Refractory periapical periodontitis is a condition of the persistent periapical pathology of endodontic origin even after completion of root canal therapy. Although a plethora of reasons exists for failure, improper diagnosis of pulpal etiology is one of the primary causes for endodontic failures. Inability to diagnose the presence of foreign body can have risk on the success of endodontic treatment. Discovery of foreign bodies is always almost accidental in root canals of tooth. Foreign bodies lodged in pulp chambers or canals can often act as a nidus of infection. In the present case, we report a case of persistent/refractory chronic periapical abscess even after orthograde root canal treatment and retrograde periapical surgery (apicoectomy) and several regimens of multiple antibiotic therapies.

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Presently, various countries face significant challenges with regards to their health-care system, quality of care, health budget, provision of universal health-care accessibility to its citizens. Kingdom of Saudi Arabia (KSA) is located in the South Western part of Asia and is considered to be one of the largest countries in the Middle East. According to the Saudi constitution, health- care services are provided by the government, and all citizens and residents have the right for complete and free accessibility to the health services. The health-care system is consist of a mix between governmental and private health sector. Even though the government supplies dental care services free of cost for Saudi, yet majority of the Saudi population choose to be treated in the private dental sector. 200 people in the KSA were questioned about dental health and the accessibility to care. Patients believe that with paid care they can get enough time with doctors and better care. In spite of the full governmental supported dental care services in KSA, the Saudi population faces difficulties to meet the proper dental care. Extending and promoting the dental care in primary health institutions and increasing the number of advanced referral dental care centers can help to meet the demand of services between Saudis. For non-Saudis, evaluating the present regulations and implementing new regulations are needed regarding the foreigners' health insurance to insure their right to receive proper dental care services, as stated in the law of KSA.

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The essence in cancer care has shifted from mere "survival" to "rehabilitation," which aims to improve multiple impairments and quality of life. Head and neck cancers constitute one of the most devastating forms of cancer resulting in maxillofacial defects. Rehabilitation of acquired maxillofacial defects is accomplished either by surgical or prosthodontic rehabilitation. The goal of prosthetic rehabilitation is to obturate the defect, allowing for optimum esthetics and function. However, this has remained as a challenging process due to the lack of adequate retention, stability, and support of the prosthesis. This study presents a simplified approach to rehabilitate an extensive maxillectomy defect secondary to surgical resection in a patient with the limited oral opening. The patient had undergone left hemimaxillectomy for squamous cell carcinoma of the left alveolus 7 days back. The patient did not have a surgical obturator and required prosthesis to restore the lost teeth and function. The treatment plan initially was to improve the mouth opening using screw gag prosthesis to facilitate the clinical steps, and then rehabilitate the defect using interim obturator prosthesis. Some modifications in the impression procedure like the use of modified stock trays and sectional custom trays also aided in obtaining adequate impressions. The obturator comprised silicon obturator with reduced bulb extension and heat cure acrylic denture base which were attached using cyanoacrylate adhesive. Different design features have been incorporated into the design to achieve adequate prosthesis retention, support, and stability. Post-insertion instructions were given to the patient and were scheduled on a regular recall protocol to evaluate the fit and functioning of the prosthesis Post-insertion results showed improvement in speech, mastication, swallowing, and facial aesthetics. The primary objectives of maxillofacial prosthetic rehabilitation were achieved with this novel design contributing to enhancement of quality of life of the cancer patient.

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Background: Dermatoglyphics, coined by Cummins and Midlo in 1926, is a branch of genetics dealing with the skin ridge system. From cradle to grave, until the body decomposes fingerprints remain unchanged. Dermatoglyphics is the study on epidermal ridges on the palmar and plantar surfaces of the feet and hand. Dermatoglyphic patterns, share their development time during the intrauterine period, with the development and completion of dental hard tissues. Malocclusion, a dental disorder, with its genetic etiology being proven, thus gains attention in this field. Materials and Methods: A total of 60, 9-12 years old, healthy children, with mixed dentition, were included in the study. Their left and right handprints were recorded on a paper, and the fingerprints were studied to find the frequency of occurrence of different types of patterns. Based on the dental aesthetic index, malocclusion was graded into four groups and then was correlated with the patterns' frequency. Results: Loops were found to increase and while the whorls decreased, with increasing severity of malocclusion. In this study, loop pattern is a more common in the thumb and middle finger. Whorl pattern is a more common in the ring finger and index finger. Conclusion: Dermatoglyphic analysis can be used as an indicator of malocclusion at an early age, thereby aiding the development of treatments aiming to establish favorable occlusion. Inheritance and twin studies, as well as those conducted in different ethnic groups, are required to examine these relationships further.

