Background: Researchers considered the use of selective cyclooxygenase-2 inhibitors offered the prospect for reducing periodontal inflammation without the side effects, which typically were observed after long-term, non-selective, non-steroidal anti-inflammatory drug therapy. The aim of the present study is to investigate the effectiveness of ibuprofen gel as an adjunct to non-surgical periodontal treatment of chronic periodontitis. Materials and Methods: A total of 22 individuals were randomized into two treatment groups: Scaling and root planing (SRP) plus ibuprofen and SRP plus placebo gel. Periodontal clinical parameters noted at baseline and all following (within 3 months) visits were included: Plaque index (PI), bleeding index, probing depth, and clinical attachment level (CAL). Results: 22 patients completed the study; the outcomes revealed improvement in all clinical periodontal parameters in Group A, B which was declared within 3 months (P < 0.05); whereas SRP with ibuprofen gel resulted in a significant reduction of PI, bleeding on probing, probing pocket depth, and CAL parameters at 3 months as compared to baseline and placebo group. Conclusion: Ibuprofen gel as an adjunct to SRP can provide a new direction in the management of periodontal treatment and could be used to complement the therapy to resolve the inflammatory process and clinical signs of the disease more rapidly.

Background: Studies show that the presence of maternal periodontal disease and hypovitaminosis D are associated with multiple health outcomes in neonates including low birth weight (LBW). It's speculated that vitamin D supplementation in pregnancy may improve birth weight and maternal periodontal health. An interventional study was planned to determine if oral vitamin D supplementation to pregnant women reduces the incidence of LBW among neonates and to determine if oral vitamin D supplementation improves periodontal probing depth (PD), bleeding on probing (BoP) and clinical attachment loss (AL) among pregnant women. Materials and Methods: A community-based randomized controlled trial was conducted at Jhelum, Pakistan. Pregnant females (n=85) at ~12 weeks of gestation were recruited. Periodontal parameters such as PD, BoP and the AL were assessed. Blood samples were drawn to measure vitamin D levels and blood indices. The birth weight of the babies born to study participants was also recorded. The study was registered at clinical trials.gov (# NCT01422122). Results: There were 85 pregnant women in the final analysis. Of which 36 were supplemented with vitamin D and 49 were given placebo. Participants were comparable at baseline. Periodontal disease was detected in 5/85 (6%) pregnant mothers. Birth weight of only 63 deliveries could be recorded. The proportion of LBW deliveries was 18/63 (29%). There was no difference in the birth weight and periodontal status of women supplemented with vitamin D compared to placebo. Conclusions: About 6 months oral supplementation of vitamin D to pregnant women did not bring any improvement in their periodontal status. Similarly, no significant improvement was observed in the birth weight.

Background: An important objective of orthodontic treatment during adolescence is to take advantage of growth in patients with skeletal discrepancies. The reliability of beta angle in assessing the changes following activator high pull headgear as well as normal growth has received less attention. Therefore, the aim of this study was to assess the reliability of beta angle following activator high pull headgear therapy. Materials and Methods: For this study, 20 subjects each were selected who had been treated by activator high pull headgear therapy. Lateral cephalograms were analyzed for skeletal changes during activator high pull headgear treatment. After cephalometric measurements were made, the changes between T0 and T1 were determined for each patient. The mean difference between T0 and T1 was compared to assess the effects of activator high pull headgear group. Results are expressed as mean ± standard deviation and are compared by paired t-test. Results: Findings of this study demonstrated that, in general the maxilla did not move in downward and forward direction in the treated group, suggesting that maximum restraint of maxillary complex was achieved following activator high pull headgear therapy. Conclusion: Activator high pull headgear appliance is an effective method in holding maxilla by preventing its downward and forward growth as well as effective in allowing the mandible to express its actual growth potential as compared to untreated subjects.

Background: To determine in vivo oxidative stresses induced by dental amalgam, composite resin, and glass ionomer cement (GIC). Materials and Methods: A total of 60 patients were selected for the study between the ages of 15 and 40 years. Informed consent and Institutional Ethical Approval was obtained. The samples were divided into three groups depending on the type of restorative material planned for them, i.e., silver amalgam, composite resin, and GIC. Saliva was collected before restoration, 24 h, 7 days, and 14 days after restoration. The salivary oxidative stress malondialdehyde (MDA) was measured and statistically analyzed using Mann-Whitney test, Kruskal-Wallis test, and Friedman's test. Results: The results show that the patients treated with amalgam restoration had shown significantly higher values as compared to composite and GIC at all the three-time intervals studied. Conclusion: This study revealed that amalgam fillings were associated with the highest oxidative stress marker MDA as compared with composite and glass ionomer restoration at all the three-time intervals studied. Even after 14 days, the values were much higher indicating free ion leaching from the restoration.

