Aim and objective: This study aims to optimize the radiation dose and the image quality of a large field of view (FOV) cone-beam computed tomography (CBCT). Materials and methods: Effective dose (E) and image quality delivered by six protocols that varied according to voxel size (VS) (0.25, 0.3, and 0.4) and exposure time (ET) (7, 4, and 2 seconds) were compared by scanning a large FOV (16 × 13 cm) of a RANDO phantom using CBCT and each protocol was scanned twice. Thermoluminescent dosimeters placed on the phantom head were used to calculate E. Image noise and subjective image assessment were utilized to quantitatively and qualitatively assess the image quality, respectively. Repeated-measures analysis of variance (ANOVA) was used for comparisons with a significant level set at ≤0.05. Results: All protocols generated significantly different E values compared with each other (p values ranged between <0.0001 and <0.05) except for protocols V and VI (p > 0.05). Regarding image quality, both image noise and subjective assessment revealed that protocol V had acceptable image quality when compared with the standard protocol. Conclusion: The use of 0.3 VS together with the lowest ET, as recommended by the manufacturer, can minimize the radiation dose while maintaining the diagnostic image quality generated from a large-FOV CBCT. Clinical significance: Balancing between radiation dose reduction and diagnostic image quality is an important issue in diagnostic imaging that maximizes the clinical benefits and decreases the patient risks of ionizing radiation, especially for a large-FOV CBCT.

Aim and objective: The prevalence of dentinal hypersensitivity after tooth preparation is high and there is a need to explore the usage of contemporary agents in prosthodontics for this purpose. Therefore, the present study aims to evaluate the retention of fabricated copings on prepared teeth coated with freshly prepared arginine-calcium carbonate-fluoride and casein phosphopeptide (CPP)-amorphous calcium phosphate-fluoride desensitizing agents. Materials and methods: Forty-five extracted premolar teeth were mounted in autopolymerizing acrylic resin and prepared for complete cast metal copings following the standardized protocol. These preparations were randomly divided into three groups for the application of desensitizing agent: arginine based, CPP based, and control (without any agent). Each group was further subdivided into three and luted using either glass ionomer (GIC), resin modified glass ionomer (RMGIC), or resin cement. All these specimens were subjected to tensile bond strength evaluation using a universal testing machine. Results: The mean bond strengths (in Newtons) in the control group were 308.62 ± 58.84, 176.89 ± 35.46, and 300.35 ± 27.9 with GIC, RMGIC, and resin types of cement, respectively. On the application of arginine-based desensitizer, the bond strengths decreased to 90.26 ± 10.68, 85.07 ± 18.82, and 236.05 ± 43.62 with GIC, RMGIC, and resin types of cement, respectively. On the other hand, on the application of CPP-based desensitizer, the bond strengths in the same order of luting were 272.32 ± 30.5, 203.47 ± 60.57, and 158.66 ± 25.32. Conclusion: Arginine-based desensitizer did not influence the retention of crowns with resin cement, whereas CPP-based coat did not affect the retention of crowns luted with GlC as well as RMGIC. Clinical significance: The present study shows the importance of choosing a desensitizing agent based on the luting cement selected for prosthesis retention.

Aim and objective: This study aims to evaluate the use of hyaluronic acid (HA) on the free gingival graft (FGG) applied to mandibular canines with Miller class I or II gingival recession (GR) or without attached gingiva by evaluating tissue healing, swelling, and dimensional changes. Materials and methods: This split-mouth clinical study has an examiner–patient blinded design. Eighteen patients with bilateral class I or II of Miller classification of GR in the mandibular canine region with <2 mm of attached gingiva were treated with FGG and randomly assigned to experience either natural healing (control group) or HA-assisted healing (test group). Tissue healing index, swelling, and dimensional changes were registered at baseline, 1, and 3 months post-surgery. Statistical analysis was performed to examine differences between study groups. Results: The test group showed better healing and swelling compared to the control group and these differences were statistically significant. No statistically significant difference was found for dimensional changes between groups. Conclusion: It may be concluded that within the limits of this study that the adjunctive use of HA may be beneficial in the healing process of FGG. Clinical significance: The application of HA helped improving the healing of FGG, which makes the process faster and more predictable.