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Background: Rejection of dental treatment could be attributed due to dental fear and anxiety in many patients. Health sciences students are educational resources for the general population. Their reaction to dental treatment is very important to know their dental behavior. This study was designed to evaluate dental anxiety levels among medical, dental, and nursing students and its correlation between faculties. Materials and Methods: A total of 500 undergraduate students from the faculties of medicine, nursing, and dentistry were recruited into the study. Dental anxiety among study group was measured using modified dental anxiety scale. Results: Around 425 complete questionnaires were returned, which accounts for a response rate of 82% (425/500). The mean anxiety scores were the following: Dental students, 28.6% (40/140); medical students, 35.4% (70/198), and nursing students, 46.0% (40/87). Women exhibited higher anxiety level but the difference was not statistically significant. Most of the participants were anxious about local anesthetic injection (P < 0.0001). Conclusion: Most of the medical and nursing students exhibited high dental anxiety. Inadequate knowledge about dental health education may result in a high level of dental anxiety among non-dental students. Further studies are required to identify the correlation of dental anxiety among health sciences students.

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Background: The incidence of deviation in simulated curved canals was compared after preparation with nickel-titanium instruments driven by continuous rotation and reciprocal movement motors. Materials and Methods: A total of 40 epoxy resin blocks were filled with ink, and pre-instrumentation images were obtained by a stereomicroscope. Instrumentation was performed using either Reciproc (R25) or ProTaper (up to F3). Post-instrumentation images were obtained under the same conditions as those of the previous images, and then, images were superimposed. Differences along and on the mesial and distal surfaces of the canal were measured in 8 points. Results: Intragroup analysis demonstrated that the two systems promote deviations along the 8 points of measurement in the canal. Within the ProTaper group, significant differences (P < 0.01) with greater deviations were at the following points: 4 mm >7 mm >3 mm >6 mm. In Reciproc group, significant differences (P < 0.05) were found at points: 3 mm >4 mm >2 mm >1 mm. ProTaper group presented smaller deviation at points: 0, 2, 3, 4, and 6 mm compared with Reciproc group. Conclusion: The results suggest that continuous mechanized instrumentation with previous and progressive cervical preparation in the apical direction, with specific files, tends to perform a more adequate preparation with less risk of displacing the original canal when compared with a single instrument with reciprocal movement.

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Background: Cone-beam computed tomography (CBCT) images have favorable quality and are more valuable in the evaluation of the dimensions and density of the alveolar bone. In the present study, CBCT images were used to compare the height and density of the alveolar bone and the width of the inferior cortex of the mandible in smoking and non-smoking male subjects. Materials and Methods: In this descriptive/cross-sectional study, a total of 286 subjects were included in the study based on inclusion and exclusion criteria. The subjects were divided into two groups of smokers and non-smokers. Digital CBCT images were taken, and data were analyzed separately with the use of descriptive statistics and independent samples t-test and non-parametric Mann-Whitney test, using SPSS 21. Results: The heights of the alveolar crest in smokers and non- smokers were 3.12 ± 0.22 and 3.49 ± 0.85 mm, respectively (P = 0.001). The means of the width of the inferior cortex of the mandible in smoking and non-smoking subjects were 4.36 ± 1.00 and 4.43 ± 1.47 mm, respectively (P = 0.65). The means of alveolar bone density based on the gray level in non-smokers and smokers were 684.49 ± 126.8 and 653.25 ± 131.45, respectively (P = 0.063). Conclusion: In the present study, the alveolar bone density and the width of the inferior cortex of the mandible were the same in smokers and non-smokers while the heights of the alveolar crest were less in smokers.

