Aims: The aim of the present study is to evaluate the paper point technique (PPT) in curved canals, comparing this technique with the traditional electronic apex locator (EAL) evaluation. Materials and methods: A total of 100 root canals with at least 30° of curvature according to Schneider's criteria in unsalvageable lower molars were evaluated in the present study. The working length (WL) was measured comparing traditional EAL evaluation and PPT, as described in the literature; therefore, the maximum length a paper point returned dry, without any visible sign of wetness, was recorded as the canal length according to PPT. All statistical analyses were performed using student's t-test. The significance level was set at p < 0.05. Results: Between mean final EAL-WL (19.8 ± 0.4 mm) and mean paper points technique WL (19.2 ± 2.4 mm), there was a statistically significant difference, p < 0.05. Conclusion: The present study found that PPT is not suitable for estimating the location of the apical foramen (AF) in curved canals. Despite the fact that the mean WL determination using the PPT was only 0.5 mm short of the WL determined with the apex locator, the results showed a high variability witnessed by the high standard deviation (SD), making the proposed technique unpredictable. Clinical significance: The PPT alone cannot be considered a valid tool for WL determination. Despite this, it could be a valid support to confirm the EAL-WL, replacing the periapical X-radiation (X-ray) with instruments placed at WL and reducing this way the X-rays for the patient.

Aims: The effectiveness of cuttlefish bone powder (CBP) in inducing mineralization and cell migration of the osteoblast cell line (MC3T3-E1) was investigated. Materials and methods: The cytotoxicity of 0.5, 1, 5, 25, 50, 100, or 200 µg/mL CBP on an osteoblast cell line was evaluated using the 3-(4,5-dimethylthiazol-2-yl)—2,5-diphenyltetrazolium bromide (MTT) assay. A Boyden chamber assay was used to evaluate the migration of osteoblasts treated with 0.5, 25, or 100 µg/mL CBP. The mineral deposition of treated cells with CBP in the osteogenic medium was determined on days 7, 14, and 28 using alizarin red staining. The area of the calcified nodules was determined on day 28. Analysis of variance and the Mann–Whitney U test were used to compare the difference between the groups. The alkaline phosphatase (ALP) activity of the target cell treated with 0.5 µg/mL CBP was analyzed by using the ALP colorimetric assay kit. Results: All CBP test concentrations were nontoxic to the osteoblast cells. Cell migration after 16 hours in the 0.5, 25, and 100 µg/mL CBP group was 127, 112, and 113%, respectively, compared with the control. The calcified nodule formation on day 28 was greater than on days 7 and 14 and in control groups. ALP expression was found to increase significantly after 28 days of treatment with CBP. Conclusion: The results demonstrate that CBP induces mineralization and cell migration of the osteoblast cell line and the expression of the ALP enzyme. Clinical significance: The cuttlefish bone is a biomaterial that not only induces cell migration but also mineral deposition. The scaffold made from cuttlefish should be suitable for clinical use for bone regeneration.

Aim: The aim of the study was to compare the flexural strength of repair materials, silane-incorporated glass fiber, and metal fibers with conventional acrylic repair systems. Materials and methods: A total of 48 heat-cure denture base resin specimens were prepared and finished and divided into three groups of 16 acrylic specimens. In every group, the final repair samples were made by placing two acrylic specimens separated by a 4 mm space in a silicone mold to make a place for the repair. The final repair samples were eight per group. Group I (control) was repaired by filling the space with autopolymerizing resin and used as comparative specimens. For group II, 30 mm long metal wire (18 gauge) reinforcement air-abraded (with 50 µ alumina oxide particles) and treated with the adhesive primer was placed in the center of the groove. For group III, the glass fiber was immersed in a Monobond-S (Ivoclar) silane coupling agent for 10 minutes before being placed into the groove and air-dried. Twenty-four final samples were tested for flexural strength on an Instron testing apparatus. All data was analyzed using the analysis of variance (ANOVA) test followed by Bonferroni test. Results: The transverse strength of acrylic resin specimens, repaired with autopolymerizing acrylic resin alone, increased when reinforcement materials were used. When the two reinforcements used were compared it was found that the flexural strength of group II (stainless steel) was 95.868 MPa and was greater than the flexural strength of group III (glass fibers) which was 78.351 MPa. Conclusion: Reinforcements improve the repair strength. Glass fiber and stainless steel metal wire reinforcement material provide greater repair strength than autopolymerizing resin alone. Clinical significance: Use of repair resins can reduce the need to construct a new denture altogether thereby decreasing the chair side time and cost.

