Aim: This study analyzes changes in exposure settings periapical plane on the assessment of dental implants in rabbit tibia by analyzing image quality and osseointegration parameters. Material and methods: A quasi-experimental study was conducted on the tibia bone of rabbits that had been implanted with dental implants for 28 days from the previous research. The sample selection in this study used a purposive sampling technique and obtained a sample of 23 periapical radiographic images of the rabbit tibia bone that had been installed with dental implants for 28 days, with each image having an exposure setting. Data were tested for normality using the Shapiro–Wilk test. Mann–Whitney conducted a qualitative assessment and one-way analysis of variance (ANOVA) and post hoc tests carried out the quantitative evaluation. Results: Assessment results in image quality using the Mann–Whitney U test (0.001 < 0.05) and the results of the osseointegration assessment (relative bone density and fractal dimension) using the one-way ANOVA and post hoc test (0.001 < 0.01). Conclusion: Automatic exposure settings produce better image quality, relative bone density, and fractal dimension than manual exposure settings for osseointegration dental implants. Clinical significance: Differences in assessment of dental implant osseointegration in different periapical radiograph exposure setting groups can be obtained for the best exposure setting to evaluate dental implant osseointegration.

Aim: The aim of this study was to assess the demographic variables and clinical parameters and to quantify the levels of L-plastin in subgingival tissue samples of generalized severe chronic periodontitis subjects with and without type 2 diabetes mellitus. Materials and methods: The participants in this study were chosen from the Outpatient Department of Periodontology, Meenakshi Ammal Dental College (MADC), Meenakshi Academy of Higher Education and Research (MAHER), Chennai, Tamil Nadu, India. Two groups of 70 participants, each with generalized severe chronic periodontitis, were chosen. A total of 35 people in the group I had generalized, severe chronic periodontitis without any other systemic causes. Group II included people with type 2 diabetes who had generalized severe chronic periodontitis. Age, height, weight, body mass index (BMI), and income were all recorded, as well as periodontal metrics like plaque index, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Both groups had subgingival tissue samples taken at the site of the periodontal surgery. The obtained samples were then subjected to molecular analysis, including real-time polymerase chain reaction (RT-PCR) for measuring L-plastin messenger RNA (mRNA) expression and enzyme-linked immunosorbent assay (ELISA) for measuring protein concentration. Results: The mean income, plaque index, CAL, and the mRNA expression and protein quantification of L-plastin were found to be statistically significant between the groups. On correlating the periodontal parameters with the mRNA expression and protein quantification, plaque index and CAL had a significant correlation with L-plastin in both groups. However, group II showed higher periodontal destruction with the presence of this protein. Conclusion: The subgingival tissue samples of subjects with generalized severe chronic periodontitis and type 2 diabetes mellitus showed elevated levels of mRNA expression and L-plastin protein quantification, indicating that these molecules were locally involved in the pathogenesis of both periodontitis and type 2 diabetes mellitus. It can be utilized as a biomarker for the early detection of individuals at risk for periodontitis and diabetes mellitus.

Aim: The aim of this study was to compare clinical and occlusal patterns in patients with and without periodontitis using the T-scan software. Materials and methods: A total of 30 healthy subjects and 30 subjects with periodontal disease were recruited for this study. A T-scan analysis was done for all these patients before any intervention, and the force distribution on each side, first contact, maximum biting force, forces at maximum intercuspation, and time taken for occlusion and disocclusion were recorded for all patients. Clinical parameters, such as pocket depth, clinical attachment level, and gingival index, were also recorded. Results: Chi-squared tests reveal no significant relationship between occlusal stresses and pocket depth or clinical attachment levels (p > 0.05). The relationship between occlusal force and tooth type was statistically significant (p = 0.04). The maxillary posteriors had the highest occlusal forces, followed by the mandibular posteriors. There was no significant difference between right and left force distribution between healthy and periodontitis groups (p > 0.05); however, a significant difference was observed in occlusion and disocclusion time (p = 0.042 and 0.000, respectively). Conclusion: T-scan system is useful in the diagnosis, progression, and severity of periodontal disease, the distribution of deleterious eccentric forces that lead to periodontal destruction. The correlation of these forces to the location and type of tooth was seen to be of clinical significance. Clinical significance: The physiologically occurring repair and remodeling of forces directed onto the masticatory system components is critical, as disruptions in the physiological functioning of the masticatory system can cause periodontitis, which can lead to tooth loss. T-Scan is a software that analyzes occlusion in various aspects such as bite forces, force distribution, and time is taken for disocclusion; these readings can be taken in centric, protrusive, and laterotrusive contact in real-time, aiding the clinician in analyzing eccentric deleterious forces and treatment planning.

