Aim: Newer zirconia materials may have greater strength degradation under cyclic fatigue with increased yttria and cubic content. The purpose of this study was to evaluate the flexural strength (FS) degradation of newer zirconia materials compared to more traditional tetragonal zirconia materials. Materials and methods: The following materials were tested: two 3 mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) materials (Lava Plus, 3M ESPE; Katana ML, Kuraray), one 4 mol% partially stabilized zirconia (4Y-PSZ) material (Katana STML, Kuraray), two 5 mol% partially stabilized zirconia (5Y-PSZ) materials (Katana STML, Kuraray; Lava Esthetic, 3M ESPE), and one lithium disilicate material (IPS e.max CAD LT, Ivoclar Vivadent). Thirty beams were milled for each ceramic material with final dimensions of 4.0 × 1.3 × 18.0 mm after sintering or crystallization. Each specimen was placed on a 3-point bend test device on a universal testing machine (Instron, Norwood, MA). Flexural strength was determined on 10 beam specimens per group with a central load applied until fracture. Flexural fatigue strength was then measured on the remaining 20 beam specimens per group using the staircase method for 6,000 cycles at 2 Hz. Data were analyzed with one-way ANOVAs/Tukey post hoc tests (α = 0.05). Results: A significant difference was found between groups (p < 0.001) per property. The 3Y-TZP zirconia materials had the greatest flexural and flexural fatigue strength. The cubic containing zirconia materials performed more moderately. The lithium disilicate material had the lowest strength values. The percent degradation in flexural fatigue strength of the 3Y-TZP zirconia materials was less than the 5Y-PSZ, Katana UTML, and the 4Y-PSZ, Katana STML, cubic containing materials, but similar to the 5Y-PSZ cubic containing material, Lava Esthetic. Conclusion: The amount of strength degradation was material dependent, with the 4Y-PSZ or 5Y-PSZ cubic containing zirconia materials demonstrating greater or similar strength degradation compared to the primarily tetragonal 3Y-TZP zirconia materials. Clinical significance: The differences in FS degradation between cubic containing materials and traditional zirconia materials could significantly impact the long-term success of these newer materials. Clinicians should be aware that these cubic containing materials may perform differently long-term than the very strong traditional 3Y-TZP materials and to follow manufacturer instructions on required material thickness and indications for use to prevent premature failure of the restoration.

Aim: The aim of this study is to compare the efficacy of dipotassium oxalate and potassium nitrate to occlude dentinal tubules. Materials and methods: This study utilized Parkinson model of longitudinal dentin tubule occluding properties of dentifrices under a 4-day acid challenge. Dentin disks of approximately 1.5 mm thick were sectioned from the crowns of the freshly extracted molars. The disks were randomized into three sets of 15 and treated with dipotassium oxalate, potassium nitrate, or used as a control. The disks were then subjected to a 4-day acid challenge and evaluated by scanning electron microscopy (SEM). Results: On days 1, 2, and 3, dipotassium oxalate showed significant occlusion of dentinal tubules. On day 4, no significant difference was observed between dipotassium oxalate and potassium nitrate. Both test groups showed better occlusion properties in comparison to the control. Conclusion: Through the use of a 4-day acid challenge, this study demonstrates that both agents can indeed occlude dentinal tubules. Initially, dipotassium oxalate does occlude dentinal tubules faster than potassium nitrate. However, at the conclusion of the acid challenge, minimal differences were observed in occlusion rate among the two agents. Further studies should be conducted to determine the efficacy of these two agents. Clinical significance: Both dipotassium oxalate and potassium nitrate can help treat patients with dentinal hypersensitivity.

