A diverse group of the pathologic process can produce the enlargement of soft tissues in the oral cavity and often present a diagnostic challenge. This soft tissue enlargement may represent a variation of the normal anatomic structure, inflammatory reaction, cyst, neoplasm, and developmental anomalies. A group of reactive hyperplasias, which develop in response to chronic recurring tissue injury that stimulates an excessive tissue repair response. The pyogenic granuloma (PG) is a reactive enlargement that is an inflammatory response to local irritation such as calculus, a fractured tooth, rough dental restoration, and foreign materials or hormonal (pregnancy tumor) and rarely associated with bone loss. This paper presents a rare case of PG associated with periodontal abscess and bone loss in a 30-year-old male.

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Background and Objective: The present study evaluates the association of Candida albicans with normal control group, potentially malignant and malignant lesions of oral cavity by using two different liquid culture media. Materials and Methods: Saliva was collected and biopsy was taken only from those clinically suspected potentially malignant and malignant lesions for histopathological diagnosis. Saliva samples were inoculated for fungal growth in Sabouraud's dextrose agar and culture-positive samples had undergone for Germ tube test. Germ tube-positive samples were further taken for quantification of chlamydospore production in liquid media at 8 and 16 hours. Results: In normal control groups no fungus growth was found; however, potentially malignant and malignant cases showed fungus growth, positive germ tube test and chlamydospore formation. The result also showed rapid and quantitatively more chlamydospore formation in corn meal broth + 5% milk in comparison to serum milk culture media. Conclusion: The oral mucosa is compromised in potentially malignant lesions, it can be argued that this species may be involved in carcinogenesis by elaborating the nitrosamine compounds which either act directly on oral mucosa or interact with other chemical carcinogens to activate specific proto-oncogenes and thereby initiate oral neoplasia.

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The purpose of this study was to evaluate mandibular morphology in different facial types using various parameters. This study was conducted on lateral cephalograms of a total of 110 subjects, which included 55 males and 55 females between the age of 18-25 years having a mean of 22.3 years for males and 21.5 years for females. The sample was divided into normodivergent, hypodivergent, and hyperdivergent subgroups based on Jarabak's ratio. Symphysis height, depth, ratio (height/depth) and angle, antegonial notch depth, ramal height and width, mandibular depth, upper, lower, and total gonial angle, and mandibular arc angle were analyzed statistically and graphically. It was found that the mandible with the vertical growth pattern was associated with a symphysis with large height, small depth, large ratio, small angle, decreased ramus height and width, smaller mandibular depth, increased gonial angle, and decreased mandibular arc angle in contrast to mandible with a horizontal growth pattern. Sexual dichotomy was found with mean symphysis height and depth in the female sample being smaller than in the male sample, but symphysis ratio was larger in the female sample; males having greater ramus height and width, mandibular depth than females. The mandible seemed to have retained its infantile characteristics with all its processes underdeveloped in hyperdivergent group.

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We report a rare case of desmoplastic ameloblastoma lesion that filled the entire maxillary sinus. The patient visited our hospital with a chief complaint of swelling around the upper left premolars. A panoramic X-ray captured an image of a mixture of ill-defined radiolucency and radiopacity from the swollen area to the maxillary sinus. Computed tomography (CT) and Magnetic resononce imaging (MRI) showed that the lesion occupied almost the entire left maxillary sinus and had entered the nasal cavity. A pathologic diagnosis of ameloblastoma was made after biopsy, and the tumor was removed and the marginal bone curetted under general anesthesia. A CT scan at 4 months postoperatively indicated the presence of residual and recurrent tumor in the area of the upper left lateral incisor, and removal and curettage were performed again. Recurrence may be detected relatively easily based on radiographic characteristics, and therefore follow-up with an X-ray examination such as a CT scan is important.

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A case of prosthetic rehabilitation with complete dentures for a three year nine months old child is presented. Dental prosthesis are frequently used to avoid psychologic, speech, or swallowing problems in preschooler children. The case was followed up for a period of three years. These prosthesis were modified as the child grew and as the permanent teeth erupted into the oral cavity the dentures were trimmed from the areas of erupting teeth to facilitate their eruption.

