Aim: The aim of this study is to evaluate the ability of the remaining gutta-percha (GP) in the apical third of root canals after fiber post placement. Materials and methods: Thirty single root canals extracted were sectioned to 18 mm and divided into three groups. All the root canals were shaped with ProTaper Next (X3 file) and filled with GP and resin-based sealer at three different lengths (4, 5, and 7 mm) from the root apex. The fiber post placement was constructed immediately. The roots were immersed in methylene blue dye for 14 days and transversely sectioned in disks of 1 mm thick from the apex to the post. The evaluation of the dye penetration was done using a stereomicroscope. One-way analysis of variance (ANOVA) and multiple comparisons of Scheffe's tests were used to test the length of dye penetration. Chi-squared test was used to test dye penetration scale (p < 0.05). Results: In the group 3 where the left (or remaining) GP was 7 mm, the dye penetration scale was lower compared with the other groups (p < 0.05). There was less dye penetration at 6 mm from the apex, and there was no penetration at 7 mm from the apex. The dye penetration scale was generally decreased from the 1 mm level disk to the 4 mm level disk in all the groups. Conclusion: A 7 m m l ength o f r emnant G P i s n ecessary to obtain an improved apical seal in the cases where a post retention restoration is required in an endodontic treated tooth. Clinical significance: To maintain the integrity of the apical sealing, it is necessary to leave 7 mm of GP in the apical third of the root canal. The “standard gold” of 5 mm of the apical seal with GP cannot prevent apical leakage.

Aim: Many techniques have been used for quantification of Candida colony-forming unit (CFU) in the oral cavity. Also it is proved that unstimulated saliva and concentrated oral rinse show maximum fungal loading. Healthy edentulous patients prior to wearing complete denture do not possess a Candida lesion or accretion of Candida colonies in the palate. Therefore, an appropriate technique to find out the CFU of Candida in such cases is still not clear. Hence, the aim of this study was to determine if palatal swab buffered in saline can be one of the most appropriate techniques to find out CFU of Candida in healthy edentulous patients. Materials and methods: This was done by comparing CFU count obtained in unstimulated saliva and a palatal swab buffered in phosphate saline in 40 healthy edentulous patients approaching the outpatient department (OPD). Both the samples collected were inoculated on Sabouraud dextrose agar (SDA) plates for 24 hours. The CFU was counted in digital colony counter. Results: Paired t-test shows that there is statistically no difference in CFU count obtained from both the methods. The Pearson's correlation coefficient shows a statistically significant positive correlation (p < 0.05) between the two types of sampling techniques. Conclusion: From the results it can be concluded that palatal swab buffered in saline can be used as one of the techniques to quantify Candida than plain palatal swab which though site specific is not a quantifying technique for the same. Clinical significance: Using palatal swab buffered in saline technique will help the clinicians to obtain the samples from healthy edentulous patients in the studies involving quantification of Candida.

Aim: The purpose of this study was to measure traditional methods used by the people of Hail, Kingdom of Saudi Arabia to whiten teeth. This will help us to find out some of the possible reasons from them for using the techniques and would enable us to raise awareness. Materials and methods: It was an observational study having a cross-sectional design. It included 350 respondents living in Hail, and the study used a nonprobability convenient sampling technique. Data about demographics and the methods used for teeth whitening were collected using a self-administered validated questionnaire translated into Arabic. Results: The results depict that majority of the study participants (59.1%) with low income level were not satisfied with their tooth color and were willing to undergo tooth-whitening procedures. Coal was used by 21% of respondent for teeth whitening, followed by olive oil 15%, and lemon 10%. Conclusion: Based on the information, it is clear that a group of people living in Hail is still comfortable to use the conventional methods to make their teeth look whiter. Clinical significance: Despite the advances in esthetic dentistry, traditional methods of teeth cleansing and whitening are still being practiced. The practice is without evidence and without any scientific rationale. It can cost individuals their oral as well as overall health.