Aim: To assess the caries prevalence, oral health knowledge, and treatment needs among 6–12-year-old school-going children of the East Delhi region. Materials and methods: A total of 700 enrolled school-going children, of both genders, between the age of 6–12 years, recruited from schools of East Delhi were assessed. After a clinical examination of each child, a single examiner performed the World Health Organization Oral Health Assessment Proforma 2013. There were a series of questions addressing oral health knowledge that were prepared and carefully phrased into a questionnaire form. Results: Out of 700 children, 381 were male and 319 were female. The prevalence of caries in 6–12-year-old school-going children was observed to be 59.71%. Groupwise prevalence of caries was 57.14% in group I, 62.45% in group II, and 59.07% in group III. Overall mean decayed, missing, filled surfaces ± standard deviation (dmfs ± SD) and mean decayed, missing, and filled surfaces (DMFS) ± SD were 3.50 ± 5.333 and 0.25 ± 1.102, respectively. Approximately 60% of the study population required dental treatment. Conclusion: Oral health education programs have been proven to increase knowledge and have been known to positively influence self-reported oral health-related attitudes and behavior as well as clinical parameters of oral health, including oral hygiene, gingival health, and dental caries. Overall, awareness regarding the importance of oral health and the necessity for early intervention can make a significant difference in improving the oral health status of society. Clinical significance: Dental caries greatly impact people regardless of their gender, age, color, ethnicity, or socioeconomic status. Despite significant scientific advancement and the fact that caries are preventable, the condition remains to be a serious threat to public health, predominantly impacting young children. Knowledge of dental health and caries status is important for formulating appropriate preventive strategies, predicting usage trends and effective planning is essential for the improvement of oral health.

Aim: The present survey was aimed to investigate the knowledge, attitude, and awareness of the use of flexible dentures among general dentists and nonprosthodontic specialists across Chennai city through a questionnaire. Materials and methods: A total of 100 nonprosthodontist and general clinical practitioners with 0–20 years of clinical experience were taken into this cross-sectional questionnaire-based observational study across Chennai city. A questionnaire of 17 questions was prepared and distributed through online platforms to randomly selected dentists. The questionnaire was about the awareness of flexible dentures, its longevity, its advantages, indications, and the materials used. A total of 15 days was given for the participants to fill out the survey, and after reaching 100 responses, the survey was closed to attain the appropriate sample size estimated. Data were collected and analyzed. Results: General dental (GD) practitioners prefer fixed partial dentures, while nonprosthodontist dental practitioners (NPDP) opt for flexible dentures for patients allergic to acrylic resins and those with severe undercut areas, indicating that deciding and following flexible denture as a predominant treatment option is statistically significant among the study groups (p < 0.0001). The survey also revealed no significant differences in familiarity (p > 0.8168), longevity (p > 0.3794), retention type (p > 0.8168), handling of flexible denture prostheses (p > 0.8168), and advantages (p > 0.2717) between the two groups. Conclusion: Despite adequate knowledge and attitude awareness, there is definitely a need for more effective training programs, clinical workshops, hands-on sessions, personal clinical experience, and follow-up studies that can largely influence the long-term success and shift in practice toward flexible denture prosthesis. Clinical significance: Flexible thermoplastic dentures possess excellent compatibility, lower flexural modulus, and follow the contour of the tooth without compromising the retention and stability of the denture. Despite several advantages, the application of flexible dentures with adequate knowledge in routine dental practice is still crucial to ensure a successful treatment outcome.

Aim: The aim of the study was to identify the prevalence of oral mucosal lesions in patients with type II diabetes mellitus (DM). Materials and methods: The present study was a retrospective study which was conducted among patients visiting the outpatient department of a private hospital in Chennai. Patients who were diagnosed with type II DM and presented with no other additional systemic illness who reported to the hospital from June 2019 to March 2020 were included in the study. Oral mucosal alterations were recorded. The collected data was imported into the Statistical Package for the Social Sciences (SPSS) software by International Business Machines (IBM) and analyzed by descriptive analysis and Pearson correlation. Results: The prevalence of oral lesions among the study population of 200 patients with type II DM was 26 (13%). The presence of oral lesions was the most (7%) among the middle-aged population (36–60 years). The male population (52%) showed more prevalence of oral lesions, compared to the females (48%). The most common oral lesion among the study population was lichen planus (32%), followed by angular cheilitis (24%), denture stomatitis (20%), leukoplakia (8%), geographic tongue (8%), and oral candidiasis (8%). Conclusion: Patients with type II DM present with an increased risk of manifestation of oral lesions. The middle-aged population (30–60 years) are at a higher risk of developing oral mucosal lesions, compared to the other age-groups. The most common oral lesion associated with this age-group was lichen planus (30%) and also it was found that males were at higher risk of development of oral mucosal lesions. Clinical significance: Diabetes mellitus (DM) type II is characterized by impaired immune function resulting in various oral lesions. DM causes oral complications which are considered to be major complications of the disease and can decrease the patient's quality of life. Hence, early diagnosis helps in the prevention of complications.

