Panithini DB   Sita Rama Kumar M   Girija. S. Sajjan   Madhu Varma K   Kalyan Satish R   and Madhavi K   

Successful root canal therapy depends on many factors. One of the most important steps in any root canal treatment is biomechanical preparation. Additionally, respecting the original shape of the canal is of the same importance. Otherwise, canal aberrations such as transportation will be created. Purpose: To evaluate the canal transportation and canal centering ability of ProTaper Next (PTN), TruNatomy (TN), and Neohybrid (NH) file systems using cone-beam computed tomography. Materials and methods: Thirty extracted single-rooted mandibular premolars were decoronated and divided into three experimental groups, with ten in each group. Group I - ProTaper Next (PTN), Group II - TruNatomy (TN), and Group III - Neohybrid (NH) file systems. Cone-beam computed tomographic pre-scan were taken, followed by biomechanical preparation with the respective file systems. Post CBCT scans were taken and compared with pre-scans for canal transportation and canal centering ability at the levels of 3, 6, and 9mm. The data obtained were statistically analyzed. Results: Using One way ANOVA and Post hoc analysis, canal transportation at the level of 6mm from the apex, group II and group III have shown statistical significance compared to group I, and no statistically significant differences were seen at the levels of 3mm and 9mm. There is no statistically significant difference in canal centering ability among the three groups at the levels of 3,6, and 9mm from the apex. Conclusion: Under the in vitro conditions of the study, ProTaper Next (PTN), Trunatomy (TN), and Neohybrid (NH) rotary systems have shown similar behavior concerning canal transportation and canal centering ability.

Misha Efney Fernandes   and Surekha R Puranik   

Cemento-ossifying fibroma is the uncommon benign fibro-osseous lesion of the craniofacial skeleton. The origin of this lesion has been traced to the periodontal ligament since the cells can form cement, lamellar bone, or fibrous tissue. The lesion most often occurs in the jaws, especially the mandible. Most lesions are small and incidentally found. Larger lesions cause facial asymmetry or functional impairment. The lesion is more common in females. Of the craniofacial bones, the mandible is the most commonly affected site, with the lesion typically inferior to the premolars and molars. From a radiological perspective, some lesions can be exceptionally radiopaque, or some well-defined with mixed or unilocular radiolucency. A 23-year-old female presented with a swelling in the right mandibular region, radiographs revealed a mixed radiopaque – radiolucent lesion showing a centrifugal expansion. Computed tomography revealed a mixed predominantly opaque expansile lesion with massive buccolingual expansion. Complete excision of the lesion was performed and histopathology findings confirmed it as Cemento-Ossifying Fibroma. Through this case report we want to signify the importance of diagnosis, consecutive therapy after clinical and radiographic findings, as such lesions continue expanding and may lead to a severe medical complication. The knowledge of the different types of radiological findings is important. The unique radiographic appearance of the lesion, in this case, can be beneficial to help clinicians understand. Due to the good delimitation of the lesion surgical removal and curettage is the treatment of choice. Complete surgical resection of the lesion is essential to achieve good results in terms of health and recurrence.

Çağrı Çakmakçi   İhya Çakmakçi   and Fatih Çakici   

Objective: Aim of this study was to evaluate the knowledge of Ordu University, Faculty of Dentistry students about systemic antibiotic indications in endodontic infections. Materials and Methods: Third, fourth and fifth year students of Ordu University, Faculty of Dentistry were asked to provide an online survey about systemic antibiotic indications for the management of endodontic infections. Two hundred and sixteen students were requested to participate in this survey. Descriptive statistics, chi-square test and Fischer's exact test were used to analyze the data. Significance level was set at P<0.05. Results: One hundred eighty-five students (85.6%) answered the questions satisfactorily. The most preferred antibiotic prescribing duration was determined as 7 days (42.2%). Among all respondents, the most preferred antibiotics in adult patients not allergic to penicillin were Amoxicillin + Clavulanic acid 1gm (31.4%) and Amoxicillin 500mg (18.4%), respectively. The most preferred antibiotic in patients with allergies to penicillin was Clindamycin 600mg (58.4%). In symptomatic apical periodontitis (SAP) cases with necrotic pulp, moderate/severe symptoms and no swelling, 11.4% of the respondents prescribed antibiotics, while 64.9% of the respondents prescribed antibiotics at SAP cases with necrotic pulp, swelling and moderate/severe symptoms. Conclusion: Dental students showed satisfactory knowledge about antibiotic prescribing in endodontic infections when compared to their peers in other studies. Specific aspects of antibiotic prescribing knowledge that needs improvement include types of antibiotics and indications for antibiotic prescribing in endodontic infections.

Gabriele Baniulyte   Ahad Shafi   Rory MacIver   and Mark Ansell   

Background: The aim of this report is to identify cases of cervicofascial necrotising fasciitis presenting to the Queen Elizabeth University Hospital Glasgow, over the course of 10 months. We reviewed and compared these cases to the literature in order to determine the optimal treatment provision. Methods: All patients admitted to our unit December 2017-October 2018 for cervicofascial necrotising fasciitis were identified. A retrospective data collection and analysis was carried out. Demographics, treatment provision and outcomes were examined for each patient. Results: A total of 5 patients were admitted to the Queen Elizabeth University Hospital for treatment of periorbital cervicofascial necrotising fasciitis in 10 months. All patients received urgent aggressive surgeries and empirical antibiotic therapies. All patients survived and went on to have facial reconstruction. Unfortunately, due to a delay in diagnosis, one patient required enucleation of their eye. Conclusions: Immediate surgical management as well as aggressive empirical antibiotic therapy remain the best treatment of cervicofascial necrotising fasciitis Timely diagnosis is of extreme importance to provide the best outcome for the patient. The Laboratory Risk Indicator for Necrotising Fasciitis score was utilised but did not produce consistently accurate results.

Rashmi. J. Kurup   Vathsala Naik MDS   and Amandeep Sodhi MDS   

Erythema Multiforme is an acute, self- limiting inflammatory mucocutaneous condition caused by a hypersensitivity reaction with distinctive clinical eruption manifested as iris or target lesions. It is a life-threatening mucocutaneous disorder where early diagnosis and management are of utmost importance. Erythema Multiforme results from a cell-mediated immune reaction against a precipitating factor. It is clinically characterized by a ‘‘minor'' form and a ‘‘major'' form. In the Erythema Multiforme minor, only one mucous membrane is affected and usually is the oral mucosa. Erythema Multiforme is diagnosed based on stringent clinical findings which are pathognomic as microscopic evaluation carries the least significance. The range of possible etiologies for the oral disease is immense including infectious agents, drugs, food additives, etc. We report a case of a 68-year-old female who presented with a complaint of painful ulcers and burning sensation in her mouth making her difficult to eat & drink. History revealed the usage of clove to get rid of tooth pain following which she developed ulcers in the mouth. In the present case, based on patient history, the clove was found to be a probable etiological agent. The patient was successfully treated with corticosteroids adhering to systemic corticosteroid administrative protocols and no remissions and exacerbations were noticed in 6 months follow up. Early diagnosis of the disease remains essential to promptly initiate appropriate management and proper follow up. Recognition and withdrawal or prevention of contact with the etiological agent is an important step in the management of EM. In the present case, the clove was found to be a probable etiological agent.