Background: The purpose of this study was to determine the prevalence and distribution of oral mucosal lesions among Saudi female patients attending oral medicine clinic at Al-Yamamah Hospital for the treatment and management during the period of 2005-2010. Materials and Methods: The patient was selected from routine outpatient department. Sample size was determined based on the review of literature. Formula was used to calculate required sample size. A screening examination including intraoral clinical examination was performed on 5543 Saudi female patients using under strict infection control measures. Cytologic smears were obtained when necessary and lesions which required histopathological confirmation were referred to histopathology lab. After biopsy, the lesion was added to group based on the clinical appearance of the lesion and histopathology of the lesion. Descriptive statistical analysis was done using SPSS 15 and frequency distribution for lesion was obtained. Results: The most common alterations observed were pyogenic granuloma, infection, lichen planus and aphthous ulcer. Conclusion: The information presented in this study adds to our understanding of the common oral mucosal lesions occurring in the general population. Although most of these lesions are innocuous, the dentist should nevertheless be able to recognize and differentiate them from worrisome lesions, and decide on the appropriate line of treatment.

Background: Endodontically treated teeth are usually more susceptible to fracture because they have insufficient coronal tooth structure as a result of caries, trauma, or the endodontic procedure itself. Posts are recommended to strengthen weakened endodontically treated teeth against intraoral forces by distributing torquing forces along the roots. Currently, a wide variety of custom and prefabricated dowel systems are available to improve the retention of extra-coronal restorations of non-vital teeth.The objective of the study was to comparatively evaluate the fracture resistance and mode of failure of three types of dowel systems. Materials and Methods: A total of 30 premolars were used in this in vitro study. The crown portion was removed at 2 mm from the cemento-enamel junction was endodontically treated. The specimens were randomly assigned to three groups to receive cobalt chromium cast metal post, carbon post, and zirconium post. The roots were embedded in the acrylic block, and a load was applied at 90΀ to the occlusal surface until fracture, at a crosshead speed of 1 mm/min. The data were analyzed statistically with ANOVA with post-hoc Tukey honest significant difference. Results: Mean fracture resistance (KN) for cast post and core was highest with a mean value of 5.02 ± 0.32. The carbon post and zirconia post had a maximum load at failure of 1.67 ± 0.26 and 2.27 ± 0.23, respectively. The carbon fiber post and zirconium had a significantly lower strength than cast post and core. Conclusion: All the three systems exhibited fracture resistance that can withstand normal functioning of an endodontic dowel system. Carbon fiber post showed a modulus of elasticity similar to dentin and can be used in most cases. Zirconia prefabricated dowels can withstand higher load but can end up with root fracture. Hence, the selection of dowel system should be based on an individual case basis.

Background: Microorganisms in the oral cavity are still considered as serious public health problems and inflict a costly burden to health care services in and around the world. Mouthrinses have been used for centuries with the objective of reducing the amount of microorganisms in the oral cavity. Mouthrinses are used as adjuncts to mechanical oral hygiene. Therapeutic mouthwashes are often recommended as an adjunct to mechanical plaque control for prevention of plaque accumulation and to maintain gingival and periodontal health. Mechanical control alone for reducing recalcitrant biofilms in the oral cavity has been challenged because it is considered to be rather time-consuming and most importantly insufficient for effective oral hygiene. The aim of this study was to evaluate the antimicrobial efficacy of herbal and 0.2% chlorhexidine gluconate mouthrinse against Streptococcus mutans. Materials and Methods: The antimicrobial effectiveness (zone of inhibition) of an herbal mouthrinse and 0.2% chlorhexidine mouthrinse was determined by agar well diffusion method. Results: The zone of inhibition of S. mutans was 19 mm for the 0.2% chlorhexidine mouthrinse. The arowash liquid mouthrinse shows that S. mutans do not produce a zone of inhibition. Conclusion: Chlorhexidine mouthrinse (0.2%) has a better antimicrobial efficacy against the S. mutans when compared to herbal mouthrinse (arowash liquid).

