Aim: This study aimed to evaluate the mineral deposition and microhardness within the retained caries-affected dentin (CAD) after excavation with Carisolv™ gel or rotary burs. Materials and methods: Totally 20 extracted human carious molars, with caries extending into the middle third of dentin, were sectioned mesiodistally. The carious tissue in each hemi-section was excavated with gel or bur and restored with a mineral trioxide aggregate (MTA) base and resin composite. Five sound posterior teeth were hemi-sected to serve as a control. Twenty-five hemi-sections were stored in distilled water (DW) and the other 25 were stored in simulated body fluid (SBF). Each sample was scanned and tested using Raman spectroscopy and Knoop microhardness respectively, at the MTA–dentin interface at day 1 and 14. Scanning electron microscope (SEM) was used to assess the surface topography of dentin after excavation with gel/bur. Results: The results show that the baseline mineral content and microhardness of dentin were significantly lower in Carisolv.- treated samples in comparison with that treated with burs (p ≤0.05). However, there were comparable mineral levels in the two groups after 14 days'storage in SBF (p ≥0.05), which showed statistically insignificant differences from the sound control (p ≥0.05). Microhardness and mineral contents decreased significantly in the sound control after 14 days'storage in DW (p ≤0.05). The SEM images showed partially open dentin tubules with less smear layer after Carisolv. excavation compared with more occluded dentin tubules with an abundance of smear layer after bur excavation. Conclusion: Although gel excavation retains more CAD in comparison with bur, remineralization of this remaining tissue is evident after 2 weeks. Clinical significance: The use of Carisolv™ gel provides an alternative to rotary burs in terms of preserving the tooth structure and not hindering the remineralization potential of valuable tooth structure, a clinical advantage for minimally invasive dentistry

Aim: The aim of this research is to make a comparative interpretation of implant removals in the last 3½ years in the Department of Community Dentistry. Materials and methods: In the last 3½ years, 27 patients’ 46 implants were removed in the Department of Community Dentistry. The applied data were obtained by X-rays, medical charts, and patient management program, called FOGÁSZ, found in the Department of Community Dentistry. Data were evaluated with Microsoft Excel software. Results: The average age was 63.7 years; 96.3% of the patients were aged 50 or over; 63.9% of the concerned individuals’ inserted implants were removed. Among maxilla and mandible, there are equal proportions of removed implant's location partition; 22.7% of the patients lost their implants within 6 months from surgery. The removed implants were possessed 5.5 years long on average; 40.7% of the patients commanded fixed prosthesis-supported implant and teeth, and this was the most common prosthesis type. The prevalence of peri-implantitis around removed implants was 71.7%. Out of the partly edentulous patients, horizontal bone resorption was discernible in 47.6%; 15.2% of the removals were recommended because of inflammation before osseointegration. Conclusion: Fixed prostheses anchored at the same time to tooth and implant may cause implant loss, because biomechanical aspects of anchoring behave differently in the bone. Lack of peri-implantitis is a key factor in the success of implants. Periodontitis could also promote the development of peri-implantitis. Clinical significance: Avoid planning prostheses anchored at the same time to tooth and implant. Sufficient oral hygiene is essential for the prevention of inflammation. Patients with periodontitis should be cured of inflammation before implantation. Important factor for osseointegration is the inflammation-free healing.

Aim: To assess the knowledge and attitude among senior dental students in Chennai, India, on forensic odontology. Materials and methods: A questionnaire-based study was conducted among 400 senior dental students across four colleges in Chennai. Fifteen questions were formulated and circulated. Results: Majority of the population surveyed have reported to have received formal education in forensic odontology. However, most of them claimed to have inadequate knowledge due to lack of exposure pertaining to the scope, avenue, and importance related to this field. Conclusion: The questionnaire survey has determined that though senior dental students have received some training in forensic odontology, they report that their knowledge is not adequate. They also felt that more importance to this field might improve the scope in India and abroad. Clinical significance: There is a need for forensic dentistry to achieve its full potential, especially in India. Forensic odontologists serve as expert witnesses in the court of law for identification and investigation of crimes. This field, flourishing abroad, is still in an infant stage in India due to the lack of proper awareness among students, and probably not encouraged as much as the other clinical fields in dentistry.

