This case describes the management of a 12 year-old boy with mild hemophilia A, who was referred to Department of Pediatric Dentistry for orthodontic extractions. This case was treated under Desmopressin and tranexamic acid cover with caution related to local anesthesia administration technique which highlighted the importance of close and detailed liaison with the hematology team to formulate a comprehensive treatment plan.

The midline diastema is a space (or gap) between the maxillary central incisors . The space can be a normal growth characteristic during the primary and mixed dentition and generally is closed by the time the maxillary canines erupt. Researchers and clinicians now believe that multiple factors may contribute to a midline space including abnormal frenum, midline bony clefts ,oral habits, soft tissue imbalances, physical impediments, dental anomalies and/or dental/skeletal disharmonies, as well as normal dentoalveolar development. Most often, during the oral examination of the patient the dentist gives very little importance to the frenum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to an interference in the plaque control or due to a muscle pull. Orthodontic and anatomic approaches have led many authors to classify the type of the frenum exclusively according to the morphological means. The importance of various types of normal to abnormal frenii associated with diastema has not been distinguished in Indian population which is of concern to periodontist, orthodontist and restorative dentist. As of now there is no comprehensive review on diastema and frenum, a tiny fold that plays an important role silently , if found abnormal in location and morphogenetically, to and gains an interdisplinary attention in dentistry Hence a first attempt is made to present a comprehensive review on diastema and frenum in this paper.

Alkaline Phosphatase comprises a group of enzymes that catalyze the hydrolysis of phosphate esters in an alkaline environment. This enzyme plays an important role in the bone metabolism. Alkaline Phosphatase acts as a byproduct and its serum level directly corresponds to the osteoblastic activity. The aim of the present study was to measure the serum and salivary alkaline phosphatase levels to detect the rate of bone resorption. In the present clinical study, serum and saliva samples were collected from the female patients between the age groups of 30-70 years and subjected for the biochemical analysis of alkaline phosphatase and calcium in semi-auto analyzer and were analyzed statistically. Serum and salivary alkaline phosphatase and calcium levels were decreased gradually with progressive age. By the present study, we concluded that levels of alkaline phosphatase and calcium will decrease with advancing age and saliva can be used as a diagnostic tool alternate to serum.

The aim of this study was to determine provoking factors of clinical anxiety among dental students from trainers and students’ perspective. A cross-sectional study was conducted among junior dental students of Taibah Dental College and their trainers using the 38-item modified Moss and McManus clinical anxiety questionnaire. Totally, 123 students and 27 clinical trainers participated. In 5 out of 32 situations significant differences in anxiety were reported by students and trainers (P< 0.05). Dental students reported higher level of anxiety than clinical trainers when they are presenting cases in clinical sessions, helping in a faint, failure of local anaesthesia injection and not meeting the requirements before the exam. However, clinical trainers were more anxious than dental students when they get involved in arresting postoperative bleeding (P< 0.05). Clinical trainers shared largely the same perspective with dental students on the following clinical anxiety provoking situations: when they getting diagnosis wrong, inadvertently hurting the patients, are dealing with psychiatric patients, treating medically compromised patients, coping with uncooperative patient, dealing with fainting patient, fracturing a tooth, extracting wrong tooth, causing accidental pulp exposure, fear of patient’s satisfaction, tearing of the cheek/lips due to catching on a dental burr, getting infected by patients, and giving wrong treatment (P>0.05). It was concluded that clinical trainers and students have great similarity in their perspective on the clinical anxiety provoking situations with slight differences. Clinical trainers’ anxiety dramatically increased with the most risky clinical conditions such as getting infected by patients, arresting postoperative bleeding and dealing with psychiatric patients.

