Context: Today many materials have been introduced for root-end filling materials. One of them is mineral trioxide aggregate (MTA) that is mentioned as a gold standard. Aims: The purpose of this in vitro study was to evaluate the reaction of human periodontal ligament fibroblasts to the root-end filling materials, such as ProRoot MTA, Portland cement, and amalgam. Settings and Design: Eight impacted teeth were extracted in aseptic condition. The tissues around the roots were used to obtain fibroblast cells. After cell proliferation, they were cultured in the chamber slides and the extracts of the materials were added to the wells. Materials and Methods: Immunocytochemical method for measuring the expression of Fibronectin, collagen I and transforming growth factor beta (TGF®) was performed by Olysia Bioreport Imaging Software. Statistical Analysis Used: The results were analyzed by SPSS 13.0 and Tukey post hoc test with P<0.05 as the limit of significance. Results: Collagen expression in MTA specimens was higher than the other groups in 24 h significantly. After 48 h, the Portland cement group showed the most expression of collagen significantly and after 1 week, Portland cement and MTA groups had the most expression of collagen but there was no significant difference between these 2 groups. After 1 week, the Portland cement group demonstrated a higher amount of TGF® and fibronectin. Conclusions: The results suggest that Portland cement can be used as a less expensive root filling material with low toxicity. It has better effects than amalgam on the fibroblasts.

Context: Tobacco consumption initiated during the adolescent period is a major contributor to the pathogenesis of fatal diseases in adulthood. Information on tobacco use and awareness regarding tobacco legislation and hazards among adolescents in rural Kerala is limited. Aims: To assess the prevalence of tobacco use among adolescent students in a rural district in Kerala state and to understand the extent of awareness about the prominent legislative measures against tobacco and tobacco hazards. Materials and Methods: Data on awareness regarding health hazards due to tobacco use and legislation against tobacco consumption were collected from students of 15 randomly selected high schools in an educational sub-district in Kerala, using a cross-sectional study design. Chi-square and Fisher's exact test statistics were used for statistical analysis. Results: A total of 1473 students participated in the study, of which 79% were males (mean age 15.4 years, SD 1.5). The overall prevalence of 'current tobacco users' was 8%. A significant association between age and tobacco use was noted among tobacco habitues (P<0.05). Awareness regarding legislation against smoking in public places was more in the higher age-groups (P<0.05). Females were more aware of the 'smoking ban' than males (P<0.05). Our survey of the awareness regarding the hazards associated with tobacco use revealed that 41.5% of the students knew about the link between oral cancer and tobacco, with the awareness being greater among females than among males (64.3% vs 35.4%). Conclusion: The finding that tobacco consumption increases with age is a matter of concern. In addition to their clinical work, dental professionals should also educate the public on the hazards of tobacco and conduct tobacco cessation programmes for adolescent groups to control the tobacco epidemic.

Aim: The purpose of this study was to investigate and compare the linear dimensional accuracy of denture bases processed with the conventional heat-polymerization technique and the Rafael and Saide (RS) tension system, taking a multidirectional approach. Materials and Methods: Twenty standard edentulous maxillary casts were randomly assigned into two groups. A uniform denture base of 1.5 mm thickness was fabricated in wax and later processed by two methods: Group I acrylic resin flasked with the conventional technique and Group II acrylic resin flasked with the RS tension system. The dimensional accuracy was assessed using traveling microscope. Results: The linear dimensional changes that occurred between the dentures produced with the new press method and the conventional method were statistically insignificant and ranged from 0.002 to 0.11. The dimensionally stable areas were the canines and the most unstable was the posterior palate. Conclusions: The results of this study suggest that the maximum linear dimensional change occurs around the molars and palatal segment, with the most stable areas being the canines. There was no significant linear dimensional change of the dentures processed between the conventional and the new press technique.

Aim: This study compared the microleakage of light cure glass ionomer and flowable compomer as pit and fissure sealant, with and without tooth preparation. Materials and Methods: One hundred premolars that were extracted for orthodontic purpose were used. After adequate storage and surface debridement, the teeth were randomly divided into four groups. In Group I and III, the occlusal surfaces were left intact, while in Group II and Group IV, tooth surfaces were prepared. Teeth in Group I and Group II were sealed with Light cure glass ionomer, whereas flowable compomer was used to seal teeth in Group III and IV. The sealed teeth were then immersed in dye. Subsequently, buccolingual sections were made and each section was examined under stereomicroscope for microleakage followed by scoring. Results: In group I, microleakage score ranged from 2 to 4 with mean of 3.64 (±0.757), while in group II the range was observed to be 1-4 with mean of 2.88 (±1.236). Group III recorded a range of 0-4 with the mean of 2.20 (±1.443) while 0-2 and 0.60 (±0.707) being the range and mean observed, respectively, for group IV. Conclusion: Flowable compomer placed after tooth preparation showed better penetration and less marginal leakage than the light cure glass ionomer.

