Effectiveness of Removal of Hard Tissue Debris from the Mesial Root Canal System of Mandibular Molars using Different Supplementary Irrigation Protocols: An Original Study.

Introduction: An instrumented and endodontically treated tooth may sometimes impede disinfection by trapping hard tissue as well as the other canal contents at the isthmus level of the canal. Thus, the current in vitro study was piloted to assess the competence of two irrigating systems. Methods: Twenty mandibular with two mesial canals convergent into a single foramen and joined by an isthmus of the human permanent teeth were compared for the two irrigation systems of continuous and intermittent ultrasonic (US) motions of the irrigation. The teeth were prepared by a single rotary system and were imaged using the "Scanning electronic microscopy-SCM". The parameters were compared before and after the irrigation of the canal with the intended US systems for the removal of hard tissue debris. The appropriate statistical tools were used to find the significance, the value of which was kept at P < 0.05. Results: Significant percentage reduction of the hard tissue debris was achieved after the application of the supplemental irrigation protocols (P < 0.05). However between the groups, there was no significant difference. Conclusions: Comparable removal of the hard tissue debris was obtained in both the irrigation systems. Though not significant, the GentleWave performed better than the Irrisafe.

Comparison of the Quality of Life Among the Immediate Loading Implant Overdentures Using the Single and the Double Implants: An Original Study.

Introduction: In edentulous individuals, single implant-retained mandibular overdentures are an effective substitute for double implant-retained overdentures. In this current research, the oral health-related quality of life (OHRQoL) was assessed for the immediate loading overdenture using the implants. The comparisons are drawn between the single and double implants. Materials and Methods: Forty subjects received single and double implants for the placement of the mandibular overdentures. Within a week days of implant insertion, they were loaded with overdentures. Using the Oral Health Impact Profile-14 (OHIP-14) questionnaire, the OHRQoL was measured before treatment, one month following treatment, and 12 months thereafter. Results: In both the single implant and double implant groups, participants' mean OHIP-14 scores decreased statistically significantly for the different timelines. For the single implant group, the baseline total mean OHIP-14 score was 14.33, and for double implants, it was 19.15. Following therapy, it decreased to 8.55 in the single implant group and 9.48 for the double implant group at one month, and at 12 months, it further decreased to 3.25 in the single implant group while it was 5.15 in the double implant group. Conclusions: Single and double implants increase the QoL for older subjects who are edentulous at the 1-month and 1-year recall points. When two implants are used by older individuals, the single implant might offer an equivalent quality of life.

Changes in Soft Tissue Variable of Lips Following Retraction of Anterioir Teeth- A Cephalometric Study.

Aim: The purpose of this study was to assess the short-term perioral soft tissue variations of the lips before and after treatment cases in 15 patients with bi-maxillary protrusion using treated lateral cephalograms who had already achieved active growth. Methodology: Fifteen pre-treatment and post-treatment lateral cephalometric radiographs of 18-25-year-old individuals with bimaxillary protrusion treated with all four 1st premolar extractions were accessed from the records. From the reference planes and landmarks, 13 horizontal, 10 vertical, and 2 angular measurements were noted. Statistical comparisons between pre-treatment and post-treatment measurements were measured by a paired t-test to assess the importance of the mean variations at the predetermined significance level. Pearson's correlation coefficient (R) was utilized to assess the strength and significance of the linear relationship between the mean differences for paired (dependent and independent) variables. Results: Pearson's correlation exhibited a noteworthy positive association between the horizontal changes in upper lip position and the horizontal changes of the upper incisor tip point (H-tU1) (R = 0.748), the upper incisor cervical point (H-cU1) (R = 0.707), the lower incisor tip point (H-tL1) (R = 0.839), and the lower incisor cervical point (H-cL1) (R = 0.767). This indicated that upper lip changes are the aftermath of the retraction of the upper and lower incisors in class I bi-maxillary protrusion malocclusion. Conclusion: Thick upper lips showed more retraction of the upper lip in correlation with retraction of the incisors as compared with thin lips. The lower incisor cervical point displayed the strongest association with lower lip retraction.

Healing of Endosseous Implants Having Different Surface Characteristics in the Alveolar Bone: A Clinical Study.

