Background: Crestal bone level surrounding a dental implant is a dynamic structure due to bone remodeling and possible bone loss after implant loading. The study aims to compare the bone changes around single implants 1.8 mm machined collar soft tissue level versus bone level implant with nonmachined collar all roughed surface placed either in the maxilla or the mandible at 3–6 years Materials and methods: A randomized controlled clinical trial was conducted among 100 patients needing dental implants. The participants were randomly divided into two study groups; group 1 received bone level implants. Group 2 received soft tissue level implants (1.8 mm machined surface). After three months of the healing period, the implants were loaded with a screw-retained single crown. The initial measurement was done at three years and repeat measurements were recorded after six years. Statistical analysis was performed by paired sample t-test and independent sample t-test. Statistical significance was considered at α = 0.05. Results: The bone measurements for the soft tissue level implant at three years and six years were 0.556 ± 0.2742 mm and 1.172 ± 0.6128 mm, respectively while those for the bone level implant were 0.668 ± 0.3178 mm and 1.366 ± 0.8163 mm, respectively. The intragroup comparison revealed that there was a statistically significant rise in the measurement at the 6-year evaluation as compared to the three-year evaluation for both the type of implants. However, the intergroup comparison revealed no statistically significant difference in the bone measurement between the two implant types at both three years and 6-year measurements. Conclusion: There is no difference in the bone changes around single implants placed either at soft tissue level or at the bone level. Clinical significance: The choice of implant should be based on the esthetic requirement of the patient as well as the clinician's expertise.

Aim: To assess and measure the levels of Interleukin-6 (IL-6) expression in the periodontal ligament (PDL) during orthodontic treatment at various intervals of the force application. Materials and methods: A sample of 60 premolar teeth were divided into controls and test groups of 30 samples each. Each tooth was assigned a time point for its extraction at 2 hours, 15th day or the 30th day after application of force. Brackets were bonded to the experimental teeth in the mesiodistal center but at 5 degrees to the long axis of the tooth to apply a force of 200–250 g, which was measured by Correx gauge. Gracey's curette was used to scrape off all the periodontal ligament covering the root surface of the extracted teeth. Cytokine IL-6 was measured by the use of an enzyme-linked immunosorbent assay (ELISA) kit at a wavelength of 450 nm. Results: There was no difference in the levels of IL-6 at 2 hours for the test and the control groups. IL-6 concentration showed the maximum levels when measured on the 15th day and showed a decrease on the 30th day. Conclusion: This study depicted a pattern followed by IL-6 after orthodontic force application, and is a step further in establishing IL-6 as a potential biomarker for improving the orthodontic treatment in terms of decreased treatment time and decreased side effects. Clinical significance: IL-6 can be used as a potential biomarker for efficient treatment in terms of decreased treatment time intervals and decreased side effects of the orthodontic treatment.

Background: Diastema is one of the many esthetic abnormalities due to various causes. One of which is abnormal frenulum. Objective: The aim of this study is to determine the prevalence of different types of labial frenum and their effect on median diastema in 3–6-year-old children in Tehran kindergartens. Materials and methods: This study was a cross-sectional one that was performed on 639 children aged 3–6 years by referring to kindergartens. Studying these children included oral examination under normal light with a tongue depressor in upright position. By lifting the patient's lip and performing a blanching test, it was determined whether or not a person has normal frenulum. Information was also provided about the presence or absence of median diastema in upper jaw and the type of frenum adhesion. Also, the central teeth in maxilla were carefully examined in terms of spacing and caries. Data were analyzed by descriptive and analytic statistical methods. In the analytic part we used the binomial logistic regression test and also in the descriptive section of the frequency, tables and graphs are presented. Conclusion: In this research, a total of 639 children were studied, 341 of which were male and 298 were female. Among these 214 people (33.5%) had abnormal frenum and 425 people (66.5%) had normal frenum. Frenum adhesion site for 52.9% of the people was observed in attached gingiva and for 19.9% of people was observed in the mucogingival junction and for 18.8% of people was observed in the interdental papilla and for 8.5% of people the site of frenulum was in depth of the palatal papilla, and there was no significant difference between two sexes in terms of prevalence of different types of maxilla labial frenum. The results showed that there is a significant relationship between high frenum and maxillary median diastema and there is no significant relationship between age and high frenum.

