Restorative dentistry

We are blessed with a dynamic masticatory system
which allows us to function and exist. It is a highly
intricate unit and primarily related to chewing, speech
and swallowing. The ever so delicate balance between
the various components of the system is monitored by
the neuromuscular control.(1) Maxillo-mandibular
relationships establishment has got the attention of
prosthodontists ever since the dynamic and static
positions of the condyles in the glenoid fossa were
interpreted and understood. In an edentulous patient,
the teeth along with periodontal nerves are lost.

ABSTRACT: Endodontic treatment involves removal of infected tissue and microorganisms from within the root canal space to prevent further infection of the periradicular tissues as well as to allow healing of these tissues. This critical process involves the use of some chemical substances for disinfection of the root canal space. Studies have shown that contemporary chemical agents do not achieve complete disinfection, and have other disadvantages like weakening of the tooth structure, predisposing to fracture of the tooth. Recently, there has been a growing trend to seek natural remedies as part of dental treatment. This may be termed as ethnopharmacology or phytotherapy. This paper aims at providing a review that focuses on the natural agents and procedures that have been evaluated in endodontics.
KEYWORDS: Endodontics, Alternative dentistry, Naturopathy, Aryuveda, Homeopathy, Aromatherapy, Hypnosis.
| Dr  VINEET  VINAYAK | dr VINEET vinayak

The use of the removable partial denture to restore the posterior edentulous space continues to be a viable treatment option for patients who are not candidates for cantilever fixed prosthesis or dental implants because of the nature of the remaining teeth and bony support, the anatomy of the residual ridges, or financial constraints. The construction of removable partial denture is a delicate procedure since the prosthesis is supported by two different tissues namely teeth and mucosa. The different resiliency of these supporting tissues may lead to instability of the prosthesis. This article reviews various impression techniques that aim to equalize the masticatory load between teeth and edentulous areas thus enhancing the stability of partial denture during function and preserving the residual oral structures.

j o u r n a l o f d e n t i s t r y 4 0 s (2 0 1 2) e 2 5 – e 3 3 a b s t r a c t Objectives: The mechanism of tooth bleaching using peroxide oxidizers is not fully understood. It is unknown whether peroxide radicals make teeth whiter by deproteinizing, demineralizing, or oxidizing tooth tissues. This study was designed to define the mechanism of tooth bleaching and determine which of tooth enamel chemical components is/are affected by bleaching. Methods: Sixty sound teeth were collected from adult patients. The teeth were divided into 6 equal groups (n = 10). Groups 1, 2, 3 and 4 were treated for 4 days with one of the following solutions: deproteinizing (NaOH) that removes organic content, demineralizing (EDTA) that decalcifies the mineral content, oxidizing (H 2 O 2) and distilled water (control). Group 5 and 6 were pre-treated with either deproteinizing or demineralizing solutions before treating them with oxidizing solutions for 4 days. Changes in enamel elemental ratios, crystallinity index and tooth shade parameters of the treated teeth were examined by means of EDS, Raman spectroscopy and shade-spectrophotometry. The data obtained was analysed with Wilcoxon Signed-Ranks Test, and the statistical signicance was set at p < 0.05. Results: Tooth deproteinization increased the lightness by 4.8 AE 2.78, tooth demineralization resulted in 8.5 AE 5.68 decrease in the lightness and tooth oxidization induced 19.9 AE 6.58 increase in the lightness. Oxidization of the deproteinized teeth did not influence shade parameters, but oxidation of the demineralized teeth resulted in 10.7 AE 5.88 increase in the lightness. Conclusion: Hydrogen peroxide does not induce significant changes in tooth enamel organic and inorganic relative contents, and it whitens teeth just by oxidizing their organic matrix. These findings are of great clinical significance since they explain the mechanism of tooth bleaching, and help understanding its limitations and disadvantages.

ABSTRACT: Success or failure of endodontic treatment depends, among other parameters, on an accurate determination of the working length. Electronic apex locators (EALs) are a routinely used procedure in endodontic practice; yet their accuracy has been reported to vary from 35%  to 100%. The operating systems of the EALs (frequency or impedance quotient) and different investigative methodologies explain the higher accuracy obtained with the current generation of devices. It is difficult to draw conclusions on the basis of the results obtained with the new generation EALs because of research variables that can influence the results. KEYWORDS: Apex locators, Endodontics, Root apex, Working length
| Dr VINEET VINAYAK | |Dr VINEET VINAYAK |

Objective: The aim of this study was to compare the vertical margin gap distance of fixed-fixed and cantilever bridges made of two types of ceramics, translucent full-contour zirconia and press-veneered zirconia. Materials and Methods: A total number of twenty samples were constructed then divided into two equal groups according to the design of the bridge. Each group was then subdivided into two subgroups according to the material of construction.Vertical marginal gap distances were measured and statistically analyzed. Results: fixed-fixed full contour zirconia showed the lowest mean vertical margin gap distance followed by fixed-fixed veneered zirconia, cantilever veneered zirconia, and cantilever full-contour zirconia (21.01±9.63 µm, 24.99±7.52 µm, 39.17±8.3 µm and 63.26±13.92 µm respectively). Conclusion: The marginal gap distancesfor the testeddesigns and materials were within the clinically acceptable range. However the effect of the cantilever design should be further investigated.