Aim: Fracture of one or more anterior teeth results in pain, loss of function, poor esthetics, and psychological trauma. It is a true emergency and warrants immediate assessment and management. Hence, the aim of the present study was to assess the traumatic injuries to anterior teeth in children, seeking treatment at the teaching clinics of the Department of Pediatric Dentistry, Jazan University, from January 2016 to June 2016. Materials and methods: Information concerning age, sex, cause of trauma, place of trauma, and the type of the teeth was recorded in a close-ended pro forma. Garcia Godoy's classification was used to assess the traumatic dental injuries (TDIs) to the primary dentition, whereas Ellis and Davey's classification was used to assess TDIs to the permanent dentition. Results: The prevalence of TDI was recorded as 9.79%. Males experienced more TDI as compared with females. Falls (62.4%) were the most important cause of TDI and the home (54.1%) was the predominant location where the injury occurred. Luxation injury was the most common type of injury seen in primary dentition, whereas enamel dentin fracture involving the pulp was the frequently observed injury in the permanent dentition. Conclusion: The prevalence of TDI in our study was 9.79%. Males were affected more than females. Luxation injuries were commonly seen in the primary dentition and enamel dentin fracture with pulp exposure was the common type of injury seen in the permanent dentition. Clinical significance: The data obtained give us the baseline information about the prevalence of traumatic injuries to anterior teeth in this southern Saudi Arabian population of Jazan. More longitudinal studies over a longer period of time should be done which will help us to plan and implement preventive strategies.

Aim: This study aimed to investigate the relationship between breastfeeding pattern and early childhood caries (ECC) based on a case in Bukittinggi. Materials and methods: This was a cross-sectional study located in Integrated Post Service (Posyandu) in Bukittinggi City. In this study, 66 pairs of parents and children aged 2 to 3 years were selected. Breastfeeding pattern was observed using questionnaire and decayed-extract-filled teeth (deft) index was used for ECC. Data were analyzed by chi-square test. Results: The average of the deft index was 2.33. Samples with exclusive breastfeeding have an average deft index of 1.42 and nonexclusive had an average deft index of 2.48 (p = 0.783). This study also found that samples with exclusive breastfeeding and complementary foods had a deft index of 2.27. Nonexclusive breastfeeding and complementary foods had a deft index of 2.31 (p = 0.038). Conclusion: Children with breastfeeding had a lower ECC degree. Breastfeeding with complementary foods at 6 months to 2 years had a significant relationship with ECC. Clinical significance: Breastfeed could lower the occurrence of ECC. Hence, breastfeeding needs to be promoted and the mothers guided in breastfeeding.

Aim: The aim of this study was to evaluate coronal leakage of preheated nanohybrid and bulk fill composites in endodontically treated teeth. Materials and methods: A total of 100 human mandibular premolars were divided into six groups after standardized root canal treatment protocol: group I (n = 20): nanohybrid composite (Filtek Z250XT); group II (n = 20): preheated nanohybrid composite; group III (n = 20): bulk fill composite (Filtek Bulk fill); group IV (n = 20): bulk fill composite (Filtek™ Bulk fill); group V (negative control) (n = 10): Gutta-percha was kept intact till orifice and covered with nail polish; and group VI (positive control) (n = 10): Gutta-percha was kept intact till orifice. The samples were thermocycled followed by dye penetration with 2% methylene blue. Scoring was done under stereomicroscope at 10× magnification. Kruskal–Wallis test, Wilcoxon signedrank test, and Mann–Whitney U test were applied. There was significant difference among all the groups. Results: Preheated bulk fill composites sealed significantly better. Nanohybrid composites displayed the highest microleakage followed by preheated nanohybrid composite. Bulk fill composites were better than preheated nanohybrid composites. Conclusion: Preheating decreases microleakage of nanohybrid and bulk fill composites. Bulk fill composites, especially when preheated, are superior in performance to nanohybrid composites in terms of microleakage. Clinical significance: Preheated bulk fill composites are a suitable alternative to nanohybrid composites for the improvement of marginal integrity of restorations in endodontically treated teeth.