Aim and objective: This study evaluated the color difference (ΔE*), translucency, and color assimilation (CA) of monoshade resin composites (MCs) with other shaded resin composites (SCs) using disks and teeth-like resin composite models. Materials and methods: Total 72 disks, 60 anterior, and 60 posterior models were prepared using MC and each SC (VITA shades B1, A1, B2, A2, and A3; n = 12 per shade). The ΔE* and translucency parameter were determined from disks using a spectrophotometer. Tooth preparation was performed in teeth-like models made of SC and filled with MC. Recording of visual score (VS) was performed by eight viewers for shade matching of MC with SC disks and teeth-like models. The VS values were designated numerically between score 1 and 5 and CA was calculated for disks and models. Results: The mean ΔE* value for disks was least for shade B1 (6.4 ± 2.2) and showed significant increase toward darker shade A3 (19.7 ± 3.3). The MC was highly translucent than that of all SC (p < 0.01; Tukeys post hoc). Mean VS values of models showed small to acceptable difference in all shades within the range of 3–5. Mean CA values of models increased from lighter to darker shades along with increase in ΔE* (Pearson's r = 0.8) of disks. Conclusion: The MC exhibited color difference with all tested shades to various extents; however, it demonstrated relatively high translucency and admissible CA with different shades. Clinical significance: Monoshade resin composites with appreciable color matching compensate for shade mismatch and replace multiple shaded composites in the inventory.

Aim and objective: To compare the quality or quantity of dentin bridge formation of Biodentine and Propolis with the current gold standard—mineral trioxide aggregate (MTA) when used as a direct pulp-capping agent. Materials and methods: Randomized clinical trial on 102 teeth (patients aged 13–30 years) selected for extraction due to orthodontic treatment was carried out by a single operator using group I—MTA, group II—Biodentine, and group III—Propolis as vital pulp therapy agents. The patients and the outcome assessor were blinded. After 3 months of follow-up, the teeth were extracted and sent for the histopathological analysis. The Chi-square test was applied on the data for statistical analysis. Results: Pulp sensibility was maintained for all assessed teeth after the follow-up period. The difference between group I and group II was statistically insignificant. Group III showed significant differences in terms of morphology, continuity, and thickness when compared to the other two groups (p = 0.0). Conclusion: The three groups successfully aided in forming dentin bridges in all the assessed teeth after follow-up. The quality and quantity of dentin bridge formation of group I—MTA and group II—Biodentine were superior than group III—Propolis. Owing to its anti-inflammatory, antimicrobial, and tissue regeneration properties, Propolis improves wound healing and can be successfully used as an agent in direct pulp capping. Clinical significance: Biodentine is an effective pulp capping agent and is comparable to MTA. Among other advantageous properties, Propolis is an organic anti-inflammatory material that can be successfully used as a direct pulp-capping material due to its ability to induce reparative dentin, which is good enough to maintain pulp sensibility over a long period of time.

Aim and objective: To compare the airway morphology and volume in skeletal class I and class II patients of ages ranging from 14 to 20 years. Materials and methods: This retrospective study used cone-beam computed tomography (CBCT) scans of 60 patients in natural head position. Patients were classified into skeletal Class I and Class II based on ANB value and Witt's appraisal. CBCT data was in Digital Imaging and Communications in Medicine (DICOM) format and 3D data and 3D coordinate system were constructed using Dolphin 3D software and airways were analyzed. Results: Class I skeletal pattern patients had more airway volume (mean = 20733.2 mm³) than patients with class II skeletal pattern (mean = 19032.2 mm³), but the results were not statistically significant. Conclusion: Skeletal class I and class II samples showed “wide” type of airway morphology with skeletal class II patients having more width to depth ratio compared to skeletal class I patients. Airways in class II patients are smaller anteroposteriorly compared to airways of class I patients. Clinical significance: In this era of airway-centric treatment planning, this study is a stepping stone for understanding the uniqueness and diversity of airway among different individuals and thus plan orthodontic treatment holistically so as to minimize treatment relapse.

