The aim of this study was to evaluate the efficacy of intensive application of sodium fluoride varnish in prevention of caries in molars in children between 6 and 7 years and to evaluate the caries status in molars before and after application of fluoride varnish (Cavity Shield).

Two hundred fifty children (6-7 years) randomized into varnish and control groups. Children in varnish group received fluoride varnish (Cavity Shield) three times during one week (once every 2 days). Clinical and radiographical examinations of all children were performed prior to the first application of varnish and 1 year later. For evaluation and comparison, all the collected data were subjected to statistical analysis.

At the end of 1 year period, varnish group had 27.7% caries reversal in deciduous dentition which was statistically significant. Though there was a decrease in the caries increment in the permanent dentition, it was not statistically significant.

Application of fluoride varnish Cavity Shield three times once a week, once a year either in permanent or in deciduous dentition, is associated with substantial reduction in caries increment.

Fluoride varnish can prove to be an effective tool in prevention of dental caries in both primary and permanent dentitions.

Gugwad SC, Shah P, Lodaya R, Bhat C, Tandon P, Choudhari S, Patil S. Caries Prevention Effect of Intensive Application of Sodium Fluoride Varnish in Molars in Children between Age 6 and 7 Years. J Contemp Dent Pract 2011;12(6): 408-413.

One of the major hurdles in clinical prosthodontics has been the selection and replacement of maxillary anterior teeth in the absence of pre-extraction records. The aim of this study was to determine if a relationship exists between intraoral and extraoral facial measurements that could assist dental practitioners in selecting esthetically appropriate maxillary anterior teeth in the absence of pre-extraction records.

A cross-sectional study design was used with a sample size of one hundred and twenty participants. A questionnaire was used to identify the selection criteria and a photograph was taken for facial measurements using digitally calibrated software. Ninety-eight participants met the selection criteria and were included in the study. Measurements of intraoral landmarks were taken from stone casts of maxillary impressions using calibrated digital calipers. Each measurement was completed by two assessors to obtain mean values. Data were statistically analyzed using SPSS version 17 software. Data were assessed by one way analysis of variance (ANOVA) followed by post hoc (p < 0.05) to find any difference between tested groups. Pearson coefficients were used to determine whether correlation exists between measurements.

The mean values for intraoral maxillary landmarks were: Central incisor width = 8.39 mm, circumferential canine tip to canine tip distance = 34.89 mm, arch width = 48.24 mm, left arch length = 45.24 mm, right arch length = 45.56 mm. The mean values for extraoral landmarks were: Intercanthal distance = 33.24 mm, interpupillary distance = 60.68 mm, interalar distance = 38.27 mm, intercommissure distance = 50.61 mm. Differences existed within subgroups for all intraoral and extraoral measures. A weak positive correlation existed between intraoral (r < 0.4) and extraoral measurements (r < 0.38) that remained consistent when examined by gender.

This study showed that the average length and width of the maxillary arch and interalar width were the anatomical landmarks that provided the strongest predictive relationship with anterior maxillary teeth (r = 0.38 – 0.4). Using these dimensions an average multiplying factor can be used to calculate maxillary incisor width or canine tip to canine tip distance. As the predictive strength is not strong, the authors recommend its use as a preliminary guide for determining the width of the maxillary anterior teeth during the initial selection of artificial teeth in the absence of pre-extraction records.

The results of this study can be used to help dentists select the size of artificial maxillary anterior teeth in the absence of pre-extraction records.

Ellakwa A, McNamara K, Sandhu J, James K, Arora A, Klineberg I, El-Sheikh A, Martin FE. Quantifying the Selection of Maxillary Anterior Teeth Using Intraoral and Extraoral Anatomical Landmarks. J Contemp Dent Pract 2011;12(6):414-421.

The objective of this study was to evaluate density changes around the apices of teeth during orthodontic treatment by using digital subtraction radiography to measure the densities around six teeth (maxilla central incisors, lateral incisors, and canines) before and after orthodontic treatment in 36 patients and also assess treatment variables and their coorelation with root resorption.