Aim: This study aims to evaluate the effect of sterilization and disinfection of rotary diamond burs on their cutting efficiency. Materials and methods: A total of 20 freshly extracted intact premolar teeth were subjected to tooth preparation using rotary diamond burs. Group I (n = 10) teeth were subjected to electroplated burs and group II (n = 10) teeth were subjected to welded diamond and vacuum diffusion technology (WDVDT) burs. They were further subdivided into two subgroups, groups I1 and I2, and II1 and II2 (n = 5 each), depending on different sterilization procedures. Each bur was then subjected to the stereomicroscopic examination, preusage and after the first usage, 5th and 10th subsequent usages. Each tooth was also measured for its weight using a digital weighing machine (preand post-preparation) to assess the cutting efficiency. Results: On statistical comparison, the results of the study revealed that there is a definitive correlation between groups I and II specimens (p = 0.0002^*, F = 17.7172). However, there was no statistical significance observed within the subgroups (p = 1.0000, F = 0.00001). Conclusion: The conventional electroplated burs, when subjected to different sterilization procedures, resulted in greater structural alterations with a reduced cutting efficiency when compared with WDVDT burs. Clinical significance: Diamond rotary burs should be sterilized and disinfected to prevent cross-contamination between the dentist and dental personnel. However, different sterilization and disinfection methods can have undesirable effects on the ability of the burs to effectively reduce the tooth structure. Irrespective of the type of bur and sterilization process used, the cutting efficiency decreases.

Aim: The present study aims to estimate as well as compare the amount of immunohistochemical expression of heat shock protein 27 (HSP27) in oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC). Materials and methods: The study group comprised 24 cases of OPMDs, 12 OSCC cases, and 9 normal (controls) oral mucosa specimens. All sections were stained immunohistochemically with HSP27 antibody kit followed by analysis. Results: Increased intensity of staining with statistically significant difference (p = 0.001) was observed in OSCC cases when compared with normal oral mucosa sections. Statistically insignificant results were obtained between OPMDs and normal tissues. Conclusion: Due to significant increase in the staining intensity of OSCC cases when compared with normal sections, HSP27 can be possibly used as a prognostic marker in OSCC cases. Clinical significance: Early diagnosis of malignant transformation through diagnostic markers will markedly improve the overall quality of life. Therefore, early monitoring of the expression of HSP27 in OPMDs will give an insight into their malignant transformation.

Aim: Tissue fibrosis can be considered as a component of normal healing process in response to various kinds of injury. It involves the recruitment of immune cells and inflammatory molecules to the site of injury and accumulation and reorganization of extracellular matrix components. The stress exerted during fibrogenesis leads to the activation of immune cells. Based on these, we intended to study the level of serum immunoglobulins at various stages of a precancerous condition of oral mucosa called oral submucous fibrosis (OSMF). Materials and methods: The major serum immunoglobulin levels, namely, immunoglobulin G (IgG), Immunoglobulin A (IgA), Immunoglobulin M (IgM), and Immunoglobulin E (IgE), were analyzed by chemiluminescence immunoassay. The results obtained were subjected to analysis of variance and Tukey–Kramer multiple comparisons to reveal the statistical significance of the disease. Results: The present study reported a significantly high level of IgG, IgA, IgM, and IgE in all stages of OSMF when compared with healthy individuals. Conclusion and clinical significance: Thus, the alterations in the routine immunological analysis observed in the present study could be utilized both as prognostic and diagnostic marker in case of oral potentially malignant disorder, especially OSMF.

Aim: To evaluate the antimicrobial efficacy of nisin and calcium hydroxide with and without pantoprazole against Enterococcus faecalis in comparison with chlorhexidine (CHX) 2% solution. Materials and methods: The antibacterial effect of the following experimental groups as intracanal medicaments (group I nisin, group II Ca(OH)₂ powder 29% conc., group III Ca(OH)₂ with pantoprazole 20 mg, group IV Ca(OH)₂ with pantoprazole 40 mg, group V CHX 2% solution, and group VI saline) was evaluated using the agar diffusion test for a time period of 24 hours. The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) against E. faecalis were also determined. Statistical analysis was performed using Kruskal–Wallis test and chi-square test. Results: The agar diffusion test showed zones of inhibition for groups I, II, and V. Nisin and CHX groups showed the maximum zone of inhibition compared with other experimental groups. The MIC values for the experimental groups I, II, III, and V were 0.2 mg/mL, 0.45%, 0.45% + 0.03 mg/mL, and ≤ 0.01% respectively. The MBC values were tabulated. Conclusion: The antimicrobial efficacy of nisin as an intracanal medicament was similar to CHX 2%; Ca(OH)₂ with pantoprazole was not effective against E. faecalis. The MIC value of nisin is 0.2 mg/mL against E. faecalis. Clinical significance: Nisin, when used as an intracanal medicament, is effective in eliminating E. faecalis when compared with the combination of Ca(OH)₂ with pantoprazole, a proton pump inhibitor (PPIs).

