Background: Pharmacological methods have been used as an adjunct to enhance child cooperativeness and facilitate dental treatment. Objective: Purpose of this study was to evaluate and compare the effect of sedation by intranasal dexmedetomidine and oral combination drug midazolam–ketamine in a group of children with uncooperative behavior requiring dental treatment. Materials and Methods: This was a prospective, randomized, double-blind study that included patients 3–9 years old with American Society of Anesthesiologists-I status. About 36 children presenting early childhood caries were randomly assigned to one of three groups studied: Group MK received intranasal saline and oral midazolam (0.5 mg/kg) with ketamine (5 mg/kg) mixed in mango juice; Group DX received intranasal dexmedetomidine (1 μg/kg) and oral mango juice; and Group C received intranasal saline and oral mango juice. Patients' heart rate, blood pressure, and oxygen saturation were recorded before, during, and at the end of the procedure. Patients' behavior, sedation status, and wake up behavior were evaluated with modified observer assessment of alertness and sedation scale. Ease of treatment completion was evaluated according to Houpt scale. Results: Hemodynamic changes were statistically insignificant in Group MK and Group DX. About 75% patients in Group MK were successfully sedated as compared to 53.9% Group DX and none of the patients in Group C. Ease of treatment completion was better with Group MK as compared to Group DX and least with Group C. Around 50% patients in Group MK had postoperative complications. Conclusion: Oral midazolam–ketamine combination and intranasal dexmedetomidine evaluated in the present study can be used safely and effectively in uncooperative pediatric dental patients for producing conscious sedation.

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Background: The role of cytokines as a marker in the oral inflammatory process in ECC has not been fully explored before and after full mouth rehabilitation. Aims: The aim of this study was to assess the level of salivary interleukin-6 (IL-6) in children with ECC and to compare its levels before and after comprehensive full mouth rehabilitation. Methods and Materials: Saliva samples were collected from children with ECC prior to dental treatment and 3-month post treatment. The salivary IL-6 levels were analyzed using the ELISA method. The gingival index was also timely recorded. Oral health awareness sessions were conducted for children and their parents at regular intervals during the 3-month study period. Statistical analysis used: Wilcoxon Signed Rank test compared the levels of salivary IL-6 while, the paired t test compared the values of gingival index before and after treatment. Results: The mean level of salivary IL-6 before and 3 months after treatment had reduced and this reduction was statistically significant (P< 0.000). The gingival index scores had also reduced significantly 3-months post treatment (P< 0.002). Conclusions: Children with ECC when completely rehabilitated and kept under frequent follow up, which includes reinforcement of oral hygiene measures and maintaining a low caries activity state, the level of inflammation (IL-6) can definitely be minimized and thereby improving the quality of life of affected children.

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Background: Loss of retention has been cited to be the most common cause of the failure of postretained restoration with irreversible consequences when materials with different compositions are in intimate contact at the post/adhesive interface. With this background, a study was conducted to improve the adhesion at the resin phase of fiber posts using silane and other chemical pretreatments. Materials and Methods: Hundred glass fiber-reinforced posts were tested with 4 different protocols (n = 25) using silane as a control (Group A) and other three experimental groups, namely, Group B-20% potassium permanganate, Group C-4% hydrofluoric acid, and Group D-10% hydrogen peroxide were pretreated on the postsurface followed by silanization. These specimens were bonded with dual-polymerizing resin-based luting agent, which were then loaded at the crosshead speed of 1 mm/min to record the shear bond strength at the post/adhesive interface. The data were analyzed using one-way ANOVA test for multiple group comparisons and the post hoc Bonferroni test for pairwise comparisons (P < 0.05). Results: Group B showed more influence on the shear bond strength when compared to other protocols, respectively (P < 0.001). Conclusion: Alone silanization as a surface treatment did not improve the bond strength. Combination of chemical presurface treatments followed by silanization significantly enhanced the bond strength at the post/adhesive interface.

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Dental pain is the most common symptom associated with a wide array of dental problems and significantly impacts the oral health-related quality of life. The epidemiology and prevalence of oral diseases that could lead to dental pain are diverse and indicate regional variations. Several researchers have dwelled into the neurobiology and pathophysiology of dental pain making the pain pathways more clear and deciphering the precise targets for the management of pain. Although a number of pharmacological drugs are available in the market, a significant percentage of the population in India prefers alternative herbal medication for relief from dental pain due to the side effects and interactions of pharmacological treatment. However, there is a void in dental literature pertaining to the use, benefits, and safety of the herbal medicines. Therefore, the present assessment has been penned down, focusing on the current multimodal approaches for treating dental pain, the current unmet need, and the role of herbal medication in India for the management of dental pain, with a discussion on novel herbal dental gel.