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Aim: The aim was to restore the function and form of both arches with a proper occlusal relationship and eruption of tooth in the cleft area. Materials and Methods: Eleven patients were selected irrespective of sex and socio-economic status and whose age was within the mixed dentition period. Iliac crest is grafted in cleft area and subsequently evaluated for graft success using study models, and periapical and occlusal radiographs. Results: At the time of evaluation teeth were erupted in the area and good alveolar bone levels were present. Premaxilla becomes immobile with a good arch form and arch continuity. There are no major complications in terms of pain, infection, paraesthesia, hematoma formation at donor site without difficulty in walking. There is no complication in terms of pain, infection, exposure of graft, rejection of graft, and wound dehiscence at the recipient site. Discussion: It is evident that secondary alveolar grafting during the mixed dentition period is more beneficial for patients at the donor site as well as the recipient site. Conclusion: Long-term follow-up is required to achieve maximum advantage of secondary alveolar grafting; the age of the patient should be within the mixed dentition period, irrespective of sex, socio-economic status. It may be unilateral or bilateral.

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Crouzon's syndrome is an autosomal dominant disorder with complete penetrance and variable expressivity. Described by a French neurosurgeon in 1912, it is a rare genetic disorder. Crouzon's syndrome is caused by mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. Normally, the sutures in the human skull fuse after the complete growth of the brain, but if any of these sutures close early then it may interfere with the growth of the brain. The disease is characterized by premature synostosis of coronal and sagittal sutures which begins in the first year of life. Case report of a 7 year old boy is presented with characteristic features of Crouzon's syndrome with mental retardation. The clinical, radiographic features along with the complete oral rehabilitation done under general anesthesia and preventive procedures done are described.

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Central giant cell granulomas are non-neoplastic lesions of unknown etiology. They affect females more than males with the mandibular anterior region being the most common site of occurrence. Clinically central giant cell granulomas present as asymptomatic, expansile swellings causing deviation of associated teeth. Radiologically they usually presents as multilocular lesions causing expansion or perforation of cortical bone. Central giant cell granulomas are usually confused as other lesions both clinically and radiologically, and a definitive diagnosis can be made only histologically. We report here a rare case of central giant cell granuloma in association with congenitally missing tooth which was misdiagnosed to be an adenomatoid odontogenic tumor both clinically and radiologically. This case report also highlights yet another unique presentation of central giant cell granulomas that is in association with a congenitally missing maxillary lateral incisor.

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Odontomas are benign tumors containing various component tissues of teeth. They usually remain asymptomatic and are diagnosed on routine radiographs. Clinically, they are often associated with delayed eruption or impaction of permanent teeth and retained primary teeth. A case of compound odontoma in association with an unerupted, rotated and dilacerated maxillary permanent right central incisor in a 12-year-old boy is reported. Such combination is rare, making it an interesting case for reporting. We have also discussed the clinical features, diagnosis and treatment of such a condition.

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Congenital hemifacial hyperplasia (CHH) is a rare congenital malformation characterized by marked unilateral overdevelopment of hard and soft tissues of the face. Asymmetry in CHH is usually evident at birth and accentuated with age, especially at puberty. The affected side grows at a rate proportional to the nonaffected side so that the disproportion is maintained thr oughout the life. Multisystem involvement has resulted in etiological heterogeneity including heredity, chromosomal abnormalities, atypical forms of twinning, altered intrauterine environment, and endocrine dysfunctions; however, no single theory explains the etiology adequately. Deformities of all tissues of face, including teeth and their related tissues in the jaw, are key findings for correct diagnosis of CHH. Here an attempt has been made to present a case of CHH with its archetypal features and to supplement existing clinical knowledge.

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Objective: To determine the prevalence of tooth size discrepancy (TSD) in a representative orthodontics population, to explore how many millimeters of TSD is clinically significant and to determine the ability of simple visual inspection to detect such a discrepancy. Materials and Methods: The sample comprised 150 pretreatment study casts with fully erupted and complete permanent dentitions from first molar to first molar, which were selected randomly from records of the orthodontic patients. The mesiodistal diameters of the teeth were measured at contact points using digital calipers and the Bolton's analysis was carried out on them. Simple visual estimation of Bolton discrepancy was also performed. Results: In the sample group, 24% of the patients had anterior tooth width ratios and 8% had total arch ratios greater than ±2 standard deviation (SD) from Bolton's means. For the anterior analysis, correction greater than ±2 mm was required for 24% of patients in the upper arch or 14% in the lower arch. For the total arch analysis, correction greater than ±2 mm was required for 36% of patients in the upper arch or 32% in the lower arch. Conclusion: Bolton's analysis should be routinely performed in all orthodontic patients and the findings should be included in orthodontic treatment planning. 2 mm of the required tooth size correction is an appropriate threshold for clinical significance. Visual estimation of TSD has low sensitivity and specificity. Careful measurement is more frequently required in clinical practice than visual estimation would suggest.

