New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal.

AIM: The present study proposed a new classification system based on computed tomography (CT) scan appraisal; this enables the surgeon to identify the extent of the defect and helps to execute the proper treatment plan. BACKGROUND: Various terminologies and classifications were proposed to understand developmental defects. But none of the existing classifications/nomenclatures used the preoperative radiographic evaluation (i.e., computed tomography scan-CT scan) in the management and prognosis. Various treatments were advocated and practiced successfully for the surgical correction of lip and palate. MATERIALS AND METHODS: The available CT scans from archives of the Department of Radiology and Oral and Dental Surgery were evaluated (retrospectively) for cleft alveolus and its morphology as per the proposal. The English language literature was searched in the MEDLINE database without date restriction to revise existing literature on numerous classification systems/nomenclatures using MeSH keywords related to cleft lip, palate, alveolus, developmental disturbance, facial clefts, and classification. Existing classification systems were revisited with a note on the drawbacks. After careful examination of morphological patterns of all clefts, the new CT scan-based alveolar cleft classification is proposed depending on the extent of cleft. RESULTS: The literature revealed a total of twenty-nine classifications of cleft lip and palate starting from the year 1922 to the year 2015, but none exclusively classified the cleft alveolus based on CT scan observations. The observation of three thousand CT scans showed five types of cleft alveolus, depending on the extent of involvement. CONCLUSION: The CT scan-based classification is essential to the surgeon for successful surgical planning of cleft alveolus. The proposed classification is clinically relevant in this digital era for relating surgical outcomes. The three-dimensional viewing of a defect is essential for the surgeon for virtual planning. This paper provides a CT scan-based classification for universal acceptance in this era of digital technology, and CT scan aids in achieving these goals. CLINICAL SIGNIFICANCE: The new proposal is based on preoperative evaluation of cleft using a CT scan. CT scan imaging provides a clear picture of the cleft in three dimensions for the operating surgeon. Advanced technology-enhanced surgical management modalities like CAD/CAM guided templates to support graft for successful management. The classification system will help the medical and surgical fraternity in various aspects. The three-dimensional modeling of defect and printing of a defect model using additive manufacturing technology helps the surgeon for presurgical visualization and virtual planning in a better way. This strategy of defect classification using a CT scan will help obtain better clinical outcomes and patient satisfaction.

Quality Assessment of Systematic Reviews of Temporomandibular Joint Ankylosis Surgical Treatment Outcomes.

AIM: Temporomandibular joint ankylosis (TMJA) management involves many surgical treatment modalities depending on the experience of the operator. A lot of literature has been published on various treatment modalities. Many systematic reviews (SRs) were published without any published prior protocol. So, the study aimed to evaluate the quality of SRs with meta-analysis of TMJA management. MATERIALS AND METHODS: Systematic reviews with meta-analysis were included for the quality assessment using AMSTAR (assessment of multiple SRs) and Glenny et al. checklist by two independent teams. The search was limited to the Medline database archival (from January 1980 to December 2018). RESULTS: The primary search identified 1,507 related articles. After activation of different filters, abstracts screening, and cross-referencing, finally, a total of six studies were assessed to make the overview up-to-date. CONCLUSION: The articles scored 8 to 11 with AMSTAR and 7 to 13 with the Glenny et al. checklist. None of the published reviews received maximum scores. The methodology and heterogeneity are essential factors to assess the quality of the published literature. CLINICAL SIGNIFICANCE: None of the included meta-analysis was registered or published protocol with Prospero or Cochrane before publication for better validity of the studies. The authors are advised to follow reporting criteria so that in the future it is possible to provide the standards of care for TMJA with the highest quality of evidence.

Role of Synthetic Hydroxyapatite-In Socket Preservation: A Systematic Review and Meta-analysis.