High flexural strength of computer-aided manufacturing resin composite blocks (CAD/CAM RCBs) are required in clinical scenarios. However, the conventional in vitro approach of modifying materials' composition by trial and error was not efficient to explore the effective components that contribute to the flexural strength. Machine learning (ML) is a powerful tool to achieve the above goals. Therefore, the aim of this study was to develop ML models to predict the flexural strength of CAD/CAM RCBs and explore the components that affect flexural strength as the first step. The composition of 12 commercially available products and flexural strength were collected from the manufacturers and literature. The initial data consisted of 16 attributes and 12 samples. Considering that the input data for each sample were recognized as a multidimensional vector, a fluctuation range of 0.1 was proposed for each vector and the number of samples was augmented to 120. Regression algorithms-that is, random forest (RF), extra trees, gradient boosting decision tree, light gradient boosting machine, and extreme gradient boosting-were used to develop 5 ML models to predict flexural strength. An exhaustive search and feature importance analysis were conducted to analyze the effective components that affected flexural strength. The R 2 values for each model were 0.947, 0.997, 0.998, 0.983, and 0.927, respectively. The relative errors of all the algorithms were within 15%. Among the high predicted flexural strength group in the exhaustive search, urethane dimethacrylate was contained in all compositions. Filler content and triethylene glycol dimethacrylate were the top 2 features predicted by all models in the feature importance analysis. ZrSiO 4 was the third important feature for all models, except the RF model. The ML models established in this study successfully predicted the flexural strength of CAD/CAM RCBs and identified the effective components that affected flexural strength based on the available data set.

Annual failure rates in posterior stress-bearing restorations are: 0% to 7% for amalgam restorations, 0% to 9% for direct composites, 1.4% to 14.4% for glass ionomers and derivatives, 0% to 11.8% for composite inlays, 0% to 7.5% for ceramic restorations, 0% to 4.4% for CAD/CAM ceramic restorations, and 0% to 5.9% for cast gold inlays and onlays.

Dental caries is a multifactorial microbial disease that affects tooth hard tissue leading to destruction of its mineral and
organic components. The current work reviewed the development of caries assessment methods and excavation concepts in the past two centuries. In the late ninetieth century, G.V. Black introduced a classification of dental caries, as well as established the principals of tooth preparation, based on his understanding of the nature of the disease. However, due
to the great development of dental materials and caries detection methods, most of Black’s principals are no longer valid nowadays. In light of the minimal invasive philosophy, several new caries excavation concepts were introduced. These concepts converts ‘old’ Black’s caries excavation concept of “extension for prevention” to “prevention of extension”. Since 2000 the concepts of caries excavation have greatly changed due to the popularity of the ‘partial caries removal’ concept.
As an example of this new ‘conservative’ vision, the “Fédération Dentaire Internationale” (FDI) (World Dental Federation) approved the atraumatic restorative technique (ART) as one of the caries excavation methods in 2002.
Keywords: Caries; Extension For Prevention; Caries Excavation; Minimally Invasive Technique; Atraumatic Restorative Technique.

Introduction
For PEEK to be used as a valid material for dental restorations, much evidence is needed regarding its clinical application. This includes search for certain characteristics like good mechanical and biological properties. The purpose of this review was to observe and analyze the clinical use of PEEK reported in the previous literature. Until now, this has never been done before.
Material and Methods
A combined electronic search was carried out via PubMed (Medline) database using different key words (dent* AND impl* AND peek) and (peek, dental, clinical), respectively.
The review method involved a systematic screening of all the studies on the basis of titles and abstracts to determine whether they met the inclusion criteria. The full text of the studies was then reviewed to ensure complete relevance of the included studies. Constructing tables summarizing the most important findings reported in the included studies did export of relevant data. Several descriptive statistics were done as a quantitative method for the description of data. All analysis was done using GraphPad Prism 8.0 software.
Results
In total 13 clinical studies were included in the review. 9 studies suggested the use of PEEK as a prosthesis framework. As a crown, PEEK was mentioned in 2 studies. One study used it as a healing abutment and 2 other studies as an abutment.
Conclusion
It can be concluded that PEEK is a promising material for use in restorative dentistry and if combined with proper clinical evidence and in-vitro outcomes, it could be suggested as a valid alternative for some restorative materials.

GV Black proposed a classification for recording caries which served the purpose efficiently for almost 100 years. Owing to its inbuilt shortcomings and current knowledge on cariology and induction of modern technology and restorative materials, Black's philosophy has been rendered despondently ineffective. Though various more comprehensive classifications and caries management systems have been evolved but Black's classification remains popular tool for recording of caries worldwide. The similar situation is found among dental professionals in Pakistan. This study was planned with the objective to know the reason for not using other classification systems and awareness about the existence of newer systems among Operative Dentistry / cariology specialists or teachers. A content validated close-ended questionnaire was used as a tool for this survey based study. The questionnaire based on two-point Likert scale with options of ―Yes ―and ‗No‖ comprising of ten simple queries regarding Black's caries classification was sent personally to all those who showed willingness to participate in the study and was recollected within 15 days. 85% of the participant agreed that Black's classification focuses on treating dental cavities and not the carious process itself and 95% were aware of existence of more conservative modes of caries classification. Majority confirmed that Black's classification isn't compatible with minimal interventional approach to dental treatment. Even then, this is the chief classification that is followed in dental schools in Pakistan. Black's classification isn't well-suited for existing philosophy for caries management and dental profession should switch over to already existing more compatible classification.

(Abstract): The aim of this study is to determine the advantages of using caries-revealing dyes in differentiating between infected and affected dentin during restorative treatment. Material and method: The patients selected for this study presented to the Discipline of Cariology and Restorative Odontotherapy within the faculty of Dental Medicine, UMf "Gr. T. Popa" Iaşi, for a restorative treatment of carious lesions. sable seek dye was applied in order to differentiate the infected dentin from the affected one at the level of 26 molars and premolars that presented cavi-tary occlusal caries. Results: In all cases, the dye remained fixed in the cavity in the dentin, but the color intensity was different. Due to the difference in the intensity of the staining produced by the caries detector, it is possible to differentiate between the infected tissues with a much more intense staining (dark green) and the affected tissue with a less intense staining (light green). Conclusions: The contrast obtained by the caries developer can help to identify carious dentin if tactile discrimination is not available, and can be used as a complementary means of diagnosis.

