Punjab Government Dental College and Hospital

In this review, most of the known and postulated mechanisms of osteopontin (OPN) and its role in bone remodeling and orthodontic tooth movement are discussed based on available literature. OPN, a multifunctional protein, is considered crucial for bone remodeling, biomineralization, and periodontal remodeling during mechanical tension and stress (orthodontic tooth movement). It contributes to bone remodeling by promoting osteoclastogenesis and osteoclast activity through CD44- and αvβ3-mediated cell signaling. Further, it has a definitive role in bone remodeling by the formation of podosomes, osteoclast survival, and osteoclast motility. OPN has been shown to have a regulatory effect on hydroxyapatite crystal (HAP) growth and potently inhibits the mineralization of osteoblast cultures in a phosphate-dependent manner. Bone remodeling is vital for orthodontic tooth movement. Significant compressive and tensional forces on the periodontium induce the signaling pathways mediated by various osteogenic genes including OPN, bone sialoprotein, Osterix, and osteocalcin. The signaling pathways involved in the regulation of OPN and its effect on the periodontal tissues during orthodontic tooth movement are further discussed in this review. A limited number of studies have suggested the use of OPN as a biomarker to assess orthodontic treatment. Furthermore, the association of single nucleotide polymorphisms (SNPs) in OPN coding gene Spp1 with orthodontically induced root resorption remains largely unexplored. Accordingly, future research directions for OPN are outlined in this review.

Nowadays exploration of novel lipid-based formulations is akin to a magnet for researchers worldwide for improving the in vivo performance of highly lipophilic drugs. Over the last few years, new compositions of lipids have been developed, and the probable bioavailability enhancement has been investigated. We reviewed the most recent data dealing with backlogs of conventional lipid-based formulations such as physical instability, limited drug loading capacities, drug expulsion during storage along with all the possible hindrances resulting in poor absorption of highly lipophilic drugs such as P-glycoprotein efflux, extensive metabolism by cytochrome P450 etc. In tandem with these aspects, an exclusive formulation approach has been discussed in detail in this paper. Therefore, this review focuses on resolving the concerned ambiguity with successful oral administration of highly lipophilic drugs through designing novel lipidic formulations (nanostructured lipid carriers [NLC]) that constitute a blend of solid and liquid lipids. The article highlights the potential role of such formulation in normalizing the in vivo fate of poorly soluble drugs. Finally, the present manuscript discusses the dominance of NLC over other lipid-based formulations and provides a perspective of how they defeat and overcome the barriers that lead to the poor bioavailability of hydrophobic drugs.

The success of restorative dentistry is determined on the basis of functional and esthetic results. To achieve esthetics, four basic determinants are required in sequence; viz., position, contour, texture and color. The knowledge of the concept of color is essential for achieving good esthetics. This review compiles the various aspects of color, its measurements and shade matching in dentistry.

AIMS: The aim of this study was to explore the perceived sources of stress reported by dental students from fourteen different countries. METHODS: A total of 3568 dental students were recruited from 14 different dental schools. The dental environmental stress (DES) questionnaire was used including 7 domains. Responses to the DES were scored in 4-point Likert scale. Comparison between students was performed according to the study variables. The top 5 stress-provoking questions were identified amongst dental schools. Data were analysed using SPSS software program. Mann-Whitney and Kruskal-Wallis tests were used as appropriate. Logistic regression analysis was also conducted to determine the effect of the studied variables on the stress domains. The level of statistical significance was set at <.05. RESULTS: Internal consistency of the scale was excellent (0.927). Female students formed the majority of the total student population. The percentage of married students was 4.8%. Numbers of students in pre-clinical and clinical stages were close together. The most stress-provoking domain was "workload" with a score of 2.05 ± 0.56. Female students scored higher stress than male students did in most of the domains. Significant differences were found between participating countries in all stress-provoking domains. Dental students from Egypt scored the highest level of stress whilst dental students from Jordan scored the lowest level of stress. CONCLUSION: The self-reported stress in the dental environment is still high and the stressors seem to be comparable amongst the participating countries. Effective management programmes are needed to minimise dental environment stress.