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Managing mild to moderate Class II malocclusion is a one of the common and major challenges to orthodontists. Class II discrepancies with mandibular deficiency during active growth are usually treated by myofunctional appliances. Fixed functional appliances evolved due to the noncompliance with conventional myofunctional appliances. This case report illustrates the efficiency of PowerScope in correction of skeletal Class II with mandibular deficiency in a patient aged 13 years who has reported to the department with a chief complaint of forwardly placed upper front teeth. This case with functional jaw retrusion was treated initially with MBT 0.022” prescription followed by PowerScope. Pre-, mid- and post-treatment cephalograms were obtained, and cephalometric analysis was performed. Stable and successful results were obtained with a substantial improvement in facial profile, skeletal jaw relationship, and overall esthetic appearance of the patient. A significant forward displacement of the mandible was the principal element for successful correction of Class II malocclusion. PowerScope provides the best results for Class II management, thus enables us to treat such cases by a nonextraction approach rather than contemplating extractions.

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Background: Despite the absence of dispute about the efficacy of bleaching agents, a prime concern is about their compromising effect on the enamel structure. This in vitro study investigated whether the addition of three different biomaterials, including nano-bioactive glass (n-BG)/nano-hydroxy apetite (n-HA)/nano-amorphous calcium phosphate (n-ACP), to bleaching agents can affect the fracture toughness (FT) and vickers hardness number (VHN) of bovine enamel. Materials and Methods: The crowns of the newly extracted permanent bovine incisors teeth were separated from the root and sectioned along their central line; one half serving as the control specimen and the other half as the test specimen. After mounting and polishing procedure, all the control specimens (C) were subjected to nano-indentation test to obtain the baseline values of FT. Then, the control specimens were exposed to a 38% hydrogen peroxide for four times, each time for 10 min. The test specimens were divided into three groups and treated as follows, with the same protocol used for the control specimens: Group 1; ACP + hydrogen peroxide (HP) mixed gel; Group 2 BG + HP mixed gel; and Group 3 HA + HP mixed gel. FT measurements with nano-indentation were carried out subsequent to bleaching experiments. Data were analyzed using SPSS and Kruskal–Wallis test (α = 0.05). Results: A significant difference in young's modulus (YM), VHN, and FT at baseline and subsequent to bleaching in control group was observed. However, no significant differences were found in YM, VHN, and FT between the test groups, compared to the respective baseline values. Conclusion: Under the limitations of the current study, it can be concluded that the n-HA, n-ACP, and n-BG could be potential biomaterials used to reduce the adverse effects of tooth bleaching.

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Tuberous sclerosis complex is an unusual autosomal dominant neurocutaneous syndrome characterized by the development of benign tumors affecting different body systems affecting the brain, skin, retina, and viscera. It is characterized by cutaneous changes, neurologic conditions, and the formation of hamartomas in multiple organs leading to morbidity and mortality. The most common oral manifestations are fibromas, gingival hyperplasia, and enamel hypoplasia. The management of these patients is often multidisciplinary involving specialists from various fields. Here, we present a case report of a 26-old-year male patient with characteristic clinical, radiological, and histological features of tuberous sclerosis complex.

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Laser first came into light in 1960 and had been used extensively in various fields of medicine. Laser has been experimented in the various dental field, and its utility is being recognized and established well in the dentistry. Lasers are widely used for a number of procedures such as cavity preparation, scaling, and root planning, surgical procedures like excision of soft tissue growths, etc., Improved healing, hemostasis, and sutureless excisions are some of the many advantages of laser over conventional treatment modalities. It is because of these advantages that laser is becoming more and more popular as a treatment option in various aspects of dentistry. We hereby present a case report, where we have used diode laser for surgical management of a proliferative verrucous leukoplakia (PVL), because of its many advantages over conventional methods. It presents very specific characteristics, mainly a more aggressive biological behavior than other forms of leukoplakia expressed by: A tendency toward multifocality (field cancerization); a high prospect of recurrence; and a high rate of malignant transformation, which can range between 40% and 100% in a follow-up period of 4.4–11.6 years. In this case, we evaluated the advantages of diode laser for the treatment of verrucous leukoplakia, where the results that we obtained were excellent. The patient had come for evaluation till the time of complete healing.