Aim: The objective of this study was to evaluate the wear of opposing natural teeth, hardness, and fracture toughness of all three generations of zirconia. Materials and methods: Three groups were divided based on the generation of zirconia (n = 12): groups I (first generation of zirconia), II (second generation of zirconia), and III (third generation of zirconia). Wear of opposing tooth: the discs and extracted human premolars were placed onto holders on a two-body wear machine under a constant load of 5 kg. Hardness was calculated using Vicker's microhardness tester, Reichert Austria Make. International Organization for Standardization (ISO) standardized chart was used to check the hardness number based on the indentation length. Fracture toughness was calculated using Niihara's formula. Results: Statistical analysis was done using paired t-test and one-way analysis of variance (ANOVA). The maximum amount of wear was seen with the first generation of translucent zirconia—group I (0.93 mm) followed by group II and III (0.76 and 0.22 mm, respectively). Hardness and fracture toughness value from highest to lowest was in the following order group I > group II > group III. Conclusion: Within the limitations of this in vitro study, it can be concluded that the third generation of zirconia (group III) showed the least amount of wear of a natural opposing tooth, hardness, and fracture toughness values among all three generations of zirconia. Clinical significance: Around 5% of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) monolithic translucent zirconia is clinically significant in anterior aesthetic restorations since it is superior to glass ceramics in terms of mechanical properties and is almost similar in terms of translucency. Good esthetic results can also be achieved in the posterior region with minimal occlusal reduction. Also, monolithic translucent zirconia (third generation of zirconia) abrades the antagonist dentition less than other esthetic ceramics.

Aim: The aim of the study was to compare the minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of three intracanal medicaments against Enterococcus faecalis (E. faecalis). Materials and methods: Three intracanal medicament groups were used in the current study. Each group had five samples. Group I—calcium hydroxide paste, group II—triple antibiotic paste (TAP) (metronidazole, ciprofloxacin, minocycline), group III—double antibiotic paste (DAP) (metronidazole, ciprofloxacin). The nutrient agar was then stored at room temperature for 2 days before use to verify that it had remained sterile. Brain heart infusion broth was also prepared and stored in 5 mL vials for 2 days. The serial dilution was done with concentrations ranging from for each intracanal medicament in the other test tubes. The lowest dilution inhibiting the growth was taken as MIC. A loopful of the broth dilutions was taken and streaked on nutrient agar plates. The growth of bacteria was checked after incubation for 24 hours at 37°C. The lowest dilution which showed no growth of bacteria was taken as the minimum bactericidal concentration. Results: Growth of E. faecalis was found to be inhibited even with the lowest dilution of the TAP itself which was 1.8 ± 0.7 µgm per mL while it was a little higher for calcium hydroxide paste with a dilution of 4.39 ± 1.6 µgm per mL and of 5.01 ± 1.69 µgm per mL for DAP (p < 0.05). While the bactericidal effect was seen at 2.19 ± 0.8 µgm per mL for triple antibiotic paste, 4.39 ± 1.69 µgm per mL for CaOH, and 5.63 ± 1.38 µgm per mL for DAP (p < 0.05). Conclusion: It had been found that MIC and MBC were least for TAP compared to other intracanal medicaments. The addition of minocycline in a TAP increased the antimicrobial property. Clinical significance: For successful root canal treatment choosing effective intracanal medicament is important to debride the microorganism completely even at lower concentration. The present study provides a minimum concentration of some intracanal medicament used in root canal treatment.

