Aim: The aim of this in vitro study was to compare the effect of different manipulation techniques on the surface hardness of ChemFil Rock glass ionomer. Materials and methods: The changes in Vickers surface hardness (VH) of ChemFil Rock were evaluated after the application of five manipulation techniques and compared with one control group (n = 60). The manipulation techniques included: finger pressure set, electronic piezo producing a high frequency set, air piezo producing a low frequency set, heat-set achieved with a curing light and the last technique was a combination of electronic piezo followed by heat-set. Standard set was the control. Results: The average surface hardness for the standard set was 49.5 VH. No statistical differences were demonstrated when the means were compared for finger pressure set (49.2 VH) or the air piezo set (48.49 VH) with standard set. The electronic piezo (54.21 VH) and the heat-set (57.5 VH) had an increased mean surface hardness when compared to other techniques. Heat-set had the highest surface hardness demonstrating a significant statistical difference when compared with standard set, finger pressure set, air piezo set as well as the combination of electronic piezo (p < 0.05). Conclusion: The surface hardness of the glass ionomer cement (GIC) material assessed in this study can be predictably improved by applying the heat-set technique. A command set can be achieved with the electronic piezo or the air piezo, however, the surface hardness will only increase with the use of the electronic piezo. Clinical significance: The clinical advantage of using the air piezo as well as the electronic piezo technique would lie in preventing moisture contamination and dissolution of the GIC due to the command set effect of the ultrasonic vibrations within 15 seconds. The heat technique with the LED curing light will reduce the setting time to 90 seconds.

Aim: The aim of this work was to evaluate if the use of a silicone device for muscular rebalancing (Alifix®) can be useful in treating of temporomandibular disorders (TMD) of muscular origin and improving the electromyographic indexes of the chewing muscles. Materials and methods: Thirteen patients (11 F and 2 M aged between 24 years and 65 years) with TMD of muscular origin according to diagnostic criteria (DC)/TMD were involved. At the first visit (T0), each patient reported the pain intensity of masseters and temporal muscles. A surface electromyography (EMG) was performed using Teethan® (Teethan S.p.A.) and then Alifix® was delivered instructing the patient on its use. Each subject was visited again after 1 month (T1) and 2 months (T2). New EMG had been made at T1 and T2, and patients were asked again to report the pain intensity. Statistical analysis was calculated between T0 and T1, T1 and T2, and T0 and T2 for all EMG, and muscle pain measurements by Wilcoxon test with statistical significance p < 0.05. Results: Regarding the pain values between T0 and T1, T1 and T2, and T0 and T2, the difference is statistically significant, since the intensity of pain between T0 and T2 is decreased, if not disappeared, in 90% of cases. The use of Alifix® also determined a gradual improvement in the values of the EMG indexes, which, however, is not statistically significant. Conclusion: The effectiveness of Alifix® is demonstrated clinically but not at an instrumental level. Further studies involving a larger sample and taking longer therapy duration are needed. Clinical significance: Alifix® works by improving the blood circulation of the muscle, which allows the removal of catabolites with a consequent reduction of the algic symptomatology and promotes a greater supply of oxygen. It also encourages a conversion of IIA type muscle fibers into slow-twitch type I fibers that are more resistant to neuromuscular fatigue.

Aim: The utilization of fixed partial dentures (FPD) ceramic frameworks for replacing the missing posterior teeth is observed to have reported high failure rates. For this reason, 3-units FPD are designed and used extensively in the clinical practices, particularly for posterior mandibular region. The current study however, aims to carry out an evaluation of different stress patterns that are induced in a 3-units FPD within posterior part of mandible using finite element analysis (FEA). Materials and methods: Different modalities of the implant-supported FPDs such as type of connector, length and diameter of implants were taken into account. A three-dimensional (3D) model simulation of a mandibular Kennedy class II removal partial denture (RPD) was designed from a computerized tomography (CT) input with digital imaging communication on medicine (DICOM) format. In addition, occlusal load of 100 N was also used for central fossae of first premolar, first molar and second molar of the 3-units’ reconstruction for each model. The magnitude of von Mises stress including minimum stress, maximum stress and average stress were also evaluated for each loading condition. Results: The findings of the current study showed evidence that tooth-implant design with a nonrigid connector has significantly increased the average stress. Furthermore, it was observed that rigid connector has considerably minimized the stress within the tooth-implant-supported FPD. Conclusion: The study concluded that stress designs significantly influence the stress distribution around the bone. Clinical significance: This study gives some guidance and criteria for the selection of the type of fixed implant prosthesis in the posterior mandibular region.