Aniket U. Vaidya   Nivedita Chinam   Manisha M. Khorate   and Nigel Figueiredo   

Objective: To evaluate the co relation of clinical symptoms and MRI findings of TMJ in symptomatic Temporomandibular Dysfunction (TMD) patients. Material and Method: MRI TMJ scan of 25 patients were evaluated. The subjects had clinical evidence of reciprocal TMJ clicking or restricted mouth opening. This study determined the variability of temporomandibular joint (TMJ) disk position in antero-posterior aspect of the joint using magnetic resonance imaging (MRI). Disk position was evaluated on MRI by measuring the angle formed by a line through the middle of the condyle and tangential to the posterior-most aspect of the disk. Joint effusion was checked using T2 weighted image sequence. Thickness of superior and inferior head of lateral pterygoid muscle was measured. These MRI findings were then correlated statistically to clinical findings. Results: Out of 50 TMJ's (25 patients); 40% had biconcave shape (no deformity), 16% cases showed lengthened disc, 12% cases showed a flattened disc, 12% cases showed thick posterior band. Varying degrees of disc displacement was associated with disc shape deformity. Increased thickness of Inferior head of lateral Pterygoid had statistically strong association with pain. Conclusion: A strong positive co relation was seen between the clinical and MRI findings in symptomatic TMD patients. Further using this, a new Disc Displacement angle measurement method and classification of disc shape was proposed for better disc evaluation.

Luisa Maria Arvide Cambra   

Abulcasis Al-Zahrāwī (c.936-c.1013) is a very important physician of Al-Andalus, besides an eminent surgeon, the first one of Medieval Islam. His main work, titled Kitāb al-Taṣrīf (Book of medical arrangement), contains in its 19^th treatise, which deals with cosmetics and drugs for health and embellishment of body, interesting recipes of a great value to the diverse scientific fields, such as the pharmacology, dentistry, dermatology, cosmetics and aesthetic medicine. Reading this handbook allows to reconstruct the aesthetic canons of Arab society in the late 10^th and early 11^th centuries, as well as indicates the interest showed by this society in hygiene, beauty, ornament and perfume, and how these factors are closely connected to body health. This article is an approach to the study of the treatise above mentioned, and includes the translation from Arabic to English of some recipes about toothpastes, according to the 5774^th Arab manuscript of the National Library at Paris. The pages translated in this article exemplify the high level achieved by Arab scientific knowledge in the Middle Ages, and certify the importance of Abulcasis Al-Zahrāwī in the history of Islamic science. His work Kitāb al-Taṣrīf is in a high-ranking place within surgery, medicine and pharmacology of Al-Andalus. For the influence exercised in Europe until the early 17^th century, among other reasons, Abulcasis has a very relevant position in the history of both universal culture and science.

Larissa Fernandes da Costa   Marta Cléa Costa Dantas   and Amanda Cypriano Alves   

Dental bleaching is a procedure performed on the enamel surface to provide harmony and aesthetics to the smile. It is carried out through the use of bleaching agents, which presents as products in mechanism of action, water and oxygen molecules - in which residual oxygen is associated with a possible reduction in bond strength values (BS) of the teeth submitted to bleaching preventing the effectiveness of the adhesive procedure. The purpose of this review was to analyze the data available in the literature on this subject, since the use of antioxidants and the way they are applied in clinical practice seems to act significantly in the BS values of bleached teeth. Database searches were performed with descriptors associated with bleaching and antioxidants, analyzing in particular natural antioxidants and their laboratory and clinical action in dentistry. The results obtained varied according to the compound used, the concentration, the application time and the specific methodology of each research, however it is possible to observe the significant increase in the BS of teeth that were submitted to the antioxidant treatment. Thus, it is possible to observe the importance of studying the mechanism of action that influences the adhesive procedure and the way in which antioxidants are applied to reverse this impasse.

Antonia Alcaina Lorente   Olga Cortes   Sonia Guzmán   Ascensión Vicente   and Nuria Garrido   

Oral habits are customs acquired by the repetition of a series of events that serve to calm an emotional need. Early diagnosis of these anomalous habits is crucial to the early prevention or correction of malocclusions. The objective of the study is to determine the prevalence of malocclusion in school and its possible relationship with the nutritive and non-nutritive habits. Design: Cross- sectional study on 113 school children with ages between 3 and 8 years old. Surveys were carried out from parents related to nutritional habits and non-nutritive. Results: The prevalence of children with malocclusion class II is 34.5%, followed by overjet (33.6%), cross bite (10.6%), open bite (9.7%) and the habits of lip interposition (15%), lingual habit (11.5%) and oral breath (7.1%). There is a statistically significant relationship (p˂0, 05) between the habit of snoring at night with the overjet (p = 0, 001), also with class II molar (p = 0.037) and with oral breath (p = 0.016). Finally, there is a statistically significant relationship between prolonged bottle habit (p = 0.047) with the posterior crossbite. Conclusions: The habits of nutritive and non-nutritive sucking in the early stages of the childhood, may be a risk factor for the development of class II molar, increased overjet and posterior crossbite malocclusion.

Cortés Lillo O   Boj Quesada JR   and Alcaina Lorente A   

Currently many materials have been used with pulpotomies in primary teeth. These include MTA, that as a direct pulp capping material seemed to stimulate natural dentin repair at pulpal exposure sites. The composition of this product is based on Portland cement. Later, white MTA was introduced as an esthetic improvement over the original material (grey MTA). A number of studies have been performed on this new material to determine if it shows the same properties as gray MTA. The biocompatibility of MTA has been previously investigated in vitro using a number of the cell lines. However, the use of primary cultures (in this case pulp fibroblasts) is often desirable. Objective: The objective of this in vitro study was to compare the cytotoxicity in a pulp fibroblasts culture, of regular (grey) MTA, white MTA and Portland cement Material and method: A cytotoxicity study was made in a primary pulp fibroblasts culture of MTA, white and grey, and a grey Portland cement. Results: Without taking into account concentrations, there were no significant differences between regular MTA and white MTA (p=0.146). A significant difference was recorded between grey Portland cement, which were less biocompatible, and regular MTA (p=0.029), and white MTA (p=0.002). Conclusion: The results found in the present study might be an additional argument to support that MTA is biocompatible, and may be considered as a pulp dressing agent in pulpotomized primary molars with carious pulp exposures. However, the grey Portland cement, under the same conditions, shows reduced biocompatibility.

Ibtesam Orafi   and Mohammad Hammad   

Aims: this study investigated the attitudes of adult patients in Benghazi towards the use of rubber dam (RD) and evaluated time needed for rubber dam application and duration of use. Methodology: A self-administrated questionnaire was designed and distributed to 200 patients receiving endodontic treatment by: (a) General Dental Practitioners (GDPs) (b) Endodontists. Patients were kindly requested to fill the questionnaire directly after the treatment. Data were entered into a database and subsequently analyzed using SPSS. Results: The majority of patients (77% and 70%) whom were treated by endodontists and GDPs respectively reported they would prefer RD to be used at their next appointment, and most had a positive attitude of the experience. A statistically significant association between age and gender was found among the GDPs' patients (P<0.05). 87.9% and 65.6% of patients whom were treated by endodontists and GPDs respectively reported that the operators sufficiently explained the purpose of rubber dam to them, a statistically significant difference between the two groups of patients (P<0.001) was reported. The mean time needed for rubber dam placement was 4.28 min for GDPs and 1.10 minutes for endodontists, which was statistically significant. A significant difference between the two groups of patients with regards to their opinions toward the benefit of using the rubber dam was noticed (P< 0.05). Prolonged RD use exhibited association with a negative opinion of the experience of RD. Conclusions: Patients generally showed a positive attitude towards the RD. Moreover, some patients showed a negative attitude because of time taken by inexperienced operator in placement of rubber dam.

