Dental fluorosis is a developmental disturbance of dental enamel, caused by successive exposures to high concentrations of fluoride during tooth development, leading to enamel with lower mineral content and increased porosity. Fluorosis, which seriously adversely effects, is not only the teeth and bones but also damages the DNA and chromosomes, resulting in the genetic mutations which may prove very damaging to the health of an individual. The damage caused by fluorosis is permanent, making prevention very important in regions of the world, where the problem is endemic like Pakistan, India, and China. Fluorosis appears to be especially common in the developing world. The severity of dental fluorosis depends on when and for how long the overexposure to fluoride occurs, the individual response, weight, degree of physical activity, nutritional factors, and bone growth. Esthetics changes in permanent dentition are the greatest concern in dental fluorosis, which is more prone to occur in children who are excessively exposed to fluoride between 20 and 30 months of age. It is also important to remind that the critical period to fluoride overexposure is between 1 and 4 years old, and the child would not be at risk around 8 years old. Fluorosis can be prevented by monitoring the amount of fluoride that children up to 6 years old are exposed; therefore, the dentist must be aware of the main sources of fluoride to prevent fluorosis and instruct parents or caregivers on how daily dose should be managed to achieve success in prevention. Bonding of orthodontic brackets to fluorosed enamel is a challenge for all dental clinicians. The objective of this case report is how to manage dental fluorosis patients for the success of orthodontic bracket bonding by the use of microabrasion technique. The recommended microabrasion protocol saves chair side time of the orthodontist, improves the success rate of the treatment and minimizes the cost of the treatment by preventing recurrent bond failures.

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Background: Eggshell (ES) is a rich source of minerals since it contains calcium, phosphorous, magnesium, strontium, and fluoride. This study sought to compare the efficacy of nano-hydroxyapatite (NHA) and ES for remineralization of enamel caries-like lesions by pH cycling. Materials and Methods: In this in vitro experimental study, artificial enamel carious lesions were induced in 47 human teeth using an acidic buffer solution. Deionized water was used as the control group, and 10% NHA and 3% and 10% ES powders in deionized water were tested as therapeutic agents. The surface microhardness of the samples was measured by a Vickers hardness tester before and after demineralization and after the application of therapeutic agents in a 7-day pH-cycling model. The data were analyzed using repeated measures analysis of variance. Results: Microhardness significantly decreased in all samples after demineralization and significantly increased after exposure to therapeutic solutions. Microhardness of the samples was not significantly different among the therapeutic groups after pH cycling. Conclusion: Based on the results of this study, ES can be used as a remineralization agent in enamel caries-like lesions.

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Background : Acute herpetic gingivostomatitis causing pain and discomfort to the patients in human immunodeficiency virus (HIV) positive individuals and in patients suffering from acquired immunodeficiency syndrome (AIDS) represents one association of different disease entity. The purpose of this study was to characterize the clinical features of oral ulcers associated with herpes simplex virus (HSV) infection in AIDS. Materials and Methods: 135 patients infected with HIV developing oral ulcers were included in this study. Immunohistochemical staining is done to detect herpes simplex viral infections associated with this manifestation. The mucositis index is taken for quantitative analysis of oral ulceration. Qualitative analysis of the association of acute febrile condition is done. CD4 T-cell count was done for these patients. Here, analysis is done to detect if there is any correlation between extensiveness and aggressiveness of acute herpetic gingivostomatitis lesions and CD4 T-cell count. Results : Association of herpes simplex viral infections is found in 36 out of 135 cases. In HIV + patients with CD4 count <500, the lesions due to HSV infection reaches a significant level within 1 week and remains more or less unchanged in the oral cavity up to 3 months . Mucosal ulcers due to acute herpetic gingivostomatitis in HIV + patients with adequate immune status get manifestated for a period of 1-week with spontaneous remission within 2 weeks. Conclusion: Persistent oropharyngeal mucosal ulcers along with acute febrile condition in AIDS are found to be associated with HSV infection in patients with low CD4 T-cell count.