Aim: The aim of this study was to determine types of facial fractures that use the preseptal transconjunctival approach and to evaluate the lower eyelid condition. Materials and methods: Ninety-one patients who underwent open reduction internal fixation of facial fractures using preseptal transconjunctival approach from 2005–2013 were included and analyzed from clinical records. We evaluate the incidence of postoperative complication such as visible scar at rest, entropion, ectropion, scleral show, trichiasis, conjunctival granuloma, lower eyelid laceration, corneal lesion, and lacrimal drainage lesion. The types of facial fractures that frequently use this approach were also analyzed. Results: Four out of ninety-one patients were excluded because of insufficient data. Zygomatic complex fracture occurring in isolation or combination with other fracture was the commonest fracture type encountered (93.5%). Two complications (entropion and trichiasis) occurred in one out of eighty-seven patients. The complication rate in this study was very low at 1.1%. Conclusion: A preseptal transconjuctival approach is a versatile approach that can be used in all mid-face fracture situations providing an alternative to the invasive transcutaneous approach. It provides minimal complications with superior esthetic result. Clinical significance: The management of facial fractures that involve orbital rim or floor often poses a challenge to the surgeon because surgeons aim for complete repair of the orbital anatomy with least complication and superior esthetic result. Two surgical incisions existed in the process of reaching orbital bony component which is the transcutaneous and transconjunctival approach. It will help clinicians to know which approach provides minimal complication.

Aim: Extrusion of debris during endodontic preparation carries the risk of flare-ups. Purpose of this study was to evaluate and compare the three different rotary systems (ProTaper Next, WaveOne and iRace) for the amount of debris, irrigant, and bacteria they extruded apically. Materials and methods: Present study is an in vitro, experimental single-blinded randomized study. Thirty extracted premolars were used for the study. Biomechanical preparations of the specimens were done using either ProTaper Next, WaveOne or iRace file systems. The apically extruded irrigant was collected and measured using the Myers and Montgomery model. Statistical analysis was done using Mann–Whitney and Kruskal–Wallis test. The level of significance was set at <0.05. Results: Study revealed that WaveOne extruded least bacteria and debris and Protaper Next the highest which was statistically significant. WaveOne group and Protaper Next had more number of irrigant extrusion than iRace. The difference between WaveOne and iRace was statistically significant. A significant difference was noted in the amount of debris, bacteria, and irrigant between WaveOne and iRace. A significant difference was also noted in the amount of debris, irrigant, and bacteria extruded between Protaper Next and iRace. Conclusion: Significant amount of debris and bacterial extrusion was seen in ProTaper Next followed by iRace and WaveOne, whereas apical extrusion of irrigant solution, was greater with WaveOne than ProTaper Next and iRace. Clinical significance: WaveOne causes the least extrusion of debris and bacteria and this outcome would help in the selection of the system while choosing the rotary system for endodontic treatment.

Aim: The study was aimed to find out the prevalence of tobacco use and to assess the perception of young tribal adolescent toward tobacco use in a tribal area of Hamalkasa, Gadchiroli, Maharashtra, India. Materials and methods: A cross-sectional study design was carried out at four schools located at different villages of Hemalkasa, Gadchiroli, Maharashtra, India. Total of 1872 school children of 10–17 years of age was included in this study. Perception of tobacco use was recorded by a modified global youth tobacco survey questionnaire which was translated in a local language. Statistical analysis was performed by using statistical package for the social sciences (SPSS), version 11.5 and Chi-square test was used to analyze the significant difference. Results: Out of 1872 tribal adolescent screened, 856 (45.7%) were tobacco consumer among them 544 (29.1%) were male and 312 (16.7%), female tobacco users. Mean age of starting tobacco use was 6.07 ± 1.47 years and the majority of tobacco consumers 679 (79.3%) were using smokeless tobacco while 139 (15.4%) were current smokers. Among tobacco users, 704 (82.2%) admit the use of tobacco by their family members and 260 (30.4%) reported the reason for starting tobacco use was peer pressure. Conclusion: It can be concluded that the prevalence of tobacco use among tribal adolescent was exceptionally high. Overall, the study provides valuable information for future community-based studies on tobacco use in tribal area. Clinical significance: The exploratory finding provides valuable input into current tobacco usage among the tribal adolescent and potential reasons for adopting the use of tobacco at an early age. The study finding can be used as baseline data for the planning and implementation of a tobacco cessation program among tribal adolescent.

