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Background: Adequate horizontal and vertical bone volume is an ideal prerequisite to achieving good primary stability, osseointegration, and long-term survival of an implant. Several techniques are available to achieve adequate bone volume for implant placement. Among the various non-subtractive methods, ridge expansion with motorized bone expanders is a commonly used method to expand bone volume in the anterior maxilla. At the same time, osseodensification is another non-subtractive method that aims to improve primary stability., Aim: This study aimed to compare the expansion achieved by the two most commonly used expansion methods, i.e., motorized bone expanders technique and a relatively newer technique of osseodensification suggested by Densah Bur (Jackson, Michigan, United States), for expanding the alveolar ridge in the anterior maxillary region.  Materials and methods: A total of 30 implants were placed in the anterior maxillary region in 15 patients. Fifteen implants were placed with the bone expander method (Dentium Ridge Spreader (RS) kit, Cypress, California, United States) and 15 with the osseodensification method (Densah® Bur). At least two implants were placed in each patient. The implants were placed in the first and second quadrants of the same patients in whom one of the methods was performed. Alveolar ridge expansion was determined using pre-op and post-op cone beam computed tomography (CBCT) instantly before implant placement and after six months. Primary stability was also analyzed using Osstell (Gothenburg, Sweden) immediately after implant placement and after one month and secondary stability after six months in implant stability quotient (ISQ). These parameters were used to assess which method promoted greater alveolar ridge expansion and primary stability., Result: The test for normality was performed using the Shapiro-Wilk test between the pre- and post-treatment data between group A (motorized ridge expander) and group B (osseodensification technique). There were p-values of 0.737 and 0.429, which were not significant. Bone thickness was measured both preoperatively and postoperatively among the groups. The mean bone thickness in group A was 4.37 mm preoperatively and 5.8 mm postoperatively. The similarity between the preoperative and postoperative bone thickness was 4.336 mm and 5.24 mm, respectively. For the bone measurements, the p-value <0.001 is highly significant. On further analysis, the p-value for the paired samples t-test for group A postoperative bone thickness and group B postoperative bone thickness was 0.894, and the p-value for the t-test for group A postoperative bone thickness and group B postoperative bone thickness was 0.955. ISQ was also analyzed. In group A, the mean ISQ one month postoperatively was 53.2 and six months postoperatively was 73.4. In group B, the mean ISQ one month postoperatively was 65.4 and six months postoperatively was 76.2. The p-value for the ISQ of group A was 0.004, the ISQ of group B was 0.023, and the ISQ of groups A and B in the first month was 0.015. In the sixth month, the ISQ in group A and group B was 0.592.  Conclusion: According to the results of the study, motorized ridge expanders proved to be more effective in terms of ridge expansions and achieving better primary stability than the osseodensification technique., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee of the Institute of Technology and Sciences issued approval ITSDCGN/2018/001. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tushar et al.)

Background: The biocompatibility of 3D-printed dental resins has become a critical concern in modern dentistry due to the increasing utilization of additive manufacturing (AM) techniques in dental applications. These resins serve as essential materials for fabricating dental prostheses, orthodontic devices, and various dental components. As the clinical adoption of 3D printing in dentistry grows, it is imperative to comprehensively assess the biocompatibility of these materials to ensure patient safety and dental treatment efficacy. This systematic review aimed to evaluate the existing body of literature on the biocompatibility of 3D-printed dental resins, thereby providing valuable insights into the potential biological risks associated with their use., Methods: The search strategy to identify relevant papers was implemented across PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, CINAHL, and Google Scholar to identify relevant studies. Study selection was not limited to any particular timeframe of publishing. The revised CONSORT criteria were used to ascertain the authenticity and dependability of the review's outcomes. Comprehensive screening and eligibility assessment processes were conducted to select studies meeting predefined criteria. Biocompatibility-related parameters, including toxicity, mechanical properties, cell viability, and other relevant outcomes, were analyzed across selected studies using a standardized variable extraction protocol., Results: A total of 9 studies were included in the systematic review. The findings encompassed various aspects of biocompatibility assessment, including material composition, mechanical properties, cell viability, and cytotoxicity. Some studies revealed significant improvements in flexural strength and cell viability with specific resin formulations, demonstrating their potential for enhanced clinical utility. Conversely, certain resins exhibited cytotoxicity, while others displayed promising biocompatibility profiles., Conclusion: As per the assessed findings, material composition, post-processing techniques, and manufacturing methods emerged as critical factors influencing biocompatibility outcomes. While some resins exhibited favorable biocompatibility profiles, others raised concerns due to cytotoxicity. These findings emphasize the need for careful consideration when selecting and implementing 3D-printed dental resins, with a focus on materials engineering and comprehensive biocompatibility testing. Further research is warranted to elucidate the long-term biocompatibility and clinical implications of these materials., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Prakash et al.)