Aim: The aim of the study was to evaluate and compare the marginal fit of casting made by conventional and accelerated casting techniques using inlay wax and pattern resin. Materials and methods: A total of 40 cobalt-chromium copings were fabricated on typodont tooth using two types of pattern materials and two different casting techniques and divided into two groups of pattern resin and inlay wax with 20 copings each and two subgroups of conventional and accelerated casting technique with 10 copings each. A marginal gap of copings was examined under a stereomicroscope, and collected data were statistically analyzed. Result: Mean gap in inlay wax castings made using the traditional casting process was 258 µm, whereas the marginal gap in inlay wax castings made using the accelerated casting technique was 300.3 µm. The castings created with autopolymerizing pattern resin using conventional and accelerated casting procedures had maximum mean gaps of 358.4 and 392.5 µm, respectively. Conclusion: Within the constraints of this investigation, all castings fall within a range of clinical acceptability. Inlay wax is a better material than autopolymerizing pattern resin for pattern fabrication, and the conventional casting technique has the least vertical marginal discrepancy when compared to the accelerated casting technique. Clinical significance: Traditional casting methods that adhere to manufacturer instructions take a lot of time. Although documented, the accuracy of accelerated casting procedures using base metal alloys has not been sufficiently investigated. Also, there are very few studies to compare two pattern materials; inlay wax and pattern resin.

Aim: To examine the relationship between salivary cotinine level and its effect on dental caries, oral hygiene, and dental behavior changes in children. Materials and methods: The study was conducted on 40 child patients and their parents from the outpatient department using a preliminary questionnaire comprising the demographic details and particular substance use details. With self-reported information from parents about the smoking habit, their children 7–12 years old were identified as passive smokers. Around 1–1.5 mL of unstimulated whole saliva was collected. Estimation of salivary cotinine was done using liquid chromatography and mass spectrometry (LC–MS). The selected subjects were also assessed for caries activity using the deft/dmft/DMFT index, Oral Hygiene Index-Simplified (OHI-S), and behavior assessment using Frankl's behavior rating scale. All the data were recorded and statistically analyzed. Results: Salivary cotinine was present in 35% (n = 14) and absent in 65% (n = 26). On comparing the salivary cotinine level with the status of dmft/ deft/ DMFT index the p-value was 0.003, whereas the p-value was insignificant for oral hygiene and dental behavior status in association with the salivary cotinine level. Conclusion: The salivary cotinine level was statistically significant with the prevalence of dental caries. However, the salivary cotinine level with oral hygiene was not statistically significant. No significant association was observed with the presence of salivary cotinine on the status of dental behavior of the children. Clinical significance: Attention needs to be paid to the ill effects of passive smoking (PS). Pediatric dentists need to know the parental tobacco use to assess a child's risk of oral health and behavioral changes as well.

Aim: To evaluate and compare resin infiltration (RI) and pit and fissure sealants on demineralized caries lesions with respect to the change in microhardness and surface roughness of lesions. Materials and methods: A total of 36 human-extracted premolars were used to create artificial demineralized lesions in enamel using the demineralizing solution. A total of 12 samples in each group was treated with respective materials—group I: nonfluoridated pit and fissure sealant; group II: RI; and group III: fluoridated pit and fissure sealants. Six samples in each group were subdivided for surface roughness and microhardness assessments using a digital surface roughness tester and a microhardness tester, respectively. The normality of the data was checked by Shapiro–Wilk test. Inferential statistics were performed using a one-way analysis of variance (ANOVA). Results: The value of microhardness for group I was 275.6 Vickers hardness number (VHN), group II 315.5 VHN, and group III 213.1 VHN, the same being statistically significant. The surface roughness values for group I was 0.377 μm, group II 0.296 μm, and group III 0.434 μm, the same being statistically significant. Conclusion: Group II showed the highest microhardness, followed by groups I and III, the same being statistically significant. Group II showed minimum surface roughness, followed by groups I and III with highest surface roughness, the same being statistically significant. Clinical significance: Resin infiltration (RI) and fissure sealants allow clinicians to manage early carious lesions with minimal invasion. These simple techniques are easy to acquire and practice for dentists and dental auxiliaries too. When used judiciously, these techniques can minimize the extensive and expensive treatment needs later.

Aim: To assess the antibiotic prescription pattern for periodontal conditions among periodontists and nonperiodontists in South India. Materials and methods: This cross-sectional, observational study included 1,000 responses obtained from periodontists to nonperiodontists in South India using an online self-reported questionnaire, adopting a snowball sampling technique. Chi-squared test was used to analyze the data. A p-value of <0.05 was considered statistically significant. Results: Around 96.2% of clinicians keep themselves updated by reading the latest scientific material/attending continuing dental education (CDE). A total of 39.1% of clinicians do not follow combination antibiotic therapy to treat any periodontal disease. About 90.8% of clinicians have opted for mechanical instrumentation in conjunction with antimicrobial therapy for the initial treatment for aggressive periodontitis, and 92.6% preferred doxycycline 100 mg twice daily, followed by 100 mg once daily. Conclusion: This study suggests strengthening antibiotic prescribing knowledge through attending CDE programs and establishing antibiotic prescription guidelines in periodontology is necessary. Clinical significance: Systemic antimicrobial agents are a crucial therapeutic approach in the management of periodontal diseases, but the decision is mostly based on the clinician's personal experience.