Olga Cortés Lillo   Antonia Alcaina Lorente   and Sonia Guzmán Pina   

Purpose: To compare the degrees of marginal microleakage undergone by different intermediate materials used for provisional restoration in indirect pulp treatment: glass ionomers (Ketac^TM Fil Plus (3M ESPE), Ketac^TM Molar Easy Mix (3M ESPE), Fuji IX^TM GP (GC)) and zinc oxide eugenol. Materials and methods: Twenty young permanent premolars, extracted for orthodontic reasons, were prepared by creating Class II cavities and then divided into four groups according to the material used for pulp capping. The materials were applied following the manufacturers' instructions and stained with methylene blue at 2% to evaluate microleakage. Results: Results were evaluated applying variance analysis (ANOVA). It was found that glass ionomers showed better outcomes than zinc oxide eugenol, with Fuji IX^TM GP and Ketac^TM Molar Easy Mix producing the best results. Conclusion: For indirect pulp capping, glass ionomer is a favorable material for reducing one of the main causes of treatment failure - microleakage - although there are differences between brands.

Ibtesam Orafi   and Mohammad Hammad   

The aim of this study was to evaluate the optimal horizontal beam angulation for the detection of second mesiobuccal canal (MB2) in maxillary first molar using three imaging modalities in terms of receiver operating characteristic (ROC) curve. Micro-computed tomography (micro-CT) was used to validate the presence or absence of MB2 canal. Images were generated with three different imaging modalities (analogue film, Visualix and VistaScan) for the twelve models at 10^° intervals between 0^。 to 30^。 from both right and left sides. Each model consisted of maxillary second premolar, maxillary first and second molar arranged to replicate a posterior dentate maxilla. Images were scored on a 5-point scale by 15 observers. ROC analysis was performed to identify the optimal horizontal angulation for the three imaging modalities and the best observer groups. ANOVA was also used to assess if there was a difference between the three imagining modalities and between the observer groups. ROC analysis demonstrated that the highest area under the curve (AUC) was related to angle +20^。 (right). The AUC for the three radiographic techniques at angle +20^。 were as followed (analogue film, 0.625; Visualix, 0.544; VistaScan, 0.508). There was a significant difference between the analogue film and the other two digital systems (p<0.05). The +20^。 horizontal beam angulation for the analogue film was found to be optimal in the identification of MB2 canal with all imaging modalities. Endodontists demonstrated a significantly better performance compared with the other two groups.

Jon Delsnyder   Thomas Colina   Nagy Elsemary   Mariela Padilla   and Reyes Enciso   

The objective of this study was to determine if the use of flat stabilization appliances would benefit patients with myogenous temporomandibular disorders. Methods. The studies chosen were randomized controlled trials which evaluated flat plane stabilization splints (SS) versus non-occluding palatal splints (NOS) for the treatment of myogenous temporomandibular disorders. The Cochrane Library, Medline through PubMed and Web of Science were searched for studies which met the criteria mentioned above. Results. Review authors assessed 544 unduplicated references which were reduced to eight randomized controlled clinical trials. Four were assessed at unclear risk of bias and four were at high risk. Patients wearing a flat plane stabilization splint only at night had a significantly better reduction in pain intensity (p=.015), and the subjects had a greater chance to have a 50% or more of reduction of pain intensity (p=.037) than patients wearing a non-occluding splint. However, there were no statistically significant differences between SS worn 24 hours a day and a non-occluding splint in reduction of pain intensity (p=.646) or number of responders to treatment (p=.323). There were no significant differences detected between SS (worn at night or 24 hours a day) and NOS in any of the other outcomes measured (tenderness of muscles of mastication at palpation, interincisal opening or clicking). Conclusions. There is low quality of evidence to support the use of flat stabilization splints worn only at night or 24 hours to provide a reduction of pain intensity in the treatment for myogenous temporomandibular disorders. Large RCTs with lower risk of bias and standardized methodology comparing stabilization splints to non-occluding splints are needed to confirm these results.

Byron Larsen   Kristin Mau   Mariela Padilla   and Reyes Enciso   

The objective of this study is to evaluate the efficacy of N-Methyl-D-aspartate (NMDA) receptor antagonists on neuropathic pain disorders that can occur in the orofacial region. These disorders included: Postherpetic Neuralgia (PHN), Complex Regional Pain Syndrome (CRPS), Atypical Odontalgia, Temporomandibular Joint (TMJ) Arthralgia and facial neuropathies. Materials and Methods: Three databases (Medline through PubMed, Web of Science, and Cochrane library) were searched on January 25, 2017 for randomized placebo-controlled studies using a NMDA receptor antagonist to treat spontaneously occurring neuropathic pains as compared to placebo. Two review authors separately evaluated the risk of bias. Results: The initial search yielded 267 unduplicated references, of which only 16 were eligible for inclusion. Six of these studies had an unclear risk of bias and ten had a high risk of bias. Four studies were included for meta-analysis. Oral memantine was found not to be more effective than placebo in treating PHN (p=0.735), while oral and IV ketamine were more effective than placebo in treating CRPS (p<.001). Conclusions: The quality of the evidence favorable to the use of ketamine in the treatment of CRPS is low. Inconclusive evidence in favor of other NMDA antagonist receptors was found. Additional studies with lower risk of bias and larger sample sizes are needed in this area of study.

Alexander Heatrice II   Mahsa Alavi   Phuu P. Han   and Reyes Enciso   

The purpose of this systematic review was to examine the efficacy of oral corticosteroids for prevention of postherpetic neuralgia (PHN). Randomized controlled trials of patients suffering from herpes zoster comparing corticosteroids to control therapy (placebo or carbamazepine) or acyclovir were included. Three electronic databases (MEDLINE via PubMed, Web of Science and The Cochrane Library) were searched. Two authors assessed all eligible studies for risk of bias. Ninety-one references were found. After applying inclusion/exclusion criteria 7 studies were eligible for this systematic review. All 7 studies were at high risk of bias. Corticosteroids, rather than carbamazepine, protected the patients against PHN (Relative Risk [RR] = 0.543, 95% CI 0.087 to 3.376, p=0.512), however the results were not statistically significant. Additionally, a second meta-analysis showed that the use of corticosteroids does not prevent PHN compared to the use of a placebo (RR=0.990, 95% CI 0.092 to 10.663, p=0.994). Mild and reversible side effects were reported in patients taking only corticosteroids; two serious cardiovascular events were reported in the patients prescribed acyclovir and corticosteroid, though those two events were probably unrelated to the therapy. Individual studies reported quality of life improvements and reduction in the incidence and severity of pain with the addition of prednisone to acyclovir therapy; however the heterogeneity of the outcomes and comparison group prevented from performing meta-analyses on these outcomes. Due to the low number of studies, high risk of bias, heterogeneity of the outcomes and comparison groups, the evidence this systematic review provided was of low quality.

