Aim: To compare and assess the efficacy of buccal pad fat in combination with demineralized freeze-dried bone allograft (DFDBA) as a barrier material vs buccal pad fat alone in the treatment of grade II furcation defects. Materials and methods: Participants (n = 12) in the study age-group of 30–50 years old with no systemic disease, chronic generalized periodontitis, and grade II furcation defects were randomly assigned to groups I and II. Group I patients were assigned DFDBA and buccal fat pad (BFP), while group II received BFP alone. At baseline, 3 months, and 6 months, clinical measures such as gingival index (GI), plaque index (PI), relative clinical attachment level (CAL), horizontal pocket depth, vertical pocket depth, probing pocket depth (PPD), and radiographic findings were compared between groups I (buccal pad and DFDBA) and II (buccal pad). Results: In both groups, clinical parameters from baseline to 6 months at varied time intervals revealed a significant reduction in mean GI and PI. Intergroup comparisons, however, showed a clinically and statistically significant reduction in group I at the end of 6 months. Conclusion: According to the findings of this study, the association between DFDBA and BFP is a practical and acceptable therapeutic method that leads to higher patient compliance and has high regenerative potential. Clinical significance: In the treatment of grade II furcation defects, the combined treatment of BFP and DFDBA produced a good response.

Aim: The aim of this research was to evaluate the extent and level of accuracy of two different occlusal caries detection techniques. Materials and methods: Freshly extracted 40 permanent human premolars for orthodontic or periodontal reasons were utilized in the study. The current study used two different methods of testing—a visual examination and an air-water syringe. Occlusal surfaces were inspected under a normal dental operatory light. Laser fluorescence examination—the DIAGNOdent (DD) pen tip was positioned perpendicular to the testing location, and the area where the lesion progressed more was recorded by rotating the pen tip. For every site, three readings were taken in a row, and all the teeth underwent both tests. Following section photography and attachment to a stereomicroscope set to ×10 magnification, the samples were validated. The student's t-test was used for intragroup and intergroup comparisons, with a significance threshold of p < 0.05. Results: On visual examination, with air-drying score was 1.418, and without air-drying was 1.722. On laser fluorescence examination, with air-drying score was 1.142, and without air-drying, it was 1.286. The accuracy, sensitivity, and specificity values were determined using the reference standard. The receiver operating characteristic (ROC) analysis approach was used to calculate the area under the curve (AUC). The diagnostic accuracy was higher (88.4%) in laser fluorescence examination with air-drying, with 93.7% sensitivity and 60.8% specificity. The diagnostic accuracy without air-drying was 85.8% with 88.2% sensitivity and 63.2% specificity. On visual examination, the diagnostic accuracy with air-drying was 84.2% with 90.4% sensitivity and 70.3% specificity. The diagnostic accuracy without air-drying was 75.8% with 74.8% sensitivity and 76.4% specificity. Conclusion: In conclusion, enhanced efficacy in terms of sensitivity and specificity has been demonstrated by both the visual and laser fluorescence (DD) methods. However, the DD laser fluorescence instrument has demonstrated better diagnostic performance for occlusal caries. Clinical significance: Dental caries is a common chronic condition that affects virtually all individuals in developing nations. Early caries detection is essential for successful remineralization and a better prognosis. The subjective nature of visual examination makes it difficult for many healthcare professionals worldwide to diagnose smooth surface caries in their early phases, and newer methods are required to identify them.