Since a long time, the preservation of the socket is emphasized for various reasons. Many studies have suggested the ridge preservation through socket grafting using various bone graft substitute materials (GSMs). But none of the studies suggested the material of choice for the grafting. So, the systematic review was planned to analyze the outcomes of synthetic hydroxyapatite (SHA) graft material for socket preservation. The review was aimed to determine the existing evidence for the use of SHA GSM for grafting and its usefulness. MATERIALS AND METHODS: The literature search was performed for the studies published in the English language independently by all four authors (search team) in the Medline database through the PubMed search engine for the past 5 years. The study involved predetermined inclusion and exclusion criteria for the search. The final lists of clinical trials were analyzed to determine the existing evidence and suggested the mechanism of action. REVIEW RESULTS: The search resulted in 117 titles. After application of inclusion and exclusion criteria, a total of seven studies were found eligible for this systematic review. Out of seven, two studies were found eligible for meta-analysis whereas remaining included for the systematic review. CONCLUSION: The meta-analysis favors socket grafting compared to control in terms of preservation of existing bone height and width. The SHA grafting showed successful bone regeneration with less connective tissue component. The histomorphometric evaluation showed a good bone regeneration associated with SHA than xenograft. Within the limitations of this meta-analysis, the synthetic GSM can be used for socket grafting. CLINICAL SIGNIFICANCE: In the wake of increasing graft materials in the market and different origin raw material sources for the preparation of graft materials, clinicians are in dilemma for selection and its use. The success of grafting depends on the selection of appropriate material with a suitable calcium/phosphate (Ca/P) ratio. The review provided available evidence for the use of SHA.

Biograft Block Hydroxyapatite: A Ray of Hope in the Reconstruction of Maxillofacial Defects.

BACKGROUND: Improving quality of human life has been the rationale for increase in the applications of bone substitute materials for bone regeneration. High prevalence of loss of bone tissue due to disease remains a major challenge for reconstruction. Shortcomings of autografts and allografts have made the clinicians go for artificial implant materials. AIM AND OBJECTIVE: To prospectively study the structural and esthetic reconstruction of resected mandibular site with biograft porous block hydroxyapatite (BBHA). The study evaluated the efficacy of BBHA as a material for reconstruction of large bone defects. METHODS: Patients requiring reconstruction after resection of cyst/tumors and who denied conventional reconstruction were enrolled for BBHA reconstruction during 2008 to 2015. All patients were clinically and radiologically followed and assessed for a range of 4 to 60 months for outcome. RESULTS: During follow-up periods no one had infection, dissolution, migration, or absorption, but new bone formation and bridging observed in proximity with graft and bone interface. CONCLUSION: Structural and esthetic reconstruction using BBHA significantly reduces donor site morbidity. BBHA have satisfactory results in relation to esthetics and are useful material for reconstruction. Clinical application of this technique will minimize an additional surgical procedure required to harvest donor bone. BBHA provides good esthetics and structural balance to face. As this is an ongoing study the outcome is expected to improve. The incorporation of implants in the BBHA block may fulfill the function also in near future.

Interarch tooth size relationship of Indian population: does Bolton's analysis apply?

BACKGROUND: Orthodontists have several methods to detect inter arch-tooth size discrepancies in patients presenting for orthodontic treatment. Many methods such as Pont's analysis, Nance and Carey's analysis, Peck and Peck ratio, Bolton's analysis are commonly used methods. A thorough search of literature reveals a paucity of reliable data on the mesiodistal dimensions of the crowns of the permanent dentition of Indian population. Without information about the size of individual tooth and groups of teeth for Indian population, it is difficult for the clinician to make an adequate diagnosis and treatment plan and to carry out a plan of therapy. AIM: To determine the size of individual permanent tooth and the sex differences, with tooth size ratios according to Bolton's formula and to evaluate the reliability of Bolton's norms (Anterior/ Posterior) in Indian population. MATERIALS AND METHODS: One hundred and twenty cases in which an excellent occlusion was naturally existent with the mean age of 22 years (18-27 years) were selected in the study. The casts were prepared after taking alginate impression of maxillary and mandibular arches and pouring them immediately with dental stone. A sliding Digital Vernier calliper used to measure the teeth. The ratios of the mean of mesiodistal dimensions of types of teeth were computed. RESULTS: The mean overall ratio for the Indian population is found to be 92.11 with a standard deviation of 2.12. The values ranged from 86.50-97.13 and the median is 92.16. The mean anterior ratio for the Indian population is found to be 78.14 with a standard deviation of 2.59. CONCLUSION: Bolton's original data does not represent Indian population. In our study greater size variability was found in maxillary teeth as compared with mandibular teeth except mandibular first molar. Our study indicated that population-specific standards are necessary for clinical assessments. Significant differences were shown for the overall ratio and anterior ratio for both sexes as compared to Bolton's ratio.

