Aim: To investigate the difference of enamel hardness score on tooth immersed in artificial saliva and cow milk. Materials and methods: The present study was an experimental laboratory with pre- and post-test design. Thirty-two maxillary first premolars were collected and randomly divided into two groups, with 16 samples each immersed in artificial saliva and cow milk. Samples were immersed in an orange flavored soft drink for 5 minutes before exposing to cow milk (group 1) or artificial saliva (group 2) for 5 minutes twice a day until day 3. Enamel hardness score was measured as follows: pretreatment, post demineralization stage and posttreatment at day 1 and day 3 by Micro Vickers hardness tester. Data were analyzed using paired t-test and one way analysis of variance (ANOVA). Results: There was a significant difference (p value = 0.000) on enamel hardness score of group 1 at day 1 (324.39 ± 20.35 VHN) and day 3 (354.80 ± 21.09 VHN) as well as group 2 at day 1 (308.06 ± 15.94 VHN) and day 3 (322.18 ± 16.94 VHN). Tooth enamel hardness on group 1 was significantly different to group 2 both at day 1 (p value = 0.018) and day 3 (p value=0.000). Conclusion: These results suggest that artificial saliva and cow milk can increase the enamel hardness score. However, the efficacy of cow milk to augment the tooth enamel hardness is much higher than that of artificial saliva. Clinical significance: Can be used as a primary advice to the public in as precautionary measures and inhibiting tooth enamel damage from acidic drinks.

Aim: The study aimed to understand the interfacial bonding and diffusion of elements between substrate metal and HAcoated titanium implants in different plasma gas atmosphere. Materials and methods: Commercially pure titanium and Ti-6Al-4V substrate metals were coated with hydroxyapatite by plasma spray in plasma gas atmospheres of argon, argon/hydrogen, nitrogen, and nitrogen/hydrogen. The microstructure and interfacial bonding between the metal substrate and HA coating were studied by scanning electron microscopy, energy dispensive X-ray analysis (EDAX), and X-ray diffraction. Results: The analyses of the coatings obtained showed a different microstructural pattern of HA and diffusion of elements across the interface of metal and HA coating and chemical bonding for all plasma gas atmospheres. Conclusion: The plasma-coating atmosphere influences the microstructure and crystallization of HA. Diffusion of elements from metal substrate to HA coating and coating to metal surface indicate chemical bonding between the metal and coating in addition to usual mechanical bonding. Clinical significance: Bonding between the metal substrate and HA coating play a significant role in the stability of the dental implant. In addition to mechanical bonding, the plasma coated implants show some amount of chemical bonding at the interface.

Aim: The present study was aimed to assess the success of immediate implants in the anterior esthetic zone. Materials and methods: Fifteen patients with 15 teeth to be replaced were selected for the study. After extraction, the socket was thoroughly cleaned and curetted with betadine and saline. Using physiodispenser and drills socket was prepared for implant insertion and implants were placed with initial stability with hand motion followed by complete insertion with hand ratchet. The socket was closed with 3-0 silk and medications were given with instructions to care for wound and recall after 1 week. The variables were measured postoperatively according to clinical parameters, i.e., mobility, exudate, pain, patient satisfaction score at a regular interval of 1, 3, 6 and 12th month. A p value of < 0.05 was considered as statistically significant. Qualitative data were analyzed using the Fischer exact test. Results: The mean age was found to be 23.33 years (range 14–38 years). There were 13 (86.6%) males and 2 (13.4%) females. Central incisors were replaced in 12 (80%) patients, lateral incisors were replaced in 2 (13.33%) patient and 1st premolar was replaced in 1 (6.66%) patient. No pain, exudates was experienced by any of the patients in all 4 follow up scheduled. Only 2 (13.33%) implant which was experienced mobility of grade 1 at 12 months follow-up. Three (20%) patients had satisfaction scores of 8, 6 (40%) had a satisfaction score of 9 and 6 (40%) had a score of 10. Thus, the majority of patients were very happy with the implants placed. Conclusion: In conclusion, the present study has shown that immediate placement of implants in the anterior esthetic zone has a predictable success rate with good patient acceptance. Clinical significance: Clinically, placing an implant at the time of extraction has more advantages like healing time reduction, helps maintain alveolar architecture, surgical interventions will be decreased. So it helps enhance the success rate.