Aim: The aim of this study was to evaluate the force–release behavior of closed coil nickel–titanium springs of three different commercial brands available on the market, as well those from different batches, tested over multiple distances, according to the number of deactivations. Materials and methods: For this in vitro analysis, closed coil nickel–titanium springs of the following numbers and brands: eight, 3 mm GAC® springs; eight, 3 mm springs from TP Orthodontics® and eight, 5 mm springs from MORELLI® were standardized at 200 gf force. Two batches of all three brands were tested and compared. All springs were evaluated on a test machine and extended to a distance of five times beyond their original length. The springs were extended, and the distances of force released were measured and marked at every 20% of the total spring length, during their deactivation, and the process was repeated five times for each spring. Results: The intraclass correlation coefficients showed that the value of 200 gf indicated by the manufacturers was poorly reproduced. The springs did not change their force release after successive extensions. All springs presented higher deactivation force values as their stretching increased. Conclusion: All springs presented the greater release of force as their stretch was increased, but the GAC® brand springs presented a more uniform pattern. TP Orthodontics® springs exhibited an acceptable force release pattern, but MORELLI® springs proved to be far below expected strength. Clinical significance: As a clinical consideration of the study, the results obtained in the present research are relevant to the use of nickel–titanium closed springs with regard to the quantity of force released during the mechanics of space closure after extraction (main application of nickel–titanium closed springs), and to the pattern of forces released by springs in view of the real context of gradual closure of spaces after tooth extractions.

Aim: This study evaluated the influence of the resin composite and bonding strategy on the push-out bond strength of the self-adhesive, Fusio liquid dentin (FUS) (Pentron Clinical), and of two conventional resin composites of different viscosities, Filtek Z250 (3M ESPE) and tetric flow (Ivoclar Vivadent). Materials and methods: Thirty-two bovine incisors were used after disinfection. The roots were sectioned and the buccal and lingual surfaces were polished until a 2-mm slab was achieved, maintaining enamel at the buccal surface and dentin at the lingual surface. Standardized cavities were then prepared (2.0 × 1.5 mm) and restored according to the following bonding strategies: Fusio liquid dentin with selective etching (FUSSE) in enamel, FUS, Filtek Z250, and tetric flow-total etching (TET). All groups were restored in bulk. After 24 hours of storage in distilled water, finishing and polishing were performed. The push-out test was conducted on a universal testing machine (0.05 mm/minute). Data were analyzed through Kruskal–Wallis and Mann–Whitney tests (p = 0.05). The extruded restorations were evaluated under a stereomicroscope (10×) for failure-mode evaluation. Results: There were no statistically significant differences between the groups TET, Z250, and FUS, with 145.59, 108.91, and 104.12 MPa means, respectively. The FUSSE group (40.92 MPa) showed a statistically significant lower bond strength. The predominant failure mode was a mixed failure for all groups. Conclusion: The self-adhesive resin composite achieved a satisfactory result on bond strength when compared to conventional composites with regular and low viscosities, except when selective enamel etching was done. Clinical significance: This study shows that the clinicians must be aware of the viscosity of the phosphoric acid to avoid dentin contamination whenever performing selective enamel etching. And the self-adhesive resin composite studied presented as another restorative alternative.