Rhinoscleroma (RS) is defined as a specific disease of chronic nature involving upper respiratory passages and nasal area and is caused by Klebsiella rhinoscleromatis bacilli. The diagnosis of RS is based on the identification of mickulicz cells (MCs). These cells are mostly seen during granulomatous phase & absent during the sclerotic phase. The present case report highlights the diagnosis and management of Rhinoscleroma.

Aim: To evaluate the effect of different endodontic irrigation regimens on the sealing ability of resin composite restorations placed within the pulp chamber using contemporary simplified adhesives. Materials and Methods: Seventy-five extracted human molars were divided into six groups. After de-roofing the pulp chamber and extirpating the pulp, pulp chambers were bonded with either G-Bond after irrigation with saline (Group 1); ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) (Group 2), and NaOCl + QMix (Group 3) or bonded with OptiBond adhesive after irrigation with saline (Group 4), EDTA and NaOCl (Group 5), and NaOCl + QMix (Group 6). All the samples were restored with composite. Ten samples per group were assessed for dye penetration. Fifteen samples were assessed under scanning electron microscope. Data were statistically analyzed using Mann-Whitney and Kruskal-Wallis tests at a significance level of P < 0.05. Results: Both EDTA + NaOCl or NaOCl + QMix pretreatment of pulp chamber dentin significantly reduced microleakage scores in adhesive OptiBond, but did not affect the microleakage of G-Bond. Conclusions: EDTA + NaOCl or NaOCl + QMix irrigation of the pulp chamber was not deleterious to the bonding of any of the adhesives tested.

The concepts of traditional full mouth reconstruction have been used in the rehabilitation of a patient. A practical full mouth rehabilitation technique has been described combining the chairside advantages of the programmed reconstruction with the laboratory advantages associated with the complete mouth simultaneous rehabilitation. The particular case involved rehabilitation with fixed and removable prosthodontic therapy in accordance with the conventional and the contemporary prosthodontic treatment options and principles.

The use of the removable partial denture to restore the posterior edentulous space continues to be a viable treatment option for patients who are not candidates for cantilever fixed prosthesis or dental implants because of the nature of the remaining teeth and bony support, the anatomy of the residual ridges, or financial constraints. The construction of removable partial denture is a delicate procedure since the prosthesis is supported by two different tissues namely teeth and mucosa. The different resiliency of these supporting tissues may lead to instability of the prosthesis. This article reviews various impression techniques that aim to equalize the masticatory load between teeth and edentulous areas thus enhancing the stability of partial denture during function and preserving the residual oral structures.

Personal identification in natural and manmade disasters can be made by using methods like DNA analysis, finger prints, carbon 14 enamel dating, rugaescopy, cheiloscopy, skull shape and size, dental structure chart and various denture labeling methods. Implementations of labelled dentures system linked with AADHAAR CARD, a unique identification card of India citizen can be important in identifying people who have lost their memory or in states of unconsciousness or in identifying the bodies of those who have died in natural calamity, disasters, accident etc. Identification is an essential issue in all medico legal investigation because a wrong identity may pose a problem in delivering justice. Positive identification through labelled dentures plays a key role in forensic odontology. A number of labeling systems are available and are broadly classified into either surface marking methods or inclusion methods. This article describes various methods involved in labeling dentures and suggests unique method of labelling dentures linked with Aadhaar ID card in India.

Objectives. The aim was to evaluate the color stability and water uptake of two hybrid composite resins polymerized in two different conditions after exposure to commonly consumed beverages. In addition, the effect of repolishing and bleaching on the stained composite was evaluated. Methods. Eighty specimens (12 mm
12 mm
3 mm) were made from two hybrid composite resins of shade A2. Forty specimens of each composite were divided into two groups (n = 20 per each) according to the curing method used (hand light cure HLC or oven light cure OLC). Then each group (HLC or OLC) was subdivided randomly into four sub-groups (n = 5), which were immersed for 60 days in different beverages (distal water, coffee, tea and pepsi) and incubated at 37C. Water uptake was measured during this time and followed by measurement of color difference (DE) by using a spectrophotometer. After complete staining, repolishing (grit 4000 FEPA at 300 rpm under water) and bleaching (40% hydrogen peroxide bleaching gel) were conducted. The repolished and bleached specimens were submitted to new color measurements. Results. Color value of the specimens immersed in tea displayed the highest statistically significant (p < 0.05) mean color difference (DE) compared to other beverages, whereas the DE value of pepsi was significantly lower than the others. After staining of the composite resins, both the bleaching and repolishing were able to reduce the DE value. Conclusions. All beverages used affected the color stability of tested composite resins. The effect of beverages on color change of composites depends on type of beverage and water uptake value of resins used. A superior whitening effect was obtained with repolishing technique compared to bleaching.

a r c h i v e s o f o r a l b i o l o g y 5 7 ( 2 0 1 2 ) 1 3 1 -1 3 8 Glass-ionomer cement Antibacterial activity Cell culture Mechanical properties a b s t r a c t Objectives: To characterize the mechanical and biological properties of a resin-modified glass ionomer cement (RMGIC) containing doxycycline hyclate.

Aim: This study aimed to evaluate the microleakage of Class V restorations filled with a 7th-generation self-adhesive composite.