The goal of modern dentistry is to restore optimum oral health, function, and comfort for a patient. For an implant-supported fixed prosthesis, these goals cannot be met if the biomechanical factors governing the success of the prosthesis are overlooked. Mandibular flexure is one such factor that needs to be considered, especially when implants are being placed posterior to the interforaminal region. If not, it can lead to problems like increased stress, bone resorption, poor fit of the prosthesis, screw loosening, and patient discomfort. The use of a split-framework prosthesis is one of the measures that could be taken to decrease the stress, ensure a passive fit of the framework, and long-term maintenance of patient comfort and function. This case report describes the oral rehabilitation of a patient using a maxillary cast partial denture and mandibular split framework fixed prosthesis to compensate for mandibular flexure., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, . et al.)

Objective: The objective is to comparatively assess the impact strength and flexural strength of polyether ether ketone (PEEK) vs. computer-aided design/computer-aided manufacturing (CAD/CAM) polymethyl methacrylate denture base material., Methods: A total of 90 samples were fabricated with traditional heat cure PMMA, PEEK, and CAD/CAM PMMA and divided into three groups of 30 samples each. The impact strength of all the samples was measured using an Izod impact tester with a pendulum in the air at 23±2°C. A three-point bending test was used in a Universal Testing Machine to assess the flexural strength of all the samples. The impact strength and flexural strength mean values were computed using a one-way ANOVA test., Result: Impact strength and flexural strength of PEEK (IS=10.22±1.25 kJ/m 2 and FS=120±8.0 MPa) is almost identical to CAD/CAM PMMA sample (IS=9.595±3.313 kJ/m 2 and FS=118.11±5.00 MPa) whereas for conventional heat cure PMMA (IS=4.00±.011 kJ/m 2 and FS=75.4±4.50 MPa) the values are least among the three., Conclusion:  PEEK or CAD/CAM PMMA share almost identical and superior mechanical properties, and both can be used as better alternatives for complete denture fabrication rather than using conventional heat cure PMMA., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, . et al.)

Satisfactory restorations can be difficult in partially edentulous patients, especially those with unilateral or bilateral posterior ocular defects. With traditional and modern treatment options, recovery can be successful. Partial dentures with attachments are such a treatment. An implant-supported prosthesis is another option for therapy in these circumstances. Precision extracoronary attachments are the preferred treatment option when implant treatment does not give good results. This research offers two examples of partial cast prosthetic rehabilitation for distal extension utilizing precise attachments., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, S et al.)

Background: The discrimination power of the pediatric risk of mortality (PRISM), pediatric index of mortality (PIM), sequential organ failure assessment (SOFA), and pediatric logistic organ dysfunction (PELOD) may not always be true for countries such as India due to differences in factors from those nations where these scoring systems were validated. Therefore, this study was undertaken to determine and compare severity, course of illness, and outcomes in critically ill children admitted to the pediatric intensive care unit (PICU) using different scoring systems such as PRISM 4, PIM 3, PELOD 2, and the pediatric sequential organ failure assessment (pSOFA ) score, and to analyze the clinical spectrum and demographic profile of children admitted to the PICU., Materials and Method: This was a prospective, single-center, observational study conducted in the PICU of the Indira Gandhi Institute of Medical Science, Patna, India, over two years. Two hundred children in the age group of one month to 14 years admitted to the PICU were recruited into the study. Prognostic scoring systems, including PRISM4 and PIM3, were used to compare the outcome, mortality, and length of PICU stay, whereas PELODS and pSOFA were descriptive scores that assessed the multiorgan dysfunction. A correlation between the different scoring systems and the outcome was determined., Results: The majority of children (26.5%, n=53) were one to three years of age. The maximum number of patients was male (66.5%, n=133). Renal complications were the predominant admission diagnosis in 19% (n=38) of children. The mortality rate was found to be 18.5%. The mortality was most common in infants <1 year of age (n=11, 29.73%) and those of the male sex (n=22, 59.46%). A significant correlation was found between length of stay and mortality (p<0.00001). A significant positive correlation was observed between mortality and PRISM 4, PIM 3, PELOD 2, and pSOFA scores on the first day of admission (p<0.00001). The pSOFA and PELOD2 showed better discrimination power (area under the curve (AUC): 0.77 and 0.74, respectively)., Conclusion: The study concluded that the pSOFA and PELOD2 scores are reliable predictors of mortality in critically ill children., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, . et al.)