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Antiresorptive agents are drugs used for the management of osteoporosis and metastatic bone disease to provide protection against complications affecting the skeletal system. Side effects occur rarely; one such potentially serious side effect is antiresorptive agent-induced osteonecrosis of the jaws (ARONJ). ARONJ affects the quality of life even with the risk of pathologic mandibular fractures. The treatment of patients affected by ARONJ is a challenge. This review briefly explains the epidemiology and pathogenesis of ARONJ and the various modalities proposed for its management.

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Background: Apical periodontitis (AP) is the result of infection of the periapical tissues. Clinical and radiographic diagnosis determines whether to treat the infected teeth with root canal therapy or not. Prognosis of pulpal therapy is mostly dependent on the quality of treatment pursued. Therefore, we evaluated the prevalence of AP along with the quality of pulp therapy in geriatric patients in a given population. Materials and Methods: The present study included 1942 teeth in 1000 patients if age 60 years and above. Diagnosis irreversible pulpitis was confirmed after radiographic and clinical examination of the patients. Pulp therapy was carried out in these patients after confirmation of the diagnosis. Periapical index scores of teeth and treatment quality were assessed using Tronstad et al. and Ψrstavik's criteria, respectively. Chi-square test was used to evaluate the level of significance. Results: About 36% of the total study population was of females with maximum subjects belonging to the age group of 60-69 years. In more than 40% of the teeth, adequate root canal therapy was performed. Over 90% of the teeth with adequately performed root canal therapy had healthy periapical tissue. Approximately 59% of the teeth with inadequately filled root canal had periapical lesions. Statistically significant results were obtained while comparing the periapical tissues with the quality of root canal therapy and coronal restorations. Conclusion: Quality of root canal therapy is significantly associated with post-treatment AP. Persistence of infectious agents in the treated teeth can lead to failure of endodontic therapy and further significantly increases the chances of occurrence of AP.

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The current study reports replantation of an avulsed tooth after 30 h. The avulsed tooth was the left maxillary permanent central incisor that was kept in a plastic envelope under dry condition in an 8.5-year-old girl. After soaking of the avulsed tooth in hydrofluoric acid gel and irrigation of the socket with sterile saline solution, mineral trioxide aggregate was placed over the apex of avulsed tooth and root canal filling was completed. Finally, the avulsed tooth was soaked in doxycycline solution and placed in the socket. Subsequently, the tooth was splinted with 0.7 mm orthodontic wire for 8 weeks. At 2-, 6- and 12-month follow ups, the clinical and radiographic findings of the tooth did not reveal any signs of replacement or inflammatory resorption.

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Background: Recently, erbium: yttrium aluminum garnet (Er: YAG) laser used for tooth preparation and silorane-based composite is a new material in dentistry so that the purpose of this study is to compare microtensile bond strength (MTBS) of silorane- based adhesive and composite (Filtek P90 silorane, 3M/USA) to dentin by Er: YAG laser irradiation versus bur cut. Materials and Methods: A total of 40 extracted human molars were flattened to obtain dentin surfaces. Mid-coronal dentin was prepared to adhesion process. The dentin (D) specimens were divided into 4 groups, according to the surface treatments: (1) D1: Laser preparation + acid etching + composite. (2) D2: Laser preparation + composite. (3) D3: Bur preparation + acid etching + composite. (4) D4: Bur preparation + composite. After application of primer and adhesive, composite builtups were created with a silorane-based composite. The composite material was irradiated with light cure (Demi/kerr/USA) for 40s. Specimens were sectioned into serial 1 mm2 sticks hour glass and MTBS was measured with universal testing machine in all sticks, 20 sticks for every group. MTBS test data were analyzed by ANOVA and post-hoc (Sheffe) test. Failure modes were determined under a stereomicroscope (ZTX-3E, Zhejiang/china) (Χ20). Failure mode distributions were analyzed by ANOVA. Results: In groups, group D3 showed the highest MTBS and groups D3, D4 that prepared by bur, showed higher bond strength results with a significant difference, than Er: YAG laser groups (D1,D2). Analysis of failure mode showed that predominantly adhesive for all tested groups. Conclusion: According to the results of this study bur preparation is preferred than laser in dentin.

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