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Background: To analyze the role of proinflammatory cytokines in drug-induced gingival enlargement in Indian population. Aim: To evaluate for the presence of interleukin-6 (IL-6) in drug-induced gingival enlargement and to compare it with healthy control in the absence of enlargement. Materials and Methods: Thirty-five patients selected for the study and divided into control group (10) and study group (25) consisting of phenytoin (10); cyclosporin (10) and nifedipine (5) induced gingival enlargement. Gingival overgrowth index of Seymour was used to assess overgrowth and allot groups. Under LA, incisional biopsy done, tissue sample fixed in 10% formalin and immunohistochemically evaluated for the presence of IL-6 using LAB-SA method, Labeled- Streptavidin-Biotin Method (LAB-SA kit from Zymed- 2^nd generation LAB-SA detection system, Zymed Laboratories, CA). The results of immunohistochemistry were statistically analyzed using Kruskaal–Wallis and Mann–Whitney test. Results: The data obtained from immunohistochemistry assessment shows that drug-induced gingival overgrowth (DIGO) samples express more IL-6 than control group and cyclosporin expresses more IL-6 followed by phenytoin and nifedipine. Conclusion: Increased IL-6 expression was noticed in all three DIGO groups in comparison with control group. Among the study group, cyclosporin expressed maximum IL-6 expression followed by phenytoin and nifedipine.

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Gardner's syndrome is an autosomal dominant disease characterized by the presence of colonic polyposis, osteomas, and a multitude of soft-tissue tumors. Dental anomalies are present in estimated 30% of all affected individuals of Gardner's syndrome, so dental professionals play an important role in determining the early signs of the syndrome. The intestinal polyps have a 100% risk of undergoing malignant transformation if not treated thus, early diagnosis and regular surveillance are important. In this report, we describe classical presentation of Gardner's syndrome in a patient who presented with bilateral swellings on palate along with multiple impacted teeth.

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Periodontitis is an inflammatory disease of the gingiva and tissues of the periodontium. It is characterized by pocket formation and destruction of supporting alveolar bone. Periodontal diseases of aggressive nature are not very common in children. They are usually associated with systemic conditions. The present case report is of a 5-year-old male child who reported with rapid attachment loss and bony defects of the gingiva and supporting structures. His family and medical history gave no contribution for the diagnosis. Blood investigations did not reveal any abnormality. The microbial examination of culture revealed the presence of periodontal pathogen Aggregatibacter actinomycetemcomitans. The treatment objective in the present case was to prevent the further progress of the condition, restore esthetic and function in the child which would psychologically benefit the child.

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Background: The present cross-sectional survey study was conducted to assess whether the transtheoretical model for oral hygiene behavior was interrelated in theoretically consistent directions in chronic periodontitis patients and its applicability to assess the compliance of the chronic periodontitis patients to the treatment suggested. Materials and Methods: A total of 150 chronic periodontitis patients were selected for the proposed study. The selected patients were given four questionnaires that were constructed based on transtheoretical model (TTM), and the patients were divided subsequently into five different groups (precontemplation, contemplation, preparation, action, and maintenance groups) based on their answers to the questionnaires. Then, each patient was given four appointments for their periodontal treatment spaced with a time gap of 10 days. The patients visit for each appointments scheduled to them was documented. The results obtained were assessed using TTM. Results: Higher mean pro scores of decisional balance, self-efficacy, and process of change scores was recorded in maintenance group followed by action group, preparation group, contemplation group, and precontemplation group, respectively, whereas higher mean cons score was recorded in precontemplation group followed by contemplation group, preparation group, action group, and maintenance group, respectively. The difference scores of TTM constructs were statistically highly significant between all the five groups. Furthermore, the number of appointment attended in were significantly more than maintenance group followed by action group, preparation group, contemplation group, and precontemplation group. Conclusion: Within the limitations of this study, it can be concluded that transtheoretical model can be successfully applied to chronic periodontitis patients to assess their compliance to the suggested periodontal treatment.