Aim: The in vitro study observed the effects of high temperatures and time on teeth and restorative materials and also grossly analyzed the degree of change in color, shape, and structure of teeth and restorative material after incineration. Materials and methods: A total of 72 extracted teeth, unrestored or restored (class I cavities) with amalgam, two composites, compomer, glass ionomer cement (GIC), metal crown, and metal-ceramic crowns were divided into eight groups (n = 3) of nine teeth each, and the ninth group was blocks of heat cure acrylic. The effect of incineration at 500°C (15 minutes, 30 minutes) and 1000°C (30 minutes) was examined for macroscopic and stereomicroscopic changes. Results: At 1000°C, all materials except amalgam, metal crowns, and metal-ceramic crowns were incinerated. At 500°C, it was possible to identify the specimens with either scorched (burnt) [500°C (15 minutes)] or charred [500°C (30 minutes)] appearance. The scorched specimens had brownish to black discoloration, whereas, in the charred specimens, the discoloration was complete to give a black appearance. Conclusion: Forensic studies to identify the victims are possible using metal crowns, metal ceramics, and amalgam restorations even at 1000°C, whereas other materials can be used to identify the victim up to 500°C (30 minutes). Clinical significance: Studying the effect of elevated temperature on teeth and restorations would help odontologists compare the postmortem results of burned, charred, or incinerated teeth or restorations with the antemortem clinical history of the victims of mass disasters (fires), accidents, and criminal investigations. Valuable insights from research on the effect of incineration on tooth and dental materials can greatly aid forensic analysis for the identification of humans.

Aim: The purpose of this study was to determine the accuracy and reliability of direct digital radiograph tracing using WebCeph, comparing it to manually tracing digital printouts. Materials and methods: A single operator measured 12 linear and angular cephalometric parameters digitally and manually, which comprised 25 digital lateral cephalometric photographs. The difference in measurements obtained from manual to digital tracings was compared using the intraclass correlation coefficient (ICC) and confidence interval (CI), while the intraexaminer error was assessed using the coefficient of variation (CV). Results: A comparison of hand and WebCeph tracing showed an excellent level of agreement except for upper incisor (UI) to nasion-point A (NA), Frankfort-mandibular plane angle (FMA), incisor mandibular plane angle (IMPA), and lower incisor (LI) to nasion-noint B (NB), which showed moderate to good agreement. Intraexaminer reliability was excellent for both manual and digital approaches. Conclusion: In conclusion, except for UI to NA, FMA, IMPA, and LI to NB, all measurements in this study demonstrated excellent agreement between digital and manual tracing. Clinical significance: It can be concluded that digital tracing with WebCeph is suitable for clinical uses and equivalent to manual cephalometric tracings. For everyday use and research, digital imaging may be preferred over analog methods due to the advantages of digital imaging in terms of storage, enhancement, and transmission quality.

Aim: The study aimed to evaluate the effects of an electric toothbrush with vibrational frequencies of 125 and 150 Hz on the changes in temperature of the pulpal chamber. Materials and methods: A total of 30 extracted teeth were included in the study which were divided into two groups I and II comprising 15 teeth each to which mechanical vibration of 125 and 150 Hz, respectively was applied through the electric toothbrush for one minute per tooth. The temperature of the pulpal chamber was measured using a J-type thermocouple with a 0.36-inch diameter attached to a data recorder. The temperatures of the pulp chamber in both groups I and II were measured at T0 where no application of mechanical vibration onto the teeth was done and at T1 where the mechanical vibration of 125 and 150 Hz was applied onto the teeth, respectively using an electric toothbrush. The data was recorded and statistically analyzed. Results: The mean difference in temperature from T0 to T1 in group I was 0.37° ± 0.27° and that of group II was 0.36° ± 0.23°, respectively. When the temperature of the pulp chamber from T0 to T1 between both groups was compared, it did not show any statistically significant difference (p = 0.94). Conclusion: The mechanical vibrations of 125 and 150 Hz through the electric toothbrush did not have any significant effect on the thermal changes of the pulp chamber. Clinical significance: One of the most important applications of mechanical vibrations in orthodontics is to accelerate the rate of orthodontic tooth movement. However, evaluation of the changes in the temperature of the pulpal chamber due to its application is equally important. The establishment of a balance is much required wherein tooth movement can be achieved without compromise.