Aim of study: No evidence is found in literature to assess that malocclusion can lead to postural or craniocervical–mandibular disorders. The aim of this study is to investigate with surface electromyography (EMG) of masticatory muscles and stabilometric analysis the relationship between malocclusion and presence of temporomandibular disorders (TMDs) or postural variations in a group of athletes of different sports. Materials and methods: Seventy-four athletes belonging to different sport societies were included in this study. Chi-square test, taking as significance index χ² > 0.05, was used to compare in pairs the postural interference, muscle disharmony, malocclusion, and TMDs. Results: No statistical significance emerged, correlating postural interference and muscle disharmony (χ² = 0.15), muscular imbalance, and anatomical findings of malocclusion (χ² = 0.62), muscular imbalance and TMDs (χ² = 0.15), and TMDs and malocclusion (χ² = 0.09). Statistically significant association [χ² = 0.019, odds ratio (OR) = 3.10] emerged from the correlation between TMDs and postural interference. Conclusion: A correlation between posture and occlusion is very difficult to be demonstrated. A multidisciplinary approach is required for TMDs: therapy with oral splints allows to give greater compliance to the system by allowing muscles to guide the jaw in a position of functional equilibrium. Clinical significance: Gnathological treatment evaluated through EMG and stabilometric platform allows to obtain improvements in the occlusal balance.

Aim: The objective of this study was to compare the microleakage rate between immediate and delayed post space preparation in the root canal filled with the bioceramic-based root canal sealer by the fluid filtration technique. Material and methods: Sixty extracted human mandibular premolars were used. The coronal portion was resected 12 mm from the apex, and the root canal was prepared with Mtwo NiTi rotary instruments to apical size 50/0.04 and filled with a matched-taper gutta-percha impregnated with bioceramic particles and a bioceramic-based root canal sealer. The samples were divided into two experimental groups (n = 50) and two groups of positive (n = 5) and negative control groups (n = 5). Twenty-five roots of the immediate post space preparation group were prepared post space immediately following completion of root canal obturation and 25 roots of delayed post space preparation group were kept for 7 days before preparation of the post space. Evaluation of the apical leakage was performed with a fluid filtration method under a 15 cm H₂O pressure. Results: There was no significant difference (p = 0.55) in apical microleakage between immediate and delayed post space preparation groups. Conclusion: In terms of apical microleakage, immediate and delayed post space preparation produced similar outcomes when the root canal filled with bioceramic-based root canal sealers by a single-cone technique. Clinical significance: The timing of post space preparation does not affect the apical microleakage results when the root canal filled with bioceramic-based root canal sealers by a single-cone technique.

Aim: To measure and compare the facial soft tissue thicknesses (FSTT) between skeletal class I and class II patients. Materials and methods: The sample consisted of lateral cephalograms of 120 patients (60 females and 60 males) of 18–30 years. These were subdivided into groups I, II, and III (n = 40 each) consisting of individuals with skeletal class I, mandibular retrognathism-induced skeletal class II, and maxillary prognathism-induced skeletal class II, respectively. Selected digital cephalograms were imported into the Nemoceph software (Nemotec, Spain) and calibrated. The thickness of the facial soft tissue was assessed and compared at 10 anthropological landmarks. Result: Significant differences between the study groups were noted with respect to the mean Gls-G, Sn-A, and St-U1 values. In addition, sexual dimorphism was also noted. Conclusion: Given the significant variation in the FSTT among the study groups, it is vital that the clinician in addition to accounting for the skeletal malocclusion also considers the soft tissue dimensions while formulating the treatment protocol. Clinical significance: The differences among different skeletal malocclusions may be taken into account in patients undergoing orthodontics or corrective jaw surgery, both during diagnosis and treatment planning.

