For complete periodontal regeneration, delivery of growth factors in the local environment holds a great deal in adjunct to bone grafts. Platelet rich fibrin (PRF) is considered as second generation platelet concentrate, consisting of viable platelets, releasing various growth factors such as platelet-derived growth factor, vascular endothelial growth factor, transforming growth factor, insulin-like growth factor, epidermal growth factor and basic fibroblast growth factor. Hence, this case report aims to investigate the clinical and radiological (bone fill) effectiveness of autologous PRF along with the use of xenogenic bone mineral in the treatment of intra bony defects. Intrabony defect was treated with autologous PRF along with the use of xenogenic bone mineral. A decrease in probing pocket depth, gain in clinical attachment level and significant bone fill was observed at end of 6 months. The result obtained with the use of PRF may be attributed to the sustained and simultaneous release of various growth factors over a period of 7 days. In this case report, the positive clinical impact of additional application of PRF with xenogenic graft material in the treatment of periodontal intrabony defect was seen.

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Objective: C-reactive protein (CRP) is an acute-phase reactant and has been proved to be a significant predictor of future cardiovascular events. Recent studies have demonstrated a correlation between periodontitis and elevated CRP levels. However, most of the studies have focused on chronic periodontitis and very few studies are done in patients with aggressive periodontitis. The aim of this study was to determine and compare the relative levels of serum CRP in aggressive and chronic periodontitis patients. Materials and Methods: A total of 75 systemically healthy subjects were divided into three groups: Group I, nonperiodontitis subjects; group II, chronic generalized periodontitis patients and group III, generalized aggressive periodontitis patients. All participants were subjected to quantitative CRP analysis using enzyme-linked immunosorbent assay. Results: Mean CRP levels were significantly greater in both group II and III as compared to group I and group III having greater level than group II. Furthermore, CRP levels positively correlated with the amount of periodontal destruction as measured by probing depth and clinical attachment loss. Conclusion: The present study indicates a positive correlation between CRP and periodontal disease severity with particular concern in younger individuals that could be a possible underlying pathway in the association between periodontal disease and the observed higher risk for cardiovascular disease in periodontitis patients.

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Background: Mothers play a key role as transmitters of oral health behavior for their children. Hence increasing their knowledge about positive attitude toward desirable oral health behaviors regarding their children will lead to the better oral health of the children. Aim: The aim was to evaluate the effectiveness of oral health education program among mothers with 6-18 months old children in the prevention of early childhood caries. Materials and Methods: A total of 480 mothers with 6-18 months old children were selected using cluster randomization of the primary health center. The allocated mothers were assigned into three groups: Motivation group (group A), traditional health education group (group B) and control group (group C). Clinical examination was carried out to record the dental decay of the child. Statistical Analysis: The data was analyzed using SPSS 13. Evaluation of statistical significance between groups was made using the Chi-square test, ANOVA and Kruskal-Wallis. Results: Mean number of decayed teeth was 0.23 + 0.58 in group A that was significantly less as compared to 0.39 + 0.79 and 1.17 + 1.32 in group B and C, respectively. Conclusion: Motivational intervention was more effective in reducing dental decay in the children as compared to the other two groups.