Aim: The aim of this study was to evaluate and compare the diametral tensile strength (DTS) of 4 types of composite materials including bulk fill type (tetric evo ceram) cured with two different curing intensities. Materials and methods: Four types of light-activated composite materials of A3 shade were selected for this study: Tetric Evo Ceram-Ivoclar Vivadent; Ceram X.mono- Dentsply; Nano Ceram-Bright-DMP; Estelite Sigma Quick-Tokuyama. Twenty specimens of each composite material were prepared: ten specimens were cured with high intensity 1200 mW/cm2 (n = 10) (high-intensity group) for 20 seconds and ten specimens were cured with low intensity 650 mW/cm2 (n = 10) (low intensity group) for 20 seconds. Specimens were prepared following the ISO 4049 and ADA/ANSI 27 Specifications in which cylindrical specimens (n = 20 of each material) of 4 mm in depth and 6 mm in diameter were prepared and stored in distilled water for 24 hours at 37°C. The DTS test was performed using the universal testing machine (Testometric/UK) with a crosshead speed of 1.0 mm/minute. The specimens were placed with their long axes perpendicular to the surface of the applied compressive load until failure. Values of the DTS in MPa were calculated and statistically analyzed by one way analysis of variance (ANOVA) and Tukey tests at 95% level of significance. Results: The mean of DTS in the high-intensity group ranged from 38.49 to 48.79 MPa, whereas the mean of DTS in the lowintensity group ranged from 24.58 to 38.15 MPa. The p values of statistical tests were all less than 0.05. One-way analysis of variance (ANOVA) tests for DTS values of all the four composite groups cured with high intensity at 1200 mW/cm2 and for DTS values of all the four composite groups cured with low intensity at 650 mW/cm2 revealed that there were statistically significant differences (p. 0.05). Conclusion: Within the limitations of the study we can conclude that high-intensity curing significantly resulted in higher DTS values in all the composites being tested in this study due to a better degree of conversion and composite composition also significantly influences its DTS values. Clinical significance: Diametral tensile strength (DTS) of any restorative material is an essential test that simulates the tensile behavior of the restorative material during function in the oral cavity which is an indicator for the general strength and durability of the restoration in oral service.

Aim: Several recent studies have indicated that a number of salivary biomarkers seem to be compromised in smokers with periodontal disease. The aim of this study is to assess salivary levels of cyanide and thiocyanate in Syrian patients with chronic (ChP) and aggressive (AgP) periodontitis, and to investigate the effect of smoking on these two biomarkers. Material and methods: The study population comprised 162 individuals allocated within four groups: chronic periodontitis (ChP), elderly control group (EC), aggressive periodontitis (AgP), Young control group (YC). All participants were asked to follow certain rules for at least 2 hours before the collection of morning samples of unstimulated whole saliva. Levels of Cyanide (CN) and thiocyanate (SCN) were estimated using a spectrophotometer. Statistical analysis was performed to examine differences between study groups. Results: Salivary CN and SCN levels were significantly higher in AgP and ChP groups compared to healthy subjects. Smokers in disease groups had a significant increase in CN and SCN compared to nonsmokers. Conclusion: This study exhibited significantly elevated levels of salivary CN and SCN in smokers with periodontitis as opposed to nonsmokers. Clinical significance: Salivary CN and SCN could be considered as important indicators for monitoring periodontitis.

Aim: Squamous cell carcinoma is the most common malignancy affecting the oral cavity. In spite of advanced therapeutic interventions, it is still a common cause of morbidity and mortality worldwide. The clinical presentation and prognosis of the carcinomas occurring at different sites in the oral cavity is varied and could be explained by the difference in the type of epithelia from which they originate. Therefore this study aimed to assess the patient and tumor characteristics, clinical presentation and behavior of a sample of oral squamous cell carcinomas (OSCC) to determine the parameters most likely to influence the prognosis based on the origin of the epithelium. Materials and methods: Eighty-nine cases of histologicallyproven oral squamous cell carcinoma with a minimum followup of three years were categorized based on their epithelia of origin. The clinical follow-up data and survival were collected from the patient's records. New malignancy grading by Anneroth et al. was utilized for histopathological grading following which the lymph nodes (in cases of neck dissection) were assessed for evidence of nodal metastasis. Results: Most of the carcinomas originated from the nonkeratinized epithelium (42.7% n = 38) followed by the keratinized epithelium. Carcinomas arising from the non-keratinized epithelium had the poorest outcome with a mortality of 27.7% (n = 10) and disease-free survival of 38.8% (n = 14) at the end of 36 months. Conclusion: The present study though limited in its sample size and follow-up concluded that the nature of epithelium of origin has a bearing on the prognosis of oral squamous cell carcinoma. Clinical significance: Knowledge of the prognostic significance of the oral squamous cell carcinomas based on the type of epithelia of origin will help the clinicians to plan a more aggressive treatment plan for patients with carcinomas originating from the non-keratinized epithelium.