The number and configuration of root canals in mandibular first permanent molar, studied by radiographic method, on 60 teeth revealed (1) one canal in the mesial root in 5 percent, two in 78.3 percent, three in 13.3 percent and four in 3.3 percent. In distal root, one canal was observed in 58.3 percent, two in 40 percent and three in 1.7 percent of the cases; (2) transverse anastomosis existed in about half of the mesial roots; whereas in distal root, it was only 21.7 percent; (3) biconvex canal curvature was seen in 18.3 percent of mesial and 1.7 percent of distal roots (4) apical foramina: in mesial root two apical foramina were observed in 60 percent of specimens, three in 6.7 percent and four in 3.3 percent. In distal root, two apical foramina were seen in 25 percent and three in 1.7 percent cases; (5) type of root canal: type 2-1 was the most common feature of mesial as well as distal roots; (6) the mesial root canals tended to be curved in 51.7 percent, while distal root canal straight in 58.3 percent.

INTRODUCTION: Despite the improved techniques of repair of cleft palate, fistula occurrence is still a possibility either due to an error in the surgical technique or due to the poor tissue quality of the patient. Though commonly the fistula closure is established by use of local flaps but at times the site and the size of the fistula make use of local flaps for its repair a remote possibility. The use of tongue flaps because of the central position in the floor of the mouth, mobility and the diversity of positioning the flaps make it a method of choice for closure of anterior palatal fistulae than any other tissues. The aim of this study was to analyse the utility of tongue flap in anterior palatal fistula repair. MATERIALS AND METHODS: We had 41 patients admitted to our hospital during the period 2006-2012 for repair of palatal fistula and were enrolled into the study. In the entire 41 cases, fistula was placed anteriorly. The size of the fistulae varied from 2 cm × 1.5 cm to 5.5 cm × 3 cm. The flaps were divided after 3-week and final inset of the flap was done. OBSERVATION AND RESULT: None of the patients developed flap necrosis, in one case there was the dehiscence of the flap, which was reinset and in one patient there was bleeding. None of our patients developed functional deformity of the tongue. Speech was improved in 75% cases. CONCLUSION: Leaving apart its only drawback of two-staged procedure and transient patient discomfort, tongue flap remains the flap of choice for managing very difficult and challenging anterior palatal fistulae.

BACKGROUND: Platelet-rich plasma (PRP) contains high levels of polypeptide growth factors that may enhance periodontal regeneration when combined with graft materials. AIM: The purpose of this study was to compare the efficacy of autologous PRP in combination with β-tricalcium phosphate (β-TCP) versus β-TCP alone in the treatment of human infrabony defects. MATERIALS AND METHODS: Using a split-mouth design, 20 patients showing clinical evidence of almost identical bilateral infrabony defects were randomly selected. The right infrabony defects of the patient were designated as Group A and treated by the placement of β-TCP alone. The left infrabony defects of the same patient were designated as Group B and treated by the placement of PRP mixed with β-TCP. Clinical assessment of probing pocket depth and attachment level and radiographic evaluation of the defect depth were done preoperatively and at 12, 24 and 36 weeks postoperatively. The relative efficacy of two treatment modalities was evaluated using paired Student's t-test and the comparative evaluation between the two groups was done using independent Student's t-test. RESULTS: Both the groups exhibited a highly significant reduction in probing pocket depth, gain in clinical attachment level and linear bone fill at the end of 36 weeks postoperatively. Comparative evaluation between the two study groups revealed a significant reduction in probing pocket depth (P = 0.036FNx01), mean gain in clinical attachment level (P = 0.042FNx01) and linear bone fill (P = 0.014FNx01) in Group B as compared to Group A. CONCLUSIONS: Combination of PRP and β-TCP led to a significantly more favorable clinical and radiographic improvement in infrabony periodontal defects.