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Context: There are various regions in India that have high levels of fluoride in drinking water sources. Many people residing in such places suffer from dental fluorosis (DF). Aims: To evaluate the prevalence of DF in children residing in Salem and also to find any correlation between DF and other related factors. Materials and Methods: One school from each block of Salem (total 21 blocks) was selected for the study. A single examiner had evaluated untreated caries, lesions, and DF (for permanent anterior teeth and molars) using the Dean's fluorosis index, in all children. Water fluoride level determination at each school was done using the Tamil Nadu Water Fluoridation and Drainage Board field kit. Other factors that may have contributed to DF were assessed using a questionnaire, which was provided to each student. The data obtained were statistically analyzed using the SPSS software version 11.5. Statistical Analysis: Chi-square test was used for statistical analysis. Results: DF was present in 56.9% of the children examined. It was mostly seen in 9 years old (72%) and male (59%) children. A positive correlation was found between the occurrence of DF and the duration of residence in a place with high water fluoride content, consumption of borewell water (64%), the parts per million of fluoride in drinking water, consumption of black tea (59%). However, no correlation was found between DF, dental caries, consumption of milk, or consumption of foods cooked in aluminum vessels. Conclusion: There was a correlation between DF and factors such as male gender, bore well water consumption, black tea consumption and the duration of residence in a place with high water fluoride content.

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Clinicians are often intrigued by the varied manifestations of the gingival tissue. Gingival overgrowth is a common clinical finding and most of them represent a reactive hyperplasia as a direct result of plaque-related inflammatory gingival disease. These types of growth generally respond to good plaque control, removal of the causative irritants, and conservative tissue management. This case series highlights three different cases of localized gingival overgrowth and its management with emphasis on the importance of patient awareness and motivation.

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The purpose of this study was to report the clinical findings, dental treatment, and improvement in quality of life for a child with Rothmund-Thomson syndrome. The patient had alopecia, delayed speech, low weight and height, cholestasis, and iron deficiency anemia. Furthermore, there were carious lesions and darkened spots on all primary molars. Microdontia of a premolar was observed at the radiographic examination. The patient and family had no commitment to her oral health and dental treatment at first appointments. Oral hygiene instructions, composite restorations, endodontic treatments, teeth extractions, and stainless steel crown installations were performed. The patient was followed up for 7 years through the present due to other possible future clinical findings associated with the syndrome. An improvement in social aspects was observed after removal of toothache and improved esthetics. Such patients need continuous periodic services, which contributes to improving the quality of life in both buccal and general aspects.

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Pulpectomy is preferably more conservative treatment option than the extraction of deciduous teeth despite few undesirable consequences of obturating materials of which odontogenic cysts are one. This article aims to report a case of an 11-year-old female child having bilateral odontogenic cysts, i.e., radicular and infected dentigerous cyst followed by pulpectomy of deciduous molars using zinc oxide eugenol which was surgically enucleated and followed up to 6 months until satisfactory healing of bone was observed. The article also emphasizes on the importance of regular follow-up of the pulpectomized tooth which can be harmful otherwise.

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Isolated lesions of gingiva arise in succession to the hyperinflammatory reactions in response to the underlying local irritants. Despite their overlapping clinical and histological features, these lesions are distinctive regarding their biological behavior. Recurrence has been reported after surgical excision because of the incomplete removal of underlying local irritants. This article describes the clinical and histological features of four localized gingival lesions, adding a note on their molecular pathogenesis and surgical management.

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The endodontic treatment of a mandibular molar with aberrant canal configuration can be diagnostically and clinically challenging. Successful endodontic therapy thus depends on the clinician's ability to anticipate and look for these aberrant variations. A mandibular first molar with seven canals represents a rare anatomical variant, particularly when four canals are found in distal root. Based on in vitro studies, its incidence is reported to be between 0.2% and 3%. With the advent of cone-beam computed tomography (CBCT) as an adjunctive diagnostic aid, the determination of root canal anatomy in teeth with complex canal configurations has become more precise. The present case report discusses successful nonsurgical management of radix entomolaris along with middle mesial canal and middle distal canal in mandibular first molar with seven canals (four canals in distal and three in mesial) employing CBCT as an adjunctive diagnostic aid to conventional radiography.