Aim: The aim of this study was to compare the effectiveness of Mtwo and RaCe rotary instruments in cleaning and shaping root canals curvature. Materials and methods: The present study was conducted on 160 simulated canals in resin blocks with an angle curvature of 15°–30°. These 160 simulated canals were divided into two groups, where each group consisted of 80 blocks. In the first group, the canals were prepared using Mtwo rotary system (VDW, Munich, Germany). In the second group, the canals were prepared using RaCe instruments (La Chaux-De-Fonds, Switzerland). The data were recorded using SPSS version 23 software (Microsoft, IL, USA). Results: The results obtained by using the Mtwo rotary instruments showed that these instruments were able to clean and shape in the right-to-left motion curved canals, at different levels, without any deviation and in perfect symmetry, with a p value = 0.000. The data showed that greater the depth of the root canal, greater the deviations of the RaCe rotary instruments. These deviations occurred in three levels, which are the following: S2 (p = 0.004), S3 (p = 0.007), and S4 (p = 0.009). The Mtwo files can go deeper and create a greater angle in S4 level (21°–28°) compared to RaCe instruments with an angle equal to 19°–24°. Conclusion: The present study noted a clinical significant difference between Mtwo rotary instruments and RaCe rotary files used for the canal preparation and indicated that Mtwo instruments are a better choice for the curved canals. Clinical significance: There are a large number of procedures and instruments used in the preparation of the root canal. Mtwo and RaCe rotary files were the instruments taken under comparison, in order to determine which of them would perform better.

Aim: The aim of this study was to compare the level of mercury in the saliva of children with attention deficit/hyperactivity disorder (ADHD) as compared to age- and gender-matched controls in specific age groups. Materials and methods: A case-control observational study design was used. In school children with ADHD and outpatient dental clinics of a university dental hospital, the participants were schoolchildren diagnosed with ADHD studying in the first grade (6–7 years), sixth grade (12–13 years), and ninth grade (15–16 years) and were gender-matched to children without ADHD attending regular classes in school. Ninety children with ADHD comprised the test group while 90 children without ADHD comprised the control group. Results: In this study, we found that children with ADHD had higher levels of salivary mercury than their age- and gender-matched counterparts; however, this difference was significant only in the 6–7 years of age group. The regression model showed a mild positive association between salivary mercury and ADHD; however, the association was not statistically significant. Conclusion: While there is some indication that salivary mercury may be higher in children with ADHD, there is insufficient evidence to establish a definite association between the two. Clinical significance: The study highlights the need to evaluate existing evidence on the role of mercury, especially salivary mercury, in ADHD.

Aim: The aim of the current study was to correlate the clinical symptoms that are associated with temporomandibular disorder (TMD) to the osseous changes occurring in the affected temporomandibular joint (TMJ), as detected by cone-beam computed tomography (CBCT). Materials and methods: The clinical data of patients that presented with TMJ symptoms was collected and correlated with the CBCT findings for the same patients. Patient recruitment took place over a 1-year period in the Oral and Maxillofacial Surgery and Oral and Maxillofacial Radiology department of the same academic institution. Results: There was a limited mouth opening (MO) (<3 cm). More importantly, there was a statistically significant positive relation between pain and loss of cortication. Conclusion: There was no significant correlation between CBCT findings consistent with TMJ degeneration and clinical symptoms. Clinical significance: Cone-beam computed tomography evaluation of the TMJ is important for providing information about the state and level of TMJ degeneration if any. However, clinical findings should be the most important factor when considering management options for symptomatic TMJ.

Aim: The aim of this study was to evaluate the effects of different concentrations of sodium ascorbate (SA), green tea (GT), and chamomile (CM) on the shear bond strength (SBS) of metal orthodontic brackets bonded to teeth bleached with 40% hydrogen peroxide (HP). Materials and methods: Ninety-four sound premolars were divided into eight groups: group I (control + no bleaching), group II (bleaching + immediate bonding), group III (bleaching + 10% SA), group IV (bleaching + 35% SA), group V (bleaching + 0.5% GT), group VI (bleaching + 1% GT), group VII (bleaching + 0.5% CM), and group VIII (bleaching + 1% CM). In groups III–VIII, teeth were treated with the antioxidants for 10 minutes after bleaching with 40% HP, but before bonding. All the specimens were bonded with the resilience adhesive, and the SBS was tested with a universal testing machine (Instron 5965). The cross-head speed to break the bond was 1 mm/minute. The adhesive remnant index (ARI) was tested under 50× magnification. One-way analysis of variance, Tukey's post hoc, and Chi-squared tests were used for analysis (p ≤ 0.05). Results: The differences in SBS among the eight tested groups were highly significant (p < 0.001). Comparison of the eight groups using Tukey's post hoc test revealed significantly lower SBS (p < 0.001) in test groups II, III, IV, and VIII than in group I. Adhesive remnant index scores showed significant intergroup differences (p = 0.005). Most groups had a failure score of 1 (<50% of the bonding material adhering to the tooth), whereas groups II and VIII showed a failure score of 0 (no material adhering to the tooth). Conclusion: Bond strength can be enhanced by using 0.5% or 1% GT or 0.5% CM to allow bracket bonding immediately after bleaching. Clinical significance: The use of antioxidants would allow clinicians to bleach teeth before orthodontic treatment without delaying bonding.

