Objective: The aim of this retrospective study was to evaluate the involvement of fascial spaces, their bacteriology, sensitivity to antibiotics and management of odontogenic infection in 100 patients of age less than 60 years. Results: The mandibular 3 ^rd molar was found to be the most commonly offending tooth, followed by the mandibular 2 ^nd molar. The submandibular space was the most frequently involved fascial space both in single fascial space infections and multiple fascial space infections. Mixed growth (aerobic and anaerobic) was seen in culture smears of 60 patients, only aerobic bacterial growth was seen in 25 patients and anaerobic bacterial growth was seen in culture smears of 15 patients. Streptococcus viridans was the most frequently isolated bacteria among the aerobes, whereas Bacteroides and Prevotella were the most common bacterial species among anaerobes. Empirical antibiotic therapy in the form of Co amoxiclav and Metronidazole was given. Incision and drainage followed by extraction of the offending tooth/teeth was carried out. Conclusion: It was concluded that odontogenic infections were mixed aerobic-anaerobic infections. Anaerobic as well as aerobic cultures were necessary to isolate all pathogens. Successful management of these infections depends on changing the environment through decompression, removal of the etiologic factor and by choosing the proper antibiotic.

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Idiopathic thrombocytopenic purpura (ITP) is defined as a hematologic disorder, characterized by isolated thrombocytopenia without a clinically apparent cause. The major causes of accelerated platelet consumption include immune thrombocytopenia, decreased bone marrow production, and increased splenic sequestration. The clinical presentation may be acute with severe bleeding, or insidious with slow development with mild or no symptoms. The initial laboratory tests useful at the first visit to predict future diagnosis were erythrocyte count, leukocyte count, anti-glycoprotein IIb/IIIa antibodies, reticulated platelets, plasma thrombopoietin level. Treatment should be restricted to those patients with moderate or severe thrombocytopenia who are bleeding or at risk of bleeding. We present a case report on ITP with clinical presentation, diagnosis and management.

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Background and Aim: The present study was undertaken to evaluate the pH, buffering capacity, viscosity and flow rate of saliva in caries free, minimal caries and nursing caries children and to evaluate the relationship of these on the caries activity of children. Materials and Methods: A total of 75 school children of age group between 4 and 12 years were selected and divided into three equal groups: Group I, Group II and Group III, consisting of 25 subjects each. Group I included caries-free subjects, Group II included subjects with minimal caries and Group III included subjects with nursing caries. Saliva samples were collected from all subjects and were estimated for flow rate, pH, buffering capacity and viscosity. Results: There was a significant decrease in the mean salivary flow rate, salivary ph and salivary buffer capacity and a significant increase in the salivary viscosity among caries-free subjects, subjects with minimal caries and subjects with nursing caries. Conclusion: The physicochemical properties of saliva, such as salivary flow rate, pH, buffering capacity and viscosity, has a relation with caries activity in children and act as markers of caries activity.

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In recent years, age estimation has become increasingly important in living people for a variety of reasons, including identifying criminal and legal responsibility, and for many other social events such as a birth certificate, marriage, beginning a job, joining the army, and retirement. Objectives: The aim of this study was to assess the developmental stages of left seven mandibular teeth for estimation of dental age (DA) in different age groups and to evaluate the possible correlation between DA and chronological age (CA) in South Indian population using Willems method. Materials and Methods: Digital Orthopantomogram of 332 subjects (166 males, 166 females) who fit the study and the criteria were obtained. Assessment of mandibular teeth (from central incisor to the second molar on left quadrant) development was undertaken and DA was assessed using Willems method. Results and Discussion: The present study showed a significant correlation between DA and CA in both males (r = 0.71 and females (r = 0.88). The overall mean difference between the estimated DA and CA for males was 0.69 ± 2.14 years (P < 0.001) while for females, it was 0.08 ± 1.34 years (P > 0.05). Willems method underestimated the mean age of males by 0.69 years and females by 0.08 years and showed that females mature earlier than males in selected population. The mean difference between DA and CA according to Willems method was 0.39 years and is statistically significant (P < 0.05). Conclusion: This study showed significant relation between DA and CA. Thus, digital radiographic assessment of mandibular teeth development can be used to generate mean DA using Willems method and also the estimated age range for an individual of unknown CA.