Aim and objective: The aim of the study is to radiographically evaluate the marginal accuracy of metal coping in sectioned and unsectioned three-dimensional (3D) printed models and gypsum models. Materials and methods: A cross-over, double-blinded randomized control trial was performed on 20 patients. The patients were given metal copings fabricated by conventional (control group) and digital impression techniques (experimental group). Sectioned and unsectioned 3D printed models were obtained from the digital impressions. Marginal accuracy of the copings was evaluated using radiographs. Results: The marginal discrepancy was maximum in the copings fabricated by conventional impression (0.143 ± 0.24 mm), followed by 3D printed die-sectioned models (0.125 ± 0.16 mm), and the least marginal discrepancy was seen in the 3D printed undie-sectioned models (0.095 ± 0.15). Conclusion: It would be prudent to conclude that the digital impression technique producing 3D printed undie-sectioned models demonstrated the highest dimensional and marginal accuracy. However, in the clinical scenario, both the conventional and digital impression techniques demonstrate variations within clinically acceptable limits.

Aim: Dental discoloration after the application of endodontic materials has become a primary cause of concern for many dental patients in recent times. Regarding this, the present in vitro study was performed to evaluate tooth discoloration induced by calcium-enriched mixture (CEM) cement, mineral trioxide aggregate (MTA), and Endocem. Materials and methods: This study was conducted on 54 healthy central incisors extracted due to orthodontic treatment or periodontal disease. The samples were assigned into three groups in which the pulp chambers were filled with Endocem (group I), CEM cement (group II), and MTA (group III). The samples were sealed by glass ionomer cement. Color change was measured using the Vita Easyshade spectrophotometer at the baseline as well as 30 and 90 days after the application of cements. Data analysis was performed using SPSS software (version 23). Results: A visible color change with a delta of >3.3 was observed in all groups 1 month postintervention. The results revealed a significant difference among the three groups in terms of color change 1 month after the intervention (p value <0.001). In this regard, group I and group II showed the highest and lowest color change, respectively. However, there was no significant difference 3 months after the application of the cements. Conclusion: As the findings indicated, tooth discoloration was similarly detectable 1 month after the application of CEM cement, MTA, and Endocem. Clinical significance: CEM cement, MTA, and Endocem showed similar tooth discoloration after 3 months placement.

Aim: The aim of the study was to assess the relationship between chief complaints (CCs) and severity of periodontitis in patients seeking periodontal treatment at Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai. Materials and methods: This retrospective study was carried out by analyzing the patient records from June 2019 to March 2020. Two hundred and forty-four patients who reported to the Department of Periodontics, seeking periodontal therapy in this period were included in the study. Parameters assessed were (a) demographic details—patient name, patient identity number, age, and sex; (b) periodontal parameters—periodontal probing depth (PDD), loss of attachment (LOA), bleeding on probing (BOP), severity of periodontitis (mild, moderate, and severe); (c) CCs and type of CCs (chronic symptomatic, acute symptomatic, and asymptomatic). Chi-square test was performed to assess the relationship between type of CC and severity of periodontitis using SPSS version 23.0 (Statistical Package for the Social Sciences). Results: The overall distribution of the CCs shows that most common CC was bleeding gums (22.95%), second most common CC was missing teeth (17.62%), and third most common CC was tooth pain (15.68%), followed by mobile teeth (14.75%), swollen gums (9.02%), teeth moved position (6.56%), sensitivity (5.33%), pain on chewing (2.05%), bad breath (2.05%), pus discharge (1.64%), pain in gums (0.82%), need gum treatment (0.82%), and cleaning (0.41%). Chi-square test shows that there is a significant relationship between type of CC and severity of periodontitis with a p value of 0.015. Conclusion: The most common CC reported was bleeding gums. But further longitudinal studies with larger sample size are needed to be performed. Clinical significance: Patient's CC is considered as a vital component for providing competent and good quality healthcare. The severity of the disease is said to have an influence on the CCs reported by the patients.