Aim: To evaluate and compare the stress distribution in periimplant area and posterior region of completely edentulous mandible rehabilitated using implant-retained overdenture (IOD) with two types of ball attachment configuration, i.e., rigid and resilient. Materials and methods: Two mathematical models were prepared simulating completely edentulous mandibular ridge. Model 1 represented implant with rigid stud attachment. Model 2 represented implant with resilient stud attachment. Both the models were subjected to the compressive force of 35 N. The stresses in the peri-implant area and posterior region of the mandible were evaluated and compared for both the models. Results: The IOD with rigid stud configuration showed 12.1% higher peri-implant stresses than resilient configuration, whereas the resultant stress values in posterior edentulous region were 1.5% lower with resilient configuration. Conclusion: Highest stress value was seen in the crestal part of bone around the implant with both rigid and resilient attachment configuration. Implant-retained overdentures with resilient stud attachment showed better dissipation of forces when compared with rigid attachment. Clinical significance: Correct choice of attachment configuration can influence the peri-implant stresses in IOD, which in turn reduces the complications that can be a result of excessive stresses around the implant.

Introduction: Cocoa bean extracts contain certain anticariogenic substances and studies have proven that it has a role in preventing dental caries. Theobromine, a white crystalline powder, is an alkaloid, readily available in cocoa and chocolate has been considered responsible for its anticariogenic activity. Aim: The aim of the present study was to evaluate the in vivo anticaries activity of theobromine toothpaste and a commercially available low-fluoridated toothpaste against plaque Streptococcus mutans in children of age group 6 to 9 years and to evaluate the efficacy of both the toothpastes on supragingival plaque. Materials and methods: A total of 14 subjects were selected and randomly divided into experimental and control groups (n=7) in which theobromine toothpaste and a low-fluoridated toothpaste were provided. The subjects were instructed to carry out toothbrushing twice daily for 1 minute and the plaque samples were collected at baseline and after 21 days of intervention. Microbial analysis was done using selective media, mitis salivarius bacitracin (MSB) agar. The plaque index (Turesky modification of Quigley–Hein index) and gingival index (Loe and Silness) were recorded at baseline and after 21 days. The values were statistically analyzed using paired and unpaired t test. Results: There was a significant reduction in the S. mutans count and plaque scores from baseline to postintervention in both the groups (p = 0.001). When both the groups were compared, there was no significant difference in the mean S. mutans count and plaque scores (p = 0.254). Conclusion: Theobromine toothpaste is highly effective in reducing S. mutans count and plaque formation in children. Clinical significance: In the future, theobromine toothpaste will prove to be beneficial as a safe anticariogenic agent, which could open a new era of approach to caries prevention.

Aim: The success of an endodontic treatment depends on the complete elimination of the microorganisms from the root canal system for which effective eradication of smear layer is crucial. Hence, various final irrigating solutions were introduced in endodontics. The aim of this in vitro study is to compare the smear layer removal efficacy of different final irrigating solutions at the apical third of the root canal through scanning electron microscopic (SEM) image analysis. Materials and methods: Forty human single-rooted mandibular premolar teeth were taken and decoronated to standardize the canal length. Each tooth was prepared endodontically with same chemomechanical technique and the teeth were randomly divided into four groups based on the final irrigation regimen. Group I: saline, group II: Tubulicid Plus, group III: BioPure MTAD, and group IV: QMix. After final irrigation, SEM evaluation was done for the assessment of removal of the smear layer at apical third, and data were analyzed using the Kruskal–Wallis test and Mann–Whitney U test. Results: Intergroup comparison of the groups showed statistically significant differences in the smear layer removal efficacy of irrigating solutions tested. QMix is most effective in the removal of smear layer when compared with other tested irrigating solutions. Conclusion: QMix is the most effective final irrigating solution for smear layer removal followed by MTAD and Tubulicid Plus. Clinical significance: Final irrigating solution plays a major role in the elimination of smear layer, thereby enhancing the hermetic seal of obturating materials, resulting in greater success rate of root canal treatment. Further research is required regarding the use of QMix on smear layer removal and also its effect on ultrastructural changes in dentin.