Materials and methods: In 40 permanent premolars and 80 primary canines, 160 Class V cavities were prepared, which were filled with four restorative materials (n of each material = 20 permanent and 20 primary restorations): control: nonbonded composite (Heliomolar), GI: glass ionomer (Fuji IX GP), BC: bonded Heliomolar, SC: self-adhesive composite (Embrace WetBond). Dye penetration was scored 0 to 4 at 160 coronal and 160 gingival margins under 40× magnification by two examiners. The data were analyzed with Mann-Whitney U test (α = 0.01).

Results: The mean microleakages of the materials (in the order of ‘control, GI, BC, SC’) at each margin-dentition (n = 20 margins) were: coronal-permanent (3.25 ± 0.72, 2.75 ± 0.72, 0.35 ± 0.59, 2.7 ± 0.73), coronal-primary (3.3 ± 0.66, 2.85 ± 0.88, 0.55 ± 0.76, 2.65 ± 1.14), gingival-permanent (3.35 ± 0.67, 0.85 ± 0.67, 2.95 ± 0.83, 1.55 ± 1.23), and gingival-primary (3.25 ± 0.72, 0.85 ± 0.59, 2.85 ± 0.89, 2.85 ± 0.93). Compared with the control microleakage at each margin-dentition (each group’s n = 20 margins), BC microleakage was significantly lesser at coronal margins only (p = 0.000), GI microleakage was lower at gingival margins only (p = 0.000), and SC microleakage was smaller at gingival margins of permanent teeth only (p = 0.000). After combining coronal/gingival margins, only SC microleakage in primary dentition (n = 40 margins) was not significantly lesser than the control in primary teeth (p = 0.018); and microleakage of all other material-dentitions were lesser than corresponding control-dentitions (p = 0.000). Permanent and primary teeth had similar results for all material-margins (p > 0.5) except for SC at gingival margins (p = 0.001).

Conclusion: SC should be used only at gingival margins of permanent teeth.

Clinical significance: Application of self-adhesive composite should be limited to gingival margins of permanent teeth.

A b s t r a c t Clinical longevity of composite resin restorations is a significant problem in adhesive dentistry. Most of the current simplified adhesives present good immediate bonding, but the bond strength gradually falls over a period due to biodegradation at the resin‑dentin interface. Various strategies have been proposed to improve the durability of resin‑dentin bond including the use of matrix metalloproteinases inhibitors and collagen cross‑linkers, biomimetic remineralization, ethanol wet bonding, to improve the physical and mechanical properties of the bonding substrate, i.e., dentin. However, all are under preliminary research and without any conclusive evidence. Therefore, this paper addresses the current challenge in dental adhesion, i.e., poor durability of resin‑dentin bond and introduces the concept of dentin biomodification as an alternative way for improving the long‑term bonding effectiveness of current adhesives to dentin and also provides an overview of a synthetic collagen cross‑linking agent carbodiimide (EDC) including its mechanism of action, literature review of studies evaluating EDC, variables associated with its use and its cytotoxicity. Search was performed across the electronic databases (PubMed, Ebsco host, and Google search engine) to identify manuscripts for inclusion, using the keywords: carbodiimide, dentin bonding, durability, resin‑dentin interface, and collagen cross‑linking. Thirty‑five articles were finally included, and the last search was made in February 2016.

Increased Mercury release due to exposure to electromagnetic radiation as a limiting factor for using dental amalgam

M. Paknahad, A. Dehghani, S. Jarideh, M. Haghani, H. Mozdarani, Dr. G. Mortazavi *, J. Eslami, S.M.J Mortazavi

Background: Although it is one of the most toxic nonradioactive elements, mercury is widely used in dental amalgam. Mercury is a toxic element which can damage various organs such as central nervous system, renal, respiratory and hematologic systems. The adverse health impacts associated to exposure to some common sources of electromagnetic fields including laptop computers, mobile phones, MRI and mobile phone jammers have been evaluated by our laboratory in our previous investigations. In this study, we aimed to evaluate the effect of X ray exposure on microleakage of amalgam restoration. Materials and Methods: Standardized class V cavities were prepared on the buccal surfaces of 46 non-carious freshly extracted human premolars. The teeth were randomly divided into experimental and control groups. Experimental group were exposed to X-ray using an intraoral radiography machine at 60 kVp, 0.1 s, 7 mA with 2.5 mm Al total filtration. The absorbed dose was 245.0 ± 0.5 µGy. All specimens were placed in 2 % basic fuchsin solution for 24 hours. Then the specimens were sectioned and microleakage was assessed according to dye penetration using a stereomicroscope. Statistical analysis was performed with the Mann-Whitney U-test. Results: Microleakage was significantly higher in the X-ray exposed teeth compared to those of the non-irradiated samples. Conclusion: The results of the present study suggest that X-ray exposure increased microleakage of amalgam restorations

Ultrasonic irrigation has been proved for its remarkable cleaning efficiency in the field of endodontics. But its role in endodontic re-treatment has been understated. There is not much data available to understand the effect of ultrasonic irrigation for the evaluation of cleanliness of dentinal tubules when it is used with or without chloroform, a gutta percha solvent during endodontic retreatment.
Dr VINEET VINAYAK | dr VINEET VINAYAK |