Aim: The present study was carried out to assess the effectiveness of pulp tissue of deciduous teeth stored in fresh water and natural soil, as a source of nuclear DNA and its use for the determination of gender using polymerase chain reaction (PCR). Materials and methods: One hundred and twenty extracted deciduous teeth were divided into two groups of 60 each and were stored in fresh water (group I) and natural soil (group II). These groups were divided into 3 subgroups (A, B, and C) of 20 each and stored for 3, 9, and 15 months, respectively, before subjecting for the PCR analysis. DNA was isolated and quantified. X and Y chromosomes were amplified by PCR and compared with the actual gender of the child. The data were analyzed using the Shapiro–Wilk test, the independent sample t-test, the paired t-test, and the chi-square test. Results: The pulp tissue of teeth stored in natural soil showed significantly higher correct interpretation than that of the teeth stored in fresh water. Conclusion: Even though the ability of determination of gender from the samples stored in fresh water and natural soil decreased with the prolongation of storage period, teeth stored in natural soil were found to be better than that of the ones stored in fresh water. Clinical significance: The pulp tissue of deciduous teeth is effective for gender determination and that would be extremely helpful for forensic experts for the identification of markedly skeletonized bodies.

Aim: The present study aimed to evaluate the presence of white spot lesions in 3-year-old children visiting a private dental institution and belonging to the Chennai population. Materials and methods: A total of 165 patients and 990 teeth were reviewed for white spot lesions using photographs obtained after reviewing case sheets. The data extracted were analyzed using descriptive statistics on SPSS software. Results: The highest percentage of lesions was present in the maxillary right and left canines and was 78 and 67.7%, respectively, and the least was observed in mandibular right and left central incisors namely 9.2 and 5.5%. Conclusion: The prevalence of white spot lesions was maximum in maxillary canines and the least was observed in mandibular incisors in 3-year-old children visiting a private dental college in Chennai. Clinical significance: Early detection and intervention of white spot lesions can minimize the symptoms associated with early childhood caries, thereby halting its progression.

Aim: To perform a systematic review comparing the canal-shaping ability of WaveOne and ProTaper rotary using cone-beam computed tomography (CBCT) and to evaluate the file that provides better performance clinically. Materials and methods: The eligibility criteria selected for the study was based on the population intervention comparison outcome(s) study (PICOS). Using different search strategies from the keywords and their combinations, English language articles only between January 1, 2009, and October 31, 2019, from electronic biomedical journal databases were obtained. In vitro studies comparing the canal-shaping ability of ProTaper and WaveOne file systems using the CBCT method were included. Total 137 articles were reviewed out of which 61 articles were excluded during title screening as they did not meet the motive of our study. Total 76 articles were screened for duplicates and 63 articles were excluded. A total of 13 articles were selected for reviewing abstract and full text. Total 13 relevant articles were selected for final synthesis. The pilot Microsoft Excel sheet was filled with the relevant data that matched the study. Review results: Total 13 relevant articles were selected for final review. The file systems were compared based on two main parameters such as the apical transportation caused and the ability of the file to remain centered within the canal. We found significant differences in these two parameters when the WaveOne reciprocating file system was compared with the ProTaper rotary file system. A definite conclusion could be drawn that the WaveOne reciprocating file system was better in shaping the canal. Conclusion: Based on the results, the canal-shaping ability of the WaveOne reciprocating file system was better than the ProTaper rotary file system. Clinical significance: Clinically, the canal-shaping ability determines the performance of a particular file system and CBCT is the most effective 3-D mode to determine the centering ratio and apical transportation caused. Thus, further comparative studies between these two file systems using CBCT with larger sample size and with elaborate search strategies are required for better result.