The purpose of the present study was to study the occurrence of radicular dentinal defects after using EDTA gel during preparation of the root canal with ProTaper Universal (Dentsply Maillefer, Switzerland), HyFlex (ColteneWhaledent, Allstetten, Switzerland), and ProTaper Next (Dentsply Maillefer) rotary instruments. Forty-eight single rooted premolars were selected. Twelve teeth were instrumented with hand files; another 12 teeth were instrumented with the ProTaper Universal system up to size F3 and the remaining 24 teeth were shaped with Hyflex CM 25/0.6 and ProTaper Next X3. EDTA gel was used during the root canal preparations of each tooth. After the completion of root canal instrumentation, the roots were sectioned at 3mm,6mm and 9mm followed by stereomicroscopic observation of the sections. The absence/presence of radicular dentinal defects was documented, and the data analysis was done with a chisquare test. The significance level was set at P = 0.05. The ProTaper Next and HyFlex CM instruments caused fewer cracks (33.33% and 50%) than the ProTaper Universal instrument (66.7%) (P < .05). However, there were no significant variances in radicular dentinal defects formation between the Hyflex CM and ProTaper Next groups (P > 0.05). Within the confines of this in vitro study, all of the instrumentation systems used induced radicular defects in the root dentin. The ProTaper Next and HyFlex instruments tended to cause fewer dentinal cracks compared with the ProTaper Universal instrument.

Gingival recession is the displacement of the gingival margin apical to the cemento-enamel junction resulting in the exposure of root surface which puts the patient at risk for dentine hypersensitivity, root caries, abrasion/erosion of roots etc. The etiology can be inflammatory periodontal disease, developmental anatomic abnormalities (aberrant frenal attachment, thin bony plate), toothbrush injury, tooth malposition and iatrogenic factors. Besides, gingival morphology plays an important role in causing gingival recession. The present study aims at assessing the co-relation between gingival biotype and occurrence of gingival recession. A total no. of 20 patients with 30 recession sites were clinically examined for the type of gingival recession present followed by the assessment of gingival biotype after administration of topical anaesthetic agent. Based on the findings a correlation between the incidences of gingival recession will be assessed with that of the biotype through Pearson co-relation test. A statistically significant co-relation between gingival biotype and occurrence of gingival recession was found with higher no. of incidence of recession in patients with thin biotype. A clinician’s knowledge in identifying gingival biotypes is paramount in identifying the indirect causes of recession. Patients with thin biotype are susceptible to higher incidence of gingival recession.

The aim of the present study is to evaluate the changes in mechanical properties of stainless steel, nickel titanium and beta titanium archwires after clinical use and sterilization. Thirty wires each of Stainless steel, Nitinol and Beta titanium (3M Unitek) were tested in as received (Group A), as received and autoclaved (Group B), and clinically retrieved then autoclaved conditions (Group C). A sterilization protocol of 134 0C for 18 minutes was performed using an autoclave. Mechanical properties were tested using an universal testing machine and the load deflection data was plotted as stress-strain curves from which ultimate tensile strength, elastic modulus as well as 0.2% offset yield strength was calculated. Ultimate tensile strength of Group C archwires showed significantly lower values when compared with Group A and B archwires (P<0.001). Elastic modulus of stainless steel and beta titanium Group C archwires showed significantly lower values when compared with Group A and B archwires (P< 0.001). Elastic modulus of Group Band Group C Nitinol wires showed significantly higher values when compared with Group A archwires (P = 0.03 and P =0.02 respectively). Yield strength of Group C beta titanium archwires showed significantly lower values when compared with Group Aarchwires(P< 0.001). Autoclave sterilization did not affect considerably on mechanical properties of any archwire. Ultimate tensile strength of all archwires were significantly reduced after intraoral exposure.

The aim of this study was to compare the microtensile bond strengths (µTBS) and nanoleakage (NL) of four universal adhesives (UAs) applied in two different etching modes, self-etch (se) or etch-and-rinse (er). The occlusal onethird of 48 freshly extracted intact human molars was removed, and the exposed surfaces were treated with one of the four UAs [Single Bond Universal (SBU), Prime Bond NT (PNT), Peak Universal Adhesive (PUA) or All-Bond Universal (ABU)] in se or er mode, with Clearfil SE Bond (CSE) and Adper Single Bond 2 (ASB) as controls (n=8). After composite build-up, specimens were stored in distilled water (37oC/24 h). Composite resin–dentine beams were prepared (0.9 mm2), and the µTBS test was performed. Data were analyzed using one-way ANOVA and Duncan‘s test (α = 0.05). Additional specimens were processed and examined to assay interfacial NL. The failure patterns of the debonded specimens were evaluated using a stereo electron microscope. One additional tooth was prepared for each group for evaluation of NL. The teeth were immersed in a tracer agent (AgNO3 50% w/v) for 24 h. After longitudinal sectioning and polishing, the generated interfaces were examined under scanning electron microscope (SEM). Statistical analysis indicated that the addition of an etching step significantly affected the µTBS of all UAs, except for SBU, compared to se application modes (p<0.05). The highest µTBS value (38.84±2.07 MPa) was obtained in the SBU er group, and the lowest (15.96±1.21 MPa) in the ABU se group. While no NL was determined in the SBU adhesive se or er groups, varying levels were detected in the other groups. The results show that UA performance was material-dependent. Application of an etching step prior to UAs increases their bonding effectiveness and reduces levels of NL.