Aim: The present study aimed to evaluate the association between prediabetes with chronic periodontitis utilizing glycated proteins like fructosamine and inflammatory markers like interleukin-6 (IL-6). Materials and methods: This cross-sectional study was conducted on 36 subjects for a duration of approximately 7 months (between August 2021 and February 2022) screened for random blood sugar (RBS) levels (110–170 mg/dL) and glycated hemoglobin (HbA1C) levels (5.7–6.4%) as prediabetes and were grouped into three groups (n = 12)—group I—systemically healthy with chronic periodontitis; group II—prediabetic with chronic periodontitis; group III—prediabetic without chronic periodontitis. The periodontal health was evaluated by employing bleeding on probing (BOP), clinical attachment loss, Loe and Silness Gingival Index, and pocket depth. Unstimulated whole saliva (UWS) samples were obtained and subjected to enzyme-linked immunosorbent assay (ELISA) for the evaluation of fructosamine and IL-6 levels. Data were analyzed by Statistical Package for the Social Sciences (SPSS) version 2.0. Results: The intragroup comparison of salivary IL-6 values were highest among group II (52 ± 73) followed by group I (47 ± 71.7), and then group III (17.8 ± 17.8), while the intragroup comparison of salivary fructosamine values were highest among group I (2.4 ± 1.1) followed by group II (2.0 ± 1.1), and then group III (1.7 ± 0.8) which were statistically highly significant. (p < 0.001). Intergroup comparison revealed no significant difference between salivary IL-6 and fructosamine levels. Although mean fructosamine levels tended to be slightly lower in prediabetic individuals without periodontitis, it was not statistically significant. Conclusion: Considering the alarming prevalence of undiagnosed diabetes around the world and the benefits of early illness detection, it's obvious to notice why diabetes screening with noninvasive markers like salivary fructosamine is so significant. Clinical significance: Periodontitis may be associated with prediabetes, which is categorized by impaired glucose tolerance. Early detection of diabetes utilizing noninvasive indicators, such as salivary fructosamine, which appears to become more stable with time due to improved stability against microbiological deterioration, may help to reduce the tissue damage caused by the disease. The present study verifies the dentist's involvement and highlights the importance of focusing on chronic periodontitis patients in this situation.

Aim: The study was conducted to assess the fluoride concentrations in the water sources of Kothamangalam taluk, Kerala, India. Materials and methods: A total of 10 villages and two towns, belonging to Kothamangalam taluk, Kerala, India, were included in the study. Three samples of drinking water from each of the available water sources from each village/town were collected and analyzed for fluoride. The sources of water were—shallow wells, deep wells/borewells, rivers/canals, and municipal piped water supply. The fluoride level was measured by the colorimetric sodium 2-(parasulfophenylazo-)— 1,8-dihydroxy-3,6-naphthalene disulfonate (SPADNS) method. Results: Among the samples obtained from shallow wells, Kothamangalam town, Pindimana, Varapetty, and Keerampara villages showed a mean fluoride concentration of more than the permissible limit of 1.5 ppm. The bore wells samples of Kottappady, Neriamangalam, and Keerampara; water samples from rivers and canals of Pindimana and Neriamangalam villages, showed the high mean fluoride concentration. The samples were obtained from municipal piped water supply from all places with permissible concentrations. Conclusion: The study identified a few sources of water that contained fluoride in excess of the permissible limit in water sources from shallow wells, bore wells, and rivers. The piped water supply had acceptable levels of fluoride. Clinical significance: Fluorine is a micromineral required for normal growth, development, and maintenance of human health. Fluoride acts as a double-edged weapon. It plays an important role in preventive dentistry due to its cariostatic potential. Excessive intake of fluoride leads to fluorosis. Fluoride is found in all-natural water at some concentration.