Aim: This cross-sectional study aims to evaluate the patient's perception of discomfort and pain arising from brass wire and elastomeric separators used in orthodontic appliances among Pakistani adolescents. Materials and methods: A total of 80 patients (40 females and 40 males) aged 18–28 years who had undergone fixed orthodontic therapy were included in this study. Details were gathered through a self-administered questionnaire provided to patients via a single investigator. The discomfort and the pain initiated by the immediate placement of separators until the seventh day were evaluated. Results: Results showed that after immediate placement, brass wire separators caused the highest pain levels (88.6%) compared to elastomeric separators (2.9%). The pain perception for elastomeric separators was higher (71.4%) after 2 days of insertion than that for brass wire separators. A gradual decline in pain from both separators over 7 days was observed. Patients reported discomfort while eating and chewing. The perception of discomfort and pain between genders was not significant (p value > 0.05). Conclusion: After immediate insertion, the brass wire separators caused more discomfort and pain, which lasted until 24 hours than elastomeric separators. The discomfort and the pain associated with elastomeric separators lasted until the fourth day of insertion. Clinical significance: The study indicated the clinical significance of brass wire and elastomeric separators to separate the placement of orthodontic bands.

Aim: The aim of this retrospective study is to assess the demographic details, mode of extraction, and prevalence of dry socket in patients with mandibular third molar extraction. Materials and methods: Patients who had undergone mandibular third molar (impacted/nonimpacted) extraction were included in this study. The case sheets were obtained from Saveetha Dental College and Hospitals. The information retrieved from the Saveetha Dental College and Hospitals dental information archiving software (DIAS) system included patient's age, gender, systemic disease (diabetes), teeth no. and the mode of extraction of teeth (transalveolar, surgical extraction of impacted teeth, extraction), and the postoperative complications (dry socket) associated. The data included for this study were from June 2019 to March 2020 and tabulated. The statistical test was carried out through SPSS and the Pearson's Chi-square test was performed. Results: Total 691 patients who had undergone mandibular third molar extraction during June 2019 to March 2020 were included in this study. Out of 691 patients, 53.91% were males and 46.09% were females. The higher prevalence of age groups of 26–35 (36.06%) was noted. Total 94.5% of the patients were diabetic and 5.5% were nondiabetic. The most number of treatments done is through surgical extraction of impacted teeth (surgical exposure of flap and tooth) (48.48%), followed by extraction (forceps extraction) (42.55%) and transalveolar extraction (removing section of tooth, open sectioning) (8.97%). The prevalence of dry socket was 4.05%, and 95.95% of the patients did not experience dry socket. There was higher prevalence of dry socket in nondiabetic patients (3.62%) than diabetic patients (0.43%). Conclusion: The dry socket was most commonly associated with males and during normal extraction (i.e., without surgical exposure of flap and tooth). The dry socket remains as the common postoperative complication. Clinical significance: The study observed that the extraction (through forceps) procedure leads to an increased incidence of dry socket. Hence, this signifies the importance of postoperative instructions to be followed irrespective of the type of extraction.

Aim: The aim of this case report is to document an aggressive odontogenic myxoma (OM) of the mandible causing dramatic displacement of the unerupted third molar up to the coronoid process, a rare entity. Background: The OM is an aggressive neoplasm that can cause significant destruction of the jaws. They present as large multilocular lesions often causing thinning of the cortical plates and displacement of teeth. The OM has a high rate of recurrence that brings into significance their mode of management that varies from curettage to radical excision depending on the surgeon's school of thought. Case description: An OM of the mandible in a 17-year-old patient is described here with cone-beam computed tomography (CBCT) and orthopantomograph (OPG) findings. The OM had displaced the unerupted mandibular third molar to the coronoid process that makes this case interesting to report. Conclusion: Intensity of alcian blue and safranin O staining reveal the hyaluronic acid, glycosaminoglycans (GAG's), and proteoglycan content of OM. The pattern of picrosirius red staining under polarizing microscope indicates aggressive potential of OM. Clinical significance: The article highlights the use of appropriate differential stains like alcian blue, safranin O, and picrosirius red that facilitate in arriving at precise biologic behavior of OM. Original research studies to validate intensity and pattern of special stains with odontogenic lesions are mandated to establish a significant correlation.