services in public hospitals, but the rural and deprived sections are struggling to get basic dental procedures done in public hospitals. Aim: To study variations within and across public hospitals for provisioning of dental health settings in Jalandhar district of Punjab. Settings and Design: The study area consisted of four Community Health Centers (CHCs) and District Hospital situated in Jalandhar, Punjab, India. Materials and Methods: The dental infrastructure and dental procedures performed in the public hospital were checked with the help of a checklist as listed in the Indian Public Health Standards 2012 for CHCs and district hospital, and then, the variations within and across these public hospitals were compared. Statistical Analysis: Percentages were used to make comparisons within and across the public health institutions. Results and Conclusions: The results showed that out of total outpatient department (OPD) of the public hospitals, dental OPD formed 5%–10% in public hospitals and extraction was the most frequently performed procedure. There is no availability of prosthodontic and orthodontic procedures in the public hospitals. There were no dental auxiliaries in the CHCs, and there was lack of proper dental materials needed in the dental clinics.

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Aim: The purpose of this study was to analyze the presence of Aggregatibacter actinomycetemcomitans in saliva and cardiac tissue samples of children requiring cardiac surgery in Istanbul, Turkey. Subjects and Methods: Twenty-five patients (mean age: 6.24 ± 2.93) undergoing surgery for congenital heart defects (CHDs) and an age/gender-matched control group of 25 healthy children were enrolled in the study. Saliva samples were collected from all children; plaque index (PI) and gingival index (GI) were also determined. In CHD group, cardiac tissue samples were received during surgery. All samples were evaluated for the presence of A. actinomycetemcomitans and its highly leukotoxic JP2 clonal strains using polymerase chain reaction. The findings were analyzed by Mann–Whitney U, Chi-square, and Fisher's exact tests. Results: No significant differences were found in PI and GI values between the groups. A. actinomycetemcomitans was not detected in cardiac tissue samples. A. actinomycetemcomitans in saliva was detected in 2 (8%) of the CHD and 5 (20%) of the control children (p > 0.05). A. actinomycetemcomitans JP2 clonal strains were determined from 1 (4%) of the control group while it was not determined from the samples of the CHD group. Conclusions: Early colonization of A. actinomycetemcomitans in oral cavities could be assessed as a risk marker for periodontal disease. Periodontal pathogens may enter bloodstream through bacteremia; thus, the presence of periodontal pathogens in the oral cavity of children should be assessed as a risk marker for cardiac diseases in older ages.

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Context: Mouthrinses are used, by many of our patients, as a complement to daily dental hygiene routine. The use of a toothbrush and an interproximal cleaning method may not be enough to control dental plaque. Essential oils and delmopinol mouth rinses are effective for the prevention of dental caries and gingivitis. To study the effect of an essential oil and a delmopinol mouth rinse on dental plaque bacteria, an in vitro study was developed. Aims: The objective of this study was to determine the antibacterial activity of an essential oil and a delmopinol mouth rinse on Streptococcus mutans, Lactobacilli, and aerobic and anaerobic dental plaque nonspecific bacteria. Design: Samples of human dental plaque were collected from consenting participants and bacteria isolated. Disk-diffusion tests were performed to obtain the minimum concentration of the mouth rinses necessary to inhibit bacterial growth. The ability of the commercial mouth rinses to inhibit bacterial growth was studied in comparison to a positive control (0.2% chlorhexidine) and a negative laboratorial control (sterilized water). Results: The minimum inhibitory concentration was found to be inferior to the commercial essential oils and delmopinol mouth rinses concentrations. Delmopinol and essential oils have significant antibacterial properties shown in vitro only for aerobic bacteria, and for S. mutans, Lactobacillus, and anaerobic bacteria, the results were not statistically significant. Conclusions: Essential oils and chlorhexidine are statistically similar and better than delmopinol for aerobic bacteria growth inhibition. For the other bacteria, essential oils and delmopinol are not statistically promising. Results show that essential oils only may help patients to maintain good oral health as a complement to daily brushing and interproximal cleaning.

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