Watch a video presentation of this article Watch an interview with the author Hepatitis C virus (HCV) infection remains a matter of global concern despite concerted efforts by the World Health Organization (WHO), national bodies, and civil society groups. Despite ready availability of cost-effective and efficacious generic direct-acting antiviral agents (DAAs), the majority of the estimated 71 million persons living with HCV (PLHCVs) remain untreated. Viral hepatitis has become the seventh leading cause of death worldwide.1 More than 90% of the deaths and disability caused by viral hepatitis can be attributed to HCV and hepatitis B virus infections.2 The WHO target of HCV elimination by 2030 requires that 90% of PLHCVs need to be diagnosed, and 80% of these individuals need to be treated in conjunction with means to reduce the incidence of HCV in high-risk groups, such as persons who inject drugs (PWIDs), dialysis patients, and recipients of unsafe blood transfusion. In 2015, it was estimated that China has 10 million PLHCVs, followed by Pakistan (7.2 million), India (6.2 million), and Egypt (5.6 million), and these account for 40% of global PLHCVs. The main source of transmission is unsafe medical practices and in the pre-HCV screening birth cohort was blood transfusion.3 The main source of HCV incidence is in PWIDs, leading to two distinct groups of PLHCVs: (1) an older cohort who were infected by unsafe medical practices and have comorbidities, such as obesity, alcohol use, and diabetes, are at higher risk for cirrhosis; and (2) a younger group with recent infection caused by injection drug use (IDU).4 There are six main platforms for the rollout of the Global HCV Elimination Coalition. First, the meteoric success of DAAs ensures cure rates of >95% with even short courses of 8 to 12 weeks and have shifted the focus of HCV elimination programs from “control” to “cure.” The second platform is allocation of resources in terms of finances, logistics, and manpower. Not only a reduced cost of drugs, but the availability of comprehensive, affordable, validated point-of-care tests and nucleic acid tests (NATs) for HCV will make the laboratory diagnosis and management of HCV simpler.5 Third, education and training of medical health personnel to provide safe injections and prevention of cross-infection, and patient education services that counsel those with the disease, as well as cater to prevention of HCV incidence, are essential services in such a setting. Fourth, integration of services in the available health care systems to serve socially marginalized groups, such as PWIDs, prison populations, and poor households, who may not be catered to by routine health care, is important. Fifth, inclusion of a primary health care system as the frontline for treating HCV in a decentralized fashion is key to success.6 The Project Extension for Community Health Outcomes is another such model for treatment of HCV.7 This uses a tele-mentoring system for primary care providers (PCPs) and nurse practitioners by specialists in a hub-and-spoke fashion. This method of collaborative care enables PCPs to provide specialized health care for HCV under guidance from specialists who provide didactic teaching with case-based learning.6 The major health care programs started in HCV across different WHO regions are shown in Fig. 1. The WHO requires every country to look at its existing health care system and to develop a cascade of care (Figs. 2 and 3) to ensure capacity building, performance amplification at each step, and surveillance mechanisms to ensure case capture and treatment. Lastly, other than state-run public health programs, several initiatives from civil society, such as Buyer’s Club (FixHepC, South-East Asia Buyer’s Club, Eastern Europe Buyer’s Club, Hepatitis C Treatment Without Borders, etc.), screening programs, and health awareness campaigns pave the way for inclusive health care.8, 9 Several studies have shown the use of DAAs to be cost-effective because they effectively curtail the progression of HCV and reduce risk for cirrhosis, decompensation, and HCC, thus making them cost saving in public health terms in the long run.10 In the United States, an estimated 3.5 million PLHCVs were in need of treatment in 2015.2 The initial list price for sofosbuvir (SOF) was US $1000 per pill when first introduced, making the cost of the initial regimen US $94,500.5 An 8-week course of glecaprevir-pibrentasvir costs US $26,400 in the United States.4 Treating HCV even at originator drug price is favorable due to significant reduction in cost of managing complications of severe stages. Such treatment is cost-effective, that is, has incremental cost-effectiveness ratio per quality-adjusted life-year (QALY) of less than annual per capita national income. However, despite cost-effectiveness, the uptake of HCV treatment is lower than expected because of lack of access to care. Iyenger et al. systematically compared the price and affordability of SOF ± ledipasvir (LDV) across 26 member countries of the Organisation for Economic Cooperation and Development and reported that 90% of the analyses would conclude DAAs to be cost-effective for genotypes 2 to 5 at the discounted price of US $40,000, irrespective of the presence of cirrhosis, prior treatment history, or the region of the study. Furthermore, the listed originator price of DAAs (US $539-$94,500) was substantially lower than the threshold price (US $144,400-$225,000) at which they would be deemed cost-effective. However, the threshold price at which DAAs would be deemed cost saving was in the range of US $17,300 to $25,400. In several low- and middle-income countries (LMICs), DAAs are available at highly discounted prices. Therefore, treatment of HCV infection with DAAs at the prices prevalent in LMIC is not only cost-effective, but also cost saving. Several countries, including Argentina, Brazil, Egypt, Georgia, Indonesia, Morocco, Nigeria, Pakistan, Thailand, and Ukraine, are getting drugs for HCV elimination thanks to the WHO and partners’ aid for treatment access and favorable licensing agreements (Table 1). In India, the market price of generic SOF+velpatasvir (VEL) ranges from US $ 714 to $857 for a 12-week course, which is almost four times the price at which the Punjab state government is procuring the same combination and is providing it free to patients. This implies that the cost of treatment is offset by the savings in future health care costs, thus leading to an overall monetary savings while at the same time increasing QALYs.11 Other than cost of the drugs itself, another factor contributing to overall expenditure is the cost of screening tests and the confirmatory nucleic acid tests (NATs) for diagnosing viremia and sustained virological response (SVR12). Table 2 shows the costs of testing for HCV under the Punjab HCV treatment program (Mukh-Mantri Punjab Hepatitis C Relief Fund [MMPHCRF]) and the market price in the state of Punjab in India. With the advent of the National Viral Hepatitis Control Programme, these