Background: The clinical success of relining depends on the ability of reline resin to bond to denture base. Surface preparations may influence reline bond strength of urethane-based dimethacrylate denture base resin. Aim: To investigate the effect of bur preparation on the surface roughness (R _a ) of eclipse denture base resin and its shear bond strength (SBS) to an intra-oral self-curing reline material. The mode of reline bonding failure was also examined. Materials and Methods: Twenty-four cylindrical Eclipse™ specimens were prepared and separated into three groups of eight specimens each. Two groups were subjected to mechanical preparation using standard and fine tungsten carbide (TC) burs and the third group (control) was left unprepared. The R _a of all specimens was measured using a contact stylus profilometer. Subsequently, relining was done on the prepared surface and SBS testing was carried out a day later using a universal testing machine. Results: One-way ANOVA revealed significant differences (P<0.05) in R _a and SBS values for all the groups. Post-hoc Tukey's HSD test showed significant differences (P<0.05) between all the groups in the R _a values. For SBS also there were significant differences (P<0.05), except between standard bur and control. Conclusions: 1) There was a statistically significant difference in the R _a of Eclipse™ specimens prepared using different carbide burs (P<0.05). 2) There was a statistically significant difference in the relined SBS (P<0.05) when prepared using different burs, but the difference between the standard bur and the control group was not statistically significant.

Background: Dermatoglyphics can prove to be an extremely useful tool for preliminary investigations in conditions with a suspected genetic base. Since caries is a multifactorial disease with the influence of genetic pattern, early prediction for high-risk children can help in using effective and efficient caries preventive measures that are a part of the pedodontist arsenal. Aims and Objectives: This study was done to determine the genetic aspect involved in the occurrence of dental caries through a cost-effective means, which can be used in field studies. Materials and Methods: 550 kindergarten school children in the age group 3-6 years were examined during a school examination camp. Of these, only 336 children were included in the study. They were divided into four groups as follows: caries-free males (df score=0), caries-free females, caries males (df score≥10), caries females. The handprints of each child were taken and the frequency of occurrence of type of dermatoglyphic pattern on fingertip of each digit was noted. Separate df scores were recorded. SPSS software and test of proportions were used for the analysis. Results and Conclusion: Handprints of caries-free children, especially females, showed maximum ulnar loops. The caries group showed maximum occurrence of whorls (r=2:1), which were more prevalent in females on the left hand 3rd digit than in males where the whorls were found on the right hand 3 ^rd digit, and also low total ridge count, especially in males.

Background and Objective: Digital photo stimulable phosphor (PSP)-based radiography has many known theoretical advantages over conventional film radiography but its diagnostic efficacy has to be assessed clinically. This study compared the efficiency of conventional film-based panoramic radiographs with that of digital PSP-based panoramic radiographs in the assessment of position and morphology of impacted mandibular third molars. Materials and Methods: We selected a total of 80 impacted mandibular third molars that fulfilled the inclusion and exclusion criteria of this study. Both conventional film-based panoramic radiographs and digital PSP-based panoramic radiographs were taken of all the study samples and the teeth were later surgically removed. Conventional film-based and digital PSP-based panoramic radiographs were compared for their relative efficiencies in the assessment of impaction status, position of tooth, number of roots, root morphology, and proximity to mandibular canal of impacted mandibular third molars. An oral surgeon graded these same factors during/after surgical exploration and this assessment was considered the gold standard. The data obtained were statistically analyzed using descriptive statistics, chi-square test, and McNemar's test. Results: There was no statistically significant difference between conventional film-based radiographic assessment and digital PSP-based panoramic radiographic assessment of impaction status, position of tooth, number of roots, and proximity to mandibular canal of impacted mandibular third molars (P>0.05). However, there was significant difference between the two methods with regard to assessment of root morphology of impacted mandibular third molars (P=0.00). Interpretation and Conclusion : Conventional film-based panoramic radiographs and digital PSP-based panoramic radiographs were comparable in their accuracy in the preoperative study of impacted mandibular third molar with regard to impaction status, tooth position, number of roots, and proximity to the mandibular canal. Digital PSP-based panoramic radiographs were more accurate than conventional film-based panoramic radiographs in the assessment of root morphology of impacted mandibular third molars. Hence, we conclude that digital PSP-based panoramic radiographs can be used as an effective alternative to conventional film-based panoramic radiographs for assessment of position and morphology of impacted mandibular third molars.

Background: Mucoperiosteal flap surgery stimulates varying amounts of alveolar bone loss due to accelerated osteoclastic activity [Regional Accelerated Phenomenon (RAP)]. Alendronate sodium inhibits osteoclastic activity and is thought to result in a net increase in osteoblastic activity. We undertook a preliminary study evaluating the effect of adjunctive use of topically delivered bisphosphonate alendronate (ALN) along with regenerative bone graft material in the treatment of periodontal infrabony defects. Materials and Methods: Fifteen patients with two-walled or three-walled infrabony defects were selected. In each patient, the infrabony defect of one side of arch was designated as group A (control site) and received hydroxyapatite (HA) bone graft material, while the infrabony defect on the contralateral side of same arch was designated as group B (test site) and received HA + 200 μg drug solution of ALN. Results: Both the groups exhibited a highly significant reduction in probing depth and gain in clinical attachment level and linear bone fill at the end of 24 weeks. Comparative evaluation between the study groups revealed a statistically nonsignificant reduction in probing depth (P=0.128 ^NS ) and mean gain in attachment level (P=0.218 ^NS ). However, there was a statistically significant gain in linear bone fill (P=0.040*) in group B as compared to group A. Conclusions: The results suggest that use of ALN along with graft material led to enhanced linear bone fill at the surgical site. This research provides a clue that bone-targeting properties of bisphosphonates can be harnessed along with regenerative materials to potentiate osseous regeneration.