Evaluation and comparison of quantity and pattern of fluoride release from orthodontic adhesives: an in vitro study.

BACKGROUND: Orthodontic treatment has gained popularity since beginning of era of dentistry. Now a day, everyone is conscious about their appearance, smile and function. During orthodontic treatment use of brackets and adhesives are common. The bonding of brackets will cause demineralization which requires the fluoridation. So the study has been under- taken to analyze the pattern of fluoride release by commercially available adhesive bonding material for the prevention of demineralization. AIM: To evaluate and compare the clinical significance of quantity and pattern of fluoride release from three commercially available adhesives. OBJECTIVES: To assess the pattern of fluoride release and quantity, to reduce the decalcification of enamel around orthodontic brackets and bands during treatment and to prevent further use of topical fluoride both office and self-use agents for prevention of demineralization/for remineralization. MATERIALS AND METHODS: The comparison of quantity and pattern of fluoride release study involved commercially available bonding adhesives. They are: Group I--resin reinforced glass Ionomer light cure material (OrthoLC), Group II--fluoride releasing composite resin material (Excel) and Group III--conventional composite (Relay-a-bond) evaluated on 78 freshly extracted premolar teeth divided into three groups consisting 26 specimens in each group. The prepared specimens were stored in artificial saliva at 37°C in an incubator for subsequent fluoride analysis using ORION ion selective electrode coupled with ionalyzer 901. Fluoride analysis made at 24 hours intervals for first 3 consecutive days and thereafter at the end of 10th, 17th, 24th and 31st day of bonding. The data obtained were tabulated and interpreted by statistical analysis using 't' test and one-way analysis of variance (ANOVA). OBSERVATIONS AND RESULTS: The quantity of fluoride release in groups I and II was significant even at the end of 31st day. The one-way AVOVA showed intra and inter group significance in the quantity of fluoride release. But group III with zero fluoride release with significant decalcification on enamel which requires external use of topical fluorides. The pattern of fluoride released was 3.06 ppm for group I and 2.01 ppm for group II and was declined sharply after 24 hours; and continued to decline in subsequent weeks. Mean quantity of fluoride release by group I was 15.08 ppm were as group II was 9.02 ppm over the test period of 31 days. At the end of 31st day the group I bonding adhesive was releasing considerable amount of fluoride compared to group II whereas group III was nil. At all the periods inter and intra group mean values were highly significant. And group III acted as base line or control group as it was non-fluoride releasing material. CONCLUSION: Both the fluoride releasing adhesive bond material are useful to reduce the risk of demineralization and further prevent the usage of topical fluoride application and reduce cost and clinical visiting time for both patient and clinician.

Observer strategy and radiographic classification of healing after grafting of cystic defects in maxilla: a radiological appraisal.