Aim: The aim of this case–control study is to estimate the circulatory levels of tumor necrosis factor alpha (TNF-α) in saliva and serum of patients with chronic periodontitis and periodontally healthy subjects. Materials and methods: Forty-four patients were screened, and based on biofilm-gingival interface (BGI) index, they were grouped into group I healthy periodontium [BGI-H (20)] and group II periodontitis [BGI-P3 (24)]. Venous blood and salivary samples were collected and analyzed using solid-phase enzyme-linked immunosorbent assay. Independent sample t test was performed to determine the association. Results: Overall, there were differences in both the saliva and the serum TNF-α levels in healthy and periodontitis subjects. The average serum TNF-α concentration in group I healthy subjects was 23.12 pg/mL and in group II periodontitis was 24.06 pg/mL. In the saliva, the mean TNF-α level in group I healthy subjects was 45.69 pg/mL and in group II diseased subjects was 46.58 pg/mL. However, the values were not statistically significant (p > 0.05). Conclusion: Circulatory and salivary TNF-α levels were found in detectable quantities. They showed a marginal increase in chronic periodontitis patients when compared with normal healthy patients in the absence of systemic diseases. Further studies are required in a large scale and with different methodologies to substantiate the role of TNF-α in the progression of periodontal diseases. Clinical significance: Clinical significance of this study is to analyze the TNF-α levels in saliva and serum, which may be the aggravating factor in causing periodontal disease, thereby helping to treat periodontitis.

Aim: The study aimed to examine the oral health-related quality of life (OHRQoL) of children with cleft lip and palate who were treated with presurgical nasoalveolar molding (PNAM) and to compare the results to age- and gender-matched controls without cleft lip and palate. Materials and methods: Parents of 51 children with cleft lip and palate who were treated with PNAM were administered a validated Arabic version of the short-form child oral health impact profile (COHIP-SF) and were asked to rate their experience with PNAM. The children with treated cleft lip and palate (study group) were age- and gender-matched to children with no cleft lip and palate (control group). The differences in COHIP-SF domains were compared between groups using the Mann–Whitney U test. Results: The children in the test group had significantly higher COHIP-SF scores than in the test group (p < 0.001). However, there were no significant differences in the oral health (p = 0.532) or the oral function (0.232) domains. There were, however, significant differences in the socioemotional domain (p < 0.001). Most of the parents (86%) of children with cleft lip or palate felt that they would recommend PNAM to other parents. Conclusion: While there are no differences in the oral health and functional domains of OHRQoL, children with cleft lip and palate treated with PNAM have significantly lower scores in the socioemotional domain of OHRQoL when compared to age- and gender-matched controls. Clinical significance: Presurgical nasoalveolar molding does not have any negative impact on the OHRQoL of children with cleft lip and palate.