Aim: Melatonin possesses antioncotic, anti-inflammatory, and immunomodulatory properties. It aids in the expression of matrix metalloproteinases (MMPs), reactive oxygen species (ROS), and growth factors and thereby inhibits invasion, endometriosis, and fibrosis. The objective of this study was to evaluate the effect of melatonin in topical gel formulation on the oral health and salivary nickel and chromium levels of patients undergoing fixed appliance therapy. Materials and methods: Sample consisted of 30 patients undergoing orthodontic fixed appliance therapy using metal brackets (12 ± 6.01 years). A novel melatonin-based oral gel was provided to the patients for use once daily for a period of 1 month. The salivary samples of patients were collected prior to and postgel usage and subjected to inductively coupled plasma optical emission spectrometry (ICP-OES), energy dispersive X-ray spectroscopy (EDS), and scanning electron microscopy (SEM). The independent t-test was used to compare the level of chromium and nickel in saliva, the plaque, and the gingival index pre and postadministration of the gel. Results: The results of the ICP-OES indicated that there was a reduction in both salivary nickel and chromium levels after the application of topical melatonin gel over a period of 1 month. The results, however, were not statistically significant (p > 0.005). A statistically significant result (p < 0.005) was observed with respect to the gingival index. Conclusion and clinical significance: The use of 2% topical melatonin gel in patients undergoing fixed appliance therapy showed a positive effect in terms of gingival and oral health and a reduction in salivary nickel and chromium levels.

Aim: This study aims to evaluate and compare surface roughness and microhardness of bulk-fill composite in three different salivary pH at various time intervals. Materials and methods: A total of 45 disks of bulk-fill composite resin were fabricated and polished from both sides. These disks were divided into 15 in each group for three different pHs, that is, 5.5, 6.5, and 7. Each group was further subdivided into three subgroups according to time intervals of 7 days, 15 days, and 1 month. Before immersion into artificial saliva, the surface roughness and microhardness of samples were recorded. Disks were immersed in artificial saliva for respective pH and time intervals. After each interval, surface roughness and microhardness were checked, and data were statistically analyzed. Results: A significant increase in surface roughness and a decrease in microhardness was observed when bulk fill composite was exposed to an acidic pH. Also, surface roughness was increased, and microhardness was decreased with increasing the contact period with artificial saliva. Conclusion: Acidic pH has more detrimental effects on physical properties than neutral salivary pH. A decrease in the pH of saliva increases the surface roughness and decreases the microhardness of bulk fill composites. Clinical significance: Food beverages and systemic conditions affect the salivary pH of the oral cavity. Acidic saliva may affect the surface integrity of composite restoration, causing discoloration and microcracks, resulting in fracture of restoration and affecting its longevity. So, patients with acidic saliva require frequent follow-ups for bulk-fill composite restorations for surface finishing and polishing for better performance.

Aim: The aim of the current study was to assess the influence of three different chelating agents on fibrin clot union to the exposed radicular surface. Materials and methods: A total of 40 recently extracted human teeth with a solitary root afflicted with periodontal disease were chosen for this research. Postroot planing, every sample was divided to procure two dentinal blocks more or less 3 × 3 × 1 mm in dimensions. Consequently, 80 radicular specimens were attained that were subjected to individual storage in saline solution. A total of 20 specimens were assigned to one of the following groups: group I—control group, group II—radicular surface subjected to treatment with doxycycline (10%), group III—radicular surface subjected to treatment with 24% ethylenediaminetetraacetic acid (EDTA) gel, and group IV—radicular surface subjected to treatment with saturated citric acid. Following the above, a single drop of fresh human whole blood was included in every dentin block while permitting clot formation for roughly 20 minutes. The blocks were then subjected to rinsing thrice for 5 minutes in 10 mL of phosphate-buffered saline (PBS). Ultimately the specimens were evaluated beneath a scanning electron microscope (SEM) unit. Results: The highest mean fibrin network value was noted with the use of saturated citric acid at 2.88 ± 0.06, in pursuit by the use of 24% EDTA gel at 2.62 ± 0.12, doxycycline (10%) at 2.18 ± 0.18 while 1.28 ± 0.02 for the control group. The difference between the groups was statistically significant, with a p < 0.001. Conclusion: It may be inferred that the highest fibrin network was found with the use of saturated citric acid group compared to 24% EDTA gel, doxycycline (10%), as well as control group. Clinical significance: Applying chelating agents on periodontally-afflicted radicular surfaces subject to instrumentation augments the union of the fibrin clot while proving to be vital in the organization of a novel connective tissue attachment in periodontal rejuvenation techniques.