ABSTRACT Background: Ultrasonic irrigation has been proved for its remarkable cleaning efficiency in the field of endodontics. But its role in endodontic re-treatment has been understated. There is not much data available to understand the effect of ultrasonic irrigation for the evaluation of cleanliness of dentinal tubules when it is used with or without chloroform, a gutta percha solvent during endodontic retreatment. Aim: To compare the influence of ultrasonic irrigation with syringe irrigation on cleanliness of dentinal tubules after gutta perch removal for endodontic retreatment with or without the use of chloroform a gutta percha solvent using scanning electron microscope (SEM). Materials  and  Methods: Freshly extracted 45 human mandibular premolar teeth for periodontal and orthodontic reasons were taken and were occlusally adjusted to a working length of 19 mm. The root canals of all teeth were prepared chemo mechanically to a master apical file size 40 and were divided in various groups. In Group 1 (n = 5; control group), the canals remained unfilled. In Groups 2 and 3 (n = 20 each), the canals were filled using lateral compaction with gutta-percha and AH plus sealer, removal of root fillings was undertaken after 2 weeks using Gates Glidden drills and H files without chloroform in Group 2 and with chloroform in group 3. The specimen of Group 2 and 3 were further divided into two subgroups I and
II (n=10). In subgroup I, irrigation was done using side vented needles and sodium hypochlorite. In subgroup II irrigation was done using passive ultrasonic irrigation with sodium hypochlorite. Thereafter, the roots were split and the sections were observed under SEM. The number of occluded dentinal tubules /total number of dentinal tubules were calculated for the coronal, middle and apical third of each root half. Statistical analysis was performed using one-way ANOVA followed by Tukey’s test using standardized technique. Result: Results indicated that the cleanest dentinal tubules were found in the control group (Group 1 where the canals were unfilled) followed by the non chloroform group with ultrasonic irrigation (Group 3 subdivision II) followed by chloroform group with ultrasonic irrigation (Group 2 subdivision II), the non chloroform group with syringe irrigation (Group 3 subdivision I) and least cleanliness was found in the chloroform group with syringe irrigation (Group 2 subdivision I). Conclusion: Under the limitations of this study it could be concluded that both ultrasonic and syringe irrigation showed cleaner canals when chloroform was not used. Irrigation when done with ultrasonics leads to cleaner tubules than syringe irrigation. Hence, mechanical methods of retrieval in conjunction with use of passive ultrasonic irrigation should be a part of retreatment protocol.
dr VINEET VINAYAK  | dr VINEET VINAYAK|

Objective: This study evaluated the effectiveness of three surface treatments on repair shear bond strength (SBS) of aged composites. Methods: 120 cylindrical samples made of a micro-hybrid composite (Clearfil AP-X) were randomly assigned to one control and three experimental groups (n=30) after water storage (3 weeks). All experimental groups included surface roughening with diamond burs. The subsequent treatments were: group1. Only (self-etching) bonding, group2. Silane and bonding, and group3: phosphoric-acid etching, silane, and bonding. The composites were repaired with the same brand and were aged (water storage [48h] and thermocycling [2000 cycles]). Each group was divided to two subgroups of n=15: New: water storage at 37°C for one week; Old: water storage for 6 months. The SBS was tested. The fracture mode was assessed under 40x magnification. Results: the mean SBS values (MPa) for the study subgroups were: Control (new:3.38±1.6, old:1±0.76), group1 (new:27.3±1.8, old:25.7±1.9), group2 (new:59.1±7.9, old:50.8±4.6), and group3 (new:48.5±8.6, old:39±3.5). A significant influence of the conditioning method and duration of water storage was observed (p<0.01 [two-way ANOVA]). The SBS of all groups were significantly different from those of the other ones (all p values<0.01 [Tukey's]). The longer time of water storage reduced the repair bond strength in all of the experimental groups, significantly (p<0.01). While the groups control and 1 showed approximately 100% and 75% adhesive failures, respectively, the group 2 and 3 respectively demonstrated about 75% mixed and cohesive failures. The Weibull analysis showed that the group 2 and 1 had the lowest and the highest probabilities of failure among the experimental groups, respectively. Conclusion: All the experimental groups produced acceptable SBS levels, however the use of silane and bonding system showed the most superior results. Acid etching reduced the SBS. Clinical Significance: To achieve a durable composite-composite bond, it is highly recommended besides selective grinding of the surface to be repaired to use specific combinations of silane primers and bonding agents, without the need for acid etching the composite surface.

Background: Pain is considered a key symptom associated with possible impairment of oral-health-related quality of life and its assessment is important for the planning and evaluation of preventive and treatment effort. The tools for assessing pain must therefore be valid and consistent. The objective of this study was to assess dental patients' level of pain based on the clinical diagnosis of their dental condition and the correlation between two pain assessment scales, Visual analogue scale (VAS) and the Full Cup Test (FCT), for the assessment of pain among dental patients. Methods: A total of 185 patients presenting at the University of Benin Teaching Hospital dental outpatient clinics with various forms of orofacial pain were included in this study. The mean VAS scores and mean FCT scores for the different dental conditions were compared. Agreement between VAS and FCT was evaluated using the Intra-class correlation (ICC) coefficients and Cronbach alpha coefficient was also calculated to assess consistency of the two pain scales. Results: Majority i.e. 95.1, 96.2 and 100% who presented with acute pulpitis, acute apical periodontitis and peric-oronitis respectively, presented with moderate to severe pain levels (p < 0.05). Only 25.9 and 4% who presented with chronic marginal gingivitis and chronic pulpitis respectively presented with no pain (p < 0.05). A large proportion (75%) of patients with no pain had single diagnosis while more than half (52.1%) of those who presented with severe pain had multiple diagnoses (p = 0.025). The mean VAS and FCT scores for acute pain were 6.1 ± 2.1 and 5.9 ± 2.4 respectively and for chronic pain 3.9 ± 2.7 and 3.7 ± 2.7 respectively (P = 0.001). The interclass correlation coefficient revealed that the mean VAS and FCT scores were statistically correlated and reliable with a Cronbach alpha coefficient of 0.85. Conclusion: It can be concluded that patients who presented with either acute or chronic dental conditions may experience moderate to severe level of pain, with patients with multiple diagnoses experiencing more severe pain, and there is a correlation between the VAS and FCT for pain assessment among dental patients.