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This clinical report presents a 46-year-old man diagnosed with nasopharyngeal carcinoma with the chief complaint of masticatory and speech deficiency because of radiation therapy. After a period of controlling post radiation caries, the patient was rehabilitated with tooth and implant supported metal ceramic restorations following surgical and endodontic intervention.

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Buccal exostoses are benign, broad-based surface masses of the outer or facial aspect of the maxilla and less commonly, the mandible. They begin to develop in early adulthood and may very slowly enlarge over the years. They are painless and self-limiting, but occasionally may become several centimeters across and then contribute to periodontal disease of the adjacent teeth by forcing food during chewing in toward the teeth instead of away from them, as is normally the case. The following paper presents a very rare case of buccal-sided mandibular angle exoxtosis and its management with surgical exploration.

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This article on the dental management of a neonate with Pierre Robin sequence describes the clinical and laboratory procedures for construction of a feeding plate due to the presence of a cleft palate. Emphasis has also been laid on a few literatures to describe medical complications associated with this condition. A 56-day-old neonate had been referred to the outpatient department with the complaint of difficulty in feeding, description, and management of which has been described in the case report.

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Odontomas are considered to be hamartomatous malformations rather than true neoplasms. This most common odontogenic lesion results from the growth of completely differentiated epithelial and mesenchymal cells that give rise to ameloblasts and odontoblasts. Dentigerous cyst is an epithelium-lined sac enclosing the crown of an unerupted tooth. Apparently, the dentigerous cyst arises by the accumulation of fluid between reduced enamel epithelium and the tooth crown. Occasionally it is associated with supernumerary tooth or odontoma. We report a case of dentigerous cyst associated with complex composite odontoma and an impacted lateral incisor in a 30-year-old male patient.

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Aim: The aim was to evaluate the effect of different cavity disinfectants on dentin bond strengths of composite resin applied with two different adhesive systems. Materials and Methods: Two-hundred mandibular molars were sectioned parallel to the occlusal surface to expose dentin in the midcoronal one-third. The dentinal surfaces were polished with waterproof-polishing papers. The specimens were randomly divided into five groups of 40 teeth each as follows: group 1(control) -- specimens were not treated with any cavity disinfectants. Groups 2--5 (experimental groups) -- dentin surfaces were treated with the following cavity disinfectants, respectively; 2% chlorhexidine solution, 0.1% benzalkonium chloride-based disinfectant, 1% chlorhexidine gel, and an iodine potassium iodide/copper sulfate-based disinfectant. The specimens were then randomly divided into two subgroups including 20 teeth each to evaluate the effect of different bonding systems. Dentin bonding systems were applied to the dentin surfaces and the composite buildups were done. After the specimens were stored in an incubator for 24 hours, the shear bond strength was measured at a crosshead speed of 1 mm/min. The specimens were then statistically analyzed. Statistical Analysis Used: One way analysis of variance and Tukey-HSD tests were used. Results: There was no significant difference between chlorhexidine gel and control groups regardless of the type of the bonding agent used (P>0.05). On the other hand, pretreatment with benzalkonium chloride-based, iodine potassium iodide/copper sulfate-based disinfectants or chlorhexidine solutions had a negative effect on the shear bond strength of self-etching bonding systems. Conclusions: The findings of this study suggest that when benzalkonium chloride-based, iodine potassium iodide/copper sulfate-based disinfectants or chlorhexidine solutions are used as a cavity disinfectant, an etch-and-rinse bonding system should be preferred.

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Aims and Objective: The aim of this study was to assess crown angulations, crown inclinations, and tooth size discrepancy in a sample population from Davangere, South India. Materials and Methods: One hundred adults (50 male and 50 female) of age 18-30 years, with Angle's class I ideal occlusion and balanced profiles, were selected for the study. Study models were prepared and crown angulations and crown inclinations were measured using a customized protractor device. Bolton's analysis was used to measure the tooth size discrepancies. Results: Maxillary and mandibular teeth had less crown angulations. Maxillary and mandibular incisors and maxillary molars showed increased crown inclinations, whereas mandibular molars and premolars had less crown inclinations than the original Andrews sample. The mean maxillary and mandibular tooth size ratios, overall and anterior, were similar to Bolton's ratios. Conclusions: The finding of this study indicates that there are possible racial and ethnic factors contributing to variations in crown angulations and crown inclinations.