Aim: The aim of the present study was to compare two different nickel–titanium (NiTi) rotary files, F-One Blue and F2 Protaper Gold (PTG), evaluating their properties such as cyclic fatigue resistance, torsional resistance, and bending properties. Materials and methods: Sixty F-One Blue (25.06) and 60 PTGF2 have been randomly divided into 3 groups of 20 instruments each. Each group was tested in a different way, in order to analyze three different properties: cyclic fatigue resistance, torsional resistance, and flexibility. Cyclic fatigue resistance was evaluated by inserting the instruments for 16 mm in a stainless-steel artificial canal with a 90° angle and 5 mm of curvature with recommended speed and torque. Time to fracture was recorded using a chronometer (1/100 seconds). The number of cycles to fracture (NCF) was then calculated. Fragments were collected, and their lengths were measured. Torsional resistance was evaluated on the apical 3 mm of each of the files to calculate torque to fracture (TtF) using an endodontic motor (KaVo, Biberach, Germany), which automatically recorded the torque values every 1/10 s. All instruments were rotated at the same speed (300 rpm) and torque value (5.5 Ncm). Flexibility was evaluated using a calibrated load cell supported by a computer program. All the collected data were statistically analyzed (t-test) with a significance level set at 5%. Results: A significant difference in terms of cyclic fatigue resistance, torsional resistance, and flexibility between F-One Blue and F2 PTG was found (p < 0.05). The mean value of NCF was 604.16 (SD ± 23.32) for F-One Blue and 300.5 (SD 19.92) for F2 PTG. The mean value of TtF was 1.41 Ncm (SD ± 0.01) and 1.39 Ncm (SD ± 0.01) for F2 PTG. The mean value of bending test was 29 gcm (SD ± 1.15) for F-One Blue and 50 gcm (SD ± 2.30) for F2 PTG. Conclusion: F-One Blue better resists to flexural and torsional stresses and seemed to be more flexible. Since F-One Blue mechanical tested performances were better than the F2 PTG ones, these instruments should be considered a very promising instrument. Clinical significance: As evidenced by the results of this study, F-One Blue should be considered a very promising instrument that could improve endodontic clinical practice.

Aim: The present study aimed at determining the association between salivary hemoglobin (SH) and chronic periodontitis in type II diabetic subjects and check whether SH can function as a noninvasive biomarker to assess the level of chronic periodontitis. Materials and methods: This cross-sectional comparative study included 40 subjects aged between 40 and 65 years with at least 20 teeth remaining. The diabetic status was confirmed with HbA1c levels and categorized into group I: healthy controls with HbA1c < 5.6% and no periodontitis with bleeding on probing (BOP) at ≤10% of sites, <3% of sites with probing pocket depth (PPD) ≥4 mm, and no sites with clinical attachment level (CAL) ≥ 2 mm and group II: type II diabetes mellitus (T2DM) cases with HbA1c > 5.7% and periodontitis with BOP at >10% of sites, with CAL ≥ 2 mm and with >5% of sites with PPD ≥ 4 mm. Unstimulated fasting whole saliva was collected from each participant and the salivary hemoglobin level analyzed using a colorimetric assay kit. Both groups were compared using the t-test and multiple linear regression model analysis. Relationship between different variables were compared using the Karl Pearson's correlation coefficient. Statistical significance was set at 5% level (p < 0.05). Results: A significant difference was observed between the salivary hemoglobin level (t −3.7710, p < 0.001), PPD (t −13.9023, p < 0.001), and CAL (t −9.3759, p < 0.001) between healthy controls and type II diabetics with T2DM subjects exhibiting much higher value compared to healthy controls. Conclusion: In conclusion, data from this study demonstrated that type II diabetic adults have high prevalence of chronic periodontitis and exhibit elevated salivary hemoglobin indicating a valuable noninvasive screening method for detecting periodontitis.

Aim: The study was aimed to examine the effectiveness level of minimum inhibition concentration (MIC) and minimum bactericidal concentration (MBC) of the star fruit leaf extract on the growth of Streptococcus sanguinis (S. sanguinis) bacteria at concentration 60, 40, 20, 10, and 5%. Materials and methods: This study was laboratory experimental research with the posttest-only control group design. The effectiveness test of the star fruit leaf extract on the growth of S. sanguinis was performed with dilution method. The leaf extract of star fruit was made by the maceration technique from each concentration, suspension of S. sanguinis bacteria was added, repetition done four times, and then observation was conducted. The data analysis used was the one-way ANOVA test. Results: The result showed that MIC concentration of the extract on the growth of S. sanguinis was 5% and MBC concentration was 10%. Conclusion: The star fruit leaf extract has antimicrobial efficacy against S. sanguinis. Clinical significance: The star fruit leaf extract has the potential capacity to prevent and cure dental caries, recurrent aphthous stomatitis (RAS), and periodontal disease.