Aim: The aim of this work was to study the effect of adding zirconium oxide (ZrO₂) nanofiller at different concentrations (0.5 wt%, 1 wt%, and 3 wt%) on the impact strength (IS) and fracture toughness (FT) of heat-polymerized polymethylmethacrylate (PMMA). Materials and methods: Zirconium oxide nanofiller (ZrO₂) was added at different concentrations (0.5 wt%, 1 wt%, and 3 wt%) to PMMA. Total of eighty specimens was prepared for both tests, 40 for an individual test. For the individual test, four groups were formed (10 specimens each). There were three experimental groups with ZrO₂ powders at different concentrations (0.5%, 1%, and 3%) by weight and one control group without any addition. For measuring IS, Charpy's impact test was used, and the universal testing machine was used for FT. The values obtained for IS and FT were tabulated and statistically analyzed. Analysis of variance (ANOVA) and Tukey's test were utilized to analyze the level of significance in between the obtained means of the various groups, where the level of significance was set at a p value of .0.05. Results: Reinforcement of PMMA with ZrO₂ nanofiller significantly increased the IS and FT values between study groups (p = 0.000). Highest values obtained for IS and FT by adding 3 wt% nanofiller were 3.89 kJ/m² and 2.76 MPa.m^1/2, respectively in comparison to control values of 1.53 kJ/m² and 1.23 MPa.m^1/2. Clinical significance: PMMA resin with improved properties obtained by addition of ZrO² nanofillers can serve in prosthodontic applications. Conclusion: It was found that addition of ZrO₂ at different concentrations improved the values for IS and FT of PMMA in comparison to the control group. The maximum values were obtained with 3 wt% of ZrO₂ nanofiller.

Aim: To evaluate and compare the quality of root canal filling performed by junior and senior undergraduate students attending College of Dentistry at King Khalid University (KKUCOD). Materials and methods: A total of 460 radiographs of teeth treated by two different levels of students were eligible for the study. Undergraduate students under the close supervision of endodontists following KKUCOD endodontic protocol performed all randomized controlled trial (RCTs). Three different examiners independently evaluated the radiographs after 4 weeks training with endodontists on radiographic analysis with the good interexaminer agreement. The quality of root canal filling was evaluated in regard to length, density, taper and encountered procedural errors during treatment having the final outcome as either acceptable or not-acceptable root canal filling. Results: The percentage of root canal obturation with adequate length of was 57% for lower-level students and 69.3% for higher-level students. A higher proportion of students in lower-level performed obturation with inadequate density compared to higher-level students. Inadequate tapering was significantly more in lower-level student. Considering tooth type, overall RCT quality was similar in anterior and premolars between different student levels while it was significantly inadequate in molars among lower-level students. Conclusion: The quality of root canal filling was satisfactory compared to other similar studies in Saudi Arabia. Teaching crown-down technique and rotary instrumentation training are recommended. Finally, Molars and multirooted premolars should be referred to specialists. Clinical significance: It is highly important to closely monitor undergraduate students in performing RCTs to increase the quality of treatment. This will increase the success of treatment performed by general practitioners, reduce a load of referral to specialists and decrease the long waiting lists in dental service centers in Saudi Arabia.

Aim: To analyze the sociodemographic determinants of dental fluorosis among high school children aged 12–16 years in Mangaluru, Karnataka, India. Materials and method: A cross-sectional study was conducted. Simple random sampling technique was employed to select the three schools for the present study. Demographic details and previous medical history was assessed by administering the questionnaire to the study subjects. Presence of dental fluorosis was assessed using the World Health Organization (WHO) oral health assessment form of 2013. Results: A total of 500 students were examined for the present study. A major fraction of the study population was formed by males. It was observed that 95 participants were affected by varying severity of dental fluorosis with the prevalence of 19%. Correlation and logistic regression analysis showed the occupation of father and dietary pattern to be significantly correlated with the presence of fluorosis in study subjects. Conclusion: Prevalence and severity of the condition are found to have a huge burden in the given urban population of Mangaluru city. As the occupation of father and dietary pattern showed significant association with fluorosis, further interventional studies are recommended to be conducted considering these socioeconomic factors. Clinical significance: Results of the present study will further our understanding of the association between prevalence and social determinants of dental fluorosis, which may be critical for prevention and control of the condition.