AIM: The aim is to radiographically quantify the bone density and relate the same with observer strategy in the bone healing. OBJECTIVES: To assess pattern of bone regeneration following grafting of defects with hydroxyapatite after apicoectomy/cystic enucleation. MATERIALS AND METHODS: An observer strategy involving trained and experienced examiners used in large series of cases, evaluated radiographically over a period of 1 year with intervals. The cases were grouped into different categories depending on (1) surgical site outline merging with material margin, (2) internal portion of surgical site (i.e. bone formation characteristics) and (3) density of surgical site. The radiographs examined by blind process and the findings were tabulated. Operating surgeon (oral surgeon) has done the interpretation of data to create observer strategy of grafting cases. OBSERVATIONS AND RESULTS: The outline of the defect was changed, partly reduced and completely absent along with remodeling, which showed ground glass, specular or trabecular pattern of bone over a time with increasing density correlating bone regeneration within a short duration. The applied strategy and classification are recommended for follow-up studies. In this study the characteristics of the new bone formation were also delineated. This strategy is helpful for follow-up studies; implant procedures and so; to know quality and condition of bone after treatment.

Repurposing the Antibacterial Activity of Etoposide─A Chemotherapeutic Drug in Combination with Eggshell-Derived Hydroxyapatite.

Drug repurposing has been gaining increasing interest recently due to the reduction in development cost and reduced development timelines. Here, we report the antibacterial activity of the anticancer drug etoposide investigated in combination with the eggshell-derived hydroxyapatite (EHA). Hydroxyapatite (HA) is a well-known bioactive material with enhanced osteoconductivity and possesses superior drug delivery properties. In the present work, we have synthesized etoposide-loaded EHA by the wet precipitation method. The physicochemical characterization of the samples confirmed the composition and amount of drug encapsulation. Screening for antibacterial activity confirmed the antibacterial effect of etoposide against Staphylococcus aureus. Biofilm formation test on pristine and etoposide-loaded samples showed the inhibition of biofilm formation on etoposide loading, which was further studied by confocal laser scanning microscopy (CLSM) and colony forming units (CFUs). It has been found that etoposide-loaded HA exhibited a sustained release of the drug upto 168 h. Analysis of the inhibition mechanism of etoposide against S. aureus revealed damage to the cell membrane and has been quantified using flow cytometry by the uptake of propidium iodide. Etoposide-loaded eggshell-derived HA (EHA-ET) exhibited excellent bioactivity and cytocompatibility against mouse fibroblast cells (L929) and supressed the growth of osteosarcoma cells (MG-63). Our studies reveal that the EHA-ET has a great potential for treating osteosarcoma and osteomyelitis.

A Perioral Soft Tissue evaluation after Orthognathic Surgery Using Three-Dimensional Computed Tomography Scan.

BACKGROUND: Facial appearance is an important factor, affects social and psychological well-being. The ideal positioning of jaws and soft tissues is crucial during orthognathic surgery for a better outcome, but the response of facial soft tissues does not always reflect the exact movements of the underlying jaws in 1:1 ratio. So, soft tissue changes following orthognathic surgery require utmost attention during surgical correction to make successful treatment. AIMS AND OBJECTIVES: Evaluation of perioral soft tissue changes after orthognathic surgical procedures. The objectives of the study were to assess and compare pre and post-operative perioral soft tissue changes of lip width, nasolabial and mentolabial angle using Three Dimensional Computed Tomography scan (3DCT). PATIENT AND METHODS: The study involved ten patients for evaluation requiring orthognathic surgical procedures (maxillary or mandibular anteroposterior excess or deficiency, transverse deformities, vertical maxillary excess and facial asymmetry) presented to the department of oral and maxillofacial surgery during 2014-2016. Pre and post-operative 3DCT scan were taken after 12 months using iCT 256 slice whole body CT scanner and evaluated for changes using Dicom PMS D view. RESULTS: Significant changes were observed in nasolabial angle after maxillary advancement (1.81°) and maxillary setback procedure (2.73°). The mentolabial angle was significantly increased with mandibular setback procedures (3.27°). Mandibular advancement procedures showed both increase (3.6°) and decrease (7.6°) in mentolabial angle. CONCLUSION: 3DCT showed a significant difference in perioral soft tissue changes in nasolabial and mentolabial angle but no significant change was observed in lip width. 3DCT is a reliable tool for 3D assessment. The conventional thought of changes in Nasolabial angle after surgery is changing due to the underlying factors which should be considered for prediction.