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Background: The objectives of this study were to determine the attitude of the dental practitioners practicing dental implants in Saudi Arabia toward the restorative phase of implant dentistry. In particular, this study investigated the most accepted impression materials and techniques used to make impressions for dental implants among these practitioners and their opinions regarding the clinical factors that may influence the decision-making process for the selection of impression materials and techniques. Materials and Methods: An email questionnaire, of a closed response format, was sent to dental practitioners across Saudi Arabia. Returned responses were subjected to qualitative and quantitative analysis. Results: A total of 315 dental implant practitioners responded to this survey. The majority (about 85%) of the respondents preferred using additional silicone and polyether as an impression material, and 70% of them used the open-tray technique. About two-thirds of the respondents agreed that the presence of angulated implants and sub-gingival implant depth adversely affect the impression's accuracy. About 63% of the respondents preferred splinting the copings before taking the impression for multiple implants whereas 71% confirmed the seating of the copings with radiographs. Only 45% of the respondents used the verification jig while taking the impression. Significant relationships between the choice of the impression technique and some of the demographic characteristics of the respondents were noted. The open-tray technique was more used by non-Saudi practitioners (P = 0.008) and those respondents who had an implant degree (P = 0.036). Conclusions: It can be concluded from the current study survey that, most of the dentists with postgraduate diploma or board qualification in dental implant followed the well-documented technique and proven materials.

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A persistent post-extractional bleeding in an apparently healthy patient must warn dentists about a possible bleeding diathesis such as misdiagnosed von Willebrand disease (vWD), hemophilia A, and hemophilia C. Mild type of vWD and mild hemophilia A can be diagnosed in women with menorrhagia, in persons with excessive mucocutaneous bleeding such as bruising without recognized trauma, in persons with recurrent nose bleeds and prolonged oral cavity bleeding including gingivorragia after brushing or flossing teeth or dental cleaning or extractions, and in persons with persistent post-extractional bleeding. Dentists have indeed a primordial role in the management of post-extractional bleeding complications related to these diseases and in the orientation of patient to a specialized medical center for further investigations and management. In this study, a case of mild vWD was diagnosed after persistent post-extractional bleeding of the right second maxillary molar, on a 43-year-old patient without medical or bleeding history. Extraction of 17 was performed and 24 h later persistent bleeding was noted. Ruling out local causes by clinical examination and periapical radiograph, a complete blood screening including complete blood count, platelets count, bleeding time, prothrombin time (PT), and cephalin kaolin clotting time (CKCT) was performed to evaluate the primary hemostasis and coagulation. Prolonged CKCT (46.30 s) and normal PT (14 s) illustrated a disorder function of intrinsic coagulation pathway including Factors VIII, IX, and XI. Factors VIII and IX had normal values. Further laboratory investigations of Ag von Willebrand factor and its ristocetin cofactor activity permitted the diagnosis of vWD.

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Background: The aim of the study was to evaluate, in vitro, the weakest bond interface of lava ultimate onlays luted with Scotchbond Universal and RelyX Ultimate. Materials and Methods: A total of 56 Lava Ultimate onlays were milled and divided into eight groups according to the luting procedure to the human teeth (n = 7): G1 and G2 - Scotchbond Universal using the etch-and-rinse technique; G3 and G4 - Scotchbond Universal using the self-etch technique; G5 and G6 - Scotchbond Universal using the etch-and-rinse technique + adhesive application on the onlay; G7 and G8 - Scotchbond Universal using the self-etch mode + adhesive application on the onlay. The onlays were luted with RelyX Ultimate. Only the samples from G2, G4, G6 and G8 were submitted to cyclic loading. Beams with a cross section area of ~0.80 mm2 were obtained and submitted to microtensile bond strength (μTBS) test in a universal testing machine. The types of failure were observed in optical microscope. Results: According to three-way analysis of variance, there was a significant interaction between the three factors (P = 0.006). The μTBS means (MPa) followed by the same letter represent no statistical difference by Tukey's post-hoc test (P < 0.05): G6 = 34.64a, G1 = 34.48a, G2 = 31.94ab, G5 = 30.88abc, G7 = 26.66bc, G8 = 24.03cd, G4 = 18.81de, G3 = 14.64e. Most failures were at the resinous agent-restoration interface. Conclusion: The resinous agent-restoration interface corresponded to the weakest interface. The application of Scotchbond Universal on the internal surface of the onlay was not a relevant procedure.