Aim: To investigate the prevalence and distribution of oral mucosal lesions among geriatric patients attending the Outpatient Department (OPD) of Vishnu Dental College (VDC), Bhimavaram, Andhra Pradesh, India. Materials and methods: A cross-sectional, questionnaire-based study using a modified World Health Organization (WHO) oral health assessment form for adults (2013) was carried out to perform the clinical assessment of the patient among 600 geriatrics (324 males and 276 females) attending Vishnu Dental College (VDC), Bhimavaram, Andhra Pradesh, India. Data were subjected to statistical analysis using Statistical Package for the Social Science (SPSS) software version 20.0, International Business Machines Corporation-United States of America (IBM-USA). Chi-squared test was used to analyze the data. The p-value < 0.05 was considered statistically significant. Results: Around 40% of the patients presented oral lesions, associated with tobacco, and lesions secondary to prosthesis. Males were more affected than females and this difference was clinically significant (p = 0.00). The lesions were more frequently observed between 60 and 69 years of age. The most common lesion observed was smoker's melanosis (37%) and the site of occurrence was buccal mucosa (49%) with deleterious habits like smoking and its related lesions (leukoplakia and smoker's palate) were more prevalent among males while lichen planus and denture stomatitis occurred more frequently in females. Conclusion: The findings of the present study have provided important information on epidemiological aspects of oral mucosal lesions, including the relationship to etiological factors such as smoking, systemic disease, and faulty denture usage, which might prove valuable information in planning future oral health studies and implementing preventive programs in Vishnu Dental College (VDC), Bhimavaram, Andhra Pradesh, India. Clinical significance: Oral health is important to all age-groups of individuals. Whereas in geriatrics they exhibit different oral environments when compared to younger individuals, hence studies of this nature dealing with oral mucosal lesions will potentially help clinicians in identifying high-risk populations and that would be most beneficial for better oral hygiene programs.

Introduction: Children and adolescents display a wide range of oral lesions, including lesions of the oral and maxillofacial hard and soft tissues. The causes of oral health problems in children are unique and distinct from those observed in adult populations. Aim: The purpose of this study was to retrospectively examine pediatric oral biopsies obtained between 2014 and 2021 from an oral and maxillofacial center in Chennai, Tamil Nadu, India, based on age, gender, location, and histopathology. Materials and methods: A retrospective examination of pediatric lesions biopsied over a period of 7 years (2014–2021) was conducted using the data of an institutional referral center for oral and maxillofacial pathology. Patients under the age of 18 were considered pediatric patients. Results: Four thousand sixty-seven biopsies received in the period of 7 years between 2014 and 2021 were examined, 164 of which were taken from pediatric patients. Male to female ratio was 1.5:1. The distribution of the cases was 45 odontogenic pathologies, 25 salivary gland pathology, 20 reactive lesions, 11 connective tissue tumors, 9 fibro-osseous lesions, 20 tumor-like lesions, 9 infectious pathologies, 3 osseous pathologies, and 2 giant cell lesions. Out of these 45 odontogenic pathologies, 35 cases were odontogenic cysts and 20 cases were odontogenic tumors. Conclusion: Biopsies received from the pediatric population were largely odontogenic and salivary gland pathology followed by reactive lesions. Most of them were benign requiring minimal intervention and malignancies were less than 1%. Clinical significance: To identify the incidence and prevalence in oral pathologies in the pediatric population improves the awareness of the various diseases with oral manifestations in children, especially among general and dental practitioners.