Aim: The aim of this study was to observe the effects of coenzyme Q10 (CoQ10) in patients with localized periodontitis and place Sticky Bone™ in defects not resolved in the test or control group. Materials and methods: A total of 30 patients with periodontitis of pocket depth ≥5 mm were randomly divided into test and control groups, each comprising 25 sites, where CoQ10 was placed in the test group and methyl cellulose in the control group; all the parameters were recorded, and patients were followed up for 12 months. At the end of 12 months, patients who did not respond to subgingival placement of CoQ10 were treated surgically where Sticky Bone™ was placed and further followed up for 6 months. Results: There was significant difference between plaque index (PI), gingival index (GI), and probing pocket depth (PPD) at baseline and 1 month, and there was an increase in values of PI and PPD seen at 6 months and significant increase in values of GI, PI, and PPD seen at 12 months, and no significant difference in values was seen at 12 months and baseline. Conclusion: Coenzyme Q10 does not aid in the treatment of periodontitis. Clinical significance: Clinically, it shows that CoQ10 has no role to play in the cases of periodontitis. In such cases, without delay patients should be taken up for periodontal flap surgery after complete scaling and root planning (SRP), if the pocket does not resolve.

Aim: The purpose of this in vitro study was to determine the effect of different composite placement techniques on gingival microleakage of giomer restorations. Materials and methods: Sixty class II preparations were created in 30 extracted molar teeth with cervical margins 1 mm below the cementoenamel junction. The teeth were divided into three groups of 10 teeth each. In group I, teeth were restored with open sandwich technique using Beautifil II and Beautifil II Flow. In group II, teeth were restored with snowplow technique using Beautifil II and Beautifil Flow. In group III, teeth were restored with oblique increment technique using Beautifil II. After thermocycling and immersion in 2% methylene blue, the teeth were sectioned and dye penetration was evaluated. Results: Statistically significant reduction in microleakage was found along the gingival walls in snowplow restorations compared to sandwich restoration and oblique increment restorations. Clinical significance: Microleakage was reduced along the gingival walls in snowplow restorations. Conclusion: Microleakage was significantly lower in the snowplow restorations.

Aim: The present in vitro study aimed to evaluate the transverse strength of heat cure acrylic denture base resins repaired with three different joint surface designs, repair material being the glass-fiber-reinforced self-cure repair material along with surface pretreatment. Materials and methods: A total of 40 heat cure resin specimens were fabricated and finished to a size of 64 mm × 10 mm × 2.5 mm. These specimens were divided into four groups of 10 each, with butt, round, and bevel repair surface joints, respectively, along with the control group. After the specimens were cut in the middle for the repair procedure to proceed, the aforementioned joint surface contours were prepared for groups I, II, and III, respectively, treated with dimethyl chloride for 30 seconds, and the repair was done with E-glass-fiber-reinforced self-cure repair material. Results: The mean transverse strength of the control group was 100.37 N, which was highest (significant p value of <0.05), followed by group III (bevel joint) 54.23 N, group I (butt joint) 53.93 N, and group II (round joint) 44.55 N. Conclusion: Distribution of stresses evenly in the repair region will be achieved by the proper selection of the joint surface contour, and this study showed that the 45° bevel joint was an appropriate selection along with promising repair material and surface pretreatment. Clinical significance: Clinically, in the event of repairing a broken denture, a rapid and economically convenient material with superior physical and mechanical properties is important to maintain the adequate transverse strength of the repaired denture. Glass-fiber-reinforced autopolymerizing resin, with a 45° bevel joint design of the broken surfaces and surface pretreatment proved to reduce stress concentration, improving the transverse strength of the repaired heat cure denture base resins.

Aim: Nickel–titanium (NiTi) instruments were designed to be used in continuous rotation mode with controlled speed and torque and a sequence of different sizes. The reciprocating motion was purposed to improve cyclic fatigue of rotary instruments if compared to the conventional rotation. The purpose of this work was to compare the shaping ability of Reciproc R25, Mtwo #25/0.06 used as a single file, and Mtwo sequence used in reciprocating motion and in continuous rotation. Materials and methods: Forty-eight endodontic training resin blocks ISO 15, 2% taper, 7 mm radius, and a 60° angle of curvature were shaped with four different protocols. Group I (Rrsf) was shaped with Reciproc R25 used as a single file in a reciprocating motion. Group II (Mrsf) was shaped with Mtwo #25/0.06 used as a single file in a reciprocating motion. Group III (MSrec) was shaped with Mtwo sequence in reciprocating motion, and finally, group IV (MSrot) was shaped with the Mtwo sequence used in continuous rotation. Preoperative and postoperative images of the simulated canals were taken under standardized conditions and combined exactly. The amount of resin removed was determined at both the inner and outer sides of the canal curvature. The ability of the instruments to remain centered in the canal was determined by calculating a centering ratio. These data were analyzed statistically using two factors analysis of variance (ANOVA) with Bonferroni correction (Bonferroni post-hoc test). Results: Group Rrsf produced a greater enlargement of the canal, especially on the outer side, in the apical and middle third (p < 0.05). Group MSrot produced a lower enlargement in the middle third (p < 0.05). Group Rrsf displayed a lower centering ratio in the apical third (p < 0.05). Group MSrot displayed a lower centering ratio in the coronal third (p < 0.05). Conclusion: The shaping of simulated canals using a sequence of instruments in continuous rotation resulted in a more centered preparation of the apical third. The reciprocating motion for all tested instruments produced a bigger enlargement of the canals. Clinical significance: Reciprocating movement results in a more pronounced canal enlargement but appears to be less respectful of the original canal curvature and produces more apical transportation than a sequence of rotary NiTi files with the same ending apical size.