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Objectives: To estimate the prevalence of musculoskeletal symptoms among dental students in different levels of their pre-clinical and clinical training. Materials and Methods: A total of 255 dental students were randomly selected. An interviewer guided questionnaire was used to gather information pertaining to demographics, medical history, and self-reported pain using standardized Nordic questionnaire for the analysis of musculoskeletal symptoms in various body regions. After applying the study's exclusion criteria, 191 female students were included; 80 from the preparatory year, 63 from pre-clinical years, and 48 from the final clinical year; all underwent a physical examination for the musculoskeletal system to assess muscle weakness, limitation of movement, pain upon movement, and any other related abnormalities. Results: 87.3% of the pre-clinical students and 95.8% of final clinical year students reported symptoms of musculoskeletal disorders (MSDs) in one or more body regions. The highest prevalence of symptoms was reported in the shoulders (46.1%), neck (37.2%), lower back (36.6%), and upper back (31.4%), and it was higher among both pre-clinical and final clinical years in comparison with preparatory years. Conclusion: The prevalence of MSDs increased among dental students during their pre-clinical training even before going to clinics. Application of ergonomics needs to be emphasized in the early levels of dental school.

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Herpes zoster (HZ) or shingles consist of a reactivation of the Varicella Zoster virus that had entered cutaneous nerve endings through an earlier occurrence of chicken pox, passes to the dorsal root ganglia and resides there in a latent form. Nerves usually involved are C3, T5, L1, L2, and the first division of trigeminal nerve. The characteristic appearance of this condition is occurrence of multiple, unilateral, painful vesicles, and ulceration involving a single dermatome. The infection commonly affects elderly individuals, however if present in the younger age group, raises the suspicion of immunocompromised status such as acquired immuno deficiency syndrome (AIDS)/human immunodeficiency virus. In this case report, we present a patient with AIDS who developed HZ of the left side involving the maxillary and mandibular divisions of the trigeminal nerve. The patient presented with unilateral crustations involving the left side of lower and middle one-third of the face along the tract of the trigeminal nerve, intra-orally involving buccal and labial mucosa ipsilaterally.

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Background: Pain control forms the foremost aim of doing any dental procedure. Adrenaline is a common component of various local anesthetic solutions used for controlling pain for various dental procedures. Literature quotes that adrenaline containing anesthetic agents do have some effect on the blood glucose levels of the diabetic patients. Hence, we aim to evaluate the effect of adrenaline containing anesthetic solutions in diabetic patients undergoing dental extractions. Materials and Methods: A total of 110 patients attending the hospital for the purpose of extraction of teeth were included for the study. Patients were divided into three groups. The first group (n = 50) comprised patients who had a negative history of diabetes. The second group consisted of those diabetic patients (n = 30) who were on antidiabetic therapy. The last group comprised diabetic patients who were on antidiabetic therapy. Blood glucose levels measurement was done three times. First, before administration of local anesthesia (LA) solution, second time after administration of LA solution, and finally after extraction of the teeth. Student t-test was used to measure the level of significance. Results: Blood sugar levels in healthy patients, diabetic patients with medication, and diabetic patients without medication before and after administration of LA solution were 106.51, 107.55, 192.19, 194.22, 171.28, and 169.37 mg/dl, respectively. There was no significant difference seen in the blood glucose values in these individuals (P > 0.05). Blood sugar levels in healthy patients. Blood sugar levels in healthy patients, diabetic patients with medication, and diabetic patients without medication before and after extraction of teeth were 106.51, 104.46, 192.19, 198.22, 171.28 and 169.37 mg/dl, respectively. Only significant alterations which were observed were in the group containing diabetic patients which were not on antidiabetic medication (P < 0.05). Conclusion: Adrenaline alters the blood glucose levels only in those patients who were not on antidiabetic therapy.

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Background: People in rural areas neglect oral health as they lack awareness on dental diseases and also due to inadequate availability of dental services. The prevalence of illiteracy is also a reason which can be attributed to poor oral health. This epidemiological study is undertaken to assess the oral health status of one such population in Mustabad - A rural area in Andhra Pradesh. Materials and Methods: A cross-sectional study based on randomized sampling method was carried out using the WHO assessment form (1997) on a population of 470. The data were subjected to statistical analysis. Results: The prevalence of dental caries according to age groups was highest in the age group of 34-44 years (83.50). There was a significant difference in the prevalence of dental caries according to gender, with females having higher caries prevalence (53.19%) than males (46.81%). Conclusion: The increasing prevalence is an impending problem which needs immediate intervention if not would have a serious negative impact on the future oral health.