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Introduction: Oral lichen planus (OLP) is a chronic inflammatory disease characterized by bilateral white striations or plaques on the buccal mucosa, tongue or gingiva that has a multifactorial etiology, where the psychogenic factors seem to play an important role. Purpose: The aim of this study was to determine the existing relation between the OLP and psychological alterations of the patient, such as stress, anxiety, and depression. Materials and Methods: Hospital anxiety and depression scale was applied for psychometric analysis. Results: The study indicates a definitive relationship between a stressful life event and onset and progression of OLP. Conclusion: Stress management and bereavement counseling should be a part of management protocol of OLP.

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Objectives: The aim of the present study was to infer and to record the prevalence of incidental maxillary sinus pathologies in patients presenting with dental problems using the cone-beam computed tomography (CBCT) scans performed for maxillofacial diagnostic purposes. Materials and Methods: This retrospective study has evaluated 201 patients (402 maxillary sinuses consecutive CBCT) for various incidental maxillary sinus pathologies by two observers. Pathologic findings were categorized as mucosal thickening (MT), opacification (OPA), polypoidal-mucosal thickening (PT), others (antrolith and discontinuity of the sinus fl oor) and no pathologic findings. Correlations for pathologic findings and the factors of age and gender were calculated. Results: The prevalence for total incidental findings is 59.7%. The present study showed MT (35.1%) as most prevalent finding followed by OPA in (16.6%), PT in 7.2% and others in 0.7%. There was no statistically significant difference between gender and between the age groups. There was no statistically significant difference between different indications groups for CBCT scans. Conclusions: The incidental maxillary sinus abnormalities are highly prevalent in the asymptomatic dental patients; hence oral radiologists should be aware of these incidental findings and comprehensively evaluate the entire captured CBCT volume, which can help in early diagnosis, treatment and follow-up of the patient.

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Oral mucosal melanoma is a rare malignancy with the tendency to metastasize and locally invade tissues more readily than other malignant tumor of the oral cavity. It occurs approximately four times more frequently in the oral mucosa of the upper jaw usually on the palate or alveolar gingiva. The chameleonic presentation of malignant melanoma, its asymptomatic condition, rarity of the lesion, poor prognosis and the necessity of a highly specialized treatment are factors that should be seriously considered by the involved health care provider. Herein we report a rare and interesting case of oral malignant melanoma of the maxillary anterior gingiva, which was clinically and histopathologically diagnosed with a brief review of literature, has been discussed.

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Objectives: To study the correlation between blood glucose levels and salivary glucose levels in type 2 diabetic patients, to study the relationship between salivary glucose levels and oral candidal carriage in type 2 diabetic patients and to determine whether salivary glucose levels could be used as a noninvasive tool for the measurement of glycemic control in type 2 diabetics. Study Design: The study population consisted of three groups: Group 1 consisted of 30 controlled diabetics and Group 2 consisted of 30 uncontrolled diabetics based on their random nonfasting plasma glucose levels. Group 3 consisted of 30 healthy controls. Two milliliters of peripheral blood was collected for the estimation of random nonfasting plasma glucose levels and glycosylated hemoglobin (HbA1c). Unstimulated saliva was collected for the estimation of salivary glucose. Saliva was collected by the oral rinse technique for the estimation of candidal counts. Results: The salivary glucose levels were significantly higher in controlled and uncontrolled diabetics when compared with controls. The salivary candidal carriage was also significantly higher in uncontrolled diabetics when compared with controlled diabetics and nondiabetic controls. The salivary glucose levels showed a significant correlation with blood glucose levels, suggesting that salivary glucose levels can be used as a monitoring tool for predicting glycemic control in diabetic patients. Conclusion: The present study found that estimation of salivary glucose levels can be used as a noninvasive, painless technique for the measurement of diabetic status of a patient in a dental set up. Increased salivary glucose levels leads to increased oral candidal carriage; therefore, oral diagnosticians are advised to screen the diabetic patients for any oral fungal infections and further management.