Aim: The study investigated salivary cathelicidins (LL-37) as a biomarker for dental caries in relation to nutritional status among a sample of adolescents. Materials and methods: The current study is an observational (comparative study) with (90) 15-year-old male and female adolescents. The participants were split into two groups—60 who had previously suffered from caries (the study group) and 30 who had not (the control group). Adolescents with various caries experiences were divided into two groups, according to World Health Organization (WHO) guidelines from 2013. A total of 30 had moderate (1_3) carious teeth and 30 had severe (DT >10) carious teeth. To quantify caries experience, the decayed, missing, and filled (DMFT) index was used. An unstimulated salivary sample was collected for analysis of cathelicidins, salivary flow rate (SFR), and salivary pH. Assessment of nutritional status by measurement of weight and height and using body mass index (BMI). Adolescents were classified as healthy, at risk of being overweight, or overweight based on their BMI. Results: Salivary cathelicidin levels decrease with caries severity and are significantly different in healthy weight groups and the entire sample. It increased within nutritional status and differed significantly within the severe caries group and the overall sample. Salivary cathelicidin has a weekly negative but not significant correlation with salivary pH and flow rate in nutritional status and caries severity groups, except in the mild caries group where it is strongly negatively correlated with SFR, and with the exception of the healthy weight group with SFR, the risk overweight group, and the overweight group with salivary pH. Conclusion: Salivary cathelicidin protects against bacteria, fungi, viruses, and parasites, hence its level decreases with caries severity. Nutritional status enhances salivary cathelicidin, especially in severe caries. Nutrition and dental caries affect salivary cathelicidin levels. Clinical significance: A substantial percentage of adolescents in Baghdad had severe caries teeth. To improve teenage oral health, public health dentists should create and implement prevention programs. Nutritional status is linked to dental caries. Thus, community-wide initiatives can prevent dental caries and obesity. To prevent dental cavities and obesity, promote healthy eating habits.

Aim: The aim of the present study was to compare and determine the association between gingival biotype [gingival thickness (GT)] and recession in smokers and nonsmokers. Materials and methods: A total of 64 systemically healthy nonperiodontitis subjects aged between 20 and 35 years with gingival recession (GR) were included in this cross-sectional study and divided into two groups—smokers and nonsmokers as per the Centers for Disease Control and Prevention (CDC) criteria for cigarette smoking. GT was assessed in the maxillary and mandibular teeth (premolar to premolar) using a colored periodontal probe (CPP) for the probe transparency method. Results were then subjected to statistical analysis. The Chi-squared test was used to assess the association between the habit of smoking and the gingival biotype and determine the association between the gingival biotype and GR. Mann–Whitney U test was used to determine the difference in quantitative data between smokers and nonsmokers. A p-value of <0.05 was considered statistically significant. Results: Around 40.6% of smokers had thin gingival biotypes, 34.4% had medium, 15.6% had very thick, and 9.4% had thick biotypes. In the nonsmoking group, 40.6% of the nonsmokers (13 out of 32) were reported with medium gingival, 31.3% with thin, and 28.1 % with thick biotypes. A comparison of gingival biotypes in smokers and nonsmokers demonstrated a statistically significant association between the habit of smoking (smokers and nonsmokers) and the gingival biotype (p = 0.03). There was no significant difference in mean GR among smokers (2.34 ± 0.94 mm) and nonsmokers (2.16 ± 1.08 mm) [(p > 0.05)]. No significant association was found between gingival biotype and GR in both groups (p > 0.05). Conclusion: Considering the limitations of this study, it can be concluded that there exists a significant association between the habit of smoking and gingival biotypes. However, there was no significant association found between gingival biotypes and GR in both groups. Clinical significance: Assessment of gingival biotypes during routine dental procedures can help to predict how various biotypes would respond and enhance treatment outcomes for the recession in smokers and nonsmokers.

