Bone is a highly dynamic tissue undergoing constant adaptation to the mechanical and metabolic demands of the body by bone regeneration and repair. In order to facilitate or promote bone healing, bone grafting materials have been placed into bony defects. The advantages of using bone grafts are space maintenance, inhibiting collapse of defect and acting (at least) as osteoconductive scaffold (though they can be osteoinductive or osteogenic also). After their successful use around teeth afflicted by periodontal disease, in ridge augmentations, and in socket preservations, we now look forward to their use around implants during the osseointegration phase. A few questions arise pertaining to the use of bone grafts along with implants are whether these are successful in approximation with implant. Do they accelerate bone regeneration? Are all defects ultimately regenerated with new viable bone? Is the bone graft completely resorbed or integrated in new bone? Does the implant surface characteristic positively affect osseointegration when used with a bone graft? What type of graft and implant surface can be used that will have a positive effect on the healing type and time? Finally, what are the dynamics of bone graft healing around an implant? This review discusses the cellular and molecular mechanisms of bone graft healing in general and in vicinity of another foreign, avascular body, namely the implant surface, and further, the role of bone grafts in osseointegration and/or clinical success of the implants.

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Aim: To determine the antibacterial efficacy of Nisin in comparison with Calcium hydroxide and Chlorhexidine. Materials and Methods: Fifty extracted lower premolar single-rooted teeth were collected and were instrumented with K3 rotary files. Then, root canals were inoculated with a bacterial solution of Enterococcus faecalis. After 21 days, the canals were inoculated with Saline, Nisin, Vancomycin, Calcium hydroxide, and Chlorhexidine. The roots were left for 7 days and on the 8 ^th day, to investigate the degree of infection of the radicular dentin, specimens of the dentin chips from the full length of the root canal were harvested using a sterile rotary K3 instrument (size 25 6% taper). Results: The results of the present study showed that Nisin and Chlorhexidine showed none of Colony Forming Units (CFU) in their respective group. Conclusion: Within the limits of the study, Nisin was effective in eradicating E. faecalis cells in pure culture and root canal dentin.

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Placing dental implants in the maxillary posterior region can be both challenging and un-nerving for a regular implant dentist who is not well versed with advanced surgical procedures. It is vital for a general dentist to understand the fundamentals of bone grafting the maxillary sinus if he/she is really committed to providing the best health care for their patients. The dental practice is seeing an increasing group of patients who are living longer, and this group of older baby boomers often has an edentulous posterior maxilla either unilateral or bilateral. When edentulous, the posterior maxilla more likely has diminished bone height, which does not allow for the placement of dental implants without creating additional bone. Through grafting the maxillary sinus, bone of ideal quality can be created (allowing for placement of dental implants), which offer many advantages over other tooth replacement modalities. The sinus graft offers the dental patient a predictable procedure of regenerating lost osseous structure in the posterior maxilla. This offers the patient many advantages for long-term success. If dentists understand these concepts, they can better educate their patients and guide them to have the procedure performed. This article outlines bone grafting of the maxillary sinus for the purpose of placing dental implants. This review will help the readers to understand the intricacies of sinus augmentation. They can relate their patient's condition with the available literature and chalk out the best treatment plan for the patient, especially by using indirect sinus augmentation procedures which are less invasive and highly successful if done using prescribed technique.

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The primary objective of any implant system is to achieve firm fixation to the bone and this could be influenced by biomechanical as well as biomaterial selection. An array of materials is used in the replacement of missing teeth through implantation. The appropriate selection of biomaterials directly influences the clinical success and longevity of implants. Thus the clinician needs to have adequate knowledge of the various biomaterials and their properties for their judicious selection and application in his/her clinical practice. The recent materials such as bioceramics and composite biomaterials that are under consideration and investigation have a promising future. For optimal performance, implant biomaterials should have suitable mechanical strength, biocompatibility, and structural biostability in the physiological environment. This article reviews the various implant biomaterials and their ease of use in implant dentistry.