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Context and Objective: Statin treatment, apart from its hypolipidemic action has proven its antimicrobial activity by improving the survival rate of patients with severe systemic bacterial infections. Periodontitis is an inflammatory disorder of tooth supporting structures caused by a group of specific microorganisms. The objective of the present study was to determine the antimicrobial activity of pure simvastatin drug against the primary periodontal pathogens. Materials and Methods: Minimum inhibitory concentration (MIC) was determined against Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans using serial dilution method. Results: MIC of simvastatin against P. gingivalis was 2 μg/ml and A. actinomycetemcomitans was found to be <1 μg/ml which requires further dilutions to determine the exact value. Conclusions: Data suggests a potent antimicrobial activity of simvastatin against both A. actinomycetemcomitans and P gingivalis. Hence simvastatin can be prescribed as a dual action drug in patients with both hyperlipidemia and periodontal disease.

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Background: Many diseases present themselves in oral and maxillofacial regions and various modalities may be applied for their diagnosis, including intraoral and panoramic radiography, ultrasonography (USG), computer tomography, magnetic resonance imaging, and nuclear medicine methods such as positron emission tomography. Of these modalities, USG is easy to-use for the detection of non-invasive and soft tissue related diseases in oral and maxillofacial regions. USG plays an important role in analyzing normal and abnormal structures. In particular, in oral and maxillofacial regions, the USG may be clinically applied to evaluate lymph nodes, subcutaneous, and oral cavity-related diseases. Aims: The aim was to correlate the findings of USG and histopathology for the diagnosis of oral and maxillofacial pathology and to evaluate whether USG can be used as an adjunct in diagnosing oral and maxillofacial pathology. Materials and Methods: A total of 10 clinically diagnosed patients with intraoral cancerous growths, swellings in maxillary and neck region were included in this study. Incision biopsy was obtained for confirming provisional clinical diagnosis. The selected cases were advised USG. All patients were then posted either for hemi-glossectomy, hemi-mandibulectomy, and partial maxillectomy with or without radical neck dissection. Statistical Analysis: Student's t-test and coefficient of correlation was used to statistically analyze significant relationship of both the methods. Result: In all 10 cases, USG correlated well with histopathology findings, it could also delineate tumor extent and measure tumor thickness. Conclusion: USG is an excellent method for the diagnosis of soft tissue lesions and can be used as an adjunct in diagnosing oral and maxillofacial pathology.

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Purpose: The aim of the present study was to compare the periosteal fenestration (PF) and free mucosal graft (FMG) techniques in mandibular anterior region to increase the vestibular depth. Methodology: A total of 20 systemically healthy cases (10 patients in each group) with shallow vestibular depth and reduced width of attached gingiva in lower anterior region were included in the present study. Clinical parameters recorded included Gingival index (GI), Plaque index (PI), Oral hygiene index simplified (OHI S), Vestibular depth (VD), width of attached gingiva and post operative discomfort. Findings: The results at the end of 3 months showed that the mean GI, PI, OHI S decreased significantly and remained low throughout the study period. The mean gain in percentage of vestibular depth at the end of 3 months for group 1(PF) was 48.4% with relapse of 7.2% from the baseline. For group 2 (FMG), the mean gain in percentage of vestibular depth at the end of 3 months for was 50% with relapse of 6.2% from the baseline. The mean gain in percentage of attached gingiva at 3 months for group 1 and 2 was 65.9% and 74%, respectively. In comparison of group 1 and 2, group 2 showed better results in terms of increasing the vestibular depth and attached gingiva than group 1 although the intergroup comparison was not statistically significant. Conclusion: When aim of the clinician is to treat a patient with shallow vestibule together with reduced width of attached gingiva, the use of periosteal fenestration yields similar results to that of FMG.