costs have been reduced further by use of standard pan-genotypic regimens, that is, SOF/daclatasvir (DCV) for persons without cirrhosis, SOF/VEL for compensated cirrhosis, and SOF/VEL/weight-based ribavirin for decompensated cirrhosis, which obviates the need for a genotype test. Another measure under the program was to perform the NATs at the time of diagnosis and at the time of SVR12, reducing testing costs. The HCV elimination program will require collaboration with insurance agencies to ensure wider access to screening and linkage to care.12 In the United Kingdom, there were an estimated 2,14,000 PLHCVs in 2016, and DAA treatment led to a decline of almost 10% in the annual number of HCV-related deaths between 2014 and 2016. The National Health Service sponsors the treatment, and the price of a combination of SOF and VEL in 2016 ranged from approximately US $10,500 to US $17,000 for a 28-day supply.13 The Australian Programme has a unique volume purchase licensing agreement that allows PLHCVs to be treated under the Pharmaceutical Benefits Scheme (which reimburses patients’ treatment expenses), treating an estimated 62,000 people for AUS $1 billion.14 The Mongolian strategy has incorporated HCV treatment in the National Health Insurance System, which covers 98% of the population. All PLHCVs are reimbursed $265 regardless of using public or private health care providers. Yehia et al.12 performed a meta-analysis that suggests that the programs have a steep slope to cover. The use of generic drugs available in countries with licensing agreements has reduced the cost of treatment to a fraction (Table 1).13-18 Of all of the PLHCVs, only a small fraction go on to have their disease diagnosed and viremic status conformed by NATs, and fewer still have the disease staged and initiated on treatment. Until DAAs were available, only 9% of the total PLHCV burden was cured, which is a far cry from the 80% required to achieve HCV elimination by 2030.12 Another model to rationalize costs of DAAs is the subscription-based flat-fee model similar to Netflix, a video-streaming service that provides unlimited content for a flat fee. This model engages a drug corporation in a subscription-based arrangement to pay for HCV treatment for the state’s residents. Australia instituted the “Netflix model” in 2015, agreeing to spend about AUS $1 billion to treat an estimated 104,000 people with the disease over 5 years, saving about AUS $6.5 billion more than if it had tried to treat the same number of people under the traditional pricing method.19, 20 In the HCV elimination 2030 strategy, prevention of new infections is of equal importance to screening, diagnosing, and treating the existing HCV pool. One of the primary areas of concern is terminating transmission in PWIDs. Coupling HCV treatment with needle and syringe programs (NSPs), counseling, and deaddiction services or opioid substitution therapy (OST) under one roof will reduce risk for HCV reinfection (Table 3). Recently, the SIMPLIFY trial reported that currently injecting PWIDs achieved SVR12 of 94%, irrespective of IDU before or during therapy.21 In the ANCHOR study, those receiving OST were more adherent to follow-up and change in high-risk behavior.22 These studies suggest that active drug use during HCV treatment did not impact treatment outcomes. A systematic review concluded that OST (relative risk [RR] = 0.50, 95% confidence interval [CI] = 0.40-0.63) reduces risk for new HCV infection and is strengthened in combination with NSP. There is weaker evidence for the impact of NSP (RR = 0.79, 95% CI = 0.39-1.61), although stronger evidence that high coverage is associated with reduced risk in Europe.23 A target of 90% reduction in new HCV is needed for preventing new infections. Secondary measures include reuse prevention syringes, blood banking regulation, better biomedical waste disposal, and education of dialysis and medical care personnel for improved medical care safety. Chen et al.24 performed a modeling study on the HCV burden, treatment capacity, and clinical landscape of HCV treatment in five European countries: France, Germany, Italy, Spain, and the United Kingdom. First, the number of PLHCVs with SVR12 will exceed the number diagnosed but have not yet received DAAs. Second, the patients already diagnosed with HCV will have received treatment by the end of 2020, which implies that aggressive screening strategies are required to treat the bulk of the iceberg, that is, the undiagnosed burden of PLHCVs. Hence rather than birth cohort or high-risk screening strategy, the trend will shift toward universal screening and treatment. Third, the capacity-building measures for a nonrestrictive treatment of PLHCV will be required. Initially, these five states treated only F4 patients, and then gradually included F3, then F2, and finally F0-F1. For example, the number of patients receiving treatment would remain steady in France and Italy until at least 2020, whereas the number of patients receiving treatment will decline substantially in Germany, Spain, and the United Kingdom by 2020, unless the diagnosis rate is increased. Therefore, a low treatment rate limits HCV coverage in France and Italy; whereas in the United Kingdom, Germany, and Spain, a restrictive diagnosis rate due to current screening practice is the bottleneck.24 Screening strategies suggest appreciable prevention benefits could be achieved from WHO’s treat-all strategy, although greater benefits per treatment can be achieved through targeting PWIDs. Under the current process, treatment coverage achieved will be between 65% and 74%, a far cry from the target of 90%. Hence the restrictive strategy should be phased out. Higher impact will be achieved in countries with high population growth. Analyses have been performed in several countries with a high prevalence of HCV, including the United States, Japan, and Egypt. Kim et al. reported that one-time screening for HCV in South Korea is likely to be highly cost-effective in people aged 40 to 69 years at current levels of treatment uptake due to a higher cost of managing cirrhosis.25 Similarly, Japan has adopted national screening for both the general population and the high-risk groups.26 Another issue faced by public health programs is the cumulative treatment failure cases, which are about 8% of all cases.6 These PLHCVs, already linked to care, require longer duration and expensive and multidrug rescue regimens. This is a necessary cost because successful retreatment will go a long way in reducing decompensation, HCC, and liver-related mortality. Global elimination of HCV requires a multipronged approach as mandated by the WHO. Every state needs to formulate a locally relevant health care policy targeting not only the high-risk population but also the general population to curb transmission of HCV. Adopting the dual approach of depleting the reservoir of HCV and decreasing the incidence of new infection would help curtail the disease and decrease liver-related mortality attributable to HCV.