Introduction: Oral submucous fi brosis (OSF) i s t he m ost common potentially malignant disorders which is widely spread and has high malignant transformation rates. The use of immunohistochemical (IHC) studies has become one of the stepping stones to establish new surrogate markers to analyze the malignant transformation of a potentially malignant disorder to malignancy. Oral submucous fibrosis has been classified as stages 1, 2, and 3 according to severity of fibrosis and hyalinization, but the intensity of IHC staining of cytokeratin 19 (CK19) among these stages has not been done to analyze and establish the fact whether the intensity increases according to clinical stages. Materials and methods: Thirty-five cases of OSF were taken according to the clinical stages and an IHC study was done using CK19. The p-value was calculated using Fisher's exact tests. Results: Among 35 cases, 6 cases of stage 1 showed 33.3% of negative, 0% of mild, 50% of moderate, and 16.6% of intense staining. Twelve cases of stage 2 showed 16.6% of negative, 25% of mild, 33.3% of moderate, and 25% of intense staining. Seventeen cases of stage 3 showed 5.8% negative, 47% mild, 35.2% moderate, and 11.7% intense staining. The overall and comparative p-values were insignificant. Conclusion: Since the overall and comparative p-values were insignificant, the present study shows that there is no relation between the clinical stages of OSF and the CK19 staining. Hence, there is no increase in intensity according to clinical stages. Clinical significance: Establishing a direct relation between clinical stages of OSF and many cellular and extracellular proteins through IHC studies would make a well-established proof directly correlating the severity and staging in mouth opening to intensity of CK19. In this study, p-values were less and hence the study showed an insignificant clinical outcome.

Introduction: Glioblastoma is one of the most common and most aggressive malignant primary tumors of the central nervous system which originates in astrocyte cells accounting for ~12 to 15% of all intracranial neoplasms. Its development to extracranial areas is very rare, occurring in <2% of patients. Very few cases (<200) of extracranial metastases have been reported so far. Despite advances in treatment of GBM, the prognosis is poor with an average survival time of about 14 months. Aim: The aim of the study is to present the spread of glioblastoma multiforme (GBM) to the extracranial area. Case report: A 29-year-old woman suffering from severe headaches revealed a history of brain surgery due to GBM in the temporal area done 5 months ago. Conclusion: With regard to this, extracranial metastasis of GBM is rare and the nature of the lesion is not well defined; therefore, the treatment for patients is not favorable and their survival is short (after metastasis). Since the molecular and genetic factors in metastatic GBM may have a key role, these markers can be used as future therapeutic goals. Clinical significance: In this study, we presented a 29-year-old woman with the spread of GBM to the maxillofacial area after GBM surgery 5 months ago.

Background: Patient's perspective is analyzed on the treatment options when invasive treatments, such as implant, bone grafting, or vestibuloplasty become contraindication, and a noninvasive approach, such as conventional complete dentures became treatment of choice that could be done. Aim: This clinical report describes a modification of impression procedure and modification of occlusal scheme in fabricating complete dentures to manage flabby ridge, flat ridge, and prognathic jaw relation with posterior cross-bite at once in complete edentulous patient. Case report: A 66-year-old female patient was wearing single upper complete denture since her lower complete denture was broken a year ago. On clinical examination, there were flabby ridge on anterior and flat ridge on posterior residual ridges of maxilla. Moderate resorption was found on posterior mandibular residual ridges. Prognathic jaw relation with posterior cross-bite was discovered from tentative vertical dimension (VD) procedure. Conclusion: Modified impression procedure, which was used in this case for flabby and flat ridge on maxilla using clear processed acrylic resin tray with controlled minimally displacive impression technique, provides mucofunctional impression on posterior and mucostatic impression on anterior. Anterior artificial teeth were arranged to neutrognathic jaw relation without vertical overlap to avoid pressure on the flabby ridge. Modified lingualized occlusion was used to overcome flat ridge with posterior cross-bite. Clinical significance: Modified impression procedure used in this case was simple and can record abnormal residual ridges in its compressibility. The modified lingualized occlusion can help maintain the occlusal forces right on the crest of residual ridges without interfering the neutral zone. Hence, fabrication of a stable and satisfying denture can be achieved.