A total of 36 consecutive patient files were selected initially. The selected patients presented with a class I or II relationship and were treated with or without premolar extractions and fixed appliances. Some class II patients were treated additionally with extraoral forces or functional appliances. External apical root resorption (EARR) per tooth in millimeters was calculated and was also expressed as a percentage of the original root length. Image reconstruction and subtraction were performed using the software Regeemy Image Registration and Mosaicing (version 0.2.43-RCB, DPI-INPE, São José dos Campos, São Paulo, Brazil) by a single operator. A region of interest (ROI) was defined in the apical third of the root and density calibration was made in Image J® using enamel (gray value = 255) as reference in the same image. The mean gray values in the ROIs were reflective of the change in the density values between the two images.

The root resorption of the tooth and the factors of malocclusion were analyzed with a one-way ANOVA. An independent t-test was performed to compare the mean amount of resorption between male and female, between extraction and nonextraction cases. The density changes after orthodontic treatment were analyzed using the Wilcoxon signedrank test. In addition, the density changes in different teeth were analyzed using the Kruskal-Wallis test. The cut-off for statistical significance was a p-value of 0.05. All the statistical analyses were carried out using SPSS (version 13.0 for Windows, Chicago, IL, USA).

Gender, the age at which treatment was started and Angle's classification was not statistically related with observed root resorption. The mean percentage density reduction as assessed by DSR was greatest in both central incisor: by 27.2 and 25.2% in the upper-right and upper-left central incisors, respectively, followed by the upper-right and upper-left canine teeth (23.5 and 21.0%) and then the upper-right and upper-left lateral incisors (19.1 and 17.4%).

Tooth extraction prior to treatment initiation and the duration of orthodontic treatment was positively correlated with the amount of root resorption. DSR is useful for evaluating density changes around teeth during orthodontic treatment. The density around the apices of teeth reduced significantly after the application of orthodontic forces during treatment.

Assessment of density changes on treatment radiographs of patients undergoing orthodontic therapy may help in the monitoring of external apical root resorption during course of treatment.

Sunku R, Roopesh R, Kancherla P, Perumalla KK, Yudhistar PV, Reddy VS. Quantitative Digital Subtraction Radiography in the Assessment of External Apical Root Resorption Induced by Orthodontic Therapy: A Retrospective Study. J Contemp Dent Pract 2011;12(6):422-428.

Thalassemia is a group of inherited hemoglobinopathies with thalassemia major representing the severe form of the disease characterized by craniofacial deformities. The aim of this study is to provide a detailed description of dental arch dimensions in subjects with thalassemia major.

The sample consisted of 43 thalassemic subjects, 24 males and19 females, aged 7.3 to 15.4 years (mean ± SD = 10.6 ± 3.5 years) and control group matched by age and sex. Dental casts of the participants were measured for arch lengths, arch widths, using a digital sliding caliper. Student t-test was used for comparison of mean values between males and females as well as between thalassemic and control groups.

The results show that all means of maxillary and mandibular arch dimensions in thalassemic males and females were smaller than their controls, with 14 of the 16 comparisons being statistically significant (ranged from p < 0.05 to p < 0.001). The segmental arch lengths in the maxilla and mandible of thalassemic group were reduced by an average of 2.59 and 2.55 mm respectively, compared with the control group. The mean maxillary and mandibular arch depths (lengths) in the thalassemic group were shorter by 3.21 and 2.63 mm respectively, relative to the controls (p < 0.001). All arch widths thalassemic patients were significantly reduced by an average ranged from 1.33 to 1.90 mm in the maxilla and 1.37 to 1.77 mm in the mandible.

The present study showed that the maxillary and mandibular dental arches dimensions are significantly reduced in patients with thalassemia major compared with healthy control subjects.

Changes in the size of dental arches and tooth dimensions in thalassemic patients have an impact on the occlusal relationships. These changes should be taken into account when planning orthodontic treatment and orthognathic surgery.

Hattab FN, Yassin OM. Dental Arch Dimensions in Subjects with Beta-thalassemia Major. J Contemp Dent Pract 2011;12(6):429-433.

To determine the resistance failure value of nonprecious metal-ceramic restorations at the incisal edge with varying thickness under different application of load.

An Ivorian central incisor was prepared to receive metal-ceramic crown, which was further duplicated, invested, casted and 72 metal dies were fabricated in Co-Cr alloy. Metal dies were relieved with die spacer, lubricated and wax patterns were prepared for metal copings, which were further invested and casted and 72 metal copings were fabricated. The ceramic materials were used for the study viz. Vita/VMK, IPSd SIGN, and superporcelain. Ceramic built-up was carried out according to manufacturer instructions. Incisal ceramic built-up was carried out with increasing thickness from 2.00 to 2.5 and 3.00 mm.