Background: Lingual vascular canal (LVC) is an important anatomical structure in mandibular anterior region. Trauma to this structure during implant placement has been reported in this study. Dental computed tomography (DCT) provides a three-dimensional visualization of lingual vascular canal. Aim: To assess the frequency, location, and size of LVC using dental CT. Materials and Methods: A retrospective analysis of 75 mandibular DCT was done. Evaluation was done to detect the frequency, size, and number of lingual vascular canal using Seimens Somatom Sensation 64. Results: About 73.3% patients (male=34, female=21) demonstrated presence of LVC with only one patient showing two canals. The mean distance from the inferior border of mandible was 0.5 mm, S.D.±0.70. The mean diameter of the canal was 0.31 mm, S.D.±0.70. Conclusion:Dental CT provides adequate information regarding frequency, number, and size of lingual vascular canal, which is an important anatomical structure in mandibular anterior region.

Background: Maintenance of gingival health is a key factor for longevity of the teeth as well as of restorations. The physiologic dentogingival unit (DGU), which is composed of the epithelial and connective tissue attachments of the gingiva, functions as a barrier against microbial entry into the periodontium. Invasion of this space triggers inflammation and causes periodontal destruction. Despite the clinical relevance of the determination of the length and width of the DGU, there is no standardized technique. The length of the DGU can be either determined by histologic preparations or by transgingival probing. Although width can also be assessed by transgingival probing or with an ultrasound device, they are either invasive or expensive Aims: This study sought to evaluate an innovative radiographic exploration technique - parallel profile radiography - for measuring the dimensions of the DGU on the labial surfaces of anterior teeth. Materials and Methods: Two radiographs were made using the long-cone parallel technique in ten individuals, one in frontal projection, while the second radiograph was a parallel profile radiograph obtained from a lateral position. The length and width of the DGU was measured using computer software. Transgingival probing (trans-sulcular) was done for these same patients and length of the DGU was measured. The values obtained by the two methods were compared. Pearson product correlation coefficient was calculated to examine the agreement between the values obtained by PPRx and transgingival probing. Results: The mean biologic width by the parallel profile radiography (PPRx) technique was 1.72 mm (range 0.94-2.11 mm), while the mean thickness of the gingiva was 1.38 mm (range 0.92-1.77 mm). The mean biologic width by trans-gingival probing was 1.6 mm (range 0.8-2.2mm). Pearson product correlation coefficient (r) for the above values was 0.914; thus, a high degree of agreement exists between the PPRx and TGP techniques. Conclusions: We conclude that the biologic width of the DGU in humans can be measured with the PPRx technique. The values obtained agree with the values obtained by transgingival probing, a technique considered standard so far. Thus, the PPRx technique offers a simple, concise, noninvasive, and reproducible method that can be used in the clinical setup to measure both the length and thickness of the DGU with accuracy.

Background: When we smile, our smile could often become the target of close scrutiny by the person you are smiling at. A trained eye readily detects any asymmetricity or any aspect of that smile which may be out of balance, or disharmonious with its environment. The purpose of this study was to determine whether any such asymmetric or symmetric dental discrepancies were detectable by various groups of evaluators. Aims: The aim was to determine whether asymmetric and symmetric anterior dental discrepancies were detectable by orthodontists, general dentists, and laypersons, and to establish threshold levels for several specific aesthetic criteria that could be used by orthodontists and general dentists as an aid in the treatment planning. Materials and Methods: Three images of smiles were intentionally altered with a software-imaging program. The alterations involved the crown length, crown width, midline diastema, and the papillary height of the maxillary anterior teeth. These altered images were then rated by groups of general dentists, orthodontists, and laypersons using a visual analog scale. Statistical analysis of their responses resulted in the establishment of threshold levels of attractiveness for each group. Results: The orthodontists were more critical than the general dentists and laypersons when evaluating asymmetric crown length discrepancies. All three groups could identify a unilateral crown width discrepancy of 2.0 mm. A small midline diastema was not rated as unattractive by any group. Reduction of papillary height was generally rated as less attractive. Conclusions: Asymmetric alterations make teeth more unattractive not only to the dental professionals, but also to laypersons.

Aim: To determine the periodontal status and treatment needs among dental fluorosis subjects residing in Ennore, Chennai, using Community Periodontal Index of Treatment Needs (CPITN). Materials and Methods: All the subjects with dental fluorosis above 15 years of age, permanent residents of Ennore, were included in the study. Subjects with known systemic diseases and subjects with other intrinsic dental stains were excluded from the study. Periodontal status was estimated using CPITN and Dental fluorosis was recorded using Dean's Dental Fluorosis Index. Results: The total number of study subjects was 1075, of which 489 were males and 586 were females. Males were predominantly affected with periodontal disease than females. This was found to be statistically significant (P=0.000). The association between Degree of Fluorosis and Periodontal Status is statistically significant (P=0.000). There was statistically significant difference in mean number of sextants between the degree of fluorosis in each of the periodontal status (P=0.000). Conclusion: The finding that the lower prevalence of shallow pockets in the study area, where the fluoride level in the drinking water ranges from 1.83 to 2.01 ppm, indicates that the use of fluoride in water is beneficial to the periodontal tissues.