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Introduction: Intracanal medicaments have traditionally been used in endodontics to disinfect root canals between appointments. Calcium hydroxide is widely used as an intracanal medicament for disinfection and to promote periapical healing. It is stable for long periods, harmless to the body, and bactericidal in a limited area. The efficacy of calcium hydroxide as a disinfectant is dependent on the availability of the hydroxyl ions in the solution that depends on the vehicle in which the calcium hydroxide is carried. In general, three types of vehicles are used: Aqueous, viscous or oily. Some in vitro studies have shown that the type of vehicle has a direct relationship with the concentration and the velocity of ionic liberation as well as with the antibacterial action when the paste is carried into a contaminated area. Aim of the Study: To evaluate the calcium ion release and measure the change in pH of the environment that occurred when calcium hydroxide was combined with different vehicles (distilled water, propylene glycol, calcium hydroxide containing gutta-percha points and chitosan) over different time periods. Materials and Methods: Forty single rooted mandibular first premolar teeth were decoronated for this study. Working length was established and the root canals were enlarged and irrigation accomplished with 2 ml of NaOCl solution after every file. The teeth were then randomly divided into four groups. The canals were then packed with different preparations of calcium hydroxide using the following vehicles-distilled water, propylene glycol, gutta-percha points and chitosan. Calcium ion release in different groups was analyzed using an ultraviolet spectrophotometer at 220 nm. The change in pH of was determined using a pH meter. Results were statistically evaluated using one-way ANOVA test. Result: For calcium ion release, Group 2 showed cumulative drug release of 81.97% at the end of 15 days, whereas Group 1, 3 and 4 showed a release of 99.53, 17.98, 74.93% respectively with a significant difference among all groups. Group 1 reached the highest Ca ²⁺ level (39.79%) at the end of 1 day but showed almost complete release of calcium hydroxide at the end of 15 days. Group 3 showed least calcium ion release (17.98%) at 15 days. Group 4 showed a sustained release of Ca ⁺² ions from 74% at 15 days to 95% at the end of 30 days. After the 1 ^st h; Group 1 showed the highest pH level (11.8). However, pH reduced to 7.8 at the end of 30 days in this group. Group 2 showed the highest pH value (10.35), followed by Group 4 (10.32) after 30 days. Conclusion: Chitosan can be used as a promising vehicle for calcium hydroxide to maintain an alkaline pH and to allow sustained release of calcium ions in the root canal system.

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Objective: This study aims to evaluate and compare with the existing literature on the etiology, pattern, gender, and anatomical distribution of mandibular fractures. Materials and Methods: The data of 225 cases were analyzed over a period of 5 years between March 2009 and November 2013. Of this 110 were unilateral, 23 bilateral, 18 symphysis and 74 multiple fractures. Results: Males are more affected than females.The peak incidence rate is occurring in 30-35 years of age group. The most common fracture site is parasymphysis and least common site is ramus of mandible. The most common etiological factor is road traffic accident (RTA) (45.3%) followed by falls (42.6%), assaults (8.9%), sport injuries (2.2%), and gunshot wounds (0.89%). Conclusion: Thus, we conclude that RTA is the leading cause of mandibular fractures and males are more affected. The most common site is parasymphysis fracture in association with angle fracture. We observed that gender was significantly associated with body and angle fracture (P = 0.04) and significant relationship between etiology with multiple site fracture such as (parasymphysis-angle), (body-condyle), (body-angle), and (symphysis-condyle) was observed (P ≤ 0.05).

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Background: Diabetes Mellitus is a metabolic syndrome, affecting the oral health in various ways with dental caries being one of the most common problems encountered. Saliva is one of the most abundant secretions in the human body with a variety of natural protective and defence molecules bathing the oral cavity maintaining equilibrium. Its collection is easy and non-invasive. Aims: To compare and evaluate salivary alkaline phosphatase levels and calcium ion levels between caries active type II diabetes mellitus patients and non-diabetics. Materials and Methods: This study was carried out on caries-active age and gender matched 60 non-diabetic and 60 patients with known Type II diabetes mellitus subjects of age group 25-50 years with DMFT index >10. Saliva sample was collected to analyse for alkaline phosphatase enzyme and concentration of calcium ions using Agappe kits. Statistical Analysis: Student 't' test was used to correlate the salivary electrolyte concentration in non- diabetic and diabetic patients with dental caries. A 'P' value of 0.05 or less was considered significant. Results are presented as mean ± standard deviation (X ± SD). Results: The alkaline phosphatase (ALP) activity in saliva was higher in diabetic patients when compared to that of non-diabetic patients with salivary calcium ions were significantly higher in non-diabetic individuals. Conclusion: Diabetes Mellitus patients are more prone to dental caries, hence require intervention to improve the quality of saliva.