CONTEXT: The surgical removal of impacted mandibular third molar is associated with minor but expected complications like pain, swelling, bruising and trismus. The lingual nerve damage sometimes occurs after the removal of mandibular third molar producing impaired sensation or permanent sensory loss. This complication is usually unexpected and unacceptable for the patients particularly if no prior warning has been given. AIMS: The aim of the present clinical prospective study was to determine the clinical incidence of lingual nerve injury following mandibular third molar removal and to analyze possible factors for the lingual nerve injury. SETTINGS AND DESIGN: Clinical prospective study in the Department of Oral Surgery, Punjab Government Dental College and Hospital, Amritsar. MATERIALS AND METHODS: Ninety patients were selected randomly, amongst the patients, who reported to our department from January 2009 to December 2009 for the surgical removal of impacted mandibular third molar. To minimize the risk of lingual nerve injury, the standard terence wards incision was made in all cases and only buccal flap was raised. STATISTICAL ANALYSIS: The small number of paraesthesia precluded statistical analysis. RESULTS: Out of 90 patients, six patients were diagnosed with lingual nerve paraesthesia. The overall incidence rate of lingual nerve injury was 6.6%. CONCLUSIONS: It can be concluded that lingual nerve paraesthesia can occur with or without reflection of lingual flap in spite of all the measures taken to protect it. It may be contributed to the fact of anatomical variations of lingual nerve.