A total of 72 samples, prepared for the study, were divided into two groups, i.e. group I (36 samples) and group II (36 samples), as per the direction of application of load. The samples were mounted on acrylic block (6 samples/block). A total 12 acrylic blocks were prepared. All the samples were tested using universal testing machine (MTS/USA). The load was applied with crosshead speed of 5 mm/min.

Fracture resistance was found to be highest for the 2.00 mm and lowest for 3.00 mm incisal ceramic thickness samples regardless of the ceramic material in both groups. There was a gradual decrease in fracture resistance as the incisal ceramic thickness increased from 2.00 to 3.00 mm in all samples. Fracture resistance was marginally higher for incisal ceramic build-up of 3 mm thickness on group II metal copings than on group I copings. Fracture resistance was highest for IPSd SIGN followed by that of Vita/VMK-95 and superporcelain.

A 3.00 mm incisal ceramic thickness offered greater fracture resistance in comparison to lower values of incisal thickness; IPSd SIGN offered greatest fracture resistance followed by that of Vita/VMK-95 and superporcelain.

Danappanavar PM, Nanda Z, Bhaskar M, Gowd V, Molugu M, Reddy KA, Reddy RK, Kumar MA. Comparative Evaluation of Resistance Failure in Nonprecious Metal-Ceramic Restoration at the Incisal Edge with Varying Thickness Under Different Application of Load: An in vitro Study. J Contemp Dent Pract 2011;12(6):434-440.

The goal of the study was to evaluate the effect of caries removal by three various methods on the permeability of class II composite resin restorations in primary molar teeth.

Forty-five recently extracted primary molars were randomly assigned to three groups for three different methods of caries removal; group 1-mechanical, group 2-caries detector dye, and group 3-Carisolv (n = 15). After that, class II cavities in all groups were restored with the adhesive (Opti Bond Solo Plus) that was applied according to the manufacturer's instruction and a posterior composite (Herculite XRV), which was used incrementally. After 24 hours the samples were thermocycled in water for 500 cycles between 5 and 55°C with a dwell time of 30 sec. Permeability was assessed by the fluid filtration method. The data were analyzed using the ANOVA test while study groups were compared with Tukey test for statistically significant differences at a 5% significance level.

The evaluation of tested groups indicated that the highest (0.80) and least (0.37) mean of permeability was observed in group 2 and 3 respectively. Significant difference was revealed among the tested groups (p = 0.045). The comparison of Carisolv and caries detector dye groups indicated a statistically significant difference (p = 0.037). There was not any significant difference between Carisolv or caries dye in the conventional group.

Using the chemomechanical and staining methods for caries removal had no more detrimental effect on permeability than the conventional technique. However, caries detection dye for caries removal could be more harmful than chemomechanical method.

None of the current caries-excavation techniques could eliminate permeability in class II composite resin restorations. Furthermore, staining methods do not have an adverse effect on sealing ability in comparison to the conventional technique.

Shabzendedar M, Moosavi H, Talbi M, Sharifi M. Permeability Evaluation after Decay Removal in Primary Teeth with Current Caries-excavation Techniques. J Contemp Dent Pract 2011;12(6):441-446.

To assess the prevalence of dental caries and dental fluorosis among 13- to 15-year-old school children in Panyam, Andhra Pradesh, India.

The cross-sectional study was conducted among 202 school children and were examined for dental fluorosis and dental caries.

This study shows that male students have a decrease in DMFT (Decayed, missing, filled, teeth) index and increase in Dean's index when compared with females. Among students with 13 to 15 years of age, 13-year-old student has increase in DMFT score when compared with other age groups and 14-year-old students has increase in Dean's score when compared with other age group students.

The prevalence of dental caries decreased with the increase of fluorosis among the students examined.

Patients with dental fluorosis show a decreased prevalence of dental caries.

Anuradha BR, Sri Laxmi G, Sudhakar P, Malik VN, Reddy KA, Reddy SN, Prasanna AL. Prevalence of Dental Caries among 13 and 15-Year-Old School Children in an Endemic Fluorosis Area: A Cross-sectional Study. J Contemp Dent Pract 2011;12(6):447-450.