Aim: To compare the antimicrobial efficacy of sodium hypochlorite (NaClO at 2.5% and 5.25%) and calcium hypochlorite [Ca(ClO)₂ at 2.5%] on a biofilm of Enterococcus faecalis ATCC 29212™ and Candida albicans ATCC 10231™. Materials and methods: We performed an experimental in vitro study. Strains of C. albicans and E. faecalis, which had previously been reactivated were used. Then the colonies to be used were standardized in a turbidity standard to guarantee a quantity of 108 (CFU/mL) using the McFarland scale (0.5). Subsequently, the biofilm formed in brain-heart infusion agar was seeded into 42 sterile disks previously embedded with the experimental substances. Both 2.5% NaClO and Ca(ClO)₂ solutions were placed in each Petri dish. They were then incubated at 37°C for 24 hours and the inhibition halos were measured using the Kirby-Bauer technique. Results: The means between the halos corresponding to NaClO and Ca(ClO)₂ at 2.5% were 13.38 ± 0.64 mm and 13.42 ± 0.62 mm, respectively. According to the Tukey test, no statistically significant differences were found between the hypochlorite groups evaluated (p = 0.989). Conclusion: Both Ca(ClO)₂ and NaClO have a similar antimicrobial efficacy with biofilm based on E. faecalis and C. albicans, with no statistically significant differences between the two. Clinical significance: This study demonstrates the effectiveness of Ca(ClO)₂ and NaClO as endodontic irrigators to combat the most frequent microorganisms of the root canal.

Aim: To evaluate and validate minimal thickness required for computer-aided designed (CAD) and computer-aided manufactured (CAM) monolithic zirconia crowns to withstand occlusal load. The study compares two systems. Materials and methods: Forty-eight rapid prototype die models with varying occlusal reductions were fabricated. Group I samples had an axial wall height of 7.0 mm with occlusal reduction of 0.5 mm, group II had axial wall height 6.5 mm with occlusal reduction 1.0 mm, group III had axial wall height 6.0 mm with occlusal reduction of 1.5 mm. Control group IV had axial wall height 5.5 mm with occlusal reduction of 2.0 mm. Laboratories A (Czar) and B (3M) were provided with 24 samples each, 6 samples in each group for fabricating CAD/CAM monolithic zirconia crowns of 0.5, 1.0, 1.5, and 2 mm occlusal thickness, respectively, and cemented using resin-modified glass ionomer cement over the die models. Samples were loaded on a universal testing machine for fracture testing. Surface topography analysis of fractured specimens was done under the scanning electron microscope (SEM). The results were subjected to one-way analysis of variance (ANOVA) and honestly significant difference (HSD) Tukey test to analyze statistical significance at 0.05 levels. Results: Samples of laboratory A performed superior to laboratory B. The t test showed fracture resistance of group AI (0.5 mm) > group BII (1.0 mm) and also group AIII (1.5 mm) > control of Lab B (2 mm). Conclusion: Monolithic zirconia crowns showed a favorable mechanical property to withstand occlusal load with minimal tooth preparation. The occlusal thickness of Czar with 0.5 mm is found to resist fracture under physiological masticatory load. Scanning electron microscope revealed increased voids in the microstructure of 3M, which lead to decreased fracture resistance. Clinical significance: Preservation of tooth structure can be considered using monolithic crowns with minimal thickness of 1 mm.