Background Total treatment time in implant placement can be significantly reduced by placing immediate implants into the freshly extracted sockets. Also, immediate implant placement can act as a guide for proper and accurate implant placement. Additionally, in immediate implant placement, the resorption of bone associated with the healing of the extraction socket is also reduced. This clinical study aimed to clinically and radiographically assess the healing of endosseous implants having different surface characteristics in nongrafted and grafted bone. Methodology In 68 subjects, 198 implants were placed, including 102 oxidized (TiUnite, Göteborg, Sweden) and 96 turned surface implants (Nobel Biocare Mark III, Göteborg) were placed. Survival was considered with clinical stability and acceptable function with no discomfort and no radiographic or clinical signs of pathology/infection. Rest cases that showed no healing and implant no osseointegration were considered failures. Clinical and radiographic examination was done by two experts after two years of loading based on bleeding on probing (BOP) mesially and distally, radiographic marginal bone levels, and probing depth (mesial and distal). Results Five implants failed in total where four implants were with the turned surface (Nobel Biocare Mark III) and one was from the oxidized surface (TiUnite). The one oxidized implant was in a 62-year-old female and was placed in the region of mandibular premolar (44) of length 13 mm and was lost within five months of placement before functional loading. Mean probing depth had a nonsignificant difference between oxidized and turned surfaces with the mean values of 1.6 ± 1.2 and 1.5 ± 1.0 mm, respectively, with P = 0.5984; mean BOP in oxidized and turned surfaces was 0.3 ± 0.7 and 0.4 ± 0.6, respectively (P = 0.3727). Marginal bone levels, respectively, were 2.0 ± 0.8 and 1.8 ± 0.7 mm (P = 0.1231). In marginal bone levels related to implant loading, a nonsignificant difference was seen in early loading and one-stage loading with P-values of 0.06 and 0.09, respectively. However, in two-stage placement, significantly higher values were seen for oxidized surfaces (2.4 ± 0.8 mm) compared to turned surfaces (1.9 ± 0.8 mm), with P = 0.0004. Conclusions This study concludes that nonsignificantly higher survival rates are associated with oxidized surfaces compared to turned surfaces after two years of follow-up. Higher marginal bone levels were seen in oxidized surfaces for single implants and implants placed in two stages.

Fracture toughness of 3D printed denture teeth.

BACKGROUND: Advances in digital dentistry lead to use of three-dimensional (3D) printed resin denture teeth. Fracture toughness of these teeth must be assessed. OBJECTIVE: This study aimed to compare the chipping and indirect tensile fracture resistance of denture teeth fabricated by 3D printing technique with traditionally fabricated resin denture teeth. METHOD: Four groups (Gr) were made (n= 50/group): Gr-1 3D printed denture teeth (denture teeth; Formlabs Inc., Somerville, MA, USA), Gr-2 SR-Orthosit-PE (Ivoclar Vivadent AG), Gr-3 Portrait IPN (Dentsply Sirona), Gr-4 Pala Premium 8 (Heraeus Kulzer GmbH). Stereolithography 3D printing was used to create the methacrylate-based photopolymerized resin teeth models and remaining group teeth were collected commercially. A 1 mm/min chipping and indirect tensile fracture speed tests were carried out till fracture occurred. The data so obtained were statistically analysed using one-way analysis of variance with Tukey's honestly significant difference multiple comparisons test (p< 0.05). At the end of the test, the fractured areas of the specimens were evaluated by the chief researcher to assess the fracture pattern of the teeth. RESULTS: The indirect tensile fracture values of the 3D printed teeth were more than that of Pala Premium-8 and SR-Orthosit-PE but it was lower than that of Portrait IPN teeth. In chipping test, buccal chipping of the loaded cusp was seen in 3D printed resin without distortion and in indirect tensile test in 3D printed resin teeth, line of fracture emerges near the loading point propagates from the inner incline of both cusps and extends cervically, unlike in other groups where first deformation occurs then fracture. CONCLUSION: Prosthetic teeth fabricated by the 3D printing technique using printable resin material provide adequate fracture resistance as denture teeth.

Utilization of Dental Care, Tooth Loss, and Oral Health-Related Quality of Life in Older Adults Visiting Dental Care Centers in Indian Settings.

