The concurrent development of better techniques has resulted in greater understanding of the apical anatomy, greater treatment success, and a more favorable patient response. These developments marked the beginning of the endodontic microsurgery era that began in the 1990s. There is a substantial difference in surgery outcome between those using the microscope and those do not. Use of advanced technology like a microscope, specially designed instruments, improved root end filling materials help to achieve faster wound healing with lesser postoperative complication.

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In the practice of fixed prosthodontics, certain situations like pier abutments, tilted abutments pose problems with rigid connectors. If rigid connectors are used in this situation, the pier abutment will act as a fulcrum because of physiologic tooth movement, arch position of the abutment, and the retentive capacity of the retainers. A nonrigid connector may be preferred in fabrication of fixed partial denture (FPD) with pier abutment. In this prosthesis, the movement of the nonrigid connector is enough to prevent the pier abutment from serving as a fulcrum. This clinical report describes rehabilitation of a patient with FPD with pier abutment using semi-precision attachment. The technique used is simple, economical, and feasible in an ordinary laboratory set up.

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The aim of this study is to suggest a technique to improve the retention of the prosthesis in grossly resorbed ridge and minimize the trauma of thin, atrophic knife edge ridge with severe undercuts. Significant numbers of patients seek treatment for edentulism throughout the world. In the current scenario, implant retained/supported prostheses have been considered a standard of care for rehabilitation of completely edentulous patients, but still this treatment modality is out of reach of many patients due to economic factor. In such patients, conventional removable complete dentures are considered for functional rehabilitation. However, in some of the patients with grossly resorbed ridges and knife edge ridges or ridges with severe undercuts, these prostheses have compromised retention and also continuously causes trauma to knife edge ridges and mucosa covering the undercuts during insertion and removal of the prosthesis thereby reducing the compliance of the patient. By incorporating, a layer of resilient permanent silicone soft liner on the tissue surface of a new or old denture is a novel way to reduce the trauma of thin and severe undercut ridges and also improve the retention of the prosthesis. This study described the successful functional rehabilitation of three completely edentulous patients with grossly resorbed, thin knife edge, and severe undercut mandibular ridges with permanent silicone soft liner. Permanent silicone soft liner act as a shock absorber, helps in equal dissipation of occlusal stresses, maintains an intimate contact with the underlying tissues and compressed during function thereby increasing retention and minimizing trauma by preventing a direct contact of hard denture base with compromised tissues.

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A total of 305 stools samples during the period of October 2011 to June 2012 were collected from patients attending Brack General Hospital and Medical Technology, Department of Brack, Al-Shati, Libya. All stool samples were examined by direct smear preparation in normal saline, iodine, and eosin stains and 4 concentration methods (formalin-ether, normal saline sedimentation, zinc sulfate, and Sheather's sugar flotation). Of the 305 samples, 18.03% stools were found positive for protozoan parasites in direct smear microscopy. Normal saline sedimentation and zinc sulfate flotation detected 27.21% and 23.6% positive samples, respectively. However, formalin-ether was found to be the most sensitive method. Sheather's sugar flotation failed to detect Entamoeba histolytica/dispar, Entamoeba coli, and Blastocystis hominis. B. hominis was the most common parasite among the patients. Concentration techniques showed significantly higher (P < 0.05) detection rates of parasites compared with direct smear microscopy.

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Introduction: Zygomatic complex fractures or the tetrapod fractures are common to occur followed by the nasal bone fractures because of its prominent location. At the same time, it is difficult to obtain perfect reduction and contour postoperatively because of its complex involvement with four bones namely maxillary, temporal, orbital and greater wing of sphenoid bone. Various classifications have been put forward for better understanding and planning of treatment protocol. Aim: This study aims at comparing the following variables after reduction and fixation of fracture zygomatic complex; 1. Esthetics 2. Restoration of anatomical form 3. Occlusion 4. Function 5. Neurological deficits. Materials and Methods: Twenty patients were selected following a clinical and radiographic examination of fracture of the zygomatic complex. Reduction techniques used were Gillie's, Dingman's lateral eyebrow, and upper buccal sulcus approaches. Fixation was done at single-point or two-point or three-point protocol by transosseous wiring or miniplate osteosynthesis. Results: Among the twenty cases treated, all were males. Age distribution of the patients was between 20-60 years with a mean age of 39.5 years. There was facial asymmetry in four cases postoperatively and two among them did not follow postoperative instructions. Conclusions: Closed reduction namely Gillie's temporal approach was found to be the best reduction technique and the protocol of three point, miniplate fixation was effective in terms of stability and relapse.