Aim: The aim of this cross-sectional study was to identify and analyze the attitudes and practices of general dental practitioners of Karachi, Pakistan while performing dental composite restorations. Material and methods: A self-applied questionnaire was furnished to 150 general dental practitioners. A total of 125 practitioners filled and returned the filled questionnaire. The questionnaire mainly enquired about the commercial brand of composite resin used, dispensing and curing methods, handling techniques, finishing/polishing practices, and discoloration complaints made by the patients (if any). The results were collected and analyzed statistically. Results: The response rate was 83% (n = 125). The results indicated that 80% (n = 100) of the respondents claimed that they use a single paste system and blue light for curing. The number of dentists who covered the lid of single paste composite after usage was 68% (n = 85), whereas 72% (n = 90) used transparent matrices after placement the final layer of the composite restoration. Majority of the practitioners preferred finishing discs 53% (n = 66), and 84% (n = 105) of the patients returned with the discoloration complaint after two years. Conclusion: Majority of the general dental practitioners in Karachi, Pakistan preferred single paste system, blue light for curing, and discs for finishing restorations. Most patients returned after two years with a complaint of discoloration. Clinical significance: The study is relevant clinically as it deals with the techniques used by general dental practitioners while performing composite resin restorations. The study highlights clinical practices which are in line with evidence-based dentistry and also with techniques adapted by dentists which are obsolete and require an update.

Aim: To evaluate and compare the dentinal tubule penetration of glycerine, propylene glycol and ringer's lactate solution. Materials and methods: Forty-five single-rooted human mandibular premolars with mature apices were decoronated keeping a length of 12 mm of a root. Biomechanical preparation till rotary protaper F2 and irrigation according to the protocol of all the roots was performed. The specimens were randomly assigned into three random groups (n = 15) of glycerine, propylene glycol and ringer lactate mixed with safranin o dye. Roots were split into two halves using disks. The evaluation of the area of penetration of glycerine, propylene glycol, and ringer lactate solution was performed using stereomicroscope and Image J software. For analysis single way ANOVA test followed by post hoc test was used. The level of significance was set at p <0.05. Results: The maximum depth of dye penetration with propylene glycol was significantly greater than glycerine and ringer lactate solution when the level of significance was set at p <0.05 Conclusion: Propylene glycol penetration in the dentinal tubules was more effective than glycerine and ringer lactate solution indicating its potential use in delivering intracanal medicaments Clinical significance: The low surface tension vehicles help in propagating the intracanal medicaments into the canal irregularities to aid in thorough disinfection of the canals.

Aim: The main aim of the study was to evaluate the prevalence of caries on anterior teeth of Dakshin Kannada population. Materials and methods: Two thousand patients were examined for carries in the anterior tooth using mouth mirror and explorer under good lighting facilities, followed by a questionnaire to determine the prevalence of caries on the anterior tooth in Dakshina Kannada population. Results: It was found that 304 (15.2%) patients had anterior caries out of which the highest incidence was seen among the age of 15–30 years with 17.6% occurrence. It was found that there was a correlation between the time of sugar intake and anterior caries wherein 59.9% of the people consumed sugar in-between meals. Around 142 (46.7%) patients who had anterior caries also exhibited anterior crowding. Conclusion: Within the limitations of this study, it can be concluded that a strong correlation exists between the occurrence of anterior tooth caries and age, gender, location, dietary habits, and oral hygiene habits. Anterior teeth crowding should also be considered as a risk factor for the development of anterior tooth caries. Clinical significance: Anterior caries occurs as a result of poor oral hygiene which may be due to improper brushing technique, lack of patient education; unhealthy dietary habits, systemic conditions, and negligence. This study summarizes the changing trends in the prevalence of anterior caries which may be attributed to better oral hygiene maintenance, patient education, and awareness, routine dental check-ups.