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Extracted teeth can be bonded directly to adjacent teeth utilizing a prefabricated composite resin framework reinforced with polyethylene fiber as a noninvasive long-term provisional tooth replacement. This immediate provisional restoration allow for exact repositioning of the coronal part of the extracted tooth in its original intraoral three-dimensional position and thus relieves the apprehension of the patient caused by the sudden loss of an anterior tooth.

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Aim: To evaluate the effect of salivary contamination on the bond strength of one-bottle adhesive systems - (the V generation) at various stages during the bonding procedure and to investigate the effect of the contaminant removing treatments on the recovery of bond strengths. Materials and Methods: In this study the V generation one-bottle system - (Adper Single Bond) was tested. Fifty caries-free human molars with flat dentin surfaces were randomly divided into five groups of ten teeth each: Group I had 15 second etching with 35% Ortho Phosphoric acid, 15 second rinse and blot dried (Uncontaminated); Group II contaminated and blot dried; Group III contaminated and completely dried; Group IV contaminated, washed, blot dried; Group V contaminated, retched washed, and blot dried. The bonding agent was applied and resin composite (Z-100 3M ESPE) was bonded to the treated surfaces using the Teflon mold. The specimens in each group were then subjected to shear bond strength testing in an Instron Universal testing machine at a crosshead speed of 1 mm / minute and the data were subjected to one way ANOVA for comparison among the groups (P<0.05). Results: There was a significant difference between the group that was dried with strong oil-free air after contamination (Group III) and the other groups. When the etched surface was contaminated by saliva, there was no statistical difference between the just blot dry, wash, or the re-etching groups (Groups II, IV, V) if the dentin surface was kept wet before priming. When the etched dentin surface was dried (Group III) the shear bond strength decreased considerably. Conclusion: The bond strengths to the tooth structure of the recent dentin bonding agents are less sensitive to common forms of contamination than assumed. Re-etching without additional mechanical preparation is sufficient to provide or achieve the expected bond strength.

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It is important for the clinician not only to gather as much information about a case as possible, but also to be able to correctly interpret the data to arrive at an accurate diagnosis. Occasionally, a case presents with symptoms that might be suggestive of a condition; however, the final diagnosis may be totally different. This paper reports on an interesting case of a true vertical root fracture, in an intact maxillary molar in a 55-year-old man. The case was misdiagnosed and treated as a periodontal defect for over two months. The paper discusses the various causes and diagnostic dilemmas of root fractures.

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Franceschetti syndrome is an autosomal dominant disorder of craniofacial development with variable expressivity. It is commonly known as Treacher Collins syndrome (TCS). It is named after E. Treacher Collins who described the essential components of the condition. It affects both genders equally. This article reports a case of TCS in an 18-year-old female.

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Aim: To evaluate and compare the antibacterial activity of newer dentin bonding agents on Streptococcus mutans using the direct contact test. Materials and Methods: Streptococcus mutans was used as test organism and a direct contact test was performed. The dentin bonding agents to be tested were grouped as Group I, Clearfil Protect Bond, Group II, Adper Easy One, and Group III, Prime and Bond NT. For the direct contact test, three microtiter plates consisting of 96 wells each were taken (288 wells). These wells were divided into three groups of 96 wells; 16 wells of a microtiter plate were utilized, of which four were designated as 'A' wells (with the dentin bonding agent and bacterial suspension), another four as 'B' wells (without the dentin bonding agent, but with the bacterial suspension), another four as the 'C' wells (with the tested material, but without bacteria, which served as the negative control), and the remaining four as the 'D' wells (without the dentin bonding agent, which served as the positive control). Each group was treated with their respective bonding agents as per the manufactures instructions. Broth of 15 mL was then transferred from the A wells into an adjacent set of B wells containing fresh medium (215 mL). This resulted in two sets of four wells for each tested material containing an equal volume of liquid medium, so that bacterial growth was monitored both in the presence and in the absence of the tested material. The plate was placed for incubation at 37°C in the microplate reader and the optical density in each well was measured at 600 nm. The readings were taken at regular intervals. (Every 30 minutes for 16 hours). Results: The Dentin bonding agents evaluated in this study showed different inhibitory effects. Clearfil Protect Bond and Prime and Bond NT were most effective, and Adper Easy One was least effective against Streptococcus mutans. Interpretation and Conclusion: The Dentin bonding agents evaluated in this study showed different inhibitory effects. Clearfil Protect Bond and Prime and Bond NT were most effective, and Adper Easy One was the least effective against Streptococcus mutans. Hence, the incorporation of antibacterial agents into the dentin bonding agents may become an essential factor in inhibiting residual bacteria in the cavity and secondary caries.