BACKGROUND: Oral disease prevalence is rising globally in a major way, with a heavier impact and concern on developing countries like India. Also, limited data in literature has previously assessed oral health-related quality of life (OHRQoL) in older adults in Indian settings. AIMS: The present study aimed to evaluate OHRQoL in older adults seeking dental care in Indian settings. METHODS: In 140 subjects, an oral examination to detect any oral condition was done followed by filling out a questionnaire for OHRQoL assessment using the Geriatric Oral Health Assessment Index 12 (GOHAI-12). The treatment needs of each study subject were governed by prosthetic and dental status individually. Statistical evaluation of the data collected was done to formulate the results. RESULTS: Concerning age, a significant impact was seen, where increasing age was associated with poor quality of life (p=0.025). For gender, older females had poor OHRQoL with p-values of <0.001, 0.01, 0.04, and <0.001 respectively for behaviour, psychological, pain and discomfort, and functional limitation. Also, edentulous patients had poorer OHRQoL compared to subjects with >20 teeth Conclusion: The present study concludes that oral diseases can significantly affect the OHRQoL, with higher female and edentulous state preponderance. Early diagnosis and management can aid in improving QoL in older adults.

Clinical Assessment of Anatomic Origin Effect on the Clinical Outcomes in Primary Squamous Cell Carcinomas Affecting Nasoethmoidal Complex.

Background: Sinonasal squamous cell carcinomas (SCCs) present a great challenge in their diagnosis and management owing to their rapid growth, regional recurrence, local recurrence, and aggressive spread locally. Aims: The present clinical trial was conducted to evaluate anatomic subsites' impact on the outcomes concerning SCCs affecting ethmoid sinuses and nasal cavity. Materials and Methods: Medical records for tumor staging, tumor classification, grading (histologic) clinical features, symptoms, anatomic subsite, p16 results, treatment provided, and the Tumor-related outcomes were obtained for 28 subjects. Following staging and grading, p16 assays were evaluated along with disease-specific survival and disease-free survival. The collected data were subjected to the statistical evaluation and the results were formulated by keeping the level of significance at P < 0.05. Results: Origin was seen from nasal septum, nasal floor, lateral wall, ethmoid sinus, and edge of naris to mucocutaneous junction in 21.4% (n = 6), 7.14% (n = 2), 35.71% (n = 10), 7.14% (n = 2), and 28.57% (n = 8) subjects, respectively. For tumor staging, Stages I, II, III, and IV tumors were seen in, respectively, 39.28% (n = 11), 21.42% (n = 6), 10.71% (n = 3), and 28.57% (n = 8) study subjects. Node status was N0, N1, N2, and N3 in 78.57% (n = 22), 3.57% (n = 1), 7.14% (n = 2), and 10.71% (n = 3) subjects. Carcinoma arising from nasal septum had statistically significant worse disease-specific survival compared to carcinomas arising from other sites (P < 0.001). Conclusion: The present study concludes that anatomic subsites largely govern the outcomes and tumor behavior. Also, squamous cell carcinoma affecting the nasal septum is an aggressive tumor with more compromised outcomes and more lymph node involvement.

Outcomes Following Hydraulic Pressure Indirect Sinus Lift in Cases of Simultaneous Implant Placement With Platelet-Rich Fibrin.

Background To achieve a better long-term prognosis in the posterior maxilla with poor quality of bone, the sinus lift must ensure bone regeneration till the apex of the dental implant for osseointegration. An indirect sinus lift is a minimally invasive procedure where simultaneous bone condensation is achieved. During the sinus lift procedures, different graft materials are used to gain the height of the bone in the sinus. The present study aimed to evaluate the outcomes of indirect sinus lift with hydraulic pressure and the simultaneous placement of implant using platelet-rich fibrin (PRF). Methodology In total, 24 subjects aged 18-74 years with missing maxillary premolars and first and second molars who opted for dental implants placed with indirect sinus lift with hydraulic pressure and had low sinus with less residual ridge height, bone density, and bone height were assessed at one day, one week, one month, three months, and six months. Results The average mean height preoperatively was 5.573 ± 0.66 mm which showed a significant increase postoperatively to 9.603 ± 0.78 mm (p < 0.001). Mean sinus membrane lift was 4.8 ± 2.2 mm at six months. The implant stability quotient increased significantly at six months postoperatively from 69.07 ± 3.39 at the immediate postoperative time to 72.92 ± 2.714 at six months postoperatively (p < 0.001). Conclusions The current study suggests that minimally invasive indirect sinus lift with bone augmentation utilizing PRF increased residual alveolar ridge height and implant stability with fewer problems than previous sinus lift procedures in the posterior maxillary area.