Simplified Technique to Change the Endotracheal Tube from Nasal to Oral Cavity.

We introduce modified nasal to oral tube switch technique for modified alar cinching to prevent alar flare after orthognathic and nasal corrective surgeries. The technique is beneficial to prevent alar flare. Modified alar base cinching is effective in patients with modified tube switch technique. It increased positive results. The technique of tube switch is effective in prevention of alar flare. We suggest multi center randomized studies to know the technical difficulties of tube switch for cinching.

Evaluation of modified nasal to oral endotracheal tube switch-For modified alar base cinching after maxillary orthognathic surgery.

BACKGROUND: Soft tissue changes secondary to Maxillary orthognathic surgery are many fold. The alar flare is one among them, which affects the appearance of the patient. Cinch suture has been used to prevent alar flare; but the presence of anaesthetic tube hinders cinching. So, the study was aimed to assess an efficacy of modified nasal to oral tube switch technique for modified alar cinching to prevent alar flare after orthognathic and nasal corrective surgeries. MATERIALS AND METHODS: Patients were randomly allocated in each group, who underwent modified alar base cinching with and without nasal to oral tube switch. Changes in alar base width, upper lip length was measured with Digital Vernier Caliper and nasolabial angle (Cotg-Sn-Ls) on lateral cephalogram at 1st, 3rd, 6th, and 12th months after surgery. The time taken and ease of tube switch were noted. The data obtained were tabulated and interpreted using a test of significance. RESULTS: Study results showed no statistical significant difference in perinasal soft changes among both groups. But tube switch appears to be beneficial to prevent alar flare. CONCLUSION: Modified alar base cinching was performed effectively in patients with a modified tube switch technique. It increased positive results in comparison with non-shift. The technique of tube switch used is effective in prevention of alar flare. Because of small sample size and limited period of follow up, our study suggests multi centre, randomized studies to know the technical difficulties of tube switch for cinching and aesthetic results with varying anaesthetist and the surgeon's experience.

Adult immunization-Need of the hour.

Immunization is the process or the act of making individuals immune, which is usually done during childhood. Everyone is aware about immunization during childhood, however, very few know about adult immunization. This led us to review the adult immunization literature for the preventive strategies through various vaccination protocols. Adults do require vaccination protocols with booster doses for hepatitis B, Shingles, communicable diseases, traveler's diseases, etc. In this context, this article revises much of the available adult immunization literature and presents comprehensive guidelines. This article will increase the awareness regarding the importance of vaccination for adults to prevent a variety of conditions prevalent in our country as well as epidemics. The article comprehensively provides insights into the available vaccination and preventive strategy of human papilloma virus (HPV), hepatitis, and human immunodeficiency virus (HIV) infection in this part of the review. We strongly recommend all the health care professionals to educate their co-professionals and the public to use the benefits of adult immunization. It is the need of the hour and reduces the burden of treatment and increases productivity.

One Phase versus Two Phase Treatment in Mixed Dentition: A Critical Review.

The mixed dentition is the developmental period after the permanent first molars and incisors have erupted, and before the remaining deciduous teeth are lost. Phase I treatment is usually done early in this period. Mixed dentition treatment goals often focus on skeletal rather than dental correction. To design a treatment plan, the clinician must understand the growth and development patterns, and the known effects of the chosen treatment modality. Jaw growth affects orthodontic treatment, usually favorably, but sometimes unfavorably. When and how much growth will occur is completely unpredictable. However, we know some useful facts about jaw growth in the mixed dentition. The two areas that remain controversial in the orthodontic literature are the treatment of crowding and of Class II malocclusions in the mixed dentition. Is there a benefit to early treatment for these problems? This question has yet to be fully answered by researchers. Hence, we planned for review of all available literature to come to a consensus about preventive or interceptive orthodontics or in other words Phase 1 and Phase 2 treatment. The clinician can diagnose and intercept certain developing problems with early treatment. Many other cases should be supervised, but not treated until the permanent teeth are in place. We must base our decision to treat on experience, knowledge of growth and dental development, and research.