Aim: In an effort to minimize tooth preparation, yet provide additional retention to compromised tooth structure, bonded amalgam restorations were introduced. Various resin-based adhesives have been tried earlier under bonded amalgam restorations. Still there are controversies regarding the outcome of bonded amalgam restorations regarding their adaptability to the tooth structure and microleakage. Therefore, this study was undertaken to compare the microleakage of bonded amalgam restorations using different adhesive materials. Materials and Methods: Standard Class I cavities were prepared on occlusal surfaces of 60 human molars. Teeth (n=60) were divided into three groups according to the material employed, as follows: group I: amalgam with glass ionomer cement (GIC) (type I); group II: amalgam with resin cement (Panavia F 2.0) and group III: amalgam with Copalex varnish as a control. Following restoration, the teeth were submitted to thermal cycling. The teeth were subsequently immersed in 2% rhodamine B dye under vacuum for 48 hours and sectioned to allow the assessment of microleakage under stereomicroscope. Results: The values were tabulated and the results were statistically analyzed using analysis of variance (ANOVA), Tukey's post hoc test and Kruskal-Wallis test. Amalgam with type I GIC showed the least leakage with no statistically significant difference (P value 0.226) when compared to amalgam with Panavia F 2.0 and amalgam with varnish (P value 0.107). Conclusion: It can be concluded that bonded amalgam with type I GIC is a good alternative to amalgam with resin cement (Panavia F 2.0) and amalgam with varnish for large restorations, with the added advantages of GICs. Clinical Significance: Bonded amalgam restorations prevent over-preparation and reduce the tooth flexure. GIC type I under amalgam provides chemical bonding in between amalgam and tooth structure and thus reduces the microleakage.

Background: Heat shock proteins are a highly conserved group of protective cellular proteins whose synthesis is increased in response to a variety of environmental or pathophysiological stresses. Heat shock proteins are useful biomarkers for carcinogenesis in tissues and signal the degree of differentiation and the aggressiveness of cancers. Regulation of heat shock protein 70 (HSP70) expression in oral submucous fibrosis is not known much, and the aim of this study was to evaluate HSP70 expression in oral submucous fibrosis and oral squamous cell carcinoma by immunohistochemical method and to understand the role of HSP70 in tumorigenesis. Materials and Methods: Immunohistochemical method was used to detect HSP70 expression in normal oral mucosa, oral submucous fibrosis (n=30) and oral squamous cell carcinoma (n=20). HSP70 immunoreactivity was correlated with histological and clinicopathological features. Results: A significant increase in expression of HSP70 was observed (P<0.000) as the tissue progressed from oral submucous fibrosis towards oral squamous cell carcinoma. Conclusion: HSP70 is synthesized upon stress situations arising in cells of all living organisms. Expression of HSP70 indicates that stress plays an important role as a predisposing factor in oral submucous fibrosis and its subsequent progression to oral squamous cell carcinoma.

Background: Halitosis has been correlated with the concentration of volatile sulfur compounds (VSCs) produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal pockets and the dorsum of the tongue. It has been assumed that there is a relationship between periodontal disease and diabetes mellitus. Objectives: The aim of the study was to assess the malodor using the organoleptic method and tanita device; to quantify odoriferous microorganisms of subgingival plaque and tongue coating, such as P. gingivalis (Pg), T. forsythia (Tf), and F. nucleatum (Fn) using polymerase chain reaction (PCR) in nondiabetic and diabetic chronic periodontitis patients. Patients and Methods: Thirty chronic periodontitis patients (with and without diabetes) with 5-7 mm pocket depth, radiographic evidence of bone loss, and presence of oral malodor participated in this study. Subjective assessment of mouth air was done organoleptically and by using a portable sulfide monitor. Tongue coating was also assessed. Results: The scores of plaque index, gingival index, gingival bleeding index, VSC levels, and tongue coating between the nondiabetic and diabetic patients were not significant (P>0.5). In nondiabetic patients, Fn was found to be significantly (P<0.5) more in tongue samples, whereas Pg and Tf have not shown significant values (P>0.5). In diabetic patients, Fn and Tf have shown significant (P<0.5) an increase in subgingival and tongue samples, respectively, whereas Pg has not shown significant difference between subgingival and tongue samples. Interpretation and Conclusion: The results confirm that there is no difference in clinical parameters between nondiabetic and diabetic periodontitis patients, but the odoriferous microbial profiles in tongue samples of diabetic patients were found to be high. However, there is a weak positive correlation between VSC levels, clinical parameters, and odoriferous microbial profiles.

Aim: Radiographic interpretation of a disease requires knowledge about normal structures. The calcifying jaw diseases can range from radiolucent areas to varying degrees of calcification. Therefore, it is vital to differentiate radiographically between various hard tissues. Materials and Methods: We have illustrated the use of computed tomography scan to quantify the calcified structures as dentin and enamel in a case of ameloblastic fibro-odontoma. Results: The enamel, dentin and cementum showed different values. Conclusion: The "Dentascan" can be used to distinguish the hard tissues in a variety of calcifying diseases of jaws.