Background: Urinary Neutrophil Gelatinase Associated Lipocalin (uNGAL) has been demonstrated to be a powerful marker of progression in chronic kidney disease. The present study was done to find out the ability of uNGAL as a biomarker to differentiate steroid-sensitive nephrotic syndrome (SSNS), steroid-dependent nephrotic syndrome (SDNS), and steroid-resistant nephrotic syndrome (SRNS) from each other., Method: The cross-sectional study included 45 patients with Idiopathic Nephrotic Syndrome (INS) (15 each of SSNS, SDNS, and SRNS). uNGAL was measured by ELISA. Demographic profile of patients with INS, lab parameters including Serum albumin, cholesterol, urinary albumin, creatinine, etc., were estimated using standard laboratory methods. Various statistical methods were used to assay the usefulness of NGAL as a diagnostic marker., Results: Among the three groups, the median value of uNGAL was 8.68 ng/ml in SSNS, higher in SDNS (32.8 ng/ml), and highest in the SRNS group (50 ng/ml). The receiver operating curve (ROC) was generated for uNGAL to differentiate between SDNS and SSNS. Cut-off 13.26 ng/ml had a sensitivity of 86.7% and specificity of 97.4%, PPV 92.9%, and NPV 87.5 % with an area under the curve (AUC) of 0.958. Another ROC was generated for uNGAL to differentiate between SRNS and SDNS, and cut-off 40.02 ng/ml had a sensitivity of 80% and specificity of 86.7% with an AUC of 0.907. A similar result was observed when ROC was generated to differentiate SRNS from SSNS and SDNS combined., Conclusion: uNGAL can distinguish between SSNS, SDNS, and SRNS., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kumar et al.)

Background: Post and core restorations are performed (generally after treating the root canals of the tooth) when the majority of the tooth structure has been rendered ineffective to support itself/the crown of the tooth. In this clinical study, we aim to compare the difference between post and core treatment of anterior and posterior teeth and their success/failure rates., Objective: Our investigation aimed to compare the clinical survival rates of custom-fabricated cast metal post-and-cores in cases of anterior and posterior teeth while controlling for the population's age and gender, type of post material, length of the post, amount of alveolar bone tissue supporting the roots, tooth location in the dental arch, and type of cement used, as well as the effect of opposing dentition and the type of definitive prosthetic treatment received., Methods: 112 individuals who had received root canal therapy (RCT) and were chosen to receive post and core therapy following their RCT were chosen for the study, and a total of 164 teeth were scheduled to undergo the therapy. All the posts used were made of cast metal, and the patients were divided into two groups: 48 individuals had the posts placed in their posterior teeth (a total of 71 teeth in this case), and the second group was made up of the remaining 64 patients, all with 93 teeth in the anterior region. The follow-up was done twice at a six-month interval after cementation was complete., Results: No significant changes were observed between the stability of the post structures in the anterior and posterior teeth that were examined, and the survival rates were found to be similar in both instances., Conclusion: The cast metal posts performed at a similar success rate for the one-year period when the teeth were under our observation, and there were no considerable changes seen statistically. But it must be mentioned that a short follow-up period was observed, so the results might probably see some variations when a longer period of time is taken into consideration., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Prakash et al.)

Background An epidemiological survey was conducted among the geriatric population to determine the status and need for dental prosthetics and their influence on oral health-related quality of life (OHRQoL). Methodology The study population consisted of 270 patients aged 60 or older. All pertinent demographic information, clinical data on prosthesis status and need, and the Oral Health Impact Profile (OHIP)-14 questions to assess OHRQoL were collected using a pretested structured questionnaire written in the patient's native tongue. In addition, a type 3 oral examination was performed on a sample of the geriatric population. Results The OHRQoL was found to be unaffected by the prosthetic status. However, there was a strong correlation between the elderly study population's OHRQoL and the need for a prosthetic. Of each variable in OHRQoL, physical pain, discomfort when eating, and loss of taste were the most affected in this population. Conclusions The prosthetic needs of the study population must be given high priority as there are many unmet needs. The concerned health departments need to seriously consider increasing facilities with an affordable system. There is a lack of appreciation for OHRQoL. However, given that a satisfactory clinical assessment of the mouth does not always indicate good oral health status, the justification for evaluating dental care with respect to oral well-being is compelling., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Prakash et al.)