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The purpose of this case report is to demonstrate the use of orthodontic miniscrew implant in the intrusion of overerupted molar as a preprosthodontic therapy. A 37-year-old woman with an overerupted maxillary right first molar encroaching on the opposing mandibular edentulous space was successfully intruded using a single miniscrew implant and partial fixed orthodontic appliance. The prosthodontic clinician may adopt this conservative and cost-effective strategy in their routine practice and avoid clinical crown reduction.

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Background: To evaluate the diagnostic accuracy of different radiographic methods in the assessment of proximal alveolar bone loss (ABL). Materials and Methods: ABL, the distance between cement-enamel junction and alveolar bone crest, was measured in 70 mandibular human teeth - directly on the mandibles (control), using conventional periapical radiography with film holders (Rinn XCP and Han-Shin), digital periapical radiography with complementary metal-oxide semiconductor sensor, conventional panoramic, and cone-beam computed tomography (CBCT). Three programs were used to measure ABL on the images: Image tool 3.0 (University of Texas Health Sciences Center, San Antonio, Texas, USA), Kodak Imaging 6.1 (Kodak Dental Imaging 6.1, Carestream Health ^® , Rochester, NY, USA), and i-CAT vision 1.6.20. Statistical analysis used ANOVA and Tukey's test at 5% significance level. Results: The tomographic images showed the highest means, whereas the lowest were found for periapical with Han-Shin. Controls differed from periapical with Han-Shin (P < 0.0001). CBCT differed from panoramic (P = 0.0130), periapical with Rinn XCP (P = 0.0066), periapical with Han-Shin (P < 0.0001), and digital periapical (P = 0.0027). Conventional periapicals with film holders differed from each other (P = 0.0007). Digital periapical differed from conventional periapical with Han-Shin (P = 0.0004). Conclusions: Conventional periapical with Han-Shin film holder was the only method that differed from the controls. CBCT had the closest means to the controls.

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Introduction: Amnion allograft has been used in the field of medicine for its exceptional wound-modulating properties. However, in the field of dentistry, only a limited number of reports have explored its potential in healing of oral wounds. Materials and Methods: Amnion allograft in conjunction with coronally advanced flap has been used in the management of gingival recession. Results: A complete coverage along with excellent esthetics and an improvement in gingival biotype was observed at 6 months postoperatively. Discussion: Because of its inherent wound-modulating properties, amnion allograft may be used to enhance periodontal wound healing and enable tissue regeneration such as that in the coverage of gingival recession. Conclusion: Amnion allograft may provide an alternative to other conventional methods of treating gingival recession.

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Aim: A survey was set out to evaluate the knowledge of patients about tooth replacement as a whole, and assess their awareness of implant-retained prosthesis as an option of tooth replacement. Materials and Methods: Information on sociodemographic characteristics, knowledge about implant-retained tooth as an option for missing tooth replacement, cost implication, source of information and knowledge about other options of tooth replacement were obtained from patients attending the dental clinics of the University College Hospital, Ibadan, using structured self-administered questionnaires. Data were analyzed using SPSS version 20. Result: A total of 220 patients aged 18-84 years with a mean age of 37.6 (±16.5) years participated in the study, with a male to female ratio of 1:1.1. The majority (92.5%) knew that missing teeth can be replaced, while a significantly lower proportion (28.9%) knew about dental implants as an option (P < 0.01). Dentists were the major source of information on dental implants (68%). Only 21 (36.8%) of those who had heard about dental implant had knowledge about the cost (P < 0.000). Conclusion: A low level of awareness about dental implant as tooth replacement option exist in this environment, although most of the study participants were aware that missing teeth can be replaced.

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Preservation of the pulp in a traumatized immature fractured incisor tooth is of prime importance in order to achieve apexogenesis, a natural apical closure. The main factor influencing this is pulpal protection by a bioactive material proving optimum marginal seal in preventing any microleakage. This case report presents an 8-year-old female diagnosed with Ellis Class 3 fracture of immature tooth 11 involving the mesial pulp horn. Under rubber dam isolation, a partial pulpotomy was performed and the pulp was sealed using a new bioactive material BIODENTINE to stimulate apexogenesis, dentine replacement and pulp protection. The fractured segment was reattached for optimum esthetics, which was a concern for the patient. The patient was followed-up for 1, 3, 6 and 12 months, which revealed continued apical closure and maintenance of pulp vitality. The patient remained asymptomatic. This case report provides evidence for the potential use of Biodentine as an effective pulp capping material in the future.