Background: Data suggest that postmenopausal women with osteoporosis are at an increased risk for periodontal attachment loss and tooth loss; however, the extent of relationship between these two diseases is still not clear. Aim: The aim of the study was to evaluate the correlation of periodontal status and bone mineral density (BMD) in postmenopausal women. Materials and Methods: The study population included 60 postmenopausal women aged 50-60 years (mean±SD: 55.5±3.4 years). Periodontal status was examined by plaque index, bleeding index, probing depth, and clinical attachment level (CAL). Digital panoramic radiograph was taken to measure the maxillary and mandibular alveolar bone density values. Skeletal (calcaneal) BMD was measured by quantitative ultrasound technique for T-score values. The recorded data for T-score, maxillary and mandibular alveolar bone densities, and periodontal status were subjected to statistical analysis for correlation and regression procedures. Results: The results showed that mandibular alveolar (r=0.907, P<0.001) and maxillary alveolar bone density (r=0.898, P<0.001) had significant positive correlation with calcaneal T-score. Probing depth (r=-0.316, P<0.05), bleeding index (r=-0.277, P<0.05), and plaque index (r=-0.285, P<0.05) showed weak but significant negative correlation with calcaneal T-score and alveolar bone density of both the jaws, whereas CAL showed weak correlation with T-score which could not reach to a statistically significance level (r=-0.221, P>0.05). Conclusion: Calcaneal BMD was related to alveolar bone loss and, to a lesser extent, to clinical attachment loss, implicating postmenopausal bone loss as a risk indicator for periodontal disease in postmenopausal women.

Background: Using implants for dental applications are well-accepted procedures as one of the solutions for periodontal defect repair. Suitable design and materials, their reaction with the surrounding hard tissues and interfacial biomechanical properties are still considered to be the primary criteria which need to be addressed systematically. In the present study, a thorough and systemic approach was made to identify a suitable implant, considering the above criteria after both in vitro and in vivo animal trials. Materials and Methods: Titanium alloy (Ti-6Al-4V) implants, with thread and without thread models, were implanted to the mid-metaphysial portion of the tibia of the right hind leg of three white Australian Chinchilla rabbit species and their effects and response to the surrounding bone were investigated. Parameters studied included hematological and biochemical features (serum alkaline phosphatase and calcium), both preoperatively and postoperatively, consecutively for 7 days and after 1-3 months. The interfacial integrity and compositional variation along the interface were studied using scanning electron microscope (SEM) with energy dispersive analysis of X-ray (EDAX) and histopathology from 1 to 3 months consecutively. Finally, biomechanical properties were studied with the help of push-out test. Results: Bone remineralization started through the process of electro-physiological ionic exchanges, which helps in formation of osteoblastic cells in the area of bony injury. The SEM-EDAX results confirmed the initial stability for the Ti (with thread) implant, but the regeneration of new bone formation was faster in the case of Ti (Without thread) implant, and hence could be used for faster healing. These have also been substantiated through push-out and histopathlogical tests. Conclusion: From the physico-chemical and biomechanical observations, it was found that that smooth type implants were well accepted in the physiological condition although chances of elemental leaching from the surface were also observed. Increase of the surface roughness can help into the formation of physico-chemical bondage with the surrounding hard tissues.

Background: Signs such as +, ++ and +++ for mild, moderate and severe stains/calculus are being used in India effectively for more than four decades. However, there are no standardized criteria for grading, and no data regarding how and when this system was introduced, but it became very popular throughout India and is being used since then. Aims and Objectives: An attempt was made here to standardize the criteria on which the grades would be given and designate it as "Sign Grading System". Along with this, the objective of this paper was to evaluate whether this index/system satisfies all the requirements of an ideal index, particularly reliability and reproducibility. Settings and Design: Inter-examiner and intra-examiner reliability and reproducibility of this index was assessed through a randomized clinical study. Patients were recruited from an institutional setting by random selection from the outpatient department. Materials and Methods: One month of training was conducted before the actual start of study. The clinical aspect of the study involved 3 investigators and 50 patients of whom 45 patients were reassessed. All the data were kept blind by a research assistant to reduce bias. Necessary measures were taken to reduce/eliminate the confounding variables, which could have affected the outcome of this study. Cohen's kappa and Fleiss' kappa statistics were employed for statistical analysis. Results and Conclusion: The index fulfills most of the ideal requirements of an index along with a high degree of reliability and reproducibility.

Aim: Diabetes mellitus is a chronic metabolic disorder of the carbohydrate, protein and fat metabolism, resulting in increased blood glucose levels. Various complications of diabetes have been described with periodontitis being added as the sixth complication of diabetes mellitus. The aim of this study was to assess periodontal status and treatment needs (TN) in diabetic patients and to compare the findings between diabetic and non-diabetic individuals using community periodontal index (CPI). Materials and Methods: We evaluated the periodontal status and periodontal TN in diabetic and non-diabetic individuals in Guwahati, Assam. A total of 459 (223 diabetic and 236 non-diabetic) individuals were assessed. A person was considered to be diabetic when his blood glucose levels were above 140 mg/dl under fasting condition and 200 mg/dl 2 hours postprandially. Periodontal status was assessed using CPI. Results: Periodontal destruction was found to be increased in diabetic individuals, with periodontal destruction increasing with increased blood glucose levels. The necessity of complex periodontal treatment also increased with increasing blood glucose levels. Conclusions: Individuals with diabetes are more prone to periodontal destruction, and hence, regular periodontal screening and treatment is essential in these individuals.