Aim: The present study was done to determine the activity of licorice root extract on Streptococcus mutans (S. mutans) in comparison to chlorhexidine and fluoride mouthwash. Materials and methods: In the current study, the different concentrations of aqueous and ethanolic licorice root extract were subjected to microbiological assay and zone of inhibition was determined against S. mutans by agar ditch method. Minimum inhibitory concentration (MIC) of aqueous and ethanolic solution was obtained by using broth dilution method and agar dilution method. Chlorhexidine and fluoride mouthwash were kept as a positive control in the present study. One-way ANOVA along with Tukey post hoc test were used at 5% level of significance to analyze data. Results: Mean zone of inhibition of chlorhexidine mouthwash, fluoride mouthwash, aqueous and ethanolic licorice root extracts against S. mutans at 24 hours were 23 mm, 14.2 mm, 15.8 mm and 22.4 mm, respectively. Minimum inhibitory concentration of aqueous and ethanolic licorice root extract on S. mutans was 20 mg/mL and 12.5 mg/mL, respectively by both broth dilution method and agar dilution method. Conclusion: The antibacterial effect produced by ethanolic licorice root extract on S. mutans was comparable to chlorhexidine mouthwash while significantly higher in comparison with aqueous form and fluoride mouthwash. Clinical significance: The interest in the plants with antibacterial and anti-inflammatory activity has increased now days to treat various dental diseases as consequences of current problems associated with the conventional agents. Licorice root is easily available, economically feasible and culturally acceptable and may possess minimal side effects as compared to conventional means of chemicotherapeutic agents used for reduction of S. mutans in oral cavity and hence can be recommended for prevention of dental caries.

Aim: The aim of this study was therefore to evaluate the conventional intraoral mandibular vestibular incision approach in symphysis and parasymphysis fractures and compare prognosis of the incision site, fracture healing, and associated complications with the staircase modification of the intraoral mandibular vestibular incision approach for symphysis and parasymphysis fractures. Materials and methods: This study was conducted on 34 healthy individual of age 18–60 years, reporting to the department with a history of trauma having mandibular symphysis or parasymphysis fractures and underwent open reduction and internal fixation under either local or general anesthesia. The treated patients were prospectively followed and examined for the postoperative complications such as pain, swelling, infection, dehiscence, sensory disturbances, and nonunion/malunion of the fracture site. Patients were followed up at the intervals of 2nd postoperative day, 1 week, 2 weeks, and 6 weeks postoperatively and were evaluated for any of the above complications. Results: There was no statistically significant difference in the assessment parameters between the conventional intraoral mandibular vestibular approach and the staircase modification of the same. Conclusion: The conventional method and the staircase modification of the intraoral mandibular vestibular approach have similar treatment outcomes in terms of osteosynthesis and soft tissue healing but the staircase modification fairs better in terms of healing till the 6th week. Clinical significance: This study contributes to the understanding of the comparatively treatment outcomes of the conventional and staircase modification of the intraoral mandibular vestibular approach with respect to postoperative complications such as pain, swelling, infection, dehiscence, sensory disturbances, and nonunion/malunion of the fracture site, which may influence the choice by the dental surgeon.

Background: Chlorhexidine is considered one of the options for the management of periodontal diseases. This present study was conducted to assess the usefulness of controlled-release chlorhexidine chip in addition to scaling and root planning (SRP) while comparing with SRP alone in the treatment of chronic periodontitis clinically, microbiologically and radiographically. Materials and methods: This study included 20 patients age ranged from 30 to 55 years with chronic periodontitis. A total of 40 sites were selected. Two bilateral pockets with probing depth 4–6 mm were put in test and control groups in all subjects. SRP plus Periochip™ was used in the test group and SRP alone in the control group. In all subjects, all the analysis such as clinical parameters, the radiographic and anaerobic culture of P. gingivalis, T. denticola, and T. forsythia were performed and compared in both groups at baseline and 3 months interval. Results: There was a significant improvement in all clinical and radiographic parameters in the test group in comparison to control group. Total colony counts also reduced significantly. At baseline, Tf was recovered from 15 test group sites and 16 control group sites, Pg from 14 test group and 14 control group sites, Td from 16 test group and 15 control group sites. At 3 months, Tf was recovered from 4 test group and 10 control group sites, Pg from 3 test group and 9 control group sites, Td from 4 test group and 8 control group site. Conclusion: Periochip™ placement as an adjunct to SRP, showed promising results when compared to SRP alone. Clinical significance: Periochip is considered the best treatment option in the treatment of chronic periodontitis.