Pulp is a vascular and vital part of a healthy tooth. Pulps of teeth with breached enamel become vulnerable to infections and succeeding necrosis if the lost tissue remains unreplaced. The dentists replace it using restorative materials which are not friendly to the pulp. Pulp protection measures are therefore necessary to be taken to save pulp vitality during a restorative procedure. Concepts about pulp protection have changed with time. Previously, pulp was considered under threat due to toxicity or heat conductivity of restorative materials. It is now believed that ingress of bacteria under a restoration causes pulp inflammation. The materials with enhanced sealing ability protect pulp very effectively. Contemporary pulp protection protocol were therefore, put forward 12-14 years ago. This study is designed to assess clinical execution of these protocols in Pakistani institutions of undergraduate dental education. METHODS: A meticulously designed questionnaire was circulated in various dental schools situated in various cities of Pakistan. Data collected was analyzed with the help of a biostatistician using SPSS version 18. RESULTS: If the remaining dentin thickness is more than 1.5 mm, there is no need to use any cement base or liner for pulp protection. 89 % of respondents do not care about dentin thickness before using liners / bases. Materials employed for cavity lining may be a cement, varnish or dentin adhesive. 70 % of them consider it essential to give cement lining under the restorations. A vast majority uses Calcium Hydroxide as base and 90 % of them cover the whole exposed dentin with it. Dentin sealer and Dentin adhesives are not used as pulp protecting agent respectively by 76 % and 63 % of participants of the study. CONCLUSION: Contemporary protocols for pulp protections are not being followed in the institutions which participated in the survey.

Facial paralysis is a disfiguring disorder that has a great impact on the patient. Facial nerve paralysis may be congenital or neoplastic or may result from infection, trauma, toxic exposures, or iatrogenic causes. The most common cause of unilateral facial paralysis is Bell's palsy, more appropriately termed 'Idiopathic facial paralysis' (IFP). In Bell's Palsy, the onset is rapid, unilateral and there may be an ache beneath the ear. The weakness worsens over one to two days. Bell palsy is an acute, unilateral, peripheral, lower-motor-neuron facial-nerve paralysis that gradually resolves over time in 80-90% of cases. In an upper motor neuron lesion eg stroke, the forehead is spared since this region is bilaterally represented in the cortex. Looking for 'forehead sparing' is thus a way of differentiating between upper and lower motor neuron causes of facial weakness.
| Dr VINEET VINAYAK| dr VINEET vinayak

The aim of the study was to evaluate antibacterial activity of composite materials modified with calcium fluoride against cariogenic bacteriaS. mutansandL. acidophilus. One commercially available conventional light-curing composite material containing fluoride ions (F2) and two commercially available flowable light-curing composite materials (Flow Art and X-Flow) modified with 1.5, 2.5, and 5.0 wt% anhydrous calcium fluoride addition were used in the study. Composite material samples were incubated in 0.95% NaCl at 35°C for 3 days; then dilution series ofS. mutansandL. acidophilusstrains were made from the eluates. Bacteria dilutions were cultivated on media afterwards. Colony-forming unit per 1 mL of solution (CFU/mL) was calculated. Composite materials modified with calcium fluoride highly reduced (p&lt;0.001) bacteria growth compared to commercially available composite materials containing fluoride compounds. The greatest reduction in bacteria growth was observed for composite ma...

The absence of an associated part of an ear may be a considerable aesthetic drawback which affects the patient's scientific discipline and social behaviour. Prosthetic rehabilitation of auricular defects is often a demanding procedure due to broad variety of clinical approaches and a wide array of treatment options. This can be corrected surgically, prosthetically or through a combination of these approaches, however the choice of treatment depends on patient. Auricular prostheses have been retained by methods including implants, adhesives and spectacle frames however the selection of repair ultimately depends on patient factors, amount of soft tissue loss, and replacement of auricular defect. The patients opt for prosthetic rehabilitation over surgical procedures and retention became an essential issue in this approach. Replacement of such parts for restoring their loss of function and esthetics is done by using numerous biocompatible materials, strategies we tend to select new materials and used latest technology to ensure the best quality prosthesis. This case report describes the clinical and laboratory procedure for fabricating an auricular prosthetic device for a patient with trauma associated unilateral auricular deformity.

Osteonecrosis of the jaw has been described in patients taking bisphosphonates after oral surgery procedures, including the placement of dental implants. The success of these procedures depend on the fixation of the implants which, in turn depends on the strength of the bone that holds them. Bisphosphonates are anti-resorptive drugs that act specifically on osteoclasts, thereby maintaining bone density and strength. These drugs inhibit bone resorption and are used to treat a range of pathologies, including Paget disease, osteoporosis, multiple myeloma and metastases associated with breast or prostate cancer. At present, there is no effective treatment for bisphosphonate induced osteonecrosis, so prevention is extremely important. Since quality of life deteriorates for those suffering osteonecrosis, maximum precautions should be taken with patients at risk. The aim of this study was to conduct a systematic review in order to evaluate whether patients on BP therapy are appropriate candidates for dental implants as compared to patients not taking BP drugs with respect to successful implant osseointegration and the risk of developing bisphosphonaterelated osteonecrosis of the jaw.