Background: Antibiotic treatment for a clinical infection should be based on a thorough knowledge of the causative organisms involved in the infection. Methods used to evaluate microbiology should provide a comprehensive and accurate assessment of the microbiological spectrum. Currently, there is limited evidence on the microbiology of postoperative infection after third molar surgery, leading to inappropriate antibiotic prescription. Aim: The objective of this review was to summarize the current documented evidence on bacteriology of postoperative infection samples after third molar surgery with a systematic search of the literature. Results: A systematic search was performed in three databases (PubMed, Web of Science, and Medline-Ovid) on March 17, 2017 with no filters applied. After exclusion of duplicates, 142 records were screened, based on predetermined exclusion criteria and finally, 11 case reports recording microbiological data for clinical infection samples were selected. The most common genus of organisms isolated from third molar infections was Streptococcus. Anaerobic species dominated in cases where prior antibiotic treatment was initiated. However, documented microbiological data are only culture based and predominantly report fascial space infections after third molar surgery. Conclusion: Culture-based methods may not be accurately representing the true microbial profile of postoperative infections. There is an urgent need for comprehensive microbiological data employing next-generation sequencing techniques on postoperative infections to prevent inappropriate antibiotic prescription. Clinical significance: Prescribing broad spectrum antibiotics to treat postoperative infections with inadequate information on the microbiology is a questionable clinical practice that propagates antibiotic resistance. Clinicians should utilize recent advances in microbiological diagnosis to reduce unsuitable antibiotic prescription.

Background: Functionally graded material (FGM) is a smart configuration for designing composite materials to improve their long-term endurance. The main characteristic of an FGM is the gradual variation in composition and microstructure across its dimensions, resulting in enhanced properties. This approach has been applied in several fields of thermal barrier coatings, power industry, biomechanical, automotive, aerospace, mechanical, civil, nuclear, aeronautic, and naval engineering. Aim: This article is intended to provide an overview of the FGMs, their application in dentistry, and the employment of the concept on the mechanical performance of dental restorative systems. Results: A thorough review of FGM dental applications has found that several researchers have been able to develop different configurations based on FGM concept to avoid failures, such as infrastructure, abutment failures in implantology, and prosthodontics. These strategies result in a gradual transition between dissimilar materials decreasing residual stresses generated during fabrication and function. Conclusion: Of late, multiple parallel researches based on the FGM concept are being carried out on dental implants coated with hydroxyapatite (HA), zirconia (Zr), and its oxides to improve osseointegration and reduce stress behavior. This review attempts to present a thorough understanding of FGMs, their characterization, manufacturing techniques and technology, and their dental applications. Clinical significance: Throughout the past decade, the use of endosteal dental implants as a treatment modality of choice in oral rehabilitation cases has increased. Unfortunately, no artificial implants have biomechanical properties equivalent to that of the surrounding bone. Based on FGM concept, a graded composition between titanium and HA/Zr on the implant surface has now been achieved that has resulted in improved mechanical behavior and osseointegration.