Aim: While dental caries and periodontal disease are the most prominent oral diseases, other oral conditions have not been adequately investigated. This study was undertaken to assess and compare prevalence of extraoral and oral mucosal lesions, temporomandibular disorders (TMDs), and traumatic dental injuries among children enrolled in high schools in Mangaluru taluk. Materials and methods: A cross-sectional study was carried out among 1,340 children selected through stratified cluster sampling from government and private high schools in urban and rural areas. A pro forma was prepared to record demographic data, and oral findings according to the World Health Organization criteria. Data were analyzed using Chi-squared test and t-test with a p value of less than 0.05 considered statistically significant. Results: Prevalence of extraoral lesions was found to be 0.2%. The prevalence of TMD symptoms and TMD signs was 2.4% and 2.5%, respectively. The presence of TMD symptoms and TMD signs was significantly higher among females, children belonging to rural areas, and among private schoolchildren. The oral lesions found were traumatic ulcerations (in 0.8% study participants), the majority of which affected children attending urban schools. The prevalence of traumatic dental injuries was 6.7%, and it was significantly higher among males. Maxillary incisors were the most affected teeth. Conclusion: Although the prevalence of the oral conditions was low, their presence indicates a need for early identification of those affected so that the treatment can be expedited and the severity of the condition can be limited. Clinical significance: Data on prevalence and severity recorded according to standardized criteria are a prerequisite for effective interception of oral conditions such as oral mucosal lesions, TMDs, and dentofacial injuries. This survey will provide data on children from diverse socioeconomic backgrounds and facilitate prioritizing of treatment services to the most deserving.

Aim: To evaluate the antimicrobial efficacy of neem leaf extract, Morinda citrifolia and saline, against Enterococcus faecalis. Materials and methods: A total of 120 teeth were selected for the study from the subjects between the age group of 6 and 12 years. Forty teeth were randomly assigned to one of the 3 groups corresponding to the irrigant to be tested; group I (Azadirachta indica), group II (M. citrifolia) and group III (saline). After irrigation with the respective irrigant, the post-irrigation sample was sent for the microbiological analysis to determine the antimicrobial efficacy of each irrigant. Results: The mean E. faecalis growth of group I after irrigation was 15.48, group II was 24.73 and group III was 40.08. It was statistically significant (p value 0.000) among all the three groups. This shows that the mean E. faecalis growth was significantly higher after irrigation with saline when compared to other groups. Conclusion: Neem leaf extract exhibited maximum inhibition against E. faecalis while saline exhibited the least antimicrobial efficacy with least inhibition. Clinical significance: In the clinical setup, saline which is used as a common irrigant significantly reduces the number of bacteria in the root canal, but could not completely eliminate them. This study was an effort to find out alternative herbal irrigants which can perform effectively and are available easily for clinical practice.

Aim: The present study was conducted to evaluate the type of bacteria present in necrotic root canals of permanent teeth. Materials and methods: All 60 participants with infected root canals were made to use 10 mL of mouthwash containing 0.12% chlorhexidine. Access to pulp chamber was established, and the sterile absorbent paper cones were inserted into the canal for 20 seconds. The contaminated paper cones were inoculated in a brain–heart infusion (BHI) agar culture medium and incubated in an oven for 48 hours at 37°C. Results were analyzed statistically with SPSS version 20.0 using Chi-square test and analysis of variance (ANOVA). Results: In root canals with periapical lesions, gram-positive bacilli was present in 50 cases, gram-negative in 48 and yeast cells in 28; while in root canals without periapical lesions, gram-positive bacilli was present in 8. In 16 root canals of chronic apical periodontitis cases, gram-positive bacteria was present in 100%, gram-negative bacteria in 100%, and yeast cells in 20% cases. In 12 cases of periapical granuloma, gram-positive bacteria was present in 98%, gram-negative bacteria in 100%, and yeast cells in 40% cases. In 10 cases of chronic abscess with fistula, gram-positive bacteria was present in 86.2. In six cases of phoenix abscess, gram-positive bacteria was present in 100% and gram-negative bacteria in 100% cases. Conclusion: There is predominantly gram-positive and -negative bacteria as well as the presence of yeast cells in periapical lesions. Clinical significance: Knowledge about the bacterial species in root canal infection helps in its management and in selecting antibiotic.

Aims: The present study was undertaken to compare the effect of herbal and non-herbal toothpastes on the enamel surface of human permanent maxillary premolars by measuring surface roughness and SEM observation and analyzing the element content in both types of toothpaste. Materials and methods: Forty specimens (10/group) were brushed using distilled water, non-herbal toothpaste, or two different herbal toothpastes on the buccal surfaces with their respective group's toothpaste or distilled water. The specimens were brushed twice a day; 2 minutes per time in the morning and evening routinely for 15 days. The roughness average (Ra value) was measured using a Profilometer. SEM observation and element content in both types of toothpaste were also determined. The data was analyzed using the paired samples T-test, the Kruskal–Wallis test, and the Mann–Whitney U test at a significance level of 5%. Results: The enamel surface roughness after brushing with non-herbal toothpastes was 0.049 μm while the other two herbal toothpastes were 0.095 and 0.071 μm respectively. R_a value of enamel in both herbal toothpastes groups were higher than the non-herbal toothpaste (p = 0.000). While R_a values of non-herbal toothpaste after brushing for 15 days were not significant difference from distilled water, control group. SEM revealed both herbal toothpaste resulted in rougher enamel surface than non-herbal toothpaste and distilled water. The volume of elements in each toothpaste was relatively similar. Conclusion: Although toothpastes containing herbal substances increase enamel surface roughness, it is below the upper limit of enamel roughness (0.2 μm) to cause bacterial accumulation in the clinic. Clinical significance: Herbal toothpaste brushing has no significant pathological effect on enamel.