Background: Oral submucous fibrosis (OSMF) is a chronic condition of the oral mucosa that has been largely reported among Indians and to lesser extent in other Asian people and other countries. There has been no satisfactory treatment for OSMF. The aim of this study is to measure the submucosal layer thickness using ultrasonography during the treatment of OSMF with lycopene and curcumin over a period of 3-month. Materials and Methods: Based on inclusion and exclusion criteria, 30 study subjects were included in the study. The patients have signed an informed consent before the start of the study. Patients under Group A (n = 15) were given lycopene 8 mg/day in 2 divided doses prescribed for 3 months. Patients under Group B were given curcumin 800 mg/day in 2 divided doses prescribed for 3 months. A clinical examination was carried out at every recall visit and the findings compared with those at the beginning of the treatment. The results were analyzed with unpaired t-test, Chi-square test, and ANOVA test. Results: At 3-month follow-up, all the patients in both groups showed significant improvement in mouth opening and severity of burning sensation and blanching. When measured using ultrasound, a decrease in the thickness of fibrous bands was noticed in all patients in Group A and Group B. Conclusion: Lycopene is better when compared to curcumin in the treatment of OSMF, but studies with larger sample and long-term follow-up are needed for better understanding of curcumin in the treatment of OSMF.

Background: Tooth avulsion cases occurring because of these injuries require immediate treatment to restore and maintain their position and function in the jaws. Once the avulsed tooth is replanted, it requires stabilization by a process known as splinting of teeth along with natural teeth for support. Avoiding the complications forms the mainstay of treatment modalities for tooth avulsion cases. Materials and Methods: Data were collected from 2005 to 2010 of 80 patients retrospectively, reporting to the outpatient department with a chief complaint of avulsion of the permanent tooth due to trauma and accidental injuries. Only those cases of permanent tooth avulsion were included for the study for whom follow-up details of a minimum of 1 year was available. Assessment of the cases was done based on the extraoral time between the avulsion and replantation and based on the type of transporting media. Chi-square test was used to measure the level of significance. P < 0.001 was considered as significant. Results: We found that out of 80 cases of replantation, 48 showed successful results without any pathologic change or mobility at the end of 1-year follow-up. We observed that patients, in which extraoral time was minimal, had maximum number of successful replantation results on 1-year follow-up (P > 0.001). We also observed that only cases where milk was used as a transporting media showed maximum successful results as compared to other groups (P > 0.001). Conclusion: From this study, we conclude that avulsed tooth should be replanted as soon as possible for a good prognosis. Replantation not only restores functional stability but also establishes the esthetics shortly following injury.

Background: In this study, composite samples of four different types were exposed to carbamide peroxide 16% and hydrogen peroxide 40%, and the results were compared with a control group. The aim of this study was to investigate color changes in a variety of composite materials after bleaching treatments and to compare them with one another. Materials and Methods: A total of 36 composite discs from each composite (Z100, Z250, Z350, P90) were prepared with dimensions of 3 mm Χ 8 mm. The aging process and staining of samples were done for 4 weeks, then specimens were placed on 5000 cycle in thermocycling device. The samples were numbered, and primary color of each specimen was recorded. Samples of each composite material were divided into two subgroups, 12 specimens each and each subgroup were exposed to different bleaching treatments: (1) Untreated control group and (2) carbamide peroxide 16% (home bleaching) and hydrogen peroxide 40%. After 14 days of treatment, secondary colors and color changes were recorded accordingly. The data were analyzed by analysis of variance and Tukey, and a P = 0.05 was calculated. Results: The mean ΔE reported after treatment of home bleaching in composite Z100 (17.4), Z250 (21.1), Z350 (17.0), P90 (16.9) and after office bleaching treatment in composite Z100 (16.0), Z250 (21.1), Z350 (16.6), P90 (17.5) with difference from the untreated samples of Z100 (2.5), Z250 (2.8), Z350 (2.3), P90 (2.4). All composites were significantly brighter after bleaching treatments than the control group (ΔE >3.3). In our study, there was no significant difference between the effectiveness of different bleaching methods. Conclusions: Hydrogen peroxide and carbamide peroxide bleaching agents are effective in whitening of the discolored composite. These two treatments are not significantly different in terms of their effects. Among different composites, Z250 showed the greatest color change among all others.

Background: To evaluate the effect of calcium sucrose phosphate (CaSP) application on demineralized enamel using energy dispersive X-ray spectroscopy (EDX) and scanning electron microscope (SEM). Materials and Methods: About 20 non-carious pre-molars were studied before and after application of CaSP. About 15 samples were subjected for EDX spectroscopy analysis while five were subjected to SEM examination. After baseline examination of microhardness, all samples were demineralized with artificially prepared solution to produce carious lesions and microhardness was rechecked to determine the efficiency of the demineralization procedure before starting treatment with the Toothmin tooth cream. All samples were brushed with Toothmin CaSP cream twice a day till 21 days and all examinations were repeated at 7, 14, and 21 days. Results: Baseline microhardness (357.9 ± 31.2) reduced to 130.5 ± 60.4 after demineralization (P < 0.001) while EDX ratio increased from 2.32 ± 0.09 at baseline to 2.36 ± 0.09, 2.34 ± 0.23, and 2.44 ± 0.20 after 7, 14, and 21 days, respectively (P < 0.001). The SEM analysis showed significant surface smoothness in 3/5 samples after 7 days and 5/5 samples after 14 days. Further improvement in surface changes of two samples and no change in other three was noted after 21 days. Conclusion: Enhanced surface smoothness of enamel was observed with 2 weeks of brushing with Toothmin. The elemental analysis using EDX can be a suitable parameter to assess the remineralizing ability of anticay.