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Background: Aggressive periodontitis is a characterized by rapid attachment loss, bone destruction and familial aggregation. Platelet-rich plasma (PRP) has been proposed to promote regeneration of the lost periodontal tissues. The aim of this study was to evaluate and compare the efficacy of PRP combined with hydroxyapatite (HA) graft in the treatment of intra-bony defects in localized aggressive periodontitis (L-AgP) patients. Materials and Methods: Ten L-AgP patients having bilateral intra-bony defect ≥2 mm and probing depth (PD) ≥6 mm were randomly treated either with the PRP/HA graft or HA graft alone. The clinical (plaque control record, bleeding on probing index, PD, and relative attachment level [RAL]), and radiographic parameters (size of the bone defect) were recorded pre- and post-operatively at 3, 6, and 12 months. Results: After 12 months, for both maxillary and mandibular arches, the mean PD decrease was significantly more (P < 0.05) for the test group than the control group (3.2 mm vs. 1.9 mm and 3.6 mm vs. 1.9 mm, respectively). Furthermore, the mean RAL decrease in both maxillary and mandibular arches was significantly more (P < 0.05) for the test group than the control group (3.0 mm vs. 1.2 mm and 3.1 mm vs. 1.4 mm, respectively). Radiographically, the test group showed significantly more defect fill as compared with the control group. Conclusion: Both treatments provided significant improvements in clinical and radiographic parameters in a 12-month postoperative period. PRP/HA group presented superior results regarding PD reduction, clinical attachment gain and radiographic bone fill than HA group.

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Objective: The aim of this study was to compare the antiplaque and antigingivitis effects of a mouthwash containing tea tree oil (TTO) with a cetylpyridinium chloride (CPC) mouthwash. Materials and Methods: This was a randomized 4 × 4, controlled, cross-over, involving 20 healthy volunteers in a 5-day plaque re-growth model. Test mouthwashes were TTO (Tebodont^® ) and a mouthwash containing CPC 0.05% (Aquafresh^® ). A 0.12% chlorhexidine (CHX) mouthwash (Oro-Clense^® ) was used as positive and colored water (placebo [PLB]) as negative controls. Gingival bleeding index (GBI) and plaque index (PI) scores were recorded before and after each test period. Test periods were separated with 2 weeks washout period. Results: All four mouthwashes significantly (P < 0.001) reduced the GBI scores when compared to the baseline GBI scores. There was no significant difference between PLB and active mouthwashes in the GBI scores. CHX and CPC mouthwashes were found more effective in reducing the PI scores than TTO and PLB mouthwashes. There was no significant difference in PI scores of CHX and CPC mouthwashes. Conclusion: 0.05% CPC mouthwash can be an alternative to CHX mouthwash since it is alcohol free and found as efficient as CHX in dental plaque reduction with lesser side effects. More studies are needed to test antigingivitis effects of the mouthwashes used in this study, preferably without initial scaling and polishing.

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Aim: Traumatic dental injuries frequently occur in society and may occur at home. The ultimate prognosis of an avulsed tooth occurring in a child may depend on the parents' knowledge of appropriate emergency measures. This study is aimed at evaluating the awareness level of a sample of Indian (Rohtak, Haryana) parents in the management of dental trauma. Materials and Methods: A total of 1500 parents were surveyed using a self-administered structured questionnaire. The questionnaire was divided into three parts. The tabulated data were statistically analyzed using the Chi-square test. Result: This study indicated a low level of knowledge regarding tooth avulsion and replantation procedures to be followed in emergency. The residing area and age of parent did not affect the knowledge and awareness of parents. Moreover, well-educated parents also had very little or no information about dental trauma first-aid. The lack of significance in correct answers between those with and without such experience indicated that past experience did not seem to have increase the knowledge of the correct emergency procedures. Very little or no information about tooth avulsion and replantation had been given to most of them. Conclusion: Dental injury prevention and management should be recognized as a major public health issue and adequate resources to be allocated for research in this area. Educational programs to improve the knowledge and awareness among the parents have to be implemented.

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Treacher Collins syndrome (TCS) or Franceschetti syndrome is an autosomal dominant disorder of craniofacial development with variable phenotypic expression. It presents with characteristic facial appearance enabling it to be easily recognizable. A case of a 10-year-old girl having TCS is briefly described in this article. A review of the etiology, clinical features, differential diagnosis, and treatment options are also discussed.