Juxtacortical osteosarcoma of the mandible: Challenges in diagnosis and management.

Parosteal osteosarcoma (OS) of the jaw is a rare type of OS with peculiar clinical radiographic and microscopic features. The aim of this article was to report and discuss a case of high-grade parosteal OS in the mandible of a 35-year-old woman. The patient reported sensing mild pain and swelling in the retro molar area on the left side of the mouth for a period of 4 years, despite continuous dental treatment. The radiographic evaluation showed a mixed radiopaque/radiolucent lesion in the body of the left side of the mandible. Destruction of the mandibular cortex in that area was also observed. After the initial histological study, the patient underwent partial hemi-mandibulectomy. Microscopic findings showed a tumor exhibiting spindle cells with nuclear hyperchromasia, moderate pleomorphism, and irregular osteoid formation, with chondroid differentiation noted with tumor-free margins. The immunohistochemical analysis showed the expression of negativity to p53, human epidermal growth factor receptor 2/neu, and positivity to S-100. The diagnosis was high-grade parosteal OS of the jaw. The 4 years clinical and imaging postoperative follow-up showed no evidence of recurrence. The literature on this unusual pathologic entity reviewed and diagnostic challenges described.

Evaluation of Hi-Tec Implant Restoration in Mandibular First Molar Region- A Prospective Clinical Study.

BACKGROUND AND AIMS: Missing teeth lead to loss of structural balance, inefficient function, poor aesthetics and psychological effects on human beings, which needs restoration for normal contour, function and aesthetics. Several natural or synthetic substitutes are being used for replacement of missing tooth since centuries. Implants are the latest modality of replacement. So, the study was aimed to assess clinical success rate of Hi-Tec implant; which is economical and new in market. Results of the study will help clinician for appropriate implant selection. MATERIALS AND METHODS: The study included 10 patients from 19 to 31 years and needed restoration of missing mandibular first molar. Restoration had done using Hi Tec Single-tooth implants with metal-ceramic single crown prosthesis after three months of osseointegration. The implants were evaluated clinically (bleeding on probing, probing depth, implant mobility- periotest) and radiographically (marginal bone loss and peri-implant radiolucency) for six years. The observers were blinded for the duration of the study to prevent bias. RESULTS: All the patients had uneventful post-surgical healing. No bleeding on probing, Implant mobility, peri-implant radiolucency with minimal marginal bone loss and constant probing depths were observed well within the normal range during follow-up periods. CONCLUSION: Two stage single-tooth Hi Tec implant restoration can be used as a successful treatment modality for replacing mandibular first molar in an economic way. However, these results were obtained after 6 years of follow up with a smaller sample size, so long term multi center studies with a larger sample size is recommended for the predictability of success rate conclusively.

Orbito-rhino-antro access osteotomy for anterior skull base lesions.

Even with advent of endoscopic assisted surgeries the access osteotomy plays an important role for accessing the pathological lesions of anterior skull base since beginning of the era of surgery. This report introduces the orbito-rhino-antral access osteotomy for the removal of juvenile nasio angio fiboma extending in to the cranial base. This osteotomy provides good access to the lesion with lesser morbidity and without hampering the occlusion as in lefort osteotomies. It is safe, easy and faster to perform. Osteotomised segment is easy to replace and gives ease for the surgeon to access without any hindrance. The osteotomised segment act as free graft and there are no complications postoperatively even after 48 mnth of follow-up.

Comparative evaluation of bovine derived hydroxyapatite and synthetic hydroxyapatite graft in bone regeneration of human maxillary cystic defects: a clinico-radiological study.