Yen Phan   Richard Yeh   Gil Colmenar   Piedad Suarez-Durall   and Reyes Enciso   

The objective of this review is to determine the efficacy of cognitive behavioral therapy, oral and topical medications as well as dietary supplements to reduce pain in burning mouth syndrome patients (BMS). Methods: The Cochrane Library, Medline via PubMed and Web of Science were searched. Eligible studies were limited to randomized placebo-controlled trials on interventions used to treat BMS. Risk of bias was independently assessed in triplicate. Results: Twenty-two studies were included in this review. Fifteen reported baseline and post-treatment pain intensity, however due to the heterogeneity of the interventions subgroup analyses are presented by intervention. Subgroup analyses on the reduction of pain with alpha-lipoic acid (ALA) showed no significant difference with placebo (p=.713). However, a subgroup analysis with four studies showed ALA improved patients' symptoms significantly (RR=2.676; 95% CI 1.933 to 3.705; p<.001). Individual studies showed significant improvement in pain intensity with topical clonazepam (p<.001), capsaicin (p<.001), catuama (p=.009), and CBT (p<.001). No significant differences were found in individual studies reporting pain reduction with benzydamine HCl, chamomile, H. perforatum, lidocaine, lycopene-enriched olive oil and trazodone (p>.05). Pooled results with two studies each showed capsaicin (p<.001) and CBT (p=.031) significantly improved patients' symptoms. Conclusions: Low quality of evidence is available due to heterogeneity of the interventions, unclear or high risk of bias and differences in outcomes reported resulting in small number of studies included in each subgroup analysis. ALA, topical clonazepam, CBT, catuama and capsaicin should be studied further in high quality randomized clinical trials to provide recommendations for BMS patients.

Meriam Khawam Al-maajoun   Tomás Escuin Henar   Antoni España Tost   and Carlos Ascaso Terren   

Introduction: The aim of this study is to measure the strength needed to debond ceramic cylinders by using CO₂ and Er,Cr:YSGG lasers. Materials and methods: The in vitro experiment consists of 60 human teeth divided in 3 groups: Group 1 control, Group 2 with 3 seconds application of CO₂ laser, and Group 3 with 5 seconds application of Er,Cr:YSGG laser. The 3mmx3mm cylinders are made with E-max Press pressed ceramic and are cemented to the teeth with Relyx ®. After the laser application on the samples, a Shear Bond Tester device was used to measure the shear strength. Results: Significant differences are found between the Group 1 control and the two treated with laser (p<0.001). Conclusion: The use of CO₂ and Er,Cr:YSGG lasers can be considered as a valid and safe method of ceramic restoration debonding. Further studies are necessary to evaluate different currents, the use water spray and different debonding times.

Toshihide Watanabe   Chonji Fukumoto   Kazuya Hiroshima   and Kohei Kawasaki   

Benign lymphoid hyperplasia (BLH) is a rare type of lymphoproliferative disease of the oral mucosa. The present study reports a 61-year-old man who presented to the hospital with a soft polyp formation in the left buccal mucosa. He was suspected with a granuloma from cracked tooth, and an excisional biopsy was performed under local anesthesia. The histopathological examination of the specimen confirmed BLH. The patient's condition was well and free of disease at 2 years after the surgery. In this present case study, we concluded that BLH may be considered as a differential diagnosis of lymphoid disease in the oral soft tissue.

Sara Alvarez   Tomas Escuin   Rafael Claramunt   and Carlos Ascaso   

Introduction: The objective of this study in vitro was to evaluate the retentive forces of PEEK and Co-Cr alloy clasps by the insertion and removal test simulating 10 years use. Material and Methods: 16 PEEK clasps and 16 Co-Cr clasps were fabricated for 32 third molars with similar dimensions. Each clasp assembly was subjected to an insertion /removal test on its abutment molar with a Test Universal Machine (Instron® 4465, Instron Co. Ltd, Norwwod, MA) to analyze with Newton the retention force. To analyze the retention over the course of insertion/removal test, retention was measured every 1500 cycles. With a total of 15000 cycles, which represents the insertion / removal of the clasp for 10 years, estimating that the patient would do four full cycles a day. Results: Co-Cr clasps showed higher retention (mean 13,63 Nw) than PEEK clasps (mean 8,04 Nw). All clasps exhibited an increase in retentive force during the first period of cycling followed by continuous decrease. Were obtained significant differences between retention forces of each material groups (p<0.001). Conclusions: We can use PEEK clasps for removable prostheses. Retention forces of PEEK clasps were clinically acceptable, but inferior retention forces of Co-Cr clasps. They are needed in vivo studies to contrast the results.

Chonji Fukumoto   Kazuya Hiroshima   and Toshihide Watanabe   

Salivary gland tumors are rare and constitute about 2 to 6.5% of all head and neck neoplasms. Basal cell adenoma (BCA) is a rare benign tumor in salivary gland, accounting for 1 to 3% of all salivary gland tumors. Histopathologically, BCA is composed of basaloid cells and can be classified into solid with most common type, trabecular, tubular, and membranous types. It is mainly found in the parotid gland, and it is commonly treated via a parotidectomy. In this study, we report a case of surgical excision trabecular-tubular mixed type BCA in the surface of the parotid gland, with preservation of the facial nerve and body of the parotid gland.

Nezar Watted   Emad Hussein   Peter Proff   Aksoy Dodan   and Abu-Hussein Muhamad   

Maxillary canines are one of the most common teeth that are impacted among patients seeking orthodontic treatment. Depending on the position of these impacted teeth, various surgical techniques have been employed for their exposure. His primary goal of surgical phase is to provide the means for correct position of orthodontic anchorage. Additionally, the technique used must ensure favorable tissue anatomy that will permit long-term maintenance of periodontal health. In the present case, a labially impacted maxillary left canine was surgically exposed using an apically positioned flap. Orthodontic extrusion was carried out further.

Antonia Alcaina Lorente   Olga Cortés Lillo   Miguel Ángel Gómez Sánchez   and Manuel Canteras Jordana   

Background: This article will review different materials for the treatment of pulps of primary and young permanent teeth. However, innovations in materials and advances in biology suggest that there may soon be a convergence of therapies for teeth of either dentition needing pulp treatment. Objectives: The objective of this study was evaluated the pulp and liver response to biocompatible agents such as lyophilized bone in comparison with classical formocresol. Materials and Methods: Treatment was applied to the upper right and left first molar of each animal, for a total of 120 teeth. Six groups were established according to the agent used and the time elapsed (30, 45 and 60 days). In each group five livers were selected, and a control group subjected to no treatment was also evaluated. At the end of the study the rats were sacrificed and the samples were processed for histological evaluation. Analysis of variance (ANOVA) for repeated measures was used. Results: Dentinal bridge formation and reparative dentin reached higher values in the group treated with lyophilized bone. The formocresol treatment group showed increased inflammation and necrosis. Conclusions: Lyophilized bone afforded improved pulp tissue response. No histological evidence of liver damage was observed in any of the hepatic samples studied.

Awah, N. S.   Agu, K. C.   Okorie, C. C.   Okeke, C. B.   Iloanusi, C. A.   Irondi, C. R.   Udemezue, O. I.   Kyrian-Ogbonna, A. E.   Anaukwu, C. G.   Eneite, H. C.   Ifediegwu M. C.   Umeoduagu, N. D.   Abah, N. H.   and Ekong, U. S.   

In-vitro assessment of the antibacterial quality of four commonly used brands of herbal toothpastes in comparison with their corresponding non-herbal toothpastes on Streptococcus mutans was examined. Eight brands of commercially available toothpastes comprising of four herbal and non-herbal brands respectively were purchased in a local market in Awka South, Anambra State, Nigeria. The herbal brands selected were designated AH, BH, CH and DH and their respective non-herbal brands designated ANH, BNH, CNH and DNH served as positive controls. The use of distilled water served as negative control. The antibacterial activity evaluation was performed using agar well diffusion method. Different concentrations of toothpastes were made by 2-fold serial dilution method using sterile distilled water as diluents. Inhibition zones were measured in millimeters after 24hrs. Among the non-herbal toothpastes, triclosan containing toothpaste gave the highest zone of inhibition compared to non-triclosan toothpastes. The herbal toothpaste of each brand gave better inhibition result in comparison with their corresponding non-herbal brands. BH toothpaste gave maximum inhibition followed by AH, CH and lastly DH toothpastes. The result of this study indicates that herbal toothpastes are marginally better in inhibiting the growth of Streptococcus mutans; although both herbal and non-herbal toothpastes were equally effective in reducing pathogenic plaque and maintaining oral hygiene.