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Neural tumors located centrally in jaw bones are relatively rare compared with soft tissue neurofibromas. Less than 50 cases have been reported in the literature with a predilection for mandible. This article aims to elucidate a unique case of intraosseous neurofibroma of mandible in a 62-year-old edentulous female patient associated with facial asymmetry due to the swelling extending from the right body of mandible to left body of mandible. The uniqueness of this case is related to the age and extensiveness of this lesion. A review of clinical, radiographic, histological, and immunohistochemical features, and the surgical management pertaining to this case are discussed along with a review of the literature.

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Ectomesenchymal chondromyxoid tumor (ECMT) is a rare benign neoplasm of uncertain histogenesis, which exclusively involves the oral cavity, particularly the tongue. Clinically, it presents as slow growing, painless, firm, submucosal swelling exclusively occurring on the anterior dorsum of the tongue. Histopathologically, it comprised well circumscribed, unencapsulated lobular proliferation of fusiform and polygonal cells, with varying degree of cellularity, with neoplastic cells often seen in a myxoid, chondroid or hyalinized background. Until date, only 40 cases have been reported in the literature. Most documented lesions involve anterior tongue, however 2 cases in posterior tongue and one palatal tumor has been described. Here, we present a rare case diagnosed clinically and histopathologically as (ECMT) in a 7-year-old girl with the size of the lesion 5.0 cm making this case even rarer and throwing some light on this distinct entity.

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Exophytic growth of the oral cavity often presents a diagnostic challenge because a diverse group of the pathologic process can produce such lesions. Inflammatory hyperplasia is one of the important etiology behind the exophytic growths of the oral cavity. The pyogenic granuloma (PG) is the most common type of inflammatory hyperplasia found in the oral cavity especially in the gingiva. Extragingival occurrence of PG is very rare. This case report has described an extragingival PG which occurred on the lower labial mucosa in a 54-year-old male patient.

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Aim: The aim of this clinical study was to determine if progressive bone loading was effective in improving bone density and rigidity of implants. Materials and Methods: 11 implants were placed with conventional loading and 14 implants were placed with progressive loading. The Periotest instrument was used to assess implant mobility. Mean difference of values were recorded in both qualities of bone. Results: Conventional loading in poor quality bone showed a significant decrease in rigidity of the bone as compared to conventional loading in good quality of bone. Progressive loading in both poor and good quality bone showed a significant increase in bone rigidity. Conclusion: Implants should not be loaded conventionally in poor quality bone but should be progressively loaded to prevent decrease in density and rigidity around implants.

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Introduction: Rapid maxillary expansion (RME) is an orthopedic treatment procedure routinely used to treat constricted maxillary arches and also a potential additional treatment in children presenting with sleep-disordered breathing (SDB). Aims and Objectives: The main objective of this study was to evaluate the effects of RME on sleep characteristics in children. Materials and Methods: Polysomnography was done on children of 8-13 years of age before expansion (T0), after expansion (T1) and after a period of 3 months after retention (T2). Bonded rapid maxillary expander was cemented in all children. Inter-molar distance was also measured at T0 and T2. Statistical Analysis: Nonparametric Friedman test was used for comparing the averages of sleep parameters at different time period (T0, T1, T2). Wilcoxon signed ranks test was used for comparing the averages of inter-molar width (T0-T2). P < 0.05 were considered as significant. Results: All children showed an improvement in sleep parameters with an increase in sleep efficiency, decreased in arousal and desaturation index after expansion. Total sleep time showed a statistically significant increase after expansion. A statistically significant increase in inter-molar distance was obtained after expansion. Conclusions: Rapid maxillary expansion is a useful treatment option for improving quality of sleep even in normal children without SDB. It also induces widening of the maxilla, corrects posterior crossbites and improves maxillary and mandibular dental arch coordination.

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Background: Oral exfoliative cytology includes the study and interpretation of the features cells exfoliated from the oral mucosa. The aim of this study was to analyze cytological changes in the periodontal pocket of patients with different clinical stages of aggressive periodontitis (AP) and chronic periodontitis (CP). Materials and Methods: Patients aged 24-54 years, of whom 41 were diagnosed with AP, 40 with CP, sub-classified as mild, moderate and severe periodontitis, and 40 healthy individuals who were the control group. Samples of the epithelium of the periodontal pocket were taken for the cytological study. Results: Superficial and intermediate cell values were significantly greater in patients with AP than in patients with CP or the control group. Histiocyte number was higher in patients with CP than in those with AP, and differed significantly in both types of periodontitis compared to the control group. There were significant differences in polymorphonuclear neutrophil leukocytes when both types of periodontitis were compared to the control group. Microbial flora was statistically higher in patients with CP, and there were differences between patients with periodontitis and the control group. Conclusions: The cytological study demonstrated that patients with AP had greater tissue damage, shown by the increase in intermediate and superficial cells of the epithelium of the periodontal pocket compared to the group of healthy subjects and to a lesser extent, to patients with CP. Only superficial cells made it possible to differentiate the sub-stages of the disease.