Aim: To develop an independent, noninvasive procedure for age estimation (AE) in the Saudi population using mandibular first molar tooth (MFM) by digital panoramic radiographs. To determine and compare the accuracy of pulp/tooth ratio method in MFM tooth in forensic AE. Materials and methods: A total of 120 digital orthopantomographs (OPG) of the Saudi population were studied. The measurements of pulp chamber height (PCH) and crown root trunk height (CRTH) were performed on the MFM teeth. The acquired data was subjected to correlation and regression analysis. Results: The pulp chamber crown root trunk height ratio (PCTHR) of the studied age groups were (0.365), (0.561), (0.040), and (0.002) respectively for (21–30 years), (31–40 years), (41–50 years), and (51–60 years) age groups, significantly correlated with the age of the individual. Individual regression formulae derived were tested on control age groups to calculate the age. The standard errors estimate (SEE) for the control age groups were (26.09 ± 1.43), (37.61 ± 1.08), (45.66 ± 0.18) and (55.85 ± 0.60) respectively. There was no statistically significant age difference between chronological and calculated age. Conclusion: An independent, noninvasive and cost-effective procedure was developed which employed, PCH was found to be fairly accurate to perform forensic age prediction in Saudi populations. Clinical significance: Accurate AE from MFM tooth is possible in the Saudi population.

Background: The incidence of injury to the inferior alveolar nerve during mandibular molar extraction increased the demand for pre-surgical planning to avoid any complications. Aim: To investigate the diagnostic accuracy of the dental panoramic image compared to cone-beam computed tomography (CBCT) in predicting the inferior alveolar nerve (IAN) exposure during impacted third molar extraction. Materials and methods: This is a prospective study of consecutive patients, consulted for third molar extraction under local anesthesia. Thirty-two patients showed sign of proximity of the roots of the third molars to the mandibular canal from the dental panoramic image, were selected for CBCT. Results: With respect to the interobserver reliability, no significant difference (p < 0.05) was observed for the prediction on nerve exposure and injury from the dental panoramic image, however, showed a significant difference (p = 0.001) for the cone-beam computed tomography. The prevalence of contact between the third molar to the inferior alveolar canal (IAC) was 96.8% with a significant finding p = 0.002. There was a significant difference in the loss of cortex in predicting nerve exposure with p = 0.04. Clinically, three patients had nerve exposure and two patients had neurosensory disturbances. Conclusion: Dental panoramic image is still valuable for predicting the proximity of the third molar to the inferior alveolar canal. Nevertheless, CBCT has the best precision in localizing the close contact between the third molar and the inferior alveolar canal. Clinical significance: There was no significant finding from the CBCT for the incidence of the inferior alveolar nerve exposure and injury. However, it was seen to be accurate in predicting the IAN exposure. All these findings prove that cone-beam computed tomography contributes in the surgical plan, reduced operative time and patient morbidity.

Background: This study aimed to evaluate and compare the static frictional forces between the gold-plated and conventional stainless steel brackets following immersion in three types of mouthwashes. Materials and methods: Eighty orthodontic brackets (40 stainless steel and 40 gold-plated) were divided equally into four subgroups and dipped in 15 mL of different mouthwashes for 45 days. The mouthwashes included chlorhexidine, aloe vera, aloe vera with fluoride and distilled water as a control group. The brackets then attached to an experimental model consisted of acrylic block. Frictional resistance was measured on 0.019 × 0.025 inch stainless steel archwires using Tinius Olsen Instron universal testing machine. Independent sample t-test and one way ANOVA were used to analyze the collected data. Results: Gold-plated brackets showed high significant friction in comparison with stainless steel one in all mouthwashes. In both types of brackets, there was a statistically highly significant difference among different mouthwashes. Aloe vera mouthwash showed the highest friction with steel brackets while Chlorhexidine had a maximum effect on the frictional force with gold-plated bracket. Conclusion: During orthodontic treatment and when sliding mechanics with minimum friction is required, the orthodontist should prescribe fluoridated herbal mouth rinse with Goldplated brackets. Chlorhexidine should be excluded due to exaggerated frictional resistance that may impede or delay the intended tooth movement, from the same point of view, when using stainless steel brackets, chlorhexidine is the best mouth rinse, while herbal mouth rinse without fluoride (aloe vera mouthwash) is contraindicated. Clinical significance: Orthodontists should take care of prescribing mouth rinses to decrease their effects on the friction.

Aim: Interleukin-17 (IL-17) is a proinflammatory cytokine that plays an important role in inflammation and tissue destruction in periodontal disease. This study aimed to assess the level of IL-17 in gingival crevicular fluid (GCF) of patients with chronic periodontitis (CP) and healthy controls.