BACKGROUND: We undertook this study to assess the incremental cost per quality adjusted life year (QALY) gained with the use of pan-genotypic sofosbuvir (SOF) + velpatasvir (VEL) for HCV patients, as compared to the current treatment regimen under the universal free treatment scheme in Punjab state. METHODOLOGY: A Markov model depicting natural history of HCV was developed to simulate the progression of disease. Three scenarios were compared: I (Current Regimen)-use of SOF + daclatasvir (DCV) for non-cirrhotic patients and ledipasvir (LDV) or DCV with SOF ± ribavirin (RBV) according to the genotype for cirrhotic patients; II-use of SOF + DCV for non-cirrhotic patients and use of SOF+VEL for compensated cirrhotic patients (with RBV in decompensated cirrhosis patients) and III-use of SOF+VEL for both non-cirrhotic and compensated cirrhotic patients (with RBV in decompensated cirrhosis patients). The lifetime costs, life-years and QALYs were assessed for each scenario, using a societal perspective. All the future costs and health outcomes were discounted at an annual rate of 3%. Finally, the incremental cost per QALY gained was computed for each of scenario II and III, as compared to scenario I and for scenario III as compared to II. In addition, we evaluated the lifetime costs and QALYs among HCV patients for each of scenario I, II and III against the counterfactual of 'no universal free treatment scheme' scenario which involves patients purchasing care in routine setting of from public and private sector. RESULTS: Each of the scenarios I, II and III dominate over the no universal free treatment scheme scenario, i.e. have greater QALYs and lesser costs. The use of SOF+VEL only for cirrhotic patients (scenario II) increases QALYs by 0.28 (0.03 to 0.71) per person, and decreases the cost by ₹ 5,946 (₹ 1,198 to ₹ 14,174) per patient, when compared to scenario I. Compared to scenario I, scenario III leads to an increase in QALYs by 0.44 (0.14 to 1.01) per person, and is cost-neutral. While the mean cost difference between scenario III and I is-₹ 2,676 per patient, it ranges from a cost saving of ₹ 14,835 to incurring an extra cost of ₹ 3,456 per patient. For scenario III as compared II, QALYs increase by 0.16 (0.03 to 0.36) per person as well as costs by ₹ 3,086 per patient which ranges from a cost saving of ₹ 1,264 to incurring an extra cost of ₹ 6,344. Shift to scenario II and III increases the program budget by 5.5% and 60% respectively. CONCLUSION: Overall, the use of SOF+VEL is highly recommended for the treatment of HCV infection. In comparison to the current practice (scenario I), scenario II is a dominant option. Scenario III is cost-effective as compared to scenario II at a threshold of one-time GDP per capita. If budget is an important constraint, velpatasvir should be given to HCV infected cirrhotic patients. However, if no budget constraint, universal use of velpatasvir for HCV treatment is recommended.