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Background: Increasing evidences support the role of genetic factors in susceptibility to chronic periodontitis. The aim of the present pilot study was to explore the association of two potential single nucleotide polymorphisms (SNPs): Interleukin (IL)-1β + 3954 (rs1143634, C > T) and vitamin D receptor (VDR) TaqI (rs731236, T > C) with chronic periodontitis in a North Indian population. Materials and Methods: Twenty-eight chronic periodontitis subjects and 47 periodontally healthy controls were recruited. Individual samples of venous blood were obtained from each subject. Genotyping was done by polymerase chain reaction, followed by restriction fragment length polymorphism (PCR-RFLP). Logistic regression and chi square test were used for genetic association analysis and a P value less than 0.05 taken as statistical significance. Statistical Analysis Used: Chi square test and odds ratio (OR) was used. Results: Genotypes and alleles of SNP IL-1β + 3954 did not show a significant association (P > 0.05) with chronic periodontitis. Genotype CC and allele C of VDR TaqI were significantly associated with a higher risk for chronic periodontitis as compared to subjects with TT genotype (CC/TT OR = 4.615; 95% confidence interval [CI]: 1.17 to 18.078 P = 0.028) and allele T (C/T OR = 2.423; 95% CI: 1.179 to 4.980). Conclusion: In North Indian population, genotype CC and allele C of VDR TaqI were associated with risk of chronic periodontitis. No significant correlation was found for IL-1β + 3954 polymorphism and chronic periodontitis.

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Aim: To evaluate the effect of smear clear, 7% maleic acid, 10% citric acid, and 17% EDTA on the push-out bond strength of epoxy resin-based endodontic sealer to dentin. Materials and Methodos: Fifty extracted mandibular premolars were collected. After decoronation using a diamond disc and water spray to obtain approximately 14 mm long root segments, canal patency and working length were established by inserting K file #15 (Mani). The root canals were enlarged using Protaper nickel-titanium rotary instruments to size #F3 at the working length irrigating with 3 mL of 2.6% sodium hypochlorite between each file size. The roots were then randomly divided into four groups (n = 10) according to the final irrigation regimen Group1: Saline (control). Group 2: 17% EDTA, Group 3: 7% maleic acid, Group 4: 10% citric acid, Group 5: Smear clear. Obturation was done using gutta-percha with AH Plus sealer. Each root section was then subjected to a compressive load via a universal testing machine, to measure the push out bond strength followed by assessment of fracture pattern under stereomicroscope. Results: The data was collected and submitted to statistical analysis by one-way analysis of variance (ANOVA) test. Group 3: NaOCl/maleic acid/distilled water showed greater bond strength (2.2+/-0.278 MPa) as compared to other groups. Mixed type of bond failure was predominant. Conclusion: Removal of smear layer with maleic acid as a final rinse enhanced the adhesive ability of AH plus sealer, followed by EDTA and smear clear.

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The histopathological analysis of the tissue includes a detailed study of cellular and nuclear structures and their altered presentation in a given pathology. This is carried out by using a large spectrum of staining procedures and a variety of microscopic techniques. One of the specific and interesting features is the observation of various histopathological bodies seen in different pathologies. The presence of histopathological bodies is often an important diagnostic-aid in identifying the underlying disease. Hence, the present article is an attempt to compile different histopathological bodies seen in various diseases with special emphasis on pathogenesis, microscopic and ultramicroscopic features of the same

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Periodontitis is a chronic infectious inflammatory disease characterized by the destruction of tooth. The contribution of bacteria to the disease progression is poorly understood probably due to the multifactorial background of this disease. Aggregatibacter actinomycetemcomitans is part of the normal flora in many healthy individuals, but is also a major etiologic agent in some aggressive forms of periodontitis. The genetic diversity among different isolates of Aggregatibacter actinomycetemcomitans is great and its ability to express and release virulence factors varies. Aggregatibacter actinomycetemcomitans, a pathogen not only in periodontal but also in some nonoral infections, possesses several virulence determinants which contribute to its ability to colonize the oral cavity, persist in the periodontal pocket, resist and evade host defenses, cause destruction of soft and hard tooth-supporting tissues, and interfere with host tissue repair after infection. Authors conducted a comprehensive search through PubMed/Medline databases to compile the available literature till June 2014, for the purpose of detailed insight into the bacteria. The search was designed to identify appropriate articles related to virulence factors of Aggregatibacter actinomycetemcomitans, and the articles were independently screened for eligibility.