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Background: The development of dental caries has been associated with the oral prevalence of Streptococcus mutans. Four serotypes of S. mutans have been reported, namely serotype c, e, f, and k that are classified based on the composition and linkages of cell wall polysaccharides, response to physiological reactions, sero-specificity and 16s rRNA homology. Although the oral prevalence of S. mutans serotype c in Indian subjects with or without caries is known, the prevalence of the other three serotypes, e, f, and k are not known. Hence in this study, we have investigated the occurrence of the e, f, and k serotypes in children with or without caries within the age group of 6-12 years. Materials and Methods: Genomic DNA isolated from whole saliva of caries active (CA) and caries free (CF) groups were first screened for the presence of S. mutans by strain specific polymerase chain reaction (PCR). Those samples that tested positive for the presence of S. mutans were further analyzed by serotype specific PCR to identify the prevalence of the serotypes. Results: Strain specific PCR indicated a higher prevalence of S. mutans in CA group (80%) relative to CF group (43%). Further analysis of the S. mutans positive samples in both groups indicated a higher prevalence of serotype k and e, followed by serotype f in CA group. Conclusion: The present data clearly establishes a novel S. mutans serotype prevalence hierarchy in children from this region, compared with those that have been reported elsewhere. Besides, the data are also clinically significant as the occurrence of serotype k has been associated with infective endocarditis.

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Various etiological factors are associated with gingival recession which may be anatomical, physiologic, or pathologic factors. Several root coverage procedures have been described to manage the gingival recession. However, it has been found that root coverage procedures in Miller's Class III and IV gingival recession have a poor prognosis with current techniques. A newer predictable technique, pedicled buccal fat pad (PBFP) has been introduced in cases of severe gingival recession. The buccal fat pad (BFP) is a specialized capsulated fat tissue that has the property of maintaining its volume and structure over a long period of time. It can also serve as a well vascularized, readily obtainable local flap for reconstructive purposes and increasing the dimensions of keratinized mucosa. The aim of this case report is to establish a new technique for root coverage using pedicled BFP in Miller Class IV recession on the maxillary right first molar.

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Background: Periodontal disease is an immune-inflammatory disease characterized by connective tissue breakdown, loss of attachment and alveolar bone resorption. In normal physiology, there is a dynamic equilibrium between reactive oxygen species activity and antioxidant defense capacity and when that equilibrium shifts in favor of reactive oxygen species, oxidative stress results. Oxidative stress is thought to play a causative role in the pathogenesis of periodontal diseases. Catalase (CAT) protects cells from hydrogen peroxide generated within them. Even though, CAT is not essential for some cell types under normal conditions, it plays an important role countering the effects of oxidative stress on the cell. Aim: This study was designed to estimate and compare the CAT and total antioxidant capacity (TAOC) levels in the serum of periodontitis, gingivitis, and healthy individuals before and after nonsurgical periodontal therapy. Materials and Methods: This study was conducted in the Department of Periodontics, A. B. Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore. The study was designed as a single blinded interventional study comprising of 75 subjects, inclusive of both sexes and divided into three groups of 25 patients each. Patients were categorized into chronic periodontitis, gingivitis and healthy. The severity of inflammation was assessed by using gingival index and pocket probing depth. Biochemical analysis was done to estimate the TAOC and CAT levels before and after nonsurgical periodontal therapy. Results obtained were then statistically analyzed using ANOVA test and paired t-test. Results: The results showed a higher level of serum TAOC and CAT in the healthy group compared with the other groups. The difference was found to be statistically significant (P < 0.0001). The posttreatment levels of TAOC were statistically higher than the pretreatment levels in periodontitis group.