Materials and methods: This case-control study was performed on 30 patients with CP (53% males, 47% females, mean age of 37.2 ± 5.95 years) and 30 healthy controls (53% males, 47% females, mean age of 30.63 ± 5.22 years). The GCF was collected using paper points. A paper point was inserted into the pocket and remained there for 30 seconds. It was then placed in a sterile tube containing 300 μL of phosphate buffered saline and stored at -70° C. Level of IL-17 was measured using enzyme-linked immune sorbent assay (ELISA). The level of IL-17 was compared between the two groups using independent sample t-test at 0.05 level of significance.

Results: The mean GCF level of IL-17 was 53.46 pg/L in CP patients and 38.1 pg/L in healthy controls. This difference was statistically significant (p = 0.025).

Conclusion: The CP patients had significantly higher GCF level of IL-17 compared to healthy controls.

Clinical significance: The finding of this study highlight the role of IL-17 in the pathogenesis of periodontal disease. Within the limitations of the present study, it may be suggested that measurement of GCF level of IL-17 can serve as a bioindicator of periodontal destruction and gingival inflammation.

Keywords: Chronic periodontitis, Gingival crevicular fluid, Interleukin-17.

How to cite this article: Kalate FA, Gholami L, Alijani E, Hedayatipanah M, Kosari S. Level of Interleukin-17 in Gingival Crevicular Fluid of Patients with Chronic Periodontitis . World J Dent 2018;9(6):495-499.

Introduction: Natural extract dyes are eco-friendly and nonhazardous when compared with synthetic stains. Routinely, hematoxylin and eosin (H&E) stain is used to stain tissues. Eosin is a synthetic stain and attempts have been made to substitute eosin with a natural dye, one among them being rose extract. Staining using rose extract is economical, easily available and has not been explored before. Aims and objectives: The study aims to compare between two different extraction methods for rose, namely maceration and soxhlet, to compare the staining efficacy of rose with (REM) and without mordant, to compare the efficacy of rose extracts with synthetic eosin, in both normal and pathological oral tissues [e.g., oral squamous cell carcinoma (OSCC)]. Materials and methods: Rose was dried, powdered, and extracted by maceration and soxhlet techniques. Tissue sections were stained with and without the mordant potassium alum. Hematoxylin and rose (H&R) and H&E stained normal and pathologic tissues were compared. Statistical analysis was done using Chi-square test. Results: Statistically significant results were observed in sections stained by soxhlet method than that of maceration, sections stained by REM was comparatively better than those stained with rose extract alone, the normal and pathologic tissues stained with H&R gave comparable result with H&E. Conclusion: The REM can be used as a substitute to eosin for the staining of tissues. Clinical significance: Natural substitute for synthetic eosin.

Aim: An in vitro study to evaluate and compare the antibacterial efficacy of giomer and compomer against Streptococcus mutans (S. mutans) and Lactobacillus acidophilus (L. acidophilus). Material and methods: Antibacterial activity of giomer (Beautifil flow plus, Shofu Inc., Kyoto, Japan) and compomer (Dyract XP, Dentsply, Germany) was assessed using the agar diffusion test, in triplicate. Test specimens for both the dental materials were prepared using a custom made teflon ring mold with a diameter of 6.5 mm and thickness of 2 mm and inserted into the punched wells (6.5 mm x 2 mm) in the BHI agar, 0.2% chlorhexidine digluconate placed in other well acted as a control. The agar plates were incubated at 37o C for 24 hours, later size of the inhibition zones was measured (in mm) by digital vernier caliper at three different points at 24 hours, 48 hours and 7 days interval. Results were tabulated and subjected to statistical analysis. Results: Nearly 0.2% chlorhexidine, the control group showed an inhibition zone, whereas the restorative materials did not show the inhibition zone as well the antibacterial efficacy against S. mutans and L. acidophilus. Conclusion: None of the hybrid esthetic restorative material tested in this study possesses antibacterial properties.