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There is a lack of knowledge regarding genetic diseases and its prevention among general population an important premise is that a better understanding of the genetic etiology of the diseases can facilitate early detection in high risk subjects. It also helps in designing more effective intervention strategies. Exciting new technology based on the foundation of genetic research has the potential to further enhance the quality of life. Progress in the field will require training of a new generation of the scientists with requisite skills, as well as greater collaboration and interdisciplinary work. The traditional epidemiologic approach has proved useful for generating hypotheses and unraveling disease etiologies. But now it is possible to go beyond these methods and look inside the "black box" of the disease process which would be able to change the definition of the risk factors or clarify their location in the casual model.

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Tobacco is a plant product derived from a variety of plants belonging to the genus Nicotiana. The alkaloid nicotine present in the plant leafs is a stimulant and has an addictive effect. The tobacco plants have been historically grown and used for recreational purposes by the American local population. The dried tobacco leaves are consumed as chewing tobacco, snuff, and smoked in a variety of dispensations. Tobacco use (TU) has an adverse effect on various body systems and is a determinant for different diseases ranging from cancers to atherosclerosis. TU is a modifiable environmental risk factor for various diseases. Hence, with public health education and behavior modification, its burden can be reduced in a given society. Thus, the understanding of the incidence and prevalence of its use is necessary. This review attempts to sum up the significance and determinants of TU.

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The susceptibility to various diseases is studied with association to genetic polymorphisms. Among these polymorphisms, single-nucleotide polymorphisms (SNPs) are very common throughout the genome. The recent advances in genetic assay techniques and increase in SNP databases are paving a way for investigation of susceptibility genes for periodontitis. This article attempts to review the role of SNP and its implications in periodontal disease and management.

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Ossifying fibroma is a benign, slow growing, and expansile lesion of the jaws. It is classified as one of the benign fibro-osseous lesions of the jaws. The juvenile ossifying fibroma (JOF) is commonly found in children and young adults. The juvenile variety of ossifying fibroma is more aggressive and requires a more extensive therapy because it might recur after curettage. It usually occurs in the mandibular premolar-molar area. The slow growth of the tumor may produce expansion and thinning of the buccal and lingual cortical plates. The treatment of the JOF is conservative surgical contouring either using curettage or enucleation. The lesion can be separated easily from the surrounding normal bone. Large ossifying fibroma requires surgical resection to reestablish normal facial symmetry. A long-term follow up is required for the lesion.

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Introduction: Dental caries and inflammatory periodontal diseases result from the accumulation of many different bacteria that form dental plaque, a naturally acquired bacterial biofilm that develops on the teeth. Periodontal diseases are one of the most prevalent oral diseases affecting more than 50% of Indian community. Materials and Method: A two months randomised controlled trial was conducted among ninety school children aged between 13 and 15 years, from a hostel located in Davangere city. The 90 study subjects who fulfilled inclusion and exclusion criteria were randomly divided into 3 groups namely Placebo, Chlorhexidine and Probiotic groups. Plaque scores were recorded at baseline (0 day), on 15 ^th day (after 14 days of intervention) and 3 weeks (after discontinuation of intervention). Statistical analysis was done using one way ANOVA and paired 't' test and P value less than 0.05 was considered statistically significant. Results: There was no statistically significant difference between groups at baseline. On 15 ^th day and after 3 weeks, plaque scores were significantly higher in placebo group compared to probiotic group. On 15 ^th day and after 3 weeks, plaque scores were higher in chlorhexidine group compared to probiotic group but difference was not statistically significant. Conclusion: Probiotic mouth rinse was more effective for inhibition of dental plaque accumulation after 14 days of intervention and also after 3 weeks of discontinuation of intervention.