Aim: The purpose of the present study was to evaluate and compare the effects of two types of cavity designs and different types of composites on the fracture resistance of mesio-occlusal-distal (MOD) cavities. Materials and methods: Ninety maxillary premolars were selected. Ten samples were used as negative controls. The remaining 80 samples were divided into two groups: group I, samples with cavity width of 1/2 the intercuspal width; and group II, samples with cavity width of 2/3 the intercuspal width. Ten samples from each group were left unrestored and used as positive controls. The remaining 30 samples of each group were further distributed into three subgroups: subgroup A, restored with Tetric N-Ceram (bulk-fill composite) (TNC-BFC); subgroup B, TNC-BFC + Interlig fibers (Angelus); and subgroup C, GC EverX Posterior (EXP) (FRC). An Instron universal testing machine (UTM) was used to evaluate the fracture resistance. The data were tabulated and subjected to statistical analysis. Results: Intergroup and intragroup analyses showed significant differences in fracture resistance. All the experimental subgroups showed significantly greater fracture resistance compared to their respective positive controls and reduced fracture toughness compared to the negative control, except group IC, which showed similar results to intact teeth. Conclusion: Considering the limitations of the study, it may be concluded that fracture resistance is affected by different designs of MOD cavities in upper premolars and that using short fiber-reinforced composites as a restoration for weakened premolars can significantly reinforce the teeth with improved fracture resistance. Clinical significance: Fiber-reinforced composite can restore the fracture resistance of a tooth in extensive cavity designs.

Aim: This study aimed to evaluate the minimum inhibitory concentration (MIC) of Syzygium cumini (jambolina) seed extract and Psidium guajava (guava) leaf extract against Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), and Aggregatibacter actinomycetemcomitans (Aa). Materials and methods: The preparation of the herbal aqueous extracts and alcohol extracts was done by Soxhlet extraction method. MIC of different extracts of S. cumini and Psidium guajava was determined. Results: The MIC of aqueous Psidium guajava leaf extract for Aa was 100 μg/mL, for Tf was 6.25 μg/mL, and Pg was sensitive at all concentrations. The MIC of the aqueous extract of S. cumini was 25 μg/mL for Aa, 12.5 μg/mL for Tf, and Pg was sensitive at all concentrations. The MIC of alcoholic extract of Psidium guajava and S. cumini was found to be 100 μg/mL for Aa and 1.6 μg/mL for Tf. Conclusion: The S. cumini seed extract and Psidium guajava leaf extract showed antibacterial activity against periodontopathogen species Aa, Tf, and Pg. The MIC for the species examined, however, ranged widely and were often very high. Traditional knowledge may nevertheless offer some insights into probable candidates for the creation of new antibiotics in the future. Clinical significance: Peri-pathogens are responsible for periodontitis. The present herbal extracts could be used as antimicrobial agents to eradicate or minimize the bacterial load in dental plaque and be used for oral hygiene maintenance.

Aims: To investigate the effect of postbleaching casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on the shear bond strength (SBS) of ceramic brackets. Materials and methods: This in vitro experiment was conducted on 27 healthy upper premolars that were randomly allocated to one of three groups (n = 9): the control group, the bleached group followed by casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) treatment, and the bleached group followed by CPP-ACP treatment. All of the samples were instantly attached to ceramic brackets, soaked for 24 hours, and then debonded with a universal testing machine. The adhesive remnant index (ARI) was measured with a stereomicroscope to determine how much adhesive was left. SBS data were evaluated using one-way analysis of variance (ANOVA) followed by Tukey's test, while ARI index data were analyzed using Kruskal–Wallis and Mann–Whitney U tests with a significance level of 5%. Results: Analysis of variance analysis of the shear strength revealed a significant difference between the groups (p < 0.05) in the shear strength. A significant difference between the control and treatment groups was shown by post hoc Tukey (p < 0.05); however, there was no significant difference between the two treated groups (CPP-ACFP and CPP-ACP). Regarding the ARI, there were no notable differences across the groups (p > 0.05). Conclusion: Bleaching decreased the SBS of ceramic brackets bonded with glass ionomer cement. However, the CPP-ACFP and CPP-ACP were able to increase the SBS of ceramic brackets immediately after bleaching. Clinical significance: By applying CPP-ACFP and CPP-ACP to provide adequate SBS during orthodontic treatment, bonding of orthodontic brackets can be performed immediately following bleaching.