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Background: Root canal irrigants are considered momentous in their tissue dissolving property, eliminating microorganisms, and removing smear layer. The present study was aimed to compare the removal of endodontic smear layer using ethylene glycol bis (beta-amino ethyl ether)-N, N, N', N'-tetraacetic acid (EGTA) and citric acid solutions with saline as a control in primary anterior teeth. Materials and Methods: Thirty primary anterior teeth were chosen for the study. The teeth were distributed into three groups having ten teeth each. Following instrumentation, root canals of the first group were treated with 17% EGTA and the second group with 6% citric acid. Only saline was used as an irrigant for the control group. Then, the teeth were subjected to scanning electron microscopy (SEM) study. The scale given by Rome et al. for the smear layer removal was used in the present study. Results: The pictures from the SEM showed that among the tested irrigants, 17% EGTA + 5% sodium hypochlorite (NaOCl) group showed the best results when compared to other groups. Conclusion: The results advocate that the sequential irrigation of the pulp canal walls with 17% EGTA followed by 5% NaOCl produced efficacious and smear-free root canal walls.

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Aim: Study was carried out to evaluate the efficacy of a glucometer for screening diabetes using gingival crevicular blood and to compare the blood glucose levels in the gingival crevicular blood sample and blood sample collected by finger puncture method using glucometers. Subjects and Methods: A total of 24 known diabetic patients who fulfilled the selection criteria were selected after obtaining their informed consent. Samples were collected from two sites, i.e., gingival crevice and fingertip which was measured using a self-monitoring device. Statistical Analysis Used: Karl Pearson correlation. Results: This study revealed the existence of a positive correlation between gingival crevicular blood and capillary blood glucose level (r = 0.826), and gingival blood glucose level estimates 68.2% of capillary blood glucose level. Hence, based on the observations of the study using gingival crevicular blood glucose level, capillary blood glucose level may be estimated based on the following regression equation. Capillary blood glucose = 84.66 + 0.77x gingival crevicular blood glucose level. Conclusions: The intraoral sampling technique is safer, convenient, and cost-effective for the dental practitioner as the sample can be obtained during the routine periodontal examination. It can be concluded that with the regression equation based on the gingival crevicular blood glucose level, capillary blood glucose can be estimated.

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Objective: To assess and compare the salivary flow rate (SFR), pH and taste perception among oral submucous fibrosis (OSMF) and apparently healthy subjects. Materials and Methods: Ninety subjects (45 OSMF + 45 controls) were enrolled in the study for estimating and analogizing the SFR, pH, and taste perception executing modified Schirmer, pH, and taste strips. The SFR, pH, and taste perception were evaluated and compared between 14 Stage I and 31 Stage II OSMF subjects. The entered data were analyzed using SPSS 21.0 software. Results: A statistically significant decrease in SFR among OSMF group (23.4 mm at 3^rd min) and hypogeusia to salty (62.2%), and dysgeusia to sour taste (40%) when compared to apparently healthy subjects (30.7 mm at 3^rd min) was noted. Statistical significance (P < 0.05%) inferring hyposalivation in Stage II OSMF (24.1 mm at 3^rd min) juxtaposing with Stage I OSMF (31.4 mm at 3^rd min). Statistically significant hypogeusia to salty (n = 23) and sweet (n = 16) and dysgeusia (n = 14) to sour among Stage II OSMF when differentiated with Stage I OSMF. The mean pH among the OSMF and control groups demonstrated no statistical significance. Conclusion: The findings from the study demonstrated marked decrease of SFR and taste perception to salty and sour among Stage II OSMF when compared to Stage I OSMF subjects.

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Background: Oral health has a profound effect on the daily activities of geriatric group. India being a multilingual country, it is essential that instruments used to evaluate the quality of life is in local languages. However, the validation and translational aspect are important before involving a larger cohort of geriatrics. Aim: To assess the reliability of Malayalam version of Geriatric Oral Health Assessment Index (GOHAI-m). Settings and Design: Institutionalized elderly in Alleppey, Kerala, cross-sectional study. Materials and Methods: The 12 items in GOHAI were translated into Malayalam using a back-translation technique. The comprehensibility of the Malayalam version was assessed by a pilot study. Fifty institutionalized elderly answered the questionnaire. Impact based on age and marital status was also assessed. Statistical Analysis: Independent sample t-test, Cronbach's alpha, test–retest reliability using intraclass correlation coefficient (ICC). Results: The mean GOHAI-m scores were higher for elderly participants with slightly more impact on quality of life such as for biting or chewing food, and lower mean GOHAI-m scores indicated a positive impact on quality of life such as their self-conscious of oral health. Cronbach's alpha of 0.677 was reached with 12 items. Item 12 had a negative item-total correlation, −0.016, the deletion of Item-12 increased the item correlation to 0.7. Test–retest reliability of 0.65 for ICC indicated moderate stability. Females had more impact than males (P < 0.05). Age and marital status had no impact on their quality of life. Conclusion: The primary analysis of GOHAI-m indicated moderate stability. The elimination of negative items depends on the objectives of the study and/or after conducting a larger study keeping in view various parameters of the study.