Background: Causes of failures in class V restorations have always been controversial until now, since the biomechanical aspects of these restorations have been understood. Aims and Objective: This study was aimed to verify the hypothesis that eccentric forces are the cause of cuspal flexure, which lead to excessive stresses at the periphery of a class V restoration, further it identifies the amount of the stress and the flexure increase in the presence of an occlusal restoration using different restorative materials to restore (both cervical and occlusal) along with their comparison with respect to amount of stresses around the cervical restorations. Materials and Methods : The study was done by modeling a mandibular first premolar which was sectioned bucco-lingually, in the NISA, EMRC II finite element software. A 100N eccentric load was applied on the tooth structure and stresses were observed at the peripheries of the class V restoration when it was restored with composite and with glass ionomer cement. The stresses were further analyzed in the presence of occlusal restorations with different materials and configurations. Results: It was seen that the stresses at the gingival wall interface in case of class V glass ionomer cement was more than that for composite. In the presence of an occlusal amalgam restoration, the cuspal flexure was more than that of occlusal composite and the stresses at the class V peripheries were also statistically significant. Conclusion: It was suggested that lower modulus composites can flex with the tooth structure decreasing the bond failure and that the stresses are much lesser when there is absence of an occlusal restoration. Occlusal composite restorations reinforce the tooth structure and reduce the cuspal flexure as compared to silver amalgam.

Background: To investigate the effect of restoration of lost vertical by centric stabilizing splint on electromyographic (EMG) activity of masseter and anterior temporalis muscles bilaterally in patients with generalized attrition of teeth. Materials and Methods: EMG activity of anterior temporalis and masseter muscle was recorded bilaterally for 10 patients whose vertical was restored with centric stabilizing splint. The recording was done at postural rest position and in maximum voluntary clenching for each subject before the start of treatment, immediately after placement of splint and at subsequent recall visits, with splint and without the splint. Results: The EMG activity at postural rest position (PRP) and maximum voluntary clench (MVC) decreased till 1 month for both the muscles. In the third month, an increase in muscle activity toward normalization was noted at PRP, both with and without splint. At MVC in the third month, the muscle activity without splint decreased significantly as compared to pretreatment values for anterior temporalis and masseter, while with the splint an increase was seen beyond the pretreatment values. Conclusion: A definite response of anterior temporalis and masseter muscle was observed over a period of 3 months. This is suggestive that the reversible increase in vertical prior to irreversible intervention must be carried out for a minimum of 3 months to achieve neuromuscular deprogramming. This allows the muscle to get adapted to the new postural position and attain stability in occlusion following splint therapy.

Background and Objectives: Aim of this study was to determine the validity of cervical vertebrae radiographic assessment to predict skeletal maturation. Materials and Methods: Left-hand wrist and lateral cephalometric radiographs of 100 Bangalore children aged 8-18 years, divided into 10 groups of 10 subjects each with equal distribution of males and females, were measured. On left-hand wrist radiograph, the classification of Fishman was used to assess skeletal maturation. Cervical vertebrae maturation was evaluated with lateral cephalometric radiograph, using the stages developed by Hassel and Farman. The changes in hand wrist and cervical vertebrae were correlated. Results: Significant association was observed between skeletal maturation indicator stages and cervical vertebrae maturation indicator stages. Correlation coefficient was found to be significant (P<0.0001). Conclusion: The results of the study indicated that the cervical vertebrae maturation and hand wrist skeletal maturation was significantly related.

The level of bone crest surrounding the implant is of utmost significance to determine osseointegrated implant success, as preservation of marginal bone height is highly important for long-term dental implant survival. Various approaches have been described in the literature to prevent the crestal bone loss, including platform switching, non-submerged approach, scalloped implants, implant design modifications, progressive loading, immediate implant placement, etc. The purpose of this paper is to review all the possible methods to preserve the crestal bone, when each method should be used and their success rates in an attempt to address this complex problem of crestal bone resorption. "PubMed" and "Google Scholar" were used to find out any studies involving platform switching concept from 1990 up to 2009. Twenty-four studies involving methods for preservation of crestal bone were evaluated, which included 26% studies on platform switching, 22% on non-submerged approach, 17% on scalloped implants, 13% on progressive loading and 22% on immediate implant placement. Crestal bone preservation should be thought of starting from the design of the implant to be placed. The technique to be followed in a given case will depend upon the density of bone, force factors by the patient, bone volume and amount of soft tissues, etc. The best possible method or the combination of the methods should be used to preserve the crestal bone for the long-term success of the implants.

There has been a paradigm shift toward ecological and microbial community-based approach in understanding oral diseases. A marked improvement in gastrointestinal health has been reported after using probiotic bacteria and/or prebiotic supplements,which has prompted much interest in the use of this approach for oral applications. Treatment of periodontal disease in recent years has moved toward an antibiotic/antimicrobial model of disease management. With increase in the incidence of resistance to antibiotics, probiotics may be a promising area of research in periodontal therapy. This paper reviews the evidences for the use of probiotics or prebiotics for the prevention of dental caries or periodontal diseases, and also adresses the risk associated with their prolonged use. Many questions have been raised pertaining to the benefits of probiotic administration, as the role of probiotics in periodontics is still in infancy, and a complete understanding of the broad ecological changes induced in the mouth by probiotics or prebiotics is essential to assess their long-term consequences for oral health and disease.