Aim: To assess the efficacy of omega-3 (ω-3) polyunsaturated fatty acid (PUFA) as a dietary supplement vs local drug delivery (LDD) agent based on periodontal and microbiological parameters in patient with generalized chronic periodontitis. Materials and methods: Around 10 systemically healthy individuals diagnosed with “generalized chronic periodontitis” were selected, and after randomization, five patients were allotted to each group. Group I (n = 5) patients were given ω-3 PUFA capsules as a dietary supplement of 500 mg BD orally after scaling and root planing (SRP), and in group II (n = 5), ω-3 PUFA oil was placed as LDD after SRP. Pocket depth, clinical attachment level (CAL), gingival, and plaque index (PI) were recorded, and colony-forming unit (CFU) of Porphyromonas gingivalis were recorded at baseline, after 3, 4, and 6 weeks from plaque samples. Data were recorded and statistically analyzed. Results: Both groups showed a reduction in bleeding index, pocket depth, PI, CAL, and P. gingivalis CFU count at 3, 4, and 6 weeks follow-up, with more reduction in group II. Further statistically significant reduction was seen at a 6-week follow-up in group II in PI with a p-value of 0.023 and P. gingivalis CFU counts with a p-value of 0.024. Conclusion: It may be concluded that ω-3 PUFA is more efficacious as an LDD agent compared to a dietary supplement and showed a significant reduction in periodontal and microbiological parameters. Clinical significance: Till now, ω-3 fatty acid was used as a dietary supplement with a dose of 500 mg BD for 1–2 months. Further, in the present study, it has been used as an LDD agent in periodontitis. The potential of ω-3 fatty acid, due to its host modulation factors, has increased in management as an adjunct in the treatment of periodontitis.

Aims and background: To evaluate the effect of the piezosurgery device as a recent modality for bone removal of impacted mandibular third molars in comparison to the high-speed handpiece, along with the efficacy of hyaluronic acid (HA) regarding its effect on postoperative pain, trismus, dry socket, and swelling. Materials and methods: This prospective study involved 40 patients divided into four groups with 10 patients in each group. Group I and group II included 10 patients each, where third molar removal was done using conventional technique (carbide burs) with or without placement of HA soaked in gelfoam in the socket, respectively. Group III and group IV included 10 patients each, where third molar removal was done using piezosurgery with or without placement of HA soaked in gelfoam in the socket, respectively, and no gelfoam was placed. All patients were followed up clinically at 1, 3, 5, and 7 days postoperatively. The parameters included swelling, trismus, pain, and dry socket. Data were recorded and statistically analyzed. Results: There were no significant differences in postoperative swelling on the 1st, 3rd, and 5th postoperative days in all the groups. However, on day 7, a significant difference was found, highest in group I and lowest in group II patients. Trismus was significantly lower in group IV, having lower third molar disimpaction using piezosurgery with HA gelfoam placed. Conclusion: Hyaluronic acid with gelfoam is effective in controlling trismus and dry socket postoperatively after mandibular third molar extraction with the conventional bur technique. However, our results showed no significant changes in the case of pain and swelling. Clinical significance: Hyaluronic acid is a biomaterial introduced as an alternative approach to enhance wound healing. Trismus and dry socket are the most common sequelae following impacted third molar surgical extraction. Applying HA with gelfoam can reduce the severity of unhealed socket and trismus, which could be useful in surgeons’ daily practice.

Aim: The aim of the present study was to evaluate the antimicrobial efficacy of 2.5% sodium hypochlorite (NaOCl), ozonated oil, and normal saline. Materials and methods: A total of 75 deciduous teeth indicated for pulpectomy treatment were selected for the study. These were divided into three groups: group I (n = 25)—2.5% NaOCl, group II (n = 25)—normal saline, and group III (n = 25)—ozonated oil. After completion of access opening and extirpation of the pulp, the first sample was taken by placing a paper point into the canal. The second sample was taken after completion of canal preparation and irrigation of the canals with the respective solutions. The paper points were then sent to the department of microbiology for culture. Results: A statistically significant difference was seen in all three groups for pre- and postirrigation values. The greatest percentage difference was observed in group I (214.4 ± 70.27), followed by group III (76.92 ± 32.66) and group II (54.16 ± 26.8). Conclusion: Among all three irrigating solutions, 2.5% NaOCl had the maximum antimicrobial efficacy on the root canal microflora, followed by ozonated oil. Clinical significance: To understand the advantages of using NaOCl and ozonated oil as irrigant mediums in the root canals of primary teeth.