The aim of this article is to review Morinda citrifolia in the field of endodontics. Herbal medicaments have been used as remedies for various illnesses and diseases for centuries. Furthermore, it has been a topic of interest in dentistry for many years. Morinda citrifolia juice (MCJ), also commonly known as “Noni,” a tropical fruit, has a wide range of uses in endodontics and in the eradication of endodontic pathogens without any potential side effects. A literature review is conducted using electronic databases, such as “PubMed,” “Google Scholar,” and “Scopus,” using keywords “Herbal Medicine” and “M. citrifolia.” Furthermore, an advanced or refined search was carried out using the keywords “Endodontics,” “Root canal Therapy,” “Irrigation,” “Herbal Endodontics,” and “Endodontic Disinfection.” The MCJ can be used as an endodontic irrigant along with ethylenediaminetetraacetic acid (EDTA) as an adjuvant to sodium hypochlorite and chlorhexidine (CHX) due to its better smear layer removal properties and antimicrobial activity. It also does not have any major side effects as compared with sodium hypochlorite and CHX. It also helps in caries prevention and control, which is the main crux for the requirement for endodontic treatment. Further studies on MCJ on the endodontic aspect of dentistry can alter the chemical aspect of endodontic therapy in the near future. The MCJ, due to its advantages compared with sodium hypochlorite and CHX, can be used in the field of endodontics.

Introduction: Oral HPV infections affect 1 to 50% of the general population. Naturally, about 90% of HPV is eliminated by the immune system, but the ones that persist may result in serious diseases. Human papillomavirus is the main cause of cancer at various body sites, such as cervix, uterus, oropharynx, head and neck. The prevalence of oral HPV infections in India ranges from 15 to 16%. About 80% of HPV infections are present with koilocytosis as an important morphological marker. Aim: This review focuses on the importance of koilocytes and its early detection to alert malignant risk for facilitating human papillomavirus (HPV)-targeted therapeutic strategies. Results: Research in the past has primarily focused on cervical cancer, as >99% of them harbor HPV. It has been observed that the incidence of HPV-associated cancers may be minimized by effective preventive and targeted therapeutic modalities. Although oral HPV infections have been minimally researched lesions such as verruca vulgaris, squamous papilloma, focal epithelial hyperplasia and condyloma acuminatum are significantly prevalent in India. The characteristic cell observed in all these HPV-associated lesions is koilocytes as demonstrated using immunohistochemistry (IHC) with p16 antibody. Although advanced techniques, such as polymerase chain reaction (PCR), deoxyribonucleic acid (DNA) breakage detection fluorescence in situ hybridization (DBD-FISH), and comet assay may confirm their presence, they are cumbersome and not economical. Conclusion: Detection of malignancy-prone oral HPV infections by the demonstration of koilocytes showing positivity to p16 IHC stain has shown promising avenues in the field of research for the prediction of diagnosis and prognosis of oral squamous cell carcinomas (OSCC). Clinical significance: Koilocytic cells are pathognomonic of HPV infection. Identification of koilocytes in histopathologic sections alerts the pathologist to suspect any underlying HPV infection and directs the surgeon for appropriate treatment. Human papillomavirus infection affects the function or host gene expression that is marked by cellular changes, and unmasking of such changes has an important role in the identification and follow-up of such patients.

Odontogenic infections (OIs) are common in the oral and maxillofacial regions and can affect both genders at any age. Infection of the dental pulp resulting from caries and their major pathogens, the streptococci, is the most important cause of OIs. In fact, following bacterial attack, the dental pulp becomes necrotic and the bacteria of the normal flora undergo a change from main aerobes to anaerobes leading to an abscess formation at the apex of the root. In some cases, the infection may spread to the surrounding spaces resulting in additional complications. Hence, their early diagnosis and adequate therapy are requisite. Successfully treating OIs depends from one side on eliminating the causal factor and from the other side selecting the appropriate anti-infectious agent. This selection should be considered according to each and every clinical case based on clinical and bacteriological factors, with the use of broadspectrum antibiotics for short periods of time. This article aims to set out the most common odontogenic infectious diseases as well as the involved germs and to help dentists choosing the right antibiotic.

Cancer is a multifactorial disease characterized by uncoordinated proliferation and growth of tumor cells. To survive, cancer cell undergoes various metabolic reprogramming by changes in the pathways. The role of glucose and amino acid metabolism in cancer has been studied extensively. However, lipid metabolism and its role in cancer are less explored. The concept of lipid metabolism has gained attention of researchers to discover its importance in understating the need of lipids for tumor cell growth and survival through various mechanisms to help us for improvising therapeutic strategies. Hence, in this review, we have highlighted the pivotal role of lipid metabolism in normal cell and cancer cell with illustrations.