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Background: The microbial florae in adult periodontitis lesions are comprised of anaerobic rods with Porphyromonas gingivalis as one of the major components (Slots 1976; Slots 1979; and Tanner et al., 1979). P. gingivalis is a black-pigmented gram-negative anaerobic rod and a secondary colonizer of dental plaque requiring antecedent organisms. The presence of this organism either alone or as a mixed infection with other bacteria and with the absence of beneficial species appears to be essential for disease activity. It is a predominant member of the subgingival microbiota in disease. It possesses and "excretes" numerous potentially toxic virulence factors. Aim of this study is to perform a systematic review of studies on P. gingivalis and its virulence factors with a special focus on its vaccine. Materials and Methods: An electronic and manual search based on agreed search phrases between the primary investigator and a secondary investigator was performed for the literature review till January 2014. The articles that were identified by this systematic review (total of 190) were analyzed in detail, which included the study of inference and conclusion. Conclusions: Within the limits of this systematic review, it can be concluded that P. gingivalis induce immune inflammatory response in periodontitis subjects. Therapeutic vaccines need to be developed and studied for their efficacy in controlling periodontitis.

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Peripheral giant cell granuloma (PGCG) is a non-neoplastic, tumor-like reactive lesion occurring exclusively on gingiva/alveolar crest. It is thought to arise from the periodontal ligament or the periosteum. Clinically, it bears resemblance to pyogenic granuloma, peripheral ossifying fibroma and many other peripheral lesions seen in the oral cavity, thereby histopathology is mandatory for the diagnosis of this lesion. The lesion although being relatively common, but still carries a lot of ambiguity. The ambiguity is in terms of its etiology, growth potential, biological behavior (recurrence), histogenesis of its cells and its treatment. The entity further holds significance because of its notorious behavior and its high tendency to recur. The present paper describes recurrent PGCG with a comprehensive insight of the literature on its etiology, clinical, radiological, histological, ultrastructural and molecular aspects. Special attention is given on the histogenesis of cells and their types as also on the differential diagnosis and treatment of this lesion.

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To improve the long-term prognosis of teeth, the treatment of periodontal diseases has evolved from resection to regeneration. Regeneration of the supporting structures of the teeth involves the use of a variety of materials of natural and synthetic origins. The ultimate aim of a true connective tissue attachment to the cementum, however, is difficult to achieve and a few of the materials have shown promising results. Autogenous bone graft obtained from the same individual has always been considered the gold standard because of its high osteogenic potential and virtually nil side effects. The present paper describes the use of autogenous grafts in the periodontal practice. The compilation of the data was done by PubMed search since the first use of the graft in periodontics.

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The most important criterion for the success of dental implants is the selection of a suitable implant biomaterial. To improve the biologic performance of an implant, it is necessary to select a material that does not elicit any negative biological response and at the same time maintains adequate function. It is mandatory for a dentist to have a comprehensive knowledge of various biomaterials used for dental implants. The material of choice for fabrication of the dental implant till date is titanium. With the advancements in the field of implants, zirconia seems to be propitious in the future. However, more advanced in vitro and in vivo studies are required before reaching any such conclusion. To increase the success of zirconia implants, care should be taken to reduce the incidence of mechanical failures. Such failures can be taken care of by having a thorough technical knowledge of implant designing and manufacturing defects. This article attempts to compare the advantages and disadvantages of various dental implant biomaterials. Focus is placed on the recent advances in this field with the recently introduced zirconia and its comparison to conventional titanium.

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The purpose of this review is to highlight the orthodontics and periodontics interface in clinical practice for optimized treatment outcomes. Orthodontic treatment aims at providing an acceptable functional and esthetic occlusion. Tooth movements are strongly related to interactions of teeth with their supportive periodontal tissues. In recent years, due to the increased number of adult patients seeking orthodontic treatment, orthodontists frequently face patients with periodontal problems.Esthetic considerations, like uneven gingival margins or functional problems resulting from inflammatory periodontal diseases, should be considered in orthodontic treatment planning. Potentials and limitations that derive from the interdisciplinary approach of complex orthodontic-periodontal clinical problems are discussed along with the role of light forces and self-ligating brackets.

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The purpose of this review is to highlight the current etiological and therapeutic concepts of aggressive periodontitis which is rapidly progressing and aggressive in nature. It leads to destruction of periodontal tissues and loss of teeth. We need advanced diagnostic techniques to learn about current disease activity and rate of progression. We also require strategies to keep the disease under control with proper maintenance regime and prevent tooth loss, because it can result into complicated prosthetic rehabilitation in a very young patient. The evidence suggests that aggressive periodontitis is influenced by microbiological, genetic, and host factors. This paper reviews clinical, microbiological, immunological, and genetic aspects of pathogenesis of aggressive periodontitis, as well as diagnostic criteria of the disease and appropriate nonsurgical and surgical treatment options.