Aim: The present study aimed to evaluate the efficacy of different subgingival irrigating solutions, which can be used in the treatment of chronic periodontitis. Materials and methods: Altogether 60 patients (both females and males) aged between 20 years and 60 years who were diagnosed with mild to moderate chronic periodontitis were chosen for this study. After providing oral hygiene maintenance instructions, the patients were grouped randomly divided into three divisions. Group I: subgingival irrigation with tetracycline HCl 10 mg/mL, group II: subgingival irrigation with 0.2% chlorhexidine, group III: Subgingival irrigation with 10% povidone-iodine. The subgingival plaque samples were collected and clinical parameters such as probing pocket depth, gingival index, plaque index, and clinical attachment level were recorded at the selected sites at baseline, after 15 days and at the end of 1 month. Results: The mean gingival index score decreased from 1.76 ± 0.10 at baseline to 1.07 ± 0.01 after 1 month of irrigation, and the mean plaque index score decreased from 1.52 ± 0.20 at baseline to 1.10 ± 0.71 after 1 month of irrigation in group I. A statistically significant difference was found on intergroup comparisons of clinical attachment level, pocket probing depth, and colony-forming units. Conclusion: In conclusion, a significant improvement in the clinical parameters was seen in all the three investigational groups in our study. Nevertheless, slightly better improvement in clinical parameters was demonstrated by the tetracycline HCl irrigation group when compared to povidone-iodine and chlorhexidine irrigating solutions. Clinical significance: The use of subgingival irrigating solutions interferes with the development of the intricate ecosystem, which is required for the commencement and sustained destruction of the periodontium in any vulnerable host. The administration of antimicrobial agents locally offers a “site-precise” method of periodontal treatment and it has numerous advantages.

Aim: To achieve a full-mouth rehabilitation of partial edentulousness using modified/extended precision attachments in a removable partial denture (RPD). Background: The success of a prosthodontic rehabilitation requires crucial balance between the modern and conventional treatment techniques. The attachment-retained partial dentures are one such type of prosthodontic treatment modality. Most traditional RPD are well designed but not used by the patient only because the individual does not prefer its appearance and the retentive quality. A modified extended precision attachment for eliminating metal display to upgrade the esthetics and to improve the retention of a long-span partial edentulous arch restored with a prosthodontic rehabilitation is described in this article. Case description: A 58-year-old male patient was referred to the Department of Prosthodontics for the replacement of missing teeth. On clinical examinations, it was diagnosed Kennedy's class I in the maxillary arch and class II in the mandibular arch with a reduced vertical dimension of occlusion. Precision attachment-retained partial dentures were planned in the maxillary and the mandibular arch. Conclusion: The success of the RPD depends on the retentive components and the underlying residual alveolar ridge. This case report highlights the esthetic outcome and improved retention in the maxillary and mandibular partial denture using precision attachments. Clinical significance: The treatment plan explained satisfactorily restores the esthetics, masticatory function, and improves the retention of the prosthesis by using precision attachment.

Aim: This case report illustrates the treatment outcome of immediate implant placement replacing the maxillary central incisor with various graft materials like platelet-rich fibrin (PRF), guided bone regeneration (GBR), and alloplast. Background: Whenever the anterior tooth replacement, especially in the esthetic zone, the patient's demand for the shortening the treatment time has led to the introduction of the immediate implant. Case description: A 22-year-old male patient reported to our college with chief complaint of frequent failure of crown in the maxillary right central incisor. Preoperative investigations were made. Atraumatic extraction of tooth was done. Dental implant was placed along with PRF, alloplast, and GBR. Cover screw and sutures were placed. Postoperative radiovisiography (RVG) was taken. The temporary removable denture was provided. After 6 months of the healing period, again intraoral periapical radiograph (IOPA) was taken and second-stage surgery of replacing the cover screw with the healing cap was done and after 10 days, implant-level impression was made and restoration was cemented. Follow-up was done. Conclusion: Immediate implant placement has highly predictable means of tooth replacement and shows success rates. For the long-term success of restoration, attempt was made using various graft materials that had shown a soft tissue and hard tissue regeneration and also they fill the jumping distance between the adjacent bone and implants. Clinical significance: When compared to the conventional procedure of implant placement, implants placed after extraction show a significant result. This case gives an excellent clinical outcome and esthetic was well appreciated. Hence, the quality of life increases.