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Introduction: Laser is an acronym for "light amplification by stimulated emission of radiation." They are being developed for a variety of uses in periodontal therapy. The diode laser in dentistry is used for treatment of diseased periodontal soft tissue, allowing significant bacterial reduction, and removal of the inflammatory products while creating excellent hemostasis. A flexible fiber optic delivery system allows the clinician easy and safe access around the periodontal pocket. The wavelengths are transmitted through water and are very poorly absorbed in apatite crystals, making them an excellent choice to use in a periodontally involved sulcus that has inflamed tissue and pigmented bacteria. This study was undertaken to evaluate the effectiveness of diode laser as an adjunct to scaling and root planing (SRP) in the nonsurgical treatment of chronic periodontitis. Aim: To evaluate the effectiveness of diode laser on plaque index (PI), gingival index (GI) probing pocket depth (PPD) and clinical attachment level (CAL) in chronic periodontitis patients and to compare the outcome with SRP alone. To evaluate the efficacy of diode laser on plaque microorganisms namely Aggregatibacter actinomycetemcomitans and Prevotella intermedia. Materials and Methods: A total number of 20 generalized chronic periodontitis patients were selected for the study. A randomized split-mouth design was followed to assign quadrants in each to one of the two treatment groups: SRP alone (Group I control group) and diode laser as an adjunct to SRP (Group II test group). The assessment of clinical parameters was carried out at baseline, day 30, 90, and 180. The microbiological analysis was done prior to the start of the treatment at baseline, day 15, 30, 90, and 180, respectively. Results: At baseline mean colony count was equal in both groups, however, at all the subsequent time intervals, mean colony count was lower in Group II as compared to Group I. All the groups showed statistically significant reduction in relation to PI, GI, PPD, CAL, and microbial count. Discussion: In this study, an attempt was made to evaluate the adjunctive role of diode lasers on gingival inflammation, pocket probing depth, the level of clinical attachment, and microbial count in relation to SRP using a case-control design. Recently, the use of laser has emerged as an adjunctive procedure in enhancing the clinical outcome of the periodontal treatment. It is one of the most promising new technical modalities for nonsurgical periodontal treatment and has an advantage of reaching sites that cannot be approached by conventional mechanical instrumentation. Conclusion: In the present study, an attempt was made to evalute the adjunctive role of diode lasers on plaque index, gingival index, pocket probing depth, level of clinical attachment and microbial count in relation to scaling and root planning using a case-control design. On the basis of these findings, adjunctive treatment with diode laser at a higher but clinically safe frequency (940nm) at repeated intervals showed a better efficacy in ensuring a better periodontal health as compared to SRP alone.

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The purpose of this article is to review and understand currently used elastomeric impression materials in the fabrication of complete dentures. The article focuses on polyether (PE), polysulphide, vinylpolysiloxanes (VPS) (addition silicones) and condensation silicone (CS) by comparing their clinical implications and properties. The choice amongst different elastomeric impression materials depend on the combination of their characteristics, clinician's comprehension of the notions and principles in impression making.

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Background: Electronic apex locators can be a useful adjunct with a high level of accuracy for determining the real root canal length in clinical practice. Aim: The objective of this ex vivo study was to evaluate the accuracy of electronic apex locator for real working length determination in comparison with a manual method. Materials and Methods: Forty single-rooted teeth were used in this study. After coronal access, manual measurement of the real working length of each root canal was performed by placing a size 10 K-file, using as reference the exceeding of the file in the apical foramen. The file was retracted by 1 mm, and its extension was measured to determine the real working length. The electronic measurement of the working length was performed in the same teeth using the Joypex 5 electronic apex locator. Results: Data were submitted to statistical analysis (Wilcoxon-Mann-Whitney test, P > 0.05) and no significant difference was found between the electronic and manual methods (P > 0.05). Conclusions: It may be concluded that the electronic apex locator is a reliable and accurate method for determining the working length of root canals, optimizing the odontometric procedure in clinical practice.

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Background: The protozoa parasite Entamoeba histolytica is an important cause of human morbidity and mortality worldwide besides malaria and schistosomiasis. Prevalence of E. histolytica in Sebha, Libya has been scantily studied and risk factors associated with this parasite are unavailable in Libya. Aims: A cross-sectional study was aimed to provide the first data on the prevalence and epidemiological risk factors associated with E. histolytica infection among school children in Sebha, Libya. Subjects and Methods: A total of 150 stool samples randomly were collected (during period from April 2017 to May 2017) from school children residents of Sebha and examined by direct smear microscopy (in normal saline and iodine smears) for the detection of E. histolytica infection. Results: Of one hundred fifty children, six children (4%) were found to be infected with this parasite. Boys were more significantly (P < 0.5) infected with E. histolytica than girls. A higher prevalence rate (6.66%) was found among 8 to 11 years old age group. There was no significant difference of E. histolytica infection among different age groups (P > 0.05). It has been noted that those who had large family size have significantly (P < 0.05) higher risk of being infected with E. histolytica. A significant (P < 0.05) association was found between education level of children's parents and E. histolytica exposure among children. No, significant correlation was found between monthly income of family and the presence of E. histolytica infection among children. Conclusions: Prevalence of E. histolytica among school children is low and this parasite may play a minor role in causing morbidity in this population in Sebha, Libya. Large size of families and education of parents of children were significant predictors of this parasite. In addition, more studies are needed to provide data on epidemiological risk factors of E. histolytica to improve health education and environmental sanitary conditions to protect children from the infection of this parasite in Libya.