LaQuia A. Vinson   

Cleft lip and palate is one of the most common birth defects occurring 1 of every 700 live births. Historically, cleft lip and palate care typically involves the use of presurgical infant orthopedics appliances (PIOA) fabricated by a pediatric dentist as an adjunct to the overall management of the defect approximate the cleft segments prior to surgical repair. However, the necessity of presurgical orthopedics in managing the resulting orofacial deformity is still one that elicits discussion by craniofacial teams due to the variety of methodologies available and the inconsistency in long-term results produced by these devices. Nonetheless, presurgical orthopedics used for patients with cleft lip and palate remains primarily focused on four types' devices which have produced varied results; however, there are other techniques which offer promising results. In spite of contradictory findings, presurgical orthopedics is believed to be a vital influence on growth in cleft life and palate deformities.

Fatma Al-Zhraa Abdel-Rahman   Nadia Badr   Eatimad Shoreibah   Monazah Khafagy   and Inas Motawea   

This study aimed to establish local drug delivery system based on 3D micro porous architecture implants' surfaces. Twenty two Ti-6%Al-4%V cylindrical root-form implants were divided into two groups according to surface treatment; acid etching and anodization. Firstly, samples' surfaces were characterized by XRD, SEM, AFM and FTIR. Then, each sample was drug loaded by immersion into an antibiotics solution mixture of Ciprofloxacin (CFX) and Metronidazole (Mtz) in concentration of 200 mg/100 mL and 500 mg/100 mL; respectively for 24 hrs. The amount of released drug traced by UV-Spectroscopy was observed up to 28 days. The antimicrobial activity of the antibiotic mixture was estimated on a group of gram +ve and gram -ve bacteria. Drugs released with an initial burst; afterward, an abrupt decrease with a sustained steady release rate up to 28 days. The anodized samples showed faster rate and greater amount of drug release than the acid etched ones owing to greater density, larger size and more uniformly distributed micro-pores. The antimicrobial activity of CFX-Mtz drugs mixture was slightly higher in anodized group. However, acid etched samples showed significantly sustained antimicrobial activity up to 14 days.

Bacem AE Ottoman   

Among the commonest reactive lesions of the oral cavity is the peripheral giant cell granuloma. PGCGs rarely exceed 3 cm in their greater dimension. Although they are encountered at any age, the fourth to sixth decades are more frequent. The rarity of this reported case is the impressive size of PGCG and its unusual epidemiological find.

Ibtesam Orafi  

Objectives: To investigate the ability of endodontists and general dental practitioners (GDPs) to interpret early periapical pathology and to examine effect of age, undergraduate education and attendance at courses upon radiographic interpretation. The hypothesis was that there would be no significant difference between GDPs and endodontists. Methods: General dental practitioners (n=603) and endodontists (n=132) had access to high quality images of 12 periapical radiographs. The images had been previously scanned to obtain the same resolution as the original radiograph. Each was presented to observers as an exact replica of the size of a size 2 periapical film. Six radiographs demonstrated the presence of an early periapical lesion on a specific tooth whilst the remaining six radiographs showed normal periodontium. Each radiograph was printed on high quality paper. Each participant was asked to examine a specific tooth for the presence/absence of apical pathosis. Results: The mean sensitivity and specificity for the endodontists was 0.65 and 0.73 respectively and, for the GDPs, mean sensitivity was 0.53 and specificity 0.66. The independent T-test found a significant difference (p<0.001) for both sensitivity and specificity between GDPs and the endodontists. The study also found a significant difference between the sensitivity and specificity of GDPs and their undergraduate education (p-value of 0.01 and <0.001 respectively). GDPs also recorded a significant difference between attending continuing education courses in radiology and their specificity (p< 0.004). Conclusions: Endodontists were more able than GDPs in recognising apical pathology. Attending postgraduate courses in radiology interpretation increased the specificity of GDPs

E. Russell Vickers   and Karen L. Woodcock   

Oral lichen planus is a frequently occurring chronic mucocutaneous inflammatory disease characterized by erosion and ulceration. The incidence is 1.7% of the population and typically presents in the 60+ yrs age group. Current standard treatment uses topical steroids. This prospective case series analysis assessed the potential of the herb raspberry leaf (rubus idaeus) that is used traditionally by herbalists for symptomatic relief of oral ulcerative lesions. The active compounds are the small molecule flavonoids quercetin and kaempferol with demonstrated antioxidant, anticancer and chronic anti-inflammatory properties. Ten adult female subjects (mean age 69.3 yrs, SD 6.4) consented to participate in the herbal trial for 6 months. A standardized daily oral dose of 10ml (5ml BD) of professional grade high potency liquid extract (LE 1:1) was used. Results showed a significant reduction in pain intensity (p = 0.03) and clinical features of reticulation, erosion and ulceration (p = 0.007) at the end of the trial. No adverse clinical or systemic effects were observed in the subjects. In addition, dermal symptoms were improved. This study showed that raspberry leaf herbal extract is both a safe and efficacious treatment for oral lichen planus and potentially its dermal variant.

Bacem AE Ottoman   

Since the argyrophilic nucleolar organizer region (AgNOR) technique has successfully distinguished various grades of malignancies and enabled prognostic assessment, this paper traces its prognostic validity in predicting the behavior of pleomorphic adenoma (PA). Ten cases of recurrent PAs were compared, on the one hand, where AgNOR score of area fraction was measured before and after recurrence. The same findings were contrasted to ten cases of normal glandular mucosa. Diagnosing both pleomorphic adenomas was based on clinical and histological records of the archival submitted cases. The data were statistically analyzed by t-test, ANOVA, Tukey and Pearson's tests. The study concludes that AgNOR score lack the prognostic validity on testing PA, in terms of distinguishing and or predicting recurrence.

Priyadarshni Bindal   Umesh Bindal   Ali Dabbagh   Anand Ramanathan   and Kishore Ginjupalli   

Objective: To compare the staining intensity of turmeric and chewable tobacco with that of coffee and to investigate the impact of staining status on the bleaching efficacy of discolored restorative materials. Study Design: A total of 72 specimens from two types of dental composites (nanocomposite, and microhybrid composite) and two types of glass ionomer cements (conventional glass ionomers, and resin-modified glass ionomers) were immersed in different staining media including turmeric, coffee, and chewable tobacco (3 Hour/day). The color changes were measured at 15th, 30th, and 45th days of staining according to the CIELAB system. The discolored specimens were then bleached using a 10% carbamide peroxide solution (2×30 min daily) and the color changes were quantified after 7 and 14 days of bleaching. The obtained data were further analysed using ANOVA with complementary Tukey's test (p<0.05). Results and Conclusion: Chewable tobacco displayed the most overall staining effect on the selected materials, followed by coffee and turmeric. Nanocomposites showed the highest vulnerability to color change due to the exposure to coffee and turmeric, while the highest color change by chewable tobacco was observed in the resin-modified glass ionomers. In contrast, the conventional glass ionomers were least stained in all staining solutions. Carbamide peroxide also exhibited more bleaching effect on nanocomposites compared to other selected restorative materials. Clinical Significance: Conventional glass ionomers and microhybrid composites are more suitable compared to resin-modified glass ionomers and nanocomposites for utilization in places where esthetic longevity is the prime concern (anterior teeth and premolars in smile line) and patient has high intake of coffee, turmeric, or chewable tobacco.