INTRODUCTION: Bone grafts are frequently used in the treatment of bone defects. Bone harvesting can cause postoperative complications and sometimes does not provide a sufficient quantity of bone. Therefore, synthetic biomaterials have been investigated as an alternative to autogenous bone grafts. AIM AND OBJECTIVES: The aim of this study was to evaluate and compare bovine derived hydroxyapatite (BHA) and synthetic hydroxyapatite (SHA) graft material as bone graft substitute in maxillary cystic bony defects. Patients were analyzed by computerized densitometric study and digital radiography. MATERIALS AND METHODS: In this study, 12 patients in each group were included randomly after clinical and radiological evaluation. The integration of hydroxyapatite was assessed with mean bone density, surgical site margin, and radiological bone formation characteristics, of the successful graft cases using computer densitometry and radio-visiograph. Statistical analysis was carried out using Mann-Whitney U-test, Wilcoxon matched pairs test and paired t-test. RESULTS: By the end of 24 th week, the grafted defects radiologically and statistically showed similar volumes of bone formation. However, the significant changes observed in the formation of bone and merging of material and surgical site margin at 1 st week to 1 st month. The results were significant and correlating with all the parameters showing the necessity of the grafting for early bone formation. However, the bone formation pattern is different in both BHA and SHA group at 3 rd month interval with significant P value. CONCLUSION: Both BHA and SHA graft materials are biocompatible for filling bone defects, showing less resorption and enhanced bone formation with similar efficacy. Our study showed maximum bone healing within 12 weeks of grafting of defects. The BHA is economical; however, price difference between the two is very nominal.

Eggshell derived hydroxyapatite as bone graft substitute in the healing of maxillary cystic bone defects: a preliminary report.

BACKGROUND: Since ancient times, use of graft materials to promote healing of defects of bone is wellknown. Traditionally, missing bone is replaced with material from either patient or donor. Multiple sources of bone grafts have been used to graft bone defects to stimulate bone healing. Hydroxyapatite is naturally occurring mineral component of bone, which is osteoconductive. This versatile biomaterial is derived from many sources. The aim of this study is to evaluate the efficacy of eggshell derived hydroxyapatite (EHA) in the bone regeneration of human maxillary cystic bone defects secondary to cystic removal/apicoectomy and compare the material properties of EHA in vitro. MATERIALS AND METHODS: A total of eight maxillary bone defects were grafted after cystic enucleation and/or apicoectomy in the year 2008 and completed the study at 1 year. The patients were followed-up 2 weeks after surgery for signs and symptoms of infection or any other complications that may have been related to surgical procedure. Follow-up radiographs were obtained immediately after surgery followed by 1, 2, and 3 months to assess the efficacy of EHA in bone healing. Physicochemical characterization of the EHA was carried out in comparison with synthetic hydroxyapatite (SHA), also compared the biocompatibility of EHA using in vitro cytotoxicity test. RESULTS: By the end of the 8(th) week, the defects grafted with EHA showed complete bone formation. However, bone formation in non-grafted sites was insignificant. The values of density measurements were equal or more than that of surrounding normal bone. These results indicate that the osseous regeneration of the bone defect filled with EHA is significant. EHA showed the superior material properties in comparison with SHA. CONCLUSION: EHA is a versatile novel bone graft substitute that yielded promising results. Because of its biocompatibility, lack of disease transfer risks, ease of use and unlimited availability, EHA remains a viable choice as regenerative material. EHA is very cost-effective, efficient bone graft substitute, which can be prepared in a very economical way. It is a worthwhile bone substitute because it is safe and easily available material. How to cite the article: Kattimani VS, Chakravarthi PS, Kanumuru NR, Subbarao VV, Sidharthan A, Kumar TS, Prasad LK. Eggshell derived hydroxyapatite as bone graft substitute in the healing of maxillary cystic bone defects: A preliminary report. J Int Oral Health 2014;6(3):15-9.

Management of pregnant patient in dentistry.