Aim: To evaluate the bond strength of two commercially available universal tray adhesives on polyvinylsiloxane addition silicone and condensation silicone impression materials to an autopolymerizing polymethyl methacrylate acrylic tray material. Materials and methods: Sixty flat square specimens were fabricated from autopolymerizing polymethyl methacrylate tray material to which an eye hook was incorporated to serve as the point of attachment to a universal testing machine. A polyvinyl chloride (PVC) pipe of 15 mm diameter and 25 mm long was used to house the impression material, and a metal rod was inserted into two centered holes to provide retention that serves as the second point of attachment to the universal testing machine. The specimens were divided into 4 groups of 15 specimens each. The first and second groups of specimens were applied with Coltene and Zhermack universal tray adhesives and tested with addition silicone impression material. The third and fourth groups were coated with the above-mentioned adhesives, respectively, and tested with condensation silicone. Each specimen was then attached to the universal testing machine. The maximum force at which separation failure occurred was divided by the area of adhesion and recorded as the adhesive strength in MPa. Results: A significant difference was observed between mean MPa values of Zhermack and Colten universal tray adhesives, where the F value of 1314.116 was found to be significant at 0.000 levels indicating that the Zhermack adhesive had higher MPa than Coltene adhesive. Impression material again indicated significant difference (F = 132.514; p = 0.000), where addition silicone had higher MPa value than condensation silicone. Also, the interaction between adhesive and impression material was found to be significant (F = 10.794; p = 0.002). Conclusion: The adhesive bond strength of Zhermack universal tray adhesive was higher compared to that of Coltene universal tray adhesive irrespective of the elastomeric impression material. It was also found that bond strength of Zhermack universal tray adhesive with addition silicone impression material was the highest and Coltene universal tray adhesive with condensation silicone impression material was the least of all the four groups. Clinical significance: Tray adhesives need to be applied to the tray to obtain an accurate and consistent impression. If there is a separation of impression materials from the tray, it may results in a distorted impression leading to poor final restorations.

Aim: To assess the impact of different surface treatment protocols on the shear bond strength (SBS) of metal orthodontic brackets (MOBs) and ceramic orthodontic brackets (CBOs) bonded to provisional crowns via the SBS test. Materials and methods: A total of 120 provisional indirect composite crowns (SR Nexco; Ivoclar Vivadent) for maxillary first premolars were fabricated and evenly allocated into two groups: MOBs and CBOs. According to the surface treatment protocol, each group was divided into three subgroups: group CO, no treatment; group HF, the surface was etched with 10% hydrofluoric acid; and group SA, the surface was sandblasted followed by silanization. After bracket bonding, the samples were subjected to 3,000 thermocycles between 5°C and 55°C. SBS was evaluated using a universal testing machine at a crosshead speed of 1 mm/minute and the adhesive remnant index (ARI) was identified. For statistical analysis, ANOVA and Tukey HSD post hoc tests were performed. Results: Mean bond strength values for CBOs cemented to control, HF-, and SA-treated subgroups before and after thermocycling were (9.6 ± 1.4, 6.2 ± 1.1), (17.8 ± 2.1, 13.8 ± 1.3), and (17.2 ± 1.4, 12.1 ± 1.8) MPa, respectively. For the metallic brackets, the results were (7.7 ± 2.3, 3.9 ± 1.4), (15.5 ± 1.6, 12.8 ± 1.2), and (15 ± 1.2, 11.2 ± 1.6) MPa, respectively. There was a significant difference (p = 0.000) between ceramic and metallic bracket groups. Conclusion: Conditioning of indirect composite provisional crowns either with HF or SA was significantly affecting the adhesion to both bracket types. Clinical significance: Increasing the bond strength between provisional crowns and orthodontic brackets (OBs) may improve the treatment standard provided to patients.