Nima Ebrahimi   Julio E Obando   Michael L. Schmerman   Saba M. Khan   and Nadia I. Kawar   

Background: In the United States, orthodontic therapy has become a common phase in people's lives. Patients seek treatment for esthetic and functional reasons. As with most treatment modalities, it has its own risks and benefits. Anatomic variations can predispose certain patients to problems. Presenting with a thin gingival tissue biotype, where arch expansion is needed, can predispose the patients for mucogingival defects and bony dehiscences. The purpose of this case report is to present a surgical approach to augment both hard and soft tissue, post orthodontic treatment to manage the resulting dehiscence and prevent potential future recession. Methods: An eighteen year old patient presented to the University of Illinois, College of Dentistry six years after completion of active orthodontics. The lower anterior segment was characterized by a thin gingival tissue biotype, prominent roots and a minimal zone of keratinized tissue. A surgical procedure was performed by placing an allogenic bone graft with subepithelial connective tissue graft and enamel matrix protein. Results: Surgical procedure augmenting hard and soft tissue was completed with uneventful post-operative healing. The goals of increased tissue thickness and prevention of recession were accomplished through this technique and the results were stable after a one year follow up.

Scott McNab   Paul Monsour   Daniel Madden   and Deanne Gannaway   

Background: Increasing numbers of panoramic radiographs (PRs) are being taken every year worldwide. This study was designed to assess the ability of dental students, bachelor of oral health (BOH) students, graduate dentists and graduate oral health therapists (OHT) in Queensland, Australia, in the interpretation of PRs in order to assess future teaching needs. Methods: This study was conducted as a web-based survey. Final year dental students, final year BOH students, graduate dentists and graduate OHTs in Queensland were invited to participate in this study. The study examined three topics; 1) radiographic anatomy, 2) positioning errors, and 3) pathology/anomalies relating to PRs. Results: No significant difference was found between any of the four groups regarding identification of radiographic anatomy on PRs. Undergraduate dental students correctly identified significantly more positioning errors than graduated dentists. Undergraduate OHTs identified significantly more positioning errors than graduated OHTs. Graduate dentists scored significantly higher than final year dental students in the identification of pathology/anomalies in PRs. Graduated dentists who had access to a PR machine or had completed a refresher course in extra-oral radiography displayed significantly higher performance in identifying positioning errors. Generally the scores were low in all areas. Conclusions: Additional teaching of the three areas assessed would be beneficial in both the undergraduate curriculum and in the form of continuing education courses. Findings from this study support the findings from similar international studies [1-7] and have the potential to be extrapolated to teaching and learning initiatives in other Australian States.

Bacem AE. Ottoman   

Since treatment options for vascular anomalies are widely variable and often debated, it is fundamentally significant to differentiate vascular tumors from vascular malformations. On the one hand, vascular malformations are usually congenital and potentially progressive without involution. They usually expand because of hormonal changes such as trauma, puberty, aging or pregnancy. On the other hand, vascular tumors are neoplastic. Hemagiomas are interchangeably used to depict all vascular lesions. Technically, a hemangioma is an early childhood tumor that may gradually grow over a period of time typically should undergo gradual involution and mostly or totally disappear. This paper reports four exemplary cases of peripheral vascular lesions of the oral cavity; two cases whose diagnosis were recurrent low flow vascular malformation of the lower lip, a case of low flow vascular lesion of the tongue and arteriovenous malformation of the chin with history of recurrence as well as cosmetic disfigurement from incomplete excision. It contrasts the used diagnostic tools and modalities of treatment to similar cases in literature with exploring the advantages and disadvantages of sclerotherapy. Eventually, this paper suggests that excising a peripheral vascular malformation of low-flow is quite easy using nerve block anesthesia.

Prajna V. Kini   Vinod Rakesh Jathanna   Ramya V. Jathanna   and Karthik Shetty   

Barodontalgia is a symptom that reflects a flare up of preexisting sub clinical oral disease. Deep sea divers, Aircrew members and passengers are at increased risk of experiencing barodontalgia due to exposure to increased air pressure. It is important for dentists to understand the etiology and features of barodontalgia in order to prevent it. This article reviews the literature regarding barodontalgia, its etiology, features, and prevention.

Shivjot Chhina   

One of the key elements of implant maintenance and longevity is good physiological architecture of the supporting tissues to form an appropriate environment for implants to yield both functional and cosmetic benefits. This paper analyzes the position of periimplant soft tissues which is largely determined by biological factors like periodontal bioform, the biotype, biological width and the osseous architecture which in turn determine the position of the gingival margin and the interdental papilla. The adequacy of keratinized gingiva and its relevance to implant based restorations has also been appraised. Clinical relevance: Understanding the soft tissues parameters dentists can ensure long term success and longevity of implant based restorations especially with respect to the highly demanding esthetic zone. Objective: To understand the impact of soft tissue parameters on successful outcome of implant based restorations in the esthetic zone.

Bindal U.   Shajan K.   Mitra NK.   and Priydarshni B.   

Introduction: Lips are two fleshy folds surrounding the oral orifice. Grooves in the zone of transition of the human lips were named as “sulci labiorum rubrorum”. Study of lip prints is called as “cheiloscopy”. The morphological patterns of the two fleshy folds vary grossly in both sexes. Aim: The study was aimed to find the most common patterns, sexual variations, anthropometric measurements and the morphology of lips. Material and Methods: The present study was conducted on 300 subjects in the age group between 18 - 65 years. The impressions of the vermellion border were obtained. Morphometric analysis of the obtained impressions was done by using scale. The height, width of the mouth was measured. The wrinkles and grooves on the impressions obtained were studied with help of a magnifying lens using Suzuki’s classification. The prints of an individual subject were repeated each year for seven years. Results and discussion: The range in the width of mouth varied from 35-75 mm. The observed widths in males and females subjects varied. The male lips were wider compared to the females. In all age groups studied, in the maximum number of subjects (male and females), the height was ranging between 16-20 mm. the morphometric description of labial folds recognizes, the lips as thin, medium, thick and puffy. The present study on the subjects was medium variety in both sexes i.e. 40% each. The analysis of wrinkles and grooves on the impressions reveals that no impression matches with each other. There was no change observed in the impression of the study subject after seven years. Conclusion: The measurements of width of mouth, height of upper and lower lips and total lip height was greater in males as compared to females. It was concluded that males have a larger mouth and bigger lips than female. The medium types of lips were common in both sexes. There was no change in the lip prints patterns and the anthropometric measurements during seven years of duration. The knowledge of the patterns and measurements can be used as an instrument to identify subject under in the court of law.

Nezar Watted   Obaida Awadi   Josip Bill   Peter Proff   and Muhamad Abu-Hussein   

The continuously growing esthetic awareness for the facial appearance and the spreading of information about the possibilities of adult treatment by public media result in an increase of adult patients seek orthodontic treatment to improve their facial esthetics. In general, these patients show such a severe skeletal deformity that it is detectable even by non-experts because of its extraoral manifestation, which is the main motivation for treatment. Because of the nature of these deformities and because of the lacking growth usable for therapy the only promising treatment for these patients is the combined orthodontic-surgical approach. Besides a stable and functional occlusion with physiologic position of the condyle, the goals of treatment are the improvement of the dental and, above all, facial esthetics since the patient judges the success of treatment mostly by the extraoral appearance. The dentofacial appearance must be defined prior to treatment to plan the individual right approach in knowledge of the different treatment possibilities for Angle Class II deformities and thus be able to reach both sides –patient and orthodontist- satisfying result. With this article a systematic therapy concept to treat patients with Class II deformities and skeletal open bite with a long lower face (long face syndrome).