Aim: To assess the relationship of the maxillary intercanine line to incisive papilla in the South Indian states of Karnataka, Kerala, and Tamil Nadu. Materials and methods: Dental casts obtained from impressions of 90 dentate subjects were used. The maxillary occlusal plane was standardized using a novel device, and the distance between canine tips and the anteroposterior border of the incisive papilla was established. After the division of the incisive papilla into the anterior, middle, and posterior third, the relationship between the intercanine line and the incisive papilla was established using a novel method. Data was analyzed statistically using the Statistical Package for the Social Sciences (SPSS) software. Results: The mean intercanine distance and anteroposterior length of incisive papilla were found to be 35.45 ± 1.84 mm and 7.84 ± 1.30 mm, respectively. The results of the analysis of variance (ANOVA) test showed no ethnic differences. The intercanine line passed through the middle third of incisive papilla in 60, 63.3, and 56.7% of subjects from Karnataka, Kerala, and Tamil Nadu, respectively. The results of the Chi-squared test showed no gender difference. Conclusion: It can be concluded that the intercanine line fells within the middle third of the incisive papilla in the majority of the study population, inferring that there is no variation between these different ethnic groups. Clinical significance: Incisive papilla may be used as a biometric guide during teeth arrangement in complete denture prosthesis in the absence of preextraction records.

Aim: This systematic review aims to evaluate the antimicrobial efficacy of octenidine dihydrochloride (OCT) and chlorhexidine (CHX) as endodontic irrigants when used against Enterococcus faecalis (E. faecalis) and to compare the efficacy of both when used as a chemomechanical agent. Background: This systematic review literature search was undertaken in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE) Ovid (from 1946), Scopus, and Google Scholar, as well as a hand search of the references of included publications. Ex vivo and in vitro, studies were included. The risk of bias was assessed using a customized tool. In vitro and ex vivo studies were done on a natural tooth and agar cultures to measure the colony forming unit (CFU), zone of inhibition (ZOI), minimum inhibitory concentration (MIC), and proportion of dead cells to evaluate the antimicrobial efficacy of octenidine and CHX were considered outcomes in this review. Review results: From 152 articles, 25 were reviewed for full text. A total of 12 in vitro studies were included for qualitative analysis. Out of 12 studies, eight studies reported better antimicrobial efficacy for OCT than CHX; two studies showed comparable results, and two studies favored CHX. Conclusion: Octenidine was a more potent disinfectant in the root canal for better antimicrobial efficacy than CHX as an irrigant against E. faecalis. Clinical significance: Octenidine dihydrochloride (OCT) has been described as a potential substitute for CHX during chemomechanical debridement in endodontic treatment. OCT is less cytotoxic to the periapical tissues than CHX; however, as an antimicrobial, it is highly effective against a range of gram-positive and gram-negative oral bacterial species. The substance of CHX in dentin seems to be an advantage over OCT. Thus, different studies have been conducted to compare the effectiveness of OCT and CHX for disinfection of the root canal, and the evidence seems to support the clinical use of OCT more.

Aims and background: Mineral trioxide aggregate (MTA) is a bioactive calcium (Ca) silicate-based material that is commonly used in endodontic and restorative procedures. The material interacts with living host tissues in close proximity to promote tissue healing. This paper reviews the interaction and effect of MTA on the various components of the local immune response cascade. Results: Mineral trioxide aggregate (MTA) is capable of releasing Ca ions (Ca²⁺), increasing the alkalinity of surrounding tissues, and altering enzymatic activity within cells. By recruiting cells to the application site, MTA is capable of eliciting a local immune response. MTA has been found to enhance the actions of interleukin-1α (IL-1α), IL-6, and IL-12, upregulate macrophage M2 polarization, promote angiogenesis, and suppress proinflammatory interferon (IFN) and messenger RNA (mRNA) expression of IFN-γ. However, MTA has no effect on cytokines tumor necrosis factor-α (TNF-α), RANKL, and IL-10. MTA's anti-inflammatory properties facilitate tissue healing, and the mineralization induced by MTA is significant even in the presence of systemic diseases such as diabetes mellitus and hypertension. MTA modulates the expression of various components and enzymes involved in the immune response cascade, resulting in antiinflammatory effects, angiogenesis, and optimal healing of inflamed or injured tissues. Conclusion: Mineral trioxide aggregate (MTA) has demonstrated bioactivity and is capable of promoting healing without any cytotoxic effects. The activation and suppression of specific immune responses by MTA are responsible for its antiinflammatory properties, making it a valuable tool for clinicians in various endodontic, and restorative applications. Clinical significance: The MTA's clinical significance lies in its ability to promote healing and modulate the immune response cascade in a manner that facilitates optimal tissue repair.