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Interdisciplinary approach for the management of malocclusion provides a holistic approach of patient management. Prudent treatment planning is necessary to achieve the various treatment goals. This case report describes the orthodontic management of a 16-year-old adolescent female patient with bilateral labially impacted maxillary canines. The problems associated with impacted maxillary canines and the biomechanical interventions used for this patient are discussed. The treatment protocol involved surgical intervention, followed by sequential traction of the impacted teeth. An interdisciplinary approach to treatment with different mechanical strategies led to the achievement of the desired esthetic, functional, and occlusal treatment goals.

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Objective: The study was carried out to compare the morphometry of the cervical column between adult Class I and Class II individuals and between gender and to analyze the correlation between the cervical column morphology, the cranial base angle, the craniocervical inclination with craniofacial morphology and stature of Angles Class I and Class II individuals. Materials and Methods: The data for this institutional retrospective study were systematically selected according to the specified inclusion and exclusion criteria from the pretreatment cephalometric radiographs of 19 male and 30 female patients visiting the Department of Orthodontics, Manipal College of Dental Sciences, Mangalore, Manipal University, based on their ANB angle. The radiographs were traced and digitized. The reliability of the variables describing the cranial base and vertical and sagittal craniofacial dimensions was assessed. Conclusions: Our results showed that there was no statistically significant variation in the cervical vertebrae dimensions between Class I and Class II patients. There was found to be a definite sexual dimorphism, which was not statistically significant. Correlation exists between sagittal skeletal patterns, especially mandibular length and cervicovertebral morphology, but its use to classify the subjects in different sagittal classes is questionable.

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Sclerosing mucoepidermoid carcinoma (SMEC) is extremely rare variant of the mucoepidermoid carcinoma, which is the most common primary malignancy of the salivary glands. As its name suggests, SMEC is characterized by an intense central sclerosis that occupies the entirety of an otherwise typical tumor, frequently with an inflammatory infiltrate of plasma cells, eosinophils, and/or lymphocytes at its peripheral regions, but its uncompanionship with inflammatory cell infiltration might explain its progressive stage of the sclerosis. The sclerosis associated with these tumors may obscure their typical morphologic features and result in diagnostic difficulties. Tumor infarction and extravasation of mucin eventuating in reactive fibrosis are two mechanisms of formation that have been suggested as underlying this morphologic variant. Morphologic evidence in support of the mucin extravasation hypothesis was identified, as small pools of mucin were present throughout the tumor.

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Context: Prediction of the child's behavior can adequately equip the dentist in rendering effective and efficient dental treatment. Aim: This study was planned to evaluate and validate a specially prepared questionnaire as a child behavior prediction scale. Design: A two-center cross-sectional study was done to validate the new scale. Materials and Methods: Children aged 3-12 years (n = 296), from two different centers participated in this study. The questionnaire used was a 10-point observational scale. Observations involved perceiving overt and subtle behavioral characteristics of a child, to assess the child's behavior in the dental office before treatment. An independent observer approached the children and their parents in the waiting room. The child's behavior was then evaluated by the dentist using Frankl behavior rating scale during and after treatment. The prediction of behavior compared to the Frankl scale was assessed and validated. Statistical Analysis: Sensitivity, specificity tests, and receiver operating curve analysis were used to validate the new scale and calculate the cut-off score for positive and negative behavior. All data were processed by SPSS software (16.0, SPSS Inc., Chicago, Ill, USA). Results: The best cut-off score to predict a positive Frankl rating was ≥ 8.0 in both the centers. The sensitivity and specificity scores were 93.4% and 62.5% in center 1; 83.1% and 59.6% in center 2 respectively. Conclusion: This novel prediction scale can be of great importance in predicting children's behavior in the dental environment.