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Background: Porphyromonas gingivalis (P. gingivalis) is a periodontal pathogen that is commonly harbored in the dental plaque of humans. The aim of this study was to look into the prevalence of P. gingivalis and its association with herpesvirus in Indian subjects. This is probably the first study on the association of this bacterium with herpesvirus in Indians. Materials and Methods: This cross-sectional study consists of 200 subjects, with 100 subjects each in the healthy group and the chronic periodontitis (CP) group. Upon plaque collection, one portion of the samples was immediately plated, on culture media that is selective for P. gingivalis. Total colony-forming units (CFU)/mL from each plate was recorded. The remaining plaque sample was subjected to DNA extraction and polymerase chain reaction (PCR) was performed using specific primers for Cytomegalovirus (CMV) and Epstein–Barr virus (EBV). The data are analyzed using the chi-square test, Spearman's rho correlation coefficient, and Mann–Whitney U test. Results: P. gingivalis was detected in 66% of the subjects with CP and in 40% in the healthy group, and this difference was statistically significant (P = 0.00023). The correlation of clinical parameters with P. gingivalis showed a significant positive correlation, indicating that higher levels of clinical parameters were associated with higher CFUs of P. gingivalis in culture. The comparison of the presence of P. gingivalis between herpesvirus-negative and -positive cases showed that CMV-positive cases had significantly higher levels of this bacterium. Conclusions: The results of this study confirmed the earlier finding of P. gingivalis presence in significantly higher levels in CP subjects and in CMV-positive sites. In addition, there was a positive association of the bacterium with clinical parameters.

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Fluorosis is a world-wide prevalent endemic disease due to high-fluoride water intake, especially in the developing countries. Among the various environmental etiological factors, the influence of high-fluoride water intake on the periodontium is still unexplored. With this background, we conducted a group of epidemiological and in vitro studies in a single group of the population residing in high-fluoride water areas (1.5-3.0 ppm) of Davangere district, Karnataka, India. The studies not only explored an epidemiological association between fluorosis and periodontal disease, but also the influence of fluorosis on periodontal structures along with the comparison of influence of periodontal treatment on fluorosed and nonfluorosed teeth. These preliminary studies conducted in our institution are hereby elaborately presented and discussed in this article along with their important conclusions. The results of these studies necessitate further exploration of the influence of high-fluoride water intake on the periodontium in other affected populations of the world.

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One of the most important and challenging aspects of implant dentistry is the correct planning and placement of the dental implant so as to achieve a prosthetically, aesthetically, and biologically stable outcome. It is also important to prevent encroachment on vital structures. To aid in the correct placement of dental implants, a variety of surgical guides have been proposed. If a fully limiting surgical guide is used, the encoded information should be reliable, as deviations are not possible during surgery. This article describes an acrylic resin implant placement guide, which is based on bone mapping of the edentulous ridge at the implant site.

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Multiple myeloma is a relatively rare malignant hematological disease, which is characterized by multicentric proliferation of plasma cells in the bone marrow and radiographically by osteolytic bone lesions and detectable presence of monoclonal immunoglobulins in serum and/or urine. Diagnosis of multiple myeloma can sometimes be challenging because of its plethora of clinical signs and symptoms. The product of the malignant plasma cells causes the different types of unusual clinical manifestations. We present the case of a 55-year-old female who presented with a periapical swelling in anterior maxilla in relation with 11 as the first sign of the disease.

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Traumatic injuries of teeth are the main cause of emergency treatment in dental practice. Radicular fractures in permanent teeth are uncommon, being only 0.5-7% of the cases. Horizontal root fractures are more frequently observed in the maxillary anterior region of young male patients and vary in severity from enamel fractures to avulsions. Fracture occurs often in the middle-third of the root followed by apical and coronal third. The present case report describes a clinical case of a horizontal root fracture located at the middle third of a maxillary left-central incisor treated endodontically after approximating fracture segment with the help of orthodontic appliance. After 6 months follow-up, the tooth was asymptomatic with normal periodontal health.