Aim: The present study aimed to evaluate and compare salivary leptin levels in normal-weight and overweight female participants bonded with conventional and self-ligating preadjusted brackets and compared before and after orthodontic force application. The results were then correlated with the rate of orthodontic tooth movement. Materials and methods: The present study involved 48 female subjects who were divided equally into three main groups: group I—conventional bracket, group II—self-ligating bracket, and group III—control. Each group was further subdivided based on their body mass index (BMI) into normal-weight and overweight groups. All subjects required distalization of the maxillary canine after maxillary first premolar extraction. Active lacebacks were incorporated to apply distal force to the maxillary canine. Salivary samples were collected from each subject at T0 (before force application), T1 (1 hour after force application), and T2 (1 month after force application). The salivary samples were analyzed for leptin levels using an enzyme-linked immunosorbent assay (ELISA) test. The rate of tooth movement was also measured at T2 on study models. Results: The mean salivary leptin concentration in conventional bracket (591.4 ± 213.2) and self-ligating bracket (608.1 ± 217.7) groups showed a significant initial increase at T1, and then decreased at T2 (423.1 ± 208.2 and 407.1 ± 214.3, respectively), whereas in the control group, there were no changes. In the self-ligating bracket group, both normal-weight (0.85 ± 0.03) and overweight (0.77 ± 0.02) participants had a significantly higher mean rate of tooth movement than the conventional (0.81 ± 0.04 and 0.71 ± 0.02, respectively) bracket group (p < 0.05). Conclusion: The overall salivary leptin concentration in the self-ligating bracket group at T2 was much lower than its baseline compared to other groups. There was a significant inverse relationship between salivary leptin concentration and tooth movement rate. Clinical significance: Leptin has cytokine-like effects that are responsible for bone remodeling, and since orthodontic tooth movement involves the inflammatory process, leptin can affect the rate of orthodontic tooth movement, with a difference in orthodontic tooth movement between normal-weight and overweight persons.

Aims: To assess the prevalence and severity of early childhood caries (ECC) in children, using the pulpal involvement, ulceration, fistula, abscess primary teeth/pulpal involvement, ulceration, fistula, abscess permanent teeth (pufa/PUFA) index, and to evaluate the associated risk factors in the development of ECC in children aged 24–71 months in Kollam district, Kerala, India. Materials and methods: A cross-sectional study was carried out for a duration of 18 months among 400 children aged 24–71 months and their mothers in Kollam district, Kerala, India. The indices used to evaluate dental caries and the consequence of untreated dental caries were the decayed, missing, filled surfaces primary teeth/decayed, missing, filled surfaces permanent teeth (dmfs/DMFS) index and pufa/PUFA index, respectively. The study was conducted in two phases. In the first phase, data were generated through a structured questionnaire, and in the second phase, clinical examinations of children and their mothers were conducted. All the data collected were entered into a Microsoft Excel datasheet and were statistically analyzed. Results: The overall prevalence of caries and untreated dental caries (PUFA) among children was 63.3 and 51.1%, respectively. Maternal factors such as increased DMFS and PUFA scores, lack of awareness regarding prolonged use of bottles in a child's mouth, and maternal sharing of utensils were found to be major risk factors in identifying children susceptible to caries. Feeding habits of the child, including feeding frequency, type of feeding, and presence of nighttime feeding, were other factors associated with ECC. Conclusion: The results of this study showed a high prevalence of ECC and associated pulpal pathology in children and their mothers. Clinical significance: Maintaining a healthy primary dentition is always important for children's well-being. The associated pain from untreated caries has a negative impact on a child's overall development. Hence, early detection and prevention of ECC is of utmost importance.