Aims: This study aimed to assess the use of doxycycline in adjunct to periodontal therapy on the glycemic levels for chronic periodontitis patients with type 2 diabetes mellitus (DM). Materials and methods: Fifty-one diabetic subjects with chronic periodontitis were selected and randomly assigned into 3 groups with 17 subjects each. Scaling and root planing (SRP) was done in group I, SRP and doxycycline was given in group II, and group III did not receive any periodontal treatment till 3 months. Probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and metabolic parameters were evaluated at baseline (day 0) and after 3 months (day 90). The statistical analysis was carried out using SPSS 17.0 software with significance fixed at 95% CI (p < 0.05). Results: The mean difference between baseline and day 90 for all periodontal parameters was significantly higher (p < 0.01) in group I and group II compared to control (group III). The metabolic parameters such as fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (PPG), and glycated hemoglobin (HbA1c%) level were reduced in groups I and II compared to group III; however, only HbA1c% values were found significantly reduced (p < 0.01) at day 90. Group II showed significantly better metabolic parameters than group I at day 90. Conclusion: The adjunct of doxycycline to conventional periodontal therapy provides additional benefit in reducing glycemic level and improves periodontal health. Clinical significance: The prevalence of diabetes as well as periodontitis is increasing nowadays in the world. With treatment of periodontitis, it is found that there is reduction of glycemic level in diabetes. So it is an alert to health professionals about the relation of diabetes and periodontitis and so that they conduct a multidisciplinary treatment.

Aim: To identify sleep-domains as well as clinical features in children with trisomy 21 that may shed light on a possible sleep disturbance as compared with typically developing (TD) age-matched-controls. Materials and methods: A convenient sample of 100 Saudi Arabian children between the ages of 3–12 were invited to participate from several schools and centers in Riyadh during February 2018 to April 2018. Fifty of these children had trisomy 21, and 50 were TD age-matched-controls. A clinical examination of participants’ oral characteristics as well as the Wisconsin's 22 item Children's Sleep Habit Questionnaire (CSHQ) were utilized to help identify the impact of these variables on sleep quality. Results: Sleep domains that harbored strong evidence in differences between the two groups were sleep anxiety, parasomnia, and sleep-disordered-breathing. The clinical features unique to trisomy 21 were Mallampati score, macroglossia, lip-incompetence, tongue-ridging, and wear-facets. Conclusion: Clinical features and sleep quality coexist, providing better insight into the degree of sleep disturbance a child with trisomy 21 may have. Clinical significance: Dental clinicians must consider such factors that preclude to poor sleep, which might place children with trisomy 21 at a further disadvantage despite the fact that their baseline is already at risk of being at such a stage.

Aim: The aim of this split-mouth, blinded randomized controlled trial was to evaluate the clinical and radiographic effects of locally delivered 1,25 dihydroxycholecalciferol (1,25 DHC) on the amount of canine distalization. Materials and methods: Fifteen patients between age groups of 15 years to 30 years willing to undergo orthodontic treatment in a dental college participated in the study. A computer-generated randomization list was generated to divide the maxillary arch into experimental side and control side. Allocation concealment was applied. Canine distalization was initiated using nickel–titanium (NiTi) closed coil springs delivering a force of 150 g per side, which was attached to the maxillary first molar tube and canine hook. Local periodontal gel injection of 1,25 DHC was given on the experimental side and placebo gel on the control side at distal side of the maxillary canine at monthly interval, respectively. Patients were evaluated from beginning (T₀), 4 weeks (T₁), 8 weeks (T₂), and 12 weeks (T₃). CT scans were taken at T₀ and T₃ to measure the changes in bone density. The difference in amount of canine distalization and the changes in bone density were assessed on the experimental and control sides, respectively. Descriptive statistics and paired t test were used to determine any differences. Results: The results showed statistically significant increase in the amount of canine distalization and decrease in cancellous bone density on the experimental side when compared to control side. Conclusion: The active form of vitamin D can be an effective agent to accelerate orthodontic tooth movement (OTM). Clinical significance: This study provides a new insight into the scope of vitamin D in clinical orthodontics and its innovative method of application to accelerate tooth movement in patients will revolutionize treatment as well as open newer boundaries in orthodontic research at a biomolecular level.