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The C-shaped root canal system is an aberration of the root canal system in which a characteristic fin or web connects individual canals, resulting in a C-shaped cross section. This configuration has been rarely reported in the mandibular second premolar. The only other known reported case of a C-shaped canal, with its configuration, in relation to mandibular second premolar is of an extracted tooth. The purpose of this report is to describe the diagnosis, configuration and endodontic management of C-shaped root canal in mandibular second premolar. Clinical techniques to addresses the challenges in endodontic disinfection as well as cleaning and shaping of the C-shaped canal, which is prone to endodontic mishaps, are also discussed in this case report. Reporting of this case emphasizes the need and added advantage of using the dental operating microscope hand in hand with conventional radiography in management of the C-shaped root canal configuration.

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Endodontic treatment may sometimes fail because morphological features of the tooth adversely affect the treatment procedures. Many investigators have reported the anatomical variations associated with mandibular canines. Mandibular canines are recognized as usually having one root and one root canal in most cases. This case report describes a clinical case of mandibular canine with two canals. Human mandibular canines do not present internal anatomy as simple as could be expected; there are such canines with a single root and two canals, two roots or fused roots. The existence of mandibular canines with more than one root canal is a fact that clinicians ought to keep in mind, in order to avoid failure during endodontic treatment. In spite of the low incidence of lower canines with one root and two canals, this possibility cannot be forgotten, inasmuch as the presence of a second canal in these teeth leads to difficulties in endodontic treatment. The precise knowledge of the dental endocanalicular system's anatomy is essential in the success of the root canal therapy, because the failure to detect the accessories canals and the incomplete radicular obturation leads to the infection of the periapical space, which will ultimately result in the loss of the tooth.

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Aim: Due to the weakness of endodontically treated posterior teeth requires more strengthened restoration to withstand occlusal forces. The purpose of the present study was to determine and compare the resistance to fracture of endodontically treated maxillary 1 ^st premolars restored with different materials in mesio-occluso-distal (MOD) cavity preparations. Materials and Methods: MOD cavity preparations in 80 endodontically treated maxillary 1 ^st premolars were restored using four different methods. Fiber rings were filled with stone plaster and the teeth were placed into the plaster up to the level of cemento-enamel junction. The teeth were grouped according to restorative method, mounted in an Instrom T.T. machine, and the buccal walls subjected to a slowly increasing compressive force until fracture occurred. Result: The force of fracture of the walls of each tooth was recorded and the results in the various groups compared. All teeth fractured in a similar manner irrespective of the restorative method used. Conclusion: The resistance to the fracture of the teeth was the same when they were stored with glass ionomer cement as a base over which composite resin was placed. When the entire cavities were filled with glass ionomer cement, the resistance to fracture of the teeth decreased significantly compared with the acid etch resin technique.

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Background: Periodontal diseases are chronic bacterial infections that lead to gingival inflammation, periodontal tissue destruction, and alveolar bone loss. Acting as powerful allies in the fight against periodontal disease, natural compounds can help safeguard against lethal age-related diseases that emanate from our mouths. Punica granatum (pomegranate) shrub belongs to the Punicaceae family which has been used as an astringent, hemostatic, antidiabetic, antihelmintic, and also for diarrhea and dysentery. The aim of the present work was to investigate the possible efficacy of hydroalcoholic extract from Punica granatum fruit as an antiplaque and antigingivitis agent when compared with chlorhexidine. Materials and Methods: Twenty subjects diagnosed with chronic generalized gingivitis were selected and randomly divided into two groups: Group 1 - Pomegranate mouthwash and Group 2 - Chlorhexidine mouthwash. Punica granatum mouthwash was prepared using raw Punica granatum fruit. Patients were instructed to use the prescribed mouthwash for 15 days. Clinical evaluation was undertaken using the gingival index, the plaque index, and bleeding on probing at baseline, 7 days, and 15 days. Results: The clinical study observed significant improvement in gingival status in both the sites (P<0.05). Subjects using Punica granatum mouthwash showed significant improvement in bleeding and gingivitis score as compared with chlorhexidine. In contrast, Punica granatum was shown not to be so effective in reducing plaque scores. Chlorhexidine still remains as a standard in the reduction of plaque in subjects with gingivitis. Conclusion: Punica granatum mouthwash is beneficial in improving gingival status due to its profound styptic action, with sufficient reduction in plaque scores.

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