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Background: To compare the gingival and periodontal health of adults undergoing conventional fixed orthodontic therapy against patients undergoing treatment with orthodontic aligners over a year. Materials and Methods: The study population consisted of 46 subjects; 26 treated with conventional fixed orthodontic therapy and 20 treated with orthodontic aligners. Indices that were used for assessment included gingival index (GI), pocket depth (PD), and bleeding on probing (BOP). Indices were noted pre-treatment, at 6 weeks, 6 months, and at 1 year. Results: At 6 weeks, only probing depth was greater in the fixed therapy group. At 6 months, it was seen that the fixed therapy group had significantly higher values for PI, PD, and GI scores. The fixed therapy group continued to have a greater value for GI, BOP, and PD even at 12 months. Conclusions: The results advocate that fixed orthodontic therapy has an association with poor periodontal status compared to orthodontic treatment using removable aligners.

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Background: Dental luting cements possessing antibacterial and fluoride release properties reduce bacterial induced white spot lesion formation around orthodontic bands and crown tooth interface. The purpose of this study was to evaluate the antibacterial efficacy, fluoride release, and correlation between two properties of the three commercially available resin reinforced glass ionomer luting cements. Methodology: The antibacterial efficacy of the selected cements Meron Plus (Type I), RelyXT (Type II), and GC Fuji CEM (Type III) were evaluated using direct contact test (DCT) on Streptococcus mutans strain, and bacterial growth was measured at 5 time intervals for 1 day, 1 week, and after 1 month with a spectrophotometer. Fluoride release was estimated from the 30 standardized disc-shaped specimens, using "ion-specific electrode" (Orion) for 1 day, 1 week, and after 1 month. Results: With time, the materials showed a consistent decrease in antibacterial efficacy. After 1 week, Type III and Type I showed almost equal antibacterial property, and Type II showed the least. After 1 month, the antibacterial property of Type II was drastically decreased, and Type III showed highest. The fluoride release on the 1st day was the highest for Type III and the lowest for Type II. Type III and Type I showed a continued increase in fluoride ion release at all the time intervals, whereas Type II showed a decrease after 1 week. Conclusion: GC Fuji CEM possessed greater antibacterial efficacy and fluoride release followed by Meron Plus and RelyXT. No significant correlation could be drawn between antibacterial efficacy and amount of fluoride release.

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Background: Increase evidence indicates that lymphangiogenesis in cancer is an important factor in promoting tumor progression and lymphatic vessels are major routes for metastasis in head and neck squamous cell carcinoma (HNSCC), but lymphatic endothelial cells (LCEs) are difficult to recognize in tumor histological section. Of all recent markers, D2-40 stains podoplanin, a molecule expressed in LEC's but its prognostic usefulness in HNSCC is not so well understood. In this study, we aimed to investigate immunohistochemical expression of D2-40 in different stages and grades of oral SCC (OSCC) and also studied lymphatic vessel density (LVD) both intratumorally and peritumorally to determine its prognostic value. Materials and Methods: A total of 50 cases of HNSCC were stained for D2-40. LVD was assessed both intratumorally as well as peritumorally by counting positive reaction in 10 hot spot areas at Χ100 magnification. Results: D2-40 was specific for LEC's and, therefore, stained only lymphatic vessels. Peritumoral lymphatic vessel (PTLV) was more numerous and larger than intratumoral lymphatic vessel (ITLV). Statistically significant differences were observed between PTLV density (PTLVD) and ITLV density (ITLVD). PTLVD was found be more significantly associated with higher grades of OSCC. Tumor D2-40 staining was positively associated with lymphatic vessel invasion. Conclusion: D2-40 can be considered as an ideal lymphatic marker and LVD is an important parameter to predict the prognosis of HNSCC. PTLVD and D2-40 positive tumor cells are strongly associated with metastasis and other clinical parameters of worse prognosis. D2-40 may play a vital role in deciding on therapeutic strategies for the patient with oral cancer.