Major chemical constituents from Illicium griffithii Hook. f. & Thoms of North East India and their cytotoxicity and antimicrobial activities.

Illicium griffithii Hook. f. & Thoms is an endemic medicinal plant of North East India found in the Eastern Himalayan region of biodiversity mega centre. Herein, chemical investigation of I. griffithii, afforded five compounds and their structures were determined through extensive use of NMR, HRMS, and FT-IR spectroscopy. The complete proton-proton, proton-carbon coupling network of compound 1 was determined using 1H-1H COSY, HSQC and NOESY NMR experiments. All the compounds were evaluated for their cytotoxic activity by MTT assay and antimicrobial activity by Agar well diffusion method. Compound 1 exhibited significant cytotoxicity activity against Lung cancer (A549) and pancreatic cancer (MIAPaCa2) cell lines with IC50 values of 15.01 ± 2.69 µg/mL and 47.77 ± 2.38 µg/mL, respectively. Further, the compound 1 exhibited good antimicrobial activities against Escherichia coli and Candida albicans with MIC 7.50 ± 0.28 µg/mL and 7.50 ± 0.86 µg/mL, respectively. The other isolated compounds along with the extracts of I. griffithii also displayed moderate anticancer and antimicrobial activities against respective strains. To the best of our knowledge, this is the first study of isolation of compounds from bark, wood, and leaf along with cytotoxicity and antimicrobial activities of I. griffithii from the North Eastern region of India and could be a potential herbal medicine in near future.

Knowledge, Attitude and Practice towards Kangaroo Mother Care.

BACKGROUND: Kangaroo mother care is an effective and low cost technique which prevents neonate from hypothermia, a leading cause of preventable neonatal mortality. Knowledge and practice of Kangaroo mother care is of utmost importance in developing countries such as Nepal. Purpose of this study was to find out knowledge, attitude and practice of kangaroo mother care among health workers in tertiary health centres in Nepal. METHODS: This cross sectional study was carried out in three teaching hospitals in Nepal during the period from January 2016 to April 2016. Doctors and nurses working in Paediatrics/Neonatal and Obstetrics/Gynaecology wards were surveyed using pretested questionnaire. Responses from the doctors and the nurses were compared. RESULTS: Response rate of the survey was 65%. All of the doctors and 95.3% of the nurses who participated in the survey had knowledge about kangaroo mother care.37.7%of the doctors and 48.8% of the nurses thought that this method is only used for neonates with low birth weight (<2500grams) (p= 0.013).Three fourth of the doctors and half of the nurses agreed that KMC is practiced regularly in their ward (p = 0.016). 22.2% participants informed that main reasons for not practicing kangaroo care regularly could be lack of skill and knowledge. CONCLUSIONS: We found that general knowledge and attitude of majority of doctors and nurses towards kangaroo mother care was good, however, its practise was not uniform.

Non-surgical Management of Skeletal Class III Malocclusion with Bilateral Posterior Crossbite: A Case Report.

A 16-year-old female patient with skeletal Class III malocclusion and bilateral posterior cross bite complaining of difficulty in chewing was treated orthodontically without surgery (camouflage treatment). The treatment comprised of fixed orthodontic treatment with MBT prescription (0.022˝×0.028˝ slot) using quad helix appliance for bilateral expansion of maxillary arch and Class III elastics for occlusal correction. Post-treatment records showed normal overbite and overjet with acceptable occlusion. So with this treatment strategy of expanding the maxillary arch using a quad helix appliance and use of Class III elastics, we achieved a good result with optimal occlusion.

Scope of photodynamic therapy in periodontics.

Periodontal disease results from inflammation of the supporting structure of the teeth and in response to chronic infection caused by various periodontopathic bacteria. The mechanical removal of this biofilm and adjunctive use of antibacterial disinfectants and antibiotics have been the conventional methods of periodontal therapy. However, the removal of plaque and the reduction in the number of infectious organisms can be impaired in sites with difficult access. Photodynamic therapy (PDT) is a powerful laser-initiated photochemical reaction, involving the use of a photoactive dye (photosensitizer) activated by light of a specific wavelength in the presence of oxygen. Application of PDT in periodontics such as pocket debridement, gingivitis, and aggressive periodontitis continue to evolve into a mature clinical treatment modality and is considered as a promising novel approach for eradicating pathogenic bacteria in periodontitis.