Background: The use of resin-based dentin adhesives has become routine in dentistry. As a result, marginal leakage in conjunction with bonded restorations is greatly reduced, however true adhesive restorative materials do not exist at present, and the bonding is due to micromechanical retention of the resinous material to the tooth. As some endodontic sealing materials have high bond strength to dentin but may suffer from solubility and improper sealing ability. Consequently, evaluation of some properties of these materials may be advantageous for proper selection of which type to be used. Aim: The aim of this study was to evaluate the sealing capacity and the bond strength of two different types of root canal sealing materials. Methodology: A total of 20 single-rooted human mandibular premolar teeth with single canals were instrumented using step back technique. The prepared canals were obturated with lateral compaction technique using gutta percha and two different types of sealer...

Dentistry is a combination of art and science but when a Prosthodontist can understand the patient needs, the final outcome of the treatment is more successful. A completely edentulous patient undergoes many consequences as a result of loss of teeth among them facial esthetic disfigurement as a result of slumped cheeks is a serious problem as it has got some psychological effect on the patient. There are many lines of treatments available both surgical and non-surgical, this article focuses on nonsurgical management of a patient with slumped cheeks with the fabrication of 4 different types of cheek prop prosthesis.

Background: The use of resin-based dentin adhesives has become routine in dentistry. As a result, marginal leakage in conjunction with bonded restorations is greatly reduced, however true adhesive restorative materials do not exist at present, and the bonding is due to micromechanical retention of the resinous material to the tooth. As some endodontic sealing materials have high bond strength to dentin but may suffer from solubility and improper sealing ability. Consequently, evaluation of some properties of these materials may be advantageous for proper selection of which type to be used. Aim: The aim of this study was to evaluate the sealing capacity and the bond strength of two different types of root canal sealing materials. Methodology: A total of 20 single-rooted human mandibular premolar teeth with single canals were instrumented using step back technique. The prepared canals were obturated with lateral compaction technique using gutta percha and two different types of sealers; 10 with resin-based sealer (Group 1) and 10 with silicone-based sealer (Group 2). Each root was sectioned horizontally into 2 slices, each slice is 2mm, the coronal part just below the cemento-enamel junction was used in the push-out shear bond strength test. The following 2 mm slice of the filled roots was used in the sealing capacity or permeability test, using fluid filtration device. Permeability was measured by tracing the displacement of an air bubble on top of a millimeter scale for 24 hours. A random disc from each group was kept for qualitative evaluation of dentin\sealer interfaces with the scanning electron microscope. The results were subjected to statistical analysis using Kruskal Wallis and Mann Whitney tests. Results: The data indicates that the mean fluid leakage value of the silicone-based sealer (Group 2) was less than that of the resin-based sealer (Group 1). While the resin-based sealer (Group 1) exhibited higher statistically significant mean shear bond strength than silicone-based sealer. Conclusion: Improved bonding of sealers to dentin does not necessarily mean the improvement of sealing ability.

Road accidents, industrial accidents and engaging in sporting activities are responsible for most fractures of the midface. A careful history, oral and facial examination and radiographs are imperative whenever any fracture is suspected. Treating edentulous or partially dentate patients of maxillary /mandibular fracture with gunning splints is the standardized procedure followed. For the elderly patients it becomes difficult to do open reduction surgery due to various complications and compromised medical conditions. The complication rate of infection or mal-union is higher as compared to fractures in younger dentulous patients. The present article discusses a case where a patient who had met a road accident was treated with gunning splint which was customized suiting the prevailing condition as only few teeth were present at the time of trauma.

a r c h i v e s o f o r a l b i o l o g y 5 7 ( 2 0 1 2 ) 1 3 1 -1 3 8 Glass-ionomer cement Antibacterial activity Cell culture Mechanical properties a b s t r a c t Objectives: To characterize the mechanical and biological properties of a resin-modified glass ionomer cement (RMGIC) containing doxycycline hyclate.

With great interest, we have read the article by Daokar et al. entitled “Assessment of Oxidative Stress Induced by Various Restorative Materials: An In Vivo Biochemical Study” that is published in the journal of International Oral Health 2016; 8(6):670-674. Daokar et al. investigated the in vivo oxidative stresses induced by dental amalgam, composite resin, and glass ionomer cement (GIC). They showed that the patients treated with amalgam restoration revealed significantly higher values of oxidative stress as compared to composite and GIC at all the three-time intervals studied. Our lab at the non-ionizing department of the Ionizing and Non-ionizing Radiation Protection Research Center (INIRPRC) has performed experiments on the health effects of exposure to different sources of electromagnetic fields such as cellular phones [1-9], mobile base stations [10], Wi-Fi [11, 12], mobile phone jammers [13, 14], laptop computers [15], radars [2], dentistry cavitrons[16] MRI [7, 17] and Helmholtz coils [18, 19].

Although the paper authored by Daokar et al. addresses a challenging issue, it has some shortcomings. One of the shortcomings of this study comes from this point that the authors have ignored substantial evidence which indicates the role of exposure to electromagnetic fields (e.g. mobile phones, Wi-Fi and cordless phones) on oxidative stress induction [20-23]. It should be noted that in modern life, due to rapid advances in telecommunication technology, we are all surrounded by electromagnetic fields produced by a variety of sources. Daokar et al. in their study collected saliva samples before restoration and 24 h, 7 days, and 14 days after restoration. Therefore, alterations observed in salivary oxidative stress (MDA levels) could be simply due to frequent use of mobile phones or cordless phones.