Aim: Vector relationship of the anterior corneal plane (ACP) and sella-nasion-orbitale (SNO) angle are used for assessing anteroposterior position of malar eminence. The purpose of this study was to evaluate the vector relationship of ACP and SNO angle and compare these parameters for assessing malar eminence. Materials and methods: Forty study subjects (18 males and 22 females) aged 14–24 years without any craniofacial syndromes, facial asymmetries or a history of previous orthodontic treatment were randomly selected for this study. Vector relationship of ACP was evaluated on profile photographs and SNO angle was measured on lateral cephalograms. Pearson correlation coefficient was used to evaluate correlation between vector relationship of ACP and SNO angle. Results: Sella-Nasion-Orbitale (SNO) angle was 5.08° smaller in subjects with negative vector relationship as compared to subjects with a positive vector relationship of ACP. Also, there was highly significant correlation between SNO angle and vector relationship of ACP (p < 0.001). Conclusion: This study suggests that malar eminence is less prominent in subjects with a negative vector relationship as compared to a positive vector relationship of ACP. Clinical significance: Vector relationship of ACP can be used to assess malar eminence on profile photographs.

Aim: To introduce the use of minimally invasive transbuccal approach in open reduction and internal fixation of linear vertical ramus fractures of the mandible and to discuss its various advantages, limitations and possible complications.

Materials and methods: Till date the use of transbuccal approach has been widely discussed in the management of mandibular angle fractures and mandibular osteotomy fixation. However, its application has not been mentioned in the management of more posterior mandibular fractures, such as mandibular ramus fractures. Various advantages of this approach have also been discussed with little mention of its limitations and involved complications.

Case report: Here, we discuss its use in the management of linear vertical ramus fractures by open reduction and internal fixation combined with the intraoral approach with a detailed description of the technique and 3 case reports where this technique was used. It involves the use of a combination of transbuccal and intraoral approach. Following reduction, fixation of linear vertical ramus fractures was done using trocar cannula for drilling and miniplate fixation transbuccally.

Results: In all the three cases adequate reduction and rigid fixation were achieved with this technique with reduced intraoperative time. All patients on follow-up reported with no complication and minimal scarring.

Conclusion: Use of transbuccal approach for rigid internal fixation of linear vertical ramus fractures is a minimally invasive, esthetic and a superior alternative to extraoral approach with a very low complication rate.

Clinical significance: Reduced operating time, Minimally invasive, superior esthetics, stable fixation, lower complication rates, easy to learn.

Keywords: Transbuccal approach, Trocar cannula, Vertical ramus fracture management.

How to cite this article: Kale TP, Motimath A, Korlepara Y, Kotrashetti SM. Transbuccal Approach for Management of Linear Ramus Fractures of Mandible: A Clinical Technique. World J Dent 2018;9(6):517-522.

Aim: To propose a quantitative classification scheme that is useful for all impacted teeth as well as to describe their angulations, relationships to adjacent teeth and proximity to adjacent vital structures. Materials and methods: The abbreviation SPAN was used as a system of classification. S stands for size, which indicates the relationship of the mesiodistal diameter of the impacted tooth to its normal space. P stands for the position, which indicates the relationship of the most occlusal point of the impacted tooth to the crown of the mesial tooth or distal tooth if the mesial tooth is missing. A stands for angulations, which means the relationship of the long axis of the impacted tooth to that of the adjacent mesial tooth or distal tooth if the mesial one is missing. N stands for proximity to vital structures. Results: This proposal has been applied to some radiographic examples and was found to be effective. Conclusion: This proposal is effective and inexpensive as it only depends on panoramic views. Cone beam computed tomography (CBCT) may become readily available in the future and decrease radiation exposure and expenses, making future classifications more accurate, easier and beneficial. Clinical significance: The scientific rationale for this study is to propose a quantitative classification system for the impacted teeth. This system can be applied to all impacted teeth by using a panoramic view, which is less expensive and readily available. It also describes angulations, space available, depth, and the relationship of the impacted teeth to vital structures. By applying this scheme, the clinicians can quantify surgical difficulty.

Background: The first step in a biomedical investigation of a disease entity involves framing a research hypothesis. The hypothesis is framed based on the pre-existing information. Evidence for the hypothesis is usually gathered starting with epidemiological studies to estimate the prevalence, etiology, associated risk factors of the disease. Once an epidemiological association is established then the investigation involves the use of experimental (in vivo, in vitro) studies to decode the molecular biology of the disease based on which we can formulate appropriate interventions. The major limiting factors in this approach is translating the data obtained from experimental studies on to clinical trials. These limitations are because of the inability of the in vivo and in vitro studies to replicate the microenvironment of the disease in humans. Experimental studies capable of closely simulating disease environment in humans would aid in eliciting the true nature of these diseases. At present, mouse models are largely being used to study human diseases including cancer. Aim and clinical significance: Although mouse models are considered better than other experimental models, it is vital that researchers select appropriate mouse models which would suit the purpose of the study. Thus, the present manuscript aims to critically review the applications and limitations of all mouse models employed in oral oncology which may aid the researchers in selecting the most optimal mouse models for their respective research.