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A total of 56 anterior blepharitis cases including 22 cases of ulcerative blepharitis and 34 cases of seborrheic blepharitis were studied. The predominant age group of anterior blepharitis cases was above 40 years. With males affected more than females. In the order of decreasing frequency, the isolated bacteria from anterior blepharitis in order of decreasing frequency were Staphylococcus aureus 14 (25%), Staphylococcus epidermidis 14 (25%), similar Klebsiella species 10 (18%), viridans Streptococci five (9%), Pseudomonas aeruginosa five (9%), Proteus species four (7%), Enterobacter aerugenes three (5%), and Escherichia coli one (2%). The common isolates observed in both samples were S. aureus, S. epidermidis, and Proteus species. The Gram-positive cocci S. aureus were resistant to four antibiotics and viridans Streptococci were resistant to three antibiotics, whereas the Gram-negative bacteria were resistant to two antibiotics. Improper selection of antibiotics, inadequate dosing, and poor compliance to therapy may play an important role in increasing resistance. Identification of anterior blepharitis pathogens and performing antibiotic susceptibility test are important factors in reducing the resistance to therapy.

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Purpose: The purpose of the present study was to assess current status of knowledge and attitude regarding preventive options in oral care among dentists in Davangere city, Karnataka, India. Materials and Methods: A cross-sectional questionnaire-based survey was adopted to carry out the study among 97 practising dentists in the city. Data on preventive options in oral care was collected by means of 26 self-administered knowledge-, attitude-, and practice-based questions. Microsoft excel and Statistical Package of Social Sciences (SPSS) software were used for statistical analysis of the data collected. Statistical evaluation was done by Chi-square test. Results: Among 97 respondents, 91 (93.80%) were aware of preventive dentistry and 88 (90.7%) were aware that initial lesions can be remineralized. Forty-eight (49.5%) of the respondents were aware that Casein Phosphopeptide and 93 (95.90%) were aware that tooth mousse can be used as remineralizing agent. A total of 53.95% respondents correctly answered the knowledge-based questions. Statistically significant differences were found (P < 0.05) between variables like professional reading and responses. There were no associations found between gender, age, practice location, years of experience, practice type, and participation in continuing dental education programs. Conclusions: The result of this study demonstrated the need to increase the emphasis on preventive dentistry education. It alarms the need to carry out a continuing dental education programs for practising dentists in order to update dentists' knowledge and attitude regarding preventive dental care .

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Background: Dental caries can be traced to be as old as civilization with its evidence seen even in skeletal remnants of prehistoric humans. Dental caries is the most prevalent dental affliction of childhood. Materials and Methods: A stratified cluster sampling technique was employed in the selection of 39 schools in the geographical region. A total of 5688 students was screened. Of the total students screened, 1623 students were 5-year-old, 1936 were 12-year-old and 2129 were 15-year-old students. Pearson Chi-square test and Fishers exact test were the statistical tests employed in the survey. The level of significance was set to be P < 0.05. Results: The present study revealed that the majority (73.9%) of the 12 years students had healthy gingiva. It was revealed that among girls, 21.8% had calculus, and 2.5% had bleeding gums. Among boys, 24.3% had calculus, and 3.1% had bleeding gums. The prevalence of dental caries was the highest among 5 years students who belonged to the lower socioeconomic status (41.5%). The difference was found to be statistically significant (P = 0.004). The mean decayed, missing, and filled teeth was found to be the highest in students of 5 years age group when compared to their counterparts (P = 0.041). Conclusion: The study reveals that dental caries still remains as a major oral health problem among school children of all age group. Gingival problems also formed one of the major oral health problems of 12 and 15-year-old school children.

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Background: Hepatitis B virus (HBV) is a major worldwide cause of acute and chronic liver infection. Dentists, dental students, and their paramedical staff are at a heightened risk of exposure to HBV. Aim: The aim of this study was to assess the knowledge and attitude of the graduating dentist from Faculty of Dentistry, Sebha University (Libya), toward hepatitis B infection. Subjects and Methods: Ninety-nine participants completed the self-administered, structured, pilot-tested close-ended 37-item questionnaire. Results: It was found that the graduating dental students from different study years have similar knowledge and attitude, except for the responses to questions on curriculum, contracting hepatitis B virus (HBV) from patient, vaccination schedule, perception, and treatment modality for HBV-infected patient, where statistically significant difference was noted. Conclusion: The results indicate that there is need to spread greater awareness about risk and seriousness of the HBV infection among the graduating dentists. We recommend that the dental policymaker considers modifying the dental curriculum to include a detailed session of training in areas of universal infection control procedures, handling high-risk patients, combating fear while treating patients, and teaching them to avoid discriminatory behavior beginning in the 3rd year itself.