Aim: To compare the surface topography and composition of As-received and retrieved initial archwires using scanning electron microscope (SEM) and energy dispersive X-ray spectroscopy (EDS). Materials and methods: The as-received round 0.016-inch stainless steel and nickel titanium archwires were taken from wire packets. The surface and composition of retrieved 0.016-inch stainless steel and nickel-titanium wires (n = 15), in service intraorally for at least 2 months, were compared using SEM and EDS. Results: The SEM images of As-received wires showed surface irregularities. The As-received stainless steel wire was found to be rougher than the As-received nickel titanium wire. In comparison with the As-received wire, the retrieved stainless steel archwires revealed deeper grooves, pits, and areas of corrosion. The retrieved nickel titanium wires, on the comparison, revealed no appreciable difference. The EDS analysis showed leaching of iron, nickel, and chromium in stainless steel wires and leaching of nickel in nickel-titanium wires. Oxygen and carbon concentrations were increased in both. Conclusion: There does occur a change in the surface topography and composition of wires after use intraorally. Changes were more appreciable in stainless steel wires than nickel-titanium wires. Leaching and deposition of surface elements need to be correlated with the toxic human levels. Clinical significance: Surface topography and surface roughness of the orthodontic archwires affect the efficacy of orthodontic treatment. This study will try and elicit the qualitative and quantitative changes in the initial archwires with respect to surface topography and surface roughness and also attempt to shed some light on the ways to minimize any alterations.

Aim: The case series discusses the various interdisciplinary treatment modalities that can be implemented in the management of amelogenesis imperfecta (AI). Background: Amelogenesis imperfecta is a developmental genetic disorder which affects the deciduous as well as permanent dentition. As prosthetic rehabilitation is very important for esthetics as well as for function, Interdisciplinary approach plays an important role in the management. Case description: Two patients, a 17-year-old female and 16-year-old male, who was diagnosed as cases of AI, were treated with an interdisciplinary approach. After restoring the oral hygiene and carious lesions, fixed partial dentures was given in both the cases and followed up for 8 years. Conclusion: The management of AI involves careful planning and a stepwise with the most conservative treatment option. Maintenance program aimed at preventive care adds to the success in the rehabilitation of such cases. Clinical significance: Early diagnosis and careful treatment planning play an important role in the success of this case. Patient age should be kept in mind as long term prognosis should be our primary aim in treating AI cases.

Aim: Dental implant placement is potentially invasive and hemorrhagic. Patients on the new oral anticoagulants (NOAC) have a potential risk of hemorrhage postoperative. The present study systematically reviews if NOAC medication presents the potential to increase the bleeding risk after dental implant placement. Materials and methods: A systematic review was conducted of randomized clinical trials evaluating the risk of hemorrhage after dental implants in patients taking NOAC medication. The literature search was conducted using Cochrane Central Register of Controlled Trials, PubMed, Science Direct without the restriction of language from June 2010 to December 2018. The inclusion criteria were: anticoagulant therapy, dental implant placement and postoperative incidence of bleeding follow-up. The reviewers performed data extraction, bias risk assessment, and determination of the overall quality of evidence for each of the outcomes using the Jadad scale. Review results: Two articles regarding the incidence of bleeding risk post dental implant placement were included in the review. The first article showed that one patient from the intervention group and two patients from the control group presented slight bleeding the day after the surgery, with the relative risk of 0.919 and the 95% confidence interval of 0.078–10.844. The second article showed that two patients from the intervention group and two patients from the control group presented slight bleeding the day after the surgery, with the relative risk of 0.675 and the 95% confidence interval of 0.090–5.088. Conclusion: The results suggested that continuing the intake of NOAC during and post procedure has not increased the hemorrhage risk. Hence, drugs modification or alteration was not necessary. Clinical significance: More well-designed studies are required for future research.

Aim: This review provides an overview of various classifications and aims to focus on the characteristic distinguishing features of oral verrucopapillary lesions that direct towards arriving at a diagnosis and assessment of their biologic behavior. Background: A variety of pathological conditions affect the normal morphologic and surface characteristics of the oral mucosa. Verrucopapillary lesions (VPLs) are one such group of diseases that are diagnostically disputed and comprise of a spectrum of reactive, benign and malignant lesions. They can be categorized broadly into focal and multifocal lesions. Review results: The classic clinical, histopathological and Immunohistochemical characteristics of oral verrucopapillary lesions may help in their accurate diagnosis. Clinical significance: Despite, few indistinguishable clinical presentations of VPLs, their specific morphology, etiology, and discrete histopathological features may ease out the diagnostic dilemma and facilitate appropriate treatment.