OBJECTIVE: To measure fluoride release and recharge ability of restorative materials in deionised water, artificial saliva and lactic acid. MATERIALS AND METHODS: Pellets were prepared from GC2, Ketac N100 and Beautifil II. Each pellets were individually immersed in 10 ml deionised water, artificial saliva or lactic acid as per respective subgroup for 24 h and then elutes were collected. Specimens were reimmersed in respective container. Fluoride released was analysed after 24 h, 7(th) and 15(th) day. On 15(th) day all specimens were exposed to 1.23% APF gel and fluoride release in respective solution was measured on 16(th), 22(nd), 30(th) day. RESULT: Fluoride release was more after 24 h for all materials in all media then decrease gradually. GC2 shows more fluoride release than Ketac N100 at 24 hours and on 7(th) day but onwards Ketac N100 released significantly more fluoride. Beautifil II showed least fluoride release at all measured intervals in all media. Order of fluoride release in media was lactic acid > deionised water > artificial saliva for all materials. CONCLUSION: GICs are smart material which release more fluoride when environment become more acidic and also show tendency to recharge which helps clinically in caries risk children.

Fifty-two young individuals suffering from severe haemophilia A and B volunteered to be compared with school- and college-going students for oral health status description and subsequent management. A total of 244 students (84.42% boys and 15.58% girls) with the age group of 13-23 years were divided into two groups, A and B (controls). The purpose of this study was to increase awareness about evidence-based dental practices by oral examinations followed by comparisons of periodontal health and prevalence of malocclusions among medically compromised students and healthy controls. Results described the oral health in severe haemophilic population to be compromised with combined simplified health index score of 0.50 and Decayed/Modified/Filled Teeth (DMFT) index score of 2.07 when compared with 0.42 and 0.95, respectively, among group B. Although prevalence of malocclusion and orthodontic treatment needs among group A were higher, yet it was not confirmed as a reason for degraded dental and periodontal status. However, spontaneous and/or toothbrush (trauma)-induced gingival bleeding episodes among group A could be explained as factors discouraging oral hygiene maintenance, particularly self-administered measures. Four haemophiliacs presented with symptoms of Temporomandibular Joint Dysfunction Syndrome (TMPDS). Evidence-based oral medicine and clinical practices need to be encouraged and applied to enhance the quality of life among haemophiliacs, particularly in developing world. Dental treatment needs of haemophilic population appear to be greater and maybe incorporated in routine dental practices, at institutional and individual levels.

Context. An in vitro study carried out to evaluate and compare the effect of Cola drink on surface roughness of esthetic restorative materials. Purpose. To compare the effect of different immersion regimes in a Cola drink on surface roughness of esthetic restorative materials. Method. Two hundred samples were grouped into 4 equal groups of 50 samples each: Group I: conventional glass ionomer, Group II: resin modified glass ionomer, Group III: polyacid-modified resin composite, Group IV: Composite resin. Each group was further subdivided into 5 subgroups of 10 samples each. Subgroup A (Control Subgroup). Samples were kept immersed in artificial saliva. Subgroup B. Samples were immersed in Cola drink once a day. Subgroup C. Samples were immersed in Cola drink, 3 times a day. Subgroup D. Samples were immersed in Cola drink 5 times a day. Subgroup E. Samples were immersed in Cola drink 10 times a day. Each immersion lasted 5 minutes. The immersion protocol was repeated for 7 days. Results. Maximum surface roughness was seen in Group I conventional glass ionomer cement, followed by Group II resin modified glass ionomer, Group III polyacid modified resin composite, and Group IV composite resin samples. Conclusion. Resistance to change in surface roughness is more in resin based restorative materials as compared to glass ionomer based materials.

An unusual case of superolateral dislocation of an intact mandibular condyle into the temporal fossa is reported. The different methods of treatment and the difficulties that may arise in the treatment of such cases are discussed briefly, and the literature is reviewed.

A 16-year-old girl had a history of unilateral ankylosis of the temporomandibular joint, which was reconstructed with an autogenous costochondral graft. About 2.5 years after surgery, the patient presented with overgrowth of the costochondral graft, resulting in deviation of the jaw toward the unaffected side.

BACKGROUND: There is no standard technique to monitor impact absorption capability of mouthguards. Earlier investigations have established that strain transferred to the teeth through mouthguard is a good indication of their efficiency. In the present study, a unique experimental scheme utilizing fiber Bragg gratings (FBGs) as distributed strain sensors is proposed and investigated to estimate impact absorption capability of custom-made mouthguard. The proposed methodology is useful due to advantages such as, very small size and flexibility for ease of bonding, self-referencing, and multiplexing capability of using FBG sensors. MATERIAL AND METHODS: Finite-element analysis was performed to simulate the stress distribution due to impact on the mouthguard. The FBGs were fabricated by exposing the core of photosensitive fiber to intense Ultra-Violet light through a 'phase mask'. One FBG sensor was bonded on the jaw model and another on the mouthguard surface at similar positions, so that both gratings are simultaneously affected by impact. Two different sets of the sensors were used, one for the anterior region and another for posterior region. The impact was produced using customized pendulum device with interchangeable impact objects i.e. cricket ball, hockey ball, and steel ball. Response of gratings was monitored using optical spectrum analyzer and strain induced due to each impact was determined from the Bragg wavelength shifts for each grating. RESULTS AND CONCLUSIONS: Strain induced due to impact was calculated from the Bragg wavelength shifts. Difference in the strain values for the two gratings is interpreted as impact energy absorbed by the mouthguard. The Bragg wavelength shifts (induced strain) for FBG bonded on the jaw model was much lower than the shift for FBG bonded on the mouthguard, indicating that most of the impact energy is absorbed by the mouthguard.