Aim: To evaluate the prevalence of Haller cells and the association between their existence and size of these cells with maxillary sinusitis and orbital floor dehiscence on cone beam computed tomography (CBCT) scans. Materials and methods: This was a retrospective study conducted on 300 CBCT scans with 200 ×170 cm field of view (FOV) taken for various purposes like implants and temporomandibular joint (TMJ) analysis. The CBCT scans and demographic details, such as age and gender of the patients obtained from the institution's Digital Imaging and Communications in Medicine (DICOM) archive folder. The scans were checked for the presence of Haller cells, maxillary sinusitis, and orbital dehiscence. Chi-square test was used to assess the association between Haller cells and maxillary sinusitis and orbital dehiscence and p-values of 0.05 were considered to be statistically significant. Results: A statistically significant association was noted between the existence of Haller cells and maxillary sinusitis. There was no statistically significant difference in the mean size of the Haller cells between both the groups, although the more number of medium and large size Haller cells are noted in the population with sinusitis. Orbital dehiscence and Haller cells have shown statistically significant association. Conclusion: The explanation of maxillary sinusitis based on mechanical obstruction is likely. This study provides evidence for the usefulness of CBCT scan in delineation of the sinonasal anatomy. Clinical significance: The present study also marks the usefulness of CBCT scan in delineating osteomeatal complex at substantially higher precision with lesser radiation and low cost.

Aim: To compare the shear bond strength of microhybrid and BulkFill composite, when they are placed under three different incremental curing techniques: gingival-occlusal layering (horizontal), wedge-shaped layering (oblique), and bulk technique. Materials and methods: A flat dentinal surface of 60 teeth was prepared by removing 1.5 to 2.0 mm of their occlusal surfaces with the help of single-sided diamond disk for testing. These samples were randomly divided into two groups of 30 samples each: group I for microhybrid composite (Filtek Z250, 3M ESPE, St. Paul, Minnesota, USA) and group II for BulkFill Filtek composite resin (3M ESPE, St. Paul, Minnesota, USA). The two groups were further divided into three subgroups based on the layering techniques (group I—bulk technique, group II— horizontal layering, and group III—oblique layering techniques). These specimens were loaded in a universal testing machine at a speed of 0.5 mm/minute till failure for determining the shear bond strength. The modes of failures of each group were observed under a scanning electron microscope (SEM), and analysis of variance (ANOVA) and t-value calculation analysis was applied. Results: The statistical analysis showed that there was significant difference between BulkFill and microhybrid composite and also between different layering techniques (p < 0.05). Conclusion: The highest shear bond strength was observed for BulkFill when compared with microhybrid composite resin. The BulkFill bulk technique has the highest bond strength followed by BulkFill oblique layering and microhybrid oblique layering techniques. Clinical significance: BulkFill composites might be the material of choice for restoring cavities where procedural time is of concern, especially in pediatric, geriatric, and apprehensive patients where the treatment time should ideally be kept short.