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The Van der Woude syndrome is a rare autosomal dominant developmental malformation usually associated with lower lip pits, cleft lip and palate. These congenital lip pits appear, clinically, as a malformation in the vermilion border of the lip, with or without excretion. Obligate carriers of this dominant mutation may have lip pits alone, cleft(s) alone, clefts and pits or neither. Here, we present a case report of a 10 year-old male patient with Van der Woude syndrome and a brief literature on its treatment modalities.

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Aim: A double-blind randomized control trial was conducted to assess the effect of oral-transmucosal midazolam sedation on changes in anxiety levels of precooperative children during a Class II amalgam restorative procedure. Methodology: A sample of 40 healthy, American Society of Anesthesiologists I, children aged 3-4 years having at least one carious primary mandibular molar requiring a Class II amalgam restoration with no previous dental history were randomly divided into experimental and control groups comprising of 20 children each. The children in the experimental group (Group I) received 0.5 mg/kg body weight of midazolam mixed in strawberry syrup and those in the control group (Group II) received the same syrup mixed in saline, 15 min prior to the restorative procedure. Routine nonpharmacological behavior management techniques were used in both groups. The anxiety levels were recorded using Venham's anxiety scale at the start and end of each procedural step. Results: There was a significant (P < 0.001) reduction in the anxiety levels of children in the experimental group on entry into the operatory compared with the control group. Introduction of each fear evoking stimuli showed a somewhat similar increase in anxiety levels in the two groups. In spite of a similar trend, the anxiety levels remained much lower in Group I than in Group II. Conclusion: Midazolam in conjunction with behavior management is more helpful in relaxing the child initially than behavior management alone, thus increasing the chances of successful and easy accomplishment of further treatment steps.

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We present an osteolytic nasal polyp of the maxillary sinus with clinical features and radiographic features mimicking that of a malignancy. Maxillary sinusitis being a common inflammatory condition progressed to cause destruction of the maxillary bone and spread into the facial soft tissue, which is quite a rare occurrence. We have discussed in detail the clinical, radiological, histopathology and management of this uncommon presentation of a common case.

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Clear cell tumor in oral cavity constitutes an assorted group of lesions, which may be odontogenic, metastatic or of salivary gland origin. Those associated with salivary glands accounts for less than 1% of total cases mainly seen in the major salivary gland. Occurrence of clear cell carcinoma in minor salivary gland is rare and uncommon. Hence, this case of intraoral clear cell carcinoma associated with minor salivary gland of palate in a 57-year-old male patient is being reported.

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Nevoid basal cell carcinoma syndrome is a syndrome with wide variety of manifestations ranging from oral lesions to skeletal deformities. It calls for due responsibility of maxillofacial surgeon to diagnose the syndrome because very often they are the first health professionals to see the patient for the treatment of keratocystic odontogenic tumor. Keratocystic odontogenic tumor has been the topic of numerous investigators, is known for its potentially aggressive behavior, significant rate of recurrences. KCOT often occurs as a solitary lesion, in some instances multiple keratocysts may occur in association with a syndrome called Gorlin-Goltz syndrome (nevoid BCC, jaw cyst bifid rib basal cell nevus syndrome). Here, we present a case of multiple keratocysts in the mandible in association with skeletal, ocular, cutaneous anomalies in the given clinical scenario, which has profound relevance in the clinical dental practice.

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Dentigerous cysts are commonly encountered associated with impacted teeth; however the exact histogenesis of these cysts is not known even though numerous theories have been proposed. Majority of the maxillary cysts arise as a result of defect in the embryonal development, which can be either abnormal fusion of facial processes or as a result of abnormality in the development of dental follicle. Congenital Tessier's number 7 unilateral facial cleft is a rare anomaly, which arises as a result of defect in the fusion of facial processes. We report an unusual case of concomitant occurrence of Tesssier's number 7 cleft and maxillary dentigerous cyst in 11-year-old child.