BACKGROUND: Organic amine fluorides and nano-hydroxyapatite dentifrices have shown remineralization potential in various studies. However, there is a lack of direct comparison between amine fluoride and nano-hydroxyapatite with conventional inorganic fluorides as sodium monofluorophosphate. AIM: The aim of the study is to evaluate remineralizing efficacy of the three dentifrices on both primary and permanent enamel surfaces. METHODS: Enamel sections were obtained from 40 sound molars - 20 primary and 20 permanent molars. Five enamel slabs were prepared from these extracted molars stored in artificial saliva, wherein one slab acted as control, second as demineralized (negative control), and other three slabs were brushed with sodium monofluorophosphate, amine fluoride, and nano-hydroxyapatite dentifrices, respectively, twice daily for 21 days. Scanning electron microscopy- Energy dispersive spectroscopy (SEM-EDS) analysis for surface morphology and calcium and phosphorus content and Vickers surface microhardness (SMH) values were evaluated at baseline, after demineralization, and postapplication of the experimental agents. RESULTS: Highly significant changes in calcium phosphorus ratio and SMH values were seen in enamel slabs treated with nano-hydroxyapatite and amine fluoride dentifrice as compared to sodium monofluorophosphate in both primary and permanent teeth. Surface morphology of enamel slabs treated with amine fluoride most closely resembled natural enamel morphology, while sodium monofluorophosphate-treated surfaces showed globular pattern of remineralization. Deposition of a separate highly mineralized layer over existing surface was seen in nano-hydroxyapatite-treated surfaces. CONCLUSIONS: Nano-hydroxyapatite exhibited highest remineralization potential in terms of mineral gain followed by amine fluoride and sodium monofluorophosphate dentifrice.

Background: Considering the biological concerns of calcium hydroxide (CH) as a pulpotomy agent, an alternative silicate based dentin substitute i.e. Biodentine (Ca3SiO5) was evaluated clinically and radiographically. Aims: To evaluate the effectiveness of dentin substitute (Biodentine) in regenerative pulpotomy of vital primary teeth that would giv a biological base to its use in forming reactive dentin bridge and overcoming the drawbacks of calcium hydroxide. Material and Methods: Randomised clinical trial on 40 bilateral carious primary molars in 20 participant children (aged 5-10 years) was carried out by same operator using Ca3SiO5(group-1) and CH (group-2) as vital pulpotomy agents. Blinded clinical and radiographic outcomes were observed at 3, 6 and 12 months interval. Results: Clinical outcomes of both protocols were analysed using Pearson's chi-square test applied at P < 0.05. Descriptive statistics were expressed as mean increase in dentin bridge formation in mms from two reference points in standardized radiographs using paired ‘t’- test at baseline and 12 months and found to be statistically significant (P < 0.05) in group-1 when compared with group-2. Conclusion: Group-1 revealed statistically favourable regenerative potential along with clinical success compared to group 2 thereby sharing both indications and mode of action with CH, but without its drawbacks of physical and clinical properties.

Lipoma, a benign tumor of adipose tissue is one of the most common benign neoplasms of the body. However, its occurrence in oral cavity is very rare. It accounts for 1 to 4% of benign neoplasms of mouth affecting predominantly the buccal mucosa, floor of mouth and tongue. We report three cases of intraoral lipoma, two in buccal mucosa and one in labial mucosa. An excisional biopsy was performed and histopathological examination revealed proliferation of mature adipocytes arranged in lobules and separated by fibrous septa. After 3 years follow up, the patients showed no signs of recurrence.

Root canal morphology of deciduous mandibular first molar was studied using roentgenographic and decalcification and clearing methods. Two groups of 15 teeth were formed. In the roentgenographic group, roots of the teeth were separated from the crown at the level of CEJ. Cut roots of the teeth were radiographed from both mesiodistal and buccolingual directions using separate IOPA films. In the decalcification and clearing group, teeth were decalcified and made transparent. Dye was injected later. The roots of the teeth were examined under 10 times for number, curvature, types and additional features of root canals. Deciduous mandibular first molar showed variability in root canal morphology. Four to five root canals were recorded. Majority of the teeth had 1-1 type of root canal anatomy, but 1-2 type anatomy was also reported. Straight, curved and S-shaped canal curvatures were recorded. Horizontal anastomosis, lateral canals and buccolingually broad root canals were also recorded.