Altered lipid profile patterns have been associated with malignancies because lipids play a pivotal role in the maintenance of cell integrity. The present study evaluated alterations in serum lipid profile in oral squamous cell carcinoma patients as well as its association with the habit of tobacco consumption.

The study included 30 oral squamous cell carcinoma patients, 20 patients with the habit of tobacco consumption and 20 controls. Serum lipids, including (i) total cholesterol, (ii) LDL cholesterol (LDLC), (iii) HDL cholesterol (HDLC), (iv) VLDL cholesterol (VLDLC) and (v) triglycerides, were analyzed by spectrophotometric kits.

A significant decrease in serum total cholesterol (TC) levels, triglyceride levels (p = 0.007, p = 0.029 respectively) were observed in oral squamous cell carcinoma patients as compared to the healthy control group. The mean serum HDLC levels (p = 0.003) were significantly lowered in the tobacco habituates when compared to the healthy controls. The mean serum total cholesterol levels were significantly lower in subjects with oral squamous cell carcinoma (p = 0.000) as compared to the tobacco habituates. Likewise, LDLC levels and TC:HDLC ratios (p = 0.000 and p = 0.000 respectively) were significantly decreased in oral squamous cell carcinoma patients as compared to the tobacco habituates. Our data strengthens the evidence of an inverse relationship between serum lipid levels and oral squamous cell carcinoma.

The lower level of serum cholesterol and other lipid constituents in the patients is thought to be due to their increased usage by tumor cells for new membrane biogenesis.

The lower serum lipid profile status serves as a useful indicator for gauging initial changes occurring in tumor cells. A detailed study of the cholesterol carrying lipoprotein transport mechanisms helps in better understanding of the underlying mechanisms of the regulation of serum cholesterol concentrations in cancer.

Ghosh G, Jayaram KM, Patil RV, Malik S. Alterations in Serum Lipid Profile Patterns in Oral Squamous Cell Carcinoma Patients. J Contemp Dent Pract 2011;12(6): 451-456.

Adhesion of composite resin and pulp capping biomaterials remarkably influences treatment outcomes. This in vitro study aimed to compare the shear bond strength of composite resin to calcium enriched mixture (CEM) cement, mineral trioxide aggregate (MTA) and resin modified glass ionomer (RMGI) with or without acid etching.

A total of 90 cylindrical acrylic blocks containing a central hole, measuring 4 mm diameter and 2 mm height were prepared. The blocks were randomly divided into three experimental groups based on being filled with CEM, MTA or RMGI. Samples in each group were then randomly divided into two subgroups, i.e. with or without phosphoric acid etching. Placing composite resin cylinders on the samples, shear bond strengths were measured using a universal testing machine. Failure modes of the samples were evaluated under a stereomicroscope. Data were analyzed using two-way ANOVA and Tukey tests.

Shear bond strengths in the etched and nonetched samples were not significantly different (p = 0.60). There was a significant difference in shear bond strength values of the three experimental materials (p < 0.001) and RMGI showed the highest strength values (p < 0.001); no significant difference was observed between MTA and CEM (p = 0.51). The interaction of the type of material and surface etching was statistically significant (p < 0.001). All of the samples showed cohesive failure mode.

Acid etching of MTA, CEM and RMGI do not improve the shear bond strength of these materials to composite resin. Besides, shear bond strength values of MTA and CEM to composite resin, are favorable due to their cohesive mode of failure.

When MTA and CEM biomaterials are used in vital pulp therapy, it is advisable to cover these materials with RMGI. In addition, if it is not possible to use RMGI, the surface etching of MTA and CEM biomaterials is not necessary prior to composite restoration using total-etch adhesive resin.

Oskoee SS, Kimyai S, Bahari M, Motahari P, Eghbal MJ, Asgary S. Comparison of Shear Bond Strength of Calcium-enriched Mixture Cement and Mineral Trioxide Aggregate to Composite Resin. J Contemp Dent Pract 2011;12(6):457-462.

Aim of the study is to study the surface epithelial cells of erosive, nonerosive lichen planus by scanning electron microscope (SEM) and to correlate it with that of normal mucosa and oral leukoplakia.