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Aims and Objectives: This clinical study was conducted to compare the interactive self-ligating twin brackets and the standard double width brackets for their efficiency in Rate of Retraction. Materials and Methods: A total of 20 patients with Angle's class I or class II or class III dento-alveolar malocclusions between the age group of 18-25 years were selected. 10 patients in each group both males and females were randomly selected for the study. Ten patients were bonded using conventional brackets (Group I) the other ten patients were bonded using Interactive self-ligating brackets (Group II). The Rate of retraction was quantified using the scanned models. Pretreatment and post treatment models were taken and scanned to measure the amount of Incisor movement and Anchor loss. Results: (1) Interactive Self-ligating brackets showed significant Rate of retraction when compared with conventional brackets on right and left quadrant. (Group I 0.545 ± .205: Group II 0.827 ± .208 P= .013*) (Group I 0.598 ± .160: Group II 0.804 ± .268 P= .071) (2) Interactive self-ligating brackets when compared with conventional brackets had significant amount of incisor movement on right and left quadrant. (Group I 3.51 ± .548: Group II 4.38 ± .1.06 P= .047*) and (Group I 3.66 ± .899: Group II 4.67 ± 1.02 P= .047*) (3) Conventional brackets showed significant Amount of Anchor loss when compared with that of Interactive self-ligating brackets on right and left quadrant. (Group I .948 ± .392: Group II 0.501 ± .229 P= .013*). In the left side (Group I 0.861 ± .464: Group II 0.498 ± .227 P= .060). Conclusion: The interactive self-ligating brackets show more efficiency in Rate of Retraction, Amount of Incisor movement and Amount of Anchor loss when compared with the conventional brackets.

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At present, implant supported or retained prostheses are considered as a first therapeutic alternative for patients. Although the success rate of dental implants is very high, no treatment is without complications; same applies to implants also. Implant failure can be due to biological factors, i.e., loss of osseointegration or due to technical complications. This case report presents implant complications involving both factors along with the management of these cases. In implant supported overdenture patient, loss of implant on the right side and implant body fracture of the left side implant is reported and in another patient abutment screw fracture and its management is reported.

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Fracture of the angle of the mandible accounts for nearly one-third of all fractures involved. The presence of lower third molar increases the risk of fracture in angle region. The third molar acts as an area of weakness leading to fracture lines passing medially, distally, and occasionally through it. Angle fracture leads to the mobility of the third molar and sometimes its displacement. Third molars maintain its position in favorable fracture and can be displaced in unfavorable fractures. Displacement of lower third molar in lateral pharyngeal space due to mandibular fracture is not seen commonly. To our knowledge, this is the first reported incidence of displacement of the third molar into lateral pharyngeal space in a case of mandibular fracture.

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Missing teeth are a common developmental abnormality in humans. It may manifest as absence of varying numbers of primary and/or secondary teeth. Early treatment and follow-up are the key to successful rehabilitation of young patients with congenitally missing teeth. It is critical that oral rehabilitation is started early to maintain and correct the oral functions. Mucosa borne removable prostheses are the commonly selected treatment options for the young patients who present with oligodontia or anodontia. This clinical report describes esthetic, functional, and psychological rehabilitation of a young boy with severe oligodontia in maxillary arch and anodontia in mandibular arch. The individualized conservative graded approach in prosthetic rehabilitation with removable acrylic prosthesis helped to achieve esthetics, functionality, and psychological benefits.