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The dental enamel is the strongest part of the human body. Although one of the most vulnerable to diseases, owing to the lack of viable cells it is unable to repair itself. Thus, various methods have been put forward to replace the lost structure. The most documented is the use of fluoride; however, it is no longer the only option available. This review focuses on the newer techniques of rebuilding the enamel such as casein derivatives and crystalline forms of calcium. These methods provide a more user-friendly. The method of delivery of the required is calcium and phosphate ions to build-up the enamel. In spite of the varied options available regeneration of the natural enamel still remains the most coveted option. Although still in experimental stages, enamel regeneration is being attempted by the use of amelogenins, enamel matrix derivatives, peptide blocks, and dendrimers.

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Objectives: Oral health-related quality of life (OHQoL) is a multidimensional concept which considers various aspects of life including functional factors, psychological factors, social factors, and experience of pain/discomfort in relation to orofacial conditions. The aim of this study was to assess the impact of severity of periodontal disease and educational level on OHQoL in patients referring to Yazd Dental University and Khatamolanbia Clinic. Materials and Methods: This cross-sectional study was performed on 145 patients attending Yazd Dental University and Khatamolanbia Clinic. OHQoL was measured with OHQoL-United Kingdom questionnaire that was translated to Persian which the patients were randomly asked to complete. Clinical attachment loss was examined by the clinician. Data were analyzed via SPSS software 18.0 using ANOVA. P ≤ 0.05 was considered statistically significant. Results: This study included 145 adults (61 men and 84 women) aged between 17 and 70 years. There was a statistically significant association between the severity of periodontal disease and OHQoL scores (P < 0.05). The mean QoL score was significantly lower in patients with severe periodontitis than in patients with mild periodontitis specifically with regard to psychological factors (P < 0.05). As well, patients with better educational level have higher mean QoL score that was statistically significant (P = 0.0001). Conclusion: According to the effect of severity of periodontal disease on QoL, required intervention should be done for early diagnosis and treatment to improve QoL as a result.

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Background: The purpose of this study was to evaluate the morphological alterations of the ProTaper next rotary file (PTN) under scanning electron microscopy (SEM). Materials and Methods: A total of 18 simulated root canals were allocated to three groups. Six new sets of PTN instruments were used 3 times. A #10 K-file was inserted into the working length, followed by ProGlider to create a glide path. Ensuring the manufacturer's instructions with 99% ethyl alcohol for irrigation, all canals were prepared. Files were photographed in the same position before and after three canals preparations using a high-resolution SEM. Result: A metal strip appeared on one X1 instrument surface preoperatively. Microcrack defects were observed on two X2 files postoperatively, and the blunt cutting edge was observed on three X1 files before and after use and one file fractured. Conclusion: Small number of changes appeared on PTN surfaces, yet same PTN file can be used safely 3 times to prepare multi-rooted teeth within the same patient.

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Background: In present scenario majority of the people is suffering from systemic disease. Diabetes is a metabolic disorder known to involve many important organs and also systems of the body, including oral tissues. Oral care is the most preceding priority because it doesn't threat life. Present study was done to evaluate awareness among Bengaluru individuals regarding diabetes in general and association between diabetes and periodontal diseases. Materials and Methods: The present cross sectional questionnaire study was conducted in Bengaluru city. The study sample included 400 residents of Bengaluru city. The survey was scheduled to spread over a period of 1-month. Data was collected by using self designed questionnaire. Questionnaire was administered by investigator himself to each participant on scheduled days and collected back on next visit. Collected data was coded, compiled and tabulated. The data was analyzed by applying descriptive and inferential statistical analysis. Analysis was carried out using SPSS package version 17. Results: The entire individual responded. A strong correlation between educational status and awareness was found whereas a weak positive correlation with age was established ( R2 = 0.102 and R2 = 0.004 respectively). Other questions revealed overall limited knowledge and awareness among the study group regarding diabetes and its oral and periodontal association. Conclusion: Overall findings and results of the study reveal that knowledge among the study group was not up to the mark and the healthcare professionals need to take up the responsibility of educating the masses regarding the same.