Twenty biopsies of lichen planus and five biopsies of normal mucosa were taken. Half piece of each biopsy was processed for H&E stain and another half for SEM study.

Surface epithelial cells were showing different features.

Definite different features were seen in lichen planus-leukoplakia group than in normal oral mucosa. These changes are due to abnormality in cell maturation and differentiation.

SEM study is helpful in early detection of dysplasia. It can lead to early treatment of the lesion and thus prevention of squamous cell carcinoma.

Thakur M, Hazare V. Scanning Electron Microscopic Study of Surface Epithelial Cells in Erosive and Nonerosive Oral Lichen Planus. J Contemp Dent Pract 2011; 12(6):463-468.

The panel concluded that certain nonfluoride agents may provide some benefits as adjunctive therapies in children and adults at higher risk of developing caries.

Pickett FA. Nonfluoride Cariespreventive Agents: New Guidelines. J Contemp Dent Pract 2011; 12(6):469-474.

These skills indulge positive energy in human relationship for working in symbiosis and explore infinite capabilities at institutional and doctoral level. Here, some optimistic suggestions are given for improving dental practices and academic fulfillments.

These soft skills help to organize, plan and manage, and track changes during the course of the growing dental practices. However, understanding of the soft skills in practice management, its simplicity and complexity and also, its contributing factors, helps practitioners to understand the dynamic, social and complex contexts of practices. It is really helpful to all practitioners to grow their practices using soft skills.

Jawale BA, Bendgude V, Husain N, Thosar N, Tandon P. Soft Skill Appraisal for Dentistry: A Tool for Positive Practice Management. J Contemp Dent Pract 2011;12(6):475-478.

This review intends to provide a brief overview regarding quorum sensing among bacteria in biofilms and also attempts to throw light on the new research focusing on interference with the quorum sensing.

Dental plaque is an example of microbial biofilm leading to periodontal disease and dental caries. Quorum sensing is widely employed by a variety of gram-positive and gram-negative bacterial species to coordinate various activities in biofilms. Quorum-sensing-interfering compounds have either a positive or a negative effect on the expression of bacterial phenotypes regulated by quorum sensing. These studies of bacterial quorum sensing have also suggested several ideal targets for drug design which can be promising in preventive and therapeutic aspects of periodontal diseases and dental caries.

Studies have shown that periodontal disease and dental caries is caused by plaque biofilm bacteria. Quorum sensing is the means of communication between these bacteria to regulate a wide range of behavior patterns among them. The in vitro studies reviewed here have a vital role in opening up this field, because they reveal the basic machinery of cell—cell signaling in microbial communities. The signal machinery bacteria use to coordinate a variety of their activities is identified by these studies.

Further, this review aims to discuss several natural and synthetic methods which were used for manipulating bacterial quorum sensing.

The future challenge lies in the ability of the dental research to develop additional mechanisms for interfering with bacterial quorum sensing which can be used as preventive and therapeutic tools for combating oral polymicrobial diseases.

This article aims at reviewing the literature and helping us to understand the ways of communication among bacteria in biofilms, which further open up the prospects in the treatment of diseases caused by biofilms.

Biradar B, Devi P. Quorum Sensing in Plaque Biofilms: Challenges and Future Prospects. J Contemp Dent Pract 2011;12(6):479-485.

To address the indications, contraindications, surgical procedure, complications following treatment, factors influencing the results and success rate of intentional replantation procedure.

Intentional replantation is extraction of a tooth to do extraoral root canal therapy, curettage of apical lesion when present, and its replacement in its socket. It has been proposed as an alternative to routine extraction; however, it should be considered a last resort because the root may be fractured during extraction.

The success rate of intentional replantation is far below than routine endodontic treatment or apical surgery. Difficultness of tooth extraction, the possibility of fracture during extraction and the risk of external resorption are some limitations of this treatment. The most common causes of failure in intentionally replanted teeth are external inflammatory resorption or replacement resorption and ankylosis caused by periodontal ligament damage.

The success rate up to 95% with an average retention of 3 to 5 years, has been reported.

In some cases, endodontic retreatment or apical surgery is impossible or impractical. In these situations, intentional replantation may be considered as a last resort for preserving the tooth, so all clinicians should know about its indications/contraindications, surgical procedure and complications following treatment.