The purpose of this article is to update general dentists and maxillofacial surgeons in the perioperative management of the pregnant patient. Pregnancy results in physiologic changes in almost all organ systems in the body mediated mainly by hormones; which influences the treatment schedule. Understanding these normal changes is essential for providing quality care for pregnant women. The general principles that apply in this situation are discussed, followed by the relevant physiologic changes and their treatment implications, the risks of various medications to the mother and fetus, the management of concomitant medical problems in the pregnant patient, appropriate timing of oral and maxillofacial surgery during pregnancy, and management of emergencies during pregnancy. Information about the compatibility, complications, and excretion of the common drugs during pregnancy is provided. Guidelines for the management of a pregnant patient in the dental office are summarized. How to cite this article: Kurien S, Kattimani V S, Sriram R, Sriram S K, Prabhakar Rao V K, Bhupathi A, Bodduru R, Patil N N. Management of Pregnant Patient in Dentistry. J Int Oral Health 2013; 5(1):88-97.

A comparative evaluation of dimensional stability of three types of interocclusal recording materials-an in-vitro multi-centre study.

BACKGROUND: The introduction of different interocclusal recording materials has put clinicians in dilemma that which material should be used in routine clinical practice for precise recording and transferring of accurate existing occlusal records for articulation of patient's diagnostic or working casts in the fabrication of good satisfactory prosthesis. In the era of developing world of dentistry the different materials are introduced for interocclusal record with different brand names because of this; the utility of the material is confusing for successful delivery of prosthesis with lack of in vitro or in vivo studies which will predict the property of the material with utility recommendations. PURPOSE OF THE STUDY: The aim of this multicenter research is to evaluate the time dependent linear dimensional stability of three types of interocclusal recording materials; which gives very clear idea to clinicians in regard to its usage in routine practice and recommendations for usage of the different materials. Also to find out ideal time for articulation of three types of interocclusal recording materials with accuracy. MATERIALS AND METHOD: Commercially available and ADA approved Polyether bite registration paste (Ramitec), Poly vinyl siloxane bite registration paste (Jetbite) and Zinc oxide eugenol (ZOE) bite registration paste (Super bite) were used in the study.A stainless steel die was made according to modified American dental Associations (ADA) specification no. 19. Each one of the tested materials were manipulated according to manufacturers' instructions. The materials separated from die, 3-mins after their respective setting time, resulted in disks of standard diameter. Two parallel lines and three perpendicular lines reproduced on the surface. The distance between two parallel lines was measured at different time intervals i.e. 1 hour, 24, 48 and 72 hours by using travelling microscope (magnus) and compared with standard die measurements made according to ADA specification no.19 to find out the dimensional stability of these interocclusal recording materials. Total 120 samples were made for observation and results were subjected to statistical analysis. Statistical analysis was performed using analysis of variance (ANOVA) and then Tukey's Honestly Significant Difference (HSD) test for comparison among groups at the 0.05 level of significance. After statistical analysis of the data, results were obtained and analyzed for interpretation. RESULTS: The results shows significant difference between the dimensional stability of all three material at different intervals with p-value <0.05. Comparatively the polyether bite registration material showed less distortion with good dimensional stability compared to Poly vinyl siloxane bite (Jetbite), Zinc oxide eugenol(ZOE) bite (Super bite) at 1 hour, 24, 48, and 72 hours. CONCLUSION: The dimensional stability decreased with increase in time and is influenced by both material factor and time factor. Polyether was found to be more dimensionally stable interocclusal recording material, which was followed by Silicone and Zinc oxide eugenol (ZOE). The dimensional stability of Polyether was good. Zinc oxide eugenol is dimensionally more unstable when compared with polyether and polyvinyl siloxane. We recommend that the polyether interocclusal records must be articulated within 48 hours and Polyvinylsiloxane interocclusal records must be articulated within 24 hours and the ZOE should be articulated within 1 hour to get a correct restoration to have very minimum distortion and maximum satisfaction without failure of prosthesis.