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Hereditary gingival fibromatosis (HGF) is a rare hereditary condition characterised by slow, progressive, nonhemorrhagic, fibrous enlargement of gingiva caused by increase in sub-mucosal connective tissue component. This paper presents a case report of a 14-year-old male suffering from HGF with positive family history. After through clinical examination, routine blood investigation was advised. All the parameters were within normal physiological limits. Surgical excision of enlarged gingival mass was planned after meticulous scaling and root planning. Patient was recalled 1-week after surgery. Postoperative healing was good and desired crown lengthening was achieved with significant improvement in speech and masticatory problems. There was no recurrence of the disease even after 2 years follow-up.

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Usually, treatment of impaction includes: Welcome preparation (to create space), surgical exposure and attachment to the impacted tooth and the orthodontic guidance for the eruption of the impacted tooth. Sometimes, due to deficiency of space, creation of space for impacted tooth requires first, and space regaining efforts may require the distal movement of posterior teeth and or mesial movement of anterior teeth in the arch, but it may create some problems. To overcome the unwanted problem in this clinical situation and to reduce overall treatment duration of the patient, we have developed the Simultaneous space creation, Eruption and Adjacent root control spring to control crown as well as root movement.

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Background: The properties of the composite materials and the clinical expertise while layering them carry many esthetic implications in restorative dentistry. Aims: The aim of the present study is to assess the influence of scattering properties of G-aenial A2 shade on color perception when used in esthetic restorations. Materials and Methods: Two composite resins were evaluated in this study: Gradia Direct (shade A3) and G-aenial (shade A2). A colorimetric evaluation according to the CIE L*a*b* system, relative to standard illuminant A against a white background, was performed to assess the referred chameleonic properties of G-aenial when used in simulated clinical situations. Statistical Analysis Used: The differences in color change between the test group G-aenial and the test Group Gradia Direct were considered clinically not perceptible (ΔE* <3.3). Differently, the differences in color change were considered clinically perceptible (ΔE* >3.3) between the control group G-aenial and the control group Gradia Direct and between the test group G-aenial and the control specimens obtained with G-aenial. The CIE Lab parameters which brought to ΔE were investigated using t-test (P < 0.05). Results and Conclusions: Color harmonization in simulated clinical conditions depends on different factors related to dentine and to composite resins. In this study dentine variables were dropped in order to analyze the influence of thickness and of the composition of the composite resin.

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Introduction: Mixed dentition regression equations analyses (Moyers, Tanaka-Johnston) are based on European population , reliability of these methods is questionable over other population. Materials and Methods: The present study was conducted on total 260 study models. This study was done in two phases. In the first phase, linear regression equations were made. In the second phase, comparison of actual values of sum of mesiodistal width of canine, first and second premolars with the predicted values proposed by Moyers, Tanaka-Johnston, and the new proposed mixed dentition analysis for North Indian population were made. Results: Set of four linear regression equations for predicting sum of mesiodistal width of permanent canine, first premolar and second premolar in North Indian population from sum of mesiodistal width of mandibular incisors and mandibular first molars, were proposed as ; (a) for males, maxillary arch, Y = 2.9 + 0.40X, (b) mandibular arch Y = 3.91 + 0.37X (c) for females, maxillary arch Y = 0.56 + 0.45X (d) mandibular arch Y = 1.14 + 0.42X. Moyers and Tanaka-Johnston, mixed dentition analysis , is found to be overestimating the mesiodistal width of unerupted canine and premolars in North Indian population.

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Aim: This study aims to evaluate the clinical, radiographic, and histological success rate of antioxidant mix as a new pulpotomy agent for primary teeth. Settings and Design: Commercially available antioxidants, namely Antioxidants plus trace elements (OXIn-Xt ^tm , India) were used. Materials and Methods: This prospective study was carried out on 36 primary molar teeth in 32 children, with age that ranged from 6 to 9 years. Regular conventional pulpotomy procedure followed by placement of antioxidant mix over the radicular orifice was done. Recall was scheduled for 3, 6, and 9 months, respectively, after treatment. Results: Thirty-six pulpotomized primary molars were available for follow-up evaluations. Scanning electron microscopy analysis of samples showing convex shaped hard tissue barrier formation may be proof of the role of antioxidant material in localization and direction and morphology of the hard tissue barrier. One tooth which presented with pain was assessed as unsuccessful. Conclusion: Quite promising clinical, radiographic, and histological results of antioxidants in the present study shows their potential to be an ideal pulpotomy agent.