Aim: To report full dental treatment of 7-year-old fraternal twin girls diagnosed with cyclic neutropenia. Background: Cyclic neutropenia is a rare autosomal-dominant disorder characterized by neutropenia that recurs every 14–35 days. It is estimated that the incidence of cyclic neutropenia is one to two per million. Clinically, it manifested by repetitive episodes of fever, susceptibility to infection, pharyngitis, recurrent mouth ulcerations, and periodontal diseases. Medical management includes supportive treatment, antibiotic therapy for infectious diseases, and granulocyte colony-stimulating factor (G-CSF), to raise blood neutrophils. Dental management of cyclic neutropenia patients varies from thorough oral hygiene, regular dental follow-ups, and surgical or nonsurgical periodontal treatment. Case description: Seven-year-old fraternal twin girls diagnosed with cyclic neutropenia at the age of 6 months. They were referred from their pediatric hematologist after complaining of recurrent aphthous ulcer and extensive dental caries. Dental treatment started with preventive and supportive treatment and then full dental treatment under general anesthesia and maintenance visits for 6 months. Conclusion: This report emphasizes the importance of dental treatment for patients with compromised medical conditions. Clinical significance: The oral cavity is a potential source of inflammation or infection, and treating oral diseases could prevent serious systemic diseases.

Aim: The purpose of this review was to comprehensively explore various aspects of motivational interviewing, its principles, goals, steps, and relevance to tobacco cessation. Background: Tobacco use is one of the major public health issues all over the world due to the mortality and morbidity associated with it. Counseling is an important tool in helping the patients quit tobacco. Traditional counseling assumes that the counselor is an expert and the patient is a passive recipient. Person/client-centered approach marks a paradigm shift in these processes. It identifies that client as an expert about his/her problems and the counselor is a facilitator. Motivational interviewing (MI) employs counseling skills, such as, asking open-ended questions, affirmation, reflecting and summarizing, known by the acronym OARS. The strategic goals of MI are to increase self-esteem, self-efficacy, and dissonance. Review results: Literature search was performed with the aid of Endnote software, which was followed by systematically arranging the retrieved articles in a harmonized manner. Conclusion: The number of studies employing MI in the field of public health dentistry was found to be sparse, with a majority of them focusing on tobacco cessation. Motivational interviewing appears to be a promising tool in bringing about the change in behavior of clients. By placing the onus on the client himself/herself in bringing about behavior change, MI transforms the role of the counselor from an expert to a facilitator. Motivational interviewing can be used to bring about long-term and sustained changes in lifestyle of individuals, thereby contributing to the better health of populations. Clinical significance: Motivational interviewing can be implemented among patients who are aware of their condition and want to change, but are ambivalent. As a public health dentist, MI can be effectively used in tobacco cessation, alcohol abuse, lifestyle modification, dental anxiety, proper brushing technique, and healthy choices.

Aim: This review aims to recapitulate the available literature for skill development, instruction, and evaluation of the dental and dental hygiene preclinical students. Background: The attainment of psychomotor skills is a crucial competence in dental education. The dental profession demands high precision and skill that require the development of cognition, distinctive abilities, and motivation, which influence motor performance. Practical instructions and knowledge for dental instrumentation necessitate the association of knowledge of motor skills with excellent motor skills attainment. Dental trainees need small, unequivocal steps that outline production. Preceding any task, the skill needed for the task should be projected precisely by the learner. Appropriate and detailed feedback from the trainer to the trainee contributes to learning and evolving. Review results: This review reveals that learning of dexterity accretion should ingress both the aspects of psychomotor skills, that is the motor performance and motor learning, to obtain data that can be used to support skill learning. Conclusion: To gain a better understanding of the accretion of cognitive content in operative dentistry, and differences in dental performance, more research should focus on factors such as the learning environment, including the type and sequence of learning activities. There is a critical need for staff development for the laboratory tutors who develop positive learning environment and provide students with effective feedback. Clinical significance: This review highlights the importance of preclinical exercises in dentistry and how it enhances the psychomotor skills of students making them better clinicians in future. Reforms are needed in dentistry for improvement in learning atmosphere, proper arrangement of learning activities, and staff development for the laboratory tutors.