Gopinath. A. L   Reyazulla. M. A   Ajay Kumar. N   and Sushi kadanakuppe   

The purpose of this article is to present a case series of facial dog bites injuries, its management and emphasize the importance of primary closure. Animal bite injuries, unlike wounds caused by assaults and accidents, are more distinctive, as they cause deep puncture wounds. Such wounds are inoculated with pathogenic bacteria from the saliva of the attacking dog due to the penetration of tissue by excessive bite force. Hence, these wounds are at a high risk of infection. The key point in its management is thorough cleansing, meticulous but not overzealous debridement, followed by rabies immunization, tetanus immunization, primary closure, and appropriate antibiotic therapy. A retrospective study of 27 cases that underwent primary repair or reconstruction after wound toilet, debridement and administration of prophylactic antibiotics has been presented.

Zafer Azizi   

Management of white spot lesions has always been an important issue in modern dentistry. Many preventive measures have been suggested recently to slow the demineralization process and allow better remineralization of enamel as soon as white spot lesions begin to appear and just before proceeding into the cavitated lesion stage. A new technology in dealing with such lesions is known as “Resin Infiltration”. It seems to provide an intermediary treatment modality between prevention and restorative therapy. The concept was introduced as a micro-invasive approach for the management of smooth surface and proximal non-cavitated carious lesions. The purpose of this review is to present the scientific basis and principles of the usage of resin infiltration technique as well as its importance in the clinical practice.

Zsuzsanna Gurdán   Gyula Marada   Gejza Herényi   and Ákos Nagy   

Introduction: In orthodontic diagnosis and treatment planning it is an important goal to reach the best functional and esthetic results. However, during treatment planning the size of the teeth is a frequently ignored factor. The discrepancies of the mesiodistal widths of the teeth can be examined with the Bolton analysis. Our aim is to investigate whether the results described by Bolton are applicable to the population treated by us. Methods: At our clinic we examined the relative tooth size differences of the maxillary and mandibular teeth in 102 clinical patients (64 girls and 38 boys). During the study we formed groups based on gender and dental anomalies. Results: Our resultant measurements diverged from the results published by Bolton to some extent but did not show significant differences. Conclusions: As a conclusion, it can be stated that the diagnostic method developed by Bolton can be applied to the regional dento-alveolar values.

Raed Mukhaimer   and Naji Arandi   

Anatomical variation in the number of roots and root canals can occur in any tooth. Aberrant morphology of the root canal system may hinder cleaning and shaping procedures, leading to failure of endodontic treatment. The aim of this paper is to show one an example of root canal anatomical variation. Mandibular canines usually have one root with a centrally located root canal; however, anatomical variation may also exist. In this case report, the author described the successful endodontic treatment of a mandibular canine with two separate roots and root canals.

Mehtap Muglali   Nurgul Komerik   Betul Tas   and Samet Sonmez   

Objectives: The purpose of this study was to investigate whether perceptions of radiographic factors related to the mandibular third molar vary according to the grade of clinician. Methods: One hundred panoramic tomographs were scored for mandibular third molar spatial position, and the interface with bone, root morphology and proximity to the inferior alveolar canal, by a senior surgeon. The scorings were repeated by another senior surgeon, two residents at different grades and a general dental practitioner. The level of agreement between scores was determined. Results: The other examiners reached fair to excellent agreement with scoring by the ‘reference’ senior surgeon on most of the radiographic variables investigated, among which ‘intimate relationship of third molar to inferior alveolar canal’ and ‘shape of roots’ were the variables where least agreement was recorded. Compared to the other examiners, the scorings of the general dental practitioner were in least agreement. Conclusions: There was more agreement in the interpretation of variables between clinicians at higher grades of expertise. However, there were inconsistencies in a number of areas where levels of agreement were not related to the grade of clinical expertise

Amam Amam   and Jafari Rustom   

Objectives: Many studies indicated that reduction of skeletal bone mineral density (BMD) may lead to loss of the mandibular alveolar bone mass (MABM). Since osteoporosis is characterized with low bone mineral density, it may affect both maxilla and mandible. This study aims to evaluate the correlation between mandibular alveolar bone density (MABD) and bone mineral density (BMD), and to assess the use of intra-oral periapical radiographs in osteoporosis detection. Methods: Participants were patients attending periodontal clinic, Dentistry School, Damascus University then referred to the bone density unit at Al-Mowassat teaching hospital in Damascus to receive DEXA. Dual X-ray absorptiometry (DEXA) was done on Lumbar spine vertebrae (L2-L4) and femoral neck for each participant. They were classified into three groups: osteoporotic, osteopenic and normal (control) subjects. A periapical radiograph was taken for each participant using a standardized paralleling technique with an aluminum step wedge. MABD was measured using computerized software (Digora) to calculate MABD. Results: the number of the participants was 169 individuals (age= 42± 5.3 years), they were assigned as follows (Osteopenic 57, Osteoporotic 52, control 60). A significant positive correlation between MABD and BMD was found in osteoporotic group (R = 0.527 & p < 0.01). Also there were significant differences of MABD between osteoporotic group versus both osteopenic and normal groups. Conclusions: Mandible can be affected by osteoporosis. Intra-oral periapical radiographs using aluminum step wedge is considered one of the important and useful techniques for the detection of osteoporosis

Mordechai Findler   and Yaron Haviv   

Lymphangiomatosis with Gorham-Stout syndrome is a rare disease involving two pathological processes: Infiltration of nonmalignant, aberrant lymphatic vessels into soft and hard tissues and bone lysis. This report will describe a patient suffering from Lymphangiomatosis with external dental cervical resorption that mimics caries lesions. The rate of resorption was found to be related to disease progression. All the radiographic records of the patient were collected and compared, including three full mouth peri-apical series. Seven teeth with external cervical resorption were selected for comparison. Measurements of total tooth area and resorbed areas were performed and the ratio of resorption versus total tooth area was calculated. The rate of resorption in this patient correlated with the destructive activity of the disease. Since the clinical course of the disease followed the dental resorption rate we can assume that both bone lysis and root resorption are parts of the same process.

Marta Dyszkiewicz Konwinska   Katarzyna Mehr   Magdalena Owecka   and Tomasz Kulczyk   

Purpose: The main purpose of this study was to assess the oral health status of patients receiving two different chemotherapy regimens (cisplatin/etoposide vs cisplatin/vinorelbine) for non small cell lung cancer .We analyzed local and general factors which may influence the prevalence and intensity of oral mucositis in the course of chemotherapy. Methods: Patients were examined before, and after, one cycle of chemotherapy. The oral examination was carried out with the use of a dental mirror, dental probe and a head light. For evaluation of the dental status common epidemiological indices were used. To analyze the status of the oral mucosa we used the National Cancer Institute Common Toxicity Criteria Adverse Events v 3.0 scale. We compared the presence and intensity of oral mucosa’ changes induced by two different chemotherapy regimens. Results: The frequency of oral mucositis was at comparable levels in both the patients receiving cisplatin/etoposide and those treated with cisplatin/vinorelbine. Statistically significant differences were found in the mean simplified oral hygiene index (p= 0.0038), the impact of removable dentures on the presence of oral mucositis (p= 0.0038) and the pain intensity in patients with symptoms of oral mucositis (p=0.0018).The other factors studied did not show any significant differences between the two groups studied. Conclusions: Patients with good oral hygiene had a lower incidence of oral mucositis during chemotherapy. The use of both cisplatin/etoposide and of cisplatin/vinorelbine had a similar, deleterious effect on the condition of the oral mucosa of patients with lung cancer.