Aim and objectives: The present study aimed to evaluate the clinical and microbiological effects of the cefixime-ofloxacin combination as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. Materials and methods: Forty subjects, aged 30–60 years, with generalized chronic periodontitis were selected. They were randomly assigned and divided into the following two groups: a test group, which received cefixime-ofloxacin combination therapy along with SRP, and a control group receiving SRP alone. Gingival index (GI), papillary bleeding index (PBI), and probing pocket depth (PPD) scores were recorded at baseline and the 90th day. Saliva samples were collected at baseline and the 90th day and inoculated on sheep blood medium. Colonies were observed for their morphology and counted using a digital colony counter. Results: Both groups showed a reduction in GI, PBI, mean PPD, and microbial colony counts from baseline to 3 months, with better improvement in scores observed in the SRP + cefixime-ofloxacin combination group compared to the SRP alone group. The intergroup comparison of GI, PBI, mean PPD, and microbial colony counts at baseline and 3 months showed a statistically significant difference. Conclusion: Cefixime-ofloxacin combination therapy proved to be an effective adjunct to SRP in the treatment of generalized chronic periodontitis. This combination was safe and well tolerated by patients. Clinical significance: The cefixime-ofloxacin combination acts on a wide range of periodontal pathogens and has fewer side effects, making it safe for administration as an adjunct to SRP in the treatment of generalized chronic periodontitis.

Aim: The purpose of this study was to assess the impact of different flowable liners on cuspal deflection (CD) in extracted maxillary premolars that have been restored using bulk-fill composite. Materials and methods: A total of 48 mesio-occlusal-distal (MOD) cavities were prepared in extracted human maxillary premolar teeth. The preparations (n = 12) were randomly divided into four groups. Groups I, II, and III were lined with Neo Spectra ST, Tetric N-Ceram, and Filtek 3M liners, respectively, and all were further restored using Tetric N-Ceram bulk-fill composite. The control group, group IV, received Tetric N-Ceram bulk-fill packable composite. In this study, CD was measured using a digital micrometer, and measurements were recorded in millimeters. Results: Cuspal deflection mean values were statistically significant immediately after restoration (CD2) and post 24 hours of restoration (CD3) in all groups, with group IV, in which no liner was used, showing maximum deflection and group II showing minimal deflection compared to all other groups. The intergroup comparison showed no significant difference between groups I, II, and III, but all three groups were statistically significant when compared to group IV. Hence, restorations in which liner was used recorded less CD compared to those in which no liner was used, indicating higher polymerization stresses in that group. Conclusion: The application of a liner has a positive impact on CD, reducing it by decreasing polymerization shrinkage, distributing stress, and improving marginal adaptation. Clinical significance: Minimizing CD in dentistry prevents cohesive and adhesive restorative failures and prolongs the lifespan of dental restorations by reducing stress on them. In this study, it was proven that restorations lined with a liner recorded less deflection than those in which no liner was used.

Introduction: Oral submucous fibrosis (OSMF) is an oral premalignant disorder marked by inflammation of the submucosal tissues, leading to progressive fibrosis and ultimately resulting in rigidity and limited mouth opening. Literature has indicated that a multitude of microRNA (miRNAs) are abnormally expressed in OSMF, and this dysregulation may play a role in the condition's diagnosis, prognosis, and therapeutic aspects. Aim: The aim of this study was to identify miRNA targets of candidate genes in OSMF using a computational approach. Materials and methods: The Gene Expression Omnibus (GEO) software was used to obtain data on differentially expressed genes for OSMF without dysplasia (OSMWT), OSMF with dysplasia (OSMWD), and OSMF with squamous cell carcinoma (OSCC). The genes that were common to OSMWT, OSMWD, and OSCC were further subjected to analysis by miRNA Target Prediction Database (miRDB) software to identify the miRNAs that targeted the candidate genes. Results: This study yielded 63 miRNAs with a target score of 90–100 and potentially associated with OSMF. The miRNAs hsa-miR-5011-5p and hsa-miR-8087 had the highest target score of 100. This was followed by hsa-miR-520d-5p, hsa-miR-524-5p, hsa-miR-7162-3p, hsa-miR-499a-5p, hsa-miR-1324, and hsa-miR-520d-5p with a target score of 99. Conclusion: This study has aided in the process of gene and miRNA prioritization in the context of OSMF, which can serve as a useful tool for understanding the disease. Clinical significance: The findings of this study can serve as the basis for formulating appropriate pharmacotherapy for OSMF along the lines of personalized medicine.