Current management of fracture healing does not involve ultrasound therapy. We describe a systematic review of randomized controlled clinical trials of low intensity pulsed ultrasound therapy for bone healing and its clinical efficacy in maxillofacial surgeries. We searched 3 electronic databases (MEDLINE, EMBASE, Cochrane Database of Randomised Clinical Trials) and selected studies done in the area of ultrasound therapy and fracture healing and evaluated separately. Therapeutic effects of ultrasound therapy have been studied in the past few decades and various clinical studies have been published, showing its beneficial results on bone healing and its mechanism of action. Ultrasound treatment is an innovative, noninvasive modality to enhance bone healing, with minimal side effects. It may be considered as an adjunct treatment of choice, in management of fractures, reconstructive surgeries and healing of bony pathologies. Further clinical trials are advised, to access its mechanism of action and application in surgeries of maxillofacial region.

Dens invaginatus is a tooth malformation resulting from an infolding of the dental papilla at the time of tooth development. The deep infolding of enamel and dentin are seen in the affected tooth. Maxillary lateral incisors are commonly affected tooth and bilateral occurrence is rare. It shows a broad spectrum of morphologic variations and it usually results in pulpal necrosis. Root canal therapy may undergo severe problems due to its complex anatomy of teeth. This review addresses the etiology, clinical and radiographic features of taurodontism, its association with various anomalies, as well as important considerations in various areas of expertise dental treatments of such teeth.

Implant supported Over dentures are prescribed in order to enhance retention, support and stability. Over denture is the treatment of choice when lip or facial support is required. Implant supported over dentures have been found to be very useful prosthodontic treatment modality. A number of case reports suggest the use of customized implant abutments in order to enhance esthetics as well as to rehabilitate excessively angulated implant fixtures. Several studies have indicated the use of stress breaking as well as soft relining material which would have a protective effect on perimplant tissue. This article will throw a light on the use of customized implant abutments as well as soft relining material in an maxillary implant supported over denture.

Combination syndrome when an edentulous maxilla is opposed by natural mandibular anterior teeth. The present article aims at recording the signs of combination syndrome in study population. This study was conducted in department of Prosthodontics in 2016. It included 160 patients having edentulous maxilla wearing maxillary denture and partially edentulous mandible wearing mandibular removable partial denture (Kennedy class I). They were assessed for various signs. 160 (30%) patients were found positive for combination syndrome out of 480 examined cases. Out of 160 patients, males were 75 and females were 85. Maximum cases were recorded for lack of maxillary denture adaptation (male- 13, female- 15). The need for replacement for maxillary denture was seen equally in 11 cases in males and females. Lack of mandibular denture adaptation was seen in males (9) and females (9). Growth of the tuberoisities was seen in 8 males and 10 females. Need for replacement for mandibular denture was seen in 10 males and 5 females. The difference was significant (0.02). Papillary hyperplasia was significantly higher in females (14) than males (7). Hypermobility of the anterior part of the maxilla was seen significantly higher in females (12) than males (6). 6 males and 2 females showed extrusion of lower anterior teeth. The difference was significant. Author concluded that the prevalence rate of combination syndrome was 30% with slight female predominance.

Complete cleaning and shaping of the root canal system is essential for success of endodontic treatment. Accurate measurement of working length and 3D obturation till the apical constriction is necessary for ensuring fluid tight seal. One of the disadvantages of overextended root canal obturations is post-operative pain. The treatment options in such cases are endodontic surgery to remove the extruded filling material or Intentional Replantation. This case report discusses the advantages of Intentional Replantation and the procedure involved in endodontic retreatment of a mandibular molar with this technique.