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Background: In orthodontic treatment multiple teeth are involved by placing brackets and bands on the teeth, which provide tooth movement. Earlier, banding was done on all the teeth in fixed orthodontic treatment to correct the malaligned teeth which prolongchairside time and has a badesthetic appearance. To overcome this, brackets were introduced. Instead for molars, most of the orthodontists use the molar band as it has better contact, and high amount of force can be applied. The purpose of the study was to compare the corrosion depth and extent of bands in customized welded and pre-welded preformed molar bands in various intraoral simulated conditions and to find the suitable welded band material for molars. Materials and Methods: The molar bands of Group A - Customized welded molar bands (24 numbers) and Group B - Preformed molar bands (24 numbers) were divided into six samples for each subgroup, i.e., artificial saliva, artificial saliva with fluoride toothpaste, artificial saliva with coffee, and artificial saliva with South Indian spices and kept in the incubator. Incubator was set at the temperature of 37°C for 72 h. After 72 h of incubation, all samples were removed from the dietary medium, and the samples were dried using tissue paper to remove the wet particles. Now, the samples from each group were measured under scanned electron microscope to know the corrosion depth and extent. All samples of all groups are examined for corrosion depth and extent at the areas of attachment at Χ100, and the pictures are clicked automatically for further assessment. Results: In both customized welded and preformed molar bands expressed a statistically increased corrosion depth and extent in samples immersed in artificial saliva with coffee when compared to other dietary media. Pre-welded molar bands showed less amount of corrosion when compared to welded molar bands. Conclusion: In this study, pre-welded bands showed superior quality with less corrosion compared to welded bands in all the dietary media. Hence, pre-welded bands are advised for banding in orthodontic treatment as it has less amount of corrosion.

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Objective: To study the quality of hybrid layer generated in non- carious cervical sclerotic lesions by two different adhesives and techniques, using scanning electron microscope (SEM). Materials and Methods: A total of 32 pre-molars and molars were grouped randomly into four experimental groups consisting of eight specimens in each group and (six pre-molars and molars) as two control groups, consisting of three specimens in each group. All the experimental groups and control groups were treated with two different dentin bonding systems with two different techniques (Group 1 - Sclerotic dentin was treated with Prime and Bond NT, Group 2 - Sclerotic dentin was removed with a bur and treated with Prime and Bond NT, Group 3 - Sclerotic dentin was treated with Xeno III, Group 4 - Sclerotic dentin was removed with a bur and treated with Xeno III, Group 5 - Where normal dentin was treated with Prime and Bond NT, and Group 6 - Normal dentin was treated with Xeno III). The thickness of the hybrid layer was measured on gingival, axial, and occlusal interfaces using SEM. Statistical analysis was performed using one-way ANOVA and intergroup comparisons were done using Tukey's multiple comparison test. Results: The mean hybrid layer thickness measured was highest in Group 3 (0.665 μm) and lowest in Group 1 (0.432 μm). Multiple group comparison showed high significant differences when Group 1 was compared with Group 3, and significant differences were seen when Group 1 compared with Group 2 and Group 3 compared with Group 4. In the control group, the highest thickness of the hybrid layer was found in Group 6 and lowest in Group 5. Conclusion: Before rank ordering a particular dentin substrate or a dentin adhesive system, one must understand that there are several methods of evaluation, and SEM is one of the known methods to compare and correlate bond strength studies. However, more in-vivo research is needed in the field of self-etching primers to establish micromorphological relationship of resin-dentin interface with modified smear layers.

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Background: Inflammation of the periapical tissues is caused by persistent microbial infection in the root canal of the tooth affected by disease process. Primarily being asymptomatic, this inflammation is frequently detected on routine radiographic investigations. Literature revealed numerous studies highlighting the prevalence of periapical lesions in association with root filled teeth. Materials and Methods: Evaluation of a total of 750 teeth of 400 patients was done to assess the periapical health and quality of root canal treatment (RCT) done with the help of intraoral periapical radiographs and clinical sign and symptoms. De Moor et al. criteria were used for the assessment of the quality of root canal therapy. Results: Among the endodontic treated tooth, a significant amount of cases showed periapical or periodontal pathologies (P > 0.005). About 76.5% of teeth showed inadequate RCT in the form of radiographically short or overextended apical fillings. Out of all the cases of endodontically treated teeth, 71.5% of the cases showed associated pathologies in the periapical regions with only 28.5% cases showing adequate periapical health. Conclusion: The present study provides epidemiological data about periapical health and the mechanical quality of endodontic therapy. Results showed a high incidence of periapical pathologies and a significantly high number of inadequately root canal treated teeth. Hence, we emphasize on the need to improve the standard and quality of the endodontic treatment to satisfactory level in order to reduce the incidence of the periapical pathologies.