Furthermore, it has been shown that exposure to low levels of mercury from dental amalgam fillings affects kidney tubular functions via oxidative stress[24]. As mercury level can be linked to oxidative stress, the key role of exposure to electromagnetic fields on the accelerated release of mercury from amalgam restorations that is fully addressed in our previous publications cannot be ignored [25-27]

RESUMO Objetivo: Avaliar o desempenho clínico de 5 protocolos alternativos de Tratamento Restaurador Atraumático (ART) após 2, 4 e 6 meses da restauração. Métodos: Trata-se de um ensaio clínico longitudinal, no qual 60 dentes necessitando de restaurações simples (uma superfície) foram submetidos ao tratamento restaurador atraumático convencional. Estes foram divididos aleatoriamente em 5 grupos: Grupo I – restaurado por Ketac Molar Easimix (3M ESPE, Brasil); Grupo II – Vitro Fill (DFL, Brasil); Grupo III – Vitro Fill + Clorexidina a 2% (Farmácia Roval, Brasil); Grupo IV – Vitro Fill + Diamino Fluoreto de Prata (DFP) a 30% (Cariestop 30%, Biodinâmica, Brasil); Grupo V – Vitro Fill + Clorexidina a 2% + DFP a 30%. Resultados: A sobrevivência das restaurações, independentemente do grupo, foi de 65,0%. O percentual de sucesso foi de 91,7% para o Grupo III e de 41,7% para o Grupo IV, respectivamente o de melhor e o de pior desempenho. Conclusões: O Grupo III obteve melhor desempenho clínico quando comparado aos outros grupos. Palavras-chave: Assistência Odontológica para Crianças; Cárie Dentária. ABSTRACT Objectives: To evaluate the clinical performance of 5 protocols of Atraumatic Restorative Treatment (ART) elapsed 2, 4 and 6 months of the restoration. Methods: On a longitudinal clinical study, 60 teeth, which were in need of simple restorations (one surface), were submitted to the conventional atraumatic restorative treatment. These were randomly divided in 5 groups: Group I – restorated with Ketac Molar Easimix (3M ESPE, Brazil); Group II – Vitro Fill (DFL, Brazil); Group III – Vitro Fill + 2% Clorexidine (Roval Pharmaceutics, Brazil); Group IV-Vitro Fill + 30% Silver Diamine Fluoride (SDF) (30% Cariestop, Biodynamics, Brazil); Group V-Vitro Fill + 2% Clorexidine + 30% SDF. Results: The restorations survival, independently of the group, was 65,0%. The success rate was 91,7% on Group III and 41,7% on Group IV, the groups which exhibited the best and the worse performance, respectively. Conclusions: Group III showed a better performance when compared to the other groups.

a r c h i v e s o f o r a l b i o l o g y 5 7 ( 2 0 1 2 ) 1 3 1 -1 3 8 Glass-ionomer cement Antibacterial activity Cell culture Mechanical properties a b s t r a c t Objectives: To characterize the mechanical and biological properties of a resin-modified glass ionomer cement (RMGIC) containing doxycycline hyclate.

High flexural strength of computer-aided manufacturing resin composite blocks (CAD/CAM RCBs) are required in clinical scenarios. However, the conventional in vitro approach of modifying materials’ composition by trial and error was not efficient to explore the effective components that contribute to the flexural strength. Machine learning (ML) is a powerful tool to achieve the above goals. Therefore, the aim of this study was to develop ML models to predict the flexural strength of CAD/CAM RCBs and explore the components that affect flexural strength as the first step. The composition of 12 commercially available products and flexural strength were collected from the manufacturers and literature. The initial data consisted of 16 attributes and 12 samples. Considering that the input data for each sample were recognized as a multidimensional vector, a fluctuation range of 0.1 was proposed for each vector and the number of samples was augmented to 120. Regression algorithms—that is, ra...

Ito ay isang article na naglalaman ng mga paalala para sa mga Pilipino/Filipino-proficient na pasyente pagkatapos silang mapastahan ng Composite (Tooth-colored Restorations), kasama ang pangangalaga nito. Maaari itong gamitin ng mga dental practitioners sa kanilang mga pasyente at maaaring gamitin ng general public para sa kanilang personal na kaalaman. (This is an article containing instructions for Filipino/Filipino language proficient patients after they received composite restorations, including their maintenance. This can be used by dental practitioners in practice and by the general public for their personal knowledge.)

Background: Health behaviours have direct influence to individuals' health and remain major explanatory factors for the differences in health-related outcomes. Aim: To investigate adolescents' hygiene behaviours, dietary behaviours and the associated dental and medical consultation. Materials and Methods: A cross-sectional survey that was carried out in twelve regions of Tanzania among school going adolescents. A structured questionnaire was used for data collection. Data processing and analysis was done using SPSS computer program version 20, whereby proportions, cross-tabulations for bivariate analysis and binary logistic regression in OR (95% CI) for multivariate were conducted. The level of significance was set at p-value ˂ 0.05. Results: 4,847 adolescents aged 11-17 years participated in the study. Slightly more than half (51%) exhibited good hygiene behaviours, 36.3% often consumed at least three sugary items, 76.2 % vegetables and 42.1% fresh fruits. Significantly larger proportions of older adolescents (55.6%), secondary school attendees (56.4%), adolescents whose fathers (55.8%) and mothers (54.5%) had secondary to university education demonstrated good hygiene behaviour as compared with their counterparts. The odds of having good hygiene behaviours were higher among those who had visited a medical doctor 1.4 (1.2, 1.6). Higher odds of frequent sugar consumption were seen among adolescents who had visited a dentist 1.6 (1.4, 1.9). Conclusion: Adolescents had good hygiene behaviours; tooth brushing being the most practiced behaviour. Sugar consumption frequency was noteworthy whereas eating vegetables was the most reported healthy eating behaviour. Good hygiene and frequent sugar consumption were positively associated with medical and dental consultation.