Background: Dental caries is the most common infectious diseases found in human beings. When a fermentable dietary carbohydrate undergoes bacterial action, they produce acids that lead to the demineralization of tooth structure and ultimately form the dental caries. Among dietary products, sugar substances are the main cause of dental caries. Among today's diet, an increased amount of fermentable carbohydrates including highly processed starch-containing foods, and food products that contain novel synthetic carbohydrates such as sucralose and aspartame also follows the etiology. Coupled with this, there now exists a wide range of non-cariogenic sweeteners such as natural and synthetic that have an important role to play in caries control. Materials and Methods : A total of 100 extracted single-rooted premolars were taken. Five groups of sugar solution were prepared using honey, palm sugar, sucralose, glucose, and sucrose, respectively, and the teeth were immersed. 1.5 × 108 cells of Streptococcus mutans were inoculated into each group for 21 days. Teeth were sectioned buccolingually into 300 μm using hard tissue microtome followed by evaluation under a stereomicroscope. Results : The mean depth of enamel demineralization for all groups was calculated at three points. The mean depth of enamel demineralization was least for sucralose followed by honey, palm sugar, and glucose and the highest was with sucrose group. One-way ANOVA test was used to compare the mean depth of demineralization between all five experimental groups and Bonferroni test to compare between individual groups. Conclusion : Within the limitations of the present study, it may be concluded that even though sucralose group exhibited the least mean depth of enamel demineralization, it cannot be statistically proved better than the honey group.

Background: The aim of this study was to investigate the effects of three denture cleaners (sodium hypochlorite, professional, and dentipur) on the possible color changes of thermoplastic denture base materials. Materials and Methods: A total of 88 thermoplastic resins samples were randomly divided into four groups (n = 22) for computer- assisted analysis of photographs within the L* a* b* color space system. The high-resolution digital images of the samples were taken using a digital camera under standardized conditions and saved in RAW format; then the images were imported into Adobe Photoshop CS4 for shade analysis. Mean and standard deviations were calculated for all cleansers. One-way ANOVA with Tukey's HSD post-hoc analyses was performed to compare all the chromatic ordinates L*, a* and b* of the study groups. P < 0.05 was considered statistically significant. Results: One-way ANOVA showed that the type of denture cleanser influenced the color changes and the differences among the study groups were statistically significant (P < 0.001). Conclusions: All three cleansers showed observable color changes up to very much level and thus were unacceptable for cleaning thermoplastic materials.

Background: Implant dentistry education has been introduced only recently in Saudi Arabian university dental schools and there is only limited data about the same. The objective of the present study was to evaluate the current status of undergraduate dental implant (DI) education in Saudi Arabian universities. Materials and Methods: A two-part questionnaire-based study was conducted in Saudi Arabian university dental schools targeted toward program directors of undergraduate implant education to assess the quantity and quality of implant education being integrated into the curriculum. In addition, interns were asked to assess the degree of exposure to implant dentistry and their satisfaction regarding implant dentistry education. Results: Five program directors (83.3%) and 195 interns (82.9%) responded to the questionnaires. Implant dentistry was taught to the undergraduate students in multidisciplinary departments with teaching hours ranging from 22 to 30 h. Only three schools exposed students to laboratory (workshop) or clinical training. There seemed to be an agreement among the program directors in respect of the didactic contents. Majority of the interns reportedly acquired knowledge regarding implant dentistry based on theoretical (96.1%), laboratory (33.5%) and/or clinical (30%) training. While 50% of the interns agreed acquiring knowledge by assisting and observing DI procedures, only 52.8% of the interns expressed satisfaction regarding implant dentistry training obtained during their undergraduate period. Conclusion: The present study revealed the variability in undergraduate implant dentistry education offered at Saudi Arabian dental schools. To optimize the undergraduate implant dentistry education and to produce competent dentists, learning guidelines for such courses should be developed and implemented by competent authorities.