Background This study aimed to determine the clinical and echocardiography profile of congenital heart diseases (CHDs) among admitted children as well as patients presenting to the outpatient department of the Indira Gandhi Institute of Medical Sciences, Patna, which is a tertiary care and apex institute located in Bihar, India. Methodology A retrospective, cross-sectional study was conducted in a tertiary care hospital from January 2019 to January 2021. In total, 200 patients aged 0-12 were enrolled in the study. The study design was exploratory, with a proforma drafted to study patients with features suggestive of CHDs. All pediatric echocardiography was performed by a trained cardiologist. Records were obtained from the departmental record-keeping register, and reports were available for analyzing the data. For data collection, cardiology and pediatric department registers were reviewed and all CHD data were collected. Data analysis was done using SPSS software version 25.0 (IBM Corp., Armonk, NY, USA). Results Of the 200 children with CHDs, 142 were diagnosed to have acyanotic heart disease (ACHD), while 58 had cyanotic congenital heart disease (CCHD). Among 200 cases of CHD, ventricular septal defect (VSD) constituted 62 cases comprising 31% of the total CHD cases and 44% of all ACHD cases. Atrial septal defect (ASD) was the second most common CHD comprising 23% of all CHD cases. Tetralogy of Fallot (TOF) constituted 23 cases accounting for 11.5% of all CHD cases. It was the most common CCHD. Based on the age at the time of presentation, 90 (45%) cases were diagnosed below one year of age. Congestive heart failure (CHF) was most common in ACHD comprising 30% compared to CCHD in which only 7% of cases had CHF. This finding was statistically significant (p < 0.05). Analyzing the symptoms of different CHDs, of both ACHDs and CCHDs, the common symptoms were fast breathing (38%). Conclusions Among ACHD patients, 31% VSD and 21% ASD were noted. In CCHD, TOF was the most common with 11.5% of cases. Respiratory tract conditions were the most common comorbidities encountered. Because this is one of the first studies conducted in Bihar in the pediatric age group, it can help know the prevalence of CHDs in this region and will be useful for developing policies by stakeholders., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kishore et al.)

Background Hospital-acquired infections (HAIs) are the most severe complications of intensive care stay, especially in pediatric patients. Proper hand hygiene (HH) is the cheapest, simplest, but often neglected method to prevent HAIs. The World Health Organization (WHO) has formulated and promoted a standardized recommendation for HH. Both the WHO and the Centers for Disease Control and Prevention (CDC) recommend the use of soap and water for handwashing whenever there is visible dirt on the hands. In all other situations, an alcohol-based hand rub is an effective alternative. The quality improvement (QI) methodology has been widely followed in many countries to improve basic and advanced healthcare systems. The QI strategy follows the plan-do-study-act (PDSA) method. Methodology This quasi-experimental (pre- and post-intervention), prospective, QI study was conducted at the neonatal intensive care unit and pediatric intensive care unit of the pediatrics department in a tertiary care hospital in Bihar, India. A QI team was formed. The study was divided into four phases. WHO charts for assessing HH compliance were used for observation and data collection. The EQUATOR Checklist (Squire Checklist) was used to accurately report the QI work. Epi Info™ (version 7.2.5) was used for statistical analysis. The chi-square test was used to measure the statistical difference between pre- and post-intervention HH compliance (proportions). Results In the pre-intervention phase, a total of 106 HH opportunities were observed. The HH compliance at this stage was 40.6%. The QI team conducted several meetings, and a root cause analysis was performed with the help of the Fishbone diagram. It was decided to target three probable causes, namely, (a) less awareness, (b) inconvenient locations of hand rub dispensers, and (c) forgetfulness. The QI team decided to run three PDSA cycles. In the last phase, 212 HH opportunities were observed with a compliance percentage of 69.8%. There was a significant improvement when data of pre- and post-intervention HH compliance were compared in all categories of healthcare workers (HCWs), except doctors, where the improvement was not statistically significant. When the cumulative data of all subtypes of HCWs were analyzed, there was a significant improvement (p < 0.0001). Run charts and box plots were used for the easy depiction of the results. Conclusions Adopting proper HH methods remains the most effective way of preventing nosocomial infections, especially in intensive care units. We used the WHO model of HH in our study. The pre-intervention HH compliance was 40.6%. QI methodology using root cause analysis and implementation of three PDSA cycles were used to increase the HH compliance percentage. Post-intervention HH compliance increased to 69.8% and the effect was sustained. The study highlights the usefulness of the QI methodology in bringing small but important changes in clinical practice for better patient care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kumar et al.)