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Background: Dentistry has long sought a cementing medium that would adhere to tooth structure. Such material would eliminate microleakage around restorations and provide better retention for indirect restorations. Bonding of luting cement to enamel, dentin, and restorations is important and is one of the factors that determine the success of indirect restorations. Adhesive luting cements such as glass ionomer, resin-modified glass ionomer, and composite resin luting cements have been shown to reduce microleakage and increase retention. The purpose of this in vitro study is to compare and evaluate the tensile bond strength of different luting agents for a base metal alloy (ceramo-metal) bonded to dentin. Methods: After cementing metal samples to dentin surfaces with respective luting cements, excess cement was removed from margins after initial setting. Samples were stored in distilled water at 37΀C for 24 h. Metal cups were mounted in an Instron universal testing machine. Tensile load was applied at a cross head speed rate of 1 mm/min. The load at which the bond failure occurred was recorded and tabulated. Results: The results showed that tensile bond strength of All Bond C&B composite luting cement is highest (25.941 MPa) followed by tensile bond strength of resin-modified glass ionomer luting cement (12.25 MPa) and conventional glass ionomer luting cement (4.7 MPa). Conclusion: The composite resin luting cement (All Bond C&B), because of its higher bond strength to dentin than any other luting cements, can be used in critical clinical situations such as short tooth preparations, tapered preparations, and any other clinical circumstances where retention is compromised.

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Continued bone loss in edentulous patients causes a great challenge in prosthetic rehabilitation by conventional denture. Retention has been the most problematic area for mandibular complete denture especially when compared to maxillary complete denture, but retention and stability are greatly compromised in conventional dentures, especially if mandibular ridge is severely resorbed. Osseointegrated dental implants have been proven as a successful treatment modality while prescribing prosthodontic services to an edentulous patient. The predictability of the implant supported prosthesis has been established, and several techniques are present for successful restoration depending on the number of implants, bone quality, bone quantity, prosthesis movement, economical constraints, patients desires, etc. However, in cases of advanced ridge restoration in which facial tissue support is needed from the flanges of the prosthesis or when a removable type of prosthesis is preferred by the patient, an implant supported prosthesis is indicated. This case report describes the two techniques of mandibular implant retained overdenture fabrication, i.e., surgical driven implantology and prosthetically driven implantology. In surgical driven implantology, the implants were placed according to the available bone in the interforaminal region with the help of an orthopantogram which gives us two dimensional view, whereas in prosthetically driven implantology the implants were placed at the canine positions with the help of a duplicated prefabricated denture, which was then modified as a radiographic stent and surgical guide. A dentascan was made with the radiographic stent in position intraorally and the appropriate angulation was determined for the third dimension of implant angulation and then converted into a surgical guide to guide our implant placement.

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Background : The purpose of this study was to investigate compliance, awareness and practices of infection control procedures among senior dental students at the College of Dentistry, Jazan University, Saudi Arabia. Materials and Methods : The study comprised 350 students of College of Dentistry, Jazan. A questionnaire developed with 15 closed-ended questions related to barrier techniques, vaccination status, infection control practices and awareness regarding mercury hygiene was distributed to all the dental students who were posted in the clinics and collected after it was answered. Results: Of the 350 students, 284 responded and giving a response rate of 81%. Compliance with the use of protective barriers was an impressive 100% for use of gloves and face mask, but the use of protective eyewear was 33%, head cap 44%, and face shield a mere 18.6%. About 75.7% of students scrubbed their hands before and after treatment. While all students knew about the role of rubber dam in isolation and infection control, 89.4% said that they used it occasionally, and the rest never used it. All students were aware of the need for sterilization, color coding of wastes, need for vaccination against hepatitis B, and injection safety procedures. Awareness on managing patients with respiratory infections was 65.4%, and flushing of dental handpieces before and after use was carried out by 15.8% of students. All the students said that they did not dispose excess amalgam appropriately. Conclusions: The results of this study can help us to focus on the areas of weakness and conduct continuing dental education programs to close the gaps in knowledge. Constant efforts are needed to motivate students in the routine use of infection control measures.

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