Background: Congenital missing laterals are considered a quite common dental abnormality. The limited arch length makes implant procedure sometimes very challenging to be considered as a restorative option. Aim: This case report aimed to demonstrate the benefit of utilizing three-dimensional (3D) printed models in managing challenging implant cases in limited arch length for congenitally missing maxillary lateral incisors. Case report: A 39-year-old female Afro-American patient presented at the Ashman Department of Periodontology and Implant Dentistry, New York University College of Dentistry, to replace her congenitally missing maxillary laterals. Adequate mesiodistal arch length was present for edentulous areas of #12 and 22 clinically. Cone beam computed tomography (CBCT) showed adequate buccolingual bone width. Three-dimensional printed models were used to evaluate the labial angulation of the alveolar ridge, facial concavities and to demonstrate the surgical implant placement prior to the day of surgery. Bonelevel tapered implant with 3.3 mm diameter and 12 mm length (StraumannRoxolid®SLActive® implant) was placed in palatal position. Immediate cement retained nonfunctional provisional crown, fabricated, cemented on a prefabricated abutment to provide soft tissue contouring and immediate esthetic restoration. One week later, the same surgical protocol was followed in the area of missing #12. Conclusion: Placement of dental implant in limited mesiodistal edentulous space in an esthetic zone is a challenging procedure that requires thorough assessment and adequate surgical and restorative expertise to achieve optimum outcome. The 3D printing has proved its valuable benefit in treatment planning and executing difficult implant treatment by visualizing the supporting tissues in spatial dimensions and providing accurate measurements and in demonstrating hands on before the surgery time. Clinical significance: The 3D visualization (using CBCT) allows for rapid site analysis and predictable treatment planning in various difficult cases of implant placement, especially in cases of congenitally missing maxillary lateral incisors with less arch length.

Introduction: Mandibular retrognathism is the most common feature in class II malocclusions. Functional appliance therapy focuses on reducing the increased overjet and overbite, establishing better conditions for mandible growth response in phase I. Phase II corrects the position of the teeth and gives an adequate stable occlusal relationship. Aim: (1) To describe a class II, division 1 malocclusion treated with the Andresen activator in a growing patient followed by comprehensive orthodontic fixed appliances, and (2) to take advantage of both approaches performed immediately one after the other in adolescence to obtain better and stable results without tiring the patient and parents, prolonging the treatment time. Case report: A 13-year-old female patient presented with a class II, division 1 malocclusion with increased overjet and deep overbite, due to mandibular retrognathism. She wore the Andresen activator approximately 12 to 14 hours per day during afternoons and nights for 9 months, followed immediately by comprehensive fixed appliances for an extra period of 1 year. Conclusion: Clinical results showed that class II, division 1 malocclusion was corrected, overjet and deep overbite were reduced to normal parameters, and convex profile was improved to a straight one. Clinical significance: These two phases performed one after the other in the early permanent dentition were beneficial for the patient, and due to good results obtained in phase I, phase II with fixed appliances was simplified, focusing on small details of dental movements. The total time of treatment was 21 months.

Introduction: Lichen planus is a chronic inflammatory, autoimmune, mucocutaneous disease of which the etiology is unknown. In Greek “lichen” means tree moss and “planus” means flat. It affects the skin, mucous membrane, nails, and hair. It is seen in 1 to 2% of the population. As the exact causative factor for oral lichen planus (OLP) is a matter of conflict, the failure to achieve proper or specific treatment for it may be reason for its incomplete regression. Corticosteroids are the mainstay of OLP but because of their adverse effects various other agents have been tried in the treatment of OLP. Aim: The aim of this review is to provide an update on the recent advances in the treatment of OLP. Results: An electronic search was conducted across Medline, Cochrane, Web of Science databases, and Google Scholar for the purpose of literature analysis on the mentioned topic. The studies were reviewed and compared. This article summarizes the recent advances in the treatment of OLP. Conclusion: Oral lichen planus has been an advanced researched oral potentially malignant disorder over the years. The newer treatment modalities have been considered to be beneficial with lesser amount of side effects than corticosteroids like amlexanox (AX), aloe vera gel, green tea, curcumin, propolis, and lycopene. Clinical significance: Oral lichen planus is seen in 1 to 2% of the population who come with varied symptoms or may be asymptomatic. Although treatment options are plenty, the mainstay of treatment is corticosteroids. However, the use of alternate therapeutics is proven to be effective with lesser side effects.