Aim: To analyze the differences between novice and expert orthodontists examining panoramic radiographs with incidental findings of varying difficulty. The null hypothesis states no difference in the examination pattern of panoramic radiographs between novice and expert orthodontists. Materials and methods: Expert and novice orthodontic observers were asked to examine six panoramic radiographs with incidental findings of varying difficulty. The eye-tracking software recorded and analyzed their eye movements during the examination. After examining each radiograph, the observers were asked questions about the radiograph. All these collected data were analyzed to compare the performance of the two sets of observers. Results: The total number of observers was 72 in the novice group and 64 in the expert group. There was only one statistically significant finding between the two groups of observers, which was the end time. Expert orthodontists recorded longer panoramic radiograph examination times. Conclusion: There is no significant difference in the abilities of expert and novice orthodontists to examine panoramic radiographs and identify incidental findings. Clinical significance: Orthodontists might benefit from additional education and continued training in examining and reporting radiographs commonly utilized by this specific group of dental specialists, such as panoramic and cephalometric radiographs.

Aim: The aim of this study was to assess the efficacy of different pretreatments with fluoride-releasing material on shear bond strength (SBS) of orthodontic bracket. Materials and methods: A total of 60 human mandibular premolars were taken in this study. These samples were stored in periodically changed distilled water at room temperature so as to stop bacterial growth. All samples were randomized to three pretreatment groups: group I, acid etching; group II, fluoride varnish; group III, casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) paste. Later, Transbond XT was applied on brackets made of stainless steel and brackets were centered buccally and then light-cured. The INSTRON universal machine was used to measure SBS. Based on the values, the adhesive remnant index (ARI) was estimated. Results: The maximum SBS was seen in group III (18.84 ± 1.04), followed by group II (14.18 ± 0.23), and the minimum bond strength was found in group I (13.90 ± 1.22). The one-way analysis of variance (ANOVA) showed high statistically significant difference within the pretreatment groups. The pretreatment group comparisons showed statistically significant difference between group I vs group III and group II vs group III. Score 0 was more in group III [8 (40%)] followed by group II [4 (20%)] and group I [2 (10%)]. The lowest number of score 3 was found in CPP–ACP paste group. After comparing the ARI scores within the groups, the Chi-square test showed a probability of 0.001 which was statistically significant. Conclusion: Our study established that the CPP–ACP paste pretreatment improves the SBS of orthodontic bracket significantly followed by fluoride varnish and acid etching. Clinical significance: The bond strength of orthodontic brackets that were bonded should be adequate to resist orthodontic forces applied during treatment. The effect of the adhesive material to improve the adequate bond strength depends on the efficient pretreatment methods.

Aim: Dental healthcare professionals are at a considerable risk of infectious diseases such as hepatitis B (HB). The study aims to present the details on the current knowledge, attitude, and practice of dental students towards HB in the Kingdom of Saudi Arabia. Materials and methods: A cross-sectional study was designed targeting fifth academic year and 6th academic year dental students as well as dental interns. Knowledge, attitude, and practice of HB were checked using a self-reported questionnaire. Wherein, 11 questions were about knowledge, 6 about attitude, and the final 6 were on practice. Chi-square analysis was followed by Spearman's correlation to report on the relation between knowledge, attitude, and practice. SPSS version 24 was used for analyzing the data. Results: The response rate was 87% of which, 41% were females, and 59% were males. It was seen that 61.3% of the respondents had good knowledge, 55% indicated a positive attitude, and 77% of them demonstrated safe practices. We also observed that the students or interns with good grade point average (GPA) had the strongest correlation (r = 0.70; p < 0.001) with their knowledge on HB. Knowledge was also significantly correlated with the attitude (r = 0.373, p < 0.001 and safe practices (r = 0.11, p = 0.004) of HB among the students and the interns. Conclusion: Findings from the current research conclude that having good knowledge on HB accounts for a positive attitude and safe practices among undergraduate dental students. Clinical significance: Potential oral health practitioners at dental schools should have a thorough knowledge of infectious diseases such as HB so that they implement safe practices from an early stage. The medical and dental curriculum should be reformed to include specific learning outcomes in every clinical course on stringent and effective ways to implement infection control practices.