Rouhani A, Javidi B, Habibi M, Jafarzadeh H. Intentional Replantation: A Procedure as a Last Resort. J Contemp Dent Pract 2011;12(6):486-492.

In this case report, treatment of lymphangioma (a red-purple vesicular apperance, nonulcerated lesion, located on the gingiva of the mandibular alveolar bone) with CO2 laser on a 63-year-old female patient and 2 years clinical outcome is presented.

Lymphangiomas are hemorrhagic, rare, benign hamartomatous tumors of lymphatic system have a marked predilection for the head, neck and oral cavity. Lymphangiomas are congenital lesions and an often present at or around the time of birth (60%). Among the dental laser systems, CO2 laser is the most suitable instrument for the treatment of soft tissue pathologies because of its affinity for water-based tissues. The absorbed energy causes vaporization of the intra- and extracellular fluid and destruction of the cell membranes. A major advantage of the 10.600 nm wavelength CO2 laser is its ability to seal blood vessels during surgery and to make the excision of vascular lesions with its hemostatic effect.

CO2 laser application (focused CO2 laser beam, 10.600 nm) was performed in a separate operation room at 3 watt (W), continous wave (CW) with 90 degree angle tip under local anesthesia. The mouth was protected from reflection of the laser by wet gauzes. The wound formed by laser was left open to secondary epithelization. Excessive bleeding was not observed during the procedure. The wound formed by laser was left open to secondary epithelization. Neither sutures nor dressings were used after surgery. Only paracetamol and chlorhexidine digluconate mouthwash were prescribed during the postoperative period. There was no postsurgical complaints from the patient.

CO2 laser worked well while making the excision with its hemostatic effect. No recurrence was seen in the two years follow-up period.

CO2 laser therapy can be used as a primary alternative method in the treatment of lymphangiomas. It can be safely used and recurrence may be less than conventional excision with scalpel. However, long-term clinical follow-up is neccessary for the recurrence of the lesion.

CO2 laser treatment can be used safely in the treatment of lymphangiomas.

Arslan A, Gursoy H, Cologlu S. Treatment of Lymphangioma with CO2 Laser in the Mandibular Alveolar Mucosa. J Contemp Dent Pract 2011;12(6):493-496.

Tripathi NB, Patil SN. Treatment of Class II Division 1 Malocclusion with Myofunctional Trainer System in Early Mixed Dentition Period: J Contemp Dent Pract 2011;12(6):497-500.

The treatment of anterior region's traumas in a single appointment would provide patient's expectation as well as preventive of remaining dental hard tissues.

Arslan H, Barutcigil G, Alada™ H, Kürklü D. Management of Fractured Permanent Incisors: 1 year Follow-up. J Contemp Dent Pract 2011;12(6):501-505.

The aim of this study is to present a clinical case in which an occlusal matrix device was used in a patient who needed to restore a posterior tooth.

A direct duplicate occlusal appliance was used (biteperf) in a patient who needed an occlusal restoration in two posterior teeth.

Using the matrix helps having fast and accurate reproduction of the original anatomical details of the occlusal surface. The final result surprised with the presented restoration in terms of esthetic quality, despite the simplicity of the technique.

Posterior teeth with initial lesions were confined to the occlusal surface of anatomically complex or fissured anatomy with or without signs of proximal caries wich are ideal candidates for this technique. The overlying enamel surface must be relatively intact; lesions of hidden or occult caries.

The aesthetic and time-saving benefits of the occlusal device (biteperf) are immediately clear. The matrix allows the fast and accurate reproduction of the anatomic details of the original occlusal surface of the tooth. The professionals who lack an artistic penchant and marked manual ability will be able to carry out excellent posterior resin composite restorations.

de Carvalho Dekon SF, Pereira LV, Zavanelli AC, Goiato MC, do Amparo Resende C, dos Santos DM. An Effective Technique to Posterior Resin Composite Restorations. J Contemp Dent Pract 2011;12(6):506-510.

It highlights the sequelae of trauma to primary teeth with the aim of aiding in detection of probable alterations in the traumatized primary teeth and its succedaneous permanent teeth.

Agarwal RK, Sharma P, Gupta I, Patil RU, Singh SK, Bharath KP. The Reverberations of Traumatized Primary Dentition: A Practitioner's Perspective. J Contemp Dent Pract 2011;12(6):511-515.