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A 14-year-old girl reported with severely proclined maxillary anterior teeth with fractured and discolored right maxillary central incisor with questionable prognosis. Autotransplantation of premolar to replace central incisor was considered a risky option as patient was 14-year-old with presence of advanced root development of premolar. The immediate placement of the prosthetic implant was also not possible because of patient's age. Therefore, it was decided to use the space obtained by extracting questionable maxillary right central incisor for orthodontic purpose and also sacrificing the healthy premolar is invariably an excessive biological cost for a modest functional and aesthetic gain. Hence, the treatment plan for this case includes extraction of right maxillary central incisor and left maxillary first premolar, movement of right maxillary lateral incisor mesially, achieving normal axial inclination of maxillary anteriors with normal overjet and overbite. Mandibular arch was treated nonextraction due to congenitally missing central incisors with presence of normally inclined lower anteriors thereby maintaining Angles class I occlusion. Tipping, usually, seen in Begg mechanotherapy was used for our advantage to correct severely proclined maxillary anteriors with simultaneous bite opening mechanics. Case was completed in 19 months and posttreatment records including photographs, radiographs and study models were made. Begg wrap around the retainer was placed in the maxillary arch allowing natural settling of occlusion.

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The efficacy of the Herbst appliance in a normalizing sagittal relationship in patients with a Class II malocclusion is well-documented. This case report describes the treatment of a 14-year-old male patient with severe Class II Division 1 malocclusion due to retrognathic mandible and mildly prognathic maxilla, convex profile, and lip trap. He had severely proclined maxillary incisors and retroclined mandibular incisors, overjet of 13 mm and overbite of 7 mm. Since the patient was in the peak pubertal growth phase, growth modulation was carried out with the Herbst appliance for 8 months, followed by fixed appliance therapy with the Begg appliance for 11 months. Combination of Herbst and Begg appliance led to a very favorable treatment outcome and greatly improved the patient's appearance.

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Ameloblastomas are rare histologically benign, locally aggressive tumors arising from the oral ectoderm that occasionally reach a gigantic size. Giant ameloblastomas are a rarity these days with the advent of panoramic radiography in routine dental practice. Furthermore, the granular cell variant is an uncommon histological subtype of ameloblastoma where the central stellate reticulum like cells in tumor follicles is replaced by granular cells. Although granular cell ameloblastoma (GCA) is considered to be a destructive tumor with a high recurrence rate, the significance of granular cells in predicting its biologic behavior is debatable. However, we present a rare case of giant GCA of remarkable histomorphology showing extensive craniofacial involvement and dural extension that rendered a good prognosis following treatment.

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Introduction: WITS appraisal is a common parameter in cephalometrics to assess maxillo-mandibular skeletal relationship as an adjunct to angle ANB. The high variability of the WITS appraisal is attributable to difficulties or inaccuracies in identifying the occlusal plane or variations due to tooth eruption, dental development or treatment changes by vertical movement of incisors, molars, or both. Aim: An extracranial reference line common to both denture bases, instead of the occlusal plane is proposed to assess antero-posterior jaw relationships. Materials and Methods: A true vertical obtained by plumb line was recorded, while taking the cephalogram for 40 subjects. A line drawn perpendicular to this true vertical gave a stable and reproducible extracranial true horizontal (HOR) reference line. The linear distance between perpendiculars from points A and B was measured as an adjunct to angle ANB. Result: The Pearson's product moment correlation coefficient calculated for the entire sample indicated higher correlation coefficient (r = 0.8712) for the linear measurements on HOR (AH-BH) with respect to the angle ANB when compared with the WITS readings (AO-BO) (r = 0.549). Conclusion: The horizontal appraisal method proposed eliminates the demerits of the occlusal plane and has the merits of simplicity and accuracy in comparison to WITS appraisal.

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