Mucormycosis, caused by saprophytic fungi of the order Mucorales of the class Zygomycetes, is a rare opportunistic fungal infection, which has a rapidly progressive and fulminant course with fatal outcome. These fungi are ubiquitous, found in soil, bread molds, decaying fruits and vegetables. The most common form of mucormycosis is rhinocerebral and is usually seen in uncontrolled diabetes mellitus or in immunocompromised patients. This fungus invades the arteries, leading to thrombosis that subsequently causes necrosis of hard and soft tissues. We report a case of palatal perforation by rhino-maxillary mucormycosis in an immunocompromised patient. The aim of this article is to draw attention to the clinical presentation and pathogenesis of mucormycosis and to emphasize the need for high degree of suspicion in its diagnosis and management.

A post traumatic parotid sialocele is an acquired lesion that arises from extravasation of saliva into glandular or periglandular tissues secondary to disruption of the parotid duct or parenchyma. Facial trauma and surgery in the parotid region are the most common causes of this rare condition. This paper presents an unusual incidence of post traumatic parotid sialocele after Le-Fort II fracture reduction and its management by relatively simple and cost-effective technique which can be carried out in routine dental surgery suite. The results achieved justify our recommendation of scalp vein cannula for the treatment of sialocele in clinical practice.

Burkitt's lymphoma (BL) is the most common childhood cancer in Africa and is most prevalent in areas endemic for malaria. The disease, a malignant growth of lymphoid tissue, usually presents itself as a large tumor of the jaw. It is however, a rarity in the Indian subcontinent. Through an extensive literary survey, it is seen that only a few cases of BL have been reported, accounting for only 0.76% of solid malignant tumors among Indian children. Here we present a case of BL of mandible extending to maxilla in a 13-year-old boy of Indian origin.

Odontogenic tumors comprise a complex group of lesions of diverse histopathological types and clinical behavior. The group of mixed odontogenic tumors, which are also rare, is composed of proliferating odontogenic epithelium in a cellular ectomesenchyme resembling dental papilla. Ameloblastic fibrodentinoma is a rare benign odontogenic tumor. The present case report discusses this tumor composed of odontogenic epithelium and odontogenic mesenchyme with dentin or dentin like tissue. The present paper also throws light on various histological similarities and complexities which make the interpretation of these set of odontogenic tumors a diagnostic dilemma.

Ectodermal dysplasia is characterized by the absence or defects of two or more ectodermally derived structures. Anodontia or hypodontia is the most striking dental manifestation. In severe hypodontia, there is lack of alveolar development with consequent protrusion and eversion of the lips. Patients with anhidrotic forms suffer from heat intolerance due to lack of sweat glands and mild infections may lead to death in infancy from hyperthermia. A case of a 4-year-old child with anhidrotic ectodermal dysplasia with partial anodontia is presented. Dental, oral, and physical features were taken into consideration in diagnosis and treatment planning for this patient. Clinical management consisted of removable partial prosthesis in maxillary arch and complete denture prosthesis in mandibular arch. The main aim of the treatment was to improve psychological development and to promote better functioning of the stomatognathic system.

Cemento-ossifying fibromas (COFs) are benign lesions affecting the jaws and other craniofacial bones. They commonly affect adult females between the third and fourth decade of life, predominantly occurring in the premolar/molar region of the mandible. Most of the lesions typically show slow and often expansile growth, centrally within the jaw and characteristically behave in a benign form, but occasionally they may present as an aggressive gigantiform lesion. Radiographically, they appear as well-defined unilocular or multilocular intraosseous masses. The lesion is invariably encapsulated and of mixed radiolucent densities. The tumor may grow quite extensively; thus, the term "aggressive" is sometimes applied. Surgical resection is the treatment of choice. They are insensitive to radiotherapy and recurrences are uncommon. Clinical, radiographic and histopathologic features of COF and other fibro-osseous lesions are overlapping and may cause confusion in classification, diagnosis and treatment.

Palatopharyngeal dysfunction may take place when palatopharyngeal valve is unable to perform its own closing due to a lack of tissue (palatopharyngeal insufficiency) or lack of proper movement (palatopharyngeal incompetence). Palatopharyngeal insufficiency induces nasal regurgitation of liquids, hypernasal speech, nasal escape, disarticulations and impaired speech intelligibility. Prosthetic management of palatopharyngeal insufficiency requires a close co-operation between an otolaryngologist and a speech pathologist. As a result, the patient can be socially and physically rehabilitated with the improved speech quality as well as prevention of leakage of liquids.

A patient presented with an unfavorable distribution of teeth in the arch which precluded treatment with a removable partial denture. The unique pattern of partial edentulism was treated with an overdenture restoration using accesspost system. The final restoration was stable, well retained and esthetic, serving as a conservative approach to root preservation.

Background: Digital radiography has so far not resulted in improved rates of proximal caries detection. Historically, automated caries detection tools have been largely academic. Opinions regarding the performance of the only such commercially available tool, viz., Logicon caries Detector (LCD) have been equivocal. This study was conducted to evaluate the reliability of LCD in the detection and depth assessment of proximal caries. Materials and Methods: Digital images were obtained of 100 proximal tooth surfaces using the Kodak RVG 5000 sensor and analyzed by three observers. The images were then analyzed by the principal investigator using the LCD software. The teeth were then sectioned and magnified photographic images were obtained which were taken as the gold standard. All the grades were entered in proformas and the data were statistically analyzed using the chi-square test. Five parameters of reliability were calculated. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of LCD for the grade No caries were 33, 96, 73, 82, and 81%, respectively; for the grade Enamel caries were 5, 97, 33, 80, and 79%, respectively; and for the grade Dentin caries were 100, 96, 50, 100, and 96%, respectively. Conclusions: In conclusion, LCD appears to be more reliable in ruling out (both enamel and dentin) caries than in detecting caries.