Aim: The aim of the study was to evaluate the dimensional accuracy of three combinations of polyvinyl siloxane impression material by double-mix single-step impression technique. Materials and methods: Metal master model was made according to the ADA specification no. 19; ISO 4823:2000/AMD 2007. Impressions were made using perforated custom-made metallic trays of 2 mm and 4 mm spacing, the impression materials used were putty, heavy body, regular body and light body. A total of 30 impressions were made by single-step technique and poured in die stone to obtain resultant cast. Ten impressions were made of each combination of polyvinyl siloxane (PVS). Three dimensions (interabutment distance, height and diameter) on resultant cast were measured and compared with metal master model. The results were statistically analyzed and tabulated. Results: Diameter of abutment, the height of abutment and interabutment distance in each group were larger in dimensions as compared with metal master model. The dimensional discrepancies of group I, group II and group III casts when compared with the master model were significantly different from each other. The least difference was found in group I. Conclusion: The one-step putty–light body combination (group I) produced the most accurate stone casts compared with one-step heavy body–light body and regular body–light body combinations. Clinical significance: In everyday dental practice, impression making is imperative. Hence, by doing this study, we tried to find out which material combination is suitable to give us predictable and accurate results.

Aims: To study the prevalence of three-rooted mandibular permanent first molars (PFM) among Saudi population in Al Zulfi. Materials and methods: Subjects were selected from the patients’ records, College of Dentistry, Majmaah University, Al Zulfi, Kingdom of Saudi Arabia. Healthy patients with the presence of both mandibular PFM, orthopantomogram (OPG) and/or intraoral periapical (IOPA) radiographs were included in the study. All patients included were evaluated by a single examiner using OPG and IOPA radiographs. The occurrence of three roots, status of the tooth and associated anomalies were considered for analysis. Descriptive statistics performed using IBM SPSS (Version 21.0) at a 95% confidence interval (p < 0.05) while the Chi-square test and Fisher test were used for the incidence, and comparison of occurrence of the third root in PFM in the mandibular arch. Results: A sample of 433 subjects was selected randomly based on our inclusion criteria. Only 24 (5.5%) subjects had evidence of three-rooted mandibular PFM with the mean age of 27.67 years. The frequency of bilateral and unilateral three-rooted mandibular PFM was 2.3% (10) and 3.2% (14), respectively. Overall 41.6% of subjects were witnessed with the bilateral occurrence and unilateral occurrence was 58.4% [(57% (8) were on the right and 42% (6) were left side] (p < 0.05). However, no significant relationship was observed between the left and right occurrence of three-rooted mandibular PFM (p < 0.05). Thirty-four (7.8%) PFM were presented with three roots and among them, 70% (24) received treatment. Dilacerations (12.5%), taurodontism (37%) and hypodontia (4%) were associated with three-rooted PFM in the mandibular arch. Kappa statistics showed excellent intra-examiner reliability (κ = 0.9). Conclusion: The prevalence of three-rooted PFM was 5.5% in the present study and unilateral occurrence is very common. Over 70% of these PFM received dental treatment in Saudi Arabia population. Always, IOPA radiographs are required to confirm the evidence of three-rooted mandibular PFM where three-dimensional imaging is not available. Clinical significance: An Eagle's eye of an endodontist on three-rooted PFM is of utmost importance in the treatment protocol when the tooth is planned for root canal therapy.