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Objectives: The aim was to evaluate the relationship of the K-primer variant of the transforming growth factor-alpha (TGF-α) gene and C677T variant of the methylenetetrahydrofolate reductase (MTHFR) gene with nonsyndromic cleft lip and palate (CL/P) in the Indian population. Setting and Sample Population: The study group consisted of DNA samples of 25 subjects with nonsyndromic CL with or without cleft palate and 25 unrelated controls, already existing in the Department of Orthodontics, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India. Materials and Methods: The DNA samples were divided into two categories: Group A which included the 25 subjects with nonsyndromic CL/P; and Group B, which consisted of the 25 unrelated controls. The polymerase chain reaction (PCR) test was done for amplification of the region of interest from the DNA samples. Restriction digestion was then performed on the amplified product using the restriction enzyme HinfI, separately for each of the variants. The digested PCR products were separated into channels on a 1.5% agarose gel containing ethidium bromide in an electrophoretic chamber. A U.V. transilluminator was used to see the specific bands of base pairs of the digested PCR products. Results: In Group A, the TGF-α gene variant was present in 16 subjects (P = 0.001) and MTHFR gene variant was present in 8 subjects (P = 0.185). A combination of both gene variants were present in seven subjects, which was an interesting finding. In Group B, four subjects tested positive for the TGF-α and MTHFR gene variants. Conclusions: The TGF-α gene variant and a combination of TGF-α + MTHFR gene variants significantly contribute to the development of nonsyndromic CL/P and can be considered as genetic markers for Indian population. The MTHFR gene variant, though a minor risk factor, cannot be considered as a genetic marker.

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Background: Root canal preparation may produce a large quantity of smear layer that covers canal walls. Aims: The aim of this study was to evaluate by Scanning Electron Microscope (SEM) the root canal dentine after instrumentation with nickel-titanium rotary files, in order to evaluate the presence/absence of smear layer and the presence/absence of open tubules on the root canal walls at the coronal, middle, and apical third of each sample. Materials and Methods: A total of 20 single-rooted freshly extracted teeth were selected and divided into two groups. For each group, root canals were shaped with Mtwo and Revo-S instruments under irrigation with Sodium hypochlorite and 17% ethylenediaminetetraacetic acid. Specimens were fractured longitudinally and SEM analyzed at standard magnification of ×1000 and ×5000. The presence/absence of smear layer and the presence/absence of open tubules at the coronal, middle, and apical third of each canal were evaluated using a three-step scale for scores. Statistical Analysis Used: Numeric data were analyzed using the Kruskall-Wallis and Mann-Whitney U-Statistical tests and significance was pre-determined at P < 0.05. Results and Conclusions: This study did not reveal differences among the two groups. Mtwo and Revo-S showed no significant difference between them and both presented very low smear layer scores and open tubules scores, with no significant difference among coronal, middle, and apical third. Mtwo and Revo-S rotary instruments seem to be effective in removing smear layer from canal walls.

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To appreciate any enhancement in speech following gingivectomy of enlarged anterior palatal gingiva. Periodontal literature has documented various conditions, pathophysiology, and treatment modalities of gingival enlargement. Relationship between gingival maladies and speech alteration has received scant attention. This case report describes on altered speech pattern enhancement secondary to the gingivectomy procedure. A systemically healthy 24-year- female patient reported with bilateral anterior gingival enlargement who was provisionally diagnosed as "gingival abscess with inflammatory enlargement" in relation to palatal aspect of the right maxillary canine to left maxillary canine. Bilateral gingivectomy procedure was performed by external bevel incision in relation to anterior palatal gingiva and a large wedge of epithelium and connective tissue was removed. Patient and her close acquaintances noticed a great improvement in her pronunciation and enunciation of sounds like "t", "d", "n", "l", "th", following removal of excess gingival palatal tissue and was also appreciated with visual analog scale score. Exploration of linguistic research documented the significance of tongue-palate contact during speech. Any excess gingival tissue in palatal region brings about disruption in speech by altering tongue-palate contact. Periodontal surgery like gingivectomy may improve disrupted phonetics. Excess gingival palatal tissue impedes on tongue-palate contact and interferes speech. Pronunciation of consonants like "t", "d", "n", "l", "th", are altered with anterior enlarged palatal gingiva. Excision of the enlarged palatal tissue results in improvement of speech.

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