Purpose: Telomerase is a specialized ribonucleoprotein complex that stabilizes telomeres by adding "TAG" repeats to the end of chromosomes. The catalytic subunit of telomerase is human telomerase reverse transcriptase (hTERT), whose expression is the critical determinant of telomerase activity. Telomeres and telomerases play an important role in the longevity of cell and are known to conform "immortalization" on neoplastic cells. Although there exists a lot of information on telomerase in oral cancer, very little is known about their expression in leukoplakia and oral submucous fibrosis (OSF). This study addresses this lacuna. Materials and Methods: In this preliminary study, immunohistochemistry (IHC) was used to detect the expression of hTERT protein in oral squamous cell carcinoma (OSCC) (n=30), leukoplakia (n=15), OSF (n=15) and normal oral mucosa (n=10). The cellular localization of immunostain, intensity of stain, mean nuclear labeling index (LI) and mean nuclear labeling score (LS) of hTERT protein were studied. A total number of 1000 cells were counted in each slide. All the data were analyzed using SPSS software version 10.0.2. The cellular localization of cytoplasmic/nuclear/both of hTERT stain, staining intensity and LI were compared across the groups using Pearson's χ² test. The mean LI and LS for OSF, leukoplakia, OSCC and normal were compared using analysis of variance (ANOVA). A P-value <0.05 was considered to be statistically significant. Results: The mean nuclear LI increased from OSF (22.46±4.53), through normal (28.3±12.3) to OSCC (47.56±21.30) (P=0.002) and from normal (28.3±12.3), through leukoplakia (44.06±14.6), to OSCC (47.56±21.30) (P=0.00). The mean nuclear labeling score was observed to increase from OSF (37.8±15), through normal (64.9±30.7), to OSCC samples (106.9±29.77) (P=0.00) and from normal (64.9±30.7), through leukoplakia (85.6±25.1) to OSCC samples (106.9±29.77) (P=0.00). Conclusion: There was increased expression of hTERT protein in OSCC and leukoplakia samples when compared to normal oral mucosa. The cellular localization, LI and LS in OSF were significantly different from OSCC and leukoplakia.

Aim: To compare the cleaning ability and preparation time of rotary instruments (Mtwo) and conventional manual instruments (K-file) in preparing primary and permanent molar root canals. Materials and Methods: Access cavities were prepared in 70 primary and 70 permanent teeth and India ink was injected into 120 canals of selected molars. The teeth were randomly divided into two main subgroups (n=20) and three control groups (n=10). In each of these main subgroups, either the manual instrument (K-file) or the rotary system (Mtwo) was used to prepare root canals. After cleaning the canals and clearing the teeth, dye removal was evaluated with the help of a stereomicroscope. In addition, the time needed for root canal preparation was recorded by a chronometer. Statistical Analysis: Statistical analyses were done using the Kruskal-Wallis, Mann-Whitney and t tests. Results: With regard to the cleaning ability of root canals, there were no significant differences between the K-file and Mtwo rotary system in primary and permanent teeth in the apical, middle or coronal third of the canals. Moreover, there were no significant differences between primary and permanent teeth prepared with K-files and rotary instruments. In all the groups, shorter times were recorded with the rotary technique. The working time was shorter in primary than in permanent teeth. Conclusion: The Mtwo rotary system showed acceptable cleaning ability in both primary and permanent teeth, and achieved results similar to those of K-files in less time.

Aim: To determine the prevalence of permanent tooth loss among children and adults in a suburban area of Chennai. Design: Cross sectional descriptive study. Study setting: The study was conducted in Tiruverkadu, a suburban area of Chennai. Materials and Methods: A house-to-house survey was done in Tiruverkadu. The study population consisted of 6, 12, 15 years children, 35-44 years, and 65-74 years adults. Type III dental examination was carried out. Cross tabulations and Chi-square statistics were computed. The level of significance was chosen as P<0.05. Results: Out of the total 679 subjects, 309 subjects had tooth loss. Females (47.9%) had greater tooth loss compared to males (42.9%). Tooth loss increased as age progressed. Subjects in the lower socio-economic status had greatest tooth loss. The mean tooth loss among the subjects was 2.7. Conclusion: This study indicates that tooth loss increases with age and differs for gender and socio-economic status. The prevalence of tooth loss among the subjects was found to be high in children as well as in adults. Therefore, dental professionals should utilize various measures available in preventive dentistry to minimize tooth loss.

Glandular odontogenic cyst (GOC) is a recently recognized rare developmental odontogenic cyst having an aggressive behavior and accounting for 0.012% to 1.3% of all jaw cysts. GOC usually presents as a painless, slow-growing swelling that tends to affect the anterior part of the jaws. It chiefly occurs in the fourth and fifth decades of life and presents as an expansion of jaws with or without pain or paresthesia. Aggressive nature of the lesion has been reported, as supported by the fact that 25 to 55% of cases recur following curettage. So far only just over 113 cases of GOC have been reported in the literature. Here, we report a case of bilateral GOC in the posterior region of the maxilla, in a 29-year-old male patient, which is unique, being the first case of bilateral GOC to be reported in the literature.