Aim: To compare the in vitro antibacterial activity of different types of hydroalcoholic extracts of the leaves of the Mangifera indica L. (mango) plant on the strain of Staphylococcus aureus ATCC 6538™. Materials and methods: This study was experimental in vitro and determined the antibacterial activity of four dilutions: Mangifera indica L. ethanol extract (MEE) and Mangifera indica L. hydroalcoholic extract (MHE) at 50% and 100% on cultures of S. aureus ATCC 6538™ comparing with the positive control (chlorhexidine 0.12%) and negative (alcohol 96°) in Mueller Hinton agar cultures using the Kirby-Bauer diffusion method for each study group and incubating the cultures at 37°C for 24 hours. Results: It was found that the 50% and 100% MEE had a smaller size of the inhibitory halo of 21.3 ± 0.5 and 24.1 ± 0.8 mm, respectively. In addition, with respect to the 50% and 100% MHE, it was found that they had a higher antibacterial activity of 24.6 ± 0.5 and 33.5 ± 1.2 mm, respectively. Conclusion: Mango leaf extracts are potent antibacterial, proving 100% MHE to be more effective, thus confirming the presence of active constituents in medicinal plants. Clinical significance: This research has a great clinical applicability due to the opening of research lines that prove the usefulness of these extracts in the therapeutic control of certain oral diseases.

Aim: The aim of the study was to quantify the specific spatial displacement of gingival zenith (GZ) and determine a representative value for the interdental papilla height as a percentage ratio of clinical crown length (CL), as measured from GZ in the maxillary anterior dentition. Materials and methods: A total of 100 subjects and 1,200 interdental papillae were included. Eighty percent of the population presented with the gingival margin of lateral incisor (LI) teeth positioned coronally to the GZ of the ipsilateral canine (C) and central incisor (CI). Results: No significant difference was found between mesial and distal papilla proportion (DPP) of maxillary incisor groups. In the C group, numerical values showed higher DPP. Conclusion: The data achieved provide the ideal numerical values for prosthetic, restorative, periodontal, implant, postorthodontic, and esthetic treatment outcomes. Clinical significance: The study describes the importance of quantifying the ideal numerical values for prosthetic, restorative, periodontal, implant, postorthodontic, and esthetic treatment outcomes. The readers should understand to quantify the specific spatial displacement of GZ and determine a representative value for the interdental papilla height as a percentage ratio of clinical CL, as measured from GZ in the maxillary anterior dentition.

Aim: The aim of the present study was to present a case of maxillary aspergillosis with unusual clinical presentation and imaging findings. Background: The range of lesions and conditions that affect the maxillary sinus is wide and vast. This necessitates a dynamic multidisciplinary approach for proper diagnosis and effective management. Case description: We present an unusual case of maxillary aspergillosis that mimicked apical periodontitis and was most consistent with lymphoma from the diagnostic imaging perspective. Histopathology, however, established the correct diagnosis; appropriate management commenced promptly. Conclusion: It is imperative that maxillary aspergillosis be diagnosed and managed properly and promptly to improve prognosis. Advanced imaging is required, but it plays an adjunct role to histopathology. Long-term follow-up is also necessary to ensure complete resolution of the infection. Clinical significance: Correlating clinical and imaging findings is a crucial step and any inconsistencies should be resolved promptly so as not to delay adequate management. Histopathology often serves to dispute any inconsistencies and allows the establishment of a proper diagnosis.

Aim: This case report describes about a distinctive custom-made attachment on the abutment teeth to improve the retention and stability of the removable partial denture (RPD). It also throws light on the cost-effective method for altering the abutment teeth with the aid of the crowns and custom-made attachments. Background: Achieving retention in Kennedy's class I bilateral edentulism usually affects the abutment teeth's periodontal health and eventually the retention is compromised. Distal extension edentulism also affects patient's masticatory efficiency. The rehabilitation of a patient with the long span Kennedy's class I condition complicates the problem because of the unavailability of enough abutments to support the prosthesis. Conventional removable prosthesis with clasps and cantilever fixed partial prosthesis are not advisable in this situation for the same reason. Case description: A case with Kennedy's class I modification 1 partially edentulous arch with 1st and 2nd molars missing along with central incisors was rehabilitated with an inexpensive custom attachment using die pin and sleeve for giving a fixed prosthesis on abutment teeth and removable prosthesis with missing teeth. Conclusion: This technique has advantages of retention better than conventional RPDs, protection of abutment health by restoring it with crown, easy to place and remove and very cost-effective. Clinical significance: The entire technique demands less skill compared to semi precision and precision attachments.