Background: Forensic dentistry plays a major role in the human identification, mainly in mass disasters situations. Forensic odontologist applies several techniques and correlates different parameters to establish an accurate scheme toward identification. Materials and Methods: A PubMed search was carried out for different parameters involved in human identification in forensic dentistry; the results focused on oral and dental correlated factors, genetics, and radiology. 47 articles were included in this review. Results: The main parameters found to be involved in forensic dentistry procedures were divided into four categories: (1) Comparative identification of oral and dental parameters, especially when ante-mortem records are available; (2) reconstructive identification of oral and dental parameters helping in gender and age estimation; (3) genetics and DNA extraction and printing that can be found in dental structures and biological remains; (4) radiographs and computed tomography images included in the matching procedure that is of great help in identification. Conclusion: The results of this study reported the correlation and importance of different parameters to be included in the process of human identification.

Background: To assess the accuracy of multi-frequency based fifth generation apex locator Propex II (Dentsply, Maillefer) in primary anterior teeth, in comparison with a conventional radiography and an actual working length (AWL) obtained through direct measurement. Materials and Methods: The study was conducted on 60 retained primary anterior teeth in 7-9 years old children. Following endodontic access cavity preparation, working length was measured by the conventional radiography using Ingle's method, new generation electronic apex locator (EAL) (Propex II) and compared with AWL measured by direct observation after extraction. The results were analyzed statistically by analysis of variance. Results: There was no significant difference in the working length determined by the radiographic method, EAL, and the AWL (P > 0.05). Conclusion: An accuracy of Propex II apex locator is comparable to conventional radiograph for the determination of the working length in primary teeth.

Background: Space maintenance is a critical process in the developing dentition as a preventive measure for multiple malocclusion problems related to the loss of arch length. The aim of this study was to assess the level of adults' awareness toward space maintainers in Saudi Arabia. Materials and Methods: An online survey was conducted from January to May 2015. The questionnaire consisted of 19 multiple-choice questions assessing four main categories; (a) Demographic data, (b) oral health knowledge regarding brushing behaviors and dental check-ups, (c) previous experience with early loss of primary teeth and space maintainers, and (d) awareness toward the uses and maintenance of space maintainers. Descriptive statistics and correlations were conducted using SPSS (V16.0). Significance level was set at P < 0.05. Result: Out of 600 completed questionnaires collected, 77.3% were males, 94% Saudi majority from provinces in western region. Private dental clinics were the most visited clinics for children care (71%). A higher percent of respondents (72.7%) showed unsatisfactory level of knowledge toward the importance of regular dental visits for children and 88.3% showed satisfactory level of knowledge toward the role of parents in supporting children in their brushing. Moreover, satisfactory level of awareness was found in the followings; the need for special brushing care with space maintainers (74%), management of broken or lost space maintainers (68.7%), and the best time to visit the dentist for lost space maintainers (69.8%). Oral health knowledge and awareness levels showed significant correlations with some demographic and previous experience variables (P < 0.05). Conclusion: The level of knowledge and awareness about the usage, maintenance, and advantages of space maintainers among Saudi adults population is very low, as a result the deleterious effects of neglected lost primary teeth.

For years, orthodontics has been used mainly as a treatment of choice for esthetic purpose. In such a scenario, it had been used as a comprehensive treatment procedure, i.e., orthodontic appliance either in one full arch or both upper and lower arches. In this, the vast majority of the patients come for orthodontic treatment are adolescent or very early adult group which require comprehensive orthodontic procedures. Now a days, there is an increase in a number of patients come for orthodontic treatment are adults. Recent increases in adult patients who seek orthodontic treatment require multidisciplinary approach than purely orthodontic approach alone. Orthodontics for adult patients can be used as an adjunctive tool for restorative, prosthodontic, and periodontal purposes. Adjunct orthodontics is mentioned in literature as a valuable tool for multidisciplinary dental treatment. However, the usage of adjunct orthodontics in multidisciplinary dentistry is very less as compared to comprehensive orthodontics.

Head and neck soft tissues calcifications can result from physiological or pathological mineralization. Some of these calcifications may be found on panoramic radiography because of their proximity to the focal trough and their superimposition over hard and soft tissue structures. Such radiographic images are common and create a diagnostic challenge. Differentiation of these entities can be done when radiographic features and locations are taken into consideration. Since cone-beam computed tomography (CBCT) has been used in dentistry, fortuitous discovery of such calcifications has increased. However, by providing images in the third dimension, CBCT facilitates their precise localization. Adequate diagnosis of these calcifications may enhance their approach and management by clinicians. The aim of this article is to describe the radiographic characteristics of some head and neck calcifications in dental practice on panoramic X-rays and CBCT.