Pragati B Hebbar. MDS   Sheshaprasad R MDS   and Anuradha Pai MDS   

Abstract Background: Allergies manifest in various forms, which can be mild and unnoticeable to life threatening anaphylaxis. To pin point the exact agent causing the allergy is a challenge. Case Description: A 6 year old boy presented with pain and burning sensation in the right side of the mouth since 10 days. His mother gave a history of visiting a dentist 1 month back where he was prescribed fluoridated pediatric toothpaste. On using the toothpaste the patient noticed occurrence of small fluid filled boils in the right cheek region and the right side of the tongue which slowly increased in size and turned flat. Since 10 days the pain is severe and causing difficulty to open the mouth, talk and eat. Clinical implications: Dentists should exercise care when prescribing any new products to patients and be aware of their allergic potential. Also any allergic manifestations should be recognized early and managed appropriately.

Pao-Hsin Liu   Tong-Yui V Wong   Jing-Jing Fang   Ken-Chun Chen   Jenn-Ren Hsiao   and Jehn-Shyun Huang   

Computer aid design and manufacture have been widely applied in oral and maxillofacial surgery. Reconstruction of hemi-mandibular defects after tumor ablation is a major challenge for clinicians due to its complex architecture. We report of a case treated with innovation technique, including the use of computer assisted modeling to preoperatively design of the excision of the mandible tumors and the integration of rapid prototyping techniques in mandibular reconstruction. The patient received hemimandibulectomy for the tumor excision and reconstructed with titanium condyle-plate, and followed up for 4 years without recurrence and retained good function.

EmmaMoloney   Srinivas Varanasi   Ian A Meyers   LlewRintoul   and Anne L Symons   

This in vitro study evaluated the effect of commercially available remineralising products on demineralised dentine. Demineralised dentine was stored in pooled saliva or treated with Tooth Mousse, Tooth Mousse Plus, Gel-Kam or NeutraFluor 5000, for 7 days at room temperature. Dentine slices were microhardness tested, and assessed using scanning electron microscopy (SEM) and energy dispersive and Raman spectroscopy. Demineralisation decreased dentine microhardness and was increased following storage in saliva. However, Tooth Mousse and NeutraFluor 5000 treatment significantly increased (p<0.05) microhardness. SEM analyses showed that following demineralisation, dentine tubule openings were more clearly defined and treatment with saliva did not alter this surface appearance. Dentine tubules appeared to be occluded following treatment. With the exception of fluoride, few significant differences in elemental content between Tooth Mousse, Tooth Mousse Plus and NeutraFluor5000 were observed. All products significantly increased (p<0.001) fluoride levels compared with control, demineralised and saliva stored specimens. The increase in surface fluoride levels was significantly higher for Gel-Kam andNeutraFluor5000 (p<0.001). Raman spectrometry indicated that fluoride was being incorporated into apatite crystals following treatment with Tooth Mousse Plus, NeutraFluor 5000 and Gel-Kam.

Gupta B   Kumar VN   and Mallaiah S   

Aim: To assess the antimicrobial activity of various concentrations of Tulsi (Ocimum sanctum) extract, obtained from commercially available Tulsi powder, against Streptococcus mutans. Setting and design: Experimental design, in vitro study, Lab setting. Materials and methods: Ethanolic extract of Tulsi was prepared by the cold extraction method. The extract was then diluted with an inert solvent, dimethyl formamide, to obtain 7 different concentrations (2%, 3%, 4%, 5%, 6%, 7% and 8%). 0.2% chlorhexidine was used as a positive control and dimethyl formamide was used as a negative control. The extract, along with the controls, was then subjected to microbiological investigation to determine which concentration among the 7 different concentrations of the extract gave a wider inhibition zone against Streptococcus mutans. The zones of inhibition were measured in millimetres using a vernier caliper. Results: At the 6% concentration of Tulsi extract, a zone of inhibition of 27 millimetres (mm) was obtained at a volume of 50 µl. This was the widest zone of inhibition observed among all the 7 different concentrations of Tulsi that were investigated. Conclusion: Tulsi extract demonstrated an antimicrobial property against Streptococcus mutans and can be used as a mouthwash. This could be further confirmed by in-vivo studies.

Jeelani S.   Sowmya Krishna   Jagat Reddy   and Vishwanath Reddy   

Prolotherapy reinitiates the inflammatory process thereby augmenting the natural healing process of the body by stimulating fibroblastic activity. It is a promising approach in the management of TMDs, especially in refractory cases where conservative management has failed and in patients where surgical management is not possible. The osmotic agent used is dextrose. It produces a hypertonic extracellular environment causing lysis of adjacent cell walls resulting in migration of the macrophages and granulocytes to the area, thus initiating the process of localized inflammation and fibrous healing.

Nir Shpack Tamar Finkelstein Yon H. Lai Mladen M. Kuftinec Alexander Vardimon and Yehoshua Shapira 

To determine the prevalence of mandibular second molar impaction in orthodontic patients of two ethnic groups, present treatment options and discuss their outcome. 6500 panoramic radiographs of orthodontically treated patients (3500 Israeli and 3000 of Chinese-American origin) aged 11-15 years were examined for mandibular second molar impactions. 120 patients with 165 impacted mandibular second molars were identified, presenting a prevalence of 1.8%. Many (88%) were mesially angulated. Impactions were more prevalent in the Chinese-American group than in the Israeli group (59% and 41%, respectively). Sequential treatment options are presented and discussed, and the outcomes of several treatments are presented. A prevalence of 1.8% for MM2 impactions was detected in our sample. Clinicians should be aware of the possible impaction of mandibular permanent second molars. Early detection and initiating of orthodontic intervention directed toward correction of the impaction are recommended for best clinical results and long-term prognosis.

Roopa  Siddegowda and Rani. M.S 

Awareness of malocclusion and the need to make corrections has increasingly become prevalent among our population. As growing public interest in oral health increased, the demand for orthodontic treatment also became more noticeable in dental practices. Enhancing appearance and improving psychosocial status have been identified as important motivating factors behind the decision to initiate orthodontic treatment. This survey was formulated to investigate the awareness of children towards Orthodontic treatment and to create awareness of orthodontic treatment among the children.

Ridhi Narang Litik Mittal Kunal Jha Anamika   and Roseka   

AIM- The aim of the present study was to assess the caries experience and its relationship with parent’s education, occupation and socio economic status of the family among 3-6 years old preschool children of Sri Ganganagar city, India. MATERIAL AND METHODS-A sample of 512 preschool going children were selected. The socioeconomic status was elicited using modified B.G.L. Prasad’s classification for the year 2010. Parent’s education, occupation and income were recorded. Dental caries experience was recorded using Dentition status and treatment needs (WHO Basic Oral Health Survey 1997). Association between Socioeconomic status and caries experience was obtained using chi square test. RESULTS-The prevalence of nursing caries was 33.01%.Nursing caries was significantly associated with lower parents education, occupation and socioeconomic status of the family (p<0.001). CONCLUSION- Instilling the positive attitudes of the parents especially mothers towards the prevention of nursing caries would reduce the prevalence at this tender age of life.