Aim: An evaluation for the existence of the golden percentage and golden standard in Jaipur population: a comparative study. Materials and methods: Sample includes a total of 300 dentulous casts of participants including 150 males and 150 females. The cast belongs to the students, patients, and their attendants of Jaipur origin by birth who visited the Jaipur Dental College and Hospital. The width and height of maxillary teeth were measured by using a digital caliper. A grid was used to measure apparent widths of teeth. Student's t test was used to analyze the data using SPSS for Windows software (version 21) at the level of significance p < 0.05. Results: The mean and standard deviation (SD) for the golden percentage of right and left central incisors, right and left lateral incisors, and for right and left canines was found to be statistically significant from the ideal golden percentage (p < 0.05). The difference between mean and SD of the golden standard for right and left central incisors from the standard (80%) was statistically significant (p < 0.05). Conclusion: The golden percentage and golden standard did not exist in Jaipur population. Clinical significance: The result of this study shows deviation from the ideal golden percentage and golden standard for Jaipur population which can be used clinically as a guideline for esthetic results.

Aim: This clinical report evaluated changes in the mandibular condyles of patients diagnosed with osteoarthritis (OA) at the temporomandibular joint (TMJ), who were treated with a modified dental splint. Materials and methods: Four adult patients (age range: 24–47 years) were treated with a dental splint appliance that delivered a low load at the molar region and permitted lateral and protrusive mandibular excursions. An initial magnetic resonance imaging (MRI) scan was performed for diagnosis purpose before treatment. A second MRI scan was conducted after 12 months of treatment to evaluate changes at the TMJ. Results: The observations from the MRI results in the four patients showed positive changes at the end of the study period. The results presented here suggest the treatment provided significantly reduced the forces damaging the tissues covering the surface of the mandibular condyle, such as cartilage and cortical bone, which may be the cause of the OA. In that context, it is suggested that that reduction in the overloading of the TMJ produced by the functional dental splint permitted the recovery of those tissues. Conclusion: The present results support the idea that the tissues composing the TMJ are viable and may respond to positive stimulus. In that way, this report proposes a way to treat those patients with TMJ OA, who may respond when the treatment aims to reduce the overloading forces affecting the TMJ. Clinical significance: This report proposes a noninvasive clinical treatment for patients with TMJ OA, who may respond when the treatment aims to reduce the overloading forces affecting the TMJ.

Aim: The aim of this paper is to report a rare case in which two dental anomalies in primary dentition coexisted—fusion and concrescence in a 4-year-old boy. This highlights the significance of the accurate early diagnosis of these dental anomalies. Background: Odontogenic anomalies are frequently encountered in dental practice. These anomalies can occur due to abnormalities during the differentiation stage and lead to abnormalities in the hard tissue formation. Dental anomalies in number and form include fusion, gemination, and concrescence. Case description: Primary dentition with fusion between the right central and lateral primary incisors with increased mesiodistal width. Concrescence between the left central and lateral primary incisors with a groove through the incisal edge. Clinical observation along with radiographic evaluation using intraoral periapical (IOPA) radiographs and orthopantomogram (OPG) were used to arrive at a diagnosis. Conclusion: Early diagnosis of concrescence will reduce the risk of possible complications associated with any need of extraction later on. Monitoring the patient and long-term follow-up is required to manage the case with coexisting anomalies of true fusion and acquired concrescence. Clinical significance: A thorough history taking and clinical and radiographic evaluation of fusion and concrescence at an early stage result in an accurate diagnosis. A careful monitoring plan is a key to reduce the risk of possible complications later on.