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A palatal prosthesis can improve function by closing the palatal defect, preventing regurgitation, and improving swallowing and speech. Although techniques have been previously described for fabrication of palatal obturator, but there has not been any technique to devise an obturator for a patient with palatal defect with a quadhelix orthodontic appliance overlying it. One cannot wait in such patients for completion of lengthy orthodontic treatment and then think of devising prosthesis as the patient cannot carry out normal functions like swallowing and speech without the closure of defect. This article focuses on an innovative method of fabricating a palatal obturator which aims at restoring the above-mentioned functions along with improving aesthetics. It also enables us to devise the fabrication of prosthesis in two parts for easy insertion and removal and as well as to be self-cleansable. Such prosthesis would markedly improve patient psychology and confidence.

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Adenomatoid odontogenic tumor (AOT) is a slow-growing, benign tumor that appears in the anterior portion of the jaws and more frequently, the anterior maxilla usually in association with the crowns of unerupted teeth. Most of the tumors are diagnosed in second decade of life. A rare case report of AOT associated with an impacted right mandibular first premolar in a 24-year-old female is reported.

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Context: Heat cured acrylic resins undergo dimensional changes during polymerization. Dimensional changes which occur in the heat cure acrylic resins are shrinkage and expansion which affects the fit of the denture and occlusal relationship. Aims: The purpose of this study was to access the linear dimensional changes of four heat cure acrylic resins before and after curing and compare the changes among four different acrylic brands. Materials and Methods: Twenty four patients irrespective of age and sex were taken and four commercially available brands were procured. After the teeth arrangement on the mandibular trial denture, two pins were fixed in central fossae of first molar on both sides and one pin in the cingulum of left central incisor. Meliodent heat cure acrylic resin was used in Group A; Trevalon heat cure acrylic resin was used in Group B; Triplex heat cure acrylic resin was used in Group C and Vertex heat cure acrylic resin was used in Group D. Linear measurements of the trial wax up before and after curing and before and after finishing and polishing were measured and compared. Collected data was analyzed with analysis of variance and 't' test at 95% level of confidence (P=0.05). Results: The maximum percentage changes were seen in cases of Group A (Meliodent) followed by Group B, Group C and Group D (Trevalon, Triplex and Vertex). Meliodent showed the highest percentage change i.e. 1.18% and Vertex showed least percentage change of 0.37 %. Conclusions: Shrinkage occurred after curing and after finishing and polishing, which varies significantly with the four commercially available heat cure acrylic resins. Among the four different brands of heat cure acrylic resin Group D (Vertex) had the least linear dimensional changes after curing and after finishing and polishing, so that D (Vertex) could be the material of choice for fabrication of complete denture among the four brands.

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Purpose: An integrated fixture mount/impression coping/ temporary abutment can provide many advantages for immediate loading of dental implants, such as simpler procedure, less chair time, cost reduction, and comfort for the patients. Materials and Methods: A newly designed dental implant fixture mount (DIFMA) can be used as an impression coping for taking an immediate impression. An immediate load provisional prosthesis can then be fabricated shortly after implant placement to immediately load the implants. This fixture mount can also serve as a temporary abutment for immediate chair-side fabrication of provisional prosthesis. Two clinical cases are presented. Results: A clinical case utilizing the fixture mount abutment (DIFMA)/implant assembly is presented. The precision of fitting between the impression copings and implants is secured with this system. The chair time for taking an immediate impression is greatly reduced. Less cost for the restoration is provided and patient comfort is delivered. Conclusions: More patient satisfaction can be conferred by employing the fixture mount in the process of immediate impression taking and as an immediate provisional abutment.

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