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Background: The increasing emphasis on the open reduction and internal fixation of orbito-zygomatico-maxillary complex fractures has led to a more critical appraisal of the various surgical approaches to the orbital and zygomatic skeleton. Transconjunctival approach popularized by Tessier although credited to Bourquet in 1924 offer excellent exposure of the orbito-zygomatico-maxillary complex fracture especially the infra-orbital rim, frontozygomatic suture and the orbital floor. The argument against a transconjunctival access focuses primarily on concern about limited exposure that apparently makes accurate reduction and osteosynthesis of displaced fracture fragments difficult or impossible. Also, due to close association with eye and various ocular complications reported in the literature, most of the surgeons feel skeptical about using this approach. Aim: The aim of this study is to analyze the efficacy of transconjunctival approach in the treatment of orbito-zygomatico-maxillary complex fractures by evaluating the functional and esthetic results and its associated complications. Material and Method: We report a series of eight patients who have undergone fracture repair of the orbito-zygomatico-maxillary complex via a transconjunctival approach. Postoperative patient evaluation was performed with specific attention paid towards wound healing, functional stability, esthetic appearance and postoperative ocular complications. Postoperatively clinical examination along with radiographic examination was done to evaluate the position of the zygoma and determine the adequacy of fracture reduction. Results: In all the patients excellent surgical exposure has been achieved for reduction and rigid fixation of the fracture fragments. None of the patients had any form of complication related to the approach. There were no postoperative ocular complications. Only one patient had postoperative chemosis which was transient and subsided subsequently. All the patients had excellent esthetic outcome, with symmetry of malar prominence restored and without any evident post-operative complications. Conclusion: Superior esthetic results and direct simultaneous access to the orbital rim, orbital floor and lateral orbital wall, support the use of the transconjunctival approach as a frontline approach to access the orbito-zygomatico-maxillary complex.

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The presence of mucogingival problem around anterior teeth is a challenge to the clinician as not only biological and functional aspects has to be addressed but esthetic aspirations of the patient have to be met. The use of guided tissue regeneration (GTR) procedures for the treatment of gingival recession has shown encouraging results and is gaining clinical acceptance. However, maintenance of space under the membrane remains a problem for clinicians. Hence, this case study was an innovative attempt to evaluate the effect of adjunctive calcium sulfate placement along with collagen membrane GTR-based root coverage procedure.

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Infantile hemangiomas (IHs) are common, benign vascular tumors of infancy, with more than half affecting the head and neck region. IHs involving the lips and oral cavity can often present to the oral surgeon and the pedodontist. Till date, several doubts exist among clinicians regarding the use of propranolol to treat infantile hemangiomas in neonates and small infants, appropriate dose, treatment duration, side effects, response, and long-term follow-up. We present a 2-month-old male infant with extensive hemangioma involving the face, orbit, buccal mucosa and palate with feeding difficulties, and risk of life-threatening complications such as airway compromise, aspiration, and visual loss which showed excellent response with high-dose propranolol and had no side effects. We also reviewed literature for the mechanism of action of propranolol and possible minor and serious side effects.

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Canine deviation from its path of eruption is usually followed by either delayed or impaction of canine. One of the important and not so noticed reasons for canine displacement is formerly impacted central incisor. The difference in age of eruption of these two teeth is 4 years; however, the absence of maxillary incisor should be perceived with utmost conviction about impending canine displacement leading to its impaction as well. This case presents similar picture where composite, compound odontoma with respect to maxillary central incisor led to its impaction resulted in deviated path of eruption for erupting canine. This canine displacement to worsen prognosis ended up getting impacted if not dealt with cautiously in the later stages of occlusal development.

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Background: Immune mechanism shares a common pathway both for systemic autoimmune diseases and periodontal diseases. Scientific exploration of literature revealed limited studies on the association between systemic autoimmune diseases and periodontal diseases in India. Aim: The aim of the study is to find whether the presence of systemic autoimmune diseases in an individual is a risk factor for the development of periodontal disease. Settings and Design: This was a hospital-based case–control study. Materials and Methods: A sample of 253 patients with systemic autoimmune diseases, attending the Rheumatology Department of Government General Hospital, Chennai-3, and 262 patients without systemic autoimmune diseases, attending the outpatient department of the Tamil Nadu Government Dental College and Hospital, Chennai-3, constituted the case and control groups, respectively. Age, gender, and oral hygiene status matching was done. Oral hygiene status was assessed using oral hygiene index (OHI) and periodontal status was assessed using community periodontal index (CPI) and loss of attachment (LOA) index. Statistical Analysis: Statistical analysis was done using SPSS version 15 (SPSS Inc, 2006, Chicago). Results: Results showed 99.2% and 73.9% prevalence of gingivitis and periodontitis, respectively, in the case group as compared to 85.5% and 14.9%, respectively, in the control group. There is no linear relationship between OHI scores and prevalence of periodontitis (CPI and LOA scores) in the case group. Patients suffering from systemic autoimmune diseases showed more prevalence of periodontal diseases irrespective of oral hygiene scores. Conclusion: It is postulated that the presence of systemic autoimmune diseases may pose a risk for the development of periodontal diseases.

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