Aim: To describe a rare case in which a patient developed severe trismus associated with pain and paresthesia on the left side of the face, which, on comprehensive assessment and findings from fine needle aspiration cytology (FNAC), computed tomography (CT), and positron emission tomography-computed tomography (PET-CT), revealed metastasis involving left lateral pterygoid muscle from lung cancer. Background: Metastatic tumors involving the oral cavity are rarely encountered in clinical practice and act as a diagnostic challenge to the clinician. The presence of trismus as a clinical symptom can hamper the diagnosis, as it can lead to misjudgment, thereby hindering the early identification of the underlying malignancy and delaying timely treatment for the patient. Case description: A 45-year-old male, presented with the chief complaint of trismus and pain in the left side of the face for the past 5 months, associated with paresthesia. The patient also gave a history of weight loss with no other significant medical history. He had a habit of smoking cigarettes and alcohol consumption since 30 years. On comprehensive examination, a single left submandibular lymph node was palpable, and also tenderness in masseter, temporalis, and sternocleidomastoid muscle on the left side was present. Intraorally, there was tenderness in the buccal vestibule of mandibular left posterior tooth region with no other significant soft tissue and hard tissue findings. Blood investigation reports, orthopantomogram (OPG), and chest X-ray did not reveal any pathology. Based on the above findings, a provisional diagnosis of pterygomandibular space infection secondary to periodontal infection from the mandibular left third molar was considered. A full course of antibiotics administration did not cause any improvement; hence, a CT scan of the head and neck was advised, which unveiled a peripherally enhancing hypodense lesion with central hypodensity involving left lateral pterygoid muscle and further specialized investigations like FNAC and PET-CT revealed primary malignant lesion of the lung with metastasis to left lateral pterygoid muscle and left cervical lymph nodes. A teatment plan of chemotherapy in combination with radiotherapy was devised at a regional oncology center. However, due to the advanced stage of the condition and poor prognosis, the patient succumbed to the disease within 6 months of initiating treatment. Conclusion: This is one of the unique cases of metastasis to lateral pterygoid muscle from lung carcinoma with the clinical presentation of trismus, which mimicked odontogenic infection or a temporomandibular joint disorder. This case report also emphasizes the role of CT and PET-CT in diagnosing the primary malignant lesion and its metastasis to distant sites. Clinical significance: This is a rare case where metastasis to the oral and maxillofacial region manifested as trismus, a rare sign that was the first clinical indication of an undiscovered distant primary tumor. This case highlights the critical role of comprehensive clinical assessment and advanced imaging in identifying underlying malignancies in patients with seemingly innocuous symptoms like trismus and facial pain.

Aim: This systematic review aims to evaluate the evidence available on the clinical effectiveness such as survival rate, gingival health, and patient/parent acceptance of various fixed space maintainers vs band and loop (B&L) space maintainers (BLSMs) in mixed dentition. Materials and methods: A comprehensive electronic search and synthesis of existing evidence was conducted using databases such as PubMed Central, Cochrane Database of Systematic Reviews, Google Scholar, LILACS, and Science Direct from 2012 to 2022 for randomized controlled trial (RCT) that describes the clinical efficiency of unilateral fixed space maintainer compared to conventional BLSM. Results: Out of 52 RCTs, 46 were excluded based on inclusion and exclusion criteria. Only six split-mouth RCT comparing BLSM with other unilateral fixed space maintainers were included in the final review. Conclusion: Within the limitations of the study, fiber-reinforced space maintainers exhibit better parental acceptance than conventional BLSM. Conventional B&L demonstrate higher survivability, followed by fiber-reinforced composite space maintainer. Gingival health on all the space maintainers shows fair results. Clinical significance: This systematic review holds significant clinical implications by specifically examining the split-mouth RCT, which makes it unique from the previous literature and enhances evidence-based decision-making.