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Hypertension is a growing global problem, which mostly affects the adults. It is a risk factor for death from stroke, myocardial infarction, congestive heart failure, ischemic heart disease, peripheral vascular disease, and progressive renal damage. These diseases are responsible for considerable morbidity and high mortality rate. Human essential hypertension (EH) is a complex and multifactorial trait influenced by environmental and genetic determinants. Early detection of genetic predisposition in hypertensive patients will enable prompt treatment and avoidance of complications. The use of SNPs in genetic disease detection is facilitated by the recent discovery of more than 4 million SNPs in the human genome that have the potential to be a rich source of genetic markers to establish genetic linkage and as indicators of disease. Such genetic research will open the new frontiers in diagnosis and treatment of diseases like hypertension.

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Background: Many studies have demonstrated the beneficial effect of tea on dental caries. Aim: The aim of the present study was to compare and evaluate the effect of green tea and black tea infusions on salivary pH in caries free and with caries individuals. Settings and Design: Randomized double-blinded concurrent parallel study. Materials and Methods: Forty healthy subjects, aged 18-20 years participated in the study. Commercially available green tea (Tetley Pure Green Tea) and black tea (Tetley Black Tea) were used in the study. The pH of saliva and of the tested tea products was determined with a digital pH meter. pH of whole saliva was measured at baseline and immediately after the intake of product (0), 5, and 10 min later. Data analysis was carried out by Student's t-test and repeated measure ANOVA. Results: In vitro pH determination of infusion showed pH value of green tea (6.27 ± 0.02) was higher compared to black tea (6.13 ± 0.03). Both green and black tea infusion intake led to a statistically significant rise in salivary pH, both in caries-free and with caries groups, which remained above the base salivary pH over the whole period of measurements. Conclusion: The present study demonstrated that after intake of both green and black tea there was an increase in salivary pH both in caries-free and with caries groups. The pH rise was more in green tea intake compared to black tea.

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There is an expansive usage of adhesives in all branches of dentistry. Newer adhesives can be more beneficial to the patients. This review attempts to highlight the important features of adhesive cements in general and emphasize the applications of Rely-X Unicem cement.

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Background: Autologous platelet rich fibrin (PRF) and Recombinant human bone morphogenetic protein 2 (rhBMP 2) technologies have been shown to significantly support alveolar bone. The present randomized, controlled clinical trial was conducted to compare the clinical and radiographic efficacy of autologous platelet rich fibrin (PRF) and recombinant human bone morphogenetic protein 2 (rhBMP 2) in the treatment of intrabony defects (IBDs) in patients with chronic periodontitis. Methods: A randomized controlled clinical trial conducted where in the IBDs were treated with either autologous PRF with open flap debridement (OFD) or recombinant rhBMP 2 with OFD or OFD alone. Clinical and radiologic parameters including probing pocket depth, clinical attachment level (CAL), IBD depth, defect fill, and percentage of original defect resolved were recorded at baseline and 6 months postoperatively. Results: The mean pocket depth reduction was greater in PRF (1.3 ± 0.78 mm) than rhBMP 2 group (1.3 ± 0.78 mm). No significant difference was seen in CAL gain in PRF and rhBMP 2 groups (3.3 ± 0.43 mm and 1.2 ± 0.74 mm, respectively). However, the percentage of original defect resolved was significantly greater in rhBMP 2 group (41.1% ± 19.2%) compared to PRF group (26.75% ± 6.03%). Conclusions: Within the limits of the present study, results suggest that in terms of hard tissue regeneration, rhBMP 2 has shown significantly better outcome in treatment of IBDs. However, PRF encourages superior soft tissue healing compared to rhBMP 2. Furthermore, added advantages of PRF being readily available and cost effective cannot be disregarded.

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Dental caries is a dynamic process which results in demineralization of inorganic constituents and destruction of organic structure of the tooth. The basic mechanism of inorganic demineralization has been studied and documented well enough. However, the exact mechanisms and enzymes responsible for the organic matrix breakdown remain unknown. Matrix metalloproteinases (MMPs), a family of endopeptidases which are responsible for degrading all extracellular matrix components, which are expressed in normal dentin-pulp complex. MMP's are believed to act as double-edged sword since it causes progression of caries process and also helps in repair and defense mechanism initiated by caries in dentin-pulp complex. Several MMPs are also found in normal dentin-pulp complex cells and tissues, and they are considered to be involved in many physiological processes during the formation and maintenance of the dentin-pulp complex. This article gives a brief review of MMPs and its role in oral health.

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